Zhang Xi Chun Academic Philosophy and Clinical Approach

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By Professor Chen Bao Gui

Zhang Xi Chun was a modern late Qing and early Republic Chinese medicine practitioner (1860~1933) renowned for his integrated Western and Chinese Medicine approach in the treatment of many diseases. He was associated with the Huitong School which is an Integrated School of Western and Chinese medicine. His book entitled “Yi Xue Zhong Zhong Can Xi Lu Records of Chinese Medicine with Reference to Western Medicine “ is the result  of his lifelong research  in the use of herbs and TCM theory. As a practitioner, Zhang Xi Chun can be ranked behind Zhang Zhong Jing and his book can be rated behind Shang Han Lun. (Ref: Survey conducted  by Zhong Guo Zhong Yi Yao Bao on many famous renowned TCM practitioners in the history of Chinese medicine. )

In January 2016 I published an article on “An Insight into the clinical applications of Sheng Xian Tang” on the Pearls Seminars website. This article concerns the clinical application of Sheng Xian Tang and touched on Zhang Xi Chun’ theory on Da Qi (or Ancestral Qi). I would now like to further expand on Zhang Xi Chun’s clinical approach, his knowledge on many commonly used herbs and a few of his formulas. The following introductory examples reflect my appreciation of the wisdom of  Zhang Xi Chun and his creative and unique approach in the management of diseases.

  1. Zhang Xi Chun’s use of herbs: Zhang Xi Chun often used Yin Chen to substitute Chai Hu. Yin Chen is a dedicated herb to treat jaundice in Shang Han Lun (Yin Chen Hao Tang)

Zhang said that Yin Chen is aromatic, slightly bitter and acrid with a function to cool and disperse, similar to the function of Chai Hu. For patient who is weak and deficient and unable to tolerate the lifting and dispersing nature of Chai Hu, Yin Chen is a perfect substitute. Yin Chen is one of the key ingredients in Zhen Gan Xi Feng Tang to purge liver heat and disperse liver constraint for treatment of liver wind harassing the head characterised by vertigo.

Zhang Xi Chun was fully conversant in using large dosage of Shan Yao, Sheng Shi Gao, Sheng Huang Qi, Sheng Shao Yao, Ji Nei Jin, Sheng Yi Mi, Sheng Qian Shi and Sheng Bai Zhu. He used 4 liang of Shan Yao infused in water as a substitute to tea known as Shu Yu Yin (薯蓣饮) for treatment of fever, wheezing, spontaneous sweating and heart palpitation due to over-taxation. Zhang Xi Chun said that the colour of Shan Yao is white and is sweet in flavour, enters the spleen with a function to augment the kidney and nourish the spleen yin. Shan Yao can eliminate and has an astringent effect to sedate cough and calm wheezing. Shi Gao is cool in nature and can disperse heat, vent the exterior and release pathogen from the muscle layer. It is regarded as a dedicated herb to clear Yang Ming stomach heat.

  1. Treatment of Cancer: During his years of clinical practice in China Zhang Xi Chun discovered many cancerous-like symptoms and recorded them in his book entitled “Yi Xue Zhong Zhong Can Xi Lu (Records of Chinese Medicine with Reference to Western Medicine): Treatment of Ge Shi Disorders膈食病 ” and said: “ The patient can only swallow brittle food to be taken with water … when vomiting there is copious phlegm.” This is similar to early stage of esophageal cancer with subjective feeling of difficulty in swallowing. In his case studies, he nominated Shen Zhe Pei Qi Tang 参赭培气汤 as a key formula to treat esophageal cancer. This formula is indicated for patients suffering from counterflow of stomach qi due to weakening of the middle qi and accompanied by phlegm manifested as Ye Ge (difficulty in swallowing). As for the aetiology and pathogenesis, Zhang advocated that this is due to deficiency of the middle qi with subsequent generation of phlegm causing obstruction and congestion. In his latter years, Zhang said that in stomach cancer, apart from weakness of the middle qi with phlegm obstruction, there would also be blood stasis. Hence, the key treatment strategy of Ye Ge (oesophageal cancer) is to tonify the middle qi and invigorate blood. The recommended formula is Shen Zhe Pei Qi Tang (Dang Shen 6 qian; Tian Dong 4 qian; Qing Ban Xia 3 qian; Rou Cong Rong 4 qian; Zhi Mu 5 qian; Dang Gui Shen 3 qian; Shi Bing Xiang 3 qian. For blood stasis, add San Leng and Tao Ren 2 qian each.

