[Patient] Hu, a 46 year old female, had [suffered from] cough and wheezing for seven years. She recently contracted a wind-cold invasion which manifested as a blockage and stifling sensation in the chest, hindered breathing, cough and wheezing with profuse phlegm, and water sounds in the throat. The tongue coat was white and the pulse was floating.  Two packets of a modified ma huang tang (Ephedra Decotion) prescription was given:

ma huang (Ephedrae Herba) 6g
gui zhi (Cinnamomi Ramulus) 9g
hou po (Magnoliae officinalis Cortex) 9g
zhi shi (Aurantii Fructus immaturus) 9g
xing ren (apricot seed or kernel) 9g
gan cao (Glycyrrhizae Radix) 6g

After taking the herbs, the cough and wheezing was reduced. Two packets of the above formula was given minus hou po (Magnoliae officinalis Cortex) with the addition of  chen pi (Citri reticulatae Pericarpium) 3g. [Following this] the cough stopped, wheezing was pacified, and the breathing was easy and smooth.

Transalted by: Jason Blalack

Source: 陕西中医学院学报1990;<l>:3

Original Chinese: 姜春华医案:胡某某，女，46岁。咳喘已七年，近受风寒侵袭，胸闷窒塞，呼吸不利，咳喘多痰，喉间作水鸣声，苔白，脉软。以麻黄汤加味，处方:麻黄6克，桂枝9克，川朴9克，棋实9克，杏仁9克，甘草6克，2剂。药后咳喘减轻，上方去川朴，加陈皮3克，又服2剂，咳止喘平，呼吸通畅。

Commentary: This is a practical and fairly straightforward use of ma huang tang (Ephedra Decotion). In this case the patient had a constitutional condition of phlegm and thin mucus internally lurking in the Lungs. She contracted a wind cold pathogen which triggered an exacerbation of her cough and wheezing. Ma huang tang (Ephedra Decotion) not only externally resolves to wind cold but also internally diffuses the Lung qi. zhi shi (Aurantii Fructus immaturus) and hou po (Magnoliae officinalis Cortex) were added in order to clarify the Lungs and direct qi downwards.

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

A 52 year old male came in for a diagnosis on July 18, 1994. He had diarrhea that had been going on for more than one year and had used many kinds of antibiotics with no avail. Every day he had diarrhea 3 to 6 times, and at the time of the intake it was a watery type with small amount of pus and blood. There was also tenesmus, abdominal tenderness, which was especially severe on the lower left quadrant. There was also a fear of cold and a fever (approx 37.5C / 99.5F).

Tongue: red with a white coat
Pulse: submerged and wiry

Western Exam: Microscopic examination of stool revealed leukocytes and a small amount of phagocytes. Western medicine had diagnosed “chronic bacterial dysentery.“

Differential diagnosis: qi and blood congealing in the Spleen, wood constraining the earth center.

Treatment method: regulate the yin and yang of the Spleen, free the qi and blood, while simultaneously curtailing wood, preventing it from attacking the earth center.

Presciption:

guì zhī (Cinnamomi Ramulus) 10g
bái sháo (Paeoniae Radix alba) 30g
zhì gān cǎo (prepared licorice root) 10g
shēng jiāng (fresh ginger rhizome) 10g
dà zǎo (Jujubae Fructus) 12 pieces

After 2 packets the frequency of the diarrhea was remarkably decreased and the abdomen was more relaxed. After 3 more packets the stool was basically formed, abdominal urgency of the lesser abdomen was gone. After 4 more packets of herbs his pattern was resolved.

Source: 《刘渡舟临证验案精选》1996:105一106

Commentary: The patient suffered from chronic dysentery due to a  disharmony of the Spleen and Stomach and disharmony of the qi and blood. There was diarrhea, pain, and tenesmus. If there is pain there is no free flow. These signs belong to qi stagnation and blood stasis of the Spleen. The Spleen belongs to earth and Liver belongs to wood. When the Spleen’s qi and blood is inhibited this causes the qi of Liver / wood to not outthrust. Therefore the pulse was deep and wiry. Furthermore, because of the ongoing diarrhea there was damage to the yin, qi and blood stagnation, and Spleen yin disharmony. Therefore we see a red tongue.

