After receiving numerous requests for more case studies based upon new variations on classical Chinese medical formulas, I have decided to continue my journey into the classic TCM text "Essentials from the Golden Chamber." The following case studies reflect two distinctly different case pathologies using the variations of the same classic formula "Gui Zhi Fu Ling Wan." I find it fascinating how a simple classical formula can be intelligently modified to target diverse clinical conditions.

Patient was a 28-year-old Caucasian female experiencing extremely painful menstrual cramps two to three weeks prior to menses. Menses flow was slow, dark in color and with significant clotting. Patient had no other symptoms. This condition had been present for one year after the patient discontinued birth control pills. The patient's pulse was deep and wiry, tongue was dark red with normal coat with engorged sublingual veins. Fear of needles prevented the patient was seeking acupuncture therapy therefore herbal medicine was used. The TCM pattern differentiation was Blood Stasis in the lower jiao with concomitant Liver Depression. The following formula variation was administered:

Gui Zhi Fu Ling Wan variation:
Gui Zhi, 15gr
Fu Ling 10gr
Chi Shao 15gr
Bai Shao 15gr
Dang Gui 10gr
Yu Jin 10gr
Mu Dan Pi 10gr
Tao Ren 10gr

Patient was instructed to drink two servings of above tea daily. After four weeks on above tea, taken five days per week, the patient's menstrual cramps had lessened by 50 percent and menses flow was heavier with increased clotting. Patient also commented that her sleep was "more restful." After four more weeks on same dosage of above tea, patient's menstrual cramps had continued to diminish and menses flow was strong with no clotting. Patient was then prescribed a standard pill version of Gui Zhi Fu Ling Wan dosed at three tabs BID. After four weeks on tablet formula she experienced no menstrual cramps and menses was light to normal with no clotting. This was an interesting case as the TCM formula worked rather quickly. Once Blood Stasis was significantly resolved, the qi mechanism was able to flow smoothly and freely hence the effectiveness of the pill formula, which did not address Liver Depression not having Yu Jin and Bai Shao found in the tea variation.

Case 2

Patient was a 54-year-old Caucasian male suffering from chronic lower leg pain occurring in both legs. The patient was referred by his primary care physician with the diagnosis of "arthritis." The patient had tried acupuncture prior to visit with minimal relief. The patient had no other presenting complaints and was otherwise in excellent health. Upon examination, the patient's lower limbs were dry and scaly and the feet were extremely dry with cracking skin on both feet. The tongue was dry and slightly purple with engorged sublingual veins, pulse was wiry and slow. The TCM pattern differentiation was Blood Stasis/Liver Depression/Blood Vacuity. The following formula variation was administered:

Gui Zhi Fu Ling Wan Variation:
Gui Zhi 15gr
Fu Ling 5gr
Chi Shao 15gr
Bai Shao 15gr
Ji Xue Teng 10gr
Huai Niu Xi 10gr
Dang Gui 10gr
Chuan Xiong 5gr

Patient was instructed to have two cups daily, five days a week. After two weeks on the above variation, the patient experienced a significant reduction in pain. Due to pain reduction, patient was compliant with tea and requested to continue formula for four more weeks as he was traveling out of town. On follow-up visit four weeks later, patient was experiencing no leg pain and commented that his scaly skin was no longer flaking. At this point he requested a pill formula to use instead of tea. His tongue was no longer dry having a thin wet coating and was a normal red color; pulse was slippery and regular. He was prescribed a pill formula of Huan Shao Wan or "Return to Spring" patent pills dosed at 16 pills BID. On a follow-up at eight weeks later, patient was experiencing no leg pain and dry scaly skin was completely resolved. This was an interesting case as the remedy to his "arthritis" was a simple variation on a classical formula and a standard patent remedy. The additions of Ji Xue Teng and Huai Niu Xi to the tea variation were to guide the formula to the lower limbs as well as quicken the blood.  I hope this installment inspires practitioners to continue to study and mine the classical texts for modern remedies. In part 2 we will continue to examine simple classical formula modifications of formulas from Essentials from the Golden Cabinet.

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