December 30, 2013

A Concretions and Conglomerations Case- Féng Shì-Lún (冯世纶)


A seventy-two year old retired gentleman presented on September 14, 2004 with a three- year history of liver and spleen hypertrophy.
At sixty years of age he had contracted and suffered from gallbladder inflammation and onychomycosis (ringworm of the nails). At sixty-nine he was given griseofulin to treat the ringworm, which consequently damaged his liver function.  In 2001 his ringworm had gotten much worse and so he was administered Itraconazole for several months. Although the ringworm did improve, his liver function was now abnormal, and his blood platelets had decreased.  His diagnosis was drug-induced hepatitis with splenic-liver syndrome. Western medications were ineffective. The results of his medical exams were as follows:

Blood panels: WBC 4.6 x 1012/L, RBC 3.93 x 1012/L, Platelets 59 x 109/L.
Ultrasound showed a fatty liver, liver enlargement (hepatomegaly), spleen enlargement (splenomegaly), with the thickness of the liver being 156mm and the thickness of the spleen being 70mm.
Liver function tests: AST 45IU/L, TP 8.4g/DL, GGT 76IU/L, TBA 37umol/L.

Current symptoms: Lack of strength, dryness of the mouth in the morning, frequent chest fullness, and frequent passing of flatus. He had a white tongue coat, which was greasy at the root, and his pulse was wiry and thin.

Pattern identification and basis of treatment:

Chest fullness belongs to Shào Yáng
Mouth dryness belongs to Yáng Míng
Lack of strength is associated with Tài Yīn

He was administered a modified version of xiǎo chái hú jiā shí gāo tāng (Minor Bupleurum Decoction with Gypsum)

chái hú (Bupleuri Radix) 12g
huáng qín (Scutellariae Radix) 10g
bàn xià (Pinelliae Rhizoma preparatum) 15g
dǎng shēn (Codonopsis Radix) 10g
zhǐ shí (Aurantii Fructus immaturus) 10g
chén pí (Citri reticulatae Pericarpium) 30g
shēng jiāng (Zingiberis Rhizoma recens) 12g
dà zǎo (Jujubae Fructus) 4 pieces
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
yīn chén hāo (Virgate Wormwood herba) 15g
dān shēn (Salvia Militiorrhiza) 15g
tiān huā fěn (Trichosanthis Radix 12g
biē jiǎ (Trionycis Carapax) 10g
wǔ wèi zǐ (Schisandrae Fructus) 10g
shēng shí gāo (Gypsum fibrosum) 45g

Seven packages were given.

Question: Is the ancient rén shēn actually dǎng shēn, bái shài shēn or gāo lí shēn?

Answer: If we look, we see that rén shēn’s applications in Zhòng Jǐng’s formulas are quite numerous, and dǎng shēn is capable of meeting these major requirements.

Question: In this treatment xiǎo chái hú tāng (Minor Bupleurum Decoction) was used, and in Japan it is also frequently used for hepatitis. Is this formula especially efficacious at treating hepatitis?

Answer: Not necessarily. Chinese medicine looks at the individual systems when treating and is not influenced by western medical diagnosis.  Japan’s misuse of this formula for treating hepatitis has created lots of disputes around the use of this formula, mainly because they are not relying on pattern (identification) for herb usage and strictly use western medical diagnosis to determine its use. From the perspective of orthodox Chinese medicine this use is incorrect, erroneous and can bring about side effects from the formula.  In this case xiǎo chái hú tāng (Minor Bupleurum Decoction) was used for an extended period of time, yet none of these so-called side effects were observed. These are the lessons the Chinese western integrative doctors should be drawing from.

Second consultation on September 21, 2004:  The chest fullness was not as pronounced, yet he was still lacking strength and was frequently passing gas. Shēng shí gāo (Gypsum fibrosum) was removed from the previous formula and 30g of chén pí (Citri reticulatae Pericarpium) was added. Seven packages were administered and he was also given dà huáng zhè chóng wán (Rhubarb and Ground Beetle Pill) and was instructed to take three grams once daily.

