December 10, 2024 • 57 mins
This episode covers the covers an interesting Chinese herbal formula, huang lian e jiao tang (coptis and ass-hide gelatin decoction). This is, relatively, not so commonly used, at least in my experience, formula for treating irritability, insomnia, and palpitations with a sensation of heat in the chest. Could this formula be of help in anxiety conditions? Join us as we find out! And, as usual, we will be adding something a little different…we are going to discuss calcium, its physiological role as well as its Chinese medical role and its supplementation. 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 find out more about this fascinating Chinese formula, huang lian e jiao tang (coptis and ass-hide gelatin decoction)!
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Speaker 1 (00:00):
Spurs that Angelica.
Speaker 2 (00:08):
Sperb Okay. Well, welcome everybody to Sperbs Herbs Episode seventy four.
Today we're going to be talking about an interesting Chinese
formula Huang leon jiao tongue or let me try and
get those toe marks correct, Huang leon uh jiao tang
koptis and ass hidh gelatin decoction. So an interesting formula,
(00:33):
so we're gonna see how it goes.
Speaker 1 (00:35):
And without further ado, why don't we get into it.
Speaker 2 (00:39):
Today we'll be looking at another traditional Chinese formula huanglian
jiao tongue or coptus and outside gelatin decoction. This is
relatively not so commonly used, at least in my experienced experience.
Formula for treating irritability, insomnia, and palpitations with a sensation
of heat in the chest.
Speaker 1 (00:59):
Could this be of help in anxiety conditions? Join us
as we find.
Speaker 2 (01:04):
Out, and as usual, we will be adding something a
little different. We're going to discuss calcium its physiological role
as well as its Chinese medical role and its supplementation.
So please stay tuned. It's going to be another good one.
And before we get into all that, I just wanted
to ask you guys a quick question. Did you know
(01:25):
that I have written a couple of books? Well, if
you've been listening, you've heard this last few times, so
hopefully you do know that I've written a couple of
books at this point. The first book is Integrative Pharmacology,
combining modern pharmacology with integrative medicine. This is a pretty
thorough book discussing pharmaceuticals, what they're used for, how they work,
and how they may interact with other drugs, herbs and supplements.
(01:48):
It is the perfect reference book for all acupuncturists, herbalists, chiropractors,
natural paths, and really any integrative practitioner, but is also
perfect for anyone. It goes in depth, but it is
easy to read and has difficult terminology bolded with definitions
on the same page. There's not only a great book
explaining pharmaceuticals, it is also available.
Speaker 1 (02:10):
At an amazing price.
Speaker 2 (02:11):
It is available for ten percent off its regular price
and you get it signed by me the author, for
just sixty seven dollars and forty five cents. My second book,
written with an amazing insurance expert, Tiffany Anderson Heffner, is
called Playing the Game a step by step approach to
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(02:33):
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Speaker 1 (02:39):
We go in Should You Accept Insurance?
Speaker 2 (02:42):
It gives step by step advice at every part of
the insurance game, from getting set up, through the patient encounter,
and of course getting paid, all in easy to digest language,
honest advice, and lots of handholding through the process. And
you guessed it. It is also ten percent often signed
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dollars and ninety eight cents. You can get either or
(03:05):
both of these books at the shop at www dot
sperbserbs dot com. That's sperbserbs dot com, just like the
title of this podcast. So I started a new webinar
series called Integrative Nutrition, where I explore the biochemistry, the
Chinese medical approach, and supplements available of various topics of nutrition.
(03:30):
I recently taught the sixth course in the series, micro
and Macronutrients, where I discussed the macronutrients protein, fats and carbohydrates,
as well as trace and ultra trace minerals here as
are something a little different. I would like to very
briefly look at minerals in general and then spend some
time exploring calcium as an important mineral biochemically, its role
(03:53):
in Chinese medicine, as well as discussed supplements in supplementation.
Speaker 1 (04:01):
So introduction.
Speaker 2 (04:03):
Minerals are inorganic, in other words, lacking carbon substances, basically
elements required to do various functions in the body. These
functions include formation of teeth, bones, catalysis, which is the
making reactions easier, signaling, fluid balance and nerve conduction, and
(04:27):
muscle contraction. They are required in microgram to milligram amounts,
with macrominerals necessary in over one hundred milligrams per day amounts,
and microminerals are trace minerals in one to one hundred
milligrams per day. When a mineral is necessary and less
than one milligram per day amounts, they are called ultra
(04:49):
trace minerals.
Speaker 1 (04:50):
So there you go.
Speaker 2 (04:51):
There's sort of three categories, and really we're talking about
macrominerals today and which only one. Actually, we're going to
talk about calcium right now. Calcium or A two plus
is the most abundant mineral in the body, with about
ninety eight percent of it in the bones, and that
explains why it is the most abundant mineral in the body,
(05:12):
because calcium makes up most a good portion of our bones.
I think it's most, but I'm just going to say
a good portion of our bones, which of course is
a huge part of our body. So that's why it's
the most abundant mineral in the body. It is also
used for signaling muscle contraction and blood coagulation, so when
you get a cut or something along those lines, blood
(05:34):
coagulation is very important. It combined to several proteins and
alter their activity, so that catalysis that I was saying earlier,
that helps equate. You know, reactions happen, and it can
either make them faster or slower. When it's found to calcium,
depending on the individual. Enzyme sources include many green vegetables,
(05:55):
but not spinach.
Speaker 1 (05:56):
Spanish is not good.
Speaker 2 (05:58):
Even though there is calcium and spinach it's found it's
bound by phytic acid and is not absorbable in any
appreciable quantities. The RDA so the recommended daily allocation. It's
maybe I don't think it's an allowance. I think they
changed that, but I can't remember it off the top
of my head. The RDA for calcium range is from
one thousand to two thousand milligrams for adults. That's a
(06:21):
lot for a macrimonual emfact. I think it's the most,
though sodium is kind of up in the same range.
The upper limit, so upper limit or UL, is what
is considered to be the highest level you can take
before you start having potential for negative effects or side
adverse effects with it. The upper limit for this is
(06:42):
twenty five hundred milligrams per day for adults. There's not
much of a difference between the RDA, which can be
as high as two thousand milligrams, and the upper limit
is twenty five hundred milligrams.
Speaker 1 (06:52):
That's pretty tight. It's actually right now.
Speaker 2 (06:54):
There have been some very recent studies like can the
last month or two that suggests toxic effects can occur
with as low as two thousand milligrams per day. In
other words, the upper limit is in the upper ranges
of the RDA. So we're starting to see that people
are generally really good at supplementing calcium, and they may
they are probably in a lot of cases over supplementing it.
Speaker 1 (07:18):
We'll talk about that just a minute.
Speaker 2 (07:21):
But how is calcium viewed in Chinese medicine? So Bob
Flaws in his book The Dow of Healthy Eating nineteen
ninety eight, you're not been with Bob Flaws. Bo Flaws
was one of my co authors or a contributor to
my pharmacology book, and I've worked with him closely. He's
probably written more books on Chinese medicine than anyone else
(07:41):
in English.
Speaker 1 (07:44):
He's hundreds.
Speaker 2 (07:45):
I mean, he's just he's translated a lot, he's written
his own, so it's just really he's retired now but
has written quite a bit. So one of those is
The Dow of Healthy Eating. And then he says calcium
estringes yin and suppresses young, strengthens the bones and promotes
the generation of new tissue, absorbs acid and stops pain.
(08:07):
So you see, there's lots of good things that in
Chinese medicine. Calcium is good for Paul Pitchford in his
book The Whole Foods, I don't have it here, so
I can't remember. I think I can't remember the exact
title off the top of my head, but a very
common and.
Speaker 1 (08:26):
Frequently used book on.
Speaker 2 (08:30):
Nutrition, and it has a lot of Chinese medicine in it,
but it's also a general book on nutrition as well.
Maybe alternative nutrition might be a good way to say it, so,
Paul Prichford says, in the East Asian healing traditions, calcium
and mineral rich substances such as oyster shell, fluorite, gypsum, calcitum,
(08:50):
and fossilized bones of animals are taken as medicine for
their cooling, relaxing, calming, and moistening dimensions.
Speaker 1 (09:00):
Us these kinds.
Speaker 2 (09:01):
Of substances typically appear in formulas for insomnia, thirst, nervous anxiety,
and various overheated conditions. In Chinese physiology, the yin fluids
that calm the spirit, relax the liver, and moisten lungs
are undoubtedly infused with calcium and other minerals, and as
(09:21):
such relate to the Western practice of using calcium foods
to benefit the nerves and heart. So you can see
there's a lot of Chinese medicine and calcium. That's I mean,
calcium being the most abundant mineral, you would expect Chinese
medicine to have some thoughts on the matter. So her bunch.
(09:46):
Let's talk about calcium supplements. Calcium supplements are one of
the most common supplements in the US. They are available
in a wide variety of forms, including tablets, caplets, chewable tablets,
soft chewes, soft gels, syrups, gummies, ant acids, and even added.
Speaker 1 (10:04):
To food and juices.
Speaker 2 (10:07):
It also comes in a variety of chemical configurations, including
calcium carbonate, calcium citrate, calcium malate, calcium lactate, calcium glucenate,
calcium aspartate, calcium phosphate, and calcium hydroxy appetite. That last one,
hydroxy appetite. If you're familiar with physiology, you know that
that's actually sort of the calcium hydroxy appetite is sort
(10:29):
of the matrix for the bones. So it's actually that's
a lot of what's in our bones. Different manufacturers will
say different forms have advantages over others. Calcium carbonate is
the least expensive form and therefore the most commonly used
in supplements. Uses for calcium supplements. The primary use of
calcium is to strengthen bones and prevent fractures, especially as
(10:54):
we age. It is also said to reduce cancer risk,
cardiovascular risk, weight loss, age related macular degeneration or AMD
PMS or pre menstrual syndrome symptoms, lowering blood pressure, and
possibly for COVID nineteen. We're going to talk about that
right now. So let's talk about the science.
Speaker 1 (11:17):
The science.
Speaker 2 (11:17):
Calcium supplementation is often combined with vitamin D to increase
its absorption, so often you'll see that supplements of calcium
also have vitamin D included with them. Calcium and vitamin
supplementation has been found to be helpful in increasing bone
strength and density in nine to thirteen year old girls,
preventing osteoporosis and postmenopausal women, and there is but there
(11:40):
is inconsistency in studies evaluating fracture prevention. So you know,
if you build up the bones, hopefully you prevent fractures.
That's the thought behind prevention fractures. But the studies, some
studies say yes, some studies say no. It's inconsistent. Two
studies showed calcium supplementation did not lower risk of cancer
or in fact, I'm going to go, I don't think
(12:04):
this raises risk of cancer. But one of the ways
we detect many cancers is by looking on X rays
and looking for parts of areas of calcification, so where
calcium has kind of been there and that kind of
gives us a point or to where there might be
some cancer. So calcium is definitely involved in cancer, but
supplementation has not lowered the risk of cancer. It doesn't
(12:27):
seem like it's raised did either. Otherwise we'd probably see
that as well. Some implementary studies have shown that hospitalized
COVID nineteen patients are admitted with low calcium serum levels,
where it's low calcium in the blood. This may suggest
calcium supplementation may help prevent COVID nineteen complications or even
(12:47):
play a role in treatment. However, more evidence is necessary,
and other similar similar deficiencies have shown supplementation is not beneficial.
So when you look at COVID nineteen and you look
at mineral and vitamin deficiencies for those who have been hospitalized,
there's a lot of them.
Speaker 1 (13:04):
There's I think, off the.
Speaker 2 (13:05):
Top of my head, I think there's magnesium and zinc.
Calcium is in there. There's a few vitamins I can't
remember which ones. Some of the B vitamins are in there,
and these show that people who are hospitalized have lower
levels of these particular substances, but then they've followed up
and they've done supplementation of those substances and found it
does not help in the treatment of COVID nineteen at all.
(13:28):
So my take home for that is it's good for
you to be in good nutrition in order to prevent
complications of COVID nineteen. So you want to have all
these levels up to normal levels. But if you don't
have them up to normal levels, supplementing them after the
fact is not going to help. That's what we've seen
over and over again, even though we quite haven't seen
that at least that I found with calcium. So another
(13:52):
study found supplementation of lower than nine hundred milligrams of
calcium daily reduced risk of death in post menopause women.
