There are some great teachings within the exploration of this next formula. The ingredients, at first glance, seem to be exactly the same as Xiǎo Bàn Xià Tāng. However, this formula uses the juice of ginger and, more importantly, has the opposite proportions from Xiǎo Bàn Xià Tāng. Here there is double the ginger relative to the pinellia. Xiǎo Bàn Xià Tāng has double the pinellia to the ginger. So, what difference does this make? To me, the lesson is – the more cold fluids there are in a stomach vomiting pattern, the more ginger you use. If the fluids – meaning clear fluids like saliva or spittle – are abundant, use more ginger. And, ginger juice is better for this than just fresh ginger. The thicker or more diminished the fluids, the greater the proportion of Bàn Xià.
It is also very interesting to read the commentary about the application method. So often in our practices, our patients gag on the herbs. Zhong Jing knows this and knows that often this is due to the presence of phlegm in the stomach. So, even though it is a RULE in Chinese medicine, passed down from the Su Wen, to treat cold conditions with warmth, he has the wisdom to go against this when needed. He tells us that we can be flexible with this rule. When someone gags, try letting it cool a bit and take it in smaller doses. In my own practice I may recommend taking herbs in sips throughout the day or diluting it significantly. Sometimes taking it cold makes people gag – so warm it up. The important thing is to be flexible and creative.
This translation includes a case by Ye Tian-Shi. His cases are so cryptic! And difficult.
生姜半夏汤方Shēng Jiāng Bàn Xià Tāng (Fresh Ginger and Pinellia Decoction)
|Shēng Jiāng Bàn Xià Tāng|
|Jiāng Zhī||姜汁||1 sheng|
|Bàn Xià||半夏||½ sheng|
Case 1: Phlegm Qi
Ye Tian Shi
Patient named Tao. The left pulse was wiry and hard. There was abundant phlegm. The food did not move easily. There was also extreme constraint and worry. This was the Liver insulting the Spleen and Stomach.
When one is on in years, it is most desirable to keep the heart content so as to avoid causing hiccups or choking.
半夏Bàn Xià, 姜汁Jiāng Zhī, 茯苓Fú Líng, 杏仁Xìng Rén, 郁金Yù Jīn and橘红Jú Hóng.
The pulse was as before so I removed Xìng Rén and added白芥子Bai Jie Zi.
Ye Tian-Shi叶天士(指南医案) 上海人民出版社第1版1976年7月
Cold fluids knot in the chest and obstruct the Qi mechanism. One should use Shēng Jiāng Bàn Xià Tāng as the principle treatment. Shēng Jiāng Bàn Xià Tāng uses the same herbs as Xiǎo Bàn Xià Tāng. However though these formulas are the same, there are differences. Shēng Jiāng Bàn Xià Tāng uses the juice of Shēng Jiāng and the amount of Shēng Jiāng is twice that of Bàn Xià. Shēng Jiāng Zhī is the principle herb. Its chief function is to open through the Yang, disperse knotting and cleanse fluids.
The original instructions say to wait until it is slightly cool and then drink in 4 doses. Taking this slightly cool is because there is the concern that the cold fluids have become knotted in the middle. [If taken warm] the herbs may be rejected and this may result in vomiting. The Su Wen: 五常政犬论 says “When there is cold, use heat and the cold will move along.” Zhong Jing is using a method that is the inverse to this. It is recommended to divide this into 4 doses in order to prolong the effect of the herbs, gradually dispersing the cold fluids from the center of the chest. This method also prevents vomiting that may come with too great a dose. This has an important clinical significance.
In this case the phlegm and Qi became knotted together. The food did not easily transform. Master Ye used Shēng Jiāng Bàn Xià Tāng with added flavors to disperse knotting, dispel phlegm and down bear Qi. This truly stems for the teaching of Zhong Jing. Later generations considered Master Ye’ application of herbs to be unimportant. This is an extremely one-sided view.