Nice case, and nice explanation by you. Thanks! Not to pick nits, but you suggest that Ye doesn’t use anything specific for relaxing the sinews. However, Gou Teng does in fact have a direct effect on the sinews. It is said to 舒筋/relax/soothe the sinews, presumably via its functions of clearing Liver heat and subduing Liver wind, and possibly by virtue of it being a vine (vines often having some effect on the sinews). Not that this is any less interesting- it’s an excellent choice since this one herb addresses multiple aspects of the condition.

Greg

1. Damage from constraint simply means that the patient had a constraint pattern. To elaborate,

Constraint patterns mostly come from tense (unwell, constrained) emotions and a stagnation of the qi dynamic that leads to disease. The chief symptoms are depressed mood, disquieted emotions, stifling sensation and fullness in the chest, rib side distention and pain, or easily angered with the desire to cry, or a feeling of a foreign matter blocking the throat. (from: The Study of Ye Tian-Shi’s case studies)”

2. Distended sinews are swollen, painful, and potentially hot. Basically inflamed. Thinking about this symptom specifically, I find the formula even more interesting. For example he uses no specific herbs for painful obstruction syndrome, or relaxing the sinews etc.

Hope that helps… Do others have different ideas?