So that's a nice study just in general in that
it's very specific in the people that it's looking at,
postmenopausal women, so it's hard to project that to other groups.
(14:13):
Another study showed supplementation of up to one thousand milligrams
of calcium reduced the risk of death by twenty two percent.
Speaker 1 (14:20):
In women, but not men, So that's an.
Speaker 2 (14:24):
Interesting Some men should not be supplementing as much probably
as women do. There are some risks to over supplementation,
and another study specifically looked at cardiovascular deaths and found
a lower rate in both men and women who supplemented
up to twelve hundred milligrams. So there you go, there's
some positive on the cardivascar. I've seen some negatives in
(14:45):
the cardiovascular realm of things as well. I don't know
if calcium is something I would choose to deal with
with cardiovascular risks, but I certainly am a fan of
having at least low levels of calcium supplementation. Early studies
in DKAY there may be some benefit to supplementing calcium
for weight loss. However, larger subsequent studies have not supported
(15:09):
this use higher consumption of calcium from foods.
Speaker 1 (15:13):
This is important.
Speaker 2 (15:14):
Not supplementation from foods has been associated with lower risk
of AMD, that's the macular degeneration, age related macular degeneration.
While there's mixed evidence regarding the effects of calcium from supplements,
and this is something that we see in general. I
think we should get all our vitamins and minerals from
our foods rather than from supplements. I am a big
(15:36):
fan of having a multi vitamin supplement just because I
think of it as nutritional insurance. So if you don't
get everything you need from your food, at least you're
not going to get into deficiency or deficit. But in general,
foods are where it's at, not supplements. Other considerations about
calcium supplements. Calcium carbonate requires stomach acid to become soluble
(15:59):
and absorb herbabole. In cases of reduced stomach acid, using
another form of calcium suffment, such as calcium citrate or
calcium malate should be considered. Calcium carbonate should be taken
with food to stimulate gastric acid production.
Speaker 1 (16:14):
So there you go.
Speaker 2 (16:15):
That's the thing with calcium carbonate. The other thing is
reduced stomach acid. You kind of go, well, how do
I know if I have reduced stomach acid. Well, you
probably won't, but if you're on something long term that
reduces your stomach acid. These would be the proton pump
inhibitors or a histamine some of the anta. There's specific
types of histamine antagonists that can actually reduce stomach acid.
(16:39):
These are your pepsidacs and your nexiums and those sort
of things. If you're on those long term, then you
have reduced stomach acid and you should consider some of
these other substances. Dosage in general is considered healthier and
more effective to obtain calcium from foods for slowing bone loss,
oney to twelve hundred milligrams. For building bone in girls
(17:02):
aged nine to thirteen, eight hundred milligrams combined with four
hundred iu of D three and four hundred milligrams of magnesium.
These are what the studies have shown and to help
reduce PMS symptoms twelve hundred milligrams. Again, you notice we
didn't mention much about the science of reducing PMS symptoms.
I don't think the sciences is really super supportive of
(17:23):
PMS symptoms.
Speaker 1 (17:25):
I'll tell you where I'm at.
Speaker 2 (17:26):
Because of the upper limits of calcium and the fact
that we do get a lot of calcium from our foods,
I'm at the point where with my patients I am
not recommending that they take more than one thousand milligrams
a day, and I'm actually for most people, depending on diet,
I would suggest six hundred milligrams a day at most,
(17:46):
because I think that you can get into toxic levels
if you take more than that and have a good
diet with some calcium in it. So we're not supposed
to be hitting that twenty twenty five hundred market is
basically what we're trying to avoid. And it's relative easy
if he dairy foods to get a thousand or fifteen
hundred milligrams from your diet. So what are some side
(18:08):
effects in red flags of calcium supplements, gas floating and
constipation or common adverse effects to calcium supplementation which can
be reduced using divided doses or calcium citrate overdosing, especially
from supplementation not taking into account calcium aggestion from foods
can cause toxic effects with dosing as those two thousand
milligrams and adults over fifty. And by the way, my
(18:31):
experience is this becomes an issue especially with women postmen
apostle women. They start going, okay, I need to be
worried about osteoporesis now that on postment apausal, I need
to take more calcium and.
Speaker 1 (18:42):
That's where some of these issues.
Speaker 2 (18:43):
And yet the upper limit has lowered in that age group,
so you do have to be careful with supplementation of calcium. Men,
my experience are men don't.
Speaker 1 (18:53):
Take supplements as frequently as women do.
Speaker 2 (18:56):
Calcium is usually one of the first ones that they
do take if not a multi vitamin, so definitely a
concern there as well. There's an increased risk of kinneystones
with calcium supplementation. When taken over a thousand milligrams of
calcium supplementation, there appears to be an increased risk of
mild cardio infraction and cerebrovascular accident or stroke. So my
(19:20):
cardial infraction is a heart attack, a heart attack constructor
is what we're talking about. That's why I'm not a
huge fan of thinking about these things for cardiovascular for
helping cardiac events.
Speaker 1 (19:31):
I don't think it's very helpful.
Speaker 2 (19:33):
If you want to take it, that's okay, but definitely
stay between below that one thousand milligrams, and like I said,
I'm really recommending six hundred milligrams at this point. There
are some interactions with these supplements. Proton pump inhibitors, as
I mentioned earlier, substantially reduced calcium absorption, especially from calcium carbonate.
That's because it reduces acid in the stomach and general
(19:56):
calcium supplementation will reduce the absorption and therefore the effectiveness
from fluoroquin alone and tetracycling class antibiotics that's actually one
of the rules of antibiotics is you should not take
calcium supplements while taking antibiotics. Calcium supplements may decrease the
absorption of thyroid hormones. Interesting, that's the first two interactions
(20:18):
here were B level on abcd A being the highest,
so B levels pretty good on this last one about
decreasing the absorption of thyroid hormones is actually C level,
so kind of in the realm of case studies are
poorly done in study, so I think there's more says
that need to be looking at calcium supplementation and thyroid hormones,
but there's indication that it could be an issue. And
(20:41):
that's it for calcium supplementation. So Yael says recommended dietary
allowance average daily level of intake sufficient to meet the
nutrient requires to nearly all healthy individuals often used to
plan nutritionally adequate diets for individuals. Yes, thank you, And
it is allowance recommended daily allowance, so they are still
using that terms they.
Speaker 1 (20:59):
Changed every up.
Speaker 2 (21:00):
They also have the RDI which is recommended daily intake
and so it gets it's it's gotten a little confusing
for me with those even though I just lectured on
this and added all in my my lecture, it apparently
did not stay in my brain. So but yes, that's
the great definition of the RDA. In fact, I think
I had the exact same definition in my in my
(21:22):
my thing is in my presentation.
Speaker 1 (21:24):
So thank you, I l okay.
Speaker 2 (21:27):
So with that, let's get into our formula today, which
is huangli on jiao tongue. Huangli on edge tongue has
translated as coptis and ass high gelatin decoction, so jiao.
If you're not familiar with that, that is basically donkey gelatine.
So that's why they're saying ass high gelatine.
Speaker 1 (21:47):
It's donkey is no name for donkeys an ass.
Speaker 2 (21:50):
Other names include coptis and egg yolk decoction or huangli
on jit zid tongue, and as we're gonna find out,
yolk is part of this decoction. This formula is in
the subcategory of formulas that nourish the heart, blood and
you in and calm the spirit. Under the category of
formulas that calm the spirit. According to Shide and their team,
(22:14):
are other usual formulas textbooks. So I usually have two
textbooks that I use the other one is called Chinese
Medical Herbal Formulas and Applications, Pharmacological Effects and Clinical Research
by Chen and Chen, and they don't have a monograph
on this formula, so usually they're pretty lock step in
what they have. Every once in a while, I've found some
differences with what's included. So this formula is not included
(22:37):
at all in Chen and Chen's books, So it's interesting
and I usually like to compare and contrast between the
two books. So I feel like we're getting a little
bit of a one sided approach to Honglan a Jet
Tongue today, but it's still a really good one. So
we're going to continue with our forging ahead. So let's
talk about those formulas that calm the spirit. So this
(22:57):
is the overall category the falls under, and there's a
subcategory we're going to talk about after this, and for
let's talk about the overall category. And Shide and his
team always has a really great overview of these, so
we're going to listen to what Shide and his team
have to say. So spirit and Chinese medicine denotes the
non physical aspects of a person's being. Unlike in the West,
(23:21):
these are not seen as being separate and qualitative, qualitatively
different from the body, rather a Sho shway high rights
and random notes while reading about medicine or the Deuyi
Swibe written in eighteen ninety eight. The five spirits are
dispositions of blood and che elation, anger, pondering, sadness, and
(23:44):
fear have their foundations in the personal mandate of heaven.
A person who does not possess these dispositions will be
dull witted, their personality dead.
Speaker 1 (23:57):
Interesting disturbances in.
Speaker 2 (23:59):
This spirit then are regarded as manifestations of disorders that
prevent a person from living their life in a manner
appropriate to who they are. Chinese medicine offers many different
ways to treat such disorders. These include changes in diet
and lifestyle, emotional counter therapy where one excess of emotion
is treated by generating other emotions following the doctrine of
(24:20):
the five phases, and counseling, as well as herbal medicine. Indeed,
as the seventeenth century physician yat En Sure noted in
case records as a guide to clinical practice, prescribing medicine's
draws on the function of herbs, I'm afraid that these
may not be enough to make the patient happy. Formula
(24:43):
is that common spirit thus should not be confused with
psychoactive drugs in the biomedical sense of the term, nor
are they substitutes for treatment that seeks to enable a
person to devise autonomous strategies for overcoming difficulties in living. Nevertheless,
the formulas discussed in this category can plain important support
of function in treating such disorders, for in seeking a
(25:06):
regulated person's chia and blood that provide a space from
which they may seek to understand and develop their dispositions.
As outlined by Jou shwe Hi, the main strategy for
treating disorders of the spirit in Chinese medicine is to
calm them.
Speaker 1 (25:22):
And here's a quote from his book.
Speaker 2 (25:24):
The multiple transmutations of spirit disorders cannot be fathomed, and
they are also the most difficult to treat among all
the various types of illness. To do this, it is
essential to know about the roots and branches. Generally speaking,
for the spirit to be in charge of its functions,
it needs to be regulated. In order for it to
(25:44):
be regulated, it needs to be calm. So off of
that quote, this strategy was first described in Basic Questions,
chapter seventy four some basic questions is the Wangdhi nae
Jingsu Win, which is the Yellow Emperor's Classic of internal medicine,
and that comes in two parts. In one of those
is the basic question. So in chapter seventy four it
(26:05):
says calm disorders with palpitations and anxiety. Like all other
disorders in Chinese medicine, those of the spirit can be
sorted into two major types, deficiency and excess. Here these
refer both to the branch manifestations and to the root
and to the root. Manifestations of deficiency include palpitations with anxiety, forgetfulness, disorientation,
(26:33):
and insomnia. Generally, such patterns are due to deficiency or
constraint of chim blood, preventing the expression of the spirit
and thereby causing it to become agitated. The method of
treating this type of disorder is to toonify and harmonize the
chim blood. Manifestations of excess include a feeling of being overstressed,
(26:56):
manic behavior, bad temper, and agitation. Much patterns are due
to excess heat, uncontrolled young blood stasis, phlegm, and severe
chi stagnation. The strategy for treating this type of disturbance
is to sedate and calm the spirit. In practice, the
(27:16):
manner in which disturbances of the spirit present clinically tends
to be complex and often involves aspects of both deficiency
and excess. A combination of treatment strategies is therefore utilized
in most cases. Furthermore, because disturbances of the spirit occur
as a result of imbalances of chat and blood, they
(27:37):
often occur in contexts where formulas not discussed in this
category are more appropriate. For example, young brightness, heat can
cosmatic behavior that should be treated by purging, Phlegm can
veil the orifices which should be opened. Rebellious chie can
present with severe irritability, insomnia, blood stasis can lead to
(27:59):
insanity and forgetfulness, and deficiencies deficiency of various types can
result in palpitations, disorientation, or insomnia. Historically, the formulas in
this category come from many different periods in the history
of Chinese medicine, reflecting the different preoccupations of their authors
(28:20):
regarding this spirit and its treatment. Han Dynasty formulas from
discussion of cold damage, and essentials from the Golden Cabinet,
which we talk a lot about. Modern day those are
split into two different books. They were originally one book,
and it is the first book that we have that
talks about formula. So this is kind of the foundational
(28:41):
formula book. So in this book generally, it generally emphasized
emphasizes regulating the nutritive and protective gy be it by
draining fire, harmonizing the middle burner, or enriching blood. From
the top dynasty onward, and especially during the Jinuan period,
(29:04):
fire became a main concern of Chinese physicians, and this
is reflected in their attempts to calm the spirit. A
greater focus on organ systems rather than chi and bled
led to formulas being designed to specifically treat the heart
as the organ most closely associated with both fire and
the spirit. Phlegm disorders also attracted closer attention, while discussions
(29:25):
of the ministerial fire and its interaction with the heart
or sovereign fire brought into play the relationship between the
heart and kidneys. These trends continued throughout the Ming and
into the Qing epoch, intertwined with the emergence of warm
pathogen disorders as a major concern for physicians during this time.
