Course: Formulas 1 Date: September 30, 2009 Class #: 2 Prof: Dr. Ma WEEK TWO: Class 2 Goals: Students will learn traditional treatment methods - sweating, vomiting, draining downward, harmonizing, warming, clearing, reducing, tonifying. Categories of Chinese herbal formulations --- the different methods which were used in different dynasties. Objectives: Upon the end of class, student will be able to: 1. Understand the definition and application of 8 treatment methods. 2. Understand the different methods for categorizing herbal formulas. Study/Learning guide: Students should understand the following: A. The 8 treatment methods can not be separated, one may involve the other B. The categorizing methods for formulas are different in different dynasties and in different book. Class Assignment: 1. READING for the WEEK Read the following select passages and taking notes. Bensky, Chinese Herbal Medicine - Formulas and Strategies. Eastland Press, ppg. 9-14 (Traditional Strategies: 1.Sweating, 2.Vomiting, 3.Draining Downward, 4.Harmonizing, 5.Warming, 6.Clearing, 7.Reducing, 8.Tonifying) State Administration of TCM, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, Vol.II, New World Press, ppg. 259-263 Page 1 of 6
Eight Treatment Methods There are two basic treatments; tonifying and reducing. These are about removing the evils and therefore reducing. 1. Sweating Principle: Induce sweating to open Lung Qi, open pores, harmonize ying wei, expel exterior evils. Herbs are given to promote sweating. How does sweating affect your health? It has many functions, one of which is to expel. If you induce sweating, you have to be cautious when treating elderly people, weak folks, small kids, and pregnant women. Sweat is the heart fluid. You can feel relaxed after sweating like after exercise or a good sauna. This has similar function to herbs to induce sweating. Beware of over-sweating and profuse sweating, which hurts the Qi. This is a principle both in herbs and exercise. Don t induce sweating for bleeding syndromes either because blood and body fluids are so interrelated. 2. Vomiting Principle: Induce vomiting to expel phlegm, stagnant food, and toxins from throat, chest, and stomach. This treats the stomach and above. This method is not used so much because it is so damned unpleasant. It isn t used much here or in China either for that matter, but it is an option. The danger with this treatment method is inducing too much vomiting and depleting the body fluids. And of course, you never know what your patient is going to do with herbs. Be sure you instruct them thoroughly especially if you are using strong herbs. Make your herbals as bullet proof as possible. Remember patients will modify for their convenience like the patient that mixed her powders into her coffee or one of Dr. Ma s who froze her decoction into ice cubes and then microwaved them to make them liquid again. Cautions for this treatment: Weak patients, pregnant patients. Keep a close eye on stomach Qi as this can damage it. Obviously, if a patient has problems with weak stomach, use with extreme caution. 3. Draining Down Principle: Draining down unblocks the intestines and stomach to expel accumulations of water, blood stagnation, food stagnation, dry stool and phlegm. This treats the stomach and below. The Daoist philosophy recommends following the path of least resistance, going with the flow. If an evil is below the stomach, use this method. There are other methods for something like constipation besides draining down/pushing you can also moisten the intestines with yin tonics (if from dryness). Think of it like a boat: if there s insufficient flow in the river you can t just push the boat, you need water! Page 2 of 6
When there is constipation or retention of urine, you need to clear that first, regardless of the other problems they came for. Herbs and drugs have to have a way to get out of the system. The GI tract and renal routes are the major avenues of exit. Retention of feces or urine causes a myriad of other problems. Retention of feces is linked to colon cancer, for instance and retention of urine is linked to kidney stones, kidney disease, etc. Cautions for this treatment: Again, weak patients, pregnant patients. 4. Harmonizing There are 3 conditions within this one and it s a bit hard to understand. Xiao Yao San is a harmonizing herbal formula it harmonizes spleen deficiency and liver stagnation (excess). You can t just harmonize anything, but has a very specific indication. You can t use it when you re confused about what to do you have to be clear. You can only use it for the 3 conditions below. a. Evil that is half interior, half exterior b. Spleen and Liver c. Stomach heat and intestinal cold 5. Warming Warm the middle, expel cold, restore Yang, unblock the channels, for interior cold. You use hot herbs to treat internal cold. Could be a cold evil causing it or could be an internal Yang qi deficiency. Cold evils can block the channels by causing contraction, so warming herbs free the flow in the channel. Cautions: Strong hot herbs require cautious use. Fu zi is one example. You must be sure the patient really has internal cold before you use hot herbs like this. Start with small doses. Don t over use them. 6. Clearing Clear internal heat and fire. Before you use this treatment, you must differentiate between external and internal heat. External heat is superficial even if there is fever (which could seem like an internal heat, but is generated by external pathogens). You use light herbs for external heat and sweat it out. Sweating is part of the external system external system clears the external heat. Internal heat on the other hand is deeper in the body and requires stronger treatment and a different method for ushering it out of the body. (Shi gao, huang lian and those kinds of herbs.) Internal heat might burn up Yin fluids. Watch for yin fluid damage. You might need to combine these herbs with herbs to tonify Yin. Page 3 of 6
