Pleurisy Root as Mahuang ??

I was browsing in William Cook's The Physio-Medical Dispensatory, where I came upon his account of Pleurisy Root (asclepias tuberosa). Allow me to share a few passages: "The root of this plant is probably one of the most reliable and serviceable relaxing diaphoretics in the whole Materia Medica. ... Its principle action is upon the sweat glands ... The chief employment of this agent is in febrile and inflammatory affections, where the perspiration needs to be decidedly promoted ... It secures a slow, steady, and free perspiration, and the same time suitably diminishing excessive heat on the surface; which action renders it highly serviceable in [various fevers] and other forms of fever with hot skin and a rigid pulse ... Most commonly it is combined with some diffusive and more prompt stimulant, especially about one-fourth its own weight of ginger [and, I would add, guizhi]."

This seems to set us up perfectly to use Pleurisy Root in a Mahuang Tang type formula. But does it open the Lungs, for use in a Ma Xing Shi Gan Tang type formula? Ellingwood & Lloyd (1915), list Pleurisy Root in their chapter on "Agents Acting Upon the Respiratory Tract." They say: "It is of special service in the treatment of affections involving the serous membranes, as pleuritis, peritonitis, etc. ... It is beneficial in acute pleuritis specifically, also in bronchitis, pneumonitis, and peritonitis. It has distinct expectorant properties. In tight and painful coughs with difficult respiration, especially where there is a general suppression of secretion, with dry skin and mucous membranes, and in soreness of the chest from coughing, it is a most excellent remedy." That seems to line up pretty well, but I cannot tell whether it is working on the lungs through the same mechanism as Ma Huang. I have not yet seen wheezing mentioned specifically although "difficult respiration" comes pretty close. I'm not sure that I would rely on it in a case of whooping cough.

In terms of flavor, Holmes calls Pleurisy root bitter and pungent, which is how Bensky lists Mahuang. Holmes considers Pleurisy Root to be a cold herb, however, Matthew Wood (1997) notes that Pleurisy Root is called for in patients who are worse in the cold and damp.

A First Look at Wood

Laying the foundation for a systematic study of herbs which work on the Wood phase (Shaoyang and Jueyin, but mostly Shaoyang), I thought I would look at the different actions that the western traditions ascribe to herbs that we would regard as Wood herbs: anti-spasmodic, alterative, bitter, carminative, cholagogue, emenagogue, nervine, circulatory stimulant, lymph decongestant, blood tonic, and anti-inflammatory.

Not all of these categories belong entirely to Wood. Those nervines which relieve nervous tension belong to Wood, but others are Water or Earth tonics (when anxiety is due to depletion). Many circulatory stimulants work by moving qi, a Wood function. But those herbs which use a warming force to drive the blood, often called "diffusives," of which Prickly Ash is a strong example, work through the Taiyang. Of the anti-inflammatories, only those which relieve inflammation from stagnation belong to Wood, others we would ascribe to Yangming Metal.

Alteratives seem to straddle shaoyang and yangming functions: As downward, detoxifying agents they could be ascribed to yangming (they perform the function that some in Chinese Medicine seek to achieve with small doses of Da Huang). Indeed, most of the alteratives also promote bowel movements, however they are not purgatives like Da Huang, instead they encourage the the production and release of bile, which in turn drives the bowels, thus we could say that they use gallbladder energy to move the bowels. Finally, The alteratives work on the interstial fluids, a region that belongs to the Shaoyang Triple Burner. This is perhaps the strongest reason for regarding them as Wood herbs.

We can also note that many of the listed western functions can be regarded as specialized forms of qi-moving. I would include anti-spasmodic, carminative, cholagogue, nervine, emenagogue, and circulatory stimulant in this category. These different functions are moving the qi in different domains (perhaps we could use a five evils model to express this). Carminatives are moving qi in the digestion (Earth), Nervines are moving qi in the nerves (which belong to the Fire-Water axis), circulatory stimulants are moving qi in the vessels (belonging to Fire, but also possibly to Metal), Cholagogues move qi the gallbladder (Yang wood) Emenagogues are moving qi & blood in the reproductive organs (belonging to mostly to Yin Wood), Anti-spasmodics move qi in the muscles, often the smooth muscles (we should probably regard these as. tendons, belonging again to Wood.)

Three Prescribing Styles

As I learn more about practicing with western and local herbs, I think of myself as working toward precision in my prescribing. But precise means different things to different people. This writing is meant to help me think about what my goals are.

