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Mu Li and Long Gu Ebook 1 Chai Hu Gui Zhi Gan Jiang Tang 3 Original Clause 4 Discourse by Feng Shi Lun 4 Discourse by Dr Li Pei Sheng This formula is indicated to treat for the presentation of Shaoyang illness accompanied by water congealed internally 8 Discourse by Tang Rong Chuan 10 Discourse By Liu Du Zhou 13 Further Discourse by Liu Du Zhou 13 1 The theory of the disease mechanism maintains it is gallbladder heat and spleen cold 14 2 To grasp this formula one must stress bitter mouth and viscous stool 16 3 Paying attention to the adjustment of the herbs dosages 18 Application 20 Case 1 Abdominal distention Chronic Hepatitis B 20 Case 2 Stomach Duct Pain Stomach prolapse 22 Case 3 Cough Chronic Bronchitis 24 Case 4 Heart Palpitations Sinus type Tachycardia 26 Case 5 Dizziness 28 Case 6 Rheumatic Fever 30 Case 7 Inhibited Urination Urinary Infection 33 Case 8 Stuttering 35 Case 9 Breast Mass 35 Case 10 Hepatitis 37 Case 11 Epilepsy 38 Case 12 Amenorrhea 40 Chai Hu Jia Long Gu Mu Li Tang Original Text Collection of Shang Han Lun case studies from renowned physicians Case 1 Epilepsy Case 2 Constraint Pattern Case 3 Insanity Case 4 Fear and anxiety with palpitations Case 5 Insomnia Case 6 Dizziness Case 7 Tinnitus Case 8 Impotence Case 9 Spermatorrhea 42 43 43 43 45 46 48 49 51 52 52 53

Mu Li and Long Gu Ebook Case 10 Parkinson s Case 11 Pediatric Hyperactivity Case 12 Menopausal Syndrome Feng Shi Lun Case 1 Tinnitus Fan Zhong Lin Case 1 Shao Yang Pattern Insanity Differentiating Formulas and When to use Shells Interview with Nigel Dawes Gua Lou Mu Li San Original Text Discussion 2 54 56 57 58 58 61 61 64 66 66 66 Gui Zhi Gan Cao Long Gu Mu Li Tang 68 Original Text 68 From my Blog about using Shells and Minerals 68 From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zou 71 Explanation of Formula 72 Case 1 spontaneous sweat 72 Case 2 Palpitations 73 Case 3 Twitching Eye Muscle 73 Gui Zhi Jia Long Gu Mu Li Tang 74 From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zou 74 Original Text Jin Gui Chapter 6 Deficiency Taxation line 8 75 Case 1 Damage from Wind Vomiting Blood and Wet Dreams 75 Case 2 Spontaneous sweating from the neck 75 Case 3 Deficiency Taxation 76 Case 4 Spermatorrhea 76 Case 5 Postpartum bleeding 77 Cases From The Big Book on Gynecology 78 Case 1 Excessive Menstruation 78 Case 2 Excessive Menstruation 79 Case 3 Beng Luo 80 Huang Huang on Gui Zhi Jia Long Gu Mu Li Tang 81 Pediatric Use 83 Neurasthenia 83 Respiratory or Digestive 83 Notes on Gui Zhi Jia Long Gu Mu Li Tang 83 Case 4 Fear and Fright 84

3 Mu Li and Long Gu Ebook Case 5 Fear and Insomnia Fu Yan Ling on Gui Zhi Jia Long Gu Mu Li Tang Case 6 Stomach and Duodenal Ulcer Feng Shi Lun on Gui Zhi Jia Long Gu Mu Li Tang Case 7 Chronic Prostatitis Case 8 Heart Palpitation Dr Yu Guo Jun on Gui Zhi Jia Long Gu Mu Li Tang Case 9 Spontaneous Sweating Case 10 Pediatric Night Sweats Case 11 Fever 85 86 86 88 88 91 92 93 94 95 Gui Zhi Long Mu Feng Sui Dan 97 Gui Zhi Qu Shao Yao Jia Shu Qi Mu Li Long Gu Jiu Ni Tang 98 Original text 99 From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zhou 99 Case 1 Disordered Spirit 99 Case 2 Insanity 101 Mu Li Ze Xie Tang Original Text Discussion Case 1 Water Swelling Case 2 Suspended fluids Seeping type pleurisy 102 102 102 103 103 Chai Hu Gui Zhi Gan Jiang Tang Chai Hu Jin 24 gm Gui Zhi peel 3 Liang 9 gm Gan Jiang 2 liang 6 gm Gua Lou Gen 4 liang 12 gm Huang Qin 3 liang 9 gm removed

4 Mu Li and Long Gu Ebook Mu Li Dry Fried 2 liang 6 gm Zhi Gan Cao 2 liang 6 gm Boil these 7 flavors in 1 Dou 2 Sheng down to 6 Sheng and remove foam Boil again down to 3 Sheng Drink 1 Sheng warm three times a day After the first dose there may be slight vexation Recovery will be brought about by sweating after taking it the second time Original Clause Clause 147 After suffering from cold damage for 5 or 6 days sweating has been promoted first and then purging has been applied There is fullness in the chest and hypochondriac region with a feeling of slight blockage abnormal urination thirst and the absence of vomiting sweating only on the head alternating chills and fever and a sick and discomforting feeling in the stomach These indicate the disease has not resolved Chai Hu Gui Zhi Gan Jiang Tang governs Discourse by Feng Shi Lun Chai Hu 24 Gui Zhi 10 Gan Jiang 6 Tian Hua Fen 12 Huang Qin Mu Li 10 10

5 Mu Li and Long Gu Ebook Zhi Gan Cao 6 Formula Explanation This formula is a modified version of Xiao Chai Hu Tang It removes Ban Xia and adds Gua Lou Combining the bitter cold Huang Qin with the pungent warm flavor of Gan Jiang for the slight knotting The moistening quality of Gua Lou Gen and the containing quality of Mu Li help to stop thirst Gui Zhi and Gan Cao treat the surging Qi while supplementing Ren Shen supplements the middle and Da Zao causes congestion In an effort to avoid knotting these are both removed Therefore the formula is for the Xiao Chai Hu Tang without Ban Xia and with Gua Lou Gen added presentation with Qi surging with slight knotting or with the exterior not harmonized Although this formula is a taken from Xiao Chai Hu Tang because the Ren Shen and Da Zao are removed and the Gan Jiang is added the whole formula is more heavily weighted to dispelling cold and expelling water Because of this it treats slight knotting and fullness below the heart Xiao Chai Hu Tang treat half exterior half interior Yang presentations which are Shaoyang illnesses This formula treats half exterior half interior Yin presentations which are Jueyin illnesses This difference is mainly due to the presence of Gan Jiang Zhang Zhong Jing s Discussion

6 Mu Li and Long Gu Ebook Clause 147 Shang Han Lun Clause 147 Shang Han for five or six days sweating has been promoted and then purgation method employed the chest and ribs are full with a slight bind of bowel urination is not free there is thirst but no vomiting sweating only from the head alternating chills and fever heart vexation this means there is no resolution Chai Hu Gui Zhi Gan Jiang Tang governs Analysis There was Shang Han for five or six days and although sweating was promoted the illness did not resolve Commonly there will be a transmutation into a Xiao Chai Hu Tang pattern Because the patient was mistaken diagnosis and the patient was purged the evil heat caved inward The chest and rib side fullness had diminished slightly but there is slight knotting The fluids do not descend so there is inhibited urination The fluids are also scanty because the heat has damaged them and caused dryness This is why there is thirst but no vomiting The Qi surges upward and so sweat issues from the head The alternating chills and fever and heart vexation show that the Chai Hu presentation has not resolved In this case Chai Hu Gui Zhi Gan Jiang Tang governs Discussion The slight knotting is like that described for Da Xian Xiong Tang However in this case there is only slight knotting The Da Xian Xiong Tang presentation appears with harder knotting

7 Mu Li and Long Gu Ebook Jin Gui Yao Lue on Malarial Illness Chai Hu Gui Jiang Tang treats malarial illness with abundant cold There is only slight heat There may also be cold with no heat at all One package is very effective Analysis When malarial illness breaks out and there is more cold with less heat more chills than fever or cold with no heat chills with no fever this formula is suitable to use Discussion Reflections on the Clinical Presentation From the above two clauses one cans see that this formula treats illness that is half exterior and half interior This is like the Xiao Chai Hu Tang presentation However Xiao Chai Hu Tang treats a Yang heat presentation while the presentation for this formula is either abundant cold with slight heat or abundant cold with no heat This is why this is for a half exterior and half interior Yin presentation Generally Yin presentations do not present with heat The half exterior and half interior is not the same as the Shaoyin or Taiyin in which there is no heat and the evil has a pathway to exit A Jueyin evil has not pathway for exit and so it is very easy for cold to turn to heat This is why there is often upper heat with lower cold But this heat is very slight This formula treats malarial illness when there is abundant cold and slight heat It is also for cases in which cold is the main cause with heat being only minimally relevant

8 Mu Li and Long Gu Ebook A fellow student I know from when I was in Jiangxi named Zhang Qiu Shui treated constipation He often used this formula modifying according to the presentation and it was invariably effective Although the idea that this is a Spirit like formula that will cure with one package is an exaggeration it is true that it is very effective and this should be believed However this formula is not only for this illness Many chronic illnesses match this formula presentation For example someone may have coldness of the four limbs This is inversion cold with a bitter taste in the mouth and a parched throat When there is an indescribable fever that goes on and on this is generally considered a chronic illness This is an opportunity to use this formula or a modification of it Important points for differentiating the pattern This is a half exterior and half interior deficiency cold pattern and so it manifests with coldness of the 4 limbs There is also dryness or bitter taste in the mouth and slight epigastric knotting Discourse by Dr Li Pei Sheng1 This formula is indicated to treat for the presentation of Shaoyang illness accompanied by water congealed internally In this case there has been damage from cold that has gone on for 5 or 6 days There has been sweating followed by purging After this the exterior is presentation is finished and the evil has entered the Shaoyang There is heat and cold alternating and heart vexation This is a Shaoyang 1 From

Mu Li and Long Gu Ebook 9 presentation Usually the Shaoyang presentation is accompanied by chest and rib side fullness vomiting with lack of thirst and natural urination In this case there is only slight rib side knotting thirst but no vomiting and inhibited urination This is Shaoyang illness accompanied by water congealed internally This is somewhat different than Shaoyang illness alone The Shaoyang includes both the foot Shaoyang gallbladder channel and the arm Shaoyang San Jiao channels When the pivot mechanism of the Shaoyang is inhibited the gallbladder inner fire is constrained in the interior This can lead to abnormality of the function of dredging the ditches of the San Jiao and this can lead to water accumulation in the middle In addition the evil is knotted in the Shaoyang and so there is slight fullness in the chest and rib side The ditches are not dredged so that they are open through The water fluids are not able to move downward and so the urination is not open through There is water stoppage and Qi constraint without the ability to transform and generate body fluid and so the Stomach Qi is still harmonious This is why there is no vomiting However there is sweating from the head and the Shaoyang pivot mechanism is inhibited The water pathways are not flowing The Yang is constrained and cannot drain the whole body or steam up to the upper parts For this presentation one uses Chai Hu Gui Zhi Gan Jiang Tang This method harmonizes the center of Shaoyang as well as transforms water and resolves accumulation

Mu Li and Long Gu Ebook 10 A simple table to illustrate the presentation and treatment of the Shaoyang illness accompanied by water congealed internally 1 Disease Cause and Mechanism The evil enters the Shaoyang the San Jiao Qi mechanism is inhibited water fluids stop internally 2 Presentation 1 Heart vexation and still sweating from the head this is due to the evil being constrained in the Shaoyang the pivot mechanism is inhibited and gallbladder fire upwardly harasses 2 Slight knotting and fullness of the chest and rib side thirst with no vomiting and inhibited urination this is due to evil constrained in the Shaoyang San Jiao obstruction lack of dredging with water fluids stopping internally 3 Treatment Method Harmonize and resolve the Shaoyang warm and transform water fluids 4 Formula Chai Hu Gui Zhi Gan Jiang Tang Discourse by Tang Rong Chuan There has already been sweating and so the Yang Qi has been discharged out There has also been purging and so the Yang Qi has descended downward Water and fluids move internally reverting into the chest and

Mu Li and Long Gu Ebook 11 rib side This is why there is fullness in the chest and rib side with slight knotting The urine is inhibited The knotted water causes the fluids to be unable to rise and so there is thirst This is similar to the meaning behind the Wu Ling San presentation Yang is restrained in the interior and so is unable to scatter in the 4 directions It is however able to upwardly emit and so there is sweating on the head The bodies Yang Qi desires to go out but cannot and so there is alternating hot and cold This is similar to the meaning behind the Xiao Chai Hu Tang presentation This is all cold water Qi It stops in the chest diaphragm and connecting tissues and reverts into the heart wrapper causing heart vexation Chai Hu is used to penetrate through the membrane fascia Gui Zhi and Gan Jiang are used to break up and remove the cold water Huang Qin and Tian Hua Fen are used to clear the fire from inner constraint When scattering cold one must first assist the fire This presentation includes heart vexation This is fire constrained in the interior The Gui Zhi and Gan Jiang will assist the fire and that is why there is still slight vexation The nature of Gui Zhi and Gan Jiang are already rising upward and so the fire will issue out There will be a slight sweat and a cure will follow This formula is Xiao Chai Hu Tang with Ban Xia Ren Shen Gan Cao and Sheng Jiang removed and Gui Zhi Gua Lou Gen Mu Li and Gan Jiang added This harmonizes and resolves the Shaoyang and warms and transforms the water fluids Ban Xia is removed because there is thirst

12 Mu Li and Long Gu Ebook with no vomiting and so it is clear that there is no counter flow of the stomach Because there is water stoppage in the interior with obstruction of the San Jiao and the Shaoyang evil has not been resolved the sweet supplementation of Ren Shen and Da Zao are removed After listing the formula the text says Taking three doses in one day first there will be slight vexation and then there will be sweating and then there will be a cure This is a formula for coursing and disinhibiting the Shaoyang half interior half exterior At the start herbs are for the correct Qi and then the correct and the evil mutually wrestle The constrained Yang must spread but at first the Qi mechanism does not flow and open through and there for there is a slight feeling of vexation Continuing to take the herbs promotes the unimpeded flow of the Qi mechanism The interior and exterior Yang flows smoothly and so there is sweating of the whole body and through the sweating the evil is resolved The illness is cured This is not the evil steaming upward causing the disease symptom of sweating from the head This is sweating that causes a cure This formula has a broad clinical application It is able to treat conditions with a lot of cold and less heat or malaria with cold and no heat It is also often used to treat Chai Hu presentations accompanied by phlegm fluids knotting in the interior Regardless of whether or not there are external symptoms this formula is very effective A simple breakdown of the formula Chai Hu and Huang Qin harmonize the Shaoyang

13 Mu Li and Long Gu Ebook Mu Li and Tian Hua Fen expel fluids and open knotting Chai Hu and Mu Li together are able to transform phlegm and open knotting and treat epigastric and rib side hard fullness Gui Zhi Gan Jiang and Gan Cao warm and transform water fluids Discourse By Liu Du Zhou Chai Hu Gui Zhi Gan Jiang Tang is a modified version of Xiao Chai Hu Tang Because Ban Xia Ren Shen Da Zao and Sheng Jiang are removed and Gan Jiang Gui Zhi Mu Li and Tian Hua Fen are added it is for treating gallbladder heat with Taiyin spleen cold with inhibited Qi transformation and dry fluids all causing abdominal distention sticky diarrhea stool inhibited urination and chest and rib side fullness This can also cause a presentation of rib side pain into the back thirst heart vexation alternating cold and heat numbness of the arms and fingers red tongue with white moss and wiry moderate pulse This formula harmonizes and resolves Shaoyang while warming the cold damp in the spleen Da Chai Hu Tang also harmonizes and resolves Shaoyang while discharging the Yangming internal excess Together they express one formula is for excess and the other for deficiency We can know that Shaoyang influences the spleen and stomach yet one must differentiate cold and heat excess and deficiency in order to treat Further Discourse by Liu Du Zhou Harmonize resolve and scatter cold generate fluid and absorb Yin

14 Mu Li and Long Gu Ebook This formula treats Shaoyang patterns with light alternating chills and fever chest and rib side fullness with slight knotting inhibited urination thirst without vomit heart vexation and sweating from the head malaria with more chills than fever or chills with no heat 1 The theory of the disease mechanism maintains it is gallbladder heat and spleen cold Dr Liu Du Zhou considered it to be the Shang Han Lun s half exterior half interior and the pivot mechanism between the exterior and interior Shaoyang is the pivot and is not just the pivot mechanism between exterior and interior It iw the pivot mechanism where the 3 Yang changes into the 3 Yin Because of this the Shaoyang illnesses commonly have both interior and exterior presentations For example when Shaoyang is shows with an exterior pattern there is Chai Hu Gui Zhi Tang When Shaoyang manifests with an interior excess pattern there is Da Chai Hu Tang or Chai Hu Jia Mang Xiao Tang Chai Hu Gui Zhi Gan Jiang Tang is the opposite of Da Chai Hu Tang This pattern is a Shaoyang pattern with interior deficiency cold Thus it is exterior and interior simultaneously with both interior excess and interior deficiency Shaoyang has the meaning of the pivot In clause 146 Zhang Zhong Jing wrote that a Shaoyang with simultaneous exterior pattern is governed by Chai Hu Gui Zhi Tang Right after this clause is clause 147 in which the Shaoyang transfers into Taiyin This is governed by Chai Hu Gui Zhi Gan

15 Mu Li and Long Gu Ebook Jiang Tang The meaning here is very profound Modern people ponder this endlessly Therefore commenting about chapter 14 of the Shang Han Lun Dr Liu says This formula is used to harmonize and resolve Shaoyang while simultaneously treating spleen cold He also talks about Da Chai Hu Tang harmonizing and resolving Shaoyang while simultaneously treating stomach excess It can be seen that Shaoyang illness influences the spleen and stomach yet we must be able to differentiate cold heat deficiency and excess in order to treat In terms of gallbladder heat and spleen cold Dr Liu discussed the idea that Shaoyang illness is a transfer into a Yin pattern Generally everyone thinks that the mechanism of this formula is difficult to understand Dr Chen say that Chai Hu Gui Zhi Gan Jiang Tang is a transfer into a Yin pattern Dr Liu asked what the meaning of transfer into Yin pattern is Dr Chen looked to the left and said that he could not explain it Dr Liu thought long and hard about these words for many years He combined this thinking into his clinical practice and discovered the theory and from this he could treat In the clinic Chai Hu Gui Zhi Gan Jiang Tang has amazing effectiveness Dr Liu was a stickler for clinical effectiveness and his power of understanding was extremely high He is worthy of the title of great doctor He explains this idea of gallbladder heat and spleen cold This is logical There is chest and rib side fullness with slight knotting and only

