It often is said that traditional Chinese medicine is easy to learn but hard to practice. Novice clinicians and students know this adage all too well, often encountering patients who never respond to by-the-book treatment protocols.
These approaches typically portray patients with single pattern disorders. This type of presentation, while helpful for learning TCM, does not effectively convey the complex multi-patterned presentation of the typical Western patient. In the next three articles, I will discuss ways to combine simple formulas to more accurately treat multi-pattern disorders. In this month's column, I will examine how to combine traditional formulas to address colds/flu or gan mao in ways that will expand the TCM clinician's repertoire beyond the typical Yin Qiao San prescriptions.
It is rare for a patient to arrive at a TCM clinic with the prodromal signs of a cold or flu. More often than not, the patient has attempted to self-medicate, with mixed results, prior to seeking the aid of the clinician. Patients also typically present with underlying patterns beyond just a "wind-cold or wind-heat" pattern. What if the patient also shows underlying signs of yin vacuity, phlegm heat in the lungs or gastro-intestinal symptoms besides chills, fever and sore throat? In these scenarios, administering Yin Qiao San as a stand-alone formula will not work.
The following combinations can be very helpful to have on hand in such situations:
Wind-heat with lung yin vacuity: Gan Mao Ling + Qing Zao Jiu Fei Tang or Sha Shen Mai Dong Wan. (According to TCM, the lung is a "tender" organ that can easily be irritated by the drying effects of interior heating in the winter season, which can dry the yin fluids.)
Wind-heat with qi vacuity: Gan Mao Ling with Gui Zhi Tang or Ren Shen Bai Du San
Wind-heat with phlegm heat in lungs: Sang Ju Wan/Gan Mao Ling with Qing Qi Hua Tan Wan
Wind-heat with excess heat in the lungs: Gan Mao Ling with Yang Yin Qing Fei Pian
Wind-heat with severe sore throat: Yin Qiao San with Pu Ji Xiao Du Wan or Zhong Gan Ling
Wind-heat with nausea and diarrhea: Gan Mao Ling with Huo Xiang Zheng Qi Wan
Wind-heat with severe headaches/body aches: Gan Mao Ling with Chuan Xiong Cha Tiao Pian or Chai Ge Jie Ji Wan
Wind-heat with excess internal heat: Zhong Gan Ling with Fang Feng Tong Sheng Wan
These are just some very basic examples using very traditional formulas. I chose to focus exclusively on wind-heat instead of wind-cold, as most patients self-medicate at the initial stages. The patterns can quickly transform to wind-heat patterns if not treated effectively in the prodromal stages. The clinician must remember that the above combinations must also be modified, based upon the patient's unique constitution or symptoms.
This being said, I do feel that the above combinations can be very effective if administered at the right time and with the right dosage, coupled with bed rest and proper diet. I hope this short article stimulates the reader to create their own formula combinations to treat multi-patterned gan mao presentations. In my next article, I will address simple formula combinations for common gynecological complaints.
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