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Zhen Gan Xi Feng Tang

Sedate Liver and Extinguish Wind Decoction

This beautiful formula is used in cases of Wind stroke or impending Wind stroke from ascending Liver Yang due to a root cause of Liver and Kidney Yin deficiency.  Signs and symptoms include dizziness, distension of the eyes, tinnitus, irritability, headaches, belching, nausea, sudden loss of consciousness, mental function disturbances, motor function disturbances, and hemiplagia.  Look for a wiry forceful pulse.

This formula treats both the branch and root.  Huai Niu Xi, Zhe Shi, Long Gu, and Mu Li directly sedate the Liver and anchor the Yang, thus extinguishing the Wind.  Gui Ban, Xuan Shen, Tian Men Dong, and Bai Shao Yao nourish the Yin and fluids hence treating the root.  To avoid further stagnating the Liver Qi from the sedating and anchoring herbs, Yin Chen Hao, Chuan Lian Zi, and Mai Ya with Huai Niu Xi clear Liver excess and soothes the flow of Liver Qi.  Mai Ya and Gan Cao work to aid the stomach with the metals and minerals in the formula. 

Benskly and Barolet note that that fresh varieties of the ingredients are used whenever possible because they are more effective in sedating the Liver.

This formula is commonly used for biomedicine termed disorders such as hypertension, cerebral vascular accidents, and heart disease.

Use this formula with caution on patients with Spleen deficiency, heavy, anchoring, cold, nourishing, and sticky herbs are hard on the digestion.

High Blood Pressure (Hypertension)

Hypertension (western definition): is generally a symptom less condition in which abnormally high pressure in the arteries increases the risk of problems such as stroke, aneurysm, heart failure, heart attack, and kidney damage.

Normal blood pressure is slightly different with age:

Average - systolic under 130, diastolic under 85 mm Hg

*over 160/90 should be checked again and be treated

*over 180/100 make sure patient is safe before they leave your clinic, treat or hospitalize (fear of stroke)

High diastolic is more dangerous and effects the right heart more, high systolic pressure effects the left heart more.

Types of Hypertension

1. Primary hypertension 85% +/-
2. Secondary hypertension (caused by other disease) 15% +/-
3. White coat hypertension (fear of getting blood pressure checked).

Symptoms:      Liver – headache, dizziness, eye disorders, numbness

                                Heart – palpitations, irritability, poor memory, insomnia

                                Kidney – Tinnitus, ankle edema, poor memory

                - Most important: headache, dizziness, numbness, when very high can cause nausea and   vomiting, these are signs of possible stroke.

TCM

2 types of high blood pressure:

1. Liver – if liver Qi goes up too much there is possibility of stroke (i.e. 220/140), this can happen from Liver problems, or Yangming not being able to descend (this explains nausea and vomiting from brain edema).  80% are this type. 

      Symptoms: headache, dizziness, red/dry eyes, palpitations (heart)

Rx - Long Dan Xie Gan Tang, Tian Ma Gou Teng Yin, Qi Ju Di Huang Wan

Emergency- use Da Huang to bring down pressure by relieving acute water pressure in         the brain (use high dosage to ensure movement), or try Senna (Fan Xie Ye), Aloe Vera         (Liu Hui).                            

2. Lung – Lung Qi cannot descend.  This is usually later in life, or late stage hypertension (following Liver HBP).

Symptoms: shortness of breath, cough, wheezing, fatigue, quiet voice,    edema (kidney)

Rx - Sheng Mai San, Si Jun Si Tang, Du Qi Wan, Liu Wei Di Huang Wan + Sheng Mai San, Jing Sheng Shen Qi Wan (Jin Gui Shen Qi Wan + Niu Xi, Chuan Xian Zi)

Stages of hypertension

1^st degree (early stage)

                Liver Yang rising - distended throbbing headache, red face, dry mouth, bitter taste, Pulse   wiry,                 irritable, insomnia

