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

On December 3, 2011April 2, 2021 By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)3 Comments

On June 14, 1965, a 74-year-old female presented at the clinic suffering from angina pectoris. Her condition had lasted many years, and she commonly experienced severe pain in the anterior chest. Whenever the symptoms would arise, she was unable to lie down, and had difficulty breathing, for which she would take various medications including, nitro-glycerine, and sulphanilamide. In addition, she sweat copiously, had a dry mouth without a desire to drink, dry stools, a thick-white tongue coating, and a wiry-thin pulse.

This is a pattern of phlegm, and thin-fluids obstruction in the chest, with blood-stasis in the collaterals. Treatment should involve transforming phlegm, freeing yáng, eliminating stasis, and freeing the vessels, with a modified version of Guā Lóu Xiè Bái Bàn Xià Tāng (Trichosanthes, Chinese Chive, and Pinellia Decoction)

Guā Lóu 1.5 liǎng
Xiè Bái 9 qián
Bàn Xià 2.5 liǎng
Bái Jiǔ 2 liǎng
Guì Zhī 3 qián
Zhǐ Shí 3 qián
Táo Rén 3 qián
Chén Pí 1 liǎng
Bái Sháo 4 qián

Results: After taking three packages of the above formula, the pain had decreased, and pain was only felt after exertion. 4 qián of Fú Líng was added to the formula, and another six packages were administered. At this point the pain was quite sporadic, so the formula was continued. After one month, the chest pain had ceased, and there was no relapse.

Huáng Lián assists sleep- A case by Huáng Huáng （黄煌)

On October 11, 2011July 27, 2022 By eranevenIn Case Studies （医案), Huáng Huáng (黃煌), Jīng Fāng (经方), Medicinals (中草药), Translations & Writings (译著与文章)4 Comments

One early morning last week as I had just turned on my cell phone, I received information about a patient from northern Jiāng Sū province that had suffered with insomnia. He had been here nine months previously for a formula and had taken seven packages. He recently returned, and after taking one package had completely recovered. This was quite remarkable!!

Now that he had finished his formula, he was asking how this was dealt with.

He was a forty year old male that was suffering with severe insomnia which started last year in December. He found it difficult to sleep for the entire night, and had repeatedly taken western medications all to no avail.

The formula he was given consisted of the following;

Huáng Lián 5g, Ròu Guì 10g, Zhì Fù Zǐ 10g, Gān Jiāng 10g, Shēng Gān Cǎo 5g.

This is Jiāo Tài Wán combined with Sì Nì Tāng. Now why would, these formulas be considered for this case? Let’s take a look at this patient. The man had a strong, robust physique; his skin was a dark color, he had no trouble eating, and his stools lacked shape. Now although he felt cold on the inside, he suffered from agitation and insomnia. This is what the ancients called ‘non-interaction of the heart and kidneys’, which is the ‘tried and true’ Jiāo Tài Wán formula pattern. Sì Nì Tāng harmonizes the body, and Huáng Lián and Ròu Guì treat the disease.

Huáng Lián is beneficial for insomnia. The Huáng Lián in Huáng Lián Ē Jiāo Tāng is used to treat “vexation in the heart, with an inability to sleep”. Huáng Lián Tāng uses equal parts Huáng Lián and Ròu Guì along with (Rén) Shēn, (Bàn) Xià, (Shēng) Jiāng, (Dà) Zǎo, and (Gān) Cǎo to treat “heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit”. The heat in the chest is commonly expressed as heart vexation with an inability to sleep. Jiāo Tài Wán only contains two medicinals, Huáng Lián and Ròu Guì and is originally from the Míng dynasties ‘Comprehensive Medicine According to Master Han’ (韩氏医通, Hán Shì Yī Tōng). The author Hán Fēi-Xiá said;

“brew numerous times, add honey, take on an empty stomach, and this will instantly bring forth the interaction between the heart and kidneys”.

Yú Tīng-Hóng (余听鸿) had written about a patient from Zhè Jiāng County that had suffered with an inability to sleep the entire night for many years. He had taken over two hundred spirit calming, blood nourishing formulas which offered him no relief. The famous Mèng Hé physician Mǎ Shěng-Sān (马省三) prescribed;

Huáng Lián 8 fēn, Shān Zhī 3 qián, Zhū Dǎn Zhī 1 qián (mix fried), decocted. That night he slept soundly.

