abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)
Prof. Wang teaches at the Henan College of Chinese Medicine in Zhengzhou. He has 30 years clinical experience treating knotty, difficult diseases. On pages 3-4 of issue #11, 2008 of Si Chuan Zhong Yi (Sichuan Chinese Medicine), Jia Xiang et al. published an article titled, “Prof. Wang Xin-zhi’s Experiences Using Sheng Xian Tang in the Treatment of Eye-muscle Pattern Myasthenia Gravis.” A summary of some of the main points in this article is presented below.
Chinese medical disease categorization:
The clinical symptoms of eye-muscle pattern myasthenia gravis correspond to the traditional Chinese medical diseases of “wilting condition,” “reckless eyes,” and “abnormal vision.”
Disease causes & mechanisms:
The Zhu Bing Yuan Hou Lun (Treatise on the Origin & Symptoms of Various Diseases) states:
The eyes are the efflorescence of the viscera and bowels’ qi and blood,... If blood and qi are vacuous, this may lead to the interstices of the skin being open and contraction of wind. [If] wind lodges in the skin of the eyelids, this skin may become relaxed and let loose. The eyes become heavy and closed and cannot open. This is called reckless eyes as well as attack by wind.
Reckless eyes refers to downward drooping of the eyelids. In the Ling Shu (Spiritual Axis) it is said:
The essence qi of all the five viscera and six bowels ascends to pour into the eyes and makes their essence... [If] evils strike this essence, this essence is not able to mutually exist with [these evils]. This leads to essence scattering, and essence scattering leads to abnormal vision [means] seeing double things.
Based on the foregoing, Prof. Wang believes that the disease causes and mechanisms of this condition are closely related to the spleen and stomach. First, it is the spleen that transports the essence qi upward to the eyes. If the spleen’s movement and fortification are effulgent, the engenderment and transformation of the qi and blood have a source. Thus the eyes are able obtain essence qi and constructive blood to nourish them. Secondly, the spleen upbears the clear yang. The eyes are the orifices of clear yang, and their vessel pathways are fine and minute. Therefore, the qi of clear yang easily reaches them. However, if the body habitually suffers from spleen-stomach depletion vacuity or enduring disease produces vacuity, the central qi suffers detriment and falls downward. This may then lead to abnormality of the spleen-stomach’s function of intake, movement and transformation, and transporting and spreading. In that case, the source of the engenderment and transformation of qi and blood, fluids and humors becomes insufficient. Hence the eyelids lose their moistening and nourishment and their opening and closing loses its use. In addition, non-obtaint of the spleen’s essence qi may also cause seeing double. Because the human body’s yang qi is engendered and emitted during the morning, the disease condition is relatively lighter during that time. However, in the afternoon, the yang qi gradually declines and the condition becomes heavier. As it is said in the Yi Zong Bi Du (Required Recitation of Collected/Ancestral Medicine):
The yang ming is the stomach [which] governs the intake of water and grains. [It] transforms the finest essence in order to enrich and nourish the exterior and interior. Therefore, it is the sea of the five viscera and six bowels, while below it moistens the gathered sinews... [It also] governs the tying together of the bones and the disinhibition of the joints.
Further, it is said:
If the yang ming is vacuous, this leads to the blood and qi being scanty. [In that case, blood and qi] are unable to moisten and nourish the gathered sinews which become slack and let loose.
Thus, Prof. Wang believes that this condition is mainly due to spleen vacuity falling downward with non-transportation of the finest essence.
Prof. Wang treats this condition on the basis of a combination of Chinese medical theory and his many years clinical experience. While he believes that spleen vacuity falling downward is the main disease mechanism of this condition, he differentiates between Li Dong-yuan’s central qi insufficiency and Zhang Xi-chun’s vacuity of the great qi. Most sufferers of this condition also present with chest oppression, shortness of breath, loose stools, and a deep, weak pulse. These signs and symptoms suggest a pattern of the great (or chest) qi falling downward, not the central qi falling downward. Therefore, Prof. Wang uses Master Zhang’s Sheng Xian Tang (Upbear the Fallen Decoction) as opposed to Master Li’s Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction). This formula consists of:
Huang Qi (Radix Astragali)
Chai Hu (Radix Bupleuri)
Sheng Ma (Rhizoma Cimicifugae)
Zhi Mu (Rhizoma Anemarrhenae)
Jie Geng (Radix Platycodi)
Within this formula, Zhi Mu is meant to control Huang Qi’s propensity for engendering heat due to its being warm and dry and easily damaging yin.
Representative case history:
The patient was a 21-year-old female who was first seen by Prof. Wang on September 10, 2007. The patient had an habitually vacuous, thin body. In August of that year, she noticed the onset of a right-sided drooping eyelid. She was subsequently diagnosed as suffering from eye-muscle pattern myasthenia gravis at her local hospital. Because she had an allergic reaction to the original medication she was prescribed, she came to see Prof. Wang. At the time of examination, her right eyelid was drooping and there was accompanying shortness of breath, fatigue, occasional chest oppression, loose stools, a pale tongue with white fur, and a fine, deep, weak pulse. She was given an MRI of the chest, but no abnormality was found. Prof. Wang’s Chinese medical disease diagnosis was wilting condition, and his pattern discrimination was qi vacuity falling downward. His treatment principles were to boost the qi, upbear and lift. Therefore, he prescribed the following version of Sheng Xian Tang with added flavors:
Huang Qi (Radix Astragali), 30g
Chai Hu (Radix Bupleuri), 10g
Sheng Ma (Rhizoma Cimicifugae), 9g
Zhi Mu (Rhizoma Anemarrhenae), 9g
Jie Geng (Radix Platycodi), 6g
Du Zhong (Cortex Eucommiae), 15g
Shan Yao (Radix Dioscoreae), 15g
Fu Ling (Poria), 12g
Gan Cao (Radix Glycyrrhizae), 10g
One packet of these medicinals was decocted in water and administered per day in two divided doses, morning and evening. After taking this prescription for one week, the patient returned for her second visit. Her right eyelid had gradually opened but had not regained its former strength. There were varying degrees of improvement in the young woman’s other symptoms. Her stools were still loose. Therefore, Prof. Wang reduced the Zhi Mu to six grams and added 30 grams of stir-fried Yi Yi Ren (Semen Coicis). After taking 15 packets of this formula, all the woman’s symptoms were alleviated and there was no recurrence on follow-up after three months.
In his discussion of this case, Prof. Wang noted that Chai Hu courses the liver and rectifies the qi at a dose of 6-9 grams, while it upbears yang and lifts the fallen at a dose of 9-12 grams. Shan Yao and Fu Ling were added to Master Zhang’s standard formula in order to supplement the qi, fortify the spleen, and seep dampness. Du Zhong was added to supplement and boost the essence qi.
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