Author: shennongsociety

Chinese Herbal Strategies for the Treatment of Estrogen Dominance

Cara O. Frank, L.OM.

Many Chinese herbal formulas date back centuries, if not millennia. They are well documented historically and endure to this day based on their efficacy. They work and surpass the test of time. Despite a wide range of doctors, currents of thought, herbs, formulas, strategies, and diseases, the core architecture of well written Chinese herbal formulas incorporates a kind of synchronous harmony of qi mechanisms: of building and clearing; of holding and moving; of ascending and descending; of expansion and contraction. Herbs are relational: they enhance one another; they control one another, and often they become more than the sum of their parts together.

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We are honored present some thoughts of another of our fantastic featured speakers at Conference 2018, Dr Craig Mitchell. Well known and respected scholar, translator and educator, Craig will speak at the Conference on the topic, “A Frog at the Bottom of the Well: Why Siloing and Polarization in East Asian Medicine Leads to Poor Patient Outcomes”

In Essentials from the Golden Cabinet, Zhang Zhong-Jing discusses the formula Tangkuei and Peony Powder (dāng guī sháo yào sǎn) in the chapter on miscellaneous women’s diseases and also diseases occurring during pregnancy. In both cases, the formula is recommended for abdominal pain, without much additional information. Of course, this terseness is often found in classical texts and it is one of the aspects that makes this fascinating, as well as difficult, for modern readers. 

One of my own strategies for understanding a classical formula in a modern context has been to look in books of case studies to see what physicians have used the formula to treat and to see if that can help me to get an idea of the pathodynamic that unites the cases. In the modern book, Selected Medical Cases from Famous Physicians [Employing Formulas from] the Golden Cabinet, we find a list of cases that ranges from gynecologic complaints such as dysmenorrhea and vaginal discharge to other pain complaints, such as headache and angina, to problems of fluid metabolism, such as edema and diarrhea. 

My approach then is to combine the information gleaned through reading cases with an understanding of the formula dynamics, the individual medicinals, the abdominal diagnosis, and my own clinical experience to form a practical understanding of how to use the formula. This approach can be used for any formula, but is particularly useful for times when the associated text is not modern and when the formula indications seem difficult to understand in the modern clinical context. 

Most modern texts on herbal medicine include a great deal of information about the specific medicinals in the formula and about the formula dynamics, but they often include very limited or no information about abdominal diagnosis. In reviewing the Chinese literature, I found some useful information about the abdominal pattern. From the modern text,  Abdominal Diagnosis: Patterns and Treatment, the pattern is described as follows, “The abdominal musculature is lax and there is a feeling as though one is kneading dough. However, there are spasms and tension in the peri-umbilical area and with pressure on the area, pain may radiate to the back. There may be water sounds and/or pulsations in the epigastric region. The classical text, Extraordinary Evaluation of Abdominal Patterns, describes the abdomen as, “There are spasms above, below, and to the sides of the umbilicus. Application of pressure will cause pain to radiate to the back. In addition, there are epigastric pulsations and strong pain in the lower abdomen. There may also be thirst and inhibited urination.” 

By combining these two perspectives, modern and classical, we begin to get a useful picture of the Tangkuei and Peony Powder (dāng guī sháo yào sǎn) abdomen. It will likely be lax overall, yet will have areas of spasm and tension. Pressure on the abdomen will cause pain and the sensation may radiate to the back. Finally, problems of water metabolism will be in evidence, as a water sound or even as urinary problems. This type of investigation can deepen our understanding of the formula, even as it aids us with increased diagnostic guidelines. 

Dr. Craig Mitchell, Ph.D.(China), E.A.M.P., received a Master of Science degree in Traditional Chinese Medicine from the American College of Traditional Chinese Medicine in San Francisco (1993). Craig completed his PhD from the China Academy of TCM (Beijing) in 2006. He has written numerous articles and translated several Chinese medical texts, including On Cold Damage: Translation and Commentaries. Craig is the President of the Seattle Institute of Oriental Medicine, where he is also a clinic supervisor and teaches classes on herbal medicine and medical Chinese. Craig maintains a private practice in Seattle, WA.

A Walk Along the River, by Yu Guo-Jun, a translation that came out this spring, has delighted many of us with its nuanced case discussion between a master and several physicians studying with him. We asked Sharon Weizenbaum to review the book for the Shen Nong Society monthly newsletter:

I use most of my Chinese medical books as reference texts.  I become familiar with what is in the book and then look things up in it as I need to.  I’ve not had that motivation since Huang Huang’s Ten Key Formula Families, came out in 2009.  Now, with the publication of Eastland Press’s A Walk Along the River, by Yu Guo-Jun, I am hooked again.  Except this time, I am not only reading this text carefully, I am taking 

notes and even making flash cards!  I know it sounds a bit obsessive to do this but this text is filled with such incredible clinical gems and I want to make them my own. 

Already this text has made a difference in my clinical experience and results.  For example, in chapter 7 Dr. Yu describes his use of a formula called Gua Lou San.  He writes:

“As a young doctor I initially treated herpes zoster following the common custom of prescribing Long Dan Xie Gan Tang.  I treated many cases…sometimes effectively and sometimes not….later, white thumbing through Cheng Guo-Peng’s Qing dynasty text Awakening the Mind in Medical Studies, I came across a passage where Cheng elaborated on the dynamics of the function of Gua Lou San: ‘This formula is for chronic fire from constraint, where Liver Qi has been parched, tight, and unable to diffuse; thus blisters arise on the skin and give rise to distention and pain.’ …I am entirely convinced that this formula matches the fundamental disease dynamic of herpes zoster and is the perfect specialized formula to use for this disorder.”

Soon after reading this, my mother called to tell me that she was feeling pain reminiscent of her previous run in with herpes zoster.  Based on her pattern and what I had read from Dr. Yu, I gave her Gua Lou San and her pain did not develop as usual.  Rather it faded away quickly. 

I thought of another patient with neuropathy secondary to multiple sclerosis.  She was on a heavy medication for the neuropathy which gave 

her the side effects of headache and mental fogginess.  Her liver was very dry and tight so I gave her Gua Lou San as well.  Within two weeksshe went off of her medication and has now had no pain and no medication for several months.  She took four weeks of this formula altogether. 

I have other examples of Dr. Yu’s influence in my clinic life however, his influence goes beyond his insight about herbs and formulas.  In the paragraph above, Dr. Yu shared that “as a young doctor” he worked in a limited way that was consistent with his training.  We learn, throughout this text, how Dr. Yu so carefully paid attention day after day, patient after patient.  He was not initially a master.  He was just like you and me – floundering about trying to make sense of poor results.  What makes him stand apart from many is that he kept at it.  I find it almost funny that he describes himself as “thumbing through” Cheng’s text.  It is so clear that he became more and more familiar with the early writings and applied the words of these predecessors in his clinic and watched to see the results for himself.  He carefully thought things through and is able to describe his thinking process for us.  We are so lucky! 

The text is a conversation between Dr. Yu and some of his students.  This format makes the text very accessible for me.  He is kind and patient.  I hope this can inspire practitioners to stick with it, study deeply and pay attention to the nuances in the clinic.  In case after case, Dr. Yu learns from his own or other doctor’s mistaken treatment, always trying to understand what he was missing. 

This text will be required reading in my future herbal programs. 

The AHPA (American Herbal Products Association) in March released a White Paper on Good Herbal Compounding and Dispensing Practices that we believe is relevant to all practitioners of Herbal Medicine who maintain a pharmacy. 

Please read the paper here

Pro-D Video now available of 2017 SNS Conference here