Herb Grove Members Zone

The Members Zone is where we post useful Chinese Medicine content and is only accessible for practitioners with a Herb Grove account. We’ll be posting webinar recordings, herbal formulas, case studies, stories and useful tidbits with a focus on content that can be applied in your clinic! There’s plenty of great material here already including a webinar on Ye Tian Shi from May 2020, and a formula for infertility with scanty periods. So make sure you check it out!

Menopause: Hot Flushes with Pale Tongue

By Steve Clavey
(Posted 18th June, 2021)


(This is a photo of the prescription dispensed for this patient 1/6/21)

The Case

It is always nice when a “menopause” case comes in with a red tongue with little coat and a thready rapid pulse. You just tonify yin, right?

But most of the time it is not that easy. Take this case, the other day: 55 years old, menopause symptoms for the last year, hot flushes 10-20 times per day with most heat in the upper body. She would wake up feeling hot and cold at 1:00 AM and could not return to sleep. Her affect was one of suspicion toward me. “I used to be irritable”, she said. She liked to fast for long periods, and often. “It empowers me.”
She had a foggy head, red eyes which felt tired and heavy with all day computer work, and mild vaginal dryness. Energy-wise, it was the eyes which bothered her the most.

One differentiation to focus my treatment is to ask: “What is worse, the heat or the sweating?” Often it is not the heat itself, but the sweating that bothers them. In that case you can focus on sweating with herbs such as Fu Xiao Mai (Tritici Fructus levis), Ma Huang Gen (Ephedrae Radix), Nuo Dao Gen (Oryzae glutinosae Radix), Shan Zhu Yu (Corni Fructus), Sheng Huang Qi (unprepared Astragali Radix) and so on.

In this case, though, she did not sweat very much.

Another question I like to ask is whether, even though they are not getting periods, whether they notice a cycle of symptoms, as if they were still having a menstrual cycle. If this is very obvious, I’ll often start off with a formula such as Jia Wei Xiao Yao San (Augmented Rambling Powder), and it usually help a lot.

This patient thought it was possible, but was not sure. She had tried HRT but it had just led to headaches. She liked wine, and her last question to me was: “Should I take my herbs before or after my coffee?”

Shudder.

The real kicker though was her tongue and pulse. Her tongue was pale, almost white, while the pulse was languid and soft (濡 rú meaning only felt faintly at the surface) except at the chi position (proximal), where it was slippery and strong.

So what to do?

Liver is key here, with the waking hot and cold, the eyes being sore, and the irritable suspicion. The distinct difference between the strong lower body pulse and the soft weak upper body pulse shows lack of pivotal communication.

So I decided to base the treatment on Xiao Chai Hu Tang (Minor Bupleurum Decoction):

Chai Hu 15g Bupleurum
Gu Jing Cao 10g Eriocauli Flos
Dang Shen 15g Codonopsis
Mi Meng Hua 10g Buddlejae Flos
Huang Qin 12g Scutellaria
He Huan Pi 15g Albizzia
Ban Xia 12g Pinellia
Gou Qi Zi 12g Lyciii Fructus
Ju Hua 10g Chrysanthemi Flos
Chao Gan Cao 3g dry-fried Glycyrrhizae Radix
Mu Li one spoon (granules) Ostreae Concha

At the next appointment she was audibly happier (a phone consult). She had enjoyed the taste, and even better, her sleep was improved and she was feeling good all over. She’d had no hot flushes.
BUT, she said, she wasn’t sure whether it was the herbs, or the new diet she had started about a week before starting the herbs. “I know you said not to change anything,” she said, “but I’d already started the diet.”

There is an easy way to tell which was doing the trick, I told her.
“What’s that?”
“Stop the herbs and find out.”

Formula for Premenstrual Migraines

By Steve Clavey
(Posted 21st of May, 2021)


(This is a photo of the prescription dispensed for this patient 13/5/21)

This patient, in her mid-thirties, is a clinical psychologist with premenstrual migraines.

Intro
Migraines (which I define as severe headaches with nausea and/or vomiting) are often multi-faceted, and especially so if long-term. I tell patients that one needs to unravel the knotted threads that make up their particular tangle of pathology. The following case is an excellent example of this.

If patients vomit, one key migraine type differentiation is whether the patient vomits bile, or whether it is some other liquid.
My go-to formula (listed immediately below) is for migraines with pain behind the eyes and vomiting of bile:
Shi Jue Ming 15g
Ju Hua 10g
Jue Ming Zi 15g
Niu Xi 10g
Man Jing Zi 10g
Chuan Xiong 10g
Chao Zhi Zi 10g
Gan Cao 3g
Mu Dan Pi 10g

If patient vomits thick liquid or phlegm instead of bile, I will base the formula on Ban Xia Bai Zhu Tian Ma Tang (Pinellia, White Atractylodes and Gastrodia Decoction).

