Category: Case Studies （医案)

Two Cases on the use of Si Ni San

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A Collection of the Clinical Experience of He Ren%E4%BD%95%E4%BB%BB.jpg

何任临床经验辑要

Case #1

On April 8 1983, a 48 year old female presented with irregular menstruation.  She was a very sceptical woman and was easily angered.  Her sleep was poor with copious dreaming, she experienced rib side pain, abdominal distension, her bowel movements alternated between hard and loose, her tongue had a thin white coat and her pulse was wiry.  In this case it is appropriate to harmonize and scatter the depression, course the liver, and regulate qi.  The following formula was prescribed;

Zhi Shi 9g

Chai Hu 9g

Sheng Gan Cao 9g

Dang Gui 9g

Bai Shao 15g

Huai Xiao Mai 30g

Zhi Xiang Fu 9g

Da Zao 7 pieces

5 packages were administered.

Follow up consultation on April 15 1983:  After taking the above formula, her sleep had improved and she felt calmer.  The abdominal distension had decreased, her bowel movements were regular, but the rib side pain was still occasionally present.  Tongue coating was still thin and the pulse was wiry.  A modified version of the original formula was prescribed.

Zhi Shi 9g

Chai Hu 9g

Sheng Gan Cao 9g

Yu Jin 9g

Bai Shao 15g

Zhi Xiang Fu 9g

Huai Xiao Mai 30g

Da Zao 7 pieces

5 packages were administered.

Commentary:  The patient in this case originally suffered from neurosis occurring alongside menopause.  Therefore we have a pattern of qi and blood disharmony with liver depression, causing rib side pain and abdominal distension.  This pattern is effectively treated with a combination of Si Ni San and Gan Mai Da Zao Tang.  On follow up after finishing the formula, the patient reported a full resolution of symptoms.

Case #2

A 41 year old male presented on August 17, 1981 with a depressed spirit, irritability and anger.  In addition he had epigastric pain, an increase in bowel movements, with occasional diarrhea, cold fingers and toes, slight sweating, fatigue, a wiry-rapid pulse, and a thin yellow tongue coat.  In this case it is appropriate to course the liver, regulate qi and resolve depression.  The following formula was prescribed;

Chai Hu 9g

Bai Shao 9g

Sheng Gan Cao 9g

Zhi Shi 9g

Chun Yang Zheng Qi Wan 3g* (separated into two doses and taken with decoction)

*Pure Yang to Rectify the Qi pills is a patent formula containing Chen Pi, Cang Zhu, Rou Gui, Ding Xiang, Huo Xiang, Bai Zhu, Fu Ling, Zhi Ban Xia, and Qing Mu Xiang.

Four packages were administered.

Commentary:  The patient in this case suffered from a depressed spirit.  He tended to think excessively and was easily angered.  This patient was initially diagnosed during the summer, and was manifesting a Si Ni San presentation.  Taking the season into consideration and the conditions of his diet with the mild reversal symptoms, we are unable to say that this is a pure case of binding depression of liver qi.  Due to these factors, Chun Yang Zheng Qi Wan was added to clear the stomach and intestines and eliminate seasonal pathogenic factors.  After taking two packages of the formula his (epigastric) pain and diarrhea had completely resolved, and he felt much calmer.

The clinical scope of Si Ni San is quite vast.  In all cases of qi stagnation, qi depression, and qi reversal the pattern and presentation of Si Ni San is often present with several opportunities for use.  The formula is applicable in cases of cholelithiasis, cholecystitis, intercostal neuralgia, weak digestive system functioning, stomatitis, panting, palpitations, colitis, neurological disorders, menopause, and several other conditions.  Generally when the pattern is correctly identified and the herbs and/or formula are matched to the presentation, our results can be 100% effective.

Stomach Pain and Irregular menstruation rectified with Si Ni Huang Lian (Tang)

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A case of Professor Fan Zheng-Lun (樊正伦)

Recently a 37 year old female presented at the clinic.  She was thin and pallid and was covering her abdomen with both hands.  She complained of stomach pain for several months occurring before or after meals.  Her abdomen feared cold and enjoyed warmth, she often felt nauseous with the occasional desire to vomit.  Her bowel movements seemed to be unaffected.  Her stomach pain occurred prior to her menstrual cycle which had also become quite long, dark and unsmooth.  In addition the soles of her feet often felt warm.  Her mother, who was sitting next to her commented that her daughter really enjoyed spicy foods and ate too much of them, which was probably causing some of her pain.  Her mother recently restricted her consumption of these foods.

