SHL lines 1-3

[Guest guest]

Z'ev told me I should wait till later in the month and repost the

invitation to join the SHL study group. It looks like all the vacationers

are back online now. So, as promised, here are the postponed shang han lun

threads.

 

Dear Members

 

I have been wanting to use CHA for more structured threads for some time.

CHA was founded to talk about Chinese Herbology. Turns out there are

quite a few political and academic issues to wrestle with, which will go

on for some time. My personal nature is mainly journalistic and editorial.

I believe journalism was the first profession that interested me. Thus CHA

has been loaded with news and politics and science and philosophy and

" theory " , all of which I relish. It has been largely unstructured in that

posters typically do not have a planned

series of messages. This makes that aspect of the list more like

conversation. Though the " conversation " can become eloquent or passionate

or verbose or sophisticated at time, the goal of posting is typically not

thought of in terms of outcomes.

 

However, the nice thing about cyberspace is that multiple interactions

can go on simultaneously without interfering with one another. Some can

be conversational. Others can be structured, such as CHA's online classes.

I was hoping some of you out there might be interested in trying an

experiment. We could go through Mitchell's translation of the Shang Han

Lun clause by clause. If any of you have not yet seen this translation,

it organized by diseases such as taiyang disease. Much as the zhen jiu jia

yi jing organized the nei jing by topic, this text pulls together all the

clauses

in the SHL in a similar fashion. It also includes extensive commentary.

The

chinese text, pinyin and wiseman translation are all present, so it forms

an ideal language learning tool for those who have studied grammar and

character construction already. My idea is to post a clause and discuss

it from whatever perspective commentators think relevant, whether it be

the etymology and meaning of particular characters or the practical

application of this material in their clinic.

 

Before beginning I note that in the intro to the book, it is pointed out

that nowhere in the original text is the word stage used to describe the

six diseases. While there are certainly clauses that talk of one disease

transforming into another, the detailed idea of the progression through

the six stages is based largely upon commentary. Thus there are differing

opinion as to the " correct " order of the stages, if there is one and to the

applicability of this model to the progression of illness, whether it be

chronic or acute. I hope we will hear from all sides of the issue.

 

The first clause says,

 

In disease of the greater yang, the pulse is floating, the head and nape

are stiff and painful, and there is aversion to cold

 

What occurs to me here are:

 

1. the primacy of the floating pulse; in contrast, clause 2 on wind

strike and clause 3 on cold damage list the pulses last. In addition,

floating is listed as a general and also " most important? " feature of

taiyang in clause 1. floating is not restated in clause 2 or 3, yet

floating is implied in those clauses. This is considered to be the nature

of the SHL. terse and nonrepetitive.

 

2. the absence of heat effusion as a defining feature of taiyang. in

fact heat effusion is a defining feature of wind strike as noted in clause

2, but not in cold damage as noted in clause 3. so the classic does not

require fever to be present to make the dx. On the other hand, as we will

see, high palpable fever can still be part of taiyang as well.

 

3. the commentary is that aversion to cold does not require an external

source of cold, but rather refers to a feeling of cold that cannot be

diminished by covering up. the translators admit however that this point

is not always clear in the SHL literature.

 

It makes sense to consider line 2 and 3 at this point since what they say

bears

on the discussion of line 1

 

From Mitchell and Wiseman:

 

Line 2:

 

when in greater yang disease there is heat effusion, sweating, aversion to

wind

and a pulse that is moderate, it is called wind strike

 

Line 3:

 

greater yang disease, whether heat has effused or not, as long as there is

aversion to cold, with generalized pain, retching counterflow and yin and

yang

pulses both tight, is called cold damage

 

Of particular interest here is:

 

1. the retching counterflow in clause 3, a symptom I rarely hear discussed

in clinic. Also note the absence of respiratory symptoms in lines 1-3.

 

2. that heat effusion is the primary symptom listed for wind strike.

According to

Mitchell, this refers to palpable heat, not just subjective sensation. I

find

it interesting because the more excess pattern of cold damage does not

require

heat at the outset. Mitchell says this is because the extreme cold has

blocked

any escape of heat.

