February 18, 2025 • 54 mins
This episode will be looking at another traditional Chinese formula: Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng or Licorice, Ginger, Poria, and White Atractylodes Decoction. This is a formula that warms the spleen and overcomes dampness and is in the sub-category of formulas that warm and transform water and dampness under the category of formulas that expel dampness. As always, we will do our deep dive into this herb formula and look at its traditional uses, and its preparation, interactions, and cautions. And, as usual, we will be adding something a little different…we are going to talk about mandatory reporting. Each episode of the podcast will go into great depth about a single herb or formula. Besides covering the basics of herbology including category, and functions, we will explore the history, quality, science, pharmacology, evidence, and any potential interactions of each herb or formula. Please join us as we undertake another interesting expedition into the exciting universe of herbs exploring Gan Cao Gan Jiang Fu Ling Bai Zhu Tang or Licorice, Ginger, Poria, and White Atractylodes Decoction!
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Speaker 1 (00:03):
Angelic Sperver. Welcome to episode seventy eight of Sperbs or
Sperbs Herbs. Today we're gonna be talking about an interesting
Chinese formula gon zau gone Jiang. I can't even read
(00:25):
the food ling by juang, so sorry for my my Chinese.
As usually, Gonzell ganjiong fooling by jutang or licorice, ginger,
pooria and white attracted lotus to coction. There's a lot
to cover, so let's get into it. So today we're
looking at another traditional Chinese formula, Gonzell ganjiong fooling by
(00:48):
jiu tongue. Now that's a mouthful, but as we're gonna
find out, that's actually the name of all the herbs
that are in this formula. So that's licorice, ginger, pooria,
and white attracted lotus to coction. This is a formula
that warms the spleen and overcomes dampness, and of course
we're going to talk about that as we go along.
As always, we will do our deep dive into this
(01:08):
herb formula and look at its traditional uses and its
preparation interactions and cautions, and as usual we'll be adding
something a little different. We're going to talk a little
bit about mandatory reporting, so definitely a little bit different.
It's going to be another interesting expedition into the exciting
universe of herbs. Please join us. So I've been teaching
(01:34):
for quite a while now on a wide variety of topics.
If you like this podcast and want to explore more
of my courses, they are available at www dot Integrativemedicinecouncil
dot org and include a ton of different topics, including
my Drug Herb series looking at drugs and how they
interact with herbs and vice versa, several ethics and safety courses,
(01:56):
Chinese medical research, several treatment of conditions courses such as arthritis,
neck and back pain, COVID and depression and anxiety, and
one of my favorite courses of all time, the Chinese
Herbal First Aid Kit. And they're all at a reasonable
cost to begin within were listening to this podcast, you
can get an additional twenty percent off with the code
(02:20):
SH twenty off. That's all lower case shs for sperbs
Herbs twenty off. So please feel free to take a
look at those courses at Integrativemedicinecouncil dot org. So I said,
for a little some different Today we're going to talk
about mandatory reporting. So as acupuncturist and herbalists as well
(02:41):
as other licensed professionals, we may be mandatory reporters. And
if you're not a licensed professional, then this is still
interesting information for you to know what does need to
be reported, what doesn't. So we maybe mandatory reporters, or
maybe we aren't mandatory reporters, and what does being a
(03:02):
mandatory reporter mean? So we're briefly going to discuss these
questions today. If you want to know more about this topic,
I have a one hour continuing education course available at
that www dot Integrative Medicine Council dot org that we
just did and if you use that SAH twenty off,
you get twenty percent off of it. So the first
question a practitioner needs to ask is whether they are
(03:24):
mandatory reporters. States and countries may have different laws in
this matter. In California, we are considered medical practitioners and
therefore we are mandatory reporters. Other states may not have
similar laws, and or they may say we are reporters
for certain situations but not others. Whether or not, however,
(03:45):
it is mandatory. It may still be ethical and a
practitioner should consider reporting any cases that would fall under
our discussion today. So even if it's not mandatory, where
what does mandatory mean? In this case, mandatory reporting means
that if you don't don't report something, then there are
consequences in lie can affect your license. It can. Actually
(04:05):
there's actually a situation happening. I was just reading about
it this week where someone is actually being sued for
not It's a pastor who was not who did not
report suspected sexual abuse against a child, and he is
being pursued. He's actually been arrested and is being prosecuted
(04:27):
for that and can be put in jail. So there
are consequences if you are mandatory and don't do it. Now,
if you're not mandatory, you can still report it. It's
still ethical, it's still appropriate. May not have all the protections,
but you definitely have all the ethics behind you. So
let's talk about this. So what do we actual report?
Can we might we be required to report? So one
(04:47):
of those theres where we might be mandatory reporting is
in diseases, and many diseases must be reported in order
to protect population safety. These are generally communicable or and
or have an unusual risk for society. And what's interesting
is the one disease that is usually not included in
these lists of diseases HIV, even though back in the
(05:12):
day I was around. I mean, I remember the very
first report, so I was fascinated with it when it
first started coming out in the early eighties. I was
a kid, but I was still I was interested in medicine,
so I was interested in it. But the reason why
that wasn't is because there are a lots that specifically
say you can't be because otherwise people wouldn't get tested
and things like that, so it can get convoluted. But
there are a lot long lists. In fact, I have
(05:34):
a long list that I usually and in my one
hour I talk about, but it's too long to talk
about here. They may change slightly or sometimes dramatically from
county to county, state to staying country to country. In California,
each county has their own health department and they may
have different diseases that you may or may not have
(05:55):
to do have to report based on the county you're
in as well, So you have to look this up
for where you're at. Another area where we have to do.
Mandatory reporting is an abuse. In most states, both older
abuse and child abuse must be reported to authorities. Most
locales have something like Adult Protective Services and Child Protective
(06:16):
Services to receive reports. Now that's state California. I know
there's like my wife's from New Jersey, so she's aware
of something called DIIFIS. I don't even probably a department
of something in safety. I don't even know, but that
would be their child protective service. So everyone has their
own sort of name to it. Don't hesitate to call.
(06:36):
They will make the determination of intervention is necessary. If
you suspect something, go ahead and call it in. You
have a lot more risk in not reporting suspected abuse
than in reporting it. And in California, failure to report
is a misdemeanor crime punishable way up to six months
in jail and or up to one thousand dollars fine,
And there are protections if you report it. If you
(06:59):
do it in good faith, you cannot be held liable.
So very little downside for reporting it. Quite a bit
of ups of downside if you don't report it, So
report it. So let's talk briefly about elder abuse, harmful
treatment of people include embannment, isolation, abduction, emotional, financial, verbal, mental, sexual,
(07:19):
or physical abuse, corporal punishment, involuntary restraint or seclusion, neglect,
the failure to provide care necessary to prevent physical or
mental harm, deprivations of goods or services that are necessary
to avoid physical harm or mental suffering, and physical and
financial abuse are the most common forms that we see
(07:41):
in the real world. The elderly do often do not
report abuse because they fear retaliation, not being believed in,
or shame about being abused. Now I've had to call
in for elder abuse and report it, and I gotta
say the process was straightforward, was relatively easy, and they
(08:02):
were very helpful on the end of NONET. That's where
I'm at. They were very helpful, and it did turn
out there was old abuse and the person doing it
actually ended up in jail last I heard. So it
was really good that we reported it, and so do it.
You know, it's not an issue so child abuse, of course,
(08:24):
we hear about this all the time. Unfortunately, an abused
child is one who has suffered intentional, serious, mental, emotional, sexual,
and or physical injury by a parent or other person
responsible for the child's care. Some states add in suffering
from starvation, moral neglect, and or immoral associations, And according
(08:47):
to one of my sources, an abused child is generally
defined as a person younger than eighteen years of age
whose parent or other person legally responsible for his or
her care does any of a number of physical, mental,
or sexual abuses, so any of those would count as
child abuse. Another category of mandatariy reporting is suicide and harm.
(09:12):
It is manetary to report a patient who is in
quote unquote imminent danger of harm to self or others.
Call your accounting's mental health department. They will tuck you
through the process and confirm the imminent danger. You can
call the police of actions are impending. It's one thing
to say I have a gun at home and as
soon as I leave here, I'm going to use it
(09:33):
on myself. That's imminent danger. You got to call them
a mental health department. If they have the gun in
their purse and they say as soon as they walk
out into the into the into the lobby, they're going
to use it, that is impending action. Call the police.
So there's a little bit of difference those that word
in imminent danger. That phrase imminent danger is very important. Again,
(09:54):
I have had to report this. We you know, when
I was a supervisor, I had a patient who said
she was suicidal, but she was not an imminent danger.
So instead of reporting, we actually called her psychologist and
he said, yes, I'm aware of it, we're working with it,
don't worry about and that was the end of that.
So I did follow up and it was an imminent danger.
(10:15):
And that was kind of early in my career where
I didn't really know this term imminent danger, and so
if I had known it, I probably wouldn't have gone
down that road. Another area of potential mandatary reporting is
domestic violence. Any health practitioner employed in a health facility, clinic,
(10:35):
physicians office, local or state public health department, department, and
or clinic, or other type of facility operated by a
local or state public health department, who and his or
her professional capacity, or within the scope of his or
her employment, provides medical services for a physical condition to
a patient whom he or she knows or reasonably suspects
as a victim of domestic violence, shall immediately make a report,
(10:58):
even if the patient deny abuse. So this actually, if
you listen to what I just said, it sounds very
lawyer esque, and I believe I got it. I did
it a long time ago, and unfortunately I'm really good
at at keeping track of my sources. I did not
on this. I think it was probably from a website
of a lawyer or something along those lines, and it
was probably in the state of California. So this again
(11:21):
may or may not be helpful for those in other states.
For a long time, I didn't think we needed to
report domestic violence, and then as I looked more into it,
yes we do need to. The law had changed, and
we do need to, at least in the state of California,
because what was happening is people just weren't reporting it
and then it would escalate. So again, something to look
(11:42):
at where you're located. It's impossible for any person like
me to know all the laws everywhere and all the countries,
all the states where this could be at. You know,
just in today's today's people listening today, I have people
from all over the world. I have I think at
least eight country trees that are have signed up for
(12:03):
listening to this, and I know there's a lot more
once it hits the actual podcast universe. So yeah, there's
a lot of different laws out there, so when you
do report, there's no legal requirement to inform the patient
of the report. However, ethically you should inform the patient
(12:23):
of your obligation. As a mandatory reporter. You must report
whether or not the patient consents to report. So if
they say no, or if they consent or not consent,
that's one thing, but you still need to report it
whether or not they consent, if it's a mandatory reporting situation.
