Wu Zi Yan Zong Wan for Infertility

五子衍宗丸 Wu Zi Yan Zong Wan is an interesting formula I'd like to share. It's not found in either Bensky & Barolet or the Chen & Chen formula books, nor is it mentioned in Jiao Shu-De's formula book translated by Wiseman et al. (I don't have the 2nd edition of Formulas & Strategies so it may be in that book).

Wu Zi Yan Zong Wan consists of five herbs, all seeds:

菟丝子 Tu Si Zi
枸杞子 Gou Qi Zi
覆盆子 Fu Pen Zi
五味子 Wu Wei Zi
车前子 Che Qian Zi

I first encountered this formula in the Yosan clinic as an intern. My supervisor, Dr. Jin, used it as a base formula to treat infertility in a woman in her early 30's. The full formula had more than 18 herbs, but Wu Zi Yan Zong Wan was where we started. Without any English-language texts that I know of to go on, I'll take a stab at the functions of this formula.

Tu Si Zi tonifies Yang and is often used in fertility formulas. Gou Qi Zi tonifies the Liver and Kidney, Fu Pen Zi and Wu Wei Zi are both in the category of 固涩 gu se, translated as "stabilize and bind" or "astringe". Che Qian Zi is a draining herb but there are several interesting paragraphs in the 2nd edition of the Bensky et al Materia Medica on the use of Che Qian Zi as a Kidney tonic, particularly when used together with herbs that astringe. I won't retype it all here - it starts on page 278, take a look.

Study Finds Chinese Herbal Formula Effective for Endometriosis

Picture: Amber, one of the main ingredients of Nei Yi Wan No picture? Click here.

Nei Yi Wan has just three ingredients, according to ITM: turtle shell (鳖甲 Bie Jia or 龟板 Gui Ban), vinegar-treated rhubarb (醋炒大黄 Cu Chao Da Huang), and succinum (琥珀 Hu Po). From Reuters:

"I think the positive message is that Chinese herbal medicine may offer equivalent benefits to conventional medicine but with fewer side effects," lead researcher Andrew Flower, of the University of Southampton in the UK, told Reuters Health.

Here's a link to the original study, from the Cochrane Library: Chinese herbal medicine for endometriosis

Finally and most interesting to people in the TCM world, an exhaustive article by Subhuti Dharmananda of the Institute of Traditional Medicine, detailing the many different Chinese herbal approaches to endometriosis: Chinese Herbal Therapy for Endometriosis.

A1/H1N1 Flu Prophylactic

金银花 Jin Yin Hua, 板蓝根 Ban Lan Gen, 甘草 Gan Cao, 薄荷 Bo He

The four herbs above are currently being used in China to make a drink that prevents the flu due to H1N1 virus. Below is the full story from CCTV.com:

A type of Traditional Chinese Medicine (TCM) to prevent the A1/H1N1 influenza, dubbed the “flu prevention drink”, goes on sale on July 2, in every drugstore and hospital dispensary for TCM medicines.

The prescription was formulated and issued by the Committee of Experts for Flu Prevention and Control under Beijing Administration of Traditional Chinese Medicine to cope with the A1/ H1N1 influenza and the recent hot weather. The daily adult prescription consists of 3 grams of Honeysuckle, Woad root, Liquorice root and Peppermint. After it is mixed with boiled water, it can be gargled or drunk as a tea substitute. It can be used for seven consecutive days. According to experts from the administration, the prescription can be used by people of all ages, children and even pregnant women. If people don’t like the taste, they can add rock sugar or honey to it, without altering the effect of the medicine. It can be purchased in every drugstore or hospital dispensary for TCM medicines and a daily dose will only cost little more than one yuan.

Viral Meningitis and TCM

Here are some FAQ's about viral meningitis from the CDC:

Q:What is viral meningitis?
A:Meningitis is an inflammation of the membranes ("meninges") that cover the brain and spinal cord. Viral infections are the most common cause of meningitis; bacterial infections are the second most common cause. Other, rarer causes of meningitis include fungi, parasites, and non-infectious causes, including those that are related to drugs.

Q:Can I get viral meningitis if I’m around someone who has it?
A:If you are around someone with viral meningitis, you may be at risk of becoming infected with the virus that made them sick. But you have only a small chance of developing meningitis as a complication of the illness.

Q:Is viral meningitis a serious disease?
A:Viral ("aseptic") meningitis is serious but rarely fatal in people with normal immune systems. Usually, the symptoms last from 7 to 10 days and the patient recovers completely.

Q:How is viral meningitis treated?
A:There is no specific treatment for viral meningitis. Most patients completely recover on their own within 2 weeks. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

No specific treatment... that's too bad.

But wait! I hear the sweet, sweet voice of Zhang Zhong Jing telling me that there must be a way to alleviate the symptoms and encourage faster recovery from such a painful disease process.

I had to find out for myself. Really.

