Zé Xiè from Zhāng Zhì-Cōng’s Běn Cǎo Chóng Yuán (本草崇原)

On May 9, 2020April 2, 2021 By eranevenIn Medicinals (中草药), Translations & Writings (译著与文章), Zhāng Zhìcōng (张志聪)Leave a comment

Zé Xiè from Zhāng Zhì-Cōng’s Běn Cǎo Chóng Yuán (本草崇原)

The Qi and flavor of Zé Xiè are sweet, cold and non-toxic. It treats wind, cold, damp impediment, difficult lactation; [it] nourishes the five viscera and boosts qi and strength, makes one plump and healthy, and disperses water. Taken for extended periods of time, the ears and eyes will become sharp and bright. It reduces hunger, extends the years [life], lightens the body, brightens the complexion, and [gives one] the ability to walk on water. [1]

Zexie is a water medicinal, which is sweet and cold. It is able to ascend the qi of water-yin upwards and nourish center earth. It governs the treatment of wind, cold, damp impediment, by initiating the water-fluids in the lower body, which then from center earth irrigate the muscles, interstices and skin. Breast milk is the fluid of the middle burner, so by the nourishment of water-fluids in center earth, it is able to treat difficult lactation. The five viscera receive the essence of food and grains, and since zexie flows and pools in center earth, it can therefore nourish the five viscera. The kidneys are the unyielding official, whose water essence supports the upper, and therefore boosts qi and strength. By irrigating the muscles and interstices from center earth, [zexie] is able to make one plump and healthy. Water qi first ascends then descends, therefore [zexie] disperses water. The sharpening and brightening of the ears and eyes after being taken over an extended period of time are the result of water assisting fire. Decreasing hunger and extending the years is due to water nourishing the earth. Lightening the body and brightening the complexion is due to the outward flow of water. With [giving one] the ability to walk on water, it can be said that [when one’s] ears and eyes are sharp and bright, and hunger is reduced, the years are extended, the body is lightened, and the complexion is bright, [they feel as if] they can walk on water!

[1] This last line is very interesting and can be translated and interpreted a couple different ways. The first translation, which is the most common interpretation and the one that makes sense according to later commentaries, is “the ability to walk on water.” Based on Zhāng’s reasoning it makes the most sense. However when first reading the line from the Běn Cǎo, I read it as “[zexie] is able to move water upwards.” This is a common function of the plant and the justification used for many of the positive effects experienced from taking this medicinal, therefore it would make sense. As there is no actual commentary found after the original entry, it’s impossible to know for sure what Shén Nóng meant with this string of characters.

Zhāng Zhì-Cōng on Bái Zhú

On April 19, 2020April 2, 2021 By eranevenIn Medicinals (中草药), Translations & Writings (译著与文章), Zhāng Zhìcōng (张志聪)Leave a comment

%E6%9C%AC%E8%8D%89%E5%B4%87%E5%8E%9F.jpg Bái Zhú from Zhāng Zhì-Cōng’s Běn Cǎo Chóng Yuán (本草崇原)^[1]

The qi and flavor of Bái Zhú are sweet^[2], warm, and non-toxic. [It] treats wind, cold, damp impediment, dead flesh, tetany, jaundice; stops sweating, expels heat, and disperses food. Make into fried cakes. Long-term consumption lightens the body, extends the years, and relieves hunger.

Bái Zhú’s qi and flavor is sweet and warm, and is abundant in fat and fluids. It is a medicinal for harmonizing and regulating spleen-earth. A major medicinal for treating wind, cold, damp impediment, Sù Wèn chapter 43 [‘discussion on impediment’] says “When the qi of wind, cold and damp all arrive together, they merge and result in impediment.” The taste of Bái Zhú is sweet and its nature is warm, for it supplements and boosts spleen earth; when earth qi moves, then the qi of the flesh moves externally to the skin and internally to the channels and vessels, therefore, impediment due to wind, cold and damp can be treated. The spleen governs the flesh, and (Bái Zhú) treats dead flesh, by moving spleen qi. In addition, the spleen governs the four extremities, and in tetany, the four extremities are strong but in disharmony. The color of the spleen is yellow; in jaundice the body and the eyes are yellow and the earth is deficient. Bái Zhú supplements the spleen therefore both tetany and jaundice can be treated. Stopping sweating (is achieved) through (the medicinals effect in assisting) the earth in overcoming dampness. Expelling heat refers to the expelling of deficient heat of spleen-earth. For dispersing food, (Bái Zhú) helps spleen-earth transport and transform. Fried cakes are made as it is said that Bái Zhú is rich in fats and can therefore treat dryness of spleen-earth. When made into cakes the flavor is sweet, warm and its nature is to enrich and moisten, thereby harmonizing and settling earth qi. As a result, the body is lightened, the years are extended and hunger is relieved.

Cāng Zhú (addendum)

Bái Zhú is superior to Cāng Zhú. When one desires to supplement the spleen then use Bái Zhú. If one desires to move the spleen, then Cāng Zhú is used. If both these functions are desired, then both can be used in combination. So for example, ‘to supplement more and move less, use Bái Zhú more and Cāng Zhú less’, while to ‘move more and supplement less, use Cāng Zhú more and Bái Zhú less.’^[3]

The Běn Jīng does not differentiate between Cāng or Bái (Zhú). Master Zhāng (Zhòng-Jǐng) in his Shāng Hán Lùn always used Bái Zhú, while in his Jìn Guì Yào Lüè used Chì (Red) Zhú^[4]. It is only when arriving at Táo Hóng-Jǐng’s Míng Yī Bié Lù (Additional Records of Famous Physicians) that the two are differentiated, with key information on both Chì and Bái Zhú. Chì Zhú is Cāng Zhú, and its function and use is slightly similar to Bái Zhú, as it relates to the main treatments in the Běn Jīng. However, Bái Zhú is sweet and Cāng Zhú is bitter; Bái Zhú stops sweating while Cāng Zhú promotes sweating, therefore the reference to stopping sweating in the original text should be removed and not recorded! Later commentators say that Cāng Zhú is bitter, but in actual fact it is sweet and slightly bitter.

^[1] Note that the original text contains more information on the identification, harvesting and processing of the herbs, however, I have opted to merely translate the clinically relevant information from the text, so this translation is by no means a compete rendering of the original work.

^[2] It’s interesting here that Zhāng went ahead and changed the entry from the Shén Nóng Běn Cǎo Jīng referring to Bái Zhú as sweet, where the original text considered the medicinal bitter. He does go onto to say “The Běn Jīng refers to this medicinal as bitter, Táo Hóng-Jǐng calls it sweet, Zhēn Quán considers it sweet and acrid, while Zhāng Gǎo refers to it as bitter and sweet. If collected in the summer, the plant is more acrid and less sweet; if collected in the winter, it is more sweet and less acrid, while more bitter if collected any other time.” It is clear from this passage that Zhāng sides with Táo on this one.

