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Treatment of meningitis

  1. Acupuncture wise, you can bleed ST 40, BL 40, San zhong/ three weights, and PC 3. You can needle Zheng jin and Lung 7.

All these point regions are implicated for brain disease.

ST 40 and San zhong/ three weights are yangming/ shaoyang points to help treat phlegm fire in the brain and systemic blood stasis. St 40 the luo point also treats dampness of the spleen, and Suwen 74 tells us that spasms and head stiffness belongs to dampness 諸痙項強,皆屬於濕. And dampness is the qi of the spleen 諸濕….皆屬於脾. Sanzhong and yangming help treat dampness in sanjiao, connective tissue/ meninges in the brain.

BL 40 and PC 3 help treat blood heat and infectious disease. BL 40 alternative name is called the blood xi cleft, 血 . Also treats disease in the brain because a branch of foot taiyang enters and nets with the brain 其直者,從巔入絡腦 (Lingshu 10).
PC 3, the water of fire, helps cool disease at the blood level of jueyin. Pericardium is the upper axis of foot jueyin, which enters the brain/ top of the head. Also Pericardium 6 is applicable because Lingshu 10 tells us that vacuity symptoms of the Luo mai causes head rigidity 虛則為頭強.

Zhengjin and Lung 7 are guiding points to taiyang/ back of the neck.

Meningitis is therefore seen as a disease of Taiyang, yangming, Shaoyang, and jueyin. One can say even Taiyin because of the dampness. But its a hot dampness so we treat through yangming and shaoyang. But what led to susceptibility was the weak zhong qi.

Taiyang and Jueyin because they affect the brain are both full of blood.

Here are formulas that would treat meningitis and have been historically used for epidemic encephalitis. Bai hu tang would be the first in the list, if there is dampness then Bai hu jia cang zhu tang, can even think of adding Qiang huo for wind dampness in Taiyang. One has to go high on the shi gao (50 grams-200 grams). High cang zhu might also be needed.

Another important yangming strategy and for infectious disease is to purge yangming, bowels, so Da cheng qi tang. But if its really febrile, Tao he cheng qi tang, since it treats abscess and purulence. It can treat purulence in the brain, since the brain is a called an extraordinary bowel 腦髓…名曰奇恆之府. So one can open the bowels below to treat the bowels above. Da cheng qi tang treats more the qi layer while Tao he cheng qi tang is focused more on the blood than DCQT.
If its very yang excess, one can even purge with Da huang mu dan pi tang (here there is more blood heat than Tao he cheng qi tang), hene why THCQT has gui zhi and DHMDPT has mu dan pi, one is to warm and move the static blood, another cools and moves the static blood. Not to say THCQT does not clear heat, all yangming methods do, the difference is that in THQT there is some yin cold within yangming that is basically now trapping the yang so one needs to warm within the cooling approach.

With that train of thought, also Bai hu jia gui zhi tang, technically a hot malaria formula per the Jingui, it can be used for all viral infectious disease. Gui zhi also helps treat the taiyang aspect of meninigitis.

Another formula used is Ge gen tang, which treats stiffness in the neck. Its been used for brain disease in fact. Also the cold malaria formula chai hu gui zhi gan jiang is the equivalent of the Tung point, San zhong. It has tian hua fen and mu li to flush phlegm heat in shaoyang, and gui zhi and gan jiang to warm and guide to taiyang and taiyin so yang and yin open, and chai hu to guide to the brain. Huang qin to clear the fire in the upper jiao.

Since we are talking of viral diseases, we need to think about shaoyang and jueyin. Shaoyang particularly for lurking disease.

Xiao chai hu tang comes to mind, especially Xiao chai hu tang minus Ban xia plus Tian hua fen and mu li to incorporate Gua lou mu li san.

But since we are opening the bowels, Da chai hu tang is important to think about. Chai hu jia long gu mu li tang also is an important consideration and opens the bowels (all open bowels methods I’ve mentioned are Da huang methods).

A Wenbing formula one should think about is Chai hu da yuan yin, this treat lurking disease in shaoyang, which includes the connective tissue of the brain.

Huang lian jie du tang is another consideration, for fire toxin. San huang xie xin tang also treats all heat in the orifices, usually manifesting as bleeding, like intracranial bleeding, but bleeding is not necessary, since that’s just a sign of hot blood due to yangming.
Of course, this can also be heat in the blood layer, and one can use Xi jiao di huang tang, or the jueyin formula, Sheng ma bie jia tang. Sheng ma treats the most pestilent of fire toxins in the blood, bie jia (the turtle) has correspondance with the brain, the tissue of shaoyin. The brain like the turtle has a shell, the cranium. So biejia can move static blood in the brain while protecting it through its simultaneous nourishing and invigorating properties of the deep yin.

