Tag Archives: Chinese Medicine

Chinese & East Asian Medicines, Global Asian Medicines

Alternatives to Oriental-ism

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[Although this post was written for practitioners of acupuncture and East Asian medicines working in the United States, I am posting it here in the hopes of inviting historians, anthropologists, and others working on related topics into this active conversation.]

Orientations:

Beginning in the wake of the protests memorializing George Floyd, Breonna Taylor, and too many others in summer 2020, two movements began to address a related issue of racism within our own scholarly and professional field. At the grassroots level, Influential Point launched a petition and campaign requesting that the U.S. acupuncture and oriental medicine (AOM) community remove this racist word from our professional discourse. At the administrative level, Dr. David Lee, the Academic Vice President of Alhambra Medical University in California, initiated a campaign among his peers to “repeal and replace” the word “oriental,” school by school, in school names and degree titles, with the goal of carrying this momentum forward into pressuring ACAOM and NCCAOM to do the same. Collectively, it would seem, the moment has come for making long-overdue, necessary change.

But after determining to not use this word, what other word should we use? And more importantly, how do we make that choice? How might we, the professionals impacted by the name and public face of our craft get a say in making it? If practitioners wish to have a voice in the decision about how we redefine the AOM profession to patients and our broader communities, step one is educating ourselves about the pros and cons of commonly proposed alternative names.

This list of terms, and breakdown of some of their more salient associated issues, is by no means exhaustive. This paper presents a starting point for opening an informed discussion based on something other than personal opinions. It is further my hope that it will help readers cultivate an appreciation for the many different filters through which different people can see the world, let alone a single word. For this reason, each term needs to be looked at from many possible perspectives. One person’s opinion is not going to decide this for us. Nor should it.

I am a clinician, philologically trained translator of classical Chinese, and historian-in-training. This is to say that I have spent countless hours researching and thinking closely about exactly what a word means, or what is the best way to translate X concept into Y language, or for Z type of audience. At the most fundamental level, any alternative would be better than the deeply embarrassing, racist word that we currently use. That said, how we choose our marginally better word matters, too. It is an opportunity not only for learning and self-reflection about the word “oriental” that we seek to replace. It is also an opportunity to recognize some of the many ways in which our field is Orientalist – perpetuating a reified notion of an exotic, but ultimately undifferentiated or falsely uniform, “alternative” or “other-than” medical culture.

Credit: World map in the form of an FFA of the retina. Credit: Jon Brett.

How much do we wish to engage in the work of examining Orientalism within our field – self and public perceptions – along with changing its presently Orientalist name?

To change the broader dynamics (removing Orientalism), rather than only the most visible external manifestation of those dynamics (removing only the word oriental), are two separate things. In my opinion, we should not neglect the former opportunity in our rush to correct the latter problem. The work of examining the Orientalism that permeates our field is important work because it can help us to clearly define and create a professional community. At present, the AOM field in the United States, with its crazy-quilt patchwork of organizations, state practice scopes, regulatory agendas, and heterogeneity of training, entirely lacks professional cohesion. Such fragmentation prevents us from standing united against threats to our scope of practice, such as dry-needling, let alone advocating more strongly for our potential role as first point of contact providers of healthcare in a country desperately in need of primary care providers.

How might we use the process of reflecting on replacement terms as a kind of professional praxis, forcing us to confront the ways in which words matter because words connote as well as denote, delimit, and define?

The idea that the name or definition of something matters – that a name should accord well with the thing it names – is not a new or radical one. Rather, we know that Confucius himself advocated for the “Rectification of Names,” warning against the confusion and social unmooring created by the drift between signs (names) and the things they signify. As we come together as a collective in exploring the full context of each possible term, we are also forced to open a conversation about what values undergird our selection strategy. Naming ourselves presents an opportunity to better define the dynamics of our profession as a whole, our individual positioning within these dynamics, and a collective re-envisioning of how we wish to define ourselves and our practice.

Click here to continue onto a term-by-term discussion of replacement words (document linked to preserve footnotes and formatting of the reference list included as a bibliography):

“Alternatives to Oriental-ism”Download

Chinese & East Asian Medicines

Why Study Chinese Medicine?

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A guest post by Élisabeth Rochat de la Vallée (www.elisabeth-rochat.com)

As a scholar more than a practitioner, my knowledge of Chinese medicine is based more on classical texts than on the practice itself, even if I see some patients. But I also meet a great number of practitioners, in various countries, and work with several of them. And I have been a patient of Chinese medicine for more than half a century, during which time I have encountered many people, of diverse origins, who are treated with Chinese medicine.

The Chinese medicine I know and praise, is the “classical Chinese medicine,” a rather different approach from TCM or bio medicine.

Indeed, studying from another viewpoint is always interesting: it questions our convictions, what we too often take as “given,” “natural,” “scientific,” “unquestionable,” “obvious,” or even “the only possibility.” Another way to approach human beings and their health leads us to ask ourselves: How do we know what we know? Where does our knowledge comes from?