Her tongue was purplish-dark with stasis macules on both edges.  Her right pulse was wiry-thin, and the left pulse was deep-weak.  At this point, Professor Fan kindly asked her, “Do you find that you easily get angry”?  The patient nodded her head and said “yes, I don’t have a very good temper”.

Professor Fan said that this is a case of Liver Qi depression with a disharmony of the Spleen and Stomach, which can be treated with ‘Huang Lian Tang’ and ‘Si Ni San’ with additions and subtractions.

Formula:

Gui Zhi 9g

Bai Shao 9g

Fa Ban Xia 9g

Gan Jiang 9g

Zhi Gan Cao 15g

Chai Hu 9g

Zhi Shi 9g

Zhi Xiang Fu 9g

Dang Gui 9g

Dang Shen 12g

Da Zao 4 pieces

Sheng Sha Pu Huang 6g

Huang Lian 6g

7 Packages were administered.

A week later the patient returned for a follow up consultation and said her spirits were up and turning for the better.  She was so happy to report that after taking the herbs, her stomach felt very comfortable.  She was still having one bowel movement a day.  Her cycle came and only lasted 4-5 days, was not very heavy and contained small clots.  She has had no abdominal pain, her soles no longer felt warm, and occasionally there was a gurgling sound in her abdomen.

Her tongue edges were purplish-dark and her pulse was wiry.

Professor Fan felt that the formula was addressing her condition and prescribed another seven packages of the original formula to consolidate the treatment.

In clause 173 of the ‘Shang Han Lun’ it says;

“When in Cold damage, there is heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit, Huang Lian Tang (Coptis Decoction) governs”

In actuality, Huang Lian Tang is Ban Xia Xie Xin Tang with the removal of Huang Qin and the addition of Gui Zhi.  It treats stomach heat and spleen cold, while Ban Xia Xie Xin Tang treats damp heat in the spleen and stomach.

Within the formula, bitter Huang Lian is used to descend heat in the upper body, as per the adage “To treat upper body heat, drain with bitterness”.  Acrid warm Gui Zhi, Gan Jiang, and Fa Ban Xia are used to raise spleen yang.  “With cold in the lower body, scatter with acridness”.  Ren Shen, Gan Cao, and Da Zao are used for their sweet flavour to boost the stomach, remembering the adage “The spleen desires warmth, so with tension use sweet foods to moderate”.

Huang Lian Tang is a very useful formula for treating spleen and stomach conditions resulting from spleen cold and stomach heat.  When combined with Si Ni San It is able to course the liver, regulate qi and protect liver wood from exploiting spleen earth.  In clinical practice we are often able to achieve positive clinical outcomes through this combination.

In this patients’ case, aside from the above mentioned formulas, Professor Fan added Zhi Xiang Fu in order to strengthen the formulas function of coursing the liver.  Dang Gui and Sheng Sha Pu Huang were added to nourish and move the blood, and transform stasis.

This case was adapted and condensed from ‘A Taste of Chinese Medical Chicken Soup’ by Xiong Hong

A Case of Rheumatic Arthritis

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He Bei Chinese Medicine, 1984; (3): 40

Found in ‘A Brief Guide to Cold Damage Formula Patterns’ by Liu Shao-Yi (伤寒方证便览)

Huang a 49 year old male presented with joint pain in both legs and knees which had started the previous year and has gradually become worse. At a local hospital, he was diagnosed with rheumatic arthritis, and received treatments for over a month with no positive effects. 

Recently his pain has become quite severe, especially in both knee joints. He experiences pulling pain, which prevents him from walking. Both legs and knees were cold, and his pain intensifies with any changes in weather or on cold rainy days. His tongue had a greasy white coating and his pulse was deep and thin.

This pattern is usually the result of living in wet-damp locations for extended periods of time allowing wind and dampness to amass in the joints. The following formula was administered: %E9%A3%8E%E6%B9%BF.jpg

Zhi Gan Cao 6g (Glycyrrhizae Radix preparata)

Bai Zhu 9g (Atractylodis macrocephalae Rhizoma)

Gui Zhi 9g (Cinnamomi Ramulus)

Pao Fu Zi 15g (Aconiti Radix lateralis preperata)

Niu Xi 9g (Achyranthis bidentatae Radix) 

1 package was to be taken daily. 

After taking 3 packages, both limbs felt warmer and the pain had decreased slightly. The above formula was repeated with an increase in herb dosages. 

Zhi Gan Cao 9g (Glycyrrhizae Radix preparata)

Bai zhu 24g (Atractylodis macrocephalae Rhizoma)

Gui Zhi 15g (Cinnamomi Ramulus)

Pao Fu Zi 30g (Aconiti Radix lateralis preperata)

Niu Xi 15g (Achyranthis bidentatae Radix) 

After another 3 packages, his legs felt warmer, there was mild sweating, a white tongue coat and a harmonious moderate pulse. The joint pain in the legs had now been eliminated and he was even able to walk the 3 miles to the hospital for a follow up visit. In order to consolidate the treatment and eliminate the wind damp, another 5 packages of the previous prescription (with the lower dosages) was used. On a recent follow up visit there had been no relapse of the condition.

**The following case was found in the above mentioned book’s section on ‘patterns of wind and damp retention in the joints’ with the representative formula being Gan Cao Fu Zi Tang (Licorice and Aconite formula)

Hu Xi Shu (胡希恕）Case #5- Foot pain

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A 19 year old male presented on February 15, 1966 complaining of left foot swelling and pain for over 5 years. Over the last two years the pain has gotten quite severe. X-ray imaging confirmed osteogenesis of the heel.

Current symptoms: swelling and pain in the left foot, fear of cold, severe pain after walking, normal taste in the mouth, no desire to drink, a thin-white tongue coating and a deep-wiry pulse.

This is wind-dampness in the Shao-Yin and Tai-Yin, and is therefore a Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig,Peony and Anemarrhena Decoction) pattern.

Formula: 

Gui zhi 4 qian (Cinnamomi Cassiae, Ramulus)

Ma Huang 2 qian (Ephedrae, Herba)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)
Sheng Jiang 4 qian (Zingiberis Officinalis Recens, Rhizoma)
Chuan Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)
Fang Feng 4 qian (Ledebouriellae, Radix)
Cang Zhu 4 qian (Atractylodis, Rhizoma)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

Results: After taking seven packages of the above formula, the foot pain had decreased. He still experienced pain after walking but would recover quickly after taking a rest. Chuan Fu Zi (Aconiti Carmichaeli Preparata, Radix Lateralis) was increased to 3 qian and after taking the above formula for another month the swelling in the foot had resolved and the pain was no longer present.

Hu Xi Shu’s Love affair with Da Chai Hu Tang 胡希恕真的爱大柴胡汤!!

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After reading numerous Hu Xi Shu case studies over the last few years, I have come to realize that he had a special affinity to the use of Da Chai Hu Tang and utilized this great formula in combination with other medicinals and/or formulas to treat a vast array of medical conditions.  His unique way of using this formula have been mentioned in previous posts, and I would like to offer yet another of his innovative cases.

A 48 year old male presented at the clinic on August 12, 1964 complaining of feeling flustered and unwell for over six months. He was treated at a previous hospital with various qi supplementing, blood nourishing formulas consisting of modified versions of Zhi Gan Cao Tang, Bai Zi Yang Xin Tang, and Tian Wang Bu Xin Dan. None of these treatments were effective and in addition he started feeling warm and had trouble sleeping. An Electrocardiogram revealed atrioventricular blockage and cardiac muscle strain.

