Chinese Medicine Case Studies

A case of Shào Yīn headache- Wú Pèi-Héng (吴佩衡）

2012-01-17T13:27:00.000-08:00

A male (no age or date given) was seen at the clinic complaining of a headache that began to manifest after contracting cold. He was erroneously given an acrid-cool formula, which offered him no relief.

The headache has lasted for over ten days now, and felt as if his head was being split open by a hatchet, which was described as “unbearable”. In the afternoon he would feel an aversion to cold, and generalized body pain. His pulse was deep and weak with no strength. His tongue coating was slippery-white, and he had no desire to drink.

The head is the gathering point for all the yáng, and currently we have a case of yīn pathogens rising and attacking the head. Yáng is insufficient and unable to transform and move these pathogens. The pathogenic factor and right qì are fighting one another, thereby causing this condition. The method of treatment should involve assisting the right qì and expelling pathogens. A modified version of má huáng fù zǐ xì xīn tāng (Ephedra, Aconite Accessory Root Tuber and Asarum Decoction) is able to address this.

fù zǐ (Aconiti Radix lateralis preparata) 100g

gān jiāng (Zingiberis Rhizoma) 36g

gān cǎo (Glycyrrhizae Radix) 6g

má huáng (Ephedrae Herba) 10g

xì xǐn (Asari Herba) 5g

qiāng huó (Notopterygii Rhizoma seu Radix) 10g

After taking one package of the formula, the headache pain was cut in half, and after taking another package, his condition quickly resolved.

Commentary: This is a Shào Yīn headache, and because it was treated accordingly, the effect was excellent. Within the formula we see sì nì tāng (Frigid Extremities Decoction), which is able to warm and assist yáng qì to reach the head. má huáng (Ephedrae Herba), qiāng huó (Notopterygii Rhizoma seu Radix), and xì xǐn (Asari Herba), can dispel the cold which has settled in the Tài Yáng, transforming in the bladder (channel). Therefore, the formula is able to warm the channels, scatter cold, assist the right qì, and expel pathogens, to offer an effective treatment.

Headaches can occur in diseases of all six channels, but when we adhere to the methods of six-channel pattern identification given to us by Zhòng-Jǐng, we are able to treat and achieve positive results.

A Menopausal case

2012-01-04T15:42:00.000-08:00

When I think back of my undergraduate studies in Traditional Chinese medicine just under ten years ago, I remember a time where the possibilities of treatments were endless. I felt that when thrown into the real world of practice I would be invincible. We were taught hundreds of formulas for hundreds of conditions, and were led to believe that we would achieve excellent outcomes if we were only to memorize these specific formulas and apply them to these conditions. Once in practice we quickly learn that this is in fact not reality! One that specifically comes to mind is the treatment of menopausal conditions (更年期综合症).

In many English language textbooks (and even standard mainland texts), menopause is most commonly associated with a yīn deficiency pattern, and is treated with formulas such as Liù Wèi Dì Huáng Wán, Dāng Guī Liù Huáng Wán, etc. However, once in clinical practice when encountering these kinds of patients, these formulas tend to exert only minimal effects. Now I’m not saying that these kinds of yīn deficiency patients do not exist, they do, albeit in much smaller numbers than we may have been taught.

In my experience practicing in the cold and wet pacific north west, the majority of menopausal woman I treat rarely suffer from a yīn deficiency pattern, but in fact manifest with various patterns, with a strong majority showing signs of yáng deficiency. Yáng deficiency? When I discuss cases with colleagues and talk about treating hot flashes, night sweats, and other menopausal complaints with high doses of herbs like Fù Zǐ or Ròu Guì, they think I’m nuts. However, the proof is in the pudding. The way I see it is that as a culture we are eating poorly, are under an enormous amount of stress, take far too many pharmaceutical drugs, get inadequate amounts of sleep, lack exercise, are far too over stimulated, and consume various vitamins, supplements, and undertake random fasts and cleanses. These are all practices that inevitably deplete our yáng reserves. The essential mechanism that I recognize in many of the woman I see, is a deficiency of yáng that is unrooted in the lower body and floats upwards causing symptoms such as insomnia, hot flashes, night sweats, etc. I feel that it is these ‘heat like’ symptoms that confuse many practitioners, who prescribe various heat clearing, yīn nourishing medicinals all to no avail.

When a patient presents with these seemingly signs of heat, how are we to distinguish between a yīn or yáng deficiency? In his well-written article in the Lantern entitled ‘Playing with Fire’, Gunter Neeb quotes Xú Dà-Chūn from his ‘On the Origins and Development of Medicine’, outlining a very basic diagnostic approach to patients with excessive sweating which can be applied to the excess sweating seen in menopausal conditions:

“Sweating due to loss of yin manifests with aversion to heat, warm hands and feet and skin that is warm to the touch and with warm sweat. The patient is thirsty for cool drinks. His breath is agitated, his pulse overflowing (hong). Sweating due to loss of yang is exactly the opposite: the patient fears cold, the extremities and skin are cool with a cold sweat. He favours bland or slightly sweet foods and is not very thirsty, but has desire for warm drinks. His breath is feeble and the pulse is rapid, superficial and empty”.

This diagnostic guideline above is essentially the same that I have been using when faced with cases of night sweating and have found the results to be extremely gratifying both for me, and my clients. When dealing with hot flashes, I simply inquire how the patient feels following the flush. If they feel very cold afterwards, and also have a lack of thirst, no major dry symptoms, and possible lumbar pain, I will diagnose the pattern as a yáng deficiency.

I would like to illustrate this further with a case from my own practice.

On June 22, 2011 a 48-year-old female presented at the clinic complaining of general menopausal symptoms. These included; irritability, low libido, night sweats, weight gain, occasional hot flashes, poor sleep, light-headedness, a history of low back pain, slight thirst, a strong aversion to cold, and some pretty intense stress recently. Her tongue was essentially unremarkable, and her pulse was deep, and slightly weak. Her bowel movements and urination were normal, and she experienced no digestive issues. Her last menstrual period was in November 2010.

When asked how she felt after either the sweating or hot flashes, she mentioned that she felt very cold, and needed to really bundle up to stay warm. In addition, she had given birth to two boys three and a half years prior, after several rounds of intensive in vitro fertilization treatments.

I saw her pattern as a yáng deficiency, with the yáng being un-rooted in the lower burner, and floating upwards. She was also manifesting very mild yīn deficiency symptoms.

She was administered a formula in granule form, at two teaspoon (6g), twice daily.

Fù Zǐ 20g
Ròu Guī 10g
Bái Sháo 10g
Hé Huān Pí 10g
Fú Xiǎo Mài 12g
Nǔ Zhēn Zǐ 12g
Hàn Lián Cǎo 12g
Mǔ Lì 12g
Lóng Gǔ 12g
Zhì Gān Cǎo 10g
Fú Shén 10g

Results: On follow up one week later, she reported that all her symptoms had improved, and she was feeling “wonderful”. She was given another two weeks of the same formula. On follow up five months later, she informed me that since taking the formula, all her symptoms disappeared, and have yet to return.

Poetry of Bái Jū-Yì (白居易)

2011-12-16T13:06:00.000-08:00

Reading Chinese poetry with a warm cup of wū lóng tea seems very fitting these days with the arrival of winter and its short, dark, and wet days. The following are two personal favorites of mine written by Bái Jū-Yì (772-846) of the tang dynasty known for his plain, direct, and easily comprehensible style of verse, as well as for his social and political criticism.

Thoughts, interpretations, and comments are always welcome and encouraged.

花非花
白居易

花非花
雾非雾
夜半来
天明去
来如春梦几多时
去似朝云无觅处

A Bloom is not a Bloom

Bái Jū-Yì

A bloom is not a bloom,
The mist not mist.
It comes at midnight,
And leaves again at dawn.
Arrives like a spring dream, but for how long?
Departs like morning clouds, without a trace.

读老子
白居易

言者不如知者默
此语吾闻于老君
若道老君是知者
缘何自著五千文

Reading Lǎo Zǐ

Bái Jū-Yì

Those who speak do not know, while the ones that do are silent.
These are the words I’ve heard from the old gentleman (Lǎo Zǐ).
If the old gentleman knew the way,
Then for what reason did he write five-thousand characters.

Hú Xī-Shù (胡希恕)- A Case of Prostatitis

2011-12-03T14:38:00.001-08:00

On June 11, 1966, a 30-year-old male worker from the capitol airport presented at the clinic.

The patient has suffered with prostate inflammation for over half a year, for which he has taken numerous western medications, and results have been less than ideal.

Current signs and symptoms: lumbar pain, occasional lower abdominal pain, which was sometimes accompanied by sagging, distension and pain in the testicles, occasional painful urination, sticky, milky white colored discharge exuding from the urethra, frequent and scanty urination with a reddish-yellow color, a dry mouth with a desire to drink, a white tongue coating with a slimy root, and a wiry-slippery pulse.

This is a pattern of damp stasis and obstruction, for which treatment should involve disinhibiting dampness, and transforming stasis. Zhū Líng Tāng (Polyporus Decoction) with Shēng Yǐ Rén and Dà Huáng was prescribed.

Zhū Líng 3 qián
Zé Xiè 4 qián
Huá Shí 5 qián
Shēng Yǐ Rén 1 liǎng
Shēng Ē Jiāo 3 qián
Dà Huáng 1 qián

Results: After taking only two packages of the formula, his symptoms were greatly reduced. Because the lumbar pain was still present, Chái Hú Guì Zhī Gān Jiāng Tāng (Bupleurum, Cinnamon Bark, and Dried Ginger Decoction) was added to the above formula.

After a half a month on the formula, all his symptoms were basically gone.

Hú Xī-Shù (胡希恕)- A case of Angina Pectoris

2011-12-02T21:42:00.001-08:00

On June 14, 1965, a 74-year-old female presented at the clinic suffering from angina pectoris. Her condition had lasted many years, and she commonly experienced severe pain in the anterior chest. Whenever the symptoms would arise, she was unable to lie down, and had difficulty breathing, for which she would take various medications including, nitro-glycerine, and sulphanilamide. In addition, she sweat copiously, had a dry mouth without a desire to drink, dry stools, a thick-white tongue coating, and a wiry-thin pulse.

This is a pattern of phlegm, and thin-fluids obstruction in the chest, with blood-stasis in the collaterals. Treatment should involve transforming phlegm, freeing yáng, eliminating stasis, and freeing the vessels, with a modified version of Guā Lóu Xiè Bái Bàn Xià Tāng (Trichosanthes, Chinese Chive, and Pinellia Decoction)

Guā Lóu 1.5 liǎng
Xiè Bái 9 qián
Bàn Xià 2.5 liǎng
Bái Jiǔ 2 liǎng
Guì Zhī 3 qián
Zhǐ Shí 3 qián
Táo Rén 3 qián
Chén Pí 1 liǎng
Bái Sháo 4 qián

Results: After taking three packages of the above formula, the pain had decreased, and pain was only felt after exertion. 4 qián of Fú Líng was added to the formula, and another six packages were administered. At this point the pain was quite sporadic, so the formula was continued. After one month, the chest pain had ceased, and there was no relapse.

Huáng Lián assists sleep- A case by Huáng Huáng （黄煌)

2011-10-11T10:36:00.000-07:00

One early morning last week as I had just turned on my cell phone, I received information about a patient from northern Jiāng Sū province that had suffered with insomnia. He had been here nine months previously for a formula and had taken seven packages. He recently returned, and after taking one package had completely recovered. This was quite remarkable!!

Now that he had finished his formula, he was asking how this was dealt with.

He was a forty year old male that was suffering with severe insomnia which started last year in December. He found it difficult to sleep for the entire night, and had repeatedly taken western medications all to no avail.

The formula he was given consisted of the following;

Huáng Lián 5g, Ròu Guì 10g, Zhì Fù Zǐ 10g, Gān Jiāng 10g, Shēng Gān Cǎo 5g.

This is Jiāo Tài Wán combined with Sì Nì Tāng. Now why would, these formulas be considered for this case? Let’s take a look at this patient. The man had a strong, robust physique; his skin was a dark color, he had no trouble eating, and his stools lacked shape. Now although he felt cold on the inside, he suffered from agitation and insomnia. This is what the ancients called ‘non-interaction of the heart and kidneys’, which is the ‘tried and true’ Jiāo Tài Wán formula pattern. Sì Nì Tāng harmonizes the body, and Huáng Lián and Ròu Guì treat the disease.

Huáng Lián is beneficial for insomnia. The Huáng Lián in Huáng Lián Ē Jiāo Tāng is used to treat “vexation in the heart, with an inability to sleep”. Huáng Lián Tāng uses equal parts Huáng Lián and Ròu Guì along with (Rén) Shēn, (Bàn) Xià, (Shēng) Jiāng, (Dà) Zǎo, and (Gān) Cǎo to treat “heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit”. The heat in the chest is commonly expressed as heart vexation with an inability to sleep. Jiāo Tài Wán only contains two medicinals, Huáng Lián and Ròu Guì and is originally from the Míng dynasties ‘Comprehensive Medicine According to Master Han’ (韩氏医通, Hán Shì Yī Tōng). The author Hán Fēi-Xiá said;

“brew numerous times, add honey, take on an empty stomach, and this will instantly bring forth the interaction between the heart and kidneys”.

Yú Tīng-Hóng (余听鸿) had written about a patient from Zhè Jiāng County that had suffered with an inability to sleep the entire night for many years. He had taken over two hundred spirit calming, blood nourishing formulas which offered him no relief. The famous Mèng Hé physician Mǎ Shěng-Sān (马省三) prescribed;

Huáng Lián 8 fēn, Shān Zhī 3 qián, Zhū Dǎn Zhī 1 qián (mix fried), decocted. That night he slept soundly.

In the past, I have given patients equal parts powdered Huáng Lián and Ròu Guì infused in boiling water, and taken prior to going to sleep. This has indeed helped with sleep difficulties.

However, Huáng Lián is bitter and cold, and many people are unable to take it. Huáng Lián’s strength by itself is quite weak, and it is incapable of treating all stubborn cases of insomnia. Nevertheless, we always want to select the corresponding formula according to the body constitution. For example, with a red, oily facial complexion, heat vexation, headaches, and constipation, we can use Sān Huáng Xiè Xīn Tāng. With pale skin, red lips, red tongue, and heart vexation, me may use Huáng Lián Ē Jiāo Tāng. In a thin patient with dark lips, abdominal pain and insomnia, Huáng Lián Tāng may be used. With dry retching, epigastric focal distension, and mouth ulcers, we use Bàn Xià Xiè Xīn Tāng. With strong pain in the back and nape, diarrhea, chest oppression, vexation, palpitations, and insomnia, use Gé Gēn Qín Lián Tāng.

Originally, because Huáng Lián and Ròu Guì were combined with Sì Nì Tāng, we know that it is applicable in cases of a cold body with a hot disease. This is commonly seen in strong, robust men with a yellowish-dark skin color, and insomnia. After taking these medicinals, not only will insomnia improve, but enduring cases of abdominal pain and diarrhea, can be ameliorated.

This case was taken from Huáng Huáng's great classical formulas blog. The original case can be found here.

A Case of Wü Méi Wán (Mume Pill)

2011-09-19T23:19:00.000-07:00

A case of the Fire spirit currents’ Fàn Zhōng-Lín
Translated from 'Five Steps to Cold Damage Treatment According to Pattern Identification'

A 39 year old male farmer from the Jīn Niú district of Chéng Dū city presented at the clinic:

Step 1: Chinese medical diagnosis

In August of 1977 in the last third of the month, while working in the fields, the patient suddenly felt discomfort throughout his entire body. He experienced cold extremities, dizziness, cold sweats, abdominal pain and borborygmus. Shortly after, he experienced continuous diarrhea, which frequently contained pus and bloody discharge. On September 2nd he came in for a consultation.

Every day, the patient would have over ten bouts of diarrhea. The stools were quite loose, sticky and jelly like, which had a yellowish-red color. This was accompanied by abdominal pain, with urgency followed by heaviness. In addition, he experienced dry retching, heart vexation, thirst, and cold extremities. His tongue was dark pale with a slightly red tip, with a yellow, slippery and thick coating.

Step 2: List of Disease Mechanisms

Dry retching, heart vexation, nausea, slightly red tongue tip, are all associated with upper heat.

Reversal cold in the body and extremities, cold pain in the lower abdomen, clear-thin diarrhea, which are all described as ‘white’, ‘cold’, and ‘freezing’, are obvious signs associated with lower cold.