16 Mu Li and Long Gu Ebook the head sweats There is mouth thirst alternating chills and fever and heart vexation These symptoms all indicate that the illness is in Shaoyang The Shaoyang pivot mechanism is inhibited and this is the cause of the gallbladder heat being constrained above The cause of the inhibited urination is two fold On the one hand the Shaoyang pivot mechanism influences the Qi transformation On the other the spleen Yang is insufficient so the transformation and transport of the fluids is not good The lack of retching tells us that the Shaoyang evil has been transferred to the Taiyin so it is not influencing the stomach Fu Although Zhang Zhongjing was not clear about the condition of the bowels a viscous stool presentation is unavoidable Without saying it the disease pathology indicates this involvement of Taiyin It may not influence the bowel so therefore there is the saying that it has transferred into a Yin pattern This has the same meaning as when we look at the Taiyang opening clause It does not say fever The meaning is identical 2 To grasp this formula one must stress bitter mouth and viscous stool In regard to the application of Chai Hu Gui Zhi Gan Jiang Tang Dr Liu thinks that chapter 14 of the Shang Han Lun clearly points out that this formula treats gallbladder heat and spleen cold with inhibited Qi transformation and diminished fluids This causes abdominal distention

17 Mu Li and Long Gu Ebook sticky diarrhea inhibited urination mouth thirst heart vexation or rib side pain effecting the back numbness of the arms and fingers wiry moderate pulse and a pale tongue with white moss Dr Liu says that the primary symptoms are bitter mouth and viscous stool This was deduced by understanding the disease mechanism Since this is a concurrent Shaoyang Taiyin presentation there should be evidence of a Shaoyang pattern and evidence of a Taiyin pattern Then one can boldly use this formula Dr Liu determines the Shaoyang illness with the bitter mouth This is also how he determines when to use a Chai Hu family formula Dr Liu has said that it is fire that has the bitter taste Even if this fire causes an extremely slight bitter mouth this can only be liver gallbladder fire It is very common to see bitter mouth and therefore bitter mouth has a very practical significance for reflecting the Shaoyang evil heat This is why Dr Liu considered bitter mouth to be the primary symptom from the Shaoyang opening clause in the Shang Han Lun As for the symptom of sticky stool it is a very important symptom for determining Taiyin illness In the Taiyin opening clause of the Shang Han Lun it says When there is Taiyin illness there is abdominal fullness with vomiting The food does not go down There is extreme spontaneous diarrhea occasional spontaneous abdominal pain Below the chest there his knotting and hardness This stresses diarrhea This is why Dr Liu saw diarrhea as the principle deficiency symptom In the clinic no matter what the disease is or how long the patient has suffered for all who have

18 Mu Li and Long Gu Ebook abdominal distention and extreme diarrhea one should consider the Taiyin deficiency cold illness and you will probably be in the right vicinity One accommodates oneself to what one sees in the clinic Dr Liu on the basis of sticky stool or watery diarrhea or viscous diarrhea or extreme unformed stool one can understand that the movement of the terrestrial pole and give this formula The scholar should give this on the basis of the disease mechanism and flexibly apply it One shouldn t base your work on whether or not there is one symptom This formula can teach us about Chinese medicine 3 Paying attention to the adjustment of the herbs dosages On the basis of this formula s clinical application in relation to chapter 14 of the Shang Han Lun Dr Liu Duzhou wrote this formula can be used to treat chronic hepatitis In this pattern you will see rib side pain abdominal distention viscous stool diarrhea dry mouth In these cases this formula will often be effective If you see a diabetes manifesting with a Shaoyang illness pattern this formula is extremely right on In the beginning Dr Liu s use of this formula for hepatitis with abdominal distention was very effective Patients with hepatitis because they have used bitter cold clearing and disinhibiting liver gallbladder herbs for a long period of time often the heat toxin does not clear and the spleen yang is damaged One sees that the liver gallbladder have heat and there

19 Mu Li and Long Gu Ebook is also cold in the spleen stomach Clinically not only will one see liver gallbladder constraint and heat and inhibited Qi mechanism signs like discomfort in the liver area bitter mouth and poor appetite one will also see spleen and stomach deficiency cold signs such as abdominal distention and viscous stool When the liver gallbladder Qi mechanism isflowing and discharging is inhibited and in addition the spleen deficiency leads to lack of movement so that the spleen and stomach Qi mechanism of up bearing and down bearing is without command this causes abdominal distention that is particularly extreme Because the Taiyin is deficient and cold often the abdominal distention comes on or is worse at night In terms of treatment clearing heat can further damage the spleen and warming the spleen yang can aggravate the heat and generate toxin making the liver heat symptoms worse And yet Liu Du Zhou uses this formula for this pattern Moreover he has amazing results This is by no means accidental To apply this formula clinically one should explain its meaning There should be nimble adjustment of the herbal dosage Chai Hu and Huang Qin clear and dishinhibit the liver gallbladder while Gan Jiang and Zhi Gan Cao warm and supplement the spleen Yang Gui Zhi helps open through the cold and hot Yin Yang function When using this formula in the clinic if the viscous stool is serious increase the dosage of Gan Jiang

20 Mu Li and Long Gu Ebook or decrease the Huang Qin If there is more serious bitter mouth increase the dosage of Huang Qin and decrease the Gan Jiang Application Case 1 Abdominal distention Chronic Hepatitis B 2 Dr Liu Duzhou The patient was a mister Liu age 54 He had Hepatitis B In spite of this his body condition had been very stable and he had not suffered Recently he began to have abdominal distention This always got worse in the late afternoon and evening When this came on he was extremely uncomfortable and in pain sitting or lying down Not only did he come for a consult his family also requested to come to the consultation He put his hands on his belly and said When the illness is not flaring I can speak At night time my abdomen becomes distended The Qi gathers in my abdomen and I can t belch It is so stifling that I want to die I requested treatment and was given many western medicines that were not effective His stool was viscous and thin without form He moved his bowels frequently each day three times At night his distention became severe His urine was short and scanty he had rib side pain that radiated into his should and back that was hard to bear His pulse was wiry and moderate His tongue was pale and tender with white slippery moss Dr 2 1996 77 78

21 Mu Li and Long Gu Ebook Liu said that Zhong Jing says When Taiyin has illness the abdomen is full and food does not go down and there is extreme diarrhea This tells us that diarrhea with abdominal fullness and lack of thirst is related to Taiyin Yin cold flourishes at night and that is why it gets extreme at night The moderate pulse is Taiyin and the wiry pulse is related to liver gallbladder The gallbladder pulse move on both sides and this is why there is rib side pain going to the back Although Taiyin abdominal pain is not commonly seen in the clinic a case like this is quite serious Could this be due to the lack of free flow and inhibition of the liver gallbladder qi mechanism so that the rising and falling of the 6 Fu were unregulated Dr Liu examined this carefully and thought it over fully and decided to treat the liver and spleen together He first used the Shang Han Lun s Chai Hu Gui Zhi Gan Jiang Tang Chai Hu 16 gm Gui Zhi 10 gm Gan Jiang 12 gm Gua Lou Gen 10 gm Huang Qin 4 gm Mu Li 30 gm Zhi Gan Cao 10 gm

22 Mu Li and Long Gu Ebook After taking one package the night time abdominal pain was decreased by half After 3 more packages the pain was completely gone The diarrhea also had stopped Discussion When considering chronic liver gallbladder disease that is hepatitis B the long term use of bitter cold heat clearing medicines can over time lead to a deficient cold condition of the spleen Qi It is then that this formula can be used to disinhibit the liver gallbladder and simultaneously warm the deficient cold pattern of the Taiyin The amount of Huang Qin in this formula is low and the Gan Jiang is slightly high When the urination is scanty add Fu Ling If the body is deficient add 8 Dr Liu often uses this formula to treat hepatitis B Case 2 Stomach Duct Pain Stomach prolapse Dr Gong Mingli Ms Qi was age 61 and came for her consultation on May 26 1983 She had suffered from stomach duct pain for more than a year In the hospital she was diagnosed with stomach prolapse In the previous month the pain had become severe This was accompanied by mental weakness and fatigue Her appetite was poor and she had bad breath and thirst Other symptoms were stomach area water sounds heart

23 Mu Li and Long Gu Ebook palpitations occasional watery stool red sides to the tongue with thin white tongue moss Her pulse was soft and without strength This was heat constraint in the liver gallbladder spleen Qi deficiency fatigue with no power in the movement and transportation and water stoppage in the stomach The treatment needed to clear and disinhibit the liver gallbladder warm the spleen and transform water Modified Chai Hu Gui Zhi Gan Jiang Tang was used Chai Hu 10 gm Gui Zhi 6 gm Gan Jiang 6 gm Gua Lou Gen 12 gm Huang Qin 6 gm Mu Li 12 gm Zhi Gan Cao 6 gm Fu Ling 10 gm Altogether 3 packages were given and the stomach pain decreased The bad breath was also better There were still loud sounds in the abdomen This was the sound of the constraint gradually starting to flow The spleen Qi was already moving She was given the above formula with 12 gm of Huang Qi added After 10 packages there was a cure

24 Mu Li and Long Gu Ebook 3 Discussion The symptoms of bad breath dry mouth heart palpitations and red sides to the tongue were all signs that there was heat in the liver gallbladder The fatigue poor appetite sticky stool and thin pulse without strength were due to spleen cold The gallbladder heat spleen cold inhibited Qi mechanism and congealed fluids being unable to moisten all caused stomach pain In addition there were water sounds The treatment was to clear and disinhibit the liver gallbladder while warming the spleen and transforming fluids This pattern matches this formula Fu Ling was added to strengthen the function of transforming fluids and disinhibiting dampness Case 3 Cough Chronic Bronchitis 4 Dr Yang Shoujun Mr Zhu was age 59 and came for his consultation on February 15 1984 The patient reported that he had developed bronchitis three years previously Recently due to emotional issues the cough got more severe He went to several doctors for treatment to no avail So he decided to come for a consultation with Dr Yang There was a cough with abundant phlegm chest and rib side fullness and oppression belching poor 3 1985 12 11 4 1986 9 46

25 Mu Li and Long Gu Ebook appetite pale red tongue with thin greasy slightly yellow moss and a wiry pulse This was after careful consideration obviously wood tension and constraint The function of orderly reaching was not occurring as it should Although this was liver illness the liver had passed it onto the spleen Furthermore the spleen is the source of the phlegm The phlegm followed the liver Qi in its rebellion upward to invade the lung This was the cause of the belching and cough The treatment needed to help the liver flow smoothly and fortify the spleen while transforming phlegm and stopping cough Modified Chai Hu Gui Zhi Gan Jiang Tang was used Chai Hu 9 gm Gui Zhi 9 gm Gan Jiang 4 5 gm Gua Lou Ren 9 gm broken Huang Qin 6 gm Mu Li broken 12 gm Zhi Gan Cao 6 gm Tian Hua Fen 9 gm Ban Xia 9 gm Zhi Ke 9 gm Three packages decocted in water

26 Mu Li and Long Gu Ebook He came for a return visit three days later on February 18 The cough had very much decreased as had the chest and rib side fullness and oppression His tongue moss was white and slightly sickey and his pulse was slippery The herbs treat the disease mechanism so he was given the above formula with Tian Hua Fen removed and Chen Pi 9 gm added He took 3 packages and came back on the 21st of February for his third visit His appetite had increased He had a slight cough with scanty phlegm and all other pathology was gone He was then given Xiang Xia Liu Jun Zi Wan and Jian Hua He Dong San to consolidate the treatment A year later there was no relapse Discussion In this case the 3 Zang liver spleen and lung were troubled Nonetheless the root was in the liver spleen and the branch was the lung Chai Hu Gui Zhi Gan Jiang Tang was used to treat this This made the liver constraint open up and the spleen damp was transformed The lung Qi could then return to its clearing The cough was cured Case 4 Heart Palpitations Sinus type Tachycardia 5 Dr Chen Jinsheng Mr Kang was age 20 and came for a consult on November 13 1984 He was very thin with red cheeks and dry lips He said that for half a year he had had chest oppression When it was extreme he felt movement under his left breast that moved his clothing He would become cold and 5 1989 2 28

27 Mu Li and Long Gu Ebook shiver at night Then after around 11 00 to 1 00 he would sweat and his body became hot and the cold resolved During the day his temperature was normal This was accompanied by glomus and poor appetite and dry mouth The pulse was wiry thin and rapid His tongue was red and the tongue body was slightly fat with thin white moss The electrocardiogram showed tachycardia Modified Chai Hu Gui Zhi Gan Jiang Tang was used Chai Hu 25 gm Gui Zhi 10 gm Gan Jiang 10 gm Tian Hua Fen 15 gm Huang Qin 10 gm Mu Li 25 gm Long Gu 25 gm Wu Wei Zi 12 gm Zhi Gan Cao 10 gm He returned 3 days later on November 16 The night time cold and heat had stopped The chest oppression and heart palpitations greatly decreased and his appetite improved His pule became harmonious He was give 3 more packages of the above formula with the dosages decreased by half and there was a cure Discussion

28 Mu Li and Long Gu Ebook Zhong Jing says that this formula can treat heart vexation Dr Chen has the clinical experience of using this formula to treat sinus type tachycardia This is especially effective for those who have resting type pre ventricular contraction abnormal heart rhythm Shaoyang syndroms In this case of heart palpitations there was alternating hot and cold at night This indicated the Shaoyang syndrome So he was given Chai Hu Gui Zhi Gan Jiang Tang and there was a cure without a hitch Case 5 Dizziness6 Dr Chen Jinsheng Ms Heng was age 65 and came for her first visit on June 4 1987 She reported feeling dizzy already for several years At times it was light and other times it was heavy When it was extreme she had to lay down When it was moderate though she could sit walking around was difficult This was accompanied by an aversion to cold without sweat red face chest oppression vexation and agitation insomnia and fatigue Her tongue was slightly red with thin white moss In the center of her tongue there was no moss The pulse was wiry thin and rapid Three packages of Chai Hu Gui Zhi Gan Jiang Tang was given with Gan Mai Da Zao Tang She came back for a return visit 2 days later on June 7 The above formula did not have an effect The pattern was as before so Dr Chen 6 1989 2 28

29 Mu Li and Long Gu Ebook considered carefully He again gave Chai Hu Gui Zhi Gan Jiang Tang complying with the original formula s dosages Chai Hu 25 gm Gui Zhi 10 gm Gan Jiang 10 gm Tian Hua Fen 12 gm Huang Qin 10 gm Mu Li 6 gm Zhi Gan Cao 3 gm 3 packages After the first package the dizziness stopped She concluded after 3 packages Her appetite and sleep were good and her spirit had changed for the better She could walk about smoothly She still had slight chest oppression so she took another 10 packages and was fine thereafter Discussion The Japanese doctor Shu Daoming in his considers this formula to be a Qi and water formula It can treat many kinds of patterns that are due to lack of regulation of Qi and water In this case the dizziness was primarily due to a lack of regulation of Qi and water pattern Clinically it is seen that this type of dizziness is often induced by emotions Alternatively it could come on with menopause Chai Hu Gui Zhi Gan Jiang Tang has the function of regulating and harmonizing Yin

30 Mu Li and Long Gu Ebook and Yang resolving constrain and scattering fluid It is very effective for this type of dizziness Case 6 Rheumatic Fever7 Dr Fu Youfeng Ms Li was age 24 She was an inpatient in the hospital Her consultation was March 26 1979 She had a high fever and body pain Her chest and rib side were inhibited She didn t dare breathe deeply On March 12 she went to the hospital as as ab outpatient She took Gan Mao Shui and had an anti biotic injection but these were not effective Her body temperature was 39 C when high but would go down to 38 C Because she bathed once again her body temperature became high Mid day on March 21 it went up to 39 6 Her family urgently brought her to the hospital The check up showed she had bleeding from her left nostril and throat as well as a stuffy nose Her blood pressure was 140 70 without abnormality She entered the hospital and had blood tests White blood cells 22800 mm3 Neutrophils 89 Sed rate 55mm hour Negative for strep There were many other tests that were all negative The electrocardiogram test show a T wave change The diagnosis was rheumatic fever She went into the hospital and received intravenous antibiotics and medicines to bring down the fever and stop pain Yet the body temperature could not be controlled This is when she came to Dr 7 1993 3 25

31 Mu Li and Long Gu Ebook Fu for a consultation The condition was as described above She reported herself that she had fever and chills body pain and pain in both knees for two weeks The fever was high in the afternoon She would feel frequent palpitations in front of her left side chest and soon her body temperature would rise At times she felt chest and rib side fullness and oppression dizziness heart vexation dry throat bitter mouth no vomiting but thirst slightly yellow and inhibited urination When she had the fever she would sweat but just on her head Her pulse was wiry and rapid and her tongue moss was white and slightly yellow in the center The sides of her tongue were red and the top had scanty moisture This illness was in the exterior and interior The exterior was not resolved and fluids were knotted on the interior He again gave Chai Hu Gui Zhi Gan Jiang Tang Chai Hu 10 gm Gui Zhi 3 gm Gan Jiang 2 gm Tian Hua Fen 5 gm Huang Qin 4 gm Mu Li 3 gm Sheng Gan Cao 2 gm Two packages The patient took the herbs that afternoon at 5 00 This was just when the aversion to cold and fever would arise After she took the herbs she

32 Mu Li and Long Gu Ebook felt a slight vexation After that there was a slight sweat and the fever resolved The next day she felt her body pain had decreased That afternoon her temperature was 37 5 C She only had the feeling of cold in her arms chest oppression stuffy nose and her family noticed that her lips appeared purplish and contracted That afternoon according to the precedent she got 2 more packages of the same formula That evening at 11 00 she suddenly felt an aversion to cold and then she began to shiver Her body temperature went up to 40 5 C Then she had a big sweat with thirst She sweat profusely all the way until dawn Her body that had felt cold began to feel warm and her lips turned red She was tired and wanted to sleep Her body temperature was 37 2 The flourishing heat had resolved The electrocardiogram and blood tests also became normal She would only occasionally feel a stuffy nose and slight chest oppression She was given several packages of the above formula with 10 gm of Gua Lou Pi and 6 gm of Yu Jin and there was a complete cure Discussion This case began with receiving an evil and getting a fever Yet there was also the chest oppression palpitations due to a water knotting on the interior pattern The doctor however used herbs to clear heat He used cold ingredients like Shi Gao and Xuan Shen Although the heat was deferred the fluid evil had not been dispelled Because she took a bath and got damp the heat caught like a prairie fire with body pain chills and fever Days went by without resolution Based on the

