Shang Han Sweating

November 6, 2002

Z'ev

Bensky also uses honey-fried licorice. I think it is more of a dosage issue. At 3g, the objective is to harmonize the herbs and protect the spleen/stomach and, (Will's theory - potentiate the uptake of the other herbs via sugar pathways. Ginger will do this via the vasodillatory effect of it's spicy flavor.)

Will Morris

Actually, you are right here. There is a typo in the Mitchell text that states that mix-fried licorice (zhi gan cao) is used. But in the Chinese, it is raw gan cao. If it were mix-fried gan cao, it could be used to replenish fluids and supplement qi depleted by sweating, less so with raw gan cao.

November 6, 2002

Actually, you are right here. There is a typo in the Mitchell text

that states that mix-fried licorice (zhi gan cao) is used. But in the

Chinese, it is raw gan cao. If it were mix-fried gan cao, it could be

used to replenish fluids and supplement qi depleted by sweating, less

so with raw gan cao.

Thanks for the clarification.

Z'ev

On Wednesday, November 6, 2002, at 07:43 AM, WMorris116 wrote:

> Z'ev -

>

> According to Feng, ma huang tang opens the interstices, promotes

> sweating, diffuses the lungs and calms panting. What source do you

> have that states that it will " supplement spleen and stomach qi? "

>

> Will Morris

>

> Sweating alone is not

> the goal of the treatment. For example, in ma huang tang, the goal is

>

> to open the exterior, diffuse the lung qi, and supplement spleen and

> stomach qi.

> Sweating without these other supportive actions will not correctly

> dispel the disease evil.

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

November 6, 2002

Good points Will. The program I went through had 33 hours in Shang Han

Lun and 33 hours in Wen Bing, which was taught by Dr. Su Yi-Wen from

Cheng Du. I'm glad I got a thorough basic introduction, but it will

take a lifetime to get a good grasp of the info, I believe.

Unfortunatley, it was through NIAOM, which is no longer with us.. So I

hope the other schools start to adopt this coursework as well. I'd love

another 66 hours in Jin Gui and Nei Jing. Guess it's like the martial

arts - after 10-15 years, you start to realize how much you don't

know...

Geoff

> __________

>

> Message: 22

> Wed, 6 Nov 2002 10:32:25 EST

> WMorris116

> Re: Re: Shang Han Sweating

>

> Emperor's has a 40 hour SHL/Wen Bing track. Beijing TCM

> University has a full

> year of 'classics' study that is divided between SHL, Golden

> Cabinet, Wen

> Bing, and Nei Jing.

>

> It takes years to gain working mastery over these topics.

> That is why I

> provide two supervisors in clinic who have high degree of

> mastery on the SHL

> - the esteemed Yang Tiande and the young PhD, hot shot Dina Tang. Gu

> Naiqiang's interest in classics is the Nei Jing, his teacher

> chairs the

> department of classics at Shanghai and is chair of the

> government office for

> Nei Jing. This way, if students have such an interest, they

> can pursue such

> studies during the clinical phase of training.

>

> Will

>

November 6, 2002

, " " <zrosenbe@s...> wrote:

>

> You do see wind/heat here in southern California, when the santa ana

> winds blow off the deserts from the east, increasing heat and vastly

> lowering humidities.

I don't find that to be the case. As usual, being around a school, I treat far

more acutes with raw herbs than when I was in private practice. so I have

treated at least a hundred cases of common cold with raw herbs in the past 2

years. I find that treatments for dryness invasion succeed where typically

those for windheat fail. and as stated, that wind cold is by far the most

common initiator. In fact, the majority of my cold patients have first been

treated to no avail with formulas for windheat. In a rare case, full blown

windheat actually presents.

November 6, 2002

, WMorris116@A... wrote:

According to Zhang, and strictly speaking,

> the use of gui zhi tang is differentiated from ma huang tang on the basis of

> zhong feng vs zhong han (wind strike vs cold strike) rather than deficiency

> vs excess.

I also understand this to be the discrimination.

November 6, 2002

, WMorris116@A... wrote:

> Z'ev

>

> Bensky also uses honey-fried licorice. I think it is more of a dosage issue.

