Case from Fei Sheng-Fu (费绳甫）

Mr. Wu from northern Jiangsu [suffered] from Liver wood encroaching the Spleen until only it’s [qi] was present in the abdomen  致成單腹. The abdomen was distended like a drum, the umbilicus protruded outward, the tendons were blue. The back was normal but the waist full. This constituted a dangerous pattern. In this situation [the appropriate strategy] is to curb wood and support earth, unblock with warming [medicinals], and leach out dampness. Prescription was:

** Translated by: Volker Scheid

Volker’s Commentary: Read together with the previous case, this record from FSF’s case histories further illustrates the importance of the middle burner at the centre of the qi dynamic and of fluid metabolism. The situation is described as dangerous because both the qi and yang of the middle burner have collapsed. Movement and transformation have come to a standstill, hence the position of earth is seized by wood. This is visibly manifest in the protruding umbilicus, representing Spleen earth, which is pushed upwards by Liver qi. The treatment therefore is aimed directly and only at the middle burner employing a combined strategy of warming in order to reignite transformative process, acrid downward moving in order to break up stasis, and leaching out of excess dampness from the middle burner. The core formula used for this purpose is modified Bolster the Spleen Drink (shí pí yîn), which in turn builds on True Warrior Decoction (zhën wû täng) and Three-Substance Decoction with Magnolia Bark (hòu pò sän wù täng). Even here, however, FSF takes account of the role and relation between Liver and Lungs, qi and blood. This explains his use of Angelicae sinensis Radix (däng guï), on the one hand, and of Benincasae Semen (döng guä zî) and Coicis Semen (yì yî rén) on the other, which together with Amomi Fructus rotundus (bái dòu kòu) and Magnoliae officinalis Cortex (hòu pò) suggest the intention of Three-Seed Decoction (sän rén täng).

Thus, like his grandfather, FSF skillfully interweaves cold damage and warm pathogen strategies to realize the principles of harmonization and moderation even in a strongly warming and draining prescription.”

Original case by: Fei Bo-Xiong (费伯雄)

[1st Visit]: Qi deficiency with fullness of the middle [burner]. The abdomen is distended and resistant to palpation. Both flanks are acutely painful, with focal distension and a stifling sensation in the chest and diaphragm. On getting up [in the morning] the patient feels well, but in the afternoon the stifling feeling becomes worse and the mood depressive. The stools are loose. The pulse is deep and wiry on the right, and wiry and rapid on the left. [Treatment will not be successful] unless one regulates and extends [the qi dynamic].

Citri reticulatae Pericarpium (chén pí) 3g, Pogostemonis/Agastaches Caulis (huò xiäng gêng) 4.5g, Polyporus (zhü líng) 9g, Poria rubra (chì fú líng) 9g, Arecae Pericarpium (dà fù pí) washed in alcohol 6g, Perillae Caulis (zî sü gêng), 6g, Alismatis Rhizoma (zé xiè) 6g, Amomi Fructus rotundus (bái dòu kòu) (pounded and with kernels removed) 2 pcs, Asari Radix et Rhizoma (xì xïn) 0.6g, burnt Atractylodis Rhizoma (cäng zhú) 3g, Trichosanthis Pericarpium (guä lóu pí) 9g, Toosendan Fructus (chuän liàn zî) 6g, Zingiberis Rhizomatis Cortex (shëng jiäng pí) 6g

2nd Visit: The abdominal distension is reduced and more comfortable, and the chest also feels more relaxed. I follow the above strategy with some modifications.

Paeoniae Radix alba (bái sháo) 6g, Aurantii Fructus (zhî ké) 3g, Schisandrae Fructus (wû wèi zî) 1.5g, Glycyrrhizae Radix preparata (zhì gän câo) 1.8g, Trichosanthis Pericarpium (guä lóu pí) 9g, Zingiberis Rhizomatis Cortex (shëng jiäng pí) 6g, Perillae Caulis (zî sü gêng), 6g, Pogostemonis/Agastaches Caulis (huò xiäng gêng) 6g, houpi 4.5g, Bupleuri Radix (chái hú) 9g, Acanthopanacis Cortex (wû jiä pí) 6g, Arecae Pericarpium (dà fù pí) washed in alcohol 9g, Citri reticulatae Pericarpium (chén pí) 3g, Mori Cortex (säng bái pí) 9g, Poriae Cutis (fú líng pí) 9g, Corydalis Rhizoma (yán hú suô) 6g

3rd Visit: The abdominal distension continues to be dispersed, the pulse also is gradually coming to 醒 [awakening-JB], the tongue coating has changed, from which the generally [positive] momentum [of the treatment] can be determined. I continue with clearing and dredging.

