Category: Translations & Writings (译著与文章)

Guìzhī Jiā Lónggǔ Mǔlì Tāng Combined with Líng Guì Zhú Gān Tāng for the Treatment of Palpitations and Vertigo

On By eranevenIn Case Studies （医案), Kampo, Translations & Writings (译著与文章)

From ‘The Study of Kampo Clinical Practice and Diagnosis’ by Terasawa Katsutoshi (寺泽捷年), and translated into Chinese by Wang Ningyuan.

A 34-year-old housewife presented with paroxysmal palpitations and vertigo.

Approximately six months earlier, while driving through an intersection on a rainy day, the vehicle in front of her stopped suddenly. She was unable to brake in time and rear-ended the other car. Fortunately, she sustained no obvious injuries, and the accident was resolved without incident. However, following the accident, she began experiencing several episodes of palpitations every day.

During each episode, she felt as though a ball-like object surged upward from the epigastrium and beside the umbilicus toward the chest. Within a few seconds it reached the chest, her pulse gradually accelerated, and palpitations developed, accompanied by a sensation of chest oppression, uneasiness, and vertigo.

When the attacks were mild, this state lasted 10–20 minutes before resolving completely. During more severe attacks, however, she experienced intense anxiety, a sensation of heat in the face, vertigo, and even transient loss of consciousness. She was required to remain in bed for 2–3 hours before recovering. There was no associated nausea or vomiting.

She had previously sought treatment locally. Electrocardiography and other examinations revealed no abnormalities. She was prescribed a sedative, which reduced the severity of the attacks and improved her sleep, but the frequency remained essentially unchanged, with palpitations occurring one to two times daily.

Height: 152 cm
Weight: 45 kg
Blood pressure: 108/72 mmHg
Temperature: 36.7°C
Pulse: 72 beats/min

Her complexion was slightly flushed, the lower limbs were cold, her appearance was otherwise normal, there was sweating of the hands and feet, the pulse was weak, and the tongue was normal with a thin white coating.

Abdominal examination: The abdominal strength was slightly weak.

  • Pulsation above the umbilicus (++) (脐上悸（++)
  • Epigastric pulsation (心下悸)
  • Splashing sound in the stomach (胃部振水音)
  • Tension of the rectus abdominis muscles (腹直肌拘挛)

Abdominal strength: 2/5 (腹力 2/5)

A 24-hour Holter ECG captured changes during an attack. Her resting heart rate was 70 beats/min but gradually increased over several minutes to 120 beats/min, at which point she perceived the palpitations. Ten minutes later, the pulse rate gradually declined and returned to normal. During the attacks there was no hyperventilation. Arterial blood gas analysis, electroencephalography, blood biochemistry, and other investigations revealed no abnormalities.

Discussion

Although this condition resembles paroxysmal tachycardia, it was excluded because the pulse increased gradually rather than abruptly. It must also be differentiated from hyperventilation syndrome; however, there was no hyperventilation during the attacks, and arterial blood gas analysis was normal, allowing this diagnosis to be excluded. The condition would generally be diagnosed as cardiac neurosis or neurosis.

From the perspective of Kampo medicine, this presentation represents the pathological state of Qi Counterflow (Running Piglet Qi, 奔豚气). Most cases of Running Piglet Qi are triggered by events involving intense fear, shock, or frightening memories. In this case, the precipitating factor was becoming the responsible party in a traffic accident.

Treatment Course

The patient was prescribed Guìzhī Jiā Lónggǔ Mǔlì Tāng granules and Língguì Zhúgān Tāng granules, 7.5 g of each daily in three divided doses, while continuing the previously prescribed 2 mg sedative as needed.

On the day treatment began, she noticed warmth returning to her lower limbs. Beginning on the second day, she experienced only one mild attack. During the following two weeks, she had only three attacks in total. After taking a cumulative dose of 10 mg of the sedative, it was discontinued. After one month of treatment, the attacks had almost completely disappeared, and after three months the herbal treatment was discontinued.

This pattern corresponds to the indication for Língguì Gānzǎo Tāng. However, because granules of Língguì Gānzǎo Tāng were unavailable, Guìzhī Jiā Lónggǔ Mǔlì Tāng combined with Língguì Zhúgān Tāng was used as a substitute.

Terasawa Katsutoshi (寺泽捷年)

Born in 1944, Terasawa Katsutoshi is a renowned Japanese Kampo physician and Medical Doctor. He served as Professor of Kampo Medicine at the Graduate School of Chiba University and Director of the Kampo Department at Chiba Central Medical Center. He studied under Fujihira Ken, Ogura Shigenari, and Itō Kiyoo. 

He has held numerous distinguished positions, including Director of the World Health Organization (WHO) Collaborating Centre, Vice President of Toyama Medical and Pharmaceutical University, Director of its affiliated hospital, President of the Japan Society for Oriental Medicine, President of the Society of Japanese and Oriental Medicine, and President of the East Asian Medical Association.

His principal works include Clinical Kampo Medicine (originally published as Kampo Diagnosis and Treatment: Learning from Clinical Cases), Research on Yoshimasu Tōdō: The Thought that Founded Japanese Kampo, Studies on Kampo Abdominal Diagnosis: Mechanisms of Pattern Formation, Complete Translation of Hōgi Zasshi, Complete Translation of Ikai no Tetsuzui, and Supplement to the Iken Collection.

Wūméi Wán from Huáng Huáng’s Jīngfāng Formula Presentations

On By eranevenIn Huáng Huáng (黃煌), Translations & Writings (译著与文章)

In my last class, I taught on Wūméi Wán (乌梅丸). While gathering material for the lecture, I translated the section on Wūméi Wán from my teacher Huáng Huáng’s (黄煌) Jīngfāng Formula Presentation.

There is so much valuable clinical information in this section that I thought it was worth sharing here as well.

Wūméi Wán is an incredible formula with a remarkably broad clinical scope—far beyond the treatment of intestinal worms, which is how many of us are first introduced to it. When we look beyond that traditional association and examine its formula presentation, characteristic symptoms, and modern clinical applications, a much richer picture begins to emerge.

I hope this translation helps shed some light on the depth and versatility of this fascinating classical formula.

Wumei Wan is the classical formula for Jueyin disease and the specific formula for hui jue (roundworm reversal). Traditionally, it is a formula that clears the upper while warming the lower, warms the viscera, and calms roundworms. It has the effects of calming roundworms, stopping diarrhea, relieving pain, relieving vexation, and treating reversal cold. The Wumei Wan presentation is characterized by reversal cold, abdominal pain and colicky pain, vexation and agitation, vomiting, and diarrhea, and is most commonly seen in diseases of the digestive system.

I. Classical Formula

Wumei, 300 pieces; Xixin, 6 liang; Ganjiang, 10 liang; Huanglian, 16 liang; Danggui, 4 liang; Fuzi, 6 liang (processed, peeled); Shujiao, 4 liang (sweated); Guizhi, 6 liang (peeled); Renshen, 6 liang; Huangbai, 6 liang.

Pound and sift the above ten ingredients separately, then combine them. Soak the Wumei overnight in bitter wine, remove the pits, and steam them beneath five dou of rice. When the rice is cooked, pound the Wumei into a paste and mix it thoroughly with the medicinal powders. Place the mixture in a mortar, add honey, and pound two thousand times. Form pills the size of wutong seeds. Before meals, take 10 pills, three times daily, gradually increasing to 20 pills.

(Shānghán lùn)

II. Classical Formula Presentation

In cold damage, when the pulse is faint and there is reversal, and at seven or eight days, [there is] cold skin and the person is agitated without temporary [periods of] quiet, this is visceral reversal, and not roundworm reversal. In roundworm reversal, the person should vomit roundworms. Now, the person is still, and then has periodic vexation, which indicates visceral cold. The roundworms ascend and enter the diaphragm, and therefore there is vexation; after a short while it stops again. After eating, there is retching and again vexation, when the roundworms smell the malodorous food.  The person should spontaneously vomit roundworms. For roundworm reversal, Wumei Wan governs. It also governs enduring diarrhea. 

(Shānghán lùn 338)

1. Roundworm Reversal

Jue (厥) refers, in one sense, to qi closure and collapse or loss of consciousness, as in syncope, phlegm reversal, qi reversal, and roundworm reversal. In another sense, it refers to a condition characterized primarily by lack of warmth in the four limbs. As stated in the Suwen, Treatise on Reversal:

“The cold of cold reversal must ascend from the five digits to the knees.”

This suggests that Wumei Wan can treat disorders involving sudden collapse or icy-cold extremities.

Roundworm reversal also suggests that Wumei Wan can treat diseases related to roundworms. The Shang Han Lun Fang Jie records:

“This formula has outstanding efficacy for abdominal pain due to accumulation of worms, in which extreme pain leads to reversal.”

2. Enduring Diarrhea

This symptom indicates that Wumei Wan treats chronic diarrheal diseases, an application continued by later generations.

“This is the sacred formula for treating enduring dysentery.”
—Xu Lingtai, Shang Han Lun Lei Fang

“Treats postpartum dysentery from cold and heat, with prolonged diarrhea that does not cease.”
—Sheng Ji Zong Lu

“Used for enduring dysentery that does not cease, or recurrent dysentery; repeatedly effective.”
—Huang Han Yi Xue Yao Jue

3. Vexation

Here, fan (烦) refers to a distressing psychological experience. The patient is restless, uncomfortable, depressed, or anxious, and most often has accompanying insomnia.

