Author: eraneven

Guìzhī Jiā Lónggǔ Mǔlì Tāng Combined with Líng Guì Zhú Gān Tāng for the Treatment of Palpitations and Vertigo

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

From ‘The Study of Kampo Clinical Practice and Diagnosis’ by Terasawa Katsutoshi (寺泽捷年), and translated into Chinese by Wang Ningyuan.

A 34-year-old housewife presented with paroxysmal palpitations and vertigo.

Approximately six months earlier, while driving through an intersection on a rainy day, the vehicle in front of her stopped suddenly. She was unable to brake in time and rear-ended the other car. Fortunately, she sustained no obvious injuries, and the accident was resolved without incident. However, following the accident, she began experiencing several episodes of palpitations every day.

During each episode, she felt as though a ball-like object surged upward from the epigastrium and beside the umbilicus toward the chest. Within a few seconds it reached the chest, her pulse gradually accelerated, and palpitations developed, accompanied by a sensation of chest oppression, uneasiness, and vertigo.

When the attacks were mild, this state lasted 10–20 minutes before resolving completely. During more severe attacks, however, she experienced intense anxiety, a sensation of heat in the face, vertigo, and even transient loss of consciousness. She was required to remain in bed for 2–3 hours before recovering. There was no associated nausea or vomiting.

She had previously sought treatment locally. Electrocardiography and other examinations revealed no abnormalities. She was prescribed a sedative, which reduced the severity of the attacks and improved her sleep, but the frequency remained essentially unchanged, with palpitations occurring one to two times daily.

Height: 152 cm
Weight: 45 kg
Blood pressure: 108/72 mmHg
Temperature: 36.7°C
Pulse: 72 beats/min

Her complexion was slightly flushed, the lower limbs were cold, her appearance was otherwise normal, there was sweating of the hands and feet, the pulse was weak, and the tongue was normal with a thin white coating.

Abdominal examination: The abdominal strength was slightly weak.

  • Pulsation above the umbilicus (++) (脐上悸（++)
  • Epigastric pulsation (心下悸)
  • Splashing sound in the stomach (胃部振水音)
  • Tension of the rectus abdominis muscles (腹直肌拘挛)

Abdominal strength: 2/5 (腹力 2/5)

A 24-hour Holter ECG captured changes during an attack. Her resting heart rate was 70 beats/min but gradually increased over several minutes to 120 beats/min, at which point she perceived the palpitations. Ten minutes later, the pulse rate gradually declined and returned to normal. During the attacks there was no hyperventilation. Arterial blood gas analysis, electroencephalography, blood biochemistry, and other investigations revealed no abnormalities.

Discussion

Although this condition resembles paroxysmal tachycardia, it was excluded because the pulse increased gradually rather than abruptly. It must also be differentiated from hyperventilation syndrome; however, there was no hyperventilation during the attacks, and arterial blood gas analysis was normal, allowing this diagnosis to be excluded. The condition would generally be diagnosed as cardiac neurosis or neurosis.

From the perspective of Kampo medicine, this presentation represents the pathological state of Qi Counterflow (Running Piglet Qi, 奔豚气). Most cases of Running Piglet Qi are triggered by events involving intense fear, shock, or frightening memories. In this case, the precipitating factor was becoming the responsible party in a traffic accident.

Treatment Course

The patient was prescribed Guìzhī Jiā Lónggǔ Mǔlì Tāng granules and Língguì Zhúgān Tāng granules, 7.5 g of each daily in three divided doses, while continuing the previously prescribed 2 mg sedative as needed.

On the day treatment began, she noticed warmth returning to her lower limbs. Beginning on the second day, she experienced only one mild attack. During the following two weeks, she had only three attacks in total. After taking a cumulative dose of 10 mg of the sedative, it was discontinued. After one month of treatment, the attacks had almost completely disappeared, and after three months the herbal treatment was discontinued.

This pattern corresponds to the indication for Língguì Gānzǎo Tāng. However, because granules of Língguì Gānzǎo Tāng were unavailable, Guìzhī Jiā Lónggǔ Mǔlì Tāng combined with Língguì Zhúgān Tāng was used as a substitute.

Terasawa Katsutoshi (寺泽捷年)

Born in 1944, Terasawa Katsutoshi is a renowned Japanese Kampo physician and Medical Doctor. He served as Professor of Kampo Medicine at the Graduate School of Chiba University and Director of the Kampo Department at Chiba Central Medical Center. He studied under Fujihira Ken, Ogura Shigenari, and Itō Kiyoo. 

He has held numerous distinguished positions, including Director of the World Health Organization (WHO) Collaborating Centre, Vice President of Toyama Medical and Pharmaceutical University, Director of its affiliated hospital, President of the Japan Society for Oriental Medicine, President of the Society of Japanese and Oriental Medicine, and President of the East Asian Medical Association.

His principal works include Clinical Kampo Medicine (originally published as Kampo Diagnosis and Treatment: Learning from Clinical Cases), Research on Yoshimasu Tōdō: The Thought that Founded Japanese Kampo, Studies on Kampo Abdominal Diagnosis: Mechanisms of Pattern Formation, Complete Translation of Hōgi Zasshi, Complete Translation of Ikai no Tetsuzui, and Supplement to the Iken Collection.

