The Classic Formulas (Jīng Fāng) System of Treatment Based on Pattern Identification By Féng Shì Lún

 
 
1.     What is Treatment Based on Pattern Identification
Pattern identification is a method in which (one) gathers disease responses and symptoms through the four diagnostic methods, and also uses Chinese medical theory to summarize and analyze (these responses) in order to distinguish the disease nature and location (and to have) a clear understanding of the disease signs. This is another step in elucidating the pattern involved, and this process is referred to as pattern identification. Determining treatment is essentially the use of medicinals in accordance with the pattern. The characteristic (of this process) is that both the patient and the doctor work together in gathering the symptoms (to obtain information), and the doctor, in accordance with Chinese medical theory, will summarize and analyze (these) to have a clear understanding of where these signs belong (information classification), in order to clearly define the pattern (treating the specific information), and use medicinals according to the pattern (information processing). This is the entire process involved in treating disease.
The pattern identification methods commonly used in Chinese medicine are: eight principles pattern identification, bowel and viscera pattern identification, qì, blood, liquids, and humors pattern identification, defensive qì and nutritive blood pattern identification, triple warmer pattern identification, channels and collaterals pattern identification, six conformation pattern identification, and so on. The Shāng hán lùn (傷寒論 Discussion of Cold Damage) specifically uses the six conformations pattern identification method.
2.    The Evolution of the Shāng hán lùn’s Treatment Based on Pattern Identification
Treatment based on pattern identification is also referred to as treatment based on pattern differentiation. The Chinese medicine use of formulas and medicinals to treat disease is a particularly traditional method, which has been put into practice for extensive periods of time by our ancestors through the ages to combat disease, and is summed up as a major extraordinary accomplishment. The earliest recording, which established and summarized these methods is found in the Decoction classic ().
  
