[Patient] Ni had lots of pain and ascending yang. The yin fluids were endlessly pouring out from the upper part of the body. The tongue was dried-up and red-crimson colored. There was irritability and inability to sleep. It was suitable to augment the Kidney water in order to control Heart fire.

xian sheng di (fresh Rehmanniae Radix)
xuan shen (scrophularia, ningpo figwort root)
mai men dong (Ophiopogonis Radix)
lu dou pi (Phaseoli Radiati Testa)
jin yin hua (Lonicerae Flos)
zhu ye xin (Lophatheri Folium Immaturum)

Translated by: Jason Blalack

Original Chinese: 倪 多痛阳升。阴液无以上注。舌涸赤绛。烦不成寐。当益肾水以制心火。（心火）鲜生地 元参 麦冬 绿豆皮 银花 竹叶心

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

Commentary:

lu dou pi (Phaseoli Radiati Testa) is cold and sweet. It resolves heat toxin, clears wind-heat, eliminates eye screen (目翳), transforms maculopapular eruption, and disperses swelling and distention. From: 《纲目》& 《随息居饮食谱》

Comments?

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.

Case by Fei Sheng-Fu (费绳甫）

The wife of Mr. Zhu Zhushi from Zhejiang was ill with cough and panting so that it was difficult for her to lie down at night. Her heart was irritable and vexed, she had a stifling sensation in the upper abdomen, and the mouth was greasy with little intake of either food or drink. The face was puffy and the legs swollen, and at night she could not sleep. The momentum [of this disorders] was extremely serious. When I examined her the pulse came overflowing, big, wiry and rapid.

[Diagnosis & Pathodynamic]: Both qi and yin fluids were deficient so that Liver yang ascended excessively. This combined with habitually steaming phlegm dampness blocking Lungs and Stomach so that clarifying and directing downward had no force.

[Treatment Principle]: The [appropriate] strategy was to build and nourish qi and yin fluids, clear the Liver and transform phlegm.

[Prescription]:

Ginseng Radix (rén shën) 3g
Panacis quinquefolii Radix (xï yáng shën) 4.5g
Eucommiae Cortex (dù zhòng) 9g
Poriae Sclerotium pararadicis (fú shén) 6g
Fritillariae cirrhosae Bulbus (chuän bèi mû) 9g
Aurantii Fructus (zhî ké) 3g
Trichosanthis Pericarpium (guä lóu pí) 9g
Ligustri lucidi Fructus (nu zhën zî) 9g
Armeniacae Semen (xìng rén) 9g
Paeoniae Radix alba (bái sháo) 4.5g
Ostreae Concha (mû lì) 12g
Fossilia Dentis Mastodi (lóng chî) 6g
Benincasae Semen (döng guä zî) 12g
Bambusae Caulis in taeniam (zhú rú) 3g

After two prescriptions the momentum of the excessively ascending Liver yang was gradually being pacified, the heart irritability and vexation had stopped, and she was able to sleep at night. I continued the previous formula with the addition of Dendrobii Herba (shí hú) 9g, five slices of pear, and five pieces of Eleocharitis Rhizoma (bí qì). As the bowel moved [regularly] phlegm was being drained from below so that Stomach and Lungs clarified and directed downward [once more], and wheezing and coughing were pacified, and she could lie down at night. The appetite gradually returned and the facial swelling and swelling of the legs subsided. I continued the formula with the addition of mao yan (毛燕), regulating [the condition] for half a month until she was cured.

** Translated by: Volker Scheid

Volker’s Commentary: This case by FSF does not correspond to any of his own or FBX’s manifestation patterns for swelling and edema. It thereby demonstrates that these patterns, where they are made explicit, constitute a general assessment of the terrain from which pathological processes can be deduced and not an attempt to provide prescriptive protocols. Here, the overflowing rapid pulse when related to the symptom pattern indicates the pathological process described by FSF. Hence, while facilitating the clearing and downward directing functions of Lungs and Stomach is necessary to treat the manifestations, root treatment focuses on pacifying hyperactive Liver yang. 

Jason’s Commentary: This 毛燕 (mao yan) is a type of bird’s nest (燕窝, yan wo) that is of a relatively inferior quality. It is grey colored and contains many feathers.

Herbal prescription:

yu jin (Curcumae, Tuber)
gou teng (Uncariae cum Uncis, Ramulus)
mu dan pi (Moutan, Radicis Cortex)
xia ku cao (Prunellae, Spica)
sheng xiang fu (Unprocessed Cyperi, Rhizoma)
bo he (Menthae, Herba)
chen pi (Citri Reticulatae, Pericarpium)
fu ling (Poriae Cocos, Sclerotium)

Chinese: 程（妪） 脉弦涩。外寒内热。齿痛舌干。无寐。乃肝脾郁结不舒。郁金 钩藤 丹皮 夏枯草 生香附 薄荷广皮 茯苓