Seattle Institute of Oriental Medicine

Translations: Cases

Zhi Gan Cao Tang Cases

Zhi Gan Cao Tang

Ingredients

Zhi gan cao, sheng jiang, ren shen, sheng di huang, gui zhi (remove bark), e jiao, mai men dong, huo ma ren, da zao.

Preparation and Doseage
With the above nine ingredients, use 7 sheng of clear alcohol, 8 sheng of water, decoct the first eight ingredients down to three sheng of liquid, remove the dregs; add e jiao and let it completely dissolve. Take 1 sheng warm three times per day (current method: water decoct two times and take warm).

Source Text
In cold damage, with a pulse that is floating and intermittent and there are stirring palpitations, Zhi Gan Cao Tang Governs this.

Commentary
This pattern is the condition of Heart Yin and Yang both deficient. If the Heart Yin is deficient, then the Heart loses its nourishment; if the Heart Yang is insufficient, then the heartbeat does not have strength. Stirring palpitations and a pulse that is bound and intermittent are often seen in Coronary Artery Disease. This formula simultaneously regulates yin and yang and tonifies qi and blood. The sovereign herb, zhi gan cao, "opens the channels, disinhibits blood and qi" (Ming Yi Bie Lu); furthermore, when it is [prepared] with clear alcohol, it harmonizes qi and blood and profoundly unblocks the channels. Clinically, when Coronary Artery Disease belongs to the category of yin and yang dual deficiency, this formula is appropriate.

Applications

1.) Stirring Palpitations
Luo Qian Fu Medical Cases: a person over 50 years of age, has [constitutional] weakness of middle qi. In June, the patient contracted cold damage for 8 or 9 days. The doctor saw this as a heat presentation. After taking a cold, purging formula, the patient ate 3 or 4 pears, which injured the Spleen and Stomach, the 4 limbs became cold, at times he/she was confused and muddleheaded. Upon examination, his/her pulse beats and sometimes stops; this is a bound pulse. His/Her Heart also [has] stirring palpitations, the patient is tired but not severely exhausted, color has become cyan and yellow, jing-shen slightly reduced, no desire to open eyes, curls up and doesn't want to speak to people. Zhi Gan Cao Tang was used to treat this. Cheng Wu Jin says: tonification can remove weakness. Ren shen and da zao are sweet, they are used to tonify insufficient qi; gui zhi & sheng jiang are acrid and used to boost the zheng qi; the 5 zang are weak and the flow of the construction (ying) and defense (wei) have dried up. [Resolve] this with a moistening formula. Therefore, use huo ma ren, e jiao, mai dong, di huang: they are sweet, they moisten the channels, nourish the blood and will recover the pulse by opening/unblocking the Heart. Gui zhi and ren shen were added to urgently revive the zheng qi. Sheng di was reduced by 1/2 for fear of damaging the Yang qi. The patient took 1 or 2 packets with no effect.
The author reevaluated [and still stood by his diagnosis of] this disease. Were the medicinals old and stale and [because of this] ineffective? The doctor went to the market [to buy herbs which the doctor] tasted for rich flavor, again made the decoction [using new herbs] and [the patient] took it. The disease reduced by 1/2, after taking the formula again, the patient recovered.

Comments: Because the middle qi was deficient, the erroneous use of a draining formula, "damaged the Spleen and Stomach," after that, the patient lacked source of post-heaven essence, didn't have adequate yang to diffuse qi, and didn't have sufficient yin to nourish the Heart. This caused the pulse to be bound and intermittent and lead to stirring palpitations as well. In the formula, ren shen and da zao are sweet and used together to tonify insufficient qi. The acrid nature of gui zhi and sheng jiang moves weakened yang; huo ma ren, mai dong, and di huang are moistening and augment to stop the depletion of yin. An especially high dose of zhi gan cao the Stomach qi to support the heart vessel at its source. The formula tonifies earth and engenders fire, enriches yin and recovers pulse, in this case, with great effect.

Case 4: Glaucoma, Central Retinitis

Yao Fang Wei Medical Case: 57 y.o. female, Sept. 9, 1953 doe.
In childhood, the patient developed right eye cyanosis and loss of vision. In recent years, her left eye also began to darken. It seemed like there was presence of fog [clouded vision] and spots were obstructing here vision. At times, there was white light as if an electrical flash or there were flashes of red light. These seemed to set off one another. She would become dizzy and confused, have head and eye vertigo, eyeball pain and socket pain, her Heart was vexed and not calm. Pulse is sunken and fine, the center of the tongue is bare and crimson. Her yin-essence is deficient, and [because of this] the Heart spirit is not peaceful and the deficient yang is floating upward, therefore there is chaotic flashing and the yang is not contained. The appropriate treatment is to tonify the yin and boost blood, calm the spirit and subdue yang. Use Zhi Gan Cao Tang with Long Gu and Mu Li. She repeatedly took it and disease largely cleared; the red and white light practically vanished. Nevertheless, because her vision is often still cloudy, one should continue to tonify using the source formula to [resolve this].

Comments: Ling Shu - Da Huo Lun says: "The eyes are what the Heart employs, [and the Heart is where the spirit lodges]." Therefore, the eyeball is nourished by the Heart blood. If the Heart blood is insufficient, the Heart qi is naturally reduced, the eye loses its enrichment and vision is compromised. The use of Zhi Gan Cao Tang to tonify and boost the qi and blood of the Heart, [allows] the eyes to moisten and recover.

from Selected Cases from Famous Doctors in the Shang Han Tradition
summary of translation by Kim Ulmer; July 2004