Preliminary Summary on Studying
Shanghan Lun
Lectured by Prof. Engin CAN/Zhang Enqin
E-mail:prof.engincan@hotmail.co.uk
(Notes: in Classroom P7, the Middlesex University Enfield Campus,
for TCM postgraduates of
Middlesex University, London, UK)
1.
The History of
Shanghan Lun:
Shanghan Lun,
most often translated as ※Treatise on Febrile Diseases Caused by Cold§, is
originally a part of ※Shanghan Za Bing
Lun§, usually translated into ※Treatise on Febrile and
Miscellaneous Diseases§ which was written by the outstanding physician Zhang
Ji (Zhang Zhongjing) in the East Han Dynasty.
Though Dr. Zhang Zhongjing
is extremely well known in TCM (Traditional Chinese Medicine) and considered
as one of the finest TCM doctors in Chinese history, very little is known
about his private life. According to some later sources, Zhang Zhongjing was
born in Nie-yang, today known as Nanyang, in Henan Province, P.R.China.
During his time, with warlords fighting for their territories, many people
were infected with and even died from febrile diseases- his family was no
exception. This could be the main reason for him deciding to study TCM. He
learned TCM from his own hometown＊s fellow Dr. Zhang Bozu. Later he also
held an official position 每Taishou of
Changsha (the governor of Changsha) in Hunan
Province and lived
from approximately 150-219 AD. The exact dates of his birth and death vary
from source to source; however, an upper limit of 220AD is generally
accepted by most scholars today. It is also said that he was the
father-in-law of Dr. Hua Tuo (?-208 AD), another outstanding TCM surgeon in
the latter period of the East Han Dynasty.
Dr Zhang Zhongjing, studied
previous TCM classical literature, and collected many effective herbal
prescriptions elsewhere, and finally wrote his masterpiece
Shanghan Zabing Lun.
Unfortunately, shortly after being published, his book was lost during
wartime. Dr. Zhang＊s masterpieces were collected by later generations,
re-arranged by Dr. Wang Shuhe in the Jin Dynasty and then separated by the
Bureau for Collation of Medical Books of the Song Dynasty (1065). As a
result, his book was divided form one book into 2 books, one titled
Shanghan Lun ※Treatise on
Febrile Diseases Caused by Cold§; the other,
Jin Kui Yao Lue ※Synopsis of
Prescriptions of the Golden Chamber§.
Dear students, from the
above we can understand that Shanghan
Lun and Jin Kui Yao Lue
were from one and-the same book and the same author, so when we learn
Shanghan Lun, we should also
need to study Jin Kui Yao Lue
at the same time.
2.
The Contributions of
Shanghan Lun to TCM:
As I mentioned above, Dr.
Zhang Zhongjing, made thorough study of TCM classics such as
Su Wen ※Plain Questions§,
Zhenjing ※Canon of Acupuncture§,
and Nanjing ※Classic on
Medical Problems§ and the like, targeted and collected extensively many
useful herbal prescriptions, and finally
created a new TCM theory and diagnostic and therapeutic
principle, namely ,
Bian Zheng Shi Zhi
in TCM history, i.e. the diagnosis and treatment are according to
syndrome differentiation, including the
Six-Meridian Syndrome Differentiation, or the diagnosis and
treatment of febrile diseases are based on the analysing and
differentiating stages and syndromes during febrile diseases. Six-Meridian
Syndrome Differentiation is also the
embryo of the Eight-Principle Syndrome Differentiation, and
Zang-Fu
(the internal organs) Syndrome Differentiation, and Meridian Syndrome
Differentiation.
Shanghan Lun
is the first classical book in
TCM which deals with mechanism,
therapeutic principles and methods,
prescriptions and herbs.
Particularly, therapeutic principles and methods are plentiful in
Shanghan Lun which includes
eight-therapeutic methods such as diaphoresis, emetic method, harmonizing,
purgative therapy, heat clearing, warming method, tonifying therapy, and
resolving therapy; as well as external therapy, acupuncture, moxibustion,
combination of herbal prescription and acupuncture, etc.
