August 26, 2014

膠艾湯 Jiāo Ài Tāng from the Jīn Guì Fāng Gē Kuò

The following is another teaser from the book, which will most likely be the last, as we are literally in the final stages of publishing.  The book should be set free into the world within the next few weeks.

Jiāo Ài Tāng
Donkey-Hide Gelatin and Mugwort Decoction

A treatment for women with [either] spotting, incessant blood descent following late miscarriage, or blood descent in pregnancy. If [there is] abdominal pain in pregnancy, [then] this is uterine obstruction, and this decoction rules it.

乾地黃(六兩)川芎   阿膠     甘草(各二兩)艾葉   當歸(各三兩)芍藥(四兩)
gān dì huáng
chuān xiōng
ē jiāo
gān cǎo
ài yè
dāng guī
sháo yào

上七味,以水五升、 清酒三升,合煮取三升,去滓,內膠令消盡,溫服一升,日三服,不差更作。
Simmer the seven ingredients above in 1,000ml of water with 600ml of clear wine, until reduced to 600ml. Remove the dregs, and dissolve the ē jiāo in the decoction. Take 200ml warm, three doses per day, and repeat if [the condition] fails to resolve.

Song 歌曰:
Abdominal fullness in pregnancy with fetal obstruction, this is called fetal obstruction, which is the result of qì and blood vacuity with cold, which hinders the growth and development of the fetus. Six grams chuān xiōng*,  gān cǎo, and ē jiāo, nine grams each of dāng guī and ài yè, twelve of sháo yào, and eighteen of dì huáng eliminates the tip of the branch.

Commentary by [Chén] Yuánxī男元犀按:
芎藭、 芍、 地,補血之藥也;然血不自生,生於陽明水谷,故以甘草補之。阿膠滋血海,爲胎産百病之要藥;艾葉暖子宮,爲調經安胎之專品,合之爲厥陰、 少陰、 陽明及衝任兼治之神劑也。後人去甘草、 阿膠 、艾葉,名爲四物湯,則板實而不靈矣。
Chuān xiōng , sháo yào, and dì huáng are blood-supplementing medicinals. Blood is not generated on its own, but is engendered from water and grains in yángmíng therefore, gān cǎo is used to supplement [yángmíng]. Ē jiāo enriches the sea of blood, and is a very important medicinal for treating various pregnancy related diseases. Ài yè warms the uterus, and is a specific medicinal to regulate menstruation and calm the fetus. This is a divine formula, which unites juéyīn, shàoyīn and yángmíng, and simultaneously treats the thoroughfare and controlling vessel. In later times, people have removed the gān cǎo, ē jiāo and ái yé, renaming it Sì Wù Tāng, making this formula stiff, bound and ineffective!

*Although the Chinese above says xiōng qiáng 芎藭, I have opted to translate this medicinal using its alternate, more common name chuān xiōng 川芎, and will appear as such in the remainder of the text.

June 23, 2014

溫經湯 Wēn Jīng Tāng (Channel Warming Decoction)

It's been a while since I've posted anything up here. Now it's not that I've been intentionally neglecting the site, but these days have been quite busy moving house, finishing up my book, and well, life!

Here's another teaser from my upcoming translation of Chén Xiūyuán's Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), which should be released this summer. 

Wēn Jīng Tāng
Channel Warming Decoction

治婦人年五十所, 病下利數十日不止, 暮即發熱, 少腹裡急, 腹滿, 手掌煩熱, 唇口乾燥, 此屬帶下。  何以故? 曾經半產, 瘀血在少腹不去。  何以知之? 其証唇口乾燥, 故知之, 當以此湯主之。
A treatment for women in their fifties who suffer from incessant diarrhea more than ten times per day, with heat effusion in the evening, lesser abdominal urgency, abdominal fullness, vexing heat in the palms, and dry lips and mouth. This belongs to women’s diseases. What is the reason?  There was a history of late miscarriage and static blood now remains in the lesser abdomen.  How can one know this?  The pattern manifests with dry lips and mouth, and this is how one knows this, and this formula rules it.

吳茱萸(三兩)當歸   芎藭   芍藥   人參   桂枝   阿膠    丹皮    甘草(各二兩)生薑(三兩。  一本二兩)半夏(半升。  一本二升)麥冬(一升)

wú zhū yú

dāng guī

xiōng qióng

sháo yào

rén shēn

guì zhī

ē jiāo

dān pí

gān cǎo

shēng jiāng

bàn xià

mài dōng


上十二味, 以水一斗, 煮取三升, 分溫三服。  亦主婦人少腹寒, 久不受胎; 兼治崩中去血, 或月水來多, 及至期不來。
Simmer the eleven ingredients above in 2,000ml of water until reduced to 600ml. Divide and take heated in three doses. It also rules (the treatment) of lesser abdominal cold in women, infertility, and simultaneously treats flooding, copious menstruation, as well as delayed menstruation.

