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
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.

Yáng Dàn Tāng (陽旦湯) Yáng Dawn Decoction from the Jīn Guì Fāng Gē Kuò

As I am approaching close to 18 months of ardently working on the translation of the second volume of Chén Xiū-Yuàn’s Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), I thought it was due time to share a small tidbit of the material.  I am getting quite close to finishing the text and it should be out sometime in the next few months.  

陽旦湯Jīn Guì Fāng Gē Kuò.jpg

Yáng Dàn Tāng

Yáng Dawn Decoction

治產後中風續續數十日不解頭微疼惡寒時時有熱心下悶乾嘔汗出 ,雖久陽旦症續在者可與之。  即桂枝湯增桂加附。  坊本謂加黃芩者未知《傷寒論》太陽篇中已明其方孫真人及各家俱誤。  桂枝湯見《傷寒論》。

A treatment for post-partum wind strike that remains unresolved for several tens of days with, a mild headache, aversion to cold, frequent heat effusion, oppression below the heart, dry retching, and sweating. Even though (the condition) has persisted for a long time, yáng dàn tāng signs are still present, and can be given. (This formula) is guì zhī tāng with increased guì zhī and the addition of fù zǐ.

An old block-printed version of the text refers to this formula as (guì zhī tāng) with the addition of huáng qín, but it is unknown whether this is the same tài yáng formula as in the Shāng hán lùn. Master Sūn Sīmiǎo and various others believed it to be so (for which) they were mistaken. For guì zhī tāng see the Shāng Hán Lùn.

 Commentary by (Chén) Yuánxī 男元犀按:

頭痛發熱、 惡寒汗出太陽表症也。  心下悶者太陽水邪彌漫心下而作悶也。  陽旦湯即桂枝湯倍桂枝加附子。  雖産後數十日不解其邪仍在於太陽之經故仍用桂枝湯解太陽之表邪加桂以化膀胱之水氣加附子以溫固水臟使經臟氣化則內外之邪出矣。  《傷寒論》桂枝加附子治漏汗加桂治氣從少腹上衝心去芍治胸滿俱有明文可據。  孫真人以桂枝湯加黃芩爲陽旦湯其意以心下悶爲熱氣誤矣。  夫有熱氣則當心煩今日心下悶則非熱可知矣。  況微惡寒時時有熱乾嘔汗出爲太陽桂枝湯之的症。  蓋太陽底面便是少陰續續至數十日不解顯系少陰之君火微而水寒之氣盛寒氣上淩陽位是以爲心下悶之苦。  故取桂枝湯增桂以扶君主之陽加附子以鎮水陰之逆使心陽振水臟溫則上逆之陰邪不攻而自散矣。

Headaches, heat effusion, aversion to cold, and sweating are symptoms associated with a tài yáng exterior pattern. (With) oppression below the heart, tài yáng water evils pervade (the area) below the heart and cause oppression. Yáng dàn tāng is guì zhī tāng with double the guì zhī and the addition of fù zǐ. Although there is a lack of resolution ten days post partum, evils are still located in the tài yáng channel, and it is for this reason that guì zhī tāng is used to resolve exterior evils in the tài yáng. Guì zhī is increased in order to transform water qì in the bladder.  Fù zǐ is added to the formula to warm and secure the water viscus, enabling the transformation of qì in the channels and viscera, and ensuring the expulsion of evils in both the interior and exterior. In the Shāng Hán Lùn, guì zhī jiā fù zǐ tāng is used to treat leaking sweat; increasing guì zhī treats surging qì from the lesser abdomen into the heart, and removing sháo yào treats chest fullness. These (principles) are in accordance with the (original) writings. (According to) master Sūn (sīmiǎo), yáng dān tāng is guì zhī jiā huáng qín tāng, (as he felt that) oppression below the heart was due to hot qì; this is a mistake! Now if there were hot qì, then there would be heart vexation, (but) presently with the oppression below the heart, we know there is no heat!  Moreover, slight aversion to cold, and frequent heat (effusion), dry retching, and sweating, is a guì zhī tāng tài yáng presentation. In all (cases) of tài yáng, there is shào yīn at the bottom, and with continuous (wind strike) reaching ten days without resolution, there is a clear relation to the debilitation of shào yīn sovereign fire, with exuberance of cold water qì. Cold qì ascends and encroaches into the position of yáng, resulting in oppression below the heart. Therefore, guì zhī tāng with increased guì zhī, supports sovereign yáng, and with the addition of fù zǐ counterflow of water yīn is settled, heart yáng is vitalized, and the water viscus is warmed.  Then, ascending counterflow of yīn evils will not attack, and dissipate on their own!

