Fire
Noon
Summer
South
Metal
Evening
Autumn
West
Wood
Morning
Spring
East
Water
Midnight
Winter
North
Jue Yin Disease Wu Mei Wan (Mume Pill) defined
by Arnaud Versluys
The jue yin chapter of the Shang Han Lun is one of the most
enigmatic in Han-dynasty clinical literature. The chapter is
apparently confused and many attempts at explaining it fail in the
face of the seeming disconnect between the standard description
of jue yin disease in these lines1 and the formulas contained within
the actual chapter. Even if one succeeds with an intellectual
understanding of the chapter and its core concept of jue yin
disease, most practitioners still fail to gain a visceral comprehension of the identification and treatment of jue yin disease in
everyday clinic.
Jue yin physiology
Jue yin jing (
) is the jue yin conform­
ation of the wind wood of the east. Its
branches (biao ) on the body’s periphery
are the foot jue yin Liver and hand jue yin
Pericardium channels, while its root (ben2
) is wind. Contained within jue yin is the
middle qi (zhong qi3
) of the shao yang
28
Vol 5–3
ministerial fire (xiang huo4
). Jue yin is
the unity of wind and ministerial fire. It is
the fanning force behind the circulation of
ministerial fire in the hollow yang realm, as
well as the warm rising of blood within the
solid yin realm in the body. Jue yin contains
and steers blood, which it spreads freely in
all four directions: up, down, in and out.
The driving force behind this distribution
of blood is the moving warm qi contained
within the blood, or in other words shao
yang within jue yin.
Jue yin is born from water and gives birth to
fire.As such it is the bridge between water and
fire and the eastern pathway through which
rising water of the north communicates and
connects with descending fire of the south.
The yin segment of the jue yin tract belongs
to the Liver, which stores and moves blood.
The yang segment of the jue yin tract belongs
to the Pericardium which stores the nutritive
(ying/rong ) ������������������������������
which it holds closely around
the Heart to provide protection and cooling
to the emperor.
In the separation and union (li he
)
feature
sequence of yin and yang, the function of
jue yin is to close (he5 ) yin. Jue yin is the
resolution of yin, the death of yin. As such it
is the precursor to the birth of yang just as
on a material level blood is the mother of qi.
Yang is born from the water within the earth
at the midnight (zi6 ) time as represented
by the hexagram (fu )or “the recovery”7.
Jue yin wood fans the birth of this initially
lesser fire allowing it to increasingly warm
and ascend the steaming and boiling fluids
of the northern water element. The ascent of
this decreasingly yin and increasingly warm
water will ultimately spur the growth of shao
yang Gallbladder wood and the consecutive
birth of tai yang fire. Hence the Shang Han
Lun says that the resolution time of jue yin,
or in other words the period during which
jue yin fulfills its function of resolving yin
and fanning yang, happens from chou
time to mao time.8 This is the end of night
until the break of dawn, during which time
yang rises from within the water upwards
through the earth to arise from the horizon
and form the yang conformations. Of all
yin conformations, jue yin thus holds the
most yang and the least yin, and its overall
direction is upward and outward, such is
the quality of its root qi wind.
Jue yin pathology
Jue yin and yang ming are the only exceptions
to the first two rules of biao-ben-zhong
qi transformation as outlined in chapter
seventy-four of the Su Wen9. That is, they do
not follow the first rule and transform from
the root, nor do they follow the second rule
and transform from either from the branch
or from the root. Rather, due to the opposing
yin and yang natures of jue yin’s biao and
ben qi, i.e. yin branch jue yin channels and
yang root wind qi, jue yin transforms from
its middle qi of shao yang ministerial fire.
Physiologically this means that the warming
and moving qualities of the ministerial fire
are exclusively responsible for the warming
of the yin channels of jue yin as well as the
production of wind wood internally. In
pathology, this means that jue yin disease
is a disease of ministerial fire, precisely
ministerial fire contained within jue yin.
From a functional anatomical perspective,
jue yin disease manifesting either too much
or too little ministerial fire always occurs
from the jue yin organ within shao yang
ministerial fire, i.e. the Pericardium.
The second rule of biao-ben-zhongqi
pathophysiology could conceivably be
applied to jue yin disease, for example in
relation to a peripheral jue yin channel
pathology as treated by Dang Gui Si Ni
Tang (Dang Gui Decoction for Frigid
Extremities) or an internal jue yin wind
pathology as treated by Wu Mei Wan. But
even when this is the case, the expression
of the pathology inevitably revolves around
the Pericardium’s inability to warm the
blood and the experience of cold extremities
due to the lack of fire within the blood, or
alternatively a reversal flow of qi striking
the Pericardium, the Heart’s proxy, due to
an excess of internal wind. Consequently,
when ministerial fire is stirred in jue yin
disease, the flaring fire can invade metal
along the control cycle of the phases and
either lead to suppuration and bleeding
from the metal Lung as is treated with
Ma Huang Sheng Ma Tang (Ephedra and
Cimicifuga Decoction)10 or will invade the
metal Large Intestine and create dysentery
with pus and bleeding as is treated by Bai
Tou Weng Tang (Pulsatilla Decoction)11. The
relationship and sequence between the
aforementioned throat obstruction (hou bi
) and the latter pus and blood in the
stool (bian nong xue
) are evident in
12
line 334 of the original text.
From the perspective of jue yin’s function
of closing yin to prepare for the birth of the
yang conformations through the pivot of
shao yang, when jue yin closes too much,
or too prematurely, yang is not born due to
absence of resolution of the yin stage. This
results in blood remaining too cold and too
stagnant, unable to rise and float and failing
to warm and nourish the extremities and
the surface such as in Dang Gui Si Ni Tang.
When jue yin fails to close, the upward rising
of internal wind as the fanning force of the
rising blood will be left uncontrolled and
thus will stir excessively. This then results in
the upward rising of reversal qi striking the
Heart13; the fanning of disturbing fire in the
Pericardium with vexing heat and pain14;
vomiting or at least the inability to get
food down15; and the upward crawling of
restlessly moving roundworms16 disquieted
n Dr Versluys joins Dan Bensky
and Craig Mitchell in presenting next year’s seminar series
in Australia, Core patterns of
the Shang Han Lun – a clinical
approach. See Page 39.
n Dr Versluys is one of the very
few Western scholars to have
received his full medical training
in China. He respectively spent
more than 10 years at the Chinese
medical universities of Wuhan,
Beijing and Chengdu, where
he consecutively pursued his
Bachelor, Master and Doctorate
degrees in Chinese medicine.
