formulas

Lessons in balance from Chinese herbal formula Guizhi tang 桂枝湯

March 10, 2016 by Eric Grey 1 Comment

When I think about the Lung organ system with relationship to herbal formulas, my mind goes one of two places. The first is to Guizhi 桂枝 based formulas like Guizhi tang – used in treating disorders of the surface that tend to end up with a respiratory component. I think this way despite the fact that, in a general manner of speaking, when I think about Guizhi tang, I more strongly think about Taiyang. The second is to nourishing Lung yin type formulas containing herbs like Baihe 百合 and Maimendong 麥門冬. Not only the actual use of these formulas, but the moist, nourishing energy of both of those herbs resonates strongly with what I know of Lung.

That said, given that I’m currently obsessing about Guizhi in my first Materia Medica course (click here to learn more), I think it makes more sense to discuss what Guizhi and Guizhi tang can teach about Lung that might be of use here in this Year of Sagely Living.

So, I’m going to take some time to break down the formula a bit, and then share the thoughts I’ve had about what it can teach us about balance. Join me?

Guizhi 桂枝 + Shaoyao 芍藥

These two form the most obvious functional pair of the formula. Guizhi, cinnamon twig, in its pungency sends everything up and out, warms and resonates with yang. Everything about the plant and its medicinal material tells the same story – the tree is large, powerful, the essential oils in the bark penetrate the air around it. We prefer to use the spring twig tips – the most young, yang, moving part of the plant.

On the other side of the divide, we have the yin and fluid nourishment of Shaoyao, peony root (here I’ll consider mostly Baishao). Bitter in the Shennong ben cao jing, this inward, downward flavor provides a counterbalance to what Guizhi brings. An herbaceous perennial with showy blooms, I’ve found that peony has a delicacy at the surface that belies the strong roots below (the actual medicinal material).

As a pair, Guizhi provides the yang and Baishao the yin. They nourish and enliven the ying and wei to help the body provide active defenses to help the body resist the inucrsion of external pathogens. The balance inherent in the contrary forces of Guizhi and Baishao is necessary. Too much pushing outwards and the interior could be compromised (though of course the rest of the formula does protect against that). Guizhi tang is used chiefly when a person already has an existing weakness – really all of us – and so asking the body to do TOO MUCH yang would be in poor form.

Baishao helps resist this tendency of Guizhi, but also provides the active fluid nourishment the body needs during an external invasion. But, if we were to have too much in, down, yin, fluid we may not have the yang force needed for active resistance. Both herbs are needed – balance is crucial.

Shengjiang 生薑 – Gancao 甘草 – Dazao 大棗

Everyone knows that Chinese medicine is frequently obsessed with the center. From this inner pivot, qi is pulled from what we consume and sent to the four corners of the body. From this bodily “Home” the building of the physical form begins and proceeds. If you have a weak center, if Spleen or Stomach aren’t doing their job, it’s difficult to do very much well. All of the organ systems are critical, of course, but when the center is compromised, full system compromise isn’t far behind.

These three herbs form one of the most powerful combinations for tonification of the center. Gancao, licorice root, and Dazao, Chinese date, offer the sweet nourishment that is in concordance with the fundamental nature of the Spleen. Of course, too much sweet and the Earth suffers, but Gancao provides movement via its woody nature to keep things flowing. Dazao, being the fire herb of the earth class in the Tangye jing, and resonating with fire via its red color and nature as a subtropical fruit, provides some needed warmth as well. Between the two of these, the fundamental energy needed to fight off the external invasion is present and accounted for…

But balance is brought in this trio of herbs through the ginger root.

Spicy, warming, moving and yet rooted in the middle, to me ginger is a more substantial and Taiyin oriented lung herb. It helps me to understand what seems like a contradiction – Lung is related to the surface and the hairs but also the Taiyin which is most often considered as resonating with the center. How can something be both surface and internal? Ginger tells the tale, I think. Pushing the qi and warmth out from Taiyin center to the surface, ginger serves both as something of a diaphoretic and continues the work on the interior necessary to shore up the defenses from within.

