Chén Xiūyuán on Gùi Líng Wǔ Wèi Gān Cǎo Tāng

On March 18, 2022March 18, 2022 By eranevenIn Chén Xiūyuán (陈修园), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Jīng Fāng (经方), Translations & Writings (译著与文章)

桂苓五味甘草湯
Guì Líng Wǔ Wèi Gān Cǎo Tāng
Cinnamon Bark, Poria, Schisandra, and Licorice Decoction

治青龍湯下已, 多唾口燥, 寸脈沉, 尺脈微, 手足厥逆, 氣從少腹上衝胸咽, 手足痹, 其面翕熱如醉狀, 因復下流陰股, 小便難, 時復冒者, 與此湯, 治其氣衝。

A treatment for when after taking xiǎo qīng long tāng there is copious spittle, a dry mouth, a deep pulse at the inch opening and a faint pulse at the cubit position. [In addition] there is reverse counterflow in the hands and feet, qi surging up from the lower abdomen to the chest and throat, impediment in the extremities, a red flushed face as if drunk, and because of repeated downpour into the groin, there is difficult urination, and periodically recurring muddledness. Give this decoction to treat the surging qi.

按: 脈沉微, 支厥痹, 面如醉, 氣衝時復冒, 似少陰陰陽不交之症, 學者可於臨症時參辨之則可。

Commentary: [When there is] a deep and faint pulse, propping [rheum] with reversal impediment,
a face as if drunk, and qi surging with periodic muddledness, this resembles a pattern of
non-interaction between the yīn and yang of shaoyīn. When arriving at these patterns, students can
compare and differentiate these principles.

Guì Zhī 4 liǎng 桂枝
Fú Líng 4 liǎng 茯苓（各四兩）
Wǔ Wèi [Zǐ] 五味[子] 1/2 shēng（半升）
Zhì Gān Cǎo 3 liǎng 甘草（三兩, 炙）

上四味, 以水八升, 煮取三升, 去滓, 分溫三服。

Simmer the four ingredients above in 1,600ml of water, until reduced to 600ml. Remove the dregs, divide, and take warm in three doses.

Song歌曰:

青龍卻礙腎元虧,
腎元虧而誤服之,
則動衝任之火,
致變為已下諸証。
上逆下流又冒時;
氣從少腹上衝胸咽,
或面熱如醉,
或熱氣流於兩股,
或小便難而昏冒,
忽上忽下,
在陽無主,
如電光之閃爍無定,
味用半升苓桂四,
甘三扶土鎮衝宜。

Xiǎo Qīng Lóng Tāng may cause (further) depletion to the original (qì) of the kidney.
(Original kidney qi was debilitated, and (Xiǎo Qīng Lóng Tāng) was erroneously administered.
This led to the stirring and surging of conception vessel fire,
which changed into one of the various patterns (which follow) administration].
Ascending counterflow with downpour, in addition to periodic muddledness,
[qi surging upward from the lower abdomen into the chest,
or a red flushed face as if drunk,
or warm qi flowing into the groin,
or difficult urination, and clouded veiling,
which fluctuate sharply, are (the result) of yáng not ruling,
and is unpredictable like the flickering of lightening].
100ml of wǔ wèi zǐ, twelve grams of fú líng and guì zhī,
and nine grams of gān cǎo, are suitable to support earth and settle the surging.

Commentary by (Chén) Yuánxī 男元犀按:

仲師五味子必與乾薑同用, 獨此方不用者, 以誤服青龍之後衝氣大動, 取其靜以制動, 故暫停不用也。尤雲: 苓、桂能抑衝氣使之下行, 然逆氣非斂不降, 故以五味之酸斂其氣, 土厚則陰火自伏, 故以甘草之甘補其中也。

Master (Zhàng) Zhōng Jǐng’s wǔ weì zǐ is always combined with gān jiāng (however) in this formula (gān jiāng) is not used. Following the erroneous administration of Xiǎo Qīng Lóng Tāng, there is major stirring of surging qì. Take this (formula) to tranquilize in order to control the stirring, and once it stops, there is no need to (continue) taking it. Yóu Zàijīng says: fú líng, and guì zhī are able to control surging qì allowing it to move downwards, and (if) counterflow qì fails to go down due to a lack of restraint, sour wǔ wèi zǐ is used to restrain it. (Once) earth is thickened, yīn fire will conceal on its own, and for this reason sweet gān cǎo is used to supplement earth.

Huáng Yuányù discusses Bǎi Hé

On January 20, 2022February 17, 2022 By eranevenIn Formulas (方剂), Huáng Yuányù (黃元御), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)

With today being the arrival of ‘Major Cold ‘(大寒 – the 24th solar term in the Chinese calendar lasting until Feb 3), what better day than today, to sit down with a cup of warm Wulong or Hongcha to translate passages from some of my favourite books.
The following is a direct translation from the Bǎi Hé section of Huáng Yuányù’s (1705-1758) excellent ‘Interpretation of Medicinals’ (黃元御藥解).

Huáng Yuányù discusses Bǎi Hé

– Translated from Huáng’s Interpretation of Medicinals (黃元御藥解)

百合　味甘、微苦，微寒，入手太陰肺經。涼金瀉熱，清肺除煩。

Bǎi Hé – Sweet flavour, slightly bitter and slightly cold. Enters the hand Taiyin lung channel. Cools metal, drains heat, clears the lungs and eliminates vexation.

金匱百合知母湯，百合七枚，知母二兩。治百合病，發汗後者。傷寒之後，邪氣傳變，百脈皆病，是為百合。其證眠食俱廢，吐利皆作，寒熱難分，坐臥不安，口苦便赤，心煩意亂，不能指其為何經何臟之病也。然百脈之氣，受之於肺，肺者，百脈之宗也，是宜清肺。其在發汗之後者，津枯而金燔。百合清肺而生津，知母涼金而瀉熱也。

The Jīn Guì’s Bǎi Hé Zhī Mǔ Tāng

Bǎi Hé 7 pieces
Zhī Mǔ 2 liǎng [listed as 3 liǎng in the Jīn Guì Yào Lüè]

Treats Bǎi Hé disease following the induction of sweat. Following cold damage, pathogenic qi shifts, and the hundred vessels are diseased. This is Bǎi Hé [disease]. Its symptoms present with disturbance to sleep and appetite, the occurrence of diarrhea and vomiting, difficulty differentiating between cold and heat, disquietude whether sitting or laying down, a bitter taste in the mouth, red urination, heart vexation, and a confused state of mind, with an inability to point to any specific channel or visceral disease. Now, the qi of the hundred vessels is received in the lungs, as the lungs are the ancestor of the hundred vessels. Thus, it is appropriate for the lungs to be clear. Following the promotion of sweat, the fluids [may be] desiccated and metal burned. Bǎi Hé clears the lungs and generates fluids. Zhī Mǔ cools metal and drains heat.