33 Mu Li and Long Gu Ebook symptoms of chest and rib side fullness inhibited urination thirst without vomiting head sweating and chills and fever Chai Hu Gui Zhi Gan Jiang Tang was given The pattern corresponded to the disease mechanism and so there was a cure after 2 packages Shivering and sweating indicates that the internal evil has taken the common route to the outside Ye Tianshi said if there is an evil that is completely in the Qi level and reluctant to leave one can hope that a shivering sweat will out thrust the evil In this case there is a lot of meaning in the fact that the symptoms occur just at the time of night when Yin uses up the Yang movement Master Fu has many cases in which he uses this formula for fevers that show up after a course in time He stresses the importance of dosage In addition to Chai Hu he uses an extremely light dose for the other herbs as well He first takes into account whether the patient has inner heat with fluid damage Secondly he takes into account Zhang Zhong Jing s original formula as the clinical reference Case 7 Inhibited Urination Urinary Infection 8 Dr Chen Jinsheng Ms Zhang was age 24 when she came for her consultation on January 25 1985 Her western medical diagnosis was urinary tract infection She took antibiotics as well as Chinese herbs to clear and disinhibit damp heat 8 1989 2 28

34 Mu Li and Long Gu Ebook for one month Still her urination was inhibited frequent and slightly painful She had slight chills and fever and occasional heart palpitations He stool was soft viscous and her appetite was poor Her tongue was slightly red with a scattering of purple spots and a thin white moss Her pulse was wiry and thin Modified Chai Hu Gui Zhi Gan Jiang Tang was used Chai Hu 25 gm Gui Zhi 10 gm Gan Jiang 10 gm Tian Hua Fen 10 gm Huang Qin 10 gm Mu Li 25 gm Zhi Gan Cao 6 gm Wu Wei Zi 10 gm Wu Yao 10 gm 3 packages She drank them all and her urination opened through The heart palpitaitons and chills and fever stopped Her stool also had form Discussion Chai Hu Gui Zhi Gan Jiang Tang has the function for disinhibiting urination and opening through Lin On the basis of a report it can be used when there is a pattern with a urinary tract infection nephritis or urinary block in elderly people accompanied by chills and fever

35 Mu Li and Long Gu Ebook Case 8 Stuttering Dr Yu Yifu The patient claimed to have long lasting stuttering Dr Ye says that when there is long term stuttering one can know that herbs to open through will not be effective The had come especially to see the doctor so he fortunately did not commit this crime Doctor asked if it was the same every day Shi answered no He said that there were times when it was very easy but that when he was upset it became extreme The doctor said okay Only then did he diagnose He was without strength and there was extreme movement in his chest and abdomen He was given Chai Hu Gui Zhi Gan Jiang Tang A many year illness and he completely returned to normal Case 9 Breast Mass9 Dr Qiao Baogou Ms Wang was age 39 She came in March 21 1975 She reported breast distention oppression and discomfort This had gone on for more than a year already and recently she found a lump on her breast Before her menstruation the distention and pain became worse and the lump got clearly getting larger After menstruation the distention and pain lightened and the lump got smaller The lump also got larger when 9 1979 1 33

36 Mu Li and Long Gu Ebook her spirit became depressed This was accompanied by chest and rib side fullness and pain bitter mouth dry throat Her 6 pulses were wiry and slippery and her tongue body tended to be fat with wet moist moss The check up revealed a left upper side breast lump about the size of a walnut It was firm to the touch with slight pain It was also moveable when pushed but the borders were not clear There were several yellow bean sized lumps in the surrounding area The lymph nodes in her armpits were swollen and large This was liver constraint and Qi stasis with congealed knotted phlegm damp The treatment needed to smooth the flow of the liver clear heat while warmly transforming phlegm damp softening hardness and dispersing knotting Chai Hu Gui Zhi Gan Jiang Tang was used Chai Hu 9 gm Gui Zhi 4 5 gm Gan Jiang 4 5 gm Tian Hua Fen 21 gm Huang Qin 9 gm Mu Li 15 gm Zhi Gan Cao 9 gm 1 package for 1 day decocted in water After 20 packages the two sides of the breast were completely clear of lumps All symptoms had completely cleared There was no recurrence at a check up a year later

37 Mu Li and Long Gu Ebook Discussion Breast lumps are mostly thought of as related to damage to the spleen and coming when there is worry and indignation effecting the liver These cause the liver to become stagnant and for phlegm to congeal This takes the form of a plum or chicken egg or nodes Treatment usually aims to smooth the flow of the liver with Chai Hu Xiao Yao type herbs In this case an inhibited Qi mechanism was the root while phlegm damp congealed and knotted was the branch Therefore Chai Hu Gui Zhi Gan Jiang Tang was used to sooth and disinhibit the liver gallbladder transform phlegm and soften hardness There was a cure Case 10 Hepatitis A 35 year old man named Li with a main complaint of hepatitis He was staying in an infectuous disease hospital His most prominent symptoms were abdominal distention that was worse in the afternoon He was fidgety with no resolution His pulse was wiry moderate and rapid His tongue body was pale and tender with white slippery moss Her bowel movements were sticky and unformed and moved 2 3 times each day Her urination on the contrary was scanty There was also mouth thirst This was differentiated as a Liver and Spleen illness with deficiency cold of the middle warmer This is why the bowels were pasty and to the contrary there was abdominal distention However treating only the Liver and Spleen there was no effect Treatment method was coursing and

38 Mu Li and Long Gu Ebook disinhibiting the Liver and Gallbladder while warming the cold in the Spleen I gave him 5 packages of the following formula Chai Hu 10 gm Huang Qin 6 gm Zhi Gan Cao 6 gm Gan Jiang 6 gm Tian Hua Fen 12 gm Mu Li 12 gm After these 5 packages the abdominal distention was cured His bowels also became normal I then gave him herbs to regulate the liver and harmonize the Stomach Case 11 Epilepsy Feng Shi Lun Case Case Study Hu is a 14 year old male patient who came in on October 18 1965 4 years previously he had developed acute infectuous hepatitis with jaundice He took western drugs and the jaundice receded However his appetite was still poor and his liver function would fluctuate He occasionally had dizziness and for the past year he had an epileptic seizure about once every month Before a seizure he would feel Qi

39 Mu Li and Long Gu Ebook surging up to his throat Then his 4 limbs would spasm and he would get lockjaw He vomited frothy white liquid and was not coherent He took western tranquilizing medication but still had the seizures every two weeks He often felt weak especially after an episode Because he could not eat well he became very thin His tongue was clean and without moss His pulse was wiry and slightly rapid This was an evil constrained half exterior and half interior with cold fluids harassing upward Treatment needed to harmonize the half exterior and half interior and warm and transform cold fluids I used Chai Hu Gui Zhi Gan Jiang Tang and Dang Gui Shao Yao San Chai Hu 12 Huang Qin 10 Tian Hua Fen 12 Gui Zhi 10 Chi Shao 10 Bai Shao 10 Sheng Long Gu 15 Sheng Mu Li 15 Dang Gui 10 Chuan Xiong 10 Sheng Jiang 10 Cang Zhu 10

40 Mu Li and Long Gu Ebook Fu Ling 10 Ze Xie 15 Gan Cao 9 Outcome After taking 6 packages of the above formula his appetite returned After 6 more packages the dizziness had changed for the better He did not have any epileptic seizures I gave him another week s worth and his strength had improved I still continued with the original formula for another month with slight additions and subtractions After another month there were still no seizures so I gave him another month and then stopped the herbs There were no more outbreaks Translator s musings How do we get to the half exterior and half interior Yin pattern We know it is not Taiyang or Yangming so we use Dr Feng s ruling out method There is dizziness and a wiry pulse but pure Shaoyang would have more heat Here we know it is cold because of the white frothy liquid Case 12 Amenorrhea Ms Chen was 23 years old and came in January 20 1990 She had not menstruated for 5 months She had profuse leucorrhea and showed no signs of pregnancy For the last 7 days she had a bitter taste in her mouth chest and rib side fullness and a poor appetite The previous

41 Mu Li and Long Gu Ebook day first her whole body felt pain and she had back pain The her menstruation come and the color was dark red There was a fishy smell and it was scanty Her urination was inhibited and she felt a cutting pain when she urinated Her lips were dry she was slightly thirsty and liked to drink warm beverages She was agitated and at night she sweat from her head Her back was sore and her abdomen was painful Her tongue was pale with thin moss Her pulse was wiry and rapid I gave her the following formula Bei Chai Hu 15 Gui Zhi 10 Tan Jiang 6 Tian Hua Fen 12 Huang qin 10 Zhi Gan Cao 6 Mu Li 12 cook ahead Gan Di Huang 10 Chi Shao 10 Chuan Xiong 3 Dang Gui 10 Second visit the bitter taste in the mouth the back soreness and abdominal pain had greatly decreased The thirst agitation and chest

42 Mu Li and Long Gu Ebook oppression had all cleared The leucorrhea also decreased but the menstruation had still not arrived I gave her 2 more packages and all was normal Discussion In this case she began with scanty menstruation The Shaoyang was then damaged Chai Hu and Huang Qi harmonize the Shaoyang Gui Zhi Gan Cao and Gan Jiang assist the Yang in scattering cold as well as in warming and transforming water fluids Tian Hua Fen clears heat generates fluid and stops thirst Mu Li scatters knotting and dispels fullness Di Huang Chi Shao Dang Gui and Chuan Xiong constitute Si Wu Tang They nourish the blood and vitalize the blood Combined altogether these herbs harmonize Yin and Yang and disinhibit the Qi and blood Chai Hu Jia Long Gu Mu Li Tang Bupleuri Radix ch i h 4 liang 12 gm Fossilia Ossis Mastodi l ng g 1 5 liang 5 gm Scutellariae Radix hu ng q n 1 5 liang 5 gm Zingiberis Rhizoma recens sh ng ji ng 1 5 liang 5 gm Minium qi n d n 1 5 liang 5 gm Ginseng Radix r n sh n 1 5 liang 5 gm Cinnamomi Ramulus gu zh 1 5 liang 5 gm Poria f l ng 1 5 liang 5 gm Pinelliae Rhizoma preparatum zh b n xi 2 1 2 ge 6 gm Jujubae Fructus d z o 6 dates 3 dates

43 Mu Li and Long Gu Ebook Da Huang 2 liang 6 gm Mu Li 2 liang 6 gm Boil the above 12 flavors in 12 Sheng of water until it is 4 Sheng Add the Da Huang slice and boil again down to 2 liang remove the foam and drink 1 Sheng warm Original Text Shang Han Lun Clause 107 Shang han for eight or nine days with purgation if the chest is full there is vexation and fright the urination is not free there is delirious speech the whole body feels heavy so that the patient can not turn over Chai Hu jia Long Gu Mu Li Tang governs This formula is Xiao Chai Hu Tang with Gan Cao removed and other herbs added These added flavors are Gui Zhi Fu Ling Da Huang Long Gu Mu Li and Qian Dan It treats disharmony of the Shao Yang along with constrained Qi and Fire The pattern includes symptoms such as chest fullness that harasses the heart spirit impatience and fright delirious speech and inhibited urine This formula uses Xiao Chai Hu Tang without Gan Cao to harmonize and resolve the evil in the Shao Yang Long Gu Mu Li and Qian Dan down bear the liver and calm the Hun Da Huang discharges heat that has knotted on the interior Gui Zhi opens through the Yang and transforms the Qi Fu Ling disinhibits water in the three Jiao This ensures that the interior and exterior evil heat can be resolved It has the aim of regulating and and smoothing the flow of the liver and gall bladder Qi In regard to schizophrenia epilepsy pediatric dancing and pediatric epilepsy food fainting and heat fainting The patho mechanism is irregularity of the liver and gall bladder Qi mechanism For all of these there is a relatively good effect Qian Dan has a toxin so the amount should be quite small and it should only be used for a short time Long term use or large doses are not suitable Ensure that it is safely wrapped in gauze Collection of Shang Han Lun case studies from renowned physicians Case 1 Epilepsy By Dr Liu Du Zhou Mr Yin age 34 Due to a fright this patient developed epilepsy When he had an episode he would scream and twitch He would vomit white froth from his mouth and sweat He also had

44 Mu Li and Long Gu Ebook chest and rib side fullness and he would endlessly talk in his sleep In addition he had numerous chaotic dreams one after the other His spirit was not peaceful and his bowels were not great My inspection revealed that his spirit was dull and his facial color was dark His tongue was red with yellow and white moss mixed together and his pulse was deep and wiry This was liver gallbladder constraint combined with Yang Ming hollow organ heat Phlegm and heat were generated in the interior and rising up to harass the heart spirit As a result he Hun and Shen of the liver and heart could not submerge and be contained The treatment principle was to course the liver discharge the stomach cleanse phlegm and clear fire descend fright and calm the spirit Bupleuri Radix ch i h 12 gm Scutellariae Radix hu ng q n 9 gm Pinelliae Rhizoma preparatum zh b n xi 9 gm Codonopsis Radix d ng sh n 10 gm Zingiberis Rhizoma recens sh ng ji ng 9 gm Fossilia Ossis Mastodi l ng g 15 gm Ostreae Concha m l 15 gm Rhei Radix et Rhizoma d hu ng add later 6 gm Minium qi n d n 3 gm wrapped Poriae Sclerotium pararadicis f sh n 9 gm Cinnamomi Ramulus gu zh 5 gm Jujubae Fructus d z o 6 dates After one package his bowels opened and the chest and rib side pain and talking in his sleep cleared His spirit became peaceful He still felt like vomiting but didn t and he had very loud noises in his stomach I gave him the same formula with 16 gm of Bambusae Caulis in taeniam zh r and 10 gm of Citri reticulatae Pericarpium ch n p and there was a cure Discussion The cause of this illness was an emotional factor namely fright This is what gave rise to the epilepsy The L n Zh ng Zh N n Y n Case Records as a Guide to Clinical Practice considers that epilepsy is due to terror cause lack of peace in the inner solid organs

45 Mu Li and Long Gu Ebook When this goes on for a long time without resolution there is accumulation of phlegm and a turning inward of the Qi Wind suddenly then violently counter flows In this case treat with Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng It has a relatively good effect Professor Liu will flexibly make additions and subtractions in accordance with the clinical reality For example if there is an overabundance of liver fire he will add Gentianae Radix l ng d n c o Prunellae Spica xi k c o and Gardeniae Fructus zh z If the illness is in the blood level he will add Paeoniae Radix alba b i sh o Persicae Semen t o r n and Moutan Cortex m d n p If there is obstinate phlegm knotting with closure Curcumae Radix y j n Arisaema cum Bile d n n n x ng Alumen m ng f n and Tian Du Huang can be added From 1996 44 Case 2 Constraint Pattern Dr Lan Yi Qing Patient Wei female age 32 She was emotionally ill disposed Sometimes she would cry or laugh and mutter to herself This became more extreme at night This had gone on for more than 10 days already This condition was due to an emotional reaction to a termination of pregnancy She had taken a large amount of sedatives without effect and on March 20th she came for a consultation Her tongue body was red with yellow sticky moss and her pulse was wiry and without strength Bupleuri Radix ch i h 10 gm Scutellariae Radix hu ng q n 10 gm Pinelliae Rhizoma preparatum zh b n xi 10 gm Codonopsis Radix d ng sh n 20 gm Albiziae Flos h hu n hu 20 gm Fossilia Ossis Mastodi l ng g 15 gm Ostreae Concha m l 15 gm Rhei Radix et Rhizoma d hu ng add later 7 5 gm Rehmanniae Radix sh ng d hu ng 25 gm

46 Mu Li and Long Gu Ebook Poria f l ng 10 gm Cinnamomi Ramulus gu zh 10 gm Jujubae Fructus d z o 10 dates She took this 3 times After these herbs her emotions changed for the better The laughing and crying stopped however she still felt blocked in her chest and occasionally she felt confused and worried Her lochia flow came back from post surgery The amount was normal and the blood color was dark and there were clots Her tongue body was slightly red and the moss had become thin instead of sticky Her pulse was slightly wiry I continued with 3 packages of the above formula and all of the symptoms decreased and her spirit was cheerful She still suffered from agitation and her lochia had ceased Her tongue was pale red with thin white moss Her pulse was moderate I gave her 3 more packages and all was well From 1984 12 24 25 Discussion This case uses Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng to course the liver and resolve constraint It discharged static blood to calm the 5 zang When Bupleuri Radix ch i h is combined with Albiziae Flos h hu n hu it resolves constraint and knotting of the liver Qi When Rhei Radix et Rhizoma d hu ng is combined with Rehmanniae Radix sh ng d hu ng it can dispel evil blood in order to generate the new Fossilia Ossis Mastodi l ng g mu li and Poria f l ng contain the heart Qi and regulate the spirit Codonopsis Radix d ng sh n Rehmanniae Radix sh ng d hu ng Cinnamomi Ramulus gu zh and Jujubae Fructus d z o are also able to supplement the deficiency in a post partum woman Case 3 Insanity Dr Zhou Lian San Mr Peng age 32 came for his first consult on November 27 1963 Due to a provocative emotional experience in 1959 his spirit became abnormal He became manic and acted rashly He hit people and cursed at them He was treated over time without a cure He lived in a psychiatric hospital doing many treatments but all were without effect Dr Zhou was asked to consult The

47 Mu Li and Long Gu Ebook observations were that he had a red face and eyes and aside from the issues sited above he also laughed and cried abnormally His tongue was red with sticky yellow moss and his pulse was flooding and rapid This was liver constraint transforming into fire and phlegm fire upwardly harassing The treatment principle was to soften the liver and disinhibit the gallbladder dispel phlegm and discharge fire Bupleuri Radix ch i h 24 gm Scutellariae Radix hu ng q n 24 gm Pinelliae Rhizoma preparatum zh b n xi 21 gm Zingiberis Rhizoma recens sh ng ji ng 15 gm Fossilia Ossis Mastodi l ng g 30 gm Ostreae Concha m l 30 gm Rhei Radix et Rhizoma d hu ng add later 18 gm Poria f l ng 30 gm Cinnamomi Ramulus gu zh 9 gm Jujubae Fructus d z o 12 dates Minium qi n d n 6 gm After taking the above formula Mr Peng vomited up more than 2 bowls of phlegm and spittle He also had frothy diarrhea and then he slept at night All the pathology decreased I then decreased the Minium qi n d n to 3 gms and the Rhei Radix et Rhizoma d hu ng to 9 gms and continued with this using 4 more packages I followed up with recuperative care and he was cured From 1982 3 18 Discussion This formula courses and disinhibits the gallbladder and weighs down the spirit It is used for liver constraint transforming into fire and simmering the fluids into phlegm The phlegm fire harassing upward causing fear and anxiety mania chest oppression muttering to oneself agitation and epilepsy patterns This formula has a very good effect for these cases

