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2 Ge Gen Formulas Discussions and Case Studies Discussion 8 Case 3 Depression 9 Case 4 Ben Tun 11 Ge Gen Huang Qin Huang Lian Tang 14 Original Text 14 Formula Explanation 14 Case 5 Diarrhea Dr Feng Shilun 14 Ge Gen Jia Ban Xia Tang 15 From Liu Du Zhou s Collected Shang Han Lun Cases 16 Case 1 Common Cold with Vomiting 16 Case 2 Stomach pain Duodenal Intestinal Bulbar Ulcer 17 Case 3 Diarrhea 18 Ge Gen Tang 19 Original Text 20 Li D zh u s primary techniques for the application of Ge Gen Tang 20 Discussion 22 Cases 24 Case 1 Common Cold 24 Case 2 Facial paralysis 25 Case 3 Convulsions 26 Case 5 Facial Paralysis 28 Gui Zhi Jia Ge Gen Tang 28 Original Text Clause 14 29 From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zhou 29 Explanation 29 Cases 29 Case 1 Acute spasm of the neck and back 29 Case 2 Convulsions 30 Case 3 Stiff neck 32 Case 4 Spastic Type Torticollis 33 Compiled and Translated by Sharon Weizenbaum 2021

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3 Ge Gen Formulas Discussions and Case Studies Case 5 Tetany Pattern Rigid person syndrome 34 Case 6 Twitching Facial Muscle peripheral facial nerve numbness 36 Case 7 Prolapsed eyelid 37 Case 8 Urticaria 38 Appended Notes 39 Ge Gen Principle Indications The principle indications for Ge Gen are stiffness and pain of the neck and back diarrhea and thirst Stiffness and Pain of the Neck and Back The ancients used Ge Gen to treat illness in which neck and back pain is a symptom The Shanghanlun says that Ge Gen Tang treats The Shihou Fang says that one should drink fresh Ge Gen juice for back and loin pain and the pain will stop In ancient times was the common term for stiffness and pain in the back and neck In modern language this could be described as constricted acute muscle pain from the back of the head to the back sometimes extending to the lower back At the same time this is often accompanied by headache dizziness what is the difference between AB and A 5 This feeling of stiffness and pain in neck and back pain is usually seen in patients with relatively thick and heavy muscles In addition the symptoms may extend to the face area involving the five sense organs with symptoms of headache dizziness tinnitus and other feelings of discomfort This can also be seen as an extension of the idea of stffness and pain of the neck and back Diarrhea Besides treating stiffness and pain of the neck and back Ge Gen also treats diarrhea Diarrhea was called Xia Li in ancient times In the Shanghanlun Ge Gen Tang is used to treat Taiyang and Yangming combined presentation spontaneous diarrhea In this formula the dosage of Ge Gen is 4 liang But when used in Ge Gen Huang Qin Huang Lian Tang for incessant diarrhea the dosage of Ge Gen is increased to 8 liang It can be seen that the more severe the diarrhea the Compiled and Translated by Sharon Weizenbaum 2021

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Ge Gen Formulas Discussions and Case Studies 4 more the dosage of Ge Gen is increased So in distinguishing if there is a Ge Gen presentation it is necessary to see if diarrhea is present or not Diarrhea can be divided into a light degree and a heavy degree The patient with a light degree of diarrhea has a semi liquid stool and an increased frequency The patient with a heavy degree of diarrhea has diarrhea that does not stop Ge Gen was considered the efficacious herb for diarrhea by Li Dongyuan Thirst Ge Gen is also an important herb for treating thirst The Sheng Hui Fang recommends drinking the juice made from pounding the Ge Gen to treat thirst agitation and dry skin Moreover Ge Gen powder can be mixed with Xu Mi in a congee to treat heat oppression in the chest with thirst accompanied by vexation and agitation The Gu Jin Yi Tong recommends using Ge Gen with Tian Hua Fen daily to treat Xiao Ke dispersion thirst diabetes and kidney thirst The Pu Ji Fang recommends using taking small drafts of powdered Ge Gen to treat constant fever with thirst in children According to Zhang Yuansu this is thirst from Spleen deficiency and without Ge Gen it cannot be eliminated In the Yi Xue Zhong Zhong Can Xi Lu this herb is combined with fresh Huang Qi fresh Shan Yao and fresh Ji Nei Jin to treat wasting and thirsting disorder The term thirst here refers to thirst with no sweating lack of sweating refers to the fact that the patient does not suffer from internal heat nor is the thirst due to high fever with sweating This thirst is also not due to constipation and dryness of the intestines or from dehydration with sunken eyes and withered skin This kind of thirsty feeling is a dry mouth with an inability to create fluids It is often seen in chronic type illness and various internal diseases The patient s state of general nourishment is relatively good their flesh and muscles are relatively well developed and they usually don t sweat easily Chinese medicine says that Ge Gen functions to resolve the exterior The Shanghanlun uses Ge Gen combined with Ma Huang and Gui Zhi to treat aversion to wind without sweating The above mentioned three presentations of stiffness and pain in the back and neck diarrhea and mouth thirst form an integrated whole and are by no means separate They are simply the three symptoms that must be stressed Clinically you might see for example headache and stiff neck Compiled and Translated by Sharon Weizenbaum 2021

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5 Ge Gen Formulas Discussions and Case Studies with diarrhea or simply diarrhea with thirst without symptoms of stiff painful neck and back or you may just see mouth thirst with stiffness and pain of the head and neck The Formulas 1 For illnesses in which stiffness and pain of the neck and back are the principle complaint such as common cold or stiff neck Ge Gen is combined with Ma Huang Gui Zhi and Gan Cao in formulas such as Ge Gen Tang 2 For illnesses in which headache or dizziness are a main complaint such as in hypertension cerebral arteriosclerosis diseases of the cervical vertebrae or cerebral infarction as well as in sudden deafness nerve type deafness or tinnitus Ge Gen is often combined with Gui Zhi and Bai Shao in formulas such as Gui Zhi Jia Ge Gen Tang 3 For illnesses characterized by diarrhea such as bacterial dysentery acute or chronic colitis diabetes or pediatric diarrhea Ge Gen is used in formulas such as Ge Gen Qin Lian Tang or Qi Wei Bai Zhu San 4 For illnesses characterized by mouth thirst such as diabetes or alcoholism Ge Gen is used in such formulas as Ge Gen Huang Lian Tang Reference Material 1 J ng B i Qi ng J J was the expression used for the Ge Gen presentation in Zhang Zhongjing s era It is not normally used in the modern clinic This should be seen as a symptom set whose principle manifestations are discomfort and acute pain of the head neck lumbar and back areas In my experience there is objective evidence for determining the presentation One must first look at the body type which in the case of Ge Gen is robust with well developed flesh and muscles The second aspect one must look at is the location In this case the disease usually manifests in the area of the face the shoulders and the back or lower back There will be pain a feeling of soreness or heaviness or even small pox The third aspect to look at is the quality of the skin For the Ge Gen presentation the skin is rough and thick and the color is dark Compiled and Translated by Sharon Weizenbaum 2021

