Treating Periodic Issues with Xiao Chai Hu Tang

Eight Cases of Periodically Arising Illnesses

In all of the cases below the patients had symptoms that arise in a very periodic manner.  In some of the cases, the patient was treated improperly because the focus of the treatment was on the symptoms rather than the periodicity of the symptoms.

Case 1: Periodic Serious Stomach and Rib-side Pain

Dr. Liu Xi刘熹

Mr. Yan was age 53 when he came for a consultation on April 4, 1986.  Every day at midnight, the Zi 子 time, he had left rib-side distention and pain that extended to his stomach area.  This gradually got worse so that after an hour it was so painful that it was difficult to bear.  He had to get out of bed and move about and the strength of the pain would gradually decrease.  By Mao 卯time, 5 am, without medication, the pain would spontaneously stop.  The disease had already gone on for more than 8 months.   He had become emaciated.  An ultrasound revealed gallstones. He used anti-inflammatories and anti-spasmodics, but these medications did not have an effect.  He took Chinese herbs to clear heat, disinhibit the gallbladder and discharge stones but the condition got steadily worse.  Every night the pain would come on and afterwards his spirit became weary.  I could diagnose this without knowing any of the other symptoms because the rib-side pain showed it was due to Shao Yang Qi being inhibited in its rising and expressing.  Wood could not express its orderly reaching.  The depressed constraint attacked the stomach.  This is why it happened from the Zi time to the Mao time.  I used Xiao Chai Hu Tang.

Chai Hu 10 gm
Ban Xia (washed 18 gm
Huang Qin 4 gm
Ren Shen 4 gm
Gan Cao 4 gm
Da Zao 12 dates
Sheng Jiang 4 gm

3 packages, decocted in water.

Return visit: April 9, 1986.  After two packages, the left-side rib pain that extended to the stomach stopped.  The patient requested more herbs in a pill form and then was completely cured.  He followed up with Xiao Yao Wan, 1 pill, 3 X/day, to regulate the liver and spleen and harmonize the gallbladder and stomach in order to raise and express the Qi of the Shao Yang. He took this for more than 2 months and there was no recurrence and his body returned to health. 吉林中医药1988: 1: 23

Case 2: 子,午,卯,酉 time stomach pain

Dr. Liu Xi刘熹

Mr. Yang was age 19 an came for his first visit on June 22, 1984.  For the past half month he had woken up at the子,午,卯,酉 times and suffered from stomach pain for 10 minutes each time.  After each episode, the pain would spontaneously stop without treatment.  He had no other abnormal symptoms.  He had an X-ray and gastroscopy but no abnormalities were found.  Because of the periodicity of the symptoms it was diagnosed as Yin and Yang failing to flow into connection with each other.

Chai Hu 10 gm
Ban Xia (washed 18 gm
Huang Qin 4 gm
Ren Shen 4 gm
Gan Cao 4 gm
Da Zao 12 dates
Sheng Jiang 4 gm

He was given 3 packages to be decocted in water.  In July of that same year he came in for a follow-up and reported that the pain had stopped and had not come again. 吉林中医药1988: 1: 23

Case 3: Midnight Toothache

Li Pei-Jun  李佩君

The patient, Xu, was age 50 and had suffered from tooth pain with increasing severity so he came for a consult in the dental department of my hospital on February 9.  He was given Flagyl, long acting sulfanimamide and quick acting medication for tooth pain but there was no effect.  He purchased Happy Tooth pain medication and also used medication that he sprinkled on a cotton ball and kept in his mouth but all of this had no effect.  On February 19 he sought treatment because the pain was so acute.  Only after pressing on the acu-points He Gu, Nei Ting and Xia Guan for a full minute did his pain decrease so that he was able to speak.  He reported that the teeth on the upper and lower left side had severe blunt pain or needle like pain when he chewed.  He did not want hot or cold.  When his breath blew on his teeth, he had a hollow feeling.  His eyes would water and his mouth would fill with saliva.  His hands and feet became slightly cold.  This happened several times a day.  The outward appearance of his teeth was normal.  There were no cavities or overcrowding.  His tongue moss was thin and white and his tongue body was pale red.   His pulse was slightly deep and wiry.  The pattern was without cold, hot or deficiency symptoms or signs.  He was given Zhi Bai Di Huang Tang and he used a powder for tooth pain.  The next day he said that the powder was effective but then, when he used it again, it was not effective.  He also said that for two days, around noon, from 11:00 to 1:00 and then at night around 10:00 or midnight the pain became severe.  Then around 1 am it decreased.  I suddenly thought of Xiao Chai Hu Tang because it can harmonize Yin and Yang.  If the illness arises in a regular, periodic pattern, this formula can be used.  So, I gave it to him:

Chai Hu 15 gm
Fa Xia 12 gm
Huang Qin 12 gm
Sha Shen 4 gm
Zhi Cao 10 gm
Da Zao 20 gm
Sheng Jiang 3 big slices

I advised him to boil the herbs twice and mix the two liquids.  This he could then divide into an afternoon dose and a before bed dose.  If he woke with pain in the night, he could take 1 analgesic pill.

On February 18 he came back in the afternoon.  After taking the herbs, the pain greatly decreased.  He had taken the analgesic only once.  Now, every hour he would have pain one time that lasted for 2 minutes.  The pain was less.  I could see that giving the Xiao Chai Hu Tang had been effective.  I gave him two more packages.  After one, the pain completely stopped.  He was afraid it would come back so I gave him 2 packages and up to now, there was no relapse. 湖北中医杂志1992; 4: 66

Case 4: Periodic Gasping and Agitation

Dr. Liu Xi  刘熹

Ms. Li was age 30.  She came for a consultation on September 15, 1986.  For the recent for days, in the middle of every night from 子 (11 pm to 1 am)  time to 卯 time (5-7 am) she would suffer from gasping and heart vexation.  She was unable to lay down and had to get up and lean on something.  She took dethamexasone and aminophylline but these were not effective.  After 7 am the agitation and gasping spontaneously calmed but in the aftermath she had a dry mouth, a bitter taste in her mouth and her stomach made noises.  Her tongue moss was thin white and slightly yellow.  Her pulse was thin, wiry and rapid.  She received and electrocardiogram and chest X-ray but these were normal.  This seemed like asthma but she was treated with asthma medication and this was also ineffective.  The differentiation was based on the periodicity within the 12 two-hour periods of the day.  The illness arose between 子and 卯 times which is the time the Shao Yang rises and expresses.  The illness is one of inhibited Shao Yang.

Chai Hu 10 gm
Ban Xia (washed) 18 gm
Huang Qin 4 gm
Gan Cao 4 gm
Da Zao 12 dates
Sheng Jiang 4 gm

On September 19, after three packages of herbs, the 子to 卯 gasping and agitation had disappeared.  The dry mouth and bitter taste was also gone.  The noisy stomach had decreased.  She only felt weakness of her limbs.  I gave her Bu Zhong Yi Qi Wan, one pill to be taken 3 X/day.   After one weak, the noisy stomach and weakness was also gone and the illness was cured. 吉林中医药1988; 1: 23

Case 5: Periodic Asthma (Allergic Type Asthma)

Dr. Lu Guo-Sen  路国森

Mr. Li was age 30.  He came for his first visit October 23, 1990.  Three months previously, for no apparent cause, he began to have urgent panting and anxiety.  This became worse around midnight.  He went to one hospital after another for treatment using many types of antibiotic and hormones as well as Chinese herbs.  These were all without effect.  He finally went to the allergy department of a provincial hospital and it was discovered that he was allergic to many types of allergens.  He was treated with desensitizing injections for 20 days but the effect was very slight.  Then he came to my hospital for treatment.  The patient was of a fat body type with slight panting.  There were water sounds in his throat, his tongue was pale and fat and the tongue moss was thin white and sticky.  His pulse was deep and thin.  I began with a formula for which the fundamental principles were to warm the lungs, transform phlegm, stop cough and calm panting.  There was no effect after 10 packages.  I suddenly realized that I had overlooked the master’s Xiao Chai Hu Tang jia Wu Wei Zi. For panting.  I gave him this with 12 gm of Wu Wei Zi.  After three packages, the illness improved and so I gave him seven more packages at which point there was a complete cure.  After half a year, at a return visit, there had been no reccurance. 四川中医1992: 3: 17

