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.