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Constraint Case #2: A certain patient presented with qi constraint and general discomfort. This is wood not orderly reaching. After belching she felt more comfortable. Rambling Powder (xiao yao san) minus Atractylodis macrocephalae Rhizoma (bái zhú) plus Cyperi Rhizoma (xiäng fù) was given.

Original Chinese: 某 气郁不舒。木不条达。嗳则少宽。逍遥散去白术加香附。

Rambling Powder (xiao yao san) originally includes: Bupleuri Radix (chái hú), dry-fried Angelicae sinensis Radix (châo däng guï), Paeoniae Radix alba (bái sháo) , Atractylodis macrocephalae Rhizoma (bái zhú), Poria (fú líng), Glycyrrhizae Radix preparata (zhì gän câo) , Zingiberis Rhizoma recens (wëi jiäng), Menthae haplocalycis Herba (bò hé).

Constraint Case #3: A certain patient presented with Liver constraint engendering heat. Augmented Rambling Powder (jia wei xiao yao san) minus Atractylodis macrocephalae Rhizoma (bái zhú) plus Curcumae Radix (yù jïn) was given.

Original Chinese: 某 肝郁成热。加味逍遥去白术加郁金。

Augmented Rambling Powder (jia wei xiao yao san) originally includes: Angelicae sinensis Radix (däng guï), Paeoniae Radix (sháo yào) Poria (fú líng), dry-fried Atractylodis macrocephalae Rhizoma (châo bái zhú), Bupleuri Radix (chái hú), Moutan Cortex (mû dän pí­), dry-fried Gardeniae Fructus (châo zhï zî), Glycyrrhizae Radix preparata (zhì gän câo)

Jason’s Commentary: Even from these simple cases we can start to figure out how Ye Tian-Shi thinks about herbs, and this really is the goal. For example, in the first case the only symptom is belching. This must be significant. xiang fu is added, which most likely demonstrates his belief that it harmonizes the Liver and Stomach. In both cases bai zhu is eliminated most likely because a) there is no real deficiency as well as it being warm and drying, which definitely would be problematic for the second case. The addition of yu jin seems fairly straightforward. It is cooling and also moves the Liver qi. However, does Ye merely think of this medicinal as a qi level medicinal or is he also thinking about it also moving blood? As we see more cases this hopefully will become more clear.

Do  others have disagreements or other opinions?

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Showing 3 comments
  • Steve Bonzak
    Reply

    Jason-

    From what I understand of my studies of the Shanghan Lun, baizhu is often removed if there are signs and symptoms like “pounding above the umbilicus,” vomiting, and abdominal fullness. Since I would assume Ye to be well versed in SHL, he probably removed baizhu for that reason in both of these cases.

    Again, while I sort of get why yujin would be added to a case of Liver constraint engendering heat, I wonder what clinical signs and symptoms make him choose this medicinal over something like chuan lian zi?

    -Steve

  • Jason Blalack
    Reply

    This is a good question, and one that I hope will be clearer as we look at some more cases. However here are some quick thoughts:

    Yu jin regulates the qi within the blood. chuan lian zi, in comparison, only enters the qi level. Although this is not a blood stasis pattern per se, the use of yu jin prevents the stagnation from going to a deeper level. chuan lian zi does not have this ability. Or, quite simply, it points that there is some blood level involvement, for it is said, (in relation to constraint patterns), “In the beginning the disease is in the qi aspect, if it endures it enters the blood aspect.”

    If I’m not mistaken, Ye Tian-Shi only uses chuan lian zi for constraint patterns when there is clear pain. Consequently, if it was added to the above cases, I would assume that there is a more severe presentation that is not mentioned, such as strong pain.

    ** Steve, nice observation in regard the SHL symptoms. Lets keep this in mind as we look at more cases.

  • Jason Blalack
    Reply

    In regard to bai zhu, I just read some further commentary about this case. It quite simply says “in cases of Liver constraint and Spleen deficiency, XYS was Ye’s representative formula… if the spleen deficiency is not obvious then Ye would frequently eliminate bai zhu.”

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