TRADITIONAL CHINESE MEDICINE – THE CLASSICS
Thinking Out of the Box:
Shang Han Lun Formulas and Fatigue
The Shang Han Lun is routinely considered the most important historical text in Chinese herbal medicine. Written in the Eastern Han period (25–220 CE) by Zhang Zhong-Jing, the original text, called the Shang Han Za Bing Lun, was later edited and split into two different texts: The Shang Han Lun (“Treatise on Febrile Diseases Caused by Cold”) and the Jin Gui Yao Lue (“Synopsis of Prescriptions of the Golden Chamber”).
Remarkably, both books are still extremely popular as textbooks and reference books, which is mainly due to the revolutionary method of recognising disturbances of bodily function as patterns defined by a certain combination of symptoms and signs. Once the pattern or “zheng” is recognised, it can be treated by a specific formula that addresses that particular pattern. The formula can then be modified to allow for variations in the pattern. This method of pattern differentiation and treatment made the Shang Han Lun a work far beyond its time, allowing for diseases not even existent at the time of writing to be differentiated into a pattern and thus be linked with a specific treatment strategy and formula. In this way, the Shang Han Za Bing Lun has provided the foundation of diagnosis, pattern differentiation and treatment strategy of Chinese Medicine today.
Staying with the theme of fatigue, below are some case study examples of the incredible versatility of the Shang Han Lun formulas in the treatment of “xu lao” (vacuity taxation, any pattern of severe vacuity) and insomnia in cases that seemed untreatable.
INSOMNIA TREATED WITH XIAO CHAI HU TANG [MINOR BUPLEURUM COMBINATION]
A 52 year old female with persistent insomnia that started 30 years ago when she suffered an extreme fright. At the beginning it was hard for her to go to sleep and she awoke with the slightest noise such as a closing door, people talking outside, etc. After waking it was impossible to for her to fall asleep again. Her family took to tiptoeing and not daring to touch things on the rare occasions that she was asleep. Her sleep time was around four hours per night, with many nights not sleeping at all. She had already undergone TCM treatment elsewhere, modalities including herbs, acupuncture, massage and qi gong therapy.
At the time of consultation, the conditioned had worsened to the degree that she didn't sleep at all for several days and had at one point broken down and wept without being able to talk. At the consultation her spirits were admirably well and she was still working, her appetite was normal and there were no obvious other signs and symptoms.
Previous unsuccessful treatment strategies had aimed at common patterns of insomnia, including nourishing blood and calming the spirit, calming the heart, nourishing yin, clearing heat, eliminating phlegm and clearing the heart, moving blood and transforming stasis, and dispersing food and harmonising the stomach. Nothing had worked.
Considering the numerous failed treatment approaches and the persistent nature of the disorder, the treating doctor remembered the quote from Lin Pei Qin's Lei Zheng Zhi Cai (“Collection of Differential Diagnosis and Treatment”): “In insomnia, the disorder stems from yang not associating with yin”. Upbearing and outward movement are yang, while downbearing and inward movement are yin. These movements of yin and yang are facilitated through the shao yang (lesser yang) pivot. During the day, defense qi moves in the yang channels and a person is awake. For the person to fall asleep at night, defense qi has to enter the yin channels.
This patient's insomnia was due to the shao yang pivot mechanism not functioning correctly, preventing yin and yang from associating correctly. The main formula for correcting the shao yang pivot mechanism is Xiao Chai Hu Tang [Minor Bupleurum Combination]. After taking one dose, the patient slept through the night for ten continuous hours. She was told to take another nine packets to stabilise the result.
XIAO CHAI HU TANG [MINOR BUPLEURUM COMBINATION] ¡E
TCM Functions: Harmonises and resolves half exterior half interior pattern (midstage pattern), resolves exterior heat, soothes the liver and resolves depression, supplements qi and strengthens the spleen, harmonizes the stomach and stops vomiting.
Case Study: Insomnia treated with Da Chai Hu Tang [Major Bupleurum Combination]
38 year old female, neurasthenia for 10 years, frequently takes sedatives, sleeps only 3 to 5 hours per night. Due to her lack of sleep and resulting fatigue and nervousness she seeks consultation in hospital. Her appetite is low, she is emaciated and is worn out. No strength, pale tongue with thin yellow coating, deep string-like pulse, takes three sleeping pills at night but still can't sleep, dizziness, hard stool.
The treating doctor diagnoses her insomnia to be due to vacuity heat disturbing the heart spirit and prescribes formulas including Suan Zao Ren Tang [Ziziphus Combination], Huang Lian A Jiao Tang, Yang Xin Tang [Astragalus & Ziziphus Combination], Zhu Sha An Shen Wan. None of these formulas yield any result. The doctor changes his treatment strategy and prescribes Xue Fu Zhu Yu Tang to move blood, also with no result.
The patient now also suffers from oppression in the chest, agitation, and constipation. She changes doctor. The new doctor diagnoses her with inhibited shaoyang qi dynamic and disturbed downbearing in the yangming (hand yangming large intestine and foot yangming stomach channels). As the ancient classic Xia Jing (Classic of Medicine) stated, ¡¥when the stomach is in disharmony, one cannot sleep peacefully at night.' Hence, his treatment strategy is to course the liver (shaoyang), drain heat and free the intestine and stomach with Da Chai Hu Tang [Major Bupleurum Combination] with modifications: The doctor added Bai Zi Ren [Biota] and Ye Jiao Teng [Polygonum Stem] to the Da Chai Hu Tang [Major Bupleurum Combination] to calm the spirit. After taking three doses, the oppression in the chest and agitation are significantly reduced, and she can sleep for 2 to 3 hours per night. After another five doses, she passes stool once a day, all other symptoms are significantly relieved, and her sleep is restored to normal.
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*Reproduced with kind permission from Health World Limited – Australia and New Zealand
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