Wūméi Wán from Huáng Huáng’s Jīngfāng Formula Presentations

On By eranevenIn Huáng Huáng (黃煌), Translations & Writings (译著与文章)

In my last class, I taught on Wūméi Wán (乌梅丸). While gathering material for the lecture, I translated the section on Wūméi Wán from my teacher Huáng Huáng’s (黄煌) Jīngfāng Formula Presentation.

There is so much valuable clinical information in this section that I thought it was worth sharing here as well.

Wūméi Wán is an incredible formula with a remarkably broad clinical scope—far beyond the treatment of intestinal worms, which is how many of us are first introduced to it. When we look beyond that traditional association and examine its formula presentation, characteristic symptoms, and modern clinical applications, a much richer picture begins to emerge.

I hope this translation helps shed some light on the depth and versatility of this fascinating classical formula.

Wumei Wan is the classical formula for Jueyin disease and the specific formula for hui jue (roundworm reversal). Traditionally, it is a formula that clears the upper while warming the lower, warms the viscera, and calms roundworms. It has the effects of calming roundworms, stopping diarrhea, relieving pain, relieving vexation, and treating reversal cold. The Wumei Wan presentation is characterized by reversal cold, abdominal pain and colicky pain, vexation and agitation, vomiting, and diarrhea, and is most commonly seen in diseases of the digestive system.

I. Classical Formula

Wumei, 300 pieces; Xixin, 6 liang; Ganjiang, 10 liang; Huanglian, 16 liang; Danggui, 4 liang; Fuzi, 6 liang (processed, peeled); Shujiao, 4 liang (sweated); Guizhi, 6 liang (peeled); Renshen, 6 liang; Huangbai, 6 liang.

Pound and sift the above ten ingredients separately, then combine them. Soak the Wumei overnight in bitter wine, remove the pits, and steam them beneath five dou of rice. When the rice is cooked, pound the Wumei into a paste and mix it thoroughly with the medicinal powders. Place the mixture in a mortar, add honey, and pound two thousand times. Form pills the size of wutong seeds. Before meals, take 10 pills, three times daily, gradually increasing to 20 pills.

(Shānghán lùn)

II. Classical Formula Presentation

In cold damage, when the pulse is faint and there is reversal, and at seven or eight days, [there is] cold skin and the person is agitated without temporary [periods of] quiet, this is visceral reversal, and not roundworm reversal. In roundworm reversal, the person should vomit roundworms. Now, the person is still, and then has periodic vexation, which indicates visceral cold. The roundworms ascend and enter the diaphragm, and therefore there is vexation; after a short while it stops again. After eating, there is retching and again vexation, when the roundworms smell the malodorous food.  The person should spontaneously vomit roundworms. For roundworm reversal, Wumei Wan governs. It also governs enduring diarrhea. 

(Shānghán lùn 338)

1. Roundworm Reversal

Jue (厥) refers, in one sense, to qi closure and collapse or loss of consciousness, as in syncope, phlegm reversal, qi reversal, and roundworm reversal. In another sense, it refers to a condition characterized primarily by lack of warmth in the four limbs. As stated in the Suwen, Treatise on Reversal:

“The cold of cold reversal must ascend from the five digits to the knees.”

This suggests that Wumei Wan can treat disorders involving sudden collapse or icy-cold extremities.

Roundworm reversal also suggests that Wumei Wan can treat diseases related to roundworms. The Shang Han Lun Fang Jie records:

“This formula has outstanding efficacy for abdominal pain due to accumulation of worms, in which extreme pain leads to reversal.”

2. Enduring Diarrhea

This symptom indicates that Wumei Wan treats chronic diarrheal diseases, an application continued by later generations.

“This is the sacred formula for treating enduring dysentery.”
—Xu Lingtai, Shang Han Lun Lei Fang

“Treats postpartum dysentery from cold and heat, with prolonged diarrhea that does not cease.”
—Sheng Ji Zong Lu

“Used for enduring dysentery that does not cease, or recurrent dysentery; repeatedly effective.”
—Huang Han Yi Xue Yao Jue

3. Vexation

Here, fan (烦) refers to a distressing psychological experience. The patient is restless, uncomfortable, depressed, or anxious, and most often has accompanying insomnia.

The formula contains 16 liang of Huanglian, far exceeding the amounts of Ganjiang, Guizhi, Renshen, Danggui, and the other ingredients. Among classical formulas, the formula containing the largest amount of Huanglian is Huanglian Ejiao Tang, which contains 4 liang of Huanglian and treats:

“Shaoyin disease of two or three days or more, with vexation in the heart and inability to sleep.” (303)

This suggests that Wumei Wan can relieve vexation and aid sleep, as well as treat psychological and emotional disorders such as chest oppression, palpitations, anxiety, and depression.

4. Vomiting

“In roundworm reversal, the person should vomit roundworms… After eating, there is retching” (338)

This suggests that Wumei Wan can treat disorders involving vomiting and reflux, including dry retching, nausea, and regurgitation.

5. Abdominal Pain

Dajianzhong Tang, which contains Chuanjiao, Renshen, and Ganjiang, treats:

“Great cold and pain in the heart and chest, vomiting with inability to eat or drink, cold in the abdomen, something surging upward and raising the skin, appearing as though it has a head and feet, with pain moving upward and downward that cannot tolerate being touched.”