Two days of a splitting headache with the sensation of my neck and back wanting to explode, and I found myself in the care of Dr.Yu Hong Chen at the Yo San University Clinic. She's pretty much the most awesome person on Earth. As an intern, I was witness to her genius when she constructed custom formulas for patients that brought them back from hopelessness into well-being. Now it was my turn to be the patient, and she did not disappoint.

The diagnosis? Tai Yang he Shao Yang Bing. Straight from the Shang Han Lun.

The formula? Gui Zhi Tang Jia Xiao Chai Hu Tang, with Ge Gen and a couple of other herbs to address my secondary symptoms.

I also got an amazing acupuncture treatment, working on the Du and Gallbladder channels, followed by some bleeding-cupping along those channels and the Urinary Bladder. Worked like a charm. I feel mostly human again! Life is great!

Dissociative Fugue: Is Your Hun Out Partying?

Jason Bourne, Matt Damon's fictional character from the movie series Bourne Identity, is the most famous 'person' who suffers from this rare amnesia. The name Bourne was taken from Ansel Bourne, the first recorded case of the dissociative fugue in 1887.

Dissociative fugue is a very rare form of amnesia, whereby the person loses complete memory of their identity and personality, but have full mental functioning for all other purposes. It's so fascinating, especially since the fugue state is associated with travel, and people sometimes end up across continents, not knowing how they got there. Psychiatrists attribute the onset of a fugue state with extreme stress, resulting in the person 'running away' or 'hiding' from their problems. In a recent story, a woman in a fugue state was able to go into an Apple store and check her email, but not remember who she was or what she was doing. She was eventually found three weeks after she went missing, floating in the water miles from where she lived.

In modern TCM theory, there is not one soul or consciousness, but five separate and distinct ones, each housed in the five major organs of the body. The 神 Shen, 意 Yi, 魄 Po, 志 Zhi, and 魂 Hun have their independent characteristics, but work together to form the mental-spiritual aspect of an individual.

From The Foundations of Chinese Medicine, by Giovanni Macciocia:

The Mind (Shen) is the consciousness that is responsible for thought, feeling, emotions, perceptions, and cognition. The Mind resides in the Heart and it is primarily for this reason that the Heart is called the 'Emperor' in relation to all the other Internal Organs. As the Mind is the consciousness that defines us as individual human beings and that is responsible for thinking, willing and feeling, the Heart plays a leading role among the Internal Organs.

The Intellect (Yi) is responsible for memory, concentration, thinking, logical thinking, capacity for studying, and application. In pathology, the capacity for thinking may become pensiveness, overthinking, obsessive thining, fantasizing or brooding. The intellect resides in the Spleen.

The Corporeal Soul (Po) is responsible for physical sensations, feelings, and generally somatic expressions. It resides in the Lungs and it plays a role in all physiological processes of the body. It is formed at conception, it is Yin in nature, and, at death, it dies with the body returning to the Earth. The Corporeal Soul is described as the 'entering and exiting of the Essence (Jing)'.

The Will-power (Zhi) resides in the Kidneys and it is responsible for will-power, drive, determination and constancy.

The Ethereal Soul (Hun) is a soul that is Yang in nature and that, according to Chinese culture, enters the body three days after birth and is imparted to the baby by the father. After death, the Ethereal Soul survives the body and returns to a world of spirit. The Chinese character for Hun confirms the spiritual, non-material nature as it is made up by the radical gui, which means 'spirit' or 'ghost', and the radical yun, which means 'clouds'. The Ethereal Soul resides in the Liver and particularly in the Blood and Yin of the Liver where it should be 'anchored'; if Liver-Blood is deficient and the Ethereal Soul is not anchored in the Liver, it 'wanders' at night and causes the person to dream a lot. The Ethereal Soul is described as 'the coming and going of the Mind (Shen)'.

So if a person were to lose complete memory of their identity, which soul would be the one affected, and how would Chinese medicine proceed in the treatment of an individual who has had a fugue state experience?

My guess would be the Hun. If the Shen were to go on vacation, all mental faculties would cease. If the Po were to leave the body, the person would die, since it is in charge of all things physical and only returns to Earth upon death. The Hun is the only one known for 'wandering', and is the one most immediately affected by stress and deficiency. A person in a dissociative fugue state could be said then to be suffering from a case of their Hun going out to party during the day when it should be at home in the Liver. It's like being in an extended dream that ultimately can't be remembered.

To treat this individual, one would have to Nourish Liver Blood and Yin, and Soothe the Liver. Without a look at the tongue and pulse, I would guess that the base formula for such a condition would be 酸枣仁汤 Suan Zao Ren Tang, with the addition of herbs like 熟地黄 Shu Di Huang, 夜交藤 Ye Jiao Teng, 白芍 Bai Shao and 当归 Dang Gui to more strongly tonify Blood. 柴胡 Chai Hu could be added and 赤芍 Chi Shao could substitute for Bai Shao if there is more Qi stagnation, and 茯神 Fu Shen for 茯苓 Fu Ling to more strongly calm the shen. 远志 Yuan Zhi and 石菖蒲 Shi Chang Pu can be added to calm the spirit and clear the head, in the same way they're used in 定志丸 Ding Zhi Wan.

