From doctor Huang Dao-fu[1], September 14, 1984:
Ms. Chen was age 17.  Seven days previously she had developed a cold with fever and fear of cold.  The heat was more than the cold.  Everyday she had fever 2-3 times.    Though she had dizziness, there was no vomiting and her two excretions were normal.  She did not sweat easily.  She had itching and an unpleasant body odor that did not go away with bathing.  The school doctor suspected malaria but blood tests were negative for the malaria organism.  She was then diagnosed with an endocrine disorder and treated with oryzanol but there was no improvement.  She then came to see me.  I saw that her tongue was pale with thin white moss and her pulse was minute and weak.  This was a case of long term wind cold damp and Ying and Wei disharmony.  It was appropriate to dispel wind and scatter cold while harmonizing the Ying and the Wei.  I thought to try Zhang Zhong-jing’s method and gave her two packages of Gui Zhi Ma Huang Ge Ban Tang with added flavors. 

Gui Zhi 5g
Bai Shao 3g
Chao Xing Ren 3g
Zhi Gan Cao 3g
Sheng Jiang 2 Slices
Ma Huang 3g
Da Zao 4g
Yi Yi Ren 15g

After one package the patient experienced a physiological sweat and the body itching stopped.  After 2 packages, she noticed that her body felt light and relaxed after bathing and that the unpleasant odor had gone.  After several days there was no recurrence.

Discussion: In terms of unpleasant body odor, Chao Yuan-fang says in the Zhu Bing Yuan Hou Lun (诸病源侯论),

That when the Qi is not harmonized, the fluids become mixed with dirtiness.  This causes unpleasant body odor.” 

In this case, the symptom followed the contraction of a cold.  This was Qi closure in which the remaining evil had not completely left and it mixed with damp turbidity.  This was contained and flowed out the surface with a bad odor.  It is said that,

When the body cannot slightly sweat, there will be body itching”

and therefore one should use pungent warm to resolve the exterior in order to induce a slight sweat with Gui Zhi Ma Huang Ge Ban Tang.  The added Yi Yi Ren increases the formula’s ability to transform and induce the dampness to seep out and makes the formula’s action very quick. 

Translated by: Sharon Weizenbaum

NOTE: For further reading on this case and formula, please see Sharon’s introduction, Guizhi mahuang ge ban tang & guizhi er mahuang yi tang

[1] From the Hu Nan Journal of Traditional Chinese Medicine, 1990 (5) :29

Original Chinese:  体臭 – 黄道富医案；陈某，女，17岁，1989年9月14日初诊。自述7天前曾患“感冒”，发热恶寒．热多寒少，一日二三发，头晕不呕，二便正常；汗出不畅，身痒体臭，浴后不减，校医疑为“疟疾”，建议至某院诊治。血液检验未找到疟原虫，诊断为内分泌功能紊乱．予谷维素等药治疗，症情依然，遂求治于余。证见舌质淡、苔薄白，脉微弱。此届风寒湿久稽，营卫不和。宜祛风散寒，调和营卫。仿张仲景小发汗例，试投桂麻各半汤加味：桂枝5克，白芍3克，麻黄(先煎)3克，杏仁3克，炙甘草3克，生姜2片，薏苡仁15克，2剂，水煎服。
服药1剂，汗出、身痒即止；2剂后自觉身如浴后轻松舒畅，体臭等症随之消失，至今未复发。
(湖南中医杂志1990，(5)：29)
按语：体臭一症，隋·巢元方《谙病源侯论》云：“体气不和，使津液杂秽，故令体臭。”本例发于感冒之后，当为余邪未尽与湿浊之气相搏，蕴蒸外溢作臭。所谓“以其不得小汗出，身必痒。”故采用辛温解表，小发其汗的桂枝麻黄各半汤，更加薏苡仁一味以增强其宣化渗湿之功，故取效甚捷。

This is a case from Dr. Wang Zhan[1], January 5, 1976

Ms. Liu, age 26, had a cold for 4-5 days.  She still had a fever, fear of cold and a temperature of 38°C.  She was sweating slightly.  Although she had taken an instant tea for colds and anti-inflammatory analgesics, these had had no effect.  She had body pain, her excretions were normal, her tongue moss was thin and white and her pulse was floating and tight.  I gave her Gui Zhi Ma Huang Ge Ban Tang with added flavors.

Gui Zhi 8 gm
Bai Shao 5 gm
Xing Ren 5 gm
Gan Cao 5 gm
Sheng Jiang 5 gm
Ma Huang 8 gm
Da Zao 4 gm
Fu Ping 9gm

After the herbs, she had a slight sweat and after two more packages the illness was completely resolved.

