Lecture 4

Lecture 4 Wind-Dispelling Formulas, Cold-Dispelling Formulas,

and Dampness-Dispelling Formulas

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Wind is the chief of the hundred diseases. Since wind evil easily damages the body, we often prescribe wind-dispelling formulas in clinic. However, external wind, internal wind, and vacuity wind cause different wind diseases. Also, when wind binds together with the individual viscera and bowels it causes a variety of pathological changes, such as liver wind, kidney wind, heart wind, and intestinal wind. Moreover, when wind unites with the other six excesses there are significant differences between wind-phlegm, wind-damp, wind-cold, wind-cold-damp, wind-fire, summerheat-wind, and wind-dryness.

A further characteristic of wind evil is that it is swift and changeable. Whenever you see frequent transmutations, rapid onset, and symptoms that come and go, wind is usually involved. In recent years we have reached the conclusion that allergies, as diagnosed in Western medicine, are frequently ascribable to the Chinese medicine category of wind evil. Finally, if a disease is the result of wind evil, its determining characteristics can include: itching, convulsion, shaking, and dizziness; whenever these symptoms are present, wind is likely involved. In summary, when you use a wind-dispelling formula, you have to clearly distinguish the various wind patterns. This allows you to use wind-dispelling formulas in combination with other formulas that apply other treatment principles.

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Cold evil, as a cause of disease, is also as common in the clinic as wind. Moreover, the developments and transformations of cold are very complex. In the Shang1 Han2 Lun4 (On Cold Damage), Zhang1 Zhong4-Jing3 () discussed the transformation of disease due to cold damage and handed down to later generations an established method of treatment that has stood the test of time. Beyond cold damage diseases, many miscellaneous diseases1 are cold diseases. The characteristic symptoms of cold are: pain; congelations; fear of cold; clear watery fluids; accumulations; spasms; contractions; and the sensation of cold. Furthermore, cold evil can also deeply invade the kidneys and cause reverse-flow of the limbs. This is why our predecessors had cold-dispelling formulas.

Cold evil manifests in the exterior or interior, in the qi4 and blood, in the channels and network vessels, and in the skin, muscles, and bones. Since cold evil differs in each area of the body, one must pay attention to pattern identification when using cold-dispelling formulas. Even more importantly, one should pay attention to the transformation of the disease itself and its subsequent symptoms for these will differ as well. Remember to use formulas flexibly.

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Dampness is sticky and slimy as well as heavy and turbid. Damp that collects causes phlegm or water, and often phlegm leads to disease in combination with wind, heat, cold, or summerheat evil. While external dampness is often interrelated with wind, cold, or summerheat, internal dampness usually relates to insufficient right qi4 of the viscera and bowels, or

1 As explained in an earlier footnote, miscellaneous diseases specifically means diseases that are not cold damage diseases. (Ed.)

Lecture 4 3

it is due to erroneously treated external dampness that has subsequently entered the interior. Another characteristic of damp evil is that it lingers and is very difficult to treat.

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In summary, when you use formulas that dispel wind, cold, or damp, you cannot just pay attention to the characteristics of individual evils. You must also analyze how evils are interacting with each other, assay the strength or weakness of the right qi4, and grasp the transformations of the disease itself. For example, cold depression may transform into heat, wind evil may transform into dryness, and damp evil may transform into heat; an exterior evil may enter the interior, and an interior evil may pass to the exterior. Always remember to identify the pattern to determine the treatment.

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4.1 Feng1 Yin3 Tang1 ( Wind-Drawing Decoction) from Jin1 Gui4 Yao4 Lue94 ( Essential Prescriptions of the

Golden Coffer)

60 45 30 90 46

34 1

da4 huang2 ( rhubarb, Rhei Radix et Rhizoma) 60 g gan1 jiang1 ( dried ginger, Zingiberis Rhizoma) 60 g long2 gu3 ( dragon bone, Mastodi Ossis Fossilia) 60 g gui4 zhi1 ( cinnamon twig, Cinnamomi Ramulus) 45 g gan1 cao3 ( licorice, Glycyrrhizae Radix) 30 g mu3 li4 ( oyster shell, Ostreae Concha) 30 g han2 shui3 shi2 ( glauberite, Gypsum seu Calcitum) 90 g hua2 shi2 ( talcum, Talcum) 90 g chi4 shi2 zhi1 ( halloysite, Halloysitum Rubrum) 90 g

Lecture 4 4

bai2 shi2 zhi1 ( kaolin, Kaolin) 90 g zi3 shi2 ying1 ( fluorite, Fluoritum) 90 g shi2 gao1 ( gypsum, Gypsum Fibrosum) 90 g

Grind the above medicinals into a coarse powder, and use 46 g per dose. Bring to a boil in 2 small cups of water, but only allow it to boil a few seconds. Remove the dregs, divide into two doses, and drink warm. For dry stools, slightly increase the dosage; for loose stools, slightly decrease the dosage or take one dose each day. Remain flexible when prescribing this formula.

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Our predecessors used feng1 yin3 tang1 to treat wind-induced paralysis (wind epilepsy) in adults, 2 fright epilepsy in children, and tugging and slacking in which the patient may suffer dozens of attacks per day. But since the 1960s I have used this formula to treat hypertension in overweight patients with intense constipation, dizziness, and tendency to wind strike; for such patients this formula can prevent wind strike. Furthermore, I use feng1 yin3 tang1 to treat hemiplegic sequelae to cerebrovascular disease (wind strike). This formula is ideal for preventing recurrent strike (i.e., second and third wind strikes).

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2 In most cases the paralysis is the sequela of wind strike. (Ed.)

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FORMULA ANALYSIS

Feng1 yin3 tang1 is a settling, downbearing, and heat-clearing formula. Although there are a variety of causes for wind strike disease, mostly it is due to internally arising wind-fire with exuberant phlegm-heat that counterflows and blocks the spirit orifices; this is why the patient faints and loses consciousness. Phlegm obstructing the channels and network vessels causes the paralysis. Within this formula, long2 gu3 subdues, settles, and quiets the spirit, mu3 li4 subdues the mind and constrains the spirit, gui4 zhi1 frees yang2 qi4, and gan1 cao3 moderates urgency. These four medicinals are the chiefs of this formula, and together they quiet the heart and kidney.

Stirring internal wind harasses liver wood, which in turn insults spleen earth. When spleen qi4 does not transport, dampness stagnates and humors gather. If the patient further has wind and fire fanning each other, then damp-heat engenders phlegm, and wind-phlegm will invade the upper body. This is why da4 huang2 serves as the support medicinal in this formula. It flushes away damp-heat and wind-fire evils to quicken the blood and dispel stasis and thereby push out the old and lead in the new. Thus, da4 huang2 stops the source of phlegm-fire obstructions.

The assistants in this formula are: gan1 jiang1, which warms the spleen and dries dampness to prevent the cold medicinals from damaging the center; chi4 shi2 zhi1 and bai2 shi2 zhi1, which dry dampness and fortify the spleen; hua2 shi2, which disinhibits dampness and fortifies the spleen; and shi2 gao1, which clears the lung to restrain the liver. Finally the couriers are han2 shui3 shi2 and zi3 shi2 ying1. The former is a cold-natured medicinal that strengthens the yin1 qi4 of kidney water to restrain fire, and the latter is a sweet-warm medicinal that settles the spirit and supplements the heart vacuity. Together the ingredients in this formula quiets the five viscera and govern all of the above-mentioned symptoms.

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There are many causes of wind strike, but we can summarize the causes as wind, fire, qi4, blood, and phlegm evils, along with various combinations of these five evils. Feng1 yin3 tang1 has medicinals that treat wind, fire, phlegm,

Lecture 4 6

and blood diseases, and it also regulates and balances the five viscera. It only lacks medicinals that treat qi4. While shi2 gao1 clears metal and restrains wood, and mu3 li4 subdues liver yang2, the formula is missing medicinals that course and outthrust liver qi4. So, whenever I prescribe this formula, I usually add 45 g of xiang1 fu4 zi3 (cyperus) to course the liver and rectify qi4. This medicinal not only soothes the liver and extinguishes fire, it also moves qi4 in the twelve channels and thereby assists with the unobstructed movement of qi4 and blood.

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The formula I have explained above comes from the Jin1 Gui4 Yao4 Lue94. Yet, the Qian1 Jin1 Yao4 Fang13 includes a formula named zi3 shi2 zhu3 san3 (Flourite Decocting Powder) while the Wai4 Tai2 Mi4 Yao44 includes the formula zi3 shi2 tang1 (Flourite Decoction), and both of these formulas are identical to feng1 yin3 tang1. Some scholars in later generations attributed feng1 yin3 tang1 to an author of the Song4 dynasty, and others attributed it to Zhang1 Zhong4-Jing3. Some say do not use this formula lightly, while others praise it highly. These all have some degree of truth, but there is still no final conclusion. Within those discussions of the origin of this formula, no one mentions whether or not the formula is effective. As the Qing1 dynasty physician Wang1 Ang2 () said in the Jin1 Gui4 Yao4 Lue94 Ji2 Yi4 (Comprehensive Elucidation of Essential Prescriptions in the Golden Coffer), Do not worry about the opinions of others, try to figure it out yourself!

3 Qian1 Jin1 Yao4 Fang1 ( A Thousand Gold Pieces Prescriptions); this was by Sun1 Si1-Miao3 () and was published in the 7th Century. (Ed.) 4 Wai4 Tai2 Mi4 Yao4 ( Essential Secrets from Outside the Metropolis); this was by Wang2 Tao2 () and was published in the 8th Century. (Ed.)

Lecture 4 7

The greatest feature of Chinese medicine is its intimate connection to clinical practice. Clinical efficacy is the criterion for testing theory on the one hand and medicinals and formulas on the other. I know from several years of clinical experience with feng1 yin3 tang1 that it effectively treats wind strike disease and produces very good results. I hope readers will use this formula with the proper pattern identification to determine treatment and accurate selection of medicinals. In this way we can broaden the applications of this ancient formula in alleviating suffering in the modern world.

CONTRAINDICATIONS

Do not use feng1 yin3 tang1 for vacuity-cold patterns.

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4.2 Tian1 Ma2 Wan2 ( Gastrodia Pill) by Zhang1 Jie2-Gu3 ()

180 180 () 180 180 210() 300 300 150 30 500() 5070 100 l

tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) 180 g niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix) 180 g bi4 xie4 ( fish poison yam, Dioscoreae Hypoglaucae seu

Semptemlobae Rhizoma) 180 g xuan2 shen1 ( scrophularia, Scrophulariae Radix) 180 g du4 zhong4 ( eucommia, Eucommiae Cortex) 210 g (wine-fried)5 quan2 dang1 gui1 ( whole tangkuei, Angelicae Sinensis Radix

Integra) 300 g qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 300 g du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix)6 150 g pao4 fu4 zi3 ( blast-fried aconite, Aconiti Radix Lateralis

Tosta) 30 g sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix

5 Fry this ingredient in wine to eliminate the natural elasticity of du4 zhong4 and make it easier to break. (Au.) 6 One version of this formula omits this ingredient. (Au.)

Lecture 4 8

Exsiccata seu Recens) 500 g

Soak the tian1 ma2 and niu2 xi1 together in wine for three days, and dry them over a fire. Grind all the medicinals into a fine powder, and mix with lian4 mi4 (processed honey) to form pills the size of wu2 tong2 zi3 (firmiana seed). Take 5070 pills at a time. If the illness is serious, the patient may take up to 100 pills. Take the pills with warm water once a day early in the morning on an empty stomach.

FORMULA ANALYSIS

Tian1 ma2 wan2 nourishes blood, dispels wind, supplements the kidney, and strengthens the muscles and bones. It treats kidney channel vacuity fire that engenders wind.7 The associated symptoms are: sinew pulling; pain in the entire body; numbness in the hands and feet; deviated eyes and mouth; and hemiplegia.

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This formula emphasizes di4 huang2 and dang1 gui1, the chief medicinals, which supplement the kidney and nourish blood. Even so, its magical effect comes entirely from using tian1 ma2 and niu2 xi1 that have been wine-soaked and dried together. These two support medicinals make wind-phlegm and turbidity-dampness downbear and not ascend counterflow. The four assistant medicinals are bi4 xie4, du4 zhong4, xuan2 shen1, and fu4 zi3. Bi4 xie4 and du4 zhong4 boost the kidney, dispel wind-dampness, and strengthen the sinews and bones; xuan2 shen1 nourishes kidney yin1 and invigorates water to restrain fire; fu4 zi3 supplements kidney yang2 and warms the channels to free the network vessels. Moreover, the combination of di4 huang2 and xuan2 shen1 allow yin1 to obtain the help of yang2 to provide a 7 This refers to wind engendered from liver-kidney yin1 vacuity (Ed.)

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never-ending source. The couriers, du2 huo2 and qiang1 huo2 (notopterygium), dispel wind from the greater yang2 (tai4 yang2) and track down latent wind in the lesser yin1 (shao4 yin1) to eliminate wind evil.

The medicinals in tian1 ma2 wan2 together support right qi4 and dispel evil to treat both the branch and the root. This formula nourishes blood, dispels wind, strengthens tendons and bones, supplements kidney, and secures the root.

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In recent years we have used this formula with modifications to treat kidney vacuity stirring wind that manifests in dizziness, flowery vision, heaviness of the head, unstable legs, numbness or pain in the limbs, and hypertension. (You can also us it when hypertension is not present.) For this purpose, consider adding medicinals such as:

sheng1 zhe3 shi2 ( crude hematite, Haematitum Crudum) sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) gou1 teng2 ( uncaria, Uncariae Ramulus cum Uncis) ze2 xie4 ( alisma, Alismatis Rhizoma) sang1 ji4 sheng1 ( mistletoe, Taxilli Herba) ju2 hua1 ( chrysanthemum, Chrysanthemi Flos)

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; 1012 1520 1525 (); 10

1520 20

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FORMULA VARIATIONS

The Ling2 Shu1 (The Magic Pivot) states:

The brain is the sea of marrow. When the sea of marrow is insufficient, [the patient experiences symptoms such as] spinning brain and ringing ears, aching in the lower legs, vertigo, diminished vision, sluggishness, and somnolence.

This is why tian1 ma2 wan2 contains very large amounts of kidney-supplementing medicinals. I use it to treat dizziness, tinnitus, and neurasthenia that according to pattern identification are attributable to a kidney vacuity pattern. The accompanying symptoms include: head dizziness, tinnitus, diminished vision, forgetfulness, soreness and weakness in the lumbus and legs, and entire body fatigue. When I treat such patterns the prescriptions are usually decoctions, and the dosages for the main ingredients are about 1/20th of the original dosage for the pills. To such a decoction I add 30 g of pre-decocted sheng1 shi2 jue2 ming2 (raw abalone shell), which nourishes liver yin1 to subdue liver yang2 while also brightening the eyes.

To promote heart-kidney interaction and to quiet the spirit, add 1012 g of yuan3 zhi4 (polygala) and 1520 g of ye4 jiao1 teng2 (flowery knotweed stem). To promote kidney qi4 absorption and to treat tinnitus, add 1525 g of pre-decocted ling2 ci2 shi2 (magnetic loadstone). To dispel wind and brighten the eyes, add 10 g of ju2 hua1 (chrysanthemum) and 1520 g of gou1 teng2 (uncaria); these two medicinals combine with tian1 ma2 to eliminate head dizziness. These modifications always achieve very good results, so please consider using this formula.

() 250 180 180 180 45()

For patients who are more than 45 years of age and who have symptoms such as dizzy head and flowery vision, headache with distending pain, tinnitus and forgetfulness, sore lumbus and weakness in the knees, and

Lecture 4 11

unstable legs, combine tian1 ma2 wan2 with feng1 yin3 tang1 (Wind-Drawing Decoction)8 and add the following medicinals:

sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha Cruda) 250 g

hua4 ju2 hong2 ( Huazhou pomelo rind, Citri Grandis Exocarpium Rubrum) 180 g

ze2 xie4 ( alisma, Alismatis Rhizoma) 180 g gou1 teng2 ( uncaria, Uncariae Ramulus cum Uncis) 180 g

Make into pills. The patients may also have: stubborn hypertension or intermittent numbness in the limbs, fingers, and toes. Such patients have a tendency to wind strike, and frequently taking this pill can prevent wind strike. Use this formula even if blood pressure is not high when the patient has the above-mentioned symptoms.

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FORMULA COMPARISONS

Tian1 Ma2 San3 ( Gastrodia Powder) from Wei4 Sheng1 Bao3 Jian4 ( Precious Mirror of Health)

tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) ban4 xia4 ( pinellia, Pinelliae Rhizoma) fu2 ling2 ( poria, Poria) bai2 zhu2 ( white atractylodes, Atractylodis Macrocephalae

Rhizoma)

Grind the medicinals into a fine powder. Take 34 g per dose taken with decocted sheng1 jiang1 (fresh ginger). 8 Double the dosages of the medicinals in feng1 yin3 tang1. (Au.)

Lecture 4 12

Both tian1 ma2 wan2 and tian1 ma2 san3 treat wind strike, hemiplegia, deviated eyes and mouth, and difficult speech. Yet you should use tian1 ma2 wan2 to treat internal stirring of vacuity wind that results from kidney vacuity or blood vacuity. In contrast, use tian1 ma2 san3 to treat internally exuberant phlegm turbidity and wind-phlegm harassing the upper body. Although we use the term wind strike in both cases, the patterns that each formula treats are different. This is why clinicians must correctly perform the pattern identification to avoid mistakes.

Finally, note that within the ancient books there are versions of this formula that only use qiang1 huo2 and omit du2 huo2. But, such books specify that the qiang1 huo2 should have a single stem, which was actually du2 huo2.9 Thus, they did not separately specify du2 huo2. I mention this for your reference.

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4.3 Zhen4 Gan1 Xi1 Feng1 Tang1 ( Liver-Settling Wind-Extinguishing Decoction) from Yi1 Xue2 Zhong1 Zhong1 Can1 Xi1 Lu4 ( Records of

Chinese Medicine with Reference to Western Medicine)10

30 30() 15() 15() 15() 15 15 15

6() 6 6 4.5

niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix) 30 g sheng1 zhe3 shi2 ( crude hematite, Haematitum Crudum) 30 g

(finely ground) sheng1 long2 gu3 ( crude dragon bone, Mastodi Ossis Fossilia

Cruda) 15 g (crushed) sheng1 mu3 li4 ( raw oyster shell, Ostreae Concha Cruda) 15 g

(crushed) sheng1 gui1 ban3 ( raw tortoise plastron, Testudinis Plastrum

9 This is confusing because the names of these ingredients have changed over time. In effect, the ancients called both qiang1 huo2 and du2 huo2 by the same name, qiang1 huo2. However, certain formulas specified that the qiang1 huo2 should have but one stem, which is what we now call du2 huo2. (Ed.) 10 This book, by Zhang1 Xi1-Chun2 (), was published in seven volumes between 1918 and 1934. It is notable for presenting some of the first comparisons between Western medicine and Chinese medicine, and it also recorded many very effective formulas. (Ed.)

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Crudum) 15 g (crushed) sheng1 bai2 shao2 ( raw white peony, Paeoniae Radix Alba Cruda)

15 g xuan2 shen1 ( scrophularia, Scrophulariae Radix) 15 g tian1 men2 dong1 ( asparagus, Asparagi Radix) 15 g chuan1 lian4 zi3 ( toosendan, Toosendan Fructus) 6 g (crushed) sheng1 mai4 ya2 ( raw barley sprout, Hordei Fructus Germinatus

Crudus) 6 g yin1 chen2 hao1 ( virgate wormwood, Artemisiae Scopariae

Herba) 6 g gan1 cao3 ( licorice, Glycyrrhizae Radix) 4.5 g

Decoct in water. In recent years we generally pre-decoct the many stone, shell, and bone medicinals in this formula.

"" 30 6 24 15 30

For extreme heat in the heart, add 30 g of sheng1 shi2 gao1 (raw gypsum). For profuse phlegm, add 6 g of dan3 xing1 (bile arisaema). For a cubit pulse that is forceless when heavy pressure is applied, add 24 g of shu2 di4 huang2 (cooked rehmannia) and 15 g of shan1 zhu1 yu2 (cornus). For soft stools, remove gui1 ban3 and zhe3 shi2, and add 30 g of chi4 shi2 zhi1 (halloysite).

Zhen4 gan1 xi1 feng1 tang1 treats wind strike disease caused by internal wind. This condition manifests symptoms such as a stringlike long forceful pulse, especially in the inch position, and excessively high blood pressure.11 The patient could also have: upper body exuberance and lower body vacuity with frequent dizziness; frequent pain in the brain with heat effusion; eye

11 Normally Dr. Jiao1 does not mention a modern medicine symptom as a primary indication for formulas. Perhaps the mention of high blood pressure here reflects modern medical explanations in the source text. (Ed.)