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6 Ge Gen Formulas Discussions and Case Studies 2 Ge Gen is safe and non toxic It is categorized as a food substance and the amount can be large For adults up to 20 grams or more is suitable In my experience between 20 and 80 grams can be given 3 In terms of clinical combinations Ge Gen can be combined with hot herbs cold herbs qi tonics and herbs to invigorate blood Combined with Ma Huang and Gui Zhi it can treat aversion to cold with no sweating Combined with Huang Lian and Huang Qin it can treat sweating with diarrhea Combined with Huang Qi and Bai Zhu it can be used to treat Qi deficiency with edema and dizziness Combined with Chuan Xiong and Dan Shen it treats blood stasis chest pain Ben Tun Tang Dang Gui 2 liang 6 gm Chuan Xiong 2 liang 6 gm Ban Xia 4 liang 12 gm Gan Cao 2 liang 6 gm Huang Qin 2 liang 6 gm Sheng Ge Gen 5 liang 15 gm Bai Shao 2 liang 6 gm Sheng Jiang 4 liang 12 gm Gan Li Gen Bai Pi 5 sheng 15 gm Cortex Radicis Pruni Salicinae Compiled and Translated by Sharon Weizenbaum 2021

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7 Ge Gen Formulas Discussions and Case Studies Decoct in 20 Sheng until 5 Sheng remain Take 1 Sheng warm three times during the day and once in the evening Original Text Jingui Yaolue chapter 8 on pulses patterns and treatment for running piglet Line 2 For running piglet manifesting with Qi upsurging to the chest abdominal pain and alternating heat and cold Ben Tun Tang is indicated Case 1 Abdominal Pain1 Dr C o Y ngf I treated a woman named Li She had just given birth When she arrived home a person she was in conflict with began to abuse her verbally in a loud and strident way She was terrified She then developed a lump in her lower abdomen After several days there were two lumps They sometimes went up and sometimes went down There was a sharp pain in her abdomen that was unbearable In the afternoon she had fever and chills To begin with I gave her the following Dang Gui Chuan Xiong Pao Jiang Shu Fu prepared Fu Zi Bai Shao 1 1 1959 5 Compiled and Translated by Sharon Weizenbaum 2021

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8 Ge Gen Formulas Discussions and Case Studies After 2 packages she was a little better I then gave her Ben Tun Tang After a dose the symptoms disappeared Only Li Gen Bai Pi was left out The patient was unexpectedly cured Case 2 Surging Qi2 Ms Huang age 45 was from the village Zhen Jinxi just outside the city gates She had aversion to cold and fever as well as pain in her abdomen She felt Qi surging upward from her lower abdomen for more than 10 days She also had mouth thirst white tongue moss and a rapid pulse This came on just after she had a quarrel with her neighbor I gave her Ben Tun Tang for treatment Gua Lou Gen 16 gm Dang Gui Gen 5 gm Sheng Bai Shao 10 gm Chuan Xiong 3 gm Huang Qin 10 gm Fa Ban Xia 6 gm Ge Gen 10 gm Gan Cao 4 gm Jing Jie 5 gm After 4 packages the fever and chills were gone and the surging Qi subsided Discussion 3 When Running Piglet happens a lump suddenly appears in the lower abdomen There is a surging upward into the throat with a feeling that one wants to die There is surging Qi shortness of 2 1982 8 From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 124 3 Compiled and Translated by Sharon Weizenbaum 2021

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Ge Gen Formulas Discussions and Case Studies 9 breath and abdominal pain Then it moves down and the surging calms Zhong Jing says that this is all due to fright and fear and this is accurate The cause is a fright or fear stimulating the liver gallbladder to become constrained and knotted This transforms into heat and surges upward into the chest There is abdominal pain and alternating fever and chills The principle treatment is Ben Tun Tang which sooths and regulates the liver and gallbladder and downbears the rebellious surging The formula uses Gan Li Gen Bai Pi which is bitter and cold It enters the foot Jue Yin liver channel clears heat and down bears Qi The Zhang Xia Pharmacopeia says It down bears the rapid Ben surging of liver Qi and clears constrained heat in liver wood The liver likes to be dispersed and Sheng Jiang Ban Xia and Sheng Ge are all pungent so they disperse The liver suffers from urgency and tension and Gan Cao s sweetness moderates The liver stores the blood and the blood contains the ministerial fire and Dang Gui Bai Shao and Chuan Xiong all nourish blood and regulate the liver Huang Qin clears and discharges the constrained heat Therefore this formula is suitable to use for constrained heat in the liver gallbladder that is leading to running piglet Qi disease Both of the above cases of running piglet were due to a fright and both manifest with Qi surging into the chest and alternating fever and chills This is why the Jin Gui s Ben Tun Tang was used Often the Li Gen Bai Pi is unobtainable Therefore in these cases it was substituted with Gua Lou Gen This also clears constrained heat Modern doctors use this formula to treat autonomic nerve disturbance Case 3 Depression4 Ms Zh u age 39 was a telecommunications worker and came in for her initial visit on May 11 2000 Two months previously because of domestic affairs and a falling out with her husband she gradually developed rib side tension stomach pain and hiccups She sought treatment at the hospital and the western diagnosis was gastric neurosis Up until her visit she had taken Chinese and western medicines but there was no effect At the exam her facial color was sallow yellow and her body was emaciated She vomited sour bitter water and repeatedly hiccupped Her 4 Clinical Experience Treating Disease with Classical Formulas by Li H nt ng Beijing University Press China 2008 Compiled and Translated by Sharon Weizenbaum 2021

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Ge Gen Formulas Discussions and Case Studies 10 appetite was poor and she had pale lips Her tongue was pale red with thin yellow moss and her pulses were wiry and thin This was diagnosed as depression pattern The pattern was differentiated as liver constraint and blood deficiency with constraint transforming into heat and reversal Qi of the stomach and liver The treatment was to course the liver nourish blood clear heat harmonize the stomach descend Qi and level surging I gave her modified Ben Tun Tang Gan Li Gen Bai Pi 30 gm Qing Ban Xia 15 gm Huang Qin 10 gm Dang Gui 2 gm Bai Shao 10 gm Chuan Xiong 6 gm Zhi Gan Cao 6 gm Zhi Pa Ye 10 gm Zhi Qiao 10 gm Qing Chen Pi 10 gm Fou Shou 10 gm Sheng Jiang 10 gm She was given 5 packages to be decocted in water and taken The stomach pain and vomiting disperse and the other symptoms decreased She continued with another 6 packages and all of the symptoms resolved Discussion This case was due to emotional upset so that the liver Qi was constrained and thereupon there was transformation into heat that harassed the stomach The liver and stomach Qi reversed and the liver blood was also deficient This led to the manifestation of the above narrated emotional illness Ben Tun Tang was used modified There was a large amount of Gan Li Compiled and Translated by Sharon Weizenbaum 2021

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Ge Gen Formulas Discussions and Case Studies 11 Gen Bai Pi to level and descend the surging reversal of the liver wood Huang Qin clears the liver fire while Ban Xia and Sheng Jiang assist the Gan Li Gen Bai Pi in descending Qi and down bearing reversal This causes the liver and stomach Qi to return to their descent and thereby curbs the vomiting and hiccupping Dang Gui Bai Shao Chuan Xiong nourish blood and regulate the liver Bai Shao and Gan Cao moderate the liver to stop stomach pain The addition of Pa Ye and Zhi Qiao assist the down bearing of the liver and stomach Qi reversal Qing Chen Pi and Fou Shou can assist in the coursing of the liver moving the Qi and awakening the stomach Because Ge Gen does not benefit vomiting and hiccup it was removed Ben Tun Tang can be applied for emotional and mental illnesses In modern times it is mainly used to treat illnesses such as neurosis hysteria insomnia and epilepsy The key differentiating points are liver constraint with blood deficiency that has transformed to heat and surged upward The symptom is as if there is something surging from the lower abdomen into the chest or a feeling of surging Qi ascending upward This can be accompanied by dry mouth rib side distention abdominal pain belching and emotional abnormalities The mouth and lips are pale and the tongue is pale red with thin yellow moss The pulses are wiry and thin Modern usages Ben Tun Tang has been used for duodenal ulcers chronic hepatitis irritable bowel syndrome hematoporphyrin syndrome plum pit Qi pediatric tonsilitis menstrual vomiting postpartum infection abdominal pain after ligation pelvic inflammation after abortion The sage Zhong originally created this formula for constrained liver Ben Tun but the modern indications are not limited to this Case 4 Ben Tun5 Dr Xi ng J b i The patient Ms Cheng was age 46 and was a peasant At the start of her illness she had dizzy spells with restlessness and palpitations She shut herself in a room and gradually would not get out of bed She had photophobia so she kept the room dark with closed doors and window She was like this for four years She ate and went to the toilet in her dark room Why did she shut herself into this room In the first place she could not bear light Every time she saw light rays 5 Compiled and Translated by Sharon Weizenbaum 2021

