Featured Conference Speaker Craig Mitchell on Understanding Classical Formulas

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.