Professor Liu Du Zhou (1917-2001) was a famous Chinese medicine practitioner, a lifelong professor at Beijing University of Chinese Medicine and one of the first batch of doctoral supervisors in Chinese medicine. He has long been engaged in teaching, clinical and scientific research in Chinese medicine, and is good at treating difficult and miscellaneous diseases with sutra prescriptions, and has unique insights into them.
The original text reads: “Typhoid fever, five or six days, has been sweating and again put down, chest full of slight knots, urine is not conducive, thirsty but not vomiting, but head sweating, exchange of cold and heat, heart bothered, this is not resolved. Chai Hu Gui Zhi Gan Jiang Tang is the main.” This formula has been considered for generations as a formula for the treatment of Shaoyang and watery drink, but there are only a few clinical applications and its effect is not satisfactory. In this regard, Professor Liu Du Zhou explored for many years and clarified its mystery, and applied it in clinical practice, achieving miraculous results and forming a unique experience. The following is a discussion of Professor Liu’s understanding and clinical application of Chai Hu Gui Zhi Gan Jiang Tang for the benefit of fellow practitioners. Yin Lihua, Department of Integrative Medicine, Taixing Pi Defense Hospital
l On the pathogenesis, advocating bile-heat and spleen-cold
Professor Liu Duzhou believes that Shaoyang is the half-epidemic and half-lienic in the Treatise on Typhoid Fever, and is the pivot for the transmission of epidromes to the li, and Shaoyang is the pivot not only for the transmission of epidromes to the li, but also for the transmission of triple yang diseases to the triple yin. Therefore, Shaoyang disease has many concurrent testimonies, such as the evidence of Chai Hu Gui Zhi Tang for Shaoyang with superficial, and the evidence of Da Chai Hu Tang and Chai Hu plus Mannite Tang for Shaoyang with internal reality. And Chai Hu Gui Zhi Gan Jiang Tang is the opposite formula to Da Chai Hu Tang, which is the evidence of deficiency cold in Shao Yang. In this way, it is both superficial and internal, and the internal reality and internal deficiency are both available, so the meaning of Shaoyang as the pivot is perfect. In Article 146, Zhongjing discusses Chai Hu and Gui Zhi Tang of Shao Yang, and immediately afterwards in Article 147, he discusses Chai Hu, Gui Zhi and Gan Jiang Tang of Shao Yang passing into Tai Yin, which is a deep intention that is endlessly interesting. Therefore, Liu Lao in his “Fourteen Lectures on Typhoid” cloud: “Use this formula to reconcile Shao Yang and treat Spleen Cold, and Dachai Hu Tang and reconcile Shao Yang and treat Stomach Real mutually invented, it can be seen that Shao Yang for the disease affecting the Spleen and Stomach, need to be divided into different treatment of Cold, Heat, Deficiency and Real.”
Regarding the proposal of “biliary heat and spleen cold”, Liu Lao got it from Mr. Chen Shenwu, the first director of the Typhoid Department of Beijing University of Traditional Chinese Medicine, who said that “Shaoyang disease has Yin evidence of machine transfer”. When I was following Liu Lao’s research and consultation, Liu Lao said that when he first came to Beijing University of Traditional Chinese Medicine to teach typhoid fever, everyone was puzzled by the mechanism of this formula, and Chen Lao said that Chai Hu, Gui Zhi, and Gan Jiang Tang “have Yin evidence of machine transfer”. Chen asked what was meant by “yin evidence machine turn”, but Chen did not say anything about it. Liu Lao remembered this statement, thought hard for many years, combined with clinical practice, and then realized its reasoning. Since then, he has been treated in the clinic and has gotten many miraculous results, which shows his dedication to the medical path and reflects his great enlightenment, and he is worthy of being a master of Chinese medicine. The main evidence of this formula is explained according to biliary heat and spleen cold, which is logical. Chest full of slight knots, but the head sweating, thirst, cold and heat, heart trouble, all for the disease in Shao Yang, Shao Yang pivotal machine is not conducive, bile heat depression on the cause; urine is not conducive to the cause, one is Shao Yang pivotal machine is not conducive, affecting the gasification, the second is the spleen Yang deficiency, fluid transfer is not due to; and not vomiting is the evil of Shao Yang into Tai Yin, not affecting the stomach and internal organs of the reason. Although Zhongjing did not expressly say the stool situation, loose stool evidence is inevitable, not to say, although the change involves Taiyin, may not affect the stool, so that there is “Yin evidence machine turn” also. This is the same meaning as “fever” which is not mentioned in the syllabus of solar disease.
2 Grasp the main evidence, pay attention to the bitterness of the mouth and loose stools
For the application of Chai Hu Gui Zhi Gan Jiang Tang, Liu Lao clearly pointed out in his “Fourteen Lectures on Typhoid,” that this formula “treats abdominal distension, loose stools and diarrhea, unhealthy urination, thirst, heartburn, or pain in the back, numbness of the fingers, slow and stringent pulse, and pale tongue with white coating due to heat in the gallbladder and cold in the spleen. However, in the author’s clinic, Liu Lao applied this formula to the main evidence of bitterness in the mouth and loose stools. After thinking about it, I realized where the mechanism lies. Since it is the evidence of Shaoyang and Taiyin, of course, there should be a main evidence of Shaoyang as evidence of the disease in Shaoyang, and a main evidence of Taiyin as evidence of the disease in Taiyin, so that we can use this formula boldly.