Third consultation on October 8, 2004:  Gas was reduced and bowel movements were normalized. The chén pí (Citri reticulatae Pericarpium) was kept at 30g and 15g of cāng zhú (Atractylodis Rhizoma) was added. Fourteen packs were given.

Fourth consultation on October 22, 2004: Chest fullness was still not pronounced, he experienced itchiness of his abdomen and back, he was only tired after walking and his mouth was no longer dry in the morning. Here we see the lack of strength and harmony of the mouth (no abnormal taste or sensation in the mouth) as the key signs of a Tài Yīn vacuity pattern. Therefore fú líng yǐn (Poria Beverage) is used combined with medicinals to nourish the blood, eliminate stasis, and soften hardness.

bàn xià (Pinelliae Rhizoma preparatum) 10g
dǎng shēn (Codonopsis Radix) 10g
zhǐ qiào (Aurantii Fructus immaturus) 10g
chén pí (Citri reticulatae Pericarpium) 30g
cāng zhú (Atractylodis Rhizoma) 10g
fú líng (Poria) 12g
bái sháo (Paeoniae Radix alba) 10g
táo rén (Juglandis Semen) 10g
dāng guī (Angelicae sinensis Radix) 10g
chuān xiōng (Chuanxiong Rhizoma) 6g
yīn chén hāo (Virgate Wormwood herba) 15g
dān shēn (Salvia Militiorrhiza) 15g
biē jiǎ (Trionycis Carapax) 10g
wǔ wèi zǐ (Schisandrae Fructus) 10g

After taking seven packages he occasionally had a dry mouth with a bitter taste and his GPT levels had increased. He was given a modified version of the formula from the first consultation. Afterwards he had abdominal distention, a lack of strength, and an absence of dryness or bitterness in the mouth. He was then given a modified version of the formula from his fourth consultation.

He was seen again in April of 2005 where he was commonly experiencing a dry mouth with a bitter taste, and a lack of strength in the lower limbs. His tongue coating was white and greasy and his pulse was wiry and thin.  This was a Jué Yīn pattern of blood vacuity with water exuberance and cold-heat complex for which he was given a combination of chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) and dāng guī sháo yào sǎn (Tangkuei and Peony Powder) to treat it. This formula was taken for roughly one year after which his abdominal distention, poor appetite, and lack of strength were resolved, and his overall spirit had improved. In July of 2005 he returned for a follow-up ultrasound. The results were as follows:
1.     Hepatic diffused lesion
2.     Spleen enlargement, increase of the Spleen’s portal vein (thickness of liver was 110mm, and the thickness of the spleen was 50mm)
Overall, his symptoms were improved, and his liver and spleen had reduced in size. He was advised to stop his formula and keep a close watch (on his symptoms).

Question: In the first consultation this man was given a modified version of xiǎo chái hú tāng (Minor Bupleurum Decoction), in the fourth consult he was given wài tái fú líng yǐn (Poria Beverage from the Wài Tái), and afterwards he was given a combination of chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) with dāng guī sháo yào sǎn (Tangkuei and Peony Powder). Can you please elucidate as to whether a half interior half exterior pattern can shift into the interior, and also if an interior condition can shift into the half interior half exterior?

Answer:  It’s not exactly like that. Generally, a disease shifts due to the diminishing of fluids and can pass through the exterior, half exterior half interior, and interior. In disease, Shào Yáng can pass through to Yáng Míng, but Yáng Míng can absolutely not pass to Shào Yáng. This is the reason it is said that in Yáng Míng disease “there is nothing to return to”.  So when a disease presents as a combination of half exterior half interior with an interior (condition), one must use medicinals on the basis of the aspect that is stressed more.

Question: It is said the Dr. Hú was greatly influenced by the great Kampo doctors.  What are the differences and similarities between his research on the works of Zhòng Jǐng’s to those done by Japanese physicians?

Answer: Both sides attached great importance to the work of Zhòng Jǐng and the reasoning, thought process, and identification of the cause of diseases. They both used the perspective of the eight principles pattern identification in order to research and study classic formulas, and paid particular attention to formula pattern correspondences. They felt the six channels were established rules (suitable) for (diagnosing) hundreds of diseases.

October 23, 2013

Xiǎo Qīng Lóng Tāng from the Zhù Jiě Shāng Hán Lùn


Line 40:

“In cold damage when the exterior has not yet resolved, and there is water qì below the heart, with dry retching, heat effusion, and cough, and possibly thirst or diarrhea, or dysphagia, or inhibited urination and lesser abdominal fullness, or panting, xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

In cold damage when the exterior has not yet been resolved and there is water qì below the heart, this will result in the contention of water and cold with cold qì counterflow in the lung manifesting with symptoms of dry retching, heat effusion, and cough. The Acupuncture classic says, “Physical cold with cold rheum damages the lungs”. What this means is that there is contraction of two kinds of cold, and both the center and exterior are damaged, which results in the upward movement of counterflow qì. By administering xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) sweat is effused and water is dissipated. With the steeping of water qì in the interior, several signs can manifest, and therefore it must be resolved and transformed. 


Xiǎo Qīng Lóng Tāng (Minor Bluegreen Dragon Decoction)

má huáng (Ephedrae Herba) 3 liǎng (remove nodes), flavor is sweet and warm
sháo yào (Paeoniae Radix) 3 liǎng, flavor is sour and slightly cold
wǔ wèi zǐ (Schisandrae Fructus) ½ shēng, flavor is sour and warm
gān jiāng (Zingiberis Rhizoma) 3 liǎng, flavor is acrid and warm
zhì gān cǎo (Glycyrrhizae Radix preparata) 3 liǎng, flavor is sweet and neutral
guì zhī (Cinnamomi Ramulus) 3 liǎng (remove the bark), flavor is acrid and warm
bàn xià (Pinelliae Rhizoma preparatum) ½ shēng (washed), flavor is acrid and slightly warm
xì xǐn (Asari Herba) 3 liǎng, flavor is acrid and warm.


When cold evils are present in the exterior, without the use of acrid and sweet (medicinals), one would be unable to dissipate them.  Má huáng (Ephedrae Herba), guì zhī (Cinnamomi Ramulus), and gān cǎo (Glycyrrhizae Radix) are acrid and sweet, and can therefore effuse and dissipate cold evils. When there is stoppage of water qì below the heart that fails to move, then the kidney qì will become dry. The Nèi Jīng says, “When the kidneys suffer from dryness, swiftly eat acrid to moisten them”. Gān jiāng (Zingiberis Rhizoma), xì xǐn (Asari Herba), and bàn xià (Pinelliae Rhizoma preparatum) are acrid and can (therefore) move water qì and moisten the kidneys. Coughing counterflow and panting are (the result of) counterflow lung qì.  The Nèi Jīng says, “(When) the lungs desire to be collected (astringed), swiftly eat sour in order to collect them”.  Sháo yào (Paeoniae Radix) and wǔ wèi zǐ (Schisandrae Fructus) are both sour and can collect (astringe) counterflow qì and calm the lungs.

Use one dǒu of water for the eight ingredients above.  First boil the má huáng to reduce the water by two shēng.  Remove the foam collecting on top and add the other ingredients.  Boil until reduced to three shēng, remove the dregs, and take one shēng warm. 


Modifications:

If there is slight diarrhea remove the má huáng and add a piece of ráo huā (Wikstroemia Flos) the size of a chicken egg, and dry fry until red.

