RE: Shang Han formula?

March 21, 2010

Jason, Stephen,

I wanted to remark first of all that I am impressed at the increased

sophistication on CHA in recent months, the in-depth discussions and debates

have been of great interest to me.

I agree that there are different currents in Chinese internal medicine.

Most of us are familiar with the Zhang Jin current, much fewer with the Suzhou

current, which was solidly based in classical medicine, but highly eclectic.

Ding Gan-ren was a great synthesizer, combining warm disease and cold damage

currents, along with influences from such physicians as Li Dong-yuan and his

spleen-stomach approach.

I've looked over the case histories you've submitted (thank you so much

Jason), and I must say that I have a difficult time following Ding Gan-ren's

clinical reasoning in choosing his variation of gui zhi tang with the amount of

clinical information that is there. I'll look over your other case histories

this evening.

It is a much more 'creative' method than the more 'conservative' Shang Han

Lun approach. However, my opinion is that one has to have a great deal of study

of classical texts to practice methods such as Ding Gan-ren's. If one reads

Volker Scheid's text " Currents of Tradition " , he talks about how physicians such

as Ding and more modern physicians such as Chen Meng-xue were deeply versed in

such classics as the Jin gui yao lue and the Mai jing, among others. It is this

steeping in the classics that allowed them to be 'creative' in their

prescriptions.

I thought a quote from Wu Ju-tong, the great warm disease current physician,

would be useful at this point. I am using a translation from my colleague Yaron

Seidman:

" Master Ye Tianshi’s book is very difficult to understand. His book uses

classical

views the most, so the reader does not know where Ye is coming from and what

are his profound ideas. If you are not well versed with the yellow emperor and

the

golden chamber (of Zhang Zhongjing) you cannot use this knowledge. "

" Other then these few examples (he gives examples of post-partum disease or high

fever), diseases are all Yang injuries

(cold injuries like in the Shan Hanlun). Today’s practitioners always want to

tonify the Yin. They use cool and cold herbs to do that. The injuries to the

Yang

are extreme. The ancient sages said: “If the Yang is not exhausted you cannot

die” as well as “If a person doesn’t have Yang energy he can’t live”. Testimony

to that you can see in that after a person dies his muscles and flesh are not

missing even one ounce. Even though his Yin is full, it does not help him live

at all.

From all throughout the ages there is no one like Zhang Zhongjing who knows

how to tonify deficiencies.

This is a very interesting quote, considering that the warm disease current

was considered to be a revolutionary approach to medicine in its time, and Wu

Ju-tong was the architect of such famous formulas as yin qiao san and sang ju

yin! (I translated an article by him on how to use gui zhi tang in warm disease

several years ago).

I agree that formula approaches such as those of Ye Tian-shi and Deng

Gan-ren's are very sophisticated and deserve our respect. I tip my hat to those

practitioners who are schooled in this approach to herbal medicine. But at this

point of my practice in Chinese medicine, I put my trust in classical formulas

with minimal modification, as I do not feel anywhere near Zhang Ji's level of

practice (or that of Li Dong-yuan, Wu Ju-tong, or anyone of that elevated

status). There is also a tremendous basis of evidence on use of classical

formulas, whereas using prescriptions such as those of Ye Tian-shi's are very

personal, and at least in the bits of his case history text I've seen, not well

documented as to his methodology.

More later,

On Mar 21, 2010, at 3:01 PM, wrote:

> Stephen,

>

> I'm not at all suggesting that you have to grow into this style that I

> present. You're missing the point. I am merely presenting a different point

> of view. Obviously, there are many lineages in SHL tradition and there are

> more points of view then you can shake a stick at.

>

> But you so boldly start off your e-mail with " the formula you posted is not

> a SHL formula " - actually there is no debate, they tell us it is a Shang Han

> formula. It is in the Shang Han chapter and labeled gui zhi tang. You

> though, instead of trying to understand why, are dismissing it, calling it a

> warm disease formula. As stated before, you have a choice, you can try to

> understand their thinking or completely dismiss it. You have opted to

> dismiss it (and relabeled it) therefore of course I think that you " do not

> understand it. " - Therefore, if you Steven, are only saying that you don't

> prefer such a style, then okay. However if you are stating that such a style

> is not valid Shang Han (which is how your e-mail read to me), then you have

> a hard sell in my opinion. To elaborate...

>

> Ding Gan-Ren's style is one valid way of approaching the text and clinical

> reality. Your disagreement is only based on your predilection towards a more

> " traditional " style, and that is fine. I personally have no attachment

> either way and try to embrace multiple perspectives, and actually have not

> presented anything that is " my opinion " . Consequently, I see no reason to

> have a restrictive viewpoint and won't be tied down to only one current of

> thought. For example, sometimes I use chi shao instead of bai shao,

> sometimes I use both chi shao and bai shao. I also sometimes use an

> unmodified gui zhi tang and sometimes I give a 10 ingredients modified gui

> zhi tang. I that the patient in front of me dictate how I treat them.

