December 16, 2011

Poetry of Bái Jū-Yì (白居易)


Reading Chinese poetry with a warm cup of wū lóng tea seems very fitting these days with the arrival of winter and its short, dark, and wet days. The following are two personal favorites of mine written by Bái Jū-Yì (772-846) of the tang dynasty known for his plain, direct, and easily comprehensible style of verse, as well as for his social and political criticism.

Thoughts, interpretations, and comments are always welcome and encouraged.

花非花
白居易

花非花
雾非雾
夜半来
天明去
来如春梦几多时
去似朝云无觅处

A Bloom is not a Bloom

Bái Jū-Yì

A bloom is not a bloom,
The mist not mist.
It comes at midnight,
And leaves again at dawn.
Arrives like a spring dream, but for how long?
Departs like morning clouds, without a trace.




 读老子                                     
白居易


言者不如知者默
此语吾闻于老君
若道老君是知者
缘何自著五千文


Reading Lǎo Zǐ

Bái Jū-Yì

Those who speak do not know, while the ones that do are silent.
These are the words I’ve heard from the old gentleman (Lǎo Zǐ).
If the old gentleman knew the way,
Then for what reason did he write five-thousand characters.

December 3, 2011

Hú Xī-Shù (胡希恕)- A Case of Prostatitis


On June 11, 1966, a 30-year-old male worker from the capitol airport presented at the clinic.

The patient has suffered with prostate inflammation for over half a year, for which he has taken numerous western medications, and results have been less than ideal.

Current signs and symptoms: lumbar pain, occasional lower abdominal pain, which was sometimes accompanied by sagging, distension and pain in the testicles, occasional painful urination, sticky, milky white colored discharge exuding from the urethra, frequent and scanty urination with a reddish-yellow color, a dry mouth with a desire to drink, a white tongue coating with a slimy root, and a wiry-slippery pulse.

This is a pattern of damp stasis and obstruction, for which treatment should involve disinhibiting dampness, and transforming stasis. Zhū Líng Tāng (Polyporus Decoction) with Shēng Yǐ Rén and Dà Huáng was prescribed.

Zhū Líng 3 qián
Zé Xiè 4 qián
Huá Shí 5 qián
Shēng Yǐ Rén 1 liǎng
Shēng Ē Jiāo 3 qián
Dà Huáng 1 qián

Results: After taking only two packages of the formula, his symptoms were greatly reduced. Because the lumbar pain was still present, Chái Hú Guì Zhī Gān Jiāng Tāng (Bupleurum, Cinnamon Bark, and Dried Ginger Decoction) was added to the above formula.

After a half a month on the formula, all his symptoms were basically gone.

December 2, 2011

Hú Xī-Shù (胡希恕)- A case of Angina Pectoris


On June 14, 1965, a 74-year-old female presented at the clinic suffering from angina pectoris. Her condition had lasted many years, and she commonly experienced severe pain in the anterior chest. Whenever the symptoms would arise, she was unable to lie down, and had difficulty breathing, for which she would take various medications including, nitro-glycerine, and sulphanilamide. In addition, she sweat copiously, had a dry mouth without a desire to drink, dry stools, a thick-white tongue coating, and a wiry-thin pulse.

This is a pattern of phlegm, and thin-fluids obstruction in the chest, with blood-stasis in the collaterals. Treatment should involve transforming phlegm, freeing yáng, eliminating stasis, and freeing the vessels, with a modified version of Guā Lóu Xiè Bái Bàn Xià Tāng (Trichosanthes, Chinese Chive, and Pinellia Decoction)

Guā Lóu 1.5 liǎng
Xiè Bái 9 qián
Bàn Xià 2.5 liǎng
Bái Jiǔ 2 liǎng
Guì Zhī 3 qián
Zhǐ Shí 3 qián
Táo Rén 3 qián
Chén Pí 1 liǎng
Bái Sháo 4 qián


Results: After taking three packages of the above formula, the pain had decreased, and pain was only felt after exertion. 4 qián of Fú Líng was added to the formula, and another six packages were administered. At this point the pain was quite sporadic, so the formula was continued. After one month, the chest pain had ceased, and there was no relapse.

