Physiological Fluids – Tears & Saliva (Formulas, Herbs, Patterns)

Review & Context

• Recap of previous lecture
  • Discussed Tom’s warming/transforming formula for “fixed kidney disorder” (low-back pain, sensation of “sitting in cold water”)
  • Formula is essentially $Ling\,Gui\,Zhu\,Gan\,Tang$ with $Dang\,Shen$ substituted – warms yang, transforms fluids, stops back pain
• This week: transition from pathological accumulations (damp, phlegm, edema) to physiological fluids
  • Physiological fluids considered: tears, saliva (mucoid & thin), sweat, urine (sweat & urine to follow in later classes)
  • 29 formulas listed for the week; many are repeats from earlier units because the root mechanism (water metabolism failure) is the same
• Text reference: 2nd ed. Steve Klaber/Clabby “Chinese Medical Physiology” (1st ed. lacks index; 2nd & 3rd identical text + extra section)
• Exam logistics
  • Instructor away wk-13; practice questions supplied then
  • Week-14 review, wk-15 final
  • For quizzes/exam: recognise pattern + core formula; exotic/minor prescriptions not required

Key Herbs Discussed

• Bai Zhi (*Bi Zhe)
  • Category: Warm, Acrid, Release Exterior (Lung ♁ Spleen ♁ Stomach)
  • Functions: release wind-cold, open nasal passages, dry damp/phlegm (frontal sinus), analgesic (frontal/yang-ming headache), treat leucorrhoea
  • Combos: ▸+ Chuan Xiong (headache)
    ▸+ Gao Ben or Xin Yi Hua (sinuses)
  • Preparation: Chao Bai Zhi (dry-fry) ⟹ less dispersing, for vaginal discharge
  • Caution: blood/yin deficiency, heat disorders
• Ju Hua (Chrysanthemum fl.)
  • Category: Cool, Release Wind-Heat (Lung ♁ Liver)
  • Actions: mildly disperse wind-heat, cool liver, calm liver wind, benefit eyes (redness, blurred vision)
  • Colour difference
  • White (pale) ➜ tonifying/deficiency eye disorders
  • Yellow ➜ exterior wind-heat
  • Core pairs: Sang Ye + Ju Hua (Sang Ju Yin)
    Gou Qi Zi + Ju Hua (Qi Ju Di Huang Wan)
  • Beverage: common summer tea; can be dry-fried (carefully) to reduce dispersing quality

Disorders of Lacrimation (Tears)

Pattern 1 – Liver-Blood Deficiency + Wind-Cold (Cold Tears)

• S/Sx: excessive cold watery tearing on wind exposure, pale complexion/lips, cold limbs, faint pulse
• Formulas
  • Yang Ying Shui Han Tang (Ju Hua, Gou Qi Zi, Dang Gui, Bai Shao, Bai Zhu, Fu Ling, Gan Cao, Fu Pen Zi, etc.) – warm, scatter cold, nourish blood, astringe tears
  • Gou Qi Zi Jiu (Lycium fruit wine)
  • Modified Dang Gui Si Ni Tang + Ju Hua, Gou Qi Zi, Fu Pen Zi

Pattern 2 – Liver Heat / Liver Fire (Hot Tears)

• S/Sx: red swollen eyes, burning tears, headache, thirst, red tongue, wiry-rapid pulse
• Base formulas
  • Bai Jiang San (Silkworm powder) or Long Dan Xie Gan Tang
  • Clinically convenient: Sang Ju Yin (+ eye herbs)
• Eye-directing additions (choose 1-3)
  • $Jue\,Ming\,Zi$ • $Xia\,Ku\,Cao$ • $Mi\,Meng\,Hua$ • $Qing\,Xiang\,Zi$ • $Bai\,Ji\,Li$ • $Ye\,Ju\,Hua$

Pattern 3 – Liver & Kidney Dual Deficiency (Yin + Yang)

• S/Sx: watery cold tears esp. in wind/cold, underlying ocular dryness, low-back/knee soreness, dizziness
• Formulas
  • Ju Jing Wan (Gou Qi Zi, Ju Hua, Ba Ji Tian, etc.)
  • Liver/Kidney Dual-Tonification Pill
  • Practical: Zuo Gui Wan + Ju Hua, Gou Qi Zi, Fu Pen Zi (retains fluids)

Pattern 4 – Yin Deficiency with Deficient Heat Forcing Tears

• S/Sx: dryness alternating with hot tearing, malar flush, night sweats
• Formulas
  • Jia Zhu Wan (Shu Di Huang + Shan Zhu Yu + Chuan Jiao)
  • Zhi Bai Di Huang Wan (Liu Wei + Zhi Mu + Huang Bai) + eye herbs

Pattern 5 – Insufficient Lacrimation (Dry Eyes)

• Etiology: Liver-Yin / Blood deficiency
• Formula: Qi Ju Di Huang Wan (= Liu Wei Di Huang Wan + Ju Hua + Gou Qi Zi)

Herbs to “Send” a Formula to the Eyes

• Ju Hua • Gou Qi Zi • Jue Ming Zi • Xia Ku Cao • Mi Meng Hua • Qing Xiang Zi • Bai Ji Li • Ye Ju Hua • Sang Ye — add 1-3 to any base prescription to target ocular disorders

Disorders of Salivation / Drooling

Fluids involved

• Thin / Watery saliva = Spleen fluid
• Thick / Mucoid saliva = Kidney fluid (channel terminates at root of tongue)

A. Watery Saliva Patterns

B. Mucoid (Thick) Saliva Patterns

Useful Stabilise-&-Bind Herbs for Drool

• $Yi\,Zhi\,Ren$ — warms KD/SP, holds fluids
• $Rou\,Dou\,Kou$ — warms middle, binds
• $Wu\,Mei$ • $Wu\,Bei\,Zi$ • $Fu\,Pen\,Zi$

C. Drooling from Channel Obstruction (not fluid excess)

1. Wind-Stroke in Collaterals (Bell’s Palsy)

• Drooling because mouth cannot close; possible facial paralysis, mouth deviation
• Formula: Qian Zheng San = $Bai\,Fu\,Zi + Quan\,Xie + Jiang\,Can$ (+ Fang Feng, Jing Jie for exterior wind)

2. Internal Wind-Phlegm Obstructing Channels (Epilepsy / CVA)

Stabilise & Bind Category (Quick Reference)

• $Fu\,Pen\,Zi$ (Rubus) – astringes essence, restrains urine/tears
• $Yi\,Zhi\,Ren$ (Alpinia) – warms KD/SP, holds saliva & urine
• $Rou\,Dou\,Kou$ (Nutmeg) – warms middle, binds intestines/fluids
• $Wu\,Mei$, $Wu\,Bei\,Zi$ – sour/astringent, various discharges

Course & Testing Notes

• Only ~15 of the 29 listed formulas will be examined in depth; instructor will supply updated study list
• Exam questions emphasise: recognise pattern ➜ choose appropriate base formula ➜ (optionally) state logical modifications (eye herbs, astringents, etc.)
• Rare or hard-to-source items (e.g.
  Musk / She Xiang, Antelope horn) will not be required knowledge

Coming Up

• Next sessions: Nasal mucus, Sweat regulation, Urinary disorders
• Reading: instructor will circulate specific Clabey page numbers before class