^[3] Rhythmic mnemonics have been a major feature of Chinese medicine to aid in increasing memorization and therefore the recall of long passages or complex bits of information. The nature of the Chinese language is as such that one can contain an enormous amount of information in just a few characters.

^[4] Chi Zhu (赤术) is an alternate name for Atractylodes root, and in this text refers specifically to Cang Zhu.

Zé Xiè Tāng from the Jīn Guì Fāng Gē Kuò

On December 1, 2017November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)Leave a comment

澤瀉湯

Zé Xiè Tāng

Alisma Decoction

治心下有支飲, 其人苦冒眩者, 主之。

A treatment for propping rheum below the heart, where the person suffers from veiling dizziness, (this formula) rules it.

澤瀉（五兩）白朮（二兩）

zé xiè	澤瀉		15g
bái zhú	白朮		6g

上二味, 以水二升, 煮取一升, 分溫再服。

Simmer the two ingredients above in 400 ml, until reduced to 200 ml. Divide and take heated in two doses.

Song 歌曰:

清陽之位飲邪乘, 眩冒頻頻苦不勝; 澤五為君朮二兩, 補脾制水有奇能。

The location of clear yáng has been overwhelmed by the presence of pathogenic rheum, causing (one to) suffer from frequent veiling dizziness which is difficult to endure; fifteen grams of the sovereign zé xiè and six of bái zhú, have the special ability of supplementing the spleen and controlling water.

Commentary by Lín Lǐfēng[1] 受業林禮豐按:

心者, 陽中之陽。頭者, 諸陽之會。人之有陽氣, 猶天之有日也。天以日而光明, 猶人之陽氣會於頭而目能明視也。夫心下有支飲, 則飲邪上蒙於心, 心陽被遏不能上會於巔, 故有頭冒目眩之病。仲師特下一“苦”字, 是水陰之氣\\盪漾於內, 而冒眩之苦有莫可言傳者, 故主澤瀉陽。蓋澤瀉氣味甘寒, 生於水中, 得水陰之氣而能利水, 一莖直上, 能從下而上, 同氣相求, 領水陰之氣以下走, 然猶恐水氣下而復上, 故用白朮之甘溫, 崇土制水者以諸之, 猶治水者之必筑堤防也。古聖用方之妙, 有如此者; 今人反以澤瀉利水伐腎, 多服傷目之說疑之。其說創於宋元諸醫, 而李時珍、張景岳、李士材、汪讱庵輩和之, 貽害至今弗熄。然天下人信李時珍之《本草》者, 殆未讀《神農本草經》耶? 余先業師《神農本經小注》最詳, 願業斯道者, 三復之而後可。

The heart is yáng within yáng; the head is the gathering place of all yáng. Humans have yáng qì, as heaven has the sun. Heaven, by means of the sun is bright, as such human\’s yang qì gathers in the head and eyes providing bright vision. When there is propping rheum below the heart, water rheum will ascend and cloud the heart obstructing heart yáng, which is (then) unable to gather at the top of the head, causing dizziness and dizzy vision. Master Zhòng used the following character “苦” (kǔ) to convey the suffering of dizziness, (resulting from) the qì of water yīn agitating and flowing into the interior. This is ruled by zé xiè tāng. The qì and flavor of zé xiè tāng is sweet and cold, and since it grows in water, where it obtains the qi (of water yīn), it is able to disinhibit water. (Similar to the way) the stalk ascends vertically it can (help) bring the qì together from the bottom to the top and guide the qì of water yīn in its downward movement. However (with) fear of water rising again after it has descended, sweet and warm bái zhú is used so earth can restrain the various forms of water so while still treating water, an embankment is built. The ancient sages were very clever in using formulas like these.
People nowadays, are administering copious amounts of zé xièto disinhibit water and quell the kidneys, which damages the objective (of this) doctrine and (creates) doubt (of its effectiveness). This doctrine began with the physicians of the Sóng[2]and Yuàn[3]dynasties, as well as contemporaries such as Lǐ Shízhēn[4], Zhāng Jǐngyuè[5], Lǐ Shìcái[6], and Wāng Rènān[7], who have left a legacy, which has yet to die even to the present day. Even though people of the world trust the words of Lǐ Shízhēn’s Běn Cǎo, why have almost (none of them) read the Shén Nóng Běn Cǎo Jīng? My passed masters’ copy of the classic was annotated with extreme detail, and it is my hope that one follows this way in their course of study, repeatedly returning to (the classic).

[1] Lín Lǐfēng was believed to be a student of Chén Xiūyuán. The characters 受業can be translated as ‘to receive instructions’, ‘to study’, ‘to learn from a master’, or as a first pronoun as ‘I’, or ‘your student’, often used as a title by a teachers’ disciple. I have opted to translate this as the latter, but in the interest of keeping the translation clean, have left is as commentary by Lín Lǐfēng, as opposed to ‘Commentary by I (your student) Lín Lǐfēng’.

[2] Sòng Dynasty (960–1179 A.D.)

[3] Yuán (Mongol) Dynasty (1260–1368 A.D.)

[4] Lǐ Shízhēn (1518-1593), Míng botanist and pharmacologist, as well as the author of the Compendium of medical herbs 本草綱目

[5]Late Míng dynasty physician who wrote several books including the ‘Rectification of the Materia Medica’本草正

[6] Míng dynasty phyisician who wrote several books including the ‘Essential Knowledge from the Inner Classic’內經知要

[7] Wāng Áng (1615-1694), Late Míng and early Qīng dynasty physician who wrote the ‘Essentials of the Materia Medica’ 本草備要

Huáng Yuán-Yù on line 80 of the Shāng Hán Lùn

On October 22, 2017March 31, 2021 By eranevenIn Huáng Yuányù (黃元御), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)Leave a comment

“伤寒，医以丸药下之，身热不去，微烦者，栀子干姜汤主之。”

“In cold damage, (which was) treated with a great purging pill; (if) the fever has not abated (and there is) slight vexation, Zhī Zǐ Gān Jiāng Tāng governs”.

This formula treats cold damage following major purgation (manifesting with) body heat and slight vexation.
(Here) major purging has injured center qì, with turbid yīn ascending counterflow, and the generation of stasis, (which) injures the bowels (fǔ organs); this results in obstruction to imperial fire, which is unable to descend, therefore there is body heat and heart vexation. Zhī Zǐ Gān Jiāng Tāng is used, as gān jiāng descends counterflow and warms the center, while zhī zǐ ejects stasis and eliminates vexation.

Zhī Zǐ

Bitter flavor, cold nature; enters the hand shào yīn heart, foot tài yīn spleen, foot jué yīn liver, and foot tài yáng bladder channels.
Clears heart fire and eliminates vexation depression, drains spleen earth and eliminates damp heat. (It) ejects turbid stasis from the chest and diaphragm and cools smokey-yellowing from the skin.