October 11, 2011

Huáng Lián assists sleep- A case by Huáng Huáng (黄煌)


One early morning last week as I had just turned on my cell phone, I received information about a patient from northern Jiāng Sū province that had suffered with insomnia. He had been here nine months previously for a formula and had taken seven packages. He recently returned, and after taking one package had completely recovered. This was quite remarkable!!

Now that he had finished his formula, he was asking how this was dealt with.

He was a forty year old male that was suffering with severe insomnia which started last year in December. He found it difficult to sleep for the entire night, and had repeatedly taken western medications all to no avail.

The formula he was given consisted of the following;

Huáng Lián 5g, Ròu Guì 10g, Zhì Fù Zǐ 10g, Gān Jiāng 10g, Shēng Gān Cǎo 5g.

This is Jiāo Tài Wán combined with Sì Nì Tāng. Now why would, these formulas be considered for this case? Let’s take a look at this patient. The man had a strong, robust physique; his skin was a dark color, he had no trouble eating, and his stools lacked shape. Now although he felt cold on the inside, he suffered from agitation and insomnia. This is what the ancients called ‘non-interaction of the heart and kidneys’, which is the ‘tried and true’ Jiāo Tài Wán formula pattern. Sì Nì Tāng harmonizes the body, and Huáng Lián and Ròu Guì treat the disease.

Huáng Lián is beneficial for insomnia. The Huáng Lián in Huáng Lián Ē Jiāo Tāng is used to treat “vexation in the heart, with an inability to sleep”. Huáng Lián Tāng uses equal parts Huáng Lián and Ròu Guì along with (Rén) Shēn, (Bàn) Xià, (Shēng) Jiāng, (Dà) Zǎo, and (Gān) Cǎo to treat “heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit”. The heat in the chest is commonly expressed as heart vexation with an inability to sleep. Jiāo Tài Wán only contains two medicinals, Huáng Lián and Ròu Guì and is originally from the Míng dynasties ‘Comprehensive Medicine According to Master Han’ (韩氏医通, Hán Shì Yī Tōng). The author Hán Fēi-Xiá said;
“brew numerous times, add honey, take on an empty stomach, and this will instantly bring forth the interaction between the heart and kidneys”.

Yú Tīng-Hóng (余听鸿) had written about a patient from Zhè Jiāng County that had suffered with an inability to sleep the entire night for many years. He had taken over two hundred spirit calming, blood nourishing formulas which offered him no relief. The famous Mèng Hé physician Mǎ Shěng-Sān (马省三) prescribed;

Huáng Lián 8 fēn, Shān Zhī 3 qián, Zhū Dǎn Zhī 1 qián (mix fried), decocted. That night he slept soundly.

In the past, I have given patients equal parts powdered Huáng Lián and Ròu Guì infused in boiling water, and taken prior to going to sleep. This has indeed helped with sleep difficulties.

However, Huáng Lián is bitter and cold, and many people are unable to take it. Huáng Lián’s strength by itself is quite weak, and it is incapable of treating all stubborn cases of insomnia. Nevertheless, we always want to select the corresponding formula according to the body constitution. For example, with a red, oily facial complexion, heat vexation, headaches, and constipation, we can use Sān Huáng Xiè Xīn Tāng. With pale skin, red lips, red tongue, and heart vexation, me may use Huáng Lián Ē Jiāo Tāng. In a thin patient with dark lips, abdominal pain and insomnia, Huáng Lián Tāng may be used. With dry retching, epigastric focal distension, and mouth ulcers, we use Bàn Xià Xiè Xīn Tāng. With strong pain in the back and nape, diarrhea, chest oppression, vexation, palpitations, and insomnia, use Gé Gēn Qín Lián Tāng.

Originally, because Huáng Lián and Ròu Guì were combined with Sì Nì Tāng, we know that it is applicable in cases of a cold body with a hot disease. This is commonly seen in strong, robust men with a yellowish-dark skin color, and insomnia. After taking these medicinals, not only will insomnia improve, but enduring cases of abdominal pain and diarrhea, can be ameliorated.

This case was taken from Huáng Huáng's great classical formulas blog.  The original case can be found here.