The treatment was to use guì zhï jiä sháo yào täng (Cinnamon Twig Decoction plus Peony) in order to regulate and harmonize the Spleen and Stomach, free the qi and blood, boost the Spleen yin, calm the Liver’s urgency (tension). This is a unique usage of this formula for diarrhea and abdominal pain in tai yin disease. It is exactly like what li dong-yuan said, “If there is abdominal pain one should use gān cǎo (Glycyrrhizae Radix) and bái sháo (Paeoniae Radix alba). Ssowing and reaping is regarded as [the flavor] sweet, and sweet is the 6th heavenly stem (earth). Bending and straightening is regarded as [the flavor] sour, and sour is 1st  heavenly stem (wood). [Using the] 1st and 6th heavenly stems transforms earth, this is the marvelous (mistaken character: 炒=妙？) method of Zhong-Jing. ” *** (I am not sure how to interpret and translate this quote, does someone have any better  insights?)

This formula can be used in the clinic if one sees the three issues of disharmony of the Spleen and stomach, inhibited qi and blood, and Liver / wood overwhelming earth. Then this formula can be used without danger and obtain good results.

Translated by: Jason Blalack

Original Chinese: 一、下利(慢性菌痢)

刘渡舟医案：林某某，男，52岁，1994年4月18日就诊。大便下利达一年之久，先后用多种抗菌素，收效不大。每日腹泻3～6次，呈水样便，并挟有少量脓血，伴有里急后重，腹部有压痛，以左下腹为甚，畏寒，发热(37．5℃左右)舌红，苔白，脉沉弦。粪便镜检有红、白细胞及少量吞噬细胞。西医诊为“慢性菌痢’’。
辨证：脾脏气血凝滞，木郁土中所致。
治法：调脾家阴阳，疏通气血，并于土中伐木。桂枝1O克，白芍30克，炙甘草1O克，生姜1O克，大枣12枚。服汤2剂，下利次数显著减少，腹中颇觉轻松。3剂后则大便基本成形，少腹之里急消失，服至4剂则诸症霍然而瘳。

按语：患痢日久，致脾胃不和，气血不调。腹泻而痛，里急后重，痛则不通，为脾家气滞血瘀之象。脾为土，肝属木，脾家气血不利，而使肝木之气不达，故其脉见沉弦。又因久利伤阴，气血郁滞，脾阴不和，故见舌红。治用桂枝加芍药汤以调和脾胃，疏通气血，益脾阴，平肝急，兼能疏泄肝木。本方用于太阴病之下利、腹痛，别具一格，正如李东垣所说：“腹中痛者加甘草、白芍药，稼穑作甘，甘者己也；曲直作酸，酸者甲也。甲己化土，此仲景之炒法也。”临床运用本方时，如能抓住脾胃不和，气血不利和肝木乘土三个环节，则用之不殆，历验不爽。

Yang, a two and five month-year-old girl, presented with the chief complaint of cough, that  had been going on for one month. There was sometimes white and sometimes yellow phlegm, nasal congestion, profuse sweating, fear of wind, reduced food intake, no thirst, and her bowels were not dry. She tried many Chinese and Western treatments without success. Her tongue body was normal and there was a white coat. Her pulse was deep and rapid.

Diagnosis: cough (wind pathogen invading the Lungs, which has started to slightly transform to heat).

Prescription: modified guì zhī tāng (Cinnamon Twig Decoction)

guì zhī (Cinnamomi Ramulus) 20g
chì sháo (Paeoniae Radix rubra) 15g
shēng jiāng (fresh ginger rhizome) 20g
dà zǎo (Jujubae Fructus) 15g
zhì gān cǎo (prepared licorice root) 15g
zǐ sū gěng (Perillae Caulis) 15g
qián hú (Peucedani Radix) 10g
fáng fēng (Saposhnikoviae Radix) 10
xì xīn (asarum, Chinese wild ginger) 10g
cāng ěr zǐ (Xanthii Fructus) 8g
sāng yè (Mori Folium) 15g
shén qū (medicated leaven) 20g

She was given three packets to take over three days.

Follow-up visit: the cough had greatly reduced, the sweat was lessened, and appetite was back to normal, but there was still some nasal congestion with clear runny mucus. The tongue coat was white, and the pulse was deep and not rapid. The previous formula, minus sāng yè (white mulberry leaf) and shén qū (medicated leaven), was given.