One style of precision is very precise about the actions and indications of each herb employed. This style tends toward single-herb prescribing, and, as this style reaches its apogee, it begins to develop bizarrely specific herbal profiles, with guidelines that might read: “the patient who needs this herb tends, while thinking, to stroke downward along his or her nose, especially with the left hand.” While such an indication would certainly be useful to remember if you happen to come across such a patient, it is hard to draw from such an indication any more general understanding of what the herb is doing, what its range of applicability might be, or how it will work with other herbs. Nevertheless, this style is quite valuable for clarifying the specificity of each herb, so that we aren’t stuck with vague understandings such as “oh, that’s qi tonic.” When used in its pure form, this style will depend on a large and ever-growing materia medica; As one makes finer and finer distinctions between the herbs, one needs more and more herbs to fill out the spectrum of effect, or, seen another way, since the aim is to perfectly match an herb to a patient, one will need at least one herb for each of the 6 trillion people on the planet.

A second style seeks precision in its diagnostic categories. The aim here is to understand and perceive the fundamental dynamics of human health. The hallmark of this approach is that it seeks to be systematic: organized, integrated, and simplifying, thus I name this the systematic style. One still needs a good refined understanding of particular herbs to use such a system, but the attention is not on the herbs in their individuality, but on the way they affect the fundamental dynamics identified by the diagnostic system. This style moves toward using fewer and fewer herbs. To the extent that one’s system is truly fundamental, one can recognize a few basic dynamics underlying a variety of clinical manifestations. Consequently one can seek to treat using only the handful of herbs needed to rectify those dynamics. This style risks clipping one’s awareness of the individuality of both herb and patients - seeing the ways that they fit in one’s system, but failing to see the ways that they do not fit. In other words, it is unclear whether one really can shoehorn the blooming, buzzing biological world into a tidy system with only 5, 10, or 25 variables.

There is a third style which is not precise in an obvious way. In this style, herbal actions are again understood in terms of diagnostic categories. (I will call this the categorical style.) The difference from the second style is that instead of preferring to use one specific herb for each action, there is a tendency to use lower doses of several herbs from the same category. Instead of trying to choose between dandelion, burdock, or oregon grape, one would just blend the three, and that blend would represent one function within a formula. The categorical style seems especially suited to long-term treatments, which cannot afford to have too many rough edges. Even if a formula is carefully balanced, the eccentricities of one’s preferred herbs may create problems if they are given for several years. Moreover, this prescribing style allows one to rotate individual herbs out of the formula without changing the direction of the formula. It does seem that the categories of thought used in this style are also less precise than in the systematic style. Perhaps this is because the body cannot be told to go to a particular point 20 miles away, rather you can point it in a general direction and begin to refine matters as the destination draws closer.

Rosemary

Morphology

Bushy growth is abundant and thick. I am always surprised how much herb is available from one plant, ie there is a dense abundance. The stem is woody with much branching. The leaves are fine, almost needles. New growth shows little distinction between leaf and stem, but with time the stem grows more woody. The leaves also dry and harden somewhat, but less dramatically. The flowers also are small and in the angles. The many small flowers all bloom together, but they remain only briefly.

It is clear that this plant places most of its emphasis on the vegetative growth process, and it focuses specifically on multiplication of the stem process, as opposed to any watery swelling of the leaf. Also, this is a dense growth, not a sprawling one. It is a steady, patient growth which does not over-extend itself. This principle of growth extends briefly to the leaves, which are abundant, but it does not fully enter into a leaf process. Instead, after forming each leaf, it quickly moves on. On the contrary, we can see the leafy vitality being usurped by stem process, being used there to promote its own growth.

The flowers are in the angles, further showing us that the growth principle does not extend itself far beyond the stem. This form also allows the stem to go on growing indefinitely. The plant does not allow the flower principle to establish itself as the final flowering, to cap the growth, to declare itself as the final cause of the plant.

 Compared to yarrow, which plays in the region between the leaf and flowering processes, rosemary keeps its vital force much closer to its center. This suggests an almost Fuzi-like storage of yang. 

Taste and Experience

I find two or three different tastes in rosemary. One is smooth, sweet, and light while also being deep and woody. There can also be an initial harshly pungent taste (this is especially noticeable in stronger tinctures). This flavor quickly dissipates, leaving the previously mentioned woody sweetness as the general impression. This harsher flavor seems to be doing some kind of cleansing, so that the lighter flavor may float forth. Concentrating on this harsh flavor also seems to pull my awareness deep within, quite as though it uses its cutting quality to sink toward the core. What is this cleasing? My sense is that it works on what we would call immaterial phlegm and turbidity.

 (Can we find this cleansing, opening, turbidity transforming quality in the plant morphology? It is not quite apparent to me. If I were interested in post-hoc mnemonics, I could say that a branch of rosemary together with its many needle-like leaves looks like a bottle brush, therefore it can be used for cleansing fine crannies, but this does not help me understand the language of plant morphology. Still, this might be a clue. Perhaps the watery life of the leaves, condensed by a drying force, have developed an inner intensity which allows them to be cutting in this way. It’s just an idea.)

