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.

Dr. Hú Xī-Shù (胡希恕) -Chest Pain

On May 28th, 1965, a 67 year-old male presented at the clinic suffering from shortness of breath, chest pain, and hu xi shu 2.jpgchest oppression for over a month. On April 23rd he was diagnosed with a myocardial infarction, and was administered both nitroglycerine and aminophylline, which were ineffective. He also sought out Chinese medical treatments and was given various qi boosting, blood invigorating, phlegm transforming, and collateral freeing medicinals (such as rén shēn, huáng qí, mù guā, chì sháo, jiàng xiāng, táo rén, xiè bái, and yù jīn), which he had been taking for the last month but no obvious improvement was observed.  Currently he was experiencing a burning hot pain in the left side of his chest, shortness of breath, which was exacerbated with movement, he was occasionally cold and hot, had a stifling sensation below his heart, a bitter taste in the mouth, occasional head distention, insomnia, and dry stools. He had a yellow tongue coating, and a wiry, slippery pulse.  

Dr. Hú administered a modified version of dà chái hú tāng (Major Bupleurum Decoction) combined with guì zhī fú líng wán (Cinnamon and Poria Pill).

chái hú (Bupleuri Radix) 4 qián

bàn xià (Pinelliae Rhizoma preparatum) 3 qián

huáng qín (Scutellariae Radix) 3 qián

bái sháo (Paeoniae Radix alba) 3 qián

zhǐ shí (Aurantii Fructus immaturus) 3 qián

shēng jiāng (Zingiberis Rhizoma recens) 3 qián

dà zǎo (Jujubae Fructus) 4 pieces

guì zhī (Cinnamomi Ramulus) 3 qián

fú líng (Poria) 4 qián

táo rén (Juglandis Semen) 3 qián

dà huáng (Rhei Radix et Rhizoma) 2 qián

shí gāo (Gypsum fibrosum) 1 liǎng

zhì gān cǎo (Glycyrrhizae Radix preparata) 1 qián

Second consultation (June, 1st): After taking three packages of the formula most of his symptoms had improved, but he was still feeling suffocated in the evenings, had heartburn after meals, and his stools were still dry. His tongue coat was still yellow, and his pulse was wiry, slippery, and slightly rapid.  The same formula was administered but the dà huáng was increased to 3 qián.

Third consultation (December 23rd): After taking two packages of the formula, the suffocating feeling in the evenings disappeared, and while he still experienced some shortness of breath on exertion, it would gradually resolve after a little bit of rest. Afterwards he did not return for a follow up.  He was currently being treated for a weeklong cough with a modified version of bàn xià hòu pò tāng (Pinellia and Magnolia Bark Decoction).

Commentary:  In regards to the treatment of this case, the previous physicians had used blood invigorating, qi regulating medicinals, however they all failed to provide any relief for the patient, while Dr. Hú was able to offer a good effect by grasping the crucial aspect of the condition.  The previous physician paid little attention to whether the condition involved heat, cold, repletion, or vacuity, while Dr. Hú recognized this to be a repletion heat pattern stuck in the half exterior half interior portion of the body.  In addition, he recognized this as a dà chái hú tāng and guì zhī fú líng wán formula presentation, which is the reason why his treatment worked so well.

Dr. Hú Xī-Shù- A Case of a Gastrointestinal Common Cold

On July 6, 1967 a thirty-six-year old female presented at the clinic complaining of a cough and diarrhea, which has hu xi-shu.jpglasted for over twenty days after contracting a common cold. She has undergone IV injections of streptomycin, and taken various western medications all to no avail. 

Current signs and symptoms: cough with shortness of breath, an aversion to wind and cold, dry mouth with no desire to drink, no desire to eat, loose bowel movements occurring three to four times a day, a white tongue coating, and a thin-wiry and rapid pulse. 

She was administered gé gēn tāng (Kudzu Decoction) with shí gāo (Gypsum fibrosum)

gé gēn (Kudzu Radix) 3 qián

guì zhī (Cinnamomi Ramulus) 3 qián

bái sháo (Paeoniae Radix alba) 3 qián

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 qián

dà zǎo (Jujubae Fructus) 4 pieces

má huáng (Ephedrae Herba) 2 qián

shēng jiāng (Zingiberis Rhizoma recens) 3 qián

shēng shí gāo (Gypsum fibrosum) 1 ½ liǎng

Results: After taking two packages of the above formula, all her symptoms were immediately resolved.

