Build up of blood with mania (YTS)

Original Case by: Ye Tian-Shi (叶天士)

[Patient] Wu [suffered from] a warm disease for 70 days. The right pulse was long and left was deep. The tongue was limp with [a desire] to drink cold beverages. There was heart irritability-heat. The spirit qi was sometimes clear yet sometimes deranged. On the third day of menstrual bleeding the disease started. Hot qi settled internally in the blood, overwhelming the emptiness leading to inward fall. This disease should be considered stasis heat in the interior. However it had already become dangerous, and [must be approached] from a condition of buildup of blood with mania.

sheng di huang (Rehmanniae Radix),

mu dan pi (Moutan Cortex)

zhi da huang (prepared Rhei Radix et Rhizoma)

chao tao ren (dry-fried Persicae Semen)

ze lan (lycopos, bugleweed)

ren zhong bai (Hominis Urinae Sedimentum)

Translated by: Jason Blalack

Original Chinese: 吴（氏） 热病十七日，脉右长左沉，舌痿饮冷，心烦热，神气忽清忽乱，经来三日患病，血舍内之热气，乘空内陷，当以瘀热在里论病，但病已至危，从蓄血如狂例。（蓄 血）细生地 丹皮 制大黄 炒桃仁 泽兰 人中白

Source: From the Heat entering the Blood Chamber chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》

Commentary: Just as we often hear of cold entering the uterus during menstruation, Ye, in this case, makes the connection of warm disease entering the blood during menstruation. The “limp” in limp tongue also has the meaning of atrophy. This corresponds to yin deficiency. Ren zhong bai (Hominis Urinae Sedimentum) is salty, cold, and enters the Lungs, Heart, and Bladder. It clears heat, directs fire downwards, stops bleeding, and transforms phlegm. It treats taxation heat, Lung atrophy, nosebleeds, spitting up blood, throat impediment, gan of the teeth and gums, and sores in the mouth and tongue. Therefore the formula clears heat from the blood while also promoting the movement of blood.