How an herbal prescription works. And why I can’t answer questions like: What herb do you use for abdominal pain? What herb is good for headaches?
Chinese medicinal formulas are made to match patterns of disharmony, always embedded within an individual person. Therefore the main problem, say abdominal pain, needs to be both looked at closely and put into the context of a persons overall health. Here is a little example of the diagnostic process used to decide what formula is appropriate. It's simplified but I hope makes the point!
Chief Complaint- Abdominal Pain.
The first question is what area of the abdomen? The epigastric area over the stomach? Under the ribs on the left or right? The center above the belly button or the center around the belly button? Left or right of the belly button? The sides of abdomen below the belly button? The center below the belly button? The whole abdomen?
In this case it is the lower center which we call lower abdomen.
The most common core mechanisms of lower abdominal pain are these patterns:
Blood amassment in the lower burner
Damp heat in the bladder
Lower burner vacuity cold
Liver depression qi stagnation.
We keep these in mind while conducting the examination to differentiate what pathologies may be involved.
The first thing is to ask all about the chief complaint, it’s qualities, what makes it better or worse and it’s history. Next the 'Four Examinations' are used to put the chief complaint into context.
The 4 examinations
Looking, listening, touching, asking
Look: does the person look strong? What is the complexion? Do the hair, nails and eyes look bright and healthy? Skin spots or veins? Tongue diagnosis
Listen: how is the sound of the voice? Strong, weak, raspy, etc. Any smells? (listen and smell are the same word)
Touch: pulse diagnosis, abdominal diagnosis, skin temperature and moisture, edema type, muscle/ tendon textures, meridians and points
Ask: the 10 questions: temperature, sweat, head and face, chest and abdomen, pain, urine and stools, thirst appetite and taste, sleep, gynecological, history
These are the distinguishing features of the four major patterns of lower abdominal pain.
Blood amassment in the lower burner
Lower abdomen hardness and pain which refuse pressure, inhibited urination, delirium and mania when severe, possible amenorrhea or scant bleeding, pulse that is deep, replete, or choppy
Base formula: Tao He Cheng Qi Tang
Damp heat in the bladder
Lower abdominal distention, fullness, and pain, short voiding of
dark colored urine, if severe, riding of bloody urine, pain and
burning on urination, dribbling urinary block hypertonicity in lower
abdomen, vexation, thirst, constipation, pulse that is slippery and
rapid
Base formula: Ba Zheng Tang
Lower burner vacuity cold
Dull pain in lower abdomen that gets better and worse episodically, a cold or icy feeling in the abdomen even in the summertime, pain liking warmth while disliking cold, cold body and limbs, long voiding of clear urine, dribbling urination, lassitude of the spirit, possible loose stools, seminal emission and impotence, a pulse that is deep and fine
Base formula: You Gui Wan
Liver depression qi stagnation
Lower abdomen distention, pain, and fullness with more distention than
pain, movable pain with no fixed location, erratic pain, distention pain and
fullness which get better with burping, defecation or flatulence, possible
poor appetite, possible nausea, borborygmus, inhibited defecation, a pulse
that is wiry
Base formula: Pai Qi Yin
Putting an individual case together is a little more complicated as people mostly do not fall into tidy discrete patterns. Here is an example which actually shows a deficiency cold along with blood stasis, so a mix of two of the major patterns.
In this case the tongue was normal. The pulses were thin and weak, complexion a little pale, thirst, digestion and sweat normal, urine inhibited, tight upper back and neck, mild menstrual cramps, runs cold- lower belly and butt are cold to the touch, with a little bit of water weight around the waist.
Putting all of these together her diagnosis was abdominal pain due to blood deficiency not nourishing the muscles leading to cramping pain. Here we want to pull the water from surrounding tissues into the blood to nourish and soften the muscles.
Dang gui shao yao san is the base formula to do this. From the book Jin Gui Yao Lue, 200 CE. This was a formula for pregnant women with low abdominal pain, it’s application has been expanded over the centuries.
Base formula:
9 grams dang gui
48 g bai shoo
12 g fu ling
12 g bai zhu
12 g ze xie
12 g chuan xiong
With the addition of gui zhi to address the cold.