經方學

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That little side trip to Taiwan ate up all my attention there for a while. As promised, here are a few pages from the Extraordinary Views of the Abdomen. Not only that, but there is a bit of discussion from a doctor friend in Beijing that I hope you will find interesting. As ever, please leave your comments or questions in the comments section.

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Major Bupleurum Decoction (dà chái hú täng)

This is a drawing of the dà chái hú täng presentation. It indicates the presence of chest and hypochondriac fullness, epigastric urgency with muscle spasms, and when palpated deeply the abdominal tissue has a feeling of strength.
Additionally, there could be hard lumps that influence the ability to breath as the upper abdomen has clumping with a slight feeling of fullness; there can also be abdominal pain. If only one side of the hypochondria or the epigastrium is painful, if there is pain in the area around the navel, or if there is an indistinct and unfixed feeling of distention and pain, these also can be seen as part of the presentation.

This formula is Minor Bupleurum Decoction (xiâo chái hú täng) with the Ginseng Radix (rén shën) and Glycyrrhizae Radix (gän câo) removed, and the additions of Paeoniae Radix alba (bái sháo), Aurantii Fructus immaturus (zhî shí), Rhei Radix et Rhizoma (dà huáng) and a double dose of Zingiberis Rhizoma (gän jiäng).
It is used to treat patient’s those abdomen is large; they are referred to as dà chái hú types.

In this formula the meaning of epigastric urgency is that there is focal distention and hardness in the epigastrium, which is the result of a process of gradual internal accumulation that over time becomes an interior excess condition. Both fluids and qi stagnate outside of the Stomach, leading to continual vomiting. Thus, Bupleuri Radix (chái hú), Pinelliae Rhizoma preparatum (zhì bàn xià), Scutellariae Radix (huáng qín) and Jujubae Fructus (dà zâo) are used. Paeoniae Radix alba (bái sháo) is used to treat the fullness, pain and urgency aspects of the presentation. Additionally, Aurantii Fructus immaturus (zhî shí) and Rhei Radix et Rhizoma (dà huáng) are added to treat what is between the interior and exterior (枳實，大黃可及於內外 zhî shí dà huáng kê jí yú nèi wài).

This phrase: 枳實，大黃可及於內外 zhî shí dà huáng kê jí yú nèi wài, is interesting in that it indirectly refers to the shào yáng as the space between. In discussions with a friend, who teaches at the Beijing TCM University and has an incurable taste for the classics, she brought forth this gem; “the illness is in the shào yáng which means it is half interior and half exterior, at the same time it has already entered into the organ level of the yáng míng. So using Minor Bupleurum Decoction (xiâo chái hú täng) addresses shào yáng illness, while the two additional herbs treat the yáng míng.

The Classics state: tài yáng illness that for 10 days, the patient was erroneously purged for two or three days. In the four to five days afterward a xiâo chái hú täng presentation persists; first use Minor Bupleurum Decoction (xiâo chái hú täng) to treat it.

Commentary: As the illness has already passed from the tài yáng level [to the shào yáng], the patient has been ill for 12 days without any further changes in their condition. After being ill for a long time, following and treating according to the presentation is what masters the problem. In this case the patient was erroneously given purgative medicinals. After one course results were not seen so a second and third course were given which caused diarrhea. Four to five days after this mistaken treatment there was still a xiâo chái hú täng presentation. One does not have to be a stickler for the number of days a patient has been ill, it is enough prescribe the herbs based on the observing the manifestations of the xiâo chái hú täng presentation.

Ceaseless vomiting with tightness and pressure pain sensitivity in the epigastrium, a sense of constraint with slight irritability, [the illness has] not yet resolved. Giving Major Bupleurum Decoction (dà chái hú täng) to purge it can bring about the cure.

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When there is just vomiting and tightness in the chest, it is appropriate to continue using Minor Bupleurum Decoction (xiâo chái hú täng). When there is irritability that then turns into a feeling of constraint with irritability Minor Bupleurum Decoction (xiâo chái hú täng) will not be able to resolve it. This kind of tightness in the epigastrium with pressure pain sensitivity accompanied by feeling of constraint with irritability is indicative of a condition of internal accumulation. If it is not purged, it will be difficult to cure.

