On Gé Gēn 葛根

Gé Gēn (Radix Puerariae)

《神农本草经》: 味⽢,平。主消渴,⾝⼤热,呕吐,诸痹,起阴⽓,解诸毒。
[Shén Nóng Běn Cǎo Jīng]: Sweet flavour, and neutral Qi. Governs dispersion thirst, major body heat, vomiting, and various kinds of impediment. It raises the Yīn Qì and resolves all toxins.

《名医别录》:⽆毒。主治伤寒中风头痛,解肌发表出汗,开腠理,疗⾦疮,⽌痛,肋风痛。
[Míng Yī Bié Lù (Táo Hǒngjǐng – 456-536)]: “[It] has no toxicity. It governs the treatment of cold damage and wind strike headache; [it] releases the muscles, effuses the surface and promotes sweating; [it] opens the interstices, heals metal sores, stops pain and [treats] subcostal wind pain.”

东垣云:葛根⽢平温,世⼈初病太阳证,便服葛根升⿇汤,⾮也.
Lǐ Dōngyuán (1180-1251) said: “Gé Gēn is sweet, neutral and warm; common people, at the onset of a taiyang disease pattern, give Gegen Shengma Tang, this is incorrect.”

好古⽈:⽓平味⽢,升也,阳也。阳明经⾏经的药也。
(Wáng) Hǎogǔ (1200-1264) said: “It’s qi is neutral and flavour sweet, [for it] ascends, and is yang. Gé Gēn is a medicinal which moves the Yangming channel.”

Zhāng Zhìcōng (1616-1674): “sweet and acrid, white when powdered, therefore enters Yangming; the skin is black and flower red, and so unites with Taiyang. Therefore, Gé Gēn is able to diffuse and outthrust the qi of yangming center earth, and unite the taiyang channel on the exterior.”

《本草备要》:轻宣解肌,升阳散⽕。
[Essentials of the Materia Medica (Wáng Āng 1664)]: “[Gé Gēn] Lightly effuses and resolves the muscles, ascends yang, and scatters fire.”

(唐宗海 : “根深能引⽔⽓上达苗叶,故兼能升津液也.”
Táng Zōnghǎi (1846-1897): “[The] Deep roots [of Gé Gēn] are able to carry water qi upwards into the sprouts and leaves, [and is] therefore able to ascend fluids.”

According to Professor Huáng Huáng, patients that respond well to Gé Gēn formulas have the following characteristics.

  • Big, strong patients with thick, strong muscles
  • Slightly overweight
  • Heavy, cumbersome bodies
  • Coarse, thick skin
  • Hairy
  • Lazy appearance
  • Sallow, dark complexion

These patients have the following propensities:

  • Stiff neck and back due to tight muscles (tension in traps, levator scapula, sub-occipitals, etc.)
  • Headaches (Taiyang – Yangming)
  • Heavy Head (cloudy, foggy, etc.)
  • Dizziness
  • Loose Stools
  • Heavy and Cumbersome body

To learn more about Ge Gen and its various formulas, click here to check out my Gé Gēn class

Gé Gēn Tāng Case – Liú Dùzhōu

Selected Clinical Case Histories of Liu Duzhou《刘渡舟临证验案精选》

Li X, a 38-year-old male.

He had suffered with persistent migraines for 2 years that remained unresolved despite long periods of treatment. He was introduced to Doctor Liu by a good friend and brought in for a consultation.

Chief complaint: right sided headaches, which commonly extended to the forehead and supraorbital ridge. This was accompanied by an absence of sweating, chills, a runny nose with clear mucus, irritability, a red complexion, dizziness, and poor sleep. The range of motion in his back was limited and he reported tightness in his neck and occipital area that became more severe during his headaches. His tongue was pale with a white coat, and his pulse was floating and slightly rapid.

This was differentiated as being cold pathogen lodged in the taiyang channels, resulting in symptoms of inhibited flow of channel qi.

Treatment required the promotion of sweat to expel pathogens, and unblock taiyang qi, so Kudzu Decoction (gé gēn tāng) was given:

Ephedrae Herba (má huáng) 4g
Puerariae Radix (gé gēn) 18g
Cinnamomi Ramulus (guì zhī) 12g
Paeoniae Radix alba (bái sháo) 12g
Glycyrrhizae Radix praeparata (zhì gān cǎo) 6g
Zingiberis Rhizoma recens (shēng jiāng) 12g
Jujubae Fructus (dà zǎo) 12 pieces.

