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Yin Fire Scenarios (Li Dong-Yuan; Li Gao)


#1

I’ve been on a self-constructed formula for one month now. I’m at a point where I would appreciate some guidance in regards to recent changes in my health. Here’s some back-story:

For three years going, I have had regular liver-spleen disharmony (wood invading earth) with marked spleen deficiency and liver stagnation. For quite some time I’ve had diarrhea, fatigue, weight loss, and many other bowel issues (leaky gut). I have from time to time moderate blood deficiency, with simultaneous heat and cold. My liver has a history of assailing the heart spirit (I’ve had some pretty scary cardiac issues in the past, but have since calmed down significantly). My disease is long past the invasion and assimilation phase; it’s developed into a knotty, repurcussive, stubborn condition–an Yin fire scenario.

I’ve experienced a huge variety of ailments and symptoms since autoimmune onset. For the sake of efficiency I’ll mention the symptoms experienced in relation to certain time periods, mentioned later (scroll down).

I’m on a strict diet regimen of only select vegetables, fruits, cooking oils, meats, fish, and fermented products. I eat absolutely no processed foods, grains (including rice), or added sugars (beyond field honey). I cook every meal, peel the skin of every fruit and vegetable, eat only grass-fed meats, and organic produce. I ferment my own coconut water kefir, yogurt, and sauerkraut. I’m basically a homesteader! I’ve been eating this way for almost a year, but still have regular gut issues–mainly bloating (inflammation) and lots of foul-smelling gas. My dysbiosis is a serious issue, and this formula was planned to tackle this head-on.

One month ago I began a self-constructed decoction targeted to (1) supplement and boost the spleen, clear heat and drain fire–downbear turbid; upbear clear; (2) release exterior (anti-Gu: I have moderate-severe tested and diagnosed gut dysbiosis–I can provide these results on request if need be), dredge the liver; (3) dry dampness, resolve phlegm; (4) rectify the qi (primarily yang), counter ascending yang (assailing my lungs–I have thyroid disease so this entails a lot of inflammation, constriction, moodiness, heat, neurological dysfunction), nourish blood, warm the center, and calm the shen (anxiety)–respectively. The following prescription did the trick, with items that varied often indicated with a ** (for the first 3 weeks, keep in mind this has varied slightly over this period from day-to-day and I’ve kept records of these variations and my symptoms):

Tier ONE (supplement spleen, clear heat, etc.):

Bai Zhu (Chao) 9 g
Yi YI Ren 12 g
Dang Shen 12 g
Jiang Huang 9 g
Huang Qin 6 g**
Mu Xiang 3 g**
Gan Cao (Zhi) 3 g

Tier TWO (release exterior–kill Gu, dredge liver):

Chai Hu 9 g
Bai Shao 9 g**
Ge Gen 6 g**
Qing Hao 6 g
Fei Zi 9 g**
Wu Mei 9 g
Shi Jun Zi 12 g
Bing Lang 12 g
Huang Lian 9 g
Zi Su Ye 9 g
Niu Zhi (You) 9 drops
Olive Leaf Extract 1 cap

Tier THREE (dry dampness, resolve phlegm):

Zhi Shi 9 g**
Chen Pi 9 g**
Cang Zhu 4.5 g**

Tier FOUR (everything else):

Gan Jiang 6 g**
Ding Xiang 3 g
Bo He 3 g

(On a few occasions I used Ban Xia, Da Huang, and Mu Xiang circumstantially).


During the first day of my formula I had a Herxheimer reaction. This subsided within a few hours, and the next following few days my abdominal distention (lower epigastrium/lower burner) or “drum belly” was greatly reduced, and inflammation almost null. However, from then on I have been having most of my issues resolved with the exception of this drum belly and mainly very excessive and foul-smelling flatulence. So I continued on with the regimen until about a week ago (3 weeks into treatment) I was feeling well; diarrhea/loose stools had become solid and regular each day, epigastrium signs (difficulty breathing, palpitations, fullness) were resolved, and liver yang rising stopped happening (sinus, thyroid, swelling, anger) all improved. Checking my pulses, I discovered that liver was now smooth and untaught while heart had greatly reduced to normal. However, for the past week the epigastric and abdominal issues are resurfacing. Now the liver pulse is deficient and kidney yang is slightly wiry. BPM is still moderate–so no immediate signs of internal cold and/or heat. But my instinct tells me I might have squelched the fire too well and possibly extinguished ministerial fire via all the many cold, bitter medicinals.

