This newsletter focuses in on the Three Treasures remedies that treat digestive problems. An accurate diagnosis of the patterns causing any particular digestive problem is extremely important as very different patterns can cause similar symptoms. As always, the tongue is of paramount importance in helping to determine whether the patient has a Full, Mixed or Empty condition, and which remedy should be prescribed accordingly.

EPIGASTRIC PAIN
Full patterns
Cold invading the Stomach
Retention of Food
Liver-Qi stagnation invading the Stomach
Stomach-Heat
Stomach-Fire
Stomach Phlegm-Fire
Stomach Damp-Heat
Stomach and Liver Heat
Stasis of Blood in the Stomach
Phlegm-Fluids in the Stomach

Empty patterns
Stomach and Spleen Deficient and Cold
Stomach-Yin deficiency

ABDOMINAL PAIN
Full patterns
Cold in the Intestines
Damp-Heat in the Intestines
Retention of Food
Stagnation of Qi
Stasis of Blood

Empty patterns
Deficiency of Qi and Empty-Cold in the abdomen


THREE TREASURES REMEDIES WHICH TREAT DIGESTIVE CONDITIONS

1. Soothe the Centre
Patterns: Stomach and Spleen Qi Deficiency, some Stomach-Yin Deficiency, Dampness and stagnation of Qi in Middle Burner
Digestive symptoms: Poor appetite, feeling of fullness, distension and pain of the epigastrium, poor digestion, loose stools.
Tongue: Pale, teethmarks, sticky coating in the centre which may be rootless, possibly small transversal cracks on the side.
Explanation: this formula is for conditions of primarily a deficient nature, i.e. Spleen-Qi deficiency is primary to the Dampness and the main symptoms will be tiredness and digestive problems. It treats problems of the Middle Burner rather than the Intestines and focuses on digestive problems of the Stomach and Spleen with some Dampness and some stagnation of Qi

2. Prosperous Earth
Patterns: Spleen-and Lung-Qi Deficiency, Dampness.
Digestive symptoms: poor digestion, slight abdominal distension and fullness, poor appetite, craving for sweets, loose stools.
Tongue: Pale
Explanation: This is a very simple formula which primarily tonifies Spleen-Qi and secondarily resolves Dampness. Spleen-Qi deficiency with Dampness is probably one of the most common clinical findings in digestive problems and it will nearly always be accompanied by tiredness.

3. Central Mansion
Patterns: Stomach and Spleen-Qi Deficiency, Stomach-Yin Deficiency, Dampness in the Middle Burner.
Digestive symptoms: loose stools, diarrhoea, poor appetite, poor digestion, a slight feeling of fullness and heaviness of the epigastrium, nausea, epigastric pain.
Tongue: Pale, slightly Swollen, sticky but rather thin coating, slightly rootless coating, coating too thin in the centre, central Stomach crack, scattered Stomach cracks, transversal Spleen cracks.
Explanation: Firstly, this formula tonifies the Stomach- and Spleen-Qi and resolves Dampness. It also tonifies Stomach- and Spleen-Yin and is suitable to treat the beginning stages of this.

4. Drain Fields
Patterns: Dampness, Spleen-Qi Deficiency.
Digestive symptoms: Feeling of oppression and heaviness in the epigastrium, nausea, poor appetite, loose stools.
Tongue: Sticky-white coating
Explanation: this formula is used primarily to drain dampness and therefore should be chosen if the Excess aspect predominates over the Deficiency. It is appropriate for Dampness without Heat.

5. Ease the Muscles
Patterns: Damp-Heat in the Middle Burner
Digestive symptoms: a feeling of oppression of the epigastrium, a sticky or bitter taste, poor appetite, loose stools
Tongue: Red or slightly red with a sticky-yellow coating. Even if the tongue is not red, the presence of a sticky-yellow coating is an essential sign for the prescription of this formula.
Explanation: this formula can be used in all cases when the condition is characterised predominantly by retention of Damp-Heat. It is appropriate only when the Excess aspect predominates over the deficiency.

6. Smooth Passage
Patterns: Spleen- and Liver not harmonized, Spleen-Qi Deficiency, Liver-Qi Stagnation, Dampness.
Digestive symptoms: alternation of constipation and diarrhoea, abdominal pain, fullness and distension, stools at times like small pellets and at other times very loose, mucus in the stools, poor appetite.
Tongue: Pale or normal, teethmarks, thin-sticky coating. If stagnation of Liver-Qi predominates, the sides could be slightly red.
Explanation: this formula is aimed at treating irritable bowel syndrome (IBS) when it is caused by a disharmony of Spleen and Liver. Its main therapeutic aim is to tonify and move Qi and resolve Dampness in the Intestines and it therefore addresses the three main patterns which are nearly always present in irritable bowel syndrome: deficiency of Spleen-Qi, stagnation of Liver-Qi and Dampness.

