Author: eraneven

Case Studies of Yì Jùsūn 易巨荪

On By eranevenIn Case Studies （医案)

Case Studies of Yì Jùsūn 易巨荪

From ‘Case Studies from Collective Insight’ 集思医案

Introduction

Late Qing medical literature is often remembered through the works of prominent theorists and canonical editors, yet much of classical Chinese medicine was preserved and transmitted through the lived experience of working clinicians. Yì Jùsūn 易巨荪 belongs firmly to this latter group. Active in the late Qing period and practicing primarily in the Yuè 粤 (Guangdong) region, Yì was not a court physician nor a system-builder, but a physician whose legacy survives through detailed clinical case records. These cases provide a rare and valuable window into the day-to-day application of classical formulas in real clinical settings.

Yì Jùsūn’s medicine is unmistakably grounded in the Shānghán lùn tradition. His diagnostic reasoning consistently prioritizes concrete signs—pulse, abdominal findings, and the patient’s immediate presentation—over abstract theorization. Treatment follows the principle of formula–pattern correspondence (fāng zhèng xiāng yìng 方证相应), with classical formulas applied decisively and adjusted according to the evolving pattern. 

Throughout his cases, Yì demonstrates a willingness to employ strong attacking methods when indicated, including in postpartum conditions, directly challenging later doctrinal assumptions that such presentations must always be treated as deficiency.

Stylistically, Yì’s writing is direct and pragmatic. He frequently critiques prevailing medical habits—such as rigid seasonal explanations of disease or formula selection based on theoretical preference rather than presentation—and instead insists on reassessing the pattern as it unfolds. His cases illustrate dynamic transformations between yīn and yáng, interior and exterior, and excess and deficiency, embodying the flexible, moment-to-moment clinical reasoning central to classical Shānghán medicine.

Although Yì Jùsūn never achieved the renown of figures such as Kē Qín柯琴, his work reflects the same clinical spirit that later informed the modern jīngfāng 经方 revival. Preserved largely in regional compilations rather than widely circulated standalone texts, his writings have remained relatively obscure. Yet precisely because of this, they retain a raw clinical clarity, offering contemporary readers insight into how classical medicine functioned outside the academy and beyond rigid doctrinal frameworks. Revisiting Yì Jùsūn’s cases today allows us to reconnect with a lineage of practice that is concrete, responsive, and deeply rooted in classical clinical reality.

Case Studies

【一】福建谢宽，寄居粤城，癸未三月，其妻患腹痛，杂药乱投，月余不效。延余诊视，六脉滞涩，少腹满痛，拒按，大小便流通。断为瘀血作痛。投以桃仁承气汤，二服痊愈。盖拒按本属实症，大便通，知不关燥屎，小便通知非蓄水，其为瘀血无疑。

[1] Xiè Kuān 謝寬 of Fújiàn 福建, residing temporarily in Yuèchéng 粤城. In the third month of the guǐwèi 癸未 year, his wife suffered from abdominal pain. Various miscellaneous medicinals were administered indiscriminately; after more than a month there was no effect. I was invited to examine her. The six pulses were stagnant and rough; there was fullness and pain in the lesser abdomen, with resistance to pressure; urination and defecation were unobstructed. I judged the pain to be caused by static blood. Táorén Chéng Qì Tāng 桃仁承气汤 was prescribed; after two doses she was cured. Resistance to pressure fundamentally belongs to an excess pattern. With the stools free, it was known not to involve dry feces; with urination free, it was known not to be water accumulation. That it was static blood was beyond doubt.

【二】河南永发店，予先人旧日所做生理也。癸未六月，有店伴陈姓者，其妻患产难，二日始生，血下甚少，腹大如故，小便甚难，大渴。医以生化汤投之，腹满甚，且四肢头面肿。延予诊视。不呕不利，饮食如常，舌红黄，脉滑有力，断为水与血结在血室。投以大黄甘遂汤。先下黄水，次下血块而愈。主家初亦疑此方过峻。予曰：”小便难知其停水，生产血少知其蓄瘀，不呕不利，饮食如常，脉有力知其正气未虚，故可攻之。若泥胎前责实，产后责虚之说，延迟观望，正气即伤，虽欲攻之不能矣。”主家坚信之，故获效。

[2] Yǒngfādiàn 永发店 in Hénán 河南 was a place where my late father formerly engaged in livelihood. In the sixth month of the guǐwèi 癸未 year, there was a shop companion surnamed Chén 陈, whose wife suffered from difficult childbirth. The child was delivered only after two days; the blood discharged was very scant, the abdomen remained as distended as before, urination was extremely difficult, and there was great thirst. A physician administered Shēng Huà Tāng 生化汤. The abdominal fullness became severe, and moreover the four limbs, head, and face became swollen. I was invited to examine her. There was no vomiting and no diarrhea; appetite was normal; the tongue was red with yellow coating; the pulse was slippery and forceful. I judged this to be water and blood binding together in the blood chamber (xuè shì 血室). Dàhuáng Gānsuì Tāng 大黄甘遂汤 was prescribed. First yellow water was discharged, then blood clots were expelled, and she recovered. The family at first also doubted that this formula was too drastic. I said: “Difficulty in urination indicates retained water; scant bleeding after delivery indicates stored stasis. With no vomiting or diarrhea and normal appetite, and with a forceful pulse, it is known that the upright qì has not yet become deficient; therefore it can be attacked. If one rigidly adheres to the saying that before delivery one treats excess and after delivery one treats deficiency, and delays while observing, the upright qì will then be damaged, and even if one wished to attack, it would no longer be possible.” The family firmly trusted this, and thus efficacy was obtained.

【三】甲申六月，木匠李某亦在永发店出入。其妻患发热恶寒，不药自愈。转而腹痛，渴欲饮水，水入则吐，大小便不通。予曰：”脾不转输，故腹满痛，不输于上渴饮而吐，不输于下故二便不通，法宜转输脾土。”投以五苓散，一服痊愈。

[3] In the sixth month of the jiǎshēn 甲申 year, a carpenter surnamed Lǐ 李 also frequented Yǒngfādiàn 永发店. His wife suffered from fever and aversion to cold; without medicinals she recovered on her own. Subsequently she developed abdominal pain, thirst with desire to drink water, vomiting upon intake of water, and obstruction of both urination and defecation. I said: “The spleen fails to transport and transform; therefore there is abdominal fullness and pain. Not transporting upward, there is thirst with drinking and vomiting; not transporting downward, therefore the two excretions are obstructed. The method should be to restore the transport of the spleen earth.” Wǔ Líng Sǎn 五苓散 was prescribed; after one dose she was cured.

【四】甲申十月，西关锦龙南机房潘某之妻，少腹痛，每腹痛甚则脉上跳动，气上冲不竭，息苦楚异常，月余不效。予断为奔豚。投以桂枝加桂汤一服，茯苓桂枝甘草大枣汤一服，痊愈。

[4] In the tenth month of the jiǎshēn 甲申 year, the wife of Pān 某, from the southern weaving workshop of Jǐnlóng 锦龙 in Xīguān 西关, suffered from pain in the lesser abdomen. Whenever the pain became severe, the pulse leapt upward, qì surged upward incessantly, and breathing was extremely distressed. After more than a month there was no effect. I judged this to be bēn tún 奔豚 [running piglet]. One dose of Guìzhī Jiā Guì Tāng 桂枝加桂汤 was given, followed by one dose of Fúlíng Guìzhī Gāncǎo Dàzǎo Tāng 茯苓桂枝甘草大枣汤, and she was cured.