Guizhi tang and the (barely) bearable complexity of living

Well, that was a fun little romp through Guizhi tang, but what of it? The formula is important – and I’m handing modifications of it out like candy during this late winter season. But the way it speaks to me about balance is where this comes into Year of Sagely Living territory.

In modern life, people talk about the need for balance quite a bit. Work-life balance. Balancing seated computer work with frequent movement. Balance between caring for friends & family and nourishing the self. Balance between perfect health and indulgent pleasure. For most people, figuring out how to achieve that balance is difficult, if not impossible. Many of us swing wildly from one side of the (admittedly likely false) dichotomy to the other. You make a New Year’s resolution to work out 4 times weekly, and do so for a couple of weeks, but soon find that maintaining that habit while simultaneously barelling through a few important work projects is just too much. Before you know it, you’re sitting 50 hours a week, and feeling it.

I think a strategy for working towards greater balance in life is suggested by Guizhi tang that subverts these tendencies.

Lesson 1 : It starts with the center.

If you’re not nourished – if you don’t have a stable inner center – no change is going to get traction. This, of course, can be interpreted in various ways, but I do think the idea of sweetness makes some sense here. You need to feel FED. I do think this points to our need to really take care of our nutrition, regardless of what other habits or goals we may be working towards.

But, beyond that, it speaks to the importance of self-care in a general way. So, if you don’t feel that you take particularly good care of yourself, if you’re feeling frequently overtaxed, balancing THAT out takes priority before any other type of balance can be addressed.

Lesson 2 : Address the true balance of yin and yang when moving towards change

I think here specifically about input and output. Output is yang – it is creating things in the world, showing the surface, doing, acting. Input is yin – it is that nourishing aspect above, but also learning, contemplating, organizing, planning, readying. So, let’s say I realize that I need to take action to provide balance in my relatively sedentary lifestyle.

It’s tempting to go all out, to join a gym, to work out five days a week, to get a trainer. That would balance out the sedentary professorial life I’ve got going on, but it would violate the principle here. What I need to do is spend some time at rest, and considering what I want to achieve. I need to act, and create, yes, but if I act from a place of frantic activity without balancing that with more yin activities, burnout is likely to be the result.

These two lessons I’ve taken are obviously deeply interrelated, and maybe just one thing, ultimately. But, they’re interesting to think about and came directly from my considering Guizhi tang, so I thought they were worth sharing.

Guizhi tang and Miles Davis – an exploration in the harmony of Chinese herb formulas

June 6, 2012 by Eric Grey 24 Comments

Editor’s note : This post, one of the most popular on CMC, was written by my friend and CMC contributor, Sunjae Lee. He also provided the image used in this post (used elsewhere to illustrate other Guizhi tang posts as well). You can learn more about Sunjae here.

One of the words for Medicine in Chinese is 藥 yao, the top part of which indicates plant and the bottom which translates as either happiness or music.

The etymology suggests a close relationship between Chinese Medicine and music: both disciplines use external agents (in one case sound, in the other case herbs and acupuncture) to balance and harmonize the internal energetic landscape of the body and mind. As a longtime jazz musician and fledgling Chinese medicine student, one of my goals is to elaborate on this relationship between music and medicine, and I am finding connections in unexpected places.

One day in my herbs lab class, Eric had us taste combinations of herbs from the classic formula Guizhi Tang, which has 5 herbs: Guizhi, Baishao, Shengjiang, Dazao, and Gancao. It was the second week in a series in which he had us taste individual herbs, observe their effects in our body, and then observe specific combinations and note how the herbs modified each others effects.

This was a familiar feeling to me even though I had no prior experience in herbal medicine.

