Key Sign for Gui Zhi Gan Cao Tang

Key Sign for Gui Zhi Gan Cao Tang

Most practitioners of Chinese medicine have learned to ask the 10 questions as the “asking” part of our diagnostic process. We may go through the questions this way:

“how is your urination?
” fine.”

“how are your bowels?”
“fine.” etc.

However, as I have practiced and studied, I have learned that I will miss out on crucial information if I go through the questions this way. I have to have in mind what I am trying to discover through asking the question. When I ask about urination I am looking to see if water and heat are able to leave through the bladder properly. When I ask a question in a more directive way, I discover that what some people consider “fine” is actually not so fine from my point of view. So, for example, when I ask about urination I ask questions like “Do you ever have to pee but when you go, you have to sit there and wait for urination to begin to flow?” or “Does your urine flow start and stop?” You will be amazed at how many people have inhibited urination if you inquire a bit more deeply!

This is a bigger topic to be sure as there are so many exploratory questions I’ve learned to ask regarding the 10 questions. (If you would like to learn more check out the White Pine Graduate Mentorship Program!) However, there are other questions I’ve learned to ask from my study of the Shang Han Lun. One of the 10 questions includes asking about the Chest. Based Clause 64 of the Shang Han Lun, I have learned to first notice if patients hold their hands over their chest area and secondly to ask if they like to hold their hands there. Patient’s will not tell you this if you don’t ask, but if you do ask, you will be surprised that this symptom happens not infrequently. I had a patient who once told me that she could only fall asleep if she had one hand on her chest and one on her epigastric area. Another patient said that when I asked she realized that she held her hand there often when she spoke to people or was still, like when she waited in line at the post office.

Clause 64: “When copious sweating has been promoted and the person’s hands are crossed over the heart and there are palpitations below the heart with a desire for pressure, Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) governs.”

Gui Zhi Gan Cao Tang is a little known formula from the Shang Han Lun. One may notice that the two ingredients in the formula are also in many other formulas, most notably, Gui Zhi Tang. I have found that I can learn so much about a formula, for example Gui Zhi Tang, by understanding the formulas inside of it. Inside Gui Zhi Tang we can find Gui Zhi Gan Cao Tang, Shao Yao Gan Cao Tang and in an important way, Gan Cao Gan Jiang Tang. In the class I am teaching (live and streaming) in San Francisco on May 3-4 this year, I go into all of these smaller formulas as a way to deeply understand the essence and amazing usefulness of Gui Zhi Tang. Below is a discussion as well as case studies I translated on Gui Zhi Gan Cao Tang. It is a useful formula for the clinic and it is useful to understand this combination of herbs when we see it in other formulas. It can be used when the pattern matches for illnesses such as depression, heart disease, dizziness and as you see below, deafness.

You may think that you will not see patients who have excessive promotion of sweating but we should consider hot yoga and excessive exercising that many of our thin and weak patients take part in.

Li Pei-Sheng(李培生)on Gui Zhi Gan Cao Tang
From 伤寒论讲义

Explanation:

1. Hands crossed over the heart, means that the area in front of the heart is covered by both hands crossed over.
2. Below the heart palpitations is referring to heart palpitations in which there is movement of the heart that won’t settle.

Summary:
This is a pattern in which excessive sweating has damaged the heart Yang.

Analysis:
Sweat is the fluid of the heart. When there is excessive sweating promoted, the heart Yang is emitted as it follows the discharge of fluid. This causes deficiency of the heart Yang. When the heart Zang looses the protective guard of the Yang Qi it is then void of any governance. This is why there are heart palpitations with no rest. Deficiency likes pressure and there for the patient will cross their hands over their chest area. This is an attempt to give a bit of peace. In addition to there being heart palpitations that like pressure, clinically you will also see chest oppression, shortness of breath and a general lack of strength.

Selected notes:
You Zai-Jing 尤在经

The heart is a Yang Zang and sweat is the fluid of the heart. When there is excessive sweating, the heart Yang is damaged and this person wants to cover their heart with their hands. Inner deficiency wants to be protected on the outside. Palpitations are a movement of the heart. Although putting pressure there does not alleviate the issue, it helps the movement stop. It is appropriate to supplement and assist the heart with the combined pungent and sweet flavors of Cinnamomi Ramulus (guì zhī) and Glycyrrhizae Radix (gān cǎo). This is a good formula to generate the Yang and transform Qi. (伤寒贯珠集·太阳篇)

Xu Ling-Tai 徐灵胎

When there is mistaken sweating and the patient sweats excessively, since the sweat is the fluid of the heart, this will cause Qi deficiency. These two flavors restore the Yang and supplement the middle. This alleviates the Yang deficiency. If there is an extreme case in which there is shaking and a desire to pound, use True Warrior Decoction (zhēn wǔ tāng). The light and heavy patterns are not the same and the formulas are very different from each other. This is the essential meaning. (伤寒论类方·太阳篇)

Treatment method: Warm and open through the heart Yang.