The previous prescription plus Adenophorae Radix (nán shä shën) 6g, Glehniae Radix (bêi shä shën) 6g, honey-fried Farfarae Flos (kuân döng huä) 6g, Benincasae Exocarpium (döng guä pí) 9g, Aucklandiae Radix (mù xiäng) 1.5g, Amomi Fructus (shä rén) 3g, Akebiae Caulis (mù töng) 4.5g Citri reticulatae viride Pericarpium (qïng pí) 3g, Zanthoxyli Pericarpium (huä jiäo) 2.4g

4th Visit: The abdominal distension has further decreased from the previous visit, chest and upper abdomen are also more comfortable. Only, the [patient’s] strength remains insufficient so that he finds it difficult to walk. [The appropriate strategy] is to support earth and build up the original [qi].

Angelicae sinensis Radix (däng guï) 6g, Chuanxiong Rhizoma (chuän xiöng) 3g, burnt Atractylodis macrocephalae Rhizoma (bái zhú) 4.5g, Poriae Cutis (fú líng pí) 9g, honey-fried Astragali Radix (huáng qí) 4.5g, Citri reticulatae Pericarpium (chén pí) 3g, Zingiberis Rhizoma recens (shëng jiäng) 1 slice, Dendrobii Herba (shí hú) 9g, Citri reticulatae Exocarpium rubrum (jú hóng) 2.4g, fried Paeoniae Radix alba (bái sháo) 4.5g, Dipsaci Radix (xù duàn) 9g, Glycyrrhizae Radix preparata (zhì gän câo) 3g, Zanthoxyli Pericarpium (huä jiäo) 3g, Jujubae Fructus (dà zâo) 3 pcs

5th Visit: The abdominal distension has been removed, the qi dynamic has also been woken up. Merely walking is still [made difficult] by lack of strength. I continue [treatment] by building up earth and nourishing yin.

Glycyrrhizae Radix preparata (zhì gän câo) 3g, Jujubae Fructus (dà zâo) 3 pcs, Zingiberis Rhizoma recens (shëng jiäng) 2 slc, Codonopsis Radix (dâng shën) 6g, Moutan Cortex (mû dän pí) 6g, Pinelliae Rhizoma preparatum (zhì bàn xià) 4.5g, Corni Fructus (shän zhü yú) 6g, Poria (fú líng) 9g, burnt Atractylodis macrocephalae Rhizoma (bái zhú) 6g, Achyranthis bidentatae Radix(niú xï),6g, Citri reticulatae Exocarpium rubrum (jú hóng) 3g

** Translated by: Volker Scheid

Volker’s Commentary: This is one of a small number of case records by FBX documenting a succession of visits. The case series is also instructive regarding the amount of information supplied at each successive stage. This focuses almost entirely on those symptoms that are actually treated, i.e. considered most important by the physician, rather than on the overall picture. Thus, we only learn on the fourth visit that the patient feels weak and has difficulty in walking, while the precise nature of the pulse and tongue signs are left implicit throughout. It is expected that the experienced reader will be able to deduce them from the presentation. Yet, they are nevertheless important to the clinician in as much as that they confirm changes taking place in the body beyond surface symptoms and signs.

The strategies employed over the course of the five visits narrated here follow a conventional pattern that gradually moves from a focus on draining pathogenic qi to one of tonifying deficiency. At the first visit, the elimination of water qi excess by promoting the qi dynamic of the Triple Burner through the Lungs, Spleen/Stomach and particularly the Bladder is the clear priority. For this purpose, a combination of Five-Ingredient Powder with Poria (wû líng sân), Five-Peel Drink (wû pí yîn), and Calm the Stomach Powder (píng wèi sân) are used. Flank pain indicating stagnation in the Liver channel is cleared by means of Toosendan Fructus (chuän liàn zî), a herb that drains excess from the Liver channel via the Small Intestine; while Asari Radix et Rhizoma (xì xïn) is added to an overall somewhat cooling formula to support the fire of the gate of vitality.

