Subscribe to our RSS Feed Chinese Medicine Times Facebook Fan Page Chinese Medicine Times Twitter Page Chinese Medicine Times Linkedin Page
Chinese Medicine Times

A Prelimary Summary on Studying the Shanghan Lun - Part Two

by Enqin Zhang


Shaoyang
Disease

Shaoyang (Lesser yang) Disease is a special stage and condition seen in febrile diseases, when the pathogen is half outside, half inside, half excess and half deficient. It manifests as alternating chills and fever, chest and costal discomfort, reluctant to speak and eat with restlessness and nausea. Its therapeutic principle is to harmonise using the chief formula Xiao Caihu Tang/Minor Bupleurum Decoction.

Chief Formulas in Shaoyang Disease

Xiao Caihu Tang/Minor Bupleurum Decoction

Ingredients:

  • Caihu/Radix Bupleuri, half jin/15g
  • Huangqin/Radix Scutellariae, 3Liang/9 g
  • Renshen/Radix Ginseng, 3 Liang/9g
  • Banxia/Rhizoma Pinelliae, half Sheng/9g
  • Zhigancao/Radix Glycyrrhizae Praeparatae 3 Liang/9g
  • Shengjiang/Rhizoma Zingiberis Recens, 3 Liang/9g
  • Dazao/Fructus Ziziphi Jujubae, 12pcs/4 pcs.

Administration: According to my experience, decoct all the above herbs in water in the pot over a low flame for 25-30 minutes. Drink 1/3 of the decoction, 2 or 3 times a day.

Actions: Harmonizing the Shaoyang.

Explanation: Caihu is the principle herb and has the effects of dispelling pathogenic factors located in the half exterior of Shaoyang meridian. It can also relieve depressed liver-qi. Huangqin is an assistant herb and clears out stagnated heat located in the half. The combination of these two herbs, one for dispelling pathogen out and the other for clearing away stagnated heat from the interior, together removes pathogenic factors from the Shaoyang. Banxia and Shengjiang can regulate the functions of the stomach and lower the adverse flow of qi. Renshen and Da Zao invigorate qi and strengthen the middle-jiao. Zhigancao can coordinate the actions of various herbs in the formula.

Indications in the original Shanghan Lun text

Clause 96: After 5-6 days of during febrile disease, the patient has alternating attacks of chills and fever, feels a distension and a sensation of oppression in the chest and costal region, reluctance to speak and eat, restlessness and no nauseous, or thirsty, or abdominal pain, or with mass below the costal margin, or with palpitation and dysuria, or no thirsty but with a slight fever, or with coughing. Xiao Caihu Tang can serve as a remedy in this case.

Key indications of Xiao Caihu Tang

  1. Alternate fever and chills;
  2. Feeling a distension and a feeling of oppression in the chest and costal region;
  3. Reluctant to eat and speak;
  4. Restlessness and nausea.

There are other clauses that discuss Xiao Caihu Tang in the Shanghan Lun, for example: 37, 97, 98, 99,100, 101,103, 104, 144, 148,149, 266, 229, 230, 231, 379 and 394.

Modern clinical application

  1. Clinically, we often use Xiao Caihu Tang for the treatment of the common cold, malaria, infection of the biliary tract, hepatitis, pleurisy, chronic gastritis, indigestion, mastosis, inter-costal neuralgia, neurosis and AIDS marked by the symptoms of Shaoyang disease. Of course, we often modify the formula according to the presenting pattern.
  1. Prof. Liu Duzhou stated that the formula is effective for impotence caused by stagnation of liver-qi.
  1. Dr Li Xinghua reported this formula can be used for acute pancreatitis.

Notes: For more information, please refer to the text, 'Research in Classical Prescriptions of TCM'.

Modern research

1) Modern researches have proved that this formula has some effects of inhibiting bacteria, viruses and leptospira, relieving the reaction of the human body to the invading pathogen and remarkably allaying fever and resisting inflammation. For more information, please refer to the text, 'A Practical English-Chinese Library of TCM'.

