Ch. 2: Formulas that Release Exterior Wind Cold Flashcards
What are the function of formulas that release the exterior?
Promote sweat, release exterior pathogens, vent rashes.
What are the signs/symptoms and indications for formulas that release the exterior?
Manifestations: chills and fever, headache, general body aches, superficial pulse
- Invasion of external pathogens
- Initial stage of wind cold, wind heat, wind damp
- Dysfunction of lungs in dispersing and descending
- Skin rashes: Early stage of rashes, measles, sores, edema, malaria, dysentery along with symptoms of chills and fever, body aches and floating pulse
What are the preacautions for formulas that release the exterior?
- Cook for a short time
- Drink warm to promote slight sweating, but not profuse sweating
- Stop use when exterior symptoms are relieved
- Avoid cold, raw, greasy, fatty foods
- Avoid cold environments
- Contraindicated to measles that have already completed eruption.
- Contraindicated to open sores, deficiency edema, vomiting, diarrhea with fluid impairment and loss of blood.
What are the three subcategories for formulas that release the exterior?
- Formulas that are pungent and warm to release exterior wind cold
- Formulas that are pungent and cold to release exterior wind heat
- Formulas that tonify vital energy and release exterior pathogens
What are the indications for formulast that are pungent and warm to release exterior wind cold?
Exterior wind cold or wind cold damp
- Chills or aversion to cold
- Fever
- Headache
- Stiff neck
- Body aches
- No thirst
- Thin white coating
- Normal tongue colour
- Floating tense or floating tardy pulse
Note: There may be sweating if more wind than cold. If more cold than wind, pores close, no sweating.
What are the indications for formulas that are pungent and cold to release exterior wind heat?
Exterior wind heat or initial stage of febrile disease
- Fever
- Headaches
- Sweat
- Slight chills or aversion to cold
- Thirst
- Sore throat
- Cough
- Thin white or thin yellow coating
- Red tipped tongue
- Floating rapid pulse
What are the indications for formulas that tonify vital energy and release exterior pathogens?
Qi, Blood, Yin or Yang deficiency with exterior pathogen invasion
- Fatigue
- Pale coplexion
- Shortness of breath
- Intolerance to cold
- Weak pulse
- Chills and fever
- Sore throat
- Headache
What are the formulas taht release exterior wind-cold? (name the four 3 star ones out of 6)
- Ma Huang Tang
- Gui Zhi Tang
- Jiu Wei Qiang Huo Tang
- Xiao Qing Long Tang
- Xiang Ru San
- Jia Wei Xiang Su San
What are the ingredients of Ma Huang Tang?
- Ma Huang (Ephedra) 9g
- Gui Zhi (Cinnamon twig) 6g
- Xing Ren (Apricot seed) 6g
- Gan Cao (Licorice) 3g
Remember: ratio for Ma Huang to Gui Zhi is 3:2
What are the functions of Ma Huang Tang?
- Promote sweat and release exterior
- Disperse and descend lungs, soothe asthma
What are the indications for Ma Huang Tang?
Wind cold exterior excess syndrome due to invasion by exogenous pathogen of wind cold
What are the manifestations that indicate a need for Ma Huang Tang?
Bonus: describe the pathogenesis for each symptom
Chills - defensive qi fails in warming body surface
Fever - inhibition of defensive qi, fight of Wei qi and external EPI
No sweating - pores closed from exterior cold and obstruction of nutrient Ying
Headache - disharmony of qi flowing in Tai Yang meridian
General pain - obstruction of the circuation of ying and wei qi
Wheezing - lung fails in dispersing and descending
Thin white coating, superficial tense pulse - invasion of the exterior by external wind cold
Explain why cold keeping the skin pores closed would affect lung qi?
Lung separates the qi where it enters the skin level. When pores close the lung fails to separate qi which then fails to disperse and descend.
What are the actions of Ma Huang?
Bonus: category
- Promote sweat, release exterior, dispel wind and cold
- Spread yang qi and relieve asthma
1.1 Herbs that are pungent and warm for dispersing
What are the actions of Gui Zhi?