That all comes to mind.

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Canabis hyperemisis syndrome, one of the symptoms is the desire to take hot baths to stop the vomiting. Any thoughts from a TCM perspective as to why?

Vomiting is yin coming upward, either through yin excess or yang driving it. There is CM saying that when there is no yin there is vomiting 無陰則嘔. This is because as the zang yin is depleted then it causes yang to separate and rush upward bringing the contents of the stomach with it. Marijuana is drying to taiyin and yangming, that is why one gets munchies to try to replace the nutritive lost by its hot acrid flavor. Acrid flavors move up. In addition, the vomiting can be seen as the body’s own mechanism of purging out what is sees as a poison. Marijuana induces yin yang disharmony, causing ming men yang to go to the brain/ sea of marrow and steam it to release its essence and the yang within it, endorphins, and thus the associated high.

Furthermore, one uses hot water because the hot water helps drive the yang back in. The yang that is coming up, and the yin that it seperated from, the hot water on taiyang and the skin, helps cause a slight sweat releasing excess wei qi so yang can cool off and metal can descend and the brain’s yang can once again internalize to water. Also all the symptoms associated with the condition (vomiting, nausea, crampy abdominal pain) are spleen taiyin signs. Hot water helps warm the interior essentially by warming its taiyin pair, the lungs. There is also taiyang and taiyin relation as taiyang wei qi excess is released then ying and wei find balance, ying here meaning the yin in the interior stops being propelled upward by yang.

Keto diet from a CM lens

Ketosis causes yangming disease. Symptoms are bad breath, dry mouth thirst, constipation, weight loss, high energy, possible digestive issues, and insomnia, These are all yangming symptoms caused by drying up the system. People lose weight because the body is producing stomach heat and fire to try to digest excess protein and fat. Ketosis is a type of fasting essentially, therefore, the body interprets it in such way. That’s why there are ketones in the blood (that’s yangming blood heat), increased urination, thirst and dry mouth (person is drying out the taiyin damp due to yangming dryness). To digest these heavier molecular substances (protein and fat) the body has to use prenatal qi since it now has to metabolically process these heavier substances. All food is yin, so the body, ergo has to use yang qi to digest it. Heavier food takes more yang to metabolize, so if there is weakness of postnatal qi which weakens when there is a type of yo-yo dieting and excess heavy food, then the body uses prenatal to support postnatal. Therefore, the body starts using kidney jing and kidney yang to amp up stomach fire. Now the diet does create a certain damp clearing effect, so it is not all bad, it can be cleansing to a certain degree.
But carbohydrates are often digested faster because they require less metabolic yang energy, so in a way they are easier on the system. In CM, all foods for very sickly people, are essentially carbohydrates (long cooked congees). If one avoids all carbs, then one is asking of one’s body to increase metabolic fire with the expense of one’s own jing potentially.

Glimpse into Kaiheshu 開闔樞 (open, closing and pivot) of yin and yang as one functional unit of the six stages 六經.

Suwen 5 《陰陽應象大論》first defines yin and yang for us, giving us the image. Then, Suwen 6, 《陰陽離合論》the treatise of the separation and reunion of yin yang, describes the functionality of yin and yang. It says Taiyang is the opening, yangming is the closing, and shaoyang is the pivot 太陽為開,陽明為闔,少陽為樞. In the yin realm it is then said that taiyin is the opening, shaoyin is the pivot, and jueyin is the closing.

One first has to understand what taiyang opening too much is and taiyang opening too little is (essentially the surface is either opened too much or closed too much). Yangming not closing enough is yang doesn’t internalize (Baihu tang) and yangming closing too much is yang is internalized too much (interior heat and constipation). Shaoyang pivoting too much is yang is arising from the yin realm too rapidly, and shaoyang pivoting too little is yang is not arising from the yin realm at all (the sun isn’t rising when its supposed to).

Taiyin opening too much is everything is coming out, there is a lot of yin in the system, earth is too wet. Taiyin opening too little, is there isn’t absorption of yin, the earth is dry. Shaoyin pivoting too little is yang isn’t moving into the blood and zang, yang is up and out when its supposed to be inward (one should be sleeping and resting). Shaoyin pivoting too much is the creation of too much yin as yang lies hidden in the zang. Jueyin closing too much is blood isn’t moving and yin keeps being created and yang can’t be born. Jueyin closing too little is yin isn’t engendered and yang is being born rapidly and ascending too quickly causing liver wind to strongly surge upward. This is dangerous since this is just the beginning of yang and this can cause the flame that is kindling to extinguish by the uncontrollable fire and wind.

