Reach the Membrane Source Decoction

[Guest guest]

All,

Has anyone out there ever used Da Yuan Yin/Reach the Membrane Source Decoction for anything? As I browse through the Formulas that Harmonize chapter of Bensky/Barolet, I keep stumbling over this one and wondering at it. No one in my school ever talked about it. The membrane source is said to refer to the membrane found between the viscera and the wall of the trunk and is believed by some to be the greater omentum and by others to be the pleura and peritoneum. The formula is a Wen Bing/Warm Febrile School formula and is for half-exterior, half-interior lodging of an epidemic pathogenic influence.

 

I have a particularly difficult fibromyalgia patient who has both intestinal complaints and upper back, neck and shoulder pain which may track the Large Intestine main channel where it goes to Du-14, St-12 and such, as well as LI-14. When the intestine gets better, the upper body gets worse and vice versa. I wonder if this formula might not be a potential template for a lot of fibromyalgia cases, particularly this one. Can anyone shed any light on this formula for me? Page 143 of Bensky/Barolet.

Joseph Garner

[Guest guest]

I have known some herbalists who do use it for fibromyalgia or other "latent pathogenic diseases". Their theory is that it can help the cells excrete toxic materials. This is a theory that has been construed from that of the membrane source idea. They will use tonic herbs to "add flavor" (jia wei) to the formula. I can't comment on the efficacy nor the "rightness" of the theoretical principle. However, they do use it often.

GZ

acugrpaz wrote:

All,Has anyone out there ever used Da Yuan Yin/Reach the Membrane Source Decoction for anything? As I browse through the Formulas that Harmonize chapter of Bensky/Barolet, I keep stumbling over this one and wondering at it. No one in my school ever talked about it. The membrane source is said to refer to the membrane found between the viscera and the wall of the trunk and is believed by some to be the greater omentum and by others to be the pleura and peritoneum. The formula is a Wen Bing/Warm Febrile School formula and is for half-exterior, half-interior lodging of an epidemic pathogenic influence.I have a particularly difficult fibromyalgia patient who has both intestinal complaints and upper back, neck and shoulder pain which may track the Large Intestine main channel where it goes to Du-14, St-12 and such, as well as LI-14. When the intestine gets better, the upper body gets worse and vice versa. I wonder if this formula might not be a potential template for a lot of fibromyalgia cases, particularly this one. Can anyone shed any light on this formula for me? Page 143 of Bensky/Barolet.Joseph Garner Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

, acugrpaz@a... wrote:

 

>

> I have a particularly difficult fibromyalgia patient who has both intestinal

> complaints and upper back, neck and shoulder pain which may track the

Large

> Intestine main channel where it goes to Du-14, St-12 and such, as well as

> LI-14.

 

Joe

 

How have you treated this patient. what is the CM dx? I find that fibro

patients

often respond better to liver spleen harmonizing than bi syndrome treatments,

for example. I do not find that dispel wind damp herbs work well for these

patients, though warm interiro may help in some cases. Herbs like dang gui

and ji xue teng (make sure you get millettia and not the substitute) are also

better than strong blood moving in most cases I have seen.

 

[Guest guest]

fibro patients

> often respond better to liver spleen harmonizing than bi syndrome

treatments

 

My experience too. In addition, it is a well known clinical fact that

many patients with FMS are also diagnosed with IBS.

 

Bob

[Guest guest]

fibro patients > often respond better to liver spleen harmonizing than bi syndrome treatments>>>Not my experience but then again one really needs to better categories what one calls fibro patients. I see many many patients that were told they have it and definitely do not.

alon

[Guest guest]

Bob -

 

Patients with fibromyalgia also frequently have correlated hypotension and sleep disorders. Shen ling bai zhu san is particularly useful for moving fluid from the interstices into the vessels, thereby increasing blood pressure and circulating blood volume - provided the pattern differentiation is correct. As far as sleep disorders, consider disregulation of wei qi circulation in the night (controlling cycle) if the sleep is up and down, up and down. Consider disruption of ying/rong qi if it is disturbed for extended blocks of time (the pulse that reveals the organ where the qi is stagnant will assist in identifying which qi regulator to use). See AT for more information: http://www.acupuncturetoday.com/archives2002/may/05morris.html

Will Morris

 

> often respond better to liver spleen harmonizing than bi syndrome treatments

 

My experience too. In addition, it is a well known clinical fact that many patients with FMS are also diagnosed with IBS.

[Guest guest]

Alon - your comments concur with my experience...another pattern is blood stasis as a result of traumatic events - emotional or physical. I had one patient who collapsed while doing marathon in summer heat - he had chronic fatigue and fibromyalgia for four years prior to coming to my office. I prescribed modified Qing Shu Yi Qi Tang in various forms for a period of eight months with complete recovery (I think this captures some of the patterns you describe with a different etiology).