The formula contains 16 liang of Huanglian, far exceeding the amounts of Ganjiang, Guizhi, Renshen, Danggui, and the other ingredients. Among classical formulas, the formula containing the largest amount of Huanglian is Huanglian Ejiao Tang, which contains 4 liang of Huanglian and treats:

“Shaoyin disease of two or three days or more, with vexation in the heart and inability to sleep.” (303)

This suggests that Wumei Wan can relieve vexation and aid sleep, as well as treat psychological and emotional disorders such as chest oppression, palpitations, anxiety, and depression.

4. Vomiting

“In roundworm reversal, the person should vomit roundworms… After eating, there is retching” (338)

This suggests that Wumei Wan can treat disorders involving vomiting and reflux, including dry retching, nausea, and regurgitation.

5. Abdominal Pain

Dajianzhong Tang, which contains Chuanjiao, Renshen, and Ganjiang, treats:

“Great cold and pain in the heart and chest, vomiting with inability to eat or drink, cold in the abdomen, something surging upward and raising the skin, appearing as though it has a head and feet, with pain moving upward and downward that cannot tolerate being touched.”

Huanglian Tang, containing Huanglian and Rougui, treats:

“Cold damage with heat in the chest, pathogenic qi in the stomach, abdominal pain, and a desire to vomit.” (173)

Chi Wan, containing Fuzi and Xixin, treats chest and abdominal pain from “cold qi reversal” (Chapter 10), while Dahuang Fuzi Tang (Dahuang, Fuzi, Xixin) treats “one-sided pain below the ribs” (Chapter 10).

This suggests that Wumei Wan can treat severe abdominal colicky pain, with raised, fluctuating masses appearing in the abdomen, accompanied by chest oppression, a choking sensation in the throat, dizziness and headache, and even syncope with loss of consciousness.

Using roundworm reversal as an example, the original passage depicts a Wumei Wan presentation characterized by a mixture of cold and heat, with vomiting above and diarrhea below. Its pattern of onset has two main characteristics:

First, vomiting and counterflow above, with pain and diarrhea below. There may be gastric and esophageal reflux, vomiting, belching, acid regurgitation, or epigastric discomfort; together with abdominal pain and diarrhea, diarrhea triggered by cold exposure, or predawn diarrhea.

Second, internal vexing heat with external reversal cold. There may be chest oppression and agitation, insomnia with night sweating, or easy hunger with a strong appetite; yet the patient is also averse to cold, wears heavy clothing, and has icy-cold hands and feet.

Regarding the pathological mechanism of the Wumei Wan presentation, traditional explanations include “intermingling of yin and yang, confusion of cold and heat” (Wu Qian); “stomach qi deficiency with pathogens of mixed cold and heat accumulating in the chest” (Zhang Lu); and “the principal formula of Jueyin” and “the method for the various presentations of Jueyin” (Ke Yunbo).

Wumei Wan has the effects of relieving pain, stopping diarrhea, stopping vomiting, relieving vexation, resolving reversal, calming roundworms, and treating wasting-thirst. Pharmacological research suggests anti-inflammatory, antidepressant, and glucose-lowering effects, as well as promotion of gastrointestinal functional recovery, regulation of the intestinal microbiota, and repair of the mucosal barrier. On this basis, it may be inferred that reflux, depression, inflammation, gastrointestinal dysfunction, and intestinal microbiota dysregulation constitute the basic pathological foundation of the Wumei Tang presentation.

III. Suitable Patient Population

The clinical manifestations of this formula presentation are complex and varied. Although there is pain and diarrhea, the abdomen does not resist pressure. Although there is aversion to cold, the pulse is not faint, fine, and weak. Although there is vexation and agitation, there is no clouding of consciousness, delirium, or mania. Although the patient has numerous distressing complaints, examinations reveal no abnormalities. Severe symptoms with mild objective signs are characteristic.

1. Greenish-Yellow, Thin Face

The complexion is yellow, greenish, or pale. The brows are tightly furrowed, with a distressed appearance and an expression of agitation or depression.

2. Red, Eroded Lips and Tongue

Most have dry, red lips, or dark-red lips; the lips may be swollen and eroded, or there may be sores of the mouth and tongue. The tongue is dark red, with a thick or white greasy coating.

There are often chronic inflammatory conditions of the head and face, such as conjunctivitis, periodontitis, otitis media, and pharyngitis.

3. Wiry, Slippery, Large Pulse

The pulse is wiry and hard, or slippery and rapid, or large and forcefully strikes the finger.

4. Icy-Cold Hands and Feet

The hands and feet are cold and feel like ice to the touch. The patient is averse to cold and wears heavy clothing.

5. Frequent Pain

There are numerous complaints of pain. The pain may be stabbing, distending, or pulling in nature. Abdominal pain is most common, but there may also be headache, chest and hypochondriac pain, testicular pain, dysmenorrhea, and other forms of pain.

6. Onset Around Midnight

Abdominal pain, insomnia, or reflux often begins or worsens around midnight or in the early morning. Examples include gastroesophageal reflux disease, the dawn phenomenon in diabetes, and predawn diarrhea.

IV. Suitable Diseases and Conditions

The key clinical manifestations of the Wumei Wan presentation are “pain, vomiting, diarrhea, vexation, and reversal.” However, because diseases and presentations differ, identification of the formula presentation may be made when only one or two of these signs are present; it is not necessary for all of them to be present.

There are various types, including abdominal pain type, reflux type, vexing-heat type, and diarrhea type, involving multiple systems such as the neuropsychiatric, digestive, and circulatory systems.

1. Irritable Bowel Syndrome

Most commonly seen in thin middle-aged and elderly women, with longstanding painful diarrhea or chronic diarrhea, depression and anxiety, insomnia and agitation, reflux and abdominal distention, with attacks occurring around midnight or in the early morning.

Wumei Wan is effective for diarrhea-predominant irritable bowel syndrome. This formula can stop diarrhea, improve sleep, regulate mood, and suppress reflux.

2. Crohn’s Disease

This is an inflammatory intestinal disease of unknown cause. Clinical manifestations include abdominal pain, diarrhea, and intestinal obstruction, accompanied by extra-intestinal manifestations such as fever and nutritional disorders.

The disease course is often prolonged, with recurrent attacks, and it is difficult to cure completely. This formula has relatively pronounced effects on abdominal pain and diarrhea. It is suitable for those whose abdomen becomes raised or distended during attacks of abdominal pain, as well as those with severe abdominal pain that worsens at night. It is more commonly seen in younger people.

3. Gastrointestinal Polyps

This formula is suitable for middle-aged and elderly men with diarrhea and abdominal pain that are easily triggered by cold exposure, a tendency toward oral ulcers, and lack of response to conventional treatment.

The formula is relatively effective at improving clinical symptoms, but whether it can eliminate polyps remains to be observed.

4. Depression

This formula is suitable for those with numerous distressing complaints and many sudden-onset symptoms, but whose examinations reveal no abnormalities.

The formula can improve sleep, relieve pain, and eliminate symptoms such as abdominal pain, vomiting, and diarrhea.

5. Diabetes

There are reports of this formula being used for diabetic gastroparesis, diabetic diarrhea, and diabetic heart disease.

The formula is suitable for those with a strong appetite, dry mouth around midnight, diarrhea, and persistently elevated blood glucose.

6. Other Conditions

There are individual case reports of this formula treating allergic purpura, psychogenic vomiting, oral ulcers, corneal ulcers, pelvic inflammatory disease, infertility, functional uterine bleeding, obesity, and skin diseases.

V. Formula Presentation Differentiation

1. This Formula and Sini San

Both formula presentations may involve painful diarrhea and aversion to cold.

The Wumei Wan presentation includes reflux and vomiting, whereas these are not prominent in the Sini San presentation. On abdominal palpation, the Sini San presentation often has abdominal muscle tension, whereas this is not prominent in the Wumei Wan presentation.

Heat signs are prominent in the Wumei Wan presentation, often including erosion of the mouth and tongue, agitation, and a red tongue, whereas these are not prominent in the Sini San presentation.

2. This Formula and Huanglian Tang

Both formulas can treat painful diarrhea and insomnia.

The pulse in the Wumei Wan presentation is wiry, hard, large, and slippery, whereas the pulse in the Huanglian Tang presentation is weak and moderate.

Pain and diarrhea are more prominent in the Wumei Wan presentation, whereas pain and vomiting are more prominent in the Huanglian Tang presentation.

VI. Reference Dosage

Wumei (with pit) 20–50 g; Huanglian 5–15 g; Huangbai 5 g; Renshen 5 g or Dangshen 10 g; Danggui 5 g; Xixin 5 g; Rougui 5 g; processed Fuzi 5 g; Ganjiang 10 g; Chuanjiao 5 g; a small handful of Gengmi; and 1 tablespoon rice vinegar.

Decoct in water. Divide into 2–3 doses daily and take after meals. When taking each dose, mix in 1 tablespoon of honey.

Alternatively, prepare honey pills according to the proportions of the original formula. Take 2–3 g per dose, three times daily.

