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Unpacking Gui Zhi Tang● Huang Huang’s Notes on Gui Zhi Tang● Case Studies from Renowned Physicians● Gui Zhi Tang for Pregnancy and Postpartum DepressionBy Sharon Weizenbaum

1 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Zhi Tang Instructions for use Original Text Huang Huang Notes on Gui Zhi Tang Gui Zhi Tang Gui Zhi Tang pattern is made up of three categories of symptoms 6 6 7 9 9 10 Fever 13 Sweating 14 Cardiovascular illness 14 Skin problems 14 Nasal Allergies 15 Vomiting in Pregnancy 15 Modifications 15 Gui Zhi Tang Qin Bo Wei Case 16 From Experience with Classic Formulas from Renowned Physicians 17 Formula Explanation 17 Cases and Discussion 21 Case 1 Ying Wei disharmony 21 Case 2 High Fever 22 Case 3 Spontaneous Sweating 23 Case 4 One sided sweating 25 Case 5 Lack of sweat 26 Case 6 Aversion to Cold 28 Case 7 Early Wind Warmth 29 Case 8 Running Piglet 30 Case 9 Diarrhea 31 Case 10 Extreme Deficiency 31 Case 11 Reversal Pattern Urination related Dizzy Reversal 33 Case 12 Gradually Worsening Esophageal Spasm 35 Case 13 Urticaria 36 Copyright Sharon Weizenbaum 2022

2 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 14 Menstrual itch 37 Case 15 Fever during pregnancy 38 Case 16 Pediatric fright wind 39 Case 17 Pediatric frequent urination 41 Case 18 Corneal viral keratitis dendritic keratitis 42 Case 19 Ablepsia lack of sight 43 Case 20 Crohn s Disease 45 Case 21 Diarrhea 47 Case 22 Diarrhea 47 Case 23 Diarrhea 48 Case 24 Esophageal Spasm 49 Case 25 Common Cold 50 Case 26 Pediatric Persistent Fever 51 Case 27 Low Grade Fever 52 Case 28 Nausea in Pregnancy 53 Dr Xia on Gui Zhi Tang for Postpartum Depression 54 Jie Yu He Ying Tang 54 Formula Name 54 Function 55 Application 55 Formula composition 56 Clinical Application 57 Jin Gui Yao Lue s use of Gui Zhi Tang in Pregnancy 58 Original Text 60 Formula Analysis 61 Discussion 61 Case Examples 64 1 Nausea and vomiting in pregnancy 64 2 Nausea and vomiting in pregnancy 65 3 Cold back in pregnancy 66 Copyright Sharon Weizenbaum 2022

3 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted 4 Reversal surging of the Chong Qi in pregnancy 67 5 Slippery Fetus 69 6 Urinary retention in pregnancy 70 Is Yang Dan Tang Gui Zhi Tang 71 Xiao Yang Dan Tang 71 Jin Gui use of Yang Dan Tang for Postpartum Women 72 Case 1 Postpartum Ying Wei disharmony 72 Case 2 Postpartum Vomiting 74 Case 3 Postpartum Wind Cold with Simultaneous Heat 74 Case 4 Postpartum Sweating 76 Case 5 Postpartum Body Pain 78 Case 6 Post Termination External Contraction 79 Case 7 Postpartum External Contraction 81 Case 8 Postpartum External Contraction 82 Case 9 Postpartum Spontaneous Flow of Breast Milk 83 Case 10 Postpartum Lack of Breast Milk 84 Case 11 Menstrual Related Wind Rash 86 Case 12 Menstrual Itching 87 The gynecological application of Gui Zhi Tang for the stages of a woman s life 88 Unpacking Gui Zhi Tang 94 Introduction to Unpacking Gui Zhi Tang 94 Liu Du Zhou 96 Yu Guo Jun 97 Huang Huang Notes on Gan Cao 98 Gan Cao in Formulas 100 Addendum 102 Notes on Shao Yao 104 Shen Nong Ben Cao Jing 104 Huang Huang Notes 104 Principle Indications Copyright Sharon Weizenbaum 2022 104

4 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted The principle indication for Bai Shao is pain 104 Spasms of the foot 105 Abdominal pain 105 Formulas 106 Addendum 107 Notes on Rou Gui 108 Curious Uses for Rou Gui 110 Formulas that include Rou Gui 112 1 Gui Fu Tang 112 2 Kan Li Dan 112 3 Da Hui Yang Yin 112 4 Gui Fu Li Zhong Tang 113 5 Yang Ba Wei Di Huang Wan 114 Shao Yao Gan Cao Tang 114 Original Clause 115 From Cases of Renowned Physicians 115 Formula Explanation 115 Cases 116 Case 1 Restless Legs 116 Case 2 Hiccup 117 Case 3 Priapism 118 Case 4 Anal Fissure 119 Case 5 Constipation 120 Case 6 Tooth grinding 121 Other Cases from various texts 122 Case 7 Stomach pain 122 Case 8 Lower calf pain Charlie horse 123 Case 9 Yin contraction syndrome 125 From Liu Han Tang s A Record of Clinical Experience using Classical Formulas For Nerve Disorders Copyright Sharon Weizenbaum 2022 126 126

5 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted For Digestive Disorders 126 For the Vascular System 127 For the Endocrine System Disorders 127 For Urinary and Reproductive Disorders 127 For Gynecological Disorders 128 Other disorders 128 From Walking Along the River By Yu Guo Jun 129 Spastic Cough 129 Constipation 129 Kidney Stone Pain 131 Post Herpatic Neuralgia 131 Gan Cao Gan Jiang Tang 132 Original text Clause 29 132 Formula explanation 133 Cases 133 Case 1 Nose bleed 133 Case 2 vomiting blood 135 Case 3 Taxation Lin 137 Case 4 bed wetting 139 Case 5 diarrhea 140 Case 6 Lung Atrophy 142 Case 7 Dispersion Thirst 143 Case 8 Dizziness 144 Case 9 Stomach Duct Pain 145 Gui Zhi Gan Cao Tang 146 Formula Explanation 147 Cases 147 Case One Heart Palpitations and Pain 147 Case 2 Dizziness 148 Case 3 Insanity 149 Copyright Sharon Weizenbaum 2022

6 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 4 Deafness 151 Case 5 Flustered with Fright Palpitations 152 Other Cases 153 Gui Zhi Tang Gui Zhi 3 liang 9 gm Shao Yao 3 liang 9 gm Zhi Gan Cao 2 liang 6 gm Sheng Jiang 3 liang 9 gm Da Zao 12 dates 3 dates Feng says 20 gm Instructions for use Break the first three ingredients into pieces add to the rest of the ingredients in a pot and decoct in 7 Sheng of water Reduce to 3 Sheng and strain Take 1 Sheng at a moderate temperature followed by 1 Sheng of hot thin gruel to reinforce the effect of the decoction Cover the body with a blanket for a time until the whole body is damp from light sweat One cannot allow the sweat to flow like water since the disease will not be dispelled If one dose causes sweating and the disease is diminished stop taking the doses One need not finish the whole packet If sweating is absent take another dose according to the previous method If sweating is again absent reduce the time between doses finishing three doses in half a day If the disease is severe take it throughout the whole day and continually observe the patient After finishing one packet if the disease signs are still showing take it again If sweating is absent one can take up to 2 3 packets Copyright Sharon Weizenbaum 2022

7 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Avoid raw cold sticky slimy foods and meat noodles the five pungents alcohol milk products and foods with smell funny or are spoiled Original Text 12 In Tai Yang Zhong Feng the Yang floats and the Yin is flaccid When Yang floats there is spontaneous fever and when Yin is flaccid there is sweating The patient huddles up due to their aversion to cold and they have aversion to wind as if their body has been splashed with cold water gentle fever as if their body is covered with feathers sneezing or hoarse breathing in the nose and dry retching Gui Zhi Tang governs 13 In Tai Yang disease when there is headache fever sweating and aversion to wind Gui Zhi Tang governs 15 In Tai Yang disease after being purged the patient feels Qi surging one may use Gui Zhi Tang according to the methods mentioned previously If Qi surging is absent Gui Zhi Tang cannot be prescribed 24 After taking the first dose of Gui Zhi Tang Tai Yang disease is still not resolved and rather there is vexation The recovery can be brought about by first needling Feng Chi and then Feng Fu and then continuing Gui Zhi Tang 25 Profuse sweating occurs after taking Gui Zhi Tang If the pulses are flooding and big use Gui Zhi Tang the same way If the patient presents with malaria like symptoms and signs which take place twice a day the disease would be resolved after sweating Gui Zhi Er Ma Huang Yi Tang is indicated 53 The disease with frequent spontaneous sweating indicates that the Ying Qi is in harmony When the Ying Qi is harmonious yet the exterior is not in harmony then they are not harmonious with each other Since Ying qi circulates toward the vessels while the Wei circulates toward the outside recovery will be achieved with harmonizing the Ying and Wei through sweating Gui Zhi Tang governs Copyright Sharon Weizenbaum 2022

8 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted 54 Patients whose Zang organs have no other illness periodically have fever and spontaneous sweating without recovery This means that the defensive Qi is not harmonious The recovery will be brought about by the promotion of sweating prior to the onset of fever and spontaneous sweating Gui Zhi Tang is appropriate 57 Cold damage has been resolved by sweating However after half a day there is vexation again and floating rapid pulses so one might promote sweating again Gui Zhi Tang governs 95 In Yang disease when there is fever and sweating it is caused by weakness of the Ying Qi and unreasonable strength of Wei Qi In order to eliminate pathological wind Gui Zhi Tang governs 234 In Yang Ming illness when there is a slow pulse profuse sweating and slight aversion to cold these symptoms indicate that the exterior syndrome has not resolved Sweating can be promoted and Gui Zhi Tang may be appropriate 276 In Tai Yin illness when there is a floating pulse the promotion of sweating can be employed and Gui Zhi Tang is appropriate 387 When vomiting and diarrhea have stopped but mild pain continues one should consider relieving the exterior condition Gui Zhi Tang is indicated to slightly harmonize the exterior Jin Gui Yao Lue 21 Postpartum wind persisting over 10 days with mild headache aversion to cold occasional heat sensations oppression below the heart dry retching sweating despite its long duration the Yang Dan Tang pattern persists Jin Gui Yao Lue Among women with normal pulses that appear slightly weak at the Yin position along with thirst inability to eat an absence of chills or fever this indicates a disease of pregnancy Gui Zhi Tang governs As a rule this pattern should appear within sixty days of conception However with reverse treatment Copyright Sharon Weizenbaum 2022

9 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted vomiting and diarrhea will appear within another month In this case there will be termination Huang Huang Notes on Gui Zhi Tang1 The uses of Gui Zhi Tang are quite broad It is one of the first formulas one must learn and know To understand Gui Zhi Tang one must understand the flavors of the herbs Gui Zhi is a dry twig primarily from Guan Dong and Guan Xi It has a special fragrance and is sweet and pungent hot The uses of Gui Zhi are quite broad Of the 113 formulas in the Shang Han Lun 44 include Gui Zhi Clinically Gui Zhi is used for disease patterns such as fever sweating body pain multiple joint pain headache abdominal pain diarrhea cold limbs dizziness with dry heat nocturnal emission palpitations knotted pulse panting shortness of breath edema blood stasis and spirit disorders Gui Zhi Tang Gui Zhi Tang is the first formula mentioned in the Shang Han Lun It is said that it was invented by an high official in the Shang Dynasty In the past high officials were great chefs They summarized their experience in utilizing the pharmacopeia and they use cooking technology to create many kinds of soup formulas Gui Zhi Tang was a useful pungent and fragrant formula as well as a regulating formula We don t know how many years this formula has been used nor how many people have used it At any rate it is a classic formula that has had a long history of experience It is a crowning formula in Chinese medicine and there is not a study of medicine that does not include it Gui Zhi and the Gui Zhi Tang pattern are the same Gui Zhi Tang has a particularly large scope of use There has been a struggle throughout Chinese people s history between this scope of use and diseases There are not any diseases nor any one symptom nor any western medical science disease concept to compare the use of Gui Zhi Tang with The 1 From lecture notes translated by Sharon Weizenbaum for a 2008 course with Huang Huang at White Pine Institute Amherst MA 01002 Copyright Sharon Weizenbaum 2022

10 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted concepts related to Gui Zhi Tang are purely Chinese medical concepts In those days the Shang Han Lun author Zhang Zhong Jing called it Gui Zhi Tang Pattern This book continues to use the same method of naming this Gui Zhi Tang will be the formula to use for Gui Zhi Tang pattern regardless of the disease Chinese medicine has a saying which is according to the pattern determine the treatment This saying points to the principle of coordinating the formula with the pattern Chinese medicine looks to see if the formula and pattern correspond and does not pay attention to what kind of disease the patient complains of This is because the disease name does not have a definite pattern and relatively fixed It is the essence of traditional Chinese medicine to know how to cope with a constantly changing situation The clinical use of Gui Zhi Tang reflects this principle Gui Zhi Tang pattern is made up of three categories of symptoms 1 Spontaneous sweating fear of wind fever or awareness of a heat feeling 2 Upward surging feeling palpitations muscles and flesh are spastic and tense 3 Pulse is floating or weak or moderate or fast or large without strength Tongue is pale red or dark pale with thin white moss Spontaneous sweating refers to spontaneous sweating even when the environment is not hot nor has the patient taken drugs to induce sweat Fearing wind refers to wind and cold allergy When the patient is in a warm room or adds more clothes this is resolved Fever can refer to the body temperature going up or to the subjective feeling of heat by the patient Of the above three types of symptoms if only one manifests you cannot say it is a Gui Zhi Tang pattern But if all three manifest at the same time the correspondence to the Gui Zhi Tang pattern is very significant The symptoms in number 2 above all relate to neurotic weakness of sexual function A feeling of up surging includes dizziness feeling feverish red face insomnia lots of dreams Copyright Sharon Weizenbaum 2022

11 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted and an up surging feeling in the Chest and abdomen There may be throbbing in the navel area and the muscles are spastic and tight with spastic type stomach and intestinal pain The rectus abdominus are tight and the muscles of the four limbs are spastic and painful The pulse floating refers to feeling the pulse beat clearly with just a light touch Clinically you will see this in thin patients The Gui Zhi Tang pulse pattern is not just floating though It is often simultaneously moderate or moderate and fast or weak so that when you press it there is little or no strength Sometime you might see a weak fast pulse From a Chinese medical perspective Gui Zhi Tang pattern is the manifestation of a typical exterior deficiency pattern There is a relationship between the exterior and interior and there is a relationship between excess and deficiency Exterior and interior refer to the location of the illness When the disease is in the outer form of the body this is considered the Biao The outer form includes the sweat glands the skin the subcutaneous tissue the joints and upper respiratory tract Symptoms of fever fear of wind and cold not sweating or sweating profusely body pain floating pulse and thin tongue moss are all symptoms of the pathology being located on the exterior When the disease is located in the interior there are pathological changes in the digestion the heart blood vessels the internal secretions the blood and the central nervous system Symptoms such as constipation diarrhea listlessness or agitation body heat with thirst or cold limbs with fear of cold deep pulse thick tongue moss etc are all symptoms of illness located in the interior Gui Zhi Tang pattern is an exterior pattern Excess and deficiency refer to the strength of the illness In other words we must analyze the strength of the body s resistance and ability to balance and regulate In regard to the whole body deficiency refers to Qi deficiency in which the body s resistance is low and the physiological function has decreased Excess refers to the evil Qi flourishing and the strength of the disease toxin is flourishing and the strength of the body s resistance is strong Yet this is only part of the story With deficiency there is a weak hollowness which allows the secretions to go out and restraint to be insufficient With excess there is Copyright Sharon Weizenbaum 2022

12 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted substantiality with an excess of ability to restrain so there are not enough secretions going out This is similar to the saying that if the great gate is open the people can go in and out by themselves This is how it is with deficiency When the great door is shot tightly the wind blows but cannot enter and the people cannot leave This is how it is with excess We can see from this that the person s body has many such gates such as the po gate cardiac gate or anus Under normal physiological conditions these gates are sometimes open and sometimes closed When there is illness the opening and closing may lose its regulation or a gate may become steadily closed or steadily open Being open is a state of deficiency and being closed is a state of excess If the Po gate is consistently open then there will be lots of sweating constant sweating or spontaneous sweating This is deficiency on the exterior When the Po gate is closed there is no sweat aversion to cold dry skin and this is excess on the exterior If the anus is open then there will be diarrhea that is watery and clear and prolapsed anus This is interior deficiency If the anus is closed then there will be constipation or stool only every few days and abdominal pain that resists touch This is excess on the interior Gui Zhi Tang pattern includes aversion to wind sweating and fever and is therefore an exterior deficiency pattern Analyzed from a single substance pharmodyamics perspective as well as from a clinical practice perspective Gui Zhi Tang has the following applications It is a febrifuge an anti allergen anti inflammatory analgesic sedative and stomach stimulant In particular Gui Zhi Tang has been shown to not have a single part of the body it treats On the contrary it regulates the nervous system the vascular system and the immune system and all of these relate to the whole body function Chinese medicine talks about regulating the Ying and the Wei In terms of Ying it nourishes the Yin Qi of the minute essences of the whole body In terms of the Wei it is the body s protection and Yang Qi When Ying and Wei are harmonized the body is strong and healthy and it is not easy to get sick and sweating occurs in a normal way The opposite of this manifests with spontaneous sweating night sweating aversion to wind fear of cold susceptibility to getting colds and other illnesses We can see that the two Qi Ying and Wei are equivalent to the body s Copyright Sharon Weizenbaum 2022

13 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted balancing and defensive systems They serve an extremely important function in relation to keeping the body healthy Now we can see that the function of Gui Zhi Tang to harmonize and regulate the Ying and the Wei is very important too Therefore Gui Zhi Tang is considered a regulating formula and it s application in every department is extensive Fever The Shang Han Lun recorded in writing the following In Tai Yang illness there is headache fever sweating fear of wind and Gui Zhi Tang is the principle formula What one sees as a Gui Zhi Tang pattern in the clinic is feverish type illness Whether the fever is from an infectious non infectuous or is a long term fever from an unknown cause whether it is a low grade or high grade fever If there is a Gui Zhi Tang presentation you can use this formula The well known doctor from the past Yue Mei Zhong treated a 14 year old girl with fever she had had for over half a year Her temperature would go up to 40 C She had taken many formulas without any effect She had a fever with aversion to wind with sweating sometimes Her pulse was floating and moderate She had thirst but didn t drink a lot Her stool and urination were regular and the tongue was pale and yellowish He used Gui Zhi Tang and after 3 packages was cured A Dr Lin saw 68 cases of fever of unkown origin 5 cases used antibiotics and anti fever drugs without effect He used Gui Zhi Tang and there was a cure Sweating Abnormal sweating is a common symptom in the Gui Zhi Tang presentation It says in the Shang Han Lun that the patient is without disease in the Zang and there is unresolved fever with spontaneous sweat use Gui Zhi Tang Gui Zhi Tang can treat spontaneous sweat night sweats or localized sweating such as sweating from the head or yellow sweat It is effective for autonomic nervous system disorders and neurasthenia Copyright Sharon Weizenbaum 2022

14 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Cardiovascular illness The Gui Zhi Tang pattern often manifests in cardiovascular illness such as myocarditis hypertensive myocardial illness with palpitations paroxsysmal tachycardia and absence of pulse There are many types of treatment methods for these illnesses so it is important to pay attention to the distinguishing charactaristics when choosing Gui Zhi Tang In addition to the aroused heart symptoms you many also see such symptoms as spontaneous sweat aversion to wind poor sleep and many dreams with a dark pale tongue In my own experience the patient s body type will also be a Gui Zhi body type Use it with caution for patients who are red and plump or yellow and pulmp Skin problems The Gui Zhi Tang pattern also often manifests with skin issues during the course of the illness A Dr gu treated many types of erythema eczema urticaria puritis winter skin inflammation chilblain and tinnea As long as the tongue has a thin white moss and the pulse is floating moderate or floating and slippery you can use this formula and it will be effective I have similar experience but in addition to the choices for the appropriate pattern above of tongue and pulse I also look to see if the body type is thin with a white complexion if the patient catches cold and sweats easily when they encounter wind and cold There are many types of skin illness and the pathology is complex In clinical practice Gui Zhi Tang is usually with added flavors or combined with other formulas Nasal Allergies It is written in the Shang Han Lun that the Gui Zhi Tang pattern includes a symptom named nasal ming ringing sound Clinical what is seen is aversion to wind spontaneous sweating with the patient having sensitive type body Many of these patients have allergic typ nasal inflammation or allergic asthma I use Gui Zhi Tang and add Xi Xin or Fu Zi to treat this pattern when there is clear nasal mucous or watery phlegm with good effect There is a report using this formula with Ting Li Zi and Chan Tui to treat 20 cases Copyright Sharon Weizenbaum 2022

15 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted of allergic type sinusitis Except for 2 cases for which the results were unclear and 4 cases who experienced a relapse 14 cases had a complete cure Vomiting in Pregnancy There is a report of using Gui Zhi Tang to treat vomiting in pregnancy There were 64 patients treated with good results In 54 cases Gui Zhi Tang was used on it s own while in the remaining cases Ren Shen Ban Xia and Gan Jiang were added Another report also showed good results in which 3 cases showed improvement and 7 cases were cured Many pregnant women with morning sickness also have an aversion to wind and dry retching This is similar to the Shang Han Lun symptoms of spontaneous sweating aversion to cold and wind feverishness nose ming and dry retching If the tongue body is red with yellow sticky moss Gui Zhi Tang should not be used Modifications There are many added flavors for Gui Zhi Tang Fu Zi is added to become Gui Zhi Fu Zi Tang to treat severe joint pain with a clammy feeling Hou Po and Xing Ren are added to create Gui Zhi Jia Hou Po Xing Zi Tang This treats Gui Zhi Tang pattern with Chest fullness and abdominal distention cough and panting with lots of phlegm Da Huang is added to become Gui Zhi Jia Da Huang Tang to treat the Gui Zhi Tang body type with constipation Huang Qi is added to create Gui Zhi Jia Huang Qi Tang to treat spontaneous sweat night sweats yellow sweat and superficial edema and inhibited urine Ren Shen is added to create Xin Jia Tang This treats profuse sweat with heart palpitations dizziness and poor appetite Ge Gen is added becoming Gui Zhi Jia Ge Gen Tang to treat the Gui Zhi body type with restriction at the back of the neck or diarrhea We can see that the application of Gui Zhi Tang is quite broad According to our predecessors clinical application of Gui Zhi Tang after taking it is good to drink hot gruel and get under a quilt to create a sweat This supports the strength of the herbs One should avoid eating raw or cold foods greasy foods and foods that are hard to Copyright Sharon Weizenbaum 2022

16 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted digest In addition for plump people or people with fever fear of cold but no sweat or people with fever agitation thirst with drinking a red tongue that is dry or with a yellow sticky moss one should avoid this formula or use it very cautiously Gui Zhi Tang Qin Bo Wei Case2 Mr Zhang was 67 years old He frequently suffered from colds and flu In January and February it was incessant His symptoms were stuffy nose cough and cough with phlegm His head and face sweated and with a slight cold he felt weary He took Yu Ping Feng San with no apparent effect Treatment method After checking Mr Zhang I gave him Gui Zhi Tang with Huang Qi After that he felt that the strength of his spirit essence had increased All of his pathology gradually resolved and he no longer had symptoms of a cold Discussion The formulas this person took before and after seeing me both included Huang Qi but the results were not the same Yu Ping Feng San treats deficient patients who receive an evil when the evil is unresolved It has the purpose of strengthening the Qi in order to expel the evil Fang Feng and Huang Qi are generally considered opposite yet empowering of each other If you add Fang Feng s dispelling quality with Huang Qi you don t have to worry about consolidating the evil If you add Huang Qi s strengthening quality to Fang Feng you don t have to worry about overly dispersing the exterior Within supplementation there is scattering and with scattering there is supplementation This is not the same as supporting the correct and consolidating the exterior Because of this if the root is without external evil the frequent use of Yu Ping Feng San can have the contrary effect of helping the evil make a sneak attack 2 From A Qin Bowei Anthology translated by Charles Chace and Zhang Ting Liang Paradigm Publications 1996 pg 183 Copyright Sharon Weizenbaum 2022

17 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted From Experience with Classic Formulas from Renowned Physicians3 Formula Explanation This formula is used for a pattern in which there is lack of harmony between the Ying and Wei The Qi and blood the Yin and Yang and the Exterior and Interior The principle symptoms are sweating aversion to wind and cold and a weak pulse Gui Zhi Tang is used to regulate and harmonize the Ying and Wei and Yin and Yang It opens through to connect the exterior with the interior and the upper with the lower The special characteristics of it are 1 It regulates and harmonizes the Ying and Wei by both generating and stopping sweat Because in the Gui Zhi Tang pattern the Ying is weak and the Wei is strong the Wei Qi is not in a harmonious relationship with the flourishing Qi Ying The Ying Yin is weak on the interior and it is of no use to the Wei Yang This is the so named lack of harmony Because there is a loss of the functions to warm the muscle layer fill the skin fertilize the straie of the flesh and govern the opening and closing there are the constant symptoms of a moderate and weak pulse sweating and aversion to cold Gui Zhi Tang has the special ability to regulate and harmonize the Ying and Wei In the formula there is Gui Zhi which is pungent and warm It opens through the Yang and benefits the Wei Shao Yao is sour and cold It boosts the Yin and contains the Ying When the Gui is combined with the sourness of Shao it is not overly scattering When Shao is combined with the pungent quality of Gui the Yin does not congeal Sheng Jiang is pungent and scattering It assists the Gui to move to the exterior Da Zao is sweet and moderate It assists the Ying to move toward the interior Gan Cao is sweet and balanced For the Wei it is warm and for the Ying it is nourishing It is a regulating and harmonizing herb This formula uses sour and pungent together Cold and 3 Sha ng Ha n Mi ng Yi Ya n A n Ji ng Xu an Selected Cases from Famous Physicians in the Shang Han Tradition Ed Che nMi ng Zha ngYi n She ng Xue Yua n Publishing Company Be iji ng China 1998 Copyright Sharon Weizenbaum 2022

