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Hello Academy,

I am new to the group so hopeful I will post this case with the needed info.

Thank you in advance for the advice.

32-year-old women

Main symptom: insomnia sleeps only 4-6 hours a night. Started after her gall

bladder was removed a few years ago. Has trouble falling asleep and staying

asleep. Tosses and turns and feels irritated by not being able to sleep. Has

dream disturbed sleep and nightmares.

Other symptoms:

Severe allergies- both food and environmental. Manifest as congestion and runny

nose with clear discharge, sore throat that is itchy, and left ear pain that

also keeps her up at night, and sneezing.

Overweight: has been trying to lose weight but it is not coming off.

Digestion: bloated, has a bowel that does not feel complete. BM dry and small.

Menses: heavy, blood clots, pain before and first few days.

Acne: Many small raised bumps all over face skin colored.

Tongue: red tip with stasis dots back slightly thick white fur.

Pulse: slippery rapid

Diagnosis: damp-heat, wind-damp heat and blood stagnation

Chai Hu Jia Long Gu Mu Li Tang was given for one week. No effect on the

insomnia. Digestion seemed more complete though.

This week gave Fang Feng Tong Sheng San so no report on this Rx yet.

What are your thoughts on this case if you could please recommend a formula.

Thanks so much excited to hear comments.

~Suzanne

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What about Ding zhi san?

Less intense than Chai hu jia long gu mu li tang:

 

Ingredients:

Poria cocos fungus-spirit, Dens draconis mineral, Polygala tenuifolia root,

Poria cocos fungus, Panax ginseng root, Pseudostellaria heterophylla root,

Acorus tatarinowii rhizome. - Fu shen, Long chi, Yuan zhi, Fu ling, Ren

shen, Tai zi shen, Shi chang pu

and then you can add Suan zao ren

 

or based on gall bladder removed, sore throat, left ear pain...a Xiao chai

hu tang modification?

 

Chai hu, Huang qin, Ban xia, Ren shen, Sheng jiang, Gan cao, Da zao,

Fu shen, Long chi, Yuan zhi, Shi chang pu, Suan zao ren (12 herbs total)

 

 

K

 

 

 

On Fri, Mar 12, 2010 at 7:38 AM, suz <suzstricker wrote:

 

>

>

> Hello Academy,

> I am new to the group so hopeful I will post this case with the needed

> info. Thank you in advance for the advice.

> 32-year-old women

> Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

> gall bladder was removed a few years ago. Has trouble falling asleep and

> staying asleep. Tosses and turns and feels irritated by not being able to

> sleep. Has dream disturbed sleep and nightmares.

> Other symptoms:

> Severe allergies- both food and environmental. Manifest as congestion and

> runny nose with clear discharge, sore throat that is itchy, and left ear

> pain that also keeps her up at night, and sneezing.

> Overweight: has been trying to lose weight but it is not coming off.

> Digestion: bloated, has a bowel that does not feel complete. BM dry and

> small.

> Menses: heavy, blood clots, pain before and first few days.

> Acne: Many small raised bumps all over face skin colored.

> Tongue: red tip with stasis dots back slightly thick white fur.

> Pulse: slippery rapid

> Diagnosis: damp-heat, wind-damp heat and blood stagnation

> Chai Hu Jia Long Gu Mu Li Tang was given for one week. No effect on the

> insomnia. Digestion seemed more complete though.

> This week gave Fang Feng Tong Sheng San so no report on this Rx yet.

> What are your thoughts on this case if you could please recommend a

> formula. Thanks so much excited to hear comments.

> ~Suzanne

>

>

>

 

 

 

--

 

 

""

 

 

www.tcmreview.com

 

 

 

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Guest guest

Hi Suzanne,

 

Your case looks to me like post-operative blood stagnation turning into heat

which is causing the insomnia.

 

I suggest a cold-natured blood activating formula along with a cooling shen

calming formula.

 

Gui Zhi Fu Ling Wan is cool and activating for the blood.

Tian Wang Bu Xin Dan is cooling and calming to the shen.

 

If you're in a position to add a few single herbs, consider adding a dash of

huang lian and lian qiao which both remove heat from the Yang Ming but also

calm the shen by clearing heat from the Heart.

 

-al.

 

On Fri, Mar 12, 2010 at 7:38 AM, suz <suzstricker wrote:

 

>

>

> Hello Academy,

> I am new to the group so hopeful I will post this case with the needed

> info. Thank you in advance for the advice.

> 32-year-old women

> Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

> gall bladder was removed a few years ago. Has trouble falling asleep and

> staying asleep. Tosses and turns and feels irritated by not being able to

> sleep. Has dream disturbed sleep and nightmares.

> Other symptoms:

> Severe allergies- both food and environmental. Manifest as congestion and

> runny nose with clear discharge, sore throat that is itchy, and left ear

> pain that also keeps her up at night, and sneezing.

> Overweight: has been trying to lose weight but it is not coming off.

> Digestion: bloated, has a bowel that does not feel complete. BM dry and

> small.

> Menses: heavy, blood clots, pain before and first few days.

> Acne: Many small raised bumps all over face skin colored.

> Tongue: red tip with stasis dots back slightly thick white fur.

> Pulse: slippery rapid

> Diagnosis: damp-heat, wind-damp heat and blood stagnation

> Chai Hu Jia Long Gu Mu Li Tang was given for one week. No effect on the

> insomnia. Digestion seemed more complete though.

> This week gave Fang Feng Tong Sheng San so no report on this Rx yet.

> What are your thoughts on this case if you could please recommend a

> formula. Thanks so much excited to hear comments.

> ~Suzanne

>

>

>

 

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

http://twitter.com/algancao

 

 

 

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Hi Al, I was a little surprised to see your description of gui zhi fu ling wan

as 'cool', would you mind explaining that?

 

Have you seen/heard of it being used to treat heat syndromes?

 

Regards, Henry

 

Al Stone wrote:

 

> I suggest a cold-natured blood activating formula along with a cooling shen

> calming formula.

