SHEETS - Release Exterior - Interior Excess

8/7/2019 SHEETS - Release Exterior - Interior Excess

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CHAPTER SEVEN FORMULAS THAT RELEASE THE EXTERIOR INTERIOR EXCESS

and Purge the Interior and Clear the Interior

y Da Chi H Tng *** y GGn Hung Lin Tng ***

y Fng Fng Tng Shng Sn *

Chapter Seven

FORMULAS THAT RELEASE EXTERIOR-INTERIOR EXCESS

IN EXTERNALLY-CONTRACTED diseases there is often a stage where the pathogenic influence remains lodged inthe exterior even though it has already penetrated into the interior. Similar problems occur if a person with aninterior disorder contracts a new pathogen, which then obstructs the exterior. In each case, the patient will present witha combined exterior-interior disorder.

There are three basic treatment strategies for dealing with such problems: (1) resolve the exterior first and then treat theinterior, (2) dispel the pathogen from the interior first and then treat the exterior, or (3) simultaneously treat the interiorand exterior. The formulas in this chapter utilize the third approach. This is most appropriate when the pathogens in theexterior and interior are both relatively strong. In clinical practice, these are often relatively acute disorders where boththe exterior and interior require urgent attention. If the exterior is released without treating the interior, the conditionwill worsen; if the interior is treated without releasing the exterior, the pathogenic influences cannot be completelyeliminated from the body. A similar scenario applies where exterior excess is combined with interior deficiency, as

discussed in Chapter 1.

Although the core strategies used in the formulas discussed here-sweating, warming, cooling, and purging were alreadyknown to the authors of the Inner Classic, it was Zhang Zhong-Jing at the end of the Han dynasty who first composedspecific formulas to treat exterior-interior excess patterns: Major Bupleurum Decoction (da chai hu tang) for combined yangbrightness and lesser Yang disorders; Seven-Substance Decoction with Magnolia Bark (hou po qi wu tang) for combinedyang brightness and greater yang disorders; Kudzu, Scutellaria, and Copt is Decoction (ge gen huang qin huang lian tang) foryang brightness disorders with heat pathogens in both the exterior and interior; and Cinnamon Twig and GinsengDecoction (gui zhi ren shen tang) for cold in the interior complicated by wind-cold in the greater yang. These formulascontinue to be widely used today. They also became the models for all later formulas in this section.

Besides Zhang Zhong-Jing, the second most influential physician to focus on the joint treatment of internal and external

excess disorders was Liu Wan-Su, one of the four masters of the Jin-Yuan period (1115-1368). His clinical strategiesfocused on the elimination of fire from the body and he invented a method known as 'double releasing' ( shuang jie),exemplified by Saposhnikovia Powder that Sagely Unblocks (fang feng tong sheng san) and its variations. This method aimsat releasing wind-cold from the exterior by means of sweating, while simultaneously draining internal heat via the stooland urine.

In contemporary Chinese medicine, external disorders are generally divided into heat- and cold-type disorders, whileinterior disorders are divided into deficiency and excess as well as heat and cold disorders. Accordingly, formulas in thischapter can be divided according to whether heat or cold in the exterior combines with heat or cold excess in the interior

Accurate diagnosis is imperative for successful use of these formulas. The practitioner must identify which pathogenicinfluence is involved, its location (interior or exterior), and the extent of its development (level or warp) before the

appropriate formula can be selected and modified to match the precise pattern. Once a formula's composition and itsindication have been understood, however, its use can be expanded beyond its original indication to problems facingevery clinician in contemporary practice.


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Yang MingVs.

Interior Heat

Irritability, big fever, big thirst, big sweatRapid big and full pulse

LI, ST

ShaoYangVs.

Half Interior/Half Exterior

Alternating chills and fever, chest/flankdistention, bitter taste in mouth, no appetite,

irritability, urge to vomit, blurry vision; wiry

pulseTW, GB

Tai YangVs.

Exterior Cold

Fear of cold/wind, occipital headache, stiffneck, fever

Floating pulse

SI, BL

Tai YinVs.

Interior Cold

Full and distended abdomen, lack of thirst,vomiting, no appetite, great diarrhea and

occasional painDeep and slow pulse

LU, SP

Jue YinVs.