Yin deficiency was accorded great attention, and so was the liver,
(29:48):
which many physicians now viewed as the most important organ
in treating all kinds of internal medicine disorders. From the
Republican period onward and well into post Maoice China, concepts
borrowed from Western medicines, such as neurasthenia or nervous exhaustion
became tremendously important in China and Chinese medicine. As always,
(30:09):
these changes not only stimulated the composition of new formulas,
they also influenced the interpretation and uses of usage of
existing ones. For example, the organ systems again became regarded
as paramount. Consequently, almost all the formulas in this chapter
in this category are currently defined as treating predominantly the
(30:30):
heart and the liver. So that was the calm the
spirit category. Now we're going to talk about the subcategory
under that which this formula falls under, which is called
formulas that nourished the heart, blood and yan and calm
the spirit. And this is what Shid continued says about
(30:50):
this subcategory. Disturbances of the spirit due to deficiency of
the chieve blood and yin usually manifest its palpitations, irritability,
and insomnia. The heart and liver are the organ systems
most often involved in such pathologies pathologies, although the swen,
stomach and kidneys often also often require attention. The proper
(31:12):
strategy is to toonify and regulate the chi, enrich the yin,
and nourish the blood. Typical herbs used for this purpose
are ziciphy spinosis semen or swan zareen, platyclatdy semen, bide ziren,
and polygali radix yuan ju. These are usually combined with
three other types of ingredients, depending on the precise nature
(31:34):
of the pattern to be treated. One those that enrich
the yin and nourish the blood more generally, such as
sofio pagonis, redex mamandong romania, redex shend huang, romania aradex
preparata shu di huang as sine koreai cola or a
jaw which is what we're going to see in today's formula,
and lechi fructus go chidza, where such deficiency is the
(31:58):
root of a spirit disorder. Two. The second type of
verbs added are those that augment the chiese, such as jinsen, redix,
renshen ilycceri, radix, gonsal licorice in order to enable the
heart to direct the chi and blood downward and thereby
control the spirit. And three those that clear fire and
(32:19):
drain heat, such as fritillar area, bulbous bay mu, coptitis
raizoma huangyan, which is in today's formula is one of
the chief verbs as well, and anna marina raizoma is
germu when deficiency of blood yin is accompanied by yong
excess noe. While the formulas in this group can be
(32:40):
taken over a longer period of time than those that
settle in sedate, which is the other group subcategory, they
are not intended to replace tranquilizers and must also be
adjusted regularly to the pattern change as the result of treatment.
In other words, don't do this forever. So where are
(33:00):
the Chinese medical actions of this formula. Shide and his
team say, this formula enriches the gin, causes fire to descend,
eliminates irritability.
Speaker 1 (33:11):
And calms the spirit.
Speaker 2 (33:13):
So it tells us a lot about what's going on
in this So we're going to talk about that now
under Chinese medical indications. And they say, again, I only
have the one source At this point, Shide in his
team say this formula can be used for irritability with
a sensation of heat in the chest, insomnia, palpitations with anxiety,
a red tongue which indicates heat, with a dry yellow
(33:35):
coat coating which also indicates heat in dryness or indeficiency,
and a thin rapid pulse. A rapid meats heat then
means deficiency, so indeficient rapid pulse heat heat from the
indeficiency in that pulse. There may also be sores in
the tongue or in the mouth. This is a so
called heat transformation or ra hua pattern in the lesser
(34:00):
warp of a cold damage disorder. So that's talking about
the six levels. We've talked about that before on spursers,
but it's been a little while. It's one of the
ways we can look at how a disease enters the body.
The lesser yen corresponds to the kidneys, which govern the
fluids and store the essence, and the heart, which covers
the blood vessels. When pathogenic heat enters the lesser yen,
(34:23):
it consumes the yin fluids, blood and essence. This results
in a pattern characterized by excess heat at the chi level.
The pathogen usually enters via the stomach or intestines, combined
with deficiency of yin and blood, the presence of chi
aspect pathogenic heat is reflected in the red tongue with
(34:44):
a dry yellow coating of the thin rapid pulse. In
a case that the yen has already been damaged, lesser
yin water the kidneys is no longer able to properly
control lesser yen fire the heart. This leads to a
sensation of heat in the chest and symptoms of a
disturbed spirit. Palpitations with anxiety, irritability, and insomnia characterized by
(35:07):
an inability of the patient to calmly lie down. Stores
in the mouth and on the tongue are also a
sign apathogenic heat in the heart. History of this is
actually pretty straightforward. Shi and his team says, it's from
the Discussion of Cold Damage of Shan Hong Lung written
two twenty by Jiang zhog Jing. So again, that is
(35:28):
that book that we were talking about. Discussion of cold
damage and miscellaneous diseases used to.
Speaker 1 (35:32):
Be one book.
Speaker 2 (35:35):
Golden Cabinet, Golden Coffers. Treatment of the miss Lane's Disease
used to be one book. It was split into two.
This is one of those two discussion of cold damage. Again,
both or the singular initial book are considered to be
the first books that we have historically that talk about formulas.
(36:00):
Talk about the ingredients of this formula. So to treat
a pattern characterized by heat excess and blood deficiency, whose
symptoms predominantly manifest in the heart lesser yen. This formula
utilizes a strategy of directing fire downward that means bitter
cooling herbs while simultaneously nourishing the yin and blood with sweet, salty,
and sour substances. Let's talk about these substances first.
Speaker 1 (36:24):
One up is.
Speaker 2 (36:26):
Coptous Rhizoma huanglian that's huanglion of the huanglanjeaton fame. We
need twelve grams in this formula and it comes from
herbs that clear heat and dry damnness. It's actually a
very important IRF that does ap, clears he and dry.
Its functions are clear as heat drains dampness, drains fire
and resolves fire toxicity, clears heat and stops bleeding, and
(36:48):
clears heat. Topically, this is one of the two chief
ingredients and it directly clears fire from the heart and
thereby calms the spirit. Our second herb, which is also
in the title, is a sini coreai cola or a jaw.
We need nine grams for this strained into the decoctionri.
(37:09):
We'll talk about preparation later on herbs, and this is
This comes from herbs that tanify the bloods is a
blood tonifying herb, and its functions include tanofi is the blood,
nourishes the blood and stops bleeding, and nourishes and moistens
the yin. This is the other chief ingredient, and Shinda,
seems to say the sweet and neutral jaw, which indirectly
(37:32):
controls the heart fire by enriching the yin and nourishing
the blood. Together, huangli on a jaw facilitate interaction between
water and fire to effectively treat the root and branch
of this pattern. Our next herb, this is a relatively
small formula. I think there's only six herbs in it,
sort of. Our third herb is scutulary rat x huang chin.
(37:55):
We need six grams of it for this formula, and
this is also in the herbs that clear heat and
dry damness. Often you'll see huangli On. There's something called
the three yellows, which are huangwi on which we already discuss,
this orb wang Chin, and then a third herb, which is.
Speaker 1 (38:11):
Why am I totally blinking? Uh. This is scu area,
coptus and Philodendri Huangbai. There we go.
Speaker 2 (38:17):
If I can get the Latin, I can get the Chinese.
Hwangbai is the third third yellow, and they all come
of the same category. This herb clears heat and drys damnus,
resolves toxicity and stops bleeding, calms the fetus, and sedates
ascendant liver yong. This is one of the two deputy
(38:38):
herbs which drains heat from the upper burner and the
intestines to assist huanglion in directing fire downward. This is
a very good draining, clear heat draining herb. Our fourth
herb is uh well. The formula says to use Paoni
radix or shao Yeah, which is a generic term for
(38:59):
red or white peony and in Chinese methsa. Those are
They have some similarities, but generally they're totally different herbs. However,
a note under method of preparation says Paoni riddix alba
or Bischow. That's the white peony is the current species
to use for this formula. So we're gonna say that here,
and so that's by show. We need six grams of it.
(39:19):
That herb comes from the herbs that toonify the blood
category and it nourishes the blood, regulates mensis, calms and
curbs liver, young, preserves yen, adjusts the nutritive and protective levels.
Speaker 1 (39:32):
And alleviates pain. In this formula, the sour and.
Speaker 2 (39:36):
Cooling by shall which assists a jow and enriching and
retaining the yen to harmonize the functions of the chi
and also both of the heart heat draining herbs and
controlling the yong. So what we have basically are two
herbs that are going to be containing the heat and fire.
That'shuangwian and wang Chin. And we have two herbs they're
(39:58):
going to be supporting the yen and enriching the blood
and yen, which are the ud jaw and this deputy
by shall. So for a fifth herb we have Wang
Wanglian ud Jao tongue, and that's it.
Speaker 1 (40:09):
There's actually only.
Speaker 2 (40:10):
Five herbs, and I thought there were six five which
if I look closer at the picture at the beginning,
might have done it. So the fifth herb is golly
uh ginger a vitellus or egg yoke or in Chinese
that's jidzi huang, and so that's a, that's this uh,
(40:30):
and it's it is traditionally in the herbs that tonify
the yen.
Speaker 1 (40:34):
So again tonifying.
Speaker 2 (40:35):
Traditionally, this herb quote unquote herb nourishes yin, tnifies the
blood and moisten's dryness and extinguishes wind. The assistant and
envoy is sweet and balanced egg yolk, which enters the
heart and kidneys. Tnifies the yen and blood and resolves
heat toxicity.
Speaker 1 (40:55):
So it kind of helps with everything.
Speaker 2 (40:57):
It assists the heat draining herbs and a limit the
pathogen while protecting against their drying properties, but also acts
in concert with the blood tonifying substances to enrich the yen.
So a very good herb all around here. So how
do we prepare this formula? It's mentioned earlier both ajiao
(41:18):
and a yolks should be added into the strained decoction,
and it says the decoction should be cooled down before
adding the yolks otherwise you just cook the yolks. Decoction
is the preferred method of preparation, and the amount of
wanglon is usually reduced by one third to one half
in modern times. Wangleon is an interesting when you look
(41:38):
at a lot of the do sne it's fairly normally dosed,
but then when you see how it's used in modern formulas,
a lot less is used in general. I don't know
if that means. I often that will mean that the
current strains of a particular herb are more potent, or
maybe it's just that they've found that it doesn't need
to be used as much, so there's different thing it happens,
(42:00):
But generally we use much smaller amounts of poi on
that than's called for traditionally.
Speaker 1 (42:05):
In this formula.
Speaker 2 (42:08):
May also be expense by the way it's a wild
is not a cheaper in general as usual, Shida does
team have a great commentary on this herb, so let's
get into it. Like Ardinia and Prepared soybean decoction jured
ze Cher Tongue and discuss discussed chapter four of the book,
(42:31):
and sour jijb decoction Swanza rentong discussed above.
Speaker 1 (42:35):
In this in this category.
Speaker 2 (42:36):
This formula treats a form of deficiency, irritability or shoe fonon.
