經方學

We know from the texture of our lives that the Chinese yin/yang theory of opposites attracting and mutually transforming into one another is one of the ways that life grows, unfolds, and transforms. It is somehow comforting to know that moments of despair will in time tranform, and that present frustrations can be the inspiration to questions that lead us to wider view of the world.

But, on a less grand scale, opposites as they are currently constellated can give us deeper insight and understanding into the present situation. Anyone who has studied even a little of the six warp of the Shang Han Lun will easily recognize the da huang presentation of excessive heat that burns the tongue coating into a dry yellow-black, turns the stool into a dry compacted mass, and causes thirst as a rescue signal to replace the fluids that are pouring out as sweat.

Ever stop to think about what is the opposite of this kind of presentation?

It is the presentation for gan jiang! Check it out:

• Vomiting of saliva or phlegm fluid. Clear, thin and odorless stool and urine.

• Abdominal distention and pain, nausea and vomiting, or coughing.

• The mouth is moist and there is a lack of thirst, aversion to cold with a desire for warmth, listless and dispirited.

• Pale or pale red tongue, with a greasy coating; the coating is usually white and greasy, grey-black and greasy, or white and glossy. (This is the ginger tongue)

Notice here that both the da huang and gan jiang presentation include signs of abdominal distention and pain. As is so often the case with Chinese medicine, we can not even begin to consider what herbs to use from a single symptom, the entire gestalt must be considered.

While these two herbs lives pages and pages away from each other in the materia medica, in practice patients with signs of the cinnamon twig and astragulas presentations are often puzzlingly similar.

Both have signs of spontaneous sweating, both have moist skin, and an aversion to wind will dog both types. Likewise, there often are complaints about the limbs with both constitutions.

How to tell them apart?

First, look to the abdomen. Those with a gui zhi constitution will tend to have flat, tight abdomens, while the huang qi clan has a soft belly that can be deeply palpated without discomfort. Both can have pale tongues, but the gui zhi tongue tends to be red and pale, or dark red; while the huang qi tongue is pale or dull and pale, it also tends to be flabby.

Both of these types sweat easily, but sometimes the sweat of the astragalus body type will have a yellowish color. They both dislike wind and are quite effected it. If you ask a patient if they are sensitive to drafts, and they don’t really understand the question, they likely are NOT one of these body types.

While both might complain of limb discomfort, the character of that discomfort is quite different. The cinnamon twig people tend to have joint pain, while our astragalus friends have more of a sensation of heaviness or numbness.

When faced with similarities in constitutional type, it helps to know the key aspects that lead you to see the distinctive differences!

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We learn about in our Chinese medicine textbooks, a certain kind of insubstantial mix of phlegm and qi that collects in the throat... 咽喉異物感Plum Pit Qi.

It is a pretty little diagnosis. Sounds very….Asian…Sounds very beautiful, and somehow exotic, but I have yet to have have a patient Western, or Asian, walk into my clinic and say “I have plum pit qi.”

Dr Huang talks about this particular condition as a subjective feeling on the part on the patient where there is some kind of odd sensation involving the throat. It could be that there is a feeling that something is stuck in the throat, something that can neither be swallowed or coughed out. It could be a bit of phlegm, or an irritation or tickle that constantly has someone clearing their throat.

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Or, it could be some kind of issue that causes problems with speaking, or leaves people with a feeling of chest stuffiness, that the breathing is somehow off, or the words that one seeks to speak come out not quite right, or that somehow something is causing the functions that run through the throat to not quite work so smoothly.

This kind of presentation could have its roots in either an emotional issue, or some physiological process that has gone astray. It really does not matter the origin, what matters is the patient has arrived at this juncture in their state of health, and there are formulas that treat it, and treat it well.

As practitioners, it is our job to figure this stuff out, to take what our patients say, express, or leave out, and see if matches what we know about the particular uses of an herb or formula. Ban xia hou po tang, is the formula that is famous for treating “plum pit qi.” But, if we can begin to see under the iceberg of “an odd feeling in the throat”, we can begin to see a whole constellation of patterns and situations where this formula may be of benefit.

And it helps if you understand something about Ban Xia Constitution, which was talked about here.

We learned this in our first quarter of Chinese medicine school, and if you read through the advertisements and support materials for any of the multitude of herbal products you will see this……

Jade Windscreen is for building the immune systems in those who easily get colds.

I’m one of those people.I’ve easily gotten colds my entire life.I wish it were not so.I remember reading about Jade Windscreen and thinking my troubles were over. But, after taking it for a week or so, I woke one winter night in a panic thinking the house was on fire.It was not, but I had this odd smell of burning paper in my nose. Which followed me around for a few days until I stopped the Jade Windscreen.Let’s look at this from the point of view of constitution. The main herb in Jade Windscreen is Huang Qi. And the body type associated with Huang Qi tends to be a bit on the heavy side, and what in the usual Chinese medicine lingo we would say is damp, with a bit of a fluid metabolism problem. The Bai Zhu in that formulas also is one of the main herbs that Zhang Zhong-Jing used to correct water metabolism problems. The Fang Feng? While it does release the exterior, it also can be a bit drying as it promotes the expulsion of water via the sweat.For a guy like me that tends toward dryness it is little wonder this stuff kindled an internal fire!

Consider that different body types have affinities for different herbs, and need to be regulated in different ways.

Someone who does not tend toward dampness, likely will have trouble with drying formulas like Jade Windscreen. Perhaps you have noticed in your clinical work that some textbook seemingly easy to apply formulas are terrifically ineffective.Huang suggests if you have a Cinnamon Twig person who frequently gets colds in front of you, see how they do on Gui Zhi Tang. Likewise, if they are a Bupleurum type consider Xiao Chai Hu Tang. There may also be opportunities to combine Jade Windscreen with these more constitutional formulas as well. As always, by the presentation, chose the herbs!

In Chinese medicine school we learned that ban xia is a premier herb for dispersing phlegm, a great medicinal for those kinds of people that were soggy and damp, phlegmy and with the accompanying lethargy that comes from fluids gone rubbery with stagnation.But, none of my books in school made mention of the constitutional type that benefits from this herb.Indeed, while I learned about how people can fall into the roulette wheel slots of the Five Phases, I did not even have a clue that us human beings had a tendency to fall into a certain herb category.Now, us human beings love to divide up the world into categories, and then take those maps and try to make sense of our experience. Are you a wood type? A water person? A year of the Rat Sagittarian? An Enigram number 7, or Meyers-Briggs ENTP? The list goes on and on. And not without merit, so long as we remember that we laying our maps onto reality.Look at any group of people, and it is clear that some of us are more alike and others quite different. I suspect we inhabit groups and types. Whether it is influence or destiny is a question to which I’ve no answer. But, in my recent clinical experience, I am beginning to see that understanding the herb that confirms a person’s constitutional type is useful when selecting formulas to treat them.

I am beginning to understand this.That there are constitutional types who respond well to particular herbs.

As Dr Huang outlines in The Ten Major Formula Families there are a number of different families of which we tend to be a part. Those of the Ban Xia family are a most interesting part of the family tree.Ban xia types, unlike my original concept of a person phlegmy and dull with fatigue, according to Huang these people are lively, vivacious and extremely emotional. They have big, expressive eyes that spark like those of a movie star. Their presence is felt when they enter a room. They tend to be rather photogenic too.And they are sensitive. Very sensitive. Often, they are artists. They make good actors, performers and speakers. They are that kinds of people that are very involved with their own emotions. These are the people that have odd symptoms for which no amount of blood work, CAT scans or X-rays will show a cause. They often experience problems with the throat, and easily get worked up into insomnia.There are some kinds of phlegm that are not substantial. For these people the ban xia based formulas are a tremendous benefit.

Six months of planning. Uncountable hours of preparation. Like cultivating a soil that will bring forth a burst of brilliance and flower, this has been my life this past year.The first international Classic Formula class in Nanjing with Dr Huang has wound its course. Nourishing as a long cooked soup, where flavors slip and blend into a more complex creation, the knowledge and skill of Huang, combined with the experience and inquiry of the practitioners who travel from a world away created two weeks of rich exchange that will be a benefit drunk by our patients. While it was my intentions and effort that built the frame, and strung the weft. And my ability to shuttle between languages helped to weave the tapestry that was to unfold, however as the vehicle I didn’t so often get to see or experience the collage of thread and connection that are the tapestry itself.This trip, however, has not been for me. It has been for the practitioners that entrusted their time and effort to this endeavor. It has been for Dr. Huang, to give him a chance to teach a western group of doctors. And it has been for the pursuit of taking the seeds of an ancient medicine that offers solutions to modern problems, and planting them in a foreign and ready soil..The success of this class lies not with one person. The ever dependable Andrea Elliott, with her excellent Chinese language, and more importantly cultural skills, and our master of arrangements Tracy Wang were responsible to hiding the complexity of structure that supported us in our two weeks with Dr. Huang.They get the credit for making this event run smoothly, in a country where things rarely run smoothly.….And then, there were the practitioners who came from America and Italy. Seasoned and thoughtful doctors who brought their thirst for knowledge and desire to be of service to their patients. They were the water and sunlight that gave Dr Huang the opportunity to share this ideas and experience in ways that will no doubt help all of us to serve our communities, and to further the development of Classic Formulas in our own lands!

If you are a reader of The Lantern, then you perhaps have already seen this interview with Dr. Huang. If you are not a reader of The Lantern, and you are the kind of practitioner that would rather read the Classics, than sift through modern research. If you are the kind of person that prefers to noodle through the thoughts and clinical experience of seasoned doctors, instead of following the latest on how MRI’s say acupuncture works. Then The Lantern is certainly worth your time and money!In the last issue, they published this interview which came from an afternoon discussion of medicine, and in particular, the origins of his book The Ten Major Formula Families. It is a good introduction, not only to his particular style of clinical reasoning, but also touches on the history of this method of treatment.Of course, if you would actually like to sit down with Dr Huang and discuss medicine, that is also a possibility. We have just a couple more spaces left in the fall trip to Nanjing.Come join us!

This October in Nanjing will be a unique opportunity to study constitution and the classic formulas of the Shang Han Lun and Jin Gui Yao Lue with Dr. Huang.

What you will gain from this special course:

• Learn the 10 basic constitutional types as outlined in The 10 Major Formula Families
• Understand the similarities and differences between the frequently used formulas families of the Shang Han Lun and Jing Gui Yao Lue.
• Observe and discuss clinical cases.
• Learn to use constitution diagnosis, and how to select appropriate prescriptions from within formula families.
• Become facile with the classic formulas.
• See Chinese medicine as it is practiced in China.
• Learn specific indications for particular formulas.

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When and where?
We will depart Seattle as a group on Oct 1st, begin classes on Oct 4th, and then leave China and return to the States on Oct 19th. Classes will be held in Nanjing in the conference room of our hotel, and clinic observation will be at the Nanjing TCM University, which is a 10 minute walk from the hotel.

What else?
There will be an optional day trip to Shanghai for a day of shopping, eating, and a trip to the top of the tallest building in China for a bird’s eye view of China’s biggest and most exciting city.
Of course, Nanjing itself is full of history, and colorful Chinese life to be explored.

China is a long way to go for just two weeks.
For those wishing to extend their stay in China, and explore the otherworldly natural beauty of Guilin, for an additional fee, we are offering an optional 5 days in Yangshuo. This lovely river town is at the very center of Guanxi province’s watercolor-like karst limestone mountains and meandering streams.

It all sounds great. How much for this adventure?
Price of $2,795 includes tuition, translation, accommodations, airfare from Seattle, ground transportation between Shanghai and Nanjing, and a Chinese visa.
Space is limited to 8 participants!
To reserve your place, a non-refundable US$300 deposit is required.

But wait, there’s more!
We are applying for NCCAOM PDA units.

Contact:
To be considered for this unique trip, email: michael@classicformulas.com
or call 206-788-5941.

Through the miracle of MP3, I’ve been having discussions with Dr. Huang on my morning walks to work. Actually, re-listening to the discussions we had in Nanjing. But, since words in Chinese have this sneaky way of going transparently through my ears when engaged in thinking and making sense, listening again to our conversations yields all kinds of new information.I have recently begun to translate the Ma Huang (麻黃類方) chapter, and in the Ma Huang Constitution it includes the sign of “aversion to cold.” People with the Gui Zhi Constitution also have that. So, I asked Huang about it.

This feeling of aversion to cold, is it different for Ma Huang and Gui Zhi types? 

His answer was surprising to me in that it had little to with the patient’s subjective sense, and more to do with an intersection of their feelings and objective perception of the practitioner.

Yes, they are different. The Ma Huang type has sensitivity to cold, but there is a lack of sweating, their skin is course and even sandy looking. Those Gui Zhi types, they also dislike cold, but their skin is fine, moist, and tends to be pale. 

It is not helpful to simply go on what the patient says. People all have different ways of experiencing themselves and body. Of course, listen to a patient’s subjective experience, but then back it up with your own objective observation. There is a more dimensional image that emerges when the observable and reported mutually inform each other.I rather like this approach of Dr Huang’s. That there are concrete physical signs that help us to differentiate a patient’s particular constitution. It is this background, along with the various signs and symptoms that help us to to determine how best to help a patient.It is not just a matter of what symptoms are present, but more importantly, the kind of person that is having those symptoms.

I did not expect so many comments so quickly. If this continues I will have to look into setting up a discussion forum on this site as well.I love going to Chengdu for the ma-la hotpot, cheap foot massage, and teahouses. I also love to visit there because I get to hang out with Eran Pupkin, an Israeli friend who is about to begin a 5 year Masters program there. I’m jealous!A recent email of his had this:

Can you write more about the gui zhi type, and what happened if the person does not sweat at all, but have all the other symptoms, does he/she still consider a gui zhi type? 

Oddly enough, this was the question that was at the top of my list to ask Dr. Huang when I met with his last week to discuss some questions I had about the book.He had this to say:This is tricky. First of all, you can not really rely on your patients for much useful information. Often they really don’t know what it is that you are looking for. Then, there are those that will try to tell you what they think you want to hear. Others, will exaggerate. Still others, just do not really pay much attention to their experience. So, if you ask them questions like “do you sweat easily”, they either misunderstand what you are asking about, or just plain don’t know.What to do? Look for yourself at the skin, if it is coarse, dry, and looks kind of sandy, they are NOT a gui zhi type. If, however, they have skin that is fine, more white in color and is moist, then this is can be seen as an indication that they are a gui zhi kind of person.You as the doctor need to use your own eyes and hands to make sense of the person in front of you. Do not overly rely on what they have to say!