48 Mu Li and Long Gu Ebook Case 4 Fear and anxiety with palpitations Dr Zhu Jin Zhong Mr Bi age 41 felt oppression in the area in front of his heart At time he felt that his heart stopped He was diagnosed with frequent premature ventricular contractions He went into the hospital and was treated for 4 months with no effect He had dizziness insomnia heart vexation and palpitations noisy digestion with acid regurgitation weakness and fatigue of the 4 limbs bitter dry mouth His tongue had a thin white moss and his pulse was wiry knotted and rough Coordinating the information this was evil entering the Shao Yang with the heart Yang being unable to flourish and water fluids not transforming I used Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng with additions and subtractions Bupleuri Radix ch i h 15 gm Scutellariae Radix hu ng q n 10 gm Pinelliae Rhizoma preparatum zh b n xi 10 gm Zingiberis Rhizoma recens sh ng ji ng 9 gm Fossilia Ossis Mastodi l ng g 15 gm Ostreae Concha m l 15 gm Rhei Radix et Rhizoma d hu ng add later 3 gm Poria f l ng 15 gm Cinnamomi Ramulus gu zh 15 gm Jujubae Fructus d z o 7 dates Codonopsis Radix d ng sh n 10 gm Glycyrrhizae Radix g n c o 6 gm After 3 packages the illness had decreased I continued with 40 more packages and the presentation cleared and there was a cure From 1983 4 30 Discussion Fear and anxiety with palpitations can be divided into both excess and deficiency types Deficiency types are most often due to heart blood insufficiency while excess types are due to

49 Mu Li and Long Gu Ebook phlegm fire This is why nourishing the blood calming the spirit clearing heat and transforming phlegm are the frequently used methods If the liver is constrained and the Qi is static the heart Yang does not flourish and water surges upward For this pattern this formula is truly very effective Case 5 Insomnia Dr Hu Guo Zhen Ms Mei age 42 had suffered from insomnia for more than 4 years This year it became especially severe When the insomnia is extreme she could not close her eyes for the whole night 4 years ago in the month Ms Mei was giving birth she quarreled angrily with someone and then could not sleep an entire night After this she had frequent recurrences of this illness She took sedatives but was still only able to sleep 3 4 hours and when she stopped them she was then unable to sleep at all again She then came to Yanhu city hospital for a consultation and treatment She wanted a fresh start as she was loosing confidence in any treatment s ability to help This year the illness had gotten worse with no decrease She was barely sleeping at all and some nights not at all In the past she went out to work late in the evening and only coming home deep into the night She was hoping that doing excessive labor would tire her out enough for her to fall asleep but it did not work As her physical strength declined her spirit also became weakened to the point that she wanted to die She was then introduced to me and came for a diagnosis At the first visit it was observed that the patient was a fat type and her skin color was dark without luster Her upper eyelids were puffy She was sleepy and drowsy eyed She was dispirited and dull As soon as I asked about the disease history she spoke without ceasing Her mood was changeable Sometimes she laughed a lot and other times she would sob She told me that she felt stuffy and oppressed in her chest and rib side and she liked to sigh deeply She felt dizzy and heavy in her body and had difficulty moving about Her stool was slightly hard and her appetite decreased Her pulse was thin and wiry Her tongue moss was thin and white and slightly sticky I looked up the previous formulas she had taken and these were Warm Gallbladder Decoction w n d n t ng Sour Jujube Decoction su n z o r n t ng Arborvitae Seed Pill to Nourish the Heart b i z y ng x n w n and Restore the Spleen Decoction gu p t ng and these were all without effect This illness began after an angry episode Her liver Qi was anxious and constrained and her gallbladder Qi was not peaceful The ministerial fire was

50 Mu Li and Long Gu Ebook rashly rising from inside the liver and gallbladder and the heart spirit was being harassed She was frightened and her spirit was unsettled This came from loosing sleep The liver lost its ability to release stagnated Qi and the spleen lost its strength and movement Water damp was not transformed and this damp was simmered by constrained fire and became phlegm The phlegm rose with the Qi to throw the spirit brightness into confusion This was the cause of the illness and so I used Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng with modifications Bupleuri Radix ch i h 9 gm Polygalae Radix yu n zh 10 gm Pinelliae Rhizoma preparatum with bamboo juice zhu li zh b n xi 9 gm Zingiberis Rhizoma recens sh ng ji ng 3 slice Fossilia Ossis Mastodi l ng g 15 gm Ostreae Concha m l 15 gm Rhei Radix et Rhizoma d hu ng add later 6 gm Poriae Sclerotium pararadicis f sh n mixed with cinnabar 10 gm Cinnamomi Ramulus gu zh 6 gm Jujubae Fructus d z o 3 dates Codonopsis Radix d ng sh n 9 gm Glycyrrhizae Radix g n c o 6 gm Second visit After 5 days the patient happily reported that after 3 more packages she was able to sleep at night for 2 3 hours and her chest and rib side felt comfortable She was emotionally peaceful compared to before I gave her 5 more packages and she then slept for 4 5 hours Her dizziness was less During the day her spirit was full Her tongue was no longer big so I knew the formula was effective I gave her 5 more packages adding Ziziphi spinosae Semen su n z o r n 9 gm At the 3rd visit the puffiness under her eyes has decreased and the red canthus had also gotten better Her color had become lustrous and her spirit was good She was now able to peacefully enter sleep She still woke easily if she received a shock but her pulse was moderate and harmonious and all of the issues had resolved I continued to have her take herbs to nourish the heart to consolidate the effect From 1984 11 22

51 Mu Li and Long Gu Ebook Discussion When Shao Yang receives and evil the gallbladder wood looses its luxuriance and phlegm heat gathers in the diaphragm Above this harasses the heart spirit and causes insomnia and intense fearfulness Clinically this type of insomnia patient has received an emotional trauma or has a buried emotional drama The formula mainly harmonizes and releases the Shao Yang and courses and disinhibits the liver gallbladder channel Qi This is assisted by its ability to boost the spleen nourish the heart settle fright and calm the spirit Minium qi n d n has a toxin but one can substitute heavy down bearing calming the spirit herbs such as Haematitum d i zh sh Magnetitum c sh or Cinnabaris zh sh along with Polygalae Radix yu n zh Bambusae Concretio silicea ti n zh hu ng and Arisaema cum Bile d n n n x ng to clear heat and transform phlegm Case 6 Dizziness From Dr Zhu Jin Zhong Ms Zhi was age 21 and she suffered from dizziness for more than 2 months She was diagnosed with Mennier s disease She was treated over a period of time but there was no effect The dizziness was sometimes light and sometimes severe When it was severe she was overcome by vertigo and she did not dare to open her eyes When it was extreme she would feel nauseated and vomit and hear a sound in her ears like cicadas She felt chest oppression and vexation and pulsations below the heart Her tongue moss was thin and white and her pulse was thin and rough Taking all this into account the diagnosis was liver constraint with knotted Qi and untransformed phlegm and damp This was a mixed cold and heat pattern I gave her Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng with Glycyrrhizae Radix g n c o and Minium qi n d removed After two packages the illness decreased and after 10 packages it had dispersed I continued with 20 more packages and there was a cure From the 1983 3 30 Discussion This case of dizziness is not liver Yang rising excessively It is also not Qi and blood dual depletion It is liver constraint with Qi stasis with heat and cold mixed together This is why this formula is appropriate

52 Mu Li and Long Gu Ebook Case 7 Tinnitus From Dr Zhu Jin Zhong Ms Guo was an adult woman She had tinnitus and deafness for 5 years The hospital diagnosis was sclerosis of the ear She was treated but there was no effect She had dizziness and distention of the head at times it was light and at times it was heavy When it was severe she was overcome by vertigo and she did not dare to open her eyes When it was extreme she would feel nauseated and vomit she had insomnia and heart vexation as well as chest and rib side discomfort and fullness Her stool was constipated and her urination was sometimes clear and sometimes yellow Her pulse was wiry and slippery Taking all this into account the diagnosis was phlegm fire constrained and knotted liver gallbladder Yang Ming concurrent illness I gave Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng without the Minium qi n d n but with added Glycyrrhizae Radix g n c o and gave her 10 packages There was a change for the better I then gave her 30 more packages and after that the dizziness and deafness were gone though she still had some tinnitus 1983 4 31 Case 8 Impotence Dr Zhu Jin Zhong Mr Chen was age 41 He had suffered from nocturnal emissions for 7 8 years After acupuncture this did not decrease Then he developed impotence He took Gui Ling Ji and San Shen Wan to warm the kidney and stimulate virility There was no effect after more than 300 packages During the last year he began to feel dizzy with heart palpitations vexation and easy anger His mouth was bitter and his throat was dry His tongue moss was thin and white His pulse was deep and wiry as well as rapid Coordinating the pulse and pattern the diagnosis was Qi stasis in the 3 Jiaos cold damp not transforming heart and kidney not communicating and ministerial fire lacking nourishment Chai Hu Jia Long Gu Mu Li Tang regulates the 3 Jiao transforms dampness and connects the heart and kidney Chai Hu 6 gm Ban Xia 9 gm

53 Mu Li and Long Gu Ebook Gan Cao 6 gm Chuan Lian 3 gm Huang Qin 9 gm Dang Shen 9 gm Gui Zhi 12 gm Sheng Jiang 3 gm Sheng Long Gu 15 gm Mu Li 15 gm After 3 packages the impotence changed for the better He continued with another 20 packages and the pattern resolved 1983 4 29 Discussion Most often impotence is due to depletion of the ministerial fire and this means that warming and supplementing the lower source methods are often used In this case the disease characteristics are complex There is Qi stasis in the 3 Jiao with cold and heat mixed together The heart and kidney are not in communication This formula opens and helps the 3 Jiao to flow Cold and heat are both treated and the heart and kidney connect When treating this illness one must pay attention to the causes in order to treat Case 9 Spermatorrhea Dr Zhu Jin Zhong Mr Guo was 40 years old He had suffered from spermatorrhea for the past 5 years He had taken herbs to consolidate Jing and stop spermatorrhea with no effect In the last two years the illness became more serious Generally he would have a discharge every 2 3 days At times it was continuous for several days He also had headaches head distention dizziness insomnia palpitations vexation easy anger chest oppression with bunching pain bitter mouth and dry throat He also would have lower abdomen spasming with a sense of coldness Her fingers and toes had reversal cold Her tongue moss was yellow and white and moist Her pulse was deep and wiry Coordinating the pulse and pattern the diagnosis was liver constraint with knotted Qi The normal function of flowing and discharge was not working and the kidney lost its function of consolidation This was a Chai Hu Jia Long Gu Mu Li Tang

54 Mu Li and Long Gu Ebook Chai Hu 6 gm Ban Xia 9 gm Gan Cao 6 gm Tian Hua Fen 9 gm Huang Qin 9 gm Dang Shen 9 gm Gui Zhi 9 gm Sheng Jiang 3 slices Sheng Long Gu 15 gm Mu Li 15 gm Fu Ling 9 gm Da Zao 5 gm Chuan Lian 3 gm After 4 packages the spermatorrhea changed for the better I gave 80 more packages and there was a cure 1983 4 29 30 Discussion For the most part spermatorrhea is due to lack of consolidation of the Kidney Qi However it can also arise due to lack of regulation of the Zang Fu Yin Yang or Qi Blood One should ask about the heart liver and kidney to differentiate In this case the herbs to consolidate kidney jing was not effective The issue was with the liver wood Case 10 Parkinson s Dr Zhu Dong Qi Mr Jiang was age 42 He received a consultation on November 2 1982 a year previously while working in the farm fields he suddenly heard his son being in a traffic accident He held his son in his arms and made his way to the hospital It began to rain and he had only flimsy clothing He was feeling desperate He sweat all over from head to foot The next day he felt unwell in his muscles and in his body in general His body felt heavy Sometimes he had fever and chills and

55 Mu Li and Long Gu Ebook his speech was slow He also felt abdominal distention with a poor appetite Over time his tendons and flesh changed He was unable to work His walking was uneven His whole body became emaciated and weak Her limbs and body were numb and cold She went to a hospital and was diagnosed with Parkinson s She was given medicines such as artane and l dopa and the symptoms were alleviated for a short time However they returned In the last month the condition increased in severity In the last half month the condition got worse and he became completely bed ridden He had to invite the doctor to come to his home His pulse was wiry and slippery and his tongue was red with yellow thick slippery moss at the root His mouth was sticky and had a bitter taste in it His bowel was dry and knotted and his urination was yellow This patient had a very withheld personality He was taciturn and did not speak much The recent fright damaged him internally In addition the unexpected wind and rain resulted in a problem that was both internal and external He was chronically ill with no regulation Every day he became more worried and this caused more and more constraint and knotting of his liver Qi This horizontally invaded his spleen earth The treatment had to course the liver and regulate the spleen resolve constraint and calm the spirit clear heat and settle fright Chai Hu 12 gm Ban Xia 10 gm Dan Shen 15 gm Bai He 12 gm Huang Qin 10 gm Dang Shen 12 gm Gui Zhi 6 gm Sheng Jiang 3 slices Sheng Long Gu 15 gm Mu Li 15 gm Fu Ling 10 gm Da Zao 6 dates After 5 packages the symptoms decreased significantly He was conscious of being flexible from head to foot He had some trembling of his muscles and flesh I continued with the same formula removing the Da Huang and Fu Ling and adding Jiao San Xian 10 gm of each herb and 10 gm of Lai Fu Zi I gave him 5 more packages After that I used Xiao Yao Wan for more than a

56 Mu Li and Long Gu Ebook month to help him recuperate A follow up 1 year later revealed no relapse He was able to join normal work and activities 1989 2 32 Discussion In this case the disease pathology was in the liver The liver rules the tendons and stores the Hun When there is a sudden fearful shock the liver qi reverses chaotically It is unable to govern the tendons or store the hun This causes the flesh and tendons to move and become flaccid soft and weak with the spirit as if in a trance This formula can be used to course the liver and regulate the Qi resolve constraint and calm the spirit clear heat and settle fright The formula and presentation conform to each other and this is why the results are obtained Case 11 Pediatric Hyperactivity Dr Zhu Jin Zhong The patient was a 12 year old child For more than 5 months she had been moving her arms and legs chaotically been unable to be still with constant moving about and she had twitching of her eyes She was diagnosed with chorea She was vexatious and got angry easily She constantly sighed and her pulse was wiry and thin Coordinating the pulse and presentation this was evil entering the Shao Yang with phlegm damp constrained on the interior The treatment was modified Chai Hu Jia Long Gu Mu Li Tang to resolve Shao Yang transform phlegm damp course wind and stop spasming Chai Hu 3 gm Ban Xia 6 gm Gui Zhi 6 gm Bai Shao 6 gm Huang Qin 6 gm Dang Shen 6 gm Fu Ling 6 gm Sheng Jiang 2 slices Sheng Long Gu 6 gm Mu Li 6 gm Gan Cao 6 gm

57 Mu Li and Long Gu Ebook Da Zao 2 dates After 3 packages all of the pattern indications had changed for the better After 30 packages there was a cure Discussion According to reports this formula has very good results for pediatric chorea when it is due to combined liver gallbladder illness with harboring of phlegm fire and stomach heat Case 12 Menopausal Syndrome Liu X Female 48 years old First consultation 26th October 1979 For the past month the patient s mental state was disturbed as a result of her husband s experiences He had been trained as a member of an anti Japanese youth group during the cultural revolution and was later sent to Inner Mongolia for re education for ten years before finally being re instated She was even suspicious when her husband was talking to other women At night she suffered from severe mood swings with crying spells and would throw furniture and fight with her husband hitting and scratching his face The Western diagnosis was menopausal syndrome and Western medication had given with only slight relief S S Vexation chest oppression worsening at night insomnia with only 2 3 hours sleep at night a parched mouth with a bitter taste a short menstrual cycle with copious bleeding of red blood a dry stool every 2 3 days Her tongue had a red tip and a white greasy tongue coat and her pulse was thready wiry and rapid Diagnosis Tai Yang Shao Yang Yang Ming concurrent pattern Formula pattern Chai Hu jia Long Gu Mu Li Tang Chai Hu 12 gm Long Gu 15 Huang Qin 10 Ling Ci Shi 15 Dang Shen 10

58 Mu Li and Long Gu Ebook Gui Zhi 10 Fu Ling 15 Ban Xia 15 Da Hung 6 Mu Li 15 Da Zao 4 dates 20 Sheng Jiang 15 Sheng Shi Gao 45 After the first dose she had a good night s sleep lasting for 4 5 hours and her vexation and chest oppression were eased The same formula was repeated for a month or so and she returned to normal Discussion The above case reflects a diagnosis of menopausal syndrome which can be attributed to a Tai Yang Shao Yang Yang Ming concurrent pattern where the indicated formula is Chai Hu jia Long Gu Mu Li Tang Feng Shi Lun Case 1 Tinnitus This illness can be a Shao Yang and Yang Ming disease Ms Feng female 38 years old First st consultation 31 March 2010 The patient presented with bi lateral tinnitus for 1 1 2 years ENT doctor diagnosed this as nervous tinnitus She did not respond to western and Chinese medicine treatment Current S S Continuous bi lateral tinnitus accompanied by vertigo oppressed sensation in the chest insomnia easily frightened lumber ache lethargic and lack energy difficult bowel movement white greasy tongue coat and a wiry and thready pulse Six Channel Pattern Identification Tai Yang Shao Yang and Yang Ming concurrent pattern Formula pattern Chai Hu jia Long Gu Mu Li Tang Cang Zhu Fang Ji Chai Hu 12g Huang Qin 10g Qing Ban Xia 15g Dang Shen 10g Gui Zhi 10g Sheng Long Gu Mu Li 15g each Cang Zhu 15g Zhi Gan Cao 6g Zhi Shi 10g Fang Ji 10g Sheng Jiang 15g Da Zao 4 pieces

59 Mu Li and Long Gu Ebook Seven packs Second consultation After the medication there was substantial improvement of her tinnitus her sleep was improved and also her energy was better there was not chest oppression her tongue coat was white and greasy and her pulse was thready Omit Zhi Shi Fang Ji Yuan Zhi 10g Chang Pi 10g Bai Shao 10g Dang Gui 10g Chi Xiao Dou 15g Seven packs th Third consultation 14 April 2010 All the symptoms continued to improve and her energy was restored as she said two weeks ago prior to the medication she was not able to do anything Her tongue was white and greasy and her pulse was thready and wiry Prescription Chai Hu 12g Huang Qin 10g Qing Ban Xia 15g Dang Shen 10g Gui Zhi 10g Cang Zhu 10g Fu Ling 12g Yuan Zhi 10g Chang Pu 10g Sheng Long Gu Mu Li 15g each Zhi Gan Cao 6g He Huan Pi 15g Sheng st Shi Gao 45g Sheng Jiang 15g Da Zao 4 pieces Seven packs Fourth consultation 21 April 2010 She still suffered from occasional tinnitus and said that she can now deep sleep and her temperament was better than prior treatment her lips were moist At the time of her consultation she was having her period and said that she suffered from lower abdominal coldness prior to menstruation Her tongue coat was white and greasy and her pulse was thready Prescription Dang Gui 10g Bai Shao 10g Chuan Xiong 6g Fu Ling 15g Cang Zhu 10g Chai Hu 12g Zhi Gan Cao 6g Gui Zhi 10g Sheng Long Gu Mu Li 15g He Huan Pi 15g Yuan Zhi 10g Chang Pu 10g Suan Zao Ren 15g Seven packs th Fifth consultation 28 April 2010 Her tinnitus stopped and all the other symptoms were no longer apparent Two days ago she participated in a tug of war competition and felt she was energetic There was slight discomfort in her epigastrium and abdomen difficult bowel movement white greasy tongue coat and thready pulse Add Chen Pi 30g to the above formula Seven packs There was no discomfort after the medication and no further treatment or medication afterwards Overview Nervous tinnitus is a prevalent disease and is relatively difficult to treat There is no know aetiology or pathology with western medicine nor is there any specific treatment for this condition Chinese medicine is generally diagnosed from the zang fu perspective or network vessels saying Excess is to purge the liver while deficiency is tonify the