Now, while we can look at formulas within each of the 6 in and yang stages as either opening, pivoting, or closing too much or too little. This is simply for us to try to grasp it. In reality, the six stages are operating as one functional physiological unit.

Yes mahuang tang is taiyang not opening enough. But when taiyang can’t open enough, yangming can’t close. Therefore there is panting and no sweat in Mahuang tang. Since yangming can’t close, Taiyin is not open enough (so the lungs can’t descend), and then jueyin is closed since yang is stuck above. Also why Mahuang tang has been used for amenorrhea, when jueyin is closed then blood can’t flow out.

Now, lets other examples of this yin and yang in motion.
If shaoyin pivots too much, then taiyin opens too much and jueyin closes too much. Therefore, shaoyang pivots too little, and taiyang can’t open, but potentially taiyang also can’t close. What does this mean?

Explanation:
Shaoyin pivoting too much is too much cold water and yin, which pours down (taiyin opening too much) causing diarrhea. Yin water doesn’t let yang be engendered so jueyin closes too much, since there is no birth of yang. Jueyin needs to not be so close for yang to be born. As yang isn’t born then shaoyang isn’t pivoting and taiyang either opens too much or little depending if there is not enough yang to break the surface or too much yang coming outward without anchor. This is si ni tang and/or tong mai si ni tang. Shaoyin disease.

Guizhi tang is taiyin not opening enough causing jueyin to not close enough and taiyang to open too much. Guizhi tang there is dryness so we know taiyin isnt opening enough. That’s why we use sweet nourishing medicinals in Guizhi tang. Since there is dryness and no yin, then jueyin can’t close and therefore there is easy contracture of wind and upsurge (hence retching in Guizhi tang) and aversion to wind and ying disharmony. And now that wind is surging then fire is engended on taiyang and the pores open, and taiyang can’t close, so there is this mild sweat.
Or we can say simplistically that Guizhi tang is taiyang opening too much, but that’s just looking at yin and yang statically and not in interactive motion.

Baihutang is yangming not closing enough (hence profuse sweat and big pulse, big fever) as yang is just coming out the system. As yangming can’t close due to lack of surface dryness then taiyang (cold water) cannot dry off and taiyang is opening too much (profuse sweat). Shaoyang begins too pivot too much since all the yang is coming out from the interior to exterior, and shaoyin cannot pivot at all since the yang cannot come into the zang, but is leaving through the fu (yangming and taiyang). This is leading to yin and yang collapse, since the yang cannot internalize through yangming so shaoyin can pivot yang internally so yin can be created once yang is at rest so this yin now can hold yang in place.

Xiao chaihu tang is shaoyang pivoting too much causing ministerial fire to flare outward, causing shaoyang symptoms of wind and fire. But as shaoyang pivots too much, then taiyang opens too much, therefore we see chaihu guizhi tang combinations. We don’t really see chaihu and mahuang tang combos where taiyang isn’t opening enough. Then because of this shaoyang pivoting too much, then taiyin can’t open enough, hence dryness in Chaihu patterns. Hence, the use of nourishing earth herbs in Chaihu formulas.

Sini san is shaoyang not pivoting enough, this causes a qi depression dynamic. As shaoyang doesn’t pivot enough, then shaoyin pivots too much, hence the limbs go cold and why Sini san is the SHL is viewed as a Shaoyin formula. 少陰病四逆….四逆散主之. As shaoyin pivots too much, jueyin can’t close enough and there is sini, since yang can’t rise and expand outward. Also as yang is closed then this stagnation eventually consumes yin, hence why Sini san is the base for Xiao yaosan, which is a dangui chai hu combo/ jueyin-shaoyang. When shaoyang pivots too little, then this can cause a functional dryness of the blood since the qi stops moving the blood and therefore nourishing the blood. Qi is the commander of blood as the axiom says.

So these are just examples of yin and yang in motion through Kaiheshu theory. But its just a glimpse, every formula can be explained through Kaiheshu, particularly SHL formulas.

Few more examples:
Xiao jian zhong tang is taiyin not opening enough and jueyin not closing enough. This is dry earth causing heat symptoms where the person might bleed out, be vexed, have hot palms, palpitations, loss of essence, dry mouth and throat, etc 悸,衄,腹中痛,夢失精,四肢痠痛,手足煩熱,咽乾口燥,小建中湯主之. This is because as taiyin becomes dry then jueyin heat manifests as earth nutritive cannot control jueyin fire, so wind and fire symptoms appear since there is not enough spleen yin.

Danggui sini tang is the opposite, taiyin is not open enough but jueyin here is closed too much. There is a dry earth, but now the blood is cold here. Jueyin is not hot, but static and cold. There is dry cold blood here, instead of dry hot blood.