Gān Jiāng

Acrid flavor, warm nature; enters the foot yáng míng stomach, foot tài yīn spleen, foot jué yīn liver, and hand tài yīn lung channels. (Gān Jiāng) dries dampness, warms the center, moves depression, downbears turbidity, supplements and boosts fire (of the) earth, breaks up the absorption of water and grains, warms the spleen, stomach and extremities; regulates yīn and yáng and settles nausea and vomiting; downbears turbid counterflow, calms coughing, lifts desertion and sinking and stops efflux diarrhea.

**Above medicinal info translated from ‘Huáng Yuán-Yù’s Interpretation of Medicinals’ (黄元御药解)

Huáng Yuán-Yù on line 100 of the Shāng Hán Lùn

On October 22, 2017March 31, 2021 By eranevenIn Huáng Yuányù (黃元御), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)Leave a comment

“伤寒，阳脉涩，阴脉弦，法当腹中急痛，先与小建中汤，不差者，小柴胡汤主之。”

“In cold damage (where) the yáng pulse is choppy, and the yīn pulse is wiry, as a rule there should be urgent abdominal pain; first give Xiǎo Jiàn Zhōng Tāng. If it is not reduced, Xiǎo Chái Hú Tāng governs.”

The liver and gall-bladder are from the same qì. If the gall-bladder fails to descend the cùn pulse will be choppy; if the liver fails to ascend, then the chǐ pulse will be wiry. (When) gall-bladder qì ascends counterflow, and restrains stomach-earth, abdominal pain will be seen in the chest and diaphragm. (If) the liver descends and restrains spleen-earth, abdominal pain will be seen in the abdomen and rib-sides. When wood qì is desiccated and dry, then pain will be urgent. When pathogenic factors are in both the liver and gall-bladder, wind-fire will be depressed, injuring central qì. Xiǎo Jiàn Zhōng Tāng is first used; Yí Táng, Gān Cǎo, and Dà Zǎo supplement spleen essence and moderate urgent pain. Shēng Jiāng, Guì Zhī and Sháo Yào outthrust wood depression and clear wind-fire. If it is not reduced and remains, give (Xiǎo) Chái Hú (Tāng) in order to drain ministerial fire.

The Wandering Kidney – A Discussion on Shèn Qí Wán by Keisetsu Ōtsuka

On August 13, 2016July 17, 2024 By eranevenIn Case Studies （医案), Formulas (方剂), Translations & Writings (译著与文章)Leave a comment

The Wandering Kidney

– Keisetsu Ōtsuka (大塚敬節)

A while back, a male presented at the clinic looking to improve his overall health. He complained that he would be easily fatigued following exercise, and afterwards would experience lower back and abdominal pain. He had been diagnosed with various conditions such as gallstones, kidney stones, and chronic appendicitis. Most recently following thorough examination, he was diagnosed with a wandering or floating kidney[1]on the right side. During abdominal diagnosis his kidney was easily palpated below his ribs on the right side when sitting up, however, when laying down the kidney was difficult to palpate. His appetite was normal as were his bowel movements and urination.

Shèn Qì Wán was administered, in accordance with the Jīn Guì Yào Lüè line that states,

“For deficiency taxation manifesting with lumbar pain, lesser abdominal hypertonicity, and inhibited urination, Bā Wèi Shèn Qì Wán (Eight-Ingredient Kidney Qi Pill) is indicated”.

After one month his fatigue had markedly improved and he no longer felt the lower back and abdominal pain.

Not long after this case, I saw a woman with a floating kidney, for which I reluctantly administered Shèn Qì Wán. Although the previous patient had excellent results with the formula, after giving this patient Shèn Qì Wán, she suffered from vomiting and poor appetite. The formula was discontinued after two days. This patients’ entire abdomen was soft and weak, with water sounds in the abdomen on percussion. In addition, her pulse was weak, appetite poor, and she experienced abdominal, back and lumbar pain, which were affecting her work. If Shèn Qì Wán is used in gastroptosia[2] or in patterns associated with sluggish stomach function manifesting with poor appetite, diarrhea, or vomiting there will frequently be side effects and great difficulty in resolution of the patients’ condition. There is also a line related to the formula in the Jīn Guì Yào Lüè, which states, “Eating and drinking as normal”, which clearly specifies that Shèn Qì Wán is not indicated in cases involving obstruction of the gastrointestinal tract. Although the line is very clear, I still administered the formula, ignoring the pattern identification and therefore failed to control the disease. I changed the formula to Liáng Zhǐ Tāng, which was able to control the symptoms, and reduce the abdominal, back and lumbar pain. In addition, this patient also had obvious umbilical pulsations.

The famous Japanese doctor Wada Tōkaku (和田東郭– 1744-1803), said that umbilical pulsations are a typical Dì Huáng formula sign, but should be combined with lóng gǔ (Fossilia Ossis Mastodi), mǔ lì (Ostreae Concha), guì zhī (Cinnamomi Ramulus) and gān cǎo (Glycyrrhizae Radix) formulas, which also present with umbilical pulsations. Therefore one must be cautious in using Shèn Qì Wán based on umbilical pulsations alone.

Liáng Zhǐ Tāng is líng guì cǎo zǎo tāng (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) with the addition of zhǐ shí (Aurantii Fructus immaturus), bàn xià (Pinelliae Rhizoma preparatum), and liáng jiāng (Alpiniae Officinarum Rhizoma). When I find umbilical pulsations with hardness in the abdomen, I will typically use this formula to attack and move the pain.[3]

[1] Floating kidney is a condition that is also termed as hypermobile kidney or the wandering kidney. The medical name of such a condition is nephroptosis. In such a condition the kidney is seen to drop downwards when a person stands up or is transiting from a lying down to an upright position. It is also known as the kidney prolapse condition. The kidney moving downward suggests that it is not fixed fully by the tissues that surround it. Such a condition is not uncommon and has been noted over a century by physicians in many cases.

[2] Downward displacement of the stomach.

Dr. Féng Shì-Lún on Tài Yīn Presentations

On October 6, 2015March 31, 2021 By eranevenIn Féng Shìlún (冯世纶), Jīng Fāng (经方), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)Leave a comment

Classical Formulas Interior Yīn Presentations (Tài Yīn disease)

The Concept of Interior Yīn Presentations

Clause 273 in the Shāng hán lùn (傷寒論 Discussion of Cold Damage) says:

“In Tài Yīn disease, there is abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain, and if purgation is used, there will be a hard bind below the chest”.

This is the essential outline of a Tài Yīn and interior yīn presentation, which is describing an interior vacuity with accumulation of rheum, therefore manifesting with abdominal fullness and vomiting, and an inability to get food down, not only because there is cold rheum in the stomach, but also because (the stomach) is unable to receive it, thus also manifesting with severe spontaneous diarrhea. (When) cold qì descends into the lower abdomen there will be spontaneous abdominal pain, and when cold does not descend, pain will spontaneously cease. Tài Yīn disease should be treated with warmth, and not with purgation. If one fails to heed to these words and erroneously purges, this will increase the vacuity of the stomach and the rheum accumulation, which will result in the transformation of cold, manifesting with a hard bind below the chest. This is the general characteristics of a Tài Yīn disease, and any disease manifesting with these signs, can be deemed a Tài Yīn disease, and if (one) uses the methods of treatment for a Tài Yīn disease, all errors would be avoided.

