Category: Jīng Fāng (经方)

Hu Xi Shu (胡希恕）Case #5- Foot pain

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A 19 year old male presented on February 15, 1966 complaining of left foot swelling and pain for over 5 years. Over the last two years the pain has gotten quite severe. X-ray imaging confirmed osteogenesis of the heel.

Current symptoms: swelling and pain in the left foot, fear of cold, severe pain after walking, normal taste in the mouth, no desire to drink, a thin-white tongue coating and a deep-wiry pulse.

This is wind-dampness in the Shao-Yin and Tai-Yin, and is therefore a Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig,Peony and Anemarrhena Decoction) pattern.

Formula: 

Gui zhi 4 qian (Cinnamomi Cassiae, Ramulus)

Ma Huang 2 qian (Ephedrae, Herba)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)
Sheng Jiang 4 qian (Zingiberis Officinalis Recens, Rhizoma)
Chuan Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)
Fang Feng 4 qian (Ledebouriellae, Radix)
Cang Zhu 4 qian (Atractylodis, Rhizoma)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Results: After taking seven packages of the above formula, the foot pain had decreased. He still experienced pain after walking but would recover quickly after taking a rest. Chuan Fu Zi (Aconiti Carmichaeli Preparata, Radix Lateralis) was increased to 3 qian and after taking the above formula for another month the swelling in the foot had resolved and the pain was no longer present.

Hu Xi Shu’s Love affair with Da Chai Hu Tang 胡希恕真的爱大柴胡汤!!

On By eranevenIn Case Studies （医案), Formulas (方剂), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)2 Comments
 

After reading numerous Hu Xi Shu case studies over the last few years, I have come to realize that he had a special affinity to the use of Da Chai Hu Tang and utilized this great formula in combination with other medicinals and/or formulas to treat a vast array of medical conditions.  His unique way of using this formula have been mentioned in previous posts, and I would like to offer yet another of his innovative cases.

A 48 year old male presented at the clinic on August 12, 1964 complaining of feeling flustered and unwell for over six months. He was treated at a previous hospital with various qi supplementing, blood nourishing formulas consisting of modified versions of Zhi Gan Cao Tang, Bai Zi Yang Xin Tang, and Tian Wang Bu Xin Dan. None of these treatments were effective and in addition he started feeling warm and had trouble sleeping. An Electrocardiogram revealed atrioventricular blockage and cardiac muscle strain.

Current symptoms: Flustered feeling, insomnia, poor food intake, epigastric pain, dull pain in the region of the heart, numbness in the hands and feet, a bitter taste in the mouth, yellow urination, dry stools, a greasy white tongue coating and a bound and intermittent pulse.
He was prescribed Da Chai Hu Tang with Gui Zhi Fu Ling Wan and Sheng Long (Gu) Mu (Li)

Chai Hu 4qian
Ban Xia 3qian
Huang Qin 3qian
Gui Zhi 3qian
Fu Ling 3qian
Bai Shao 3qian
Zhi Shi 3qian
Tao Ren 3qian
Hong Hua 2qian
Da Zao 4pcs
Sheng Jiang 3qian
Da Huang 2qian
Sheng Long Gu 5qian
Sheng Mu Li 5qian

Results: After taking 3 packages of the above formula the epigastric pain was alleviated, his appetite had improved, the numbness in the hands and feet were gone and sleep was improving. Hong Hua was removed from the formula and 3qian of Mu Dan Pi were added. After 6 packages, the chest pain had receded, his sleep was excellent, the flustered feeling was not as apparent and the pulse was normal.

Comments: Originally this patient presented as feeling flustered, with a poor appetite, numbness in the hands and feet and a bound and intermittent pulse. These symptoms can indicate a vacuous condition, which is why a modified version of Zhi Gan Cao Tang was originally administered. After taking the formula, the patient had a bitter taste in his mouth, yellow urination, dry stools, a dull pain in the area of the heart, etc. These symptoms belong to a Shao-Yang Yang-Ming combination disease, therefore Da Chai Hu Tang with Gui Zhi Fu Ling Wan and Long Gu and Mu Li were administered. This formula is used to resolve both the Shao-Yang and Yang-Ming, quicken the blood, eliminate stasis and calm the spirit. Because the herbs were chosen according to the pattern, an extended period of treatment time was unnecessary.