>

> Gui Zhi Fu Ling Wan is cool and activating for the blood.

> Tian Wang Bu Xin Dan is cooling and calming to the shen.

>

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Hi Al,

Gui zhi fu ling san looks good, but do you think that Tian wang bu xin dan

might be a little too sticky?

She has phlegm, mucus, is overweight... slightly thick fur and slippery,

rapid pulse...

 

K

 

 

 

On Fri, Mar 12, 2010 at 10:59 PM, Al Stone <al wrote:

 

> Hi Suzanne,

>

> Your case looks to me like post-operative blood stagnation turning into

> heat

> which is causing the insomnia.

>

> I suggest a cold-natured blood activating formula along with a cooling shen

> calming formula.

>

> Gui Zhi Fu Ling Wan is cool and activating for the blood.

> Tian Wang Bu Xin Dan is cooling and calming to the shen.

>

> If you're in a position to add a few single herbs, consider adding a dash

> of

> huang lian and lian qiao which both remove heat from the Yang Ming but also

> calm the shen by clearing heat from the Heart.

>

> -al.

>

> On Fri, Mar 12, 2010 at 7:38 AM, suz <suzstricker wrote:

>

> >

> >

> > Hello Academy,

> > I am new to the group so hopeful I will post this case with the needed

> > info. Thank you in advance for the advice.

> > 32-year-old women

> > Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

> > gall bladder was removed a few years ago. Has trouble falling asleep and

> > staying asleep. Tosses and turns and feels irritated by not being able to

> > sleep. Has dream disturbed sleep and nightmares.

> > Other symptoms:

> > Severe allergies- both food and environmental. Manifest as congestion and

> > runny nose with clear discharge, sore throat that is itchy, and left ear

> > pain that also keeps her up at night, and sneezing.

> > Overweight: has been trying to lose weight but it is not coming off.

> > Digestion: bloated, has a bowel that does not feel complete. BM dry and

> > small.

> > Menses: heavy, blood clots, pain before and first few days.

> > Acne: Many small raised bumps all over face skin colored.

> > Tongue: red tip with stasis dots back slightly thick white fur.

> > Pulse: slippery rapid

> > Diagnosis: damp-heat, wind-damp heat and blood stagnation

> > Chai Hu Jia Long Gu Mu Li Tang was given for one week. No effect on the

> > insomnia. Digestion seemed more complete though.

> > This week gave Fang Feng Tong Sheng San so no report on this Rx yet.

> > What are your thoughts on this case if you could please recommend a

> > formula. Thanks so much excited to hear comments.

> > ~Suzanne

> >

> >

> >

>

>

>

> --

> , DAOM

> Pain is inevitable, suffering is optional.

> http://twitter.com/algancao

>

>

>

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Guest guest

I was actually looking for a blood moving formula that had dan shen (Rx.

Savliae) and chi shao (Rx. Peonae Rubra) in it. Those were really the goal.

But seeing the fu ling (Poria) and tao ren (Sm. Persica), both of which are

neutral works for me too. The fu ling is good for her phlegm/dampness too.

 

To address the heat, it may be prudent to lower the dosage of the gui zhi in

there, otherwise if you look at the formula all at once, it seems to me that

it is on the cool side on balance.

 

-al.

 

On Sat, Mar 13, 2010 at 7:10 AM, henry_buchtel <henry.buchtelwrote:

 

>

>

> Hi Al, I was a little surprised to see your description of gui zhi fu ling

> wan as 'cool', would you mind explaining that?

>

> Have you seen/heard of it being used to treat heat syndromes?

>

> Regards, Henry

>

> Al Stone wrote:

>

> > I suggest a cold-natured blood activating formula along with a cooling

> shen

> > calming formula.

> >

> > Gui Zhi Fu Ling Wan is cool and activating for the blood.

> > Tian Wang Bu Xin Dan is cooling and calming to the shen.

> >

>

>

>

 

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

http://twitter.com/algancao

 

 

 

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Guest guest

Yeah, I hear ya, John, but based on the patient's chief complaint of

insomnia, I gave the heat and stagnation more weight and other things less

weight. My goal with Tian Wang Bu Xin Dan was to cool the heart and its

blood. But I recognize that might aggravate the middle jiao stuff. That's

one reason I would encourage the addition of huang lian and lian qiao to

cool and dry the yang ming.

 

And this is really about case management too, Heart problems get in the way

of compliance. If she's feeling more calm and sleeping better, she'll be

back, and then you can start to focus on the dampness. I don't even know

where that's coming from right now. Could be the backup of fluids that are

addressed by the fu ling in the stagnation of qi, blood, and fluids in gui

zhi fu ling wan.

 

If she gets indigestion on the TWBXD, then we'd want to add something for

that, maybe some cang zhu, shan zha and mai ya. Something like that.

 

-al.

 

 

On Sat, Mar 13, 2010 at 8:02 AM, <johnkokko wrote:

 

>

>

> Hi Al,

> Gui zhi fu ling san looks good, but do you think that Tian wang bu xin dan

> might be a little too sticky?

> She has phlegm, mucus, is overweight... slightly thick fur and slippery,

> rapid pulse...

>

> K

>

> On Fri, Mar 12, 2010 at 10:59 PM, Al Stone <al<al%40gancao.net>>

> wrote:

>

> > Hi Suzanne,

> >

> > Your case looks to me like post-operative blood stagnation turning into

> > heat

> > which is causing the insomnia.

>

> >

> > I suggest a cold-natured blood activating formula along with a cooling

> shen

> > calming formula.

> >

> > Gui Zhi Fu Ling Wan is cool and activating for the blood.

> > Tian Wang Bu Xin Dan is cooling and calming to the shen.

> >

> > If you're in a position to add a few single herbs, consider adding a dash

> > of

> > huang lian and lian qiao which both remove heat from the Yang Ming but

> also

> > calm the shen by clearing heat from the Heart.

> >

> > -al.

