Insomnia

[Guest guest]

Many physicians over the years have used chi shao instead of bai shao for

gui zhi tang and related formulas. Years ago, I remember reading an

interesting case by Ding Gan Ren who first alerted me to this idea. It was a

GZT case. The book is at the office, therefore I will try to hunt it down

next time I am in.

 

 

 

-Jason

 

 

 

 

On Behalf Of stephen woodley

Monday, March 15, 2010 2:05 PM

 

Re: Insomnia

 

 

 

 

 

Kokko

In the earliest materia medicas and in the Shang han za bing lun,

Bai shao and Chi shao were not differentiated...

Stephen

Sure, we've all heard this...but with your studies of the Tangye

jing you know that Baishao is the Earth herb of the metal class

and Chishao can't fulfill this positioning. So, I had to poke you

 

Kokko

So, by going with the rules of the formula, we can choose either

herb to use.

In this particular patient's case, we can choose either one. but

Chi shao works better for her case with the blood stasis and

heat.

 

Stephen:

Don't think I can agree with this...the relationship of Guizhi +

Baishao is one of outside and inside the vessels and can't be

improved upon. IMO, Chishao doesn't represent an improvement,

only straying from a perfectly balanced formula.

 

I do agree that we could use more info on the patient, that's why

I asked for more pulse info from Suzanne.

It is interesting and yeah, without actually seeing the patient

it is mostly an exercise in conjecture.

 

see you this weekend

 

Stephen Woodley LAc

www.shanghanlunseminars.com

 

 

 

 

 

 

 

[Guest guest]

Thanks for following up more data regarding your patient. In light of the new

data, I withdrew my previous assumption. This one cannot follow strictly with

the visceral and bowel pattern differentiation. I second Mr Rosenberg's protocol

based upon your description.

 

Sorry cannot be more helpful.

 

Sung, Yuk-ming

[Guest guest]

Many people are bustling around all day, frantic, and their brains are frazzled

at the end of the day. Cardio gets the Qi moving and resolves stagnation.

Peaceful and calming exercise might help, but I've found that cardio beats

restorative type of practice 9 out of 10 times when there's a lot of 'crap'

(aka. Liver Qi Stagnation) built up during the day. Talk to runners who can't

run due to injury or something and you will see a lot of similarities with

people with certain kinds of insomnia. Or the common joke about men falling

asleep after sex.

 

Geoff

 

, <johnkokko wrote:

>

> Geoff wrote: " Lastly - make her do some cardio between dinner and bedtime.

> Not 2 hours of a spin class, but even 15 minutes of some 80% max HR (220 -

> age) kind of something to blow some steam off before calming down for the

> evening. "

>

> Can you explain more about how this is effective for insomniacs?

[Guest guest]

joke?

 

 

ozark.canuck

Tue, 16 Mar 2010 21:46:23 +0000

Re: Insomnia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Many people are bustling around all day, frantic, and their brains are

frazzled at the end of the day. Cardio gets the Qi moving and resolves

stagnation. Peaceful and calming exercise might help, but I've found that

cardio beats restorative type of practice 9 out of 10 times when there's a lot

of 'crap' (aka. Liver Qi Stagnation) built up during the day. Talk to runners

who can't run due to injury or something and you will see a lot of similarities

with people with certain kinds of insomnia. Or the common joke about men

falling asleep after sex.

 

 

 

Geoff

 

 

 

, <johnkokko wrote:

 

>

 

> Geoff wrote: " Lastly - make her do some cardio between dinner and bedtime.

 

> Not 2 hours of a spin class, but even 15 minutes of some 80% max HR (220 -

 

> age) kind of something to blow some steam off before calming down for the

 

> evening. "

 

>

 

> Can you explain more about how this is effective for insomniacs?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________

Hotmail: Trusted email with Microsoft’s powerful SPAM protection.

http://clk.atdmt.com/GBL/go/210850552/direct/01/

 

 

[Guest guest]

, <johnkokko wrote:

 

 

> Gui zhi, .... great idea

 

--

 

I'm not sure about using gui zhi for this kind of patient. Gui Zhi might not be

ok if there is damp heat and/or heat in this patient. I was trying to remember

where in the Shang Han Lun it was, and found a blog entry on Bob Flaws site:

 

http://www.bluepoppy.com/blog/blogs/blog1.php/2009/11/27/modular-approaches-to-f\

ormula-combining-2

 

One of the class lectures I watched when I was at NIAOM from 'back in the day'

was a class lecture by Dr. Ma Shou Chun translated by Dan Bensky. Dr. Ma was

explaining this concept that in the Shang Han, it is prohibited to use gui zhi

tang in alcoholics (Bob's post says the term 'sick drinkers' isn't exactly

agreed upon, but I'll go with Dr. Ma here). It's way back in my memory banks,

but Dr. Ma explains that it means that alcoholics normally have damp heat, so

don't use it for people with damp heat, but it's ok to use it for alcoholics

that don't have damp heat. Bob's post above elucidates in further detail.

 

Geoff

[Guest guest]

I agree, any formula with gui zhi is imprecise for this diagnosis / pattern.

 

 

 

-Jason

 

 

 

 

On Behalf Of yingsuke2002

 

I'm not sure about using gui zhi for this kind of patient. Gui Zhi might not

be ok if there is damp heat and/or heat in this patient. I was trying to

remember where in the Shang Han Lun it was, and found a blog entry on Bob

Flaws site:

 

 

 

 

 

 

 

 

[Guest guest]

Can you be more precise?

