[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.

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.

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》.

Shen was 43 years old with a deficient and choppy pulse. The emotions had become unsmooth and the Liver and Spleen qi and blood were excessively constrained. This had persisted without relief for half a year. Giving a drastic formula was difficult [not appropriate]. Therefore giving the official prescription, Rambling Powder (xiäo yáo sân) with Tonify the Middle to Augment the Qi Decoction (bû zhöng yì qì täng) was decided upon.

Original Chinese: 沈（四三） 脉虚涩。情怀失畅。肝脾气血多郁。半载不愈。难任峻剂。议以局方逍遥散。兼服补中益气。

** Other Rambling Powder (xiäo yáo sân) Ye Tian-Shi constraint case studies .