This is a disorder characterized by symptoms like vexation, restlessness, insomnia,
and subjective sensations of fullness in the chest, indicating the
presence of pathogenic heat. Such he represents a local excess,
but unlike patterns where the heat has led to clumping
(42:57):
of body fluids or other substances, its form deficiency in
this context thus does not refer primarily to deficiency of
cheat or essence, but functions as a designator that refers
to a class of disorders in which the pathodynamic does
not manifest with palpable excess or fullness. In the conditions
(43:21):
treated by this formula, the heat will tend to be
of external origin, including alcohol, sugar, and other food stuffs
that generate heat. Hence, even though the patient will show
signs of blood and yin deficiency, these are secondary to
treat patterns characterized by yin and blood deficiency and empty fire.
Once should select a formula like acide gelatin and egg
(43:41):
yolk decoction ajau jitsu, huang tong or major arrest wind
pearls DoD ding fung ju. These formulas retain the yin
n blood, tonifying ingredients of coptis and a high gelatin
decoction wang on a jea tongue, but combine them with
salting and cooling substances that clear heat without dam gene
the yen. The reticular combination of excess heat and deficiency
(44:06):
of essence treated by this formula, as reflected in this
strategy often said to embody. The principle of draining the
south Ie fire while tonifying the North i e water
first outlined in the Classic of Difficulties with the non
Jing circa Eastern Han. So this is an early text.
So it's interesting we look at the the Yellow Emperor,
(44:28):
the Emperor Yellow Emperor's Classic of Internal Medicine, that is
about two hundred years BCE, two or three hundred years
of PC. The nan Jing kind of comes next about
I think it's about one hundred. It's Eastern Han, so
that went from basically.
Speaker 1 (44:46):
Around two hundred BCE to two hundred C.
Speaker 2 (44:50):
So it's a long time. I'm not sure about the
Han period, and I'm not sure about the Eastern Hunt.
I think the Naging was about one hundred CE, so
a couple hundred years after and a little bit for
our herbal book that we were just talking by a
little bit.
Speaker 1 (45:03):
It's still a hundred years. That's quite a bit.
Speaker 2 (45:05):
Anyways, important book, a difficult book, hence the classic of difficulties.
It's distinguishing characteristics. Going back to the quote, it's distinguishing
characteristics as formula are a capacity for draining DMPA pathogens
from the body while simultaneously enriching the yin and tonifying
the blood. And the type of cold damage disorders for
(45:26):
which this formula was first composed. Such pathogens entered the
body primarily via the mouth and lodge in the stomach
and intestines. The scope of this formula has been expanded
by later writers to include chi aspect heat penetrating to
the blood aspect bleeding disorders, and dysenteric disorders due to
heat toxin. A passage in the nineteenth century Japanese work,
(45:49):
expansion of the categorized categorized collected Formulas or the Rui
ju hul Kogi kog by Oda Yodo in eighteen fifty
three notes it treats all kinds of patterns evolving loss
of blood, chest palpitations, body fever, abdominal pain and mild dysentery,
a dry tongue, burnt lips, irritability and restlessness with inability
(46:13):
to light down, bodily exhaustion, a complexion trained of blood,
or alternatively a red fluxed flushed complexion. In clinical practice,
the following point is provided by the contemporary physician Huang
Quang and one hundred classic formulas written in two thousand
and six, so quite modern based on a review of
(46:35):
both Chinese and Japanese sources will prove useful in determining
when this formula is appropriate. The tongue will be red,
indicating the presence of heat. The pulse will be thin
and rapid, indicating the presence of both heat and yan deficiency.
The skin will tend to be dry and may show
signs of flaking or chafing, but there will also be redness,
particularly in the face, and there will often be bleeding
(46:58):
or a tendency to bleed, indicating heat string the blood
to move recklessly. So that's commentary on this formula. Let's
talk about a few modifications. Shai does discuss several modifications
for this formula for severe in deficiency with injured fluids
in a dry throat at Scruffalaria Radix for schwan shin Ofio,
(47:18):
Pons Redix, Maman Dong and Dendrobi Erba sure who for
heat in the five centers at Guardina Fruitus Jerza and
Lofatheri Erba, don Julie for fever ishness with dark urin
and Jensi Medulla deng shin Tsao tetrapanicis Medulla tong Tsao
and emperate Raizoma bay mal Gen for purpura or bleeding
(47:44):
of the gun gums. Add Lugustri, Lucidi, fructus or new
Jenza Eclipte Erba and Mohan Leon Mutan cortex, Moudan Pi
and Romania Radix shengd yu wang for dysenteric disorders with
abdominal pain and pus and black in the stool.
Speaker 1 (48:01):
Remove the egg yolk or the jiitsu huang he does
shine in their team.
Speaker 2 (48:07):
Also compare today's formula two other formulas, one of them
we already mentioned the sour Jiujibi dicoction Swanseau Rentong Classic formula.
In the calm this uh you know uh support the
art and calm the spirit category, So the same category
as a formula. Both formulas treat irritability and insomnia. Comparing
the indications of these formulas in their source texts, the
(48:31):
differences between them become clear. Koptus and as hy gelatine
decoction of huangwian adje out tongue is for irritability when
the patient is unable to lie down, that is, when
he is so irritable that he cannot even tolerate lying
in bed. This is due to the young failing to
enter the yin and the treatment strategy focuses on draining
fire from the heart and enriching the yin and blood.
(48:53):
Sour jiujubi decoction swans ou rentong is for irritability with insomnia,
in which the patient is able to lie in bed
but cannot sleep. This occurs when deficient liver blood is
unable to nourish the heart, and the treatment strategy focuses
on tonifying and harmonizing the liver and our second formula
(49:13):
compared is polyperus decoction or juling tongue. Both of these
formulas treat patterns characterized by irritability and insomnia due to
heat damaging in the yin and use a seni coorei
cola a jaw to address this deficiency. However, coptus in
as hy gelatin decoction quangli on other gel tongue focuses
on patterns where both the pathogenic heat and the indeficiency
(49:36):
are relatively pronounced, with such symptoms as focal distension in
the epigastrium, abdominal pain, irritability, and thirst and palpitations. Polyperus
decoction is juling tongue, on the other hand, treats patterns
with the momentum of the heat and damage to the
inn are less severe, but instead clump with the water
and the lower burner, leading to the main symptom of
(49:57):
obstructed urination. A question here from Ralph, how do you
give a yoke? Again, this is stirred into the strained
cool decoction. So you do a decoction, you strain it.
Speaker 1 (50:15):
Which we normally do so we don't get herbs in there,
and we let it cool a little bit and then
we'll mix in the egg yoke. So that's how you're
supposed to do that. So thank you.
Speaker 2 (50:23):
So biomedical indications for this formula, Sha I'd say, with
the appropriate presentation site and his team with the appropriate presentation.
It's firmly maybe used to treat a variety of biomedically
defying disorders, including nervous exhaustion through cuperative stage of an
infected infectious disease, autonomic dystonia, a rectile dysfunction, appithys ulcers,
(50:46):
and hypertension.
Speaker 1 (50:49):
So let's talk about the science behind this.
Speaker 2 (50:51):
There were two interesting Chinese papers mentioned in another paper,
so I don't have I couldn't get access to these
Chinese papers, so I'm kind of that's why I kind
of mentioned in another paper that kind of weakens and
it doesn't allow me to assess them very well.
Speaker 1 (51:05):
But here's what they said.
Speaker 2 (51:06):
Both of these papers appear to me in Chinese and
was unable to obtain copies, so take the following information
with a grain of salt. According to the original paper,
there was a study that compared the use of long
way on agel tongue with an end of thirty so
thirty subjects and lorazepam, a common anzialytic medication, to something
that helps anxiety, again with an equals thirty so thirty subjects.
Speaker 1 (51:28):
Finding the herbal.
Speaker 2 (51:28):
Formula was ninety three point three to three percent effective
in treating anxiety, while lazepam was only seventy three point
three to three percent effective. So basically, what this is
saying is that this formula is better than la razapam
and treating anxiety. Take that with a huge grain of salt.
I could not figure out the age. There is a
certain point in time that Chinese papers would say this
(51:51):
effectiveness and they define what the efficacy was, but they're
not standard definitions and they weren't very useful, and so
whenever I see this ninety percent effective versus, I don't
buy it. So I'm I think this is very interesting.
I'd love to see another study on this, but I
would not buy this study at face value based on
what I know about it at this point. Another study
(52:13):
found huangli on edge l decoction had a better curative
effect and fewer adverse reactions than flew voxamine in the
treatment of anxiety that pertain to indeficiency and fire activity cent.
So I again, there's no specifics here. So again, both
of these the first one small can't get any of
the specifics. This one doesn't even have any of the specifics.
(52:35):
These are not guiding principles at all. What I do
think is interesting is that they're comparing this formula to
drugs that treat anxiety and this formula came out better.
I want to see a lot more more on that,
but it's definitely something to kind of keep in mind
when looking at this formula that this might be a
very effective formula for specifically, I like that about the
(52:55):
second study specifically says indefficiency and fire fire activity hyperactivity syndrome.
So in that case of anxiety, then this form that
can be very good. Again, overall, these are not strong
actually quite poor uh studies as far as.
Speaker 1 (53:08):
I can tell, So I you know, but that's what
I found all I could.
Speaker 2 (53:12):
Find as far as Drugger Burner actions. A couple of
verbs in this fronts may affect sarchrome pe for fifty enzymes.
These include huang leon which may inhibit sea why cytochrome
p for fifty two D six and wang qin may
inhibit cytochrome P for fifty two C nine two E one,
and three A four. That's the one we're particularly worried about.
Speaker 1 (53:34):
Three A four. Again, something to keep in mind.
Speaker 2 (53:37):
I'm not super worried about it, but if someone's on
a lot of especially three A four metabolizers. I might
be concerned about it, but again we don't have to
go into too much depth on that. Uh Hide and
his team did not discuss any major concerns for this
from which is interesting to me. I guess you know,
(54:00):
I would say, you know, be careful if there's not
some heat involved, because this can be a little bit cooling,
but it's also kind of supports the end, so it
kind of balances itself. So I can I understand where
there aren't a ton of concerns about this formula.
Speaker 1 (54:17):
That's it for today's forma.
Speaker 2 (54:18):
So that was today's formula hungli on o j al
tan or coptus and as higelatin decoction and interesting, if
not commonly used formula for Communist spirit, reducing in fire
and helping irritability. We started by discussing calcium in its
biochemistry and Chinese medical implications as well as its supplementation,
and then we got into the formula including its ingredients, commentary,
(54:41):
the science are concerns and cautions, as well as its
potential drug interactions. All in all another expiration of a
fascinating and useful Chinese format. It may not be used commonly,
but when it is used, it's quite useful. So this
is a very is a useful Chinese formula. And like
I said, I haven't seen it used much, but have
seen it used it is, it is useful and I
(55:02):
have seen it work well, so it is a good formula.
In our next episode in two weeks, we are going
to be looking in another single Chinese herb, go teng
on carria ramulus com unsis or on carria. This herb
is a relatively commonly used herb in Chinese medical category,
(55:23):
in the Chinese medical category of substances that extinguish wind
and stop tremors, and can be used in a wide
variety of conditions, including spasms and convulsions, headache, irritability, and
even hypertension, especially hypertension.
Speaker 1 (55:39):
As usual, we.
Speaker 2 (55:40):
Will explore all the intricacies of this herb as well
as an explanation of its category, and as always we
will look at something a little different. We will continue
our exploration of macro minerals. Join us in two weeks
for another interesting episode. And with that, I'd like to
thank you very much if you like this podcast. Oh man,
(56:02):
it would be such a big favor if you were
to subscribe to our podcast and your favorite podcast app,
just U. It helps us so much and we appreciate
it and thank you for even considering that. And remember
you can get CUS and ncc O m PDAs that's
Continuing Education Units and National Certification Fissions of acupunction Oriial
Medicine Professional Development Activities at www dot Integrative Medicinecouncil dot org.
Speaker 1 (56:29):
That's Integrated Medicine Council co o U n cil dot org.
Speaker 2 (56:34):
You can always get in touch with me at doctor
Greg at sperbserbs dot com or at our website www
dot sperbserbs dot com.
