Ge Gen Tang (Kudzu Decoction)

This episode will be looking at another Chinese herbal formula: Gé Gēn Tāng or Kudzu Decoction. This is from the formulas that release exterior wind-cold subcategory of the formulas that release the exterior category. It is a useful formula for treating colds with a stiff neck and upper back. As always, we will do our deep dive into this herb and look at its traditional uses, and its preparation, interactions, and cautions. And, as usual, we will be adding something a little different…an introduction to macronutrients. 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 look at Gé Gēn Tāng or Kudzu Decoction. It is going to be another interesting vacation into the exciting continent of herbs…please join us!

Episode Transcript

Speaker 1 (00:03):
That Angelica.

Speaker 2 (00:08):
Sper Hello and welcome to Sperbs Herbs, Episode eighty six.
Today we're gonna be talking about gugun tongue or kudzu decoction,
so let's find out more about that.

Speaker 1 (00:22):
So we'll be looking at another Chinese herbal formula. That's
what we're talking about, gougin tongue or kudzu decoction. This
is from the formulas that release exterior wind cold subcategory
of the formulas that release the exterior category. So we've
been talking a lot about these formulas and herbs as well,
so we're going to continue that. It is a useful

(00:45):
formula for trening colds with a stiff neck and upper back.
That's sort of its resonant tatra. I don't know if
I'm pronouncing that correctly, which I rarely know if I'm
pronouncing things correctly or not. As always, we will do
our deep dive into this herb and look into the
serbal formula and look at its traditional uses, its preparation,
interactions and cautions, and as usual, we will be adding

(01:10):
something a little different. We're going to do an introduction
to macro nutrients today, which are important because guess what
a lot of our herbs have macro nutrients in it,
so we're going to be doing that and it's going
to be another interesting vacation into the exciting continent of herbs.
So please join us. Before we get going through, want

(01:32):
to remind er what I've been teaching 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 Integrative Medicinecouncil dot org.
That's Integrated Medicine Council Council dot org and include a
ton of different topics, including my Drug Herb series looking

(01:54):
at drugs and how they interact with herbs and vice versa.
Several ethics and safety courses, which I just got to
notice yesterday that if you are a California licensed acupuncturist,
you now need to have four hours of ethics and
safety every two years. So I have plenty of courses
that fit that bill. We have Chinese medical research and

(02:18):
several treatment of condition courses such as arthritis and I
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and anxiety, and one of my favorite courses, the Chinese
Herbal First Aid kit. That is a great course, and
they're all at a reasonable cost to begin with. Just
full on, they're at a reasonable cost, but you can
get an additional twenty percent off with the code SH

(02:40):
twenty off. That's SHS and sperbs herbs and twenty the
number twenty off all lower cases. So SH two zeroff.
Can't beat that deal. Okay, So let's do a get
into our little introduction of macro nutrients, so it as
our little something different today. I thought we would look

(03:02):
at macro nutrients. Macronutrients are generally used for energy, have
larger intake in the gram amounts, and generally include fats, carbohydrates,
and proteins. Those are the three major macronutrients right there.
Macronutrients are taken in small amounts, either in microgram to

(03:26):
milligram amounts, so one millionth of a gram to one
thousandth of a gram amounts, and generally consist of vitamins
and minerals. Minerals are further broken down into macrominerals. Intake
of more than one milligram daily is necessary and microminerals
intake of less than one milligram daily is necessary. These
are also called trace and ultra trace minerals as well.

(03:50):
So there it goes. Those are just breef micronutrients. Let's
get back to macronutrients. Remember we said these are mostly
about energy requirements, not entire but a lot of it
is about energy requirements. And so we have a number
called the estimated energy requirement or e R, and this

(04:11):
is defined as predicted average energy intake to maintain energy equilibrium.
In other words, it is how much energy intake matches
energy output. And the best way to say this is
from a human point of view, this is what you
need in order not to gain or lose weight. Is
your EER estimated energy requirement. This changes by gender, age

(04:35):
eight height say age height and weight of an individual
based on genetics, body composition, metabolism, and behaviors. This is
difficult to determine, but there are some approximations. Generally, it
ranges from thirty killer calories per kilogram per day for
a sedentary person to forty kilo calories per kilogram per

(04:59):
day for a very active person. You can this is
sort of an interesting number of killer calories kilogram per day.
So the reason why that's weird is killer calories are
technically imperial measurements. Those are not metric. We're going to
talk about the metrics in just a second. It's killing
jewels in metric, but kilograms are metric rather than pounds,

(05:20):
so it's kind of a mixture of stuff in these numbers.
I was always taught for men it is approximately twelve
killer calories per pound and ten killer calories per pound
for women as a baseline, with activity levels adding to this.
So you know, one of the things that you know,
we have our watches now. Back in the day, I

(05:40):
used to always wear a little pedometer, so I knew
how much I was walking and stuff. And I was
going to college and I was walking a lot at
that point because parking was nowhere near college and it
was a big campus. But the idea is at twelve
calories per pound is you know, kind of my baseline,

(06:00):
and then any activity you do on top of that
would add to that baseline. So generally we think of,
you know, you know, give or take one hundred and
fifty pounds person, so generally men are a bit above that,
women are a bit below that. But that's where of
the average at one hundred and fifty pounds a man

(06:21):
would have about eighteen hundred kilo calories per day and
a woman would have about fifteen hundred kilo calories per
day before any activities. So on foodstuffs in the US
and the United States, energy is usually list as calories,
and technically they are not calories. They are kilo calories

(06:42):
or one thousand calories cakews. So here I'm being technical,
so I've been saying cake cows, but technically it's calories.
Elsewhere we're in the world, which is almost everywhere, they
use the metric system, and they use jewels or kilo jewels,
and one kila calorie is equal to about four point
one point eight four kilojoules. So that is the thing.

