When I arrived, I saw that the patient was experiencing hasty wheezing and shoulder breathing and spontaneous sweating from his head. This was heat in both the exterior and interior. His tongue coat was dark grey and his tongue was so contracted that he was unable to speak. I immediately took his pulse and found it floating, rapid, and strong, yet extremely empty upon stronger pressure. Because of this I thought that this was a pattern of extreme yang ming heat where the yin aspect was about to be exhausted. It actually was a worsening pattern from incorrect administration of  (gui zhi tang) and Minor Bupleurum Decoction (xiao chai hu tang).

I immediately gave her White Tiger and Ginseng Decoction (bai hu jia ren shen tang), substituting Dioscorea Radix (shan yao) for the nonglutinous rice (jing mi) [1]. In addition, I substituted Scrophulariae Radix (xuan shen) for Anemarrhenae Rhizoma (zhi mu). She took two packets of the formula in succession and her thirst was relieved, and her wheezing stopped. Her pulse was no longer floating and rapid although it was still strong. Her tongue stretched out and she was able to speak. Her phlegmatic cough was no longer intense and appeared to be milder. He then continued with a modification of Follow the Dragon Decoction (cong long tang), omitting the Perillae Fructus (su zi) and adding 4 qian of Ginseng Radix (ren shen) and 8 qian of Ophiopogonis Radix (mai men dong).

After taking 7 packets she was completely cured.

赵××，患温病。医者投以桂枝汤，觉热渴气促。又与柴胡汤，热尤甚，且增喘嗽，频吐痰涎，不得卧者六七日。医者谓病甚重，不能为矣。举家闻之，惶恐无措。伊芳弟××延为延医。急投以白虎加人参以山药代粳米汤，更以玄参代知母。连服两剂，渴愈喘止，脉不浮数，仍然有力，舌伸能言，而痰嗽不甚见轻。继投以从龙汤，去苏子，加人参四钱，天冬八钱，服七剂全愈

—

Follow the Dragon Decoction (cong long tang) contains:

Fossilia Ossis Mastodi (long gu) (not calcined, crushed) 30 grams
Ostreae Concha (mu li) (not calcined, crushed) 30 grams
Paeoniae Radix alba (bai shao) 15 grams
purified Pinelliae Rhizoma (qing ban xia) 12 grams
Dry-fried Perillae Fructus (chao su zi) (crushed) 12 grams
Dry-fried Arctii Fructus (chao niu bang zi) 9 grams

Charles Chace and I provided  commentary to the case in the article Tracing The Dragon, published in the RCHM Journal Autumn 2011, Vol. 8, No. 2.

Please feel free to leave any comments, questions, or criticisms here.

The object was removed from the chamber pot with fire tongs, washed off with water, and then carefully examined. It was a “duck butt.” The patient had attended a banquet about 10 days previously where he ate a piece of under cooked duck meat. Because of the circumstances he was too embarrassed to spit it out and reluctantly swallowed it resulting in the illness described above.

又如一76歲老人陳某，15年前患結腸癌，曾手術切除，自後身體一直健康。近1周來，大便不通，少腹手術一側又捫及一塊狀物，幾個醫院均要患者入院作進一步檢查，并認為手術也無希望。要求中醫服些中藥，也覺無能為力而未給處方。後病人竟排出一粒硬屎，頓覺少腹輕鬆。用火鉗從便桶中鉗出硬物，用水沖洗之後仔細辨認，原來是一個“”，是十幾天前赴宴，揀得一塊鴨肉，覺得未燒酥，礙於親朋面前不便吐掉而囫圇吞下，於是發生前述的病證。

Qì and Blood Depletion – Liver and Kidney insufficiency mistaken for wind-cold-damp painful obstruction.

Misuse of the Fire Spirit Current.

[Patient] Xu was a 59 year old woman who is chronically exposed to water- damp while working. After many years she developed joint-bone limp aching pain that sometimes was mild and sometimes was serious. After retirement it progressively worsened year after year. She sought out many treatments from the hospital, but with no results. Someone recommended her an empirical formula of chuan cao wu (Aconiti et Aconiti Kusnezoffii Radix Lateralis) 50g, zhi fu zi (Aconiti Radix Lateralis Praeparata) 50g, gui zhi (Cinnamomi Ramulus 30g, qiang huo Notopterygii Rhizoma seu Radix) 30g, chuan xiong (Chuanxiong Rhizoma) 30g, ma huang (Ephedrae Herba) 15g, xi xin  (Asari Herba) 15g, gan song (Nardostachydis Radix seu Rhizoma) 30g, tao ren (Persicae Semen) 15g, hong hua (Carthami Flos) 15g, chi shao (Paeoniae Radix rubra) 15g, ru xiang (Olibanum) 15g, mo yao (Myrrha) 15g, and qian nian jian (Homalomenae Rhizoma) 30g.