Huanglian Tang, containing Huanglian and Rougui, treats:

“Cold damage with heat in the chest, pathogenic qi in the stomach, abdominal pain, and a desire to vomit.” (173)

Chi Wan, containing Fuzi and Xixin, treats chest and abdominal pain from “cold qi reversal” (Chapter 10), while Dahuang Fuzi Tang (Dahuang, Fuzi, Xixin) treats “one-sided pain below the ribs” (Chapter 10).

This suggests that Wumei Wan can treat severe abdominal colicky pain, with raised, fluctuating masses appearing in the abdomen, accompanied by chest oppression, a choking sensation in the throat, dizziness and headache, and even syncope with loss of consciousness.

Using roundworm reversal as an example, the original passage depicts a Wumei Wan presentation characterized by a mixture of cold and heat, with vomiting above and diarrhea below. Its pattern of onset has two main characteristics:

First, vomiting and counterflow above, with pain and diarrhea below. There may be gastric and esophageal reflux, vomiting, belching, acid regurgitation, or epigastric discomfort; together with abdominal pain and diarrhea, diarrhea triggered by cold exposure, or predawn diarrhea.

Second, internal vexing heat with external reversal cold. There may be chest oppression and agitation, insomnia with night sweating, or easy hunger with a strong appetite; yet the patient is also averse to cold, wears heavy clothing, and has icy-cold hands and feet.

Regarding the pathological mechanism of the Wumei Wan presentation, traditional explanations include “intermingling of yin and yang, confusion of cold and heat” (Wu Qian); “stomach qi deficiency with pathogens of mixed cold and heat accumulating in the chest” (Zhang Lu); and “the principal formula of Jueyin” and “the method for the various presentations of Jueyin” (Ke Yunbo).

Wumei Wan has the effects of relieving pain, stopping diarrhea, stopping vomiting, relieving vexation, resolving reversal, calming roundworms, and treating wasting-thirst. Pharmacological research suggests anti-inflammatory, antidepressant, and glucose-lowering effects, as well as promotion of gastrointestinal functional recovery, regulation of the intestinal microbiota, and repair of the mucosal barrier. On this basis, it may be inferred that reflux, depression, inflammation, gastrointestinal dysfunction, and intestinal microbiota dysregulation constitute the basic pathological foundation of the Wumei Tang presentation.

III. Suitable Patient Population

The clinical manifestations of this formula presentation are complex and varied. Although there is pain and diarrhea, the abdomen does not resist pressure. Although there is aversion to cold, the pulse is not faint, fine, and weak. Although there is vexation and agitation, there is no clouding of consciousness, delirium, or mania. Although the patient has numerous distressing complaints, examinations reveal no abnormalities. Severe symptoms with mild objective signs are characteristic.

1. Greenish-Yellow, Thin Face

The complexion is yellow, greenish, or pale. The brows are tightly furrowed, with a distressed appearance and an expression of agitation or depression.

2. Red, Eroded Lips and Tongue

Most have dry, red lips, or dark-red lips; the lips may be swollen and eroded, or there may be sores of the mouth and tongue. The tongue is dark red, with a thick or white greasy coating.

There are often chronic inflammatory conditions of the head and face, such as conjunctivitis, periodontitis, otitis media, and pharyngitis.

3. Wiry, Slippery, Large Pulse

The pulse is wiry and hard, or slippery and rapid, or large and forcefully strikes the finger.

4. Icy-Cold Hands and Feet

The hands and feet are cold and feel like ice to the touch. The patient is averse to cold and wears heavy clothing.

5. Frequent Pain

There are numerous complaints of pain. The pain may be stabbing, distending, or pulling in nature. Abdominal pain is most common, but there may also be headache, chest and hypochondriac pain, testicular pain, dysmenorrhea, and other forms of pain.

6. Onset Around Midnight

Abdominal pain, insomnia, or reflux often begins or worsens around midnight or in the early morning. Examples include gastroesophageal reflux disease, the dawn phenomenon in diabetes, and predawn diarrhea.

IV. Suitable Diseases and Conditions

The key clinical manifestations of the Wumei Wan presentation are “pain, vomiting, diarrhea, vexation, and reversal.” However, because diseases and presentations differ, identification of the formula presentation may be made when only one or two of these signs are present; it is not necessary for all of them to be present.

There are various types, including abdominal pain type, reflux type, vexing-heat type, and diarrhea type, involving multiple systems such as the neuropsychiatric, digestive, and circulatory systems.

1. Irritable Bowel Syndrome

Most commonly seen in thin middle-aged and elderly women, with longstanding painful diarrhea or chronic diarrhea, depression and anxiety, insomnia and agitation, reflux and abdominal distention, with attacks occurring around midnight or in the early morning.

Wumei Wan is effective for diarrhea-predominant irritable bowel syndrome. This formula can stop diarrhea, improve sleep, regulate mood, and suppress reflux.

2. Crohn’s Disease

This is an inflammatory intestinal disease of unknown cause. Clinical manifestations include abdominal pain, diarrhea, and intestinal obstruction, accompanied by extra-intestinal manifestations such as fever and nutritional disorders.

The disease course is often prolonged, with recurrent attacks, and it is difficult to cure completely. This formula has relatively pronounced effects on abdominal pain and diarrhea. It is suitable for those whose abdomen becomes raised or distended during attacks of abdominal pain, as well as those with severe abdominal pain that worsens at night. It is more commonly seen in younger people.