滑石代赭湯，百合七枚，滑石三兩，碎，代赭石如雞子大。治百合病，下之後者。下敗中脘之陽，土濕胃逆，肺熱鬱蒸。百合清肺而瀉熱，滑石、代赭，滲濕而降逆也。

Huá Shí Dài Zhě Tāng

Bǎi Hé 7 pieces
Huá Shí 3 liǎng (broken)
Dài Zhě Shí (a pellet sized piece)

Treats Bǎi Hé disease following purgation. Purgation damages the yang of the central stomach duct, [resulting in] earth-damp counterflow [of the] stomach and depressed steaming lung heat. Bǎi Hé clears the lungs and drains heat; Huá Shí and Dài Zhě percolate dampness and downbear counterflow.

百合雞子湯，百合七枚，煎湯，入雞子黃一枚，攪勻，煎。治百合病，吐之後者。吐傷肺胃之津，金土俱燥。百合清肺熱而生津，雞子黃補脾精而潤燥也。

Bǎi Hé Jī Zǐ Tāng

Bǎi Hé 7 pieces
Boil the decoction and add one egg yolk, blend until smooth, and boil. Treats Bǎi Hé disease following vomiting. Vomiting damages the fluids of the lungs and stomach, resulting in the dryness of both metal and earth. Bǎi Hé clears the lungs and generates fluids. Jī Zǐ Huáng [egg yolk] supplements spleen essence and moistens dryness.

百合地黃湯，百合七枚，生地黃汁一斤。入百合湯，煎服。大便當如漆。治百合病，不經發汗吐下，病形如初者。不經發汗吐下，而瘀熱淫蒸，敗濁未泄。百合清肺而瀉熱c生地黃汁涼瀉腸胃而下垢濁也。

Bǎi Hé Dì Huáng Tāng

Bǎi Hé 7 pieces
Shēng Dì Huáng juice 1 jīn [listed as 1 shēng in the Jīn Guì Yào Lüè]
Add to Bǎi Hé decoction, boil and take. The stools should be like lacquer. Treats Bǎi Hé disease when neither sweating, vomiting or purgation have been used, and the disease appears as in the beginning. [Here] sweating, vomiting or purging have not been used and there is excess steaming of stasis heat [as well as] turbidity [which] has not been drained. Bǎi Hé clears the lungs and drains heat, while the juice of Shēng Dì cools and drains the stomach-intestines, and purges foul turbidity.

百合洗方，百合一斤。水一斗，漬一宿，洗身。洗後食煮餅，勿以鹽。治百合病，一月不解，變成渴者。火炎金燥，則肺熱不解，變而為渴。肺主皮毛，百合洗皮毛，以清肺熱也。

Bǎi Hé Xǐ Fāng [Lily bulb wash]

Bǎi Hé 1 jīn [listed as 1 shēng in the Jīn Guì Yào Lüè]
Use 1 dǒu of water and soak overnight. Use [the liquid] to bathe the body. After bathing, eat boiled cake, and avoid salt. Treats Bǎi Hé disease, which has not resolved within a month, and has resulted in thirst. [Here] fire flares and dries metal, resulting in lung heat which fails to resolve, leading to thirst. The lungs govern the skin and hair, and the Bǎi Hé is used to wash the skin and hair, thereby clearing lung heat.

百合滑石散，百合一兩，滑石二兩。為散，飲服方寸匕，日三服。微利，止服，熱則除。治百合病，變發熱者。濕動胃逆，肺郁生熱。百合清金而瀉熱，滑石利水而除濕也。

Bǎi Hé Huá Shí Sǎn

Bǎi Hé 1 liǎng
Huá Shí 2 liǎng [listed as 3 liǎng in the Jīn Guì Yào Lüè]
Powder [the ingredients], and take a square-inch spoonful in liquid, three times per day. When there is slight diarrhea, stop taking, as [this indicates that] heat has been eliminated. Treats Bǎi Hé disease, which has transmitted into heat effusion. [When] dampness is stirred, the stomach runs counterflow, resulting in lung depression that generates heat. Bǎi Hé clears metal and drains heat; Huá Shí disinhibits water and eliminates dampness.

百合涼金潤燥，瀉熱消郁，清肅氣分之上品。其諸主治，收涕淚，止悲傷，開喉痹，通肺癰，清肺熱，療吐血，利小便，滑大腸，調耳聾耳痛，理脅癰乳癰、發背諸瘡。
水漬一宿，白沫出，去其水，更以泉水煎湯用。

Bǎi Hé is a superior medicinal, which cools metal, moistens dryness, drains heat, disperses depression, and depurates the qi layer. It’s various treatments include stopping tearing, stopping sadness, opening throat impediment, disinhibiting welling-abscess of the lung, clearing lung heat, treating vomiting of blood, disinhibiting urination, lubricating the large intestine, controlling deafness and ear pain, rectifying subcostal and breast welling-abscesses, and effusing the back of various sores. Steep Bǎi Hé in water overnight. [When] white foam appears, discard the water, and then decoct with spring water and use.

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Huáng Huáng’s Use of Guì Zhī Fú Líng Wán in Respiratory Conditions

On December 8, 2021 By eranevenIn Case Studies （医案), Formulas (方剂), Huáng Huáng (黃煌), Jīn Guì Yào Lüè (金匱要略), Jīng Fāng (经方), Translations & Writings (译著与文章)

Cinnamon Twig and Poria Pill (guì zhī fú líng wán)

Indications: Bronchial asthma, chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, pleurisy, pleural effusion, interstitial pneumonia, pulmonary fibrosis, and recurrent pulmonary infections typically manifesting with a dark-red complexion, a stifling sensation and pain in the chest, purple lips and a dark tongue. This formula has a blood invigorating, stasis transforming effect, which can improve the blood supply of the heart and lungs.

