In

Original case: Liu Du-Zhou

A 52 year old male came in for a diagnosis on July 18, 1994. He had diarrhea that had been going on for more than one year and had used many kinds of antibiotics with no avail. Every day he had diarrhea 3 to 6 times, and at the time of the intake it was a watery type with small amount of pus and blood. There was also tenesmus, abdominal tenderness, which was especially severe on the lower left quadrant. There was also a fear of cold and a fever (approx 37.5C / 99.5F).

Tongue: red with a white coat
Pulse: submerged and wiry

Western Exam: Microscopic examination of stool revealed leukocytes and a small amount of phagocytes. Western medicine had diagnosed “chronic bacterial dysentery.

Differential diagnosis: qi and blood congealing in the Spleen, wood constraining the earth center.

Treatment method: regulate the yin and yang of the Spleen, free the qi and blood, while simultaneously curtailing wood, preventing it from attacking the earth center.

Presciption:

  • guì zhī (Cinnamomi Ramulus)10g
  • bái sháo (Paeoniae Radix alba)30g
  • zhì gān cǎo (prepared licorice root)10g
  • shēng jiāng (fresh ginger rhizome)10g
  • dà zǎo (Jujubae Fructus)12 pieces

After 2 packets the frequency of the diarrhea was remarkably decreased and the abdomen was more relaxed. After 3 more packets the stool was basically formed, abdominal urgency of the lesser abdomen was gone. After 4 more packets of herbs his pattern was resolved.

Source: 《刘渡舟临证验案精选》1996:105一106

Commentary: The patient suffered from chronic dysentery due to a  disharmony of the Spleen and Stomach and disharmony of the qi and blood. There was diarrhea, pain, and tenesmus. If there is pain there is no free flow. These signs belong to qi stagnation and blood stasis of the Spleen. The Spleen belongs to earth and Liver belongs to wood. When the Spleen’s qi and blood is inhibited this causes the qi of Liver / wood to not outthrust. Therefore the pulse was deep and wiry. Furthermore, because of the ongoing diarrhea there was damage to the yin, qi and blood stagnation, and Spleen yin disharmony. Therefore we see a red tongue.

The treatment was to use guì zhï jiä sháo yào täng (Cinnamon Twig Decoction plus Peony) in order to regulate and harmonize the Spleen and Stomach, free the qi and blood, boost the Spleen yin, calm the Liver’s urgency (tension). This is a unique usage of this formula for diarrhea and abdominal pain in tai yin disease. It is exactly like what li dong-yuan said, “If there is abdominal pain one should use gān cǎo (Glycyrrhizae Radix) and bái sháo (Paeoniae Radix alba). Ssowing and reaping is regarded as [the flavor] sweet, and sweet is the 6th heavenly stem (earth). Bending and straightening is regarded as [the flavor] sour, and sour is 1st heavenly stem (wood). [Using the] 1st and 6th heavenly stems transforms earth, this is the marvelous (mistaken character: 炒=妙?) method of Zhong-Jing. ” *** (I am not sure how to interpret and translate this quote, does someone have any better insights?)

This formula can be used in the clinic if one sees the three issues of disharmony of the Spleen and stomach, inhibited qi and blood, and Liver / wood overwhelming earth. Then this formula can be used without danger and obtain good results.

Translated by: Jason Blalack

Original Chinese: 一、下利(慢性菌痢)

刘渡舟医案:林某某,男,52岁,1994年4月18日就诊。大便下利达一年之久,先后用多种抗菌素,收效不大。每日腹泻3~6次,呈水样便,并挟有少量脓血,伴有里急后重,腹部有压痛,以左下腹为甚,畏寒,发热(37.5℃左右)舌红,苔白,脉沉弦。粪便镜检有红、白细胞及少量吞噬细胞。西医诊为”慢性菌痢”。
辨证:脾脏气血凝滞,木郁土中所致。
治法:调脾家阴阳,疏通气血,并于土中伐木。桂枝1O克,白芍30克,炙甘草1O克,生姜1O克,大枣12枚。服汤2剂,下利次数显著减少,腹中颇觉轻松。3剂后则大便基本成形,少腹之里急消失,服至4剂则诸症霍然而瘳。

按语:患痢日久,致脾胃不和,气血不调。腹泻而痛,里急后重,痛则不通,为脾家气滞血瘀之象。脾为土,肝属木,脾家气血不利,而使肝木之气不达,故其脉见沉弦。又因久利伤阴,气血郁滞,脾阴不和,故见舌红。治用桂枝加芍药汤以调和脾胃,疏通气血,益脾阴,平肝急,兼能疏泄肝木。本方用于太阴病之下利、腹痛,别具一格,正如李东垣所说:”腹中痛者加甘草、白芍药,稼穑作甘,甘者己也;曲直作酸,酸者甲也。甲己化土,此仲景之炒法也。”临床运用本方时,如能抓住脾胃不和,气血不利和肝木乘土三个环节,则用之不殆,历验不爽。

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