Will

 

Patients that relay a history of viral infection at onset often have significant damp-heat or dampness alone. When trauma is a cause then often there is liver, kidney, spleen and blood stasis dampness syndromes. Patients in which depression is a factor often have liver spleen patterns. Patients with neuraly mediated hypotension often do well with kidney yang treatments, razing clear yang, gan cao and salt. There is a fair amount of patients with primary sleep problems that do not fit many the usual TCM syndromes. Also many just have MPS (even though they have been given the dx of fibro) which is somewhat generalized and can be easily cured if the primary musculoskeletal problem is taken care of.

[Guest guest]

, acugrpaz@a... wrote:

 

>

> I have a particularly difficult fibromyalgia patient who has both intestinal

> complaints and upper back, neck and shoulder pain which may track the

Large

> Intestine main channel where it goes to Du-14, St-12 and such, as well as

> LI-14.

 

>>>Joe

 

How have you treated this patient.  what is the CM dx?  I find that fibro patients

often respond better to liver spleen harmonizing than bi syndrome treatments,

for example.  I do not find that dispel wind damp herbs work well for these

patients, though warm interiro may help in some cases.  Herbs like dang gui

and ji xue teng (make sure you get millettia and not the substitute) are also

better than strong blood moving in most cases I have seen.

<<<

et al.,

Thank you all for your enlightening comments regarding this topic. I diagnosed this 60-year-old female patient with Damp Heat in the Muscle Level following from Damp Heat Simultaneously in Shaoyang/Yangming, Heat in the Liver/GB/Heart, Stomach Yin Xu, Qi and Blood Xu, and Blood Stasis and Phlegm in the Network Vessels. Her tongue is somewhat flabby and slightly pale, with truncated (scrunched), reddish sides and tip, a moderately large crevasse in the center, and a moderate amount of dark blue veininess underneath. Her pulse is soggy and has alternated between rapid for long periods and lately is about 64bpm. She has pain in her left neck and shoulder area as well as occasional low back pain, intestinal pain, occasional heart pain/constriction, difficulty sleeping at night (off and on) and intense sleepiness during the day, and whenever she eats, her nose runs with profuse clear fluid. Her pain and fatigue worsen dramatically with relatively slight exertion or positional muscle fatigue such as sitting at a computer.

 

Acupuncture helps her pain symptoms a great deal for a few days, but then she falls back into her round of symptoms, and I have not been able to do much for her sleepiness. She is very herbally delicate in that she can't stand a high dose of anything, and although she has responded well temporarily to a number of formulas in the past, she always has had side effects and no long-term relief. I have used formulas I thought fit her situation, but I must say that I have always included bi syndrome herbs somewhere in the formula, and, as several of you have pointed out, this doesn't seem to work.

 

Looking over Reach the Membrane Source Decoction/Da Yuan Yin, Master Li's Decoction to Clear Summerheat and Augment the Qi/Li Shi Qing Shu Yi Qi Tang (which seems more for her than Qing Shu Yi Qi Tang) and Major Bupleurum Decoction/Da Chai Hu Tang, as well as Seven-Substance Decoction with Magnolia Bark/Hou Po Qi Wei Tang, a variation on Da Chai Hu Tang, and considering your comments, I have written up the following formula:

 

Cao Guo 1.5

Hou Po 3

Bing Lang 3

Huang Lian 1.5

Huang Qin 3

Zhi Mu 3

Bai Shao 3

Gan Cao 1.5

Huang Qi 3

Xi Yang Shen 3

Gui Zhi 1

Dang Gui 1

Sheng Ma 3

Shen Qu 1.5

Chai Hu 3

Ji Xue Teng 3

 

Comments?

Joseph Garner

[Guest guest]

Patients with fibromyalgia also frequently have correlated hypotension and sleep disorders. Shen ling bai zhu san is particularly useful for moving fluid from the interstices into the vessels, thereby increasing blood pressure and circulating blood volume - provided the pattern differentiation is correct. As far as sleep disorders, consider disregulation of wei qi circulation in the night (controlling cycle) if the sleep is up and down, up and down. Consider disruption of ying/rong qi if it is disturbed for extended blocks of time (the pulse that reveals the organ where the qi is stagnant will assist in identifying which qi regulator to use).

>>>>>I think there is a basic difference depending on the precipitating cause of the fibromyalgia. Only a small % is primary disease and that is highly questionable. Patients that relay a history of viral infection at onset often have significant damp-heat or dampness alone. When trauma is a cause then often there is liver, kidney, spleen and blood stasis dampness syndromes. Patients in which depression is a factor often have liver spleen patterns. Patients with neuraly mediated hypotension often do well with kidney yang treatments, razing clear yang, gan cao and salt.

There is a fair amount of patients with primary sleep problems that do not fit many the usual TCM syndromes.

Also many just have MPS (even though they have been given the dx of fibro) which is somewhat generalized and can be easily cured if the primary musculoskeletal problem is taken care of.

