Si ni san contraindications; reflections on severe Yin Vacuity; exciting new possible development

[Guest guest]

Hi Kokko,

 

It would seem to me that the problem with Si Ni San, relative to Yin deficiency,

has more to do with the nature of the Yin vacuous patient and less to do with

the proportions.  I'll relate to you an interesting phenomenon that I have

noticed with my wife, who, as I think you know has SEVERE Yin Xu. Besides all

the other symptoms that she displays, often in the past, she would be fatigued

and drool sputum.  An intelligent approach would seem to be to strengthen

the Spleen and dry dampness, using herbs such as Bai Zhu and Ban Xia. 

Unfortunately, whenever I have used ANY drying herbs such as these, her symptoms

became MUCH worse, not just once, but on multiple occasions.  This experience

has helped me greatly in my understanding of just how fragile the severely Yin

Xu patient is.  Some of you may know Dr. Ji Zhang, a superb practitioner and

teacher of Chinese medicine here in LA.  For nearly 2 years Dr. Zhang prescribed

for

Chana formulas designed to aggresively extinguish internal wind, regularly

using herbs such as the above 2, Dan Nan Xing, Di long, and when her spasms were

severe, heavy duty herbs such as  wu gong, Quan Xie, and  jiang Can. Despite the

fact that he included large doses of Yin nourishing herbs, her condition

deteriorated, the sputum got thicker and sticker, and her spasms and seizures if

anything, got worse.  Over the past couple of years, and particularly after

talking at length with my dear friend , I decided to take a

different approach.  Rather than " attack " the symptom, which clearly wasn't

working (and frankly if a very Western Biomedical over-simplistic approach),

instead I started to consider that the liver was raw, was working overtime and

in essence was doing the work of the Kidneys.  So, we reasoned, by filling in

the vacuity in the deeply empty kidney, though slowly, over the course of the

past two years, lo

and behold, her spasms are much less severe, her sleep is much deeper,  more

restful, and more refreshing,  her tongue, though still without coat, is no

longer red or purple, but is now moist and a much healthier pink color, and much

more rarely, usually right before or after seizures, is she burdoned with the

thick, clear sticky drool. 

 

So getting back to my original point, Kokko, though cool,  I would contend that

the acrid nature of both Chai Hu and Zhi Shi would create serious problems for

the severely Yin Xu patient. Not because of the temperature, but rather because

of the acridity.  Think of it like pouring salt into a wound, the Yin Xu patient

literally being raw.   I speak from experience.

 

BTW, I happened to speak to Z'ev, this evening, and he asked me to share with

him the current formula that she is taking, so since we're on the topic, I share

it with the group as well: 

 

Mu Li-30, long gu-30,(pre-cooked for 20 minutes  chuan bei mu-9,  fu ling-6,

chen pi-6,

Jie Geng-6,  Tai Zi Shen-30, Mai Men dong-15, Wu Wei ZI-6, Sheng Di Huang-21,

Bai Shao Yao-15, Gan Cao-9, Dang Gui-12, Han Lian Cao-15, Tian Ma-9, Gou

Teng-15,

Zhi Zi-6, Shi Chang Pu-6, Yu Jin-9, Suan Zao Ren-15, Bai Zi Ren-15, Suo Yang-12,

Ba Ji Tian-12, and Xing Ren-9 (added at the end). 

 

On the bio-medical front, last week, Chana had a lumbar puncture to check for

intracranial pressure, and Thank G-d, the result were negative for the presence

of any bacteria, fungi or virus.  We are now considering the introduction  of

two related drugs:  Piracetam and Levetiracetam.  Our neurologist suggested that

the latter  is  a selective cholineric stimulant, with  anticonvulsant

properties,  not affecting the excitatory receptors  and seeming  to reduce

tremors as well.   It was my thought of complementing it synergistically with

Piracetam, the original intelligence boosting Nootropic, that I had read about

many years ago, and from which Levepiracetam is derived.  Piracetam's primary

action is cogniscence enhancement, but it also has a slight anticonvulsant

activity as well.  Since they are so similar biochemically, it was my thought to

use them together to fortify both areas.  I am waiting to hear back from our

neurologist and

will report back to the group as things develop.  I am very excited and

anxiously look forward to having my wife back.  Keep us in your thoughts!

 

 

 

 

 

 

 

 

--- On Mon, 6/29/09, <johnkokko wrote:

 

 

<johnkokko

Si ni san contraindications

 

Monday, June 29, 2009, 8:25 AM

 

 

 

 

 

 

 

 

In the new Formulas and Strategies book 2nd ed, pg. 117

the authors write that *Si ni san :*

 

*Cautions and Contraindications: *

" This formula unblocks the Qi dynamic with *warm* and acrid herbs.