One packet of this formula was taken and the pain did not decrease but instead there was incessant great sweating, flusterdness, and palpitations. At nightfall her extremities would alternately stretch out and contract, quiver, shake, tremor, and when serious they would jerk, cramp and produce pain that was difficult to endure. Although she went through emergency western medicine treatment to resolve the spasms and stop the pain, there still was no long-term relief. She therefore sought out Chinese medicine.

Upon examination, she had a bright white facial complexion and the tip of her nose, lips, mouth, and yin tang [area] all were green-blue purplish. [In general] her extremities would spasm and at times her muscles were stiff and rigid.  Massage felt good, although she incessantly moaned. In her retelling of the past, she reported that after taking the medicine, mentioned above, she had shortness of breath, lack of strength, incessant sweating, aversion to wind, fear of cold, whole body stiffness, and increasing pain. Her tongue body was dark and crimson, the fur was thin with little fluid, and the centre of the tongue had fissures. Her pulse was thin, weak, and slightly rapid.

Differential Diagnosis: This was a deficiency painful obstruction with a misuse of a big formula that effused, dissipated, and attacked the painful obstruction [disease] which further damaged the qi, blood, and fluids,  loss of nourishment of her sinews (and vessels), which lead to convulsions.

 The treatment method was to augment qi and nourish blood, tonify and augment the Liver and Kidneys in order to treat the root, as well as to dispel wind, eliminate dampness, and stop painful obstruction pain, simultaneously treating the tip. The formula given was a modified ba zhen juan bi tang jia jian (Eight Treasure Remove Painful Obstruction Decoction). After 2 packets the convulsions were reduced, pain was clearly relieved, and afterwards the method of supporting the right and dispelling pathogen was applied to bring about recuperative care and healing.

Commentary: This is a pattern of deficiency painful obstruction. The patient was close to 60 years old, and had chronic painful obstruction disease. Qì, blood, yīn and yàng all were deficient and  normal [qì] deficiency was at the root. A lodged pathogen was the tip. The treatment method should support the normal as well as eliminate the pathogen. However, the first doctor thought the disease was an excess painful obstruction [disease], and stubbornly dispelled wind and eliminated dampness. Furthermore he used a large formula with chuan cao wu (Aconiti et Aconiti Kusnezoffii Radix Lateralis), zhi fu zi (Aconiti Radix Lateralis Praeparata), ma huang (Ephedrae Herba), xì xīn (Asari Herba), gui zhi (Cinnamomi Ramulus, and qiang huo (Notopterygii Rhizoma seu Radix) to effuse, dissipate, and attack the painful obstruction which consumed and damaged the qi, blood and fluids. This resulted in the channels [and vessels] losing nourishment and leading to convulsion. From the second examination the patient was seen to have flusteredness and palpations at night fall, her extremities alternately expanded and contracted, quivered and had tremors, bright white facial complexion, shortness of breath, lack of strength, dark crimson and red tongue with fissures and fur that was shiny with little fluids, and a weak slightly rapid pulse. This was a pattern of qi and blood deficiency and Liver and Kidney insufficiency.

Source:  [缪以星•临证随笔2 则•湖南中医学院学报，1986,(1):33]

Translated by: Jason Blalack

Commentary: I found this case interesting because it demonstrated how quickly and severely an incorrect formula can cause problems. The original formula was a fire spirit current approach. At first sight, it looks incredibly odd and somewhat incomprehensible as to why one would would give such high dosages of such medicinals. However, this type of formula (and dosages) is not uncommon in the fire spirit current. Such dramatic formulas, can have incredibly fast results, however they can also be extremely damaging. Obviously, correct diagnosis is important.

Spleen and Stomach Yang Deficiency
(Chronic Hepatitis)

(Thanks Greg for this instructive case!)

