1

Golden Chamber 1

Violet Song

2

Structure of Jin Gui Yao Lue

• Chapter 1 General Introduction• Chapter 2-17 Internal Miscellaneous Diseases • Chapter 18 External Miscellaneous Diseases• Chapter 19 Non category Miscellaneous

Diseases• Chapter 20-22 Gynecology Miscellaneous

Diseases• Chapter 23-25 Food therapy and caution

3

• 22 chapters : 205 formulas, 166 herbs– Formula without ingredients:

• Xing Zi Tang• Fu Zi Tang• Jiao Jiang Tang• Huang Lian Fen• Li Lu Gan Cao Tang

4

• 1.Discusses disease in different chapters– Multiple diseases in 1 chapter

• Similar pathogenesis, symptoms, location• Non category Miscellaneous Diseases• Departments

– 1 disease in 1 chapter ( chapter 8, 12, 14, 15)

5

• 2. Discuss syndrome and treatment in clauses by Q&A

6

• 3. Provide formulas according to syndrome– Detail in formula but brief in symptoms– Detail in syndromes but without formulas

7

• 4. Metric system of Han Dynasty– Weight

• 1 Jin (250g)= 16 Liang(15.625g)• 1 Liang = 24 Zhu (0.65g)

– Volume• Dou (2000ml)• Sheng (200ml)• He (20ml)

8

• Chapter 1 On Pulse Syndrome Complex and Transmission of the Disease of Viscera, Bowels, Channels and Collaterals

9

Prevention and causes

• 1.Prevention

• Prevent from onset: 【 1 】【 2 】• Prevent from transforming and

transferring 【 1 】• Early treatment 【 2 】

10

• 2.Treat deficient and excessive diseases differently– Liver excessive pattern——strengthen

Sp– Liver deficient pattern——sour,

scorched, bitter and sweet

11

• The example of preventive treatment is: when (superior doctor)saw liver disease, he would know liver disease will pass to spleen, so consolidate spleen first.

• It is not necessary to tonify spleen, if (patient ) has strong spleen function at all the four season

• Mediocre (middle level) doctor do not know the pass of disease. When treat liver disease do not understand to consolidate spleen, only focus on liver.

12

• Relationship of liver & spleen– Physiology – Five element– Clinic facts

13

• 3.Causes– Pathogenic factors

• Channels been attacked by pathogenic factors Zang Fu(Interior) 【 2 】

• 4 extremities and 9 body orifices Exterior 【 2 】• Intermperance in sexual life, various traumata, animal and

insect bites 【 2 】– Abnormal climate 【 8 】– Five pathogenic factors （ wind, cold, damp, fog, i

mproper food ）【 13 】

Fog Clear Upper Skin

Damp Turbid Lower Joints

Wind Big Exterior Floating pulse

Cold Small Interior Tight pulse (ji)

Food yu Grain Mouth Injures spleen

14

2.Pathogenesis

• Exuberant yang 【 10 】

15

3. Four examination samples

• Observation – Vitality and complexion –Face and nose 【 3 】– Formation 【 6 】

• Hearing and Smelling– Hearing 【 4 】– Smelling （ Chapter 7 ）

• Inquiry—— 【 16 】• Palpation—— 【 9 】• Combine 4 examinations—— 【 7 】

16

4.Treatment principles

• 1.Prevention• 2.Treat excessive pattern and deficient pattern di

fferently• 3.Exterior and interior pattern coexist 【 14 】• 4.Old (chronic) and new (acute) disease coexist

【 15 】• 5. food therapy and nursing 【 16 】• 6. Differentiation based on analysis of causes

【 17 】

17

5. Transmission and Prognosis

• Cu Jue 【 11 】• Jin yin chuang 【 12 】

18

• Chapter 2 On Pulse Syndrome Complex and Treatment of Jing, Humidity, and Ye Disease

19

Jing (Convulsion)• Concept 【 7 】• Cause and pathogenesis

– Internal ： constitutional body fluid insufficient or improper body fluid transportation

– External ： external wind cold attack or mistreatment

• Location ： tendon and sinew

• Pulse ：【 9 】

20

• Classification – Gang Jing 【 1 】 wind cold excess syndro

me • fever• no sweating• aversion to cold

– Rou Jing 【 2 】 wind cold deficiency syndrome • fever• sweating• no aversion to cold

21

• Main symptoms 【 7 】– Fever throughout the body with cold feet– Rigid neck– Aversion to cold– fever in the head– red face – blood shot eyes– tremble head– 口噤 trismus （牙关紧闭） – opisthotonus 角弓反涨

22

• Differentiation and treatment– no promoting (heavy) sweat treatment 【 7 】– If promote sweat

• Heavy sweating: entangle of cold with dampness• Heavy sweating: weaken the defensive Qi more

aversion to cold• Proper sweating: Snake pulse 蛇脉 uneven pul

se

– If pt has moxa ulcer difficult to treat Yin and blood deficiency 【 10 】

23

• Differentiation and treatment– Rou Jing:

• wind cold deficiency– Taiyang syndrome– Rigid felling through the body – deep and slow pulse insufficient of body fluid

• Gua Lou Gui Zhi Tang 【 11 】– 天花粉 tian hua fen (Radix Trichosanthis Kirilowii) clear heat

and promote body fluid production– Cinnamon Twig Decoction 桂枝汤 (Gui Zhi Tang) . regulate

Ying and Wei » 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)» 白芍 bai shao (Radix Paeoniae Lactiflorae)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)» 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)» 大枣 da zao (Fructus Zizyphi Jujubae)

24

• Differentiation and treatment– Gang Jing About to onset

• wind cold excess– No sweat wind cold excess– Scanty urine body fluid depletion – qi rush up to the chest– 口噤 trismus （牙关紧闭）

• Ge Gen Tang 【 12 】– 麻黄 ma huang (Herba Ephedrae)– 葛根 ge gen (Radix Puerariae) – Cinnamon Twig Decoction 桂枝汤 (Gui Zhi Tang)

» 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)» 白芍 bai shao (Radix Paeoniae Lactiflorae)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)» 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)» 大枣 da zao (Fructus Zizyphi Jujubae)

25

• Differentiation and treatment– Jing caused by interior heat

• Yangming organ disease with 痉 Jing syndrome excess heat over consume body fluid

– 胸满 Fullness in the chest interior excess retention– Excess heat over comsume Yin and body fluid fail to nourish

sinew» 口噤 trismus» 卧不着席 opisthotonus» 脚挛急 cramping in the leg and feet» 介齿 grinding of teeth

• Purging to rescue the body fluid• Da Cheng Qi Tang 【 13 】

– 大黄 da huang (Radix et Rhizoma Rhei) – 厚朴 hou po (Cortex Magnoliae Officinalis)– 枳实 zhi shi (Fructus Immaturus Aurantii)– 芒硝 mang xiao (Mirabilitum)

26

• Mistreatment and transformed pattern 【 3 】【 4 】【 5 】【 6 】【 8 】【 10 】

27

Shi (Humidity/ Dampness)

• Concept ： a kind of disease manifested as fever, heavy sensation in body and pain in joints.

• Cause and pathogenesis– Exterior ： external damp attack, or combined with wi

nd or cold– Interior ： constitutional yang deficiency, Sp deficienc

y

• Classification ： Exterior type and interior type• Location ： Muscle, joints

28

• Treatment principles– Internal type--dysuria and smooth stool ——diuretic”

【 14 】• Symptom and treatment for damp Bi

– painful joint and irritable (annoying/suffering ) 因痛而烦– deep pulse interior – thready pulse dampness– loose stool– difficult urine

• Treatment promote urine– Five Ingredient Powder with Poria 五苓散 wu ling san

» 茯苓 fu ling (Sclerotium Poriae Cocos)» 猪苓 zhu ling (Sclerotium Polypori Umbellati) » 泽泻 ze xie (Rhizoma Alismatis Orientalis)» 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)» 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)

29

• Treatment principles– External type——“slight diaphoresis” 【 18 】

• the whole body achy dampness inhibit Yang Qi circulation

– Should promote sweat to resolve exterior pathogen– Worse during a rainy day more humid – Dampness sticky– Sweat too much still dampness– Moderate sweating

30

• Differentiation and treatment

• Excessive Pattern– 1.Damp cold in head——nasal intake herbs

【 19 】• cold damp in upper Jiao

– pale complexion– difficult breath– headache with stuffy nose and irritable (lack of oxygen)– dampness did not interfere interior normal apatite

31

• Differentiation and treatment• Excessive Pattern

– 2.Exterior Damp cold ——Ma Huang Jia Zhu Tang (promote sweating to release exterior, expel cold and damp) 【 20 】

• exterior cold damp – body ache and irritable

• no fire treatment• 麻黄加术汤 Ma Huang jia Zhu Tang

– Ephedra Decoction 麻黄汤 Ma Huang Tang » 麻黄 ma huang (Herba Ephedrae) » 桂枝 gui zhi (Ramulus Cinnamomi Cassiae) » 杏仁 xing ren (Semen Pruni Armeniacae)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)

– 白术 bai zhu (Rhizoma Atractylodis Macrocephalae) 苍术 cang zhu (Rhizoma Atractylodis)

32

• Differentiation and treatment• Excessive Pattern

– 3. Exterior Wind damp——Ma Xing Yi Gan Tang (expel and resolve exterior damp) 【 21 】

• causes and treatment of wind damp disease – body achy

– fever severe in the late afternoon

– causes expose when sweat, over take cold food

• 麻黄杏仁薏苡甘草汤 ma huang xing ren yi yi gan cao tang – 麻黄 ma huang (Herba Ephedrae)

– 薏苡仁 yi yi ren (Semen Coicis Lachryma-jobi)

– 杏仁 xing ren (Semen Pruni Armeniacae)

– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

33

Ma Huang Jia Zhu Tang Ma Xing Yi Gan Tang

Pattern C-D exterior excessive W-D exterior excessive

Cause &Pathogenesis

C-D obstruct yang qi in exterior

W-D obstructed yang qi in exterior and transformed into heat and dryness

Symptoms Heavy fixed pain, fever no difference in morning or evening, aversion to cold, no sweating

Dragging pain, can stretch properly, fever worsen in afternoon 3-5pm and better in morning.

Treatment Warm pungent herbs to expel cold and damp

Dispersing and eliminating exterior damp

Compatability Ma Huang 3 liang, Gui Zhi 2 liang

Strong pungent warm

Ma Huang 0.5 Liang, Yi Yi RenSlight pungent cool

34

• Deficiency Pattern– 1. Exterior wind damp pattern——Fang Ji Hua

ng Qi Tang (strengthen qi to consolidate exterior, eliminate damp) 【 22 】

• wind damp attack with exterior (Wei qi) deficiency– Floating pulse Wei Qi deficiency– Heavy sensation over the body dampness– Spontaneous sweating– Aversion to wind

• 防己黄芪汤 fang ji huang qi tang – 防己 fang ji (Radix Stephaniae Tetrandrae) – 甘草 gan cao (Radix Glycyrrhizae Uralensis)– 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)– 黄芪 huang qi (Radix Astragali Membrnacei)

Fang ji + bai zhuStrengthens vital qi

35

• Deficiency Pattern– 2. Wind damp pattern

• 2-1.Exterior yang deficiency – (1). Wind>Damp—Gui Zhi Fu Zi Tang (warm channel, stren

gthen yang, expel wind, resolve damp) 【 23 】– wind damp with exterior Yang deficiency

» severe body achy, even can not make turns» no vomiting, no thirsty dampness did not interfere stoma

ch » floating and weak pulse

– 桂枝附子汤 Gui Zhi fu zi Tang » 桂枝 gui zhi (Ramulus Cinnamomi Cassiae) » 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)» 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)» 大枣 da zao (Fructus Zizyphi Jujubae)

– (2). Damp>Wind—Bai Zhu Fu Zi Tang (eliminate damp, warm channel) 【 23 】

– firm stool ( not constipation) – no difficult urine

» Take out 桂枝 gui zhi (Ramulus Cinnamomi Cassiae) » add 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)

36

• Deficiency Pattern– Wind damp pattern

• 2-2. Exterior & Interior yang deficiency, Wind=Damp—Gan Cao Fu Zi Tang (warm channel, strengthen yang, expel wind, eliminate damp) 【 24 】

– wind damp with both exterior and interior Yang deficiency » severe joint radiating pain» refuse to be touched / tender to touch» sweating» shortness of breath» difficult urination» aversion to wind» edema

– 甘草附子汤 gan cao fu zi tang » 甘草 gan cao (Radix Glycyrrhizae Uralensis)» 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)» 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)» 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)

37

• Yellow complexion due to damp heat 【 15 】– damp heat jaundice

• the whole body ache• fever• jaundice like been smoked damp severe than

heat

38

• Mistreatment and transformed pattern– 【 16 】 dampness constitution patient affect by exterior cold da

mp• sweat only on the head dampness restrict Yang releasing rush

up to head (weak)• stiff back dampness inhibit meridian Qi cieculation• prefer heavy clothing and warmth Yang deficiency• if purging further impair Yang

– dry heaves stomach– fullness in the chest– difficult urine– thick tongue coating– Thirst but do not want to drink– Dry mouth– Irritable thirst / hea

– 【 17 】 dampness disease easy to inhibit and damage Yang • if purging severely impair Qi and Yang • forehead sweating deficient Yang upward escaping• panting

• fatal case– frequent urine– continuous diarrhea

39

Ye

• Concept ： summer heat attack 【 25 】 – symptom and treatment for summer heat ( 中

暍 zhong ye) • impairment of both Qi and Yin

– fever, chills– heavy and body achy– wiry, thready and hollow pulse– more chill (quivering after urination)– cold hand and feet– fever on exertion – Dry teeth

40

• Differentiation and treatment– 1. Yangming excessive heat damage fluid——Bai Hu

Jia Ren Shen Tang (clear summer heat, promote body fluid, strengthen qi) 【 26 】

• summer heat impair Qi and Yin – sweat – aversion to cold – fever– Thirst

• 白虎汤加人参 bai hu jia ren shen tang – White Tiger Decoction 白虎汤 bai hu tang

» 石膏 shi gao (Gypsum)» 知母 zhi mu (Radix Anemarrhenae Asphodeloidis)» 粳米 jing mi (Nonglutinous Rice)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)

– 人参 ren shen (Radix Ginseng)

– 2. Summer heat attack with damp——Yi Wu Gua Di San (eliminate damp and dispel water) 【 27 】

41

• Mistreatment and transformed pattern 【 25 】– if sweating further impair Yang

• more aversion to cold

– if using warm needle more impair Yin and body fluid

• more fever

– if purging more impair Yin and body fluid • difficult urination