Fifth Formula Installment: Adding Da Huang

Wow, this formula name just gets longer and longer!  For the final formula, Rhei Radix et Rhizoma (dà huáng) is added.  There is the line from the Shang Han Lun

 If the face is hot as if the person were drunk, this is stomach heat surging upward to smoke the face.  In this case, add Rhei Radix et Rhizoma (dà huáng) to disinhibit.

In this case, not only are there cold fluids in the lungs, there is also a Yang Ming large intestine fullness which causes the Yang to surge upward to the face.  This kind of facial color, a deep penetrating rubor, is a good indicator for the use of Rhei Radix et Rhizoma (dà huáng).  When this is seen in the clinic it is good to check for other Rhei Radix et Rhizoma (dà huáng) signs such as a full, distended belly.  Below, this kind of red face is contrasted with the “feather light” redness of the first formula in which Gui Zhi and Fu Ling are used for flushing up.

5. Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia, Armeniacae and Rhubarb Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren da huang tāng) 

Cooking: Boil the above 7 ingredients in one dou of water to get three sheng.  Remove the dregs.  Take half a sheng warm, 3 times each day.

Original Text [Chapter 12. 40]:  If the face is hot as if the person were drunk, this is stomach heat surging upward to smoke the face.  In this case, add Rhei Radix et Rhizoma (dà huáng) to disinhibit.

Case Study 1, Propping Fluids:
浅田宗伯  Dr. Qian Tian Zong Bai

50 years previously this patient had bled profusely.  His face had become very dark and his lips were pale.  He also had edema in his four limbs and palpitations in his chest, shortness of breath and an inability to walk.  Sometimes the bleeding would return.  I gave him Six-Gentleman Decoction (liù jūn zǐ tāng) with Cyperi Rhizoma (xiāng fù), Magnoliae officinalis Cortex (hòu pò) and Aucklandiae Radix (mù xiāng) made into pellets. The bleeding stopped and the water Qi also decreased but the blood luster did not return to normal.   When autumn turned into winter he developed an extreme cough with chest fullness and whole body swelling.  He had to lean on something to breath and could not lay down.  One doctor erroneously considered this the type of water swelling that needed disinhibiting urination formulas but these had no effect.  When I saw him I was fearful that this was propping fluids.  I needed to first control these fluids and then the cough and superficial swelling would spontaneously be cured.  I used Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia, Armeniacae and Rhubarb Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren da huang tāng) with Lepidii/ Descurainiae Semen (tíng lì zǐ) for 2-3 days and the cough and chest fullness decreased.  The flooding swelling also suddenly cleared.  I later used this method to cure water swelling in several other people.  You younger students should commit this to memory!

Case 2, phelgm rheum
Dr. Liu Wei-Xin 刘立新

Ms. Wang was 55 years of age.  She lived in Chongqing city, middle region on Zheng Yang road, #11.  She was a staff person at a household goods shop at the Jie Fang monument.  In may of 1977 she came for a consultation.  She suffered from cough and panting with fatigue that recurred each winter.  It became very heavy in the winter and then, at the awakening of insects, it lightened.  It had recurred like this for more than 10 years.  She went from this hospital to hospital being hospitalized for treatment many times.  She was diagnosed with chronic bronchitis and with obstructive pulmonary edema and cardiopulmonary disease.  She took western medicines for treatment and would get better but each time she encountered and external evil, it would return.  Her family was worried.  The next time the illness recurred, she not only suffered the above symptoms, in addition her face flushed red as if she was inebriated and her bowels had not moved for 3 days.  When they did move they were like sheep turds.  After she moved her bowels, the coughing became worse.  Her pulse was thin and rapid and her tongue moss was thin and white and the body of her tongue had scanty fluids.  Based on the pulse and presentation this was determined to be water fluids harassing the lungs so that they could not be regulated or open.  This caused the bowel to become constipated.    To discharge heat and disperse fluids I used I used Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia, Armeniacae and Rhubarb Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren da huang tāng).

After 1 package her bowels moved and her red flushed face as if drunk resolved.  I repeated this formula without the Rhei Radix et Rhizoma (dà huáng) and I added 24 gm of Glehniae Radix (běi shā shēn) and gave her two more packages.  Her whole illness then decreased.  To follow up I gave her Sheng Mai Di Huang Tang and she was cured.

From Liu Wei-Xin’s case studies

Discussion:
To become completely familiar with fluid retention patterns one must see the pattern in which the face becomes red as if drunk.  This is likened to stomach heat following the channel and surging upward and causing sweltering on the face.  This is because the stomach Yang Ming channel travels up to the face.  This is why Rhei Radix et Rhizoma (dà huáng) is added to Poria, Licorice, Schisandra, Ginger, Pinellia and Asarum Decoction (líng gān wǔ wèi jiāng xīn xia tāng).  This addition will open and disinhibit the stool and discharge stomach heat.  Although the formula includes Zingiberis Rhizoma (gān jiāng), Asari Radix et Rhizoma (xì xīn), and Pinelliae Rhizoma preparatum (zhì bàn xià), the herbs each have their respective functions and are not mutually exclusive.  Moreover stomach heat surging into the face causing facial heat as if drunk is not the same as surging Qi with feather-warm heat as if drunk.  The first is middle warmer Yang Ming heat and therefore bitter cold herbs should be used to purge.  The later is a lower jiao surging Chong vessel illness. Therefore, one should use sour warm herbs to restrain in order to down bear.  This must be differentiated.

In case 1 there was cough with chest fullness with edema of the whole body.  He had to lean on things to breath and could not lay down.  This was propping fluids.  Dr. Qian Tian used Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia, Armeniacae and Rhubarb Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren da huang tāng) with Lepidii/ Descurainiae Semen (tíng lì zǐ).  In order to verify this formula pattern there must be inhibition of the bowels and urination.  Rhei Radix et Rhizoma (dà huáng) and Lepidii/ Descurainiae Semen (tíng lì zǐ) are used to remove the closure.  One must not be eager to simply treat cough and edema.

In case 2 there was phelgm rheum with cough and facial heat as if drunk.  This conforms to the Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia, Armeniacae and Rhubarb Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren da huang tāng) as outlined in the Jin Gui Yao Lue.  Zhang Zhong Jing’s original formula was given with Trichosanthis Fructus (quán guā lóu) given to clear the upper and discharge below.  After one package the bowels moved and the face became less red.  Because this breathing illness was chronic with Yin deficiency, the formula was changed to Sheng Mai Di Huang Wan as a way to continue to regulate.  This follows the treatment principle to “treat the branch when acute and treat the root when this has calmed.”