This is one hundred percent an obvious case of upper heat and lower cold. Jué yīn is the qi of wind and wood that when vigorous will cause wind pathogens to flee to the upper (body).

[Plain Questions-Treatise on Tài yīn and Yáng míng] says:

“When one is invaded by a robber wind or depletion evil, yáng receives it. When food and drink are consumed without restraint, when rising and resting occur out of time, yīn receives it. When yáng receives it, then it enters the six bowels.

When yīn receives it, then it enters the five viscera. When it enters the five viscera, then distension and blockage result. In the lower [body] it causes outflow of [undigested] food, and when enduring causes intestinal afflux (dysentery)”.

From this passage we can see that intestinal afflux is commonly due to the exploitation of yīn and yáng, with signs of intermingling cold and heat.

In summary, the disease mechanism involved is the lack of mutual connection between the qi of yīn and yáng. The upper belongs to yáng, and pure yáng is heat; the lower belongs to yīn, and pure yīn is cold. Therefore, “When Jué yīn prevails” intestinal afflux will occur.

Step 3: Comprehensive Analysis

This is a pattern of cold and heat mixing causing intestinal afflux, with the disease in the Jué yīn level.

Step 4: Formula According to Pattern

The appropriate method of treatment is to eliminate evils and support the right using both cold and warm medicinals. Wü méi wán (Mume Pill) governs.

Step 5: Medicinals According to Pattern

Prescription:
wü méi (Mume Fructus) 30g
xì xïn (Asari Herba) 6g
gän jiäng (Zingiberis Rhizoma) 30g
huáng lián (Coptidis Rhizoma) 12g
däng guï (Angelicae sinensis Radix) 10g
zhì fù piàn (Aconiti Radix lateralis preparata) 60g (extended cooking)
shǔ jiāo (Zanthoxyli Pericarpium) 6g
guì zhï (Cinnamomi Ramulus) 10g
dâng shën (Codonopsis Radix) 12g
huáng bâi (Phellodendri Cortex) 10g

2 packages were prescribed, and the patient was asked to refrain from eating oily, raw, cold and strong smelling foods (onions, garlic, leeks, etc.).

After taking two packages of the formula, his intestinal afflux had resolved. On follow up consultation with the patient in June, 1979, he reported that in the year since his recovery, there had been no relapse of the condition.

[Realizations]

Wü méi wán (Mume Pill) is said to “govern enduring diarrhea”, yet in this case enduring diarrhea was not present.
Then why was this formula chosen?
Generally speaking in patterns of Jué yīn diarrhea there simply must be reversal. Enduring diarrhea is usually seen in patterns where there is a mixture of cold and heat, for which it is appropriate to use a combination of cooling and warming methods by mixing both cool and warm formulas.

This was not a case of enduring diarrhea, but was originally seen as a Jué yīn condition with both cold and heat signs present. Wü méi wán (Mume Pill) is a formula which cools, warms and supplements simultaneously. Acrid, sour, sweet and bitter flavours are all present in the formula. The formula was correct for this presentation and therefore by adapting to the original formula, we were able to obtain positive results.
In actual fact, Wü méi wán (Mume Pill) has been used by countless physicians of past and present to treat various disorders, especially diarrhea, and its use is continuously expanding.

Take the ‘Important Formulas Worth a Thousand Gold Pieces’ (千金方Qiān Jīn Fāng) for example, where it discusses Zhang Zhong-Jing’s concept of using wū méi (Mume Fructus) and huáng lián (Coptidis Rhizoma) in heat type diarrhea, combined with fù zǐ (Aconiti Radix), gān jiāng (Zingiberis Rhizoma), etc. in cases of deficient cold natured enduring diarrhea.

The ‘Comprehensive Recording of Divine Assistance’ (圣济总录 Shèng Jì Zŏng Lù), mentions Wü méi wán (Mume Pill) for the treatment of unceasing post-partum cold and heat type diarrhea.

In the ‘Standards for Diagnosis and Treatment’ (证治准绳 Zhèng Zhì Zhŭn Shéng), this formula is used for treating coughing issuing from the stomach and the vomiting of long worms.

The Japanese physician Zhì Jiān-Huàn says that generations of physicians have had great difficulties in treating stomach reflux, and that this is an extraordinary formula for treating this pattern. (quoted from the Initial Draft of Lectures on Cold damage).

According to Rèn Yìng-Qiū, Wü méi wán (Mume Pill) functions to strengthen the stomach and intestines, reduce inflammation and kill worms, and when used to treat chronic diarrhea, can achieve positive results. (Interpretation of the Shāng Hán Lùn).

In the past, there have also been reports of using this formula in treating cases of chronic colitis of fifteen years.
From the above, we can see that the scope of using Wü méi wán (Mume Pill) is by no means limited to just treating roundworm reversal and enduring diarrhea, and in actual fact it’s use is continuously expanding.

Hu Xi-Shu (胡希恕): Two cases of Meniere’s disease

2011-08-15T13:41:00.000-07:00

Case #1

A 25 year old female Qīng Huá University student presented at the clinic on October 16, 1965: For the last four to five months she has been experiencing dizzy head and vision, accompanied with nausea, flusteredness, inability to eat, and difficulty reading. A western medical doctor diagnosed her condition as Meniere’s disease, and administered medications which were ineffective. Her blood pressure was normal, she had a dry mouth with no desire to drink, a desire to sleep, a lack of strength, but with no problems moving, and her cycle had arrived late but was slightly scanty. She had a white tongue coat with a slippery root, and her pulse was deep, thin and wiry.

This is a pattern of blood vacuity with water exuberance. She was administered Dāng Guī Sháo Yào Sǎn combined with Xiǎo Bàn Xià Tǎng and Wú Zhū Yú.

Dāng Guī 3 Qián
Bái Sháo 3 Qián
Chuān Xiōng 2 Qián
Cáng Zhú 3 Qián
Zé Xiè 5 Qián
Fú Líng 3 Qián
Bàn Xià 5 Qián
Shēng Jiāng 4 Qián
Wú Zhū Yú 3 Qián

Results: After taking three packages of the formula, her symptoms resolved completely.

Commentary: In this case the blood vacuity was pretty obvious which is why Dāng Guī Sháo Yào Sǎn was administered. This was coupled with yang vacuity of the stomach with counterflow of thin mucus, so Xiǎo Bàn Xià Tǎng and Wú Zhū Yú were used in combination.

Case #2

On October 3, 1977, a 19 year old female student presented at the clinic:

Originally the patient first experienced dizziness, tinnitus and deafness for two months. A local hospital diagnosed her with Meniere’s syndrome, and she was treated with a combination of western and Chinese medicines to no avail. She had already taken two months off her schooling, and it was at this point that her parents called for Dr. Hú to treat their daughter. At the time of the consultation she had been experiencing dizziness to the point where she was unable to get up, and when she opened her eyes, the dizziness would get worse. Her tinnitus and deafness were still present, and she also had a dry mouth with no desire to drink, occasional chest fullness, flusteredness, a thick, white tongue coating, and a deep, thin pulse.

This is cold thin-mucus attacking the upper, and obstructing the clear orifices. Treatment should involve warming the centre and transforming mucus, with Líng Guì Zhú Gān Tāng.

Fú Líng 6 Qián
Guì Zhī 3 Qián
Cáng Zhú 3 Qián
Zhì Gān Cǎo 2 Qián

Follow up consultation on October, 12: After taking six packages of the formula, her dizziness had resolved, and both the tinnitus and deafness had improved significantly. Guì Zhī was increased to 4 Qián, and Fú Líng was increased to 8 Qián.

Third consultation on October, 20: After another six packages of the formula were taken, all the symptoms had resolved. Because she was frightened of having a relapse of her condition, she requested more of the same formula in order to consolidate the treatment, but was advised that further treatment was unnecessary.

Commentary: This case was caused by the exuberance of interior cold thin-mucus, and when these fluids attack and surge into the upper body, the representative formula is Líng Guì Zhú Gān Tāng. This formula’s function is to warm the centre, transform thin-mucus and downbear counterflow and because this presentation fit this formula’s pattern perfectly, modifications were unnecessary, and quick resolution was attained.

Two cases using Li Zhong Tang (Rectify the Centre Decoction)

2011-07-12T16:45:00.000-07:00

Case #1

Vacuity cold diarrhea

Case of Yuan Wen-Fei; (Jiang Xi Chinese Medicine); 1964; 3:149

A 39 year old male presented on February 11, 1949 complaining of diarrhea that has lasted for over a year, with borborygmus, and quite watery-sloppy stools. He usually has around eight or nine bowel movements in the first half of the day, his appetite is poor and there are undigested food particles present in the stools. Over ten Chinese medical physicians have been consulted in the past, and very minimal effects have occurred. On consult with this patient I found his facial complexion to be very pale and lustreless. He was emotionally fatigued, his abdomen was slightly distended, but favoured pressure, his tongue had a layer of thick yellow and slimy coating, and his pulse was thin and slow.

This is a case of spleen vacuity diarrhea, and the treatment method is to supplement the centre, and boost earth. The formula used was Zhong Jing’s Li Zhong Tang.

Ren Shen 9g
Chao Bai Zhu 9g
Hei Gan Jiang 7.5g
Zhi Gan Cao 6g

He was given six packages and asked to return for a follow up consultation. He reported that his condition had improved drastically for the better, and was therefore administered another six packages of the same formula after which he made a complete recovery.

Case #2

Wheezing and Panting (Left heart failure, cardiogenic asthma)

Case of Lu Zhi-Jie (Journal of Chinese Medicine); 1998; supplementary issue: 104

On May 4, 1998 a 60 year old male presented with cardio-pulmonary disease of over 10 years duration. In the first year of the condition he would often experience difficulty breathing in the evening, which would most commonly occur roughly around midnight waking him from a deep sleep. He suffered with an oppressive sensation in his chest, and once his breathing became forced he would suddenly wake up with a fright, compelling him to sit up in bed. This was accompanied with coughing fits, a rale at the back of the throat, and spitting up of frothy phlegm. These attacks would last anywhere from ten minutes to one hour, and once they would resolve on their own, he was able to return to sleep. During the day he also experienced wheezing on exertion. His pulse was wiry and weak, and the tongue was purple and slightly dark, with a thin yellow, slimy coating. According to this man’s symptoms of weakness, coughing fits and breathing difficulties at night, he was diagnosed by western physicians with left heart failure and cardiogenic asthma.
On disease analysis, we see that this man is in his sixtieth year and his condition has persisted for an extended period, therefore we can deduce from this that there must be a vacuity and weakness of right qi, however, his symptoms seem to develop in the evening, so in addition there is a blockage in lung qi. In such a scenario we must address both the root and branch of the condition and treat both simultaneously. We treat the root with Ren Shen Tang in order to supplement the centre and assist yang to ensure that the lungs and heart are able to generate sufficient and ample original qi. The branch is addressed with Ting Li Da Zao Xie Fei Tang.

Formula:

Ren Shen 30g
Bai Zhu 30g
Gan Jiang 30g
Gan Cao 30g
Ting Li Zi 24g
Da Zao 12 pieces

The first evening after taking one package, he experienced no breathing difficulties, and after fourteen packages, his condition seemed to be stabilized. He was able to sleep peacefully in the evenings. The daytime wheezing on exertion had also obviously improved, and as long as he moved around slowly, experienced no symptoms. He continued to take the formula every other day in order to consolidate the treatment.

Two Cases of Wind Rash (Urticaria)

2011-06-29T22:05:00.000-07:00

The following are two translated cases by Matt Branham of Eugene, Oregon.

Wind hidden rash (urticaria) Case #1

Dr. Liu Jun Shi case: patient Wu, male 57 yrs old, outpatient service #43115, came for a visit on 6/27/1983. The whole body was covered with rash which periodically got better and then returned over the past ten years, the whole body itched making life hard to bear. The rash was worse on the upper body, there was fear of cold, ordinarily when he encountered cold the whole body would break out. He had tried many treatments, which gave temporary relief, but the effectiveness of the treatments were lacking. Whenever he encountered cold the rash would flare up again. The tongue body had teeth-marks, and both pulses were slippery and moderate. This pattern belongs to constitutional yang deficiency. In addition there is wind evil, so one must warm yang and disperse cold, Wu Tou Chi Shi Zhi Wan with modifications is the treatment.

Zhi chuan wu, cao wu 3g each, gui zhi 3g, bai shao9g, xi xin 3g, gan jiang 9g, bai zhi 4g, chuan jiao 9g, gan cao 9g, chi shi zhi 30g, decoct and take 3 packets.

Second visit was on 6/30/86. The urticaria had greatly decreased, the itching and pain were also alleviated. He was asked to continue taking the original 3 packets.

Third visit on 7/5/86. Urticaria had completely receded, and on follow up with the patient regularly after two years there was no recurrence.

Beijing Journal of Traditional Chinese Medicine

Editors comments: When yin cold flourishes internally, yang qi becomes weak, thus the exterior cannot defend against wind evil, leading to wind rash. Other treatments failed to dispel cold, therefore yang qi had difficulty in recovering; they did not warm yang, and wind did not go, therefore, over a long period of time he wasn’t healing. Wu Tou Chi Shi Zhi Wan was used to warm yang and dispel cold, only then can one get to the root of the problem, therefore remedying chronic illness in a relatively short amount of time.

Addendum: This formula by Zhang Zhong Jing is an example of his use of wu tou and fu zi at the same time. Wu tou and fu zi belong to the same category, but their functions are slightly different: Wu tou is good at lifting out sunken and chronic cold. It also can scatter and disperse wind and cold from the channels. Fu zi is good at treating organ level cold damp, and is able to warm and transform cold damp. Due to the fact that this pattern was a yin cold evil, as well as affecting the interior and exterior, zang fu, channels and collaterals as well as the core and surface, Zhang Zhong Jing used both wu tou and fu zi to rouse yang and disperse cold evil.

Chen Ming, Zhang Ji Sheng, Wang, Jin Gui Ming Yi, Beijing University Press 2003

Wind hidden rash (Urticaria) Case #2

Dr. Li Mao Xing's case: patient Zhang, male, age 34. Two years ago the patient caught a wind cold and his whole body broke out in rash with severe itching. When he scratches, the rash gets worse. He has tried cyproheptadine hydrochloride and vitamin c treatments which brought about some relief, but still he had frequent recurrence and a cure had not been served. A week ago, after eating seafood there was a recurrence of the rash, and on 11/15/91 he came in to my office for an interview.

Examination: his whole body was covered with rash of unequal size, the form of the rash was not uniform, bright red in color and bumpy, the rash color faded with pressure, and itched intensely. It was also accompanied by low grade fever, headache, thirst, constipation, turbid urine, red tongue, yellow coat, and wiry rapid pulse. The pattern belongs to excess heat held internally, externally contracted evil, and the issuing of heat toxin to the exterior. Treatment used Fang Feng Tong Sheng Tang modified.

Herbs used: fang feng, jing jie, chuan xiong, shan zhi zi, huang qin, da huang(cooked later) all 10g, ma huang, bo he 6g, gan cao 8g, shi gao, ku shen, 15g, mang xiao 12g (decoct separatly) bai xian pi 30g. Take one packet per day water decocted. After taking 8 packets, the rash, for the most part disappeared, the itching was controlled, but his bowel movements increased in number. The next step in the prescription removes mang xiao, and decreases da huang, with the addition of jin yin hua 20g, in order to increase the heat clearing, toxicity resolving functions. After 6 packets the skin rash had disappeared, and the itching was completely resolved. The illness had been completely resolved and after one year follow up there was no recurrence.

Zhejiang Journal of Traditional Chinese Medicine

Editors comments: Urticaria is commonly called wind rash; Chinese doctors call it hidden rash. There are several treatment methods, with the principle methods being; coursing wind, clearing heat, resolving toxicity and alleviating itching. This case belongs to excess heat in the interior, affected by externally contracted evil, causing both interior and exterior excess syndrome. Therefore, Fang Feng Tong Sheng Tang was used as it, resolves the exterior and unblocks the interior, courses wind, clears heat and resolves toxicity. The formula with the addition of ku shen and bai xian pi to clear heat, disinhibit dampness and stop itching, and jin yin hua to resolve toxicity and eliminate fire was used. The whole formula clears and penetrates both the interior and exterior, thereby disinhibiting dampness and eliminating heat and dispelling toxins.