September 19, 2011

A Case of Wü Méi Wán (Mume Pill)


A case of the Fire spirit currents’ Fàn Zhōng-Lín
Translated from 'Five Steps to Cold Damage Treatment According to Pattern Identification'

A 39 year old male farmer from the Jīn Niú district of Chéng Dū city presented at the clinic:

Step 1: Chinese medical diagnosis

In August of 1977 in the last third of the month, while working in the fields, the patient suddenly felt discomfort throughout his entire body. He experienced cold extremities, dizziness, cold sweats, abdominal pain and borborygmus. Shortly after, he experienced continuous diarrhea, which frequently contained pus and bloody discharge. On September 2nd he came in for a consultation.

Every day, the patient would have over ten bouts of diarrhea. The stools were quite loose, sticky and jelly like, which had a yellowish-red color. This was accompanied by abdominal pain, with urgency followed by heaviness. In addition, he experienced dry retching, heart vexation, thirst, and cold extremities. His tongue was dark pale with a slightly red tip, with a yellow, slippery and thick coating.

Step 2: List of Disease Mechanisms

Dry retching, heart vexation, nausea, slightly red tongue tip, are all associated with upper heat.

Reversal cold in the body and extremities, cold pain in the lower abdomen, clear-thin diarrhea, which are all described as ‘white’, ‘cold’, and ‘freezing’, are obvious signs associated with lower cold.

This is one hundred percent an obvious case of upper heat and lower cold. Jué yīn is the qi of wind and wood that when vigorous will cause wind pathogens to flee to the upper (body).

[Plain Questions-Treatise on Tài yīn and Yáng míng] says:

“When one is invaded by a robber wind or depletion evil, yáng receives it. When food and drink are consumed without restraint, when rising and resting occur out of time, yīn receives it. When yáng receives it, then it enters the six bowels.

When yīn receives it, then it enters the five viscera. When it enters the five viscera, then distension and blockage result. In the lower [body] it causes outflow of [undigested] food, and when enduring causes intestinal afflux (dysentery)”.

From this passage we can see that intestinal afflux is commonly due to the exploitation of yīn and yáng, with signs of intermingling cold and heat.

In summary, the disease mechanism involved is the lack of mutual connection between the qi of yīn and yáng. The upper belongs to yáng, and pure yáng is heat; the lower belongs to yīn, and pure yīn is cold. Therefore, “When Jué yīn prevails” intestinal afflux will occur.

Step 3: Comprehensive Analysis

This is a pattern of cold and heat mixing causing intestinal afflux, with the disease in the Jué yīn level.

Step 4: Formula According to Pattern

The appropriate method of treatment is to eliminate evils and support the right using both cold and warm medicinals. Wü méi wán (Mume Pill) governs.

Step 5: Medicinals According to Pattern

Prescription:
wü méi (Mume Fructus) 30g
xì xïn (Asari Herba) 6g
gän jiäng (Zingiberis Rhizoma) 30g
huáng lián (Coptidis Rhizoma) 12g
däng guï (Angelicae sinensis Radix) 10g
zhì fù piàn (Aconiti Radix lateralis preparata) 60g (extended cooking)
shǔ jiāo (Zanthoxyli Pericarpium) 6g
guì zhï (Cinnamomi Ramulus) 10g
dâng shën (Codonopsis Radix) 12g
huáng bâi (Phellodendri Cortex) 10g

2 packages were prescribed, and the patient was asked to refrain from eating oily, raw, cold and strong smelling foods (onions, garlic, leeks, etc.).

After taking two packages of the formula, his intestinal afflux had resolved. On follow up consultation with the patient in June, 1979, he reported that in the year since his recovery, there had been no relapse of the condition.

[Realizations]

Wü méi wán (Mume Pill) is said to “govern enduring diarrhea”, yet in this case enduring diarrhea was not present.
Then why was this formula chosen?
Generally speaking in patterns of Jué yīn diarrhea there simply must be reversal. Enduring diarrhea is usually seen in patterns where there is a mixture of cold and heat, for which it is appropriate to use a combination of cooling and warming methods by mixing both cool and warm formulas.

