Musings on Bēn Tún Tāng

A formula I’ve been quite intrigued with for many years, and use quite often in clinic, is Bēn Tún Tāng from the Jīn Guì Yào Lüè. The following is a short translation from one of my favourite Qīng dynasty scholar/physicians Huáng Yuán-Yù, followed by some brief clinical musings written by myself. 

Huáng Yuán-Yù on Bēn Tún Tāng

Translated from the Cháng Shā Yào Jiě (长沙药解)

The Golden Cabinet’s Bēn Tún Tāng

Gān Cǎo  2 liǎng

Bàn Xià 4 liǎng

Shēng Jiāng 4 liǎng

Shēng Gé (Gēn) 5 liǎng

Huáng Qín 2 liǎng

Xiōng Qióng 2 liǎng

Dāng Guī 2 liǎng

Sháo Yào 2 liǎng

Gān Lǐ Gēn Bái Pí 1 jīn 

This formula treats Bēn Tún qi, with surging into the chest, abdominal pain, and alternating heat and cold. When yang collapses, and the spleen is vanquished, (this causes) sinking and obstruction in Liver-wood, wood qi depressed effusion, and surging from the umbilicus, abdomen, chest and diaphragm, (resulting in) pain and concurrent heat and cold. Because Liver-wood surges upwards, both the stomach and gall-bladder run counterflow, and the Shaoyang is depressed and distressed, this results in a struggle between the interior and the yin, and this ongoing battle manifests with alternating cold and heat. The qi of Jué Yīn is wind-wood. When wind stirs it consumes the blood, and when warmth is depressed, it results in heat. Gān Cǎo supplements the earth and moderates the center; Shēng Jiāng and Bàn Xià descend stomach and gall-bladder counterflow; Huáng Qín and Shēng Gé (Gēn) clear depressed heat in the stomach and gall-bladder; Xiōng Qióng and Sháo Yào course wood and moisten wood dryness; Gān Lǐ Gēn Bái Pí clears the liver and descends surging qi. 

Gān Lǐ Gēn Bái Pí is sweet, cold, collecting and astringent. It is excellent at descending the surging qi of Jué Yīn, which can therefore treat bēn tùn. It is mainly indicated for alleviating thirst, eliminating vexing counterflow, arresting dysentery, and stopping vaginal discharge. 

Notes:

In my experience, Bēn Tùn (running piglet) can be both objective and subjective. Subjective in that the patient will feel some sort of rush that starts in the lower body, and rises either to the chest, throat, or face. It’s pretty hard to get a patient to tell you that they feel a surging sensation from their lower abdomen to their chest. Some do, but it’s not something I hear very often. Anxiety can manifest this way for some people, while some will tell you that they get facial redness, slightly dizzy or a bit of a rush when they are nervous. Another possibility for some is that this sensation, or ‘rush’ can cause patients to become anxious. I would interpret these manifestations as a form of running piglet. 

However, running piglet is also objective, manifesting in several ways such as; sudden sweating, facial redness, epigastric pain, chest tightness, shortness of breath, dizziness, headaches/migraines, premenstrual acne, etc.

This is due to a wood-earth pathology, where wood is abundant, which damages the earth, hence we see the abdominal pain. Since we have a Shào Yáng element here, there is alternating heat and cold (往来寒热), which can be interpreted the way Huáng Huáng (黄煌) does in that this alternating heat and cold can refer to anything that alternates, or occurs cyclically. This is a major feature of the Shào Yáng, and so having someone that breaks out into sweats, gets cyclical acne, cyclical migraines, anxiety attacks, etc., that is due to a wood-earth pathology, Bēn Tùn Tāng is a great choice. 

In addition, we have an element of a Jué Yīn pathology as well just to complicate things. Here, blood was affected which left a slight blood deficiency and when there is not enough blood and wood-qi tries to move, this can get stuck and lead to heat (which is the flaring of ministerial fire). 