In the past, I have given patients equal parts powdered Huáng Lián and Ròu Guì infused in boiling water, and taken prior to going to sleep. This has indeed helped with sleep difficulties.

However, Huáng Lián is bitter and cold, and many people are unable to take it. Huáng Lián’s strength by itself is quite weak, and it is incapable of treating all stubborn cases of insomnia. Nevertheless, we always want to select the corresponding formula according to the body constitution. For example, with a red, oily facial complexion, heat vexation, headaches, and constipation, we can use Sān Huáng Xiè Xīn Tāng. With pale skin, red lips, red tongue, and heart vexation, me may use Huáng Lián Ē Jiāo Tāng. In a thin patient with dark lips, abdominal pain and insomnia, Huáng Lián Tāng may be used. With dry retching, epigastric focal distension, and mouth ulcers, we use Bàn Xià Xiè Xīn Tāng. With strong pain in the back and nape, diarrhea, chest oppression, vexation, palpitations, and insomnia, use Gé Gēn Qín Lián Tāng.

Originally, because Huáng Lián and Ròu Guì were combined with Sì Nì Tāng, we know that it is applicable in cases of a cold body with a hot disease. This is commonly seen in strong, robust men with a yellowish-dark skin color, and insomnia. After taking these medicinals, not only will insomnia improve, but enduring cases of abdominal pain and diarrhea, can be ameliorated.

A Case of Wü Méi Wán (Mume Pill)

On September 20, 2011April 2, 2021 By eranevenIn Case Studies （医案), Fàn Zhōnglìn（范中林), Formulas (方剂), Jīng Fāng (经方), Translations & Writings (译著与文章)4 Comments

A case of the Fire spirit currents’ Fàn Zhōng-Lín %E4%B9%8C%E6%A2%85.jpg

Translated from ‘Five Steps to Cold Damage Treatment According to Pattern Identification’

A 39 year old male farmer from the Jīn Niú district of Chéng Dū city presented at the clinic:

Step 1: Chinese medical diagnosis

In August of 1977 in the last third of the month, while working in the fields, the patient suddenly felt discomfort throughout his entire body. He experienced cold extremities, dizziness, cold sweats, abdominal pain and borborygmus. Shortly after, he experienced continuous diarrhea, which frequently contained pus and bloody discharge. On September 2nd he came in for a consultation.

Every day, the patient would have over ten bouts of diarrhea. The stools were quite loose, sticky and jelly like, which had a yellowish-red color. This was accompanied by abdominal pain, with urgency followed by heaviness. In addition, he experienced dry retching, heart vexation, thirst, and cold extremities. His tongue was dark pale with a slightly red tip, with a yellow, slippery and thick coating.

Step 2: List of Disease Mechanisms

Dry retching, heart vexation, nausea, slightly red tongue tip, are all associated with upper heat.

Reversal cold in the body and extremities, cold pain in the lower abdomen, clear-thin diarrhea, which are all described as ‘white’, ‘cold’, and ‘freezing’, are obvious signs associated with lower cold.

This is one hundred percent an obvious case of upper heat and lower cold. Jué yīn is the qi of wind and wood that when vigorous will cause wind pathogens to flee to the upper (body).

[Plain Questions-Treatise on Tài yīn and Yáng míng] says:

“When one is invaded by a robber wind or depletion evil, yáng receives it. When food and drink are consumed without restraint, when rising and resting occur out of time, yīn receives it. When yáng receives it, then it enters the six bowels.

When yīn receives it, then it enters the five viscera. When it enters the five viscera, then distension and blockage result. In the lower [body] it causes outflow of [undigested] food, and when enduring causes intestinal afflux (dysentery)”.

From this passage we can see that intestinal afflux is commonly due to the exploitation of yīn and yáng, with signs of intermingling cold and heat.

In summary, the disease mechanism involved is the lack of mutual connection between the qi of yīn and yáng. The upper belongs to yáng, and pure yáng is heat; the lower belongs to yīn, and pure yīn is cold. Therefore, “When Jué yīn prevails” intestinal afflux will occur.

Step 3: Comprehensive Analysis

This is a pattern of cold and heat mixing causing intestinal afflux, with the disease in the Jué yīn level.

