1 THE THREE TREASURES by Giovanni Maciocia
2 2 AROUSE POWER Tu Si Zi Semen Cuscutae Suo Yang Herba Cynomorii Yin Yang Huo Herba Epimedii Gou Qi Zi Fructus Lycii Wu Wei Zi Fructus Schisandrae Dan Shen Radix Salviae miltiorrhizae Yuan Zhi Radix Polygalae Lu Lu Tong Fructus Liquidambaris Chuan Niu Xi Radix Cyathulae Gui Zhi Ramulus Cinnamomi Mu Dan Pi Cortex Moutan Huang Bo Cortex Phellodendri She Chuang Zi Fructus Cnidii Zhi Gan Cao Radix Glycyrrhizae preparata Pattern: Kidney-Yang deficiency, Heart-Qi deficiency, Damp-Heat in the Lower Burner. Action: tonify Kidney-Yang, tonify Heart-Qi, stimulate the descending of Heart-Qi, drain Damp- Heat, calm the Mind. Indications: impotence, premature ejaculation, decreased libido, decreased sexual function, frigidity, insomnia, depression, backache, urinary difficulty, dizziness, tinnitus. Tongue: pale. Pulse: Deep, Weak. Explanation Tu Si Zi, Suo Yang and Yin Yang Huo tonify Kidney-Yang and strengthen the sexual function. Gou Qi Zi nourishes Liver- and Kidney-YIn. Wu Wei Zi, Dan Shen and Yuan Zhi enter the Heart and calm the Mind. Lu Lu Tong and Chuan Niu Xi invigorate Blood and remove obstructions from the Luo channels: Chuan Niu Xi directs the formula to the Lower Burner. Gui Zhi and Mu
3 Dan Pi enter the blood vessels: one hot, the other cold, they invigorate Blood. Huang Bo and She Chuang Zi eliminate Dampness from the Lower Burner. 3 Mental-emotional pattern Key word: Steadfastness This remedy acts on the Zhi of the Kidneys and the Shen of the Heart. It is designed to promote the communication and mutual nourishment between the Heart and the Kidneys. To understand this remedy, we must look at a different 5-Element diagram that the circular one of the Sheng cycle (Wood nourishes Fire, Fire nourishes Earth, etc.). We must visualize a cross-like 5- Element diagram with the Water at the bottom (North), Fire at the top (South), Wood on the left (East), Metal on the right (West) and the Earth in the centre. In this view of the 5 Elements, Fire and Water (and therefore Heart and Kidneys) communicate with each other and nourish each other: Fire descends to meet the Water and Water rises to meet Fire (each contrary to their normal movements as Fire normally rises and Water descends). The communication and mutual nourishment of Heart and Kidneys has many clinical applications and an important one is in the field of mental-emotional life. The Heart houses Shen and the Kidneys Zhi. Zhi may refer to distinct aspects: one is memory, the other is will-power. The second one is clinically more important. In the second and clinically more important sense, the Kidneys house Will-Power which indicates drive, determination, single-mindedness in the pursuit of goals, enthusiasm and motivation. Thus if the Kidneys are strong, the Will-Power is strong and the person will have drive, enthusiasm, motivation and determination in the pursuit of goals. If the Kidneys are depleted and the Will-Power weakened, the person will lack drive and initiative, will be easily discouraged and swayed from his or her aims. A deficiency of the Kidneys and Will-Power is an important aspect of chronic depression. As we know, the Kidneys also control the sexual function: in men, they control sexual desire and sexual function (i.e. erection and ejaculation). In women, they control sexual desire and the capacity to reach an orgasm. However, the connection and mutual nourishment between Heart and Kidneys also influences the sexual function. Thus, all the sexual functions just described in
4 4 both men and women, depend not only on the Kidneys but also on the capacity of Heart-Qi to descend to the Kidneys. For example, in men the descending of Heart-Qi is important to induce erection and control ejaculation. Therefore, in many cases (and especially in young men) sexual problems such as erectile dysfunction and premature ejaculation may be due to Heart-Qi not descending to the Kidneys in the case of the former and descending too quickly in the case of the latter. This remedy stimulates the communication and mutual nourishment between Heart and Kidneys both in the mental-emotional and sexual sphere. From the mental-emotional point of view, when the Heart and Kidneys fail to communicate, the person may be depressed and lack will-power, enthusiasm and drive, all functions of the Zhi of the Kidneys. Caution and contraindications There are no special contraindications for this remedy; one should remember that it contains two quite hot Yang tonics (Suo Yang and Yin Yang Huo) and one should therefore be certain that the patient is indeed suffering from Yang deficiency. Therefore, a pale tongue is an important necessary sign for the prescription of this formula. Remedy in a nutshell: tonify the Kidneys and the Heart and the Zhi and Shen, promote the communication between Heart and Kidneys for sexual and mental-emotional life.
5 5 BEND BAMBOO Dang Gui Radix Angelicae sinensis Chuan Xiong Rhizoma Chuanxiong Shu Di Huang Radix Rehmanniae preparata Sang Ji Sheng Herba Taxilli Bai Shao Radix Paeoniae alba Ju Hua Flos Chrysanthemi Gou Teng Ramulus Uncariae cum Uncis Man Jing Zi Fructus Viticis Bai Ji Li Fructus Tribuli Gou Qi Zi Fructus Lycii Fu Ling Poria Zhi Gan Cao Radix Glycyrrhizae preparata Pattern: Liver-Blood deficiency, causing Liver-Yang rising. Action: Nourish Liver-Blood, subdue Liver-Yang, stop headaches. Indications: chronic headaches which occur sometimes along the Gall-Bladder channel and temples with a throbbing pain, and sometimes on the vertex with a dull ache, accompanied by nausea, dizziness and possibly vomiting. Other symptoms may include poor memory, tingling of limbs, blurred vision, dry hair and skin, scanty periods. Tongue: Pale and Thin. Pulse: Choppy. Explanation Bend Bamboo is a new prescription formulated to nourish Liver-Blood and subdue Liver-Yang.