And in this course I get into the ethics involved
with reporting, because you're violating the patient's privacy and autonomy
(12:46):
sometimes by doing a report, but you're also demonstrating a
key ethical concept called beneficence. And of course there's legal
aspects and we get into that as well, So we
talk about all that, and then here's a very important
thing to keep in mind. Reporting is not a substitute
for thorough documentation in the medical record. The medical record
(13:08):
is generally a more valuable source of documentation for legal
cases and is critical to the patient's ongoing care. In
other words, just because you get wrapped up in making
a report or trying to decide if you should or
shouldn't make a report, doesn't mean you need to collect
your your your actual medical records. You have to still
put in all the information in your medical records. Ace
(13:28):
you're doing this, and I think that's it for mandatory reporting.
Thank you guys. That's a little something different. Let's get
into today's formula. Gonsa god so it's a it's a twister,
gonsa Ganjiang, fooling, baijiutang, and as I mentioned earlier, it's
basically these are the name the Chinese names for the
(13:48):
four herbs in this formula, So liquors ginger, poia, and
white attracted lotus to coction. There are lots of other
names for this formula. These include licorice, ginger, pooria, and
attracted lotus. That sounds really same, but it doesn't have
the white there. So in fact, when you look at
(14:10):
the Chinese, it's ganjiang ling xu tong, so it's much shorter.
Ah just shortens up all the names. Liquorice decoction, gonsou
tongue decoction for fixed kidneys, schuenzuo tongue damnous eliminating decoction
or chu shirt tongue, poria, ginger, attracted los and liquorice
de coction, So just kind of mix up everything and
(14:30):
again use this the shorter versions of the name, so
ling jiong Ju gan tong poria, ginger white attracted los
and licorice tocoction or fooling ganjiog buy Ju Gonsu tongu
shen chu tong, which we kind of got close to
uh jen ju tong h u and kidney fixity decoction.
(14:54):
I kind of like that kidney fixity decoction. So there's
lots of different names, all just very similar scrambles of
the name that we're talking about today. So this formula
is in the subcategory of formulas that warm and transform
water and damtness under the categories category of formulas that
(15:14):
expel damnus. And this is according to Shide and his team.
That's one of our big textbooks that we use. Are
other usual Formula's textbook Chinese Medical Verbal Formulas and Applications,
Pharmacological Effects and Clinical Research by Chen and Chen say
it is in says it is in the warm formulas
that dissolved damnus subcategory under the damp dispelling formulas category.
(15:39):
In other words, pretty much the same thing, just using
slightly different words. In the translation. So let's talk about
these formulas that expel damnus in general, and then we'll
get into the specific subcategory of formulas here. So Shide
usually has a really good explanation of the overall category.
(16:00):
And here's what they have to say about this overall category.
Fluid physiology and pathology are at the foundation of Chinese medicine,
and Chinese physicians have always been greatly concerned with damp disorders.
And Chapter seventy one of basic questions. If you're not
with the Basic questions, this is the Huangdi siu Ween
(16:21):
or the Yellow Emperor's Classic of Internal Medicine Wang dn
Jing su Wen so Yellow Emperor's Classic of Ventural Medicine.
This is the oldest existing medical book really. It was
written probably around two hundred BCE, so it's been around
for a while, and it is noted. It's in two
(16:41):
different parts. One of the is the basic questions is
sun and so we're talking about here. So chapter everyone
there says it is noted that water constraint is treated
by breaking it up. Chapter fourteen of the same book
lists sweating diarrhsis, which is urination and elimination via the
stools as three possible routes for eliminating water excess passage.
(17:03):
In chapter seventy four elaborates on the nature of herbs
used for these purposes. Damp pathogens in the interior are
treated with bitter warming medicinals assisted by sour and bland medicinals,
because one can use bitterness flavor to dry dampness and
the bland flavor to drain it. If damnness is more
(17:25):
pronounced above leading to heat, it is treated with bitter
warming medicinals assisted by sweet and acrid medicinals to promote
sweating and thereby arrest the disorder. Chung Chong Jing's Discussion
of Cold Damage and Essential Formulas from the Golden Cabinet
offered formulas that translated these strategies into clinical practice. So
(17:47):
this is another super multi mega ultra famous book, Discussion
of Cold Damage and Essential Formulas from the Golden Cabinet.
This is the oldest existing book we have on formulas
and it was written about It was written near to
twenty CE. It's almost four hundred years after that. Wangden
Agings who win that we just talked about. But so
(18:09):
that's where this formula actually comes from. As we're going
to find out sort of, and so they have strategies
that bring this into clinical practice. Many of these not
only continue to be widely used today, but also served
as platforms for the development of other formulas and strategies
by the Tang dynasty. So several hundred years later, the
(18:30):
adage drying can eliminate damnas had become one of the
ten exemplary treatment principles in chen Soong cheese emissions from
the classic of the Materia Medica or the Bensu Shiryu
written in seven to twenty CE, and every epoch in
the history of Chinese medicine since then has added to
the evergrowing therapeutic arsenal in this group. The importance accorded
(18:54):
to the Chi dynamic by the various genuine masters and
part of a new stimulus to the tree of damp disorders.
So we talk about the genuine masters in a previous
spur observes very very important time period of expansion in
Chinese medicine again after the tongdynocese, so we're kind of
(19:15):
dicking through this. Historically, most innovative, without doubt was Jiang
Yuan Su and Lee Dang Yuan's use of wind medicinals
or fong Yao to assist in the uplifting of middle
burner chi and thus the transformation and dispelling of dampness.
They also devised the strategy of separating and reducing or fenshaw,
(19:37):
which utilizes the different functions of the triple burner vis
a VI the fluid metabolism as a method for treating
complex damp pathologies. This strategy was later taken up by
ytn Sure and other exponents of the warm pathogen disorder
current in Chinese medicine, who perfected it as one of
the key methods in their treatment of damp warmth disorders.
(20:03):
Damnus is a yin pathogenic influence that has a heavy,
sluggish nature. Damp disorders progress slowly and linger in the body.
Internally generated damnas is usually associated with improper eating habits,
overindulgence in alcohol, and obsessive deliberation or other emotional behavior
that injures the spleen. Manifestations include generalized and focal abdominal distension, nausea,
(20:30):
vomiting diarrhea, jaundice, painful urinary dribbling, or edema of the
lower extremities. Damness can also be externally contracted from living
in a damp climate or environment, or getting wet from
rain or sweat. Manifestations of externally contracted damness include chills
and fever, a feeling of distension in the head and
(20:52):
heaviness in the body, stiffness and pain in the joints,
or superficial edema. Because it is not uncommon for conditions
of damness to present with both externally contracted and internally
generated aspects, it must therefore be approached carefully in each
case to gain a full understanding of its ideology and
(21:13):
the underlying constitution of the patient. The word water or
shway is often used in connection with dampness. Sometimes this
word refers to the fluids in general, and sometimes specifically
to edema, or to an accumulation that is more distinct
and localized than damnness. The latter usage is reflected in
(21:34):
the adage damness is the premeation of water, while water
is the accumulation of dampness. In this text, sui is
translated as edema when it refers specifically to that condition,
but otherwise we have left it simply as water. Problems
with those organs that are most intimately connected with the
process of water metabolism in the body often result in
(21:58):
dampness orders. The three most important organs are the kidneys,
which are said to govern water, the spleen which controls water,
and the lungs, which govern the sending and descending aspects
of water metabolism, known as the water pathways are swayed
out among the young organs. The triple burner and the
bladder also have important connections with water metabolism and therefore
(22:22):
with dampness. If the she is obstructed in the triple burner,
there's no force behind the metabolism of water. If the
bladder does not function smoothly and urination becomes difficult, the
G mechanisms of the triple burner can be affected by
the backflow because damnus is a heavy, sluggish, pathogenic influence
(22:44):
that readily ehinders and obstructs the G mechanisms. These formulas
often include she regulating herbs. The value of such herbs
in treating damness is succinctly stated in Systematic Differentiation of
warm pathogen diseases or when being Tabian written in seventeen
ninety eight. When the G mechanic quote, when the G
(23:05):
mechanisms are transformed damness will likewise be transformed. For example,
when the bladdergy is obstructed by damness, these herbs can
regulate the bladder ye and thereby provide an avenue for
water and damness to exit the body. The principal patterns
of externally contracted damness are damp heat and wind dampness,
(23:28):
which are generally conditions of excess. Manifestations of damp heed
include jaundice, painful urinary dribbling, and atrophy disorder. It is
always important to carefully distinguish both the level burner at
which the process is active and the pathogenic influence that predominates,
and treat accordingly. When damnness is marked by pain, usually
(23:50):
of the joints, and is sometimes accompanied by edema, here
it is also important to discern whether wind or damnness predominance. Furthermore,
because these conditions lodge primarily in the channels, ensuring the
free flow of healthy blood is an important aspect of treatment.
The flow in the channels is open, the wind has
(24:11):
no place to lodge, hence the adage when treating wind disorders,
first treat the blood. In general, the formulas in this
category are comprised of acrid aromatic and warm substances that
dry damness or sweet land substances that leach out damnness.
They should be used with extreme caution in cases of
yin deficiency and depleted fluids. In patients with debility brought
(24:36):
on by disease or pregnancy with edema or other signs
of damness, these formulas must be modified with spleen strengthening
herbs to protect the normal chieve. So that is formulas
that expel dampness. Let's go into the specific subcategory of
formulas that warm and transform water and damness, and this
is the subcategory where the serve is situation. So again
(25:01):
this is from shine at all, and they continue to
describe the subcategory. The formulas in this section are used
in treating patterns of damness caused by cold or where
cold and damnos clump together. The reasons for this may
be young deficiency or invasion of cold dampness from the outside.
When the kiddy young is deficient and its chi loses
the ability to transform water, the water becomes pathogenic by
(25:24):
overflowing and causing edema or stagnant in giving rise to damnness.
Symptoms include urinary difficulty, edema, and lower abdominal numbness, spleen
young deficiency can give rise to similar problems. Cold damness,
which has many ideologies, tends to settle in the lower
(25:46):
parts of the body. It may lodge in the intestines,
manifesting as thin mucus, or it may cause cloudy, painful
urinary dribbling, leg chi or various types of edema. Leg
Chi is sort of a term we use for a
demon of the legs, basically to treat cold damness. The
formulas in this chapter ely on chief verbs that warm
(26:07):
the young and promote the resolution of dampness, such as cinemama, rhymulous,
quadir aconiti, radix, lateralis preparata or jerfudza poria fuling and
attracted lotus, macrophil pala, rhizoma baiju. We actually use those
last two in our formula. Depending on the pattern, they
may be combined with deputies and assistants that strengthen the
(26:30):
spleen and tonify the kidneys, or that regulate the chi.