In
Shanghan Lun,
there are 398 clauses/sections,
with 113 herbal formulae
(only 112 in fact,
as among them is one named ＆Yu Yu Liang
Wan/Pills ＊existing just in name).
Additionally,
in Jin Kui Yao Lue, there are
25 Chapters with 262 herbal formulae, as some of which are the
same as those introduced in the Shanghan
Lun. Hence, the number of the formulae from these
2 books is up to 269 in all.
They contain, basically, the
prescriptions often used in every department of clinical medicine and are
known as the earliest ancestor of all the other books on the study of herbal
formulae. Clinically, the most of herbal
formulae from Shanghan Zabing Lun
are really effective and still extensively used by TCM doctors in the world
every day till now, such as
Mahuang Tang/ Ephedra Decoction,
Guizhi Tang/ Cinnamon Twig
Decoction, Xiao Qinglong Tang/
Minor Green Dragon Decoction, Xiao
Chaihu Tang/ Minor Bupleurum Decoction,
Baihu Tang/ White Tiger
Decoction, Chengqi Tang/
Bowels-purging Decoctions, Sini Tang/Decoction
for Resuscitation, Wumei Wan/
Black Plum Pill, etc.. In Japan, only the herbal formulae of
Shanghan Zabing Lun are
officially recognized by the authorities and applied and sold in Herbal
Shops which are named Kan Po
(Chinese Herbal Formulae).
3.
The Main Patterns &Chief Recipes of
Six Meridian Diseases
Dr. Zhang Zhongjing
classified all symptoms and signs, stages as well as special conditions
during febrile diseases into 6 groups of symptoms and signs每Six Meridian
Diseases, including Taiyang
Disease, Yangming Disease,
Shaoyang Disease,
Taiyin Disease,
Shaoyin Disease and
Jueyin Disease, and all the
discussions on febrile diseases are based on the Six Meridian Diseases. The
main patterns and chief recipes of Six Meridian Diseases can be summarized
as the following:
(1)
Taiyang
(Great Yang) Disease:
It is a mild stage occurring in the beginning period during febrile
diseases, manifested as chills, fever,
stiff neck, floating pulse, without sweating (termed
Taiyang Shanghan) or sweating
(termed Taiyang Zhongfeng);
The therapeutic principles and chief recipes:
inducing sweat (Mahuang
Tang/ Ephedra
Decoction that is for Taiyang Shanghan);
or regulating
Ying and
Wei (Guizhi
Tang/ Cinnamon Twig Decoction that is for
Taiyang Zhongfeng).
Chief Recipes in
Taiyang Disease
Mahuang
Tang /
Ephedra Decoction
Ingredients:
Mahuang/
Ephedra/Herba Ephedrae (with joints removed) 3
Liang/6g,
Notes: in the UK, you may choose Xiangru
/ Elscholtzi, Mosla/Herba Elscholtziae seu Moslae 9g instead of
Mahuang/Ephedra.
Guizhi/
Cinnamon twig /Ramulus Cinnamomi 2
Liang /4g
Zhigancao/
Prepared licorice root / Radix Glycyrrhizae Praeparatae 1
Liang/4g
Xingren
/ Bitter apricot kernel/ Semen Armeniacae Amarum (with its skin removed) 70
pcs / 9g
Note: Today＊s dosages of all
recipes in this article are mostly according to the
Converting the Dosage in the East Han
Dynasty into Today＊s Dosage (see the table in the appendix
attached) as well as our own experience.
Administration: Decoct
Mahuang/Ephedra in water (9
Sheng= 198.1mlx9) in the pot
over a fire until 2 Sheng
(198.1mlx2 ) of the water is reduced , remove the foam (containing more
ephedrine) floating on the water; and add other herb into the pot which will
be boiled until the decoction is reduced to 2.5
Sheng=198.1mlx2.5. Drink 8
Ge (19.81mlx8) of the decoction
when it is warm, if necessary 2-3 times a day. After drinking the decoction,
ask the patients to stay in a warm bed to induce slight perspiration.