This is not about contradicting Western medicine, nor criticizing it; it is rather about extending medicine to areas and in ways which may not have been thought of previously or not given enough consideration. Studying a medicine which for some 2000 years has quite successfully treated billions of people is a good opportunity to deepen and expand Western medicine.

It allows us to change our view on the importance of certain aspects, which are considered as particularly relevant in Chinese medicine:

1) Another view on health and disease.

In Western medicine, a disease is recognizable with a set of symptoms, identified with a name, and can be treated mainly after this official identification, with the appropriate protocol. In the classical Chinese approach, the disease is rather a disorder, an imbalance (in yin yang), with no clear limits between healthy and unhealthy condition other than the seriousness in the lack of equilibrium. It also shows if a person is capable of re-establishing their equilibrium by themselves or if the help of another person is needed. According to the classical Chinese thought, there is no real dichotomy, not even in yin yang.

Health and illness are not considered as two states, with a clear-cut border; one can shift from one condition to the other but – before an illness can be identified with the Western approach – the signs are already there, ready to be read by the penetrating (shrewd) practitioner or understood by the person experiencing the disorder. One can address the situation then, either by themselves or with the help of a therapist. 

And this is strictly connected to the following points:

2) Prevention

Prevention is present at all levels and in every moment. Not only to avoid falling ill––which depends on the personal conduct of life––but, once sick, also to prevent further damage; this belongs to the practitioner’s skill.

3) Nurturing life

The art of nurturing life (yang sheng 養生) is one of the foundations of Chinese medicine, which definitively opts for the care and taste of life rather than focusing on fighting death. Nurturing life is the best possible prevention, especially when it includes an inner work on one’s emotions and spirit.

This is deeply bound to a harmonious relationship with nature. The pattern for the organization of all interactions of the yin yang qi is the natural order. There is a profound analogy between the process of life in natural phenomena and in human beings; therefore, to know, understand and respect the natural order of life is to be aware of our true nature, original organization of qi and also the model for what we ought to be.

Nobody can be really healthy if they are at odds with the environment and their surroundings. It is the function of medicine to help people recognize a toxic surrounding as well as adjust to a viable environment.

4)  Holistic approach

As is widely known, Chinese medicine considers all the aspects of a person: the physical, psychological, mental health are seen as one, responding to the same balance or unbalance in the interaction of Qi.

5) Humaneness

Any therapeutic act is about two human beings interacting with each other. The bond between patient and practitioner takes part – one way or another – in the accuracy of the diagnosis and the effect of the treatment.

To be true therapists, practitioners must constantly work on themselves, to get closer to what it means for them to be a human being, to develop their ability to receive and accept the sick person with all their disorders, without becoming themselves destabilised; thus remaining able to treat them as human beings.

6) Emotions

A human being cannot be considered, treated and cured if the healing transformation does not reach the core of the person, what is usually called the “spirit” (shen 神).

Consequently, emotions are fully integrated in any pathological situation. Emotions, whether at the origin of the disorder, or a consequence of it, or just a customary state of mind (the psychological background of a person), alter the movements of qi. Chinese medicine regulates the movement of qi inside a human being; therefore emotions are part of the diagnosis. A more balanced psychology is normally one of the results of a good treatment. It is radically different from the psychosomatic approach of Western medicine and emphasizes the unity of the human being.

7) Guidance

More than giving simple advice, the practitioner of Chinese medicine educates the patients about what caused the disease and what will restore the balance, so that they may become co-partners in the treatment and even change the conduct of their lives (for instance, through diet or emotion).

8) Diagnosis and treatment

Both diagnosis and treatment are individualised to suit each particular patient; both are an evolving process.

9) Multiple Tools

Chinese medicine combines several therapeutic “tools,” such as pharmacopeia, acupuncture and moxibustion, massages, qigong and Taiji, diet… 

For these aspects of medicine, the Chinese approach is especially rich and interesting. A dialogue between Western and Chinese medicines is therefore highly desirable and advantageous. But a dialogue can only exist when both medicines are fully recognized as such.

Several prerequisites:

  • A text corpus, that contains the knowledge, expresses theories and explains patterns to understand how to proceed to make a diagnosis;
  • Operating procedures and techniques to treat according to the diagnosis;
  • Research based on the corpus and methods of treatment. 

What is often called research on Chinese medicine is in fact research of Western medicine on Chinese medicine. That can be interesting and even fruitful, but it is not real research on Chinese medicine. To scrutinise one aspect of Chinese medicine, with the tools and postulates of Western science cannot qualify––or disqualify––the Chinese approach of health and treatments as true medicine. One medicine cannot receive its value from another but must draw it from itself. 

To continue to study Chinese medicine not only allows the practice of its techniques, knowing how to make a diagnosis and understanding the subsequent treatment, but it also keeps this medicine alive by innovations and renovations that do not alter its essential attributes. 