Xiǎo Qīng Lóng Tāng from the Zhù Jiě Shāng Hán Lùn

Line 40:

“In cold damage when the exterior has not yet resolved, and there is water qì below the heart, with dry retching, heat effusion, and cough, and possibly thirst or diarrhea, or dysphagia, or inhibited urination and lesser abdominal fullness, or panting, xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

In cold damage when the exterior has not yet been resolved and there is water qì below the heart, this will result in the contention of water and cold with cold qì counterflow in the lung manifesting with symptoms of dry retching, heat effusion, and cough. The Acupuncture classic says, “Physical cold with cold rheum damages the lungs”. What this means is that there is contraction of two kinds of cold, and both the center and exterior are damaged, which results in the upward movement of counterflow qì. By administering xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) sweat is effused and water is dissipated. With the steeping of water qì in the interior, several signs can manifest, and therefore it must be resolved and transformed. Cheng Wu-ji.jpeg

Xiǎo Qīng Lóng Tāng (Minor Bluegreen Dragon Decoction)

má huáng (Ephedrae Herba) 3 liǎng (remove nodes), flavor is sweet and warm

sháo yào (Paeoniae Radix) 3 liǎng, flavor is sour and slightly cold

wǔ wèi zǐ (Schisandrae Fructus) ½ shēng, flavor is sour and warm

gān jiāng (Zingiberis Rhizoma) 3 liǎng, flavor is acrid and warm

zhì gān cǎo (Glycyrrhizae Radix preparata) 3 liǎng, flavor is sweet and neutral

guì zhī (Cinnamomi Ramulus) 3 liǎng (remove the bark), flavor is acrid and warm

bàn xià (Pinelliae Rhizoma preparatum) ½ shēng (washed), flavor is acrid and slightly warm

xì xǐn (Asari Herba) 3 liǎng, flavor is acrid and warm.

When cold evils are present in the exterior, without the use of acrid and sweet (medicinals), one would be unable to dissipate them.  Má huáng (Ephedrae Herba), guì zhī (Cinnamomi Ramulus), and gān cǎo (Glycyrrhizae Radix) are acrid and sweet, and can therefore effuse and dissipate cold evils. When there is stoppage of water qì below the heart that fails to move, then the kidney qì will become dry. The Nèi Jīng says, “When the kidneys suffer from dryness, swiftly eat acrid to moisten them”. Gān jiāng (Zingiberis Rhizoma), xì xǐn (Asari Herba), and bàn xià (Pinelliae Rhizoma preparatum) are acrid and can (therefore) move water qì and moisten the kidneys. Coughing counterflow and panting are (the result of) counterflow lung qì.  The Nèi Jīng says, “(When) the lungs desire to be collected (astringed), swiftly eat sour in order to collect them”.  Sháo yào (Paeoniae Radix) and wǔ wèi zǐ (Schisandrae Fructus) are both sour and can collect (astringe) counterflow qì and calm the lungs.

Use one dǒu of water for the eight ingredients above.  First boil the má huáng to reduce the water by two shēng.  Remove the foam collecting on top and add the other ingredients.  Boil until reduced to three shēng, remove the dregs, and take one shēng warm. 

Modifications:

If there is slight diarrhea remove the má huáng and add a piece of ráo huā (Wikstroemia Flos) the size of a chicken egg, and dry fry until red.

With diarrhea one cannot attack the exterior, as when sweat is issued, this will result in distention and fullness. Má huáng effuses yáng, which can lead to the steeping of water into the stomach, inevitably resulting in diarrhea. Ráo huā is able to purge water, and once water is removed, diarrhea will cease. 

If there is thirst, remove bàn xià and add three liǎng of guā lóu gēn (Trichosanthis Radix).