Actions: Inducing sweat to
relieve the exterior syndrome , and smoothing the lung＊s descending function
to relieve cough and asthma.
Explanation:
Mahuang/Ephedra dispels
pathogenic wind-cold from the exterior by inducing sweat and relieves
asthma, acting as a principle herb in the recipe. In the UK, we may choose
Xiangru/Elscholtzi or Mosla
instead of Mahuang/Ephedra
because the use of Mahuang is
prohibited in the UK. Guizhi/
Cinnamon twig, as an assistant herb, can also dispel pathogenic wind-cold.
The combination of Mahuang/Ephedra
or Xiangru /Elscholtzi or
Mosla and Guizhi/Cinnamon
twig has a strong diaphoretic function.
Xingren/Bitter apricot kernel brings down the abnormal ascending
of the lung-qi, and helps
Mahuang/Ephedra to ease cough
and asthma as an adjuvant herb.
Zhigancao/ prepared licorice root can reinforce the middles-jiao,
replenish qi as well as
harmonize all other herbs in the recipe as a guiding herb.
Indications in the original
texts of Shanghan Lun
Clause
35: Taiyang Disease with headache, fever, body aches, lumbago,
arthralgia, aversion to wind, no perspiration, and asthma, can be treated by
Mahuang Tang/ Ephedra Decoction.
Note: the indications of
Mahuang Tang /Ephedra Decoction
can be also seen in Clauses 36, 37, 46, 51, 52, 55, 232,
235 in the book Shanghan Lun.
Modern clinical application
1)My own experiences: I have
used Mahuang Tang/Ephedra
Decoction since 1982 to treat common cold , influenza, and upper respiratory
tract infection that marked by fever, aversion to cold, no sweating, body
aches, cough or asthma, floating and tense pulse. I achieved a satisfactory
result in most of my patients. See ※New Research in Prescriptions of TCM§.
2)Dr Huang Hai proposed that
Mahuang Tang /Ephedra
Decoction can be used ※ for asthma and cough of wind-cold excess syndrome
caused by upper respiratory tract infection, pneumonia, bronchitis and
asthma§ ; also for ※ arthralgia-syndrome of cold-wind , mainly at early
stage and characterized by fever, aversion to cold, no perspiration, body
aches, and floating-tense pulse§. See the book, ※Introduction to Treatise on
Exogenous Febrile Diseases§.
3) Dr Liu Huimin, a very
famous TCM doctor in Shandong Province, P.R. China, once treated the late
Chinese leader Mao Zedong who suffered common cold but could not recover for
a long time. He used modified Mahuang
Tang /Ephedra Decoction. Mr. Mao recovered in very short time.
It was said that Dr Liu Huimin later was promoted as deputy director of
Health Dept of Shandong Government as well as first president of Shandong
TCM University where I graduated and lectured. Dr Liu Huimin＊s god-daughter
Ms Chen Luwen, a dancer, was one of my patients in UK.
Modern research:
1)
Modern researches have proved that
Mahuang /Ephedra and
Guizhi /Cinnamon Twig can excite
sweat glands in the thenar of hamsters;
2)
Volatile oil of
Mahuang /Ephedra can inhibit
activities of influenza virus (AR8) that may be a base to treat influenza.
3)
A Japanese Dr Xi Ze Fang Nan (Nishi
Zawa Yoshi O) found Mahuang
Tang /Ephedra Decoction can inhibit histamine released by
basophilic cell and mast cell during allergic reaction.
For all the above, please
check the book, ※Research in Classical Prescriptions of TCM§.
