Deepest Health: Recent Episodes
None
I’m excited to explore the extremely clinically relevant formula Gualou guizhi tang in some detail. What a great first formula in this JGYL formulas project.
I just love all the derivatives of Guizhi tang. How incredible is Gui zhi tang? It forms the foundation of a large proportion of Zhang zhongjing’s (ZZJ) formulas and yet is the simplest, most unassuming formula we have in the materia medica. Here, we make the slightest addition to that pure formula and end up with a quite different energy and effect. This is the minimalist power of classical Chinese herbal formulas!
In this article, I’ll go over the basics and some clinical notes from my own practice.
Gualou guizhi tang 栝楼桂枝湯 in the JGYL This formula is the first in the second chapter of the Jin gui yao lue, thus the first in the text.
“In greater yang disease, if all signs are present and [in addition] the body is rigid and stretched but the pulse is sunken and slow, this is tetany. Gua lou gui zhi tang governs.1
This is the only appearance of this formula in ZZJ’s works, though the majority of this formula is contained inside of Chaihu guizhi ganjiang tang. A conversation for a different day!
Ingredients and proportions Note : In this work, I chiefly rely on the Shennong bencao jing 2, Shanghan lun, Jingui yaolue and a few related secondary texts. If I say an herb is the X herb of the X class, this refers to its classification in the Tangye jing. In some cases, this information (seems to) conflict with what you see in the standard textbooks, a fruitful space for discussion!
The Prince of Chinese Herbs – Guizhi Guizhi – 3 liang Cinnamon twig is one of the most commonly used herbs in ZZJ’s formulas. It works to warm and release the muscle layer and thus the Taiyang surface. It is pungent and warm, as well as being the wood herb of the wood class. That intensified wood energy feeds the fire via the generation cycle, filling the yang of the Heart and encouraging outward movement and warmth to the surface. In decoction of this formula, Guizhi DOMINATES.
Shaoyao – 3 liang Peony root, common companion to Guizhi, comes in white (Baishao) and red (Chishao) versions. It’s a bitter and neutral herb and the earth herb of the metal class. Here we use 3 liang – so in a 1:1 relationship with Guizhi. The pungent woody warmth of Guizhi is combined with the condensing moistening Shaoyao, they together help to restore normal regulation to the surface – stopping any tendency towards sweating. Also, this simple combination establishes normal qi and blood circulation in the surface which may, in itself, gently release the tight musculature typical of the Gualou guizhi tang pattern.
Gancao – 2 liang Licorice root, one of the most recognizable Chinese herbs is used in this formulas – like so many others. Here, it appears we want the licorice fried version, so Zhi Gancao. Gancao is sweet and neutral and is the wood herb of the earth class. 3:2 ratio with the other herbs so far, a typical dosage for Gancao in ZZJ’s formulas. We know that Gancao detoxifies and “harmonizes” formulas, but in thinking about it as the wood herb of the earth class, we can also consider that it builds the center while simultaneously encouraging appropriate movement.
Shengjiang – 3 liang Fresh ginger root – one of my favorite things on Earth! It is pungent and warm and the earth herb of the wood class. It is in that way the inverse of Gancao. Both work on the relationship of wood and earth, essential for the proper functioning of the center – around which everything else in the body turns. But here, our focus is on the generative and moving qualities of wood, and doing so in such a way that benefits earth.
Dazao – 12 pieces Chinese date, or Jujube, is a common pairing with Gancao, where they work together to protect the center and harmonize the formula. This completes the formula Guizhi tang within Gualou guizhi tang. Dazao is sweet and neutral in the SNBCJ, and in the TYJ is the fire herb of the earth class. What is a piece of Dazao in granule gram weight? My teachers have used anywhere from 9-12 grams, and I’ve seen as many as 15 grams used as a “piece.”
