May 26, 2012

A Case of Wǔ Líng Sǎn (Five Ingredient Powder with Poria)

- Fire Spirit Currents’ Fàn Zhōng-Lín (范中林)

Translated from 'Five Steps to Cold Damage Treatment According to Pattern Identification'


A six-month old child of a local Chéng Dū office worker was seen in August of 1960.

Chinese Medical Diagnosis

On the day that the child had come in, he had been crying endlessly. His appetite had recently decreased; he had a sallow facial complexion, and had lost weight. His parent’s had no clue as to why this was occurring. One day they had suddenly noticed that the child’s scrotum was swollen, to the size of a chicken egg. Water sounds were heard when the lower abdomen was palpated. He was brought in immediately for a diagnosis.

List of Disease Mechanisms

· Scrotal swelling, and water sounds on palpation of the lower abdomen, signify a water pattern

Comprehensive Analysis

This is a case of water mounting (水疝), caused mainly by the congealing and stagnation of cold and dampness in the yīn organ (scrotum). The qì transforming function of the bladder is abnormal, causing qì to accumulate, which fails to disperse after a prolonged period. Water and fluids have essentially gathered and amassed causing scrotal swelling. This is congealing and amassment of cold-dampness, obstruction of the channels and vessels, qì stagnation in the lower body, and water-dampness macerating in the scrotum.

Treatment method

Treatment method should be to transform qì, move water, warm the kidneys, and disperse cold. Wǔ Líng Sǎn (Five Ingredient Powder with Poria) masters it.

Formula:

zhū líng (Polyporus) 6g
fú líng (Poria) 6g
zé xiè (Alismatis Rhizoma) 6g
bái zhú (Atractylodis macrocephalae Rhizoma) 6g
guì zhī (Cinnamomi Ramulus) 6g
shǎng roù guì (Cinnamomi Cortex) 3g

After taking one package, the scrotal swelling had deceased, and the pain stopped.

[Commentary]

The term ‘mounting disease’ (疝病) was first introduced in the Nèi Jīng (Inner Classic). Today, this condition is referred to in western medicine as hernia, however the meaning of these two is not identical.

Physicians of later generations have had numerous names for mounting qì, and have always believed it to be a condition that is heavily related to the Jué Yīn liver channel, hence the saying “All mounting homes to the liver channel”. Treatment mainly involves, warming the liver, and coursing wood. However, we must carry out a concrete analysis in relation to this specific case. For example, this particular case of mounting disease belongs to a Tài Yáng water amassment pattern, and therefore wǔ líng sǎn (Five Ingredient Powder with Poria) masters it. This kind of treatment need not only be applied to children or males, but can also be adapted to fit changes in females. For example, with young woman experiencing lower abdominal cold, numbness, and heaviness and prolapse in the genitals, with paroxysmal pain, this may be a suitable treatment option.

In this particular case Dr. Fàn proceeded to treat from the hand-foot Tài Yáng channel by using wǔ líng sǎn with the ‘two guì’s’ (roù guì, guì zhī) in order to disinhibit water from the centre, and diffuse yáng qì. After only two packages, the patient completely recovered.

May 3, 2012

Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction)


[Formula Composition] 

cōng bái (Allii fistulosi Bulbus) 4 stems
gān jiāng (Zingiberis Rhizoma) 1 liǎng
fù zǐ (Aconiti Radix lateralis preparata) 1 piece (raw, skin removed, break into 8 pieces)

[Usage] For the three ingredients above, use three shēng of water, and boil until one shēng remains. Remove the dregs, divide into two doses, and take warm twice daily.

[Interpretation of Formula Presentation] This formula’s function is to break yīn, return yáng, and diffuse and free the upper and lower burners. It is essentially sì nì tāng (Frigid Extremities Decoction) with the moderating gān cǎo (Glycyrrhizae Radix) removed, and the yīn breaking, yáng freeing cōng bái (Allii fistulosi Bulbus) added. This formulas presentation is one of yīn exuberance and yáng deficiency. The repelling of yáng is the main pathomechanism involved in this presentation. It is quite easy to recount the usage of this formula from the Shāng hán lùn (傷寒論 Discussion of Cold Damage), as it is simply a Shào Yīn pattern with diarrhea, and a faint pulse. In addition to these signs, in clinical practice we may also see; reversal-flow in the extremities, fear of cold, a cold back, throat pain, a pale throat, diarrhea with undigested food particles, a slippery-white tongue coating, and a faint, deep, and hidden pulse.