Prescription:

guì zhī (Cinnamomi Ramulus) 20g
chì sháo (Paeoniae Radix rubra) 20g
shēng jiāng (fresh ginger rhizome) 30g
dà zǎo (Jujubae Fructus) 15g
zhì gān cǎo (prepared licorice root) 15g
zǐ sū gěng (Perillae Caulis) 15g
qián hú (Peucedani Radix) 15g
fáng fēng (Saposhnikoviae Radix) 10
xì xīn (asarum, Chinese wild ginger) 10g
cāng ěr zǐ (Xanthii Fructus) 8g

She was given two packets to take over three days and she completely covered.

Commentary: guì zhï täng (Cinnamon Twig Decoction) is a formula that treats taiyang wind strike and is Zhang Zhong-Jing’s foremost harmonizing formula. It is able to dispel wind and resolve the exterior, harmonize the nutritive and protective, harmonize the yin and yang, and harmonize the exterior and interior.

This is a case of wind cough, but the pulse was deep and rapid and the cough’s mucus was yellow. The dynamic had already moved to the interior and transformed to heat. Therefore a modified guì zhï täng (Cinnamon Twig Decoction) was given. zǐ sū gěng (Perillae Caulis), qián hú (Peucedani Radix), and fáng fēng (Saposhnikoviae Radix) were added to dispel wind, resolve the exterior, diffuse the Lungs, and stop cough. Xì xīn (asarum, Chinese wild ginger) esters the interior to track down the pathogen as well as diffuse the nasal orifices providing assistance to cāng ěr zǐ (Xanthii Fructus). Sāng yè (Mori Folium) was added to clear the Lungs and release heat. Shén qū (medicated leaven) opens the stomach and increases food intake.

Source: <经方医案系列>

Translated by: Jason Blalack

Shang Han Case

There was external cold assaulting the tai yang with damp stagnation internally blocking the middle burner. This pattern presented with sweat and chills that failed to resolve the condition. There was also full body aching pain, stifling sensation in the chest, upflow nausea, and abdominal distention. It was suitable to disperse the pathogen, release the muscle layer, transform stagnation, and open the middle burner.

Prescription:

Cinnamomi Ramulus (guì zhï) 8 fen
Pinelliae Rhizoma preparatum (zhì bàn xià) 2 qian
dry-fried Aurantii Fructus (châo zhî ké) 1 qian
Amomi Fructus rotundus (bái dòu kòu) 8 fen
dry-fried Paeoniae Radix rubra (châo chì sháo) 1 qian 5 fen
Citri reticulatae Pericarpium (chén pí) 1 qian
Arecae Pericarpium (dà fù pí) 2 qian
Massa medicata fermentata (shén qü) 3 qian
Perillae Caulis (zî sü gêng) 1 qian 5 fen
Zingiberis Rhizoma recens (shëng jiäng) 2 slices.

Commentary: This is a case that uses Cinnamon Twig Decoction (guì zhï täng) to resolve the exterior of the tai yang, Two-Aged [Herb] Decoction (èr chén täng) to harmonize the stomach, descend counterflow, and transform damp in the middle burner.  Magnoliae officinalis Cortex (hòu pò) and Arecae Pericarpium (dà fù pí) was used in order to eliminate distention. Aurantii Fructus (zhî ké) and Massa medicata fermentata (shén qü) was used in order to guide out stagnation.

Translated by: Jason Blalack

Case from: Dr. Liu Du Zhou

This patient was a 10-year-old girl who received a cold Qi in late autumn.  She developed fever and an aversion to cold and had episodes of this many times a day.  This went on for several months.  Her pulse was floating and without strength.  Her tongue body was red and the moss was thin and white.  Her food and drink intake and excretions were normal.  This was a case of wind cold stagnating on the outside chronically without resolution.  The cold had transformed to heat but was a light case.  I gave her two packages of Gui Zhi Er Yue Bi Yi Tang (modified).

Gui Zhi 5g
Bai Shao 5g
Chao Xing Ren 3g
Zhi Gan Cao 3g
Sheng Jiang 3g
Ma Huang 3g
Da Zao 4g
Zhu Ru 3g

There was slight sweating and this brought resolution.

