Guest guest Report post Posted March 19, 2010 Cara, When I originally proposed GZFLW I was thinking blood level heat and stagnation. I would have also preferred to add only the sheng di and dan shen from Tian Wang Bu Xi Dan. So, I like what you're talking about here, though I would still like to see some dan shen in there, that seems core to me. When I originally assessed the case, I looked at the most likely cause of the insomnia which, given the numerous indications of heat in the heart along with some possible blood stagnation signs suggested the blood situation that I've favored all along. My thinking was that the damp indications such as being unable to lose weight, and a thicker coating in the rear are simply too widely found in any patient population. So I gave these indications less weight. This isn't something I would necessarily do with a patient I see in person, but it is how I think when assessing an email case. Although a good follow up quesiton would be asking if these damp indications were around prior to the GB removal. As for the slippery and rapid pulse, that doesn't have to mean dampness or it can mean heat in the yang ming. -al. On Fri, Mar 19, 2010 at 12:27 PM, cara <herbbabe wrote: > Gentleman, > > I want to offer up a slightly different perspective: the woman has heavy > clotty periods and insomnia. I feel that the formula should focus on > clearing heat. I don't see her as having a gzflw presentation. I think that > qin lian si wu tang address a wider scope of what is going on with her. > the ingreds are si wu tang ( with sheng di), huang qin, huang lian and mai > dong: > > the si wu tang will harmonize the blood, the huangs will clear heat from > the blood, clear heat and dry dampness from the MW and also eliminate > vexation, the sheng di cools the blood and also clears heat from the heart, > the mai dong also will calm the spirit. > > whaddya think? > > Cara > On Mar 19, 2010, at 2:05 PM, wrote: > > > K, > > > > If you don't understand how this can be based on BXXXT please check out > Ye > > tian-shi, Ding gan-ren, Qin-Bo-Wei, or other meng he style doctors. There > > are many others that can teach such ideas but I just like those. But > > essentially it is understanding the principles behind the formula and not > > rigidly being confined to the exact ingredients. Check out the latest > case > > study by Ding gan-ren which demonstrates this idea for Gui Zhi Tang. > > > > > Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/ > > > > SO, I agree if you mix GZFLW with this BXXXT idea this might work. > However > > this was not what we were talking about and not the original modification > > that Al presented. As a base formula for the core pathodynamic it seems > > second best and I think you would agree, since you like XCHT and BXXXT > > ideas. So why even go there? > > > > Any formula, modified enough, can work, but the real question is does it > hit > > the core pathodynamic. If the core pathodynamic is based on the middle > > burner then GZFLW is not a good base formula choice. If the core > > pathodynamic is from blood stasis then XCHT and BXXXT are not good base > > formulas. You can't have it both ways, it is one or the other. The key is > to > > diagnosis clearly and find the core idea to unravel it. SO once you have > > made a diagnosis you must come up with treatment principles, this then > must > > be reflected in the formula. I find a bit of disconnect in this process > with > > your formulas. > > > > Thanks for the convo... > > > > -Jason > > > > > > > > On Behalf Of > > Friday, March 19, 2010 9:40 AM > > > > Re: Insomnia > > > > Jason wrote: > > " BTW - xie xin tang's obviously focuses on the middle burner which is > > exactly where > > my diagnosis is...if you will notice the formula I wrote is based on ban > > xia > > shu mi tang, ban xia xie xin tang, mu xiang bing lang wan... " > > > > Your 11 herb formula has 2 herbs that are in Ban xia xie xin tang, so > > how > > does this make it based on BXXXT? > > ... Ban xia and Huang lian > > leaving out... Huang qin, Gan jiang, Ren shen, Gan cao, Da zao (5/7 of > > the > > formula). > > > > Patient's diagnosis: Shen disturbance, wind-phlegm-heat in upper jiao, > > Damp > > congestion in middle jiao, blood stasis in lower jiao. > > > > I've wriiten this before, but here it is again.... > > What signs show blood stasis? (possible internal scarring from GB > > removal > > surgery.. this is just conjecture though) > > Menses: heavy, blood clots, pain before and first few days.... this > > seems > > self-explanatory > > Tongue: red tip with stasis dots .. stasis dots show blood stasis, red > > tip relates to the acne, sore throat and insomnia > > back slightly thick white fur (possible damp in the MJ or LJ) > > Pulse: slippery and rapid (slippery can mean food stagnation and/or > > dampness and/or phlegm and/or heat and pregnancy) > > > > For instance... > > Modified Gui zhi fu ling tang: > > > > Gui zhi (6 gms), Fu shen (9 gms), Chi shao (6 gms), Mu dan pi (6 gms), > > Tao > > ren (6 gms) > > Ban xia (6), Huang qin (6), Huang lian (3), Mu xiang (6), Suan zao ren > > (12), > > Zhi mu (6), Yuan zhi (6) > > > > (12 herbs/ 78 gms total) > > > > Great conversation, but seems like we're going in circles now. > > Giving respect to Zhang Zhong Jing was just some parting words, in light > > of > > the investigation of these ZZJ formulas. > > > > K > > > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 19, 2010 I agree that there is heat in the heart, but the question is where is it coming from? As far as the pulse, I agree with you, but we don't see other signs to lead us to believe this is a yang ming presentation, or do you? If it is not that, the pulse and tongue must be reckoned with. I personally consider pulse and tongue to trump most things and these cannot be thrown to the side. With the other digestive symptoms this is almost a slam dunk on a key place to focus one's treatment. -Jason On Behalf Of Al Stone As for the slippery and rapid pulse, that doesn't have to mean dampness or it can mean heat in the yang ming. -al. Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 19, 2010 Z'ev, This is 100% correct, hence my attention on addressing the middle burner. If one does not address the issues of impaired qi dynamic, as well as the bowels, then everything else will be in vein. This is of course especially a concern when giving cloying medicinals. Therefore why even monkey around with baishao, sheng di etc? It does not really fit the pattern. Why do you need to harmonize / tonify the blood? There is no real indication that this is a problem. -Jason On Behalf Of Friday, March 19, 2010 1:36 PM Re: Insomnia Cara, As long as there are digestive problems and bloating, it doesn't matter what you do. Giving cold or greasy herbs will just block the middle burner more, worsen spleen transformation, and the pattern will just exascerbate. Upper burner heat that contributes to insomnia in this case would only respond to normalizing the upbearing of clear yang and downbearing of turbid yin. On Mar 19, 2010, at 12:27 PM, cara wrote: Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 19, 2010 On Fri, Mar 19, 2010 at 2:25 PM, < > wrote: > > > I agree that there is heat in the heart, but the question is where is it > coming from? > Blood stagnation with heat is my working theory. The reason I didn't bark up the digestive system tree was because these indications were ambiguous to me while the heart heat and blood stagnation wasn't. Suzanne mentioned that the patient is a little bit overweight and has a slightly thick tongue coating in the rear. These are very common signs, and so they really didn't stand out to me as narrowing anything down. The other indications (tenesmus and bloating) could also be secondary to the removal of the GB itself, but I'm not convinced that they're creating heat. Maybe the dry poop says heat. Maybe. However, the red tip and " stasis dots " are less commonly found for me, so those items stuck out. One thing I'd like to know is why the GB was removed in the first place. If it is due to what we might deem qi stagnation, dampness, phlegm, something like that, we might then assume that the condition in the digestion was related to whatever happened that caused her GB to be removed, but not necessarily causing her insomnia. Keep in mind too that diagnosing a patient is staring into a black box. But diagnosing someone else's patient through email is staring into a black box with another black box obscuring your view. Naturally, we're going tilt our heads one way or another to see the patient, and thus we're going to approach things differently. As Tiende Yang always reminded me, " the patient is the teacher " . So, I look forward to hearing more about how this patient's insomnia plays out so we can all