 

It seems important to understand here that there is a distinction between

" taiyang cold damage " in general and the ephedra decoction pattern for cold

damage. This pattern, first described in line 35 does indicate ma huang

tang for taiyang disease with heat effusion and panting (a respiratory

symptom), though notably not for cough or sinus congestion. It is xiao

qing long tang that is indicated when cough and phlegm present. Since I

had to jump ahead to ephedra decoction patterns in order to understand this

passage, I have to comment on two other things here.

 

a) the discussion of spontaneous bleeding in exterior resolution in

lines 46-48. This speaks to an issue that has been raised by some that the

SHL was clearly not about the common cold, but something much more serious

(it killed 2/3 of ZZJ's family). Thus the application of SHL to the common

cold is perhaps no more of a stretch than its application to HIV.

 

b) a taiyang disease of up to ten days may still require ma huang

tang. This stated in line 37 and the commentary goes further, suggesting

that if the pulse floats and other taiyang symptoms present, one may use ma

haung tang " no matter how long the disease has lasted " . the most liberal

interpretation of this commentary I have seen applied by Ma shou chun,

Heiner Fruehauf and Dan Bensky. In other words, using ma huang tang even

years after the onset of symptoms.

 

3. the aversion to wind specifically refers to an external source of draft.

It does not linger after the cessation of a draft, while the cold of cold

damage

is not necessarily related to an external source of cold. This appears to

be an

important diagnostic distinction, which should be easily discerned upon

careful

questioning

 

 

Question: Does ZZJ list the symptoms in his clauses in order of most

important?

 

Re: Sweating digression

 

According to Dan Bensky at PCOM a few years back, one can use modified gui

zhi tang for hot, sweaty patients who present with signs of cold vacuity.

 

How would one go about distinguishing whether to use something like bu

zhong yi tang in a patient who sweats easily versus gui zhi tang. Both

patients would be deficient in presentation, yet exhibiting feverishness.

The SHL gives

no tongue signs but I note that the pulse of the gui zhi tang clause is

quite

different that given for BZYQT. I believe Dan modifed the formula by

lowering

the dose of gui zhi and adding huang qi to make a new formula. Of note is

that

the gui zhi tang pulse could be confused with a " normal pulse " . Has anyone

seen such a patient?

 

 

 

Chinese Herbs

 

voice:

fax:

[Guest guest]

How would one go about distinguishing whether to use something like bu

zhong yi tang in a patient who sweats easily versus gui zhi tang. Both

patients would be deficient in presentation, yet exhibiting feverishness.

The SHL gives

no tongue signs but I note that the pulse of the gui zhi tang clause is

quite

different that given for BZYQT.

>>>>This two formulas are coming from very different traditions. If we are

talking of chronic weakness you can definitely use either one as a starting

point. If we are talking about a clear Exterior syndrome than Gui Zhi is

probably more appropriate.

Alon

 

 

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

> How would one go about distinguishing whether to use something like bu

> zhong yi tang in a patient who sweats easily versus gui zhi tang. Both

> patients would be deficient in presentation, yet exhibiting feverishness.

> The SHL gives

> no tongue signs but I note that the pulse of the gui zhi tang clause is

> quite

> different that given for BZYQT.

> >>>>This two formulas are coming from very different traditions. If we are

talking of chronic weakness you can definitely use either one as a starting

point. If we are talking about a clear Exterior syndrome than Gui Zhi is

probably more appropriate.

> Alon

 

 

I am referring to interior syndromes here. Mitchell, et. al. write that one of

the uses of gui zhi tang is for an interior vacuity cold caused by ying and wei

disharmony with NO evidence of zang fu involvement. this raises several

points:

 

1. What causes a chronic ying and wei disharmony if zang fu are not

involved?

 

2. gui zhi tang pattern may present as repeated colds, frequent spontaneous

sweating and feverishness, all treated with bu zhong yi qi tang. But BZYQT also

has clear symptoms of spleen zang vacuity, such as diarrhea and prolapse. the

pulse in bu zhong is much more indicative of vacuity, while GZT has symptoms

such as nasal congestion and retching associated. (aside - has anyone used GZT

for chronic nasal congestion or chronic retching?)

