[Patient] Wu, age 41, [after] undergoing excessive agitation, had Liver and Gallbladder ascendant yang. The Stomach qi was getting worse and worse. The pulse should be pulsing on the left. The treatment was through [addressing] the constrained heat.

mu dan pi (Moutan Cortex)
hei shan zhi zi (black gardenia)
bo he geng (Menthae haplocalycis Stem)
gou teng (Uncariae Ramulus cum Uncis)
chen pi (Citri reticulatae Pericarpium)
bai shao (Paeoniae Radix alba)
fu ling (Poria)
shen qu (medicated leaven)

Translated by: Jason Blalack

Original Chinese: 吴（四一） 操持过动。肝胆阳升。胃气日减。脉应左搏。从郁热治。（肝胆郁热）丹皮 黑山栀 薄荷梗 钩藤 广皮 白芍 茯苓 神曲

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Commentary: Although the main issue is ascendant yang, Ye treats the root and focuses on the heat from constraint. Although gou teng (Uncariae Ramulus cum Uncis) has an ability to descend yang and bai shao can curb the Liver yang, his approach is mild. Compare to formulas such as tian ma gou teng yin (Gastrodia and Uncaria Drink) where there is tian ma, gou teng, shi jue ming and niu xi to descend or zhen gan xi feng tang which uses niu xi, dai zhe shi, long gu, mu li, and gui ban. His choose is one of style as well as to a certain extant a reflection of the severity of the condition.

[Patient] Wu [suffered from] a warm disease for 70 days. The right pulse was long and left was deep. The tongue was limp with [a desire] to drink cold beverages. There was heart irritability-heat. The spirit qi was sometimes clear yet sometimes deranged. On the third day of menstrual bleeding the disease started. Hot qi settled internally in the blood, overwhelming the emptiness leading to inward fall. This disease should be considered stasis heat in the interior. However it had already become dangerous, and [must be approached] from a condition of buildup of blood with mania.

sheng di huang (Rehmanniae Radix),
mu dan pi (Moutan Cortex)
zhi da huang (prepared Rhei Radix et Rhizoma)
chao tao ren (dry-fried Persicae Semen)
ze lan (lycopos, bugleweed)
ren zhong bai (Hominis Urinae Sedimentum)

Translated by: Jason Blalack

Original Chinese: 吴（氏） 热病十七日，脉右长左沉，舌痿饮冷，心烦热，神气忽清忽乱，经来三日患病，血舍内之热气，乘空内陷，当以瘀热在里论病，但病已至危，从蓄血如狂例。（蓄 血）细生地 丹皮 制大黄 炒桃仁 泽兰 人中白

Source: From the Heat entering the Blood Chamber chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Commentary: Just as we often hear of cold entering the uterus during menstruation, Ye, in this case, makes the connection of warm disease entering the blood during menstruation. The “limp” in limp tongue also has the meaning of atrophy. This corresponds to yin deficiency. Ren zhong bai (Hominis Urinae Sedimentum) is salty, cold, and enters the Lungs, Heart, and Bladder. It clears heat, directs fire downwards, stops bleeding, and transforms phlegm. It treats taxation heat, Lung atrophy, nosebleeds, spitting up blood, throat impediment, gan of the teeth and gums, and sores in the mouth and tongue. Therefore the formula clears heat from the blood while also promoting the movement of blood.

[Patient] Dai [habitually] held in his/her feelings with no desire to speak up. This was a Heart disease and herb medicine is difficult to treat such an illness disease. This is damage caused by constraint of the seven emotions. [Zhu] Dan Xi’s yue ju wan (Escape Restraint Pill) method was used.

xiang fu (Cyperi Rhizoma)
chuan xiong (Chuanxiong Rhizoma)
huang lian (Coptidis Rhizoma)
fu ling (Poria)
zhi ban xia (Pinelliae Rhizoma preparatum)
ju hong (Citri reticulatae Exocarpium rubrum)
chao shan zha (dry-fried Crataegi Fructus)
shen qu (medicated leaven)

Made into pasty pills.

Translated by: Jason Blalack

Original Chinese: 戴（氏） 隐情曲意不伸。是为心疾。此草木攻病。难以见长。乃七情之郁损。以丹溪越鞠方法. 香附 川芎 小川连 茯苓 半夏 橘红 炒楂肉 神曲浆丸

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Commentary: This is a modified yue ju wan (Escape Restraint Pill). Ye chooses not to prescribe cang zhu , but instead uses ban xia, fu ling, and ju hong, er chen tang (Two-Aged [Herb] Decoction) . He also uses huang lian instead of zhi zi. One might assume that there are symptoms such as focal distention and a stifling sensation in the chest and abdomen.

This is a great example of how a master herbalist modifies a stock formula to fit the individual’s presentation.

Original Case by: Ye Tian-Shi (叶天士)

[Patient] Wang (63) was overworked and had anger, which damaged the yang. There was qi counterflow and blood constraint leading to pain. There was focal distention and sloppy stools. This was wind and wood rebelling against earth. Previous formulas were ineffective.  A formula that unblocks and boosts the yang ming and jue yin was given.

