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

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。