Chen Ming, Zhang Ji Sheng, Wang, Wen Bing Ming Fang, Beijing University Press 2003

A quote from the Wen Re Lun that Chip Chace had mentioned in our class on warm disease got me thinking about the effectiveness of Jing Fang formulas for the treatment of rashes. The quote goes something like this, “You can ride your horse and enjoy the landscape when treating shang han (cold damage), but things can change when you look over your shoulder in treating rashes.” Both of these cases treated urticaria, or skin rashes, from a different perspective. The first case involved a formula from the Jin Gui Yao Lue while the second used a formula from the Wen Bing tradition. As rashes of this nature can occur through many etiologies using appropriate pattern identification will lead to the desired outcome. In case 1, exposure to cold caused the rash to flare. This patient had weak wei qi due to a constitutional yang deficiency, the appropriate treatment was thus to warm yang to secure the exterior. Chi Shi Zhi is sweet and warm thus augmenting the qi, its astringent nature was also well suited to aid in securing the exterior. In case 2, initially the patient developed rash from exposure to wind cold, later after eating seafood the rash recurred this time with marked heat signs. The wind cold evil was never released from the exterior. After eating bad seafood the patient experienced a toxic reaction to the food that brought a recurrence of the skin rash. The skin is ruled by the lungs, the lungs are interiorly related to the large intestine, when the patient presented with heat signs and constipation a purging method was appropriate. Here the Dr. was consistent with Wen Bing thinking to add exterior resolving herbs so as to vent some of the pathogen up and out to the wei level while also purging the interior heat through the bowels. While both of these traditions use their formulas in a particular way, they both employ basic pattern identification to reach their conclusions. To me the unification of these systems comes in the effective use of the Eight Parameters. These archetypal structures are the hallmark of a phenomenological world view espoused by the ancients and of great value to modern day people.

Rib-side pain (Hepatitis)

2011-06-20T15:06:00.000-07:00

Liu Du-Zhou, New Chinese Medicine, 1979; 2: 36

Mr. Liu, a 54 year old male presented at the clinic with hepatitis manifesting with abdominal distension and diarrhea. He had very little desire to eat, and experienced rib-side pain that extended to his back. He had taken several formulas which offered very little benefit. It was at this point that I was asked to treat this gentleman. His pulse was wiry and moderate, and his tongue was pale with a white coat.

This was a case of liver disease affecting the spleen manifesting with a decline in spleen yang.

I decided to course (the liver) using Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction).

Chai Hu 12g
Huang Qin 4.5g
Zhi Gan Cao 9g
Gan Jiang 9g
Gui Zhi 9g
Tian Hua Fen 12g
Mu Li 12g

Altogether 4 packages were taken which resulted in the complete resolution of the abdominal distension and diarrhea. His appetite also improved indicating that the liver and spleen were harmonized and his GOT (Glutamyl oxaloacetic transaminase) and GPT (Glutamyl pyruvic transaminase) levels were basically back to normal and thus he recovered.

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning

2011-06-13T16:57:00.000-07:00

Here is a guest post from the great Sharon Weizenbaum

By Dr. Shi Jin-Mo 施今墨 (1881-1969)

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning.

Translated with Commentary by Sharon Weizenbaum

In an age in which there is a strong impulse to “detoxify” through various kinds of purges and cleanses, I feel this case offers a breath of fresh insight. So many times our patients ask us how they can get some bad stuff out of their bodies – whether this bad stuff is heavy metals, candida, lyme or other chemicals. What I feel Dr. Shi is reminding us to do is to look not at what the toxin is or how to get rid of it. Rather we should look at the actual signs and symptoms to determine how the toxin damages. We should ask what the response of the body is and not focus on the toxin itself.

In addition, this case inspires me to consider brain damage in a less fixed and fatalistic way.

Dr. Shi’s case:

Ms Zhang was 60 when she came in for her first visit. A couple of months previously she had received carbon monoxide poisoning. After receiving emergency care she unexpected lived. However, she suffered from abnormal spirit essence, inability to eat or dress without help from her family, inability to speak or sleep or control her bowels properly. In general, she seemed to be like a retarded person, frequently covering her head with her arms. At the hospital in Beijing, she was given the diagnosis of post carbon monoxide poisoning neurosis.

Her check-up revealed that her pulses were wiry, deep and rough.

Diagnosis: Post carbon monoxide poisoning central brain damage with loss of control of body functions and Qi and Blood obstruction.

Treatment method: Open through the Luo vessels and regulate the Qi mechanism.

Prescription:

Jiu Chang Pu 10 gm

Jiu Chao Chong Wei Zi 10 gm

Bai Ji Li Fructus Tribuli 12 gm

Sang Zhi 18 gm

Chao Yuan Zhi 10 gm

Su Di Long 10 gm

Sang Ji Sheng 18 gm

Huai Niu Xi 10 gm

Xia Ku Cao 10 gm

Chen Bai Wei 6 gm

Chang Gou Teng 12 gm

Shou Wu Teng 15 gm

Jiu Chuang Xiong 5 gm

Discussion: This patient’s appearance was very much like a retarded person. She was unable to speak or sleep and her movement was slow. Her pulse was wiry, rough and irregular. These symptoms all belong to the category of Liver vacuity and Heart Qi insufficiency. In addition her meridian and luo vessels pathways were not open through. It was important to principally treat the Heart and Liver channels as well as the three aspects Qi, Blood and Phlegm. Every time she came there was gradual improvement. The fourth visit was after half a month of taking the herbs. Follow up showed that her eating, sleeping, urination, bowels and spirit essence were all normal. Her movement was still sluggish. These kinds of clinical illnesses do not appear very often. I carried out treatment according to my rich experience. Using differential diagnosis I determined the formula. With the group of herbs that open through and quicken blood, I had to find just the right balance of drastic and fierce measures. Altogether she took about 50 packages of herbs and gradually improved.

Pu Huang treats Blood stoppage pain. Prepared it can stop bleeding. Fresh it vitalizes Blood. It can be used at the base of the tongue to treat inability to speak. If it is used repeatedly, it will be effective. This is also a formula from my experience.

Translators Unite!!!

2011-06-10T11:21:00.000-07:00

Are you an aspiring Chinese medicine translator?

Have you translated some interesting cases in the past and never shared it with the world?

If so, then our profession needs to read them. I would like to extend an invitation to anyone out in the cyber-world to post one or two of their translated cases here as a guest writer/translator. There is so much out there to translate and quite honestly 'the more, the merrier'. With my current schedule it is hard for me to get too many cases done a month and I would love to see even more posted.
Chinese medical cases are an incredible medium and learning tool to delve into the mind of the experienced practitioner, and offer us a wealth of useful clinical information. To date very few case studies have been translated into English, and so for the non-Chinese readers out there, it is critical we get more done.

So if this is of interest to you, please send me an e-mail with a case study to info[at]eraneven.com

Thanks!!!

A Case of Infertility

2011-06-08T15:09:00.000-07:00

In keeping with the theme of using classical formulas to treat conditions they are not typically indicated for, I offer a translation of an interesting case of infertility treated with Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi). The importance of treating the presentation and not getting too attached to the disease at hand rings true once again.

Liu Du-Zhou’s Clinical Experience in the use of Classical formulas
Journal of the Beijing University of Chinese Medicine, (Volume 17-5: 1994)
Written by Liu Bao-Hua

On December 20, 1989, a 30 year old female presented at the clinic complaining of an inability to conceive for over four years. She was diagnosed in the gynecology department with primary infertility, and has taken numerous formulas to date without any positive outcomes. Her cycle arrived every forty days or so, and would be complicated by lower abdominal and lumbar pain, scanty flow mixed with clots, and she was easily constipated. Her pulse was slippery-rapid and strong, tongue coat was thin-yellow, and the tongue body was bluish-purple. The diagnosis was binding of heat and blood, with obstruction of the chong and ren vessels, causing difficulty in conceiving.

Treatment principle: Discharge heat, and move static (blood), in order to eliminate the old to make room for the new. A powerful formula needs to be used in order to positively treat this obstinate condition.

The formula used was Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi):

Tao Ren 15g
Da Huang 4g
Mang Xiao 4g (added to strained decoction)
Gui Zhi 10g
Zhi Gan Cao 6g

After taking five packages of the formula she reported that her bowels were looser, and she had also discharged relatively copious amounts of black menstrual blood. Her lower abdominal and lumbar pain had settled, and her cycle arrived on schedule. On follow up six months later, she reported that she was indeed pregnant and went on to have a healthy baby girl.

Commentary: Tao He Cheng Qi Tang is basically Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the qi decoction) with the addition of Tao Ren, and Gui Zhi. Tiao Wei Cheng Qi Tang is used to discharge heat, and break binds. Tao Ren is moistening and disinhibiting, and is very good at expelling and eliminating static blood. Combined with Mang Xiao, and Da Huang the action of eliminating static blood and stagnation is strengthened. Gui zhi is used to free and move the defensive qi, following the adage of ‘when the qi moves, the blood will follow’, which will invariably strengthen the overall blood moving effect of the formula. In addition the warm nature of Gui Zhi moderates the cooling nature of both the Mang Xiao and Da Huang.

Case study of Zhang Xiang-Fu (张祥福)

2011-06-05T00:05:00.000-07:00

One of the great things about reading and studying case study literature is that we are able to learn from experienced practitioners, new and unique ways of using classical formulas we may never had thought of. When first seeing this case written up under the Wu Ling San heading, I was surprised, as treating uterine bleeding with this formula would never have existed within my thought process. Initially I thought I stumbled upon a true goldmine, but after reading the case it was clear that the practitioner was merely putting more stock into the presentation, rather than the actual disease. This is essentially the bread and butter of Chinese medicine, yet so easily disregarded these days. So nothing too dramatic nor enlightening here but still an interesting case.

***A 35 year old female presented at the clinic on May 12, 1978. The patient has always been overweight and suffered with excessive menstrual bleeding. The timing of her period has always been indeterminate, with flows usually lasting longer than seven days. This afternoon she suddenly experienced acute lower abdominal pain, and violent, heavy menstrual flooding. A local hospital treated her in the emergency department and administered medicinals to stop bleeding, along with intravenous fluid injections, all to no avail. At this point she was referred to me for treatment.

Current signs and symptoms: Sallow white facial complexion, icy cold extremities, beads of sweat emanating from the head, spitting up of turbid frothy phlegm, acute lower abdominal pain, which favours palpation, a pale, tender, enlarged tongue body, with stasis macules on the edges, a white slightly greasy tongue coat, and a choppy pulse. Laboratory results were as follows: Hemoglobin 6.5g, white blood cells 5200 m3, neutrophils 65%, lymphocytes 30%, monocytes 2%.

Diagnosis: Fulminant flooding (functional uterine bleeding)

Pattern: Damp-phlegm obstructing the uterus

Treatment Principle: Boost qi, stop bleeding, free the yang, and disinhibit dampness.

Formula: The formula used was Wu Ling San (Five ingredient powder with poria), with the addition of Shai Shen 10g (Sun-dried ginseng), E Jiao 10g (melted and added to decoction), San Qi 10g (powdered and infused). 2 packages were administered.

Follow up consultation on May 14: She reported that her spirit felt awakened, her limbs now felt warm, and the bleeding had ceased. The original formula was continued for another five packages which were enough to completely resolve the bleeding and bring about a resolution to her condition.

Commentary: Along with her main symptoms, this patient was also presenting with spitting up of turbid, frothy phlegm, an enlarged tongue body, with a greasy coat, and had always been overweight, which signify the presence of damp-phlegm retention. This damp-phlegm was obstructing the uterus, and causing insecurity of the ren and chong channels, causing menstrual flooding. Wu Ling San was chosen to free the yang, and disinhibit dampness. Shai Shen, E Jiao, and San Qi were added to boost qi, nourish the blood, and stop bleeding. Therefore by simultaneously treating the root and branch of the syndrome, we are able to achieve excellent results.

(This case was translated from 'Selected Cold Damage cases from the Clinical Experience of Famous Physicians'. Originally found in the ‘Chao Nan Journal of Traditional Chinese Medicine, 1989; (6): 19)’

It's been a while......

2011-06-03T10:38:00.000-07:00

It’s been a while since I’ve posted a case study, so I apologize to anyone who checks out the site regularly. I have been incredibly wrapped up with home life, clinic, and a relatively large translation job that has left little time nor desire to translate anything else. Now that the job is done, I can refocus on translating pieces I actually want to and enjoy.

Last month in Portland at the Zeng Rong-Xiu conference I was chatting with a couple colleagues who write blogs as well about how lonely the blogging world is. It’s hard to know if anyone ever reads these blogs (as comments are few and far between) let alone what they actually think. So if folks don’t mind, I’d love it if you would leave a comment just to say hi, let me know I’m not alone within this blog, and leave any constructive criticism you may have no matter how ego shattering it may be. Don’t worry, I can take it.

Thanks for reading.

Hu Xi-Shus' approach in the treatment of coughs

2011-04-19T10:51:00.000-07:00

According to Dr. Hu Xi-Shu, the main cause of coughing is the invasion of phlegm-rheum, which should be treated by warm transformation, descending counterflow, and calming (the cough).

When treating coughs in general, there are numerous formulas to choose from, some may even go so far as to say that there are thousands upon thousands, but Dr. Hu would most commonly use the formula Ban Xia Hou Po Tang (Pinellia and Magnolia decoction). When asked about the reasoning for this, he would answer that in the Jin Gui Yao Lue’s (Essential formulas from the golden cabinet) section on coughs it is said that there exists an intimate relationship between phlegm-rheum and coughs, and that many cases are in fact due to the upward invasion of phlegm-rheum, which causes qi counterflow with an inability to descend. In regards to the treatment of phlegm-rheum, it is said in the Jin Gui Yao Lue,

“In phlegm-rheum diseases, one must harmonize with warm medicinals”.

This is the most important main treatment principle when treating phlegm-rheum conditions, and in addition is the main treatment principle when treating coughs. When adapting this principle (in the treatment of coughs), one must also use appropriate medicinals to guide the treatment downwards in order to descend (counterflow). Clinical practice offers us many opportunities to promptly offer a resolution of this symptom.

To read one of Dr. Hu’s cases utilizing this formula, click here.

Hu Xi-Shus’ unique approach and commonly used formulas for treating wheezing and panting

2011-03-28T20:55:00.000-07:00

Patterns where phlegm –rheum is the primary cause of wheezing and panting

A commonly seen presentation in wheezing and panting is the contraction of an external pathogenic factor with simultaneous retention of phlegm-rheum. In patients who are constitutionally predisposed to phlegm-damp retention, usually the initial attack by an external factor will stir the interior phlegm which will counterflow into the lung, invariably causing the wheezing and panting. This pattern is mentioned in the Shang Han Lun, where it states:

“In cold damage where the exterior is unresolved, (and) there is water qi below the heart….”

In these cases treatment generally involves, effusion to resolve the exterior, with simultaneous warm transformation of fluids. The various manifestations of this condition can be treated with the following prescriptions:

She Gan Ma Huang Tang: (Belamcanda and Ephedra Decoction)

射干麻黄汤

Main signs: Aversion to cold, generalized body pain, copious phlegm, and the sound of phlegm in the back of the throat. If this pattern is accompanied by signs such as a dry mouth, dry tongue, and heart vexation, Sheng Shi Gao may be added.

Xiao Qing Long Tang: (Minor Blue-Green Dragon Decoction)

小青龙汤

Main signs: Aversion to cold, generalized body pain, an absence of sweating, coughing with a need to rest and lean up against something, yet unable to lie down. (This is normally due to the presence of copious phlegm), severe coughing with frothy phlegm. If this is accompanied by signs such as a dry throat, vexation and agitation, Sheng Shi Gao may be added.

Ge Gen He Xiao Xian Xiong Tang: (Minor Sinking into the Chest Decoction with Pueraria)

葛根和小陷胸汤

Main signs: Hypertonic back and nape, chest fullness, oppression or pain, heat effusion, aversion to cold and panting. If heart vexation is quite obvious, then Sheng Shi Gao may be added.

Ling Gan Wu Wei Jiang Xin Xia Xing Tang: (Poria, Licorice, Schisandra, Ginger, Asarum, Pinellia and Apricot Seed Decoction)

苓甘五味姜辛夏杏汤

Main signs: Coughing, panting with chest fullness, spitting up of frothy phlegm and a normal taste in the mouth.

Ma Huang Fu Zi Xi Xin Tang: (Ephedra, Asarum and Prepared Aconite Decoction)

麻黄附子细辛汤

Main signs: Aversion to cold, absence of sweating, perhaps an aversion to cold felt in the back, counterflow cold of the extremities, a fatigued spirit, and a deep-thin pulse.