 When the sweet, woody flavor is dominant, I felt nurturing, as through I wanted to hold that which is gentle through the fall and winter. I also experienced an inner image of a hearth fire. This corresponds well with the morphological theme of a contained yang.

 With time I felt a pleasant warmth in the chest. I also experienced an increased sense of alertness.

Authorities

 Culpeper states that by its “warming and comforting heat” it helps all cold diseases of head, liver, stomach, and belly - including drowsiness, mental dullness, and weak memory, windiness of stomach, bowels, and spleen, those that are “liver-grown by opening the obstructions thereof,” and can cure jaundice if it is followed by physical exercise. He says that it is good for women with leukorrhea, and can be used externally for cold, benumbed joints and limbs.

William Cook merely states that the leaves are stimulating, somewhat emmenagogue, useful in suppression of the menses from exposure, and for painful menstruation.

 Pelikan repeats Steiner’s idea that Rosemary strengthens the ‘I’ and its influence on the rest of the body. This includes both its mental acuity and blood stimulating properties. He says that it promotes digestion by “firing the metabolism,” can be used in the treatment of epilepsy, and used for diabetes.

 David Winston adds that it is a carminative cholagogue useful for flatulence, burping, and borbor. He uses it for “liver headaches and biliousness,” as well as headaches with impaired circulation. Although he also mentions that its circulatory tonic function is mild. He says that it is a powerful antioxidant, useful for preventing arterial sclerosis.

 Mills and Bone mention that, as an emenagogue, it should be avoided during pregnancy. 

 Holmes say that Rosemary is an arterial circulatory stimulant which warms the interior, treating for yang deficiency cold and damp, and says that it is one of the few remedies for HT and KD yang deficiency. Also good for conditions he attributes to zong qi deficiency: mental depression, palps, shallow breathing. Also warming to treat cold stagnation of digestion, liver, and uterus. Finally, he says that it is an adrenal restorative.

 Jeremy Ross defines its action as tonifying and moving HT, SP, and LV qi, calming and regulating intestine qi, and calming hyperactive LV yang.

 Matthew Wood says that it stimulates metabolism, enhances the burning of sugars and fats. He says that it warms and cleans through-out the body, and quotes Dr John Quincy: “[Rosemary leaves] abound with a subtile detergent oil which makes them universally deobstruent and opening.” He uses it for cardiac edema and congestive heart failure, saying that it has all three properties needed in a HT remedy: tonic, cleansing, and nervine. He finds that its influence extends to the extremities - opening capillaries and improving sensation. He also mentions that although classified as warming and drying, it is moistening to the gallbladder and bowels, so it can be used there for dryness and atrophy

Conclusions

 We can summarize these finding by saying that Rosemary: 1) Is a warming tonic to the shaoyin, with its warmth working also on the digestion and uterus. 2) Transforms some kind of turbidity or phlegm, although this sphere of action is underdefined. My sense is that it does not work well on copious or heavy phlegm but on micro-turbidity. Much of its awareness stimulating function can be ascribed to opening of the orifices through this cleansing. It is not clear what other aspects of physiology this might affect. 3) Has some wood affinities, working with jaundice and liver headaches.

Rosemary seems somewhat less activating than guizhi but somewhat more active than fuzi - with its circulatory stimulation and its center more on the HT rather than resting in the KD (although we should remember that Holmes mentions that it is an adrenal restorative and considers it a kidney yang tonic).

 Both rosemary and yarrow have some opening or moving properties, however yarrow seems to emphasize relieving qi constraint and has a significant upward and outward direction, while rosemary moves through warmth and by cleansing turbidity which might impede motion. Both herbs also have significant Wood phase connections. They might make a good combination for situations where we need both warmth and motion, and especially for situations involving chest stagnation.

 In the guizhi family of formulas, Rosemary seems less appropriate to a straight guizhi tang type formula, but well suited to Danggui Sini Tang and Ling Gui Zhu Gan tang type formulas. It seems appropriate to a Lizhong Wan type formula and perhaps even something like a Sini Tang. It will also be useful for any formulas addressing cold gynecological conditions (Wenjing Tang, etc). I have not finished working out its uses in the Wood sphere, and will address that in the future when I make a study of Wood-phase herbs.

