Category: Case Studies （医案)

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning

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Here is a guest post from the great Sharon Weizenbaum


By Dr. Shi Jin-Mo  施今墨 (1881-1969)

Using the Opening Through the Muscles and Vitalizing the Luo Method to Treat Brain Damage due to Carbon Monoxide Poisoning.

Translated with Commentary by Sharon Weizenbaum

 In an age in which there is a strong impulse to “detoxify” through various kinds of purges and cleanses, I feel this case offers a breath of fresh insight.  So many times our patients ask us how they can get some bad stuff out of their bodies – whether this bad stuff is heavy metals, candida, lyme or other chemicals.  What I feel Dr. Shi is reminding us to do is to look not at what the toxin is or how to get rid of it.  Rather we should look at the actual signs and symptoms to determine how the toxin damages.  We should ask what the response of the body is and not focus on the toxin itself.

In addition, this case inspires me to consider brain damage in a less fixed and fatalistic way.

Dr. Shi’s case:

Ms Zhang was 60 when she came in for her first visit.  A couple of months previously she had received carbon monoxide poisoning.  After receiving emergency care she unexpected lived.   However, she suffered from abnormal spirit essence, inability to eat or dress without help from her family, inability to speak or sleep or control her bowels properly.  In general, she seemed to be like a retarded person, frequently covering her head with her arms.  At the hospital in Beijing, she was given the diagnosis of post carbon monoxide poisoning neurosis.

Her check-up revealed that her pulses were wiry, deep and rough.

Diagnosis:  Post carbon monoxide poisoning central brain damage with loss of control of body functions and Qi and Blood obstruction.

Treatment method:  Open through the Luo vessels and regulate the Qi mechanism.

Prescription: 

Jiu Chang Pu                           10 gm

Jiu Chao Chong Wei Zi            10 gm

Bai Ji Li     Fructus Tribuli        12 gm

Sang Zhi                                  18 gm

Chao Yuan Zhi                        10 gm

Su Di Long                              10 gm

Sang Ji Sheng                          18 gm

Huai Niu Xi                             10 gm

Xia Ku Cao                             10 gm

Chen Bai Wei                           6 gm

Chang Gou Teng                     12 gm

Shou Wu Teng                        15 gm

Jiu Chuang Xiong                      5 gm

Discussion:  This patient’s appearance was very much like a retarded person.  She was unable to speak or sleep and her movement was slow.  Her pulse was wiry, rough and irregular.  These symptoms all belong to the category of Liver vacuity and Heart Qi insufficiency.  In addition her meridian and luo vessels pathways were not open through.  It was important to principally treat the Heart and Liver channels as well as the three aspects Qi, Blood and Phlegm.  Every time she came there was gradual improvement.  The fourth visit was after half a month of taking the herbs.  Follow up showed that her eating, sleeping, urination, bowels and spirit essence were all normal.  Her movement was still sluggish.  These kinds of clinical illnesses do not appear very often.  I carried out treatment according to my rich experience.  Using differential diagnosis I determined the formula.  With the group of herbs that open through and quicken blood, I had to find just the right balance of drastic and fierce measures.  Altogether she took about 50 packages of herbs and gradually improved.

Pu Huang treats Blood stoppage pain.  Prepared it can stop bleeding.  Fresh it vitalizes Blood.  It can be used at the base of the tongue to treat inability to speak.  If it is used repeatedly, it will be effective.  This is also a formula from my experience.

A Case of Infertility

On By eranevenIn Case Studies （医案), Liú Dùzhōu (刘渡舟), Translations & Writings (译著与文章)6 Comments

In keeping with the theme of using classical formulas to treat conditions they are not typically indicated for, I offer a translation of an interesting case of infertility treated with Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi). The importance of treating the presentation and not getting too attached to the disease at hand rings true once again.

Liu Du-Zhou’s Clinical Experience in the use of Classical formulas
Journal of the Beijing University of Chinese Medicine, (Volume 17-5: 1994)
Written by Liu Bao-Hua

On December 20, 1989, a 30 year old female presented at the clinic complaining of an inability to conceive for over four years. She was diagnosed in the gynecology department with primary infertility, and has taken numerous formulas to date without any positive outcomes. Her cycle arrived every forty days or so, and would be complicated by lower abdominal and lumbar pain, scanty flow mixed with clots, and she was easily constipated. Her pulse was slippery-rapid and strong, tongue coat was thin-yellow, and the tongue body was bluish-purple. The diagnosis was binding of heat and blood, with obstruction of the chong and ren vessels, causing difficulty in conceiving.