2) The formula also has the effects of promoting digestion, preventing vomiting, expelling phlegm, relieving coughing, protecting the liver, normalising the functions of the gallbladder and tranquilising the mind.

Taiyin Disease

Taiyin (Great yin) Disease is an advanced stage and condition that can be caused by the mistreatment of the three yang meridian diseases, especially the Yangming Disease evolving Taiyin Disease. It is marked by deficiency of the spleen-yang due to invasion by pathogenic cold-dampness, manifested as abdominal distension, poor appetite, nausea or vomiting, diarrhoea with loose stools and occasional abdominal pain. Its therapeutic principles are to warm the spleen-yang. Formula: Sini Tang/Decoction for Resuscitation or (Lizhong Wan/Pill for Regulating Middle-jiao). Note: a purgative is contraindicated.

Chief Formulas in Taiyin Disease

Lizhong Wan/Pill for Regulating Middle-jiao

Ingredients:

  • Renshen/Radix Ginseng, 3 Liang/9g
  • Ganjiang/Rhizoma Zingiberis, 3 Liang/ 9g
  • Zhigancao/Radix Glycyrrhizae Praeparatae 3 Liang/9g
  • Baizhu/Rhizoma Atractylodis Macrocephalae 3 Liang 9g

Administration: According to the Shanghan Lun and my experience, we should first grind the above herbs into a fine powder, and then mix them with honey to make them into pills. Take the pills with warm boiled water, 9g each time, 3-4 times a day, twice a night if necessary. Otherwise, decoct the herbs in water in the pot for 25-30 minutes, and then take the decoction three separate times a day.

Actions: Warms the middle-jiao and eliminates pathogenic cold-dampness from Taiyin.

Explanation: Ganjiang acts as a principle herb, acrid in taste and hot in nature, it has the effects of warming the middle-jiao. Renshen acts as an assistant herb, slightly bitter in flavour and slightly warm in nature, it is good in strengthening the spleen-qi. Baizhu serves as an adjuvant herb, with its sweet and bitter flavour and warm nature; it is used to dry dampness and strengthen the spleen. Zhigancao is sweet and mild in property, and acts to harmonize the spleen and stomach and tempers the effects of other herbs in the formula.

Indications in the original Shanghan Lun text

Clause 277: Diarrhoea without a thirsty for water is the symptom of Taiyin disease. It is caused by coldness in the viscus. Sini Tang or equivalent can be adopted to warm the coldness.

Note: As the above case is in a deficient and cold syndrome, so the patient feels no thirsty. The viscus here means the spleen in this clause. "Sini Tang or its like" means the Lizhong Tang or Lizhong Wan.

There are other such clauses, for example 386, 396 in Shanghan Lun and also in Jin Kui Yao Lue, Chapter 9.

Modern clinical application

  1. We often use Lizhong Tang for the treatment of acute or chronic gastritis, peptic ulcer, gastro-intestinal neurosis, chronic diarrhoea, chronic enteritis or non-specific colitis, AIDS, etc.
  1. Dr Li Zhongjie introduced an ointment of Lizhong Wan to apply on the umbilicus; then cover it with a compress and keep it for 3-7 days. It is used to treat chronic diarrhoea, oedema, cough, and uterus bleeding.

Modern research

1) The Pharmaceutical Dept and Microbiology Dept of Shanghai TCM University made a simulated syndrome of spleen-deficiency in a mouse by feeding Dahuang/Radix et Rhizoma Rhei. As a result the mouse shown symptoms of spleen-deficiency marked by diarrhoea as well as lower function of the immune system and less ability to resist coldness. They then treated the mouse with Lizhong Tang. The mouse's symptoms were then relieved.

2) Many new studies have also ascertained that this formula has the effects in adjusting the functions of the stomach and intestine, promoting blood circulation, strengthening metabolism, relieve spasm, alleviating pain, arresting vomiting and diarrhoea, and inducing diuresis.