Usage & Modifications:

1. Patients for whom this formula is suitable tend to have a red or purple-red complexion, abdominal fullness, resistance to pressure in the lower left abdomen with possible tenderness, headaches, dizziness, insomnia, irritability, restlessness, stirring palpitations, and a dark tongue body with possible purple spots.

2. For patients that experience diarrhea after taking the formula, have them take in after meals or decrease the dosage.

3. Use with caution in pregnancy.

4. Modifications:

If there is a stifling sensation and pain in the chest, a chronic cough, and a wan and sallow complexion, add Angelicae sinensis Radix (dāng guī) 15g, Chuanxiong Rhizoma (chuān xiōng) 15g, and Salviae miltiorrhizae Radix (dān shēn) 15g

If there is a stifling sensation in the chest, abdominal distention, and an oily complexion, add Citri reticulatae Pericarpium (chén pí) 20g, Aurantii Fructus (zhǐ ké) 20g, and Zingiberis Rhizoma recens (shēng jiāng) 20g

If there is a stifling sensation in the chest and constipation, add Aurantii Fructus (zhǐ ké) 20g, Allii macrostemi Bulbus (xiè bái) 20g, and Trichosanthis Fructus (quán guā lóu) 30g.

Representative Case History:

Yu, 74-year-old male, 160cm/70kg.

Initial consultation on June 5, 2018

Chief complaint: Recurrent cough and wheezing for 9 years, with dyspnea, an inability to climb stairs quickly, and abdominal distention following meals.

History: In April 2018 during a hospital visit, he was diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD), arrhythmia, atrial fibrillation, cardiac insufficiency, heart valve disease, and a fatty liver.

Signs: average build, dark, red and oily complexion, obvious bags under the eyes, purple-dark lips and tongue, stasis marks under the tongue, abdominal fullness, and resistance to pressure in the lower costal arch (flanks).

Prescription: Cinnamomi Ramulus (guì zhī) 10g, Cinnamomi Cortex (ròu guì) 10g, Poria (fú líng) 20g, Paeoniae Radix rubra (chì sháo) 20g, Moutan Cortex (mǔ dān pí) 15g, Persicae Semen (táo rén) 15g, Angelicae sinensis Radix (dāng guī) 15g, Chuanxiong Rhizoma (chuān xiōng) 15g, Salviae miltiorrhizae Radix (dān shēn) 15g, Aurantii Fructus (zhǐ ké) 30g, Citri reticulatae Pericarpium (chén pí) 30g, Zingiberis Rhizoma (gān jiāng) 10g; 15 packets.

Second consultation on June 25, 2018: After taking the herbs, his breathing was smooth and easy, however cough and wheezing were still present, but he was still able to play mah-jong. The same formula was continued.

Third consultation on August 20, 2018: No labored breathing when walking and he was able to climb 3 floors. The stasis marks under his tongue had improved.

Musings on Bēn Tún Tāng

On April 10, 2021 By eranevenIn Formulas (方剂), Huáng Yuányù (黃元御), Jīn Guì Yào Lüè (金匱要略)

A formula I’ve been quite intrigued with for many years, and use quite often in clinic, is Bēn Tún Tāng from the Jīn Guì Yào Lüè. The following is a short translation from one of my favourite Qīng dynasty scholar/physicians Huáng Yuán-Yù, followed by some brief clinical musings written by myself.

Huáng Yuán-Yù on Bēn Tún Tāng

Translated from the Cháng Shā Yào Jiě (长沙药解)

The Golden Cabinet’s Bēn Tún Tāng

Gān Cǎo 2 liǎng

Bàn Xià 4 liǎng

Shēng Jiāng 4 liǎng

Shēng Gé (Gēn) 5 liǎng

Huáng Qín 2 liǎng

Xiōng Qióng 2 liǎng

Dāng Guī 2 liǎng

Sháo Yào 2 liǎng

Gān Lǐ Gēn Bái Pí 1 jīn

This formula treats Bēn Tún qi, with surging into the chest, abdominal pain, and alternating heat and cold. When yang collapses, and the spleen is vanquished, (this causes) sinking and obstruction in Liver-wood, wood qi depressed effusion, and surging from the umbilicus, abdomen, chest and diaphragm, (resulting in) pain and concurrent heat and cold. Because Liver-wood surges upwards, both the stomach and gall-bladder run counterflow, and the Shaoyang is depressed and distressed, this results in a struggle between the interior and the yin, and this ongoing battle manifests with alternating cold and heat. The qi of Jué Yīn is wind-wood. When wind stirs it consumes the blood, and when warmth is depressed, it results in heat. Gān Cǎo supplements the earth and moderates the center; Shēng Jiāng and Bàn Xià descend stomach and gall-bladder counterflow; Huáng Qín and Shēng Gé (Gēn) clear depressed heat in the stomach and gall-bladder; Xiōng Qióng and Sháo Yào course wood and moisten wood dryness; Gān Lǐ Gēn Bái Pí clears the liver and descends surging qi.

Gān Lǐ Gēn Bái Pí is sweet, cold, collecting and astringent. It is excellent at descending the surging qi of Jué Yīn, which can therefore treat bēn tùn. It is mainly indicated for alleviating thirst, eliminating vexing counterflow, arresting dysentery, and stopping vaginal discharge.

Notes:

In my experience, Bēn Tùn (running piglet) can be both objective and subjective. Subjective in that the patient will feel some sort of rush that starts in the lower body, and rises either to the chest, throat, or face. It’s pretty hard to get a patient to tell you that they feel a surging sensation from their lower abdomen to their chest. Some do, but it’s not something I hear very often. Anxiety can manifest this way for some people, while some will tell you that they get facial redness, slightly dizzy or a bit of a rush when they are nervous. Another possibility for some is that this sensation, or ‘rush’ can cause patients to become anxious. I would interpret these manifestations as a form of running piglet.

However, running piglet is also objective, manifesting in several ways such as; sudden sweating, facial redness, epigastric pain, chest tightness, shortness of breath, dizziness, headaches/migraines, premenstrual acne, etc.

This is due to a wood-earth pathology, where wood is abundant, which damages the earth, hence we see the abdominal pain. Since we have a Shào Yáng element here, there is alternating heat and cold (往来寒热), which can be interpreted the way Huáng Huáng (黄煌) does in that this alternating heat and cold can refer to anything that alternates, or occurs cyclically. This is a major feature of the Shào Yáng, and so having someone that breaks out into sweats, gets cyclical acne, cyclical migraines, anxiety attacks, etc., that is due to a wood-earth pathology, Bēn Tùn Tāng is a great choice.

