A case of Xiǎo Jiàn Zhōng Tāng (minor construct the middle decoction)

Fàn Zhōng-Lín

A 22-year-old female factory manager from Chóng Qìng city presented at the clinic.

In July 1959 the patient had developed a high fever and lost consciousness. She was immediately taken into a local hospitals emergency department for investigation. She was administered an anti-pyretic medication, however her fever would not reduce. She was also given various medications to manage and reduce her heat all to no avail. Her diagnosis was inconclusive. At this point she was discharged from the hospital after requesting Chinese medical treatment. After taking two packages of a heat reducing formula, she had gradually regained consciousness. However, in the evening the following day she once again lost consciousness. Again, she was sent to the hospital for treatment, but as she had once again come down with a critical condition as before, they were still unable to make a clear diagnosis. The old Chinese medical doctor[1] was once again consulted who said he was able to diagnose her. After taking Chinese medicinals, her condition gradually improved.

The old Chinese medical doctor believed her condition was due to cerebral stagnation. She was sent for examination and film of her head, which clearly showed blood stagnation in her cranium, and was thus immediately sent to surgery in order to escape any form of danger.

A month following the surgery she was experiencing twitching in her extremities and coldness in the lower half of her body. She was discharged from hospital and continued using herbal medicines for the next five or six years, with very little clear improvement. In 1965 she travelled here to Róng[2] for a consultation.

Her current symptoms were, twitching in her extremities on the right side, occasional deviation of her mouth and eyes, which occurred five or six times per month and would precede the twitching. Afterwards she would feel numbness on her right side. Over the last few years she was especially fearful of cold, and even during the intense heat of June she would wear a sweater, and her extremities still experienced coldness. Her menstrual cycle was irregular with a pale dark color. Her vision had been receding becoming dim and unclear, and her memory and reaction time were remarkably decreased and slow. She was fatigued and had a poor appetite. Her tongue was pale with a scant amount of grey coating. Pulse was deep and thin.

Symptoms and Disease Mechanisms

  • Deep thin pulse, pale tongue, fear of cold, cold extremities, fatigue, twitching in half the body and extremities: symptoms belongs to a Tài Yīn and Shào Yīn spleen and kidney yáng deficiency pattern.
  • Twitching of the extremities, deviation of the mouth and eyes: This pattern belongs to tetany disease[3].

After suffering from such a major illness, both qì and blood are damaged, and thus tetany may form. When qì and blood are both deficient, the sinews and vessels will jerk and become hypertonic. For example, Sù Wèn chapter 74 ‘The Great Treatise on the Utmost Truth’ says,

“All Cold, with contraction and tautness belongs to the kidneys”. 

The Channels and Sinews chapter (ch.13) of the Líng Shū says,

“[When] the sinews of the Foot Shào Yīn [are diseased], [they manifest with] epilepsy, tugging and tetany”.


Tài Yīn, Shào Yīn; qì and blood deficiency.
Among these the qì and blood deficiency are primary.

Treatment Strategy

Here it is appropriate to first warm the center, strengthen the spleen, and harmonize qì and blood.
For this xiǎo jiàn zhōng tāng (minor construct the middle decoction) masters.


guì zhī (Cinnamomi Ramulus) 12g
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
bái sháo (Paeoniae Radix alba) 15g
shēng jiāng (Zingiberis Rhizoma recens) 30g
hóng zǎo (Jujubae Fructus) 15g
yí tang (Maltosum) 60g (dissolved in decoction)

6 packages were given.

She took the six packages above, and followed up ten days later, at which point the twitching in the extremities only occurred once, and the numbness in the body was reduced. In addition, both her spirit and appetite were harmonized, and she was overall making a great recovery.

[1] A Lǎo Zhōng Yī (老中医 ) refers to an older, highly experienced Chinese medical physician, typically held in very high regard throughout the country.
[2] Róng is another name for Chéng Dū.
[3] Refer to chapter 2 in the Jīn Guì Yào Lüè.