Current symptoms: Flustered feeling, insomnia, poor food intake, epigastric pain, dull pain in the region of the heart, numbness in the hands and feet, a bitter taste in the mouth, yellow urination, dry stools, a greasy white tongue coating and a bound and intermittent pulse.
He was prescribed Da Chai Hu Tang with Gui Zhi Fu Ling Wan and Sheng Long (Gu) Mu (Li)

Chai Hu 4qian
Ban Xia 3qian
Huang Qin 3qian
Gui Zhi 3qian
Fu Ling 3qian
Bai Shao 3qian
Zhi Shi 3qian
Tao Ren 3qian
Hong Hua 2qian
Da Zao 4pcs
Sheng Jiang 3qian
Da Huang 2qian
Sheng Long Gu 5qian
Sheng Mu Li 5qian

Results: After taking 3 packages of the above formula the epigastric pain was alleviated, his appetite had improved, the numbness in the hands and feet were gone and sleep was improving. Hong Hua was removed from the formula and 3qian of Mu Dan Pi were added. After 6 packages, the chest pain had receded, his sleep was excellent, the flustered feeling was not as apparent and the pulse was normal.

Comments: Originally this patient presented as feeling flustered, with a poor appetite, numbness in the hands and feet and a bound and intermittent pulse. These symptoms can indicate a vacuous condition, which is why a modified version of Zhi Gan Cao Tang was originally administered. After taking the formula, the patient had a bitter taste in his mouth, yellow urination, dry stools, a dull pain in the area of the heart, etc. These symptoms belong to a Shao-Yang Yang-Ming combination disease, therefore Da Chai Hu Tang with Gui Zhi Fu Ling Wan and Long Gu and Mu Li were administered. This formula is used to resolve both the Shao-Yang and Yang-Ming, quicken the blood, eliminate stasis and calm the spirit. Because the herbs were chosen according to the pattern, an extended period of treatment time was unnecessary.

Hu Xi-Shu (胡希恕) Case #4-Duodenal Ulcer

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hu xi-shu.jpgMr. Wang, male, 46 years old.

Initial diagnosis on November 30, 1965: For over 10 years the patient has suffered with epigastric pain which has recently been getting worse. Treatment at a local Chinese-Western integrative clinic was unsuccessful. Chinese medicinals were used to warm the centre, rectify the Qi, quicken the blood and dispel stasis. Western medications were ineffective as well and surgery was recommended. Since the patient feared surgery, he came to the capital (BeiJing) for treatment.

Current symptoms: stabbing epigastric pain most notable when hungry, heat effusion in the back, late afternoon heat in the palms of the hands, occasional worry, palpitations, dizziness, cool body with a fear of cold, sweating and an aversion to wind. There was harmony of the mouth* with no desire to drink and slightly sloppy stools. Tongue coating was white, tongue tip was red and his pulse was thin and wiry. Barium examination revealed a 0.4cm2 postbulbar duodenal ulcer. 

Dr. Hu prescribed Xiao Jian Zhong Tang (Minor construct the centre decoction)

Gui Zhi 3 qian

Bai Shao 6 qian

Sheng Jiang 3 qian

Da Zao 4 pieces

Zhi Gan Cao 2 qian

Yi Tang ½ liang (mixed into prepared decoction)

Second consultation (12.3.1965): The pain and heat in the palms had slightly decreased but overall the epigastric stabbing pain, heat in the back and daily bowel movements were still present. The following medicinals were added to the above formula;

Chao Wu Ling Zhi 2 qian

Yuan Hu Fen 5 fen (mixed into decoction)

Third consultation (12.9.1965): The epigastric pain is no longer as obvious, but after eating the patient is experiencing focal distension below the heart. In addition, his four limbs are cold and he is unable to sleep peacefully at night. At this point the patient had to return to his hometown in Dong Bei. The formula was changed to Fu Ling Yin and sent home with him where he was to take it and until recovery. The formula ingredients were as follows:

Fu Ling 5 qian

Dang Shen 3 qian

Zhi Ke 3 qian

Cang zhu 3 qian

Sheng Jiang 3 qian

Chen Pi 1 liang

Ban Xia 4 qian

Commentary: In this case the patient presented with sweating, an aversion to wind, dizziness and heart palpitations which can signify pathogens in the exterior, specifically an exterior vacuity pattern. Therefore Xiao Jian Zhong Tang was administered. After taking three packages of the formula there was already a significant effect and after nine packages, the symptoms were basically resolved. Xiao Jian Zhong Tang is essentially Gui Zhi Jia Shao Yao Tang with the addition of Yi Tang. Gui Zhi Jia Shao Yao Tang is originally a formula used to treat abdominal pain. With the addition of a large dose of sweet, warm, vacuity supplementing, spasm moderating Yi Tang we have the dual action of both treating abdominal pain and supplementing vacuity, hence the name ‘Construct the centre’.