Treatment Principles for Interior Yīn Presentations

Clause 277 of the Shāng hán lùn (傷寒論 Discussion of Cold Damage) says:

“When there is spontaneous diarrhea and an absence of thirst, this belongs to Tài Yīn disease; because there is cold in the viscera, a warming treatment should be used, and a Sì Nì type (of formula) is suitable”.

Not only is this line expounding on the characteristics of a Tài Yīn disease, but also mentions its treatment principle. It is saying that all diseases manifesting with spontaneous diarrhea with an absence of thirst, belong to Tài Yīn disease. Here, there is no thirst due to cold rheum in the stomach, and in order to treat it, a sì nì type of formula is suitable to warm the center and expel cold. In short, both Yáng Míng and Tài Yīn diseases are located in the interior, with the former being a yáng presentation and the latter a yīn presentation. Interior yáng Yáng Míng presentations manifest with copious heat and excess, while interior yīn Tài Yīn presentations manifest as cold and vacuity. Diarrhea can occur in both Yáng Míng and Tài Yīn diseases, however, with heat there is thirst, and with cold there is an absence of thirst. This is the key in differentiating these two patterns. Sì Nì types of formulas warm the center, and expel cold, and not only do they treat Tài Yīn disease diarrhea, but they are also the standard formulas for addressing Tài Yīn diseases in general.

The Major Formula Presentations in Interior Yīn patterns

In the Shāng hán lùn (傷寒論 Discussion of Cold Damage), it is said that in order to treat Tài Yīn disease, a warming strategy is appropriate, and a sì nì type of formula should be used. However, there is not one specific formula for the multitude of presentations, and according to the concept of “cold in the viscera” the following are the formulas used to address these patterns.

(i) Gān Jiāng Fù Zǐ Tāng (Dried Ginger and Aconite Accessory Root Decoction) Category of Formulas:

Gān Jiāng Fù Zǐ Tāng (Dried Ginger and Aconite Accessory Root Decoction):

gān jiāng (Zingiberis Rhizoma) 3 liǎng

fù zǐ (Aconiti Radix lateralis preparata) (used fresh) 3 liǎng

Cooking method: Use three glasses of water, boiling until reduced to one cup, and take warm.

Indications: Both gān jiāng (Zingiberis Rhizoma) and fù zǐ (Aconiti Radix lateralis preparata) are center warming, cold expelling medicinals. However, gān jiāng is mainly used to treat ascending counterflow of cold rheum, while fù zǐ is used to address cold rheum distressing the lower body. Combining these two medicinals to warm the upper and lower, creates a strong formula that will invariably warm the center and expel cold. It is used to treat cold extremities, generalized body coldness, and a deep-faint pulse.

Other similar formula presentations:

Sì Nì Tāng (Frigid Extremities Decoction):

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 liǎng

gān jiāng (Zingiberis Rhizoma) 1 ½ liǎng

fù zǐ (Aconiti Radix lateralis preparata) (fresh) 1 piece

There are over ten detailed clauses in the Shāng hán lùn (傷寒論 Discussion of Cold Damage) describing the use of this formula, however, the main presentation of this formula is severe interior cold vacuity manifesting with cold extremities and a faint pulse verging on expiry.

Tōng Mài Sì Nì Tāng (Vessel Freeing Frigid Extremities Decoction):

This formula is sì nì tāng with increased dosages of gān jiāng and fù zǐ. It is used for a sì nì tāng presentation with more extreme vacuity cold.

Tōng Mài Sì Nì Jiā Zhū Dǎn Zhī Tāng (Vessel Freeing Frigid Extremities Decoction Plus Pig’s Bile:

This formula is tōng mài sì nì tāng with the addition of zhū dǎn zhī (pig’s bile). It is indicated for a more severe tōng mài sì nì tāng presentation with a faint pulse verging on expiry, or an imperceptible pulse.

Sì Nì Jiā Rén Shēn Tāng (Frigid Extremities Decoction plus Ginseng):

This is sì nì tāng with rén shēn (Ginseng Radix). It is indicated in cases of stomach qì vacuity with a weak pulse following vomiting or purgation.

Fú Líng Sì Nì Tāng (Poria Frigid Extremities Decoction):

This formula is sì nì jiā rén shēn tāng with fú líng (Poria). It is typically used in a sì nì jiā rén shēn tāng presentation with additional signs of palpitations below the heart, vexation, agitation, and inhibited urination.

(ii) Fù Zǐ Tāng (Aconiti Radix lateralis preparata Decoction) Category of Formulas:

Fù Zǐ Tāng (Aconiti Radix lateralis preparata Decoction):

fù zǐ (Aconiti Radix lateralis preparata) [blast fried] 1 piece

fú líng (Poria) 3 liǎng

rén shēn (Ginseng Radix) 2 liǎng

bái zhú (Atractylodis macrocephalae Rhizoma) 4 liǎng

sháo yào (Paeoniae Radix) 3 liǎng

Indications: stomach vacuity with cold rheum manifesting with inhibited urination, generalized body pain, joint pain, and possible abdominal cramping pain.

Other similar formula presentations:

Zhēn Wǔ Tāng (True Warrior Decoction):

This formula is fù zǐ tāng with the rén shēn removed, and the addition of shēng jiāng. It is used for a fù zǐ tāng presentation with dizziness, palpitations, edema in the lower extremities, and possible pain.

Fù Zǐ Jīng Mǐ Tāng (Aconite Root And Glutinous Rice Decoction):

fù zǐ (Aconiti Radix lateralis preparata) [blast fried] 1 piece

jīng mǐ (Glutinous Rice) ½ shēng

bàn xià (Pinelliae Rhizoma preparatum) ½ shēng

zhì gān cǎo (Glycyrrhizae Radix preparata) 1 liǎng

dà zǎo (Jujubae Fructus) 10 pieces

This formula is indicated for patterns of interior vacuity cold with abdominal pain, intestinal noise, nausea, and retching counterflow.

Chí Wán (Red Pill):

fú líng (Poria) 4 liǎng

bàn xià (Pinelliae Rhizoma preparatum) 4 liǎng

wū tóu (Aconiti Radix) [blast fried] 1 piece

xì xǐn (Asari Herba) 1 liǎng

This is indicated for cold natured abdominal pain accompanied by counterflow qì.

Dà Wū Tóu Jiān (Major Aconite Main Tuber Brew):

This formula is simply 5 large pieces of wū tóu (skin removed) boiled with honey added afterwards. It is used for cold mounting abdominal pain, reversal counterflow in the four extremities, and a deep, wiry pulse.

(iii) Gān Cǎo Gān Jiāng Tāng (Licorice and Ginger Decoction) Category of Formulas:

Gān Cǎo Gān Jiāng Tāng (Licorice and Ginger Decoction):

zhì gān cǎo (Glycyrrhizae Radix preparata) 6 liǎng

gān jiāng (Zingiberis Rhizoma) 3 liǎng

Indications: Stomach vacuity cold with ejection of foamy drool and vomiting counterflow.

Other similar formula presentations:

Lǐ Zhōng Tāng or Wán (Regulate the Middle Decoction or Pill):

This formula is gān cǎo gān jiāng tāng with the addition of rén shēn and bái zhú. It treats a gān cǎo gān jiāng tāng presentation with hard epigastric glomus and inhibited urination.

Dà Jiàn Zhōng Tāng (Major Construct the Middle Decoction):

shǔ jiāo (Zanthoxyli Pericarpium) 3 liǎng

gān jiāng (Zingiberis Rhizoma) 6 liǎng

rén shēn (Ginseng Radix) 3 liǎng

jiāo yí (Malt Sugar) 1 shēng

This formula is indicated for stomach vacuity cold patterns manifesting with severe chest and abdominal pain, vomiting counterflow, and an inability to eat.

(iv.) Jú Pí Tāng (Tangerine Peel Decoction) Category of Formulas:

Jú Pí Tāng (Tangerine Peel Decoction):

jú pí (Citri Reticulatae Pericarpium) 4 liǎng

shēng jiāng (Zingiberis Rhizoma recens) 8 liǎng

Indications: Dry retching and poor food intake.

Other similar formula presentations:

Jú Pí Zhǐ Shí Shēng Jiāng Tāng (Tangerine Peel, Unripe Bitter Orange, and Fresh Ginger Decoction):

This formula is jú pí tāng with a higher dose of jú pí and distention clearing, bind breaking zhǐ shí added. It treats a jú pí tāng presentation with more severe counterflow fullness and glomus and congestion in the chest.

Jú Pí Zhú Rú Tāng (Tangerine Peel and Bamboo Shavings Decoction):

This formula is jú pí tāng with a double dose of jú pí and the additions of zhú rú (Bambusae Caulis in Taenia) to treat coughing and counterflow ascent of qì and gān cǎo, rén shēn, and dà zǎo to calm the center and relax tension. It is used to treat a jú pí tāng presentation with stomach vacuity hiccups, retching, cough and counterflow.

Fú Líng Yǐn (Poria Beverage):

This formula is jú pí zhǐ shí shēng jiāng tāng with the addition of rén shēn to strengthen the stomach, and fú líng to disinhibit water. It is indicated for patterns manifesting with epigastric distention and fullness, epigastric glomus, poor food intake, shortness of breath, and inhibited urination.

(v) Bàn Xià Tāng (Pinellia Decoction) Category of Formulas:

Bàn Xià Tāng (Pinellia Decoction):

bàn xià (Pinelliae Rhizoma preparatum) 1 shēng

shēng jiāng (Zingiberis Rhizoma recens) ½ jīn

Indications: water rheum in the stomach with vomiting counterflow and possible headaches and a lack of thirst.

Other similar formula presentations:

Shēng Jiāng Bàn Xià Tāng (Fresh Ginger and Pinellia Decoction):

This formula is xiǎo bàn xià tāng with an increased dosage of shēng jiāng. It treats a bàn xià Tāng presentation with more severe rheum.

Xiǎo Bàn Xià Jiā Fú Líng Tāng (Minor Pinellia Decoction Plus Poria):

This is xiǎo bàn xià tāng with the addition of fú líng, and treats a similar presentation with the additional signs of heart palpitations and dizziness.

Bàn Xià Gān Jiāng Sǎn (Pinellia and Dried Ginger Powder):

This is xiǎo bàn xià tāng with gān jiāng used instead of shēng jiāng. It treats dry retching, and ejection of foamy drool due to stomach vacuity cold.

Dà Bàn Xià Tāng (Major Pinellia Decoction):

This formula is composed of:

bàn xià (Pinelliae Rhizoma preparatum) 2 shēng (washed)

rén shēn (Ginseng Radix) 3 liǎng

bái mì (honey) 1 shēng

It is used in stomach vacuity cold patterns with epigastric glomus and vomiting.

Gān Jiāng Bàn Xià Rén Shēn Wán (Dried Ginger, Pinellia, and Ginseng Pill):

This formula is a combination of xiǎo bàn xià tāng and bàn xià gān jiāng sǎn, and is used to treat more sever vomiting, and a hard epigastric glomus. The pill form of this medicine is milder, but is safer to use when treating morning sickness in pregnant patients.

Hòu Jiāng Bàn Gān Shēn Tāng (Officinal Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction):

This formula is shēng jiāng bàn xià tāng with a high dose of hòu pò to eliminate distention and fullness, and the additions of rén shēn and gān cǎo to supplement the center; therefore, it treats a shēng jiāng bàn xià tāng presentation with abdominal fullness and distention.

Bàn Xià Hòu Pò Tāng (Pinellia and Magnolia Bark Decoction):

This formula is xiǎo bàn xià jiā fú líng tāng with the addition of hòu pò and sū yè (zǐ). It treats phlegm-rheum qì bind causing chest fullness, throat blockage, coughing and counterflow.

Xuán Fù Dài Zhě Tāng (Inula and Hematite Decoction):

This formula is hòu jiāng bàn gān shēn tāng with hòu pò removed and xuán fù huā, dài zhě shí, and dà zǎo added. It is indicated in patterns of stomach vacuity cold with vomiting counterflow.

(vi) Zhū Líng Sǎn (Polyporus Powder) Category of Formulas:

Zhū Líng Sǎn (Polyporus Powder):

This formula is composed of equal parts zhū líng, fú líng, and bái zhú. It treats stoppage and depression of fluids in the stomach transforming into heat with symptoms of vomiting, thirst, and inhibited urination.

Other similar formula presentations:

Zé Xiè Tāng (Alismatis Decoction):

This formula is zhū líng sǎn, with both zhū líng and fú líng removed, and zé xiè added. It treats water rheum in the stomach with inhibited urination and dizziness.

Fú Líng Zé Xiè Tāng (Poria and Alismatis Decoction):

This is líng guì zhú gān tāng with the addition of zé xiè and shēng jiāng, and treats vomiting, inhibited urination, and thirst with a desire to drink water.

Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng (Licorice, Dried Ginger, Poria, and Atractylodes Decoction):

This is gān cǎo gān jiāng tāng with the addition of fú líng and bái zhú. It treats lumbar cold and heaviness, and spontaneously uninhibited urination.

The above-mentioned formulas all treat Tài Yīn disease interior vacuity cold presentations. Tài Yīn disease is an interior yīn pattern, where pathogens have entered the interior, which will present with interior yīn signs. When a persons’ right qì is insufficient, and the right and pathogens contend with each other in the interior for an extended period of time, this can result in a whole host of transmuted patterns.