18 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted warm are unified Force is tempered with mercy This is the meaning of inducing sweat while containing it There is the function of regulating the Wei within the function of harmonizing the Ying When the Yin and Wei are harmonized as one the muscles and pores are resolved and disinhibited The external evil follows the sweat and is resolved The sweat going out creates harmony and so it stops The Tang Ye Ben Cao explained it like this The Gui Zhi method induces sweat It does so by regulating the Ying Qi which causes the Wei Qi to spontaneously harmonize The wind Qi is not contained and so it is resolved with the sweat Inevitably Gui Zhi is able to open the pores to induce a sweat When there is abundant sweating use Gui Zhi in order to regulate and harmonize the Ying and Wei The evil will leave with the sweat and the sweating will stop In this way Gui Zhi is able to stop sweat 2 Gui Zhi Tang is also able to regulate and harmonize Yin and Yang and resolve the exterior while treating the interior The Lei Jing points out Entering the body is none other than the exterior and interior The exterior and interior is no more than Yin and Yang Yin and Yang are Ying and Wei and Ying and Wei are actually Qi and blood Regardless of whether it is an exterior pattern or an interior pattern it all is a result of unregulated Yin and Yang The treatment is inevitably to carefully observe the regulation of Yin and Yang so they can be balanced again Gui Zhi Tang regulates and harmonizes the Ying and Wei The foundation of this is the regulation and attention to Yin and Yang Gui Zhi Tang contains Gui Zhi Gan Cao Tang In this formula pungent and sweet transform the Yang It also contains Shao Yao Gan Cao Tang in which sour and sweet transform the Yin When Yin and Yang are harmonized the exterior and interior are also harmonized Therefore Gui Zhi Tang not only treats contraction of and exterior evil it also treats miscellaneous illnesses It is as Xu Ling Tai said This soup treats the exterior pattern by resolving the muscles and harmonizing the Ying and Wei It treats the interior pattern by transforming Qi and regulating Yin and Yang Copyright Sharon Weizenbaum 2022

19 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted 3 Gui Zhi Tang regulates the spleen and stomach It attends to and protects the root of the post heaven Within the formula there is Gui Jiang Zao and Cao which are all food ingredients They fortify the spleen and open the stomach effectively The spleen and stomach are the root of the post heaven They are the source of generation and transformation By regulating the spleen and stomach Gui Zhi Tang achieves the goal of regulating Ying and Wei as well as the Yin and Yang It is really as Zhang Xu Gu said This formula establishes a method that begins in the spleen and stomach and goes to the Rong Wei making a circuit around the whole body to blend the exterior and interior regulate Yin and Yang and harmonize Qi and blood This is why it is not only for exterior contraction It is also a method that can also treat interior damage Professor Liu Du Zhou pointed out that the Shang Han Lun has two prerequisites The first is to harmonize Yin and Yang and the second is to protect the stomach Qi to preserve the fluids These to prerequisites are both contained in Gui Zhi Tang One can see that Zhang Zhong Jing placed this formula at the head of the formulas for the masses It is worthy of Ke Yun Bo s appellation that this is the Chief formula for the masses The use of this formula in the clinic is very broad It is not only used for Zhong Feng Shang Han and miscellaneous illnesses It can be used for any problem in which there is lack of harmony of the Ying and Wei and Yin and Yang where there is sweating aversion to wind and cold and a weak pulse When using it keep in mind the following points 1 Keep the dosage ratio of Gui Zhi and Bai Shao the same Changing the amounts of either of them changes the treatment parameters 2 If you are using Gui Zhi Tang to induce a sweat you must give hot gruel in order to nourish the source of the sweat and to prevent damage 3 When inducing sweat you do not want it to pour out A very slight sweat is good Copyright Sharon Weizenbaum 2022

20 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted 4 It is contraindicated to use Gui Zhi Tang when there is an exterior excess pattern or a hot disease Cases and Discussion Case 1 Ying Wei disharmony Dr Liu Du Zhou Ms Li was age 53 This patient had suffered from paroxysmal fever with sweating for more than a year Every day she had episode 2 3 times a day A previous doctor had given her herbs to treat fever from Yin deficiency but there was no effect after 20 packages Inquiry revealed that that her eating and drinking were normal as were her bowels and urination Observation revealed that her tongue was pale with a thin white moss Palpation revealed that the pulse was moderate and soft and without strength This was differentiated as a Ying and Wei disharmony in which the Wei was not protecting the Ying The treatment principle was to harmonize the Ying and Wei and Yin and Yang The method uses diaphoresis was used to stop sweating Gui Zhi 9 gm Bai Shao 9 gm Sheng Jiang 9 gm Zhi Gan Cao 6 gm Da Zao 12 dates Copyright Sharon Weizenbaum 2022

21 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted I gave two packages with a hot thin gruel and had her put a cover on She sweat slightly and the illness was gone From 1996 3 Discussion When there is a case of fever and sweating in which the tongue pale as opposed to red the tongue moss is white rather than sparse and the pulse is moderate rather than thin this is not a case of Yin deficiency heat It is a lack of harmony of the Ying and Wei The Ying and Wei are actually the body s Yin and Yang These must be seen as one and not separated When Ying and Wei are harmonious Yin and Yang are coordinated Wei must be consolidated and Ying protected If Ying and Wei are not harmonious Yin and Yang go contrary to their mutuality When the Ying Yin is not helping the Wei Yang there will be fever When the Wei Yang is not consolidating the Ying Yin there is then sweating When Gui Zhi Tang is used there will be a sweat and then a cure Case 2 High Fever Dr Yue Mei Zhong Ms Zhang was age 15 She had suffered from a fever for more than half a year Her temperature went as high as 40 degrees C She had taken many herbs without effect In the morning although she was thirsty she did not want to drink abundant amounts of fluid Her bowels and urination were regulated Her tongue was pale with yellow moss She was hot and had an aversion to wind Her pulse was floating and moderate and sometimes she sweat This was wind strike in which the Ying and Wei were not harmonized I gave Gui Zhi Tang according to the method and there was a cure From 1989 6 Copyright Sharon Weizenbaum 2022

22 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Discussion Although the fever was high in this case there was no thirst for abundant liquids and the bowels and urination were normal This was not an interior pattern There was an aversion to wind and sweating with a floating moderate pulse Thus it was an exterior pattern Gui Zhi Tang benefits the Ying and regulates the Wei and so the illness was cured Case 3 Spontaneous Sweating Dr Liu Xiao Xuan The patient was named Lin and he was a youthful fisherman His body was healthy and strong In the summer one afternoon he sweat into his clothing and did not dry himself He dove into the sea to catch fish When he returned home the sweating was profuse From then on he had frequent spontaneous sweating winter and summer day and night He had gone for many consultations and treatments in order to consolidate the Wei Yang Yu Ping Feng San was used with Long Gu Mu Li and Ma Huang Gen Afterwards Gui Zhi Tang with Huang Qi was also used and he slightly improved but the illness returned When he went to a different hospital they suspected tuberculosis and he underwent an X ray This revealed that his heart and lung were normal Another year past and he became weakened The skin of his body became pale white and his pores increased in size as he sweat When he sweat it could be seen by the naked eye Though he sweat a lot he was not thirsty however his urination amount decreased He sweat in the afternoon and it became worse in the evening while in the mornings it stopped For a little while before he got out of bed there was no sweating He noticed that his legs were feeling slightly numb and he was dizzy His pulse was floating and moderate and was without strength when pressed heavily For treatment it was appropriate to slightly induce sweat while regulating the Ying and Wei Gui Zhi Shao 9 gm Hang Bai Shao 9 gm Copyright Sharon Weizenbaum 2022

23 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Sheng Jiang 9 gm Zhi Gan Cao 3 gm Da Zao 7 dates Instructions Boil 6 minutes in one bowl of water Drink it down in the morning upon waking Wait a bit and then take a hot bowl of gruel This will benefit the strength of the herbs Stay in bed for half and hour preventing any wind from disturbing After these herbs his whole body became warm and his limbs felt comfortable The sweating stopped I gave the original formula with 15 gm of Huang Qi with the same instructions but without the gruel I gave him two more packages and this obtained the desired result After this he gradually became stronger and after 7 years had no more sweating From 1964 5 35 Discussion This illness arose because the patient s pores were loose Water damp flowed directly into the space of the Ying and Wei The Ying and Wei are in charge of opening and closing They were unable to function this way and so the pores opened wide and could not contain This is why there was ceaseless sweating Although this illness was prolonged the pattern had not changed Fortunately we know that if there is profuse sweating but no thirst and the pulse is floating and moderate the Zang Qi is not damaged The illness was still at the Tai Yang Ying and Wei space This goes along with the saying when one has frequent spontaneous sweating this means that the Wei is not harmonized with the Ying Gui Zhi Tang is used for recurring sweating When the Ying and Wei harmonize there is a cure Case 4 One sided sweating Dr Liu Du Zhou Copyright Sharon Weizenbaum 2022

24 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Mr Sun age 39 This patient had spontaneous sweating on the left side of his body while the right side of his body had no sweating at all The demarcation line was very clear Otherwise he did not feel unwell Hi pulse was moderate and slightly floating His tongue moss was thin and white This was a lack of harmony of the left and right Yin and Yang and Qi and blood One should harmonize the Yin and Yang This will harmonize the Qi and blood and there will be a cure Gui Zhi Tang is used Gui Zhi 9 gm Bai Shao 9 gm Sheng Jiang 9 gm Zhi Gan Cao 6 gm Da Zao 12 dates After 3 packages taken with hot gruel he sweat slightly and was cured From 1993 2 Discussion The Su Wen chapter on Yin and Yang states The left and right are the avenues of Yin and Yang Ying and Wei Yin and Yang all move in circles throughout the whole body circling again and again In this case there was sweating on one side of the body The means that the Ying and Wei were not harmonized This is a case presentation in which the Yin and Yang were not regulated If treatment does not happen in a timely way the Ying and Wei go in opposite directions and the Yin and Yang are not safeguarded This probably explains the hemiplegia pattern The meaning of this is explained in the Su Wen says sweating on one side of the body leads to hemiplegia This illness often arises due to exposure to wind and cold Gui Zhi Tang will dispel wind resolve the muscles and allow Yin and Yang to flow around their cycle as they should This is the Copyright Sharon Weizenbaum 2022

25 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted correct treatment method as it corresponds to the presentation Therefore after 3 packages there was a cure Case 5 Lack of sweat Dr Sun Bai Shan This patient is named Lu and he was 9 years old He came for a visit on July 5 1985 His mother reported that since childhood every summer when he sweat he broke out in a red skin rash over his whole body It was dry and itchy so he scratched it often so that there were bloody scabs He suffered greatly and it was difficult to endure He had visited the local hospital where he was diagnosed with an autonomic nerve dysfunction and given Oryzanol This was not effective Diagnosis His whole body was red and dry There were stripes of bloody scab lines on his limbs chest and abdomen His respiration was rough and he was agitated His mouth and nose were dry His tongue was pale red with a thin white moss and his pulse was floating and rapid Although this appeared as heat the determination of etiology was not internal excess heat Rather this was lack of regulation of the Ying and Wei Sweating did not function to drain and so the pores needed to be opened For this I used Gui Zhi Tang Gui Zhi 5g Bai Shao 5g Gan Cao 5g Sheng Jiang 3 slices Da Zao 5 dates 5 packages decocted in water Copyright Sharon Weizenbaum 2022

26 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted I summarize the results after taking the herbs below The boy sweat and compared to before his skin felt comfortable and softer Because drinking the decoction was difficult for children I switched to giving him the formula in powder form I ground up the Gui Zhi Bai Shao and Gan Cao into powder and put them in gelatin capsules He took 10 grams twice a day He drank this down with a liquid made from decocted Sheng Jiang and Da Zao He took this for 20 days His whole body was able to issue sweat and the pathology was all dispersed He was like a normal person A follow up 3 months later showed no relapse 1989 5 45 Discussion In this case the lack of sweating had occurred since childhood and yet there is no history of externally contracted wind cold or floating tight pulse So we knew that this was no stagnation of the Ying and Wei on the exterior wind cold excess pattern Rather this was a Moistness weak Protective strong Gui Zhi Tang presentation The Ying Qi was internally weak and was not able to aide the Protective Yang This caused the protective Yang to lack Ying and stagnate in the sweat pores This externally strong protective qi constrained in the pores gave rise to the red itchy skin that even went so far as to leave bloody scabs cause agitation and a floating rapid pulse All of these symptoms appear as heat However this was not the same as a patient with vexation thirst with a desire to drink red urine or knotted bowel in which you would use bitter cold herbs This was a decline of the Ying Wei One must avoid using Ma Huang Tang to open the pores because it will damage the Ying and Wei Gui Zhi Tang is the only thing that is suitable to promote sweating and resolve the flesh It will benefit the Ying and free the Wei mutually benefiting both the Ying and Wei so that they can perform their functions When sweating issues the flesh is disinhibited and the vexatious heat is spontaneously dispelled In truth Gui Zhi Tang s function of inducing sweat resides in its ability to resolve the flesh and regulate and harmonize the Ying and Wei Copyright Sharon Weizenbaum 2022

27 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 6 Aversion to Cold Dr Zhu Zhan Yu Mr Luo age 50 came for a consultation in August of 1971 It was during the summer heat but he still wore thick padded clothing He had extreme aversion to cold He constantly sweat and the more he sweat the colder he became When he took off his padded coat he became cold to the bone and clammy Although it was during the heat of the summer he did not dare take off his coat He was suffering deeply This person did not eat much and was weak I diagnosed Qi deficiency and Ying and Wei not harmonized I treated him with Gui Zhi Tang and gave him 5 packages He came back after 5 days He was already no longer afraid of wind He even rode is bicycle to the appointment He had taken off his padded coat and the sweating decreased He took another 3 packages and was cured 1979 1 45 Discussion This is a Ying and Wei disharmony in which the Wei was not consolidated and the Ying was not protected in the interior and so there was sweating This was a case with abundant sweating The Wei Yang followed the sweat out The muscle layer was without Yang and so there was aversion to wind and cold Gui Zhi Tang boosts the Ying and harmonizes the Wei Then the two move properly together Case 7 Early Wind Warmth Dr Ren Ji Xue Mr Chou age 63 came for his first visit on November 21 1987 Because he exercised intensively he sweat a lot and took off his clothing In the evening he got a headache and dizziness with a congested and runny nose He had a cough with itchy throat body soreness aching joints and when he moved he felt that he wanted to sweat but it did not arrive His facial complexion was not red his mouth and lips were red and moist His tongue was pale red and his throat was not red His tongue moss was thin and white and Copyright Sharon Weizenbaum 2022

28 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted moist The skin at his Chi was slightly hot and his pulse was deep moderate and without strength This illness came 2 days before the time of slight snow This is just at the time when the Qi movement should finish It would be following along with the change of the season Instead there was warmth and the disease was warm For treatment it was appropriate to supplement using sweet to discharge and sour to contain Gui Zhi 15 g Bai Shao 10 gm Gan Cao 5 gm Sheng Jiang 3 slices Da Zao 3 dates After taking one package of the herbs with a bowl of gruel to increase the herb s strength he was cured From 1988 2 10 Discussion This is a case in which wind warmth is beginning He contracted the wind warmth because his body resistance was low The Wen Bing Tiao Bian says In Tai Yin wind warmth wind heat epidemic warmth and winter warmth in the beginning there is aversion to wind and cold Gui Zhi Tang governs When warm disease begins there can also be symptoms of wind cold such as sweating However it is appropriate to resolve the muscles and regulate and harmonize the Yin and Yang It is as Wu Tang said In warm disease avoid sweating It is most relevant to resolve the muscles and Gui Zhi Tang resolves the muscles Gui Zhi s fragrance transforms turbidity while Shao Yao contains the Yin and absorbs the sweat Gan Cao defeats toxins and harmonizes the Copyright Sharon Weizenbaum 2022

29 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted middle Jiang and Zao harmonizes the Ying and Wei This can be used at the beginning of warm disease According to Dr Wen Gui Zhi Tang is not only for deficiency patients with wind cold illness It can also treat deficiency people with wind heat illness Clinically it is used to treat winter and spring colds and flu that are an attack of wind cold or wind heat The results are very good Case 8 Running Piglet Qin Bo Wei Mr Suo age 70 Due to the recent sudden death of his wife he was extremely sorrowful First he vomited and then he developed abdominal pain This lasted over a year He had a lump in his lower abdomen that was painful When the lump decreased in size the pain also decreased Qi surged up from his lower abdomen to below his heart He suffered greatly and felt like he was going to die Over time the surging Qi diminished and descended and the pain decreased as well This was running piglet After 16 packages of Gui Zhi Tang the running piglet greatly improved 1964 144 Discussion When the Yang is very weak there is no command and the Qi of the lower Jiao cold water surges upward This leads to running piglet Gui Zhi Tang warms and stimulates the heart Yang and levels the surging and down bears rebellion It was suitable for this presentation If it is extreme add two liang of Gui Zhi to improve the effect Case 9 Diarrhea By Zhong Shen Qin This woman had had diarrhea for several years Due to not eating much she became thin and emaciated Her skin was dry and scaly and she was not able to get out of bed Over time she had tried treatments with Ren Shen Fu Zi He Zi and Ying Su Ke The master s diagnosis was Bai He Pian in reference to the Yin and a Yang method to rescue He gave a large dosage of Gui Zhi Tang and the diarrhea stopped Then he added Bai He Copyright Sharon Weizenbaum 2022

30 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zhi Mu Tang and had her regulate her diet Gradually she recovered Discussion When there is chronic diarrhea the body becomes emaciated and the skin becomes scaly and dry This is the manifestation of the ying wei and Qi blood lacking harmony When the Ying and Wei lack harmony and the Qi and blood are chaotic this can cause ceaseless diarrhea to arise Using Gui Zhi Tang to induce sweat and resolve the muscles regulate and harmonize the Ying and Wei will stop the diarrhea This is the method that uses counter flow to draw up the boat Case 10 Extreme Deficiency Dr Liu Du Zhou Mr Liu was 18 years old He was married early and was very timid After marriage for half a year he had lower back soreness and leg weakness He also had dizziness tinnitus frequent short urination gradual aversion to cold a numb cold feeling on his lower legs poor appetite with abdominal distention a sweet sticky taste in his mouth abundant dreams with sexual desire and feebleness during the day In the summer even when it was hot outside he wore a padded jacket and when he moved he easily sweat He had taken supplementing herbs such as Ren Shen and Lu Rong but there was no effect This man s form was emaciated and he was timid His face was wan and his spirit was weak His voice was timid and weak His two pulses were deep thin and weak His tongue was red and tender with scanty moisture Coordinating the pulse and presentation with the fact that he labored excessively this was consumed Qi with damage to the Jing His Zang Fu function was irregular and his Yin and Yang were feeble It was correct to supplement the Kidney to foster the root but he had previously used Ren Shen and Lu Rong without effect I put Gui Zhi Tang to use in order to recuperate the Yin and Yang 5 packages After the herbs the illness greatly decreased However this was a case of deficiency damage so it is difficult to get quick results I continued with the above formula adding 15 gm Shan Yao 12 gm Chao Bai Zhu and 10 gm Ji Nei Jin in order to foster and supplement Copyright Sharon Weizenbaum 2022

31 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted the post heaven I also gave him Gui Fu Ba Wei Wan to supplement the Kidney Qi In half a month he reported I am full of vigor and my appetite has increased All illness is gone 1992 5 6 Discussion In this case early marriage meant that he indulged in sensual pleasures which lead to depletion Even though it was summer he wore a fur coat and when he moved he sweat His tongue body was red and tender and his pulse was deep and weak This was a Yang deficiency pattern He also had a sore low back weak legs dizziness tinnitus abundant dreams and red tongue with scanty moss All of this was Yin deficiency Yin and Yang were not regulated and this caused the Ying and Wei to have a difficult time harmonizing The treatment was to regulate and harmonize Yin and Yang Without this it would be difficult to be effective He had already used Ren Shen and Lu Rong to greatly supplement and this can be used as a reference Prof Liu recognized the pattern clearly He cleverly used Gui Zhi Tang to enrich Yin and harmonize Yang and regulate and harmonize the Ying and Wei Gui Zhi 15 gm Bai Shao 15 gm Zhi Gan Cao 6 gm Sheng Jiang 6 gm Da Zao 10 dates This correctly and accurately hit the disease target When the Yin was calmed and the Yang was hidden the Jing and spirit were protected on the interior This way the deficiency and exhaustion were cured Moreover when the illness had significantly Copyright Sharon Weizenbaum 2022

32 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted improved he increased the herbs to bank up and fortify early so that the post heaven could nourish the pre heaven and the Yin and Yang of the Kidney could flourish This way he was brought back from a chronic illness Case 11 Reversal Pattern Urination related Dizzy Reversal Dr Jin Shu Wu Patient named Meng age 12 came for a consultation on June 4 1987 The last two months she would faint when she urinated She lost awareness of her surroundings There were no sounds and she did not vomit spittle She would be unconscious 3 5 minutes After she woke up her arms and legs lacked warmth She sweat over her limbs and body She also suffered from dizziness and weakness After she rested a short while she would be fine This influenced her studies She went to the hospital but all of the tests were negative The diagnosis was dizziness and fainting with urination She was given sedatives Oryzanol vitamins Shen Fu Tang and Si Wei Hui Yang Yin These were all without effect Examination Her mental condition was clear and her face was red and moist Her tongue was pale red with a thin white moss and her pulse was wiry and moderate The diagnosis was reversal pattern The Chinese medical differentiation was that the Qi of the Yin and Yang was unable to flow along the correct path and connect This required a harmonizing method in order to calm the episodes and regulate and harmonize the Yin and Yang Gui Zhi Tang was used Gui Zhi 15 gm Bai Shao 15 gm Zhi Gan Cao 10 gm Sheng Jiang 3 slices Da Zao 4 dates Copyright Sharon Weizenbaum 2022

33 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Decocted in water After taking the herbs the frequency of the fainting clearly decreased It only came at the 4th earthly branch west 5 7 in the morning and evening The time of the 4th earthly branch west is the time when Yin and Yang connect together The herbs met the patho mechanism but the effect was not complete Three more packages were given and there was a cure Discussion The Shang Han Da Lun says When there is reversal Yin and Yang was unable to flow along the correct path and connect When this is extreme there is reversal Gui Zhi Tang harmonizes and regulates the Yin and Yang They flow along correctly and connect above and below They open through to the interior and exterior This is why they are able to treat reversal When there is sweating with a moderate pulse this is especially effective Case 12 Gradually Worsening Esophageal Spasm Dr Yu Shi Wei Mr Huang age 56 came for a consultation on June 18 1984 He had paroxysmal difficulty swallowing for more than 2 years When the illness came on his spirit was in a bad way and gradually he felt that it was difficult to swallow dry food This got worse day by day He went to the hospital for a check up and the diagnosis was gradual worsening esophageal spasm functional esophageal syndrome She was given nitrate type medicines and dark room treatment but there was no clear effect He reported that he could not sleep and had many dreams poor appetite and abdominal distention He was dizzy with spontaneous sweating and when he swallowed food he would choke He belched with frequent sounds When it was extreme the Qi would come from her nose Her tongue was pale with a thin white moss The pulse was moderate This was a lack of regulation of Yin and Yang with inhibited stomach Qi Copyright Sharon Weizenbaum 2022

34 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Zhi 9 gm Bai Shao 9 gm Zhi Gan Cao 6 gm Sheng Jiang 9 gm Da Zao 12 dates Hou Po 10 gm Wu Yao 10 gm Chen Xiang 10 gm One package for one day This was decocted in water After 4 packages of herbs the symptoms improved and the swallowing opened through He took more than 20 packages All the pathology cleared 1992 5 50 Discussion When difficulty swallowing shows with spontaneous sweating and a moderate pulse nasal noises and dry throat the illness resides in the lack of regulation of Yin and Yang with an inhibited Qi mechanism The stomach Qi was fundamentally deficient and then the emotional stress caused damage Gui Zhi Tang regulated and harmonized the Yin and Yang It opened and smoothed out the Qi mechanism We can say that it captures the crux of the illness Case 13 Urticaria Liu Du Zhou The patient was a 60 year old man The patient had urticaria that he scratched and Copyright Sharon Weizenbaum 2022

35 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted it was painful The pulse was floating and moderate This was accompanied by sweating and aversion to wind The tongue moss was thin white and moist This was a wind evil trapped in the openings of the muscles The Ying and Wei were not harmonized Because this was induced by wind rash the treatment needed to dispel wind and regulate and harmonize the Ying and Wei The formula was Gui Zhi Tang Gui Zhi 9 gm Bai Shao 9 gm Zhi Gan Cao 6 gm Sheng Jiang 9 gm Da Zao 12 dates After taking the herbs with hot gruel and then getting under covers the patient sweat The rash dispersed and the itching stopped 1993 2 Discussion A rash is Yang and wind is a Yang evil When it invades the muscles and skin and it is detained without being dispelled this can cause itching At the same time wind entering causes the Ying and Wei to lack harmony This causes sweating and aversion to wind with a pulse that is floating and moderate Gui Zhi Tang resolves the muscles and dispels wind It regulates and harmonizes the Ying and Wei There was no treatment of rash or itch bu the rash dispersed and the itching stopped Case 14 Menstrual itch Dr Zhang Bo Hua Li was age 22 and came for her first visit on October 20 1988 At age 16 after Copyright Sharon Weizenbaum 2022