This was not a case of enduring diarrhea, but was originally seen as a Jué yīn condition with both cold and heat signs present. Wü méi wán (Mume Pill) is a formula which cools, warms and supplements simultaneously. Acrid, sour, sweet and bitter flavours are all present in the formula. The formula was correct for this presentation and therefore by adapting to the original formula, we were able to obtain positive results.
In actual fact, Wü méi wán (Mume Pill) has been used by countless physicians of past and present to treat various disorders, especially diarrhea, and its use is continuously expanding.

Take the ‘Important Formulas Worth a Thousand Gold Pieces’ (千金方Qiān Jīn Fāng) for example, where it discusses Zhang Zhong-Jing’s concept of using wū méi (Mume Fructus) and huáng lián (Coptidis Rhizoma) in heat type diarrhea, combined with fù zǐ (Aconiti Radix), gān jiāng (Zingiberis Rhizoma), etc. in cases of deficient cold natured enduring diarrhea.

The ‘Comprehensive Recording of Divine Assistance’ (圣济总录 Shèng Jì Zŏng Lù), mentions Wü méi wán (Mume Pill) for the treatment of unceasing post-partum cold and heat type diarrhea.

In the ‘Standards for Diagnosis and Treatment’ (证治准绳 Zhèng Zhì Zhŭn Shéng), this formula is used for treating coughing issuing from the stomach and the vomiting of long worms.

The Japanese physician Zhì Jiān-Huàn says that generations of physicians have had great difficulties in treating stomach reflux, and that this is an extraordinary formula for treating this pattern. (quoted from the Initial Draft of Lectures on Cold damage).

According to Rèn Yìng-Qiū, Wü méi wán (Mume Pill) functions to strengthen the stomach and intestines, reduce inflammation and kill worms, and when used to treat chronic diarrhea, can achieve positive results. (Interpretation of the Shāng Hán Lùn).

In the past, there have also been reports of using this formula in treating cases of chronic colitis of fifteen years.
From the above, we can see that the scope of using Wü méi wán (Mume Pill) is by no means limited to just treating roundworm reversal and enduring diarrhea, and in actual fact it’s use is continuously expanding.
 

August 15, 2011

Hu Xi-Shu (胡希恕): Two cases of Meniere’s disease

Case #1

A 25 year old female Qīng Huá University student presented at the clinic on October 16, 1965: For the last four to five months she has been experiencing dizzy head and vision, accompanied with nausea, flusteredness, inability to eat, and difficulty reading. A western medical doctor diagnosed her condition as Meniere’s disease, and administered medications which were ineffective. Her blood pressure was normal, she had a dry mouth with no desire to drink, a desire to sleep, a lack of strength, but with no problems moving, and her cycle had arrived late but was slightly scanty. She had a white tongue coat with a slippery root, and her pulse was deep, thin and wiry.

This is a pattern of blood vacuity with water exuberance. She was administered Dāng Guī Sháo Yào Sǎn combined with Xiǎo Bàn Xià Tǎng and Wú Zhū Yú.

Dāng Guī 3 Qián
Bái Sháo 3 Qián
Chuān Xiōng 2 Qián
Cáng Zhú 3 Qián
Zé Xiè 5 Qián
Fú Líng 3 Qián
Bàn Xià 5 Qián
Shēng Jiāng 4 Qián
Wú Zhū Yú 3 Qián

Results: After taking three packages of the formula, her symptoms resolved completely.

Commentary: In this case the blood vacuity was pretty obvious which is why Dāng Guī Sháo Yào Sǎn was administered. This was coupled with yang vacuity of the stomach with counterflow of thin mucus, so Xiǎo Bàn Xià Tǎng and Wú Zhū Yú were used in combination.


Case #2

On October 3, 1977, a 19 year old female student presented at the clinic:

Originally the patient first experienced dizziness, tinnitus and deafness for two months. A local hospital diagnosed her with Meniere’s syndrome, and she was treated with a combination of western and Chinese medicines to no avail. She had already taken two months off her schooling, and it was at this point that her parents called for Dr. Hú to treat their daughter. At the time of the consultation she had been experiencing dizziness to the point where she was unable to get up, and when she opened her eyes, the dizziness would get worse. Her tinnitus and deafness were still present, and she also had a dry mouth with no desire to drink, occasional chest fullness, flusteredness, a thick, white tongue coating, and a deep, thin pulse.

