The patient is a 50-year-old male farmer from Yongqiang. He has always been healthy and has never been ill until the last 5 years. Recently, he frequently experiences coldness in his toes, especially in the summer. Whenever his toes feel cold, he also feels discomfort in his abdomen, which is followed by diarrhea. This year, the symptoms have become more frequent, and his hands and feet have started to experience spasms, which he never had before. This has caused him some anxiety. He has visited many doctors who all diagnosed him with intestinal dysfunction, but the treatments did not bring noticeable results. The patient is also a distant relative of mine, so he came to seek my help.

First Consultation (July 10, 2005):
Upon examination, the patient reported the symptoms mentioned above, along with night sweats in winter, spontaneous sweating in summer, and a lack of thirst. However, there were no significant abnormalities found in his pulse or tongue. Abdominal examination revealed thin, weak abdominal muscles. Based on this, I suspected a Guìzhī Tāng pattern. The patient’s symptoms of cold feet in summer leading to abdominal discomfort reminded me of a Japanese Kampo [physicians] experience, where he said: “Cold feet in summer causing abdominal pain should be treated with Guìzhī Jiā Fùzǐ Tāng.” Therefore, I prescribed 7 doses of Guìzhī Jiā Fùzǐ Tāng, replacing shēngjiāng with gānjiāng, essentially combining Guìzhī Tāng and Sì Nì Tāng.

Follow-up Consultation (July 17, 2005):
After taking the medicine for one week, the patient reported feeling very comfortable and as if he had met a long-lost friend. The coldness in his toes, abdominal discomfort, and diarrhea had also improved. Since the prescription had been effective, I continued with Guìzhī Jiā Fùzǐ Tāng for another 7 doses.

Follow-up Consultation (July 24, 2005):
After another week of medication, the patient’s condition continued to improve. The spasms in his hands and feet had disappeared, and the symptoms of cold toes, abdominal discomfort, and diarrhea had significantly improved. However, spontaneous sweating continued. Based on the symptoms, I added Yù Píng Fēng Sǎn to the original formula and instructed the patient to take it for two weeks before stopping the medication to observe the results.

After a month of continuous treatment with the combined formula of Guìzhī Jiā Fùzǐ Tāng and Yù Píng Fēng Sǎn, the patient’s symptoms disappeared, and he stopped the medication. A year later, when I met his family, I learned that his condition had been completely cured.

Note:
In classical Chinese medicine, it’s important to pay attention to experience-based maxims. As Gě Hóng from the Jin Dynasty mentioned in Bàopǔzǐ: “In the transmission of medical secrets, words are not written down, only passed down through oral formulas.” In traditional herbal medicine, treatment is based on patterns and symptom differentiation. The treatment in this case is simple and effective when considering the pattern and maxim: “Cold feet in summer causing abdominal pain should be treated with Guìzhī Jiā Fùzǐ Tāng.”

In this case, the “coldness in the toes” symptom might suggest the use of xìxīn, which treats retained fluids and dampness. However, the patient’s coldness, spontaneous sweating, and diarrhea were more in line with the Sì Nì Tāng pattern, so I added fùzǐ and replaced shēngjiāng with gānjiāng to match the correct pattern.