Original Case by: Ye Tian-Shi (叶天士)

[The patient] had hemilateral withering on the left side of the body. [There was] blood deficiency not nourishing the sinews and bones, [leading to] internal wind assaulting the collaterals. The left pulse was moderate and large.

Zhi Shou Wu (Polygoni Multiflori Radix Preparata) (baked) 4 liang
Gou Qi Zi (Lycii Fructus) (stems removed) 2 liang
Dang Gui Shen (Angelicae Sinensis Radix) (use that with a single stalk, remove the tips) 2 liang
Huai Niu Xi (Achyranthis Bidentatae Radix) (steamed) 2 liang
Tian Ma (Gastrodiae Rhizoma) (roasted) 2 liang
Chong Wei Zi (Leonuri Fructus) (crushed, water rinsed ten times, then baked) 2 liang

These were ground into a powder.

Then Gan Ju Hua (sweet chrysanthemum flower) 3 liang, Shi Hu (Dendrobii Herba) 4 liang and Xiao Hei Dou Pi (small black bean skin) 4 liang were decocted down into a syrup. A paste [was then made] by adding honey [and the powder from the other herbs]. This was made into extremely fine pills. Every morning [the patient was instructed to] take four qian [of pills] with recently boiled water.

Commentary by Qin Bo-Wei: This case only mentions the one manifestation, “hemilateral withering on the left side”. Hemilateral withering is simply paralysis in half of the body. However since the body can be differentiated by the left side, corresponding to blood, and right the side, corresponding to qi, then this emphasis on the left relates to blood. Paralysis in half of the body is in the category of wind-stroke and can have symptoms such as impaired consciousness or coma, deviated eyes and mouth and so on. These however are not described in the case history, showing that this is the sequela of a wind-stroke, and other such symptoms no longer exist for this patient.

Therefore starting from the “hemilateral withering on the left side” and a moderate and large left pulse, we can say that this relates to the Liver. There is also Kidney yin and blood insufficiency with disquieted internal wind, which can be diagnosed from “blood deficiency not nourishing the sinews and bones, [leading to] internal wind assaulting the collaterals.”

Although there is no treatment method mentioned, a method to nourish blood and extinguish wind is implied. In addition, since the Liver governs the sinews and the Kidneys governs the bones, this is emphasizing the method of enriching and nourishing the lower burner. Therefore, the formula used He Shou Wu (Polygoni Multiflori Radix Preparata), Gou Qi Zi (Lycii Fructus), Dang Gui (Angelicae Sinensis Radix), Tian Ma (Gastrodiae Rhizoma), and Hei Dou (Glycinis Semen) to tonify both the Liver and Kidneys while also paying particular attention to nourishing the blood. Shi Hu (Dendrobii Herba) enriches the Kidneys and eliminates deficiency heat. So it is said, to treat wind one must first treat the blood. When blood moves then wind disappears on its own.

These medicinals were assisted by Tian Ma (Gastrodiae Rhizoma) and Ju Hua (Chrysanthemi Flos) which extinguish wind and Niu Xi (Achyranthis Bidentatae Radix) which fortifies the sinews and bones. Also, Chong Wei Zi (Leonuri Fructus) and Shi Hu (Dendrobii Herba) are able to treat wind painful obstruction and weak legs. Therefore this formula deals with both the root and branch and is regulating and nourishing. Xu Ling-Tai, in analyzing this formula, said “this formula neutrally tonifies, and does not have the drawback of supplementation that generates heat.”

Translated by: Jason Blalack

Original Chinese:




Source: Case from the Wind Stroke chapter of Case Records as a Guide to Clinical Practice (Lín zhèng zhî nán yï àn) 《临证指南医案》. Commentary from Complete Famous Medical Works of Qin Bo-Wei.

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Showing 2 comments
  • Barry Levine

    To call this case history laconic understates its brevity. Should we assume it worked? And to what degree? What was the course of treatment?
    I’ll assume a longish course of treatment based on the use of nourishing herbs and a rather low dosage, moreover administered as a convenient pill.

    Post-stroke syndrome, with muscle atrophy? Prognosis of recovery of movement at this point is poor, don’t you think? Maybe the treatment is designed to prolong life and preserve general vitality. Never-mind getting back use of the withered side.

    Why is the left pulse “moderate and large”? Especially seeing that the left side is withered?

  • Jason Blalack

    Hi Barry,

    1. I would suggest reading these two articles, which should address some of your questions / issues.

    2. I do not have large patient experience with hemilateral withering, but I agree a “cure” is unlikely. But I think that improvement is possible. So yes, prolonging life, increasing vitality, increasing muscle mass, and ‘use’ seems possible. To what extent depends on the individual circumstance.

    3. Moderate (or slack) pulse (from Ding Ganren, Qin’s teacher) = nutritive weakness and surplus in the defensive. This pulse often corresponds to stiffness in the upper (neck) and paralysis in the lower and can be differentiated floating, deep, large and small.

    Hope this helps a little.

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