Gui Zhi Er Ma Huang Yi Tang #1
1. A light presentation with stasis on the exterior.
This is a case from Dr. Yu Zhangrong[1], April 10, 1963
Mr. Li, age 49: Chills and fever. After sweating from the fever his body would become cold. This happened once a day and had continued for three days. He also had headache, leg pain, and back pain, cough with slight amount of phlegm, poor appetite and normal excretions. His pulse was floating and tight and his tongue moss was thick white and slippery. For treatment it was appropriate to use pungent and warm to lightly resolve the exterior. I used Gui Zhi Er Ma Huang Yi Tang.
- Gui Zhi9gm
- Bai Shao9gm
- Xing Ren6gm
- Zhi Gan Cao6gm
- Sheng Jiang6gm
- Ma Huang4.5gm
- Da Zao3gm
After he took the herbs the fever and chills cleared and the other symptoms lessened. He developed palpitations and shortness of breath and soreness in his back that responded favorably to pressure. His bowels were normal. His pulse had become wiry and moderate. The outside evil was resolving and the insufficiency of the moistening blood and qi stasis were now apparent. I gave him 1 package of Xiao Jian Zhong Tang and these symptoms quieted down.
Discussion: In this case the patient suffered from a daily episode of chills and fever, headache and limb pain. This had gone on for three days and yet because there was no agitation or desire to vomit, his bowels were normal and he had no chest or rib-side fullness, this was not a Shao Yang pattern. Additionally, because his excretions were normal so this was also not a Yang Ming pattern. This was a weak evil in Tai Yang. The floating and tight pulse was an indication to use Ma Huang to induce sweat yet the deficiency contraindicates the promotion of sweat. It was inappropriate to use as strong diaphoretic formula and so I used Gui Zhi Er Ma Huang Yi Tang to lightly induce sweating and drain off and benefit the Lung Qi.
Translated by: Sharon Weizenbaum
NOTE: For further reading on this case and formula, please see Sharon’s introduction, Guizhi mahuang ge ban tang & guizhi er mahuang yi tang
Original Chinese: 一、表部轻证
俞长荣医案：李某，男，49岁，1963年4月10日就诊。恶寒战栗，发热，热后汗出身凉，日发一次，连续三日。伴见头痛，肢楚，腰疼，咳嗽痰少，食欲不振，二便自调。脉浮紧，舌苔白厚而滑。治宜辛温解表轻剂，与桂枝二麻黄一汤。处方：桂枝9克，白芍9克，杏仁6克，炙甘草6克，生姜6克，麻黄4.5克，大枣3枚。服药后，寒热已除，诺症悉减。现惟心悸少气，昨起腹中微痛而喜按。大便正常，脉转弦缓。此因外邪初解，荣血不足，气滞使然，遂与小建中汤，1剂而安。、 (《伤寒论汇要分析b1964：70一71)
按语：恶寒发热，头痛肢楚，日发一次，连续三日，但无心烦喜呕，胸胁苦满，知未入少阳；又二便自调，知未传阳明。邪在太阳之表，其脉浮紧，本当麻黄取汗，但虑已出汗，不便峻剂发表，故取桂二麻一汤以小发其汗，宣利肺气。
[1] From the 伤寒论汇要分析， Shang Han Lun Hui Yao Fen Xi, 1964, pg 70-71
