I thought that this case might be a nice follow-up to the question that was asked about why Ye Tian-Shi chose this or that medicinal for the Liver.

Original Case by: Ye Tian-Shi

Ye was melancholic, which agitated the Liver, causing disease. After persisting for a long time [the disease process] began to involve the Spleen and Stomach. Hence, the center became damaged and he was unable to take in food and had an inability to taste flavors. There was fire and wind that transformed and moved. There was also horizontal movement of qi leading to pain and then distention. This was a failure in free-coursing. There was also constipation then sudden diarrhea and constraint of the emotions.

It is difficult for medicine to immediately work because the disease had endured for many years. Furthermore, the patient’s body was thin and had his liquids were desiccated. If one continually gave fragrant dry medicinals this would plunder [the yin and fluids], even though it would certainly have make the abdominal fullness better. In contrast, one should give a few acrid moist medicinals to assist in harmonizing the yang.

Prescription:

bâi zî rén (Platycladi Semen) 6g
däng guï (Angelicae sinensis Radix) 6g
táo rén (Persicae Semen) 9g
bái sháo (Paeoniae Radix alba) 3g
huáng lián (Coptidis Rhizoma) 0.9g
chuän liàn zî (Toosendan Fructus) 3g

Original Chinese: 叶（氏） 悒郁动肝致病。久则延及脾胃。中伤不纳。不知味。火风变动。气横为痛为胀。疏泄失职。便秘忽泻。情志之郁。药难霍然。数年久病。而兼形瘦液枯。若再香燥劫 夺。必变格拒中满。与辛润少佐和阳。柏子仁（二钱） 归须（二钱） 桃仁（三钱） 生白芍（一钱） 小川连（三分） 川楝子（一钱）

Translated by: Jason Blalack

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Jason’s commentary:

Within the formula, bâi zî rén (Platycladi Semen) and bái sháo (Paeoniae Radix alba) enter the Liver and enrich and nourish the yin and blood. Däng guï (Angelicae sinensis Radix) and táo rén (peach kernel, persica) invigorate the blood and open the collaterals. Huáng lián (Coptidis Rhizoma) and chuän liàn zî (Toosendan Fructus) clear the Liver and regulate the qi. The whole formula is acrid and moist to assist harmonizing the yang. It also has the function of enriching the yin, opening the collaterals, and clearing constraint. It treats constraint damaging the yin collaterals.

From this case, we notice that when the Liver affects the middle we see the key signs of unable to eat, lack of taste, pain and distention, and alternating bowels. There is underlying liquid deficiency. Hence, this patient’s chronic disease has its root in deficiency. Notice that the first four medicinals are all moistening.

Many people believe chuän liàn zî (Toosendan Fructus) is harsh and not suitable for sensitive patients. It is considered toxic and used for killing parasites. However, we can see that in this case Dr. Ye favors it over typical Liver moving medicinals such as xiäng fù (cyperus, nut-grass rhizome) and chái hú (Bupleuri Radix). Since he specifically warns against using fragrant and drying medicinals (so as not to damage the yin) his inclusion demonstrates how mild he believes this herb actually is.

Another reason for its inclusion is because there is pain. In all of Dr. Ye’s constraint case studies chuän liàn zî (Toosendan Fructus) is only chosen when there is pain. Nonetheless this herb is suitable for yin and blood deficient patients with Liver qi constraint invading the Stomach/Spleen, especially when there is pain.

Note on dosage: the original dosages were in qian (钱) not grams. The conversion to grams was made using a modern rounded system, 1 qian = 3g. However more accurately, 1 qian at this time was probably equal to 3.73 grams. Making, for example, bâi zî rén (Platycladi Semen) equal to 7.46g.)

Tags: Constraint, Qing Dynasty, Ye Tian-Shi