Case 6: Midnight nausea

Dr. Yuan Xing-shi   袁兴石

Ms. Xi was age 54.  She had suffered from midnight nausea for more than a month.  Because she had suffered from lymph gland tuberculosis, she had been treated with the  method of using toxin to treat toxin.  Bitter cold herbs such as snake and bat were used.  This had changed the disease significantly so that her blood sedimentation rate became normal.  However, every night during the Chou 丑period (1-3 am)she became nauseous.  At the Mao 卯 time (5-7)  it would stop.  The previous doctor had attacked excessively and damaged her stomach Qi.  She was given Si Jun Zi, Liu Jun Zi type formulas but these were not effective.  She was also given herbs to downbear reversal like Huang Lian, Shi Di and Pi Ba Ye which also did not change her circumstances. I could see that this was caused by excessive attacking.  Although the stomach Qi was not actually damaged, the rising and emitting Qi was.  This was wood damaging the Qi so that the generating and expressing was weak.  Midnight is when Yin accumulates and it is difficult to prevent Yin from overcoming earth so the stomach Qi reverses and nausea is seen.  The 卯 time is when the rising sun comes to help the generation and expression of the Qi so the flowing and discharging can then have authority.  The earth Qi is spontaneously harmonized and this is why the nausea stops.  In this way, Xiao Chai Hu Tang harmonizes and synchronizes the wood Qi so that the rising and expressing is uninhibited.

Chun Chai Hu 10 gm
Zhi Ban Xia 10 gm
Sheng Jiang 4 slices
Gan Cao 5 gm
Da Zao 7 dates
Dang Shen 10 gm

This was cooked in 1000 ml of water cooked down to a thick 400 ml.  Then boild again in 600 ml down to a thick 400 ml..  Cook this 800 ml. down to 400 ml. and take this warm in three doses.

She took 2 doses and the nausea was gone.  After two more doses her spirit returned and the herbs were stopped. 黑龙江中医药1990: 4: 24

Case 7: Before midnight Chills – After midnight Fever

Dr. Liu Xi  刘熹

Ms. Sun was age 31 and came for her first consultation on April 10, 1994. Every evening, before midnight, she would develop an aversion to cold.  She would cover up but could not get warm.  After midnight she became hot and could not be under covers.  During the day she did not suffer like this.  She was checked with modern medicine but there was no abnormality.  The periodic nature of this differentiated the syndrome.  Yin and Yang were not flowing in a mutual way.

Chai Hu 10 gm
Ban Xia (washed) 18 gm
Huang Qin 4 gm
Gan Cao 4 gm
Da Zao 12 dates
Sheng Jiang 4 gm

April 14 she came for a return visit.  After 3 doses, she felt slight dizziness but the other symptoms were gone.  I then switched to Qi Ju Di Huang Wan, 1 pill 3X/day.  She took this for 1 month.  Several years later, on April 16, 1987, she came back because she had stomach pain.  She reported that the original illness had not returned. 吉林中医药1988;(1) : 23