He also trained in traditional
Shanghan Lun discipleship for
many years. Dr Versluys’ scholastic passion is the Han-dynasty
canonical style of Chinese medicine. During the past five years,
he worked as assistant professor
at the School of Classical Chinese
Medicine at the National College
of Natural Medicine in Portland,
OR, USA. He is in private practice
in Portland, and teaches seminars
domestically and internationally.
Arnaud can be reached at info@
arnaudversluys.com.
The Lantern
29
feature
‘’
As internal wind fans
the flare-up of shao
yang ministerial fire, it
consecutively produces
more hot wind. This is a
perpetuating vicious cycle
that requires immediate
and precise treatment.
by the fanning wind, all as treated with Wu
Mei Wan. Jue yin reversal or counterflow
is internal wind. As internal wind fans the
flare-up of shao yang ministerial fire, it
consecutively produces more hot wind. This
is a perpetuating vicious cycle that requires
immediate and precise treatment. Much can
go wrong. For example, since jue yin wood
relates to the functions of tai yin earth along
the control cycle of the phases, when the
pattern is purged with bitter herbs, jue yin
will not only fail to close but its ability to
close can be broken permanently. When this
happens, like a closed door kicked open by
force, the controlled opening function of tai
yin will be damaged, and this can result in
incessant downpour diarrhea.17 In the worst
case scenario this can result in irreparable
damage not only to tai yin but also to the
shao yin pivot, such that yin perishes from
below and separates from yang, leading
not only to diarrhea but the incessant
downpour of clear fluids and undigested
food (xia li qing gu18, 19
) typical of
certain shao yin patterns.
Wind
Wind in nature does not exist as an
independent force but is rather the natural
effortless product of the interplay between
opposing forces. When in one region
there is a dominant cold front with low
temperatures and low barometric pressure,
while in another not-too-distant location
there is a predominant heat front with
higher temperatures and higher barometric
pressure, then a current is created from
the low-pressured front towards the highpressured front, or in other words from
the cold locale to the hot locale. This
movement in nature is called wind. It is
exactly the same in the human body: all
upward moving forces are the product of
the temperature and pressure differential
between the human body’s cold and hot
fronts, i.e. the water element and the fire
element. Nothing in human physiology has
to do anything actively to produce wind, as
it suffices to merely possess a healthy Heart
in the hot south and healthy Kidneys in
the colder north of the body. Wind is then
created because of their opposing qualities
and their relative proximity to each other.
30
Vol 5–3
A current will then move from the lower
burner to the upper burner, causing qi and
blood to ascend. This is exactly like the
pumping mechanism of a tree, in the way
that it can draw water from the ground to
the tips of the leaves on its branches high
in the sky.
Any change, however, in this temperature
differential will lead to a change in this
current of upward-flowing qi. When the fire
element of the south drops in temperature
due to yang deficiency of the Heart, the
temperature difference between Heart and
Kidneys equalises and wind stills, resulting
in the cold stagnation of blood failing to
ascend and spread. This is a Dang Gui Si Ni
Tang pattern. But when the temperature of
the Kidney water drops and the temperature
differential between fire and water therefore
increases, then the subsequent current of
upward surging wind gains pathological
strength. This is the actual mechanism
behind a Wu Mei Wan pattern pathology
which manifests with a multitude of internal
wind symptoms and reversal upward flow of
qi and blood. This is the explanation of the
working mechanism behind the common
understanding of jue yin disease being cold
below with heat on top.
The functional treatment of wind wood is
specified in the Huang Di Nei Jing. According
to chapter 22, encouraging the dispersing
movement of the Liver is fulfilled through
the administration of a pungent flavour,
while the reduction of such movement, in
other words the stilling of Liver’s wind, is
achieved through the application of a sour
flavour.20 And from the six qi perspective
presented in chapter 74, when wind is in
the spring (which is when wind is internal)
treatment is to be conducted with a sour
and bitter combination.21 In even greater
detail, the treatment of dominant internal
wind is done through the carefully balanced
administration of a sour formula of warm qi
with the assistance of bitter and sweet, along
with the check-and-balance of a pungent
flavour.22 The mechanism of redressing
deficient jue yin closure is through the sour
astringing of wind directly, assisted by the
bitter descent of fire and sweet tonification
of earth accompanied with mild pungent
dispersal to prevent excessive therapeutic
closure of the circulation of qi and blood.
feature
The warmth of the overall formula is created
by choosing a majority of warm herbs
as well as through the pungent flavour of
these herbs. But since too much fire can also
create wind, the warmth of the formula is
balanced by choosing cold-natured bitter
herbs to lead physiological fire downwards
and inwards. The internalisation of the
physiological fire needs to be done to reestablish the physiological warming of the
water specifically and the yin conformations
in general.
Wu Mei Wan architecture
From the original text in the Shang Han
Lun it is obvious that Wu Mei Wan can
treat the acute proliferation of roundworm
infestation23 in the human body. But every
serious practitioner must have wondered at
some point as to whether this prescription
could not have a broader clinical application
than in the field of parasitology and the
occasional “long-standing diarrhea”24.
Line 338 of the Shang Han Lun starts by
clearly distinguishing between Roundworm
Reversal (hui jue
) pattern and Visceral
Reversal (zang jue
) pattern. It is made
clear that Wu Mei Wan does not exclusively
treat Visceral Reversal since that treatment
is in the realm of shao yin disease. However,
the fact that the opening part of the clause
makes this distinction indicates the need to
clarify and prevent this kind of confusion.