I can give many more examples. But I want to now focus on an even deeper aspect of yin and yang in motion within each other. Meaning that by know you are aware that Kaiheshu motion of yin and yang does not just occur in isolation, but as a simultaneous unit. But that’s not where it ends. That is still a fragmented insight. There is opening, closing, and pivoting within each stage. Just like in 5 phases/ Wuxing has all the other phases juxtaposed within each other, Kaiheshu also does as well. In fact, it is important to realize the Kaiheshu is like the Wuxing of Yin and yang. Its yin and yang in motion, its the dynamic movement of yin and yang as they interact.

Now let us proceed. Yangming not closing enough within taiyang opening too much is Guizhi jia gegen tang. How is this different than taiyang opening too much and yangming closing too much as a seperate but cohesive functional unit? Well because this pathology of GZJGGT is happening in Taiyang. Yes there is yangming manifestation, but it is occuring at the taiyang level. Therefore, we need to think in a more microscopic dissection of the yin and yang dynamic involved.

Taohe cheng qi tang is similar, taiyang bladder is not opening enough, because there is build of heat bound in the bladder 熱結膀胱,and, therefore, yangming is closing too much which then leads to hot blood and then if jueyin doesn’t close enough leading to bleeding and then potential resolution since bleeding cools the blood heat 血自下,下者愈, but if jueyin remains closed then this hot blood will lead to abscess.

Wuling san is taiyang not opening enough, this leads to yangming closing too much (internal fu bowel closure of taiyang), and then shaoyin pivoting too much. Hence there is water accumulation. As shaoyin pivots too much, then shaoyang can’t pivot and there is thirst since wood can’t rise to circulate fluids into the system and for yang to rise to the brain and stop it from signaling thirst.

Huanglian ejiao tang is yangming not closing enough within shaoyin while pivoting too little. Here we are talking specifically about the yang of the heart in relation to sleep patterns. Here we then see shaoyang pivoting too much as shaoyin’s yang can’t anchor and the person’s heart is vexed and they can’t sleep 心中煩,不得臥. We then use yangming and shaoyang methods (huang lian and huang qin) to bring down the yang inward. Now as shaoyin isn’t pivoting due to yangming not closing within shaoyin, then of course taiyin isn’t opening enough (there is dryness happening) since yin isn’t being engendered since the person can’t sleep. Hence, why we use Ji zi huang (egg yolk), use a yellow taiyin substance to nourish yin and help sink the yang. Then we use baishao and ejiao so jueyin can close and taiyang cannot be created so yang isn’t being sent to the periphery and head.

This is yin and yang in motion, happening simultaneously and occurring within each other. A three dimensional Yin and yang rotational axis if you will.

Chinese sources I referenced and used:
1. https://www.hftcm.com/academy-detail.php?content=39

2. https://www.zhihu.com/question/33271310

http://www.360doc.cn/article/15703677_437468903.html

4. http://hqzyyold.yywkt.com/oa/pdfdow.aspx?Sid=201708010

5. http://blog.sina.cn/dpool/blog/s/blog_500e196c0102vbz5.html

CM perspective on chewing

Not chewing enough is yangming weakness that can depending on your congenital fire in your middle burner lead to taiyin and taiyang weakness.

Yangming is about 合 closure, which pertains to mastication and chewing, earth governs the mouth. Nanjing 44 speaks about the 5 gates of the digestive tract. The lips being the first gate, called the flying gate. The teeth is the door gate, the epiglottis is the absorption gate, etc, all the way to the anus/ po men.
然:唇為飛門,齒為戶門,會厭為吸門,胃為賁門,太倉下口為幽門,太腸小腸會為闌門,下極為魄門,故曰七衝門也。

Besides the lips and teeth, what’s important to note is the zang fu mentioned (stomach, and the intestines/ tai chang and xiao chang). This is yangming and taiyang. Yangming is about earth and metal, they even mention po men which is the gate of po, the lungs house the Po.