(07:06):
When I was I was living in Australia for many
years when I went to medical school, and so what
I would always do is just quarter whatever the kilodols were,
and I'd get a pretty good estimate of how many
calories something was. The energy of a food is determined
from the heat released when burning it in a calorimeter.
That's where the word calories comes from, is it's burnt

(07:26):
in a calorimeter. Basically, a calorie is the amount of
energy needed to raise a gram of water. One degree
celsius or a kilo calorie is the amount of energy
needed to raise one kilogram. One degree celius is celsius,
so one kilogram of water. There are four basic types
of food that produce energy, and they are consistent with

(07:49):
how much energy they produce. One gram of carbohydrate or
protein produces approximately four kilo calories. It's with proteins. With
amino acids, it can be a little bit above, a
little bit below, but definitely averages out to about four
kilo calories. One gram of fat produces nine kilo calories,
and one gram of alcohol produces seven kilo calories. Alcohol

(08:11):
is not a great energy source, just to make that clear.
It is a poison to the human body, but it
does give us some energy as well. This brings us
to another aspect of macronutrients, and these are This is
called the acceptable macronutrient distribution ranges or amd rs, and

(08:33):
describe a range of intakes for particular macronutrients. These are
associated with reduced risk of chronic disease, while at the
same time providing adequate amounts of essential nutrients for adults.
The acceptable Macronutrient Distribution Range is approximately twenty to thirty
five percent from fat, forty five to sixty five percent

(08:53):
of calories from carbohydrates, and ten to thirty five percent
from protein. Of course, there's been a lot of high
protein carbohydrate diets around in the last couple decades, and
that's where some of these bigger ranges come from. You know,
there's twenty percent difference in in you know, forty five
sixty percent difference in how many carbohydrates you should have

(09:16):
ten to thirty five percent, and protein sets twenty five percent.
That's a that's a big chunk, you know, whether you
should have ten percent of your diet from protein or
thirty five percent of your diet from protein. So let's
get it all specifically of these three. So let's talk
about dietary fats. So, dietary fats strongly influenced the incidence

(09:38):
of coronary heart disease WILL. Past health recommendations have been
focused on reduced fat intake. Current studies show that type
of fats are more important than reduced intake. Triasoglyceryl tag
TAG quantitatively are the most important type of dietary fats.
So triasoglysrools are I'm not getting into all the chemistry

(10:02):
of this, but those are the most common types of
dietary fats we actually have in our diet. We can
get into poly unsaturated, monoen saturated, saturated fats. There's a
lot more to cover in this, but this is just
a brief introduction to these, but generally, when you are
looking for healthy fats, you want to be looking at

(10:24):
poly unsaturated fats like a lot of the vegetable oils
will be in that regard, and mono insaturated fats like
olive oil. That's why olive oil is very commonly considered
a healthy fat. I was just reading an article two
saying that full fat dairy products can also be relatively

(10:46):
healthy as an acupuncture. So I'm going to refrain from
suggestion that we have a general tendency to say that
that dairy isn't isn't good for people from a Chinese
medical perspective, I have my doubts about that as just
a whole on prohibition. But we're gonna see there's some

(11:07):
interesting stuff coming out. Okay, let's talk about dietary carbohydrates.
That's the second type of macronutrient, and this is the
primary physiologic role of carbohydrates is to provide energy, and
there are three types of dietary carbohydrates. There are simple sugars,
which are mono and disaccharides, and when we talk about

(11:28):
like that high protein, low carbohydrate diet, these are the
types of carbohydrates they definitely want eliminated in that kind
of diet. And I'm not promoting that diet. I'm just
saying this is what the diet says. Simple sugars are
not considered healthy in that type of high protein, low
carbohydrate diet. The second type of dietary carbohydrate is complex

(11:51):
carbohydrates or polysaccharides. These are primarily polymers of glucose in
our starch from plants, glycogen from animals, and can include
fiber as well, which is the third type. We're going
to talk about that in a second. So generally these
are from vegetables, you know, rather than sugars and stuff,
and generally, even with a high protein, low carbohydrate diet,
they don't say avoid vegetables, and that is where this

(12:15):
would come from. And also within vegetables often we have
the third type of dietary carbhydrate vegetables and fruits, which
is fiber and fiber is and non digestible parts oft
polysacharides in lignin. I think fiber is excellent and we
generally as people eating a modern diet, eat more fiber.

(12:37):
So good thing to have. And since it doesn't actually
get ingested at all, well, it does take up part
of carbohydrates, it doesn't actually have any energy promotion properties
to it does not increase our energy. In fact, it
kind of takes away a little bit because it takes
a little bit to move it through the body, but

(12:58):
that's not a big part of energy use. In front
of that, we have dietary protein, and the quality of
proteins determined by how much of the essential amino acids
are in the protein. This is measured on a scale
of zero to one point zero zero called the protein
digestibility corrected amino acids score or the PDCAAS, with a

(13:23):
one point zero meaning that after digestion all of the
essential amino acids are present in the protein source. And general,
animal proteins have all of the essential amino acids in
the appropriate ratio in or its high pd caaas and
are easy to digest. The opposite is true of plant proteins.