6 This combination of patterns is a common cause of chronic headaches, especially in women and existing Chinese patent remedies do not address this clinical situation. The nucleus of the formula is Si Wu Tang Four Substances Decoction which nourishes Blood. Liver-Yang rising may originate from different patterns: Kidney-Yin deficiency, Kidney- and Liver-Yin deficiency, Liver-Blood deficiency and simultaneous Kidney-Yin and Kidney-Yang deficiency. Bend Bamboo is mostly for Liver-Yang rising from Liver-Blood deficiency but it may also be used if there is Liver-Yin deficiency. Liver-Yang rising is not a Full pattern in the same way as, for example, Liver-Fire, Dampness or Phlegm. Liver-Yang rising, rather than being a pathogenic factor is an imbalance between Yin and Yang: the Yin is deficient below (i.e. Liver-Blood, Liver-Yin or Kidney-Yin deficiency) and the Yang rises to the head. Therefore, there are two aetiological factors to this clinical situation. On the one hand, there are factors that cause a deficiency of Liver-Blood, Liver-Yin and Kidney-Yin. These are emotional factors such as sadness and fear and life factors such as overwork, poor diet of excessive blood loss during childbirth. On the other hand, there are factors that cause Liver-Yang to rise: these are definitely emotional factors such as anger, frustration, resentment and worry. Please note that the rising of Liver-Yang is not always due to anger: worry may also make Liver- Yang rise. With regard to worry, chapter 23 of the Simple Questions says: When Qi rushes 1 upwards it affects the Liver causing worry. Zhang Jie Bin summarizes the effect of each emotion on groups of organs in chapter 216 of his book The Classic of Categories (Lei Jing, 1624) in a long statement from which I will quote only the part relevant to worry: Worry makes Qi rise and can affect the Liver; the Liver becomes overactive. 2 Note that Liver-Yang rising is very different from Liver-Fire. Liver-Fire is a real pathogenic factor while Liver-Yang is purely an imbalance of Qi with Yang rising and Yin being deficient below. With Liver-Fire, there are symptoms of solid Fire such as intense thirst, dark urine, dry stools and bitter taste: there are no such symptoms with Liver-Yang rising. It follows that the treatment of these two patterns is very different: with Liver-Fire, we need to drain it by using bitter-cold herbs. With Liver-Yang rising we need to subdue it with herbs that subdue Qi (often minerals). Also, in headaches from Liver-Yang rising, we also need to use 6
7 7 herbs that extinguish Liver-Wind. At the same time, of course, we need to nourish Yin (which may be Liver-Blood, Liver-Yin or Kidney-Yin). Mental-emotional pattern Key words: Interior Peace Liver-Blood is weakened by prolonged sadness. Although we do not associate usually sadness with the Liver, in women, sadness can indeed weaken Liver-Blood. For example, the Spiritual Axis in chapter 8 mentions injury of the Liver from sadness rather than anger: When sadness affects the Liver it injures the Ethereal Soul [Hun]; this causes mental confusion the 3 Yin is damaged, the tendons contract and there is hypochondrial discomfort. Of course, it is not unusual for patients to suffer from complex emotional patterns so that sadness injuring Liver- Blood may be associated with frustration and resentment which cause Liver-Yang to rise. In some cases, Liver-Blood deficiency may be due to fear and the rising of Liver-Yang to worry. Caution and contraindications There are no specific contraindications for this remedy. Remedy in a nutshell: nourish Liver-Blood and subdue Liver-Yang for chronic headaches. BENEFIT THE SINEWS Tao Ren Semen Persicae Hong Hua Flos Carthami Chuan Xiong Rhizoma Chuanxiong Dang Gui Radix Angelicae sinensis Ru Xiang Gummi Olibanum Ban Xia Rhizoma Pinelliae preparatum Chen Pi Pericarpium Citri reticulatae Gua Lou Fructus Trichosanthis
8 8 Xi Xian Cao Herba Siegesbeckiae Hai Feng Teng Caulis Piperis kadsurae Wei Ling Xian Radix Clematidis Du Zhong Cortex Eucommiae Gou Qi Zi Fructus Lycii Cang Zhu Rhizoma Atractylodis Huang Bo Cortex Phellodendri Shen Qu Massa medicata fermentata Pattern: Blood stasis, Phlegm and Dampness in the joints, Kidney deficiency. Action: Invigorate Blood, resolve Phlegm, expel Wind-Dampness, dry Dampness. Indications: Chronic Bi Syndrome, chronic joint pain with swelling of the joints and bone deformities, rigidity of joints, backache, dizziness, tinnitus, tiredness, lack of will-power, mental confusion, anxiety, mental restlessness. Tongue: pale, red or purple, swollen, sticky coating. Pulse: Choppy, Wiry or Firm (from Blood stasis) or Slippery (from Phlegm). Explanation Tao Ren, Hong Hua, Chuan Xiong, Dang Gui and Ru Xiang invigorate Blood; in particular, Ru Xiang invigorates Blood in the channels and frees the joints. Ban Xia, Chen Pi and Gua Lou resolve Phlegm. Xi Xian Cao, Hai Feng Teng and Wei Ling Xian expel Wind-Dampness from the channels and joints. Du Zhong and Gou Qi Zi nourish the Kidneys and Liver. Cang Zhu and Huang Bo resolve Dampness. Shen Qu helps to digest the herbs. Mental-emotional pattern Key words: Breaking Through Both Phlegm and Blood stasis are obstructive: not only do they obstruct the channels and joints but they also affect the Mind and obstruct the Mind s orifices. Phlegm and Blood stasis
9 9 both results from long-standing imbalances with emotional problems at their root. Blood stasis often derives from Qi stagnation which itself derives from emotional problems. Most emotions may lead to Qi stagnation: sadness, worry, anger, joy (which means excessive stimulation), fear, grief, shame and guilt. In the case of chronic Bi, I find the stagnation underlying this disease often due to worry, resentment or guilt. The association of Blood stasis with Phlegm will obstruct the Mind s orifices even more and a person suffering from such a pathology will tend to be frustrated, resentful and often tormented by guilt: they will take all the burdens of the world onto themselves. Caution and contraindications Although Benefit the Sinews contains some Kidney tonics, its main impact is on the Manifestations (Biao): it resolves Phlegm and invigorates Blood in chronic Bi Syndrome when there is Phlegm and Blood stasis in the joints. For this reason, the remedy should not be prescribed for longer than about 4-6 months, after which time it should be discontinued for one month. Acupuncturists can direct their attention to treating the Root (Ben) by tonifying the Kidneys and Liver. Benefit the Sinews is contraindicated in pregnancy. Remedy in a nutshell: chronic Bi syndrome with Phlegm, Dampness and Blood stasis in the joints and an underlying Kidney deficiency. Swollen joints, rigidity, severe pain, rheumatoid arthritis. BREAK INTO A SMILE Chai Hu Radix Bupleuri Bai Shao Radix Paeoniae alba Zhi Gan Cao Radix Glycyrrhizae preparata Zhi Ke Fructus Aurantii
10 10 Chen Pi Pericarpium Citri reticulatae Xiang Fu Rhizoma Cyperi Chuan Xiong Rhizoma Chuanxiong Dan Shen Radix Salviae miltiorrhizae Tai Zi Shen Radix Pseudostellariae Yan Hu Suo Rhizoma Corydalis Suan Zao Ren Semen Ziziphi spinosae Fu Ling Poria Pattern: Liver-Qi stagnation, Spleen- and Stomach-Qi deficiency. Action: regulates Qi, eliminates stagnation, harmonizes the Liver, stops pain. Indications: epigastric or abdominal distension, abdominal pain against a background of emotional problems, flatulence, belching, irritability, depression. Tongue: normal or slightly red on the sides. Pulse: Wiry. Explanation Break into Smile is a variation of Chai Hu Shu Gan Tang Bupleurum Soothing the Liver Decoction which moves Liver-Qi and eliminates stagnation. The classic prescription was modified by adding Dan Shen Radix Salviae militiorrhizae to invigorate Blood and calm the Mind. Tai Zi Shen Radix Pseudostellariae was added to nourish Stomach-Yin as this often accompanies Liver-Qi stagnation or to protect Stomach-Yin from the hot and pungent herbs in the formula. Suan Zao Ren Semen Ziziphi spinosae was added to anchor the Hun. Yan Hu Suo Rhizoma Corydalis was added to enhance the analgesic effect of the formula and Fu Ling Poria to resolve Dampness.. The formula treats the symptom of distension (zhang) that is a typical symptom of Qi stagnation. Most English-speaking patients would use the word bloating. It is useful to compare and contrast this formula with Smooth Passage and Soothe the Centre. All three treat Liver-Qi stagnation, but there are differences:
11 11 - Break into a Smile is for Liver-Qi stagnation as a Full condition, while Smooth Passage is for stagnant Liver-Qi invading the Intestines and Spleen in the Lower Burner; Soothe the Centre is for stagnant Liver-Qi invading the Stomach in the Middle Burner. - The pulse indicating the use of Break into a Smile is Wiry on all positions, while that indicating the use of Smooth Passage is often Wiry on one side only or Wiry on both third positions. The pulse indicating the use of Soothe the Centre is Wiry on the left and Weak on the right or Wiry on both second positions. - Break into a Smile is specific for abdominal pain while Smooth Passage and Soothe the Centre can be used for a feeling of distension of fullness. Table 1 compares and contrasts Break into a Smile, Soothe the Centre and Smooth Passage. Table 1. Comparison of Break into a Smile, Soothe the Centre and Smooth Passage. Break into a Smile Soothe the Centre Smooth Passage Pattern Liver-Qi stagnation Liver-Qi stagnation, Stomach deficiency Liver-Qi stagnation, Spleen deficiency, Dampness Burner Lower Middle Lower Pulse Wiry Wiry on guan position Wiry on chi position Symptoms Lower abdominal Upper abdominal Lower abdominal distension and pain distension and pain distension and pain, alternation of loose stools and constipation Mental-emotional pattern Key word: Acceptance. The pattern derives from anger especially if it is repressed and not manifested. Anger is
12 12 used here in a broad sense including frustration, resentment, repressed anger and hatred. From an emotional perspective, the most characteristic and common signs are depression, alternation of moods, irritability, snapping easily and frustration. Qi stagnation hinders the movement of the Hun and leads to depression, disorientation and a feeling of lack of direction in one s life. Just as the formula treats physical pain, it also treats emotional pain and anguish deriving from frustration and resentment. Caution and contraindications Herbs that move Qi are pungent and mostly hot and, in the long run, they may damage Yin. For this reason, the formula contains Tai Zi Shen to protect Stomach-Yin. However, the damage to Yin is not likely to occur in the short term. If the patient needs to take this remedy for the long term, it is advisable to stop it for a month every 4-5 months. Classical antecedent: Chai Hu Shu Gan Tang Bupleurum Soothing the Liver Decoction. Remedy in a nutshell: Liver-Qi stagnation from emotional problems, abdominal pain. BREAKING CLOUDS Ren Shen Radix Ginseng Huang Qi Radix Astragali Bai Zhu Rhizoma Atractylodis macrocephalae Dang Gui Radix Angelicae sinensis Sheng Ma Rhizoma Cimicifugae Chai Hu Radix Bupleuri Chen Pi Pericarpium Citri reticulatae Zhi Gan Cao Radix Glycyrrhizae preparata Yuan Zhi Radix Polygalae Shi Chang Pu Rhizoma Acori tatarinowii
13 13 Bai He Bulbus Lilii Qing Pi Pericarpium Citri reticulatae viride Du Zhong Cortex Eucommiae Wu Wei Zi Fructus Schisandrae Pattern: Qi deficiency, sinking of Qi, Qi stagnation. Action: Tonify and lift Qi, move Qi, lift the Spirit, open the Mind's orifices. Indications: Mental depression, tiredness, sadness, despondency, lack of will power, negativity, feelings of guilt, feelings of worthlessness, poor appetite, craving for sweets, loose stools, slight breathlessness, weak voice, pale complexion. Tongue: Pale. Pulse: Choppy, without "wave", short. Explanation There are three possible disharmonies of the Mind and Spirit: the Mind can be Weakened which is characterized by mental depression; Unsettled which is characterized by anxiety; and Obstructed which is characterized by some loss of insight. In mental depression, the Mind is Weakened and the Spirit is depressed. Depression can be caused by many patterns and the present formula addresses depression primarily from Qi deficiency and secondarily from Qi stagnation. "Obstruction" of the Mind occurs when severely stagnant Qi, stagnant Blood or Phlegm cloud the Mind's orifices: this results, in extreme cases, in psychosis. For example, stagnant Blood after childbirth may cause postpartum psychosis (addressed by the ancient formula Tao He Cheng Qi Tang); or Phlegm-Heat may cause bipolar disorder. However, obstruction of the Mind's orifices may also occur in milder degrees resulting in phobias, obsessive behaviour, obsessive thinking, etc. Clouding of the Mind's orifices may occur as a secondary problem in depression resulting often in obsessive thinking and behaviour. This formula is primarily for Mind Weakened, i.e. depression occurring against
14 14 a background of Qi deficiency. However, it is also for Mind Obstructed and, for this reason, it contains Yuan Zhi and Shi Chang Pu to open the Mind's orifices. The formula is a variation of Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction which tonifies and lifts Qi: the mental correspondent of this action on Qi is a lifting of mood. Ren Shen, Huang Qi and Bai Zhu tonify and lift Qi. In particular, Huang Qi lifts Qi in combination with Sheng Ma and Chai Hu. Dang Gui Shen nourishes Blood. Chen Pi prevents a possible "sticky" action of the Qi tonics. Yuan Zhi and Shi Chang Pu open the Mind's orifices. Bai He and Wu Wei Zi nourish the Lungs to relieve sadness. Qing Pi moves Qi; Du Zhong tonifies Kidney-Yang and strengthens the will-power, which is an important action in relieving depression. Mental-emotional pattern Key word: Rebirth. This person will be intensely depressed and suffer from lack of self-esteem and selfconfidence. He or she will find pleasure in nothing and will suffer from intense feelings of guilt. Although they may bravely try to soldier on, they are in a constantly depressed mood and the strain of carrying on may sometimes feel too much for them. They will have a feeling of unreality and will find it difficult to cope socially; they have a tendency to bouts of crying and will often describe their feeling as "if being in a dark tunnel without exit". Caution and contraindications This remedy is contraindicated in asthma (because it lifts Qi). Classical antecedent: Bu Zhong Yi Qi Tang (Tonifying the Centre and Benefiting Qi Decoction). Remedy in a nutshell: depression from Qi deficiency.