Bai, male, 39. January 24, 1964, initial consultation, in-patient department. Patient had suffered from chronic hepatitis for six years with intermittent bilateral flank pain, abdominal distention and bloating, anorexia, frequent belching, borborygmus, flatulence, and loose stools one to two times per day or once every-other day. Previously, he had been admitted to the hospital five successive times and undergone hepato-protective therapies, testosterone propionate therapy, etc., all with only temporary effects. When his job was stressful the condition would flare. Formulas such as Chai Hu Shu Gan San (Bupleurum Liver-Coursing Powder) had been applied in the past without obvious benefit. Upon examination, all six pulses were deficient, slow, and weak, and the tongue was swollen and large with a greasy, floating coat. Origin of the disease occurred in his early years when famine and forced labor led to dysfunction of Spleen and Stomach ascension, descension, and transportation. His presentation closely resembled a syndrome from Essential Prescriptions of the Golden Coffer (Jin Gui Yao Lue) “nausea and borborygmus, epigastric distention, Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction) commands.” The prescription followed:

法半夏 fa ban xia (Pinelliae Ternatae, Rhizoma Praeparata) 9g
萸炒连 huang lian fried with wu zhu yu (Coptidis Chinensis, Rhizoma fried with Evodiae Rutecarpae, Fructus) 3g
黄芩 huang qin (Scutellariae Baicalensis, Radix) 9g
干姜片 gan jiang (Zingiberis, Rhizoma) 6g
炙甘草 zhi gan cao (Glycyrrhizae Melle Tosta, Radix) 6g
潞党参 dang shen (Codonopsitis Pilosulae, Radix) 9g
大枣 da zao (Zizyphi Jujubae, Fructus ) 4 pieces

2^nd consultation: February 29, 1964. One package of the previous prescription was taken each day, and one month later the poor appetite, borborygmus, flatulence, and other symptoms had decreased significantly. However, there was still abdominal distention and flank pain, and the tongue and pulse were same as before. It was suitable to use Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction) from On Cold Damage (Shang Han Lun):

厚朴 hou po (Magnoliae Officinalis, Cortex) 9g
生姜 sheng jiang (Zingiberis Rhizoma Recens) 6g
半夏 ban xia (Pinelliae Ternatae, Rhizoma Praeparata) 6g
党参 dang shen (Codonopsitis Pilosulae, Radix) 9g
炙甘草 zhi gan cao (Glycyrrhizae Melle Tosta, Radix) 6g

3^rd consultation: 20 bags of the above prescription were taken, the abdominal distention was essentially resolved, and aside from some lurking flank pain, all other symptoms were gone. The pulse had more strength than before, energy was abundant, and the patient was discharged from the hospital and returned to his job in Sichuan province. He was advised to continue taking Ban Xia Xie Xin Tang and Bu Zhong Yi Qi Wan for a short period of time to assist with his recuperation.

Commentary: The treatment in this case of chronic hepatitis differed from most common methods. The patient had been ill for six years, with symptoms of abdominal distention, anorexia, borborygmus, diarrhea, deficient, slow, and weak pulses, enlarged tongue, etc. Even though flank pain was present, use of  “soothing the Liver and rectifying the qi” method, as in Chai Hu Shu Gan San (Bupleurum Liver-Coursing Powder), was ineffective. This shows that it was not a case of Liver and Stomach disharmony, but rather of Spleen and Stomach Yang Deficiency. Initially, Ban Xia Xie Xin Tang, “pungent opening, bitter downbearing”, was used, and after one month the anorexia, belching, borborygmus, and other symptoms were greatly reduced. However, the abdominal distention remained, and the six pulses were as before, showing that the Spleen yang was severely debilitated. Shang Han Lun states, “After sweating, abdominal distention and bloating, Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang commands.” “After sweating” refers to an etiology whereby sweating results in damage to the Spleen yang. Even though this case was not the result of [improper] sweating, because the condition had existed for six years there was significant debilitation of Spleen yang, with stubborn abdominal distention, and deficient, slow, and weak pulses. Although the etiology is different, the syndrome is similar. Therefore, after switching to Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction) for 20-plus bags, significant results were obtained.

Source: From Yue Mei-Zhong’s Case Record Collection (Yue Mei Zhong Yi An Ji) 《岳美中医案集》, People’s Medical Publishing House, 1978.