With diarrhea one cannot attack the exterior, as when sweat is issued, this will result in distention and fullness. Má huáng effuses yáng, which can lead to the steeping of water into the stomach, inevitably resulting in diarrhea. Ráo huā is able to purge water, and once water is removed, diarrhea will cease. 


If there is thirst, remove bàn xià and add three liǎng of guā lóu gēn (Trichosanthis Radix).

Acrid dries, and bitter moistens. Bàn xià is acrid and can therefore dry fluids, so without thirst it is appropriate.  (Here) there is thirst, and it is therefore eliminated. Guā lóu gēn is bitter and can generate fluids therefore it is added.  


If there is dysphagia, remove má huáng and add one piece of blast-fried fù zǐ (Aconiti Radix lateralis preparata).

The classics say, “when water obtains cold qì, there will be mutual contention amongst them and the person will experience dysphagia”.  Fù zǐ is added to warm and dissipate cold water.  When a person has cold, and sweat is repeatedly effused, this will leave the stomach cold, which will result in the vomiting of roundworms, therefore má huáng is removed out of fear of effusing sweat. 


If urination is inhibited and there is fullness in the lesser abdomen, remove má huáng and add four liǎng of fú líng (Poria).

When there is water amassment in the lower burner that fails to move resulting in inhibited urination and fullness in the lesser abdomen, má huáng is inappropriate as it effuses fluids into the exterior; fú líng discharges amassed water out through the lower, and is therefore used instead. 


If there is panting, remove má huáng and add ½ shēng of xìng rén (Armeniacae Semen amarum), removing the skin and tips.

The Jīn Guì Yào Lüè says, “When a person (suffers) from generalized swelling, one should not add má huáng but instead use xìng rén”.  The reason is that má huáng effuses the yáng. With panting and generalized swelling, water qì is the branch and root of the disease.


Line 41:

“In cold damage when there is water qì below the heart, cough, mild panting, and heat effusion without thirst, (but with) thirst after taking the decoction, this means cold is leaving and (the disease) is about to resolve; xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

Cough and mild panting are due to cold water shooting into the lungs. Heat effusion and an absence of thirst are due to an exterior pattern, which has not yet ceased. Xiǎo qīng lóng tāng is given to effuse the exterior and dissipate water. (If) after taking the decoction there is thirst, this means that the interior has been warmed, water qì has been dissipated, and (the disease) is about to resolve.

October 21, 2013

Má Xìng Gān Shí Tāng from the Zhù Jiě Shāng Hán Lùn


Chéng Wú-Jǐ (1050-1144) 
A scholar/physician from the Northern Sōng dynasty who compiled the Annotations to the Shāng Hán Lùn (注解伤寒论), which became what’s known as the Sōng version of the Shāng Hán Lùn used to the present day.  Chéng devoted over forty years of his life to compiling his seminal work, which he completed in 1140. However, Chéng never saw it published, which occurred in 1172, close to thirty years after his death. Chéngs’ annotation was extremely comprehensive and detailed, citing numerous sources and references in his attempt to repair and resolve the various inconsistencies that existed amongst the numerous surviving versions of the text.
The following is taken from Chéngs Annotations to the Shāng Hán Lùn


Line 63:

“Following the promotion of sweat, Guì Zhī Tāng should not be given again; (if) there is sweating with panting and the absence of great heat, one can use má xìng gān shí tāng (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)”. 1
 
With panting after the promotion of sweat, one can typically use guì zhī jiā hòu pò xìng zǐ tāng (Cinnamon Twig Decoction Plus Magnolia Bark and Apricot Kernel), as once sweat (further) effuses, the condition will resolve.  (However) here there is sweating with panting signifying that evil qì is quite severe, therefore guì zhī tāng (Cinnamon Twig Decoction) would be unable to effuse and dissipate (evils), and so this is the reason, the guì zhī tāng should not be given again. Sweating and panting with great heat, indicates the presence of severe hot qì in the interior. The absence of great heat signifies that exterior evils must be severe. In this case it is suitable to give má xìng gān shí tāng in order to dissipate the evils.


Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)

má huáng (Ephedrae Herba) 4 liǎng (remove nodes)- flavor is sweet and warm
xìng rén (Armeniacae Semen amarum) 50 pieces (remove skin and tips)- flavor is sweet and warm
zhì gān cǎo (Glycyrrhizae Radix preparata) 2 liǎng- flavor is sweet and neutral
shí gāo (Gypsum fibrosum) ½ jīn (crushed and cotton wrapped)- flavor is sweet and cold

The Huáng Dì Nèi Jīng says “When the liver suffers from urgency, swiftly eat sweet (flavors) in order to moderate it”. (Here) wind qì passes through the liver and wind evils are severe in the exterior, therefore a purely sweet formula is given to effuse it.

For the four ingredients above use seven shēng of water.  First boil the má huáng and reduce (the water) by two shēng and remove the foam collecting on top. Add the remaining ingredients and boil until reduced to two shēng, remove the dregs and take one shēng warm.  The original text says that the formula should be put into a yellow-eared cup (a Hàn dynasty drinking vessel). 




1. It should be noted here that line 162 is almost identical to this one with the only difference being that the line starts off by saying “following precipitation”.

September 24, 2013

Guì Zhī Jiù Nì Tāng (Cinnamon Counterflow-Stemming Decoction)



Case of Dr. Hú Xī-Shù (胡希恕)


A twenty-six year old air force translator came in for an initial consultation. Recently while observing the repair of some electric wiring, he (suddenly) became very frightened, which manifested with fright palpitations, flusteredness, insomnia, headaches, poor appetite, nausea, and the occasional sound of phlegm in the back of his throat, which caused him to become uncontrollably angry, restless, and vexed every time he would hear this sound, but over some time (his emotions) would gradually recede slightly. Nonetheless two people assisted him when he had come in for a consultation.
(Aside from the symptoms above) he had a thick white tongue coat, and his pulse was wiry, slippery and the cùn (inch) position was floating. This pattern is due to the upward harassment of enduring cold rheum, and treatment should involve warming, transforming, and downbearing counterflow. He was given a modified version of (guì zhī) jiù nì tāng (Cinnamon Twig Counterflow-Stemming Decoction).


guì zhī (Cinnamomi Ramulus) 10g
shēng jiāng (Zingiberis Rhizoma recens) 10g
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
dà zǎo (Jujubae Fructus) 4 pieces
bàn xià (Pinelliae Rhizoma preparatum) 12g
fú líng (Poria) 12g
shēng mǔ lì (Ostreae Concha) 15g
shēng lóng gǔ (Fossilia Ossis Mastodi) 15g


Results: After taking three packages of the above formula his flusteredness and phlegm sound in the back of his throat were reduced. After six packages, his appetite increased, and his sleep had improved. He continued on the formula and after ten packages all of his symptoms disappeared.


Line 112 in the Shāng hán lùn (傷寒論 Discussion of Cold Damage) says:


“(When) in cold damage the pulse is floating, and a fire (method) is used to force (sweating), as a result yáng collapses and there will be fright mania, and fidgetiness whether lying or sitting; guì zhī qù sháo yào jiā shǔ qī mǔ lì long gǔ jiù nì tāng governs”.


Analysis: When there is cold damage with a floating pulse, one should consider treating it with má huáng tāng to promote sweating, however, if it is treated with a fire method, which could include moxibustion, fire needling, fire fuming, and other similar methods, to force sweating, it can result in major sweating, and this is an erroneous treatment. When there is major sweating, this will result in the collapse of liquids and humors. Not only will this fail to meet the objective of resolving the exterior, but major sweating, will result in upper vacuity, causing qì to overwhelm the vacuity and surge upwards. This will also stimulate the interior causing the ascent of rheum, which will cloud the clear orifices resulting in symptoms of fright mania, and fidgetiness whether lying or sitting. The suitable treatment here is with guì zhī qù sháo yào jiā shǔ qī mǔ lì long gǔ jiù nì tāng.

