Occasionally when reading books written by clinical masters of our time regarding the usage of Jing Fang 经方 (classic formulas) we stumble upon what seems at first to be bizarre yet intriguing ways of using these formulas that in no way reflect any of the usages we were taught in school. One in particular that comes to mind is Hu Xi-Shu’s usage of Major Buplureum Decoction (Da Chai Hu Tang) for wheezing and panting (what we may call modern day asthma). In his ‘Popular Lectures on Cold Damage’ (伤寒论通俗讲话), Dr Hu explains that many patients presenting with wheezing and/or panting manifest a Shao-Yang, Yang-Ming combination disease. Therefore, the cardinal Shang Han Lun formula Da Chai Hu Tang (Major Buplureum Decoction) may be used with quite astonishing results. Many of Dr. Hu’s students would often ask him why when treating wheezing he wouldn’t just use Ma Huang (Radix Ephedra)? He would simply state that unless the case presenting was a Ma Huang pattern, its use was not warranted. In the Shang Han Lun (On Cold damage) it states that “In wheezing with chest fullness, Ma Huang is appropriate, but in wheezing with abdominal fullness, Ma Huang should not be used”.
Dr. Hu has said that in order to diagnose a Shao-Yang Yang-Ming case of wheezing and panting, we need to look for symptoms such as; wheezing and panting with occasional chest fullness, rib-side pain, sweating, dry throat, dry bowel movements, etc.
In addition Dr. Hu felt that blood stasis plays a major role in many of the chronic recalcitrant patterns of panting and wheezing and would therefore use Major Buplureum decoction in combination with other formulas such as Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria pills) or Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi). He explains that originally there is latent blood stasis in a persons’ body caused by cold contraction, food damage or emotional changes. Any of these factors when left untreated will create a situation of blood stasis which will then invade the Liver and Lungs and cause wheezing and panting. If this stasis is not expelled, long term resolution will be difficult to achieve, therefore many incessant cases of wheezing and panting even when mixed with cold or summer-heat involve elements of blood stasis. A couple of his formula combinations with their clinical manifestations are as follows;
Da Chai Hu Tang plus Gui Zhi Fu Ling Wan: 大柴胡汤合桂枝茯苓丸
Chest and rib-side bitter fullness, difficulty breathing, urgency below the heart (epigastrium), bitter taste in the mouth, dry throat and dry bowel movements.
Da Chai Hu Tang plus Tao He Cheng Qi Tang: 大柴胡汤合桃核承气汤
Symptoms include the above with the addition of abdominal fullness and distension and difficult bowel movements.
If there is a dry mouth and tongue, with vexing thirst, Sheng Shi Gao (Gypsum fibrosum) may be added.
If there is a simultaneous external contraction with symptoms of heat effusion, aversion to cold, and no sweating then Ge Gen Tang (Pueraria Decoction) can be combined with any of the above two combinations depending on the presenting pattern.
Sheng Shi Gao is appropriate as well if symptoms of dry throat, agitation or vexation present.
If sweating and panting are quite obviously seen in any of the above patterns then Ma Xing Shi Gan Tang (Ephedra, Apricot kernel, Gypsum and Licorice decoction) can be combined with any of the two combinations as well.
To read another blog post regarding unique and interesting ways of using classical formulas, click here