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Treating Chronic Fatigue Syndrome and Fibromyalgia Syndrome (CFS/FMS) by means of the Deficiency Taxation (Xu Lao) theory and method first introduced by Zhang Zhongjing
Jin Gui Lao Yue: Insights into Xu Lao- Consumptive Diseases

by Therese Walsh, LAc, PhD

 


Abstract

The discussion pivots around the sixth chapter of the Synopsis of Prescriptions of the Golden Cabinet by Zhang Zhongjing. This chapter deals with Xu Lao/Consumptive diseases, also referred to as Deficiency Taxation Diseases by Nigel Wiseman.1 The chart at the end summarizes chapter 6. 

The analysis section compare: 1. Formulas in Chapter 6, and 2. Cases demonstrating application of these formulas, and 3. Similar cases in clinical practice, drawing correlations and making commentaries. Of the principle formulas presented in Zhang Zhongjing’s chapter 6, six herbal formulas are highlighted as they apply to the discussion on the treatment of CFS/FMS, including a more in-depth discussion on one of the two most important contributions of herbal formulation.

The last discussion includes references to a published article from the New Yorker Magazine by Laura Hillenbrand and a parallel case study from clinical practice. The final discussion includes the consideration of seasonal cycles as an influence, experiences of the patients in the study, onset parameters, disease progression and treatment strategies that are relevant to these cases.

Introduction


Consumptive diseases have been grouped into a category of “Miscellaneous Diseases” (Za Bing) by Zhang Zhongjing in his text Jin Gui Lao Yue (Synopsis of Prescriptions of the Golden Cabinet) written in 220 A.C.E2., during the Han Dynasty. This text proves to be one of the most important references used by doctors of herbal medicine for the past 1,800 years. Chinese Herbal Medicine stresses supporting the body’s resistance to disease and promoting the elimination of pathogens. It is a preventative medicine approach that perceives the disease process early and treats the patterns before the progression enters deeper layers of the anatomy that require more aggressive means of extracting offending pathogens or toxins, and finding ways to escort them out of the body.

Consumptive diseases are of special interest in clinical practice because many patients seek help who have not been able to acquire a diagnosis through means of western-based diagnostic testing where the tests are designed to identify a single causative agent responsible for the illness symptoms. The Western approach, when faced with consumptive disorders, is unable to offer insights or assistance in de-mystifying the conditions that deplete the vital forces of the patient.

Patients seeking Chinese Medical treatment have often been referred to a psychiatrist for psychological diagnosis and pharmacological solutions in the attempts to bring some kind of relief to the patient. Though some relief may be gained by this approach, it does not address the consumptive process, the causative factors and questions the authenticity of the patient’s physical symptom experiences.

Cases the demonstrate the presenting symptom picture of Xu Lao disease

A collection of five cases studies help to demonstrate the consumptive disease process presenting picture

1. Case 1, female age 42, could not leave her bed for several months after delivering her first child.  With each passing week after the birth, she became weaker and weaker until she ended up in the ER after a state of physical collapse, ushering in a therapeutic regime of anti-depressants and sleep medications. She was advised that a psychiatrist could help her with her symptoms. Later, with the help of Chinese medicine, Chinese dietary therapy and homeopathic care directed at exhaustion, she recovered to the point of being able to enjoy her infant son, and work again as a fine artist. Yet, she needs to manage her energy carefully and conservatively in order to continue to enjoy her life. Her presenting picture reflects Liver and Heart (6-17) Organ stage Xu Lao. See Chart.