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions.

Zhu Ren-Kang- Collection of clinical experience in dermatology （朱仁康-临床经验集-皮肤外科）

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Eczema-Case #2

Tian, male, 24 years old presented on March 13, 1967.

Chief complaint: Patient has suffered with a pruritic erythematous papular eruption covering his whole body for the last month. 

Disease history: Last month the patient initially noticed small red papular eruptions over his limbs and torso that when scratched exuded fluid. Currently the eruptions are generalized over the entire body being more severe over the upper arms and thighs. Several decoctions have been taken as well as injections of sodium hyposulfide all to no avail. 

Inspection: Scattered over the entire body were small millet-grain like red papules with exudate, more obvious on the limbs. The papules were quite diffused and symmetrical. 

Pulse was moderate and the tongue was normal with a clean coating. 

Chinese medical diagnosis: Millet sore (粟疮)

Western medical diagnosis: Generalized eczema

Pattern: Interior spleen vacuity with enduring accumulation transforming to heat, transmutation and steaming of damp-heat coupled with external wind. 

Treatment principle: Disinhibit dampness and clear heat.

Formula: 4 packages of Long Dan Xie Gan Tang with additions and subtractions were prescribed.

Second Visit (March 17): Patient reported that the condition was basically the same as before with no improvement. The itchiness was still present and his sleep was disturbed. Tongue body was now red with a thin white coat, and his pulse was wiry and thin. 

The treatment principle was changed to cool the blood, clear heat, disperse wind and alleviate itching.

Formula:

Sheng Di 30g

Dan Shen 9g

Chi Shao 9g

Jing Jie 9g

Ren Dong Teng 12g

Ku Shen 9g

Di Fu Zi 9g

Bai Xian Pi 9g

Er Miao Wan 9g

Liu Yi San 9g

4 Packages were administered.

Third visit (March 21): After taking the above formula, the itchiness had decreased considerably and the skin was gradually clearing up. The above formula was repeated with the additions of;

Qian Cao 9g

Chan Yi 6g

Cang Er Zi 9g

5 packages were administered.

Fourth visit (March 26): After taking the above formula, a major portion of his skin had returned to normal and no new lesions were observed. The itchiness was still present in the evenings. 

9g of Chi Ling was added to the previous formula and after taking 5 packages the patients’ condition was resolved.

Case Study of Wu Pei Heng (吴佩衡医案)

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吴佩衡医案

The following is a case study by the late Wu Pei Heng (吴佩衡) (1886-1971) from Si Chuan province who was extremely proficient in using classical formulas and practiced in the style of the fire god school (火神派).  My initial fascination with Dr Wu’s cases are his use of extremely large doses of Fu Zi.  There are a number of cases in his book where he uses up to 300g a day, even with a few of his younger patients. Due to Dr. Wu’s prolific use of Fu Zi he attained the nickname ‘Wu Fu Zi’ (吴附子). 

 

Late miscarriage blood loss

 Mrs Fang, 35 years old, originally from Luo Ping county currently living in the city of Kun Ming in Yunnan province.

On May 12, 1923 she presented at the clinic after suffering a miscarriage in her fifth month of pregnancy.  Initially she felt painful sagging in her abdomen and low back which continued until she miscarried.  She had excessive menstrual bleeding (flooding) with clots, twisting abdominal pain, flusteredness, dizziness and shortness of breath.  Her pulse was scallion like, vacuous, weak and both inch positions were short.  Her lips were pale red, tongue coating was slippery white and the tongue body was bluish and dark.  According to her husband on that particular evening she had fainted twice.   Late miscarriages are usually due to major vacuity of kidney qi, qi vacuity sinking and unable to absorb blood, and yang qi descending with blood and escaping.   The qi is born within the kidneys and gathers in the lungs and here we have a lack of merger between the kidneys and lungs, therefore there is shortness of breath with desertion.  The plan is to administer Si Ni Dang Gui Bu Xue Tang with (Da) Zao and Ai (Ye).  Within the formula, Si Ni Tang supports Yang allowing it to rise.  The assistants (Huang) Qi and Dang Gui supplement the centre, boost qi and re-generate the excessively damaged blood.  Gan Jiang, Ai (Ye) and (Da) Zao blackened, can warm the blood, separate the cold and return blood back to the channels. 