Step 4: Formula According to Pattern

The appropriate method of treatment is to eliminate evils and support the right using both cold and warm medicinals. Wü méi wán (Mume Pill) governs.

Step 5: Medicinals According to Pattern

Prescription:

wü méi (Mume Fructus) 30g

xì xïn (Asari Herba) 6g

gän jiäng (Zingiberis Rhizoma) 30g

huáng lián (Coptidis Rhizoma) 12g

däng guï (Angelicae sinensis Radix) 10g

zhì fù piàn (Aconiti Radix lateralis preparata) 60g (extended cooking)

shǔ jiāo (Zanthoxyli Pericarpium) 6g

guì zhï (Cinnamomi Ramulus) 10g

dâng shën (Codonopsis Radix) 12g

huáng bâi (Phellodendri Cortex) 10g

2 packages were prescribed, and the patient was asked to refrain from eating oily, raw, cold and strong smelling foods (onions, garlic, leeks, etc.).

After taking two packages of the formula, his intestinal afflux had resolved. On follow up consultation with the patient in June, 1979, he reported that in the year since his recovery, there had been no relapse of the condition.

[Realizations]

Wü méi wán (Mume Pill) is said to “govern enduring diarrhea”, yet in this case enduring diarrhea was not present.

Then why was this formula chosen?

Generally speaking in patterns of Jué yīn diarrhea there simply must be reversal. Enduring diarrhea is usually seen in patterns where there is a mixture of cold and heat, for which it is appropriate to use a combination of cooling and warming methods by mixing both cool and warm formulas.

This was not a case of enduring diarrhea, but was originally seen as a Jué yīn condition with both cold and heat signs present. Wü méi wán (Mume Pill) is a formula which cools, warms and supplements simultaneously. Acrid, sour, sweet and bitter flavours are all present in the formula. The formula was correct for this presentation and therefore by adapting to the original formula, we were able to obtain positive results.

In actual fact, Wü méi wán (Mume Pill) has been used by countless physicians of past and present to treat various disorders, especially diarrhea, and its use is continuously expanding.

Take the ‘Important Formulas Worth a Thousand Gold Pieces’ (千金方Qiān Jīn Fāng) for example, where it discusses Zhang Zhong-Jing’s concept of using wū méi (Mume Fructus) and huáng lián (Coptidis Rhizoma) in heat type diarrhea, combined with fù zǐ (Aconiti Radix), gān jiāng (Zingiberis Rhizoma), etc. in cases of deficient cold natured enduring diarrhea.

The ‘Comprehensive Recording of Divine Assistance’ (圣济总录 Shèng Jì Zŏng Lù), mentions Wü méi wán (Mume Pill) for the treatment of unceasing post-partum cold and heat type diarrhea.

In the ‘Standards for Diagnosis and Treatment’ (证治准绳 Zhèng Zhì Zhŭn Shéng), this formula is used for treating coughing issuing from the stomach and the vomiting of long worms.

The Japanese physician Zhì Jiān-Huàn says that generations of physicians have had great difficulties in treating stomach reflux, and that this is an extraordinary formula for treating this pattern. (quoted from the Initial Draft of Lectures on Cold damage).

According to Rèn Yìng-Qiū, Wü méi wán (Mume Pill) functions to strengthen the stomach and intestines, reduce inflammation and kill worms, and when used to treat chronic diarrhea, can achieve positive results. (Interpretation of the Shāng Hán Lùn).

In the past, there have also been reports of using this formula in treating cases of chronic colitis of fifteen years.

From the above, we can see that the scope of using Wü méi wán (Mume Pill) is by no means limited to just treating roundworm reversal and enduring diarrhea, and in actual fact it’s use is continuously expanding.

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

On August 15, 2011April 2, 2021 By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)6 Comments

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.