Shaoyin Disease

Shaoyin (Lesser yin) Disease is a more severe stage and condition during febrile diseases. In TCM theory, Shaoyin includes the kidney meridian of the foot Shaoyin and the heart meridian of the hand Shaoyin. The causes of Shaoyin Disease include many factors: exterior pathogens intrude the interior; or Taiyin disease develops to Shaoyin disease; pathogenic cold invades the Shaoyin meridian directly; or both Taiyang and Shaoyin are affected by pathogenic factors.

Shaoyin disease is divided into two main syndromes:

  1. Cold syndrome, manifested in Clause 281 'the essential symptoms and signs of Shaoyin Disease are a feeble and thready pulse, a tendency for the patient to continue to fall asleep'. Its therapeutic principle is described in Clause 323 'therapeutic method of warming, Sini Tang should be given urgently to Shaoyin disease with a deep pulse'.
  1. Heat syndrome, marked by yin deficiency with yang hyperactivity, manifested in Clause 303 'more than two or three days of Shaoyin disease, the patient feels restless and suffers from insomnia. Huanglian Ejiao Tang/Coptis and Donkey-hide Gelatin Decoction will act as a curative in the case'.

Chief Formulas for Shaoyin Disease

Sini Tang/Decoction for Resuscitation

Ingredients:

  • Fuzi/Radix Aconiti Praeparatae 1 pcs/ 9g
  • Ganjiang/Rhizoma Zingiberis 1.5 Liang/9g
  • Zhigancao/Radix Glycyrrhizae Praeparatae 2 Liang/ 6 g

Administration: According to my experience, Fuzi should be decocted one hour prior to other two; and then add the other two ingredients and boil the three ingredients together for another 45 minutes. Drink half of the decoction in the morning and the other half in the evening.

Actions: Warms the heart, spleen and kidney, recuperating depleted yang to rescue the patient from collapse.

Explanation: Fuzi is extremely pungent and hot. It acts on the meridians of the heart, kidney and spleen, helping to warm the yang-qi and recuperate the depleted yang to rescue the patient from collapse. It is preferred as a principle herb. However, in the UK and other such countries where the herb is banned, we can use Renshen 9g plus Huangqi 30g as an alternative to Fuzi. Ganjiang acts as a assistant herb and performs the functions of warming the yang of the middle-jiao and eliminating interior coldness. The combination of Fuzi and Ganjiang can develop drastic flavour to strengthen forcefully the effects of warming the yang. Zhigancao acts as an adjuvant and guiding herb with it's effects of strengthening the spleen and replenishing qi. It is used to assist Fuzi to recuperate depleted yang and promote blood circulation, and also in assisting Ganjiang in warming and restoring yang of the middle-jiao to reduce the toxin effects of Fuzi. It also acts to relieve the extremely pungent property of other two herbs so as to make it possible to warm yang and remove cold without injuring yin.

Notes: Shengfuzi/crude Aconite contains Wutoujian (aconine), which is highly toxic and should be boiled for a longer time (1-2 hours), because the long time boiling can change its Wutoujian into Wutoucijia (sub-aconine) which has just 1-2 % of Wutoujian' toxin with the same efficacy.

Indications in the original Shanghan Lun text

Clause 323: Therapeutic method of warming, Sini Tang should be given urgently to Shaoyin disease presenting with a deep pulse.

Notes:

1) This clause is very simple. Only a pulse, and other symptoms and signs are omitted;

2) The pulse is deep, feeble and thready;

3) According to other clauses on Sini Tang, there are other symptoms and signs such as cold limbs, a feeling of chills, huddling up from feeling cold, water diarrhoea with undigested food in the stools, mental fatigue and sleepiness, and deep, feeble and thready pulse.

In the Shanghan Lun, there are other clauses on Sini Tang; 29, 91, 92, 225, 277, 323, 324, 353, 354, 372, 377, 388 and 389.