Patterns where blood stasis is the primary cause of wheezing and panting.

Originally when blood stasis is laying dormant in the interior, any changes caused by external contraction, food damage or damage from the seven affects will induce and entice the movement of blood stasis which will eventually invade the liver and lungs and cause wheezing and panting. If this stasis is not eliminated than the wheezing and panting will endure and recovery would be difficult to achieve. Therefore many cases of wheezing and panting due to cold, or summer-heat that fail to resolve, usually contain elements of static blood. The following are a couple formulas that can effectively treat these presentations.

Da Chai Hu Tang He Gui Zhi Fu Ling Wan (Major Bupleurum Decoction combined with Cinnamon Twig and Poria Pill)

大柴胡汤和桂枝茯苓丸

Main signs: Chest and rib-side bitter fullness, difficulty breathing, hypertonic epigastrium, bitter taste in the mouth, dry throat, and dry bowel movements.

Da Chai Hu Tang He Tao He Cheng Qi Tang (Major Bupleurum Decoction combined with Peach Pit Decoction to Order the Qi)

大柴胡汤和桃核承气汤

Main signs: Similar symptoms to the above, with the addition of abdominal distension and fullness, and difficult bowel movements.

Modifications to the above formulas:

With signs of dry mouth, throat or tongue, vexation, agitation and/or vexation thirst, add Sheng Shi Gao

With signs of external contraction with symptoms of heat effusion, aversion to cold and an absence of sweating, combine with Ge Gen Tang.

With signs of sweating and significant wheezing, combine with Ma Xing Shi Gan Tang

Patterns where both phlegm-rheum and blood stasis are the primary cause

If for example our patient presents with a Xiao Qing Long Tang presentation with elements and signs of Da Chai Hu Tang He Gui Zhi Fu Ling Wan, then these three formulas may be combined.

With difficult bowel movements it is easy to see signs of either Gui Zhi Fu Ling Wan or Tao He Cheng Qi Tang. If in this case a She Gan Ma Huang Tang presentation exists, then the combination of these formulas would be applicable.

If signs of mouth or tongue dryness, or vexation and agitation are seen with the above formulas, then Sheng Shi Gao may be added.

Why Da Chai Hu Tang?

Dr Hu explained that many patients presenting with wheezing and/or panting manifest a Shao-Yang, Yang-Ming combination disease. Therefore, the cardinal Shang Han Lun formula Da Chai Hu Tang (Major Buplureum Decoction) may be used with quite astonishing results. Many of Dr. Hu’s students would often ask him why when treating wheezing he wouldn’t just use Ma Huang (Radix Ephedra)? He would simply state that unless the case presenting was a Ma Huang pattern, its use was not warranted. In the Shang Han Lun (On Cold damage) it states that “In wheezing with chest fullness, Ma Huang is appropriate, but in wheezing with abdominal fullness, Ma Huang should not be used”.

Dr. Hu would explain that in order to diagnose a Shao-Yang Yang-Ming case of wheezing and panting, we need to look for symptoms such as; wheezing and panting with occasional chest fullness, rib-side pain, sweating, dry throat, dry bowel movements, etc.

Two Cases on the use of Si Ni San

2011-03-02T11:32:00.000-08:00

A Collection of the Clinical Experience of He Ren

何任临床经验辑要

Case #1

On April 8 1983, a 48 year old female presented with irregular menstruation. She was a very sceptical woman and was easily angered. Her sleep was poor with copious dreaming, she experienced rib side pain, abdominal distension, her bowel movements alternated between hard and loose, her tongue had a thin white coat and her pulse was wiry. In this case it is appropriate to harmonize and scatter the depression, course the liver, and regulate qi. The following formula was prescribed;

Zhi Shi 9g

Chai Hu 9g

Sheng Gan Cao 9g

Dang Gui 9g

Bai Shao 15g

Huai Xiao Mai 30g

Zhi Xiang Fu 9g

Da Zao 7 pieces

5 packages were administered.

Follow up consultation on April 15 1983: After taking the above formula, her sleep had improved and she felt calmer. The abdominal distension had decreased, her bowel movements were regular, but the rib side pain was still occasionally present. Tongue coating was still thin and the pulse was wiry. A modified version of the original formula was prescribed.

Zhi Shi 9g

Chai Hu 9g

Sheng Gan Cao 9g

Yu Jin 9g

Bai Shao 15g

Zhi Xiang Fu 9g

Huai Xiao Mai 30g

Da Zao 7 pieces

5 packages were administered.

Commentary: The patient in this case originally suffered from neurosis occurring alongside menopause. Therefore we have a pattern of qi and blood disharmony with liver depression, causing rib side pain and abdominal distension. This pattern is effectively treated with a combination of Si Ni San and Gan Mai Da Zao Tang. On follow up after finishing the formula, the patient reported a full resolution of symptoms.

Case #2

A 41 year old male presented on August 17, 1981 with a depressed spirit, irritability and anger. In addition he had epigastric pain, an increase in bowel movements, with occasional diarrhea, cold fingers and toes, slight sweating, fatigue, a wiry-rapid pulse, and a thin yellow tongue coat. In this case it is appropriate to course the liver, regulate qi and resolve depression. The following formula was prescribed;

Chai Hu 9g

Bai Shao 9g

Sheng Gan Cao 9g

Zhi Shi 9g

Chun Yang Zheng Qi Wan 3g* (separated into two doses and taken with decoction)

*Pure Yang to Rectify the Qi pills is a patent formula containing Chen Pi, Cang Zhu, Rou Gui, Ding Xiang, Huo Xiang, Bai Zhu, Fu Ling, Zhi Ban Xia, and Qing Mu Xiang.

Four packages were administered.

Commentary: The patient in this case suffered from a depressed spirit. He tended to think excessively and was easily angered. This patient was initially diagnosed during the summer, and was manifesting a Si Ni San presentation. Taking the season into consideration and the conditions of his diet with the mild reversal symptoms, we are unable to say that this is a pure case of binding depression of liver qi. Due to these factors, Chun Yang Zheng Qi Wan was added to clear the stomach and intestines and eliminate seasonal pathogenic factors. After taking two packages of the formula his (epigastric) pain and diarrhea had completely resolved, and he felt much calmer.

The clinical scope of Si Ni San is quite vast. In all cases of qi stagnation, qi depression, and qi reversal the pattern and presentation of Si Ni San is often present with several opportunities for use. The formula is applicable in cases of cholelithiasis, cholecystitis, intercostal neuralgia, weak digestive system functioning, stomatitis, panting, palpitations, colitis, neurological disorders, menopause, and several other conditions. Generally when the pattern is correctly identified and the herbs and/or formula are matched to the presentation, our results can be 100% effective.

Stomach Pain and Irregular menstruation rectified with Si Ni Huang Lian (Tang)

2011-02-24T12:09:00.000-08:00

A case of Professor Fan Zheng-Lun (樊正伦)

Recently a 37 year old female presented at the clinic. She was thin and pallid and was covering her abdomen with both hands. She complained of stomach pain for several months occurring before or after meals. Her abdomen feared cold and enjoyed warmth, she often felt nauseous with the occasional desire to vomit. Her bowel movements seemed to be unaffected. Her stomach pain occurred prior to her menstrual cycle which had also become quite long, dark and unsmooth. In addition the soles of her feet often felt warm. Her mother, who was sitting next to her commented that her daughter really enjoyed spicy foods and ate too much of them, which was probably causing some of her pain. Her mother recently restricted her consumption of these foods.

Her tongue was purplish-dark with stasis macules on both edges. Her right pulse was wiry-thin, and the left pulse was deep-weak. At this point, Professor Fan kindly asked her, “Do you find that you easily get angry”? The patient nodded her head and said “yes, I don’t have a very good temper”.

Professor Fan said that this is a case of Liver Qi depression with a disharmony of the Spleen and Stomach, which can be treated with ‘Huang Lian Tang’ and ‘Si Ni San’ with additions and subtractions.

Formula:

Gui Zhi 9g

Bai Shao 9g

Fa Ban Xia 9g

Gan Jiang 9g

Zhi Gan Cao 15g

Chai Hu 9g

Zhi Shi 9g

Zhi Xiang Fu 9g

Dang Gui 9g

Dang Shen 12g

Da Zao 4 pieces

Sheng Sha Pu Huang 6g

Huang Lian 6g

7 Packages were administered.

A week later the patient returned for a follow up consultation and said her spirits were up and turning for the better. She was so happy to report that after taking the herbs, her stomach felt very comfortable. She was still having one bowel movement a day. Her cycle came and only lasted 4-5 days, was not very heavy and contained small clots. She has had no abdominal pain, her soles no longer felt warm, and occasionally there was a gurgling sound in her abdomen.

Her tongue edges were purplish-dark and her pulse was wiry.

Professor Fan felt that the formula was addressing her condition and prescribed another seven packages of the original formula to consolidate the treatment.

In clause 173 of the ‘Shang Han Lun’ it says;

“When in Cold damage, there is heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit, Huang Lian Tang (Coptis Decoction) governs”

In actuality, Huang Lian Tang is Ban Xia Xie Xin Tang with the removal of Huang Qin and the addition of Gui Zhi. It treats stomach heat and spleen cold, while Ban Xia Xie Xin Tang treats damp heat in the spleen and stomach.

Within the formula, bitter Huang Lian is used to descend heat in the upper body, as per the adage “To treat upper body heat, drain with bitterness”. Acrid warm Gui Zhi, Gan Jiang, and Fa Ban Xia are used to raise spleen yang. “With cold in the lower body, scatter with acridness”. Ren Shen, Gan Cao, and Da Zao are used for their sweet flavour to boost the stomach, remembering the adage “The spleen desires warmth, so with tension use sweet foods to moderate”.

Huang Lian Tang is a very useful formula for treating spleen and stomach conditions resulting from spleen cold and stomach heat. When combined with Si Ni San It is able to course the liver, regulate qi and protect liver wood from exploiting spleen earth. In clinical practice we are often able to achieve positive clinical outcomes through this combination.

In this patients’ case, aside from the above mentioned formulas, Professor Fan added Zhi Xiang Fu in order to strengthen the formulas function of coursing the liver. Dang Gui and Sheng Sha Pu Huang were added to nourish and move the blood, and transform stasis.

This case was adapted and condensed from ‘A Taste of Chinese Medical Chicken Soup’ by Xiong Hong

A Case of Rheumatic Arthritis

2011-01-18T22:42:00.000-08:00

He Bei Chinese Medicine, 1984; (3): 40
Found in ‘A Brief Guide to Cold Damage Formula Patterns’ by Liu Shao-Yi (伤寒方证便览)

Huang a 49 year old male presented with joint pain in both legs and knees which had started the previous year and has gradually become worse. At a local hospital, he was diagnosed with rheumatic arthritis, and received treatments for over a month with no positive effects.

Recently his pain has become quite severe, especially in both knee joints. He experiences pulling pain, which prevents him from walking. Both legs and knees were cold, and his pain intensifies with any changes in weather or on cold rainy days. His tongue had a greasy white coating and his pulse was deep and thin.
This pattern is usually the result of living in wet-damp locations for extended periods of time allowing wind and dampness to amass in the joints. The following formula was administered:

Zhi Gan Cao 6g (Glycyrrhizae Radix preparata)
Bai Zhu 9g (Atractylodis macrocephalae Rhizoma)
Gui Zhi 9g (Cinnamomi Ramulus)
Pao Fu Zi 15g (Aconiti Radix lateralis preperata)
Niu Xi 9g (Achyranthis bidentatae Radix)

1 package was to be taken daily.

After taking 3 packages, both limbs felt warmer and the pain had decreased slightly. The above formula was repeated with an increase in herb dosages.

Zhi Gan Cao 9g (Glycyrrhizae Radix preparata)
Bai zhu 24g (Atractylodis macrocephalae Rhizoma)
Gui Zhi 15g (Cinnamomi Ramulus)
Pao Fu Zi 30g (Aconiti Radix lateralis preperata)
Niu Xi 15g (Achyranthis bidentatae Radix)

After another 3 packages, his legs felt warmer, there was mild sweating, a white tongue coat and a harmonious moderate pulse. The joint pain in the legs had now been eliminated and he was even able to walk the 3 miles to the hospital for a follow up visit. In order to consolidate the treatment and eliminate the wind damp, another 5 packages of the previous prescription (with the lower dosages) was used. On a recent follow up visit there had been no relapse of the condition.

**The following case was found in the above mentioned book's section on 'patterns of wind and damp retention in the joints' with the representative formula being Gan Cao Fu Zi Tang (Licorice and Aconite formula)

Hu Xi Shu (胡希恕）Case #5- Foot pain

2011-01-10T23:23:00.000-08:00

A 19 year old male presented on February 15, 1966 complaining of left foot swelling and pain for over 5 years. Over the last two years the pain has gotten quite severe. X-ray imaging confirmed osteogenesis of the heel.

Current symptoms: swelling and pain in the left foot, fear of cold, severe pain after walking, normal taste in the mouth, no desire to drink, a thin-white tongue coating and a deep-wiry pulse.

This is wind-dampness in the Shao-Yin and Tai-Yin, and is therefore a Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig,Peony and Anemarrhena Decoction) pattern.

Formula:

Gui zhi 4 qian (Cinnamomi Cassiae, Ramulus)

Ma Huang 2 qian (Ephedrae, Herba)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)

Sheng Jiang 4 qian (Zingiberis Officinalis Recens, Rhizoma)

Chuan Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)

Fang Feng 4 qian (Ledebouriellae, Radix)

Cang Zhu 4 qian (Atractylodis, Rhizoma)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Results: After taking seven packages of the above formula, the foot pain had decreased. He still experienced pain after walking but would recover quickly after taking a rest. Chuan Fu Zi (Aconiti Carmichaeli Preparata, Radix Lateralis) was increased to 3 qian and after taking the above formula for another month the swelling in the foot had resolved and the pain was no longer present.

Hu Xi Shu’s Love affair with Da Chai Hu Tang 胡希恕真的爱大柴胡汤!!

2010-12-07T22:34:00.000-08:00

After reading numerous Hu Xi Shu case studies over the last few years, I have come to realize that he had a special affinity to the use of Da Chai Hu Tang and utilized this great formula in combination with other medicinals and/or formulas to treat a vast array of medical conditions. His unique way of using this formula have been mentioned in previous posts, and I would like to offer yet another of his innovative cases.

A 48 year old male presented at the clinic on August 12, 1964 complaining of feeling flustered and unwell for over six months. He was treated at a previous hospital with various qi supplementing, blood nourishing formulas consisting of modified versions of Zhi Gan Cao Tang, Bai Zi Yang Xin Tang, and Tian Wang Bu Xin Dan. None of these treatments were effective and in addition he started feeling warm and had trouble sleeping. An Electrocardiogram revealed atrioventricular blockage and cardiac muscle strain.

Current symptoms: Flustered feeling, insomnia, poor food intake, epigastric pain, dull pain in the region of the heart, numbness in the hands and feet, a bitter taste in the mouth, yellow urination, dry stools, a greasy white tongue coating and a bound and intermittent pulse.
He was prescribed Da Chai Hu Tang with Gui Zhi Fu Ling Wan and Sheng Long (Gu) Mu (Li)

Chai Hu 4qian
Ban Xia 3qian
Huang Qin 3qian
Gui Zhi 3qian
Fu Ling 3qian
Bai Shao 3qian
Zhi Shi 3qian
Tao Ren 3qian
Hong Hua 2qian
Da Zao 4pcs
Sheng Jiang 3qian
Da Huang 2qian
Sheng Long Gu 5qian
Sheng Mu Li 5qian

Results: After taking 3 packages of the above formula the epigastric pain was alleviated, his appetite had improved, the numbness in the hands and feet were gone and sleep was improving. Hong Hua was removed from the formula and 3qian of Mu Dan Pi were added. After 6 packages, the chest pain had receded, his sleep was excellent, the flustered feeling was not as apparent and the pulse was normal.

Comments: Originally this patient presented as feeling flustered, with a poor appetite, numbness in the hands and feet and a bound and intermittent pulse. These symptoms can indicate a vacuous condition, which is why a modified version of Zhi Gan Cao Tang was originally administered. After taking the formula, the patient had a bitter taste in his mouth, yellow urination, dry stools, a dull pain in the area of the heart, etc. These symptoms belong to a Shao-Yang Yang-Ming combination disease, therefore Da Chai Hu Tang with Gui Zhi Fu Ling Wan and Long Gu and Mu Li were administered. This formula is used to resolve both the Shao-Yang and Yang-Ming, quicken the blood, eliminate stasis and calm the spirit. Because the herbs were chosen according to the pattern, an extended period of treatment time was unnecessary.