Therefore, it comes to my next point how breathing is very important to digesting. The smell of food already begins to help produce saliva, and saliva is spleen fluid. There is digestive enzymes in saliva for carbohydrates (which are yin/ material building foods). The rate you breathe also affects how fast you swallow since calmly breathing can affect your nervous system (wood). If you are breathing shallowly and rapidly, this affects the air going in your mouth and nose (depending if you are mouth breathing or not, that’s another factor of digestion). Mouth breathing can impact your long-term jaw health. Any malocclusion of your teeth and bite can greatly impact your chewing. Suwen 61 says the kidneys is the stomach gateway 腎者,胃之關也. This is not just organ related, like in edema or ascites, but what’s implied is tissue correspondence. Teeth (kidney) and stomach/ mouth relationship. Li Shi Zhen said the nose is the orifice of mingmen, so depending how you are breathing during your food, what Ayurveda calls Sattvic or Tamasic behavior, can impact the rate of air coursing through your system. Swallowing a bunch of air isn’t good, but also if you breathe calm and deep then it relaxes and expands your diaphragm and ribs, causing good descencion. This is metal controlling wood (nervous system). The relaxation breathe sends signals to your brain (liver vessel penetrates the brain) so your body can be in a parasympathetic state and not think you are in danger while eating which sends blood away from the digestive organs. The liver stores/ hoards the blood. Then if you don’t calmy breathe then wood stirs, besides acid reflux and such where qi is going up instead of down, wood stirs stomach fire, But in this case the stomach fire causing you to be restless and anxious while you are eating so you eat and chew rapidly without masticating. So you swallow air and food in one gulp almost. The food doesn’t become liquid, which lessens the burden on your digestive tract.

Also chewing is not jusy about the teeth, but the purpose of chewing food into liquid almost is so your tongue can properly roll the food down your epiglotis, which is one of the gates. So the food doesn’t doesn’t go into your windpipe and lungs. The epiglottis responds to swallowing in this way because of tiny sensitive nerve endings in the mouth and throat that surround and coat the epiglottis. All of those nerve endings help the brain know when to swallow, and have a role in other functions like breathing, eating, sleeping and talking. When you swallow, your mouth analyzes the liquid or the food that you’re preparing to swallow, and all of that analysis gets communicated to your brain in a lightning quick fashion. As your tongue pushes the material to the back of the throat, the nerve endings collect that information, send it to the brain, and the brain sends out its program for swallowi

The tongue is also a muscle, so its ruled by earth. But it also has tendons, if your tongue tied for example, that can affect your chewing and breathing, and your TMJ health. Chewing improperly can be a jaw joint issue. You masticate quickly because possibly your yangming masseter muscles and inflamed and tight. But obviously the tongue is the blossom of the heart. So the tongue proper motion should be a mindful thing as well. The proper motion of the tongue, by the way, is a wave like motion that propels food down your digestive tract, you shouldn’t use your buccal muscles too much. So you should train yourself to learn proper swallowing patterns if you haven’t.

This brings me to the point of mindfulness. The tongue and the mind that is governed by fire/ heart. You should enjoy what you eat, you should be present. Because then fire can generate earth (good appetite and digestive fire in the stomach and small intestine) and then also control the breath/ metal and descension of food down the alimentary canal. Speaking of fire, its also important that your small intestine fire is strong, since most absorption happens here (no leaky gut and such) so you can seperate the pure from the turbid, and the turbid isn’t going into your blood. Same thing with stomach acid health.

Lastly, sitting down, which is the motion related to earth is important. If you eat standing up or even sitting down but watching TV or on your phone, then this all impacts the way you will chew, breathe, and digest.

I’ll consider all that.

The treatment and the various causes of fever

Fever is the body’s normal and intrinsic response to a variety of conditions, the most common of which is an infection. For instance, although a chronic low-grade fever is a symptom for a variety of cancers, particularly blood and lymph cancers, the resolution of cancers has been reported when high fevers have been spiked after inducing hyperthermia (high body temperature) as means to treat cancer. It is as if the low-grade fevers is the body’s mechanistic attempt to treat itself, but without success. It is only when fever is induced at high enough levels that certain diseases can be treated. Unfortunately, not everyone can survive such a raise in body temperature, so it is not a panacea for everyone since one needs to actually be able to survive the hyperthermic event. Those who did survive, for example, often go into mini-comas/ unconsciousness lasting for a few days and if they do wake up then often the cancer is in remission. Therefore, fever is the body’s attempt to clean house, i.e. a self-corrective rectification of physiology, an immunological expression back to normalcy.

Clinically those with an immunological compromise such as those with Lyme disease, Chronic Fatigue, to HIV, and other viral conditions often report the sensation of low-grade fever. This is because the body is attempting to combat the virus without success, making the person feel chronically feverish, the temperature, if taken, may even be slightly elevated, usually not pass 100 degrees. But even if it isn’t elevated, they might still feel feverish, what’s important is the subjective sensation they are experiencing. In biomedicine, to categorize a fever as a fever then the body temperature must be elevated more than normal, whereas in CM the subjective sensation is just as clinically valid than just an objective flux; we call this 发热 heat effusion. The subjective and objective are both considered as important signs to what is happening, one can be having an external event without objective signs of heat, line 3 of the treatise of Cold/ external damage says in Taiyang disease, whether there is already heat effusion or whether there is not yet heat effusion 太陽病,或已發熱,或未發熱….. This line tells us that heat effusion isn’t a necessary sign for external damage, this is important because certain individuals who are immunologically compromised often do not have normal spikes in temperatures, like the elderly or those with autoimmune or endocrine imbalances.