(13:43):
Most have relatively low pdcaas values because they do not
contain all of the essential amino acids and are more
difficult to digest. Soybeing protein is the exception of this,
as it has a pdcaas value of one point zero
zer zero. So people will often say dofu is a
really good source of protein, and it can be, but

(14:05):
just remember that dofu is mostly water. It's the proteins
it has are great, but there's not a ton of
protein in dophi. You have to eat a lot of
dofu in order to get enough protein. I love it though,
I mean I think it's a great source of protein,
and I do tend to eat it frequently. Often plant
proteins are combined with other plant proteins to make a
more complete protein. Examples include combining beans and rice or

(14:27):
wheat and kidney beans in order to get closer to
that one point zero p DCaaS value. And that is
a brief overview of macro nutrients. And so without fairdo
why don't we get into today's discussion of our herbal formula,
and we're going to be talking about gougan tongue, kudzu

(14:48):
decoction and googan tongue is simply the name of its
chief ingredient, which is Googan, So this technically just means
kudzuo decoction are Googan decoction. Other names include cocine tongue.
That's ko k e tongue, but technically ks in uh.
It's not the way giles. I think it's the Yale

(15:10):
system are pronounced with the G sounds, so it is
Gogan tongue rather than Gogan tongue, but it's pretty similar.
Sometimes it's just called Peraria decoction and peraria combination. This
formula is in the subcategory of formulas that released exterior
when cold, under the category of formulas that released the

(15:31):
exterior as we mentioned earlier, and that's from one of
our major textbooks. That's Shied, which is I don't have
it up, but that's a very common and frequently used
textbook for Chinese herbal formulas. We have another herbal formulas textbook,
and that is Chinese Medical Herbal Formulas and Applications Pharmacological

(15:55):
Effects in Clinical Research by Chen and Chen, and they
say it is in the acrid and warm exter releasing
formulas subcategory under the exter releasing formulas category. They basically
say the same thing. One says it releases exterior when cold.
The other one says it is a warm exterior releasing formula.

(16:17):
So it's basically one's looking at the action and the
other ones looking at the what the herbs are doing,
So one is what is It's hard to explain the difference,
but they're the same, different sides of the same coin.
So let's talk about these formulas that release six sterere
and and we've discussed this in several previous episodes. Shite

(16:37):
has a great overall discussion of formulas that release the
exterior and we're gonna talk about that here again. So
this might be a repeat if you've been listening to
our our sperbs orbs podcast on a regular basis, but
it's it's it's good. It's a good repeat. So here's
what they say about formulas that released sixterire so is
the overall category. When a pathogenic influence first penetrates the body,

(17:01):
it tends to cause the disorder of the exterior. In
this context, the term exterior biao denotes the superficial layers
of the body comprised of the skin and muscles. These
are perfused by the body's protective chi, which is fierce
and hot in nature and whose task it is to
warm and defend against penetration into the body by external pathogens.

(17:26):
If a pathogenic influence lodges in this aspect of the body,
it not only obstructs the normal physiological diffusion of chi
and fluids there, but encourages the body to move more
protective chi towards the exterior in an attempt to push
out the invading pathogen. For this reason, exterior disorders are

(17:46):
characterized by fever and chills, indicating obstruction of normal physiological
warming even as protective young, and the exterior tends towards
excess head and body aches indicating obstruction of chia and
fluids in the most young, the exterior portions of the body,
and a floating pulse indicating the movement of protective young

(18:06):
toward the exterior. Since wind is the vehicle by which
other external pathogenic influences enter the body via the exterior,
it is involved in most exterior disorders, especially those involving
cold and heat. Thus it is said that wind is
the leader of the hundred diseases fung way by being
church hang the Symptoms associated with an exterior disorder indicate

(18:33):
that the body is actively trying to overcome obstruction of
the chi dynamic by one or more of the six
pathogenic influences. Treatment in Chinese medicine seeks to support these
physiological reactions through strategies that release the pathogenic influence from
the exterior gabl for this reason. For this purpose, one

(18:54):
deploys light, acrid moving herbs that block obstruction to fuse
the protective chi and disseminate fluids to vent pathogenic influences
back towards the outside. No other strategy will prevent the
pathogenic influence from penetrating more deeply into the body. Often,
but not always, this results in sweating. This type of

(19:21):
sweating indicates that an obstruction has been overcome and that
the g influids can once again stream to the surface
of the body, like the flow of water that breaks
through a dam. The sweating may initially be pronounced, especially
if a very acrid and warming formula is used. However,
the profuse sweating should quickly abate as the body finds

(19:41):
its physiological balance. For this reason, releasing the exterior is
often equated with inducing sweating, yet in many contexts where
formulas to release the exterior are used, the sweating may
hardly be noticeable, or strong pathological sweating may evolve into
a milder physiological sweat. This is because the ultimate goal

(20:05):
of these formulas is not to promote sweating, but to
unblock and restore order to the flow of chi and fluids.
The term release from the exterior was first described in
chapter five Basic Questions. This is Basic Questions of the
wand and Ajing, the Yellow Emper's classic. It's the wangtan
Ajing sou when so it's one of the parts of

(20:27):
that book, which is the first existing book on Chinese medicine,
and it's in this chapter five says if a person
harbors a pathogen, the body becomes soaked as the movement
of protective cheet of the exterior transforms fluids into sweat. Hence,
when the pathogen is at the level of the skin,

(20:47):
use sweating to discharge it. The first known text list
herbal formulas that embody this strategy is the early third
century work Discussion of Cold Damage or Shang hong Lung,
which provides some of the most influential formulas in this category,
such as the feder decoction, mahwang tong, cinnamon twig decoction,

(21:07):
guader tongue, and their variants. Its focus on acrid warming
herbs to overcome obstruction from wind, cold, and damnus dominated
medical practice dominated medical practice until the Genuine dynasties of
the twelfth to fourteenth centuries. Innovation until then consisted of
extending the range of substances used to promote sweating, rather

(21:30):
than seeking new areas of application. This changed in the
twelfth century with Leo Wansu's focus on heat pathogens, which
led to the idea that heat in the exterior can
occur there directly, rather than being due to constraint caused
by cold. Venting. Such heat requires the use of acrid

(21:50):
cooling substances, which do not necessarily promote noticeable sweating. The
treatment strategies and formulas composed by seventeenth and eighteenth century
physicians like Yatien Sure and Wuju tang Are, who are
associated with the warm pathogen current, are most emblematic of
this approach. Other innovations stemming from the Genuine area are