3.     Discussion on the Six Conformations and Eight Principles
The Shāng hán lùn (傷寒論 Discussion of Cold Damage) used the six conformations as a method of division. Later commentators have stated that with the six conformations, one would only be confined to cold damage methods. In fact, the six conformations come from the eight principles (and are the) general principles behind (the treatment) of numerous diseases. In order to explain further, the following discussion will begin from the eight principles.
(1) Eight Principles [ ]
The eight principles refer to the exterior, interior, yīn, yáng, cold, heat, vacuity, and repletion. In actual fact, within the exterior and interior, there is also the half-exterior and half-interior, so really, they should be called the nine principles. However, the half-exterior, half-interior portion is usually discussed with the interior, so it is customary to simply refer to them as the eight principles.  I will now explain them in order.
The Exterior, Interior, and Half-Exterior Half-Interior: 
The exterior, interior, and half-exterior half-interior are essentially the location of a disease response.  The exterior refers to the exterior of the body, namely the skin, muscles, flesh, tendons, and bones, and anything, which constitutes the outer part of the body can be called the exterior.  If pathogenic factors accumulate and cause a reaction in this part of the body, we can call this an exterior pattern.  The interior refers to the inner aspect of the body, namely the esophagus, stomach, large intestine, and small intestine, and anything, which constitutes the digestive tract, is referred to as the interior. If pathogenic factors accumulate and elicit a response in this part of the body, this can be called an interior pattern.  The half-exterior half-interior portion refers to the exterior of the interior, and the interior of the exterior, which is namely the large space between the chest and abdomen. This is the location of all the organs and bowels, and is considered to be the half-exterior half-interior portion of the body. If pathogenic factors accumulate here and cause a reaction, this is called a half-exterior half-interior pattern.  It needs to be explained here that the exterior, interior, and half-exterior half-interior disease location responses are fixed, and regardless of what the disease is, (one needs to look at) the location of the disease response, whether it be in the exterior, interior, or half-exterior half-interior. In addition, two or even all three of these may sometimes appear simultaneously. It must also be emphasized that here when discussing disease location, it refers to the location of the response to the disease pathogens, and not to be mistakenly believed to be the location of the disease changes. That is to say, if there are pathological changes in the interior, but pathogenic factors have accumulated and caused a response in the exterior, this is referred to as an exterior pattern, and is also referred to as pathogens in the exterior or an exterior disease. For the same reason, even if a condition manifests with exterior symptoms, yet there is an accumulation of pathogenic factors with a response in the interior of the body, this is referred to as an interior pattern, for which it can also be said that pathogens are in the interior, or simply called an interior disease.
Yīn and Yáng: Yīn and Yáng refer to the nature of the pathological changes. Yīn has namely a yīn nature, and yáng a yáng nature. When a person contracts a disease, there will be a struggle between right (qì) and the pathogen. This will have not yet influenced any changes of bodily functions, and will particularly first make changes to metabolic functions. If this change is relatively abnormal, than it is called excessive, and if relatively normal, it is considered deficient. With excess, the body will correspond with and reflect hyperactivity, rising, and excited types of disease characteristics, which are referred to as a yáng pattern. With deficiency, the body will reflect decline, hypo-function, and inhibition types of deficient disease characteristics, which are referred to as a yīn pattern. 
Cold and Heat: 
Cold refers to a cold type of pattern, while heat refers to a hot type of pattern. If a patient reflects cold natured symptoms, then this is ultimately considered a cold pattern; if a patient reflects heat type symptoms, then this is referred to as a heat pattern. As was mentioned above in the explanation of yīn and yáng, cold is a reflection of deficiency, which belongs to yīn, therefore cold is also yīn, and heat is a reflection of excess, which belongs to yáng, so therefore heat must also be yáng.  However, cold and heat have characteristics of yīn and yáng, and if we generally say yīn, then indefinitely there must be cold, and if we say yáng, then there will indefinitely be heat. In instances of an absence of cold or heat in disease, this by no means indicates an absence of yīn or yáng.)
Vacuity and Repletion: 
Vacuity refers to a vacuous patient, while repletion refers to repletion of disease (factors). If a disease has not yet been resolved, and a patients’ energy is failing to sustain to some extent, the reflection of the body manifests a type of vacuous, debilitated state, which is typically referred to as a vacuity pattern. If the dynamics of the disease are advanced, and the patients’ energy is not vacuous, the body will manifest with disease characteristics of fullness and repletion, which would be referred to as a repletion pattern. From the aforementioned explanation, we are able to see that vacuity, repletion, cold and heat are similar, containing both yīn and yáng characteristics within them. When vacuity, repletion and cold intertwine with one another, there is still (either) yīn or yáng. For example, vacuity and cold are definitely yīn, but vacuity and heat is on the contrary yáng. Repletion and heat are most certainly yáng, however, repletion and cold would be considered yīn. In a yáng pattern it is possible to have heat, or repletion, or heat with repletion, no heat or no repletion, or even heat and vacuity. In a yīn pattern, we can have either cold, or vacuity, or vacuity with cold, no cold or no vacuity, or cold with repletion. This can be seen in the following chart.
 