Hu Xi-Shu’s commonly used formulas for impediment syndrome (痹证 Bi Zheng)

On By eranevenIn Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)4 Comments

Dr. Hu was a master at utilizing classical formulas for the treatment of a wide array of syndromes. The following is a list of his most commonly used formulas and their specific patterns for the treatment of pain. hu xi-shu.jpg

I. Ge Gen Jia Zhu Tang (Kudzu Decoction plus Atractylodes Decoction)(葛根加术汤):

Neck and nape tightness and pain, heat effusion, aversion to cold, lumbar soreness, generalised heaviness, white tongue coating, wiry-slippery pulse.

Ge Gen 4 qian (Radix Puerariae)

Ma Huang 3 qian (Ephedrae, Herba)

Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)

Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)

Bai Shao 2 qian (Paoniae Lactiflorae, Radix)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Da Zao 4 pieces (Zizyphi Jujubae, Fructus)

Cang Zhu 5 qian (Atractylodis, Rhizoma)

This formula is used in both acute and chronic inflammatory joint problems, especially when manifesting with heat effusion, an absence of sweating and aversion to cold. The use of this formula is still warranted in cases of acute joint inflammation without the presence of neck and nape pain. This formula may be utilised in treating cases of lumbar muscular injury, hyperosteogenesis, ankylosing spondylitis and chronic arthritis.

II. Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coicis, and Licorice Decoction)

(麻杏薏甘汤):

Whole body joint pain, late afternoon heat effusion, body heaviness or swelling of the joints in the four extremities, harmony in the mouth* or sticky taste in the mouth, greasy-white tongue coating, deep-wiry-slippery pulse.

Ma Huang 3 qian (Ephedrae, Herba)

Xing Ren 2 qian (Pruni Armeniacae, Semen)

Yi Yi Ren 6 qian (Coicis Lachryma-jobi, Semen)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula pattern is commonly seen in cases of chronic and acute rheumatoid arthritis with a tendency towards damp heat. 

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions. 

III. Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) (桂枝芍药知母汤):

Whole body joint pain, joint swelling in the extremities or knees, stiffness and/or deformities in the extremities, fingers or toes, dizziness, shortness of breath, white tongue coating, wiry pulse.

Gui Zhi 4 qian (Cinnamomi Cassiae, Ramulus)

Ma Huang 2 qian (Ephedrae, Herba)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Sheng Jiang 5 qian (Zingiberis Officinalis Recens, Rhizoma)

Bai Zhu 5 qian (Atractylodis Macrocephalae, Rhizoma)

Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)

Fang Feng 4 qian (Ledebouriellae, Radix)

Pao Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)

Gan Cao 2 qian (Glycyrrhizae Uralensis, Radix)

This formula pattern is commonly seen in chronic rheumatic cases such as damp-heat type rheumatoid arthritis and is classified as a combination of the Shao-Yin and Tai-Yin disease stages. This formula is especially indicated in cases of swelling with joint deformities accompanied by upward rising qi and nausea. In cases where redness, swelling and heat are significant, Sheng Shi Gao (Gypsum) may be added to the above formula. 

IV. Gui Zhi Jia Ling Zhu Fu Tang (Cinnamon Twig plus Poria, Atractylodis, and Aconite Decoction) (桂枝加苓术附汤):

Lumbar, knee or shoulder joint pain, head, neck and nape pain, possibly accompanied by palpitations, epigastric pain, sweating, aversion to wind, cold extremities, harmony of the mouth, white tongue coating, wiry pulse. 

Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Zhi Gan Cao 3 qian (Glycyrrhizae Radix Preperata)

Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)

Da Zao 4 pieces (Zizyphi Jujubae, Fructus)

Cang Zhu 3 qian (Atractylodis, Rhizoma)

Fu Ling 3 qian (Poriae cocos, Sclerotium)

Pao Fu Zi 3 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)

This was one of Dr. Hu’s most commonly used formulas. If joint pain was more evident on one side of the body, he would consider this obstruction and stasis of blood and would add a small dose of Da Huang (Radix Rhubarb) in order to quicken the blood and free the collaterals. 

V. Gui Zhi Jia Huang Qi Tang (Cinnamon Twig plus Astragali Decoction)

(桂枝加黄芪汤):

Enduring joint pain, obvious sweating and aversion to wind, cold extremities, with perhaps a warm body and numbness in the extremities. Thin-white tongue coating, moderate pulse. 

Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)

Da Zao 4 pieces (Zizyphi Jujubae, Fructus)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Huang Qi 3 qian (Astragali Membranacei, Radix)

This formula is used in cases of exterior vacuity combined with water-damp evils seen in cases of impediment pain, numbness and sores. 

VI. Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San (Bupleurum, Cinnamon Twig, and Ginger Decoction, plus Tangkuei and Peony Powder)

(柴胡桂枝干姜汤合当归芍药散):

Lumbar and/or pelvic pain, neck and back pain, weak knees, palpitations, fullness below the heart, spontaneous or night sweating, lower extremity oedema, white tongue coating, deep-thin-wiry pulse.

Chai Hu 4 qian (Bupleuri, Radix)

Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)

Gan Jiang 2 qian (Zingiberis Officinalis, Rhizoma)

Huang Qin 3 qian (Scutellariae Baicalensis, Radix)

Hua Fen 4 qian (Trichosanthis Kirilowii, Radix)

Sheng Mu Li 5 qian (Ostreae, Concha)

Dang Gui 3 qian (Angelicae Sinensis, Radix)

Bai Shao 3 qian (Paoniae Lactiflorae, Radix)

Chuan Xiong 2 qian (Ligustici Chuanxiong, Radix)

Bai Zhu 3 qian (Atractylodis Macrocephalae, Rhizoma)

Ze Xie 5 qian (Alismatis Orientalis, Rhizoma)

Fu Ling 4 qian (Poria cocos, Sclerotium)

Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula is commonly used in the treatment of lumbar and cervical hyper-osteogenesis, osteoporosis, ankylosing spondylitis and wind-damp type rheumatic disorders. The location of this disease is found in both the Jue-Yin and Tai-Yin levels and is a pattern of blood vacuity with damp exuberance therefore treatment involves resolving the two Yin’s nourishing the blood and disinhibiting water. 

According to numerous recorded cases studies, Dr. Hu commonly employed this formula in the treatment of Systemic Lupus erythematosus (SLE).

Hu Xi-Shu (胡希恕) Case #4-Duodenal Ulcer

On By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)4 Comments

hu xi-shu.jpgMr. Wang, male, 46 years old.

Initial diagnosis on November 30, 1965: For over 10 years the patient has suffered with epigastric pain which has recently been getting worse. Treatment at a local Chinese-Western integrative clinic was unsuccessful. Chinese medicinals were used to warm the centre, rectify the Qi, quicken the blood and dispel stasis. Western medications were ineffective as well and surgery was recommended. Since the patient feared surgery, he came to the capital (BeiJing) for treatment.

Current symptoms: stabbing epigastric pain most notable when hungry, heat effusion in the back, late afternoon heat in the palms of the hands, occasional worry, palpitations, dizziness, cool body with a fear of cold, sweating and an aversion to wind. There was harmony of the mouth* with no desire to drink and slightly sloppy stools. Tongue coating was white, tongue tip was red and his pulse was thin and wiry. Barium examination revealed a 0.4cm2 postbulbar duodenal ulcer. 