36 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted starting her menstruation her whole body broke out in a rash She took some western medical anti allergy medication and the next day the rash was gone After that every time her menstruation came she would break out in a rash She again used western medicine without effect When her menses finished the rash dispersed only to return next cycle This happened again and again up until her visit Observation Her whole body was covered with patches of red rash that was very itchy Her tongue was pale with a thin white moss and her pulse was floating and weak This was differentiated as Yang floating with Yin weakness The Ying and Wei were not harmonized Gui Zhi Tang was used to regulate and harmonize the Ying and Wei 3 packages After stopping the herbs the itching dispersed The next cycle her menstruation came early by one week I continued with 2 packages and the itching did not appear A follow up after 1 2 a year revealed no recurrence Discussion When the menses arrive the Yin and blood become depleted and the Yang Qi can have a floating movement This causes a Ying and Wei disharmony If the outer layer openings have stasis and constraint of the Qi and blood this gives rise to rash and itching When one is affected by a wind evil the Ying and Wei are not harmonized and the Qi and blood loose their regulation This is when Gui Zhi Tang is used Case 15 Fever during pregnancy Dr Zhong JingJie The patient was in her 7th month of pregnancy Every afternoon an intense fever would rise up It would get as high as 38 C This had gone on for 10 days without improvement One doctor diagnosed this as tuberculosis and recommended an abortion However the patient did not want this She contacted me for a consultation The observation revealed that her pulse was floating big and weak without being rapid She also had a cough but it was not intense She had an appetite Her left lung lobe showed infiltration I gave her Gui Copyright Sharon Weizenbaum 2022

37 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zhi Tang which she took for 3 weeks Her fever began to go down She gave birth normally 1960 8 71 Gui Zhi 10 gm Bai Shao 10 gm Zhi Gan Cao 6 gm Sheng Jiang 10 gm Da Zao 12 dates Discussion This case of fever in pregnancy was due to Yang floating with Yin weakness When the Yang Qi floats there can be fever In addition the Yin and blood were depleted and so the pulse was floating big and weak Gui Zhi Tang addressed the disease mechanism precisely so it was used to harmonize the Wei Yang and nourish the Ying Yin and so there was a cure Case 16 Pediatric fright wind Dr Wu Pei Heng Mr Ke s eldest son was 11 2 years old On the morning of the 6th day of the 7th lunar month of 1922 he awoke and felt a wind and was frightened He had a fever spontaneous sweating confusion bending and stretching with twitching of his arms and legs His finger prints were red and floating his lips were red and his tongue was pale and white His pulse was floating and moderate This was wind cold hindering the movement of the Tai Yang channel His Ying and Wei were without fullness His Zang and Fu were soft so he could not manage the wind and cold The result was sudden fever with twitching that became acute wind fright symptoms This was a Tai Yang muscle exterior pattern for Copyright Sharon Weizenbaum 2022

38 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted which Zhong Jing s Gui Zhi Tang governs The evil was in the muscles and pores and so there was a slight sweat and a cure Gui Zhi 10 gm Hang Shao 10 gm Zhi Gan Cao 6 gm Sheng Jiang 10 gm Xiao Zao 7 dates 1983 2 Discussion A child s Zang and Fu are tender and the Ying and Wei are not full In addition when a child first wakes up the muscles and pores are loose This is why a wind evil can be contracted This can cause the Tai Yang channel and vessels to spasm and loose their softness This can manifest as bending and stretching with twitching of the arms and rolling up of the eyes The Su Wen says All rigidity belongs to wind Therefore there is fever with sweating with a floating moderate pulse This is a Tai Yang muscle exterior pattern Gui Zhi Tang dispels wind and resolves the muscles When the evil is in the muscles and pores of the Tai Yang after inducing a slight sweat there is resolution from the muscles and pores Case 17 Pediatric frequent urination Dr Cheng Wei Dong Liu was a 5 year old boy who came in on May 19th 1986 His father represented him saying Due to a urinary tract infection a half year ago he developed frequent urination with urgency and pain After taking Chinese herbs the urgency and pain dispersed but there was still frequency of urination This gradually got worse He urinated 3 5 times Copyright Sharon Weizenbaum 2022

39 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted every half hour This patient had an aversion to wind spontaneous sweating and bedwetting His tongue body was pale with thin white moss and his pulse was deep and thin The urine test was negative He was treated to supplement his Kidney to consolidate and astringe He was given Suo Quan Wan with additions but after 3 packages this was not effective Considering the spontaneous sweating I gave him Gui Zhi Tang to harmonize the Ying and Wei Gui Zhi 4 gm Bai Shao 6 gm Zhi Gan Cao 4 gm Sheng Jiang 3 gm Da Zao 3 dates 1 package for 1 day After 6 packages the aversion to wind and spontaneous sweating dispersed and the urination frequency decreased by half The effect was not quite complete so I continued with 10 more packages and there was a cure 1988 4 50 Discussion The Su Wen says When the spring does not stop the bladder is not storing There are many why the bladder does not store including deficiency and excess patterns This case appeared with spontaneous sweating and aversion to cold so it was a Tai Yang exterior pattern The Wei Qi could not harmonize with the Ying Wei Qi warms the flesh layer fills the skin and fattens the straie of the skin in order to open and close the pores When the ability to open and close fails this means that the Tai Yang Qi is not restraining On the outside there is spontaneous sweating and on the interior there is frequent urination In addition when there is no warming and nourishing there is a subjective feeling of aversion to cold At this time constricting and consolidating will not work Rather the treatment principle should be to harmonize the Ying and Wei When Gui Copyright Sharon Weizenbaum 2022

40 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zhi Tang is given the Ying will be full and the Wei will consolidate There is mutual coordination of the formula and the pattern and so the effect was good Case 18 Corneal viral keratitis dendritic keratitis Dr Wei Cheng Pu Ms Gao was age 36 For two weeks her right eye was dry and rough There was a history of flu She underwent treatment at the hospital but it was not effective On March 20 1990 she came to see me for a consultation Check up Farsighted 6 Vision strength 6 30cm Conjunctive congestion There was grey colored spots infusing the cornea 2 florescent stain Corneal perception KP She also had a runny nose with fear of wind spontaneous sweating pale red tongue body white slippery tongue moss and a floating pulse The diagnosis was corneal viral keratitis of the right eye dendritic keratitis The treatment needed to course wind and dispel the evil regulate the Ying and Wei remove the eye screen and clear the eye Gui Zhi 9 gm Bai Shao 9 gm Zhi Gan Cao 6 gm Sheng Jiang 10 gm Da Zao 12 dates Chan Yi 6 gm After 6 packages the Farsighted 8 Conjunctive congestion decreased Grey colored spots infusing the cornea decrease 2 florescent stain A follow up 2 years later showed no recurrence Discussion Eye obstruction from dendritic keratitis has complex pathology The disease conditions are confusing and easily recur When it is serious this can cause Copyright Sharon Weizenbaum 2022

41 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted blindness Clinically there is no effective treatment In this case the illness was due to contraction of wind evil Doing the differentiation of patterns it was seen that there was also spontaneous sweating aversion to wind and a floating moderate pulse This is why Gui Zhi Tang with Chan Yi was used It dispels wind and clears the eye If there is a different cause to the eye obstruction then one still has to treat according to the pattern flexibly using the herbs One should not be a stickler Case 19 Ablepsia lack of sight Dr Peng Lu Xiang Male patient age 20 When this patient first developed eye disease he had red swelling and pain of the eye He underwent western medical treatment and the swelling and pain faded away However his vision gradually became weak and then he could not see To the observer his eyes appeared normal with nothing unusual He did not have other complaints This went on without a cure All of the previous herbs had been given based on the idea that the eyes are the door of fire He was given formulas to clear heat and discharge fire Looking at the beginning of the disease we can see that the patient had intense red swelling and pain but he was still able to see When the swelling and pain decreased so did his eyesight The cure caused the sight to become weak The bitter cold Yin softening herbs then damaged the middle Qi and made the Ying and Wei chaotic The Jing and blood were unable to rise and flourish in the eye This was why the eyes could not see The medicine was inappropriate for this eye disease I used the method of regulating and harmonizing the Ying and Wei Gui Zhi Bai Shao Gan Cao Sheng Jiang 9 gm 9 gm 9 gm 9 gm Copyright Sharon Weizenbaum 2022

42 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Da Zao 18 dates After 3 packages the eyes became bright Though his vision was still blurry he was able to see After 6 more packages his vision was relatively clear I still continued with 6 more packages A check up after 1 2 a month he could read the newspaper A follow up 1 year later showed no recurrence 1981 4 Discussion The Ling Shu says The Jing Qi of all the five Zang and 6 Fu rises and pours into the eyes In this case of eye disease the use of bitter cold herbs damaged the spleen and stomach so that the source of transformation was not flourishing The Ying and Wei lost their regulation The Jing Qi was not able to rise to the eyes Gradually the eyes were unable to see Gui Zhi Tang supplements the spleen and stomach so that the Ying and Wei flourish and the Jing Qi can pour upward This way the decreased vision becomes clear Case 20 Crohn s Disease Dr Fu Yan Ling Wang xx Female 59 years old Chief complaint Diarrhoea and abdominal pain for one and half years History The patient suffered from abdominal pain diarrhoea low grade fever poor appetite emaciated during the past year and was diagnosed with chronic enteritis and TB of the large intestine The antibiotic therapy was not effective Copyright Sharon Weizenbaum 2022

43 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Observation Right side abdominal pain diarrhoea absence of tenesmus and blood and pus in the stool Her temperature was 37 5o C Other symptoms were aversion to wind tendency to sweat easily fatigue body aches and joint pain She had a thin white tongue coat and her pulse was floating and weak Diagnosis Concurrent Tai Yang and Tai Yin pattern with disharmony of ying and wei with spleen and stomach deficiency Treatment Regulate ying and wei warm the yang and supplement the middle Gui Zhi Tang modified Gui Zhi 10 gm Bai Shao 10 gm Gan Cao 8 gm Sheng Jiang 5 gm Da Zao 20 gm Gan Jiang 5 gm Dang Shen 10 gm Bai Zhu 10 gm After the medication the abdominal pain and diarrhoea were alleviated and her appetite improved Other symptoms of generalized ache and fatigue were reduced There was slight nausea and her pulse was slightly slippery Repeat the same formula add Huang Lian 1g Seven packs Copyright Sharon Weizenbaum 2022

44 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Follow up treatment Modified version of Gui Zhi Tang Xiao Jian Zhong Tang Huang Qi Jian Zhong Tang to consolidate for a further two months Discussion The patient manifested prominent signs of Tai Yang and Tai Yin Tai Yang Low grade fever aversion to wind cold sweating generalized and joint pain Tai Yin Diarrhoea abdominal pain reduced appetite Formula Modified Gui Zhi Tang Li Zhong Tang Rationale for not using Gui Zhi Ren Shen Tang Gui Zhi Ren Shen Tang is indicated where the interior deficiency is greater than the exterior symptoms The above case would not be effective if Gui Zhi alone were used Therefore it is appropriate to combine Gui Zhi Tang with Li Zhong Tang with Sheng Jiang targeting the exterior and Gan Jiang warming the interior Second consultation The pulse was slightly slippery and it was feared that Gui Zhi and Li Zhong were too warm generating too much heat therefore Huang Lian was added to counter the warm properties of Gui Zhi and Gan Jiang Huang Lian Sheng Jiang together descend counterflow stomach qi and stop vomiting Case 21 Diarrhea Sun Jiao jun drank plum syrup and developed diarrhea She had fear of wind and a cold sweat issued She also had head distention chest oppression bone soreness weak legs and a poor appetite with vomiting This was just like Shen Jun and so the formula is also the same as I used for Shen Jun Sun could not find Hong Zao at the at the night market After taking the herbs he had a hot sweat over his body He was comfortable and went to Copyright Sharon Weizenbaum 2022

45 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted bed When he woke up he had no illness and he went out Case 22 Diarrhea Dr Cao Ying fu Mr Xie During the hot days of summer the extreme heat oppressed a person He sweat profusely and repeatedly breathed the heat Mr Xie was covered with quilts shivering with a cold body There was no vomiting but there was diarrhea 10 times a day He had abdominal pain then the diarrhea was heavy His urination was short His pulse was not deep but rather was floating The text says this is Tai Yin illness with a floating pulse One can induce sweat and it is suitable to use Gui Zhi Tang The presentation matches the Gui Zhi Tang presentation Gui Zhi 4 5 g Da Bai Shao 4 5 g Zhi Gan Cao 4 5 g Sheng Jiang Hong Zao 2 slices 4 dates Chao Gu Ya 9 g Chao Mai Ya 9 g Chi Fu Ling 9 g Case 23 Diarrhea Dr Cao Ying fu th In 1936 June 24 the season became suddenly very hot My friend Shen Yun He was thin like a crane He ate ice cream that evening and was then in a slight wind He was sick the next day He had head distension fear of wind slight sweating His forehead felt cool Copyright Sharon Weizenbaum 2022

46 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted to the touch He had sticky diarrhea He had a relapse of long standing heart palpitations His pulse was knotted I gave him Gui Zhi Tang which he drank in the evening and in the morning all the illness was gone except for the heart palpitations I then gave him 4 packages of Zhi Gan Cao Tang and there was complete recovery Both of these formulas are related to Gui Zhi From Gui Zhi 4 5 g Bai Shao 4 5 g Zhi Gan Cao 4 5 g Sheng Jiang 1 slice Hong Zao 4 dates Case 24 Esophageal Spasm Dr Fu s cases Mr Liang Male age 57 May 2004 Principle Complaint Esophageal Spasm History Paroxysmal difficulty swallowing for 2 years 1 2 year after this began Mrs Liang underwent and gastroscopy that did not reveal anything abnormal Esophageal spasm was diagnosed diffuse type Western drugs had no effect During the check up he stated that he felt a blockage behind his breastbone when he swallowed that it was difficult to swallow down These symptoms were accompanied by a poor appetite upper abdominal distention and fullness lack of thirst Sometimes he felt a surging from his epigastric area into his chest and throat Tongue body was pale red with a thin white moss and pulse was thin and slow Copyright Sharon Weizenbaum 2022

47 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Differentiation of the presentation Lack of regulation of Yin and Yang and inhibited stomach qi Treatment principle warm the middle and scatter cold relax spasms and down bear rebellion Treatment Gui Zhi Tang modified Gui Zhi 15 gm Bai Shao 15 gm Zhi Gan Cao 6 gm Sheng Jiang 12 gm Da Zao 30 dates Wu Yao 10 gm Chen Xiang 10 gm Decoct in water and drink warm in 3 doses Result She took 3 packages and there was a clear effect After 7 packages this was even more pronounced Her throat was open and the surging qi descended I continued with 21 packages and there was a cure I advised her to avoid cold and raw food and to keep his body warm Case 25 Common Cold Feng Shi Lun Xie x female 51 years old First consultation 26th of September 2004 The patient contracted a cold after having been soaked by rain Copyright Sharon Weizenbaum 2022

48 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Signs and Symptoms Fever 38 6 o C aversion to cold severe headache generalized body aches clear nasal discharge After one week of Western treatment she suffered from low grade fever 37 5o C accompanied by sweating and aversion to wind particularly after exertion Her sweating had worsened particularly after exertion and there was a dull headache Her nasal discharge had worsened after exposure to cold wind and she had a white tongue coat and a floating and weak pulse Diagnosis Fever sweating aversion to wind and a floating and weak pulse is indicative of a Tai Yang pattern The pattern is one of deficiency and wind strike pertaining to a Gui Zhi Tang Cinnamon Twig Decoction pattern Formula Gui Zhi Tang Gui Zhi 9 gm Bai Shao 9 gm Zhi Gan Cao 6 gm Sheng Jiang 9 gm Da Zao 4 dates After one pack of medication her body temperature returned to normal The same formula was continued for two more packs to consolidate the treatment Recovery was complete Case 26 Pediatric Persistent Fever Mr He male 8 years old Initial consult October 23 1965 For the past week the patient had a cold with a persistent fever Every morning at 11 30 he developed a fever of approximately 38 C He would then sweat and after 12 noon the fever would subside His Copyright Sharon Weizenbaum 2022

49 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted appetite and spirits were good Bowel movements were every other day He had no other issues Tongue coating white and wet Pulse weak and rapid Vacuity of fluids with heat Weak and rapid pulse Disharmony of the ying and wei Recurring fever at a fixed time of day followed by sweating The diagnosis was a Tai Yang wind strike Gui Zhi Tang pattern Gui Zhi 9 gm Bai Shao 9 gm Zhi Gan Cao 6 gm Sheng Jiang 9 gm Da Zao 4 dates Results Two packages of the prescription were taken There was no longer any fever in the morning In the afternoon after 1 00 he had a low grade fever 37 2 37 5 C The tongue coating was thin and yellow The pulse was still slightly rapid The patient took 3 packages of Gui Zhi Tang combined with Xiao Chai Hu Jia Sheng Shi Gao Tang Afterwards the illness was resolved Case 27 Low Grade Fever Ms Xie female 51 years old Initial consult September 26 2004 After getting wet in the rain the patient developed a fever temperature of 38 6 C aversion to cold severe headache body aches and clear nasal discharge After one week of western medical treatment she had a low grade fever 37 5 C with sweating and an aversion to wind The sweating was visible with activity She had a persistent headache Her clear nasal discharge worsened when exposed to wind and cold Tongue coating white Pulse floating and weak The western medical diagnosis was an Copyright Sharon Weizenbaum 2022

50 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted upper respiratory viral infection Greater yang tai yang wind strike pattern Floating and weak pulse white tongue coating aversion to wind aversion to cold fever with sweating headache clear nasal discharge The diagnosis was a greater Tai Yang wind strike Gui Zhi Tang pattern Gui Zhi 9 gm Bai Shao 9 gm Zhi Gan Cao 6 gm Sheng Jiang 9 gm Da Zao 4 dates Results The patient s fever subsided after 1 package of the prescription After taking 2 more packages the illness was resolved Case 28 Nausea in Pregnancy Ms Li was age 24 She came for a consultation on September 18 1985 She had stopped menstruating for 45 days previously and then she felt her whole body had an aversion to cold After that she would feel nauseous every morning when she got up and she would vomit The vomit contained abundant clear spittle She was dizzy and fatigued and somnolent with no appetite The urine test was positive for pregnancy This was nausea of pregnancy The tongue moss was thin white and slippery Her pulse was thin and slippery The treatment was to harmonize and regulate her Qi and blood down bear reversal and stop vomiting She was given modified Gui Zhi Tang Gui Zhi Bai Shao Gan Cao 6 gm 6 gm 3 gm Copyright Sharon Weizenbaum 2022

51 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Sheng Jiang 6 gm Da Zao 4 dates Fa Ban Xia 10 gm Fu Ling 10 gm Chen Pi 5 gm Sha Ren added after 5 gm She was also given 30 gm of the clear juice of Fu Long Gan to take the place of water to decoct the herbs After two packages there was no longer aversion to cold and the vomiting of clear liquids stopped She took 3 more packages and there was no more illness 11 34 1986 Discussion After a woman becomes pregnant the Chong vessel looses harmony Upward reversal harasses the stomach so that the stomach cannot harmoniously down bear Gui Zhi Tang is not only able to regulate Yin and Yang and harmonize Ying and Wei it can also down bear the surging Qi and supplement the spleen and stomach This is why it is a good recipe for nausea in pregnancy This case shows us the truth in the saying that the Chong vessel is subservient to the Yang Ming This theory has immediate significance This formula treats nausea due to spleen and stomach deficiency and weakness It is effective for someone whose tongue moss is thin and white If the Yin fluids are damaged there is heat in the stomach heart vexation with thirst or a red tongue with yellow moss it cannot be used Copyright Sharon Weizenbaum 2022

52 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Dr Xia on Gui Zhi Tang for Postpartum Depression4 Jie Yu He Ying Tang Formula Name When there is postpartum depression constraint must be resolved When the cause is a lack of harmony of the Ying and Wei the Ying and Wei must be harmonized I have developed this formula based on this pathology and it is very effective This is my own experiential formula though it began from the formula Wen Yan Jie Yu He Ying Tang I modified this formula to become Jie Yu He Ying Tang Zhi Gui Zhi 6 10 Chi Shao 10 Bai Shao 10 Chen Pi 6 Duan Mu Li 15 pre cook Qing Long Chi 10 pre cook Suan Chao Chai Hu 5 Gan Cao 6 Guang Yu Jin 9 Xian Ling Pi 9 Sang Sheng 12 Sheng Jiang 3 Da Zao 3 5 dates 4 Xia Guicheng s 15 Chapters on the Clinical Experience with Herbs and Formulas in Gynecology Beijing People s Press 4 2006 Copyright Sharon Weizenbaum 2022

53 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Function Warms the Yang harmonizes the Ying courses the Liver and resolves constraint Application Postpartum depression combined with Ying Wei disharmony This manifests as chest oppression agitation insomnia sweating and aversion to cold In the extreme there will be obvious joint pain tossing and turning in bed and whole body is thin and weak Formula composition The herbs in this formula are appropriate for postpartum body weakness There is Liver constraint and Qi stasis that is caused by the Ying and Wei loosing harmony This is why this formula combines Gui Zhi Tang with Xiao Yao Tang In terms of the characteristics of this illness in the postpartum period there is a Ying and Wei disharmony with sweating cold body and body discomfort To resolve the muscles and harmonize the Ying Gui Zhi Tang is appropriate We can hear the words of our predecessors of which there is no shortage Gui Zhi is pungent and warm and it is an herb to resolve the exterior However Shao Yao is sour and restraining and when it is combined with Gui Zhi there is one to scatter and one to restrain one warm and one cold This scattering while restraining resolves the muscles and this warm with cold resolved the exterior If there is no sweat this will create one If there is sweating this will restrain it Therefore this combination promotes sweating resolves the exterior warmly moves the exterior Yang and at the same time it restrains sweating and protects the middle It has these dual mutually regulating functions This illness arises after giving birth It is characterized by depression and often with agitation and insomnia It can be seen that this is Heart and Liver constraint as well a disharmony of the Ying and Wei This is why I use Xiao Yao San and add Guang Yu Jin to resolve constraint Xiao Yao San also contains Chai Hu This herb not only courses the Liver and resolves constraint it also functions to harmonize and resolve As everyone knows Xiao Chai Hu Tang harmonizes and resolves the Shao Yang Shao Yang is also the gallbladder channel which is the external partner of the Liver Jue Yin channel So Chai Hu courses the Liver and resolves constraint and also harmonizes and resolves Shao Yang Internally this illness is related to both Liver and Heart constraint Externally this illness is a Ying and Wai disharmony From the treatment perspective synchronizing and resolving the Liver constraint is the pre requisite To achieve this the formula includes Long and Mu li Long Mu calm and descend and pacify the Shen The original formula Copyright Sharon Weizenbaum 2022

54 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted of Gui Zhi with Long Mu is for deficiency weakness illnesses The basic presentation postpartum is one of weakness So while resolving constraint we must calm descend and pacify the Shen and do this in a way that helps the woman recuperate For this I add Xian Ling Pi and Sang Sheng This will treat Kidney deficiency and joint soreness and pain I also add Chen Pi to harmonize the middle and Gan Cao and Sheng Jiang to harmonize Clinical Application This formula is designed to treat postpartum depression though it can also be used to treat menopausal syndrome for weak and depleted patients 1 Menopausal syndrome After undergoing menopause the patient is depressed and uncomfortable They feel negative and lack enthusiasm They may even think of committing suicide They feel agitated and anxious with chest oppression and a feeling of suffocation Their body is cold and they sweat in a relatively profuse amount They do not sleep peacefully and they feel mentally weak The pulse is thin and wiry and the tongue is pale red with white sticky moss You can use this formula adding 6 gm Guang Mu Xiang and Chen Pi and 12 gm of Dang Shen 2 Weakness depletion illnesses The patient is weak and depleted and thin they are unable to work and their spirit is very weak When they move they sweat and when they sweat they feel cold Their body is emaciated They have chest oppression and discomfort and feel despondent They sigh repeated yawn and are unable to sleep Their tongue is pale red with sticky white moss and their pulse is thin weak and wiry In this case you can add 15 gm Tai Zi Shen 9 gm He Huan Pi and 10 gm Su Lei Zi Modifications If there is a lot of sweating and the patient is very cold with cold sweats you can add 15 30 gm Zhi Huang Qi 15 gm Dang Shen and 6 gm Zhi Fu Pian When there is abdominal distention and sticky stool poor appetite and mental weakness you can add 9 gm Pao Mu Xiang 6 gm Chen Pi 10 gm Chao Bai Zhu and 5 gm of Sha Ren If there is dizziness headache vexatious heat and thirst you Copyright Sharon Weizenbaum 2022