Sāng Bái Pí is the most common substitute for the Gān Lǐ Gēn Bái Pí. Some doctors like Hu Xi-Shu used Chái Hú as they saw this pattern as a Shào Yáng-Tài Yīn concurrent pattern, and added Chái Hú to clear Shào Yáng heat from the chest. I personally use Sāng Bái Pí, as I feel that due to the flaring of ministerial fire, there is a bit of heat in the lungs and adding Sāng Bái Pí ensures that it gets cleared but also that metal descends. With the Spleen-earth affected, ascent and descent in the entire body is affected and we always need to make sure that the proper physiological wheel keeps turning. 

Huáng Yuán-Yù on Wú Zhū Yú Tāng

Wú Zhū Yú (吳茱萸): Acrid and bitter flavor, warm nature; enters the foot Yángmíng stomach, foot Tàiyīn spleen, and foot Juéyīn liver channels. Warms the centre, drains dampness, opens depression, breaks congealment, descends turbid yin to stop vomiting, and ascends clear yang to stop diarrhea. 

Cold Damage’s Wú Zhū Yú Tāng

Wú Zhū Yú (吳茱萸) 1 shēng

Rén Shēn (人蔘) 3 liǎng

Shēng Jiāng (生薑) 6 liǎng

Dà Zǎo (大棗) 12 pieces

Treats Yángmíng cold damage with a desire to vomit after eating. Normally, stomach qi descends, [which results] in the absence of vomiting on the intake [of food]. [When] stomach qi adversely ascends, this results in vomiting and reduced [food] intake. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng warm the stomach and descend counterflow. [This] treats Juéyīn disease with dry retching, vomiting of foamy drool, and headaches. 

Due to deficiency of the earth, wood becomes stagnant, centre qi is harmed, the stomach ascends as opposed to descending, and turbid qi is upthrusted, resulting in headaches and dry retching. 

When damp qi is congealed and stagnant, this results in vomiting of foamy drool. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng descend counterflow and course wood. [This] treats Shàoyīn disease with vomiting, diarrhea, reversal cold of the extremities, vexation, agitation and a desire to die. 

When cold water rebels against the earth, the spleen sinks and the stomach [runs] counterflow, which leads to both vomiting and diarrhea. [When] center qi is depleted, the four limbs lack warmth, resulting in reversal cold of the extremities. [When] yang departs from its root, it disperses and strays without returning, resulting in vexation, agitation and a desire to die. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng descend counterflow and ascend that which is sinking. 

In the Jīn Guì [this formula] treats vomiting and chest fullness. [When] the center is deficient and the stomach runs counterflow, turbid qi becomes congested in the chōng vessel, resulting in vomiting and chest fullness. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng descend counterflow and drain fullness. 

Huáng Huáng – A Bàn Xià Hòu Pò Tāng Case

Huang, 65-year-old male, 171cm/75kg. 

Initial consultation on January 29, 2019.

History: Superficial gastritis with ulceration for over 10 years. Patient reported that he often experienced abdominal pain after taking western medications as well as abdominal discomfort after eating fruit. He felt a sticky sensation in his umbilicus, and also experienced abdominal distention, belching, poor appetite, difficulty falling asleep, and had no issues with his bowel movements. He was worried that his digestive disease will develop into cancer, and therefore, his mood was quite poor. 

Signs: Robust build, double eyelids, frowning eyebrows, lively facial expressions, a red face, and dusky red lips. In addition, he procrastinated when he spoke. His abdomen was soft, there were purple stasis marks below his tongue, his throat was red, tongue coating slightly greasy, and his pulse was slippery. 

Prescription: jiangbanxia 15g, houpo 15g, fuling 15g, sugeng 15g, zhike 15g, zhizi 15g, lianqiao 30g, huangqin 10g; 9 packets; 3 days on, 2 days off. 

Second consultation on February 26, 2019: After taking the formula, his symptoms had improved. However, once stopping them, the symptoms returned, yet this time there was no abdominal pain, and only a feeling of discomfort, plus the location of the pain had now changed. He was also belching, had subcostal distention, and his sleep was reduced. 9 packets of the same formula with chenpi 20g was given; 3 days on, 2 days off. 

Kē Qín on Xuán Fù Dài Zhě Shí Tāng from the Collected Writings on Renewal of the Discussion of Cold Damage (伤寒来苏集)

 

“In Cold Damage which has resolved following sweating, purging or vomiting, [but there is now] a hard glomus below the heart and belching which will not resolve, Xuán Fù Dài Zhě Shí Tāng (Inula and Hematite Decoction) governs.”

(Shāng Hán Lùn clause 161) 

 

 

In cold damage, cold damages the heart. Now if sweat is effused, or one is purged or made to vomit, heart qi will become majorly deficient, and exterior cold will exploit this deficiency and bind below the heart. Heart qi will be unable to descend and instead ascend upwards resulting in noise [belching]. The sovereign [medicinal] governs the manifestation of this fleeing. Belching is the sound of pain. It cannot be referred to as sound, but should be named qi. Qi follows the sound and is seen on the outside.  

Xuán Fù Huā 3 liǎng

Gān Cǎo 3 liǎng

Rén Shēn 2 liǎng

Bàn Xià half a shēng

Dài Zhě Shí 1 liǎng

Shēng Jiāng 5 liǎng

Dà Zǎo 12 pieces

Use one dou of water for the above 7 ingredients, and boil until 6 shēng remain. Remove the dregs, and simmer again until 3 shēng remain. Take 1 shēng warm, three times daily.

This formula is shēng jiāng xiè xīn tang with huáng qín, huáng lián, and gān jiāng removed, and xuán fù huā and dài zhě shí added. In a heart qi deficiency a xiè xīn tang [formula] should not be taken, and can therefore be controlled with this formula. The heart governs the summer, and xuán fù huā reaches its end stage in the summer. Its salty flavor can supplement the heart, soften hardness, and disperse bound qi. Bàn xià grows at the beginning of summer, and its acrid flavor can scatter pathogens, disperse glomus, and move bound qi. Dài zhě shí is endowed with the fire of the south, which enters and frees the heart, scatters hard glomus, and settles the deficient counterflow. The sweetness of rén shēn, gān cǎo, and dà zǎo assist xuán fù huā in draining deficient fire, while acrid shēng jiāng assists bàn xià in scattering bound water. This will result in the dispersal of the hard glomus, and the elimination of belching. If huáng qín and huáng lián are used to drain the heart, how can one protect subtle yang from not being extinguished?

Kē Qín (柯琴), courtesy name Yùn Bó (韵伯) (1662 – 1735) was a Qīng Dynasty Shāng Hán Lùn (傷寒論 Discussion of Cold Damage) scholar, from Cí Xī county in Zhè Jiāng province. A prolific writer, Kē authored several books in his time and was a large proponent of the ‘school of formula types’ (方类证派), famously saying,  “Patterns are differentiated from the conformations, therefore the pattern is named after the formula (证从经分,以方名证).”

Zé Xiè Tāng from the Jīn Guì Fāng Gē Kuò

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
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 “” () 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’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

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

 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.

[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.

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


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.