 

Formula:

Hei Fu Pian 160g

Pao Hei Jiang 50g

Zhi Gan Cao 24g

Bei Kou Qi 60g

Dang Gui 26g

Qi Ai 6g (fried until blackened)

Da Zao 5 pieces (roasted until blackened)

 

After taking 13 days worth of formula, her menstrual flooding stopped, the shortness of breath was calmed and most of her symptoms were alleviated by days 6 or 7 and even her spirit was slightly improved.  In keeping with the original formula, another 14 days were given to complete the course, after which she successfully recovered.

                                                                                          

A case of Shao-Yin Infertility

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Fan Zhong Lin- Liu Jing Bian Zheng Yi An （六经辩证医案)

Huang. 34 year old female cadre residing in Si Chuan province.

[Disease history]: Couple have been trying to conceive unsuccessfully for the last 7 years beginning in the winter of 1959. Both male and female medical investigations were normal. Her initial symptoms were dizziness and poor energy. In the early mornings she would have facial edema and in the afternoon the swelling would be in her legs. Her menstruation was irregular.
In 1965 when she had come in for a consultation the state of her condition had already become quite serious. Her initial consultation was on June 20 1965.

[Initial consultation]: Amenorrhea for a half a year with copious leucorrhea. There was mild edema throughout her entire body and her lower limbs felt rather heavy. There was whole body pain, a fear of cold, excessive dreaming, poor appetite and her blood pressure was occasionally high. Her urination was inhibited and her bowels would be initially dry and then sloppy. Tongue body was pale, flabby and tender with teeth marks on the edges, coating was slippery overall and thicker at the centre. Pulse was deep.
This is an irregular menstruation and Infertility pattern due to evils entering the Shao-Yin with fire debilitation, water effulgence and Kidney Yang vacuity. A modified version of Zhen Wu Tang was appropriate to warm Yang, transform Qi and move water.

Prescription:

Zhi Fu Pian 120g (extended cooking time)
Fu Ling 30g
Sheng Jiang 30g
Gui Zhi 15g
Pao Jiang 30g
Zhi Gan Cao 15g
4 Packages.

[Second consultation]: After taking the above formula her whole body edema was markedly reduced and her appetite was improved. Another four packages of the above formula were prescribed.

[Third consultation]: Patients exhaustion, aversion to cold and other symptoms were greatly improved except for the amenorrhea. A modified version of the above formula combined with Dang Gui Bu Xue Tang was prescribed.

Prescription:

Zhi Fu Pian 60g (extended cooking)
Fu Ling 20g
Bai Zhu 15g
Sheng Jiang 30g
Gui Zhi 10g
Huang Qi 30g
Dang Gui 10g
Zhi Gan Cao 10g
Pao Jiang 30g

[Fourth consultation]: Eight packages of the above formula were taken after which her menstruation arrived. The colour was pale, the amount scanty and contained clots. Her lower abdomen felt cool with a dull pain. She was still manifesting congealing and stagnation of cold in the uterus. A modified version of Wen Jing Tang was administered.

Prescription:

Wu Zhu Yu 6g
Dang Gui 10g
Chuan Xiong 6g
Bai Shao 10g
Xue Yu Tan 20g
Pao Jiang 20g
Zhi Gan Cao 10g
2 Packages were given.

[Fifth consultation]: The abdominal pain had ceased indicating that the stasis of blood had decreased. All other symptoms were obviously reduced as well. Out of fear that the cold would return, she was advised to abstain from sexual intercourse for a half a year. The patient was given a prescription to take back home with her to continue to regulate and improve her health.

