Acupuncture CEU Online Course:
Series: Overview of TCM Classics and Doctrines
Author: Dr. Daoshing Ni, Yo San University of Traditional Chinese Medicine
Class: Herbal Formulas Part 1: Essential Prescriptions of Golden Cabinet (Jin Gui Yao Lue)
Thank you very much for being with me today. We’re going to continue with where we left last time. We’re going to stay with the formulary doctrine. Jing Fang Xue Pai. But we’re going to delve into a specific subject. And for the next two classes this one and the next one. We are going to focus on Jin Gui Yao Lue. Jin Gui Yao Lue frequently has been translated as the Essential Strategies of Golden Cabinet. And this book along with Shang Han Lun was written by Zhang, Zhong Jing. As you know Zhang, Zhong Jing was the father of TCM. He has written two great books. And these two great book, one is on Shang Han which deals with Febrile diseases, mostly infectious. And Jin Gui which really deals with everything else. What we call the Miscellaneous Conditions. And later on as you know this is basically a book of formula book Jin Gui and that deals with a lot of the Internal Medicine conditions. These two books together we call it Shang Han Za Bing Lun one or the Discussion of Injuries by Cold and Miscellaneous Diseases. Now the original text of Jin Gui has only were added on by people later which not most, most scholars do not believe that is accurate Zhang, Zhong Jing’s original work. These last three chapters – Chapter 23, 24, other people. There many contemporary translations. There are many elucidations, elaborations, and most of the later one’s use these twenty five chapters as the basis for Jin Gui. So in this class and the next class we’re going to do an overview on Jin Gui. Jin Gui is considered to be the Bible of formulary doctrine. Any serious Herbal students who want to study herbal formulas, well it would be really wonderful for you to dwell deeper into this classical text. So 25 chapters. The first chapter focuses on the fundamentals of diagnosis such as pulse, color, disease progression. And as you can see Zhang, Zhong Jing put it in chapter 1 because he believed the importance of really understanding the Zang Fu theories, really understanding the fundamentals of good diagnosis. And where a good diagnosis can lead you to correct treatments, correct therapies, for the condition. So. Chapter 2 to chapter 22 are all the different chapters on specific disease treatments ranging from internal medicine, to dermatology, to OBGYN and to external injuries. Now Chapters 23, 24, 25, were added by people later on different topics. Chapter 23 for example on miscellaneous diseases on top of miscellaneous diseases. Chapter 24 is on food contraindications, especially around animal products. Chapter 25 is on food contraindications which is on plant products. So these are the three additional chapters in the end. Let’s look at each chapter one by one. Chapter 2 to Chapter 7. For example Chapter 2 talks about how to treat Spasms, Dampness, as well as any Stroke caused by Summer Heat. And Chapter 3 introduces us to a condition called Bai He syndrome. Hu Huo Syndrome. And Yin Yang Toxin. This is not a very easy chapter to read. Some the disease names no longer exist now and it’s kind of hard to translate for some latest scholars, what these condition exactly are. Chapter Four is on malaria. And Chapter Five is on Wind Stroke and Joint-running conditions. Again Joint-running conditions have a lot to do with arthritis that moves around to different joints or rheumatism problems that move to different joints Chapter six. It’s on Blood impediment and deficiency taxation condition. This is a condition that we deal mostly with over straining, depletion of the physical body. And then chapter 7 is on lung conditions. Lung wilting, welling-abscesses of the lung, and coughing with Qi Ascent conditions. So that will be Chapter 7. Now chapter 8 to chapter 14 again, goes through different conditions. And chapter 8. we call it the Running Piglet Qi Conditions. Again, difficult to translate, but I’m going to take a look at this with you to see what that this all about. Chapter 9 is Chest Impediment Heart Pain and Shortness of Breath conditions. And Chapter 10 is on Abdominal fullness, cold mounting and abiding foods. And so that deals with nutrition and food intake and how food intake can cause issues in the stomach conditions. Chapter 11 is on Visceral wind and cold, accumulations and gatherings conditions. And Chapter Twelve is some phlegm and cough conditions. And Chapter 13 is