Author: eraneven

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

On By eranevenIn Case Studies （医案), Formulas (方剂), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)2 Comments
 

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

On By eranevenIn Medicinals (中草药), Translations & Writings (译著与文章)Leave a comment

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)

On By eranevenIn Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)4 Comments

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. hu xi-shu.jpg

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

On By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)4 Comments

hu xi-shu.jpgMr. 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）

On By eranevenIn Case Studies （医案), Translations & Writings (译著与文章), Zhū Rénkāng (朱仁康)1 Comment

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)

On By eranevenIn Formulas (方剂), Liú Dùzhōu (刘渡舟), Translations & Writings (译著与文章)Leave a comment

%E5%88%98%E6%B8%A1%E8%88%9F.jpgShoulder 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 Study of Wu Pei Heng (吴佩衡医案)

On By eranevenIn Case Studies （医案), Huǒ Shén Pài (火神派), Jīng Fāng (经方), Translations & Writings (译著与文章), Wù Péihèng (吴佩衡)Leave a comment

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’ (吴附子). 

 

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

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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

On By eranevenIn Case Studies （医案), Fàn Zhōnglìn（范中林), Hú Xīshù (胡希恕), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)4 Comments

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

On By eranevenIn Poetry (诗), Translations & Writings (译著与文章)1 Comment
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.