Geoff

 

, ben zappin <btz23 wrote:

>

>

> joke?

[Guest guest]

We have to remember that the ingredients are not alone in their actions, but

symbiotic with the rest of the formula.

Gui zhi stokes the HT yang, promoting circulation when there is blood

stasis....

This is a balance and balanced by the cooling herbs in the formula.... mu

dan pi and shao yao.

 

It's not ideal, but I can see where Al was going with this one.

 

K

 

 

 

 

On Wed, Mar 17, 2010 at 11:02 AM, yingsuke2002 <ozark.canuckwrote:

 

>

>

> --- In

<%40>,

> <johnkokko wrote:

>

> > Gui zhi, .... great idea

>

> --

>

> I'm not sure about using gui zhi for this kind of patient. Gui Zhi might

> not be ok if there is damp heat and/or heat in this patient. I was trying to

> remember where in the Shang Han Lun it was, and found a blog entry on Bob

> Flaws site:

>

>

>

http://www.bluepoppy.com/blog/blogs/blog1.php/2009/11/27/modular-approaches-to-f\

ormula-combining-2

>

> One of the class lectures I watched when I was at NIAOM from 'back in the

> day' was a class lecture by Dr. Ma Shou Chun translated by Dan Bensky. Dr.

> Ma was explaining this concept that in the Shang Han, it is prohibited to

> use gui zhi tang in alcoholics (Bob's post says the term 'sick drinkers'

> isn't exactly agreed upon, but I'll go with Dr. Ma here). It's way back in

> my memory banks, but Dr. Ma explains that it means that alcoholics normally

> have damp heat, so don't use it for people with damp heat, but it's ok to

> use it for alcoholics that don't have damp heat. Bob's post above elucidates

> in further detail.

>

> Geoff

>

>

>

 

 

 

--

 

 

""

 

 

www.tcmreview.com

 

 

 

[Guest guest]

K,

 

 

 

I am not sure I'm following your logic here. Obviously herbs work together,

but one must still evaluate each individual herb and why it is in the

formula, and does it fit the case.

 

 

 

Blood stasis can come about from almost anything. For example, blood

deficiency can cause blood stasis. However that does not mean we use blood

tonics for this case. We must find evidence for blood deficiency. Likewise,

for us to " stoke the Ht yang " we would need some evidence that there is a

deficiency of Heart yang. I do not see this. Furthermore, there is already

heat agitating the heart. Furthermore, I do not think that gui zhi in GZFLW

is still being the Heart Yang, but that is a different issue... do others

think otherwise?

 

 

 

In this case, we have a diagnosis of damp/phlegm heat with blood stasis.

Although, GZFLW in a sense treats this, but its primarily focuses is on the

lower burner. However, in this case the symptoms suggest a strong middle

burner involvement where the middle burner's qi dynamic is disrupted. This

formula will do little to address this aspect.

 

 

 

First take note of the major disease patterns that Bensky mentions for

GZFLW. He then follows it with a summary stating, " The common thread among

these various patterns is the for-mula's ability to regulate the circulation

of qi, blood, and body fluids that has become blocked by the penetration of

cold into the lower burner. " He also states that the presence of cold signs

(as well as heat) is a key diagnostic factor for this formula. I do not see

this in our case. I also do not see the " systemic signs of blood stasis "

that is also a key diagnostic factor for this formula. I also interpreted

from Suzanne's presentation that there are red spots on the tip of the

tongue not the purple stasis spots that we see with blood stasis. Am I

incorrect Suzanne? Was there a darkish complexion? or other blood stasis

signs?

 

 

 

Unless one can make a strong case that everything is coming about from blood

stasis in the lower burner I think the formula is imprecise. With these type

of damp heat/phlegm heat patterns (which there are obvious symptoms for) a

much more straightforward approach seems most likely to work. Post jing

fang, IMO, is best for these types of patterns.

 

 

 

In reviewing my previous formula, I probably would add chi fu ling or dan

zhu ye and reduce mu xiang to 3.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Wednesday, March 17, 2010 1:29 PM

 

Re: Re: Insomnia

 

 

 

 

 

We have to remember that the ingredients are not alone in their actions, but

symbiotic with the rest of the formula.

Gui zhi stokes the HT yang, promoting circulation when there is blood

stasis....

This is a balance and balanced by the cooling herbs in the formula.... mu

dan pi and shao yao.

 

It's not ideal, but I can see where Al was going with this one.

 

K

 

 

 

 

 

 

 

[Guest guest]

Jason,

actually GZFLW treats phlegm or dampness and blood stasis together anywhere in

this body. Even though historically we think of it as a formula for the lower

burner, there is nothing in the formula that limits it's use to the lower

burner. there is not one herb in the rx that focuses the rx on the lower

burner. for instance: I am using it right now in a formula that I have written

for a woman with ulcerations in her elbows and ankles due to a mysterious

clotting problem: there is evidence of both phlegm ( it's pustular) and bl.

stasis ( purple, painful fixed pain).

I use it for leg swelling from varicose veins and spider veins.

Dr HUang uses it for geriatric issues: dementia, post stroke sx, insomnia,

constipation. ( all modified of course).

also acne, rosacea

 

and of course fibroids, PID, endometriosis--- the usual ways we think about

GZFLW.

 

that said: I agree- there needs to be systemic signs of blood stasis to use the

rx. the presentation has to be correct.