This is mainly because, as the second
sentence implies, Roundworm Reversal
occurs on the basis of Cold Viscera (zang han
)25 or cold yin organs. Cold yin organs
are the condition of cold of the deepest
solid yin level in the body. In the Shang Han
Lun this is mentioned in one other location,
namely in Tai Yin chapter’s line 277 where
cold of the solid organs is to be treated with
prescriptions of the Si Ni family (si ni bei
Frigid
�����������������������������
Extremities formulas).26 Tai yin
is the ultimate yin. It contains both water
and earth and is also identified in Su Wen
chapter four as the Ultimate Yin (zhi yin
),27 which is even more yin than Kidney
water which is identified as “just” yin within
‘’
Encouraging the dispersing
movement of the Liver
is fulfilled through the
administration of a
pungent flavour, while
the reduction of such
movement, in other words
the stilling of Liver’s wind,
is achieved through the
application of a sour
flavour.
Chinawest
Concentrated Chinese Herbs Exclusively for TCM Practitioners
Are you using patent pills? Why not dispense your own herbs with your
own clinic label and give your patients Chinaʼs hospital grade herbs.
Over 600 leading Chinese Hospitals use our herbs.
$0* Dispensary start-up!
(For new graduates and established TCM practitioners)
“.... my patients are VERY happy with the herbal medicine and so am I.
This is the first time I have found granules similar to actual raw herbal decoctions.”
LB, Sydney.
*conditions apply.
www.chinawest.com.au
Free Call: 1800 888 198
Ask about our 10% Discount.
e-mail: info@chinawest.com.au
The Lantern
31
feature
‘’
Interestingly enough,
wind does not exclusively
move up in the body. The
temperature differential
exists not only along a
vertical axis between
Heart and Kidney, but also
along an in-and-out axis
between solid (yin) organs
and hollow (yang) organs.
32
Vol 5–3
yin.28 As such, when: 1) yin organs are cold,
2) this visceral cold in the Shang Han Lun
is considered to belong to tai yin, and 3) its
treatment is performed by treating the shao
yin mother of earth; then: 4) healthy wood
cannot be generated by ice water inside
a frozen earth, which will 5) result in the
pattern called Cold Viscera, thus increasing
the fire-water temperature differential,
and 6) function as the foundation for
Roundworm Reversal.
With the northern waters freezing over,
internal wind is thus engendered due to
an increase in the temperature differential
between north and south. And due to this
temperature difference, the rising current
in the body increases furiously and rushes
to the relatively warmer region of the south,
creating the upwards surging of wind
from lower to upper burner. This surge of
wind then stirs a pathological flare-up of
ministerial fire in the Pericardium, as well
as thrusting upward at earth and impeding
the proper descent of food, thus leading to
an inability to get food down.
But, interestingly enough, wind does
not exclusively move up in the body. The
temperature differential exists not only
along a vertical axis between Heart and
Kidney, but also along an in-and-out axis
between solid (yin) organs and hollow
(yang) organs. The internal wind stirs
ministerial fire which also circulates in the
hollow realm of the yang conformations as
qi. The solid yin organ interior is cold and
the hollow exterior realm becomes hotter,
thus also producing the outward movement
of wind. This is treated with cold-natured
bitter herbs that will drive ministerial fire
inwards and downwards. So it becomes clear
that the nominal concept of clearing heat
with a bitter cold herb is nothing more than
to drive fire inwards and downwards and
submerse it within water. This is why, in Nei
Jing chapter 22, a bitter flavour is considered
to tonify the water element since this refers
to the function of communicating fire with
water by symbolically benefiting water with
a fire flavour. This is echoed in the Decoction Classic (Tang Ye Jing
)29 from
which Zhang Zhong-Jing drew most of his
formulaic knowledge and in which bitter
herbs like Huang Lian (Coptis) and Huang
Qin (Scutellaria) and so on are considered
to be functional Kidney tonics and are listed
as bitter water-category herbs.30
Zhang Zhong-Jing’s prescriptions are in
large part the fruit of his lifelong study and
research of all formula and prescription
literature available to him. Research31,32,
33,34,35,36
has shown that the formulas for
the treatment of the six conformations
are to a large extent based on six pairs of
prescriptions named after star constellations
whose celestial movements were deemed to
govern the six types of qi of this planet’s
weather patterns. This is evident in remnant
prescription names such as Qing Long Tang
(Blue-Green Dragon Decoction
), Bai
Hu Tang (White Tiger Decoction
),
and Shen Wu Tang (Black (True) Warrior
Decoction
).
The research mentioned above shows that
these prescriptions were originally listed
in identical or slightly varied form in the
aforementioned work named the Decoction
Classic (Tang Ye Jing) written by unidentified
authors in the western Han dynasty. This
book was lost to the ravages of time but
parts of it were preserved in Tao HongJing’s37 writings called Secret Instructions
for Assisting the Body and Essential
Methods for the Application of Herbs for
Yang and Yin Organs (Fu Xing Jue Zang
Fu Yong Yao Fa Yao
)38
retrieved in the 1930s from the Dun Huang
caves in Northwest China. In this book, the
authors list a table of 25 herbs outlined
along a five phase-five flavours grid. Of
these categories, the wood category of herbs
is a collection of pungent herbs to stir wind
with the objective of reviving fire through
the functional tonification of its wood
mother. The herbs in this category then
each have an elemental affinity through
their respective signatures conditioned by
their natural appearance in the phenomenal
world. The five herbs of the wood class
are: Gui Zhi (Cinnamomi Ramulus) as
the wood herb of the wood class and the
governor of the category through its woody
branch-like signature; Shu Jiao or Chuan
Jiao (Zanthoxyli Pericarpium) is the most
spicy fire herb of the wood class linked with
the Heart through its hollow, chamber-like
shape and red color; Jiang, ginger, both raw
and dried, is the earth herb of the wood
class because of its yellow colour and earth
feature
warming action; Xi Xin (Asari Herba) is
the metal herb of the wood class with its
Lung affinity conditioned by its leaves; and
Fu Zi (Aconiti Radix Lateralis Preparata) is
the water herb of the wood class, pungent
hot to warm the Kidneys through its black
colour of the water element. These five
herbs are the core herbs to warm Wu Mei
Wan and provide the necessary pungency
to balance the strong dominant sour and
bitter flavours. Since in Wu Mei Wan all five
solid organs of the yin conformations are
cold as established in the aforementioned
line 338 of the Shang Han Lun, these five
herbs warm the five solid organs, one each.
