Gan Mai Da Zao Tang in Pediatrics

Gan Cao is said to “moderate acuteness.”  In the last post on using Gan Cao to treat mushroom poisoning, Gan Cao was used to treat an acute illness.  However, This is not quite what this idea of moderating acuteness means.  The Chinese character for this “acuteness” is an awkward one to translate. Obviously it is awkward because “acuteness” is such a strange word, turning and adjective into a noun!   Jí, 急, can be translated as acute but it can also be translated as urgency or anxious.  When speaking of abdominal diagnosis, a 急 finding means that you are finding tension and hypertonicity in the abdominal muscles.  With this in mind, we can say that Gan Cao relaxes tension, whether emotional or physical.  We see it used in formulas to do just this, such as in Shao Yao Gan Cao Tang or Xiao Jian Zhong Tang.   Then there is the wonderful formula Gan Mai Da Zao Tang.  This formula is made up of just three herbs:  Gan Cao, Da Zao and Xiao Mai.  Often the Gan Cao is honey-fried, the Red Da Zao and Huai Xiao Mai as opposed to Fu Xiao Mai are used.  I will be teaching about this formula in the upcoming Graduate Mentorship Program’s sixth weekend and so I translated some material I found about this formula.  I will be doing a series of posts about it’s use in pediatrics.   The series of case studies will be followed by some wonderful discussion about how this formula works. Below is the first case study, which is a child diagnosed with IBS.  One thing I find instructive about this case is to see how constipation and diarrhea are not always so easily distinguished.  Dr. Yu Guo-Jun likes to use the term “difficult bowel movement” rather than constipation for this kind of thing.  Here is the case: 

The Use in Pediatrics

By Zhao Chao-Ting, Zhu Zhen-Xi and He Dan

赵朝庭, 玉振熹, 何舟

Gan Mai Da Zao Tang originated for Zhang Zhong-Jing’s Jin Gui Yao Lue.  It governs the treatment of “Zang Zao, restless organs.”  It is composed of Gan Cao, Xiao Mai and Da Zao.  The author has treated some very difficult cases with this formula, modified, in the pediatric department with very good results.  At present, the author narrates a bit of his experience with cases.

Case 5: Irritable Bowel Syndrome

The patient was a 5-year-old boy.  He came for an initial consultation on March 5, 2006.  His stool was irregular, pasty and congealed and this was accompanied by agitation.  A half year earlier he began to suffer from unresolved constipation as well as agitation, poor appetite.  He was diagnosed with functional constipation and was given medicines to open his bowels as well as duphalac (乳果糖).  After this, his stool was sticky and watery and at time incontinent.  The parents decided to Chinese herbs but the results were also not good.  I looked through his medical history.  He was given formulas such as Bu Zhong Yi Qi and Shen Ling Bai Zhu to supplement his spleen and stop diarrhea but his stool was still viscous and knotted and would not come out.  After that Zeng Ye Cheng Qi Tang and Ma Zi Ren Wan were used but again his stool was sticky, watery and incontinent.

At the time of his visit, he moved his bowel daily 2-3 X.  He did not have control over his bowels and the substance was sticky and watery.  His spirit was agitated and it was difficult to undergo the four examinations.  His appetite was poor.  His bowels followed a regular routine.  The substance of the stool was rotten and yellow colored.  All else was normal.  The child had a Yin deficiency constitution with withered yellowish hair and a lack-luster complexion.  His tongue was pale with scanty moss and his pulses were thin.  The diagnosis was “irritable bowel syndrome.”  I gave him 7 packages of Gan Mai Da Zao Tang with the following herbs added:

Second visit, 3/13:  After the herbs, his spirit changed for the better and he was able to smoothly cooperate with the four examinations.  He was having one bowel movement per day.  The substance was slightly watery. However, he was still not able to control it.  I gave him the previous formula with 8 gm. Shi Chang Pu, and 5 gm. Yu Jin.

Third visit: 4/9: After the herbs, his stool was regulated and he was able to control it and go by himself.  His spirit was peaceful.  However, after a few weeks, for the las 5 days, he had not had a bowel movement.  His spirit illness also returned.  He was very timid.  I questioned the parents and they said that they had told him many stories with monsters of every kind since he was young and that they berated him frequently.  I added the following herbs to Gan Mai Da Zao Tang:

4 packages

I advised the parents not to frighten or berate the child as a way to cooperate with the treatment.

After these herbs, his spirit changed for the better but at night he sweat a lot.  I added 6 gm of Shan Zha and 8 gm of Suan Zao Ren to the previous formula and gave him 7 packages.  This consolidated the treatment.  I introduced these special points to treat this illness to the parents, in hopes that it will transform and teach this method of combined treatment.  On 12/25, the child returned because of a cold.  I learned that his spirit had been peaceful and the disease did not come back.

Discussion:    In addition to this patient’s opening and draining function being hindered, his emotional and psychological state were both important manifestations of the illness and important causative factors.  Although the treatment was aimed at fortifying the spleen, moistening the intestine, and regulating smooth flow of the Qi mechanism in accordance with the symptoms, it was not aimed at the true deficiency.  The rashness and lack of calm were the root of the illness that needed treatment.  The true Zang deficiency made the heart abandon its duty to govern the spirit brightness, it made the liver become abnormal in its governance of coursing and discharging, the spleen to stop commanding fortification and movement, and for the Yin and Ying to lose its nourishment.  The Zang Fu function was in trouble.  Gan Mai Da Zao Tang uses sweet to nourish Yin and moisten “rashness” of Qi so that the heart is enriched, the liver nourished an the spleen benefitted.  This is what calms the spirit and helps the Qi flow smoothly so the illness spontaneously departs.