60 Mu Li and Long Gu Ebook kidney Clinically treatment for a lot of tinnitus sufferers is not mainly focused on purging the liver or tonify the kidney The above case study was based on the Six Channel pattern identification followed by the relevant formula pattern and recovery was achieved after five consultations Analysis of Clause 107 in Shang Han Lun Chai Hu jia Long Gu Mu Li Tang was discussed in Clause 107 Shang han for eight or nine days with purgation if the chest is full there is vexation and fright the urination is not free there is delirious speech the whole body feels heavy so that the patient can not turn over Chai Hu jia Long Gu Mu Li Tang governs Historically there are many explanations by annotators with different interpretations Incorrect treatment of Shang Han may result in damage to zheng qi and pathogenic attacking Shao Yang The presentation is very complex with pathogenic qi spreading across the triple burners others suggest that this is a three yang concurrent pattern or Shao Yang and Jue Yin concurrent pattern another interpretation is constrained heat of the liver and gallbladder or phlegm fire of the heart and the gallbladder or deficiency of zheng qi with harassment of pathogenic qi with pathogenic influence prevailed Professor Feng suggests that this is a Tai Yang Shao Yang and Yang Ming concurrent pattern In his book Jie Du Zhang Zhong Jing Yi Xue he pointed that Shang Han for eight or nine days the disease has transmitted to Shao Yang and the practitioner used purging with the patient suffering from chest fullness implying an unresolved Chai Hu pattern dampness knotted in the upper jiao hence there is vexation and fright with inhibited urination Disharmony of the stomach and pathogenic heat harassing the heart shen may lead to delirious speech water retention may cause generalized heaviness with inability to turn Chai Hu jia Long Fu Mu Li Tang Anyone who is conversant with the use of this formula share the same view Chai Hu jia Long Gu Mu Li Tang is a frequently used formula with good effect but as for the interpretation of this formula there is no clear cut explanation Lu Yuan Lei said The formula is complex and there suspicion that it cannot be used If treatment is according to the pattern it is effective Chai Hu jia Long Gu Mu Lu Tang is Xiao Chai Hu Tang omit Gan Cao add Gui Zhi Fu Ling Da Huang Long Gu Mu Li Qian Dan This formula harmonizes Shao Yang free obstruction in the triple burner calm and sedate the shen and can be used for exterior disorder with impaired Shao Yang pivot accompanied by vexation and fright for internal disease characterized by constrained liver and gallbladder heat with phlegm fire harassing the heart Professor Feng regards Xiao Chai Hu Tang by omitting Gan Cao can support to zheng qi to dispel

61 Mu Li and Long Gu Ebook pathogenic qi harmonize and clear heat Gui Zhi suppress the counterflow upsurge Fu Ling disinhibit water Da Huang purging heat Long Gu Mu Li and Qian Dan calm and sedate the shen indicated for Xiao Chai Hu Tang pattern presented with upsurge qi heart palpitations difficult bowel and urination and vexation fright and restlessness Case study analysis The chief complaint of the patient was tinnitus associated with disorders of the orifice and first consideration should be half exterior and half interior The patient s symptoms were complicated Her energy was low but the patient was 38 years old and there was absence of cold extremities Therefore treatment should be focused on half exterior and half interior yang pattern Clinical presentations of chest oppression easily frightened insomnia fit in with Clause 107 description of Chest fullness vexation and fright and the diagnosis is Xiao Chai Hu jia Long Gu Mu Li Tang Fu Ling and Da Huang were removed hence there is absence of constipation and inhibited urination white greasy tongue coat and chest oppression were apparent therefore Cang Zhu Fang Ji and Zhi Shi were added to transform qi and water retention Qian Dan is toxic and it was not used in the formula Professor Feng normally did not include Qian Dan in his prescription and instead Sheng Shi Gao was added As the patient improved during the second and third consultations the focus is on relieving the constraint and calm the shen At the fourth consultation she had her period switch to Dang Gui Shao Yao San Gui Zhi jia Long Gu Mu LI Tang modified to nourish blood and transform water retention as well as calming the shen and relieving constraint At the fifth consultation on account of the discomfort of the epigastrium and abdomen add Chen Pi to regulate qi and warm the middle Fan Zhong Lin Case 1 Shao Yang Pattern Insanity Ms Wu age 43 elementary school teacher from Sichuan Disease History Ms Wu had suffered from insomnia with many dreams for a long period of time She easily lost her temper and was easily depressed Occasionally her mind would suddenly become vague She was diagnosed with neurosis In September of 1974 she had a quarrel with a co worker One episode of anger caused her to faint When she regained consciousness her mind was unclear and

62 Mu Li and Long Gu Ebook her speech was disordered She had poor boundaries and continuously scolded strangers She was quickly brought in for a diagnosis This was a Shao Yang pattern of Insanity There was a cure after two visits Initial visit As soon as the patient came into the consult room she began to curse the doctor and speak incoherently She had chest fullness intermittent belching a dull expression red face and lips as well as constipation Her tongue was red with a thin yellow sticky moss The was a Shao Yang pattern of insanity The treatment principle was to harmonize resolve and clear heat while heavily down bearing and calming the spirit Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng with additions was used Bupleuri Radix ch i h 12 gm Fossilia Ossis Mastodi l ng g 60 gm pre cooked Scutellariae Radix hu ng q n 12 gm Codonopsis Radix d ng sh n 12 gm Cinnamomi Ramulus gu zh 6 gm Pinelliae Rhizoma preparatum zh b n xi 12 gm Fresh Rhei Radix et Rhizoma d hu ng 10 gm post cooked Ostreae Concha m l 60 gm pre cooked Jujubae Fructus d z o 15 gm Haematitum d i zh sh 60 gm pre cooked Differentiation of the Pattern The patient s illness was light in the beginning She had insomnia and a tendency to anger with with her mind becoming more and more unstable This was a mild degree of withdrawal illness Because at this point she did not receive treatment her condition worsened Her liver Qi was constrained and knotted Over time heat transformed into fire When she encountered an emotional situation this caused the fire to become agitated The gallbladder fire surged upward and the heart Qi could not descend Her mind suddenly shut down and she would faint This conforms to withdrawal and mania Her face and tongue was red and her pulse was wiry and rapid Coordinating the above presentations one can diagnose without a doubt

63 Mu Li and Long Gu Ebook Shang Han Lun Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng is used to after there has been mistaken purging downward after a Tai Yang damage from cold There is chest fullness and fright agitation with raving Later generations often used this formula to treat patients with epilepsy and insanity Recent clinical experience confirms that it is truly effective for this illness Bupleuri Radix ch i h 10 gm Fossilia Ossis Mastodi l ng g 30 gm pre cooked Scutellariae Radix hu ng q n 10 gm Codonopsis Radix d ng sh n 10 gm Poria f l ng 12 gm Pinelliae Rhizoma preparatum zh b n xi 12 gm Uncariae Ramulus cum Uncis g u t ng 12 gm Ostreae Concha m l 30 gm pre cooked Glycyrrhizae Radix g n c o 3 gm Haematitum d i zh sh 30 gm pre cooked Ku Hua Prunellae Spica xi k c o 12 gm After 3 packages of the following formula the illness was cured On July 24th 1979 I tracked down this patient and she had not had a relapse Comments The Su Wen Thorough Deliberation on Excess and Deficiency Treatise says Withdrawal illness and rreversal insanity is generated from chronic reversal Su Wen Declaration on the Five Qi Treatise Evil enters the Yang and leads to insanity patterns mountain top illness mania is this fighting Yang Bupleurum plus Dragon Bone and Oyster Shell Decoction ch i h ji l ng g m l t ng treats epilepsy and insanity patterns This is in the ancient records Since it contains Fossilia Ossis Mastodi l ng g and Ostreae Concha m l to contain and astringe it also has Rhei Radix et Rhizoma d hu ng and Poria f l ng to open through and disinhibit It has Rhei

Mu Li and Long Gu Ebook 64 Radix et Rhizoma d hu ng to attack and Ginseng Radix r n sh n to supplement The meaning behind this formula is mixed and it should not be used if there is doubt Some say that it is a mistake that this formula contains Fossilia Ossis Mastodi l ng g and Ostreae Concha m l but clinical experience indicates that this is not so Differentiating Formulas and When to use Shells Interview with Nigel Dawes In an excess person with abdominal fullness and pulsations how would you differentiate Da Chai Hu Tang from Chai Hu Jia Long Gu Mu Li Tang The constitutional typing is quite different Both are Strong Constitution Qi types with well developed toned musculature however they nonetheless differ in body mass The Da Chai Hu Tang abdomen is ample broader and more inflated and full with gas etc than the Chai Hu Jia Long Gu Mu Li Tang abdomen which is thinner more wiry and less distended with a tendency for the abdominal wall to be thinner and the surface muscles such as rectus abdominis to be tighter In addition the Da Chai Hu Tang type is relatively more wet and the Chai Hu Jia Long Gu Mu Li Tang type more dry This means that the Da Chai Hu Tang type is more prone to damp accumulation when there is Qi stasis The Chai Hu Jia Long Gu Mu Li Tang abdomen does not reflect this fullness in terms of mass and in the presence of this dryness excess Yang Qi will of course rise more quickly and more dramatically This gives rise to all the characteristic psycho emotional and sleep disturbances of that formula SHO Presentation This is compared to the abject fullness and accumulation in the middle and lower jiao which characterize Da Chai Hu Tang Pulsations will occur on both abdomens but the intensity of the Chai Hu Jia Long Gu Mu Li Tang ones will be especially dynamic and often very visible on the surface of the abdomen This is due to the absence of any Yin factor Eg water damp to check them Conversely the Da Chai Hu Tang pulsations will be more subdued subsumed as it were by the engorged fullness of the abdomen as a whole Da Chai Hu Tang is also Fuku Man abdominal fullness where Chai Hu Jia Long Gu Mu Li Tang is not

Mu Li and Long Gu Ebook 65 Perhaps a quick clinical profile might serve to highlight some differences between these two closely related formulas A hypertensive patient with the Chai Hu Jia Long Gu Mu Li Tang Sho will tend to be a thin wiry hyperactive and anxious type whose blood pressure can be very labile and is always elevated by anxiety provoking situations and experiences Typically they do NOT fit the profile of obese more sedentary types with high cholesterol and sclerotic changes in the vascular system typical of the congested Da Chai Hu Tang type who is damp hot and full The hypertensive state of the latter is likely to be constant and worsened by poor eating habits and lack of exercise The former will do well with learning how best to manage stress in their lives and maintain relative emotional stability whilst the latter will undoubtedly need to make major dietary and exercise routine changes in order to improve the condition In other words how do you determine when to use the Shells and Bones Is there a key symptom or sign that tells you to use shells As we know these substances descend and anchor Qi and tend to be very cooling As such they appear in formulas treating either deficient or excess types but who in both cases have a dry constitution The drier the type the more unstable the Qi The tendency for Qi to rise increases and with the Qi heat may flare as well Chai Hu Jia Long Gu Mu Li Tang patients often have night sweats and feel hot at night when they experience palpitations insomnia and nightmares Gui Zhi Jia Long Gu Mu Li Tang patients though KYO deficient and often HYO SHO cold constitution nevertheless they can experience mild sweating at night with insomnia and palpitations as the Yang Qi after the day s activities is without an anchor The Yang Qi instead remains at the surface and cannot be contained What distinguishes the pulsations in these cases is the intensity with which both the patient and the practitioner experiences them This is due to the thinness and tightness of the abdominal wall in these dry types The pulsations in Da Chai Hu Tang are less due to the upward surge of Qi itself They are rather more due to the accumulation of Qi in the abdomen thus the formula concentrates strongly on

Mu Li and Long Gu Ebook 66 dispersing and draining rather than descending cooling and anchoring In the case of Zhi Gan Cao Tang the pulsations are due to blood stasis caused by blood dryness and so blood moistening and invigorating is called for Gua Lou Mu Li San Gua Lou Mu Li San Tian Hua Fen 20 30 gm Mu Li 20 30 gm Grind the above herbs into powder and take 3 6 gm 3X day Take in rice water Alternately this can be decocted in water and should be taken slowly Original Text Jin Gui Yao Lue Chapter 3 line 7 In Lily Disease if thirst is not cured the following formula is indicated Gua Lou Mu Li San Discussion10 Function Boost Yin and submerge Yang moisten dryness and stop thirst Principle Presentation Lilly disease Yin deficiency with inner heat deficiency Yang floating upward thirst dry mouth slightly rapid pulse Principle Illness wandering mind heart vexation Principle actions 10 From the 1983 cs 351

Mu Li and Long Gu Ebook 67 Principle Presentation Lilly disease Yin deficiency with inner heat deficient Yang floating to the surface mouth thirst dry mouth rapid and minute pulse Adjunctive Presentation Obscured consciousness and heart vexation Clinical Modifications 1 Yuan Zhi Gui Ban Shi Hu and Sheng Di can be added to treat Lilly Disease when the Yin is extremely deficient 2 Bai He Zhi Mu Yuan Zhi Tai Zi Shen and Sheng Di can be added to treat neurosis 3 When this formula is used as a decoction it is also very effective 4 In regard to the cooking and administration method A decoction made from the powder is recommended Generally the boiled powder is taken 3 4 times This way it will be easy to assimilate One should avoid taking a large dosage as it could stimulate the digestion Taken as a decoction 1 3 to 1 6th can be taken once every 4 hours This method is similar to the western medical concept of half life This can be quite effective Application method for boiled powder The herbs should be coarsely ground and 20 30 gm can be given 2 3 times a day for an adult This can be increased when the condition is more serious

Mu Li and Long Gu Ebook 68 After soaking the powder in cold water bring to a boil while stirring Then simmer 3 6 minutes stirring vigorously Gui Zhi Gan Cao Long Gu Mu Li Tang Cinnamomi Ramulus gu zh 1 liang 3 gm Glycyrrhizae Radix g n c o 2 liang 6 gm Ostreae Concha m l 2 liang 9 gm Fossilia Ossis Mastodi l ng g 2 liang 9 gm Boil the above 4 herbs in 5 sheng of water down to 2 1 2 sheng Remove the froth Take 8 ge warm 3 times each day Modern method is to pre boil Fossilia Ossis Mastodi l ng g and Ostreae Concha m l and drink warm twice a day Original Text Shang Han Lun Line 118 Fire Reversal after purging or vexation after hot needling Gui Zhi Gan Cao Long Gu Mu Li Tang governs From my Blog about using Shells and Minerals As promised here is the first installment of a short series of entries on Kampo These next three entries are all taken from a written conversation between Nigel and myself in the form of questions and answers I hope you all find this as interesting and useful as I do In a deficient person with a tight abdomen and pulsations how would you differentiate whether to use Gui Zhi Jia Long Gu Mu Li Tang vs Zhi Gan Cao Tang Firstly on the abdomen the location of the pulsations will be different for each formula Gui Zhi Jia Long Gu Mu Li Tang will often have pulsations along the midline in the upper portion of the abdomen especially around Ren 12 13 14 though they can also occur lower down at the navel area In the case of Zhi Gan Cao Tang the pulsations are always around and below the navel and less commonly higher up What is more helpful in differentiating these two abdomens though is the other findings that tend to occur along with the pulsations Gui Zhi Jia Long Gu Mu Li Tang is

Mu Li and Long Gu Ebook 69 a Qi formula and the abdomen especially the rectus will generally be thin tight with a tendency for Shin Ka Hi Ko Epigastric subjective and objective tightness This kind of abdominal presentation is generally referred to constitutionally as the Gui Zhi Tang abdomen and is seen as related to the Chu Ki Kyo Zhong Qi Xu dry type as opposed to the Deficient Middle Qi Wet type for whom the Si Jun Zi Tang family is usually prescribed Sometimes the abdomen will be cool and clammy which is a Qi deficiency sign On the other hand Zhi Gan Cao Tang is a Blood formula and so the abdomen will show Oketsu blood stasis findings typically clustered around the navel the Terasawa Oketsu points and often Sho Fuku Fu Jin lax and powerless lower abdomen Ri kyu rectus tightness may also be found in relation to Zhi Gan Cao Tang The skin will be dry and rough which is a blood deficient sign With an overly deep palpation technique Ri kyu in the lower abdomen area is sometimes mistaken for Oketsu Thus in the first formula the pulsations arise from Qi nobose flushing upward reflecting in symptoms such as anxiety and sleep disorders and sometimes sexual dysfunction whereas in the second Zhi Gan Cao Tang they arise from the obstructive influence of Oketsu due to blood dryness in the lower abdomen In an excess person with abdominal fullness and pulsations how would you differentiate Da Chai Hu Tang from Chai Hu Jia Long Gu Mu Li Tang This is more straightforward since the constitutional typing is quite different Both are Strong Constitution Qi types with well developed toned musculature however they nonetheless differ in body mass The Da Chai Hu Tang abdomen is ample broader and more inflated and full with gas etc than the Chai Hu Jia Long Gu Mu Li Tang abdomen which is thinner more wiry and less distended with a tendency for the abdominal wall to be thinner and the surface muscles such as rectus abdominis to be tighter In addition the Da Chai Hu Tang type is relatively more wet and the Chai Hu Jia Long Gu Mu Li Tang type more dry This means that the Da Chai Hu Tang type is more prone to damp accumulation when there is Qi stasis The Chai Hu Jia Long Gu Mu Li Tangabdomen does not reflect this fullness in terms of mass and in the presence of this dryness excess Yang Qi will of course rise more quickly and more dramatically This gives rise to all the characteristic psycho emotional and sleep disturbances of thatformula SHO Presentation

