A twenty-four-year old male, university student presented with lumbar and neck pain, lasting for over one month. In addition, he experienced a dry mouth with a desire to drink fluids, cold hands, and soft bowel movements occurring once daily. His urination was normal; he slept soundly, and also frequently masturbated. Everyday he experienced moderate nervousness, which would result in copious sweating of his hands. At this point, he had not yet undergone any western medical examinations. He had a thick slimy white tongue coating, and a thin-wiry pulse. 

Dr. Féng: a dry mouth with a desire to drink, and cold hands are signs of a cold-heat complex disorder. Soft bowel movements, a thick slimy white tongue coating, and a thin-wiry pulse are due to blood vacuity with an abundance of water. 

This is a Jué Yīn disease, and chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) with dāng guī sháo yào sǎn (Tangkuei and Peony Powder) masters it. 

chái hú (Bupleuri Radix) 12g

huáng qín (Scutellariae Radix) 10g

tiān huā fěn (Trichosanthis Radix) 12g

lóng gǔ (Fossilia Ossis Mastodi) 15g

mǔ lì (Ostreae Concha) 15g

guì zhī (Cinnamomi Ramulus) 10g

gān jiāng (Zingiberis Rhizoma) 6g

dāng guī (Angelicae sinensis Radix) 10g

bái sháo (Paeoniae Radix alba) 10g

chuān xiōng (Chuanxiong Rhizoma) 6g

cāng zhú (Atractylodis Rhizoma) 12g

zé xiè (Alismatis Rhizoma) 10g

fú líng (Poria) 12g

zhì gān cǎo (Glycyrrhizae Radix preparata) 6g 

He was given seven packages. 

Question: dāng guī sháo yào sǎn treats abdominal pain, however in this case this is not seen. Is it still okay to use it? 

Answer: In Jué Yīn disease you often see chest, abdominal and lumbar pain, which is mostly the result of upper heat, lower cold, blood vacuity and the over-abundance of water. (One should) warm the lower, and specifically use dāng guī sháo yào sǎn to nourish the blood and disinhibit water. 

Commentary: Blood vacuity and an over-abundance of water can often easily cause upper heat with lower cold, and this type of Jué Yīn disease. Dr. Féng often uses chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) in combination with dāng guī sháo yào sǎn (Tangkuei and Peony Powder) to treat it. 

Question: The prototypical sign of Tài Yáng disease is a headache and a painful stiff neck, and is often seen with lumbar pain, so why was the lumbar and neck pain in this case not diagnosed as an exterior pattern? 

Answer: In exterior patterns you cannot have a cold-heat complex. Lumbar and neck pain does not specifically belong to an exterior pattern, as you can also experience these in exterior, half exterior half interior, interior, and in combination diseases. In exterior patterns, a má huáng or guì zhī formula can be used, with lóng gǔ and mǔ lì commonly added; if there is cold damp in the interior, shèn zhuó tāng is typically used; with lumbar and chest pain reflected in the bodies mid section, which is relatively more of a half exterior half interior pattern like in Jué Yīn disease, then chái hú guì zhī gān jiāng tāng and dāng guī sháo yào sǎn are commonly used. 

Question: What are the characteristics of a Jué Yīn disease? 

Answer: Jué Yīn disease is a half exterior half interior yīn pattern, which is not purely an exterior nor interior (condition) and manifests with numerous complex changes. By applying Dr. Hú’s theories, this (pattern) can be ascertained using the process of elimination method. With upper heat and lower cold, the cold is at the root, and a harmonization method must be employed to treat it. There are numerous formula presentations in half exterior half interior conditions, but we can simply say that when pathogens first enter the half exterior half interior (aspect) there will be alternating cold and heat, with the heat being most obvious, and this belongs to Shào Yáng for which xiǎo chái hú tāng (Minor Bupleurum Decoction) is used. If (pathogens) have entered into the half exterior half interior (with a) yīn pattern, either chái hú guì zhī gān jiāng tāng (Bupleurum, Cinnamon Twig, and Ginger Decoction) or wū méi wán (Mume Pill) can be used. 

After taking the formula, the lumbar and neck pain disappeared, the dryness in the mouth was reduced, and his bowel movements were normal. He was given another seven packages of the same formula to consolidate the treatment with cāng zhú (Atractylodis Rhizoma) increased to 15g.