It is therefore contraindicated for Qi constraint associated with yin

deficiency,

which may also manifest with pain in the hypochondria, epigastrium and

abdomen. "

 

The ingredients. .. Chai hu, Bai shao, Zhi shi (all cool-cold) and Zhi gan

cao (sl. warming)

seem to disagree with this statement.

and although Chai hu can injure the yin, it is balanced by Bai shao at twice

the dosage.

Also, Zhi gan cao can support the MJ and generate fluids.

 

So, I'm perplexed by this contraindication and its rationale.

I can see that the formula seems as though it's warming, because it warms

the extremities. .

but only because it moves the Qi constraint (heat) out from the torso.

The ingredients themselves are predominately cool-cold.

 

Any clarity on this?

 

--

 

Turtle Island Integrative Health

www.turtleclinic. com

 

TCM Review director

CA State Board Prep Courses

www.tcmreview. com

 

 

[Guest guest]

Yehuda,

 

Thanks for the lengthy reply and the good news from Chana.

The Long gu and Mu li combination is a miracle.

Seems as though it's anchoring the drying ascending acrid nature of Shi

chang pu, Tian ma and Gou teng.

The KD yang tonics are moderated with the non-cloying Yin tonics...

Gou teng itself needs Bai shao to moderate it for long-term use.

Shi chang pu vaporizes the phlegm, but not like Dan nan xing, which is like

a SWAT team on the head.

The old formula with Bai zhu and Ban xia can literally suck the yin out of

the body.

One piece of Ban xia on the tongue can make the throat feel like a dry stick

in the desert.

 

Yehuda, you wrote:

" I would contend that the acrid nature of both Chai Hu and Zhi Shi

would create serious problems for the severely Yin Xu patient.

Not because of the temperature, but rather because of the acridity.

 

The Formulas and Strategies 2nd edition states in the contraindication:

" This formula unblocks the Qi dynamic with *warm* and acrid herbs. "

My beef is the description of the formula containing " warm " herbs, not acrid

herbs.

 

I agree that the acridity from Chai hu

and Zhi shi (which is bitter..downward draining more than acrid... )

can do a number on yin, but since Bai shao's dosage (15 gms) is higher than

Chai hu

and Zhi gan cao (honey processed licorice) is also supporting the yin

through the Lung and MJ

I don't see how Si ni san can be contraindicated for yin xu, especially due

to temperature.

 

If we say that all formulas containing Chai hu, no matter what other

ingredients are in the formula,

are contraindicated for yin xu patients,

we're going back to that thread about Chai hu dredging and drying out the LV

yin.

My temporary statement, after talking with Arnaud about this, is that from

the classics,

the Bai shao dosage must be at least that of Chai hu or greater, to anchor

the yin from spreading up and out,

since Chai hu is cool and acrid, light and dispersing.

 

I have seen yin xu patients react with unmodified Xiao yao san,

mainly because Chai hu is not moderated with enough Bai shao

in those proportions, plus the inclusion of Dang gui (which is warm and

acrid),

the drying properties of warm Bai zhu and Fu ling

and the acrid spreading properties of warm Sheng jiang/Pao jiang and Bo he.

In fact, many yin xu patients feel more irritable after taking Xiao yao san.

 

So, I'm wondering more about the description from the Formulas and

Strategies 2nd edition,

that Si ni san is composed of " warm " herbs.

Is that a classical contraindication and description?

We know that cupping is considered a warming technique, not a cooling

technique, which is sort of anti-intuitive,

but makes sense when we think that we're promoting blood circulation which

warms the body,

instead of opening the pores and cooling the body.

 

In the same way, Si ni san warms the extremities, but is composed of cool

herbs.

Warming the extremities and cooling the torso. 3 cool/ cold herbs and 1

warm herb.

 

So, do we see this formula as warming or cooling?

 

K

 

 

 

 

 

 

 

 

 

 

 

 

 

On Tue, Jun 30, 2009 at 1:46 AM, wrote:

 

>

>

> Hi Kokko,

>

> It would seem to me that the problem with Si Ni San, relative to Yin

> deficiency, has more to do with the nature of the Yin vacuous patient and

> less to do with the proportions. I'll relate to you an interesting

> phenomenon that I have noticed with my wife, who, as I think you know has

> SEVERE Yin Xu. Besides all the other symptoms that she displays, often in

> the past, she would be fatigued and drool sputum. An intelligent approach

> would seem to be to strengthen the Spleen and dry dampness, using herbs such

> as Bai Zhu and Ban Xia. Unfortunately, whenever I have used

> ANY drying herbs such as these, her symptoms became MUCH worse, not just

> once, but on multiple occasions. This experience has helped me greatly

> in my understanding of just how fragile the severely Yin Xu patient is.