This patient
This patient did not vomit. The migraines occurred just before and during the periods, and would last three to four days. Her headache was generalised involving first the back of the head, then the whole head, especially around the eyes (instead of behind the eyes): ie it involved more the sinus area.
The migraine was worse at midday. They have been worsening over the last two years.
She reported “fuzzy brain,” lack of concentration, and being very emotional, nightsweats and photophobia. Another contributing factor was her very tight shoulders and neck.
Periods were early 5/23-24, light to moderate flow with clots and tissue
She had a greasy yellow tongue coat, and the front of the tongue was red on the tip and edges; her pulse was slippery and rapid.
Complicating matters to some extent is the fact that the patient is allergic to shellfish. While that applies to the flesh, and not necessarily the shells such as abalone shell or oyster shell, it is better to be cautious unless nothing else is working.

This is phlegm-fire with Liver qi constraint: that’s the branch. We will need to end up by supporting Liver blood and Kidney yin. That is the root.

Symptom explanation
A few comments on the less obvious symptoms:
Worse at midday? Midday is when the element Fire is at its peak.

Around the sinus? When the sinus is somewhat stuffed with phlegm, it will get worse before the period when generalised fluid retention makes everything swell up, including the sinus. The sinus pressure is just one more factor increasing the discomfort.

Early periods? Liver heat (in this case). Also the relative lightness shows Liver blood deficiency (confirmed by the photophobia), and the clots and tissue show qi and blood stasis.

Formula of the week
Below is the initial formula, dealing primarily with the branch symptoms. We have to stop the migraines worsening and then roll them back before we can spare the time to address the root.

Prescription:
Tian Ma 12g
He Huan Pi 15g
Ban Xia 12g
Pian Jiang Huang 12g
Huang Qin 12g
Man Jing Zi 12g
Bai Zhu 12g
Mei Gui Hua 8g
Yu Jin 8g
Dan Nan Xing 6g
Chen Pi 6g
Chao Gan Cao 3g
Fu Ling 20g
Shi Chang Pu 6g

Number of Bags: 8 bags
Instructions: 100 mls AM 130 mls PM
If the migraine is severe, take Ban Xia Bai Zhu Tian Ma Pills: 10 pills AM & PM, as well as the herbs. You can also take the pills if you go away or otherwise are not taking the herbs.

Formula explanation
The basis is Ban Xia Bai Zhu Tian Ma Tang (Pinellia, White Atractylodes and Gastrodia Decoction).
As for the additional herbs, He Huan Pi calms the spirit and frees Liver qi constraint. Pian Jiang Huang (Curcumae longae Rhizoma) relaxes the tense shoulders and neck, while removing blood stasis. Huang Qin cools Liver fire. Man Jing Zi cools heat, helps eye pain and is specific for headaches of all types. Mei Gui Hua and Yu Jin are an excellent herbal pair that combine to free Liver qi constraint. Dan Nan Xing (Bile-prepared Arisaema) cuts phlegm and extinguishes Liver wind. Shi Chang Pu (Acori tatarinowii Rhizoma) cuts phelgm and clears the mind.

Two comments:
a) Liver qi constraint is different to Liver qi blockage. The latter is “physical” involving body symptoms such as bloating or breast distention. Liver qi constraint is more “emotional”. Both are obstructions of qi, but the level of qi is a bit different. Qi constraint is a fine level of ethereal qi, qi blockage is a coarser level of substantial qi.
The differentiation is important for both herb choice and herb dosage: qi blockage needs bigger doses of qi moving herbs, eg Xiang Fu 12-15g, Mu Xiang 12g or He Huan Pi (ie the bark of Albizzia) 15g. Qi constraint needs smaller doses of light fragrant herbs, eg Mei Gui Hua or He Huan Hua (ie the flower of Albizzia), or even Xiang Fu but at a lighter dose, eg 8-10g.

b) It may be obvious, but sometimes it bears repeating that “releasing or expelling wind” and “extinguishing wind” are different things. The latter refers to internal wind, the type that causes twitching, dizziness or vertigo, and is treated with wind-extinguishing herbs such as Tian Ma, Dan Nan Xing () or Quan Xie (Scorpio). External wind needs releasing or expelling through the surface with herbs such as Ma Huang, Zi Su Ye, Fang Feng or Bai Zhi.
In this patient’s case the wind involved is not external, but internal due to Liver heat rising prior to periods, and complicated with phlegm being carried upward by the fire. That is why Tian Ma and Dan Nan Xing are so appropriate. I was tempted to add Quan Xie (Scorpio) which is usually fantastic for many types of migraines but I kept that particular arrow in my quiver for the future if needed. For those who wonder, Quan Xie is not particularly bad tasting (in the context of all the other herbs).