…suddenly I realized that the language that Eric used to describe the herbs’ interrelationships was exactly the same way that I thought of the dynamics within a small jazz group

As Guizhi tang is arguably the central formula in Chinese herbal medicine, I sought to compare a similarly prominent small jazz group with five members and settled upon the Miles Davis Quintet. There were many permutations of this group throughout the various decades that Miles Davis was active on the jazz scene, but my personal favorite was the one with the following members: Miles Davis (trumpet), Wayne Shorter (tenor sax), Herbie Hancock (piano), Tony Williams (drums), and Ron Carter (bass), which was most prominent in the mid to late 1960’s and was considered his “second great quintet”.

The more I pondered about the correlations between the two worlds the more things clicked:

Guizhi 桂枝– cinnamon twig, is the leader of the formula and its acrid and warm nature helps to “release the exterior”– bringing the body’s energy to the surface of the body to aid in expelling pathogens that have invaded. It gives the formula its name, is the most prevalent ingredient portion wise, and reflects the main medicinal action of the formula. It’s also felt to “connect the yang” and open up the lungs; all of its actions in general are expansive and energizing. Guizhi is thus clearly Miles Davis, the leader of the quintet, who with his high pitched trumpet and poetic yet piercing phrasing, takes moment to moment command of the quintet’s dynamic.

Just as all the other herbs mainly function to support Guizhi in Guizhitang, all the other musicians in the quintet are essentially beholden to Miles’ leadership, who by this period in jazz history had already risen to the status of living legend.

Baishao 白芍– peony root, is often paired with Guizhi and tends to compliment Guizhi’s upward, expansive energy with a downward, contractive quality. In our herbs lab class when we were tasting the Guizhi / Baishao combination, I had the sensation that Baishao lowered the seat of Guizhi’s action, as well as tempering it. The complimentary relationship with Guizhi suggests that Baishao is Wayne Shorter the tenor saxophonist in this metaphor.

Listening to the two play a melody together demonstrates this perfectly; Wayne syncs up to the exact tempo and mood of Miles’ phrasing, and to me adds a depth that is undeniable and melodious. In addition, Baishao is known to be a blood nourishing herb, having an affinity for the liver and therefore the element wood.

Listening to Wayne Shorter’s solos fits this description perfectly; in particular the propulsive, wood quality of his melodic ideas. During this period he was already a master jazz composer and while listening to his solos it seems as if he has endless inspiration, evoking the birthing energy of springtime and thus of wood and the liver.

Guizhi and Baishao also have affinities for different areas of the body

Guizhi is directed more at the chest, whereas Baishao allows for more of an abdominal focus. This is exemplified with the formula that is a slight modification of Guizhi Tang– Guizhi qu Shaoyao tang, which just takes out the Baishao from Guizhi tang, and is used for cases in which chest symptoms such as a sense of fullness in the chest are prominent.

If one looks at the body’s vertical dimension as a metaphor for frequency / pitch, this translates exactly to the relative relationships between the high pitched Miles Davis as the chest oriented Guizhi, compared to the low toned tenor saxophone of Wayne Shorter, who represents Baishao’s abdominal action.

Shengjiang 生薑– fresh ginger, is the agent in guizhi tang that energizes and potentiates the action of the other herbs. Its main flavor is acrid, which is known by any who have tasted ginger to have a dispersing, spreading effect. It is another herb that releases the exterior, warms, and disperses. The effect that Shengjiang has on me, both in this formula as well as in culinary use, very much reminds me of Tony Williams, the young drummer who was hired by Miles Davis at 17 years old.

Tony Williams’ way with the ride cymbal in particular, the highest pitched cymbal with which jazz drummers provide a steady, syncopated beat, is forceful yet light, and provides a sizzling backdrop against which any soloist seems younger and more energetic. He has a tendency to play ahead of the beat, which might be correlated to ShengJiang’s ability to treat “dampness” if one imagines dampness in terms of a group slowing down in tempo– something that would never happen in a group with Tony Williams.