(22:12):
the combination of exterior venting with tonifying herbs to treat
exterior excess, combined with deficiency of cheap blood or fluids
in the interior, and the use of herbs to dispel
pathogens from specific channels and their associated surface regions. Sweating
is the first of the eight methods of treatment formulated

(22:33):
by the eighteenth century physician Chung Guo Pung, underlining its
importance in clinical practice. Yet many practitioners continue to underrate
this method. This is unfortunate because the odds of preventing
the development of a serious condition are always better when
intervention occurs at the early stage of an illness. It
is best to treat diseases at the level of the

(22:55):
skin and hair. The next best is to treat them
at the level of the muscles and flesh. Next best
is to treat them at the level of the sinews
and vessels. The next best is to treat them at
the level of the six young organs. The next best
is to treat them at the level of the five
yin organs. When treating at the level of the five
yen organs, half the patients die and the other half survive.

(23:18):
And this is from that basic questions. The Wangdan Aging
Suen Chapter five Successful Use of the formulas. Discussing this
chapter will be aided by paying attention to the following principles. First,
actorate diagnosis is essential. If an interior disorder develops before
the exterior has been released, the rectian must choose between

(23:41):
releasing the exterior first or treating the exterior and interior simultaneously.
The formulas in this chapter are inappropriate for treating disorder
solely of the interior expressed rashes or a dima due
to deficiency. Likewise, it is important to be clear about
the precise nature of the pathogenic influence to be released,
as this determines the choice of formula. One must also

(24:03):
be cognizant of the type of sweating to expect from
a particular formula. So that was the first of the principles.
The second second most of these formulas should be cooked briefly.
They treat acute disorders and are prepared as decoctions or powders.
They contain substances that are light and volatile in nature,

(24:24):
which if subjected to too much heat, lose their efficacy. Third,
formulas taken hot after meals will provide the best results.
Sweating is further encouraged by instructing the patient to bundle
up after taking the medicine as the goal of sweating
is not sweating itself, but to assist the function of
the protective chi. Only a slight sweat over the entire

(24:45):
body is needed to release the exterior. Excessive sweating dissipates
the chie and fluids, and finally, fourth, the formula INDSAG
should be adjusted to the individual's constitution, local climate and seas.
For example, a person who sweats easily lives in a
warm climate and contracts in the illness during the spring

(25:06):
or summer requires only mild treatment. On the other hand,
a person who does not sweat easily lives in a
cold climate and contracts an illness in the autumn or
winter requires stronger treatment. So that was formulas that released
the exterior. Let's talk a bit about the subcategory formulas
that release exterior wind cold shy it at All continues

(25:29):
to describe the subcategory. Wind cold disorders are marked by
fever and chills, chills, predominant head and body aches, clear
or white secretions, nasal discharge, susputum, and a floating pulse.
There are many types of wind cold disorders and all
require the use of formulas that release pathogenic influences from
the exterior by inducing sweating. By definition, all exterior cold

(25:54):
disorders are excessive in nature, depending on the body's defensive
reaction to many types can be differentiated. In practice, cold
damage shanghan and wind attack shong fong chong fong. Cold
damage is characterized by a strong defensive reaction to a
strong pathogen. Cold blocks the circulation of protective chi and

(26:16):
fluides in the outer layers of the body and closes
up the interstices and poores, which prevents sweating, which prevents sweating. Meanwhile, internally,
the constraint of protective and nutritive chiek causes high fever
and severe body aches. Patients displaying this pattern require formula
that strongly induces sweating. If the defensive reaction is characterized

(26:38):
by disorder and disruption rather than complete obstruction, it is
termed wind attack. In this case, although there is sweating,
the condition does not improve. This is because the protective
chi is unable to expel the pathogen. Treatments still requires sweating,
but it must be accomplished by appropriate regulation and harmonization

(27:02):
of the relationship between the protective and nutritive chi, so
the sweating will achieve the goal of expelling the pathogen.
The lungs focus on the skin and surface of the
body and govern the dissemination and clarification of chi. Cold
externally contracted diseases often enter through the skin and disrupt
the downward directing functions of the lungs with such symptoms

(27:24):
as cough and nasal congestion. Because cold has a tendency
to congeal, which can lead to headaches and body pain
from constraint and stagnation of the nutritive aspect, often warm
acrid exteri releasing herbs are matched with those that invigorate
the blood and unblock the vessels. The tendency of cold

(27:45):
to cause contraction also affects the fluids, transforming them into
dampness or phlegm. So that is an overview of these
cate category and subcategory of herbs. Get into this actual
herbal formula itself with talking about its Chinese medical actions,
and Shi'd say shine at all. Say this formula releases

(28:09):
the exter in muscle layer and generates fluids. That's pretty straightforward,
not a whole bunch, you know, that's pretty straightforward medical actions.
Chan chend do not have specific actions for this formula,
but they say it releases does have specific actions. They
do have specific actions to this formula, and they say
it releases the exterior and muscle layer and promotes generation

(28:33):
of body fluids. So that's the actions. The indications get
a little bit more in detail, So let's talk about
the Chinese medical indications and shid gets into more depth here.
Try it at all. His team say this formula can
be used for fever and chills without sweating. Stiff and
rigid neck and upper back. That's kind of the key

(28:56):
symptom here, a thin white tongue coating and a floating
tight pulse. This is one type of externally contracted wind
cold affecting the Greater Young warp. So you know, we
have something in Chinese medicine called the six stages, which
is a description of how cold goat attacks the body,

(29:17):
and we have another one for heat attacking the body
called the four levels. Here instead of stage, they're using
the word warp. So this is part of the six stages,
and the Greater Young is one of those stages or warps. Okay,
continuing with what they're saying, the distinguishing feature is the
stiff and rigid neck and upper back, the appearance of
which the source text likens to a small bird that