In addition, we have an element of a Jué Yīn pathology as well just to complicate things. Here, blood was affected which left a slight blood deficiency and when there is not enough blood and wood-qi tries to move, this can get stuck and lead to heat (which is the flaring of ministerial fire).

Sāng Bái Pí is the most common substitute for the Gān Lǐ Gēn Bái Pí. Some doctors like Hu Xi-Shu used Chái Hú as they saw this pattern as a Shào Yáng-Tài Yīn concurrent pattern, and added Chái Hú to clear Shào Yáng heat from the chest. I personally use Sāng Bái Pí, as I feel that due to the flaring of ministerial fire, there is a bit of heat in the lungs and adding Sāng Bái Pí ensures that it gets cleared but also that metal descends. With the Spleen-earth affected, ascent and descent in the entire body is affected and we always need to make sure that the proper physiological wheel keeps turning.

Zé Xiè Tāng from the Jīn Guì Fāng Gē Kuò

On December 1, 2017November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)Leave a comment

澤瀉湯

Zé Xiè Tāng

Alisma Decoction

治心下有支飲, 其人苦冒眩者, 主之。

A treatment for propping rheum below the heart, where the person suffers from veiling dizziness, (this formula) rules it.

澤瀉（五兩）白朮（二兩）

zé xiè	澤瀉		15g
bái zhú	白朮		6g

上二味, 以水二升, 煮取一升, 分溫再服。

Simmer the two ingredients above in 400 ml, until reduced to 200 ml. Divide and take heated in two doses.

Song 歌曰:

清陽之位飲邪乘, 眩冒頻頻苦不勝; 澤五為君朮二兩, 補脾制水有奇能。

The location of clear yáng has been overwhelmed by the presence of pathogenic rheum, causing (one to) suffer from frequent veiling dizziness which is difficult to endure; fifteen grams of the sovereign zé xiè and six of bái zhú, have the special ability of supplementing the spleen and controlling water.

Commentary by Lín Lǐfēng[1] 受業林禮豐按:

心者, 陽中之陽。頭者, 諸陽之會。人之有陽氣, 猶天之有日也。天以日而光明, 猶人之陽氣會於頭而目能明視也。夫心下有支飲, 則飲邪上蒙於心, 心陽被遏不能上會於巔, 故有頭冒目眩之病。仲師特下一“苦”字, 是水陰之氣\\盪漾於內, 而冒眩之苦有莫可言傳者, 故主澤瀉陽。蓋澤瀉氣味甘寒, 生於水中, 得水陰之氣而能利水, 一莖直上, 能從下而上, 同氣相求, 領水陰之氣以下走, 然猶恐水氣下而復上, 故用白朮之甘溫, 崇土制水者以諸之, 猶治水者之必筑堤防也。古聖用方之妙, 有如此者; 今人反以澤瀉利水伐腎, 多服傷目之說疑之。其說創於宋元諸醫, 而李時珍、張景岳、李士材、汪讱庵輩和之, 貽害至今弗熄。然天下人信李時珍之《本草》者, 殆未讀《神農本草經》耶? 余先業師《神農本經小注》最詳, 願業斯道者, 三復之而後可。

The heart is yáng within yáng; the head is the gathering place of all yáng. Humans have yáng qì, as heaven has the sun. Heaven, by means of the sun is bright, as such human\’s yang qì gathers in the head and eyes providing bright vision. When there is propping rheum below the heart, water rheum will ascend and cloud the heart obstructing heart yáng, which is (then) unable to gather at the top of the head, causing dizziness and dizzy vision. Master Zhòng used the following character “苦” (kǔ) to convey the suffering of dizziness, (resulting from) the qì of water yīn agitating and flowing into the interior. This is ruled by zé xiè tāng. The qì and flavor of zé xiè tāng is sweet and cold, and since it grows in water, where it obtains the qi (of water yīn), it is able to disinhibit water. (Similar to the way) the stalk ascends vertically it can (help) bring the qì together from the bottom to the top and guide the qì of water yīn in its downward movement. However (with) fear of water rising again after it has descended, sweet and warm bái zhú is used so earth can restrain the various forms of water so while still treating water, an embankment is built. The ancient sages were very clever in using formulas like these.
People nowadays, are administering copious amounts of zé xièto disinhibit water and quell the kidneys, which damages the objective (of this) doctrine and (creates) doubt (of its effectiveness). This doctrine began with the physicians of the Sóng[2]and Yuàn[3]dynasties, as well as contemporaries such as Lǐ Shízhēn[4], Zhāng Jǐngyuè[5], Lǐ Shìcái[6], and Wāng Rènān[7], who have left a legacy, which has yet to die even to the present day. Even though people of the world trust the words of Lǐ Shízhēn’s Běn Cǎo, why have almost (none of them) read the Shén Nóng Běn Cǎo Jīng? My passed masters’ copy of the classic was annotated with extreme detail, and it is my hope that one follows this way in their course of study, repeatedly returning to (the classic).

[1] Lín Lǐfēng was believed to be a student of Chén Xiūyuán. The characters 受業can be translated as ‘to receive instructions’, ‘to study’, ‘to learn from a master’, or as a first pronoun as ‘I’, or ‘your student’, often used as a title by a teachers’ disciple. I have opted to translate this as the latter, but in the interest of keeping the translation clean, have left is as commentary by Lín Lǐfēng, as opposed to ‘Commentary by I (your student) Lín Lǐfēng’.

[2] Sòng Dynasty (960–1179 A.D.)

[3] Yuán (Mongol) Dynasty (1260–1368 A.D.)