 
(1) Six Conformations ()
The six conformations refers to the three yáng conformations of Tài Yáng, Yáng Míng, and Shào Yáng, and the three yīn conformations of Tài Yīn, Shào Yīn, and Jué Yīn. Although the Shāng hán lùn (傷寒論 Discussion of Cold Damage) refers to these as diseases, they are actually patterns, which come from the eight principles. I will now explain the relationships between them.
The so-called exterior, interior, and half exterior half interior, all reflect disease location, while yīn, yáng, cold, heat, vacuity, and repletion reflect the nature of the disease.  However, the manifestation of the disease nature must reflect the disease location, and the location of the disease will inevitably reflect the nature of the disease, therefore, without the nature of the disease, there is no location, and vice versa. Exterior, interior, or half exterior half interior patterns will always be accompanied by signs of either yīn, yáng, cold, heat, vacuity or repletion.  At the same time, yīn, yáng, cold, heat, vacuity, and repletion patterns will be accompanied by exterior, interior, or half exterior half interior signs. Therefore, regardless of whether it’s an exterior, interior, or a half exterior half interior pattern they will all be accompanied by various yīn and yáng signs and responses.  
Disease location and nature of the six conformations
Eight Principles
Disease nature
Six conformations
Disease location
Exterior
Yáng
Tài Yáng disease
Interior
Yáng
Yáng Míng disease
Half exterior half interior
Yáng
Shào Yáng disease
Interior
Yīn
Tài Yīn disease
Exterior
Yīn
Shào Yīn disease
Half exterior half interior
Yīn
Jué Yīn disease
The following are the representative lines from the Shāng hán lùn (傷寒論 Discussion of Cold Damage) for each of the six conformations with a small commentary.
“In Tài Yáng disease, the pulse is floating, the head and nape are stiff and painful, and there is aversion to cold” [line 1]
Commentary: Tài Yáng disease is an exterior yáng pattern. The characteristics signs of a Tài Yáng disease are a floating pulse, stiff and painful head and nape, and aversion to cold. With that being said, in any disease, whenever a floating pulse, a stiff and painful head and nape, and aversion to cold are seen, one can most certainly diagnose it as a Tài Yáng disease, thereby avoiding any errors.
“In Yáng Míng disease, the stomach domain is replete” [line 180]
Commentary:  Yáng Míng disease is an interior yáng pattern. The term ‘stomach domain is replete’ means that pathogens are full and replete in the stomach and intestines, and with palpation is hard with resistance and possibly painful on pressure. The general idea here is that any disease with a replete stomach domain, can definitely be considered a Yáng Míng disease.
“What are the external signs of Yáng Míng disease? Answer: generalized heat effusion, spontaneous sweating, and no aversion to cold, but aversion to heat” [line 182]
Commentary: The stomach domain being replete, is a Yáng Míng disease abdominal finding, and in addition there is also a Yáng Míng disease exterior pattern. Symptoms of generalized heat effusion, spontaneous sweating, and no aversion to cold, but aversion to heat exemplify the exterior pattern.  Any disease with these external signs can be diagnosed as a Yáng Míng disease.
“In Shào Yáng disease, there is a bitter taste in the mouth, dry throat, and dizzy vision” [line 263]
Commentary: Shào Yáng disease is a half exterior half interior yáng pattern. The characteristic symptoms for a Shào Yáng pattern are a bitter taste in the mouth, dry throat, and dizzy vision. Any disease with these characteristic signs could be diagnosed as a Shào Yáng disease.
 
