Gui Zhi Gan Cao Tang

This is the final post in the short series on Gui Zhi Tang.  I hope you have enjoyed this series and that it has had some enlightening moments for you.  I’ve certainly enjoyed putting it together.  In this post, there are case studies and discussions about Gui Zhi Gan Cao Tang, another precious teeny tiny formula.

A key sign, according to Zhang Zhong Jing, to indicate the use of Gui Zhi Gan Cao Tang is the desire to put one’s hands on the chest, over one’s heart.  I have found that many people do this but we’d never know unless we asked.  If you have a patient with palpitations, anxiety, insomnia, fearfulness, night mares, dizziness or shortness of breath, ask them if they have a desire to put their hands on their chests.  With an eye for this, you may notice patients that put their hands on their chests during your time with them.  I’ve had patients tell me that they always fall asleep with their hands on their chests or that they love for their partner to place their hands on their chest.   Sometimes the patient is not even aware that they keep their hand there until we ask.  At any rate, this desire for a hand or pressure is a chest deficiency sign.  Gui Zhi Gan Cao Tang warms and nourishes the heart Yang.  As a teeny tiny formula it is found in many other formulas including Zhi Gan Cao Tang, Wen Jing Tang, Ling Gui Zao Gan Tang and of course Gui Zhi Tang.

Cook the above herbs in 3 sheng of water down to 1 sheng.  Remove the froth and drink immediately.

Clause 64: When copious sweating has been promoted and the person’s hands are crossed over the heart and there are palpitations below the heart, with a desire for pressure, Gui Zhi Gan Cao Tang governs.

Formula Explanation[1]

This formula is effective for heart Yang depletion with a special characteristic of having epigastric palpitations that like pressure.  It uses Cinnamomi Ramulus (guì zhī) combined with Glycyrrhizae Radix preparata (zhì gān cǎo).  These stimulate and rouse the heart Yang.  Although it is a simple formula, it does return the heart Yang.  If there is simultaneous pattern you can add other flavors.

Cases[2]

Case One: Heart Palpitations and Pain

Dr. Hu Meng-Xian

Mr. Lin was 39 years old and came for a consultation on August 8, 1960.  He said that he had heart palpitations with pain that desired pressure.  He took analgesics but they were not effective.  His bowels and urination were both normal.  He sometimes had spontaneous sweating.  His pulses were slightly moderate and his tongue moss was white and slippery.  I used Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) to be taken warm.

After these herbs the pain was gone.

Discussion:

In general, if pain is worse with pressure it is excess pain and when it likes pressure it is due to deficiency.  There was also heart palpitations and sweating so this was obvious heart Yang depletion.  Without the balmy warmth in the Luo vessels there was pain.  Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) is given warm.  This is very straightforward.  It stimulates the Yang of the imperial palace.  There is a small amount of herbs but the strength is concentrated.

Case 2: Dizziness

Dr. Liu Yong-Yun

Mr. Tai was 46 and had suffered from dizziness and weakness for 4 years.  In the recent 20 days this had gotten worse.  On July 30, 1978 he was hospitalized.  For 4 years his blood pressure had tended to be low.  This was accompanied by dizziness, flowery vision, insomnia with many dreams, forgetfulness and weakness of the whole body.  He also had heart palpitations with a pressure feeling above his heart.  He used western medicine but it was not effective.  Physical exam revealed that his blood pressure was 85/58.  Everything else was normal.  This was diagnosed as constitutional hypotension.

After 4 days the blood pressure had increased and the symptoms had changed for the better and his sleep improved.  He felt that his body had more strength and her spirit was happy.  I consolidated the treatment for one more week and he left the hospital.  Afterward there was no relapse.

Discussion: This was a case of deficiency type dizziness.  The clear Yang did not rise.  The Ling Shu: Ko Wen says “when the upward Qi is insufficient, the brain is empty and the ears suffer from ringing.  The head suffers from slanting and the eyes are dizzy.”  Therefore Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) warms and supplements the Yang Qi of the upper Jiao.  The addition of Cinnamomi Cortex (ròu guì) and Schisandrae Fructus (wǔ wèi zǐ) supplement both the Yin and Yang.  Yin flourishes and Yang ascends and the clear orifices are nourished.  The dizziness is naturally gone.

Case 3: Insanity

Li Zi-Zhao 李自召

Ms. Li was 21 years old and came for a consultation on August 17, 1983.  Her mother spoke to me.  The previous year she and her mother had quarreled and she became very depressed and melancholy.   She did not want to speak and then slept a lot and did not want to wake.  She was drowsy and was not breathing deeply.  Or she spoke incoherently.  At times her symptoms were mild and sometimes they were severe.  She repeatedly sought medical advice and treatment and was given herbs to regulate Qi and purge downward.  The illness did not improve and became chronic up to our visit.  This woman’s growth and development was normal but her facial expression was dull and mechanical.  Her two arms were crossed to protect her chest.  I asked her questions but she spoke fearfully.  It was as if her ears were blocked up.  Her pulse was floating and big and her tongue was pale with white moss.  This was insanity disease and was due to heart Yang deficiency damage.

After one package her spirit had improved.  After 2 more packages her desire to sleep was go
ne and her speaking increased.  The patient’s condition had stabilized.  The heart palpitations and tinnitus had dispersed.  She said it was all like a dream.  The effectiveness was still not complete so I gave her two more packages and there was a complete cure.

