Fourth Installment: Adding Xing Ren

The cases and discussions in this series of posts are all taken from the previously mentioned text, 金贵方百家医案评议, An Appraisal through Cases and Discussion of Jin Gui Formulas from Various Schools of Thought.  This is a text that goes through all of the formulas in the Jin Gui Yao Lue and gives case studies from a variety of well known classic formula physicians.  They also offer a discussion after most of the case studies and formula sections.  These discussions are written by the editors of this text, Doctors He Ren 何任, Zhang Zhi-Min 张志民 and Lian Jian-Diao连建伄.

The fourth formula in this family of formulas adds Armeniacae Semen (xìng rén) to the previous formula.  In addition, the warming and transforming herbs are increased.  As we can see from the case studies here, all of these formulas can be used for cough and asthma. However, this formula is, in my mind, most suited for a presentation in which the lung is most effected by the cold fluids.  This is evidenced by the presence of swelling (as mention in the Jing Gui Yao Lue) and the relative diminishment of vomiting.  The stomach may still be involved but the lung is the main location of the pathology.

When there is a presentation with asthma or cough with cold fluids and water swelling, one will clearly consider a formula that includes Ephedrae Herba (má huáng).  After all, Ephedrae Herba (má huáng) does diffuse the lungs and scatter swelling. However, the swelling in this case is related to cold fluids but also to weakness of the lungs.

Ephedrae Herba (má huáng) will not only cause the Yang to go up and out through the pores, it will also cause the physiological fluids to go up and out.  Though Armeniacae Semen (xìng rén) is also pungent, it is bitter as well.  This bitter flavor down bears the rebellion and helps counter the very pungent warmth of the Zingiberis Rhizoma (gān jiāng), Asari Radix et Rhizoma (xì xīn) and Pinelliae Rhizoma preparatum (zhì bàn xià), thereby protecting the body from over dispersion.  Notice the case from Dr. Zhang Zhi-Min 张志民 in which the patient was first over dispersed, requiring the correction with this formula.

I find this formula very useful for wet type asthma, pediatric asthma, allergic asthma, nasal allergies, food allergies with swelling and asthma and chronic bronchitis, especially when the face appears puffy.

From the text:

4. Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia and Armeniacae Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren 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 12.39]  After water has been eliminated and vomiting is checked, if the person displays generalized swelling, add Armeniacae Semen (xìng rén).  For this pattern, Ephedrae Herba (má huáng) would normally be added but since the patient presents with impediment, it is not included.  If one acts against the condition and adds this, it will cause reversal.  The reasoning is that the person is blood deficient, and Ephedrae Herba (má huáng) will act to diffuse the Yang.

Case Study 1, Phlegm Rheum

Dr. Cao Ying-Fu

Dr. Cao Ying-Fu 曹颖甫
Mr. Ye Rui-Chu worked with make-up for the Li Hua company.  He came for a consultation on February 17 complaining of a cough that had gone on for 4 months.  Sometimes he would vomit spittle.  His right pulse was wiry on all three positions.  It was appropriate to down bear this surging Qi.

Second visit:  February 19.  After this formula, the cough had slightly calmed but there was still a lot of spittle.  When he coughed, the phelgm was not easy to dispel.  I added Platycodi Radix (jié gěng) to the original formula.

After 2 packages of this formula the illness decreased.  After giving this formula again, He was quickly cured.

From Cao Ying-Fu’s Jing Fang Shi Yan Lu (Actual Case Records using Classic Formulas)

Case Study 2, Phelgm Cough

Dr. He Ren

Dr. He Ren 何任
Mr. Sun, age 60, Cadre.  On December 29, 1977 he came for a consultation.  He had phlegm panting (asthma) with cough rebellion.  His chest and epigastric areas were full and oppressed.  When it was acute his Qi would surge in an upward rebellion.  He had coughing fits during which his face became red and he would become dizzy.  He had an aversion to cold, scanty urination and a puffy face.  His pulse was deep and his tongue moss was white and completely covered his tongue.  The treatment principle was to calm the Qi and reduce the fluids.