At the second visit, once the edema has been reduced, the focus shifts to the Lungs and middle burner via a modification of Minor Bluegreen Dragon Decoction (xiâo qïng lóng täng). This is complemented by a more forceful regulation of Liver qi by means of combining Frigid Extremities Powder (sì nì sân) with Melia Toosendan Powder (jïn líng zî sân), allowing clear yang to rise and turbid yin to be directed downward.

The role of the Lungs as the upper source of water, and by implication yin, is emphasized in the third prescription, with the inclusion of tonifying herbs for the upper burner. This further enhances the curtailing of Liver qi by exploiting the controlling relationship of the five phases cycle. Zanthoxyli Pericarpium (huä jiäo) here is a specific herb for cold water qi in the Liver channel.

During the fourth visit, the focus of tonification shifts to the middle burner and constructive blood, with a formula based on Tangkuei and Peony Powder (däng guï sháo yào sân); while the fifth formula moves this focus even further inward towards the Liver visceral system by way of combining Six-Gentleman Decoction (liù jün zî täng) with a modified Six-Ingredient Pill with Rehmannia (liù wèi dì huáng wán).

Viewed together this case series underlines the sophistication of FBXs strategic thinking and his ability to view and address a pathological process from different positions. The emphasis on the bowels, as places through which stuff is moved, is gradually substituted by one on the viscera, as places where essences are stored. At the same time, the treatment also moves in a circular fashion following the qi dynamic from an initial focus on the lower burner Bladder, as the organ where water is transformed and excreted, to one on the upper burner, where water is collected. From there, it moves downward again via tonification first of the Lungs and the jin fluids, then the qi, constructive and blood, and finally the Liver.

This emphasis on treating the Liver is another very interesting aspect of the case. At the most simple level, this can be explained symptomatically: initially because of pain in the flanks as a manifestation that water qi is obstructing the Liver channel; and later because of the association between Liver blood and the muscles and sinews. A more sophisticated understanding is that water and qi, fire and blood continuously produce and interpenetrate each other, and that this movement and interpenetration is facilitated by the function of the organ systems. Just as the Lung qi controls the movement of water downward, Liver blood reigns in the upward rushing of yang qi. Obstruction, constraint and blockage in one system will have repercussions in the other and vice versa. Hence, even as the treatment process focuses on water qi, it always also addresses ministerial fire and blood. Furthermore, precisely because it is located in the middle burner, anchoring both the ascending and directing downward of qi, water and fire, the functions of Spleen/Stomach earth are crucial to the water metabolism. This is succinctly summarized one generation later by Tang Zonghai in Discussion of Blood Patterns:

“Blood is produced from Heart fire and stored below in the Liver. Qi is produced from Kidney water and is controlled above by the Lungs. In between, the activator of the rising and falling is the Spleen.”

Finally, this sequence of treatment episodes convincingly showcases FBX’s intent as well as ability to break through existing boundaries in the Chinese medical tradition. Almost all prescriptions used are built around formulas from the Discussion of Cold Damage, often combined with formulas from the Song or Jin-Yuan periods. However, the thinking that informs their composition, specifically the emphasis placed on the functions of the Triple Burner and the Lungs in regulating the water metabolism are clearly borrowed from the warm pathogen disorder current and physicians such as Ye Tianshi and Xue Shengbai. The ingenuity of this synthesis was unique at the time, and is not seen often in the case record literature even today.

** For more reading on Fei Bo-Xiong, please look for Volker’s upcoming book from Eastland Press. Its working title is, “Menge Medicine,  Vol. 1, Fei Boxiong’s Refined Medicine Remembered with Commentaries and Fei Family Case Histories”

Case by: Ye Tian-Shi (叶天士)

Yu, 55 years old, suffered from constraint that harmed the Heart yang. The yang sunk into the yin leading to a  turbid painful urinary dribbling disorder. This was internal damage from the emotions leading to a  yin [area?] deficiency resulting in disease. Merely seeing the symptoms will bring about a disordered (incorrect) treatment and is most inferior.

The Heart stores the Spirit. The spirit was damaged with symptoms such as muddle-headedness; all the orifices were disturbed. The herb treatment should not emphasize cold or hot medicinals. It must be opening and bright, striving for tranquility. If one only uses botanicals (e.g. no animal products) then I am afraid the results will be unsatisfactory. This is constraint harming the Heart yang and the prescription was Marvelously Fragrant Powder (miao xiang san).

Translated by: Jason Blalack

Jason’s Commentary: This is a brilliant case where Mr. Ye sees beyond the chief complaint and addresses the underlying mechanism for the turbid painful urinary dribbling disorder, constraint harming the Heart yang. Of note, Ye differentiates elsewhere between painful urinary dribbling (淋 lín) and turbid urine (濁 zhuó).  He states,

Painful urinary dribbling is attributed to the Liver and Gall­bladder. Turbidity is attributed to the Heart and Kidneys.”

Yang deficiency can easily lead to turbidity. Turbidity is heavy and sinks causing the urinary disorder. I can’t say that I truly understand his point of “yin deficiency causing disease.” This formula does not address this. Maybe the yin was addressed after this formula. Does anyone have any additional ideas?

Marvelously Fragrant Powder (妙香散, miao xiang san)

Source: Formulary of the Pharmacy Service for Benefiting the People in the Taiping Era (1148)

Ginseng Radix (rén shën) 15g
Dioscoreae Rhizoma (shän yào) 30g
Astragali Radix (huáng qí) 30g
is Poria (fú líng) 30g
Poriae Sclerotium pararadicis (fú shén) 30g
Polygalae Radix (yuân zhì) 30g
Cinnabaris (zhü shä) 9g
Aucklandiae Radix (mù xiäng) 75g
Moschus (shè xiäng) 3g
Platycodi Radix (jié gêng) 15g
Glycyrrhizae Radix preparata (zhì gän câo) 15g

Original Chinese: 于（五五） 郁损心阳。阳坠入阴为淋浊。由情志内伤。即为阴虚致病。见症乱治。最为庸劣。心藏神。神耗如愦。诸窍失司。非偏寒偏热药治。必得开爽。冀有向安。服药以草木功能。恐不能令其欢悦。（郁损心阳） 妙香散。

Case By: Jason Blalack

Intro: This is a somewhat informal presentation of a recent case that I found quite educational for myself. It is definitely not the cleanest case (easy success) but that is why I like it. I am still working out the best way to present these cases and if anyone has any suggestions please let me know. I also welcome others to submit their cases for us to learn from. I hope you enjoy it and welcome any feedback or criticisms.

Case: 55 year old male presented with testicular and perineal pain, sensation of “peeing glass”, strong sensation heat in the lower burner, unable to sit due to the pain, and frequent urination in both night and day. This had persisted for many months and had been labeled “chronic prostatitis.” He also presented with a painful left big toe, dry mouth, and very strong emotions (anger, anxiety, fear etc.). The pulse was cloudy (模糊,mó hú mài) and wiry, and his tongue was dark red/purple with a thick coat. The diagnosis was damp-heat stasis in the lower with the treatment principle of transform damp, clear heat, promote urination, and promote the movement of blood.

Long dan cao     6
Che qian zi           9
Huang qin            9        
Zhi zi                      9
Sheng di                9         
Ze xie                     9
Dang gui               6        
Mu tong                6
Chai hu                 6         
Gan cao                6
Huang bai            6
Ku ding cha         2

Instructions: 1 bag=2 days. Cook time =45 minutes. Take 2-3 times a day.

Visit #2: Heat was 40-50% better. Pain had improved. Started a course of Cipro for 1 month. Tongue was red.

Visit #3: In the previous three days the pain was severe. Dx: damp heat + toxin pouring into the lower burner.

Visit #4: Feels very hot, insomnia, urine is yellow, very angry, dry mouth, thirst, and feels energy shooting up. Uncomfortable sensation over his liver. Red tongue, wiry pulse. Diagnosis: Liver Fire.

Visit 5-6: more of the same.