In summary, here are some reasons to study Chinese medicine:

  • It is an efficient method of treatment, with considerably fewer side effects than Western medicine.
  • It approaches health and disease from a different angle. This is always necessary but even more mandatory in a field where two (or several) human beings interact. Medicine is a science but it must also remain an art.
  • When correctly understood, it offers perspectives and reflections that enrich the whole approach of medicine.

Conclusion

It is vital that classical Chinese medicine should be kept alive and therefore studied seriously.

The study of classical Chinese medicine empowers its own evolution and transformation, but only from its own roots, not as a graft making it merely a scion of Western medicine. 

It allows Chinese medicine to be and remain a true medicine, able to converse with Western medicine (or others).

Not only does it preserve the knowledge, tradition and reflection, but it also contributes to the expansion of human medicine for the future.

If we don’t study (and practice) classical Chinese medicine, it will disappear definitively. It would be a shame not to use its richness to continue to cure people and also to develop the best possible medicine for human beings.

Chinese & East Asian Medicines

Classical Formula Powders: Dosage and Application

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Treatment periods are rarely discussed in classical Chinese medical literature.  While classics like the Shanghan Lun meticulously describe formula preparation and administration over the course of a day, the number of days a formula should be used for is never plainly described.  Due to this ambiguity, many physicians apply a saying that originates in the Huangdi Neijing to classical formula use, “after one dose one knows, after two doses there is resolution.”[i]

However, by examining powder and pill formula dosage, we can gain more specific insight into classical treatment timeframes.  Whereas with liquid decoctions the written herb weights compose a single day’s worth of formula, with powders the daily dose is fixed at a few grams and the herb weights define a formula’s projected treatment period.

This article is an exploration into the treatment periods and patterns for four foundational classical formula powders, accurate weights and measures based on Han period archeological evidence, and the drinks traditionally used to aid powder consumption. The goal is to provide insight into how and why classical clinicians used medical powders.

Classical Weights

A liang (兩) is the core unit of weight used in classical Han dynasty formulas.  Though there has been some debate as to the exact weight of a classical liang throughout Chinese history, and a great deal of inaccuracy in modern texts, recent archeological findings indicate that a liang weighed between 13.8 and 15.6 grams.  Contemporary doctors in mainland China generally simplify a classical liang’s weight to 15g.  A classical Liang can be subdivided into 24 zhu (銖) or four fen (分).  16 Liang combine to make one jin (斤)[iii].  The table below describes the weight of each measurement unit:

Table 1.  Han Period Weight Units

Measure Unit Approximate Weight Simplified Weight
Jin 斤 220.8g to 249.6g 240g
Liang 兩 13.8g to 15.6g 15g
Fen 分 3.45g to 3.9g 3.75g
Zhu 銖 0.575g to 0.65g 0.625g

Single doses of powdered formulas were most commonly dosed by heaping powder onto a fangcunbi (方寸匕, Square Inch Spoon) or a qianbi (錢匕, Coin Spoon).  The cun (寸), a classical unit of measurement, is 2.32cm long.[iv]  Therefore, a square cun measures 5.4 cm2 in area.  The Zhongyao Da Cidian (中藥大辭典, Great Encyclopedia of Chinese Medicine) states that a fangcunbi weighs 2g for metal and stone powders and 1g for plant powders.  However, the actual tested weights are somewhat heavier, causing researcher Li Yuhang (李宇航) to conclude that plant powders should be dosed at 1-2g and mineral powders at 3-4g[v].  A portion of his findings is translated on the following table:

Table 2. Actual Fangcunbi Powder Weights

Formula Actual Weight
Wu Ling San 五苓散 1.59g
Muli Zexie San 牡蠣澤瀉散 1.27g
Banxia San 半夏散 1.46g
Sini San using Baishao 四逆散（白芍） 1.66g
Sini San using Chishao 四逆散（赤芍） 1.68g
Chishizhi (in Taohua Tang) 赤石脂（桃花湯） 3.31g
Wenge San 文蛤散 3.33g

The qianbi dose was measured using the Han Dynasty wuzhuqian (五銖錢, five zhu coin).  The coin’s radius measures 2.5cm and it has an approximately 1 cm2 square hole in the center.  Assuming a finger is used to plug the square hole in the center of the coin when used as a scoop, the area measures 4.9 cm2, giving it roughly 10% less area than the fangcunbi.

For the purposes of this article, I simplified unknown formula powder weights to 1.66g per dose for a fangcunbi and 1.5g for a qianbi.  Given that most formulas suggest three daily doses this works out to 5g total per day for the fangcunbi and 4.5g per day for the qianbi.

Intake Methods

Classically, powders are stirred into a warm liquid and drank.  The choice of liquid gives additional insight into the formula’s purpose and should be considered an essential part of powdered formula construction.  The main liquids used for powder administration in the Shanghan Lun and Jingui Yaolue are baiyin (白飲, the water from boiled rice[vi], also called miyin 米飲), maizhou (麥粥, wheat porridge), jiangshui (漿水, fermented millet water), jiu (酒 rice wine, likely analogous to modern huangjiu 黃酒) and water.  In formulas that don’t specifically mention what drink to use, Ge Hong and Sun Simiao suggest that any of the above can be used[vii], presumably leaving the choice of liquid assistant to the practitioner.