Anti-pathogenic Qi exhausted

Hospice patients Yin on verge of extinctionand Yang growing hot and cold

simultaneouslyPC, LV

Shao YinVs.

Hypo-functioning of HT/KI

FALSE COLD: Great desire to sleep, aversionto cold, cold limbs, no fever, listless, diarrhea,

absence of thirst, profuse clear urine, diarrhea;feeble, thready deep-fine pulse

FALSE HEAT: mental restlessness, fever,irritability, insomnia, dry mouth and throat,

scanty, dark or yellow urine; rapid and threadpulse

HT, KD

SECTION1

FORMULAS THAT RELEASE THE EXTERIOR AND PURGE THE INTERIOR

The formulas in this group are indicated for patterns characterized by the presence of an externally-contractedpathogen in the exterior while excess accumulation obstructs the interior. The term 'interior' here does not generally

refer to the organs as opposed to the channels, but more often to the bowels associated with the yang brightness asopposed to the greater and lesser yang warps, or the exterior of the yang brightness warp itself. This is because heatexcess in the interior is typically a manifestation of a yang brightness pattern.

The patterns treated by formulas in this section are characterized by fever and chills that are accompanied by abdominalfullness, constipation, and a red tongue with a yellow coating. Formulas that treat these disorders combine herbs thatrelease the exterior, such as Cinnamomi Ramulus (gui zhi), Ephedrae Herba (ma huang), Bupleuri Radix (chai hu), Menthaehaplocalycis Herba (bo he), Schizonepetae Herba (jing jie), and Saposhnikoviae Radix (fang feng), with herbs that purgeaccumulation from the interior, such as Rhei Radix et Rhizoma (da huang) and Natrii Sulfas (mang xiao).


and Purge the Interior

y Da Chi H Tng Major Bupleurum Decoction ***

y Fng Fng Tng Shng Sn Saposhnikovia Powder that Sagely Unblocks *


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***Da Chi H Tng(Major Bupleurum Decoction)

y Harmonize and release the lesser Yang (shaoYang)

y Drain internal clumping due to heat

NOTES

yThis formula is modified by two formulas which separately treat two stages of disorders. Xio Chi HTng, a harmonize formula) omitted ren Shen, Zh Gn Co) for shao Yang disorder. Da chen Qi Tng, adownward draining formula (omitted Hu P Mng Xio) for Yang Ming stage disorder

y This formula is often used for cholecystitis, cholelithiasis, acute pancreatitis, etc. with concurrent lesserYang and Yang brightness symptoms

Da Chi H Tng

VsHeat in Yang Ming and Shao Yang

Xio Chi H Tng

VsHeat in Shao Yang disorder

Da Chi H TngVs

Da cheng Qi TngVs

Yang Ming organ stage disorder

INGREDIENTS INDICATIONS CONTRAINDICATIONS

C Chi H ( : )

-

-

C D Hung ( : )

-

-

D Hung Qn ( : )

-

-

D Zh Sh ( : )

-

-

A Bi Sho (: )

-

-

A Bn Xi ( : )

-

-

E Shng Jing ( : )

-

-

E D Zo ( : )

-

-

yAlternating fever and chillsyFullness in the chest and hypochondria (with or without pain)yBitter taste in the mouthyNauseayContinuous vomitingyHard focal distention or fullness and pain in the epigastriumyBurning diarrhea or no bowel movementsyMelancholyySlight irritabilityyT: yellow TC

yP: wiry, forceful

y

HERBAL PAIRS MAIN PATHOLOGY PURPOSE

Chi H _ Hung Qn toZhSh + D Hung toBi Sho + D Hung toShng Jing + BnXi to

yThe pathogen constraining the lesser Yang warp and impeding its abilityto direct the clear upward and the turbid downward and causing thedisharmony between the Gallbladder and Stomach while heat excessaccumulating in the Yang Ming organ, Stomach and intestines where itinjures the fluids, dries the stool and forms clumps that obstruct thedownward flow of Qi

yConcurrent lesser Yang(shao Yang) and Yangbrightness (Yang Ming)organ-stage disorder