Ephedrae Herba (má huáng) and Puerariae Radix (gé gēn) were to be decocted first with the froth removed before adding the other ingredients. After taking the decoction, the patient was covered up so a slight sweat could be obtained. He was to avoid drafts and cold.

After taking 3 packets, his back felt warm, which was followed by a mild sweat throughout the body, and a reduction in his headache and neck tension. 15 packets of the same formula were prescribed again, which completely resolved his headaches and neck tension.

A Cháihú jiā lónggǔ mǔlì tāng case – Huáng Huáng

Wang, 58-year-old male, 186cm/64kg. 

Initial consultation on June 11, 2019. 

History: Patient had a history of stomach disease for over 30 years, accompanied by an inability to eat much food, stomach distention following meals, poor appetite, no desire to eat, coldness in the lower abdomen, a fear of cold, constipation, difficulty falling asleep, and a shallow, dream-disturbed sleep.  

Lab results: Gastroscopy on May 2, 2019, which revealed intermediate chronic atrophic gastritis with intestinal metaplasia in the lesser curvature of the gastric antrum and mild chronic atrophic gastritis with intestinal metaplasia in the greater curvature of the gastric antrum.  

Signs: Sallow complexion, distinct abdominal pulsations, a long face, indifferent expression, slightly thin build, red tip of the nose, and a thin-slippery pulse. 

Prescription:

Bupleuri Radix (chái hú) 15g, Scutellariae Radix (huáng qín) 10g, ginger-fried Pinelliae Rhizoma praeparatum (jiāng bàn xià) 10g, Codonopsis Radix (dǎng shēn) 15g, Cinnamomi Ramulus (guì zhī) 10g, Poria (fú líng) 15g, prepared Rhei Radix et Rhizoma (zhì dà huáng) 5g, Fossilia Ossis Mastodi (lóng gǔ) 15g, Ostreae Concha (mǔ lì) 15g, Zingiberis Rhizoma (gān jiāng) 5g, Jujubae Fructus (dà zǎo) 20g; 10 packets, 1 packet for 2 days. Taken right before bed. 

Second consultation on July 2, 2019: Patient now had a desire to eat, daily bowel movements, and decreased coldness in his lower abdomen. If he overate then he experienced abdominal distention, still had a fear of cold, woke easily due to a dream-disturbed sleep, and was fatigued. 

Prescription 1: Same formula; 1 packet to be taken over 2 days. 

Prescription 2: Bupleuri Radix (chái hú) 15g, Paeoniae Radix alba (bái sháo) 15g, Aurantii Fructus (zhǐ ké) 15g, Glycyrrhizae Radix (gān cǎo) 5g, dried Lilii Bulbus (bǎi hé gān) 30g; 10 packets of each, to be taken on an alternating basis. 

What is a Formula Presentation 方证?

The formula presentation is a theoretical model of herbal formula application that lies between the herbs and formulas on one hand, and the disease pattern on the other. It is the arrow aiming for the target in relation to disease treatment. The formula presentation is the guiding principle behind how a formula is selected. ‘Zheng’(证) refers to evidence, proof, results or efficacy (证验), and also symptoms (症状). Therefore, when all these definitions are taken together, the formula presentation refers to a formula’s key presentation, or instance where a formula displays its main efficacy or results.

Currently in China, many consider the earliest recording of this concept to be found in the Wu Shi Er Bing Fang (五十二病方, Prescriptions for Fifty-Two Diseases), yet many scholars believe that it wasn’t until Zhang Zhongjing’s (张仲景) writings that the concept really took hold, only to be further developed by later generations of physicians. The idea of a formula correspondence (方证相应) is seen in the postscript for line 317 of the Shang Han Lun (伤寒论, Treatise on Cold Damage) which states:

[Only when] the disease corresponds to the formula [can the formula] be taken.

病皆与方相应者,乃服之。

This line offers the most succinct explanation and definition of a formula presentation and implies that all diseases have a corresponding formula, a ‘formula presentation.’ The Shang Han Lun also refers to specific ‘herb presentations’ (药证) such as a ‘Chai Hu (Bupleuri Radix) presentation’ (柴胡证), or a ‘Gui Zhi (Cinnamomi Ramulus) presentation’ (桂枝证). In addition, line 16 of the Shang Han Lun states: 

Observe the pulse and signs, know what error [you] have committed, [and then] treat according to the signs. 