7. Jade Spring
Patterns: Stomach, Spleen and Lung Yin Deficiency, Stomach-Empty Heat
Digestive symptoms: excessive hunger, poor digestion, slight burning epigastric pain, dry stools.
Tongue: Dry, either no coating or rootless coating in the centre, Stomach crack in the midline or scattered small cracks, may be slightly red in the centre.
Explanation: this formula nourishes Stomach-, Spleen- and Lung-Yin.

8. Break into a Smile
Patterns: Liver Qi invading Spleen and Stomach
Digestive symptoms: epigastric or abdominal distension and pain which is worse when stressed, flatulence, belching.
Tongue: almost normal or slightly red on the sides
Explanation: this formula moves Qi and eliminates stagnation. Abdominal distension is an important indication for the use of the formula. Distension is often described as "bloating" by Western patients.

COMPARISON OF THE FORMULAE ACCORDING TO FULL AND EMPTY

Formulae for purely Full conditions
Break into a Smile

Formulae for Mixed conditions where Fullness predominates
Smooth Passage
Ease the Muscles
Drain Fields

Formulae for Mixed conditions where Emptiness predominates
Central Mansion
Prosperous Earth
Soothe the Centre

Formulae for purely Empty conditions
Jade Spring


COMPARISON OF CENTRAL MANSION, SOOTHE THE CENTRE AND JADE SPRING

CASE HISTORIES

A 29-year-old woman complained of irritable bowel syndrome, with pain, bloating and constipation. The pain improved after a bowel movement. Her tongue was Pale and Swollen and her pulse Wiry.

I diagnosed Liver-Qi stagnation (pain better with bowel movement), Spleen-Qi deficiency (Pale tongue) and Dampness (Swollen tongue). I prescribed Smooth Passage and gave her acupuncture to move Qi and strengthen the Stomach and Spleen.


23-year-old woman presented with abdominal distension and pain, diarrhoea, undigested food in the stools. She had also felt very tired for the past year The abdominal pain was better after a bowel movement. Her tongue was Pale and quite Swollen and the Middle position on the right was Weak.

I diagnosed a primary pattern of Spleen-Qi deficiency (tiredness, Pale tongue, right-Middle position Weak) also with some Liver-Qi stagnation (abdominal distension and pain, pain better after a bowel movement). I prescribed Soothe the Centre to strengthen the Spleen and move Liver-Qi.


62-year woman presented with constipation, having a bowel movement once every 4 or 5 days. Her stools were dry and difficult to evacuate. She also said she felt a "sort of discomfort" in the epigastrium which became more pronounced as the day went on. Her tongue was slightly Red with small, scattered cracks. Her pulse was normal.

I diagnosed that Stomach-Yin deficiency was the primary cause of the constipation and epigastric pain and this was confirmed by the tongue being slightly Red and cracked. I prescribed Jade Spring (3 tablets twice a day).

A 16 year old man presented with tiredness, loose stools, a feeling of being "weighed down" and craving sweet foods. He also complained of some abdominal bloating and a "vague discomfort" in the epigastrium which came on when he was tired. His complexion was quite yellow. He had begun to feel like this while studying for exams, about which he was very anxious. His tongue was Pale and Swollen with a sticky, rootless coating and his pulse was Slippery on the right-hand side.

The main pattern present here is Stomach- and Spleen-Qi deficiency (tiredness, loose stools, Pale tongue). However, unusually in someone of this age, the rootless coating and epigastric discomfort indicate that there is a small amount of Stomach-Yin deficiency as well. On top of this, there is also some Dampness which is reflected by the tongue being Swollen and the pulse being Slippery. I therefore prescribed Central Mansion which will treat primarily the Stomach- and Spleen-Qi deficiency, but will also address the Yin deficiency and Dampness.


For further information on any of the above, please consult the Three Treasures and Women's Treasure manual. We are always interested to hear any case histories where you have used the remedies on your patients. Please e-mail these and any ideas or suggestions you may have for future newsletters to: SuWenHerbs@aol.com.


Researched and edited by Rebecca Avern ( B.A. Hons, Lic. Ac., M.B.Ac.C)

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