PC3: This is the water point of the fire channel. It effectively treats conditions of KD deficiency + HT Fire. Probably a Tian Wan Bu Xin Dan patient.

PC4: The Xi-cleft point of the PC, and best point for acute chest pain caused by heart conditions such as angina pectoris. Like nitroglycerin, PC4 is first for chest pain. PC4 is not limited just to heart or coronary artery problems, it can be applied to any vascular condition presenting as pain due to vessel blockage. Clinically used for Buerger's Disease.

PC5: This point is like the "second-string player" for PC6. PC6 has a powerful action on the HT. If the HT is too weak to use PC6, or if PC6 can not be used for some other reason such as a burn or scar, then PC5 can take its place. PC5 is also used as the empirical point for malaria.

PC6: "Inner Pass," indicates the paths leading inward like the esophagus, stomach & trachea. PC6 targets the chest, diaphragm & epigastrium. When used alone it goes to the Upper Jiao & Middle Jiao, but reaches the Lower Jiao when combined with SP4. Famous for treating nausea & vomiting, research has shown that simply placing a slice of ginger directly onto PC6 can reduce nausea & vomiting.

PC7: Local point for Carpal Tunnel syndrome; needle toward the palm. Clinically also for nausea or vomiting due to motion sickness. Another clinical use is to calm the Shen for emotional disturbances, like Long Gu (Fossilia Ossis Mastodi) which anchors & calms Shen. HT7 is like Suan Zao Ren (Ziziphi Spinosae Semen), because both nourish & calm Shen.

PC8: Both PC8 & HT8 are horary points (fire point on the fire channel), & Ying-spring points, so needling these points disperses Heat. "Lao" is translated as fatigue or overwork, & "Gong" implies the mouth. Clinical indications include dry mouth, bitter taste in the mouth, or tongue ulcers. This point can reduce excessive sweating of the palms.

PC9: According to Korean Hand Acupuncture, PC9 corresponds to DU20, since the distal phalange of the middle finger represents the head. So PC9 can stimulate the brain in that microsystem. PC9 is the wood point of the fire channel, so it has a tonifying action. The HT & PC encompass brain functions, so PC9 can be used to increase intellectual acuity. Tonify PC (+LV1, +PC9, -KD10, -PC3) in Korean Four Needle Technique is commonly used for treatment of dementia or Alzheimer's disease, and PC9 is the most important point in this prescription.

These days it's popular to use big formulas with long ingredient lists.  The general principle of many of these formulas is simple, but they include many herbs with the same function just to achieve one action.  This actually kind of "dilutes" the strength of the formula because so many different herbs tend to cancel each other out in terms of taste, temperature, and action.  Energetically the big combinations easily lose their direction.  This is the same case when too many acupuncture points are chosen for use in one treatment.  The Qi becomes scattered and confused, rather than focusing unanimously on a single task. 

There is a general concept in science that the simplest answer is most likely the best one.  This is also true in the context of Oriental Medicine.  The simplest formula is the strongest, and the simplest point prescription is the most direct.  For example, Shang Han Lun formulas are very simple, yet very strong.  When used correctly, they work like a snap; but when used incorrectly they may cause side effects.  I believe that's the reason why the bigger formulas have become more popular. 

When the skill or the confidence to choose the one single most appropriate herb is lacking, a broad spectrum approach of using a numerous herbs that have the desired action can have some effect to accomplish the desired goal while reducing the risks associated with committing to the wrong choice of a single herb.  The price paid for that method, however, is not only the health of our patients but also the reputation of our profession.  Simple is usually better.  Why should we practice compromise when we have the knowledge to make the best choice?  The key is to understand the basic principles of creating a formula, and develop the skill to custom design simple, powerful and accurate formulas based on the individual cases.

There are situations when using a milder formula or acupuncture treatment is more appropriate.  For example, when treating children or the elderly, or when the diagnosis is unclear.  In these situations, "diluting" the energetic direction is appropriate because it reduces side effects.  The way to make a formula milder is to use multiple herbs with the same functions, but reduce the dosage of each herb so the formula doesn't become too big.  The way to make an acupuncture treatment milder is to increase the number of needles but use a gentle technique.  Using a gentle approach is wise when it is chosen for the right reasons.  The strong simple approach may cause side effects, but when used correctly it yields a faster result and is more effective.  Therefore, simple is usually better.

Tian Ma (Rhizoma Gastrodia)

Tian Ma can treat the root of many problems in the brain, such as cerebrovascular disease and neural conduction disorders.  The importance of this herb is increasing as the baby boomer generation is reaching retirement age.  One of the most common diseases in the elderly is dementia.  Not limited to use for the elderly, Tian Ma can help people of any age with epilepsy, or any circulation problem in the brain including tinnitus, headache and dizziness.  A very unique characteristic of Tian Ma is that it crosses the blood-brain barrier, which allows it to help cerebrovascular circulation and improve neurotransmitter function. 

Imagine a rusty old light socket with a bulb that intermittently blinks on and then off, on and then off.  When that light socket is cleaned up or changed, the very same bulb will glow brightly and consistently.  Tian Ma has the power to physically restore the "hardware" in the brain, allowing the spirit to shine through, like replacing the rusty socket so the bulb glows brightly and consistently.

Although Tian Ma is the king herb in some formulas, I like to use it as a deputy.   In cases of deficiency, use it with herbs to tonify Liver Blood (Shu Di Huang, He Shou Wu, Dang Gui) or tonify Liver Yin (Gou Qi Zi).  In cases of excess,  use Tian Ma with herbs that open the orifices and move the Qi (Shi Chang Pu, Mu Xiang, Wu Yao).