Acupuncture could include points like 曲泉 LV-8, 太冲 LV-3, 三阴交 SP-6, 足三里 ST-36, 手三里 LI-10, 四化 Four Flowers, 神堂 UB-44, 魂门 UB-47, and 四神聪 Si Shen Cong. Other points would be added or subtracted according to tongue and pulse and symptom pattern.

Give Your Patients More Herbs at a Higher Dose and See Better Results

Here's a quote from one of my favorite bloggers, Eric Brand, on one of my favorite subjects, the chronic underdosage of herbs here in the U.S. All emphasis is mine and does not appear in the original.

It could be said that the greatest overall differences in Chinese herbal medicine between the US and Asia relate to dosage. In Asia, raw herbs are generally taken by decoction at a dose of one pack per day, whereas in the Americas, one pack of raw herbs is often taken for two days. Despite the fact that North American patients tend to have a higher body weight than their Asian counterparts, they often consume Chinese herbs at a dosage that is essentially half of the traditional dose.

In a similar paradox, Taiwanese granules are often prescribed at doses that are a fraction of the doses used in Taiwan. Part of the confusion seems to lie with the labeling information, which is required by US law to state a specific dose. Given the litigious nature of American society, most companies are understandably cautious in their dosage recommendation, so the dosage listed on the label is often well-below the dosage that is regularly used by a trained practitioner. Furthermore, most loose granules have the Asian labeling on concentration ratios removed for the US market, so practitioners are often at a loss to know how the powder corresponds to the raw herbal weight.

Taiwanese granules are generally used at a dose of around 18g/day in Taiwan, but many practitioners in the US use doses as low as 4—6 g/day. Perhaps the majority of Western practitioners prescribe granules in a dose range of around 6—12g/day, but many practitioners remain uncertain about how proper granule dosing is determined. Additionally, many instructors in American schools come from China but teach in schools that stock Taiwanese granules, which are more prominent on the American market. The granule product is different than what they used in their training in China, and teachers cannot effectively educate students on granule dosage because the standard raw dose equivalent is absent from the label. Consequently, practitioners often rely on the label information, which is essentially just an overly cautious (read: “please don’t sue me”) guideline that is required by FDA laws.

As I work in the Yosan clinic, this continues to amaze me. Most of us are giving our patients less than a half dose of herbs. I have to admit I don't always insist that my patients take one bag per day of raw herbs. Whenever you see a patient there is a calculation that takes place - how committed to getting better is this person? How much are they buying what I'm saying? If they really want to get better and have trust in me as a practitioner, I'll generally prescribe five bags of herbs, one for each day, with one day off before the next weekly check-up. If they're one of these people that don't really believe Chinese medicine can help them, or they were cajoled into getting an appointment by a relative or a friend, I might give three bags of raw herbs, with the idea that some herbs is better than none.

The best patients are the ones that are ready to change their lives and just need some help doing it. I saw some amazing results with heavy smokers with life-long asthma using acupuncture and variations on 白果定喘汤 Bai Guo Ding Chuan Tang, but these people were also doing yoga every morning, going running, changing their diets, and had the support of partners and friends. Without Chinese medicine, these people might be the ones who said "I tried everything but I still need my inhaler" - their kidneys too weak, their lungs too encumbered with phlegm. For one of my patients, we got him from using his inhaler up to ten times a day down to once or twice a day within a week, and shortly after that he didn't need the inhaler at all. This patient of course took one bag of raw herbs per day. With a half dose, who knows how effective it would have been?

This is something I feel strongly about, and hopefully I've convinced a few TCM students it's an important subject that needs attention. Supervisors are another matter. Some clinical supervisors that were educated in California are so used to using one bag of raw herbs for two days that suggesting otherwise gives them a shock. "Why you brat," they seem to be thinking, "I've been doing this since 1987! I think I know what I'm doing!" Supervisors who were educated in China might be gung-ho about herbs, or they might just want to fit in and not rock the boat too much.

In either case, most supervisors I've encountered give wide latitude in dosing herb granule extracts. Using the method detailed here, you can figure the dose yourself and tell your patient just how to take it. You'll quickly find that most patients need 100 grams to last at least a week.

p.s. It almost goes without saying that a higher dose of herbs means absolutely nothing if your diagnosis is incorrect... it's just important to understand all the weapons at your disposal.

How To Cook Chinese Herbs

In the modern age, there are many ways to take your Chinese herbal formulas. But preparing your herbs the traditional way does have some advantages.

1. Strength. Modern technologies are all aimed at reproducing the strength of stove top cooking. While they have come close, they still can't equal what you can do in your kitchen.

