Library

After one dose, the condition will gradually become quiet. The patient should decoct and take the medicine according to the method. Initially, there is a feeling of nausea and desire to vomit; by the time half is consumed, it feels relatively stable. After finishing the entire dose, rest in a reclining position for a while until the urge to vomit subsides, then lie down. However, abdominal cramping pain persists. Half an hour later, a sense of warmth is felt in the abdomen and throughout the body, and the pain slightly alleviates. At two hours and ten minutes, sounds are heard in the abdomen, gradually moving downward. Suddenly, there is a pressing sensation at the anus, and bowel movement occurs shortly thereafter. First, dry feces are passed, followed by dry fecal pellets, and finally sticky, mud-like material. Consequently, the pain immediately reduces by half. By the next morning, after taking the second decoction, two more bowel movements occur. The sticky residue is deeper, and the blackish dirt has decreased, but small kernel-like fecal particles remain. In the afternoon, a follow-up consultation is requested. The dosage of the previous formula is reduced, and qi-regulating herbs are added for another prescription. Thus, the abdominal pain is completely eliminated. Subsequently, a conditioning formula is taken to support the healthy qi.

Da Huang Fu Zi Tang combined with Gan Cao Gan Jiang Tang Formula: Raw Da Huang (Rhei Radix et Rhizoma) 5 qian (washed with wine), Shu Fu Pian (Prepared Aconiti Lateralis Radix) 5 qian, Bei Xi Xin (Asari Radix) 1 qian, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 3 qian, Pao Jiang Tan (Charred Zingiberis Rhizoma) 3 qian, Sheng Jiang (Fresh Zingiberis Rhizoma) 5 slices. Note: For the second treatment, the dosages of Da Huang, Gan Jiang, and Fu Zi are slightly reduced, Xi Xin is removed, and Mu Xiang, Sha Ren, Bing Lang, and Zhi Ke are added.

Qi Stagnation Abdominal Pain Syndrome: The patient suffers from chronic abdominal pain that has resisted treatment for over a year. During episodes, the pain is dull and not severe, with no fixed tender point. Bowel movements vary between hard and loose, or appear jam-colored, occurring once or twice daily. The diagnosis is dietary irregularity leading to turbid stagnation and qi stagnation in the intestines. The primary treatment is A Wei Xiang Bin Wan.

Student Gu Yuchu studied at the former Shanghai College of Traditional Chinese Medicine for one year in 1942, when I served as the Director of Academic Affairs. Later, due to the Japanese occupation of the old concession, the medical school was closed to demonstrate resistance against the enemy puppet regime. Gu Yuchu thus suspended his studies. His father and brothers were merchants, so he was directed to switch to the lacquer industry at a lacquer shop on Jinling East Road, abandoning medicine for commerce.

Time flies. In the third year after the victory of the Anti-Japanese War, Mr. Gu developed abdominal pain. Initially, it presented as watery diarrhea, which later turned into loose stools after treatment. The abdominal pain shifted from severe to mild, leading him to believe medication was unnecessary.

Due to busy work, even occasional mild pain was ignored. It persisted for over a month without recovery, causing fear, and he sought medical help. Qi-regulating agents were ineffective; purgative agents were ineffective; warming and tonifying agents were ineffective; warming and dispersing agents were also ineffective. Doctors changed frequently, and treatment was intermittent. Over a year and a half, the dull abdominal pain remained unchanged.

He subsequently consulted Western medicine. After detailed examination, the doctor suspected chronic peritonitis or possible chronic appendicitis. However, the diagnosis was uncertain, requiring laparotomy to locate and remove the lesion. His family disagreed, and Mr. Gu refused outright. Firstly, the diagnosis was unclear, making surgery risky; secondly, store duties prevented prolonged hospitalization. He left the hospital decisively. While hesitating, he recalled me as his former teacher and came to see me.

I inquired about his past medical history and reviewed previous prescriptions, all of which had failed, leaving me puzzled. I understood that this chronic abdominal pain stemmed from long-standing intestinal uncleanness and turbid stagnation. With deep roots, tonification was ineffective, and given the duration of over a year, aggressive purgation was contraindicated. I considered using A Wei, which has effects in removing filth, detoxifying, and regulating the intestines. Thus, I prescribed a formula with only three ingredients, made into capsule pills. Since A Wei has a foul odor difficult to swallow, capsules were used. The pills consisted of A Wei, Mu Xiang, and Bing Lang, named A Wei Xiang Bin Wan.