> At 3g, the objective is to harmonize the herbs and protect the spleen/

stomach

In addition, the function of zhi gancao is mild for qi supplementation and fluid

production. By itself, with no reinforcement from other herbs, this is not a

prominent function, as I understand it. In addition to harmonization, zhi gan

cao accentuates the effect of xing ren in stopping cough. As to where the typo

is, I guess that dpends on which version of the chinese one has. I doubt this

was an error in both Bensky and Mitchell, especially when pertaining to such

a central formula.

November 6, 2002

Perhaps it has something to do with the patients we each see. . . or

the air conditioning that many buildings use. However, I stand by what

I said about wind/heat invasion. Of course, I see quite a bit of

wind/cold as well (especially this autumn season), little wind/heat so

far this fall.

On Wednesday, November 6, 2002, at 10:40 AM, wrote:

> , " " <zrosenbe@s...> wrote:

>

>>

>> You do see wind/heat here in southern California, when the santa ana

>> winds blow off the deserts from the east, increasing heat and vastly

>> lowering humidities.

>

> I don't find that to be the case. As usual, being around a school, I

> treat far

> more acutes with raw herbs than when I was in private practice. so I

> have

> treated at least a hundred cases of common cold with raw herbs in the

> past 2

> years. I find that treatments for dryness invasion succeed where

> typically

> those for windheat fail. and as stated, that wind cold is by far the

> most

> common initiator. In fact, the majority of my cold patients have

> first been

> treated to no avail with formulas for windheat. In a rare case, full

> blown

> windheat actually presents.

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

November 6, 2002

Sorry, but clearly the ma huang tang pattern is more replete than the

gui zhi tang pattern.

On Wednesday, November 6, 2002, at 10:50 AM, wrote:

> , WMorris116@A... wrote:

> According to Zhang, and strictly speaking,

>> the use of gui zhi tang is differentiated from ma huang tang on the

>> basis of

>> zhong feng vs zhong han (wind strike vs cold strike) rather than

>> deficiency

>> vs excess.

>

> I also understand this to be the discrimination.

>

November 6, 2002

Perhaps it has something to do with the patients we each see. . . or the air conditioning that many buildings use. However, I stand by what I said about wind/heat invasion. Of course, I see quite a bit of wind/cold as well (especially this autumn season), little wind/heat so far this fall

>>>>>This is a very interesting discussion to me. Besides the fact that it is difficult to really know if one's formula really makes a big difference in the course of a disease which gets better on its own in just a few days, almost all the practitioners I followed up here, in the bay area, would treat wind-heat with the addition of herbs such as feng feng, Jing Jie, bai zhi, yin yi as needed almost all the time. I am very interested in others experience in treating colds and flues

Alon

November 6, 2002

, " " <@i...> wrote:

>I find that treatments for dryness invasion succeed where typically

> those for windheat fail. and as stated, that wind cold is by far

the most common initiator. In fact, the majority of my cold patients

have first been treated to no avail with formulas for windheat. In a

rare case, full blown windheat actually presents.

:

This is for two reasons. The first is that it is a Horse year, so

the energy of the year is Fire which attacks metal (lungs) during

the first half of the year. It dries up yin fluids and makes the

body produce more mucus to balance. That's why we alternately see

several types of coughing (productive and dry, raspy) in the same

person. The autumnal changes move the ambient energy of the body

deeper. So it's like two weather fronts confronting each other.

The second reason is that last part of the year is dominated by the

cold energy of the 5-Phase Revenge cycle, helping to make the

cold/flu syndromes a deeper problem---without necessarily starting

or going through the more superficial Taiyang level.

The pulses are deeper---Zang depth, not floating---and show dampness

and phlegm in the lung. The phlegm can transform into heat on its

own, or can be a good breeding ground for viruses which are

concentrate and exchanged by children going back to school, etc.

The changes in the presentation of colds and flu over the last

decade hs been interesting. In the early 1990's, we had obvious

superficial Taiyang syndrones. Each year, it seemed to start at a

deeper level or had shorter and shorter periods of Taiyang. For the

last few years, there has been no substantial Taiyang syndrome; and

now, this year, it seems to be moving up the levels again.

