On the Road to Recovery

As we slowly re-open our clinics, there are a few reasons to feel optimistic while still being cautious and very careful. Whether patients have had the virus or not, bodies, hearts and minds have certainly been stressed more than normal times. In the office, we may see patients that are recovering from milder illnesses as well as new pathologies and possibly aggravations of underlying constitutional conditions. With this in mind, I'd like to share my thoughts on some straightforward prepared herbal formulas to address a variety of clinical pictures you may encounter in the weeks and months ahead.

The Zang organs are the storehouses of Qi, Blood, Yin, Yang and Essence. These organs directly support the Fu organs, as well as all body tissues. Whether an external pathogen has attacked a specific organ or not, even a generalized immune response can impact the body's vitality. Likewise, during times of significant emotional or psychological stress, these organs can be weakened. What follows is a simple guide to helpful formulas for restoring vitality to the Lung, Spleen, Liver, Heart and Kidney.

The Lung

The Lung is called "The Tender Organ" in TCM because it is in continuous contact with the environment via the respiratory process and is the first organ to be attacked by external pathogenic factors. Via its role in regulating the exterior, the Lung is the body's first line of defense against pathogenic influences. For example, during the recovery phase from a Lung invasion we want to first determine the type and quantity of phlegm, fluid or Yin damage, lingering presence of an external pathogen, severity of symptoms, and how significant the deficiency of Qi and Yin/fluids is. These factors guide our selection of the appropriate herbal prescription.

Qi Guan Yan Wan

This prescription is ideal for descending the Lung Qi, mild to moderate lingering phlegm, and fluid and Qi deficiency following acute Phlegm Heat in the Lung. Pi pa ye, Sang ye, Chuan bei mu, Xing ren and Sang bai pi very effectively cool and moisten the Lung and descends the Lung Qi, while Qian hu, Yuan zhi, Ju hong and Chuan bei mu eliminate phlegm. Dang shen and Da zao gently tonify the Qi, while Wu wei zi consolidates the Lung Qi. Combine this formula with Chuan Xin Lian tablets when lingering external toxic heat is still present.

Ping Chuan Wan

This formula descends the Lung Qi and restores normal breathing from Lung and Kidney Qi deficiency and is ideally suited for addressing the final stages of recovery from acute respiratory disorders or for chronic failure to descend the Lung Qi in patients with this underlying picture. Dang shen, Dong chong xia cao, and Ge jie strongly tonify the Lung and Kidney qi, while Xing ren, Sang bai pi, Wu zhi mao tao, Man hu tui zi, Chen pi, and Bai qian descend the Lung Qi, restore normal breathing, and regulate Lung mucous. Ping Chuan Wan is best used when an external pathogen is no longer present.

Bai He Gu Jin Wan

This prescription is best suited for Lung and Kidney Yin deficiency with a lingering failure to descend the Lung Qi with dryness. If the condition is severe, other symptoms may include dry throat, skin, and mucous membranes, dry stool, night sweats, five centers heat and mild temperature spikes. Shu di huang, Sheng di huang, Mai men dong, and Bai he all nourish the Lung and Kidney yin and fluids. Chuan bei mu, Jie geng and Gan cao descend the Lung Qi and restore normal breathing. Finally, Dang gui and Bai shao nourish Liver blood to relax the diaphragm and strengthen Kidney essence. This formula should not be used when an external pathogen is present.

The Spleen

The Spleen rules digestion and absorption, as well as the generation of Qi, Blood, Essence, and the Upright Qi. According to Li Dong Yuan, it is the pre-eminent Zang organ as all post-natal life depends on its proper functioning. According to Li, "The Original Qi is always abundant as long as it is nourished by a Spleen and Stomach free of damage." Both acute and chronic illness places greater demands on the Spleen's role in supporting both the Lung Qi and Upright Qi. During the recovery phase from an illness, the health of the Spleen should be evaluated and addressed. The patient's available energy, mental clarity, facial color, digestion and tongue/pulse picture are all essential in evaluating Spleen health.