Liu Lao judged that the disease was in Shao Yang, based on bitterness in the mouth. This is also the main basis of his clinical application of Chai Hu class prescriptions. Liu once said that the taste of fire is bitter, but the fire of other meridians is rarely bitter, but the fire of liver and gall bladder is more bitter, so the bitterness of the mouth reflects the evil heat of Shao Yang and has practical significance. Therefore, Zhang Zhongjing took the bitterness of the mouth as the first evidence of the syllabus evidence of Shaoyang disease in the Treatise on Typhoid.
The evidence of loose stools is the main basis for judging Taiyin disease. The “treatise on typhoid” Taiyin disease syllabus as “Taiyin is a disease, abdominal fullness and vomiting, not eating, self-interest is very, when the abdomen from the pain, if the next, must be hard under the chest.” The importance of downward profit is highlighted. Therefore, according to Prof. Liu Du Zhou, Yang Ming is the main closure, and its constipation is the actual evidence, while Tai Yin is the main opening, and its bowel movements are diarrhea and deficiency. In clinical practice, no matter what the disease is, and how long it is, whenever you see abdominal distension and fullness and downward benefit, you should first consider Taiyin deficiency cold as the disease, then it is close to it. In the author’s clinic, Liu Lao is extremely flexible in understanding the evidence of loose stools, either as diarrhea like water, or loose diarrhea, or even those with unformed stools, also as loose stools and use this formula. Scholars should be subject to the disease mechanism, flexible grasp, do not stick to a certificate of the presence or absence, in order to learn Chinese medicine well.
3 Talk about the application Pay attention to the adjustment of the amount of medicine
Regarding the clinical application of this formula, Professor Liu Du Zhou wrote in Fourteen Lectures on Typhoid, “In clinical practice, this formula is often effective in the treatment of chronic hepatitis with evidence of dysmenorrhea, abdominal distension, loose stools, diarrhea, and dry mouth. If diabetes is seen with evidence of Shaoyang disease, this formula is also extremely suitable.”
Professor Liu Du Zhou first used this formula to get results for the treatment of abdominal distension in hepatitis. Hepatitis patients, due to long-term use of bitter and cold medicine to clear the liver and gallbladder, often cause heat toxicity not yet cleared, while the spleen Yang has been injured, appearing in the liver and gallbladder have heat, the spleen and stomach have cold bile hot spleen cold evidence. Clinical evidence of heat and depression in the liver and gallbladder, and Qi failure, is not only seen in the liver area, but also in the abdominal distension and loose stool, which is a sign of deficiency cold in the spleen and stomach. The liver and gallbladder qi is unfavorable to draining, coupled with the spleen deficiency, the spleen and stomach qi is out of order, so the abdominal distension is very high. And because of Taiyin deficiency cold, abdominal distension more at night or aggravated. At this time, treatment, but clearing heat will hurt the spleen and Yang, and warming the spleen and Yang is afraid to help heat to produce toxicity and aggravate the symptoms of hepatitis. It is no coincidence that Liu Lao was able to choose Chai Hu, Gui Zhi and Gan Jiang Tang among the sutra prescriptions to treat this evidence and achieve miraculous results.
I have been serving the teacher for a year and have seen Liu Lao use this formula to treat more than just hepatitis. As long as it fits the pathological mechanism of bile-heat and spleen-cold, it is effective no matter what disease it is used for. For example, if diabetes mellitus is a gastrointestinal disorder, the stool is often loose and sometimes dry, or does not have stool for several days, or has diarrhea several times a day for several days, which is extremely difficult to treat. Treatment with this formula can regulate the functions of liver, gallbladder, intestines and stomach, and use smallpox powder to produce fluid and quench thirst, which is suitable for diabetic gastrointestinal dysfunction or thirsty, bitter and loose stools. Other diseases such as bile reflux gastritis and enlarged abdominal lymph nodes have been treated with this formula with miraculous results.
To apply this formula clinically, one should understand the meaning of the formula and adjust the dosage of drugs flexibly. The meaning of this formula is to use Chai Hu and Scutellaria to clear the liver and gallbladder, dry ginger and roasted licorice to warm and tonify the spleen and Yang, and Gui Zhi to transport cold and heat, yin and Yang. When applied clinically, in case of loose stools, the dosage of scutellaria should be reduced, and in case of bitter mouth, the dosage of scutellaria should be increased, and the dosage of scutellaria should be reduced. If you can not master the method of adjusting the amount of medicine, you will not benefit from the use and suffer the harm, we must not be cautious.
Prof. Liu Du Zhou is fond of Chai Hu, Gui Zhi and Gan Jiang Tang, and the high frequency of clinical application, the wide range of diseases and the divine effect of the formula have amazed my generation. This only on Liu Lao on the party’s pathogenesis, the main evidence, the basic guiding principle of clinical application has been elaborated, limited to space, not to list many cases, scholars if you can understand the mechanism, the clinical evidence to obtain the effect of what is difficult!