Dazao 大棗 (Jujube), and Gancao 甘草 (Licorice) are both sweet herbs that act upon the spleen / stomach system and help to harmonize the effects of the other herbs. Because of these similarities, when I first considered the assignments of the last two players in the group (Herbie Hancock and Ron Carter) it seemed somewhat arbitrary until I talked to Eric, who pointed out some of the differences between the two herbs: Gancao is much more ubiquitous than Dazao, and even has the distinction of being the only herb that is also considered to be a formula onto itself: Gancao tang.

This alone points to the fact that Gancao is the bassist Ron Carter, considering the fact that jazz groups oftentimes don’t have piano players, but almost always have bass players. This argument is bolstered by the fact that Gancao is actually a root, which can be easily likened to the bass, whereas Dazao is a red fruit, which evokes the piano more strongly.

Also, one might consider the words of Japanese scholar Yoshimasu Todo, who said of Gancao,

“主治急迫也”: “Gancao mainly treats urgent pressing”, and of Dazao, “主治攣引強急也”: “DaZao mainly treats pulling tightness and urgent stiffness”.

Our single herbs teacher Dr. Joonhee Lee thus describes the main ability of Gancao as moderating urgency, and Dazao as moderating pulling tightness/stiffness.

To me this goes along with Ron Carter and Herbie Hancock’s roles in the group: in a sense, Ron Carter moderates the urgency of Tony Williams with his grounded basslines, and Herbie moderates the potential “stiffness” of the soloists, by filling the empty spaces with quirky piano accompaniment and by adding harmonic depth. Although Todo was likely referring the effect on the patient, rather than on the other herbs in the formula, it is still something to consider.

Finally, according to the Tangye Jingfa, a rediscovered herbal classic that categories 25 major herbs into 5-element categorization, Gancao is classified as the “wood herb of the earth realm” where as Dazao is the “fire herb of the earth realm”. It makes sense that both of these herbs fall under the earth realm as they are both sweet, moderating herbs that target the spleen/stomach primarily. Ron Carter as the “wood of earth” Gancao makes sense, as his walking bass is characterized by its sense of propulsion partly due to huge interval leaps and accented rhythms that suggest wood-like movement.

On the other hand, Herbie Hancock as the “fire of earth” Dazao also makes sense: although he mainly plays a supportive role behind the soloists, when he does take a solo it is full of flair, technical expertise (of perhaps more of a metal quality) and fiery expressiveness.

Although the metaphor isn’t perfect, and my understanding of these herbs and this formula is rudimentary at best, it has been an intriguing way of looking at the hallmark formula of Chinese Medicine with far reaching implications– what sort of musical dynamics do other formulas represent? Is it possible to make custom tailored music that that will have specific medicinal effects just as Chinese Formulas do?

These questions and many more have inhabited my mind since I began contemplating the relationship between medicine and music and I look forward to the doors that will open up in the future from them.

Hierarchy and herb combinations in learning Chinese herbal formulas

November 30, 2010 by Eric Grey 11 Comments

One of the most important reasons Chinese herbal medicine is different than the majority of Western herbal medicine because of its intentionally constructed formulas of multiple herbs. Where herbs are abstracted from their formulas and extracted to reveal their constituent components, the results are usually disappointing. I have personally found the most success with formulas when I seek (and manage) to fully appreciate the structure of a formula. This, unfortunately, is not very often a simple task.

The way most students learn about formula structure is twofold. First, students learn herbal combinations and interpret all formulas based on the combinations they contain. Second, if they’re diligent, they learn some version of Jun, Chen, Zuo, Shi (Emperor, Minister, Assistant and Servant). In other words, they learn a hierarchy of importance of each herb within the formula. Learning these things steadfastly can certainly improve formula recall and allow some basic comprehension of the formula. What more can you ask for, really?

Well, a lot more, if you’re me. This seems a good time to post this video:

The relevant quote, of course, being, “How DARE you waste my time with anything less than your very best?”

So, let’s break it down – quickly – because I have to drive for 1.5 hours here in a minute. I think I’ve already talked about learning formulas by learning combinations first. I don’t like it, in short. I’d prefer if we just started out with formulas, and proceeded to single herbs from there. Failing that, let us learn single herbs through the Shennong Bencao Jing and then proceed directly to formulas. Why?

Well, an example is the best way to illustrate what I’m thinking about. But, the same example will serve well to address the problems in the Jun, Chen, Zuo, Shi method of learning formula hierarchy. So, let’s talk briefly about that first.

I do believe that formulas have hierarchies. By that, I mean, I do believe that there are herbs that are so critical to a formula that removing them destroys the formula completely. This is due to the interrelatedness (and/or modularity) of most classical formulas. If you remove one herb, you usually have another formula – or most of one. However, the assignment of Jun, Chen, Zuo, Shi that you see in textbooks is not something laid down by the formula originators on creation of the formulas. You will find different assignments, particularly past the Emperor, depending on what resource you are using. This can be very, very confusing. At minimum, it makes a student unclear as to the utility of the concept of hierarchy in formulas. Most students don’t pay much attention to it, and sort of grow numb to the concept.

Those who DO learn it, committing it to memory, end up with a problem. The Emperor herb is usually pretty clear, and makes sense. What is Sini San without Chaihu? Guizhi Tang without Guizhi? Knowing that the formula has one major protagonist helps you to understand what sort of basic universe the formula operates within. However, the positions beyond that are difficult to interpret. Is the minister herb in Guizhi Tang Baishao? Why? Why not Shengjiang? Why are Shengjiang, Dazao and Gancao always relegated to an inferior position? If you think that doesn’t negatively impact people’s understandings of formulas, I’d be interested to hear your reasoning.

Anyway – to wrap up, let’s just take an example – my favorite formula and yours Xiao Chaihu Tang (小柴胡湯). Using one method of translating the classical dosage units, we end up with the following composition:

Chaihu 24g
Huangqin 9g
Banxia 12g
Shengjiang 9g
Renshen 9g
Dazao 9g
Gancao 9g

Interpreted through most people’s understanding of combinations, the formula looks like a couple of pairs and some other random stuff. The pairs in question would be Chaihu + Huangqin and Banxia + Shengjiang. The former is mostly memorized as a pair to harmonize the Shaoyang, relieving alternating fever and chills as well as congested Qi and heat in the Shaoyang channels and organs. The latter is typically thought to be a pair for phlegm in the center, nausea and vomiting. The last three are usually thought to be something having to do with digestion, harmonizing and detoxifying the formula, or something like that.

Interpreted through most people’s understanding of Jun, Chen, Zuo, Shi, we have Chaihu as the clear emperor (by dosage and effect) with Huangqin the minister (poorly explained in every source I’ve found) and everyone else sort of hanging out there for fun.

What have we learned through these methods about this formula? It has something to do with Shaoyang, the person probably has those classic Shaoyang symptoms we learn by rote. Maybe there’s something to do with nausea, or maybe some kind of phlegm. The digestion must be weak, or maybe the Qi needs to be tonified, or something. I’m telling you, this is the farthest most people go. If someone comes in with alternating chills and fever or a temporal headache or a sore throat, they might think of this formula. Of course, if they have learned through some level of discipleship the wide application of Xiao Chaihu Tang, then the poor understanding of the formula structure is compensated for.

Chaihu and Huangqin are undoubtedly an important part of this formula. But can we understand the combination of Chaihu and Shengjiang? What about Chaihu and Dazao? Are they not also combined in this formula? What about the combination of Shengjiang, Dazao and Gancao – 3/5ths of Guizhi Tang? What is the difference of the combination of Chaihu and Gancao in this formula as differentiated from Sini San? What happens to our understanding if we think of Chaihu and Huangqin as equal in the hierarchy with all the rest of the herbs combining to be equally important as one of those two?

Many of these questions, and many more, could be explored and even answered by reading the original modification commentary in the Shanghan Lun. If the patient is thirsty, what is done? What does this mean about those herbs?

If we simply learn formulas by memorizing combinations and Jun, Chen, Zuo, Shi we can quickly become too mentally constipated to perform these acrobatics. By doing so, we miss out on the vast utility of some of our most beautiful formulas. That’s all I’m saying, folks.

These symbols are meant to be questioned (they just don't often give clear answers)

September 23, 2010 by Eric Grey 7 Comments

I have a feeling I’m going to get in trouble for my teaching. It’s not that I’m that revolutionary, or that I really even know that much more than my students. It’s just that my fundamental orientation towards the universe is to be always, always asking questions. I don’t always need to let those questions come out of my mouth (undergrad philosophy students, take notice!) but they are always in there. In particular, I tend to question fundamentals. Fundamentals, here, are those basic concepts that act as building blocks for entire edifices of knowledge. Fundamentals, here, are also those things that people most often tend to take for granted.

It’s just the philosopher in me, some might say. But, I could just have easily learned the habit in my work in a microbiology lab in my undergrad years. Or in my work as a forest ranger. Or in my all-important work as a father. I think almost any situation can be helped by a willingness to ask very simple, very essential, very difficult questions with a willingness to be surprised. The clarity of thought that can emerge from such investigations is worth the effort. It is effort, though, there’s no doubt.

So, what are these trouble-making lectures I’m giving? Well, I probably inflate myself unnecessarily. Some of it is just introducing the students to interesting concepts at an early stage – such as the flavor/element combinations introduced in the “lost” Yiyin Tangye Jing (伊尹湯液經). I’m assuming that a number of you have already read the eye-opening article by Wang Shumin, found in the book Medieval Chinese Medicine: The Dunhuang Medical Manuscripts after her extensive research into the remnants of the text found in the Dunhuang caves. While it’s not instigating trouble as such, I do think that being forced to consider these things makes the students more inquisitive, and more likely to think deeply about what they are learning in other classes. But, again, maybe I am congratulating myself a little too quickly.

Not familiar with the text I’m referencing? The essence is this : twenty five herbs are categorized according to the five elements. This would be cool enough, particularly given that the text was likely referenced by Zhang Zhongjing in his writing. What an insight into the construction of Han dynasty formulas! But the herbs are also given flavors, some contradictory to those we know in modern times and the flavors are in turn related to the five elements in a unique way.

You know wood as being affiliated with sour. In the Tangye – it’s affiliated with pungent. Think of the spreading action of wood, its reaching and movement and activity.
You know fire as being affiliated with bitter. In the Tangye – it’s affiliated with salty. What is softer than fire? And what better to soften than salt?
You know earth as being affiliated with sweet. Ok, no changes there.
You know metal as being affilated with pungent. Perhaps predictably, the Tangye talks about sour instead. Think about the condensing and gathering power of sour, and the condensed and gathered nature of metal.
You know water as being affiliated with salty. Bitter anyone? Bitter is a downward draining flavor, one that is almost universally associated with cooling and making things more dense for their eventual expulsion. That is fitting for water, our “lower” (but Northern!) element, and while not condensed as such – is certainly the coolest of our elements.

In class we have been making use of these flavors as we work with our senses to understand herbs. I’m learning, of course, just as much as they are – it’s a wonderful journey so far.

One thing I’ve noticed, and something I continually impress upon my students, is the importance of keeping withincategories – at least at first. Let me explain, briefly. Consider a spectrum. On the left side, you have the world of ideas, of Form (in the Platonic sense) and of the Universal. Moving rightward you have the constellations, stars, planetary motions. Further finds you looking at the Earth, the weather patterns, moving on to flora and fauna. Getting still more focused we find the human being, but considered as a whole, and organ systems considered in their symbolic totality. Going further right, we have specific physiology of organ systems (generation of Qi and so forth) and even getting a little more narrow to consider biochemistry, genetics. Finally, we have pathology and the specifics of what goes wrong, when and why.