> Some of you may know Dr. Ji Zhang, a superb practitioner and teacher of

> Chinese medicine here in LA. For nearly 2 years Dr. Zhang prescribed for

> Chana formulas designed to aggresively extinguish internal wind, regularly

> using herbs such as the above 2, Dan Nan Xing, Di long, and when her spasms

> were severe, heavy duty herbs such as wu gong, Quan Xie, and jiang

> Can. Despite the fact that he included large doses of Yin nourishing herbs,

> her condition deteriorated, the sputum got thicker and sticker, and her

> spasms and seizures if anything, got worse. Over the past couple of years,

> and particularly after talking at length with my dear friend ,

> I decided to take a different approach. Rather than " attack " the symptom,

> which clearly wasn't working (and frankly if a very Western Biomedical

> over-simplistic approach), instead I started to consider that the liver was

> raw, was working overtime and in essence was doing the work of the Kidneys.

> So, we reasoned, by filling in the vacuity in the deeply empty

> kidney, though slowly, over the course of the past two years, lo

> and behold, her spasms are much less severe, her sleep is much deeper,

> more restful, and more refreshing, her tongue, though still without coat,

> is no longer red or purple, but is now moist and a much healthier pink

> color, and much more rarely, usually right before or after seizures, is she

> burdoned with the thick, clear sticky drool.

>

> So getting back to my original point, Kokko, though cool, I would contend

> that the acrid nature of both Chai Hu and Zhi Shi would create serious

> problems for the severely Yin Xu patient. Not because of the temperature,

> but rather because of the acridity. Think of it like pouring salt into

> a wound, the Yin Xu patient literally being raw. I speak from experience.

>

> BTW, I happened to speak to Z'ev, this evening, and he asked me to share

> with him the current formula that she is taking, so since we're on the

> topic, I share it with the group as well:

>

> Mu Li-30, long gu-30,(pre-cooked for 20 minutes chuan bei mu-9, fu

> ling-6, chen pi-6,

> Jie Geng-6, Tai Zi Shen-30, Mai Men dong-15, Wu Wei ZI-6, Sheng Di

> Huang-21,

> Bai Shao Yao-15, Gan Cao-9, Dang Gui-12, Han Lian Cao-15, Tian Ma-9, Gou

> Teng-15,

> Zhi Zi-6, Shi Chang Pu-6, Yu Jin-9, Suan Zao Ren-15, Bai Zi Ren-15, Suo

> Yang-12, Ba Ji Tian-12, and Xing Ren-9 (added at the end).

>

> On the bio-medical front, last week, Chana had a lumbar puncture to check

> for intracranial pressure, and Thank G-d, the result were negative for the

> presence of any bacteria, fungi or virus. We are now considering the

> introduction of two related drugs: Piracetam and Levetiracetam. Our

> neurologist suggested that the latter is a selective

> cholineric stimulant, with anticonvulsant properties, not affecting the

> excitatory receptors and seeming to reduce tremors as well. It was my

> thought of complementing it synergistically with Piracetam, the original

> intelligence boosting Nootropic, that I had read about many years ago, and

> from which Levepiracetam is derived. Piracetam's primary action

> is cogniscence enhancement, but it also has a slight anticonvulsant activity

> as well. Since they are so similar biochemically, it was my thought to use

> them together to fortify both areas. I am waiting to hear back from our

> neurologist and

> will report back to the group as things develop. I am very excited and

> anxiously look forward to having my wife back. Keep us in your thoughts!

>

>

>

>

>

>

>

>

> --- On Mon, 6/29/09, <johnkokko<johnkokko%40gmail.com>>

> wrote:

>

> <johnkokko <johnkokko%40gmail.com>>

> Si ni san contraindications

> <%40>

> Monday, June 29, 2009, 8:25 AM

>

> In the new Formulas and Strategies book 2nd ed, pg. 117

> the authors write that *Si ni san :*

>

> *Cautions and Contraindications: *

> " This formula unblocks the Qi dynamic with *warm* and acrid herbs.

> It is therefore contraindicated for Qi constraint associated with yin

> deficiency,

> which may also manifest with pain in the hypochondria, epigastrium and

> abdomen. "

>

> The ingredients. .. Chai hu, Bai shao, Zhi shi (all cool-cold) and Zhi gan

> cao (sl. warming)

> seem to disagree with this statement.

> and although Chai hu can injure the yin, it is balanced by Bai shao at

> twice

> the dosage.

> Also, Zhi gan cao can support the MJ and generate fluids.

>

> So, I'm perplexed by this contraindication and its rationale.

> I can see that the formula seems as though it's warming, because it warms

> the extremities. .

> but only because it moves the Qi constraint (heat) out from the torso.

> The ingredients themselves are predominately cool-cold.

>

> Any clarity on this?

>

> --

>

> Turtle Island Integrative Health

> www.turtleclinic. com

>

> TCM Review director

> CA State Board Prep Courses

> www.tcmreview. com

>

>