 

 

Cara

 

On Mar 18, 2010, at 9:18 AM, wrote:

 

>

>

> In this case, we have a diagnosis of damp/phlegm heat with blood stasis.

> Although, GZFLW in a sense treats this, but its primarily focuses is on the

> lower burner. However, in this case the symptoms suggest a strong middle

> burner involvement where the middle burner's qi dynamic is disrupted. This

> formula will do little to address this aspect.

> Text-Only, Daily Digest • Un • Terms of Use

> .

>

>

[Guest guest]

A typo.. This should be:

 

 

 

" is working through the Heart Yang. " or basically treating the blood stasis

by " stoking " the Heart yang.

 

 

 

-Jason

 

 

 

 

On Behalf Of

 

 

 

Furthermore, I do not think that gui zhi in GZFLW

is still being the Heart Yang, but that is a different issue... do others

think otherwise?

 

 

 

 

 

 

 

[Guest guest]

Thanks for the elaboration and I agree it can be used for many things, when

blood stasis is the key factor. However does Huang (or others) use it for

damp heat in the middle burner? This seems a little odd to me...

 

-Jason

 

 

 

 

On Behalf Of cara

Thursday, March 18, 2010 8:09 AM

 

Re: Re: Insomnia

 

Jason,

actually GZFLW treats phlegm or dampness and blood stasis together anywhere

in this body. Even though historically we think of it as a formula for the

lower burner, there is nothing in the formula that limits it's use to the

lower burner. there is not one herb in the rx that focuses the rx on the

lower burner. for instance: I am using it right now in a formula that I

have written for a woman with ulcerations in her elbows and ankles due to a

mysterious clotting problem: there is evidence of both phlegm ( it's

pustular) and bl. stasis ( purple, painful fixed pain).

I use it for leg swelling from varicose veins and spider veins.

Dr HUang uses it for geriatric issues: dementia, post stroke sx, insomnia,

constipation. ( all modified of course).

also acne, rosacea

 

and of course fibroids, PID, endometriosis--- the usual ways we think about

GZFLW.

 

that said: I agree- there needs to be systemic signs of blood stasis to use

the rx. the presentation has to be correct.

 

 

Cara

[Guest guest]

what do you mean DH in the lower burner? you mean PID? if that's what you are

referring to, he'd modify it with da huang. I can also check my notes for other

modifications

 

Cara

 

On Mar 18, 2010, at 10:14 AM, wrote:

 

> Thanks for the elaboration and I agree it can be used for many things, when

> blood stasis is the key factor. However does Huang (or others) use it for

> damp heat in the middle burner? This seems a little odd to me...

>

> -Jason

>

>

>

> On Behalf Of cara

> Thursday, March 18, 2010 8:09 AM

>

> Re: Re: Insomnia

>

> Jason,

> actually GZFLW treats phlegm or dampness and blood stasis together anywhere

> in this body. Even though historically we think of it as a formula for the

> lower burner, there is nothing in the formula that limits it's use to the

> lower burner. there is not one herb in the rx that focuses the rx on the

> lower burner. for instance: I am using it right now in a formula that I

> have written for a woman with ulcerations in her elbows and ankles due to a

> mysterious clotting problem: there is evidence of both phlegm ( it's

> pustular) and bl. stasis ( purple, painful fixed pain).

> I use it for leg swelling from varicose veins and spider veins.

> Dr HUang uses it for geriatric issues: dementia, post stroke sx, insomnia,

> constipation. ( all modified of course).

> also acne, rosacea

>

> and of course fibroids, PID, endometriosis--- the usual ways we think about

> GZFLW.

>

> that said: I agree- there needs to be systemic signs of blood stasis to use

> the rx. the presentation has to be correct.

>

> Cara

>

[Guest guest]

No, I said *middle burner* because this case has clear signs of middle

burner involvement. But I guess you are no longer talking about the case, is

that correct? sorry for the confusion...

 

-Jason

 

 

 

 

On Behalf Of cara

Thursday, March 18, 2010 8:23 AM

 

Re: Re: Insomnia

 

what do you mean DH in the lower burner? you mean PID? if that's what you

are referring to, he'd modify it with da huang. I can also check my notes

for other modifications

 

Cara

[Guest guest]

right- I wasn't talking about the case. I was just elaborating on GZFLW. but

later I can look at my notes and see if I have anything on modifications for

middle burner involvement.

 

Cara

On Mar 18, 2010, at 10:33 AM, wrote:

 

> No, I said *middle burner* because this case has clear signs of middle

> burner involvement. But I guess you are no longer talking about the case, is

> that correct? sorry for the confusion...

>

> -Jason

>

>

>

> On Behalf Of cara

> Thursday, March 18, 2010 8:23 AM

>

> Re: Re: Insomnia

>

> what do you mean DH in the lower burner? you mean PID? if that's what you

> are referring to, he'd modify it with da huang. I can also check my notes

> for other modifications

>

> Cara

>

[Guest guest]

I found quite a few ding gan-ren cases that uses chi shao instead of bai

shao with a gui zhi tang formula / method. Here is the first one.

 

 

 

Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/

 

 

 

Hope this is as interesting to others as it is for me.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Monday, March 15, 2010 7:29 PM

 

RE: Insomnia

 

 

 

 

 

Many physicians over the years have used chi shao instead of bai shao for

gui zhi tang and related formulas. Years ago, I remember reading an

interesting case by Ding Gan Ren who first alerted me to this idea. It was a

GZT case. The book is at the office, therefore I will try to hunt it down

next time I am in.

