Syndrome Based Herbs. Yuxing Liu. Academy of Oriental Medicine at Austin

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1 Syndrome Based Herbs Yuxing Liu Academy of Oriental Medicine at Austin

2 The Characters of This Course Bridge /Combination Foundation diagnosis Herbs formulas (Internal medicine)

3 Important Concepts of Chinese medicine 1. Wholism Human and the nature Human body in side (five Zang organs as a center)

4 2. Pattern differentiation 1) Same disease, different treatment LIV Yang rising and LIV & KI Yin def. Tian Ma Gou Teng Yin Hypertension LIV fire flaring Long Dan Xie Gan Tang Phlegm disturb upper body Ban Xia Bai Zhu Tian Ma Tang Blood stasis Tong Qiao Huo Xue Tang KI Yin & Yang def. (menopause) Er Xian Tang

5 2) Different disease, same differentiation Dizziness, fatigue Prolapse of organs Bu Zong Yi Qi Tang Fever due to Qi deficiency Chronic diarrhea In pattern differentiation, the pulse & tongue diagnosis are very important!

6 3) The syndromes are changeable Common cold: Wind cold invasion wind heat LU heat

7 Structure of Syndromes (internal) SYNDROME QI EXCESS DEFICIENCY XUE EXCESS DEFICIENCY YIN EXCESS DEFICIENCY YANG EXCESS DEFICIENCY COMBINATIONS

8 Structure of Syndromes (external) SYNDROME FOUR LEVEL WEI QI YING XUE SIX STAGES TAIYANG SHAOYANG YANGMING TAIYIN SHAOYIN JUEYIN

9 Internal Injuries / Syndromes

10 Qi Yu (Qi stagnation) Key Symptoms: Distention feel, fullness feeling, stuffy Pain: dull pain, level of pain changes, better after movement, often worse w/ stress or bad mood, release of gas / belching will relieve pain P: wiry T: normal (if only Qi Yu alone)

11 Etiology Internal: 1.Emotions; 2. Diet (esp. w/ difficulty digesting); 3. obstruction due to pathogenic substances[existing Phlegm or Damp retention (Stones: KID, UB); Existing Xue stasis]; 4. Qi Xu (no power to push through stagnation) External: 1. Trauma (may be combined w/ xue stasis); 2. Cold 1. Chest area (HT, LU) Diseases Position 2. Hypochondriac area (LIV, GB) 3. Gastro-abdominal area (SP, ST, IT) 4. Four limbs and Joints (Meridians)

12 Can lead to Stagnant Heat Xue Stagnation / Stasis Damp, phlegm Related Zang-Fu organs

13 Single herbs in the category of Move LIV Qi Move SP/ST move Qi LU Qi Qi Yu pain Qing Pi Chen Pi Ma huang Qing pi Xiang Fu Zhi Shi Xin ren Zhi shi Chuan lian Mu Xiang Jie Geng Xiang fu zi Fo shou Da fu pi Qian hu Mu xiang Xie bai Chuan lian zi Fo shou Chen xiang Xie bai Tan xiang

14 Other Single herbs can move Qi Release exterior Aromatic, transform damp Invigorate blood Zi su ye (geng) Hou po Chuan xiong Bo he Bai dou kou Yan hu suo Chai hu Sha ren Yu jin Cao dou kou Herbs that anti-depression: Ru xiang Mo yao Bo he, mei gui hua, lu e mei, he huan hua, he huan pi, yu jin, chai hu Herbs can be used for a long time, not damage LIV yin or LIV blood: fo shou, mei gui hua. Precautions:

15 Representative formula for Qi Yu Si Ni San 四逆散 / 4 Frigid Powder from Zhang Zhong Jing Shang Han Lun More for Excess cases: Promotes circulation Tx 4 cold extremities d/t Qi Yu blocking circulation (the cold feeling only in the very extremities possible not above the elbows or knees, although the trunk is warm) [compare: yang xu: whole limb may be cold Si Ni Tang]

16 Chai hu 6g Bai shao 6g Zhi gan cao 6g Zhi shi 6g Qi (lifts the Yang Qi), release exterior (disperse), spreads Liver Qi, soothes Liver, clear heat Soften LIV, nourish xue & yin 1) controls side effect of chai hu, astringent Tonify middle Jiao, harmonize taste 1) gan cao [sweet] + bai shao [sour] balances, harmonizes LIV, relieve spasms, stops pain Move Qi 1) & balances chai hu to promote circulation 2) + bai shao harmonize Qi and blood