3. Gastrointestinal Polyps

This formula is suitable for middle-aged and elderly men with diarrhea and abdominal pain that are easily triggered by cold exposure, a tendency toward oral ulcers, and lack of response to conventional treatment.

The formula is relatively effective at improving clinical symptoms, but whether it can eliminate polyps remains to be observed.

4. Depression

This formula is suitable for those with numerous distressing complaints and many sudden-onset symptoms, but whose examinations reveal no abnormalities.

The formula can improve sleep, relieve pain, and eliminate symptoms such as abdominal pain, vomiting, and diarrhea.

5. Diabetes

There are reports of this formula being used for diabetic gastroparesis, diabetic diarrhea, and diabetic heart disease.

The formula is suitable for those with a strong appetite, dry mouth around midnight, diarrhea, and persistently elevated blood glucose.

6. Other Conditions

There are individual case reports of this formula treating allergic purpura, psychogenic vomiting, oral ulcers, corneal ulcers, pelvic inflammatory disease, infertility, functional uterine bleeding, obesity, and skin diseases.

V. Formula Presentation Differentiation

1. This Formula and Sini San

Both formula presentations may involve painful diarrhea and aversion to cold.

The Wumei Wan presentation includes reflux and vomiting, whereas these are not prominent in the Sini San presentation. On abdominal palpation, the Sini San presentation often has abdominal muscle tension, whereas this is not prominent in the Wumei Wan presentation.

Heat signs are prominent in the Wumei Wan presentation, often including erosion of the mouth and tongue, agitation, and a red tongue, whereas these are not prominent in the Sini San presentation.

2. This Formula and Huanglian Tang

Both formulas can treat painful diarrhea and insomnia.

The pulse in the Wumei Wan presentation is wiry, hard, large, and slippery, whereas the pulse in the Huanglian Tang presentation is weak and moderate.

Pain and diarrhea are more prominent in the Wumei Wan presentation, whereas pain and vomiting are more prominent in the Huanglian Tang presentation.

VI. Reference Dosage

Wumei (with pit) 20–50 g; Huanglian 5–15 g; Huangbai 5 g; Renshen 5 g or Dangshen 10 g; Danggui 5 g; Xixin 5 g; Rougui 5 g; processed Fuzi 5 g; Ganjiang 10 g; Chuanjiao 5 g; a small handful of Gengmi; and 1 tablespoon rice vinegar.

Decoct in water. Divide into 2–3 doses daily and take after meals. When taking each dose, mix in 1 tablespoon of honey.

Alternatively, prepare honey pills according to the proportions of the original formula. Take 2–3 g per dose, three times daily.

On the Therapeutic Principles and Clinical Applications of Wumei Wan

On By eranevenIn Gāo Tīsān (高体三), Translations & Writings (译著与文章)

Gao Tisan 高体三
Department of Formula Studies, Henan College of Chinese Medicine

Henan Chinese Medicine Journal, December 1978

Translated by Eran Even

In recent years, increasing numbers of physicians have used Wumei Wan from the Shanghan Lun to treat biliary ascariasis, achieving remarkable clinical results. Consequently, many people have come to regard Wumei Wan simply as the representative formula for expelling parasites. In reality, expelling parasites is only one of its functions and does not fully reflect the therapeutic capabilities of the formula.

In order to inherit, develop, and further advance the medical heritage of our country, thereby achieving the goal of “making the ancient serve the present,” I believe it is necessary to further investigate the therapeutic principles and clinical applications of Wumei Wan. In my opinion, such an investigation must begin with the following points.

I. The Physiology and Pathology of Jueyin Must Be Understood Through the Relationships of the Three Yin Channels of the Foot

Both traditional medical theory and clinical practice fully demonstrate the intimate relationship among the three yin channels of the foot. Concepts such as “Yi and Gui share the same source” (乙癸同源), “Spleen and Kidney Yang deficiency,” and the statement, “When disease is seen in the Liver, one knows that it will transmit to the Spleen; therefore, one should first strengthen the Spleen,” all describe the physiological and pathological relationships among these three systems.

The three yin channels of the foot refer to the Foot Jueyin Liver, Foot Shaoyin Kidney, and Foot Taiyin Spleen. Wumei Wan is one of the representative formulas of the Jueyin Liver channel. To fully understand its composition, therapeutic principles, and range of clinical applications, one must study it through the interrelationship of the Liver, Spleen, and Kidney. Only then can the full therapeutic significance of Wumei Wan be appreciated.

The opening line of the Jueyin chapter of the Shanghan Lun states:

When disease is in Jueyin, there is wasting thirst, Qi surges upward to strike the Heart, heat and pain in the Heart, hunger without desire to eat; if food is taken, vomiting of roundworms occurs; after purgation, diarrhea continues unabated.

Judging from the patterns described in this passage, it clearly encompasses more than a disorder confined solely to the Liver channel. It also includes the persistent diarrhea resulting from Spleen and Kidney deficiency cold, together with wasting thirst arising from upward blazing heat. Only by considering the interrelationship of the Liver, Spleen, and Kidney can one arrive at a comprehensive understanding of Wumei Wan.