A Case of Guì Zhī Fù Zǐ Tāng (Cinnamon Twig and Aconite Accessory Root Decoction)

A Case of Wǔ Líng Sǎn (Five Ingredient Powder with Poria)

– Fire Spirit Currents’ Fàn Zhōng-Lín (范中林)

Translated from ‘Five Steps to Cold Damage Treatment According to Pattern Identification’

A six-month old child of a local Chéng Dū office worker was seen in August of 1960.

Chinese Medical Diagnosis 

On the day that the child had come in, he had been crying endlessly. His appetite had recently decreased; he had a sallow facial complexion, and had lost weight. His parent’s had no clue as to why this was occurring. One day they had suddenly noticed that the child’s scrotum was swollen, to the size of a chicken egg. Water sounds were heard when the lower abdomen was palpated. He was brought in immediately for a diagnosis.

List of Disease Mechanisms 

· Scrotal swelling, and water sounds on palpation of the lower abdomen, signify a water pattern

Comprehensive Analysis 

This is a case of water mounting (水疝), caused mainly by the congealing and stagnation of cold and dampness in the yīn organ (scrotum). The qì transforming function of the bladder is abnormal, causing qì to accumulate, which fails to disperse after a prolonged period. Water and fluids have essentially gathered and amassed causing scrotal swelling. This is congealing and amassment of cold-dampness, obstruction of the channels and vessels, qì stagnation in the lower body, and water-dampness macerating in the scrotum.

Treatment method

Treatment method should be to transform qì, move water, warm the kidneys, and disperse cold. Wǔ Líng Sǎn (Five Ingredient Powder with Poria) masters it.


zhū líng (Polyporus) 6g
fú líng (Poria) 6g
zé xiè (Alismatis Rhizoma) 6g
bái zhú (Atractylodis macrocephalae Rhizoma) 6g
guì zhī (Cinnamomi Ramulus) 6g
shǎng roù guì (Cinnamomi Cortex) 3g

After taking one package, the scrotal swelling had deceased, and the pain stopped.


The term ‘mounting disease’ (疝病) was first introduced in the Nèi Jīng (Inner Classic). Today, this condition is referred to in western medicine as hernia, however the meaning of these two is not identical.

Physicians of later generations have had numerous names for mounting qì, and have always believed it to be a condition that is heavily related to the Jué Yīn liver channel, hence the saying “All mounting homes to the liver channel”. Treatment mainly involves, warming the liver, and coursing wood. However, we must carry out a concrete analysis in relation to this specific case. For example, this particular case of mounting disease belongs to a Tài Yáng water amassment pattern, and therefore wǔ líng sǎn (Five Ingredient Powder with Poria) masters it. This kind of treatment need not only be applied to children or males, but can also be adapted to fit changes in females. For example, with young woman experiencing lower abdominal cold, numbness, and heaviness and prolapse in the genitals, with paroxysmal pain, this may be a suitable treatment option.

In this particular case Dr. Fàn proceeded to treat from the hand-foot Tài Yáng channel by using wǔ líng sǎn with the ‘two guì’s’ (roù guì, guì zhī) in order to disinhibit water from the centre, and diffuse yáng qì. After only two packages, the patient completely recovered.

A Shào Yáng Fever-Fàn Zhōng-Lín (范中林)

Screen Shot 2012-02-11 at 4.15.37 PM.pngIn October of 1960, a 54-year-old male Chéng Dū resident presented at the clinic.

Over the last two years, this patient had been experiencing daily fevers immediately after eating breakfast, with temperatures around 38° C. These fevers would be accompanied by relatively copious sweating, which would continue for over two hours, and would subside as soon as the fever receded. Afterwards, a strong fear of cold was felt. This was an everyday occurrence.

In addition, he experienced, dizziness, a bitter taste in the mouth, a dry throat, fullness in the chest and ribs, and irritability. His tongue was red, with a sticky, white and slightly yellow tongue coat. His pulse was wiry and rapid.

He was seen at a local hospital, where he was diagnosed with fevers of unknown origin. No positive effects were seen from any of the treatments offered.

