July 23, 2012

Professor Chén Rùi-Chūn’s experience in the usage of Wǔ Líng Sǎn (Five-Ingredient Powder with Poria) (陈瑞春教授应用五苓散经验)

The following is a small excerpt of my most recent article/translation, which will be published in the Lantern's September issue.   

Article by: Zhèng Yàn-Huá, Jiāng Xī University of Traditional Chinese Medicine
Translated by:  Eran Even

 Professor Chén Ruì-Chūn (1936-2008), originally from Tóng Gǔ county in Jiāng Xī province, was a very well known classical formulas (jīng fāng 经方) specialist, whose impressive career as a clinician, scholar, and clinical advisor spanned well over fifty years.   

In order to truly understand the clinical application of Wǔ Líng Sǎn  (Five-Ingredient Powder with Poria), Dr. Chén would often emphasize that one must begin from the perspective of the patho-mechanism, and not be limited by just the Shāng Hán Lùn’s (傷寒論 Discussion of Cold Damage) concept of water amassment. This would provide more varied opportunities to use this formula. 
I was fortunate enough to have had the opportunity to study with Dr. Chén, and observe his extensive use of this formula.  The following are just a few examples illustrating these ideas.    

In the Shāng Hán Lùn (傷寒論 Discussion of Cold Damage), Wǔ Líng Sǎn  (Five-Ingredient Powder with Poria) appears in eight different lines (71, 72, 73, 74, 141, 156, 244, and 386), and with the exception of line 386 where it is indicated in the treatment of sudden turmoil disease, the remaining lines are all mainly associated with tài yáng water amassment patterns, with symptoms of thirst, and difficult urination, accompanied by either the presence or absence of exterior signs.  Excerpts from the following lines illustrate the major signs and symptoms associated with this formula:

Line 71: “If the pulse is floating, urination is inhibited, and there is slight heat with dispersion thirst, Wǔ Líng Sǎn masters it”

Line 72: “Irritability and thirst”

Line 73: “There is sweating and thirst”

Line 74: “There is an exterior and interior pattern present, with thirst and a desire to drink water, and vomiting immediately following the ingestion of fluids”

Line 141: “A desire to drink water”

Line 156: “Thirst with a dry mouth, irritability, and difficult urination”

In regards to clinical practice, Dr. Chén would emphasize the need for a comprehensive analysis of Wǔ Líng Sǎn ’s (Five-Ingredient Powder with Poria) patho-mechanism, and as students, would require us to delve into deep study in order to comprehend the main points or ‘gist’ of the original text in the Shāng Hán Lùn (傷寒論 Discussion of Cold Damage). 
He felt that the essential patho-mechanism involved with Wǔ Líng Sǎn  (Five-Ingredient Powder with Poria) is the inability of qì to transform water.  With the loss of qì transformation causing the non-distribution of water and fluids, we see thirst, and with the accumulation and stagnation of these fluids, we see difficult urination.  In addition, the inability of qì to transform water can also manifest with copious urination.  Therefore, in order to increase one’s flexibility in clinic, and successfully treat numerous conditions, one must grasp the basic mechanism of “qì being unable to transform water” when using Wǔ Líng Sǎn  (Five-Ingredient Powder with Poria). 

1.    Copious Urination

Copious urination is a commonly seen symptom in clinic in both the young and the elderly, usually manifesting as frequent urination.  In children, copious urination is commonly due to pre-heaven insufficiency, with inhibited Bladder qì transformation and a lack of water transformation.  In the elderly, where qì, blood, yīn and yáng may all be deficient, Bladder qì may be inhibited manifesting as frequent urination, and even in some cases as incontinence and enuresis.  Dr. Chén thought that when these kinds of patients were treated from the perspective of a Kidney qì deficiency with Kidney supplementing, urine astringing medicinals, the results were typically less than satisfactory.  This is because copious urination (especially night time urination), and frequent urination are not just simply due to Kidney deficiency, or qì deficiency, but more directly caused by the decline of the transformative function of the Bladder.  Therefore, in treatment one should warm the Kidneys and transform qì, adding a small amount of assistant medicinals to support the Kidney function of absorption and intake.  Dr. Chén would commonly use Wǔ Líng Sǎn  (Five-Ingredient Powder with Poria) with the addition of medicinals such as Sāng Piāo Xiāo (Mantidis Ootheca) and Yì Zhì Rén (Alpiniae oxyphyllae Fructus), in order to obtain satisfactory results.  

Case:  A seventy-three year old female patient presented at the clinic on January 8, 2002.  She was seeking treatment with Chinese medicine following breast cancer surgery.  She complained of frequent nighttime urination, occurring five-six times a night, which was significantly affecting her sleep.  Her appetite was normal, as were her bowel movements, with one movement per day.  She was in generally good health, with no other major complaints.  She was given a modified version of Wǔ Líng Sǎn  (Five-Ingredient Powder with Poria). 

Guì Zhī 10g (Cinnamomi Ramulus)
Fú Líng 15g (Poria)
Zhū Líng 10g (Polyporus)
Zé Xiè 10g (Alismatis Rhizoma)
Bái Zhú 10g (Atractylodis macrocephalae Rhizoma)
Sāng Piāo Xiāo 10g (Mantidis Ootheca)
Qiàn Shí 20g (Euryales Semen)
Yì Zhì Rén 10g (Alpiniae oxyphyllae Fructus)

After taking five packages of the above formula, urination decreased to two-three times per night.  After another five packages, it decreased to once or twice a night, which greatly improved her sleep and overall spirit.  Afterwards, she was given a formula to boost qì, strengthen the Spleen, and regulate the Spleen and Stomach. 


Unknown said...

This is actually one of the first times I am not so impressed with a Chinese doctor's prescription on your blog. While certainly common and mainstream, a trend I do not like in writing prescriptions is taking classical scripts and then adding two or three empirical herbs to it when treating specific problems such as urination. Why not bolster the yang instead of using stabilizing and bind medicinals? I feel that when adding medicinals to classical formulas that one has to keep in mind the overall architecture of the prescription, and whether the new medicinals are actually adding to or obscuring the overall effect. That's at least my opinion.

Eran Even said...

Hi Z'ev,

While I completely agree with you, and too favor an approach which utilizes the classical formulas as they were intended to be used, with little modification, these translations are put up in order to show readers the various other methods used by other highly skilled practitioners. I believe these kinds of modifications were common for Dr. Chen, and his work often reminds me of that of Dr. Jiao Shu-De.
I also agree with the idea that if the pathomechanism is clearly defined (in this case poor bladder transformation) and addressed, the need for herb additions is unnecessary.
Thanks for reading and sharing your opinion. Much appreciated.

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