on Depression-thirst, and, I’m sorry, not depression – so it’s Dispersion-thirst, inhibited urination and strangury conditions. Chapter 14 is on Water Qi Diseases. And Chapter 15 discusses about the treatment and understanding of jaundice. Chapter sixteen it’s on Fright Palpitations, Blood Ejection, Nosebleed, Purgation of Blood, Basically bleeding disorders. Fullness in the Chest, and Static Blood. And chapter 17 is on vomiting, hiccups, and diarrhea. And Chapter 18 is on more external injuries, Incised Wounds, Wellling-Abcess, Intestinal Welling-Abcess, and Wet Spreadng Sores which we’ll talk about. And Chapter 19. It’s about Hobbled Dorsum of the Foot, Swelling in the Fingers and Arms, Cramping, Yin Fox Mounting, and Roundworm Diseases. Chapter 19. And Chapter 20 is diseases in pregnancy. And chapter 21 is postpartum condition, so you have basically 3 Chapter on women’s conditions. And Chapter 22 is on gynecological diseases. And not the least, Chapter 23, which we say is not really written by him, but written later. It’s on Miscellaneous Treatments. So in general if you look at the Jin Gui Yao Lue Fang Lung you’ll see the total is approximately Obviously different people are going to tell you different numbers of herbal formulations. But it is, you know here, it is you are talking about 200 plus formulations that are even today – a lot of them are still widely used and practiced. And many contemporary formulas are a variation of such formulas. So for us to understand our contemporary formulas, Well it behooves us to study basically these wonderful classical formulations. Now there’s a few unique. uniqueness, about the formulas in this book. It is that these, each formula contains less herbs per formula overall. Very, very good for formulary students. We we do not like to memorize tons of herbs and they are difficult to memorize. The beauty of studying this formula book is that you have much less formulas. Much less ingredients per formula that you’re to study. It’s a great learning tool for beginning students to learn about formulas and many fundamental formulas are to later formulations. And how do we study it. There is really three distinct way to study Jin Gui Yao Lue. First is the passage approach. Well you take the ancient passage and you go phrase by phrase and it is scholarship, it is comprehensive but it’s kind of cumbersome and difficult to remember and difficult to link it up clinically. The second approach is a disease approach which has much more clarity on disease mechanism but devoid of formulary flexibility would be the cons. So a lot of times when you have a certain disease, you just fit a certain condition to a certain disease without really understanding the modification possibilities. So you lose a certain flexibility of formulating. Third is the formulation approach. On the pro side of it, when you study each formula it’s more clear on what treatment you can use. And a lot of time if you understand the formula well, what you realize is that this formula can be used for many different condition and not just for the for the disease that Jin Gui tells you. So more flexibility, more adaptability, more clarity on treatment, easier to remember. But you may lose some disease mechanism details. So those are the pros and cons. In our class we are going to approach it by formulation. And the reason, it is much easier to study that way. We’re going to look at some selective formulas. because not every single formula is useful for later on usage. then again, a lot of the formulas are still useful today. So we want to take a look at the study of formulas, the treatment of disease and the contemporary use of some of these formulas. So I have selected 22 formulas for us to study these 22 are Gua Lou Gui Zhi Tang, Ge Gen Tang … Da Cheng Qi Tang ….. Bai He Di Huang Tang ….. Gan Cao Xie Xin Tang ……. Huang Qi Gui Zhi Wu Wu Tang ….. Huang Qi Gui Zhi Wu Wu Tang ….. Xiao Jian Zhong Tang ….. Shen Qi Wan …. Shen Qi Wan) Suan Zao Ren Tang …. Zhi Gan Cao Tang ….. Ma Zi Ren Wan …… Xiao Qing Long Tang ….. Wu Ling San … Xiao Chai Hu Tang ….. Si Ni Tang … Gui Zhi Tang … Xiao Cheng Qi Tang …… Wu Mei Wan …. Gui Zhi Fu Ling Wan ….. Dang Gui Shao Yao San….. Gan Mai Da Zao Tang……. Wen Jing Tang… These are sound a very well known formulas as well as formula that is still used widely in a contemporary setting today that’s the reason why I chose this twenty two different formulas. Now before we move forward we need to talk about dosages solve the dosage though is this that in the book are ancient dosages so