[4] Lǐ Shízhēn (1518-1593), Míng botanist and pharmacologist, as well as the author of the Compendium of medical herbs 本草綱目

[5]Late Míng dynasty physician who wrote several books including the ‘Rectification of the Materia Medica’本草正

[6] Míng dynasty phyisician who wrote several books including the ‘Essential Knowledge from the Inner Classic’內經知要

[7] Wāng Áng (1615-1694), Late Míng and early Qīng dynasty physician who wrote the ‘Essentials of the Materia Medica’ 本草備要

膠艾湯 Jiāo Ài Tāng from the Jīn Guì Fāng Gē Kuò

On August 26, 2014November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)1 Comment

The following is another teaser from the book, which will most likely be the last, as we are literally in the final stages of publishing. The book should be set free into the world within the next few weeks. ai+ye.jpg

膠艾湯

Jiāo Ài Tāng

Donkey-Hide Gelatin and Mugwort Decoction

治婦人有漏下者，有半產後因續下血都不絕者，有妊娠下血者，假令妊娠腹中痛，為胞阻，以此湯主之。

A treatment for women with [either] spotting, incessant blood descent following late miscarriage, or blood descent in pregnancy. If [there is] abdominal pain in pregnancy, [then] this is uterine obstruction, and this decoction rules it.

乾地黃（六兩）川芎阿膠甘草（各二兩）艾葉當歸（各三兩）芍藥（四兩）

gān dì huáng	乾地黃	18g
chuān xiōng	川芎	6g
ē jiāo	阿膠	6g
gān cǎo	甘草	6g
ài yè	艾葉	9g
dāng guī	當歸	9g
sháo yào	芍藥	12g

上七味，以水五升、清酒三升，合煮取三升，去滓，內膠令消盡，溫服一升，日三服，不差更作。

Simmer the seven ingredients above in 1,000ml of water with 600ml of clear wine, until reduced to 600ml. Remove the dregs, and dissolve the ē jiāo in the decoction. Take 200ml warm, three doses per day, and repeat if [the condition] fails to resolve.

Song 歌曰:

妊娠腹滿阻胎胞，名曰胞阻，以胞中氣血虛寒，而阻其化育也。二兩芎藭草與膠，歸艾各三芍四兩，地黃六兩去枝梢。

Abdominal fullness in pregnancy with fetal obstruction, this is called fetal obstruction, which is the result of qì and blood vacuity with cold, which hinders the growth and development of the fetus. Six grams chuān xiōng*, gān cǎo, and ē jiāo, nine grams each of dāng guī and ài yè, twelve of sháo yào, and eighteen of dì huáng eliminates the tip of the branch.

Commentary by [Chén] Yuánxī男元犀按：

芎藭、芍、地，補血之藥也；然血不自生，生於陽明水谷，故以甘草補之。阿膠滋血海，爲胎産百病之要藥；艾葉暖子宮，爲調經安胎之專品，合之爲厥陰、少陰、陽明及衝任兼治之神劑也。後人去甘草、阿膠、艾葉，名爲四物湯，則板實而不靈矣。

Chuān xiōng , sháo yào, and dì huáng are blood-supplementing medicinals. Blood is not generated on its own, but is engendered from water and grains in yángmíng therefore, gān cǎo is used to supplement [yángmíng]. Ē jiāo enriches the sea of blood, and is a very important medicinal for treating various pregnancy related diseases. Ài yè warms the uterus, and is a specific medicinal to regulate menstruation and calm the fetus. This is a divine formula, which unites juéyīn, shàoyīn and yángmíng, and simultaneously treats the thoroughfare and controlling vessel. In later times, people have removed the gān cǎo, ē jiāo and ái yé, renaming it Sì Wù Tāng, making this formula stiff, bound and ineffective!

*Although the Chinese above says xiōng qiáng 芎藭, I have opted to translate this medicinal using its alternate, more common name chuān xiōng 川芎, and will appear as such in the remainder of the text.

溫經湯 Wēn Jīng Tāng (Channel Warming Decoction)

On June 23, 2014November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)Leave a comment

It’s been a while since I’ve posted anything up here. Now it’s not that I’ve been intentionally neglecting the site, but these days have been quite busy moving house, finishing up my book, and well, life!

Here’s another teaser from my upcoming translation of Chén Xiūyuán’s Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), which should be released this summer.

溫經湯

Wēn Jīng Tāng

Channel Warming Decoction

治婦人年五十所, 病下利數十日不止, 暮即發熱, 少腹裡急, 腹滿, 手掌煩熱, 唇口乾燥, 此屬帶下。何以故? 曾經半產, 瘀血在少腹不去。何以知之? 其証唇口乾燥, 故知之, 當以此湯主之。

A treatment for women in their fifties who suffer from incessant diarrhea more than ten times per day, with heat effusion in the evening, lesser abdominal urgency, abdominal fullness, vexing heat in the palms, and dry lips and mouth. This belongs to women’s diseases. What is the reason? There was a history of late miscarriage and static blood now remains in the lesser abdomen. How can one know this? The pattern manifests with dry lips and mouth, and this is how one knows this, and this formula rules it.

吳茱萸（三兩）當歸芎藭芍藥人參桂枝阿膠丹皮甘草（各二兩）生薑（三兩。一本二兩）半夏（半升。一本二升）麥冬（一升）

wú zhū yú	吳茱萸	9g
dāng guī	當歸	6g
xiōng qióng	芎藭	6g
sháo yào	芍藥	6g
rén shēn	人參	6g
guì zhī	桂枝	6g
ē jiāo	阿膠	6g
dān pí	丹皮	6g
gān cǎo	甘草	6g
shēng jiāng	生薑	9g[1]
bàn xià	半夏	100ml[2]
mài dōng	麥冬	200ml

十二味, 以水一斗, 煮取三升, 分溫三服。亦主婦人少腹寒, 久不受胎; 兼治崩中去血, 或月水來多, 及至期不來。

Simmer the eleven ingredients above in 2,000ml of water until reduced to 600ml. Divide and take heated in three doses. It also rules (the treatment) of lesser abdominal cold in women, infertility, and simultaneously treats flooding, copious menstruation, as well as delayed menstruation.

Song 歌曰:

溫經芎芍草歸人, 膠桂丹皮二兩均, 八物各二兩。半夏半升麥冬倍用, 生薑吳茱萸三兩對君陳。

For wēn jīng tāng (use) chūan xiōng, sháo yào, gān cǎo, dāng guī, rén shēn, ē jiāo, guì zhī, and dān pí each at six grams, (6 grams for each of the eight medicinals). Use 100ml of bán xiá and double of mài dōng, plus nine grams each of shēng jiāng and wú zhū yú.