Commentary:  This is diarrhea due to a Tài Yáng Yáng Míng combination disease, for which Dr. Hú commonly used gé gēn tāng (Kudzu Decoction) with shí gāo (Gypsum fibrosum) to treat it. Can shí gāo be used in cases presenting with diarrhea?  This fact is usually faced with skepticism.

In clause 4 of the Shāng hán lùn (傷寒論 Discussion of Cold Damage) it says;

“On the first day of cold damage, Tài Yáng has contracted the disease, (and if) the pulse is tranquil, (this means) there has been no passage. (With) a strong desire to vomit, agitation, vexation, and a rapid and urgent pulse, (this) means passage (has occurred)”.

Here the patient had a cough, aversion to wind and cold, a dry mouth, and a rapid pulse, which suggests a passage from Tài Yáng to Yáng Míng. The major cause of diarrhea is Yáng Míng heat, therefore, gé gēn tāng (Kudzu Decoction) with shēng shí gāo (Gypsum fibrosum) is used to resolve the exterior and clear Yáng Míng heat. Once the exterior is resolved, the diarrhea will cease. In cases like this, one’s who are unfamiliar with classical formulas, will tend to use modified versions of huò xiāng zhèng qì tāng (Patchouli Qì-Regulating Decoction), however, clinically their results are very often never as quick as with this case, so therefore, cases such as these are provided to offer opportunity for further study and contemplation.

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.

Dr. Hú Xī-Shù’s approach in the treatment of coughs (Part 2)

Exterior cold and interior thin-fluids are common allies, therefore resolving the exterior and dispelling thin-fluids must be carried out simultaneously

A patient who had once come to see Dr. Hú with a chronic cough was given xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) with the addition of fú líng (Poria). A senior physician asked the doctor whether he felt this gentleman’s cough was due to external contraction or to internal damage? Dr. Hú simply answered “this patient’s cough is the result of external contraction combined with interior thin-fluids, and fits a xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) with fú líng (Poria) presentation”. This is a complete formula, which is able to address the root cause, and treat the cough’s pattern of external contraction and interior thin-fluids. Zhāng Jǐng-Yuè pointed out that coughs can be divided into two main patterns, one being external contraction, the other being internal damage. This is how we classify them according to theory, however in clinical reality, these two patterns frequently simultaneously coexist. Internal damage can easily provoke external contraction, and external contraction can also easily bring about internal damage. Therefore, in clinical practice, one does not necessarily need to determine whether the cause is external contraction or internal damage, as long as there are definite symptoms of each, and treatment is based on pattern identification, that would be sufficient. Classifying coughs into either external contraction or internal damage is of course easy to remember for new practitioners or ones with little clinical experience, however, once faced with these presentations in clinic, one would run in to difficulties finding the right formulas. For example, if a patient presents with cough, and we were to use this aforementioned strategy, determining whether or not one should diffuse and resolve (the exterior), or supplement, and boost would prove difficult and would completely neglect treatment of one or the other pattern, prolonging and failing to treat the disease. The following case clearly elucidates this problem. hu xi-shu.jpg

Case Study 

On January 7th, 1966, a 32-year-old female patient presented at the clinic complaining of a cough that starts every winter for the last three years. The current cough has already been going on for the last two months. A previous physician had prescribed sān ǎo tāng (Three-Unbinding Decoction), and a modified version of xìng sū sǎn (Apricot Kernel and Perilla Leaf Powder), which offered her no relief. Afterwards, she was given over twenty packages of modified zhǐ sòu sǎn (Stop Cough Formula), which had very little effect, and finally, she was prescribed a formula containing èr chén täng (Two-Aged [Herb] Decoction) combined with sān zǐ yǎng xīn tāng (three seed decoction to nourish ones’ parents), which again offered very little effect. 

Current signs and symptoms: cough, spitting up of copious amounts of white colored phlegm, an aversion to cold felt over her back, cold extremities, dry mouth with little desire to drink, chest fullness, epigastric fullness and focal distention, poor appetite, loose stools, a white-slippery tongue coat, dark tongue body, and a deep-wiry-thin pulse. 

