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By Philippe Sionneau

The formulas brought up in this work are based upon the clinical experience of modern physicians and have all stood the test of clinical practice. They stand at the edge of Chinese medical research and are recognized as such. This article is an attempted testimony on the way Chinese people use their traditional medicine in our modern times. Formulas are composed either according to the parameters of pharmacology and science [e.g. Fructus Crataegi (Shan Zha) reduces cholesterol level], or based on a reorganization or adaptation of ancient and traditional therapeutic principles.

What are the sources of this article?

I have used many Chinese books, as usual, to write this article. Nevertheless, I drew my inspiration from two books that made me feel like sharing these new ideas. The first book is entitled Zhong Yi Zhi Liao Xian Dai Nan Bing Ji Cheng (Synthesis of Chinese medicine treatments for difficult diseases of our modern times) by Zhang Ren et al. As evoked in its title, this book presents an intelligent synthesis of the potency at Chinese medicine's disposal to treat "modern" pathology. After studying each disease, it presents recently invented formulas, the efficiency of which has been proven. This is exactly the kind of book that makes me thing that Chinese medicine has never been more efficient. The second reference book is, "Shi Yong Zhong Yi Xiao Yan Xin Fang Da Quan" (Practical great book of new efficient formulas in Chinese medicine) by Yang Jinghai et al. It compiles articles coming from the best Chinese medical journals that present the works and clinical results of bona fide practitioners on a regular basis. The authors are, most of the time, the inventors of the formula, but sometimes they are only the ones that have applied the prescription. I have neither invented nor modified any formula.

What are the origins of the remarks?

The remarks are sometimes inspired by the articles but are mostly personal, since the explanations given in the Chinese medical reviews and books are often insufficient (or even non-existent) to enable the Western reader to fully appreciate the subtle mechanism or the interest of the formulas. These remarks are the actual elements of highest interest in the presentation of the formulas. I encourage practitioners to understand the philosophy behind these remedies before prescribing them. Any symptomatic use of these formulas would be most inconsistent.

This article does not intend to be a treatise on internal medicine, therefore the causes, mechanisms and symptoms of the diseases have been little developed. I concentrated instead on the functions of the medicinals and the spirit of the prescriptions. For those who wish to go into the diagnosis and the mechanisms of these diseases more thoroughly, please refer to the series, The Treatment of Disease in TCM by Lu Gang and Philippe Sionneau and also, The Treatment of Modern Western Disease with Traditional Chinese Medicine by Bob Flaws and Philippe Sionneau, that are both available at Blue Poppy Press.

Modern formulas: betrayal or progress?

Some might consider that the theme of this article betrays a millenary tradition. In my view, this approach is rather a confirmation of an ancestral knowledge by modern means and contemporary observation. And this attitude is in no way new. Indeed, Zhang Congzheng (1150-1228), one of the four great masters of the Jin-Yuan d ynasty stated: "recipes of long ago cannot completely cure today's diseases". During the same period, Zhang Yuansu (Jin dynasty) who was the master of two great innovators (Li Dongyuan, leader of the school of the spleen, author of the Pi Wei Lun and Wang Haogu, author of the Tang Ye Ben Cao), clearly evokes in his Yi Xue Qi Yuan (Account on medical teaching) the fact that olden-day prescriptions and modern-day diseases are not in harmony. We could also quote Wu Yuke (1592-1672) who was more critical towards the intellectual sclerosis and the stubborn conservatism of his peers: "When seeking advice for current diseases in old scriptures, not a single word sheds light on today's issues. For this reason, medicines are useless, (.), diseases worsen, the use of remedies is more and more chaotic, and if the affection itself is not deadly, the doctor's actions are." One must bear in mind that hew saw his contemporaries die of outbreaks that his peers attempted to treat according to the ancient, unsuitable methods. All this means the adaptation of ancient principles is in no way a betrayal but rather a clinical necessity. As far as I am concerned, I seek efficiency rather than getting involved into philosophy. And the current contribution of Chinese doctors is precious, pragmatic and fficient. And finally, in the medical field, leading the patient towards recovery is what actually matters.