Indian Pipe

Trying to work with local NW herbs presents some unique challenges. There is very little accessible tradition on their use of herbs which are specific to this region. The 19th century American medical traditions (the Physiomedicalists and Eclectics, mostly) did not work with them, and records of Native uses are extremely scanty and vague: it seems that everything was used either for “rheumatism” or tuberculosis. Similarly, because they are not well known or commonly used in the wider herbal traditions, they do not receive much contemporary research. This is where we have to play Shen Nong, and our ability to accurately perceive an herb and its actions becomes most important. Conceptually, I imagine training my ability to recognize herbal actions by working first with better documented herbs (so that I can compare my own insights with those of medical predecessors) before trying to tackle the under-documented local herbs. In reality my curiosity spreads without regard to such schemes.

Anyone reading this who does not know what Indian Pipe looks like should first have a look at the pictures here and here. Indian Pipe is an epiparasite, meaning that it parasitizes certain fungi which in turn parasitize the roots of photosynthesizing plants. Since it does not participate in photosynthesis, it has no need for chlorophyll, allowing its white color. Other saprophytes and parasites, also freed from the green chlorophyll express a variety of colors; the distinct whiteness of indian pipe indicates something particular about this plant. Being freed from the demands of photosynthesizing it is also able to grow under complete shade cover, such as under patches of salal, in places where other plants cannot grow.

While growing from a common, tangled mass or rootlets, each aerial growth consists of one thick, juicy stalk, with a very tough fibrous cord in the middle. There are a number of small, scale-like, vestigal leaves. As it grows, the plant is bent at the top, so that the white flower faces downward. It is pollinated in this position. Then, as the plant ages, the top of the stem straightens out, the leaves and flower petals dry to a black color, leaving a seed pod which looks strikingly like a miniature opium seed pod.

The morphological indications of this plant is quite clear: We might say that this plant is not oriented toward the realm of light, but more accurately those processes pertaining to the upward and outward realm of light are, in this plant, shifted down under the ground. Thus the flower - which in other plants opens toward the sun and provides a plant interpretation of the sun - in this case faces downward, toward the earth where it receives its “light.”
The medical uses of the plant follow quite directly from this observation. It is used as a hypnotic, sedative, and analgesic. I.e., it affects our consciousness, which is our own inner light. What I hope to discover and elucidate in some greater detail are the specific alterations of consciousness this plant effects. Sedatives and analgesics are easily dismissed as symptomatic medicines, appropriate in their place, but holding no great curative potentials. However, if properly understood, they may have something to curative to offer in the right situation.

The aerial parts and the roots of Indian Pipe are both medicinal, although they are reported to have slightly different effects. So far I have only experimented with the aerial parts. My description below pertains to that part; I will be experimenting with the roots in the future. The taste of Indian Pipe tincture is distinctly bland, so bland that I had trouble keeping a mental lock on it. When I did focus on this flavor, I felt as if a heavy blanket were being thrown over me. Everything felt muted. As time progressed, I began to detect blank patches in my sensoria - as though a few frames were missing from the movie, or more accurately as if one corner of one frame was missing, then another corner was missing from the next. My wife and I each discovered that we were increasingly aware of areas of areas of muscular tension in our bodies, and especially in our faces. Those areas began to feel mildly painful. We then fell asleep and experienced extremely vivid dreams. We were notably lethargic into the middle of the next day.

The high level of dream activity corresponds with the awareness of muscular tension: they represent buried features of consciousness returning to awareness. This corresponds also with the plant form: in turning the light of consciousness down under the earth, we loose consciousness of the outward world, but gain consciousness of those factors properly belonging to consciousness which have been deposited into material form.

This is where I suspect the plant could be therapeutic: in treating conditions resulting from psychological tension, and more specifically, tension which the patient has difficulty even becoming aware of. This is not an issue addressed directly, at least in those terms, within CCM. Nevertheless, we can explain this as a reorientation in the consciousness aspect of the water-fire axis. Specifically, in cases where the Water and perhaps Wood have suffered drying (i.e. Metal) displacements in order to allow Fire to continue its activity, Indian Pipe will promote the transition between Fire and Metal, so that the other phases can be restored.

While this herb makes falling asleep feel really good, and makes being asleep really fun, it also leaves me feeling lethargic well into the next day - at least in the doses I have been using it (4-10 drops of my rather strong tincture). Thus this is an herb which seems to call out for usage in formula so that these effects can be moderated.  It also seems very promising for homeopathic use, for those who are interested in that style of medicine.

Yarrow

I begin with the form of the living plant. The stem is is woody, although one senses a resinous quality in it: it is not quite sticky, but feels like it might be.

The leaves are small (both short and narrow) and doubly divided into many thin rays. From each leaf axil, a number of leaves develop - one primary leaf and a number of confused and underdeveloped leaves which range from shorter leaves to partial buds. Leaves appear on the stem even in the superior region, after it begins dividing to form the flowering head. In fact, a leaf appears at the root of each division, showing the continuity between the leafing and flowering processes.