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12 Ge Gen Formulas Discussions and Case Studies her eyes would become distended Secondly she could not move about She said that every time she moves she feels as if there is a great flood colliding with her heart It was a terrible feeling like a river running into a rock Whenever she moved this symptom would increase It became a bit better if she lay down and did not move Finally she was terrified This had gone on for more than four years She could not open windows or even light a lamp She had already seen many doctors When her family members came to me I was also trepidatious because this disease had lasted a long time and many doctors had already failed At this time I was still young and nervous and did not want to go But the family wanted me to go and so I had to go At the time of the consult the patient s voice was loud and clear and she was of sound mind She could hear eat sleep urinate and move her bowels in a normal way I wanted her to come out but she said that if she went out she would die I then called her and forced her out of the room Why did I do that First I wanted to see her Secondly I wanted to observe her facial color and finally I wanted to see her tongue moss The moment she came to the door opening she shouted out that she was so uncomfortable in her heart then she shouted I want to die She wailed and then abruptly made no sound and did not move I was very anxious but I put my hand in front of her nose and could still feel her breath I put a needle in He Gu LI 4 and offered a bit of ginger water After about a minute she revived consciousness and began breathing without shouting She said her eyes were going to explode as well as her heart organ Her tongue body was pale red with grayish white moss Her pulses were wiry This person who has been bedridden for 4 years unexpectedly had wiry and rapid pulses What could this mean great water colliding with the heart eyes that want to explode and terror What disease is this A thought suddenly occurred to me The patient said that it was water flowing up hill and colliding However this may not mean that it is actually water Also when it came on she wanted to die I suddenly related this to the passage in the Jingui Yaolue about Ben Tun disease In Ben Tun disease there is a surging up from the lower abdomen to the throat and one wants to die Then there is recovery and this stops This is all due to fright This is what it says in the classical works that are my foundation and my tools If I had not read the Jingui Yaolue I would not have been familiar with this and it would have been impossible to suddenly call this to mind The patient was not familiar with this text so she could not have described her symptoms based on it And yet did she not describe the symptoms as Qi surging to the heart Compiled and Translated by Sharon Weizenbaum 2021

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13 Ge Gen Formulas Discussions and Case Studies with a fit of wanting to die After I thought of Ben Tun I quickly thought of Zhang Zhongjing s treatment for it He has three formulas Gui Zhi Jia Gui Tang Ling Gui Zao Gan Tang and Ben Tun Tang Which should I use Gui Zhi Jia Gui Tang treats Yang deficiency Ben Tun Ling Gui Zao Gan Tang treats water fluid pulsating below the navel that is about to Ben Tun Ben Tun Tang is for liver Qi reversing upward Ben Tun What are the symptoms that indicate Ben Tun Tang Zhang Zhongjing said Ben Tun with Qi surging upward to the chest abdominal pain and alternating heat and cold This patient did not have aversion to cold or cold limbs Also her pulse was wiry and rapid This showed it was not Yang deficiency Was it water then Her tongue was not slippery and there was no pulsating below the navel therefore this was not water I also went back to considering Ben Tun Tang Why was this patient s eyes so distended She also had a clear aversion to light Why was this The light made her eyes worse Is this not clearly liver Qi reversing upward The liver opens into the eyes and her pulse was wiry and rapid These three symptoms put this in the category of liver Qi reversing upward which indicates Ben Tun Tang Therefore I gave her Ben Tun Tang The primary herb in Ben Tun Tang is Li Gen Bai Pi which the pharmacy did not have However there was plenty of it in the rural valley There were plum trees everywhere Right then and there I dug some up and put a Liang into each package with the rest of Ben Tun Tang I put the Gui Shao Xiong Ban Ge Long Cao and Sheng Jiang in to make up Ben Tun Tang And I added the Li Gen Bai Pi Thought about the greyish white tongue moss as well as the fact that even though no vomit came out at the time I brought her out of the room she retched I decided to add the one flavor Fu Ling to transform water So her first formula was the complete Ben Tun Tang with added Fu Ling After 5 packages I checked in because this disease was so strange I wanted to know the results However after 5 packages the patient s family did not come By the time they came she had already had 8 packages and the patient had emerged from her room That this disease was cured was a huge surprise for me It was completely beyond my expectations I did not know that the results from classical formulas could be so miraculous Compiled and Translated by Sharon Weizenbaum 2021

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14 Ge Gen Formulas Discussions and Case Studies Ge Gen Huang Qin Huang Lian Tang Ge Gen Jin 15 grams Huang Lian 3 liang 9 gm Huang Qin 3 liang 9 gm Zhi Gan Cao 2 liang 6 gm Take these four flavors and 8 Sheng of water First boil the Ge Gen until the water is down by 2 Sheng Add the remainder herbs and boil down to 2 Sheng Remove the foam divide into 2 doses and drink warm Original Text Clause 34 In Tai Yang disease there is a Gui Zhi pattern but a purging method was used instead This led to incessant diarrhea with hasty pulses This indicates an unresolved exterior If there is panting and sweating Ge Gen Huang Qin Huang Lian Tang is indicated Formula Explanation 6 This formula is a Tai Yang exterior pattern that was unresolved with a Yang Ming internal heat that is already very hot The emphasis of the formula is on the interior This is in accordance with the saying The evil has sunk into the interior 7 out of 10 and is on the exterior 3 out of 10 The key points of differentiation are a hot body diarrhea anal heat yellow tongue moss and a rapid pulse This formula uses a large amount of Ge Gen to slightly clear and ascend to emit Case 5 Diarrhea Dr Feng Shilun Patient female Ms Peng age 30 August 26 1965 The previous afternoon she had eaten grapes and then that night had gotten cold She woke up feeling weakness and soreness in her legs and thirsty She drank 4 cups of hot tea and the developed body heat and aversion to cold That afternoon she developed vexation and sweating with abdominal pain She had 3 bouts of diarrhea and then came in for a check up Her tongue moss was white and sticky and his pulse was slippery and rapid and floating in the cun position This was exterior and interior heat with diarrhea It was From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 92 6 Compiled and Translated by Sharon Weizenbaum 2021