After preparation, I instructed on administration: take one pill with warm water, twice daily (morning and evening) or three times daily. After three days of taking the pills, Mr. Gu’s abdominal pain gradually decreased, accompanied by frequent passage of foul-smelling gas. Bowel movements became smooth but extremely odorous. After ten days of continuous use, the abdominal pain vanished completely. Upon stopping for two or three days, slight pain recurred. I ordered continued use, as the root cause was not yet fully eradicated. After twenty days of continuous use, upon stopping again, the pain did not return. This demonstrates that A Wei’s efficacy lies in attacking toxicity with its strong odor and clearing the intestines.

A Wei Xiang Bin Wan Formula: True A Wei 8 qian, Guang Mu Xiang and Hua Bing Lang 4 qian each. First, cut A Wei into small granules, size of beans, and dry them over low heat. Because it is sticky and hard, drying facilitates grinding. Next, grind Mu Xiang and Bing Lang into fine powder. Place together in a large mortar and grind slowly into an ultra-fine powder. Fill No. 2 capsules from a Western pharmacy, approximately 150–160 pills. Take one pill twice daily (morning and evening) or three times daily (morning, noon, evening) with warm water.

Severe Water Distension Syndrome: A patient over forty suffered from water distension. Both legs were swollen, the abdomen was drum-tight, the umbilicus protruded, swelling extended to both hypochondria, accompanied by shortness of breath and wheezing, difficulty urinating, and dry mouth. The doctor drained fluid three times, but swelling returned within ten days. Fluid drainage provides only temporary relief; warming Kidney Yang is necessary for spontaneous urination. The main formula was Fu Shi Jue Liu Tang. One dose produced over a dou of urine; three doses reduced swelling by more than half. Interspersed with Xiang Sha Liu Jun Zi Tang, and subsequent doses of the original formula at reduced amounts led to recovery.

Two years before the Anti-Japanese War, a patient surnamed Zhang, a forty-something-year-old worker from Yancheng at Renji Hospital, suffered from ascites (Water Distension). His abdomen swelled like a drum, with symptoms as described above. Hospital doctors drained fluid via subcutaneous needle puncture, releasing a large volume and providing immediate relief. However, due to fluid intake from diet, swelling returned within days, recurring every ten days. After three drainages with similar results, the doctors exhausted their methods, and the patient became terrified.

His fellow townsman, Xu Rujie, an assistant physician at the hospital, advised him. Xu asked if he wished to try TCM. Zhang replied he only wanted cure, regardless of system. Xu introduced him to me. I listened to the history and prior treatments. I pondered that while many TCM formulas for water distension have variable efficacy, I had never tried Jue Liu Tang from *Fu Qingzhu Nan Ke*. Given that hospital drainage and prior medications failed, a potent formula was needed. Due to the severity and recurrence, I increased the dosage. Also, since Gui Rou (Cinnamon Bark) was expensive and the patient could not afford it, I reduced the Gui Rou dosage and added Gui Zhi (Cinnamon Twig), instructing him to decoct and take as directed.

The next day, Zhang returned by car. Upon arrival, he appeared lighter, walked better, and looked happy. He reported: "After taking the medicine yesterday, less than two hours later, I urinated once with a large volume, feeling very relieved. Two hours later, I took the second decoction. Throughout the night, I urinated five times, each time smoothly. Today, abdominal swelling has greatly reduced, and the umbilicus is no longer protruding." He showed me his abdomen; the skin was slightly wrinkled. I was overjoyed, as this was the first trial of this formula. I instructed him to take two more doses, with a follow-up visit in two days.

He indeed returned on the scheduled day, moving as easily as a normal person. He reported that each urination strengthened the contraction of the abdominal wall and bladder, resulting in smoother urination than ever since the illness began. His appetite also increased daily. I reduced the original formula dosage and prescribed Xiang Sha Liu Jun Zi Tang to support the Spleen and Stomach. Alternating these two formulas for a total of eight doses resulted in recovery. This occurred in 1935, my fifth year practicing in Shanghai. Since this successful trial, I have cured all cases of water distension with this formula.