【五】乙酉四月，南海李总戎斌扬之妻患头痛。每痛则头中隐隐有声，即有血从鼻中流出，精神颓，肌肉瘦。诸医川祛风活血之药，愈治愈其。延予诊视，适座中有一老医，谓其脑下陷，例在不治。予笑而不答，许以十五日愈。病家未之深信。然素慕贱名，亦姑试之也。予用大剂当归补血汤加鹿茸数两，如期而愈。盖督脉从腰上头入鼻，又主衄血，故重加鹿茸以治督脉，不似他方之泛泛，故奏效也。

[5] In the fourth month of the yǐyǒu 乙酉 year, Bīn Yáng, the wife of Lǐ Zǒngróng of Nánhǎi suffered from headaches. Whenever the pain occurred, there was a faint sound within the head, followed by bleeding from the nose. Her spirit was dejected and her flesh emaciated. Various physicians administered medicinals to dispel wind and invigorate blood, yet the more she was treated, the worse she became. I was invited to examine her. It so happened that an elderly physician was present, who said that her brain had sunken downward and that this condition was, by precedent, incurable. I smiled and did not reply, but promised recovery within fifteen days. The family did not deeply believe this. However, having long admired my humble reputation, they tentatively tried it. I used a large dosage of Dāngguī Bǔ Xuè Tāng 当归补血汤, adding several liǎng of Lùróng. She recovered as promised. The Dū Mài runs from the waist up to the head and enters the nose, and it also governs epistaxis; therefore Lùróng was heavily added to treat the Dū Mài. This was unlike other formulas applied indiscriminately, and thus efficacy was achieved.

【六】乙酉夏，吾粤霍乱盛行，从阳化者热多，口苦渴，舌红，古法川五苓散，粤人用纯阳仙方多效。然入阴者死，出阳者生。阳症其轻，亦有不药自愈者。惟从阴化之症寒多，不欲饮，即饮亦喜热水，古法用理中汤，且有吐利一刻紧一刻，手足冷，声嘶日陷或手足拘急，复大汗出则死矣。古人嫌理中力薄用通脉四逆汤或四逆汤。予遂其法治之。附子有用至二两，干姜有用至两以上者。全活甚多，但此症内霍乱外伤寒，从阴从阳瞬息不同用药亦当(如转圈)。营长李某，上吐下利，恶寒，盛暑亦覆被，面目青，昏不知人。延予诊视，断为阴症。甫订方，即闻病者呻吟，自发去衣被，恶寒转而恶热，面青转而面赤，吐利亦渐止。予为之贺喜曰：”病已由阴出阳，自内而外，为将愈之兆。拟桂枝汤一服全愈。​（凌波按：今日此等热症颇多，往往视而畏寒、口渴，处方甫毕转为恶热口渴。走马看伤寒，信不我诬。​）

[6] In the summer of the yǐyǒu 乙酉 year, cholera (huòluàn 霍乱) was rampant in our Yuè 粤 region. Those transforming from yáng were mostly heat patterns, with bitter mouth and thirst, red tongue; according to ancient methods Wǔ Líng Sǎn 五苓散 was used, and among the Yuè people, the use of purely yáng “Immortal formulas” was often effective. Yet those entering yīn died, and those emerging into yáng lived. Yáng patterns were relatively mild, and some even recovered without medicinals. Only the patterns transforming from yīn had much cold, no desire to drink; even when drinking, they preferred hot water. According to ancient methods Lǐ Zhōng Tāng 理中汤 was used. In some cases vomiting and diarrhea alternated in urgency, the hands and feet were cold, the voice hoarse and daily sinking, or the hands and feet were clenched; if copious sweating then occurred, death followed. The ancients considered Lǐ Zhōng Tāng insufficient in strength and used Tōng Mài Sì Nì Tāng 通脉四逆汤 or Sì Nì Tāng 四逆汤. I accordingly followed this method in treatment. Fùzǐ 附子 was sometimes used up to two liǎng, gānjiāng 干姜 sometimes exceeding one liǎng. Many lives were fully saved. However, this pattern is internally cholera and externally cold damage 伤寒; transformation from yīn or yáng can change in an instant, and medication must also change accordingly (like turning a wheel).

A battalion commander surnamed Lǐ 李 had profuse vomiting and diarrhea, aversion to cold, and even in the height of summer covered himself with quilts. His face was bluish, and he was unconscious. I was invited to examine him and judged it to be a yīn pattern. Just as the formula was being decided, I heard the patient groan; he spontaneously removed his clothing and bedding, aversion to cold turned into aversion to heat, the bluish complexion turned red, and the vomiting and diarrhea gradually ceased. I congratulated him, saying: “The disease has already emerged from yīn into yáng, moving from interior to exterior—this is a sign of impending recovery.” One dose of Guìzhī Tāng 桂枝汤 was prescribed, and he fully recovered.

(Líng Bō 凌波 notes: Today such heat patterns are quite common. Often they present with aversion to cold and thirst; just as the prescription is completed, they turn into aversion to heat with thirst. To observe cold damage as if galloping on horseback—this saying does not deceive.)

The Poetry of Wáng Wéi 王维

On By eranevenIn Poetry (诗), Translations & Writings (译著与文章)

Wáng Wéi 王维 (693 or 694 or 701 – 761), courtesy name Mójí 摩诘, also known as Mójí Jūshì 摩诘居士, was originally from Hédōng Púzhōu 河东蒲州 (modern Yongji, Shanxi). He later moved to Jīngzhào Lántián 京兆蓝田 (modern Lantian, Shaanxi), and his ancestral home was Qíxiàn 祁县 in Shanxi. He was a poet and painter of the Tang dynasty.

He came from the Hedong branch of the Tàiyuán Wángshì 太原王氏, known specifically as the Hédōng Wángshì 河东王氏. At nineteen, he traveled to Jingzhao prefecture to sit for the examinations and won first place. At twenty-one, he passed the jìnshì 进士 examination. Over the years, he served as Yòu Shíyí 右拾遗 (Right Remonstrator), Jiǎnchá Yùshǐ 监察御史 (Censor), and Héxī Jiédùshǐ Pànguān 河西节度使判官 (Assistant to the Military Commissioner of Héxī).

During Emperor Xuánzōng’s Tiānbǎo era, he was appointed Lìbù Lángzhōng 吏部郎中 (Director in the Ministry of Personnel) and Gěishìzhōng 给事中 (Palace Aide). When Ān Lùshān 安禄山 captured Cháng’ān 长安, Wáng Wéi  was forced to accept an official position under the rebel regime. After Cháng’ān was retaken, he was demoted to Tàizǐ Zhōngyǔn 太子中允 (Assistant to the Heir Apparent), but later rose to Shàngshū Yòuchéng 尚书右丞 (Vice Minister of the Ministry of Works). He died in the second year of the Shàngyuán 上元 era (761), in the seventh month, at the age of sixty-one.

Wáng Wéi  not only practiced Chán 禅 Buddhism and studied Daoist teachings (Zhuāngxué 庄学, Xìndào 信道), but also excelled in poetry, calligraphy, painting, and music. His poetic fame was especially prominent during the Kāiyuán 开元 and Tiānbǎo 天宝 eras, and he was particularly skilled in five-character verse (wǔyán 五言).

Many of his poems describe landscapes and pastoral life; together with Mèng Hàorán 孟浩然, he was known as “Wáng–Mèng 王孟” and was honored with the title “Poet-Buddha” (Shīfó 诗佛). His painting, especially his landscape style, reached great heights, and later generations regarded him as the founder of the Southern School of landscape painting (Nánzōng shānshuǐhuà zhī zǔ 南宗山水画之祖).

Sū Shì 苏轼 said of him:
“Taste Mojie’s poems and there are paintings within them; view Mojie’s paintings and there is poetry within them.”

More than 400 of his poems survive today. Representative works include “Xiāngsī 相思” (Longing) and “Shānjū Qiūmíng 山居秋暝” (Autumn Evening in the Mountains). His extant writings include Wáng Yòuchéng Jí 《王右丞集》 and Huàxué Mìjué 《画学秘诀》.

1.《鸟鸣涧》
鸟鸣涧
人闲桂花落，
夜静青山空。
月出惊山鸟，
时鸣春涧中。


Birds Calling in the Ravine
With people at leisure, osmanthus blossoms fall;
In the still night, green mountains lie empty.
When the moon rises, it startles the mountain birds,
Who now and then cry out in the spring ravine.