Gualou / Tianhuafen – 2 liang Gualou / Tianhua fen botanical drawing Trichosanthes is used as a root, whole fruit, peel or seed, and is commonly known as Chinese snake gourd (though the species is slightly different from the common grocery store snake gourd!). This is the most interesting herb in the formula in that it is relatively unique in ZZJ’s works. I know a lot about Guizhi tang, which forms the bulk of this formula, but comparatively less about Trichosanthes.
Because of this, I’m going to follow up this article with one looking specifically at Gualou / Tianhuafen in more detail. What I can say is that Gualou is not in the Tangye jing’s 25 herbs, but in the Shennong bencao jing, Tianhuafen is listed as bitter and cold. That’s true of the fruit as well. This bitter coolness will, in part, help to drain heat and restore moisture to the dry and damaged tissues.
To summarize: * Guizhi 3 liang * Shaoyao 3 liang * Shengjiang 3 liang * Gancao 2 liang, mix fried * Dazao 12 pieces * Gualou 2 liang
More about the relationship with Guizhi tang In the formula preparation instructions, the formula reflects Guizhi tang in that you are meant to take the decoction in three doses and stay bundled so as to induce slight sweating. If the sweating doesn’t happen, you feed hot gruel to assist in the sweating process by both supplying the types of substances necessary to make sweat AND warming the person internally.
A key point in the text is where it says that the pulse is sunken and slow, confounding expectations. The implicit understanding is that, like in other Taiyang disease, the pulse should be superficial or floating (as we learn first in the first line of the Shanghan lun) and – while not necessarily rapid – certainly not slow. In this situation, the body is not working at the surface, but at the interior – it is no longer a simplex yang conformation illness. It’s a more complex situation – thus its presence in the Jingui, which deals in complex diseases.
Given that this formula is based on Guizhi tang, we can surmise a thing or two about how the pathology developed. Obviously, this is Taiyang disease, and thus requires the regulation of the surface (Guizhi, Baishao, to some extent Shengjiang) while simultaneously bolstering the Taiyin center (Shengjiang, Gancao, Dazao). So, there is surface dysregulation, with the attendant sensitivity to wind & claminess.
If the surface is open too long, or if the patient is already deficient of fluids to begin with, Yangming type dryness could definitely be the result. The “Stomach domain” gets dry, impacting the fluids, tissues and areas associated with that domain. I’ll return to this point at the end of this article, and it will dominate the deeper discussion of Gualou in the next article.
Tetany – what is it and how does it show up today? Chronic dehydration + long days hunched at the computer = Gualou guizhi tang As mentioned above, the JGYL indicates that this formula treats tetany. What, exactly, is tetany – and how might it show up in your clinic?
Tetany is written as either jìng 痙 or as cì 痓. It is described as being an intense tightness, rigidity and spasming of muscle tissues, usually with attendant loss of easy movement and significant pain. Tetany can occur anywhere in the body and can be accompanied by a wide range of symptoms. In clinic, it can be challenging to decide whether a given tight, painful back is truly tetany in this sense, or whether it is something else.
As always, paying close attention to the accompanying signs and symptoms is key to differentiating similar presentations. There are two forms of tetany described in the JGYL. The soft/yin form, as would be treated by Gualou guizhi tang, involves an open surface, and thus, sweating. The hard/yang form, then, has no sweating, and is associated with formulas like Gegen tang. I think we can safely assume that the hard form would be more acute, tight and painful than the soft form. 3.
In my clinical practice, I have used this formula to treat very mild and very severe cases of tight, painful muscles – especially in the back and shoulders. One classic type of person I see with this presentation is the typical office worker. In an office environment with forced air HVAC and lots of intellectually oriented work, dehydration is a common problem. Add to that 8+ hours hunched over a computer, particularly if no efforts are made to improve ergonomics? Well, I’m not going to say that these conditions by themselves will cause a Gualou guizhi tang pattern, but it sure isn’t helping.