The Foot Jueyin Liver governs wind and wood and occupies the position between water and fire. Water is the mother of the Liver, while fire is its child. Liver wood arises from Kidney water and gives rise to Heart fire, thereby assisting water in ascending to nourish fire.

The Foot Shaoyin Kidney transforms Gui water upward to communicate with Heart fire. Under normal physiological conditions, Kidney water ascends to unite with fire, while Heart fire descends to unite with water. Water and fire mutually support one another, Yin and Yang are rooted in each other, and the two qi harmonize. Consequently, fire does not flare upward and water does not descend into coldness. This is the physiological state of health.

The mutual communication of water and fire, however, depends to a certain extent upon the Liver’s ability to assist the ascent of water. If Liver wood fails to assist water in ascending to nourish fire, the characteristic Jueyin pattern of upper heat and lower cold develops.

The Liver belongs to wood. Whether cold or heat predominates depends upon the relative strength of opposing influences. When the influence of the child predominates, heat develops; when the influence of the mother predominates, cold develops. heat represents the potential for recovery, whereas reversal cold indicates the approach of serious disease. Between these two extremes, the strength or weakness of the Central Qi is the decisive factor.

When the Central Qi is abundant, Yang is restored. When the Central Qi declines, cold reversal develops.

The Central Qi belongs to Earth.

The Foot Taiyin Spleen governs Damp Earth. When healthy, no pathology arises, but once diseased it is characterized by Dampness and deficiency. Under normal circumstances, the Spleen not only transforms food and fluids and generates Qi and Blood, but also nourishes Liver wood and restrains Kidney water.

When Taiyin deficiency develops, however, the Spleen is no longer able to nourish wood or control water. Instead, water overacts upon Earth while wood is deprived of nourishment. Therefore, deficiency cold patterns of both the Liver and Kidney are closely related to deficiency of the Taiyin Central Earth.

Although Wumei Wan was established for disorders of the Jueyin Liver channel, the inclusion of Renshen, Fuzi, and Ganjiang is intended to supplement Spleen deficiency and warm Kidney Yang, thereby harmonizing the water and Earth of the Spleen and Kidney so that they may nourish and support the growth of Liver wood.

From this it is evident that the Wumei Wan pattern is by no means confined solely to the Liver channel. Rather, it bears a very close relationship to Taiyin Spleen deficiency and Shaoyin Kidney cold.

As the saying goes:

“The Liver belongs to wood. It is the residence of the generating Qi and the storehouse of Blood. Its nature is firm yet it delights in free coursing. It must be nourished by water and supported by Earth before it can fulfill its function of growth and development.”

This statement likewise illustrates the intimate relationship among the Liver, Spleen, and Kidney. Accordingly, the Wumei Wan pattern of the Jueyin channel necessarily involves both the pathology and therapeutic methods of the Taiyin and Shaoyin systems.

II. The Therapeutic Principles of Wumei Wan Must Be Understood Through the Physiology and Pathology of the Foot Jueyin Liver

The Liver governs ascending movement and prefers free coursing. It depends upon the supportive functions of the Spleen and Kidney so that it has an adequate source of nourishment, allowing it to flourish and grow freely with wood in harmony and wind remaining calm. The cold pattern of the Jueyin zang is closely related to the inability of the deficient Spleen and Kidney to nourish and support it.

Accordingly, Wumei is used as the chief herb because of its sour and warm nature, which enters the Liver. It is combined with the sweet, acrid, and warm Guizhi and Danggui to nourish the Blood and soothe the Liver. Renshen, which enters the Spleen, supplements the Central Qi and strengthens Spleen Earth. Fuzi, Ganjiang, Xixin, and Huajiao, all intensely warming herbs, warm Kidney Yang and dispel cold of the zang organs.

Since the Liver is unable to assist water in ascending to nourish fire, the pattern manifests as upper heat with wasting thirst. Therefore, Huanglian and Huangbo are added as bitter and cold medicinals to drain fire and treat the heat above.

This demonstrates that Wumei Wan primarily supplements the Liver and nourishes the Blood, secondarily warms the Spleen and Kidney, and additionally clears the upper heat. As for the formula’s ability to expel parasites, this will be discussed below.

III. The Clinical Applications of Wumei Wan Must Be Understood Through Its Therapeutic Principles

Supplementing the Liver, nourishing the Blood, expelling parasites, strengthening the Spleen, warming the Kidney, and clearing heat above constitute the fundamental therapeutic principles underlying Wumei Wan.

Because Liver disease readily overacts on the Spleen, Zhang Zhongjing stated in the Jingui Yaolue:

“When disease is seen in the Liver, know that it will transmit to the Spleen; therefore, one should first strengthen the Spleen.”

This makes it clear that in the cold pattern of the Jueyin zang, Wumei Wan must include medicinals that supplement the Center and strengthen the Earth.

Likewise, in discussing the treatment of Shaoyin disease, Zhang Zhongjing wrote in the Shanghan Lun:

“When Shaoyin receives Yang, it is favorable.”

This further illustrates that when Kidney water is cold, it is unable to nourish Liver wood and will inevitably overact upon Spleen Earth, leaving Liver wood without a source of nourishment. Therefore, in treating the cold pattern of the Jueyin zang, Wumei Wan necessarily includes herbs that warm the Kidney.

The Liver normally assists water in ascending to nourish above. When disease prevents this function, upper heat develops; consequently, Wumei Wan also contains herbs that clear the upper region.