2. Control. With the herbs right in front of you, you know exactly what goes into your herbal tea. Your acupuncturist may give you special instructions on whether to cook your herbs for a long time or a short time, your even whether to cook some ingredients separately.

3. Time. The cooking process forces us to slow down from the busy pace of our lives and concentrate on doing something good for ourselves. Instead of popping a pill and forgetting about it, we become more engaged in our recovery to good health.

4. Aroma. Now, this might not be a positive for some people. But we absorb just as much information from our sense of smell as we do from our other senses, and the aroma of your herbs cooking on the stove signals your body that something profound is about to happen.

5. Steam, Dregs. There are many uses for Chinese herbs other than drinking the tea. For acne or skin-related formulas, your acupuncturist may tell you to steam your face over the herbs (be very careful not to burn yourself if you do this - wait until the tea has cooled significantly, enough so that you can safely put your face or other affected body part over the steam). Or they may suggest using the cooked herbs themselves, rather than the tea, as a poultice on a particular acupuncture point or region of the body. Be sure to follow your acupuncturist's directions in this regard.

How to Cook Chinese Herbs

Keeping in mind that your Chinese medicine doctor may have special instructions for you, here are some general guidelines on cooking herbal teas.

1. Put the herbs into a pot. The best type of pot to use is a traditional ceramic herb pot. Enamel ware such as Le Creuset is also a good choice, and stainless steel will work fine as well. Just be sure to avoid aluminum pots as the herbs may react with some of the constituents of the pot.

2. Cover with cold, clean water. How much water should you use? A general guideline is two fingers above the level of the herbs, but you may have some herbs that float or very bulky, grassy herbs, in which case you can use about 5 cups.

3. Let soak for at least 30 minutes.

3a. Some people advise to then pour off this soaking water and cover the herbs again with more cold water. If you do this, be careful that you don't lose any herb material down the drain. Remember to not soak any powders as these will mix with the water and be poured off.

4. Turn the heat to high and bring to a boil.

5. Once boiling, turn down the heat to medium and simmer for about 25 minutes, or until you have about one cup of liquid left, and then pour off the decoction (use a strainer to catch any herb matter). If you are new to cooking Chinese herbs, check the water level occasionally to make sure you don't boil the herbs dry. If you do happen to burn the herbs, throw them out and start again with a fresh packet - burning the herbs completely changes their character.

6. Let the decoction cool a bit, and drink while still warm.

6a. Some herb doctors will tell you to cook the herbs again, using the same herbs but more water, BEFORE you drink your herbs. Then you combine the results with the first batch and divide them. You will then have two doses, one for the morning and one for the evening. The idea is that the second cooking extracts more active ingredients than could be achieved by simply cooking it once for a longer period of time. However some people think this is unnecessary. Ask your Chinese medicine professional which procedure to follow.

7. Do not mix any sugar or honey with your herbs, unless your Chinese medicine doctor has instructed you to. If the taste puts you off, you drink something sweet or have a small spoonful of honey directly afterwards.

8. Congratulations! You have just participated a very old tradition that still brings great benefit to our modern lives.

Meet the Herbs: Bai Zhu

Chinese: 白术
Pin Yin: Bai Zhu
Pharmaceutical: Actractylodes Macrocephalae Rhizoma
English: white atractylodes rhizome

Bai Zhu is bitter, sweet, and warm, and travels to the Spleen and Stomach meridians. The photo above shows the flower, and inset, the prepared pharmaceutical product. Chinese herb preparation generally involves washing, slicing and drying, with various other steps along the way. Once the herb has been prepared in this way it can be stored for quite awhile at room temperature.

Bai Zhu is classified as a qi tonic, which generally means that it increases the amount of usable energy in the body. Because it primarily affects the Spleen and Stomach, it raises the digestive energy.

Bai Zhu is one of the four herbs in 四君子汤 Si Jun Zi Tang (Four Gentlemen Decoction) - the other three being 人参 Ren Shen, 茯苓 Fu Ling, and 炙甘草 Zhi Gan Cao (ginger, poria, and honey-fried licorice root). Si Jun Zi Tang is an important building block for many other tonic formulas, such as 八珍汤 Ba Zhen Tang, 十全大补汤 Shi Quan Da Bu Tang, 参苓白术散 Shen Ling Bai Zhu San, and 补中益气汤 Bu Zhong Yi Qi Tang. Therefore Bai Zhu is used frequently in a safe and effective way in many Chinese herbal formulas.

Bai Zhu is available in raw and granule powder format from Fat Turtle Herb Company.

Case Study: Me!