观其的脉证,知犯何逆,随证治之。

The Shang Han Za Bing Lun (伤寒杂病论, Treatise on Cold Damage and Miscellaneous Diseases) was arguably the first text to suggest not just the concept of a formula presentation, but also the principle that became known as ‘determining treatment by patterns identified’ (辨证论治), which lays importance on not just simply knowing which formula treats specific signs, but also on having a clear understanding of the underlying pathomechanism involved. Once the pattern is clearly understood, the choice of the correct formula can be made. According to Professor Huang Huang (黄煌教授), once a formula presentation is clearly identified, not only will the formula be safe to use, but the treatment will also be effective. Following Zhang Zhongjing, physicians such as Sun Simiao (孙思邈), Zhu Gong (朱肱), Xu Lingtai (徐灵胎), Ke Qin (柯琴) and Yu Jiayan (喻嘉言) were highly influential in the ‘school of formula types’ (方类证派), adhering to the concept of ‘formula presentations with similar clauses’ (方证同条).  Song dynasty Zhu Gong referred to a formula presentation simply as a ‘herb presentation.’ The Japanese physician Todo Yoshimasu (吉益东洞) was a strict adherent to the model laid out by Zhang Zhongjing, and was a major contributor to the Japanese Classical Formula School (日本古方派). Although many of these physicians adhered to the formula presentation model, there are some differences in their overall approach and in the method with which they arrived at the presentation. For example, Ke Qin wrote: “Patterns are differentiated from the conformations, therefore the pattern is named after the formula” (证从经分,以方名证), referring to the six conformations (六经), while Xu Lingtai wrote: “In order to [determine] the formula presentation type, [one must] not differentiate according to the conformations” (以方类证,方不分经). While both used the formula presentation model as their method to choose a formula, Ke Qin recorded signs and symptoms exactly as they appear in the Shang Han Lun’s six conformations, while Xu Lingtai worked with general signs and symptoms.  Essentially, a formula presentation is experience: the experienced usage of herbs and formulas over thousands of years. 

Chén Xiūyuán on Gùi Líng Wǔ Wèi Gān Cǎo Tāng

桂苓五味甘草湯
Guì Líng Wǔ Wèi Gān Cǎo Tāng
Cinnamon Bark, Poria, Schisandra, and Licorice Decoction

治青龍湯下已, 多唾口燥, 寸脈沉, 尺脈微, 手足厥逆, 氣從少腹上衝胸咽, 手足痹, 其面翕熱如醉狀, 因復下流陰股, 小便難, 時復冒者, 與此湯, 治其氣衝。

A treatment for when after taking xiǎo qīng long tāng there is copious spittle, a dry mouth, a deep pulse at the inch opening and a faint pulse at the cubit position. [In addition] there is reverse counterflow in the hands and feet, qi surging up from the lower abdomen to the chest and throat, impediment in the extremities, a red flushed face as if drunk, and because of repeated downpour into the groin, there is difficult urination, and periodically recurring muddledness. Give this decoction to treat the surging qi.

按: 脈沉微, 支厥痹, 面如醉, 氣衝時復冒, 似少陰陰陽不交之症, 學者可於臨症時參辨之則可。

Commentary: [When there is] a deep and faint pulse, propping [rheum] with reversal impediment,
a face as if drunk, and qi surging with periodic muddledness, this resembles a pattern of
non-interaction between the yīn and yang of shaoyīn. When arriving at these patterns, students can
compare and differentiate these principles.

Guì Zhī 4 liǎng 桂枝
Fú Líng 4 liǎng 茯苓(各四兩)
Wǔ Wèi [Zǐ] 五味[子] 1/2 shēng(半升)
Zhì Gān Cǎo 3 liǎng 甘草(三兩, 炙)

上四味, 以水八升, 煮取三升, 去滓, 分溫三服。

Simmer the four ingredients above in 1,600ml of water, until reduced to 600ml. Remove the dregs, divide, and take warm in three doses.

Song歌曰:

青龍卻礙腎元虧,
腎元虧而誤服之,
則動衝任之火,
致變為已下諸証。
上逆下流又冒時;
氣從少腹上衝胸咽,
或面熱如醉,
或熱氣流於兩股,
或小便難而昏冒,
忽上忽下,
在陽無主,
如電光之閃爍無定,
味用半升苓桂四,
甘三扶土鎮衝宜。

Xiǎo Qīng Lóng Tāng may cause (further) depletion to the original (qì) of the kidney.
(Original kidney qi was debilitated, and (Xiǎo Qīng Lóng Tāng) was erroneously administered.  
This led to the stirring and surging of conception vessel fire,
which changed into one of the various patterns (which follow) administration].
Ascending counterflow with downpour, in addition to periodic muddledness,
[qi surging upward from the lower abdomen into the chest,
or a red flushed face as if drunk,
or warm qi flowing into the groin,
or difficult urination, and clouded veiling,
which fluctuate sharply, are (the result) of yáng not ruling,
and is unpredictable like the flickering of lightening].
100ml of wǔ wèi zǐ, twelve grams of fú líng and guì zhī,
and nine grams of gān cǎo, are suitable to support earth and settle the surging.

Commentary by (Chén) Yuánxī 男元犀按:

仲師五味子必與乾薑同用, 獨此方不用者, 以誤服青龍之後衝氣大動, 取其靜以制動, 故暫停不用也。 尤雲: 苓、 桂能抑衝氣使之下行, 然逆氣非斂不降, 故以五味之酸斂其氣, 土厚則陰火自伏, 故以甘草之甘補其中也。

Master (Zhàng) Zhōng Jǐng’s wǔ weì zǐ is always combined with gān jiāng (however) in this formula (gān jiāng) is not used. Following the erroneous administration of Xiǎo Qīng Lóng Tāng, there is major stirring of surging qì.  Take this (formula) to tranquilize in order to control the stirring, and once it stops, there is no need to (continue) taking it.  Yóu Zàijīng says: fú líng, and guì zhī are able to control surging qì allowing it to move downwards, and (if) counterflow qì fails to go down due to a lack of restraint, sour wǔ wèi zǐ is used to restrain it. (Once) earth is thickened, yīn fire will conceal on its own, and for this reason sweet gān cǎo is used to supplement earth.

Cáo Yǐngfǔ on the Use of Xiǎo Jiàn Zhōng Tāng 

Master Cao was a pivotal force in the classical formulas school (经方派) and was a true master in using the underlying principles and formulas found in the Shang Han Lun and Jin Gui Yao Lue. Master Cao felt that the medical texts, which followed were too insignificant to study and discuss, and therefore he attached great importance to the thorough study of these texts to his students, and felt that Zhang Zhongjing’s theories and formulas were the perfect framework for successful medical practice. In addition to being skillfully versed in these medical canons, Cao Yingfu was also an accomplished poet, often interweaving the two when attempting to convey his thought process in clinic, often instructing his students to compose a poem and matching it with a relevant line from the classics. This kind of inquiry and thought process truly shows the breadth of his skill and how his mind rarely waivered from the classical Chinese medicine concept of the human body being a reflection of his environment, the microcosm of the macrocosm.
However, master Cao was not completely strict in his formula choices and would often use formulas like Bu Zhong Yi Qi Tang, Xiao Yao San, and Liu Wei Di Huang Wan, in addition to herbs such as niu bang zi, qian hu and various others. This shows that he was obviously well read and did not quickly write off more modern formulas. His use of these non Zhang Zhongjing formulas displayed his deep understanding in the formula constructions and where they were applicable. He advocated that students must understand and study the root of the medical philosophies and not just pick the flowers, and it’s from this same feeling that he encouraged his students to read the Yue Fu (乐府诗集) poetry of the Han and Wei dynasties and specifically the poet Wang Yuyang (王漁洋).

When the Japanese invaded the south, his hometown of Jiangyin, Jiangsu province fell into enemy hands and on December 7th, 1937, he died heroically resisting the invaders. While master Cao died a hero, the world lost a great Chinese medicine master. We are very fortunate to have several of his books available in order for subsequent generations to learn from not just in China, but also around the world. It is my hope in translating some of his cases that this knowledge can spread. We are also very fortunate to have scholar-physicians like my teacher Dr. Huang Huang uphold this love and dedication to master Cao’s work and to classical literature.

Case 1
Female. Since delivering a child her cycles come every forty days, which are accompanied by distending pain in the epigastrium following meals. When the cycle arrives, there is pain extending from the stomach to the lower abdomen. During the pain she experiences a strong desire to have a bowel movement. After the bowel movement the pain would typically stop. Pain would return the following afternoon and stop during the menstrual flow, and once again come and go the following day. Both pulses were wiry.
This is liver and gall-bladder exploiting deficiency of the spleen viscera. In this case Xiao Jian Zhong Tang with Chai hu and Huang Qin is appropriate.