we don’t have a very clear picture of whether or not we are able to convert them but it is we attempt to cover them Jin = 250 grams Liang = 15.625 grams Fen = 3.906 grams Sheng = 200 ml Jin = 250 grams Liang = 15.625 grams Fen = 3.906 grams Sheng = 200 ml Ge = 20 ml All right so that does move forward to go into our first formulation first Formulation Gua Lou Gui Zhi Tang When Taiyang disease appears with all signs present, but with stretched stiffness of the body, and the pulse are sunken and slow, this is called tetany. Gua Lou Gui Zhi Tang is indicated OK so we talking treating a condition where that there is some kind of seizure some kind of seizure disorder the stiffness of a body the pulse of sunken and slow. So this is a condition where Gua Lou Gui Zhi Tang it can be used to treat. So you can look at the formula yourself is combined and is composed of Gua Lou Gen, Gui Zhi , Shao Yao Gan Cao , Sheng Jiang , Da Zao Again, Gua Lou Gen, Gui Zhi , Shao Yao Gan Cao , Sheng Jiang , Da Zao take a look at a clinical case. A six month old boy beginning of a summer with fever sweating thirst. He has now slanted eyeballs. Stiff neck seizure. Feet and hands spasm fingertips cold and purple tongue coating thin and yellow. Now a child who get high fever will get febrile disease is not unusual sometimes you start to see some seizure kind of symptoms. This is an obvious seizure situation in Chinese medicine can be diagnosed as damp enduring with when attacking Tai Yang wait portion and Biao is consider is deficient in a body fluid is lacking the tendons therefore are poorly nourished. So this is a case where Gua Lou Gui Zhi Tang will work well so the treatment principle is to harmonize yin and yang to nourish ying fluid and to use Gua Lou Gui Zhi Tang primarily to treat this condition. So the formula is basically Gua Lou Gen 6 g, , Gui Zhi 3 g, , Bai Shao 3 g, Gan Cao 2.4 g, , Sheng Jiang 2 pieces, Hong Zao 2 pieces. It’s been use for this particular condition and after three bags. Symptoms as usual is much reduced. And in this case that actually happened. This is so in my cases. I also have a female case to 20 years old. This is the autumn time postpartum for seven to eight days gradually develop dizziness vertigo. She can not even stand up fingers is in spasm yawns or law pale face your complexion and is staring as well salvation cold sweat. Semi consciousness pulses wiry slow and forceless. So I diagnosed as a pulse. Postpartum Blood and yin loss sweating costs loss of young exposure to wind pathogen allows the body to have the collapse of yin and yang. So the treatment is to reverse of yang, prevent collapse and disperse wind and stop spasms. So you could also give Korean Ginseng 15 gram tea first because that will help to bring the true Qi the righteous Qi up before you can treat a condition. So in this case I used Korean Ginseng 9g, Zhi Huang Qi 30 g, Gui Zhi 6g, Bai Shao 9g, Fu Zi 4.5g Gua Lou Gen 12g, Zhi Gan Cao 9g, Sheng Jiang 9g, Da Zao 5g. So after taking this earth for packs of the week her sentence a much reduced after just just three packs which is a one we supply In clinical research Gua Lou Gui Zhi Tang Later on in a contemporary world that has shown that it’s effective in the treatment of cervical spine problems. Effective in the treatment of reducing seizure in mouse models. So this is some very interesting development that we should be aware of should be aware of. OK so let’s move for to talk about seizure. So what happens during seizures in our brain? Well I’ll seizure can occur a seizure can occur when a large number of the cells send out an electrical charge at the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a seizure which can cause muscle spasms or loss of consciousness strange behaviors or other symptoms. So anyone can have seizure under certain circumstances. For example a fever, lack of oxygen, head trauma or illness can actually bring on these situations. In most cases. About seven out of 10 the cause of seizures can be identified. We don’t know whether we know fever or aggravates the type of seizure. When is no understanding of cause. We call that ideopathic or cryptogenic. Basically means we don’t know what causes them and the problem may be with an uncontrolled firing of neurons in the brain that triggers a seizure. And that’s what brings us to epilepsy. These are epilepsy seizure epilepsy seizure. It’s a transient occurrence of signs and those symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. Epilepsy is a disorder of the brain characterized by this enduring predisposition to generate epileptic seizure and by the neuro biological cognitive psychological and social consequences of this condition. So the definition of epilepsy requires the occurrence at least one epileptic seizure. OK so that’s a definition of epilepsy. Now epilepsy is a disease of the brain and defined by the following conditions than 24 hours apart. 