“In Tài Yīn disease, there is abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain. If purgation is used, there will be a hard bind below the chest” [line 273]
Commentary: Tài Yīn disease is an interior yīn disease. The characteristic symptoms of a Tài Yīn disease are abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain. Any disease manifesting these characteristics can be diagnosed as a Tài Yīn disease. The abdominal fullness in a Tài Yīn disease is a vacuity type of fullness, which is quite different than the repletion fullness seen in a Yáng Míng repletion of the stomach domain disease. If one erroneously mistakes this for a repletion type of fullness and purges it, this will further increase the vacuity and cause a hard bind below the chest.
“In Shào Yīn disease, the pulse is faint and fine, and there is a desire only to sleep” [line 281]
Commentary: Shào Yīn disease is an exterior yīn pattern, which needs to be compared to a Tài Yáng pattern. Basically, if there is a Tài Yáng pattern with a faint and fine pulse, accompanied by a desire only to sleep, this can be diagnosed as a Shào Yīn disease.
Commentary: Jué Yīn disease is a half exterior half interior yīn disease. The symptoms which typically reflect a Jué Yīn disease are wasting thirst, qi surging upward to the heart, pain and heat in the heart, hunger with no desire to eat, and vomiting of roundworms after eating. Any disease seen with these symptoms can be considered a Jué Yīn disease. Half exterior half interior pattern cannot be purged, and it is especially strictly prohibited when they are yīn patterns. If one is not careful and erroneously uses purgation, then this will cause a calamity of incessant diarrhea.
1.     Summary of Treatment Principles
The so-called treatment principles are essentially the principle of determination of treatment based on six conformation and eight principles pattern identification.  I will now differentiate and give an account of these principles.
Tài Yáng disease: Because this is an exterior pattern, it is appropriate to effuse sweat, and not to purge nor cause vomiting. Formulas such as guì zhī tāng (Cinnamon Twig Decoction), má huáng tāng (Ephedra Decoction), and gé gēn tāng (Kudzu Decoction) are specific sweat effusing Tài Yáng disease formulas.
Shào Yīn disease: This is a type of Tài Yáng disease, and although they both belong to the exterior, for which sweating should resolve it, here sweat effusion must be combined with warm natured, stimulating medicinals such as fù zǐ (Aconiti Radix lateralis preparata), and xì xǐn (Asari Herba) in formulas such as guì zhī jiā fù zî tāng (Cinnamon Twig Decoction plus Aconite), má huáng fù zǐ gān cǎo tāng (Ephedra, Aconite Accessory Root Tuber and Licorice Decoction), and má huáng fù zǐ xì xīn tāng (Ephedra, Aconite Accessory Root Tuber and Asarum Decoction). These are specific Shào Yīn sweat effusing formulas.
Yáng Míng disease: When heat has bound in the interior and the stomach domain is replete, it is appropriate to purge it. However, when there is (simply) heat and no repletion (in the stomach domain), it is appropriate to simply clear heat. A typical purging formula would be one of the chéng qì tāng (Order the Qi Decoction) formulas, and bái hǔ tāng (White Tiger Decoction) to clear heat. If there is repletion in the chest, it is appropriate here to cause vomiting and not to purge using a formula such as guā dì sǎn (Melon Stalk Powder).
Tài Yīn disease: With interior vacuity and cold obstruction, only warming and supplementation is warranted. The promotion of sweat, vomiting and purgation are all contraindicated. Formulas such as lǐ zhōng tāng (Regulate the Middle Decoction), and sì nì tāng (Frigid Extremities Decoction) are typical Tài Yīn warming and supplementing formulas.
Shào Yáng disease: In half exterior half interior patterns, the appropriate method of treatment is to harmonize and resolve. Promoting sweating, vomiting and purgation are all unnecessary. xiǎo chái hú tāng (Minor Bupleurum Decoction) and huáng qín tāng (Scutellariae Decoction) are prototypical Shào Yáng harmonizing and heat resolving formulas.
Jué Yīn disease: Although this is also a half exterior half interior pattern, for which harmonizing and resolving are appropriate, this must be combined with warm, strengthening medicinals. Chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) and wū méi wán (Mume Pill) are typical formulas for this pattern.
Cold and Heat: In cold patterns, warming medicinals should be used to expel cold such as gān jiāng (Zingiberis Rhizoma), fù zǐ (Aconiti Radix lateralis preparata), and wū tóu (Aconiti Kusnezoffi Radix) in combination with specific formulas. In heat patterns, cool and cold medicinals are used in order to eliminate heat such as huáng qín (Scutellariae Radix), zhī zǐ (Gardeniae Fructus), huáng lián (Coptidis Rhizoma), and shí gāo (Gypsum fibrosum) in combination with specific formulas.
Vacuity and Repletion: In vacuity patterns it is appropriate to use strengthening medicinals in order to supplement insufficiency. Sweat promoting, vomiting, and purgative medicinals are all contraindicated. Formulas such as zhì gān cǎo tāng (Honey-Fried Licorice Decoction), lǐ zhōng tāng (Regulate the Middle Decoction), and shèn qì wán (Kidney Qì Pill) are all used to supplement vacuity. In repletion patterns, sweat promoting, vomiting inducing, and purgation are all methods, which are utilized to thoroughly attack and eliminate pathogenic factors. Examples of attacking repletion formulas would be má huáng tāng (Ephedra Decoction) and dà chéng qì tāng (Major Order the Qi Decoction).
Case Example:
 
Guì Zhī Jiā Gé Gēn Tāng (Cinnamon Twig Decoction plus Kudzu)
On December 10, 1965 a twenty one-year-old female presented at the clinic. Yesterday she had contracted a common cold manifesting with symptoms of headache, dizziness, sweating, aversion to cold, weak pain in her shoulders and back, and a tight obstructive pain in the left side of her neck on rotation towards the left. She had a thin white tongue coating, and her pulse was floating and slightly rapid.
A floating, slightly rapid pulse, thin-white tongue coat, aversion to cold, sweating, and headaches signify a Tài Yáng wind strike pattern. Shoulder and back pain, and neck pain on left rotation of the head signify a gé gēn tāng (Kudzu Decoction) pattern. The dizziness indicates that the exterior has not yet been resolved, with upward surging of qì.
Comprehensive analysis: This is a Tài Yáng wind strike pattern with simultaneous stretched stiff nape and back, seen in a guì zhī jiā gé gēn tāng (Cinnamon Twig Decoction plus Kudzu) formula presentation.
Formula:
guì zhī (Cinnamomi Ramulus) 10g
bái sháo (Paeoniae Radix alba) 10g
shēng jiāng (Zingiberis Rhizoma recens) 10g
dà zǎo (Jujubae Fructus) 4 pieces
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
gé gēn (Kudzu Radix) 12g
Results:  After taking 1 package of the formula, her symptoms decreased, and after 2 more, her symptoms had completely resolved.
 