55 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted can add 15 gm Gou Teng 10 gm Chao Dan Pi and Bai Ji Li If the patient is flustered and unsettled with insomnia add 5 g of Lian Zi Xin 10 gm of He Huan Pi and 6 9 gm Chao Zao Ren Clinical Experience This formula is actually Gui Zhi Tang with added Er Jai Long Mu Tang and Xiao Yao San Gui Zhi Tang is a frequently used formula for synchronizing and harmonizing the Ying and the Wei It is much used for the Shang Han Lun exterior presentations and there are many modifications of it for exterior presentations Gui Zhi Tang with the addition of pleasing and sweet ingredients is Xiao Jian Zhong Tang It is said that Xiao Jian Zhong Tang harmonizes the Ying and Wei on the outside while on the inside it harmonizes Yin and Yang It fortifies the middle Qi It is a return the correct formula Er Jia Long Mu Tang is basically Gui Zhi Gan Cao Long Gu Mu Li Tang The String of Pearls of the Shang Han Lun considers that Gui Zhi and Gan Cao return the Qi of the Heart Yang Long Gu and Mu Li calm the chaotic agitation of the Shen So this formula is relatively effective for insomnia I often replace Long Gu with Long Chi because the effect for insomnia is really good However the Gu Fang Xuan Zhu Principles for Selecting Ancient Formulas considers the combination of Gui Zhi Gan Cao Long Gu and Mu Li Long Gu and Mu Li are there to consolidate and astrict They are herbs that are Yin and dulling and without assisting the Yang herbs they will be ineffective Therefore the pure Yin herbs Long Gu and Mu Li must take advantage of the clear Yang of Gui Zhi and Gan Cao This way the channels can be entered and the floating Yang can be restrained There can be press down and consolidate the Yang that is being lost Xiao Yao San is a famous formula for resolving constraint When there is depression there is constraint Psychological counseling is also required Jin Gui Yao Lue s use of Gui Zhi Tang in Pregnancy5 In postpartum depression presentations there are often wind damp presentations mixed in Patients on the one hand feel cold sweat and have body and joint pain On the other hand they also have chest oppression vexation or depression with sighing poor sleep and mental weakness If you treat from the perspective of the wind damp and either dispel wind and remove dampness or vitalize blood and open the luo vessels the result will not be good On the other hand if focus on coursing the Liver and resolving constraint calming the Heart and Shen to diagnose and treat you 5 36 Women s Illnesses of the Jin Gui by Zhang Jianrong Beijing People s Medical Publishing House 2001 Copyright Sharon Weizenbaum 2022

56 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted will be unable to resolve and remove the wind and damp pathology On the outside you must harmonize the Ying and Wei to dispel the wind damp while on the interior the Yin and Yang must be synchronized and the Shen and Hun calmed This is why Gui Zhi Tang is used in combination with Xiao Yao San This is my own Jie Yu He Ying Tang You should make modifications based on the presenting internal and external symptoms and the result will be even better When young women of childbearing age stop their menstruation for more or less two months the begin to manifest nausea and vomiting and a lack of desire for food and drink Their tongues are pale with thin white moss and their Cun and Guan pulses are strong and harmonious Only the Chi pulse is slightly weak They are without aversion to cold or heat effusion If they are given mistaken treatment at three months they will show vomiting above and diarrhea below This then belongs to a very serious pattern The symptoms mentioned above are the reaction symptoms of a pregnant woman If her spleen and stomach are normally fortified and moving and her Qi and blood are abundant the reaction symptoms will be relatively light They don t need to be treated It will spontaneously improve after about three months If the nausea and vomiting are relatively serious this is deficiency of the spleen and stomach Qi and blood insufficiency and the Chong vessel s Qi that is harbored by the fetal Qi rebels upward At the beginning of a pregnancy especially in about the second month the fetal source is especially congealed and the Yin and blood gather up in the uterus to nourish the fetus If the mother s Yin and blood are both insufficient the insufficient blood leads to lack of filling of the pulse This is why the Chi pulse is thin and small as well as weak The Qi of the fetal source is not yet vigorous and so it is also unlikely that the pulse will appear like a slippery diseased pulse The Chong vessel rises from the uterus and joins with the foot Yangming This is outside of the gathering of the Qi and blood of the twelve channels and therefore this is called the sea of blood This is the hub of the organism s channels and vessels internally storing and diffusing the Qi After a woman becomes pregnant because the blood gathers to nourish the fetus the sea of blood is relatively empty making the Qi of the Chong vessel correspondingly over abundant The duty to harmonize surging is lost so the Chong Qi Copyright Sharon Weizenbaum 2022

57 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted even more dramatically follows the channel and vessel rebelling upward to harass the stomach The stomach is then unable to harmoniously down bear and this manifests as nausea vomiting and a disinterest in food and drink If this is combined with a pale tongue with this white moss this is deficiency cold of the spleen and stomach and lack of harmony of Yin and Yang Formula method regulated the spleen and stomach coordinate Yin and Yang Original Text Jin Gui Yao Lue Chapter 20 Line 1 The master says When a woman s pulse is balanced with slight weakness in the Yin pulse and she has thirst inability to eat and she is without cold and heat this is pregnancy Gui Zhi Tang governs This pattern should appear within 60 days If there is adverse treatment by a doctor in a month there will be vomiting and diarrhea and the pregnancy will be severed Formula Gui Zhi Tang Gui Zhi Tang Gui Zhi 3 liang 9 gm Shao Yao 3 liang 9 gm Zhi Gan Cao 2 liang 6 gm Sheng Jiang 3 liang 9 gm Da Zao 12 dates 12 dates Copyright Sharon Weizenbaum 2022

58 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Formula Analysis X Zh ngk said When one uses Gui Zhi Tang for external patterns it resolves the muscles and harmonizes the Ying and Wei For internal patterns it harmonizes Qi and regulates Yin and Yang The formula contains Gui Zhi and Sheng Jiang with Zhi Gan Cao and Da Zao which uses pungent and sweet to transform Yang so as to nourish the Yang Qi Shao Yao is with Zhi Gan Cao and Da Zao which uses sour and sweet to transform Yin so as to nourish the Yin and blood Therefore this formula regulates the spleen and stomach and coordinates the Yin and Yang while helping Qi and blood flow harmoniously Furthermore in the Jin Gui Yao L e Gui Zhi is an important herb to apply in order to descend surging Qi and cold Qi that is rebelling upward Examples of this are the formulas Gui Zhi Jia Gui Tang Ling Gui Zao Gan Tang and Gui Ling Wu Wei Gan Cao Tang If the doctor does not understand pregnancy and does not treat correctly the diease will expand and diarrhea and vomiting will result This will deplete and damage Qi and blood and Jin and Ye of the mother s body and influence the embryo s development At that point one must use extreme measures to protect the fetus or terminate the pregnancy Discussion In regard to the pregnant woman s pulse being balanced with small weak Chi pulses Y u Z ij ng said the balanced pulse is a pulse of no disease This meaning is as the Neijing refers to as the body has illness but the pulse is without evil After a woman becomes pregnant her Cun and Guan pulses are balanced and strong while the Chi is thin small and weak This manifests in many newly pregnant women The word small means slightly and basically means that the Chi is smaller than the Guan and Cun Clinically speaking when the woman passes 40 days of pregnancy the Cun and Guan pulses have the slippery disease feel Considering this Copyright Sharon Weizenbaum 2022

59 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted early pregnancy can be verified as an excess presentation As the fetal Qi gradually fills and flourishes the Chi pulse manifests as slippery illness image As the Suwen Treatise on the Image of the Balanced Person says When a woman s hand Shaoyin vessel beats vigorously she is pregnant The Suwen Treatise on Differentiating Yin and Yang says When the Yin pulses and the Yang separates this means there is a child The Shaoyin pulse is the Chi pulse and vigourous means the slippery disease pulse After 3 months of pregnancy it is noticeable that the Chi pulse appears as the slippery diseased pulse It is as the Thousand Ducats says The three Yin Chi pulse is rapid L Zh ngz also said when there is a slippery disease pulse that is scattered the fetus must be at 3 months This person is thirsty and is unable to eat As for this thirst Y u Z ij ng in his Heart Dictionary the nausea of pregnancy is the same as nausea However the mouth thirst is not actually due to a heat pattern For example in the Jin Gui chapter on vomiting hiccup and diarrhea it says when thirst follows vomiting the condition is about to resolve If there is thirst first and then vomiting this is water collecting below the heart This in the category of water Generally one with habitual vomiting should have thirst as well However if there is no thirst this is propping rheum below the heart Therefore this thirst is the thirst that comes after vomiting and is a sign of the renewal of Yang There is vomiting damaging the Jin and there is water stoppage below the heart Looking at this person is thirsty and unable to eat it should be pointed out that the pregnant woman vomits and hence Jin is damaged and so there is thirst She is unable to take in food or drink Integrating all of this taking Gui Zhi Tang this undoubtably refers to spleen and stomach deficiency weakness The original text points out that the patient is without cold and heat This is basically to differentiate this from the phraseology of an outside contraction exterior pattern without cold and heat is a skillful way of writing as it is also true that a method is used for outside invasion This is mainly to determine the principle Copyright Sharon Weizenbaum 2022

60 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted pattern and to remove and confusion about the symptoms Here we point out the use of Gui Zhi Tang where there is even more sense of dispelling outside influences Here Gui Zhi Tang is not used for an external contraction It is used to regulate the spleen and stomach and harmonize Yin and Yang Supposing there is heat in the middle Jiao there would be heart vexation and vomiting with a desire for cold drinks For this you would not use Gui Zhi Tang It is as K Q n said When Gui Zhi Tang is swallowed over abundant Yang is killed This pattern should appear within 60 days If there is adverse treatment by a doctor in a month there will be vomiting and diarrhea and the pregnancy will be severed This is written according to the general law that the above symptoms are the pregnancy response in a woman If the physician does not know that she is pregnant and treats her mistakenly after three months along with all of the previous symptoms she has increased diarrhea and vomiting the pregnancy should end As for the words make it end This is analyzed below 1 T ng Z ngh i said This refers to terminating the pregnancy 2 W Qi n said This refers to it being appropriate to stop the herbs 3 Y u Z ij ng said severing means completely terminating giving any herbs and instead to give stir fried glutinous rice soup In the present days this idea of make it end has a new explanation namely that there will be an inferior fetus and that this advocates a kind of eugenics It is thought that this was China s earliest initiation of eugenics Zh ng J ngyu said that if the Qi and blood are depleted and there is not enough to nourish the fetus or the mother has a weakness disease to the extent that she is unable to produce one might as well terminate to avoid disaster This conjecture that the fetus will be unable to develop normally is identical with the gist of Zhong Jing s words make it end Copyright Sharon Weizenbaum 2022

61 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case Examples 1 Nausea and vomiting in pregnancy6 The wife of a fellow student Mr Qi Weng was two months pregnant and had vomiting aversion to food Her father knew a doctor She tried Shen Ling Ru Ju type herbs but they didn t help so they sent for the doctor He tried treating so called middle Qi insufficiency with phlegm gathering in the stomach area He tried treating so called stasis of Qi and blood with foul Qi attacking upward The more she was treated the worse it got Mr Qi reviewed the Jin Gui words If there is adverse treatment by a doctor make it end And stopped all herbs for a month The reversal vomiting was as before The symptoms stopped and started and were like a serious illness They had no choice but to call me in to see her Her body type was thin and her complexion was pale Her pulses were floating and moderate and slightly wiry Her tongue was pale red with thin white slippery moss She reported strong dizziness in her head and eyes slight bitter taste in the mouth chest and rib side fullness and discomfort lack of interest in food and when she took in food she would feel distended in her stomach First she vomited fluids and then food After vomiting she felt comfortable She also had body pain and heaviness of the 4 limbs It was summer and she was wearing a padded cotton jacket She did not originally have aversion to wind but just observing her clothing I could see she was afraid of cold She was given Gui Zhi Tang and Xiao Chai Hu Tang Weng doubted me saying this is not an external contraction so isn t it a misuse to give Gui Chai This was using Zhongjing s idea from the Ping Mai Bian Zheng according to the pattern apply the method and according to the method give the formula We are not limited by inner damage and external contraction Weng had already read the Jin Gui Yao Lue so how could he have not seen that the first formula mentioned for pregnancy is Gui Zhi Tang This disease is actually not only due to external contraction but is also 6 1962 9 36 Copyright Sharon Weizenbaum 2022

62 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted from a person s basic Yang being insufficient at the start of pregnancy The Qi and blood gather to nourish the fetal source so that the upper and middle Jiao Yang qi is insufficient The central plains are then without the ability to generate and transform The Shaoyang root Qi is held back and stagnates and horizontally insults the earth This can give all sorts of symptoms Gui Zhi Tang fills the Yang Qi of the middle and upper Jiao Xiao Chai Hu Tang smooths the action of the Shaoyang pivot so that the clear Yang can flourish The interior and exterior are synchronized and harmonize so that all illness is resolved The previous people had treated the nausea and vomiting with herbs like Shen Ling Ru and Ju According to the pattern flavors are added and subtracted L Yu nl i also said Since the Thousand Ducat and the Wai Tai later generation s formulas for women no one knows this Hence it is no wonder that Dr L does not think that these symptoms match Gui Zhi Tang Actually diseases have 1000 changes and herbs also have 1000 changes so how can one possibly be rigid Upon taking the herbs twice all of the symptoms retreated except for exhaustion and poor food intake Weng asked if the herbs could be stopped now I answered not yet as the central Yang is still deficient If the root is not treated the disease will return After that I had her take Xiao Jian Zhong Tang with Ren Shen and Huang Qi one package every other day After a month she was healthy and active and her facial color was rosy 2 Nausea and vomiting in pregnancy7 Ms Li was age 24 and came for an initial consultation on September 18 1985 Her menses had stopped 45 days previously She suddenly felt that her whole body was averse to cold and thereafter every morning when she got up she would feel nausea and would vomit The vomitus was clear spittle She also felt dizzy and fatigued wanting to sleep She was picky about food and had a lack of appetite Her pregnancy test was positive The diagnosis was nausea and vomiting of pregnancy Her tongue 7 1986 11 34 Copyright Sharon Weizenbaum 2022

63 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted moss was thin white and moist Her pulses were thin and slippery For treatment it was appropriate to harmonize and regulate Qi and blood down bear reversal and stop vomiting She was given modified Gui Zhi Tang Gui Zhi 6 gm Shao Yao 6 gm Gan Cao 3 gm Sheng Jiang 6 gm Fa Ban Xia 10 gm Zhu Ling 10 gm Chen Pi 5 gm Sha Ren 5 gm add later Da Zao 4 dates She was also given 30 gm of Fu Long Gan to be boiled and taken as a clear liquid The herbs were boiled She was given 2 packages and the stomach cold dispersed and the vomiting and nausea decreased and stopped She continued with 3 more packages and there was no more illness Discussion Nausea and vomiting in pregnancy is generated mostly from the Chong Qi reversing upward resulting in lack of harmony and descent of the stomach It is also due to a time of lack of harmony of Yin Yang and Qi and blood Gui Zhi Tang is good at regulating Yin Yang harmonizing Qi and blood and rectifying the liver and spleen Actually it is the best formula for treating nausea and vomiting 3 Cold back in pregnancy8 8 1981 3 17 Copyright Sharon Weizenbaum 2022

64 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Ms Zhang was age 31 and came for her initial consultation on May 4 1980 She had stopped menstruation for more than 2 months She had nausea and vomiting of clear water with a poor appetite Recently she began to hate cold and wear more clothing Her back area was especially averse to cold She was exhausted and wanted to sleep She has slight pain in her lower abdomen Her Ying and Wei were not harmonized The treatment needed to fortify her spleen and supplement deficiency while harmonizing Ying and Wei She was given Gui Zhi Tang and Liu Jun Zi Tang Gui Zhi 10 gm Shao Yao 10 gm Xi Dang Shen 12 gm Bai Zhu 10 gm Yu Ling 6 gm Chen Pi 3 gm Zhi Gan Cao 3 gm Fa Ban xia 6 gm Da Zao 5 dates Sheng Jiang 3 slices She was given 3 packages and all of the symptoms resolved and greatly balanced Her appetite increased She was given 3 packages of the original formula with Sha Ren and Huai Shan and there was a complete cure 4 Reversal surging of the Chong Qi in pregnancy9 Ms Wang was age 24 and she came for her first visit in June of 1971 She was over a month pregnant and she was vomiting many times a day Her intake of food and 9 1984 4 12 Copyright Sharon Weizenbaum 2022

65 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted drink was extremely low After two weeks her spirit weakened and her body was tense She requested treatment from several Chinese physicians taking more than 10 packages of herbs without effect She then entered the hospital for 3 days of intravenous glucose vitamin C and ringer s solution She was also given oral vitamin E Her vomiting still did not stop She invited me for a consult She reported nausea and vomiting with surging into the heart that was difficult to bear For the past several days she felt intermittent abdominal pain I observed that her facial complexion was dull and her emotions were not peaceful Her speech was without strength There were not clear changes of her tongue or tongue moss Her pulses were wiry and rapid Her urine was yellow and her bowel was dry I asked her detailed questions She said she did not want cold or hot food and drink and that strong foods would make her vomit Also not eating made the fetal Qi ascend to attack the heart opening I thought deeply about the herbs that previous doctors had given her This was Xiao Ban Xia Jia Fu Ling Tang Huang Lian Wen Dan Tang Ding Xiang Shi Di Tang etc I thought that the previous doctors had not been effective They attributed the problem to surging up of Chong Qi yet down bearing reversal and leveling the Chong did not stop the vomiting I thereupon gave the textual formula Gui Zhi 10 gm Shao Yao 10 gm Zhu Ru 9 gm Sheng Jiang 9 gm Da Zao 3 dates Zhi Gan Cao 3 gm Copyright Sharon Weizenbaum 2022

66 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted I gave her 1 package and paid attention to the fluctuations After 5 days the patient came to see me After one package she felt her heart become peaceful The vomiting decreased I had her continue with 3 more packages of the original formula At that point the vomiting stopped the abdominal pain was gone and the fetus was peaceful 5 Slippery Fetus10 Ms Jiang was age 26 She came for her first visit on June 4 1988 She had been married for more than two years She had had 3 miscarriages When I saw her she had not menstrated for more than 2 months Her body was emaciated and her facial color was dull white She was dizzy nauseous with spirit exhaustion vomiting of spittle many dreams poor appetite Her tongue body was pale with thin moss and her pulse was thin and slippery The pattern belonged to central deficiency while pregnant The treatment was to regulate and harmonize the Qi and blood fortify the spleen and boost the kidneys Gui Zhi 10 gm Shao Yao 10 gm Zhi Huang Qi 15 gm Sheng Jiang 3 gm Da Zao 3 dates Zhi Gan Cao 6 gm Bai Shen 10 gm Bai Zhu 10 gm 10 1990 2 8 Copyright Sharon Weizenbaum 2022

67 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Sheng Ma 10 gm Sha Ren 6 gm Tu Si Zi 10 gm Du Zhong 10 gm Chen Pi 10 gm This formula was given until she recovered When she was 8 months pregnant the position of the baby was normal so she went back to work Master Zh ng considered slippery fetus to most often be due to lack of attunment of the spleen and stomach and disharmonious Qi and blood resulting in the fetus losing nourishment The treatment then needs to harmonize the Qi and blood fortify and move the spleen and stomach Gui Zhi Tang is a good formula to regulate and harmonize the Qi and blood Master Zh ng often uses Gui Zhi Tang with added flavors to treat slippery fetus With Qi deficiency he adds Dang Shen Bai Zhu and Huang Qi If there is blood deficiency he adds Dang Gui E Jiao and Shu Di If there is kidney deficiency he adds Du Zhong Tu Si Zi and Sang Ji Sheng If the stomach Qi lacks harmony he adds Sha Ren Chen Pi and Jiang Xia For fetal heat he adds Huang Qin 6 Urinary retention in pregnancy11 Ms Wang was age 24 and was more than 8 months pregnant A half month earlier her urination became scanty and frequent Two days previously after receiving cold she had lower abdominal distention and pain Her urine came out in droplets but there was no pain She was sometimes cold and sometimes hot Her tongue body was pale and her pulse was floating and rapid This was a wind evil tying up the exterior with lack of harmony of the Ying and Wei and poor Qi transformation in the bladder She was given Gui Zhi Tang with added Zhu Ling Bai Zhu Tang 11 1991 6 42 Copyright Sharon Weizenbaum 2022

68 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Zhi 12 gm Shao Yao 12 gm Ba Zhu 12 gm Zhu Ling 12 gm Da Zao 5 dates Zhi Gan Cao 3 gm Sheng Jiang 3 slices She was given 3 packages Her urination was already gradually opening through All of the symptoms decreased She was given 3 more packages and her urination opened through smoothly Is Yang Dan Tang Gui Zhi Tang Xiao Yang Dan Tang12 Gui Zhi 3 liang 9 gm Sheng Jiang 2 liang 6 gm Zhi Gan Cao 2 liang 6 gm Shao Yao 3 liang 9 gm Da Zao 12 pieces 12 pieces This formula treats celestial movement heat effusion spontaneous issuing of sweat aversion to wind noisy breathing from the nose and dry retching Decoct the above formula above in 7 Sheng of water down to 3 Sheng Take warm 1 Sheng per dose After taking eat a bowl of hot rice gruel in order to benefit the strength 12 From the Fu Xing Jue Copyright Sharon Weizenbaum 2022

69 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted of the herbs and to gently cause a slight sweating Do not creat a big sweat If the sweat is pouring and dripping down this means that the illness is not eliminated If there is no sweat coming out take another dose Once you have achieved a cure stop Take three doses a day If you add 1 Sheng of Yi Tang it becomes Zheng Yang Dan Tang Jin Gui use of Yang Dan Tang for Postpartum Women Case 1 Postpartum Ying Wei disharmony13 Ms Zhang age 35 came for a consultation on July 5 1964 Her main complaint was that on month previously she had a miscarriage and underwent a D C She lost a lot of blood and suffered from dizziness palpitations and weakness of her body 10 days later she felt cold and had an aversion to wind Though it was summer the slightest wind made her endlessly afraid of cold In the afternoon she had heat effusion With every movement she would sweat spontaneously and after sweating she felt extremely averse to wind At daybreak the heat would retreat and she would sweat profusely and have dizziness heart palpitations and exhaustion Her form had lost its fullness and her complexion lacked luster Her pulses were floating weak and big When pressing more deeply they were moderate and faint Her tongue moss was pale white and the tongue body lacked redness and moisture Her body temperature was 38 2 C 100 76 F Because she had lost a lot of blood with the miscarriage her Yin was deficiency and her Ying was feeble This led to a Ying Wei lack of regulation The treatment principle was to boost Qi generate blood regulate and harmonize Ying and Wei Chuan Gui Zhi 13 1 5 gm 1 1965 10 15 Copyright Sharon Weizenbaum 2022

70 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Chao Bai Shao 9 gm Sheng Huang Qi 30 gm Dang Gui Tou 6 gm Chao Zao Ren 12 gm Wu Wei Zi 3 gm Zhi Gan Cao 3 gm Sheng Jiang 2 slices Hong Zao without pit 7 dates After taking this she was able to enter sleep that night She took one more package and the sweating and aversion to wind decreased obviously Her body temperature became normal The following day I did a follow up visit and she was already able to accept wind and sit up I continued treatment with Ren Shen Yang Rong Tang modified She was cured after 10 days Case 2 Postpartum Vomiting14 Ms Wang was age 22 and came for her initial consultation in March of 1975 From the time 10 days before birth up to 7 days postpartum she vomited continuously Her food intake was very slight She took may western and Chinese medicines without effect I made detailed inquiries with the patient and learned that she was sweating and had a slight aversion to wind Looking I saw that her tongue moss was thin and white Her pulse was slightly floating I gave her Gui Zhi Tang with 10 gm of Fa Xia Because she was vomiting I had her take many small doses After two doses she was able to take in food and the vomiting has stopped The pattern of aversion to wind had been eliminated 14 1981 5 26 Copyright Sharon Weizenbaum 2022

71 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Discussion This patient had vomiting that was related to constrained Qi of the channels and vessels due to pregnancy unregulated Ying and Wei and reversal of stomach Qi When a woman s body is deficient postpartum it is easy for her to contract a wind evil The leads to lack of harmony of the Ying and Wei and so there is unresolved vomiting Gui Zhi Tang harmonizes the Ying and Wei Additionally Fa Xia was added to level the surging descend reversal and stop vomiting Because of this the illness was cured Case 3 Postpartum Wind Cold with Simultaneous Heat15 Ms Huang was 29 and was 4 days postpartum She had rather frequent fever and chills She underwent western medical treatment but this was ineffective Her temperature was 38 9 C 102 02 F and she had a headache dizziness and occasional spontaneous sweating She also had discomfort in her bladder and poor intake of food and fluids with an occasional desire to vomit Her urination was pale yellow and her stool was slightly knotted Her lactation was normal Her tongue was pale red with thin yellow moss and her pulses were soft and floating This was a pattern of postpartum contraction of wind cold with a simultaneous heat evil The treatment principle was to resolve the muscles harmonize Ying clear and discharge the heat evil She was given 2 packages of the Jin Gui formula Yang Dan Tang Gui Zhi 15 gm Huang Qin 10 gm Bai Shao 10 gm Sheng Jiang 3 slices Zhi Gan Cao 6 gm Da Zao 4 dates 15 1984 4 25 Copyright Sharon Weizenbaum 2022

72 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Return visit After the herbs the cold and heat were gone She was still sweating and she was exhausted so the pattern remained unresolved She was then given Gui Zhi Tang and Yu Ping Feng San Gui Zhi 10 gm Bai Zhu 10 gm Bai Shao 15 gm Bei Huang Qi 15 gm Fang Feng 8 gm Sheng Jiang 2 slices Da Zao 3 dates Zhi Gan Cao 6 gm After 3 packages all symptoms had gradually been dispelled and there was a cure Discussion In this case because the patient was postpartum her Qi and blood were deficient and faint and the Yang Qi of her Wei outside was unconsolidated In regard to the composition of Yang Dan Tang historically skilled physicians have had varying opinions There are some that consider it Gui Zhi Tang Some consider it Gui Zhi Jia Fu Zi Tang Both the Wai Tai Mi Yao and the Jin Gui Xin Dian say that it is Gui Zhi Tang with added Huang Qin How about we agree with this later interpretation and leave it at that For this case when we combine the clinical manifestation with the meaning of the Wai Tai formula we can see that Gui Zhi Tang induces sweat resolves the muscles and harmonizes the Ying and Wei Assisting with Huang Qin clears and resolves the heat evil The use of only two packages completely cleared the hot and cold This is a formula that many clinicians ignore However there are clinical patterns for which giving this formula obtains fast results Copyright Sharon Weizenbaum 2022

73 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 4 Postpartum Sweating16 Ms Shao was a 25 year old worder She came for her consultation on May 8 1984 She was postpartum 8 days and her lochia has already stopped Three days previously she contracted a outside evil and had a fever headache aversion to wind and spontaneous sweating She was given 2 packages of Yin Qiao San and she began to sweat ceaselessly She had a headache aversion to wind and an aversion to cold in her bosom Her urination was short and scanty Her tongue was pale with thin white moss and her pulse was floating moderate and weak This was a pattern of postpartum wind damage lack of harmony of Ying and Wei and Yang deficiency sweating The treatment principle was to restore Yang and consolidate the exterior harmonize the Ying and stop sweating She was given Gui Zhi Jia Fu Zi Tang with added flavors Gui Zhi 10 gm Bai Shao 10 gm Shu Fu Pian 6 gm Zhi Gan Cao 6 gm Fu Xiao Mai 20 Sheng Jiang 3 slices Da Zao 3 dates This was decocted in water and given After 2 packages there was already no aversion to wind and cold bosom and sweating had decreased She was given 2 more packages of this formula to protect her and all of the symptoms subsided and there was a cure Learning from experience 16 1986 11 345 Copyright Sharon Weizenbaum 2022

74 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted The pattern of pouring sweat is most often one of lack of consolidation of the Ying and Wei This case was a postpartum blood deficiency with wind damage While nourishing blood and resolving the exterior it is suitable to guard like the saying when there is damaged blood do not induce sweating The sweating method should be used cautiously Sweating can damage the Yang and Yang deficiency leads to an unconsolidated Wei exterior and can cause ceaseless sweating Zhongjing created the method for restoring Yang and consolidating the exterior which speaks to exactly this meaning When this patient was given Gui Zhi Jia Fu Zi Tang the Ying and Wei were harmonized the Yang was restored and the sweating stopped 4 packages led to a complete cure Case 5 Postpartum Body Pain17 Ms Li was a 35 year old peasant She was 15 days postpartum when she caught cold Consequently her four limbs became sore and painful and she had cramps and curling of her hands and feet She took western medicine and vitamins to no avail She received hot needle three times but that only worked at the time and didn t last At the exam her four limbs were sore and painful and the cramping and twisting of her hands and feet was extreme at night Her food intake was normal with slight changes in her bowels and urination Her tongue was pale with thin white moss and her pulses were deep and thin This was still postpartum Qi and blood deficiency weakness The Wei Yang was not consolidated and so she contracted a wind evil This gave rise to the illness that constrained and blocked the Qi and blood and cramped the tendons and vessels The treatment was primarily to harmonize the Ying and boost the Wei while simultaneously soothing the tendons and vitalizing the Luo Gui Zhi 15 gm Jiu Bai Shao 20 gm Sheng Jiang 20 gm 17 1986 11 345 Copyright Sharon Weizenbaum 2022

75 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Da Zao 5 dates Gan Cao 10 gm Dang Shen 15 gm Mu Hua 10 gm Dang Gui 6 gm Gou Teng 5 gm She was given 1 package and the pain decreased by half After 3 packages the cramping of her hands and feed was gone and then she was given 2 more packages All of the symptoms were then gone and her limbs and body moved freely Case 6 Post Termination External Contraction18 Ms Zai was age 33 She was a shop keeper She came in on January 5 1989 with main complaint of post termination external contraction Disease history 2 days previously she had had a surgical abortion She was not cautious in her recovery and so she contracted wind cold She had a headache pain and soreness of her four limbs and clear nasal discharge She took a quick acting cold medicine for stubborn phlegm but there was no improvement On the contrary her whole body became painful and so she came for a consultation At the visit her facial color was sallow white She had an aversion to cold cold sore painful limbs and arms abundant sweating and sleepiness Her breath was short and her speech was weak Her tongue was pale red with scanty moss Her pulse was floating and thin without strength This as differentiated as a pattern of wind cold damp evil oppressing the exterior and a Ying Wei disharmony The treatment principle was to resolve the exterior and scatter cold regulate and harmonize the Ying and Wei dispel wind and open through the Luo Gui Zhi Xin Jia Tang was used 18 1991 5 35 Copyright Sharon Weizenbaum 2022

76 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Zhi 12 gm Bao Shao 24 gm Sheng Jiang 15 gm Da Zao 5 dates Zhi Gan Cao 10 gm Lu Dang Shen 30 gm Mu Hua 10 gm Dang Gui 15 gm Bai Zhu 15 gm Huang Qi 30 gm Shen Jin Cao 10 gm Fang Feng 6 gm After 6 packages all of the symptoms decreased There was head dizziness heart palpitations abundant sweating still which was related to a deficient exterior and unconsolidated Ying and Wei Da Zao was raised to 15 gm and 11 pieces of Xiao Zao Suan Zao Ren and 30 gm each of Duan Long Gu Duan Mu Li and Fu Xiao Mai was added Case 7 Postpartum External Contraction19 Ms Liu was a 28 year old worker when she came for her first consultation in November of 1990 11 months previously she had given birth to a child by cesarean section Because 19 1996 10 43 Copyright Sharon Weizenbaum 2022

77 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted she lost a lot of blood she felt heart palpitations and weakness She also had abundant sweating and at times some surging heat The night before she had gotten out of bed to nurse her child and she was struck with shivering In the morning she got up with an aversion to wind and cold and a fever of 38C She was dizzy with a headache nasal stuffiness and running of clear mucous and abundant sweating She took a package of Jie Re Zhi Tong San but the symptoms did not resolve and the sweating became worse Her tongue was pale red with thin white moss and her pulse was floating thin and slightly rapid This was a combined pattern of external contraction exterior deficiency and insufficiency of Qi and blood The treatment was to resolve the muscles and harmonize the Ying enrich and nourish the Yin and blood Yang Dan Tang was used with added Shu Di Gui Zhi 10 gm Bao Shao 10 gm Sheng Jiang 6 gm Da Zao 3 dates Gan Cao 3 gm Shu Di 10 gm Dang Gui 10 gm At her second visit she reported that after 2 packages the disease characteristics changed for the better The common cold symptoms of aversion to wind and cold and heat effusion had completely resolved She still had heart palpitations weakness and abundant sweating She continued with the Yang Dan Tang adding Xi Yang Shen stewed and there was a complete cure Copyright Sharon Weizenbaum 2022

78 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 8 Postpartum External Contraction20 Ms Deng was age 28 and came for her initial consultation in January of 1994 Three days after giving birth a half month ago she was incautious and contracted cold She had not rested as she should In the beginning she had aversion to cold and heat effusion runny nose with clear mucous She took some medicine to clear the cold but the effect was not good 10 days later she felt a headache dizziness aversion to wind cold and slight heat effusion She was sweating profusely with nasal stuffiness stomach fullness and a wish to vomit She had no interest in food Her tongue was pale red with moist slightly sticky white moss and her pulses were soft floating and slightly rapid This was a combined pattern of external contraction exterior deficiency and damp oppressing the central Yang and lack of harmony in the stomach The treatment was to resolve the muscles and harmonize the Ying warm the stomach and dispel damp Yang Dan Tang was used with added Bai Kou Ren and Chen Pi Gui Zhi 10 gm Bao Shao 10 gm Sheng Jiang 6 gm Da Zao 3 dates Gan Cao 3 gm Bai Kou Ren 10 gm Chen Pi 10 gm After two packages there was a cure 20 1996 10 43 Copyright Sharon Weizenbaum 2022

79 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 9 Postpartum Spontaneous Flow of Breast Milk21 Ms Zhang was age 24 and a worker She came for her consult on May 11 1985 Her complain began when she was 6 days postpartum and her breast milk would spontaneously flow out At the time of her visit it had gone on for more than 20 days She had taken many formulas without having any effect Hence she came in for a consultation Her body was emaciated and her handkerchief was moist She suffered from mental weariness lack of strength heart palpitations shortness of breath aversion to wind abundant sweating and a sallow facial complexion Her tongue was pale with a thin white moss and her pulses were thin and faint This was a pattern of spleen and stomach Qi deficiency with abnormal absorption and consolidation The treatment had to boost and supplement the spleen and stomach consolidate and absorb the breast milk She was given Gui Zhi Jia Long Gu Mu Li Tang modified Gui Zhi 6 gm Bai Shao 6 gm Zhi Gan Cao 6 gm Duan Long Gu 30 gm Duan Mu Li 30 gm Huang Qi 15 gm Mai Ya 20 gm Sheng Jiang 3 slices Da Zao 3 dates This was decocted in water and after 2 packages she was not leaking breast milk and all of the other symptoms had gone A follow up showed there was no relapse 21 1991 5 221 Copyright Sharon Weizenbaum 2022

80 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Discussion The says When breast milk spontaneously leaks out after birth the stomach Qi is deficient In this case this was true The spleen and stomach were deficient so that there was no power to absorb and consolidate and hence there was spontaneous leakage of breast milk She was given Gui Zhi Jia Long Gu Mu Li Tang as treatment and this was effective There was a cure after two packages Case 10 Postpartum Lack of Breast Milk22 Ms Li was age 23 and worked as a peasant She was postpartum by a month and her breast fluid was watery and scanty She has tried many methods for 2 weeks but her breast fluid got more and more scanty until it was just drops On November 11 1992 she came in for a consultation Her two breasts were large yet soft She had mental weariness a poor appetite aversion to wind frequent spontaneous sweats and a pale tongue Her pulse was thin and moderate At 10 days postpartum she discharge a lot of blood Coordinating the pulse and pattern the diagnosis was a Ying Wei disharmony type scanty lactation She was given 3 packages of the following formula Gui Zhi 12 gm Bai Shao 12 gm Zhi Gan Cao 6 gm Sheng Jiang 6 gm Da Zao 15 gm This was decocted in water She was directed to take sips of hot gruel when the herbs created a sweat At the second visit the sweating and aversion to wind had clearly decreased She was given the above formula increasing the Bai Shao to 20 gm She took 22 2 1993 4 18 Copyright Sharon Weizenbaum 2022

81 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted 6 more packages At the third visit there was no sweating or aversion to wind and her appetite had increased Her breast became distended and full and the breast milk gradually flourished Her nursing was then normal Discussion Breast milk is transformed from the essence and blood Blood fluid issues from the same source When fluids are forced out there is no blood and when the blood is scanty this leads to scanty lactation In this case there was frequent sweating as well as loss of blood during the birth The Ying and blood were internally damaged and the Qi was without nourishment This led to a lack of harmony of the Ying and Wei so that Yin fluids leaked out and so that there was no source for the breast milk s transformation and generation Externally Gui Zhi Tang regulates the Ying and Wei so that the Ying and blood are protected Internally it can harmonize the spleen and stomach so that breast milk is transformed and generated It was given in an extremely timely way so it obtained great results Case 11 Menstrual Related Wind Rash23 Ms Zhu was age 40 and was a housewife She came for her initial consultation on March 11 1988 Three months previously at 48 days she had an abortion After the surgery she bled a lot It began to clear after half a month After this at the time of her menstruation she would sweat and experience aversion to wind At this time she also broke out in a rash It was extremely itchy and difficult to bear It would retreat when her menstruation stopped She repeatedly took antihistamines hormone and Chinese herbs to dispel wind and stop itch but the results were not clear Her facial complexion was dull and her muscles and skin lacked moisture Her tongue was pale with white moss Her pulses were thin and rapid This was a case of Ying Yin insufficiency blood deficiency generating wind and unconsolidated Ying Wei She was given modified Gui Zhi Tang 23 1991 5 207 Copyright Sharon Weizenbaum 2022

82 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Zhi 10 gm Bai Shao 15 gm Zhi Gan Cao 6 gm Sheng Jiang 6 gm Da Zao 5 dates Dang Gui 6 gm Zhi Shou Wu 30 gm Huang Qi 20 gm She was given 7 packages When her menses came the rash had decreased and the sweating and aversion to wind was less She was given 7 more packages and finished Case 12 Menstrual Itching24 Ms Wang was age 26 For more than a year at menstruation she had an itchy skin rash It began when she menstruated and was serious during the flow It would diminish when her bleeding finished Her muscles and skin were shivery cold with a feeling of ants crawling on her There was purple pigmentation where she scratched her body Her tongue moss was thin white and her pulses were floating and moderate The pattern belonged to wind evil making itself at home on the exterior lack of harmony of the Ying and Wei blood deficiency and lack of nourishment of the skin and muscles She was given Gui Zhi Tang with added Dang Gui Gui Zhi 9 gm Bai Shao 9 gm 24 1991 6 42 Copyright Sharon Weizenbaum 2022

83 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zhi Gan Cao 3 gm Sheng Jiang 3 slices Da Zao 5 dates Dang Gui 9 gm She took 6 packages when her menstruation arrived and for three months there was no outbreak She was cured The gynecological application of Gui Zhi Tang for the stages of a woman s life25 The patho mechanism of the Gui Zhi Tang pattern is lack of harmony of the Ying and Wei The location of the illness is on the exterior in the muscles and interstices The manifesting symptoms are heat effusion aversion to wind sweating head pain heat and cold Wei is transformed from Yang and Qi and Ying is transformed from Yin and blood Actually Ying and Wei are the two Qi Yin and Yang as they are spread over the exterior of the body Ying moves from within the vessels and Wei moves from outside the vessels Ying guards the interior and Wei consolidates the exterior The two are harmonized together and form a screen on the surface layer A disharmony of the Ying and Wei can generate disease in a short time This can cause an exterior contraction of a wind evil This can also cause a Ying Wei spontaneous disease Many Gui Zhi Tang gynecology diseases belong to this later cause Blood is the basis for women Before and after menstruation the Qi and blood enter the uterus If the body s surface Qi and blood is weak and deficient the two Qi Ying and Wei 25 430014 Copyright Sharon Weizenbaum 2022

84 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted will shortly become disharmonious with unilateral dominance and unilateral decline 26 If during pregnancy the Yin and blood are damages this can lead to the body surface Ying and Wei to become correspondingly diminished and disharmonious During birth it is very easy for the blood to be consumed and the Qi to be damaged During the time of nursing blood and Qi are transformed into milk All of this can cause the Qi and blood to be insufficient and influence the replenishment of the Ying and Wei At the time of menopause the kidney Qi gradually diminishes There may be damage to the Yin or to the Yang and this can have repercussions for the surface of the body so that a Ying and Wei disharmony emerges One can see that the physiological processes of women make it easy for them to develop a disharmony of Yin Yang and therefore manifest a disharmony of Ying Wei pattern Therefore it is important to emphasize the nourishment of Yin and the harmony of Ying in gynecological Gui Zhi Tang patterns Because of this the dose of Bai Shao is usually larger than that of Gui Zhi Zh ng J ng established to dosages of these two herbs Some say that I am using Xiao Jian Zhong Tang and not Gui Zhi Tang when I use more Bai Shao this way However this is not correct In Xiao Jian Zhong Tang Shao Yao is twice as much as Gui Zhi When I use this formula I use an equal or slightly larger dose of Shao Yao in relation to Gui Zhi Therefore it is still Gui Zhi Tang According to the particular characteristics of each time period During the time a woman is menstruating Gui Zhi Tang can be combined with Si Wu Tang to nourish and harmonize the blood During pregnancy when there is a pregnancy reaction27 Ju Pi and Zhu Ru can be added to harmonize the stomach and descend reversal In the postpartum time Gui Zhi Tang can be used with Sheng Hua Tang to nourish the blood and transform stasis During menopause Gui Zhi Tang can be used with Zuo Unilateral means that the Ying and Wei have come out of relationship with each other so they are alone The Wei out of relationship with the Ying surges upward and the Ying out of relationship with the Wei drips out 26 27 Pregnancy reaction means nausea and vomiting in pregnancy Copyright Sharon Weizenbaum 2022

85 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Wan or You Gui Wan to regulate and supplement the Yin and Yang of the kidneys This way the root is treated If Qi deficiency is clearly manifesting add Ren or Dang Shen and Huang Qi Below are some cases to enrich our understanding 1 Dysmenorrhea Ms Hu was age 24 Originally she suffered from painful menstruation In the last year she began to feel cold before her menstruation After this on the first day of menstruation she felt abdominal pain with an urge to vomit Her body was cold with an aversion to wind sweating occasional fever and nasal stuffiness Her blood was scanty and dark with clots The diagnosis was cold stasis in the uterine vessels and a Ying Wei disharmony The treatment principle was to warm the menses transform stasis and regulate and harmonize the Ying and Wei She was given modified Jing Xing Gui Zhi Tang 28 Gui Zhi 8 gm Bai Shao Yao 12 gm Dang Gui 10 gm Chuan Xiong 8 gm Da Zao 5 dates Zhi Gan Cao 5 gm Sheng Jiang 3 slices Ban Xia 10 gm Xuan Hu Yan Hu Suo 10 gm Niu Xi 10 gm 28 is menstrual movement Gui Zhi Tang Copyright Sharon Weizenbaum 2022

86 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Wu Zhu 8 gm Xiang Fu 10 gm After three packages her menstruation arrived and it was without aversion to wind sweating or vomiting There was a mild degree of abdominal pain and feeling cold From the above formula Ban Xia and Niu Xi were removed 12 gm of Dan Shen and 8 gm of Hong Hua were added and she was given 3 packages At the return visit she reported that the amount of blood had increased and the blood clots were fewer and smaller The color of the blood had changed to red After her menstruation the treatment principle was to warm the kidneys and uterus and generally regulate This continued for half a year and her menstruation was then without discomfort 2 Nausea and vomiting of pregnancy Ms Zhang was age 32 Her menstruation had not arrived for 50 days In the last week she began to feel hot at times and then cold at other times She had heart vexation poor appetite frequent vomiting Her pulses were thin slippery and rapid Her tongue was pale red with thin yellow moss The exam revealed an anteverted uterus that was slightly large with a soft body The urine test was positive for pregnancy The diagnosis was a Ying Wei disharmony with the fetal Qi reversing upward The treatment principle was to regulate and harmonize the Ying and Wei help the Qi flow and descend reversal She was given Ren Shen Gui Zhi Tang 29 Gui Zhi 8 gm Bai Shao Yao 10 gm Zhu Ru 10 gm Mai Dong 10 gm Da Zao 5 dates 29 is pregnancy Gui Zhi Tang Copyright Sharon Weizenbaum 2022

87 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zhi Gan Cao 5 gm Sheng Jiang 3 slices Tiao Shen30 12 gm Chen Pi 6 gm Mei Gui Hua 6 gm After 3 packages the cold and heat diminished and the vomiting became very mild She had some vexation so though the disharmony of the Ying and Wei had gradually regulated the stomach Yin was insufficient I continued with the above formula removing the Gui Zhi and adding 15 gm of Shi Hu After 5 packages there was a cure 3 Postpartum fever and body pain Ms Qi was age 30 When she was 12 days postpartum she developed a fever with spontaneous sweating She also had a headache with body pain Her pulse was floating and moderate Her tongue moss was pale yellow This was postpartum blood deficiency with the contraction of a wind evil and unharmonious Ying and Wei The treatment was to nourish blood resolve the muscles and regulate and harmonize Ying and Wei She was given Chan Hou Gui Zhi Tang 31 Gui Zhi 9 gm Bai Shao Yao 12 gm Dang Gui 12 gm Shu Di 10 gm 30 This is the root of Soroseris umbrella Franch Stebb Crepis umbrella Franch It is bitter sweet and warm It enters the spleen and stomach channels It supplements and boosts Qi and blood and is used for whole body weakness dizziness and lack of strength in the 4 limbs 31 is postpartum Gui Zhi Tang Copyright Sharon Weizenbaum 2022

88 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Da Zao 4 dates Zhi Gan Cao 6 gm Pao Jiang 3 slices Chuan Xiong 9 gm After 2 packages the heat decreased by more than half There was no more head or body pain She still felt weak and had a poor appetite Her pulses were moderate and her tongue moss was white I continued to harmonize her Ying and Wei and assisted this by restoring her spleen and boosting her Qi I added 12 gm of Dang Shen and Bai Zhu After 3 packages the fever retreated and her appetite increased Ms Shu was age 46 2 months after surgery to remove her uterus and ovaries she began to have intermittent sweating She would feel hot or cold with dizziness and agitation Her low back was sore and her limbs were cold Her pulses were deep and thin and her tongue was purplish and dark with thin white moss The diagnosis was dual deficiency of Yin and Yang and lack of harmony of the Ying and Wei The treatment principle was to enrich the Yin and warm the Yang regulate and harmonize the Ying and Wei She was given Geng Nian Qi Gui Zhi Tang 32 Gui Zhi 8 gm Bai Shao Yao 12 gm Gou Qi 12 gm Yin Yang Huo 12 gm Da Zao 5 dates Zhi Gan Cao 5 gm Nu Zhen Zi 12 gm 32 is menopausal Gui Zhi Tang Copyright Sharon Weizenbaum 2022

89 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Shan Yao 10 gm Shan Zhu Yu 10 gm Tu Si Zi 15 gm Jiang 3 slices After 3 packages the cold and heat and sweating greatly decreased She was given another 3 packages and all of the pathology resolved A half year later she came back because of back soreness cold body lack of strength and vexatious heat when she was entering sleep I supplemented both Yin and Yang with Yang being the primary After 10 days of herbs she was cured Unpacking Gui Zhi Tang Introduction to Unpacking Gui Zhi Tang By Sharon Weizenbaum Any formula that contains two herbs or less is a teeny tiny formula in my book Not that I ve written my book yet Within Gui Zhi Tang there are two teeny tiny formulas The beauty of knowing these teeny tiny formulas is that they shed immense light on the function of a larger formula that contains them Gui Zhi Tang itself is a small formula with just five ingredients It is interesting that such a small formula can still house two more formulas inside it Below are discussions several physicians about these formulas They emphasize the fact that Gui Zhi Tang not only harmonizes the Ying and Wei but also harmonizes Qi and blood and Yin and Yang It is through the action of these two teeny tiny formulas that Gui Zhi Tang s action goes beyond harmonizing the Ying and Wei Copyright Sharon Weizenbaum 2022

90 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Zhi Gan Cao Tang uses sweet and pungent to transform Yang Shao Yao Gan Cao Tang uses sweet and sour to transform Yin What does it mean to transform Yin and Yang here We have the sense that they are untransformed and need transforming What does this mean How do sweet and pungent work together to transform Yang and how do sweet and sour work together to transform Yin Why is it that sweet licorice is the common flavor between these two formulas To start we can look at the common denominator of these two formulas Gan Cao Gan Cao is the sweetest herb in the pharmacopeia It is really the essence of sweetness The sweet flavor nourishes In both the Tang Ye Jing and Neijing the sweet flavor is said to supplement the spleen Supplementing the spleen with sweetness means to add substance bring in more good stuff When sweet Gan Cao is combined with pungent Gui Zhi we can liken this to putting a fire Gui Zhi under a cooking pot that is filled with water potatoes and carrots Gan Cao This is because the pungent flavor ascends and Gui Zhi is warm as well so it is like a gentle fire going into the spleen earth Transforming Yang means to not only increase Yang but to give Yang substance to inhabit and warm Hot soup is cold water and vegetables that have been transformed by fire into something nourishing This is how sweet and pungent transform Yang Untransformed Yang is Yang that has not been strong enough to penetrate cold Yin and transform it into warm steam When the sweet Gan Cao is combined with the sour bitter cool Bai Shao there is a somewhat opposite action Substance is added with the Gan Cao s sweetness and then the sour bitter quality of Bai Shao moves that substance downward into the interior bitter and keeps it there sour thereby enriching substance or Yin Untransformed Yin is Yin that is not abundant enough and also not well contained Shao Yao Gan Cao Tang transforms Yin by nourishing Yin bringing it inward and keeping it there Copyright Sharon Weizenbaum 2022

91 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted When Gui Zhi Gan Cao Tang is combined with Shao Yao Gan Cao Tang both Yin and Yang are transformed This is how Gui Zhi Tang transforms Yin and Yang Since Yang within Yin is the root of the Qi within the blood Gui Zhi Tang also harmonizes Qi and blood Since the Qi within the blood is the root of the Ying and Wei Ying and Wei are also harmonized by Gui Zhi Tang Liu Du Zhou33 Gui Zhi Tang regulates and harmonizes the Ying and Wei The foundation of this is the regulation and attention to Yin and Yang Gui Zhi Tang contains Gui Zhi Gan Cao Tang In this formula pungent and sweet transform the Yang It also contains Shao Yao Gan Cao Tang in which sour and sweet transform the Yin When Yin and Yang are harmonized the exterior and interior are also harmonized Therefore Gui Zhi Tang not only treats contraction of and exterior evil it also treats miscellaneous illnesses Yu Guo Jun34 Cinnamon Twig Decoction gui zhi ta ng is the first formula mentioned in the Discussion of Cold Damage Sha ng h n lu n and is the ancestor of all formulas Within the formula are two others Cinnamon Twig and Licorice Decoction gui zhi ga n ca o ta ng and Peony and Licorice Decoction sh o ya o ga n ca o ta ng The former is acrid and sweet it transforms yang to adjust yin The latter is sour and sweet it transforms yin to adjust yang The combination of the two gives Cinnamon Twig Decoction gui zhi ta ng the capacity to adjust and harmonize the yin and yang of the entire body In regard to the body yin and yang relate to the blood and qi and blood and qi relate to the nutritive and protective aspects The ancients glowingly praised the ability of Cinnamon Twig Decoction gui zhi 33 From Collected Classic Formula Case Studies from Renowned Physicians complied by Chen Ming and Zhang Yin Sheng 1998 Xue Yuan Publishers Bei Jing 34 A Walk Along the River Transmitting a Medical Lineage through Case Records by Yu Guo Jun Translated by Andrew Ellis Michael Fitzgerald and Craig Mitchell Eastland Press 2017 Copyright Sharon Weizenbaum 2022

