Constraint (Liver / Spleen) Sinus (YTS)

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Original Case by: Ye Tian-Shi (叶天士)

Wu (40 years old) was exhausted and angry which led to damage. The disease was located in the Liver and Spleen. There was chronic brain leakage  and the bone marrow has been secretly damaged. The patient was to take [the below prescription] that resolves constraint for a short time, and then continue with a diffusing and tonifying one.

gōu téng (Uncariae Ramulus cum Uncis)
shēng xiāng fù (unprepared cyperus)
mǔ dān pí (Moutan Cortex)
sāng yè (white mulberry leaf)
shén qū (medicated leaven)
bái sháo (Paeoniae Radix alba)
fú líng (Poria)
chén pí ­ (Citri reticulatae Pericarpium)

Translated by: Jason Blalack

Original Chinese: 吴(四十) 劳倦嗔怒致伤。病在肝脾。久有脑泄。髓脂暗损。暂以解郁。继当宣补。钩藤 生香附 丹皮 桑叶 神曲 白芍 茯苓 广皮

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: Here is chronic condition with deep deficiency which resolves constraint before tonifying.

** Brain leakage (above) refers to deep source nasal congestion. Notice that the prescription does not contain any medicinals to directly address this symptom. Ye resolves the problem by focusing on the core underlying mechanism.

unprepared cyperus (shëng xiäng fù)
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  • Greg Livingston

    Curious what his 宣补/diffusing and tonifying formula would have looked like. I assume this means tonify and regulate/diffuse qi? I usually think of f 宣/diffuse for the lung, but here is a case of liver constraint/郁. I think 宣郁ƒ/diffuse constraint must be the idea, no? Probably nothing to do with diffusing the lung, or…?

    • Jason Blalack

      Good question I would say that you are correct; that it modern times the term diffuse or disseminate (xuan 宣) usually refers to the Lungs. However, in pre-modern texts, as you surmised, it can have a much broader meaning. For example, it can be used as a general method for eliminating (diffusing) constraint. For example, it is said,

      郁而不散,必宣剂以散之,如痞满不通之类。本草云宣可去壅,生姜橘皮之属。又曰:宣者,上召下也,谓吐剂也。(考证病源, 明•刘全德撰)”

      Diffusing is also used as one of the “ten formula types (shi ji 十剂),”as in diffusing formula (xuan ji 宣剂). A diffusing formula can simply mean eliminating congestion using such formulas as er chen tang.
      More importantly though is noticing how Ye used the term in other places. Actually, in the constraint chapter, Ye uses diffusing (xuan) a few times and it usually appears with unblocking (tong(tong 通)as in diffusing and unblocking (xuan tong 宣通)‚
      For example in,

      diffusing and unblocking the vessels and collaterals (xuan ton mai luo 宣通脉络).

      It also appears in the commentary in the phrase,

      diffusing and facilitating the shao yang (xuan chang shao yang 宣畅少阳).”

      There is also,

      diffusing and unblocking the five constraints and six constraints (xuan tong wu yu liu yu 宣通五郁六郁).”

      We can deduce by such instances, as well as the herbs used, that this diffusing does not solely relate to the Lungs.
      As I post more cases that use this term diffusing we can get a better sense of what Ye is talking about and what kind of herbs he may choose for this strategy. However, at a quick glance, two medicinals that he often uses when he uses this term are yu jin or jiang huang.
      However, in this case, I would not be surprised if he kept with the same idea of including medicinals such as xiang fu or shen qu. I would also assume that the tonifying aspect would simply be related to the Spleen and possibly Liver blood. Thoughts?

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