Return visit: January 2, 1978.  After the herbs, the coughing diminished and the surging qi calmed.  The aversion to cold also resolved and the urination was uninhibited.  I gave the original formula again.

From: He Ren’s Case Studies 何任医案

Case Study 3, Cough

Dr. Zhang Zhi Min’s  张志民
Mr. Zhang came for a consultation on March 13, 1945.  He had gotten a cold and a cough.  He was given the following herbs to moisten the lungs and transform phlegm with added herbs for resolving the exterior.  .

Return visit: March 22.  The cough was cured but returned again.  This was because the herbs were given in a lazy way.  The evil had actively seized the opportunity.  He choked if he spoke too much.  This was Qi reversal.  The treatment should down bear and so I used Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia and Armeniacae Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren tāng)

After 3 packages the coughing and choking was cured.

From: Zhang Zhi-Min’s Case Studies 张志民医案

Discussion:

When there is water in the stomach, this causes vomiting.  When one has water in the lungs this takes the form of swelling.  When recent vomiting has ceased and swelling takes form, this means that, although the stomach has been harmonized, the lung Qi is occluded.  In this case, not only is Poria, Licorice, Schisandra, Ginger, Pinellia and Asarum Decoction (líng gān wǔ wèi jiāng xīn xia tāng) given, Armeniacae Semen (xìng rén) is also added to pungently open and discharge with bitter.  This opens up the blockage in the lungs so that the lung Qi is open through and regulated.  The water will then spontaneously move and the swelling will also naturally disperse.  Generally, when there is swelling formed like this, one should add Ephedrae Herba (má huáng) to induce sweat and scatter swelling.  However, this person had blood deficiency and Ephedrae Herba (má huáng) will also push out the Yang Qi, making the deficiency worse.  Therefore it should not be used.  The Shang Han Lun points out that “When one has bleeding, one mustn’t have sweat induced.” This way of thinking is also abundantly expressed in the Jin Gui Yao Lue.

In the first case, the patient was coughing and vomiting spittle.  Dr. Cao saw that the pulse was wiry and this represented a water evil and gave him Poria, Licorice, Schisandra, Ginger, Pinellia and Asarum Decoction (líng gān wǔ wèi jiāng xīn xia tāng).  Although the cough eased, the phlegm was not easy to dispel.  He added a large amount of Platycodi Radix (jié gěng) to the formula.  Platycodi Radix (jié gěng) pungently scatters and bitterly discharges.  This formula was able to dispel the phelgm.

In the second case, there were propping fluids.  This was due to water being retained in the lungs.  The lungs could not disseminate and down bear and this resulted in phlegm panting with reversal cough.  There was chest and epigastric fullness and oppression.  In addition he had surging Qi with rebellion upward and a red face as if he was inebriated.  His urine was scanty and he had dizziness.  Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng) was used for the surging Qi and this was combined with Poria, Licorice, Schisandra, Ginger, Pinellia and Asarum Decoction (líng gān wǔ wèi jiāng xīn xia tāng) to warm the lungs and down bear fluid, disinhibit water and scatter swelling.  Chen Po Ke was added to increase the function to disinhibit water and scatter swelling. This is definitely effective to treat the facial swelling and inhibited urination.

The third case of cough started with a very minor cough.  However, because the treatment did not address the root.  After 8 or 9 days there was a choking cough with Qi rebellion which indicated that the exterior evil had entered the interior.  Therefore Poria, Licorice, Schisandra, Ginger, Pinellia and Asarum Decoction (líng gān wǔ wèi jiāng xīn xia tāng) was used and there was a cure.  This formula is a modification of Minor Bluegreen Dragon Decoction (xiǎo qīng lóng tāng).  It is actually Minor Bluegreen Dragon Decoction (xiǎo qīng lóng tāng) without Ephedrae Herba (má huáng) and with Poria (fú líng) and Armeniacae Semen (xìng rén) added.  The two books, Shang Han Lun and Jing Gui Yao Lue truly must be combined and not separated.

In modern times this formula is often used to treat acute or chronic bronchitis, bronchial asthma, pulmonary emphysema, chronic nephritis and asthma originating from the heart.