Acrid dries, and bitter moistens. Bàn xià is acrid and can therefore dry fluids, so without thirst it is appropriate.  (Here) there is thirst, and it is therefore eliminated. Guā lóu gēn is bitter and can generate fluids therefore it is added.  

If there is dysphagia, remove má huáng and add one piece of blast-fried fù zǐ (Aconiti Radix lateralis preparata).

The classics say, “when water obtains cold qì, there will be mutual contention amongst them and the person will experience dysphagia”.  Fù zǐ is added to warm and dissipate cold water.  When a person has cold, and sweat is repeatedly effused, this will leave the stomach cold, which will result in the vomiting of roundworms, therefore má huáng is removed out of fear of effusing sweat. 

If urination is inhibited and there is fullness in the lesser abdomen, remove má huáng and add four liǎng of fú líng (Poria).

When there is water amassment in the lower burner that fails to move resulting in inhibited urination and fullness in the lesser abdomen, má huáng is inappropriate as it effuses fluids into the exterior; fú líng discharges amassed water out through the lower, and is therefore used instead. 

Line 40:

If there is panting, remove má huáng and add ½ shēng of xìng rén (Armeniacae Semen amarum), removing the skin and tips.

The Jīn Guì Yào Lüè says, “When a person (suffers) from generalized swelling, one should not add má huáng but instead use xìng rén”.  The reason is that má huáng effuses the yáng. With panting and generalized swelling, water qì is the branch and root of the disease.

Line 41:

“In cold damage when there is water qì below the heart, cough, mild panting, and heat effusion without thirst, (but with) thirst after taking the decoction, this means cold is leaving and (the disease) is about to resolve; xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

Cough and mild panting are due to cold water shooting into the lungs. Heat effusion and an absence of thirst are due to an exterior pattern, which has not yet ceased. Xiǎo qīng lóng tāng is given to effuse the exterior and dissipate water. (If) after taking the decoction there is thirst, this means that the interior has been warmed, water qì has been dissipated, and (the disease) is about to resolve.

Má Xìng Gān Shí Tāng from the Zhù Jiě Shāng Hán Lùn

Chéng Wú-Jǐ (1050-1144) images.jpg

A scholar/physician from the Northern Sōng dynasty who compiled the Annotations to the Shāng Hán Lùn (注解伤寒论), which became what’s known as the Sōng version of the Shāng Hán Lùn used to the present day.  Chéng devoted over forty years of his life to compiling his seminal work, which he completed in 1140. However, Chéng never saw it published, which occurred in 1172, close to thirty years after his death. Chéngs’ annotation was extremely comprehensive and detailed, citing numerous sources and references in his attempt to repair and resolve the various inconsistencies that existed amongst the numerous surviving versions of the text.

The following is taken from Chéngs Annotations to the Shāng Hán Lùn

Line 63:

“Following the promotion of sweat, Guì Zhī Tāng should not be given again; (if) there is sweating with panting and the absence of great heat, one can use má xìng gān shí tāng (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)”. 1

 

With panting after the promotion of sweat, one can typically use guì zhī jiā hòu pò xìng zǐ tāng (Cinnamon Twig Decoction Plus Magnolia Bark and Apricot Kernel), as once sweat (further) effuses, the condition will resolve.  (However) here there is sweating with panting signifying that evil qì is quite severe, therefore guì zhī tāng (Cinnamon Twig Decoction) would be unable to effuse and dissipate (evils), and so this is the reason, the guì zhī tāng should not be given again. Sweating and panting with great heat, indicates the presence of severe hot qì in the interior. The absence of great heat signifies that exterior evils must be severe. In this case it is suitable to give má xìng gān shí tāng in order to dissipate the evils. 

Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)

má huáng (Ephedrae Herba) 4 liǎng (remove nodes)- flavor is sweet and warm

xìng rén (Armeniacae Semen amarum) 50 pieces (remove skin and tips)- flavor is sweet and warm

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 liǎng- flavor is sweet and neutral

shí gāo (Gypsum fibrosum) ½ jīn (crushed and cotton wrapped)- flavor is sweet and cold

The Huáng Dì Nèi Jīng says “When the liver suffers from urgency, swiftly eat sweet (flavors) in order to moderate it”. (Here) wind qì passes through the liver and wind evils are severe in the exterior, therefore a purely sweet formula is given to effuse it.