Dr. Hu prescribed Xiao Jian Zhong Tang (Minor construct the centre decoction)

Gui Zhi 3 qian

Bai Shao 6 qian

Sheng Jiang 3 qian

Da Zao 4 pieces

Zhi Gan Cao 2 qian

Yi Tang ½ liang (mixed into prepared decoction)

Second consultation (12.3.1965): The pain and heat in the palms had slightly decreased but overall the epigastric stabbing pain, heat in the back and daily bowel movements were still present. The following medicinals were added to the above formula;

Chao Wu Ling Zhi 2 qian

Yuan Hu Fen 5 fen (mixed into decoction)

Third consultation (12.9.1965): The epigastric pain is no longer as obvious, but after eating the patient is experiencing focal distension below the heart. In addition, his four limbs are cold and he is unable to sleep peacefully at night. At this point the patient had to return to his hometown in Dong Bei. The formula was changed to Fu Ling Yin and sent home with him where he was to take it and until recovery. The formula ingredients were as follows:

Fu Ling 5 qian

Dang Shen 3 qian

Zhi Ke 3 qian

Cang zhu 3 qian

Sheng Jiang 3 qian

Chen Pi 1 liang

Ban Xia 4 qian

Commentary: In this case the patient presented with sweating, an aversion to wind, dizziness and heart palpitations which can signify pathogens in the exterior, specifically an exterior vacuity pattern. Therefore Xiao Jian Zhong Tang was administered. After taking three packages of the formula there was already a significant effect and after nine packages, the symptoms were basically resolved. Xiao Jian Zhong Tang is essentially Gui Zhi Jia Shao Yao Tang with the addition of Yi Tang. Gui Zhi Jia Shao Yao Tang is originally a formula used to treat abdominal pain. With the addition of a large dose of sweet, warm, vacuity supplementing, spasm moderating Yi Tang we have the dual action of both treating abdominal pain and supplementing vacuity, hence the name ‘Construct the centre’.

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions.

Case Study of Wu Pei Heng (吴佩衡医案)

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吴佩衡医案

The following is a case study by the late Wu Pei Heng (吴佩衡) (1886-1971) from Si Chuan province who was extremely proficient in using classical formulas and practiced in the style of the fire god school (火神派).  My initial fascination with Dr Wu’s cases are his use of extremely large doses of Fu Zi.  There are a number of cases in his book where he uses up to 300g a day, even with a few of his younger patients. Due to Dr. Wu’s prolific use of Fu Zi he attained the nickname ‘Wu Fu Zi’ (吴附子). 

 

Late miscarriage blood loss

 Mrs Fang, 35 years old, originally from Luo Ping county currently living in the city of Kun Ming in Yunnan province.

On May 12, 1923 she presented at the clinic after suffering a miscarriage in her fifth month of pregnancy.  Initially she felt painful sagging in her abdomen and low back which continued until she miscarried.  She had excessive menstrual bleeding (flooding) with clots, twisting abdominal pain, flusteredness, dizziness and shortness of breath.  Her pulse was scallion like, vacuous, weak and both inch positions were short.  Her lips were pale red, tongue coating was slippery white and the tongue body was bluish and dark.  According to her husband on that particular evening she had fainted twice.   Late miscarriages are usually due to major vacuity of kidney qi, qi vacuity sinking and unable to absorb blood, and yang qi descending with blood and escaping.   The qi is born within the kidneys and gathers in the lungs and here we have a lack of merger between the kidneys and lungs, therefore there is shortness of breath with desertion.  The plan is to administer Si Ni Dang Gui Bu Xue Tang with (Da) Zao and Ai (Ye).  Within the formula, Si Ni Tang supports Yang allowing it to rise.  The assistants (Huang) Qi and Dang Gui supplement the centre, boost qi and re-generate the excessively damaged blood.  Gan Jiang, Ai (Ye) and (Da) Zao blackened, can warm the blood, separate the cold and return blood back to the channels. 