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*Fng Fng Tng Shng Sn(Saposhnikovia Powder that Sagely Unblocks)

y Disperse windy Release the exteriory Drain heaty Unblock the bowels

NOTES

yM Hung, fang feng and Jng Ji, a group of warm-acrid ingredients strongly induce sweatingto disperse wind, release the exterior. They can also help venting the internal heat throughsweating

y Please compare this formula with da qing long Tng p.11

y

y

y

Fng Fng Tng Shng SnVs

Da qing long TngVs


C Fng Fng ( : )

-

-

C M Hung ( : )

-

-

C Mng Xio ( : )

-

-

D Jng Ji ( : )

-

-

D B H ( : )

-

-

D ZhZi ( : )

-

-

D hua Shi ( : )

-

-

D Sh Go ( : )

-

-

D Ji Gng ( : )

-

-

D lain Qiao ( : )

-

-

D Hung Qn ( : )

-

-

A chuang xiong (: )

-

-

A Dng Gu ( : )

-

-

A Bi Sho ( : )

-

-

A Bi Zh ( : )

-

-

E Gn Co ( : )

-

-

yStrong fever and chillsyLight-headednessyDizzinessyRed and sore eyesyDifficulty in swallowingyNasal congestion with thick and sticky nasal discharge and salivayBitter taste in the mouthyDry mouthyFocal distention with a stifling sensation in the cheat and

diaphragmyConstipationyDark, rough urinationyT: yellow, greasy TCyP: flooding, rapid or wiry, slippery

y


yWind-Heat invading the exterior with pre-existing internalaccumulation of heat or Wind-Heat invasion that causes the heatto lodge simultaneously in both the exterior and interior. Thepathogens fetter the protective Qi and exterior, the heat constrainsinterior and accumulate in the upper, middle, and lower burners

yHeat excess in both theexterior and interiorpattern


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SECTION2

FORMULAS THAT RELEASE THE EXTERIOR AND CLEAR THE INTERIOR

The formulas in this section are indicated for patterns characterized by pathogens in the exterior with simultaneousblazing heat in the interior. Such patterns are characterized by chills and fever occurring together with irritability andrestlessness, thirst, dysenteric disorders due to heat, wheezing, and a rapid pulse. Because heat in the interior has not yetclumped, it is treated by clearing and draining rather than by purging. The formulas in this group thus combine herbs likeEphedrae Herba (ma huang), Sojae Semen preparatum (dan dou chi), and Puerariae Radix (ge gen) with Gypsum fibrosum (shi

gao), Coptidis Rhizoma (huang lian), or Scutellariae Radix (huang qin).


and Clear the Interior

y GGn Hung Lin Tng Major Bupleurum Decoction ***


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and Clear the Interior

***GGn Hung Lin Tng(Kudzu, Scutellaria, and Coptis Decoction)

y Release the exteriory Drain heat

NOTES

y Although this formula treats both the interior and exterior, its primary focus is on draininginterior heat

y This formula is often used in treat ing diarrhea or dysentery due to Damp-Heat accumulation withor without exterior symptoms

y The actions of the chief herb, G Gn, are: release the exterior, clear heat, reduce fever, stopdiarrhea by raising the clear Yang of the Spleen and Stomach

y

y

y

y


C G Gn ( : )-

-

-

-

D Hung Lin ( : )

-

-

-

-

A Hung Qn ( : )

-

-

-

-

E Zh Gn Co (: )

-

-

-

-

yFeverySweatingyThirstyDysenteric diarrhea characterized by especially

foul smelling stools and a burning sensationaround the anus

yA sensation of irritability and heat in the chestand epigastrium

yPossible wheezingyT: red with yellow TCyP: rapid

y


Hung Lin + Hung Qn to yHeat or Heat-Dampness accumulating in theinterior (Yang Ming organs) which disruptsthe clear Yang of the Spleen and Stomachraising upward and impacts the intestines totransform and reabsorb fluid while the mildpathogenic influence still lodges in the e xterior

y Diarrhea due to heat or Damp-Heat in theYang Ming organ (interior) withincompletely resolved exterior Wind-Heatcondition

SHEETS - Release Exterior - Interior Excess

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