It’s a kind of focusing down to the smallest thing, and represents for me my process of clinical focus (whether bottom up or top down).

When I’m trying to think through something, like the flavor/element relationships in the Tangye Jing, I try to stay in a narrow part on the spectrum. So, for instance, I tried to stay on a more symbolic level in my explanation above. I was talking about the elements as they show up on Earth, but not really within the human body. They’re still in the realm of ideas. I think I would be speaking less clearly if for wood and fire I talked about pathology, and for earth I talked about physiology, and for metal I talked about the world of Form and Idea and for water I discussed the Kidney. I see that kind of thing a lot, and it sort of confuses me.

I think staying within categories, particularly when the information is unclear or contradictory, is a helpful learning tool. Have you used something similar? Find this to be unnecessarily restrictive? I’d like to hear from you in the comments.

Eric

The concept of constitution in Chinese herbal medicine

November 11, 2009 by Eric Grey 25 Comments

Established readers : this is one of many reposted articles you will see in the coming months. It is part of the redesign process. I hope you agree that all of these articles are worth another look!

I have to admit to some weirdness around the concept of “constitution.” This is absolutely unfounded, I have no clinical or theoretical information to back up my feeling. I think I’ve just seen this concept be misused. Once you get an idea in your head that a patient is a “Chaihu person,” or a “Bladder CF,” or a “Shaoyang patient,” it seems to be a little difficult to think outside that box. It offends my desire to meet the patient where they are without preconceptions.

Now, don’t get me wrong, I realize that this is part of what WE DO in Chinese medicine in particular and natural medicine in general. We look at the gestalt of the patient, and we make a helpful generalization about their condition and the treatment that is likely to rectify it. We look into past and future and consider how the patient came to be where they are and where they might be going, and treat them based on all of this information. I have no problem with that. But, I find myself a little worried when I persistently think about a person as, say, a “Chaihu” person, even before they come in – and use that lens to view whatever it is they might be presenting with in the current moment.

Before you click on the comment button prematurely – know that this is an attitude that is changing for me. The more patients I see, the more I see really weird cases. These cases involve patients who present with a certain picture that so strongly speaks to a particular treatment strategy but for whom that treatment strategy does not work. Searching for a remedy usually guides me in a very unexpected direction. In retrospect, looking through the patient’s case, I usually see a certain pattern emerge.

Here’s an example from my time in the student clinic.

A patient presenting with very serious symptoms (serious blood stasis, ongoing memory loss, digestive chaos, emotional instability and more) also had a *very* excess pulse – pounding, tight and wiry at all depths with some choppiness throughout. A dong (flicking bean) pulse was found on both sides between the first and second positions. A lot of stasis in the tongue. The supervising doctor and I discussed the case for a while, trying to seek out the best formula. For the next six or eight weeks, we used some variation of Taohe Chengqi Tang + Zhishi Xiebai Guizhi Tang with some incorporation of Guizhi Fuling Wan. We wanted to treat the most excess, the most “outward” of the symptom picture first.

As the treatment progressed, however, it… uh, didn’t. The patient’s symptoms didn’t lessen much, the pulse picture didn’t change. We decided to work from another direction. Following the recommendation from one of my mentors, I used a modification of Shenqi Wan with some additional blood movement incorporated. The patient found almost immediate improvement and continued to improve for the next several months. Later acute episodes found us changing our formula strategy a bit, but Fuzi has always been involved and when the Fuzi is removed, the patient worsens.

Now part of this is just my clinical immaturity and maybe my inability to see signs that, for a more experienced practitioner, would seem obvious. I’m sure there are several of you in the audience shaking your heads sagely – ah yes, of course, Fuzi. But, one could easily see something about “constitution” in this case. I’ve had similar experiences otherwise. It’s not always obvious in the pulse, it’s not always clear in the history, but when you go with it – improvement is found on all levels.