Gui Zhi 3 qian
Sheng Bai Shao 5 qian
Zhi (Gan) Cao 2 qian
Sheng Jiang 5 pcs
Hong Zao 12 pieces
Yi Tang 2 liang
Chai Hu 3 qian
Jiu (Huang) Qin 1 qian
Tai Wu Yao 1.5 qian

After one package, her pain stopped and the menses ceased. Patient continued with two more packages, after which the condition resolved.
The master (Zhang Zhongjing) in his great classic said:


“In cold damage, (when) the yang pulse is choppy and the yin pulse is wiry, as a rule there should be urgent pain in the abdomen. First give Xiao Jian Zhong Tang; if it does not reduce, Xiao Chai Hu Tang governs.”
“伤寒,阳脉涩,阴脉弦,法当腹中急痛,先与小建中汤,不差者,小柴胡汤主之”.

Cao Yingfu (曹颖甫): Now here (in this case) I feel it goes without saying that there had not been a reduction and I immediately added Chai Hu and Huang Qin to treat her, why not? This woman’s situation was a menstrual disease and many belong to Chai Hu patterns, and so it was clearly obvious (to add it). The following day it was reported that the disease had resolved.

Case 2
Abdominal pain which liked pressure. During episodes of pain a distressing sensation of cold air was felt moving up and down (the body). Pulse was wiry-deficient. In addition there was an aversion to cold.
This is due to the liver exploiting the spleen and Xiao Jian Zhong Tang governs.
Gui Zhi 9g
Bai Shao 18g
Sheng Jiang 9g
Zhi Gan Cao 6g
Da Zao 6g
Yi Tang 30g

Liáo Shēng annotation: “This case is a pattern of abdominal pain (due to) central yang insufficiency with interior deficiency. The patient experienced abdominal pain, which liked pressure, the pulse was wiry-deficient and an aversion to cold was present. This signifies the overabundance of yin cold-qi, central yang insufficiency, and liver wood exploiting spleen (earth). Therefore Xiao Jian Zhong Tang was used to treat and resolve the condition.
The function of this formula is to supplement deficiency, quiet the center, moderate urgency and stop pain. The name of this formula is center fortifying (decoction). Fortify means to establish or set up, and because central qi is insufficient, it is very important to ‘establish’ or ‘set it up’. The formula contains sweat inducing (herbs) and not central effusing (herbs). It is referred to as a ‘minor’ (decoction) and only half (of the formula) resolves the exterior, so it does not completely secure the center. Xiao Jian Zhong Tang uses a heavy dose of Yi Tang, which is sweet, warm and serves as the sovereign to supplement the center. Bai Shao is the minister, which is sour and sweet to tonify yin. The assistant Gui Zhi is acrid-warm, which effuses and scatters. Combined with Bai Shao it regulates the nutritive and defense. In addition, Gan Cao, Da Zao and Sheng Jiang, which are sweet moderating and acrid warm, nourish the stomach and harmonize the center. Therefore (this formula) is able to warm and nourish central qi, calm and supplement yin and yang and regulate the nutritive and defense.”

*Xióng Liáo-Shēng (熊廖笙) style name Yǐ Xíng (以行) was born in 1905 in Ba County in Chongqing, Sichuan Province. Master Xióng was well versed in the classics, primarily the Nei Jing, Nan Jing, Shang Han Lun, and Jin Gui Yao Lue. The author of several books, Dr. Xióng possessed a deep and profound scholarship of the Shang Han Lun and was highly skilled in distilling the essence and precise details of various ancient doctors cases, which were found in his various annotations.

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Huáng Yuányù discusses Bǎi Hé

With today being the arrival of ‘Major Cold ‘(大寒 – the 24th solar term in the Chinese calendar lasting until Feb 3), what better day than today, to sit down with a cup of warm Wulong or Hongcha to translate passages from some of my favourite books.
The following is a direct translation from the Bǎi Hé section of Huáng Yuányù’s (1705-1758) excellent ‘Interpretation of Medicinals’ (黃元御藥解).

Huáng Yuányù discusses Bǎi Hé

– Translated from Huáng’s Interpretation of Medicinals (黃元御藥解)

百合 味甘、微苦,微寒,入手太陰肺經。涼金瀉熱,清肺除煩。

Bǎi Hé – Sweet flavour, slightly bitter and slightly cold. Enters the hand Taiyin lung channel. Cools metal, drains heat, clears the lungs and eliminates vexation.