Two cases using Li Zhong Tang (Rectify the Centre Decoction)

On July 12, 2011March 13, 2021 By eranevenIn Case Studies （医案), Formulas (方剂), Jīng Fāng (经方), Translations & Writings (译著与文章)Leave a comment

Case #1

Vacuity cold diarrhea

Case of Yuan Wen-Fei; (Jiang Xi Chinese Medicine); 1964; 3:149

A 39 year old male presented on February 11, 1949 complaining of diarrhea that has lasted for over a year, with borborygmus, and quite watery-sloppy stools. He usually has around eight or nine bowel movements in the first half of the day, his appetite is poor and there are undigested food particles present in the stools. Over ten Chinese medical physicians have been consulted in the past, and very minimal effects have occurred. On consult with this patient I found his facial complexion to be very pale and lustreless. He was emotionally fatigued, his abdomen was slightly distended, but favoured pressure, his tongue had a layer of thick yellow and slimy coating, and his pulse was thin and slow.

This is a case of spleen vacuity diarrhea, and the treatment method is to supplement the centre, and boost earth. The formula used was Zhong Jing’s Li Zhong Tang.

Ren Shen 9g
Chao Bai Zhu 9g
Hei Gan Jiang 7.5g
Zhi Gan Cao 6g

He was given six packages and asked to return for a follow up consultation. He reported that his condition had improved drastically for the better, and was therefore administered another six packages of the same formula after which he made a complete recovery.

Case #2

Wheezing and Panting (Left heart failure, cardiogenic asthma)

Case of Lu Zhi-Jie (Journal of Chinese Medicine); 1998; supplementary issue: 104

On May 4, 1998 a 60 year old male presented with cardio-pulmonary disease of over 10 years duration. In the first year of the condition he would often experience difficulty breathing in the evening, which would most commonly occur roughly around midnight waking him from a deep sleep. He suffered with an oppressive sensation in his chest, and once his breathing became forced he would suddenly wake up with a fright, compelling him to sit up in bed. This was accompanied with coughing fits, a rale at the back of the throat, and spitting up of frothy phlegm. These attacks would last anywhere from ten minutes to one hour, and once they would resolve on their own, he was able to return to sleep. During the day he also experienced wheezing on exertion. His pulse was wiry and weak, and the tongue was purple and slightly dark, with a thin yellow, slimy coating. According to this man’s symptoms of weakness, coughing fits and breathing difficulties at night, he was diagnosed by western physicians with left heart failure and cardiogenic asthma.
On disease analysis, we see that this man is in his sixtieth year and his condition has persisted for an extended period, therefore we can deduce from this that there must be a vacuity and weakness of right qi, however, his symptoms seem to develop in the evening, so in addition there is a blockage in lung qi. In such a scenario we must address both the root and branch of the condition and treat both simultaneously. We treat the root with Ren Shen Tang in order to supplement the centre and assist yang to ensure that the lungs and heart are able to generate sufficient and ample original qi. The branch is addressed with Ting Li Da Zao Xie Fei Tang.

Formula:

Ren Shen 30g
Bai Zhu 30g
Gan Jiang 30g
Gan Cao 30g
Ting Li Zi 24g
Da Zao 12 pieces

The first evening after taking one package, he experienced no breathing difficulties, and after fourteen packages, his condition seemed to be stabilized. He was able to sleep peacefully in the evenings. The daytime wheezing on exertion had also obviously improved, and as long as he moved around slowly, experienced no symptoms. He continued to take the formula every other day in order to consolidate the treatment.

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning

On June 13, 2011March 13, 2021 By eranevenIn Case Studies （医案), Jīng Fāng (经方), Translations & Writings (译著与文章)2 Comments

Here is a guest post from the great Sharon Weizenbaum

By Dr. Shi Jin-Mo 施今墨 (1881-1969)

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning.

Translated with Commentary by Sharon Weizenbaum

In an age in which there is a strong impulse to “detoxify” through various kinds of purges and cleanses, I feel this case offers a breath of fresh insight. So many times our patients ask us how they can get some bad stuff out of their bodies – whether this bad stuff is heavy metals, candida, lyme or other chemicals. What I feel Dr. Shi is reminding us to do is to look not at what the toxin is or how to get rid of it. Rather we should look at the actual signs and symptoms to determine how the toxin damages. We should ask what the response of the body is and not focus on the toxin itself.

In addition, this case inspires me to consider brain damage in a less fixed and fatalistic way.

Dr. Shi’s case:

Ms Zhang was 60 when she came in for her first visit. A couple of months previously she had received carbon monoxide poisoning. After receiving emergency care she unexpected lived. However, she suffered from abnormal spirit essence, inability to eat or dress without help from her family, inability to speak or sleep or control her bowels properly. In general, she seemed to be like a retarded person, frequently covering her head with her arms. At the hospital in Beijing, she was given the diagnosis of post carbon monoxide poisoning neurosis.