FORMULA #1 FOR LOW BLOOD PRESSURE

Sheng Ya Tang
(Increase the Pressure Decoction)

Functions

1. supplements Qi
2. nourishes blood

Additions & subtractions:

• In case of heart yang vacuity, add Ramulus Cinnamomi Cassiae (Gui Zhi), 10g, Os Draconis (Long Gu), 15g, mix-fried Radix Glycyrrhizae (Zhi Gan Cao), 6g.
• In case of Qi and blood dual vacuity, add prepared Radix Rehmanniae (Shu Di), Radix Angelicae Sinensis (Dang Gui), 15g.
• In case of yin vacuity exuberant fire, add uncooked Radix Rehmanniae (Sheng Di), 10g, Radix Scrophulariae Ningpoensis (Xuan Shen), 10g, Rhizoma Coptidis Chinensis (Huang Lian), 3g.

Remarks: Low blood pressure can be induced by Qi and blood vacuity, yin vacuity, spleen-kidneys yang vacuity, heart yang vacuity, which all lead to a weakness of blood circulation in the vessels, and globally to lesser nutrition of the sea of marrows and of visceras and bowels. This formula is based on the famous Sheng Mai Yin (Engender the Pulse Drink), composed of Dang Shen, Mai Men Dong and Wu Wei Zi. According to modern research, this formula increases blood pressure, which is not surprising if one takes into account its ancestral use. Furthermore, it stimulates microcirculation, myocardial anabolism, prevents hypoxia, and strengthens heart functions. To this prescription are added: Huang Qi, the use of which, along with Dang Shen, is known to strongly supplement spleen Qi and to increase blood pressure, and Chai Hu, which helps Huang Qi to upbear Qi.

FORMULA # 2 MENOPAUSE

Ingredients: uncooked Radix Rehmanniae (Sheng Di), 15g, Radix Lithospermi Seu Arnebiae (Zi Cao), 15g, Ramulus Loranthi Seu Visci (Sang Ji Sheng), 15g, Ramulus Uncariae Cum Uncis (Gou Teng), 15g, uncooked Fructus Germinatus Hordei Vulgaris (Mai Ya), 15g, Herba Epimedii (Yin Yang Huo), 10g, Radix Angelicae Sinensis Dang Gui)(, 10g, Rhizoma Cyperi Rotundi (Xiang Fu), 10g

Functions:

1. supplements kidney yin and yang
2. courses the liver and downbears yang
3. nourishes blood and clears vacuity heat

Additions & subtractions:

• If sweating is severe, add Semen Levis Tritici Aestivi (Fu Xiao Mai), 30g.
• If fatigue occurs, add Radix Codonopsitis Pilosulae (Dang Shen), 12g.
• If insomnia occurs, add stir-fried Semen Zizyphi Spinosae (Suan Zao Ren), 15g.
• In case of hot flush, add Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu), 12g.

Remarks: This apparently simple formula is actually very complete and sets the standard for modern Chinese medical practice. First of all, facts establish that menopause is more often than not a complex syndrome comprised of kidney yin and yang vacuity, the one possibly causing or aggravating the other; and liver blood vacuity (menopause induced) that favors liver depression. As a consequence of both syndromes, ascendant liver yang and/or vacuity heat are induced. It is of course extremely usual, if not constant, for this condition to be complicated by spleen vacuity.

This prescription is an answer to all of these conditions and more, Sheng Di and Sang Ji Sheng nourish kidneys yin. We could have used Shu Di instead of Sheng Di, but menopause syndrome often includes heat manifestations that Sheng Di deals better with while still nourishing kidneys. But Sang Ji Shen is very often part of modern formulas treating menstrual disorders caused by kidney vacuity, which confirms its hormonal action. Furthermore, it treats high blood pressure and rheumatic pain, which both occur frequently during menopause.

There are dozens of medicinals that warm kidney yang, such as Yin Yang Huo which is a key medicinal for gonad and menopause disorders caused by kidney yang vacuity. Like its yin companion Sang Ji Sheng, it treats blood pressure and rheumatic pain.

Xiang Fu courses the liver and resolves depression. Why not use the famous Radix Bupleuri (Chai Hu)? Because of its ascending nature in a syndrome where yang and heat already ascend too much, and also because Xiang Fu's regulating action on menses is much more definite. Xiang Fu remains a major medicinal to regulate menses, i.e. harmonize cycle and regulate female hormones, in case of liver depression.