There doesn’t seem to be something that binds these cases together in every case. For instance, I am in no way convinced that if a different person with a similar presentation as above were to come to the clinic that I would be able to resolve their situation in the same way. But, I may be able to look at this person and – over time – learn some basic characteristics that help me to identify patients who might need this approach… this is, to me, constitution.

I’ve been reading the Classicalformulas.com blog over the last couple of months. I’ve also read through the book the blog is affiliated with, Ten Key Formula Families in Chinese Medicine. I enjoyed reading it. One thing I couldn’t quite get into was the classification of people based on their body type. While I, of course, pay attention to body type – I don’t think I’ve gone as far as thinking that a person fell into a certain class of formulas because of that body type. I’d love to hear from anyone who has used, or currently uses, this type of classification. Have you found it works all the time? 90% of the time? Something else?

This is a fascinating topic, in general, and one that I know has a lot of traction out there. So, even if you haven’t read the book above, I’d like to hear your thoughts. What do you think about constitution? Where is the classical support for this method? What have you been learning in your classes and seminars about constitution?

Herbal quality : the Fuzi (aconite) dilemma

October 28, 2008 by Eric Grey 8 Comments

As you all know, Chinese herbs are my greatest passion in the Chinese medicine profession. More accurately, formulas are my passion. I can’t get over them! But, I do have a strong affinity for the single herbs as plants and study them as such. Further, I have a real desire to get as close as possible to the original way of prescribing the herbs in formulas, where “original” means Han dynasty or thereabouts. If you read the Shanghan lun, there are very specific instructions for how herbs are prepared and how they should be processed. Many of these instructions appear to be ignored in contemporary times, and I can only imagine that this is having some effect with regards to our herbal effectiveness.

However, even if we prescribe and prepare the herbs exactly as indicated it means nothing if the quality of the herbs is terrible. Recently, in a class at NUNM, a professor allowed us to taste Fuzi from different sources. We had three samples of bulk Fuzi. One was from a popular herb company, the second was from China, specially prepared in the traditional way at the instruction of Heiner Fruehauf. The third was raw Fuzi – unprepared – from China.

We were asked to observe how the herb tasted, its texture, and how it made us feel. The first batch was – depressing. It was brittle, soft, had almost no flavor and absolutely no bodily sensation resulted from tasting it. This is similar to what is found in many clinics. We tasted the second batch a few minutes later, the differences were striking! There was an almost immediate pungency and quite a bit of numbness on the tongue. This numbness continued for quite a while. We have been told by several professors that we want to find this quality in the Fuzi we prescribe to our patients – it indicates that the living potency of the herb is retained.

The best fun happened when we tasted (just a bit) of fresh Fuzi. Oh boy! My THROAT was numb after that one. You could really feel the medicinal quality – it was incredible. The only thing I could think after this little taste test was, “How can we get more of the good stuff and less of the bad stuff?” The consensus seems to be that the best quality Fuzi is not available in the states or really anywhere in the West. Further, the recent earthquake in China apparently did great damage to the areas where much of the high quality Fuzi is produced – creating even greater shortages.

The quality of the initial herb is only part of the problem – processing is the next piece of the puzzle. Fresh Fuzi is often brined, and then treated in various ways. Reports have indicated that industrial chemicals and harsh processes are used in the preparation of lots of commercial Fuzi. At the very least, you can tell that much of what’s available from the major herb companies is wildly over-brined. The brining process reduces the toxicity of the herb – but we have to remember that the “toxicity” of herbs (usually produced by alkaloid content) is a large part of why it is clinically effective! Skilled herbalists know how to exploit the positive nature of the herb while minimizing the potential for harm from the strong compounds contained within. When we overprocess herbs, we don’t do anyone any favors.

How can we, in the contemporary West, make up for these various deficiencies? How can we prescribe herbs in the way they are meant to be prescribed – full of their vital force and particular benefits? How can we know if an herb has been processed appropriately? These questions can easily be added to the ones I’ve had about using local species and other related conversations on Chinese Medicine Central.