1. DEMENTIA
Elderly patients may present with symptoms of poor memory, decreased analytical capability, affected cognition, attention difficulty, language difficulty, short-term memory loss, or progressive decline of cognitive function.  In these kinds of cases, the treatment principle of TCM is to open the channels and extinguish Wind.  For thin patients whose CT or MRI reports indicate clear brain cell damage, tonify the Liver Blood and Kidney Yin, and use about 4-6 grams of Tian Ma.   

Shu Di Huang 16g
He Shou Wu 8g
Gou Qi Zi 8g
Shan Zhu Yu 8g
Tian Ma 6g
Dang Gui 4g
Lu Rong 2g

For a slightly chubby or heavier patient with a lot of Damp-Phlegm, the following herbs expel Phlegm and open the orifices. Mu Xiang is used instead of She Xiang because She Xiang is so expensive and rare.  Mu Xiang is a suitable replacement.  This formula can be used not only for dementia, but also for post-stroke if the patient has an obese body type and still remains drowsy 2-3 months after the incident.

Tian Ma 8g
Dan Nan Xing 6g
Shi Chang Pu 6g
Mu Xiang 4g(instead of She Xiang)


2. SEIZURES
According to TCM seizures are classified as internal Liver Wind, and they are mainly related to stress.  A person who tends to be more stressed and exhibits symptoms of Liver Wind has a higher risk than others for seizures or tremors.  Tian Ma can be used in that case.

Another profile for seizures occurs in children who experience overwhelming emotion, especially anger.  Seizures can occur even in the absence of a physical brain problem or any EEG abnormality.  This type of case can be referred to as "functional epilepsy," in which there is just a temporary neurotransmitter problem and temporary ischemia, but no sustained physical or electrical problems in the brain.  In this case, Tian Ma can help to open the channels, extinguish Wind, increase blood flow to the brain, and improve neurotransmitter activity.  These types of seizures are called Hysterical Seizures.  Another good herb to be used is Xiang Fu.  Treatment with the following formula can reduce the occurrence of Hysterical seizures in just one to two months.  A longer course of treatment will be required if the patient must also be weaned off of pharmaceutical drugs.

Tian Ma 8g
Xiang Fu 6g
Chen Pi 6g
Mu Xiang 4g
Wu Yao 4g


3. HEAD (Heaviness, Tinnitus, Dizziness)

(a) Heavy Head Pain
If the head feels heavy and foggy like it's not receiving enough oxygen, this can be a pre-stroke symptom that results from poor circulation. Combine herbs to activate both the Blood and the Qi.  The following combination increases blood flow in the brain to get rid of that foggy, heavy feeling: Chuan Xiong + Gao Ben or Bai Zhi.  Chuan Xiong activates the Blood and Gao Ben and Bai Zhi guide to the head. 

(b) Brain Noise
There is a condition called Brain Noise, or Phantom Noise, in which someone experiences a heavy and painful sensation in the head accompanied by white noise which is not experienced in the ear, but from inside the head.  In the simplest terms, this situation can be explained as something like a bruit in the cerebral vasculature.  Some cases of Brain Noise may require surgery, but if surgery is not required then Tian Ma is effective for this condition.  Tian Ma is like aspirin for the brain.  The basic formula is listed below.  Other herbs should be added based on the pattern, for example Yin tonifying herbs for Liver and Kidney Yin deficiency, but the basic formula is:   

Chen Pi 12g
Chuan Xiong 8g
Tian Ma 6-8g
Fang Feng 4g

Q: If Tian Ma is like brain aspirin, then why is Chen Pi the king herb in the formula for Brain Noise?

A: According to the OM differential diagnosis, this problem stems from a lack of Qi and Blood circulation.  Therefore the main treatment principle is to move Qi and Blood, giving Chen Pi and Chuan Xiong a higher position in the formula's hierarchy while Tian Ma serves as the deputy with the function of increasing Blood circulation in the brain.  Chen Pi is the king since it can move Qi.  Since Qi moves the Blood, Chen Pi is given credit for helping to move the Qi and improve the Blood circulation of the whole body.  After 15 days of treatment with the original formula, the treatment principle can be changed to focus more on tonification and Shu Di Huang can be added.

(c) Dizziness due to Phlegm
For a patient with a weak digestive system that feels dizziness, Tian Ma makes a good deputy.  Ban Xia Bai Zhu Tian Ma Tang is a famous formula used for this type of case, but smaller, simpler formulas can be just as effective.  If the chief complaint is dizziness, plus the sensation of being on a boat, nausea, and darkness below the eyes, these are Phlegm-Fluid symptoms and the following formula is good:

Bai Zhu (fried) 12g
Fu Ling 8g
Ren Shen 6g
Tian Ma 4g
Ban Xia (ginger prepared) 4g
Sheng Jiang 8g


CLINICAL CASES

CASE 1.
A thin, 63 year old female had the chief complaint of dizziness and vertigo.  She also had indigestion.  She's never been able to eat very much at one sitting ever since childhood.  The dizziness set in six months ago when she was taking care of her young, energetic grandson and she got exhausted.  She has been feeling dizzy almost continuously since then.  She also feels nauseated and has the sensation like she's on a boat.  Her MD couldn't find any problem based on the exams and lab work, and gave her instructions just to rest.  So for a few weeks she stayed at home and ate noodle soup and got lots of sleep.  Now she's noticed that eating noodles makes her dizziness more severe.  She's developed dark circles below her eyes, and when she wakes up her eyes and hands feel swollen.  She was given this formula for two weeks: 

Bai Zhu (fried) 12g
Fu Ling 8g
Ren Shen 6g
Huang Qi 6g
Tian Ma 4g
Ban Xia (ginger prepared) 4g
Lu Rong 2g
Sheng Jiang 5pcs

At her follow-up appointment 15 days later, she reported her dizziness, digestive problems, edema, and dark circles all improved.  She sometimes still felt a little dizzy, but overall claimed to be 70-80% better and wanted more herbs.  She was given the above formula with the following modifications:
   