Prescription: dà bàn xià tang (Major Pinellia Decoction) plus

táo rén (peach kernel, persica)
bǎi zǐ rén (Platycladi Semen)
dāng guī (Angelicae sinensis Radix)
shēng jiāng (fresh ginger rhizome)
dà zǎo (Jujubae Fructus)

Commentary: dà bàn xià tang (Major Pinellia Decoction) contains zhì bàn xià (Pinelliae Rhizoma preparatum), rén shēn (Ginseng Radix), and honey 9-15g.

Translated by: Jason Blalack

Original Chinese: 王（六三） 劳怒伤阳。气逆血郁致痛。痞胀便溏。风木侮土。前方既效。与通补阳明厥阴。（肝犯胃气逆血郁） 大半夏汤加桃仁柏仁当归姜枣汤法。

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

[Patient] Lu (24) [had suffered] damage from constraint. The sinews were distended and there was heart (epigastric) pain.

gōu téng (Uncariae Ramulus cum Uncis)
xiāng fù (Cyperi Rhizoma)
yù jīn (Curcuma tuber)
cì jí lí (Tribuli Fructus)
mǔ dān pí (Moutan Cortex)
bò hé (Menthae haplocalycis Herba)
chén pí (Citri reticulatae Pericarpium)
fú líng (Poria)

Translated by: Jason Blalack

Original Chinese: 陆（二四） 郁伤。筋胀心痛。钩藤 生香附 郁金 白蒺藜 丹皮 薄荷 广皮 茯苓

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Constraint damaging the Heart and Spleen nutritive aspect with internal heat

Ji was a 69-year-old elderly person whose emotions were unwell (felt down). When there is constraint then lesser fire transforms into vigorous fire. The appetite was intact but the gastric cavity was not smooth (?). The mouth and tongue were eroded and putrid.

Diagnosis: This was damage to the Heart and Spleen nutritive aspect with wood fire scorching and removing the essence by force.

The muscles were becoming smaller day by day. Only when the patient became joyous would the overall condition begin to lighten, indicating that the internal arising of heat from constraint  could potentially be balanced. However implementing a method of clearing fire with bitter cold medicinals is wrong for regulating the emotions that are  internally causing heat from constraint.

Prescription:

jīn chāi shí hú (Dendrobium nobile)
lián qiáo xīn (Forsythiae Semen)
chǎo mǔ dān pí (dry-fried Moutan Cortex)
shuāng sāng yè (frost mulberry leaves)
chuān bèi mǔ (Fritillariae cirrhosae Bulbus)
fú líng (Poria)

Following this, Ye used the method of nourishing the nutritive aspect of the Heart and Spleen, while slightly assisted by a bitter and descending method.

rén shēn (Ginseng Radix)
huáng lián (Coptidis Rhizoma)
chǎo mǔ dān pí (dry-fried Moutan Cortex)
bái sháo (Paeoniae Radix alba)
mài yá (Hordei Fructus germinatus)
fú shén (Poriae Sclerotium pararadicis)

Translated by: Jason Blalack

Original Chinese: 季（六九） 老年情志不适。郁则少火变壮火。知饥。脘中不爽。口舌糜腐。心脾营损。木火劫烁精华。肌肉日消。惟怡悦开爽。内起郁热可平。但执清火苦寒。非调情志内因郁 热矣。（郁损心脾营内热）金石斛 连翘心 炒丹皮 经霜桑叶 川贝 茯苓 – 接服养心脾之营。少佐苦降法。 人参 川连 炒丹皮 生白芍 小麦 茯神

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

The patient had anger with Liver constraint. [In addition,] thought and preoccupation had damaged the Spleen. There was a yellow complexion, choppy pulse, and (s)he was [often] awake with an inability to go to sleep. Ancestor Xue’s method of treatment was used.

rén shēn (Ginseng Radix)
huáng qí (Astragali Radix),
shú bái zhú (steamed?? Atractylodis macrocephalae Rhizoma)
fú shén (Poriae Sclerotium pararadicis)
dà zǎo (Jujubae Fructus)
lóng yǎn ròu (Longan Arillus)
dāng guī (Angelicae sinensis Radix)
zhì gān cǎo (prepared licorice root)
hēi shān zhī zǐ (black gardenia)
mǔ dān pí (Moutan Cortex)
yuǎn zhì (Polygalae Radix)

Translated by: Jason Blalack

Original Chinese: 某 恼怒肝郁。思虑脾伤。面黄脉涩。寤不成寐。宗薛氏法治之。人参 黄 熟于术 茯神 枣仁 桂圆肉 当归 炙草 黑山栀 丹皮 远志

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Commentary: Ancestor Xue refers to Xue Ji (薛己) and this formula is based on gui pi tang (Restore the Spleen Decoction) from Categorized Essentials for Normalizing the Structure (Zhèng tǐ lèi yào). This case is interesting because this is a tonifying and fairly cloying formula with very little moving medicinals that treats a pattern that started with Liver constraint. Ye decides to treat the result of the constraint (damage to the Spleen) first and foremost. I think this demonstrates Ye’s desire for getting the patient to sleep and treating the key mechanism causing the insomnia, the Spleen. Although Ye is known for focusing in on the underlying mechanism, even at times completely ignoring branch herbs in favor of addressing the core pattern, this shows that he is flexible, not always treating the initial “cause”. Comments?

