fu ling or hou po

[Guest guest]

 

 

I think your student's experience below confirms my own observations that

students tend to get sidetracked by too many examples of herb combinations in

the basic materia medica. If they would only focus on the basic properties of

each herb and understand them well, they would know not only how to make the

most effective choice but also how to combine, with a few special exceptions

that require explicit mention.

 

Also of use will be some type of numerical estimate of how strong a given action

is for an herb - we will be including these ( " herbal action vectors " ) in our

next software update of our database. This is something that students usually do

not acquire until clinical experience with the herbs; but I see no reason why

this information cannot be imparted in a systematic manner in reference texts.

 

Roger

 

 

> <

>fu ling or hou po

>

>CASE:

>

>Your patient presents with chest and epigastric distension, abdominal

>pain, nausea and

>loss of appetite, asthma and wheezing with sputum, slippery pulse, and

>slimy tongue

>coat.

>

>What single medicinal would

>you choose that best addresses all of these symptoms and signs?

>

>a) chen pi b) fu ling c) hou po d) shan zha e) huang lian

>

>

>A student wrote: You asked for the best answer and mine was fu ling,

>and you said that it was hou po......Okay, I think I

>disagree based on Wiseman pg. 213, 7.1, Damp Phlegm

>

> " Damp Phlegm is a pattern characterized by cough and

>copius, white phlegm, and is attributable to splenic

>transformation failure " ......

>

>Wiseman lists chen pi first, fu ling second (my

>choice) and hou po as third.

>

>I believe that fu ling is by far a better choice than

>hou po because based on the top functions listed of fu

>ling:

>

> " Strenghthens the spleen and harmonizes the middle

>burner-splenic TT failure "

>

>If in fact we were to use just ho po (which in the

>real world is not the case), there would only be a

>transformation of the phlem, BUT hou po would not be

>the answer to the root cause which is the need to

>repair the spleen because it is failing to transform

>properly. Fu ling actually strengthens the spleen, hou po

>does not, it is a great mover of qi stagnation, and

>that is all.

>

>

>I replied (comments please, feel free to disagree):

>

>fu ling is not indicated for wheezing and asthma. your first

>obligation is to relieve suffering, not correct the assumed root, so

>hou po is best. In addition, the patient has no vacuity signs, so

>relieving damp and phlegm is all that is necessary. Thus, any herbs

>that disencumbers the spleen will do here. You are assuming the spleen

>needs fortifying, but there are several causes that don't present with

>vacuity. I can guarantee you that if you gave this patient fu ling and

>neglected to give him hou po, he would have zero relief from his

>suffering. the only symptoms fu ling relieves quickly are urinary

>irritation and loose stool. Wiseman's order may not be one of rank,

>but rather alphabetical in this case (c comes before f comes before h).

> I wouldn't assume any implicit hierarchy. But perhaps the missing

>piece here is whether one addresses the damp and phlegm strongly or

>should focus primarily on the spleen. Chen pi would also be a better

>choice than fu ling for the same reason. It would also dry up the

>phlegm and relieve the chest and epigastric distension very quickly.

>

>I believe there is something else you have missed and perhaps this is

>due to our focus in class on functions more than indications. Just

>because an herb has a function does not mean it is good at addressing

>every symptom that could be related to that function. For fu ling,

>under its function of transforming phlegm, symptoms listed include

>palpitations, headache and dizziness, which typically occur when phlegm

>invades the head. Note the absence of actual respiratory symptoms.

>When used to treat chest distension and actual mucus or sputum it is

>always combined with herbs like zhi ban xia and chen pi. If an

>indication for an herb is only listed as part of a combination, it

>often means the herbs does not have the function by itself. But if you

>look up ban xia and chen pi, you see they are both used for chest

>distension or stifling by themselves, thus they must be the herbs that

>do this in the combination with fu ling. Fu ling is just used in these

>combinations to address the root and open an exit way for the damp.