(29:39):
strains its neck and upper back in an attempt to fly.
This is caused by wind cold which binds the upper
portions of the greater Young channel that prevents the fluids
from reaching the area. Chen Chen has its indications and
they say gug and taker Kutzi decoction treats tai Yang syndrome,

(30:00):
So that's the same thing as what we've been talking
about greater Young Taiang warp or stage or syndrome. They
say here treats Tayang syndrome with wind cold invasion. In
comparison to the symptoms and conditions applicable to mahuangtang or
federia decoction and gwader tongue cinnamon twig decoction. The distinguishing
symptom for the use of this formula is the severe

(30:23):
stiffness and pain in the neck and back. The severe
neck stiffness and pain are caused by cold constriction and
lack of body fluids which fail to nourish the muscle layer.
Other signs and symptoms of Tayang syndrome with when cold
invasion include fever, aversion to cold, aversion to wind, and
absence of perspiration. What is the history of this formula?

(30:48):
So both Shide and his team and Chen and Chen
both agree, all agree the source for this formula is
the first existing book on Chinese verbal formulas, the Cha
Ku Lung or Discussion of Cold Induced Disorders by Jean
Jeong Jing, written in two twenty CE. So this is
the first existing book on formulas, so that basically means

(31:12):
this is old. We're also going to see that it
was mentioned in the Golden Coffers of Jingue leofan Lun,
which is the same thing as shang Ua Lung Sha
Han Lung in the Jinguei yofan Alum were one book
that later on we're split into two.

Speaker 3 (31:30):
So all right, let's talk about the ingredients. So the
first ingredient is prioria radix or go again, and we're
supposed to use twelve grams of this. What was interesting
to me is that both texts had exactly the same
dosing on everything, which rarely happens. So so porario radex

(31:50):
gogain twelve grams and it's from the cool acrid herbs
that release the exterior category and traditionally it discharges exterior
conditions and releases the muscles, relieves heat and generates fluids,
vents and discharges measles, relieves heat and generates fluids, raises
the young and stops diarrhea, and treats symptoms of hypertension.

(32:15):
The chief herb is a quote from Shide chieferb priori
ratix go again. Releases the muscle layer, especially of the
upper back and neck by drawing fluids to the affected
area and releases the exterior. Our next herb is a
herba mahuang nine grams, and this is in the warm

(32:36):
acroderbs that release the exterior. Traditionally, it induces sweating and
releases the exterior, disseminates and facilitates the lung chi, calms
wheezing and stops coughing, promotes urination and reduces edema, warms
and disperses cold pathogens. And in this formula a fedia
herba mahuang, one of the deputies induces sweating, is the

(32:57):
most powerful herb for releasing excess cold from the exterior.
So it's a very useful verb in that context. The
problem we have with mal wang, and then for the
problem we have with this formula in general is that
you can't get legally. You can't get malhang in most
developed countries. You can't get in the US as far
as I know, you can't get in Canada, most areas

(33:18):
in Europe. That sort of thing.

Speaker 1 (33:20):
It's difficult to get and it's it's illegal technically to
use for patients. Do I use it? Yes, for myself,
I wouldn't use it. Maybe my close family, but I
wouldn't use it on patients. Personally, I think it's a
when used properly, it's a safe verb. But you look
at the literature, you understand why I was banned. There

(33:42):
have been a lot of deaths attributed to mahuang and
seem to be legitimately related to their deaths. But I
also would say the reasons why they were using it
was inappropriate, like for weight loss, and they were using
you know, if little is good for weight loss, more
is better, that sort of mentality, And they all had
heart conditions. But the bottom line, it's difficult to get

(34:04):
and it's there's not really a great substitute for it,
so kind of minimizes the effectiveness of this formula unfortunately,
but it's still important for us to understand it. The
next urb is is Cinema ramuloss or guager. We're using
six scraps, and this is also a warm acrid herb
that releases the exterior and traditionally releases the exterior, assists

(34:27):
the young worms and unblocks the channels and collaterals, warms
the young and transforms thin mucus, assists the heart young
and unblocks the young chi of the chest, warms the channels,
vessels and collaterals, and warms the middle and directs turbid
yin downward. It's a greater herb. It's cinnamon twig, is
what it is. The other deputy cinnamon remulus guager helps

(34:51):
the chief verb, release the exter and muscle layer. One
of my favorite herbs and tasty at that. Next herb
is Paonia radix alba or by show, and we're using
six grams. And this isn't the category of herbs that
tonify the blood, So that's a different category than what

(35:13):
we've been talking about traditional features. It nourishes the blood,
regulates mensis, calms and cerbs livery young, preserves y in,
adjusts the nutritive and protective levels, and alleviates pain. So
traditionally I mean When you look at the formula, it
actually doesn't say by show paonia radix alba. What it

(35:37):
actually says is paonia radix or shao yao is listed
as the ingredient. However, paonia redex alba bishoo is the
type of paoni radix shao yao that is generally used.
That's a quote from the from the Shia at all.
So shayao is sort of a general term. There's red
paony and white peony, and kim indicate either of them

(36:01):
generally when you see shah ya it's it's it's more
of a tendency towards bishoo, the white paone, and in
this form the paone radix alba by shao, one of
the assistants, preserves the yenn by preventing the extra releasing
herbs from causing excessive sweating. Together with Cinemama regulus guajure,

(36:23):
it regulates the protective and nutritive chi and assists in
the expulsion of the pathogenic influences. Our next herb is
Singibaris raisoma reasons or shen jiang, and we're using nine
grams of that. And it is in the warm acroderbs
that release the exterior category. It releases the exterior, disperses cold,