And then finally the formula contains sweet
herbs in compliance with Nei Jing chapter
22 instructions on flavour architecture to
moderate the Liver39 and nourish earth40.
Dang Gui (Angelicae Sinensis Radix) is the
core jue yin blood nourishing and wood
urgency moderating herb, while Ren Shen
(Ginseng) is the sweet earth herb of the
herb class41 to replenish nutritive qi within
the tai yin conformation.
Expanded clinical use of Wu Mei Wan
The Shang Han Lun indicates the use of Wu
Mei Wan for the treatment of visceral cold
resulting in Roundworm Reversal. It also
mentions its applicability in the treatment
of chronic diarrhoea (the latter indication
being unverifiable as to whether this was
added during the later editions of the Shang
Han Lun by other authors). But in clinic,
once the mechanism of jue yin disease
and the treatment of wind is understood
properly, the application of Wu Mei Wan can
be opened up to a larger variety of disorders.
A quick glance at recent research literature
from China reveals articles pertaining to
the use of Wu Mei Wan in the treatment of
the following selection of illnesses, to name
but a few: roundworm infection42, chronic
cholecystitis43, chronic diarrhoea44, chronic
asthma45, diabetic gastroparesis46, chronic
atrophic gastritis47,48, chronic renal failure49,
chronic colitis50, ulcerative colitis51,52,53,
angina54, urticaria55, menorrhagia56, etc.
Following are three anecdotal case
histories from personal practice illustrating
the use of Wu Mei Wan in greatly differing
conditions.
Case 1:
Interstitial cystitis and idiopathic vertigo
A female patient, 55, presented with severe
lower abdominal pain and urinary frequency.
The pain was strongly contracting. Urinary
frequency was about once every half hour
during daytime and up to 10 times at night.
The urine was clear. She also suffered from
insomnia with some difficulty falling asleep
and frequent waking. Furthermore, she
had an idiopathic “vestibular disturbance”
causing severe bouts of vertigo. The vertigo
could be severe at times causing loss of
balance and falling over. Accompanying
the vertigo was a sense of vibration in the
thoracic and cervical spine contributing
to the restlessness and insomnia at night.
Lastly, the patient suffered from heartburn
due to acid reflux, often feeling a sense of
pressure on the stomach. Pulses overall
were weak. There was a wiry and slightly
hollow quality on the left guan (medial
pulse), along with a deep cun (distal pulse)
and deep but slightly tight chi (proximal
pulse). The right hand pulses were thin
wiry at guan with a deeper cun and thin
wiry deeper chi position. The diagnosis was
jue yin disease with visceral reversal: zang
jue. The prescription was Wu Mei Wan with
Zhen Wu Tang (True Warrior Decoction)
incorporated as modification. Ban Xia
(Pinellia) was added to introduce the core
structure of Ban Xia Xie Xin Tang to drain
the epigastrium, treat reflux and promote
sleep.
Wu Mei
Huang Lian
Huang Qin
Gui Zhi
Chuan Jiao
Xi Xin
Fu Zi
Gan Jiang
Ren Shen
Ban Xia
Dang Gui
Bai Shao
Bai Zhu
Fu Ling
48g
3g
9g
3g
1g
3g
15g
9g
3g
12g
3g
9g
9g
9g
‘’
The wood category of
herbs is a collection of
pungent herbs to stir
wind with the objective of
reviving fire through the
functional tonification of
its wood mother.
Mume Fructus
Coptidis Rhizoma
Scutellariae Radix
Cinnamomi Ramulus
Zanthoxyli Pericarpium
Asari Herba
Aconiti Radix Lateralis Prep.
Zingiberis Rhizoma
Ginseng Radix
Pinelliae Rhizoma Prep.
Angelicae Sinensis Radix
Paeoniae Radix Alba
Atractylodis Macrocephalae
Poria
The patient returned after one week and
had experienced great improvement. The
The Lantern
33
feature
‘’
In clinic, once the
mechanism of jue yin
disease and the treatment
of wind is understood
properly, the application
of Wu Mei Wan can be
opened up to a larger
variety of disorders.
34
Vol 5–3
abdominal pain was all but gone. Urination
had reduced to about five or six times per
day; nocturia was still four to five times per
night. The dizziness was slightly better. The
vibrations in the spine were slightly better.
The insomnia had improved, although
the patient still used sleeping medication.
The heartburn had recently flared up with
some increased pressure in the chest but
this might have been due to diet. The pulse
showed overall similar qualities with slight
less hollow left guan, though wiriness
was now more emphasised. The same
prescription was dispensed.
On the next visit, the patient reported no
more abdominal pain. Urination during the
day had normalised. Night-time urination
varied between two and four times per
night. The daytime loss of balance was less
noticeable. Night-time vibrations in the
spine still persisted but had also improved.
Insomnia was on and off. Some nights
she slept well, even without medication.
Other nights she needed her medication.
The problem now was mostly with falling
asleep. The pulses were overall less excessive
and softer though the main trend was still
the same. The actual shao yin conformation
quality of faintness and depth was starting
to appear more prominently.
The patient was advised to continue taking
this prescription. After a period of about two
more months, the improvements had mostly
stabilised. The stomach was now completely
normal. Now the main problem was clearly
the dizziness, poor balance and occasional
insomnia. Pulses showed an overall deep
thin wiry left guan. Left cun was deep and
weak. Left chi was deep and slightly tight.
All pulses were weak. Right hand cun was
deep weak, guan was thin wiry and chi was
deep weak and slightly tight. Left guan was
weaker than right guan. Wu Mei Wan was
continued for another few months with
increased emphasis on Zhen Wu Tang and
Fu Zi (Aconiti Radix Lateralis Preparata) in
particular through its increased dosage to
30 grams. After the use of Wu Mei Wan was
halted, the treatment then carried on with
variations of Zhen Wu Tang, sometimes
combined with Dang Gui Shao Yao San
(Dang Gui and Peony Powder). The patient
is still under continued care. The urinary
bladder flares less than once a year.
Case 2:
Hypertension and diabetes
A male patient, 65, presented with chronic
hypertension unresponsive to treatment.
He was diabetic and suffered mild druginduced kidney function impairment as
evident in blood tests. Hypertension was
diagnosed 20 years ago, while the diagnosis
of diabetes was made 10 years previously.
Average blood pressure was 180/95 mmHg
with spikes of up to 250/140 mmHg. The
patient was taking multiple medications
for hypertension such as Benicar 20 mg qd
(Olmesartan Medoxomil, ACE inhibitor),
Corec 20 mg qd (Carvedilol Phosphate,
beta-blocker) and Aldectone 75 mg qd
(Spiro­nolactone, aldosterone antagonist),
but all to limited or no avail. Currently the
patient was trying to manage his diabetes
with proper diet but glucose levels hovered
around 300 mg/100ml fasting. He had
seen an unrelenting increase in both blood
pressure and blood glucose in the past six
months. The patient suffered asymptomatic
brachycardia and arrhythmia of which
he was mostly unaware but discovered
when he saw a cardiologist for his fatigue
and shortness of breath. However, further
findings were inconclusive. The patient
urinated three to five times per night; urine
colour was generally clear. Pulses showed a
deep left cun, with tight wiry and somewhat
hollow left guan, and a deep tight left chi.
Right hand pulses showed a deep tight cun,
with a deep thin and wiry tight guan, and
a deep chi position. Diagnosis was jue yin
disease with visceral reversal: zang jue. The
prescription was Wu Mei Wan plus Zhen Wu
Tang to address Kidney water metabolism.
Wu Mei
Huang Lian
Huang Bai
Gui Zhi
Chuan Jiao
Gan Jiang
Xi Xin
Fu Zi
Ren Shen
Dang Gui
Bai Shao
Bai Zhu
Fu Ling
48g
6g
3g
6g
1g
3g
3g
6g
3g
3g
6g
6g
12g
Mume Fructus
Coptidis Rhizoma
Phellodendri Cortex
Cinnamomi Ramulus
Zanthoxyli Pericarpium
Zingiberis Rhizoma
Asari Herba
Aconiti Radix Lateralis Prep.
Ginseng Radix
Angelicae Sinensis Radix
Paeoniae Radix Alba
Atractylodis Macrocephalae
Poria
feature
The patient returned after one week and
reported a steady decline in blood pressure
readings to an average of 160/90 mmHg
with occasional drops as low as 145/85
mmHg. Blood glucose averaged 180 mg/100
ml about three hours after his meals. His
nocturia had decreased to once or twice
per night. The left pulse showed a deep cun
failing to rise, along with a deep wiry tight
guan, and a deep tight chi. Right pulses
displayed a deep tight cun, with a deep
wiry tight guan, and a deep weak chi. The
pulses also showed an emphatic knotted (jie
) quality. The previous prescription was
continued.
At week two, the patient returned and
reported an average blood pressure of
140/85 mmHg with occasional lows of
135/80 mmHg. The heart rate however had
slowed to around 40 bpm with lows of 35
bpm. The overall pulse quality was similar
to the previous two weeks but there was
again an emphatic knotted quality. It was
concluded that the sour flavour of Wu Mei
strongly reduced the wind of the wood
element and as a result slowed down the
heart rate. Wood is the mother of fire and
direct reduction of wood here seemed to
negatively influence fire. The prescription
was modified to support Heart yang by
increasing Gui Zhi to 12 grams.
The patient returned at week three and
reported an average blood pressure of 115/75
mmHg. Heart rate had picked up to an
average of 65 bpm. The patient’s physician
had decreased the dose of Spironolactone
to 50 mg qd. The same prescription was
continued.
The next week, the patient was reporting
a steady average blood pressure of 110/75
mmHg with lows of sometimes 100/70
mmHg. The treatment with Wu Mei Wan
was continued for another six months after
which it was decided to shift treatment to
focus more on management of diabetes and
recovery of Kidney functions. Ultimately, the
patient was taken off of Spironolactone and
received decreased doses of his two other
medications. Even if he was never fully taken
off the drugs, there is obvious causality
detectable between the introduction of
Chinese herbs into his picture and the
steady but rapid decline in his blood
pressure. Although the use of Wu Mei Wan
in the treatment of diabetes is suggested in
contemporary Chinese literature,57 in this
patient’s case, the ultimate prescription that
lowered blood glucose to satisfactory levels
as well as decreased creatinine and BUN
values to within normal was Shen Qi Wan
(Kidney Qi Pill).
Case 3:
Myoclonus and spontaneous orgasm
Myoclonus is a symptom and not a
diagnosis of a disease. It is the sudden and
involuntary jerking of a muscle or group of
muscles. Myoclonic jerks usually are caused
by sudden muscle contractions, called
positive myoclonus. The twitching cannot
be controlled by the person experiencing it.
Commonly the symptom is of neurological
nature, caused by the central nervous
system.
Presenting at the clinic was a female
patient, 28, who had been experiencing
negative myoclonus triggered by muscle
relaxation for an undefined number of years.
Physicians suspected a case of cortical reflex
myoclonus but tests were inconclusive.
The myoclonus manifested with a sudden
strong contraction of the rectus abdominis
muscles that looked as if the person was
trying to sit up from lying down. She also
suffered spontaneous repetitive orgasms
during the night without any external
stimulation whatsoever. She was personally
unaware of the fact but her partner noticed
the events up to 20 times per night. She
had mild acid reflux and heartburn. She
also suffered poor balance with a tendency
to fall over, as well as vertigo. On the first
visit, pulses were slippery rolling upwards
from both cun onto the thumbs. The initial
diagnosis was Running Piglet (Bentun
) and Ben Tun Tang (Running Piglet
Decoction) was prescribed. This Jin Gui
Yao Lue prescription treats adverse flow of
internal wind and ministerial fire rushing
upward.
After one week the patient returned with
only mild improvement, mostly on the
level of more relaxed back muscles. The
myoclonus was unchanged. The patient was
experiencing bloating in the lower abdomen
and slow bowel movements. Pulses were
similar to the first week and displayed an
‘’
The heart rate however
had slowed to around
40 bpm with lows of
35 bpm. It was concluded
that the sour flavour of
Wu Mei strongly reduced
the wind of wood element
and as a result slowed
down the heart rate. Wood
is the mother or fire and
direct reduction of wood
here seemed to negatively
influence fire.