金匱百合知母湯,百合七枚,知母二兩。治百合病,發汗後者。傷寒之後,邪氣傳變,百脈皆病,是為百合。其證眠食俱廢,吐利皆作,寒熱難分,坐臥不安,口苦便赤,心煩意亂,不能指其為何經何臟之病也。然百脈之氣,受之於肺,肺者,百脈之宗也,是宜清肺。其在發汗之後者,津枯而金燔。百合清肺而生津,知母涼金而瀉熱也。

The Jīn Guì’s Bǎi Hé Zhī Mǔ Tāng

Bǎi Hé 7 pieces
Zhī Mǔ 2 liǎng [listed as 3 liǎng in the Jīn Guì Yào Lüè]

Treats Bǎi Hé disease following the induction of sweat. Following cold damage, pathogenic qi shifts, and the hundred vessels are diseased. This is Bǎi Hé [disease]. Its symptoms present with disturbance to sleep and appetite, the occurrence of diarrhea and vomiting, difficulty differentiating between cold and heat, disquietude whether sitting or laying down, a bitter taste in the mouth, red urination, heart vexation, and a confused state of mind, with an inability to point to any specific channel or visceral disease. Now, the qi of the hundred vessels is received in the lungs, as the lungs are the ancestor of the hundred vessels. Thus, it is appropriate for the lungs to be clear. Following the promotion of sweat, the fluids [may be] desiccated and metal burned. Bǎi Hé clears the lungs and generates fluids. Zhī Mǔ cools metal and drains heat.

滑石代赭湯,百合七枚,滑石三兩,碎,代赭石如雞子大。治百合病,下之後者。下敗中脘之陽,土濕胃逆,肺熱鬱蒸。百合清肺而瀉熱,滑石、代赭,滲濕而降逆也。

Huá Shí Dài Zhě Tāng

Bǎi Hé 7 pieces
Huá Shí 3 liǎng (broken)
Dài Zhě Shí (a pellet sized piece)

Treats Bǎi Hé disease following purgation. Purgation damages the yang of the central stomach duct, [resulting in] earth-damp counterflow [of the] stomach and depressed steaming lung heat. Bǎi Hé clears the lungs and drains heat; Huá Shí and Dài Zhě percolate dampness and downbear counterflow.

百合雞子湯,百合七枚,煎湯,入雞子黃一枚,攪勻,煎。治百合病,吐之後者。吐傷肺胃之津,金土俱燥。百合清肺熱而生津,雞子黃補脾精而潤燥也。

Bǎi Hé Jī Zǐ Tāng

Bǎi Hé 7 pieces
Boil the decoction and add one egg yolk, blend until smooth, and boil. Treats Bǎi Hé disease following vomiting. Vomiting damages the fluids of the lungs and stomach, resulting in the dryness of both metal and earth. Bǎi Hé clears the lungs and generates fluids. Jī Zǐ Huáng [egg yolk] supplements spleen essence and moistens dryness.

百合地黃湯,百合七枚,生地黃汁一斤。入百合湯,煎服。大便當如漆。治百合病,不經發汗吐下,病形如初者。不經發汗吐下,而瘀熱淫蒸,敗濁未泄。百合清肺而瀉熱c生地黃汁涼瀉腸胃而下垢濁也。

Bǎi Hé Dì Huáng Tāng

Bǎi Hé 7 pieces
Shēng Dì Huáng juice 1 jīn [listed as 1 shēng in the Jīn Guì Yào Lüè]
Add to Bǎi Hé decoction, boil and take. The stools should be like lacquer. Treats Bǎi Hé disease when neither sweating, vomiting or purgation have been used, and the disease appears as in the beginning. [Here] sweating, vomiting or purging have not been used and there is excess steaming of stasis heat [as well as] turbidity [which] has not been drained. Bǎi Hé clears the lungs and drains heat, while the juice of Shēng Dì cools and drains the stomach-intestines, and purges foul turbidity.

百合洗方,百合一斤。水一斗,漬一宿,洗身。洗後食煮餅,勿以鹽。治百合病,一月不解,變成渴者。火炎金燥,則肺熱不解,變而為渴。肺主皮毛,百合洗皮毛,以清肺熱也。

Bǎi Hé Xǐ Fāng [Lily bulb wash]

Bǎi Hé 1 jīn [listed as 1 shēng in the Jīn Guì Yào Lüè]
Use 1 dǒu of water and soak overnight. Use [the liquid] to bathe the body. After bathing, eat boiled cake, and avoid salt. Treats Bǎi Hé disease, which has not resolved within a month, and has resulted in thirst. [Here] fire flares and dries metal, resulting in lung heat which fails to resolve, leading to thirst. The lungs govern the skin and hair, and the Bǎi Hé is used to wash the skin and hair, thereby clearing lung heat.