2. Case 2, female age 40, arrived to the clinic with the main concern that every bite of food caused an inflammatory immune reaction. This resulted in chronic discomfort and pain in the abdominal region and weight loss too far below her healthy parameters, compromising her ability to sustain her life. Progress was made with herbal congee therapy beginning with one herb and one grain for a week, and adding in one more ingredient each week. The process restored her Spleen and Stomach organs until she could accept and assimilate foods once again. The process built up her qi and blood, Yin and Yang and brought back the recovery of her health. (Stage 6-13 in the Chart SP/ST organ stage)

3. Case 3, female, age 32, was not able to maintain energy for her activities, especially in the summer season. Her energy wanes leaving her drained and exhausted to the point of having to stop her academic classes, her exercise regime, her social engagements and her job.  Her activity stops for months like this until she can pick up the threads of her life again that she is periodically forced to lie down. (Hovering primarily in the Kidney 6-11 stage, but she has been to the Liver and Heart Exhaustion stage on occasion)

4. Case 4, female, age 14, experiences insomnia, severe fatigue, heavy limbs, heavy menstrual bleeding and has missed much of her Eighth grade school year. After suffering from severe fright, she has progressively escalated into a rapid descent of her sense of hope for her dreams of a future performing artist. This emotional influence has damaged her Kidney Yang’s ‘will to survive’ function. Fortunately, positive events inspired her to make plans in her future. Her recovery is less rapid than her decline, but she makes remarkable progress with herbs to repair the consumptive deficiency. The recovery takes about a year. (Stage: Sp/Kd yang with elements of Liver and Heart organ exhaustion)

5. Case 5, female, age 49, fearing she may have Multiple Sclerosis comes in concerned about her nervous system. She experiences her skin being highly sensitive to touch, which causes irritability, and burning sensations. She has weakness in the limbs, beginning in the lower limbs, which worsen after an 18-24 hour work shift, which is occasionally required due to her demanding natal delivery practice. She continuously deals with severe fatigue. She can sleep for 2 days when she is able to completely rest. (Stage: 6-15 Kidney Yin and Yang)

Many patients arrive at the door of medical practitioners who practice natural methods of healing, with a sense of desperation for the solutions they hope for and need to regain their vitality and health. They have often read about CFS, FMS, MCS (Multiple Chemical Sensitivity) and have tried to discuss this with their doctor. They receive a variety of responses, but rarely, a course of action to take that stimulates genuine condition improvement. Zhang Zhongjing had the perception and insight to provide us with 1. The way to see these patterns, 2. How they become trapped at certain levels of progression, 3. How they progress through phases, and 4. How to tap into and utilize treatment strategies that restore health. These patterns of consumption involve the commodities of energy-Qi, blood-Ying, Yin, Yang, Jing, and exhausted organ structures.

Chapter Six overview of the Jin Gui Lao Yue


Chapter six of the Jin Gui Lao Yue covers Arthralgia and Consumptive Diseases.

Chapter 6-1 through 6-2 covers arthralgia that is not acute and involves predisposing deficiencies prior to the onset. Chapter 6-3 through 6-18 covers consumptive diseases (Xu Lao) in a progression of severity from qi deficiency, to blood deficiency, to Yin Deficiency, to Yang deficiency, to Jing deficiency, to deficiencies with Phlegm complications, and then to the consumption of the internal organs: first Spleen and Stomach, then the Kidney, then at the Spleen/Lung axis, then Liver and Heart, and finally, Blood Stagnation as the final result of the consumption process. *Please refer to the chart for symptom indications and for the progression at a glance.

Organ Consumption Stages with Herbal Strategies

The first organ hit by the consumptive process is the Spleen/Stomach or Middle Burner Organs; the seat of Gu Qi processing (Food Energy), Wei Qi origin (Defensive Energy), and Ying Qi creation (Nutritive Energy). From the Chart, note the heat signs in the Upper Burner that include:  Epistaxis, burning sensation in the palms, parched mouth and throat, and the cold signs in the Lower Burner: Abdominal pain and contraction and nocturnal emission. This leakage from below may also include heavy menstrual bleeding in women that are deficient or vaginal discharge that is unrelated to ovulation times.