Commentary by Dr. Huang Huang:

This case began with the use of Ban Xia Xie Xin Tang (Pinellia Heart-Draining Decoction), bitter and pungent to free and descend and eliminate glomus, followed by Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang (Magnolia Bark, Fresh Ginger, Pinellia, Licorice, and Ginseng Decoction) to warm the Stomach yang and eliminate fullness. The treatment followed an orderly progression, and its effectiveness is quite believable. Ban Xia Xie Xin Tang traditionally treats nausea, diarrhea, and glomus, with most patients presenting with epigastric glomus oppression and distending pain that feels worse with palpation, as well as nausea and vomiting, borborygmus and diarrhea, anorexia, vexation heat, insomnia, and often a yellow and greasy tongue coating. Hou po traditionally eliminates distention and fullness, and Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang is composed of Ban Xia Xie Xin Tang with the omission of huang lian, huang qin, and da zao, and the addition of hou po. Both formulas contain ginseng, pinellia, ginger, and licorice, and in this case while dispersion of glomus and elimination of fullness followed a specific order, warming the middle and harmonizing the stomach was present from beginning to end. (From Yi An Zhu Du 《医案助读》 2001: 314)

Translated by: Greg Livingston

Wang, a 30 year old woman peasant, on Oct. 2, 1976 came into a hospital in Zhu Ma Dian for treatment. She presented with fatigue, achiness, and numbness / tingling in both her lower limbs. She was diagnosed with “rheumatism”.  As a result she was given Phenyl Butazone and antibiotics, which had no effect. Afterwards she received treatment in a TCM hospital in Wu Han for more than a month, but whenever she would sweat and was exposed to wind, her pain would increase.

For the next six months there was pain that sometimes mild and sometimes serious. She walked with a limp requiring her to lean on a staff with the need for people to support her with movement, numbness and tingling in the lower limbs, as well as severe pain in her knee joint. Her knee was cold with palpation and cold aggravated the pain while heat soothed it. This was accompanied with chest oppression, torpid intake, occasional nausea, menstrual flow that was like yellow water, a large amount of white sticky slimy vaginal discharge with a fishy smell, lusterless facial color, disquieted sleep, essences-spirit melancholic, and diffuse swelling in the knee joints that were not red.

Her pulse was wiry, thin, and slippery and she had a pale tongue with a white and slimy coat. She was diagnosed with cold-damp type painful obstruction pattern and the treatment was to warm the channels, scatter cold, and resolve dampness.

Next visit on Oct.6:  After taking the medicinals the previous symptoms did not decrease. On the contrary she became agitated and irritable, but her tongue and pulse were the same as before. The patient’s condition was still considered to be caused by cold-damp and was just entrenched and difficult to heal. Therefore the formula was unchanged and three additional packets were given. After finishing the herbs, the cold in her legs became more severe. At night there was severe pain and she would incessantly cry out in distress. It was considered that the amount of scattering cold medicinals was too small and the warming medicinals were not doing their job of moving. Consequently zhi chuan wu 10g and fu zi 15g were added to the original formula and three more packets were given. After taking the medicinals her symptoms still did not lessen, and on the contrary a cough with profuse phlegm emerged. Furthermore, the previous symptoms of chest oppression, poor food intake, nausea and vomiting, and the tongue and pulse still not change.

There was a careful review of the symptoms. Although her lower limbs were painful, and there was numbness and tingling, taking medicals that warm the channels, scatter cold, and resolve dampness were ineffective. Her accompanying symptoms of chest oppression, poor food intake, nausea and vomiting, profuse amount of white vaginal discharge, menstrual color like yellow water, and the new emergence of cough with profuse phlegm, made one think, is there a relationship with these symptoms and the leg pain?

I (the physician) remembered that previous experts had used phlegm in such painful distraction cases, therefore I gave a dispel phlegm formula,  jia wei er chen tang.

After 10 days there was another exam:  She had taken the medicine and her condition had improved. Her pain was greatly reduced, although she still had short periods of numbness and tingling from time to time, the cough’s phlegm was reduced. The formula was not changed due to the success and five more packets were given. After taking the herbs, her legs began to warm, knee swelling disappeared, there was no pain or numbness and tingling, the oppression in the chest disappeared, and the appetite increased. To the previous formulas, 15 grams of di long was added, bai jie zi was increased to 20, and fang ji to 10. Ten more bags were given in succession. All symptoms disappeared, and a follow-up with a patient 2 years later revealed that there had been no flare-ups.

[朱光宗竿•临症失误救治2则•中医研究，1991,4(1):34]

Commentary: This is a case of severe pain that is worse with cold and improves with heat. A diagnosis of cold-damp was certainly reasonable with the clinical manifestations. However, the treatment was ineffective and the patient’s condition gradually worsened. Consequently, there was a prompt decision for a fresh evaluation, which resulted in considering the diagnosis of phlegm, although there was not the typical signs and symptoms of phlegm. There was though vaginal discharge, poor food intake, chest oppression, cough with much phlegm, which ended up pointing to the road of treatment.