Commentary by (Chén) Yuánxī男元犀按:

方中當歸、芎藭、芍藥、阿膠, 肝藥也; 丹皮、桂枝, 心藥也; 吳茱萸, 肝藥亦胃藥也; 半夏, 胃藥亦衝藥也; 麥門冬、甘草, 胃藥也; 人參補五臟, 生薑利諸氣也。病在經血, 以血生於心, 藏於肝也, 衝為血海也。胃屬陽明, 厥陰衝脈麗之也。然細繹方意: 以陽明為主, 用吳茱萸驅陽明中土之寒, 即以麥門冬滋陽明中土之燥, 一寒一熱, 不使偶偏, 所以謂之溫也; 用半夏、生薑者, 以薑能去穢而胃氣安, 夏能降逆而胃氣順也; 其余皆相輔而成溫之之用, 絕無逐瘀之品。故過期不來者能通之, 月來過多者能止之, 少腹寒而不受胎者並能治之, 統治帶下三十六病, 其神妙不可言矣。

Within the formula, dāng guī, chūan xiōng, sháo yào and ē jiāo are all liver medicinals; dān pí and guì zhī are heart medicinals; wú zhū yú is both a liver and stomach medicinal; bán xiá is both a stomach and thoroughfare (vessel) medicinal; mài dōng and gān cǎo are stomach medicinals; rén shēn supplements the five viscera, and shēng jiāng disinhibits all qì. Disease is in the menstrual blood. Blood is engendered in the heart, stored in the liver, and the thoroughfare vessel is the sea of blood. The stomach belongs to yáng míng, and is linked[3]to both the jué yīn and the thoroughfare vessel. Now (we must) carefully examine the meaning of the formula. As (the condition) is ruled by yáng míng, wú zhū yú is used to expel cold from yáng míng center earth, while mài dōngenriches dryness within yáng míng center earth – one cold and one hot medicinal. (While being) neither too cold nor too warm, (the formula) is (still) referred to as warm. As for the usage of bán xiá and shēng jiāng, shēng jiāng eliminates foulness and calms stomach qì, while bán xiá is able to downbear counterflow and smooth stomach qì. The remaining (medicinals) are used to assist in warming, and are by no means ingredients for expelling stasis. Therefore, with delayed menstruation, (this formula) is able to free it and with excessive menstruation, it is able to stop it. It is (also) able to treat lower abdominal cold and infertility, and for the thirty-six women’s diseases, its marvel is too wonderful for words!

[1]Another edition uses 6g

[2]Another edition uses 400ml

[3]麗: 系, 此為相聯系。 Here the character麗 (Lí) implies connection, integration, or linkage.

Kidney Fixity Disease (腎著病)

On March 19, 2014November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Liú Dùzhōu (刘渡舟), Translations & Writings (译著与文章)Leave a comment

What is Kidney Fixity disease? %E9%99%B3%E4%BF%AE%E5%9C%93.jpg

Kidney fixity or as it is sometimes translated Kidney stickiness, is basically cold pain and heaviness in the lumbar region that prevents (one) from normal turning and is exacerbated by yīn-type (dull-wet) weather, attributed to kidney vacuity cold-damp becoming “fixed” in the inner body. 1

The typical formula used to treat this condition is Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng. I’d like to present a section from my upcoming translation of the Jīn Guì Fāng Gē Kuò (金匱方歌括)- Prescriptions from the Golden Cabinet with Songs and a couple case studies illustrating its use.

甘薑苓白朮湯

Gān Jiāng Líng Bái Zhú Tāng

Licorice, Dried Ginger, Poria, and Ovate Atractylodes Decoction

一名腎著湯

Also called Kidney Fixity Decoction

治腎著之病, 其人身體重, 腰中冷, 如坐水中, 形如水狀, 反不渴, 小便自利, 飲食如故, 病屬下焦, 身勞汗出, 衣裡冷濕, 久久得之, 腰以下冷痛, 腹重如帶五千錢者,此主之。

A treatment for kidney fixity disease; where the patient experiences generalized heaviness and lumbar coldness, as if they are sitting in water. Symptoms resemble those of water disease, yet there is no thirst, urination is uninhibited, and eating and drinking are normal. This means that the disease is in the lower burner. Physical taxation with sweating leads to cold and dampness in the clothes, and over an extended period of time manifests with cold pain below the waist, and abdominal heaviness as if carrying five thousand coins. This formula rules it.

甘草白朮（各二兩）乾薑茯苓（各四兩）

gān cǎo	甘草	6g
bái zhú	白朮	6g
gān jiāng	乾薑	12g
fú líng	茯苓	12g

上四味, 以水五升, 煮取三升, 分溫三服, 腰即溫。

Simmer the four ingredients above in 1000ml of water until reduced to 600ml. Divide and take warm in three doses, until the lumbus feels warm.

Song 歌曰:

腰冷溶溶坐水泉, 帶脈束於腰間, 腎著則腰帶病, 故溶溶如坐水中狀。腹中如帶五千錢, 朮甘二兩薑苓四, 寒濕同驅豈偶然?

Lumbar coldness as if sitting in gently flowing water springs.

The girdling vessel binds around the lumbus.

With kidney fixity there is disease in the waist, which therefore brings the feeling as if one is sitting in water.

The abdomen feels as if it is carrying five thousand coins,

(With) six grams each of bái zhú and gān cǎo, and twelve of gān jiāng and fú ling,

is it by chance that both cold and dampness are expelled?

Quotation by Yóu Zàijīng 2 尤在涇雲:

寒濕之邪, 不在腎之中臟, 而在腎之外府, 故其治不在溫腎以散寒, 而在燠土以勝水。若用桂、附, 則反傷腎之陰矣。

Cold-damp evils are not located in the kidney viscera but in the external dwelling of the kidneys. Therefore, treatment need not involve warming the kidneys in order to dissipate cold, but to warm earth to prevail over water. If guì zhī, or fù zǐ were used, then kidney yīn would be damaged!

Case #1

A fifty-four year-old male patient presented at the clinic with cold lumbar pain, which felt as if he were immersed and sitting in water. In addition, he had little desire to eat or drink, and his bowel movements were thin and loose. Tongue coating was white and his pulse was soggy and moderate. This is a pattern of cold dampness fixed in the musculature of the lower back. The lumbus is the house of the kidney, and (this condition) is what is referred to in the jīn guì yào lüè as kidney fixity disease. It is suitable here to treat by warming the center, dissipating cold, strengthening the spleen and drying dampness with the formula gān cǎo gān jiāng fú líng bái zhú tāng (Licorice, Ginger, Poria and Atractrylodes Macrocephala Decoction).

gān jiāng (Zingiberis Rhizoma) 6g

gān cǎo (Glycyrrhizae Radix) 3g

fú líng (Poria) 10g

bái zhú (Atractylodis macrocephalae Rhizoma) 10g

Five packages were administered. This patient also received local treatment with moxibustion.