Guizhi Tang/
Cinnamon Twig Decoction
Ingredients
Guizhi
/Cinnamon twig /Ramulus Cinnamomi) 3
Liang / 9g
Shaoyao / Peony root /Radix
Paeoniae) 3Liang/9g
Zhigancao/
Prepared licorice/Radix Glycyrrhizae Praeparatae 2Liang/6g
Shengjiang/Fresh
ginger/ Rhizoma Zingiberis Recens 3
Liang/9g
Dazao/Chinese
dates/ Fructus Ziziphi Jujubae 12
mei / pcs
Administration: All the
above 5 herbs, should be boiled in the pot with water about 7
Sheng (198.1ml x 7) over a slow
fire, until the water is to be reduced to 3
Sheng(198.1ml x 3). Remove
herbal dregs and get the decoction. Drink its 1/3 of the decoction when it
is warm.
﹛
Notes:
1)
After taking the above decoction,
drink 1 Sheng(198.1ml or more
) of porridge to assist the decoction for better efficacy;
2)
Warm cover is taken for one or two
hours to get perspiration; a light perspiration would be suitable. If the
sweat is too watery, it will not do any good to the treatment.
3)
If the syndrome is cured , stop to
take the rest of the decoction; If not cured, take it again as before; If
after taking it twice with no effect, the decoction may taken a 3rd
time within a half day.
4)
For serious cases, take the decoction
day and night. If disease is not cured after taking one dose, take again,
even for two or three doses.
5)
During the period of taking the
decoction, raw, cold, greasy dishes, and food with irritant, special and
unfavourable smell, alcohol, milk and its products should be avoided.
Actions: Harmonizing the
ying and
wei to relieve the exterior (Taiyang
Zhongfeng syndrome).
Explanation: Of the
ingredients in the above recipe, Guizhi/Cinnamon
twig is a herb with pungent and sweet in flavour and warm in nature, and
acts as a principle herb to relieve exterior syndrome by expelling
pathogenic wind and cold from muscles and skin;
Shaoyao / Peony root is a herb
with sour, bitter and slight cold properties and is used as an assistant
herb for replenishing yin to
astringe ying. The
combination of Guizhi /
Cinnamon twig and Shaoyao
/Peony root result in the double roles of both being diaphoretic and
astringent for harmonizing the ying
and wei, which means that it
induces sweat without impairment of yin;
and arrest sweat without interference in dispelling exopathogens.
Shengjiang/Fresh ginger,
possessing pungent and warm properties, can not only aid
Guizhi /Cinnamon twig in
expelling pathogens from the muscles and skin, but also warm the stomach and
arrest vomiting. Dazao/Chinese
dates, with sweet and mild properties, is used as tonics of the stomach and
blood for supplementing qi
and reinforcing the middle-jiao,
nourishing yin and tonifying
blood; and, used in combination with
Shengjiang /Fresh ginger as an adjuvant herb, it can harmonize
ying and
wei.
Zhigancao/ Prepared licorice
root, as a guiding herb, is used to tonify the middle-jiao
and replenish qi and to
coordinate all the herbs in the recipe.
Indication in the original
texts of Shanghan Lun
Clause 12:
Zhongfeng syndrome of
Taiyang Disease is characterized
by floating-pulse at yang and
weak-pulse at yin (floating
pulse signifies fever, and weak 每pulse signifies spontaneous perspiration),
aversion to cold and wind, fever, stuffy nose and nausea. It could be
effectively treated by Guizhi Tang/
Cinnamon Twig Decoction.
Clause 13:
Taiyang disease, marked by
headache, fever, sweating, and aversion to cold, could be effectively
treated by Guizhi Tang/
Cinnamon Twig Decoction.
Besides Clauses 12 and 13,
in Shanghan Lun, there are
other clauses on Guizhi Tang/Cinnamon
Twig Decoction, including Clauses 15,24,42, 44,45, 53, 54,56,
57,91,95,164,234,240,372,387; and also in Chapter 21 On Pulse, Syndrome and
Treatment of Postpartum Diseases of Jin
Kui Yao Lue.
Modern clinical application:
﹛
1)
My own experiences: I have used
Guizhi Tang /Cinnamon Twig
Decoction since 1982 mostly for treatments of
common cold, influenza, urticaria,
eczema, neuralgia and myalgia characterized by fever, aversion to wind with
perspiration, floating-moderate pulse and spontaneous perspiration due to
disharmony between Ying and
Wei. It is really effective.