Her check-up revealed that her pulses were wiry, deep and rough.

Diagnosis: Post carbon monoxide poisoning central brain damage with loss of control of body functions and Qi and Blood obstruction.

Treatment method: Open through the Luo vessels and regulate the Qi mechanism.

Prescription:

Jiu Chang Pu 10 gm

Jiu Chao Chong Wei Zi 10 gm

Bai Ji Li Fructus Tribuli 12 gm

Sang Zhi 18 gm

Chao Yuan Zhi 10 gm

Su Di Long 10 gm

Sang Ji Sheng 18 gm

Huai Niu Xi 10 gm

Xia Ku Cao 10 gm

Chen Bai Wei 6 gm

Chang Gou Teng 12 gm

Shou Wu Teng 15 gm

Jiu Chuang Xiong 5 gm

Discussion: This patient’s appearance was very much like a retarded person. She was unable to speak or sleep and her movement was slow. Her pulse was wiry, rough and irregular. These symptoms all belong to the category of Liver vacuity and Heart Qi insufficiency. In addition her meridian and luo vessels pathways were not open through. It was important to principally treat the Heart and Liver channels as well as the three aspects Qi, Blood and Phlegm. Every time she came there was gradual improvement. The fourth visit was after half a month of taking the herbs. Follow up showed that her eating, sleeping, urination, bowels and spirit essence were all normal. Her movement was still sluggish. These kinds of clinical illnesses do not appear very often. I carried out treatment according to my rich experience. Using differential diagnosis I determined the formula. With the group of herbs that open through and quicken blood, I had to find just the right balance of drastic and fierce measures. Altogether she took about 50 packages of herbs and gradually improved.

Pu Huang treats Blood stoppage pain. Prepared it can stop bleeding. Fresh it vitalizes Blood. It can be used at the base of the tongue to treat inability to speak. If it is used repeatedly, it will be effective. This is also a formula from my experience.

Hu Xi-Shus’ approach in the treatment of coughs

On April 19, 2011April 2, 2021 By eranevenIn Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)5 Comments

According to Dr. Hu Xi-Shu, the main cause of coughing is the invasion of phlegm-rheum, which should be treated by warm transformation, descending counterflow, and calming (the cough). hu xi-shu.jpg

When treating coughs in general, there are numerous formulas to choose from, some may even go so far as to say that there are thousands upon thousands, but Dr. Hu would most commonly use the formula Ban Xia Hou Po Tang (Pinellia and Magnolia decoction). When asked about the reasoning for this, he would answer that in the Jin Gui Yao Lue’s (Essential formulas from the golden cabinet) section on coughs it is said that there exists an intimate relationship between phlegm-rheum and coughs, and that many cases are in fact due to the upward invasion of phlegm-rheum, which causes qi counterflow with an inability to descend. In regards to the treatment of phlegm-rheum, it is said in the Jin Gui Yao Lue,

“In phlegm-rheum diseases, one must harmonize with warm medicinals”.

This is the most important main treatment principle when treating phlegm-rheum conditions, and in addition is the main treatment principle when treating coughs. When adapting this principle (in the treatment of coughs), one must also use appropriate medicinals to guide the treatment downwards in order to descend (counterflow). Clinical practice offers us many opportunities to promptly offer a resolution of this symptom.

To read one of Dr. Hu’s cases utilizing this formula, click here.

Hu Xi-Shus’ unique approach and commonly used formulas for treating wheezing and panting

On March 29, 2011April 2, 2021 By eranevenIn Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)2 Comments

Patterns where phlegm –rheum is the primary cause of wheezing and panting

A commonly seen presentation in wheezing and panting is the contraction of an external pathogenic factor with simultaneous retention of phlegm-rheum. In patients who are constitutionally predisposed to phlegm-damp retention, usually the initial attack by an external factor will stir the interior phlegm which will counterflow into the lung, invariably causing the wheezing and panting. This pattern is mentioned in the Shang Han Lun, where it states:

“In cold damage where the exterior is unresolved, (and) there is water qi below the heart….”