The formula given by Zhang Zhongjing for consumption of the Spleen/Stomach is Xian Jian Zhong Tang, or Minor Building Up the Interior of the Middle Decoction. The herbs in the formula include:

Gui Zhi/Cinnamon Twigs, Zhi Gan Cao/Honey-Baked Licorice Root, Da Zao/Chinese Red Dates, Bai Shao/White Peony Root, Sheng Jiang/Fresh Ginger Root, and Yi Tang/Saccharum.

The formula dynamics warm and tonify the middle burner and moderate spasmodic abdominal pain.  Gui Zhi tonifies deficiency and weakness and harmonizes the Defensive/Wei Qi and Nutritive/Ying Qi together with Bai Shao.  Bai Shao is double the amount of Gui Zhi to aid Gui Zhi in treating the upper heat and lower cold as well as the spasm in the stomach and intestines. Yi Tang is the principal herb to tonify the Spleen. This herb is not used if the patient is vomiting.

The next stage of progression in the consumption pattern moves beyond the Spleen and Stomach organs and affects the 1. Defensive/Wei Qi depletion, 2. Yang Qi depletion, 3. Chronic, pathogenic cold at the interior level of the Middle burner, and 4. Qi stagnating in the Chest and Abdomen and 5. The patient is becoming weak and thin. For this stage, the formula recommended is Huang Qi Jian Zhong Tang, when the Qi of the Five Viscera is exhausted. The symptoms (also in the chart) are: heaviness of the four limbs, weakness and achy bones and muscles, difficulty breathing or short of breath, fatigued when moving, lack of vitality, fullness in the chest, stiffness and pain in the back and waist, palpitations, dry lips and throat, poor appetite, distention in the chest, ribs, and abdomen with abdominal contraction, preference for lying down. All pulses are weak and deficient. At this stage, there is Chronic Fatigue and Muscular and joint aching (Fibromyalgia)

Using the last formula as a comparison, Huang Qi/astragalus is added to tonify the overall deficiency more effectively, while Da Zao is taken out when there is abdominal distention, and Fu Ling/Poria Cocos is added to reduce turbidity. With Lung Qi deficiency signs, (short of breath), Ban Xia/Pinellia is added to rid sputum which will help free the Lung. Now the Herbs in the Formula are: Huang Qi/Astragalus, Gui Zhi/Cinnamon Twigs, Bai Shao/Peony, Sheng Jiang/Ginger, Fu Ling/Poria, and Ban Xia/Pinellia, and Yi Tang/Saccharum.

This formula is given to Case 4 who presents with the symptoms: Pain in the Stomach and abdomen with distention and contracting spasm that is worse after eating, fatigue, insomnia, irritability, difficulty getting up in the morning, prefers lying down whenever possible, low appetite, shiny tongue, peeled tongue coating, dusky and trembling tongue. Pulse is weak and deficient. Case 3, Age 32, female, is also given this formula and her symptoms include: pain around the umbilicus as a child, heat packs that relieve abdominal pain, severe fatigue to the point of stopping college classes and her job. She is achy and weak in her muscles. Both patients benefit from Huang Qi Jian Zhong Tang for strengthening the Middle organs. They are advised to not eat cold, frozen or raw, uncooked food until their middle organs are stronger as this will weaken the organs, making them more deficient and contributing to further interior cold in the Middle Burner (Jiao).

The other important formulas that Zhang Zhongjing discusses in chapter six are: Jin Gui Shen Qi Wan (Pills from the Golden Cabinet) for Kidney Organ level deficiency, Shu Yu Wan (Dioscorea Pills), which addresses the deficiencies of Qi, Blood, Yin, Yang, Spleen, Kidney and Lung, and, Suan Zao Ren Tang (Ziziphus Decoction) which nourishes the Liver and Heart, eliminates restlessness and irritability and holds onto wandering “shen” or consciousness. The final formula discussed in this chapter is Zhi Gan Cao Tang, which summarizes the consumption of Qi and substances and provides materials for the body to begin the process of restoration. Applications of these formulas to specific cases with discussions can be found in the extended version of this paper.3

For the list of herbs in these formulas, please refer to Appendix A.

