Mr. Bai presented with a pathogen in the tai yang that had not yet resolved. There was a loss of normal order of the nutritive and protective aspects. There was physical cold, fear of cold, cough, stifling sensation in the chest, full body aching pain, reduced food intake, and a greasy tongue coat. It was proper to use a Cinnamon Twig Decoction (guì zhï täng) method.

Cinnamomi Ramulus (guì zhï) 8 fen
Fritillariae thunbergii Bulbus (zhè bèi mû) 3 qian
Pinelliae Rhizoma preparatum (zhì bàn xià) 2 qian
dry-fried Setariae (Oryzae)Fructus germinatus (gû yá) 4 qian
Benincasae Semen (döng guä zî) 3 qian
dry-fried Paeoniae Radix rubra (châo chì sháo) 1.5 qian
Poria (fú líng) 3 qian
Perillae Caulis (zî sü gêng) 1.5 qian
Eupatorii Herba stalk (pèi lán gêng)1.5 qian
stripped apricot kernel (guäng xìng rén) 3 qian
dry-fried Aurantii Fructus (châo zhî ké) 1 qian
Citri reticulatae Pericarpium (chén pí) 1 qian
Gentianae macrophyllae Radix (qín jiäo) 1.5 qian

Translated by: Jason Blalack

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。

A 67 year old male presented with frequent common colds (感冒 gân mào), which would last for 1 to 2 months without recovery. His presentation only had symptoms of nasal congestion, cough with phlegm, copious sweat from the head and face, and a slight feeling of fatigue. In the past he took Jade Windscreen Powder (yù píng fëng sân), for a half of a month, but there was not effect.

Treatment: I gave him Cinnamon Twig Decoction (guì zhï täng) plus Astragali Radix (huáng qí), and after taking this, he felt increased physical strength, and the common cold occurrences were eliminated.

Discussion: Both of the formulas used huang qi, yet the results were different. The reason for this is simple. Cinnamon Twig Decoction (guì zhï täng) harmonizes the nutritive and defensive and adding huang qi secures the exterior. This is strengthening the correct qi in order to resist the pathogen.

Jade Windscreen Powder (yù píng fëng sân) treats deficient patients who contract a pathogen, which lingers without resolution. The aim is to boost the qi in order to eliminate the pathogen. Generally it is thought that Astragali Radix (huáng qí) and Saposhnikoviae Radix (fáng fëng) have a “fearing” yet “empowering” relationship. When Astragali Radix (huáng qí) obtains the dispersing nature of Saposhnikoviae Radix (fáng fëng) then one does not have to worry about locking in the pathogen. When Saposhnikoviae Radix (fáng fëng) obtains the securing nature of Astragali Radix (huáng qí) then one does not have to worry about scattering the exterior. Actually, within scattering there resides tonification, and within tonification there is dispersing. This is different than supporting the right and securing the exterior.

For this reason, if the body does not have an exterior pathogen, and one frequently gives Saposhnikoviae Radix (fáng fëng) to disperse and scatter, this conversely gives a pathogen a chance to invade.

Original Chinese: 男，六十七。经常感冒，往往一、二月接连不断，证状仅见鼻塞咳痰，头面多汗·稍感疲劳。曾服玉屏风 散，半个月来亦无效果。我用桂枝汤加黄茂，服后自觉体力增强，感冒随之减少。此证同样用黄甚而收效不同，理由很简单。桂枝汤调和营卫·加黄氏固表，是加强 正气以御邪。玉屏风散治虚人受邪，邪恋不解·目的在于益气以怯邪。一般认为黄茂和防风相畏相使，黄英得防风，不虑其固邪，防风得黄英，不虑其散表·实际上 散中寓补，补中寓疏，不等于扶正固表。正因为此，如果本无表邪，常服防风疏散，反而给予外邪侵袭的机会。

Translated by: Jason Blalack

Instructive and straight forward. Any questions or comments?

Zhang XX, a 15 year old female, had a fever for more than a half a year. It would reach up to 40c and many formulas were tried with no avail. Moreover, there was a thirst without large fluid intake and urination and bowel movements were normal. There was pale tongue with a yellow coat. There was a fever and aversion to wind, floating and moderate pulse, and occasional sweating. The diagnosis was wind-strike pattern that had not ceased, nutritive and defensive disharmony. Three packets of gui zhi tang were used according to the method and there was a complete cure.

Commentary: Even though there was a high Fever, the thirst was without a large intake of fluids and the urination and bowel movements were normal. One can see that this was not an interior pattern. However, there was an aversion to wind, sweat, and a floating and moderate pulse, confirming an exterior pattern. Therefore the defensive qi was outwardly floating and there was fever. Gui zhi tang was given to save the nutritive and regulate the defensive to eliminate the disease and bring about a cure.

Original Chinese:

二、高热

岳美中医案：张某某，女，15岁。发热半年余，体温高达40℃，多方治疗无效，且但渴不多饮，二便自调，舌淡苔黄，发热恶风，脉见浮缓，时有汗出，诊为中风证未罢，营卫失和，用桂枝汤3剂，如法服用而痊愈。   (《桂枝汤类方证应用研究》1989：64
按语：发热虽高．但渴不多饮，二便自调，自无里证。但见恶风、汗出、脉来浮缓，表证备焉。乃卫气外浮而发热，与桂枝汤济营调卫，中病即愈。

[Patient] Lǐ was a 53 year old female that suffered from paroxysmal heat effusion and sweating for over one year.  This would occur 2-3 times every day.  A previous doctor treated her for a yin deficiency fever, but after taking over 20 bags there was no result.  When questioned, her diet, urination and bowel movements were normal.  She had a pale tongue with a white coat, slack and soft pulse that lacked strength.

The differential diagnosis was a pattern of nutritive and defensive disharmony, where defensive is not safeguarding the nutritive.  The treatment method was to harmonize the nutritive and defensive, yin and yang, and use the method of promoting a sweat in order to stop a sweat. She was given two packets of gui zhi tang: gui zhi 9, bai shao 9, sheng jiang 9, zhi gan cao 6, da zao 12p.  The medicinals were sipped warm with water gruel, and then she covered up, obtaining a light sweat. After this the disease was gone.

Source: (《刘渡舟临证验案精选》1996:3)

Commentary: There was heat effusion, sweating with a tongue that was not red, but pale; the coating is not scant, but white, the pulse was not thin but moderate. This is not a pattern of yin deficiency with fever. It is a disharmony between the nutritive and protective.  Nutritive and protective is the body’s yin and yang, it is more suitable for them to work together then for them to work apart. If the nutritive and protective are harmonious then yin and yang are coordinated and protective qi secures and the nutritive qi guards.  If the nutritive and protective are not harmonious then yin and yang mutually will go against each other. Nutritive-yin fails the protective-yang resulting in fever, protective-yang does not secure the nutritive-yin and there is sweat.  Gui zhi tang is used to “first promote a sweat which will then bring about a cure”

(Translated by:  Jason Blalack)

Original Chinese: