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.

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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.

Sharon Weizenbaum who is one of the members of the group that is going to Nanjing this fall to study the classical formulas with Doctor Huang, has put together a nice little study guide to the major formulas that we will be studying over there.

You can find it here.

In addition to the nice little quiz format of the study guide, she has collected quite a few of the articles in English that touch on Huang Huang’s work. Some good reading there.

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.

It takes practice this abdominal diagnosis method. It is not just a matter of feeling where there is tension, or where the patient experiences discomfort. Getting a sense of how differences in skin, moisture, innate muscular tension, where there is fullness, and how emptiness can be easily not found are all part of the process.

The more I touch patient’s abdomens, the more I approach it with a sense of inquire and curiosity, rather than with the demand to find something, the more I discover patterns and presentations that at times lead to a clear sense of a patient needs, and at other times leads to further questions.

Here is part two of the abdominal palpation article that Steve Clavey and I did last year. It originally was written in Japanese, translated to Chinese where I found it in Taiwan, and then appeared for the first time in English in The Lantern, which of course, you are already subscribed to.

What? You haven’t yet?  Well, then click below, and remedy that situation!

It is not common in the practice of acupuncture to use palpation as a method of gathering information to help one decide on a course of treatment. In herbal medicine, this has been a much less used method. At least here in the United States.

When living in Taiwan, I came across a book called the Medical Dictionary of Kampo Diagnosis and Treatment, (漢方診療醫典 Han Fang Zhen Liao Yi Dian), it was written by Dr. Otsuka Yoshinori, a Japanese practitioner of Chinese medicine, and translated into Chinese. It is a fine collection of the author’s clinical experience, written in a refreshingly candid fashion. Most interesting to me, was a section in the front, where he outlines a variety of abdominal patterns which indict which classic formula would be appropriate.

Abdominal signs are discussed in both the Ling Shu and Su Wen in the Yellow Emperior’s Internal Classic. While it appears abdominal diagnosis was a part of Han dynasty medical practice, and indeed there are lines in the Shang Han Lun that mention palpatory abdominal findings, it fell out of favor in later years. In Japan, however, that portion of the tradition has been preserved, and is part of the Kampo (漢方 han fang) tradition, where abdominal signs are the confirmation for prescribing various formulas.

The translation of this material on abdominal palpation and formula selection was a collaborative effort with Steve Clavey, editor of the fine Australian English language journal on Chinese medicine, The Lantern, where this article was first published. Get it here: SHL Abdominal Patterns I

While Michael Max and Steve Clavey retain the copy write on this article, it may be downloaded for individual use.

Watch for part two, coming to this blog in the near future!

Most Westerner’s exposure to the Shang Han Lun is that is an an old book that has something to do with the common cold, and the various complications that result. We get a smattering of it in acupuncture school, but it is a book that really has nothing to do with acupuncture. It does, however, have a lot to do with herbal medicine.

I am no expert in the Shang Lan Hun, but I have been fortunate enough to have teachers and friends who are. And Dr. Huang is no slouch when it comes to this classic text of herbal medicine. In fact, he reads it not as a book about the progression of acute infectious disease, he reads it as a manual of how to use herbs to treat a wide wide range of issues.

My time in Nanjing is winding down, three weeks goes by in the blink of an eye. We share a home-cooked meal and discuss history. He loves history, and in fact, history of medicine and medical theory is what his Master’s study was about.

“War is a catalyst for medical advancement”, he says.

Of course, this is true. Plastic surgery got its start in treating the injuries of WWII, and most people are aware of the advances in prosthetics that has resulted from America’s current adventure in Iraq.

The late Han dynasty was a turmoil of war and upheaval. The usual story is that Zhang Zhong Jing, the author of the Shang Han Lun cultivated his skill because so many people were suffering the resulting effects of scarcity, injury and want. Dr. Huang agrees on this point, but his opinion has a twist.

“Those days were not so different from now, all the good stuff went to the army. The best of the food, clothing and medical care too. ZZJ, a doctor of his skill and talent was most likely an army doctor. All the good ones were.”

It is never boring around being around Dr Huang. He has bright quick eyes, iconoclastic opinions, a distaste for the status quo, and a fierce dedication to helping people get better. He is a rare voice in committee approved and sanctioned China. It is never a dull moment.

“Gui Zhi Tang (Cinnamon Twig Decoction)”, he says with a smile as he knifes through golden ginger that is on its way to becoming the soup for our lunch.
“You know, it is not just for colds and those miscellanious sweating conditions.”

Think about it this way. Imagine a soldier who has seen battle, he is beat and weary. Probably in a state of shock from the bloodshed and watching his friend’s head rolling about on the ground. Imagine exposure to the elements, days of not eating well, no real rest. He stumbles into camp, half death and starving. What do you do?

He is certainly not in a state to eat much solid food. He has lost blood and is cold and without vital energy. His spirit is disordered, anyone’s would be after this kind of experience.

Now, think about Gui Zhi Tang. Cinnamon and ginger to warm, peony to nourish the blood and calm the heart, licorice to settle the frayed nerves, and plums to build the digestion. Chase it down with a nice easy to digest bowl of rice gruel, and have a nap.

The thing about Dr. Huang is that he makes a lot of sense, even when he is talking about medicine in ways I’ve never heard or imagined.

I’m thinking Gui Zhi Tang would be the perfect thing for those people that get lost in the woods for a few days.