On the Therapeutic Principles and Clinical Applications of Wumei Wan

On By eranevenIn Gāo Tīsān (高体三), Translations & Writings (译著与文章)

Gao Tisan 高体三
Department of Formula Studies, Henan College of Chinese Medicine

Henan Chinese Medicine Journal, December 1978

Translated by Eran Even

In recent years, increasing numbers of physicians have used Wumei Wan from the Shanghan Lun to treat biliary ascariasis, achieving remarkable clinical results. Consequently, many people have come to regard Wumei Wan simply as the representative formula for expelling parasites. In reality, expelling parasites is only one of its functions and does not fully reflect the therapeutic capabilities of the formula.

In order to inherit, develop, and further advance the medical heritage of our country, thereby achieving the goal of “making the ancient serve the present,” I believe it is necessary to further investigate the therapeutic principles and clinical applications of Wumei Wan. In my opinion, such an investigation must begin with the following points.

I. The Physiology and Pathology of Jueyin Must Be Understood Through the Relationships of the Three Yin Channels of the Foot

Both traditional medical theory and clinical practice fully demonstrate the intimate relationship among the three yin channels of the foot. Concepts such as “Yi and Gui share the same source” (乙癸同源), “Spleen and Kidney Yang deficiency,” and the statement, “When disease is seen in the Liver, one knows that it will transmit to the Spleen; therefore, one should first strengthen the Spleen,” all describe the physiological and pathological relationships among these three systems.

The three yin channels of the foot refer to the Foot Jueyin Liver, Foot Shaoyin Kidney, and Foot Taiyin Spleen. Wumei Wan is one of the representative formulas of the Jueyin Liver channel. To fully understand its composition, therapeutic principles, and range of clinical applications, one must study it through the interrelationship of the Liver, Spleen, and Kidney. Only then can the full therapeutic significance of Wumei Wan be appreciated.

The opening line of the Jueyin chapter of the Shanghan Lun states:

When disease is in Jueyin, there is wasting thirst, Qi surges upward to strike the Heart, heat and pain in the Heart, hunger without desire to eat; if food is taken, vomiting of roundworms occurs; after purgation, diarrhea continues unabated.

Judging from the patterns described in this passage, it clearly encompasses more than a disorder confined solely to the Liver channel. It also includes the persistent diarrhea resulting from Spleen and Kidney deficiency cold, together with wasting thirst arising from upward blazing heat. Only by considering the interrelationship of the Liver, Spleen, and Kidney can one arrive at a comprehensive understanding of Wumei Wan.

The Foot Jueyin Liver governs wind and wood and occupies the position between water and fire. Water is the mother of the Liver, while fire is its child. Liver wood arises from Kidney water and gives rise to Heart fire, thereby assisting water in ascending to nourish fire.

The Foot Shaoyin Kidney transforms Gui water upward to communicate with Heart fire. Under normal physiological conditions, Kidney water ascends to unite with fire, while Heart fire descends to unite with water. Water and fire mutually support one another, Yin and Yang are rooted in each other, and the two qi harmonize. Consequently, fire does not flare upward and water does not descend into coldness. This is the physiological state of health.

The mutual communication of water and fire, however, depends to a certain extent upon the Liver’s ability to assist the ascent of water. If Liver wood fails to assist water in ascending to nourish fire, the characteristic Jueyin pattern of upper heat and lower cold develops.

The Liver belongs to wood. Whether cold or heat predominates depends upon the relative strength of opposing influences. When the influence of the child predominates, heat develops; when the influence of the mother predominates, cold develops. heat represents the potential for recovery, whereas reversal cold indicates the approach of serious disease. Between these two extremes, the strength or weakness of the Central Qi is the decisive factor.

When the Central Qi is abundant, Yang is restored. When the Central Qi declines, cold reversal develops.

The Central Qi belongs to Earth.

The Foot Taiyin Spleen governs Damp Earth. When healthy, no pathology arises, but once diseased it is characterized by Dampness and deficiency. Under normal circumstances, the Spleen not only transforms food and fluids and generates Qi and Blood, but also nourishes Liver wood and restrains Kidney water.

When Taiyin deficiency develops, however, the Spleen is no longer able to nourish wood or control water. Instead, water overacts upon Earth while wood is deprived of nourishment. Therefore, deficiency cold patterns of both the Liver and Kidney are closely related to deficiency of the Taiyin Central Earth.

Although Wumei Wan was established for disorders of the Jueyin Liver channel, the inclusion of Renshen, Fuzi, and Ganjiang is intended to supplement Spleen deficiency and warm Kidney Yang, thereby harmonizing the water and Earth of the Spleen and Kidney so that they may nourish and support the growth of Liver wood.

From this it is evident that the Wumei Wan pattern is by no means confined solely to the Liver channel. Rather, it bears a very close relationship to Taiyin Spleen deficiency and Shaoyin Kidney cold.

As the saying goes:

“The Liver belongs to wood. It is the residence of the generating Qi and the storehouse of Blood. Its nature is firm yet it delights in free coursing. It must be nourished by water and supported by Earth before it can fulfill its function of growth and development.”

This statement likewise illustrates the intimate relationship among the Liver, Spleen, and Kidney. Accordingly, the Wumei Wan pattern of the Jueyin channel necessarily involves both the pathology and therapeutic methods of the Taiyin and Shaoyin systems.

II. The Therapeutic Principles of Wumei Wan Must Be Understood Through the Physiology and Pathology of the Foot Jueyin Liver

The Liver governs ascending movement and prefers free coursing. It depends upon the supportive functions of the Spleen and Kidney so that it has an adequate source of nourishment, allowing it to flourish and grow freely with wood in harmony and wind remaining calm. The cold pattern of the Jueyin zang is closely related to the inability of the deficient Spleen and Kidney to nourish and support it.

Accordingly, Wumei is used as the chief herb because of its sour and warm nature, which enters the Liver. It is combined with the sweet, acrid, and warm Guizhi and Danggui to nourish the Blood and soothe the Liver. Renshen, which enters the Spleen, supplements the Central Qi and strengthens Spleen Earth. Fuzi, Ganjiang, Xixin, and Huajiao, all intensely warming herbs, warm Kidney Yang and dispel cold of the zang organs.

Since the Liver is unable to assist water in ascending to nourish fire, the pattern manifests as upper heat with wasting thirst. Therefore, Huanglian and Huangbo are added as bitter and cold medicinals to drain fire and treat the heat above.

This demonstrates that Wumei Wan primarily supplements the Liver and nourishes the Blood, secondarily warms the Spleen and Kidney, and additionally clears the upper heat. As for the formula’s ability to expel parasites, this will be discussed below.

III. The Clinical Applications of Wumei Wan Must Be Understood Through Its Therapeutic Principles

Supplementing the Liver, nourishing the Blood, expelling parasites, strengthening the Spleen, warming the Kidney, and clearing heat above constitute the fundamental therapeutic principles underlying Wumei Wan.

Because Liver disease readily overacts on the Spleen, Zhang Zhongjing stated in the Jingui Yaolue:

“When disease is seen in the Liver, know that it will transmit to the Spleen; therefore, one should first strengthen the Spleen.”

This makes it clear that in the cold pattern of the Jueyin zang, Wumei Wan must include medicinals that supplement the Center and strengthen the Earth.

Likewise, in discussing the treatment of Shaoyin disease, Zhang Zhongjing wrote in the Shanghan Lun:

“When Shaoyin receives Yang, it is favorable.”

This further illustrates that when Kidney water is cold, it is unable to nourish Liver wood and will inevitably overact upon Spleen Earth, leaving Liver wood without a source of nourishment. Therefore, in treating the cold pattern of the Jueyin zang, Wumei Wan necessarily includes herbs that warm the Kidney.

The Liver normally assists water in ascending to nourish above. When disease prevents this function, upper heat develops; consequently, Wumei Wan also contains herbs that clear the upper region.

Because cold within the zang organs is unfavorable for the survival of roundworms, and because roundworms prefer warmth, they flee the cold below and move upward toward the heat above, producing vomiting of roundworms. Although Wumei Wan contains no typical vermicidal herbs, an examination of the flavors of its ingredients reveals a definite antiparasitic effect.

Wumei is sour, and sourness restrains the worms.

Xixin and Huajiao are acrid, and acrid herbs drive out the worms.

Huanglian and Huangbo are bitter, and bitterness directs the worms downward.

For this reason, Wumei Wan has demonstrated remarkable efficacy in the treatment of biliary ascariasis.

Nevertheless, one must not overemphasize its antiparasitic action while overlooking its much broader functions of supplementing the Liver and nourishing the Blood, strengthening the Spleen, and warming the Kidney.

Accordingly, in addition to treating ascariasis, Wumei Wan may be modified for disorders arising from deficiency cold of the Liver, Spleen, and Kidney, including cold-type dysmenorrhea, deficiency-cold abdominal pain, chronic adnexitis, leukorrhea due to deficiency cold, chronic enteritis, chronic colitis, chronic dysentery, deficiency-cold stomach pain, chronic prostatitis, impotence, enuresis, sciatica, chronic trigeminal neuralgia, rectal prolapse, uterine prolapse, and similar disorders. Clinical experience has shown that the formula is frequently effective in such conditions.

This demonstrates that Wumei Wan is not merely an excellent prescription for biliary ascariasis, but an important formula for a wide range of chronic disorders resulting from deficiency cold of the Liver, Spleen, and Kidney.

Conclusion

In summary, the key to understanding both the therapeutic principles and the indications of Wumei Wan lies in approaching it through the relationship of the three yin channels of the foot. Once the physiology and pathology of the Liver, Spleen, and Kidney are understood, the rationale underlying the composition of Wumei Wan becomes clear.

Only then can one avoid the mistaken belief that Wumei Wan is merely a formula for expelling parasites while neglecting its powerful actions of supplementing the Liver, nourishing the Blood, strengthening the Spleen, and warming the Kidney.

In short, Wumei Wan was designed for roundworm disorders occurring in the presence of deficiency cold of the Liver, Spleen, and Kidney, rather than for all cases of roundworm disease regardless of constitutional state.

Therefore, in addition to treating zang cold with roundworm reversal, it may be modified for many chronic disorders arising from deficiency cold of the three yin systems. When upper heat is absent, Huanglian and Huangbo may be omitted.

Because it simultaneously employs both warming and cooling medicinals, Wumei Wan is particularly effective for patterns of upper heat and lower cold. Its clinical applications are broad and deserve continued attention and investigation.

Owing to the limitations of my knowledge and clinical experience, my understanding is undoubtedly incomplete. I respectfully welcome correction from my colleagues.

Gao Tisan 高体三 (November 1920–2011) was a renowned Chinese medicine physician, educator, and scholar from Yuanchang Village, Qinghua Township, Wolong District, Nanyang County, Henan Province (now part of Dengzhou City). A member of the Chinese Communist Party, he served as Professor and Chief Physician at Henan College of Chinese Medicine. He was a director of the Henan Branch of the China Association of Traditional Chinese Medicine, a member and consultant for the editorial committee of the Chinese medicine textbook series for the five central-southern provinces, a member of the Fifth and Sixth Henan Provincial Committees of the Chinese People’s Political Consultative Conference (CPPCC), and was recognized by the Ministry of Health, the Ministry of Personnel, and the State Administration of Traditional Chinese Medicine as one of China’s nationally renowned senior Chinese medicine experts and clinical mentors. He is regarded as the founding figure of the Formula Studies (Fangji) discipline at Henan College of Chinese Medicine.

Gao inherited his family’s medical tradition from an early age, studying under his father. In 1943, he established his own medical practice in Deng County. In 1958, he was recommended for advanced study at the Henan Provincial School of Chinese Medicine, where he remained after graduation in 1959 to join the faculty, serving as Head of the Department (later Division) of Formula Studies. He retired in 1990 but was subsequently reappointed to continue clinical practice at the National Medicine Clinic of the Third Affiliated Hospital of Henan College of Chinese Medicine.

Over more than sixty years of clinical practice, Gao developed the academic theory of “Water Warm, Earth Harmonized, Wood Flourishes” (水暖土和木达). He emphasized pattern differentiation based on the three yin channels of the foot (Taiyin, Shaoyin, and Jueyin) and was especially skilled in the use of classical formulas (Jingfang) and warming medicinals for the treatment of difficult and complex disorders.

He authored numerous textbooks and monographs, including Lecture Notes on Chinese Medical Formula Studies, Lecture Notes on Common Diseases in Chinese Medicine, Clinical Chinese Materia Medica, Treatment Methods and Formulas, and A New Interpretation of the Tangtou Gejue (Songs of Decoctions), the latter of which has been reprinted multiple times. His development of the Weijinkang Health Beverage (维金康保健饮料) received the Second Prize for Scientific and Technological Progress from the Henan Provincial Department of Light Industry in 1993. In 2008, he was awarded the Lifetime Achievement Award for Traditional Chinese Medicine in Henan Province by the Henan Provincial Administration of Traditional Chinese Medicine. His academic theories and clinical experience were also incorporated into China’s Tenth and Eleventh Five-Year National Key Science and Technology Support Programs.

On Xù Mìng Tāng (Life-Restoring Decoction)

On By eranevenIn Huáng Huáng (黃煌), Translations & Writings (译著与文章)

Translated from Huáng Huáng’s Jīngfāng Formula Presentations 经方方证

Xù Mìng Tāng (Life-Restoring Decoction) from Gujin Luyan (Ancient and Modern Records of Proven Prescriptions)

Xù Mìng Tāng is an ancient formula for fēngfèi (wind paralysis).1 Traditionally it is classified as a wind-dispelling, cold-scattering prescription. It has the functions of restoring motor function, improving speech, relaxing the muscles, treating numbness, and relieving cough and wheezing. The presentation of Xù Mìng Tāng is characterized by paralysis or weakness of the limbs, numbness, and aphasia, and is most often seen in sudden-onset disorders.

I. Classical Formula

Má Huáng, Guì Zhī, Dāng Guī, Rén Shēn, Shí Gāo, Gān Jiāng, and Gān Cǎo, 3 liǎng each;

Chuān Xiōng, 1 liǎng;

Xìng Rén, 40 pieces.

Combine the nine ingredients. Decoct in one dǒu of water and reduce to four shēng. Take one shēng warm. A slight sweat should result. Lightly cover the back and sit leaning against a support. Recovery follows once sweating occurs. If sweating does not occur, administer another dose. There are no dietary restrictions, but exposure to wind should be avoided.

II. Classical Formula Presentation

Treats wind fēi strike [where] the body is unable to control itself, an inability to speak, clouded confusion and a lack of pain sensations, or hypertonicity preventing one from turning over to the side. Also treats those who can only lie prone and cannot lie flat, with cough, panting, and swelling of the face and eyes.

(Jīnguì Yàolüè, Chapter 5, addendum formula)

1. “The body is unable to control itself” (身体不能自收)

This generally refers to quadriplegia or hemiplegia. Commonly seen in:

  • Post-stroke sequelae
  • Cerebral infarction
  • Guillain-Barré syndrome
  • Acute myelitis
  • Hypokalemic paralysis
  • Radiculitis

2. “Inability to speak” (口不能言)

This refers to aphasia, where the patient cannot answer questions. It likely describes central aphasia caused by damage to language centers in the brain. Common causes include:

  • Stroke
  • Brain tumors

3. “Clouded confusion and a lack of pain sensations” (冒昧不知痛处)

Màomèi (冒昧) describes mental confusion.

  • Mào (冒) depicts a hat covering the eyes.
  • Mèi (昧) means obscured or unclear.

In the Waitai Miyao, the phrase is followed by “does not recognize people,” suggesting impairment of consciousness.

This represents mild cerebral dysfunction.

“Lack of pain sensations” refers to sensory impairment: when stimulated with a sharp object, the patient cannot localize the stimulus or withdraw appropriately. This corresponds to numbness and sensory loss, often seen in:

  • Radiculitis
  • Guillain-Barré syndrome

4. “Hypertonicity preventing one from turning over to the side.” (拘急不得转侧)

This describes increased muscle tone and associated neuropathic pain. Commonly seen in:

  • Parkinsonian syndromes
  • Post-stroke sequelae

The hypertonicity reflects upper motor neuron damage (“spastic paralysis”). Flaccid paralysis generally indicates lesions of the spinal cord or other lower motor neuron disorders.

5. “Can only lie prone and cannot lie flat, with cough, panting, and swelling of the face and eyes” (但伏不得卧，咳逆上气，面目浮肿)

This refers to:

  • Cough and wheezing
  • Orthopnea (inability to lie flat)
  • Sitting upright to breathe
  • Facial edema

Seen in:

  • Chronic obstructive pulmonary disease (COPD)
  • Cor pulmonale with heart failure
  • Bronchial asthma

The formula contains elements of both Má Xìng Shí Gān Tāng and Má Huáng Tāng, well-known formulas for relieving wheezing. Like Mù Fáng Jǐ Tāng, it employs Guì Zhī, Rén Shēn, and Shí Gāo, herbs commonly used in pulmonary-heart disease.

⸻

The key terms in the classical text encompass many of the major clinical manifestations of neurological disease. The formula may be viewed as a combination of Má Huáng Tāng, Má Xìng Shí Gān Tāng, and Dà Qīng Lóng Tāng. However, the addition of Dāng Guī, Chuān Xiōng, and Rén Shēn gives it a distinctive affinity for neurological disorders.

Traditional commentators explained:

“It is not merely disturbance by pathogenic qi, but also decline of the true qi.”

— You Yi

“A specialized formula for treating stroke.”

— Mo Meishi

“Wind enters and blocks the pores, obstructing the movement of ying and wei. Wind is often accompanied by cold. Initially it enters through the skin and gradually penetrates inward. Prolonged stagnation transforms into heat; heat damages yin. When yin is damaged, the zang-fu are no longer nourished internally, nor can nourishment reach the body externally. Thus arise loss of motor control, inability to speak, confusion, and loss of sensation.”

— Chen Xiuyuan

The pathological basis of the formula is closely related to disorders of the central nervous and motor systems.

The text’s emphasis on respiratory distress also deserves attention, suggesting usefulness in severe pulmonary disease.

III. Suitable Patient Characteristics

This is primarily an emergency formula and does not require a specific constitutional type. However, when used for chronic conditions over longer periods, characteristic patient features can be considered.

1. Robust Build with Yellow-Dusky Complexion (黄黯壮实)

Suitable for patients who are:

  • Solidly built and sturdy
  • Yellow-dusky rather than flushed
  • Rough, dry skin
  • Puffy or fatigued appearance
  • Not prone to sweating

Symptoms are often triggered by fatigue, exposure to cold, or sudden invasion of wind-cold.

2. Slippery-Wet Tongue Coating (水滑苔)

Suitable when:

  • Tongue coating is white, greasy, or moist/slippery
  • Excess saliva or phlegm is present
  • Urination is clear and copious

3. Prominent Neurological Symptoms

Suitable for patients with:

  • Headache
  • Neck and upper back soreness
  • Muscular tension
  • Joint pain
  • Slowed reactions
  • Aphasia
  • Slurred or difficult speech
  • Difficulty walking
  • Difficulty swallowing
  • Wheezing with phlegm sounds

Use cautiously or avoid in patients with:

  • Marked heat intolerance
  • Profuse sweating
  • Significant arrhythmias
  • Markedly elevated blood pressure
  • Prostatic enlargement with urinary difficulty

IV. Applicable Disorders

This formula is most commonly used for neurological diseases affecting either the central or peripheral nervous systems.

Consider it when the presentation includes:

  • Acute flaccid weakness or paralysis
  • Increased muscle tone with neuropathic pain
  • Sudden impairment of speech or swallowing
  • Cough, wheezing, facial edema, or excessive salivation

1. Wind Paralysis (风痱)

An ancient disease category characterized by:

  • Limb paralysis
  • Numbness
  • Aphasia

It resembles modern conditions such as:

  • Myelitis
  • Acute inflammatory polyneuropathy (Guillain-Barré syndrome)
  • Certain forms of brainstem encephalitis

“Wind fēi is when one suddenly cannot speak, the mouth is clenched, and the limbs become impaired and rigid.”

(Beiji Qianjin Yaofang, Vol. 8)

The original instructions state:

“If sweating occurs, recovery follows; if not, administer another dose.”

Thus, mild sweating is considered a sign that the formula is taking effect.

If sweating does not occur, the dosage of Má Huáng may be increased.

According to Huang Shipei, tolerance to Má Huáng varies greatly among individuals; dosing should begin conservatively and increase gradually.

2. Stroke (脑卒中)

The formula presentation corresponds well to acute stroke symptoms such as:

  • Facial deviation
  • Hemiplegia
  • Altered consciousness
  • Difficulty speaking or understanding speech
  • Visual disturbances
  • Difficulty walking
  • Dizziness
  • Loss of balance and coordination

Use cautiously in:

  • Severe hypertension
  • Cerebral hemorrhage

Hu Xishu cautioned:

“One should be cautious when using this formula clinically for stroke.”

3. Parkinson’s Disease

The phrases:

“The body is unable to control itself” and “Hypertonicity preventing one from turning over to the side” closely resemble Parkinsonian features such as:

  • Increased muscle tone
  • Shuffling gait

Most appropriate in patients who are:

  • Robustly built
  • Have a moist, slippery tongue coating
  • Maintain a normal appetite

For excessive salivation, combine with Wú Zhū Yú Tāng.

V. Formula Differentiation

1. Xù Mìng Tāng vs. Má Huáng Tāng

Both may be used for:

  • Stroke
  • Hemiplegia
  • Aphasia

However, the neurological manifestations of Xù Mìng Tāng are considerably more severe.

2. Xù Mìng Tāng vs. Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng

Both can treat movement disorders.

  • Xù Mìng Tāng treats:
    • “The body is unable to control itself” and “Hypertonicity preventing one from turning over to the side”
  • Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng treats:
    • “The whole body feels heavy and cannot turn over”

However:

  • Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng is more commonly used in patients with depression and insomnia.
  • Fullness in the chest, vexation, and fright are characteristic signs.

These symptoms are generally absent in Xù Mìng Tāng, whose defining feature is sudden disease onset.

VI. Reference Dosage

  • Má Huáng 15 g
  • Guì Zhī 15 g
  • Dāng Guī 15 g
  • Rén Shēn 15 g
  • Shí Gāo 20 g
  • Gān Jiāng 15 g
  • Gān Cǎo 15 g
  • Chuān Xiōng 10 g
  • Xìng Rén 15 g

Decoct in 1000 mL water and reduce to 400 mL.

Take in 2–3 divided doses throughout the day.

A mild sweat is considered the ideal therapeutic response.

If treatment is required for longer than seven days, the dosage may be reduced by half.

  1. Nigel Wiseman translates the character fèi 痱 as ‘wind disablement’, where he goes on to say, “Wilting, and loss of the use of the limbs without pain and with loss of mental faculties. The língshū states, ‘when disablement is the disease, and there is no generalized pain, the limbs cannot contract, cognitive faculties are not seriously confused, and speech is faint, the condition can be treated.’ This passage would indicate that disablement is a sequela of wind stroke.” (Wiseman, Practical Dictionary of Chinese Medicine, Pleco edition.)   ↩︎

The Poetry of Wáng Wéi 王维

On By eranevenIn Poetry (诗), Translations & Writings (译著与文章)

Wáng Wéi 王维 (693 or 694 or 701 – 761), courtesy name Mójí 摩诘, also known as Mójí Jūshì 摩诘居士, was originally from Hédōng Púzhōu 河东蒲州 (modern Yongji, Shanxi). He later moved to Jīngzhào Lántián 京兆蓝田 (modern Lantian, Shaanxi), and his ancestral home was Qíxiàn 祁县 in Shanxi. He was a poet and painter of the Tang dynasty.

He came from the Hedong branch of the Tàiyuán Wángshì 太原王氏, known specifically as the Hédōng Wángshì 河东王氏. At nineteen, he traveled to Jingzhao prefecture to sit for the examinations and won first place. At twenty-one, he passed the jìnshì 进士 examination. Over the years, he served as Yòu Shíyí 右拾遗 (Right Remonstrator), Jiǎnchá Yùshǐ 监察御史 (Censor), and Héxī Jiédùshǐ Pànguān 河西节度使判官 (Assistant to the Military Commissioner of Héxī).

During Emperor Xuánzōng’s Tiānbǎo era, he was appointed Lìbù Lángzhōng 吏部郎中 (Director in the Ministry of Personnel) and Gěishìzhōng 给事中 (Palace Aide). When Ān Lùshān 安禄山 captured Cháng’ān 长安, Wáng Wéi  was forced to accept an official position under the rebel regime. After Cháng’ān was retaken, he was demoted to Tàizǐ Zhōngyǔn 太子中允 (Assistant to the Heir Apparent), but later rose to Shàngshū Yòuchéng 尚书右丞 (Vice Minister of the Ministry of Works). He died in the second year of the Shàngyuán 上元 era (761), in the seventh month, at the age of sixty-one.

Wáng Wéi  not only practiced Chán 禅 Buddhism and studied Daoist teachings (Zhuāngxué 庄学, Xìndào 信道), but also excelled in poetry, calligraphy, painting, and music. His poetic fame was especially prominent during the Kāiyuán 开元 and Tiānbǎo 天宝 eras, and he was particularly skilled in five-character verse (wǔyán 五言).

Many of his poems describe landscapes and pastoral life; together with Mèng Hàorán 孟浩然, he was known as “Wáng–Mèng 王孟” and was honored with the title “Poet-Buddha” (Shīfó 诗佛). His painting, especially his landscape style, reached great heights, and later generations regarded him as the founder of the Southern School of landscape painting (Nánzōng shānshuǐhuà zhī zǔ 南宗山水画之祖).

Sū Shì 苏轼 said of him:
“Taste Mojie’s poems and there are paintings within them; view Mojie’s paintings and there is poetry within them.”

More than 400 of his poems survive today. Representative works include “Xiāngsī 相思” (Longing) and “Shānjū Qiūmíng 山居秋暝” (Autumn Evening in the Mountains). His extant writings include Wáng Yòuchéng Jí 《王右丞集》 and Huàxué Mìjué 《画学秘诀》.

1.《鸟鸣涧》
鸟鸣涧
人闲桂花落，
夜静青山空。
月出惊山鸟，
时鸣春涧中。


Birds Calling in the Ravine
With people at leisure, osmanthus blossoms fall;
In the still night, green mountains lie empty.
When the moon rises, it startles the mountain birds,
Who now and then cry out in the spring ravine.

Commentary
In the first two lines, the poem’s focus settles on the words “fall” and “empty.” “Fall” portrays the poet’s unhurried, leisurely state of mind—only then can one sense the tiny osmanthus blossoms drifting down without a sound. “Empty” depicts the vast, far-reaching atmosphere created by the stillness of night.
The next two lines shift from silence to sound: “startled” and “crying” further express the tranquility of the moonlit night and the emptiness of the valleys. The most interesting point is that through the birds’ cry, the desolate quiet of the first lines suddenly gives rise to a pulse of life, filling the poem with vitality amidst its serenity. This is precisely the elegant, leisurely attitude toward life that Wáng Wéi  pursued.

2.《杂诗》
君自故乡来，应知故乡事。
来日绮窗前，寒梅着花未？


Miscellaneous Poem
You come from my old hometown—
You must know the affairs of home.
Tell me, before the embroidered window,
Has the winter plum begun to bloom?

Commentary
This is a uniquely conceived poem of homesickness. The poet expresses intense longing for home through concern for the plum blossoms there. All four lines are the traveler’s questions—implying deep care for his homeland.
He could ask about many things, yet he chooses the plum outside the window. This seemingly small and casual question contains boundless longing and affection. The “winter plum” is no longer just a plant before the window, but a symbol of all that is worth remembering at home—an embodiment of homesickness that feels intimate, natural, and full of meaning.