Using high dosages of Bai Hua She She Cao in the treatment of Acne

2010-10-11T17:38:00.000-07:00

Chinese Medical department affiliated with Ning Xia medical school
Ma Xiao-Yong, Ding Yu-Mei

Journal of Traditional Chinese medicine, 2008, Vol. 49, No. 8

Bai Hua She She Cao (Herba Hedyotidis Diffusae) 白花蛇舌草 is slightly bitter, sweet and cold. This medicinal enters the stomach, large intestine and small intestine channels. Its main functions are to clear heat, disinhibit dampness, resolve toxicity and disperse abscesses. This year we have been employing Bai Hua She She Cao quite often in combination with other medicinals in the treatment of acne. The following are a couple of case studies representing the positive results we have experienced.

Case 1: Wang, a 26 year old male presented in December 2006 with red papules on his face that had been present for 3 months. The papules were pus filled, nodular, painful and quite itchy. This was accompanied with a bitter taste in the mouth, dry stools, red tongue, slippery-yellow tongue coat, and a wiry-slippery pulse. The diagnosis was acne with the pattern belonging to accumulation and exuberant toxic heat in the Lungs and Stomach. The formula prescribed was:

Bai Hua She She Cao 60g
Sheng Shi Gao 45g (cooked first)
Huang Qin 15g
Bai Xian Pi 15g
Pu Gong Ying 15g
Sheng Di Huang 10g
Kun Bu 10g
Chi Shao 10g
Hong Hua 12g
San Leng 12g
E Zhu 12g
Yan Hu Suo 12g
Dan Shen 20g
Da Huang 10g
Gan Cao 6g

After taking 7 packages of the above formula the papules along with the pus were beginning to recede and were more of a pale color. The nodules were slightly softer, bowel movements were smoother and the bitter taste in the mouth, pain and itching were pretty much resolved. The tongue coat was now thin slippery-yellow. The above formula was given with Da Huang reduced to 5g and with the additions of Cang Zhu 12g and Sha Ren 6g. After taking 30 packages of this formula, the papules and pustular nodules had receded. The patient was advised to eat less acrid, spicy and greasy foods. On a two month follow up, the patients’ condition had completely resolved.

Case 2: A 21 year old female patient presented in January 2006, with small red facial papules, that had been present for 2 years. The papules were slightly itchy and were accompanied with a sticky bitter taste in the mouth, slightly dry stools, a slightly red tongue with a thin slippery-yellow coat and a slippery pulse. She had previously used an external cream with no effect. The diagnosis was acne with the pattern belonging to heat exuberance in the lungs and stomach. The formula prescribed was:

Bai Hua She She Cao 30g
Huang Qin 15g
Sheng Di Huang 10g
Chi Shao 10g
Mu Dan Pi 10g
Bai Xian Pi 10g
Hong Hua 12g
Sang Bai Pi 12g
Dan Shen 20g
Da Huang 6g
Gan Cao 6g
Zhu Ye 6g

After taking 7 packages of this formula, the papules were clearly improving. The bitter-sticky taste, and itchiness were relieved to some extent but she was experiencing thin and watery bowel movements occurring twice daily. Da Huang was removed from the above formula, while Bai Hua She She Cao was increased to 60g and 10g each of Sha Ren and Huo Xiang were added to the formula. After taking 14 packages of the formula the papules had disappeared and the condition had resolved.

In Traditional Chinese medicine acne is commonly seen in conditions of the Lungs and Spleen. The ‘Orthodox Lineage of External Medicine’ says “Acne belongs to the lungs, while red sores on the nose belong to the spleen. This is caused by the non scattering of depressed and stagnant blood heat”. According to this passage in order to treat acne we must clear and diffuse heat in the lungs and stomach. Due to Bai Hua She She Cao’s functions, it is commonly combined with heat clearing, blood cooling medicinals in order to soften hardness, clear heat in the lungs and stomach, harmonize Qi and blood and resolve papular eruptions.

Hu Xi-Shu’s commonly used formulas for impediment syndrome (痹证 Bi Zheng)

2010-09-01T15:06:00.000-07:00

Dr. Hu was a master at utilizing classical formulas for the treatment of a wide array of syndromes. The following is a list of his most commonly used formulas and their specific patterns for the treatment of pain.

I. Ge Gen Jia Zhu Tang (Kudzu Decoction plus Atractylodes Decoction)(葛根加术汤):
Neck and nape tightness and pain, heat effusion, aversion to cold, lumbar soreness, generalised heaviness, white tongue coating, wiry-slippery pulse.

Ge Gen 4 qian (Radix Puerariae)
Ma Huang 3 qian (Ephedrae, Herba)
Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)
Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)
Bai Shao 2 qian (Paoniae Lactiflorae, Radix)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)
Da Zao 4 pieces (Zizyphi Jujubae, Fructus)
Cang Zhu 5 qian (Atractylodis, Rhizoma)

This formula is used in both acute and chronic inflammatory joint problems, especially when manifesting with heat effusion, an absence of sweating and aversion to cold. The use of this formula is still warranted in cases of acute joint inflammation without the presence of neck and nape pain. This formula may be utilised in treating cases of lumbar muscular injury, hyperosteogenesis, ankylosing spondylitis and chronic arthritis.

II. Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coicis, and Licorice Decoction)
(麻杏薏甘汤):
Whole body joint pain, late afternoon heat effusion, body heaviness or swelling of the joints in the four extremities, harmony in the mouth* or sticky taste in the mouth, greasy-white tongue coating, deep-wiry-slippery pulse.

Ma Huang 3 qian (Ephedrae, Herba)
Xing Ren 2 qian (Pruni Armeniacae, Semen)
Yi Yi Ren 6 qian (Coicis Lachryma-jobi, Semen)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula pattern is commonly seen in cases of chronic and acute rheumatoid arthritis with a tendency towards damp heat.

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions.

III. Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) (桂枝芍药知母汤):
Whole body joint pain, joint swelling in the extremities or knees, stiffness and/or deformities in the extremities, fingers or toes, dizziness, shortness of breath, white tongue coating, wiry pulse.

Gui Zhi 4 qian (Cinnamomi Cassiae, Ramulus)
Ma Huang 2 qian (Ephedrae, Herba)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Sheng Jiang 5 qian (Zingiberis Officinalis Recens, Rhizoma)
Bai Zhu 5 qian (Atractylodis Macrocephalae, Rhizoma)
Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)
Fang Feng 4 qian (Ledebouriellae, Radix)
Pao Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)
Gan Cao 2 qian (Glycyrrhizae Uralensis, Radix)

This formula pattern is commonly seen in chronic rheumatic cases such as damp-heat type rheumatoid arthritis and is classified as a combination of the Shao-Yin and Tai-Yin disease stages. This formula is especially indicated in cases of swelling with joint deformities accompanied by upward rising qi and nausea. In cases where redness, swelling and heat are significant, Sheng Shi Gao (Gypsum) may be added to the above formula.

IV. Gui Zhi Jia Ling Zhu Fu Tang (Cinnamon Twig plus Poria, Atractylodis, and Aconite Decoction) (桂枝加苓术附汤):
Lumbar, knee or shoulder joint pain, head, neck and nape pain, possibly accompanied by palpitations, epigastric pain, sweating, aversion to wind, cold extremities, harmony of the mouth, white tongue coating, wiry pulse.

Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Zhi Gan Cao 3 qian (Glycyrrhizae Radix Preperata)
Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)
Da Zao 4 pieces (Zizyphi Jujubae, Fructus)
Cang Zhu 3 qian (Atractylodis, Rhizoma)
Fu Ling 3 qian (Poriae cocos, Sclerotium)
Pao Fu Zi 3 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)

This was one of Dr. Hu’s most commonly used formulas. If joint pain was more evident on one side of the body, he would consider this obstruction and stasis of blood and would add a small dose of Da Huang (Radix Rhubarb) in order to quicken the blood and free the collaterals.

V. Gui Zhi Jia Huang Qi Tang (Cinnamon Twig plus Astragali Decoction)
(桂枝加黄芪汤):
Enduring joint pain, obvious sweating and aversion to wind, cold extremities, with perhaps a warm body and numbness in the extremities. Thin-white tongue coating, moderate pulse.

Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)
Da Zao 4 pieces (Zizyphi Jujubae, Fructus)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)
Huang Qi 3 qian (Astragali Membranacei, Radix)

This formula is used in cases of exterior vacuity combined with water-damp evils seen in cases of impediment pain, numbness and sores.

VI. Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San (Bupleurum, Cinnamon Twig, and Ginger Decoction, plus Tangkuei and Peony Powder)
(柴胡桂枝干姜汤合当归芍药散):
Lumbar and/or pelvic pain, neck and back pain, weak knees, palpitations, fullness below the heart, spontaneous or night sweating, lower extremity oedema, white tongue coating, deep-thin-wiry pulse.

Chai Hu 4 qian (Bupleuri, Radix)
Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)
Gan Jiang 2 qian (Zingiberis Officinalis, Rhizoma)
Huang Qin 3 qian (Scutellariae Baicalensis, Radix)
Hua Fen 4 qian (Trichosanthis Kirilowii, Radix)
Sheng Mu Li 5 qian (Ostreae, Concha)
Dang Gui 3 qian (Angelicae Sinensis, Radix)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Chuan Xiong 2 qian (Ligustici Chuanxiong, Radix)
Bai Zhu 3 qian (Atractylodis Macrocephalae, Rhizoma)
Ze Xie 5 qian (Alismatis Orientalis, Rhizoma)
Fu Ling 4 qian (Poria cocos, Sclerotium)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula is commonly used in the treatment of lumbar and cervical hyper-osteogenesis, osteoporosis, ankylosing spondylitis and wind-damp type rheumatic disorders. The location of this disease is found in both the Jue-Yin and Tai-Yin levels and is a pattern of blood vacuity with damp exuberance therefore treatment involves resolving the two Yin’s nourishing the blood and disinhibiting water.
According to numerous recorded cases studies, Dr. Hu commonly employed this formula in the treatment of Systemic Lupus erythematosus (SLE).

Hu Xi-Shu (胡希恕) Case #4-Duodenal Ulcer

2010-07-26T13:33:00.000-07:00

Mr. Wang, male, 46 years old.

Initial diagnosis on November 30, 1965: For over 10 years the patient has suffered with epigastric pain which has recently been getting worse. Treatment at a local Chinese-Western integrative clinic was unsuccessful. Chinese medicinals were used to warm the centre, rectify the Qi, quicken the blood and dispel stasis. Western medications were ineffective as well and surgery was recommended. Since the patient feared surgery, he came to the capital (BeiJing) for treatment.

Current symptoms: stabbing epigastric pain most notable when hungry, heat effusion in the back, late afternoon heat in the palms of the hands, occasional worry, palpitations, dizziness, cool body with a fear of cold, sweating and an aversion to wind. There was harmony of the mouth* with no desire to drink and slightly sloppy stools. Tongue coating was white, tongue tip was red and his pulse was thin and wiry. Barium examination revealed a 0.4cm2 postbulbar duodenal ulcer.
Dr. Hu prescribed Xiao Jian Zhong Tang (Minor construct the centre decoction)

Gui Zhi 3 qian
Bai Shao 6 qian
Sheng Jiang 3 qian
Da Zao 4 pieces
Zhi Gan Cao 2 qian
Yi Tang ½ liang (mixed into prepared decoction)

Second consultation (12.3.1965): The pain and heat in the palms had slightly decreased but overall the epigastric stabbing pain, heat in the back and daily bowel movements were still present. The following medicinals were added to the above formula;

Chao Wu Ling Zhi 2 qian
Yuan Hu Fen 5 fen (mixed into decoction)

Third consultation (12.9.1965): The epigastric pain is no longer as obvious, but after eating the patient is experiencing focal distension below the heart. In addition, his four limbs are cold and he is unable to sleep peacefully at night. At this point the patient had to return to his hometown in Dong Bei. The formula was changed to Fu Ling Yin and sent home with him where he was to take it and until recovery. The formula ingredients were as follows:

Fu Ling 5 qian
Dang Shen 3 qian
Zhi Ke 3 qian
Cang zhu 3 qian
Sheng Jiang 3 qian
Chen Pi 1 liang
Ban Xia 4 qian

Commentary: In this case the patient presented with sweating, an aversion to wind, dizziness and heart palpitations which can signify pathogens in the exterior, specifically an exterior vacuity pattern. Therefore Xiao Jian Zhong Tang was administered. After taking three packages of the formula there was already a significant effect and after nine packages, the symptoms were basically resolved. Xiao Jian Zhong Tang is essentially Gui Zhi Jia Shao Yao Tang with the addition of Yi Tang. Gui Zhi Jia Shao Yao Tang is originally a formula used to treat abdominal pain. With the addition of a large dose of sweet, warm, vacuity supplementing, spasm moderating Yi Tang we have the dual action of both treating abdominal pain and supplementing vacuity, hence the name ‘Construct the centre’.

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions.

Zhu Ren-Kang- Collection of clinical experience in dermatology （朱仁康-临床经验集-皮肤外科）

2010-07-12T20:17:00.000-07:00

Eczema-Case #2
Tian, male, 24 years old presented on March 13, 1967.

Chief complaint: Patient has suffered with a pruritic erythematous papular eruption covering his whole body for the last month.

Disease history: Last month the patient initially noticed small red papular eruptions over his limbs and torso that when scratched exuded fluid. Currently the eruptions are generalized over the entire body being more severe over the upper arms and thighs. Several decoctions have been taken as well as injections of sodium hyposulfide all to no avail.

Inspection: Scattered over the entire body were small millet-grain like red papules with exudate, more obvious on the limbs. The papules were quite diffused and symmetrical.
Pulse was moderate and the tongue was normal with a clean coating.

Chinese medical diagnosis: Millet sore (粟疮)

Western medical diagnosis: Generalized eczema

Pattern: Interior spleen vacuity with enduring accumulation transforming to heat, transmutation and steaming of damp-heat coupled with external wind.

Treatment principle: Disinhibit dampness and clear heat.

Formula: 4 packages of Long Dan Xie Gan Tang with additions and subtractions were prescribed.

Second Visit (March 17): Patient reported that the condition was basically the same as before with no improvement. The itchiness was still present and his sleep was disturbed. Tongue body was now red with a thin white coat, and his pulse was wiry and thin.
The treatment principle was changed to cool the blood, clear heat, disperse wind and alleviate itching.

Formula:
Sheng Di 30g
Dan Shen 9g
Chi Shao 9g
Jing Jie 9g
Ren Dong Teng 12g
Ku Shen 9g
Di Fu Zi 9g
Bai Xian Pi 9g
Er Miao Wan 9g
Liu Yi San 9g
4 Packages were administered.

Third visit (March 21): After taking the above formula, the itchiness had decreased considerably and the skin was gradually clearing up. The above formula was repeated with the additions of;
Qian Cao 9g
Chan Yi 6g
Cang Er Zi 9g
5 packages were administered.

Fourth visit (March 26): After taking the above formula, a major portion of his skin had returned to normal and no new lesions were observed. The itchiness was still present in the evenings.
9g of Chi Ling was added to the previous formula and after taking 5 packages the patients’ condition was resolved.

Clinical usage of Bupleurum and Cinnamon Twig Decoction (柴胡桂枝汤)

2010-06-10T14:17:00.000-07:00

Shoulder and back pain (Shoulder inflammation)

Case study of Liu Du Zhou: Mr. Yu, Male, 43 years old presented on November 29, 1993 with left side shoulder and back pain and swelling. He was unable to lift his left arm or turn over on his side. Western medications were taken including strong pain killers which would only alleviate the pain for a short time where soon after the pain would return. At a previous hospital he was diagnosed with inflammation of the shoulder. This patient was suffering with exceptional pain. On inquiry the patient complained of chest and rib-side fullness, a bitter taste in the mouth, an occasional need to sigh, no desire to eat, occasional sweating and tightness in the back. His bowel movements and urination were normal. His tongue was pale with a thin coat and his pulse was wiry. His pattern was diagnosed as qi depression and stagnation causing a lack of free flow in the Tai-Yang and Shao-Yang channels. A lack of free flow causes pain. ‘不通则痛’。
This must be treated by expelling evils in the Tai-Yang, harmonizing Shao-Yang and regulating the nutritive and protective Qi. The formula administered was Chai Hu Gui Zhi Tang with Pian Jiang Huang.