Dr. Hú’s formula: 

má huáng (Ephedrae Herba) 3 qián

guì zhī (Cinnamomi Ramulus) 3 qián

bái sháo (Paeoniae Radix alba) 3 qián

xì xǐn (Asari Herba) 3 qián

gān jiāng (Zingiberis Rhizoma) 3 qián

zhì gān cǎo (Glycyrrhizae Radix preparata) 3 qián

wǔ wèi zǐ (Schisandrae Fructus) 4 qián

bàn xià (Pinelliae Rhizoma preparatum) 5 qián

fú líng (Poria) 4 qián 

Results: After taking three packages, her chest fullness, and spitting up of phlegm had decreased substantially. After another six packages, the cough had obviously improved. The formula was continued for another two weeks, after which the cough had completely disappeared, and her overall condition was eliminated. 

At the end of treatment, Dr. Hú once again emphasized the treatment principles for external cold with interior thin-fluids; “This treatment principle has repeatedly been stressed in the explanations of specific formula presentations such as, guì zhī qù guì jiā fú líng bái zhú tāng (Cinnamon Twig Decoction Minus Cinnamon with Added Poria and Atractylodes), and xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) where the root is as such”: “There are cold pathogens in the exterior, and thin-fluids in the interior. These fluids create stoppage in the interior, whereas the interior is somewhat obstructed. At the same time nothing is able to penetrate the exterior and if water is unable to be disinhibited, the exterior would be unable to resolve. If a strong sweat is promoted, or if the exterior is diffused strongly, the interior thin-fluids will be agitated and numerous signs will appear. If we simply disinhibit water, pathogens will invariably enter the interior”. In this particular case, an exterior resolving formula with medicinals to disinhibit water, and drive out thin-fluids was used, thereby, affecting both the exterior and interior. The formula used contains má huáng (Ephedrae Herba), guì zhī (Cinnamomi Ramulus), bái sháo (Paeoniae Radix alba), and gān cǎo (Glycyrrhizae Radix) to promote sweating, in order to expel exterior pathogens. bàn xià (Pinelliae Rhizoma preparatum), gān jiāng (Zingiberis Rhizoma), wǔ wèi zǐ (Schisandrae Fructus), and fú líng (Poria) drive out cold in order to eliminate interior thin-fluids. Therefore, once the exterior is resolved and interior thin-fluids removed, the cough will spontaneously cease. 

A dry cough does not necessarily mean an absence of phlegm. A formula to transform phlegm and lower qì can arrest these coughs

Patients with dry coughs are commonly seen in clinical practice, and Dr. Hú would commonly treat these patients with phlegm transforming, counterflow descending medicinals such as, Bàn Xià Hòu Pò Tāng (Pinellia and Magnolia Bark Decoction), or Líng Gān Wǔ Wèi Jiāng Xīn Xià Tāng (Poria, Licorice, Schisandra, Ginger, Asarum, and Pinellia Decoction), which can quickly arrest coughing. Because this can seem quite puzzling many of us have asked, “Since many cases of dry coughs are due to yīn deficiency or hyperactive fire, and treatment should involve enriching yīn or clearing heat and descending fire, wouldn’t this be considered an adverse treatment?” Dr. Hú would just say, “This is actually the correct treatment and not an adverse treatment”. Furthermore, he shared with us his vast experience and clinical applications of their treatment. He would say that there are many patients with dry coughs who continuously take formulas, and the coughs fail to resolve even after several months. One would view the case and identify the pattern as lung fire, or liver fire, or yīn deficiency, and treat with medicinals such as huáng qín (Scutellariae Radix), zhī zǐ (Gardeniae Fructus), shēng dì huáng (Rehmanniae Radix), zhī mǔ (Anemarrhenae Rhizoma), bèi mǔ (Fritillariae Bulbus), etc, and even after extended periods of time, there is minimal effect. What is the reason? Actually this principle is quite simple; the Chinese medicine concept of treatment based on pattern identification is used for the whole body, and not just according to one individual symptom. Phlegm and thin-fluids harassment is one of the main causes of coughing and wheezing, and the coughing up of phlegm is one basis for pattern identification, but is not the only symptom. The Chinese medical concept of phlegm and thin-fluids is quite extensive, and there are numerous cases where in an absence of phlegm, there is an absence of cough, just as there are numerous cases of cough in the absence of phlegm. We must do an overall differentiation of patterns. The following case helps illustrate this point. 

