Original Case by: Ye Tian-Shi (叶天士)

[The patient’s] pulse was thin and rapid. The thin [pulse] indicates visceral yin exhaustion and the rapid [pulse] indicates nutritive yin-fluid depletion. The previous summer and fall the patient was ill. Following this, there was a contraction of winter warmth leading to failure to store. In the spring when the earth’s qi started to ascend, there was Liver wood stirring wind, resulting in right-sided atrophy. The collaterals at the root of the tongue were stiff leading to difficult speech. All of this was caused by a root base exhaustion pattern. The common treatment to drain qi, descend phlegm, and discharge, disperse, and attack wind [was given], which removed the true yin by force and the spirit gradually became muddled as if asleep. If it had worsened, there would have been clouding inversion and then how can one treat this? Zhang Zhong-Jing’s Fu Mai Tang (Restore the Pulse Decoction) method was used. [This was a pattern of] yin fluid deficiency with stirring wind.

On follow up: [It was appropriate] to deal with the channels and nutritive level, the spirit depletion, the harm to the essence, the yin being unable to maintain a grasp [of the yang], and the stirring and jumping of internal wind were all signs of disability attack (fei zhong 痱中). The [previous] treatment of phlegm damaged [the body’s] warming tonification [ability], further damaging the yin and leading to withering that progressively became more severe.

It would have been fortunate to be able to foster yin and extinguish wind thereby slightly calming the situation. However, at that time the summer’s heat was increasingly rising and the true qi was even more deficient. Therefore, every day it was important to actively generate fluids and boost qi, because it was the hot part of the summer. [It was voiced that] if the summer’s heat did not change, they would then discuss adjusting the treatment approach. Gu ben wan (Secure the root pill) minus Shu Di Huang (cooked rehmannia root), plus Wu Wei Zi (schisandra fruit) [was given].

[The prescription was]

Tian Men Dong (Asparagi Radix)
Sheng Di Huang (Rehmanniae Radix)
Ren Shen
(Ginseng Radix)
Mai Men Dong (Ophiopogonis Radix)
Wu Wei Zi (Schisandrae Fructus)

Qin Bo-Wei’s Commentary [for the first visit]: This was also a case of wind-stroke. There was a connection between the manifestation and aetiology and qi and blood deficiency. However, as a result of an inappropriate treatment, the true yin was further removed by force. The particular manifestation was the muddled spirit as if asleep and a thin and rapid pulse, which illustrated that the Heart was extremely deficient. The Heart generates blood, stores the spirit and governs the vessels. The flow of the channel vessels was hindered, which is bound to lead to one-sided worsening atrophy. One should surely guard against clouding reversal. Therefore Ye gave Fu Mai Tang (Restore the Pulse Decoction) to first treat the Heart. Fu Mai Tang (Restore the Pulse Decoction) fundamentally nourishes Heart fluids, augments the Heart qi and unblocks the Heart yang. Since the pulse was thin and rapid he did not use the acrid and hot Sheng Jiang (Zingiberis Rhizoma recens) and Gui Zhi (Cinnamomi Ramulus), which changed the formula into a softening and moistening one. Actually, years later Wu Ju-Tong in the Wen Bing Tiao Bian (Systematic Differentiation of Warm Pathogen Diseases) (1798), according to this method, designed Jia Jian Fu Mai Tang (Modified Restore the Pulse Decoction), which rescues the yin and fluids for a warm pathogen that spreads into the lower burner. Although our predecessors have used both this formula and the previous Di Huang Yin Zi (Rehmannia Drink) in ways that are different than the original set prescription’s usage, the methods are intelligent and should be studied.

Translated by: Jason Blalack

Original Chinese: 脉细而数,细为脏阴之亏,数为营液之耗,上年夏秋病伤,更因冬暖失藏,入春地气升,肝木风动,遂令右肢偏痿,舌本络强,言蹇,都因根蒂有亏之症,庸俗泄气降痰,发散攻风,再劫真阴,渐神愦如寐,倘加昏厥,将何疗治,议用仲景复脉法,(液虚风动)。复脉汤去姜桂,又 操持经营,神耗精损,遂令阴不上朝,内风动跃,为痱中之象,治痰攻劫温补,阴愈损伤,枯槁日甚,幸以育阴熄风小安,今夏热益加发泄,真气更虚,日饵生津益气勿怠,大暑不加变动再商调理,固本丸去熟地加北味。天冬、生地、人叁、麦冬、五味

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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