2 one unprovoked seizure and the possibility of further seizures similar to a general recurrence risk after 2 unprovoked seizure and which is approximately 75 percent or more and at least two seizures in a setting of reflex epilepsy and we would give this definition of epilepsy when these conditions are met. Now epilepsy is considered to be no longer present for individual who have an age dependent epilepsy. So sometimes they could have a when are a little kid but it grew out of it OK. And that is something pretty common. So let’s move on to epilepsy drug Neurontin coming in. known now Generally Gabapenton. That’s very effective. And Lamictal, Topamax and and Zonegran and Keppra Trileptal and Gabitril which are all very helpful drugs for this condition. One of the nice thing about these new drug is that they tend to have fewer side effects are they are easy to use and and more predictable and that’s helpful since well we know that drugs interactions are the bane of many patients. So it kind of nice when they can all work together. Let’s move on to the next topic next. Formula Ge Gen Tang If we look at a passage for Taiyang conditions manifesting with an absence of sweating, but with a scant urine, Qi surging upward in the chest clenched jaw and appearing on the verge of hard tetany – seizure. Ge Gen Tang is indicated. If we can look at Ge Gen Tang and its composition you’ll see Ge Gen the basically the top ingredient then you have Ma Huang Gui Zhi, Bai Shao, Gan Cao Sheng Jiang, Da Zao all in the mix. So is basically Ge Gen Tang adding some great stuff into the mix all right. Let’s talk about the case in this using this Ge Gen Tang effectively. First clinical case is an 82 year old male wintertime woke up with facial paralysis. This is Bell’s Palsy – spasm of right face, right face slanted, unable to make clear speech because of slanting, tongue coated Then white, the pulse is floating and tight. We diagnosed this condition as Attack by Wind. Treatment to relieve muscle spasm and disperse disperse wind and cold should be a priority. So let’s use Ge Gen Tang for this condition. So we use Ge Gen10, Ma Huang10, Bai Shao 10 gram Zhi Gan Cao10, Sheng Jiang10g, And Da Zao about 10 grams. OK. And then we also do warm compresses on the right on the right face. So that’s the clinical case. One clinical case well Bell’s Palsy that’s about Bell’s palsy. The number one cause of any facial paralysis United States is Bell’s Palsy. OK Bell’s Palsy first appeared and discovered by Sir Charles Bell. He is a prominent physician and it’s terminology has been confused with facial paralysis ever since. Now not all patient who has facial paralysis has Bell’s Palsy and Bell’s palsy is coined for any type of facial paralysis that does not have any other associated causes such as tumors traumas and salivary gland inflammation. OK so that’s Bell’s Palsy. OK so let’s talk about etiology of Bell’s palsy. The recent research has shown that Bell’s palsy occurs when a virus mostly herpes simplex virus gets reactivated in the bone behind the temporal lobe the temporal bone the area when the nerve gets reactivated and this swells up it ends up causing the nerve to essentially shut down. And this occurs in a very rapid manner and most patients who have Bell’s Palsy present have acute onset and immediate facial paralysis. So it occurs is very fast. Now other symptoms of Bell’s Palsy may include an aura that precedes it almost like a visual distortion almost like a little migrain feeling or sensation that your face movement may be inhibited. So in clinical research Ge Gen Tang has been known to use for cervical spine conditions facial paralysis childhood viral colitis situations it’s known to stop inflammation stop pain preventing clotting and reduce allergic reactions. Now let’s move on to our next formula Da Cheng Qi Tang is for the use of disease of tetany manifesting with fullness in the chest clenched jaw an inability to a lie flat and hyper tonicity of the feet grinding of the teeth is certain to occur. Da Cheng Qi Tang is indicated in this kind of tetany problem again Da Cheng Qi Tang has about four herbs .you have Da Huang, Huo Po. Zhi Shi, and Mang Xiao