We also see clinically that not everyone has the same normal bodily temperature, i.e. normothermia. Some people with cold and frail constitution and/ or endocrine imbalance (like those with hypothyroid disorder) often have lower body temperatures and so a raise in temperature for them might be in the range of normal to slightly elevated in someone with standard body temperature. So it can be misleading and one might be thinking they are not spiking a fever, since their temperature is in the normal range, but for their starting baseline it is not normal.

Line 7 of the Shang han lun says “In those where there is heat effusion and aversion to cold, this is emanating from yang, and those without heat [but with] aversion to cold, this is emanating from yin. 病有發熱惡寒者,發於陽也;無熱惡寒者,發於陰也
This passage has several meanings, first of all yang and yin here can pertain to the yang and yin stages (taiyang-yangming-shaoyang as yang and taiyin, shaoyin, and jueyin as yin). Commentators state that yang here can pertain more specifically to Taiyang and yin pertains to shaoyin.
What’s more we can say since this is speaking about Taiyang disease, that this yang and yin is pertaining to a yang or yin pattern of Taiyang, whether the surface is closed or open and causing a fever. That’s all valid ways of interpreting the line and clinically useful.

Now, let us begin breaking down the various causes and treatment of fever. This is a summation of the 16 methods of abating fever from the famous 20th century physician, Qin Bo Wei 秦伯未, in his anthology of medical essays collated in Qin Bo Wei Yi Wen Ji 秦伯未医文椺.

What is important to notate that Qin Bo Wei was a synthesist from the Meng he tradition, so his ideas spans many CM schools of thought and is not limited to one.

His 16 methods of abating fever 退热 are as followed:

1. Diaphoresis
2. Harmonization of ying and wei/ constructive and nutritive
3. Clearing the stomach
4. Freeing the stool
5. Ejection/ vomiting
6. Harmonization
7. Joint resolution of exterior and interior
8. Clearing and transforming damp-heat
9. Clearing the constructive and resolving fire toxins
10. Soothing depression
11. Dispelling stasis and abscess
12. Abduction and dispersal (for food stasis and gan accumulation)
13. Combatting Malaria
14. Averting epidemic
15. Warming the channels and supplementing qi/ yang
16. Enriching yin and/ or blood

Now, within these 16 categorical methods, each one can be broken down further. Just because one needs to diaphorese, doesn’t mean one uses Ma huang tang without the formula presentation. There has to be tha pathophysiology for one to use those medicinals. Within diaphoresis, one needs to differentiate the cause, from wind-heat to wind-cold, to summerheat, to autumn warmth dryness to autumn cool dryness, to external damage causing feverish illness (such as mumps, gingival swelling, peridontitis with chills and fever, throat moth/ tonsilitis, infection the ear/ middle and inner ear to mastoiditis, etc). All require different formula, even though they are technically under the banner of diaphoresis. So that’s number one. So representative formulas include, but are not limited to, Yin qiao san, Sang ju yin, Xiang su yin, Shen zhu san, sang xing tang, xing su yin, chai hu ge gen tang, xie huang san, xi gan san, gan jie she gan tang.

Number 2 is Gui zhi tang essentially, where the surface is open, and there is sweating/ moist skin, due to wind strike.

Number 3 is a yangming method of treating, i.e. Bai hu tang and its variants, that’s yangming channel involvement. But if there is yangming fire/ toxicity with possible qi level bleeding one can use Da huang huang lian xie xin tang or huang lian jie du tang.

Number 4 and 5 are purgation methods, where one either expelling from above or from below (Gua di san and Zhi zi chi tang to induce vomiting, to the Cheng qi tangs variants to precipitate from below).

Number 6 is the method of treating the half-exterior and half-interior so Xiao chai hu tang and its variants. Interestingly, Qin Bo Wei puts Huo xiang zheng qi san in this category.

Number 7 is the treatment of joint resolution exterior and interior. This is not to be confused with half-exterior and half-interior since that is an actual layer. Here there is damage at Taiyang/ yangming with some taiyin approach. But can be a triple yang approach with some interior approach. Representative approaches include San huang shi gao tang, chai hu sheng ma tang, chai ge jie ji tang, and fang feng tong shen san.