Chai Hu 16g
Huang Qin 10g
Ban Xia 10g
Sheng Jiang 10g
Dang Shen 8g
Zhi Gan Cao 8g
Gui Zhi 12g
Bai Shao 12g
Da Zao 12g
Pian Jiang Huang 12g

After taking 3 packages of the above formula the back pain had decreased, he was able to lift his arm on his own, flexibility was increased and his chest and rib-side felt better. After a further 3 packages he was able to completely recover.

(Effective cases from the clinical experience of Liu Du Zhou)

Commentary: Professor Liu Du Zhou says that in order to treat shoulder and back pain we must address the Tai-Yang, Shao-Yang and Du channels. The shoulder is traversed by the Shao-Yang channel, and the back by the Tai-Yang and Du channels. Enduring diseases enter the collaterals and bind the blood. For this we may add Pian Jiang Huang, Tao Ren, Hong Hua, Chuan Xiong, etc, to invigorate the blood, free the collaterals and alleviate pain. If pain extends to the lower back, the head and body are heavy and cumbersome, the tongue coating is slimy and if copious vaginal discharge is observed in females, then one may administer Qiang Huo Sheng Shi Tang to attain a positive effect.

The above case and commentary are taken from 'Selected Cold Damage cases from the Clinical Experience of Famous Physicians' pg 359.

Case Studies of Wu Pei Heng (吴佩衡医案)

2010-06-08T12:07:00.003-07:00

吴佩衡医案

The following is a case study by the late Wu Pei Heng (吴佩衡) (1886-1971) from Si Chuan province who was extremely proficient in using classical formulas and practiced in the style of the fire god school (火神派). My initial fascination with Dr Wu’s cases are his use of extremely large doses of Fu Zi. There are a number of cases in his book where he uses up to 300g a day, even with a few of his younger patients. Due to Dr. Wu's prolific use of Fu Zi he attained the nickname 'Wu Fu Zi'.

Late miscarriage blood loss

Mrs Fang, 35 years old, originally from Luo Ping county currently living in the city of Kun Ming in Yunnan province.

On May 12, 1923 she presented at the clinic after suffering a miscarriage in her fifth month of pregnancy. Initially she felt painful sagging in her abdomen and low back which continued until she miscarried. She had excessive menstrual bleeding (flooding) with clots, twisting abdominal pain, flusteredness, dizziness and shortness of breath. Her pulse was scallion like, vacuous, weak and both inch positions were short. Her lips were pale red, tongue coating was slippery white and the tongue body was bluish and dark. According to her husband on that particular evening she had fainted twice. Late miscarriages are usually due to major vacuity of kidney qi, qi vacuity sinking and unable to absorb blood, and yang qi descending with blood and escaping. The qi is born within the kidneys and gathers in the lungs and here we have a lack of merger between the kidneys and lungs, therefore there is shortness of breath with desertion. The plan is to administer Si Ni Dang Gui Bu Xue Tang with (Da) Zao and Ai (Ye). Within the formula, Si Ni Tang supports Yang allowing it to rise. The assistants (Huang) Qi and Dang Gui supplement the centre, boost qi and re-generate the excessively damaged blood. Gan Jiang, Ai (Ye) and (Da) Zao blackened, can warm the blood, separate the cold and return blood back to the channels.

Formula:

Hei Fu Pian 160g

Pao Hei Jiang 50g

Zhi Gan Cao 24g

Bei Kou Qi 60g

Dang Gui 26g

Qi Ai 6g (fried until blackened)

Da Zao 5 pieces (roasted until blackened)

After taking 13 days worth of formula, her menstrual flooding stopped, the shortness of breath was calmed and most of her symptoms were alleviated by days 6 or 7 and even her spirit was slightly improved. In keeping with the original formula, another 14 days were given to complete the course, after which she successfully recovered.

A case of Shao-Yin Infertility

2010-05-26T11:28:00.000-07:00

Fan Zhong Lin- Liu Jing Bian Zheng Yi An （六经辩证医案)

Huang. 34 year old female cadre residing in Si Chuan province.

[Disease history]: Couple have been trying to conceive unsuccessfully for the last 7 years beginning in the winter of 1959. Both male and female medical investigations were normal. Her initial symptoms were dizziness and poor energy. In the early mornings she would have facial edema and in the afternoon the swelling would be in her legs. Her menstruation was irregular.
In 1965 when she had come in for a consultation the state of her condition had already become quite serious. Her initial consultation was on June 20 1965.

[Initial consultation]: Amenorrhea for a half a year with copious leucorrhea. There was mild edema throughout her entire body and her lower limbs felt rather heavy. There was whole body pain, a fear of cold, excessive dreaming, poor appetite and her blood pressure was occasionally high. Her urination was inhibited and her bowels would be initially dry and then sloppy. Tongue body was pale, flabby and tender with teeth marks on the edges, coating was slippery overall and thicker at the centre. Pulse was deep.
This is an irregular menstruation and Infertility pattern due to evils entering the Shao-Yin with fire debilitation, water effulgence and Kidney Yang vacuity. A modified version of Zhen Wu Tang was appropriate to warm Yang, transform Qi and move water.

Prescription:

Zhi Fu Pian 120g (extended cooking time)
Fu Ling 30g
Sheng Jiang 30g
Gui Zhi 15g
Pao Jiang 30g
Zhi Gan Cao 15g
4 Packages.

[Second consultation]: After taking the above formula her whole body edema was markedly reduced and her appetite was improved. Another four packages of the above formula were prescribed.

[Third consultation]: Patients exhaustion, aversion to cold and other symptoms were greatly improved except for the amenorrhea. A modified version of the above formula combined with Dang Gui Bu Xue Tang was prescribed.

Prescription:

Zhi Fu Pian 60g (extended cooking)
Fu Ling 20g
Bai Zhu 15g
Sheng Jiang 30g
Gui Zhi 10g
Huang Qi 30g
Dang Gui 10g
Zhi Gan Cao 10g
Pao Jiang 30g

[Fourth consultation]: Eight packages of the above formula were taken after which her menstruation arrived. The colour was pale, the amount scanty and contained clots. Her lower abdomen felt cool with a dull pain. She was still manifesting congealing and stagnation of cold in the uterus. A modified version of Wen Jing Tang was administered.

Prescription:

Wu Zhu Yu 6g
Dang Gui 10g
Chuan Xiong 6g
Bai Shao 10g
Xue Yu Tan 20g
Pao Jiang 20g
Zhi Gan Cao 10g
2 Packages were given.

[Fifth consultation]: The abdominal pain had ceased indicating that the stasis of blood had decreased. All other symptoms were obviously reduced as well. Out of fear that the cold would return, she was advised to abstain from sexual intercourse for a half a year. The patient was given a prescription to take back home with her to continue to regulate and improve her health.

Prescription:

Zhi Fu Pian 60g (extended cooking)
Rou Gui 10g (powdered and steeped in cooked decoction)
Pao Jiang 30g
Xue Yu Tan 20g
Tu Si Zi 20g
Rou Cong Rong 10g
Huang Qi 30g
Dang Gui 10g
Nan Sha Shen 15g
Zhi Gan Cao 15g
Gou Qi Zi 20g
Ba Ji Tian 12g

July 26, 1979 follow up: During the entire course of treatment over a hundred packages of herbs were taken. Following the advice of Dr. Fan she was able to become pregnant in 1967 and currently has two children.

5 Steps to 'Shang Han' treatment

2010-05-18T17:17:00.000-07:00

I am currently reading a book titled ‘5 Steps to Shang Han treatment based on Pattern Identification”. It is a fascinating look at a very systematic approach to diagnosis and treatment using the formulary of Zhang Zhong Jing. The book is essentially centred around three very famous modern physicians, Hu Xi Shu (胡希恕), Liu Du Zhou (刘渡舟) and Fan Zhong Lin（范中林）. The book includes numerous case studies by each one of them detailing their step-by-step process from diagnosis to treatment. The 5 step process is as follows;

I. TCM diagnosis (signs, symptoms, origin and constitution of patient)
II. List of disease mechanisms (6 channel differentiation, differentiation of principles, zang-fu, channels, etc…)
III. Comprehensive analysis (detailing process and location of disease)
IV. Formulas according to pattern
V. Medicinals according to pattern

I would like to offer a translation of one case from the book by Fan Zhong-Lin a prominent physician in the Fire God school of thought (火神派).

Mr.Yang, a 54 year old male from Cheng Du presented at the clinic.

Step 1: Chinese medical diagnosis
October, 1960. Over the last 2 years every day after breakfast, the patient felt very warm and feverish. His body temperature was always around 38 degrees celcius. He had relatively copious sweating that would go on for about 2 hours. Once the heat would decline, the sweating would stop and he would feel an aversion to cold. His daily symptoms included; dizziness, a bitter taste in the mouth, dry throat, chest and rib-side fullness as well as vexation and agitation felt in the chest. His tongue body was red and the coating was slightly yellow and greasy. Pulse was wiry-rapid. At his previous hospital examination the cause of his fevers were unknown and the medications administered had very little effect.

Step 2: List of disease mechanisms
The wiry pulse, alternating cold and heat, bitter taste in the mouth, dry throat, dizziness, chest and rib-side fullness and heart vexation are all obvious Shao-Yang channel signs and symptoms.

Step 3: Comprehensive Analysis
This is Shao-Yang channel disease heat effusion. Treatment methods should involve harmonizing and resolving the Shao-Yang.

Step 4: Formula according to pattern
Xiao Chai Hu Tang with additions and subtractions governs.
This condition has been going on for 2 years so as the Shang Han Lun says “When Chai Hu signs still exist, administer Xiao Chai Hu Tang”

Step 5: Medicinals according to pattern

Because the signs of heat effusion, sweating, thirst and a red tongue signify depressed heat, we remove Sheng Jiang (Rhizoma Zingiberis) and Da Zao (Fructus Jujubae) , and add Zhi Mu (Rhizoma Anemarrhenae) and Shi Gao (Gypsum Fibrosum) to clear heat.
In addition, because the chest and rib-side fullness were quite severe, this can signify that the pattern is interspersed with damp evils, therefore Mu Li (Concha Ostreae), Chen Pi (Pericarpium Citri reticulatae) and Fu Ling (Poria cocus) were added to percolate dampness, transform stasis and disperse bind.

Formula:

Chai Hu 24g
Huang Qin 10g
Fa Ban Xia 15g
Sha Shen 15g
Gan Cao 10g
Zhi Mu 15g
Shi Gao 30g
Mu Li 24g
Chen Pi 9g
Fu Ling 12g

After taking one package of the above formula, the heat declined and there was a reduction in most of his symptoms. After stopping the herbs he was instructed to rest and take care of himself for several days and afterwards he would recover. After much time the patient had come to visit Dr. Fan at his home and reported the condition had not recurred.

Thoughts on a Quiet Night

2010-05-01T14:50:00.000-07:00

静夜思

李白

床前明月光，

疑是地上霜,
举头望明月,

低头思故乡。

Thoughts on a Quiet night

Li Bai

Before my bed the moon shines bright,

As frost upon the ground.

Raising my head I glare at the bright moon,

Lowering it I think of home.

Although this post is not Chinese medicine 'Per se', I have decided to include my translation of a very short Poem by the very famous Tang dynasty poet Li Bai.

Li Bai is best known for the extravagant imagination and striking Taoist imagery in his poetry, as well as for his great love for liquor. He spent much of his life travelling, although in his case it was because his wealth allowed him to, rather than because his poverty forced him. He is said to have drowned in the Yangtze River, having fallen from his boat while drunkenly trying to embrace the reflection of the moon.

Can Major Buplureum Decoction treat panting & wheezing?

2010-04-10T13:11:00.001-07:00

Occasionally when reading books written by clinical masters of our time regarding the usage of Jing Fang 经方 (classic formulas) we stumble upon what seems at first to be bizarre yet intriguing ways of using these formulas that in no way reflect any of the usages we were taught in school. One in particular that comes to mind is Hu Xi-Shu’s usage of Major Buplureum Decoction (Da Chai Hu Tang) for wheezing and panting (what we may call modern day asthma). In his ‘Popular Lectures on Cold Damage’ (伤寒论通俗讲话), Dr Hu explains that many patients presenting with wheezing and/or panting manifest a Shao-Yang, Yang-Ming combination disease. Therefore, the cardinal Shang Han Lun formula Da Chai Hu Tang (Major Buplureum Decoction) may be used with quite astonishing results. Many of Dr. Hu’s students would often ask him why when treating wheezing he wouldn’t just use Ma Huang (Radix Ephedra)? He would simply state that unless the case presenting was a Ma Huang pattern, its use was not warranted. In the Shang Han Lun (On Cold damage) it states that “In wheezing with chest fullness, Ma Huang is appropriate, but in wheezing with abdominal fullness, Ma Huang should not be used”.

Dr. Hu has said that in order to diagnose a Shao-Yang Yang-Ming case of wheezing and panting, we need to look for symptoms such as; wheezing and panting with occasional chest fullness, rib-side pain, sweating, dry throat, dry bowel movements, etc.

In addition Dr. Hu felt that blood stasis plays a major role in many of the chronic recalcitrant patterns of panting and wheezing and would therefore use Major Buplureum decoction in combination with other formulas such as Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria pills) or Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi). He explains that originally there is latent blood stasis in a persons’ body caused by cold contraction, food damage or emotional changes. Any of these factors when left untreated will create a situation of blood stasis which will then invade the Liver and Lungs and cause wheezing and panting. If this stasis is not expelled, long term resolution will be difficult to achieve, therefore many incessant cases of wheezing and panting even when mixed with cold or summer-heat involve elements of blood stasis. A couple of his formula combinations with their clinical manifestations are as follows;

Da Chai Hu Tang plus Gui Zhi Fu Ling Wan: 大柴胡汤合桂枝茯苓丸

Chest and rib-side bitter fullness, difficulty breathing, urgency below the heart (epigastrium), bitter taste in the mouth, dry throat and dry bowel movements.

Da Chai Hu Tang plus Tao He Cheng Qi Tang: 大柴胡汤合桃核承气汤

Symptoms include the above with the addition of abdominal fullness and distension and difficult bowel movements.

If there is a dry mouth and tongue, with vexing thirst, Sheng Shi Gao (Gypsum fibrosum) may be added.

If there is a simultaneous external contraction with symptoms of heat effusion, aversion to cold, and no sweating then Ge Gen Tang (Pueraria Decoction) can be combined with any of the above two combinations depending on the presenting pattern.

Sheng Shi Gao is appropriate as well if symptoms of dry throat, agitation or vexation present.

If sweating and panting are quite obviously seen in any of the above patterns then Ma Xing Shi Gan Tang (Ephedra, Apricot kernel, Gypsum and Licorice decoction) can be combined with any of the two combinations as well.

To read another blog post regarding unique and interesting ways of using classical formulas, click here

A taste of Chinese medical chicken soup, Xiang Hong (项红)

2010-03-26T23:07:00.000-07:00

This is a translation of a case study from a great book titled ‘A Taste of Chinese Medical Chicken Soup’ written by Dr. Xiang Hong in Beijing. This is a case study book which presents several of her own cases as well as numerous by prominent modern Beijing physicians (老医). The case I will be translating is one by professor Fan Zheng-Lun (樊正伦), a great physician who I had the pleasure of observing while in Beijing.

Pre-Menstrual headaches and heart vexation (treated by) calming the liver and clearing heat with the happy free and easy wanderer.

On July 15, 2000 it was professor Fan Zheng-Lun’s clinical day at the ‘Ping Xin Tang clinic’. A 47 year old female patient was presenting her case. Recently her menstrual cycles were arriving early and much heavier than ever with numerous large blood clots. She experienced headaches and distension in her head prior to her cycles along with heart vexation and a sore and achy low back. In addition she was seen in the Gynecology department where she was diagnosed with a uterine myoma and since menopause was approaching, surgery was unnecessary. She felt warm quite easily and found herself quite irritable prior to the cycle.
Professor Fan simultaneously felt her pulse and inspected her tongue. Only the tongues margins were red and there was a thin white coating. The tongue body was swollen with slight teeth marks on the margins. The left bar (guan) position of the pulse was wiry and the cubit (chi) weak. The right pulse had an overall slippery wiry manifestation.