When interior vacuity cold is affected by blood vacuity or vacuity of fluids, blood nourishing or fluid generating formulas should be used, such as, xiōng guī jiāo ài tāng (Chuanxiong, Chinese Angelica, Ass Hide Glue, and Mugwort Decoction), dāng guī sháo yào sǎn (Tangkuei and Peony Powder), wēn jīng tāng (Channel-Warming Decoction), zhì gān cǎo tāng (Honey-Fried Licorice Decoction), huáng tǔ tāng (Yellow Earth Decoction), bā wèi wán (Eight-Ingredients Deoction), etc. In addition, when disease pathogens are in the interior and the condition responds differently, we must select different formulas with specific indications to address these changes, such as guā lóu xiè bái bàn xià tāng (Trichosanthes, Long Stamen Onion, and Pinellia Decoction), yì yǐ fù zǐ bài jiàng sǎn (Coix, Aconite, and Patrinia Powder), and several others. Zhòng Jǐng discussed these fine details quite meticulously, and when we carefully consult his works, we can achieve positive (clinical) results.

The Position of Tài Yīn Disease Amongst The Six Channels

In regards to classical formulas, generally speaking, when pathogens are in the exterior, the disease is easy to resolve and the disease nature is quite mild. If pathogens are located in the interior, then the disease is difficult to cure, and the nature is more serious. This can be seen clearly from the analysis of formula presentations. With an interior disease, regardless if it is a yáng presentation or a yīn presentation, they are all more serious patterns. For example, in an interior yáng Yáng Míng presentation, we see; “late afternoon tidal heat effusion, no aversion to cold and soliloquy as if the person is seeing ghosts, and if serious the person will not recognize people, will pick at the bedclothes, feel fear and disquietude, pant slightly and stare forward”. “Delirious speech and tidal heat” is a dà chéng qì tāng (Major Order the Qi Decoction) presentation; Another example is; “abdominal fullness, generalized heaviness, difficulty turning sides, insensitivity of the mouth, grimy face, delirious speech, and enuresis. If sweating is promoted, there will be delirious speech, and if purgation is used, sweat will arise on the forehead, and there will be reversal cold of the extremities”. This is a bái hǔ tāng (White Tiger Decoction) presentation.

These are all interior yáng presentations, which are quite serious and have already affected the mind. These are the interior signs that appear when right qi is still vigorous and can resist pathogenic qì, and if it becomes too weak, it must be treated otherwise it would threaten (one’s life). With interior yīn presentations, right qi is originally vacuous, and when pathogens are exuberant in the interior, right qì is unable to overcome these pathogens and they become dangerous in a very short time. By looking at the yáng returning and counterflow stemming effect of the sì nì formulas, this concept becomes quite clear. For example, clause 388 says:

“When there is vomiting and diarrhea, sweating, heat effusion, and aversion to cold, hypertonicity of the limbs, and reversal cold of the extremities, sn sì nì tāng (Frigid Extremities Decoction governs”.

Clause 389 says:

“When there is vomiting as well as diarrhea, then uninhibited urination, and great sweating, clear food diarrhea, internal cold and external heat, and the pulse is faint and verging on expiry, sì nì tāng (Frigid Extremities Decoction) governs”.

Clause 390 says:

When the vomiting has ceased and the diarrhea has stopped, yet there is sweating and reversal, unresolved hypertonicity of the limbs, and a pulse that is faint and verging on expiry, tōng mài sì nì jiā zhū dǎn zhī tāng (Vessel Freeing Frigid Extremities Decoction Plus Pig’s Bile governs”.

Clause 309 says:

“When in Shào Yīn disease there is vomiting and diarrhea, counterflow cold of the extremities, and vexation and agitation, as if the person is about to die, wú zhū yú tāng (Evodia Decoction) governs”.

In all these presentations, the bodies right qì and yáng qì are both vacuous, and pathogenic qì is strong and exuberant in the interior, already posing a risk and threatening life. One cannot hesitate with treatment, and for there to be a gleam of hope in survival, a major formula to return yáng and stem counterflow must be used. Now, of course in clinical practice, not all Tài Yīn cases are this critical and severe, but most are chronic conditions, which are basically interior vacuity cold patterns, as seen with the xiǎo bàn xià tāng, dà bàn xià tāng, xuán fù dài zhě tāng, fú líng yǐn, wú zhū yú tāng, lǐ zhōng tāng, dà jiàn zhōng tāng, gān jiāng fù zǐ tāng, fù zǐ tāng, and sì nì tāng presentations. These formulas treat relatively mild Tài Yīn patterns, but from the perspective of the classic formulas categories we can see that many Tài Yīn disease are commonly quite dangerous, and many deaths occur in the Tài Yīn stage, hence the adage “when there is stomach qì, there is life, and the absence of stomach qì bodes death”. Because Tài Yīn patterns are commonly seen, we need to be knowledgeable about the Tài Yīn classic formulas.

A case of Xiǎo Jiàn Zhōng Tāng (minor construct the middle decoction)

On September 22, 2015April 2, 2021 By eranevenIn Case Studies （医案), Fàn Zhōnglìn（范中林), Formulas (方剂), Translations & Writings (译著与文章)2 Comments

Fàn Zhōng-Lín

A 22-year-old female factory manager from Chóng Qìng city presented at the clinic.

In July 1959 the patient had developed a high fever and lost consciousness. She was immediately taken into a local hospitals emergency department for investigation. She was administered an anti-pyretic medication, however her fever would not reduce. She was also given various medications to manage and reduce her heat all to no avail. Her diagnosis was inconclusive. At this point she was discharged from the hospital after requesting Chinese medical treatment. After taking two packages of a heat reducing formula, she had gradually regained consciousness. However, in the evening the following day she once again lost consciousness. Again, she was sent to the hospital for treatment, but as she had once again come down with a critical condition as before, they were still unable to make a clear diagnosis. The old Chinese medical doctor[1] was once again consulted who said he was able to diagnose her. After taking Chinese medicinals, her condition gradually improved.

The old Chinese medical doctor believed her condition was due to cerebral stagnation. She was sent for examination and film of her head, which clearly showed blood stagnation in her cranium, and was thus immediately sent to surgery in order to escape any form of danger.

A month following the surgery she was experiencing twitching in her extremities and coldness in the lower half of her body. She was discharged from hospital and continued using herbal medicines for the next five or six years, with very little clear improvement. In 1965 she travelled here to Róng[2] for a consultation.

Her current symptoms were, twitching in her extremities on the right side, occasional deviation of her mouth and eyes, which occurred five or six times per month and would precede the twitching. Afterwards she would feel numbness on her right side. Over the last few years she was especially fearful of cold, and even during the intense heat of June she would wear a sweater, and her extremities still experienced coldness. Her menstrual cycle was irregular with a pale dark color. Her vision had been receding becoming dim and unclear, and her memory and reaction time were remarkably decreased and slow. She was fatigued and had a poor appetite. Her tongue was pale with a scant amount of grey coating. Pulse was deep and thin.