into the mix it’s effective very effective for constipation very effective for seizure conditions so that in the research it has shown Da Cheng Qi Tang improves intestinal blockage recovery improves systemic inflamed inflammatory response syndrome it improves acute pancreatitis, improves chronic kidney failures as well as stroke so it’s a very versatile formula. it can be used in so many different conditions. So let’s go on to the next formula Bai He Di Huang Tang when Bai He disease has not been treated with ejection, purgation or sweating and it remains in the same condition as that of its initial stage. So this is where we want to use Bai He Di Huang Tang So what is a Bai He condition? This is something that has been debated for centuries now Bai He condition. Basically is someone who is thoughtful who is meditator who may have desire to eat but cannot eat its quiet desire to lie down but cannot really lay down because they feel uncomfortable desire to move but you cannot move and it’s kind of cold but not cold kind of hot and not hot the mouth is bitter it’s the bright yellow urine and vomiting or diiarrhea with herbs or medications pulse thin rapid and tongue is basically thin white this happens is as if the patient has been possessed. this is a condition when heat has not completely clear and we need to clear the remaining of heat only two herbs by Bai He and Sheng Di these two are is known to be very effective for all different kinds of conditions. Let’s talk about the individual herbs. Bai He is the lily bulb, sweet it’s cold into his heart and lung nourishes yin moisten lung clear heat calms spirit, is used in yin deficiency chronic cough blood in his sputum restlessness with palpitation insomnia with excess dreams and disoriented effect. In a clinical case a male twenty five year old reason he did not pass the board exam this is one of my patient depressed. One week ago start having chest pain went to hospital checked out fine. Is negative for heart diseases his symptoms are depression restlessness irritable anxious tired lack of energy palpitation insomnia loss of appetite yellow urine. The tongue is red. Lack of coating. Pulse thin rapid. So I basically diagnosed this patient as a Bai He syndrome the truth Qi needs to be nourished nourish yin clear heat and basically we have to treat this as a kind of chronic bronchitis. Chronic bronchitis situation. So I used Bai He 40 grams and Sheng Di After about three bags. OK so for this gentleman we realize that this formula in the clinical research has been used for depression of this. He does have a depression situation use for hyper thyroid insomnia issues and it has been known in the laboratory to stop liver cancer cells growth in rats so having Bai He combined with Sheng Di has been known to be very helpful and very effective. Let’s move on to the next formula Gan Cao Xie Xin Tang. Gan Cao Xie Xin Tang is use for a condition called Hu Huo. Hu Huo, if we translate it I find the Chinese it really doesn’t meaning mean much it means the fox delivery and the Fox delereum in condition where the fox has cheated you in some way so it doesn’t really make sense except in the mythological storytelling but it manifest and the most important is look at the symptoms and what it’s trying to say here. Hu Huo condition manifests it like a cold condition damaging reticence it’s a desire to sleep somebody inability to close the eyes fidgetiness lying down or upright they cannot sit still they cannot lay down floor they’re just fidgeting all the time there’s erosion of throat indicate Huo condition and erosion of the anal and genital orifices indicates Hu condition this is almost like Sjogren’s condition where there are peelings and dryness in the oral cavity and genital areas. Other signs include no desire to drink or eat are aversion to the smell of food and facial complexion that alternates between red dark and white or pale and erosion of the upper manifests with hoarse voice the voices also hoarse. This is where Gan Cao Xie Xin Tang is indicated so this confused by Fox condition it’s also seen in Behcet’s disease. Behcet’s disease is a syndrome is a very rare disorder that causes inflammation in blood vessels throughout your body the inflammation that Behcet’s sent disease leads to numerous symptoms and that may initially seem unrelated are the signs and symptoms of Behcet’s disease which may include the sorts in the mouth ie inflammation skin rash and lesions and genital sores. It varies from person to person and may come and go on their own. The exact