This is a Shào Yáng fever, and treatment should involve harmonizing and resolving the Shào Yáng. A modified version of xiǎo chái hú tāng (Minor Bupleurum Decoction) is appropriate.


chái hú (Bupleuri Radix) 24g
huáng qín (Scutellariae Radix) 10g
bàn xià (Pinelliae Rhizoma preparatum) 15g
shā shēn (Glehniae/Adenophorae Radix) 15g
gān cǎo (Glycyrrhizae Radix) 10g
zhī mǔ (Anemarrhenae Rhizoma) 15g
shí gāo (Gypsum fibrosum) 30g
mǔ lì (Ostreae Concha) 24g
chén pí (Citri reticulatae Pericarpium) 9g
fú líng (Poria) 12g

One package was administered.

After taking the one package, his fever had reduced, and most of his symptoms improved. He was advised that there was no need to continue the herbs, and that if he took care of himself, the condition would resolve. After a long period of time, the patient reported to Dr. Fàn, that the condition had never returned.

[Commentary] The signs and symptoms of bitter taste in the mouth, dry throat, dizziness, alternating cold and heat, bitter fullness in the chest and ribs, irritability, and a wiry pulse, are all very clear signs of a Shào Yáng channel pattern. This condition had lasted for over two years, so was treated according to the original lines of the Shāng hán lùn (傷寒論 Discussion of Cold Damage) where it states;

“When chái hú signs are still present, first administer xiǎo chái hú tāng (Minor Bupleurum Decoction)”. 

The presence of fevers with sweating, thirst, and a red tongue, signify the presence of depressed heat, and therefore, shēng jiāng (Zingiberis Rhizoma recens), and dà zǎo (Jujubae Fructus) were removed, and zhī mǔ (Anemarrhenae Rhizoma), and shí gāo (Gypsum fibrosum) were added in order to clear (heat). In addition, because the fullness in the chest and ribs was quite severe, damp pathogens were clearly also present, so mǔ lì (Ostreae Concha), chén pí (Citri reticulatae Pericarpium), and fú líng (Poria) were added to percolate dampness, transform stagnation, and disperse bind.

A Case of Wü Méi Wán (Mume Pill)

A case of the Fire spirit currents’ Fàn Zhōng-Lín%E4%B9%8C%E6%A2%85.jpg

Translated from ‘Five Steps to Cold Damage Treatment According to Pattern Identification’

A 39 year old male farmer from the Jīn Niú district of Chéng Dū city presented at the clinic: 

Step 1: Chinese medical diagnosis 

In August of 1977 in the last third of the month, while working in the fields, the patient suddenly felt discomfort throughout his entire body. He experienced cold extremities, dizziness, cold sweats, abdominal pain and borborygmus. Shortly after, he experienced continuous diarrhea, which frequently contained pus and bloody discharge. On September 2nd he came in for a consultation. 

Every day, the patient would have over ten bouts of diarrhea. The stools were quite loose, sticky and jelly like, which had a yellowish-red color. This was accompanied by abdominal pain, with urgency followed by heaviness. In addition, he experienced dry retching, heart vexation, thirst, and cold extremities. His tongue was dark pale with a slightly red tip, with a yellow, slippery and thick coating. 

Step 2: List of Disease Mechanisms 

Dry retching, heart vexation, nausea, slightly red tongue tip, are all associated with upper heat. 

Reversal cold in the body and extremities, cold pain in the lower abdomen, clear-thin diarrhea, which are all described as ‘white’, ‘cold’, and ‘freezing’, are obvious signs associated with lower cold. 

This is one hundred percent an obvious case of upper heat and lower cold. Jué yīn is the qi of wind and wood that when vigorous will cause wind pathogens to flee to the upper (body). 

[Plain Questions-Treatise on Tài yīn and Yáng míng] says: 

“When one is invaded by a robber wind or depletion evil, yáng receives it. When food and drink are consumed without restraint, when rising and resting occur out of time, yīn receives it. When yáng receives it, then it enters the six bowels. 

When yīn receives it, then it enters the five viscera. When it enters the five viscera, then distension and blockage result. In the lower [body] it causes outflow of [undigested] food, and when enduring causes intestinal afflux (dysentery)”.

From this passage we can see that intestinal afflux is commonly due to the exploitation of yīn and yáng, with signs of intermingling cold and heat. 

