yin chen hao really is a cholagogue

[Guest guest]

A cholagogue is an herb that clears bile from the GB, thus relieving sx

like jaundice. Yin chen hao with three other herbs ina formula called

yin zhi huang have been shown to activate the CAR receptor that

regulates bilirubin clearance by the liver. This clears bilirubin from

the blood and prevents further buildup of bile in the GB. This was

reported in JCM from j clin invest 113:137-143. I tis not stated what

the other three herbs are, but I note that yin chen hao tang contains

YIN chen hao, ZHI zi and da HUANG.

 

I recently had a patient who had third trimester cholestasis due to

exaggerated hormonal effects on bile transport. This led to severe

itching, which still persisted several weeks after birth. She was

initially treated as having blood xu induced wind by another clinician.

The rationale had been that since she had just given birth, she was

blood xu, which led to the arisal of wind. However, despite being a

little tired and pale in appearance, the patient actually had a red

tongue with a thick, yellow coat on it. Plus her pulse was wiry and

she was irritable. I see this commonly in young women. I think

dampheat impairs spleen blood production, but the solution is not to

build blood with tonics. In addition, knowing her western dx, I

scrapped the blood xu dx and the rx given. I often use this approach

myself with great success in skin dz, but it did not apply here. The

first clinician (an intern) did not actually look at signs and

symptoms, but made an assumption based upon the patient's appearance,

her recent birth and the prevalence of wind induced itching. This

tendency to read too much into appearance and etiological factors

without confirmation by s/s is a common, careless and dangerous trend.

 

While GB dampheat is not typically associated with itching, the

pathomechanism of the itching is quite clear from a biomedical

perspective. The bilirubin in the blood causes it. The GB just needs

to be discharged, but WM really has little to offer. Cholestyramine

often relieves the itching, but causes some bad side effects , such as

severe constipation. So it is not recommended for long term use. In

some cases, but not this one, there may be stones. Persistent itching

and/or permanent GB dysfunction may require removal. So knowing that

the GB was affected according to WM and knowing that CM also recognizes

the GB role in bile storage and knowing the patient showed signs of

dampheat in the LV/GB channel and knowing that many herbs that clear GB

dampheat and qi stagnation have known cholagogic effects. Taking all

together, I conjectured that dampheat brewing in the completely blocked

GB, paired with the liver, makes the arisal of wind (the pathogen of

wood) quite logical indeed. I looked in several OB?GYN books, but did

not find this disease or pattern listed. I am sure if I could read

chinese, I would have. But the patient was suffering and a lot of

evidence was mounting in favor of my working dx. At the very least,

even if I could not justify this from an available textbook, I was

pretty confident that the herbs I had in mind would relieve her sx.

 

This raises a question about western dx, as it it is unlikely that I

would have made all these leaps if I did not know the GB was involved.

Does chinese source material talk about this postpartum itching being

due to GB dampheat and qi stagnation? Did the s/s already point to

this? I think the patient had dark urine.

 

It also raises the issue about aggressive branch tx. I only wanted to

do the treatment short term, as I was concerned about the effects

through the milk. The patient did need some supplementing in the long

run. But I wanted to have immediate effects. Our PCOM pediatric

specialist examined my rx and said to not be concerned for the baby. I

prescribed 1 pack of the following; daily doses in tea form (1 pack/2

days):

 

18 zhi zi

18 jiang huang

18 yu jin

30 pu gong ying

30 yin chen hao

 

 

This was three weeks after birth and the itching was very severe. In

two days, it subsided 85%. The baby had some mild indigestion that may

have been unrelated. The patient returned in a week and the itching

had returned full force the day before. So I guess the bile had been

discharged or bilirubin cleared from the blood, but as long as the

hormonal sensitivity of the GB remained aberrant, the condition would

recur. My treatment plan called for the patient to be tested on the

formula for two days, which we had done, thenfollow with a week's

supply, then shift the formula to a more balanced one. My rationale

was relieve sx quickly, then work to correct normal zang fu balance.

Once the zang fu were corrected, I assumed the sx would not recur.

Interns on another shift refilled the rx for 3 packs for six days. The

patient had 100% relief in 2 days. Her sx never returned after this.

However the same interns had then followed with two more weeks of the

same rx without adjusting for zang-fu. These are the same interns,

BTW, who had originally made the dx of blood xu wind. The case was out

of my hands at this point. In fact, I only got to see the patient that

one time and followed closely over time. Well, the patient had no

negative effect from too much of the excess clearing rx. she did take

something more like xiao yao san after that for a few weeks (a

variation of my followup tx plan that was charted) and the sx have not

returned 10 weeks after stopping the yin chen hao rx.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

[Guest guest]

Amazingly, the full text of this article does not cite the full

constituents of the formula; however, it references that scutellaria

was in the formula.

 

,

wrote:

Yin chen hao with three other herbs ina formula

called

> yin zhi huang have been shown to activate the CAR receptor that

> regulates bilirubin clearance by the liver. This clears bilirubin

from

> the blood and prevents further buildup of bile in the GB. This

was

> reported in JCM from j clin invest 113:137-143. I tis not stated

what

> the other three herbs are, but I note that yin chen hao tang

contains

> YIN chen hao, ZHI zi and da HUANG.