Table 3. Liquid Assistants for Powder Administration

Liquid Function Formulas
Baiyin (白飲, boiled rice water) Sweet, balanced.  Strengthens earth harmonizes the middle qi, separates clear from turbid, generates fluids;stops thirst; promotes urination. Sini San, Wu Ling San, San Wu Xiao Bai San, Muli Zexie San.Rice is also used in Baihu Tang, Taohua Tang, and Zhuye Shigao Tang.
Maizhou (麥粥, wheat porridge) Sweet, slightly bitter, cool.  Eliminates heat, stops thirst and dry throat, promotes urination, nourishes liver qi. Zhishi Shaoyao San, Baizhu San (modification).Wheat is also used in Gan Mai Dazao Tang.
Jiangshui (漿水, fermented millet water) Sweet, sour, cool.  Regulates the stomach, dissolves food obstructions, stops thirst. Chixiaodou Danggui San, Shuqi San, Banxia Ganjiang San, Baizhu San (modification).Jiangshui is also used in Zhishi Zhizichi Tang.
Jiu (酒, rice wine) Bitter, acrid, warm.  Invigorates the channels, unblocks obstruction syndrome, warms the blood, scatters blood stasis. Danggui Shaoyao San, Danggui San, Baizhu San, Tianxiong San, Zishi Han Shi San, Tuguagen San.

A Selection of Powdered Formulas

According to Dr. Li Yuming,[viii] Zhang Zhongjing uses internal powdered formulas primarily to treat diseases of the lower jiao, especially recalcitrant conditions that involve blood deficiency and or fluid accumulation.  Below I have selected four representative formulas that each demonstrate a specific lower jiao pathology and can be considered foundational building blocks for individualized powdered formula construction.

Sini San 四逆散, Frigid Extremities Powder

SiniSan SHL Text Weight Gram Weight
Zhi Gancao 炙甘草 10 Fen分 37.5g
Zhishi 枳實 10 Fen分 37.5g
Chaihu 柴胡 10 Fen分 37.5g
Shaoyao 芍藥 10 Fen分 37.5g
Total Formula Weight 40 Fen分 150g (138g-156g)
Single Dose Weight 1 Fangcunbi 1.66g-1.68g
Daily Dose Weight 3 Fangcunbi 5g (4.98g-5.04g)
Treatment Period 30 Days (27.3-31.3days)
Administered With Baiyin白飲 (Boiled Rice Water)


Sini San treats Liver qi stagnation that manifests with cold hands and feet, possibly with cough, palpitations, inhibited urination, abdominal pain, or diarrhea with tenesmus, emotional distress, depression, chest and rib distention or pain, or breast distention pain, with a white tongue coat, and a thin wiry pulse.[ix]

According to the Shennong Bencao Jing (《神農本草經》The Divine Husbandman’s Classic of Materia Medica), Chaihu’s bitter, balanced nature has the ability to eliminate knotted qi and food accumulations from the GI tract.[x] Zhishi’s bitter, cool, slightly acrid and sour nature assists Chaihu by breaking up stagnant qi, reducing distention and pain from accumulation and directing the qi of the GI tract downwards.  Shaoyao’s bitter, sour and slightly cool nature nourishes the liver, preserves yin, and according to the Mingyi Bielu (《名醫別錄》Miscellaneous Records of Famous Physicians) eliminates blood stasis, expels water, and benefits the bladder and intestines.[xi] Zhi Gancao’s sweet, warm nature nourishes the middle qi.  Rice water’s bland, sweet and balanced nature is used to administer the formula to build thin fluids, regulate fluid metabolism, and benefit the spleen and stomach.

The Sini San pattern shows signs of dryness, blood deficiency, qi knotting, and food accumulations in the GI tract, and resultant lower jiao yang qi depression.  The formula is overall cool and bitter, with hints of acrid, sour, and sweet and should be considered a light purgative with elements of qi and blood building.  Sini San’s light dose and ability to enter the lower jiao is aimed at slowly purging the intestines without stressing the body’s upright qi.  Due to the purgative nature, caution should be used when exceeding the projected treatment period of 30 days.