Number 8 is the treatment of damp-heat or damp-cold that basically obstructs the san jiao, yangming, or taiyin domain. This oppressive dampness causes the spleen and to not be able to raise the clear yang and leads to easy contraction of evils in the exterior with wei qi disharmony. Formulas include San ren tang, gan lu xiao du dan, shen xi dan, yin chen hao tang. One can include here the methods of freeing up the bladder, such as Wuling san, which might have fever since the Qi hua of tai yang is blocked since the inhibited urination is causing Tai yang to heat up. One can also include th other formulas with jaundice, which all have some combination of dampheat and blood stasis, particularly Mahuang lian qiao chi xiao dou tang.

Number 9 is the treatment of ying and xue level, ala Wen bing 4 levels. Formulas include the 3 treasures for loss of conscousness due to evils in the pericardium (Zi xue dan, an gong niu huang wan, zhi bao dan), to macule transforming formulas Hua ban tang, to ying level formulas- Qing ying tang, to xue level- Xi jiao di huang tang. Also can be both qi and blood level, i.e. Yu nu jian and zhu ye liu bang tang.

Number 10 is the coursing of liver qi and unbinding depression. This is emotionally caused pyrogenic events, methods includes Xiao yao san, si ni san, yue ju wan, and hua gan jian. It is important to notate the long-term depression causes desiccation of fluids and flesh; this can lead to chronic fevers as the body’s qi circulation is chronically impeded the ability of zheng qi to fight off xie qi is impeded as well as the ability to nourish the body’s spirit-mind is hampered, this is linked with Zhu Dan Xi 6 depression theory as well.

Number 11 is the recognition of blood stasis and pus/ abscess causing fever. This is interlinked with the idea of infection. Formulas include Tao he cheng qi tang and Da huang mu dan pi tang to Tao si xiao chai hu tang, wu wei xiao du yin, Zhen ren huo ming yin, to more deficient causes of flesh putrification and welling-abscess such as Huang qi jian zhong tang, Shi Liu wei liu qi yin, Qian jin nei tuo san, Tuo li xiao du yin, Nei bu huang qi tang, etc. Pretty much any formula that treats abscess can treat this fever. Albeit, it is more likely excess causes will lead to fever.

Number 12 is for treatment of food accumulation, gan disorder worm accumulation, gu disorder, and dysentery. All these can cause fever, albeit as Qin states “fever in early stages dysentery is not considered a serious condition” since its a normal and expected progression of the disease. Now fever in long-term dysentery and diarrhea is quite concerning since it can lead to blood exhaustion and yin-yang separation.

Number 13 is the various methods of combating malaria. Now there are various types of malaria within the nosolgical classification with CM, there is: Heat malaria, cold malaria, taxation malaria, glomus/lump malaria/ mother of malaria, male malaria, female malaria, and various types of different kind of malarias that happen in different times (intermittent malarias that occur every two days instead of daily events). I wrote an extensive breakdown of malaria from a Classical perspective here: https://www.facebook.com/ivan.zavala.732/posts/2555161534546817?comment_tracking=%7B%22tn%22%3A%22O%22%7D

Formula for malaria include: Chai hu gui zhi gan jiang tang, Bai hu jia gui tang, Chai hu qu ban xia jia gua lou tang, Gui zhi huang tang, Shu qi san, Qi bao yin, Chan shan yin, Chai po tang, Bie jia wan, Chai hu xiong gui tang.

Number 14 is abating fever by averting epidemic. This is now in the realm of treating infectious disease in different bodily layers: Da Yuan Yin, Pu ji xiao du yin, Sheng ma ge gen tang, Sheng ma bie jia tang are examples of this.

Number 15 is treating both shaoyin and taiyang at the same time, this is taiyang cold contraction when one is shaoyin yang deficient. One cannot induce sweating here with gui zhi-ma huang approaches, but instead one has to use Fu zi ma huang approaches. Ma huang is not a taiyang based herb, but Taiyin since it opens the lungs. It is gui zhi and sheng jiang that causes ma huang to have a strong diaphoretic effect. So representative formula is Ma huang fu zi xi xin tang and Ma huang fu zi gan cao tang. Also tong mai si ni tang for yang seperating from yin causing false heat. If the patient is weak due to a weak constitution one can use Yu ping feng san and Shu yu wan to help the patient ward off the hundred wind illnesses. These last two formulas are more for those with tendency to external contraction, but not with resent contracture.

Bu zhong qi yi tang is also her for qi deficiency fever and yin fire fever/ internal damage fever.