Will see ※New Research in Classical Prescriptions of TCM§.
2)
Dr Guan Youbo, a very famous TCM
specialist in China, reported that
Guizhi Tang /Cinnamon Twig Decoction plus
Shigao/Gypsum/Gypsum Fibrosum
20g, Huangbai/ Phellodendron
bark/Cortex Phellodendri 15g, Cangzhu
/ Atractylodes rhizome /Rhizoma Atractylodis 15g, and
Yinchen/ Oriental wormwood /
Herba Artemisiae 20g, is very effective for
rheumatoid arthritis ( See the
book, ※Research in Classical Prescriptions of TCM§).
3)
Dr Qu Sheng said
Guizhi Tang / Cinnamon Twig
Decoction plus Huangqi/
Astragalus root/ Radix Astragali seu Hedysari ,
Muli / Oyster shell/ Concha
Ostreae , is very good at treating
spontaneous perspiration and night sweat.(See the book, ※Research
in Classical Prescriptions of TCM§).
4)
Dr Zhao Jinghua reported that
Guizhi Tang/ Cinnamon Twig
Decoction plus Cangpu /
Grassleavaved sweetflag rhizome /Rhizoma Acori Graminei 6g,
Yujin/ Curcuma root/ Radix
Curcumae 6g, is effective for somnolence/sleepiness
day and night. After 3 bags, the patient felt better, after 15 bags, she got
complete recovery (See the book, ※Research in Classical Prescriptions of TCM§).
Modern research
Modern researches have
proved that the recipe posses the efficacies of inducing sweat, reducing
fever, removing phlegm, relieving convulsion and pain, promoting digestion
and absorption , nourishing the body and consolidating the constitution. See
the books, ※A Practical English-Chinese Library of TCM§).
(2)
Yangming
(Yang Brightness) Disease:
It is a more severe stage occurring the middle period during febrile
diseases, marked by the internal excess
yang/heat syndromes, manifested as
high fever without chills (Yangming
Jing/Meridian Syndrome); or marked by distension in the abdomen
and constipation (Yangming-fu/organ＊s
syndromes). The therapeutic principles and recipes: cooling (Bai
Hu Tang/ White Tiger Decoction that is for
Yangming-jing-Meridian
Syndrome); and eliminating (Tiaowei
Chengqi Tang/Stomach-regulating Decoctions that is for
Yangming-fu syndrome marked by
dryness-heat in the stomach and intestine;
Xiao Chengqi Tang/Minor
Bowels-purging Decoction that is for mild cases of
Yangming-fu syndrome; and
Da Chengqi Tang/ Major
Bowels-purging Decoction that is for
Yangming-fu syndrome marked by excessive heat and constipation.
Chief Recipes in
Yangming Disease
Baihu Tang/
White Tiger Decoction
Ingredients
Shigao/
Gypsum/ Gypsum Fibrosum (ground) 1Jin/30g
Zhimu/Wind-weed
rhizome /Rhizoma Anemarrhenae 6Liang/
15g
Zhigancao/Prepared
licorice root/ Radix Glycyrrhizae Praeparatae 2Liang/6g
Jingmi
/ polished round-grained nonglutinous rice/Semen Oryzae Nonglutionosae 6
He/9 g
Administration: Decoct all
herbs in water until the rice is well-done. Take 1/3 of the decoction warm
orally after removal of the residue, 3 times a day.
Actions: Clearing away heat
from Yangming meridian and
promoting the production of the body fluid.
Explanation: In the recipe,
Shigao/Gypsum, pungent and
sweet in flavour and extremely cold in nature, acts as a principle drug
which is effective against excessive heat in
Yangming meridian;
Zhimu / Wind-weed rhizome,
bitter in taste and cold moist in nature, serves as an assistant herb for
strengthening the action of the principle drug.
Zhigancao/ Prepared licorice
root and Jingmi / Polished
round-grained nonglutinous rice function, as adjuvant and guiding herbs, can
not only reinforce the function of the stomach and protect the body fluid,
but also prevent the middle-jiao
from being injured by bitter and cold drugs.
Indications in the original
texts of Shanghan Lun
Clause 176:
Baihu Tang/White Tiger Decoction
suits the febrile disease with floating 每slippery pulse, which is caused by
heat in the exterior and interior.
Clause 219:
Syndrome involving three yang
meridians simultaneously, there are symptoms and signs of abdominal
distension, a heavy feeling in movement, difficulty in turning round, a lack
of taste, dusty face, delirium and incontinence of urine in the case. When
there is spontaneous perspiration, Baihu
Tang /White Tiger Decoction can be prescribed to the case. In
this case, if diaphoresis is adopted, the patient will suffer delirium. If a
purgative is given, sweat over the forehead and coldness on the extremities
will occur.
Notes: Although the above
syndrome involving 3 yang
meridians simultaneously mentioned in the clause, according to the symptoms
and signs in the clause, it can still be diagnosed the syndrome as an excess
heat in Yangming meridian.
As abdominal distension , a heavy feeling in movement, and difficulty in
turning round are due to excess heat in
Yangming meridian, and disorder of the meridian-qi.
A lack of taste means excess heat in the stomach. A dust face and
spontaneous perspiration is caused by evaporation of excess heat. Delirium
and incontinence of urine reflect excess heat misting the mind.
Clause 350:
It is an interior heat syndrome with slippery pulse and coldness on the
extremities. Baihu Tang
/White Tiger Decoction can be adopted in this case.
Notes: It is a severe case
of heat-jue of
Yangming meridian syndrome .The
patient might have a high fever, parched mouth and tongue, thirsty for a
cold drink, yellowish urine, red tongue with yellowish fur, rapid pulse,
etc.
Modern clinical application:
1)
For encephalitis B, and epidemic
meningitis marked by high fever, profuse
perspiration, a great thirsty, full forceful pulse, we may try to
use Baihu Tang /White Tiger
Decoction that should also be combined with Western medicine at the same
time.
2)
For
sunstroke, heat stroke, and infantile summer
fever marked by symptoms of excess heat in
Yangming meridian, we can use
Baihu Tang /White Tiger Decoction. It is effective.
3)
For upper respiratory tract infection,
influenza, pneumonia and septicaemia marked by
Yangming meridian syndrome, we
can choose Baihu Tang/ White
Tiger Decoction.
4)
For
rheumatic fever, rheumatic arthritis and
infective arthritis (heat bi
syndrome), we may apply Baihu Tang
/White Tiger Decoction with additional ingredients, such as
Guizhi/ Cinnamon twig ,
Cangzhu/ Atractylodes rhizome,
Huangbai/ Phellodendron bark,
etc.
Notes: For all the above,
please check the book, ※Research in Classical Prescriptions of TCM§.
5)
We used modified
Baihu Tang /White Tiger
Decoction for the patients with diabetes
marked with great thirst. We have found this formula to be
effective with most of these patients. Will see ※New Research in Classical
Prescriptions of TCM§.
Modern research
Modern research has proved
that Baihu Tang /White Tiger
Decoction has the efficacies of allaying fever, tranquilizing the mind,
subduing inflammation, quenching thirsty, lowering blood sugar level. See
page 98, ※Prescriptions of TCM§, a part of 14books 每※A Practical
English-Chinese Library of TCM§.
Da Chengqi
Tang/
Major Bowels-purging Decoction
Ingredients
Dahuang/Rhubarb/Radix
et Rhizoma Rhei, 4Liang/9g
Houpu/Magnolia
bark /Cortex magnoliae Officinalis, Half
Jin/9g
Zhishi/Immature
bitter orange/Fructus Aurantii Immaturus, 5 Pcs/9g
Mangxiao
/Mirabilite /Natrii Sulphas, 3Ge/3g
Notes:
1
Jin=16
Liang in the Han Dynasty=222.72
g today; 1 Ge in the Han
Dynasty =19.81 ml today
The today＊s dosages of the
above herbs are according to our own experience.