百合滑石散,百合一兩,滑石二兩。為散,飲服方寸匕,日三服。微利,止服,熱則除。治百合病,變發熱者。濕動胃逆,肺郁生熱。百合清金而瀉熱,滑石利水而除濕也。

Bǎi Hé Huá Shí Sǎn

Bǎi Hé 1 liǎng
Huá Shí 2 liǎng [listed as 3 liǎng in the Jīn Guì Yào Lüè]
Powder [the ingredients], and take a square-inch spoonful in liquid, three times per day. When there is slight diarrhea, stop taking, as [this indicates that] heat has been eliminated. Treats Bǎi Hé disease, which has transmitted into heat effusion. [When] dampness is stirred, the stomach runs counterflow, resulting in lung depression that generates heat. Bǎi Hé clears metal and drains heat; Huá Shí disinhibits water and eliminates dampness.

百合涼金潤燥,瀉熱消郁,清肅氣分之上品。其諸主治,收涕淚,止悲傷,開喉痹,通肺癰,清肺熱,療吐血,利小便,滑大腸,調耳聾耳痛,理脅癰乳癰、發背諸瘡。
水漬一宿,白沫出,去其水,更以泉水煎湯用。

Bǎi Hé is a superior medicinal, which cools metal, moistens dryness, drains heat, disperses depression, and depurates the qi layer. It’s various treatments include stopping tearing, stopping sadness, opening throat impediment, disinhibiting welling-abscess of the lung, clearing lung heat, treating vomiting of blood, disinhibiting urination, lubricating the large intestine, controlling deafness and ear pain, rectifying subcostal and breast welling-abscesses, and effusing the back of various sores. Steep Bǎi Hé in water overnight. [When] white foam appears, discard the water, and then decoct with spring water and use.

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Huáng Huáng’s Use of Guì Zhī Fú Líng Wán in Respiratory Conditions

Cinnamon Twig and Poria Pill (guì zhī fú líng wán)

Indications: Bronchial asthma, chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, pleurisy, pleural effusion, interstitial pneumonia, pulmonary fibrosis, and recurrent pulmonary infections typically manifesting with a dark-red complexion, a stifling sensation and pain in the chest, purple lips and a dark tongue. This formula has a blood invigorating, stasis transforming effect, which can improve the blood supply of the heart and lungs.

Usage & Modifications:

1. Patients for whom this formula is suitable tend to have a red or purple-red complexion, abdominal fullness, resistance to pressure in the lower left abdomen with possible tenderness, headaches, dizziness, insomnia, irritability, restlessness, stirring palpitations, and a dark tongue body with possible purple spots.

2. For patients that experience diarrhea after taking the formula, have them take in after meals or decrease the dosage.

3. Use with caution in pregnancy.

4. Modifications:

  • If there is a stifling sensation and pain in the chest, a chronic cough, and a wan and sallow complexion, add Angelicae sinensis Radix (dāng guī) 15g, Chuanxiong Rhizoma (chuān xiōng) 15g, and Salviae miltiorrhizae Radix (dān shēn) 15g
  • If there is a stifling sensation in the chest, abdominal distention, and an oily complexion, add Citri reticulatae Pericarpium (chén pí) 20g, Aurantii Fructus (zhǐ ké) 20g, and Zingiberis Rhizoma recens (shēng jiāng) 20g
  • If there is a stifling sensation in the chest  and constipation, add Aurantii Fructus (zhǐ ké) 20g, Allii macrostemi Bulbus (xiè bái) 20g, and Trichosanthis Fructus (quán guā lóu) 30g.

Representative Case History:

Yu, 74-year-old male, 160cm/70kg.

Initial consultation on June 5, 2018

Chief complaint: Recurrent cough and wheezing for 9 years, with dyspnea, an inability to climb stairs quickly, and abdominal distention following meals.

History: In April 2018 during a hospital visit, he was diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD), arrhythmia, atrial fibrillation, cardiac insufficiency, heart valve disease, and a fatty liver.

Signs: average build, dark, red and oily complexion, obvious bags under the eyes, purple-dark lips and tongue, stasis marks under the tongue, abdominal fullness, and resistance to pressure in the lower costal arch (flanks).