Jim Ramholz

November 7, 2002

, " ALON MARCUS " <alonmarcus@w...>

wrote:

> >>>>>This is a very interesting discussion to me. Besides the fact that it is

difficult to really know if one's formula really makes a big difference in the

course of a disease which gets better on its own in just a few days,

good point. I gauge my success by not worsening the patient. with my

tendency to moderately high dosages of herbs in decoction, the wrong

formula immediately has side effects not apparent when using patents or

liquid extracts. so that's how I know I am wrong. However, I often tell my

students that a cold is better in a week without treatment or seven days with

treatment (to which some will dumbfoundedly reply, that's the same thing, I

don't get it). It is always better to do nothing in an acute rather than the

wrong

thing. A typical side effect from wrong full strength treatment is a worsening

of

chills. Yin qiao san may relieve a sore throat, but I have rarely seen it nip a

cold in the bud like jing fang bai du san or evencong bai and sheng jjiang

can. Heiner Fruehauf felt yin qiao san inhibited wei qi when used incorrectly

and you were worse in the long run.

according to chip chace (a respiratory specialist), the presence of prominent

chills and mild fever at the inset of wind invasion connotes wind cold. that

wind cold may transform within hours upon contact with internal heat, but this

is not windheat and will not be successfully treated unless one treats it with

some herbs for wind cold. In fact, the incorrect use of yin qiao san may cause

pathogens to become latent.

Another unique advantage one has when working in a school clinic is the

chance to see colds right at their onset (Will, do you concur?). In private

practice, patients rarely show up at the onset of a cold. It is generally

already

transformed by the time one sees them. I find chai ge jie tang to be very

useful in such cases.

November 7, 2002

A typical side effect from wrong full strength treatment is a worsening of chills.

>>>Even though I almost never just use yin qiao san i rarely seen this as a complaint. What I have seen is people not getting better and than I always wander did the herbs make it worse or not. In all the years that I have followed practitioners of TCM (and my own practice) I am still not convinced how much we help in terms of nipping it in the bud or shortening the course. Herbs do very well for the symptoms and when chronicity develops.

Alon

November 7, 2002

In my years of practice, I've been able to nip a lot of colds and flus

'in the bud', especially with myself and my family. I'd say it has

been equally scripts such as gui zhi jia ge gen tang or sang ju yin,

wind/cold or wind/heat depending on symptoms.

On Thursday, November 7, 2002, at 10:28 AM, Alon Marcus wrote:

> A typical side effect from wrong full strength treatment is a

> worsening of

> chills.

> >>>Even though I almost never just use yin qiao san i rarely seen this

> as a complaint. What I have seen is people not getting better and than

> I always wander did the herbs make it worse or not. In all the years

> that I have followed practitioners of TCM (and my own practice) I am

> still not convinced how much we help in terms of nipping it in the bud

> or shortening the course. Herbs do very well for the symptoms and when

> chronicity develops.

> Alon

>

November 7, 2002

When my patients come in within 24 hours of a wind cold (or heat) onset,

I treat them with acupuncture and cupping, and usually send them off

with herbs too.

When they do come in early, the intensity of the cold and/or its length

gets cut in half in some cases, while others report that within 24

hours, the problem is 100% gone. Periodically, there are patients who's

pathology is unchanged, or follows its normal course, but honestly,

these people are in the minority.

I use Yin Qiao San when the fever is more pronounced or there is a

redness in the sore throat. I'll use other formulas too, depending on

the presentation.

-al.

> Alon Marcus wrote:

>

> A typical side effect from wrong full strength treatment is a

> worsening of

> chills.

> >>>Even though I almost never just use yin qiao san i rarely seen this

> as a complaint. What I have seen is people not getting better and than

> I always wander did the herbs make it worse or not. In all the years

> that I have followed practitioners of TCM (and my own practice) I am

> still not convinced how much we help in terms of nipping it in the bud

> or shortening the course. Herbs do very well for the symptoms and when

> chronicity develops.