 

Formula:

Hei Fu Pian 160g

Pao Hei Jiang 50g

Zhi Gan Cao 24g

Bei Kou Qi 60g

Dang Gui 26g

Qi Ai 6g (fried until blackened)

Da Zao 5 pieces (roasted until blackened)

 

After taking 13 days worth of formula, her menstrual flooding stopped, the shortness of breath was calmed and most of her symptoms were alleviated by days 6 or 7 and even her spirit was slightly improved.  In keeping with the original formula, another 14 days were given to complete the course, after which she successfully recovered.

                                                                                          

A case of Shao-Yin Infertility

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Fan Zhong Lin- Liu Jing Bian Zheng Yi An （六经辩证医案)

Huang. 34 year old female cadre residing in Si Chuan province.

[Disease history]: Couple have been trying to conceive unsuccessfully for the last 7 years beginning in the winter of 1959. Both male and female medical investigations were normal. Her initial symptoms were dizziness and poor energy. In the early mornings she would have facial edema and in the afternoon the swelling would be in her legs. Her menstruation was irregular.
In 1965 when she had come in for a consultation the state of her condition had already become quite serious. Her initial consultation was on June 20 1965.

[Initial consultation]: Amenorrhea for a half a year with copious leucorrhea. There was mild edema throughout her entire body and her lower limbs felt rather heavy. There was whole body pain, a fear of cold, excessive dreaming, poor appetite and her blood pressure was occasionally high. Her urination was inhibited and her bowels would be initially dry and then sloppy. Tongue body was pale, flabby and tender with teeth marks on the edges, coating was slippery overall and thicker at the centre. Pulse was deep.
This is an irregular menstruation and Infertility pattern due to evils entering the Shao-Yin with fire debilitation, water effulgence and Kidney Yang vacuity. A modified version of Zhen Wu Tang was appropriate to warm Yang, transform Qi and move water.

Prescription:

Zhi Fu Pian 120g (extended cooking time)
Fu Ling 30g
Sheng Jiang 30g
Gui Zhi 15g
Pao Jiang 30g
Zhi Gan Cao 15g
4 Packages.

[Second consultation]: After taking the above formula her whole body edema was markedly reduced and her appetite was improved. Another four packages of the above formula were prescribed.

[Third consultation]: Patients exhaustion, aversion to cold and other symptoms were greatly improved except for the amenorrhea. A modified version of the above formula combined with Dang Gui Bu Xue Tang was prescribed.

Prescription:

Zhi Fu Pian 60g (extended cooking)
Fu Ling 20g
Bai Zhu 15g
Sheng Jiang 30g
Gui Zhi 10g
Huang Qi 30g
Dang Gui 10g
Zhi Gan Cao 10g
Pao Jiang 30g

[Fourth consultation]: Eight packages of the above formula were taken after which her menstruation arrived. The colour was pale, the amount scanty and contained clots. Her lower abdomen felt cool with a dull pain. She was still manifesting congealing and stagnation of cold in the uterus. A modified version of Wen Jing Tang was administered.

Prescription:

Wu Zhu Yu 6g
Dang Gui 10g
Chuan Xiong 6g
Bai Shao 10g
Xue Yu Tan 20g
Pao Jiang 20g
Zhi Gan Cao 10g
2 Packages were given.

[Fifth consultation]: The abdominal pain had ceased indicating that the stasis of blood had decreased. All other symptoms were obviously reduced as well. Out of fear that the cold would return, she was advised to abstain from sexual intercourse for a half a year. The patient was given a prescription to take back home with her to continue to regulate and improve her health.

Prescription:

Zhi Fu Pian 60g (extended cooking)
Rou Gui 10g (powdered and steeped in cooked decoction)
Pao Jiang 30g
Xue Yu Tan 20g
Tu Si Zi 20g
Rou Cong Rong 10g
Huang Qi 30g
Dang Gui 10g
Nan Sha Shen 15g
Zhi Gan Cao 15g
Gou Qi Zi 20g
Ba Ji Tian 12g

July 26, 1979 follow up: During the entire course of treatment over a hundred packages of herbs were taken. Following the advice of Dr. Fan she was able to become pregnant in 1967 and currently has two children.

Can Major Buplureum Decoction treat panting & wheezing?

On By eranevenIn Formulas (方剂), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)2 Comments

Occasionally when reading books written by clinical masters of our time regarding the usage of Jing Fang 经方 (classic formulas) we stumble upon what seems at first to be bizarre yet intriguing ways of using these formulas that in no way reflect any of the usages we were taught in school.  One in particular that comes to mind is Hu Xi-Shu’s usage of Major Buplureum Decoction (Da Chai Hu Tang) for wheezing and panting (what we may call modern day asthma).  In his ‘Popular Lectures on Cold Damage’ (伤寒论通俗讲话), Dr Hu explains 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 has said 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. 

 In addition Dr. Hu felt that blood stasis plays a major role in many of the chronic recalcitrant patterns of panting and wheezing and would therefore use Major Buplureum decoction in combination with other formulas such as Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria pills) or Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi).  He explains that originally there is latent blood stasis in a persons’ body caused by cold contraction, food damage or emotional changes. Any of these factors when left untreated will create a situation of blood stasis which will then invade the Liver and Lungs and cause wheezing and panting.  If this stasis is not expelled, long term resolution will be difficult to achieve, therefore many incessant cases of wheezing and panting even when mixed with cold or summer-heat involve elements of blood stasis.  A couple of his formula combinations with their clinical manifestations are as follows;

Da Chai Hu Tang plus Gui Zhi Fu Ling Wan:  大柴胡汤合桂枝茯苓丸

Chest and rib-side bitter fullness, difficulty breathing, urgency below the heart (epigastrium), bitter taste in the mouth, dry throat and dry bowel movements.

 Da Chai Hu Tang plus Tao He Cheng Qi Tang:  大柴胡汤合桃核承气汤

Symptoms include the above with the addition of abdominal fullness and distension and difficult bowel movements.

If there is a dry mouth and tongue, with vexing thirst, Sheng Shi Gao (Gypsum fibrosum) may be added.

If there is a simultaneous external contraction with symptoms of heat effusion, aversion to cold, and no sweating then Ge Gen Tang (Pueraria Decoction) can be combined with any of the above two combinations depending on the presenting pattern.

Sheng Shi Gao is appropriate as well if symptoms of dry throat, agitation or vexation present.

If sweating and panting are quite obviously seen in any of the above patterns then Ma Xing Shi Gan Tang (Ephedra, Apricot kernel, Gypsum and Licorice decoction) can be combined with any of the two combinations as well. 

 

Hu Xi Shu’s discussion and elucidation on cold damage 胡希恕， 越辩越明释伤寒

On By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)5 Comments

This is an excerpt from one of Dr. Hu’s books. It is an elucidation of clause 100 of the Shang Han Lun (On Cold Damage)

In cold damage (1), when the Yang pulse is choppy(2) and the Yin pulse is wiry(3), there should be acute abdominal pain (4) . First administer Xiao Jian Zhong Tang (5) . If there is no reduction (of symptoms), Xiao Chai Hu Tang governs (6).

Interpretation:
A pulse that is floating and choppy, is what is meant by the ‘Yang pulse is floating; at the deep level the pulse is wiry, which is written as ‘the Yin pulse is wiry’. A choppy pulse governs scanty blood and wiry governs cold exuberance. What we have here is cold damage with a floating choppy pulse and a deep wiry pulse, which signifies external blood vacuity and cold exuberance in the interior. According to these laws we should expect to see acute abdominal pain therefore Xiao Jian Zhong Tang is given.
After taking the decoction there is still no reduction of symptoms which means that the condition has yet to be resolved and because Shao Yang has the same pulse (wiry) this is considered a Tai-Yang Shao-Yang combination disease with interior cold. Xiao Jian Zhong Tang only partially treats this condition, therefore we administer Xiao Chai Hu Tang in order to resolve Shao Yang evils, and only then can we offer a cure.