> >

> > On Fri, Mar 12, 2010 at 7:38 AM, suz

<suzstricker<suzstricker%40>>

> wrote:

> >

> > >

> > >

> > > Hello Academy,

> > > I am new to the group so hopeful I will post this case with the needed

> > > info. Thank you in advance for the advice.

> > > 32-year-old women

> > > Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

> > > gall bladder was removed a few years ago. Has trouble falling asleep

> and

> > > staying asleep. Tosses and turns and feels irritated by not being able

> to

> > > sleep. Has dream disturbed sleep and nightmares.

> > > Other symptoms:

> > > Severe allergies- both food and environmental. Manifest as congestion

> and

> > > runny nose with clear discharge, sore throat that is itchy, and left

> ear

> > > pain that also keeps her up at night, and sneezing.

> > > Overweight: has been trying to lose weight but it is not coming off.

> > > Digestion: bloated, has a bowel that does not feel complete. BM dry and

> > > small.

> > > Menses: heavy, blood clots, pain before and first few days.

> > > Acne: Many small raised bumps all over face skin colored.

> > > Tongue: red tip with stasis dots back slightly thick white fur.

> > > Pulse: slippery rapid

> > > Diagnosis: damp-heat, wind-damp heat and blood stagnation

> > > Chai Hu Jia Long Gu Mu Li Tang was given for one week. No effect on the

> > > insomnia. Digestion seemed more complete though.

> > > This week gave Fang Feng Tong Sheng San so no report on this Rx yet.

> > > What are your thoughts on this case if you could please recommend a

> > > formula. Thanks so much excited to hear comments.

> > > ~Suzanne

> > >

> > >

> > >

> >

> >

> >

> > --

> > , DAOM

> > Pain is inevitable, suffering is optional.

> > http://twitter.com/algancao

> >

> >

> >

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Guest guest

The chi shao and mu dan pi in GZFLW would be helpful for that clotting in

the blood in the lower jiao and cool the blood.

Gui zhi, fu ling, chi shao, mu dan pi, tao ren.... great idea

and then add something for the insomnia, like suan zao ren and ye jiao teng

(moves blood as well)

for the damp/phlegm... yuan zhi as in An mien pian... a modification of Suan

zao ren tang with yuan zhi in it.

 

K

 

 

 

On Sat, Mar 13, 2010 at 11:36 AM, Al Stone <al wrote:

 

> I was actually looking for a blood moving formula that had dan shen (Rx.

> Savliae) and chi shao (Rx. Peonae Rubra) in it. Those were really the goal.

> But seeing the fu ling (Poria) and tao ren (Sm. Persica), both of which are

> neutral works for me too. The fu ling is good for her phlegm/dampness too.

>

> To address the heat, it may be prudent to lower the dosage of the gui zhi

> in

> there, otherwise if you look at the formula all at once, it seems to me

> that

> it is on the cool side on balance.

>

> -al.

>

> On Sat, Mar 13, 2010 at 7:10 AM, henry_buchtel <henry.buchtel

> >wrote:

>

> >

> >

> > Hi Al, I was a little surprised to see your description of gui zhi fu

> ling

> > wan as 'cool', would you mind explaining that?

> >

> > Have you seen/heard of it being used to treat heat syndromes?

> >

> > Regards, Henry

> >

> > Al Stone wrote:

> >

> > > I suggest a cold-natured blood activating formula along with a cooling

> > shen

> > > calming formula.

> > >

> > > Gui Zhi Fu Ling Wan is cool and activating for the blood.

> > > Tian Wang Bu Xin Dan is cooling and calming to the shen.

> > >

> >

> >

> >

>

>

>

> --

> , DAOM

> Pain is inevitable, suffering is optional.

> http://twitter.com/algancao

>

>

>

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Guest guest

Thanks for the comments! I agree Tian Wang Bu Xin Dan seems to be too

sticky/moistening right now. Although calming/cooling to the heart the dampness

will also be nourished. I think the damp-heat needs to be cleared first.

~Suzanne

 

, Al Stone <al wrote:

>

> Yeah, I hear ya, John, but based on the patient's chief complaint of

> insomnia, I gave the heat and stagnation more weight and other things less

> weight. My goal with Tian Wang Bu Xin Dan was to cool the heart and its

> blood. But I recognize that might aggravate the middle jiao stuff. That's

> one reason I would encourage the addition of huang lian and lian qiao to

> cool and dry the yang ming.

>

> And this is really about case management too, Heart problems get in the way

> of compliance. If she's feeling more calm and sleeping better, she'll be

> back, and then you can start to focus on the dampness. I don't even know

> where that's coming from right now. Could be the backup of fluids that are

> addressed by the fu ling in the stagnation of qi, blood, and fluids in gui

> zhi fu ling wan.

>

> If she gets indigestion on the TWBXD, then we'd want to add something for

> that, maybe some cang zhu, shan zha and mai ya. Something like that.

>

> -al.

>

>

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Guest guest

Insomnia is a very common symptom that can be caused by at least four different

patterns with differnet pathomechanism respectively. By seeing which base

formula you choose, we can deduct what pathomechanisms you deem.

 

In your case, you use Chai Hu Jia Long Gu Mu Li Tang. It is a formula from

Shang Han Lun and the pathomechanism should be qi stagnation in the liver and

gall bladder, fluid and blood stagnation. The treatment methods are

blood-invigorating, phlegm-promoting, qi-moving, and calming. It best addresses

to phlegm-heat clouding the brain.

 

In accordance with the principle of pattern differenitation of visceral and

bowel established in Jin Gui Yao Lue (The Essential of Golden Cabinet), the

related viscera should be heart and spleen. I guess this may explain why Chai

Hu Jia Long Gu Mu Li Tang did not work as it did not address the heart and

spleen issue.

 

Fang Feng Tong Sheng San is a formula that addresses wind heat in dual exterior

and interior. Signs should include heat in the exterior marked exuberant heat,

chills etc. Internally there are thirst, bitterness in the mouth, fright,

dizzness, conspitation, sores,reddish urines, etc. It will increase more heat

signs and damage to yin as there are quite a few purgative medicinals.