Afterwards his appetite had increased and his bowel movements were now formed.

He was given another five packages of the formula above with 12g of dǎng shēn (Codonopsis Radix) added.

After finishing the formula his back pain had completely resolved.

Taken from page 193 of the ‘Simple Commentary on the Jīn Guì Yào Lüè’ (金匮要略浅述) by Tán Rì-Qiáng (谭日强)

Case #2

A fifty-year old male patient presented with aching pain in his lower back and legs. In addition, he experienced a fear of cold, and heaviness of both legs after walking. His pulse was deep, moderate and lacking strength, and his tongue was slightly enlarged with a slippery-white coating. A yīn pulse is typically deep, and therefore this is a pattern of shào yīn yáng qì vacuity. A moderate pulse is typically associated with dampness, and therefore this is also a tài yīn spleen yáng weakness pattern. This pattern is what is referred to in the jīn guì yào lüè as kidney fixity disease. He was administered:

fú líng (Poria) 30g

bái zhú (Atractylodis macrocephalae Rhizoma) 15g

gān jiāng (Zingiberis Rhizoma) 14g

zhì gān cǎo (Glycyrrhizae Radix preparata) 10g

After taking twelve packages of the formula his legs started feeling warmer and his fear of cold, leg heaviness after walking, and pain had completely resolved.

Taken from page 145 from the Selected Clinical Case Studies of Liú Dù-Zhōu’ (劉渡舟臨証驗案精選)

1. (Practical Dictionary of Chinese Medicine, Wiseman et al. pg.326)

2. Yóu Zàijīng (尤在涇) (?-1749), was a well known Qíng dynasty scholar-physician from cháng zhōu (modern day wú county in jiāngsū province), who had written several commentaries on hàn dynasty medical literature, including the Jīn Guì Yì (金匮翼), Appendices to the Golden Cabinet.

Yáng Dàn Tāng (陽旦湯) Yáng Dawn Decoction from the Jīn Guì Fāng Gē Kuò

On January 10, 2014November 25, 2021 By eranevenIn Chén Xiūyuán (陈修园), Formulas (方剂), Jīn Guì Fāng Gē Kuò (金匮方歌括), Jīn Guì Yào Lüè (金匱要略), Translations & Writings (译著与文章)Leave a comment

As I am approaching close to 18 months of ardently working on the translation of the second volume of Chén Xiū-Yuàn’s Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), I thought it was due time to share a small tidbit of the material. I am getting quite close to finishing the text and it should be out sometime in the next few months.

陽旦湯

Yáng Dàn Tāng

Yáng Dawn Decoction

治產後中風續續數十日不解, 頭微疼, 惡寒, 時時有熱, 心下悶, 乾嘔汗出 ,雖久陽旦症續在者, 可與之。即桂枝湯增桂加附。坊本謂加黃芩者, 未知《傷寒論》太陽篇中已明其方, 孫真人及各家俱誤。桂枝湯見《傷寒論》。

A treatment for post-partum wind strike that remains unresolved for several tens of days with, a mild headache, aversion to cold, frequent heat effusion, oppression below the heart, dry retching, and sweating. Even though (the condition) has persisted for a long time, yáng dàn tāng signs are still present, and can be given. (This formula) is guì zhī tāng with increased guì zhī and the addition of fù zǐ.

An old block-printed version of the text refers to this formula as (guì zhī tāng) with the addition of huáng qín, but it is unknown whether this is the same tài yáng formula as in the Shāng hán lùn. Master Sūn Sīmiǎo and various others believed it to be so (for which) they were mistaken. For guì zhī tāng see the Shāng Hán Lùn.

Commentary by (Chén) Yuánxī 男元犀按:

頭痛發熱、惡寒汗出, 太陽表症也。心下悶者, 太陽水邪彌漫心下而作悶也。陽旦湯即桂枝湯倍桂枝加附子。雖産後數十日不解, 其邪仍在於太陽之經, 故仍用桂枝湯解太陽之表邪, 加桂以化膀胱之水氣, 加附子以溫固水臟, 使經臟氣化, 則內外之邪出矣。《傷寒論》桂枝加附子, 治漏汗; 加桂, 治氣從少腹上衝心; 去芍, 治胸滿, 俱有明文可據。孫真人以桂枝湯加黃芩爲陽旦湯, 其意以心下悶爲熱氣, 誤矣。夫有熱氣, 則當心煩, 今日心下悶, 則非熱可知矣。況微惡寒時時有熱, 乾嘔汗出, 爲太陽桂枝湯之的症。蓋太陽底面便是少陰, 續續至數十日不解, 顯系少陰之君火微, 而水寒之氣盛, 寒氣上淩陽位, 是以爲心下悶之苦。故取桂枝湯增桂以扶君主之陽, 加附子以鎮水陰之逆, 使心陽振, 水臟溫, 則上逆之陰邪, 不攻而自散矣。

Headaches, heat effusion, aversion to cold, and sweating are symptoms associated with a tài yáng exterior pattern. (With) oppression below the heart, tài yáng water evils pervade (the area) below the heart and cause oppression. Yáng dàn tāng is guì zhī tāng with double the guì zhī and the addition of fù zǐ. Although there is a lack of resolution ten days post partum, evils are still located in the tài yáng channel, and it is for this reason that guì zhī tāng is used to resolve exterior evils in the tài yáng. Guì zhī is increased in order to transform water qì in the bladder. Fù zǐ is added to the formula to warm and secure the water viscus, enabling the transformation of qì in the channels and viscera, and ensuring the expulsion of evils in both the interior and exterior. In the Shāng Hán Lùn, guì zhī jiā fù zǐ tāng is used to treat leaking sweat; increasing guì zhī treats surging qì from the lesser abdomen into the heart, and removing sháo yào treats chest fullness. These (principles) are in accordance with the (original) writings. (According to) master Sūn (sīmiǎo), yáng dān tāng is guì zhī jiā huáng qín tāng, (as he felt that) oppression below the heart was due to hot qì; this is a mistake! Now if there were hot qì, then there would be heart vexation, (but) presently with the oppression below the heart, we know there is no heat! Moreover, slight aversion to cold, and frequent heat (effusion), dry retching, and sweating, is a guì zhī tāng tài yáng presentation. In all (cases) of tài yáng, there is shào yīn at the bottom, and with continuous (wind strike) reaching ten days without resolution, there is a clear relation to the debilitation of shào yīn sovereign fire, with exuberance of cold water qì. Cold qì ascends and encroaches into the position of yáng, resulting in oppression below the heart. Therefore, guì zhī tāng with increased guì zhī, supports sovereign yáng, and with the addition of fù zǐ counterflow of water yīn is settled, heart yáng is vitalized, and the water viscus is warmed. Then, ascending counterflow of yīn evils will not attack, and dissipate on their own!

