Discussion on Syndromes of Bentun & Zangzao

 Lecturing Date: 26/11/07

Time: 9.30am-11.30am

Address: Class Room P 7, the Middlesex University Enfield Campus

As I mentioned in the last lecture on Shanghan Lun, Jin Kui Yao Lue, often translating into “Synopsis of Prescriptions of the Golden Chamber” in English, or “Synopsis of the Golden Chamber” for short, is another part of Shanghan Za Bing Lun mostly translated “Treatise on Febrile and Miscellaneous Diseases”, written by the outstanding physician Zhang Zhongjing (Zhang Ji) in the East Han Dynasty.

It is worth knowing that one of  the Jin Kui Yao Lue’ s contributions to TCM  is that it developed the aetiology of Huangdi Neijing (“Yellow Emperor ‘s Canon of Internal Medicine”). Dr. Zhang Zhongjing in the Jin Kui Yao Lue proposed that ‘it is almost always due to the 3 causes that people perish from various diseases though there are hundreds of thousands of diseases’:

 (1) Internal factor: pathogens spread along the meridians to the Zang and Fu.

 (2) External factor: pathogens break through the surface of the skin and then invade the interior (eventually the pathogens cause blockage of the blood and qi in the 4 limbs and nine cavities).

(3) Non-internal-non-external factors: Sexual abuse, knife wounds, animal or insect bites.

 All diseases fall into one of these categories without exception.

 千般 疢难，不 越三条：一者，经络受邪， 入脏腑，为内所因也。二者，四肢 九窍，血脉相传，壅 塞不通，为外皮肤所伤也。三者，房室，金刃，虫兽所伤。以此详之，病由都尽。

 This theory has laid a preliminary foundation of TCM aetiology and influenced the later developments of aetiology and pathology of TCM.

The Jin Kui Yao Lue is divided into 25 chapters according to types of diseases, discussing characteristics of aetiology, pathology, diagnosis and treatments of more than 40 kinds of diseases. It also deals with 262 prescriptions and methods for differentiating diseases according to pathological changes of Zang and Fu and their interrelations. Because of time limits, today we just discuss Chapter 8 & some clauses in Chapter 22 of Jin Kui Yao Lue.

     2. Chapter 8 on Pulse, Symptoms and Treatment of Bentun Syndrome

         奔豚气病脉证 治第八

 Section One: The Cause of Bentun

 The original text of Jin Kui Yao Lue

Clause 8-1: The master said, “There are four kinds of diseases, namely Bentun, Vomiting of pus, Panic, and Fire-pathogen syndrome, all of the above are caused by fright.

师曰：病 有奔豚，有 吐 脓，有惊 怖，有火邪，皆 从惊发 得之。

Notes:

 1.     Bentun, or called Bentunqi: In Chinese, “Ben”, means running; “tun, means pig; “qi” means gas.  The Bentun is the syndrome characterized by a feeling of gas rushing up through the thorax to the throat from the lower abdomen. At the onset, pain may be also felt in the lower abdomen suggesting the presence of compressed gas. The patient then feels the gas ascending to the chest and finally to the throat. Some patient may experience great pain. After 2 minutes-2 hours or even more, the syndrome diminishes and finally subsides, however it may reoccur again in future.

The original text of Jin Kui Yao Lue:

Clause 8-2: The master said, “Bentun syndrome starts from the lower abdomen, and rushes upward the chest and throat. The attack is very serious, and causes the patient unbearable suffering with a feeling that she might die. Fortunately, the symptoms will gradually reduce and subside. The cause of this syndrome is due to fright and terror”.

师曰：奔豚病从少腹起，上从胸咽，发作欲死，复还止，皆从惊恐得之。

Notes

The original texts of Jin Kui Yao Lue:

The Bentun syndrome, manifests as a feeling of qi –rushing toward to the chest, abdominal pain, alternating chills and fever, and should be chiefly treated by Bentun Tang/Decoction for Bentun syndrome.

奔豚气上冲胸，腹痛，往来寒热，奔豚汤主之。

Bentun Tang/Decoction for Bentun

     奔豚汤方：

     Ingredients:

干草Gancao/Radix Glycyrrhizae 2 Liang/6 g

川芎Xiongqiong/Chuangxiong /Rhizoma Ligustici Chuangxiong2 Liang/9g

当归Danggui/ Radix Angelicae Sinensis 2 Liang/9g

半夏Banxia / Rhizoma Pinelliae 4 Liang/12g

黄芩Huangqin /Radix Scutellariae 2 Liang/9g

葛根Shengge/ Gegen/ Radix Puerariae 5 Liang/15g

     芍药Shaoyao/ Radix Paeoniae 2 Liang/ 9g

生姜Shengjiang/ Rhizoma Zingiberis Recent 4 Liang/12g

甘李根白皮Ganligenbaipi / Cortex Prunus Armeniacae 1 Sheng/9g

Note: Today’s dosages of the recipes 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: All the 9 herbs should be decocted in water about 2 Dou (4,000ml) in the pot, until reduced to 5 Sheng (1,000ml). Filter the decoction for oral use, drink 1 Sheng (200ml) each time, 3 times a day, and also drink once at night.  

上九味，以水两斗，煮取五升，温服一 升，日三服，夜一服.

Actions: Nourishing blood and calming the liver, regulating the stomach and descending   qi.

 Explanation: 

 This recipe is mostly effective for the Bentun syndrome caused by          pathogenic fire which originates with an abnormal accumulation of the liver-qi.

In the recipe, 甘李根白皮/Gan ligenbaipi, another name “李根白皮/ Ligenpi” /Cortex Prunus Armeniacae is a special herb for Bentun syndrome. Other herbs, 葛根Gegen/Radix Puerariae and 黄芩/Huangqin/ Radix Scutellariae clear away fire and calm the liver; 芍 药/Shaoyao/ Radix Paeoniae and 甘草 / Gancao can relieve pain and other symptoms of Bentun syndrome; 生姜/Shengjiang /Rhizoma Zingiberis Recens, 半 夏 /Banxia /Rhizoma Pinelliae as well as 甘李根白皮/ Ganligenbaipi /Cortex Prunus Armeniacae can regulate the stomach and reverse the abnormal ascending qi. 当归/Danggui /Radix Angelicae Sinensis and 川芎/Chuanxiong / Rhizoma Ligustici Chuanxiong can nourish blood and regulate the liver-qi. All herbs work together to form a compound recipe for the Bentun syndrome due to the stagnation of the liver-qi.

 Clinical application and case studies:

The original text of Jin Kui Yao Lue:

After adopting a diaphoretic, warming needle was used for further perspiration. If locus of puncture hole is left unprotected and comes into contact with cold, it will turn red and swell.  An impulsive feeling will rise from the lower abdomen to the chest resulting in a Bentun syndrome. The treatment of this condition should be to apply a moxibustion cone on each locus and Guizhi Plus Guizhi Tang/Decoction of Cinnamon Twig Plus Cinnamon Twig will be given.

发汗后，烧针令其汗，针处 被寒， 核起 而赤者，必发奔豚，气 从少腹上至 心，灸 其 核上 各一 壮，与桂枝加桂枝汤主之。

Note: This clause also appears in Clause 117 of Shanghan Lun.

Recipe: Guizhi Plus Guizhi Tang/Decoction of Cinnamon Twig Plus Cinnamon Twig

     桂枝加桂枝汤 方

     Ingredients:

桂枝 /Guizhi/ Ramulus Cinnamomi 5 Liang/15g

芍药/ Shaoyao / Radix Paeoniae 3 Liang/9g

甘草/ Zhigancao/ Radix Glycyrrhizae Praeparatae 2 Liang/6g

生姜/ Shengjiang /Rhizoma Zingiberis Recens 3 Liang /9g

大枣/ Dazao/  Fructus Ziziphi Jujubae 12 Pcs

Administration: Decoct the above 5 herbs in 7 Sheng (1,400ml) of water on a slow fire until 3 Sheng (600 ml) remains; discard the dregs. One Sheng (200 ml) is taken orally when it is warm.

上五 味 ， 以 水7 升，微火 煮 取3 升， 去渣， 温服一升。

 Actions: Warming yang and reversing the adverse ascending qi.

Explanation: 桂枝Guizhi / Ramulus Cinnamomi has the function of dispersing the cold and reversing the adverse ascent gas. 白芍/Baishao / Radix Paeoniae can ease abdominal pain. 生姜/Shengjiang/ Rhizoma Zingiberis Recens and 大枣Dazao/Fructus Ziziphi Jujubae can regulate the stomach and reverse the adverse ascending qi. 炙甘草Zhigancao/ Radix Glycyrrhizae Praeparatae can coordinate all the ingredients in the recipe. This recipe can be used for treatment of Bentun syndrome of cold type, whether or not it is induced by use of warming the needle.

Section 5：Symptoms and treatment of coming Bentun syndrome due to Water-retention

The original text of Jin Kui Yao Lue

After adopting a diaphoretic, a jumping feeling or palpitation, resembling a baby pig running, is sensed below the umbilicus. This can be diagnosed as the coming Bentun syndrome. The Fuling, Guizhi, Gancao, and Dazao Tang / Decoction of Poria, Cinnamon Twig, Licorice and Chinese Dates can be chosen.

发汗后，脐下 悸 者， 欲作奔豚，茯苓桂枝  甘草大枣汤主之。

Note: The above clause also appears in Clause 65 of Shanghan Lun.

Recipe: Fuling Guizhi Gancao and Dazao Tang/ Decoction of Poria, Cinnamon Twig, Licorice and Chinese Dates

茯苓桂枝甘草大枣汤方

Actions: Warming yang and reversing the adverse ascending qi, and promoting the circulation of qi to remove the water out from the body.

Ingredients:

茯苓 Fuling /Poria ,half Jin/15g

甘草 Gancao/ Radix Glycyrrhizae Praeparatae 2 Liang/6g

大枣 Dazao/ Fructus Ziziphi Jujubae 15 Pcs

桂枝Guizhi/ Ramulus Cinnamomi 4 Liang /12g

Administration: Decoct Fuling /Poria in 10 Sheng (2,000ml) of Ganlanshui/aerated water until the volume is reduced by 2 Sheng (400ml) ; and then add the other ingredients and decoct them together until 3 Sheng(600ml) remains. Discard the dregs, one Sheng (200ml) warmed is taken orally each time, 3 times a day.

上四味，以甘兰水一斗，先煮茯苓，减二升，纳诸药，煮取三升，去渣，温服一升， 日三服。

Note:

Ganlanshui/ aerated water: Place 2 Dou (2,000ml) of water in a basin. With a spoon, drip the water repeatedly into the basin until it appears that 5,000-6,000 drops of dew are moving on the surface, this is the Ganlanshui/ aerated water.

Explanation: This recipe is for the coming Bentun syndrome due to water-retention.

The mechanism of the syndrome is as follow: When a diaphoretic is adopted for a patient with water-retention at the lower portion of the body cavity, the heart-yang is damaged and becomes too deficient to control the water circulation. As result, the retention water starts to move in the interior, which can be felt a jumping or palpitation taking place below the umbilicus which is likely to ascend.

The above decoction is adopted to tonify the yang and promote water circulation. Thus the ascending tendency is eliminated.

Clinical application and case studies:

1.     Bentun syndrome: Dr Liu Deshan reported:- Ms Yu, 40 years old, and overweight. Her son had a criminal record which she dwells upon. This manifests as restlessness, poor appetite, and she has begun feeling gas from her lower abdomen rushing to her back, then abdomen and throat, 1-2 times a day. Each attack lasts 2 minutes at beginning; but increases to half an hour, and is also accompanied by pale face, cold limbs, no perspiration, white thin fur of the tongue, but the root is a bit greasy, vary and thready pulse . The Fuling Guizhi Gancao and Dazao Tang/ Decoction of Poria, Cinnamon Twig, Licorice and Chinese Dates plus Huanglian /Coptis Root 10g, Rougui / Cinnamon Bark 2g were given, after 3 doses, the patient felt better, but the problem still occurred from time to time. Juhe /Orange Kernel 6g and Xiangfu /Cyperus Tube 10g were then added to the above recipe, and she continued to take 2 doses. The patient subsequently recovered.

3. Chapter 22 On Pulse, Syndrome and Treatment of Miscellaneous Gynecological Diseases

                          妇人 杂病脉证并治第二十二

There are 22 Clauses in Chapter 22. We can only discuss some of them because of time restraints.

The original text of Jin Kui Yao Lue

Clause 22-1: A female with Zhongfeng for 7-8 days. Recently she has regularly experienced alternating attacks of chills and fever, interrupting her menses. This condition can be diagnosed as Re Ru Xue Shi (Heat invades Blood Cavity) which can lead to blood stasis and as a result produce malarial type symptoms. Xiao Chaihu Tang /Minor Bupleurum Decoction can be used for this case.

妇人中风7-8 日，续来寒热，发作有时，经水适断，此为热如血室， 其血必 结，故 使如 疟 状， 发作有时， 小柴胡汤主之。

Notes:

Xue Shi/ the Blood Cavity: In TCM theory, the concept of Xue Shi has several meanings.  These are summarised below:

 Clause 22-5: For a woman who feels as if a piece of broiled meat stuck in her throat, Banxia Houpu Tang /Decoction of Pinnellia Tube and Magnolia Bark can be used.

妇人咽中 如有炙肉，半夏厚朴汤主之。

 Notes:

In TCM today, we usually name the above syndrome as ‘Meihe Qi’ (Plum pit suffocation syndrome /Globus hystericus), a subjective sensation as if a plum pit is stuck in the throat or as if the throat is compressed.

Recipe: Banxia Houpu Tang/Decoction of Pinnellia Tube and Magnolia Bark

半夏厚朴汤

 Ingredients:

半夏Banxia/ Rhizoma Pinelliae 1 Sheng/ 9g

厚朴/Houpu / Cortex Magnoliae Officinalis 3 Liang9g

茯苓/Fuling / Poria 4 Liang12g

生姜Shengjiang/ Rhizoma Zingiberis Recens 5 Liang/9g

干苏叶Gansuye / Folium Perillae 2 Liang/6g

 Administration: Decoct the above 5 herbs in 7 Sheng (1,400ml) of water until 4 Sheng (800ml) remains.  Then divide the decoction into 4 portions. Drink warmed. Drink one portion each time, 3 times during the day; and also once at night.

上 五 味 ， 以水7 升， 煮取四升， 分温 四服， 日三， 夜一服。

Clinical application and case studies:

Ms. Zhang, 52, first treatment on April 10, 1963. The patient felt something stuck in her throat which was diagnosed as Meihe Qi/globus hystericus. She suffered from abdominal distension and had a feeling of gas rushing to the throat.  Constipation was also one of her symptoms and passing flatus made the patient feel better. The tongue was covered with thin and greasy fur and the Pulse was deep and tight.

The prescription：

Banxia/Rhizoma Pinelliae (prepared with ginger) 9 g

Chenpi/Fructus Aurantii Immaturus Praeparatae 9g

Chaolaifuzi/Semen Raphani Praeparatae 9g

Gualou/Fructus Trichosanthis 12g

Suzi/ Fructus Perillae 4.5g

Fuling/Poria 9g

Houpu/ Cortex Magnoliae Officinalis 3g

Gancao/Radix Glycyrrhizae 1.5g

2 doses of the above decoction were served. After 2 more doses, the patient called on April 12^th and 15^th and had a complete recovery.

Clause 22- 6: A women with Zang Zao (hysteria) tends to grieve and cry as if she were haunted. She frequently stretches and yawns repeatedly. Gan Mai Da Zao Tang / Decoction of Licorice, Wheat and Chinese Dates   can be used for this case.

妇人 脏躁， 喜悲伤 欲哭， 象如神灵所做，数欠伸， 甘麦大 枣汤主之。

Recipe: Gan Mai Dazao Tang/Decoction of Licorice, Wheat and Chinese Dates

Ingredients

甘草Gancao /Radix Glycyrrhizae 3 Liang/9g

浮小麦Fuxiaomai/ Fructus Tritici Levis 1 Sheng/30g

大枣Dazao/ Fructus Ziziphi Jujubae 10 Pcs

Decoct the above 3 herbs in 6 Sheng (1200ml) of water until 3 Sheng (600ml) remains. Then divide the decoction into 3 portions; one portion is taken orally when it is warm, 3 times a day. It can also tonify the spleen-qi.

上三味，以水6 升， 煮取三升，温分3服。 亦补脾气。

Notes:  This recipe is effective in treating syndrome of Zangzao (hysteria), which results from emotional depression and excessive worry. Symptoms and signs may include restless, irritability, insomnia and constipation. To strengthen the action of the recipe, we may add more herbs, such as Danggui/ Radix Angelicae Sinensis 12g, Baishao/ Radix Paeoniae Alba 15g, Fuling/Poria 9g, Suanzaoren/Semen Ziziphi Spinosae 15g, etc.

Clinical application and case studies:

Case 1, Hysteria mania:  Case Recorded in Journal of TCM, Vol .2 1960. The journal reported treatment of 25 cases of hysteria mania.

The recipe:

Fuxiaomai/Light Wheat/Fructus Tritici Levis,

Gancao/ Licorice/Radix Glycyrrhizae,

Dazao /Chinese Dates/ Fructus Ziziphi Jujubae.

The results were as follows:

Total 25 cases

22 cases were cured

2 cases had marked progress

1 case had improved

But 2 cases among them had a recurrence

Case 2 Hysteria: Case Recorded in Collection of Dr Yue Meizhong’s Case Studies. Dr Yue once treated a man of 30 in Heze County Hospital, Shandong Province, P.R.China. The patient suffered from a mental disorder and wept and laughed unreasonably. The Decoction Gan Mai Dazao Tang /Decoction of Licorice, Light Wheat and Chinese Dates was prescribed, Gancao / Radix Glycyrrhizae 9g, Fuxiaomai/ Fructus Tritici Levis 9 g, Dazao /Fructus Ziziphi Jujubae 6pcs. 7 doses of the decoction worked effectively. In the following 3 years, there was no recurrence.

Note:

Hysteria:  The term “hysteria” was first used in Greece in the 5^th century BC by Hippocratic doctors. They trying to explain an illness whose symptoms were breathing difficulties and sense of suffocation and whose suffers were seen chiefly to be recently bereaved widows. The explanation was thought to be a wandering womb putting pressure on other organs.

Modern research:

Japanese Dr 保田和美 (Yasuda Kazumi) said the decoction of this recipe has the function to extend the mouse’s sleeping time and also reduce its activities after feeding the decoction for 3-4 days. See the book, Research in Classical Prescriptions of TCM.

 Appendix:

 Converting the Dosage in the Eastern Han Dynasty

1. The above converting table is elected from the book “Research in Classical    Prescriptions of TCM” by Prof Engin CAN/Enqin Zhang, published by Yellow River Press in 1989).

2. In the East Han Dynasty, the weights and measures for herbal medicine in the terms of “zhu”, “liang” and “jin” are accounted as half of the official measurements at the time.

3. Commonly used and Simplified Convertion:

 1 Liang in the Han Dynasty=1 Qian/ 3g Today

4.About author-Prof. Enqin Zhang (Engin CAN): Prof. Enqin Zhang (Engin CAN) graduated from Shandong University of Traditional Chinese Medicine (TCM) in 1982 with post-graduate dip., Master of Medicine and later also  got his MD and Professorship from 4 international and Chinese universities and institutes. He was the chief editor& author of Book “Research in Classical Prescriptions of TCM”, published by Yellow River Press in July, 1989 as well as TCM series ‘A Practical English-Chinese Library of TCM’, composed of 14 books, the first English-Chinese TCM textbooks in the world, published by Shanghai TCM University Press in 1990, has been distributed to more than 66 countries. Now he is lecturing and practicing at the Asante Academy of Chinese Medicine for Middlesex University, London, UK; He also acts an academic advisor to Huaihua Red Cross Hospital as well as the professor (specially invited) of Huaihua Medical College, Laiyang TCM College and other international alternative medicine universities. He is very good at treating headache/migraine, obesity, insomnia, stress, poor memory, neck or back pains/cervical spondylopathy, lumbar spondylopathy, osteoarthritis, cough/bronchitis, asthma, stomach problems/gastritis, ulcer, irregular menstruation, menoxenia, dysmenorrhea, leukorrhagia, hypogalactia, urinary infection, enuresis, hair loss, quit smoking, and cancer patient’s support as well as  many difficult conditions. His today’s working address: The Asante Academy of Chinese Medicine, Clerkenwell Building, The Middlesex University Archway Campus, 2-10 Highgate Hill, London, N19 5LW.E-amil:prof.engincan@yahoo.com.tr For information, please check Google-the key word: Dr Enqin Zhang (Engin CAN) ;Or ring on 078 0470 9475(Available only on Saturday at any time)

 References