Jason’s commentary: I personally like this case because the initial treatment makes sense and just did not work. This is not uncommon, at least in my practice. However, when something doesn’t work the side effects are the gift. These “unpleasantries” can be used to decipher the underlying cause. In difficult cases, I sometimes even go out of my way to push the body in one direction to try to elicit some side effects. I will of course explain the process to the patient, and often jokingly say “have you seen the show House…” they get the idea and are usually happy that someone is willing to try to figure out what is actually happening to them.

3. Twitching of tendons and muscles:

Original case from: Xu Shu-Wei’s Case number 17

A townsperson named Jing made a living in the country village by twisting fibres into rope (“sheng”), and so was known as Jing Sheng Zi — “Roper Jing”.

Her son was almost thirty years old when he became ill, showing a slight sweat, weak pulse, and aversion to wind. The doctor mistakenly gave him Ma Huang Tang to bring on a sweat, and sweat he did — without stop! Fever, chest pain, intense palpitations, unable to sleep at night, and delirium all followed. Soon he did not recognise his mother, and began twitching convulsively, moving and shaking. The doctor then tried heavy sedators and wind extinguishing herbs as treatment.

I saw this and said: “Erroneous forcing of diaphoresis! Zhong-Jing said:

Patients with weak forceless pulse, sweating and aversion to wind cannot be given [Da] Qing Long Tang (Major Blue-Green Dragon Decoction). When they take it the result will be twitching of the tendons and convulsions of the muscles, and coldness of the limbs. “
[Clause 38 (38)]

I continued: “Only Zhen Wu Tang (True Warrior Decoction) can save him. Zhong-Jing says:

Tai Yang illness with sweating that does not stop, and the patient still has fever, palpitations, convulsive twitching that threatens to lift him off the ground: Zhen Wu Tang is the treatment.”
[Clause 82 (84)]

After giving him three doses of the worst was over; as a follow-up Qing Xin Wan (Pill to Clear the Heart) and Zhu Ye Tang (Bamboo Leaf Decoction) was given to relieve any further remaining toxic pathogen. After several days he was cured.

Steve’s comment: The above two cases [see previous Zhu Ling Tang case] are juxtaposed to illustrate Xu’s adroitness in the face of two cases, of exactly similar etiology, with yet differing consequences. Note that while each case suffered insomnia as a result of incorrect diaphoresis, in the second case this was overridden by the severity of the spasming. Each patient, too, varied in constitution and thus treatment necessarily varied.

What impresses me is Xu’s encyclopaedic familiarity with the Shang Han Lun, his appreciation that “These are no idle words!” and his ability to recognise in confusing cases the core symptoms which identify the applicable portion of the classic. Very inspiring! While it is true that we have relatively scant resources for studying the Shang Han Lun in English so far, we should remember that it could not have been easy in Song dynasty China, either.

Translated by Steven Clavey

Liao was a 62 year old man who was hospitalized because of left buttock and left lower limb pain that had been going on for 3 months. He presented with left buttock and left posterior thigh muscular pain, fatigued spirit and lack of strength, poor food intake, bland / lack of taste in the mouth that was slightly dry, dry stools, facial color was dark and stagnant.

Tongue: pale purple body and a thin yellow coat
Pulse: wiry

He was given a formula to scatter cold, dry damp, boost qi and quicken the blood. After taking 30 bags of herbs, the pain did not decrease. On the contrary there was an increase in distending pain as well as numbness and tingling in both lower legs, occasional hypertonicity of the foot, dry mouth, yellow urine, dry bowel movements. His tongue became pale purple, and he had a thin yellow coat and wiry pulse.

The formula was changed to enriching yīn, nourishing blood, and quickening the blood. After 15 packets both lower leg muscle symptoms of distending pain, numbness and tingling etc. were  gone.

