經方學

A year ago when I moved to St. Louis to take over a friend’s practice I had a suspicion that the Midwest was hungry for Chinese medicine. I figured it would be a place where I could make a significant contribution to a community that was sorely lacking in the kind of medicine that we have to offer.

What I did not expect is that the practice would grow as quickly as it has. And so I am seeking an associate to join the clinic here in St. Louis, MO.

Yong Kang Chinese Medicine Clinic is located in the delightful and accessible neighborhood of Kirkwood. We draw patients from both St. Louis city and county, as well as from southern Illinois.

St Louis offers a low cost of living, access to the arts, spectacularly vivid weather, an increasingly diverse community, some nice restaurants and the City Museum. It also is in a region that up till recently has not been exactly open to acupuncture.

That, however, has changed and Chinese medicine is rapidly becoming THE alternative treatment of choice.

Do you want to build a practice, and built it fast? Do you like the idea of a cash-only business? Does it sound appealing to practice in a community that is very supportive of new practitioners? Would you like to see patients with difficult and challenging health concerns? Do you happen to have a weak spot for frozen custard? Then this opportunity just might be for you.

Interested? Visit the clinic website to get a taste for what we have going on here. Like what you see?
Follow up with an email.

The American Midwest is desperately in need of more Chinese medicine practitioners.
You can make a difference here!

Brain damage from traffic accident

An excerpt from Deciphering the Shang Han Lun, by Chang Bu-Tao (張步桃)

A Mr. Li had a motorcycle accident and was taken to the emergency room and then into surgery. After surgery he was taken to the intensive care unit for observation. His older sister was one of my students, she come to the clinic, told me about his condition and asked me to write a prescription for him.

I used Bupleurum plus Dragon Bone and Oyster Shell Decoction (chái hú jiä lóng gû mû lì täng) with the additions of Salviae miltiorrhizae Radix (dän shën), Nelumbinis Folium (hé yè) and Notoginseng Radix (sän qï) to invigorate the blood and transform stasis. Additionally, Acori tatarinowii Rhizoma (shí chäng pû) and Polygalae Radix (yuân zhì) were added to open the orifices and awaken the brain. After being administered the herbs, the very same day he revived and awoke. Furthermore, could use his fingers to rub his nose; this provided endless surprise to the rehabilitation doctors.

Afterwards, acupuncture was also used and Mr. Li patiently continued to take herbs. As of this writing there are no signs of him having been in a serious accident.

*******************************

As students of Chinese medicine we spend countless hours memorizing an endless parade of signs and symptoms that should lead us to selecting an effective formula. Our exams have questions that must be answered correctly, our teachers have expectations for us learning the fundamentals, which will make us safe for public consumption. In an effort to orient ourselves in the Chinese medicine universe we litanize pulses, tongues and indications. It is all a necessary process, and it prepares us for the confusing constellation of patterns and presentations of our patients that come to us for help.

Study prepares us to think with a different kind of pattern language. It gives us a method of inquiry and a set of lenses with which to view the balance of illness and wellness. But, how do we get from the textbook descriptions of Bupleurum with Dragon Bone and Oyster Shell to treating brain damage due to trauma. In a word; experience.

This is one of the reasons why Chinese medicine bookstores in Asia have an abundance of case studies books. Case studies can act as a catalyst that furthers our development as doctors. They help us to navigate between knowing and discovering,  as they force us to open up our thinking.

About this project
Walk into any reasonably sized bookstore in China and you will find shelves full of the experience of Chinese medicine doctors. Case studies are the bones and blood of furthering one’s skill as a doctor. We all gain a foundation, a skeletal structure from our textbooks and first years in medical school. But it is the actual application, the use and practice of medicine that allows us to distill meaning from our experience.

Here in the West we have plenty of books that teach us how-to, books that are rich in theory and heavy with fundamentals; we all need a foundation from which to work. But to really understand how medicine unfolds in the clinic, how to engage the conversation between patient and practitioner, connect the dots between symptom and treatment, and navigate between knowing and discovering, it is within the case study literature where we really see medicine come alive.

Chinese medicine is both vast and deep. This book seeks to bring into focus one aspect: the use of the classic formulas of the Shang Han Lun and Jin Gui Yao Lue in modern practice.

Why the focus on classic formulas?
There is not just one way to read the Shang Han Lun; its 398 lines have multiple interpretations and there is a plethora of ways to apply its methods. Formulas that were used 1,800 years ago for a single purpose now have multiple applications in modern life. Just as a single substitution or changing the amount of one herb can profoundly change the function of a formula, so too does clinical perspective have a deep impact on how prescriptions are chosen and modified.

Through the window of case studies, this book seeks to allow the reader a glimpse into the contributor’s clinical reasoning, to throw light on how they gather information and distill its meaning, and to share their perspective on how the lines of the Shang Han Lun and Jin Gui can be applied to understanding the use of these ancient formulas in the modern clinic.

.

Who will be contributing?
This is not just a look at how the jing fang are used in the West. Invitations to contribute will be distributed to China, Taiwan, Japan, Singapore, Europe, Australia and New Zealand, and other countries where there are stories of innovative use of the classic formulas.

.

The goal is to improve our clinical results
We are not looking to prove the classic formulas are effective, or that Chinese medicine is useful. We already know that from our clinical work. This book, which unfolds the practice of medicine via case study, gives us a glimpse into the mind and clinical reasoning of the seasoned practitioner. It will help us to understand how to sort out what is important, as it maps out a method of inquiry and intervention. The classics have given us a common set of prescriptions, but the ways in which they are clinically applied in modern practice are as unique and varied as the practitioners themselves.

This is an invitation to contribute to a work that will give the reader a diamond-faceted look at the clinical application of the classic formulas, an opportunity to contribute a more multi-dimensional view of those formulas in modern clinical use. As well, it is an opportunity to add to the discussion that has been going on for 1800 years now about how to help our patients with these often simple, but effective formulas.

.

Would you like to join us?
If you would like to submit a case study for review and inclusion, please write and let us know of your interest. You will be sent a submission package that details format, writer’s guidelines, timetables and other pertinent information.

Rules of thumb are useful. Being able discern a constitutional type is a broad brushstroke rule of thumb. We can effectively condense experience, and it is often a shortcut to where we are headed. Except for when it is not.

I was working through the diagnosis on a young woman recently and thought I had immediately and accurately slotted her in the gui zhi tribe. She had the fine white skin, sweating, floating pulse and slender build of a cinnamon girl. However, tossing out the usual defining question for this type brought an unexpected response.

“Do you have a sensitivity to drafts?”

The unexpected reply of “what do you mean?” completely threw me.

***********************

Gui zhi types pretty much always answer with an emphatic YES!
Those who do not understand the question are generally not of this constitution. Those with this kind of wei qi deficiency usually are quite aware of any nearby draft; even if it is just a slightly cracked window two rooms away. I’ve taken “what does that mean?” as a rule of thumb to mean they are not this type.

As with any shorthand or rule of thumb, there are those who to whom it does not apply. I could not figure out how she could not be sensitive to wind as she had that pale sweat moisturized skin, and a lack of heat signs.

A different tack was called for, and the question of “do you get cold easily?” brought it all back into focus. “Yes, I get cold because the drafts evaporate my sweat and makes me chilled. It really bothers me.” So there you have it, sensitivity to wind. But, she was focusing on the sweating and it did not occur to her that she was sensitive to wind. It was the fault of the sweat. Still, a gui zhi girl in my book. And moreover a reminder that clever bits of shorthand are just that; a way of compressing and abbreviating experience. Definitely useful, but not to be confused with the patient’s reality!

Focal distention, golmus, pi, call it what you will, the name is not nearly as important as the illness process that it describes. This is one of those concepts upon which there is a wealth of thought and disagreement. Some say it is a sensation the patient has, others say it is the doctor that feels it through palpation. Some doctors differentiate the pathomechanism very carefully, while others simply say it is discomfort in the stomach area, and leave it at that.

Chen Yi-Ren, who was a rather renown Shang Han Lun doctor from Nanjing has quite a bit to say about focal distention. A future posting will contain a detailed translation of his thoughts on this matter. For now, here is a translation of a brief synopsis that written by one of his students.

________________________________________________________________________

Focal distention is an illness presentation where there is an uncomfortable feeling of fullness and distention in the epigastrium. It occurs due to obstruction and stagnation of the Stomach qi. There are many reasons for this; it can be due to:

• Stomach heat
• cold in the middle
• deficiency of the middle with knotted heat
• deficiency of the middle with fluid obstruction
• water accumulation leading to qi stagnation.

These conditions require analysis from a holistic perspective, in this way the correct patho-mechanism can found and proper treatment given.

Heat focal distention is due to Stomach heat leading to qi stagnation; it is treated by using Rhubarb and Coptis to Drain the Epigastrium Decoction (dà huáng huáng lián xiè xïn täng)
Fx: Rhei Radix et Rhizoma (dà huáng), Coptidis Rhizoma (huáng lián), Scutellariae Radix (huáng qín)
Deficiency cold in the middle congeals the qi and causes stagnation, leading to a deficient cold presentation of focal distention; it is treated using Regulate the Middle Decoction (lî zhöng täng)
Fx: Ginseng Radix (rén shën), Zingiberis Rhizoma (gän jiäng), Atractylodis macrocephalae Rhizoma (bái zhú) and Glycyrrhizae Radix (gän câo)

As for the presentations of the three Drain the Epigastrium Decoctions (xiè xïn täng) based on Pinelliae Rhizoma preparatum (zhì bàn xià), Glycyrrhizae Radix (gän câo), and Zingiberis Rhizoma recens (shëng jiäng), these are for presentations of heat focal distention with other concurrent complications.
Chen Yi-Ren summarized this patho-mechanism as

“deficiency of the middle with heat that knots, thus forming focal distention.”

This is treated by the use of bitter and cold to drain heat, acrid and warm to open knotting, along with sweet and warm to tonify the middle. The three Drain the Epigastrium Decoctions (xiè xïn täng)

Fx: Pinelliae Rhizoma preparatum (zhì bàn xià), Zingiberis Rhizoma (gän jiäng), Coptidis Rhizoma (huáng lián), Scutellariae Radix (huáng qín), Ginseng Radix (rén shën), Glycyrrhizae Radix (gän câo) and Jujubae Fructus (dà zâo)

are actually formed from combining Rhubarb and Coptis to Drain the Epigastrium Decoction (dà huáng huáng lián xiè xïn täng) and Regulate the Middle Decoction (lî zhöng täng) along with minor modifications. As to the rational for removing Rhei Radix et Rhizoma (dà huáng), naturally this is related to the diarrhea from the focal distention’s jumble of cold and heat. As to the removal of Atractylodis macrocephalae Rhizoma (bái zhú) and substitution of Pinelliae Rhizoma preparatum (zhì bàn xià) and Zingiberis Rhizoma recens (shëng jiäng) these are accord with Zhong-Jing’s basic modification methods; as from this line concerning Regulate the Middle Pill (lî zhöng wán)

“For those with frequent vomiting, remove the Atractylodis macrocephalae Rhizoma (bái zhú) and add three liang of Zingiberis Rhizoma recens (shëng jiäng).”

Also the line from Seven-Substance Decoction with Magnolia Bark (hòu pò qï wù täng) states, “For those who vomit, add five he of Zingiberis Rhizoma recens (shëng jiäng).” Methods of decoction and administration are important aspects in the process of treating by differential diagnosis. The decoction and administration methods of the five Drain the Epigastrium Decoctions (xiè xïn täng) each have their own unique clinically valuable characteristics.

As to the diagnosis and treatment of other focal distention presentations, they too need to be examined from a holistic perspective with concrete analysis; there is not just one way of draining the epigastrium.

.

The most exciting phrase to hear in science, the one that heralds the most discoveries, is not “Eureka!”, but “That’s funny…”
~Isaac Asimov

.

We have these kinds of opportunities all the time in our clinical work. The pulse that does not feel quite like any pulse we have felt before. The odd reaction a patient has to a formula. The strange way that an acupuncture point that seems unrelated to a person’s problem, when palpated suddenly unfreezes a stuck joint.

Moments of discovery, more often than not first manifest as a head scratching annoyance. If we are quick enough and can turn it to curiosity, we have the opportunity to learn something new.

.

One of our astute readers pointed out some discrepancies between the description of the astragalus constitution as it is written in The 10 Key Formula Families, and how it was presented in one of Huang’s recent lectures. This prompted a little email discussion with him about how his thinking has changed since the original publishing of the book in Chinese nearly 15 years ago.

As we all know, the more clinical experience we have, the more refined our ability to differentiate and treat disease.

What follows is Huang’s current thinking about the astragalus constitution.

*******************************************************

.

.

Q: How does one differentiate the Astragali Radix (huáng qí) constitution?
A: From the following five aspects, one can differentiate and understand the astragalus constitution.

1. Physical appearance and build: the physique of these people tends toward being overweight, however their muscles are flabby; while the skin lacks elasticity it also however is relatively moist. These people’s abdomen is soft, the abdominal muscles are weak and there is an accumulation of flesh and fat, and the navel is sunken. When palpated there is no feeling of resistance, nor is there a feeling of pain or distention on the part of the patient. This is called the “astragalus belly.” The tongue body for the most part is pale red, or pale and flabby, or purple and dark.

2. Appetite and digestion: These people have a good appetite and can eat a large quantity of food without feeling bloated or pain. Some experience a feeling of abdominal fullness, however more of a soft heavy feeling than one of distention. Taking large amounts of Astragali Radix (huáng qí) can control the appetite. The lower legs of these people are often edematous.

3. Daily activity: These people easily feel fatigued and sweat profusely. They are easily dizziness and short of breath, especially when exercising they feel like their ambition is not equal to their ability.

4. Commonly experienced illnesses: These people are inclined toward edema, especially in the feet. Their hands and feet have a tendency to get numb, and are prone to getting infections and ulcerations. They tend toward illnesses such as diabetes, hypertension, arteriosclerosis, coronary heart disease, vertebrobasilar insufficiency, spinal disc herniation, cervical spine disease, bone spurs, adhesive capsulitis, problems due to the sequel of stroke, or obesity.

5. Other factors: the possibility of seeing the astragalus constitution in those who are of advanced age, undergone chronic illness, are fatigued, lack physical exercise, have poor nutrition, or thoughtlessly take large amounts of prescription medication is high.

Q: What kinds of people should be cautious about the use of Astragali Radix (huáng qí)?

A: Astragali Radix (huáng qí) should be used with caution, and large amounts may not be used in prescriptions for those who have white complexions and thin physiques with tight musculature whose throats are often red, swollen and painful, and who have constipation. If this herb is used incorrectly it can result in adverse side effects of abdominal distention and reduction in appetite.

Today we have another guest post from a member of the group that journeyed to Nanjing this past November to study jing fang with Dr. Huang. Bernd Schleifer is a practitioner from Munich who has an active practice, and weak spot for good books on medicine written in Chinese.

*************************************

Reading the Ten Key Formula Families I always tried to create a picture in my mind of how these people might look. Working with Dr. Huang in the hospital was great, because a lot of those pictures really came to life.

As it was written before I was also very impressed by his use of Ephedrae Herba (má huáng) for acne. By seeing those introverted, closed-in Ephedra type acne patients, with their silent voices and reduced expression, the idea of using a warm and acrid herb to open them up was striking to me.