- Promote sweat
- Relax muscles
- Warm meridians
- Stop pain
1.1 Herbs that are pungent and warm for dispersing
What are the actions of Xing Ren?
- Disperse and descend lung qi to pacify asthma and stop cough
8. 3 Herbs that resolve phlegm, stop cough, soothe
What are the actions of Gan Cao?
- Harmonize other herbs
- Tonify qi to avoid MH and GZ damaging qi
12.1 Herbs that Tonify Qi
What are the characteristics of the combination of Ma Huang and Gui Zhi?
Open the pores, remove stagnation in Cou Li, regulate ying and wei to enhance the function of promoting sweat.
What are the characteristics of combining Ma Huang and Xing Ren?
MH disperse lung qi, XR descend lung qi, enhance function of lung qi to soothe asthma.
What are the key symptoms necessary to choose Ma Huang Tang?
Fever, aversion to cold, no sweat, wheezing, superficial tense pulse
What are western medicine disease categories that may be relevant for Ma Huang Tang?
- Acute rheumatic arthritis
- Asthma
- Acute bronchitis
- Asthmatic bronchitis
- Common cold
- Influenza
What are precautions/contraindications for Ma Huang Tang?
- Deficient patient
- Loss of blood
- Post partum patient
What are the three important modified formulas?
- Da Qing Long Tang
- San Ao Tang
- Hua Gao San
What are the changes for Da Qing Long Tang? What does it focus on?
Add Shi Gao, Sheng Jiang and Da Zao
This modification treats very severe wind cold! Patient will show severe chills and severe fever along with interior heat. Includes Shi Gao to clear heat. Common formula to treat initial stages of pneumonia where the patient has severe fever and chills along with interior heat. Heat consumes yin and body fluid so you see thirst, bitter taste, (maybe sore throat).
What are the changes for San Ao Tang? What does it focus on?
Take out Gui Zhi
This is the basic formula for a slight wind cold attack. Stuffy nose, heavy voice, loss of voice, cough, stuffy chest.
Vent the lung, release the exterior.
What are the changes for Hua Gai San? What does it focus on?
Take out Gui Zhi, add Sang Bai Pi, Su Zi, Fu Ling, Chen Pi
This is for patient’s with phlegm inside. Vent the lung, release the exterior, resolve phlegm, stop cough, phlegm qi stagnation, noise in throat, floating and rapid pulse.
What is the main function of Gui Zhi Tang?
Representative formula that dispels and harmonizes simultaneously. Basic formula to harmonize Ying and Wei, Yin and Yang.
What are the ingredients of Gui Zhi Tang?
- Gui Zhi (Cinnamon twig) 9g
- Bai Shao (White Peony) 9g
- Sheng Jiang (Ginger) 9g
- Da Zao (Jujube) 10pc
- Gan Cao (Licorice) 6g
Remember: ratio of Gui Zhi to Bai Shao (Shao Yao) is 1:1
What are the functions of Gui Zhi Tang?
- Gently promote sweat and release the exterior
- Harmonize the nutrient system (Ying) and defensive system (Wei)
What are the indications for Gui Zhi Tang?
Wind cold exterior deficiency syndromes due to wind cold invasion leading to disharmony of Ying and Wei
What are the manifestations (and pathogenesis) of Gui Zhi Tang?
- Fever - defensive yang floating, fighting vital energy and pathogen
- Sweating and aversion to wind - deficiency of the nutrient (Ying) system
- Headache - wind cold blocking Tai Yang meridian
- Nasal obstruction, runny nose - dysfunction of lung in dispersing and descending
- Absence of thirst, thin white coating, superficial retarded pulse - invasion of wind cold in exterior, more wind than cold, deficiency of body surface
What is the action of Gui Zhi in Gui Zhi Tang?
King herb.