Symptoms and Disease Mechanisms

Deep thin pulse, pale tongue, fear of cold, cold extremities, fatigue, twitching in half the body and extremities: symptoms belongs to a Tài Yīn and Shào Yīn spleen and kidney yáng deficiency pattern.

Twitching of the extremities, deviation of the mouth and eyes: This pattern belongs to tetany disease[3].

After suffering from such a major illness, both qì and blood are damaged, and thus tetany may form. When qì and blood are both deficient, the sinews and vessels will jerk and become hypertonic. For example, Sù Wèn chapter 74 ‘The Great Treatise on the Utmost Truth’ says,

“All Cold, with contraction and tautness belongs to the kidneys”.

The Channels and Sinews chapter (ch.13) of the Líng Shū says,

“[When] the sinews of the Foot Shào Yīn [are diseased], [they manifest with] epilepsy, tugging and tetany”.

Analysis

Tài Yīn, Shào Yīn; qì and blood deficiency.
Among these the qì and blood deficiency are primary.

Treatment Strategy

Here it is appropriate to first warm the center, strengthen the spleen, and harmonize qì and blood.
For this xiǎo jiàn zhōng tāng (minor construct the middle decoction) masters.

Formula:

guì zhī (Cinnamomi Ramulus) 12g
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
bái sháo (Paeoniae Radix alba) 15g
shēng jiāng (Zingiberis Rhizoma recens) 30g
hóng zǎo (Jujubae Fructus) 15g
yí tang (Maltosum) 60g (dissolved in decoction)

6 packages were given.

She took the six packages above, and followed up ten days later, at which point the twitching in the extremities only occurred once, and the numbness in the body was reduced. In addition, both her spirit and appetite were harmonized, and she was overall making a great recovery.

[1] A Lǎo Zhōng Yī (老中医 ) refers to an older, highly experienced Chinese medical physician, typically held in very high regard throughout the country.
[2] Róng is another name for Chéng Dū.
[3] Refer to chapter 2 in the Jīn Guì Yào Lüè.

Headache: Two cases by Liu Duzhou 劉渡舟

On April 20, 2015April 2, 2021 By eranevenIn Case Studies （医案), Jīng Fāng (经方), Liú Dùzhōu (刘渡舟), Translations & Writings (译著与文章)1 Comment

Headache: Two cases by Liu Duzhou 劉渡舟

Translated by Daniel Eng, L.Ac.

Case 1: Zhenwu tang + Ling gui zhu gan tang

Mr. Li, male, 32 years old. The patient was a driver. When he drove in the summer, the weather was hot and he would freely drink ice-cold beer or soda, daily and without restraint. When autumn came he started experiencing headaches every night. The pain was severe, and he had to knock his fists against his head or take analgesic pills in order to obtain relief; it was also accompanied by blurred vision. The condition had persisted for over a month.

On visual inspection, the patient’s facial complexion was dark and sallow, his tongue was pale and tender with a wet, slippery coating, and his pulse was deep, wiry and moderate. This was a case of yang deficiency with water overflowing, turbid yin escaping upward, and clear yang being stifled.

Fuzi 12g, fuling 18g, baizhu 9g, shengjiang12g, baishao 9g, guizhi 6g, zhi gancao 6g

After taking six packets of the medicine, the headaches had lessened significantly. His formula was changed to Ling gui zhu gan tang, and after four packets he was cured.

Commentary by Dr. Liu: Zhenwu tangis also known as Xuanwu tang.Xuanwu is the spirit that controls water in the north. Because this formula has the function of supporting yang and controlling water, it is therefore named Zhenwu tang; it is used for patterns such as Shaoyin yang deficiency with cold, and water qi failing to transform. The Shanghan lun says: “Abdominal pain and inhibited urination . . . means there is water qi.” This indicates the key pathomechanism of this pattern. Yin deficiency with hyperactive yang often stirs wind, while yang decline with exuberant yin often stirs water—this is a basic rule of the occurrence and development of disease. Yang deficiency stirring water is normally treated with the Ling gui formulas; if the disease has reached the kidneys, with yang qi deficiency and decline, palpitations, dizziness, instability when standing, and swaying as if about to fall to the ground, then we must treat using Zhenwu tang.If one takes Zhenwu tang,and the kidney yang is warmed yet the water qi is still unable to transform completely, then we can further use the warming herbs of the Ling gui formulas to harmonize.

Case 2: Guizhi qu gui jia fuling baizhu tang

Ms. Jin, female, 42 years old. The patient had been suffering from left-sided migraines for over three years. She had tried many treatments without effect. Accompanying symptoms included stiff nape; distention, fullness and discomfort of the chest and epigastrium; and frequent, scanty urination. Bowel movements were normal. The pulse was wiry and tight, and the tongue fur was wet and slippery almost to the point of dripping.

Fuling 30g, baishao 30g, baizhu 10g, zhi gancao 10g, dazao 12 pieces, shengjiang10g.

After taking six packets, she was cured.

Commentary by Dr. Liu: Line 28 of the Shanghan lunsays: “When Guizhi tangis taken, or down-purging is used, and there is still pain and stiffness of the head and nape, feathery-warm heat effusion, no sweating, fullness and slight pain beneath the heart, and inhibited urination, Guizhi qu gui jia fuling baizhu tang masters.” Physicians throughout the ages have had quite different understandings of this line from the original text. For example, Xu Dachun of the Qing dynasty said: “Whenever formulas are modified, it is always the assistant or envoy herb [that is removed]. If the chief herb is removed, a new formula name is given. Here guizhiis removed, yet [the formula] is still named after guizhi;this cannot be explained.” Qian Tianlai also said: “The significance of treatment with Guizhi qu gui jia fuling baizhu tang is unclear. I am afraid that this was the error of a later copyist—it is impossible to know. Even if one uses it, I am afraid that it will not necessarily be effective.” And Wu Qian, the author of the Yizong jinjian, asserted even more directly that “remove guizhi” was erroneously written instead of “remove shaoyao.”

So, how should we understand this issue? First, we should remember the features of Guizhi tang and its modifications and transformations. The biggest feature of Guizhi tang is that it moistens yin and harmonizes yang, and the herbal combination that achieves this feature is guizhi combined with shaoyao. Guizhiand shaoyao,one yang and one yin, clinically can be taken to form a dichotomy. For example, there is a Guizhi jia gui tang,so there is also a Guizhi jia shaoyao tang;therefore, since there is a Guizhi qu shaoyao tang,there should also be a Guizhi qu gui tang. This way, yin and yang are counterparts, and this fits the objective rules of disease transformations and their treatments. If we analyze along these lines, Guizhi tang with the removal of guiis actually a real phenomenon.