Professor Fan believed this to be a case of Liver depression, Spleen vacuity with a Chong and Ren disharmony causing headaches. Therefore the treatment method would involve clearing the Liver, strengthening the Spleen and regulating the Ren and Chong vessels.
The formula administered was as follows:

(Mu) Dan Pi 9g
Chao Zhi Zi 6g
Chao Bai Zhu 9g
Dang Gui 9g
Fu Ling 9g
Cu Chai Hu 9g
Zhi Xiang Fu 9g
Gui Zhi 6g
Bai Zhi 6g
Zhi Gan Cao 6g
Man Jing Zi 9g
Chuan Xiong 6g
Tao Ren 9g
Bai Shao 12g
Chao Du Zhong 12g

7 Packages were given to be decocted in water.

The patient was explained that the basis of treatment was to regulate the cycle and therefore the formula should be taken one week prior to the start of her cycle.
A month later the patient said that after taking the weeks’ worth of herbs, her headaches and backache had clearly decreased, the menses was not as heavy and the clots were smaller. The patient was instructed to take these herbs again one week prior to her cycle in order to consolidate treatment. According to this method, taking these herbs for several months should have a positive effect on the uterine myoma as well.

This formula is a modified version of “Dan Zhi Xiao Yao San” (Moutan and Gardenia Free and Easy Wanderer powder) with “Gui Zhi Fu Ling Wan” (Cinnamon and Poria pills).
Dan Zhi Xiao Yao San is Xiao Yao San (Dang Gui, Bai Shao, Chai Hu, Huang Qin (1), Chao Bai Zhu, Zhi Gan Cao, Sheng Jiang, Bo He) with Dan Pi and Zhi Zi.
Xiao Yao San is from the ‘Imperial Grace Formulary of the Tai Ping Era’ (He Ji Ju Fang) and is a great Liver coursing, depression resolving, Spleen strengthening, blood nourishing formula. Adding Dan Pi and Zhi Zi increases its ability to clear Liver heat.
This patient had pre-menstrual vexation and headaches which are a manifestation of Liver channel depressive heat, therefore this formula was chosen.
Herbs are selected according to the pattern and re-analyzed if there is no reduction (of symptoms).

When seeing patients with uterine myomas the use of Gui Zhi Fu Ling Wan can be quite efficacious. Gui Zhi Fu Ling Wan is originally found in the 20th chapter of the 'Jin Gui Yao Lue' (Prescriptions from the Golden Cabinet) section on Diseases, Pulses, Patterns and Treatments of Pregnancy related (Obstetric) diseases. Gui Zhi Fu Ling Wan is a very famous and effective Gynecological formula.
Chinese medicine believes that concretions or abdominal masses are accumulations and gatherings in the abdomen becoming clots or accumulated blood creating a very typical heavy menstrual cycle with clots.
Within the formula, Gui Zhi warms and frees the vessels; Dan Pi and Tao Ren attack concretions and accumulations and break static blood. Using Fu Ling disinhibits dampness and Bai shao harmonizes the Ying (nutritive). Altogether these herbs achieve the function of breaking stasis and generating new (blood).

Generally headaches occurring prior to the menses are caused by Liver heat, while headaches occurring after the cycle are governed by blood vacuity. Clinical practice should be based on the system of treatment according to pattern identification.

(1) Huang Qin is not mentioned in the original formula. My initial assumption is that it is merely a typo, but was included in the translation in order to stay true to Dr. Xiang’s book.

Hu Xi-Shu (胡希恕) Case #3- Duodenal Ulcer (十二指肠溃疡)

2010-03-16T10:36:00.000-07:00

Hu Xi-Shu, Shang Han Lun Tong Su Jiang Hua

Bai, Male, 32 years old;

Initial diagnosis was on December 21, 1965: Patient presented with epigastric pain for over a year which has started to increase in severity over the last month. Pain is present prior to and after meals. Accompanying symptoms included belching, vomiting, epigastric focal distension, excessive worry and occasional abdominal fullness and distension. Tongue coating was white and his pulse was wiry and thin. Through a Barium meal investigation he was diagnosed with a duodenal ulcer and gastroptosis.
He was prescribed Inula and Hematite Decoction (Xuan Fu Dai Zhe Shi Tang) combined with Poria Decoction (Fu Ling Yin) and Fritillary bulb and cuttlebone powder (Wu Bei San):

Xuan Fu Hua 3 qian
Dang Shen 3 qian
Sheng Jiang 5 qian
Dai Zhe Shi 3 qian
Zhi Gan Cao 2 qian
Ban Xia 5 qian
Da Zao 4 pcs
Fu Ling 4 qian
Bai Zhu 3 qian
Chen Pi 3 qian
Zhi Ke 3 qian
Wu Zei Gu 3 qian
Chuan Bei 2 qian

Results: After taking three packages of the above formula his epigastric pain, belching, and vomiting decreased. After six packages his epigastric pain resolved and has had no obvious symptoms to this day.

Hu Xi Shu's discussion and elucidation on cold damage 胡希恕，越辩越明释伤寒

2010-02-22T22:41:00.000-08:00

This is an excerpt from one of Dr. Hu's books. It is an elucidation of clause 100 of the Shang Han Lun (On Cold Damage)

In cold damage (1), when the Yang pulse is choppy(2) and the Yin pulse is wiry(3), there should be acute abdominal pain (4) . First administer Xiao Jian Zhong Tang (5) . If there is no reduction (of symptoms), Xiao Chai Hu Tang governs (6).

Interpretation:
A pulse that is floating and choppy, is what is meant by the ‘Yang pulse is floating; at the deep level the pulse is wiry, which is written as ‘the Yin pulse is wiry’. A choppy pulse governs scanty blood and wiry governs cold exuberance. What we have here is cold damage with a floating choppy pulse and a deep wiry pulse, which signifies external blood vacuity and cold exuberance in the interior. According to these laws we should expect to see acute abdominal pain therefore Xiao Jian Zhong Tang is given.
After taking the decoction there is still no reduction of symptoms which means that the condition has yet to be resolved and because Shao Yang has the same pulse (wiry) this is considered a Tai-Yang Shao-Yang combination disease with interior cold. Xiao Jian Zhong Tang only partially treats this condition, therefore we administer Xiao Chai Hu Tang in order to resolve Shao Yang evils, and only then can we offer a cure.

Notes:
Acute abdominal pain originally belongs to both a Xiao Jian Zhong Tang pattern and to a Xiao Chai Hu Tang pattern. Ordinarily Shao yang harbors internal vacuity and central qi insufficiency and although there are Xiao Chai Hu Tang signs, we must first fortify the centre. First Xiao Jian (Zhong Tang), afterwards Chai Hu (Tang). In vacuity treating the interior first is a fixed concept, and rather than treating with the first rule of Xiao Jian Zhong Tang with no effect, it is treated with Xiao Chai Hu Tang. If in abdominal pain the pulse is wiry, this is only interior vacuity and Xiao Jian Zhong Tang can be administered without any relation to Shao Yang.

Xiao Jian Zhong Tang 小建中汤

Gui Zhi (remove skin) 3 liang
Shao Yao 6 liang
Sheng Jiang (cut) 3 liang
Da Zao (broken) 12 pieces
Gan Cao (honey fried) 2 liang
Jiao Yi 1 sheng

For the above six ingredients, use seven sheng of water. Boil until three remain, and remove the dregs. Add the malt sugar and put back on low heat until it melts. Take one sheng warm three times daily. People who vomit easily should not take this decoction due to its sweetness.

Formula interpretation:
The first five ingredients of this formula make up Gui Zhi Jia Shao Yao Tang (Tai-Yin, clause 284), which treats Tai-Yang disease abdominal fullness and periodic pain found after purgation. Adding Yi Tang which is warm and sweet makes it more supplementing. Shao Yao is bitter, sour and slightly cold and by adding the warmth of Yi Tang we have mild supplementation. This is Xiao Jian Zhong Tang.

Jiao Yi is sweet, warm, enriching, nourishing and strengthening. It relaxes tension, strengthens the Spleen and Stomach, boosts Qi and supplements vacuity cold. It governs acute abdominal pain and rumbling intestines (borborygmus). The nature and flavor of both Jiao Yi and Gan Cao are quite similar and are used for Yin, Yang, Exterior, Interior, Repletion and Vacuity, but are especially indicated in interior vacuity. They are unsuitable in abdominal pain due to excessive gastric acid.
Shao Yao is bitter, slightly cold and has the function of mild precipitation.
Jiao Yi and Bai Shao effectively treat abdominal pain, but differentiation must be made between cold, heat, vacuity and repletion. The abdominal pain associated with intestinal tuberculosis offers an opportunity to use this combination.

Notes:
Abdominal pain is found in both vacuity and repletion. Pain on palpation that is not severe even with stronger pressure belongs to Qi pain. Pain on pressure with hardness that refuses pressure is seen in accumulations and gatherings. Qi type pain should not be purged.

1. ‘Cold damage’ signifies Tai-Yang cold damage where the exterior has yet to be resolved. We do know that Xiao Jian Zhong Tang treats the abdominal pain and Xiao Chai hu Tang treats the disease if there is no reduction or lessening of symptoms. This clause is originally a Tai-Yang and Shao-Yang combination disease with interior vacuity cold.

2. ‘Yang pulse is choppy’ means the pulse is felt at a superficial level, plus liquids and blood are not filling and nourishing the exterior and the stomach is weak.

3. ‘Yin pulse is wiry’ means the pulse has a wiry quality at the deep level. A wiry pulse is thin and with strength

4. Acute pain and hyper-tonicity with pain. By the yang pulse being choppy and the yin pulse wiry, we are able to see that there is an insufficiency of liquids and blood and cold exuberance in the interior, so there should be hypertonic pain in the abdomen.

5. Xiao Jian Zhong Tang is a modified version of Gui Zhi Tang. Both these formulas can resolve the exterior, enrich and nourish the blood vessels and through its warm and sweet nature expel cold and stop pain. We can deliberate the meaning of ‘first administer’. In Tai-Yang Shao-Yang combination disease with the addition of vacuity cold in the interior, we should first save the interior and then resolve the exterior or half exterior, half interior aspect. This is the essence and spirit of clauses 93 and 94.

6. No reduction of symptoms, namely means that after taking Xiao Jian Zhong Tang the abdominal pain is not completely gone. Now because both Xiao Jian Zhong Tang and Xiao Chai Hu Tang symptoms exist, we first treat the interior and afterwards the exterior. Since Xiao Jian zhong Tang only treated half the condition we follow it with Xiao Chai Hu Tang to effect a complete resolution of symptoms

Hu Xi Shu (胡希恕) Case #2-Cough

2010-02-08T22:53:00.000-08:00

38 year old female first seen on Feb 12 1966. Patient had suffered with a dry cough and itchy throat for over a month. She had taken a modified version of Zhi Sou San (Stop Cough Powder), and modified versions of Sang Xing Tang (Mulberry Leaf & Apricot Kernel Decoction) and Mai Men Dong Tang (Ophiopogonis Decoction). The cough not only failed to improve but actually got worse. Currently she presents with a dry cough, itchy throat, dry mouth with no desire to drink, belching, chest oppression, loose bowel movements occurring once or twice daily, a thick slimy tongue coating and a slippery thin pulse.

Prescription given was Ling Gan Wu Wei Jiang Xin Xia Tang (Poria, Licorice, Schisandra, Ginger, Asarum and Pinellia Decoction) with additions and subtractions:

Fu Ling 4qian
Xi Xin 2 qian
Wu Wei Zi 4 qian
Ban Xia 5 qian
Zhi Gan Cao 2 qian
Chen Pi 5 qian
Sheng Jiang 3 qian
Xing Ren 3 qian
Ku Jie Geng 3 qian
Zhi Pi Pa Ye 3 qian

Results: After taking one package of the above formula, the cough had decreased. After three packages the cough stopped.

The above patient suffered from a dry cough, itchy throat and dry mouth commonly seen in Lung heat, Liver fire or yin vacuity. In addition this patient also had no desire to drink, belching, chest oppression, sloppy stools, a thick slimy tongue coating and a slippery pulse. All these signify a phlegm-rheum pattern. The dry cough is from phlegm-rheum invading the lung and impaired diffusion and downbearing of the lung. The dry cough and itchy throat are a result of stagnation and obstruction to fluids which are unable to bear upwards. Therefore when treating this type of dry cough, using bitter cold, heat clearing herbs or sweet cold Yin enriching herbs will only worsen the stagnation and obstruction of fluids and cause phlegm-rheum to harass the upper (burner) and delay recovery. Because phlegm was treated by restraint and the formula was chosen on the basis of the pattern, the use of only three packages were needed for recovery.

Hu Xi-Shu (胡希恕）Case #1-Cough

2010-02-08T16:37:00.000-08:00

Case #1 Hu Xi-Shu, Shang Han Lun Tong Su Jiang Hua （伤寒论通俗讲话）
Huang, Female, 38 years old

Initial diagnosis was on Feb 12, 1966: Patient presented with a cough combined with expectoration of white phlegm, itchy throat, chest fullness, a dry throat with no desire for fluids and bilateral rib side distension. She has already taken several packages of herbal formulas to no avail. Her tongue coating was thick and slimy, and her pulse slippery-thin.

This pattern belongs to phlegm-rheum harassing the upper (burner), and impaired depurative downbearing of the lungs. This was treated by warm transformation and downbearing counterflow with a modified version of Ban Xia Hou Po Tang.

Ban Xia 4 qian
Hou Po 3 qian
Fu Ling 4 qian
Su Zi 3 qian
Ju Pi 5 qian
Xing Ren 3 qian
Jie Geng 3 qian
Sheng Jiang 3 qian

Results: After taking only 2 packages of the above herbs, the cough had stopped.

Ban Xia Hou Po Tang is originally from the Jin Gui Yao Lue (Essentials from the golden cabinet) in the miscellaneous gynaecological diseases section. Originally used for “female patients with the sensation of fried meat in the back of the throat”
Dr. Hu believed this formula to be Xiao Ban Xia Jia Fu Ling Tang with the additions of Hou Po and Su Ye. It is used in phlegm-rheum qi bind manifesting with chest fullness, throat blockage and cough. It warms and transforms phlegm-rheum, downbears counterflow and regulates Qi. The patient above was manifesting with a phlegm-rheum cough, therefore the use of this formula offered a quick resolution.
The original formula contains (Zi) Su Ye, but Dr. Hu prefers to use (Zi) Su Zi. If there are obvious exterior signs present, then (Zi) Su Ye may be added, and you may also add either Gui Zhi Tang or Ma Huang Tang. If there are obvious heat signs then Sheng Shi Gao may be added. If there is an enduring cough due to cold rheum, without any obvious exterior signs, then combine with Ling Gan Wu Wei Jiang Xin Xia Tang (Poria, Licorice, Schisandra, Ginger, Asarum, and Pinellia Decoction).

The Concept of 'Survival with Tumors' in the Treatment of Cancer

2010-02-08T13:33:00.000-08:00

By DaiHan Zhou
Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China, 510405

Translated by Eran Even
Email:eraneven@hotmail.com

Originally published in the International Journal of Integrative Oncology, Volume 3 No. 1, 2009

Cancer comprises more than 100 kinds of diseases, seriously endangers human health and can affect almost every aspect of the human body.
Traditional Chinese medicine (TCM) has a long history of identifying and treating cancer. As early as the Shang dynasty (1600 BC-1046 BC), there were records of “tumor diseases” written in oracles. The Classic of Mountains and Rivers, a book compiled in the Warring States Period (475 BC-221 BC), records diseases related to tumors, such as malignant boils, goiters, carbuncles, dysphagia, etc. In a Jin Dynasty calligraphy work, composed in 7 A.D. there is mention of the surgical removal of tumors. In the Book of Wei Ji and Prescriptions of Renzhai Zhizhi, both composed in the Song dynasty (960-1279), we see for the first time the Chinese character for cancer. There are numerous records of experiences in describing and treating tumors recorded in ancient TCM books, including abdominal masses,dysphagia and various other tumors.
Due to the limits of science and technology at that time, most of those records were usually quite literal in describing localized symptoms of cancer or tumors outside of the body, for example:
‘hard as a rock’, ‘ulcers unable to heal’ and even infecting the internal organs.

It wasn’t until modern times that TCM oncology developed an independent clinical discipline.
On the basis of his own experience and from a long clinical practice, Prof. Zhou emphasizes that the pathogenesis of cancer from the TCM oncology perspective, is as follows: “Cancer exists in or issues forth from the internal organs, and this toxicity harbors deep in the body”. Cancer existing or issuing from the internal organs means that, afflictions to the internal organs manifest with external localized changes. Toxicity harboring deep in the body simply specifies that these external manifestations are the result of internal changes.
Malignant tumors are a form of chronic disease, characterized by deficiency as well as excess. During long-term treatment, there may be a stage of so-called ‘survival with tumor’, if the pathogenic factor (cancer) cannot conquer the Vital Qi. During this stage, the focus of TCM treatment is based on pattern identification with the intent of relieving symptoms, improving the quality of life and prolonging survival
time. These are the characteristics and benefits of TCM treatment in cancer.