Commentary
In the first two lines, the poem’s focus settles on the words “fall” and “empty.” “Fall” portrays the poet’s unhurried, leisurely state of mind—only then can one sense the tiny osmanthus blossoms drifting down without a sound. “Empty” depicts the vast, far-reaching atmosphere created by the stillness of night.
The next two lines shift from silence to sound: “startled” and “crying” further express the tranquility of the moonlit night and the emptiness of the valleys. The most interesting point is that through the birds’ cry, the desolate quiet of the first lines suddenly gives rise to a pulse of life, filling the poem with vitality amidst its serenity. This is precisely the elegant, leisurely attitude toward life that Wáng Wéi  pursued.

2.《杂诗》
君自故乡来，应知故乡事。
来日绮窗前，寒梅着花未？


Miscellaneous Poem
You come from my old hometown—
You must know the affairs of home.
Tell me, before the embroidered window,
Has the winter plum begun to bloom?

Commentary
This is a uniquely conceived poem of homesickness. The poet expresses intense longing for home through concern for the plum blossoms there. All four lines are the traveler’s questions—implying deep care for his homeland.
He could ask about many things, yet he chooses the plum outside the window. This seemingly small and casual question contains boundless longing and affection. The “winter plum” is no longer just a plant before the window, but a symbol of all that is worth remembering at home—an embodiment of homesickness that feels intimate, natural, and full of meaning.

3.《相思》
红豆生南国，春来发几枝。
愿君多采撷，此物最相思。


Longing
Red berries grow in the southern land—
In spring, how many new branches appear?
I hope you gather them in plenty,
For this is the seed of deepest longing.

Commentary
This poem was written for the famous singer Li Guinian. In only twenty characters, it expresses the poet’s heartfelt affection. After the An Lushan Rebellion, Li Guinian wandered in the south, and it is said he often sang this poem, deeply moving all who heard it.
The first two lines naturally and sincerely introduce the red berries. The last two lines convey feeling through metaphor—intimate and touching. Centered entirely on the symbol of the red berry, the poem expresses longing with simplicity and warmth, creating a lasting emotional resonance.

4.《九月九日忆山东兄弟》
独在异乡为异客，每逢佳节倍思亲。
遥知兄弟登高处，遍插茱萸少一人。


Thinking of My Brothers on the Double Ninth
Alone in a strange land as a lonely guest,
Every festive day my thoughts of home double.
From afar I know my brothers have climbed the heights;
Among the dogwood sprigs they wear, one person is missing—me.

Commentary
This is a festival poem expressing longing for family.
The first two lines describe the poet’s inner feelings during the festival. In the first line, one “alone” and two uses of “foreign/strange” portray a deep sense of isolation and unfamiliarity, making the second line’s “doubled homesickness” especially affecting. It resonates with anyone who has spent a holiday far from home, touching the heart and becoming a timeless line.
The last two lines use the custom of climbing heights and wearing dogwood on the Double Ninth Festival to imagine the poet’s brothers back home. This not only shows his longing for family but also emphasizes his own disappointment and loneliness—deepening the poem’s theme.

5.《渭城曲》 / 《送元二使安西》
渭城朝雨浥轻尘，客舍青青柳色新。
劝君更尽一杯酒，西出阳关无故人。


Song of Weicheng (also Seeing Yuan Er Off to Anxi)
Morning rain at Weicheng dampens the light dust;
At the travelers’ lodge, the willows look freshly green.
I urge you—drink one more cup of wine,
For once you pass west of Yang Gate, there will be no old friends.

Commentary
The poem depicts the emotional scene of parting with a close friend. The first two lines describe the beauty of the homeland after rain; the last two express the affection and reluctance at parting.
Artistically, the opening lines serve as a gentle prelude, while the final lines reveal the true theme. The poet skillfully conveys sorrow and tenderness with restraint, making the emotions sincere and warm. Thus this poem has been passed down through the ages and is loved by generations.

Professor Huáng Huáng Case Studies

On By eranevenIn Huáng Huáng (黃煌)

Case of Obstructive Jaundice

The patient is a 68-year-old male, 165 cm tall, and weighs 61 kg. Initial consultation on August 19, 2019.

Medical History: Hepatic sinusoidal obstruction syndrome, cirrhosis, portal hypertension, splenomegaly. In July of this year, he underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure, which improved ascites, but his bilirubin levels continued to rise.

Examination (August 9, 2019): Total bilirubin 216.3 μmol/L, direct bilirubin 195.5 μmol/L, indirect bilirubin 20.8 μmol/L. The patient reported poor mental state, fatigue, moderate appetite, urinating 2 liters per day, yellow urine, poor taste, and swollen feet after walking a lot. He did not experience obvious thirst. His past medical history includes hypertension, chronic bronchitis, and emphysema.

Physical Examination: The patient appeared fatigued, spoke slowly, had yellow-orange skin, yellow sclera, a soft abdomen without resistance, a thick yellow tongue coating with a red tongue, and mild edema in the lower limbs.

Prescription:

  1. Yīnchénhāo 50g, guìzhī 15g, báizhú 30g, fúlíng 30g, zéxiè 30g, zhūlíng 30g, 10 doses.
  2. Yīnchénhāo 30g, zhīzǐ  15g, zhì dàhuáng 5g, 10 doses.

These two prescriptions were alternated every other day.

Follow-up (September 23, 2019): After treatment, his taste sensation improved, and bilirubin levels decreased. A lab check on September 22, 2019, showed total bilirubin at 88.9 μmol/L and direct bilirubin at 76.5 μmol/L.

Note: The two formulas used in this case are both classical formulas for reducing jaundice. Yīnchénhāo Tāng is effective for bright-colored jaundice, while Yīnchén Wǔ Líng Sǎn is used for jaundice accompanied by ascites and edema. The method of alternating the two formulas was adopted out of respect for ancient usage in classical formulas. According to the Shānghán lùn and Jīnguì yàolüè, no formula combines zhīzǐ with báizhú, fúlíng, and guìzhī, nor does it combine dàhuáng with báizhú. Therefore, mixing them into one formula and decocting together might not be appropriate. To be cautious, they were decocted and taken separately.

Case of Rectal Cancer

Ms. Jin, a 36-year-old woman, measuring 150 cm in height and weighing 44 kg, was first seen on April 11, 2018. She had been diagnosed with rectal cancer for seven months and had not undergone surgery. She had received eight rounds of chemotherapy and 25 sessions of radiotherapy. A CT scan from March 9, 2018, showed that the rectal cancer, located about 8 cm from the anus, had shrunk compared to previous scans, while the small retroperitoneal lymph nodes remained unchanged.

At the time of consultation, she experienced dull abdominal pain, bloating after eating, and abdominal distension before defecation. Her bowel movements were sticky and adhered to the toilet bowl, occurring once or twice per day, with difficulty passing stool smoothly. She also reported a sensation of body heat, poor sleep, and frequent dreaming.

On physical examination, she appeared thin, with bright and alert eyes. Her skin was yellowish-black but had an oily sheen, and there were pigmentation spots on her face. Her tongue was thin with a yellow, greasy coating, and the sublingual veins were engorged. Although there was no tenderness in the abdomen, it felt hot to the touch. Her navel temperature was 38.9°C, while her forehead temperature was 37.1°C. Her pulse was slippery and rapid at 120 beats per minute.

She was prescribed a formula consisting of bàitóuwēng 10g, huánglián 5g, huángbǎi 10g, qínpí 10g, huángqín 15g, báisháo 15g, gāncǎo 10g, and hóngzǎo 30g, to be taken in 15 doses.