Administration: According to
the original texts of Shanghan Lun
and our experience, we should
first decoct Zhishi
/Immature bitter orange and
Houpu
/Magnolia bark about 20 minutes, and then
add Dahuang/Rhubarb
into the pot which is to be boiled again for 5-10 minutes.
Get the decoction, and then put
Mangxiao/Mirabilite
which is infused in the decoction. Take half of the decoction orally.
However, if diarrhoea occurs, do not
drink the rest half of the decoction.
Actions: Expelling heat and
loosing the bowels, promoting the circulation of
qi to purge accumulation from
the bowels.
Explanation: Of the four
ingredients in the recipe, Dahuang
/ Rhubarb, bitter in flavour and cold in property, acts as a principle herb
to treat the main symptoms by removing and purging pathogenic heat and fire,
accumulation of food and stool in the stomach and intestine and relieving
constipation; Mangxiao /Mirabilite
, salty in flavour and cold in nature, possesses the effect of moistening
the dryness , softening hard mass and purging heat, and is used in
combination with Dahuang
/Rhubarb, it serves as an assistant herb to reinforce
Dahuang/Rhubarb＊s effects of
drastic purgation. Both Houpu
/Magnolia bark and Zhishi
/Immature bitter orange can promote circulation of
qi and relieve distension and
help Dahuang/Rhubarb and
Mangxiao/Mirabilite in purging
away the accumulation of food and stool in the stomach and intestine, acting
as guiding herbs.
Indications in the original
texts of Shanghan Lun
Clause 220:
Syndrome involving Taiyang
and Yangming successively,
when the Taiyang disease is
gone, the patient has tidal fever, slight
perspiration over hands and feet, constipation and delirium. A
dose of purgative, Da Chengqi Tang
/Major Bowels 每purging Decoction can be adopted to eliminate the syndrome.
Notes:
Tidal fever is a characteristic fever type
of Yangming-fu-syndrome.
A slight perspiration over hands and feet is caused by evaporation of
excessive stomach heat. Constipation is a sign of formation of stercoroma.
Delirium results from excess heat misting mind.
Clause 212:
Febrile disease is not gone after adoption of an emetic or a purgative.
There is no stool for 5- 6 days, or even
more than 10days, with tide
fever in the afternoon but no chill. The patient speaks to
himself as if he sees the ghost. In serious case, the patient becomes
unconscious to people around him
and subconsciously touch-ups his clothes and bed .He is in terror, also has
a slight dyspnea and staring eyesight. A
tight pulse will indicate a curable case, while a hesitant pulse
is the sign of a fatal case. In a less
serious with only fever delirium,
Da Chengqi Tang/ Major
Bowels-purging Decoction can be adopted as a curative. If the first dose
induces defecation, stop taking the rest of the decoction.
Notes: This is
a severe case of
Yangming-fu-syndrome
and its prognosis, manifested as:
1)
Serious constipation for 5-6days, or
even more than 10days;
2)
Tide fever in afternoon;
3)
Delirium and coma , marked by speaking
to himself as if sees the ghost, unconscious of people around him and
subconscious hand movements touching his clothes and bed;
4)
Starting eyesight (light reaction
disappearance);
5)
A slight dyspnea (short breath).
Clause 241:
After the adoption of a drastic purgative, the patient has no stool for 6- 7
days, restlessness, and abdominal distension and pain. It can be diagnosed
that there must be stercoroma which was caused by indigestion .Da
Chengqi Tang / Major Bowels-purging Decoction is a remedy.
Notes:
1)
After the adoption of a drastic
purgative, the syndrome should have been eliminated. But if the patient has
no stool for 6-7 days, and has restlessness, abdominal distension and pain.
This is due to the intermingling of remaining pathogenic heat and
indigestion.