Speaker 1 (56:44):
As usual, we have a good bibiliography. This one's a
big bibliography, lots of stuff. Thank you very much. The
proceeding was presented by doctor Greg ferv. We would like
to thank Janelle Frawler's support and everybody else who contributed
to this program. Kimothy Roger Campbell, m
Spurs that Angelica.
Speaker 2 (00:08):
Sperb Okay. Well, welcome everybody to Sperbs Herbs Episode seventy four.
Today we're going to be talking about an interesting Chinese
formula Huang leon jiao tongue or let me try and
get those toe marks correct, Huang leon uh jiao tang
koptis and ass hidh gelatin decoction. So an interesting formula,
(00:33):
so we're gonna see how it goes.
Speaker 1 (00:35):
And without further ado, why don't we get into it.
Speaker 2 (00:39):
Today we'll be looking at another traditional Chinese formula huanglian
jiao tongue or coptus and outside gelatin decoction. This is
relatively not so commonly used, at least in my experienced experience.
Formula for treating irritability, insomnia, and palpitations with a sensation
of heat in the chest.
Speaker 1 (00:59):
Could this be of help in anxiety conditions? Join us
as we find.
Speaker 2 (01:04):
Out, and as usual, we will be adding something a
little different. We're going to discuss calcium its physiological role
as well as its Chinese medical role and its supplementation.
So please stay tuned. It's going to be another good one.
And before we get into all that, I just wanted
to ask you guys a quick question. Did you know
(01:25):
that I have written a couple of books? Well, if
you've been listening, you've heard this last few times, so
hopefully you do know that I've written a couple of
books at this point. The first book is Integrative Pharmacology,
combining modern pharmacology with integrative medicine. This is a pretty
thorough book discussing pharmaceuticals, what they're used for, how they work,
and how they may interact with other drugs, herbs and supplements.
(01:48):
It is the perfect reference book for all acupuncturists, herbalists, chiropractors,
natural paths, and really any integrative practitioner, but is also
perfect for anyone. It goes in depth, but it is
easy to read and has difficult terminology bolded with definitions
on the same page. There's not only a great book
explaining pharmaceuticals, it is also available.
Speaker 1 (02:10):
At an amazing price.
Speaker 2 (02:11):
It is available for ten percent off its regular price
and you get it signed by me the author, for
just sixty seven dollars and forty five cents. My second book,
written with an amazing insurance expert, Tiffany Anderson Heffner, is
called Playing the Game a step by step approach to
accepting insurance as an acupuncturist. This is the perfect book
(02:33):
for any acupuncturis who wants to or even importantly is
contemplating accepting insurance.
Speaker 1 (02:39):
We go in Should You Accept Insurance?
Speaker 2 (02:42):
It gives step by step advice at every part of
the insurance game, from getting set up, through the patient encounter,
and of course getting paid, all in easy to digest language,
honest advice, and lots of handholding through the process. And
you guessed it. It is also ten percent often signed
by one of the authors me all for twenty six
dollars and ninety eight cents. You can get either or
(03:05):
both of these books at the shop at www dot
sperbserbs dot com. That's sperbserbs dot com, just like the
title of this podcast. So I started a new webinar
series called Integrative Nutrition, where I explore the biochemistry, the
Chinese medical approach, and supplements available of various topics of nutrition.
(03:30):
I recently taught the sixth course in the series, micro
and Macronutrients, where I discussed the macronutrients protein, fats and carbohydrates,
as well as trace and ultra trace minerals here as
are something a little different. I would like to very
briefly look at minerals in general and then spend some
time exploring calcium as an important mineral biochemically, its role
(03:53):
in Chinese medicine, as well as discussed supplements in supplementation.
Speaker 1 (04:01):
So introduction.
Speaker 2 (04:03):
Minerals are inorganic, in other words, lacking carbon substances, basically
elements required to do various functions in the body. These
functions include formation of teeth, bones, catalysis, which is the
making reactions easier, signaling, fluid balance and nerve conduction, and
(04:27):
muscle contraction. They are required in microgram to milligram amounts,
with macrominerals necessary in over one hundred milligrams per day amounts,
and microminerals are trace minerals in one to one hundred
milligrams per day. When a mineral is necessary and less
than one milligram per day amounts, they are called ultra
(04:49):
trace minerals.
Speaker 1 (04:50):
So there you go.
Speaker 2 (04:51):
There's sort of three categories, and really we're talking about
macrominerals today and which only one. Actually, we're going to
talk about calcium right now. Calcium or A two plus
is the most abundant mineral in the body, with about
ninety eight percent of it in the bones, and that
explains why it is the most abundant mineral in the body,
(05:12):
because calcium makes up most a good portion of our bones.
I think it's most, but I'm just going to say
a good portion of our bones, which of course is
a huge part of our body. So that's why it's
the most abundant mineral in the body. It is also
used for signaling muscle contraction and blood coagulation, so when
you get a cut or something along those lines, blood
(05:34):
coagulation is very important. It combined to several proteins and
alter their activity, so that catalysis that I was saying earlier,
that helps equate. You know, reactions happen, and it can
either make them faster or slower. When it's found to calcium,
depending on the individual. Enzyme sources include many green vegetables,
(05:55):
but not spinach.
Speaker 1 (05:56):
Spanish is not good.
Speaker 2 (05:58):
Even though there is calcium and spinach it's found it's
bound by phytic acid and is not absorbable in any
appreciable quantities. The RDA so the recommended daily allocation. It's
maybe I don't think it's an allowance. I think they
changed that, but I can't remember it off the top
of my head. The RDA for calcium range is from
one thousand to two thousand milligrams for adults. That's a
(06:21):
lot for a macrimonual emfact. I think it's the most,
though sodium is kind of up in the same range.
The upper limit, so upper limit or UL, is what
is considered to be the highest level you can take
before you start having potential for negative effects or side
adverse effects with it. The upper limit for this is
(06:42):
twenty five hundred milligrams per day for adults. There's not
much of a difference between the RDA, which can be
as high as two thousand milligrams, and the upper limit
is twenty five hundred milligrams.
Speaker 1 (06:52):
That's pretty tight. It's actually right now.
Speaker 2 (06:54):
There have been some very recent studies like can the
last month or two that suggests toxic effects can occur
with as low as two thousand milligrams per day. In
other words, the upper limit is in the upper ranges
of the RDA. So we're starting to see that people
are generally really good at supplementing calcium, and they may
they are probably in a lot of cases over supplementing it.
Speaker 1 (07:18):
We'll talk about that just a minute.
Speaker 2 (07:21):
But how is calcium viewed in Chinese medicine? So Bob
Flaws in his book The Dow of Healthy Eating nineteen
ninety eight, you're not been with Bob Flaws. Bo Flaws
was one of my co authors or a contributor to
my pharmacology book, and I've worked with him closely. He's
probably written more books on Chinese medicine than anyone else
(07:41):
in English.
Speaker 1 (07:44):
He's hundreds.
Speaker 2 (07:45):
I mean, he's just he's translated a lot, he's written
his own, so it's just really he's retired now but
has written quite a bit. So one of those is
The Dow of Healthy Eating. And then he says calcium
estringes yin and suppresses young, strengthens the bones and promotes
the generation of new tissue, absorbs acid and stops pain.
(08:07):
So you see, there's lots of good things that in
Chinese medicine. Calcium is good for Paul Pitchford in his
book The Whole Foods, I don't have it here, so
I can't remember. I think I can't remember the exact
title off the top of my head, but a very
common and.
Speaker 1 (08:26):
Frequently used book on.
Speaker 2 (08:30):
Nutrition, and it has a lot of Chinese medicine in it,
but it's also a general book on nutrition as well.
Maybe alternative nutrition might be a good way to say it, so,
Paul Prichford says, in the East Asian healing traditions, calcium
and mineral rich substances such as oyster shell, fluorite, gypsum, calcitum,
(08:50):
and fossilized bones of animals are taken as medicine for
their cooling, relaxing, calming, and moistening dimensions.
Speaker 1 (09:00):
Us these kinds.
Speaker 2 (09:01):
Of substances typically appear in formulas for insomnia, thirst, nervous anxiety,
and various overheated conditions. In Chinese physiology, the yin fluids
that calm the spirit, relax the liver, and moisten lungs
are undoubtedly infused with calcium and other minerals, and as
(09:21):
such relate to the Western practice of using calcium foods
to benefit the nerves and heart. So you can see
there's a lot of Chinese medicine and calcium. That's I mean,
calcium being the most abundant mineral, you would expect Chinese
medicine to have some thoughts on the matter. So her bunch.
(09:46):
Let's talk about calcium supplements. Calcium supplements are one of
the most common supplements in the US. They are available
in a wide variety of forms, including tablets, caplets, chewable tablets,
soft chewes, soft gels, syrups, gummies, ant acids, and even added.
Speaker 1 (10:04):
To food and juices.
Speaker 2 (10:07):
It also comes in a variety of chemical configurations, including
calcium carbonate, calcium citrate, calcium malate, calcium lactate, calcium glucenate,
calcium aspartate, calcium phosphate, and calcium hydroxy appetite. That last one,
hydroxy appetite. If you're familiar with physiology, you know that
that's actually sort of the calcium hydroxy appetite is sort
(10:29):
of the matrix for the bones. So it's actually that's
a lot of what's in our bones. Different manufacturers will
say different forms have advantages over others. Calcium carbonate is
the least expensive form and therefore the most commonly used
in supplements. Uses for calcium supplements. The primary use of
calcium is to strengthen bones and prevent fractures, especially as
(10:54):
we age. It is also said to reduce cancer risk,
cardiovascular risk, weight loss, age related macular degeneration or AMD
PMS or pre menstrual syndrome symptoms, lowering blood pressure, and
possibly for COVID nineteen. We're going to talk about that
right now. So let's talk about the science.
Speaker 1 (11:17):
The science.
Speaker 2 (11:17):
Calcium supplementation is often combined with vitamin D to increase
its absorption, so often you'll see that supplements of calcium
also have vitamin D included with them. Calcium and vitamin
supplementation has been found to be helpful in increasing bone
strength and density in nine to thirteen year old girls,
preventing osteoporosis and postmenopausal women, and there is but there
(11:40):
is inconsistency in studies evaluating fracture prevention. So you know,
if you build up the bones, hopefully you prevent fractures.
That's the thought behind prevention fractures. But the studies, some
studies say yes, some studies say no. It's inconsistent. Two
studies showed calcium supplementation did not lower risk of cancer
or in fact, I'm going to go, I don't think
(12:04):
this raises risk of cancer. But one of the ways
we detect many cancers is by looking on X rays
and looking for parts of areas of calcification, so where
calcium has kind of been there and that kind of
gives us a point or to where there might be
some cancer. So calcium is definitely involved in cancer, but
supplementation has not lowered the risk of cancer. It doesn't
(12:27):
seem like it's raised did either. Otherwise we'd probably see
that as well. Some implementary studies have shown that hospitalized
COVID nineteen patients are admitted with low calcium serum levels,
where it's low calcium in the blood. This may suggest
calcium supplementation may help prevent COVID nineteen complications or even
(12:47):
play a role in treatment. However, more evidence is necessary,
and other similar similar deficiencies have shown supplementation is not beneficial.
So when you look at COVID nineteen and you look
at mineral and vitamin deficiencies for those who have been hospitalized,
there's a lot of them.
Speaker 1 (13:04):
There's I think, off the.
Speaker 2 (13:05):
Top of my head, I think there's magnesium and zinc.
Calcium is in there. There's a few vitamins I can't
remember which ones. Some of the B vitamins are in there,
and these show that people who are hospitalized have lower
levels of these particular substances, but then they've followed up
and they've done supplementation of those substances and found it
does not help in the treatment of COVID nineteen at all.
(13:28):
So my take home for that is it's good for
you to be in good nutrition in order to prevent
complications of COVID nineteen. So you want to have all
these levels up to normal levels. But if you don't
have them up to normal levels, supplementing them after the
fact is not going to help. That's what we've seen
over and over again, even though we quite haven't seen
that at least that I found with calcium. So another
(13:52):
study found supplementation of lower than nine hundred milligrams of
calcium daily reduced risk of death in post menopause women.
So that's a nice study just in general in that
it's very specific in the people that it's looking at,
postmenopausal women, so it's hard to project that to other groups.