 

-Jason

 

 

 

 

 

 

 

[Guest guest]

Just to bring it back to the patient.. here are the signs we were given:

* " Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

gall bladder was removed a few years ago. Has trouble falling asleep and

staying asleep. Tosses and turns and feels irritated by not being able to

sleep. Has dream disturbed sleep and nightmares.*

Other symptoms:

*Severe allergies- both food and environmental. Manifest as congestion and

runny nose with clear discharge, sore throat that is itchy, and left ear

pain that also keeps her up at night, and sneezing.*

Overweight: has been trying to lose weight but it is not coming off.

Digestion: bloated, has a bowel that does not feel complete. BM dry and

small.

*Menses: heavy, blood clots, pain before and first few days.*

*Acne: Many small raised bumps all over face skin colored.

*Tongue: *red tip with stasis dots back slightly thick white fur.

*Pulse: slippery rapid "

 

Jason, there is 3 jiao involvement, not just middle jiao.

Can you explain why you're only looking at " middle-burner " damp-heat

involvement?

 

What Cara wrote and Dr. Huang teaches is the way that I was taught how Gui

zhu fu ling wa/tang could be utilized.

This is both TCM and historical usage of GZFLW..

not just for Lower jiao blood stasis w/ phlegm, but especially useful for

this presentation.

 

K

 

 

 

On Thu, Mar 18, 2010 at 10:33 AM, <

> wrote:

 

>

>

> I found quite a few ding gan-ren cases that uses chi shao instead of bai

> shao with a gui zhi tang formula / method. Here is the first one.

>

> Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/

>

> Hope this is as interesting to others as it is for me.

>

>

> -Jason

>

> <%40>

>

[ <%40>\

]

> On Behalf Of

> Monday, March 15, 2010 7:29 PM

> <%40>

> RE: Insomnia

>

>

> Many physicians over the years have used chi shao instead of bai shao for

> gui zhi tang and related formulas. Years ago, I remember reading an

> interesting case by Ding Gan Ren who first alerted me to this idea. It was

> a

> GZT case. The book is at the office, therefore I will try to hunt it down

> next time I am in.

>

> -Jason

>

>

[Guest guest]

K,

 

 

 

Of course there is upper burner (etc) involvement, but I believe the core

pathodynamic is coming from the middle burner. Hence, if you address the

core pathodynamic all of the symptoms (other burners) will get better. I do

not believe that GZFLW is very effective at correcting a middle burner qi

dynamic disruption. There are clearly better formulas for this. Furthermore,

if one is diagnosing damp-heat in the three burners then a much better

choice would be another one of my suggested formula san ren tang.

 

 

 

By the way, my previous comments about GZFLW are straight from Bensky and

represent a core understanding of the pathodynamic of the formula. That is

not to say that GZFLW cannot treat conditions that manifest in other areas

of the body, of course they can. I think you're confusing pathodynamic with

symptoms. The key to diagnosis is to find the underlying pathodynamic and

zoom in on it, just because there are symptoms in all burners does not mean

that the problem must be a three burner problem. I still stick to my same

diagnosis which is the same as Z'ev's.

 

 

 

I respect that you think the whole problem is coming about from blood

stasis, but I just don't believe it, especially with the pulse and tongue.

Clinically speaking for a blood stasis pattern to cause this kind of

insomnia there would be much more systemic symptoms of blood stasis. This

is also true for picking GZFLW. In my experience, this type of pattern is

much more likely to be coming about from the middle burner leading to heat

in the upper burner etc.

 

 

 

We can agree to disagree because we will never know which approach is

actually better. But that is my rationale.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Thursday, March 18, 2010 11:31 AM

 

Re: Insomnia

 

 

 

 

 

Just to bring it back to the patient.. here are the signs we were given:

* " Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

gall bladder was removed a few years ago. Has trouble falling asleep and

staying asleep. Tosses and turns and feels irritated by not being able to

sleep. Has dream disturbed sleep and nightmares.*

Other symptoms:

*Severe allergies- both food and environmental. Manifest as congestion and

runny nose with clear discharge, sore throat that is itchy, and left ear

pain that also keeps her up at night, and sneezing.*

Overweight: has been trying to lose weight but it is not coming off.

Digestion: bloated, has a bowel that does not feel complete. BM dry and

small.

*Menses: heavy, blood clots, pain before and first few days.*

*Acne: Many small raised bumps all over face skin colored.

*Tongue: *red tip with stasis dots back slightly thick white fur.

*Pulse: slippery rapid "

 

Jason, there is 3 jiao involvement, not just middle jiao.

Can you explain why you're only looking at " middle-burner " damp-heat

involvement?

 

What Cara wrote and Dr. Huang teaches is the way that I was taught how Gui

zhu fu ling wa/tang could be utilized.

This is both TCM and historical usage of GZFLW..

not just for Lower jiao blood stasis w/ phlegm, but especially useful for

this presentation.

 

K

 

 

 

 

 

 

 

[Guest guest]

Actually, I have some further thoughts on why GZFLW is not suitable:

 

 

 

If we look at this problem from a clinical perspective, Formulas and

Strategies lays out the core diagnostic symptoms to look for choosing this

formula. However, none of them appear in this case. “In practice, the

following pointers are helpful in diagnosing a Cinnamon Twig and Poria Pill

(guì zhï fú líng wán) pattern:

 

1. • Resistance and tenderness in the lower abdomen on palpation (some

Japanese physicians think that this will be more pronounced on the left);

alternatively, patients themselves may have a subjective feeling of fullness

in the abdomen; if a mass is palpated, this will tend to be soft and movable

and painful to the touch.