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16 Ge Gen Formulas Discussions and Case Studies Gui Zhi 2 liang 6 gm Sheng Jiang 2 liang 6 gm Ban Xia Sheng 12 gm Da Zao 12 dates 4 dates From Liu Du Zhou s Collected Shang Han Lun Cases This is a Ge Gen Tang presentation accompanied by vomiting The outside evil has not been resolved and has moved into the Yang Ming The result is upward rebellion in the stomach and diarrhea However this is all due to an attack on Tai Yang that has become a Tai Yang Yang Ming concurrent pattern So Ge Gen Tang is used to resolve the exterior while Ban Xia is added to stop the vomiting Case 1 Common Cold with Vomiting Dr Hu Xi Shu Patient female named Ren age 21 She came for her first visit on December 21 1965 She had come down with a cold the day before and had a headache dizziness body and abdominal pain with aversion to cold and vomiting This was accompanied by lower abdominal pain and diarrhea a floating rapid pulse and white tongue moss This was a Tai Yang Yang Ming concurrent pattern and so Ge Gen Jia Ban Xia Tang was given Ge Gen 12 gm Ma Huang 10 gm Zhi Gan Cao 6 gm Compiled and Translated by Sharon Weizenbaum 2021

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17 Ge Gen Formulas Discussions and Case Studies Bai Shao 10 gm Gui Zhi 10 gm Sheng Jiang 10 gm Ban Xia 12 gm Da Zao 4 dates After one package the illness was greatly decreased and after two packages the illness was cured 1994 88 Discussion This is a case in which the presentation really matches the Ge Gen Jia Ban Xia Tang pattern and so the effect was very direct This formula is very effective for wind cold type gastrointestinal flu It can be used even if there is no diarrhea Case 2 Stomach pain Duodenal Intestinal Bulbar Ulcer Dr Liu Jing Qi Patient Chen male age 45 First visit was August 17 1979 Mr Chen had suffered from neck and back pain stomach pain and vomiting for 5 years Before that he often suffered from stomach pain that came on every spring Last year he had a radiographic exam which revealed a Duodenal Intestinal Bulbar Tumor This cause acute pain on the left side of his stomach duct area acid and poor appetite After meals he had occasional vomiting accompanied by strong neck pain aversion to wind and no sweating His pulse was floating and tight and the tongue moss was white and sticky His Chinese medical diagnosis was Compiled and Translated by Sharon Weizenbaum 2021

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18 Ge Gen Formulas Discussions and Case Studies stomach duct pain This was differentiated as unresolved external evil that had moved into the Yang Ming The treatment principle was to scatter cold and resolve the exterior while down bearing rebellion and harmonizing the stomach The formula was the original Ge Gen Jia Ban Xia Tang After 6 packages the pain and vomiting both diminished His eating became normal 1987 10 Discussion When there is neck pain aversion to wind no sweating and a floating tight pulse this indicates an evil at the Tai Yang Stomach pain vomiting and poor appetite with sour acid indicates that this has also gone into the Yang Ming This is why Gen Gen Jia Ban Xia Tang was used It resolves the exterior and harmonizes the stomach down bears rebellion and stops vomiting Case 3 Diarrhea Dr Hu Xue Ceng Patient Yu male age 26 First Visit October 8 1980 This morning the patient began to have a fever with aversion to cold body pain no sweat headache and distention of the head He went to the factory health center for treatment and was given herbs to resolve exterior heat That afternoon around 4 00 he began to have abdominal intestinal sounds and occasional pain Then he developed diarrhea that began to pour out There was no pus or blood This was dysentery with occasional vomiting The tongue was red with thin white moss The pulse was floating and tight This pattern was external contraction of wind cold in which the exterior Qi was blocked The external evil traveled into the Yang Ming large intestine The clear and the turbid were not separating and so there was diarrhea The treatment was to induce sweat and resolve the exterior while harmonizing the stomach and down bearing rebellion I used Ge Gen Jia Ban Xia Tang Compiled and Translated by Sharon Weizenbaum 2021

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19 Ge Gen Formulas Discussions and Case Studies Ge Gen 18 gm Ma Huang 4 gm Gan Cao 8 gm Bai Shao 8 gm Gui Zhi 8 gm Sheng Jiang 3 slices Ban Xia 8 gm Da Zao 3 dates After one package he developed a slight sweat over his body The exterior resolved and the diarrhea and vomiting stopped The illness was cured Discussion The Tai Yang evil had traveled internally to the Yang Ming It rebelled upward to the Stomach and downward to the intestine The vomiting and diarrhea occurred simultaneously Therefore Ge Gen Tang was used to stop diarrhea and Ban Xia was added to downbear rebellion and stop vomiting Ge Gen Tang Ge Gen 4 liang 12 gm Ma Huang 3 liang remove joints 9 gm Gui Zhi 2 liang remove peel 6 gm Compiled and Translated by Sharon Weizenbaum 2021

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20 Ge Gen Formulas Discussions and Case Studies Shao Yao 2 liang 6 gm Zhi Gan Cao 2 liang 6 gm Sheng Jiang 3 liang 9 gm Da Zao 20 dates 4 dates Boil all seven flavors in 1 Dou of water First boil Ma Huang and Ge Gen to decrease by two Sheng Skim the white foam and add the rest of the flavors Boil down to three Sheng and remove the foam Drink one Sheng warm Cover the body with a blanket for light sweating The instructions for care and what to avoid are the same as for Gui Zhi Tang All formulas should be administered that way Original Text Line 31 Taiyang disease with stiffness of the nape and back no sweat and aversion to wind Ge Gen Tang is indicated Line 32 Taiyang Yangming combined disease There must be spontaneous diarrhea Ge Gen Tang is indicated Jingui Yaolue Chapter 2 Line 12 Taiyang disease no sweat but contrarily there is scant urine upward surging Qi going into the chest clenched jaw that seems about to become hard tetany Jingui Yaolue Chapter 2 Line 1 Taiyang disease with heat effusion and no sweat and contrarily aversion to cold this is hard tetany Li D zh u s primary techniques for the application of Ge Gen Tang7 1 The application of Ge Gen Tang for neck and back pain According the narration of Zhang Zhongjing s formula pattern Ge Gen Tang treats neck pain strong hypertonicity of the neck and back and aching pain of the neck and back This formula s indications are in the neck or the vicinity of the neck area They are in the channels and collateral level of Taiyang and Yangming channels In this pattern the mouth is 7 Compiled and Translated by Sharon Weizenbaum 2021

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21 Ge Gen Formulas Discussions and Case Studies harmonious with moist tongue moss and there is no sweating For this Ge Gen Tang is applied Even if there is not a typical Ma Huang Tang pattern with aversion to cold and heat effusion this formula can still be used This deserves to be taken seriously In the application of Ge Gen Tang Li D zh u s diagnosis was definitely not influenced by western medicine If a patient had hypertension or coronary heart disease he would treat it with Ge Gen Tang only if there was strong neck pain and the pattern was differentiated as a Ge Gen Tang pattern Many cases of hypertension disease in particular have accompanying headache and very hard feeling neck muscles These are the cases for which Liu Duzhou often used Ge Gen Tang Although this formula contains the dispersive and rising herbs Gui Zhi and Ma Huang which easily agitate the Yang Dr Liu considered that when combined with the cold pungent Ge Gen that they could course and open through the channels and collaterals In addition when combined with Shao Yao and Gan Cao spasming and tightness in the blood vessels are relieved Because of this Ge Gen Tang should definitely not be avoided for hypertension 2 The application of Ge Gen Tang for spasm and pain of the shoulders and back The shoulders and back are related to the Taiyang Ge Gen Tang can be used for all shoulder and back pai if the tongue is not red with white moist moss and there is no sweating 3 Application of Ge Gen Tang for Ankylosing Spondylitis The pain of this disease occurs primarily in the hip joing and sacrum Although there is not strong neck pain this is still a characteristic manifestation of the Ge Gen Tang pattern However the pathology is in the Taiyang bladder channel with a harmonious mouth no thirst lack of sweating and a tongue that is not red and does have white moist moss This is a cold evil congealing the Taiyang channel and vessels Because it resolves spasming pain in the channels vessels and muscles it can treat this disease 4 Application of Ge Gen Tang to treat spastic neuropathy Ge Gen Tang can be used to disperse wind cold outward Because Ge Gen resolves the muscles and Shao Yao Gan Cao Tang resolves spasming and Ma Huang and Gui Zhi scatter wind cold outward Ge Gen Tang is often used to treat spasming neuropathy pathology such as spastic muscles around the eye Compiled and Translated by Sharon Weizenbaum 2021