In summary, the disease mechanism involved is the lack of mutual connection between the qi of yīn and yáng. The upper belongs to yáng, and pure yáng is heat; the lower belongs to yīn, and pure yīn is cold. Therefore, “When Jué yīn prevails” intestinal afflux will occur. 

Step 3: Comprehensive Analysis 

This is a pattern of cold and heat mixing causing intestinal afflux, with the disease in the Jué yīn level. 

Step 4: Formula According to Pattern 

The appropriate method of treatment is to eliminate evils and support the right using both cold and warm medicinals. Wü méi wán (Mume Pill) governs. 

Step 5: Medicinals According to Pattern 


wü méi (Mume Fructus) 30g

xì xïn (Asari Herba) 6g

gän jiäng (Zingiberis Rhizoma) 30g

huáng lián (Coptidis Rhizoma) 12g

däng guï (Angelicae sinensis Radix) 10g

zhì fù piàn (Aconiti Radix lateralis preparata) 60g (extended cooking)

shǔ jiāo (Zanthoxyli Pericarpium) 6g

guì zhï (Cinnamomi Ramulus) 10g

dâng shën (Codonopsis Radix) 12g

huáng bâi (Phellodendri Cortex) 10g 

2 packages were prescribed, and the patient was asked to refrain from eating oily, raw, cold and strong smelling foods (onions, garlic, leeks, etc.). 

After taking two packages of the formula, his intestinal afflux had resolved. On follow up consultation with the patient in June, 1979, he reported that in the year since his recovery, there had been no relapse of the condition. 


Wü méi wán (Mume Pill) is said to “govern enduring diarrhea”, yet in this case enduring diarrhea was not present.

Then why was this formula chosen?

Generally speaking in patterns of Jué yīn diarrhea there simply must be reversal. Enduring diarrhea is usually seen in patterns where there is a mixture of cold and heat, for which it is appropriate to use a combination of cooling and warming methods by mixing both cool and warm formulas. 

This was not a case of enduring diarrhea, but was originally seen as a Jué yīn condition with both cold and heat signs present. Wü méi wán (Mume Pill) is a formula which cools, warms and supplements simultaneously. Acrid, sour, sweet and bitter flavours are all present in the formula. The formula was correct for this presentation and therefore by adapting to the original formula, we were able to obtain positive results.

In actual fact, Wü méi wán (Mume Pill) has been used by countless physicians of past and present to treat various disorders, especially diarrhea, and its use is continuously expanding. 

Take the ‘Important Formulas Worth a Thousand Gold Pieces’ (千金方Qiān Jīn Fāng) for example, where it discusses Zhang Zhong-Jing’s concept of using wū méi (Mume Fructus) and huáng lián (Coptidis Rhizoma) in heat type diarrhea, combined with fù zǐ (Aconiti Radix), gān jiāng (Zingiberis Rhizoma), etc. in cases of deficient cold natured enduring diarrhea. 

The ‘Comprehensive Recording of Divine Assistance’ (圣济总录 Shèng Jì Zŏng Lù), mentions Wü méi wán (Mume Pill) for the treatment of unceasing post-partum cold and heat type diarrhea. 

In the ‘Standards for Diagnosis and Treatment’ (证治准绳 Zhèng Zhì Zhŭn Shéng), this formula is used for treating coughing issuing from the stomach and the vomiting of long worms. 

The Japanese physician Zhì Jiān-Huàn says that generations of physicians have had great difficulties in treating stomach reflux, and that this is an extraordinary formula for treating this pattern. (quoted from the Initial Draft of Lectures on Cold damage). 

According to Rèn Yìng-Qiū, Wü méi wán (Mume Pill) functions to strengthen the stomach and intestines, reduce inflammation and kill worms, and when used to treat chronic diarrhea, can achieve positive results. (Interpretation of the Shāng Hán Lùn). 

In the past, there have also been reports of using this formula in treating cases of chronic colitis of fifteen years.

From the above, we can see that the scope of using Wü méi wán (Mume Pill) is by no means limited to just treating roundworm reversal and enduring diarrhea, and in actual fact it’s use is continuously expanding. 

A case of Shao-Yin Infertility

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.


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.


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.


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.


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

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.


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.