Herbs that strengthen the spleen and tonify the kidneys include alpinia,
oxiphalle phile fruitus or yijuren attractor lotus macrocephala, rhizoma, baiju,
(26:51):
callucrous radix consau. We use both of those jiujubei, fruitus,
dodzao and aconiti, redex lateralis preparata or jerfudza kidney and spleen.
Young is essential in supporting the body's water metabolism and
in turn is easily damaged by cold damnness. This makes
it essential to ensure its vitality. Herbs that regulate the
(27:14):
chi like magnolia officialities cortex or hopo linda a, redex
wu yao Aclandia, redex muchiang citri, reticulated Pericarpium chenpi or
rique pericarpium d fupi are used to open the cheat
dynamic in order to facilitate the dispelling of damnness. Okay,
(27:36):
and that's the background for our formula of today. Let's
get into what this formula does. What are its Chinese
medical actions. According to Schid and his team, they say
this formula warms and transforms phlegm in thin mucus, strengthens
the spleen, and resolves damnness. And Changen says something similar,
(28:00):
say it warms young and strengthens the spleen and dispels
cold in dampness. So what are the indications for this formula.
You know, the actions are pretty succinct. The indications can
be a little bit more as we're gonna see here.
So Shide and his team say this formula can be
used for a heavy sensation in the body, cold and
(28:24):
pain in the lower back. Pressure in the lower back
as if carrying a heavy weight, normal appetite and absence
of thirst and copious urine. The tongue will be pale
with a white moist coating that may be thick and
greasy at the root, and the pulse will be submerged,
(28:44):
thin and moderate. This is called kidney disorder n joo
type of painful obstruction of the waist and lower back
due to cold dampness. The ideology of this disorder commonly
involves internal causes such as over worm and habitual sweating
that weaken the normal chi and the invasion of cold
(29:04):
damness from the outside. The source text speaks of exposure
to rain, walking in water, or sitting in damp places.
In modern patients, this might be swimming for too long
or in too cold water, or not tweling off properly.
The onset can be both acute and chronic. Damness in
(29:25):
the entire body causes a heavy sensation. As a yin pathogen,
it tends to float downward, settling in the lower back,
where it obstructs the flow of chi and causes a
cold sensation, pain or pressure. Normal appetite and a lack
of any particular thirst indicate that the functions of the
middle and upper burners are unimpaired. Copious urination reflects attempts
(29:49):
by the body to rid itself of damness and plant.
That kidney function is normal too, and that the pathogen
is settled in the skin and muscle layer. However, because
of the lower back is the residence of the kidneys,
and because the pain is fixed, the condition is referred
to as a fixed kidney disorder. The tongue and pulse
reflect the dampness settling in the lower burner. Chenan Chen
(30:15):
say the clinical manifestations for this formula include cold and
damness and the lower body coldness and pain of the
lower back and body feeling of extreme heavy sensation in
lower back, normal appetite and diet, absence of thirst, and
normal urination. So where do this is? This first mentioned?
(30:37):
Both shine at all and Chennan Chen both say the
source is the Jingue Yao Lue or Essentials from the
Golden Cabinet. That was that book I was talking to
you about earlier. That is the first existing book on
Chinese verbal formulas, and that was written around two twenty
CE by Jiang Xiang Jing, super super famous Chinese doctor
(31:00):
Jean Joan Jing. Talk about the ingredients of this formula.
So the first agreeient we're talking about is glitciery. So
we're gonna kind of go through these in order of gonzao,
ganziong fooling by jus. The first herb is gonzhu or
glycius or a radex. This is licorice uh and we
use six grams for this and this. These herbs are
(31:20):
in the category of herbs that toonify the chi. Its
functions include it tonifies the spleen and augments the chi,
moistens the lungs and stops coughs, moderates spasms and alleviates pain,
moderates and harmonizes the characteristics of other herbs. And it's
probably the most commonly used herb in our formulas for
that last reason. It moderates and harmonizes the characteristics of
(31:42):
other herbs. In this formula, gonzao harmonizes the function of
the other herbs while also contributing to strengthening the spleen.
Our second herb is gon gien or is zinjibaris roizoma.
We're using twelve grams of this. This is dry ginger,
so twelve grams of this in our formula. And it
(32:03):
is from the herbal category of warm acrid herbs that
release the exterior and traditionally it warms the middle and
expels cold, warms the middle and expels cold. Oh that's
a double. Rescues devastated young and expels interior cold, and
warms the lungs and transforms thin mucus. This formula treats
(32:27):
cold damness obstructing the movement of chi and fluids in
the skin and muscles, primarily in the lower back. In
the lower back, this is what we're using in this formula. Well,
that is what the formula does. Although the lower back
is the seed of the kidney's the kidney organ itself
functions normally is unnecessary. Therefore to treat the kidneys directly,
So ganjak generally doesn't treat the kidneys directly, so that
(32:50):
makes sense here. Rather by warming the young and eliminating
the damness, focusing primarily on the spleen due to its
resonance with both damness and the flesh, it is possible
to effectively treat this disorder. The main herb for this
purpose is acrid and warming Zinibaris rhizoma or gondjianng. That's
(33:10):
this herb here. It warms the middle but also drives
out wind, damp, painful obstruction, effectively addressing both the actual
pathology and the background disposition. So really good herb for this.
Our next herb is the third herb and our name fooling,
So that is porea, and we're using twelve grams of
(33:32):
that again, and this is in the herbs that drain damness,
So that's this is probably the herb for the herbs
that drain damness. It traditionally promotes urination and leaches out damness,
strengthens the spleen and harmonizes the middle. Burner strengthens the
spleen and transforms phlegm and quiets the heart and comes
the spirit. And for this formula, because damness in this
(33:55):
pattern is relatively severe, Bland fooling is added as a deputy.
It strengthens the spleen and promotes urination to eliminate damness
via the urine. The combination of fooling and gonjiong warms
the young and dispels damness, removing pathogenic chi without injuring
the normal chi. And finally, our last herb is by
(34:19):
jew or attracted lotus macrocephalae rihizoma. This is white attracted lotus.
We're using six grams of it. And this also comes
from herbs that toonify the chie but it's kind of
drying in and of itself. So let's see this herb
tonifies the spleen and augments the chee, dries damness, and
promotes water metabolism, stabilizes the exterior, stops sweating, and calms
(34:41):
the fetus. And in this form of the bitter sweet
and warming bai Jou functions as the assistant. It tonifies
the spleen cheet even as it dries damness. So it
does two very important things for this formula. It's a
nice tight or herb formula. It's a really nice little formula.
(35:02):
So houses prepared. Shyde and his team states this should
be taken as a decoction, and the source text specifies
that administration of the formula should cause the patient to
experience a warm sensation in the lower back. That's nice
as usual. Shy did his team have an excellent commentary
(35:24):
about this formula. Although modern textbooks frequently define fixed kidney
disorder as a type of painful obstruction, it differs from
other types of painful obstruction patterns in a number of ways. First,
it conjoins only two rather than three pathogens, damnness and cold,
while wind is absent. Second, cold damness here is located
(35:46):
in the skin and muscles rather than in the channels
and collaterals, and is therefore treated via the spleen. And Third,
as indicated by the symptoms of heaviness throughout the body
and coldness below the waist, the pattern involves more than
local accumulation of damnness. This is explained by Shu Bin
(36:06):
in Discussion and Annotation of the Essentials from the Golden
Cabinet or the Jingue Yaley Lunju Ridden in sixteen seventy one.
The term fixed kidneys expresses a condition of something adhering
and not moving as protective chi issues from the lower
burner the kidneys being fixed by a pathogen means that
(36:27):
damness stagnates the protective chi hence the entire body feels heavy.
The formula thus focuses on promoting young and dispelling damness
via the urine rather than sweating. Sweating and the use
of verbs that dispel wind damness would not be an
appropriate strategy, in part because of the nature of the
(36:47):
pathogen and in part because the protective young is hemmed
in by dampness. Over time, physicians have extended the application
of this formula to the treatment of girdle vessel disor.
This is based on a passage in twenty nine of
the Classic of Difficulties in the non Jiang Noang Jing,
(37:08):
written in the Hang dynasty anywhere from twenty five to
two twenty CE. This is we've talked about the Wangdi Jing.
The non Jing Classic of Difficulties is sort of an
explanatory text of the difficult issues that kind of come
out of the wangdian a Jing, and in there they
quote girdle vessel disorders are characterized by abdominal fullness. The
(37:32):
lumbar area feels weak and as if one were sitting
in water. This closely matches the description of the pattern
for Gonzaeu, Ganjiang, Fooling, Baijutang, and essentials from the Golden Cabinet.
The Jingue yaou Lai, written in approximately two twenty C,
as we've already mentioned, which speaks of a sensation quote
(37:53):
as if one were sitting in water, quote and quote
the back being heavy as if one were carrying a
belt canating five thousand coins. Another important indication is a
demon during pregnancy, for which discussion of illnesses patterns of
formulas related to the unification of the three eediologies. The
sign yan ge being Jung Fong Fung, written in eleven
(38:16):
seventy four, recommends the addition of armanossier semen or shing
ren that's an apricot apricot pit clinically the key diagnostic
marker suggesting use of this formula can thus be summarized
as follows. Heaviness, coldness, or pain of the abdomen or back.
The sensation of cold can be subjective or may be palpated.
(38:39):
Heaviness may be manifest as a sensation of numbness or insensitivity,
and there may also be difficulty in bending from the waste.
Excess water may manifest as increase urination, diarrhea or soft stools,
sweating saliva, phlegm discharge, or increased secretions from the skin
(38:59):
due to the under lying cold. These will usually not
be malorderous, so they don't smell signs of damness on
the tongue such as white moist coating that may be
thick and greasy at the root, accompanied by a pulse
that is submerged, thin and moderate. So that's commentary from
(39:20):
Shide and his team. Chen Chen have a commentary brief
commentary that say, because this formula treats cold and damnous
located in lower back around the kidney area, it is
also known as Chenzho tongue or kidney fixity decoction. It
is important to note that this formula treats cold and
damnus affecting the muscles near the kidney area. It does
(39:41):
not address kidney imbalance nor treat kidney diseases. So even
though the kidney's in the name, it doesn't treat kidney
issues directly. And then we have a lot of commentary.