Like the previous medicinal, Dang Gui is also a major medicinal used to regulate menses, when blood has to be nourished. Furthermore, it supplements liver blood so as to prevent liver depression. And finally, it quickens the blood and dispels stases that are always liable to occur at such a time, since yin and blood are punctually depleted.

Zi Cao is traditionally used to cool the blood in cases of dermatological disease. Here, it is mostly used to treat hot flash. Clinical observation has indeed shown its effectiveness in treating this symptom, as well as its slight hypotensive action.

Gou Teng clears the liver (liver depression can easily transform into heat) and downbears yang, which provides a better control over phenomena such as irritability or hot flash. Finally, Mai Ya strengthens spleen's transport/transformation to help heaven-related essence production. Here again, numerous medicinals could have been prescribed, but ,Mai Ya is well adapted for the two following reasons. First, it helps digestion and the assimilation of plants, which is particularly interesting when using rich supplementing medicinal, like Sheng Di over a long period of time, thus preventing digestive side effects. Second, according to modern clinical data, it regulates hormones within women. Just as it allows to painlessly cut milk production in breast feeing women, it seems to also painlessly help discontinue menses (at menopause time). Very few women are not improved by this salutary formula.

Origin: formula quoted by Gu Miao Zhen in Zhong Yi Zhi Liao Xian Dai Nan Bing Ji Cheng (synthesis of Chinese medicine treatments for difficult diseases of our modern times). (see bibliography)

FORMULA # 3 FOR PROSTATE ADENOMA

Qian Lie Xian Zeng Sheng Wan

Ingredients: Radix Astragali Membranacei (Huang Qi), 20g, Rhizoma Curcumae Zedoariae (E Zhu), 15g, Rhizoma Alismatis (Ze Xie), 15g, Herba Cistanchis Deserticolae (Rou Cong Rong), 15g, prepared Radix Rehmanniae (Shu Di), 15g, Radix Angelicae Sinensis (Dang Gui), 12g, Squama Manitis Pentadactylis (Chuan Shan Jia), 12g, (yan zhi) Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu), 12g, (yan zhi) Cortex Phellodendri Huang Bai)(, 12g, Herba Epimedii (Yin Yang Huo), 12g, Caulis Akebiae (Mu Tong), 9g, Cortex Cinnamomi Cassiae (Rou Gui), 9g, Lumbricus (Di Long), 9g.

Directions for use: Grind the medicinals into a fine powder, and form into pills with honey. Each pill must weight about 9g. Take one pill three times a day. To use this formula as a decoction, reduce the dosage of medicinals by 30%. Chuan Shan Jia is essential for prostate adenoma, but if it is not available, it can be replaced with Semen Vaccariae Segetalis (Wang Bu Liu Xing). In decoction, do not use more than 3g Cortex Cinnamomi Cassiae (Rou Gui). Do not use Caulis Akebiae (Mu Tong) over a long period of time. After a few weeks, both medicinals should be subtracted and replaced with Rhizoma Dioscoreae (Bei Xie), for example.

Functions:

1. warms and supplements spleen and kidneys
2. quickens blood and transforms stasis
3. disinhibits water and frees the obstruction

Indications: prostate hyperplasia (hypertrophy) caused by spleen-kidney vacuity and blood stasis with frequent and difficult urination, thin urinary stream, post-miction dribbling, a dark tongue, a bowstring pulse.

Additions & subtractions:

• In case of constipation, add Radix Et Rhizoma Rhei (Da Huang), 6g, Mirabilitum (Mang Xiao), 6g.
• In case of spleen Qi vacuity, add Radix Codonopsitis Pilosulae (Dang Shen), 10g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g.