August 14, 2013

A Breakdown of thirst in the Shāng hán lùn (傷寒論) by Liú Dù-Zhōu (刘渡舟)

 
1.     Heat Exuberance

Original Lines:

Line 26:
“When after guì zhī tāng is taken and following major sweating there is major vexation and thirst, and the disease is unresolved and the pulse is surging and large, bái hǔ jiā rén shēn tāng (White Tiger plus Ginseng Decoction) governs”.

Line 168:
“In cold damage if vomiting or purgation (methods) are used, and after seven or eight days the condition has not resolved, heat is bound in the interior, (and there is) heat in both the exterior and interior, (with) frequent aversion to wind, great thirst, a dry tongue, vexation, and a desire to drink several shēng of water, bái hǔ jiā rén shēn tāng (White Tiger plus Ginseng Decoction) governs”.

Line 170:
“In cold damage when the pulse is floating, and there is heat effusion with an absence of sweating, the exterior has not yet resolved; bái hǔ tāng (White Tiger Decoction) can not be given. If there is thirst with a desire to drink and no exterior signs, bái hǔ jiā rén shēn tāng (White Tiger plus Ginseng Decoction) governs”.

Line 169:
“In cold damage when great heat effusion is absent and there is a dry mouth, thirst, heart vexation, and slight aversion to cold in the back, bái hǔ jiā rén shēn tāng (White Tiger plus Ginseng Decoction) governs”.

Line 222:
“If there is thirst with a desire to drink water, a dry mouth, and dry tongue, then bái hǔ jiā rén shēn tāng (White Tiger plus Ginseng Decoction) governs”.

Line 373:
“When there is diarrhea with a desire to drink water, this indicates heat and bái tóu wēng tāng (Pulsatilla Decotion) governs”.

Summary:

The Shāng Hán Sù Yuán Jí (Discourse on Tracing back to the Source of (the Discussion) of Cold Damage)[1] says: “the presence or absence of thirst is the main determining factor of the existence of heat.  When there is no heat in the interior, there will be no thirst, and if thirst is present, (due to) a lack of fire in the lower burner, fluids are unable to be steamed by the bladder resulting in a lack of moisture (fluids) in the mouth.  Although thirst is present, there will be a lack of desire and an inability to drink copious amounts of water. If the stomach is hot and dry, it would be completely logical that there would be thirst with a desire to drink, as opposed to an absence of heat in the interior still with a desire to drink fluids”.  In the Jué Yīn chapter in the Shāng hán lùn, major heat has caused excessive loss of water, and this lack of water will result in thirst. All of the patterns in the lines above are the result of great heat, which has damaged fluids; therefore they all use bái hǔ jiā rén shēn tāng.  Bái tóu wēng tāng is also used to clear superabundant heat. 


2.     Water Ammassment

Original Lines:

Line 71: 
“…………If the pulse is floating, urination is inhibited, and there is slight heat with dispersion thirst, wǔ líng sǎn (Five-Ingredient Powder with Poria) governs”.

Line 74: 
“In wind strike when there is heat effusion that is unresolved for six or seven days and vexation; (here) there is an exterior and interior pattern[2] with thirst with a desire to drink water and vomiting immediately after ingesting fluids, this is called water counterflow, and wǔ líng sǎn (Five-Ingredient Powder with Poria) governs”.

Line 72: 
“When sweat has already been promoted and the pulse is floating and rapid, and there is vexation and thirst, wǔ líng sǎn (Five-Ingredient Powder with Poria) governs”.

Line 244: 
“In Tài Yáng disease……when there is thirst with a desire to drink water, give a small amount of water, for only by this method will the condition be eliminated. If there is thirst, wǔ líng sǎn (Five-Ingredient Powder with Poria) is suitable”.


