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Original Case by: Ye Tian-Shi (叶天士)

[The patient] had hemilateral withering on the left side of the body. [There was] blood deficiency not nourishing the sinews and bones, [leading to] internal wind assaulting the collaterals. The left pulse was moderate and large.

Zhi Shou Wu (Polygoni Multiflori Radix Preparata) (baked) 4 liang
Gou Qi Zi (Lycii Fructus) (stems removed) 2 liang
Dang Gui Shen (Angelicae Sinensis Radix) (use that with a single stalk, remove the tips) 2 liang
Huai Niu Xi (Achyranthis Bidentatae Radix) (steamed) 2 liang
Tian Ma (Gastrodiae Rhizoma) (roasted) 2 liang
Chong Wei Zi (Leonuri Fructus) (crushed, water rinsed ten times, then baked) 2 liang

These were ground into a powder.

Then Gan Ju Hua (sweet chrysanthemum flower) 3 liang, Shi Hu (Dendrobii Herba) 4 liang and Xiao Hei Dou Pi (small black bean skin) 4 liang were decocted down into a syrup. A paste [was then made] by adding honey [and the powder from the other herbs]. This was made into extremely fine pills. Every morning [the patient was instructed to] take four qian [of pills] with recently boiled water.

Commentary by Qin Bo-Wei: This case only mentions the one manifestation, “hemilateral withering on the left side”. Hemilateral withering is simply paralysis in half of the body. However since the body can be differentiated by the left side, corresponding to blood, and right the side, corresponding to qi, then this emphasis on the left relates to blood. Paralysis in half of the body is in the category of wind-stroke and can have symptoms such as impaired consciousness or coma, deviated eyes and mouth and so on. These however are not described in the case history, showing that this is the sequela of a wind-stroke, and other such symptoms no longer exist for this patient.

Therefore starting from the “hemilateral withering on the left side” and a moderate and large left pulse, we can say that this relates to the Liver. There is also Kidney yin and blood insufficiency with disquieted internal wind, which can be diagnosed from “blood deficiency not nourishing the sinews and bones, [leading to] internal wind assaulting the collaterals.”

Although there is no treatment method mentioned, a method to nourish blood and extinguish wind is implied. In addition, since the Liver governs the sinews and the Kidneys governs the bones, this is emphasizing the method of enriching and nourishing the lower burner. Therefore, the formula used He Shou Wu (Polygoni Multiflori Radix Preparata), Gou Qi Zi (Lycii Fructus), Dang Gui (Angelicae Sinensis Radix), Tian Ma (Gastrodiae Rhizoma), and Hei Dou (Glycinis Semen) to tonify both the Liver and Kidneys while also paying particular attention to nourishing the blood. Shi Hu (Dendrobii Herba) enriches the Kidneys and eliminates deficiency heat. So it is said, to treat wind one must first treat the blood. When blood moves then wind disappears on its own.

These medicinals were assisted by Tian Ma (Gastrodiae Rhizoma) and Ju Hua (Chrysanthemi Flos) which extinguish wind and Niu Xi (Achyranthis Bidentatae Radix) which fortifies the sinews and bones. Also, Chong Wei Zi (Leonuri Fructus) and Shi Hu (Dendrobii Herba) are able to treat wind painful obstruction and weak legs. Therefore this formula deals with both the root and branch and is regulating and nourishing. Xu Ling-Tai, in analyzing this formula, said “this formula neutrally tonifies, and does not have the drawback of supplementation that generates heat.”

Translated by: Jason Blalack

Original Chinese:

案-:偏枯在左,血虚不荣筋骨,内风袭络,脉左缓大。

制首乌四两,构把子二两,归身二两,淮牛膝蒸二两,炬天麻二两,三角胡麻二两,研末,用黄甘菊三两,川石斜四两,小黑豆皮四两煎汁,加蜜,丸极细,早服四钱,滚水送。(中风门)

按:此案在症状方面只提”偏枯在左”。偏枯即半身不遂,因半身有左血右气之分,故特别指出在左。半身不遂,属于中风病,可以伴见昏撅和口眼喝斜等,案中并不叙列,说明是中风的后遗证,其他症状已不存在。所以单从偏枯在左考虑,结合脉象缓大,系肝。肾阴血不足,内风不静,诊为”血虚不荣筋骨,内风袭络”。虽末指出治法,而养血熄风已在言外,并因肝主筋,肾主骨,应着重在滋养下焦。为此,方用首乌、柜子、归身、胡麻、黑豆并补肝肾而侧重养血,石斜亦能滋肾除虚热,所谓治风先治血,血行风自灭。佐以天麻、菊花熄风,牛膝壮筋骨,而胡麻、石斜也能疗风痹脚弱,合成标本兼顾调养方剂。故徐灵胎分析此方的血药和风药,评为”此方平补,并无用补生热之弊”。

Source: Case from the Wind Stroke chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》. Commentary from Complete Famous Medical Works of Qin Bo-Wei.

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Showing 2 comments
  • Barry Levine
    Reply

    To call this case history laconic understates its brevity. Should we assume it worked? And to what degree? What was the course of treatment?
    I’ll assume a longish course of treatment based on the use of nourishing herbs and a rather low dosage, moreover administered as a convenient pill.

    Post-stroke syndrome, with muscle atrophy? Prognosis of recovery of movement at this point is poor, don’t you think? Maybe the treatment is designed to prolong life and preserve general vitality. Never-mind getting back use of the withered side.

    Why is the left pulse “moderate and large”? Especially seeing that the left side is withered?

  • Jason Blalack
    Reply

    Hi Barry,

    1. I would suggest reading these two articles, which should address some of your questions / issues.

    http://www.chinesemedicinedoc.com/misc-chinese-medicine-articles/understanding-case-records-pt-1/

    http://www.chinesemedicinedoc.com/misc-chinese-medicine-articles/understanding-case-records-pt-2/

    2. I do not have large patient experience with hemilateral withering, but I agree a “cure” is unlikely. But I think that improvement is possible. So yes, prolonging life, increasing vitality, increasing muscle mass, and ‘use’ seems possible. To what extent depends on the individual circumstance.

    3. Moderate (or slack) pulse (from Ding Ganren, Qin’s teacher) = nutritive weakness and surplus in the defensive. This pulse often corresponds to stiffness in the upper (neck) and paralysis in the lower and can be differentiated floating, deep, large and small.

    Hope this helps a little.

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