Xiè Xīn Tāng (Heart Draining Decoction)-泄心汤

On November 17, 2012April 2, 2021 By eranevenIn Formulas (方剂), Jīn Guì Yào Lüè (金匱要略), Jīng Fāng (经方), Translations & Writings (译著与文章)Leave a comment

From the ‘Interpretation of the Jīn Gùi Yào Lüè’ by Sòng Jiàn-Píng (2009)

I am currently in the process of translating the second volume of the Jīn Guì Fāng Gē Kuò (金贵方歌括) by Chén Xiū-Yuán. I have been so immersed in it lately, that I feel I’ve been neglecting this site, and figured I should work on something to put up. Because of the intense amount of work and dedication this book requires, I figured it would make more sense to translate something I’ve been using as reference, helping myself and others elucidate the deeper meaning behind the formulas discussed in the text. The following is the small section on Xìe Xīn Tāng, for which I recently worked on. I’ve had a bit of a hard time with the line “heart qi insufficiency” (心气不足), as I’ve read several commentaries, including the Qiān Jīn Fāng, which state that this is a typo, and the actual line should read, 心气不定 (heart qi instability/unsettled). Neither one of these still make immediate sense to me, but I am getting closer to understanding what it means and it’s pathological/physiological implications. Since I am still processing and working with this line, I’ll share my thoughts on a later date. I’d love to get other perspectives in the comments section.

[Original Text]
“(When) heart qì is insufficient, with blood ejection and spontaneous external bleeding, Xiè Xīn Tāng masters it”. (JGYL 17)

Xiè Xīn Tāng also treats sudden turmoil (cholera) disease

Dà Huáng 2 liǎng
Huáng Lián 1 liǎng
Huáng Qín 1 liǎng

Use 3 shēng of water for the three ingredients above, boil until reduced to one shēng, and take in one single dose.

[Comparisons] Heart qì vacuity: In the Qiān Jīn Fāng it is written as heart qì instability/unsettled) (心气不定)

[Presentation] A treatment for patterns of blood ejection and spontaneous external bleeding due to exuberant heat.

[Explanation] Both blood ejection and spontaneous external bleeding are categorized as exuberant heat patterns. The heart stores the shén, and governs the blood vessels. If heart fire is exuberant, it will cause frenetic movement of the blood, which results in blood ejection and spontaneous external bleeding. If the spirit is harassed there will be vexation and disquietude. Xiè Xīn Tāng is the treatment of choice, which clears heat and discharges fire. Within the formula, Huáng Lián and Huáng Qín clear heat, downbear fire, and discharge heat from the heart channel, so heart blood can quiet down on it’s own. Dà Huáng is bitter, cold, downbearing and discharging. It causes the descent of fire qi so blood can be calmed and stop moving frenetically. When these three medicinals are combined, they directly break heat, downbear fire, and stop bleeding.

[Commentary] Xiè Xīn Tāng and Bǎi Yè Tāng both treat blood ejection, however, Bǎi Yè Tāng mainly treats blood ejection due to central qì vacuity cold. Typical signs seen with this presentation are a somber white facial complexion, lassitude of spirit and fatigue, pale tongue body with a white coating, and a vacuous weak pulse. Xiè Xīn Tāng treats blood ejection due to exuberant heat, which is typically accompanied with heart vexation and disquietude, a red complexion, red tongue body, vexation thirst, constipation, a rapid pulse, etc. The two prescriptions above introduce us to two major methods and treatment principles for the treatment of blood ejection. One to warm yáng and restore qì, and one to discharge fire and clear heat in order to stop bleeding. In regards to Xìe Xīn Tāngs’ treatment of blood heat with frenetic movement, bleeding can manifest in several different ways including, vomiting of blood (hematemesis), external bleeding, blood in the urine (hematuria), blood in the stools (hemafecia), etc. which can all be treated quite effectively.

This is a commonly used formula for treating exuberant heat in the three burners, and is used clinically for the congestion of pathogenic-toxic fire and heat causing disorders in either the upper or lower burners, or the exterior or interior. Examples being, the upward harassment of toxic heat causing a red complexion and tongue, ulcerations of the mouth and tongue, tooth swelling and pain, vexation heat, and oppression in the chest, or toxic heat manifesting on the exterior with skin damage due to swollen and toxic sores.

[Case Example] A sixty-year-old female patient presented on April 20, 1994. She has a history of a duodenal ulcer for many years, and has recently been quite fatigued, with unbearable epigastric pain. This morning after eating breakfast, she immediately felt nauseous and had a desire to vomit. Soon after she vomited approximately 300ml of fresh blood, which contained stasis clots but no food from her digestive tract. She has continued to feel nauseous and has been vomiting blood quite frequently up until the time of her consultation. Her tongue was red, with a thin yellow coating, and she had a wiry-slippery-rapid pulse. The diagnosis was blood ejection. The pattern belonged to heat accumulation in the stomach causing frenetic movement of the blood. Treatment involved clearing the stomach, discharging heat, transforming stasis, and stopping bleeding.

Formula:

Dà Huáng 30g
Huáng Qín 9g
Huáng Lián 9g
Dài Zhě Shí 30g

The medicinals above were to be decocted (and drunk) quickly

After taking the formula, the vomiting of blood stopped, and the epigastric pain decreased. She was continued on two more packages of the formula to clear the remaining pathogens.

(Luó Wèi Dōng: Effective Treatments with Classical Formulas, vol. 4.)