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0Prof. ZHANG Zhi-jun's Experience in the Combined Treatment with Acupuncture and Chinese Herbs — A Report of 3 Illustrative Cases
ZHANG Li-ling \ ZHANG Gang 2 & ZHANG Li-ping 3
1The PLA 454 Hospital, Nanjing 210002, Jiangsu, China
2The Second Affiliated Hospital of Jiangxi Medical College, Jiangxi, China
3The Red Cross Hospital of Jiangxi Province, Jiangxi, China
Prof. ZHANG is one of the supervisors for the successive work on the academic experiences of the national veteran TCM experts. He has been engaging in the TCM field for more than 50 years. In clinical practice, he always pays great attention to the combined treatment of acupuncture with herbs so to raise the therapeutic effect. The following is the sample cases to show his experience in this aspect.
1. Palpitation (arrhythmia due to coronary heart disease)
A female patient, 55 years old, came for the first visit on August 15, 2001 with the chief complaint of palpitation, chest distress, shortness of breath, and distending pain in the chest and hypochondrium for more than half a year. Before the attack, the patient would feel qi going upward from the chest, making discomfort in the throat, which became worse on exertion. She often had dizziness, lassitude, sighing frequently, forgetfulness, vexation at the night, and leukorrhagia. Examination at the moment showed that she had pale-red tongue with teeth marks on the border and thin coating, and irregularly rapid pulse (premature beat 12 times/min.). The ECG suggested depressed S-T segment, and frequent atrial premature beats. Syndrome differentiation: stagnation and adverse flow of the liver-qi, and deficiency of both the heart and spleen. Treating principle: soothing the liver and lowering down the adverse flow of qi, and regulating and tonifying the heart and spleen. Herbal prescription: Cu Chai Hu (If^iH stir-baked Radix Bupleuri with vinegar) 10g, Zhi Qiao Fructus Aurantii) 12g, Bai Shao (S^ Radix Paeoniae Alba)
15g, Zhi Gan Cao (^^^ Radix Glycyrrhizae Preparata) 6g, Qing Pi (Pericarpium Citri Reticulatae Viride) 10g, Chuan Lian Zi ( Fructus Toosendan) 10g, Gan Song (^fö Radix et Rhizoma Nardostachyos) 12g, Huang Qi Radix Astragali) 10g, Bai Zhu Rhizoma Atractylodis Macrocephalae) 10g, Shu Di Huang (^ÄÄ Radix Rehmanniae Preparata) 10g, Dang Gui Radix Angelicae Sinensis) 10g, Ku Shen (Radix Sophorae Flavescentis) 10g, Zi Shi Ying Fluoritum) 15g (decocted first), Huai Xiao Mai (^'h M wheat from Henan of China) 20g, Suan Zao Ren Semen Ziziphi Spinosae) 10g, and Fu Shen (^tt Poria cum Radix Pini) 12g. Decoction, oral taking, 5 doses, one dose daily.
Acupuncture: New Ximen (the tender spot 2 cun above Neiguan (PC 6)), Neiguan (PC 6), Taichong (LR 3), Anmian (Extra). The treatment was given every other day, with needles retained for 20 minutes each time.
Five days later the patient came for a returned visit. Her palpitation, chest distress and shortness of breath were greatly alleviated. The distending pain in her chest and hypochondrium and dizziness disappeared. Her sleep was improved, and no atrial premature beat was found within 1 minutes. The modified above herbal and acupuncture prescriptions were kept on using for more than one month. Afterwards, all her symptoms disappeared. No premature beat was found and the S-T segment depression was shown improved by ECG.
Comment: This is the case of arrhythmia due to coronary heart disease. According to TCM, the heart dominates the blood vessels of the whole body, and the liver regulates the constant movement of qi in ascending, descending, exiting and entering. When the liver's function in keeping unrestrained free flow of qi is normal, the qi and blood circulation in the body can be ensured regular. Whereas, depressed liver-qi would lead to derangement of qi activities and disorder of blood flow, which may attack the spleen and stomach. The spleen is the source of production of qi and blood, and the foundation of acquired constitution. Deficiency of the spleen can cause insufficient formation of qi and blood. The deficient blood would fail to nourish the heart, making failure of the heart-mind to be nourished, and resulting in the symptoms of deficiency of both the heart and spleen. Therefore, the modified Sini San Counterflow-relieving Powder) for soothing the liver and activating the flow of qi and the modified Guipi Tang ( J/3 ^ Decoction for Invigorating the Spleen and Nourishing the Heart) for tonifying the heart are used for the patient. In the acupuncture treatment, Neiguan (PC 6) is used for arrhythmia; New Ximen (the tender point 2 cun above Neiguan (PC6)) is an experienced point found by Prof. ZHANG for chest distress and pain; Taichong (LR 3) is used for purging pathogenic fire in the liver and lowering down the adverse flow of qi, and Anmian (Extra) is a commonly-used extra point for treating insomnia.