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22 Ge Gen Formulas Discussions and Case Studies 5 Application of Ge Gen Tang to treat motor neuron pain Ge Gen Tang can be used to treat motor neuron damage with atrophy of the limbs and trunk Ge Gen Tang can be used for muscle atrophy with clear pain because it resolves congealed stasis in the muscles and stops pain 6 The Ge Gen Tang boiling method Liu Duzhou adhered strictly to Zhang Zhongjing s preparation methods He stressed pre boiling Ma Huang and Ge Gen removing the foam and then adding the other herbs He thought that this method moderated the pungent scattering nature of Ma Huang and Ge Gen stopping them from being excessive diaphoretic or from causing too much sweating This can diminish the adverse effects of Ma Huang such as palpitation agitation and dizziness 8 7 The dosage of Ma Huang relative to the other herbs Liu Duzhou did not consider Ge Gen Tang to be Ma Huang Tang with added Ge Gen He thought of it as Gui Zhi Tang with added Ma Huang and Gui Zhi If one did use Ma Huang Tang Jia Ge Gen the strong diaphoresis would be increased with the Ge Gen making the Yang raising and exterior opening action even stronger There would be the danger of causing excessive sweating Using Gui Zhi Tang with Ma Huang added can also scatter wind cold outward to resolve the muscles and it also includes Bai Shao Gan Cao and Da Zao so it enriches the Yin and blood and protects the stomach Qi while relieving the spasming of the channels and vessels This is unlikely to damage the fluids through sweating excessively Considering this Liu Duzhou was especially cautious with his dosage of Ma Huang in Ge Gen Tang He only used 3 4 gm of it while using 14 16 gm of Ge Gen He often used 12 gm of Gui Zhi and Bai Shao though sometimes as much as 14 gm This point very much deserves our attention Discussion9 Ge Gen has an important chief position in the formula Ge Gen Tang It spreads the Jin Ye fluids which resolves strong spasming of the neck and back Ma Huang is the minister It induces sweat to resolve the exterior by opening blockage of the pores and interstices With Gui Zhi Tang the 8 From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 5 9 Compiled and Translated by Sharon Weizenbaum 2021

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23 Ge Gen Formulas Discussions and Case Studies formula also harmonizes the Ying and Wei After taking the herbs there should be a light sweat This is in so that the doctor avoids the unfavorable effect of sweating damaging the fluids Discussion10 This pattern is one in which the evil enters the Taiyang channel pathways so that the channel Qi is inhibited and the tendons and vessels lose their nourishment The clinical manifestation consists of lack of sweating aversion to wind neck and back tightness and discomfort For this Ge Gen Tang is appropriate in order to resolve the exterior and scatter the evil from the channel pathways This formula is Gui Zhi Tang with Ma Huang and Ge Gen added The formula uses four Liang of Ge Gen so this is the principle herb Its characteristic flavor is sweet and pungent It is able to raise up the Jin Ye and moisten the sinews and vessels It can also resolve the exterior and dispel the evil This pattern is one of exterior excess without sweating and therefore three liang of Ma Huang is added to Gui Zhi Tang so that there is not only harmonization of the Ying and Wei there is also induce sweating and dispel the evil Because the sinews and vessels are lacking nourishment one mustn t aggressively induce sweating This is why there is Gui Zhi Tang which gathers the Yin and harmonizes the Ying boost the middle Jiao and benefits the stomach Qi When there is an exterior deficiency pattern with neck and back tightness one uses Gui Zhi Jia Ge Gen Tang When there is an exterior excess with neck and back tightness one should not use Ma Huang Tang with added Ge Gen This is because Ma Huang Tang aggressively induces sweating and excessive sweating damages the Yin This causes a loss of nourishment for the sinews and vessels This is why Gui Zhi Tang is used with added Ma Huang and Ge Gen This can treat an exterior excess without sweating and yet it does not over do the sweating to damage Yin If the Taiyang evil cannot be resolved on the exterior it goes interior to the Yangming and descend to the large intestine This leads to the large intestine being unable to keep up with its duties of separating the food and fluids The result is diarrhea This is due to the exterior pattern and this is why there is a focus on the exterior pattern Ge Gen Tang should be used as it will 10 Sha ng Ha n Mi ng Yi Ya n A n Ji ng Xu an Selected Cases from Famous Physicians in the Shang Han Tradi tion Ed Che nMi ng Zha ngYi n She ng Xue Yua n Publishing Company Be iji ng China 1998 Compiled and Translated by Sharon Weizenbaum 2021

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24 Ge Gen Formulas Discussions and Case Studies resolve the exterior and in resolving the exterior the interior is spontaneously harmonized which will stop the diarrhea This is what is called reversing the current to pull up the boat Cases11 Case 1 Common Cold12 Dr H R n Mr Wang age 19 came in for a consultation on February 13 1979 He had a common cold with aversion to cold body heat cough shortness of breath and pain of his whole body His neck and back had strong tension and tightness He had great difficulty and suffering when he moved at all 3 days previously he had taken some western medicine but was unable to sweat His urine was yellow and scanty and his appetite was low His tongue moss was thick and his pulses were floating I had to first resolve the exterior harmonize and regulate Ge Gen 9 gm Ma Huang 6 gm Gui Zhi 6 gm Bai Shao 9 gm Ren Dong Hua 6 gm Ren Dong Teng 6 gm Sang Zhi 6 gm Sheng Gan Cao 6 gm Jing Hua Shi 6 gm Sheng Jiang 3 slices Hong Zao 3 dates 3 packages From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 2 12 11 Compiled and Translated by Sharon Weizenbaum 2021

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25 Ge Gen Formulas Discussions and Case Studies Return visit 2 16 79 After the herbs he was able to sweat and felt more comfortable He noticed that the neck and back pain tightness was gone The aversion to cold and body heat were also gone He could move his neck about smoothly His urine was relatively long and he had interest in food He still had a cough His pulses were balanced and his tongue moss was thin I continued with a plan to stop cough Discussion In this case there was a common cold aversion to cold heat sensations lack of sweat and contrarily scanty urine The whole body discomfort with strong tightness of the neck so that it was difficult to move about This was consistent with the Taiyang tetany pattern The illness had begun three days earlier when wind and cold gathered on the exterior and did not resolve so that there were symptoms that showed that it transformed into heat This is why Ge Gen Tang was given to induce sweating and resolve the muscles At the same time Ren Dong Hua and Teng was added along with Sang Zhi to clear heat and dispel wind sooth the sinews and open through the collaterals Hua Shi clears heat and benefits urination Cold and hot herbs are used together though warming is primary The combinations were considered very carefully Case 2 Facial paralysis13 Dr Qu n Y j ng Mr Wang age 25 came in for an initial consultation on April 18 1973 He was an agricultural worker in G ol n county He had to go by car on a business trip and there was an accident He received an injury and afterwards had left side facial paralysis He could not close his left eye or wrinkle his forehead He was drooling from the corner of his mouth and would accidentally drool when he spoke His tongue was crooked and slanted to the right The dip between his nose and lips had vanished His speech articulation was unclear In the local hospital he was given herbs to dispel wind for several months but there was no effect Thereupon he came to L n for a diagnosis and treatment The pattern was differentiated as the Yangming channels and collaterals were obstructed due to injury Three packages of Ge Gen Tang with added Tao Ren were given Ge Gen 13 12 gm I 1981 2 Compiled and Translated by Sharon Weizenbaum 2021

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26 Ge Gen Formulas Discussions and Case Studies Ma Huang 9 gm Gui Zhi 6 gm Bai Shao 6 gm Sheng Jiang 9 gm Zhi Gan Cao 6 gm Da Zao 4 dates Tao Ren 9 gm Dang Gui 9 gm This was decocted in water and divided into two doses Second visit After taking the above formula the patient began for see wrinkles on his forehead and his left eye could shut more than before He felt more soft in his face The herbs were continued as before Third visit After taking the herbs again the illness changed for the better He took more than 30 packages and was completely cured His eyes closed smoothly and the wrinkles on his face returned Discussion In this case because of head trauma the Yangming channels became congealed and obstructed This manifested as facial paralysis lack of wrinkles and disappearance of the dip between his nose and lips had vanished The foot Yangming channels and vessels rise up to the nose and join to the chin They embrace the mouth circle the lips exiting at Da Ying to follow the lower jaw to arrive at the forehead Ge Gen Tang with Tao Ren or Dang Gui to course and open through the Yangming channels and vessels They work together to free up the obstruction rapidly Case 3 Convulsions14 Dr Xu J nf ng 14 1 24 1979 Compiled and Translated by Sharon Weizenbaum 2021

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27 Ge Gen Formulas Discussions and Case Studies Ms Zhang was age 13 and came for her initial consultation on September 13 1977 At the start of her illness she just had a common cold with discomfort in her body Two days later she suddenly had convulsions with lockjaw This continued to become strong neck and back tension though distended in the bend of the neck There was no sweat and the spirit was clear She felt like she was suffocating She was tired with heavy soreness The lab test showed her temperature was 37 5 C Blood pressure was 110 70mm Hg which was normal and not reflecting pathology Blood tests were normal as well Her tongue moss was thin and white and her pulses were tight and rapid The diagnosis was convulsions due to wind cold stagnating in the vessels and collaterals Qi and blood obstructions so that the sinews and vessels spasmed with rigidity in the neck and back The treatment needed to dispel wind scatter cold resolve the muscles and harmonize the Ying Ge Gen 10 gm Ma Huang 3 gm Gui Zhi 5 gm Bai Shao 12 gm Sheng Jiang 3 slices Gan Cao 3 gm Da Zao 4 dates Tian Hua Fen 12 gm She was also given 3 gm Jie Jing San Quan Xie Wu Gong etc powdered and covered with a blanket until she sweat Return visit She took one package of the herbs and she sweat The convulsions stopped She took one more package and was cured Discussion In this case the convulsions arose from responding to both wind and cold You need wind to generate dryness Without wind you to scurry through the channels there won t be recovery Y u Z ij ng says Experience shows that most convulsion disease resides in the Compiled and Translated by Sharon Weizenbaum 2021

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28 Ge Gen Formulas Discussions and Case Studies Yangming and Taiyang There is a strong body and lockjaw so that one cannot speak Ma Huang is therefore used to emit the evil from Taiyang outward Ge Gen is added to course the Yangming channel Additionally Yangming governs the muscles and flesh on the exterior In the interior it governs the Jin Ye Ge Gen opens through the valleys and expels wind damp The addition of Gua Lou generates Jin Ye and moistens the channels and vessels The prescription for this case reflects these words Combining the formula with Jie Jing San searches out wind and subdues convulsions and dispels the wind toxin evil Case 4 One sided headache15 Dr Li D zh u Case 5 Facial Paralysis16 Dr B M ngy Gui Zhi Jia Ge Gen Tang Gui Zhi 2 liang 6 gm Bai Shao 2 liang 6 gm Ge Gen 4 liang 12 gm Sheng Jiang 3 liang 9 gm Zhi Gan Cao 2 liang 6 gm Da Zao 12 dates 4 dates Cooking instructions 15 16 1996 134 1991 5 43 Compiled and Translated by Sharon Weizenbaum 2021

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29 Ge Gen Formulas Discussions and Case Studies First boil Ma Huang17 and Ge Gen in 1 dou of water boiling until reduced by 2 sheng Strain and add the rest of the ingredients Simmer reducing to 3 sheng and strain again Take 1 sheng of the decoction warm and cover the patient with a blanket to induce a mild sweat There is no need to eat hot gruel The rest is as per standard Gui Zhi Tang methods and contraindications Original Text Clause 14 In Tai Yang illness the neck and back are stiff and taut and yet there is sweating and aversion to wind Gui Zhi Jia Ge Gen Tang governs From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zhou Explanation This pattern is one of root deficiency and branch excess The root is lack of harmony of the Ying and Wei and the branch is inhibited Qi and blood of the Tai Yang channels and vessels The particular clinical signs of the presentation are sweating aversion to wind spasming discomfort of the neck and back Gui Zhi Tang harmonizes the Ying and Wei and this treats the root The addition of Ge Gen arouses the raising of the Yang Ming Jin and Ye to moisten the Tai Yang channels and vessels In terms of the clinical reality this pattern is one of exterior deficiency in which the Tai Yang channel Qi is inhibited In these cases one can use this formula Cases Case 1 Acute spasm of the neck and back Dr Liu Du Zhou Mr Liu was age 41 and had been suffering already for 3 months His neck and back had been stubbornly tight He could not smoothly look around or move He had spontaneous sweating and aversion to wind With asking I learned that his bowel movements were watery and viscous coming 2 3 times day He also had anal prolapse and felt rectal heaviness Touching his pulses were floating Looking revealed his tongue moss to be white and moist This was a Gui Zhi Jia 17 See discussion regarding Ma Huang in the formula below Most commentators consider the addition of Ma Huang here to be an error in the Song edition of the Shang Han Lun Compiled and Translated by Sharon Weizenbaum 2021

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30 Ge Gen Formulas Discussions and Case Studies Ge Gen Tang pattern The pasty bowel movements and rectal heaviness showed that the Yang Ming had received an evil that inhibited the raising of the clear This was a combined Tai Yang Yang Ming illness Gui Zhi 15 gm Bai Shao 15 gm Ge Gen 16 gm Sheng Jiang 12 gm Zhi Gan Cao 10 gm Da Zao 12 pieces After the herbs he did not need to take warm gruel He took 7 packages and was cured quickly 1996 140 Discussion In this case the patient had neck and back pain combined with diarrhea with heaviness and rectal prolapse This is the actual summary of this formula presentation Later generations use this formula to treat unresolved external contraction or diarrhea presentations and obtain good results Dr Liu uses this formula to treat wind cold back numbness and pain as well as for low level joint inflammation For these it also has a good effect Case 2 Convulsions Dr Pu Fu Zhou The patient was a 4 5 year old boy who came for a consultation on August 15 1963 He had suddenly developed a fever with nausea and vomiting In 4 hours he had convulsions 2 times Because he was unconscious he was urgently taken to the hospital There was pus and blood in his stool sample and he had tenesmus He was diagnosed at that time with an acute toxic illness He was given winter sleep drugs and also had warm wet compresses placed on his body The next day his facial complexion had become grey and dark He was shivering and had a high fever Compiled and Translated by Sharon Weizenbaum 2021