This is cold thin-mucus attacking the upper, and obstructing the clear orifices. Treatment should involve warming the centre and transforming mucus, with Líng Guì Zhú Gān Tāng.

Fú Líng 6 Qián
Guì Zhī 3 Qián
Cáng Zhú 3 Qián
Zhì Gān Cǎo 2 Qián

Follow up consultation on October, 12: After taking six packages of the formula, her dizziness had resolved, and both the tinnitus and deafness had improved significantly. Guì Zhī was increased to 4 Qián, and Fú Líng was increased to 8 Qián.  

Third consultation on October, 20: After another six packages of the formula were taken, all the symptoms had resolved. Because she was frightened of having a relapse of her condition, she requested more of the same formula in order to consolidate the treatment, but was advised that further treatment was unnecessary.

Commentary: This case was caused by the exuberance of interior cold thin-mucus, and when these fluids attack and surge into the upper body, the representative formula is Líng Guì Zhú Gān Tāng. This formula’s function is to warm the centre, transform thin-mucus and downbear counterflow and because this presentation fit this formula’s pattern perfectly, modifications were unnecessary, and quick resolution was attained.  

July 12, 2011

Two cases using Li Zhong Tang (Rectify the Centre Decoction)


Case #1

Vacuity cold diarrhea

Case of Yuan Wen-Fei; (Jiang Xi Chinese Medicine); 1964; 3:149

A 39 year old male presented on February 11, 1949 complaining of diarrhea that has lasted for over a year, with borborygmus, and quite watery-sloppy stools. He usually has around eight or nine bowel movements in the first half of the day, his appetite is poor and there are undigested food particles present in the stools. Over ten Chinese medical physicians have been consulted in the past, and very minimal effects have occurred. On consult with this patient I found his facial complexion to be very pale and lustreless. He was emotionally fatigued, his abdomen was slightly distended, but favoured pressure, his tongue had a layer of thick yellow and slimy coating, and his pulse was thin and slow.

This is a case of spleen vacuity diarrhea, and the treatment method is to supplement the centre, and boost earth. The formula used was Zhong Jing’s Li Zhong Tang.

Ren Shen 9g
Chao Bai Zhu 9g
Hei Gan Jiang 7.5g
Zhi Gan Cao 6g

He was given six packages and asked to return for a follow up consultation. He reported that his condition had improved drastically for the better, and was therefore administered another six packages of the same formula after which he made a complete recovery.


Case #2

Wheezing and Panting (Left heart failure, cardiogenic asthma)

Case of Lu Zhi-Jie (Journal of Chinese Medicine); 1998; supplementary issue: 104

On May 4, 1998 a 60 year old male presented with cardio-pulmonary disease of over 10 years duration. In the first year of the condition he would often experience difficulty breathing in the evening, which would most commonly occur roughly around midnight waking him from a deep sleep. He suffered with an oppressive sensation in his chest, and once his breathing became forced he would suddenly wake up with a fright, compelling him to sit up in bed. This was accompanied with coughing fits, a rale at the back of the throat, and spitting up of frothy phlegm. These attacks would last anywhere from ten minutes to one hour, and once they would resolve on their own, he was able to return to sleep. During the day he also experienced wheezing on exertion. His pulse was wiry and weak, and the tongue was purple and slightly dark, with a thin yellow, slimy coating. According to this man’s symptoms of weakness, coughing fits and breathing difficulties at night, he was diagnosed by western physicians with left heart failure and cardiogenic asthma.
On disease analysis, we see that this man is in his sixtieth year and his condition has persisted for an extended period, therefore we can deduce from this that there must be a vacuity and weakness of right qi, however, his symptoms seem to develop in the evening, so in addition there is a blockage in lung qi. In such a scenario we must address both the root and branch of the condition and treat both simultaneously. We treat the root with Ren Shen Tang in order to supplement the centre and assist yang to ensure that the lungs and heart are able to generate sufficient and ample original qi. The branch is addressed with Ting Li Da Zao Xie Fei Tang.

Formula:

Ren Shen 30g
Bai Zhu 30g
Gan Jiang 30g
Gan Cao 30g
Ting Li Zi 24g
Da Zao 12 pieces

The first evening after taking one package, he experienced no breathing difficulties, and after fourteen packages, his condition seemed to be stabilized. He was able to sleep peacefully in the evenings. The daytime wheezing on exertion had also obviously improved, and as long as he moved around slowly, experienced no symptoms. He continued to take the formula every other day in order to consolidate the treatment.

