The clinical application of Shang Han Lun: 76 fomula anaysis with case studies

Acknowledgement

Foreword

In my previous book , two clinical methodologies were introduced for the prescription of traditional Asian herbal medicine. One is Dr. Lee Jema’s individual constitutional perspective (Sasang Medicine) , and the other is single herbal functional perspective of Dr. Todo Yoshimas (Yakucho).

This book is mainly focused on the clinical application of Shang Han Lun providing the case studies of contemporary Korean medicine doctors and Kampo medicine doctors, in addition to the descriptions of Yakucho. It is more likely pathological approach of Shang Han Lun.

However, it is also critical to consider the constitution of each individual to make more accurate diagnosis and prescription. please refer to to further understand how to use the right formula for the right person from the constitutional medicine perspective.

This book also provides 76 formulas with the related clauses excerpted from Kang Ping Shang Han Lun to help understand the formulas in the context of the original text. Kang Ping Shang Han Lun is the closest edition to the original, and my other book also offers the full translation of the Kang Ping edition along with the historical background.

Each formula is analyzed with modern interpretation of Shang Han Lun in the specific clinical settings.

My clinical case studies are also added. These clinical cases are the little fruits of my fifteen years of practice after struggling to find better way to approach to Asian Medicine. I hope this book can provide herbal practitioners with stepping stones on the journey to mastering Asian Medicine.

Angie Young Kim,Ph.D., L.Ac.

About the Author

Angie Young Kim

Angie Young Kim has practiced acupuncture and traditional Asian herbal medicine in California since 2005. Her vision is to contribute herself to the development of traditional Asian Medicine by healing people in the most natural way and sharing her knowledge and experience with others.

Angie holds a doctorate in Traditional Asian Medicine. On graduating Summa Cum Laude from Emperor’s College of Traditional Oriental Medicine, she has taken her continuing trainings including Korean Medicine Program at Kyung Hee University of South Korea, Korean Sasang Constitutional Medicine Program with Dr. Man Hur who is the third generation Sasang Medicine practitioner, and studies of Shang Han Lun and Jin Gui Yao Lue with great Korean Medicine scholars.

She also lectured at Dongguk University in Los Angeles, California, and School of Alternative Medicine, Life University in Gardena, California. Now her passion is to share her clinical experience of Sasang Constitutional Medicine and Shang Han Lun with peer acupuncturists and herbalists all over the world.

1. Gui Zhi Formula Family

Gui Zhi Tang(桂枝湯)

Cinnamon Twig Decoction

Gui Zhi 6, Shao Yao 6, Sheng Jiang 6, Da Zao 6, Gan Cao 4

Indication: upward counterflow, headache, fever, sweating, aversion to wind

治上衝 頭痛 發熱 汗出惡風者.

太陽中風 脈陽浮而陰弱 陽浮者 熱自發 陰弱者 汗自出 嗇嗇惡寒 淅淅惡風 翕翕發熱 鼻鳴乾嘔者 桂枝湯主之 . (12)

In Tai Yang Zhong Feng, the pulse is floating in the superficial level (yang) and weak in the deep level (yin). The floating pulse reflects spontaneous heat effusion, and the weak pulse reflects spontaneous sweating. If there is aversion to cold, aversion to wind, persistent fever, nasal congestion with noisy breathing, or dry retching, Gui Zhi Tang should be used.

太陽病 頭痛 發熱 汗出 惡風者 桂枝湯主之 . (13)

Gui Zhi Tang primarily treats Tai Yang disorder with headache, fever, sweating, and aversion to cold.

太陽病 下之後 其氣上衝者 可與桂枝湯 . (15)

Gui Zhi Tang also can be used for Tai Yang disorder that has been treated with purging method causing upward counterflow to the chest.

太陽病初服桂枝湯 反煩不解者 先刺風池 風府 却與桂枝湯則愈 . (24) 服桂枝湯 大汗出 脈洪大者 與桂枝湯 如前法 若形如瘧 一日再發者 汗出必解 宜桂枝二麻黃一湯 . (25)

If in Tai Yang disorder the symptoms are not resolved even after the first administration of Gui Zhi Tang, acupuncture points GB20 and Du20 need to be needled. Then Gui Zhi Tang can be given again to make it effective. If there is profuse sweating and flooding pulse after taking Gui Zhi Tang, the same formula can be administered again as in previous methods. If there are malaria like symptoms, relapsing twice per day, it is necessary to induce sweating to recover. Gui Zhi Er Ma Huang Yi Tang can be used.

太陽病 外證未解 脈浮弱者 當以汗解 宜桂枝湯 . (42)

In Tai Yang disorder when the exterior pattern has not resolved and there is floating weak pulse, it is necessary to induce sweating by using Gui Zhi Tang.