3.《相思》
红豆生南国，春来发几枝。
愿君多采撷，此物最相思。


Longing
Red berries grow in the southern land—
In spring, how many new branches appear?
I hope you gather them in plenty,
For this is the seed of deepest longing.

Commentary
This poem was written for the famous singer Li Guinian. In only twenty characters, it expresses the poet’s heartfelt affection. After the An Lushan Rebellion, Li Guinian wandered in the south, and it is said he often sang this poem, deeply moving all who heard it.
The first two lines naturally and sincerely introduce the red berries. The last two lines convey feeling through metaphor—intimate and touching. Centered entirely on the symbol of the red berry, the poem expresses longing with simplicity and warmth, creating a lasting emotional resonance.

4.《九月九日忆山东兄弟》
独在异乡为异客，每逢佳节倍思亲。
遥知兄弟登高处，遍插茱萸少一人。


Thinking of My Brothers on the Double Ninth
Alone in a strange land as a lonely guest,
Every festive day my thoughts of home double.
From afar I know my brothers have climbed the heights;
Among the dogwood sprigs they wear, one person is missing—me.

Commentary
This is a festival poem expressing longing for family.
The first two lines describe the poet’s inner feelings during the festival. In the first line, one “alone” and two uses of “foreign/strange” portray a deep sense of isolation and unfamiliarity, making the second line’s “doubled homesickness” especially affecting. It resonates with anyone who has spent a holiday far from home, touching the heart and becoming a timeless line.
The last two lines use the custom of climbing heights and wearing dogwood on the Double Ninth Festival to imagine the poet’s brothers back home. This not only shows his longing for family but also emphasizes his own disappointment and loneliness—deepening the poem’s theme.

5.《渭城曲》 / 《送元二使安西》
渭城朝雨浥轻尘，客舍青青柳色新。
劝君更尽一杯酒，西出阳关无故人。


Song of Weicheng (also Seeing Yuan Er Off to Anxi)
Morning rain at Weicheng dampens the light dust;
At the travelers’ lodge, the willows look freshly green.
I urge you—drink one more cup of wine,
For once you pass west of Yang Gate, there will be no old friends.

Commentary
The poem depicts the emotional scene of parting with a close friend. The first two lines describe the beauty of the homeland after rain; the last two express the affection and reluctance at parting.
Artistically, the opening lines serve as a gentle prelude, while the final lines reveal the true theme. The poet skillfully conveys sorrow and tenderness with restraint, making the emotions sincere and warm. Thus this poem has been passed down through the ages and is loved by generations.

Liú Dùzhōu Case Studies

On By eranevenIn Liú Dùzhōu (刘渡舟), Translations & Writings (译著与文章)

With my upcoming Liú Dùzhōu book release, I felt it would be apt to share a couple random cases from this brilliant physician. These cases do not appear in my book, but were ones I found during my many deep dives and Liú Dùzhōu rabbit holes. Enjoy!

Case of Dysmenorrhea
Patient: Li, female, 45 years old. Initial consultation on May 5, 1993.

History:
The patient developed dysmenorrhea one year prior after undergoing an induced abortion. During each menstrual period, she experienced severe, cold pain in the lower abdomen that was unrelieved by analgesics. Her menstrual cycle was delayed, with scanty, dark-colored blood containing clots. This menstrual period began yesterday. She also presented with dry mouth, chapped lips, dizziness, soreness in the waist, weakness in the legs, and fatigue when lifting. The tongue was dark, and the pulse was deep.

Diagnosis:
This was diagnosed as a condition of deficiency and cold in the Chong and Ren channels, with blood stasis obstruction.

Treatment:
The treatment principle was to warm the channels, dispel cold, eliminate blood stasis, and nourish the blood. The prescription was derived from the Jīnguì yàolüè formula Wēn Jīng Tāng:

wüzhūyú 8g

guìzhī 10g

shēngjiāng 10g

dāngguī 12g

báisháo 12g

chuānxiōng 12g

dǎngshēn 10g

zhìgāncǎo 10g

mǔdānpí 10g

ējiāo (dissolved separately) 10g

bànxià 15g

màidōng 30g

Outcome:
After taking five doses, the cold pain in the lower abdomen was significantly relieved. The same prescription was continued for five more doses. By the next menstrual period, the abdominal pain did not recur. From that point forward, her menstruation became regular and without discomfort. (Selected Clinical Case Studies of Liú Dùzhōu)

Commentary:
Wēn Jīng Tāng is effective for treating dysmenorrhea. Renowned Hangzhou physician Qiu Xiaomei once recalled:
“I was fortunate to work alongside the famous Zhejiang physician Ye Xichun. Ye’s profound and unique medical skills provided me with many valuable insights. For example, when treating cold-induced dysmenorrhea, the routine application of Wēn Jīng Tāng often proved effective. However, there were cases where it was ineffective.” (The Path of Renowned TCM Physicians)

This highlights that even when using Wēn Jīng Tāng, it is crucial to match the formula to the correct pattern. In this case, Dr. Liú Dùzhōu documented not only the patient’s localized symptoms (such as delayed menstruation, severe cold pain in the lower abdomen, and scanty dark menses) but also systemic characteristics such as dry lips, a dark tongue, and a deep pulse, along with the abortion as the inducing factor.

Case of Neurotic Disorder and Irritability

Patient: Cao, a 72-year-old female, who first consulted on October 26, 1995.
The patient had been experiencing persistent irritability for two years, with a recent worsening trend.
Western medicine diagnosed it as a neurotic disorder, and she was given sedatives and anxiolytics, but there was no improvement. She then sought traditional Chinese medicine treatment.

Presenting Symptoms: The patient complained of intense irritability, which was unbearable. Her family members were sympathetic and cautious, but she could not express herself or felt misunderstood. She became agitated and, during severe episodes, felt relief only after hitting her chest and abdomen with a stick. She felt a rising sensation from the navel to the chest, which worsened the irritability. She also experienced abdominal bloating with a feeling of obstruction. Additional symptoms included insomnia, restlessness, nausea, poor appetite, irregular bowel movements, and yellow urine. Her tongue was red at the tip, with a greasy coating, and the pulse was wiry and slippery.

Diagnosis: A pattern of fire stagnation in the chest and abdomen, with downward pressure on the stomach and intestines.

Treatment Strategy: Soothe stagnation, clear heat, regulate qi, and reduce fullness.
Prescription: Zhīzǐ Hòupò Tāng

zhīzǐ 14g

zhǐshí 10g

hòupò 15g.

7 doses.

Follow-up: After 7 doses, the patient reported a 50% reduction in irritability. Her chest and abdomen felt clearer, and her mood stabilized. She was able to sleep at night, and her appetite improved. The treatment was highly effective, and the patient continued with 7 more doses. Upon follow-up, she still had symptoms of sleep disturbances, dry mouth, a bitter taste, and yellow urine, indicating that heat had not fully resolved.
The prescription was then changed to Chái Qín Wēn Dǎn Tāng [Wēn Dǎn Tāng plus cháihú & huángqín) combined with Zhīzǐ Hòupò Tāng to clear phlegm-heat and treat the remaining symptoms. After one month, the patient fully recovered.
(From Liú Dùzhōu Lin Zhen Yan An Xuan (Selected Clinical Cases of Liú Dùzhōu))

Note: The difference between Zhīzǐ Hòupò Tāng and Zhīzǐ Shí Tāng lies in the abdominal symptoms. The former is indicated when abdominal symptoms like bloating and constipation are present, while the latter is primarily used for chest-related symptoms like chest oppression and cough. Zhīzǐ Hòupò Tāng and Xiǎo Chéng Qì Tāng both contain zhǐshí and hòupò, which treat abdominal fullness and pain. The key difference is that zhīzǐ and dàhuáng have distinct effects: Zhīzǐ clears irritability, while dàhuáng is used to purge and clear heat. Therefore, Zhīzǐ Hòupò Tāng is more suitable for chest obstruction and irritability, while Xiǎo Chéng Qì Tāng is better for constipation and abdominal pain. The patient’s detailed symptoms of irritability and abdominal fullness illustrate the application of Zhīzǐ Hòupò Tāng for heat-related disturbances and its ability to address both physical and emotional symptoms.

acupuncture in port coquitlam

Case of Coldness in the Tips of the Toes Followed by Abdominal Discomfort and Diarrhea (Lóu Shàokūn)

On By eranevenIn Case Studies （医案), Lóu Shàokūn (娄绍昆), Translations & Writings (译著与文章)

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.

Two Cases On The Use of Táohé Chéng Qì Tāng In Severe Psychiatric Disorders

On By eranevenIn Case Studies （医案), Cáo Yǐngfǔ (曹颖甫), Jīng Fāng (经方), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

Case of Blood Amassment Induced Madness by Cao Yingfu 曹颖甫

Shen Shiwan’s younger sister, a frail young woman under the age of twenty, suddenly suffered a fright while out shopping. Upon returning home, she descended into madness—attacking anyone she encountered with seemingly boundless strength.

Several days passed without improvement, and I was called to examine her. By then, her condition had persisted for seven or eight days, with no signs of relief. Upon inquiry, I learned that she had not had her menstrual period for two months. Seizing an opportunity while she slept, I entered her room to examine her. Her pulse was deep and tight, and her lower abdomen appeared distended.

