Answers to questions for course F

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1.      Moxa preparation - ‘made from Chinese mugwort leaves’ – is this the same as the Argyi leaf (Ai Ye) which is used to make moxa sticks?

2.      Frequency of taking herbs – in general one dose is divided into 2 or 3 portions and taken 2 or 3 times a day.

a.      Is it correct that for acute diseases a patient can take a formula up to 3 times a day for as long as needed until the condition clears up?

b.      How many doses can be taken before it may be considered unsafe assuming the condition is not cleared up?

c.      Also for chronic conditions, a patient can take a formula twice a day for how long before an effect is expected?

d.      It is probably likely to be dependent upon a patients’ constitution and the status of the disease, etc but in general how many times does a formula need to be taken before beneficial effects should be seen?

3.      Gui Zhi Tang – ‘peony root’ – is this white peony root as that can be used to nourish ying to help relieve exterior syndrome of deficiency type?

4.      Jie Wei Qiang Huo Tang – one of the listed cautions is ‘exterior syndrome due to wind-cold’ is this correct as I thought the decoction was suitable for syndromes due to exogenous wind, cold and dampness with interior heat?  

5.      Xiao Qing Long Tang – ‘peony root’ – is this white peony root which can be used to nourish ying? Also looking at the notes for Bai Shao, it can be used to rebalance any harmony between the ying and wei divisions and can be used to stop sweating (so is good in Gui Zhi Tang). Therefore would it also have a dual effect of rebalancing any disharmony between ying and wei divisions to help induce diaphoresis where there is absence of sweating because this decoction is indicated in exterior cold with chill and fever and absence of perspiration. Or is the absence of sweating treated by the other herbs in the formula such as cinnamon twig and ginger?

6.      Yin Qiao San – reed rhizome (Lu Gen) ‘in proper dosage’ – what is the proper dosage?

7.      Chai Ge Jie Ji Tang – ‘peony root’ – again is this white peony root?

8.      Jia Jian Wei Rui Tang – the decoction is taken warm and in separate portions? How do you separate the decoction, e.g. how many portions, taken all in one day or over a period of days, etc?

9.      Zhu Ye Shi Gao Tang – it states that this not advisable when ‘there is excessive heat in the body’ – I thought the decoction functioned to clear away heat and help with the production of body fluid.

10.  Qing Ying Tang – is water buffalo horn (Shui Niu Jiao) a suitable replacement for rhinoceros horn and would it still be 9g? Also would the buffalo/rhinoceros horn be taken separately from the decoction?

11.  Xi Jiao Di Huang Tang – peony root – is this red peony root (Chi Shao) as this herb can clear heat from the blood?

12.  Qing Wen Bai Du Yin – rhinoceros horn – again is this typically replaced by water buffalo horn and again would it be 3g?

13.  In some decoctions, e.g. Pu Ji Xiao Du Yin, Long Dan Xie Gan Tang, some herbs are ‘parched with wine’ – does this mean the herb is heated with wine until all the wine has evaporated or soaked in wine then dried in the sun or something else?

14.  What is ‘vegetative nerve functional disturbance’ as some formulas can be used to treat it, e.g. Dao Chi San, Long Dan Xie Gan Tang, or inhibit the excitability of the vegetative nerve, e.g. Qing Gu San?

15.  Xie Huang San – ingredients can be administered in powder form but if they are ‘decocted in water the dosage is modified with reference to the proportion of the original formula’ – does this mean for example that gypsum is 15g and liquorice is 90g so in a decoction use 1/6 of gypsum to liquorice – and the amount can be modified according to the patients constitution, accompanying symptoms, state of the disease, etc?

16.  Shao Yao Tang – ‘peony root’ – is this white peony root as it can help to regulate qi and blood and remove damp-heat in the lower jiao?

17.  Da Chen Qi Tang – it says it is indicated ‘for cold limbs due to excess of heat’ – can you get symptoms of cold limbs in excess heat syndromes?