 

 

 

so maybe huang was huang qin.

 

[Guest guest]

 

 

Thanx for sharing...

 

-Jason

 

, wrote:

> A cholagogue is an herb that clears bile from the GB, thus relieving sx

> like jaundice. Yin chen hao with three other herbs ina formula called

> yin zhi huang have been shown to activate the CAR receptor that

> regulates bilirubin clearance by the liver. This clears bilirubin from

> the blood and prevents further buildup of bile in the GB. This was

> reported in JCM from j clin invest 113:137-143. I tis not stated what

> the other three herbs are, but I note that yin chen hao tang contains

> YIN chen hao, ZHI zi and da HUANG.

>

> I recently had a patient who had third trimester cholestasis due to

> exaggerated hormonal effects on bile transport. This led to severe

> itching, which still persisted several weeks after birth. She was

> initially treated as having blood xu induced wind by another clinician.

> The rationale had been that since she had just given birth, she was

> blood xu, which led to the arisal of wind. However, despite being a

> little tired and pale in appearance, the patient actually had a red

> tongue with a thick, yellow coat on it. Plus her pulse was wiry and

> she was irritable. I see this commonly in young women. I think

> dampheat impairs spleen blood production, but the solution is not to

> build blood with tonics. In addition, knowing her western dx, I

> scrapped the blood xu dx and the rx given. I often use this approach

> myself with great success in skin dz, but it did not apply here. The

> first clinician (an intern) did not actually look at signs and

> symptoms, but made an assumption based upon the patient's appearance,

> her recent birth and the prevalence of wind induced itching. This

> tendency to read too much into appearance and etiological factors

> without confirmation by s/s is a common, careless and dangerous trend.

>

> While GB dampheat is not typically associated with itching, the

> pathomechanism of the itching is quite clear from a biomedical

> perspective. The bilirubin in the blood causes it. The GB just needs

> to be discharged, but WM really has little to offer. Cholestyramine

> often relieves the itching, but causes some bad side effects , such as

> severe constipation. So it is not recommended for long term use. In

> some cases, but not this one, there may be stones. Persistent itching

> and/or permanent GB dysfunction may require removal. So knowing that

> the GB was affected according to WM and knowing that CM also recognizes

> the GB role in bile storage and knowing the patient showed signs of

> dampheat in the LV/GB channel and knowing that many herbs that clear GB

> dampheat and qi stagnation have known cholagogic effects. Taking all

> together, I conjectured that dampheat brewing in the completely blocked

> GB, paired with the liver, makes the arisal of wind (the pathogen of

> wood) quite logical indeed. I looked in several OB?GYN books, but did

> not find this disease or pattern listed. I am sure if I could read

> chinese, I would have. But the patient was suffering and a lot of

> evidence was mounting in favor of my working dx. At the very least,

> even if I could not justify this from an available textbook, I was

> pretty confident that the herbs I had in mind would relieve her sx.

>

> This raises a question about western dx, as it it is unlikely that I

> would have made all these leaps if I did not know the GB was involved.

> Does chinese source material talk about this postpartum itching being

> due to GB dampheat and qi stagnation? Did the s/s already point to

> this? I think the patient had dark urine.

>

> It also raises the issue about aggressive branch tx. I only wanted to

> do the treatment short term, as I was concerned about the effects

> through the milk. The patient did need some supplementing in the long

> run. But I wanted to have immediate effects. Our PCOM pediatric

> specialist examined my rx and said to not be concerned for the baby. I

> prescribed 1 pack of the following; daily doses in tea form (1 pack/2

> days):

>

> 18 zhi zi

> 18 jiang huang

> 18 yu jin

> 30 pu gong ying

> 30 yin chen hao

>

>

> This was three weeks after birth and the itching was very severe. In

> two days, it subsided 85%. The baby had some mild indigestion that may

> have been unrelated. The patient returned in a week and the itching

> had returned full force the day before. So I guess the bile had been

> discharged or bilirubin cleared from the blood, but as long as the

> hormonal sensitivity of the GB remained aberrant, the condition would

> recur. My treatment plan called for the patient to be tested on the

> formula for two days, which we had done, thenfollow with a week's

> supply, then shift the formula to a more balanced one. My rationale

> was relieve sx quickly, then work to correct normal zang fu balance.

> Once the zang fu were corrected, I assumed the sx would not recur.

> Interns on another shift refilled the rx for 3 packs for six days. The

> patient had 100% relief in 2 days. Her sx never returned after this.

> However the same interns had then followed with two more weeks of the

> same rx without adjusting for zang-fu. These are the same interns,

> BTW, who had originally made the dx of blood xu wind. The case was out

> of my hands at this point. In fact, I only got to see the patient that

> one time and followed closely over time. Well, the patient had no

> negative effect from too much of the excess clearing rx. she did take

> something more like xiao yao san after that for a few weeks (a

> variation of my followup tx plan that was charted) and the sx have not

> returned 10 weeks after stopping the yin chen hao rx.

>

>

>

> Chinese Herbs

>

>

> FAX:

>

>