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Case by: Ding Gan-Ren (1865-1926)

Mr. Bai presented with a pathogen in the tai yang that had not yet resolved. There was a loss of normal order of the nutritive and protective aspects. There was physical cold, fear of cold, cough, stifling sensation in the chest, full body aching pain, reduced food intake, and a greasy tongue coat. It was proper to use a Cinnamon Twig Decoction (guì zhï täng) method.

  • Cinnamomi Ramulus (guì zhï)8 fen
  • Fritillariae thunbergii Bulbus (zhè bèi mû)3 qian
  • Pinelliae Rhizoma preparatum (zhì bàn xià)2 qian
  • dry-fried Setariae (Oryzae)Fructus germinatus (gû yá)4 qian
  • Benincasae Semen (döng guä zî)3 qian
  • dry-fried Paeoniae Radix rubra (châo chì sháo) 1.5 qian
  • Poria ((fú líng)3 qian
  • Perillae Caulis (zî sü gêng)1.5 qian
  • Eupatorii Herba stalk (pèi lán gêng)1.5 qian
  • stripped apricot kernel (guäng xìng rén) 3 qian
  • dry-fried Aurantii Fructus (châo zhî ké)1 qian
  • Citri reticulatae Pericarpium (chén pí) 1 qian
  • Gentianae macrophyllae Radix (qín jiäo)1.5 qian

Translated by: Jason Blalack

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Showing 6 comments
  • Steve Bonzak
    Reply

    Jason-

    I am always intrigued by people that claim to use a method, in this case the “guizhi tang method,” but then do not use the formula in their prescription, and in this case not even the right ratio between ingredients (guizhi and shaoyao are not equal doses here). If anything, the ratio of guizhi to shaoyao in this case is more like a xiao jianzhong tang ratio. What do you think DGR was getting at here?

    -Steve

  • Jason Blalack
    Reply

    Many strict SHL enthusiasts will disagree with this style, but on the flip side I think many times people are too dogmatic when it comes to “modifying” SHL formulas. I agree such formulas barely resemble the core formula, and one can only help but wonder what is happening. However there is a method to the madness and many doctors practice in this manner, including myself. The trick is figuring out the treatment principles which are not always clearly stated.

    Once one understands the core principles behind the formula and can treat flexible without restraints, meaning one does not have to rigidly stick to the exact formula. I will present some more cases and hopefully this idea will become clearer. In this case there is obviously more going on besides just gui zhi tang / tai yang. He is treating a dual pattern.

    One thing to keep in mind is that people like Ye Tian-Shi and Ding Gan-Ren knew Shang Han material very well. It is not that they didn’t understand something. Essentially they are taking the knowledge to the next level and creating specific treatments for their individual patients. They are not just fitting people into SHL boxes.
    Hope this helps…

  • Steve Bonzak
    Reply

    Thanks Jason-

    But can you answer the question I had about the ratio between ingredients? Given that these gentlemen were undoubtedly SHL masters, why would DGR call it a “guizhi tang method” when the ratio between the ingredients is much more like a xiao jianzhong tang method or a guizhi jia shaoyao tang method, which is much more a taiyin strategy than a taiyang strategy.

    Is it customary to change the ratio of doses when taking this more liberal method of using a particular method in your experience? How does one approach dosing in general in this method if the original ratio between ingredients is not followed?

    -Steve

  • Cara Frank
    Reply

    Jason,
    what really stands out for me is the use of aromatic herbs in the formula. in fact- I think that the construction of the rx reflects more of a wen bing strategy

    • Jason Blalack
      Reply

      Steve & Cara,

      Sorry, I forgot to address your ratio in my response. I actually address this in quite detail in the book I’m working on, but I will try to concisely explain this question here.

      First one must look at the function of gui zhi in gui zhi tang. It primarily works on the protective level. He has chosen to use other herbs to assist in gui zhi’s “normal” function. For example, zi su geng, xing ren, zhe bei mu, and even qin jiao. In addition, one can think of gu ya as supplementing the nutritive. Hence he obtains a balance using the functions of various herbs to create harmony between the nutritive and protective levels.

      This strategy is not uncommon and again one should look at the treatment principles not the specific herbs. For example, one could choose to use gui zhi 9 and bai shao 4.5 and dang gui 4.5. It is not just about gui zhi and bai shao.

      However, this is not a random choice, but based on the specific presentation of the individual. Obviously, if the patient just had a tai yang presentation then he would have just used gui zhi tang. This though would not have been that interesting and probably would have never made it into his book. Here, he treats the underlying constitution with the external attack. Too often, when people get sick we try to fit them into some purely external formula box, ignoring their constitutional pattern. This case demonstrates one way to start thinking about this method.

      (to Cara) Doctors such as Ding Gan-Ren were masters of both Shang Han and Wen Bing. They routinely integrated both ideas into one formula. This is one reason why this lineage of doctors was considered so interesting.

      No one is saying that such a formula is easy to understand, and is definitely not as straightforward when compared to practitioners who just use a stock formula for their patients. However, by looking at multiple cases from the same doctor we can start to get an idea of how they think and try to understand the methodology.

      Does that help?

  • Michael Tierra
    Reply

    permission to use this formula as a Tai yang example in the east West Herb Course.

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