15 15 BRIGHT SPIRIT Zhu Ru Caulis Bambusae in Taeniam Ban Xia Rhizoma Pinelliae preparatum Chen Pi Pericarpium Citri reticulatae Fu Shen Sclerotium Poriae pararadicis Qing Pi Pericarpium Citri reticulatae viride Shi Chang Pu Rhizoma Acori tatarinowii Yuan Zhi Radix Polygalae Xiang Fu Rhizoma Cyperi He Huan Pi Cortex Albiziae Mei Gui Hua Flos Rosae rugosae Yu Jin Radix Curcumae Pattern: Liver- and Heart-Qi stagnation, Phlegm obstructing the Mind s orifices. Action: moves Liver- and Heart-Qi, calms the Mind, resolves Phlegm, opens the Mind s orifices, stimulates the movement of the Hun. Indications: depression, labile mood, indecision, a feeling of lack of direction in life, confusion about one s aims, bad digestion with a feeling of distension and fullness, sighing, palpitations, a feeling of oppression of the chest, a feeling of obstruction of the throat, slight breathlessness, poor appetite, weak and cold limbs, pale complexion. Tongue: slightly Pale-Purple in the chest area, swollen, sticky coating. Pulse: Wiry and slightly Overflowing on the left-cun position or Wiry and Slippery. Explanation Zhu Ru, Ban Xia, Chen Pi and Fu Shen resolve Phlegm. Qing Pi, Xiang Fu and Yu
16 16 Jin move Qi; Yu Jin also invigorates Blood and opens the Mind s orifices. Shi Chang Pu and Yuan Zhi open the Mind s orifices. He Huan Pi and Mei Gui Hua move Liver-Qi and lift depression. Mental-emotional pattern Key word: Bright Soul Qi stagnation impairs the movement of the Hun. The movement of the Hun confers movement to the Shen of the Heart: this movement means inspiration, a sense of direction in life, enthusiasm, creativity. In the absence of these, the person will feel depressed. It is therefore important in such cases to stimulate the movement of the Hun. Phlegm tends to obstruct the Mind s orifices: in very severe cases, this results in loss of insight and mental illness such as bipolar disease and schizophrenia. However, obstruction of the Mind can occur in many degrees of severity and, in mild cases, it causes some mental confusion. When combined with the depression deriving from Qi stagnation, the person is depressed and confused. Obstruction of the Mind may also cause obsessive behaviour. As the Liver is affected, there is also irritability. This combination of patterns is most likely to derive from anger, repressed anger, frustration, resentment, worry and guilt. Please note that Qi stagnation affects not only the Liver: indeed, it may affect any organ. In the context of mental-emotional problems, Qi stagnation can and does affect the Heart leading to depression and irritability. Caution and contraindications None. Remedy in a nutshell: Qi stagnation and Phlegm causing depression.
17 17 BRIGHTEN THE EYES Dang Gui Radix Angelicae sinensis Shu Di Huang Radix Rehmanniae preparata Chuan Xiong Rhizoma Chuanxiong Bai Shao Radix Paeoniae alba Gou Qi Zi Fructus Lycii Tu Si Zi Semen Cuscutae Nu Zhen Zi Fructus Ligustri lucidi Ju Hua Flos Chrysanthemi Man Jing Zi Fructus Viticis Mi Meng Hua Flos Buddleiae Bai Ji Li Fructus Tribuli He Shou Wu Radix Polygoni multiflori preparata Hong Zao Fructus Jujubae Pattern: Deficient Liver-Blood and Kidneys not nourishing the eyes. Action: Nourish Liver-Blood and the Kidneys, brighten the eyes. Indications: dull headaches from Liver-Blood deficiency, especially if located around the eyes and eyebrows, blurred vision, floaters, gritty eyes, tired eyes, dry eyes, dizziness, tiredness, dullpale complexion, scanty periods, depression, insomnia (difficulty in falling asleep), slight anxiety, tingling in the limbs, poor memory, lower backache, slight tinnitus, dry hair. Tongue: Pale, especially on the sides, thin. Pulse: Choppy or Fine. Explanation This is a new formula based on the prescription Si Wu Tang ("Four Substances Decoction" ) with the addition of herbs to nourish the Kidneys and brighten the eyes, such as Tu Si Zi, Gou Qi Zi and Nu Zhen Zi. This formula can be used where there is deficiency either of Kidney-Yang or
18 18 of Kidney-Yin, which may be combined with Blood deficiency as explained below. Shou Wu was added as it nourishes Blood and the eyes. Ju Hua, Man Jing Zi and Bai Ji Li were added to brighten the eyes. Chuan Xiong was added to invigorate Blood; this is necessary when several Blood-nourishing herbs are used. The formula is new in so far as it combines nourishing Blood with strengthening the Kidneys, although it is primarily for the former. Especially in women, there is very often an overlap between Blood deficiency and Kidney deficiency. This is because the Uterus (as an extra Fu organ) stores Blood and is functionally related to the Kidneys (through the Bao Mai, the channel that links the Uterus with the Kidneys, and through the extraordinary vessels Ren Mai and Chong Mai). The formula is for a wide range of eye problems stemming from a deficiency of Liver-Blood and Kidneys. This is the most common pattern at the root of chronic eye problems in practice. With the appropriate pattern presentation, it may also be used for other symptoms centered around the head, especially dizziness or headaches. Although Brighten the Eyes was formulated for eye problems deriving from Liver-Blood deficiency, it can also be used as a general Blood tonic as it is based on the formula Si Wu Tang Four Substances Decoction with addition of other Blood tonics. As a Blood tonic, it is particularly suitable for women as it also nourishes the Kidneys. Mental-emotional pattern Key words: Inner Vision. The person may feel easily depressed and lack a sense of direction in life. He or she will be undecided about goals and unable to plan life. These patterns are due to the deficient Liver-Blood not rooting the Ethereal Soul (Hun). Just as this formula helps eyesight by nourishing Liver-Yin, on a mental-spiritual level it roots the Ethereal Soul which gives the individual spiritual "vision". Caution and contraindications Many of the Blood-nourishing herbs may tend to weaken the Spleen and increase Dampness if used for several months without interruption. The formula should therefore either be used
19 19 intermittently or combined with an acupuncture treatment aimed at tonifying the Spleen and resolving Dampness. Classical antecedent: Si Wu Tang Four Substances Decoction. Remedy in a nutshell: eye problems from Liver-Blood deficiency. Timing of administration: Take after meals if used for eye problems. BROCADE SINEWS Dang Shen Radix Codonopsis Dang Gui Radix Angelicae sinensis Chuan Xiong Rhizoma Chuanxiong Bai Shao Radix Paeoniae alba Shu Di Huang Radix Rehmanniae preparata Gou Qi Zi Fructus Lycii Sang Ji Sheng Herba Taxilli Sang Zhi Ramulus Mori Wei Ling Xian Radix Clematidis Mu Gua Fructus Chaenomelis Wu Jia Pi Cortex Acanthopanacis Xi Xian Cao Herba Siegesbeckiae Ji Xue Teng Caulis Spatholobi Fu Ling Poria Yi Yi Ren Semen Coicis Cang Zhu Rhizoma Atractylodis Zhi Gan Cao Radix Glycyrrhizae preparata Pattern: Chronic Wind-Damp Painful Obstruction (Bi) Syndrome with Liver-Blood and/or