For the four ingredients above use seven shēng of water.  First boil the má huáng and reduce (the water) by two shēng and remove the foam collecting on top. Add the remaining ingredients and boil until reduced to two shēng, remove the dregs and take one shēng warm.  The original text says that the formula should be put into a yellow-eared cup (a Hàn dynasty drinking vessel). 

1. It should be noted here that line 162 is almost identical to this one with the only difference being that the line starts off by saying “following precipitation”.

Guì Zhī Jiù Nì Tāng (Cinnamon Counterflow-Stemming Decoction)

Case of Dr. Hú Xī-Shù (胡希恕)

A twenty-six year old air force translator came in for an initial consultation. Recently while observing the repair of some electric wiring, he (suddenly) became very frightened, which manifested with fright palpitations, flusteredness, insomnia, headaches, poor appetite, nausea, and the occasional sound of phlegm in the back of his throat, which caused him to become uncontrollably angry, restless, and vexed every time he would hear this sound, but over some time (his emotions) would gradually recede slightly. Nonetheless two people assisted him when he had come in for a consultation. 

(Aside from the symptoms above) he had a thick white tongue coat, and his pulse was wiry, slippery and the cùn (inch) position was floating. This pattern is due to the upward harassment of enduring cold rheum, and treatment should involve warming, transforming, and downbearing counterflow. He was given a modified version of (guì zhī) jiù nì tāng (Cinnamon Twig Counterflow-Stemming Decoction). 

guì zhī (Cinnamomi Ramulus) 10g

shēng jiāng (Zingiberis Rhizoma recens) 10g

zhì gān cǎo (Glycyrrhizae Radix preparata) 6g

dà zǎo (Jujubae Fructus) 4 pieces

bàn xià (Pinelliae Rhizoma preparatum) 12g

fú líng (Poria) 12g

shēng mǔ lì (Ostreae Concha) 15g

shēng lóng gǔ (Fossilia Ossis Mastodi) 15g

Results: After taking three packages of the above formula his flusteredness and phlegm sound in the back of his throat were reduced. After six packages, his appetite increased, and his sleep had improved. He continued on the formula and after ten packages all of his symptoms disappeared. 

Line 112 in the Shāng hán lùn (傷寒論 Discussion of Cold Damage) says:

“(When) in cold damage the pulse is floating, and a fire (method) is used to force (sweating), as a result yáng collapses and there will be fright mania, and fidgetiness whether lying or sitting; guì zhī qù sháo yào jiā shǔ qī mǔ lì long gǔ jiù nì tāng governs”.

Analysis: When there is cold damage with a floating pulse, one should consider treating it with má huáng tāng to promote sweating, however, if it is treated with a fire method, which could include moxibustion, fire needling, fire fuming, and other similar methods, to force sweating, it can result in major sweating, and this is an erroneous treatment. When there is major sweating, this will result in the collapse of liquids and humors. Not only will this fail to meet the objective of resolving the exterior, but major sweating, will result in upper vacuity, causing qì to overwhelm the vacuity and surge upwards. This will also stimulate the interior causing the ascent of rheum, which will cloud the clear orifices resulting in symptoms of fright mania, and fidgetiness whether lying or sitting. The suitable treatment here is with guì zhī qù sháo yào jiā shǔ qī mǔ lì long gǔ jiù nì tāng.

Rén Yīng Qiū- A Zhēn Wǔ Tāng (True Warrior Decoction) Case

Hú Xī-Shù-Guì Zhī Jiā Gé Gēn Tāng (Cinnamon Twig Decoction plus Kudzu)

C1889F76D1DD4A168D3241E3F09F193A.jpgHere’s a case of a wind strike pattern. Nothing too enlightening or complicated here, but sometimes we need to be reminded of the simple stuff!!

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.

Gé Gēn Jiā Bàn Xià Tāng (Kudzu Decoction with Pinellia)

On December 21, 1965 a twenty one-year old female presented at the clinic. The previous day she had contracted a common cold manifesting with symptoms of headache, dizziness, generalized body pain, lumbar pain, nausea with a desire to vomit, aversion to cold, and frequent abdominal pain with loose bowel movements. Her pulse was floating-rapid, and she had a thin white tongue coating.