Prescription: Cinnamomi Ramulus (guì zhī) 10g, Cinnamomi Cortex (ròu guì) 10g, Poria (fú líng) 20g, Paeoniae Radix rubra (chì sháo) 20g, Moutan Cortex (mǔ dān pí) 15g, Persicae Semen (táo rén) 15g, Angelicae sinensis Radix (dāng guī) 15g, Chuanxiong Rhizoma (chuān xiōng) 15g, Salviae miltiorrhizae Radix (dān shēn) 15g, Aurantii Fructus (zhǐ ké) 30g, Citri reticulatae Pericarpium (chén pí) 30g, Zingiberis Rhizoma (gān jiāng) 10g; 15 packets.

Second consultation on June 25, 2018: After taking the herbs, his breathing was smooth and easy, however cough and wheezing were still present, but he was still able to play mah-jong. The same formula was continued.

Third consultation on August 20, 2018: No labored breathing when walking and he was able to climb 3 floors. The stasis marks under his tongue had improved.

Huáng Yuán-Yù (黄元御) on the importance of center earth in physiological regulation

The following is a collection of notes gathered for research on a course I am developing on center earth physiology and pathology. This is a large subject, and therefore the following information is far from complete, but is merely presented here to provide a glimpse into this important concept of proper physiological movement and dynamics. 

In the majority of Huáng’s books, great importance is laid on proper physiological movement throughout the body. Huáng’s interpretations of formulas and disease mechanisms are usually described through the lens of the proper or faulty movement and breakdown of this dynamic. The basic tenet of this medicine is based on proper movement and interaction of yin and yang, and when describing physiology or pathology, the terms Shùn (顺) translated as ‘normal’, ‘favourable’ or ‘to follow the course of’, and Nì (逆), typically translated as ‘counterflow’ are used. In very simple terms, when the body is running in ‘Shùn’, all physical processes are in harmony, running along their proper course, resulting in a state of health. When ‘Nì’ occurs and the natural movement or order of things are running against their proper course, physiological processes start to break down, resulting in dis-ease. 

As can be seen from the image below, proper healthy movement in the entire human organism is dependant on this specific circular dynamic. Elucidation on this concept is not mentioned in many literary works, with the exception of Qing Dynasty scholar/physician Péng Zǐ-Yì’s (彭子益), Circular Movements in Ancient Chinese Medicine (圆运动的古中医学), a text primarily focused on these circular movements. 

Physiological Implications

The following commentary is essentially a translation of Huáng’s original chart, with a few extra tidbits added from some of his other works. 

“When ascending and descending are balanced, and yin and yang interact, this is referred to as center qi.”

Center Qi debilitation results in an obstruction to ascent and descent. 

Foot Taiyin Spleen governs ascent on the left – Foot Yangming Stomach governs descent on the right. 

When Kidney water is too cold, this results in diseases of the Essence. 

When the stomach fails to descend, the heart is unable to descend as well leading to excessive cold of kidney water due to lack of fire. 

Heart fire flaring results in diseases of the Shen. 

When the spleen fails to ascend, both the liver and kidneys are unable to ascend. When water fails to ascend, fire flares. 

** Proper movement of center qi ensures a good balance between water and fire. 

When liver wood is depressed, this results in blood diseases. 

When the spleen fails to ascend, wood is depressed. Because the liver stores blood, when wood is depressed, this results in blood disease. 

When the lungs are obstructed on the right, this results in qi diseases. 

When the stomach fails to descend, the lungs are also unable to descend. Because the lungs store the qi, obstructed metal leads to qi disease. 

Spleen dampness is the result of center qi non-transformation resulting in a failure to ascend or descend. This leads to the improper movement of both the clear yang and turbid yin. Another possibility is a yang deficiency in the body which leads to the earth being unable to descend. As a result dampness forms.

[Upper] – Lung-Metal and Heart-Fire —> descend through stomach-earth —> When stomach earth fails to descend, this leads to counterflow ascent of both metal and fire. 

[Lower] – Liver-Wood and Kidney-Water —> ascend through spleen-earth —> When the earth is weak or center earth yang is deficient this leads to earth dampness with a failure to ascend, and thus both wood and water sink. 

Huáng Yuán-Yù on Wú Zhū Yú Tāng

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

Cold Damage’s Wú Zhū Yú Tāng

Wú Zhū Yú (吳茱萸) 1 shēng

Rén Shēn (人蔘) 3 liǎng

Shēng Jiāng (生薑) 6 liǎng

Dà Zǎo (大棗) 12 pieces

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

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

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

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

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