20 20 Liver-Yin deficiency. Action: Nourish Liver-Blood and Liver-Yin, benefit sinews, expel Wind-Dampness from the joints. Indications: chronic soreness and slight swelling of the joints, dizziness, numbness or tingling of limbs, poor memory, insomnia, dry skin and hair, dry eyes, blurred vision. Tongue: Pale and Thin if there is Liver-Blood deficiency or red and Thin without coating if there is Liver-Yin deficiency. Pulse: Choppy or Fine, possibly only on the left side. In the case of Liver-Yin deficiency it could be empty at the deep level on the left side. Explanation Brocade Sinews is a new formula aimed at expelling Wind-Dampness from the joints and nourishing Liver-Blood. This corresponds to a very frequent finding in practice that chronic rheumatic pains are caused by Wind and Dampness in the joints and that they occur against a background of Liver-Blood or Liver-Yin deficiency. The problem is especially common in women. The new formulation was considered necessary as most of the existing patent remedies for chronic rheumatic pains are very warming. As very many patients (especially women) with chronic rheumatic problems suffer from deficient Liver-Blood or Liver-Yin failing to nourish the sinews, warm or hot herbs are contraindicated. Dang Gui, Chuan Xiong, Bai Shao, Shu Di Huang and Gou Qi Zi nourish and invigorate Blood. Sang Ji Sheng nourishes Blood and expels Wind-Dampness from the joints. Sang Zhi, Hai Tong Pi, Mu Gua and Xi Xian Cao expel Wind-Dampness from the joints. Wu Jia Pi and Ji Xue Teng expel Wind-Dampness from the joints and benefit the sinews and bones. Fu Ling, Yi Yi Ren and Cang Zhu resolve Dampness. Mental-emotional pattern Key words: Single-Minded Aim. The patient will lack a feeling of direction in life and feel depressed. There will be
21 21 mental confusion and fear of the unknown. He or she will be anxious and find it difficult to sleep at night, rest being disturbed by dreams. The condition is often caused by prolonged sadness (which can affect the Liver) combined with guilt. Caution and contraindications The formula is suitable for long-term use as the cloying blood tonics within it are counterbalanced by the herbs which resolve Dampness. Classical antecedent: Si Wu Tang Four Substances Decoction. Remedy in a nutshell: Bi Syndrome from Liver-Blood deficiency. Timing of administration: Take one dose half an hour before breakfast. BUDDHA S HAND Mu Xiang Radix Aucklandiae Bai Dou Kou Fructus Amomi rotundus Cang Zhu Rhizoma Atractylodis Qing Pi Pericarpium Citri reticulatae viride Chen Pi Pericarpium Citri reticulatae Fu Ling Poria Hou Po Cortex Magnoliae officinalis Fo Shou Fructus Citri sarcodactylis Ban Xia Rhizoma Pinelliae preparatum Zhi Shi Fructus Aurantii immaturus Lai Fu Zi Semen Raphani Shan Zha Fructus Crataegi Shen Qu Massa medicata fermentata
22 22 Gu Ya Fructus Setariae germinatus Gan Cao Radix Glycyrrhizae Pattern: Qi stagnation in the Middle Burner, rebellious Stomach-Qi, Dampness in the Middle Burner. Action: moves Qi in the Middle Burner, subdues rebellious Stomach-Qi, resolves Dampness. Indications: bad digestion, distension and/or epigastric pain, acid reflux, nausea, vomiting, belching, feeling of fullness in the epigastrium, sticky taste. Tongue: slightly red on the sides in the central section (Spleen area), sticky coating. Pulse: Wiry on the right-guan position. Explanation Mu Xiang, Qing Pi, Fo Shou and Zhi Shi move Qi; Zhi Shi has a downward movement and will contribute to subduing Qi. Bai Dou Kou, Hou Po, Cang Zhu, Chen Pi, Fu Ling, Ban Xia resolve Dampness. Some of these herbs also move Qi (Hou Po, Bai Dou Kou). Lai Fu Zi, Shan Zha, Shen Qu and Gu Ya are digestive herbs that relieve retention of Food. Mental-emotional pattern Key words: Inner Peace. This patient suffers from Qi stagnation in the Middle Burner but also with rebellious Qi of the Stomach. This sets it apart from other remedies that eliminate Qi stagnation (e.g. Soothe the Centre, Break into a Smile, Smooth Passage, etc.). Thus, there are three patterns: Qi stagnation, Qi rebellious and Dampness, all in the Middle Burner. The aetiology of this clinical picture is emotional stress causing Qi stagnation and Qi rebellious and irregular diet leading to Dampness. How do emotional problems leading to rebellious Qi differ from those leading to Qi stagnation? Qi stagnation may be cause by virtually any emotion, e.g. anger,
23 23 repressed anger, worry, frustration, resentment, sadness, fear, joy and guilt. That is because most emotions lead either to Qi stagnation or Qi deficiency: however, also those that lead to Qi stagnation also involve some Qi stagnation deriving from deficient Qi not moving Qi. By contrast, rebellious Qi must be caused by emotions that make Qi rise and that would therefore exclude emotions such as sadness, fear and guilt. In my experience, rebellious Qi is caused by one of three emotions: anger, worry and joy. That anger makes Qi rise is well known and we do not need to repeat here. Less well known is that worry also may make Qi rise (apart from making it stagnate). Indeed, Zhang Jing Yue says that worry can make Liver-Qi rise. As for joy. I am using quotation marks because I feel that joy is not a good translation of the emotion that ancient Chinese doctors referred to. In feel that the best translation of xi is excessive stimulation. When interpreted in this sense, we can see how it is a major emotional cause of disease in the Western world where everyone is subject to excessive stimulation by media, advertising, alcohol and drugs. In the case of children, they are subject to even more stimulation such as TV, computer games, advertising. Thus, this person will be intensely worried and perhaps suffering from anger about some life situation. This person will also be impatient; he or she will tend to worry about their loved ones and will try be helpful but sometimes in a controlling way. Caution and contraindications The formula contains pungent herbs which, in the long run, may injure Yin. If the patient needs to take the remedy in the long run, it is advisable to stop it for a month every 4-5 months. Contraindicated during pregnancy. Classic antecedent: Mu Xiang Shun Qi Wan (Aucklandia Pill to Subdue Qi).
