Lǐ X 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: Heat effusion, sweating, 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 nutritive and defensive disharmony.  Nutritive and defensive 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 defensive are harmonious then yin and yang are coordinated, and defensive qi secures and the nutritive qi guards.  If the construction and nutritive are not harmonious then yin and yang mutually go against each other. Nutritive-yin fails the defensive-yang resulting in fever, defensive-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: