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.
﹛