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

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


溫經湯 Wēn Jīng Tāng (Channel Warming Decoction)

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

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

溫經湯
Wēn Jīng Tāng
Channel Warming Decoction
治婦人年五十所, 病下利數十日不止, 暮即發熱, 少腹裡急, 腹滿, 手掌煩熱, 唇口乾燥, 此屬帶下。  何以故? 曾經半產, 瘀血在少腹不去。  何以知之? 其証唇口乾燥, 故知之, 當以此湯主之。
A treatment for women in their fifties who suffer from incessant diarrhea more than ten times per day, with heat effusion in the evening, lesser abdominal urgency, abdominal fullness, vexing heat in the palms, and dry lips and mouth. This belongs to women’s diseases. What is the reason?  There was a history of late miscarriage and static blood now remains in the lesser abdomen.  How can one know this?  The pattern manifests with dry lips and mouth, and this is how one knows this, and this formula rules it.
吳茱萸(三兩)當歸   芎藭   芍藥   人參   桂枝   阿膠    丹皮    甘草(各二兩)生薑(三兩。  一本二兩)半夏(半升。  一本二升)麥冬(一升)
wú zhū yú
吳茱萸
9g
dāng guī
當歸
6g
xiōng qióng
芎藭
6g
sháo yào
芍藥
6g
rén shēn
人參
6g
guì zhī
桂枝
6g
ē jiāo
阿膠
6g
dān pí
丹皮
6g
gān cǎo
甘草
6g
shēng jiāng
生薑
9g[1]
bàn xià
半夏
100ml[2]
mài dōng
麥冬
200ml
上十二味, 以水一斗, 煮取三升, 分溫三服。  亦主婦人少腹寒, 久不受胎; 兼治崩中去血, 或月水來多, 及至期不來。
Simmer the eleven ingredients above in 2,000ml of water until reduced to 600ml. Divide and take heated in three doses. It also rules (the treatment) of lesser abdominal cold in women, infertility, and simultaneously treats flooding, copious menstruation, as well as delayed menstruation.
Song 歌曰:
溫經芎芍草歸人, 膠桂丹皮二兩均, 八物各二兩  半夏半升麥倍用, 吳茱萸三兩對君陳。
For wēn jīng tāng (use) chūan xiōng, sháo yào, gān cǎo, dāng guī, rén shēn, ē jiāo, guì zhī, and dān pí each at six grams,  (6 grams for each of the eight medicinals). Use 100ml of bán xiá and double of mài dōng, plus nine grams each of shēng jiāng and wú zhū yú.
Commentary by (Chén) Yuánxī男元犀按:
方中當歸、芎藭、 芍藥、 阿膠, 肝藥也; 丹皮、 桂枝, 心藥也; 吳茱萸, 肝藥亦胃藥也; 半夏, 胃藥亦衝藥也; 麥門冬、 甘草, 胃藥也; 人參補五臟, 生薑利諸氣也。  病在經血, 以血生於心, 藏於肝也, 衝為血海也。  胃屬陽明, 厥陰衝脈麗之也。  然細繹方意: 以陽明為主, 用吳茱萸驅陽明中土之寒, 即以麥門冬滋陽明中土之燥, 一寒一熱, 不使偶偏, 所以謂之溫也; 用半夏、 生薑者, 以薑能去穢而胃氣安, 夏能降逆而胃氣順也; 其余皆相輔而成溫之之用, 絕無逐瘀之品。  故過期不來者能通之, 月來過多者能止之, 少腹寒而不受胎者並能治之, 統治帶下三十六病, 其神妙不可言矣。
Within the formula, dāng guī, chūan xiōng, sháo yào and ē jiāo are all liver medicinals; dān pí and guì zhī are heart medicinals; wú zhū yú is both a liver and stomach medicinal; bán xiá is both a stomach and thoroughfare (vessel) medicinal; mài dōng and gān cǎo are stomach medicinals; rén shēn supplements the five viscera, and shēng jiāng disinhibits all qì. Disease is in the menstrual blood. Blood is engendered in the heart, stored in the liver, and the thoroughfare vessel is the sea of blood. The stomach belongs to yáng míng, and is linked[3]to both the jué yīn and the thoroughfare vessel. Now (we must) carefully examine the meaning of the formula. As (the condition) is ruled by yáng míng, wú zhū yú is used to expel cold from yáng míng center earth, while mài dōngenriches dryness within yáng míng center earth – one cold and one hot medicinal. (While being) neither too cold nor too warm, (the formula) is (still) referred to as warm. As for the usage of bán xiá and shēng jiāng, shēng jiāng eliminates foulness and calms stomach qì, while bán xiá is able to downbear counterflow and smooth stomach qì. The remaining (medicinals) are used to assist in warming, and are by no means ingredients for expelling stasis. Therefore, with delayed menstruation, (this formula) is able to free it and with excessive menstruation, it is able to stop it.  It is (also) able to treat lower abdominal cold and infertility, and for the thirty-six women’s diseases, its marvel is too wonderful for words!