* Anyone have any further insight on translating this, 寤不成寐.

** Anyone have any further insight on this medicinal name, 熟于术.

Wu (40 years old) was exhausted and angry which led to damage. The disease was located in the Liver and Spleen. There was chronic brain leakage  and the bone marrow has been secretly damaged. The patient was to take [the below prescription] that resolves depression for a short time, and then continue with a diffusing and tonifying one.

gōu téng (Uncariae Ramulus cum Uncis)
shēng xiāng fù (unprepared cyperus)
mǔ dān pí (Moutan Cortex)
sāng yè (white mulberry leaf)
shén qū (medicated leaven)
bái sháo (Paeoniae Radix alba)
fú líng (Poria)
chén pí (Citri reticulatae Pericarpium)

Translated by: Jason Blalack

Original Chinese: 吴（四十） 劳倦嗔怒致伤。病在肝脾。久有脑泄。髓脂暗损。暂以解郁。继当宣补。钩藤 生香附 丹皮 桑叶 神曲 白芍 茯苓 广皮

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Commentary: Here is chronic condition with deep deficiency which resolves constraint before tonifying.

** Brain leakage (above) refers to deep source nasal congestion. Notice that the prescription does not contain any medicinals to directly address this symptom. Ye resolves the problem by focusing on the core underlying mechanism.

Case By: Fei Sheng-Fu (费绳甫)

Mr Xu Zhongxiu from Zhenjiang [suffered] from swelling of the feet and legs as well as of the testicles, abdominal distension, coughing, facial edema, and reduced urination. He came to me for examination and treatment because treatment so far had not worked. His pulse was floating and wiry in the right cun position indicating water swelling. The Lungs were unable to afford regular passage through the water ways towards the Bladder so that water qi flowed over transversely into the spaces between the skin and flesh. I considered Yu’s treatment [strategy] for flooding, which relies on first dredging [the water pathways] so that [water qi] can flow downward. Once the water has a way to exit [the body] it will no longer have cause to flow over [into the body].

mole cricket (lóu gū) 9g
Tetrapanacis Medulla (töng câo) 9g
Kochiae Fructus (dì fü zî) 9g
Acanthopanacis Cortex (wû jiä pí) 6g
Poriae Cutis (fú líng pí) 12g
Benincasae Exocarpium (döng guä pí)  12g
Armeniacae Semen (xìng rén) 9g
Fritillariae cirrhosae Bulbus (chuän bèi mû) 9g
Citri reticulatae Exocarpium rubrum (jú hóng) 3g
Junci Medulla (dëng xïn câo) 3 chi

Commentary: Whereas in the previous two cases (#6 and #5) obstruction of Lung qi was due to Liver yang or fire, here it is due to obstruction of Lung qi by dampness. No longer moving downward it spills into the body, including the Liver channel (the testes). The treatment strategy relies of draining dampness from the Lungs via the Three Heater with a combination of Three-Seed Decoction (sän rén täng) and Five-Peel Drink (wû pí yîn).

Translated by: Volker Scheid

For more reading on Fei Bo-Xiong, please look for Volker’s upcoming book from Eastland Press. Its working title is, “Menge Medicine,  Vol. 1, Fei Boxiong’s Refined Medicine Remembered with Commentaries and Fei Family Case Histories”

Hu, 46 years of age, had been weeping due to grief. The disease arose from internally generated emotions, which led to constraint. There was a physical manifestation in the area below the heart  that was gradually getting larger with a hardness upon palpation.

Treatment principle: A bitter-acrid and downward-draining method was used. First must treat the qi clumping.

Diagnosis:  (Focal distention and clumping below the heart).

Coptidis Rhizoma (huáng lián)
Zingiberis Rhizoma (gān jiäng)
Pinelliae Rhizoma preparatum (zhì bàn xià)
Zingiberis Rhizomatis Succus (jiāng zhī) (ginger juice)
Poria (fú líng)
poria with cutis (lián pí fú líng)
Trichosanthis Fructus (guā lóu)

Commentary: poria with cutis (lián pí fú líng)  “While it still strengthens the Spleen, its ability to leach out dampness and facilitate water is enhanced, which makes it especially suitable for water-damp edema due to weakness in the transportive function of the Spleen (Clavey and Bensky, p.270).”

Translated by: Jason Blalack

Original Chinese: 胡（四六） 悲泣。乃情怀内起之病。病生于郁。形象渐大。按之坚硬。正在心下。用苦辛泄降。先从气结治。（心下痞结）川连 干姜 半夏 姜汁 茯苓 连皮栝蒌

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.