The multiply divided umbellifer-like flowering head repeats the theme of division seen in the leaves. Flowers are small and generally white or white-ish, 5-petaled, attached to small, bulbous calyx.

It grows in direct sunlight and tolerates poor, sandy soil. I find it growing at the beach, often in very sandy soil, along with horsetail (the toughest of the tough) and, surprisingly, coltsfoot.

A few themes emerge from this plant form:

First is the principle of divisions. The leaves are multiply divided, as is the flowering head. Divisions indicate a strong rhythmic process, which is quite normal to find in plant leaves, but in this case extends into the flower. Divisions can also be seen to indicate that the plant has a light, airy nature.

Second, this plant does not make a firm distinction between the leaf and flower processes. Leaves are found surprisingly far upward into the flowering head, while at the same time, the flower begins to assert itself early on, with little undeveloped buds appearing quite far down the stem.

Third, the whole plant has a dry quality: woody stem, fine leaves, small flowers, growing in dry soil. This dryness seems to be of a specific kind that indicates an inner strength. Although the leaves are light and airy, there seems to be an inner force which is held back.

When taking a tincture of yarrow, I find two distinct tastes: a sweet taste and a bitter taste. Concentrating on the sweet flavor I experience an upward opening: I become especially aware of my upper body, head and chest, I wear a gentle smile, everything seems a little lighter and easier. At other times, I feel an expansion in my chest. Concentrating on the bitter flavor I have an experience of inner strength and determination, which is almost like a gathering of the zhi (will). I am reminded of the plant’s ability to grow in very poor soil. Also speaking of determination, Pelikan notes that the plant continues to flower into the winter. It is not clear that it corresponds to a particular taste, but I also find that my guts resettle after taking the tincture. In all this I find that yarrow does not have a significant warming action.

These perceived actions correspond very well with the themes of the plant form. The light, floating, expansive quality matches the light, airy leaves which easily transitions upward into the flower. This is an expansion both upward and outward. Increased blood-flow to the surface is found in the rhythmic property of the leaves moving into the flowering process. The dense strength is like dry, inner force of the plant which grows in difficult, sandy soil and persists into difficult weather. Because this plant allows expansion but also holds onto something for the winter, I would not be too worried about yarrow over-dispersing yang.

We can expand on these parallels between living form and medical function by considering some of the more specific functions for which yarrow is used.

Diaphoretic & peripheral vasodilator - this has been well covered above.

Anti-hemorrhagic - this is the counter pole, the determined holding back

General regulator of blood (“regulates flow of blood to and from the surface, in and out of capillaries, thins and thickens blood”) - this is suggested by the strong rhythmic signature in the plant form.

Digestive tonic - this corresponds to the plant’s ability to grow in poor soil, it is able to extract nutrients in tough conditions. I have not yet uprooted a yarrow plant to examine its root structure.

Anti-spasmodic  (mostly for digestive and gynecological conditions) - this is probably indicated through the rhythmic, airy nature of the plant. It is able to restore healthy rhythms and establish healthy function in relation to the gripping of air /wood-wind forces.

Harmonizing urination: promoting urination & controlling urinary incontinence - if we regard the bladder as part of the surface, then this is not surprising to us given the plant’s regulatory action on the surface.

Here are some more specific use suggestions from the historical record.

Culpeper records yarrow for “the bloody flux, ulcers and fistulas ... It helps the gonorrhea in men and the whites in women.” Cook calls yarrow a stimulant and astringent, moderately slow in action for chronic dysentery and diarrhea, weakness of digestion with weak appetite and feeble looseness of the bowels. He also uses it for leukorrhea and urinary incontinence, as well as spitting and vomiting of blood. Lloyd and Ellingwood state that it is specific for passive hemorrhage (hemorrhage d/t SP not controlling the blood?), however Matthew Wood states that it is specific for hemorrhages with bright red bleeding and contraindicated in passive, dark, coagulated flow. If anyone has further information on this point, please let us know. Lloyd and Ellingwood also use it for irritated mucosa and deficient kidney action, with evidence of poisoning, with or w/o edema. Santillo uses it for hemorrhoids and hemorrhage of the lungs. Mills and Bone list it as a spasmolytic (for dysmenorrhea) which can reduce excessive menstrual bleeding over time, and as an anti-hemorrhagic for menorrhagia. Holmes finds it a “gentle, universal regulator of menstruation” specifically stating that it removes venous congestion in the uterus, stimulates the uterus (relieving delayed periods), and is spasmolytic for spasmodic dysmenorrhea. He also records that it is traditional for neuralgic and rheumatic conditions, especially of the upper trunk. Jeremy Ross states that yarrow can clear retained pathogens and that it has some phlegm-busting ability for both lung hyper-secretion and hyperlipidemia.