Because cold within the zang organs is unfavorable for the survival of roundworms, and because roundworms prefer warmth, they flee the cold below and move upward toward the heat above, producing vomiting of roundworms. Although Wumei Wan contains no typical vermicidal herbs, an examination of the flavors of its ingredients reveals a definite antiparasitic effect.

Wumei is sour, and sourness restrains the worms.

Xixin and Huajiao are acrid, and acrid herbs drive out the worms.

Huanglian and Huangbo are bitter, and bitterness directs the worms downward.

For this reason, Wumei Wan has demonstrated remarkable efficacy in the treatment of biliary ascariasis.

Nevertheless, one must not overemphasize its antiparasitic action while overlooking its much broader functions of supplementing the Liver and nourishing the Blood, strengthening the Spleen, and warming the Kidney.

Accordingly, in addition to treating ascariasis, Wumei Wan may be modified for disorders arising from deficiency cold of the Liver, Spleen, and Kidney, including cold-type dysmenorrhea, deficiency-cold abdominal pain, chronic adnexitis, leukorrhea due to deficiency cold, chronic enteritis, chronic colitis, chronic dysentery, deficiency-cold stomach pain, chronic prostatitis, impotence, enuresis, sciatica, chronic trigeminal neuralgia, rectal prolapse, uterine prolapse, and similar disorders. Clinical experience has shown that the formula is frequently effective in such conditions.

This demonstrates that Wumei Wan is not merely an excellent prescription for biliary ascariasis, but an important formula for a wide range of chronic disorders resulting from deficiency cold of the Liver, Spleen, and Kidney.

Conclusion

In summary, the key to understanding both the therapeutic principles and the indications of Wumei Wan lies in approaching it through the relationship of the three yin channels of the foot. Once the physiology and pathology of the Liver, Spleen, and Kidney are understood, the rationale underlying the composition of Wumei Wan becomes clear.

Only then can one avoid the mistaken belief that Wumei Wan is merely a formula for expelling parasites while neglecting its powerful actions of supplementing the Liver, nourishing the Blood, strengthening the Spleen, and warming the Kidney.

In short, Wumei Wan was designed for roundworm disorders occurring in the presence of deficiency cold of the Liver, Spleen, and Kidney, rather than for all cases of roundworm disease regardless of constitutional state.

Therefore, in addition to treating zang cold with roundworm reversal, it may be modified for many chronic disorders arising from deficiency cold of the three yin systems. When upper heat is absent, Huanglian and Huangbo may be omitted.

Because it simultaneously employs both warming and cooling medicinals, Wumei Wan is particularly effective for patterns of upper heat and lower cold. Its clinical applications are broad and deserve continued attention and investigation.

Owing to the limitations of my knowledge and clinical experience, my understanding is undoubtedly incomplete. I respectfully welcome correction from my colleagues.

Gao Tisan 高体三 (November 1920–2011) was a renowned Chinese medicine physician, educator, and scholar from Yuanchang Village, Qinghua Township, Wolong District, Nanyang County, Henan Province (now part of Dengzhou City). A member of the Chinese Communist Party, he served as Professor and Chief Physician at Henan College of Chinese Medicine. He was a director of the Henan Branch of the China Association of Traditional Chinese Medicine, a member and consultant for the editorial committee of the Chinese medicine textbook series for the five central-southern provinces, a member of the Fifth and Sixth Henan Provincial Committees of the Chinese People’s Political Consultative Conference (CPPCC), and was recognized by the Ministry of Health, the Ministry of Personnel, and the State Administration of Traditional Chinese Medicine as one of China’s nationally renowned senior Chinese medicine experts and clinical mentors. He is regarded as the founding figure of the Formula Studies (Fangji) discipline at Henan College of Chinese Medicine.

Gao inherited his family’s medical tradition from an early age, studying under his father. In 1943, he established his own medical practice in Deng County. In 1958, he was recommended for advanced study at the Henan Provincial School of Chinese Medicine, where he remained after graduation in 1959 to join the faculty, serving as Head of the Department (later Division) of Formula Studies. He retired in 1990 but was subsequently reappointed to continue clinical practice at the National Medicine Clinic of the Third Affiliated Hospital of Henan College of Chinese Medicine.

Over more than sixty years of clinical practice, Gao developed the academic theory of “Water Warm, Earth Harmonized, Wood Flourishes” (水暖土和木达). He emphasized pattern differentiation based on the three yin channels of the foot (Taiyin, Shaoyin, and Jueyin) and was especially skilled in the use of classical formulas (Jingfang) and warming medicinals for the treatment of difficult and complex disorders.

He authored numerous textbooks and monographs, including Lecture Notes on Chinese Medical Formula Studies, Lecture Notes on Common Diseases in Chinese Medicine, Clinical Chinese Materia Medica, Treatment Methods and Formulas, and A New Interpretation of the Tangtou Gejue (Songs of Decoctions), the latter of which has been reprinted multiple times. His development of the Weijinkang Health Beverage (维金康保健饮料) received the Second Prize for Scientific and Technological Progress from the Henan Provincial Department of Light Industry in 1993. In 2008, he was awarded the Lifetime Achievement Award for Traditional Chinese Medicine in Henan Province by the Henan Provincial Administration of Traditional Chinese Medicine. His academic theories and clinical experience were also incorporated into China’s Tenth and Eleventh Five-Year National Key Science and Technology Support Programs.