17 Indications: 1. Cold extremities (hands, feet only) may also be thirsty d/t stagnant heat in trunk, have irritability, 2. Disharmony of LIV & SP: (LIV Qi stagnation overacting on the Spleen) hypochondriac pain, fullness and distention in the epigastrium and chest, abdominal pain, alternating diarrhea & constipation (zhi shi will help), etc 3. LIV Qi Yu dysmenorrhea, distending breast pain [Compare: Xiao Yao San: more for Qi Yu w/ Xu sx] P: wiry Hepatitis, cholecystitis, gallstone, intercostal neuralgia, gastritis, ST ulcer, PMS

18 LIV Qi Yu LIV Qi YU LIV Qi stagnation (no deficiency) LIV Qi stagnation with Blood deficiency LIV overacting on SP LIV overacting on ST without heat LIV overacting on ST with heat

19 LIV Qi stagnation (no deficiency) More for excess, More focus on the LIVER (than Si Ni San) not tonifying Pain: distending pain which may shift in area & intensity along LIV Channel hypochondriac, breast tenderness, menstrual cramps, genital pain Emotions: Sign, depression, or easy to be angery Digestion: belching, fullness in the abdominal area Irregular menses: early, delayed, or amenorrhea P: wiry T: normal [possible diseases: cholecystitis, Hepatitis, intercostals neuralgia, emotions, etc.]

20 Chai Hu Su Gan San 柴胡疏肝散 (modified from Si Ni San) Jing Yue Quan Shu Chai hu 6g (chief) Xiang fu 5g (deputy) Chuan xiong 5g (deputy) Zhi ke 5g (assistant) Chen pi 6g (assistant) Baishao5g (assistant) Zhi Gan cao 3g (assistant, envoy) Soothe liver, relieve stagnation Soothe liver, strength the function of Chai Hu Move Qi and Blood, + chai hu: relieve stagnation on liver channel + xiang fu: strength move Qi Move Qi, relieve stagnation Move Qi, relieve stagnation Nourish blood, soften liver, stop pain Harmonize + bai shao: nourish blood, stop pain

21 Si Ni San Chai Hu shu Gan San Ingredients dosage Si Ni San (zhi Ke) + chen pi, chuan xiong, xiang fu Zhi Gan cao dosage reduce function 1) Harmonize LIV and SP 2) Move Qi Soothe LIV Qi

22 LIV Qi stagnation with Blood deficiency or LIV overacting on SP SP def. LIV stagnation Blood def. (not nourish LIV) LIV Qi stagnation: Depression, moodiness, hypochondriac pain or fullness, bitter taste in mouth, irregular menstruation, dysmenorrhea, PMS, dry mouth and throat (when there is stagnant heat) Blood deficiency: headache, dizziness, floaters, blurred vision SP deficiency: fatigue, poor appetite, chronic diarrhea, gas and bloating P: wiry, or thin & wiry, or wiry & weak T: pale &/or TM, or normal

23 Xiao Yao San 逍遥散 (free easy wander powder) Chai hu 30g Bo he (some) (Chao) Dang gui 30g Bai shao 30g Bai zhu 30g Fu ling 30g Zhi gan cao 15g Wei jiang 1pc (Bensky: Sheng jiang) Spreads LIV Qi, soothe the liver, anti-depression Soothes the liver Nourishes blood, nourish LIV, regulate menses Nourishes blood, nourish LV, nourish and soothe LV Tonifies SP (middle Jiao), dry dampness Strengths SP (middle Jiao), drain dampness Tonifies SP and harmonize Warms middle Jiao (wei-roasted: warm stronger)

24 LIV overacting on ST without heat Stomach ache, gas, bloating, may be combined w/ poor appetite Sx become worse w/ stress, esp. stomach ache No heat signs P: wiry T: normal Formula: Chai Hu Su Gan San

25 LIV overacting on ST with heat Stomach ache, acid reflux, sour regurgitation; gas, bloating. Burning sensation in ST Sx become worse w/ stress, esp. stomach ache With Heat signs: Voracious appetite, easily hungered, may be irritable or easily angered T: red w/ yellow coat - P: wiry and rapid Can be used to treat stomach ulcers w/ heat (LIV Fire ST): may see acid regurgitation, esophageal problems w/ heat (including belching, nausea, etc.)

26 Zuo Jin Wan 左金丸 Huang Lian 9 Wu Zhu Yu 1.5 Grind into powder and make pills, 6g per time. Proportion: 6:1 Herbs has the function of treating acid reflux: Hia piao xiao Hai ge ke Duan wa leng zi Duan long gu, duan mu li

27 Stagnation in digestive system (food stagnation) food stagnation Food stagnation in the middle Jiao Food stagnation in the ST and intestine Qi stagnation in Intestines

28 Food stagnation in the middle Jiao - Pain (adverse to touch) - Belching (which relieves pain) - Nausea, poor appetite - Vomiting (which relieves pain) - Diarrhea (may have foul odor) - Gas - T: thick, greasy coating - P: 1) slippery, or 2) strong Food stagnation in short time, without Qi deficiency

29 Bao He Wan 保和丸 Dan Xi Xin Fa 丹溪心法 Shan Zha 180g Shen qu 60g Lai Fu Zi 30g Fu Ling 90g Ban Xia 90g Chen Pi 30g Lian Qiao 30g Improve digestion, reduce food stagnation (esp. meat and fat) Improve digestion, reduce food stagnation (esp. alcohol and fermented foods) Improve digestion, reduce food stagnation (esp. starch), resolves phlegm-damp, regulates the Qi Strengthens the SP, dries dampness, stop diarrhea Resolve phlegm-damp, harmonize the ST, descends rebellious Qi, stops nausea and vomiting Move Qi, dries dampness, harmonize the ST, stops nausea and vomiting Clear heat, reduces accumulation

30 Food stagnation in the ST and intestine Intestinal sx - May have history of overeating - Stomach ache, belching, nausea, poor appetite due to Food stagnation - Diarrhea (excess) w/ strong/foul odor or constipation - Pain relieved after B.M. - Looks more like D-H - T: thick, yellow greasy coat - P (excess): rapid & full or slippery

31 Zhi Shi Dao Zhi Wan 枳实导滞丸 Nei Wai Shang Bian Huo Lun da huang 30g (chao) zhi shi 15g ze xie 6g fu ling 9g huang qin 9g Chief, clear heat, purgative Ministry, move Qi, relieve stagnation Deputy, drain dampness, stop diarrhea Deputy, Clear heat, dry dampness, stop diarrhea huang lian 9g (chao) shen qu 15g bai zhu 9g *Only for excess cases! * CC: pregnancy Deputy, Relieve food stagnation, resolve dampness Strength SP and dry dampness, protect Qi

32 Qi stagnation in Intestines -Qi Yu: Gas, bloating, abdominal distension or/and pain (gas relieves distension and pain) - May have diarrhea - Often have history of food allergies - May have syndrome of colitis, etc.

33 Mu Xiang Shun Qi Wan 木香顺气丸 Zheng Zhi Zhun Sheng 证治准绳 /yi xue tong zi 医学统旨 Mu xiang (chief) Xiang fu (chief) Bing lang (cu zhi) Qing pi Move Qi, harmonize middle Jiao Soothe liver, relieve stagnation, move Qi and stop pain break Qi, relieve distention, resolve stagnation Move Qi and Chen pi Zhi ke (zhi) Cang zhu (jiang zhi) Hou po Sha ren Zhi gan cao Sheng jiang Patents: different brands have different herbs

34 Stagnation in chest Stagnation in chest Phlegm heat/qi Yu in chest Obstruction of Yang Qi in chest

35 Phlegm heat/qi yu in chest and upper abdomen - Chest and gastric area tightness or discomfort, do not like pressure (xiao jie xiong zheng) - Coughing w/ expectoration of yellow phlegm - T: thick yellow coating - P: wiry, slippery, rapid Xiao Xian Xiong Tang 小陷胸汤 Huang lian 6g Ban xia 12g Gua lou shi [whole] 30g Ministry, clear heat, relieve stagnation at ST area (bitter taste descending) Deputy, Desecding Qi, relieve stagnation and phlegm (pungent taste opening, dispersing) Chief, clear heat, resolve dampness, open the chest

36 Obstruction of Yang Qi in chest (HT) Cold sensation, stagnation in the chest area, fullness of the chest tends to be chest pain, may radiate to the back of the chest, poor sleeping due to chest pain May have dyspnea, SOB Palpitations and other heart sx T: white, greasy coating (with phlegm symptoms) P: deep, thin May be used to tx coronary heart disease, esp. w/ hypochondriac pain, intercostals neuralgia, etc. Gua Lou Xie Bai Ban Xia Tang 瓜蒌薤白白酒汤 Jin Gui Yao Lue Gua lou shi 24 g Xie bai 9 g Ban xia 12 g Bai jiu Open chest, move Qi Move Qi Resolve phlegm 4 herbs cooking together, TID