(14:13):
Another study showed supplementation of up to one thousand milligrams
of calcium reduced the risk of death by twenty two percent.
Speaker 1 (14:20):
In women, but not men, So that's an.
Speaker 2 (14:24):
Interesting Some men should not be supplementing as much probably
as women do. There are some risks to over supplementation,
and another study specifically looked at cardiovascular deaths and found
a lower rate in both men and women who supplemented
up to twelve hundred milligrams. So there you go, there's
some positive on the cardivascar. I've seen some negatives in
(14:45):
the cardiovascular realm of things as well. I don't know
if calcium is something I would choose to deal with
with cardiovascular risks, but I certainly am a fan of
having at least low levels of calcium supplementation. Early studies
in DKAY there may be some benefit to supplementing calcium
for weight loss. However, larger subsequent studies have not supported
(15:09):
this use higher consumption of calcium from foods.
Speaker 1 (15:13):
This is important.
Speaker 2 (15:14):
Not supplementation from foods has been associated with lower risk
of AMD, that's the macular degeneration, age related macular degeneration.
While there's mixed evidence regarding the effects of calcium from supplements,
and this is something that we see in general. I
think we should get all our vitamins and minerals from
our foods rather than from supplements. I am a big
(15:36):
fan of having a multi vitamin supplement just because I
think of it as nutritional insurance. So if you don't
get everything you need from your food, at least you're
not going to get into deficiency or deficit. But in general,
foods are where it's at, not supplements. Other considerations about
calcium supplements. Calcium carbonate requires stomach acid to become soluble
(15:59):
and absorb herbabole. In cases of reduced stomach acid, using
another form of calcium suffment, such as calcium citrate or
calcium malate should be considered. Calcium carbonate should be taken
with food to stimulate gastric acid production.
Speaker 1 (16:14):
So there you go.
Speaker 2 (16:15):
That's the thing with calcium carbonate. The other thing is
reduced stomach acid. You kind of go, well, how do
I know if I have reduced stomach acid. Well, you
probably won't, but if you're on something long term that
reduces your stomach acid. These would be the proton pump
inhibitors or a histamine some of the anta. There's specific
types of histamine antagonists that can actually reduce stomach acid.
(16:39):
These are your pepsidacs and your nexiums and those sort
of things. If you're on those long term, then you
have reduced stomach acid and you should consider some of
these other substances. Dosage in general is considered healthier and
more effective to obtain calcium from foods for slowing bone loss,
oney to twelve hundred milligrams. For building bone in girls
(17:02):
aged nine to thirteen, eight hundred milligrams combined with four
hundred iu of D three and four hundred milligrams of magnesium.
These are what the studies have shown and to help
reduce PMS symptoms twelve hundred milligrams. Again, you notice we
didn't mention much about the science of reducing PMS symptoms.
I don't think the sciences is really super supportive of
(17:23):
PMS symptoms.
Speaker 1 (17:25):
I'll tell you where I'm at.
Speaker 2 (17:26):
Because of the upper limits of calcium and the fact
that we do get a lot of calcium from our foods,
I'm at the point where with my patients I am
not recommending that they take more than one thousand milligrams
a day, and I'm actually for most people, depending on diet,
I would suggest six hundred milligrams a day at most,
(17:46):
because I think that you can get into toxic levels
if you take more than that and have a good
diet with some calcium in it. So we're not supposed
to be hitting that twenty twenty five hundred market is
basically what we're trying to avoid. And it's relative easy
if he dairy foods to get a thousand or fifteen
hundred milligrams from your diet. So what are some side
(18:08):
effects in red flags of calcium supplements, gas floating and
constipation or common adverse effects to calcium supplementation which can
be reduced using divided doses or calcium citrate overdosing, especially
from supplementation not taking into account calcium aggestion from foods
can cause toxic effects with dosing as those two thousand
milligrams and adults over fifty. And by the way, my
(18:31):
experience is this becomes an issue especially with women postmen
apostle women. They start going, okay, I need to be
worried about osteoporesis now that on postment apausal, I need
to take more calcium and.
Speaker 1 (18:42):
That's where some of these issues.
Speaker 2 (18:43):
And yet the upper limit has lowered in that age group,
so you do have to be careful with supplementation of calcium. Men,
my experience are men don't.
Speaker 1 (18:53):
Take supplements as frequently as women do.
Speaker 2 (18:56):
Calcium is usually one of the first ones that they
do take if not a multi vitamin, so definitely a
concern there as well. There's an increased risk of kinneystones
with calcium supplementation. When taken over a thousand milligrams of
calcium supplementation, there appears to be an increased risk of
mild cardio infraction and cerebrovascular accident or stroke. So my
(19:20):
cardial infraction is a heart attack, a heart attack constructor
is what we're talking about. That's why I'm not a
huge fan of thinking about these things for cardiovascular for
helping cardiac events.
Speaker 1 (19:31):
I don't think it's very helpful.
Speaker 2 (19:33):
If you want to take it, that's okay, but definitely
stay between below that one thousand milligrams, and like I said,
I'm really recommending six hundred milligrams at this point. There
are some interactions with these supplements. Proton pump inhibitors, as
I mentioned earlier, substantially reduced calcium absorption, especially from calcium carbonate.
That's because it reduces acid in the stomach and general
(19:56):
calcium supplementation will reduce the absorption and therefore the effectiveness
from fluoroquin alone and tetracycling class antibiotics that's actually one
of the rules of antibiotics is you should not take
calcium supplements while taking antibiotics. Calcium supplements may decrease the
absorption of thyroid hormones. Interesting, that's the first two interactions
(20:18):
here were B level on abcd A being the highest,
so B levels pretty good on this last one about
decreasing the absorption of thyroid hormones is actually C level,
so kind of in the realm of case studies are
poorly done in study, so I think there's more says
that need to be looking at calcium supplementation and thyroid hormones,
but there's indication that it could be an issue. And
(20:41):
that's it for calcium supplementation. So Yael says recommended dietary
allowance average daily level of intake sufficient to meet the
nutrient requires to nearly all healthy individuals often used to
plan nutritionally adequate diets for individuals. Yes, thank you, And
it is allowance recommended daily allowance, so they are still
using that terms they.
Speaker 1 (20:59):
Changed every up.
Speaker 2 (21:00):
They also have the RDI which is recommended daily intake
and so it gets it's it's gotten a little confusing
for me with those even though I just lectured on
this and added all in my my lecture, it apparently
did not stay in my brain. So but yes, that's
the great definition of the RDA. In fact, I think
I had the exact same definition in my in my
(21:22):
my thing is in my presentation.
Speaker 1 (21:24):
So thank you, I l okay.
Speaker 2 (21:27):
So with that, let's get into our formula today, which
is huangli on jiao tongue. Huangli on edge tongue has
translated as coptis and ass high gelatin decoction, so jiao.
If you're not familiar with that, that is basically donkey gelatine.
So that's why they're saying ass high gelatine.
Speaker 1 (21:47):
It's donkey is no name for donkeys an ass.
Speaker 2 (21:50):
Other names include coptis and egg yolk decoction or huangli
on jit zid tongue, and as we're gonna find out,
yolk is part of this decoction. This formula is in
the subcategory of formulas that nourish the heart, blood and
you in and calm the spirit. Under the category of
formulas that calm the spirit. According to Shide and their team,
(22:14):
are other usual formulas textbooks. So I usually have two
textbooks that I use the other one is called Chinese
Medical Herbal Formulas and Applications, Pharmacological Effects and Clinical Research
by Chen and Chen, and they don't have a monograph
on this formula, so usually they're pretty lock step in
what they have. Every once in a while, I've found some
differences with what's included. So this formula is not included
(22:37):
at all in Chen and Chen's books, So it's interesting
and I usually like to compare and contrast between the
two books. So I feel like we're getting a little
bit of a one sided approach to Honglan a Jet
Tongue today, but it's still a really good one. So
we're going to continue with our forging ahead. So let's
talk about those formulas that calm the spirit. So this
(22:57):
is the overall category the falls under, and there's a
subcategory we're going to talk about after this, and for
let's talk about the overall category. And Shide and his
team always has a really great overview of these, so
we're going to listen to what Shide and his team
have to say. So spirit and Chinese medicine denotes the
non physical aspects of a person's being. Unlike in the West,
(23:21):
these are not seen as being separate and qualitative, qualitatively
different from the body, rather a Sho shway high rights
and random notes while reading about medicine or the Deuyi
Swibe written in eighteen ninety eight. The five spirits are
dispositions of blood and che elation, anger, pondering, sadness, and
(23:44):
fear have their foundations in the personal mandate of heaven.
A person who does not possess these dispositions will be
dull witted, their personality dead.
Speaker 1 (23:57):
Interesting disturbances in.
Speaker 2 (23:59):
This spirit then are regarded as manifestations of disorders that
prevent a person from living their life in a manner
appropriate to who they are. Chinese medicine offers many different
ways to treat such disorders. These include changes in diet
and lifestyle, emotional counter therapy where one excess of emotion
is treated by generating other emotions following the doctrine of
(24:20):
the five phases, and counseling, as well as herbal medicine. Indeed,
as the seventeenth century physician yat En Sure noted in
case records as a guide to clinical practice, prescribing medicine's
draws on the function of herbs, I'm afraid that these
may not be enough to make the patient happy. Formula
(24:43):
is that common spirit thus should not be confused with
psychoactive drugs in the biomedical sense of the term, nor
are they substitutes for treatment that seeks to enable a
person to devise autonomous strategies for overcoming difficulties in living. Nevertheless,
the formulas discussed in this category can plain important support
of function in treating such disorders, for in seeking a
(25:06):
regulated person's chia and blood that provide a space from
which they may seek to understand and develop their dispositions.
As outlined by Jou shwe Hi, the main strategy for
treating disorders of the spirit in Chinese medicine is to
calm them.
Speaker 1 (25:22):
And here's a quote from his book.
Speaker 2 (25:24):
The multiple transmutations of spirit disorders cannot be fathomed, and
they are also the most difficult to treat among all
the various types of illness. To do this, it is
essential to know about the roots and branches. Generally speaking,
for the spirit to be in charge of its functions,
it needs to be regulated. In order for it to
(25:44):
be regulated, it needs to be calm. So off of
that quote, this strategy was first described in Basic Questions,
chapter seventy four some basic questions is the Wangdhi nae
Jingsu Win, which is the Yellow Emperor's Classic of internal medicine,
and that comes in two parts. In one of those
is the basic question. So in chapter seventy four it
(26:05):
says calm disorders with palpitations and anxiety. Like all other
disorders in Chinese medicine, those of the spirit can be
sorted into two major types, deficiency and excess. Here these
refer both to the branch manifestations and to the root
and to the root. Manifestations of deficiency include palpitations with anxiety, forgetfulness, disorientation,
(26:33):
and insomnia. Generally, such patterns are due to deficiency or
constraint of chim blood, preventing the expression of the spirit
and thereby causing it to become agitated. The method of
treating this type of disorder is to toonify and harmonize the
chim blood. Manifestations of excess include a feeling of being overstressed,
(26:56):
manic behavior, bad temper, and agitation. Much patterns are due
to excess heat, uncontrolled young blood stasis, phlegm, and severe
chi stagnation. The strategy for treating this type of disturbance
is to sedate and calm the spirit. In practice, the
(27:16):
manner in which disturbances of the spirit present clinically tends
to be complex and often involves aspects of both deficiency
and excess. A combination of treatment strategies is therefore utilized
in most cases. Furthermore, because disturbances of the spirit occur
as a result of imbalances of chat and blood, they
(27:37):
often occur in contexts where formulas not discussed in this
category are more appropriate. For example, young brightness, heat can
cosmatic behavior that should be treated by purging, Phlegm can
veil the orifices which should be opened. Rebellious chie can
present with severe irritability, insomnia, blood stasis can lead to
(27:59):
insanity and forgetfulness, and deficiencies deficiency of various types can
result in palpitations, disorientation, or insomnia. Historically, the formulas in
this category come from many different periods in the history
of Chinese medicine, reflecting the different preoccupations of their authors
(28:20):
regarding this spirit and its treatment. Han Dynasty formulas from
discussion of cold damage, and essentials from the Golden Cabinet,
which we talk a lot about. Modern day those are
split into two different books. They were originally one book,
and it is the first book that we have that
talks about formula. So this is kind of the foundational
(28:41):
formula book. So in this book generally, it generally emphasized
emphasizes regulating the nutritive and protective gy be it by
draining fire, harmonizing the middle burner, or enriching blood. From
the top dynasty onward, and especially during the Jinuan period,
(29:04):
fire became a main concern of Chinese physicians, and this
is reflected in their attempts to calm the spirit. A
greater focus on organ systems rather than chi and bled
led to formulas being designed to specifically treat the heart
as the organ most closely associated with both fire and
the spirit. Phlegm disorders also attracted closer attention, while discussions
(29:25):
of the ministerial fire and its interaction with the heart
or sovereign fire brought into play the relationship between the
heart and kidneys. These trends continued throughout the Ming and
into the Qing epoch, intertwined with the emergence of warm
pathogen disorders as a major concern for physicians during this time.