Er Chen Wan

This is a very simple and useful prescription to address excess phlegm distressing the Spleen, or to assist with the Spleen's role in regulating Damp and Phlegm in the Lung. The warm, drying Ban xia and Chen pi make up 60% of the formula and is a powerful classic herb pair for resolving phlegm in the Lung or Spleen. Fu ling assists in eliminating phlegm, as well as removing dampness and strengthening the Spleen. Sheng jiang warms and dries the Spleen, enlivens the appetite and descends the Lung and Stomach Qi, and Gan cao gently tonifies Lung and Spleen Qi while also harmonizing the prescription. Er Chen Wan is Ideal for supporting the Spleen in eliminating excess lingering Damp Phlegm in the Lung.

Xiang Sha Liu Jun Zi Wan

An important modification of Si Jun Zi Tang, the Four Gentlemen Decoction, this formula tonifies the Spleen Qi and benefits digestion, while also eliminating both Dampness and Phlegm in the Spleen and Lung. Ren shen, Bai zhu, Fu ling and Gan cao tonify Spleen Qi and digestive function. Ban xia and Chen pi resolve lingering Phlegm, while Mu xiang and Sha ren effectively dry dampness in the Spleen and Large Intestine. Sheng jiang and Da zao benefit the Spleen and harmonize the interior and exterior. Ideal for Spleen Qi deficiency, poor digestion with soft or loose stools, and lingering Damp Phlegm in the Spleen and Lung.

Shen Qi Da Bu Wan

This simple formula is ideal when straightforward tonification of the Spleen and Lung Qi is required. Dang shen and Huang qi very powerfully tonify the Spleen and Lung Qi and support the Wei Qi. Shen Qi Da Bu Wan is ideal for low energy, difficulty in achieving normal breath, impaired breathing, spontaneous perspiration, poor appetite, reduced Wei Qi, and to assist in the recovery phase of a prolonged illness due to an external pathogen.

Heart and Liver

The Heart and Liver are grouped together because they both depend on Yin and Blood for healthy functioning, and they share regulation of psychological and emotional experience. Also, due to their association with the Yin and Blood, they lie deeper in the body than those organs associated with the Qi. As a result of this, they are less likely to be directly damaged by external pathogens. At present, damage to these organs is most likely the result of emotional and psychological pressure related to social circumstances.

Xiao Yao Wan

This frequently used formula nourishes the Blood, frees the Liver from constraint and regulates Qi. It is ideal for those patients with a constitutional tendency for Liver blood deficiency, Spleen Qi deficiency and subsequent Liver Qi stagnation. Chai hu and Bo he free Liver Qi stagnation and release constrained emotions. Dang gui and Bai shao nourish the Blood and pacify the Liver, while Bai zhu, Fu ling and Sheng jiang harmonize and benefit the Spleen. Gan cao harmonizes the prescription. This formula is suitable for those patients with the above underlying deficiencies being aggravated due to current social or situational stress.

Xiao Chai Hu Wan

Zhang Zhong Jing's famous harmonizing formula stands out as an important treatment for addressing external pathogenic toxins entering the Shao Yang. Symptoms include alternating anxiety and depression, flushing and chills, fatigue and agitation, discomfort in the hypochondrium, rib and chest tightness, loss of appetite, loss of balance, and a general feeling of being ill at ease. Chai hu and Huang qin clear pathogenic toxic heat from the Shao Yang while freeing local channel constraint, while Ban xia and Sheng jiang transform phlegm and direct rebellious Qi downward. Dang shen, Da zao and Gan cao tonify the Qi and assist the Lung in consolidating the exterior. Xiao Chai Hu Tang is also able to treat disharmony between Liver and Stomach, and can ease irritability, anger, frustration and resentment from purely emotional causes as well.