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

Kidney Fixity Disease (腎著病)

What is Kidney Fixity disease? %E9%99%B3%E4%BF%AE%E5%9C%93.jpg

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

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

甘薑苓白朮湯

Gān Jiāng Líng Bái Zhú Tāng

Licorice, Dried Ginger, Poria, and Ovate Atractylodes Decoction

一名腎著湯                                                                                                                                                         

Also called Kidney Fixity Decoction

治腎著之病其人身體重腰中冷如坐水中形如水狀反不渴小便自利飲食如故病屬下焦身勞汗出衣裡冷濕久久得之腰以下冷痛腹重如帶五千錢者,此主之。

A treatment for kidney fixity disease; where the patient experiences generalized heaviness and lumbar coldness, as if they are sitting in water.  Symptoms resemble those of water disease, yet there is no thirst, urination is uninhibited, and eating and drinking are normal. This means that the disease is in the lower burner.  Physical taxation with sweating leads to cold and dampness in the clothes, and over an extended period of time manifests with cold pain below the waist, and abdominal heaviness as if carrying five thousand coins.  This formula rules it.  

甘草    (各二兩)乾薑 茯苓(各四兩)

gān cǎo

甘草

6g

bái zhú

6g

gān jiāng

乾薑

12g

fú líng

茯苓

12g

上四味以水五升煮取三升分溫三服腰即溫。

Simmer the four ingredients above in 1000ml of water until reduced to 600ml.  Divide and take warm in three doses, until the lumbus feels warm. 

Song 歌曰:

腰冷溶溶坐水泉帶脈束於腰間腎著則腰帶病故溶溶如坐水中狀。  腹中如帶五千錢朮甘二兩薑苓四寒濕同驅豈偶然?

Lumbar coldness as if sitting in gently flowing water springs.

The girdling vessel binds around the lumbus.

With kidney fixity there is disease in the waist, which therefore brings the feeling as if one is sitting in water.

The abdomen feels as if it is carrying five thousand coins,

(With) six grams each of bái zhú and gān cǎo, and twelve of gān jiāng and fú ling,

is it by chance that both cold and dampness are expelled?

Quotation by Yóu Zàijīng 2 尤在涇雲:

寒濕之邪不在腎之中臟而在腎之外府故其治不在溫腎以散寒而在燠土以勝水。  若用桂、 則反傷腎之陰矣。

Cold-damp evils are not located in the kidney viscera but in the external dwelling of the kidneys.  Therefore, treatment need not involve warming the kidneys in order to dissipate cold, but to warm earth to prevail over water.  If guì zhī, or fù zǐ were used, then kidney yīn would be damaged!

Case #1

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

gān jiāng (Zingiberis Rhizoma) 6g

gān cǎo (Glycyrrhizae Radix) 3g

fú líng (Poria) 10g

bái zhú (Atractylodis macrocephalae Rhizoma) 10g

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

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

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

After finishing the formula his back pain had completely resolved.

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

Case #2

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

fú líng (Poria) 30g

bái zhú (Atractylodis macrocephalae Rhizoma) 15g

gān jiāng (Zingiberis Rhizoma) 14g

zhì gān cǎo (Glycyrrhizae Radix preparata) 10g

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

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

1. (Practical Dictionary of Chinese Medicine, Wiseman et al. pg.326)

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