If yáng repels upwards, we may see a reddish facial complexion as if makeup were applied, which is why this presentation is sometimes called ‘upcast yang pattern’. Both bái tóng tāng (Scallion [Yáng] Freeing Decoction), and tōng mài sì nì tāng (Vessel Freeing Frigid Extremities Decoction) are used in patterns of yáng deficiency and weakness, yīn exuberance, and repelling yáng. The Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction) presentation is characterized by exuberant interior yīn cold, with repelling of yáng into the upper burner, and can therefore be referred to as a ‘yīn exuberant, upcast yáng pattern’. tōng mài sì nì tāng (Vessel Freeing Frigid Extremities Decoction) on the other hand is characterized by exuberant interior cold, and repelling of yáng into the exterior, and can therefore be referred to as a ‘yīn exuberant, yáng repelling pattern’. Essentially, both these formulas are quite different, and must be differentiated.

[Primary Patterns]
 “In Shào Yīn disease with diarrhea, Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction) masters it” (Shāng hán lùn (傷寒論 Discussion of Cold Damage) line 314)

“In Shào Yīn disease, with diarrhea and a faint pulse, give Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction)………..” (Shāng hán lùn (傷寒論 Discussion of Cold Damage) line 315)



Two Cases using Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction)

(1) A Pattern of Reverse-Flow Upcast Yáng in Pregnancy

Lǐ Xiǎo-Pǔ
Journal of the Yúnnán College of Traditional Chinese Medicine, (1979; 2: 40)

The following is a case of a thirty-six year old female patient treated in hospital after losing consciousness. After getting out of bed that morning, she had felt completely normal, but had suddenly experienced dizziness and flowery vision. After falling over in her kitchen, she went to bed to quietly lie down, and it was at this point that she had lost consciousness.

Consultation: The following signs and symptoms were noted; a hidden, imperceptible pulse, reversal cold in the extremities, white facial complexion, with slightly red cheekbones, and occasional nausea with a desire to vomit.

The dizziness and reversal were due to the dual deficiency of liver and kidney yáng. The exuberance of yīn qì in the lower burner caused deficient yáng to float upwards, bringing forth the signs of upcast yáng. At this point she had just entered her ninth month of pregnancy. In this particular case, a modified version of Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction) was indicated.

Formula:

fù zǐ (Aconiti Radix lateralis preparata) 15g
gān jiāng (Zingiberis Rhizoma) 9g
chǎo zhū yú (Evodiae Fructus preparata) 6g
gōng dīng xiāng (Caryophylli Flos) 2.4g
guì zhī (Cinnamomi Ramulus) 9g
cōng bái (Allii fistulosi Bulbus) 3 stems
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g

After taking the above decoction, sounds of water seeping through her chest and abdomen were noted, and afterwards copious amounts of water were discharged trough a bowel movement. When returning to visit her later in the afternoon, she was already feeling normal and had completely recovered. She was still experiencing diarrhea, so a modified version of lǐ zhōng tāng (Regulate the Middle Decoction) was administered.



(2) Yáng deficiency headache

Liú Yǔ
Journal of the Shāndōng University of Traditional Chinese Medicine (1977; 1: 30)

A twelve-year old male student was brought to the clinic for a consultation. Every morning after getting up, he experienced continuous headaches, which were accompanied by spontaneous sweating, exhaustion, a fear of cold with a desire to be warm, a pale tongue body with a white coat, and a deep-thin and strengthless pulse. If no treatments were administered the headaches would usually subside by the afternoon. Previous Chinese medicine doctors treated his headaches as qì deficiency type headaches, which offered no relief, and was now seriously starting to affect his studies.

The author treated this as yáng deficiency type headaches and used Bái Tóng Tāng (Scallion [Yáng] Freeing Decoction) with the addition of zhì gān cǎo (Glycyrrhizae Radix preparata), and after 2 packages, the headaches disappeared.

Formula:

shú fù zǐ (Aconiti Radix lateralis preparata) 6g
gān jiāng (Zingiberis Rhizoma) 4.5g
zhì gān cǎo (Glycyrrhizae Radix preparata) 4.5g
cōng bái (Allii fistulosi Bulbus) 2 stems



Translated from the ‘Zhāng Zhòng-Jǐng Formula studies’ book (张仲景方剂学), compiled by Lǔ Zhì-Jié, and published by the China Medical Science Press (2005)