Next I will be writing about which pulses that might call for yarrow and possible formulas to use it in.

Herbal Pairing

There are a number of different possible approaches to putting Western and Chinese herbalism into conversation with one another. As has been argued already on this site, however, looking for one-to-one substitutes from one pharmacopeia to the other is probably not the way to success. Rather, we must acknowledge that every herb is different, even, typically, different members of the same genus. I'm an advocate of learning from the beauty and efficiency of the classical Chinese (mainly Shang Han Za Bing Lun) formulas and then applying some of the strategies in broad strokes to Western herbs. In other words, we may not even end up trying to replicate a specific formula, but rather use principles demonstrated in the SHZBL to create our own formulas that, like Zhang Zhong Jing's, are more than the sum of their parts. 

By way of example, take the well-known Shang Han Lun formula Si Ni San. In my understanding, it treats a pattern of slightly cold extremities due to qi constraint in the center. Unlike the Si Ni Tang or Dang Gui Si Ni Tang patient, this person isn't suffering from true cold, and may in fact have significant heat signs and be full of vitality. However, they exhibit an internal tension that prevents the qi from circulating freely, and therefore the blood circulation is also compromised. The formula consists of Chaihu, Baishao, Zhishi, and Gancao. Chaihu is of course the great disperser of constrained qi--but in order to circulate something you need to clear the way first. So I understand the strategy of this formula to be one of "relax, then circulate." The Baishao and Gancao together serve to relax the Liver, easing the tension in the center. It's a way of controlling addressing the Wood-Earth relationship: Baishao restrains Wood in its attack on Earth while Gancao bolsters Earth directly. Then the Chaihu can do its work of freeing up the qi and spreading it out to the limbs. The addition of Zhishi aids in keeping the qi dynamic moving and countering any over-cloying or over-relaxing aspect of Baishao and Gancao. 

So, how to to apply this strategy to Western herbs? In fact, the 19th Century herbalist Sameul Thomson was one step ahead of us.  He was well-known for his use of Lobelia inflata, an idiosyncratic relaxant, as well as Cayenne, an obvious stimulant. While Lobelia is no Baishao and Cayenne certainly no Chaihu, the idea behind combining the two is parallel to the operative one in Si Ni San. As in that formula, there is a principle of relaxing and one of stimulating (moving the qi or blood). In practice, the indications for the two formulas may indeed by similar, as Cayenne is specifically indicated, according to Matthew Wood, by "unequal circulation,"as expressed by out-of-sync pulse qualities, or red-purple complexion, or even varicose veins--and, presumably, by warmth in the center with cold at the periphery. Of course, the proof is in the pudding; it would be interesting to try a Cayenne and Lobelia for a Si Ni San pattern, or vice versa.

Coming finally to the topic of the title, it seems to me that building up a Western formulary should proceed from knowing individual herbs to combining them into pairs. After all, it's combinations like Guizhi-Baishao and Fuzi-Ganjiang that lie at the heart of classical formulation.

By the way, Colorado herbalist Paul Bergner has an excellent lecture available on CD on Herbal Pairing in Western herbalism.  

Hormonal profiles in gynecological conditions

Many books on western herbs describe the gynecological patterns for which various herbs are appropriate in terms of hormonal profiles: estrogen excess, progesterone deficiency, androgen excess, etc. The meaning of these terms might be standard knowledge to some of you, but not for me. The following is a record of my attempt to understand these indications. I do draw rough parallels between these hormonal patterns and familiar CM patterns. I do not mean to establish any one-to-one relationships between biomedical diagnoses and CM pattern differentiations. These comparisons are offered only as an initial attempt to reckon with the hormonal patterns. (Also it would be rather strange if these common hormonal patterns were not reflected some way in our system.)

There are three major hormone groups involved in the menstrual cycle (and gynecology generally): androgens, estrogens, and progesterone. The androgens are generated in the ovaries, adrenal cortex, and fat cells. They are precursors for the other two.
Estrogens are generated primarily in the ovaries, but also in the adrenals, and, during pregnancy, in the placenta. Estrogen is primarily generated during the follicular phase and is considered an anabolic hormone.
Progesterone is dominant during the luteal phase. It is relatively catabolic, but is in fact more regulating than one-sidedly catabolic. It promotes an increased body temperature as the body prepares to incubate a fertilized egg.
Production of both estrogen and progesterone decrease with age. The balance between the two is often more important than absolute levels, although absolute levels are also relevant. Thus we have either four or six different hormonal patterns:
Estrogen dominance
    estrogen excess
    progesterone deficiency
Progesterone dominance
    estrogen deficiency
    progesterone excess
Androgen excess
Androgen deficiency