At her follow-up visit on May 8, 2018, she reported that the abdominal pain had disappeared after taking the medicine. Her complexion had become fairer and more radiant. Sticky stool, excessive hunger, and night sweats had resolved, and the heat in her palms and soles had decreased. She felt comfortable overall, and her navel temperature had dropped to 36.6°C. The same formula was prescribed for another 15 doses, to be taken every other day.

At her third consultation on May 15, 2018, a test report from May 11 confirmed that the tumor was no longer present. Her stool had returned to normal in consistency and color, her navel temperature was 37.8°C, and her appetite was good with no significant discomfort. The same prescription was continued for another 15 doses.

This case was treated with a combination of Bàitóuwēng tāng and Huángqín Tāng, two classical formulas used to stop dysentery. These formulas are effective for conditions such as cervical cancer, rectal cancer, colon cancer, prostate cancer, and bladder cancer in patients presenting with symptoms such as foul-smelling, sticky, and incomplete bowel movements with tenesmus, anal heaviness, and a burning sensation, or with foul-smelling vaginal discharge or thick uterine bleeding.

This formula, being bitter and cold in nature, is particularly suited for individuals with a heat-type constitution. Such patients often have red lips that appear as if they are wearing lipstick, a red tongue with prickles, an irritable temperament, a sensation of heat in the body and limbs, a burning sensation on the skin, and an abdomen that feels hot to the touch, with an especially high temperature at the navel.

The presence of internal heat is a key indication for huángqín. The Jīnguì yàolüè describes Sān Wù Huángqín Tāng as treating postpartum women who develop heat and agitation in the limbs due to exposure to wind. The Qifang Leibian records that boiling huángqín in a decoction can treat extreme summer heat symptoms, where the head feels swollen like a large bucket and the body burns like fire. The elevated navel temperature mentioned in this case also warrants further study, as the Leizheng Huoren Shu states that in cases of concurrent heat diarrhea, the area below the navel is always warm.

Liú Dùzhōu Case Studies

On By eranevenIn Liú Dùzhōu (刘渡舟), Translations & Writings (译著与文章)

With my upcoming Liú Dùzhōu book release, I felt it would be apt to share a couple random cases from this brilliant physician. These cases do not appear in my book, but were ones I found during my many deep dives and Liú Dùzhōu rabbit holes. Enjoy!

Case of Dysmenorrhea
Patient: Li, female, 45 years old. Initial consultation on May 5, 1993.

History:
The patient developed dysmenorrhea one year prior after undergoing an induced abortion. During each menstrual period, she experienced severe, cold pain in the lower abdomen that was unrelieved by analgesics. Her menstrual cycle was delayed, with scanty, dark-colored blood containing clots. This menstrual period began yesterday. She also presented with dry mouth, chapped lips, dizziness, soreness in the waist, weakness in the legs, and fatigue when lifting. The tongue was dark, and the pulse was deep.

Diagnosis:
This was diagnosed as a condition of deficiency and cold in the Chong and Ren channels, with blood stasis obstruction.

Treatment:
The treatment principle was to warm the channels, dispel cold, eliminate blood stasis, and nourish the blood. The prescription was derived from the Jīnguì yàolüè formula Wēn Jīng Tāng:

wüzhūyú 8g

guìzhī 10g

shēngjiāng 10g

dāngguī 12g

báisháo 12g

chuānxiōng 12g

dǎngshēn 10g

zhìgāncǎo 10g

mǔdānpí 10g

ējiāo (dissolved separately) 10g

bànxià 15g

màidōng 30g

Outcome:
After taking five doses, the cold pain in the lower abdomen was significantly relieved. The same prescription was continued for five more doses. By the next menstrual period, the abdominal pain did not recur. From that point forward, her menstruation became regular and without discomfort. (Selected Clinical Case Studies of Liú Dùzhōu)

Commentary:
Wēn Jīng Tāng is effective for treating dysmenorrhea. Renowned Hangzhou physician Qiu Xiaomei once recalled:
“I was fortunate to work alongside the famous Zhejiang physician Ye Xichun. Ye’s profound and unique medical skills provided me with many valuable insights. For example, when treating cold-induced dysmenorrhea, the routine application of Wēn Jīng Tāng often proved effective. However, there were cases where it was ineffective.” (The Path of Renowned TCM Physicians)

This highlights that even when using Wēn Jīng Tāng, it is crucial to match the formula to the correct pattern. In this case, Dr. Liú Dùzhōu documented not only the patient’s localized symptoms (such as delayed menstruation, severe cold pain in the lower abdomen, and scanty dark menses) but also systemic characteristics such as dry lips, a dark tongue, and a deep pulse, along with the abortion as the inducing factor.

Case of Neurotic Disorder and Irritability

Patient: Cao, a 72-year-old female, who first consulted on October 26, 1995.
The patient had been experiencing persistent irritability for two years, with a recent worsening trend.
Western medicine diagnosed it as a neurotic disorder, and she was given sedatives and anxiolytics, but there was no improvement. She then sought traditional Chinese medicine treatment.

Presenting Symptoms: The patient complained of intense irritability, which was unbearable. Her family members were sympathetic and cautious, but she could not express herself or felt misunderstood. She became agitated and, during severe episodes, felt relief only after hitting her chest and abdomen with a stick. She felt a rising sensation from the navel to the chest, which worsened the irritability. She also experienced abdominal bloating with a feeling of obstruction. Additional symptoms included insomnia, restlessness, nausea, poor appetite, irregular bowel movements, and yellow urine. Her tongue was red at the tip, with a greasy coating, and the pulse was wiry and slippery.

Diagnosis: A pattern of fire stagnation in the chest and abdomen, with downward pressure on the stomach and intestines.

Treatment Strategy: Soothe stagnation, clear heat, regulate qi, and reduce fullness.
Prescription: Zhīzǐ Hòupò Tāng

zhīzǐ 14g

zhǐshí 10g

hòupò 15g.

7 doses.

Follow-up: After 7 doses, the patient reported a 50% reduction in irritability. Her chest and abdomen felt clearer, and her mood stabilized. She was able to sleep at night, and her appetite improved. The treatment was highly effective, and the patient continued with 7 more doses. Upon follow-up, she still had symptoms of sleep disturbances, dry mouth, a bitter taste, and yellow urine, indicating that heat had not fully resolved.
The prescription was then changed to Chái Qín Wēn Dǎn Tāng [Wēn Dǎn Tāng plus cháihú & huángqín) combined with Zhīzǐ Hòupò Tāng to clear phlegm-heat and treat the remaining symptoms. After one month, the patient fully recovered.
(From Liú Dùzhōu Lin Zhen Yan An Xuan (Selected Clinical Cases of Liú Dùzhōu))

Note: The difference between Zhīzǐ Hòupò Tāng and Zhīzǐ Shí Tāng lies in the abdominal symptoms. The former is indicated when abdominal symptoms like bloating and constipation are present, while the latter is primarily used for chest-related symptoms like chest oppression and cough. Zhīzǐ Hòupò Tāng and Xiǎo Chéng Qì Tāng both contain zhǐshí and hòupò, which treat abdominal fullness and pain. The key difference is that zhīzǐ and dàhuáng have distinct effects: Zhīzǐ clears irritability, while dàhuáng is used to purge and clear heat. Therefore, Zhīzǐ Hòupò Tāng is more suitable for chest obstruction and irritability, while Xiǎo Chéng Qì Tāng is better for constipation and abdominal pain. The patient’s detailed symptoms of irritability and abdominal fullness illustrate the application of Zhīzǐ Hòupò Tāng for heat-related disturbances and its ability to address both physical and emotional symptoms.

acupuncture in port coquitlam

Case of Coldness in the Tips of the Toes Followed by Abdominal Discomfort and Diarrhea (Lóu Shàokūn)

On By eranevenIn Case Studies （医案), Lóu Shàokūn (娄绍昆), Translations & Writings (译著与文章)

The patient is a 50-year-old male farmer from Yongqiang. He has always been healthy and has never been ill until the last 5 years. Recently, he frequently experiences coldness in his toes, especially in the summer. Whenever his toes feel cold, he also feels discomfort in his abdomen, which is followed by diarrhea. This year, the symptoms have become more frequent, and his hands and feet have started to experience spasms, which he never had before. This has caused him some anxiety. He has visited many doctors who all diagnosed him with intestinal dysfunction, but the treatments did not bring noticeable results. The patient is also a distant relative of mine, so he came to seek my help.