Mu Li and Long Gu Ebook 70 This is compared to the abject fullness and accumulation in the middle and lower jiao which characterize Da Chai Hu Tang Pulsations will occur on both abdomens but the intensity of the Chai Hu Jia Long Gu Mu Li Tang ones will be especially dynamic and often very visible on the surface of the abdomen This is due to the absence of any Yin factor Eg water damp to check them Conversely the Da Chai Hu Tang pulsations will be more subdued subsumed as it were by the engorged fullness of the abdomen as a whole Da Chai Hu Tang is also Fuku Man abdominal fullness where Chai Hu Jia Long Gu Mu Li Tang is not Perhaps a quick clinical profile might serve to highlight some differences between these two closely related formulas A hypertensive patient with the Chai Hu Jia Long Gu Mu Li Tang Sho will tend to be a thin wiry hyperactive and anxious type whose blood pressure can be very labile and is always elevated by anxiety provoking situations and experiences Typically they do NOT fit the profile of obese more sedentary types with high cholesterol and sclerotic changes in the vascular system typical of the congested Da Chai Hu Tang type who is damp hot and full The hypertensive state of the latter is likely to be constant and worsened by poor eating habits and lack of exercise The former will do well with learning how best to manage stress in their lives and maintain relative emotional stability whilst the latter will undoubtedly need to make major dietary and exercise routine changes in order to improve the condition In other words how do you determine when to use the Shells and Bones Is there a key symptom or sign that tells you to use shells As we know these substances descend and anchor Qi and tend to be very cooling As such they appear in formulas treating either deficient or excess types but who in both cases have a dry constitution The drier the type the more unstable the Qi The tendency for Qi to rise increases and with the Qi heat may flare as well Chai Hu Jia Long Gu Mu Li Tang patients often have night sweats and feel hot at night when they experience palpitations insomnia and nightmares Gui Zhi Jia Long Gu Mu Li

71 Mu Li and Long Gu Ebook Tang patients though KYO deficient and often HYO SHO cold constitution nevertheless they can experience mild sweating at night with insomnia and palpitations as the Yang Qi after the day s activities is without an anchor The Yang Qi instead remains at the surface and cannot be contained What distinguishes the pulsations in these cases is the intensity with which both the patient and the practitioner experiences them This is due to the thinness and tightness of the abdominal wall in these dry types The pulsations in Da Chai Hu Tang are less due to the upward surge of Qi itself They are rather more due to the accumulation of Qi in the abdomen thus the formula concentrates strongly on dispersing and draining rather than descending cooling and anchoring In the case of Zhi Gan Cao Tang the pulsations are due to blood stasis caused by blood dryness and so blood moistening and invigorating is called for From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zou Gui Zhi Gan Cao Long Gu Mu Li Tang Gui Zhi 1 liang 3 gm Gan Cao 2 liang 6 gm Mu Li 2 liang 9 gm Long Gu 2 liang 9 gm Explanation of Formula This is a heart Yang insufficiency pattern in which the heart spirit is floating more and more causing vexation and agitation This is the primary presentation When there is agitation that changes into fright mania it is common to use White Tiger Decoction b i h t ng Order the Qi Decoction ch ng q t ng clearing and discharging methods to dispel the evil Qi This kind of

Mu Li and Long Gu Ebook 72 excess heat pattern is certainly prevalent there are also those with a deficiency cold pattern who must have a warm supplementing calming the spirit method Case 1 spontaneous sweat Dr Yue Mei Zhong Mr Li age 40 came for a consultation on June 11 1972 He had begun to sweat spontaneously from the back of the neck Every day he would drip sweat without stopping He repeatedly wiped his neck He felt quite worried so he requested treatment with Chinese herbs At the check up his pulse was floating and moderate and without strength He was spontaneously sweating Analyzing the condition The nape has the Tai Yang channel passing through it This long term sweating was related to the upward surging of the channel Qi that was prolonged without resolving Because it was so chronic there had to be deficiency Based on this I gave him Cinnamon Twig Licorice Dragon Bone and Oyster Shell Decoction gu zh g n c o l ng g m l t ng to harmonize the Yang down bear rebellion coordinate the Ying and Wei Qi and astringe and contain the floating Qi At first I gave 4 packages and the sweating stopped I again gave 4 packages to consolidate the effect Discussion The Su Wen Yin Yang Ying Xiang Da Lun says Yin is on the interior where it guards the Yang Yang is on the exterior and creates the Yin This case is one in which there is profuse sweating on the nape of the neck with heart Yang deficiency weakness The Yang was not consolidated on the exterior Cinnamon Twig and Licorice Decoction gu zh g n c o t ng warms and supplements the heart Yang and so it treats the root The addition of Fossilia Ossis Mastodi l ng g and Ostreae Concha m l treats the branch by consolidating and astringing to stop sweating Case 2 Palpitations Dr Liu Du Zhou Mr Song was a colleague at the hospital We would often chat about Chinese medicine in the hallways One day Mr Song suddenly had heart palpitations They were extreme and he was very anxious and fidgety I invited him to come see me for a consultation His pulse was wiry and moderate and had no strength on pressure His tongue was pale with white moss The cause was

73 Mu Li and Long Gu Ebook that this man worked at night which had disturbed his spirit This had caused his heart Qi to become deficient so that it could not contain the spirit Cinnamomi Ramulus gu zh 9 gm Glycyrrhizae Radix preparata zh g n c o 9 gm Ostreae Concha m l 12 gm Fossilia Ossis Mastodi l ng g 12 gm After 3 packages the illness was cured Discussion The tongue was pale with white moss and the pulse was wiry and moderate and when pressed it lacked strength This was the appearance of dew from Yang deficiency The Su Wen Sheng Qi Tong Tian Lun says Yang Qi is the essence that nourishes the spirit There is waning of the fire of the imperial fire and the hidden nourishment is lost and the spirit Qi floats That is why this case had palpitations and unsettled spirit Cinnamomi Ramulus gu zh and Glycyrrhizae Radix g n c o warm and stimulate the heart Yang while Fossilia Ossis Mastodi l ng g and Ostreae Concha m l submerge and down bear the heart spirit The branch and root are treated simultaneously 3 packages led to a cure Case 3 Twitching Eye Muscle Hao Wen Xuan Ms Li was age 30 and came for a consultation on February 15 1986 For the last 3 months her left eye lid twitched The western medical diagnosis was spasm of the eye muscle All treatment was in vain Her tongue was normal and without moss Her pulse was thin and rapid Her spirit was agitated She had pale lips and a harmonious mouth Her urine was clear and her bowel was moist After becoming ill he took Scorpio qu n xi and Scolopendra w g ng but this made the condition worse This was chaotic movement of deficiency wind It was not suitable to treat movement with more movement It was appropriate to treat movement with lack of movement so I applied Fossilia Ossis Mastodi l ng g and Ostreae Concha m l Nowadays people give bugs to search out wind and this causes the Qi to extend even more It is no wonder that the twitching got worse I gave Zhong Jing s Cinnamon Twig Licorice Dragon Bone and Oyster

Mu Li and Long Gu Ebook 74 Shell Decoction gu zh g n c o l ng g m l t ng I added Typhonii Rhizoma preparatum zh b i f z to lead the herbs into the head and after two packages the patient was cured The Nei Jing says The Yang Qi s essence nourishes the spirit and it s softness nourishes the tendons When the spirit is calm and the tendons are soft the muscles no longer move Discussion This case of eye twitching was a presentation with vexation and agitation and a thin and rapid pulse This was deficiency of Yang with internal harassment and the generation of wind Excessive wind leads to movement I used Cinnamon Twig Licorice Dragon Bone and Oyster Shell Decoction gu zh g n c o l ng g m l t ng because it warms returns and submerges When Yang is established in its place the wind stops and the twitching eye stops twitching Gui Zhi Jia Long Gu Mu Li Tang From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zou Formula Gui Zhi 3 liang 9 gm Shao Yao 3 liang 9 Gan Cao 2 liang 6 Sheng Jiang 3 liang 9 Da Zao 12 pieces 4 Long Gu 3 liang 9 Mu Li 3 liang 9 Original Text Jin Gui Chapter 6 Deficiency Taxation line 8 For men with loss of semen tensed lower abdomen cold sensations of the penis blurred vision and hair loss the pulses are extremely deficient hollow slow indicating clear food diarrhea causing blood collapse and seminal loss Hollow stirring faint or tight pulses indicate seminal essence loss in men and dreaming of intercourse in women Gui Zhi Jia Long Gu Mu Li Tang governs

Mu Li and Long Gu Ebook 75 Case 1 Damage from Wind Vomiting Blood and Wet Dreams Dr Zhang Lu Yu treated Shen Lu Yu s second son age 17 Each time this patient received wind damage he began to vomit blood and have wet dreams The liver contains concealed fire and when this fire is stirred it leads to trouble Now the liver is the earthly Zang that stores the blood and the Hun If the liver does not store the blood it will follow flaring fire If the Hun is not calm the sperm will follow the wet dream I gave him 4 packages of Gui Zhi Tang with added Long Gu and Mu Li Thereafter the exterior resolved so the bleeding stopped Gui Zhi Tang harmonizes the Ying and scatters the evil Adding Long Gu and Mu Li subdues the liver and calms the Hun Enveloping the Zang s consolidation makes it so it is not easy for the wind to enter When the Hun s dreams are calmed the Jing does not rashly stir If the fire is contained and used with wisdom there will rarely be deficiency detriment 1 1959 5 Case 2 Spontaneous sweating from the neck Dr Yue Mei Zhong Mr Li was age 46 He came for a consultation on June 11 1972 He complained of sweating on his neck This was constantly drenching wet all day long He frequently wiped his neck off and was often quite worried He wanted to consult with and get treated by the doctor The check up revealed that his pulses were floating moderate and without strength He sweat spontaneously I analyzed the symptoms The Tai Yang channel goes through the neck area Prolonged sweating caused the channel Qi to surge upward becoming chronic with no resolution This had the effect of weakening him I gave him Zhang Zhong Jing s Gui Zhi Jia Long Gu Mu Li Tang to harmonize the Yang and downbear reversal Harmonize the Ying and Wei and restrain the ever increasing floating Qi At first I gave him four packs and the sweating stopped I gave another four packs to consolidate the result 1 1978 7 Case 3 Deficiency Taxation Mr Lin was age 32 He came for a consultation on February 7 1974 He suffered from spermatorrhea syndrome His complexion was pale white and he felt dizzy and distended in his head He had heart palpitations and insomnia spontaneous sweating and soreness of his back and

Mu Li and Long Gu Ebook 76 knees His tongue was pale and his pulse was hollow and tense It was appropriate to supplement and boost the heart and kidney absorb the Jing and restrain sweat Gui Zhi 6 Bai Shao 9 Gan Cao 6 Dan Shen 9 Lian Xu 6 Du Zhong 12 Tu Si Zi 9 Bai Zi Ren 9 5 packages Case 4 Spermatorrhea Dr Zhang Zhi Min Mr Qin came for a consultation on April 16 1941 He suffered from extreme spermatorrhea which was related to an unconsolidated Kidney closure This went on for a long time without treatment and hence it became a taxation illness His pulse was thin and his tongue was white For treatment it was appropriate to consolidate the kidney closure and stop leakage Gui Zhi 9 Chi Bai Shao Each 12 Gan Cao 9 Sheng Jiang 9 Da Zao 12 Mu Li 21 Long Gu 21 Duan Gui Ban 9 Wu Wei Zi 9 Yi Zhi Ren 12 Huang Qi 9

Mu Li and Long Gu Ebook 77 Case 5 Postpartum bleeding Ms Feng was age 28 She was a worker She came for a consultation October 20 1971 The issue related to the fact that she was a primiparas woman Her lochia has cleared but she felt lower abdominal pain Suddenly when she was 26 days postpartum in the evening she developed Beng which did not cease She was rushed to the hospital She was given western medicine to stop bleeding and this was combine with 400 ml of blood transfusion This changed things for the better However she continued to drip without stopping She also took herbal formulas with herbs like Dang Gui Tan Chao Bai Shao Sheng Di Tan Dan Shen Tang to nourish blood and stop bleeding However she developed heart palpitations and her appetite decreased She decided to invite me to see her Differentiating the pattern determining treatment Postpartum Beng without pain is due to a pattern of Qi deficiency in which the Qi is unable to absorb the blood Qi commands the blood and Qi deficiency means that the blood does not flow along the proper channels and instead moves absurdly This pattern must be treated to boost the Qi and absorb the blood Additionally the blood must be nourished and bleeding stopped Yet sticky nourishing herbs can damage the Yang When the heart Yang receives damage there are heart palpitations In addition the spleen Yang is not stimulated and so the appetite goes down The pulse was thin and weak and the tongue was pale with no life This was all due to extreme deficiency of the Qi and blood The treatment needed to boost the Qi and nourish the Ying while guiding the blood and restoring the spleen Gui Zhi 4 5 Chao Bai Shao 9 Zhi Gan Cao 4 5 Sheng Jiang 3 slices Da Zao 5 dates Mu Li 24 Long Gu 24 Dang Shen 12 Zhi Huang Qi 12 Chao Bai Zhu 9 Guang Pi 6

Mu Li and Long Gu Ebook Hei Gui Pi Wan 78 12 taken as a draft 3 packages Second visit October 23 The dripping gradually stopped and her appetite increased Cases From The Big Book on Gynecology Modifications If the pulse is rapid and there is Yin deficiency you can add Sheng Di Huang Gui Ban or E Jiao It this is more extreme then you can add Bai Wei If the pulse is slow and the hands and feet are cold it is appropriate to add Fu Zi type herbs If there is profuse bleeding you can add herbs such as Ci Hua Pi Tang Ji Guan Hua Tan and Lian Fang Tan Case 1 Excessive Menstruation Ms Liu was 47 and came for her first visit on May 15 1985 Her menstruation had not stopped for half a year Formally her menstruation had been normal Just before this began she had gotten angry and this brought on this irregular menstruation The amount was heavy when she menstruated and then would drip Last month it came on the 10th and was especially heavy and did not stop The color was deep red without clots She was also flustered and had shortness of breath She also had heat in her hands and feet dry mouth and lips weak body without strength spontaneous sweating low back and leg soreness and weakness and poor appetite Her tongue was pale with white dry moss Her pulse was wiry and big but when pressed was soft The presentation was differentiated as dual Yin and Yang deficiency with lack of harmony of the Ying and Wei The Chong and Ren were not consolidated It was appropriate to regulate Yin and Yang and constrain and consolidate what is falling away I gave her the following formula Gui Zhi 10 Bai Shao 20 Gan Cao 15 Sheng Jiang 10 Da Zao 5 dates Duan Long Gu 25 Duan Mu Li 25 Hai Piao Xiao 20

Mu Li and Long Gu Ebook Qian Cao 15 Shan Zhu Yu 20 Sheng Di Huang 20 Huang Qin 15 Zong Lu Tan 15 79 This was decocted in water and she was given 12 packages and there was a cure Case 2 Excessive Menstruation Ms Shao was 29 years old and came for her first visit on March 11 1983 Her menstruation had been especially persistent for the last 10 years Every time she got her period it lasted between 15 to 70 days The cycle had no regular schedule Her last menstruation arrived on February 10 and had not stopped up to our appointment The color was red with blood clots She also had dizziness many dreams agitation chest oppression heat in her hands and feet and dry mouth Her tongue body was dark with red sides Her pulse was wiry and slippery The presentation was differentiated as Yin deficiency with blood heat and lack of consolidation of the Chong and Ren For treatment it was appropriate to clear heat and harmonize the Ying and Wei calm the Chong and regulate the menstruation Gui Zhi 5 Qing Hao 20 Bai Shao 30 Sheng Jiang 10 Hong Zao 3 Gan Cao 10 Mu Dan Pi 15 Huang Qin 15 Duan Mu Li 40 Duan Long Gu 40 Hai Piao Xiao 20 Qian Cao 15 This was decocted in water and she was given 6 packages and there was a cure

Mu Li and Long Gu Ebook 80 The above two cases were from the Hei Long Journal of Chinese Medicinal Herbs 1986 6 3 Case 3 Beng Luo Ms Kang was 20 and unmarried She came for her first visit in May of 1982 She had flooding and trickling for more than half a year She had seen many doctors but had not responded to any treatment When she came to see me I noticed that her face had no luster and that her body felt weak She also had dizziness and fever Her cycle had been early or late without regularity She bled continuously sometimes for 15 30 days without stopping Sometimes it was heavy and sometimes scanty She had heart palpitations and was not able to eat or drink well Her pulse was thin and weak and her tongue was white Her diagnosis was liver and gallbladder damp heat mixed with Qi deficiency and that was sinking down I used Long Dan Xie Gan Tang and Bu Zhong Yi Qi Tang together with modifications in order to clear and disinhibit the lower warmer damp heat boost the Qi nourish the blood and stop bleeding regulate the Chong and Ren After one month of treatment the symptoms were all as before I decided to look at this really carefully The dripping was around noon and midnight and before bleeding she would sweat profusely Taking this peculiar characteristic into account I saw that this was due to lack of harmony of Yin and Yang and lack of synchronizing in the Ying and Wei I changed my approach to one in which I regulated the Ying and Wei moved the blood and returned the spleen I changed my formula to modified Gui Zhi Jia Long Gu Mu Li Tang Gui Zhi 15 Da Zao 15 Dang Shen 20 Dang Gui 20 Long Gu 30 Mu Li 30 Bai Shao 30 Bai Zhu 30 Sheng Jiang 3 slices

Mu Li and Long Gu Ebook 81 Discussion The patient was young and was strong and full of vigor Since her Qi and blood were flourishing giving her herbs to supplement her Qi and nourish her blood would certainly not be effective I failed to see that her Yin and Yang were moving apart and lose their harmony and continued to treat her for damp heat and dropping down of Qi Later I regulated and harmonized the Ying and Wei to induce the blood to return and this was effective I treated on the basis of the following saying To treat the illness one must seek the root I treated a bleeding presentation but did not use bleeding herb and yet the bleeding spontaneously stopped Huang Huang on Gui Zhi Jia Long Gu Mu Li Tang Gui Zhi Tang pattern includes being conscious of an up surging feeling palpitations There are also more serious symptoms such as a pulsing in the chest and abdomen an up surging feeling being easily frightened without peace light sleep insomnia nightmares spontaneous sweat or night sweats In this case you should use Gui Zhi Jia Long Gu Mu Li Tang Clinically this is often seen in thin children with a pale complexion Even though they have spirit in their eyes they are easily frightened This can be sustained night crying in infants and profuse sweat This pale thin boy or girl also may have heart and abdominal palpitations poor sleep with lots of dreams and easy to have night sweats When these symptoms appear though it may or may not be a Gui Zhi Jia Long Gu Mu Li Tang pattern it is important to consider this Zhang Zhong Jing used this formula to treat loss of Jing with lower abdominal tightness and cold at the head of the penis and decline in eyesight Many of the patients who loose Jing have a white complexion and thin gaunt body sweat easily and have nocturnal emission This can be considered a Gui Zhi body type The Long Gu within this formula in antiquity was from many different kinds of mammals fossilized bones None of these bones have any flavor nor smell and they have a high degree of hygroscopicity11 Nevertheless this is an herb that is very important for settling and calming as well as for restraining In the clinic the above symptoms may be accompanied by pulsing below the navel with panic and lack of calm agitation loss of Jing and bleeding Long Gu is effective 11 Hygroscopy is the phenomenon of attracting and holding water molecules from the surrounding environment which is usually at normal or room temperature This is achieved through either absorption or adsorption with the absorbing substance becoming physically changed somewhat This could be an increase in volume boiling point viscosity or other physical characteristic or property of the substance as water molecules can become suspended between the substance s molecules in the process