June 29, 2011

Two Cases of Wind Rash (Urticaria)

The following are two translated cases by Matt Branham of Eugene, Oregon.


Wind hidden rash (urticaria) Case #1

Dr. Liu Jun Shi case: patient Wu, male 57 yrs old, outpatient service #43115, came for a visit on 6/27/1983.  The whole body was covered with rash which periodically got better and then returned over the past ten years, the whole body itched making life hard to bear.  The rash was worse on the upper body, there was fear of cold, ordinarily when he encountered cold the whole body would break out.   He had tried many treatments, which gave temporary relief, but the effectiveness of the treatments were lacking. Whenever he encountered cold the rash would flare up again.  The tongue body had teeth-marks, and both pulses were slippery and moderate.  This pattern belongs to constitutional yang deficiency.  In addition there is wind evil, so one must warm yang and disperse cold, Wu Tou Chi Shi Zhi Wan with modifications is the treatment.
 Zhi chuan wu, cao wu 3g each, gui zhi 3g, bai shao9g, xi xin 3g, gan jiang 9g, bai zhi 4g, chuan jiao 9g, gan cao 9g, chi shi zhi 30g, decoct and take 3 packets.

Second visit was on 6/30/86.  The urticaria had greatly decreased, the itching and pain were also alleviated.  He was asked to continue taking the original 3 packets.    
Third visit on 7/5/86.  Urticaria had completely receded, and on follow up with the patient regularly after two years there was no recurrence.

Beijing Journal of Traditional Chinese Medicine

Editors comments: When yin cold flourishes internally, yang qi becomes weak, thus the exterior cannot defend against wind evil, leading to wind rash.  Other treatments failed to dispel cold, therefore yang qi had difficulty in recovering; they did not warm yang, and wind did not go, therefore, over a long period of time he wasn’t healing.   Wu Tou Chi Shi Zhi Wan was used to warm yang and dispel cold, only then can one get to the root of the problem, therefore remedying chronic illness in a relatively short amount of time.

Addendum: This formula by Zhang Zhong Jing is an example of his use of wu tou and fu zi at the same time.   Wu tou and fu zi belong to the same category, but their functions are slightly different: Wu tou is good at lifting out sunken and chronic cold.  It also can scatter and disperse wind and cold from the channels.   Fu zi is good at treating organ level cold damp, and is able to warm and transform cold damp.  Due to the fact that this pattern was a yin cold evil, as well as affecting the interior and exterior, zang fu, channels and collaterals as well as the core and surface, Zhang Zhong Jing used both wu tou and fu zi to rouse yang and disperse cold evil.
Chen Ming, Zhang Ji Sheng, Wang, Jin Gui Ming Yi, Beijing University Press 2003




Wind hidden rash (Urticaria) Case #2

Dr. Li Mao Xing's case: patient Zhang, male, age 34. Two years ago the patient caught a wind cold and his whole body broke out in rash with severe itching.  When he scratches, the rash gets worse.  He has tried cyproheptadine hydrochloride and vitamin c treatments which brought about some relief, but still he had frequent recurrence and a cure had not been served.  A week ago, after eating seafood there was a recurrence of the rash, and on 11/15/91 he came in to my office for an interview. 
Examination: his whole body was covered with rash of unequal size, the form of the rash was not uniform, bright red in color and bumpy, the rash color faded with pressure, and itched intensely.  It was also accompanied by low grade fever, headache, thirst, constipation, turbid urine, red tongue, yellow coat, and wiry rapid pulse.  The pattern belongs to excess heat held internally, externally contracted evil, and the issuing of heat toxin to the exterior.  Treatment used Fang Feng Tong Sheng Tang modified.
  Herbs used: fang feng, jing jie, chuan xiong, shan zhi zi, huang qin, da huang(cooked later) all 10g, ma huang, bo he 6g, gan cao 8g, shi gao, ku shen, 15g, mang xiao 12g (decoct separatly) bai xian pi 30g. Take one packet per day water decocted.  After taking 8 packets, the rash, for the most part disappeared, the itching was controlled, but his bowel movements increased in number.  The next step in the prescription removes mang xiao, and decreases da huang, with the addition of jin yin hua 20g, in order to increase the heat clearing, toxicity resolving functions.  After 6 packets the skin rash had disappeared, and the itching was completely resolved.   The illness had been completely resolved and after one year follow up there was no recurrence. 