Discussion: When someone has a cold for several days and it is not a Shao Yang and or Yang Ming presentation and yet there is a fever with an aversion to cold, sweating, a floating tight pulse, it is appropriate to lightly induce sweat using Gui Zhi Ma Huang Ge Ban Tang.

Translated by: Sharon Weizenbaum

[1] 伤寒论临床应用 The Clinical Application of the Shang Han Lun, 1990, pg 24

Original Chinese:

二、表部不解

王占玺医案：刘某，女，26岁，1976年1月5日初诊。感冒已四五日，仍发热恶寒，体温38℃，微汗出，虽经服感冒冲剂及解热镇痛剂不效，身酸 痛，二便正常，苔薄白，脉浮紧。随予桂枝麻黄各半汤加味：桂枝8克，白芍5克，生姜5克 甘草5克，大枣4枚，麻黄8克 杏仁5克,浮萍9克。
药后取微汗，2剂诸证悉平。(《伤寒论临床应用》1990：24)
按语：外感数日，无少阳、阳明见证，仍发热恶寒，汗出，脉浮紧，宜小发汗，与桂麻各半汤愈之。

NOTE: For further reading on this case and formula, please see Sharon’s introduction, Guizhi mahuang ge ban tang & guizhi er mahuang yi tang

Gui Zhi Ma Huang Ge Ban Tang

Gui Zhi (1 liang + 16 zhu) 4 grams
Sheng Jiang (1 liang) 3 grams
Bai Shao (1 liang) 3 grams
Zhi Gan Cao (1 liang) 3 grams
Ma Huang (1 liang) 3 grams
Da Zao 4 dates
Xing Ren (24 pieces) 3 grams

Gui Zhi Er Ma Huang Yi Tang

Gui Zhi (2 liang + 17 zhu) 4 grams
Sheng Jiang (1 liang +6 zhu) 3 grams
Bai Shao (1 liang + 6 zhu) 3 grams
Zhi Gan Cao (1 liang +2 zhu) 3 grams
Ma Huang (6 zhu) 1 grams
Da Zao 5 dates
Xing Ren (6 pieces) 2 grams

Original clauses from the Shan Han Lun

1.Tai Yang disease, for 8 or 9 days, malaria like symptoms, fever and aversion to cold, more fever, less cold, the person does not vomit, urine and stool are normal, episodes occurring 2-3 times each day.  2. Where the pulse is slightly moderate, there will be imminent recovery. 3. Where the pulse is faint with aversion to cold, this is deficiency of both Yin and Yang and one should not further promote sweating, purging or vomiting, 4. Where the complexion is like that of a hot color, there has been no imminent recovery.  This is because the patient cannot raise a mild sweat, the body will be itchy and Gui Zhi Ma Huang Ge Ban Tang is appropriate. (clause 23)”

Having taken Gui Zhi Tang, there is copious sweat; if the pulse is flooding and big, give Gui Zhi Tang as before.  If the disease resembles malaria, occurring again during the day, sweating will resolve it, Gui Zhi Er Ma Huang Yi Tang will resolve it. (clause 25)”

Explanation of Formulas:

Although there are symptoms of illness in this presentation, the cold and heat manifest together and these episodes occur two to three times a day and there is no vomiting.  This means that the illness has not entered the Shao Yang.  Although the heat is more than the cold, there is still clear urine and normal bowels.  This means that the illness has not entered the Yang Ming.  Since there is not a Yang Ming or a Shao Yang pattern, there has been no transmutation.  This means that the illness is still at the Tai Yang and that it has become mild and chronic.  The correct Qi attempts to push the evil out by sweating but the sweating is not effective to resolve the evil.  The result is that the illness becomes chronic and yet one cannot create a big sweat.  Gui Zhi Ma Huang Ge Ban Tang is appropriate because it will create a light sweat.

Gui Zhi Er Ma Huang Yi Tang is similar to the above formula in that it is also for a mild condition.  In order to resolve the muscles, the ingredients only slightly promote sweating.

Clinically, this illness presentation is most often seen in young people and elderly people as well as those who are weakened with chronic illness.  There is no discussion as to whether this is cold damage or wind strike.  What is important is only that this is chronic without resolution, that the presentation is relatively light, and that there is cold and heat like malaria.  For this, one can use the above two formulas.

Case examples:

1. A light presentation with stasis on the exterior
2. Unresolved stasis on the exterior
3. Urticaria
4. Unpleasant Body Oder