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31 Ge Gen Formulas Discussions and Case Studies His breathing was weak He was given a drug to reduce fever and his breathing improved His fever returned and two days later every morning he would start to shiver and become purplish His limbs were cold In the afternoon his fever would go up to 42 43 C without sweat Sometimes he would speak and act rashly and restless Every day he would have diarrhea with blood and pus more than 20 times He had abdominal distention and tenesmus There was no vomiting and he still had an appetite The blood test revealed that his white blood cell leukocyte count was gradually decreasing as was the granulocytes White blood cells down to 600 cubic ml neutral 30 The stool test showed Fu Shi type bacterial dysentery He endured experimental drugs taking many antibacterial with no allergic reactions On the 26th day I was asked to come to the hospital for a consultation In my office he had rapid breathing and a red face His abdomen was full but not hard In the morning he shivered and in the afternoon he would be hot The right pulses were deep and stagnant and the left pulses were wiry big and contracted Hi tongue body was pale and the moss was thin white and sticky This was summer heat dampness hiding in the interior with new cold added to the exterior The exterior was constrained and the interior was knotted This was the cause of the rising and falling and obstruction The Ying and Wei were not harmonized If only the exterior was treated then the hidden evil would not be able to go out to the exterior The inward knotting would get worse The correct was deficient and the evil was excess Luckily the stomach Qi remained and the fluids were not exhausted It was appropriate to urgently raise the Yang Ming harmonize the Ying and Wei while opening the obscure blockage of the Yang hollow organ This way the evil could go to the exterior and the interior could be resolved Gui Zhi Jia Ge Gen Tang was used Gui Zhi 3 gm Bai Shao 3 gm Ge Gen 6 gm Sheng Jiang 2 slices Zhi Gan Cao 3 gm Da Zao 2 pieces Compiled and Translated by Sharon Weizenbaum 2021

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32 Ge Gen Formulas Discussions and Case Studies I had them cook these herbs in 180 ml with a slow boil and then drink 30 ml every 4 hours After the herbs I also recommended He Ye and Chao Geng Mi cooked in a soup This reflects the Gui Zhi Tang method to help induce sweat After the herbs he sweat except his lower legs did not sweat His temperature decreased and his 4 limbs became warm In the morning he did not shiver However he still had bloody stool and tenesmus He was given the same formula with Gui Zhi and Bai Shao removed Herbs to supplement his spleen and transform dampness were added to regulate and in 1 week there was a cure 1964 8 13 Discussion This case is a case of toxic dysentery with high fever pus and blood in the stool Yet it is clear that there was a pale face and cold limbs shivering from cold On the basis of this Dr Pu did not just give bitter cold clear heat resolve toxin to treat dysentery Instead he used a pungent warm formula to open the exterior and guide out the evil He changed the current in order to turn the boat With the surface open the interior could flow the heat was dispelled and the diarrhea stopped One simply must read this as Zhang Zhong Jing s military strategy Case 3 Stiff neck Dr Cheng Zhaohuan Mr Ma was 18 years old He had suffered from stiff neck 3 5 times a year When this occurs he is unable to turn his head The pain was strong on his nape but his back was also in spasm and painful Each time he would get acupuncture and Tuina 3 5 times and this would be effective Yet he would again randomly get wind cold or rotate and it would happen again This was accompanied by sweating aversion to wind He requested Chinese herbs to treat the root At the time of the consultation his tongue was pale with thin white moss and his pulse was floating in the Cun position I said I would give him a formula When the stiff neck came on take it When it came again take it again Gui Zhi 9 gm Bai Shao 9 gm Ge Gen 15 gm Compiled and Translated by Sharon Weizenbaum 2021

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33 Ge Gen Formulas Discussions and Case Studies Sheng Jiang 6 slices Zhi Gan Cao 9 gm Da Zao 5 pieces Dang Gui 12 gm He took this two times and had no more outbreaks 1989 81 Discussion Stiff neck is a common issue The neck and back become stiff and taut When there is sweating aversion to wind and the pulse is floating on the cun this is the Gui Zhi Jia Ge Gen Tang pattern The effect is very good Case 4 Spastic Type Torticollis Dr Wang Weiheng Mr Wang was 32 years old He came for a consultation on August 5 1980 He said that 5 hours previously out of nowhere he had a paroxysm which left him uncontrollably turned to the right with torticollis He was given 50 mg of an intramuscular injection and 8000 units of gentamycin but his condition did not get better He urgently came to my clinic for consultation and treatment His tongue body was pale with thin white moss His pulse was moderate Body checkup Before an episode comes on he has some slight head shaking After this continues his head by degrees angles to the right or upward His lower jaw goes to the side and slightly upward His mouth is distended and difficult to close His eyes crossed With this he has strong spasming of the neck and back He also has spontaneous sweating aversion to wind and dry throat This happened 1 time every 5 10 minutes The western diagnosis was Spastic Type Torticollis The Chinese medical differentiation of patterns was a sneak attack of an external evil The Ying and Wei lost their harmony The Tai Yang channels had become inhibited and the fluids were not spreading The tendons and vessels were un nourished For treatment it was Compiled and Translated by Sharon Weizenbaum 2021

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34 Ge Gen Formulas Discussions and Case Studies appropriate to resolve the muscles and dispel wind regulate Ying and Wei smooth and disinhibit the channels and vessels For this Gui Zhi Jia Ge Gen Tang was used Gui Zhi 12 gm Hang Bai Shao 30 gm Ge Gen 15 gm Sheng Jiang 3 slices Zhi Gan Cao 10 gm Da Zao 5 pieces Decocted in water 1 package for 1 day divided into two doses a day He took 2 doses and the disease was cured A follow up after two years revealed no relapse 1990 I 18 Discussion Spastic type torticollis is an illness of the nervous system It is due to involuntary muscle contraction and spasms of the neck muscles or sternocleidomastoid muscles In Chinese medicine this is in the category of tetany illness In this case there was simultaneous spontaneous sweat aversion to wind and moderate pulse So Gui Zhi Jia Ge Gen Tang was used Case 5 Tetany Pattern Rigid person syndrome Dr Zhang Zhendong Ms Wang was age 52 Generally she sweated easily On October 10 1985 she felt her lower limbs twitch and there was pain as well Gradually this became neck pain Her lower limbs were rigid and straight She was unable to get out of bed This was accompanied by episodes of difficult breathing When this was extreme she felt she was suffocating She came to the hospital and the diagnosis was rigid person syndrome At the time of the consult her head and Compiled and Translated by Sharon Weizenbaum 2021

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35 Ge Gen Formulas Discussions and Case Studies neck were rigid and she could not bend to the side Her whole body was emaciated and weak Her facial complexion was sallow white and her speech was unclear Her spirit was apathetic Her two eyes were looking toward the outside Her SCM and abdominal muscles were tight and distended Her four limbs were very tense Her reflexes were hyperactive Both feet and toes were contracted toward the soles of the feet Her whole body was warm and moist with sweat Her tongue was red with a thin white moss and her pulse was wiry and thin This was lack of harmony of the Ying and Wei Sweating had damaged the fluids so that the tendons and muscles were not nourished She was treated with Gui Zhi Jia Ge Gen Tang Gui Zhi 10 gm Hang Bai Shao 12 gm Ge Gen 30 gm Sheng Jiang 10 gm Zhi Gan Cao 5 gm Da Zao 5 pieces She was given 30 packages and the sweating stopped Her whole body had a soft relaxed feeling 3 gm of Quan Xie was added to be powdered and given as a draft She took another 30 packages The whole body rigidity was resolved Her muscles became relaxed and soft and her speech became clear and distinct Although she still had foot and toe tension she was able to walk about 1988 2 89 Discussion This case related to the fact that her body was depleted The Cou Li were soft and sweat issued like a river Over time this damaged the fluids so that they could not nourish and moisten the tendons and vessels This manifested as head and neck rigidity and spasming of the feet and hands This was repetitive without cure Gui Zhi Jia Ge Gen Tang was used to harmonize the Ying and Wei and stop sweating A large amount of Ge Gen was used to raise the Compiled and Translated by Sharon Weizenbaum 2021