Remarks: This formula perfectly befits prostate adenoma sufferers encountered in our practice. Indeed, far from exhibiting a single pattern, they are more likely to suffer from the following mingle: spleen Qi vacuity, kidney yin vacuity, kidney yang vacuity, damp heat and blood stasis. Huang Qi fortifies the spleen and boosts Qi, Shu Di nourishes kidney yin, Rou Cong Rong, Yin Yang Huo and Rou Guisupplement kidney yang, Ze Xie, Di Long, Huang Bai and Mu Tong clear and disinhibit damp heat, Huang Bai and Zhi Mu downbear ministerial fire, and E Zhu, Dang Gui and Chuan Shan Jia quicken blood, dispel stasis and scatter binds. The reader should note this prescription is based on Li Dongyuan's famous formula: Zi Shen Tong Guan Wan (Kidney Nourishing and Closure Freeing Pill) that uses medicinals of opposite nature (Rou Gui, Huang Bai) to treat uro-genital diseases of elderly people where vacuity, repletion, cold and heat often coexist.

FORMULA # 4 FOR MIGRAINE

Ingredients: Radix Ligustici Wallichii (Chuan Xiong), 20g, Rhizoma Atractylodis (Cang Zhu), 10g, Fructus Gardeniae Jasminoidis (Zhi Zi), 10g, Massa Medica Fermentata (Shen Qu), 15g, Rhizoma Cyperi Rotundi (Xiang Fu), 10g, Flos Chrysanthemi Morifolii (Ju Hua), 6g, Semen Cassiae Torae (Jue Ming Zi), 15g, Fructus Tribuli Terrestris (Bai Ji Li), 10g, Ramulus Uncariae Cum Uncis (Gou Teng), 10g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 15g, Radix Glycyrrhizae (Gan Cao), 6g.

Functions:

1. rectifies Qi and resolves depression
2. clears heat and quickens blood
3. fortifies the spleen and dries dampness

Remarks: This formula is based on Zhu Danxi's six depression (liu yu) theory. If Qi stagnates, sooner or later blood, dampness, food, phlegm, and heat will also stagnate. The author's prescription rests on one of Zhu Danxi's formulas, Yue Ju Wan (Escape Restraint Pills). It is composed of Xiang Fu that treats Qi depression, Zhi Zi that treats depressive heat, Chuan Xiong that treats blood depression, Cang Zhu that treats dampness and phlegm depression and Shen Qu that treats food depression. Since this migraine is caused by emotionally triggered liver depression, Zhu Danxi reinforces this prescription by adding Bai Shao and Bai Ji Li that level the liver and resolve depression. Furthermore, Bai Shao nourishes liver blood-yin so as to root liver yang, and Bai Ji Li downbears yang and treats headache. Moreover, Ju Hua, Jue Ming Zi, and Gou Teng clear the liver and downbear yang. Gan Cao, along with Bai Shao attenuate tensions and stop pain. This formula seems to meet perfectly our patients' needs, since they suffer more from multiple intermingled syndromes in which liver depression is often the starting point.

FORMULA # 5 FOR EMOTIONAL DISORDERS

Ingredients: uncooked Concha Margaritiferae (Zhen Zhu Mu), 30g, Ramulus Uncariae Cum Uncis (Gou Teng), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 15g, Spica Prunellae Vulgaris (Xia Ku Cao), 15g, Sclerotium Pararadicis Poriae Cocos (Fu Shen), 10g, Cortex Albizziae Julibrissinis (He Huan Pi), 10g

Functions:

1. drains the liver and clears fire
2. quiets the spirit

Indications: insomnia caused by liver fire with profuse dreaming, vexation, anger, irritability, headache with a sensation of distension, a bitter taste in the mouth, a red tongue with yellow tongue fur, a stringbow, rapid, forceful pulse.

Remarks: Whether it is caused by heat accumulation in the liver channel or a liver depression that transforms into heat, fire ascends anyway, upsetting and burning the heart. Hence, the heart cannot peacefully store the spirit, which causes insomnia and vexation. This formula contains Zhen Zhu Mu that levels the liver and quiets the spirit, Gou Teng that clears heat and quiet the spirit, Xia Ku Cao that drains fire depression in the liver channel and He Huan Pi that courses the liver and quiets the spirit. An excessive liver with repercussions on the heart that stores the spirit, appears to me as a frequent cause of psychic disorders in our society. Therefore, this prescription fits daily practice. So as to adapt it a bit further to our Western patients, we will consider supplementing the spleen, which is often deficient in our countries.