92 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted ta ng to address external disorders by releasing the muscle layer and harmonizing the nutritive and protective aspects and to address internal disorders by transforming qi and adjusting yin and yang From a clinical viewpoint a large number of chronic stubborn and complex patterns are lingering and difficult to cure Although they have a complex disease origin and disease dynamic equally so based on a Western medical etiology in the final analysis these disorders fall into the category of disharmony between the nutritive and protective aspects This disharmony may be between the blood and qi between the yin and yang or a combination of the two Huang Huang Notes on Gan Cao35 Gan Cao primarily treats emaciation with throat pain cough with spittle restlessness anxiety pain inversion and palpitations Emaciation often refers to being skinny with withered muscles and skin color In the clinic it is suitable to use Gan Cao in a large dose or over a long period of time for patients who are emaciated It is not suitable to use if for people with edema or who are plump It can be said that emaciation is what Gan Cao primarily treats Yan4 Tong4 Throat pain is when the larynx and pharynx area has pain A feeling of dryness or burning often accompanies this The local area becomes swollen and red In modern times Gan Cao is used to treat acute or chronic type throat inflammation It is able to ease the irritating effect on the throat s mucous membrane 35 From lecture notes translated by Sharon Weizenbaum for a 2008 course with Huang Huang at White Pine Institute Amherst MA 01002 Copyright Sharon Weizenbaum 2022

93 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Ke2 Tuo4 Coughing spittle This is cough with expectoration of phlegm especially thick sticky phlegm In Zhang Zhong Jing s time this was called turbid spittle Therefore Gan Cao treats cough and this often refers to a choking violent cough cough with throat pain cough with expectoration of sticky phlegm or phlegm with pus For this purpose Gan Cao is often combined with Jie Geng or Ban Xia Zao4 restlessness is namely the feeling of not being at peace Within this there is fan zao and Zang Zao Fan Zao is often seen after vomiting in which there is a great loss of body fluid or when the body is especially weak It is also seen when there is incessant diarrhea leading to heart palpitations Zhang Zhong Jing often mixed it with Gan Jiang and Ren Shen in these cases Zang Zao is an ancient disease name It manifests with being sorrowful and wanting to cry as well as wanting to stretch and yawn This is most often seen in women Zang Zao in women in which they are sorrowful and like to cry with a lot of yawning It is as if this is being done by a spirit 22 In the Jin Gui Yao Lue Zhang uses Gan Mai Da Zao Tang When there is illness with lots of tension lack of peace fright and restlessness this can all be categorized as Zao The one flavor soup Gan Cao Decoction also went by another name in ancient times Wang You Decoction Decoction for forgetting cares and worries Ji2 Tension This term refers to muscle spasms as well as when being keyed up results in pain It also refers to the muscles becoming stiff For example leg spasm Ji mid back Ji pain and tenesmus Shao Yao Gan Cao Tang is used for leg spasms Tong4 Pain here is tense pain which is spastic type pain Copyright Sharon Weizenbaum 2022

94 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Ni4 Inversion here is vomiting and cough inversion type illness Zhu Ru Shi Gao Tang treats a thin patient with weak breathing after damage from cold Their Qi rebels and they have a desire to vomit Mai Men Dong Tang treats Great Qi upward inversion with unproductive cough 7th There is also Gan Cao Xie Xin Tang which treats diarrhea and dry retching Ji4 Palpitation with fear This mostly refers to palpitation below the heart and a moving feeling below the navel This is mostly seen in thin people and is accompanied by arrhythmia shortness of breath and lack of strength In this case Gan Cao is often combined with Gui Zhi Ren Shen Fu Ling Long Gu and Mu Li It must be pointed out that many of the classical formulas contain Gan Cao but that among most of these formulas Gan Cao only has a secondary role Dr Zuo Shu in his Ben Jing Shu Zheng writes The Shang Han Lun and Jin Gui Yao Lue contain 250 formulas 120 of which contain Gan Cao Yet most of these formulas are not for Gan Cao type illnesses Therefore the formulas are selected according to the characteristics of the illness yet must use Gan Cao For example there are formulas that combine Gan Cao with Ma Huang Fu Zi Wu Tou Ren Shen Da Huang Shi Gao and Long Gu In these formulas the principle effect of Gan Cao is synergistic and resolving of toxins This is why later generations say that Gan Cao is a regulating and harmonizing herb Traditionally in Chinese medicine Gan Cao is a resolve toxin medicinal It is used for problems such as boils and ulcers and surgical infections It is also used for food poisoning as well as drug poisoning Copyright Sharon Weizenbaum 2022

95 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gan Cao in Formulas When emaciation is a principle characteristic of an illness for example in chronic adrenal cortex insufficiency chronic hepatitis cirrhosis of the liver and AIDS it is suitable to use large amounts of Gan Cao When throat pain is the principle symptom for example chronic pharyngitis or edema of the larynx Gan Cao is often combined with Jie Geng and Ban Xia in formulas such as Jie Geng Tang For oral mucous membrane broken sores for example mouth ulcers or Bechet s disease Gan Cao is often combined with Huang Lian or Huang Qin in Gan Cao Xie Xin Tang For an illness in which cough is a main complaint for example chronic type bronchitis bronchial asthma sore throat or pulmonary tuberculosis often compounded formulas are used For illnesses in which heart palpitations are a main complaint for example morning wrestle Zao Bo arterial fribulation tachycardia sick sinus syndrome viral myocarditis or valvular heart disease Gan Cao is often combined with Ren Shen Di Huang and Mai Dong in formulas such as Zhi Gan Cao Tang For illnesses characterized by trance like states and twitching such as neurosis menopausal syndrome schizophrenia epilepsy somnambulism early childhood hyperactivity Gan Cao is often combined with Da Zao Xiao Mai Bai He Suan Zao Ren in formulas such as Gan Mai Da Zao Tang and Suan Zao Ren Tang Copyright Sharon Weizenbaum 2022

96 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted For surgical infections Gan Cao is often combined with Lian Qiao Chi Shao Jin Yin Hua in formulas such as Si Miao Yong An Tang For food poisoning Gan Cao can be used to assist in resolving toxins Addendum 1 Gan Cao and the formulas Gan Cao is in principally treat the following types of illnesses A Withered type emaciation B Spastic type muscle spasms and angina pain C Irritation pain type throat pain and mucous membrane ulcers D Restlessness type Heart palpitations and restless organ E Bursting out type poisoning and surgical infections 2 There is a lot of room for varying the amount of Gan Cao used in formulas This is determined completely based on the characteristics of the illness and the compatibility of medicinals In general we could say that for emaciated people and acute illness a large amount can be used 30 grams or even more 3 One should pay attention to the side effects of Gan Cao When large amounts of Gan Cao are used or when Gan Cao is used over a long period of time 20 of the patients develop water swelling lack of strength in the 4 limbs dizziness headache hypertension or low blood potassium For elderly patients with vascular or kidney disease excessive Gan Cao can easily lead to hypertension or congestive heart disease It can also have the effect of bringing about obesity constipation Copyright Sharon Weizenbaum 2022

97 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted excessive stomach acid or induce epilepsy I ve learned from experience that when you use Gan Cao for a relatively long period of time it can be combined with Fu ling Ze Xie or Bai Zhu These herbs have a definite effect on the symptom of water swelling 4 In the Shang Han Lun the percentage of formulas containing Shi Gao that also contain Gan Cao is 100 Other percentages are as below A Similar use i Long Gu 100 ii Gui Zhi 95 iii Da Zao 90 iv Sheng Jiang 87 1 v Chai Hu 85 7 vi Bai Shao 81 8 vii Ban Xia 77 7 viii Ren Shen 77 2 ix Gan Jiang 70 8 x Fu Ling 66 6 xi Fu Zi 65 2 B Relatively small amount i Da Huang 14 ii Zhi Shi 14 2 iii Zhi Qiao 25 iv Mang Xiao 33 3 Copyright Sharon Weizenbaum 2022

98 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted The later category is what in Chinese medicine is called purgative herbs and herbs for clearing heat and discharging fire This points out that Gan Cao is not to be used in every formula If you need to use attacking herbs such as Da Huang Mang Xiao Gan Sui or Da Ji or clearing heat disinhibiting damp heat herbs such as Huang Lian or Shan Zhi you can either not use Gan Cao or use a small amount If the patient has abdominal distention also use a small amount or none at all or use it with herbs to rectify the Qi such as Zhi Shi or Hou Po Notes on Shao Yao Shen Nong Ben Cao Jing The Qi and flavor are bitter and neutral Shao Yao governs the evil Qi of abdominal pain eliminates blood Bi breaks hard accumulations cold and heat mounting accumulation stops pain disinhibits urine and boosts Qi Chen Xiu Yuan said Shao Yao s Qi is neutral it is a summer flower and inherits the Qi of dry metal The flavor is bitter and obtains the flavor of Shao Yin imperial fire Its Qi is neutral descending and down bearing the bitter flavor drains the lower body and moves the blood This is because it is a medicinal for offensive purgation it is not a plant that supplements and nourishes 36 From Reading the Divine Farmer s Classic of the Materia Medica by Chen Xiu Yuan Translated by Corinna Theisingerm Chinese Medicine Database 2016 36 Copyright Sharon Weizenbaum 2022

99 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Huang Huang Notes37 Principle Indications The principle indication for Bai Shao is pain The pain that Bai Shao treats is tense pain and this refers to pain that is spastic pain that has a tight contracted feeling and pain that is paroxysmal Stomach spasms intestinal spasms gastrocnemius muscle spasms diaphragmatic spasms spasms of the involuntary muscles of the Fu organs and spasms of the anal sphincter and skeletal muscles of the torso are all within the domain of this sort of pain Specifically speaking there are the following few types Spasms of the foot Treating spasms of the foot was a special effect of Shao Yao in ancient times In the Shang Han Lun it says foot spasm use Shao Yao Gan Cao Tang and the foot will be able to stretch It can be seen that Zhang Zhongjing saw the correspondence between getting rid of foot spasms and Shao Yao Gan Cao Tang The Zhu Dai Ji Yan Fang The Collected Formulas of Dr Zhu Zhu Dan Xi that Shao Yao Gan Cao Tang treats weakness of the feet with difficulty walking and is also known as Qu Zhang Tang This is one type of sinew tension that leads to weakness of the feet Spasms of the foot mean that the stretching of the foot is distorted and not advantageous It can also mean that there are spasms in the muscles and flesh of the lower limb especially of the gastrocnemius muscle The patient will often complain of lower limb pain and difficulty walking or lower limb deep muscle soreness On the other hand this may also manifest as 37 From lecture notes translated by Sharon Weizenbaum for a 2008 course with Huang Huang at White Pine Institute Amherst MA 01002 Copyright Sharon Weizenbaum 2022

100 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted lower back and leg pain an inability to bend the lower limbs or an inability to walk The patient who has this characteristic symptom has a a Shao Yao Foot Abdominal pain Xiao Jian Zhong Tang Gui Zhi Jia Shao Yao Tang are similar to Gui Zhi Tang However they differ in that the amount of Bai Shao is larger than the amount of Gui Zhi This changes these formulas into formulas for stopping pain The primary indication for Xiao Jian Zhong Tang is tense pain in the abdomen clause 100 Also tension from exhaustion pain in the abdomen 6 Gui Zhi Jia Shao Yao San is indicated for abdominal fullness and pain clause 279 this is paroxysmal pain and is often accompanied by spastic pain This tense pain in the abdomen is abdominal pain appearing with spasms and paroxysmal type It may be on the upper abdomen around the umbilicus or on the lower abdomen It could also connect to the back or genitals The Yi Yao Xin Wu Understanding the Heart of Herbs says that Shao Yao Gan Cao Tang treats abdominal pain like is this a typo It could be shen like stretch The Lei Ju Fang Guang Yi The Broad View of Gathered Formulas says this is for pediatric unceasing night crying with abdominal spasms The clause below Xiao Chai Hu Tang recommends When there is pain in the abdomen take out the Huang Qin and add 2 liang of Bai Shao Zhi Shi Shao Yao San treats postpartum abdominal pain All of this points out that Bai Shao treats abdominal pain Formulas 1 For illnesses in which foot pain is a main complaint such as spasms of the gastrocnemius muscle restless leg syndrome thrombosis of the leg vein sciatica diabetes and cirrhosis of the liver Bai Shao can be combined with Gan Cao Fu Zi Copyright Sharon Weizenbaum 2022

101 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Niu Xi and Shi Hu in formulas such as Shao Yao Gan Cao Tang and Shao Yao Gan Cao Fu Zi Tang 2 For illnesses characterized by muscles spasms consider using Shao Yao Gan Cao Tang 3 For illnesses in which abdominal pain is a main complaint such as duodenal ulcers pediatric abdominal pain dysmenorrhea Gallstones urinary stones irritable bowel syndrome dysentery habitual constipation and dysmenorrhea Bai Shao is often combined with Gan Cao zhi Shi Chai Hu and Huang Qin in formulas such as Shao Yao Gan Cao Tang Xiao Jian Zhong Tang Zhi Shi Shao Yao San Huang Qin Tang and Si Ni San 4 It is often appropriate to use modified Shao Yao Gan Cao Tang for cirrhosis of the liver in formulas such as Zhen Wu Tang Xiao Jian Zhong Tang and Si Ni San 5 When Shao Yao is combined with Sheng Di Huang and San Qi it is able to stop bleeding Addendum 1 Chi Shao and Bai Shao are not differentiated in the Shang Han Lun In the Song dynasty and afterwards formulas started to differentiate between Chi Shao and Bai Shao It is customary to consider Bai Shao as an herb to nourish blood and emolliate the liver It is used for illnesses with muscle and flesh spasms Chi Shao Copyright Sharon Weizenbaum 2022

102 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted is mainly for vitalizing blood and transforming stasis It is used and is effective when the tongue is dark purple or when the blood fluid is viscous 2 Bai Shao is mostly used for thin people Ji Yi Dong put forth the idea that is it for when the abdominal skin is spasming and tense as well as not slack with pressure He also pointed out that it is for patients with a thin body type If the patient if plump with a large potbelly Bai Shao should be used with caution Yet if the patient is constipated with stool like a horse chestnut Bai Shao is quite suitable The tongue and pulse for Bai Shao is rather idiosyncratic and unclear As long as there is spastic pain it doesn t matter if the tongue is plump and large or thin and small and it doesn t matter if there is sticky tongue moss or if the tongue is glossy red You can still appropriately use Shao Yao Notes on Rou Gui38 I was delighted when I found these writings on Rou Gui by the classic formula doctor Wu Pei heng I love his experiential formulas at the end of this piece The flavor is sweet and pungent and the Qi is fragrant The character is warm Rou Gui enters the foot Jue Yin liver channel It warms the liver and heats the blood breaks stasis and disperses hard lumps expels damp and cold from the back and legs drives out abdominal and rib side pain strengthens the heart zang and warms and heats up cold damp in the blood level When deficiency fire floats upward Rou Gui will induce it to 38 Well Known Physicians of the Sichuan School Collection Wu Peiheng Compiled by Shu Shanshan Chinese Traditional Medicine Press 12 2018 Translated by Sharon Weizenbaum Copyright Sharon Weizenbaum 2022

103 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted return to the source For presentations of tooth pain throat pain pain at the center of the stomach or sudden cough Rou Gui is quite useful Adding Jiang and Fu to Rou Gui greatly increases its strength This combination can snatch a person from the jaws of death For a person whose body is weak and deficient with Yang deficiency and kidney cold Rou Gui can be steeped in boiled water Taken like this it can prevent disease and prolong life By taking more the benefits increase For Yin dryness presentations Rou Gui can also be given It generates fluids and moistens dryness Rou Gui is indescribably marvelous The liver is related to wood and it stores the blood Blood presides over the wood Qi Its character is warm Warm Qi rises and balmy warmth unfolds and spreads It accumulates and becomes the heat that transforms into heart fire With wood s warmth the Yang ascends by half With fire s heat Yang completely lifts When warm Qi is ample the Yang flourishes and the person is healthy When warm Qi is feeble Yin accumulates and the person is ill The return of Yang causes life and Yin accumulation causes death Life and death are not the same in terms of good and evil Yang and Yin have their own value regarding eminence and humility Even a wriggling insect knows about the preference for life over death yet the ordinary person does not understand the values of Yang in relation to Yin It is an eternal misfortune that there are age old schools of thought that value Yin over Yang If you wish to generate life you must return the Yang The returning the Yang method goes to the center of the Qi and blood fostering the root of the body If the Yang root is feeble the children water and wood will be insufficient with nothing leftover Copyright Sharon Weizenbaum 2022

104 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted These are the words of Huang Yuanyu When the liver and spleen rise up comfortably the warm Qi reaches ascension and transforms into Yang spirit Yang spirit is the commander and the Yin evil then has no power This is the Tao of preventing disease and prolonging life With the above in mind Rou Gui can warm the liver and heat the blood strengthen the heart and fortify the spleen It can treat disease presentations in women such as irregular menstruation abdominal and back pain during menstruation flooding and trickling leucorrhea pain in the center of the abdomen and postpartum deficiency cold It is effective for all sorts of deficiency cold presentations An Rou Gui is a tropical plant It is produced in Vietnam as well as in Guanxi on the mainland of China It is pungent hot and sweet It contains a beneficial oil high grade is better but regular is also good When a weak woman is pregnant and the fetal Qi is insufficient she will show symptoms such as poor appetite and low spirit Alternatively she may have symptoms such as chest or stomach pain with vomiting In this case taking the three flavors Gui Fu and Jiang will not only NOT harm the fetus but on the contrary they will strongly calm the fetus These are supremely miraculous medicinals Gui Jiang and Fu are contraindicated in warm disease summer heat disease and Yang Ming heat dryness presentations The Rou Gui bark is thick and oily It s character and flavor are also thick It guards and does not leave It focuses on cold of the heart liver spleen and blood level It dispels stasis and generates the new When taking it one should just soak it in water It should not be boiled If it is boiled the Qi vapor and oily substance volatilize and lose their effectiveness Gui Zhi s strength to subdue cold Qi is less than Rou Gui s but you can replace Rou Gui with it On the other hand you cannot replace Rou Gui with Gui Zhi tips There is a red kind from Yunan Yuanyang district now that is a sticky Gui Although it is pungent and hot and has a warm character after it is put in water the sticky glue congeals into a ball and this blocks the stomach and intestines It is not easy to Copyright Sharon Weizenbaum 2022

105 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted digest It makes the chest and stomach stuffy cold distended and uncomfortable I ve repeatedly tested this and find it to be unsuitable to use Curious Uses for Rou Gui 1 For summertime mushroom poisoning with vomiting and diarrhea 2 3 or 5 qian of Rou Gui can be taken Grind it into a fine powder and mix with water and there will be resolution 2 For cholera either true or false with lots of vomiting and diarrhea and abdominal pain in which the medicine has not been given in time urgently give 3 or 5 qian of Rou Gui Grind it into a fine powder and mix with water The results can be very good There is benefit without damage Then send for the doctor for diagnosis and treatment This is a first aide method 3 If one has come in contact with a lot of inclement weather so that the resistance is weakened This will often cause an acute cold presentation If medicinals are not conveniently available 1 2 3 up to 5 qian of Rou Gui can be taken until you can get medicine Grind it into a fine powder and mix with water and there will be an immediate effect as desired 4 If you are going to high mountains the frequent eating of Rou Gui powdered or put in water can ward off miasma or gastroenteristis with vomiting and diarrhea 5 If you are riding in an airplane and get dizziness with nausea and vomiting eat 5 fen to 1 qian of Rou Gui powder It will help immediately If you are going a long way on foot keep a bit of Rou Gui in your mouth It can generate fluids and keep you from panting It can also ward off thirst while you are journeying 6 If you ve taken Fu Zi Pian that has been undercooked and you develop numbness poisoning or restlessness immediately take 3 or 5 qian of Rou Gui mixed with water If it is mild it will resolve If it is serious it will gradually resolve By all means do not use a cold water stomach lavage This can cause death I have seen Copyright Sharon Weizenbaum 2022

106 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted and heard of many cases like this You will be fortunate if you pay attention to this 7 If there is a stroke without speech and medicines cannot be given in a timely way feed the person 3 4 qian of good Rou Gui in water Immediately there will be an effect If they vomit clear spittle all the better It is temporary urgent care It strengthens the heart and transforms phlegm 8 When there is a white moist tongue moss and lack of thirst with tooth pain throat pain pain at the center of the stomach or nausea with vomiting it is good to give 2 or 3 qian of Rou Gui mixed with water It is effective Formulas that include Rou Gui 1 Gui Fu Tang Fu Pian 2 liang cooked well ahead of time Rou Gui 3 qian ground into a fine powder and infused in water This formula uses Fu Zi to warm the cold of the kidney water Rou Gui warms the liver wood constraint strengthens the heart and warms the cold within the blood Taking this makes water rise and fire descend Water and fire come into right relationship Ji Ji to connect the heart and kidney The soul becomes tranquil It is quite effective for heart Zang illness with palpitations fright and insomnia It is often given to weak people to prevent illness and prolong life 2 Kan Li Dan Fu Pian 2 liang cooked well ahead of time Rou Gui 5 qian ground into a fine powder and infused in water Ge Fen 4 qian powdered clam shell Zhi Gan Cao 3 qian Copyright Sharon Weizenbaum 2022

107 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gui Yuan Rou 8 qian is Long Yan Rou Sheng Jiang 8 qian This formula treats heart illness with restlessness The result is excellent 3 Da Hui Yang Yin Fu Pian 2 liang Gan Jiang 1 liang Rou Gui 4 qian Zhi Gan Cao 3 qian This formula is able to return the Yang and rescue rebellion It strengthens the heart consolidates the kidneys warms the middle and smooths the liver It can treat any critical condition in which Yang is deficient and Yin has accumulated It can snatch a patient from the jaws of death As for ordinary weak patients with Yang deficiency without spirit I often give several packages It is easy to have this person return to health They get a new lease on life It prevents illness and prolongs life 4 Gui Fu Li Zhong Tang Ren Shen 3 qian to 1 or 2 liang one can replace with Dang Shen Gan Jiang 1 to 2 liang Bai Zhu 5 qian to 1 liang Gan Cao 3 5 qian Fu Pian 2 4 liang Rou Gui 3 5 qian This formula greatly supplements pre heaven heart and kidney along with post heaven spleen and kidney Yang It treats gastrointestinal illness such as chronic diarrhea and Copyright Sharon Weizenbaum 2022

108 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted indigestion It is very effective 5 Yang Ba Wei Di Huang Wan Shu Di 1 liang Fu Ling 5 qian Zao Pi 3 qian Huai Shan Yao 5 qian Fen Dan 3 qian Ze Xie 3 qian Fu Pian 2 liang Rou Gui 4 qian This formula treats dual deficiency of the Yin and Yang of the kidneys It should be avoided for wind cold or for patterns in which there is Yin accumulation with Yang depletion If too much is taken it can cause swelling distention and collapse Shao Yao Gan Cao Tang Bai Shao Yao 4 liang 12 gm Zhi Gan Cao 4 liang 12 gm Directions Boil the ingredients in 3 sheng of water reducing to 1 sheng 5 ge 1 1 2 sheng strain Divide into two doses to be taken warm twice in one day Copyright Sharon Weizenbaum 2022

109 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Original Clause Clause 29 In Shang Han the pulse is floating there is spontaneous sweating frequent urination there will be heart vexation a slight aversion to cold and cramps in the feet Gui Zhi Tang is given to attack the exterior but this is a mistake Having given it there is Jue fainting dry throat vexation and agitation with vomiting due to reversal Give Gan Cao Gan Jiang Tang to restore the Yang If the Jue recovers and the feet become warm then after giving Shao Yao Gan Cao Tang and the feet will stretch Where there is lack of harmony of the stomach Qi with delirious speech give a little Tiao Wei Cheng Qi Tang Where heavy sweating was promoted and repeated hot needling Si Ni Tang is indicated From Cases of Renowned Physicians39 Formula Explanation The liver stores the blood and governs the tendons When the liver blood is insufficient the tendons and vessels are not moistened and they often become painful in a tight and spastic way This formula has only two flavors Yet it has the subtle ability to use sweet with sour to transform Yin This formula emolliates the liver and harmonizes the spleen enriches Yin nourishes blood relaxes spasming and stops pain It stops spastic pain by disinhibiting the blood vessels It can allow spastic painful feet or calf muscles due to Yin and blood deficiency to smoothly stretch It is especially effective when the tongue is red and the pulses are wiry When both the Yin and Yang are deficient with aversion to cold spastic feet and a slightly thin pulse Shao Yao Gan Cao Fu Zi Tang can be used to restore the Yang and boost the Yin 39 From Collected Classic Formula Case Studies from Renowned Physicians complied by Chen Ming and Zhang Yin Sheng 1998 Xue Yuan Publishers Bei Jing Copyright Sharon Weizenbaum 2022

110 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Cases40 Case 1 Restless Legs Dr Wang Ming Ru Ms Zhu age 45 came for her consultation on November 30 1986 For the past 4 months she had an indescribable feeling in her legs They felt sore numb distended with a pain that was not quite pain Sometimes her legs would twitch or she may feel an electric shock feeling When she rested it got worse She often patted or slapped her legs and squeezing them would slightly alleviate the symptom She went to the hospital s psychiatric department and was diagnosed with restless legs However western and Chinese treatments were ineffective The she came to consult with Dr Wang The movement of her legs was normal Wei Zhong and Cheng Shan acupuncture points had a sore distended feeling when pressed She also felt dizzy and weak Her sleep was poor and she had a poor appetite She was restless when sitting Her tongue was pale red and split in the middle The moss was thin white Her pulse was thin and wiry This was liver blood deficiency in which the tendons and vessels lost their nourishment The treatment was directed to emolliate the liver nourish the blood relax spasms and sooth the tendons Sheng Bai Shao 60 gm Gan Cao 5 gm I gave her 5 packages of this formula and afterwards the pattern had clearly changed for the better She was already sleeping at night and her appetite had improved She continued with the same herbs 30 more packs and there was a cure 1988 6 273 Discussion The liver stores the blood and governs the tendons When the liver blood is 40 From Collected Classic Formula Case Studies from Renowned Physicians complied by Chen Ming and Zhang Yin Sheng 1998 Xue Yuan Publishers Bei Jing Copyright Sharon Weizenbaum 2022