The Lantern
35
feature
‘’
One can only gain mastery
of the full breadth of
a prescription’s clinical
applicability when one has
a thorough understanding
of the pathophysiology of
a conformation from all
possible angles.
additional wiry quality across all positions.
The diagnosis now was changed to jue yin
disease with visceral reversal: zang jue. The
prescription was Wu Mei Wan plus Zhi Shi
Shao Yao San (Unripe Bitter Orange and
Peony Powder) for the lower abdominal
fullness and pain, along with the addition
of Zhi Gan Cao to encourage Shao Yao Gan
Cao Tang (Peony and Licorice Decoction)
to relax muscle spasms.
Wu Mei
48g Mume Fructus
Huang Lian
6g Coptidis Rhizoma
Huang Bai
3g Phellodendri Cortex
Gui Zhi
6g Cinnamomi Ramulus
Chuan Jiao
1g Zanthoxyli Pericarpium
Gan Jiang
3g Zingiberis Rhizoma
Xi Xin
3g Asari Herba
Fu Zi
6g Aconiti Radix Lateralis Prep.
Ren Shen
3g Ginseng Radix
Dang Gui
3g Angelicae Sinensis Radix
Bai Shao
15g Paeoniae Radix Alba
Zhi Gan Cao 9g Glycyrrhizae Radix Prep.
Zhi Shi
9g Aurantii Fructus Immaturus
The patient returned at the end of the
second week reporting good progress. The
muscles in her lower back were more relaxed
and her bowel movements much easier.
The abdominal pain had disappeared. She
was still having the myoclonus but both
frequency and intensity had decreased
markedly. The pulses were less slippery and
rolling upwards onto the cun positions on
both hands. The left hand guan position
showed an increased wiry and hollow
quality while the right hand guan was
hollow overall but weak and empty. Wu
Mei Wan was refilled with the original
modifications, but since internal wind was
still strong it was decided to increase Shao
Yao Gan Cao Tang in the prescription by
increasing Bai Shao to 30 grams.
At week three, the patient was reporting
continued improvement of the myoclonus
to the point where some days it was hardly
noticeable. The pulse, however, was still
very wiry and hollow and Bai Shao in the
prescription was increased to the same
amount as Wu Mei – 48 grams. This
prescription with occasional modifications
was continued for six more months until
the patient experienced no more myoclonus.
The spontaneous orgasms decreased in
36
Vol 5–3
frequency with the addition of Long Gu and
Mu Li but never fully disappeared.
Conclusion
This article has hopefully succeeded in
demonstrating that jue yin disease deserves
as much attention as any other chapter in
the Shang Han Lun, and that its premier
prescription Wu Mei Wan (Mume Pill) is
clinically applicable for much more than
simply roundworm infection or chronic
diarrhoea. Knowing the mechanisms
involved in the pathology is the key. One
can only gain mastery of the full breadth of
a prescription’s clinical applicability when
one has a thorough understanding of the
pathophysiology of a conformation from
all possible angles.
Endnotes
1. Shang Han Lun, line 326: “In jue yin disease,
there is consumptive thirst (xiao ke), qi surging
upwards striking the heart, painful heat in the
heart, hunger without desire to eat, vomiting of
roundworms after eating, and if purged there will
be incessant diarrhea.”
2. Huang Di Nei Jing Su Wen, chapter 68: “Over
shao yang, fire qi rules, and in the middle is seen
jue yin. Over yang ming, dry qi rules, and in the
middle is seen tai yin. Over tai yang, cold qi rules,
and in the middle is seen shao yin. Over jue yin,
wind qi rules, and in the middle is seen shao yang.
Over shao yin, heat qi rules, and in the middle is
seen tai yang. Over tai yin, damp qi rules, and in
the middle is seen yang ming.”
3. Ibid.
4. Ibid.
5. Huang Di Nei Jing Su Wen, chapter 6: “So it is
that in the separation and union of the three yin,
tai yin opens, jue yin closes and shao yin pivots.”
6. Huang Di Nei Jing Su Wen, chapter 49: “Taiyin is
zi, for in the 11th [lunar] month the ten thousand
things are all stored within the centre.”
7. In the Yi Jing
hexagram 24, Fu, is “zhen
[earthquake] below and kun [earth] above”
gang zhen xia kun shang. It is also known
as “thunder within the earth”
lei zai di
zhong. Kun is the second hexagram and indicates
earth. As the Yi Jing states: “earth is power of kun”
di shi kun. While the 51st hexagram Zhen
or earthquake, is considered to be “thunderous like
flowing water”
jian lei, thus forming the overall
feature
picture of the thunderous stirring of quelling water
from within the earth and the recovery of yang-like
upward movement from silent yin-like inactivity. In
Fu, one solid line appears under five broken lines,
and is the result of the extreme yin that engenders
lesser yang. This one yang line represents shao yang
ministerial fire within the earth, and resonates with
the Gallbladder.
8. Shang Han Lun, line 328: “Jue yin disease tends
to resolve between chou time [1am] to mao time
[7am].”
9. Huang Di Nei Jing Su Wen, chapter 74: “The
emperor says: The branch and root of the six qi
follow different [rules], how so? Qi Bo answers:
The qi can follow the root, some follow branch and
root, and some do not follow branch or root. The
emperor says: I would love to finally hear about
this. Qibo says: Shao yang and tai yin follow the
root; shao yin and tai yang follow the root or the
branch; yang ming and jue yin do not follow root or
branch but follow the middle qi. So for those that
follow the root, the transformation is engendered
from the root, those that follow branch and root,
can transform from branch or root, and those that
follow the middle, will transform as their middle
qi.”
10. Shang Han Lun, line 357: “When in cold
damage that has lasted six or seven days, after
great purgation, when the cun pulse is deep and
slow, and there is mild reversal flow of hands and
feet, and the lower division pulses fail to arrive, the
throat is obstructed, and there is spitting up of pus
and blood, along with incessant diarrhea, then this
is difficult to treat, and Ma Huang Sheng Ma Tang
governs.”
11. Shang Han Lun, line 371: “For hot diarrhea, with
downward heaviness, Bai Tou Weng Tang governs.”
12. Shang Han Lun, line 334: “In cold damage,
when there first is reversal and then fever, then
diarrhea imperatively will arrest spontaneously.