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36 Ge Gen Formulas Discussions and Case Studies Jin Ye so that the tendons and vessels could be softened Quan Xie was added to relieve wind and stop spasming The formula and pattern were mutually consistent and so the effect was good Case 6 Twitching Facial Muscle peripheral facial nerve numbness Dr Jin Shuwu Ms Wei was age 45 She came for a consultation on April 25 1987 She reported that the muscles of her right side were twitching There was also a numb feeling She had had some paralysis of her mouth and eyes for the last year She reported that one year previously she had been sweating and was damaged by wind Her neck and back were tight and there was numbness on the right side of her face Gradually by degrees she developed facial numbness around her mouth and eyes Sometimes she would sweat spontaneously and she had an aversion to wind Her hands and feet were numb She had gone to doctors and the diagnosis was peripheral facial nerve numbness She took western drugs that she did not know the names of and she took Chinese herbs Zhen Gan Xi Feng Tang to correct and scatter but there was no effect She then came to my hospital for treatment Check up Her mind was clear her complexion was slightly yellow but her eyes had spirit The muscles on the right side of her face were twitching There was not obvious mouth and eye paralysis Her tongue was pale red with thin white moss Her pulse was wiry A wind evil had made a sneak attack and the Ying and Wei were not harmonized The interstices were inhibited and the tendons and vessels had lost their nourishment The principle was to dispel wind harmonize the Ying and Wei resolve spasming and sooth the tendons Gui Zhi 15 gm Bai Shao 15 gm Ge Gen 50 gm Sheng Jiang 3 slices Zhi Gan Cao 10 gm Compiled and Translated by Sharon Weizenbaum 2021

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37 Ge Gen Formulas Discussions and Case Studies Da Zao 4 pieces After taking the herbs she took 200 ml of hot gruel so there would be a slight sweat She was instructed to avoid wind After 6 packages there was a great decrease in the symptoms She then became overworked and sweat again and received wind The disease returned even more seriously The same method was used to treat and she was given 21 packages of the original formula Then there was a cure 1989 I 27 Discussion When the Cou Li are not consolidated the ying and wei are not consolidated The collaterals vessels tendons and muscles loose their nourishment Then a wind evil creates an uproar and so this illness arises The pulse and presentation matched Gui Zhi Jia Ge Gen Tang and so there was a cure Case 7 Prolapsed eyelid Dr Qin Tianfu The patient was a 6 year old girl She came for a consultation on October 10 1984 Her father spoke as her representative 3 months previously she had gone out and while en route she received wind and cold That evening she developed a fever and after 3 days the fever retreated Her family noticed that her eye lids were drooping They went to the hospital and she was diagnosed with serious eyelid prolapse She was given vitamin B1 and intermittent injections of a new medicine but there was only an effect for a short time After a moment the prolapse returned Gradually it got worse Checkup The child had developed normally Her tongue and pulse were without clear issues Her basic Qi was relatively weak She had a posture that had her head slightly tilted upward This was so she could see She would also use her fingers to lift her lids She was given Bu Zhong Yi Qi Tang modified After three packages there was no effect I thought carefully The eyes have a relationship to the foot Tai Yang bladder channel and vessels as it rises up to the eyes This child has received wind This damaged the Tai Yang vessels This inhibited the movement in the Tai Yang channel so that the channel Qi was depressed This is Compiled and Translated by Sharon Weizenbaum 2021

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38 Ge Gen Formulas Discussions and Case Studies what caused the eyelid prolapse In order to open through the Yang sooth the luo regulate and harmonize the Ying and Wei I used Gui Zhi Jia Ge Gen Tang Gui Zhi 9 gm Chao Bai Shao 9 gm Ge Gen 10 gm Zhi Ke 15 gm Zhi Gan Cao 6 gm Da Zao 3 pieces Fang Feng 5 gm After the herbs the eyelid prolapse had clearly changed for the better She was now able to see Because her form and Qi were weak I again used 3 packages of the original formula with 10 gm of Huang Qi added to return the correct Qi After half a month her father came in to give a report Her eyes were as before and after a year there was no recurrence 1987 4 5 Discussion In the clinic this illness is often treated as spleen deficiency with descending Qi In this case the wind had entered the Tai Yang and the channel Qi was inhibited We can know this because the eyelid is the place that the Tai Yang foot channel rises to This is differentiation according to the channels and vessels The result was that the Gui Zhi Jia Ge Gen Tang was effective This pattern deserves deep contemplation Case 8 Urticaria Dr Feng Wanfu Compiled and Translated by Sharon Weizenbaum 2021

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39 Ge Gen Formulas Discussions and Case Studies Ms Li was age 37 and had had urticaria for many years It happened every day The rash emitted like little grains It was more serious when she sweat or when she met wind When this came on her the muscles and skin of her whole body became uncomfortable She used many types of formulas for treatment but the effect was not good Although this was not a serious illness when it was active the pain and itching were unbearable She was agitated and both her work and leisure were influenced This was differentiated as soft Cou Li so that wind had entered the hair openings The Yang Qi was drained on the exterior Gui Zhi Jia Ge Gen Tang was used with 15 gm of Fang Feng added Altogether 20 packages were taken and there was a cure 1979 44 Appended Notes The essential points of this case are 1 the itching with the flowing of sweat and contact with wind making it worse 2 The whole body muscle and skin discomfort This was wind in the muscles and skin attacking the hollow spaces with Tai Yang channel and vessel discomfort This matched the Gui Zhi Jia Ge Gen Tang pattern and so there was a cure Gui Zhi Jia Ge Gen Tang is in the Song version of the Shang Han Lun In this version there are 3 liang of Ma Huang After the formula the text goes on to say The main principle for Zhang Zhong according to Chen Yi is caution When there is Tai Yang wind strike there is sweating use Gui Zhi When there is Tai Yang Cold Damage there is no sweating use Ma Huang More recently it is said that it is not correct to use a formula with Ma Huang when there is sweating and aversion to wind In the third scroll the pattern for Ge Gen Tang is without sweat and aversion to wind The formula is the same as the Gui Zhi Jia Ge Gen Tang in clause 14 They both use Ma Huang This means that Gui Zhi Jia Ge Gen Tang is Gui Zhi Tang with only Ge Gen added Based on these words the Ma Huang is taken out In Xu Shuwei s Ninety Treatises on the Shang Han Lun there is a case study from the 47th year of the sexagenary cycle of cold damage back pain with sweating and aversion to wind I said Gui Zhi Jia Ge Gen Tang The family replied After three packages the illness was gone Sweat issued and there was a cure I said Could it be that Zhang Zhong Jing s third formula was used meaning the Song Version Gui Zhi Jia Ge Gen Tang They said Correct I Compiled and Translated by Sharon Weizenbaum 2021

Ge Gen Ebook

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