On Xù Mìng Tāng (Life-Restoring Decoction)

On By eranevenIn Huáng Huáng (黃煌), Translations & Writings (译著与文章)

Translated from Huáng Huáng’s Jīngfāng Formula Presentations 经方方证

Xù Mìng Tāng (Life-Restoring Decoction) from Gujin Luyan (Ancient and Modern Records of Proven Prescriptions)

Xù Mìng Tāng is an ancient formula for fēngfèi (wind paralysis).1 Traditionally it is classified as a wind-dispelling, cold-scattering prescription. It has the functions of restoring motor function, improving speech, relaxing the muscles, treating numbness, and relieving cough and wheezing. The presentation of Xù Mìng Tāng is characterized by paralysis or weakness of the limbs, numbness, and aphasia, and is most often seen in sudden-onset disorders.

I. Classical Formula

Má Huáng, Guì Zhī, Dāng Guī, Rén Shēn, Shí Gāo, Gān Jiāng, and Gān Cǎo, 3 liǎng each;

Chuān Xiōng, 1 liǎng;

Xìng Rén, 40 pieces.

Combine the nine ingredients. Decoct in one dǒu of water and reduce to four shēng. Take one shēng warm. A slight sweat should result. Lightly cover the back and sit leaning against a support. Recovery follows once sweating occurs. If sweating does not occur, administer another dose. There are no dietary restrictions, but exposure to wind should be avoided.

II. Classical Formula Presentation

Treats wind fēi strike [where] the body is unable to control itself, an inability to speak, clouded confusion and a lack of pain sensations, or hypertonicity preventing one from turning over to the side. Also treats those who can only lie prone and cannot lie flat, with cough, panting, and swelling of the face and eyes.

(Jīnguì Yàolüè, Chapter 5, addendum formula)

1. “The body is unable to control itself” (身体不能自收)

This generally refers to quadriplegia or hemiplegia. Commonly seen in:

  • Post-stroke sequelae
  • Cerebral infarction
  • Guillain-Barré syndrome
  • Acute myelitis
  • Hypokalemic paralysis
  • Radiculitis

2. “Inability to speak” (口不能言)

This refers to aphasia, where the patient cannot answer questions. It likely describes central aphasia caused by damage to language centers in the brain. Common causes include:

  • Stroke
  • Brain tumors

3. “Clouded confusion and a lack of pain sensations” (冒昧不知痛处)

Màomèi (冒昧) describes mental confusion.

  • Mào (冒) depicts a hat covering the eyes.
  • Mèi (昧) means obscured or unclear.

In the Waitai Miyao, the phrase is followed by “does not recognize people,” suggesting impairment of consciousness.

This represents mild cerebral dysfunction.

“Lack of pain sensations” refers to sensory impairment: when stimulated with a sharp object, the patient cannot localize the stimulus or withdraw appropriately. This corresponds to numbness and sensory loss, often seen in:

  • Radiculitis
  • Guillain-Barré syndrome

4. “Hypertonicity preventing one from turning over to the side.” (拘急不得转侧)

This describes increased muscle tone and associated neuropathic pain. Commonly seen in:

  • Parkinsonian syndromes
  • Post-stroke sequelae

The hypertonicity reflects upper motor neuron damage (“spastic paralysis”). Flaccid paralysis generally indicates lesions of the spinal cord or other lower motor neuron disorders.

5. “Can only lie prone and cannot lie flat, with cough, panting, and swelling of the face and eyes” (但伏不得卧，咳逆上气，面目浮肿)

This refers to:

  • Cough and wheezing
  • Orthopnea (inability to lie flat)
  • Sitting upright to breathe
  • Facial edema

Seen in:

  • Chronic obstructive pulmonary disease (COPD)
  • Cor pulmonale with heart failure
  • Bronchial asthma

The formula contains elements of both Má Xìng Shí Gān Tāng and Má Huáng Tāng, well-known formulas for relieving wheezing. Like Mù Fáng Jǐ Tāng, it employs Guì Zhī, Rén Shēn, and Shí Gāo, herbs commonly used in pulmonary-heart disease.

⸻

The key terms in the classical text encompass many of the major clinical manifestations of neurological disease. The formula may be viewed as a combination of Má Huáng Tāng, Má Xìng Shí Gān Tāng, and Dà Qīng Lóng Tāng. However, the addition of Dāng Guī, Chuān Xiōng, and Rén Shēn gives it a distinctive affinity for neurological disorders.

Traditional commentators explained:

“It is not merely disturbance by pathogenic qi, but also decline of the true qi.”

— You Yi

“A specialized formula for treating stroke.”

— Mo Meishi

“Wind enters and blocks the pores, obstructing the movement of ying and wei. Wind is often accompanied by cold. Initially it enters through the skin and gradually penetrates inward. Prolonged stagnation transforms into heat; heat damages yin. When yin is damaged, the zang-fu are no longer nourished internally, nor can nourishment reach the body externally. Thus arise loss of motor control, inability to speak, confusion, and loss of sensation.”

— Chen Xiuyuan

The pathological basis of the formula is closely related to disorders of the central nervous and motor systems.