Tips for Treating Hay Fever with Raw Herbs

By Steve Clavey
(Posted 11th of November, 2020)

When treating hay fever, don’t forget the role of the Liver. Hay fever is a seasonal disorder, which means we need to consider seasonal energetics. In springtime, Liver Wood grows and ascends. Lung Metal energy should descend, but at this time it is (or can be) overwhelmed by the rising Liver Wood, and this gives rise to sneezing and runny nose, both signs of Lung qi not descending properly.

Itchy red eyes are related to Liver, in this case external wind-heat (the rising qi of springtime in excess) inciting internal movement and ascent of Liver qi, its sister energy.

To restore a normal pivot function and to balance Liver qi ascent with Lung qi descent, I base my hayfever treatments on Xiao Chai Hu Tang (Minor Bupleurum Decoction) with additions such as Fang Feng  (Saposhnikovia), Jing Jie (Schizonepeta) and a small dose of Wu Wei Zi (Schisandra, “small” being 2-3g).

If the nose is the main problem, I’ll then add Cang Er Zi (Xanthium) and Bai Zhi (Angelica dahurica).

If the eyes are the main problem, I’ll add Sang Ye (Morus folium) at around 6g, Ju Hua (Chrysanthemum) 6g and Man Jing Zi (Vitex fruit) at around 10g.

A typical prescription would look something like this:

Chai Hu 12g

Huang Qin 10g

Ban Xia 10g

Dang Shen 10g

Gan Cao 3g

Fang Feng 8g

Jing Jie 5g

Cang Er Zi 8g

Bai Zhi 6g

Small doses and short boiling time (eg 15 minutes and only boiled twice) help to guide the herbs toward the head.

If the nose is very blocked, you can have them boil and inhale fragrant herbs such as Huo Xiang (Pogostemonis) 6g, Bai Zhi (Angelica dahurica) 6g and Bo He (mint) 6g.

 

The Herb Grove Presents: Steven Clavey Uses Ye Tian-Shi’s Formulas.

(Posted 24th of August, 2020)

This is a recording of a webinar that was presented to Herb Grove Members on the 24th of May 2020.

This webinar (designed for practitioners who prescribe decoctions) presents a novel way of gleaning new approaches to old problems based on the case histories of Ye Tian-Shi and their utilisation in a modern day clinic. It is fast paced and full of formulas and useful clinical knowledge.

You can download the handout that was provided with this webinar here.

A Tale of Allergic Asthma

By Steve Clavey
(Posted 4th of August 2020)

This is a story about allergic asthma and Zhi Zi Chi Tang told by Professor Hao Wanshan that is both entertaining and clinically illuminating. You can access the story here.

Formula for Recurrent Miscarriage

By Steve Clavey

(Posted 11th of March 2020)

Da An Tai Yin (Major Calm the Fetus Decoction)

Ren Shen  1.5g (Ginseng, Radix)

Shou Di    3g (Rehmanniae glutinosae)

Sang Ji Sheng    3g (Loranthi seu Visci, Ramus)

Chao Bai Zhu     3g (Atractylodis macrocephalae)

Chao Dang Gui    6g (Angelicae sinensis, dry fried)

Chao Bai Shao   3g (Paeoniae Radix alba, dry-fried)

Chao Chuan Duan   3g (Dipsaci, Radix, salt-fried)

Chao Huang Qin   3g (Scutellariae Radix, wine-fried)

Wei Chuan Xiong   3g (Chuanxiong Rhizoma, baked)

Sha Ren    3g (Amomi, Semen, remove husks)

Jing Jie  1.5g (Schizonepetae Herba)

Chao Gan Cao 1.5g (Glycyrrhizae Radix, dry fried)

If there is difficulty breathing due to qi blockage, add:

Zi Su Geng 3g (Perillae Ramulus)

All the herbs from this formula are available through the Herb Grove shop page.

Formula for Infertility with Scanty Periods

By Steve Clavey
(Posted 3rd of March 2020)

“This Formula is based on the traditional Song Family Gynaecology formula for infertility with scanty periods. The Mai Men Dong works well to increase the amount of menstrual blood, and the strong support for the middle jiao is coupled with the kidney tonification provided by Tu Su Zi and Gou Qi Zi. The Mei Gui Hua was not in the traditional formula but has been added to lift the patients spirits – infertility can be a depressing time so this is often important” Steve Clavey

Chao Dang Shen 12

Mai Ya 12

Chao Bai Zhu 12

Chen Pi 6

Tu Su Zi 10

Fu Ling 12

Mai Men Dong 15

Dang Gui 6

Gou Qi Zi 12

Mei Gui Hua 6

Chao Gan Cao 3

All the herbs from this formula are available through the Herb Grove shop page.