(36:43):
warms the middle burner and alleviates vomiting, warms the lungs,
and stops cough and resolves toxicity. The other assistance Gingerbarro's
rizoma reasons shen jiong and jujubei fructus dodds out, which
we're about to mention regulate the protective and nutritive chi
and harmonize the stomach, protecting that organ from injury. And

(37:06):
here is that jijibi fruittus DoD zao DoD zao, and
we're using twelve pieces of four pieces are generally used
in modern times. And it's in the category of herbs
that tanify the chi, tanifies the spleen and augments that
she nourishes the blood and calms the spirit, moderates and
harmonizes the harsh properties of other herbs. We used to

(37:28):
call DoD Zhao jijibi and the fresh ginger shenjiang with
licorice gonzel, which is our next one. We used to
call those the three amigos and Chinese medicals cau. They
are in a lot of formulas and the harmonize and
help kind of make sure, as it says, or moderates

(37:49):
and harmonizes the harsh properties of the other herbs, so
those are often called put in herbal formulas. And that
brings us to our last ingredient, which is that glycirous
or a retic preparada jurgansal. So this is actually honey
fried licorice, and we're using six grams of it. And
this is also in the herbs that tanify the chi category.

(38:10):
And it says this herb is prepared with honey, which
significantly increases its ability to tonify the middle augment, the
heart and spleen, cheek and harmonize the properties of other herbs.
The envoy glcious retix preparada surgonsal harmonizes the actions of
the other herbs together with peoni redix alba or bishow.

(38:32):
It also relieves muscle spasms and is therefore useful in
the treatment of neck and back stiffness. So it's a
useful herb here preparation. According to Schid and his team,
the source text advises to place peraria redix gugin and
a fedia herba mahuang and about ten cups of water

(38:54):
and decoct until eight cups remain, then add the other
herbs and decoct until three cups remain. However, this practice
is rarely followed at the present time, and the formula
is decocted in the normal manner, which means you put
everything into it, you boil it for a while, and
then you strain it, and then you put more water
and boil it again. That's one way. There's a lot

(39:16):
of different ways prepared to coctions. We've talked about them
in the past. Commentary as usual Shine in his team
has an excellent commentary about this formula and here it goes.
In discussion of cold damage, paragraph thirty two, it is
noted that this formula can also be used for simultaneous
greater young and young brightness warp disorder with diarrhea. This

(39:39):
is usually explained by the formula's ability to help the
stomach chi rise while simultaneously releasing the exterior and essentials
from the golden cabinet Jingue Yao Lue it says circle
two hundred. Again, this is the same book as the
Shakun Lung the discussion of cold damage, it was split
apart later on in the history, so in Essentials, the

(40:00):
Golden cabinet. This formula is indicated for a greater young
warped disorder in the absence of sweating and scanty urination.
This is a condition of exterior excess in a person
with deficient fluids. In this case, the cheap pours upward
into the chest that prevents one from opening the mouth
to speak. This forum may also be used in treating

(40:23):
the transitional stage between acute and chronic rhinitis ready nose
or sinusitis, characterized by mucosal swelling, congestion, and sensitivity to
dust and cold drafts. For this reason, some practitioners use
the formula as a foundation in formulas that treat allergic rhinitis.
Tung Shau Chian, a prominent modern physician from Chungdu, uses

(40:48):
this decoction for chronic pediatric diarrhea with considerable success. It
is also very effective for acute stiff neck. Chen Chen
also has a commentary on this formula. Gogan Tong Kudzu
decoction treats Taiang syndrome with wind cold invasion. In comparison

(41:10):
to the symptoms and conditions applicable to mawang tongue of
Federa decoction and guager tongue cinnamon twig decoction. The distinguishing
symptom for the use of this formula is the severe
stiffness and pain in the neck and back. We already
mentioned that the severe next stiffness and pain are caused
by cold constriction and lack of body fluids, which fail
to nourish the muscle layer. Other signs and symptoms of

(41:31):
taiang syndrome with wind cold invasion include fever, a version
of cold, aversion to wind, and absence of perspiration. Gogan
tong is formulated by adding gogan rate ex perri labate,
and ma huang or fedra to guager tongue cinnamon twig decoction.
Gogan tongue, however, Gogan however, acts as the chief herb.

(41:56):
It promotes generation of body fluids and relieves muscle stiffness.
Mah Wang herbophedra and guager ramulus in a moment release
wind and cold from the exterior. Also, the sweet and
acrid properties of gwager ramulus cinemomi helped to relieve body
aches and pains. Bi Shao radix paoni alba, the deputy herb,
consolidates the interior yin and body fluids of the body.

(42:21):
Used together guajer rmulus innemomi and bishao radix paoni alba
harmonize chi at the way or defensive and ying in
nutritive levels. Jigonsau radix a raizoma glycerous or a preparata
cammel a camel serves as both an auxiliary and almvioyrbs.
This is different than what Schid said earlier. As an

(42:41):
auxiliary herb, it relieves aches and pains and promotes the
production of body fluids. As an envoy herb, it harmonizes
the formula shenjiog roizomas iningiberous reasons is fresh ginger helps
guager ramulus in amomi to dispel extra when cold, dodzau
or frucitus ju jubay that's Chinese dates by the way,
tanifies deficient chi embody fluids. Later in this monograph, Chinn

(43:10):
and Chen has some additional comments. Historically, gugan tong has
been used for Tayang syndrome with wind cold and accompanied
by stiffness of the neck and shoulders. Today, it is
commonly used to treat neck and shoulder stiffness and pain
associated with muscle skeletal injuries with or without Tayang syndrome
or wind cold condition. For best results, combined gugin tongue
with shao yao gonzao tong or peoni and liquorice decoction

(43:34):
to treat neck and shoulder stiffness and pain. Gogan tongue
can be used at a low dose to complement the effects
of Chibao may ron don seven Treasure special pill for
beautiful whiskers for hair growth. It helps guide the effects
of Chibao may ron don upward by relaxing the muscles

