When studying classic formulas, it can be exciting and even mind blowing to read a case study in which a formula you think you understand is used for something you never would have thought of it being used for. Recently I listened to Dr. Zhang Wen-Quan (another protégé of Dr. Liu Du-Zhou) describe observing Dr. Liu with a patient suffering from 3 years of Amenorrhea. She had been given formulas by other doctors to nourish blood, vitalize blood and warm the Kidney with no results. Dr. Liu used Ling Gui Zhu Gan Tang – unmodified! The woman got her menstruation within a week…of course, Dr. Zhang gave an in depth discussion as to why this was the correct formula. Through this discussion, I learned to understand Ling Gui Zhu Gan Tang, it’s function, mechanism of action and presentation on a much deeper level. Hint: For Dr. Liu Du-Zhou the tongue presentation was a primary key
What is even more exciting is to learn material such as this and then apply it successfully in your own clinic.
Recently I had such an experience with a patient. I had been treating her for insomnia, night urination, allergies and low blood sugar with some moderate results. Of course, when a patient is 64 and has had difficulties for many years, we can explain moderate results with the old “it just takes time”. However, having just been re-inspired and educated with Dr. Huang Huang, I re-examined my methods and changed her formula to a modified version of Ma Huang Fu Zi Xi Xin Tang. Clearly hot herbs such as Fu Zi, Ma Huang and Xi Xin are not the first herbs one thinks of for insomnia but the results for this patient were stunning. All of her pathology is markedly better with sleeping through the night, no allergy symptoms at her worst time of year and improved low blood sugar symptoms.
With this idea in mind, I’d like to inspire students to study classic formulas with Dr. Fu Yan-Ling this November (live streaming available) as he teaches on digestive illnesses. Dr. Fu was also a student-disciple of Dr. Liu Du－Zhou. Having been privy to Dr. Fu’s teachings, I know that you will not only learn how to use formulas in effective ways, you will also understand the underlying patho-mechanisms, how to identify them and how to match them with the correct formula.
Below is a case study by Dr. Fu on the use of Gui Zhi Jia Ren Shen Tang for crohn’s disease and another case in which Gui Zhi Jia Long Gu Mu Li Tang are used to treat a duodenal ulcer. I think you’ll see that this is pretty cool stuff!
Case Study: Crohn’s Disease
Wang xx Female 59 years old
Chief complaint: Diarrhoea and abdominal pain for one and half years
History: The patient suffered from abdominal pain, diarrhoea, low grade fever, poor appetite, emaciated during the past year and was diagnosed with chronic enteritis and TB of the large intestine. The antibiotic therapy was not effective.
Observation: Right side abdominal pain, diarrhoea, absence of tenesmus and blood and pus in the stool. Her temperature was 37.5o C. Other symptoms were aversion to wind, tendency to sweat easily, fatigue, body aches and joint pain. She had a thin white tongue coat and her pulse was floating and weak.
Diagnosis: Concurrent Tai Yang and Tai Yin pattern with disharmony of ying and wei with spleen and stomach deficiency.
Treatment: Regulate ying and wei, warm the yang and supplement the middle.
Gui Zhi Tang modified: Gui Zhi 10g; Bai Shao 10g; Zhi Gan Cao 8g; Gan Jiang 5g; Sheng Jiang 5g; Dang Shen 10g; Bai Zhu 10g; Da Zao 20g. Seven packs.
After the medication, the abdominal pain and diarrhoea were alleviated and her appetite improved. Other symptoms of generalised ache and fatigue were reduced. There was slight nausea and her pulse was slightly slippery.
Repeat the same formula, add Huang Lian 1g. Seven packs.
Follow-up treatment: Modified version of Gui Zhi Tang, Xiao Jian Zhong Tang, Huang Qi Jian zhong Tang to consolidate for a further two months.
The patient manifested prominent signs of Tai Yang and Tai Yin.
Tai Yang: Low grade fever, aversion to wind-cold; sweating, generalised and joint pain.
Tai Yin: Diarrhoea, abdominal pain, reduced appetite
Formula: Modified Gui Zhi Tang + Li Zhong Tang.
Rationale for not using Gui Zhi Ren Shen Tang: Gui Zhi Ren Shen Tang is indicated where the interior deficiency is greater than the exterior symptoms. The above case would not be effective if Gui Zhi alone were used. Therefore it is appropriate to combine Gui Zhi Tang with Li Zhong Tang, with Sheng Jiang targeting the exterior and Gan Jiang warming the interior.
Second consultation: The pulse was slightly slippery and it was feared that Gui Zhi and Li Zhong were too warm, generating too much heat, therefore Huang Lian was added to counter the warm properties of Gui Zhi and Gan Jiang. Huang Lian + Sheng Jiang together descend counterflow stomach qi and stop vomiting.
Gui Zhi Tang Jia Long Gu Mu Li Tang ( Stomach and Duodenal Ulcer)
Wang xx Male 29 years old
Chief complaint: Upper abdomen pain for seven years. Current attack for 4 days
History: The patient had a history of stomach and duodenal ulcer with intermittent attacks over the past seven years. Four days ago he again suffered from upper abdominal pain with each attack taking place around 4-5am in the morning. The attack would persist for 2-3 hours with food intake slightly moderating the pain.
S/S: Acid reflux, occasional heart palpitations, pale tongue with a thin tongue coat and a moderate pulse.
Diagnosis: Spleen and stomach deficiency with cold in the middle jiao.
Treatment: Gui Zhi jia Long Gu Mu Li Tang modified.
Gui zhi 10g; Bai Shao 12g; Sheng Jiang 8g; Gan Cao 6g; Da Zao 15g; Duan Long Gu and Mu Li 30g each. Seven packs.
After taking the above medication for four days, the stomach pain subsided but there was slight acid reflux. The original formula was repeated but combined with Zuo Jin Wan.
Gui Zhi 10g; Bai Shao 12g; Sheng Jiang 8g; Gan Cao 6g; Da Zao 15g; Duan Long Gu, Mu Li 30g each, Chuan Lian 2g; Wu Zhu Yu 3g. Seven packs.
The condition resolved after the course of medication
In Chinese medicine, stomach and duodenal ulcers are diagnosed as spleen and stomach deficiency and cold. Gui Zhi Long Gu Mu Li Tang was prescribed with a slightly increased dose of Shao Yao to moderate the pain and tonify the middle.
The acid reflux persisted at the second consultation and Zuo Jin Wan was added to inhibit excessive acid secretion. Huang Lian was used to counter the warm property of Gui Zhi. Acid reflux is generally attributed to constrained heat and Huang Lian can clear constrained heat in the stomach. The dose of Da Zao was reduced because of the acid reflux.
Gui Zhi jia Long Gu Mu Li Tang can be used to treat all types of gastro-intestinal disease, particularly in the case of spleen and stomach deficiency manifesting as dyspepsia, peptic ulcer, irritable bowel syndrome, gastritis with acid reflux, excessive stomach acid, dysfunction of the cardiac sphincter, etc. Zhang Zhong Jing used this formula for treatment of deficient detriment and it is efficacious for elderly patients, infants and post-partum women with spleen and stomach deficiency.
Long Gu and Mu Li are astringent and are also effective in inhibiting excessive acid secretion and they also have a calming effect on the shen.