Case Study 

A 38-year-old female was first seen on Feb 12 1966. This patient had suffered with a dry cough and itchy throat for over a month. She had taken a modified version of zhǐ sòu sǎn (Stop Cough Formula), and modified versions of sāng xìng tāng (Mulberry Leaf and Apricot Kernel Decoction) and mài mén dōng tāng (Ophiopogonis Decoction). The cough not only failed to improve, but was actually getting worse. Currently she presents with a dry cough, itchy throat, dry mouth with no desire to drink, belching, chest oppression, loose bowel movements occurring once or twice daily, a thick slimy tongue coating and a slippery thin pulse. 

She was prescribed a modified version of Líng Gān Wǔ Wèi Jiāng Xīn Xià Tāng (Poria, Licorice, Schisandra, Ginger, Asarum, and Pinellia Decoction)

fú líng (Poria) 4 qián

xì xǐn (Asari Herba) 2 qián

wǔ wèi zǐ (Schisandrae Fructus) 4 qián

bàn xià (Pinelliae Rhizoma preparatum) 5 qián

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 qián

chén pí (Citri reticulatae Pericarpium) 5 qián

shēng jiāng (Zingiberis Rhizoma recens) 3 qián

xìng rén (Armeniacae Semen amarum) 3 qián

jié gěng (Platycodi Radix) 3 qián

zhì pí pá yè (Eriobotryae Folium preparata) 3 qian

Results: After taking one package of the above formula, the cough had decreased. After three packages the cough stopped. 

The above patient suffered from a dry cough, itchy throat and dry mouth commonly seen in lung heat, liver fire or yīn deficiency patterns. In addition this patient also had no desire to drink, belching, chest oppression, sloppy stools, a thick slimy tongue coating and a slippery pulse. All these signify a phlegm-thin-fluids pattern. The dry cough is from phlegm-thin-fluids invading the lung and impaired diffusion and downbearing of the lung. The dry cough and itchy throat are a result of stagnation and obstruction to fluids, which are unable to bear upwards. Therefore when treating this type of dry cough, using bitter cold, heat clearing medicinals or sweet cold yīn enriching herbs will only worsen the stagnation and obstruction of fluids and cause phlegm and thin-fluids to harass the upper (burner) and delay recovery. Because phlegm was treated by restraint and the formula was chosen on the basis of the pattern, only three packages were needed for recovery. 

When diffusing the lungs and transforming phlegm is ineffective, harmonizing and resolving shào yáng can achieve surprisingly remarkable results

A common cause for coughs is the upward harassment of phlegm and thin-fluids, with the lungs losing their ability to diffuse and downbear. Therefore, a major method of treatment is to diffuse the lungs, and transform phlegm. However when treating according to this law, and our effectiveness is less than satisfactory, this is mainly because of failure to analyze the cause, poor pattern identification, or failing to use medicinals and formulas according to the pattern. There are some cases of coughs where pathogenic factors are neither in the exterior, nor the interior, but are half-exterior, half-interior. If we use methods such as diffusing the lungs, transforming phlegm, resolving the exterior and transforming thin-fluids when treating these kinds of coughs, then of course we won’t see positive results. Here, we must use the method of harmonizing and resolving the shào yáng, in order to obtain quick resolution of the condition. There is a very clear-cut account of this in the Shāng hán lùn (傷寒論 Discussion of Cold Damage) where it states in line 96: 

“When in cold damage or wind strike that has lasted for six or seven days, there is alternating chills and fever, chest and subcostal fullness, dejection with no desire to eat or drink, irritability, and frequent vomiting, or possibly irritability in the chest with no vomiting; or thirst, or abdominal pain, or sub-costal hard focal distention, or palpitations below the heart with difficult urination, or absence of thirst with mild generalized heat, or cough; xiǎo chái hú tāng (Minor Bupleurum Decoction) masters it”. 

