In

Liu du zhou’s case:

[Patient] Lǐ was a 53 year old female that suffered from paroxysmal heat effusion and sweating for over one year. This would occur 2-3 times every day. A previous doctor treated her for a yin deficiency fever, but after taking over 20 bags there was no result. When questioned, her diet, urination and bowel movements were normal. She had a pale tongue with a white coat, slack and soft pulse that lacked strength.

The differential diagnosis was a pattern of nutritive and defensive disharmony, where defensive is not safeguarding the nutritive. The treatment method was to harmonize the nutritive and defensive, yin and yang, and use the method of promoting a sweat in order to stop a sweat. She was given two packets of gui zhi tang: gui zhi 9, bai shao 9, sheng jiang 9, zhi gan cao 6, da zao 12p. The medicinals were sipped warm with water gruel, and then she covered up, obtaining a light sweat. After this the disease was gone.

Source: (《刘渡舟临证验案精选》1996:3)

Commentary: There was heat effusion, sweating with a tongue that was not red, but pale; the coating is not scant, but white, the pulse was not thin but moderate. This is not a pattern of yin deficiency with fever. It is a disharmony between the nutritive and protective. Nutritive and protective is the body’s yin and yang, it is more suitable for them to work together then for them to work apart. If the nutritive and protective are harmonious then yin and yang are coordinated and protective qi secures and the nutritive qi guards. If the nutritive and protective are not harmonious then yin and yang mutually will go against each other. Nutritive-yin fails the protective-yang resulting in fever, protective-yang does not secure the nutritive-yin and there is sweat. Gui zhi tang is used to “first promote a sweat which will then bring about a cure”

(Translated by: Jason Blalack)

Original Chinese:

一、营卫不和
刘渡舟医案:李某某,女,53岁。患阵发性发热汗出一年余,每天发作二到三次。前医按阴虚发热治疗,服药二十余剂无效。问其饮食、二便尚可,视其舌淡苔白,切其脉缓软无力。辨为营卫不和,卫不护营之证。当调和营卫阴阳,用发汗以止汗的方法,为疏桂枝汤:桂枝9克,白芍9克,生姜9克,炙甘草6克,大枣12枚,2剂。服药后,吸热稀粥,覆取微汗而病愈。
按语:发热汗出见舌不红而淡,苔不少而白,脉不细而缓,则非阴虚发热之证,乃营卫不和也。营卫,即人体之阴阳,宜相将而不宜相离。营卫谐和,则阴阳协调,卫为之固,营为之守。若营卫不和,阴阳相悖,营阴不济卫阳而发热,卫阳不固营阴则汗出。用桂枝汤”先其时发汗则愈”。

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Showing 3 comments
  • Jason Blalack

    1. Notice where it says “her diet, urination and bowel movements were normal.” This is a important indicator for the use of gui zhi tang. Basically it is saying that internal organ function is relatively normal (there is no internal disharmony). Diet here also refers to appetite, digestion etc.
    2. “Defensive is not safeguarding the nutritive” – This means the defensive is letting the nutritive out via sweat.

    Do others have other observations or disagreements?

  • Greg Livingston

    Hi Jason,

    Nice job. A couple minor points on translation, if I may.

    1. 饮食/diet should also include thirst, not just appetite.

    2. 服药后,吸热稀粥: “Ingestion of the medicine was followed by taking hot gruel/rice-porridge.”

    This is such a straight forward case that I don’t really have any questions or comments other than to say diagnosis, diagnosis, diagnosis. If after 20 bags of herbs the patient is still sweating, better rethink that yin-deficiency diagnosis. Hehe. 🙂

  • Jason Blalack

    Greg is correct. Case has been updated! Thanks for paying attention.

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