Summary:

A wǔ líng sǎn (Five-Ingredient Powder with Poria) pattern is primarily the result of obstruction in urinary function manifesting with inhibited urination.  There is accumulation and fullness of water toxicity in the blood, and the gastro-intestinal tract is unable to reabsorb water into the blood. Water amassment has also now been generated within the stomach resulting in this kind of obstruction to the body’s fluid metabolism and there is a failure to secrete fluids in the salivary glands and the mucus membranes in the mouth resulting in thirst.  Therefore, we know that a lack of water or water amassment can both lead to thirst, so with a lack of water, one needs to merely supplement and fill the water aspect with a formula like bái hǔ jiā rén shēn tāng, where on the hand it clears heat, while on the other, it also generates fluids. With water amassment, treatment involves disinhibiting water, and while wǔ líng sǎn can stop thirst, it primarily eliminates amassed water.  This thirst is similar to that associated with zhū líng tāng (lines 223 and 319), however the pathological changes with this formula (WLS) are in the bladder.


3.     Damage to Yīn

Original Lines:

Line 282: 
“In Shào Yīn disease when there is a desire but inability to vomit, heart vexation, a desire only to sleep, and after five or six days there is spontaneous diarrhea and thirst, this belongs to Shào Yīn. (Because there is) vacuity, water intake should relieve (the thirst)”.

Line 329: 
“In Jué Yīn disease, when there is thirst with a desire to drink water, give a small amount of water and there will be recovery”.

Line 326: 
“In Jué Yīn disease there is dispersion thirst, qì surging upwards into the heart, pain and heat in the heart, hunger with no desire to eat, and vomiting of roundworms after eating.  If purgation is used, this will result in incessant diarrhea”.


Summary:

The Shāng Hán Míng Lǐ Lùn[3] (The Clear Rationale of Cold Damage) says: “When pathogenic qì first enters the interior, warm qì is scattered and is unable to be absorbed becoming heat.  This heat is fumed and steamed, which burns the diaphragm resulting in contention and the inevitable consumption of fluids, which gradually creates thirst. Although the patient is thirsty and has a desire to drink water, they are unable to drink copious amounts.  If large amounts of water are drunk, the heat would still not be dispersed, and this would result in rheum stoppage disease”.  All yīn patterns with thirst are typically not due to repletion heat, but are the result of the exhaustion of fluids and the harassment of vacuous yáng.  Therefore, cool and cold (medicinals) should not be carelessly administered, nor should copious amounts of water be given. All three lines above are patterns due to yīn damage and vacuous fire harassing the upper, therefore Wèi Lì-Tóng recommends giving fù zǐ tāng (Aconite Decoction) in line 282 to warm Shào Yīn. 






[1] A text written in 1707 by Qián Huáng (錢潢)
[2] Wèi Lì-Tóng said: “What is the interior pattern? It manifests with vexation, thirst with a desire to drink, and vomiting immediately after ingesting fluids. What is the exterior pattern?  It manifests with a headache, tightness of the nape, and aversion to cold, heat effusion, and sweating”.
[3] A Jīn dynasty text written by Chéng Wú-Jǐ (成无己)

July 30, 2013

Rén Yīng Qiū- A Zhēn Wǔ Tāng (True Warrior Decoction) Case


A thirty-two year old male patient presented with headaches, which occur every evening.  Lately the headaches have been getting quite severe and are only slightly alleviated when he pounds on his head or after taking analgesics. When asked when the headaches started he mentioned that he works as a driver, and last summer when the weather was extremely hot, he would often drink iced soft drinks or beer on his breaks. Initially there was no problem but once the autumn arrived, the headaches began. I asked aside from the headaches, where else he felt discomfort. He mentioned that he also had black spots in his vision, and would get disorientated at times.  His complexion was soot black, his tongue was pale and tender with a wet, slippery coating, and his pulse was deep, wiry, and moderate. This is a pattern of yáng vacuity with water exuberance, and turbid yīn scurrying upwards. When clear yáng is clouded there is dizziness, and when there is struggle between yīn and yáng, this will result in headaches.