Formula constituents:

Cinnamomi Ramulus (guì zhī) with skin removed
4 liang
Glycyrrhizae Radix preparata (zhì gān cǎo)
2 liang

Decoct the above ingredients in 3 sheng of water down to 1 sheng and strain. Drink with meals.

Formula explanation: Cinnamomi Ramulus (guì zhī) is pungent and sweet with a warm nature. It enters the heart and assists the Yang. Glycyrrhizae Radix preparata (zhì gān cǎo) is sweet and warm and it boosts the Qi and supplements the middle. When these two herbs are combined, the pungent and sweet combine into each other. The warmth opens through the heart Yang so the heart Yang is restored. Then the heart palpitations are cured. This for helps the heart yang by warming and opening through. In the clinic this formula is often used as the foundation with modifications made according to the illness presentation.

From Experience with Classic Formulas from Renowned Physicians collected by Liu Du-Zhou

This formula is effective for heart Yang depletion with a special characteristic of having epigastric palpitations that like pressure. It uses Cinnamomi Ramulus (guì zhī) combined with Glycyrrhizae Radix preparata (zhì gān cǎo). These stimulate and rouse the heart Yang. Although it is a simple formula, it does return the heart Yang. If there is simultaneous pattern you can add other flavors.

Case 1: Heart Palpitations and Pain
Dr. Hu Meng-Xian

Mr. Lin was 39 years old and came for a consultation on August 8, 1960. He said that he had heart palpitations with pain that desired pressure. He took analgesics but they were not effective. His bowels and urination were both normal. He sometimes had spontaneous sweating. His pulses were slightly moderate and his tongue moss was white and slippery. I used Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) to be taken warm.

Cinnamomi Ramulus (guì zhī)
18 gm
Glycyrrhizae Radix (gān cǎo)
9 gm

After these herbs the pain was gone.

Discussion:

In general, if pain is worse with pressure it is excess pain and when it likes pressure it is due to deficiency. There was also heart palpitations and sweating so this was obvious heart Yang depletion. Without the balmy warmth in the Luo vessels there was pain. Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) is given warm. This is very straight forward. It stimulates the Yang of the imperial palace. There is a small amount of herbs but the strength is concentrated.

Case 2: Dizziness
Dr. Liu Yong-Yun

Mr. Tai was 46 and had suffered from dizziness and weakness for 4 years. In the recent 20 days this had gotten worse. On July 30, 1978 he was hospitalized. For 4 years his blood pressure had tended to be low. This was accompanied by dizziness, flowery vision, insomnia with many dreams, forgetfulness and weakness of the whole body. He also had heart palpitations with a pressure feeling above his heart. He used western medicine but it was not effective. Physical exam revealed that his blood pressure was 85/58. Everything else was normal. This was diagnosed as constitutional hypotension.

Cinnamomi Ramulus (guì zhī)
15 gm
Cinnamomi Cortex (ròu guì)
15 gm
Glycyrrhizae Radix (gān cǎo)
15 gm
Schisandrae Fructus (wǔ wèi zǐ)
25 gm
decocted in water and taken two times a day, morning and night

After 4 days the blood pressure had increased and the symptoms had changed for the better and his sleep improved. He felt that his body had more strength and her spirit was happy. I consolidated the treatment for one more week and he left the hospital. Afterward there was no relapse.

Discussion: This was a case of deficiency type dizziness. The clear Yang did not rise. The Ling Shu: Ko Wen says “when the upward Qi is insufficient, the brain is empty and the ears suffer from ringing. The head suffers from slanting and the eyes are dizzy.” Therefore Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) warms and supplements the Yang Qi of the upper Jiao. The addition of Cinnamomi Cortex (ròu guì) and Schisandrae Fructus (wǔ wèi zǐ) supplement both the Yin and Yang. Yin flourishes and Yang ascends and the clear orifices are nourished. The dizziness is naturally gone.

Case 3: Insanity
Li Zi-Zhao 李自召

Ms. Li was 21 years old and came for a consultation on August 17, 1983. Her mother spoke to me. The previous year she and her mother had quarreled and she became very depressed and melancholy. She did not want to speak and then slept a lot and did not want to wake. She was drowsy and was not breathing deeply. Or she spoke incoherently. At times her symptoms were mild and sometimes they were severe. She repeatedly sought medical advice and treatment and was given herbs to regulate Qi and purge downward. The illness did not improve and became chronic up to our visit. This woman’s growth and development was normal but her facial expression was dull and mechanical. Her two arms were crossed to protect her chest. I asked her questions but she spoke fearfully. It was as if her ears were blocked up. Her pulse was floating and big and her tongue was pale with white moss. This was insanity disease and was due to heart Yang deficiency damage.