As there continues to be ceaseless vomiting, this cannot be said to be an Order the Qi Decoction (chéng qì täng) condition, but rather it falls within the scope of the bupleurum formula family. Therefore adding Aurantii Fructus immaturus (zhî shí) and Rhei Radix et Rhizoma (dà huáng) to Minor Bupleurum Decoction (xiâo chái hú täng) to purge [address the yáng míng aspect of the presentation] will bring about the cure. Additionally, to treat the vomiting, the amount of Zingiberis Rhizoma recens (shëng jiäng) is increased. As previously mentioned, vomiting and irritability are seen as being part of the Minor Bupleurum Decoction presentation.

In the line from the Discussion of Cold Damage that describes the use of Major Bupleurum Decoction (dà chái hú täng) it uses the word “can treat” (與 yù), it does not use the commonly seen phrase “masters it” (主之 zhû zhï), should [this formula not work] and there is condition of genuine internal excess, then the appropriate treatment is with a prescription from the Order the Qi (chéng qì) family. However, as this is slow moving kind of tài yáng illness, it cannot be impatiently treated as a yáng míng illness with aggressive medicinals where purging will immediately about the cure. Adding a little Aurantii Fructus immaturus (zhî shí) and Rhei Radix et Rhizoma (dà huáng) to gently drain will cure the problem. As it says in the original text, one should know if Stomach presentation is excessive or not, otherwise purging is of no benefit.

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Andy Ellis is one of the significant contributors to our field. He is the co-author of The Fundamentals of Chinese Acupuncture, Fundamentals of Chinese Medicine, and Grasping the Wind. Author of Notes from South Mountain, and part of the team that has given us the latest edition of Eastland Press’s Formulas and Strategies. He is the founder of Springwind Herb Company; not only does he find time to teach and practice, but he manages to mix it up on a basketball court several times a week as well.

While our paths often cross in Taipei, this time we had to catch up on online.

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How did you manage to find your way to Taiwan in the 80’s, and what was your motivation at the time?

I first went to Taiwan in 1983 to further my studies in acupuncture. I had studied with Dr. So at the New England School of Acupuncture for a year or so and then Dr. So got ill. I wanted to learn the real thing and since China was not accessible at that time I opted for Taiwan. At that time I had no intention to study herbs but when I got to Taiwan I realized that Chinese medicine there was largely herbal. There were, and still are, herb shops in every neighborhood.

You have spent time both in Taiwan and Mainland China. How would you say the medicine traditions differ between these two places?

It is hard to characterize an entire population. There are many traditions in Taiwan and many in Mainland China. In herbal practice there has been a great influence by Japan in Taiwan. The most obvious one being the use of concentrated granules. Like the Japanese, Taiwanese doctors emphasize formulas from the Discussion of Cold Damage (傷寒論 Shang Han Lun) and the Restoration of Health from the Myriad Diseases (萬病回春 Wan Bing Hui Chun). In modern mainland China the Restoration of Health from the Myriad Diseases is largely ignored. The Cultural Revolution, which had a large influence on China also influenced the medicine. Much of the spiritual nature was removed and a more dialectical approach was substituted for primarily political reasons. That is not to say that there were not many wonderful schools of thought that survived this purging but it was definitely an influence and can be seen in the modern writings.

Both Taiwan and China seem to feel a need to have their medicine be taken seriously by the West. They have taken slightly different approaches to gaining this approval. That is a long topic perhaps for another discussion.

Dr. Shi was a real influence for you. What about your time with him informs the way you approach medicine today?

Dr. Shi was the kind of doctor that I had hoped I would find in China. His unending patience and kind manner set an example that my better self recognized immediately. His approach to the medicine was not dogmatic and he felt truly that he was the fortunate recipient of a tradition that dated back to the early Han. Anyone who spent time with him gleaned immediately that he felt privileged to be able to help others with the information and tradition that had been handed down to him. I can only hope to emulate his manner and the unending study he engaged in order to help his patients.

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Andy’s book about Dr. Shi, not only is part of his contribution to us in the West, but also passes along some of the essence of Dr. Shi’s experience, learning and teaching. You can download THIS pdf file that contains a few pages from the book; it gives  a glimpse into the mind of Dr. Shi. Andy is making the book available at a 10% discount to the readers of classicformulas.com.

Click HERE to go directly to the Springwind site, at the checkout page simply enter classicformulas in the coupon space. This book not only gives great clinical tips, it also gives you a taste of how a gentleman/doctor thinks and works. We don’t have many books like this.

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It may not be a trip to China, but it is an opportunity
to engage the mind of a true doctor of the art!

One of the great things about hanging out with experienced doctors, especially guys like Chang Bu-Tao, is that you get to see how a tuned and savvy doc works. Doc Chang’s ample waiting room empties and refills like a Zen bamboo water pipe; seeing 200 patients in a day is not uncommon. He is one of the senior docs in Taipei city with over 20 books to his name, students from down the street and across the world, and a reputation that drifted far, far out from his fourth floor clinic just south of Peace and Harmony East Road.

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Like all experienced doctors, he has this ways of using the classic formulas in ways that don’t quite match the first glanced at list of actions and functions in our formula books. This is a darned good reason to read the Discussion of Cold Damage (傷寒論 Shäng hán lùn) and the works of various authors who have gone deep into that tradition.

Dr. Chang has his own way of thinking about Formula Families, and sees Puerariae Radix (gé gën) as being a family of its own. Here are a couple gems from his book that explains Shang Han Lun formulas.

Treatment of spasms:
Because Puerariae Radix (gé gën) functions to control tremors, when used together with Paeoniae Radix alba (bái sháo), Jujubae Fructus (dà zâo), and Glycyrrhizae Radix (gän câo) its ability to relief spasms is even more pronounced. As written in the Yellow Emperor’s Inner Classic “sour astringes, bitter dries dampness, sweetness relaxes tightness…,” [thus we understand how] Glycyrrhizae Radix (gän câo), Jujubae Fructus (dà zâo), and Paeoniae Radix alba (bái sháo) have the effect of softening and relaxing tightness. For tightness and pain in the head, shoulders and neck, and especially for numbness due to problems with the facial nerves use of Puerariae Radix (gé gën) with peony, dates and licorice works rapidly to relax these symptoms and improve the patients condition.

Treatment of allergic rhinitis:
Kudzu Decoction (gé gën täng) can be used to good effect in the treatment of allergic rhinitis and sinus infections. Taiwan has the typical climate of an island, as it is surrounded by ocean it is usually quite humid; especially so in March when it is still bothersomely on the cool side and frequently drizzles. Due to these environmental factors there is an increase in the instances of the common cold and allergic rhinitis. Western medicine commonly uses antihistamines to treat allergic rhinitis. Although it is effective, drowsiness is one of the side effects.

I remember one year during the Chinese New Year going on a group tour to New Zealand. At that time the tour leader experienced a flare up of allergic rhinitis and was quite uncomfortable. One of the members of the tour happened to have some antihistamines, which he gave to the tour leader. This resulted in our leader constantly dozing off wherever we went. If these drugs were taken before driving, it was difficult to avoid nodding off while driving, which was quite a danger to the safety of all involved.

For nasal allergies due to climatic factors, I use Kudzu Decoction (gé gën täng) as the primary formula, and add the anti-allergy medicinals Schizonepetae Herba (jïng jiè), Saposhnikoviae Radix (fáng fëng), Cicadae Periostracum (chán tuì) and Coicis Semen (yì yî rén); the clinical effect is quite good. Should the patient also have itchy eyes, then add Equiseti hiemalis Herba (mù zéi) as well.

Treatment of sties:
Sties are a type of ophthalmologic disease. Because people these days often eat rich, fried or roasted foods and as they rely on the computer and spend long hours staring at the screen, visual acuity diminishes and there are pathological changes to the tissue of the eyes. Sties are one result of these changes.

Western medicine uses surgical procedures to treat this problem. We Chinese doctors, however, use the thought process found in the Yellow Emperor’s Inner Classic to differential illness. In the Inner Classic we find that the blood vessels that go from above to below are considered to belong to the tài yáng meridian. Those which go from below to above belong to the yáng míng meridian, and those that radiate sideways are associated with illnesses of the shào yáng meridian. In line with these relationships we select a formula representative of the yáng míng meridian; Kudzu Decoction (gé gën täng). Which is then modified with ophthalmologic medicinals such as Celosiae Semen (qïng xiäng zî), Cassiae Semen (jué míng zî), Leonuri Fructus (chöng wèi zî), and Plantaginis Semen (chë qián zî). It is quite good for treating sties!