The composition of this formula retains the essence of classical prescriptions. Qian Niu Zi and Gan Sui promote water metabolism to treat the branch (symptoms), while Rou Gui warms Yang to treat the root (cause). Few ingredients with focused efficacy explain its rapid success.

Fu Shi Jue Liu Tang Formula: Hei Qian Niu Zi (Blackened Semen Kochiae) 4 qian, Zhi Gan Sui (Prepared Kansui Radix) 3 qian, Shang Rou Gui (Top-grade Cinnamon Bark) 1 qian (decocted separately and mixed in), Chuan Gui Zhi (Sichuan Cinnamon Twig) 3 qian, Che Qian Zi (Plantaginis Semen) 1 liang. Original formula: Qian Niu Zi and Gan Sui 2 qian each, Rou Gui 3 fen, Che Qian Zi same amount, no Gui Zhi. Modified here due to severe condition.

Xiang Sha Liu Jun Zi Tang Formula: Guang Mu Xiang (Costus Root) 3 qian, Suo Sha Ren (Amomi Fructus Rotundus) 6 fen, Jiang Zhi Ban Xia (Ginger-processed Pinellia Tuber) 3 qian, Tu Chao Bai Zhu (Earth-fried Atractylodis Macrocephalae Rhizoma) 3 qian, Lu Dang Shen (Codonopsis Radix) 3 qian, Guang Chen Pi (Citrus Reticulatae Pericarpium) 2 qian 5 fen, Zhi Gan Cao (Prepared Licorice Root) 2 qian, Yun Fu Ling (Poria) 3 qian, Sheng Jiang (Fresh Ginger) 3 slices.

Chronic Water Distension Syndrome: A woman over fifty suffered from water distension. Initially mild, fluctuating with treatment, it worsened over a year. Urine was scanty and dark red, abdomen drum-tight, swelling extending to hypochondria, umbilicus protruding, legs swollen like elephant feet, sometimes palpitations. Prescribed Fu Shi Jue Liu Tang. Due to weak Stomach, interspersed with Xiang Sha Liu Jun Zi Tang plus Gui Zhi and Zhu Ling. Gradual recovery occurred over two months.

Patient Mrs. Zhang, 55, originally from Lianshui, Northern Jiangsu. In early 1952, she developed weak Stomach and fullness in the epigastrium and abdomen. Subsequently, water distension developed, swelling gradually rising from abdomen and lower limbs. Treatment yielded fluctuating results for over a year. Diet decreased, confirming water distension. Reducing water intake caused severe dry mouth. Due to repeated failures elsewhere, she came to Shanghai to seek treatment, staying in a bungalow on Meiyuan Road where her son and daughter-in-law lived. A neighbor, a female worker at an umbrella factory whom I had previously cured of Liver-Stomach Qi pain and irregular menstruation, recommended me.

Observing her symptoms as described: abdominal veins exposed, prominent umbilical protrusion, uneven breathing, hypochondriac swelling but no swelling above, visible ribs on chest, thin upper limbs without swelling. Pressing abdomen and legs left indentations that did not rise quickly. Considering her advanced age and chronic illness, Jue Liu Tang was essential. However, dosage should be reduced, and Stomach regulation interspersed, avoiding rapid results sought in robust patients. Prescriptions: 1) Fu Shi Jue Liu Tang; 2) Xiang Sha Liu Jun Zi Tang minus Ren Shen, adding Zhu Ling and Gui Zhi. Instructed to take the first formula first to open the flow; after two doses, take one dose of the second formula to nourish the root, fearing intolerance to harsh purgation.

On the fourth day, she returned with reduced swelling. She reported: "After the first dose, nighttime urination increased significantly, averaging once every 3-4 hours. Initially yellow-red, later fading. After the second dose, urination was smooth as before, but urine was yellow, not red. On the third day, taking the second formula, I felt better mentally." Seeing efficacy, I advised rest, avoiding worry. Given her age and chronicity, slow recovery without relapse was the goal. She agreed. Instructed to take three more doses of the original prescription. If efficacy continued, skip medication on the fourth day to prevent aversion to medicine. Since improvement was achieved, chronic patients need not rush medication.