Discussion:

In this case there was liver constraint however, repeated diarrhea inevitably damaged the heart Yang.  This pattern manifested with the patient’s arms pressing on her own chest, palpitations and tinnitus.  There was no doubt that this was a Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) pattern.  Although this was a serious chronic illness, it did not take a heavy formula for it to change but I did double the dosage of the herbs.  This worked very well and was right to the point.  It worked like wind in a sail.  Classic formulas are nothing less than truly miraculous.

Case 4: Deafness

Zhou Fu-Sheng 周福生

Mr. Zhou, age 29
Because he had a sudden outbreak of deafness that had lasted for 2 months, his doctor gave him Augment the Qi and Increase Acuity Decoction (yì qì cōng míng tāng) for treatment.  There was no change in the deafness.  Hi suffering was very great and after a long time he came in for a consultation.  At the exam he told me about the deafness.  Palpitations and weakness accompanied this.  He also had a slight fear of cold.  His tongue was pale red with a thin white coat.  His pulse was thin and soft without strength.  A detailed inquiry revealed that this illness had come on after he had a cold with excessive sweating.  On the basis of the pulse pattern and the disease history, I differentiated this pattern as heart Yang deficiency and use Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) with added flavors.

After 2 packages he felt that his strength had increased.  There was a change for the better with the heart palpitations and there was no longer a fear of cold.  The formula was verified so I gave 2 more packages and the deafness was cured.  All of the other symptoms also dispersed.

Discussion:

The Su Wen: Jin Gui Zhi Yan Lun says, “the south is the red color and it enters through to the heart and opens into the orifice of the ear and stores the Jing in the heart.”  When the heart Yang is insufficient, it is unable to surge upward to the ears and this can cause deafness.  Excessive sweating damaging the heart Yang caused this case of deafness.  The Da Lun says “When grasping the pulse, the patient crosses their arms over their heart.  There may or may not be cough but there is deafness without clarity.  The why and wherefore of this is that there is deficiency due to excessive sweating.”  Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) warms and opens through the heart Yang.  Acori tatarinowii Rhizoma (shí chāng pǔ) assists by opening the orifices.  The effect was very good.

Case 5: Flustered with Fright Palpitations
Feng Shi-Lun

Patient age 30, male, named Li. Mr. Li was flustered with fright palpitations and this had been going on for 3-4 years. His sleep was poor and he was wakeful through the night with frequent sweating. His tongue moss was thin and white. The treatment principle was to warm the yang and down bear rebellion. I used Gui Zhi Gan Cao Tang with added flavors.

Results: After 3 packages of this formula, the patient’s symptoms decreased. I gave 3 more packages and the shaking and fright palpitations completely cleared.

Other Cases[3]

Case 6: Heart Palpitations

Ms. Lu was a 46 year-old peasant.  She came for a consultation on May 1, 2000.  On month previously, because she was worried about family affairs and had to overwork.   She then felt flustered and had heart palpitations.  She went to the hospital and took the patent medicines Tian Wang Bu Xin Tang and Bai Zi Yang Xin Wan.  There was no effect.  She came to my hospital for a check-up.  The electro-cardiogram showed premature ventricular contraction.  Her symptoms were heart palpitation, aversion to cold, spontaneous sweat, shortness of breath, mouth thirst, pale red tongue with thin white, dry moss and a deficient, choppy pulse.  Her diagnosis was heart palpitations.  This was differentiated as Heart Yin, Yang and Qi combined deficiency.  The treatment needed to warm the heart Yang while boosting the Qi and Yin.  She was given Gui Zhi Gan Cao Tang plus Sheng Mai Yin modified.

This was decocted in water and taken.

Second visit: After 5 packages of the above formula the heart palpitations had clearly diminished.  The premature beats had gone from 8-10/minute to 0-1/minute. She continued with the above herbs for another 10 packages.  The heart palpitations along with the other symptoms had gone.  The electrocardiogram now showed that the heart beat was normal.  A follow up a year later showed no relapse.

Discussion: This case of heart palpitations, was due to strain and overwork damaging the body.  There was heart Yin, Yang and Qi deficiency.  Gui Zhi Gan Cao Tang was given with Sheng Mai Yin modified.  Gui Zhi Gan Cao Tang was given to return the Yang.  Sheng Mai Yin boosts the Qi and Yin.  Shan Zhu Yu, Long Yan Rou and Zao Ren were added to integrate Zhang Xi-Chun’s experience in treatment.  He considered Long Yan Rou to be a very effective herb to treat heart palpitations, Shan Zhu Yu to be very good for restraining the heart Qi and Chao Zao Ren to nourish the heart and calm the spirit.  All of these help treat heart palpitations.  Gui Zhi Gan Cao Tang can be used to treat circulatory illnesses.  Modern application includes coronary heart disease, rheumatic heart disease, cardiac obstruction, cardiac type asthma, congestive heart failure, congenital heart disease with pneumonia and heart palpitations.  One has to treat on the basis of the clinical manifestation.  This formula can be used along with other formulas such  as Si Ni Tang, Sheng Mai Yin or Zhen Wu Tang.  The special points for differentiation are that there is heart Yang deficiency with symptoms of heart palpitations, shortness of breath, aversion to cold, purple lips, swelling of the lower limbs, pale dark tongue, thin white moss, deficient choppy pulse and chest pain that desires pressure.

[1] From Collected Classic Formula Case Studies from Renowned Physicians, complied by Chen Ming and Zhang Yin-Sheng, 1998, Xue Yuan Publishers, Bei Jing

[2] Ibid

[3] From Liu Han-Tang’s A Record of Clinical Experience using Classical Formulas