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.
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