>But it contributes very little to short term symptom relief. I think

>the crux of the matter is you want a qi mover here, not a spleen

>strengthener, as your first choice. The chief complaint involves pain

>and distention, which means stagnation. You need a spicy herb to break

>up the stagnation here, not a sweet or bland herb.

>

>Having said all that, fu ling would likely be an ingredient in the

>final formula, buts its role would be as an assistant or deputy, not

>the chief.

>

>

>Todd

>

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

, rw2@r... wrote:

 

>>>> I think your student's experience below confirms my own

observations that students tend to get sidetracked by too many

examples of herb combinations in the basic materia medica.

 

The organization of materia medicas in English largely reflects the

presentation of the material in the Chinese source texts. Our materia

medicas have a lot of information on combinations because this is the

way the Chinese study and understand the material. The meat of the

material in a given monograph is basically composed of the

combinations used for treating specific illnesses.

 

The combinations are an essential component, and they are necessary to

include at the current level because we must first and foremost bring

the student to the material at the exact level that their Chinese

colleagues enjoy. Studying this info is how we learn how to combine

the medicinals, which ones have a relationship of mutual need, etc.

Because we never really use meds in isolation, learning which groups

of dui yao are needed for a given case is essential. One could even

make the argument that some meds don't have a particular effect unless

they are combined with others that reinforce that action.

 

While I agree that it is important that students understand the basic

actions of the medicinals, I think the most effective way to do this

is to use terminology that preserves the nuance of the Chinese words.

Chinese materia medicas are generally better than English sources at

illustrating gradations of strength and nuances of use because the

Chinese language is specific in this regard. If we translate seven

different words as " tonify, " the student has no access to the original

Chinese concepts that would have given them an impression of the type

of tonification, the strength of tonification, the approach of

treatment, etc. A good basic knowledge of when to use which drugs

comes from a solid understanding of basic theory. The medicinals all

have actions that are expressed very clearly if students understand

the concepts without simplification or dilution.

 

I think the basic theory is the most important factor when it comes to

solving student's questions such as the one that Todd presented. The

question arose because the student's knowledge of basic theory and

approach to treatment was not yet well-developed. One of the most

challenging things for students when it comes time to make clinical

decisions is the ability to know which herbs to use for which

situations. Previous texts have had a large amount of emphasis on

monographs with comparatively little emphasis on basic theory for

application. This gives students a wide range of information about

the single agents but an inability to select which ones to use under

which circumstances. Chen's materia medica contains a wealth of

information about pharmacology, Benksy's new MM contains a wealth of

information about historical use. In our MM, we have chosen to give a

greater emphasis to clinical concepts and application of medicinals.

 

Because we were aware of students' need for a better understanding of

basic theory when it comes to using herbal medicine, we chose to

develop large chapter introductions (based on Chinese sources) that

offered a more thorough grounding in the basic use of medicinals and

the appropriate selection of specific medicinals. Knowing which herbs

are stronger and weaker, or more clinically effective and frequently

used is a huge component that is missing from most books, whether in

Chinese or in English. In order to address this situation, we found

Chinese texts that discuss the frequency of use and the relative

importance of the medicinals within a given category. We have

integrated this material into the chapter introductions so that

students will learn which herbs they should gravitate towards; many

herbs appear similar in print but differ markedly in application.

Alon has asserted that this needs to come from clinical experience,

which is absolutely true. However, we should recognize that

clinically experienced doctors have already provided this information

in Chinese texts, and providing it to students when they first learn

will save them years of trial and error. It will also save their

patients thousands of dollars, not to mention time wasted being guinea

pigs simply for the sake of a practitioner's education, which could

have been advanced from the start by the simple use of appropriate

texts. Naturally, there is still no replacement for the knowledge

that comes from clinical practice, but we could have a higher starting

point than we do at present.

 

Eric Brand

[Guest guest]

, lyeric100@a... wrote:

>

> What is the name and ISBN of your book?

 

Concise Chinese Materia Medica.

 

I don't know the ISBN because it hasn't been printed yet. Later this

fall.

 

Eric