The white tongue coat, floating-rapid pulse, aversion to cold, headache, generalized body pain, and lumbar pain signify Tài Yáng cold damage. The frequent abdominal pain with loose bowel movements indicates Tài Yīn (disease). The dizziness, and nausea with desire to vomit show that there is interior rheum invading upwards, which is a bàn xià (Pinelliae Rhizoma preparatum) presentation.

Comprehensive analysis: This is a Tài Yáng Tài Yīn combination disease, which fits with a gé gēn jiā bàn xià tāng (Kudzu Decoction with Pinellia) presentation.

Formula:

gé gēn (Kudzu Radix) 12g
má huáng (Ephedrae Herba) 10g
guì zhī (Cinnamomi Ramulus) 10g
shēng jiāng (Zingiberis Rhizoma recens) 10g
bái sháo (Paeoniae Radix alba) 10g
dà zǎo (Jujubae Fructus) 4 pieces
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
bàn xià (Pinelliae Rhizoma preparatum) 12g

Results: After taking 1 package of the formula, her symptoms decreased, and after 2 packages, her symptoms had completely resolved.

Huáng Qín Tāng [Line 172]

Chéng Wú-Jǐ 成无己

From ‘A commentary on the Annotated Shāng Hán Lùn’ (注解伤寒伦) by Chéng Wú-Jǐ

Line 172 

In a Tài Yáng and Shào Yáng combination disease with spontaneous diarrhea, give huáng qín tāng (Scutellaria Decoction); if there is retching, huáng qín jiā bàn xià shēng jiāng tāng (Scutellaria Decoction plus Pinellia and Fresh Ginger) rules it. 

Commentary: In a Tài Yáng and Yáng Míng combination disease, spontaneous diarrhea is coming from the exterior, and gé gēn tāng (Kudzu Decoction) is given to effuse sweat. In a Yáng Míng and Shào Yáng combination disease, spontaneous diarrhea is coming from the interior, and a chéng qì tāng (Order the Qi Decoction) formula is used to precipitate it. This is a Tài Yáng and Shào Yáng combination disease, and the spontaneous diarrhea is a result of the condition being half in the exterior and half in the interior. Here it would be inappropriate to promote sweat or precipitate, so huáng qín tāng (Scutellariae Decoction) is given to harmonize and resolve the pathogens laying half in the exterior and half in the interior. Retching indicates counterflow of stomach qì so bàn xià (Pinelliae Rhizoma preparatum) and shēng jiāng (Zingiberis Rhizoma recens) are added to dissipate counterflow qì.

Huáng Qín Tāng (Scutellariae Decoction)

huáng qín (Scutellariae Radix) 3 liǎng (9g) [acrid-cold]
zhì gān cǎo (Glycyrrhizae Radix preparata) 2 liǎng (6g) [sweet-neutral]
sháo yào (Paeoniae Radix) 2 liǎng (6g) [sour-neutral]*
dà zǎo (Jujubae Fructus) 12 pieces, broken [sweet-warm]

*In the Běn Cǎo Jīng, sháo yào (Paeoniae Radix) is classified as bitter, and is considered to be mildly cold in the Míng Yī Bié Lù.

Commentary: In vacuity and non-repletion, (the) bitter (flavor) is used to harden, and sour is used to contract. huáng qín (Scutellariae Radix) and sháo yào (Paeoniae Radix) are bitter and sour, and are used to harden and constrain the qì of the stomach and intestines. In weakness and insufficiency, (the) sweet (flavor) is used to supplement. gān cǎo (Glycyrrhizae Radix) and dà zǎo (Jujubae Fructus) are both sweet and can supplement and secure stomach and intestinal weakness.

Simmer the four ingredients above in 1 dǒu of water (2,000ml) until reduced to 3 shēng (600ml). Remove the dregs and take 1 shēng (200ml) heated, twice during the day and one at night. If there is retching, add ½ shēng (100ml) of bàn xià (Pinelliae Rhizoma preparatum) and 3 liǎng (9g) of shēng jiāng (Zingiberis Rhizoma recens)*.

*The Sòng dynasty version does not include this modification but has a separate line for huáng qín jiā bàn xià shēng jiāng tāng (Scutellaria Decoction plus Pinellia and Fresh Ginger).