In these cases treatment generally involves, effusion to resolve the exterior, with simultaneous warm transformation of fluids. The various manifestations of this condition can be treated with the following prescriptions:

She Gan Ma Huang Tang: (Belamcanda and Ephedra Decoction)

射干麻黄汤

Main signs: Aversion to cold, generalized body pain, copious phlegm, and the sound of phlegm in the back of the throat. If this pattern is accompanied by signs such as a dry mouth, dry tongue, and heart vexation, Sheng Shi Gao may be added.

Xiao Qing Long Tang: (Minor Blue-Green Dragon Decoction)

小青龙汤

Main signs: Aversion to cold, generalized body pain, an absence of sweating, coughing with a need to rest and lean up against something, yet unable to lie down. (This is normally due to the presence of copious phlegm), severe coughing with frothy phlegm. If this is accompanied by signs such as a dry throat, vexation and agitation, Sheng Shi Gao may be added.

Ge Gen He Xiao Xian Xiong Tang: (Minor Sinking into the Chest Decoction with Pueraria)

葛根和小陷胸汤

Main signs: Hypertonic back and nape, chest fullness, oppression or pain, heat effusion, aversion to cold and panting. If heart vexation is quite obvious, then Sheng Shi Gao may be added.

Ling Gan Wu Wei Jiang Xin Xia Xing Tang: (Poria, Licorice, Schisandra, Ginger, Asarum, Pinellia and Apricot Seed Decoction)

苓甘五味姜辛夏杏汤

Main signs: Coughing, panting with chest fullness, spitting up of frothy phlegm and a normal taste in the mouth.

Ma Huang Fu Zi Xi Xin Tang: (Ephedra, Asarum and Prepared Aconite Decoction)

麻黄附子细辛汤

Main signs: Aversion to cold, absence of sweating, perhaps an aversion to cold felt in the back, counterflow cold of the extremities, a fatigued spirit, and a deep-thin pulse.

Patterns where blood stasis is the primary cause of wheezing and panting.

Originally when blood stasis is laying dormant in the interior, any changes caused by external contraction, food damage or damage from the seven affects will induce and entice the movement of blood stasis which will eventually invade the liver and lungs and cause wheezing and panting. If this stasis is not eliminated than the wheezing and panting will endure and recovery would be difficult to achieve. Therefore many cases of wheezing and panting due to cold, or summer-heat that fail to resolve, usually contain elements of static blood. The following are a couple formulas that can effectively treat these presentations.

Da Chai Hu Tang He Gui Zhi Fu Ling Wan (Major Bupleurum Decoction combined with Cinnamon Twig and Poria Pill)

大柴胡汤和桂枝茯苓丸

Main signs: Chest and rib-side bitter fullness, difficulty breathing, hypertonic epigastrium, bitter taste in the mouth, dry throat, and dry bowel movements.

Da Chai Hu Tang He Tao He Cheng Qi Tang (Major Bupleurum Decoction combined with Peach Pit Decoction to Order the Qi)

大柴胡汤和桃核承气汤

Main signs: Similar symptoms to the above, with the addition of abdominal distension and fullness, and difficult bowel movements.

Modifications to the above formulas:

With signs of dry mouth, throat or tongue, vexation, agitation and/or vexation thirst, add Sheng Shi Gao

With signs of external contraction with symptoms of heat effusion, aversion to cold and an absence of sweating, combine with Ge Gen Tang.

With signs of sweating and significant wheezing, combine with Ma Xing Shi Gan Tang

Patterns where both phlegm-rheum and blood stasis are the primary cause

If for example our patient presents with a Xiao Qing Long Tang presentation with elements and signs of Da Chai Hu Tang He Gui Zhi Fu Ling Wan, then these three formulas may be combined.

With difficult bowel movements it is easy to see signs of either Gui Zhi Fu Ling Wan or Tao He Cheng Qi Tang. If in this case a She Gan Ma Huang Tang presentation exists, then the combination of these formulas would be applicable.

If signs of mouth or tongue dryness, or vexation and agitation are seen with the above formulas, then Sheng Shi Gao may be added.

Why Da Chai Hu Tang?