- Release the exterior by inducing sweat
- Warm the channels and dispel wind cold
- Strengthen defensive yang
1.1 Herbs that are Pungent and Warm to Disperse
What is the role of Bai Shao (Shao Yao) in Gui Zhi Tang?
Deputy herb.
- Nourish the nutrient ying
- Astringe body fluids
12.2 Herbs that Tonify Blood
What are the actions of Sheng Jiang in Gui Zhi Tang?
Assistant herb.
- Aid Gui Zhi to dispel pathogenic factors in the exterior
- Strengthen the functions of the stomach to stop vomiting
1.1 Herbs that are Pungent and Warm for Dispersing
What are the actinos of Da Zao in Gui Zhi Tang?
Assistant herb.
- Strengthen the function of spleen and stomach qi in the middle jiao
- Aid Bai Shao in nourishing the blood
12.1 Herbs that tonify Qi
What are the actions of Gan Cao in Gui Zhi Tang?
Messenger herb.
- Benefit qi
- Harmonize middle jiao
- Assist Gui Zhi to relieve exterior
- Assit Bai Shao to benefit Ying
- Harmonize other herbs
12.1 Herbs that Tonify Qi
What are the characteristics of combining Gui Zhi and Bai Shao?
Gui Zhi treats strong Wei while Bai Shao treats weak ying. Together they are dispelling and boosting, dispelling and astringing. They take care of both vital energy and pathogen at the same time. Regulate Ying and Wei, Yin and Yang at the same time.
What are the characteristics of combining Gui Zhi and Gan Cao?
Pungent and sweet together benefits yang. The yang assists wei qi to relieve the exterior.
What are the characteristics of combingin Shao yao (Bai Shao) and Gan Cao?
Sour and sweet to benefit yin. The yin assist Ying to harmonize.
What is the difference between “sick sweating” and “medicine sweating”?
Sick sweating:
- Patient’s skin is cold
- Sweating only located on part of the body eg. Head, neck, back
- Sweating is slimy
- Patient feels uncomfortable
Medicine sweating:
- Body is warm
- Whole body sweating
- Sweating is refreshing and patient feels comfortableafter
What is the method for taking Gui Zhi Tang? What should the patient do after? When should the formula be stopped? Food advice?
Need to serve this formula warm to help promote sweating.
After taking this formula patient should eat congee. Also patient should cover up with a blanket wrapped around them. They should have whole body sweating, but not excessively.
Patient should stop taking GZT as soon as they have whole body sweating.
Food advice: No raw, no cold, no sticky, no meat, no flour, no spicy food.
Compare MHT and GZT in terms of:
a. Similarity
b. Herbs and actions
c. Key functions
d. Indications
e. Action in terms of symptoms
a. Both warm pungent formulas to release wind cold exterior syndrome, promote sweating
b. MHT can dispel wind cold, GZT wind cold plus harmonize ying and wei
c. MHT Taiyang Shang Han syndrome (classic wind cold exterior excess syndrome); GZT Taiyang Zhong Feng wind cold exterior deficiency syndromes leading to disharmony of ying and wei
d. MHT fever with aversion to cold, no sweating, GZT aversion to wind, sweating
e. MHT uses ma huang and gui zhi to strongly promote sweating, GZT to gently promotes sweating and harmonize ying and wei
What are the key symptoms that would lead one to choose GZT?
- Fever
- Aversion to wind
- Sweating
- Wheezing
- Superficial retarded pulse
or. ..
* Fever coming and going at a predictable time every day with sweating (disharmony of ying and wei)
or. ..
* Patient with qi, yin deficiency, postpartum problems and disharmony of ying and wei
or. ..Huang Di Nei Jing description of Ying and Wei disharmony (dysautonomia today):
heart palpitations, insomnia, numbness and tingling, stomach discomfort, intestinal dysfunction, chronic pain, pressure in the head, poor memory, eye movement disorders, breathing dysfunction, alternating chills and fevers, anxiety and emotional disorders.
Give a basic description of Jiu Wei Qiang Huo Tang.
Representative formula that uses Qiang Hou (Notopterygium root) and Fang Feng (Saposhnikovia) to treat exterior damp.