Yin deficiency was accorded great attention, and so was the liver,
(29:48):
which many physicians now viewed as the most important organ
in treating all kinds of internal medicine disorders. From the
Republican period onward and well into post Maoice China, concepts
borrowed from Western medicines, such as neurasthenia or nervous exhaustion
became tremendously important in China and Chinese medicine. As always,
(30:09):
these changes not only stimulated the composition of new formulas,
they also influenced the interpretation and uses of usage of
existing ones. For example, the organ systems again became regarded
as paramount. Consequently, almost all the formulas in this chapter
in this category are currently defined as treating predominantly the
(30:30):
heart and the liver. So that was the calm the
spirit category. Now we're going to talk about the subcategory
under that which this formula falls under, which is called
formulas that nourished the heart, blood and yan and calm
the spirit. And this is what Shid continued says about
(30:50):
this subcategory. Disturbances of the spirit due to deficiency of
the chieve blood and yin usually manifest its palpitations, irritability,
and insomnia. The heart and liver are the organ systems
most often involved in such pathologies pathologies, although the swen,
stomach and kidneys often also often require attention. The proper
(31:12):
strategy is to toonify and regulate the chi, enrich the yin,
and nourish the blood. Typical herbs used for this purpose
are ziciphy spinosis semen or swan zareen, platyclatdy semen, bide ziren,
and polygali radix yuan ju. These are usually combined with
three other types of ingredients, depending on the precise nature
(31:34):
of the pattern to be treated. One those that enrich
the yin and nourish the blood more generally, such as
sofio pagonis, redex mamandong romania, redex shend huang, romania aradex
preparata shu di huang as sine koreai cola or a
jaw which is what we're going to see in today's formula,
and lechi fructus go chidza, where such deficiency is the
(31:58):
root of a spirit disorder. Two. The second type of
verbs added are those that augment the chiese, such as jinsen, redix,
renshen ilycceri, radix, gonsal licorice in order to enable the
heart to direct the chi and blood downward and thereby
control the spirit. And three those that clear fire and
(32:19):
drain heat, such as fritillar area, bulbous bay mu, coptitis
raizoma huangyan, which is in today's formula is one of
the chief verbs as well, and anna marina raizoma is
germu when deficiency of blood yin is accompanied by yong
excess noe. While the formulas in this group can be
(32:40):
taken over a longer period of time than those that
settle in sedate, which is the other group subcategory, they
are not intended to replace tranquilizers and must also be
adjusted regularly to the pattern change as the result of treatment.
In other words, don't do this forever. So where are
(33:00):
the Chinese medical actions of this formula. Shide and his
team say, this formula enriches the gin, causes fire to descend,
eliminates irritability.
Speaker 1 (33:11):
And calms the spirit.
Speaker 2 (33:13):
So it tells us a lot about what's going on
in this So we're going to talk about that now
under Chinese medical indications. And they say, again, I only
have the one source At this point, Shide in his
team say this formula can be used for irritability with
a sensation of heat in the chest, insomnia, palpitations with anxiety,
a red tongue which indicates heat, with a dry yellow
(33:35):
coat coating which also indicates heat in dryness or indeficiency,
and a thin rapid pulse. A rapid meats heat then
means deficiency, so indeficient rapid pulse heat heat from the
indeficiency in that pulse. There may also be sores in
the tongue or in the mouth. This is a so
called heat transformation or ra hua pattern in the lesser
(34:00):
warp of a cold damage disorder. So that's talking about
the six levels. We've talked about that before on spursers,
but it's been a little while. It's one of the
ways we can look at how a disease enters the body.
The lesser yen corresponds to the kidneys, which govern the
fluids and store the essence, and the heart, which covers
the blood vessels. When pathogenic heat enters the lesser yen,
(34:23):
it consumes the yin fluids, blood and essence. This results
in a pattern characterized by excess heat at the chi level.
The pathogen usually enters via the stomach or intestines, combined
with deficiency of yin and blood, the presence of chi
aspect pathogenic heat is reflected in the red tongue with
(34:44):
a dry yellow coating of the thin rapid pulse. In
a case that the yen has already been damaged, lesser
yin water the kidneys is no longer able to properly
control lesser yen fire the heart. This leads to a
sensation of heat in the chest and symptoms of a
disturbed spirit. Palpitations with anxiety, irritability, and insomnia characterized by
(35:07):
an inability of the patient to calmly lie down. Stores
in the mouth and on the tongue are also a
sign apathogenic heat in the heart. History of this is
actually pretty straightforward. Shi and his team says, it's from
the Discussion of Cold Damage of Shan Hong Lung written
two twenty by Jiang zhog Jing. So again, that is
(35:28):
that book that we were talking about. Discussion of cold
damage and miscellaneous diseases used to.
Speaker 1 (35:32):
Be one book.
Speaker 2 (35:35):
Golden Cabinet, Golden Coffers. Treatment of the miss Lane's Disease
used to be one book. It was split into two.
This is one of those two discussion of cold damage. Again,
both or the singular initial book are considered to be
the first books that we have historically that talk about formulas.
(36:00):
Talk about the ingredients of this formula. So to treat
a pattern characterized by heat excess and blood deficiency, whose
symptoms predominantly manifest in the heart lesser yen. This formula
utilizes a strategy of directing fire downward that means bitter
cooling herbs while simultaneously nourishing the yin and blood with sweet, salty,
and sour substances. Let's talk about these substances first.
Speaker 1 (36:24):
One up is.
Speaker 2 (36:26):
Coptous Rhizoma huanglian that's huanglion of the huanglanjeaton fame. We
need twelve grams in this formula and it comes from
herbs that clear heat and dry damnness. It's actually a
very important IRF that does ap, clears he and dry.
Its functions are clear as heat drains dampness, drains fire
and resolves fire toxicity, clears heat and stops bleeding, and
(36:48):
clears heat. Topically, this is one of the two chief
ingredients and it directly clears fire from the heart and
thereby calms the spirit. Our second herb, which is also
in the title, is a sini coreai cola or a jaw.
We need nine grams for this strained into the decoctionri.
(37:09):
We'll talk about preparation later on herbs, and this is
This comes from herbs that tanify the bloods is a
blood tonifying herb, and its functions include tanofi is the blood,
nourishes the blood and stops bleeding, and nourishes and moistens
the yin. This is the other chief ingredient, and Shinda,
seems to say the sweet and neutral jaw, which indirectly
(37:32):
controls the heart fire by enriching the yin and nourishing
the blood. Together, huangli on a jaw facilitate interaction between
water and fire to effectively treat the root and branch
of this pattern. Our next herb, this is a relatively
small formula. I think there's only six herbs in it,
sort of. Our third herb is scutulary rat x huang chin.
(37:55):
We need six grams of it for this formula, and
this is also in the herbs that clear heat and
dry damness. Often you'll see huangli On. There's something called
the three yellows, which are huangwi on which we already discuss,
this orb wang Chin, and then a third herb, which is.
Speaker 1 (38:11):
Why am I totally blinking? Uh. This is scu area,
coptus and Philodendri Huangbai. There we go.
Speaker 2 (38:17):
If I can get the Latin, I can get the Chinese.
Hwangbai is the third third yellow, and they all come
of the same category. This herb clears heat and drys damnus,
resolves toxicity and stops bleeding, calms the fetus, and sedates
ascendant liver yong. This is one of the two deputy
(38:38):
herbs which drains heat from the upper burner and the
intestines to assist huanglion in directing fire downward. This is
a very good draining, clear heat draining herb. Our fourth
herb is uh well. The formula says to use Paoni
radix or shao Yeah, which is a generic term for
(38:59):
red or white peony and in Chinese methsa. Those are
They have some similarities, but generally they're totally different herbs. However,
a note under method of preparation says Paoni riddix alba
or Bischow. That's the white peony is the current species
to use for this formula. So we're gonna say that here,
and so that's by show. We need six grams of it.
(39:19):
That herb comes from the herbs that toonify the blood
category and it nourishes the blood, regulates mensis, calms and
curbs liver, young, preserves yen, adjusts the nutritive and protective levels.
Speaker 1 (39:32):
And alleviates pain. In this formula, the sour and.
Speaker 2 (39:36):
Cooling by shall which assists a jow and enriching and
retaining the yen to harmonize the functions of the chi
and also both of the heart heat draining herbs and
controlling the yong. So what we have basically are two
herbs that are going to be containing the heat and fire.
That'shuangwian and wang Chin. And we have two herbs they're
(39:58):
going to be supporting the yen and enriching the blood
and yen, which are the ud jaw and this deputy
by shall. So for a fifth herb we have Wang
Wanglian ud Jao tongue, and that's it.
Speaker 1 (40:09):
There's actually only.
Speaker 2 (40:10):
Five herbs, and I thought there were six five which
if I look closer at the picture at the beginning,
might have done it. So the fifth herb is golly
uh ginger a vitellus or egg yoke or in Chinese
that's jidzi huang, and so that's a, that's this uh,
(40:30):
and it's it is traditionally in the herbs that tonify
the yen.
Speaker 1 (40:34):
So again tonifying.
Speaker 2 (40:35):
Traditionally, this herb quote unquote herb nourishes yin, tnifies the
blood and moisten's dryness and extinguishes wind. The assistant and
envoy is sweet and balanced egg yolk, which enters the
heart and kidneys. Tnifies the yen and blood and resolves
heat toxicity.
Speaker 1 (40:55):
So it kind of helps with everything.
Speaker 2 (40:57):
It assists the heat draining herbs and a limit the
pathogen while protecting against their drying properties, but also acts
in concert with the blood tonifying substances to enrich the yen.
So a very good herb all around here. So how
do we prepare this formula? It's mentioned earlier both ajiao
(41:18):
and a yolks should be added into the strained decoction,
and it says the decoction should be cooled down before
adding the yolks otherwise you just cook the yolks. Decoction
is the preferred method of preparation, and the amount of
wanglon is usually reduced by one third to one half
in modern times. Wangleon is an interesting when you look
(41:38):
at a lot of the do sne it's fairly normally dosed,
but then when you see how it's used in modern formulas,
a lot less is used in general. I don't know
if that means. I often that will mean that the
current strains of a particular herb are more potent, or
maybe it's just that they've found that it doesn't need
to be used as much, so there's different thing it happens,
(42:00):
But generally we use much smaller amounts of poi on
that than's called for traditionally.
Speaker 1 (42:05):
In this formula.
Speaker 2 (42:08):
May also be expense by the way it's a wild
is not a cheaper in general as usual, Shida does
team have a great commentary on this herb, so let's
get into it. Like Ardinia and Prepared soybean decoction jured
ze Cher Tongue and discuss discussed chapter four of the book,
(42:31):
and sour jijb decoction Swanza rentong discussed above.
Speaker 1 (42:35):
In this in this category.
Speaker 2 (42:36):
This formula treats a form of deficiency, irritability or shoe fonon.