Pre-cooked liquid decoction in individual dosage packs from Fat Turtle Herb Company







From the taste-of-your-own-medicine department, I bring you the success story of my current herbal formula. (Note: This post is a bit more technical than most and skips over explaining any TCM basics - if you have questions please leave a comment.) Starting a few weeks ago, I developed a rash on my stomach and legs - essentially the Liver and Gallbladder channels. In general I tend to express rashes when I have emotional stagnation. Emotional stagnation, in my case, leads to overconsumption of sugar, coffee, alcohol, and greasy, fatty foods.

The aforementioned goodies in small amounts will soften the Liver, but in large amounts will increase the amount of heat and dampness in the body. Then I went home for Christmas, where there was plenty of sugar and alcohol and fatty food and emotional stagnation.

I used the opportunity of a family outing for dim sum to get an exam and an herbal prescription from one of the herb stores in Oakland Chinatown (Hong Kong Trading, 449 9th St. at Broadway if you're interested). I poked my head in and asked "医生在吗？" (is the doctor here?) The guy at the counter pointed to the back, and I went and sat down at a desk. A few minutes later the same guy (the doctor, as it turns out) came back, sat down on the other side of the desk, and with a friendly smile started asking me questions in Chinese.

How I should have responded: "医生对不起，我只会说一点中文。可以我给你看？" (Doctor, my apologies, I only speak a little Chinese. Can I just show you?) - which is actually something I know how to say.

What I actually did: laughed nervously, said "uhh, I don't really speak Chinese," and lifted up my shirt to show him my rash. Sigh. He looked a little bit shocked, possibly because my accent when asking for the doctor was quite good, but also possibly because he didn't expect me to start acting like an undergrad on spring break in his herb store.

As a result of the language difficulties, we had a four-way translation - the doctor would ask questions in Cantonese to one of the other women who worked in the store, who would then ask Nini the same question in Vietnamese. Nini would then ask me the question in English, I would answer in English, and the whole thing goes in reverse. Fortunately experienced doctors are efficient when it comes to questioning and gather more from the tongue and pulse. The tongue he glanced at for a few seconds, but the pulse he took for a few minutes.

He told me to avoid beef, shellfish, spicy food, and deep fried food.

"What about alcohol?" Nini asked the lady. The woman translated for the doctor, who then shook his head and made a tsk-tsk noise. No no no, came the answer. "See?" said Nini.

"咖啡行不行" (how about coffee?) I asked the doctor directly, trying to preserve some tastiness in my life. Coffee's okay, just don't overdo it, he told me.

Then he proceeded to write an herbal formula in long, looping Chinese characters which I had no hope of deciphering even if I had the chance to examine them closely. Having been to a few herb-store doctors, I feel like that's part of the trade secrecy: even if someone were to steal your notebooks, they can't read your handwriting.

After writing the formula, he then went back to the counter and assembled it, with help from some other employees. Fortunately I was able to ID all the herbs and reverse-engineered it to pinyin, but then lost the page I wrote it all down on. However, I do remember some key herbs:

玄参 Xuan Shen
生地 Sheng Di
牡丹皮 Mu Dan Pi
土茯苓 Tu Fu Ling
金银花 Jin Yin Hua
丹参 Dan Shen
红藤 Hong Teng
郁金 Yu Jin
枳实 Zhi Shi
地肤子 Di Fu Zi
白鲜皮 Bai Xian Pi
泽泻 Ze Xie
柴胡 Chai Hu
甘草 Gan Cao

That's 14 herbs I can remember - there were actually 21 altogether. But you can see his idea: Blood Heat, Blood Stasis, Qi Stagnation.

I've been taking the formula for a few days now, and the rash has already subsided quite a bit. The redness is gone and it no longer itches. The formula actually doesn't taste that bad - it's more sweet than bitter, definitely cold energetically.

I've also noticed that it's harder than it seems to stick to a restricted diet. I know there are things I should avoid, but until a doctor told me I essentially have been eating whatever I want. I didn't want to take all these herbs and have it be for nothing! I don't think I'll be on this diet permanently, but it's still a bit of a hassle. Something to remember when asking patients to change their diets.

As you can see from the picture, I cooked the herbs all at once and packaged them using the Fat Turtle herb cooker. This is so convenient when taking a large formula or a long-term formula. Whenever it's time to take herbs, I just cut one open and drink it. Total time spent on herbs per day: 10 seconds. No refrigeration is required. Fat Turtle Herb Company can cook herbal formulas for you and your patients - click here to learn more or send an email to orders@fatturtleherbs.com.

My Foot

I know we promised you all diabetes, all the time for the month of November, but I have to take this rare opportunity to present you with a fresh case study.

My foot.

So, I was sparring in Kenpo class last Wednesday night when the most unfortunate thing happened. My right foot was forward, my left foot behind, and I was gearing up to punch this guy. As I was lunging forward, but before making any contact with my opponent, I heard a loud "SNAP" and I fell to the floor.

This is what happened:





It's amazing all the different colors the body can make!

I believe it's a severe ligament tear, though I haven't gotten the MRI to prove it. It's definitely not a broken bone, and nothing is completely severed as far as I can tell. The night it happened, I was fortunate enough to be near the clinic while it was still open, and Keven Uchida - a wonderful supervisor and orthopedic specialist - took a look at it. I also showed it to three different MD's who agreed that it's probably not broken. So don't worry. I know those of you out there who know me well and are concerned that I'm not taking the proper precautionary measures can rest assured that I'm not self-diagnosing... not entirely, anyway.

But I am self-treating, and it's been great!

Day One:

• 30 minutes on ice immediately after injury
  
• E-stim acupuncture at SI-3 and SI-4 on contralateral for 15 minutes
• Dr. Brady Chin's dit da jow all over top and bottom of foot
• San Huang San plaster made of huang qi, huang lian, da huang, pu gong ying, hong hua, and zhi zi powdered, mixed with just enough green tea to make a thick paste. Wrapped my foot loosely in gauze roll and medical tape overnight
• Five Photos Brand hit pill (these always make my heart a little thumpity, but work like a miracle every time)
  

Day Two:

• Woke up with no swelling and no bruising, but my skin around my foot was red. Removed plaster, and within five minutes my foot started to balloon. Reapplied dit da jow til dry, then another coat of plaster and gauze. The swelling went down immediately
• Needled contralateral hand sensitive points near SI-3, SI-4, LU-10, Luo Zhen, Yao Tong Xue, and SJ-4. Manually stimulated for 20 mins.
• Change of plaster and gauze overnight
• Jin Gu Die Da Pian patent pills for the pain
  

Day Three:

• Definite bruising! All blurple in color
  
• Acupuncture treatment at the clinic with Kumiko Yamamoto (wonderful intern, by the way). E-stim acupuncture with same points on contralateral hand. Additional points without e-stim: ST-36, SP-9, SP-10, LV-8, GB-34, and Yin Tang
• Epsom salt soak
• Plaster and gauze
• Jin Gu Die Da Pian
  

Day Four:

• More purple and green in color
  
• Epsom salt soak
• Moxabustion all around foot for 30 minutes
• Dit da jow
• Jin Gu Die Da Pian
  

Day Five, Day Six, and Day Seven

• I stopped using the plaster because my foot wasn't swollen; it had effectively kept the swelling to a minimal, and then no swelling at all. The bruising seemed to reach its climax around day six (the pics are from day five), and is now lightening around the edges
  
• Moxabustion 2 times a day over affected area on foot, and on reflective areas on the opposite foot. Also ST-36, SP-10, GB-34, UB-60, KD-1 on affected foot/leg.
• Acupressure on contralateral hand
• Jin Gu Die Da Pian
  

And here I am on day eight! I can move my foot fairly freely in all directions, and wiggle all my toes, but am still unable to put any weight on it. Throughout the week, I've been doing strengthening exercises with all my new-found spare time, flexing and extending through the ball of my foot and ankle. I can stand on it just long enough to pick my other foot off the floor, as long as I'm holding on to something for balance.

There is no swelling, but there's a significant amount of bruising all along the top of my foot, as though I've spilled a bucket of ink on it or something. It's kind of purple, kind of blue, kind of green all in one. It still hurts, but at least I'm sleeping through the night now and can get around on my crutches without it hurting due to movement.

All in all, a steady and fairly speedy recovery. I'm planning on using a tendon soak from here on out, coupled with the moxa, acupuncture and exercises. I'm not taking the pills anymore, since they're really dispersing and moving, and hope to be back on my feet in another week.

If you have any questions about the herbs I used or where to find such wonderful remedies, feel free to contact us!

Herbal Dosing

Yesterday we went over raw herb dosing (one bag per day is the full dose - on the West Coast that seems to be halved). Now let's go over extract powder dosing. Today's post is a little more technical and student-oriented, but if you're a patient it's important for you to understand these issues as well.

Concentrated herbal extracts have made herbs much easier to prepare and take. Instead of the hour-long process we saw in yesterday's video, you just take your special pre-measured spoon, measure out a few scoops, mix with boiling water et voila! Your herbs are ready in liquid form, as easy as instant coffee.

The herb powder is generally in a 5:1 concentration, meaning for every 1 gram of powder herbs, it should be the equivalent of getting 5 grams of raw herbs. So, how much powder should you take?

Many practitioners and students prescribe 3 scoops, 3 times per day no matter what the formula. This is a mistake! 3 scoops 3 grams a day is not the same as boiling a bag of herbs per day or even the same as boiling a bag of herbs every other day - because of the nature of concentrated granules, each dosage should be unique.

I'm going to show you how to dose concentrated herbal powder - a procedure I had no idea about until Fritz Hudnut (supervisor at the Yosan clinic) showed me how to do it.