Commentary: Throughout all of these visits a modified Gentian Decoction to Drain the Liver (lóng dân xiè gän täng) was used with various additions to emphasize more blood invigorating (e.g. Vaccariae Semen (wáng bù liú xíng), Manitis Squama (chuän shän jiâ)), pain relieving (e.g. Corydalis Rhizoma (yán hú suô)), toxin clearing (e.g. Patriniae Herba (bài jiàng câo),Taraxaci Herba (pú göng yïng)) , cooling the blood (e.g. Paeoniae Radix rubra (chì sháo)), protecting the yin (e.g. Dendrobii Herba (shí hú)), and descending the yang and calming the spirit (e.g. Fossilia Ossis Mastodi (lóng gû), Poriae Sclerotium pararadicis (fú shén)). But the overall presentation had hardly budged. Pain and heat was certainly still an issue as well as the severe emotions (anger, fear, sadness etc.). Other modalities were also used at this time by other practitioners.

Visit 7: Due to unclear results, I decided to switch to a more modern prostatitis formula:

Huang qi                     10
Yan hu suo                  6
Di long                        4.5      
Zhi gan cao                 6
Hu zhang                     9         
Bai hua she she cao     9
Huang bai                    9         
Sheng di huang           12
He huan pi                   9         
Wang bu liu xing         9
Nu zhen zi                   12       
Ze xie                          6

Visit 8-9: “prostate” seems better. He has noticed that stress makes it worse. Anxiety is less. Pain is 5/10 (was 8/10). Feels like the muscles are very tight/pulled muscle around the perineum. Added 20 grams of Paeoniae Radix alba (bái sháo).

Visit 10: Urethral pain is still severe, pelvic pain is getting better. Lots of emotion. Pulse is very tight and wiry. Fatigue (mentioned that had been going on for awhile).

Chao Chuan lian zi      6
Mai dong                     9
Bai zi ren                     9         
Tao ren                        9
Dang gui                     6         
Huang bai                    9
Yan hu suo                  9         
He huan pi                   9

Commentary: Over the last 10 visits the pain had gone up and down many times. However even though the pain had decreased it was still significantly present. The heat was also very obvious. Due to the unclear results from the above more straightforward approaches. I decided to consider the underlying mechanism for the fire/heat. Taking inspiration from Ye Tian-Shi, I prescribed the above formula (see his constraint case). Notice the more softening approach.

Visit 11: significant improvement, pain and pelvic floor tension was much less. 3 bags of previous. Of Note: Almost all of the previous formulas contained Corydalis Rhizoma (yán hú suô).

Visit 12: + Paeoniae Radix alba (bái sháo) 25.

Visit 13: It was unclear if Paeoniae Radix alba (bái sháo) made any difference) – feeling much better.

Visit 14: Common cold / flu (gan mao), stopped herbs, pain became worse. Thought there might be a lurking pathogen and switch strategies to a yin deficient venting idea. (I was wrong)

Visit 15: Pain became much worse, went back to previous formula (visit 12-13) and pain continued to decrease once again. This confirmed that addressing the underlying mechanism, causing the fire was actually effective. Over the next few weeks the pain completely resolved.

Visit 16: Although no pain remained, there was anxiety, fear, pressure in the chest, and palpitations. This had been going on for many years since the death of his wife. He (and I) thought that this was the underlying cause of all his problems including the fire/prostatitis. This was qi and blood stagnation in the collaterals. The treatment principle was to dredge the liver and open the collaterals. I decided to use a modified Inula Decoction (xuán fù huä tang) from the Essentials from the Golden Cabinet.

Xuan fu hua                9
Hong hua                    6
Tao ren                        9         
Dang gui wei               6
Ze lan                          3         
Lu lu tong                   3
Wang bu liu xing         6         
Mei gui hua                 3

Note: Carthami Flos (hóng huä) sub for New crimson (xïn jiàng).

Emotional symptoms, energy, sensation in the chest all dramatically improved over the next couple weeks.

Original Case: Ye Tian-Shi (叶天士）

Shen was 43 years old with a deficient and choppy pulse. The emotions had become unsmooth and the Liver and Spleen qi and blood were excessively constrained. This had persisted without relief for half a year. Giving a drastic formula was difficult [not appropriate]. Therefore giving the official prescription, Rambling Powder (xiäo yáo sân) with Tonify the Middle to Augment the Qi Decoction (bû zhöng yì qì täng) was decided upon.