(43:55):
around the neck so that the tonic herbs can reach
and nourish the scalp area directly. All right, Let's talk
about some modifications. Shaide and his team discusses three modifications
for this formula. For severe nasal blockage, add chuan shang
raisoma chwan shang, scutularia retixhang qing magnolia flas shining hua

(44:19):
and platychoti redex chiegong for aicaria that is wheels or
you know hives. Excuse me hives. Add cicada periosticum chan
twee for severe facial pain. Add angelica pubacentis redex or
du huo and peach pit decoction to order the Chi
dalha chung chi tongs. That's a whole formula. Chan Chen

(44:44):
also has several modifications. For nauseum vomiting caused by a
reversed flow of stomach chie add bonsha, raisoma, penelia and
foodling poria. If there are signs of fever and thirst,
add germu raisoma and a marina and sure gao chips
and fibrosum. We're gonna talk about shugao in our next episode.

(45:06):
If accompanied by a severe paint of the shoulders, add
fooling poria buys you rhizoma, attractor litis, macrocephale and foods
of radix achinidi later lateralis peparata pepparata for abdominal paint
and diarrhea with burning sensations, add hong qing redexcutl area
and hoang leon rhizoma coptis where there's itching of the skin,

(45:27):
add young sun or bombaxicadisticatis. All right, so those are
some modifications. Comparisons. How does this compare with other formos?
So shaid it all has two formas that compares to
today's formula. The first one is a feeder decoction mahwong tong,
which we've been talking you mentioned quite a bit today.

(45:49):
Both formulas treat greater young patterns caused by wind cold
fettering protective young in the exterior. The difference is that
a fedria de coction mah hoang tk treats patterns where
this constraint is affecting the dispersion and downward directing of
lung chi, leading to coughing and wheezing. Kudzu decoction Gogan tongue,

(46:12):
on the other hand, treats patterns where the constraint is
affecting the dispersion of chi and blood in the young
brightness channel, manifesting as stiff and rigid neck or other
young brightness channel symptoms. Kudzu scutelarian coptis decoction Gogan huang
ching huang leon tongue. Both formulas are used for treating

(46:34):
a cute diarrhea. However, Kudzu decoction Gogan tong releases cold
from the exterior while it is still in the greater
young warp, while kudzus scutularia and coptist decoction Gogan huang
ching huangly on tongue clears heat after the pathogenic influence
has advanced into the interior. Biomedical indications of this formula,

(47:00):
Shide and his team say, with the appropriate presentation, this
formula may be used to treat a wide variety of
biomedically defined disorders. These can be divided and divided into
the following groups. Problems characterized by neck and back pain
including the common cold, cervical spine disease, torticolis periarthritis of

(47:22):
the shoulder, lumbar disc disease, and lumbar strain. Problems affecting
the head including trigeneral neuralgia, cerebral vascular insufficiency, hypertension, cerebrovascular disease,
otitis media so that's an earache, ear infection, gingivitis, sinusitis,
allergic rhinitis, tonsilitis, and iritis that's the inflammation of the

(47:45):
iris of the eye, and finally, acute digestive problems including
acute enteritis and vacillary dysentery. Chen say this formula has
many pharmacological effects, including being anti bacterial, anti viral so antibacterial,

(48:07):
antiviral antiporetic, which means it reduces fever, anti inflammatory immunostimulants,
so it helps the immune system and power protective. It
help it protects the liver, and helping the cardiovascular system,
including being positively chronotropic and ionotropic, so positive chronotruge means
it speeds up the beating of the heart and iotrogue

(48:29):
means it increases the strength of the contraction of the heart.
These were mostly based on animal and in vitro study,
so take them with a grain of salt because just
because it does something in animal doesn't mean it's going
to or in attest tube, doesn't mean it's going to
happen in humans. But now we talk about the science
behind this, and gensin has a good list of clinical studies,

(48:53):
so these are things that actually did happen in humans,
though a lot of them are not statistic about well,
talk about that as we call them. So they list
several clinical studies involving this formula, so they treating fever
in one hundred and ten children. All of these are
positive studies treating fever one hundred and ten children. One

(49:13):
study without a number of subjects helped upper respiratory tract
infections or irties helped thirteen patients be treated for meningitis.
So thirteen patients is not statistically valid. We'd like to
see at least thirty to forty patients before we can
start applying population statistics to a scientific study. But it's

(49:34):
an interesting indication that can help meningitis potentially. Two studies
for net controler pain, one with an n that's number
of subjects equal seventy and another using a modified version
of Gogan tongue with fifty patients aged forty to sixty.
The modified version increased the doses of Perori aratis go
again and cinemama ramulus guade jure. So there you go.

(49:56):
That's so seventy and fifty patients we're now statistic about.
Not super large studies, but they're definitely more indicative of
potentially doing something. It was treated Bell's palsy with seventy
eight patients in that study, and tension headache with an
unspecified number of subjects, liver cirrhosis with painful gynocomastia and

(50:17):
four patients, so for patients that's just a case study,
may help, may not help. Gynocomastia is the production of
breast tissue and men so they had painful kinocomastia breast
tissue modopfications of Gugu and Tong were used in treating
peri arthritis to the shoulder with an end of thirty
four soft tissue injuries and of thirty two facial paralysis

(50:42):
with an end of two hundred and sixteen. So that's
the highest powered study we have here. Scalare derma a
dermatological condition with an end of seven and two studies
looking at cataract surgery with an unknown number of sets.
That's the interest in cataract surgery. Like help people through
cataract surgery is kind of an interesting use of this formula.

(51:06):
So talk about drug herb interactions. A few herbs in
this foruma may present some risks for drug rib interactions.
Closers for a ridix preparata sugargun sala may induce cytachron
P for fifty CYP three A four, which is the
most common use one, so that's a concern for Drugger
of interactions. It's one of our targets for drug rib interactions.