Song 歌曰:
溫經芎芍草歸人, 膠桂丹皮二兩均, 八物各二兩  半夏半升麥倍用, 吳茱萸三兩對君陳。
For wēn jīng tāng (use) chūan xiōng, sháo yào, gān cǎo, dāng guī, rén shēn, ē jiāo, guì zhī, and dān pí each at six grams,  (6 grams for each of the eight medicinals). Use 100ml of bán xiá and double of mài dōng, plus nine grams each of shēng jiāng and wú zhū yú.

Commentary by (Chén) Yuánxī男元犀按:
方中當歸、 芎藭、 芍藥、 阿膠, 肝藥也; 丹皮、 桂枝, 心藥也; 吳茱萸, 肝藥亦胃藥也; 半夏, 胃藥亦衝藥也; 麥門冬、 甘草, 胃藥也; 人參補五臟, 生薑利諸氣也。  病在經血, 以血生於心, 藏於肝也, 衝為血海也。  胃屬陽明, 厥陰衝脈麗之也。  然細繹方意: 以陽明為主, 用吳茱萸驅陽明中土之寒, 即以麥門冬滋陽明中土之燥, 一寒一熱, 不使偶偏, 所以謂之溫也; 用半夏、 生薑者, 以薑能去穢而胃氣安, 夏能降逆而胃氣順也; 其余皆相輔而成溫之之用, 絕無逐瘀之品。  故過期不來者能通之, 月來過多者能止之, 少腹寒而不受胎者並能治之, 統治帶下三十六病, 其神妙不可言矣。 
Within the formula, dāng guī, chūan xiōng, sháo yào and ē jiāo are all liver medicinals; dān pí and guì zhī are heart medicinals; wú zhū yú is both a liver and stomach medicinal; bán xiá is both a stomach and thoroughfare (vessel) medicinal; mài dōng and gān cǎo are stomach medicinals; rén shēn supplements the five viscera, and shēng jiāng disinhibits all qì. Disease is in the menstrual blood. Blood is engendered in the heart, stored in the liver, and the thoroughfare vessel is the sea of blood. The stomach belongs to yáng míng, and is linked[3] to both the jué yīn and the thoroughfare vessel. Now (we must) carefully examine the meaning of the formula. As (the condition) is ruled by yáng míng, wú zhū yú is used to expel cold from yáng míng center earth, while mài dōng enriches dryness within yáng míng center earth - one cold and one hot medicinal. (While being) neither too cold nor too warm, (the formula) is (still) referred to as warm. As for the usage of bán xiá and shēng jiāng, shēng jiāng eliminates foulness and calms stomach qì, while bán xiá is able to downbear counterflow and smooth stomach qì. The remaining (medicinals) are used to assist in warming, and are by no means ingredients for expelling stasis. Therefore, with delayed menstruation, (this formula) is able to free it and with excessive menstruation, it is able to stop it.  It is (also) able to treat lower abdominal cold and infertility, and for the thirty-six women’s diseases, its marvel is too wonderful for words!

[1] Another edition uses 6g
[2] Another edition uses 400ml
[3] : , 此為相聯系。 Here the character (Lí) implies connection, integration, or linkage.

March 19, 2014

Kidney Fixity Disease (腎著病)

What is Kidney Fixity disease?

Kidney fixity or as it is sometimes translated Kidney stickiness, is basically cold pain and heaviness in the lumbar region that prevents (one) from normal turning and is exacerbated by yīn-type (dull-wet) weather, attributed to kidney vacuity cold-damp becoming “fixed” in the inner body. 1

The typical formula used to treat this condition is Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng. I'd like to present a section from my upcoming translation of the Jīn Guì Fāng Gē Kuò (金匱方歌括)- Prescriptions from the Golden Cabinet with Songs and a couple case studies illustrating its use. 

Gān Jiāng Líng Bái Zhú Tāng
Licorice, Dried Ginger, Poria, and Ovate Atractylodes Decoction

一名腎著湯                                                                                                                                                         Also called Kidney Fixity Decoction

治腎著之病, 其人身體重, 腰中冷, 如坐水中, 形如水狀, 反不渴, 小便自利, 飲食如故, 病屬下焦, 身勞汗出, 衣裡冷濕, 久久得之, 腰以下冷痛, 腹重如帶五千錢者,此主之。
A treatment for kidney fixity disease; where the patient experiences generalized heaviness and lumbar coldness, as if they are sitting in water.  Symptoms resemble those of water disease, yet there is no thirst, urination is uninhibited, and eating and drinking are normal. This means that the disease is in the lower burner.  Physical taxation with sweating leads to cold and dampness in the clothes, and over an extended period of time manifests with cold pain below the waist, and abdominal heaviness as if carrying five thousand coins.  This formula rules it.  