Original Chinese: 沈（四三） 脉虚涩。情怀失畅。肝脾气血多郁。半载不愈。难任峻剂。议以局方逍遥散。兼服补中益气。

** Other Rambling Powder (xiäo yáo sân) Ye Tian-Shi constraint case studies .

Original case by: Fei Bo-Xiong (费伯雄)

When the Spleen is deficient and dampness wins out [over physiological transformation], the momentum [of the disorder] is towards Wood seizing the position of earth. Employing [a strategy] of relaxing the movement [of the qi dynamic] while separately eliminating [the various pathogenic qi] yielded results [quickly] after [the prescriptions] was taken. However, dampness is still soaking Spleen yang disabling movement and transformation. [Therefore, I once again] employ the previous strategy in order to promote a resolution [of the disorder].

Magnoliae officinalis Cortex (hòu pò) 3g
Perillae Caulis (zî sü gêng) 6g
Pogostemonis/Agastaches Caulis (huò xiäng gêng) 6g
Artemisiae scopariae Herba (yïn chén häo) 3g
fried Atractylodis macrocephalae Rhizoma (bái zhú) 6g
Amomi Fructus (shä rén) 1.5g
Narcissus Semen (shuǐ xiān zî) (水仙子) 9g
Aurantii Fructus immaturus (zhî shí) 3g
Aucklandiae Radix (mù xiäng) 1.5g
Pinelliae Rhizoma preparatum (zhì bàn xià) 6g
Citri reticulatae viride Pericarpium (qïng pí) 3g
Citri reticulatae Pericarpium (chén pí) 3g
Poria rubra (chì fú líng) 6g
Massa medicata fermentata (shén qü) 9g
Eupatorii Herba (pèi lán) 3g
Zingiberis Rhizomatis Cortex (shëng jiäng pí) 1g

Comment: This case record is listed immediately after the preceding one and thus may well be a description of a follow-up treatment. If not, it describes a case of distension where the strategy focuses almost exclusively on promoting the movement of middle burner yang qi in order to eliminate Spleen dampness.

Translated by: Volker Scheid

For more reading on Fei Bo-Xiong, please look for Volker’s upcoming book from Eastland Press. Its working title is, “Menge Medicine,  Vol. 1, Fei Boxiong’s Refined Medicine Remembered with Commentaries and Fei Family Case Histories”

Original case by:  Ye Tian-Shi

The case of Tang: Right, posterior rib pain radiating to the low back and hip producing aversion to cold and icy-cold extremities. [The patient was so cold that] it took a long time to get the patient warm. This was a lack of movement of qi and blood within the vessels and networks, culminating in congealed cold producing pain that was an obstruction pattern of the vessels and networks and is understood in the context of a yang wei and yin wei disease.

Cervi Cornu degelatinatum (lu jiao shuang)
Foeniculi Fructus (xiao hui xiang)
Angelica sinensis Radix (dang gui)
Sechuan Cinnamomi Ramulus (gui zhi)
Astragali complanati Semen (sha yuan zi)
Poria (fu ling).[i]

Translated by: Charles Chace

Original Chinese: 唐（嶇）右後脅痛連腰胯。 發必惡寒逆冷。 暖護良久乃溫。 此脈絡中氣血不行。 遂至凝塞為痛。 乃脈絡之痹症。 從陽維陰維論病鹿角霜， 小茵香， 當歸， 川桂枝， 沙苑， 茯苓

Commentary: This case involves a yang wei disorder presenting as rib side pain radiating to the low back and hip, the supple, warm, essence-nourishing Cervi Cornu degelatinatum (lu jiao shuang) is added to the primary treatment method of opening the yang to harmonize the networks. In general, the drugs in this prescription enter the liver and kidney channels while Cinnamomi Ramulus (gui zhi) opens the yang qi in the foot greater yang.

For further reading, please view the intro to this case, Herbs & the Eight Extraordinary Vessels and Ye Tian-Shi & the Eight Extraordinary Channels.

[i] This case record appears in another anthology containing case records attributed to Ye Tian-Shi (葉天士), 2004i, Combined Case Records of Three Physicians (San jia yi an’ he ke 三家醫案合刻), juan 1, Minor Construct the Middle Decoction (xiao jian zhong tang 小建中湯), juan 7, “Obstruction” (bi 痹).

