Tai yin deficiency cold pattern with heat signs
Xu Shu-Wei’s Case

In the beginning, Mr. Cao had cold-damage that lasted for 6-7 days. There was abdominal fullness with vomiting, inability to get food down, a warm body, hot extremities, spontaneous diarrhea, pain in the abdomen, retching, and nausea. The first doctor said there was too much yang, because of the hot extremities. He feared there was an amassment of heat in the stomach leading to vomiting or because there was vomiting and diarrhea this was sudden turmoil disorder. At this point, I (Xu) was asked to give a diagnosis. The pulse was thin and submerged.  One can say that this was a tai yin pattern.

In the disease of the tai yin, there is abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain. Therefore, to bring things to a halt, I gave him Regulate the Middle Pill (li zhong wan) the size, as Zhong Jing said, of  “large chicken egg yolks”. The patient took five or six pills during the day and night. This was followed up for several days by Five-Accumulation Powder (wu ji san) and there was resolution.

Translated by: Jason Blalack

Source: (《伤寒九十论•证二十三》)

Commentary: The “hot extremities” has the meaning of  extremities that are not cold and means “extremities that are spontaneously warm”. This specific sign can be understood that this  pattern has not yet reached the shao yin with yang debilitation and yin exuberance, where there is reversal cold of the four extremities. This is therefore only a pattern of tai yin deficiency cold, where Regulate the Middle Pill (li zhong wan) was used to regulate the yang of the middle burner and the patient was healed. Furthermore, the pulse is a classic Regulate the Middle Pill (li zhong wan) pulse, which would make much less sense with a heat amassment pattern.

Original Chinese: 许叔微医案:曹生初病伤寒，六七日，腹满而吐，食不下，身温，手足热，自利，腹中痛，呕，恶心。医者谓之阳多，尚疑其手足热, 恐热蓄于胃中吐呕，或见吐利而为霍乱，请予诊。其脉细而沉。质之日:太阴证也。太阴之为病，腹满而吐，食不下，自利益甚，时腹自痛。予止以理中丸，用仲景云”如鸡子黄大”。昼夜投五六枚。继以五积散，数日愈。