Another very interesting thing for me to see was his view of the Pinellia constitution and his extensive use of Pinelliae Rhizoma preparatum (zhì bàn xià) for different emotional issues. Using Warm the Gallbladder Decoction (wën dân täng) for anxiety disorders or waking up with fright was not new to me. But apart from that my idea of a person with bàn xià issues was more one of a slow reacting, plump or puffy person; more the phlegmy kind of thing, as it is also described in the Ten Key Formula Families book.

To my surprise it was often the funniest and most entertaining people in the clinic that were labeled as Pinellia constitution!

Later on in the lecture Dr. Huang explained that he distinguishes between a bàn xià heat and a bàn xià cold type. In general these are people with round faces and round eyes. However, the cold ones are more dull and slow; while the hot ones are very talkative, have lively quick moving eyes, mood swings and are very expressive with their emotions like actors or other performing artists. Most of them don’t have serious health problems, but loads of strange complaints that they feel in their body. That’s why they are kind of full-time patients, or like Dr. Huang said “those people are always at the hospital”.

Additionally I observed a funny thing in the clinic; it was almost always the bàn xià types who after saying goodbye would came back once or twice, just to ask another question or get reassurance that all of their complaints had been considered within the formula. It might have been their anxiety issues, their muddle-headedness due to the phlegm, or their vast variety of subjective problems that moved them to behave that way.

There is a section in Comparing Formula Presentations: Five Steps to Differential Diagnosis in the Treatment of Cold Damage on formulas, presentation, and illness. Unlike the way Huang writes, the author of this book writes in a condensed, specific fashion and is very clear about where within the six warp the illness is located. The more I read it, the more there appears to be spaces to read between the lines. There are areas compact in meaning, but with pointers to other presentations which when combined together gives a three-dimensional texture to the illness and context in which it is found. Obviously, it is easier to formulate a more effective treatment when the one has a clear idea of what is being treated and the terrain in which it is found.

.

Let’s take a look at how the entry of a very simple little formula, Zingiberis Rhizoma and Aconiti Radix Decoction (gän jiäng fù zî täng), is written and use it to tease apart its associated presentation and illness, along with a read between a few of the lines.

.

Formula: Zingiberis Rhizoma and Aconiti Radix Decoction (gän jiäng zhì fù zî täng) is Frigid Extremities Decoction (sì nì täng) with the Glycyrrhizae Radix (gän câo) removed, however the dosage [of each ingredient] is relatively larger. Note: unprepared Aconiti Radix lateralis (fù zî) is called for.

Presentation: Internal Yin/ Tai Yin Level

Irritability and restlessness with general disquiet. Non-acute Frigid Extremities Decoction (sì nì täng) presentation with relatively severe cold due to deficiency.

Disease:

No vomiting- this condition has no relation to a shao yang presentation.

No thirst- this condition has no relation to a yang ming presentation.

Deep and minute pulse with no significant heat in the body, the body feels cold with reversal cold of the hands and feet- Tai Yin Level

There are no exterior presentations; the irritability is not related to an unresolved exterior presentation. During the day the patient is irritable and unable to sleep, however in the night they calm down.** — This is extreme yin cold irritability, not the deficiency irritability with insomnia that is treated by Gardenia and Prepared Soybean Decoction (zhï zî chî täng).

** Line 61 of the Shang Han Lun:

For irritability and restlessness with inability to sleep during the day, but calm and quiet at night without vomiting or thirst, no exterior presentation, a sinking, faint pulse, and no great fever [in a patient] who has had sweating induced after purging, Ginger and Aconite Accessory Root Decoction Pill (gän jiäng fù zî täng) masters it

Zingiberis Rhizoma (gän jiäng) and Aconiti Radix lateralis (fù zî) warm the middle and eliminate cold. Zingiberis Rhizoma (gän jiäng) leans toward treating cold fluids rebelling upwards; Aconiti Radix lateralis (fù zî) more toward treating tenesmus due to cold fluids. Together these herbs warm above and below, it is an important prescription that warms the middle and eliminates cold.