 

I wish i could contribute more but there are no sufficient data for me to come

up with a proper diagnosis, things that you have not included in your

description such as

 

---how long the insomnia (better use sleeplessness as insomnia is a western

medicine term, we have to use our symptom) has been

 

---color of urine

 

---mense duration, color, punctuality, etc.

 

By firming identifying the pathomechanisms, especially the teachings of Jin Gui

Yao Lue, which is first and ultimate the book of internal medicine, our

diagnosis is as evidence-based as any other medical modalities, if not more.

 

My 2 cents,

 

Sung, Yuk-ming

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Guest guest

Al,

Rather than going all over the map (two formulas, adding ingredients for this

and that), one can work with a good base formula such as, perhaps, huang lian

tang.

 

One cannot treat a 'chief complaint' and ignore other aspects of a case,

especially contradictory ones, as they may provide the key to resolving it. If

dampness is a major issue, it may be interfering with sleep. Not only that, by

exacerbating dampness, you will just worsen the case, it can't just be pushed

aside.

 

It was the gall bladder that was removed before the problem began, therefore

it may be possible that we have an issue of qi transformation involving gall

bladder, spleen and stomach, especially with the bloating. The fact that the

chai hu jia long gu mu li tang helped her digestion is a sign that you may want

to continue in this direction with a similar formula.

 

The 'ban xia xie xin tang' family is closely related to the 'xiao chai hu

tang' family, and many cases of insomnia are resolved by rectifying qi

transformation. Sharon Weizenbaum published a similar case of insomnia to this

one in a recent issue of " The Lantern " which used a modification of ban xia xie

xin tang to great effect.

 

Evil heat often collects in the chest when qi transformation is obstructed,

by opening up ascending clear yang and descending turbid yin, the evil heat will

be relieved, the bloating will be reduced, and perhaps the runny nose will

improve as well. .

 

I'd be curious about two things: 1) when did she develop menstrual problems

2) is she on any medications. .

 

 

On Mar 13, 2010, at 11:46 AM, Al Stone wrote:

 

> Yeah, I hear ya, John, but based on the patient's chief complaint of

> insomnia, I gave the heat and stagnation more weight and other things less

> weight. My goal with Tian Wang Bu Xin Dan was to cool the heart and its

> blood. But I recognize that might aggravate the middle jiao stuff. That's

> one reason I would encourage the addition of huang lian and lian qiao to

> cool and dry the yang ming.

>

> And this is really about case management too, Heart problems get in the way

> of compliance. If she's feeling more calm and sleeping better, she'll be

> back, and then you can start to focus on the dampness. I don't even know

> where that's coming from right now. Could be the backup of fluids that are

> addressed by the fu ling in the stagnation of qi, blood, and fluids in gui

> zhi fu ling wan.

>

> If she gets indigestion on the TWBXD, then we'd want to add something for

> that, maybe some cang zhu, shan zha and mai ya. Something like that.

>

> -al.

>

>

> On Sat, Mar 13, 2010 at 8:02 AM, <johnkokko wrote:

>

>>

>>

>> Hi Al,

>> Gui zhi fu ling san looks good, but do you think that Tian wang bu xin dan

>> might be a little too sticky?

>> She has phlegm, mucus, is overweight... slightly thick fur and slippery,

>> rapid pulse...

>>

>> K

>>

>> On Fri, Mar 12, 2010 at 10:59 PM, Al Stone <al<al%40gancao.net>>

>> wrote:

>>

>>> Hi Suzanne,

>>>

>>> Your case looks to me like post-operative blood stagnation turning into

>>> heat

>>> which is causing the insomnia.

>>

>>>

>>> I suggest a cold-natured blood activating formula along with a cooling

>> shen

>>> calming formula.

>>>

>>> Gui Zhi Fu Ling Wan is cool and activating for the blood.

>>> Tian Wang Bu Xin Dan is cooling and calming to the shen.

>>>

>>> If you're in a position to add a few single herbs, consider adding a dash

>>> of

>>> huang lian and lian qiao which both remove heat from the Yang Ming but

>> also

>>> calm the shen by clearing heat from the Heart.

>>>

>>> -al.

>>>

>>> On Fri, Mar 12, 2010 at 7:38 AM, suz

<suzstricker<suzstricker%40>>

>> wrote:

>>>

>>>>

>>>>

>>>> Hello Academy,

>>>> I am new to the group so hopeful I will post this case with the needed

>>>> info. Thank you in advance for the advice.

>>>> 32-year-old women

>>>> Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

>>>> gall bladder was removed a few years ago. Has trouble falling asleep

>> and

>>>> staying asleep. Tosses and turns and feels irritated by not being able

>> to

>>>> sleep. Has dream disturbed sleep and nightmares.

>>>> Other symptoms:

>>>> Severe allergies- both food and environmental. Manifest as congestion

>> and

>>>> runny nose with clear discharge, sore throat that is itchy, and left

>> ear

>>>> pain that also keeps her up at night, and sneezing.

>>>> Overweight: has been trying to lose weight but it is not coming off.

>>>> Digestion: bloated, has a bowel that does not feel complete. BM dry and

>>>> small.

>>>> Menses: heavy, blood clots, pain before and first few days.

>>>> Acne: Many small raised bumps all over face skin colored.

>>>> Tongue: red tip with stasis dots back slightly thick white fur.

>>>> Pulse: slippery rapid

>>>> Diagnosis: damp-heat, wind-damp heat and blood stagnation

>>>> Chai Hu Jia Long Gu Mu Li Tang was given for one week. No effect on the

>>>> insomnia. Digestion seemed more complete though.

>>>> This week gave Fang Feng Tong Sheng San so no report on this Rx yet.

>>>> What are your thoughts on this case if you could please recommend a

>>>> formula. Thanks so much excited to hear comments.

>>>> ~Suzanne

>>>>

>>>>

>>>>

>>>

>>>

>>>

>>> --

>>> , DAOM

>>> Pain is inevitable, suffering is optional.