Fu Ling 8g
Bai Zhu 8g (reduced)
Shan Yao 10g             

CASE 2. 
A 57 year old woman had the chief complaint of brain noise.  Her body shape was thin in the arms and legs but with a disproportionately large abdomen.  She said there's been the sound of insects singing in her brain, not in her ears, for six months now.  It started out just at night, but now it is there all night and day.  There is no abnormal finding on her CT or MRI.  She has been taking medication for diabetes for three years, and medication for hypertension for seven years.  Her MD attributes her symptom to stress.  Sometimes at night she has muscle spasms and a dry mouth.  She also sometimes feels a heavy sensation in her body or in her head, so she thinks she has a lack of circulation and is worried about stroke.  She had a hysterectomy 15 years before.  She took this formula:

Chen Pi 12g
Gou Qi Zi 8g
Tian Hua Fen 8g
Chuan Xiong 4g
Fang Feng 4g
Tian Ma 4g
Hong Hua 2g

At her follow-up appointment 15 days later, the patient was happy to report that the brain noise had reduced by 50-60%.  It was mostly gone during the day time, and now only bothered her at night and early in the morning.  She was given the formula above with the following modifications for the next two weeks: 

Shu Di 12g
Chen Pi 8g (reduced)   

CASE 3. 
A 24 year old female had the chief complaint of seizures (grand mal type).  Her emotional state was very anxious and sensitive.  When she was 19, her parents divorced.  She lives with her mother.  She was having seizures 1-3 times per month.  She was prescribed Topamax to take twice daily, which helped.  She has been stressed about finding a job and hasn't been sleeping well at all.  A few days ago after she got into an argument with her mother, she had another grand mal.  Her MD wants to increase the dosage of Topamax and prescribe a sedative, but she is concerned about the price and the side effects of the drugs and really wants to try herbs instead.  She was given:

Long Yan Rou 12g
Suan Zao Ren 8g
Dang Gui 6g
Tian Ma 6g
Chen Pi 4g
Xiang Fu 4g
Mu Xiang 3g
Huang Lian (fried) 3g

At her follow-up 15 days later, the patient reported that no seizures had occurred and she had reduced her prescription use by about 20%.  After three months of herbal treatment she was able to quit taking the Topamax altogether.  The patient was taught some Qi Gong exercises and instructed to use Qi Gong for maintenance to help keep her anxiety in check.

CASE 4.
A 72 year old female patient with a very small stature and dentures has been experiencing severe memory loss for the last 3-4 years.  Her MD diagnosed senile dementia and presbyophrenia syndrome.  Sometimes she cannot even recognize some familiar objects in her home.  She lives alone and her daughter drives her to appointments.  She has a good appetite.  Her hair is notably brittle and thin.  She was around 50 when she lost her teeth.

She was recommended a treatment course of at least three months due to her condition of Yin, Blood and Essence deficiency.  The principle was to nourish the brain to treat the memory.  Upon visiting every month her progression was easy to see: improved cognition, reduced dementia, improved hair texture, and her appetite reduced to normal.  This was the formula she took:   

Shu Di Huang 16g
Gou Qi Zi 8g
Shan Zhu Yu 8g
Tian Ma 6g
Fu Shen 6g
Yuan Zhi 4g
Shi Chang Pu 3g
Lu Rong 2g

YI YI REN (Coix lachryma jobi seed)

These days, Yi Yi Ren has become an important herb, especially in the US.  In the last few decades lifestyles have evolved to include calorie-laden diets while the amount of physical activity continues to decrease as we become more dependent on technology.  Yi Yi Ren is one of the most popular herbs for obesity and weight control.

1. MIDDLE JIAO DAMP-PHLEGM
When you think of Yi Yi Ren, think of gentle removal of damp-phlegm from the middle jiao.  If your patient has a large, squishy, cushiony abdomen, Yi Yi Ren should jump to mind regardless of the symptoms.

2. EDEMA and JOINT PAIN
Obesity in conjunction with edema or joint pain should spring to mind Yi Yi Ren.  Other symptoms that should immediately remind you of Yi Yi Ren are: getting edema easily, feeling heavy on a rainy or humid day, or seeing the "Xi Yan (ST35 & Inner-ST35)" of the knees swollen out.  For swollen knee, a good combination is Yi Yi Ren, Cang Zhu, and Niu Xi.

3. DIARRHEA
For an obese patient with loose stool, think Yi Yi Ren.  Obese patients generally have a Damp constitution.  The Spleen hates Dampness.  If Dampness keeps accumulating, the Spleen will try to overcome the situation by literally dumping the extra fluids through loose stool or chronic diarrhea.  This is the body's natural defense mechanism.  This type of diarrhea is not painful; the loose stools will lack form and disperse in the toilet.  In this type of case DON'T use astringing herbs even if the Spleen function decreases and the diarrhea becomes more severe.  The treatment method needed is to strengthen the Spleen and drain the Dampness.  This simple formula is effective: Yi Yi Ren (fried), Shan Yao (fried), and either Cang Zhu or Bai Zhu.

4. PUS
Pus can be considered as a form of Damp-Phlegm; Yi Yi Ren can loosen pus and help to eliminate it from the body.  So Yi Yi Ren is good for oily skin, acne, or other red and pussy skin disorders, especially in obese people or those with a damp constitution.  The benefits of Yi Yi Ren for the skin are well known in Korea, where commercially available face masks containing Yi Yi Ren powder are common.

5. HIGH CHOLESTEROL
Yi Yi Ren can help to control cholesterol and blood sugar in patients with a damp constitution, especially obese patients.  According to pharmaceutical research, the oil component of Yi Yi Ren can lower high cholesterol; a good combination is Yi Yi Ren + Su Mu (Sappan Root) + Hong Hua.  Use Yi Yi Ren in conjunction with Tian Hua Fen to regulate blood sugar in diabetic patients.