Modern clinical application

  1. We often used Sini Tang for the treatment of distinct declination of bodily strength caused by chronic disorders or hypopituitarism, hypothyroidism and hypoadreenocorticism marked by symptoms of yang-deficiency.
  1. We also tried to use Sini Tang for yang depletion syndrome such as shock, heart failure, cardiac infarction, etc.

Modern research

1) Recent studies have confirmed that this formula has the functions of exciting the central nervous system, promoting metabolism, improving weak conditions and preventing shock.

2) Dr Han Xinmin made a simulated hypotension in a rabbit by injecting anesthetic to the rabbit for studying the functions of each single herb in the Sini Tang as well as the compound decoction of Sini Tang. They found a single Fuzi has a cordial function, but it is weaker than compound decoction of Sini Tang. A single Zhigancao can increase blood pressure but can not strengthen the heart's contraction. A single Ganjiang has no effect on blood pressure and the heart’s functions. When giving the compound decoction of Sini Tang to the rabbit, it showed strong cordial function, slowed sinus rhythm as well as preventing arrhythmia caused by Fuzi.

Jueyin Disease

Jueyin (Absolute yin) Disease is a complicated stage and condition seen during febrile diseases. In TCM theory, Jueyin meridians include the Liver Meridian of Foot-jueyin and Pericardium Meridian of Hand-jueyin. However, in the chapter on Jueyin Disease, it mainly discusses disorders of the Liver Meridian of Foot-Jueyin. There are four main syndromes in Jueyin Disease, namely: the upper-heat and lower-cold syndrome; Cold syndrome; Heat syndrome; and Preponderance between heat and cold.

Upper-heat and lower-cold syndrome use the formulas; Wumei Wan/Black Plum Pill syndrome; GanjiangHuangqin Huanglian Renshen Tang/Decoction of Dried Ginger Scutellaria Coptis and Ginseng syndrome, Mahuang Shengma Tang/Decoction of Ephedra and Cimicifuge syndrome, etc.

Cold syndrome use the formulas; Sini Tang syndrome (Clause 353,354), Danggui Sini Tang syndrome (Clause 351); Danggui Sini Jia Wuzhuyu Shengjiang Tang Syndrome (Clause 352), etc.

Heat syndrome of Jueyin disease use the formulas; Baitouweng Tang syndrome (Clause 373), Xiao Chengqi Tang syndrome (374), etc.

The preponderance between cold and heat: such as Clause 331 "When fever occurs after a prevalence of coldness on the extremities, diarrhoea will come to a stop".

Chief Formulas in Jueyin Disease

Wumei Wan/Black Plum Pill

Ingredients:

  • Wumei/Fructus Mume, 300 pcs/15g
  • Xixin/ Asarum herb, 6 Liang/3 g
  • Ganjiang/Dried ginger, 10 Liang/ 6g
  • Huanglian/Coptis root, 16 Liang/9g
  • Zhifuzi/Prepared aconite root, 6 Liang/6g
  • Danggui/ Chinese angelica root, 4 Liang/9g
  • Huajiao /Prickly - ash peel, 4 Liang/10g
  • Guizhi/Ramulus Cinnamomi, 6 Liang/9g
  • Renshen/Radix Ginseng, 6 Liang/6g
  • Huangbai/Cortex Phellodendri, 6 Liang/9g

Administration: According to the original Shanghan Lun text, and my own experience, we should soak Wumei with vinegar overnight; grind the above herbs into a powder to make into pills. Take eight pills each time, three times a day, and then you may gradually increase the dosage according to the condition. An alternative is to use the common dosage of the above herbs to make into a decoction and take half in the morning and half in the evening.

Actions: Warms the interior-coldness, clearsaway stomach-heat, calms and removsthe ascaris.

Explanation: The chief herb in the formula is Wumei, which is quite effective in eliminating roundworms. The deputies are divided into two groups: the first group consists of Huajiao andXixin which are warm in nature and can expel parasites and warm the internal organs; the second group consists of Huanglian and Huangbai, which are cold in nature and can clear away stomach-heat.

Among the assistant herbs are Ganjiang, Fuzi, and Guizhi. They act to warm the interior and are very useful in dispersing internal cold. Additionally Guizhi and Xixin can facilitate the flow of yang-qi and thereby help Renshen and Danggui to tonify the qi and nourish the blood. The vinegar used to soak Wumei during the herbal processing is used to make the herb more acidic, thereby reinforcing the ascaris to return to the duodenum.

During the 17th century, Dr Ke Qin described the effects of this formula on round-worms, stating that "When roundworms encounter sourness, they are calmed (De suan ze jing). When they encounter acridity, they are spent. When they encounter bitterness, they are purged". This has therefore become the standard formula in treating biliary ascariasis.

From Wumei Wan, we can develop a new formula for treating biliary ascariasis, for example, Dandao Qu Hui Tang. This is more effective than the traditional formula Wumei Wan. It consists of Yinchen/Herba Artemisiae Capillaris 30g, Shijunzi/Fructus Quisqualis 15g, Kulianpi/Cortex Meliae 15g, Binglan/Semen Arecae 15g, Chuanjiao/Pericarpium Zanthoxyli 15g, Zhishi/Fructus aurantii immaturus 9g, Muxiang/Radix Aucklandiae 9g, Caihu/Radix Bupleuri 15g and Huangqin/Radix Scutellariae 9g. Decoct the above herbs for 25-30 minutes, and then take the decoction for 1-2 doses a day. Generally only prescribe 5-6 bags for a patient with biliary ascariasis.

Indications in the original Shanghan Lun text

Clause 338: The illness with coldness in the limbs with a feeble pulse on the 7th or 8th day, the patient suffers continuous restlessness and irritation, and coldness on the skin. It is a case of 'Visceral Jue'. It is not ascariasis.

If coldness in the extremities is caused by ascarides (Ascariasis Jue), the patient might vomit ascarides. The patient is quiet and feels restless occasionally. Because of deficient cold in the spleen and intestine, ascarides comes above the diaphragm, and restlessness is caused. It then stops after a time. The patient will vomit and become restless as soon as they eat, as ascarides sense the smell of food and crawls upwards. The patient usually vomits ascarides. Wumei Wan will be a curative for the case as well as for chronic diarrhoea.

In Chapter 19 of Jin Kui Yao Lue, it states 'For the patient with Hui-jue/Biliary ascariasis, Wumei Wan could be used'.

Note: Differentiate between Visceral Jue and Ascariasis Jue (Biliary ascariasis).

Modern clinical application

  1. We usually use Wumei Wan for the treatment of biliary ascariasis, chronic dysentery, colitis, etc.
  1. Dr Liu Xue Tang reported that Wumei Wan is effective for diarrhoea due to bacterial imbalance after using long term antibiotics.

Modern research

1) Twenty-one active round-worms were divided into three groups: seven in the normal saline solution at 37 degrees centigrade, after 2 minutes, they were still active. Seven in 5% of Wumei Wan saw their movements reduce, however seven in 30% of Wumei Wan, saw the round-worms were narcose or dead.

2) Prescribing Wumei Wan to the patients and animals with amphibolic fistula, found that bile excretion was increased; pH of bile was down and became more acidic and Boden's sphincter was relaxed.

3) From the above tests, I believe that Wumei Wan treats biliary ascariasis in three ways: Firstly, Wumei Wan can calm and paralyse ascarides and make their adhesive force to the biliary tract reduced or lost. Secondly, the increased bile excretion can force the ascarides downwards and return back to the duodenum. Thirdly, the relaxed Boden's sphincter can make the ascarides return back to duodenum easily. In addition, after taking Wumei Wan, the pHbalance of the biliary tract is not suitable for the ascarides to live in.

How to study the Shanghan Lun

Master the original Shanghan Lun text

The Shanghan Lun is a very old classical text, which was written in old Chinese language in the Han Dynasty (about 200-219). We should first study some archaic and ancient Chinese and then start to learn the original Shanghan Lun text. We should also understand the meaning of the texts exactly; and which clauses are most important for today's practice; what syndromes in Six Meridian Diseases are still common today; and which herbal prescriptions are really effective; and how to develop the prescriptions, etc.

Paying attention to the formulae

The formulae in the Shanghan Lun and Jin Kui Yao Lue are the most valuable parts of the texts. We should try our best to do more research on the formulas, including their ingredients, dosage, preparation, actions, indications, modern clinical applications as well as reading recent pharmaceutical studies. Since 1982 I have started to do some researches in the formulae in both Shanghan Lun and Jin Kui Yao Lue, and also wrote a book "Research in Classical Formulae of TCM", published by Yellow River Press in July, 1989. I plan to revise it again and give it a new name, "New Research in Classical Prescriptions of TCM" to introduce some new research and developments in classical prescriptions in the world since 1999 until today.

Combining TCM and Western medicine for Studying Shanghan Lun and Jin Kui Yao Lue

Shanghan Lun is a historical TCM book, if we can use both Chinese and Western knowledge and techniques to research it, it will be more scientific and practical. We can not just repeatedly read all old texts again and again without any new development and discovery. I believe that more and more post-graduates have a strong Western medicine background. I believe that an advantage and not a weakness.

Biography

Enqin Zhang (Engin Can) graduated from Shandong University of Traditional Chinese Medicine (TCM) in 1982 with a post-graduate dip. and Master of Medicine. Afterwards, he received his M.D. and Professorship from four international Chinese universities and institutes. He was chief editor & author of the text 'Research in Classical Prescriptions of TCM', published by Yellow River Press in July, 1989 as well as the TCM series 'A Practical English-Chinese Library of TCM', composed of 14 volumes, published by Shanghai TCM University Press in 1990. He now lecturers and practices at the Asante Academy of Chinese Medicine for Middlesex University, London, UK. Correspondence: prof.engincan@yahoo.com.tr

References

Enqin Zhang. (1990). A Practical English-Chinese Library of TCM. Shanghai TCM University Press.

Enqin Zhang. (1989). Research in Classical Prescriptions of TCM. Yellow River Press.

Huang Hai. (2005). Introduction to Treatise on Exogenous Febrile Disease, Shanghai TCM University Press.

Ruan Jiyuan & Zhang Guangji. (2003). Chinese–English Textbook-Synopsis of Prescriptions of the Golden Chamber. Shanghai Science & Technology Press.

Appendices

Appendix A - Conversion table for converting the dosage used in the Eastern Han Dynasty into today's dosage (Zhang 1989).

The Eastern Han Dynasty

(25-220 AD)

The Present Day:

1 Zhu

0.58g

1 Liang(=24 Zhu)

13.29g

1 Jin (=16 Liang)

222.72g

1 Fangcunbi

3.125g for herbs, 6.2g for minerals

1 Qianbi (a heaped coin's worth)

2.0g for herbs, 4.0g for minerals

1 Ge (Ten spoons' worth)

19.81ml

1 Sheng (=10 Ge)

198.1ml

1 Dou (=10 Sheng)

1981ml

1 Chi

23.04cm

Note:

1. In the East Han Dynasty, the weights and measures for herbal medicine in the terms of 'zhu', 'liang' and 'jin' are accounted as half of the official measurements at the time.

2. Commonly used and Simplified Conversion: 1 Liang in the Han Dynasty=1 Qian/ 3g today

Payment methods

| | | |

This site and contents are copyright 2006 - 2012

is the trade name of CMT Integrated Health Ltd, , , , , . Registered in England and Wales No. 6528121. VAT No. GB 941 4574 19.