2)
In
Shanghan Lun, there are other
Clauses 208,209,212,215,217, 220,238, 239,240,242,251, 252, 253, 254, 255,
256,321,322 on Da Chengqi Tang/
Major Bowels-purging Decoction; and also be seen in
Jin Kui Yao Lue in Chapter 2,
Chapter 10 (with 4 clauses), Chapter 10(with 2 clauses), Chapter 17 (with 4
clauses), Chapter 21 (with 2 clauses) on
Da Chengqi Tang/ Major
Bowels-purging Decoction.
Modern clinical application
1)
We often use
Da Chengqi Tang / Major
Bowels-purging Decoction for
febrile diseases marked by
excessive-heat syndrome of Yangming-fu
organ, manifested as constipation,
frequent wind through the anus, feeling a
fullness in the abdomen, abdominal pain with tenderness and guarding, tidal
fever, delirium, polyhidrosis (sweat) of hands and feet, prickled
tongue with yellow dry fur, or dry black tongue coating with fissures, deep
and forceful pulse.
2)
It can also be used for the cases with
syndrome of fecal impaction due to heat with water discharge, manifested as
watery discharge of terribly foul odour
accompanied by abdominal distension and pain with tenderness and guarding,
dry mouth and tongue, smooth and forceful pulse.
3)
The recipe can be modified to deal
with infectious or non-infectious febrile diseases in their climax marked by
accumulation of heat type, and in the treatment of paralytic and simple
intestinal obstruction.
4)
Some doctors introduced to apply
Da Chengqi Tang/ Major
Bowels-purging Decoction for the treatment of
coma due to cerebral bleeding.
They believed that Da Chengqi Tang/
Major Bowels-purging Decoction has the function to
bring blood downward, namely from the brain
down to the lower part of the body.
On all the above, you will
see ※New Research in Classical Prescriptions of TCM§.
Modern research
1)
Modern researches have ascertained
that this recipe has the functions of relieving inflammation, resisting
bacteria, promoting blood circulation of intestine, stimulating intestinal
peristalsis, purging stool, tranquilizing the mind, bring down fever, etc.
See the book, ※A Practical English-Chinese Library of TCM§.
2)
According to an animal test,
Da Chengqi Tang
/Major Bowels-purging Decoction can
directly acts on the smooth muscle of the intestine to relieve constipation.
See the book, ※Research in Classical Prescriptions of TCM§.
3)
Da Chengqi
Tang/ Major Bowels-purging Decoction
has been shown, in tests, to
can help the intestine of rabbits with
introsusception to return normal. See the book, ※Research in
Classical Prescriptions of TCM§.
(2)
Shaoyang
(Lesser yang) Disease: That is a special stage
and condition during febrile diseases, namely, half outside, half inside,
half excess and half deficiency, manifested as alternating chills and fever,
chest and costal discomfort, reluctant to speak and eat, restless and
nausea, its therapeutic principle: harmonizing; chief recipe is
Xiao Caihu Tang/ Minor Bupleurum
Decoction.
Chief Recipe in
Shaoyang Disease
Xiao Caihu
Tang/
Minor Bupleurum Decoction
Ingredients:
Caihu/
Bupleurum root/ Radix Bupleuri, half jin/15g
Huangqin/
Scutellaria root /Radix Scutellariae, 3Liang/9
g
Renshen/
Ginseng/Radix Ginseng, 3 Liang/9g
Banxia/Pinellia
tuber/ Rhizoma Pinelliae, half Sheng/9g
Zhigancao/
Prepared licorice root / Radix Glycyrrhizae Praeparatae 3
Liang/9g
Shengjiang/
Fresh ginger/ Rhizoma Zingiberis Recens, 3
Liang/9g
Dazao/Chinese
dates/Fructus Ziziphi Jujubae, 12pcs/4 pcs.
Administration: According to
our experience, we can decoct all the above herbs in water in the pot over a
fire for 25-30 minutes; and then get the decoction for oral use. Drink its ½
or 1/3 of the decoction, 2 or 3 times a day.
Actions: Harmonizing the
Shaoyang.