24 24 Remedy in a nutshell: digestive problems from rebellious Stomach-Qi. CALM THE SHEN Ren Shen Radix Ginseng Huang Qi Radix Astragali Bai Zhu Rhizoma Atractylodis macrocephalae Dang Gui Radix Angelicae sinensis Fu Shen Sclerotium Poriae pararadicis Suan Zao Ren Semen Ziziphi spinosae Long Yan Rou Arillus Longan Yuan Zhi Radix Polygalae Mu Xiang Radix Aucklandiae Zhi Gan Cao Radix Glycyrrhizae preparata Hong Zao Fructus Jujubae Bai Zi Ren Semen Platycladi He Huan Pi Cortex Albiziae Shi Chang Pu Rhizoma Acori tatarinowii Bai He Bulbus Lilii Pattern: Spleen-Qi and Spleen-Blood deficiency, Heart-Qi and Heart-Blood deficiency. Action: Tonify Spleen-Qi and Spleen-Blood, tonify Heart-Qi and Heart-Blood, calm the Mind, open the Mind's orifices, stimulate the Spleen's holding of Blood. Indications: Palpitations, insomnia, anxiety, poor memory, depression, dull-pale face which may also have a slight malar flush, a slight feeling of heat in the evening, poor appetite, loose stools, tiredness, weariness, constipation, despondency, weak limbs, scanty periods or very heavy periods which come early or trickle on for a long time with pale or fresh-red blood, blood in the stools or
25 25 urine, petechiae. Tongue: Pale, thin or swollen, depending on whether Blood or Qi deficiency predominates. Pulse: Weak, Choppy. Explanation This is a very important formula to tonify Spleen and Heart when they are affected by emotional problems. The formula tonifies both Qi and Blood of the Spleen and Heart and its clinical manifestations reflect both Qi and Blood deficiency. Poor appetite, loose stools, tiredness, weak limbs and a swollen tongue reflect Spleen-Qi deficiency, with deficient Spleen-Qi failing to transform and transport food essences and to nourish the muscles. Palpitations, insomnia, anxiety, poor memory, depression, dull-pale face and a thin tongue reflect Heart-Blood deficiency. In long-standing cases of Blood deficiency, there may also be some Empty-Heat arising from it, causing a slight malar flush and a slight feeling of heat in the evening. Since there is both Qi and Blood deficiency, the periods may be scanty if Blood deficiency predominates or very heavy if Qi deficiency predominates, the heavy bleeding being due to deficient Spleen-Qi failing to hold Blood. For the same reason there may be bleeding from the bladder, intestines or under the skin (petechiae). Constipation may arise from Blood deficiency. Ren Shen, Bai Zhu and Huang Qi tonify Spleen- and Heart-Qi. Dang Gui nourishes Heart-Blood. Fu Shen, Suan Zao Ren, Long Yan Rou and Yuan Zhi nourish the Heart and calm the Mind. Mu Xiang moves Qi to counteract the cloying nature of Blood tonics. Zhi Gan Cao harmonizes. Hei Zao nourishes Blood and harmonizes. I added Bai Zi Ren to nourish the Heart and Blood and calm the Mind. It also stimulates the bowel movement and is good for constipation from Blood deficiency. He Huan Pi and Shi Chang Pu were added to calm the Mind and open the Mind's orifices. He Huan Pi is also effective to treat depression. Bai He was added to soothe the Lungs: this herb is particularly effective
26 26 for emotional problems deriving from sadness and grief. Mental-emotional pattern Key word: Hope. This pattern is typically caused by sadness, grief, worry or shock over a long period of time. These emotions deplete Qi of the Spleen, Heart and Lungs and, after some time, this gives rise to Blood deficiency. This patient will be sad, depressed and weary: he or she is prone to bouts of crying. Since this crying derives from a deficiency rather than from repressed, stagnant Qi, it does not relieve the mental state. Caution and contraindications This is a tonic formula that can be taken for long periods of time. It does not have any specific contraindications as it is balanced in its tonification of both Qi and Blood. Classical antecedent: Gui Pi Tang (Tonifying the Spleen Decoction) The remedy in a nutshell: depression and sadness from Qi and Blood deficiency. CENTRAL MANSION Ren Shen Radix Ginseng Bai Zhu Rhizoma Atractylodis macrocephalae Fu Ling Poria Zhi Gan Cao Radix Glycyrrhizae preparata Bian Dou Semen Lablab album Shan Yao Rhizoma Dioscoreae Lian Zi Semen Nelumbinis Sha Ren Fructus Amomi Yi Yi Ren Semen Coicis
27 27 Jie Geng Radix Platycodi Tai Zi Shen Radix Pseudostellariae Yu Zhu Rhizoma Polygonati odorati Pattern: Spleen- and Stomach-Qi deficiency, Stomach and Spleen-Yin deficiency, Dampness in the Middle Burner, Lung-Qi deficiency. Action: Tonify Stomach- and Spleen-Qi, nourish Stomach and Spleen-Yin, resolve Dampness, stop diarrhoea, tonify Lung-Qi. Indications: Loose stools, diarrhoea, poor appetite, poor digestion, a slight feeling of fullness and heaviness of the epigastrium, nausea, weakness of the limbs, epigastric pain, tiredness, late-onset diabetes, chronic cough with white-watery sputum, dull-pale complexion, thin body. Tongue: Pale, slightly swollen, a sticky but rather thin coating, slightly rootless coating, coating too thin in the centre, central Stomach crack, scattered Stomach cracks, transversal Spleen cracks. Pulse: Weak in general, slightly slippery; it may be Floating-Empty on the right middle position. Explanation This formula, a very important Stomach and Spleen tonic, is a variation of Shen Ling Bai Zhu San Ginseng-PoriaAtractylodes Powder. Its action has some similarities to that of Liu Jun Zi Tang Six Gentlemen Decoction (Prosperous Earth) but it is more complex and wide-ranging. First of all, it tonifies Stomach and Spleen-Qi and resolves Dampness and, as such, it has a very wide application. However, it also tonifies Stomach- and Spleen-Yin and it is therefore suitable to treat the beginning stages of Stomach- and Spleen-Yin deficiency: the main symptoms of these would be a slight thirst but without desire to drink, a dry mouth, dry stools, dry lips, poor appetite and a slight epigastric pain. This formula incorporates the formula Si Jun Zi Tang Four Gentlemen Decoction
28 28 (Ren Shen, Bai Zhu, Fu Ling and Zhi Gan Cao which tonifies Stomach- and Spleen-Qi. Sha Ren and Yi Yi Ren resolve Dampness; the former fragrantly resolves Dampness through sweating, and the latter drains Dampness through urination. In addition, Sha Ren also harmonizes the ascending and descending of Qi in the Middle Burner and helps to stop nausea, vomiting and diarrhoea. Shan Yao tonifies both Stomach-Qi and Stomach- Yin and treats diabetes. Lian Zi tonifies the Stomach and Spleen and stops diarrhoea. Bian Dou tonifies Spleen-Qi and Spleen-Yin and also stops diarrhoea. Jie Geng directs the formula to the Upper Burner and the Lungs which makes the formula suitable to tonify Lung-Qi and resolve Phlegm. The function of Jie Geng in this formula is often compared to that of an oar, taking the boat, i.e. the formula, to the Upper Burner. Tai Zi Shen was added to strengthen the Stomach-Yin nourishing effect. Yu Zhu was added to nourish Stomach-Yin and clear any Empty-Heat that there might be. Xi Yang Shen was added because it nourishes both Qi and Yin of the Stomach, Spleen and Lungs. It is useful to compare and contrast this formula with Soothe the Centre (a variation of Xiang Sha Liu Jun Zi Tang Aucklandia-Amomum Six Gentlemen Decoction) and Jade Spring (a variation of Sha Shen Mai Dong Tang Glehniae-Ophiopogon Decoction) and Table 1 highlights the main differences. Soothe the Centre and Central Mansion both tonify Stomach- and Spleen-Qi and resolve Dampness; the main difference is that Central Mansion also nourishes Stomach- and Spleen-Yin. However, the latter is indicated only for slight conditions of Stomach and Spleen-Yin deficiency and in particular when they are associated with Qi deficiency: if the deficiency of Stomachand Spleen-Yin is pronounced, Jade Spring is more appropriate. A further difference between Soothe the Centre and Central Mansion is that the former also treats stagnation of Qi in the Middle Burner, which Central Mansion does not. Another crucial difference is that Central Mansion is suitable for persons who are constitutionally more deficient in the Middle Burner; in other words, although both remedies address Stomach and Spleen deficiency deriving from dietary irregularity, a person with a relatively strong Bright Yang (Yang Ming) constitution will develop the type of patterns envisaged by Soothe the Centre (Six Gentlemen Decoction), while a
29 29 person with a weaker Bright Yang constitution will develop the type of patterns envisaged by Central Mansion (Ginseng-Poria-Atractylodes Powder). See Table 2. Table 2. Comparison of Central Mansion, Soothe the Centre and Jade Spring. CENTRAL MANSION SOOTHE THE JADE SPRING CENTRE Pattern Deficiency of Qi and Yin of Stomach- and Spleen-Qi Stomach-, Lung- and Spleen- Stomach and Spleen, deficiency, Dampness, Qi Yin Dampness stagnation Action Tonify Qi and Yin of Tonify Stomach- and Spleen- Nourish Stomach- Lung- and Stomach and Spleen, resolve Qi, resolve Dampness, move Spleen-Yin Dampness Qi, eliminate stagnation Symptoms Tiredness, dry mouth without Tiredness, feeling of Dry mouth, slight thirst with desire to drink, loose stools, heaviness, fullness and desire to drink in small sips, slight epigastric pain, poor distension of the burning epigastric pain, dry appetite epigastrium, irritability, throat, dry cough, tiredness, sticky taste, slight epigastric feeling of heat in the evening pain, poor appetite Complexion Dull-pale, without lustre Dull-pale with more lustre or pale-yellow Pale, malar flush, floatingred over pale Body shape Slightly thin Overweight Thin Epigastric sensation Slight epigastric pain, slight Slight epigastric pain, Burning epigastric pain, no feeling of heaviness in the feeling of heaviness, fullness distension, fullness or epigastrium and distension of the heaviness epigastrium Tongue Pale, thin-sticky coating, Pale, slight swollen, sides Without coating, body which may be rootless in may be slightly red (if Qi normal or red depending on patches, midline Stomach stagnation is pronounced) whether there is Empty Heat crack or scattered Stomach or not, midline Stomach cracks, slight transversal crack or scattered Stomach Spleen cracks on the sides cracks, Spleen cracks on the sides Pulse Weak, slightly Floating- Weak but also Slippery, may Floating-Empty, especially Empty on the right-guan be slightly Wiry (if Qi on the right-guan position, position stagnation is pronounced) Rapid if there is Empty Heat
30 30 Mental-emotional pattern Key words: Grounding Oneself. This formula is for long-standing Stomach and Spleen deficiency. The Earth element is the Centre for the other four Elements and gives us grounding and, literally and metaphorically, a centre. A person suffering from a deficiency of the Earth Element as addressed by this formula, will feel ungrounded and without a centre. Very often this person's gait will look ungrounded, lifting their heels slightly as they walk, as if they were walking only on the ball of the foot, without putting the heels down. This person will feel depressed and his or her depression stems from a feeling of not belonging, isolation, ungroundedness and lack of centre. Very often, these people have left their family home at an early age. As adults, a weakness of the Earth may manifest in opposite ways: they may either be excessively nurturing or emotional coldness towards family members. Caution and contraindications This formula is a gentle and wide-ranging Qi tonic that can be taken for a long time without any real contraindication. As it includes herbs that drain or resolve Dampness, there is no danger of the tonic herbs causing stagnation. Classical antecedent: Shen Ling Bai Zhu San (Ginseng-Poria-Atractylodes Powder) Remedy in a nutshell: digestive problems and loose stools from Stomach-Yin deficiency. CHEMO-SUPPORT Huang Qi Radix Astragali Ren Shen Radix Ginseng Ling Zhi Ganoderma Mu Dan Pi Cortex Moutan Zhi Mu Rhizoma Anemarrhenae
