June 10, 2010

Clinical usage of Bupleurum and Cinnamon Twig Decoction (柴胡桂枝汤)

Shoulder and back pain (Shoulder inflammation)

Case study of Liu Du Zhou: Mr. Yu, Male, 43 years old presented on November 29, 1993 with left side shoulder and back pain and swelling. He was unable to lift his left arm or turn over on his side. Western medications were taken including strong pain killers which would only alleviate the pain for a short time where soon after the pain would return. At a previous hospital he was diagnosed with inflammation of the shoulder. This patient was suffering with exceptional pain. On inquiry the patient complained of chest and rib-side fullness, a bitter taste in the mouth, an occasional need to sigh, no desire to eat, occasional sweating and tightness in the back. His bowel movements and urination were normal. His tongue was pale with a thin coat and his pulse was wiry. His pattern was diagnosed as qi depression and stagnation causing a lack of free flow in the Tai-Yang and Shao-Yang channels. A lack of free flow causes pain. ‘不通则痛’。
This must be treated by expelling evils in the Tai-Yang, harmonizing Shao-Yang and regulating the nutritive and protective Qi. The formula administered was Chai Hu Gui Zhi Tang with Pian Jiang Huang.

Chai Hu 16g
Huang Qin 10g
Ban Xia 10g
Sheng Jiang 10g
Dang Shen 8g
Zhi Gan Cao 8g
Gui Zhi 12g
Bai Shao 12g
Da Zao 12g
Pian Jiang Huang 12g

After taking 3 packages of the above formula the back pain had decreased, he was able to lift his arm on his own, flexibility was increased and his chest and rib-side felt better. After a further 3 packages he was able to completely recover.

(Effective cases from the clinical experience of Liu Du Zhou)

Commentary: Professor Liu Du Zhou says that in order to treat shoulder and back pain we must address the Tai-Yang, Shao-Yang and Du channels. The shoulder is traversed by the Shao-Yang channel, and the back by the Tai-Yang and Du channels. Enduring diseases enter the collaterals and bind the blood. For this we may add Pian Jiang Huang, Tao Ren, Hong Hua, Chuan Xiong, etc, to invigorate the blood, free the collaterals and alleviate pain. If pain extends to the lower back, the head and body are heavy and cumbersome, the tongue coating is slimy and if copious vaginal discharge is observed in females, then one may administer Qiang Huo Sheng Shi Tang to attain a positive effect.

The above case and commentary are taken from 'Selected Cold Damage cases from the Clinical Experience of Famous Physicians' pg 359.

June 8, 2010

Case Studies of Wu Pei Heng (吴佩衡医案)

The following is a case study by the late Wu Pei Heng (吴佩衡) (1886-1971) from Si Chuan province who was extremely proficient in using classical formulas and practiced in the style of the fire god school (火神派).  My initial fascination with Dr Wu’s cases are his use of extremely large doses of Fu Zi.  There are a number of cases in his book where he uses up to 300g a day, even with a few of his younger patients.   Due to Dr. Wu's prolific use of Fu Zi he attained the nickname 'Wu Fu Zi'.

Late miscarriage blood loss

Mrs Fang, 35 years old, originally from Luo Ping county currently living in the city of Kun Ming in Yunnan province.
On May 12, 1923 she presented at the clinic after suffering a miscarriage in her fifth month of pregnancy.  Initially she felt painful sagging in her abdomen and low back which continued until she miscarried.  She had excessive menstrual bleeding (flooding) with clots, twisting abdominal pain, flusteredness, dizziness and shortness of breath.  Her pulse was scallion like, vacuous, weak and both inch positions were short.  Her lips were pale red, tongue coating was slippery white and the tongue body was bluish and dark.  According to her husband on that particular evening she had fainted twice.   Late miscarriages are usually due to major vacuity of kidney qi, qi vacuity sinking and unable to absorb blood, and yang qi descending with blood and escaping.   The qi is born within the kidneys and gathers in the lungs and here we have a lack of merger between the kidneys and lungs, therefore there is shortness of breath with desertion.  The plan is to administer Si Ni Dang Gui Bu Xue Tang with (Da) Zao and Ai (Ye).  Within the formula, Si Ni Tang supports Yang allowing it to rise.  The assistants (Huang) Qi and Dang Gui supplement the centre, boost qi and re-generate the excessively damaged blood.  Gan Jiang, Ai (Ye) and (Da) Zao blackened, can warm the blood, separate the cold and return blood back to the channels. 

Hei Fu Pian 160g
Pao Hei Jiang 50g
Zhi Gan Cao 24g
Bei Kou Qi 60g
Dang Gui 26g
Qi Ai 6g (fried until blackened)
Da Zao 5 pieces (roasted until blackened)

After taking 13 days worth of formula, her menstrual flooding stopped, the shortness of breath was calmed and most of her symptoms were alleviated by days 6 or 7 and even her spirit was slightly improved.  In keeping with the original formula, another 14 days were given to complete the course, after which she successfully recovered.