Notes:
Acute abdominal pain originally belongs to both a Xiao Jian Zhong Tang pattern and to a Xiao Chai Hu Tang pattern. Ordinarily Shao yang harbors internal vacuity and central qi insufficiency and although there are Xiao Chai Hu Tang signs, we must first fortify the centre. First Xiao Jian (Zhong Tang), afterwards Chai Hu (Tang). In vacuity treating the interior first is a fixed concept, and rather than treating with the first rule of Xiao Jian Zhong Tang with no effect, it is treated with Xiao Chai Hu Tang. If in abdominal pain the pulse is wiry, this is only interior vacuity and Xiao Jian Zhong Tang can be administered without any relation to Shao Yang.

Xiao Jian Zhong Tang  小建中汤

Gui Zhi (remove skin) 3 liang
Shao Yao 6 liang
Sheng Jiang (cut) 3 liang
Da Zao (broken) 12 pieces
Gan Cao (honey fried) 2 liang
Jiao Yi 1 sheng

For the above six ingredients, use seven sheng of water. Boil until three remain, and remove the dregs. Add the malt sugar and put back on low heat until it melts. Take one sheng warm three times daily. People who vomit easily should not take this decoction due to its sweetness.

Formula interpretation:
The first five ingredients of this formula make up Gui Zhi Jia Shao Yao Tang (Tai-Yin, clause 284), which treats Tai-Yang disease abdominal fullness and periodic pain found after purgation. Adding Yi Tang which is warm and sweet makes it more supplementing. Shao Yao is bitter, sour and slightly cold and by adding the warmth of Yi Tang we have mild supplementation. This is Xiao Jian Zhong Tang.

Jiao Yi is sweet, warm, enriching, nourishing and strengthening. It relaxes tension, strengthens the Spleen and Stomach, boosts Qi and supplements vacuity cold. It governs acute abdominal pain and rumbling intestines (borborygmus). The nature and flavor of both Jiao Yi and Gan Cao are quite similar and are used for Yin, Yang, Exterior, Interior, Repletion and Vacuity, but are especially indicated in interior vacuity. They are unsuitable in abdominal pain due to excessive gastric acid.
Shao Yao is bitter, slightly cold and has the function of mild precipitation.
Jiao Yi and Bai Shao effectively treat abdominal pain, but differentiation must be made between cold, heat, vacuity and repletion. The abdominal pain associated with intestinal tuberculosis offers an opportunity to use this combination.

Notes:
Abdominal pain is found in both vacuity and repletion. Pain on palpation that is not severe even with stronger pressure belongs to Qi pain. Pain on pressure with hardness that refuses pressure is seen in accumulations and gatherings. Qi type pain should not be purged.

1. ‘Cold damage’ signifies Tai-Yang cold damage where the exterior has yet to be resolved. We do know that Xiao Jian Zhong Tang treats the abdominal pain and Xiao Chai hu Tang treats the disease if there is no reduction or lessening of symptoms. This clause is originally a Tai-Yang and Shao-Yang combination disease with interior vacuity cold.
2. ‘Yang pulse is choppy’ means the pulse is felt at a superficial level, plus liquids and blood are not filling and nourishing the exterior and the stomach is weak.
3. ‘Yin pulse is wiry’ means the pulse has a wiry quality at the deep level. A wiry pulse is thin and with strength
4. Acute pain and hyper-tonicity with pain. By the yang pulse being choppy and the yin pulse wiry, we are able to see that there is an insufficiency of liquids and blood and cold exuberance in the interior, so there should be hypertonic pain in the abdomen.
5. Xiao Jian Zhong Tang is a modified version of Gui Zhi Tang. Both these formulas can resolve the exterior, enrich and nourish the blood vessels and through its warm and sweet nature expel cold and stop pain. We can deliberate the meaning of ‘first administer’. In Tai-Yang Shao-Yang combination disease with the addition of vacuity cold in the interior, we should first save the interior and then resolve the exterior or half exterior, half interior aspect. This is the essence and spirit of clauses 93 and 94.
6. No reduction of symptoms, namely means that after taking Xiao Jian Zhong Tang the abdominal pain is not completely gone. Now because both Xiao Jian Zhong Tang and Xiao Chai Hu Tang symptoms exist, we first treat the interior and afterwards the exterior. Since Xiao Jian zhong Tang only treated half the condition we follow it with Xiao Chai Hu Tang to effect a complete resolution of symptoms