Discussion:

In this case there was fever and an aversion to cold that came in frequent episodes every day.  This indicated unresolved Tai Yang evil.  These external evils have a tendency to enter the interior and transform into heat.  The pulse was floating but without strength.  This is an indication that the cold evil is wanting to journey out to the fleshy exterior.  The original text says, “The pulse is slightly weak and this means an absence of Yang”.  So treatment should not rashly use pungent and warm Ma Huang and Gui Zhi.  One should treat this patient by using Gui Zhi Er Yue Bi Yi Tang with the addition of Zhu Ru to resolve the exterior and clear the interior, generate fluids and nourish moisture.

Commentary:

In regard to the sentence “The pulse is slightly weak and this indicates an absence of Yang”, many scholars think that this means there is Yang depletion.  Because the clause has two parts, they connect the use of Gui Zhi Er Yue Bi Yi Tang to the part that says “fever is greater than cold”.  I do not agree with this.  In this case, the pulse being slightly weak is the opposite of being floating and tight.  This is a pulse that was floating and tight and it changed to be scattered and weak.  The exterior evil, though wanting to leave then has a tendency to enter the interior and transform into heat. This is not the expiring pulse of Yang depletion.  This “absence of Yang” is speaking about the evil wanting to leave the exterior.  This is exactly like that impartial saying “The absence of Yang that stagnates the exterior pattern”.  The evil qi moves into the interior from the exterior and therefore one should not use Ma Huang and Gui Zhi to promote sweating.  One should use Gui Zhi Er Yue Bi Yi Tang to resolve the exterior and clear the interior.

Gui Zhi Er Yue Bi Yi Tang

Gui Zhiu 4g
Sheng Jiang 3g
Bai Shao 3g
Zhi Gan Cao 3g
Ma Huang 3g
Da Zao 4pieces
Shi Gao 3g

This formula is indicated when there is external wind cold and internal stagnant heat.  This formula is differentiated from Xiao Qing Long Tang by the degree of seriousness.  In the Xiao Qing Long Tang pattern, in addition to the cold and heat with fever predominant, there is also lack of sweating, headache, mouth thirst and agitation.  This formula is used when one wants to create a mild sweat while clearing inner heat.

** Translated by: Sharon Weizenbaum

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。

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

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。

Dr. Liu Jingqi[1], July 20, 1982

Ms. Sun, age 45 had an aversion to cold and fever and all over her body she developed large round patches of wind rash.  She had had this for over 20 days.  Before the illness, she had been out sweating in the rain and after one day she developed the rash.  Every day she had 5-6 episodes with itching and heart vexation.  She had a calcium injection and oral chlor-trimeton and vitamin C all with no effect.  Her facial complexion was sallow and the skin scratch test was positive and her whole body had round patches though it was most profuse on her chest and thorax area.  Her tongue was pale with thin moss and her pulse was wiry.  This was a presentation of Wind Cold tied up on the exterior though it was inappropriate to drain.  The treatment principle was to use pungent warm to penetrate through to the exterior, dredge wind and stop itching.  I gave her 6 packages of the following formula:

Discussion: According to reports, this formula treats contraction of wind cold with itching, a cold and heat illness or a cold that lasts without resolution in which the evil is light with itching.  For this it is quite effective.

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

Original Chinese: 五、风隐疹(荨麻疹)
刘景棋医案：孙某某，女，45岁，1982年7月20日初诊。恶寒发热，全身起大片风团已二十余日。发病前曾汗出冒雨，过一日后即发现全身起大片风团，每日发作五六次，痒甚，心烦。曾注射钙剂，口服扑尔敏、维生素丙等无效。面色苍白，皮肤划痕试验阳性全身敲在大片风团，胸部较多。舌淡苔白，脉弦。辨证：风寒束表不得宣泄。治则：辛温透表，疏风止痒。处方：桂枝5克，白芍3克，生姜3克，炙甘草3克，麻黄3克，大枣4个，炒杏仁3克。 服6剂，临床治愈，随访三个月末复发。
(《经方验肘987；13)
按语：据报道，本方治疗感受风寒所致荨麻疹，有寒热表证或日久不愈，邪微而痒者，有良效。

[1] From 经方验, experience with classical formulas, 1987, page 13