31 31 Fu Ling Poria Chen Pi Pericarpium Citri reticulatae Mai Men Dong Radix Ophiopogonis Dang Gui Radix Angelicae sinensis Ban Xia Rhizoma Pinelliae preparatum Lu Gen Rhizoma Phragmatis Nu Zhen Zi Fructus Ligustri lucidi Sha Ren Fructus Amomi Huang Jing Rhizoma Polygonati Gan Cao Radix Glycyrrhizae Pattern: Stomach and Spleen-Qi deficiency, Stomach and Lung-Yin deficiency, Kidney deficiency, Blood Heat, Dampness. Action: Tonify Qi, nourish Yin, cool Blood, resolve Dampness. Indications: Side-effects of chemotherapy - tiredness, nausea, vomiting, loss of hair, decreased levels of white blood cells and/or platelets, bad digestion, diarrhoea, mouth ulcers. Explanation Huang Qi, Ren Shen and Ling Zhi tonify Qi. Xi Yang Shen and Mai Men Dong tonify Qi and Yin. Mu Dan Pi and Zhi Mu clear Heat. Fu Ling and Chen Pi resolve Dampness. Dang Gui, Ban Xia, Lu Gen and Sha Ren harmonize the Stomach and stop nausea and vomiting; Lu Gen also clears Stomach-Heat. Nu Zhen Zi and Huang Jing nourish Yin and help to nourish Blood. Caution and contraindications This formula should be taken every day throughout the chemotherapy course and can be started approximately two weeks before the beginning of the course and continued for
32 32 two weeks after the end of the course. The recommended dosage is 9 tablets a day but this can be increased according to severity of side-effects. Remedy in a nutshell: alleviating the side-effects of chemotherapy. CHILDREN S HERBAL SENTINEL Gui Zhi Ramulus Cinnamomi Bai Shao Radix Paeoniae alba Sheng Jiang Rhizoma Zingiberis recens Da Zao Fructus Jujubae Zhi Gan Cao Radix Glycyrrhizae preparata Shen Qu Massa medicata fermentata Lai Fu Zi Semen Raphani Shan Zha Fructus Crataegi Gu Ya Fructus Setariae germinatus Tai Zi Shen Radix Pseudostellariae Huang Qi Radix Astragali Bai Zhu Rhizoma Atractylodis macrocephalae Fang Feng Radix Saposhnikoviae Fu Ling Poria Chen Pi Pericarpium Citri reticulatae Pattern: Deficiency of Qi, Dampness, food accumulation. Action: Tonify Qi, consolidate the Exterior, raise immunity, resolve Dampness and dissolve food accumulation. Indications: Propensity to catching colds, hay fever, poor digestion, poor appetite, listlessness, constantly runny nose, recurrent slight abdominal pain.
33 33 Explanation This formula combines the two classical formulae Gui Zhi Tang (Ramulus Cinnamomi Decoction) and Yu Ping Feng San (Jade Windscreen Powder). Gui Zhi Tang harmonizes Ying and Wei and regulates the Cou Li space (the space between skin and muscles) where Wei Qi circulates. In combination with the second formula Yu Ping Feng San which tonifies Qi, this firms the Cou Li space preventing invasions of Wind. Several digestive herbs (Shen Qu, Lai Fu Zi, Shan Zha, Gu Ya) were added as most children have a weak Spleen, the younger they are, the weaker. Mental-emotional pattern This child is rather frail physically and emotionally. He or she will be a sensitive child who suffers a lot from family conflicts and often elder sibling s overpowering influence. Caution and contraindications None. Classical antecedent: Gui Zhi Tang (Ramulus Cinnamomi Decoction) and Yu Ping Feng San (Jade Windscreen Powder). Remedy in a nutshell: strengthen children s resistance to external invasions. CLEAR CHANNELS Yi Yi Ren Semen Coicis Cang Zhu Rhizoma Atractylodis Qiang Huo Rhizoma seu Radix Notopterygii Du Huo Radix Angelicae pubescentis Hai Feng Teng Caulis Piperis kadsurae Wei Ling Xian Radix Clematidis
34 34 Fang Feng Radix Saposhnikoviae Dang Gui Radix Angelicae sinensis Chuan Xiong Rhizoma Chuanxiong Ban Xia Rhizoma Pinelliae preparatum Gui Zhi Ramulus Cinnamomi Ru Xiang Olibanum Huang Qin Radix Scutellariae Gan Cao Radix Glycyrrhizae Pattern: Damp-Heat in the joints, Blood stasis. Action: Drain Dampness, expel Wind, clear Heat, benefit the joints, invigorate Blood. Indications: Sub-acute Bi Syndrome from Damp-Heat, painful, swollen, hot and red joints, rheumatoid arthritis, gout. Tongue: Swollen with sticky-yellow coating. Pulse: Slippery, rapid. Explanation Please note that this remedy treats only the Manifestation (Biao) in Bi Syndrome from Damp-Heat and not any underlying cause: it should therefore be used only for limited periods of time (say, no longer than 3 months) at a time to deal with an acute or sub-acute phase of joint pain. After suitable breaks, it can be prescribed again. Possible underlying causes of Bi Syndrome from Damp-Heat are usually Spleen-Qi deficiency and Liver-Blood deficiency. Yi Yi Ren and Cang Zhu resolve Dampness from the joints. Qiang Huo and Du Huo resolve Wind-Dampness from the Governing Vessel in its upper and lower part respectively. Fang Feng expels Wind. Gui Zhi enters the blood vessels and helps to resolve Dampness from the space between skin and muscles. Dang Gui and Chuan Xiong nourish and harmonize Blood which helps to expel Wind from the channels. Gan Cao harmonizes.