Cautions: Not for external/exterior heat! (This is a big caution!) Also, can damage yang qi. Keep a watchful eye out for this. 7. Reducing Gradually resolve food stagnation, Qi, Blood, phlegm, water, parasites in Zang fu, channels, collaterals and muscles. Note the word gradually. This is a lengthier process than just flushing out. You use it for things which you must resolve slowly, possibly because they are not on the direct route out of the body such as a fatty tumor or because strong resolution would be a bad idea (liver cirrhosis, parasites) Example: There is no way to drain a fatty tumor on the skin, so you use herbs that gradually resolve that fatty tumor it s in a special place not on a direct route out of the body. You might use strong herbs for something like phlegm in the channels but you put it in a pill and use it for a long time and you have to be careful about how much you use. The reducing method might be combined with other methods, such as tonification methods. In the case of Liver cirrhosis you can use the reducing method. 8. Tonifying Tonify deficiency of Qi, Blood, Yin, and/or Yang. You tonify these things in the Liver Heart, Spleen, Lung and/or Kidney. Please don t be too nice to yourself. This is the Dr. Ma quote of the day. Most people like the tonification method above others because it is the most pleasant. But if you tonify too much you can create as many problems as reducing or clearing too much. So beware of tonifying too much just because it s a pleasant thing to do and we all think we need more of everything. The same little caveat applies to expensive stuff most people think that the more expensive herbs are the better herbs. Taint necessarily true. Dr. Ma told the story of a woman who thought the more expensive the better her Chinese doc gave her expensive ginseng and instructed her to burn it into ash before putting it into the decoction. Why? Because this increased the price and because she didn t really need the ginseng. Qi and yang have the same nature. Yin and blood have the same nature. Yin and blood are the more important of the 4. You cannot separate qi and blood nor yin and yang. Blood is the mother because blood is the carrier of qi. Qi cannot move by itself because it has no form. No more blood, no more qi. You cannot see Qi you can only see the manifestation of qi like steam. Qi is a function and exists based on substance. The same is true of the channels you can t see them. From Qi to blood: Qi moves the blood. Qi also generates blood (spleen qi). Qi holds the blood. You can tonify Qi to generate the blood. There are a lot of tonics to tonify blood, but you often need Qi tonics also to make it all happen. Page 4 of 6
Yin and Yang are also interdependent. Beware of giving Yang tonics (or hot herbs) without watching the Yin to see if you re consuming the Yin with your treatment. Conversely, if you give cold herbs, be sure you do not damage the Yang. Yang tonics can also burn up Qi. In all things, balance. Don t abuse tonics. Use traditional and moderate formulas. Zang organs are solid and store essence. You tonify Zangs. Fu organs are hollow and are avenues of transport. This is why you only tonify Zang organs not the fu organs. Instead you unblock the fu organs. Spleen, Kidney and Liver are the most commonly tonified. For women, you often tonify Liver and Blood (mother s mother!). Liver has 2 parts Liver Qi (stagnation most common here) and Liver Blood (deficiency). For women, Spleen and Kidney are more common. Four Gentlemen formula is a spleen qi tonic. Si jun zi tang. The counterpart is Si wu tang, the Four Substances (yin/blood). Si wu tang should really be called the Four Ladies! This is a blood tonic- typically for women. If you combine the two you get the Eight Treasures formula. For women, the focus is on the blood. For men, the focus is on the Qi. Spleen is the 2 nd organ to tonify for women. Spleen is neutral think about the 5 directions Spleen is in the middle. Even with Lung Qi xu, you tonify the mother, Spleen. If you tonify the Spleen you can also help with the Kidney. (?) Basically, Spleen helps the other 4 organs. This is why Four Gentlemen is good for all organs (ren shen, bai zhu, fu ling, zhi gan cao). It s the Stomach 36 of herbs. Cautions: No yang tonics for kids! They have enough already. Many conditions might look like deficiency but might be excess. Balance symptoms with the tongue and pulse look for signs of xu and shi. Be specific in your diagnosis. Page 5 of 6
Blood tonics can be sticky and hard to digest sheng di and shu di for instance. Add something to help digestion along with these or there will be bloating and cause stagnation. Page 6 of 6