There's another book that is just a fantastic book that
I like to refer when I can. This formula is
discussed in Huang Kwang's ten Key Formula Families in Chinese Medicine,
(40:05):
translated by Michael Max And so this is where we're
gonna this formula. He has a nice commentary on this
formula as well, so we're gonna get into that right now.
In it, he says, when the renshen in li jiang
yuan is replaced with poria fooling, it becomes liquorice ginger
poia white attractive lotus to coctrine gonsa Ganjiang fooling by Jutung.
(40:27):
So this formula, which treats lower back pain from cold
and damnness. Renschen jinsing is not used in this situation
as there are no signs of emaciation, epigastric focal distension
with firmness or poor appetite. Fooling and bijou are used
together here as they treat a sense of heaviness and lethargy,
(40:48):
urinary difficulty, and superficial edema. The lower back should feel
warm after taking this prescription, which we heard before. He
also quotes essentials from the Golden Cabinet has the following
description of this formula's action in treating lower back pain.
These people's bodies feel heavy. There is a clear demarcation
(41:10):
to the pain, much like they were sitting in a
tub of cold water, and there is accompanying whole body edema.
From the waist on down, it feels cold and painful.
The back feels heavy, as if carrying five thousand coins.
The distinctive characteristics of this type of lower back pain
are cold pain, ling tongue, and heavy pain jong tong
(41:32):
Cold indicates there is pathogenic cold, and heaviness indicates there
is dampness. The licoris ginger poorium white, attractive, litistic cooctrin
presentation is as follows. One a cold feeling from the
waist down with a feeling of heaviness and pressure or
achy pain. Two edema a predisposition to edema, the entire
(41:53):
body feels fatigued and sluggish, and three dried gen tongue.
So this is something he explained earlier, and this is
how I explained it. Pale or pale red tongue with
a greasy coating that is usually white and greasy, but
maybe dark gray in greasy or white and slimy. This
(42:15):
formula's presentation is often seen in patients who are overweight
and have lived for a long time in a cold,
damp environment. Their bodies usually feel heavy and tired. The
joints and muscles often feel heavy and achy. They are
predisposed to edema or watery stools, and the tongue has
a white coating. This is a damp body type much
(42:36):
like those of the previously introduced to federa and astragulus constitutions.
When these type of people fall ill, they often experience dizziness,
lower back and body aches, diarrhea, abdominal fullness, edema, or palpitations. Therefore,
in practice, this formula, other than treating wind damp lower
(42:56):
back pain, also can be used to treat symptoms of edema,
joint pain, in diarrhea. So that's commentary from Hong Kong.
Great commentary. So what are some modifications to this formula?
Side discusses several modifications for this formula for chronic backache
and discharges of women. Add karthaming floss or hong Hua,
(43:18):
which is a blood mover for older patients with chronic
back ache and urinary frequency at akiniy rate ex latter alis,
preparaz your fudza and servie cornew. The gelatinum or lu
jau schwang so Foodza is very warming and can be
difficult to get. The serving cornew gelatinomum is actually deerhorn
(43:45):
and is probably it's super expensive if you can find it.
Probably shouldn't be using it for conservation issues, but some
people do also. For contents in both boys and girls
up to the age of fourteen. For a more severe cold,
add that akinity radix, letter alice, preparudza and sorry herba
(44:07):
or she shin that would be the other one you
can add in here. For more severe damnus, add alice,
maddis raizoma che attracted litus forraisoma's sung ju that's actually
red attracted list white is part of this formula. And
koes semen or ye wren that's that's job's tears, that's
pearl barley for pronounced spleen deficiency. Add Jensen radix or
(44:31):
renshen chen chen say with severe pain, add fudza radix, akiniti,
letter alice preparata and shi shin radix at raizoma sorry
so similar to what was already mentioned. Hong Kong adds
when combined with stefani and attracted lotus decoction fung chi
huang chi tang. It treats a dima with a feder
(44:53):
decoction plus attracted lotus mahang ja ja jutang. It treats
chills without sweating and joint pain compaired with frigid extremities.
Powder of asinisan. It treats chills, diarrhea and frigid extremities. Comparisons.
Shy compares today's formula and shine in. His team compared
(45:14):
today's formula with two other formulas. The first one is
that one that was mentioned by Hongwang Wong as well
Lijiang Wuan or regulate the middle pill. Both formulas combines
xinjibaris raisoma Ganjiang attractor list macrocephale raisoma by ju and
glycis radex gonsal regulate the middle pill. Lijiangwan adds ginsen
(45:36):
radex or renshen to tonify the middle burner focuses on
patterns characterized by cold and cheat efficiency of the spleen
and stomach gonzaw ganjiam fooling by Jutang adds poria fu
ling to focus the formula to spelling cold damness, particularly
from the lower back. The other formula is poria cinnamon
(46:00):
twig attracted lotus and liquors de coction, Lingue ju gon tongue.
Both formulas contain poria fuling attracted lotus, macrocephala orzoma by
ju and glycius or a radix gonsal poria, cinnamon twig
attracted liss and liquors to coction ling guay Jeu gan
Togu adds cinema rambulus or guay Sure that's cinnamon twig
(46:22):
focuses the focusing the action of the formula on warming
the young and transforming the fluids to treat thin mucus,
particularly in the epigastrium and abdomen. Gonzao Ganjiang fooling by
Ju Tongu, on the other hand, adds zinabarus roizoma ganjiang
to focus on warming and dispersing the cold dampness. Uh
(46:46):
Continuing with comparisons, chen Chen Say ling Lingue, zu Gan
tongue or porious cinnamon twig attractor lotus, macropha, liquors decoction
and gonza Ganjiang fooling Baiju tongue have similar ingredients in indication,
so very similar to what was just said by Shide
in his team, there are both excellent formasts to strengthen
the spleen, wormyong and dispel damnness. Lingua's Yugantang uses fooling
(47:09):
Poria as the chief herb and gwajeranmulus Cinemama as the
deputy herb. The main emphasis of this formula is to
warmyong and dispel damness to resolve time yin or phlem retention.
Gonsaw Ganjiang fooling Baiju Tong uses ganjiog rhizomas in gibaris
as the chief herb and fooling Poria as the deputy herb.
(47:31):
The main focus of this formula is to warm the
middle jaw, dispel cold, and dispel damness to treat cold
and damness in the lower back. There we go. That's comparisons.
Let's talk about some biomedical indications. Shide in his team say,
with the appropriate presentation, this formula may be used to
treat a wide variety of biomedically defined disorders, including acute
(47:54):
lumbar strain, lombar disc disease, sciatica, renal calculi, kidney stones,
chronic pulvic inflammatory disease, benign prostatic hyperchase or BPH, and
urysis or night urination. You know, wet bed, acute gastroinritis,
(48:15):
exima allergic rhinitis, and chronic bronchitis changen. So this formula
can be used to treat low back pain, sciatica, lumbago
and eurysis, superficial gastritis, duad ulcer arthritis, impotence gastritis, atrophic gastritis,
(48:36):
and diarrhea. So the science on this was interesting. There
were no papers on this formula when searched for using
Google scholar looking at the Cochrane Library, which are two
of my go tos. It's quite a rarity when I'm
researching formas, especially considering this is a janghang Jing formula.
In other words, it's an important old formula, and the
(49:00):
fact that there wasn't anything in the scientific literature was
quite interesting. That in and of itself is quite a
interesting fact. Drug rib interactions a couple of urbs in
this formulas may affect sarcroone p for fifty izymes. So
remember cyclone py for fifty is used in the metabolism
(49:23):
of drugs, and so when something affects sarachrone certain aspect,
certain isotymes, or different types a sarcroone P for fifty
can affect drugs either how they're either slowing up or
quickening how it's metabolized, So gon jiang may inhibit caraclone
P for fifty two C nineteen and gonsal may induce
(49:48):
saracon p for fifty two C nine and three A four.
Of those were always most worried about three A four.
Sarachrome P for fifty three A four has effects approximately
forty to six or of drugs and is by far
the most common subtype that drugs are using for metabolism,
So anything that affects three or four has a much
(50:10):
higher potential for a drug ERB interaction than those that
do not. There does not appear to be any pea
glycoprotein interactions with the herbs in this formula, and those
are the two big issues we look at for herbs.
There are others. We're starting to see some research, not
a lot of it at this point, where we're starting
to see some research on high protein binding with herbs.
(50:33):
With herbs, the problems that looks at herb constituents individual constituents,
and that may or may not be an issue when
you're talking about a whole herb so I think there's
a lot more research to be done, but these are
the two big points we look at for drug rob
interactions concerns. Not a ton of concerns here. Shide his
(50:53):
team say, heaviness of the body and backache due to
damp heat must not be tree with this formula. Obviously,
we don't want to treat it with damp heat because
this actually adds heat to the system, so that's not
a good thing. And heaviness of the body is fine.
That is one of the things that we talk about
(51:14):
that this formula is used for. But in addition to
low back stuff, and so just generalized heaviness of the
body is too general and non specific in the what
this formula does doesn't treat that well enough. But if
it also has that heaviness of the low back and
low back pain, then this can also treat it heaviness
(51:35):
of the body. So you just don't want to use
it with heaviness of the body as the only big,
big sign or symptom. And that gets us through this
today's formula, today's erbs herbs. So that was today's formula.
Gonsaw Gondjiang fooling by Jutang or licorice, ginger, pooria and
(51:58):
white attracti lodies, decoction and interesting, if not commonly used
formula that is among one of the first written about
is in the book where the first formulas were We
started by discussing mandatory reporting, and then we got into
the formula including its ingredients, commentary, the science, our concerns
and cautions, as well as its potential drug interactions. The
(52:20):
bottom line here is this is a great formula for
cold damnas, especially the lower body and the lower back.
And so it's warming and it's damp clearing. So that's
really what it's about. All in all, another expiration of
a fascinating and useful Chinese formula. In our next episode
(52:41):
in two weeks, we are going to be looking at
another single Chinese herb, jingj skits an herba or just
skitz anepada. This herb is a relatively commonly used herb
in the Chinese medical subcategory of warm acrid herbs that
release the exterior and can be used in colds, rats,
and even to help stop bleeding. As usual, we explore
(53:04):
all the intricacies of the serb as well as an
explanation of its category, and as always we will look
at something a little different. Join us in two weeks
for another interesting episode. I would like to thank you
very much. If you'd like this podcast, please do. It's
a humongous favor. Subscribe to our podcast and your favorite
(53:26):
podcast app that just as wonders for us, and we
thank you for even considering it. And remember you can
get CUS at ncc AO m PDA's at www dot
Integrativemedicine Council dot org and you can get twenty percent off.