First Consultation (July 10, 2005):
Upon examination, the patient reported the symptoms mentioned above, along with night sweats in winter, spontaneous sweating in summer, and a lack of thirst. However, there were no significant abnormalities found in his pulse or tongue. Abdominal examination revealed thin, weak abdominal muscles. Based on this, I suspected a Guìzhī Tāng pattern. The patient’s symptoms of cold feet in summer leading to abdominal discomfort reminded me of a Japanese Kampo [physicians] experience, where he said: “Cold feet in summer causing abdominal pain should be treated with Guìzhī Jiā Fùzǐ Tāng.” Therefore, I prescribed 7 doses of Guìzhī Jiā Fùzǐ Tāng, replacing shēngjiāng with gānjiāng, essentially combining Guìzhī Tāng and Sì Nì Tāng.

Follow-up Consultation (July 17, 2005):
After taking the medicine for one week, the patient reported feeling very comfortable and as if he had met a long-lost friend. The coldness in his toes, abdominal discomfort, and diarrhea had also improved. Since the prescription had been effective, I continued with Guìzhī Jiā Fùzǐ Tāng for another 7 doses.

Follow-up Consultation (July 24, 2005):
After another week of medication, the patient’s condition continued to improve. The spasms in his hands and feet had disappeared, and the symptoms of cold toes, abdominal discomfort, and diarrhea had significantly improved. However, spontaneous sweating continued. Based on the symptoms, I added Yù Píng Fēng Sǎn to the original formula and instructed the patient to take it for two weeks before stopping the medication to observe the results.

After a month of continuous treatment with the combined formula of Guìzhī Jiā Fùzǐ Tāng and Yù Píng Fēng Sǎn, the patient’s symptoms disappeared, and he stopped the medication. A year later, when I met his family, I learned that his condition had been completely cured.

Note:
In classical Chinese medicine, it’s important to pay attention to experience-based maxims. As Gě Hóng from the Jin Dynasty mentioned in Bàopǔzǐ: “In the transmission of medical secrets, words are not written down, only passed down through oral formulas.” In traditional herbal medicine, treatment is based on patterns and symptom differentiation. The treatment in this case is simple and effective when considering the pattern and maxim: “Cold feet in summer causing abdominal pain should be treated with Guìzhī Jiā Fùzǐ Tāng.”

In this case, the “coldness in the toes” symptom might suggest the use of xìxīn, which treats retained fluids and dampness. However, the patient’s coldness, spontaneous sweating, and diarrhea were more in line with the Sì Nì Tāng pattern, so I added fùzǐ and replaced shēngjiāng with gānjiāng to match the correct pattern.

Two Cases On The Use of Táohé Chéng Qì Tāng In Severe Psychiatric Disorders

On By eranevenIn Case Studies （医案), Cáo Yǐngfǔ (曹颖甫), Jīng Fāng (经方), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

Case of Blood Amassment Induced Madness by Cao Yingfu 曹颖甫

Shen Shiwan’s younger sister, a frail young woman under the age of twenty, suddenly suffered a fright while out shopping. Upon returning home, she descended into madness—attacking anyone she encountered with seemingly boundless strength.

Several days passed without improvement, and I was called to examine her. By then, her condition had persisted for seven or eight days, with no signs of relief. Upon inquiry, I learned that she had not had her menstrual period for two months. Seizing an opportunity while she slept, I entered her room to examine her. Her pulse was deep and tight, and her lower abdomen appeared distended.

I stepped outside and told Shen Shiwan, “This is a case of blood amassment. A strong purgative will cure it.” I prescribed Táohé Chéng Qì Tāng as follows:

  • Táorén 1 liang
  • Dàhuáng 5 qian
  • Mángxiāo 2 qian
  • Zhìgāncǎo 2 qian
  • Guìzhī  2 qian
  • Zhǐshí 3 qian

The next day, I returned to check on her. She had passed a large amount of dark blood, her madness had completely subsided, she showed no signs of exhaustion, and she could even drink porridge. She was now ashamed to face others and refused to come out. (From Jingfang Shiyan Lu – Empirical Records of Classical Formulas)

Commentary:

The key diagnostic markers for Táohé Chéng Qì Tāng include “[patient] appears as if mad” and a “tense bound lower abdomen,” which strongly indicate its use in psychiatric disorders related to blood stagnation. The case aligns closely with classical descriptions—particularly the immediate menstrual discharge of dark purple blood after treatment, a vivid demonstration of the classical principle: “when blood is discharged, the illness will resolve.”

Hormonal changes can often lead to premenstrual symptoms such as irritability, insomnia, headaches, and cognitive issues, which frequently improve after menstruation. This phenomenon, referred to as blood amassment (xu xue 蓄血), remains a fascinating area for further study.

The prescription is quite potent and purgative. If hòupò were added, it would become a combination of Táohé Chéng Qì Tāng and Dà Chéng Qì Tāng. Interestingly, Dà Chéng Qì Tāng is also used in neurological conditions, including delirium, incoherent speech, hallucinations, clouded vision, and severe restlessness, often with more pronounced abdominal fullness and distension.

Case of Shock-Induced Immobility and Chest Oppression by Yè Júquán 叶橘泉

A businessman, known for his cautious and timid nature, had a habitual fondness for alcohol. At the time, Suzhou was under Japanese occupation. One midnight, Japanese military police, accompanied by local collaborators, conducted a household inspection. Terrified, the man was left speechless, eyes wide in shock, unable to respond. He was suddenly slapped across the face by the military police and collapsed to the ground, lying rigid and unconscious, appearing as if he had suffered a stroke.

I was invited to examine him. His pulse was thin and wiry, with a slippery sensation upon deep palpation. His face was flushed, tears welled up in his eyes, and though he appeared to have sensation when touched, he remained speechless and motionless in a rigid supine posture. His pupillary reflexes were normal, and no signs of hemiplegia were present, but his feet were icy cold, his rectus abdominis was tense, and there was a palpable mass in the lower abdomen. He had not had a bowel movement for several days.

I prescribed Táohé Chéng Qì Tāng with the addition of niúxī and chuānxiōng. After taking the formula, he had a bowel movement, his feet became warm, and he soon let out a deep sigh, moaning as if relieved of an immense weight. He then spoke for the first time, saying that he had felt a crushing pressure on his chest.

A second dose was given, after which his stool contained traces of blood. Upon examination, it was found that he had preexisting hemorrhoids, which had started bleeding. I then reduced the dosage and continued treatment for several more doses, leading to a full recovery. (From Zhongguo Bainian Bainming Zhongyi Linchuangjia Congshu – Yè Júquán – A Century of Renowned Chinese Physicians: Yè Júquán)

Commentary:

This case illustrates a shock-induced immobility with clear signs of blood stasis and psychological disturbance. Although the patient did not exhibit violent mania, his mental dysfunction was undeniable. The physician skillfully identified abdominal tension, a palpable lower abdominal mass, and prolonged constipation as key indications for Táohé Chéng Qì Tāng, demonstrating a flexible application of classical formulas.

Two key diagnostic markers stand out in this case:

  1. Flushed face with cold lower limbs – a hallmark external manifestation of blood stasis, which can serve as a visual clue for selecting Táohé Chéng Qì Tāng.
  2. Post-treatment rectal bleeding – This reinforces the classical principle that “blood will discharge after taking the formula”, not only in the form of menstrual bleeding in women but also through lower gastrointestinal or even urinary tract bleeding in certain cases. However, this effect is not universally observed in all patients.