learn. -al. -- , DAOM Pain is inevitable, suffering is optional. http://twitter.com/algancao Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 19, 2010 On Fri, Mar 19, 2010 at 7:42 PM, Al Stone <al wrote: > > > On Fri, Mar 19, 2010 at 2:25 PM, < > > wrote: > >> >> >> I agree that there is heat in the heart, but the question is where is it >> coming from? >> > Blood stagnation with heat is my working theory. > I'm sorry, I meant blood stagnation with *blood level* heat. -- , DAOM Pain is inevitable, suffering is optional. http://twitter.com/algancao Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 19, 2010 Jason, I have the same question as Steven Boznak, posted at Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/ I'm not arguing with Ding Gan-Ren's methodology, especially with the limited information given. I " m just curious how he could call this a Gui zhi tang modification? ....just because it has Gui zhi and Shao yao (Chi shao) in it between 13 herbs, leaving out Sheng jiang, Gan cao and Da zao (which are vital in regulating ying/wei). None of the other medicinals in his formula regulate ying/wei. In his formula, the dose of Gui zhi is 8 fen and Chi shao 1.5 qian. Gui zhi tang's ratio is Gui zhi 3 qian , Shao yao 3 qian 1:1, not 1:2. For the case presentation, how come he didn't add the three medicinals that are integral to Gui zhi tang... Sheng jiang, Gan cao and Da zao? With the greasy coat, he could've just reduced the dose of Da zao or taken it out altogether, but why eliminate Sheng jiang and Gan cao? Please explain. Secondly, to take it to another level, we could say that the Ding Gan-Ren formula that you posted is a modification of Ma huang tang, because it has Gui zhi and Xing ren in it... or Xiao qing long tang, because it has Gui zhi and Ban xia in it... or Gui zhi fu ling tang because it has Gui zhi and Fu ling in it... or Ban xia hou po tang because it has Ban xia and Fu ling in it... or Dang gui shao yao san because it has Shao yao and Fu ling in it. In other words, for someone who likes precision, how can we be precise in our claims of root formula modifications when the herbs and dosages are so off? K Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 19, 2010 I would do 3 parts Tian Wan Bu xin Dan and 1 part Yue Ju Wan. Sorry to jump in late. Doug , " yingsuke2002 " <ozark.canuck wrote: > > Hi Suz - > The few symptoms that jumped out at me were: > > , " 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 > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 20, 2010 leaving out Sheng jiang, Gan cao and Da zao (which are vital in regulating ying/wei).   Actually the two most vital herbs in regulating construction and defense in guizhitang are guizhi and shaoyao.  Gabe Fuentes ________________________________ <johnkokko Fri, March 19, 2010 9:21:17 PM Re: Insomnia  Jason, I have the same question as Steven Boznak, posted at http://www.chinesem edicinedoc. com/case- studies/tai- yang-gui- zhi-tang- dgr/ I'm not arguing with Ding Gan-Ren's methodology, especially with the limited information given. I " m just curious how he could call this a Gui zhi tang modification? ....just because it has Gui zhi and Shao yao (Chi shao) in it between 13 herbs, leaving out Sheng jiang, Gan cao and Da zao (which are vital in regulating ying/wei). None of the other medicinals in his formula regulate ying/wei. In his formula, the dose of Gui zhi is 8 fen and Chi shao 1.5 qian. Gui zhi tang's ratio is Gui zhi 3 qian , Shao yao 3 qian 1:1, not 1:2. For the case presentation, how come he didn't add the three medicinals that are integral to Gui zhi tang... Sheng jiang, Gan cao and Da zao? With the greasy coat, he could've just reduced the dose of Da zao or taken it out altogether, but why eliminate Sheng jiang and Gan cao? Please explain. Secondly, to take it to another level, we could say that the Ding Gan-Ren formula that you posted is a modification of Ma huang tang, because it has Gui zhi and Xing ren in it... or Xiao qing long tang, because it has Gui zhi and Ban xia in it... or Gui zhi fu ling tang because it has Gui zhi and Fu ling in it... or Ban xia hou po tang because it has Ban xia and Fu ling in it... or Dang gui shao yao san because it has Shao yao and Fu ling in it. In other words, for someone who likes precision, how can we be precise in our claims of root formula modifications when the herbs and dosages are so