It has been 30 days now on the particularly anti-fungal, anti-parasitic, anti-pathogenic herbs (Qing Hao, Fei Zi, Wu Mei, Shi Jun Zi, Bing Lang, Huang Lian, Zi Su Ye, Oregano oil, and Olive leaf extract). According to the functional medicine publication by Susan Blum (The Immune System Recovery Plan) she suggests taking organic compounds (almost all contained within this list of herbs) for a minimum of 2 weeks for mild dysbiosis, 1 month for moderate-severe, and 2 months maximum if gut issues are stubborn. Question is: are gut issues still stubborn? Has the pathogenic facet of my illness(es) been effectively dealt with or am I now dealing with a damp-cold problem? How can I resolve this phlegm in the lower burner so that I don’t completely dry out the rest of my body? Or could this phlegm simply be qi and/or food stagnation? If anyone is familiar with Yin-fire or Gu theories (Bob Flaws) please fill me in what I haven’t yet connected. How can the above aforementioned patterns be distinguished within these two theoretical contexts?

As I’m going to stop taking the bitter, cold anti-Gu anti-pathogenic medicinals I’m wondering just what ratio of warm/cool my revised formula should now exhibit.


#2

In your own words you seem to indicate that you were doing quite well overall. Ideally you would not stay on any particular formula, particularly as good as you indicate your diet is. So if you are feeling much better, perhaps try nothing for awhile, see how just your diet can aid you (and exercise, meditation, etc.) and then if you start having trouble weeks/months from now evaluate what is going on and work with it then. For us a picture of your tongue would be helpful or at least a verbal description - particularly as the pulse is widely subjective - most notably when someone is taking their own pulse.

Most of these layered conditions are a process and they can be difficult to resolve completely and yin fire is a indication of how complex and layered these conditions. That said, not everyone agrees with the general diagnosis or with the methodology of treatment. Generally speaking you clear the dampness first and then work on the deficiencies whether they be yin and/or qi. But in clinical reality you usually have to clear a little, build a little, clear a little, build, until you get the body in a more maintainable balance.

All that said, I would stick to extremely basic formulas with very precise actions if I were to use herbs at all. For example, trying to “clear heat” and then “tonify the spleen” at the same time (even though that is loosely what Li Dong Yuan seemed to indicate) will often further confuse the systems in the body. With these types of conditions and with sensitive systems you need very basic and very clear instructions to be provided to the body. Assaulting your body with complex formulas rarely clears these kinds of conditions up over the long term. In short, try to do as much as humanely possible with diet and lifestyle changes and only use herbs in short periods of time with a very specific idea of what you are trying to improve at that moment. Moxa at CV 4 would also be warranted.


#3

–Done.

About the pulses: in addition to noting my own pulse changes throughout each day and week, a practitioner I see in town confirms these. He actually frowned in confusion once he felt the liver, because for the last year or so it’s always been taught and excessive. Within the past seven days it has been quite weak. In fact, it’s the weakest of all six pulses. It’s almost as if the liver and spleen have switched places. However, within the past two days in particular the liver and spleen are both on the weak end; they’re only registered on deep palpation. It’s no coincidence that within these same last two days that I’ve had considerable pain in my abdomen that I haven’t felt in more than a year now. I also had a soft stool today–not expected whatsoever. I’ll be on the lookout for see-sawing constipation-diarrhea. Today, I had an episode of extreme fatigue accompanied by dizziness, vertigo, and slight heat rush. I imagine this is liver yang, but could I exhibit concomitant liver yang rising via stagnation and liver yin deficiency? Perhaps the signs are all suggesting that by overusing pungent, bitter, and cold medicinals I’ve only added insult to injury for stagnation.