The text’s emphasis on respiratory distress also deserves attention, suggesting usefulness in severe pulmonary disease.

III. Suitable Patient Characteristics

This is primarily an emergency formula and does not require a specific constitutional type. However, when used for chronic conditions over longer periods, characteristic patient features can be considered.

1. Robust Build with Yellow-Dusky Complexion (黄黯壮实)

Suitable for patients who are:

  • Solidly built and sturdy
  • Yellow-dusky rather than flushed
  • Rough, dry skin
  • Puffy or fatigued appearance
  • Not prone to sweating

Symptoms are often triggered by fatigue, exposure to cold, or sudden invasion of wind-cold.

2. Slippery-Wet Tongue Coating (水滑苔)

Suitable when:

  • Tongue coating is white, greasy, or moist/slippery
  • Excess saliva or phlegm is present
  • Urination is clear and copious

3. Prominent Neurological Symptoms

Suitable for patients with:

  • Headache
  • Neck and upper back soreness
  • Muscular tension
  • Joint pain
  • Slowed reactions
  • Aphasia
  • Slurred or difficult speech
  • Difficulty walking
  • Difficulty swallowing
  • Wheezing with phlegm sounds

Use cautiously or avoid in patients with:

  • Marked heat intolerance
  • Profuse sweating
  • Significant arrhythmias
  • Markedly elevated blood pressure
  • Prostatic enlargement with urinary difficulty

IV. Applicable Disorders

This formula is most commonly used for neurological diseases affecting either the central or peripheral nervous systems.

Consider it when the presentation includes:

  • Acute flaccid weakness or paralysis
  • Increased muscle tone with neuropathic pain
  • Sudden impairment of speech or swallowing
  • Cough, wheezing, facial edema, or excessive salivation

1. Wind Paralysis (风痱)

An ancient disease category characterized by:

  • Limb paralysis
  • Numbness
  • Aphasia

It resembles modern conditions such as:

  • Myelitis
  • Acute inflammatory polyneuropathy (Guillain-Barré syndrome)
  • Certain forms of brainstem encephalitis

“Wind fēi is when one suddenly cannot speak, the mouth is clenched, and the limbs become impaired and rigid.”

(Beiji Qianjin Yaofang, Vol. 8)

The original instructions state:

“If sweating occurs, recovery follows; if not, administer another dose.”

Thus, mild sweating is considered a sign that the formula is taking effect.

If sweating does not occur, the dosage of Má Huáng may be increased.

According to Huang Shipei, tolerance to Má Huáng varies greatly among individuals; dosing should begin conservatively and increase gradually.

2. Stroke (脑卒中)

The formula presentation corresponds well to acute stroke symptoms such as:

  • Facial deviation
  • Hemiplegia
  • Altered consciousness
  • Difficulty speaking or understanding speech
  • Visual disturbances
  • Difficulty walking
  • Dizziness
  • Loss of balance and coordination

Use cautiously in:

  • Severe hypertension
  • Cerebral hemorrhage

Hu Xishu cautioned:

“One should be cautious when using this formula clinically for stroke.”

3. Parkinson’s Disease

The phrases:

“The body is unable to control itself” and “Hypertonicity preventing one from turning over to the side” closely resemble Parkinsonian features such as:

  • Increased muscle tone
  • Shuffling gait

Most appropriate in patients who are:

  • Robustly built
  • Have a moist, slippery tongue coating
  • Maintain a normal appetite

For excessive salivation, combine with Wú Zhū Yú Tāng.

V. Formula Differentiation

1. Xù Mìng Tāng vs. Má Huáng Tāng

Both may be used for:

  • Stroke
  • Hemiplegia
  • Aphasia

However, the neurological manifestations of Xù Mìng Tāng are considerably more severe.

2. Xù Mìng Tāng vs. Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng

Both can treat movement disorders.

  • Xù Mìng Tāng treats:
    • “The body is unable to control itself” and “Hypertonicity preventing one from turning over to the side”
  • Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng treats:
    • “The whole body feels heavy and cannot turn over”

However:

  • Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng is more commonly used in patients with depression and insomnia.
  • Fullness in the chest, vexation, and fright are characteristic signs.

These symptoms are generally absent in Xù Mìng Tāng, whose defining feature is sudden disease onset.

VI. Reference Dosage

  • Má Huáng 15 g
  • Guì Zhī 15 g
  • Dāng Guī 15 g
  • Rén Shēn 15 g
  • Shí Gāo 20 g
  • Gān Jiāng 15 g
  • Gān Cǎo 15 g
  • Chuān Xiōng 10 g
  • Xìng Rén 15 g

Decoct in 1000 mL water and reduce to 400 mL.

Take in 2–3 divided doses throughout the day.

A mild sweat is considered the ideal therapeutic response.

If treatment is required for longer than seven days, the dosage may be reduced by half.

  1. Nigel Wiseman translates the character fèi 痱 as ‘wind disablement’, where he goes on to say, “Wilting, and loss of the use of the limbs without pain and with loss of mental faculties. The língshū states, ‘when disablement is the disease, and there is no generalized pain, the limbs cannot contract, cognitive faculties are not seriously confused, and speech is faint, the condition can be treated.’ This passage would indicate that disablement is a sequela of wind stroke.” (Wiseman, Practical Dictionary of Chinese Medicine, Pleco edition.)   ↩︎

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.