Source: [缪以星•临证随笔2 则•湖南中医学院学报，1986,(1):33]

Translated by: Jason Blalack

Commentary:

Although this case seems a bit obvious in retrospect, it is far from an uncommon occurrence among inexperienced herbalists. This case does not have clear cold signs, yet the doctor stubbornly latched on the words of Elementary Questions (sù wèn, painful obstruction chapter), which says,

when the three qi of wind, cold, and damp combine (attacking at the same time), this becomes painful obstruction disease”

Consequently there was an incorrect diagnosis of cold-damp painful obstruction pattern, and scatter cold and dry damp formula was given . Although the patient was venerable, his  was blood deficient and his fluids were depleted, which prevented him from lubricating his intestines below, and enriching his mouth above. Therefore his stools were dry and his mouth was slightly dry. His limb’s sinews (and vessels) lost moisture, resulting in pain, numbness, and tingling. Because of the fluid and blood body depletion and the ongoing use of spicy, warm, fragrant, and dry medicinals, which further damaged the fluid and consumed the blood, the disease was aggravated. It was like adding fuel to the fire.

Shi a 28 year old male motor vehicle driver was hospitalised on Sept 13. Two days
previous, the patient did some heavy moving from one house to the next in the rain. That
night he had very painful sciatica along his right leg. It gradually became worse and he
went to the local hospital where he received an injection of a heavy painkiller and
diazepam, which took about two hours.(1)

Presentation upon examination: cramping in the right lower leg, that was painful and
difficult to bear. There was numbness and tingling on the posterior lateral thigh that
occasionally felt like a fire burn, there was vexation and agitation, bitter taste in mouth,
constipation, red urination, difficultly sleeping, with tossing and turning in bed that lasted
the whole night. The tip of the tongue was red and the coating was thin yellow and
slightly slimy. The pulse was slippery, rapid, and had strength. There was a positive sign
for the straight leg raise, and huántiào (GB 30) and popliteal fossa were tender with
palpation.

An x-ray of the lumbar vertebrae revealed no unusual findings. Therefore, treatment was
given for sciatic damp-heat painful obstruction blocking the channels and network
vessels. After the patient took 2 bags of herbs, the pain was unchanged. Therefore rǔ
xiāng (Olibani, Resina) and mò yào (Myrrha, Resina) were added and again two bags
were given, but the pain still did not decrease.

After meticulously sorting out the etiology and pathomechanism, it was realised that the
lower limb hypertonicity and pain were actually the disease’s root. This was related to the
fact that after the move there was fatigue, he sweated, became wet whilst working in the
rain, and then caught a cold. This caused cold-damp obstruction in the vessels and
networks. His bitter taste and dryness in the mouth, constipation, red urine, red tip of the
tongue with a yellow coat, slippery and fast pulse was because of the severe pain and
vexation. Because of the vexation there was insomnia and stirring heart fire, and
furthermore this led to a lack of food intake. All of this belonged to the branch, which
was pain.

The first diagnosis did not grasp the disease root’s essence and therefore gave a treatment
that was ineffective. On the surface it looked like it was correct but it was really a mistake. The correct treatment principle was to scatter the cold and free the network
vessels, which assists in order to clear heat. The patient took this type of [medicine] and
immediately his pain was greatly reduced. As the pain diminished, his bitter taste,
vexation, insomnia, constipation, reddish urine, was also gradually eliminated. With
some slight modifications, three more bags of herbs were given and the pain was
essentially eliminated. Afterwards a formula that boosts the kidney and opens the
network vessels was given to continue the healing.(2)

Commentary:

Various kinds of clinical manifestations of disease have differentiations of root and tip.
The root is the essence of the disease; the branch is dependent on the root. If the root is
not understood and one mistakes the incidental for the fundamental this will certainly
bring about misdiagnosis and mistreatment.

In this case the doctor grasped the patient’s main pathological condition of cold-damp
painful obstruction blocking the channels and network vessels leading to lower limb
hypertonicity pain, which was due to the patient catching a cold after being fatigued,
sweating, and being out in the rain. At the same time there were the secondary symptoms
of, bitter taste, vexation, constipation, reddish urine, red tip of tongue and yellow coating,
slippery and rapid pulse that were all caused from the severe pain and vexation. The
vexation caused insomnia and stirring of heart fire which further led to low food intake.
Scattering cold and open the network vessels was the first priority in order to secondarily
clear the heat. This is all that was needed to avoid clinical error. On the contrary, merely
basing treatment on clinical manifestations and not meticulously inquiring into the
pathomechanisms and cause of disease, and by treating the damp-heat painful obstruction,
there was of course, no resolution.

(1) This most likely is interpreted to mean that the whole hospital stay lasted about two
hours.

(2) [侯恒太•临证求真琐谈•江西中医药，1988,(2):54]