18.  Da Huang Fu Zi Tang – the notes state that ‘when the formula results in relief of constipation then the patient is out of danger, but if patient still has constipation, vomiting, cold limbs and a thready pulse then they are still in danger’ – if this happens should the decoction be given again and if so how many times should it be given if it doesn’t seem to be helping? Or should the formula be stopped if it does not seem to help and re-evaluate the patient’s diagnosis?

19.  Ma Zi Ren Wan – the herbs are powdered and made into a bolus the size of a ‘parasol seed’ – how big is this as I don’t know what a parasol seed is? When it says ‘a dosage for decoction should be reduced in proportion to that of the original formula’ how much should it be reduced to? And what are the determinants for reducing the dosage?

20.  Shi Zao Tang – genkwa, Kansui root and Knoxia root are used in equal dosage – would this be 0.5-1g each as recommended in the dosage for each herb? The formula can also be used to treat symptoms of ‘headache with halo’ – is this different from the bandaged head sensation reported by some patients that is characteristic of damp?

 

 

 

 

1. Yes.

2. Yes, usually one dose of herbal medicines (usually it’s one pack) is indeed divided into 2 or 3 portions, but:

A. for a acute case, one could take even more frequently the herbal medicines, 4 to 6 times, for example.  

B. Generally speaking, if you don’t use the drastic and poisonous materials, you could use it for quite a long period of time, possibly months. But usually for an acute condition, if in a week the treatment with herbal medicines won’t work, you should think of stopping the treatment and ask the patient to go to see doctors of western medicine to ensure the condition.

C. It could take a long time, months or even a year, maybe even more. It’s all up to the individual condition. Please do remember, to treat patient with traditional Chinese medicine you have to consider always the individual condition, then the differentiation of syndromes. Always, in all the aspects, no exception!

D. See answer for C.

3. In traditional Chinese medicine, in old time, if it’s not stressed the red peony root, it’s always the white peony root in use. Even nowadays, many TCM physicians would just write Shao Yao (peony root), which in fact refers to only white peony root Bai Shao.

4. Is it Jiu Wei Qianghuo Tang that you asked for? If so, it’s good to expel the exterior pathogenic wind-cold, and also good to eliminate the dampness, with some interior heat, but not the heat by Yin deficiency.

5. Yes, it’s white peony root. But it’s not right to say it could be used also for diaphoresis, no not really. Would you please tell me why?

6. See the dosage of that single herb Lu Gen. of course it’s not a major ingredient in this formula, so you don’t have to use it for the maximal dosage.

7. Yes.

8. It’s taken in the usual separated portions, usually twice a day.

9. It’s not really a formula for the excessive heat syndrome, from the ingredients you should know why. Could you please tell me?

10. Yes, we cannot use the rhino horns, and in fact in China it’s very difficult to find the rhino horns. Buffalo horns could be given in large dosage, 9 grams would be Ok, but it could be more, up to 30 grams, sometimes by some TCM physicians in China. Buffalo horns could be boiled together with the other materials.

11. See answer to 3. But nowadays, many physicians would use both the white and red ones.

12. See answer to 10.

13. You don’t have to worry about it, but just written as wine-parched so and so. For all the herbal materials are well prepared before you use them. It’s a specialty of preparing the herbal materials, it would also take some years to learn it.

14. Vegetative nerve system is also known as autonomous nerve system. So please find the terminology and see what it should be.

15. First of all, you could look up the dosage for each of the individual herbal material, and see how much they are usually used. Secondly, you might modify according to the importance of the ingredients in the formula. Is it a monarch, a minister, or something else?

16. Yes.

17. It’s not used to regulate the flow of Qi and blood! Please review the single herbal material.

18. Yes, it could be. The heat is accumulated in the interior so it could not be spread to the exterior, thus the cold limbs. Please review the Eight Principle differentiation.

19. I suggest you to send the patient to see a doctor of western medicine at that moment!

20. Are you going to make the pills al by yourself? J

 

It’s about 0.3 to 0.4 mm in diameter.

As to how much you should reduce the dosage for decoction, see my previous answer to 15.

21. Forget about this formula!

It contains the very drastic materials such as Genwa, Kansui, and Knoxia. The formula is mostly used for drive out the phlegm humors.