Theory is based on the classificiation of meridians. Mixed exterior and interior problem. 6 herbs that match 6 meridians.
What are the 9 ingredients for Jiu Wei Qiang Huo Tang?
Note: Jiu = nine
- Qiang Hou 6g (Notopterygium)
- Fang Feng 6g (Saposhnykovia)
- Cang Zhu 6g (Atractylodes)
- Xi Xin 2g (Chinese wild ginger)
- Bai Zhu 3g (White atractylode rhizome)
- Chuan Xiong 3g (Szechuan lovage root)
- Sheng Di Huang 3g (Rehmannia root)
- Huang Qin 3g (Scutellaria, Bacial Skullcap)
- Gan Cao 3g (Licorice root)
What are the funciton of Jiu Wei Qiang Huo Tang?
- Promotes sweating and eliminates dampness
- Clears initial interior heat
What are the indication for Jiu Wei Qiang Huo Tang?
Exterior wind cold damp invasion with interior heat
What are the manifestations (and pathogenesis) for JWQHT?
- Chills, fever, no sweating - wind, cold and damp invade the body surface, impair yang qi’s functions which closes the pores and slows teh circulation of qi and blood
- Soreness and pain over body, stiff neck - cold damp impair meridians, restrict circulation of qi and blood
- Bitter taste in the mouth, thirst - interior heat
- White or slightly yellow coating, floating pulse - exterior syndrome with initial interior heat
Qiang Huo function?
King herb
Dispel wind cold damp in exterior, stop pain
Fang Feng and Cang Zhu function?
Deputies
Fang Feng: Promote sweat, dispel damp
Cang Zhu: Resolve dampness, dispel damp
Xi Xin, Bai Zhi, Chuan Xiong functions?
Assistants
Dispel wind cold, remove obstruction of dampness, promote circulation of qi and blood, release headache and general pain (strongly stop pain)
Huang Qin and Sheng Di Huang functions?
Assistants
Huang Qin: clear interior heat
Sheng Di Huang: clear heat from blood
Together these two clear interior heat, nourish yin and produce body fluid.
Many herbs can dispel damp but consume body fluid at the same time, dry warm herbs, therefore it is good to have these herbs to nourish yin and BF
Gan Cao function?
Messenger
Harmonize other herbs
Describe the fine balance between dispelling and cooling that is achieved with JWQHT?
Dispelling herbs in combination with clear heat herbs. Dispelling herbs used with cold and cool, prevent dispelling too much.
Cool and cold herbs combined with dispel, cools the body without causing stagnation
What herb matches to Taiyang?
Qiang Huo
What herb matches to Shaoyang?
Huang Qin
What herb matches to Yangming?
Bai Zhi
What herb matches to Taiyin?
Cang Zhu
What herb matches to Shaoyin?
Xi Xin
What herb matches to Jueyin?
Chuan Xiong
What are the key symptoms to choose JWQHT?
- Chills
- Fever
- Pain in limbs
- Bitter taste
- Slight thirst
Wind cold damp invasion with mild internal heat
What are Western diagnoses that might be applicable?
- Common cold
- Flu
- Migraine
- Rheumatic arthritis
What are precautions for JWQHT?
Contraindicated for:
- Wind heat external syndrome
- Yin deficiency with internal heat
What modifications for JWQHT would you make if there were severe dampness?
Replace Sheng Di Huang with Zhi Qiao/Zhi Ke (bitter orange), Fu Ling (poria) and Zi Su Ye (Perilla leaf)
What modifications would you make to JWQHT for mild pain?
Remove Cang Zhu (Atractylodes rhizome) and Xi Xin (Asarum, Chinese wild ginger) to reduce the decoction’s pungent and drying function which impairs body fluid.
What modifications would you make to JWQHT if there were no bitter taste or thirst?
This means there is no interior heat so one would remove Sheng Di Huang (Rehmannia root) and Huang Qin (Scutellaria, Skullcap)