>>> http://twitter.com/algancao

>>>

>>>

>>>

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Guest guest

Hi all,

 

Z'ev is on the right track in my opinion, and brings to mind the formula Gan Cao

Xie Xin Tang, which includes the " vexation " angle.

 

Brandt

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Guest guest

Since Suzanne is a friend of mine and I recommended that she post her case,

I thought I should chime in. I think Z'ev's analysis, so far, makes the most

sense. First let's look at the diagnosis. I think it out is that there is

heat. There is also strong evidence for some damn/phlegm. I do not think the

blood clots alone are enough to implicate blood stagnation and the

gallbladder surgery can mean many things (one must look at the

presentation). I am curious why people see so much blood stasis here? As

Z'ev pointed out this may manifest as a chief transformation issue. Let's

look at other ideas people suggested.

 

 

 

1. Ding zhi wan, fang feng tang sheng san, & xiao chao hu tang does not

fit the diagnosis.

 

2. TWBXD + GZFLW - is too cloying and misses the damp/phlegm component

- But Al's point about getting the person to sleep is important, but should

be at the expense of missing the core dynamic.

 

 

 

But my opinion, the best sleep/Shen calming formula in the world is useless

if it does not fit the pattern.

 

 

 

Furthermore, GZFLW + " suan zao ren and ye jiao teng yuan " -- again looks

like a great insomnia formula but does not really fit the pattern. I know

everyone has their style, but I always try to understand the underlying

mechanism and treat the pattern and not focus on the " chief complaint " .

 

 

 

There is clearly some middle burner involvement, hence why Z'ev is on the

right track. This must be addressed. I suggest a classical formula idea from

the Ling Shu, such as a ban xia shu mi method.

 

 

 

Treatment Principle: improve the qi dynamic, transform damp and phlegm,

clear heat, and calm the spirit.

 

 

 

Consider something along these lines:

 

 

 

Jiang ban xia 6

 

Shu mi 12

 

Shi chang pu 6

 

Chao huang lian 3

 

Chao zhu ru 9

 

Fu shen 12

 

Yuan zhi 9

 

Yu jin 6

 

Da huang tan 6

 

Chao bing lang 6

 

Guang mu xiang 6

 

 

 

Also for a more straight forward approach consider modified versions of wen

dan tang, san ren tang, or ban xia xie xin tang family.

 

 

 

 

 

-

 

 

 

 

 

 

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Sorry, my previous post was sent by mistake- it was not edited.

 

 

 

Here is a corrected first paragraph.

 

 

 

" Since Suzanne is a friend of mine and I recommended that she post her case,

I thought I should chime in. I think Z'ev's analysis, so far, makes the most

sense.

 

 

 

First let's look at the diagnosis. I think it is clear that there is

heat. There is also strong evidence for some damn/phlegm. I do not think the

blood clots alone are enough to implicate blood stasis (or at least a

primary cause of the insomnia) and the

gallbladder surgery can mean many things (one must look at the

presentation). I am curious why people see so much blood stasis here? As

Z'ev pointed out this may be as a qi transformation issue - this makes

sense. So first let's

look at other ideas people suggested. "

 

 

 

-Jason

 

 

 

 

On Behalf Of

Sunday, March 14, 2010 9:30 AM

 

RE: Insomnia

 

 

 

 

 

Since Suzanne is a friend of mine and I recommended that she post her case,

I thought I should chime in. I think Z'ev's analysis, so far, makes the most

sense. First let's look at the diagnosis. I think it out is that there is

heat. There is also strong evidence for some damn/phlegm. I do not think the

blood clots alone are enough to implicate blood stagnation and the

gallbladder surgery can mean many things (one must look at the

presentation). I am curious why people see so much blood stasis here? As

Z'ev pointed out this may manifest as a chief transformation issue. Let's

look at other ideas people suggested.

 

1. Ding zhi wan, fang feng tang sheng san, & xiao chao hu tang does not

fit the diagnosis.

 

2. TWBXD + GZFLW - is too cloying and misses the damp/phlegm component

- But Al's point about getting the person to sleep is important, but should

be at the expense of missing the core dynamic.

 

But my opinion, the best sleep/Shen calming formula in the world is useless

if it does not fit the pattern.

 

Furthermore, GZFLW + " suan zao ren and ye jiao teng yuan " -- again looks

like a great insomnia formula but does not really fit the pattern. I know

everyone has their style, but I always try to understand the underlying

mechanism and treat the pattern and not focus on the " chief complaint " .

 

There is clearly some middle burner involvement, hence why Z'ev is on the

right track. This must be addressed. I suggest a classical formula idea from

the Ling Shu, such as a ban xia shu mi method.

 

Treatment Principle: improve the qi dynamic, transform damp and phlegm,

clear heat, and calm the spirit.

 

Consider something along these lines:

 

Jiang ban xia 6

 

Shu mi 12

 

Shi chang pu 6

 

Chao huang lian 3

 

Chao zhu ru 9

 

Fu shen 12

 

Yuan zhi 9

 

Yu jin 6

 

Da huang tan 6

 

Chao bing lang 6

 

Guang mu xiang 6

 

Also for a more straight forward approach consider modified versions of wen

dan tang, san ren tang, or ban xia xie xin tang family.

 

-

 

 

 

 

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Thank you for all of your thoughtful comments!!! I will try to answer the

questions you have.

" Sleeplessness " for about 2 years since her gallbladder was removed.

Urine color dark yellow 2-3 times a week otherwise normal.

Menses: has had menstrual issues all her life. 5 days long, 28 day cycle

regular, bright red in color.

Medications: Claritin during day, other antihistamines, allergy shots.

~Thanks Suzanne

 

 

, " Yuk Ming " <sxm2649 wrote:

>

> Insomnia is a very common symptom that can be caused by at least four

different patterns with differnet pathomechanism respectively. By seeing which

base formula you choose, we can deduct what pathomechanisms you deem.