Dr. Féng Shì-Lún on Tài Yīn Presentations

Classical Formulas Interior Yīn Presentations (Tài Yīn disease)%E5%86%AF%E4%B8%96%E7%BA%B6.jpg

  1. 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.

  1. 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.

  1. 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.

  1. 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 Concretions and Conglomerations Case- Féng Shì-Lún (冯世纶)

%E5%86%AF%E4%B8%96%E7%BA%B6.jpgA seventy-two year old retired gentleman presented on September 14, 2004 with a three- year history of liver and spleen hypertrophy.

At sixty years of age he had contracted and suffered from gallbladder inflammation and onychomycosis (ringworm of the nails). At sixty-nine he was given griseofulin to treat the ringworm, which consequently damaged his liver function.  In 2001 his ringworm had gotten much worse and so he was administered Itraconazole for several months. Although the ringworm did improve, his liver function was now abnormal, and his blood platelets had decreased.  His diagnosis was drug-induced hepatitis with splenic-liver syndrome. Western medications were ineffective. The results of his medical exams were as follows:

Blood panels: WBC 4.6 x 1012/L, RBC 3.93 x 1012/L, Platelets 59 x 109/L.

Ultrasound showed a fatty liver, liver enlargement (hepatomegaly), spleen enlargement (splenomegaly), with the thickness of the liver being 156mm and the thickness of the spleen being 70mm.

Liver function tests: AST 45IU/L, TP 8.4g/DL, GGT 76IU/L, TBA 37umol/L.

Current symptoms: Lack of strength, dryness of the mouth in the morning, frequent chest fullness, and frequent passing of flatus. He had a white tongue coat, which was greasy at the root, and his pulse was wiry and thin.

Pattern identification and basis of treatment:

Chest fullness belongs to Shào Yáng

Mouth dryness belongs to Yáng Míng

Lack of strength is associated with Tài Yīn

He was administered a modified version of xiǎo chái hú jiā shí gāo tāng (Minor Bupleurum Decoction with Gypsum)

chái hú (Bupleuri Radix) 12g

huáng qín (Scutellariae Radix) 10g

bàn xià (Pinelliae Rhizoma preparatum) 15g

dǎng shēn (Codonopsis Radix) 10g

zhǐ shí (Aurantii Fructus immaturus) 10g

chén pí (Citri reticulatae Pericarpium) 30g

shēng jiāng (Zingiberis Rhizoma recens) 12g

dà zǎo (Jujubae Fructus) 4 pieces

zhì gān cǎo (Glycyrrhizae Radix preparata) 6g

yīn chén hāo (Virgate Wormwood herba) 15g

dān shēn (Salvia Militiorrhiza) 15g

tiān huā fěn (Trichosanthis Radix 12g

biē jiǎ (Trionycis Carapax) 10g

wǔ wèi zǐ (Schisandrae Fructus) 10g

shēng shí gāo (Gypsum fibrosum) 45g

Seven packages were given.

Question: Is the ancient rén shēn actually dǎng shēn, bái shài shēn or gāo lí shēn?

Answer: If we look, we see that rén shēn’s applications in Zhòng Jǐng’s formulas are quite numerous, and dǎng shēn is capable of meeting these major requirements.

Question: In this treatment xiǎo chái hú tāng (Minor Bupleurum Decoction) was used, and in Japan it is also frequently used for hepatitis. Is this formula especially efficacious at treating hepatitis?

Answer: Not necessarily. Chinese medicine looks at the individual systems when treating and is not influenced by western medical diagnosis.  Japan’s misuse of this formula for treating hepatitis has created lots of disputes around the use of this formula, mainly because they are not relying on pattern (identification) for herb usage and strictly use western medical diagnosis to determine its use. From the perspective of orthodox Chinese medicine this use is incorrect, erroneous and can bring about side effects from the formula.  In this case xiǎo chái hú tāng (Minor Bupleurum Decoction) was used for an extended period of time, yet none of these so-called side effects were observed. These are the lessons the Chinese western integrative doctors should be drawing from.