> Alon

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

November 7, 2002

I've been able to nip a lot of colds and flus 'in the bud'

>>How do you know that they would have not gone away anyway. Many times i feel like i am getting sick only to wake up the next day fine

Alon

November 7, 2002

The response is usually dramatic enough to tell, and usually follows a

medicinal response such as sweating.

Two weeks ago I had a raging cold, and used up a box of kleenex. I had

chill and a lot of damp phlegm. I used xiao qing long tang in large

doses every few hours, and by the next day, I was almost all better.

Other people with this cold had it for several days, and in the distant

past it would go right into my weak lungs.

On Thursday, November 7, 2002, at 12:31 PM, Alon Marcus wrote:

> I've been able to nip a lot of colds and flus 'in the bud'

> >>How do you know that they would have not gone away anyway. Many

> times i feel like i am getting sick only to wake up the next day fine

> Alon

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

November 7, 2002

I would concur with Z'ev on this set of findings. And I would concur with Todd on dosage. However, if the dose of the liquid extract or patent is high enough - dramatic pharmaceutical effects can be achieved in those media as well.

Will Morris

In my years of practice, I've been able to nip a lot of colds and flus 'in the bud', especially with myself and my family. I'd say it has been equally scripts such as gui zhi jia ge gen tang or sang ju yin, wind/cold or wind/heat depending on symptoms.

November 7, 2002

Another unique advantage one has when working in a school clinic is the chance to see colds right at their onset (Will, do you concur?). In private practice, patients rarely show up at the onset of a cold. It is generally already transformed by the time one sees them. I find chai ge jie tang to be very useful in such cases.

I concur about schools and frequent treament of colds, however, I don't agree about the infrequency of such treatment in private practice. I had tremendous experience treating colds in a private practice in the Berkshires of Massachusetts during the 90s I relied heavily on SHL during those years and also emphasized it in my two year herb certification courses for MAAOM and FSOMA. Correspondingly, my students also treated many colds and flus in private practice.

I think it is critical that we not extrapolate larger commentary from single or a few case observations. This is something Alon is after in this forum and I give him kudos for holding that line. I know you also often hold this line. The point here is that we all do this, and it is important that we remain mindful of this human tendency and periodically reflect on how it occurs in our clinical lives.

Will Morris

November 7, 2002

Most of the time I used liquid extracts.

On Thursday, November 7, 2002, at 10:50 PM, WMorris116 wrote:

> I would concur with Z'ev on this set of findings. And I would concur

> with Todd on dosage. However, if the dose of the liquid extract or

> patent is high enough - dramatic pharmaceutical effects can be

> achieved in those media as well.

>

> Will Morris

>

> In my years of practice, I've been able to nip a lot of colds and flus

> 'in the bud', especially with myself and my family. I'd say it has

> been equally scripts such as gui zhi jia ge gen tang or sang ju yin,

> wind/cold or wind/heat depending on symptoms.

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

November 8, 2002

Two weeks ago I had a raging cold, and used up a box of kleenex. I had chill and a lot of damp phlegm. I used xiao qing long tang in large doses every few hours, and by the next day, I was almost all better. Other people with this cold had it for several days, and in the distant past it would go right into my weak lungs

>>>>>My problem is that i have seen many responses such as you describe and at the same time many that did not. I have never worked in an environment that I could see very large numbers or people with cold and flues to know what are the averages for such good and bad responses to herbs, drugs and doing nothing.

alon

November 8, 2002

, WMorris116@A... wrote:

> I concur about schools and frequent treament of colds, however, I don't

agree

> about the infrequency of such treatment in private practice.

I guess that varies from practice to practice

November 8, 2002

I don't have it here, but I think there's a line in the Nei Jing that

goes something like, 'crush a rebellion at the first sign of

disharmony'. I'm sure in many cases, colds are going to resolve in a

week anyways, maybe the next morning. But, there are going to be those

very rare cases where something serious could result if you don't treat

it immediately. Bacterial meningitis, for example. I figure if I help,

that's great (maybe rare for me!), if not, that's ok. When I screw up,

I feel bad, then try to figure out what happened. I've only been

practicing for a few years, so I figure I've got nothing to do than to

get better. Thanks for all the great input on this thread though, it's

definitely great to spark the imagination when you feel like you get in

a rut.