甘草    (各二兩)乾薑 茯苓(各四兩)
gān cǎo

bái zhú

gān jiāng

fú líng


上四味, 以水五升, 煮取三升, 分溫三服, 腰即溫。
Simmer the four ingredients above in 1000ml of water until reduced to 600ml.  Divide and take warm in three doses, until the lumbus feels warm. 

Song 歌曰:
腰冷溶溶坐水泉, 帶脈束於腰間, 腎著則腰帶病, 故溶溶如坐水中狀。  腹中如帶五千錢, 朮甘二兩薑苓四, 寒濕同驅豈偶然?
Lumbar coldness as if sitting in gently flowing water springs.
The girdling vessel binds around the lumbus.
With kidney fixity there is disease in the waist, which therefore brings the feeling as if one is sitting in water.
The abdomen feels as if it is carrying five thousand coins,
(With) six grams each of bái zhú and gān cǎo, and twelve of gān jiāng and fú ling,
is it by chance that both cold and dampness are expelled?

Quotation by Yóu Zàijīng 2 尤在涇雲:
寒濕之邪, 不在腎之中臟, 而在腎之外府, 故其治不在溫腎以散寒, 而在燠土以勝水。  若用桂、 , 則反傷腎之陰矣。
Cold-damp evils are not located in the kidney viscera but in the external dwelling of the kidneys.  Therefore, treatment need not involve warming the kidneys in order to dissipate cold, but to warm earth to prevail over water.  If guì zhī, or fù zǐ were used, then kidney yīn would be damaged!

Case #1

A fifty-four year-old male patient presented at the clinic with cold lumbar pain, which felt as if he were immersed and sitting in water. In addition, he had little desire to eat or drink, and his bowel movements were thin and loose.  Tongue coating was white and his pulse was soggy and moderate. This is a pattern of cold dampness fixed in the musculature of the lower back. The lumbus is the house of the kidney, and (this condition) is what is referred to in the jīn guì yào lüè as kidney fixity disease. It is suitable here to treat by warming the center, dissipating cold, strengthening the spleen and drying dampness with the formula gān cǎo gān jiāng fú líng bái zhú tāng (Licorice, Ginger, Poria and Atractrylodes Macrocephala Decoction).

gān jiāng (Zingiberis Rhizoma) 6g
gān cǎo (Glycyrrhizae Radix) 3g
fú líng (Poria) 10g
bái zhú (Atractylodis macrocephalae Rhizoma) 10g

Five packages were administered.  This patient also received local treatment with moxibustion.

Afterwards his appetite had increased and his bowel movements were now formed.

He was given another five packages of the formula above with 12g of dǎng shēn (Codonopsis Radix) added.

After finishing the formula his back pain had completely resolved.

Taken from page 193 of the ‘Simple Commentary on the Jīn Guì Yào Lüè’ (金匮要略浅述) by Tán Rì-Qiáng (谭日强)

Case #2

A fifty-year old male patient presented with aching pain in his lower back and legs.  In addition, he experienced a fear of cold, and heaviness of both legs after walking. His pulse was deep, moderate and lacking strength, and his tongue was slightly enlarged with a slippery-white coating. A yīn pulse is typically deep, and therefore this is a pattern of shào yīn yáng qì vacuity. A moderate pulse is typically associated with dampness, and therefore this is also a tài yīn spleen yáng weakness pattern. This pattern is what is referred to in the jīn guì yào lüè as kidney fixity disease. He was administered:

fú líng (Poria) 30g
bái zhú (Atractylodis macrocephalae Rhizoma) 15g
gān jiāng (Zingiberis Rhizoma) 14g
zhì gān cǎo (Glycyrrhizae Radix preparata) 10g

After taking twelve packages of the formula his legs started feeling warmer and his fear of cold, leg heaviness after walking, and pain had completely resolved.

Taken from page 145 from the Selected Clinical Case Studies of Liú Dù-Zhōu’ (劉渡舟臨証驗案)

1. (Practical Dictionary of Chinese Medicine, Wiseman et al. pg.326)
2. Yóu Zàijīng (尤在涇) (?-1749), was a well known Qíng dynasty scholar-physician from cháng zhōu (modern day wú county in jiāngsū province), who had written several commentaries on hàn dynasty medical literature, including the Jīn Guì Yì (金匮翼), Appendices to the Golden Cabinet.