The following is a case taken from ‘Five Steps to Shang Han Treatment Based on Pattern Identification’ (方证相对：伤寒辨证论治五步), which my colleague Michael Max and I are currently translating, and should be available sometime within the next year. Periodically, I will post random tidbits from the text in order to wet readers appetites, and for readers to get a feel for the overall text. To read another case from the book, click here.
A sixty-year old female Yǒng Níng native farmer from Wēn jiāng county in Sì Chūan province presented at the clinic.
Step 1: Chinese Medical Diagnosis:
This patient already had a history of rheumatic pain, and in August of 1974 she had come in for her initial consultation. She complained of an uncomfortable feeling in her body, a fear of cold, dizziness, and body pain. When she had come in, she was stooped over, and mentioned that she easily suffered from severe, acute pain in her lower back, with great difficulty stretching out. This was accompanied by continuous cold sweats emanating from her head, after which she would proceed to lay in bed without rising. At this point Dr. Fán was sought out for treatment.
Step 2: List of Disease Mechanisms
Lumbar pain which felt as if it had been cut, with great difficulty turning sides, ‘old’ feeling of the body with a fear of cold, feverishness, and numbness in the extremities. She had a green-blue dark facial complexion, dark lips, a slightly red tongue body, with a slippery, greasy coating. Her arms felt slightly cold on palpation, and her pulse was floating and deficient: This is a Tài Yáng pattern with the mutual contending of wind and dampness, and deficiency of defensive yáng.
Step 3: Comprehensive Analysis
This is a pattern of Tài Yáng wind-dampness. In order to treat, one should warm the channels, scatter cold, dispel wind, and eliminate dampness.
Step 4: Formulas According to Pattern
In this case guì zhī fù zǐ tāng (Cinnamon Twig and Aconite Accessory Root Decoction) masters it.
In clause 174 of the Shāng hán lùn (傷寒論 Discussion of Cold Damage) it is written:
“In cold damage that has lasted for eight or nine days, where wind and dampness mix with each other, there will be irritable pain in the body, an inability to turn sides, absence of vomiting, or thirst, and a pulse which is floating, deficient and rough. guì zhī fù zǐ tāng (Cinnamon Twig and Aconite Accessory Root Decoction) masters it”.
The case above is essentially identical to this clause, and therefore the original formula was used in treatment, and only the dosages of the medicinals were altered.
Step 5: Medicinals According to Pattern
The dosage of guì zhī (Cinnamomi Ramulus) was increased in order to discharge and scatter exterior wind-cold, free the yáng, and transform qì.
Combined with shēng jiāng (Zingiberis Rhizoma recens), wind pathogens are expelled from the skin and body hair.
The dosage of fù zǐ (Aconiti Radix lateralis preparata) was increased in order to warm the channels, drive out cold, stop pain, assist kidney yáng, and secure the foundation of defensive yáng.
The assistants zhì gān cǎo (Glycyrrhizae Radix preparata), and hóng zǎo (Jujubae Fructus), boost the centre, and harmonize the nutritive and defensive qì, therefore the three medicinals above can eliminate and battle to promote natural resolution.
guì zhī (Cinnamomi Ramulus) 15g
fù zǐ (Aconiti Radix lateralis preparata) 60g (cooked separately for thirty minutes)
shēng jiāng (Zingiberis Rhizoma recens) 30g
zhì gān cǎo (Glycyrrhizae Radix preparata) 10g
hóng zǎo (Jujubae Fructus) 30g
Four packages were prescribed.
After taking the four packages, all of her symptoms had basically reduced, and after another four, her condition had completely resolved. Afterwards, she was able to walk and work as per usual. On inquiry in June of 1979, the patient said that since recovering five years ago, she has never had a relapse of the condition.