CONCLUSION
Coal miners work in conditions of high air pollution and almost unanimously have bronchial problems.  One strategy for dealing with this heavy pollutant load is to eat fatty pork meat and skin.  The idea is that the fat binds up the toxins like a sponge, which can then be passed out of the body.  Yi Yi Ren works the same way.  It kind of absorbs the Damp-Phlegm like a sponge, and then passes it out through the urination since it is a diuretic.  With the high fat content of the modern diet, Yi Yi Ren has a special importance for the modern herbalist.  This herb has a mild action, and is often eaten as food.  The dosage should be at least 12 grams, and is often 15-30 grams.  In cases of obesity and diabetes, 20-40 grams may be used.

Tongue: The presentation of the tongue coat in a patient who can benefit from Yi Yi Ren will be thin white, white, or white and greasy. 

Pulse: The combination of damp-phlegm and qi deficiency can result in a soft or thready pulse.

Other body features: The Yi Yi Ren patient will probably have oily skin, chubby upper arms, and a large squishy abdomen.

Indications are listed according to the following aspects of the ST channel:
Organ: Stomach
Channel: ST channel
Five Element: Earth
Six Energy: Yangming (Dry Metal)

Note: Korean Four-Needle Technique should be understood  comprehensively including the organs, channels, five elements and six energies.

Points: Tonify SI5, ST41  Sedate GB41, ST43

Indications:
1. ST deficiency: indigestion, abdominal distention, loose stool
2. Stomach organ: stomach ulcer, esp. in overweight patients. (if skinny, tonify SP)
3. Middle Jiao: indigestion, abdominal distention/pain, loose stool; vomiting (SI5 alone is effective); constipation, diarrhea
4. Damp: nausea, indigestion due to middle Jiao Damp (like Ping Wei San)
5. Summer-Heat Damp: diarrhea, vomiting; like Huo Xiang Zheng Qi San
6. Water: pleurisy, water accumulation in the chest, excessive saliva
7. Headache: headache after eating; Wind-Phlegm dizziness
8. Dizziness/Tinnitus: Wind-Phlegm dizziness/tinnitus (like Ban Xia Bai Zhu Tian Ma Tang)
9. Heat: heat stagnation, clear ministral fire; include eye disorders
10. Bleeding disorders: epistaxis, uterine bleeding
11. Gynecology: infertility, irregular menstruation (like Wen Jing Tang); leukorrhea
12. Mental disorders: schizophrenia, hysteria (like Gan Mai Da Zao Tang); anxiety, rushing/impatience, irritability, palpitations
13. Sleep disorders: insomnia (sedate UB62), somnolence (sedate KD6)
14. Mental aspect: if money is more important than humanity, obsession with money, business is the priority, disregard for family, other stuff
15. Channel flow: nasal discharge, toothache, visual obstruction

INTRODUCTION
Imagine the feeling of being inside a sauna: hot, damp, wet, stuffy.  That is the internal condition which Huang Qin can treat.  Huang Qin can clear out the wet, damp sauna-type environment and leave the body feeling clean and fresh. 

If the differential diagnosis is Damp-Heat, Huang Qin should be the first herb that comes to mind.  The etiology is usually created in the Stomach, especially when people who have constitutional Heat recurrently take in greasy, spicy, fast food or processed foods.  Damp-Heat will easily be created in the Middle Jiao with that kind of diet.  Some people may have constitutional Damp-Heat; they will have a robust body, thick skin, sweat a lot, and tend to be obese.  Damp-Heat may start in the Middle Jiao, but it will inevitably move into other organs such as the Large Intestine or Liver.  Whatever the case, Huang Qin should come to mind, along with Cang Zhu or Bai Zhu.   


1. DAMP-HEAT moves into the LARGE INTESTINE
Damp-heat in the Large Intestine may present as diarrhea immediately after eating, irritable bowel syndrome, chronic diarrhea, or ulcerative colitis.  The treatment principle is to remove Damp-Heat first, and afterwards tonify the Large Intestine.  In this case the combination of Huang Qin + Bai Shao is a must.

CASE: A man in his 30's had a lot of stress and didn't eat regularly.  When his stomach was empty, he felt pain in the epigastric area.  He frequently ate late at night.  Sometimes he had indigestion and acid regurgitation.  After an endoscopy, his MD diagnosed chronic gastritis and prescribed a pharmaceutical drug.  The drug provided temporary relief, but didn't improve the condition, so he decided to see if herbs could help him.  Luckily he went to a clever herbalist who gave him this:
Hai Piao Xiao 8g
Bai Shao 8g
Mu Li 8g
Bai Zhu (fried) 6g
Fu Ling 6g
Huang Qin (fried) 3g


2. DAMP-HEAT moves into the LUNG
Damp-Heat may transform into Phlegm and move into the Lung, which can lead to chronic bronchitis.  The treatment principle is to clear Lung Heat and expel Phlegm.  In this case, Huang Qin is best combined with Sang Bai Pi, since it can stop cough and dissolve Phlegm.


3. DAMP-HEAT moves into the LIVER
Actually, Damp-Heat can move into either the Liver or Gall Bladder or both.  Damp-Heat in the LV/GB can form easily with the kind of lifestyle that includes a lot of alcohol and greasy foods, especially when they're consumed together.  A patient may present with indigestion, fatigue, hepatitis, fatty liver or Liver enzyme increase.  A basic combination for Damp-Heat in the LV/GB is Huang Qin, Chai Hu, Yin Chen Hao, and Ze Xie.

CASE: A man in his early 30's gained about 15 lbs after overworking at the office for two years.  He has a high stress level and drinks a lot.  He is always fatigued, his eyes easily feel strained, and he experiences indigestion with abdominal distention and gas after meals.  His MD told him he has a fatty liver and his GOT/PGT is in the range of 60-80 (under 40 is normal). 