.

Between the lines:

First looking at the formula, Frigid Extremities Decoction (sì nì täng) is made of three herbs, two that warm the interior and one that harmonizes. Not only is the harmonizer removed, but unprocessed Aconiti Radix lateralis ( fù zî) is called for as well. From this alone we know we are dealing with an internal presentation of severe cold.

Turning to the presentation, all the charts in this book specify which of the six warps are addressed by the formula. More interesting in my mind is that it also differentiates between external and internal yang, and external and internal yin. I see this as a way of helping us to further understand the character of the illness. In the case of Zingiberis Rhizoma and Aconiti Radix Decoction (gän jiäng fù zî täng) we are dealing with a problem at the inner yin aspect of the tai yin warp. What kind of illness is this? Judging from the herbs being used to treat it, it would appear it is an issue having to do with a profound depletion of the yang leading to severe internal cold.

For the sake of comparison let’s take a look at True Warrior Decoction (zhën wû täng). This formula treats illnesses that straddle the exterior yin aspect of the shao yin and interior yin aspect of the tai yin warps. Judging by the herbs that comprise this formula there are going to be issues of cold, pain and fluid metabolism. As there is an aspect of this illness presentation that touches on the shao yin, we can infer that there likely will be issues that relate to the kidney or heart. Indeed, issues of water metabolism are a key True Warrior Decoction (zhën wû täng) issue.

When prescribing herbs and going through the mental gymnastics required to find the right medicinals, it is useful to be able to rule out entire formula families, thereby being able to concentrate our attention on the realm of potentially beneficial herbs. Using the lack of symptoms is helpful here. In this case “no vomiting” and “no thirst” means we can disregard the shao yang and yang ming levels as the disease has no relation or connection those warps. There is something very elegant and clinically useful here, as it gives us a kind of shorthand for understanding a patient’s condition.

The next line describes a “sinking and minute pulse with no significant heat in the body, the body feels cold with reversal cold of the hands and feet” and then classifies this as a tai yin level condition. There are numerous conditions that could show with a sinking and minute pulse. Here it is the reversal cold of the hands and feet along with signs of internal cold that tips it into the tai yin level.

In discussing irritability and restlessness the author is using the vocabulary of context and presentation via the process of comparison. These symptoms can arise from a number of different etiologies. He is very clear that “there are no exterior presentations, so the irritability can not being coming from an unresolved exterior” more interesting is that “during the day the patient is irritable and unable to sleep, however in the night they calm down.” We often think of irritability being due to a condition of excess. Untold doses of Rambling Powder (xiäo yao sän), Frigid Extremities Powder (sì nì sân) and Bupleurum Powder to Dredge the Liver (chái hú shü gän sân) are prescribed for patients with irritability, however in this case not only has the exterior been ruled out, but we also know the illness has no connection with the shao yang warp either. The key here is that the patient is irritable in the day, but calms down at night. But, this is not the calm of contentment and wellbeing; it is they appear of calm due to severe depletion of the yang. During the daytime the patient’s depleted yang receives some assistance from the yang qi of the day. It gives them enough “oomph” to contend with the overwhelming yin cold of their condition, but they are seriously depleted and thus irritable and fussy. At night when the yin qi is ascendant they sink back into quiet and calm. This is a false condition of quiet, as the patient’s yang qi is extremely weak. Really they are more in a stuporous state than one of true calm.

The author goes further here and says that this irritability is one that is due to extreme yin and cold and is not a case of deficiency irritability that would be treated by Gardenia and Prepared Soybean Decoction (zhï zî chî täng). Again, we are seeing how comparison between presentations helps to clarify our clinical gaze. The author assumes the reader has the ability to decode a Gardenia and Prepared Soybean Decoction (zhï zî chî täng) presentation and know what that means. For those of us that think only in zang/fu terms we can be quickly be lead astray. This is not the heat of floating yang due to yin deficiency. It is a yang ming level heat in the stomach and chest that is without constipation. It is heat, but as it is only heat and not accompanied by constipation; it is therefore not considered to be excess.

So, what does the irritability of an extreme yin cold condition look like, other than an inability to sleep during the day? I suspect these patients have a fragility about them. One thing for sure, it will no doubt be a type of irritability that will respond favorably to Aconiti Radix lateralis preparata (zhì fù zî), which is interesting as that is not exactly the first herb most would consider in the treatment of irritability.

Finally there is an explanation about how the dried ginger and aconite treat cold fluids that are rebelling upward, or being forced downward. The tai yin warp is associated with the digestion, and these two herbs target the middle and warm it. Once again the author is emphasizing the involvement of the tai yin warp for this formula’s presentation.

This all may seem like a hall of mirrors, and it is if you don’t have a compass by which to steer. But like any system, the six warp, once you learn to make sense of the landscape, can bring a startling clarity to your clinical work.

One of the first concepts we hear upon walking through the gate of Chinese medicine is that of excess and deficiency (xu虛 & shi實). Deceptively simple at first glance, this is one of the foundations of accurate diagnosis that tends to become more slippery as time goes on and we see patients in the clinic with strange mixes of symptoms. All the practitioners here in Nanjing have at least 10 years of experience, and like anyone seeking mastery,  some of us are still working on refining the basics as a way to sharpen our clinical eye.

Today’s guest post comes from one of the participants of the Nanjing seminar. It gives us a fresh insight into issues of excess and deficiency and the use of Ma Huang.

*****************

.

The single most important thing I learned in the first week of studying with Dr. Huang in Nanjing is his explanation of “shi”and “xu”, most often translated as”excess” and “deficiency”. The usual translation to German is “Fülle” and “Leere”, which literally brought into English is expressed as “fullness” and “emptiness”.

.

Even though we are used to the relational nature of terminology in Chinese medicine, it never was really satisfying when teachers spoke about a Gui Zhi Tang situation as “exterior deficiency”, while at the same time saying that there was no “real deficiency”, but only compared to the Ma Huang Tang situation, which is “exterior excess”. And on the other hand both the Ma Huang Tang and Gui Zhi Tang situations are “excess” in relation to, lets say: Yu Ping Feng San or Gui Zhi Jia Fu Zi tang conditions.

.

Dr. Huang provided us with a new perspective by switching the focus to movement and function. On every level of the body there are doors, which have to open and close in appropriate ways, for example at the exterior of the body, the doors are the pores. If they stuck close (in other words don’t open properly) this is “shi”, if they stuck open (in other words: don’t close properly) this is “xu”. So in a Gui Zhi Tang Situation “Xu” means: the exterior doors are stuck open, and in a Ma Huang Situation “Shi” means: the exterior doors are stuck close.

.

Ma huang is the primary herb used to open glands, which are considered to be one kind of door, like the sweat glands of the skin. Therefore it is used for acne to open the pores which are clogged shut. It can be used as well as to help release eggs of the ovaries, or for insufficient lactation. Whether a formula (like Gegen tang) is appropriate, depends on the constitutional body type and if the formula presentation fits with the disease presentation. Another example of how Dr. Huang uses Ma Huang for problems with glands is Zhen Wu Tang together with Ma Huang Fu Zi Gan Cao Tang and Dang Gui Shao Yao San for hypothyroidism.

.

Furthermore the opening function of Ma Huang is also used for other “closed” types of problems, for example Bi-Syndrome. Dr. Huang even uses it together with Wen Dan Tang for patients with schizophrenia, who are mentally locked in by the use of anti-psychotic drugs.

.

I’m sure that the new perspectives provided by Dr. Huang will allow us to expand the use of herbs and formulas even further.