 

2. • The simultaneous presence of cold and heat signs, such as cold

below and heat above, or inflammation aggravated by cold, but none of the

signs of dryness associated with Flow-Warming Decoction (wën jïng täng) and

Tangkuei and Peony Powder (däng guï sháo yào sân) patterns, both of which

include signs of blood deficiency.

 

3. • Systemic signs of blood stasis, such as a darkish complexion, dark

rings under the eyes, increased pigmentation, and stasis spots on the

tongue.

 

4. • Other typical signs of impediments to fluid and blood circulation,

such as dizziness, vertigo, spots in front of one’s eyes, and shoulder

stiffness or pain.”

 

 

 

Also, GZFLW is not enough to address the damp/phlegm that the tongue and

pulse indicate. Furthermore, F & S states, a GZFLW pattern should be

" accompanied by a dark tongue with purple stasis spots and a submerged and

choppy pulse.” - it also will not have enough effect on the bowels for this

kind of pattern. Moving the bowels is essential.

 

 

 

So there is no question that such a formula can address insomnia, actually

almost any formula can, but one must ask, insomnia from what pattern, what

underlying pathodynamic, and what are the key diagnostic symptoms to

diagnosis.

 

 

 

-Jason

 

 

 

 

 

 

[Guest guest]

Jason,

I never said that the whole problem comes from blood stasis...

J wrote: " I respect that you think the whole problem is coming about from

blood stasis "

(thanks for the respect though...)

 

only defending Al's choice of a *modified** Gui zhi fu ling tang* for this

particular presentation.

I've already stated twice that I see a Xie xin tang family formula as ideal

from a Shang han za bing lun perspective... *specifically Gan cao xie xin

tang*, which I quoted from " Formulas and Strategies 3rd edition " . I've also

made a case for a *Xiao chai hu tang modification*, which itself is a

*modification

of Ban xia xie xin tang* (vice versa). Although it relates to a different

conformation from the six Qi model, it is still a harmonizing formula which

clears damp-heat in the middle jiao (GB-ST/SP). Without having the exact

pulse and fukushin picture, it would be difficult to state which formula is

the alpha dog. Until then, lets give respect to Zhang Zhong Jing who

compiled all of these formulas in question.

 

K

 

 

 

 

 

On Thu, Mar 18, 2010 at 3:08 PM, <

> wrote:

 

>

>

> K,

>

> Of course there is upper burner (etc) involvement, but I believe the core

> pathodynamic is coming from the middle burner. Hence, if you address the

> core pathodynamic all of the symptoms (other burners) will get better. I do

> not believe that GZFLW is very effective at correcting a middle burner qi

> dynamic disruption. There are clearly better formulas for this.

> Furthermore,

> if one is diagnosing damp-heat in the three burners then a much better

> choice would be another one of my suggested formula san ren tang.

>

> By the way, my previous comments about GZFLW are straight from Bensky and

> represent a core understanding of the pathodynamic of the formula. That is

> not to say that GZFLW cannot treat conditions that manifest in other areas

> of the body, of course they can. I think you're confusing pathodynamic with

> symptoms. The key to diagnosis is to find the underlying pathodynamic and

> zoom in on it, just because there are symptoms in all burners does not mean

> that the problem must be a three burner problem. I still stick to my same

> diagnosis which is the same as Z'ev's.

>

> I respect that you think the whole problem is coming about from blood

> stasis, but I just don't believe it, especially with the pulse and tongue.

> Clinically speaking for a blood stasis pattern to cause this kind of

> insomnia there would be much more systemic symptoms of blood stasis. This

> is also true for picking GZFLW. In my experience, this type of pattern is

> much more likely to be coming about from the middle burner leading to heat

> in the upper burner etc.

>

> We can agree to disagree because we will never know which approach is

> actually better. But that is my rationale.

>

>

> -Jason

>

> <%40>

>

[ <%40>\

]

> On Behalf Of

> Thursday, March 18, 2010 11:31 AM

> <%40>

> Re: Insomnia

>

>

> Just to bring it back to the patient.. here are the signs we were given:

> * " Main symptom: insomnia sleeps only 4-6 hours a night. Started after her

> gall bladder was removed a few years ago. Has trouble falling asleep and

> staying asleep. Tosses and turns and feels irritated by not being able to

> sleep. Has dream disturbed sleep and nightmares.*

> Other symptoms:

> *Severe allergies- both food and environmental. Manifest as congestion and

> runny nose with clear discharge, sore throat that is itchy, and left ear

> pain that also keeps her up at night, and sneezing.*

> Overweight: has been trying to lose weight but it is not coming off.

> Digestion: bloated, has a bowel that does not feel complete. BM dry and

> small.

> *Menses: heavy, blood clots, pain before and first few days.*

> *Acne: Many small raised bumps all over face skin colored.

> *Tongue: *red tip with stasis dots back slightly thick white fur.

> *Pulse: slippery rapid "

>

> Jason, there is 3 jiao involvement, not just middle jiao.

> Can you explain why you're only looking at " middle-burner " damp-heat

> involvement?