>

> In your case, you use Chai Hu Jia Long Gu Mu Li Tang. It is a formula from

Shang Han Lun and the pathomechanism should be qi stagnation in the liver and

gall bladder, fluid and blood stagnation. The treatment methods are

blood-invigorating, phlegm-promoting, qi-moving, and calming. It best addresses

to phlegm-heat clouding the brain.

>

> In accordance with the principle of pattern differenitation of visceral and

bowel established in Jin Gui Yao Lue (The Essential of Golden Cabinet), the

related viscera should be heart and spleen. I guess this may explain why Chai

Hu Jia Long Gu Mu Li Tang did not work as it did not address the heart and

spleen issue.

>

> Fang Feng Tong Sheng San is a formula that addresses wind heat in dual

exterior and interior. Signs should include heat in the exterior marked

exuberant heat, chills etc. Internally there are thirst, bitterness in the

mouth, fright, dizzness, conspitation, sores,reddish urines, etc. It will

increase more heat signs and damage to yin as there are quite a few purgative

medicinals.

>

> I wish i could contribute more but there are no sufficient data for me to come

up with a proper diagnosis, things that you have not included in your

description such as

>

> ---how long the insomnia (better use sleeplessness as insomnia is a western

medicine term, we have to use our symptom) has been

>

> ---color of urine

>

> ---mense duration, color, punctuality, etc.

>

> By firming identifying the pathomechanisms, especially the teachings of Jin

Gui Yao Lue, which is first and ultimate the book of internal medicine, our

diagnosis is as evidence-based as any other medical modalities, if not more.

>

> My 2 cents,

>

> Sung, Yuk-ming

>

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Jason,

There are many paths up a mountain...

If we're going to use a Xie xin tang family formula it should be Gan cao xie

xin tang,

which Arnaud Versluys uses to good effect for these kinds of sleep issues.

 

In Formulas and Strategies 2nd ed.. pg. 130

" This formula is used at present, particularly in Japan, for sleep disorders

including difficulty in falling asleep, frequent waking, unrefreshed sleep,

dream-disturbed sleep, talking in one's sleep and somnambulism...(from the

Jin gui yao lue): The patient is silent and desires to sleep (but) the eyes

cannot be closed (and when) they get up they are restless. "

 

However, I'm going to defend Al's recommendation of Gui zhi fu ling wan, but

not TWBXD, because her primary complaint started after surgery (blood

stasis).. the removal of her Gall Bladder. She has heavy periods with blood

clots and pain. I agree with your friend Suzanne's diagnosis that there is

blood stasis and damp/phlegm heat. So modifying Gui zhi fu ling wan to

address the damp/phlegm heat, such as adding Huang qin and Ban xia would be

just fine.

 

Gui zhi fu ling wan consists of five herbs: Gui zhi, Fu ling, Chi shao, Mu

dan pi, Tao ren

Fu ling is a damp-clearing medicinal, Chi shao and Mu dan pi move and cool

blood and Tao ren moves blood, especially in the lower jiao. Suzanne's

patient also has dry and small stools, which would be addressed with Tao

ren.

 

Also, I'm curious why a Xiao chai hu tang modification wouldn't " fit the

pattern " here?

The three major Xie xin tangs are modifications of the root formula: Xiao

chai hu tang, with only a change in Chai hu vs Huang lian and Sheng jiang vs

Gan jiang.

 

This patient has clearly a GB related issue (shao yang), has a itchy (wind)

sore throat and left ear pain (sides = shao yang). XCHT fits her pattern

of damp-heat in the MJ (shao yang specifically) and addresses the branches,

as well. The patient has sneezing and a runny nose (wind) and Chai hu vents

wind and heat.

Xiao chai hu tang: Chai hu, Huang qin, Ban xia, Ren shen, Sheng jiang, Gan

cao, Hong zao

This formula addresses the damp/phlegm heat in the MJ/UJ and harmonizes the

internal with the external.

 

Also, the blood stasis in the lower jiao could be seen as a transmission of

Shao yang into Jue yin (uterus), where Xiao chai hu tang would be the

formula to vent out the heat and wind.

 

As far as Wen dan tang, I like this formula a lot... Zhu ru and Zhi shi are

an amazing combination to harmonize the GB/ST and the rest is basically Er

chen tang, except classically Er chen tang has Ju hong and Wu mei, while Wen

dan tang has Chen pi and Hong zao.

 

Can you explain more about the Ban xia / Shu mi method from the " Ling shu " ?

Is that from the Ling shu?

 

This is a great discussion...

K

 

 

 

 

 

 

 

 

On Sun, Mar 14, 2010 at 8:30 AM, <

> wrote:

 

>

>

> Since Suzanne is a friend of mine and I recommended that she post her case,

> I thought I should chime in. I think Z'ev's analysis, so far, makes the

> most

> sense. First let's look at the diagnosis. I think it out is that there is

> heat. There is also strong evidence for some damn/phlegm. I do not think

> the

> blood clots alone are enough to implicate blood stagnation and the

> gallbladder surgery can mean many things (one must look at the

> presentation). I am curious why people see so much blood stasis here? As

> Z'ev pointed out this may manifest as a chief transformation issue. Let's

> look at other ideas people suggested.

>

> 1. Ding zhi wan, fang feng tang sheng san, & xiao chao hu tang does not

> fit the diagnosis.

>

> 2. TWBXD + GZFLW - is too cloying and misses the damp/phlegm component

> - But Al's point about getting the person to sleep is important, but should

> be at the expense of missing the core dynamic.

>

> But my opinion, the best sleep/Shen calming formula in the world is useless

> if it does not fit the pattern.

>

> Furthermore, GZFLW + " suan zao ren and ye jiao teng yuan " -- again looks

> like a great insomnia formula but does not really fit the pattern. I know

> everyone has their style, but I always try to understand the underlying

> mechanism and treat the pattern and not focus on the " chief complaint " .

>

> There is clearly some middle burner involvement, hence why Z'ev is on the

> right track. This must be addressed. I suggest a classical formula idea

> from

> the Ling Shu, such as a ban xia shu mi method.