Bai Zi Yang Xin Wan

This frequently overlooked herbal formula is a true treasure for the treatment of Heart Yin and Blood deficiency leading to unsettled Shen. It addresses dream disturbed sleep, nightmares, agitation, anxiety, disorientation, poor concentration and memory, as well as post febrile anxiety and general difficulties in achieving normal sleep. Bai zi ren strongly nourishes the Heart and calms the Spirit. Gou qi zi, Shu di huang, Mai men dong, and Dang gui nourish Heart and Liver Blood, as well as Kidney Yin. Fu ling benefits the Spleen and moves fluids, Xuan shen cools the Blood, and Shi chang pu opens the orifices and quiets the spirit. It is Ideally suited for the above symptoms due to Heart and Liver Blood deficiency coupled with exogenous situational stress and fear.

The Kidneys

The Kidneys are the storehouse of Yin, Yang and Essence, and the origin of the Upright Qi. During times of extraordinary emotional or physical stress, or persistent febrile disease, the Kidneys support the functions of the other organs via transfer of primal Yin and Yang to them. As a result, the Kidneys can become depleted and associated symptoms will arise.

Liu Wei Di Huang Wan

Originally included in Craft of Medicinal Treatment for Childhood Disease Patterns, this iconic formula nourishes the Yin of the Spleen, Liver and Kidney. Ideal for treating Yin deficiency/consumption, this formula restores the deep substantive reserves of the Yin organs due to either long standing or severe acute illness. The formula treats spontaneous sweating, night sweats, five centers heat, fluid depletion, restlessness, loss of balance and disorientation, low back weakness, and in severe cases, weight loss. Shu di huang and Ze xie nourish the Kidney Yin and fluids, Shan zhu yu and Mu dan pi tonify and clear the Liver, while Shan yao and Fu ling strengthen Spleen Qi and digestive function.

Zhi Bai Di Huang Wan

As a modification of Liu Wei Di Huang Tang and first listed in Investigations of Medicinal Formulas in 1584, this formula addresses Yin deficiency with more severe Yin deficiency Fire. The addition of the sweet, bitter and cold Zhi mu and Huang bai strengthens the prescription's ability to clear deficiency heat. Zhi Bai Di Huang Tang is best suited for patients where deficiency heat symptoms are pronounced and persistent. This formula can also be used in patients with persistent Yin deficiency heat signs to assist in the recovery of their health.

Jin Gui Shen Qi Wan

As another modification of Liu Wei Di Huang Tang, Jin Gui Shen Qi Wan focuses on more significant depletion of the Kidney Yang. The inclusion of Fu zi and Rou gui warm the Yang of the Kidney and Heart, warm the interior and greatly enhance circulation of Qi and Blood. The cardinal symptoms of this condition are those of coldness and a scattering of the Yang including reduced circulation, cold intolerance, coldness in the abdomen, nocturia, urinary incontinence, lower extremity dampness, listlessness, and deep fatigue. This formula is suitable for patients suffering constitutional Yang deficiency that is either initiated or aggravated by a recent febrile illness.

Final Thoughts

In a recent study, researchers in Italy who were tracking discharged coronavirus patients found that nearly 90% of 143 patients still had symptoms two months after becoming ill. Nearly half reported a lower quality of life in comparison to how they felt before becoming sick. The top five symptoms reported in order of severity were: fatigue, shortness of breath, joint pain, chest pain and cough. Initially, all of these patients required hospitalization. From the perspective of pattern differentiation in TCM, the above symptoms fall into clinical pictures discussed above. Both acupuncture and traditional Chinese herbal medicine can be effective in treating these patterns, offering a unique opportunity for TCM practitioners to play a role in helping our patients to recover their vibrant health during these challenging times.

References

• Bensky, D. & Barolet, R., Formulas & Strategies, Eastland Press: 1990.
• Bensky, D. et al., Chinese Herbal Medicine Materia Medica, 3rd ed., Eastland Press: 2004.
• Chen, J. & Chen, T., Chinese Herbal Formulas and Applications, Art of Medicine Press: 2009.
• Chen, J. & Chen, T., Chinese Medical Herbology and Pharmacology, Art of Medicine Press: 2004.
• Maclean, Will, Clinical Manual of Chinese Herbal Patent Medicines, Pangolin Press: 2003
• Wrinkle, A. et al., A Practitioner’s Formula Guide, Elemental Essentials Press: 2008.
• www.jamanetwork.com