causes are unknown but it may be an autoimmune disorder and both genetic and environmental factors may be responsible for Behcet’s disease and treatment aims to reduce the signs and the symptoms. Since we don’t understand we don’t know how it’s come about and to prevent serious complications such as blindness. I have included. If you’re looking at the video the PowerPoint I have included some picture of the Behcet’s conditions showing all these kind of aura saw canker sores underneath the tongue around the eye in the genital area for you to take a look. So Gan Cao Xie Xin Tang is used and if we take a look at the formula is a combination of Gan Cao 4 liang , Huang Qin 3 liang Ren Shen 3 liang, Gan Jiang 3 liang Huang Lian 1 liang , Da Zao 12 pieces, Ban Xia 1/2 sheng OK so as you could see these formula is not that big formula but it is very useful in treating all these of conditions. So in the clinical use Gan Cao Xie Xin Tang has been known to you treat sores ulcerations especially in the mouth. Chronic stomach inflammation chronic gastritis chronic colitis oral warts and fungus is reflux reflux esophagitis and also ulcerative gastritis so quite a bit. Very useful formula even today for some of these conditions. So let me share with you a clinical case. 35 five old came to my office for a very unusual hoarse voice for six months and recently developed vaginal itchiness ulceration even dryness. Syphilis was ruled out, antibiotic use ineffective. But doctor has ruled out syphilis. Vaginal ulceration with yellow pus local pain missed period for two cycles, throat pain, difficulty swallowing ulcerations in the oral cavity and throat cavity, poor appetite, bitter mouth, insomnia and disturbed sleep due to discomfort, and the tongue coating yellow, tongue is red, pulse wiry and rapid. I diagnosed her as having a damp heat stagnation interiorly, toxin disturbance. Hu Huo condition diagnosis. So treatment principle is to clear heat, relieve toxin calms middle and dissolve the damp. so the formula of selected will be Sheng Gan Cao 10, Zhi Gan Cao 10, so you can see I use both the raw and baked Gan Cao together. Dang Shen 15, These are grams. Huang Qin 10, Huang Lian 10,Ban Xia, Gan Jiang 6, Da Zao 6, Jin Yin Hua 30 grams. Ku Shen 30, She Chuan Zi 30, wash vaginally. very helpful for this patient effective to manage some of these symptoms OK. Let’s move forward to the next. Formula Huang Qi Gui Zhi Wu WuTang This formula is for blood. blood impediment with dual debilitation of Yin and Yang, faint pulses at Cun opening and Guan position, small tight pulse at Chi position, and external signs of generalized numbness resembling that of Wind impediment, And this is what this Huang Qi Gui Zhi Wu WuTang can be used for. We call this condition Xue Bi syndrome. Blood Bi syndrome blood pain kind of condition. So this formula Huang Qi Gui Zhi Wu WuTang it’s got five ingredients in there Huang Qi 3 liang Gui Zhi 3 liang Bai Shao 3 liang Sheng Jiang 6 liang Da Zao 12 pieces So really Huang Qi, Gui Zhi, Bai Shao, are your main herbs and Huang Qi as you know very good in strengthening raising the yang strengthening that qi. Huang Qi harmonize both in a way. And so this formula is only five herbs but is very useful. So contemporary setting. We have done quite a bit of research on this formula Huang Qi Gui Zhi Wu WuTang been known to be effective and helpful in quite a few conditions. One is peripheral neuropathy. The other one’s, deficiency common cold, diabetic peripheral neuropathy, intercostal neuritis and neuralgia shoulder joint conditions facial paralysis back pain thigh pain and skin itchiness. So it’s quite profound what it can be useful now peripheral neuropathy as you know as a result of some form of nerve damage often causes weakness numbness and pain usually in our hands or our feet. But may also occur in other areas of the body and people generally describe this pain of peripheral neuropathy. The thing is kind of like achy kind of tingling the numbing burning kind of feeling or sometimes can be a loss of sensations. So it happens a lot and it can result from problems of trauma enduring infections metabolic problems exposure to toxins and one of the most common cause is in this condition is diabetes. So in this situation this formula can be very helpful. Huang Qi Gui Zhi Wu WuTang can be very helpful. So in a clinical research Huang Qi Gui Zhi Wu WuTang is 93 percent effective in managing pain is especially in diabetic neuropathy. And the formula is Huang Qi 30, Gui Zhi 10, Chi Shao 10, Sheng Jiang 10, Da