Even though this patient is fatigued and there is evidence of Spleen deficiency, the Damp-Heat must be expelled first.  It might be tempting to prescribe a formula like Bu Zhong Yi Qi Tang, but in this case the result would not be the desired effect.  The priority is to first remove the pathogen, after which the Spleen can be tonified.  This combination will do: 
Ze Xie 10g
Yin Chen 8g
Bai Zhu 6g
Fu Ling 6g
Chai Hu 4g
Huang Qin 4g    


4. DAMP-HEAT moves into the UTERUS
Women who are overweight, eat a lot of instant, processed, and fast food, and get little exercise are the most susceptible to Damp-Heat in the uterus.  Leukorrhea, hysteritis, or pelvic inflammatory disease may result.  This is a situation of Damp-Heat in the Lower Jiao, so Huang Qin is best combined with Long Dan Cao and Ku Shen.

CASE: A woman in her 40's suffered from leukorrhea and vaginal itching for six months.  A protozoan test was negative.  Her MD prescribed a course of antibiotics which didn't help at all.  She was a bit overweight and had an irregular diet.  This formula helped:
Yi Yi Ren 12g
Fu Ling 6g
Cang Zhu 6g
Lai Fu Zi 4g
Huang Qin 4g
Ku Shen 5g
Long Dan Cao 4g 


5. DAMP-HEAT moves into the MUSCLE
Damp-Phlegm can move into the muscle layer and cause stiffness, especially in the shoulders and upper back.  People who do physical labor, especially those with constitutional Heat, thick skin, and a greasy diet, are the most susceptible to Damp-Heat moving into the muscle.  Huang Qin + Ge Gen are a good combination, especially when the neck, shoulder and upper back are affected.

CASE: A construction worker in his late 40's is suffering from muscle pain and spasms everywhere in his body.  He has a robust physique and consumes primarily meat.  He feels relief of the muscle pain and spasms after sweating, but he can't tolerate the heat required for that self-treatment. 

The spasms might lead some practitioners to consider a formula such as Er Chen Tang, but the priority in this case must be to expel the Damp-Heat first.  This is an ideal combination for this case:
Ge Gen 12g
Yi Yi Ren 12g
Cang Zhu 6g
Fu Ling 6g
Huang Qin 6g
Bai Shao 4g
Mu Gua 4g


CASE: A 40 year old with a good appetite and obese abdomen was experiencing indigestion and muscle spasms in various parts of the body which were relieved after sweating.  The diet consisted of a lot of meat.  Bowel movements were loose, 2-3 per day.  This formula is appropriate:
Yi Yi Ren 40g
Ge Gen 12g
Fu Ling 8g
Ma Huang 6g
Huang Qin 3g


SUMMARY
Damp-Heat originates from the Middle Jiao, but it can move into any part of the body. 
In the Upper Jiao in moves into the Lung,
in the Middle Jiao it moves into the Liver or Gall Bladder,
in the Lower Jiao it moves into the Large Intestine or the uterus,
and it may even move into the limbs and muscles. 
If Damp-Heat is identified anywhere, call on Huang Qin for help and combine with other herbs based on the location and symptoms.

DOSAGE
The usual dosage for Huang Qin is 6-9 grams; if the Damp-Heat symptoms abate, reduce the dosage to 3-6 grams.  Decrease the dosage as the symptoms diminish.

DIANGOSIS
Tongue: The Huang Qin tongue will have a greasy, yellow coat.
Pulse: In general the pulse of a Huang Qin patient will be stronger and slippery.  It will definitely be an excess pulse.
Other visual cues: An abdomen with heat signs and thick skin may tip you off about the presence of Damp-Heat.

A normal adult heart beats between 60 and 100 times a minute. A heart rate over 100 beats a minute is called tachycardia. Some tachycardias are relatively harmless and need no treatment, but others can be life threatening. Treatment for recurrent tachycardia can range from daily medication to open-heart surgery. A specific diagnosis is necessary before finding the right treatment for tachycardia.


TCM PATTERNS & FORMULAS

HEART BLOOD DEFICIENCY: palpitation, irritability, insomnia, red tongue, no coating, thready-rapid pulse
8g  Ren Shen 
8g  Wu Wei Zi
8g  Dang Gui
8g  Tian Men Dong
8g  Mai Men Dong
8g  Bai Zi Ren 
8g  Suan Zao Ren
8g  Xuan Shen 
8g  Fu Shen
8g  Dan Shen
8g  Jie Geng
8g  Yuan Zhi
8g  Huang Lian 
8g  Sheng Di Huang
8g  Shi Chang Pu
8g  Zhen Zhu Mu
8g  Long Gu
8g  Mu Li

HEART PHLEGM-HEAT: palpitation, insomnia, fever, congested feeling of the chest, nausea, yellow-greasy tongue coating, slippery-rapid pulse
6g  Huang Lian 
8g  Zhu Ru 
8g  Zhi Shi
8g  Ban Xia 
8g  Chen Pi 
8g  Fu Ling 
3g  Zhi Gan Cao 
3g  Da Zao 
6g  Yuan Zhi
8g  Zi Shi Ying
8g  Long Chi


EMPIRICAL FORMULAS

Formula 1
Ren Shen  9g
Mai Men Dong  15g
Wu Wei Zi  9g
Gui Zhi  6-9g
Chi Shao  6-9g
Bai Shao  6-9g
Dan Shen  30g
Gan Cao  9g
Long Gu  25g
Mu Li  25g
Hu Po (amber)  3-5g (take the powder separate with the decoction)

Formula 2
Tai Zi Shen  15g
Mai Men Dong  10g
Xuan Shen  10g
Wu Wei Zi  6g
Lian Zi Xin  6g
Zhu Ru  6g
Lian Qiao  8g