Prescription:

Zhi Fu Pian 60g (extended cooking)
Rou Gui 10g (powdered and steeped in cooked decoction)
Pao Jiang 30g
Xue Yu Tan 20g
Tu Si Zi 20g
Rou Cong Rong 10g
Huang Qi 30g
Dang Gui 10g
Nan Sha Shen 15g
Zhi Gan Cao 15g
Gou Qi Zi 20g
Ba Ji Tian 12g

July 26, 1979 follow up: During the entire course of treatment over a hundred packages of herbs were taken. Following the advice of Dr. Fan she was able to become pregnant in 1967 and currently has two children.

5 Steps to ‘Shang Han’ treatment

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I am currently reading a book titled ‘5 Steps to Shang Han treatment based on Pattern Identification”. It is a fascinating look at a very systematic approach to diagnosis and treatment using the formulary of Zhang Zhong Jing. The book is essentially centred around three very famous modern physicians, Hu Xi Shu (胡希恕), Liu Du Zhou (刘渡舟) and Fan Zhong Lin（范中林）. The book includes numerous case studies by each one of them detailing their step-by-step process from diagnosis to treatment. The 5 step process is as follows;

I. TCM diagnosis (signs, symptoms, origin and constitution of patient)
II. List of disease mechanisms (6 channel differentiation, differentiation of principles, zang-fu, channels, etc…)
III. Comprehensive analysis (detailing process and location of disease)
IV. Formulas according to pattern
V. Medicinals according to pattern

I would like to offer a translation of one case from the book by Fan Zhong-Lin a prominent physician in the Fire God school of thought (火神派).

Mr.Yang, a 54 year old male from Cheng Du presented at the clinic.

Step 1: Chinese medical diagnosis
October, 1960. Over the last 2 years every day after breakfast, the patient felt very warm and feverish. His body temperature was always around 38 degrees celcius. He had relatively copious sweating that would go on for about 2 hours. Once the heat would decline, the sweating would stop and he would feel an aversion to cold. His daily symptoms included; dizziness, a bitter taste in the mouth, dry throat, chest and rib-side fullness as well as vexation and agitation felt in the chest. His tongue body was red and the coating was slightly yellow and greasy. Pulse was wiry-rapid. At his previous hospital examination the cause of his fevers were unknown and the medications administered had very little effect.

Step 2: List of disease mechanisms
The wiry pulse, alternating cold and heat, bitter taste in the mouth, dry throat, dizziness, chest and rib-side fullness and heart vexation are all obvious Shao-Yang channel signs and symptoms.

Step 3: Comprehensive Analysis
This is Shao-Yang channel disease heat effusion. Treatment methods should involve harmonizing and resolving the Shao-Yang.

Step 4: Formula according to pattern
Xiao Chai Hu Tang with additions and subtractions governs.
This condition has been going on for 2 years so as the Shang Han Lun says “When Chai Hu signs still exist, administer Xiao Chai Hu Tang”

Step 5: Medicinals according to pattern

Because the signs of heat effusion, sweating, thirst and a red tongue signify depressed heat, we remove Sheng Jiang (Rhizoma Zingiberis) and Da Zao (Fructus Jujubae) , and add Zhi Mu (Rhizoma Anemarrhenae) and Shi Gao (Gypsum Fibrosum) to clear heat.
In addition, because the chest and rib-side fullness were quite severe, this can signify that the pattern is interspersed with damp evils, therefore Mu Li (Concha Ostreae), Chen Pi (Pericarpium Citri reticulatae) and Fu Ling (Poria cocus) were added to percolate dampness, transform stasis and disperse bind.

Formula:

Chai Hu 24g
Huang Qin 10g
Fa Ban Xia 15g
Sha Shen 15g
Gan Cao 10g
Zhi Mu 15g
Shi Gao 30g
Mu Li 24g
Chen Pi 9g
Fu Ling 12g

After taking one package of the above formula, the heat declined and there was a reduction in most of his symptoms. After stopping the herbs he was instructed to rest and take care of himself for several days and afterwards he would recover. After much time the patient had come to visit Dr. Fan at his home and reported the condition had not recurred.