Yu, 55 years old, suffered from constraint that harmed the Heart yang. The yang sunk into the yin leading to a  turbid painful urinary dribbling disorder. This was internal damage from the emotions leading to a  yin [area?] deficiency resulting in disease. Merely seeing the symptoms will bring about a disordered (incorrect) treatment and is most inferior.

The Heart stores the Spirit. The spirit was damaged with symptoms such as muddle-headedness; all the orifices were disturbed. The herb treatment should not emphasize cold or hot medicinals. It must be opening and bright, striving for tranquility. If one only uses botanicals (e.g. no animal products) then I am afraid the results will be unsatisfactory. This is constraint harming the Heart yang and the prescription was Marvelously Fragrant Powder (miao xiang san).

Translated by: Jason Blalack

Jason’s Commentary: This is a brilliant case where Mr. Ye sees beyond the chief complaint and addresses the underlying mechanism for the turbid painful urinary dribbling disorder, constraint harming the Heart yang. Of note, Ye differentiates elsewhere between painful urinary dribbling (淋 lín) and turbid urine (濁 zhuó).  He states,

Painful urinary dribbling is attributed to the Liver and Gall­bladder. Turbidity is attributed to the Heart and Kidneys.”

Yang deficiency can easily lead to turbidity. Turbidity is heavy and sinks causing the urinary disorder. I can’t say that I truly understand his point of “yin deficiency causing disease.” This formula does not address this. Maybe the yin was addressed after this formula. Does anyone have any additional ideas?

Marvelously Fragrant Powder (妙香散, miao xiang san)

Source: Formulary of the Pharmacy Service for Benefiting the People in the Taiping Era (1148)

Ginseng Radix (rén shën) 15g
Dioscoreae Rhizoma (shän yào) 30g
Astragali Radix (huáng qí) 30g
is Poria (fú líng) 30g
Poriae Sclerotium pararadicis (fú shén) 30g
Polygalae Radix (yuân zhì) 30g
Cinnabaris (zhü shä) 9g
Aucklandiae Radix (mù xiäng) 75g
Moschus (shè xiäng) 3g
Platycodi Radix (jié gêng) 15g
Glycyrrhizae Radix preparata (zhì gän câo) 15g

Original Chinese: 于（五五） 郁损心阳。阳坠入阴为淋浊。由情志内伤。即为阴虚致病。见症乱治。最为庸劣。心藏神。神耗如愦。诸窍失司。非偏寒偏热药治。必得开爽。冀有向安。服药以草木功能。恐不能令其欢悦。（郁损心阳） 妙香散。

Intro: This is a somewhat informal presentation of a recent case that I found quite educational for myself. It is definitely not the cleanest case (easy success) but that is why I like it. I am still working out the best way to present these cases and if anyone has any suggestions please let me know. I also welcome others to submit their cases for us to learn from. I hope you enjoy it and welcome any feedback or criticisms.

Case: 55 year old male presented with testicular and perineal pain, sensation of “peeing glass”, strong sensation heat in the lower burner, unable to sit due to the pain, and frequent urination in both night and day. This had persisted for many months and had been labeled “chronic prostatitis.” He also presented with a painful left big toe, dry mouth, and very strong emotions (anger, anxiety, fear etc.). The pulse was cloudy (模糊,mó hú mài) and wiry, and his tongue was dark red/purple with a thick coat. The diagnosis was damp-heat stasis in the lower with the treatment principle of transform damp, clear heat, promote urination, and promote the movement of blood.

Long dan cao     6
Che qian zi           9
Huang qin            9        
Zhi zi                      9
Sheng di                9         
Ze xie                     9
Dang gui               6        
Mu tong                6
Chai hu                 6         
Gan cao                6
Huang bai            6
Ku ding cha         2

Instructions: 1 bag=2 days. Cook time =45 minutes. Take 2-3 times a day.

Visit #2: Heat was 40-50% better. Pain had improved. Started a course of Cipro for 1 month. Tongue was red.

Visit #3: In the previous three days the pain was severe. Dx: damp heat + toxin pouring into the lower burner.