This is a disorder characterized by symptoms like vexation, restlessness, insomnia,
and subjective sensations of fullness in the chest, indicating the
presence of pathogenic heat. Such he represents a local excess,
but unlike patterns where the heat has led to clumping
(42:57):
of body fluids or other substances, its form deficiency in
this context thus does not refer primarily to deficiency of
cheat or essence, but functions as a designator that refers
to a class of disorders in which the pathodynamic does
not manifest with palpable excess or fullness. In the conditions
(43:21):
treated by this formula, the heat will tend to be
of external origin, including alcohol, sugar, and other food stuffs
that generate heat. Hence, even though the patient will show
signs of blood and yin deficiency, these are secondary to
treat patterns characterized by yin and blood deficiency and empty fire.
Once should select a formula like acide gelatin and egg
(43:41):
yolk decoction ajau jitsu, huang tong or major arrest wind
pearls DoD ding fung ju. These formulas retain the yin
n blood, tonifying ingredients of coptis and a high gelatin
decoction wang on a jea tongue, but combine them with
salting and cooling substances that clear heat without dam gene
the yen. The reticular combination of excess heat and deficiency
(44:06):
of essence treated by this formula, as reflected in this
strategy often said to embody. The principle of draining the
south Ie fire while tonifying the North i e water
first outlined in the Classic of Difficulties with the non
Jing circa Eastern Han. So this is an early text.
So it's interesting we look at the the Yellow Emperor,
(44:28):
the Emperor Yellow Emperor's Classic of Internal Medicine, that is
about two hundred years BCE, two or three hundred years
of PC. The nan Jing kind of comes next about
I think it's about one hundred. It's Eastern Han, so
that went from basically.
Speaker 1 (44:46):
Around two hundred BCE to two hundred C.
Speaker 2 (44:50):
So it's a long time. I'm not sure about the
Han period, and I'm not sure about the Eastern Hunt.
I think the Naging was about one hundred CE, so
a couple hundred years after and a little bit for
our herbal book that we were just talking by a
little bit.
Speaker 1 (45:03):
It's still a hundred years. That's quite a bit.
Speaker 2 (45:05):
Anyways, important book, a difficult book, hence the classic of difficulties.
It's distinguishing characteristics. Going back to the quote, it's distinguishing
characteristics as formula are a capacity for draining DMPA pathogens
from the body while simultaneously enriching the yin and tonifying
the blood. And the type of cold damage disorders for
(45:26):
which this formula was first composed. Such pathogens entered the
body primarily via the mouth and lodge in the stomach
and intestines. The scope of this formula has been expanded
by later writers to include chi aspect heat penetrating to
the blood aspect bleeding disorders, and dysenteric disorders due to
heat toxin. A passage in the nineteenth century Japanese work,
(45:49):
expansion of the categorized categorized collected Formulas or the Rui
ju hul Kogi kog by Oda Yodo in eighteen fifty
three notes it treats all kinds of patterns evolving loss
of blood, chest palpitations, body fever, abdominal pain and mild dysentery,
a dry tongue, burnt lips, irritability and restlessness with inability
(46:13):
to light down, bodily exhaustion, a complexion trained of blood,
or alternatively a red fluxed flushed complexion. In clinical practice,
the following point is provided by the contemporary physician Huang
Quang and one hundred classic formulas written in two thousand
and six, so quite modern based on a review of
(46:35):
both Chinese and Japanese sources will prove useful in determining
when this formula is appropriate. The tongue will be red,
indicating the presence of heat. The pulse will be thin
and rapid, indicating the presence of both heat and yan deficiency.
The skin will tend to be dry and may show
signs of flaking or chafing, but there will also be redness,
particularly in the face, and there will often be bleeding
(46:58):
or a tendency to bleed, indicating heat string the blood
to move recklessly. So that's commentary on this formula. Let's
talk about a few modifications. Shai does discuss several modifications
for this formula for severe in deficiency with injured fluids
in a dry throat at Scruffalaria Radix for schwan shin Ofio,
(47:18):
Pons Redix, Maman Dong and Dendrobi Erba sure who for
heat in the five centers at Guardina Fruitus Jerza and
Lofatheri Erba, don Julie for fever ishness with dark urin
and Jensi Medulla deng shin Tsao tetrapanicis Medulla tong Tsao
and emperate Raizoma bay mal Gen for purpura or bleeding
(47:44):
of the gun gums. Add Lugustri, Lucidi, fructus or new
Jenza Eclipte Erba and Mohan Leon Mutan cortex, Moudan Pi
and Romania Radix shengd yu wang for dysenteric disorders with
abdominal pain and pus and black in the stool.
Speaker 1 (48:01):
Remove the egg yolk or the jiitsu huang he does
shine in their team.
Speaker 2 (48:07):
Also compare today's formula two other formulas, one of them
we already mentioned the sour Jiujibi dicoction Swanseau Rentong Classic formula.
In the calm this uh you know uh support the
art and calm the spirit category, So the same category
as a formula. Both formulas treat irritability and insomnia. Comparing
the indications of these formulas in their source texts, the
(48:31):
differences between them become clear. Koptus and as hy gelatine
decoction of huangwian adje out tongue is for irritability when
the patient is unable to lie down, that is, when
he is so irritable that he cannot even tolerate lying
in bed. This is due to the young failing to
enter the yin and the treatment strategy focuses on draining
fire from the heart and enriching the yin and blood.
(48:53):
Sour jiujubi decoction swans ou rentong is for irritability with insomnia,
in which the patient is able to lie in bed
but cannot sleep. This occurs when deficient liver blood is
unable to nourish the heart, and the treatment strategy focuses
on tonifying and harmonizing the liver and our second formula
(49:13):
compared is polyperus decoction or juling tongue. Both of these
formulas treat patterns characterized by irritability and insomnia due to
heat damaging in the yin and use a seni coorei
cola a jaw to address this deficiency. However, coptus in
as hy gelatin decoction quangli on other gel tongue focuses
on patterns where both the pathogenic heat and the indeficiency
(49:36):
are relatively pronounced, with such symptoms as focal distension in
the epigastrium, abdominal pain, irritability, and thirst and palpitations. Polyperus
decoction is juling tongue, on the other hand, treats patterns
with the momentum of the heat and damage to the
inn are less severe, but instead clump with the water
and the lower burner, leading to the main symptom of
(49:57):
obstructed urination. A question here from Ralph, how do you
give a yoke? Again, this is stirred into the strained
cool decoction. So you do a decoction, you strain it.
Speaker 1 (50:15):
Which we normally do so we don't get herbs in there,
and we let it cool a little bit and then
we'll mix in the egg yoke. So that's how you're
supposed to do that. So thank you.
Speaker 2 (50:23):
So biomedical indications for this formula, Sha I'd say, with
the appropriate presentation site and his team with the appropriate presentation.
It's firmly maybe used to treat a variety of biomedically
defying disorders, including nervous exhaustion through cuperative stage of an
infected infectious disease, autonomic dystonia, a rectile dysfunction, appithys ulcers,
(50:46):
and hypertension.
Speaker 1 (50:49):
So let's talk about the science behind this.
Speaker 2 (50:51):
There were two interesting Chinese papers mentioned in another paper,
so I don't have I couldn't get access to these
Chinese papers, so I'm kind of that's why I kind
of mentioned in another paper that kind of weakens and
it doesn't allow me to assess them very well.
Speaker 1 (51:05):
But here's what they said.
Speaker 2 (51:06):
Both of these papers appear to me in Chinese and
was unable to obtain copies, so take the following information
with a grain of salt. According to the original paper,
there was a study that compared the use of long
way on agel tongue with an end of thirty so
thirty subjects and lorazepam, a common anzialytic medication, to something
that helps anxiety, again with an equals thirty so thirty subjects.
Speaker 1 (51:28):
Finding the herbal.
Speaker 2 (51:28):
Formula was ninety three point three to three percent effective
in treating anxiety, while lazepam was only seventy three point
three to three percent effective. So basically, what this is
saying is that this formula is better than la razapam
and treating anxiety. Take that with a huge grain of salt.
I could not figure out the age. There is a
certain point in time that Chinese papers would say this
(51:51):
effectiveness and they define what the efficacy was, but they're
not standard definitions and they weren't very useful, and so
whenever I see this ninety percent effective versus, I don't
buy it. So I'm I think this is very interesting.
I'd love to see another study on this, but I
would not buy this study at face value based on
what I know about it at this point. Another study
(52:13):
found huangli on edge l decoction had a better curative
effect and fewer adverse reactions than flew voxamine in the
treatment of anxiety that pertain to indeficiency and fire activity cent.
So I again, there's no specifics here. So again, both
of these the first one small can't get any of
the specifics. This one doesn't even have any of the specifics.
(52:35):
These are not guiding principles at all. What I do
think is interesting is that they're comparing this formula to
drugs that treat anxiety and this formula came out better.
I want to see a lot more more on that,
but it's definitely something to kind of keep in mind
when looking at this formula that this might be a
very effective formula for specifically, I like that about the
(52:55):
second study specifically says indefficiency and fire fire activity hyperactivity syndrome.
So in that case of anxiety, then this form that
can be very good. Again, overall, these are not strong
actually quite poor uh studies as far as.
Speaker 1 (53:08):
I can tell, So I you know, but that's what
I found all I could.
Speaker 2 (53:12):
Find as far as Drugger Burner actions. A couple of
verbs in this fronts may affect sarchrome pe for fifty enzymes.
These include huang leon which may inhibit sea why cytochrome
p for fifty two D six and wang qin may
inhibit cytochrome P for fifty two C nine two E one,
and three A four. That's the one we're particularly worried about.
Speaker 1 (53:34):
Three A four. Again, something to keep in mind.
Speaker 2 (53:37):
I'm not super worried about it, but if someone's on
a lot of especially three A four metabolizers. I might
be concerned about it, but again we don't have to
go into too much depth on that. Uh Hide and
his team did not discuss any major concerns for this
from which is interesting to me. I guess you know,
(54:00):
I would say, you know, be careful if there's not
some heat involved, because this can be a little bit cooling,
but it's also kind of supports the end, so it
kind of balances itself. So I can I understand where
there aren't a ton of concerns about this formula.
Speaker 1 (54:17):
That's it for today's forma.
Speaker 2 (54:18):
So that was today's formula hungli on o j al
tan or coptus and as higelatin decoction and interesting, if
not commonly used formula for Communist spirit, reducing in fire
and helping irritability. We started by discussing calcium in its
biochemistry and Chinese medical implications as well as its supplementation,
and then we got into the formula including its ingredients, commentary,
(54:41):
the science are concerns and cautions, as well as its
potential drug interactions. All in all another expiration of a
fascinating and useful Chinese format. It may not be used commonly,
but when it is used, it's quite useful. So this
is a very is a useful Chinese formula. And like
I said, I haven't seen it used much, but have
seen it used it is, it is useful and I
(55:02):
have seen it work well, so it is a good formula.
In our next episode in two weeks, we are going
to be looking in another single Chinese herb, go teng
on carria ramulus com unsis or on carria. This herb
is a relatively commonly used herb in Chinese medical category,
(55:23):
in the Chinese medical category of substances that extinguish wind
and stop tremors, and can be used in a wide
variety of conditions, including spasms and convulsions, headache, irritability, and
even hypertension, especially hypertension.
Speaker 1 (55:39):
As usual, we.
Speaker 2 (55:40):
Will explore all the intricacies of this herb as well
as an explanation of its category, and as always we
will look at something a little different. We will continue
our exploration of macro minerals. Join us in two weeks
for another interesting episode. And with that, I'd like to
thank you very much if you like this podcast. Oh man,
(56:02):
it would be such a big favor if you were
to subscribe to our podcast and your favorite podcast app,
just U. It helps us so much and we appreciate
it and thank you for even considering that. And remember
you can get CUS and ncc O m PDAs that's
Continuing Education Units and National Certification Fissions of acupunction Oriial
Medicine Professional Development Activities at www dot Integrative Medicinecouncil dot org.
Speaker 1 (56:29):
That's Integrated Medicine Council co o U n cil dot org.
Speaker 2 (56:34):
You can always get in touch with me at doctor
Greg at sperbserbs dot com or at our website www
dot sperbserbs dot com.
Speaker 1 (56:44):
As usual, we have a good bibiliography. This one's a
big bibliography, lots of stuff. Thank you very much. The
proceeding was presented by doctor Greg ferv. We would like
to thank Janelle Frawler's support and everybody else who contributed
to this program. Kimothy Roger Campbell, m
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