ACUPUNCTURE

TCM BASIC POINTS: PC6, HT7, RN14, UB15
HT Blood deficiency: +UB20, UB21, ST36
HT Phlegm-Heat: + ST40, UB19

FOUR NEEDLE TECHNIQUE: Sedate SP3 & HT7, Tonify KD10 & HT3

GOU QI ZI (Chinese Wolfberry)

Imagine some old, unkempt wooden furniture, dry, brittle and lusterless.  Or imagine a car with out oil, hot and shaking from the dry friction within.  Gou Qi Zi is like a shiny coat of wax for the old furniture, or like supreme engine oil for the car.  When a patient comes in with a face that looks lusterless and tired, with red eyes and a somewhat undernourished nourished type of appearance, this patient needs Gou Qi Zi.  For dry skin, Gou Qi Zi is like the best night creamy lotion money can buy.  It enriches the skin and helps it to flourish by nourishing the Liver and Kidney, which in turn generate fluids to feed the membranes.  To nourish the Kidney, use 6-8 grams.  To combat tired, dry, red eyes, use 12 grams of Gou Qi Zi as the king herb.   

1. LIVER FUNCTION
Overwork and too much stress lead to yin deficiency and fatigue, particularly for people with a thin body type.  Gou Qi Zi is appropriate because it nourishes yin more than blood.  It is especially useful if fatigue manifests in the face, causing red eyes and a dry deficiency-heat appearance.  Gou Qi Zi (8-12g) + Wu Wei Zi (3-4g) is useful for chronic hepatitis patients who fatigue quickly even on slight exertion.


2. DIABETES
When you think of a diabetic patient, you probably picture them as obese or at least heavy; but in reality there are also a lot of think diabetes patients.  Gou Qi Zi is useful for thin, Type II diabetes patients that fall into the pattern differentiation of Liver and Kidney yin deficiency or deficiency heat.  This is a simple but effective formula:
Gou Qi Zi 6-8g
Sheng Di Huang 8-12g
Tian Hua Fen 6-8g


3. NEUROSIS
Prolonged stress can sometimes lead to neurosis, a mild psychological disorder characterized by anxiety and mental fatigue.  In that condition, Gou Qi Zi can treat the mental fatigue.  Worrying and obsessing can result in Heart and Kidney miscommunication with heat above and cold below.  Acute stress causes qi stagnation, but over time chronic stress will yield yin, blood, and body fluid deficiency.  Symptoms might be dry eyes, dry throat, dry cough, thirst, pain or stifling sensation in the chest, and cold hands and feet.  With these symptoms, qi moving herbs alone are not enough; because a deficient condition has already been established tonics must be given.  If the patient is extremely sensitive emotionally, the treatment principle should be to nourish the Liver and Kidney yin, nourish the Heart blood, and sedate the Heart fire at the same time.
Gou Qi Zi 8-12g
Long Yan Rou 8g
Suan Zao Ren 8g
Huang Lian 3-4g
Zhi Zi 3-4g


4. KIDNEY ESSENCE
Kidney essence deficiency can occur in either men or women.  In men, the essence is most commonly damaged from over indulgence in sexual activities which manifests as low back pain, fatigue, dry eyes and a dry mouth.  For women, essence deficiency occurs naturally during menopause, although they are also subject to the same consequences as men are for over indulging.  Gou Qi Zi is an essential herb for nourishing Kidney yin.  One of the basic combinations is Shu Di Huang (12-20g) + Gou Qi Zi (6-8g).

In American culture, personal strength and courage is so highly valued; productivity and efficiency are always the top priority.  Those are good things, of course, but it's easy to see that this is not an environment in which preventative medicine can flourish without being nurtured.  In many other cultures, however, preventative medicine is both common knowledge and common sense.  For example, in Korea, recognizing early signs of personal deficiency is common knowledge, and adjusting the diet or taking some tonic is common sense.  Also when particular life events occur, such as getting married or giving birth, the stress on the body is acknowledged and eating a special diet or taking an herbal tonic is the normal thing to do.

For example, newlyweds (especially the men) generally take herbal tonics to strengthen their sexual function.  Of course herbs to tonify the Kidney fire come to mind, like Yin Yang Huo.  But we are physical beings, and we cannot escape the laws matter and energy.  A fire with a lot of energy and big flames just burns the wood faster.  If there's no more wood to add, then you will be left with nothing but ashes in no time.  Using Yang tonics alone will damage the Kidney; it's like making a raging hot fire with no wood to keep it going.  Yin tonics must be combined with yang tonics, or the libido will soar and Kidney damage will ensue.  This applies to women as well.  The following formula is an example of the proper ratio of yang tonic and yin tonic.  For more deficiency or for deficiency that affects the hearing, change Shu Di Huang to Sheng Di Huang.     
Shu Di Huang12-20g
Gou Qi Zi 6-8g
Shan Zhu Yu 6-8g
Fu Pen Zi 4-6g
Bu Gu Zhi 3-4g
Yin Yang Huo 3-4g


5. DRYNESS
a. Dry Eyes
Gou Qi Zi is very good for the eyes, especially for people with heat in the constitution, a thin or sensitive body type, or those that use the computer a lot.  It clears the heat which causes dry eyes.  The basic combination to treat dry eyes is:
Gou Qi Zi 8-12g
Qing Shang Zi 4-6g
Ju Hua 3-4g

b. Anti-aging
Gou Qi Zi is an essential herb for spa-type clinics or acupuncture face lift treatments.  It increases elasticity, reduces dryness and dark spots, so it is particularly effective for dry-type wrinkles.  The following formula must be used for a minimum of one to two months in order to see the results, since that's the time it takes for the fresh, healthy cells in the dermal layer to emerge and become the epidermis.
Gou Qi Zi 6-8g
Bai He Shou Wu 6-8g
Shu Di 8-12g
Dang Gui 6-8g
Chan Tui 1-2g
Hong Hua 1-2g

c. Dry Cough
When conventional examinations and lab work can't determine the cause of a persistent dry cough, yin deficiency is usually the culprit.  Yin deficiency often begins in the Liver and Kidney and then leads to Lung dryness and results in cough.  A patient in this condition may also suffer from Plum Pit Syndrome or dry throat.  This simple formula can help:
Gou Qi Zi 6-8g
Mai Men Dong 4g
Tian Men Dong 4g
Wu Wei Zi 3-4g