111 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted deficient the tendons and vessels loose their nourishment This can cause soreness and discomfort of the 4 limbs pain numbness or distention This requires a formula to relax spasming The amount of Shao Yao is quite big and it is generally without side effects Case 2 Hiccup Dr Feng Han Long 1988 A venerable sage named Wang had repeated hiccups Day and night he hiccupped ceaselessly The result was that he ate and drank very little At night he was unable to sleep Day and night he was suffering deeply He had gone to a doctor and taken Ding Xiang Shi Di Tang and Xuan Fu Dai Zhi Tang and these were without effect He inhaled tobacco and the hiccups would stop for a short while and then start again He used it again but it didn t help The sides of his tongue were without moss and his mouth was dry with scanty fluids His pulse was wiry thin and slightly rapid This appeared like Yin deficiency The Yin of the spleen earth had received damage This caused the liver wood to harass upward It rose and was not controlled The result was hiccups The say Shao Yao discharges the liver and supplements the spleen and stomach And Gan Cao generates the Jin fluid of the Yang Ming while Shao Yao harmonizes the Ye of Tai Yin This is a Yin harmonizing Yang method Sheng Bai Shao 30 gm Gan Cao 15 gm Boil as a soup and drink frequently When the package was finished the hiccups had ceased Because the tongue was still without fluids I gave the first formula with the addition of 15 gm of Xian Shi Hu added cooked ahead After 1 package the hiccups did not return Discussion When the liver Yin is insufficient the wood Qi rises up and coerces the earth Qi to rise up in reversal The treatment uses sour to discharge the wood and sweet to Copyright Sharon Weizenbaum 2022

112 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted supplement It fells the liver and boosts the stomach This treats Yin deficiency hiccups This is from Dong Yuan and Dan Xi s books Case 3 Priapism Chao Bao Gou Mr Wang age 36 came for a consultation on April 15 1964 3 months earlier he had a disagreement with a neighbor and his emotions were poor He had chest oppression and no joy This continued though he was able to obtain and maintain an erection In the last month he his erection would not go down After sexual relations it would stay strong and not wane He had distention and pain that was hard to bear He went to the Chinese medical hospital but the treatment was without effect He had a robust constitution and the sides of his tongue were completely red with yellow moss His pulse was wiry and it had strength This was liver constraint transforming into fire There was also Yin Qi consumed The more deficient the Yin the more effulgent the Yang The ministerial fire was steaming while the Qi and blood were insufficient I gave a heavy dose of Shao Yao Gan Cao Tang Sheng Bai Shao Gan Cao 90 gm 150 gm I had him boil the herbs and drink cold After 5 packages the distention and pain of the penis was clearly diminished There was a definite trend for it to be softer Following that I used the same formula with lower doses I gave 3 more packages and he recovers 1989 3 31 Discussion This case is one in which there was gradually increasing liver constraint and this damaged the Yin This caused the ministerial fire to flare and harass causing priapism The treatment should obey the Nei Jing when it says When the liver suffers spasming eat Copyright Sharon Weizenbaum 2022

113 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Gan Cao to moderate and sour discharges This points to using Shao Yao Gan Cao Tang in which sour and sweet transform the Yin nourish and down bear the ministerial fire This way priapism is cured Increasing the dosage makes the effect even better Case 4 Anal Fissure Yan Qi Da Ms Li was 32 She had suffered from dry bowel for half a month 5 days previously it had gotten very serious After she moved her bowels she had anal pain with a small amount of fresh blood After this every time she moved her bowels she felt a cutting pain with a small amount of fresh blood This pain lasted 3 hours and then resolved The anal check showed that there was a fissure right at the center of her anus This was both deep and at the skin level and all around it was bright red When the opening was pulled a small amount of blood would seep out and there was pain This was spastic type anal fissure I gave Shao Yao Gan Cao Tang Bai Shao Gan Cao 50 gm 12 gm The next day she had a soft bowel movement and the anal pain decreased I gave one more package and the stool was soft and there was no pain 5 days later the anal fissure was checked and it was gone 1987 8 34 Discussion Anal fissure is usually related to habitual pain with bowel movements With spastic type anal fissures the treatment is to first both moisten the stool and stop pain in order to relax and resolve spasms Shao Yao Gan Cao Tang has these two functions When used in the clinic the results are really good There are reports that generally after using the herbs the stool becomes soft and the pain stops This way the anal fissure also resolves Often the dosages are Bai Shao 40 60 gm and Gan Cao 12 gm 24 gm of Huo Copyright Sharon Weizenbaum 2022

114 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Ma Ren can also be added to increase the moistening function Case 5 Constipation Geng Shou Xu Mr Li age 62 came for a consultation on April 2 1988 For the last 3 years his stool had become dry like goat turds He moved his bowels several times a day He had to try so hard that he sweat he became flustered and had shortness of breath The western doctor often used Phenolphthalein to resolve the immediate suffering His tongue was pale and dark with thin white moss His pulse was wiry and thin as well as chopping This was geriatric constipation The treatment was to boost the Qi and nourish the blood moisten the intestine and open the bowel Bai Shao 30 gm Gan Cao 10 gm 1 package for 1 day decocted in water After 3 days the bowel opened After 10 packages the bowel consistency moderated He moved his bowel once each day A one year follow up showed no relapse 1991 3 34 Discussion The says Shao Yao enters the spleen and opens knotting Shao Yao with Gan Cao breaks the knotting in the stomach and intestines The use of this formula depends on the clinical observations This formula is definitely effective for opening through the bowel and opening knots especially in the elderly and those with weak bodies Case 6 Tooth grinding Dr Shi Yi Ming A 5 year old boy named Zhang came for a consultation on September 4 1984 He was grinding his teeth in his sleep He did treatments to expel worms clear the stomach and discharge heat but there was no effect The pattern was one of wind tightening the tendons and vessels The treatment principle was to emolliate the liver relax spasming Copyright Sharon Weizenbaum 2022

115 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted resolve spasm and dispel wind Vinegar Prepared Bai Shao 30 gm Zhi Gan Cao 10 gm Chan Tui 10 gm After 3 packages the tooth grinding decreased and after 3 more packages there was a cure After that there was an occasional recurrence and he was given herbs and they worked 1987 3 18 Discussion According to Yuan In the past a large dose of Shao Yao Gan Cao Tang was used to treat pediatric convulsions To his surprise the tooth grinding suddenly resolved as well This means that pediatric tooth grinding is due to spasms of the tendons and vessels and it can be treated with a large dose of Shao Yao Gan Cao Tang with Chan Tui Each of many cases has obtained results This still needs more clinical observation Other Cases from various texts Case 7 Stomach pain Dr Liu Han Tang41 Ms Zuo was age 38 She was an accountant for a bank On May 4 2003 she came in for a consultation Ordinarily she had mouth thirst with a desire for cold Half a month ago she had a disruption with her mother in law and then she gradually developed stomach pain and distention This arose paroxysmally Each time it lasted 6 10 minutes It came 41 From Liu Han Tang s A Record of Clinical Experience using Classical Formulas 2007 Copyright Sharon Weizenbaum 2022

116 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted on 3 5 times each day She went to the local doctor and was given anti spasmodic and analgesics but these were not effective Her complexion was greenish red she had thirst burping and a slightly dry stool Her appetite was poor He pulse was thin and wiry and her tongue was red with scanty moss This was stomach pain due to liver wood harassing the stomach The Qi mechanism was not running smoothly and the stomach Yin was insufficient The treatment principle was to constrain the liver and harmonize the stomach while regulating Qi resolving constraint enriching Yin and stopping pain Modified Shao Yao Gan Cao Tang was used with Jin Ling Zi San Sheng Bai Shao 24 gm Zhi Gan Cao 6 gm Chuan Lian Zi 10 gm Yan Hu Suo 10 gm Fou Shou 10 gm Decocted in water 5 packages The stomach pain and other symptoms all disappeared Discussion This patient usually had a dry mouth with a desire to drink cold liquids This indicates that her constitution was one of Yin deficiency with fire excess It was only in the past month that the wood arrogantly rebelled horizontally to attack the stomach This manifested as stomach pain There was also a greenish red complexion mouth thirst dry stool red tongue with scant moss and a thin wiry pulse This was how the Yin deficiency manifested to be seen There was stomach distention and pain with burping and poor appetite This was the manifestation of the liver harassing the stomach with the blocked stomach hindering the appetite She was given Shao Yao Gan Cao Tang and Jin Ling Zi San Shao Yao Gan Cao Tang constrains the liver harmonizes the stomach enriches Yin and stops pain Jin Ling Zi San sooths the liver and resolves constraint Copyright Sharon Weizenbaum 2022

117 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Together these formulas treat heat pain Fou Shou was added to assisting in moving the Qi resolving constraint and waking up the stomach Case 8 Lower calf pain Charlie horse Dr Liu Han Tang42 Mr Xu was a 46 year old peasant He came for a consultation on October 4 2000 In recent years he has suffered from occasional right side calf pain in which his calf muscles spasm This happens at night while he sleeps It happened every 4 6 days The pain was quite severe He had to stand immediately to reduce the pain He went to a local hospital for treatment so that these outbreaks would be controlled His face was red colored he had dry mouth and stool His appetite and urination were normal His tongue was red with scanty moss and his pulse was thin This was differentiated as insufficiency of the Yin fluids so that the tendons and vessels lost their nourishment For treatment it was appropriate to use sweet and sour to transform Yin while enriching and nourishing the tendons and vessels He was given Shao Yao Gan Cao Tang Chao Bai Shao 30 gm Zhi Gan Cao 10 gm Decocted in water After 10 packages there was a cure After a year there was no recurrence Discussion In this case there was calf muscle pain The disease mechanism was Yin deficiency with lack of nourishment of the tendons and muscles so that they spasmed The symptoms of red complexion mouth thirst dry stool red tongue with scanty moss and thin pulse were all indications of Yin deficiency This was what caused the calf muscle spasming pain Shao Yao Gan Cao Tang was given to use sour and sweet to transform Yin 42 Ibid Copyright Sharon Weizenbaum 2022

118 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted This enriched the tendons and vessels so that they were emolliated and harmonious Then the spasming pain spontaneously dispersed Case 9 Yin contraction syndrome 43 Dr Zhou treated a 48 year old man The day before he had traveled from home to visit relatives He got very tired and then had sexual relations He then had acute pain appearing to be suffering a lot He was having paroxysmal pain in his lower abdomen that desired heat and touch His penis and scrotum were contracted His feet had reversal cold His tongue body was pale with white moss His pulse was deep and tight This was cold stasis in the liver vessels with serious Yin contraction I immediately got some Xie Bai and Sheng Jiang which he pounded into a plaster and placed on his lower abdomen He also did moxa on Bai Hui to return the Yang and rescue reversal He was also given modified Shao Yao Gan Cao Tang Bai Shao 60 gm Gan Cao 20 gm Xiao Hui Xiang 30 gm After taking the first package the illness improved by 60 70 After two more packages the symptoms suddenly were gone 43 1987 3 44 Copyright Sharon Weizenbaum 2022

119 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted From Liu Han Tang s A Record of Clinical Experience using Classical Formulas 44 For Nerve Disorders Shao Yao Gan Cao Tang can be used for a variety of nerve disorders In modern times it is used for hysterical fainting Parkinson s syndrome shriveling tightness of the whole body lack of strength in the muscles of the body Charlie horse spasming of the 4 limbs fingers and toes eye muscle spasm long term muscle spasm muscle rigidity spasming type numbness facial muscle spasm stubborn diaphragm muscle spasm restless leg syndrome headaches due to blood vessels constriction or dilation intercostal neuralgia trigeminal neuralgia sciatica pain post surgical anal stimulation and torticollis Modern research considers Shao Yao Gan Cao Tang as a formula that treats the muscles the straie muscles and the smooth muscles of the internal organs when they are in spasm This combination of herbs controls the excitement of the central and nerve endings It can treat muscles spasms that give rise to pain It treats the muscles and brain tissue when there is a lack of nourishment due to Yin deficiency The symptoms are pain from spasming of the vessels There is inhibition of bending and stretching with pain and disordered spirit There is a red tongue with scanty moss and a wiry thin pulse For Digestive Disorders Shao Yao Gan Cao Tang can be applied to digestive system illnesses Modern doctors primarily use it for allergic and hypersensitivity type gastro intestinal inflammation gastrointestinal spasming acute stomach and abdominal pain chronic gastritis gastric polyps stomach and duodenal ulcers stomach heat type acute cholestasis round worms 44 Clinical Experience Treating Disease with Classical Formulas by Li H nt ng Beijing Garden Press China 2008 Copyright Sharon Weizenbaum 2022

120 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted in the bile duct Cholelithiasis acute gallbladder pain chronic gallbladder inflammation chronic colitis acute bleeding and necrosis type colitis viral hepatitis A or B acute edematous pancreatitis acute appendicitis pylorus blockage acute intestinal adhesions post surgical intestinal adhesions geriatric intestinal blockage and all chronic constipation The important points for differentiation are disharmony between the liver and stomach Yin deficiency with heat and lack of nourishment of tendons and muscles with the symptoms of stomach duct pain poor appetite mouth thirst red tongue with scanty moss and wiry thin pulse For the Vascular System Allergic purpura simple purpura joint type purpura and gastro intestinal purpura when there is a differentiation of the pattern as Yin deficiency with heat heat entering the blood level or heat struggling with blood or blood congealed in the muscles and skin These can be treated when there is a liver and stomach disharmony Yin deficiency with heat and spasming of the undernourished tendons and vessels For the Endocrine System Disorders Hyper prolactinemia type impotence in men bleeding disorders infertility high testosterone type bleeding patterns and polycystic ovarian syndrome These can be treated when there is a liver and stomach disharmony Yin deficiency with heat and spasming of the undernourished tendons and vessels For Urinary and Reproductive Disorders Acute renal pelvic nephritis urinary stones kidney stones combined with renal pelvic water accumulation uremia nerve damage causing numbness and pain bladder spasms impotence priapism incontinence frequent urination and hematuria These can be treated when there is a liver and stomach disharmony Yin deficiency with heat and spasming of the undernourished tendons and vessels Copyright Sharon Weizenbaum 2022

121 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted For Gynecological Disorders Dysmenorrhea abdominal pain in pregnancy post partum abdominal pain post partum fever infertility headache inappropriate lactation twitching and numbness of the four limbs These can be treated when there is a liver and stomach disharmony Yin deficiency with heat and spasming of the undernourished tendons and vessels Other disorders Damp heat leg Qi weakness of the legs with no strength angina pectoris pediatric night crying pediatric abdominal pain cervical vertebrae illness diabetes heel pain osteo proliferation on the heel geriatric hip and leg contraction cease hormone use syndrome lumbar sprain piriformis syndrome tooth grinding hersutism ulcers on the shank wind damp rheumatism pain at night with many types of cancers thrombic phlebitis due to external damage soft tissue damage osteo proliferation sprains pyogenic arthritis Yin and blood deficiency with fever local skin diseases etc In general the differentiating points for the use of Shao Yao Gan Cao Tang are as follows The disease mechanism is one of Qi constraint and damage to the liver lack of flow and discharge of liver wood lack of harmony between the liver and stomach or liver and spleen Yin deficiency with heat insufficient Yin fluids with undernourished tendons and vessels manifesting primarily as skeletal muscle or smooth muscle twitching or spasming pain syndromes convulsions dry mouth mouth thirst red tongue with scanty moisture thin or wiry thin or thin and rapid pulse The dosages of the original formula are 4 4 Clinically there are time when one can use a 4 1 or 3 1 dosage of Bai Shao with Zhi Gan Cao Copyright Sharon Weizenbaum 2022

122 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted From Walking Along the River By Yu Guo Jun45 Spastic Cough Paeoniae Radix alba b i sh o paired with Glycyrrhizae Radix ga n ca o comprises Peony and Licorice Decoction sh o ya o ga n ca o ta ng Together sour and sweet transform the yin and thus the two herbs enrich the Lung s yang fluids and soothe and moderate the Lung qi Modern pharmacological research has shown that this formula is able to relax spams in the smooth muscle of the bronchioles Although the dosage of the other herbs in this formula can be changed or even eliminated Inulae Flos xu n fu hua Paeoniae Radix alba b i sh o and Glycyrrhizae Radix ga n ca o are key herbs and thus should not be deleted when the formula is modified Constipation The Spleen is the ultimate yin zhi yi n of yin Ultimate means large and we can say that its fluid permeates the entire body However the character zhi also means far reaching and so we can also say that the Spleen distributes essence through out the body When Spleen yin is insufficient the fluids of the whole body become depleted and the Stomach and Intestines are the first to be affected by this Why Because as it says in Chapter 45 of Basic Questions Su we n the Spleen manages the proper movement of fluids on behalf of the Stomach Patients with constipation from insufficiency of Spleen yin are commonly seen with symptoms such as hunger without a desire to eat thirst without a desire to drink dry lips emaciation fatigue lack of strength a pale tongue that lacks moisture and a thin dry tongue coating The patient above fits this pattern 45 A Walk Along the River Transmitting a Medical Lineage through Case Records by Yu Guo Jun Translated by Andrew Ellis Michael Fitzgerald and Craig Mitchell Eastland Press 2017 Copyright Sharon Weizenbaum 2022

123 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted In terms of well known classical formulas that are used to enrich Spleen yin one of the first to know is Peony and Licorice Decoction sh o ya o ga n ca o ta ng The early modern physician Zhang Xi Chun praised this formula for its ability to transform yin with sour and sweet flavors and he would add Ginseng Radix r n she n for its strong ability to nourish Spleen yin When I treat habitual constipation caused by insufficiency of Spleen yin and Intestinal dryness I generally use Peony and Licorice Decoction sh o ya o ga n ca o ta ng as follows Bai Shao 30 50 gm Gan Cao 5 10 gm Zhi Gan Cao 5 10 gm These herbs greatly enrich Spleen yin If you consider the formula that I generally use there is a large dose of gentle yin natured herbs such as Paeoniae Radix alba b i sh o Glycyrrhizae Radix ga n ca o and Cassiae Semen ju m ng zi These substances must be accompanied by something like Cistanches Herba ro u co ng r ng which has the ability to generate yang qi Only then will the formula be able to stimulate peristalsis and to achieve the effect of moistening the Intestines and unblocking the bowels In fact Cistanches Herba ro u co ng r ng is the only herb in the formula for which there is no substitute The diagnosis in this case was insufficiency of Spleen yin with Intestinal dryness I used Peony and Licorice Decoction sh o ya o ga n ca o ta ng with a large dosage of Paeoniae Radix alba b i sh o and additional herbs Kidney Stone Pain When there is pain on the lower abdomen I often combine Roasted Kidney Pill we i she n wa n with Peony and Licorice Decoction sh o ya o ga n ca o ta ng If during the period Copyright Sharon Weizenbaum 2022

124 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted when the patient is taking herbs the abdominal and lower back pain increases and they have pain radiating from these areas down to the lower abdomen this indicates that the stone is moving downward and a large dose of Peony and Licorice Decoction sh o ya o ga n ca o ta ng can be used to relax tension and alleviate pain At the same time one can help the body to guide the urinary stone downward and expel it by combining Peony and Licorice Decoction sh o ya o ga n ca o ta ng with Rhei Radix et Rhizoma da hu ng to guide downward and expel the urinary stones Post Herpatic Neuralgia I usually use either Peony and Licorice Decoction sh o ya o ga n ca o ta ng with 30 60g of Paeoniae Radix alba b i sh o and 15 30g of Glycyrrhizae Radix ga n ca o or a version of that formula with normal dosages of those two ingredients in combination with Dredge the Liver Decoction shu ga n ta ng The treatment is different because the pathodynamic is different Post herpetic neuralgia is attributable to a lack of nourishment as the fire toxin has caused the yin and blood to be insufficient and the result is a lack of flow through the collateral vessels The pain comes from this so the combination of sour and sweet flavors that is Peony and Licorice Decoction sh o ya o ga n ca o ta ng can transform the yin and stop the pain Gan Cao Gan Jiang Tang46 Licorice and Dry Ginger Decoction g n c o g n ji ng t ng Glycyrrhizae Radix preparata zh g n c o 4 liang 12 gm Zingiberis Rhizoma g n ji ng 2 liang 6 gm 46 Sha ng Ha n Mi ng Yi Ya n A n Ji ng Xu an Selected Cases from Famous Physicians in the Shang Han Tradition Ed Che nMi ng Zha ngYi n She ng Xue Yua n Publishing Company Be iji ng China 1998 Copyright Sharon Weizenbaum 2022

125 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Cooking method Decoct the above ingredients in 3 sheng of water down to 1 sheng Remove the foam Divide into two doses to be taken warm twice in one day Original text Clause 29 Shang Han the pulse is floating there is spontaneous sweating frequent urination there will be heart vexation a slight aversion to cold and cramps in the feet but Gui Zhi Tang is given to attack the exterior this is a mistake Having given it there is jue the throat is dry and if there is vexation and agitation with vomiting due to reversal administer Licorice and Ginger Decoction g n c o g n ji ng t ng to restore the Yang If the jue recovers and the feet become warm then after administering Peony and Licorice Decoction sh o y o g n c o t ng the feet will then stretch Where the stomach qi is disharmonious if the speech is delirious give a little Regulate the Stomach and Order the Qi Decoction ti o w i ch ng q t ng Where heavy sweating was promoted if then there is repeated hot needling Frigid Extremities Decoction s n t ng governs Formula explanation In the past when the Yin and Yang were both depleted often the ancient sages would first benefit the Yang and afterwards enrich the Yin This presentation uses Licorice and Ginger Decoction g n c o g n ji ng t ng to restore the Yang as well When the Yang is generated the Yin grows When the Yang is consolidated the Yin is preserved When all is said and done the symptoms of restlessness and dry throat appear like Yin damage One must consider this when warming the Yang This formula uses Glycyrrhizae Radix g n c o in double the amount of Zingiberis Rhizoma g n ji ng This is because warming the Yang of the middle this way does not damage the lower Jiao Yin Later generations also use this formula for spleen and lung deficiency cold patterns For example it is used for spleen Yang deficiency depletion in which the spleen is unable to wrap the blood which leads to bleeding In this case Zingiberis Rhizoma g n ji ng should be changed to Copyright Sharon Weizenbaum 2022

126 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zingiberis Rhizoma preparata p o ji ng to warm the spleen and increase the absorption of blood It can also be used for lung emaciation with deficiency cold in which the thin fluids are cold and the Qi becomes depressed In this case the up bearing does not control the down bearing causing vomiting of saliva dizziness and bedwetting In this kind of case this formula can be very effective Cases Case 1 Nose bleed Yue Mei Zhong Mr Yan was 21 years old The patient suffered from an ordinary nose bleed and at the beginning he did not mind it At a certain point he to a long journey of and after 3 days returned home At 6 00 his not began to bleed and after 5 hours it had not stopped His family were alarmed and did not know what to do In the middle of the night they came knocking He leaned his head on a pillow and the blood was still flowing ceaselessly He kept a basin under the bed and it was half full of blood The patient s face was as white as a sheet of paper Recently a cold Qi had entered and he could not get warm and did not speak His pulse was very faint Hi spirit was defeated I urgently gave him Licorice and Ginger Decoction g n c o g n ji ng t ng Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix preparata zh g n c o 9 gm Zingiberis Rhizoma preparata p o ji ng 9 gm Copyright Sharon Weizenbaum 2022

127 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted The patient became warm in the limbs 1 2 an hour after taking the herbs His pulse gradually slowed and he was able to speak The bleeding also stopped The next day 12 gm of e jiao was added There was no reoccurrence Discussion This patient had an ordinary nose bleed and so the Yang networks were already damaged Because of recent unsatisfactory conditions his liver qi rose greatly This caused the blood to gush The Ling Shu Cold and Heat says When there is sudden disease with inner rebellion the liver and lung being very closely linked can lead to blood overflowing from the nose and mouth This is the mechanism of the above illness In this case the bleeding was profuse and the Yin fluids were suddenly lost and the Yang was without anything to attach to Although it was the middle of the night the Yin was spontaneously exuberant at the Yin time and the Yang was suddenly lost If someone had only used a method to nourish blood and stop bleeding the Yin would have been supported but the Yang would have finally been difficult to recover In order to change the course in a moment the only hope was to rescue the Yang The Jue was healed as the feet became warm and the pulse continued to issue forth Afterward he became of sound mind This formula carries out the plan slowly and gently by following this meaning Although Licorice and Ginger Decoction g n c o g n ji ng t ng is not a stop bleeding formula it was able to stop the bleeding This is because The nature of Yang is to protect the exterior by consolidating Yang consolidates and so the Yin is spontaneously calmed and guarded in the interior This means that when the dike is strong enough to hold back there is no worry of flooding over Case 2 vomiting blood Zhao Shou Zhen Copyright Sharon Weizenbaum 2022