Commentary

The importance of chapter six in the Jin Gui Lao Xue lays in the fact that taxation/consumption of Qi, Blood, Yin, Yang, Jing and Organs are the basis of how any and all deficiency patterns can progress. By understanding the deficiency patterns and their progression, one can target treatment of patients with these presentations and lead them to a state of health in a systematic fashion.

The Ling Shu (Spiritual Pivot) teaches of the “lao” or taxations on the body that will affect its resources. Excessive Walking injures the sinews and Liver. Excessive Staring injures the blood that is controlled by the Heart. Excessive sitting injures the flesh and Spleen. Excessive laying down injuries the qi, which is governed by the Lungs. And excessive standing injures the bones, which are controlled by the Kidneys.

Excessive staring may be considered in young children or adolescents who spend long hours in front of a computer screen doing their homework and in adults who rely heavily on computer work in their jobs. This taxes the blood and eventually affects the organ that controls the blood, the Heart. Taxation creates heat, heat consumes qi. Lack of qi means lack of movement, so stiffness and fatigue are signs that the qi is less abundant. The consumption of Blood leads to the degenerations of bone, muscles and a possibility of Wei/Atrophy syndrome may arise. (Myasthenia Gravis is an extreme example of Wei/Atrophy Syndrome.) The consumption of Yin begins to affect the Legs (yin aspect of the body) first with weakness or achy leg pain or both manifesting. This can be seen in the example of case 5. The consumption of bodily fluids will cause dryness and thirst and lead to more Wei/Defensive qi and Ying/Nutritive Qi deficiency. The achiness in joints and muscles occurs in CFS/FMS and is classified as Bi/Obstruction syndromes in Chinese Medicine. As resources are consumed, unresolved latent pathogenic factors begin to surface. An example of this may be the appearance of the herpes virus during times of stress, fatigue or overwork. The latent pathogens are held at the level of joints and bone, and with the loss of Yuan Qi and Jing, the pathogens, losing their latent status, show up with the signs of joint pain, achiness, stiffness and weakness whenever the consumption progresses.

When the vital fluids are consumed, the qi attempts to hold onto any fluid, dampness or turbidity that is hanging around in the body, primarily coming from the Stomach. This is the way that Phlegm is produced in Xu Lao disease patterns. Phlegm accumulates in the throat and chest due to the circulation patterns of Wei Qi. The Qi’s attempt to hold tightly to these poor substitutes for healthy fluids causes constriction in the throat and chest and produces symptoms of distention, restlessness and insomnia. These are the Heart and Liver symptoms that the formula, Suan Zao Ren Tang addresses.

Case 3, female age 32 shared an article from the New Yorker magazine titled: A Sudden Illness that carefully leads the reader through the experience of the exact process that Zhang ZhongJing is outlining for the Doctors of Chinese Medicine. Both the patient, case 3, and the author, Laura Hillenbrand, through their case studies, lead the investigating practitioner step by step through the exact progression that Zhang Zhongjing presents in his Chapter 6. In the extended version of this paper, these cases are tracked to show the correlations with chapter six’s progression of consumption. Case 3 patient shares this article with those close to her because the article demonstrates her own experiences with Xu Lao patterns that are not clearly identified in the Western Model of disease. These patients end up being referred to psychiatrists whose treatment with medications address secondary psychological suffering from the impact of prolonged illness, but the consumption patterns remain untreated and they progress. This is a fascinating story that will intrigue many readers and can be found on the internet by going to: http://www.cfids-cab.org/MESA/Hillenbrand.