2. Tremor syndrome (Chorea)
A male patient, a 10-year old boy, paid his first visit on August 24, 2002. In the recent 2 years the patient often had involuntary nod of his head, accompanied with wink and twitching of the scalp, which would stop when sleep. The child had an edgy temper, inability to concentrate his mind, dizziness and vertigo, and dry and bitter taste in the mouth. The examination at the moment found that the child was quick in manner and speech. The tongue was tenderly red with little coating, and the pulse was wiry-thready and slightly rapid. Syndrome differentiation: internal stirring of liver wind, and failure of the brain to be
nourished. Principle of treatment: calming down the liver to extinguish the wind, and nourishing the brain. Herbal prescription: Gou Teng (Ramulus Uncariae cum Uncis) 8g (to be decocted later), Sheng Long Gu Os Draconis) 10g (to be decocted
first), Sheng Mu Li Concha Ostreae) 10g (to
be decocted first), Bai Ji Li (Fructus Tribuli) 8g, Jiang Can (MS Bombyx Batryticatus) 8g, Zhi Quan Xie Scorpio Preparata) 2g, one Wu
Gong Scolopendra), Lu Xian Cao (M'ffi^
Herba Pyrolae) 8g, Gui Jia Carapax et Plastrum Testudinis) 10g (to be decocted first), Dang Gui (^ Jl3 Radix Angelicae Sinensis) 8g, Bai Shao (S^ Radix Paeoniae Alba) 8g, and Shu Di Huang Radix Rehmanniae Preparata) 8g. Seven doses.
Acupuncture: Touwei (ST 8), Yintang (EX-HN3), Fengchi (GB 20), Hegu (LI 4), Taichong (LR 3). Except for Taichong (LR 3) which was needled with reducing method, the rest points were needled with uniform reinforcing-reducing method. The treatment was given once every other day, with the needles retained for 30 minutes each time.
On his returned visit 7 days later, the child's involuntary nodding and twitching in the scalp were obviously decreased, and the edgy temper and abstraction of mind were all alleviated. Then the modified herbal and acupuncture prescriptions were kept using for more than 3 weeks. The involuntary nod accompanied with wink and twitching in the scalp disappeared, and the other symptoms were basically eliminated.
Comment: It is stated in Volume 11 of Compendium of Medicine that Cchan means shaking;
while zhen means movement'. Chorea falls into the category of tremor. The liver is a wind organ dominating relaxation and contraction of tendons. Chorea is a disease of the cerebral system, manifested by shanking of the head or trembling of the four limbs due to internal stirring of liver wind, and failure of the brain marrow to be nourished. Prof. ZHANG thinks that this disease is caused by fire resulting from disorders of emotions. According to the TCM theory, the liver stores blood and soul, and
dominates free flow of qi, which plays a very important role in regulating the volume of blood flow in the brain and regulating the emotions. Therefore, for this patient the treating principle of calming down the liver to extinguish the wind, and nourishing the brain marrow is adopted. Sheng Long Gu Os
Draconis) and Sheng Mu Li Concha Ostreae)
are used for tranquilizing the liver-wind and suppressing the hyperactive yang; Quan Xie Scorpio Preparata), Wu Gong (^te Scolopendra), Jiang Can (MS Bombyx Batryticatus), Sang Zhi (# ft Ramulus Mori), and Gou Teng Ramulus
Uncariae cum Uncis) are used for calming down the pathogenic wind and dredging the collaterals. The brain is considered as the sea of marrow, the marrow is produced from essence, and essence and blood are of the same source. Therefore, Gui Jia Carapax et Plastrum Testudinis), Shu Di Huang Radix
Rehmanniae Preparata), Bai Shao ( S ^ Radix Paeoniae Alba), and Dang Gui Radix Angelicae Sinensis) are used for nourishing the kidney, blood and marrow; and Lu Xian Cao (Mffi^ Herba Pyrolae) is used for clearing away heat in the liver. Needling at Yintang (EX-HN3) gives the effect of calming down convulsion and stopping endogenous wind. Touwei (ST 8) and Fengchi (GB 20) eliminate wind and dredge the collaterals. Needling at Hegu (LI 4) and Taichong (LR 3) can exert the effect of dredging the passes and regulating the mind, which are the important points used by Prof. ZHANG for treating diseases of the nervous system and mental disorders. When the reducing method is adopted in the needling four points located around the wrist and ankle, the effect of calming down the liver-wind can be obtained.