If you use at sh twenty off code, you get
twenty percent off your entire order. And you can always
get in touch with me at doctor Greg at sperbserbs
(53:49):
dot com or at our website www dot sperbserbs dot com.
Hope to hear from you and thank you very much again,
and as usual, we have nice piography spurs or. The
Presidium was presented by doctor Greg Sperverer. We would like
(54:09):
to thank Janelle Frawler's support and everybody else who contributed
to this program. Roger Campbell
Angelic Sperver. Welcome to episode seventy eight of Sperbs or
Sperbs Herbs. Today we're gonna be talking about an interesting
Chinese formula gon zau gone Jiang. I can't even read
(00:25):
the food ling by juang, so sorry for my my Chinese.
As usually, Gonzell ganjiong fooling by jutang or licorice, ginger,
pooria and white attracted lotus to coction. There's a lot
to cover, so let's get into it. So today we're
looking at another traditional Chinese formula, Gonzell ganjiong fooling by
(00:48):
jiu tongue. Now that's a mouthful, but as we're gonna
find out, that's actually the name of all the herbs
that are in this formula. So that's licorice, ginger, pooria,
and white attracted lotus to coction. This is a formula
that warms the spleen and overcomes dampness, and of course
we're going to talk about that as we go along.
As always, we will do our deep dive into this
(01:08):
herb formula and look at its traditional uses and its
preparation interactions and cautions, and as usual we'll be adding
something a little different. We're going to talk a little
bit about mandatory reporting, so definitely a little bit different.
It's going to be another interesting expedition into the exciting
universe of herbs. Please join us. So I've been teaching
(01:34):
for quite a while now on a wide variety of topics.
If you like this podcast and want to explore more
of my courses, they are available at www dot Integrativemedicinecouncil
dot org and include a ton of different topics, including
my Drug Herb series looking at drugs and how they
interact with herbs and vice versa, several ethics and safety courses,
(01:56):
Chinese medical research, several treatment of conditions courses such as arthritis,
neck and back pain, COVID and depression and anxiety, and
one of my favorite courses of all time, the Chinese
Herbal First Aid Kit. And they're all at a reasonable
cost to begin within were listening to this podcast, you
can get an additional twenty percent off with the code
(02:20):
SH twenty off. That's all lower case shs for sperbs
Herbs twenty off. So please feel free to take a
look at those courses at Integrativemedicinecouncil dot org. So I said,
for a little some different Today we're going to talk
about mandatory reporting. So as acupuncturist and herbalists as well
(02:41):
as other licensed professionals, we may be mandatory reporters. And
if you're not a licensed professional, then this is still
interesting information for you to know what does need to
be reported, what doesn't. So we maybe mandatory reporters, or
maybe we aren't mandatory reporters, and what does being a
(03:02):
mandatory reporter mean? So we're briefly going to discuss these
questions today. If you want to know more about this topic,
I have a one hour continuing education course available at
that www dot Integrative Medicine Council dot org that we
just did and if you use that SAH twenty off,
you get twenty percent off of it. So the first
question a practitioner needs to ask is whether they are
(03:24):
mandatory reporters. States and countries may have different laws in
this matter. In California, we are considered medical practitioners and
therefore we are mandatory reporters. Other states may not have
similar laws, and or they may say we are reporters
for certain situations but not others. Whether or not, however,
(03:45):
it is mandatory. It may still be ethical and a
practitioner should consider reporting any cases that would fall under
our discussion today. So even if it's not mandatory, where
what does mandatory mean? In this case, mandatory reporting means
that if you don't don't report something, then there are
consequences in lie can affect your license. It can. Actually
(04:05):
there's actually a situation happening. I was just reading about
it this week where someone is actually being sued for
not It's a pastor who was not who did not
report suspected sexual abuse against a child, and he is
being pursued. He's actually been arrested and is being prosecuted
(04:27):
for that and can be put in jail. So there
are consequences if you are mandatory and don't do it. Now,
if you're not mandatory, you can still report it. It's
still ethical, it's still appropriate. May not have all the protections,
but you definitely have all the ethics behind you. So
let's talk about this. So what do we actual report?
Can we might we be required to report? So one
(04:47):
of those theres where we might be mandatory reporting is
in diseases, and many diseases must be reported in order
to protect population safety. These are generally communicable or and
or have an unusual risk for society. And what's interesting
is the one disease that is usually not included in
these lists of diseases HIV, even though back in the
(05:12):
day I was around. I mean, I remember the very
first report, so I was fascinated with it when it
first started coming out in the early eighties. I was
a kid, but I was still I was interested in medicine,
so I was interested in it. But the reason why
that wasn't is because there are a lots that specifically
say you can't be because otherwise people wouldn't get tested
and things like that, so it can get convoluted. But
there are a lot long lists. In fact, I have
(05:34):
a long list that I usually and in my one
hour I talk about, but it's too long to talk
about here. They may change slightly or sometimes dramatically from
county to county, state to staying country to country. In California,
each county has their own health department and they may
have different diseases that you may or may not have
(05:55):
to do have to report based on the county you're
in as well, So you have to look this up
for where you're at. Another area where we have to do.
Mandatory reporting is an abuse. In most states, both older
abuse and child abuse must be reported to authorities. Most
locales have something like Adult Protective Services and Child Protective
(06:16):
Services to receive reports. Now that's state California. I know
there's like my wife's from New Jersey, so she's aware
of something called DIIFIS. I don't even probably a department
of something in safety. I don't even know, but that
would be their child protective service. So everyone has their
own sort of name to it. Don't hesitate to call.
(06:36):
They will make the determination of intervention is necessary. If
you suspect something, go ahead and call it in. You
have a lot more risk in not reporting suspected abuse
than in reporting it. And in California, failure to report
is a misdemeanor crime punishable way up to six months
in jail and or up to one thousand dollars fine,
And there are protections if you report it. If you
(06:59):
do it in good faith, you cannot be held liable.
So very little downside for reporting it. Quite a bit
of ups of downside if you don't report it, So
report it. So let's talk briefly about elder abuse, harmful
treatment of people include embannment, isolation, abduction, emotional, financial, verbal, mental, sexual,
(07:19):
or physical abuse, corporal punishment, involuntary restraint or seclusion, neglect,
the failure to provide care necessary to prevent physical or
mental harm, deprivations of goods or services that are necessary
to avoid physical harm or mental suffering, and physical and
financial abuse are the most common forms that we see
(07:41):
in the real world. The elderly do often do not
report abuse because they fear retaliation, not being believed in,
or shame about being abused. Now I've had to call
in for elder abuse and report it, and I gotta
say the process was straightforward, was relatively easy, and they
(08:02):
were very helpful on the end of NONET. That's where
I'm at. They were very helpful, and it did turn
out there was old abuse and the person doing it
actually ended up in jail last I heard. So it
was really good that we reported it, and so do it.
You know, it's not an issue so child abuse, of course,
(08:24):
we hear about this all the time. Unfortunately, an abused
child is one who has suffered intentional, serious, mental, emotional, sexual,
and or physical injury by a parent or other person
responsible for the child's care. Some states add in suffering
from starvation, moral neglect, and or immoral associations, And according
(08:47):
to one of my sources, an abused child is generally
defined as a person younger than eighteen years of age
whose parent or other person legally responsible for his or
her care does any of a number of physical, mental,
or sexual abuses, so any of those would count as
child abuse. Another category of mandatariy reporting is suicide and harm.
(09:12):
It is manetary to report a patient who is in
quote unquote imminent danger of harm to self or others.
Call your accounting's mental health department. They will tuck you
through the process and confirm the imminent danger. You can
call the police of actions are impending. It's one thing
to say I have a gun at home and as
soon as I leave here, I'm going to use it
(09:33):
on myself. That's imminent danger. You got to call them
a mental health department. If they have the gun in
their purse and they say as soon as they walk
out into the into the into the lobby, they're going
to use it, that is impending action. Call the police.
So there's a little bit of difference those that word
in imminent danger. That phrase imminent danger is very important. Again,
(09:54):
I have had to report this. We you know, when
I was a supervisor, I had a patient who said
she was suicidal, but she was not an imminent danger.
So instead of reporting, we actually called her psychologist and
he said, yes, I'm aware of it, we're working with it,
don't worry about and that was the end of that.
So I did follow up and it was an imminent danger.
(10:15):
And that was kind of early in my career where
I didn't really know this term imminent danger, and so
if I had known it, I probably wouldn't have gone
down that road. Another area of potential mandatary reporting is
domestic violence. Any health practitioner employed in a health facility, clinic,
(10:35):
physicians office, local or state public health department, department, and
or clinic, or other type of facility operated by a
local or state public health department, who and his or
her professional capacity, or within the scope of his or
her employment, provides medical services for a physical condition to
a patient whom he or she knows or reasonably suspects
as a victim of domestic violence, shall immediately make a report,
(10:58):
even if the patient deny abuse. So this actually, if
you listen to what I just said, it sounds very
lawyer esque, and I believe I got it. I did
it a long time ago, and unfortunately I'm really good
at at keeping track of my sources. I did not
on this. I think it was probably from a website
of a lawyer or something along those lines, and it
was probably in the state of California. So this again
(11:21):
may or may not be helpful for those in other states.
For a long time, I didn't think we needed to
report domestic violence, and then as I looked more into it,
yes we do need to. The law had changed, and
we do need to, at least in the state of California,
because what was happening is people just weren't reporting it
and then it would escalate. So again, something to look
(11:42):
at where you're located. It's impossible for any person like
me to know all the laws everywhere and all the countries,
all the states where this could be at. You know,
just in today's today's people listening today, I have people
from all over the world. I have I think at
least eight country trees that are have signed up for
(12:03):
listening to this, and I know there's a lot more
once it hits the actual podcast universe. So yeah, there's
a lot of different laws out there, so when you
do report, there's no legal requirement to inform the patient
of the report. However, ethically you should inform the patient
(12:23):
of your obligation. As a mandatory reporter. You must report
whether or not the patient consents to report. So if
they say no, or if they consent or not consent,
that's one thing, but you still need to report it
whether or not they consent, if it's a mandatory reporting situation.
And in this course I get into the ethics involved
with reporting, because you're violating the patient's privacy and autonomy
(12:46):
sometimes by doing a report, but you're also demonstrating a
key ethical concept called beneficence. And of course there's legal
aspects and we get into that as well, So we
talk about all that, and then here's a very important
thing to keep in mind. Reporting is not a substitute
for thorough documentation in the medical record. The medical record
(13:08):
is generally a more valuable source of documentation for legal
cases and is critical to the patient's ongoing care. In
other words, just because you get wrapped up in making
a report or trying to decide if you should or
shouldn't make a report, doesn't mean you need to collect
your your your actual medical records. You have to still
put in all the information in your medical records. Ace
(13:28):
you're doing this, and I think that's it for mandatory reporting.