Wu Ling San 五苓散, Five Poria Powder

Wu Ling San SHL Text Weight JGYL Text Weight Gram Weight
Zexie 澤瀉 1 Liang 兩 6 Zhu 銖 1Liang兩1Fen分 18.75g
Zhuling 豬苓 18 Zhu銖 3Fen分 11.25g
Fuling 茯苓 18 Zhu銖 3Fen分 11.25g
Baizhu 白術 18 Zhu銖 3Fen分 11.25g
Guizhi 桂枝 ½ Liang兩 2Fen分 7.5g
Total Formula Weight 4 Liang 60g (55.2g-62.4g)
Single Dose Weight 1 Fangcunbi 1.59g
Daily Dose Weight 3 Fangcunbi 4.77g
Treatment Period 12 days (11.6 – 13.1 days)
Administered With Baiyin白飲 (Boiled Rice Water)


Wu Ling San treats a number of symptom patterns, all of which revolve around dampness accumulation in the lower jiao resulting in some degree of yang qi depression and heat.  The primary acute pattern manifests with headache, low fever, irritability, aversion to cold, dry mouth and thirst, possibly with vomiting upon drinking, and urinary obstruction.  Other variants include diabetic thirst and edema patterns.

Zexie, Zhuling, and Fuling’s overall bland and cool natures act to leach out dampness, promote urination, and gently clear lower jiao heat.  Baizhu’s bitter warm nature strengthens the spleen by drying dampness and dissolving food and phlegm liquids[xii]. Guizhi’s acrid warm nature disperses yang and promotes the movement and ascent of yang out of the lower jiao.  Rice water’s bland, sweet and balanced nature is used to administer the formula to build thin fluids, regulate fluid metabolism, and benefit the spleen and stomach.

When taking the Wu Ling San the patient is advised to drink plenty of warm water and that the condition will resolve through gentle sweating which indicates that upright qi has regained control of the surface.  Presumably, the 12 day dose period is the expected term of resolution for the acute symptom pattern.

Danggui Shaoyao San 當歸芍藥散, Angelicae and Peony Powder

Danggui Shaoyao San JGYL Text Weight Gram Weight
Danggui 3 Liang 45g
Shaoyao 1 Jin 240g
Fuling 4 Liang 60g
Baizhu 4 Liang 60g
Zexie ½ Jin 120g
Chuanxiong ½ Jin (3 Liang*) 120g (45g*)
Total Formula Weight 43 Liang (38 Liang*) 645g (593.4g – 670.8g)

570g* (524.4g – 592.8g)
Single Dose Weight 1 Fangcunbi ~1.66g
Daily Dose Weight 3 Fangcunbi ~5g
Treatment Period 129days (118.7 days – 134.2 days)

114 days* (104.9 days – 118.6 days)
Administered With Jiu 酒 (Rice Wine)

*One Jingui Yaolue version states a 3 liang dose for Chuanxiong, all other versions state ½ jin.

Danggui Shaoyao San primarily treats blood deficiency with fluid accumulation in the lower jiao resulting in abdominal pain or cramping.  Though the pattern is more common among women, the formula can also be used for men.  Other possible symptoms include rib distention or pain, lack of appetite, dizziness, emotional constraint, and weakness of the limbs with a pale tongue, white tongue coating, and a deep, wiry pulse.[xiii]

The formula is composed of two main elements: Danggui, Chuanxiong and Shaoyao to nourish the blood and gently disperse blood stasis; and Fuling, Zexie, and Baizhu to regulate water metabolism, dry dampness, promote urination and fortify the spleen.  Together the two groups somewhat resemble a combination of Wu Ling San and Sini San but with a greater focus on blood level movement and nourishment.  To further promote blood movement, rice wine’s acrid, bitter and warm nature is used to administer the formula.  The Mingyi Bielu notes that Rice Wine has the specific ability to circulate a medicine’s strength[xiv] by unblocking the channels and invigorating the vessels.

While the formula is best known for treating acute stomach cramping during pregnancy, modern text books urge cautious use during pregnancy, “specifically because too high a dosage of Chuanxiong Rhizoma can affect the fetus, particularly in mothers who have deficient and weak Kidney qi”.[xv] The question of whether Danggui Shaoyao San’s daily dose of Chuanxiong at 0.93g is considered high must be left to the practitioner and further research. But clearly, it was classically thought of as a safe formula as it was dosed for around four months of use during pregnancy and is suited for long term blood and fluid regulation in the lower jiao.

Chixiaodou Danggui San 赤小豆當歸散, Adzuki and Angelicae Powder

Chixiaodou Danggui San JGYL Text Weight Gram Weight
Chixiaodou (adzuki bean, sprouted and dried) 3 Sheng* 510g
Danggui 10 Liang** 150g
Total Formula Weight 660g
Single Dose Weight 1 Fangcunbi ~1.66g
Daily Dose Weight 3 Fangcunbi ~5g
Treatment Period 132 days
Administered With Jiangshui 漿水 (Fermented Millet Water)

* A Sheng is a unit of volume that measures approximately 200ml.

** Some Jinggui Yaolue versions write 3 liang, others write 10 liang.

Chixiaodou Danggui San treats damp heat in the lower jiao which can lead to hemorrhoids, anal prolapse, excessive menstrual bleeding, ulceration, intestinal abscess, red eyes, rashes, irritability and other symptoms associated with damp head leading to blood toxicity presenting with a red tongue, yellow, greasy tongue coat, and rapid pulse.