1. Write your herbal prescription as normal, using standard raw dosages. As an example, let's use the following:
   Chai Hu 9
   Dang Gui 9
   Bai Shao 15
   Bai Zhu 9
   Fu Ling 12
   Shu Di 15
   Shan Zhu Yu 12
   Shan Yao 12
   Mu Dan Pi 9
   Ze Xie 9
   Sheng Jiang 6
   Bo He 3
   Gan Cao 3
   
2. Now, add up all the daily raw dosages: 123 grams. If you were taking a raw formula, this is how much herbs you would need to take.
   
3. Now divide by the concentration ratio of the herbs you use. Let's assume it's 5:1. 123/5 = 24.6. Let's round off to 24 grams - that's how much powdered herbs you should be using per day.
   
4. Using a standard 1 gram spoon and taking three doses a day, that works out to 8 spoons 3 times per day. It also means that, if you give your patient a 50 gram bottle of herbs, it will last all of two days.
   
5. Suppose you wanted to give them a half-dose: just divide your final result by two. 24/2 = 12 grams, or 4 spoons 3 times per day.

Introduction to a Chinese Herbal Pharmacy Part Two

We continue today with a short explanation of Chinese herbal formulas, from the same people who brought you yesterday's video.

Chinese Medicine Pharmacy

Take a look at this gorgeous Chinese medicine pharmacy. I don't know where this picture came from, but it's a nice example of a beautiful herbal pharmacy. A friend of mine went to China earlier this year and saw many pharmacies just like this.

If you're unfamiliar with Chinese herbal pharmacies, it's worth a trip to your local Chinatown to see one in action. You probably won't see one as nice as the one in this picture, but the idea is the same. You walk in with your prescription from your herbalist and hand it to someone behind the counter. They'll price it for you and, once you give the okay, will start assembling the formula.

A typical Chinese herbal prescription contains anywhere from 4-18 different ingredients. Each one has to be weighed and measured out - this all takes place on the counter in front of you, so you can see what's going on. If you want to get all Chinese about it, you can criticize the herbal pharmacists as they go about their job, telling them to give you the high-grade herbs or asking if they're sure they weighed everything correctly. Of course, this has to be done in Chinese, preferably in the dialect that the herbalists are familiar with.

Ben Cao Gang Mu

Do you know who Li Shi Zhen is? Well, you should. He's pretty awesome. During the Ming Dynasty, he compiled the book known as the Ben Cao Gang Mu 本草纲目, or the "Grand Materia Medica." He spent all of his life studying herbs, 27 years of which was spent writing this one book. It has 1,892 individual herbs listed, 374 of which were not previously listed in any other herbal manual. He also went through all other available texts for comparison and corrected errors he found. He is basically the biggest herb nerd in the history of the world... and my idol.

(Sun Si Miao is still the love of my life though... sorry, Li Shi Zhen)

The Ben Cao Gang Mu has an expansive variety of herbs listed, far more than any other herbal book in English or Chinese. Lucky for us, as of 2004, you can get the very first complete English translation of the Ben Cao Gang Mu in a six-volume set. I want it.

By the way, the video is of Jay Chou, that guy from that movie Curse of the Golden Flower. He's a big-time pop star in Taiwan and China, and he's singing his song called Ben Cao Gang Mu. Read the lyrics! I got a good chuckle out of it.

Remedy for Snake Bite

Chinese herbs can be taken long-term for chronic dis-eases such as diabetes, hepatitis, autoimmune diseases, and gastrointestinal disorders, either as palliative relief or as a preventative to a recurrence of symptoms. Herbs can also be taken for more acute problems, such as the common cold or allergic reactions, for more immediate relief. If you ever find yourself getting bit in the face by a snake, Chinese herbs can help!

According to TCM, there are three basic causes of disease:

• external environment, most notably cold and wind
• internal upset, from the stifling of emotions to improper diet and exercise
• miscellaneous causes, like being thrown from a horse or bit by a rabid dog.
  

In the case of today's blog post, you've got a one in three chance of being bit by a venomous snake! (OK, so not really)

Unfortunately this formula was taken from a web site that doesn't give dosages or tell you how to take it - how much you should take, how soon after getting bitten, aftercare, et cetera. It may be an internal or external formula... we don't know. Nevertheless, it is an interesting formula and utilizes some less-common herbs.

• 蒲公英 Pu Gong Ying - dandelion
• 金银花 Jin Yin Hua - honeysuckle
  
• 白芷 Bai Zhi - angelica dahurica
  
• 半枝莲 Ban Zhi Lian - barbed skullcap
  
• 连翘 Lian Qiao - forsythia fruit
  
• 蜈蚣 Wu Gong - scorpion
  
• 蟾酥 Chan Su - toad venom
  
• 仙鹤草 Xian He Cao - agrimony
  
• 白花蛇舌草 Bai Hua She She Cao - hedyotis/oldenlandia

You may have noticed that this snake bite remedy uses toad venom and dried scorpion. This may seem counter-intuitive but is an illustration of the Chinese medicine concept of fighting fire with fire - using toxins to lead out toxins.