Hu Xi Shu (胡希恕) Case #2-Cough

On By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)4 Comments

38 year old female first seen on Feb 12 1966. Patient had suffered with a dry cough and itchy throat for over a hu xi-shu.jpgmonth. She had taken a modified version of Zhi Sou San (Stop Cough Powder), and modified versions of Sang Xing Tang (Mulberry Leaf & Apricot Kernel Decoction) and Mai Men Dong Tang (Ophiopogonis Decoction). The cough not only failed to improve but actually got 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.

Prescription given was Ling Gan Wu Wei Jiang Xin Xia Tang (Poria, Licorice, Schisandra, Ginger, Asarum and Pinellia Decoction) with additions and subtractions:

Fu Ling 4qian
Xi Xin 2 qian
Wu Wei Zi 4 qian
Ban Xia 5 qian
Zhi Gan Cao 2 qian
Chen Pi 5 qian
Sheng Jiang 3 qian
Xing Ren 3 qian
Ku Jie Geng 3 qian
Zhi Pi Pa Ye 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 yin vacuity. 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-rheum pattern. The dry cough is from phlegm-rheum 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 herbs or sweet cold Yin enriching herbs will only worsen the stagnation and obstruction of fluids and cause phlegm-rheum 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, the use of only three packages were needed for recovery.

 


Hu Xi-Shu (胡希恕）Case #1-Cough

On By eranevenIn Case Studies （医案), Hú Xīshù (胡希恕), Jīng Fāng (经方), Translations & Writings (译著与文章)1 Comment

Case #1 Hu Xi-Shu, Shang Han Lun Tong Su Jiang Hua （伤寒论通俗讲话）
Huang, Female, 38 years old

Initial diagnosis was on Feb 12, 1966: Patient presented with a cough combined with expectoration of white phlegm, itchy throat, chest fullness, a dry throat with no desire for fluids and bilateral rib side distension. She has already taken several packages of herbal formulas to no avail. Her tongue coating was thick and slimy, and her pulse slippery-thin.

This pattern belongs to phlegm-rheum harassing the upper (burner), and impaired depurative downbearing of the lungs. This was treated by warm transformation and downbearing counterflow with a modified version of Ban Xia Hou Po Tang.

Ban Xia 4 qian
Hou Po 3 qian
Fu Ling 4 qian
Su Zi 3 qian
Ju Pi 5 qian
Xing Ren 3 qian
Jie Geng 3 qian
Sheng Jiang 3 qian

Results: After taking only 2 packages of the above herbs, the cough had stopped.

Ban Xia Hou Po Tang is originally from the Jin Gui Yao Lue (Essentials from the golden cabinet) in the miscellaneous gynaecological diseases section. Originally used for “female patients with the sensation of fried meat in the back of the throat”
Dr. Hu believed this formula to be Xiao Ban Xia Jia Fu Ling Tang with the additions of Hou Po and Su Ye. It is used in phlegm-rheum qi bind manifesting with chest fullness, throat blockage and cough. It warms and transforms phlegm-rheum, downbears counterflow and regulates Qi. The patient above was manifesting with a phlegm-rheum cough, therefore the use of this formula offered a quick resolution.
The original formula contains (Zi) Su Ye, but Dr. Hu prefers to use (Zi) Su Zi. If there are obvious exterior signs present, then (Zi) Su Ye may be added, and you may also add either Gui Zhi Tang or Ma Huang Tang. If there are obvious heat signs then Sheng Shi Gao may be added. If there is an enduring cough due to cold rheum, without any obvious exterior signs, then combine with Ling Gan Wu Wei Jiang Xin Xia Tang (Poria, Licorice, Schisandra, Ginger, Asarum, and Pinellia Decoction).