Thank you guys. That's a little something different. Let's get
into today's formula. Gonsa god so it's a it's a twister,
gonsa Ganjiang, fooling, baijiutang, and as I mentioned earlier, it's
basically these are the name the Chinese names for the
(13:48):
four herbs in this formula, So liquors ginger, poia, and
white attracted lotus to coction. There are lots of other
names for this formula. These include licorice, ginger, pooria, and
attracted lotus. That sounds really same, but it doesn't have
the white there. So in fact, when you look at
(14:10):
the Chinese, it's ganjiang ling xu tong, so it's much shorter.
Ah just shortens up all the names. Liquorice decoction, gonsou
tongue decoction for fixed kidneys, schuenzuo tongue damnous eliminating decoction
or chu shirt tongue, poria, ginger, attracted los and liquorice
de coction, So just kind of mix up everything and
(14:30):
again use this the shorter versions of the name, so
ling jiong Ju gan tong poria, ginger white attracted los
and licorice tocoction or fooling ganjiog buy Ju Gonsu tongu
shen chu tong, which we kind of got close to
uh jen ju tong h u and kidney fixity decoction.
(14:54):
I kind of like that kidney fixity decoction. So there's
lots of different names, all just very similar scrambles of
the name that we're talking about today. So this formula
is in the subcategory of formulas that warm and transform
water and damtness under the categories category of formulas that
(15:14):
expel damnus. And this is according to Shide and his team.
That's one of our big textbooks that we use. Are
other usual Formula's textbook Chinese Medical Verbal Formulas and Applications,
Pharmacological Effects and Clinical Research by Chen and Chen say
it is in says it is in the warm formulas
that dissolved damnus subcategory under the damp dispelling formulas category.
(15:39):
In other words, pretty much the same thing, just using
slightly different words. In the translation. So let's talk about
these formulas that expel damnus in general, and then we'll
get into the specific subcategory of formulas here. So Shide
usually has a really good explanation of the overall category.
(16:00):
And here's what they have to say about this overall category.
Fluid physiology and pathology are at the foundation of Chinese medicine,
and Chinese physicians have always been greatly concerned with damp disorders.
And Chapter seventy one of basic questions. If you're not
with the Basic questions, this is the Huangdi siu Ween
(16:21):
or the Yellow Emperor's Classic of Internal Medicine Wang dn
Jing su Wen so Yellow Emperor's Classic of Ventural Medicine.
This is the oldest existing medical book really. It was
written probably around two hundred BCE, so it's been around
for a while, and it is noted. It's in two
(16:41):
different parts. One of the is the basic questions is
sun and so we're talking about here. So chapter everyone
there says it is noted that water constraint is treated
by breaking it up. Chapter fourteen of the same book
lists sweating diarrhsis, which is urination and elimination via the
stools as three possible routes for eliminating water excess passage.
(17:03):
In chapter seventy four elaborates on the nature of herbs
used for these purposes. Damp pathogens in the interior are
treated with bitter warming medicinals assisted by sour and bland medicinals,
because one can use bitterness flavor to dry dampness and
the bland flavor to drain it. If damnness is more
(17:25):
pronounced above leading to heat, it is treated with bitter
warming medicinals assisted by sweet and acrid medicinals to promote
sweating and thereby arrest the disorder. Chung Chong Jing's Discussion
of Cold Damage and Essential Formulas from the Golden Cabinet
offered formulas that translated these strategies into clinical practice. So
(17:47):
this is another super multi mega ultra famous book, Discussion
of Cold Damage and Essential Formulas from the Golden Cabinet.
This is the oldest existing book we have on formulas
and it was written about It was written near to
twenty CE. It's almost four hundred years after that. Wangden
Agings who win that we just talked about. But so
(18:09):
that's where this formula actually comes from. As we're going
to find out sort of, and so they have strategies
that bring this into clinical practice. Many of these not
only continue to be widely used today, but also served
as platforms for the development of other formulas and strategies
by the Tang dynasty. So several hundred years later, the
(18:30):
adage drying can eliminate damnas had become one of the
ten exemplary treatment principles in chen Soong cheese emissions from
the classic of the Materia Medica or the Bensu Shiryu
written in seven to twenty CE, and every epoch in
the history of Chinese medicine since then has added to
the evergrowing therapeutic arsenal in this group. The importance accorded
(18:54):
to the Chi dynamic by the various genuine masters and
part of a new stimulus to the tree of damp disorders.
So we talk about the genuine masters in a previous
spur observes very very important time period of expansion in
Chinese medicine again after the tongdynocese, so we're kind of
(19:15):
dicking through this. Historically, most innovative, without doubt was Jiang
Yuan Su and Lee Dang Yuan's use of wind medicinals
or fong Yao to assist in the uplifting of middle
burner chi and thus the transformation and dispelling of dampness.
They also devised the strategy of separating and reducing or fenshaw,
(19:37):
which utilizes the different functions of the triple burner vis
a VI the fluid metabolism as a method for treating
complex damp pathologies. This strategy was later taken up by
ytn Sure and other exponents of the warm pathogen disorder
current in Chinese medicine, who perfected it as one of
the key methods in their treatment of damp warmth disorders.
(20:03):
Damnus is a yin pathogenic influence that has a heavy,
sluggish nature. Damp disorders progress slowly and linger in the body.
Internally generated damnas is usually associated with improper eating habits,
overindulgence in alcohol, and obsessive deliberation or other emotional behavior
that injures the spleen. Manifestations include generalized and focal abdominal distension, nausea,
(20:30):
vomiting diarrhea, jaundice, painful urinary dribbling, or edema of the
lower extremities. Damness can also be externally contracted from living
in a damp climate or environment, or getting wet from
rain or sweat. Manifestations of externally contracted damness include chills
and fever, a feeling of distension in the head and
(20:52):
heaviness in the body, stiffness and pain in the joints,
or superficial edema. Because it is not uncommon for conditions
of damness to present with both externally contracted and internally
generated aspects, it must therefore be approached carefully in each
case to gain a full understanding of its ideology and
(21:13):
the underlying constitution of the patient. The word water or
shway is often used in connection with dampness. Sometimes this
word refers to the fluids in general, and sometimes specifically
to edema, or to an accumulation that is more distinct
and localized than damnness. The latter usage is reflected in
(21:34):
the adage damness is the premeation of water, while water
is the accumulation of dampness. In this text, sui is
translated as edema when it refers specifically to that condition,
but otherwise we have left it simply as water. Problems
with those organs that are most intimately connected with the
process of water metabolism in the body often result in
(21:58):
dampness orders. The three most important organs are the kidneys,
which are said to govern water, the spleen which controls water,
and the lungs, which govern the sending and descending aspects
of water metabolism, known as the water pathways are swayed
out among the young organs. The triple burner and the
bladder also have important connections with water metabolism and therefore
(22:22):
with dampness. If the she is obstructed in the triple burner,
there's no force behind the metabolism of water. If the
bladder does not function smoothly and urination becomes difficult, the
G mechanisms of the triple burner can be affected by
the backflow because damnus is a heavy, sluggish, pathogenic influence
(22:44):
that readily ehinders and obstructs the G mechanisms. These formulas
often include she regulating herbs. The value of such herbs
in treating damness is succinctly stated in Systematic Differentiation of
warm pathogen diseases or when being Tabian written in seventeen
ninety eight. When the G mechanic quote, when the G
(23:05):
mechanisms are transformed damness will likewise be transformed. For example,
when the bladdergy is obstructed by damness, these herbs can
regulate the bladder ye and thereby provide an avenue for
water and damness to exit the body. The principal patterns
of externally contracted damness are damp heat and wind dampness,
(23:28):
which are generally conditions of excess. Manifestations of damp heed
include jaundice, painful urinary dribbling, and atrophy disorder. It is
always important to carefully distinguish both the level burner at
which the process is active and the pathogenic influence that predominates,
and treat accordingly. When damnness is marked by pain, usually
(23:50):
of the joints, and is sometimes accompanied by edema, here
it is also important to discern whether wind or damnness predominance. Furthermore,
because these conditions lodge primarily in the channels, ensuring the
free flow of healthy blood is an important aspect of treatment.
The flow in the channels is open, the wind has
(24:11):
no place to lodge, hence the adage when treating wind disorders,
first treat the blood. In general, the formulas in this
category are comprised of acrid aromatic and warm substances that
dry damness or sweet land substances that leach out damnness.
They should be used with extreme caution in cases of
yin deficiency and depleted fluids. In patients with debility brought
(24:36):
on by disease or pregnancy with edema or other signs
of damness, these formulas must be modified with spleen strengthening
herbs to protect the normal chieve. So that is formulas
that expel dampness. Let's go into the specific subcategory of
formulas that warm and transform water and damness, and this
is the subcategory where the serve is situation. So again
(25:01):
this is from shine at all, and they continue to
describe the subcategory. The formulas in this section are used
in treating patterns of damness caused by cold or where
cold and damnos clump together. The reasons for this may
be young deficiency or invasion of cold dampness from the outside.
When the kiddy young is deficient and its chi loses
the ability to transform water, the water becomes pathogenic by
(25:24):
overflowing and causing edema or stagnant in giving rise to damnness.
Symptoms include urinary difficulty, edema, and lower abdominal numbness, spleen
young deficiency can give rise to similar problems. Cold damness,
which has many ideologies, tends to settle in the lower
(25:46):
parts of the body. It may lodge in the intestines,
manifesting as thin mucus, or it may cause cloudy, painful
urinary dribbling, leg chi or various types of edema. Leg
Chi is sort of a term we use for a
demon of the legs, basically to treat cold damness. The
formulas in this chapter ely on chief verbs that warm
(26:07):
the young and promote the resolution of dampness, such as cinemama, rhymulous,
quadir aconiti, radix, lateralis preparata or jerfudza poria fuling and
attracted lotus, macrophil pala, rhizoma baiju. We actually use those
last two in our formula. Depending on the pattern, they
may be combined with deputies and assistants that strengthen the
(26:30):
spleen and tonify the kidneys, or that regulate the chi.
Herbs that strengthen the spleen and tonify the kidneys include alpinia,
oxiphalle phile fruitus or yijuren attractor lotus macrocephala, rhizoma, baiju,
(26:51):
callucrous radix consau. We use both of those jiujubei, fruitus,
dodzao and aconiti, redex lateralis preparata or jerfudza kidney and spleen.