Case Studies of Yè Bǐngrén 叶秉仁

On By eranevenIn Case Studies （医案), Huáng Huáng (黃煌)

Ye Bingren (1908–1994), originally named Ye Bingcheng, was a native of Huashi, Jiangyin, Jiangsu Province, and was recognized as one of Jiangsu’s first distinguished Chinese medicine practitioners. 

Ye devoted his life to clinical exploration in integrated Chinese and Western medicine and was recognized as a pioneer of this approach in Jiangyin’s Chinese medicine community. Ye Bingren was my teacher Professor Huang Huang’s first mentor in his own medical studies, and from 1973 onward, Professor Huang followed him at the Jiangyin Traditional Chinese Medicine Hospital, studying both Chinese and Western internal medicine for over six years.

Ye excelled in integrating Chinese and Western medicine, particularly in treating severe and critical conditions, and had extensive clinical experience in this field. He did not rigidly adhere to any single school or doctrine, skillfully utilizing classical formulas (jingfang), contemporary prescriptions, folk remedies, and herbal medicine. However, in Huang Huang’s view, his application of classical formulas was particularly distinctive. Practicing medicine for nearly 60 years, he saved countless lives using both Chinese and Western medical methods. He was one of the few senior Chinese medicine practitioners capable of handling emergency cases, outpatient consultations, and inpatient care.

The book Ye Bingren’s Medical Theories and Case Studies compiles and organizes his clinical experience, providing valuable insights for practitioners.

Case #1: A Malaria Case (Ye Bingren)

In the autumn of 1941, in Gongjia Alley, Huashi, Gong, who had recently married, suddenly developed chills followed by high fever and severe headaches, as if his head were splitting. After sweating, the fever subsided slightly, but the attacks recurred multiple times a day. On the fourth day, he fell into a coma. His relatives and father-in-law, who were knowledgeable in medicine, consulted renowned local physicians, all of whom diagnosed the condition as summer-heat disease, but their treatments yielded no improvement.

One evening, as the sun was setting, I was invited to examine him. I arrived to find his family gathered in panic. The patient was unconscious, but his pupils showed no abnormalities. His tongue was pale, indicating deficiency of qi and blood. His abdomen was full but not tender upon pressure, and a palpable mass was evident beneath his left ribs. Having treated similar cases successfully before, I determined that the condition was not beyond cure. The previous physicians had mistakenly attributed the illness to the six climatic factors, failing to recognize it as malarial toxin.

I prescribed a modified combination of Xiao Chai Hu Tang and Da Yuan Yin, adding Shi Chang Pu and Yu Jin. After four doses, the fever reduced, and his consciousness gradually returned. Upon the next consultation, his tongue coating was thick and turbid, and he passed foul gas, indicating a Shaoyang-Yangming combination disorder. I then prescribed Da Chai Hu Tang to purge the intestines and clear heat. After completing the prescription, his bowels moved, the fever subsided, and he recovered.

(Ye Bingren’s Medical Theories and Cases)

Commentary:
The term “pattern” (zheng) in pattern-based formulas refers to the clinical evidence used to select a formula. Disease names are crucial diagnostic evidence. The key to success in this case was the clear diagnosis of malaria, leading to the effective use of Xiao Chai Hu Tang combined with Da Yuan Yin. Classical texts describe Xiao Chai Hu Tang as treating “alternating chills and fever” that “stop and start periodically,” which aligns with malaria’s cyclic chills, fever, and sweating. The symptom “fullness in the chest and rib-sides“ also corresponds to splenomegaly and hepatomegaly seen in malaria. Later generations of physicians frequently used Xiao Chai Hu Tang for malaria.

As for Da Yuan Yin, it originates from the Wen Yi Lun (Treatise on Epidemic Diseases) and is essentially a modified version of Huang Qin Tang, serving as a fundamental formula for febrile diseases. The combination of these two formulas effectively clears heat and expels pathogens, leading to the patient’s rapid recovery.

***********************************************************************

Case #2: Persistent Dysentery Due to Yang Deficiency with Lingering Toxins (By Ye Bingren)

Patient: Hu, male, 6 years old.
Year: 1942, late summer to early autumn.

The child had been suffering from dysentery for several months, with little improvement despite various treatments. By the time he sought my care, he was severely emaciated, his eyes lacked vitality, and he was passing bloody and mucus-filled stools with abdominal pain. Additionally, rectal prolapse was observed.

Upon examination, his hands and feet were cold, his pulse was deep and thin, and his tongue was pale red with a glossy, peeled coating at the front and mixed yellow-white coating at the root. This indicated a condition of yang deficiency with lingering toxins, involving both deficiency and excess.

Treatment:

The approach required both warming and clearing therapies, so I prescribed a modified version of Baitouweng Tang from the Bei Ji Qian Jin Yao Fang, removing Houpo and Longgu.

Prescription:

  • Baitouweng 10g
  • Qinpi 10g
  • Huangbai 6g
  • Huanglian 3g
  • Ganjiang 2g
  • Danggui 10g
  • Zhigancao 3g
  • A small amount of Japonica Rice
  • Ejiao 10g
  • Chishizhi 20g
  • Danfu Pian 6g
  • Fuling 12g
  • Hongzao 4 pieces

Outcome:
After three doses, the child’s body temperature normalized, pulse became stronger, and rectal prolapse resolved. Another three doses stopped the dysentery completely, and his appetite greatly improved. With further dietary adjustments, he made a full recovery. (From Ye Bingren’s Medical Theory and Cases.)

Commentary:

This case involves a complex pattern of pathogenic heat entering the jueyin and shaoyin conformations, causing dysentery with cold extremities and yang deficiency.

  • Heat toxin damaging the lower burner’s blood level → bloody mucus stools
  • Jueyin qi rebellion → abdominal pain
  • Shaoyin cold transformation → fatigue, cold limbs, deep thin pulse

Because the condition involved both heat and cold, excess and deficiency, neither pure warming nor pure clearing methods would have been effective. Instead, a balanced formula combining warming, clearing, tonifying, and astringing herbs was used.

Therefore, I prescribed Bai Tou Weng Tang from the Bei Ji Qian Jin Yao Fang as it was quite suitable. This formula is derived from the Shang Han Lun’s Bai Tou Weng Tang, Si Ni Tang, and Huai Hua Tang, combined with Zhu Che Wan from the Bei Ji Qian Jin Yao Fang, and modified with Hou Po and Sheng Long Gu. The purpose of this combination is to use Bai Tou Weng to clear and expel the heat toxin from the intestines, Si Ni Tang to restore yang and rescue from reversal, Dang Gui and E Jiao to nourish yin and blood, and Huai Hua Tang to astringe and consolidate. By using both warming and clearing herbs together, addressing both deficiency and excess, the treatment achieves rapid results. This method reflects the effective practices learned from the experiences of later practitioners.

Hán Shān’s Legacy: Poetry, Philosophy, and Buddhist Influence

On By eranevenIn Poetry (诗), Translations & Writings (译著与文章)

Hanshan 寒山 (dates of birth and death unknown), courtesy name and sobriquet also unknown, was a native of Chang’an (modern-day Xi’an, Shaanxi) and lived in seclusion in the Tiantai Mountains of eastern Zhejiang for over 70 years, passing away at the age of over 100. According to modern day poet Red Pine, Han Shan was born in the ancient town of Hantan at the western edge of the Yellow River floodplain, about 300 kilometres east of Chang’an, and his family only moved to Chang’an when he was little.1 Scholars generally place his life during the Tang Dynasty (618–907 CE), though specific details about his life are elusive due to his reclusive lifestyle and the mythical aura surrounding him.

A renowned poet-monk of the Tang Dynasty, Hanshan hailed from an aristocratic family but failed multiple attempts at the imperial examinations. Eventually, he renounced worldly pursuits, became a monk, and after the age of 30, withdrew to the Tiantai Mountains, living in seclusion and adopting the name “Hanshan” (Cold Mountain).