Dr Hu explained that many patients presenting with wheezing and/or panting manifest a Shao-Yang, Yang-Ming combination disease. Therefore, the cardinal Shang Han Lun formula Da Chai Hu Tang (Major Buplureum Decoction) may be used with quite astonishing results. Many of Dr. Hu’s students would often ask him why when treating wheezing he wouldn’t just use Ma Huang (Radix Ephedra)? He would simply state that unless the case presenting was a Ma Huang pattern, its use was not warranted. In the Shang Han Lun (On Cold damage) it states that “In wheezing with chest fullness, Ma Huang is appropriate, but in wheezing with abdominal fullness, Ma Huang should not be used”.

Dr. Hu would explain that in order to diagnose a Shao-Yang Yang-Ming case of wheezing and panting, we need to look for symptoms such as; wheezing and panting with occasional chest fullness, rib-side pain, sweating, dry throat, dry bowel movements, etc.

Two Cases on the use of Si Ni San

On March 2, 2011March 13, 2021 By eranevenIn Case Studies （医案), Formulas (方剂), Jīng Fāng (经方), Translations & Writings (译著与文章)Leave a comment

A Collection of the Clinical Experience of He Ren %E4%BD%95%E4%BB%BB.jpg

何任临床经验辑要

Case #1

On April 8 1983, a 48 year old female presented with irregular menstruation. She was a very sceptical woman and was easily angered. Her sleep was poor with copious dreaming, she experienced rib side pain, abdominal distension, her bowel movements alternated between hard and loose, her tongue had a thin white coat and her pulse was wiry. In this case it is appropriate to harmonize and scatter the depression, course the liver, and regulate qi. The following formula was prescribed;

Zhi Shi 9g

Chai Hu 9g

Sheng Gan Cao 9g

Dang Gui 9g

Bai Shao 15g

Huai Xiao Mai 30g

Zhi Xiang Fu 9g

Da Zao 7 pieces

5 packages were administered.

Follow up consultation on April 15 1983: After taking the above formula, her sleep had improved and she felt calmer. The abdominal distension had decreased, her bowel movements were regular, but the rib side pain was still occasionally present. Tongue coating was still thin and the pulse was wiry. A modified version of the original formula was prescribed.

Zhi Shi 9g

Chai Hu 9g

Sheng Gan Cao 9g

Yu Jin 9g

Bai Shao 15g

Zhi Xiang Fu 9g

Huai Xiao Mai 30g

Da Zao 7 pieces

5 packages were administered.

Commentary: The patient in this case originally suffered from neurosis occurring alongside menopause. Therefore we have a pattern of qi and blood disharmony with liver depression, causing rib side pain and abdominal distension. This pattern is effectively treated with a combination of Si Ni San and Gan Mai Da Zao Tang. On follow up after finishing the formula, the patient reported a full resolution of symptoms.

Case #2

A 41 year old male presented on August 17, 1981 with a depressed spirit, irritability and anger. In addition he had epigastric pain, an increase in bowel movements, with occasional diarrhea, cold fingers and toes, slight sweating, fatigue, a wiry-rapid pulse, and a thin yellow tongue coat. In this case it is appropriate to course the liver, regulate qi and resolve depression. The following formula was prescribed;

Chai Hu 9g

Bai Shao 9g

Sheng Gan Cao 9g

Zhi Shi 9g

Chun Yang Zheng Qi Wan 3g* (separated into two doses and taken with decoction)

*Pure Yang to Rectify the Qi pills is a patent formula containing Chen Pi, Cang Zhu, Rou Gui, Ding Xiang, Huo Xiang, Bai Zhu, Fu Ling, Zhi Ban Xia, and Qing Mu Xiang.

Four packages were administered.

Commentary: The patient in this case suffered from a depressed spirit. He tended to think excessively and was easily angered. This patient was initially diagnosed during the summer, and was manifesting a Si Ni San presentation. Taking the season into consideration and the conditions of his diet with the mild reversal symptoms, we are unable to say that this is a pure case of binding depression of liver qi. Due to these factors, Chun Yang Zheng Qi Wan was added to clear the stomach and intestines and eliminate seasonal pathogenic factors. After taking two packages of the formula his (epigastric) pain and diarrhea had completely resolved, and he felt much calmer.