Cinnamomi Ramulus (guì zhī)
45 gm
Glycyrrhizae Radix (gān cǎo)
20 gm
2 packages decocted in water

After one package her spirit had improved. After 2 more packages her desire to sleep was gone and her speaking increased. The patient’s condition had stabilized. The heart palpitations and tinnitus had dispersed. She said it was all like a dream. The effectiveness was still not complete so I gave her two more packages and there was a complete cure.

Discussion:

In this case there was liver constraint however, repeated diarrhea inevitably damaged the heart Yang. This pattern manifested with the patient’s arms pressing on her own chest, palpitations and tinnitus. There was no doubt that this was a Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) pattern. Although this was a serious chronic illness, it did not take a heavy formula for it to change but I did double the dosage of the herbs. This worked very well and was right to the point. It worked like wind in a sail. Classic formulas are nothing less than truly miraculous.

Case 4: Deafness
Zhou Fu-Sheng 周福生

Mr. Zhou, age 29

Because he had a sudden outbreak of deafness that had lasted for 2 months, his doctor gave him Augment the Qi and Increase Acuity Decoction (yì qì cōng míng tāng) for treatment. There was no change in the deafness. Hi suffering was very great and after a long time he came in for a consultation. At the exam he told me about the deafness. It was accompanied by palpitations and weakness. He also had a slight fear of cold. His tongue was pale red with a thin white coat. His pulse was thin and soft without strength. A detailed inquiry revealed that this illness had come on after he had a cold with excessive sweating. On the basis of the pulse pattern and the disease history, I differentiated this pattern as heart Yang deficiency and use Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) with added flavors.

Cinnamomi Ramulus (guì zhī)
12 gm
Glycyrrhizae Radix (gān cǎo)
8 gm
Acori tatarinowii Rhizoma (shí chāng pǔ)
4 gm
2 packages

After 2 packages he felt that his strength had increased. There was a change for the better with the heart palpitations and there was no longer a fear of cold. The formula was verified so I gave 2 more packages and the deafness was cured. All of the other symptoms also dispersed.

Discussion:

The Su Wen: Jin Gui Zhi Yan Lun says “the south is the red color and it enters through to the heart and opens into the orifice of the ear and stores the Jing in the heart.” When the heart Yang is insufficient, it is unable to surge upward to the ears and this can cause deafness. This case of deafness was caused by excessive sweating damaging the heart Yang. The Da Lun says “When grasping the pulse, the patient crosses there arms over their heart. There may or may not be cough but there is deafness without clarity. The why and wherefore of this is that there is deficiency due to excessive sweating.” Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng) warms and opens through the heart Yang. Acori tatarinowii Rhizoma (shí chāng pǔ) assists by opening the orifices. The effect was very good.

Case 5: Palpitations
Mr. Li, age 39 came for a consultation on August 10, 1960. He reported that he felt heart palpitations and pain. He wanted pressure. For many days he had taken stop pain medicines but there was no effect. His urination and stool were normal. Occasionally he would have spontaneous sweating. His 6 pulses were minute and moderate. His tongue moss was white and slippery. This was deficiency pain. I used Cinnamon Twig and Licorice Decoction (guì zhī gān cǎo tāng)

Cinnamomi Ramulus (guì zhī) with skin removed
18 gm
Glycyrrhizae Radix preparata (zhì gān cǎo)
9 gm

I had him take this with meals. After this the pain was gone.

Comments

comments

5 Comments

  1. Sarah Rivkin March 31, 2014 at 11:26 am - Reply

    I’m thinking about a patient of mine who can only fall asleep lying on her stomach… Might this be the same pathomechanism, since it also puts pressure on the heart?

  2. Barry Levine March 31, 2014 at 11:58 am - Reply

    If a middle-aged man came into my clinic sweating copiously with his hands over his heart, I’d be well-advised to send him to the ER (unless cardiac issues within the ken of biomedicine had already been ruled out).

  3. Guy Sedan April 2, 2014 at 2:26 am - Reply

    Thanks for sharing!
    Interesting usage of such a small formula for different cases.

    BTW, in case 3: Insanity, the diarrhea is not mentioned in the case description , but just in the discussion section. I wonder how diarrhea can cause heart yang deficiency, since usually if it injures the yang it would injure Spleen Yang or maybe Kidney. I would not expect the Heart to be affected since there is no loss of sweat?

  4. Anne clossen June 13, 2014 at 10:45 am - Reply

    Beautiful article that shows the beauty of simple Shan Han lun formulas. thank you!

  5. […] When there is mistaken sweating and the patient sweats excessively, since the sweat is the fluid of the heart, this will cause Qi deficiency.  These two flavors restore the Yang and supplement the middle.  This alleviates the Yang deficiency.  If there is an extreme case in which there is shaking and a desire to pound, use True Warrior Decoction (zhēn wǔ tāng).  The light and heavy patterns are not the same and the formulas are very different from each other.  This is the essential meaning.   (伤寒论类方·太阳篇) Courtesy of White Pine Healing Arts Blog […]

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