> However, if I only have a hammer and every patient will be a nail.

>

> I have merely presented a very valid and well documented current in Shang

> Han though that hopefully can expand the way people view gui zhi tang.

> Although I knew people would argue, it always amazes me when this happens. I

> personally just don't see any debate, it is what it is.

>

> Honestly, as much as I respect you as a person, a 15 year-old opinion, that

> this is not a Shang Han formula or gui zhi tang method, doesn't remotely

> come close to overturning someone like Ding Gan-Ren's opinion, and the

> numerous other doctors, that think in this manner. We know you do not

> disagree, but you definitely are not respecting his viewpoint when you start

> off by saying this is " not a SHL formula. " He is telling you it is! - of

> course it is not a unmodified SHL, but then again most Shang Han case

> studies (that you read) are modified in ways that are not in the source

> text.

>

> Finally, when we have two completely opposing views where one is restrictive

> and the other is open and expansive, we have an interesting phenomenon.

> Simply, the expansive view almost always incorporates the restrictive view,

> however the restrictive view almost never incorporates the expansive view.

> The expansive view allows for many viewpoints and the restrictive view only

> sees that their own as valid.

>

> This is the same problem with orthodox religion. They have their point of

> view and everyone else is wrong. It often seems that orthodox SHL

> practitioners come off in this manner (this is not geared at any person on

> this list, but a general observation). However, I will argue that it will do

> us all good to try to see these stranger or less orthodox points of view,

> especially when they come from an incredibly respected lineage of doctors.

> Such doctors, including myself, are not trying to sell any certain style. No

> one is saying this is better than anything else. We are only saying this is

> another possible way to approach the Shang Han. How can one argue?

>

> For those who want to continue taking the ride, I posted two more gui zhi

> tang cases using chi shao instead of bai shao.

>

> Chinese Medicine/case-studies/tai-yang-with-internal-damp-d

> gr/

>

> Chinese Medicine/case-studies/gui-zhi-tang-with-chi-shao/

>

> -Jason

>

> On Behalf Of stephen woodley

> Sunday, March 21, 2010 9:11 AM

>

> Switch to: Text-Only, Daily Digest • Un • Terms of Use

> .

>

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

March 22, 2010

Z'ev,

Thanks for the post, I wanted to echo and expand some of your thoughts. I

too am impressed with recent CHA discussions and the desire to go deeply

into difficult issues and expand our horizons. Our level as a profession in

the West has been growing rapidly over the last 10-15 years. I remember when

I started school, only a few good books existed, now there are many.

However, we still only have access to a very small percentage of texts

(probably <1%) as compared to China. We should always keep this in mind and

hopefully it will keep us humble so we can continue to learn. Honestly, many

people on the CHA have a fairly high level of herbal knowledge for the West,

but really this does not compare to the seasons doctors in the East,

especially masters like Ding Gan-Ren.

I would be surprised if Z'ev (or others) could understand the " clinical

reasoning " of this *single* Ding Gan-Ren case that I presented. Actually,

one needs to read multiple case studies by the same doctor to start to try

to understand his style. This one case is not about anything but " it can be

done and is done. "

Furthermore, reading case studies takes a special skill and something that

many people on this list seem to not really understand how to do (evidenced

by their comments). In the next week, I hope to present some translated

material on a guide to reading case studies.

I am actually surprised that Stephan has seen thousands of these type of

Shang Han style formulas/cases. I personally have not. I am curious, where

did you see these? Either way, as Z'ev stated, understanding them takes deep

thought and dedication.

There is no doubt that Ding Gan-Ren presents a more " creative " method as

does Ye Tian-Shi, Qin Bo-Wei, and the Fei Family doctors. The treat via

treatment principles for the individual presentation. One cannot at all

expect to use their formulas for their own case (as is). One must grasp the

underlying principles and use the ideas. This takes extensive study,

contemplation, and reviewing of many cases. It actually is the complete

opposite of many Shang Han approaches, where people like Huang Huang give

you clear cut guidelines and formulas to use for specific conditions and

patterns/constitutions. You can go out after the seminar and use it on

Monday morning. Don't get me wrong, I love Huang Huang and have used much of

his material.

Z'ev is also correct that these eclectic approaches were heavily rooted in

classical studies. They knew these texts inside and out. It is also correct

that the warm disease doctors also knew Shang Han inside and out. Just for

clarity sake, Wu Ju-Tong's yin qiao san and sang ju yin (and many others)

were taken straight from Ye Tian-Shi's cases and " writings " .

Hope other people find this material interesting...