Chixiaodou has a sweet/bland, slightly sour, and balanced nature, promotes urination, drains damp heat, stops bleeding and, as noted in the Shennong Bencao Jing, has the ability to expel the blood and pus from carbuncles and welling-abscess.[xvi]  Danggui’s sweet, acrid and warm nature nourishes the blood, disperses stasis, and promotes the healing of sores.  Fermented millet water is used to administer the powder and supports Chixiaodou by dissolving food accumulation and regulating the stomach with its sweet, sour, and cool nature.

Like Danggui Shaoyao San, Chixiaodou Danggui San has an intended dose period of around four months and aims to nourish blood in the lower jiao while simultaneously eliminating fluid accumulation.  Chixiaodou, a common food in China, is a particularly safe medicine for the slow, long term elimination of damp heat and blood toxicity.

Conclusion

From the above formulas, we can clearly see that Zhang Zhongjing favored using powders for the long-term treatment of recalcitrant lower jiao and gastrointestinal diseases that present with mixed excess and deficiency patterns.  According to the Jingfang Xiaopin （《經方小品》A Small Collection of Classical Formulas), powders and pills were used after a decoction formula had eliminated the primary pathogenic factors, presumably as a long term regulatory treatment, which could then be periodically assisted with decoction formulas.[xvii]  Sun Simiao believed powders were appropriate for slowly driving out pathogens, particularly wind and damp obstructions with symptoms that come and go without a static location,[xviii] as is characteristic with many gastrointestinal disorders.

Unfortunately, formula powders are rarely used in the modern clinic.  When used, they are often decocted as liquid formulas with little concern for difference in administration form or dose.  I hypothesize that powdered formulas may offer a better, cheaper, safer, and more convenient treatment method for the long-term resolution of many gastrointestinal and other lower jiao associated disorders, especially when used in conjunction with periodic decoction formula treatments.  As renewed interest in classical formula theory and application continues to grow in China and around the world I hope that modern practitioners will also renew research into formula powders for modern clinical use.

Endnotes

[i]《黄帝内经素问·腹中论篇第四十》云，“一剂知二剂已”。

[ii] 王付.经方用量秘旨. 人民军医出版社, 2015.62-64，98-100

[iii]《汉书·律历志·权衡》云，“权者，铢、两、斤、钧、石也……一龠容千二百黍，重十二铢，两之为两，二十四铢为两，十六两为斤”。

[iv] 李宇航.《伤寒论》方药剂量与配伍比例研究. 人民卫生出版社, 2015. 64

[v] 李宇航.《伤寒论》方药剂量与配伍比例研究. 人民卫生出版社, 2015. 68

[vi] 朱西杰、晋学仁、樊恒茂. “《伤寒论》“白饮”新解”，来源：《国医论坛》2000年第02期

[vii]《千金要方·论服饵第八》云，“凡服丸散，不云酒水饮者，本方如此，是可通用也”。《肘後備急方·華陽隱居《補闕肘後百一方》序》云，“凡下丸散，不雲酒水飲者，本方如此，而別說用酒水飲，則是可通用三物服也”。

[viii] 李宇铭.伤寒治内方证原意. 中国中医药出版社, 2014.

[ix] 王付《历代经方方论》.人民军医出版社, 2013. 515

[x]《神农本草经》云，“柴胡味苦平，主心腹，去肠胃中结气，饮食积聚，寒热邪气，推陈致新”。

[xi]《名医别录》云，“芍药味酸微寒有小毒，主通顺血脉，缓中，散恶血，逐贼血，去水气，利膀胱、大小肠，消痈肿，时行寒热，中恶，腹痛，腰痛”。

[xii]《神农本草经》云，“消食”。《名医别录》云，“消痰水……消谷嗜食”。

[xiii] 王付《历代经方方论》.人民军医出版社, 2013. 574

[xiv]《名医别录》云，“酒，味苦甘辛大热有毒，主行药势，杀邪恶气”。

[xv] Bensky Chinese Herbal Medicine – Formulas & Strategies, 2nd Ed. page 588

[xvi] 《神农本草经》云， “ 味甘、酸，平。主下水肿，排痈肿脓血。生平泽”。

[xvii]《小品方·述看方及逆合备急药决》云，“病源宜服利药治取除者服汤之后宜将丸散也时时服汤助丸散耳”

[xviii]《千金要方·论诊候第四》云，“散能逐邪风气湿痹表里移走居无常处者散当平之”

Chinese & East Asian Medicines

HOLISM, CHINESE MEDICINE AND SYSTEMS IDEOLOGIES: REWRITING THE PAST TO IMAGINE THE FUTURE

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This chapter explores the articulations that have emerged over the last half- century between various types of holism, Chinese medicine and systems biol- ogy. Given the discipline’s historical attachments to a definition of ‘medicine’ that rather narrowly refers to biomedicine as developed in Europe and the US from the eighteenth century onwards, the medical humanities are not the most obvious starting point for such an inquiry. At the same time, they do offer one advantage over neighbouring disciplines like medical history, anthropology or science and technol- ogy studies for someone like myself, a clinician as well as a historian and anthropologist: their strong commitment to the objective of facilitating better medical practice. This promise furthermore links to the wider project of critique, which, in Max Horkheimer’s definition of the term, aims at change and emancipation in order ‘to liberate human beings from the circumstances that enslave them’. If we take the critical medical humanities as explicitly affirming this shared objective and respon- sibility, extending the discipline’s traditional gaze is not a burden but becomes, in fact, an obligation.