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distention and tinnitus; vexation heat in the heart; frequent belching; a feeling of gradual inhibition of the limbs; gradual deviation of the eyes and mouth; or a complexion like that of a drunkard. In extreme cases there is dizziness and fainting, loss of consciousness, and after some time the patient will regain consciousness. Thereafter they are unable to recover and have spirit-mind deficit, possibly with wilting of the limbs or with hemilateral wilting.

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FORMULA ANALYSIS

The Su4 Wen4 (Elementary Questions) states: All wind associated with shaking and dizzy vision is ascribed to the liver. The name of zhen4 gan1 xi1 feng1 tang1 (i.e., Liver-Settling Wind-Extinguishing Decoction) references this principle, and the formula was created to treat this problem. The liver governs wind. When there is kidney vacuity and water failing to moisten wood, hyperactive liver yang2 ascends and wind arises internally. With exuberance above and vacuity below, the lung qi4 does not downbear and kidney qi4 does not contain, so that the wind dynamic makes the thoroughfare qi4 and stomach qi4 ascend counterflow. This dynamic makes the qi4 of all the viscera and bowels ascend. Qi4 and blood combine, travel upward, and produce acute conditions, such as major reversal and sudden reversal.

In acute conditions, one should treat the branch. Thus, this formula emphasizes the use of niu2 xi1, which conducts qi4 and blood downward.

Lecture 4 15

Although niu2 xi1 treats the branch, it is the chief medicinal of this formula. Long2 gu3, mu3 li4, gui1 ban3, and bai2 shao2 yao4 are support medicinals that treat the root. They enrich liver and kidney yin1 and thereby emolliate the liver, settle the liver, and subdue yang2 to extinguish liver wind. The assistant medicinals are zhe3 shi2, xuan2 shen1, tian1 men2 dong1, mai4 ya2, and gan1 cao3. Zhe3 shi2 downbears stomach qi4 and thoroughfare qi4, and xuan2 shen1 and tian1 men2 dong1, which clear lung qi4 and depurate and downbear the lung qi4. This action in turn settles and restrains liver wood. Mai4 ya2 has a germinating and effusing nature; it normalizes the orderly reaching of liver qi4 yet does not result in excessive depression. Moreover, it harmonizes the stomach and assists digestion. Gan1 cao3 harmonizes the center, regulates the hundred medicinals, and moderates the urgent action of the formula. Yin1 chen2 hao1 enters the lesser yang2 (shao4 yang2) and has an upbearing and effusing nature, like the qi4 of the early spring. These actions are similar to those of the liver itself, so yin1 chen2 hao1 both drains liver heat and soothes liver depression. Chuan1 lian4 zi3 conducts the liver qi4 downward. Of these two courier medicinals, yin1 chen2 hao1 upbears while chuan1 lian4 zi3 downbears. Used together, the medicinals in this formula settle the liver and extinguish wind.

The source text explicitly states that in patients with vacuous and weak cubit pulses on both hands, then because of true yin1 vacuity-detriment of the kidney, kidney yin1 does not hold true yang2 together. When true yang2 then deserts and rushes upward, it carries qi4 and blood in surging upward to the head and brain. In such situations, add shu2 di4 huang2 (cooked rehmannia) and shan1 zhu1 yu2 (cornus) to the formula as these medicinals enrich and supplement kidney yin1 to astringe kidney qi4.

In recent years we have mostly used zhen4 gan1 xi1 feng1 tang1 to treat hypertension with accompanying symptoms such as head and eye dizziness, drunkard-like complexion, unstable legs, and tendency to wind strike. My own conclusion is that even if the patient does not have high blood pressure, this formula is still applicable as long as there are symptoms of liver and kidney insufficiency and internal stirring of liver wind (as explained above). In short, use this formula to treat dizziness and headache whenever the

Lecture 4 16

patterns of insufficient liver yin1 and internal stirring of liver wind are present.

25

FORMULA MODIFICATIONS

I have also realized that wind strike disease patients often have wind-phlegm harassing the upper body. Therefore, in those cases of phlegm exuberance, add one or two of the following medicinals:

hua4 ju2 hong2 ( Huazhou pomelo rind, Citri Grandis Exocarpium Rubrum)

quan2 gua1 lou2 ( whole trichosanthes, Trichosanthis Fructus Integer)

dan3 xing1 ( bile arisaema, Arisaema cum Bile) tian1 zhu2 huang2 ( bamboo sugar, Bambusae Concretio Silicea) fu2 ling2 ( poria, Poria)

For pronounced headache, consider adding xia4 ku1 cao3 (prunella) and ju2 hua1 (chrysanthemum). For liver depression engendering heat, add xiang1 fu4 zi3 (cyperus) and huang2 qin2 (scutellaria). If constipation continues after taking the medicinals, add 25 g of jiu3 da4 huang2 (wine-processed rhubarb) to disinhibit and precipitate the bowels.

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Lecture 4 17

FORMULA COMPARISONS

Tian1 Ma2 Gou1 Teng2 Yin3 ( Gastrodia and Uncaria Beverage)

tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) gou1 teng2 ( uncaria, Uncariae Ramulus cum Uncis) sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) shan1 zhi1 zi3 ( gardenia, Gardeniae Fructus) huang2 qin2 ( scutellaria, Scutellariae Radix) chuan1 niu2 xi1 ( cyathula, Cyathulae Radix) du4 zhong4 ( eucommia, Eucommiae Cortex) yi4 mu3 cao3 ( leonurus, Leonuri Herba) sang1 ji4 sheng1 ( mistletoe, Taxilli Herba) ye4 jiao1 teng2 ( flowery knotweed stem, Polygoni Multiflori

Caulis) fu2 shen2 ( root poria, Poria cum Pini Radice)

Zhen4 gan1 xi1 feng1 tang1 and tian1 ma2 gou1 teng2 yin3 both treat liver wind stirring internally. The accompanying symptoms for this pattern are: dizziness; headache; tinnitus; flowery vision; and trembling and numbness. In extreme cases there is also hemiplegia. The former formula is quite strong in settling the liver and extinguishing wind and also in enriching and nourishing the liver and kidneys. In contrast, the latter is more effective for clearing liver heat, quieting the heart spirit, calming the liver, and extinguishing wind. Furthermore, zhen4 gan1 xi1 feng1 tang1 extinguishes wind by emphasizing settling, enriching, and emolliating, while tian1 ma2 gou1 teng2 yin3 extinguishes wind by emphasizing clearing, cooling, and quieting the spirit as well as boosting the kidney and quieting the liver.

Some of the medicinals in tian1 ma2 gou1 teng2 yin3, such as sang1 ji4 sheng1, du4 zhong4, and huang2 qin2, also quiet the fetus. Thus, to treat epilepsy of pregnancy12 and gestational hypertension with symptoms such as dizziness and headache, fainting, bruxism, and twitching of the limbs, remove niu2 xi1 and yi4 mu3 cao3 from tian1 ma2 gou1 teng2 yin3 and add the following medicinals:

ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) 12 This is similar to eclampsia. (Ed.)

Lecture 4 18

bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) ling2 yang2 jiao3 ( antelope horn, Saigae Tataricae Cornu)

(); 3030 30 20; 2030 10 9 9

Ling2 Yang2 Gou1 Teng2 Tang1 ( Antelope Horn and Uncaria Decoction)

ling2 yang2 jiao3 ( antelope horn, Saigae Tataricae Cornu) gou1 teng2 ( uncaria, Uncariae Ramulus cum Uncis) sang1 ye4 ( mulberry leaf, Mori Folium) chuan1 bei4 mu3 ( Sichuan fritillaria, Fritillariae Cirrhosae Bulbus) zhu2 ru2 ( bamboo shavings, Bumbusae Caulis in Taenia) sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix

Exsiccata seu Recens) ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) bai2 shao2 yao4 ( white peony, Paeoniae Radix Alba) fu2 shen2 mu4 ( pine root in poria, Poriae Pini Radix) gan1 cao3 ( licorice, Glycyrrhizae Radix)

Both zhen4 gan1 xi1 feng1 tang1 and ling2 yang2 gou1 teng2 tang1 extinguish wind. The former formula, however, treats paralysis of the limbs caused by liver yin1 vacuity and liver wind internally stirring. Settling the liver and extinguishing wind are the special functions of this formula. The latter treats clouded spirit, tetanic reversal, and twitching of the limbs caused by liver heat engendering wind. Its specialty is clearing liver heat and extinguishing liver wind while simultaneously transforming phlegm and quieting the spirit.

Lecture 4 19

You can use ling2 yang2 gou1 teng2 tang1 to treat hypertension caused by liver heat transforming into wind with symptoms such as dizziness, headache, insomnia, and flowery vision by adding the following medicinals:

sheng1 zhe3 shi2 ( crude hematite, Haematitum Crudum) 30 g sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) 30 g sang1 ji4 sheng1 ( mistletoe, Taxilli Herba) 30 g ze2 xie4 ( alisma, Alismatis Rhizoma) 20 g

While zhen4 gan1 xi1 feng1 tang1 is not appropriate for treating pregnancy epilepsy, you can treat it with ling2 yang2 gou1 teng2 tang1 by adding the following medicinals:

sang1 ji4 sheng1 ( mistletoe, Taxilli Herba) 2030 g huang2 qin2 ( scutellaria, Scutellariae Radix) 10 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 9 g bai2 ji2 li2 ( tribulus, Tribuli Fructus) 9 g

CONTRAINDICATIONS

Zhen4 gan1 xi1 feng1 tang1 is inappropriate for treating patients with severe phlegm-damp.

4.(

4.4 Di4 Huang2 Yin3 Zi3 ( Rehmannia Drink) from Xuan1 Ming2 Lun4 Fang1 ( An Elucidation of Formulas)

90 30 15 10 3 1

sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix Exsiccata seu Recens) 90 g

ba1 ji3 tian1 ( morinda, Morindae Officinalis Radix) 30 g shan1 zhu1 yu2 ( cornus, Corni Fructus) 30 g shi2 hu2 ( dendrobium, Dendrobii Herba) 30 g rou4 cong1 rong2 ( cistanche, Cistanches Herba) 30 g

Lecture 4 20

pao4 fu4 zi3 ( blast-fried aconite, Aconiti Radix Lateralis Tosta) 30 g

rou4 gui4 ( cinnamon bark, Cinnamomi Cortex) 30 g fu2 ling2 ( poria, Poria) 30 g mai4 men2 dong1 ( ophiopogon, Ophiopogonis Radix) 30 g shi2 chang1 pu2 ( acorus, Acori Tatarinowii Rhizoma) 30 g yuan3 zhi4 ( polygala, Polygalae Radix) 30 g wu3 wei4 zi3 ( schisandra, Schisandrae Fructus) 15 g

Grind these medicinals into a fine powder. For each dose boil 10 g of powder in 1.5 cups of water with 3 slices of sheng1 jiang1 (fresh ginger), 1 da4 zao3 (jujube), and a little bo4 he2 (mint). Boil the water down to eight-tenths of a cup and drink warm. In modern times we adjust the dosages and prepare this formula as a decoction with modifications according to the pattern.

This formula treats wind strike, lesser yin1 (shao4 yin1) qi4 reversal, and non-interaction of the heart and kidney that manifest as wind disablement.13 The accompanying symptoms include muteness and drooping legs with inability to walk. Defecation and urination may be obstructed, incontinent, or normal. The patient may also have a red complexion and vexation thirst.

FORMULA ANALYSIS

Di4 huang2 yin3 zi3 uses a large amount of di4 huang2, which enriches the true yin1 of the kidney. Ba1 ji3 tian1, rou4 cong1 rong2, rou4 gui4, and fu4

13 Wind disablement ( feng1 fei4): Wilting and loss of the limbs without pain and sometimes with loss of mental faculties. Usually a sequela of wind stroke. (Ed.)

Lecture 4 21

zi3 restore the fire of the true origin. Shi2 hu2 nourishes the stomach, quiets the spleen, and secures the qi4. The sour and astringing medicinal shan1 zhu1 yu2 warms the liver and secures the essence. Shi2 chang1 pu2, yuan3 zhi4, and fu2 ling2 supplement the heart and open the orifices to communicate with the kidney viscus. Mai4 men2 dong1 and wu3 wei4 zi3 protect the lung and nourish yin1 to enrich the water source. Thus, the formula makes the heart and kidney interact so that essence qi4 becomes exuberant and wind and fire are naturally extinguished. Note that fu4 zi3, rou4 gui4, ba1 ji3 tian1, rou4 cong1 rong2 were originally included in the formula to expel turbid yin1, and you should not remove them from the formula lightly.

The main function of this formula is to warm and supplement the lower origin and to promote absorption of floating yang2.14 It simultaneously opens the heart orifice, expels phlegm turbidity, and promotes interaction of the heart and kidneys. Appropriate use of this formula brings very good results.

FORMULA MODIFICATIONS

I often use di4 huang2 yin3 zi3 to treat the following Western medical diagnoses when they manifest with signs of wind strike or wind disablement: myelanalosis, myelitis, lateral sclerosis, multiple sclerosis, and chronic progressive bulbar paralysis. Accompanying symptoms could include: stiff tongue with sluggish speech and choking when swallowing; paralysis in the legs; muscle atrophy in the four limbs; unsteady and unbalanced gait, as if stepping on a spongy surface or on a ball; or loss of control of the bowels and bladder.

14 In this instance, floating yang2 ( fu2 yang2) refers to yang2 that floats astray due to vacuity cold in the lower origin (i.e., kidney yang2 vacuity). (Ed.)

Lecture 4 22

For patients who have difficulty walking and cold legs with a pronounced preference for warmth, use larger dosages of rou4 gui4 and fu4 zi3 and add the following medicinals:

yin2 yang2 huo4 ( epimedium, Epimedii Herba) bu3 gu3 zhi1 ( psoralea, Psoraleae Fructus) xu4 duan4 ( dipsacus, Dipsaci Radix) niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix)

For inhibited urination, add che1 qian2 zi3 (plantago seed) and mu4 tong1 (trifoliate akebia). For urinary incontinence, add fu4 pen2 zi3 (rubus), sang1 piao1 xiao1 (mantis egg-case), and wu1 yao4 (lindera). For hypertonic muscles in the limbs, add:

shen1 jin1 cao3 ( ground pine, Lycopodii Herba) sheng1 yi3 mi3 ( raw coix seed, Coicis Semen Crudum) sheng1 bai2 shao2 ( raw white peony, Paeoniae Radix Alba Cruda) bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus)

When enduring, recalcitrant cases, add:

hong2 hua1 ( carthamus, Carthami Flos) tao2 ren2 ( peach kernel, Persicae Semen) di4 long2 ( earthworm, Pheretima) zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta)

19591960()

CASE HISTORIES

From 1959 to 1960 I worked in coordination with the Chinese Academy of Medical Sciences and its associated hospital and Institute of Dermatology and Venereology as well as the Department of Dermatology and Venereology at the hospital associated with the Tian1Jin1 College of Traditional Chinese Medicine. We did a clinical study on the use of di4 huang2 yin3 zi3 with modifications for the treatment of tabes dorsalis and myelitis. In the study,

Lecture 4 23

we used no drugs from modern medicine, but did use vitamin supplements. The research had quite satisfying results. Here I summarize two of the cases for your reference.

:49 1959 4 13 . 11 4 :;

B1B12B6C B.A.L

Case 1: Mr. Liu2, 49 years old, admitted to the hospital on April 13, 1959. Eleven days before entering the hospital the patient had shivering, heat effusion, and aching soreness and weakness in both legs. By April 4 he had anuria and could not walk. He had tried many Western drugs, but the treatments were ineffective. A neurological examination revealed complete flaccid paralysis in both legs, loss of pain sensation, tactile hypoesthesia, absence of superficial and deep reflexes, absence of plantar reflex, and urinary and fecal retention. A lumbar puncture and blood tests were also performed, and the diagnosis was myelitis. While in the hospital he took vitamins B1, B12, B6, and C as well as penicillin, and a catheter was inserted to open and drain the bladder. However, his condition did not improve.

4 22(),4 25 4 27 4 28 5 23 6 23 6 30""

On April 22 the patient started to use Chinese medicinals. The diagnosis was wind disablement, and the treatment was primarily di4 huang2 yin3 zi3, with modifications according to the pattern. He continued taking the same vitamins. By April 25 he had regained a portion of his sense of pain in the lower legs, muscle tone had increased, and the tendon reflexes appeared. By April 27 he could slightly move his right leg. By April 28 the patient could slightly move both legs; he had recovered feeling in his legs and had Babinskis sign in both legs. By May 23 he could get out of bed and get around with a walker. By June 23 he could walk by himself; the catheter had

Lecture 4 24

been removed and he could urinate without assistance. On June 30 he was basically cured and the hospital discharged him.

:22 1958 9 241956 27 0.1931958 57

: 0.1 0.5 1 2 B1B12

B.AL

Case 2: Ms. Wang2, 22 years old, admitted to the hospital on September 24, 1958. In February 1956 the patient experienced diminished vision in her left eye, and after July of that year lost her sight. After treatment she regained her eyesight only to 0.1.15 In September 1956 she experienced numbness below her waist. She recovered after three months with no treatment. In May 1958 she had diminished eyesight in both eyes, and 7 days later she could only perceive light. Her limbs were numb and weak, especially on the right side. When she entered the hospital she had difficulty urinating, and she could not walk.

Her eyesight was 0.1 and 0.5 in the left and right eyes, respectively; she had primary atrophy of the optic disk in both eyes. Below the first cervical vertebra she had a slightly diminished superficial sensibility; below the T-2 thoracic vertebra deep sensibility had disappeared. The limbs on the right side were weak, and on the left the limbs were completely paralyzed. There were hypertonic tendon reflexes in the upper limbs, tendon reflexes in the lower limbs could be elicited, but superficial reflexes were absent as were pathological reflexes. The hospital performed lumbar puncture, blood tests, and other examinations, and the diagnosis was ophthalmoneuromyelitis. The patient received vitamin therapy with B1 and B12, methenamine, penicillin, streptomycin, cortisone, and physiotherapy. Her condition would sometimes fluctuate, but overall there was no improvement.

15 The relevant scale for vision tests goes to 2.0, which is the best vision. In China, a score below 1.0 can disqualify people for certain careers, so obviously this patient has quite poor vision. (Ed.)

Lecture 4 25

1959 4 18 4 24 5 9 5 15(+)5 18 5 27

6 3 8 16""

On April 18, 1959, she turned to Chinese medicine, and continued ordinary vitamin therapy but gave up other modern medicine drugs. According to the four examinations of Chinese medicine the patient had kidney vacuity that manifested as wind disablement. The primary treatment for her was di4 huang2 yin3 zi3, prepared as a decoction and modified according to the pattern. By April 24 her lower legs could sense pain. By May 9 she had recovered some sense of pain in half of her body, and her left knee joint could resist heavy force. By May 15 she had completely recovered sensibility, both legs could resist heavy force, and the ankle reflex was (+). By May 18 bilateral pathological reflexes had disappeared. By May 27 she was urinating easily. By June 3 her arms had recovered their strength. At that point we changed to a different formula and adjusted it according to pattern identification. By August 16 she was basically cured and released from the hospital.

: 15 12 10 15 912 69 912 912 10 1015 912

912 915 12 9 69 10; 915 15; 0.61

10; 10 6

Here is the basic formula that we used in the study as well as the standard modifications:

sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix Exsiccata seu Recens) 15 g

shu2 di4 huang2 ( cooked rehmannia, Rehmanniae Radix Praeparata) 12 g

shan1 zhu1 yu2 ( cornus, Corni Fructus) 10 g rou4 cong1 rong2 ( cistanche, Cistanches Herba) 15 g

Lecture 4 26

fu4 zi3 ( aconite, Aconiti Radix Lateralis Praeparata) 912 g rou4 gui4 ( cinnamon bark, Cinnamomi Cortex) 69 g ba1 ji3 tian1 ( morinda, Morindae Officinalis Radix) 912 g yin2 yang2 huo4 ( epimedium, Epimedii Herba) 912 g lu4 jiao3 jiao1 ( deerhorn glue, Cervi Cornus Gelatinum) 10 g niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix) 1015 g yuan3 zhi4 ( polygala, Polygalae Radix) 912 g gui4 zhi1 ( cinnamon twig, Cinnamomi Ramulus) 912 g xu4 duan4 ( dipsacus, Dipsaci Radix) 915 g shi2 hu2 ( dendrobium, Dendrobii Herba) 12 g tian1 men2 dong1 ( asparagus, Asparagi Radix) 9 g mai4 men2 dong1 ( ophiopogon, Ophiopogonis Radix) 9 g

For patient with pronounced pain, add:

chuan1 wu1 tou2 ( aconite main tuber, Aconiti Radix) 69 g cao3 wu1 tou2 ( wild aconite, Aconiti Kusnezoffii Radix) 69 g an1 lu92 zi3 ( Keiske artemisia fruit, Artemisiae Keiskeanae

Fructus) 10 g

For inhibited urination, add 915 g of hai3 jin1 sha1 (lygodium spore) and 15 g of che1 qian2 zi3 (plantago seed).

For vacuity cold in the lower origin, add 0.61 g of powdered liu2 huang2 (sulfur) (taken drenched) and 10 g of zhong1 ru3 shi2 (stalactite).

For patients with thick slimy tongue fur and a poor appetite, add 10 g of huo4 xiang1 (agastache) and 6 g of sha1 ren2 (amomum).

30

I have used this formula with modifications for more than 30 years to treat spinal cord pathologies such as tabes dorsalis, myelitis, lateral sclerosis, combined sclerosis, and myelosringosis. It has always achieved quite good

Lecture 4 27

results. I hope that everyone will try this formula and advance the research even further.

FORMULA COMPARISONS

Di4 huang2 yin3 zi3 and zhen4 gan1 xi1 feng1 tang1 (Liver-Settling Wind-Extinguishing Decoction) both treat wind strike, but the former strongly supplements the kidney, nourishes the liver, and opens the orifices, whereas the latter strongly settles the liver, downbears counterflow, and extinguishes wind.

5. ()

4.5 Xiao1 Feng1 San3 ( Wind-Dispersing Powder) from Cheng2 Fang1 Qie4 Yong4 ( Effective Use of Formulas)

15() 15 15 15 60 60 60 60 60() 60 60 50 3 3 5

hou4 po4 ( officinal magnolia bark, Magnoliae Officinalis Cortex) 15 g (roasted in ginger juice)

chen2 pi2 ( tangerine peel, Citri Reticulatae Pericarpium) 15 g zhi4 gan1 cao3 ( mix-fried licorice, Glycyrrhizae Radix cum

Liquido Fricta) 15 g jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 15 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 60 g chan2 tui4 ( cicada molting, Cicadae Periostracum) 60 g qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 60 g huo4 xiang1 ( agastache, Agastaches Herba) 60 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 60 g (roasted) chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma) 60 g fu2 ling2 ( poria, Poria) 60 g ren2 shen1 ( ginseng, Ginseng Radix) 50 g

Grind the medicinals into a fine powder. Take 3 g three times a day. For serious cases, increase the dosage to 5 g per dose. Swallow the powder with tea. Patients who have sores or lichen should take the powder with huang2 jiu3 (yellow wine).

Lecture 4 28

( 9 ): 3 3 3 39 10 10 10 10 10 10 10

Since the dosages in the original formula were too large (9 g per day), later practitioners made this formula as a decoction. In general the dosages are:

hou4 po4 ( officinal magnolia bark, Magnoliae Officinalis Cortex) 3 g (roasted in ginger juice)

chen2 pi2 ( tangerine peel, Citri Reticulatae Pericarpium) 3 g zhi4 gan1 cao3 ( mix-fried licorice, Glycyrrhizae Radix cum

Liquido Fricta) 3 g ren2 shen1 ( ginseng, Ginseng Radix) 3 g jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 9 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g chan2 tui4 ( cicada molting, Cicadae Periostracum) 10 g qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 10 g huo4 xiang1 ( agastache, Agastaches Herba) 10 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g (roasted) chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma) 10 g fu2 ling2 ( poria, Poria) 10 g

Decoct in water. If the patient has no vacuity pattern or has a wind-heat pattern, omit ren2 shen1.

Xiao1 feng1 san3 treats wind evil attacking the upper body, which causes: headache with dizzy vision; hypertonicity of the nape and neck; congested nose with a heavy voice; sneezing with nasal mucus and tearing; and itchy

Lecture 4 29

wind papules or dry lichen16 that appear on the skin and are difficult to eliminate. In some cases the wind evil assails a woman during menstruation, such that the thoroughfare and controlling vessels contract wind that then enters into the blood aspect. This causes retention of wind evil in the blood, which gives rise to papules in the skin that are small, red, itchy, and difficult to endure. When the patient scratches these papules, they often rupture the skin in some areas such that sores form.

FORMULA ANALYSIS

In this formula the acrid, dissipating, light, and floating medicinals qiang1 huo2, fang2 feng1, jing1 jie4, and chuan1 xiong1 eliminate wind from the head, eyes, neck, and back. Bai2 jiang1 can2 and chan2 tui4 are light and clearing medicinals; as they are skins themselves, they tend to penetrate the human skin and thus eliminate wind from the skin. Huo4 xiang1 and hou4 po4 are aromatic and foulness repelling medicinals that regulate qi4, and disperse distention to eliminate evils and dissipate fullness. Ren2 shen1, fu2 ling2, chen2 pi2, and gan1 cao3 boost qi4 and transform dampness; they regulate the center, support the right qi4, and prevent wind evil from abiding and stagnating. Together these medicinals comprise a commonly used formula that treats wind evil.

9 15 5 13 ,

FORMULA VARIATION

Except for slight differences in dosages, this formula is similar to a formula of the same name from Tai4 Ping2 Hui4 Min2 He2 Ji4 Ju2 Fang1 (Tai4-

16 Dry lichen ( gan1 xian3): Lichen is a skin diseases characterized by elevation of the skin, serous discharge, scaling, and itching; dry lichen is a variety of lichen that is characterized by dryness and scaling. (Ed.)

Lecture 4 30

Ping2 Imperial Grace Pharmacy Formulas). The Yi1 Zong1 Jin1 Jian4 (The Golden Mirror of Medicine) also provides a formula with the name xiao1 feng1 san3 (Wind-Dispersing Powder), and it consists of the following medicinals:

dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix) 9 g sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix

Exsiccata seu Recens) 9 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 9 g chan2 tui4 ( cicada molting, Cicadae Periostracum) 9 g zhi1 mu3 ( anemarrhena, Anemarrhenae Rhizoma) 9 g ku3 shen1 ( flavescent sophora, Sophorae Flavescentis Radix) 9 g hei1 zhi1 ma2 ( black sesame, Sesami Semen Nigrum) 9 g jing1 jie4 ( schizonepeta, Schizonepetae Herba) 9 g cang1 zhu2 ( atractylodes, Atractylodis Rhizoma) 9 g niu2 bang4 zi3 ( arctium, Arctii Fructus) 9 g shi2 gao1 ( gypsum, Gypsum Fibrosum) 15 g gan1 cao3 ( licorice, Glycyrrhizae Radix) 5 g mu4 tong1 ( trifoliate akebia, Akebiae Trifoliatae Caulis) 5 g

This version of xiao1 feng1 san3 treats wind-heat assailing the exterior. The accompanying symptoms are itching skin and red papules that come and go. In extreme cases, the patient will simultaneously have headache and heat effusion.

Both formulas treat itching skin, dormant papules, wind papules, and lichen sores, and the chief action of both formulas is to course wind and stop itching. The Cheng2 Fang1 Qie4 Yong4 version of xiao1 feng1 san3 is stronger for externally dissipating wind-cold, but it is weaker for eliminating dampness and stopping itch. It furthermore supports right qi4. The Yi1 Zong1 Jin1 Jian4 version is stronger for eliminating dampness and stopping itching and for dissipating wind and clearing heat, but it cannot dissipate wind-cold and it does not support right qi4.

Lecture 4 31

(): 9 12 10 912 610 1218 10 915 1030 1030

10 69 618 9

I often mix these two formulas together and modify the resulting formula according to the pattern, which principally treats stubborn cases of diseases such as wind papules (urticaria or hives), itching eruptions due to blood-heat or wind-heat, and psoriasis. I often obtain extraordinary results with this approach. Here is a formula I frequently use:

dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix) 9 g chi4 shao2 yao4 ( red peony, Paeoniae Radix Rubra) 12 g hong2 hua1 ( carthamus, Carthami Flos) 10 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 912 g jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 610 g lian2 qiao2 ( forsythia, Forsythiae Fructus) 1218 g zhi1 mu3 ( anemarrhena, Anemarrhenae Rhizoma) 10 g chan2 tui4 ( cicada molting, Cicadae Periostracum) 915 g ku3 shen1 ( flavescent sophora, Sophorae Flavescentis Radix) 10

30 g bai2 xian1 pi2 ( dictamnus, Dictamni Cortex) 1030 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 69 g cang1 zhu2 ( atractylodes, Atractylodis Rhizoma) 618 g chen2 pi2 ( tangerine peel, Citri Reticulatae Pericarpium) 9 g

Decoct in water.

69 35 30 30 302030 610

1020 912 30 () 610 35() 1015

Lecture 4 32

10 9 36

FORMULA MODIFICATIONS

For stubborn wind papules that do not heal, change the dosages of ku3 shen1 and bai2 xian1 pi2 to 30 g, use 2030 g of lian2 qiao2, and add the following medicinals:

zao4 jiao3 ci4 ( gleditsia thorn, Gleditsiae Spina) 69 g she2 tui4 ( snake slough, Serpentis Periostracum) 35 g ren3 dong1 teng2 ( lonicera stem, Lonicerae Caulis) 30 g dan1 shen1 ( salvia, Salviae Miltiorrhizae Radix) 30 g

If the patient also has headache and late or scant menses, add 610 g of chuan1 xiong1 (chuanxiong).

For itching skin that the patient scratches and causes red skin and a burning sensation, add 1020 g of sheng1 di4 huang2 (dried/fresh rehmannia) and 912 g of chao3 huang2 bai3 (stir-fried phellodendron).

For patients who also have thirst and aversion to heat (possibly during the summertime or in a hot environment), add:

sheng1 shi2 gao1 ( raw gypsum, Gypsum Crudum) 30 g (pre-decoct)

huang2 lian2 ( coptis, Coptidis Rhizoma) 610 g bo4 he2 ( mint, Menthae Herba) 35 g (add at end) sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix

Exsiccata seu Recens) 1015 g

For red papules that are indistinct, itchy, and do not outthrust easily, add:

niu2 bang4 zi3 ( arctium, Arctii Fructus) 10 g sheng1 ma2 ( cimicifuga, Cimicifugae Rhizoma) 9 g jie2 geng3 ( platycodon, Platycodonis Radix) 36 g

I have used this method to treat many patients of this kind, and all of them had very good results, so please consider using it yourself.

Lecture 4 33

()

FORMULA COMPARISON

Many doctors use fang2 feng1 tong1 sheng4 san3 (Saposhnikovia Sage-Inspired Powder) (sometimes in pill form) to treat itching skin and lichen sores. Fang2 feng1 tong1 sheng4 san3 principally treats patterns of wind-heat congestion and exterior-interior repletion, while xiao1 feng1 san3 treats fettered wind evil depressed in the skin and exterior.

6()

4.6 Qian1 Zheng4 San3 ( Pull Aright Powder) from Cheng2 Fang1 Qie4 Yong4 ( Effective Use of Formulas)

50 50 50 6

bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 50 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 50 g quan2 xie1 ( scorpion, Scorpio) 50 g

Grind the medicinals into a fine powder. Take 6 g per dose, mixed with huang2 jiu3 (yellow wine).

()

Qian1 zheng4 san3 treats sudden occurrence of wind strike with accompanying symptoms such as deviated eyes and mouth, facial hemiparalysis, inability to pucker the mouth, deviation of the nasolabial groove, drooping at the corner of the mouth, and inability to close one of the eyes. There is an absence of other symptoms throughout the body. According to Western medicine, this is facial paralysis.

()

Lecture 4 34

According to Chinese medicine, when you see a patient has deviated eyes and mouth along with no other systemic symptoms, you can conclude that the disease is associated with the foot greater yang2 (tai4 yang2) and foot yang2 brightness (yang2 ming2) channels. The foot yang2 brightness channel passes the mouth and surrounding lips, while the foot greater yang2 channel travels upward to the medial portion of the eye. The deviated eyes and mouth are the result of wind-phlegm and brewing heat that pull and tighten in the channels. The patient has no other systemic symptoms because neither the other channels nor the viscera and bowels contract evils.

;;

FORMULA ANALYSIS

Although the name of this disease is wind strike, the character for wind indicates the abrupt and sudden nature of the disease and does not refer to damage caused by wind. Bai2 fu4 zi3 is an acrid and dissipating medicinal that expels wandering wind from the face. Bai2 jiang1 can2 is a light medicinal that travels upward to clear the face; its salty nature softens and transforms phlegm-turbidity, while its acrid nature expels wind evil. Quan2 xie1 is an important medicinal for treating wind; it is slightly toxic, and it breaks wind-phlegm binds. Finally, huang2 jiu3 has an acrid-warm nature that courses and dissipates. It conducts the other medicinals into the channels and network vessels so that they can set the eyes and mouth aright.

610( 56)

Today many people administer this formula as a decoction and add ingredients according to the pattern. In general, the dosage of each medicinal is 610 g. Some people will slightly decrease the dosage of bai2 fu4 zi3 to 56 g, and the curative effect is still very good.

: 6 10 9 10 1015 610

Lecture 4 35

10 23 1218 10 3 6 1

I have used this formula with added ingredients to treat many cases of facial nerve paralysis. The majority of the patients who have this disease can completely recover and have no sequelae. The following is my empirical formula:

bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 6 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g quan2 xie1 ( scorpion, Scorpio) 9 g bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g ge2 gen1 ( pueraria, Puerariae Radix) 1015 g jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 610 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g wu2 gong1 ( centipede, Scolopendra) 23 pieces su1 mu4 ( sappan, Sappan Lignum) 1218 g hong2 hua1 ( carthamus, Carthami Flos) 10 g xi4 xin1 ( asarum, Asari Herba) 3 g zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 6 g

Decoct in water and take one packet each day.

( 1 >; 1 1.

121 23

In addition to taking the decoction, the patient should use powdered bai2 jie4 zi3 (white mustard) mixed with hot water to form a thin paste that is placed on a gauze bandage and applied to the deviated side of the face. Here are the steps in the procedure. First place the paste inside the oralbuccal

Lecture 4 36

cavity directly on the membrane inside the cheek. Then with the patients mouth open, use needle-picking therapy to slightly bleed the front, middle, and back along the upper teeth, the lower teeth, and between the upper and lower teeth. All nine points should be on the deviated side. After the acupuncture treatment, apply the gauze bandage with the thin paste made of powdered bai2 jie4 zi3 to the deviated side. Press the bandage tightly to the shape of the face and cut it to size. Apply the plaster in the evening. Half way through the night the medicinal will have lost its efficacy and the patient can discard the plaster. Perform this supplementary treatment every evening or every other evening. If the plaster causes blisters or erosion on the skin, then wait until the skin heals before using the plaster again. In such cases, apply the bai2 jie4 zi3 paste more thinly to avoid again causing skin erosion.

Generally speaking, the above mentioned formula and the plaster together will produce the desired result in approximately 12 weeks. The patient will gradually improve over the course of one month. Please note that the best results occur when the patient simultaneously takes the decoction internally and applies the bai2 jie4 zi3 plaster externally. In this way we enhance the curative effect. If the patient also has an acupuncture treatment 23 times a week, the patient will recover even more quickly.

1980:50 1980 11 29

: 10 10

10 6 6 10 30 () 10 10 20 10 15 20() 63

CASE HISTORIES

In 1980 the mother of one of my students suddenly suffered deviation of the eyes and mouth. This is her case history:

Case 1: Mrs. Shao4, 50 years old. Date of first visit: November 29, 1980.

One day before the patient suddenly had facial paralysis on the left side. She had deviation of the mouth toward the right and her left eye would not close. She also had numbness of the tongue, tinnitus in the left ear, and heart

Lecture 4 37

palpitations. She usually had constipation, and prior to the onset of deviated eyes and mouth she had a sore throat. The tongue fur was thin and slightly yellow, and the pulse was stringlike and slippery. By correlating the pulse and signs, I diagnosed wind strike in the network vessels with depressed heat in the interior; the combined interior and exterior evils were obstructing the channels and network vessels, which resulted in the symptom of deviated eyes and mouth.

Method of treatment: Course wind and clear heat as well as calm the liver and quicken the network vessels.

I combined ideas from qian1 zheng4 san3 and xiao1 feng1 san3 (Wind-Dispersing Powder)17 and then made modifications. This was the prescription:

jing1 jie4 ( schizonepeta, Schizonepetae Herba) 10 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 10 g quan2 xie1 ( scorpion, Scorpio) 6 g ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) 10 g sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) 30 g (pre-decoct) jin1 yin2 hua1 ( lonicera, Lonicerae Flos) 10 g bai2 ji2 li2 ( tribulus, Tribuli Fructus) 10 g su1 mu4 ( sappan, Sappan Lignum) 20 g huang2 qin2 ( scutellaria, Scutellariae Radix) 10 g xuan2 shen1 ( scrophularia, Scrophulariae Radix) 15 g ling2 ci2 shi2 ( magnetic loadstone, Magnetitum

Magneticum) 20 g (pre-decoct) chan2 tui4 ( cicada molting, Cicadae Periostracum) 6 g

I gave the patient three packets.

(12 2 ):: 10 10 10 10 6 9 10

17 For the details of xiao1 feng1 san3 ( Wind-Dispersing Powder), see the preceding formula in this Lecture. (Ed.)

Lecture 4 38

10 30 30 () 30 () 12 33

Second visit: December 2. The patient still had deviated eyes and mouth, dizziness, tinnitus in the left ear, numbness on the left side of the tongue, no sense of taste, a red tongue with thin yellow tongue fur, and a stringlike fine pulse. I modified the original prescription to emphasize the liver-calming, fire-clearing medicinals. This was the second prescription:

jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 10 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g man4 jing1 zi3 ( vitex, Viticis Fructus) 10 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g quan2 xie1 ( scorpion, Scorpio) 6 g bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 6 g ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) 10 g bai2 ji2 li2 ( tribulus, Tribuli Fructus) 10 g su1 mu4 ( sappan, Sappan Lignum) 30 g sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) 30 g (pre-decoct) sheng1 zhe3 shi2 ( crude hematite, Haematitum Crudum) 30 g

(pre-decoct) chao3 huang2 qin2 ( stir-fried scutellaria, Scutellariae Radix

Fricta) 12 g da4 huang2 ( rhubarb, Rhei Radix et Rhizoma) 3 g

I again gave the patient three packets.

(12 5 ): 10 6 10 405

Third visit: December 5. The corner of the mouth on the left side could move on its own accord, and the mouth already had no visible deviation. The left side of the face and the superciliary ridge were both painful, while the tongue fur was yellow and the pulse was slippery. Using the second prescription as the base formula, I further adjusted it by omitting bai2 ji2 li2 and da4 huang2, increasing the dosage of sheng1 zhe3 shi2 (crude hematite) to 40 g, and adding:

Lecture 4 39

bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 6 g hong2 hua1 ( carthamus, Carthami Flos) 10 g

I gave the patient five packets.

(12 13 ):: 10 10 10 9 96 30 12 30 10

9 10 30 () 65

Fourth visit: December 13. The patient showed no evidence of deviated eyes and mouth except for slight asymmetry when she made a big smile. The tinnitus in the left ear continued, and the tongue and pulse were the same as the previous visit. I further modified the prescription and gave the patient five packets of the following:

bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g hong2 hua1 ( carthamus, Carthami Flos) 10 g jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 9 g quan2 xie1 ( scorpion, Scorpio) 9 g bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 6 g quan2 gua1 lou2 ( whole trichosanthes, Trichosanthis Fructus

Integer) 30 g chao3 huang2 qin2 ( stir-fried scutellaria, Scutellariae Radix

Fricta) 12 g su1 mu4 ( sappan, Sappan Lignum) 30 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma) 9 g ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) 10 g sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) 30 g (pre-decoct) zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 6 g

Lecture 4 40

(12 19 ):: 10 10 15 10 10 12 9 6 10 30 30 () 10 9 5

Fifth visit: December 19. The patient had completely recovered from the facial paralysis and deviation of the eyes and mouth. Only a few minor issues remained, such as a slightly noticeable shallowness on the left side of the nasolabial groove, tinnitus in the left ear, and ungratifying defecation. The patient had a red tongue with thin yellow fur and a fine stringlike pulse, particularly in the cubit pulse. From the pulse I knew that the patient had fire in the kidney,18 so I changed the prescription once again:

chao3 huang2 bai3 ( stir-fried phellodendron, Phellodendri Cortex Frictus) 10 g

zhi1 mu3 ( anemarrhena, Anemarrhenae Rhizoma) 10 g sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix

Exsiccata seu Recens) 15 g bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g hong2 hua1 ( carthamus, Carthami Flos) 12 g quan2 xie1 ( scorpion, Scorpio) 9 g bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 6 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g gua1 lou2 ( trichosanthes, Trichosanthis Fructus) 30 g sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) 30 g (pre-decoct) ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) 10 g zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 9 g

I gave the patient five packets.

18 Here the fire in the kidney refers to a vacuity fire, not the life gate fire that is supposed to be in the kidney. Later in the case Dr. Jiao1 further mentions liver-kidney fire, another reference to vacuity fire. (Ed.)

Lecture 4 41

(1981 1 2):: 20 12 10 12 9 10 5 30 () 20 () 10 15 10 30 6

Sixth visit: January 2, 1981. The shape of the face, the feeling on the left side of the face, and the feeling in the tongue had all made a complete recovery and returned to normal. During the preceding few days the patient had dry bound stools, dry mouth, tinnitus in the left ear, and a red tongue with thin yellow dry fur. So, although she had recovered from the paralysis, she still had liver-kidney fire. I treated her by emphasizing the kidney-boosting and liver-calming medicinals in the prescription that follows:

sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix Exsiccata seu Recens) 20 g

di4 gu3 pi2 ( lycium root bark, Lycii Cortex) 12 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 12 g quan2 xie1 ( scorpion, Scorpio) 9 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 5 g sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha

Cruda) 30 g (pre-decoct) ling2 ci2 shi2 ( magnetic loadstone, Magnetitum

Magneticum) 20 g (pre-decoct) cao3 jue2 ming2 ( fetid cassia, Cassiae Semen) 10 g tian1 hua1 fen3 ( trichosanthes root, Trichosanthis Radix) 15 g man4 jing1 zi3 ( vitex, Viticis Fructus) 10 g quan2 gua1 lou2 ( whole trichosanthes, Trichosanthis Fructus

Integer) 30 g

I gave the patient six packets. In follow-up inquiries over several years, we found that after recovering the patient had no relapses.

1960 (18 )

Lecture 4 42

: 10 10 10 10 6 9 9 10 10 10 10

1

Case 2: In 1960 my eldest daughter was eighteen years old and she suddenly had deviated eyes and mouth. I immediately needled the following acupuncture points:

Tai4 Yang2 ( Greater Yang2) TB-21 ( er3 men2, Ear Gate) GB-3 ( shang4 guan1, Upper Gate) ST-7 ( xia4 guan1, Below the Joint) SI-18 ( quan2 liao2, Cheek Bone-Hole) ST-4 ( di4 cang1, Earth Granary) LI-4 ( he2 gu3, Union Valley)

I treated her once every other day, alternating between the two sides, and at the same time gave her the following modified qian1 zheng4 san3 prescription:

bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 10 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g quan2 xie1 ( scorpion, Scorpio) 10 g bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 6 g zao4 jiao3 ci4 ( gleditsia thorn, Gleditsiae Spina) 9 g zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 9 g hong2 hua1 ( carthamus, Carthami Flos) 10 g qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 10 g dang1 gui1 wei3 ( tangkuei tail, Angelicae Sinensis Radicis

Extremitas) 10 g chi4 shao2 yao4 ( red peony, Paeoniae Radix Rubra) 10 g

We decocted these medicinals in water and she took one packet each day. Also, after brewing the medicinals and straining off all of the liquid, we

Lecture 4 43

wrapped the medicinal dregs in a towel and pressed it on the affected side of her face. She recovered in ten days.

"":(

9) 1

FORMULA COMPARISON

Bu2 Huan4 Jin1 Dan1 ( Priceless Elixir)19 Among the ancient pill prescriptions there is one known as bu2 huan4 jin1

dan1:

jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 1 liang3 gan1 cao3 ( licorice, Glycyrrhizae Radix) 1 liang3 fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 1 liang3 tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) 1 liang3 bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 1 liang3 bo4 he2 ye4 ( mint leaf, Menthae Folium) 3 liang3 qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et

Radix) 5 qian2 chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma) 5 qian2 bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 5 qian2 wu1 tou2 ( aconite, Aconiti Radix Wutou) 5 qian2 xie1 shao1 ( scorpion tail, Buthi Caudex) 5 qian2 huo4 xiang1 ye4 ( agastache leaf, Agastaches Folium) 5 qian2

Grind the medicinals into a fine powder, mix with lian4 mi4 (processed honey), and form into pills with each pill weighing 3 qian2 (or roughly 9 g). Each dose consists of one pill taken with tea or huang2 jiu3 (yellow wine).

19 The name of this formula, bu2 huan4 jin1 dan1 (), literally means do not trade gold elixir. That is, because this elixir is so efficacious, one would not want to trade it even for gold. Thus, we render it as Priceless Elixir. (Ed.)

Lecture 4 44

Like qian1 zheng4 san3, this formula also treats mouth deviation due to wind strike, and furthermore one can also dissolve the pills in huang2 jiu3 and spread the resulting tincture on the affected area. In comparison, bu2 huan4 jin1 dan1 is a stronger than qian1 zheng4 san3 for abating wind and dissipating heat as well as expelling phlegm and cold. When you treat patients with deviation of the eyes and mouth due to wind strike, you can use bu2 huan4 jin1 dan1 not only for patterns of exuberant wind evil, but also for patterns with cold accompanying wind, phlegm accompanying wind, or qi4-blood congestion. You can also modify bu2 huan4 jin1 dan1 according to the pattern and prescribe it in decoction form. Because qian1 zheng4 san3 has only a few medicinals, it is easy to modify for specific patterns and thus it is used relatively more frequently than bu2 huan4 jin1 dan1.

7. {}

4.7 Gui4 Zhi1 Shao2 Yao4 Zhi1 Mu3 Tang1 ( Cinnamon Twig, Peony, and Anemarrhena Decoction)

from Jin1 Gui4 Yao4 Lue94 ( Essential Prescriptions of the Golden Coffer)

12 9 12 15 15 12 6 6 6 3

1

gui4 zhi1 ( cinnamon twig, Cinnamomi Ramulus) 12 g bai2 shao2 yao4 ( white peony, Paeoniae Radix Alba) 9 g zhi1 mu3 ( anemarrhena, Anemarrhenae Rhizoma) 12 g sheng1 jiang1 ( fresh ginger, Zingiberis Rhizoma Recens) 15 g bai2 zhu2 ( white atractylodes, Atractylodis Macrocephalae

Rhizoma) 15 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 12 g ma2 huang2 ( ephedra, Ephedrae Herba) 6 g zhi4 fu4 pian4 ( sliced processed aconite, Aconiti Radix Lateralis

Praeparata Secta) 6 g zhi4 gan1 cao3 ( mix-fried licorice, Glycyrrhizae Radix cum

Liquido Fricta) 6 g

Decoct the medicinals in water two times and mix together the resulting medicinal juice. Divide into three doses, and take them during the course of one day.

Lecture 4 45

""

FORMULA ANALYSIS

Gui4 zhi1 shao2 yao4 zhi1 mu3 tang1 treats wind-cold-damp impediment in the channels and network vessels. It also treats impediment of qi4 and blood. This formula addresses enduring, difficult to cure disease with symptoms such as pain in the joints of the entire body, lameness with marked emaciation, extremely swollen feet, dizzy head and shortness of breath, and seething with a desire to vomit. In this formula gui4 zhi1, ma2 huang2, and fang2 feng1 warm and dissipate wind-cold. Bai2 shao2 yao4 and zhi1 mu3 harmonize and protect yin1 from heat and dryness. Sheng1 jiang1 and gan1 cao3 regulate the stomach and harmonize the center. The combination of bai2 zhu2 and fu4 zi3 warms the channels, dissipates cold, and quickly expels cold-damp impediment pain. Together, these medicinals effectively expel wind-cold-damp, warm the channels and vessels, and stop pain. When Zhang1 Zhong4-Jing3 () wrote lameness with marked emaciation in the source text, he meant the joints of the body are stiff, bent, and deformed such that they do not move independently, and the body is so emaciated and weak that the patients cannot take care of themselves and become disabled. In effect he was succinctly describing what modern medicine diagnoses as rheumatoid arthritis with deformed joints of the limbs and damaged osseous tissue.

50

Since the late 1950s, I have used this formula modified according to the pattern to treat rheumatoid arthritis with rickets and rigidity of the spine and have had very good results.

1974 ""

Lecture 4 46

1981

". "32 "1981 12 ""

1983 "" 300

;""

Around 1974 I presented a paper entitled Conclusions on Identifying and Treating Impediment Disorder to a conference of internal medicine specialists. Among other things, I introduced my empirical formula for treating rheumatoid arthritis, which was essentially gui4 zhi1 shao2 yao4 zhi1 mu3 tang1 modified according to the pattern. In 1981 a Dr. Li3 Heng2-Min3 sent a letter to me at the hospital stating that he had used my empirical formula in response to a patient of his with rheumatoid arthritis. Several months later, The Peoples Daily printed a thank you letter from the patient. Consequently, the hospital and outpatient center became very busy, and the director of the institute charged several of us with establishing a research organization for treating impediment disorders as well as with opening a specialized outpatient center and hospital ward for treating this disorder.

I then decided to use gui4 zhi1 shao2 yao4 zhi1 mu3 tang1 combined with the formula for hu3 gu3 san3 (Tiger Bone Powder) from the Tai4 Ping2 Hui4 Min2 He2 Ji4 Ju2 Fang1 (Tai4-Ping2 Imperial Grace Pharmacy Formulas), and I combined them with modifications according to the pattern. I called this new formula bu3 shen4 qu1 han2 zhi4 wang1 tang1 (Kidney-Supplementing Cold-Dispelling Lameness Decoction).

Lecture 4 47

During this same period of time, I adopted the name of lame impediment for the impediment pattern associated with the symptoms of deformed joints of the body and damage to the osseous tissue. In a few short months our organization put together a report on our results in having treated 32 cases of rheumatoid arthritis. In December of 1981 I presented a paper entitled Discussion on Lame Impediment to my colleagues in the Chinese medical community. The presentation was part of the first session of the Society of Internal Medicine of the All-China Association of Traditional Chinese Medicine, which convened in the city of Wu3 Han2. In 1983 the impediment disorders group of that Society adopted the name of lame impediment for this new disease. They also agreed to support scientific research on bu3 shen4 qu1 han2 zhi4 wang1 tang1, and eventually 300 clinical cases were included in the study.

Thereafter, we developed a new medicine, wang1 bi4 chong1 ji4 (Lame Impediment Granules), which the Number Three Pharmaceutical Company manufactured in Ben3 Xi1, a city in Liao2 Ning2 Province. It has already won many prizes for quality, including a Silver Medal in national quality awards. This product sells well at home and abroad; the demand has always exceeded the supply.

Here I present the ingredients of bu3 shen4 qu1 han2 zhi4 wang1 tang1 so that others may use it in their own practices.

Bu3 Shen4 Qu1 Han2 Zhi4 Wang1 Tang1 ( Kidney-Supplementing Cold-Dispelling Lameness Decoction)

: 912 1224 1218 912 612( 15 1020) 1020 915 912915 10-12 12 36 610 1215 30 915 69 610 20

15()69

bu3 gu3 zhi1 ( psoralea, Psoraleae Fructus) 912 g shu2 di4 huang2 ( cooked rehmannia, Rehmanniae Radix

Praeparata) 1224 g xu4 duan4 ( dipsacus, Dipsaci Radix) 1218 g yin2 yang2 huo4 ( epimedium, Epimedii Herba) 912 g zhi4 fu4 pian4 ( sliced processed aconite, Aconiti Radix Lateralis

Lecture 4 48

Praeparata Secta) 612 g20 gu3 sui4 bu3 ( drynaria, Drynariae Rhizoma) 1020 g gui4 zhi1 ( cinnamon twig, Cinnamomi Ramulus) 915 g chi4 shao2 yao4 ( red peony, Paeoniae Radix Rubra) 912 g bai2 shao2 yao4 ( white peony, Paeoniae Radix Alba) 912 g zhi1 mu3 ( anemarrhena, Anemarrhenae Rhizoma) 915 g qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 10

12 g du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix) 10

12 g fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 12 g ma2 huang2 ( ephedra, Ephedrae Herba) 36 g cang1 zhu2 ( atractylodes, Atractylodis Rhizoma) 610 g wei1 ling2 xian1 ( clematis, Clematidis Radix) 1215 g shen1 jin1 cao3 ( ground pine, Lycopodii Herba) 30 g niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix) 915 g song1 jie2 ( knotty pine wood, Pini Nodi Lignum) 15 g zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum

Liquido Fricta) 69 g zhe4 chong2 ( ground beetle, Eupolyphaga seu Steleophaga) 610 g tou4 gu3 cao3 ( speranskia/balsam, Speranskiae seu Impatientis

Herba) 20 g xun2 gu3 feng1 ( mollissima, Aristolochiae Mollissimae

Herba) 15 g zi4 ran2 tong2 ( pyrite, Pyritum) 69 g (soak in vinegar, pre-

decoct)21

:

Bu3 shen4 qu1 han2 zhi4 wang1 tang1 supplements the kidneys and expels cold, transforms dampness and courses wind, quickens the stasis and frees the network vessels, and strengthens sinew and bone.

:

20 If it is necessary to use 15 g of this medicinal, then pre-decoct it for 1020 minutes. (Au.) 21 The original formula included zhi4 hu3 gu3 (mix-fried tiger bone), which is now prohibited. I use the last three medicinals in this list to replace it. (Au.)

Lecture 4 49

This formula treats lame impediment in patients who have kidney-vacuity exuberant cold. Lame impediment encompasses diseases in modern medicine such as rheumatoid arthritis, rickets with rigidity of the spine, tuberculous arthritis, and osteoarthritis. The symptoms include pain in the joints of the limbs, joint deformity, and damage to the osseous tissue.

:

I created bu3 shen4 qu1 han2 zhi4 wang1 tang1 by combining and modifying gui4 zhi1 shao2 yao4 zhi1 mu3 tang1, which is from the Jin1 Gui4 Yao4 Lue94, and hu3 gu3 san3 (Tiger Bone Powder), from the Tai4 Ping2 Hui4 Min2 He2 Ji4 Ju2 Fang1. Within the formula, xu4 duan4 and bu3 gu3 zhi1 supplement kidney yang2 and strengthen the bones and sinews. Zhi4 fu4 pian4 strengthens kidney yang2 and dispels cold evil. Sheng1 di4 huang2 supplements the kidney and replenishes the essence and also nourishes the liver and boosts blood. These four are the chiefs.

Gu3 sui4 bu3 quickens stasis and expels bone wind. Yin2 yang2 huo4 supplements kidney yang2 and expels kidney wind.22 Gui4 zhi1, qiang1 huo2, du2 huo2, and wei1 ling2 xian1 track and dissipate wind-cold-damp evils in the lesser yin1 (shao4 yin1) and greater yang2 (tai4 yang2) channels and in the limbs. Bai2 shao2 yao4 nourishes blood and enhances the sinews and also relaxes tension and slackens hypertonicity. These are the support medicinals.

Fang2 feng1 dissipates wind, and ma2 huang2 dissipates cold. Together with shu2 di4 huang2, they warm the interstices of the flesh. Cang1 zhu2 transforms dampness. Chi4 shao2 yao4 quickens stasis and clears heat; zhi1 mu3 enriches the kidney and clears heat; chuan1 shan1 jia3 frees the

22 According to Su4 Wen4 (Elementary Questions), kidney wind ( shen4 feng1) is characterized by symptoms such as copious sweating and aversion to wind, puffy swelling of the face, pain and inability to straighten the spine, black-colored flesh, large tight pulse, and inability to eat. (Ed.)

Lecture 4 50

channels and dissipates accumulation; zhe4 chong2 quickens stasis and strengthens the sinews and bones; shen1 jin1 cao3 relaxes the tendons and quickens the network vessels; and song1 jie2 frees and disinhibits the joints. These are all assistant medicinals. Of these, chi4 shao2 yao4, zhi1 mu3, and zhe4 chong2 act as paradoxical assistants, because they prevent the transformation to heat that often results from using dampness-eliminating medicinals. Niu2 xi1, the courier, boosts the kidneys and guides the other medicinals to the kidneys.

: 10 1O 6 6

30 12 ()12

3040 912 15 912 40 9 () 12 12 9 ( 1 )

5 10 10

FORMULA MODIFICATIONS

For patients with severe symptoms in the upper limbs, add 10 g of pian4 jiang1 huang2 (sliced turmeric).

For pronounced blood stasis, add:

hong2 hua1 ( carthamus, Carthami Flos) 10 g ru3 xiang1 ( frankincense, Olibanum) 6 g mo4 yao4 ( myrrh, Myrrha) 6 g zao4 jiao3 ci4 ( gleditsia thorn, Gleditsiae Spina) 6 g

For pronounced pain in the lumbus and legs, remove song1 jie2 and cang1 zhu2 from the base formula, increase the dosages of xu4 duan4 and bu3 gu3 zhi1, and add 30 g of sang1 ji4 sheng1 (mistletoe) and 12 g of du4 zhong4 (eucommia). When taking the medicinals, the patient should also chew 12 pieces of mix-fried hu2 tao2 ren2 (walnut).

For stiff limbs, remove cang1 zhu2, fang2 feng1, and song1 jie2 and add the following:

Lecture 4 51

sheng1 yi3 mi3 ( raw coix seed, Coicis Semen Crudum) 3040 g mu4 gua1 ( chaenomeles, Chaenomelis Fructus) 912 g fu2 ling2 ( poria, Poria) 15 g bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 912 g

For rigidity, crookedness, or deformity of the spinal column, remove cang1 zhu2 and niu2 xi1, change the dosage of qiang1 huo2 to 12 g, and add:

gou3 ji3 ( cibotium, Cibotii Rhizoma) 40 g lu4 jiao3 jiao1 ( deerhorn glue, Cervi Cornus Gelatinum) 9 g23 bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 12 g

For severe pain in the joints, increase the dosage of fu4 pian4 and add 9 g of cao3 wu1 tou2 (wild aconite). Furthermore, take qi1 li2 san3 (Seven Pinches Powder) with the decoction, 1 g per dose.

If the tongue fur is white, thick, and slimy, remove shu2 di4 huang2 and add 5 g of sha1 ren2 (amomum) and 10 g of huo4 xiang1 (agastache).

For stomach duct distention with torpid intake due to center failing to move and transform, add 10 g each of chen2 pi2 (tangerine peel), jiao1 mai4 ya2 (scorch-fried barley sprout), and jiao1 shen2 qu1 (scorch-fried medicated leaven).

:(1) 46 (2) 3 3()

Pay attention to two points when using this formula. First, since this formula treats the root of the disease, patients invariably have to take the formula for 46 weeks before the curative effects begin to show. Second, after you see improvement in the patient, powder three packets of the formula and give it to the patient to take in 3 g doses with warm water or huang2 jiu3 (yellow wine). This facilitates long-term use.

"" 3

23 Alternatively, use either lu4 jiao3 pian4 (sliced deerhorn) or lu4 jiao3 shuang1 (degelatinated deer antler). (Au.)

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I use this formula with modifications according to the pattern to treat lame impediment and always have satisfactory results. I have recruited three groups of graduate students to research lame impediment, and they also all had fine results.

:

XX48,1971 10 28

: 1

CASE HISTORY

Here I would like to present a successful case study for your reference.

Case 1: Mr. Ren4, 48 years old, worker. Date of first visit: October 28, 1971.

Major complaint: For more than one year the patient had experienced joint pain, swelling and deformation of the joints, and increasing rigidity such that he was unable to independently move his limbs.

:1970 9 40 degrees C ( 55/) 80 (118 /)

Disease History: During September of 1970 the patient was digging as part of a tunnel building project, and sometimes between or after shifts he would go on breaks and rest or even go to sleep underground. One day he suddenly had a high fever of more than 40C (104.0F). Later he developed redness, swelling, and pain of the left knee and ankle, and walking became challenging. Although he received about six months of treatment, his condition was gradually getting worse. Both wrists and both index fingers developed redness, swelling, and pain, and these joints also became deformed and rigid such that motion was severely limited; when the patient got up in

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the morning he could not extend them. The patient had swollen and deformed knees and was unable to move them by himself; the left leg was particularly bad. Both ankles had extreme swelling.

A hospital tested him and diagnosed rheumatoid arthritis. At that time his erythrocyte sedimentation rate (ESR) was 55 mm per hour. He then turned to the Chinese medicine department of the hospital. The patient took 80 packets of medicinals, but there was no improvement in his condition, and in fact the ESR had increased to 118 mm per hour. That was when they sought my help with the treatment.

:( 120)

X

Presenting symptoms: In addition to the swelling, deformation, pain, and inflexibility of both knees, both ankles, both wrists, and the fingers, as explained above, the patient also had developed rigidity of the hip joints, such that his thighs and trunk were inflexibly locked at a 120 angle. The patients shoulder and elbow joints had also become rigid and immobile, so when the patient came in for treatment, someone had to carry him in.

The patient had a fever, but not continuously. He had fear of cold with vexation heat in the heart, poor appetite, and occasional nausea. He had bowel movements once or twice each day, yellow or reddish urine, slimy white tongue fur, and a stringlike rapid pulse. X-rays taken at our hospital showed that the patient still had rheumatoid arthritis.

:

Pattern identification: The conditions in underground work environments are cold and damp, and being in those conditions for a long time resulted in the patient contracting wind-cold-damp evils that assailed his channels and resulted in impediment. Cold-damp easily damages the kidney, and because the vacuous kidney could not defend against the evil, cold-damp exploited

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vacuity to make a deep invasion. Kidney governs the bones, and when cold evil entered the bones and abided for a long time, it deprived the bones of nourishment; this is what resulted in bone deformation, hypertonicity of joints and contraction of sinews, inability to bend the limbs, extremely swollen feet, and the seething with desire to vomit, all of which formed the lame impediment pattern. By correlating the pulse and signs, the diagnosis was lame impediment. Although the patient was showing signs of heat, those were from the branch and the true problem was cold.

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Method of treatment: supplement the kidney and dispel cold; dissipate wind and quicken