Treatment principle: Discharge heat, and move static (blood), in order to eliminate the old to make room for the new. A powerful formula needs to be used in order to positively treat this obstinate condition.

The formula used was Tao He Cheng Qi Tang (Peach Pit Decoction to Order the Qi):

Tao Ren 15g
Da Huang 4g
Mang Xiao 4g (added to strained decoction)
Gui Zhi 10g
Zhi Gan Cao 6g

After taking five packages of the formula she reported that her bowels were looser, and she had also discharged relatively copious amounts of black menstrual blood. Her lower abdominal and lumbar pain had settled, and her cycle arrived on schedule. On follow up six months later, she reported that she was indeed pregnant and went on to have a healthy baby girl.

Commentary: Tao He Cheng Qi Tang is basically Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the qi decoction) with the addition of Tao Ren, and Gui Zhi. Tiao Wei Cheng Qi Tang is used to discharge heat, and break binds. Tao Ren is moistening and disinhibiting, and is very good at expelling and eliminating static blood. Combined with Mang Xiao, and Da Huang the action of eliminating static blood and stagnation is strengthened. Gui zhi is used to free and move the defensive qi, following the adage of ‘when the qi moves, the blood will follow’, which will invariably strengthen the overall blood moving effect of the formula. In addition the warm nature of Gui Zhi moderates the cooling nature of both the Mang Xiao and Da Huang. 

Case study of Zhang Xiang-Fu (张祥福)

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One of the great things about reading and studying case study literature is that we are able to learn from experienced practitioners, new and unique ways of using classical formulas we may never had thought of. When first seeing this case written up under the Wu Ling San heading, I was surprised, as treating uterine bleeding with this formula would never have existed within my thought process. Initially I thought I stumbled upon a true goldmine, but after reading the case it was clear that the practitioner was merely putting more stock into the presentation, rather than the actual disease. This is essentially the bread and butter of Chinese medicine, yet so easily disregarded these days. So nothing too dramatic nor enlightening here but still an interesting case.

***A 35 year old female presented at the clinic on May 12, 1978. The patient has always been overweight and suffered with excessive menstrual bleeding. The timing of her period has always been indeterminate, with flows usually lasting longer than seven days. This afternoon she suddenly experienced acute lower abdominal pain, and violent, heavy menstrual flooding. A local hospital treated her in the emergency department and administered medicinals to stop bleeding, along with intravenous fluid injections, all to no avail. At this point she was referred to me for treatment.

Current signs and symptoms: Sallow white facial complexion, icy cold extremities, beads of sweat emanating from the head, spitting up of turbid frothy phlegm, acute lower abdominal pain, which favours palpation, a pale, tender, enlarged tongue body, with stasis macules on the edges, a white slightly greasy tongue coat, and a choppy pulse. Laboratory results were as follows: Hemoglobin 6.5g, white blood cells 5200 m3, neutrophils 65%, lymphocytes 30%, monocytes 2%.

Diagnosis: Fulminant flooding (functional uterine bleeding)

Pattern:  Damp-phlegm obstructing the uterus

Treatment Principle:  Boost qi, stop bleeding, free the yang, and disinhibit dampness.

Formula:  The formula used was Wu Ling San (Five ingredient powder with poria), with the addition of Shai Shen 10g (Sun-dried ginseng), E Jiao 10g (melted and added to decoction), San Qi 10g (powdered and infused). 2 packages were administered.

Follow up consultation on May 14:  She reported that her spirit felt awakened, her limbs now felt warm, and the bleeding had ceased. The original formula was continued for another five packages which were enough to completely resolve the bleeding and bring about a resolution to her condition.

Commentary:  Along with her main symptoms, this patient was also presenting with spitting up of turbid, frothy phlegm, an enlarged tongue body, with a greasy coat, and had always been overweight, which signify the presence of damp-phlegm retention. This damp-phlegm was obstructing the uterus, and causing insecurity of the ren and chong channels, causing menstrual flooding. Wu Ling San was chosen to free the yang, and disinhibit dampness. Shai Shen, E Jiao, and San Qi were added to boost qi, nourish the blood, and stop bleeding. Therefore by simultaneously treating the root and branch of the syndrome, we are able to achieve excellent results.

(This case was translated from ‘Selected Cold Damage cases from the Clinical Experience of Famous Physicians’. Originally found in the ‘Chao Nan Journal of Traditional Chinese Medicine, 1989; (6): 19)’

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)

On By eranevenIn Case Studies （医案), Fán Zhēnglún (樊正伦), Formulas (方剂), Jīng Fāng (经方), Translations & Writings (译著与文章)5 Comments

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.