                                Rx- Tian Ma Gou Teng Yin, Bai Hu Tang, Qing Wen Bai Du Yin

                                                - Dizziness- Xia Ku Cao, Ye Ju Hua

                                                - Insomnia, Irritable- Mai Men Dong, Zhen Zhu Mu, Long Gu, Ge Gen

                Liver Fire - red eyes, bleeding, headache

                                Rx – Xie Qin Wan, Dang Gui Long Hui Wan, Long Dan Xie Gan Tang

2^nd degree (mid stage)

                Yin deficiency with Fire, body fluids damaged

                                Rx- Zhen Gan Xie Gan Tang, Ming Mu Di Huang Wan (Liu Wei Di Huang Wan + Shi                                          Jue Ming)

                                                - Phlegm- Wen Dan Tang

                                                - Blood Stasis- Tao Hong Si Wu Tang, Liang Xue Si Wu Tang (cold, change                                                         Shu Di to Sheng Di)

3^rd degree (late stage)

                Yin and Yang deficiency

                                Rx- Er Xian Tang, Jin Gui Shen Qi Wan, Ji Sheng Shen Qi Wan, You Gui Wan, Zou Gui                       Wan, Liu Wei Di Huang Wan

Prevention

Start meditation now, do not excessive exercise, put formula inside a pillow for sleep (Ju Hua, Shi Chang Pu, Xia Ku Cao, Suan Zao Ren, magnets- Ci Shi coordinates Heart and Kidney)

Treatment

1. Promote bowel movements (remove stagnation)
2. Promote urination (relieve water pressure within vessels)
3. Promote circulation
4. Nourish the Liver, Lung, and most of all Kidney or any other applicable organ, balance.
5. Emergency points for hypertension:  LR 3 + KI 1, Du 14 + BL 34, ST 8, KI 1, Du 20, LR 3,

        LI 4, GB 34, 39, auricular (bleed HBP), if Du 20 is painful moxa can be used, if not, only needles         are used, ear seeds.

        2 groups of points- LR GB meridian, Yangming meridian, (both with Du 20 & KI 1)

6. Acupuncture: scalp

* do not lower blood pressure too low or too quickly

Notes

*When Fire and Wind combine, stroke may ensue (this damages the Yin- not as high a temperature)

*When Yang and Wind combine, stroke may also ensue (this damages the Body fluids- causing a high temperature)   Rx- Bai Hu Tang, Qing Wen Bai Du Yin

Empirical Formula

Qing Nao Jiang Ya Tang

(Zhen Zhu Mu 25g, Shi Jue Ming 25g, He Shou Wu 50g, Ju Hua 15g, Gou Teng 15g)

                - Early to mid stage modification herbs:  Xuan Shen, Bai Zhu, Niu Xi, Bai Ji Li (Liver Headache),                 Di Long, Huang Qin, Xia Ku Cao

                - Mid to late stage modification herbs:  Yin Yang Huo, Jin Ying Zi, Ba Ji Tian, Huang Qi, Fu                 Ling, Du Zhong, Shu Di Huang

Liu Fengs Herbs:

Ge Gen, Dan Shen,  Yi Mu Cao (Blood and Water circulation), Xia Ku Cao (Liver Qi circulation), Xian He Cao, Xi Xian Cao, Shan Zha

Caution:

If patient is on Western medicine (ACE inhibitors, Beta blockers, Calcium channel blockers, Diuretics), be extremely cautious of herbal and acupuncture treatments, if blood pressure is brought down too fast stroke may also ensue.  Explain risks and allow patient to make an informed decision, drugs, TCM, or a careful balance of the two.  Balancing the drug side effects could also be a good approach.

Western Medicine (ABCD)

ACE inhibitors: angiotensin converting enzyme causes the bodies blood vessels to relax.

                - side effects: dry cough (Lung Qi cannot descend)

Beta blockers: slows down the heart output volume

                - side effects: slows the heart beat, asthma

Calcium:  less calcium to the vessels walls muscles causing them to become more flaccid.

                - side effects: water retention in ankle, headache, red face

Diuretics:  promotes urination

                - side effects: after long term use, Gout may show.

Combinations commonly in use:

1. A & B:  younger persons
2. C & D:  elder patients
3. A & D:  for both young and old

Long term use causes:

1. deficiency
2. Phlegm
3. Kidney Qi deficiency

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