Herbal protocols, and well as Divergent Meridian Acupuncture methods which are available in Chinese Medicine, offer a path to health and recovery. Zhang Zhongjing will continue to play a part influencing the modern CM practitioners as they contemplate their patient’s presentation of fatigue-related disease patterns. The contribution of Xu Lao insights helps to arrange the strategies for treatment, depending on the level of resources that are involved in the consumptive process. The chart helps to focus on the discrimination of patterns, or overlapping patterns that the patient will present. There is room for creativity in the suggestions of how to modify the formulas based on the variation in symptom manifestations. Each patient who appears on the pathway of the Chinese medicine continuum contributes to the unfolding of every practitioner. Through the teachings of patients and masters, modern and classic literature, we grow and learn, adding to the richness of the Asian wisdom and insights offered to seekers of solutions.

 

 

 

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About the Author


Therese Walsh Van Keuren is Licensed in Acupuncture and Herbology by the Medical Board of California and Certified by the National Commission for the Certification of Acupuncturists. She received her Ph. D. from the American University of Complementary Medicine in the department of Classical Chinese Medicine. Through this program Therese had the opportunity to study with Jeffery Yuen, 88th generation Taoist Priest, accupuncturist and herbalist. She continues to study and consult with him in her private practice. Therese teaches as a professor at Five Branches University in San Jose, CA.

For more information visit Therese's website, True Chi.
 

 

 

 




Appendix A


Jin Gui Shen Qi Wan (Pills from the Golden Cabinet) for Kidney Organ level deficiency, include: Shu Di Huang, Shan Zhu Yu, Shan Yao, Ze Xie, Fu Ling, Mu Dan Pi, Rou Gui, Fu Zi.

Shu Yu Wan (Dioscorea Pills), which addresses the deficiencies of Qi, Blood, Yin, Yang, Spleen, Kidney and Lung, include: Shan Yao, Dang Gui, Gui Zhi, Shen Qu, Shu Di Huang, Dan Dou Chi, Gan Cao, Ren Shen, Chuang Xiong, Bai Shao, Bai Zhu, Mai Men Dong, Xing Ren, Chai Hu, Jie Geng, Fu Ling, E Jiao, Gan Jiang, Bai Lian, Fang Feng, Da Zao.

Suan Zao Ren Tang (Ziziphus Decoction) which nourishes the Liver and Heart, eliminates restlessness and irritability and holds onto wandering “shen” or consciousness, include: Suan Zao Ren, Gan Cao, Zhi Mu, Fu Ling, Chuan Xiong

Zhi Gan Cao Tang includes: Zhi Gan Cao, Gui Zhi, Sheng Jiang, Mai Men Dong, Ma Zi Ren, Ren Shen, E Jiao, Da Zao, and Shu Di Huang.

There are many more brilliant formulas detailed in this chapter for the purpose of recovering health. 

 



References


Bensky, D, Gamble, A, Materia Medica, Eastland Press, Seattle, WA © 1993

Dharmananda, Subhuti, Pearls from the Golden Cabinet, Oriental Healing Arts Institute, 1988.

Hillenbrand, L., A Sudden Illness, New Yorker July 7, 2003 http://www.cfids-cab.org/MESA/Hillenbrand.html, accessed Nov. 12, 2006

Kantrowitz, B, A Writer who Beat the Odds, Newsweek July 28, 2003

Walsh, T, Jin Gui Lao Yue, Insights into Xu Lao-Consumptive Diseases, 2003 ©.

Wiseman & Feng, A Practical Dictionary of Chinese Medicine, Second Edition, Paradigm Publications, 1998

Yang Shou-zhong & Liu Feng-ting, The Divinely Responding Classic: A Translation of the Shen Ying Jing from the Zhen Jin Da Cheng (Great Masters Series), Blue Poppy Press, 1994 (Chi-Chou Yang, Ji-Zhou Yang, Shou-Zhong Yang, Feng-Ting Liu)

Yuen, J, transcripts from July 26, 2003, Santa Fe, NM, Autoimmune Disorders and Cancer.

Zhongjing, Z, translated XiWen, L Ph.D., Synopsis of Prescriptions of the Golden Cabinet, New World Press, 1995.
 

 
 
 

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