With the interpretation of tumor genomics and a profound understanding of their pathological changes, in 2006 the World Health Organization (WHO) began to define malignant tumors as a manageable disease, resulting in a gradual acceptance by the general public of tumors simply being a form of chronic disease.
Certain chronic non-contagious diseases such as hypertension and diabetes are characterized as so-called “survival with disease” conditions which to some extent is a similar concept to ‘survival with tumors’ in TCM oncology.
Modern medicine used to take ‘survival without tumors’ as the primary objective, which would often result in so-called ‘clinical over-treatment’, and even to the point where chemotherapy would not cease until the patient died. Nowadays, as most patients diagnosed with advanced cancer are unable to be cured, the treatment focus has changed, with the aim being the improvement of symptoms and extension of survival time and not only on tumor response. This shift of strategy in the treatment of advanced cancer is in fact, consistent with the concept of ‘survival with tumors’.
The TCM approach to the treatment of tumors is a form of holistic therapy based on pattern identification and disease differentiation and is a method of whole body, individualized treatment.
The use of Chinese herbal medicine can not only improve symptoms and control tumors, but can also reduce the side effects from conventional therapies, radiation and chemotherapy, when used in combination. In addition, Chinese herbal medicine can be used to prolong survival rates by reducing the chance of relapse and metastasis. Due to these above factors, TCM should be utilized in the early stages of cancer, and used throughout the entire course of treatment, and not just as a last resort for advanced cancer patients.
Popularizing the concept of, ‘survival with tumors’ and giving up the, ‘survival without tumor’ ideology is useful in avoiding overtreatment. Increasing the role of traditional Chinese medicine in a multi-disciplinary setting, will contribute to increasing the therapeutic efficacy of cancer treatments, and assist patients with advanced cancer in improving quality of life and extending survival rates, specifically, ‘survival with tumors’.
This is the Chinese method of treating cancer, which is characteristic of
traditional Chinese medicine.

A review on the objective treatment of Cancer with Acupuncture and Chinese Herbal Medicine – Part 1

2010-02-08T13:29:00.000-08:00

A review on the objective treatment of Cancer with Acupuncture and Chinese Herbal Medicine – Part 1
By Dr. Kathryn Tian Dr. TCM, M.Sc
Translated by Dr Eran Even Dr. TCM

I recently attended a lecture where the discussion was about the recent rise in cancer rates associated with the grave state of environmental pollution. Consequently more and more people were turning to health food products to strengthen their bodies.

If we do get cancer, what really helps? Surgery is damaging and invasive, chemotherapy is toxic.

A cancer cell growing to the size of an egg could take 10 to 15 years to develop!
“Don’t worry, just look after your body” they said.

“Everybody knows that health food products are protective and strengthening, are a means of preventing illness and can be used for treating certain diseases”, however, if a person gets cancer how can you not let them receive standard medical treatment immediately? The patients biggest concern is living another day.
Having an objective place to evaluate these products as a viable treatment option will ensure that patients are receiving the greatest benefit, which of course is the most basic objective of the physician.

Since coming to Vancouver over 8 years ago, I’ve had the opportunity to see more and more cancer patients. I would like to take this opportunity to share a little of my experience.

Is there a secret formula that can effectively treat cancer?
Can this ‘secret’ formula be used in conjunction with chemotherapy, radiation and surgery?

In Beijing, due to the integrated use of Western and Chinese Medicine in the treatment of cancer, the opportunity to see cancer patients is quite high for the Chinese medical physician.
The majority of patients coming to see me here in Vancouver are not without their suspicions. The major reason for this, is that most patient’s oncologists are unaware of, or unclear on the benefits of Chinese Medicine, and do not allow them to take Chinese herbs, stating that they would not be responsible for treatment outcomes. When specialists say this to their patients very sternly, it instills a greater sense of fear in an already anxious and worried person.
There are some patients who come to me and say very straightforwardly, “I know that we Chinese use integrated methods to treat cancer, even my family knows this, but when my Doctor says this to me I get so scared.”
There are some patients who will come and see me with great hope. They’ll say, “Dr Tian, can you use your secret formula to treat me?” To a suspicious patient I might say, “The best method of treating cancer is using an integrated approach, which depends on your personal decision, as it is you alone that must grasp the end of your life”. To patients looking for a secret formula I would say that determining treatment based on pattern identification is the secret formula. You must not focus on the cancer but on your life.
I remember in Beijing doing clinical rounds with my mentor Dr.Sun Gui Zhi, and noticing that there was never anything really special about the herbal formulas she used. I wondered how could these uncomplicated formulas be extending the lives of all these late stage cancer patients? This one time I was unable to hold back any longer, so I asked. Dr. Sun said treating cancer is a lengthy battle. “You must always strengthen the right Qi. Beat it by focusing on living, and then how can it grab you? You see that although many of my patients are in late stages of cancer their quality of lives are good. The trick is to find the relative strength between the right Qi and the pathogenic factors. Grasping this well will ensure that the effectiveness of treatment will be greater and greater. Being unable to grasp this concept will only result in loss”.
So I try to learn these words by heart and put in great effort to truly grasp them.
I really have some great patients. There are two aspects to these patients. The first being the treatment results and the second being their desire to grasp onto their lives. I have this one patient with breast cancer that has metastasized to the lung. She is in a very advanced stage. She is doing chemotherapy, taking Chinese herbs and taking various health food products. Every time I see her I can’t believe my eyes. She looks beautiful and lustrous. I always say to her that I can’t believe she is in an advanced stage, and she says that everybody always says that. Even the nurse that was administering her injection had to ask if she was a patient, giving her more and more faith that she can beat cancer. “If things continue this way I could travel, cook delicious food for my family and make myself up even more beautiful. I’m so happy, I’m great”. From the bottom of my heart I truly admired her courage. I remember those days when she had just discovered that her cancer had spread to her lungs and she came to see me. She felt as if she would collapse, as her doctor told her she wouldn’t live longer than 6 months. I remember telling her that she must go on living. Treatments are being discovered and changing daily. She must keep on living! Immediately I made her a Chinese herbal formula to course and rectify Liver Qi, because in Chinese Medicine it is said that the Liver channel passes through the breasts, in addition, coursing and rectifying Liver Qi has the effect of calming the spirit and increasing immune function to directly resist cancer. She was very obedient. She drank her herbs and was very relaxed. To date, 3 years have passed and she is doing great. How could I not be ecstatic? In addition I would like to mention her husband. He was always so calm and so supportive. I really believe that family support is one of the most important aspects of effective cancer treatment.
Here I have an opposite case. Once while working at the Guang An Men hospital in Beijing in the oncology department, I was responsible for an elderly man with late stage liver cancer. Although he had jaundice and ascites, with his integrative therapy, his spirit and body were kept strong. He was able to look after himself. But this one day his son came to the hospital and didn’t know what was wrong with his father and ended up quarrelling with him. The next day I went to see this man and the nurse told me that he had already passed away. Although his chart said that he had died from liver cancer, we all believed that he died from a loss of hope and the will to live. Here I had also seen a late stage cancer patient who was taking Chinese herbs with good effect, but her son said to me that the oncologist said she could not be saved and that we should give up. It is a major blow when the family begins to give up. At that point what’s the use of having a doctor? To this date I can’t forget the look of doubt in that woman’s sons’ eyes. I thought to myself what if I was to say that your mother was in late stage cancer and there was no hope, you would not think I am a liar. However, I can’t say this, the reason being experience. Another day while doing a night shift in the oncology department, a patient had suddenly started to crash. He had late stage prostate cancer that had already spread to the bones and brain. He was sweating profusely and his blood pressure was dropping. His wife said to give up as he was in severe pain, but she was unwilling to sign a do not resuscitate form. We had no choice but to rescue him. We immediately administered a Ginseng and Aconite injection. The sweating stopped and his blood pressure returned to normal. The next morning during rounds we saw the patient who was unable to speak hold up both his hands to offer us thanks. I left the ward with tears in my eyes. His wife as well as all of us doctors didn’t expect that he had so much hope and reluctance to leave his life. From then on I knew that I would never tell a patient there is no hope.
The breast cancer patient mentioned above did not receive any additional treatments after conventional treatments. Two years later the cancer had returned and metastasized to the lungs.

I have another patient that while undertaking chemotherapy took Chinese herbs and to date there has been no relapse or metastasis. The following is her case history.

Female, 50 years old. In April 2004 she underwent a full mastectomy and in May began chemotherapy. Immediately following her first chemotherapy treatment she experienced a dry mouth and throat, which were worse at night. Concurrently she experienced hair loss, her tongue was dull-dark and her pulse was wiry. The pattern identification was damage to both Qi and Yin and blood-humor insufficiency. The formula administered contained: Yu Zhu, Sha Shen, Mai Dong, Gou Qi Zi, Fu Ling, Bai Zhu, Bai Shao, Chen Pi. After taking 5 days worth of the formula, the dryness in her mouth and throat had improved significantly, however the hair loss was still present. In June she undertook her second round of chemotherapy treatments. Once again she experienced dryness of her throat, with difficulty swallowing and extreme fatigue. She experienced very little desire to eat, her tongue body was swollen and pale and the tongue coating was thick and white. The pattern identification was major damage to the central Qi and internal generation of phlegm turbidity. Chinese Medicine holds that the Spleen and Stomach are the source for the generation and transformation of Qi and Blood. It is of upmost importance that cancer patients avoid damaging their Spleen and Stomach. It was urgent to strengthen her Spleen, boost Qi as well as enrich and nourish true Yin with: Mu Xiang, Sha Ren, Chen Pi, Fa Xia, Tai Zi Shen, Fu Ling, Huang Jing and Bai Shao. After taking this formula, her appetite increased, her energy had substantially improved, but the dryness in her throat was still present. The patient had the sensation of a hard substance obstructing her throat. The plan was to administer a formula to rectify Qi and transform phlegm combined with food therapy suitable to this patient with: Autumn pears, lotus root, milk, fresh ginger root and chives blended into juice. She was to drink one cup a day. After drinking this preparation the dryness in her throat was gone and her appetite had improved even more. In July the patient underwent her third round of chemotherapy. Due to toxic nature of the chemo drugs the patient experienced side effects of frequent belching, a decrease in energy, nausea, a bland-tasteless feeling in the mouth and tightness in her throat, all intensifying at night. Her tongue was pale and tender, the coating thick and slimy and her pulse was wiry and slippery especially on the right chi position. Her white blood cell count had dropped to 0.8. This is a very dangerous situation signaling a very vacuous or deficient right Qi and exuberance of pathogenic factors. I gave her three packages of one of my own formulations named ‘Chemotherapy Blood increasing decoction’. After taking this formula her white blood cell count increased to 4.5, and she was able to smoothly finish her round of chemo. On a recent follow up with this patient, there has been no relapse of the cancer and she is living a normal life.

In short, I believe that the most effective means of treating cancer is a comprehensive approach including rationality, specialized study and art. These methods should include Western Medical treatments, Chinese Medicine, health food products, food therapy and psychological treatments. We hope that one day all patients can say, “I got cancer, so what? I’m good. I’m happy!”

Tian Hua Fen is good for treating Jaundice

2010-02-08T13:08:00.000-08:00

Tian Hua Fen is good for treating Jaundice

Cheng Du University of Traditional Chinese Medicine, Department of Chinese Herbs

By: Yang Ai
Journal of Traditional Chinese Medicine, Vol. 47, September 2006, page 651

Translated by Eran Even Dr. TCM, R.Ac
Vancouver, BC

Tian Hua Fen (天花粉): cold nature; sweet, bitter, sour flavor. Has the action of engendering liquid, transforming stasis and dispersing swelling.
The herbs sweet and sour taste is able to generate liquids, the bitter cold nature is able to clear heat with further functions of generating liquids, moistening dryness, alleviating thirst, transforming inflammation, dispersing swelling and draining pus. It is used quite often in clinical practice for heat disease with damage to liquids, vexing thirst, dispersion thirst, dry heat coughing and in toxic, swollen sores and abscesses.
In addition, my father Chief Doctor Yang de Ming with years of clinical practice uses Tian Hua Fen in the treatment of jaundice with liver inflammation and obtains comparatively good results.

For example, on March 2nd of 2003 a 25 year old male came in for a consultation. He was suffering from yellowing of the eyes and skin for 6 days, accompanied by an aversion to food, especially oily foods, dry retching, unsettling heart palpitations, dry and bound stools for 6-7 days, red tongue tip, dry, yellow tongue coating and a wiry fine pulse.
Liver function tests revealed bilirubin (TBil) at 60.84 umol/L, the Aspartate Amino Transferase (AST) at 112U/L and the Alanine Amino Transferase (ALT) at 119U/L.
The diagnosis was chronic jaundice with liver inflammation. The medicinals used were:
Tian Hua Fen 60g
Long Dan Cao 15g
Chai Hu 10g
Sheng Di Huang 20g
Zhi Zi 10g
Shi Hu 15g
Zhi Mu 20g
Dan Dou Chi 12g
Sheng Da Huang (added at the end of the decoction)
Taken in decoction, 1 package per day.

After 5 packages the yellowing and the aversion to food was clearly changing for the better, in addition there were 2 bowel movements a day. The patient was instructed to take another 20 packages of the above formula. Afterwards all symptoms were gone and the liver function tests were normal.

This medicinal is bitter, sweet, sour, slightly cold, moistens dryness and generates liquids and can be used in patterns of jaundice with depletion of fluids and constipation.
Around 50-100g can generally be used when prescribing large doses of Tian Hua Fen.

Chinese Medicine Case Studies

A case of Shào Yīn headache- Wú Pèi-Héng (吴佩衡）

A Menopausal case

Poetry of Bái Jū-Yì (白居易)

Hú Xī-Shù (胡希恕)- A Case of Prostatitis

Hú Xī-Shù (胡希恕)- A case of Angina Pectoris

Huáng Lián assists sleep- A case by Huáng Huáng （黄煌)

A Case of Wü Méi Wán (Mume Pill)

Hu Xi-Shu (胡希恕): Two cases of Meniere’s disease

Two cases using Li Zhong Tang (Rectify the Centre Decoction)

Two Cases of Wind Rash (Urticaria)

Rib-side pain (Hepatitis)

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning

Translators Unite!!!

A Case of Infertility

Case study of Zhang Xiang-Fu (张祥福)

It's been a while......

Hu Xi-Shus' approach in the treatment of coughs

Hu Xi-Shus’ unique approach and commonly used formulas for treating wheezing and panting

Two Cases on the use of Si Ni San

Stomach Pain and Irregular menstruation rectified with Si Ni Huang Lian (Tang)

A Case of Rheumatic Arthritis

Hu Xi Shu (胡希恕）Case #5- Foot pain

Hu Xi Shu’s Love affair with Da Chai Hu Tang 胡希恕真的爱大柴胡汤!!

Using high dosages of Bai Hua She She Cao in the treatment of Acne

Hu Xi-Shu’s commonly used formulas for impediment syndrome (痹证 Bi Zheng)

Hu Xi-Shu (胡希恕) Case #4-Duodenal Ulcer

Zhu Ren-Kang- Collection of clinical experience in dermatology （朱仁康-临床经验集-皮肤外科）

Clinical usage of Bupleurum and Cinnamon Twig Decoction (柴胡桂枝汤)

Case Studies of Wu Pei Heng (吴佩衡医案)

A case of Shao-Yin Infertility

5 Steps to 'Shang Han' treatment

Thoughts on a Quiet Night

Can Major Buplureum Decoction treat panting & wheezing?

A taste of Chinese medical chicken soup, Xiang Hong (项红)

Hu Xi-Shu (胡希恕) Case #3- Duodenal Ulcer (十二指肠溃疡)

Hu Xi Shu's discussion and elucidation on cold damage 胡希恕， 越辩越明释伤寒

Hu Xi Shu (胡希恕) Case #2-Cough

Hu Xi-Shu (胡希恕）Case #1-Cough

The Concept of 'Survival with Tumors' in the Treatment of Cancer

A review on the objective treatment of Cancer with Acupuncture and Chinese Herbal Medicine – Part 1

Tian Hua Fen is good for treating Jaundice

Hu Xi Shu's discussion and elucidation on cold damage 胡希恕，越辩越明释伤寒