Second consultation on September 21, 2004:  The chest fullness was not as pronounced, yet he was still lacking strength and was frequently passing gas. Shēng shí gāo (Gypsum fibrosum) was removed from the previous formula and 30g of chén pí (Citri reticulatae Pericarpium) was added. Seven packages were administered and he was also given dà huáng zhè chóng wán (Rhubarb and Ground Beetle Pill) and was instructed to take three grams once daily.

Third consultation on October 8, 2004:  Gas was reduced and bowel movements were normalized. The chén pí (Citri reticulatae Pericarpium) was kept at 30g and 15g of cāng zhú (Atractylodis Rhizoma) was added. Fourteen packs were given.

Fourth consultation on October 22, 2004: Chest fullness was still not pronounced, he experienced itchiness of his abdomen and back, he was only tired after walking and his mouth was no longer dry in the morning. Here we see the lack of strength and harmony of the mouth (no abnormal taste or sensation in the mouth) as the key signs of a Tài Yīn vacuity pattern. Therefore fú líng yǐn (Poria Beverage) is used combined with medicinals to nourish the blood, eliminate stasis, and soften hardness.

bàn xià (Pinelliae Rhizoma preparatum) 10g

dǎng shēn (Codonopsis Radix) 10g

zhǐ qiào (Aurantii Fructus immaturus) 10g

chén pí (Citri reticulatae Pericarpium) 30g

cāng zhú (Atractylodis Rhizoma) 10g

fú líng (Poria) 12g

bái sháo (Paeoniae Radix alba) 10g

táo rén (Juglandis Semen) 10g

dāng guī (Angelicae sinensis Radix) 10g

chuān xiōng (Chuanxiong Rhizoma) 6g

yīn chén hāo (Virgate Wormwood herba) 15g

dān shēn (Salvia Militiorrhiza) 15g

biē jiǎ (Trionycis Carapax) 10g

wǔ wèi zǐ (Schisandrae Fructus) 10g

After taking seven packages he occasionally had a dry mouth with a bitter taste and his GPT levels had increased. He was given a modified version of the formula from the first consultation. Afterwards he had abdominal distention, a lack of strength, and an absence of dryness or bitterness in the mouth. He was then given a modified version of the formula from his fourth consultation.

He was seen again in April of 2005 where he was commonly experiencing a dry mouth with a bitter taste, and a lack of strength in the lower limbs. His tongue coating was white and greasy and his pulse was wiry and thin.  This was a Jué Yīn pattern of blood vacuity with water exuberance and cold-heat complex for which he was given a combination of chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) and dāng guī sháo yào sǎn (Tangkuei and Peony Powder) to treat it. This formula was taken for roughly one year after which his abdominal distention, poor appetite, and lack of strength were resolved, and his overall spirit had improved. In July of 2005 he returned for a follow-up ultrasound. The results were as follows:

1.     Hepatic diffused lesion

2.     Spleen enlargement, increase of the Spleen’s portal vein (thickness of liver was 110mm, and the thickness of the spleen was 50mm)

Overall, his symptoms were improved, and his liver and spleen had reduced in size. He was advised to stop his formula and keep a close watch (on his symptoms).

Question: In the first consultation this man was given a modified version of xiǎo chái hú tāng (Minor Bupleurum Decoction), in the fourth consult he was given wài tái fú líng yǐn (Poria Beverage from the Wài Tái), and afterwards he was given a combination of chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) with dāng guī sháo yào sǎn (Tangkuei and Peony Powder). Can you please elucidate as to whether a half interior half exterior pattern can shift into the interior, and also if an interior condition can shift into the half interior half exterior?

Answer:  It’s not exactly like that. Generally, a disease shifts due to the diminishing of fluids and can pass through the exterior, half exterior half interior, and interior. In disease, Shào Yáng can pass through to Yáng Míng, but Yáng Míng can absolutely not pass to Shào Yáng. This is the reason it is said that in Yáng Míng disease “there is nothing to return to”.  So when a disease presents as a combination of half exterior half interior with an interior (condition), one must use medicinals on the basis of the aspect that is stressed more.