Lastly, number 16 is fever caused blood and/ or yin deficiency. The formulas are Qing gu san, qin jiao bie jia san, qin jiao fu lei tang, dang gui bu xue tang, gui zhi ren shen tang, xiao jian zhong tang, ren shen bai du san, Wei rui tang (for underlying yin deficiency with cold contracture). SHL tells us that those whose throat is dry and parched we cannot effuse sweat 咽喉乾燥者,不可發汗, it also tells us we cannot sweat those with death of blood 亡血家,不可發汗. Sweating these patients will lead to severe yang and blood collapse and further fluid dessication, and possible death since one is summoning yang to the surface from a yangless root, expediating yin-yang seperation.

That’s all folks.

Inflammation and consciousness

Two of the greatest clinical presentations that Western medicine treats is inflammation and infectious disease. However, their greatest efficacy in treating inflammation and even infectious disease is when these conditions are acute. Once the disease becomes a chronic inflammatory condition, for the most part, there is only the masking of symptoms through immunosuppressive drugs, such as steroidal medication and even immuno-biologic medication. And while this can be life-saving, they are not a long-term solution for those who suffer chronic inflammation.

It is said the disease of modern man is chronic, recalcitrant, degenerative disease. These diseases are typically marked by chronic low-grade inflammation, which while not life-threatening per se, they cause afflictions characterized by long-term pain and suffering.

Speaking of inflammation, often it is seen as a hot type of state. Inflammation is characterized by rubor (redness), calor (heat), dolor (pain), and tumor (swelling). Often the knee-jerk reaction when we see this is to try to cool it and suppress it. It is hot, so we want to cool it. And, of course, that is a valid treatment approach when appropriate. But without asking oneself why the inflammation is happening and the mechanism behind it, one is stuck treating the manifestation but not the underlying cause. While yes, there might be the heat that’s apparent, the reason this heat is manifesting is that there is lack of circulation due to vasoconstriction (due to a cold pattern). Heat is a type of yang manifestation, but the reason yang is appearing doesn’t mean that it is a yang disease but might be that yang is stuck.

In Classical Chinese medicine, for example, “inflammation typically results from yin-level blockage that obstructs the free circulation of yang. When yang accumulates it generates regional heat syndromes. In Western medicine, this accumulation of heat is called inflammation (source: Ed Neal MD)”.
In other words, inflammation is a response. If we only treat inflammation as the problem we are missing a great piece of the clinical puzzle which is the underlying factors driving the inflammation.

CM recognizes that inflammation is largely a circulatory issue due to lack of bodily immuno-awareness. Blood is what brings about the healing immunological factors that initiate the cascade of healing. By suppressing inflammation or even fever (antipyretic medication) we can be delaying healing and full-resolution. Inflammation is a lack of immunological awareness and expression. Either the immune system is over-reacting or under-reacting. Relatively recent scientific research is investigating the connection between the immune system and the brain, even chronic depression is being viewed as a chronic low-grade brain inflammation, and not simply as a neurochemical imbalance.

And while there are various ways the immune system and the brain are connected, such as neuroendocrine dysfunction, larger nervous system dysfunction, problems with the microbiota–gut–brain axis, etc. And so when the body’s self-healing mechanism is disrupted (a mechanism which relies on intrinsic circulatory, immunological, and nervous system regulatory processes), then the potentiality to heal is compromised. Therefore, the job of the clinician is to restore the body’s own self-healing process. It is this process, for example, when the skin suffers a cut the healthy body responds with platelets and clotting factors that initiate bleeding to stop and for the wound to begin sealing as the hemostasis phase is finished.

But the mechanism that initiates this response to happen is the body responding through intrinsic healing mechanisms. What initiates this mechanism is the body perceiving there is something immunologically wrong so it can begin the somatic attempt to heal the issue. In Chinese medicine, we call this intrinsic healing mechanism the Shen/ awareness 神. We say the Shen is the blood and we also say this shen awareness is the righteous qi 正氣 of the body which fights off evil qi that makes us sick. So what can block the shen which is a yang type of force are yin-obstructions due to a diminishing of the metabolic fire of the body, as well as an obstruction at the level of this yang circulatory force of life due to an inability to regain healthy homeostasis after an initial immunological response.

The reversal of degenerative diseases begins by repairing the immune system’s expression and allowing the body’s own intrinsic mechanism to happen. If we get stuck on the sign of inflammation, we are blinded by the sign (the form) and lose sight of the mechanism behind the form. The needling classic says, the coarse [practioner] safeguards the form, the superior one safeguards the spirit/ awareness, the coarse one safeguards the gate, the superior one safeguards the mechanism 麤守形,上守神。麤守關,上守機.

So by understanding all of this, it is why using cold and suppresive medicine for inflammation as the only method of treatment is missing a big chunk of the puzzle, which is why in CM we often use warm and hot therapies for inflammation and are cautious of just using cold medicine without awarenss of the risks involved in regard to its effect on circulation and healing long-term.