Formula:

fù zǐ (Aconiti Radix lateralis preparata) 12g
shēng jiāng (Zingiberis Rhizoma recens) 12g
fú líng (Poria) 18g
bái zhú (Atractylodis macrocephalae Rhizoma) 9g
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
bái sháo (Paeoniae Radix alba) 9g
guì zhī (Cinnamomi Ramulus) 6g

After six packages of the above formula his headaches had decreased substantially. He was then given four packages of líng guì zhú gān tāng (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) to consolidate the treatment, and afterwards his condition completely resolved.

July 23, 2013

Dr. Hú Xī-Shù (胡希恕) -Chest Pain


On May 28th, 1965, a 67 year-old male presented at the clinic suffering from shortness of breath, chest pain, and chest oppression for over a month. On April 23rd he was diagnosed with a myocardial infarction, and was administered both nitroglycerine and aminophylline, which were ineffective. He also sought out Chinese medical treatments and was given various qi boosting, blood invigorating, phlegm transforming, and collateral freeing medicinals (such as rén shēn, huáng qí, mù guā, chì sháo, jiàng xiāng, táo rén, xiè bái, and yù jīn), which he had been taking for the last month but no obvious improvement was observed.  Currently he was experiencing a burning hot pain in the left side of his chest, shortness of breath, which was exacerbated with movement, he was occasionally cold and hot, had a stifling sensation below his heart, a bitter taste in the mouth, occasional head distention, insomnia, and dry stools. He had a yellow tongue coating, and a wiry, slippery pulse.  

Dr. Hú administered a modified version of dà chái hú tāng (Major Bupleurum Decoction) combined with guì zhī fú líng wán (Cinnamon and Poria Pill).

chái hú (Bupleuri Radix) 4 qián
bàn xià (Pinelliae Rhizoma preparatum) 3 qián
huáng qín (Scutellariae Radix) 3 qián
bái sháo (Paeoniae Radix alba) 3 qián
zhǐ shí (Aurantii Fructus immaturus) 3 qián
shēng jiāng (Zingiberis Rhizoma recens) 3 qián
dà zǎo (Jujubae Fructus) 4 pieces
guì zhī (Cinnamomi Ramulus) 3 qián
fú líng (Poria) 4 qián
táo rén (Juglandis Semen) 3 qián
dà huáng (Rhei Radix et Rhizoma) 2 qián
shí gāo (Gypsum fibrosum) 1 liǎng
zhì gān cǎo (Glycyrrhizae Radix preparata) 1 qián

Second consultation (June, 1st): After taking three packages of the formula most of his symptoms had improved, but he was still feeling suffocated in the evenings, had heartburn after meals, and his stools were still dry. His tongue coat was still yellow, and his pulse was wiry, slippery, and slightly rapid.  The same formula was administered but the dà huáng was increased to 3 qián.

Third consultation (December 23rd): After taking two packages of the formula, the suffocating feeling in the evenings disappeared, and while he still experienced some shortness of breath on exertion, it would gradually resolve after a little bit of rest. Afterwards he did not return for a follow up.  He was currently being treated for a weeklong cough with a modified version of bàn xià hòu pò tāng (Pinellia and Magnolia Bark Decoction).

Commentary:  In regards to the treatment of this case, the previous physicians had used blood invigorating, qi regulating medicinals, however they all failed to provide any relief for the patient, while Dr. Hú was able to offer a good effect by grasping the crucial aspect of the condition.  The previous physician paid little attention to whether the condition involved heat, cold, repletion, or vacuity, while Dr. Hú recognized this to be a repletion heat pattern stuck in the half exterior half interior portion of the body.  In addition, he recognized this as a dà chái hú tāng and guì zhī fú líng wán formula presentation, which is the reason why his treatment worked so well.