Mu Li and Long Gu Ebook 82 for this presentation Mu Li is the oyster s shell Its effect is much the same as that of Long Gu They are not the same in that they target different areas While Long Gu treats pulsing and tightness in the lower belly Mu Li treats chest oppression heart palpitations dizziness headache night sweat agitation and nocturnal emission Zhang Zhong Jing always combined Long Gu and Mu Li when he put them in Gui Zhi or Chai Hu formulas With them he treated chest and abdominal pulsing agitation and insomnia The Gui Zhi Jia Long Gu Mu Li Tang pattern Chest and abdominal pulsation frightfulness spontaneous or night sweats insomnia with many dreams Floating big pulse without strength tongue is pink red with scanty moss From my own clinical experience the key to determining whether or not to use this formula lies in the pulse and tongue presentation The pulse must be floating big and without strength If it is deep and thin deep and full or big with strength this is not the presentation for this formula You should pay attention If the tongue is pink red with moisture and the moss is thin white then you can use this formula This indicates the internal deficiency with no evil present If the tongue is dark red and old looking this indicates constrained heat If the tongue is pale white and large and plump this indicates cold damp water If the tongue moss is yellow and sticky burnt dry or thick and greasy this indicates that there is phlegm heat accumulated heat or turbid dampness on the interior and exterior All of these patterns rule out the use of this formula You must be cautious Pediatric Use This formula is often used in pediatrics for persistent pneumonia rickets bed wetting spontaneous or night sweat persistent night crying and low grade fever Dr Wang reported using Gui Zhi Jia Long Gu Mu Li Tang to treat 13 cases of pneumonia and weakened resistance 8 were cured and 4 had good results Only one was without effect Recently this formula was used with Shi Gao and Bei Sha Shen to treat a child with a thin body and pale facial complexion for summer heat The principle manifestation was thirst agitation and night sweating

Mu Li and Long Gu Ebook 83 Neurasthenia This formula has also been used to treat neurasthenia with insomnia many dreams heart palpitations and chest oppression For men with nocturnal emission yang wilt morning diarrhea and inability to ejaculate or for women with irregular menstruation lack of emotional affect anxiety and fearfulness it has been effective I treated a young man with a thin body who was a pale faced scholar He had prostatitis testicular pain nocturnal emission many dreams night sweat He had repeatedly been given clear heat cool the blood formulas without effect His body was thin he had bright eyes and his tongue was pink red with scanty moss His pulse was large and without strength I gave him 3 packages of Gui Zhi Jia Long Gu Mu Li Tang with Wu Wei Zi Qian Shi and Lian Xu which helped his sleep and stopped the sweating so I gave him 30 more packages and he was cured Respiratory or Digestive I often use Gui Zhi Jia Long Gu Mu Li Tang to treat chronic dyspnea with profuse sweating a pink tongue with scanty moss as well as chronic type stomach pain accompanied by lots of dreams poor sleep night sweat dizziness This pattern can lead to pulmonary emphysema bronchial asthma gastritis or digestive tract ulcer Notes on Gui Zhi Jia Long Gu Mu Li Tang Functions Settles the heart and quiets the spirit regulates and harmonizes the constructive and defensive Formula explanation Within this formula the ingredients of Zhang Zhong jing s Gui Zhi Tang regulate and supplement yin and yang regulate and harmonize the constructive and defensive Dragon Bone and Oyster Shell are added to secure and astringe as well as to quiet the spirit They have a predilection for constraining and heavily settling in order to quiet the heart spirit They also stop fright and downbear counterflow in order to stabilize fright palpitations When all these medicinals are used together the heart spirit obtains constraint and yin and yang and the constructive and defensive are regulated and harmonized Thus fear and fright are automatically dispersed and all the symptoms are cured This formula is mainly useful when heart qi vacuity causes spontaneous perspiration as part of a

Mu Li and Long Gu Ebook 84 phobic reaction or panic attack In real life situations I would tend to add the main ingredients for harmonizing the constructive and defensive and astringing yin from this formula to other formulas such as Xiao Yao San above In my experience few Western patients present such a simple pattern Case 4 Fear and Fright The patient was a 26 year old male This young man had married one year before Each night when he and his wife went to bed he would develop signs and symptoms of fear and fright when his wife touched his skin In other words the man was scared of sex His heart spirit would become disquieted and this would be followed by cold shivering His skin would perspire pearls of sweat and his whole body felt devoid of strength After some time the young man became impotent and could not get an erection This then led to difficulty sleeping at night He had already been treated with several formulas without marked effect The man was diagnosed as being phobic to sexual intercourse In terms of his Chinese medical symptoms his tongue was pale with white fur and his pulse was fine and weak Therefore he was administered Gui Zhi Jia Long Gu Mu Li Tang in order to settle his heart and quiet his spirit regulate and harmonize his constructive and defensive These medicinals were decocted in water and administered in two divided doses morning and night After taking seven packets the man still felt frightened when he entered his bedroom at night but he was neither cold nor hot and did not sweat Another seven packets were prescribed without modifications and all his clinical symptoms disappeared On follow up after one year there had been no recurrence Case 5 Fear and Insomnia Mr Liang was 36 years old He had had a big fright and now day and night he felt frightened and could not sleep In the evening he could not bear to be alone and had someone to stay with him It was difficult for him to sleep and he would often wake with a start In the daytime he did not dare to walk alone had to have someone accompany him He still felt fearful and held back while he walked She would be fearful about events that were not really scary He would become stupefied and his body and limbs would feel cold with hypertonicity as well as tightening of his scrotal tendon He would then become flaccid sweat from his 5 hearts and have flatulence and profuse urination

Mu Li and Long Gu Ebook 85 Check up Decreased food and fluids Pale tongue with white moss and wiry pulse Treatment Method This was a Gui Zhi Qu Shao Yao Jia Long Mu Pattern Formula Gui Zhi 4 qian Zhi Gan Cao 8 qian Sheng Jiang 3 qian Da Zao 6 dates Sheng Long Gu 1 liang Sheng Mu Li 1 liang Yuan Zhi 3 qian Gui Yuan Rou 2 liang Xiao Mai 2 liang Mr Liang took 3 packages of the above herbs By degrees his nights became peaceful and his sense of fear clearly decreased as did the number of times he would stare blankly He could go out and walk by himself and did not need someone to accompany him At this time it was summer but he was still wearing a padded coat and feared wind so I added 5 qian of Sheng Huang Qi to his prescription as well as 3 qian of Bai Shao I gave him several packages of this and he was completely recovered Discussion Shang Han Lun Gui Zhi Tang Qu Shao Jia Shu Qi Mu Long Tang or Gui Zhi Jia Long Mu Tang are used principally to treat fright and panic from the things of ordinary life with an inability to find peace as well as agitation Quite frankly the cause is often due to mistaken treatment damaging the Yang The pathology is heart yang vacuity leading to lack of calm of the Shen and Hun The formula should warm and supplement the Yang Qi of the Heart and Liver in order to calm the Shen and Hun This formula is very effective when the Heart and Liver Shen and Hun are not calm from vacuity cold In this example there was Heart and Liver Yang vacuity with inner cold giving rise to lack of peace of the Shen and Hun Therefore the patient was

Mu Li and Long Gu Ebook 86 fearful day and night The cold and tense body and limbs was due Shao Yin Heart Yang vacuity in which the Yang was unable to warm and nourish the vessels The tightening of his scrotal tendon and wiry pulse were due to Jue Yin Liver Yang insufficiency in which there was an inability to warm and nourish the tendons and vessels The Liver rules the tendons and the Jue Yin Liver Channel and vessel arrives at the lower abdomen and networks the genitals So I used Gui Zhi Qu Shao Yao Jia Long Mu Tang as the principle formula Gui Zhi Tang is a Yin within Yang formula When you take out Bai Shao it becomes a pure Yang formula It not only warms the Heart Yang but also warms the blood vessels It is also able to warm the Liver Yang in order to course and guide the wood Qi Our predecessors said the Gui Zhi is able to disperse the wood and calm shaking Long Gu and Mu Li are heavy and down bearing as well as consolidating and constricting so they are able to settle and cold the Shen and Hun Gui Yuan and Yuan Zhi increase the strength of the formula to nourish the Heart and Shen Xiao Mai is in Gan Mai Da Zao Tang This is able to nourish the Heart and calm the Shen as well as moderating the tension in the Liver After obtaining a good effect with this the patient had spontaneous sweating and fear of wind so I added Huang Qi and Bai Shao which boost the protective Qi consolidate the exterior and restrain sweat Fu Yan Ling on Gui Zhi Jia Long Gu Mu Li Tang Case 6 Stomach and Duodenal Ulcer Mr Wang Male 29 years old Chief complaint Upper abdomen pain for seven years Current attack for 4 days History The patient had a history of stomach and duodenal ulcer with intermittent attacks over the past seven years Four days ago he again suffered from upper abdominal pain with each attack taking place around 4 5am in the morning The attack would persist for 2 3 hours with food intake slightly moderating the pain S S Acid reflux occasional heart palpitations pale tongue with a thin tongue coat and a moderate pulse Diagnosis Spleen and stomach deficiency with cold in the middle jiao Treatment Gui Zhi jia Long Gu Mu Li Tang modified Gui Zhi 10

Mu Li and Long Gu Ebook Bai Shao 12 Sheng Jiang 8 Gan Cao 6 Da Zao 15 Duan Long Gu 30 Duan Mu Li 30 87 Seven packs After taking the above medication for four days the stomach pain subsided but there was slight acid reflux The original formula was repeated but combined with Zuo Jin Wan Gui Zhi 10 Bai Shao 12 Sheng Jiang 8 Gan Cao 6 Da Zao 15 Duan Long Gu 30 Duan Mu Li 30 Chuan Lian Zi 2 Wu Zhu Yu 3 Seven packs The condition resolved after the course of medication Discussion In Chinese medicine stomach and duodenal ulcers are diagnosed as spleen and stomach deficiency and cold Gui Zhi Long Gu Mu Li Tang was prescribed with a slightly increased dose of Shao Yao to moderate the pain and tonify the middle The acid reflux persisted at the second consultation and Zuo Jin Wan was added to inhibit excessive acid secretion Huang Lian was used to counter the warm property of Gui Zhi Acid reflux is generally attributed to constrained heat and Huang Lian can clear constrained heat in the stomach The dose of Da Zao was reduced because of the acid reflux Gui Zhi jia Long Gu Mu Li Tang can be used to treat all types of gastro intestinal disease particularly in the case of spleen and stomach deficiency manifesting as dyspepsia peptic ulcer irritable bowel syndrome gastritis with acid reflux excessive stomach acid dysfunction of the cardiac sphincter etc Zhang Zhong Jing used this formula for treatment of deficient detriment

Mu Li and Long Gu Ebook 88 and it is efficacious for elderly patients infants and post partum women with spleen and stomach deficiency Long Gu and Mu Li are astringent and are also effective in inhibiting excessive acid secretion and they also have a calming effect on the shen Feng Shi Lun on Gui Zhi Jia Long Gu Mu Li Tang Case 7 Chronic Prostatitis Inappropriate tonification of Tai Yang disease Bai x Male 30 years old First consultation 22nd March 2010 The patient suffered from chronic prostatitis for more than one year S S Frequent and urgent urination premature ejaculation accompanied by reduced sexual desire aching knees sweating parched mouth occasional nocturia normal appetite sloppy stool average two to three movement per day tendency of diarrhoea if taken the wrong food red tongue with thin white tongue coat and a thready and wiry pulse Six Channel identification Tai Yang Tai Yin concurrent pattern Formula pattern Gui Zhi Jia Long Gu Mu LI Tang Er jia Long Gu Tang Jin Ying Zi Jiu Cai Zi Cang Zhu Prescription Gui Zhi 10g Bai Shao 10g Bai Wei 12g Zhi Gan Cao 6g Sheng Long Gu Mu Li 15g each Zhi Fu Zi decoct together 10g Jin Ying Zi 10g Jiu Cai Zi 10g Cang Zhu 15g Sheng Jiang 15g Da Zao 4 pieces Seven packs decoct in water Second consultation 29th March 2010 After the medication there was a reduction of frequent and urgent urination and premature ejaculation Change the dosage of Zhi Fu Zi to 12g add Gou Ji 15g Seven packs Third consultation 12th April 2010 After the seven packs of medication his previous symptoms of frequent and urgent urination as well as early ejaculation were not apparent in particular improvement on his premature ejaculation After cessation of medication there was recurrence of symptoms His bowel movement was sloppy with two to three movement per day marked improvement of parched mouth Substitute Sheng Jiang with Pao Jiang 6g omit Gou Ji Seven packs He was told to continue the above medication until all the symptoms were gone

Mu Li and Long Gu Ebook 89 Overview From the zang fu identification perspective it can be identified as deficiency of spleen and kidney and the corresponding treatment is to tonify the kidney and spleen He was being treated on this aspect by previous practitioners but not effective Professor Feng based on the six channel pattern identification by asking the presence of sweating but in reality his sweating was not excessive but this aspect can be neglected by many practitioners If there is presence of sweating it can be Tai Yang Gui Zhi Tang pattern coupled with the patient suffering from anxiety premature ejaculation and frequent urination diagnosis is Gui Zhi Long Gu Mu Li Tang pattern Parched mouth weak knees with reduced sexual desire Er Jia Long Gu Tang is considered With the combined two formulas Jin Ying Zi and Jiu Cai Zi to achieve the effect of regulating ying and wei as well as harmonizing qi and blood tonify the deficiency and astringe the essence sedate and calm the shen Another consideration of the sloppy bowel movement and tendency to suffer from diarrhoea therefore this is Tai Yin cold dampness hence Cang Zhu was used and later changed to Pao Jiang to warm and transform the cold dampness Gui Zhi Long Gu Mu Li Tang pattern Jin Gui Yao Lue Blood Deficiency and Detriment chapter Clause 8 A person who suffers from seminal loss will present with tension and urgency of the lower abdomen cold in the glans penis dizzy vision and hair loss Extremely deficient hollow and slow pulse indicates that clear food diarrhoea blood collapse and seminal loss may occur The hollow pulse stirred faint or tight pulse reflects seminal loss in men and dreaming of intercourse in women Gui Zhi jia Long Gu Mu Li Tang governs Gui Zhi regulates ying and wei qi and blood the addition of Long Gu and Mu Li sedate and astringe the floating shen as well as securing and astringing the essence This formula has been used historically by practitioners to treat male seminal loss and women dreaming of intercourse disorders Gui Zhi Long Gu Mu Li Tang Er Jia Long Gu Tang is a frequently used formula by Professor Feng Shi Lun to treat male disorders To comprehend this formula Professor Feng in his book Jie Du Zhang Zhong Jing Yi Xue said Seminal loss dreaming of intercourse can be attributed to frenetic sexual desire with restless spirit causing hallucination The root cause is due to sweating with fluid damage and disharmony of ying and wei The use of Long Gu apart from securing the

Mu Li and Long Gu Ebook 90 essence it has a calming and sedating effect on the heart shen to address palpitations and throbbing in the chest and abdomen and when combined with Gui Zhi Tang to regulate ying and wei qi and blood this formula is indicated for the above case study Xiao Pin states Deficient and floating heat with sweating omit Gui Zhi add Bai Wei Fu Zi and the formula is known as Er Jia Long Mu Tang This formula is highly effective in the treatment of seminal loss often seen in unmarried young men or male suffering from chronic prostatitis Irrespective of men or women suffering from emotional disorders such as urinary block or enuresis this formula can be used It should be noted that this formula pattern is often being regarded as a deficient detriment disorder and prolonged use of potent tonifying formula may cause the condition to exacerbate The reason being one must identify that the key pattern is a Gui Zhi Tang pattern A reading from Lei Ju Fang Guan Yi said person with a weak disposition and excessive sexual desire emaciated body and pale complexion with slightly generalized heat cramp in the lower abdomen throbbing in the chest and abdomen a suggestion of prolonged usage of Gui Zhi jia Long Mu Tang Careful constraint of sexual activities may lead to regeneration of flesh and bone This can be used as a reference Method of decoction Due to the learning process of Chinese medicine practitioners may be taught a different way from the different schools resulting in the method of decoction being different at times As for the decocting of Long Gu Mu Li Zhi Fu Zi and Sheng Shi Gao etc Professor Feng does not advocate the above herbs to be decocted first and should be decocted with the rest of the herbs Professor Feng generally instructs the patient to soak the herbs in cold water for one hour before decocting for 15 minutes after simmering Each pack is to be decocted twice and to be taken between 9 10 in the morning and again between 3 4 in the afternoon This method of medication is not applicable to acute disease with fever Case 8 Heart Palpitation Ms Wan 32 years old First visit February 26th 2007 The patient had been experiencing palpitations for over seven days Seven days before the patient started feeling flustered and anxious due to overwork This was accompanied by precordial

Mu Li and Long Gu Ebook 91 discomfort and a general lack of strength An Electrocardiogram showed Occasional premature ventricular contraction which had significantly increased thus she sought a diagnosis Presenting symptoms were Sweating with anxiety general lack of strength a dry mouth with no desire to drink hot palms no bitterness in the mouth easy to rouse from sleep poor appetite her stools tended to be dry coming once every two to three days Her urination was normal Her tongue body was pale with a thin white coating and she had a thin pulse The vacuity sweating and hot palms represent a disharmony of the ying and wei a taiyang pattern When the patient sweats while sitting still modern medicine believes this is a disorder of the autonomic nervous system master Feng believes it is a kind of ying and wei disharmony which is related to her catching cold The thin pulse the white tongue coating the pale tongue body dry mouth without desire to drink affected sleep and general lack of strength is a taiyin pattern of blood vacuity and water exuberance The heart flustering precordial discomfort are caused by fluids encroaching on the heart The dry stools which come every two to three days are due to taiyin interior cold with fluids internally stopped up and the fluids being damaged and not yangming bowel repletion Analysis and Synthesis The differentiated patterns are taiyang taiyin combined disease along with blood vacuity and water repletion He used Gui Zhi jia Long Gu Mu Li Tang to harmonize the ying and wei and regulate the qi and blood calm the movement of the heart and contain the heart spirit Also heavily borrowing from the ideas of Ding Zhi Wan Shi Chang Pu Yuan Zhi Chao Suan Zao Ren to strengthen the spirit calming effect Along with that using Dang Gui Shao Yao San to nourish the blood and disinhibit the watery fluids so as to eliminate taiyin interior cold The dry stool that only came every two to three days was due to taiyin interior cold with water fluids stopping up internally and damaged fluids It is not yangming bowel repletion Thus in the formula he emphasized the use of Bai Zhu to moisten the yang and ascend the fluids and free flow the stool It is important to note this type of constipation to avoid confusing it with yangming heat patterns Gui Zhi 10g