Analysis: Ren Shen tonifies the middle qi; Dai Zhe Shi, Ban Xia, Shi Xiang downbear counterflow and sedate the upsurge qi; Zhi Mu, Tian Dong, Dang Gui clear heat and moisten dryness with the objective to counteract the heat and dryness of Ren Shen and Ban Xia. Rou Cong Rong tonifies the kidney and astringes the counterflow to enable the descending of the stomach qi. Most of the stomach cancer patients tend to suffer from difficult bowel movement, hence Dang Gui and Zhi Shi are included to moisten the intestines. In short, the treatment strategy for stomach cancer is to tonify the middle qi, downbear counterflow and sedate the upsurge coupled with transforming phlegm and regulating qi.

Professor Chen Bao Gui 陈宝贵教授 is a second generation disciple of Zhang Xi Chun. He studied under Liu Xue Zhu 柳学洙 who was the last disciple of Zhang Xi Chun.

Professor Chen is the head of the Chen Bao Gui Research Centre at the Wu Qing Chinese Medicine Hospital in Tianjin, an affiliated hospital of the Tianjin University of Chinese Medicine. Professor Chen Bao Gui specialises in the management of many gastro-intestinal disorders including stomach and esophageal cancers. His key treatment principle is to tonify qi, downbear counterflow and transform phlegm coupled with blood invigorating strategy. For tonifying qi, he uses Hong Ren Shen or Dang Shen; for downbearing counterflow, he uses Ban Xia, Hou Po, Zhi Shi and Dai Zhe Shi while Gua Lou, Zhe Bei Mu and Xuan Fu Hua are used to transform phlegm. As for blood invigorating, Professor Chen uses Tao Ren, Hong Hua, San Leng, Er Zhu for milder blood stagnation and Shui Zhi and Tu Bie Chong for more serious blood stagnation with stasis. The above strategy can be applied to treat a plethora of western diseases such as esophageal cancer, esophagitis, esophageal stenosis, esophageal ulcer and cardia spasm.

Case study of Professor Chen Bao Gui

Wang x, 61 year-old male patient

First consultation: 12th October 2012

The patient consulted Professor Chen due to pain and a subjective oppression behind the sternum during the past three months particularly after a meal.

S/S: Discomfort behind the sternum especially after eating, occasional vomiting after ingestion of food, difficult bowel movement, pale and dull tongue with white and slightly greasy tongue coat and a wiry and thready pulse.

Endoscopy confirmed esophagitis and Barrett syndrome.

Diagnosis: Qi deficiency with blood stasis; counterflow stomach qi

Treatment: Tonify qi, transform blood stasis, harmonize the stomach and downbear counterflow.

Qing Ban Xia 10g; Xie Bai 10g; Gua Lou 15g; Dang Shen 20g; Mai Dong 10g; Dai Zhe Shi 20g; Hou Po 10g; Rou Cong Rong 10g; Dang Gui 10g; Xuan Fu Hua 10g; Er Zhu 10g; Tao Ren 10g; Chuan Xiong 10g; Sha Ren 6g. 1 pack. Decoct in 600 ml water. Take warm three times daily.

Second consultation: 19th October 2012

There was slight improvement after one pack of medication with occasional hi-cough add Zhi Qiao 15g. 7 packs.

Third consultation: 26th October 2012

Most of his symptoms abated. Add Xiang Fu 10g to the formula to consolidate. 14 packs.

The patient continued with the same medication for another month.

Three months later, it was diagnosed as superficial gastritis by endoscopy. After the medication, instead of the intial diagnosis of Barrett esophgus, he is now diagnosed as superficial gastritis. Barrett’s esophagus refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by simple columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract). The medical significance of Barrett’s esophagus is its strong association (about 0.5% per patient-year) with esophageal adenocarcinoma, a very deadly cancer, because of which it is considered to be a premalignant condition.

Discussion: The patient complained of subjective blockage and oppression after a meal. This was in keeping with reflux esophagitis caused by esophageal mucosa edema. Professor Chen was mindful of a suspected Barrett syndrome. Based on the tongue sign, the diagnosis is qi deficiency with blood stasis causing subsequent stomach qi counterflow. Gua Lou Xie Bai Ban Xia Tang + Shen Zhe Pei Qi Tang modified was prescribed. Gua Lou, Xie Bai and Ban Xia loosen the chest and disperse the bind, downbear counterflow and harmonize the stomach; Shen Zhe Pei Qi Tang tonifies qi, transforms stasis, harmonizes the stomach and regulates qi. With the addition of Er Zhu, Tao Ren, Chuan Xiong, the function of transforming stasis is enhanced. The patient took the medication for more than two months.