>

> What Cara wrote and Dr. Huang teaches is the way that I was taught how Gui

> zhu fu ling wa/tang could be utilized.

> This is both TCM and historical usage of GZFLW..

> not just for Lower jiao blood stasis w/ phlegm, but especially useful for

> this presentation.

>

> K

>

>

[Guest guest]

Give respect to ZZJ? What are you talking about and what does this have to

do with the case? If you want to " defend " this GZFLW then please go ahead.

You should clearly lay out your diagnosis, the treatment principles, the key

signs to look for (to choose this formula) and how this is going to correct

the problem. Just defending it by saying " it is good for such problems " just

does not cut it for me.

 

 

 

Quite simply, I think we have enough information to think through this case

clearly and the logic so far for GZFLW just doesn't seem to stand up. BTW -

xie xin tang's obviously focuses on the middle burner which is exactly where

my diagnosis is. If you will notice the formula I wrote is based on ban xia

shu mi tang, ban xia xie xin tang, mu xiang bing lang wan, as well as

specific herbal pairs (dui yao) to address the whole picture.

 

 

 

-Jason

 

 

 

 

On Behalf Of

Thursday, March 18, 2010 9:01 PM

 

Re: Insomnia

 

 

 

 

 

Jason,

I never said that the whole problem comes from blood stasis...

J wrote: " I respect that you think the whole problem is coming about from

blood stasis "

(thanks for the respect though...)

 

only defending Al's choice of a *modified** Gui zhi fu ling tang* for this

particular presentation.

I've already stated twice that I see a Xie xin tang family formula as ideal

from a Shang han za bing lun perspective... *specifically Gan cao xie xin

tang*, which I quoted from " Formulas and Strategies 3rd edition " . I've also

made a case for a *Xiao chai hu tang modification*, which itself is a

*modification

of Ban xia xie xin tang* (vice versa). Although it relates to a different

conformation from the six Qi model, it is still a harmonizing formula which

clears damp-heat in the middle jiao (GB-ST/SP). Without having the exact

pulse and fukushin picture, it would be difficult to state which formula is

the alpha dog. Until then, lets give respect to Zhang Zhong Jing who

compiled all of these formulas in question.

 

K

 

 

 

 

 

 

 

[Guest guest]

Jason wrote:

" BTW - xie xin tang's obviously focuses on the middle burner which is

exactly where

my diagnosis is...if you will notice the formula I wrote is based on ban xia

shu mi tang, ban xia xie xin tang, mu xiang bing lang wan... "

 

Your 11 herb formula has 2 herbs that are in Ban xia xie xin tang, so how

does this make it based on BXXXT?

.... Ban xia and Huang lian

leaving out... Huang qin, Gan jiang, Ren shen, Gan cao, Da zao (5/7 of the

formula).

 

Patient's diagnosis: Shen disturbance, wind-phlegm-heat in upper jiao, Damp

congestion in middle jiao, blood stasis in lower jiao.

 

I've wriiten this before, but here it is again....

What signs show blood stasis? (possible internal scarring from GB removal

surgery.. this is just conjecture though)

Menses: heavy, blood clots, pain before and first few days.... this seems

self-explanatory

Tongue: red tip with stasis dots .. stasis dots show blood stasis, red

tip relates to the acne, sore throat and insomnia

back slightly thick white fur (possible damp in the MJ or LJ)

Pulse: slippery and rapid (slippery can mean food stagnation and/or

dampness and/or phlegm and/or heat and pregnancy)

 

For instance...

Modified Gui zhi fu ling tang:

 

Gui zhi (6 gms), Fu shen (9 gms), Chi shao (6 gms), Mu dan pi (6 gms), Tao

ren (6 gms)

Ban xia (6), Huang qin (6), Huang lian (3), Mu xiang (6), Suan zao ren (12),

Zhi mu (6), Yuan zhi (6)

 

(12 herbs/ 78 gms total)

 

Great conversation, but seems like we're going in circles now.

Giving respect to Zhang Zhong Jing was just some parting words, in light of

the investigation of these ZZJ formulas.

 

K

 

 

 

[Guest guest]

K,

 

If you don't understand how this can be based on BXXXT please check out Ye

tian-shi, Ding gan-ren, Qin-Bo-Wei, or other meng he style doctors. There

are many others that can teach such ideas but I just like those. But

essentially it is understanding the principles behind the formula and not

rigidly being confined to the exact ingredients. Check out the latest case

study by Ding gan-ren which demonstrates this idea for Gui Zhi Tang.

 

Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/

 

SO, I agree if you mix GZFLW with this BXXXT idea this might work. However

this was not what we were talking about and not the original modification

that Al presented. As a base formula for the core pathodynamic it seems

second best and I think you would agree, since you like XCHT and BXXXT

ideas. So why even go there?

 

Any formula, modified enough, can work, but the real question is does it hit

the core pathodynamic. If the core pathodynamic is based on the middle

burner then GZFLW is not a good base formula choice. If the core

pathodynamic is from blood stasis then XCHT and BXXXT are not good base

formulas. You can't have it both ways, it is one or the other. The key is to

diagnosis clearly and find the core idea to unravel it. SO once you have

made a diagnosis you must come up with treatment principles, this then must

be reflected in the formula. I find a bit of disconnect in this process with

your formulas.

 

Thanks for the convo...

 

-Jason

 

 

 

 

 

On Behalf Of

Friday, March 19, 2010 9:40 AM

 

Re: Insomnia

 

 

 

Jason wrote:

" BTW - xie xin tang's obviously focuses on the middle burner which is

exactly where

my diagnosis is...if you will notice the formula I wrote is based on ban

xia

shu mi tang, ban xia xie xin tang, mu xiang bing lang wan... "

 

Your 11 herb formula has 2 herbs that are in Ban xia xie xin tang, so

how

does this make it based on BXXXT?

.... Ban xia and Huang lian

leaving out... Huang qin, Gan jiang, Ren shen, Gan cao, Da zao (5/7 of

the

formula).

 

Patient's diagnosis: Shen disturbance, wind-phlegm-heat in upper jiao,

Damp

congestion in middle jiao, blood stasis in lower jiao.

 

I've wriiten this before, but here it is again....

What signs show blood stasis? (possible internal scarring from GB

removal

surgery.. this is just conjecture though)

Menses: heavy, blood clots, pain before and first few days.... this

seems

self-explanatory

Tongue: red tip with stasis dots .. stasis dots show blood stasis, red

tip relates to the acne, sore throat and insomnia

back slightly thick white fur (possible damp in the MJ or LJ)

Pulse: slippery and rapid (slippery can mean food stagnation and/or

dampness and/or phlegm and/or heat and pregnancy)

 

For instance...

Modified Gui zhi fu ling tang:

 

Gui zhi (6 gms), Fu shen (9 gms), Chi shao (6 gms), Mu dan pi (6 gms),

Tao

ren (6 gms)

Ban xia (6), Huang qin (6), Huang lian (3), Mu xiang (6), Suan zao ren

(12),

Zhi mu (6), Yuan zhi (6)

 

(12 herbs/ 78 gms total)

 

Great conversation, but seems like we're going in circles now.

Giving respect to Zhang Zhong Jing was just some parting words, in light

of

the investigation of these ZZJ formulas.

 

K

 

 

[Guest guest]

Gentleman,

 

I want to offer up a slightly different perspective: the woman has heavy clotty

periods and insomnia. I feel that the formula should focus on clearing heat. I

don't see her as having a gzflw presentation. I think that qin lian si wu tang

address a wider scope of what is going on with her.

the ingreds are si wu tang ( with sheng di), huang qin, huang lian and mai

dong:

 

the si wu tang will harmonize the blood, the huangs will clear heat from the

blood, clear heat and dry dampness from the MW and also eliminate vexation, the

sheng di cools the blood and also clears heat from the heart, the mai dong also

will calm the spirit.

 

whaddya think?

 

Cara

On Mar 19, 2010, at 2:05 PM, wrote:

 

> K,

>

> If you don't understand how this can be based on BXXXT please check out Ye

> tian-shi, Ding gan-ren, Qin-Bo-Wei, or other meng he style doctors. There

> are many others that can teach such ideas but I just like those. But

> essentially it is understanding the principles behind the formula and not

> rigidly being confined to the exact ingredients. Check out the latest case

> study by Ding gan-ren which demonstrates this idea for Gui Zhi Tang.

>

> Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/

>

> SO, I agree if you mix GZFLW with this BXXXT idea this might work. However

> this was not what we were talking about and not the original modification

> that Al presented. As a base formula for the core pathodynamic it seems

> second best and I think you would agree, since you like XCHT and BXXXT

> ideas. So why even go there?

>

> Any formula, modified enough, can work, but the real question is does it hit

> the core pathodynamic. If the core pathodynamic is based on the middle

> burner then GZFLW is not a good base formula choice. If the core

> pathodynamic is from blood stasis then XCHT and BXXXT are not good base

> formulas. You can't have it both ways, it is one or the other. The key is to

> diagnosis clearly and find the core idea to unravel it. SO once you have

> made a diagnosis you must come up with treatment principles, this then must

> be reflected in the formula. I find a bit of disconnect in this process with

> your formulas.

>

> Thanks for the convo...

>

> -Jason

>

>

>

> On Behalf Of

> Friday, March 19, 2010 9:40 AM

>

> Re: Insomnia

>

> Jason wrote:

> " BTW - xie xin tang's obviously focuses on the middle burner which is

> exactly where

> my diagnosis is...if you will notice the formula I wrote is based on ban

> xia

> shu mi tang, ban xia xie xin tang, mu xiang bing lang wan... "

>

> Your 11 herb formula has 2 herbs that are in Ban xia xie xin tang, so

> how

> does this make it based on BXXXT?

> ... Ban xia and Huang lian

> leaving out... Huang qin, Gan jiang, Ren shen, Gan cao, Da zao (5/7 of

> the

> formula).

>

> Patient's diagnosis: Shen disturbance, wind-phlegm-heat in upper jiao,

> Damp

> congestion in middle jiao, blood stasis in lower jiao.

>

> I've wriiten this before, but here it is again....

> What signs show blood stasis? (possible internal scarring from GB

> removal

> surgery.. this is just conjecture though)

> Menses: heavy, blood clots, pain before and first few days.... this

> seems

> self-explanatory

> Tongue: red tip with stasis dots .. stasis dots show blood stasis, red

> tip relates to the acne, sore throat and insomnia

> back slightly thick white fur (possible damp in the MJ or LJ)

> Pulse: slippery and rapid (slippery can mean food stagnation and/or

> dampness and/or phlegm and/or heat and pregnancy)

>

> For instance...