Visit #4: Feels very hot, insomnia, urine is yellow, very angry, dry mouth, thirst, and feels energy shooting up. Uncomfortable sensation over his liver. Red tongue, wiry pulse. Diagnosis: Liver Fire.

Visit 5-6: more of the same.

Commentary: Throughout all of these visits a modified Gentian Decoction to Drain the Liver (lóng dân xiè gän täng) was used with various additions to emphasize more blood invigorating (e.g. Vaccariae Semen (wáng bù liú xíng), Manitis Squama (chuän shän jiâ)), pain relieving (e.g. Corydalis Rhizoma (yán hú suô)), toxin clearing (e.g. Patriniae Herba (bài jiàng câo),Taraxaci Herba (pú göng yïng)) , cooling the blood (e.g. Paeoniae Radix rubra (chì sháo)), protecting the yin (e.g. Dendrobii Herba (shí hú)), and descending the yang and calming the spirit (e.g. Fossilia Ossis Mastodi (lóng gû), Poriae Sclerotium pararadicis (fú shén)). But the overall presentation had hardly budged. Pain and heat was certainly still an issue as well as the severe emotions (anger, fear, sadness etc.). Other modalities were also used at this time by other practitioners.

Visit 7: Due to unclear results, I decided to switch to a more modern prostatitis formula:

Huang qi                     10
Yan hu suo                  6
Di long                        4.5      
Zhi gan cao                 6
Hu zhang                     9         
Bai hua she she cao     9
Huang bai                    9         
Sheng di huang           12
He huan pi                   9         
Wang bu liu xing         9
Nu zhen zi                   12       
Ze xie                          6

Visit 8-9: “prostate” seems better. He has noticed that stress makes it worse. Anxiety is less. Pain is 5/10 (was 8/10). Feels like the muscles are very tight/pulled muscle around the perineum. Added 20 grams of Paeoniae Radix alba (bái sháo).

Visit 10: Urethral pain is still severe, pelvic pain is getting better. Lots of emotion. Pulse is very tight and wiry. Fatigue (mentioned that had been going on for awhile).

Chao Chuan lian zi      6
Mai dong                     9
Bai zi ren                     9         
Tao ren                        9
Dang gui                     6         
Huang bai                    9
Yan hu suo                  9         
He huan pi                   9

Commentary: Over the last 10 visits the pain had gone up and down many times. However even though the pain had decreased it was still significantly present. The heat was also very obvious. Due to the unclear results from the above more straightforward approaches. I decided to consider the underlying mechanism for the fire/heat. Taking inspiration from Ye Tian-Shi, I prescribed the above formula (see his constraint case). Notice the more softening approach.

Visit 11: significant improvement, pain and pelvic floor tension was much less. 3 bags of previous. Of Note: Almost all of the previous formulas contained Corydalis Rhizoma (yán hú suô).

Visit 12: + Paeoniae Radix alba (bái sháo) 25.

Visit 13: It was unclear if Paeoniae Radix alba (bái sháo) made any difference) – feeling much better.

Visit 14: Common cold / flu (gan mao), stopped herbs, pain became worse. Thought there might be a lurking pathogen and switch strategies to a yin deficient venting idea. (I was wrong)

Visit 15: Pain became much worse, went back to previous formula (visit 12-13) and pain continued to decrease once again. This confirmed that addressing the underlying mechanism, causing the fire was actually effective. Over the next few weeks the pain completely resolved.

Visit 16: Although no pain remained, there was anxiety, fear, pressure in the chest, and palpitations. This had been going on for many years since the death of his wife. He (and I) thought that this was the underlying cause of all his problems including the fire/prostatitis. This was qi and blood stagnation in the collaterals. The treatment principle was to dredge the liver and open the collaterals. I decided to use a modified Inula Decoction (xuán fù huä tang) from the Essentials from the Golden Cabinet.

Xuan fu hua                9
Hong hua                    6
Tao ren                        9         
Dang gui wei               6
Ze lan                          3         
Lu lu tong                   3
Wang bu liu xing         6         
Mei gui hua                 3

Note: Carthami Flos (hóng huä) sub for New crimson (xïn jiàng).

Emotional symptoms, energy, sensation in the chest all dramatically improved over the next couple weeks.

Location: Boulder, Colorado