Young is essential in supporting the body's water metabolism and
in turn is easily damaged by cold damnness. This makes
it essential to ensure its vitality. Herbs that regulate the
(27:14):
chi like magnolia officialities cortex or hopo linda a, redex
wu yao Aclandia, redex muchiang citri, reticulated Pericarpium chenpi or
rique pericarpium d fupi are used to open the cheat
dynamic in order to facilitate the dispelling of damnness. Okay,
(27:36):
and that's the background for our formula of today. Let's
get into what this formula does. What are its Chinese
medical actions. According to Schid and his team, they say
this formula warms and transforms phlegm in thin mucus, strengthens
the spleen, and resolves damnness. And Changen says something similar,
(28:00):
say it warms young and strengthens the spleen and dispels
cold in dampness. So what are the indications for this formula.
You know, the actions are pretty succinct. The indications can
be a little bit more as we're gonna see here.
So Shide and his team say this formula can be
used for a heavy sensation in the body, cold and
(28:24):
pain in the lower back. Pressure in the lower back
as if carrying a heavy weight, normal appetite and absence
of thirst and copious urine. The tongue will be pale
with a white moist coating that may be thick and
greasy at the root, and the pulse will be submerged,
(28:44):
thin and moderate. This is called kidney disorder n joo
type of painful obstruction of the waist and lower back
due to cold dampness. The ideology of this disorder commonly
involves internal causes such as over worm and habitual sweating
that weaken the normal chi and the invasion of cold
(29:04):
damness from the outside. The source text speaks of exposure
to rain, walking in water, or sitting in damp places.
In modern patients, this might be swimming for too long
or in too cold water, or not tweling off properly.
The onset can be both acute and chronic. Damness in
(29:25):
the entire body causes a heavy sensation. As a yin pathogen,
it tends to float downward, settling in the lower back,
where it obstructs the flow of chi and causes a
cold sensation, pain or pressure. Normal appetite and a lack
of any particular thirst indicate that the functions of the
middle and upper burners are unimpaired. Copious urination reflects attempts
(29:49):
by the body to rid itself of damness and plant.
That kidney function is normal too, and that the pathogen
is settled in the skin and muscle layer. However, because
of the lower back is the residence of the kidneys,
and because the pain is fixed, the condition is referred
to as a fixed kidney disorder. The tongue and pulse
reflect the dampness settling in the lower burner. Chenan Chen
(30:15):
say the clinical manifestations for this formula include cold and
damness and the lower body coldness and pain of the
lower back and body feeling of extreme heavy sensation in
lower back, normal appetite and diet, absence of thirst, and
normal urination. So where do this is? This first mentioned?
(30:37):
Both shine at all and Chennan Chen both say the
source is the Jingue Yao Lue or Essentials from the
Golden Cabinet. That was that book I was talking to
you about earlier. That is the first existing book on
Chinese verbal formulas, and that was written around two twenty
CE by Jiang Xiang Jing, super super famous Chinese doctor
(31:00):
Jean Joan Jing. Talk about the ingredients of this formula.
So the first agreeient we're talking about is glitciery. So
we're gonna kind of go through these in order of gonzao,
ganziong fooling by jus. The first herb is gonzhu or
glycius or a radex. This is licorice uh and we
use six grams for this and this. These herbs are
(31:20):
in the category of herbs that toonify the chi. Its
functions include it tonifies the spleen and augments the chi,
moistens the lungs and stops coughs, moderates spasms and alleviates pain,
moderates and harmonizes the characteristics of other herbs. And it's
probably the most commonly used herb in our formulas for
that last reason. It moderates and harmonizes the characteristics of
(31:42):
other herbs. In this formula, gonzao harmonizes the function of
the other herbs while also contributing to strengthening the spleen.
Our second herb is gon gien or is zinjibaris roizoma.
We're using twelve grams of this. This is dry ginger,
so twelve grams of this in our formula. And it
(32:03):
is from the herbal category of warm acrid herbs that
release the exterior and traditionally it warms the middle and
expels cold, warms the middle and expels cold. Oh that's
a double. Rescues devastated young and expels interior cold, and
warms the lungs and transforms thin mucus. This formula treats
(32:27):
cold damness obstructing the movement of chi and fluids in
the skin and muscles, primarily in the lower back. In
the lower back, this is what we're using in this formula. Well,
that is what the formula does. Although the lower back
is the seed of the kidney's the kidney organ itself
functions normally is unnecessary. Therefore to treat the kidneys directly,
So ganjak generally doesn't treat the kidneys directly, so that
(32:50):
makes sense here. Rather by warming the young and eliminating
the damness, focusing primarily on the spleen due to its
resonance with both damness and the flesh, it is possible
to effectively treat this disorder. The main herb for this
purpose is acrid and warming Zinibaris rhizoma or gondjianng. That's
(33:10):
this herb here. It warms the middle but also drives
out wind, damp, painful obstruction, effectively addressing both the actual
pathology and the background disposition. So really good herb for this.
Our next herb is the third herb and our name fooling,
So that is porea, and we're using twelve grams of
(33:32):
that again, and this is in the herbs that drain damness,
So that's this is probably the herb for the herbs
that drain damness. It traditionally promotes urination and leaches out damness,
strengthens the spleen and harmonizes the middle. Burner strengthens the
spleen and transforms phlegm and quiets the heart and comes
the spirit. And for this formula, because damness in this
(33:55):
pattern is relatively severe, Bland fooling is added as a deputy.
It strengthens the spleen and promotes urination to eliminate damness
via the urine. The combination of fooling and gonjiong warms
the young and dispels damness, removing pathogenic chi without injuring
the normal chi. And finally, our last herb is by
(34:19):
jew or attracted lotus macrocephalae rihizoma. This is white attracted lotus.
We're using six grams of it. And this also comes
from herbs that toonify the chie but it's kind of
drying in and of itself. So let's see this herb
tonifies the spleen and augments the chee, dries damness, and
promotes water metabolism, stabilizes the exterior, stops sweating, and calms
(34:41):
the fetus. And in this form of the bitter sweet
and warming bai Jou functions as the assistant. It tonifies
the spleen cheet even as it dries damness. So it
does two very important things for this formula. It's a
nice tight or herb formula. It's a really nice little formula.
(35:02):
So houses prepared. Shyde and his team states this should
be taken as a decoction, and the source text specifies
that administration of the formula should cause the patient to
experience a warm sensation in the lower back. That's nice
as usual. Shy did his team have an excellent commentary
(35:24):
about this formula. Although modern textbooks frequently define fixed kidney
disorder as a type of painful obstruction, it differs from
other types of painful obstruction patterns in a number of ways. First,
it conjoins only two rather than three pathogens, damnness and cold,
while wind is absent. Second, cold damness here is located
(35:46):
in the skin and muscles rather than in the channels
and collaterals, and is therefore treated via the spleen. And Third,
as indicated by the symptoms of heaviness throughout the body
and coldness below the waist, the pattern involves more than
local accumulation of damnness. This is explained by Shu Bin
(36:06):
in Discussion and Annotation of the Essentials from the Golden
Cabinet or the Jingue Yaley Lunju Ridden in sixteen seventy one.
The term fixed kidneys expresses a condition of something adhering
and not moving as protective chi issues from the lower
burner the kidneys being fixed by a pathogen means that
(36:27):
damness stagnates the protective chi hence the entire body feels heavy.
The formula thus focuses on promoting young and dispelling damness
via the urine rather than sweating. Sweating and the use
of verbs that dispel wind damness would not be an
appropriate strategy, in part because of the nature of the
(36:47):
pathogen and in part because the protective young is hemmed
in by dampness. Over time, physicians have extended the application
of this formula to the treatment of girdle vessel disor.
This is based on a passage in twenty nine of
the Classic of Difficulties in the non Jiang Noang Jing,
(37:08):
written in the Hang dynasty anywhere from twenty five to
two twenty CE. This is we've talked about the Wangdi Jing.
The non Jing Classic of Difficulties is sort of an
explanatory text of the difficult issues that kind of come
out of the wangdian a Jing, and in there they
quote girdle vessel disorders are characterized by abdominal fullness. The
(37:32):
lumbar area feels weak and as if one were sitting
in water. This closely matches the description of the pattern
for Gonzaeu, Ganjiang, Fooling, Baijutang, and essentials from the Golden Cabinet.
The Jingue yaou Lai, written in approximately two twenty C,
as we've already mentioned, which speaks of a sensation quote
(37:53):
as if one were sitting in water, quote and quote
the back being heavy as if one were carrying a
belt canating five thousand coins. Another important indication is a
demon during pregnancy, for which discussion of illnesses patterns of
formulas related to the unification of the three eediologies. The
sign yan ge being Jung Fong Fung, written in eleven
(38:16):
seventy four, recommends the addition of armanossier semen or shing
ren that's an apricot apricot pit clinically the key diagnostic
marker suggesting use of this formula can thus be summarized
as follows. Heaviness, coldness, or pain of the abdomen or back.
The sensation of cold can be subjective or may be palpated.
(38:39):
Heaviness may be manifest as a sensation of numbness or insensitivity,
and there may also be difficulty in bending from the waste.
Excess water may manifest as increase urination, diarrhea or soft stools,
sweating saliva, phlegm discharge, or increased secretions from the skin
(38:59):
due to the under lying cold. These will usually not
be malorderous, so they don't smell signs of damness on
the tongue such as white moist coating that may be
thick and greasy at the root, accompanied by a pulse
that is submerged, thin and moderate. So that's commentary from
(39:20):
Shide and his team. Chen Chen have a commentary brief
commentary that say, because this formula treats cold and damnous
located in lower back around the kidney area, it is
also known as Chenzho tongue or kidney fixity decoction. It
is important to note that this formula treats cold and
damnus affecting the muscles near the kidney area. It does
(39:41):
not address kidney imbalance nor treat kidney diseases. So even
though the kidney's in the name, it doesn't treat kidney
issues directly. And then we have a lot of commentary.
There's another book that is just a fantastic book that
I like to refer when I can. This formula is
discussed in Huang Kwang's ten Key Formula Families in Chinese Medicine,
(40:05):
translated by Michael Max And so this is where we're
gonna this formula. He has a nice commentary on this
formula as well, so we're gonna get into that right now.
In it, he says, when the renshen in li jiang
yuan is replaced with poria fooling, it becomes liquorice ginger
poia white attractive lotus to coctrine gonsa Ganjiang fooling by Jutung.