Zao 10 for and that’s the research have shown. Let’s take a look another case this is a male twenty five years, Raynaud’s Disease fingers fingers and toes white pasty, painful and cold, worse with cold climate and can even turn blue tongue is red. Coating is yellow pulse deep wiry and he had a past history of working in a cold climate and he has use cortisone NSAID- non steroidal anti inflammatory not very useful nor very effective in treating his renal condition. He is diagnose as Qi Xue deficiency cold pathogen invades from outside blocking the channels and collaterals and treatment principle is to benefit that qi, nourish the blood clear heat and open up collaterals. So in this case Huang Qi 60, Gui Zhi 12, Bai Shao 9, Ta Ren 9 Hong Hua 9, Sheng Di 15, Lian Qiao 12, Sheng Jiang 3 pcs. are used in this condition and after two months of treatment the patient is cured from the condition. Now Raynaud’s Disease is a condition that cause some area of our body such as our fingers and toes and the tip of our nose and even ears to feel numb and cool in response to cold temperature or stress. So in Raynaud’s Disease basically the smaller arteries around it that supply blood to our skin narrows it become much narrower limiting the blood circulation to the affected area. In Chinese medicine it is very much of a blood impediment situation very much of a blood stagnation situation. Now women fascinating are more likely to have Raynaud’s Disease and is also more common in people who live in much colder climates. Now as treatment of Raynaud’s depends on severity and whether or not if there are other health conditions for most people. Raynaud’s disease is more of a nuisance than a disability. And let’s move forward to look at the next formula Xiao Jian Zhong Tang for deficiency taxation condition with abdominal urgency palpitation nosebleed abdominal pain dream emissions and soreness and pain of four limbs vexing heat of the extremities, and dryness of the mouth and throat. Xiao Jian Zhong Tang is indicated that this is basically describing although all the straining over stress condition we call a […] in Chinese medicine. Xiao Jian Zhong Tang is a mixture of Gui Zh Gan Cao, Dao Zao, Bai Shao, Sheng Jiang and Yi Tang So that’s the composition of it. Now in a contemporary setting. A lot of the clinical research have shown Xiao Jian Zhong Tang is very effective in many different conditions. The very first very effective. It’s actually in premature ventricular contraction PVC. Second of all stomach pain viral myocarditis duodenal ulcers and intestinal spasms. These are some of the conditions that Xiao Jian Zhong Tang can be useful. Now PVC or premature ventricular contractions are extra abnormal heartbeats that begins in one of the heart two lower pumping chambers we call the ventricles. These extra heartbeats disrupts the regular rhythm and sometimes cause the patient to feel kind of like a flutter or like a flip flop or skipped beat in the chest. PVC are very common and they occur in most people sometimes in some time of their life. Now PVC are also called premature ventricular complexes ventricular premature beats so you know it’s definitely something that has many different names. Occasionally. otherwise a very healthy person, we could see ventricular contractions sometimes there’s nothing to be concerned about. You could have PVC for the rest of your life and your heart still pumps and still doing pretty good. OK. So if frequent PVC’s occur there may be some underlying heart disease that’s when further evaluations need to be called upon. OK so I have left some slides for people to take a look at looking at EKG look at the heart waves but nevertheless the clinical use of Xiao Jian Zhong Tang can also be used in this condition. Let’s go to the next slide. Let’s go to next case how SXiao Jian Zhong Tang came to use in this 60 year old female who have gastric pain for 10 years. Recent endoscopy confirms ulcers in the duodenum. This formula is known to be very effective for gastric pain. The pulse is sluggish and slightly wiry so she is diagnosed as middle jiao yang deficiency, deficiency cold interiorly So the treatment principle is to warm up the interior to stop the pain. So this a derivative of this formula has been used Gui Zhi 10, Bai Shao 15, Zhi Ga Cao 6, Sheng Jiang 5, Wu Zhu Yu 3, Da Zao 5pcs, Ti Tang 60 grams. So the mixture of this formula is quite effective for this condition. So this concludes our class one of two. I look forward to seeing you in the second class of Jin Gui Yao Lue Thank you.