See the source for this formula at this website, a Chinese medicine clinic in London.

TCM Remedy for Athlete's Foot

If you've ever gotten a Chinese-style foot massage, you probably soaked your feet in a warm herbal tea for awhile before the foot massage started. It's very relaxing and improves circulation. It also ensures that the massage technician doesn't have to massage dirty, smelly feet.

Here's a foot soak you can make at home specifically for athlete's foot (tinea pedis). Athlete's foot comes in three different varieties, according to TCM - blistering, erosive, and keratinized, all of which have the tell-tale itching and smell.

Blistering obviously means there are blisters. The erosive type is whitish with exudate, generally between the toes, and turns red after scratching. Keratinized is generally dry and characterized by peeling skin. These types may be present all at the same time or occur one after another. This particular recipe is for the the erosive type and consists of two parts: a soak followed by a dry powder dusted onto the affected areas.

Soak:

• Yi Yi Ren - pearl barley 30g
  
• Gan Cao - licorice root 30g

Soak the two herbs in water for one hour, bring to a boil, then turn down and simmer for another 15 minutes. When the herbal tea has cooled but is still warm, soak your foot or apply the liquid with a wet compress for about 20 minutes. Let the foot dry and dust it with a powder made of the following:

• Liu Yi San* - Six to One powder 15g
  
• Ku Fan - alum 10g
  
• Huang Bai - phellodendron bark 10g
  
• Bing Pian - synthetic borneol 1g
  
• Bai Zhi - dahurian angelica 10g

*Note: Liu Yi San is a powder consisting of six parts Shi Gao (talcum) and one part Gan Cao (licorice).

Repeat 2-3 times a day until symptoms subside. In the meantime, do not drink alcohol, and stay away from shellfish and greasy, fatty foods. This will help prevent the internal accumulation of dampness and help the athlete's foot subside quickly. And remember to change your socks frequently.

p.s. If you can't get your hands on Chinese herbs, try wiping your feet down with vinegar. Vinegar can also help kill the fungus.

TCM Remedy for Conjunctivitis

Many of us have experienced pink-eye - you wake up in the morning, and all of a sudden one eye opens. What about the other one? It's glued shut with dried, crusty mucus which has been exudating and drying all night long.

You go to the bathroom, wash your face carefully, and take a look. The white of your affected eye looks bloodshot. It may be itchy. You try and resist, but eventually you forget, touch your bad eye, then touch the other one. Congratulations! Now you have bacterial conjunctivitis in both eyes. (If there is no mucus, you probably have viral conjunctivitis.)

If you wash carefully, rinse with saline solution and avoid touching your eyes, pink-eye usually goes away within two weeks, without lasting damage. But suppose it doesn't go away. Or suppose you want it to go away faster. Today I'd like to share with you a Chinese herbal remedy for conjunctivitis, from Complete External Therapies of Chinese Drugs, by Xu Xiangcai.

• Jin Yin Hua - honeysuckle flower - 12 grams
  
• Da Qing Ye - isatis leaf - 10 grams
  
• Ban Lan Gen - isatis root - 6 grams
  
• Ye Ju Hua - wild chrysanthemum flower - 6 grams
  
• Pu Gong Ying - dandelion - 10 grams
  
• Bo He - field mint - 6 grams
  
• Qian Li Guang - ragwort - 6 grams

The ingredients above are soaked in half a liter of water in an earthenware pot for about 20 minutes. Then turn the fire on high until it comes to a high boil. Then turn down to a simmer and cook for another 15 minutes. Then filter the dregs using a fine strainer or cheesecloth. Wait until the liquid has cooled slightly but is still warm. Soak a clean cloth or piece of absorbent cotton and wash the outside of the eye slowly and carefully. Don't worry if some of the herbal tea gets in your eye, it's not dangerous. But don't try and pour the liquid directly into the eye - the main therapeutic benefit is from washing the external surface.

Too close for comfort? Here's another recipe that is even more indirect. It's prepared the same way, but all you do is steam the eye over the hot herbal tea for about 20 minutes each time - no dipping, no washing.

• Long Dan Cao - gentian root - 10 grams
  
• Ju Hua - chrysanthemum flower - 10 grams
  
• Xia Ku Cao - prunella or self-heal spike - 10 grams
  
• Chan Tui - cicada husk - 10 grams
  
• Di Gu Pi - lycium root bark - 10 grams
  
• Shi Jue Ming - abalone shell - 10 grams
  
• Mi Meng Hua - buddlejae flower - 10 grams
  
• Xuan Shen - scrophularia root - 15 grams
  
• Bai Ji Li - tribulus fruit - 10 grams
  
• Sang Ye - mulberry leaf - 10 grams

Whether steaming or washing, use the herbal tea warm for best effect. You can reuse the same herbs 3-4 times a day. The next day make a fresh batch.

You can ask your acupuncturist or Chinese herbalist to order this formula for you.