128 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted This patient was named Wang and he often had an illness of vomiting blood He was given clearing cold and astringent herbs to stop bleeding The past summer the illness returned He took the previous herbs with no effect and later took herbs to warm and supplement along with herbs to scatter stasis This was also to no avail When I saw him the bleeding was sporadic but unceasing the color was dark and the substance was watery He also had a frequent cough and vomited clear fluid His mouth was bland he had a poor appetite and yellow urine His pulse was soft and moderate I did observation in order to determine the formula There was both cold and warmth However this was 1 not a heat presentation so Zhi Zi and Zhu Ling are not used This is also not 2 damage and depletion to the original Yang with the protective qi being weak and so Gui Zhi and Fu Zi type formulas are not suitable In this case the pulse is soft and moderate but there is not 3 the presence of sticky stool spleen deficiency There is a cough with clear fluids but 4 though the lung is cold it is not deficient When there is this presentation you could use Six Gentleman Decoction li j n z t ng with Platycladi Cacumen c b i y and jiao Schizonepetae Herba j ng ji These methods were used but the bleeding did not stop It was thought about for a long time but they failed to grasp the meaning The chapter on vomiting blood in the San Zi Jing by Xuan Yi and Chen Xiu Yuan says use the warming absorptive method of Cao and Jiang The four gentlemen with Ren Shen and Bai Zhu is too supplementing and is inferior to the use of Licorice and Ginger Decoction g n c o g n ji ng t ng to warm the lung and supplement the spleen This is why it is said that this formula supplements without consolidating and it warms without drying Formula Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix preparata zh g n c o Copyright Sharon Weizenbaum 2022 18 gm

129 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zingiberis Rhizoma preparata p o ji ng 9 gm I gave the patient 4 packages and the vomiting decreased in frequency After 3 more packages it completely stopped After that I used food and drink to regulate and nourish and did not use other herbs Discussion The Qing dynasty writer Qin Bo Wei in his Qing Dai Tong Men Ji points out In chronic vomiting illness the root is deficiency and the qi is often cold and the power is moderate Therefore in terms of treatment the main principle will be to supplement and warm Blood flows along the channels When it meets warmth it moves and when it meets cold it congeals If you use cold and cool herbs in a knee jerk fashion it may stop the bleeding for a time but then suddenly the blood will flow out of the vessels and the cold will cause stasis and a lack of movement of the blood Over time there will be vomiting of blood that does not cease and cannot be cured In this case of vomiting blood there is evidence of spleen and lung deficiency cold We followed the words of Yi and Chen to use the warming and absorbing method of Jiang and Cao regulation Licorice and Ginger Decoction g n c o g n ji ng t ng warms the Yang Qi of the Tai Yin It consolidated and absorbed the blood to move appropriately Case 3 Taxation Lin Zhao Shou Zhen The patient worked very hard on a summer day in the fields It was muggy and hot in a stifling way He rested wanting to sit down frequently Unavoidably damp heat made a sneak attack Thereupon he developed lin illness His urination was rough and painful It Copyright Sharon Weizenbaum 2022

130 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted dripped and did not come out easily There was also blood seeping out He could barely stand the pain I felt his pulse and it was rapid and without strength He did not have thirst His tongue moss was with and sticky as well as slippery There was chest and epigastric oppression and a slight cough with abundant clear fluids The bowel moved easily From the interrogation I knew that the cause was extreme over work that caused the warm heat to be damaged This in turn damaged the blood However he was given lots of cold herbs to clear heat Heat was clear but damp stayed For treatment it was suitable to disinhibit urination enrich Yin course the channels and harmonize the blood I gave Polyporus Decoction zh l ng t ng with Achyranthis bidentatae Radix ni x and Trichosanthis Fructus gu l u I gave him 10 packages and although the bleeding and pain decreased the lin remained the same and the chest fullness and cough with phlegm got worse The explanation is that the water damp has floated upward and the cold was generated in the lungs so that the upper orifices were not open through and the lower orifices found it difficult to be open This is why there was a cough with phlegm This was cold and not heat The lower Lin was not heat but rather fell into the category of damp The focus was not the lower jiao but was rather the upper two jiao For treatment it was appropriate to warm the lung and fortify the spleen However the two Zhu Atractylodis macrocephalae Rhizoma b i zh and Atractylodis Rhizoma c ng zh are warm and dry and damage the fluid Ma Xin San damage the lung Qi All of these are not what should be used Instead one should use Licorice and Ginger Decoction g n c o g n ji ng t ng Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix g n c o use the tip 24 gm Zingiberis Rhizoma preparata p o ji ng 9 gm Copyright Sharon Weizenbaum 2022

131 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted I gave him 5 packages and the urination became longer and the bleeding stopped The chest also became comfortable and the watery fluids decreased Because the formula was being effective I gave him 5 more packages and the illness was cured Afterward I gave him herbs to boost the qi and fortify the stomach to regulate and recuperate Discussion This case is an example in which there was one mistake after another It was only by grasping the principle pattern that one can know how to treat this lin One cannot be constrained to the concept of warm heat The tip of Glycyrrhizae Radix g n c o is a lead herb for disinhibiting water and moving downward Case 4 bed wetting Zhao Shou Zhen Mr Liu was 30 years old He had been wetting the bed for a long time During the day there is a break between his urination but at night it is continuous The doctors agreed that his kidney qi was deficient and depleted In order to warm the kidney and enrich water Kidney Qi Pill sh n q w n was used Methods were also used to supplement the kidney and warm and astrict by using Stabilize the Yin Decoction g y n ji n Astragalus Decoction to Construct the Middle hu ng q ji n zh ng t ng and Tonify the Middle to Augment the Qi Decoction b zh ng y q t ng was also used to treat spleen and stomach deficiency cold He also tried herbs such as Cervi Cornu pantotrichum l r ng Hominis Placenta z h ch and Tian Sheng Huang He tried many things and there was some effect sometimes and sometimes there was no effect Over all though he still was left with the problem without an effective treatment method I could see that the previous formulas were not conforming to the presentation and that all his efforts were in vain I carefully examined his pulse and his right side cun and guan pulses were weak His Copyright Sharon Weizenbaum 2022

132 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted tongue was white and glossy without moss His mouth was bland He coughed with some thin fluids and his appetite was slightly diminished His urine was long and clear and extremely frequent at night His bowels were sticky In this case the 3 zang lung spleen and kidney were all ill However herbs to supplement the kidney and warm the spleen had been given repeatedly so I couldn t just tonify the lung now Instead I considered the dispersion thirst pattern The lungs are the upper source of water and in this case water was not transforming there This poured down to the Kidney with the result that the spleen and kidney were not able to keep the water within the banks What should have been closed was open wide The lungs had to be treated as the priority Why couldn t this be the root presentation As Jing Yue says Although a small amount of water is beneficial to the kidneys the kidneys also connect to the lungs If the lung qi has no strength the kidney will not be able to absorb water Therefore to treat the water one must treat the qi To treat the kidneys one must first treat the lungs The presentation in this case is related to the kidneys The treatment method is to warm the lungs and transform fluids In addition Licorice and Ginger Decoction g n c o g n ji ng t ng was originally for enuresis which is even more of a reason to use it in this case Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix g n c o 24 gm Zingiberis Rhizoma preparata p o ji ng 9 gm daily 2 doses After 3 days the enuresis had significantly decreased The excess saliva also became scanty I gave him 5 more packages and the pattern was no longer present Altogether he took 16 doses over 8 days This difficult to treat presentation was unexpectedly cured Honestly this exceeded my expectations Copyright Sharon Weizenbaum 2022

133 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Case 5 diarrhea Zhao Shou Zhen The patient Mr Dai had gone to the Dragon Boat Festival and had used indiscretion in eating and drinking That night he received a wind cold and the next day he had developed a fever and aversion to cold He also had abdominal pain and diarrhea He took some medicine to resolve the exterior and treat indigestion and the exterior resolved but the diarrhea did not stop Erroneously this was considered a deficiency pattern so he was given warming and supplementing herbs The diarrhea stopped but he had abdominal distention and pain He took laxative herbs but thereupon the diarrhea did not stop Then he came to see me He had intestinal sounds and each day he had diarrhea 5 6 times There was no distention and no pain His mouth was bland with a tasteless flavor His tongue moss was thin and white It was not dry His pulses were weak and without strength I drew my conclusion about the disease condition determining it to be stomach cold without much spleen qi deficiency It was not appropriate to use Ginseng Radix r n sh n or Atractylodis macrocephalae Rhizoma b i zh to supplement It was also not an intestinal heat with stomach cold pattern so it was not appropriate to use the three Drain the Epigastrium Decoction xi x n t ng formulas for mixed cold and heat Although it was correct to say that this was a pattern of stomach cold with spleen deficiency Regulate the Middle Decoction l zh ng t ng uses Ginseng Radix r n sh n and Atractylodis macrocephalae Rhizoma b i zh If we take these out we have Glycyrrhizae Radix g n c o and Zingiberis Rhizoma g n ji ng This becomes Licorice and Ginger Decoction g n c o g n ji ng t ng This has the ability to warm the stomach yang and supplement the spleen deficiency Ginger and Licorice Decoction g n ji ng g n c o t ng Copyright Sharon Weizenbaum 2022

134 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Glycyrrhizae Radix g n c o 24 gm Zingiberis Rhizoma preparata p o ji ng 9 gm drink warm 2 large doses a day The diarrhea decreased and after 2 more days of the herbs it stopped I used different herbs to regulate the interior and all was calmed Case 6 Lung Atrophy Dr Zhang Ying Rui This was a case of a 45 year old woman from the spring of 1951 She had difficulties since giving birth She gradually became emaciated and her facial color was very sallow He had dizziness and frothy saliva Her throat was dry and her mouth was bland At night she was not able to rest peacefully Her tongue had no moss and had slight fluids A previous doctor had mistakenly considered this a case of blood depletion and Yin damage and gave him large doses of herb to nourish blood and enrich Yin After 10 days the illness did not change and the frothy saliva increased Her spirit was despondent and her body was weak When I examined her her pulses were thin and moderate The right cun was weak This was a case of lung emaciation and I obeyed Zhong Jing s method I gave her Licorice and Ginger Decoction g n c o g n ji ng t ng to harmonize the middle and absorb fluids Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix g n c o 15 gm Zingiberis Rhizoma g n ji ng 6 gm After 1 dose in the morning by noon the saliva greatly decreased I gave her one more package and the saliva stopped She was able to peacefully sleep and did not wake up Copyright Sharon Weizenbaum 2022

135 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted until the next day I continued with herbs to enrich the lungs and supplement Qi I regulated and nourished for a few days and she was cured Discussion Lung wilt can be from deficiency cold or deficiency heat and these must be differentiated In this case because there was vomiting of white saliva with a sallow complexion dizziness bland mouth thin moderate pulse with a weak cun position and because the patient had already been given large doses of herbs to enrich Yin with an opposite effect I knew this was lung wilt from deficiency cold This is why I gave her Licorice and Ginger Decoction g n c o g n ji ng t ng Case 7 Dispersion Thirst Dr Tao Zheng Zhui The patient was a man age 43 He was suffered from dispersion thirst and a previous doctor had diagnosed him with lack of movement of the middle Yang and lower warmer Yang deficiency He used the method of supplementing and warming the spleen and kidneys He used Regulate the Middle Pill l zh ng w n and Kidney Qi Pill from the Golden Cabinet j n gu sh n q w n with no effect It was then decided that he had middle fullness with indigestion Then he came to see me for a diagnosis He had mouth thirst He would drink and drink but the thirst was difficult to bear His nose was dry without mucous His breath felt cold His tongue was pale with scanty fluids His pulse was slightly floating hesitant and thin This was a case of lung cold with dispirited Qi The fluids had become cold and congealed Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix g n c o Copyright Sharon Weizenbaum 2022 10 gm

136 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Zingiberis Rhizoma g n ji ng 10 gm I asked him to drink it like his usual tea He had his second visit after 10 days The thirst had diminished and the amount he drank decreased His nose was moist with mucous and his breath was warm I advised him to continue the formula until the end of the month and he recovered From Julin Zhong Yi Yao 1986 3 28 Discussion This illness was in the upper warmer but the treatment focused on the middle and lower and therefore it was ineffective We did use a warming method but applied a Zang Fu diagnosis as well This shows that Licorice and Ginger Decoction g n c o g n ji ng t ng treats lung cold with cold qi patterns For this it is truly effective Case 8 Dizziness Dr Zhu Yan Mr Wang was a 50 year old male who came for his first visit on April 12 1965 In the afternoon of the previous day he began to feel dizzy with a desire to vomit He asked a doctor to diagnose and treat him He was given Clear Dizziness Pill qing xuan wan without any results His pulse was hesitant at 47 beats minute His tongue was pale and he had a desire to vomit He had no thirst or fever His body temperature was 36 4 C He did not fear cold This was a cold pattern and treatment needed to warm and scatter I gave him Licorice and Ginger Decoction g n c o g n ji ng t ng Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix g n c o 9 gm Zingiberis Rhizoma g n ji ng 9 gm Copyright Sharon Weizenbaum 2022

137 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Drink one package warm He returned for a visit the next day and the dizziness had stopped The vomiting also stopped His pulse was now 67 beats minute He was able to return to his job of building walls I gave him one more package of the original formula and there was no recurrence From Zhong Yi Za Zhi 1965 11 6 Discussion In the Jing Yue Quan Shu Complete Works of Jing Yue chapter of dizziness it is pointed out that This case is due to cold deficiency of the middle jiao The clear Yang was unable to spread out Licorice and Ginger Decoction g n c o g n ji ng t ng warms the cold in the middle and spreads the clear Yang This cured the problem Case 9 Stomach Duct Pain Dr Hu Xue Ceng This is a case of a 16 year old young man After eating cold and raw food over a long period of time he developed stomach duct pain This was caused by cold and it would come and go Heat made it feel better This was accompanied by abdominal distention and a desire to vomit He vomited clear fluids He also had heart and chest vexation and oppression dizziness poor appetite weight loss and pasty stool His tongue was burned red with white moist moss His pulse was deep and wiry This was spleen and stomach Yang deficiency with cold fluids stopping internally The evil fluids were upwardly harassing It was suitable to fortify the spleen and stomach dispel cold and down bear rebellion I used Licorice and Ginger Decoction g n c o g n ji ng t ng with added flavors Copyright Sharon Weizenbaum 2022

138 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Ginger and Licorice Decoction g n ji ng g n c o t ng Glycyrrhizae Radix preparata zh g n c o 15 gm Zingiberis Rhizoma g n ji ng 8 gm Pinelliae Rhizoma preparatum zh b n xi 4 gm The illness resolved after two packages I gave him Xiang Xia Yang Wei Tang to consolidate the result From Tian Jian Zhong Yi 1986 4 14 Discussion In asking questions to determine the cause and differentiate the syndrome we can see that this case of stomach duct pain is due to spleen and stomach deficiency cold Licorice and Ginger Decoction g n c o g n ji ng t ng is Regulate the Middle Decoction l zh ng t ng without the sticky cloying Ginseng Radix r n sh n and Atractylodis macrocephalae Rhizoma b i zh This will make the formula s warm the middle action to be even more speedy The addition of Pinelliae Rhizoma preparatum zh b n xi warms the stomach and stops rebellion In this case it was effective Gui Zhi Gan Cao Tang47 Cinnamomi Ramulus gu zh 4 liang 12 gm Glycyrrhizae Radix g n c o 2 liang 6 gm Cook the above herbs in 3 sheng of water down to 1 sheng Remove the froth and drink immediately 47 Sha ng Ha n Mi ng Yi Ya n A n Ji ng Xu an Selected Cases from Famous Physicians in the Shang Han Tradition Ed Che nMi ng Zha ngYi n She ng Xue Yua n Publishing Company Be iji ng China 1998 Copyright Sharon Weizenbaum 2022

139 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Clause 64 When copious sweating has been promoted and the person s hands are crossed over the heart and there are palpitations below the heart with a desire for pressure Gui Zhi Gan jiang Tang governs Formula Explanation48 This formula is effective for heart Yang depletion with a special characteristic of having epigastric palpitations that like pressure It uses Cinnamomi Ramulus gu zh combined with Glycyrrhizae Radix preparata zh g n c o These stimulate and rouse the heart Yang Although it is a simple formula it does return the heart Yang If there is simultaneous pattern you can add other flavors Cases49 Case One Heart Palpitations and Pain Dr Hu Meng Xian Mr Lin was 39 years old and came for a consultation on August 8 1960 He said that he had heart palpitations with pain that desired pressure He took analgesics but they were not effective His bowels and urination were both normal He sometimes had spontaneous sweating His pulses were slightly moderate and his tongue moss was white and slippery I used Cinnamon Twig and Licorice Decoction gu zh g n c o t ng to be taken warm 48 From Collected Classic Formula Case Studies from Renowned Physicians complied by Chen Ming and Zhang Yin Sheng 1998 Xue Yuan Publishers Bei Jing 49 Ibid Copyright Sharon Weizenbaum 2022

140 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Cinnamomi Ramulus gu zh 18 gm Glycyrrhizae Radix g n c o 9 gm After these herbs the pain was gone Discussion In general if pain is worse with pressure it is excess pain and when it likes pressure it is due to deficiency There was also heart palpitations and sweating so this was obvious heart Yang depletion Without the balmy warmth in the Luo vessels there was pain Cinnamon Twig and Licorice Decoction gu zh g n c o t ng is given warm This is very straightforward It stimulates the Yang of the imperial palace There is a small amount of herbs but the strength is concentrated Case 2 Dizziness Dr Liu Yong Yun Mr Tai was 46 and had suffered from dizziness and weakness for 4 years In the recent 20 days this had gotten worse On July 30 1978 he was hospitalized For 4 years his blood pressure had tended to be low This was accompanied by dizziness flowery vision insomnia with many dreams forgetfulness and weakness of the whole body He also had heart palpitations with a pressure feeling above his heart He used western medicine but it was not effective Physical exam revealed that his blood pressure was 85 58 Everything else was normal This was diagnosed as constitutional hypotension Cinnamomi Ramulus gu zh 15 gm Cinnamomi Cortex r u gu 15 gm Glycyrrhizae Radix g n c o 15 gm Copyright Sharon Weizenbaum 2022

141 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Schisandrae Fructus w w i z 25 gm decocted in water and taken two times a day morning and night After 4 days the blood pressure had increased and the symptoms had changed for the better and his sleep improved He felt that his body had more strength and her spirit was happy I consolidated the treatment for one more week and he left the hospital Afterward there was no relapse Discussion This was a case of deficiency type dizziness The clear Yang did not rise The Ling Shu Ko Wen says when the upward Qi is insufficient the brain is empty and the ears suffer from ringing The head suffers from slanting and the eyes are dizzy Therefore Cinnamon Twig and Licorice Decoction gu zh g n c o t ng warms and supplements the Yang Qi of the upper Jiao The addition of Cinnamomi Cortex r u gu and Schisandrae Fructus w w i z supplement both the Yin and Yang Yin flourishes and Yang ascends and the clear orifices are nourished The dizziness is naturally gone Case 3 Insanity Li Zi Zhao Ms Li was 21 years old and came for a consultation on August 17 1983 Her mother spoke to me The previous year she and her mother had quarreled and she became very depressed and melancholy She did not want to speak and then slept a lot and did not want to wake She was drowsy and was not breathing deeply Or she spoke incoherently At times her symptoms were mild and sometimes they were severe She repeatedly sought medical advice and treatment and was given herbs to regulate Qi and purge downward The illness did not improve and became chronic up to our visit This woman s growth and development was normal but her facial expression was dull and mechanical Her two arms were crossed to protect her chest I asked her questions but she spoke Copyright Sharon Weizenbaum 2022

142 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted fearfully It was as if her ears were blocked up Her pulse was floating and big and her tongue was pale with white moss This was insanity disease and was due to heart Yang deficiency damage Cinnamomi Ramulus gu zh 45 gm Glycyrrhizae Radix g n c o 20 gm 2 packages decocted in water After one package her spirit had improved After 2 more packages her desire to sleep was gone and her speaking increased The patient s condition had stabilized The heart palpitations and tinnitus had dispersed She said it was all like a dream The effectiveness was still not complete so I gave her two more packages and there was a complete cure Discussion In this case there was liver constraint however repeated diarrhea inevitably damaged the heart Yang This pattern manifested with the patient s arms pressing on her own chest palpitations and tinnitus There was no doubt that this was a Cinnamon Twig and Licorice Decoction gu zh g n c o t ng pattern Although this was a serious chronic illness it did not take a heavy formula for it to change but I did double the dosage of the herbs This worked very well and was right to the point It worked like wind in a sail Classic formulas are nothing less than truly miraculous Case 4 Deafness Zhou Fu Sheng Mr Zhou age 29 Copyright Sharon Weizenbaum 2022

143 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Because he had a sudden outbreak of deafness that had lasted for 2 months his doctor gave him Augment the Qi and Increase Acuity Decoction y q c ng m ng t ng for treatment There was no change in the deafness Hi suffering was very great and after a long time he came in for a consultation At the exam he told me about the deafness Palpitations and weakness accompanied this He also had a slight fear of cold His tongue was pale red with a thin white coat His pulse was thin and soft without strength A detailed inquiry revealed that this illness had come on after he had a cold with excessive sweating On the basis of the pulse pattern and the disease history I differentiated this pattern as heart Yang deficiency and use Cinnamon Twig and Licorice Decoction gu zh g n c o t ng with added flavors Cinnamomi Ramulus gu zh 12 gm Glycyrrhizae Radix g n c o 8 gm Acori tatarinowii Rhizoma sh ch ng p 4 gm 2 packages After 2 packages he felt that his strength had increased There was a change for the better with the heart palpitations and there was no longer a fear of cold The formula was verified so I gave 2 more packages and the deafness was cured All of the other symptoms also dispersed Discussion The Su Wen Jin Gui Zhi Yan Lun says the south is the red color and it enters through to the heart and opens into the orifice of the ear and stores the Jing in the heart When the heart Yang is insufficient it is unable to surge upward to the ears and this can cause deafness Excessive sweating damaging the heart Yang caused this case of deafness The Da Lun says When grasping the pulse the patient crosses their arms over their heart Copyright Sharon Weizenbaum 2022

144 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted There may or may not be cough but there is deafness without clarity The why and wherefore of this is that there is deficiency due to excessive sweating Cinnamon Twig and Licorice Decoction gu zh g n c o t ng warms and opens through the heart Yang Acori tatarinowii Rhizoma sh ch ng p assists by opening the orifices The effect was very good Case 5 Flustered with Fright Palpitations Feng Shi Lun Patient age 30 male named Li Mr Li was flustered with fright palpitations and this had been going on for 3 4 years His sleep was poor and he was wakeful through the night with frequent sweating His tongue moss was thin and white The treatment principle was to warm the yang and down bear rebellion I used Gui Zhi Gan Cao Tang with added flavors Gui Zhi 30 gm Fu Ling 15 gm Zhi Gan Cao 15 gm Results After 3 packages of this formula the patient s symptoms decreased I gave 3 more packages and the shaking and fright palpitations completely cleared Other Cases50 Case 6 Heart Palpitations Ms Lu was a 46 year old peasant She came for a consultation on May 1 2000 On month previously because she was worried about family affairs and had to overwork She 50 From Liu Han Tang s A Record of Clinical Experience using Classical Formulas Copyright Sharon Weizenbaum 2022

145 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted then felt flustered and had heart palpitations She went to the hospital and took the patent medicines Tian Wang Bu Xin Tang and Bai Zi Yang Xin Wan There was no effect She came to my hospital for a check up The electro cardiogram showed premature ventricular contraction Her symptoms were heart palpitation aversion to cold spontaneous sweat shortness of breath mouth thirst pale red tongue with thin white dry moss and a deficient choppy pulse Her diagnosis was heart palpitations This was differentiated as Heart Yin Yang and Qi combined deficiency The treatment needed to warm the heart Yang while boosting the Qi and Yin She was given Gui Zhi Gan Cao Tang plus Sheng Mai Yin modified Gui Zhi 12 gm Dang Shen 15 gm Zhi Gan Cao 6 gm Mai Dong 15 gm Wu Wei Zi 10 gm Long Yan Rou 30 gm Shan Zhu Yu 15 gm Chao Zao Ren 15 gm This was decocted in water and taken Second visit After 5 packages of the above formula the heart palpitations had clearly diminished The premature beats had gone from 8 10 minute to 0 1 minute She continued with the above herbs for another 10 packages The heart palpitations along with the other symptoms had gone The electrocardiogram now showed that the heart beat was normal A follow up a year later showed no relapse Discussion This case of heart palpitations was due to strain and overwork damaging the body There was heart Yin Yang and Qi deficiency Gui Zhi Gan Cao Tang was given with Copyright Sharon Weizenbaum 2022

146 Unpacking Gui Zhi Tang Translated and Compiled by Sharon Weizenbaum except where noted Sheng Mai Yin modified Gui Zhi Gan Cao Tang was given to return the Yang Sheng Mai Yin boosts the Qi and Yin Shan Zhu Yu Long Yan Rou and Zao Ren were added to integrate Zhang Xi Chun s experience in treatment He considered Long Yan Rou to be a very effective herb to treat heart palpitations Shan Zhu Yu to be very good for restraining the heart Qi and Chao Zao Ren to nourish the heart and calm the spirit All of these help treat heart palpitations Gui Zhi Gan Cao Tang can be used to treat circulatory illnesses Modern application includes coronary heart disease rheumatic heart disease cardiac obstruction cardiac type asthma congestive heart failure congenital heart disease with pneumonia and heart palpitations One has to treat on the basis of the clinical manifestation This formula can be used along with other formulas such as Si Ni Tang Sheng Mai Yin or Zhen Wu Tang The special points for differentiation are that there is heart Yang deficiency with symptoms of heart palpitations shortness of breath aversion to cold purple lips swelling of the lower limbs pale dark tongue thin white moss deficient choppy pulse and chest pain that desires pressure Copyright Sharon Weizenbaum 2022