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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。

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  • Chip
    Reply

    J
    即为阴虚致病 is indeed opaque.
    My tentative parsing is this.
    Idea 1 郁损心阳。阳坠入阴为淋浊。
    The constraint damages the heart yang, which weakened, collapses into the yin (as in lower yin) causing urinary turbidty

    由情志内伤。即为阴虚致病
    Next idea
    The emphasis here is specifically on the emotional aspect of the constraint that causes internal damage. It causes a deficiency in the “yin” by both virtue of its damaging the heart, and/or more likely, the urogenital system. Its not that the collapse of heart yang causes a major obstruction below, it causes a weakness leading to a seconday obstruction. The herbs in the rx make that clear. Yet, Ye emphasises the heart, not the kidney.
    cool case.
    Does that make sense?

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