Where it says ‘or cough’, it is mentioning it alongside the numerous signs of a xiǎo chái hú tāng (Minor Bupleurum Decoction) presentation. When we see cases of coughing, in combination with some of the other representative signs and symptoms of a xiǎo chái hú tāng (Minor Bupleurum Decoction) presentation, this formula may be used. Therefore, Dr. Hú commonly used this formula in the treatment of coughs. 

Case Study 

On March 12, 1965, a thirty-four-year old female patient presented at the clinic, complaining of a cough that has lasted for well over two years. It had previously started after contracting a common cold, and presents all year: worse in the winter, and mild in the summer. She explained that the cough would typically manifest in the late morning (10:00am), late afternoon (between 3:00pm and 4:00pm), and again in the early evening (8:00pm). She was seen at another hospital where she was given over thirty packages of a formula (containing various lung diffusing, phlegm transforming medicinals such as xìng rén (Armeniacae Semen amarum), jié gěng (Platycodi Radix), bàn xià (Pinelliae Rhizoma preparatum), guā lóu (Trichosanthis Fructus), pí pá yè (Eriobotryae Folium), qián hú (Peucedani Radix), etc.) all to no avail.  

Current symptoms: spitting up of white-frothy sputum, nausea, dry throat, absence of sweating, bilateral subcostal distension and fullness, a red tongue body, a thin white tongue coat, and a wiry-slippery pulse. In addition, she was diagnosed with tuberculosis in 1962. 

Dr. Hú prescribed a modified version of xiǎo chái hú tāng (Minor Bupleurum Decoction) 

chái hú (Bupleuri Radix) 3 qián

dǎng shēn (Codonopsis Radix) 3 qián

bàn xià (Pinelliae Rhizoma preparatum) 3 qián

huáng qín (Scutellariae Radix) 3 qián

dà zǎo (Jujubae Fructus) 4 pieces

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 qián

shēng jiāng (Zingiberis Rhizoma recens) 3 qián

jié gěng (Platycodi Radix) 2 qián

bái sháo (Paeoniae Radix alba) 2 qián 

Results: After taking six packages of the formula, her cough had decreased. bái sháo (Paeoniae Radix alba) was removed from the formula, and 2 qián of zhǐ shí (Aurantii Fructus immaturus), and 4 qián each of shēng lóng gǔ (Fossilia Ossis Mastodi), and mǔ lì (Ostreae Concha) were added. After six more packages, the subcostal distension and fullness was gone. Afterwards, she was given over ten packages of a modified version of Bàn Xià Hòu Pò Tāng (Pinellia and Magnolia Bark Decoction), and her cough had completely resolved. 

The characteristics signs of this case were the cough, which occurred at specific times, the subcostal distension and fullness, nausea, and dry throat, which are all typical of a Shào Yáng presentation. We can say that with this case, the pathogenic factors were neither in the exterior, nor the interior, but lay in the half-exterior, and half-interior aspects of the body. It can also be said that in cases of enduring coughs, both the stomach qì and the defensive qì are deficient, which explains why lung diffusing, phlegm transforming medicinals would be ineffective, and unable to expel the pathogenic factors. Here we must use medicinals such as dǎng shēn (Codonopsis Radix), bàn xià (Pinelliae Rhizoma preparatum), shēng jiāng (Zingiberis Rhizoma recens), dà zǎo (Jujubae Fructus), and gān cǎo (Glycyrrhizae Radix) in order to supplement the center and strengthen the defense. Only then can the pathogens be expelled into the exterior, and once they are eliminated, the cough can resolve on its own. 

Commentary: The five cases above (see part 1 here) introduced us to five different formula presentations, and Dr. Hú’s main strategies and experience in treating coughs. Dr. Hú always utilized the method of differentiation according to formula presentations, and in the treatment of coughs, there are numerous such as, guì zhī jiā hòu pò xìng zǐ tāng (Cinnamon Twig Decoction Plus Magnolia Bark and Apricot Kernel), má xìng shí gān tāng (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction), sāng jú yǐn (Mulberry Leaf and Chrysanthemum Decoction), má xìng yǐ gān tāng (Ephedra, Apricot Kernel, Coicis and Licorice Decoction), xiè xīn tāng (Drain the Epigastrium Decoction), mài mén dōng tāng (Ophiopogonis Decoction), líng gān wǔ wèi jiāng xīn xià xìng dá huáng tāng (Poria, Licorice, Schisandra, Ginger, Asarum, Pinellia, Apricot Kernel, and Rhubarb Decoction), etc. With that being said, once we encounter a specific formula presentation, we are able to employ specific formulas and medicinals to treat the condition, and must not be limited by the idea of one formula – one method.