I have also used the formula with some success to treat more severe forms of tetany including rigidity in the neck due to spinal fusions as well as acute myoclonus secondary to severe viral infections.
I almost always use GLGZT as an addition to another Guizhi tang based formula, or one that works well with it. For instance Chaihu guizhi tang + Gualou guizhi tang for seasonal allergies with coughing and sneezing that results in a lot of neck and upper back tension.
What is the Gualou doing in Gualou guizhi tang? Most of this article has been about Guizhi tang, which makes sense given the composition of the formula. But, to me at least, it is initially confusing how Gua lou gui zhi tang has such different symptoms and signs than does straight Guizhi tang. So, in the next article, I’m going to get more familiar with Gualou, comparing it with a formula that should have similar signs and symptoms, Guizhi jia gegen tang.
I’ll share my sensory experiences from drinking several different decoctions, and suggest formula dynamics as well as additional information about what this formula might treat. I’ll link that article here when it is finished.
Come discuss this article at the Deepest Health Community – it’s free! The post Gualou Guizhi Tang appeared first on Deepest Health.
I recently went through the online Jingui Yaolue (JGYL) courses through the Institute of Classics in East Asian Medicine (ICEAM) for the second time. The first time, back in 2011, I was just holding on for dear life. I got married that year, and the clinic was only 2 years old – just about to take a critical step towards maturity. It was busy, and the material felt quite opaque, particularly compared to what’s in the Shanghan lun (SHL).
This time, I caught on to the structure and rhythm of the text a bit more. I had time to read a couple of different translations and slow down a bit. I also was at a point in my clinical practice where these formulas were coming up repeatedly. Still, there’s a sense that I don’t quite get it, and formulas keep dropping out of my mind. So, since I’m a sucker for a systematic project, I’m going to be working through it and documenting the results here.
Image : Cover of the “green book” translation of the Jingui Yaolue by Sabine Wilms & Nigel Wiseman Let me make something clear. I’ve been studying and using these formulas and this text for a little while, but I’m by no means an expert. In these posts, I don’t intend to put myself forward as one. I hope to talk a little about the formulas from various perspectives in a way that might be helpful to readers, but is most definitely helpful to me.
If you really want to get into the Jingui, the ICEAM courses I mentioned above are a splendid start. ICEAM just minted a new offering, too, a hybrid online-live mega course (2.5 years long) to ground yourself thoroughly in Han dynasty Chinese herbal medicine. As far as translations of the text are concerned, I rely almost entirely on the Wilms, Wiseman “green book” translation.
As I mentioned, I want to look at the formulas of the Jingui yaolue from a few different perspectives I’m a hard-headed learner, particularly with herbal medicine. It takes time for things to soak in. So, I try to immerse myself in whatever I’m learning as much as possible. More importantly, I try to come at the material from many perspectives.
In this case, I’ll focus on:
- The basic information as revealed in the text
- Any interesting variations or changes to the formula that have emerged over time
- Sensory experience with the formula
- Clinical experience with the formula
- The formula dynamics – or the way the formula hangs together and does what it does
- How the formula relates to other formulas, both in this text and in other texts and traditions
- If it’s interesting, I’ll check out any biomedical research that involves the formula
Focusing on the formulas doesn’t mean ignoring other features of the text I’m most interested in getting the formulas fully in my brain, and understanding them more deeply. But, it’s only natural that understanding of the text itself and what it teaches will emerge as I go. I plan to work through the text by chapter. Which formulas are there together, and what that means, is something I’m always interested in. This necessarily means reading the translators’ notes, whatever commentaries I can access, as well as analyzing the formulas carefully.
I’ll be using Obsidian as my primary tool for working with the data I discover and produce An image of the prior state of my Obsidian database visualized as a mindmap Given the nature of this project, it’s a perfect fit for ongoing work with my favorite new knowledge management tool, Obsidian. Obsidian is out of beta and just… incredible. Everything works perfectly, and I’ve barely begun to scratch the surface of its capacities. I’ll share my organization and graphs as I go, particularly when they demonstrate something interesting.
