In Chinese Meridian Theory, as in the law, certain tests or standards must be met in order for a syndrome to be diagnosed. In the case of Tai Yang conditions, a floating pulse and stiffness of the back of the neck mark the first two standards. The rub is numerous other distinctions must be made based upon the progression of the condition relative the body's strength. This includes preexisting conditions such as age and constitution.
The following discussion on Tai Yang formulas allows for us to refine our diagnostic skills and raise deeper questions about common conditions. Central to any exploration of Tai Yang conditions is excess (yang) and deficiency (yin).
The formulas discussed are listed below:
Ge Gen Tang
Gui Zhi Jia Ge Gen
Gui Zhi Jia Ren Shen Tang
Gui Zhi Jia Hou Pu
Ma Huang Tang
Ge Gen Tang
Ge Gen Jia Ban Xia
Gui Zhi Jia Fu Zi
Da Qing Long
Xiao Qing Long
Excess versus deficient-- the initial stages
Quite simply the difference between a TY excess and deficient presentation is the presence of sweat. This axiomatically designates the condition as deficient. The rationale relates to a stagnation of yang qi that allows for the yin qi to seep through the pores. This is called "disharmony between wei and ying," which are more superficial aspects of the body. Sweat differentiates a TY deficient condition from bi syndrome, which can also present with neck stiffness and deficiencies but at deeper levels than wei and ying. Interestingly, however, most bi formulas contain gui zhi and many contain ma huang, both of which release the exterior/wei level. The chronicity of bi patterns is also a major differentiating factor from TY deficiency patterns. Beyond sweat, other TY deficiency symptoms include a moderate or weak pulse.
The sudden onset of neck stiffness without sweat indicates an excess pattern. In such cases, the body is considered strong enough for robust formulas. Ge Gen Tang is therefore appropriate. If, on the other hand, sweat is present then Gui Zhi Jia Ge Gen Tang is what the doctor should order.
Longstanding body aches that result from improper sweating call for Guizhi Jia Ren Shen Tang. This formula is often used in cases of fibromyalgia and even postpartum pain, so understanding the nature of the deficiency vis-a-vis the individual's constitution will determine the appropriateness of this formula. A practitioner will want to pay special attention to the state of blood, as pain cases are often the result of blood stagnation in combination with deficiency.
Asthmatic presentations follow the same logic. Sudden onset asthma with sweating is best addressed with Gui zhi Ho Pu Tang, whereas non-sweating asthma calls for Ma Huang Tang. There are numerous formulas for asthma and I have my doubts about the functionality of either of these formulas. This because by the time a patient feels the need for a doctor's visit, their condition has advanced beyond the the initial stages. For instance, phlegm indicates an advanced condition that would require some modification to more directly address phlegm, which is almost always present in asthma. In an instance of another asthmatic condition, coughing at night, an entirely different etiology is at play and the above formulas should be altogether avoided.
Just what in the world does "deficiency" mean in Chinese medicine? Just because a person develops really strong symptoms doesn't mean that they are deficient. In fact, it usually means the opposite because the body has more energy with which to mount its attack. This reasoning seems to characterize the formulas that allopathically treat the strong symptoms of diarrhea and vomiting, Ge Gen Tang and Ge Gen Jia Ban Xia respectively. These two patterns represent a combination of TY and Yang Ming conditions that exhibit no weakening of the body's response to the pathogen. The advance of the pathogen nevertheless proceeds afoot.
More insight into the differences between excess and deficiency is gained when considering treatment principles. Releasing exterior occurs in both deficiency and excess patterns, however, deficiency also requires harmonizing ying and wei. Deficiency may also require tonification of yang qi, as in Gui Zhi Jia Fu Zi Tang, for copious sweating, vomiting, and loss of fluids. Similarly, an aspect of yang is boosted in Gui Zhi Jia Ren Shen, which to reiterate is for body aches.
Excess presentations require no supplementation and may include more aggressive forms of clearing, such as in Da Qing Long Tang, a pattern also known as "fire wrapped by ice," characterized by the TY symptoms and the presence of irritability. Clearing is even appropriate in presentations that appear to possess deficiency components, as in the case of Xiao Qing Long Tang, which is often prescribed for cases of pneumonia. The excess in this case is the congested fluids that must be cleared from the lung.
It's important to note that vomiting is neither a sign of excess or deficiency. Ge Gen Jia Ban Xia and Gui Zhi Jia Fu Zi both do this. In the case of the latter, vomiting will not be the primary symptom.
In short, as with all syndromes of Chinese Meridian Theory symptoms may take different forms depending on the particulars of the patient. TY syndromes are early stage conditions that must be treated quickly to prevent the advance of the pathogen. In some cases, these formulas are used to treat conditions that have nothing to do with early onset, but are presumably appropriate because the pathogen has failed to advance beyond the very superficial levels of ying and wei.
Sunday, October 21, 2007
Tuesday, October 9, 2007
Dryness Formulas
A central tenet of Chinese meridian theory is that pathogens track with a predictable progression through the body. Different seasons bring varying influences into the body. Autumn is the season of dryness. Below is a discussion of the "dryness" pathogen and its progression as articulated by Wu Ju-tong (1757-1841), one of the most highly regarded herbalists of the Qing Dynasty, heralding from the Warm Disease school, which specialized in seasonal affective disorders.
The purpose of the following article is to acquaint readers who have a passion for Chinese herbalism with Warm Disease perspectives on dryness by discussion the common formula prescriptions.
Formulas:
Sang Xing Tang
Sang Ju Yin
Sha Shen Mai Men Dong
Qiao He Tang
Qing Zao Jiu Fei Tang
Discussion
Sang xing tang and Sang ju yin are both for initial stage dryness. The condition is in the lung and wei levels. Use acrid, cool, clearing, and moistening herbs.
Sha shen mai men dong tang is for dryness that has damaged "yin aspects of the lung and stomach, [presenting] with fever or cough. This is a deeper level of damage than above, therefore the addition of sweet is needed to assist in the production of jin and ye.
Qiao he tang treats dryness transforming into fire and Qing zao jiu fei tang treats pent-up (fen yu) qi.
The interesting thing is that all these formulas treat dryness, specifically heat dryness. Dryness patterns range from conditions resembling wind-heat to yin deficiency, so the texts are adamant about doing proper differentiation. The problem is that differentiation is much easier said than done because constitutional patterns often must be considered in addition to the acute presentation.
The formulas above are characterized by their treating the lung primarily and stomach secondarily. It is interesting to note that the text's commentators place considerable emphasis on the role of earth as mother to metal. Fascinatingly, this also leads to their stunningly obvious but daring conclusion that autumn dryness is actually born from summer dampness. Be that as it may, aromatic damp transformers, so central to all dampness formulas, do not find their way into any of the above formulas.
Since these formulas track the progression of heat through the meridians of the lung, differentiation turns on duration and severity of the condition. By far the most severe presentation belongs to "dryness transformed into fire." In contrast to clear repletion fire formulas however, heavy bitter herbs are not appropriate. Toxicity is cleared through the bitter, slight sweet, and bland of he ye (lotus leaf) and the anti-toxicity of lian qiao (forcythia), an herb that must rank among the lightest of the category. Hallmark signs are tinnitus and red eyes, but accompanying upper jiao symptoms, such has weakness, wheezing, and vomiting, can also be present. Herbs that can be used are fresh ju hua, ku ding cha, xia ku cao, niu bang zi, and huang qin.
Dryness that progresses beyond the initial stage, that which damages the lung and stomach yin calls for Sha shen mai men dong tang. The first two formulas Sang xing tang and sang ju yin are for the initial stages. The latter of these two would be used for initial stage dryness that also presents with a cough.
Initial stage conditions are characterized by lung and wei presentations, whereas deeper stages do not have wei symptoms. This means when differentiating between whether to administer first stage or second stage (so to speak) formulas, it is important to determine whether wei syndromes are still present. Constitutionally speaking, deficient patients-- individuals with lung deficiency, pre-existing dampness, or yin deficiency-- may never present in the clinic with wei patterns because their wei qi, and by extension zheng qi, is already on the deficient side.
We conclude this discussion on dryness with Qing zao jiu fei tang. I have personally found this formula helpful for yin deficiency cough. A strong reminder is served to practitioners about using cold and bitter herbs for dryness for diminishing heat symptoms in the case of lung dryness. This formula focuses on stomach earth as mother of lung metal. Though it is easy to note the spleen lung relationship, this text reminds us that the yang aspect of earth is the focus of dryness conditions. Herbs that clear and moisten (run) are consequently called for.
All of the above formulas are discussed in Bensky with the exception of Qiao he tang, so its ingredients are provided below:
Bo he 1 qian 5 fen
Lian qiao 1 qian 5 fen
Sheng gan cao 1 qian
Black zhi zi 1 qian 5 fen
Jie Geng 3 qian
Lu dou yi 2 qian
Source text: Wen Bing Xue. Meng Shu-jiang ed., Ren min wei sheng chu ban she, 1989 1st edition 1997 3rd printing.
The purpose of the following article is to acquaint readers who have a passion for Chinese herbalism with Warm Disease perspectives on dryness by discussion the common formula prescriptions.
Formulas:
Sang Xing Tang
Sang Ju Yin
Sha Shen Mai Men Dong
Qiao He Tang
Qing Zao Jiu Fei Tang
Discussion
Sang xing tang and Sang ju yin are both for initial stage dryness. The condition is in the lung and wei levels. Use acrid, cool, clearing, and moistening herbs.
Sha shen mai men dong tang is for dryness that has damaged "yin aspects of the lung and stomach, [presenting] with fever or cough. This is a deeper level of damage than above, therefore the addition of sweet is needed to assist in the production of jin and ye.
Qiao he tang treats dryness transforming into fire and Qing zao jiu fei tang treats pent-up (fen yu) qi.
The interesting thing is that all these formulas treat dryness, specifically heat dryness. Dryness patterns range from conditions resembling wind-heat to yin deficiency, so the texts are adamant about doing proper differentiation. The problem is that differentiation is much easier said than done because constitutional patterns often must be considered in addition to the acute presentation.
The formulas above are characterized by their treating the lung primarily and stomach secondarily. It is interesting to note that the text's commentators place considerable emphasis on the role of earth as mother to metal. Fascinatingly, this also leads to their stunningly obvious but daring conclusion that autumn dryness is actually born from summer dampness. Be that as it may, aromatic damp transformers, so central to all dampness formulas, do not find their way into any of the above formulas.
Since these formulas track the progression of heat through the meridians of the lung, differentiation turns on duration and severity of the condition. By far the most severe presentation belongs to "dryness transformed into fire." In contrast to clear repletion fire formulas however, heavy bitter herbs are not appropriate. Toxicity is cleared through the bitter, slight sweet, and bland of he ye (lotus leaf) and the anti-toxicity of lian qiao (forcythia), an herb that must rank among the lightest of the category. Hallmark signs are tinnitus and red eyes, but accompanying upper jiao symptoms, such has weakness, wheezing, and vomiting, can also be present. Herbs that can be used are fresh ju hua, ku ding cha, xia ku cao, niu bang zi, and huang qin.
Dryness that progresses beyond the initial stage, that which damages the lung and stomach yin calls for Sha shen mai men dong tang. The first two formulas Sang xing tang and sang ju yin are for the initial stages. The latter of these two would be used for initial stage dryness that also presents with a cough.
Initial stage conditions are characterized by lung and wei presentations, whereas deeper stages do not have wei symptoms. This means when differentiating between whether to administer first stage or second stage (so to speak) formulas, it is important to determine whether wei syndromes are still present. Constitutionally speaking, deficient patients-- individuals with lung deficiency, pre-existing dampness, or yin deficiency-- may never present in the clinic with wei patterns because their wei qi, and by extension zheng qi, is already on the deficient side.
We conclude this discussion on dryness with Qing zao jiu fei tang. I have personally found this formula helpful for yin deficiency cough. A strong reminder is served to practitioners about using cold and bitter herbs for dryness for diminishing heat symptoms in the case of lung dryness. This formula focuses on stomach earth as mother of lung metal. Though it is easy to note the spleen lung relationship, this text reminds us that the yang aspect of earth is the focus of dryness conditions. Herbs that clear and moisten (run) are consequently called for.
All of the above formulas are discussed in Bensky with the exception of Qiao he tang, so its ingredients are provided below:
Bo he 1 qian 5 fen
Lian qiao 1 qian 5 fen
Sheng gan cao 1 qian
Black zhi zi 1 qian 5 fen
Jie Geng 3 qian
Lu dou yi 2 qian
Source text: Wen Bing Xue. Meng Shu-jiang ed., Ren min wei sheng chu ban she, 1989 1st edition 1997 3rd printing.
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