Zhejiang Journal of Traditional Chinese Medicine

Editors comments: Urticaria is commonly called wind rash; Chinese doctors call it hidden rash.  There are several treatment methods, with the principle methods being; coursing wind, clearing heat, resolving toxicity and alleviating itching.  This case belongs to excess heat in the interior, affected by externally contracted evil, causing both interior and exterior excess syndrome.  Therefore, Fang Feng Tong Sheng Tang was used as it, resolves the exterior and unblocks the interior, courses wind, clears heat and resolves toxicity.  The formula with the addition of ku shen and bai xian pi to clear heat, disinhibit dampness and stop itching, and jin yin hua to resolve toxicity and eliminate fire was used.  The whole formula clears and penetrates both the interior and exterior, thereby disinhibiting dampness and eliminating heat and dispelling toxins.
Chen Ming, Zhang Ji Sheng, Wang, Wen Bing Ming Fang, Beijing University Press 2003

A quote from the Wen Re Lun that Chip Chace had mentioned in our class on warm disease got me thinking about the effectiveness of Jing Fang formulas for the treatment of rashes.  The quote goes something like this, “You can ride your horse and enjoy the landscape when treating shang han (cold damage), but things can change when you look over your shoulder in treating rashes.”  Both of these cases treated urticaria, or skin rashes, from a different perspective.   The first case involved a formula from the Jin Gui Yao Lue while the second used a formula from the Wen Bing tradition.  As rashes of this nature can occur through many etiologies using appropriate pattern identification will lead to the desired outcome.  In case 1, exposure to cold caused the rash to flare.  This patient had weak wei qi due to a constitutional yang deficiency, the appropriate treatment was thus to warm yang to secure the exterior.  Chi Shi Zhi is sweet and warm thus augmenting the qi, its astringent nature was also well suited to aid in securing the exterior.  In case 2, initially the patient developed rash from exposure to wind cold, later after eating seafood the rash recurred this time with marked heat signs.   The wind cold evil was never released from the exterior.  After eating bad seafood the patient experienced a toxic reaction to the food that brought a recurrence of the skin rash.  The skin is ruled by the lungs, the lungs are interiorly related to the large intestine, when the patient presented with heat signs and constipation a purging method was appropriate.  Here the Dr. was consistent with Wen Bing thinking to add exterior resolving herbs so as to vent some of the pathogen up and out to the wei level while also purging the interior heat through the bowels.   While both of these traditions use their formulas in a particular way, they both employ basic pattern identification to reach their conclusions.  To me the unification of these systems comes in the effective use of the Eight Parameters.  These archetypal structures are the hallmark of a phenomenological world view espoused by the ancients and of great value to modern day people.

June 20, 2011

Rib-side pain (Hepatitis)


Liu Du-Zhou, New Chinese Medicine, 1979; 2: 36

Mr. Liu, a 54 year old male presented at the clinic with hepatitis manifesting with abdominal distension and diarrhea. He had very little desire to eat, and experienced rib-side pain that extended to his back. He had taken several formulas which offered very little benefit. It was at this point that I was asked to treat this gentleman. His pulse was wiry and moderate, and his tongue was pale with a white coat.

This was a case of liver disease affecting the spleen manifesting with a decline in spleen yang.

I decided to course (the liver) using Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction).

Chai Hu 12g
Huang Qin 4.5g
Zhi Gan Cao 9g
Gan Jiang 9g
Gui Zhi 9g
Tian Hua Fen 12g
Mu Li 12g

Altogether 4 packages were taken which resulted in the complete resolution of the abdominal distension and diarrhea. His appetite also improved indicating that the liver and spleen were harmonized and his GOT (Glutamyl oxaloacetic transaminase) and GPT (Glutamyl pyruvic transaminase) levels were basically back to normal and thus he recovered.