FORMULA # 6 FOR IRRITABLE BOWEL SYNDROME

Ingredients: Radix Gentianae Macrophyllae (Qin Jiao), 12g, Rhizoma Dioscoreae (Bei Xie), 12g, Fructus Psoraleae Corylifoliae (Bu Gu Zhi), 12g, roasted Fructus Terminaliae Chebulae (He Zi), 12g, Radix Codonopsitis Pilosulae (Dang Shen), 12g, Sclerotium Poriae Cocos (Fu Ling), 15g, stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), 15g, Radix Dioscoreae Oppositae (Shan Yao), 15g, Fructus Amomi (Sha Ren), 3g, Pericarpium Citri Reticulatae (Chen Pi), 10g

Functions:

• fortifies the spleen and warms the kidneys
• rectifies Qi and transforms dampness

Additions & subtractions:

In case of severe Qi vacuity or center Qi fall, add Radix Astragali Membranacei (Huang Qi), 15g, Rhizoma Cimicifugae (Sheng Ma), 10g, Radix Bupleuri (Chai Hu), 10g.

If yang vacuity is sever, add Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 6g, Cortex Cinnamomi Cassiae (Rou Gui), 3g, Rhizoma Zingiberis Praeparata (Pao Jiang), 6g.

In case of blood vacuity, add stir-fried Radix Angelicae Sinensis (Dang Gui), 10g, Fructus Lycii Chinensis (Gou Qi), 10g.

In case of severe abdominal pain, add Radix Albus Paeoniae Lactiflorae (Bai Shao), 30g.

If damp heat occurs, add Radix Scutellariae Baicalensis (Huang Qin), 6g, Rhizoma Coptidis Chinensis (Huang Lian), 3g, Cortex Magnoliae Officinalis (Hou Po), 10g.

If diarrhea is severe, ceaseless, add Fructus Pruni Mume (We Mei), 12g, Pericarpium Punicae Granati (Shi Liu Pi), 12g.

Remarks: Most of the treatment used in functional colopathy are based on Tong Xie Yao Fang (Painful Diarrhea Essential Formula) because liver-spleen disharmony is the central cause of this trouble. Furthermore, it is often associated to remedies such as Xiao Chai Hu Tang (Minor Bupleurum Decoction) or Ban Xia Xie Xin Tang (Pinellia Drain the Heart Decoction), because damp heat is frequently observed in this type of disorder.

The interest of this formula is to get us off the beaten tracks in using some medicinals that are usually not used at all for digestive troubles. In short, we'll notice the following points:

It does not include liver-coursing medicinals.

It does not include the usual spleen-supplementing diarrhea-stopping medicinals (Bai Zhu, Dang Shen, Fu Ling, Shan Yao), but it also includes kidney-supplementing, diarrhea-stopping medicinals (Shan Yao, Bu Gu Zhi) and another medicinal that secures the intestines to stop diarrhea (He Zi). Thus, virtually every known strategy to stop persistent diarrhea is used here: supplementing spleen, supplementing kidney, transforming dampness and retaining by astringency.

At first glance, the effectiveness of Bei Xie and Qin Jiao in treating digestive diseases is not well known. Despite this fact, the author of the formula uses them to dry damp turbidity that percolates into the lower burner. Furthermore, they do have a definite action on damp heat, that is almost always present in irritable bowel syndrome.

Origin: article published in Guang Xi Chinese Medicine Journal (Guang Xi Zhong Yi Yao) - 1984, # 6. Author: Dr. Wang Shu Bo.

FORMULA # 7 FOR CERVICAL ARTHROSIS

Ingredients: Radix Albus Paeoniae Lactiflorae (Bai Shao), 30g, Radix Puerariae (Ge Gen), 20g, Radix Clematidis Chinensis (Wei Ling Xian), 20g, Radix Angelicae Dahuricae (Bai Zhi), 12g, Radix Gentianae Macrophyllae (Qin Jiao), 12g, Radix Angelicae Sinensis (Dang Gui), 12g, Radix Ligustici Wallichii (Chuan Xiong), 9g, Herba Asari Cum Radice (Xi Xing), 3g

Directions for use: Make two decoctions a day using the same medicinals.