Geoff

> __________

>

> " Alon Marcus " <alonmarcus

> Re: Re: Shang Han Sweating

>

> A typical side effect from wrong full strength treatment is

> a worsening of

> chills.

> >>>Even though I almost never just use yin qiao san i rarely

> seen this

> >>>as a complaint. What I have seen is people not getting

> better and than I always wander did the herbs make it worse

> or not. In all the years that I have followed practitioners

> of TCM (and my own practice) I am still not convinced how

> much we help in terms of nipping it in the bud or shortening

> the course. Herbs do very well for the symptoms and when

> chronicity develops.

> Alon

November 8, 2002

, " Geoffrey Hudson " <list@a...> wrote:

I'm sure in many cases, colds are going to resolve in a

week anyways, maybe the next morning. But, there are going to be

those very rare cases where something serious could result if you

don't treat it immediately.

Geoff:

Many of my patients with flu have been incubating and fighting it

for often several days or more, and rarely on their own resolve it

in a day. The best of them say " I thought I was coming down with it

but it never materialized " or think they getting better on their

own. Often the immune system is able to suppress the symptoms for

short periods, but its clear from the pulses that the battle is

still going on. So simply treating the symptoms isn't enough.

My herbal treatment strategy is to modify Ren Shen Bai Du San

(remove the ginseng and add other herbs for cold/flu). If severe, I

combine it with Wu Wei Xiao Du Yin. All but a few cases are resolved

or turn around in 24 hours.

Jim Ramholz

November 8, 2002

James wrote:

>

> My herbal treatment strategy is to modify Ren Shen Bai Du San

> (remove the ginseng and add other herbs for cold/flu). If severe, I

> combine it with Wu Wei Xiao Du Yin. All but a few cases are resolved

> or turn around in 24 hours.

>

If you remove the ginseng, then why are you calling it Ren Shen Bai Du San

instead of some other wind/cold/damp formula? Are you saying that

tonification is an important part of your strategy in general? or are you

saying that wind/cold/damp is the predominant pattern since you are

practicing in the Rockies?

Julie

November 8, 2002

Greetings,

Several years ago Botanica BioScience funded a double blind, placebo

controlled, randomized study with 60 elderly subjects living in a group

housing complex outside of Beijing to evaluate the effect of an herbal

formula on cold and flu. The ingredients of the formula include: huang qi,

dang gui, ci wu jia, han fang ji, yin yang huo, renshen, and echinacea. The

formula was similar to two formulas that we had cooperatively researched

with Beijing Univ of TCM in the early 1990's, which they had developed. The

echinacea was not in either of the original formulas. Over a 5 month period

from November thru March, when compared to histories of cold and flu during

the previous winter, the treatment group showed a 67% reduction of cold and

flu incidence and over 60% reduction in severity of cold and flu symptoms

when they did get sick. The placebo group showed improved results in the

10% to 15% range. The dosage was 1350mg of extract once a day, increased to

twice a day if feeling susceptible or in the very initial stages of

symptoms... and if cold and/or flu sx take hold then they'd stop taking the

herbs until it resolved. Subjects took the product two weeks on and one

week off through that winter. My personal experience using this formula

preventively has been dramatic and it is definitely capable of " nipping the

bud " of a cold. I initially expected this formula to only work well for

those with a weak constitution but have not found this to be the case. I

have even received reports from menopausal hot-flashing women that it has

saved them more than once without an increase in menopausal symptoms. One

might also expect this formula to work better in those that stand to get a

cold from exposure to the elements, especially cold, rather than being

exposed to someone in close quarters that spreads their condition, but that

has not been the case either. The tonics are obviously critical to the

success of this formula but IMO the wind damp mitigating aspects of the ci

wu jia and han fangji are most important to the formula's ability to

eliminate the muscle stiffness in early stages that can constrain the

circulation of wei qi, thereby allowing the other tonifying antipathogenic

efforts to be more successful.

Stephen Morrissey

James Ramholz [jramholz]

Friday, November 08, 2002 4:57 PM

Re: Shang Han Sweating