With that in mind, this chapter seeks to accomplish three inter-related goals. It is first an inquiry into the historical processes whereby Chinese medicine, holism and systems biology have come to be entangled with each other in the present. The term holism is not originally Chinese and was only applied to Chinese medicine from the 1950s onward. Whether or not systems biology, the computational and mathematical modelling of complex biological systems, is holistic, as some of its proponents claim, also remains a contested issue. Holism clearly means different things to different people. Yet, in the early twenty-first century, those engaged in constructing an interface between Chinese medicine and systems biology widely agree that their project not only honours the holistic foundations of their respective traditions, but also is, in fact, driven by this shared commitment to holism and the development of a scientifically based personalised medicine. This raises the question of how this consensus was achieved and what it denotes.

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Chinese & East Asian Medicines

Memorizing Formulae

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Memorizing formulae is something no herbalist can avoid. One sometimes hears people say that memorization is unnecessary, you can just look up a formula in a book when you need it. This is somewhat like saying that memorizing vocabulary isn’t necessary when learning a foreign language, you can just look it up in a dictionary when you need it. An effective herbalist must speak the language of herbs fluently and be able to construct new sentences (formulae) on the fly to adapt to changing circumstances.

In my own studies recently I’ve been reviewing formulae that I use so infrequently it’s hard to remember their ingredients. I thought it might be interesting to share some of the methods I’ve used to memorize formulas. None of these are new by any means, but I’ve found them very helpful over the years.

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This one, Xianfang huoming yin (仙方活命飲, Immortal-Formula Life-Saving Beverage), is the representative formula for the dispersing method (xiaofa 消法) used in treating the early stages of welling abscesses (yong 癰). Historically it’s been highly respected, but I haven’t had call to use it myself (though I do get to use Wuwei xiaodu yin 五味消毒飲, Five Flavor Toxin-Dispersing Beverage, on occasion).

The notes hand-written in the text is my mnemonic. This is one of my favorite ways to remember longer formulas that don’t break down into neatly analyzable divisions. I make a rhymed verse from the names of the herbs. I thought I’d share this one for fun.

In pinyin it goes (I’ve made one change since this photo was taken):

Yin, zao, hua, fang, zhi, gan, bei./Chen, mo, ru, jia, chi, guiwei.

Which means:

Jinyinhua, zaojiaoci, tianhuafen, fangfeng, baizhi, gancao, beimu./Chenpi, moxiang, ruxiang, chuanshanjia, chishao, dangguiwei.

Part of how I make this work for me is by grouping the herbs roughly by function (when the rhyme allows it). So the first three (jinyinhua, zaojiaoci, tianhuafen) are all herbs that address the toxic swelling rather directly (I could have put chuanshanjia in this group too, but it didn’t fit). The second four (fangfeng, baizhi, gancao, beimu) are a more loose group that assists with that function. The second line is all movers, starting with one qi mover (chenpi) and finishing with a whole mess of blood movers (moxiang, ruxiang, chuanshanjia, chishao, dangguiwei).

I’m very oral-aural–and I’ve always loved poetry–so that’s probably partially why this works well for me. But I’ve been shocked at how well it works. I’ve remembered some of these rhymes for years without using the formula or reviewing the rhyme.

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I find that some formulae, however, can be easily divided into parts based on the function of the herbs. So in the example above I’ve broken down Hao-qin qingdan tang (蒿芩清膽湯, Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction) into four pairs of herbs:

Qinghao and huangqin: The  lords of the formula that clear gallbladder damp-heat. Qinghao is the source for the artemisinin malaria medicines that earned Tu Youyou the nobel prize recently. From a Chinese medicine point of view it has the useful ability to clear heat that is hidden inside dampness in the same way the ashes of a fire can look cold but still hide glowing-hot embers.

Banxia and zhuru: These two herbs resolve phlegm and stop vomiting–a common symptom in this formula’s pattern.

Chenpi and zhike: This pair move the qi, which is often obstructed by dampness leading to problems like glomus in the epigastrium.

Fuling and Biyu san: This pair is a bit of a cheat since the second member is actually a small formula containing huashi, sheng gancao, and qingdai. Nevertheless, that’s how the formula is usually written. Both these ingredients disinhibit the urine, draining dampness downward and out of the body.