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.

Hú Xī-Shù (胡希恕) -A Case of Systemic lupus erythematosus (SLE)

A 32-year-old female patient presented at the clinic on October 12, 1967. For the last year the patient has been experiencing feverishness along with red macules on her face and back. The origin of the feverishness and macules was unknown. At both the Běijīng Harmony hospital and the Běijīng University hospital she was diagnosed with Systemic lupus erythematosus. She was treated with hormone therapy, which offered no positive effects, and was then introduced to Dr. Hú for treatment. index.jpg

Current symptoms: Irregular occurrences of feverishness, with red and swollen macules on the face and back occurring as patches or covering larger areas, with shedding scales resembling ox hide tinea. In addition she commonly experienced neck, nape, back and lumbar pain, dry throat, irritability, and also sweat easily from her head. Her tongue had a thin-white coating, and her pulse was thin, wiry, and rapid.

This is a pattern of pathogenic depression in the Jué Yīn, blood deficiency and exuberance of water. Treatment should involve warming the lower, clearing the upper, nourishing the blood, and disinhibiting water. chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) with dāng guī sháo yào sǎn (Tangkuei and Peony Powder) is the appropriate formula.

chái hú (Bupleuri Radix) 5 qián

huáng qín (Scutellariae Radix) 3 qián

tiān huā fěn (Trichosanthis Radix) 4 qián

mǔ lì (Ostreae Concha) 5 qián

lóng gǔ (Fossilia Ossis Mastodi) 5 qián

guì zhī (Cinnamomi Ramulus) 3 qián

bái sháo (Paeoniae Radix alba) 3 qián

dāng guī (Angelicae sinensis Radix) 3 qián

chuān xiōng (Chuanxiong Rhizoma) 3 qián

cāng zhú (Atractylodis Rhizoma) 3 qián

fú líng (Poria) 3 qián

gān jiāng (Zingiberis Rhizoma) 2 qián

zé xiè (Alismatis Rhizoma) 5 qián

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 qián

shí gāo (Gypsum fibrosum) 1 ½ liǎng

Results: After taking six packages of the above formula, she had started to notice some positive effects, and after thirty packages, she came in for a follow up consultation. By that point, the red macules on her face and back had basically disappeared, and all her blood tests were normal. Her body temperature had decreased and she no longer felt the irregular feverishness. In addition, her pain was no longer present. When she returned to the Běijīng University hospital for a follow up, her doctor was amazed and was completely satisfied with the treatment she had received. The doctor recapitulated her medical records and advised her that she no longer needed to take her herbs. However, approximately half a month after stopping the herbs, red macules reappeared on her face. Although the symptoms weren’t as bad as before, she returned to Dr. Hú for treatment. The above formula was prescribed again with the shí gāo (Gypsum fibrosum) removed.

Commentary: Systemic lupus erythematosus (SLE) is a difficult condition to treat with western medicine, and the same can be said about Chinese medicine. Using six-channel pattern identification in conjunction with classical formula theory, we are able to achieve good results with this condition, and Dr. Hú’s many years of clinical experience is definitely worth referencing.

Hú Xī-Shù (胡希恕)- A Case of Prostatitis


On June 11, 1966, a 30-year-old male worker from the capitol airport presented at the clinic.

The patient has suffered with prostate inflammation for over half a year, for which he has taken numerous western medications, and results have been less than ideal.

Current signs and symptoms: lumbar pain, occasional lower abdominal pain, which was sometimes accompanied by sagging, distension and pain in the testicles, occasional painful urination, sticky, milky white colored discharge exuding from the urethra, frequent and scanty urination with a reddish-yellow color, a dry mouth with a desire to drink, a white tongue coating with a slimy root, and a wiry-slippery pulse.