The clinical scope of Si Ni San is quite vast. In all cases of qi stagnation, qi depression, and qi reversal the pattern and presentation of Si Ni San is often present with several opportunities for use. The formula is applicable in cases of cholelithiasis, cholecystitis, intercostal neuralgia, weak digestive system functioning, stomatitis, panting, palpitations, colitis, neurological disorders, menopause, and several other conditions. Generally when the pattern is correctly identified and the herbs and/or formula are matched to the presentation, our results can be 100% effective.

Stomach Pain and Irregular menstruation rectified with Si Ni Huang Lian (Tang)

On February 24, 2011March 31, 2022 By eranevenIn Case Studies （医案), Fán Zhēnglún (樊正伦), Formulas (方剂), Jīng Fāng (经方), Translations & Writings (译著与文章)5 Comments

A case of Professor Fan Zheng-Lun (樊正伦)

Recently a 37 year old female presented at the clinic. She was thin and pallid and was covering her abdomen with both hands. She complained of stomach pain for several months occurring before or after meals. Her abdomen feared cold and enjoyed warmth, she often felt nauseous with the occasional desire to vomit. Her bowel movements seemed to be unaffected. Her stomach pain occurred prior to her menstrual cycle which had also become quite long, dark and unsmooth. In addition the soles of her feet often felt warm. Her mother, who was sitting next to her commented that her daughter really enjoyed spicy foods and ate too much of them, which was probably causing some of her pain. Her mother recently restricted her consumption of these foods.

Her tongue was purplish-dark with stasis macules on both edges. Her right pulse was wiry-thin, and the left pulse was deep-weak. At this point, Professor Fan kindly asked her, “Do you find that you easily get angry”? The patient nodded her head and said “yes, I don’t have a very good temper”.

Professor Fan said that this is a case of Liver Qi depression with a disharmony of the Spleen and Stomach, which can be treated with ‘Huang Lian Tang’ and ‘Si Ni San’ with additions and subtractions.

Formula:

Gui Zhi 9g

Bai Shao 9g

Fa Ban Xia 9g

Gan Jiang 9g

Zhi Gan Cao 15g

Chai Hu 9g

Zhi Shi 9g

Zhi Xiang Fu 9g

Dang Gui 9g

Dang Shen 12g

Da Zao 4 pieces

Sheng Sha Pu Huang 6g

Huang Lian 6g

7 Packages were administered.

A week later the patient returned for a follow up consultation and said her spirits were up and turning for the better. She was so happy to report that after taking the herbs, her stomach felt very comfortable. She was still having one bowel movement a day. Her cycle came and only lasted 4-5 days, was not very heavy and contained small clots. She has had no abdominal pain, her soles no longer felt warm, and occasionally there was a gurgling sound in her abdomen.

Her tongue edges were purplish-dark and her pulse was wiry.

Professor Fan felt that the formula was addressing her condition and prescribed another seven packages of the original formula to consolidate the treatment.

In clause 173 of the ‘Shang Han Lun’ it says;

“When in Cold damage, there is heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit, Huang Lian Tang (Coptis Decoction) governs”

In actuality, Huang Lian Tang is Ban Xia Xie Xin Tang with the removal of Huang Qin and the addition of Gui Zhi. It treats stomach heat and spleen cold, while Ban Xia Xie Xin Tang treats damp heat in the spleen and stomach.

Within the formula, bitter Huang Lian is used to descend heat in the upper body, as per the adage “To treat upper body heat, drain with bitterness”. Acrid warm Gui Zhi, Gan Jiang, and Fa Ban Xia are used to raise spleen yang. “With cold in the lower body, scatter with acridness”. Ren Shen, Gan Cao, and Da Zao are used for their sweet flavour to boost the stomach, remembering the adage “The spleen desires warmth, so with tension use sweet foods to moderate”.

Huang Lian Tang is a very useful formula for treating spleen and stomach conditions resulting from spleen cold and stomach heat. When combined with Si Ni San It is able to course the liver, regulate qi and protect liver wood from exploiting spleen earth. In clinical practice we are often able to achieve positive clinical outcomes through this combination.

In this patients’ case, aside from the above mentioned formulas, Professor Fan added Zhi Xiang Fu in order to strengthen the formulas function of coursing the liver. Dang Gui and Sheng Sha Pu Huang were added to nourish and move the blood, and transform stasis.

This case was adapted and condensed from ‘A Taste of Chinese Medical Chicken Soup’ by Xiong Hong