(51:27):
Singji bears for isoma res shindjung may inhibit CYP two
C nineteen. That's not as commonly used by drugs as
three A four is subtype three A four, but it
can still be a concern for drug of interactions, though
not as big of concern as three A four. Well,
there are some concerns about several of the herbs in
this form of most or D level evidence, so I

(51:48):
don't usually includ D level evidence in this. The hypertensive
effects of a pedgen were blocked when mahuang was used
with aiming triptlen and one human case report despite the
possibly of hypertension and rhythmias speculatively thought to occur with
sympathalum emetics and tricyclic antidepressants are combined. So amytriptaline is

(52:10):
a TCA tricyclic Canada deepressant and mohog is considered a
sympathom ometics. That's where that all comes in. That's C
level evidence, Okay, so some potential there, but TCIs when
we're about to talk about MAOIs. Monoamine on oxidase inhibitors
are antidepressants that are still used but not very frequently,

(52:33):
So this one based on a pedroin contract a content
mahog may cause hypertension with monoamine oxidase inhibitor use. One
case report described a patient who stopped in m AOI
fenylzene and who ingested a combination pill of a phedron,
caffeine and theophalin. Twenty four hours later, she developed encephalopathy,
which is pathology of the brain, neuromuscular irritability, sinus target

(53:00):
heart attachycardia, so speaking up with the heart, hypotension, rhabdomyalysis,
which is basically a melting of the scalinal muscles can
be life threatening, and hyperthermia so overheated. Other possible effects
include rhythmias, chest pain, hyperpyrexias that's a very raised temperature,

(53:21):
and death. Another human study showed an increase in cardivascar symptoms.
Malwong should be avoided for at least two weeks after
stopping MAOIs, So there you go. That's a big drug
urb interaction. Case was a report of congestive heart failure
and hypoclamia. Are too little potassium in the blood and
a patient taking gonsw that's licorice frusimide which is a

(53:44):
loop diuretic, and dijoxin, which is an anti arrhythmic and
pretty potent and of itself. That's sea level evidence Gonzell
may increase blood pressure and fluid retention when used with
oral contraceptives, has shown in two case studies and an
un controlled human seity. And again that's sea level. You know, well,

(54:04):
I would be concerned about licorice. You know, licorice has
a lot of different potential drug rib interactions. Generally, when
used in our formulas, there are a lot of the
negatives of licorice are balanced out. So I'm not horribly
worried about that kind of interaction happening here, but we
need to take it into account. So we just did concerns.

(54:28):
So Shine at all did not have any cautions or
concerns about this formula, which is interesting. Has mahank So
right there and we're gonna see that. Chan Sheen do
have concerns in particularly about mah hoank So. Chenchen do. However,
Chen Shen do have some concerns under the heading of toxicity.
They say gugan tongue is relatively safe even at a
high dosage. No side effects or toxicities were observed following

(54:49):
an oral administration of this formula two point five grams
per kilograms and mice. Furthermore, adverse reactions were not observed
following an oral administration of this formula to mice at
a dosage equivalent to seventeen times the normal adult human dose.
So right there, I mean, that's useful and it helps
us figure out that it's probably pretty safe. But mice
are not humans, and so we have to we have

(55:11):
to be cautious about that. However, in humans, administration of
this formula in extract at seven point five grams per
day was associated with mild nausea, vomiting, fatigue, and constipation.
So maybe some stuff had higher doses. Change on under
the heading of cautions and contraindications also say to refer

(55:32):
to the formula mahank Kank of Federa decoction, and there
they have a lot to say because basically all the
herbs that are in here are also in ma hoang Kong,
in addition to a few others. So basically, as we discussed,
fer herb of mahank is banned in most developed nations
because of concerns about it safety. This passage sums it up.
This is from Chen and Chen. Mah hoang Kong is

(55:53):
extremely acrid and warm, and if used incorrectly, may induce
profuse perspiration. And damage to the chi and of the body. Therefore,
it should only be used in conditions having all the
following characteristics wind, cold, exterior, and excess. There you go.
So that's the concerns and that's it for this formula.

(56:18):
So that was today's formula. Gug and tonger cuts. You
tocoction a useful formula for treating colds or external attacks
with a stiff and rigid neck and upper back. And
I gotta say one of my things is, every once
in a while, I'll wake up in my necks out
and so and I go to the chiropractor and you
can't quite get it. This might be the formula for
me to take when I have that happen. It doesn't
happen often, usually happens every few years under conditions of

(56:40):
extreme stress. It's been a long time since I've had
that level of stress. But if it happens again, I'm
going to consider taking this formula for that. We started
by introducing macronutrients in the role in our health, and
then we got into the formula including its ingredients, commentary, science,
our concerns and cautions as well. It's his potential drug interactions.
All in all, another exploration of a fascinating and useful

(57:05):
Chinese formula. In two weeks, we're going to be looking
at another single Chinese herb sure gal gypsum, fibrosum, or
just gypsum. This herb is in the Chinese medical subcategory
of herbs that drained fire, is among the coldest herbs
in the pharmacopeia, is useful both internally to cool various

(57:27):
heat conditions as well as topically in many dermatological conditions.
As usual, we will explore 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. Thank
you very much for joining us today. If you'd like

(57:49):
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(58:11):
Council c O U n C i L dot org
and don't forget that twenty person off with the code
s H two zero o f F s Sperbserbs s
H twenty off. You can always get in touch with
me at doctor Greg at sperbserbs dot com or at
our website www dot sperbserbs dot com. And as usual

(58:34):
we have our bibliography. Very much Spurs. The preceding was
presented by doctor Greg Sperber. We would like to thank
Janelle for all our support and everybody else who contributed
to this program. Rogcamble