太陽病 外證未解 不可下 下之爲逆 欲解外者 宜桂枝湯 . (44)

In Tai Yang disorder when the exterior pattern has not resolved, the purging method cannot be used as it is an adverse treatment. To release the exterior, Gui Zhi Tang is appropriate.

太陽病 先發汗不解 而復下之 脈浮者不愈 浮爲在外 而反下之 故令不愈 今脈浮 故在外 當須解外則愈 宜桂枝湯 . (45)

In Tai Yang disorder, when the exterior has not resolved after inducing perspiration and the purging method is applied, floating pulse means the person has not recovered because floating pulse indicates the pathogen still exists on the exterior. So, if the purging method is used adversely, the disease cannot be resolved. Gui Zhi Tang is appropriate to release exterior and hasten recovery.

病常自汗出者 此爲榮氣和 榮氣和者 外不諧 以衛氣不共榮氣諧和故爾 以榮行脈中 衛行脈外 復發其汗 榮衛和則愈 宜桂枝湯 . (53)

When disease is characterized by spontaneous sweating, it means nutritive qi is in harmony but the exterior is not. It also means that defensive qi is not in harmony with nutritive qi. Since nutritive qi runs in the vessels and defensive qi runs outside the vessels, further inducing perspiration can harmonize them and lead to recovery. Gui Zhi Tang is appropriate.

病人 藏無他病 時發熱 自汗出而不愈者 此衛氣不和也 先其時發汗則愈 宜桂枝湯 . (54)

When a patient has no other disease in the organs but has fever, spontaneous sweating, and is not recovered, it is due to disharmony in defensive qi. Promote sweating first and recovery will be obtained. Gui Zhi Tang is appropriate.

傷寒不大便 六七日 頭痛有熱者 與承氣湯 其小便淸者 知不在裏 仍在表也 當須發汗 若頭痛者 必 衂 宜桂枝湯 . (56)

Shang Han condition with inability to defecate for six to seven days , headache, and fever can be treated with Cheng Qi Tang. If the urine is clear, it means that the disease is not in the interior but is still in the exterior and it is necessary to promote sweating. If there are headaches, there will be nosebleeds. Gui Zhi Tang is appropriate.

傷寒發汗已解 半日許 復煩 脈浮數者 可更發汗 宜桂枝湯 . (57)

In Shang Han condition treated by the promotion of sweating where exterior has been resolved, if a half day passes and there again occurs irritability and floating and rapid pulse, it is recommended to induce sweating again. Gui Zhi Tang is appropriate.

傷寒 醫下之 續得下利 淸穀不止 身疼痛者 急當救裏 後身疼痛 淸便自調者 急當可救表 救裏宜回逆湯 救表宜桂枝湯 . (91)

When after the purging method is applied in Shang Han condition, and there is incessant diarrhea with undigested food and generalized pain, it is necessary to treat the interior first before treating the generalized pain. Once the bowel movement is regulated, the exterior can be treated. The interior can be addressed with Si Ni Tang while the exterior with Gui Zhi Tang.

太陽病 發熱汗出者 此爲榮弱衛强 故使汗出 欲救邪風者 宜桂枝湯 . (95)

Tai Yang disorder with fever and sweating means weakness in Ying and excess in Wei. Therefore Gui Zhi Tang is appropriate to induce sweating and release the evil wind.

太陰病 脈浮者 少可發汗 宜桂枝湯 . (276)

In Tai Yin disorder with floating pulse, sweating can be induced. Therefore, Gui Zhi Tang is appropriate.

下利 腹脹滿 身體疼痛者 先溫其裏 乃攻其表 溫裏宜回逆湯 攻表宜桂枝湯 . (372)

When there is diarrhea, abdominal distention and fullness and generalized pain, first warm the interior, then attack the exterior. Si Ni Tang is appropriate to warm the interior and Gui Zhi Tang is appropriate to attack the exterior.

Yakucho

Gui Zhi mainly treats surging counterflow. Clinical symptoms can include headaches, hot flush, and sweating. Bodyaches aggravated by coldness can also be addressed.

Shao Yao mainly treats hypertonicity of muscles. This person can have spasm, cramp, or charley horse

Sheng Jiang mainly treats nausea, vomiting, and belching. Secondarily treats obstructed water toxins, diarrhea, and coldness.

Da Zao mainly treats muscle cramps with tightness and a pulling sensation. Secondarily treats cough, palpitation, irritability and agitation, bodyache, pain in the chest and abdomen.