Functions:

1. dispels wind and scatters cold
2. quickens blood and frees the network vessels

Indications: cervical arthrosis caused by wind cold dampness including a stiff neck, difficulties in rotating the head, restriction of movement, headache, numbness in the shoulders and arm.

Additions & Subtractions:

• If wind predominates, add Radix Ledebouriellae Divaricatae (Fang Feng), 10g, Radix Et Rhizoma Notopterygii (Qiang Huo), 10g.
• If cold predominates, add Ramulus Cinnamomi Cassiae (Gui Zhi), 10g, Herba Ephedrae (Ma Huang), 10g.
• If dampness predominates, add Semen Coicis Lachryma-jobi (Yi Yi Ren), 15g, Rhizoma Atractylodis (Cang Zhu), 10g.
• In case of headache at the vertex, add Radix Et Rhizoma Ligustici Chinensis (Gao Ben), 12g.
• In case of pain and numbness in the upper limbs, add Ramulus Mori Albi (Sang Zhi), 12g.
• In case of pain and numbness in the lower limbs, add Radix Achyranthis Bidentatae (Huai Niu Xi), 10g, Fructus Chaenomelis Lagenariae (Mu Gua), 10g.
• In case of kidney vacuity with low back pain, add Cortex Eucommiae Ulmoidis (Du Zhong), 10g, Fructus Lycii Chinensis (Gou Qi Zi), 10g, Radix Morindae Officinalis (Ba Ji Tian), 10g.
• In case of pain in the back, add Rhizoma Cibotii Barometsis (Gou Ji), 10g, Herba Epimedii (Yin Yang Huo), 10g.
• In case of blood stasis caused by Qi vacuity, add Radix Astragali Membranacei (Huang Qi), 12g, Radix Codonopsitis Pilossulae (Dang Shen), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 15g.

Remarks: This is the very type of simple but efficient formula that also forces my respect for the contemporary approach of Chinese medicine. Here, cervical arthrosis is considered as a standard wind cold dampness impediment. Thus, we use Ge Gen, Qin Jiao, Wei Ling Xian, and Chuan Xiong for wind impediment, Xi Xin for cold impediment and Wei Ling Xian, Qin Jiao, and Chuan Xiong for damp impediment. Together, they dispel wind, cold and dampness, remove impediment and stop pain. Bai Shao and Dang Gui are added to nourish blood. Harmonizing blood is another traditional strategy used to treat wind disorders. Furthermore, by filling up channels, they prevent the invasion of external evils that o bstruct Qi and blood circulation and thus cause i mpediment. Like Bai Shao, Ge Gen possesses a muscle- relaxant action. Bai Shao's is stronger than Ge Gen's, but Ge Gen's is much more focalized on the neck, since i t is its main tropism. So Ge Gen acts as Bai Shao's ambassador and brings it to express all of its potency at the very place where it is needed. Furthermore, Bai Z hi like Chuan Xiong, does not only dispel wind, but also stops pain in the upper part of the body: face, head, neck. It is a great antalgic for this part of the body. Finally, the reader should remember that, regarding impediment, Wei Ling Xian exerts an action on the whole body, Ge Gen on the neck, Qin Jiao on the whole spine (including cervical vertebrae), that Xi Xin, Chuan Xiong and Bai Zhi are potent antalgics and that the whole efficiently treats cervical pain caused by osteophyte, arthrosis or a narrowing of the cervical canal, etc.

FOOTNOTES:

Origin: article published in The Fu Jian Chinese Medicine Journal (Fu Jian Zhong Yi Yao) - 1986, # 1. Author: Dr Wu Fu Cai.

¹The exact Chinese term currently in use is Zhong Yao. It can be translated literally "medicinals" (Yao) of the "center" (Zhong), that is China. So the expression "medicinals from China or Chinese medicinals", appears to be a better translation than "Chinese herbs" that has a more restrictive meaning.

²Contemporary Chinese acupuncture is nowadays influenced by the materialistic and mechanistic Western way of thinking. So it has somehow left behind some more "subtle" data. It would certainly gain by recovering its own sources in some fields, but it still remains a very useful and performing therapeutic that has proved its efficiency worldwide

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