–Although I’d love to hanker down on a simple formula, I’m however quite reluctant to follow this ideology because it hasn’t worked for me in the near-past. It made things worse, actually. I had taken a week or two of Ban Xia Xie Xin Tang and had resolved some issues but they had quickly returned in full swing. Then early in January of this year I began Xiao Yao San with added Dang Shen for severe spleen deficiency. This tang aims to free the liver and supplement the spleen–respectfully. It does not account for internal heat brewing, especially runaway ministerial fire as in the yin fire scenario. In my case it was clear that the sweetness (especially of Zhi Gan Cao) only fueled the flames of my lower burner causing severe bloating, indigestion, and gas. My anger was twofold and outbursts much more frequent. Depression hit hard. “Do not supplement until evils have been eliminated…unless the righteous qi has been damaged” rings Bob in my head. To the best of my knowledge ministerial fire always consumes the righteous qi. This ties in with one of my fundamental questions: how can I differentiate between a plausible present damp-cold issue (as the result of too much fire-squelching) and any evils (pathogens; Gu) which may have resisted my gunfire barrage? Nothing tells me that I have any issues with the exterior and that everything is interior, so I must be certain that it is indeed damp-cold–right? (Flaws suggests that qi-rectifiers and exterior-resolvers are closely-related–so it is farfetched to speculate that all of this out-thrusting may be the cause of a deplete liver pulse?). I can however be certain that despite supplementing the spleen I may not be proportionally freeing the qi mechanism at the same time, simply pouring damp earth onto the lower burner (which is why I have the belly and body of a starving child in a developing nation; emaciated with a ballooned abdomen). So, how can I upbear the clear without further engendering dampness?

–I would agree with you that an yin fire scenario is complex, but I disagree that the layers metaphor can adequately describe these modern, knotty diseases (quoting Bob Flaws): “In complex, multi-pattern presentations, you cannot “peel the layers of an onion”… [because] there are no layers.” According to Li yin fire disease mechanisms are mutually engendering (相生). Li also stresses that if there are symptoms of hot and cold, dampness and dryness, vacuity and repletion at the same time then this implies either (A) concomitant blood, yin, and/or fluid vacuities; (B) heat disturbing the lungs or heart; and © kidney yang vacuity exist simultaneous with (1) spleen vacuity; (2) inhibition of qi (read: stagnation); and (3) either depressive or damp heat–in this order of impact. Therefore (quoting Flaws again): “…one must write complex formulas which treat all the disease mechanisms at the same time, not one after the other.” I truly appreciate your input and clinical experience, but personally I cannot ignore the realization that what you suggest and these texts suggest are worlds apart, adding to my sense of uncertainty.


#4

This is going to sound slightly passive aggressive, but I assure you it is not meant that way - just my honest opinion. I do disagree with most of your approaches thus far, particularly your herbal choices, although, to be fair, it is hard to say exactly not knowing your entire medical history and how you have changed over the years. And I’m 1000% open to the fact that just because I disagree with an approach doesn’t mean it won’t work. But with your reliance on Bob’s work, why don’t you make an appointment with him and ask him these questions. You can reach him via his website and perhaps he can work with you herbally. I’d personally be curious not what his response is, but what actually happens after say 3 months of following his advice.

From my viewpoint, when you are not doing well and haven’t improved in fundamental terms in years, yet you want to immediately set aside everything I’ve stated - there is little for me to add to that. Just keep in mind that we are, at least on some level, fundamentally different people than when much of TCM was being developed. So an eyes wide open approach is how we approach things and we do quite well with that. Sometimes we just want so hard to believe that TCM has all the answers as it was written and it doesn’t. And that we can explain every relationship - and we can’t. We are simply too complex and in modern times particularly there are too many variables that need to be accounted for. This is a huge part of our overall less is more approach, particularly with any chronic and/or autoimmune conditions. I have personally never seen a complex condition do well with strong approaches - particularly herbally. To the point, for most of these conditions we don’t use any herbs at all for the reasons I presented in my previous comments. We prefer lifestyle and dietary change, meditation and qi gong when appropriate - along with acupuncture.