off? K Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 20, 2010 Aahhh. one reason that I presented this case is that I knew it would get people's panties in a bunch. I hopefully will present more of these. I did post a reply which hopefully will explain some of your questions. But for people who are orthodox SHL practitioners such an approach will never be acceptable. But this style of approach, after studying it for a while, sure makes sense to me, and I consider it a further development of basic usage of Shang Han formulas. Furthermore, I can assure you that Sheng jiang, Gan cao and Da zao are far from integral for a gui zhi tang method to work. As far as your second question, these other formulas do not match the diagnosis, and I do not get your thinking here, one cannot have a ma huang tang method with just gui zhi and xing ren. This is just incorrect. The thing I think you're missing is you are looking at the individual herbs instead of the treatment principles and the actions of the herbs in the formula. It is not what specific herbs (or the number of original herbs from the formula) are in the formula, it is the functions/actions of the herbs. Therefore, precision is not about adhering rigidly to the original formula, precision is addressing the whole patient in front of you, modifying things as needed, while still adhering to the principles of the original formula, not putting the patient into a " original " formula box. -Jason On Behalf Of Friday, March 19, 2010 10:21 PM Re: Insomnia Jason, I have the same question as Steven Boznak, posted at Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/ I'm not arguing with Ding Gan-Ren's methodology, especially with the limited information given. I " m just curious how he could call this a Gui zhi tang modification? ....just because it has Gui zhi and Shao yao (Chi shao) in it between 13 herbs, leaving out Sheng jiang, Gan cao and Da zao (which are vital in regulating ying/wei). None of the other medicinals in his formula regulate ying/wei. In his formula, the dose of Gui zhi is 8 fen and Chi shao 1.5 qian. Gui zhi tang's ratio is Gui zhi 3 qian , Shao yao 3 qian 1:1, not 1:2. For the case presentation, how come he didn't add the three medicinals that are integral to Gui zhi tang... Sheng jiang, Gan cao and Da zao? With the greasy coat, he could've just reduced the dose of Da zao or taken it out altogether, but why eliminate Sheng jiang and Gan cao? Please explain. Secondly, to take it to another level, we could say that the Ding Gan-Ren formula that you posted is a modification of Ma huang tang, because it has Gui zhi and Xing ren in it... or Xiao qing long tang, because it has Gui zhi and Ban xia in it... or Gui zhi fu ling tang because it has Gui zhi and Fu ling in it... or Ban xia hou po tang because it has Ban xia and Fu ling in it... or Dang gui shao yao san because it has Shao yao and Fu ling in it. In other words, for someone who likes precision, how can we be precise in our claims of root formula modifications when the herbs and dosages are so off? K .. <http://geo./serv?s=97359714/grpId=201013/grpspId=1705060815/msgId= 48047/stime=1269074778/nc1=4025338/nc2=3848644/nc3=4836044> Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 20, 2010 Can anyone who has delved deeply into the classical formulation of " Gui zhi tang " comment on " Furthermore, I can assure you that Sheng jiang, Gan cao and Da zao are far from integral for a gui zhi tang method to work. " K On Sat, Mar 20, 2010 at 7:09 AM, < > wrote: > > > Aahhh. one reason that I presented this case is that I knew it would get > people's panties in a bunch. I hopefully will present more of these. I did > post a reply which hopefully will explain some of your questions. But for > people who are orthodox SHL practitioners such an approach will never be > acceptable. But this style of approach, after studying it for a while, sure > makes sense to me, and I consider it a further development of basic usage > of > Shang Han formulas. Furthermore, I can assure you that Sheng jiang, Gan cao > and Da zao are far from integral for a gui zhi tang method to work. > > As far as your second question, these other formulas do not match the > diagnosis, and I do not get your thinking here, one cannot have a ma huang > tang method with just gui zhi and xing ren. This is just incorrect. The > thing I think you're missing is you are looking at the individual