(40:27):
So this formula, which treats lower back pain from cold
and damnness. Renschen jinsing is not used in this situation
as there are no signs of emaciation, epigastric focal distension
with firmness or poor appetite. Fooling and bijou are used
together here as they treat a sense of heaviness and lethargy,
(40:48):
urinary difficulty, and superficial edema. The lower back should feel
warm after taking this prescription, which we heard before. He
also quotes essentials from the Golden Cabinet has the following
description of this formula's action in treating lower back pain.
These people's bodies feel heavy. There is a clear demarcation
(41:10):
to the pain, much like they were sitting in a
tub of cold water, and there is accompanying whole body edema.
From the waist on down, it feels cold and painful.
The back feels heavy, as if carrying five thousand coins.
The distinctive characteristics of this type of lower back pain
are cold pain, ling tongue, and heavy pain jong tong
(41:32):
Cold indicates there is pathogenic cold, and heaviness indicates there
is dampness. The licoris ginger poorium white, attractive, litistic cooctrin
presentation is as follows. One a cold feeling from the
waist down with a feeling of heaviness and pressure or
achy pain. Two edema a predisposition to edema, the entire
(41:53):
body feels fatigued and sluggish, and three dried gen tongue.
So this is something he explained earlier, and this is
how I explained it. Pale or pale red tongue with
a greasy coating that is usually white and greasy, but
maybe dark gray in greasy or white and slimy. This
(42:15):
formula's presentation is often seen in patients who are overweight
and have lived for a long time in a cold,
damp environment. Their bodies usually feel heavy and tired. The
joints and muscles often feel heavy and achy. They are
predisposed to edema or watery stools, and the tongue has
a white coating. This is a damp body type much
(42:36):
like those of the previously introduced to federa and astragulus constitutions.
When these type of people fall ill, they often experience dizziness,
lower back and body aches, diarrhea, abdominal fullness, edema, or palpitations. Therefore,
in practice, this formula, other than treating wind damp lower
(42:56):
back pain, also can be used to treat symptoms of edema,
joint pain, in diarrhea. So that's commentary from Hong Kong.
Great commentary. So what are some modifications to this formula?
Side discusses several modifications for this formula for chronic backache
and discharges of women. Add karthaming floss or hong Hua,
(43:18):
which is a blood mover for older patients with chronic
back ache and urinary frequency at akiniy rate ex latter alis,
preparaz your fudza and servie cornew. The gelatinum or lu
jau schwang so Foodza is very warming and can be
difficult to get. The serving cornew gelatinomum is actually deerhorn
(43:45):
and is probably it's super expensive if you can find it.
Probably shouldn't be using it for conservation issues, but some
people do also. For contents in both boys and girls
up to the age of fourteen. For a more severe cold,
add that akinity radix, letter alice, preparudza and sorry herba
(44:07):
or she shin that would be the other one you
can add in here. For more severe damnus, add alice,
maddis raizoma che attracted litus forraisoma's sung ju that's actually
red attracted list white is part of this formula. And
koes semen or ye wren that's that's job's tears, that's
pearl barley for pronounced spleen deficiency. Add Jensen radix or
(44:31):
renshen chen chen say with severe pain, add fudza radix, akiniti,
letter alice preparata and shi shin radix at raizoma sorry
so similar to what was already mentioned. Hong Kong adds
when combined with stefani and attracted lotus decoction fung chi
huang chi tang. It treats a dima with a feder
(44:53):
decoction plus attracted lotus mahang ja ja jutang. It treats
chills without sweating and joint pain compaired with frigid extremities.
Powder of asinisan. It treats chills, diarrhea and frigid extremities. Comparisons.
Shy compares today's formula and shine in. His team compared
(45:14):
today's formula with two other formulas. The first one is
that one that was mentioned by Hongwang Wong as well
Lijiang Wuan or regulate the middle pill. Both formulas combines
xinjibaris raisoma Ganjiang attractor list macrocephale raisoma by ju and
glycis radex gonsal regulate the middle pill. Lijiangwan adds ginsen
(45:36):
radex or renshen to tonify the middle burner focuses on
patterns characterized by cold and cheat efficiency of the spleen
and stomach gonzaw ganjiam fooling by Jutang adds poria fu
ling to focus the formula to spelling cold damness, particularly
from the lower back. The other formula is poria cinnamon
(46:00):
twig attracted lotus and liquors de coction, Lingue ju gon tongue.
Both formulas contain poria fuling attracted lotus, macrocephala orzoma by
ju and glycius or a radix gonsal poria, cinnamon twig
attracted liss and liquors to coction ling guay Jeu gan
Togu adds cinema rambulus or guay Sure that's cinnamon twig
(46:22):
focuses the focusing the action of the formula on warming
the young and transforming the fluids to treat thin mucus,
particularly in the epigastrium and abdomen. Gonzao Ganjiang fooling by
Ju Tongu, on the other hand, adds zinabarus roizoma ganjiang
to focus on warming and dispersing the cold dampness. Uh
(46:46):
Continuing with comparisons, chen Chen Say ling Lingue, zu Gan
tongue or porious cinnamon twig attractor lotus, macropha, liquors decoction
and gonza Ganjiang fooling Baiju tongue have similar ingredients in indication,
so very similar to what was just said by Shide
in his team, there are both excellent formasts to strengthen
the spleen, wormyong and dispel damnness. Lingua's Yugantang uses fooling
(47:09):
Poria as the chief herb and gwajeranmulus Cinemama as the
deputy herb. The main emphasis of this formula is to
warmyong and dispel damness to resolve time yin or phlem retention.
Gonsaw Ganjiang fooling Baiju Tong uses ganjiog rhizomas in gibaris
as the chief herb and fooling Poria as the deputy herb.
(47:31):
The main focus of this formula is to warm the
middle jaw, dispel cold, and dispel damness to treat cold
and damness in the lower back. There we go. That's comparisons.
Let's talk about some biomedical indications. Shide in his team say,
with the appropriate presentation, this formula may be used to
treat a wide variety of biomedically defined disorders, including acute
(47:54):
lumbar strain, lombar disc disease, sciatica, renal calculi, kidney stones,
chronic pulvic inflammatory disease, benign prostatic hyperchase or BPH, and
urysis or night urination. You know, wet bed, acute gastroinritis,
(48:15):
exima allergic rhinitis, and chronic bronchitis changen. So this formula
can be used to treat low back pain, sciatica, lumbago
and eurysis, superficial gastritis, duad ulcer arthritis, impotence gastritis, atrophic gastritis,
(48:36):
and diarrhea. So the science on this was interesting. There
were no papers on this formula when searched for using
Google scholar looking at the Cochrane Library, which are two
of my go tos. It's quite a rarity when I'm
researching formas, especially considering this is a janghang Jing formula.
In other words, it's an important old formula, and the
(49:00):
fact that there wasn't anything in the scientific literature was
quite interesting. That in and of itself is quite a
interesting fact. Drug rib interactions a couple of urbs in
this formulas may affect sarcroone p for fifty izymes. So
remember cyclone py for fifty is used in the metabolism
(49:23):
of drugs, and so when something affects sarachrone certain aspect,
certain isotymes, or different types a sarcroone P for fifty
can affect drugs either how they're either slowing up or
quickening how it's metabolized, So gon jiang may inhibit caraclone
P for fifty two C nineteen and gonsal may induce
(49:48):
saracon p for fifty two C nine and three A four.
Of those were always most worried about three A four.
Sarachrome P for fifty three A four has effects approximately
forty to six or of drugs and is by far
the most common subtype that drugs are using for metabolism,
So anything that affects three or four has a much
(50:10):
higher potential for a drug ERB interaction than those that
do not. There does not appear to be any pea
glycoprotein interactions with the herbs in this formula, and those
are the two big issues we look at for herbs.
There are others. We're starting to see some research, not
a lot of it at this point, where we're starting
to see some research on high protein binding with herbs.
(50:33):
With herbs, the problems that looks at herb constituents individual constituents,
and that may or may not be an issue when
you're talking about a whole herb so I think there's
a lot more research to be done, but these are
the two big points we look at for drug rob
interactions concerns. Not a ton of concerns here. Shide his
(50:53):
team say, heaviness of the body and backache due to
damp heat must not be tree with this formula. Obviously,
we don't want to treat it with damp heat because
this actually adds heat to the system, so that's not
a good thing. And heaviness of the body is fine.
That is one of the things that we talk about
(51:14):
that this formula is used for. But in addition to
low back stuff, and so just generalized heaviness of the
body is too general and non specific in the what
this formula does doesn't treat that well enough. But if
it also has that heaviness of the low back and
low back pain, then this can also treat it heaviness
(51:35):
of the body. So you just don't want to use
it with heaviness of the body as the only big,
big sign or symptom. And that gets us through this
today's formula, today's erbs herbs. So that was today's formula.
Gonsaw Gondjiang fooling by Jutang or licorice, ginger, pooria and
(51:58):
white attracti lodies, decoction and interesting, if not commonly used
formula that is among one of the first written about
is in the book where the first formulas were We
started by discussing mandatory reporting, and then we got into
the formula including its ingredients, commentary, the science, our concerns
and cautions, as well as its potential drug interactions. The
(52:20):
bottom line here is this is a great formula for
cold damnas, especially the lower body and the lower back.
And so it's warming and it's damp clearing. So that's
really what it's about. All in all, another expiration of
a fascinating and useful Chinese formula. In our next episode
(52:41):
in two weeks, we are going to be looking at
another single Chinese herb, jingj skits an herba or just
skitz anepada. This herb is a relatively commonly used herb
in the Chinese medical subcategory of warm acrid herbs that
release the exterior and can be used in colds, rats,
and even to help stop bleeding. As usual, we explore
(53:04):
all the intricacies of the serb as well as an
explanation of its category, and as always we will look
at something a little different. Join us in two weeks
for another interesting episode. I would like to thank you
very much. If you'd like this podcast, please do. It's
a humongous favor. Subscribe to our podcast and your favorite
(53:26):
podcast app that just as wonders for us, and we
thank you for even considering it. And remember you can
get CUS at ncc AO m PDA's at www dot
Integrativemedicine Council dot org and you can get twenty percent off.
If you use at sh twenty off code, you get
twenty percent off your entire order. And you can always
get in touch with me at doctor Greg at sperbserbs
(53:49):
dot com or at our website www dot sperbserbs dot com.
Hope to hear from you and thank you very much again,
and as usual, we have nice piography spurs or. The
Presidium was presented by doctor Greg Sperverer. We would like
(54:09):
to thank Janelle Frawler's support and everybody else who contributed
to this program. Roger Campbell
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