Wind Stroke-Blood Deficiency (YTS)

Original Case by: Ye Tian-Shi (叶天士)

[The patient] had blood loss for many years with chronic damage to the yin qi. There was a relapse due to worry, sadness, and melancholy, where yang linked with internal wind which led to a great uprushing to the head (da mao 大冒). The blood residence became empty and qi overwhelmed the left side of the body, producing a deviated mouth, numbness and tingling in the limbs, dark tongue, inability to speak, and foot atrophy with an inability to walk. Obviously the Liver and Kidneys were deficient and famished, the yin qi was unable to govern the bearing upwards. It was important to nurture the lower to extinguish wind. A method [designed by] Liu He-Jian was used.

• Shu Di Huang (Rehmanniae Radix, prepared)4 liang
• Niu Xi (Achyranthis Bidentatae Radix)1.5 liang
• Shan Zhu Yu (Corni Fructus)2 liang
• Yuan Zhi (Polygalae Radix, dry-fried until black)1.5 liang
• Gou Qi Zi (Lycii Fructus)2 liang
• Ju Hua (Chrysanthemi Flos)2 liang
• Wu Wei Zi (Schisandrae Fructus)1.5 liang
• Shi Hu (Dendrobii Herba)2 liang, 4 qian
• Fu Shen (Poriae Sclerotium Pararadicis)2 liang
• Dan Rou Cong Rong (bland Cistanches Herba)1 liang, 2 qian

Make into honey pills and take four qian a day.

Qin Bo-Wei’s Commentary: This is also a wind-stroke pattern from a blood deficiency not nourishing the sinews and bones, with internal wind assaulting the collaterals. However, there was left-sided numbness and tingling in the limbs that had not yet reached the degree of hemilateral withering.

The chief manifestation was wind harassing the upper burner leading to a deviated mouth and dark tongue. There was also lower burner yin exhaustion which resulted in foot atrophy and lack of strength. The origin of the onset of disease was a loss of blood and melancholy. The diagnosis is Liver and Kidney yin deficiency unable to govern the bearing upwards, which warranted an emphasis on nurturing the lower burner in order to extinguish wind.

The pattern belonged to silent collapse⁽¹⁾ wind-stroke disability⁽²⁾. He adapted Liu He-Jian’s Di Huang Yin Zi (Rehmannia Drink). Since there were no yang deficiency signs he did not use Zhi Fu Zi (Aconiti Radix Lateralis Preparata), Rou Gui (Cinnamomi Cortex) or Ba Ji Tian (Morindae Officinalis Radix). In addition because there was yin deficiency stirring wind heat, he removed the fragrant penetrating Shi Chang Pu (Acori Tatarinowii Rhizoma) and added Gou Qi Zi (Lycii Fructus) and Ju Hua (Chrysanthemi Flos) in order to nourish the blood and extinguish wind. He used Niu Xi (Achyranthis Bidentatae Radix) in order to descend, treating the foot atrophy.

Notes:

(1) Yin jue (喑厥) . This is an inability to talk due to a stiff tongue with reversal cold in the limbs.
(2) Feng fei (风痱) . This refers to atrophy of the limbs with an inability to move, or a paralysis after wind-stroke.

Translated by: Jason Blalack

Original Chinese:

案二:失血有年，阴 气久伤。复遭忧悲悒郁。阳挟内风大冒。血舍自空。气乘于左。口肢麻。舌喑 无声。足痿不耐行走。明明肝肾虚馁。阴气不主上承。重培其下。冀得风熄。议以河间法。熟地四两，牛膝-两半，莫肉二两，炒黑远志一两半，柜子二两，炒菊花二两，五味子-两半，川斜二两四钱，获神二两，淡灰蓉-两二钱，加蜜丸，服四钱。(中风门)

按:此亦血虚不荣筋骨，内风袭络的中风证，但偏左肢麻，末至偏枯程度。其主证为风扰于上而口喝舌暗，阴亏于下而足痞无力。故从发病的根源失血和僵郁等，诊断为 肝肾阴虚不主上承，主张重培其下以冀风熄。证属啃撅风痒，采取了刘河间的地黄饮子，因没有阳虚现象，除附子、肉桂、巴哉，并因阴虚风动，去莒蒲的香窜，加柏菊以养血熄风，牛膝下行以治足屡。

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.