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CLINICAL CASES

Case 1:
A 33 year old male has the chief complaint of chronic fatigue.  His commute to work is one hour each way, and this makes the pain and heavy feeling in his low back worse.  He feels overworked, and recently his eyes are always red and he has dry hair and dry skin.  He feels like he is starting to lose his hair, and is concerned because his sexual desire has diminished completely.  This is a good formula for him: 
Shu Di 16g
Bai He Shou Wu 8g
Gou Qi Zi 8g
Shan Zhu Yu 6g
Wu Jia Pi 4g
Wu Wei Zi 3g

Case 2:
A thin 44 year old female diabetic cannot keep her blood sugar under control.  She complains of a dry mouth and feels she is lacking saliva.  Her diabetes set in four years ago after her husband's business went bankrupt.  All of the stress and insomnia caused her blood sugar to sky rocket even though she doesn't eat sweet or fatty foods.  The drugs prescribed by her MD cause epigastric pain, but since her blood sugar continues to rise, her MD continues to increase her dosage.  She wants help to control her blood sugar.  She admits to continued stress and irritability, and says she feels mentally worn out and sensitive.  Give her this:
Sheng Di Huang 12g
Gou Qi Zi 8g
Tian Hua Fen 8g
Sha Shen 6g
Wu Wei Zi 3g

Case 3:
A woman, 51 years of age, complains of low back pain, joint pain, hot flashes, and stiff feelings in her hands and feet.  Upon questioning, it is discovered that she has had irregular menstruation for the last five months, and last month she missed her menstrual cycle completely.  You determine that she is experiencing menopausal symptoms and give her this formula:
Shu Di 12g
Gou Qi Zi 8g
Shan Zhu Yu 6g
Niu Xi 4g
Zhi Mu 2g
Huang Bai 2g

Case 4:
A 27 year old teacher is having problems with her skin itching a lot at night.  She has had dry skin since she was a teenager.  Sometimes she teaches until 11:00 PM, and she sleeps late every day until around noon.  She doesn't sleep well; she wakes up easily in the night, and she notices that she always wakes between 1:00 - 2:00 AM because she feels so dry and itchy.  She always feels tired.  Recently her eyes are red a lot and her skin is so dry that when she applies cosmetic powder it won't even stick to her skin.  Her MD diagnosed her with atopic dermatitis, and she'd like some herbs to help her.
Shu Di 12g
Bai He Shou Wu 8g
Gou Qi Zi 8g
Tian Hua Fen 6g
Dang Gui 6g
Bai Shao 4g
Chan Tui 2g
Hong Hua 2g

NOTES FOR UB POINTS IN THE HEAD

UB1 (Jing Ming = Eye brightness)
There is a sensitive area on the medial aspect of the orbit between UB1 and UB2, which can be used for nosebleeds, especially in children.  Use one hand to apply pressure to UB10 (bilaterally), while simultaneously applying pressure with the other hand to the area described above.  IF there is high blood pressure or any possibility of intercranial hemorrhage, allow the nose bleed to release heat and pressure.

UB2 (Zan Zhu = Gathering Bamboo)
For the normal indications of headache or eye problems, needle UB2 toward UB1.  For Bell's palsy or stroke, when the eye cannot close, needle subcutaneously toward Yu Yao. Interesting tidbit: some ancient texts tell us that the eyebrow hairs around UB2 stand up more during menstruation.   

UB3 (Mei Chong = Eyebrow Ascension)
In the classic texts, the UB channel was comprised of only 63 points.  The four points that were added later are: UB3, UB16, UB24, and UB26.

UB7 (Tong Tian = Reaching Heaven)
"Tong Tian," can be translated as "reaching heaven."  This point may be used to support the function of DU20, or as a local point for migraines.  When treating migraines, combine UB7 with ST8 and needle subcutaneously toward the painful area.

UB10 (Tian Zhu = Celestial Pillar)
In cases of stroke or Bell's palsy, or other conditions causing neuropathy, enervation to the left and right sides may become unbalanced.  If the trapezius muscle appears atrophic on only one side, needle UB10 on the sunken side, plus DU14 to balance both sides of the trapezius.  UB10 is also a good local point for occipital pain, neck pain, or headache.  Since it is located at the pivotal point between the head and the body, it can bring balance between the head and the body. 

HONG HUA (Carthami Flos)

INTRODUCTION
Whenever there is a blood problem, remember Hong Hua.  This herb is very useful in modern practice as a blood activator for circulatory disorders and even blood stasis, trauma, gynecological disorders, or even bone disorders.  Hong Hua is friendly with the Si Wu Tang family including Chuan Xiong, Dang Gui and Chi Shao.  Hong Hua is also a friend to Dan Shen, and plays well with Tao Ren and Su Mu.  Today Hong Hua is grown in China, but originally this herb came from Egypt.  Its warm, acrid properties are a reflection of the nature of the original environment in which Hong Hua evolved. 

The size of the dosage of Hong Hua affects its action. 
Large dose (3-4g): activates the blood
Smaller dose (1-1.5g): harmonizes the blood
Pinch (0.5-1g): can treat anemia
Pharmaceutically Hong Hua has been shown to contract the uterus, expand the blood vessels, and lower cholesterol.