I’ll do some stream-of-consciousness type sharing on the Deepest Health community If you’re not already a member, you can sign up for free right now. It’s very simple. I’ve made a special “Cohort” group on the site for containing this information so that I don’t fill up the main feed with my random observations, research notes, and resource finds. If you click this link, you can join that cohort so you get those updates. If you’re not already a member, you’ll be prompted to sign up.
I am going to start with Chapter 2 – “Tetany, Dampness and Thermoplegia” This chapter contains formulas that are very useful in the treatment of pain, particularly in the soggy Pacific Northwest – I’m very fond of Gualou guizhi tang, for instance. It also has formulas that are included in the Shanghan lun as well – something I always find interesting. I’ll be batching formulas at times, particularly when I find out less about them.
I look forward to sharing my adventures with you.
The post The Chinese herbal formulas of the Jingui Yaolue appeared first on Deepest Health.
I have always struggled with learning languages. It wasn’t something that I was introduced to in childhood, and because I skipped high school, I didn’t catch it there either. The first inkling I had to learn a language was around age 16 when I first started working with the Yijing. I was immediately interested in […]
The post Learning classical Chinese online – an exciting new resource appeared first on Deepest Health.
Now that we have a sense of the 5 acupuncture business systems (fire/executive, earth/facilities, metal/finance, water/marketing, wood/operations) I want to suggest how you might actually use them to get a handle on an overwhelming situation you are confronting in your acupuncture business. Before continuing, I want to acknowledge that I am here trying to make […]
The post Using the 5 acupuncture business systems to transform overwhelm appeared first on Deepest Health.
Previously in this series, I have discussed the conditions of overwhelm that can accompany acupuncture practice, looked at the executive system of acupuncture businesses as well as, the facilities system, the financial system and the marketing system. Now, to finish up the systems conversation, we turn to the nexus of your acupuncture practice – the […]
The post The Operations System – The Living Nexus of your Successful Acupuncture Practice appeared first on Deepest Health.
From consideration of the clarity inducing power of Metal and the Financial system, I continue my exploration of the five acupuncture business systems with Water and the Marketing system. The marketing system is one topic that dominates searches and educational products for small business owners. There’s a simple reason for this – more money requires […]
The post The marketing system – Unlocking a sustainable flow of ideal patients appeared first on Deepest Health.
From the facilities system now to the financial system – as we proceed through the creation cycle things are getting more solid, more down to brass tacks, more in the realm of yin. The financial system can be the center of significant dysfunction and anxiety in acupuncture business – really any business. The majority of […]
The post The Financial System – Breathing in, Breathing out appeared first on Deepest Health.
The executive system that I just outlined is common to most businesses – though of course it takes on a unique character in acupuncture businesses. In contrast, the facilities business system is only shared by businesses that have some type of physical location, such as an acupuncture clinic. The facilities business system is much more […]
The post The Facilities System – Nourishing Ground for your Acupuncture Practice appeared first on Deepest Health.
When I do coaching with acupuncturists, or when I’m working in my business, I inevitably end up thinking about and working with overwhelm. It’s only natural that a Chinese medicine clinic owner might run into symptoms of overwhelm from time to time – the business is complex and sometimes demanding. Further, acupuncturists typically are deeply […]
The post The Executive System – The Fire Animating your Acupuncture Business appeared first on Deepest Health.
Acupuncture practice management can be quite overwhelming, especially at first I define overwhelm as a sense of not having the capacity to handle whatever it is we are facing because of its size, intensity, complexity or importance. Overwhelm comes with a variety of symptoms and signs varying, like anything, according to the person. Nearly everyone […]
The post A novel approach to overcoming acupuncture practice management overwhelm appeared first on Deepest Health.