According to Yan Zhenfei’s Examination of Hanshan’s Life Story, supported by historical texts such as Northern History and Book of Sui, Hanshan was the son of Yang Wen, a descendant of the Sui royal family. Due to jealousy and ostracism within the imperial court, combined with the influence of Buddhist thought, he retreated to the Cold Cliffs of the Tiantai Mountains. He was known for his eccentric lifestyle, wearing a birch-bark hat, tattered clothing, and wooden clogs. He enjoyed playing with children, spoke freely and unpredictably, and was difficult for others to understand. He often visited the Guoqing Temple in Tiantai, where he befriended two monks, Fenggan and Shide. Hanshan would collect leftover temple food in bamboo tubes to sustain himself in his mountain home.

Hanshan frequently wrote poems and gathas (short Buddhist verses) on the rocks and trees of the wilderness. His poetry was straightforward, capturing the joys of mountain life and expressing Buddhist ideals of detachment, life’s wisdom, and compassion for the poor. He also criticized social norms and injustice. Han Shan’s poems focus on Buddhist and Daoist themes, with self-reflections and commentary on Tang society. These stylistic and thematic elements align with the intellectual and spiritual currents of the Tang era. His works were later compiled into the Collected Poems of Hanshan in three volumes, with 312 poems preserved in the Complete Tang Poems. In the Yuan Dynasty, his works were introduced to Korea and Japan and later translated into languages like Japanese, English, and French.

Legend has it that the Taoist that first collected Han Shan’s poetry, was a man named Xu Lingfu, who had moved to the Tiantai mountains in 815 to practice and live in seclusion as well and stayed for his remaining days. Based on several writings, we can ascertain that the two met sometime after 825 and before Xu’s death in 841.

This legendary poet, initially overlooked by society, gained increasing recognition and global dissemination in the 20th century. As one of his poems proudly declares:

“Some laugh at my poetry,
 [yet] my poems unite with the classical odes.
 No need for Zheng’s commentary,
 Nor Mao’s annotations to shine.”2

Han Shan is more often regarded as a spiritual figure than a historical one. He is depicted as a “laughing hermit” embodying Zen wisdom, with his poetry serving as a timeless bridge to his thought rather than a concrete record of his life.
The following are a few personal favourites that I feel capture the essence of Han Shan’s style and voice. All translations are my own.



我居山，勿人識。白雲中，常寂寂。

I reside in the mountains unaware of anyone, among the white clouds, always in solitude. 



寒山深，我稱心。
純白石，勿黃金。
泉聲響，撫伯琴。
有子期，辨此音。

Deep in cold mountain, I am content.
Pure white stones are not gold. 
The springs sound, and I gently pluck a qin.
If Ziqi3 were here, he’d recognize these sounds.



寒山子，長如是；
獨自居，不生死．

Master cold mountain, is always like this,
residing alone, free from birth or death.4

重岩我卜居，鸟道绝人迹。
庭际何所有，白云抱幽石。
住兹凡几年，屡见春冬易。
寄语钟鼎家，虚名定无益

In the layered cliffs, I chose my dwelling,
Where bird paths are cut from human presence.
What is at my courtyard edge?
White clouds embrace the shrouded stones.
I have lived here many years, observing the changes of the seasons.5
I send word to households with bells and tripods,6
Empty titles are of no benefit.

欲得安身处，寒山可长保。
微风吹幽松，近听声愈好。
下有斑白人，喃喃读黄老。
十年归不得，忘却来时道。

If you desire a place to calm your body, cold mountain can keep you protected.
A gentle breeze blows hidden pines, the closer you come, the more exceptional it sounds.
Below a grey haired man mutters [the words] he has read of Huang-Lao.7
For ten years he has not returned home, forgotten the path from which he came.

独卧重岩下， 蒸云昼不消。
室中虽暡靉， 心里绝喧嚣。
梦去游金阙， 魂归度石桥。
抛除闹我者， 历历树间瓢。

Alone I lie beneath the layered cliffs,
Steaming clouds, fail to disperse throughout the day.
Though the room is dim and misty,
My heart-mind is free from all clamor.
In dreams, I float within the imperial palace,
My ethereal soul returns, crossing the stone bridge.
I cast away things that disturb me,
Especially the gourd among the trees.

凡读我诗者， 心中须护净。
悭贪继日廉， 谄曲登时正。
驱遣除恶业， 归依受真性。
今日得佛身， 急急如律令。

All who read my poems,
Must protect and purify their heart-mind.
Let grudging and greed be purified daily,
And flattery and fawning be corrected at once.
Drive away and eliminate evil conduct,
Take refuge and receive your true nature.
Attain the Buddha’s body today—
Swiftly, swiftly, as the law commands.

家有寒山詩，
勝汝看經卷。
書放屏風上，
時時看一遍。

Having Hanshan’s poems at home
Surpasses your reading of scrolls.
Write them down upon a screen,
And read it through from time to time.

吾心似秋月，
碧潭清皎潔。
無物堪比倫，
教我如何說。

My mind is like the autumn moon,
A clear pond, pure and bright.
Nothing in the world compares—
How can I find the words to describe it?

  1. Red Pine, The Collected Songs of Cold Mountain (Port Townsend: Copper Canyon Press, 2000), 13.  ↩︎
  2. Han Shan is referring to the Shijing (Classic of Poetry) here and is insinuating that his poetry is easier to read, hence commentaries are unnecessary. Zheng and Mao were the standard commentaries on the Shijing.  ↩︎
  3. This is a reference to Zhong Ziqi (钟子期), a renowned Guqin (ancient Chinese seven-string plucked instrument) musician from the State of Chu during the Spring and Autumn Warring periods. Zhong Ziqi was known for his acute listening skills and deep sensitivity to music, capturing the emotions and psychological depth behind melodies. The Ziqi-style Guqin is said to have been designed in his honor, characterized by a straight and deep neck with a half-moon shape. ↩︎
  4. A reference to Samsāra, the cycle of birth and death or re-birth and re-death.  ↩︎
  5. While the text literally says spring and winter, this can be translated simply as seasons.  ↩︎
  6. This is an ancient reference to wealthy families and households.  ↩︎
  7. Huang-Lao is an early school of Daoist thought and an important branch of Daoism that advocates active engagement with the world. It applies the philosophy of traditional reclusive Daoism to governance, aiming to achieve national prosperity and military strength. The school is named after its association with the Yellow Emperor (Huangdi) and the veneration of Laozi. Huang-Lao Daoism later became the foundation of Daoism as a religious tradition. Followers of Laozi claimed to represent the teachings of the Yellow Emperor and also revered Yi Yin and Jiang Taigong. They promoted the principles of tranquility and non-action (wu wei), avoiding interference with the people and allowing the populace to “self-transform,” thereby bringing peace and stability to the world. ↩︎

Chaihu Guizhi Ganjiang Tang [柴胡桂枝干姜汤] in the treatment of skin disorders

On By eranevenIn Case Studies （医案), Jīng Fāng (经方), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

伤寒论六经辨证与方证新探——经方辨治皮肤病心法

欧阳卫权著

The following translation is taken from Ouyang Weiquan’s ‘Exploration of Cold Damage Six-Conformation Pattern Differentiation and Formula Presentations – Jingfang Approach to the Identification and Treatment of Skin Diseases.’ 