 

3. chronic cases where GZT is used for sweating often add herbs like huang qi,

thus spleen zang involvement may be implied or perhaps this is just for weak

wei qi -- this brings up a side note on the issue of strength in wei and

weakness in ying in this pattern. Mitchell, et. al. clearly delineate that this

does NOT mean the wei qi is strong in these patients. (see line 95) It is

actually weak. This brings me back to number 1, then? why is wei weak?

 

I would offer that wei may be disharmonious with ying due to weather or

dietary factors that do not impair the zang right away -- but how could they

not over time?. On the other hand, this disharmony may be rooted in a zang fu

imbalance from the get go. In which case, would it be appropriate to add

herbs for zang vacuity in order to complete the formula. the question would

then be staging. does one need to treat the gui zhi tang pattern first and then

the zang vacuity or do they need to be treated simultaneously?

 

[Guest guest]

I am referring to interior syndromes here. Mitchell, et. al. write that one of

the uses of gui zhi tang is for an interior vacuity cold caused by ying and wei

disharmony with NO evidence of zang fu involvement. this raises several

points:

>>>Todd we need to also remember the development of the use of gui zhi, for

example xiaio jian zhong treats coldness in the center and thus treats zong fu,

and is often used in chronic weakness and loss of center

Alon

 

 

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

 

> >>>Todd we need to also remember the development of the use of gui zhi, for

example xiaio jian zhong treats coldness in the center and thus treats zong fu,

and is often used in chronic weakness and loss of center

> Alon

>

 

of course, but I still wonder about the origin of the chronic ying and wei

disharmony that calls for gui zhi tang, not xiao jian zhong tang.

 

[Guest guest]

Regarding Gui Zhi Tang vs. Bu Zhong Yi Qi Tang for chronic sweating...

 

Does it seem appropriate in the case of Gui Zhi Tang to consider long-term

channel disorder such as accumulation of cold or dampness leading to disharmony

of ying-wei. In this case, bringing about sweating helps to release the

blockage in the collaterals. Thus, this might be a condition where Gui Zhi Tang

is applicable in a more chronic condition, i.e. one that is still in the

channels and not yet affecting zang-fu qi function (qi hua).

 

On the other hand, BZYQT is still the more familiar condition of Yang qi not

rising from the Sp/St leading to insufficient maintenance of the ying-wei

balance. Yang qi cannot hold/balance yin fluids in the exterior thus leading to

spontaneous sweating. This condition is now in the Spleen zang.

 

So, one condition is out in the channels and the other is in the zang organ.

Both conditions can benefit from increasing the rising of Spleen Yang toward the

surface but in the case of Gui Zhi Tang, the channels must also be invigorated.

 

respectfully,

Jason Robertson

 

In both cases, there is a

 

 

 

Jason Robertson, L.Ac.

Ju Er Hu Tong 19 Hao Yuan 223 Shi

 

Beijing, Peoples Republic of China

 

home-86-010-8405-0531

cell- 86-010-13520155800

 

 

 

 

 

 

 

[Guest guest]

, Jason Robertson <

kentuckyginseng> wrote:

> Regarding Gui Zhi Tang vs. Bu Zhong Yi Qi Tang for chronic sweating...

>

> Does it seem appropriate in the case of Gui Zhi Tang to consider long-term

channel disorder such as accumulation of cold or dampness leading to

disharmony of ying-wei. In this case, bringing about sweating helps to release

the blockage in the collaterals. Thus, this might be a condition where Gui Zhi

Tang is applicable in a more chronic condition, i.e. one that is still in the

channels and not yet affecting zang-fu qi function (qi hua).

 

 

to paraphrase Mitchell, et. al: the term miscellaneous diseases, when in the

absence of internal organ disease, construction and defense are disharmonious,

leading to intermittent heat effusion and spontaneous sweating.

 

Misc. dz are those other than caused by cold damage. but the jin gui includes

bi syndrome. however muscle or joint pain is not mentioned as a ying and wei

disharmony symptom in this context. so the question would be whether a

chronic cold invasion lodged in the exterior could cause intermittent sweating

and heat effusion or if some other pathomech is at play here.