I stepped outside and told Shen Shiwan, “This is a case of blood amassment. A strong purgative will cure it.” I prescribed Táohé Chéng Qì Tāng as follows:

  • Táorén 1 liang
  • Dàhuáng 5 qian
  • Mángxiāo 2 qian
  • Zhìgāncǎo 2 qian
  • Guìzhī  2 qian
  • Zhǐshí 3 qian

The next day, I returned to check on her. She had passed a large amount of dark blood, her madness had completely subsided, she showed no signs of exhaustion, and she could even drink porridge. She was now ashamed to face others and refused to come out. (From Jingfang Shiyan Lu – Empirical Records of Classical Formulas)

Commentary:

The key diagnostic markers for Táohé Chéng Qì Tāng include “[patient] appears as if mad” and a “tense bound lower abdomen,” which strongly indicate its use in psychiatric disorders related to blood stagnation. The case aligns closely with classical descriptions—particularly the immediate menstrual discharge of dark purple blood after treatment, a vivid demonstration of the classical principle: “when blood is discharged, the illness will resolve.”

Hormonal changes can often lead to premenstrual symptoms such as irritability, insomnia, headaches, and cognitive issues, which frequently improve after menstruation. This phenomenon, referred to as blood amassment (xu xue 蓄血), remains a fascinating area for further study.

The prescription is quite potent and purgative. If hòupò were added, it would become a combination of Táohé Chéng Qì Tāng and Dà Chéng Qì Tāng. Interestingly, Dà Chéng Qì Tāng is also used in neurological conditions, including delirium, incoherent speech, hallucinations, clouded vision, and severe restlessness, often with more pronounced abdominal fullness and distension.

Case of Shock-Induced Immobility and Chest Oppression by Yè Júquán 叶橘泉

A businessman, known for his cautious and timid nature, had a habitual fondness for alcohol. At the time, Suzhou was under Japanese occupation. One midnight, Japanese military police, accompanied by local collaborators, conducted a household inspection. Terrified, the man was left speechless, eyes wide in shock, unable to respond. He was suddenly slapped across the face by the military police and collapsed to the ground, lying rigid and unconscious, appearing as if he had suffered a stroke.

I was invited to examine him. His pulse was thin and wiry, with a slippery sensation upon deep palpation. His face was flushed, tears welled up in his eyes, and though he appeared to have sensation when touched, he remained speechless and motionless in a rigid supine posture. His pupillary reflexes were normal, and no signs of hemiplegia were present, but his feet were icy cold, his rectus abdominis was tense, and there was a palpable mass in the lower abdomen. He had not had a bowel movement for several days.

I prescribed Táohé Chéng Qì Tāng with the addition of niúxī and chuānxiōng. After taking the formula, he had a bowel movement, his feet became warm, and he soon let out a deep sigh, moaning as if relieved of an immense weight. He then spoke for the first time, saying that he had felt a crushing pressure on his chest.

A second dose was given, after which his stool contained traces of blood. Upon examination, it was found that he had preexisting hemorrhoids, which had started bleeding. I then reduced the dosage and continued treatment for several more doses, leading to a full recovery. (From Zhongguo Bainian Bainming Zhongyi Linchuangjia Congshu – Yè Júquán – A Century of Renowned Chinese Physicians: Yè Júquán)

Commentary:

This case illustrates a shock-induced immobility with clear signs of blood stasis and psychological disturbance. Although the patient did not exhibit violent mania, his mental dysfunction was undeniable. The physician skillfully identified abdominal tension, a palpable lower abdominal mass, and prolonged constipation as key indications for Táohé Chéng Qì Tāng, demonstrating a flexible application of classical formulas.

Two key diagnostic markers stand out in this case:

  1. Flushed face with cold lower limbs – a hallmark external manifestation of blood stasis, which can serve as a visual clue for selecting Táohé Chéng Qì Tāng.
  2. Post-treatment rectal bleeding – This reinforces the classical principle that “blood will discharge after taking the formula”, not only in the form of menstrual bleeding in women but also through lower gastrointestinal or even urinary tract bleeding in certain cases. However, this effect is not universally observed in all patients.

Hán Shān’s Legacy: Poetry, Philosophy, and Buddhist Influence

On By eranevenIn Poetry (诗), Translations & Writings (译著与文章)

Hanshan 寒山 (dates of birth and death unknown), courtesy name and sobriquet also unknown, was a native of Chang’an (modern-day Xi’an, Shaanxi) and lived in seclusion in the Tiantai Mountains of eastern Zhejiang for over 70 years, passing away at the age of over 100. According to modern day poet Red Pine, Han Shan was born in the ancient town of Hantan at the western edge of the Yellow River floodplain, about 300 kilometres east of Chang’an, and his family only moved to Chang’an when he was little.1 Scholars generally place his life during the Tang Dynasty (618–907 CE), though specific details about his life are elusive due to his reclusive lifestyle and the mythical aura surrounding him.

A renowned poet-monk of the Tang Dynasty, Hanshan hailed from an aristocratic family but failed multiple attempts at the imperial examinations. Eventually, he renounced worldly pursuits, became a monk, and after the age of 30, withdrew to the Tiantai Mountains, living in seclusion and adopting the name “Hanshan” (Cold Mountain).

According to Yan Zhenfei’s Examination of Hanshan’s Life Story, supported by historical texts such as Northern History and Book of Sui, Hanshan was the son of Yang Wen, a descendant of the Sui royal family. Due to jealousy and ostracism within the imperial court, combined with the influence of Buddhist thought, he retreated to the Cold Cliffs of the Tiantai Mountains. He was known for his eccentric lifestyle, wearing a birch-bark hat, tattered clothing, and wooden clogs. He enjoyed playing with children, spoke freely and unpredictably, and was difficult for others to understand. He often visited the Guoqing Temple in Tiantai, where he befriended two monks, Fenggan and Shide. Hanshan would collect leftover temple food in bamboo tubes to sustain himself in his mountain home.

Hanshan frequently wrote poems and gathas (short Buddhist verses) on the rocks and trees of the wilderness. His poetry was straightforward, capturing the joys of mountain life and expressing Buddhist ideals of detachment, life’s wisdom, and compassion for the poor. He also criticized social norms and injustice. Han Shan’s poems focus on Buddhist and Daoist themes, with self-reflections and commentary on Tang society. These stylistic and thematic elements align with the intellectual and spiritual currents of the Tang era. His works were later compiled into the Collected Poems of Hanshan in three volumes, with 312 poems preserved in the Complete Tang Poems. In the Yuan Dynasty, his works were introduced to Korea and Japan and later translated into languages like Japanese, English, and French.

Legend has it that the Taoist that first collected Han Shan’s poetry, was a man named Xu Lingfu, who had moved to the Tiantai mountains in 815 to practice and live in seclusion as well and stayed for his remaining days. Based on several writings, we can ascertain that the two met sometime after 825 and before Xu’s death in 841.

This legendary poet, initially overlooked by society, gained increasing recognition and global dissemination in the 20th century. As one of his poems proudly declares:

“Some laugh at my poetry,
 [yet] my poems unite with the classical odes.
 No need for Zheng’s commentary,
 Nor Mao’s annotations to shine.”2

Han Shan is more often regarded as a spiritual figure than a historical one. He is depicted as a “laughing hermit” embodying Zen wisdom, with his poetry serving as a timeless bridge to his thought rather than a concrete record of his life.
The following are a few personal favourites that I feel capture the essence of Han Shan’s style and voice. All translations are my own.



我居山，勿人識。白雲中，常寂寂。

I reside in the mountains unaware of anyone, among the white clouds, always in solitude. 



寒山深，我稱心。
純白石，勿黃金。
泉聲響，撫伯琴。
有子期，辨此音。

Deep in cold mountain, I am content.
Pure white stones are not gold. 
The springs sound, and I gently pluck a qin.
If Ziqi3 were here, he’d recognize these sounds.



寒山子，長如是；
獨自居，不生死．

Master cold mountain, is always like this,
residing alone, free from birth or death.4

重岩我卜居，鸟道绝人迹。
庭际何所有，白云抱幽石。
住兹凡几年，屡见春冬易。
寄语钟鼎家，虚名定无益

In the layered cliffs, I chose my dwelling,
Where bird paths are cut from human presence.
What is at my courtyard edge?
White clouds embrace the shrouded stones.
I have lived here many years, observing the changes of the seasons.5
I send word to households with bells and tripods,6
Empty titles are of no benefit.

欲得安身处，寒山可长保。
微风吹幽松，近听声愈好。
下有斑白人，喃喃读黄老。
十年归不得，忘却来时道。

If you desire a place to calm your body, cold mountain can keep you protected.
A gentle breeze blows hidden pines, the closer you come, the more exceptional it sounds.
Below a grey haired man mutters [the words] he has read of Huang-Lao.7
For ten years he has not returned home, forgotten the path from which he came.

独卧重岩下， 蒸云昼不消。
室中虽暡靉， 心里绝喧嚣。
梦去游金阙， 魂归度石桥。
抛除闹我者， 历历树间瓢。

Alone I lie beneath the layered cliffs,
Steaming clouds, fail to disperse throughout the day.
Though the room is dim and misty,
My heart-mind is free from all clamor.
In dreams, I float within the imperial palace,
My ethereal soul returns, crossing the stone bridge.
I cast away things that disturb me,
Especially the gourd among the trees.