*

Estrogen dominance is the most widely discussed hormone imbalance. It is considered the classic PMS pattern, and indeed it sounds a lot like the classic “Liver qi stagnation” pattern of dysmenorrhea.
Looking more specifically at estrogen excess, general constitutional signs include: overweight, red flushed face, and warm. Specific menstrual tendencies include: cramping, heavy bleeding. Other signs include gallbladder problems and anxious depression. That sounds a lot like a stagnant and flaring ministerial fire.
Progesterone Deficiency is less obvious. It is typified by irregular periods, clots, heavy bleeding, slow onset of menstruation, water retention, cramps, breast pain, and cyclical headaches. If progesterone is low enough it can lead to anovulation.
During his discussion of Pennyroyal, Michael Moore mentions that progesterone production can be thrown off by a cold, either in the same month or in the preceding month. That reminded me of a Wuling San pattern discussed by Dr. Zeng. Indeed almost all these symptoms, except possibly the cyclical headaches, could be directly explained by an excess or external cold affecting menstruation. There are probably other ways to look at this pattern.

Progesterone dominance is normally seen only perimenopausely, or if there has been a hysterectomy, etc. Estrogen deficiency can also occur in women who are significantly underweight.
Estrogen deficiency is marked by vaginal dryness, an increased incidence of UTIs (because of dryness also affecting the urethra), dry skin, night sweats, panic attacks, and lethargic depression. This constitutes much of the standard menopausal syndrome, which, as we know, is given a number of different CM diagnoses, primarily yin deficiency, blood deficiency, and blood stagnation. My understanding however is that treating this as a Wen Jing Tang pattern is generally more effective than as Liu Wei Dihuang Wan pattern.
Excessive progesterone is characterized by mid-cycle pain (mittelschmerz), decreased quantity of menstrual blood, increased sweating, possible urinary incontinence. Other symptoms include backache, headache, constipation, joint pain, muscular pain, nausea, vomiting, dizziness, hot flashes, palpitations, possible easy bruising, and possible insomnia in long-standing cases.
I do not see this pattern as a clear match for any particular CM diagnosis. My attempts to diagnose this pattern are further complicated by the fact that I have had difficulty discovering which of these symptoms seem to be the most characteristic. The combination of excess sweating and urinary incontinence strongly suggests that taiyang is failing to control the surface, etc. The various types of body pain can also be explained from a taiyang perspective, but I dont think this explains every symptom.
In both cases estrogen disregulations have had a shaoyang-jueyin connection, while progesterone disregulations have had a taiyang connection.

Symptoms of excessive androgenism  include periods that are irregular or absent, acne, male hair patterns (hair on the face, thinning hair on the head), chills, and PCOS.
Androgen deficiency is normally only seen around menopause. Its symptoms are rather vague: low libido, fatigue, decreased sense of well-being, and an increased susceptibility to bone disease. If those were the only symptoms, I would probably diagnose a shaoyin pattern.

Of course we should remember that hormones are not the only biomedical factor affecting menstruation. Among other things, our diagnoses must also reckon with issues such as the quality and balance of the nervous tone and possible changes in the tissue of the reproductive organs.

Please share any other information or perspectives.

Guizhi-alikes

This seems like an appropriate place to begin our discussion of particular herbs. I would like to generate a list of herbs which are similar to guizhi in various ways, undertake a comprehensive study each individually, and then make some comparisons. If anyone else would like to join me and apply their own preferred study methodology to one or more of these plants, that would be great.

First I want to make sure that I have a reasonably comprehensive list of guizhi-alike herbs.  I am thinking of guizhi as a warm, pungent, (sweet), diaphoretic, tonifying circulatory stimulant. Are there other properties of guizhi that I should be keeping in mind as I look for analogues?

Here are the herbs that I have identified so far, with some brief comments on the ways they are like or unlike guizhi: 

Cayenne - Probably the closest match to guizhi, this was a key herb in the Thompsonian / Physiomedical school, which has come down to us most clearly in the work of Dr. Christopher. In that school it was used primarily for the circulation and for “all forms of depression and atony.” Jeremy Ross uses it for “external wind-cold-damp.” It can also be used as a diaphoretic for colds, presumably including taiyang wind-strike. It is generally said to be hot, but I have tolerated it well even in times when the heat of guizhi was too much for me.

Rosemary - In the words of Peter Holmes, rosemary “permeates the whole organism with warmth and activity.” That sounds just like “yang out of the box” to me. This is a key herb in both traditional Arabic medicine and Anthroposophical medicine. Anthroposophical Medicine discovered the use of rosemary for diabetes (cinnamon is also used in western herbalism for diabetes, and for similar reasons if I understand correctly). Holmes lists a use as a diaphoretic for colds, but I haven't found anyone else describing such use. In fact, Ross states that rosemary’s action is specifically oriented toward the interior (as compared to sage). Rosemary seems to be less actively moving than Cayenne. Rosemary also seems to have some mild shaoyang properties.