Original case by: Fei Bo-Xiong (费伯雄)

Wood seizes the position of earth, hence only the abdomen is distended. [The appropriate strategy] is to curtail wood and support earth.

calcined Arcae Concha (wâ léng zî)
Corydalis Rhizoma (yán hú suô)
Benincasae Exocarpium (döng guä pí)
Benincasae Semen (döng guä zî)
Magnoliae officinalis Cortex (hòu pò)
Paeoniae Radix alba (bái sháo)
Codonopsis Radix (dâng shën)
Poriae Cutis (fú líng pí)
Atractylodis macrocephalae Rhizoma (bái zhú)
Aurantii Fructus immaturus (zhî shí)
Gigeriae galli Endothelium corneum (jï nèi jïn)
Aucklandiae Radix (mù xiäng)
Zingiberis Rhizoma preparata (páo jiäng)
Angelicae sinensis Radix (däng guï)
Cinnamomi Cortex (ròu guì)

Comment: This is a simple diagnosis of Spleen deficiency allowing Liver to encroach on earth causing stagnation of the qi dynamic and hence distension. The formula directly addresses this patho-dynamic by tonifying the Spleen, harmonizing the Stomach, and regulating the Liver. Yet, it also brings into play a complex of five-phases relationships attesting to the importance of five-phases doctrine in Fei Bo-Xiong’s thinking.

Translated by: Volker Scheid

For more reading on Fei Bo-Xiong, please look for Volker’s upcoming book from Eastland Press. Its working title is, “Menge Medicine,  Vol. 1, Fei Boxiong’s Refined Medicine Remembered with Commentaries and Fei Family Case Histories”

Orignal Case by: Ye Tian-Shi

The ren vessel and du vessel divide and travel to the anterior and posterior aspects of the body. The spontaneous appearance of a steaming fever and spontaneous [seminal] emissions without dreams indicate that all of these extraordinary channels are deficient. Acrid, moistening herbs are quite effective. Administration of Six-Ingredient Pill [with Rehmannia] (liu wei di huang wan) with the addition of Schizandrae Fructus (wu wei zi) was inappropriate.

The medicinals in this prescription would simply run through the patient [presumably causing diarrhea] and so would be unable to control the extraordinary vessels. Hence, the plan was to use methods of accumulating the essence, and securing it.

Mantidis Ootheca (sang piao xiao), Testudinus Plastrum (gui ban), Euralyes Semen (qian shi), Tribuli Fructus (ci ji li), Testudinus Plastri Colla (gui ban jiao), Coptidis Rhizoma (huang lian), Fossilia Ossis Mastodi (long gu), Rosae laevigatae Fructus (jin ying zi), Rubi Fructus (fu pen zi).[i]

Translated by: Charles Chace

For further reading, please view the intro to this case, Herbs & the Eight Extraordinary Vessels and Ye Tian-Shi & the Eight Extraordinary Channels.

[i] This case record appears in another anthology containing case records attributed to Ye Tian-Shi (葉天士), 2004i, Combined Case Records of Three Physicians (San jia yi an’ he ke 三家醫案合刻), juan 1, Minor Construct the Middle Decoction (xiao jian zhong tang 小建中湯)

Original Chinese: 任脈、 督脈， 分行乎身之前後， 自覺熱蒸， 不夢自遺， 皆奇經虛也。 辛濕藥頗效。 六味加五味於不應方藥僅僅達下， 未能約束奇經， 議用聚精固攝之法。 桑嫖峭， 龜板，熒實, 刺蒺藜 線魚膠, 胡連 龍骨, 金櫻子, 覆盆子

By: Charles Chace

The first systematic discussion of the extraordinary vessels in Chinese herbal medicine appears in Li Shizhen’s 李時珍Exposition on the Eight Extraordinary Vessels (Qijing bamai Kao奇經八脈考, circa, 1576).  In our forthcoming translation and commentary on this text, Exposition on the Extraordinary Vessels, Acupuncture, Alchemy and Herbal Medicine, Eastland Press, 2009, my co-author Miki Shima and I describe Li’s approach to herbal prescribing as an overarching “meta-diagnosis” encompassing a wide range of possible zangfu presentations. For instance, Li Shizhen considers any disease characterized by masses or accumulations in the lower burner that presents in conjunction with an ascending counterflow to the upper burner to be a disorder of the chong vessel. This might present in the context of number of possible disease or zangfu patterns, but for Li the simultaneous presence of stagnation in the lower burner and counterflow extending to the upper burner define it as chong vessel problem. This is, I believe, the most pragmatic way to make use of the extraordinary vessels in herbal medicine