Furthermore, from the perspective of the herbal composition of Guizhi qu gui jia fuling baizhu tang, it wouldn’t hurt to compare it to Ling gui zhu gan tang,in order to understand more clearly the significance of removing gui.In the Shanghan lun, Zhongjing used Zhenwu tang to support yang and disinhibit water, so he also had Zhuling tang to supplement yin and disinhibit water as its counterpart. This is because fluid metabolism dysfunction in the human body is related to the two aspects of yin and yang. Therefore, since Zhongjing offered Ling gui zhu gan tang to unblock the yang and disinhibit water, he should have a formula to harmonize yin and disinhibit water as its counterpart. The answer to this question lies precisely in Qu gui jia fuling baizhu tang.

This formula’s herbal composition is as follows: fuling, shaoyao, baizhu, zhi gancao, shengjiang and dazao.If we look at these ingredients, it is not difficult to discover that the four ingredients fuling, shaoyao, baizhuand zhi gancao are exactly analagous to the four ingredients of Ling gui zhu gan tang, with guizhiand shaoyao as yin-yang counterparts. For this reason, it wouldn’t hurt to call this “Ling shao zhu gan tang”for the moment. “Ling shao zhu gan tang” uses shaoyaoon one hand to moisten the ying and harmonize yin, and on the other hand in combination with fuling, so it also has the function of removing water qi and disinhibiting urination. So the ability of “Ling shao zhu gan tang” to harmonize yin and disinhibit water is in exact yin-yang relationship with the ability of Ling gui zhu gan tang to unblock yang and disinhibit water. And the fact that shengjiang and dazao are further included is just like how Ling gui zhu gan tang also has the adaptations known as Ling gui zao gan tang and Ling gui jiang gan tang.

Even if this is so, why didn’t Zhongjing simply name it “Ling shao zhu gan tang,” instead of naming it Guizhi qu gui jia fuling baizhu tang? There may be two reasons for this. The first is that in Zhongjing’s writings, there is often a paired relationship between lines that appear before and after each other. After all, Line 21 lists Guizhi qu shaoyao tang, so Line 28 goes on to mention Guizhi tang and the method of removing gui. This causes a person to compare, so that they see the difference between “chest fullness” in the line above, and “fullness and slight pain beneath the heart” in the line below.

Secondly, Zhongjing was afraid that later generations, upon seeing “pain and stiffness of the head and nape” and “feathery-warm heat effusion,” would grasp onto guizhi and not let it go, overly insistent on the exterior-releasing function of guizhi; so he emphasized that for this formula we must remove guizhiand keep shaoyao. Therefore, when reading Zhongjing’s books we must search in hidden places to tease out deeper meanings.

In the clinical use of Guizhi qu gui jia fuling baizhu tang, the key to pattern differentiation lies in “inhibited urination.” Inhibited urination is a manifestation of bladder qi transformation dysfunction, leading to water evil stagnating internally. Water evil stagnating internally in the bladder can obstruct the flow of yang qi in its channel. When yang qi is blocked and the channel is inhibited, there may be external signs such as feathery-warm heat effusion and pain and stiffness of the head and nape, so it looks like an exterior pattern but really is not an exterior pattern. When the water evil congeals and binds, blocking the qi mechanism and causing interior qi disharmony, there may be interior signs such as fullness and slight pain beneath the heart, so it looks like an interior excess pattern but really is not an interior excess pattern. Therefore the methods of promoting sweating and down-purging are both inappropriate. The pathomechanism of this pattern is as follows: inhibited urination → water blocking the bladder → external qi obstruction and internal qi binding.

If the key to pattern differentiation is inhibited urination, why don’t we use Wuling san to disinhibit urination? This issue has already been clearly explained by Tang Rongchuan of the Qing dynasty. He said: “Wuling sanis for the qi of Taiyang failing to reach the exterior, so guizhiis used to diffuse the qi of Taiyang; when the qi reaches the exterior, water will descend on its own, and urination will be disinhibited. This formula [Guizhi qi gui jia fuling baizhu tang]is for the water of Taiyang failing to descend, and therefore guizhi is removed, and fulingand baizhu are further added to move the water of Taiyang; when the water descends, the qi will reach the exterior on its own, and signs such as headache and heat effusion will naturally be resolved. Those without sweating can be cured with slight sweating, and therefore Wuling sanmakes special use of guizhito promote sweating; sweating is what disinhibits water. This formula makes special use of fulingand baizhu to disinhibit water; disinhibiting water is what promotes sweating. Actually this is due to the knowledge that water can transform qi, and qi can move water.”

Source: Liu Duzhou, ed., Jingfang linzheng zhinan (Beijing: People’s Medical Publishing House, 2013), pp. 50–53, 126–128.

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

On August 26, 2014November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)1 Comment

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

膠艾湯

Jiāo Ài Tāng

Donkey-Hide Gelatin and Mugwort Decoction

治婦人有漏下者，有半產後因續下血都不絕者，有妊娠下血者，假令妊娠腹中痛，為胞阻，以此湯主之。

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

乾地黃（六兩）川芎阿膠甘草（各二兩）艾葉當歸（各三兩）芍藥（四兩）

gān dì huáng	乾地黃	18g
chuān xiōng	川芎	6g
ē jiāo	阿膠	6g
gān cǎo	甘草	6g
ài yè	艾葉	9g
dāng guī	當歸	9g
sháo yào	芍藥	12g

上七味，以水五升、清酒三升，合煮取三升，去滓，內膠令消盡，溫服一升，日三服，不差更作。

Simmer the seven ingredients above in 1,000ml of water with 600ml of clear wine, until reduced to 600ml. Remove the dregs, and dissolve the ē jiāo in the decoction. Take 200ml warm, three doses per day, and repeat if [the condition] fails to resolve.

Song 歌曰:

妊娠腹滿阻胎胞，名曰胞阻，以胞中氣血虛寒，而阻其化育也。二兩芎藭草與膠，歸艾各三芍四兩，地黃六兩去枝梢。

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

Commentary by [Chén] Yuánxī男元犀按：

芎藭、芍、地，補血之藥也；然血不自生，生於陽明水谷，故以甘草補之。阿膠滋血海，爲胎産百病之要藥；艾葉暖子宮，爲調經安胎之專品，合之爲厥陰、少陰、陽明及衝任兼治之神劑也。後人去甘草、阿膠、艾葉，名爲四物湯，則板實而不靈矣。

Chuān xiōng , sháo yào, and dì huáng are blood-supplementing medicinals. Blood is not generated on its own, but is engendered from water and grains in yángmíng therefore, gān cǎo is used to supplement [yángmíng]. Ē jiāo enriches the sea of blood, and is a very important medicinal for treating various pregnancy related diseases. Ài yè warms the uterus, and is a specific medicinal to regulate menstruation and calm the fetus. This is a divine formula, which unites juéyīn, shàoyīn and yángmíng, and simultaneously treats the thoroughfare and controlling vessel. In later times, people have removed the gān cǎo, ē jiāo and ái yé, renaming it Sì Wù Tāng, making this formula stiff, bound and ineffective!

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