> Modified Gui zhi fu ling tang:

>

> Gui zhi (6 gms), Fu shen (9 gms), Chi shao (6 gms), Mu dan pi (6 gms),

> Tao

> ren (6 gms)

> Ban xia (6), Huang qin (6), Huang lian (3), Mu xiang (6), Suan zao ren

> (12),

> Zhi mu (6), Yuan zhi (6)

>

> (12 herbs/ 78 gms total)

>

> Great conversation, but seems like we're going in circles now.

> Giving respect to Zhang Zhong Jing was just some parting words, in light

> of

> the investigation of these ZZJ formulas.

>

> K

>

>

[Guest guest]

Cara,

As long as there are digestive problems and bloating, it doesn't matter what

you do. Giving cold or greasy herbs will just block the middle burner more,

worsen spleen transformation, and the pattern will just exascerbate. Upper

burner heat that contributes to insomnia in this case would only respond to

normalizing the upbearing of clear yang and downbearing of turbid yin.

 

 

On Mar 19, 2010, at 12:27 PM, cara wrote:

 

> Gentleman,

>

> I want to offer up a slightly different perspective: the woman has heavy

clotty periods and insomnia. I feel that the formula should focus on clearing

heat. I don't see her as having a gzflw presentation. I think that qin lian si

wu tang address a wider scope of what is going on with her.

> the ingreds are si wu tang ( with sheng di), huang qin, huang lian and mai

dong:

>

> the si wu tang will harmonize the blood, the huangs will clear heat from the

blood, clear heat and dry dampness from the MW and also eliminate vexation, the

sheng di cools the blood and also clears heat from the heart, the mai dong also

will calm the spirit.

>

> whaddya think?

>

> Cara

> On Mar 19, 2010, at 2:05 PM, wrote:

>

>> K,

>>

>> If you don't understand how this can be based on BXXXT please check out Ye

>> tian-shi, Ding gan-ren, Qin-Bo-Wei, or other meng he style doctors. There

>> are many others that can teach such ideas but I just like those. But

>> essentially it is understanding the principles behind the formula and not

>> rigidly being confined to the exact ingredients. Check out the latest case

>> study by Ding gan-ren which demonstrates this idea for Gui Zhi Tang.

>>

>> Chinese Medicine/case-studies/tai-yang-gui-zhi-tang-dgr/

>>

>> SO, I agree if you mix GZFLW with this BXXXT idea this might work. However

>> this was not what we were talking about and not the original modification

>> that Al presented. As a base formula for the core pathodynamic it seems

>> second best and I think you would agree, since you like XCHT and BXXXT

>> ideas. So why even go there?

>>

>> Any formula, modified enough, can work, but the real question is does it hit

>> the core pathodynamic. If the core pathodynamic is based on the middle

>> burner then GZFLW is not a good base formula choice. If the core

>> pathodynamic is from blood stasis then XCHT and BXXXT are not good base

>> formulas. You can't have it both ways, it is one or the other. The key is to

>> diagnosis clearly and find the core idea to unravel it. SO once you have

>> made a diagnosis you must come up with treatment principles, this then must

>> be reflected in the formula. I find a bit of disconnect in this process with

>> your formulas.

>>

>> Thanks for the convo...

>>

>> -Jason

>>

>>

>>

>> On Behalf Of

>> Friday, March 19, 2010 9:40 AM

>>

>> Re: Insomnia

>>

>> Jason wrote:

>> " BTW - xie xin tang's obviously focuses on the middle burner which is

>> exactly where

>> my diagnosis is...if you will notice the formula I wrote is based on ban

>> xia

>> shu mi tang, ban xia xie xin tang, mu xiang bing lang wan... "

>>

>> Your 11 herb formula has 2 herbs that are in Ban xia xie xin tang, so

>> how

>> does this make it based on BXXXT?

>> ... Ban xia and Huang lian

>> leaving out... Huang qin, Gan jiang, Ren shen, Gan cao, Da zao (5/7 of

>> the

>> formula).

>>

>> Patient's diagnosis: Shen disturbance, wind-phlegm-heat in upper jiao,

>> Damp

>> congestion in middle jiao, blood stasis in lower jiao.

>>

>> I've wriiten this before, but here it is again....

>> What signs show blood stasis? (possible internal scarring from GB

>> removal

>> surgery.. this is just conjecture though)

>> Menses: heavy, blood clots, pain before and first few days.... this

>> seems

>> self-explanatory

>> Tongue: red tip with stasis dots .. stasis dots show blood stasis, red

>> tip relates to the acne, sore throat and insomnia

>> back slightly thick white fur (possible damp in the MJ or LJ)

>> Pulse: slippery and rapid (slippery can mean food stagnation and/or

>> dampness and/or phlegm and/or heat and pregnancy)

>>

>> For instance...

>> Modified Gui zhi fu ling tang:

>>

>> Gui zhi (6 gms), Fu shen (9 gms), Chi shao (6 gms), Mu dan pi (6 gms),

>> Tao

>> ren (6 gms)

>> Ban xia (6), Huang qin (6), Huang lian (3), Mu xiang (6), Suan zao ren

>> (12),

>> Zhi mu (6), Yuan zhi (6)

>>

>> (12 herbs/ 78 gms total)

>>

>> Great conversation, but seems like we're going in circles now.

>> Giving respect to Zhang Zhong Jing was just some parting words, in light

>> of

>> the investigation of these ZZJ formulas.

>>

>> K

>>

>>