But when there adversely is sweating, for who has
a sore throat, then this is throat obstruction. When
there is fever without sweating, then downpour
imperatively arrests spontaneously, if it does not
stop, then there imperatively will be pus and blood.
For who has pus and blood, the throat will not
obstruct.”
13. See Endnote 1.
14. Ibid.
15. Ibid.
16. Ibid.
17. Ibid.
18. Shang Han Lun, line 225: “When the pulse is
floating but slow, there is fever on the surface but
cold in the interior, and downpour of clears and
grains, Si Ni Tang governs.”
19. Shang Han Lun, line 317: “In shao yin disease,
there is downpour of clears and grains, with cold
on the interior and fever on the exterior, the hands
and feet have reversal flow, and the pulse is faint
with a tendency to expire…”
20. Huang Di Nei Jing Su Wen, chapter 22: “Liver
disease is better at dawn and worse at dusk; it is
peaceful at midnight. When the Liver desires to
disperse, swiftly eat pungent to disperse, for it is
tonified with pungent and reduced with sour.”
21. Huang Di Nei Jing Su Wen, chapter 74: “When
jue yin is in the spring … its treatment is [with]
sour and bitter…”
…
22. Huang Di Nei Jing Su Wen, chapter 74: “When
wind steers the earth … treat with sour warm,
assisted by bitter sweet, and balanced by pungent.”
23. Shang Han Lun, line 338: “When in cold
damage, there is a faint pulse and reversal, and at
seven or eight days the skin is cold and the person
does not have even temporary periods of peace,
this indicates visceral reversal, not roundworm
reversal. In roundworm reversal, the person should
vomit roundworms. Now the person is still,
and then has periodic vexation, which indicates
visceral cold. Roundworms ascend and enter
one’s diaphragm, so there is vexation, but wait a
moment and it will stop. After receiving food,
there is retching and again vexation, because the
roundworms smell the malodor of food, and the
person often spontaneously vomits roundworms.
For roundworm reversal, Wu Mei Wan governs. It
also governs long-standing diarrhea.”
24. Ibid.
25. Ibid.
26. Shang Han Lun, line 277: “Spontaneous diarrhea
without thirst belongs to tai yin, for there is cold in
the solid organs, which needs to be warmed, and
for which the Si Ni family is indicated.”
27. Huang Di Nei Jing Su Wen, chapter 4: “The
abdomen is yin, the ultimate yin within yin, is the
Spleen.”
28. Huang Di Nei Jing Su Wen, chapter 4: “The
abdomen is yin, and yin within yin is the Kidney.”
29. Decoction Classic (Tang Ye Jing
) – also
referred to as Yi Yin Decoction Classic (Yi Yin Tang
Ye Jing
) or Methods of the Decoction
Classic (Tang Ye Jing Fa
) – is Chinese
medicine’s first formula classic written in WesternHan dynasty by unknown authors. The book
is named after Yi Yin who was a Shang
(1766
BCE–1027 BCE) dynasty historical figure and
the patriarch of Chinese cuisine. The book was
structured along three classes (san pin
) of
prescriptions in similar fashion as its counterpart
Divine Farmer’s Classic of Materia Medica and
recorded a total of 360 formulas. It is considered
Ante Babic’s
Tips for running
a successful clinic ...
Study the classics!
The Lantern
37
feature
the blueprint for Zhang Zhong-Jing’s work.
There is no extant copy of the work but
records of up to 56 of its prescriptions were
included in the works of Tao Hong-Jing,
which were subsequently unearthed from
the Cave for Sutra Storage (cang jing dong
) at the Dun Huang cave complex in
NW China.
30. Cullen, Lo (eds) (2005). Medieval Chinese
Medicine, pp. 293-305. London & New York:
Routledge Curzon, London & New York.
31. Ibid.
32. Versluys, A. (2006). The Transmission
Lineage of the Canonical Formulas: An
Investigation into the Source of Zhong Jing’s
Formulas (Jing Fang Zhi Chuan Cheng Mai
Luo: Zhong Jing Fang Tan Yuan)
Beijing: China
State Library, Collection of Postgraduate
Dissertations.
33. Ma, Ji-Xing.
(1988). Philological
Study of the Ancient Dun Huang Medical
Texts (Dun Huang Gu Yi Ji Kao Shi
). Nanchang: Jiangxi Science and
Technology Press.
34. Jiang, Chun-Hua.
(1985). Shang
Han Lun and Tang Ye Jing Shang Han Lun
Yu Tang Ye Jing
. Journal of
Traditional Chinese Medicine (Zhong Yi Za
Zhi
10, p.61.
35. Xu, Chun-Lin
(1984). Discussing
Yi Yin Decoctions (Lun Yi Yin Tang Ye
). Journal of Chinese Medicine History
(Zhong Hua Yi Shi Za Zhi
, 14
(3), p. 150.
36. Wang, Shu-Min.
(1991).
Examination of the Dun Huang Scroll of
Assisting the Body and Essential Methods
for the Application of Herbs for Hollow and
Solid Organs (Fu Xing Jue Zang Fu Yong Yao Fa
Yao
), Shanghai Journal
of Traditional Chinese Medicine (Shang Hai
Zhong Yi Yao Za Zhi
, 3,
p.36.
37. Tao, Hong-Jing.
(456-536 CE).
Southern Dynasty herbal medicine scholar
and Daoist layman responsible for the
preservation of and the elaboration upon the
Shen Nong Ben Cao Jing. His most famous
works include Separate Recordings of Famous
Physicians Ming Yi Bie Lu
, and
Collected Annotations on the Materia Medica
Classic Ben Cao Jing Ji Zu
.
38. See Endnote 36.
39. Huang Di Nei Jing Su Wen, chapter 22:
“The Liver rules spring, and governs the foot
jue yin and shao yang channels, its days are
jie and yi, for when the Liver suffers urgency,
swiftly eat sweet to moderate.”
40. Huang Di Nei Jing Su Wen, chapter 22:
“[When] the Spleen desires to be moderated,
swiftly eat sweet to moderate, for bitter is
used to drain, and sweet is used to tonify.”