1. Circulatory Disorders (Blood Stasis in the Vessel)
Some Western disorders corresponding to blood stasis in the vessel include: high cholesterol, coronary artery disease, or other disorders of the heart vessels.  For someone with the condition of blood stasis, even if they are already taking a cholesterol reducing drug such as Lipitor, Hong Hua can be used.  When taken over an extended period Hong Hua can lower cholesterol and triglycerides.  This combination is suitable for long-term use:
Shan Zha 8g
Chen Pi 6-8g
Su Mu 3-4g
Hong Hua 2-3g

If there is the type of pain in the heart that occurs in cases of CAD or angina, and the patient is determined to be a Xue Fu Zhu Yu Tang or PC6 + SP4 type of condition, then this combination may be used:
Dan Shen 8g
Chi Shao 6g
Hong Hua 2g


2. Gynecological Disorders (Lochia, Dysmenorrhea)
Hong Hua is widely used for gynecological disorders, especially for the conditions of Lochia and blood stasis post-partum.  Right after labor, the mother can take this combination for at least one week or until the Lochia has resolved: Dang Gui Wei, Chi Shao, Chuan Xiong, Pu Huang, Wu Ling Zhi, Hong Hua. 

For dysmenorrhea resulting from cold in the abdomen causing blood stasis, the following combination can be used: Dang Gui, Chi Shao, Chuan Xiong, Rou Gui, Pao Jiang, Tao Ren, and Hong Hua.

Case: A 31 year old woman just delivered a baby three days ago.  She wants to take herbs to resolve the abdominal pain and Lochia.  The following formula is generally given for the first week after labor, but may be used for up to 21 days if the Lochia continues.  Discontinue use of this formula when the lochia is resolved.
Dang Gui 6g
Dang Gui Wei 6g
Chi Shao 6g
Chuan Xiong 6g
Pu Huang 3g
Wu Ling Zhi 3g
Hong Hua 3g

After the lochia has stopped and the internal stagnation has been removed, then
tonification is appropriate and this formula may be given:
Shu Di 12g
Dang Gui 8g
Huang Qi 8g
Lu Rong 4g
Bai Zhu (fried) 4g
Chen Pi 4g
Sheng Jiang 2g
Da Zao 2g


3. Trauma (Traffic Accidents, Sprain)
Trauma inevitably affects the blood, at least locally.  Hong Hua can be used in various combinations to address different symptoms that can follow trauma.
(1) If the main complaint after trauma is muscular aching, use: Ge Gen, Chi Shao, Mu Gua, Gui Zhi, and Hong Hua. 
(2) If after a trauma such as car accident the symptoms include dizziness, headache, and nausea, they are likely a result of blood stasis and this combination can help: Niu Xi, Dang Gui Wei, and Hong Hua.
(3) For severe bruising after trauma use: Chen Pi, Su Mu, Tao Ren, and Hong Hua. 
(4) If the main complaint after trauma is pain then use: Chi Shao, Gui Zhi, Yan Hu Suo, Hong Hua.

CASE: Sequela of Auto Accident
A 34 year old man was in a severe car accident three months ago.  He was hospitalized for two weeks following the accident.  Now his pain has reduced, but he has continually been suffering from nausea, vomiting, dizziness and headache since the accident.  This formula will help:
Chi Shao 8g
Ge Gen 8g
Gui Zhi 4g
Tao Ren 4g
Yan Hu Suo 3g
Su Mu 3g
Hong Hua 3g


4. Bone Disorders (Osteoporosis, Weakness of Bones)
If a patient has been diagnoses with osteoporosis or bone weakness, just a pinch of Hong Hua (0.5-1g) can help to stimulate new bone cell production and bone growth.  Lu Rong also directly increases bone cell production, so these two herbs together are an excellent combination.  Use this ratio:
Lu Rong 3-4g
Hong Hua 1g

Many osteoporosis patients also have weak digestion or other Stomach disorders.  Poor calcium absorption can be a contributing factor to the osteoporosis condition.  Bai Zhu can improve the function of the middle jiao, and Lu Jiao is more easily absorbed since it has been catalyzed already.  The following formula must be used for at least two months before Bone Mineral Density measurements will show an increase.
Lu Jiao 12g (or Lu Jiao Jiao 4g)
Bai Zhu 6g
Dang Gui 4g
Niu Xi 4g
Shan Zha 4g
Lu Rong 3-4g
Hong Hua 1g

CASE: A 68 year old woman has been diagnosed with osteoporosis by her MD.  She quit taking the medication three months ago because it gave her such severe indigestion that she couldn't stand it.  When she quit the medication her low back pain got worse.  She wants to get herbs to help.
Shu Di 12g
Lu Jiao 12g
Shan Zhu Yu 6g
Bai Zhu 6g
Dang Gui 4g
Shan Zha 4g
Lu Rong 3g
Sha Ren 2g
Hong Hua 1g


5. Anemia
Hong Hua has three actions on the blood, which vary based on the dosage.  Hong Hua is a very light herb with a large surface area, so even a "big" dose is only 3-4 grams.  A dose of 3-4 grams is ample to move blood stasis.  A dose of 1-1.5 grams has the effect of harmonizing the blood and improving the circulation, and a dosage of just 0.5-1 gram has the action of stimulating the production of red blood cells and bone cells.  Therefore, a tiny dose of Hong Hua can go a long way in treating anemia.

Case: A thin, 33 year old woman has the chief complaint of dizziness every time she stands up.  Her MD diagnosed her with postural hypotension and anemia.  Also her blood pressure is low.  On the lab report her hemoglobin level is only 8 g/dL, while the normal range for women is 12-16 g/dL.  She was prescribed a pharmaceutical drug for anemia, but she can't take it because her digestive system is too weak.  She wants to try some herbs.
Shu Di 12g
Huang Qi 8g
Dang Gui 6g
Bai Zhu 6g
Lu Rong 4g
Shan Zhu Yu 4g
Sha Ren 2g
Hong Hua 1.5g