3. Dysmenorrhea
A female patient, 20 years old, paid her first visit on October 12, 2001 with the chief complaint of dysmenorrhea for 4 years. The patient stated that she would have sharp lower abdominal pain during the menstrual period, accompanied with lumbar distending pain, which could be alleviated by warmth. The menstruation was scanty in quantity, dark-red in color and with some clots. Before the menstruation,
she had distending pain in the breasts, and aversion to cold with cold limbs. Examination at the moment found that she was having a period, and has sharp lower abdominal pain. Her tongue was dark-red with thin coating, and her pulse was deep-wiry. Syndrome differentiation: stagnation of the liver-qi, and cold and deficiency of the Chong and Ren Channels. Treating principle: soothing the liver and regulating the circulation of qi, and warming the channels to stop pain. Herbal prescription: Dang Gui Radix Angelicae Sinensis) 10g, Chuan Xiong ( jl| ^ Rhizoma Chuanxiong) 10g, Shu Di Huang Radix Rehmanniae Preparata) 15g, Bai Shao (S^ Radix Paeoniae Alba) 15g, E Jiao (^K Colla Corii Asini) 10g, (melted), Wu Zhu Yu (M^^ Fructus Evodiae) 6g, Zhi Xiang Fu Rhizoma Cyperi
Preparata) 12g, Wu Yao Radix Linderae) 6g,
Huang Qi (^"K Radix Astragali) 12g, Rou Gui Cortex Cinnamomi) 5g (put later), Hu Po Mo (powder of ^^^ Succinum) 3g (infused in boiling water and drunk separately), Yan Hu Suo (M^MM Rhizoma Corydalis) 12g, Chai Hu (Radix Bupleuri) 6g, Yue Ji Hua (M ^tt Flos Rosae Chinensis) 6g, and Dai Dai Hua Flos Citri
Aurantii) 6g. The decoction was orally taken at one dose daily for four days.
Acupuncture: Shiqizhuixia (Extra), Sanyinjiao (SP 6), Taichong (LR 3). The treatment was given once daily, with the needles retained for 30 minutes each time. 4 days later when the patient came for the second visit, the lower abdominal pain was already relieved for about 70-80%, the lumbar distending pain was also alleviated. The patient still had aversion to cold and cold limbs. Based on the above treating principle, some modifications were done for the above prescription, with Wu Yao Radix Linderae),
Huang Qi (^"K Radix Astragali), Rou Gui (^ Cortex Cinnamomi), Hu Po Mo (powder of ^^^ Succinum), and Chai Hu (^SJI Radix Bupleuri) left out, and Ai Ye (X^ Folium Artemisiae Argyi) 6g, Dan Shen Radix Salviae Miltiorrhizae) 20g,
and Zhi Gui Zhi (^^ft Ramulus Cinnamomi) 8g added. The patient continued receiving the combined treatment with herbal decoction and acupuncture.
After taking 3 doses of the above modified prescription, all the symptoms disappeared. Then she was asked to come to the clinic 3 days before the menstrual period every month. Each time she would take herbal decoction for 7 days, combined with 3-day acupuncture treatment, which also began 3 days before the menstrual period. Herbal prescription: The above prescription with Gui Zhi Ramulus Cinnamomi) and Dai Dai Hua Flos Citri
Aurantii) left out. The same acupuncture prescription was used. Observation was conducted for 4 menstrual cycles in succession. Her dysmenorrhea disappeared, menstrual quantity increased, and the color of menstrual blood turned red.
Comment: This case of dysmenorrhea has the stagnation of liver-qi, blood stasis, and deficiency cold in the Chong and Ren Channels, leading to unsmooth menstrual flow and pain due to obstruction. The above prescription used is modified from Ai Fu Nuan Gong Tang ( X Pft M. a ffi Argyi-Cyperus Uterus-Warming Decoction) plus Siwu Tang (H^^ Decoction of Four Ingredients). In the prescription, the ingredients in Siwu Tang function to harmonize and nourish the blood. Dang Gui (Radix Angelicae Sinensis) and Chuan Xiong Rhizoma Chuanxiong) are the moving herbs for the blood system, promoting the circulation of qi and blood. Shu Di Huang Radix Rehmanniae Preparata)
and Bai Shao (S^ Radix Paeoniae Alba) can tonify and nourish the blood, being the calming herbs for the blood system.
These herbs with the nature of moving and calming
are effective in tonifying and regulating the blood, and promoting blood circulation to regulate the menses. When E Jiao (N'K Colla Corii Asini), Ai Ye (^Rf Folium Artemisiae Argyi) and Gan Cao Radix Glycyrrhizae) are added, the stronger effect of tonifying the blood and regulating the menses can be obtained. Chai Hu (^SJI Radix Bupleuri) and Zhi Xiang Fu Rhizoma Cyperi Preparata) are
capable of activating the flow of qi, added to remedy the defect of Siwu Tang, i.e., stronger in activating blood but weaker in circulating qi. Wu Zhu Yu (M^ ^ Fructus Evodiae) and Rou Gui (Cortex Cinnamomi) have the effect of warming the channels and eliminating cold, making qi and blood warmed and circulated freely, consequently the menses gets regulated and pain stopped. Wu Yao Radix
Linderae) and Yan Hu Suo (M iH ^ Rhizoma Corydalis) can yield the effect of soothing the liver, activating the flow of qi and checking pain. The combination of Huang Qi Radix Astragali) and Hu Po Succinum) can strengthen the effects of replenishing qi, removing blood stasis and promoting menstrual flow. Yue Ji Hua (M^tt Flos Rosae Chinensis) and Dai Dai Hua (^^^ Flos Citri Aurantii) have the effect of regulating menses and harmonizing blood. Prof. ZHANG holds that when needling Shiqizhuixia (Extra), which is a commonly used point for dysmenorrheal, the most tender spot, maybe 1-2 vertebrae higher or lower, is served as the place to puncture . The needle at this point is usually manipulated to produce strong stimulation and retained for 30 minutes.
(Translated by WANG Xin-zhong +)