Chaihu Guizhi Ganjiang Tang [柴胡桂枝干姜汤]

皮肤病辨治心法

1.不论何种皮肤病、何种皮损，凡见太阴里虚寒证又见上热表现者，可考虑本方证。

2.年轻女性面部痤疮、脂溢性皮炎患者，使用本方证机会较多，常合用当归芍药散。

3.系统性红斑狼疮经长期激素治疗，常表现出本方证，临床对证用之，可迅速使皮损消退，改善症状。且坚持服用，各项狼疮指标多能转为正常。

4.其他如荨麻疹、慢性湿疹、银屑病等，皆有使用机会。

Approach to Identifying and Treating Skin Diseases

  1. Regardless of the type of skin disease or lesion, if there is a presentation of interior cold deficiency in the Taiyin channel along with symptoms of heat in the upper body, this formula can be considered.
  2. This formula is frequently used for young women with facial acne or seborrheic dermatitis and is often combined with Dang Gui Shao Yao San.
  3. Patients with systemic lupus erythematosus (SLE) who have undergone long-term corticosteroid treatment often present symptoms corresponding to this formula. Clinically, using this formula based on the diagnosis can quickly reduce skin lesions, alleviate symptoms, and, with consistent use, normalize various lupus-related indicators.
  4. Other conditions such as urticaria, chronic eczema, and psoriasis may also benefit from this formula.

医案实录

1.系统性红斑狼疮（柴胡桂枝干姜汤合当归芍药散）

杨某，女性，51岁，2005年5月13日初诊。系统性红斑狼疮

（SLE）病史13年。一直在风湿科、内科等中西医治疗，病情较稳定，现服泼尼松用量10mg/d。但患者四肢关节痛、颈、背痛不能缓解已2年余。现双肘、腕、指关节及双膝、踝关节疼痛、颈、背痛。稍怕冷，纳可，口稍干不欲饮，饮则喜温，小便少。舌暗红苔白，脉沉细。处方柴胡桂枝干姜汤合当归芍药散加味：

柴胡10g，桂枝9g，干姜4g，黄芩10g，甘草5g，花粉15g，牡蛎（先煎）20g，当归10g，白芍10g，川芎4g，茯苓15g，白术10g，泽泻10g，葛根12g，7剂。

Case Study

Systemic Lupus Erythematosus (SLE) Treated with Chai Hu Gui Zhi Gan Jiang Tang Combined with Dang Gui Shao Yao San

Yang, female, 51 years old. Initial consultation: May 13, 2005.
History of systemic lupus erythematosus (SLE) for 13 years. Previously treated with both Western medicine and Traditional Chinese Medicine in the rheumatology and internal medicine departments, with relatively stable disease progression. Currently taking 10 mg/day of prednisone.
However, the patient had been experiencing unrelieved joint pain in the limbs, neck, and back for over two years. Symptoms included pain in the elbows, wrists, finger joints, knees, and ankles, along with neck and back pain. She reported slight sensitivity to cold, normal appetite, slight dry mouth with no desire to drink, preference for warm drinks, and reduced urination. Tongue was dark red with a white coating, and the pulse was deep and thin.

Prescription:

Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San with modifications:

  • Chai Hu 10g
  • Gui Zhi 9g
  • Gan Jiang 4g
  • Huang Qin 10g
  • Gan Cao 5g
  • Tian Hua Fen 15g
  • Mu Li (pre-cooked) 20g
  • Dang Gui 10g
  • Bai Shao 10g
  • Chuan Xiong 4g
  • Fu Ling 15g
  • Bai Zhu 10g
  • Ze Xie 10g
  • Ge Gen 12g

Seven doses were prescribed.

患者服后感觉效果非常好，又自购药服12剂。药后明显好转，四肢关节及颈背痛基本消失，不觉怕冷，精神较佳，口干明显，舌暗红，苔中黄，脉细。前方加生石膏20g。上方服至2005年7月15日。诉服后关节痛全消，无其他不适，精神佳。遂改泼尼松为5mg/d。前方去石膏，继服巩固。

After taking the formula, the patient reported significant improvement. She obtained an additional 12 doses on her own. After taking the formula her joint pain in the limbs and neck/back had almost completely disappeared. Cold sensitivity was no longer noticeable, her energy levels had improved, and her dry mouth had markedly lessened. Her tongue was dark red with a yellowish coating, and her pulse was thin. 20g ofShi Gao was added to the previous formula.

The patient continued this treatment until July 15, 2005. By then, joint pain was completely resolved, and no other discomfort was reported. Her energy levels remained good. The dosage of prednisone was reduced to 5 mg/day. The prescription was adjusted by removing Shi Gao and continued as a consolidation treatment.

【按】

柴胡桂枝干姜汤见《伤寒论》第147条：“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝干姜汤主之。”为治热郁少阳，枢机不利，又兼太阴脾寒，水饮内伏之病变。胡希恕以此方合当归芍药散治疗SLE属血虚水盛、邪郁少阳证者多有效。笔者临床观察，SLE经西药激素控制稳定后常现本方证，依证用药确有效验。

Commentary:

The formula Chai Hu Gui Zhi Gan Jiang Tang originates from the Shang Han Lun, Clause 147, where is says:

“In cold damage that has lasted five or six days, sweating has already been promoted followed by purgation, and there is fullness and mild congestion in chest and ribs, with inhibited urination, thirst but no vomiting, and only the head is sweating, with alternating cold and heat, and heart vexation, this means that [the pattern] has not yet resolved, and Chaihu Guizhi Ganjiang Tang governs.”

 This formula addresses Shaoyang depressed heat with inhibition of the pivot mechanism combined with Taiyin spleen cold and internal deep-lying water-rheum. Hu Xishu frequently combined this formula with Dang Gui Shao Yao San to treat SLE presenting with blood deficiency, exuberant water, and Shaoyang depressed heat, with notable efficacy.

The authors own clinical observations suggest that after systemic lupus erythematosus (SLE) is stabilized with corticosteroid treatment, symptoms often align with the pattern corresponding to this formula presentation. Using the formula according to the pattern has proven to be effective.

Typical Abdominal Diagnosis Cases: Da Chai Hu Tang and Tao He Cheng Qi Tang Case Example

On By eranevenIn Case Studies （医案), Kampo, Translations & Writings (译著与文章)

Original Work by Keisetsu Ōtsuka, with translation [from Japanese to Chinese] and commentary by Wang Ningyuan: Kampo and Abdominal Diagnosis

Primary Gangrene of the Left Big Toe

The patient is a 52-year-old male with a good complexion and obesity.

Two years prior, he began experiencing pain in the left big toe, which was diagnosed as primary gangrene.
At the same time, there was swelling and hardness near the left lower abdomen close to the iliac fossa, accompanied by tenderness. After being examined by a renowned surgeon, exploratory laparotomy was performed but no abnormal lesions were found.

Initial Consultation: November 7, 1925

  • Pulse: Left side was deep and choppy; right side was deep and small.
  • Blood Pressure: 112/70 mmHg.
  • Symptoms: The left dorsal artery of the foot was undetectable. The left big toe appeared purplish, with blackened toenails. The degree of pain fluctuated and worsened after exertion, significantly impacting sleep due to the pain.

Abdominal Diagnosis 

On the right side, there was fullness and discomfort in the chest and hypochondrium. In the lower left abdomen, at the site of the previous surgery, there was resistance and tenderness.

The patient had bowel movements once a day, but they were not smooth.

I considered the resistance and tenderness in the left lower abdomen to be an abdominal sign of blood stasis. The resistance and tenderness, which were previously suspected by the surgeon to indicate a tumor, may also have been due to blood stasis.

Based on the signs of right-sided chest and hypochondriac fullness and the abdominal sign of blood stasis, I prescribed a combination of Da Chai Hu Tang and Tao He Cheng Qi Tang.

Course of Treatment

  • One week later: No significant changes.
  • Ten days later: The affected foot felt lighter, and the pain lessened.
  • After about two months: The color of the toenails improved, and the patient reported almost no pain. However, the dorsal artery of the foot remained undetectable.
  • After about ten months: The affected toe started showing a reddish color, the toenails turned pink, and although weak, the pulse of the dorsal artery became palpable.

Later, the patient developed swelling in the right knee joint and was treated with Yue Bi Jia Zhu Tang for about three weeks, which resolved the condition.

It has now been eight years, and the gangrene has not recurred.

— From Thirty Years of Kampo Clinical Practice, authored by Keisetsu Ōtsuka, translated by Wang Ningyuan