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This is the 3rd case in a series about Xu Shu-Wei.

3. Twitching of tendons and muscles:

Original case from: Xu Shu-Wei’s Case number 17

A townsperson named Jing made a living in the country village by twisting fibres into rope (“sheng”), and so was known as Jing Sheng Zi — “Roper Jing”.

Her son was almost thirty years old when he became ill, showing a slight sweat, weak pulse, and aversion to wind. The doctor mistakenly gave him Ma Huang Tang to bring on a sweat, and sweat he did — without stop! Fever, chest pain, intense palpitations, unable to sleep at night, and delirium all followed. Soon he did not recognise his mother, and began twitching convulsively, moving and shaking. The doctor then tried heavy sedators and wind extinguishing herbs as treatment.

I saw this and said: “Erroneous forcing of diaphoresis! Zhong-Jing said:

Patients with weak forceless pulse, sweating and aversion to wind cannot be given [Da] Qing Long Tang (Major Blue-Green Dragon Decoction). When they take it the result will be twitching of the tendons and convulsions of the muscles, and coldness of the limbs. “
[Clause 38 (38)]

I continued: “Only Zhen Wu Tang (True Warrior Decoction) can save him. Zhong-Jing says:

Tai Yang illness with sweating that does not stop, and the patient still has fever, palpitations, convulsive twitching that threatens to lift him off the ground: Zhen Wu Tang is the treatment.”
[Clause 82 (84)]

After giving him three doses of the worst was over; as a follow-up Qing Xin Wan (Pill to Clear the Heart) and Zhu Ye Tang (Bamboo Leaf Decoction) was given to relieve any further remaining toxic pathogen. After several days he was cured.

Steve’s comment: The above two cases [see previous Zhu Ling Tang case] are juxtaposed to illustrate Xu’s adroitness in the face of two cases, of exactly similar etiology, with yet differing consequences. Note that while each case suffered insomnia as a result of incorrect diaphoresis, in the second case this was overridden by the severity of the spasming. Each patient, too, varied in constitution and thus treatment necessarily varied.

What impresses me is Xu’s encyclopaedic familiarity with the Shang Han Lun, his appreciation that “These are no idle words!” and his ability to recognise in confusing cases the core symptoms which identify the applicable portion of the classic. Very inspiring! While it is true that we have relatively scant resources for studying the Shang Han Lun in English so far, we should remember that it could not have been easy in Song dynasty China, either.

Translated by: Steven Clavey

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Showing 11 comments
  • sharon
    Reply

    Would that I had the clauses memorized! In reading these clauses it can seem that one would never see something like this in the clinic but, if the clauses are there like nuggets in the back pocket as it seems they are for Dr. Xu, they are right there when needed. Inspiring indeed. I would love to see more of Dr. Xu’s work.

    I think I remember that Arnaud taught that Ma Huang Tang used to be called Da Qing Long Tang and that it was named after a stellar constellation. Jason do you recall this from the Boulder class? That would make sense here.

  • Steve Bonzak
    Reply

    Hi Sharon-

    The correlation between the Tangye Jing and the Shanghan Lun has been discussed by Arnaud at some of his lectures. It is in the Tangye Jing that we find formulas that are precursors to the formulas we know from the Shanghan Lun. In the TYJ there are two Qinglong formulas named after the constellation. Da Qinglong Tang in the TYJ, however, is the name for what we now call Xiao Qinglong Tang in the SHL. The formula called Xiao Qinglong Tang in the TYJ is what we call Mahuang Tang from the SHL. In the TYJ, the “xiao” version of the formula was for simpler patterns, while the “da” version was for a more complex pattern. In the SHL the “xiao” version of the formula was for less serious or even slightly vacuous presentations, while the “da” version was for more serious and replete problems.

    There is some speculation as to why the names were changed. Tao Honjing, the author of the text “Fǔ Xìng Jué Zāng Fǔ Yòng Yào Fǎ Yào (輔行決贓腑用藥法要)”, and the person from whom we receive our knowledge of the TYJ (he incorporates it in his text) says the following:

    “When Zhang Ji compiled the Shanghan Lun he avoided Daoist names; therefore his formulae all are not named properly. Instead, he named them after the medicinals so as to distinguish [which agents] had to be esteemed as governing [the formulae].”

    Hope that helps.

    Best
    -Steve

    • Jason Blalack
      Reply

      Steve,

      Thanks for the informative post, much better than I could have done…
      -Jason

  • Sharon Weizenbaum
    Reply

    Thanks Steve. This is very clear. Still, I wonder what formula Dr. Xu is referring to in this case when he writes of “Qing Long Tang”? By the time he wrote, was the language of the TYJ not in use? It seems from the translation that he did not make it clear whether he was using “Xiao” or “Da” Qing Long Tang, given the brackets around the “Da”. Any thoughts?

    Sharon

  • Steve Bonzak
    Reply

    Sharon-

    The reference to “Qing Long Tang” comes from the SHL and is made by Zhang Zhong-Jing, Dr. Xu only quotes it. ZZJ writes that using “Qing Long Tang” (I think you can safely read that as any use of the Mahuang + Guizhi method) in a situation where the pulse is weak and forceless is contraindicated because the yang is already weakened. If you cause a sweat in someone in this situation it will cause the yang to become even weaker and the the cold water of the north will start to overcome the even more weakened fire of the south and cause the body to twitch and convulse due to the cold. This is why Zhenwu Tang governs.

    Best
    -Steve

  • alon marcus
    Reply

    Steve you make arnaud proud

  • Greg Livingston
    Reply

    I’m curious as to how cold causes the twitching and convulsions. Cold causes contraction, so is the mechanism at work? Anyone have a precise answer?

  • Jason Blalack
    Reply

    Greg,
    In my understanding, the twitching is not do to a cold (pathogen) but instead, a deficiency of yang. Because the patient had a weak pulse and already a slight sweat, we know he was deficient. Forcing a sweat in a deficient patient exacerbates the deficiency. The loss of sweat leads to yang collapse. The twitching etc. comes about because the yang qi is unable to warm and nourish the flesh and channels. Some people further explain this as having a subsequent fluid deficiency in the flesh and channels.
    The twitching in clause 82 is explained by a) an overactivity a water due to Kidney (and Spleen) yang deficiency, as well as b) a general channel deficiency.

    Hope that helps… Do others have any additional ideas?

  • Tengri
    Reply

    Diaphoresics with yang deficiency can kill! The only safe one I would use on purpose (watch out for those chop-suey western herbal formulas and teas) is jing jie (catnip). Also one must consider the twitching as a form of Dyskinesia. The phrase “could not recognise ones own mother” and “lifting up from the ground” have much deeper meanings than the english translation offers. I’ve also observed that cold can not only mean cold literally but too much ACH vs. Dopamine in the body. The big hint here is the speed analogue ma huang. Pay special attention to asthmatics or people that have taken prednisone or cortisone injections in the past. Also use dangerous nerotoxic street drugs such as MDMA hence “e-tard”. The problem with methamphetamine is that it fools the brain into thinking it has enough dopamine. I’ll leave the rest to others to experience and research.

    • Jason Blalack
      Reply

      Tengri said,

      “The phrase ” could not recognise ones own mother” and “lifting up from the ground” have much deeper meanings than the english translation offers.”

      I agree. Steve Clavey obviously chose a more literal translation. I would say the first phrase simply refers to low levels of consciousness. The second phrase may actually be better translated as “about to fall.” What are your thoughts?

  • Steve Bonzak
    Reply

    Greg-

    The cold water in zhenwu tang (here due to vacuity) causes twitching much like the cold of winter, a cold swim in water, or a shiver causes you to tremor and shake uncontrollably. It is important to realize that this is a similar pathology seen in ling gui zhu gan tang patterns in which there is also cold and water from vacuity. In both there is cold and water due to weak imperial fire.

    -Steve

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