Gan Cao mainly treats urgency. Therefore it can treat abdominal urgency, urgent pain, and urgent cramps. Secondarily it can treat various urgent toxins related to coldness (jue), irritability and agitation, and surging counterflow.

Application

This formula can be used for acute cold/flu symptoms when they have chills and fever, sweating, headaches, bodyaches, and muscle spasm.

Also can be used for dry nasal congestion or dry retching

This person can have floating weak pulse, spontaneous sweating, surging counterflow such as headaches or hot flash, fever, and bodyaches

There are case studies that show this formula's efficacy in Rheumatoid Arthritis

Clinical Studies

pregnant women's Tuberculosis

A 7 month pregnant woman came in to see Dr. Otsuka, suffering from fever with mild cough. Her temperature had been 100.4°F for 10 days, and she was diagnosed with Tuberculosis. Her pulse was floating and weak. Dr. Otsuka gave her Gui Zhi Tang for 3 weeks, and her temperature came down to normal and the cough stopped. She was able to deliver the baby with no problem. (Dr. Otsuka Keisetsu)

67 year old Caucasian woman with RA

Her height is 5'3", and her weight is 105lbs. She came in for Reumatoid Arthritis which causes severe pain in her eyes and feet. She tends to feel cold easily with cold hands and feet, but she occasionally gets hot flashes. Gui Zhi Tang was prescribed for 8 weeks and the tests for RA with her Rheumatology doctor came out to be negative. Her eye and foot pain was diminished. Later the formula was modified when she had low energy and poor digestion as she had weak earth energy. (Angie Kim)

Female, 15 years old, Caucasian, , 4’11", 99lbs

This adorable 15 year old girl loves ballet and practices at least 3 hours everyday. Too much repetitive motion has caused her back pain radiating down to the left hip, and it was recommended she stop practicing for a few weeks. She was diagnosed with sciatic neuritis. Aleve helped, but her pain came back when she stopped taking it.

She has soft and fair skin with cold hands and feet. She feels cold easily and frequently experiences indigestion with nausea. She stated that she had slightly yellow sputum every morning. All signs and symptoms indicate that she is a Shaoyin with a weak spleen, except that she has a less developed hip area. This could be due to her body not being fully developed, or her not fitting the Shao Yin body type completely.

The Shang Han Lun formula, Xiao Chai Hu Tang, was given to her first for a couple weeks, and nausea, phlegm, and her back and hip pain were gone. She was able to go back to ballet practice again. However, the hip flexor muscle got tight and painful with practice, and Gui Zhi Tang was prescribed. The hip flexors were then loosened and she was able to practice ballet without any discomfort. ( Angie Kim)

Gui Zhi Jia Gui Tang 桂枝加桂湯

Cinnamon Twig Decoction Plus Extra Cinnamon

Gui Zhi 10, Shao Yao 6, Sheng Jiang 6, Da Zao 6, Gan Cao 4

Indication: extreme upward counterflow, headache, fever, sweating, aversion to wind

治桂枝湯證而上衝劇者.

燒針令其汗 針處被寒 核起而赤者 必發奔豚 氣從少腹上衝心者 灸其核上各一壯 與桂枝加桂湯 . (117)

A person who gets red swelling at the acupuncture point, caused by an attack of cold pathogens responding to fire needle induced sweating, will experience running piglet - the Qi surging upward from the lesser abdomen to the heart. This can be treated with a single unit of moxibustion on each swelling site and Gui Zhi Jia Gui Tang.

Yakucho

Gui Zhi mainly treats surging counterflow. Clinical symptoms can include headaches, hot flush, and sweating. With the increased dosage of Gui Zhi, it is more appropriate to treat headaches as it is a symptom of upward counterflow.

Shao Yao mainly treats hypertonicity of muscles. This person can have spasm, cramp, or charley horse

Sheng Jiang mainly treats nausea, vomiting, and belching. Secondarily treats obstructed water toxins, diarrhea, and coldness.

Da Zao mainly treats muscle cramps with tightness and a pulling sensation. Secondarily treats cough, palpitation, irritability and agitation, bodyache, pain in the chest and abdomen.

Gan Cao mainly treats urgency. Therefore it can treat abdominal urgency, urgent pain, and urgent cramps. Secondarily it can treat various urgent toxins related to coldness (jue), irritability and agitation, and surging counterflow.

Application

This formula can be used for headaches when there is fever, sweating, headaches, bodyaches, and muscle spasm. The additional dosage of Gui Zhi enhances the effect of suppressing the surging counterflow, which checks the headaches.

can be used for Migraine with floating weak pulse, hot flash, fever and chills.

Clinical Studies

20 year old woman with Migraine

My sister had