Taiyang Continued

Course: / Herbal Classics 1 / Date: / November 9, 2010
Class #: / 8 / Prof: / Dr. Wu

Taiyang continued…

1. Cold attack – superficial excess
   No sweating – which is typical for cold excess. Use lots of warming techniques. 2/3 of the pain of this syndrome comes from cold, so use of warmth will relieve much of the pain. There’s more cold, more fever in this syndrome. The fever is due to wei qi block, so heat buildup.
   
2. Ma Huang Tang Ephedra Decoction
   Good for asthma, cough caused by external pathogen of cold. There is another type of asthma/wheezing, induced by anger, rebellion of Stomach qi – this is an acid reflux induced asthma. Don’t confuse. The tx are totally different. The 2nd fnx of Lungs – dispersal and descending of Qi. Any asthma caused by external pathogen screws with the dispersal function, so you compensate for that with Ma Huang. When there is stomach rebellion, you compensate with enhancing descending function.
   
3. Preparation notes: Ma huang is first cooked with 600ml of water before adding anything else. Remove the foam (which is where the toxicity exists) and add the rest of the herbs, cooking until 250ml left. Take 80ml at a time. See the insert above for the full instructions.
   
4. Indication for formula:
5. Applicable Sx: No sweating, superficial tight pulse. Aversion to cold, +fever.
   
6. Taiyang disease for 10+ days with floating/thin pulse and desire to lay down. The external syndrome is released. If there is chest fullness with hypochon pain (indications of Shaoyang syndrome), use Xiao Chai Hu Tang. But if the pulse is still floating, continue with Ma Huang Tang.
   
7. A person suffering from cold attack disease with floating/tight pulse who develops epistaxis as a result of not having a diaphoretic treatment, use Ma Huang Tang. In this case the wei qi is blocked – not due to Lu heat or St fire – causing heat and reckless blood. Gotta know the root! There’s a form of nasal bleeding caused by too much ma huang. This is called red sweating and indicates yin xu, dehydration, etc and thus cannot tolerate the diaphoretic treatment.
   
8. If Taiyang/Yangming are both attacked with wheezing/chest fullness. Note: no fullness of the abdomen, which is common for Yangming, but not in this case. You must have ab fullness/focal distention/etc in order to use purging effectively. Purging is not applicable. Ma Huang Tang should be prescribed. If you purge the pathogen may move deeper and will damage the Stomach. You still want to treat the Taiyang and remove those symptoms.
   
9. When not to use:
   Hypertension patients. Sweating patients. Don’t use it in the summer time. Use it cautiously in warmer climates like Austin.
   
10. Ingredients:
11. Ma huang 9g prepared
    Acrid, slight bitter, warm. Acts on the LU and UB. How it’s prepared and what part of the plant you use determines the function. Often combined with Gui Zhi for best function.
    Actions/Indications:
12. Releases exterior and dispel cold
    Diaphoretic function to disperse the pathogen. The knot part of the plant is the part that induces sweating.
13. Facilitate movement of Lu qi and control wheezing
    The stem part of the plant will stop asthma.
14. Promote urination, reduce edema.
    This is why some herbals like for weight loss contain ma huang.
15. Gui Zhi 6g peeled
16. Xing Ren 12g peeled
    
17. Other complications of Cold Attack
18. Stiff neck
    Taiyang disease + stiff neck and back, aversion to wind (and actually more aversion to cold) and no sweating (key sx), superficial tight pulse. Channels are contracted by the cold.
19. Ge Gen Tang/Kudzu Decoction
    Gui zhi jia ge gen teng is another variation of this. When you compare two, check the ingredients first and the dosage. By doing so you will see the emphasis of the formula. Next, check the treatment principles. Note the indications. In this case Gui zhi jia ge gen teng is for superficial deficiency + stiff neck. Ge Gen Tang is for superficial excess with stiff neck. Next, look at the different symptoms and the difference between the two. We will have to do this for tests in the future.
    Ge gen 12 g, Ma huang 9g, gui zhi 6g, sheng jiang 9g, gan cao 6g, shao yao 6g, da zao 12 pcs
    Nothing special. No test material here in the ingredients.
    
