Constraint (ascendant yang) (YTS)

Original Case by: Ye Tian-Shi (叶天士)

[Patient] Wu, age 41, [after] undergoing excessive agitation, had Liver and Gallbladder ascendant yang. The Stomach qi was getting worse and worse. The pulse should be pulsing on the left. The treatment was through [addressing] the constrained heat.

mu dan pi (Moutan Cortex)
hei shan zhi zi (black gardenia)
bo he geng (Menthae haplocalycis Stem)
gou teng (Uncariae Ramulus cum Uncis)
chen pi (Citri reticulatae Pericarpium)
bai shao (Paeoniae Radix alba)
fu ling (Poria)
shen qu (medicated leaven)

Translated by: Jason Blalack

Original Chinese: 吴（四一） 操持过动。肝胆阳升。胃气日减。脉应左搏。从郁热治。（肝胆郁热）丹皮 黑山栀 薄荷梗 钩藤 广皮 白芍 茯苓 神曲

Source: From the Constraint Chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》.

Commentary: Although the main issue is ascendant yang, Ye treats the root and focuses on the heat from constraint. Although gou teng (Uncariae Ramulus cum Uncis) has an ability to descend yang and bai shao can curb the Liver yang, his approach is mild. Compare to formulas such as tian ma gou teng yin (Gastrodia and Uncaria Drink) where there is tian ma, gou teng, shi jue ming and niu xi to descend or zhen gan xi feng tang which uses niu xi, dai zhe shi, long gu, mu li, and gui ban. His choose is one of style as well as to a certain extant a reflection of the severity of the condition.