Alon

[Guest guest]

Similarly, I have used Qing shu yi qi tang w/ great success for several cases of lupus

Cara

 

 

Alon - your comments concur with my experience...another pattern is blood stasis as a result of traumatic events - emotional or physical. I had one patient who collapsed while doing marathon in summer heat - he had chronic fatigue and fibromyalgia for four years prior to coming to my office. I prescribed modified Qing Shu Yi Qi Tang in various forms for a period of eight months with complete recovery (I think this captures some of the patterns you describe with a different etiology).

 

Will

 

Patients that relay a history of viral infection at onset often have significant damp-heat or dampness alone. When trauma is a cause then often there is liver, kidney, spleen and blood stasis dampness syndromes. Patients in which depression is a factor often have liver spleen patterns. Patients with neuraly mediated hypotension often do well with kidney yang treatments, razing clear yang, gan cao and salt.

There is a fair amount of patients with primary sleep problems that do not fit many the usual TCM syndromes.

Also many just have MPS (even though they have been given the dx of fibro) which is somewhat generalized and can be easily cured if the primary musculoskeletal problem is taken care of.

 

 

 

 

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

> fibro patients

> > often respond better to liver spleen harmonizing than bi syndrome

> treatments

> >>>Not my experience but then again one really needs to better categories

what one calls fibro patients. I see many many patients that were told they

have it and definitely do not.

> alon

 

do you find they respond to bi syndrome HERBAL treatments?

 

I note flaws modern western diseases also considers LV/SP the main patern

in this condition. I discovered this because bi syndrome treatments, which I

have great success with in RA, OA, plantar fascitis, never worked for patients

who claimed fibro dx. however you are right that in some or even most cases,

it may have been a self dx or wrong dx. pointis the bi syndrome tx didn't work

and the lv/sp did. Are you suggesting maybe my pt. were just depressed and

didn't have fibro but just somaticized, I can buy that.

 

It raises two issues:

 

unless we have a solid diagnosis, we shouldn't claim to treat anything but

what we are sure of. so my patients all had musculoskeletal pain, but no

signs of wind damp and plenty of signs of liver constraint and blood xu.

 

Is fibro really a distinct disease from depression? I think recent evidence

shows with PET scans that fibro patients have different brain changes than

those who are depressed. However it appears to be a brain disease, not a

local muscle or joint disease.

 

[Guest guest]

, acugrpaz@a... wrote:

> , acugrpaz@a... wrote:

I

> diagnosed this 60-year-old female patient with Damp Heat in the Muscle

Level

> following from Damp Heat Simultaneously in Shaoyang/Yangming,

 

could you explain how you arrived at this portion of your dx?

[Guest guest]

do you find they respond to bi syndrome HERBAL treatments?>>>No i do not. And as i said they have several syndromes. However, I do not find xiao yao san variation to be helpful very often.

 

Is fibro really a distinct disease from depression?

>>>No they are different. It is probably one of many conditions that relate to disautonmia, irritable bowl being another. although depression is quite common in these patients and many respond to low dose anti-depressants. There are many differences in pat, functional mri, hormonal functions, etc. FM patients for example have high levels of substance P.

Alon

[Guest guest]

She has pain in her left neck and shoulder area as well as occasional low back pain,

>>>This does not sound like fibromyalgia

Alon

[Guest guest]

She has pain in her left neck and shoulder area as well as occasional low back pain, intestinal pain, occasional heart pain/constriction, difficulty sleeping at night (off and on) and intense sleepiness during the day, and whenever she eats, her nose runs with profuse clear fluid. Her pain and fatigue worsen dramatically with relatively slight exertion or positional muscle fatigue such as sitting at a computer

 

>>>Does she have any signs of Yang-def cold in her body and tissues? does she have moons on finger nails?

If you see evidence of yang-def cold in these, i have found that warming and tonifying yang often take care of the Heat symptoms and signs in similar patients.

Alon

[Guest guest]

Is fibro really a distinct disease from depression? I think recent evidence shows with PET scans that fibro patients have different brain changes than those who are depressed. However it appears to be a brain disease, not a local muscle or joint disease.Todd

 

I'm enjoying this discussion of fibromyalgia (myofascial pain syndrome) very much. your view is close to the diagnostic manual, page 481 of the current ed. "No specific histologic abnormality is present, and the absence of cellular inflammation ... may be induced or intensified by physical or mental stress, poor sleep, trauma, or exposure to dampness or cold ..." There is much discussion of ongoing environmental and emotional stresses as etiological factors. Also much is said of restorative sleep, stretching and verbal reassurance as items which bring about relief. I'm enjoying Cara Frank's and Alon's input as well.

Emmanuel Segmen

[Guest guest]

Alon,

My patient has displayed yang xu signs/symptoms. When I first saw her I initially treated her severe heat symptoms with cooling methods, which made her worse. I thought then that I had her pegged as a chronic case that had advanced into yang xu. I treated her with moxa and warming herbs, and she got worse again.

Joseph

[Guest guest]

I treated her with moxa and warming herbs, and she got worse again.>>>What formula

Alon