At its best, this meta-diagnosis interpretation of extraordinary vessels provides a means of defining the overall pathodynamics involved in complex pattern presentations. It also provides an alternative perspective to the familiar zangfu or shanghan patterns that can facilitate more creative and effective prescribing. In this, the meta-diagnosis interpretation speaks to one of the core questions surrounding extraordinary vessel herbal prescribing. If an extraordinary vessel diagnosis does not in itself constitute a comprehensive diagnosis and a more detailed pattern differentiation is still necessary, then why bother with the extraordinary vessels at all?

In some instances, an extraordinary vessel diagnosis in herbal medicine is inarguably irrelevant, a spurious addition an already comprehensive diagnosis and treatment strategy. For me, this makes the question of extraordinary vessel herbal prescribing that much more intriguing, particularly when one considers who it was that most fully developed Li Shizhen’s ideas in clinical practice. Ye Tianshi (業天士) is among the most influential physicians in the history of Chinese medicine, and the writings attributed to him are nothing if not clinically based. That Ye made such extensive use of the extraordinary vessels suggests to me that I would do well to consider the matter carefully before coming to any definitive conclusions regarding their merits in herbal prescribing.

Like Li Shizhen, Ye clearly typically employed the extraordinary vessels as a meta-diagnosis. Also like Li, he employed a wide range of therapeutic strategies for addressing extraordinary vessel pathologies. These ranged from astringing, and using shells to restrain the yang, to eliminating qi constraint and blood stasis to name just a few. The seeds of such strategies are all evident in Li Shizhen’s Exposition on the Eight Extraordinary Vessels. Nevertheless, it is safe to say that although Ye did not actually invent any extraordinary vessels treatment strategies, they all found their fullest expression in his hands.

One approach that appears in Li’s Comprehensive Materia Medica (Ben Cao Gang Mu 本草綱目) but which is conspicuously absent from the herbal discussions in his Exposition on the Eight Extraordinary Vessels is based on the premise that the extraordinary vessels are often associated with deep essence insufficiencies, and that these deficits are most amenable to treatment using animal products. Ye took this idea and ran with it to the extent that it became one of the defining characteristics of his extraordinary vessel therapeutics. Although no one treatment strategy appears in all of Ye’s extraordinary vessel cases, the use of animal products to treat extraordinary vessel insufficiencies is present in many of them, although they are invariably p administered in the context of a specific diagnostic framework.

The two cases by Ye Tianshi that follow are excerpted from a chapter on him in Exposition on the Extraordinary Vessels, Acupuncture, Alchemy and Herbal Medicine. Both cases illustrate the principle of a meta-diagnosis, and the use of animal products in treating the extraordinary vessels.  The first case illustrates the use of astringing methods in the treatment of ren and du pathology. According to ye, plant-based tonification is insufficient to influence the extraordinary vessels and animal products are needed to get the job done.

Case 1 (Deficinecy of all Extraoridnary vessels)

Case 2 (The treatment of pain using yang wei and yin wei)

Many, if not most of the questions that arise in reading pre-modern Chinese medical literature are unanswerable in any definitive sense. In addressing such questions in our book, Miki and I adopted a novel approach. Rather than suggesting our own interpretations as to what we think it might mean, we instead discuss the questions that a clinician must ask of the text in order to make their own decisions as to how they might make clinical use of the material. In this, we hope to foster an open and creative approach to engaging the pre-modern medical literature. The above two cases are presented in this spirit. In many ways, they raise more questions than they answer. Along, with Jason’s translation of Ye Tian-Shi’s Pattern Differentiation and Treatment of the Eight Extraordinary Channelss  article, I’m hoping that this opens a dialogue on the relevance of the extraordinary vessels in herbal prescribing on this website.