February 24, 2011

Stomach Pain and Irregular menstruation rectified with Si Ni Huang Lian (Tang)


A case of Professor Fan Zheng-Lun (樊正伦)

Recently a 37 year old female presented at the clinic.  She was thin and pallid and was covering her abdomen with both hands.  She complained of stomach pain for several months occurring before or after meals.  Her abdomen feared cold and enjoyed warmth, she often felt nauseous with the occasional desire to vomit.  Her bowel movements seemed to be unaffected.  Her stomach pain occurred prior to her menstrual cycle which had also become quite long, dark and unsmooth.  In addition the soles of her feet often felt warm.  Her mother, who was sitting next to her commented that her daughter really enjoyed spicy foods and ate too much of them, which was probably causing some of her pain.  Her mother recently restricted her consumption of these foods. 
Her tongue was purplish-dark with stasis macules on both edges.  Her right pulse was wiry-thin, and the left pulse was deep-weak.  At this point, Professor Fan kindly asked her, “Do you find that you easily get angry”?  The patient nodded her head and said “yes, I don’t have a very good temper”.
Professor Fan said that this is a case of Liver Qi depression with a disharmony of the Spleen and Stomach, which can be treated with ‘Huang Lian Tang’ and ‘Si Ni San’ with additions and subtractions.

Formula:

Gui Zhi 9g
Bai Shao 9g
Fa Ban Xia 9g
Gan Jiang 9g
Zhi Gan Cao 15g
Chai Hu 9g
Zhi Shi 9g
Zhi Xiang Fu 9g
Dang Gui 9g
Dang Shen 12g
Da Zao 4 pieces
Sheng Sha Pu Huang 6g
Huang Lian 6g

7 Packages were administered. 

A week later the patient returned for a follow up consultation and said her spirits were up and turning for the better.  She was so happy to report that after taking the herbs, her stomach felt very comfortable.  She was still having one bowel movement a day.  Her cycle came and only lasted 4-5 days, was not very heavy and contained small clots.  She has had no abdominal pain, her soles no longer felt warm, and occasionally there was a gurgling sound in her abdomen. 
Her tongue edges were purplish-dark and her pulse was wiry. 
Professor Fan felt that the formula was addressing her condition and prescribed another seven packages of the original formula to consolidate the treatment.   

In clause 173 of the ‘Shang Han Lun’ it says;
“When in Cold damage, there is heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit, Huang Lian Tang (Coptis Decoction) governs”

In actuality, Huang Lian Tang is Ban Xia Xie Xin Tang with the removal of Huang Qin and the addition of Gui Zhi.  It treats stomach heat and spleen cold, while Ban Xia Xie Xin Tang treats damp heat in the spleen and stomach. 
Within the formula, bitter Huang Lian is used to descend heat in the upper body, as per the adage “To treat upper body heat, drain with bitterness”.  Acrid warm Gui Zhi, Gan Jiang, and Fa Ban Xia are used to raise spleen yang.  “With cold in the lower body, scatter with acridness”Ren Shen, Gan Cao, and Da Zao are used for their sweet flavour to boost the stomach, remembering the adage “The spleen desires warmth, so with tension use sweet foods to moderate”.  

Huang Lian Tang is a very useful formula for treating spleen and stomach conditions resulting from spleen cold and stomach heat.  When combined with Si Ni San It is able to course the liver, regulate qi and protect liver wood from exploiting spleen earth.  In clinical practice we are often able to achieve positive clinical outcomes through this combination. 
In this patients’ case, aside from the above mentioned formulas, Professor Fan added Zhi Xiang Fu in order to strengthen the formulas function of coursing the liver.  Dang Gui and Sheng Sha Pu Huang were added to nourish and move the blood, and transform stasis. 

This case was adapted and condensed from ‘A Taste of Chinese Medical Chicken Soup’ by Xiong Hong

4 comments:

sharon weizenbaum said...

Great case Eran! I must admit that Huang Lian Tang was not on my radar and now it is. What an important formula really. Thanks!

Sharon

Eran Even said...

Thanks Sharon!
I must admit that this is not a formula I use too often in clinic either. This was a very common formula for Dr. Fan to use in clinic when I was observing him, yet I seem to always gravitate towards Ban Xia Xie Xin Tang in similar presentations. For the most part I've had a hard time distinguishing between the two fx's and where and when to use one or the other. It seems that every time I translate a case with a specific formula I try to desperately find the presentation in one of my patients as I am quite eager to give it a whirl :)

Susan said...

Hello! I really enjoy your sight--thanks for all the great sleuth work. What about the presentation would have triggered you towards ST heat? She was craving spicy foods yes, but also craved warmth and feared cold. And her tongue didn't specifically point to ST heat....so why not BXXXT?

Eran Even said...

Hi Susan,

Thanks so much for reading the site, it is much appreciated. As this was not my case but Fan Zhong-Lun's I can't really speak for him, as all I did was translate. I don't believe Dr. Fan put too much stock into what the belly feared or craved, as this can sometimes be quite contrary to the presenting pattern. He would even go so far as to say that, many people's abdomens feared cold, and craved warmth, and so if the other signs and symptoms didn't support a pattern of cold or vacuity, he would rarely diagnose it as such. In this case, Dr. Fan saw this as a pattern of liver depression with a disharmony of the spleen and stomach, and so therefore used the above formulas. My only assumption at hand as to why he used Huang Lian Tang instead of BXXXT, is because the presence of damp-heat was not very obvious. Besides, he loved Huang Lian Tang and most certainly used it often with great results. Sorry I have no further insight, as I was merely the translator for this case :)
Hope this helps, and again, thanks for reading.

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