凡读我诗者， 心中须护净。
悭贪继日廉， 谄曲登时正。
驱遣除恶业， 归依受真性。
今日得佛身， 急急如律令。

All who read my poems,
Must protect and purify their heart-mind.
Let grudging and greed be purified daily,
And flattery and fawning be corrected at once.
Drive away and eliminate evil conduct,
Take refuge and receive your true nature.
Attain the Buddha’s body today—
Swiftly, swiftly, as the law commands.

家有寒山詩，
勝汝看經卷。
書放屏風上，
時時看一遍。

Having Hanshan’s poems at home
Surpasses your reading of scrolls.
Write them down upon a screen,
And read it through from time to time.

吾心似秋月，
碧潭清皎潔。
無物堪比倫，
教我如何說。

My mind is like the autumn moon,
A clear pond, pure and bright.
Nothing in the world compares—
How can I find the words to describe it?

  1. Red Pine, The Collected Songs of Cold Mountain (Port Townsend: Copper Canyon Press, 2000), 13.  ↩︎
  2. Han Shan is referring to the Shijing (Classic of Poetry) here and is insinuating that his poetry is easier to read, hence commentaries are unnecessary. Zheng and Mao were the standard commentaries on the Shijing.  ↩︎
  3. This is a reference to Zhong Ziqi (钟子期), a renowned Guqin (ancient Chinese seven-string plucked instrument) musician from the State of Chu during the Spring and Autumn Warring periods. Zhong Ziqi was known for his acute listening skills and deep sensitivity to music, capturing the emotions and psychological depth behind melodies. The Ziqi-style Guqin is said to have been designed in his honor, characterized by a straight and deep neck with a half-moon shape. ↩︎
  4. A reference to Samsāra, the cycle of birth and death or re-birth and re-death.  ↩︎
  5. While the text literally says spring and winter, this can be translated simply as seasons.  ↩︎
  6. This is an ancient reference to wealthy families and households.  ↩︎
  7. Huang-Lao is an early school of Daoist thought and an important branch of Daoism that advocates active engagement with the world. It applies the philosophy of traditional reclusive Daoism to governance, aiming to achieve national prosperity and military strength. The school is named after its association with the Yellow Emperor (Huangdi) and the veneration of Laozi. Huang-Lao Daoism later became the foundation of Daoism as a religious tradition. Followers of Laozi claimed to represent the teachings of the Yellow Emperor and also revered Yi Yin and Jiang Taigong. They promoted the principles of tranquility and non-action (wu wei), avoiding interference with the people and allowing the populace to “self-transform,” thereby bringing peace and stability to the world. ↩︎

Chaihu Guizhi Ganjiang Tang [柴胡桂枝干姜汤] in the treatment of skin disorders

On By eranevenIn Case Studies （医案), Jīng Fāng (经方), Shāng Hán Lùn (伤寒论), Translations & Writings (译著与文章)

伤寒论六经辨证与方证新探——经方辨治皮肤病心法

欧阳卫权著

The following translation is taken from Ouyang Weiquan’s ‘Exploration of Cold Damage Six-Conformation Pattern Differentiation and Formula Presentations – Jingfang Approach to the Identification and Treatment of Skin Diseases.’ 

Chaihu Guizhi Ganjiang Tang [柴胡桂枝干姜汤]

皮肤病辨治心法

1.不论何种皮肤病、何种皮损，凡见太阴里虚寒证又见上热表现者，可考虑本方证。

2.年轻女性面部痤疮、脂溢性皮炎患者，使用本方证机会较多，常合用当归芍药散。

3.系统性红斑狼疮经长期激素治疗，常表现出本方证，临床对证用之，可迅速使皮损消退，改善症状。且坚持服用，各项狼疮指标多能转为正常。

4.其他如荨麻疹、慢性湿疹、银屑病等，皆有使用机会。

Approach to Identifying and Treating Skin Diseases

  1. Regardless of the type of skin disease or lesion, if there is a presentation of interior cold deficiency in the Taiyin channel along with symptoms of heat in the upper body, this formula can be considered.
  2. This formula is frequently used for young women with facial acne or seborrheic dermatitis and is often combined with Dang Gui Shao Yao San.
  3. Patients with systemic lupus erythematosus (SLE) who have undergone long-term corticosteroid treatment often present symptoms corresponding to this formula. Clinically, using this formula based on the diagnosis can quickly reduce skin lesions, alleviate symptoms, and, with consistent use, normalize various lupus-related indicators.
  4. Other conditions such as urticaria, chronic eczema, and psoriasis may also benefit from this formula.

医案实录

1.系统性红斑狼疮（柴胡桂枝干姜汤合当归芍药散）

杨某，女性，51岁，2005年5月13日初诊。系统性红斑狼疮

（SLE）病史13年。一直在风湿科、内科等中西医治疗，病情较稳定，现服泼尼松用量10mg/d。但患者四肢关节痛、颈、背痛不能缓解已2年余。现双肘、腕、指关节及双膝、踝关节疼痛、颈、背痛。稍怕冷，纳可，口稍干不欲饮，饮则喜温，小便少。舌暗红苔白，脉沉细。处方柴胡桂枝干姜汤合当归芍药散加味：

柴胡10g，桂枝9g，干姜4g，黄芩10g，甘草5g，花粉15g，牡蛎（先煎）20g，当归10g，白芍10g，川芎4g，茯苓15g，白术10g，泽泻10g，葛根12g，7剂。

Case Study

Systemic Lupus Erythematosus (SLE) Treated with Chai Hu Gui Zhi Gan Jiang Tang Combined with Dang Gui Shao Yao San

Yang, female, 51 years old. Initial consultation: May 13, 2005.
History of systemic lupus erythematosus (SLE) for 13 years. Previously treated with both Western medicine and Traditional Chinese Medicine in the rheumatology and internal medicine departments, with relatively stable disease progression. Currently taking 10 mg/day of prednisone.
However, the patient had been experiencing unrelieved joint pain in the limbs, neck, and back for over two years. Symptoms included pain in the elbows, wrists, finger joints, knees, and ankles, along with neck and back pain. She reported slight sensitivity to cold, normal appetite, slight dry mouth with no desire to drink, preference for warm drinks, and reduced urination. Tongue was dark red with a white coating, and the pulse was deep and thin.

Prescription:

Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San with modifications:

  • Chai Hu 10g
  • Gui Zhi 9g
  • Gan Jiang 4g
  • Huang Qin 10g
  • Gan Cao 5g
  • Tian Hua Fen 15g
  • Mu Li (pre-cooked) 20g
  • Dang Gui 10g
  • Bai Shao 10g
  • Chuan Xiong 4g
  • Fu Ling 15g
  • Bai Zhu 10g
  • Ze Xie 10g
  • Ge Gen 12g

Seven doses were prescribed.

患者服后感觉效果非常好，又自购药服12剂。药后明显好转，四肢关节及颈背痛基本消失，不觉怕冷，精神较佳，口干明显，舌暗红，苔中黄，脉细。前方加生石膏20g。上方服至2005年7月15日。诉服后关节痛全消，无其他不适，精神佳。遂改泼尼松为5mg/d。前方去石膏，继服巩固。

After taking the formula, the patient reported significant improvement. She obtained an additional 12 doses on her own. After taking the formula her joint pain in the limbs and neck/back had almost completely disappeared. Cold sensitivity was no longer noticeable, her energy levels had improved, and her dry mouth had markedly lessened. Her tongue was dark red with a yellowish coating, and her pulse was thin. 20g ofShi Gao was added to the previous formula.

The patient continued this treatment until July 15, 2005. By then, joint pain was completely resolved, and no other discomfort was reported. Her energy levels remained good. The dosage of prednisone was reduced to 5 mg/day. The prescription was adjusted by removing Shi Gao and continued as a consolidation treatment.

【按】

柴胡桂枝干姜汤见《伤寒论》第147条：“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝干姜汤主之。”为治热郁少阳，枢机不利，又兼太阴脾寒，水饮内伏之病变。胡希恕以此方合当归芍药散治疗SLE属血虚水盛、邪郁少阳证者多有效。笔者临床观察，SLE经西药激素控制稳定后常现本方证，依证用药确有效验。

Commentary:

The formula Chai Hu Gui Zhi Gan Jiang Tang originates from the Shang Han Lun, Clause 147, where is says:

“In cold damage that has lasted five or six days, sweating has already been promoted followed by purgation, and there is fullness and mild congestion in chest and ribs, with inhibited urination, thirst but no vomiting, and only the head is sweating, with alternating cold and heat, and heart vexation, this means that [the pattern] has not yet resolved, and Chaihu Guizhi Ganjiang Tang governs.”

 This formula addresses Shaoyang depressed heat with inhibition of the pivot mechanism combined with Taiyin spleen cold and internal deep-lying water-rheum. Hu Xishu frequently combined this formula with Dang Gui Shao Yao San to treat SLE presenting with blood deficiency, exuberant water, and Shaoyang depressed heat, with notable efficacy.

The authors own clinical observations suggest that after systemic lupus erythematosus (SLE) is stabilized with corticosteroid treatment, symptoms often align with the pattern corresponding to this formula presentation. Using the formula according to the pattern has proven to be effective.