March 13, 2012

Jiāo Shù-Dé (焦树德) -A Case of Insomnia


“In longstanding insomnia with irritability, use a decoction to nourish the yīn, calm the liver, and lift the spirit”.

“Lift the Spirit Decoction” (挹神汤) is an experiential formula developed by the late-great Dr. Jiāo Shù-Dé (焦树德), for which he used for many years to treat neurasthenia, menopause, and various other conditions with great success.
The following is a case of chronic insomnia treated by Dr. Jiāo at Běijīng’s Píng Xīn Táng clinic (北京平心堂中医门诊部) in the summer of 2000.

In July of 2000, a fifty-five year old female patient presented at the clinic with chronic insomnia that has started to get worse over the last month. She has great difficulty initially falling asleep, and once she does, she has numerous dreams that wake her up quickly, and then falling back asleep is a challenge. The most sleep she ever gets is roughly between three and four hours a night. The situation is causing her to get quite irritated and angry. Her accompanying symptoms included; irritability in the heart, heat in the palms and soles, aching and weakness in the lower back, dry stools, unstable blood pressure, dizziness, tinnitus, and occasional night sweats. She has not had a menstrual cycle in over six years.

Dr. Jiāo diagnosed this as insomnia due to yīn deficiency with flaring of the liver.

Treatment principle: boost the kidneys, nourish the liver, subdue yáng and calm the spirit.

Formula:

shēng dì huáng (Rehmanniae Radix) 18g
bái sháo (Paeoniae Radix alba) 15g
huáng qín (Scutellariae Radix) 10g
fú líng (Poria) 15g
xiāng fù (Cyperi Rhizoma) 10g
yè jiāo téng (Polygoni multiflori Caulis) 15g
yuân zhì (Polygalae Radix) 12g
hé huān huā (Albiziae Flos) 6g
lóng gǔ (Fossilia Ossis Mastodi) 15g
mǔ lì (Ostreae Concha) 15g
suān zǎo rén (Ziziphi spinosae Semen) 20g (broken)
bái jí lí (Tribuli Fructus) 9g
shí jué míng (Haliotidis Concha) 30g

Seven packages were administered.

On a follow up consultation one week later, she reported that she was now able to sleep five or six hours a night, the dizziness and tinnitus had improved, and her stools were no longer dry. It was clear that this was a great formula for her.

Formula analysis:

shí jué míng (Haliotidis Concha), lóng gǔ (Fossilia Ossis Mastodi) and mǔ lì (Ostreae Concha) are used to calm the liver and subdue yáng.

shēng dì huáng (Rehmanniae Radix), and bái sháo (Paeoniae Radix alba) nourish yīn, boost the kidneys, enrich water to contain wood, soften the liver, and calm the spirit.

huáng qín (Scutellariae Radix) is able to drain liver and gallbladder fire, boost yīn, and reduce yáng.

fú líng (Poria) strengthens the spleen and transforms dampness.

yuân zhì (Polygalae Radix) and suān zǎo rén (Ziziphi spinosae Semen) are used to promote the interaction between the heart and kidneys, tranquilize the heart and calm the spirit.

hé huān huā (Albiziae Flos) and yè jiāo téng (Polygoni multiflori Caulis) resolve depression, and calm the spirit.

bái jí lí (Tribuli Fructus) scatters liver depression, and expels liver wind.

xiāng fù (Cyperi Rhizoma) is used for its ability to move blood in the qí level and strengthen the formulas overall function of movement.

This formulas ability of treating insomnia due to yīn deficiency with flaring of the liver is quite profound.

Dr. Jiāo believed, that with conditions such as neurasthenia, and menopause that although there is a definite relationship with the liver, kidneys, spleen and stomach, he would emphasize that the most intimate connection was with the liver. Because liver qí ascends and moves the easiest, one needs to mainly focus on this organ in treatment, and at the same time, harmonize the heart, kidneys, spleen and stomach.
Overall, this is an excellent formula for treating insomnia, and especially when associated with menopause.

March 3, 2012

Hú Xī-Shù (胡希恕) -A Case of Systemic lupus erythematosus (SLE)


A 32-year-old female patient presented at the clinic on October 12, 1967. For the last year the patient has been experiencing feverishness along with red macules on her face and back. The origin of the feverishness and macules was unknown. At both the Běijīng Harmony hospital and the Běijīng University hospital she was diagnosed with Systemic lupus erythematosus. She was treated with hormone therapy, which offered no positive effects, and was then introduced to Dr. Hú for treatment.

Current symptoms: Irregular occurrences of feverishness, with red and swollen macules on the face and back occurring as patches or covering larger areas, with shedding scales resembling ox hide tinea. In addition she commonly experienced neck, nape, back and lumbar pain, dry throat, irritability, and also sweat easily from her head. Her tongue had a thin-white coating, and her pulse was thin, wiry, and rapid.

This is a pattern of pathogenic depression in the Jué Yīn, blood deficiency and exuberance of water. Treatment should involve warming the lower, clearing the upper, nourishing the blood, and disinhibiting water. chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) with dāng guī sháo yào sǎn (Tangkuei and Peony Powder) is the appropriate formula.

chái hú (Bupleuri Radix) 5 qián 
huáng qín (Scutellariae Radix) 3 qián 
tiān huā fěn (Trichosanthis Radix) 4 qián 
mǔ lì (Ostreae Concha) 5 qián 
lóng gǔ (Fossilia Ossis Mastodi) 5 qián 
guì zhī (Cinnamomi Ramulus) 3 qián 
bái sháo (Paeoniae Radix alba) 3 qián 
dāng guī (Angelicae sinensis Radix) 3 qián 
chuān xiōng (Chuanxiong Rhizoma) 3 qián 
cāng zhú (Atractylodis Rhizoma) 3 qián 
fú líng (Poria) 3 qián 
gān jiāng (Zingiberis Rhizoma) 2 qián 
zé xiè (Alismatis Rhizoma) 5 qián 
zhì gān cǎo (Glycyrrhizae Radix preparata) 2 qián 
shí gāo (Gypsum fibrosum) 1 ½ liǎng

Results: After taking six packages of the above formula, she had started to notice some positive effects, and after thirty packages, she came in for a follow up consultation. By that point, the red macules on her face and back had basically disappeared, and all her blood tests were normal. Her body temperature had decreased and she no longer felt the irregular feverishness. In addition, her pain was no longer present. When she returned to the Běijīng University hospital for a follow up, her doctor was amazed and was completely satisfied with the treatment she had received. The doctor recapitulated her medical records and advised her that she no longer needed to take her herbs. However, approximately half a month after stopping the herbs, red macules reappeared on her face. Although the symptoms weren’t as bad as before, she returned to Dr. Hú for treatment. The above formula was prescribed again with the shí gāo (Gypsum fibrosum) removed.

Commentary: Systemic lupus erythematosus (SLE) is a difficult condition to treat with western medicine, and the same can be said about Chinese medicine. Using six-channel pattern identification in conjunction with classical formula theory, we are able to achieve good results with this condition, and Dr. Hú’s many years of clinical experience is definitely worth referencing.