Finally, there are formulae that belong to formula families. These are best understood by understanding the family’s basic structure and how each formula is a modification of that structure. Generally speaking, there are four basic ways in which the basic structure of a formula family can be modified: adding ingredients, removing ingredients, replacing ingredients, and adjusting the dosage of ingredients.

The Guizhi tang 桂枝湯 family provides good examples of all three of these methods. The basic structure of the this family is the formula Guizhi tang itself (guizhi, shaoyao, zhi gancao, shengjiang, dazao), which is built from three formula elements (small formulae of one to four ingredients that act as the building blocs of larger formulae):

guizhi + zhi gan cao: This combo supplements the yang–particularly of the heart and spleen–and the defense (wei 衛). On its own, it is a formula called Guizhi gancao tang 桂枝甘草汤 used to warm and supplement the heart yang. It embodies the principle “acrid and sweet produce yang (xin-gan hua yang 辛甘化陽).”

shaoyao + zhi gancao: These two herbs together nourish the yin-blood–especially of the liver–and construction (ying 營). As a formula it is called Shaoyao gancao tang 芍藥甘草湯. It emobides the principle “sour and sweet produce yin (suan-gan hua yin 酸甘化陰).”

zhi gancao + shengjiang + dazao: This combination is frequently used by Zhang Zhongjing 張仲景 and serves to protect and nourish the stomach. It is particularly important in Guizhi tang because this formula acts primarily through the spleen and stomach–hence the saying that it “releases the flesh (jieji 解肌).”

The first Guizhi tang modification seen in the Shanghan lun (傷寒論, Treatise on Cold Damage) is an example of adding ingredients: Guizhi jia fuzi tang (桂枝加附子湯, Cinnamon Twig Decoction with Aconite Accessory Root Added). In this formula, fuzi is added to more strongly supplement the defense yang. It is used when a patient’s defense yang is weak or damaged by improper promotion of sweating.

The second modification of Guizhi tang in the Shanghan lun is a classic example of removing an ingredient: Guizhi qu shaoyao tang (桂枝去芍藥湯, Cinnamon Twig Decoction with Peony Root Removed). In this formula, the removal of shaoyao removes the second, yin-nourishing, formula element. This results in a formula that more strongly emphasizes warming and supplementing the heart yang. In the Shanghan lun it is used when incorrect purging damages the heart yang, allowing a cold evil to fall into the heart, but the Guizhi tang pattern persists.

The third modification of Guizhi tang is an example of replacement (or removal and addition, same difference in this case): Guizhi qu shaoyao jia fuzi tang (桂枝去芍藥加附子湯, Cinnamon Twig Decoction with Peony Root Removed and Aconite Accessory Root Added). Here fuzi is added to the previous formula, increasing yet further its ability to warm and supplement the heart yang. It is used in the same patterns as the previous formula, but when stronger cold is present.

Not all examples of replacement can also be described as removal and addition. The Ma-Xing family is an excellent example. This family has three representatives in the works of Zhang Zhongjing: Mahuang tang (麻黄汤, Ephedra Decoction), Mahuang xingren gancao shigao tang (麻黄杏仁甘草石膏汤, Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction), and Mahuang xingren yiyiren gancao tang (麻黄杏仁薏苡甘草汤, Ephedra, Apricot Kernel, Job’s Tears, and Licorice Decoction). All three formulas contain the core two ingredients of the family–mahuang and xingren–as well as gancao, but by replacing the third ingredient and adjusting the doses of the remaining ingredients very different formulae are produced.

To return to Guizhi tang, one of its most famous modifications is an excellent example of how altering dosage can produce new formulae: Guizhi jia shaoyao tang (桂枝加芍药汤, Cinnamon Twig Decoction with Additional Peony Root). In this formula the dosage of shaoyao is doubled. This greatly increases the strength of the shaoyao + zhi gancao formula element, allowing the formula to more effectively soothe the liver and the sinews, treating the cramping pain that often accompanies diarrhea (in this case a taiyin-spleen vacuity diarrhea).

Understanding how the formulae of a family are related to one another–how they are constructed and modified–makes remembering their ingredients far simpler. Many such formula families exist in Chinese medicine, and understanding them is a key method of formula memorization.

All herbalists, whether just starting to learn or with many years of experience, have to keep memorizing and reviewing formulae. It’s just part of the process of being a good herbalist. Many people find memorization difficult, but everyone is capable of tremendous feats of memory–it’s part of our human skill set. We just have to learn how to use that capacity. These three methods have been very useful for me, and I hope that others may find them useful as well.

Chinese & East Asian Medicines, Religion & Medicine

The Doctor, the Scholar (and the Meditator?) 
in Middle Period China

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A doctor, a scholar, and a meditator walk into a bar… and they’re the same person!

This (admittedly rather bad) joke flitted into my head while we sat together on a grey October day at Johns Hopkins’ Institute for the History of Medicine discussing the frequent but frequently fraught intersections of meditation, healing, and the scholarship that claims to understand these two. Continue reading The Doctor, the Scholar (and the Meditator?) 
in Middle Period China →