Yarrow - Another heavy hitter. Yarrow is well known as a diaphoretic for colds. Matthew Wood further refers to Yarrow as the “master of the blood," saying that it regulates blood flow to and from the surface, in and out of the capillaries. This is perhaps less activating than the action of guizhi, but includes enough encouragement to circulation that I am happy to include it in this list. In fact, Wood likens Yarrow to Hong Hua, which is often paired with Tao Ren where classically one might use Gui Zhi. Yarrow also has some tonifying properties, but these seem to be more specific than we see with guizhi, cayenne, or rosemary.

Angelica Archangelica - I don’t have any experience with this herbs, and I have just started learning about it. It is a warm, pungent, sweet, diaphoretic that promotes blood movement. Wood reports that it substitutes adequately for Dang Gui; Michael Moore disagrees but suggests that with the proper paozhi that might change.

Sassafras - Another warm diaphoretic, circulatory stimulant that I don’t know much about. Sassafras is probably not suitable to serve as a general purpose guizhi-alike, but rather achieves a more pointed accentuation of a certain guizhi-like functions. Wood discusses it specifically for cases with thickened turbidity of the blood. Most other authors seem to consider Sassafras primarily as an herb for Bi syndrome, although it can also be used for colds.

Are there other herbs that should be on this list? Other thoughts on these herbs?

Individual relationship with herbs

Individual relationship with herbs is not much explored in Chinese Medicine, at least since the influence of ZZJ, whose goal was to create a system of medicine which would work reliably as long as it was applied correctly (ie if you got the diagnosis correct, the formula should work).
Indeed, one of the major reasons for using herbal formulas is that they stabilize the action of herbs, so that patient or practitioner idiosyncrasies will be less likely to derail the therapy.


I see interest in individual relationship coming from two places. First, it is part of the general interest in shamanic type work, which is part of our broader efforts to return to the wisdom of the earth, etc. Second, it may result in part from the chaotic state of western herbalism, in which almost every good practitioner ends up developing their own system out of a number historical traces. In such a situation, one will of course have their own way of working with herbs.


We should distinguish two different aspects to our relationship with herbs. The first aspect is our understanding of the herb. This refers to our ability to understand what an herb does and how it will affect a patient. This is certainly a kind of relationship, since herbs are subtle and complex, and our understanding of them can always deepen. Still, it seems that much this relationship can be shared with others by learning to verbalize and communicate our understanding of the herbs. The second aspect is the possibility that an herb might behave differently for one of us than for others because of our particular relationship with it.


As we go down this path of relationship with herbs, we should be careful with egoic reasons for fascination with our these relationships - an interest in finding our identity in the plants (rather than just allowing them to do their healing work) and/or developing the idea that we are someone special because we work with this-or-that plant.


One of my main reasons for want to work with local herbs is that I am interested in having more complete and direct relationships with the plants that I use. At the same time, I hope that this can be done without losing the systematic clarity of Han-style medicine.


Thoughts?

Two ideas on how to approach formula design

It seems clear to me that attempting to recreate ZZJ’s formulas with other herbs is a hopeless pursuit, and one that is overly limiting. There is no other Chai Hu, and if we are focused on recreating particular formulas, we will miss the special genius of the herbs we are working with. We need to go back to an understanding of physiology and pathology, learn to recognize how our herbs affect these, and build formulas based on this understanding.

I have two main ideas about how to start building formulas with these herbs. In the first project, after identifying the major (and minor) domains of physiology, we would identify an herb which most centrally represents, establishes, and restores each physiological function. An Ur-formula could then be defined as the combination of all those herbs. Other herbs would then be understood in terms of the way their function deviates from that of the core herbs. In building a custom formula, we would select the herbs which have the specific deviations appropriate to our patient’s condition and we would omit those herbs which are not needed. (We would probably want to refine this approach by identifying an Ur-formula for each aspect of physiology: identifying the sub-aspects of each of the major aspects of physiology and selecting an herb to establish that sub-function, etc.)


The second project is a little less systematic. In this approach we would just choose particular herbs that we are interested in, try to understand their actions, and then develop formulas which appropriately bring out that effect.


The first project takes its focus from the body; the second project takes its lead from the herbs that we have chosen to work with. If both projects could be carried out, we would have a reasonably complete system of herbalism. Ideas?

Here we go

This is a group blog for discussing the use of western and local herbs within the context of Chinese medicine. Share your ideas, discoveries, and experiences. If you would like to post here, send me an email.