41. See Endnote 36.
42. Yin, You-Xue.
38
Vol 5–3
(1995). The Treat­
ment of 11 Cases of Roundworms in the Bileduct with Wu Mei Wan Modified
. New Journal of
Traditional Chinese Medicine (Xin Zhong Yi
) 1995-1.
43. Yang, Jin-Huan
, (2006).
The Treatment of 69 Cases of Chronic
Cholecystitis with Modified Wu Mei Wan
. Henan
Journal of Traditional Chinese Medicine
(Henan Zhong Yi
) 2006-1.
44. Zhang, W.
(2006). The Treatment
of 48 Cases of Chronic Diarrhea with Wu
Mei Wan
. Yunnan
Journal of Traditional Chinese Medicine and
Materia Medica (Yunnan Zhong Yi Zhong Yao
Za Zhi
) 2006-6.
45. Peng, X
, Wang, Hong-Bei
et
al, (2005). Experimental Research on Zhang
Zhong Jing Formulas
pp. 592-593. Beijing: China Medical Science
and Technology Publishing House (Zhong
Guo Yi Yao Ke Ji Chu Ban She
).
46. Zou, Shi-Chang
(2002), Treatment
of Diabetic Gastroparesis by Wu Mei Pill:
A Clinical Observation of 42 Cases
. New
Journal of Traditional Chinese Medicine
(Xin Zhong Yi
) 2002-2.
47. Yang, Kuo-Mei.
(2004). The
Treatment of 78 Cases of Chronic Atrophic
Gastritis with Wu Mei Wan Modified
. Shaanxi
Journal Traditional Chinese Medicine
(Shaanxi Zhong Yi
) 2004-1.
48. Li, S.
(2004). Clinical Observation of
Modified Wu Mei Decoction in the Treatment
of 46 Cases of Chronic Atrophic Gastritis
. Hunan Guiding Journal of Traditional
Chinese Medicine and Pharmacology
(Hunan Zhong Yi Yao Dao Bao
) 2004-8.
49. Yang, Kuo-Mei
(2006). The
Treatment of 71 Cases of Chronic Renal
Failure with Wu Mei Wan Modified
. Henan
Journal of Traditional Chinese Medicine
(Henan Zhong Yi) 2006-2.
50. Liu, Gui-E
(2001). The Treatment
of 32 Cases of Chronic Colitis with Wu Mei
Wan Modified
. Anhui Clinical Journal of Traditional
Chinese Medicine (Anhui Zhong Yi Yao Lin
Chuang Za Zhi
) 20014.
51. Chen, Ya-Bing
Chen, Yi-Feng
(2005). The Treatment of 46 Cases
of Ulcerative Colitis with Wu Mei Wan
Compared with Control Group of 45 cases
of Western Medicine Treatment
. Zhejiang Journal of Traditional Chinese
Medicine (Zhejiang Zhong Yi Za Zhi) 200510.
52. Yang, Hong-Bo
, Luo, Yu-Mei
, Wang, Jing-Bo
(2007) The
Treatment of 44 Cases of Ulcerative colitis
with Modified Wu Mei Wan
. New Journal of
Traditional Chinese Medicine (Xin Zhong Yi
2007-1.
53. Gao, Xian-Zheng
, Guo, Xing
(2006). Fructus Mume Pills in the Treatment
of Chronic Ulcerative Colitis: Therapeutic
Effect Observation of 120 Cases
. Modern
Traditional Chinese Medicine (Xian Dai
Zhong Yi Yao
)2006-5.
54. Liu He-Qiang
(1994). The
Treatment of One Case of Recalcitrant
Angina with Wu Mei Wan
. New Journal of Traditional
Chinese Medicine (Xin Zhong Yi
)
1994-3.
55. Lao, Chang-Hui
(1995). The
Treatment of 27 Cases of Chronic Urticaria
with Wu Mei Wan
. New Journal of Traditional Chinese
Medicine (Xin Zhong Yi
) 1995-6.
56. Han, Mei-Ying
, Zhang, M.
,
Zhang, Lan-Ju
(1998). The Treatment
of Menorrhagia and Oligomenorrhea
with Wu Mei Wan
. Inner
Mongolia Journal of Traditional Chinese
Medicine (Nei Meng Gu Zhong Yi Yao
)1998-3.
57. Liu, Li-Hong
(2002). Contemp­
lating Chinese Medicine
pp. 458459. Guilin: Guangxi Normal University
Publishing House (Guangxi Shi Fan Da Xue
Chu Ban She
).
Bibliography
Meng, Jing-Chun
, Wang, Xin-Hua
,
et al (1987). Translation and Explanation of the Plain
Questions of the Yellow Emperor’s Internal Canon
(Huang Di Nei Jing Su Wen Yi Shi
). Edition used is edited by the Nanjing University
of Chinese Medicine, Taipei: Taiwan Wenguang
Book Company, Ltd (Wen Guang Tu Shu You Xian
Gong Si
).
Liu, Du-Zhou
et al (1991). Shang Han Lun
Revision and Annotation (Shang Han Lun Jiao Zhu
). Beijing: People’s Medical Publishing
House (Ren Min Wei Sheng Chu Ban She
).
Qian, Chao-Chen
, Wen, Chang-Lu
, et al, (2004). Zhang Zhong-Jing Research
Compendium (Zhang Zhong-Jing Yan Jiu Ji Cheng
). Beijing: China Medical Classic
Publishing House (Zhong Guo Gu Yi Ji Chu Ban
She
).
Qiu, Pei-Ran
, et al, (2002). Great
Encyclopedia of Chinese Medical Works (Zhong
Guo Yi Ji Da Ci Dian
.) Shanghai:
Shanghai Science and Technology Press (Shanghai
Ke Xue Ji Shu Chu Ban She
).
Yang, L.
(1989). Zhouyi and Chinese Medicine
(Zhou Yi Yu Zhong Yi Xue
). Beijing:
Beijing Science and Technology Press (Beijing Ke
Xue Ji Shu Chu Ban She
).
Mitchell, C., Wiseman, N., Feng, Y. (1999). Shang Han
Lun: On Cold Damage. Brookline, MA: Paradigm
Lo, V., Cullen, C. et al (2005). Medieval Chinese
Medicine: The Dunhuang Medical Manuscripts.
London and New York: Routledge Curzon.