shanghanlun

When not to use Cinnamon Twig Decoction…

By Fornia ⋅ March 7, 2008 ⋅  Print This Post ⋅ Post a comment

1. When the patient has an exterior pattern, but it’s an Ephedra-type pattern.
2. When the patient is a heavy drinker, he’ll vomit upon consuming it.
3. When the patient abundant with internal heat, he’ll not just vomit, he’ll go on to vomit blood!

To explain (1.):

桂枝本为解肌，若其人脉浮紧，发热汗不出者，不可与之也。 (line 16b)

Let’s first consider the individual herbs 麻黄 and 桂枝. Both are warm herbs, but they do different things. 麻黄 is able to ventilate the lungs (beta2 receptor agonist) while at the same time reduce flooding in there (alpha1 receptor agonist). 桂枝 on the other hand increases peripheral circulation, amongst other things. Used together (in effect, 麻黄汤), they are perfect for a situation of constriction, where the patient’s body is accumulating ongoing cascade of immune and biochemical reactions to an infection, but somehow doesn’t find the release and supposed pathogenic expulsion facilitated by sweating, increased breath intake and enhanced diuresis.

If we provide 桂枝汤 instead, it’s a mistake. The second part of line 16 just says “it’s a mistake to do it,” and the simple explanation to that would be that “it’s because it’s a Ephedra Decoction pattern, dude!” However, let’s think a little more and at least try to come up with something that is at theoretically reasonable.

My take: Giving Cinnamon Twig Decoction is akin to trying to blast open a heated room so as to create enough openings for the temperature to reach something normal. So we throw in several grenades and they all explode, but are not powerful enough to blast open the walls of the room. These grenades are made up of Cinnamon Twig only, and would have been more powerful if made with a combination of Cinnamon Twig and Ephedra. These Cinnamon Twig grenades end up heating up the room even more, to its own detriment. Add on to that the sealing effect of Peony (芍药) that’s like spray on cement that helps bind the wall into itself.

We need the Cinnamon Twig and Ephedra combination grenade. It will blast open the heated room.

To explain (2.):

I’m sure there’s at least some biochemical explanation for this, but what I have here is the TCM one:

酒客不喜甘故也。 (line 17)

桂枝 is consider to be sweet in nature. And this line says that heavy drinkers don’t like sweet stuff.

Also mentioned by my Shanghanlun teacher is his observation that heavy drinkers in banquets here will usually not consume the desserts and sweets while dining. Another observation is that heavy drinkers [and i guess those who have the bodily constitution to drink alot] do not usually suffer from 桂枝汤 patterns. We know that 酒能助湿助热 and so these people are more likely (if his observed assumption holds true) to have more damp-heat accumulated.

Does that somehow link to less of a liking for sweet flavors?

To explain (3.):

凡服桂枝汤吐者，其后必吐脓血。 (line 19)

In the textbook published by 中国中医药出版社, we have line 19 which says that if someone consumes 桂枝汤 and vomits, he’ll go on to vomit blood. This is not comparing 桂枝汤 to 麻黄汤, both of which are for relieving the exterior. Rather, it’s saying that you’d better not use a warm decoction when the patient is suffering from a pattern of internal heat.

Which makes sense.

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