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Chinese medicine: Wu Mei Wan and diarrhea due to irritable bowel syndrome.

Keywords: Chinese medicine, Chinese herbal medicine, gastroenterology, irritable bowel syndrome (IBS), diarrhea, Wu Mei Wan

Wu Mei Wan (Mume Pill) comes from Zhang Zhongjing's late Han dynasty Shan Han Lun (Treatise on Damage [Due to] Cold) where it is indicated for a jue yin aspect condition. Zhang's original formula consists of:

Wu Mei (Fructus Mume)

Xi Xin (Herba Asari)

Gan Jiang (dry Rhizoma Zingiberis)

Huang Lian (Rhizoma Coptidis)

Fu Zi (Radix Lateralis Praeparata Aconiti)

Dang Gui (Radix Angelicae Sinensis)

Huang Bai (Cortex Phellodendri)

Gui Zhi (Ramulus Cinnamomi)

Ren Shen (Radix Ginseng)

Chuan Jiao (Fructus Zanthoxyli)

However, over the ensuing 1800 years, this formula is mostly memorized by beginners as Chinese medicine's main formula for dispelling parasites and, more specifically, roundworms in the bile duct. However, there is much more to this formula than that, and its scope of indications is actually quite wide. In fact, Wu Mei Wan is a common subject within the "new uses" and "lifting the borders" genres of articles in contemporary Chinese medical journals. These types of articles take a classical formula and then show how it is also effective for a number of "off-label" conditions. Typically, the articles make their point by presenting several case histories showing how the author(s) used a well-known formula for a variety of conditions not among the formula's beginner's textbook indications.

[ILLUSTRATION OMITTED]

Although Wu Mei Wan is usually categorized as a parasite-dispelling formula in most "formulas and prescriptions" (fang ji xue) texts, it actually functions as a harmonizing formula. This is because it treats both hot and cold, qi and blood at the same time; it supports the righteous while dispelling evils, it supplements and clears; and, most importantly, it regulates the liver while simultaneously harmonizing the spleen. Interestingly, a liver-spleen disharmony is the sine qua non of irritable bowel syndrome. Further, when irritable bowel syndrome (IBS) causes diarrhea, there is typically both hot and cold at the same time. In other words, the spleen (yang) qi is vacuous (and therefore cold), while the stomach and intestines are hot (as in damp heat) or there is depressive heat harassing the heart above. Thus this formula can be used to treat these patterns of IBS. This is exactly what Liu Xiang-hong, Zhou Yu-Ian, and Wang Shang-jie describe in their article titled "Wu Mei Wan (Tang) with Additions & Subtractions in the Treatment of Diarrhea-pattern Irritable Bowel Syndrome." This article appears on pages 474-475 of issue 6, 2008, of Beijing Zhong Yi Yao (Beijing Chinese Medicine & Pharmacology). A summary of these doctors' three case histories all using modified Wu Mei Wan is presented below.

Case 1

The patient was a 34-year-old male who was first examined on May 12, 2006. For the last 10 years, this man had experienced recurrent bouts of abdominal pain and diarrhea. They were both worse each time after drinking alcohol. During chilly weather, the diarrhea was also markedly worse. Common accompanying signs and symptoms included dizziness, headache, a bitter taste in the mouth, lassitude of the body, lack of strength, sore low back, cold feet, a sagging sensation in the lower abdomen when the condition was worse, and diarrhea or loose stools 3 to 10 times per day. The patient's tongue was pale with thin, white fur, and his pulse was deep and bowstring. Based on these findings, the man's pattern was discriminated as a liver-spleen disharmony with wood-fire internally blazing. Therefore, he was prescribed the following version of modified Wu Mei Wan:

Wu Mei (Fructus Mume), 15g

Gui Zhi (Ramulus Cinnamomi), 10g

Gan Jiang (dry Rhizoma Zingiberis), 10g

Huang Lian (Rhizoma Coptidis), 10g

Huang Qin (Radix Scutellariae), 10g

Fu Zi (Radix Lateralis Praeparata Aconiti), 10g

Tai Zi Shen (Radix Pseudostellariae), 15g

Dang Gui (Radix Angelicae Sinensis), 10g

Xi Xin (Herba Asari), 3g

Chuan Jiao (Fructus Zanthoxyli), 5g

Suan Zao Ren (Semen Zizyphi Spinosae), 30g

Fu Ling (Poria), 20g

Bai Zhi (Radix Angelicae Dahuricae), 15g

Five packets of these medicinals were prescribed, decocted in water, and orally administered at a rate of one packet per day. After taking these medicinals, the man's abdominal pain and diarrhea were markedly improved. He now defecated two times per day, although these stools were still somewhat loose. In addition, his dizziness had improved and the bitter taste in his mouth was less. Therefore, another 10 packets of the same formula were prescribed, after which all the abdominal pain and diarrhea had disappeared. Now he defecated once per day and his stools were formed. Several more packets of the same formula were prescribed in order to consolidate the therapeutic effects.