So I do wish you the best and am open to constructive dialogue, but I hope you get in touch with Bob and get a consult with him. Please report back when you have done so and have a response to his recommendations - say after a couple months.


#5

I had a feeling you may receive my reply in this way. I truly appreciate your input. I apologize if I stepped on your toes with the references to Bob. It’s just that I’ve versed myself in his materials when I started taking the herbs seriously. This was in January of this year. To be honest, I should give myself more credit and give you more back-story than what I’ve divulged here:

I was living in Taiwan from 2012 to 2013. During the transition from the first year to the next, I suffered a heart attack (I’m 27 years old). Long-story-short, symptoms kept piling on and worsening, I spent 7 straight months seeking standard medical attention to no avail when finally I received a diagnosis only after being hospitalized and poked and prodded for clues (2 weeks in the hospital). After receiving this news, my doc literally told me “I don’t think [Western] medicine can help you.” I packed up and returned to the US, not knowing much about the nature and “origins” of autoimmunity. I was overly confident that our health systems would be more versed–and therefore more capable–of curing me. Although I still believe a cure exists, I doubt it is easily and/or often achieved.

Since returning to the US, I made my first changes to the diet early 2014. In retrospect, these were basic at the time–primarily no gluten, corn, dairy, or soy. I followed the protocol laid forth by Susan Blum (M.D.) in her publication “The Immune System Recovery Plan.” I figured if she cured herself of Hashimoto’s (also what I have according to standardized diagnosis procedures) so can I. I’ve now come to realize that it doesn’t really matter what “type” of autoimmune disease you have because all of them are really just colors or shades of the same monster.

Any-who, I kept running into a wall on this diet. As time went by I revised it further, looking at other variables beyond the composition of what I ate; how it’s prepared, what proportions, etc. So this is how I’ve come to the current diet I’m on now reflective of my initial comment on this thread (the topic post).

I regularly test with Genova Diagnostechs on stool composition–metabolic and pathological panels mostly. Consistently throughout testing this last year it shows I have a NULL value of lactobacillis species. This concerns my [TCM] practitioner and myself the most, because we both understand that gut health is pivotal to the recovery of all other systems–and therefore total recovery. The results of these tests and the symptoms I’ve experienced up until now clearly coincide with antibiotic use; overly-adventurous eating (too much street food); extreme taxation; chronic drug, alcohol, and tobacco use; genetic predisposition (I consult with an expert in Methylation Genetics) via the 23 chromosome report; and other questionable life choices. Since returning to the US, the gut-related symptoms are primary with fatigue, inflammation (swelling and discomfort–including taxed breathing and hypochondria-related issues), and psychological distress (anxiety, bipolarism, depression) following suit, respectively. The severe cardiac distress (tachycardia, arrhythmia, mitral valve prolapse) don’t happen nearly as often or consistently as they had in Taiwan.

What do you think of my tongue? Anything remarkable?

Regarding your disposition on modernity: I would have to agree with you in general, however it’s a fine line to traverse between the foundation of TCM and everything we know from the classics and today’s modern TCM, which makes amendments. To be honest, the complex formula and Flaws is a far cry from the classics–and on-par with what you suggest. I guess I can only say that I’m apprehensive mostly because I greatly fear “dropping the ball” and ruining the last few months (and in bigger perspective these last 9 months) of progress. I also question whether or not any progress has been made, ironically. Chronic disease is difficult to gauge especially when I cannot objectively assess myself since it is my own body, sensations, mentality, and emotions. I keep a log but have since learned not to embellish in its tendency to embody OCD tendencies.

I would love a consult from Bob. However, I’m currently in Minneosta and without much mobility or capital–it’s a long process waiting for disability. Perhaps I can gain his attention long-enough to hear me out in asking for his two cents. Any advice? If I do get a hold of him I will absolutely contribute my findings here for further constructive discussion. I’d also like to see other comment on this thread for some variety–it never hurts.

If I don’t hear from you tomorrow, have a wonderful weekend and again thank you very much for your insight.

Cheers :beers: and namaste :v:


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