 

  1. Treatment of Stroke: Zhang Xi Chun created Zhen Gan Xi Feng Tang 振肝熄风汤 for treatment of wind stroke also known as “nei zhong feng or internal stroke”as described in Zhang Xi Chun’s book characterized by a wiry, long and forceful pulse or simply a pattern of excess in the upper with deficiency in the lower characterized by vertigo, tinnitus or heart vexation with fever or frequent hi-coughs. gradual weakening of the body and limbs or deviated eyes and mouth, flushed complexion, lethargy and fatigue. All of the above is under the scope of “nei zhong feng”. In the Zhen Gan Xi Feng Tang, the dosages are: Niu Xi is 1 liang, Sheng Zhe Shi 1 liang; Sheng Long Gu 5 qian ; Sheng Mu Li 5 qian; Chuam Lian Zi 2 qian; Sheng Gui Ban 5 qian; Xuan Shen 5 qian; Sheng Bai Shao 5 qian; Tian Dong 5 qian; Sheng Mai Ya 2 qian; Yin Chen 2 qian and Gan Cao 1.5 qian. For heart vexation, add 1 liang Sheng Shi Gao; for excessive phlegm, add Dan Nan Xing 2 qian; for weak chi pulse, add Shu Di Huang 8 qian and Shan Yu Rou 5 qian. If the bowel movement is sloppy, omit Gui Ban and add Chi Shi Zhi 1 liang. Zhang Xi Chun said that the liver belongs to wood and if the wood fire is exuberant, this may generate endogenous wind. Niu Xi induces the blood to travel downward; Long Gu, Mu Li, Gui Ban and Shao Yao suppress the hyperactive liver yang and extinguish fire; Dai Zhe Shi downbears stomach qi upsurge while Xuan Shen and Tian Dong clear lung heat and facilitate lung qi to downbear. The root cause of this pattern is yin deficiency. Hence, Gui Ban and Bai Shao are added to nourish yin to restrain the yang while Xuan Shen and Tian Dong nourish yin to clear heat, adopting a strategy known as “nourishing water to moisten the wood”. Shu Di and Shan Yu Rou are used for the deficiency of true yin with inability to interact with the true yang. Mai Ya, Yin Chen and Chuan Lian Zi are incorporated to clear liver heat and soothe the liver qi. Shi Gao is added to clear constrained heat while Dan Nan Xing can transform phlegm.
  2. Theory on “Da Qi or Ancestral Qi”: Zhang Xi Chun regarded the health of the “Da Qi” hinges on water and essence of grain to nourish and maintain the health and normal function of the Da Qi; deficiency of the adequate nourishment of water and grain will result in the sinking of the Da Qi. The basic pathology of sinking Da Qi is qi deficiency irrespective of whatever the causes for the Da Qi to sink. The main function of Da Qi is to lift the qi of the heart and lung with ensuing circulation of qi and blood. A mild condition of Da Qi sinking will affect the heart and lung’s normal function while a more serious condition will cause sudden death. Contemporary diseases associated with sinking Da Qi are coronary heart diseases, viral myocarditis, hypotension, wheezing, cough, myasthenia gravis, prolapse of the uterus and anus; spotting and excessive menstruation. Treatment of sinking Da Qi is Sheng Xian Tang. Ingredients of Sheng Xian Tang are: Sheng Huang Qi 18g; Zhi Mu 9g; Chai Hu 4.5g; Jie Geng 4.5g; Sheng Ma 3g.

Discussion: The large dosage of Huang Qi tonifies qi and lifts the sinking qi; the warm property of Huang Qi is negated by Zhi Mu which is cool and moistening to prevent the damage to the yin fluid; Chai Hu is a Shao Yang herb to guide the Da qi to rise from the left; Sheng Ma is a Yang Ming herb to guide the Da qi to rise from the right; Jie Geng serves as a carrier to guide the herbs upwards to the chest. The combined effect of the formula is to  facilitate the sinking qi to return to the chest to govern respiration, and the qi transformation of the triple jiao.


About Professor Chen Bao Gui

Professor Chen Bao Gui 陈宝贵教授 is a second generation disciple of Zhang Xi Chun. He studied under Liu Xue Zhu 柳学洙 who was the last disciple of Zhang Xi Chun. Professor Chen is the head of the Chen Bao Gui Research Centre at the Wu Qing Chinese Medicine H… Read more »


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