herbs > instead of the treatment principles and the actions of the herbs in the > formula. It is not what specific herbs (or the number of original herbs > from > the formula) are in the formula, it is the functions/actions of the herbs. > > Therefore, precision is not about adhering rigidly to the original formula, > precision is addressing the whole patient in front of you, modifying things > as needed, while still adhering to the principles of the original formula, > not putting the patient into a " original " formula box. > > -Jason > > Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 20, 2010 We must look at this " Tongue: red tip with stasis dots " - I personally have never seen true stasis dots (purple, which signified blood stasis) on just the tip of the tongue. These usually occur on the sides etc. Since we are talking about the tip of the tongue and insomnia my guess is she is referring to red dots on the tongue which are very common. This would not signify blood stasis. However, only Suzanne can clarify this for us. Gallbladder removal is definitely not a blood stasis sign. -Jason On Behalf Of What signs show blood stasis? (possible internal scarring from GB removal surgery.. this is just conjecture though) Menses: heavy, blood clots, pain before and first few days.... this seems self-explanatory Tongue: red tip with stasis dots .. stasis dots show blood stasis, red tip relates to the acne, sore throat and insomnia back slightly thick white fur (possible damp in the MJ or LJ) Pulse: slippery and rapid (slippery can mean food stagnation and/or dampness and/or phlegm and/or heat and pregnancy) Quote Share this post Link to post Share on other sites
Guest guest Report post Posted March 20, 2010 Mentioning " gui zhi tang " isn't always a reference to five herbs as much as a treatment principle that includes a pungent flavor outhrusting and a sour flavor that astringes. Classics based practitioner Tiende Yang often speaks of adding " bu zhong yi qi tang " or " bao he wan " to a formula. This may have only meant the addition of Chai hu, shan zha and mai ya because he was speaking about the treatment principles of lifting clear yang or descending turbid yin. On Sat, Mar 20, 2010 at 5:01 AM, Gabriel Fuentes <fuentes120wrote: > > > leaving out Sheng jiang, Gan cao and Da zao (which are vital in regulating > ying/wei). > > Actually the two most vital herbs in regulating construction and defense > in guizhitang are guizhi and shaoyao. > Gabe Fuentes > > ________________________________ > <johnkokko <johnkokko%40gmail.com>> > <%40> > Fri, March 19, 2010 9:21:17 PM > Re: Insomnia > > > > Jason, > I have the same question as Steven Boznak, posted at > http://www.chinesem edicinedoc. com/case- studies/tai- yang-gui- zhi-tang- > dgr/ > > > I'm not arguing with Ding Gan-Ren's methodology, especially with the > limited > information given. > > I " m just curious how he could call this a Gui zhi tang modification? > > ...just because it has Gui zhi and Shao yao (Chi shao) in it between 13 > herbs, > leaving out Sheng jiang, Gan cao and Da zao (which are vital in regulating > ying/wei). > None of the other medicinals in his formula regulate ying/wei. > > In his formula, the dose of Gui zhi is 8 fen and Chi shao 1.5 qian. > Gui zhi tang's ratio is Gui zhi 3 qian , Shao yao 3 qian 1:1, not 1:2. > > For the case presentation, how come he didn't add the three medicinals that > are integral to Gui zhi tang... Sheng jiang, Gan cao and Da zao? > > With the greasy coat, he could've just reduced the dose of Da zao or taken > it out altogether, but why eliminate Sheng jiang and Gan cao? > > Please explain. > > Secondly, to take it to another level, we could say that the Ding Gan-Ren > formula that you posted is a modification of Ma huang tang, because it has > Gui zhi and Xing ren in it... or Xiao qing long tang, because it has Gui > zhi and Ban xia in it... or Gui zhi fu ling tang because it has Gui zhi and > Fu ling in it... or Ban xia hou po tang because it has Ban xia and Fu ling > in it... or Dang gui shao yao san because it has Shao yao and Fu ling in > it. > > In other words, for someone who likes precision, how can we be precise in > our claims of root formula modifications when the herbs and dosages are so > off? > > K > -- , DAOM Pain is inevitable, suffering is optional. http://twitter.com/algancao Quote Share this post Link to post Share on other sites