Case 8: Spring Fever

Cui Jin-min  崔健民

Ms. Wang was age 31 and came for a consultation on February 1, 1982.  She had gotten a cold after giving birth 5 years previously.  She had a fever with migrating joint pain.  She had gone to the hospital and was diagnosed with acute “wind, damp heat.” She was given anti-wind damp treatment and the symptoms dispersed.  Since then, every spring she developed a fever for 2-3 months.  Her temperature would go up to 39 ° C (102.2°F).  20 days previously, after receiving a cold, her fever returned.  She again went to the hospital but the treatment was ineffective so she became an inpatient.  The presenting pattern was fever and aversion to cold.  She had a bitter taste in her mouth and a dry throat.  She also had a poor appetite, nausea, a desire to vomit, dizziness, dizzy vision, and short, red urination.  Her body temperature was 39 ° C (102.2°F). Her tongue was tending to red with thin yellow moss and scanty moisture.  Her pulse was rapid.  After entering the hospital, she was given the original formula and Gan Lu Xiao Du Yin for two weeks but the symptoms did not diminish. Her temperature fluctuated between 37.4 to 38.3° C (99.3 to 100.9 ° F).  A fresh differentiation of the pattern was done.  Although there were symptoms of an evil hidden in the membrane source such as fever, aversion to cold and rapid pulse, however, the fever had already lasted for several days and the aversion to could should have retreated and changed to heat without chills.  Also, although the pulse is rapid, the tongue body was not crimson red, the moss was not turbid and thick, or white like accumulated powder.  This should not have been treated with the original formula.  Although the patient had a fever, vomiting, dark urine and heaviness of the low back and knees, which are signs of damp heat accumulation, there is no chest distention or abdominal fullness and the tongue is without turbid thick or pale white moss.  Therefore, this was not a Gan Lu Xiao Du Dan pattern.  The pattern included the symptoms of bitter mouth, dry throat, dizziness, despondency and poor appetite.  These are Shao Yang symptoms.  I changed the method to resolve and harmonize the Shao Yang pattern with Xiao Chai Hu Tang.  This returns the correct and guides out the evil.

Chai Hu 15 gm
Ban Xia 10 gm
Huang Qin 12 gm
Gan Cao 6 gm
Sheng Jiang 5 gm

After 2 packages, her body had a light sweat.  Her body temperature normalized.  Because the formula was effective, I gave her 2 more packages.  There was no more fever and the pattern was resolved.  There was still a dry mouth and constipation.  I then gave him Sha Shen Mai Men Dong Tang to boost the stomach and generate fluids.  On February 25th, 1982 he was cured and left the hospital.  河北中医1988: 2: 39

Discussion:

The Su Wen: Jin Gui Shen Yan Lun: says “from dawn until mid-day, this is heaven Yang and is Yang within Yang.  From mid-day to dusk this is heaven Yang and is Yin within Yang.  From the close of night to cock’s crow is heavens Yin and this is Yin within Yin.  From cock’s crow to dawn, this is Heaven’s Yin and is Yang within Yin.”  The above illnesses all came out at the 子, 午,卯 or 酉 times.  These are the times that Yin and Yang replace each other.  If they are able to flow into connection in an uninhibited way, the person has no illness.  On the other hand, if this cannot happen, many types of illness can arise.  A particular characteristic of this kind of pathology is that it emerges at particular times.  In case 1, the illness arose at the 子time.  At 丑 time it became particularly intense.  This is the time that the Shao Yang gallbladder’s strength expresses and this causes the liver wood to become stagnant.  In case two the illness arose at 子,午,卯,and 酉 times.  This meant that the Yin and Yang could not flow into mutual relationship and connect.  In case 3, the illness arose at the 子and 午times and the mechanism was the same as case 2.  In case 4 through 7, all of the illnesses arose at the 子 time.  The liver and gallbladder were not able to be responsible for raising and expressing.  This meant that the lung Qi or the stomach Qi could not go down. Case 8 was an illness that arose every spring which is also the time that the liver and gallbladder rise up and express.  This did not happen and the constraint caused a fever.  Xiao Chai Hu Tang is the principle formula for harmonizing and resolving the Shao Yang.  On the one hand it is able to raise and express the liver gallbladder Qi.  On the other hand, it can open through the turning movement of the Shao Yang pivot mechanism to promote the interconnected flow of Yin and Yang.  Therefore, whenever you see of liver gallbladder Qi failing to rise and express or you see that Yin and Yang are unable to flow together and connect AND the symptoms show up in successive and regular periods, this can be treated with Xiao Chai Hu Tang with very good results.

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