Case 2

The patient was a 59-year-old female who was first examined in June 6, 2006. This woman also had had chronic, recurrent diarrhea for 10 years. However, this had gotten worse in the last year. She had diarrhea 305 times per day with loose, watery stools. There was also insidious abdominal pain with a sagging, distended feeling This was accompanied by low back soreness, cold feet heart vexation, tired eyes, lassitude of the body, insomnia occasional throat dryness and pain, and dizziness. The woman had a pale tongue with white fur and a bowstring, rapid pulse. Based on these findings, her pattern was discriminated as liver depression-spleen vacuity with ascension of depressive heat and a simple spleen vacuity having evolved over a long time into a spleen-kidney dual vacuity. Therefore, she was prescribed the following modification of Wu Mei Wan:

Wu Mei (Fructus Mume), 15g

Gui Zhi (Ramulus Cinnamomi), 10g

Gan Jiang (dry Rhizoma Zingiberis), 10g

Fu Zi (Radix Lateralis Praeparata Aconiti), 6g

Dang Gui (Radix Angelicae Sinensis), 10g

Ren Shen (Radix Ginseng), 10g

Xi Xin (Herba Asari), 3g

stir-fried Suan Zao Ren (Semen Zizyphi Spinosae), 15g

Huang Lian (Rhizoma Coptidis), 6g

Fu Ling (Poria), 30g

Zhi Mu (Rhizoma Anemarrhenae), 10g

E Jiao (Gelatinum Corii Asini), 10g

Seven packets of these medicinals were prescribed to be decocted in water and orally administered. After taking these medicinals, the patient's abdominal pain and diarrhea were both less. She still had bowel movements 2 to 3 times per day, but the stools were now formed. The lassitude of the body, lack of strength, and tired eyes were all improved. Therefore, Dang Gui was removed from the above formula and 20 grams of stir-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae) were added. After taking 10 packets of these medicinals, the woman was cured, meaning that she now had 1 to 2 bowel movements per day and her stools were formed.

Case 3

The patient was a 40-year-old male who was first examined on October 7, 2006. This patient had a long-time habit of drinking alcohol every day, along with a history of gallstone surgery. In the last two years, the man constantly experienced abdominal distention that was worse whenever he drank alcohol. This was accompanied by abdominal pain and diarrhea with 6 to 10 movements per day. These stools were soft and contained mucus. Other symptoms included a bitter taste in the mouth; a sticky, slimy feeling in the mouth; a dry, sore throat; a dark red tongue with thick, slimy, white fur; and a bowstring, slippery pulse. Based on this, the man's pattern was discriminated as liver depression-spleen vacuity with hot above and cold below. Thus he was prescribed the following modification of Wu Mei Wan:

Wu Mei (Fructus Mume), 15g

Gui Zhi (Ramulus Cinnamomi), 10g

Gan Jiang (dry Rhizoma Zingiberis), 10g

Fu Zi (Radix Lateralis Praeparata Aconiti), 10g

Dang Gui (Radix Angelicae Sinensis), 10g

Tai Zi Shen (Radix Pseudostellariae), l0g

Xi Xin (Herba Asari), 3g

Yan Hu Suo (Rhizoma Corydalis), 15g

Huang Qin (Radix Scutellariae), 10g

Huang Qin (Rhizoma Coptidis), 10g

Fu Ling (Poria), 20g

Seven packets of these medicinals were prescribed to be decocted in water and taken orally. After taking these medicinals, the abdominal pain and diarrhea were reduced and the sore throat and sticky mouth were improved. Therefore another seven packets of the same formula were prescribed, and the patient was forbidden to drink alcohol or to eat uncooked, chilled foods. After taking this second seven packets, the abdominal pain and diarrhea had disappeared and his stool were now formed, with 1 to 2 bowel movements per day. The patient's tongue was pale red with thin, white fur (i.e., normal). Huang Qin was removed from the previous formula and 10 grams of Zhi Qiao (Fructus Aurantii) were added in order to consolidate the therapeutic effect. One month later, the man was basically cured.

Discussion

Wu Mei Wan is a much more clinically important formula than our beginner's textbooks suggest. While this formula should be the first one thought of when there is biliary ascariasis, it has a much wider scope of application. Like Xiao Chai Hu Tang (Minor Bupleurum Decoction), Ban Xia Xie Xin Tang (Pinellia Drain the Heart Decoction), Can Cao Xie Xin Tang (Licorice Drain the Heart Decoction), and Sheng Jiang Xie Xin Tang (Uncooked Ginger Drain the Heart Decoction), Wu Mei Wan functions as a harmonizing formula that treats hot and cold at the same time. Since many chronic digestive complaints involve a mixture of vacuity and repletion, hot and cold at the same time, Wu Mei Wan should always be kept in mind as a potential guiding formula in cases of a liver-spleen disharmony with depressive or damp heat. As the above case histories show, this formula can then be modified with elements of any of the other above-mentioned harmonizing formulas as well as ingredients for other concomitant patterns. So do not overlook this formula just because you learned it as the main formula for parasites. The classroom is one thing; real-life clinical practice is another.

Copyright[C] Blue Poppy Press, 2008. All rights reserved.

by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

www.bluepoppy.com
COPYRIGHT 2009 The Townsend Letter Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

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Author:Flaws, Bob
Publication:Townsend Letter
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Geographic Code:9CHIN
Date:Oct 1, 2009
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