20. Diarrhea
    Ge gen stops diarrhea, working on the Yangming to control the muscle and relax it. Yangming usually includes intestines – inside you work on that, outside, you work on the muscles to relax spasms. Must be superficial excess. This is not Yangming with constipation, fullness, manic behavior, etc. This is the organ only. You can use Ge Gen Tang here.
    
21. Vomiting
    When Taiyang/YM are both attacked – no diarrhea but with vomiting – use Ban Xia needs to be added to the Ge Gen Tang decoction.
    Ban xia is bitter, warm, toxic. To reduce toxicity, use ginger juice and fry it. Prepared ban xia (look for Fa Ban Xia in the granules). Goes to LU, Sp, St.
22. Dries dampness, transforms phlegm, guides rebelling qi downward. Good for cough, asthma, rebelling lung qi with phlegm.
23. Harmonizes stomach and stops vomiting.
    Ban Xia Xie Xin Tang is really good for this. “Stomach/Spleen should be as balanced as a scale,” per Dr. Wu. Gotta harmalize!
24. Dissipate nodules, reduce stagnation.
    

1. External Cold with Internal Heat
   Test Q! Major Blue Green Dragon is for which syndrome? External Cold with Internal Heat. Taiyang disease with floating/tight pulse, fever, aver to cold, body ache, no sweating (typical superficial excess, but with….), restlessness. This restlessness is the only sx pointing to internal heat! This is not applicable if the pulse is weak, indistinctive with sweating and aversion to wind!
   Major Bluegreen Dragon Decoction has 18g of Ma huang! That’s huge! Other ingredients: gui zhi 6, gan cao 6, xing ren 12, sheng jiang 9, da zao 10 pc, shi gao as big as an egg yolk.
   Why is this called Major Bluegreen Dragon Decoction? Because the dragon is strong, because of water. There’s a legendary story: dragon is supposed to hide in the east sea. If he jumps into the sky it causes a thunderstorm with heavy pouring rain. The effect of this script is profuse big sweating because of the high dose of ma huang – like the rain when the dragon jumps into the sky. Why “major”? Because this rx is based on ma huang and has a strong result. (There’s also a Minor Bluegreen Dragon Decoction on gui zhi tang with less strong result.)
   This is why you need to monitor use of moxibustion for overuse – look for 1) thirsty, 2) restlessness/insomnia/tossing and turning, 3) scanty dark yellow “urilation.”
   Method: once again, cook ma huang first in 700ml water until cooks down until 500ml left. Remove the foam, add other herbs and cook down to 300ml. take 100ml warm TID. Mild sweating is allowed…if too much sweat, apply herbal powder….but ZZ didn’t tell us which one! Different dynasties have had different solutions. Here they are:
2. Dr. Jin Ge Hong from the Jing dynsasty says grind chuan xiong, bai zhi, gao ben into a powder and use that.
3. During the Tang dynasty (7th C) Dr. Sun Si-miao says use huang qi, mu li and gen mi (rice) ground into powder.
4. During the Song dynasty long gu, mu li, and glutinous (sticky) rice was used, ground to powder, mixed, put into gauze pack and then patted onto the skin. This block the pores and prevents severe dehydration. That’s what’s used today.

If sweating too much, also do not finish the rest of the herb decodtion or profuse seat can cause collapse of yang, wei qi xu with aversion to wind, restlessness, insomnia. Look specifically for sweating at armpits, soles, palms. These points of the body are always open

1. Cold attack with water retention.
   Minor Bluegreen Dragon is for this syndrome. The water is retained at the upper abdomen. This is another version of Taiyang. Look for nausea, fever, cough, thirsty, diarrhea, disphagia or difficult urination. Nausea because water causing rebellion in the stomach. Water in lung = cough. Water blocking = fever. Thirsty though? This is because cold ctrx lung and cannot disperse fluids to the soft tissues. This is not dehydration! Difficult urination because causes contraction/retention in UB. Wheezing = rebellion of Lu qi due to cold causing retention. Note that water is retained in all 3 jiao.
   Still causes sweating, but not like the Major decoction. Know the differences between Major/Minor.
   Need to know the ingredients for the final!
   Ma huang, shao yao, xi xin, gan jiang, gan cao, gui zhi 9, wu wei zi 6, ban xia 6
   Other test q’s:
   Gui zhi tang what is the ratio? 1:1
   How much ma huang in Major Blue Green? 18g
   Gui zhi and shao yao are together in Minor Bluegreen Dragon – regulates wei qi and ying qi. Remember this is Gui Zhi Tang based.
   Xi Xin is acrid, warm, and slightly toxic. No more than 4.5 grams per classics. Goes to Lu, Ki. Actions:
2. Releases exterior, dispels cold
3. Warms lungs, trx phlegm
4. Warm channels, alleviate pain
5. Facilitates/disperses qi in the nasal orifices for virus type nasal congestion.

Gan jiang is acrid, hot, goes to ht lu and sp. Works on MJ to dispel internal cold. Gan jiang is static (more warming) while sheng jiang is dynamic (dispersing function).

1. Warms middle jiao and dispels cold.
2. Also save yang from yang collapse
3. Warm channels, stop bleeding

Wu Wei Zi is sour, warm. Goes to lu, ki, ht.

1. Stops/reduces leakage of lung qi, stop cough
2. Tonifies Kidneys, binds intestines, stops diarrhea
3. Stop leakage of fluids, reduce sweating, moisten body fluids.
4. Quiet heart, calm shen.
5. Allergic skin problems/dermatitis.
6. Supports Lv when suffering from hepatitis – protects liver function, but that’s a modern discovery.

Contraindications of Ma Huang:

1. A person with dry throat shouldn’t do diaphoresis therapy!
2. Also no for UTI patients – causes hematuria
   Can also guide pathogen deep inside.
3. Not for patients with chronic carbuncles – yin xu with excessive heat. This can cause inner wind. Inner wind can be caused by 1) excessive heat, 2) lv yang rising, 3) yin xu, 4) blood xu. In this case ma huang is very warm and causes excess heat, also loss of fluids = yin xu. Inner wind is an indication of nervous system damage.
4. A person with epistaxis whould not take diaphoresis – already have heat inside. Sweating can cause spasms of the veins of the forehead with upward staring eyes, poor sleep. Up staring eyes is another form of inner wind – like grand mal seizures.
5. Also inappropriate for blood loss – diaphoresis causes more fluid xu making blood xu even worse; can result in chills, tremors.

1. Restrained type of Wind Cold Attack
   Taiyang dx for 8-9 days! Sx: malaria, fever, aversion to cold, more heat than cold. Pulse will still float/superficial. This says it’s still exterior, but not the malaria sx – half internal, half external. Wei qi not strong enough to remove the exterior pathogen. Person does not vomit, has normal urination. Malaria like sx go from 2-3 times per day.
   If pulse is moderate: it is healing
   If pulse is weak/aversion to cold: yin/yang weakness - deficiency. Diaphoresis, purge/vomit are not applicable…only used in the attacking phase.
   If red face, sx have not yet been released – still fighting between Jing qi and pathogen. If the patient cannot sweat, will have itchy/wind feeling. Use Gui Zhi Ma Huang Ge Ban Tang. Itching can also mean pathogen is trying to exit, but stuck at the closed pores – this itching is the qi trying to exit from pores. Another form is from Ki failure – itching with bad smell like rotten apples. Waste is trying to exit from pores.
   Gui Zhi Ma Huang Ge Ban Tang = ½ gui zhi tang, ½ ma huang tang.
   gui zhi 4g, shao yao, sheng jiang, gan cao 3g, ma huang 3g, da zao 4 pc, xing ren 24 pcs. Half dose of each.
   

Taiyang Organ Syndromes

Taiyang foot UB channel for the channel syndrome, but this refers to the bladder itself, the taiyang organ. Only the Taiyang and Yangming have the split between channel or organ syndromes. The other syndromes are too deep to split them out like this.

1. Water Accumulation
2. After diaphoresis Taiyang pt has profuse sweating + thirst, restless, insomnia, desire for drink. Let this person drink a little to moisten stomach. If pulse floats, has dysuria, feverishness and thirst, give Wu Ling San.
   This is dehydration due to heat.
   
3. Wind attack + fever over 6-7 d and sx haven’t gone, but show w/restlessness is defined as internal syndrome. Will have thirst, desire for drinking water, will vomit soon after drinking. Give Wu Ling San.
   This isn’t dehydration, but due to Water Rebelling Syndrome rather than a body fluid deficiency. Don’t give more water, adjust urine bladder function, transform qi, unblock the Yang.
   Another set of sx to ponder for the boards: dry mouth, dry throat or thirsty, but doesn’t want to swallow water – just rinse mouth out – this is Blood Stagnation, Blood Stasis. Comes with thick, scaly, dark colored skin. See the neon green paperback NCCAOM prep book in the library.
   
4. After diaphoresis the person with Taiyang ds still has floating/fast pulse, restless, thirst. Guess what. Give Wu Ling San.

Wu Ling San analysis

Zhu ling 6g, ze xie 12g, bai zhu 6g, fu ling 6g, gui zhi 6g. Grind the above 5 herbs into powder, take 6g each time TID. Drink lots of warm water while taking them. When sweating occurs, problem is cured.

Zhu ling is sweet, bland, slightly cool. Channels: Spleen, Kidney, Bladder.

1. Promotes urination, guides out dampness.

Ze Xie is sweet, bland, cold. Channels: Kidney, Bladder

1. Promotes urination, guides out dampness.
2. Strengthens Kidney, removes fire for xu heat sx.

Bai zhu sweet bitter warm, sp, st.

1. tonify spleen, augment qi.
2. strengthens mj, removes dampness.
3. stabilize exterior, stop sweating.
4. Tonify spleen, calm fetus.

Fu ling goes to heart, lungs, spleen. Bland, sweet, neutral.

1. Tonifies spleen, strengthens mj.
2. Tonify spleen, trx phlegm
3. Promote urination, guide out dampness.
4. Calm shen, quiet heart. (fu shen is better)

Gui zhi is important to trx qi and unblock the yang. The fluid in the UB can’t exit on it’s own. Urination is promoted via Qi transformation of fluids to urine in the urinary bladder. Kidney usually does this on it’s own, but when it can’t you use herbs. This is used because it’s still a superficial syndrome.

Let patient know they’re going to pee more frequently. Let them know this speeds the metabolism and removes pathogens more quickly.

1. Blood Accumulation
   Unreleased TY ds w/heat accum in UB has sx of mania, blood in urine. Any shen disorder involves blood regardless of excess or deficiency types – the heart houses the shen because it controls blood. Heat in the blood is the excess type. With poor memory, palps, poor concentration, etc this is a deficiency type of shen disorder. Blood stasis can also be excess type – car accident with concussion for instance followed by short term memory loss.
   Ds can be cured after urinary bleeding – pathogens and heat come out. If external syn remains, release the external syn first, no purging! When external is gone and there is fullness/pain in lower ab, then do purging. Use Tao He Cheng Qi Tang

Tao He Cheng Qi Tang analysis

Tao ren 50, gui zhi 6, da huang 12, mang xiao 6, zhi gan cao 6. This is Tao wei cheng qi tang – da huang, mang xiao and zhi gan cao – plus tao ren and gui zhi.Remember that the script contains another script! Wu likes to ask about this.

Tao ren is sweet, bitter, neutral. Goes to ht, lv, lu, li

1. Breaks up blood stasis.
2. Moistens li, promotes bm.

Da huang is bitter, cold. Goes to li, st, ht, lv

1. Purges accumulations, drains fire.
2. Clears damp heat
3. Clear heat from blood
4. Promote blood circulation, remove blood stasis. Often used after stroke with cerebrovascular bleeding – keeps bm smooth so cerebral pressure doesn’t increase with straining during bm.
5. Clears heat from Xue level. This is for warm disease – don’t confuse this from clear blood.

Mang Xiao is acrid, salty, bitter, very cold. Goes to the li and st.

1. Purges accumulations and guides out stagnation
2. Clears heat and reduces swelling

Let patient know this is going to loosen the stool and they’ll probably go a lot.

What’s ZZ doing here overall? He’s regulating water metabolism. This is the key for Taiyang diseases. Lung, SJ, Taiyang channel and UB are the organs involved here. All of the Yangming Rx’s are also to regulate water metabolism! Yangming is a fluid deficiency disease while Taiyang is a water retention. Taiyang works more on Lung for superficial or promote urination for problems in the lower jiao.