Question: It is said the Dr. Hú was greatly influenced by the great Kampo doctors.  What are the differences and similarities between his research on the works of Zhòng Jǐng’s to those done by Japanese physicians?

Answer: Both sides attached great importance to the work of Zhòng Jǐng and the reasoning, thought process, and identification of the cause of diseases. They both used the perspective of the eight principles pattern identification in order to research and study classic formulas, and paid particular attention to formula pattern correspondences. They felt the six channels were established rules (suitable) for (diagnosing) hundreds of diseases.

A Shào Yáng-Yáng Míng Common Cold- Dr. Féng Shì-Lún (冯世纶)

Common cold

External contraction heat effusion

52 year-old female presented on November 6, 2006 with a fever, which has lasted for seven days. Seven days prior, the patient contracted an external invasion, which manifested with a fever of 38.7°C, and because of her age, she was admitted to hospital for treatment. White blood cell count was 1.35×109/L, neutrophil count was 0.83, and a chest x-ray revealed slight shadowing over the upper portion of the left lung. She was diagnosed with a lung infection.  She felt happy after entering the hospital, and while waiting for treatment to fight the infection was given an infusion of chái hú specifically for the fever. The fever would recede but would again rise, repeatedly remaining abnormal.  The physician administered qi boosting, yin nourishing medicinals all to no avail, and at that point Dr. Féng was asked to consult with the patient.

At the time of the consult the patients temperature was 38.9°C, she had a dry mouth with a bitter taste, dry throat, thirst with a desire to drink water, chest and sub-costal distention and fullness, vexation and agitation with a desire to sleep, right sub-costal pain, no cough but a phlegmy sound (in her chest), no aversion to cold, nor generalized body pain, sweating, which would not lower her temperature, dry stools occurring every three days, regular urination, reduced sleep, a red tongue body with a thin yellow slippery coat, and a wiry slippery pulse.

This woman’s age was already considered high, and moreover suffered from a fever with a lung infection, so western medications were used, but with no effect. Her physician felt that because of her age, the patho-mechanism involved must be due to qi and yin vacuity, and so used qi boosting, toxin resolving, and heat abating methods also with no effect.

Dr, Féng advocated in clinic, that the pattern identification should be based on the characteristics of the symptoms.

This patient suffered from a fever, dry throat, dry mouth with a bitter taste, subcostal distention and pain, which according to six channel pattern identification belongs to a shào yáng disease.

In addition, she also had thirst with a desire to drink, dry stools, a red tongue body with a thin yellow slippery coat, and a wiry-slippery pulse, which according to pattern identification belongs to the interior heat exuberance of a yáng míng disease.

There was no aversion to cold or generalized body pain so we can rule out a tài yáng disease.

In summing up the above signs and symptoms, the pattern is a shào yáng-yáng míng combination disease.

Dà Chái Hú Tāng with the addition of shí gāo can be used to harmonize and resolve the shào yáng, while simultaneously clearing yáng míng interior heat.

Formula: Dà Chái Hú Tāng Jiā Shēng Shí Gāo (Major Bupleurum Decoction plus Gypsum)

chái hú (Bupleuri Radix) 24g

huáng qín (Scutellariae Radix) 10g

dà huáng (Rhei Radix et Rhizoma) 6g

zhǐ shí (Aurantii Fructus immaturus) 10g

sháo yào (Paeoniae Radix alba) 10g

bàn xià (Pinelliae Rhizoma preparatum) 12g

shēng shí gāo (Gypsum fibrosum) 45g (cooked with the decoction)

shēng jiāng (Zingiberis Rhizoma recens) 15g

dà zǎo (Jujubae Fructus) 4 pieces

1 package cooked as a decoction

Results: After taking the one package, the patients fever went down from 39°C to 37.2°C. Her dry mouth with a bitter taste, thirst with a desire to drink, and sub-costal distention and fullness had resolved. Her bowel movements had also freed up. She continued taking another package of the formula, whereby her temperature had normalized and nothing else was troubling her. She underwent another chest x-ray, which now showed nothing abnormal in both lungs. She was observed for another two days in hospital after which she had completely recovered and was discharged.

A Case of Lumbar and Neck Pain-Professor Féng Shì-Lún (冯世纶)