>

> Treatment Principle: improve the qi dynamic, transform damp and phlegm,

> clear heat, and calm the spirit.

>

> Consider something along these lines:

>

> Jiang ban xia 6

>

> Shu mi 12

>

> Shi chang pu 6

>

> Chao huang lian 3

>

> Chao zhu ru 9

>

> Fu shen 12

>

> Yuan zhi 9

>

> Yu jin 6

>

> Da huang tan 6

>

> Chao bing lang 6

>

> Guang mu xiang 6

>

> Also for a more straight forward approach consider modified versions of wen

> dan tang, san ren tang, or ban xia xie xin tang family.

>

> -

>

>

>

>

>

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Guest guest

Yes John, there are many paths, never stated otherwise. What I present is

just my opinion. For the record Al was using GZFLW *together with* TWBXD -

and I still think this is incorrect.

 

 

 

Yes ban xia shu mi tang is from the Ling Shu.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Sunday, March 14, 2010 10:43 AM

 

Re: Insomnia

 

 

 

 

 

Jason,

There are many paths up a mountain...

If we're going to use a Xie xin tang family formula it should be Gan cao xie

xin tang,

which Arnaud Versluys uses to good effect for these kinds of sleep issues.

 

 

 

 

 

 

 

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Jason,

I'd like to read up on Ban xia shu mi... can you quote the chapter/verse?

Thanks...

 

Btw.. I also think that phlegm is kind of a dam/n thing....

 

J wrote: " There is also strong evidence for some damn/phlegm " .

 

I know this was just a typo, but it was kind of funny.

 

Also, just curious for those on the list,

1. What do you think happens with the Hun when the GB is removed from the

body? I've heard that Long gu ( " dragon bone " ) can root the Hun, anyone

else heard of this kind of thing or seen it in any literature?

 

2. According to the Five Flavors lecture from Arnaud Versluys, the sour

flavor medicinals astringe the Heart (fire phase)... Wu wei zi and Suan zao

ren.

Do you think these should be added to the formula now or later?

 

Cheers,

K

 

 

 

On Sun, Mar 14, 2010 at 11:56 AM, <

> wrote:

 

>

>

> Yes John, there are many paths, never stated otherwise. What I present is

> just my opinion. For the record Al was using GZFLW *together with* TWBXD -

> and I still think this is incorrect.

>

> Yes ban xia shu mi tang is from the Ling Shu.

>

> -Jason

>

> <%40>

>

[ <%40>\

]

> On Behalf Of

> Sunday, March 14, 2010 10:43 AM

> <%40>

> Re: Insomnia

>

>

> Jason,

> There are many paths up a mountain...

> If we're going to use a Xie xin tang family formula it should be Gan cao

> xie

> xin tang,

> which Arnaud Versluys uses to good effect for these kinds of sleep issues.

>

>

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Guest guest

I am pretty sure it is from Chapter 71, but I am sure you can find info

about if you look.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Sunday, March 14, 2010 1:28 PM

 

Re: Insomnia

 

 

 

 

 

Jason,

I'd like to read up on Ban xia shu mi... can you quote the chapter/verse?

Thanks...

 

 

 

 

 

 

 

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Guest guest

Geoff wrote: " Lastly - make her do some cardio between dinner and bedtime.

Not 2 hours of a spin class, but even 15 minutes of some 80% max HR (220 -

age) kind of something to blow some steam off before calming down for the

evening. "

 

Can you explain more about how this is effective for insomniacs?

 

I thought that a quiet walk around the block after dinner and then resting

for the night, without stimulating the brain was a good idea. Doing cardio

in the morning increases metabolism and Sympathetic NS firing. How does

doing cardio at night help with sleep....

 

Thanks,

K

 

 

 

On Sun, Mar 14, 2010 at 12:53 PM, yingsuke2002 <ozark.canuckwrote:

 

>

>

> Hi Suz -

> The few symptoms that jumped out at me were:

>

>

> --- In

<%40>,

> " suz " <suzstricker wrote:

> >Tosses and turns and feels irritated by not being able to sleep. Has dream

> disturbed sleep and nightmares.

> > Overweight: has been trying to lose weight but it is not coming off.

> > Digestion: bloated, has a bowel that does not feel complete. BM dry and

> small.

> > Menses: heavy, blood clots, pain before and first few days.

> > Acne: Many small raised bumps all over face skin colored.

> > Tongue: red tip with stasis dots back slightly thick white fur.

> > Pulse: slippery rapid

> > Diagnosis: damp-heat, wind-damp heat and blood stagnation

>

> My first thoughts are to run to Long Dan Xie Gan Wan as it sounds like a

> lot of Liver symptoms. 'Feels irritated' 'tossing and turning' 'nightmares'

> 'trying to lose weight (I immediately think of stress eating)' 'bloated'

> 'dry small stool'

>

> Is the dream disturbed sleep related to wacky dreams or the nightmares? I

> think of nightmares more related to Liver and weird dreams related to the

> Heart.

>

> It's quick and easy to cool fire - acupuncture can do a good number on heat

> too - then you can think about more long term strategies that others have

> also suggested with phelgm etc.

>

> Lastly - make her do some cardio between dinner and bedtime. Not 2 hours of

> a spin class, but even 15 minutes of some 80% max HR (220 - age) kind of

> something to blow some steam off before calming down for the evening.

>

> What dosage of herbs are you giving?

> Geoff

>

>

>

 

 

 

--

 

 

""

 

 

www.tcmreview.com

 

 

 

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Jason,

Thanks. This is very interesting... goes together with that thread of Nei

jing channels/ herbalism.