This is a pattern of damp stasis and obstruction, for which treatment should involve disinhibiting dampness, and transforming stasis. Zhū Líng Tāng (Polyporus Decoction) with Shēng Yǐ Rén and Dà Huáng was prescribed.

Zhū Líng 3 qián
Zé Xiè 4 qián
Huá Shí 5 qián
Shēng Yǐ Rén 1 liǎng
Shēng Ē Jiāo 3 qián
Dà Huáng 1 qián

Results: After taking only two packages of the formula, his symptoms were greatly reduced. Because the lumbar pain was still present, Chái Hú Guì Zhī Gān Jiāng Tāng (Bupleurum, Cinnamon Bark, and Dried Ginger Decoction) was added to the above formula.

After a half a month on the formula, all his symptoms were basically gone.

Hú Xī-Shù (胡希恕)- A case of Angina Pectoris

Hu Xi-Shu (胡希恕): Two cases of Meniere’s disease

Case #1 

A 25 year old female Qīng Huá University student presented at the clinic on October 16, 1965: For the last four to five months she has been experiencing dizzy head and vision, accompanied with nausea, flusteredness, inability to eat, and difficulty reading. A western medical doctor diagnosed her condition as Meniere’s disease, and administered medications which were ineffective. Her blood pressure was normal, she had a dry mouth with no desire to drink, a desire to sleep, a lack of strength, but with no problems moving, and her cycle had arrived late but was slightly scanty. She had a white tongue coat with a slippery root, and her pulse was deep, thin and wiry.

This is a pattern of blood vacuity with water exuberance. She was administered Dāng Guī Sháo Yào Sǎn combined with Xiǎo Bàn Xià Tǎng and Wú Zhū Yú.

Dāng Guī 3 Qián
Bái Sháo 3 Qián
Chuān Xiōng 2 Qián
Cáng Zhú 3 Qián
Zé Xiè 5 Qián
Fú Líng 3 Qián
Bàn Xià 5 Qián
Shēng Jiāng 4 Qián
Wú Zhū Yú 3 Qián

Results: After taking three packages of the formula, her symptoms resolved completely.

Commentary: In this case the blood vacuity was pretty obvious which is why Dāng Guī Sháo Yào Sǎn was administered. This was coupled with yang vacuity of the stomach with counterflow of thin mucus, so Xiǎo Bàn Xià Tǎng and Wú Zhū Yú were used in combination.

Case #2 

On October 3, 1977, a 19 year old female student presented at the clinic:

Originally the patient first experienced dizziness, tinnitus and deafness for two months. A local hospital diagnosed her with Meniere’s syndrome, and she was treated with a combination of western and Chinese medicines to no avail. She had already taken two months off her schooling, and it was at this point that her parents called for Dr. Hú to treat their daughter. At the time of the consultation she had been experiencing dizziness to the point where she was unable to get up, and when she opened her eyes, the dizziness would get worse. Her tinnitus and deafness were still present, and she also had a dry mouth with no desire to drink, occasional chest fullness, flusteredness, a thick, white tongue coating, and a deep, thin pulse.

This is cold thin-mucus attacking the upper, and obstructing the clear orifices. Treatment should involve warming the centre and transforming mucus, with Líng Guì Zhú Gān Tāng.

Fú Líng 6 Qián
Guì Zhī 3 Qián
Cáng Zhú 3 Qián
Zhì Gān Cǎo 2 Qián

Follow up consultation on October, 12: After taking six packages of the formula, her dizziness had resolved, and both the tinnitus and deafness had improved significantly. Guì Zhī was increased to 4 Qián, and Fú Líng was increased to 8 Qián.  

Third consultation on October, 20: After another six packages of the formula were taken, all the symptoms had resolved. Because she was frightened of having a relapse of her condition, she requested more of the same formula in order to consolidate the treatment, but was advised that further treatment was unnecessary.

Commentary: This case was caused by the exuberance of interior cold thin-mucus, and when these fluids attack and surge into the upper body, the representative formula is Líng Guì Zhú Gān Tāng. This formula’s function is to warm the centre, transform thin-mucus and downbear counterflow and because this presentation fit this formula’s pattern perfectly, modifications were unnecessary, and quick resolution was attained.