Mu Li and Long Gu Ebook 92 Zhi Gan Cao 6g Sheng Long Gu 15g Sheng Mu Li 15g Fu Ling 15g Bai Zhu 18g Dang Gui 10g Bai Shao 10g Yuan Zhi 10g Shi Chang Pu 10g Suan Zao Ren 15g Three packets cooked in water and taken Results After taking the three packets the palpitations diminished and did not reappear the stool appetite and sleep became more regular on follow up there had been no recurrence Dr Yu Guo Jun on Gui Zhi Jia Long Gu Mu Li Tang In TCM textbooks the etiology of spontaneous sweating is usually divided into ying and wei disharmony and Lung deficiency The former is treated with Gui Zhi Tang and the latter uses the Yu Ping Feng San The etiology of night sweats are broken into deficient Heart blood and yin deficiency Deficient heart blood is treated with Gui Pi Tang to nourish blood while yin deficiency is treated by nourishing yin and reducing fire with Dang Gui Liu Huang Tang Except for Gui Zhi Tang the other formulas are only marginally effective or ineffective In fact separating these conditions into spontaneous sweating and night sweats is unnecessary as is distinguishing patterns Gui Zhi Jia Long Gu Mu Li Tang combined with Feng Sui Dan can treat them all Case 9 Spontaneous Sweating Zhang male 32 years old The patients suffered from spontaneous sweats for more than 3 years but after numerous

Mu Li and Long Gu Ebook 93 formulas his symptoms hadn t improved Current intake Complexion lacking a healthy glow Tongue pale with a thin yellow coating Formula Gui Zhi Jia Long Gu Mu Li Tang with Feng Sui Dan Gui Zhi 15 Bai Shao 20 Da Zao 15 Sheng Jiang 15 Zhi Gan Cao 6 Long Gu 30 Mu Li 30 Sha Ren 6 Huang Bai salt treated 6 Sang Ye 30 Xian He Cao 30 After three packs the patient s sweating improved by 50 20 g of Fu Zi was added to the formula precooked 30 minutes in the patient was given six more packs after which he no longer had any sweating Case 10 Pediatric Night Sweats Female five years old The young child had night sweats for over two years She taken over 10 packs of Chinese medicine formulas but had no relief

Mu Li and Long Gu Ebook 94 Current intake The child had an aversion to eating and slightly hyperactive Her tong impulse for normal She was given and the following formula in a granules form Gui Zhi 6 Bai Shao 10 Da Zao 10 Sheng Jiang 6 Zhi Gan Cao 6 Sha Ren 6 Huang Bai salt treated 6 Sang Ye 10 Xian He Cao 10 After taking three packs of the formula her symptoms showed great improvement After three more packs her symptoms were completely resolved Case 11 Fever Surname Lu gender not specified 80 years old The patient has had a fever due to a lung infection and was in the hospital for 40 days She took antibiotics in antiviral medications and antifungals but her symptoms didn t improve Current intake The patient was lying on the bed in the hospital she was underweight and her complexion lacked vigor Her chest felt cold and she was perspiring profusely night and day the same Her mouth was dry she had a cough with sticky phlegm When she drink water she would begin hacking and coughing Tongue darkish and pale with scant moisture and in the middle of the tongue was a thin yellow coating that also lacked moisture Pulse wiry thready and rapid Nothing could be felt with heavy pressure on the chi position

Mu Li and Long Gu Ebook 95 Dx Dysregulation of yin and yang with phlegm heat accumulation in the Lung damaging Gui Zhi 12 Bai Shao 20 Da Zao 10 Sheng Jiang 6 Zhi Gan Cao 6 Long Gu 40 Mu Li 40 Sha Ren 6 Huang Bai salt treated 6 Sang Ye 30 Xian He Cao 36 Dang Gui 10 Fu Ling 20 After three packs of the formula of the patient came back in a wheelchair The fever had abated and perspiration was normal All her other symptoms had greatly improved 10 grams of Zhe Bei Mu had been added to the previous formula The patient took three more packs 1 Pathomechanism Nei Jing Yang added into yin is called sweat One explanation is thatches means yang steams the yin fluids Another explanation is that the cun pulse is more vigorous than the chi pulse but these interpretations shouldn t be taken to heart The Heart is sweat is more reliable 2 In the Ba Gua the trigram Li is a yin line in between two yang lines

Mu Li and Long Gu Ebook 96 Zheng Qin An says Blood has form and is stored within qi qi controls blood When Heart qi is deficient heart blood becomes exhausted The foundation of qi and blood are yin and yang The Nei Jing says In yin and yang what is essential is that yang is tight and hence stable and When yin is serene and yang is hidden the spirit essence will govern properly hence the underlying patho mechanism for spontaneous sweating and night sweats is yin and yang dysregulation yang damage affecting yin 2 Treatment method Nei Jing Carefully observe the state of yin and yang and regulate them with the goal of balancing them This means to regulate and harmonize yin and yang warm yang and boost yin 3 Formula Gui Zhi Tang is the foundation formula Gui Zhi Tang is the first formula in the Shang Han Lun The head of all formulas It s a formula that combines acrid and sweet to generate yang and sweet and sour to generate yin Ke Yun Bo said he often used this formula to treat spontaneous sweating and night sweats Add Long Gu to pacify the Hun and Mu Li to settle the Po Bie Lu says Long Gu treats sweating Ben Cao Gang Mu says it is able to astringe the healthy qi that floats outward Zhang Xi Chun said Long Gu is formed from the transformation of true yin and true yang Hence it has the ability to root yin and yang within one another and pacify this spirit and Hun so that they don t fly away The Ben Cao Qiu Zhen says that Long Gu and Mu Li have the same function After treating sweating according to the textbooks and not getting results Dr Yu started using Gui Zhi Jia Long Gu Mu Li Tang and the results immediately improved In the Shen Nong Ben Cao Jing Sang Ye is said to eliminate cold and heat with perspiration Wei Long Xiang has used Sang Ye to treat night sweats Xian He Cao can also be used to stop sweating Gan Zu Wang calls it the anabolic steroid of herbs i e strengthening Combined with Feng Sui Dan to supplement

Mu Li and Long Gu Ebook 97 earth and submerge fire Sweat blood and essence come from the same source Supplement earth and submerging fire sealing and stabilizing essence and marrow this is what will cause yin to be serene and conceal yang Gui Zhi Long Mu Feng Sui Dan Gui Zhi 15 Bai Shao 30 Da Zao 15 Sheng Jiang 10 Zhi Gan Cao 6 Long Gu 30 Mu Li 30 Sha Ren 6 Huang Bai salt treated 6 Sang Ye 30 Xian He Cao 36 In the exterior Gui Zhi Tang resolves the flesh and harmonizes ying and wei Internally it transforms qi and regulates qi and blood Note If a patient is suffering from spontaneous sweating or night sweats and they have a poor appetite bitter taste in the mouth yellow urine and a tongue that is red with a white or yellow greasy coating these are signs of Gallbladder heat attacking the stomach You should first give your patient a few packs of modified Hao Qin Qing Dan Tang before taking the Gui Zhi Long Mu Feng Sui Dan Hao Qin Qing Dan Tang Qing has Zhu Ru Ban Xia Chi Fu Ling Huang Qin Zhi Ke Chen Pi

98 Mu Li and Long Gu Ebook and Bi Yu San Hua Shi Gan Cao and Qing Dai Gui Zhi Qu Shao Yao Jia Shu Qi Mu Li Long Gu Jiu Ni Tang also called Gui Zhi Jiu Ni Tang Cinnamomi Ramulus gu zh 3 liang 9 gm Glycyrrhizae Radix preparata zh g n c o 2 liang 6 gm Zingiberis Rhizoma recens sh ng ji ng sliced 3 liang 9 gm Jujubae Fructus d z o 12 dates 4 dates Dichroae Folium sh q washed to remove fishy smell 3 liang 5 gm Ostreae Concha m l dry fried 5 liang 15 gm Fossilia Ossis Mastodi l ng g 4 liang 12 gm Method Boil Shu Qi first in 1 dou and 2 sheng of water reducing it by 2 sheng Add the other herbs and boil down to 3 sheng Strain and take 1 sheng warm Original text Line 112 in the Sh ng h n l n Discussion of Cold Damage says When in cold damage the pulse is floating and a fire method is used to force sweating as a result y ng collapses and there will be fright mania and fidgetiness whether lying or sitting gu zh q sh o y o ji sh q m l long g ji n t ng governs From Experience with Classic Formulas from Renowned Physicians collected by Liu Du Zhou Explanation The Su Wen Sheng Qi Tong Tian Lun says The Jing of the Yang Qi nourishes the spirit This is a pattern in which the Yang Qi is very deficient and the spirit looses its nourishment Turbid phlegm condenses and congeals and the spirit becomes disordered This is the reason why there is fright mania with an inability to rest and be peaceful The treatment must

99 Mu Li and Long Gu Ebook warm and open through the heart Yang cleanse phlegm transform turbidity settle fright and calm the spirit Fossilia Ossis Mastodi l ng g and Ostreae Concha m l settle the heart spirit Dichroae Folium sh q is a plant that grows in the mountains and its function resembles that of Dichroae Radix ch ng sh n It is relatively good at inducing vomiting to dispel phlegm Generally 3 5 grams are used however one will still want to dry fry it to reduce the side effect of stimulating the stomach and large intestine to induce vomiting If you do not have Dichroae Folium sh q you can substitute Dichroae Radix ch ng sh n Case 1 Disordered Spirit Dr Liu Du Zhou Mr Dong age 28 Due to an upset to Mr Dong s spirit an old disease relapsed He became agitated in his heart He would also become extremely fearful or filled with sorrow to the point of weeping His sleep was poor and he would have auditory sensory and visual hallucinations the 3 hallucinations His chest felt agitated and stuffy in a way that was difficult to bear His tongue moss was white thick and sticky His pulse was wiry and slippery This was liver Qi constraint and stasis with phlegm turbidity accumulating internally and upwardly harassing the heart palace Cinnamomi Ramulus gu zh 6 gm Coptidis Rhizoma hu ng li n 9 gmm Zingiberis Rhizoma recens sh ng ji ng sliced 9 gm Rhei Radix et Rhizoma d hu ng 9 gm Dichroae Folium sh q washed to remove fishy smell 4 gm Ostreae Concha m l dry fried 12 gm Fossilia Ossis Mastodi l ng g 12 gm Bambusae Caulis in taeniam zh r 10 gm Acori tatarinowii Rhizoma sh ch ng p 9 gm Arisaema cum Bile d n n n x ng 10 gm After 2 packages of these herbs the patient moved his bowels with diarrhea He had an immediate sense of comfort in his heart and chest I gave him the above formula again without the Rhei Radix et Rhizoma d hu ng After 3 more packages he suddenly vomited excessive

Mu Li and Long Gu Ebook 100 phlegm and spittle into a bowl The seriousness of the case decreased I finished by using Scour Out Phlegm Decoction d t n t ng with Warm Gallbladder Decoction w n d n t ng and the craziness was cured Discussion Disordered spirit is a phlegm constraint illness The tongue moss was thick and sticky and the pulses were wiry and slippery Phlegm heat harrasses the heart palace and causes the disordered spirit When it masks the clear orifices it can lead to the 3 hallucinations The treatment should proceed by scouring phlegm and clearing heat in order to open the heart orifice This is why Jiu Ni Tang was used Bambusae Caulis in taeniam zh r Arisaema cum Bile d n n n x ng Acori tatarinowii Rhizoma sh ch ng p Curcumae Radix y j n Coptidis Rhizoma hu ng li n and Rhei Radix et Rhizoma d hu ng were used and Jujubae Fructus d z o and Glycyrrhizae Radix g n c o were removed to avoid assisting damp and generating phlegm Case 2 Insanity Patient was age 26 female named Wang an air force interpreter When she was observing an electrical repair she became frightened and began to tremble and shake She was unable to sleep and had a headache poor appetite nausea and occasional phlegm sounds in her throat Every time she heard a sound she became frightened and would become pale She became agitated and would swear loosing control of herself She gradually became emaciated It took two people to support her to come for her visit Her tongue moss was white and sticky Her pulse was wiry and slippery and the cun was floating This was cold fluids chronically constrained in the interior and harassing upward The treatment principle was to warm and transform while down bearing rebellion This was a Gui Zhi Jiu Ni Tang with modifications pattern Cinnamomi Ramulus gu zhi 10 gm Zingiberis Rhizoma recens she ng jia ng 10 gm Jujubae Fructus d za o 4 dates Glycyrrhizae Radix preparata zh ga n ca o 6 gm

Mu Li and Long Gu Ebook Pinelliae Rhizoma preparatum zh b n xi 12 gm Poria f l ng 12 gm Fresh Ostreae Concha sheng mu l 15 gm Fresh Fossilia Ossis Mastodi sheng l ng gu 15 gm 101 Results After taking 3 packages of the above herbs the shaking with fear and phelgm sounds in the throat decreased I gave another 6 packages and the appetite increased and her sleep became good I gave another 10 packages and all the pathology was gone Analysis When there is cold damage with a floating pulse one should consider treating it with m hu ng t ng to promote sweating however if it is treated with a fire method which could include moxibustion fire needling fire fuming and other similar methods to force sweating it can result in major sweating and this is an erroneous treatment When there is major sweating this will result in the collapse of liquids and humors Not only will this fail to meet the objective of resolving the exterior but major sweating will result in upper vacuity causing q to overwhelm the vacuity and surge upwards This will also stimulate the interior causing the ascent of rheum which will cloud the clear orifices resulting in symptoms of fright mania and fidgetiness whether lying or sitting The suitable treatment here is with gu zh q sh o y o ji sh q m l long g ji n t ng ull Gui Zhi Qu Shao Yao Tang governs this Mu Li Ze Xie Tang Formula Constituents Equal amounts Mu Li dry fried Ze Xie Shu Qi washed in warm water to remove fishy smell Ting Li Zi dry fried Hai Zao wash salt away

Mu Li and Long Gu Ebook 102 Gua Lou Gen Tian Hua Fen Shang Lu Gen Using equal amounts of each ingredient Grind them separately and then blend them in a mortar Mix 6 9 gm of powder with rice soup and take three times a day When urination returns to normal stop taking the herbs Original Text Line 395 When there is water Qi below the waist after recovering from a major disease Mu Li Ze Xie Tang governs Discussion This formula treats water swelling below the waist with diminished righteous Qi In the clinic this is seen as lower limb or lower abdominal swelling that does not disperse The bowels and urination are inhibited A special characteristic of this presentation is a deep pulse Mu Li combined with Gua Lou Gen nourishes the Yin and clears heat vitalizes the blood and softens hardness This is aimed at a disease mechanism that arises from the Liver The other 5 ingredients attack and disinhibit evil water These are aimed at the branch which is in the 3 Jiao According to reports it treats liver cirrhosis very effectively Case 1 Water Swelling Ye Tian Shi Case History Male with a rough pulse Each time the Yang Qi moves there is Yi There are gurgling water sounds under the left rib side with water descending to the lower belly Evidently this swelling and distention is not due to the Yang pathway being inhibited This is a case of the Yin pathway excess The damp heat of water and grain have not transformed I suggested Mu Li Ze Xie Tang Mu Li Ze Xie Hua Fen Chuan Gui Zhi Mu Fu Ling Zi Hou Po He took it at noon and was cured Discussion Swelling distention with a rough pulse This appears as water fluids knotted together and dropping and descending into the lower abdomen When water knots it tends to go down

Mu Li and Long Gu Ebook 103 In this kind of case Mu Li Ze Xie Tang is used to vitalize blood disinhibit water soften hardness and scatter knotting Case 2 Suspended fluids Seeping type pleurisy Dr Li Hao Peng Master Du s older sister was more than 60 years old She had suffered from pulmonary tuberculosis for more than 10 years with repeated relapses Sometimes the condition was mild and sometimes it was serious Three weeks previously she began to feel a cutting pain under her ribs She coughed spittle and felt a drawing pain She had simultaneous chills and fever She was given the western medicines streptomycin and rimifon type anti TB drugs These all helped alleviate the condition but she still suffered from pain with cough An X Ray revealed exudative pleurisy on the right side Because there was a fear that fluids could penetrate into the pleural cavity she sought a consultation with a Chinese medical doctor Presentation Her facial color was grey She was frowning and made suffering groan sounds She had a cough and was flustered She had to support herself to breath and could not lay down When she coughs she must hold her rib sides and felt pain when she turned She dripped with a cold sweat She felt full and distended with a poor appetite She would go several days with no bowel movement Her urination was short and yellow Her tongue moss was white and dry with scanty fluids This was undoubtedly a case of Suspended Fluids type Qi knotted and fluids blocked For treatment it was appropriate to relieve edema and reduce fluids open knotting and regulate Qi I had to keep in mind that this patient was more than 60 years old with chronic consumption Her Zheng Qi was not strong and so while removing water and dispelling phlegm I also boosted Qi and vitalized blood Duan Mu Li 30 Ze Xie 15 Ting Li Zi 15 Shang Lu Gen 6 Gua Lou Gen 30 Hai Zao 15

Mu Li and Long Gu Ebook Hong Shen 10 Dang Gui 10 Huang Qi 15 1 package day divided into 2 doses 5 packages 104 Second visit In the beginning when taking the herbs she felt agitated and oppressive heat with the desire to vomit When she took the second package she heard gurgling noises and then had watery diarrhea with phlegm several times Immediately she felt comfortable in her chest and breath I continued with 20 more packages of this formula and her presentation resolved The X Ray showed that the water was completely cleared I continued with 8 precious and 4 gentleman to consolidate the result From He Nan Zhong Yi 1989 4 14 Discussion When evil water knots in the chest and rib side one treats by opening the knotting and scattering fluids using modified Mu Li Ze Xie San The effect is good According to Li Hao Peng s experience when there are alternating fever and chills one can combine Xiao Chai Hu Tang When there is a deficiency presentation he combines Ren Shen and Huang Qi When there is extreme rib side pain he combines Si Ni San When there is water knotting chronically with Qi deficiency and blood stasis He removes out Shu Qi and decrease Shang Lu while adding Ren Shen Hong Hua Tao Ren and Dan Shen When there is Yin damage Yi Wei Tang is combined When there is simultaneous Yang deficiency Fu Zi and Rou Gui will be added