37 Six stagnation Fullness and distention in the chest and diaphragm area Fullness and distention in the ST and abdominal area Belching, acid reflux, nausea, vomiting, poor digestion Normal tongue; Normal or wiry pulse Yue Ju Wan 越鞠丸 (Dan Xi Xin Fa) Xiang fu Chuan xiong Cang zhu Shen qu Zhi zi Qi stagnation Blood stagnation Phlegm stagnation Damp stagnation Food stagnation Fire stagnation Each herbs have the same dosage, take 6-9 per time

38 Qi Yu with Phlegm in the Throat Mei He Qi (Plum Pit Qi) Ban xia hou Po Tang (ban xia, Hou po, Fuling, Sheng jiang, zi su) Qi Yu in the four limbs and joints

39 Rebellious Qi Concept: Related Organs: 1. Rebellious of Lu Qi Cough, asthma, shortness of breath 2. Rebellious of ST Qi Belching, nausea, vomiting, hiccup 3. Liv yang rising?

40 Rebellious of Lu Qi Su Zi Jiang Qi Tang 苏子降气汤 Ding Chuan Tang 定喘汤 Xiao Qing Long Tang 小青龙汤 Ma Xing Shi Gan Tang 麻杏石甘汤 Ingredient (zi) su zi 9g Ban xia 9g qian hu 6g hou po 6g sheng jiang 2 pc dang gui 6g rou gui 3g zi su ye 5 pc Zhi gan cao 6g Da zao 1 pc Kuan dong hua 9g Sang bai pi 9g Huang qin 6g Gan cao 3g Ban xia 9g Ma huang 9g Bai guo 9g Xing ren 9g Su zi 6g Ma huang 9g Gui zhi 6g Ban xia 9g Xi xin 3g Gan jiang 3g Wu wei zi 3g Bai shao 9g Zhi gan cao 6g Ma huang 5g Xing ren 9g Shi gao 18g Gan cao 6g Indication and symptoms Upper Excess Cold-Ph retention: cough, shortness of breath, asthma, phlegm product, fullness in the chest; white watery or white greasy coating lower deficiency (KI yang def.): weakness or pain at lower back and knee, lassitude, or edema on extremities Ext. W-C concurrent w/ interior Ph-H Dyspnea, asthma, cough, profuse yellow sticky phlegm; yellow greasy coating, slippery and rapid pulse Ext W-C invasion concurrent w/ interior Phlegm-fluid retention Chills and fever, no sweating, cough, dyspnea, profuse and water phlegm, fullness in the chest (due to phlegm), can not lie down (phlegm retention), or heaviness of the body, edema on face/head/4 extremities, watery white phlegm, floating pulse W-H invasion, Ph- H retention, LU Heat Fever, cough, dyspnea, thirsty, sweating (w/ w/o), thin white or yellow coating, slippery rapid pulse

41 Rebellious ST Qi All for nourish ST Qi and descend ST Qi: formula Xuan Fu Dai Zhe Tang 旋复代赭汤 Ju Pi Zhu Ru Tang 橘皮竹茹汤 Ding Xiang Shi Di Tang 丁香柿蒂汤 Ingredient (common) Ren shen 6g Sheng jiang 10g Ren shen 3g Sheng jiang 9g Ren shen 3g Sheng jiang 6g Ingredient (different) Xuan fu hua 9 g Dai zhe shi 9 g Da zao 4pc Ju pi / chen pi 12g Zhu ru 12g Dao zao 5 pc Ding xiang 6g Shi di 9g (kaki calyx - stop hiccups) Ban xia 9g Gan cao 6g Gan cao 6g Indication ST Qi Xu: fullness in St area, belching can not relieve the fullness + Phlegm retention: white greasy coating, moderate or slippery pulse ST Xu: belching or dry heaves + Heat accumulation (b/c of zhu ru): ST Xu: belching, fullness in the gastric area + Cold accumulation: slow pulse

42 Qi disorders Qi stagnation General Qi stagnation LIV Qi stagnation (no deficiency) LIV Qi stagnation with Blood deficiency LIV overacting on SP LIV overacting on ST without heat LIV overacting on ST with heat food stagnation in ST food stagnation in ST and intestine Stagnation in digestive system (food stagnation) food stagnation in intestine stagnation in chest six stagnation rebellious of LU qi phlegm heat in chest and upper abdomen obstruction of Yang Qi in chest upper excess (cold phlegm), lower deficiency (KI yang deficiency) exterior wind cold, interior phlegm heat exterior wind cold, interior phlegm fluid retention LU heat, phlegm heat (wind heat) ST deficiency with phlegm retention ST deficiency with heat rebellious of ST qi (ST deficiency) ST defiicency with cold

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