This connects the yang qiao/ yin qiao treatment for insomnia/somnolence = UB

62/ KD 6 along with a 2 herb formula:

 

Ban xia tang formula: L 71-4

" Bo-Gao replied: Fill eight shengs (1 sheng = 1 liter) of water that runs

from one thousand miles away, and shake it for ten thousand times to strike

a balance between yin and yang. And then take 5 shengs of water to boil

over fire of reed, because reed burns fast after the water has settled

down. After water is boiling, place 1 sheng of husked sorghum (Shu mi),

five ges (1 ge= 1 deciliter or one tenth of a liter) of processed ban-xia in

the boiling water and continue to boil over low heat until water is reduced

to one and half shengs. And then, remove dregs from the utensil. Drink a

small cup of decoction each time, three times a day, or according to the

conditions of the individual patient until it takes effect. A new patient

may go to bed right after drinking the decoction and it takes effect as soon

as perspiration starts. As to an old patient, it may take three doses to

take effect. "

(Henry Lu's 2nd ed. translation)

 

I asked you to " Shu mi the money " . That's a very cool passage.

Now, just got to get some sorghum somewhere. where?

K

 

 

 

On Sun, Mar 14, 2010 at 12:53 PM, <

> wrote:

 

>

>

> I am pretty sure it is from Chapter 71, but I am sure you can find info

> about if you look.

>

>

> -Jason

>

> <%40>

>

[ <%40>\

]

> On Behalf Of

> Sunday, March 14, 2010 1:28 PM

>

> <%40>

> Re: Insomnia

>

> Jason,

> I'd like to read up on Ban xia shu mi... can you quote the chapter/verse?

> Thanks...

>

>

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Kokko:

Gui zhi fu ling wan consists of five herbs: Gui zhi, Fu ling, Chi

shao, Mudan pi, Tao ren

 

Stephen

Not sure why you keep citing Chi Shao

considering the prominent position of Bai Shao in the Tang Ye

Jing and the consistent " fit " of Bai shao in formulas of Shanghan

Zabing Lun tradition - I believe that this too is Baishao

Guizhi + Baishao is an extremely important pairing

it would be consistent with SHL formula architecture and makes

more sense functionally than chishao

 

Also, from reading the signs and symptoms - it seems that Z'ev's

approach should be looked into

 

Suzanne,

you posted that the pulse was slippery rapid

may I ask at which position you observed the slippery image?

if it was right hand 2nd position, it would strongly support the

use of dahuang or huanglian + ganjiang

 

can you give us more pulse info?

 

Stephen Woodley LAc

www.shanghanlunseminars.com

 

--

http://www.fastmail.fm - Does exactly what it says on the tin

 

 

 

 

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Stephen,

 

In the earliest materia medicas and in the Shang han za bing lun,

Bai shao and Chi shao were not differentiated, but named " Shao yao " .

The species for both is Paeonia lactiflora.

 

The difference today is that Bai shao is cultivated Paeonia lactiflora with

the bark removed,

while Chi shao is the wild-crafted and the bark is retained

(Bensky,Clavey,Stoger MM 3rd ed)

 

So, by going with the rules of the formula, we can choose either herb to

use.

 

In this particular patient's case, we can choose either one..

but Chi shao works better for her case with the blood stasis and heat.

 

I've already stated that Gan cao xie xin tang would be an ideal choice,

according to the Shang han za bing lun method,

but we should also be open to other ways of treating a patient,

especially when we don't have the fukushin reflexes and specific

pulse-position picture.

 

If the pulse is slippery, wiry and rapid in the left guan position....

Huang qin

slippery, rapid in the right guan position...da huang/ huang lian

If both positions, then a Xie xin tang would cover both.

 

Without actually being there, I stand on the potential effectiveness of

another formula helping the patient as well,

either a modified Xiao chai hu tang (my rx), modified Gui zhi fu ling tang

(wan would be too sticky- honey pill) (Al's rx)

or Ban xia shu mi tang modification (Jason's rx).

 

Great discussion.

 

K

 

 

 

 

 

 

 

 

 

 

 

On Sun, Mar 14, 2010 at 5:50 PM, stephen woodley <learntcmwrote:

 

>

>

> Kokko:

>

> Gui zhi fu ling wan consists of five herbs: Gui zhi, Fu ling, Chi

> shao, Mudan pi, Tao ren

>

> Stephen

> Not sure why you keep citing Chi Shao

> considering the prominent position of Bai Shao in the Tang Ye

> Jing and the consistent " fit " of Bai shao in formulas of Shanghan

> Zabing Lun tradition - I believe that this too is Baishao

> Guizhi + Baishao is an extremely important pairing

> it would be consistent with SHL formula architecture and makes

> more sense functionally than chishao

>

> Also, from reading the signs and symptoms - it seems that Z'ev's

> approach should be looked into

>

> Suzanne,

> you posted that the pulse was slippery rapid

> may I ask at which position you observed the slippery image?

> if it was right hand 2nd position, it would strongly support the

> use of dahuang or huanglian + ganjiang

>

> can you give us more pulse info?

>

> Stephen Woodley LAc

> www.shanghanlunseminars.com

>

> --

> http://www.fastmail.fm - Does exactly what it says on the tin

>

>

>

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Kokko

In the earliest materia medicas and in the Shang han za bing lun,

Bai shao and Chi shao were not differentiated...

Stephen

Sure, we've all heard this...but with your studies of the Tangye

jing you know that Baishao is the Earth herb of the metal class

and Chishao can't fulfill this positioning. So, I had to poke you

 

Kokko

So, by going with the rules of the formula, we can choose either

herb to use.

In this particular patient's case, we can choose either one. but

Chi shao works better for her case with the blood stasis and

heat.

 

Stephen:

Don't think I can agree with this...the relationship of Guizhi +

Baishao is one of outside and inside the vessels and can't be

improved upon. IMO, Chishao doesn't represent an improvement,

only straying from a perfectly balanced formula.

 

I do agree that we could use more info on the patient, that's why

I asked for more pulse info from Suzanne.

It is interesting and yeah, without actually seeing the patient

it is mostly an exercise in conjecture.

 

see you this weekend

 

Stephen Woodley LAc

www.shanghanlunseminars.com

 

--

http://www.fastmail.fm - A fast, anti-spam email service.

 

 

 

 

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