On the fifth day, she returned with improved complexion and continued reduction in edema. She reported that previously dry bowels now moved smoothly. After smooth bowel movement yesterday, her appetite improved today. I was delighted. Since edema greatly reduced, I slightly reduced the dosages of Qian Niu Zi and Gan Sui. Since appetite improved, I added Dang Shen 3 qian to the second formula (Xiang Sha Liu Jun Zi Tang) to strengthen healthy qi. Initially, Ren Shen was omitted fearing the Stomach Qi was too weak for heavy tonification. Now that Stomach Qi recovered, it was reinstated. Continue medication as before, but interval between doses changed to two days. Then two days off, repeating until recovery. No further visits needed.

She did not return for about three months, presumed cured. She returned one day, reporting complete recovery after three courses of medication. However, abdominal swelling recurred in the last ten days. Observing no other abnormalities and mild swelling, I instructed her to resume the previous formula. Logically, four more courses would ensure recovery. Advised strict dietary control, avoiding meat and fish. Also suggested eating boiled yam with white sugar to invigorate the Spleen and boost Qi. Healthy Spleen leads to good digestion, which strengthens healthy qi. Following this regimen, she fully recovered.

Fu Shi Jue Liu Tang Formula: Hei Qian Niu Zi 3 qian, Zhi Gan Sui 2 qian 5 fen, Shang Rou Gui 8 fen (decocted separately and mixed in), Chuan Gui Zhi 2 qian 5 fen, Che Qian Zi 8 qian.

Xiang Sha Liu Jun Zi Tang minus Ren Shen plus Zhu Ling and Gui Zhi Formula: Guang Mu Xiang 3 qian, Suo Sha Ren 8 fen, Jiang Zhi Ban Xia 3 qian, Tu Chao Bai Zhu 3 qian, Yun Fu Ling 3 qian, Mu Zhu Ling 3 qian, Guang Chen Pi 2 qian, Chuan Gui Zhi 2 qian 5 fen, Zhi Gan Cao 1 qian 5 fen, Sheng Jiang 3 slices.

Beng Tan (Running Piglet) Postpartum Syndrome: A woman postpartum contracted cold, constitutionally weak, with leukorrhea. Three days postpartum, she worked in a vegetable garden, sitting on the ground when exhausted, contracting cold and abdominal pain. Qi rushed upward from the lower abdomen, gathering and dissipating intermittently. Doctors treated for residual lochia, ineffective. During attacks, Qi rushed to the heart, thick as a forearm. Teeth clenched, eyes closed, limbs cold as ice, then spontaneously dissipated. Gui Zhi Tang plus Gui Zhi was ineffective. Gui Zhi Tang plus Rou Gui cured it in one dose (improvement), two doses (resolution), and three doses (complete peace).

Before presenting this case, I break convention to discuss this disease. Though rare, encountering it without knowledge of treatment is a physician's fault. This syndrome is called Beng Tan, recorded in *Shang Han Lun* and *Jin Gui Yao Lue*. It states: "After sweating, if needles are burned to induce sweat, and the needle site is exposed to cold, nodules appear red," is one source. It also states: "Beng Tan must occur, Qi rushes from the lower abdomen up to the heart," describing the characteristic symptom. However, in practice, it often arises from direct cold exposure to the lower abdomen rather than needle sites. Thus, cold contraction is undoubtedly the primary cause. Cold is formless Qi, invisible and intangible. Cold exposure in the lower abdomen presents differently: some have abdominal pain with constipation, some with diarrhea, some with Bladder Qi stagnation and dysuria, some with amenorrhea and lower abdominal knotting pain. The Qi of Beng Tan rushing from the lower abdomen to the heart is merely one manifestation of cold. Why does it appear and disappear, start and stop? The cause is the struggle between healthy Qi and Cold pathogen, creating disturbance. Similar to Shaoyang disease's alternating chills and fever, caused by Zheng-Xie struggle. When Zheng wins, fever occurs; when Xie wins, chills occur. In Beng Tan, sudden Qi rushing indicates Cold overcoming Zheng; sudden dissipation indicates Zheng overcoming Xie, creating the intermittent pattern. Later physicians, violating Zhongjing's intent, did not diagnose Cold, attributing it to Kidney accumulated Qi, prescribing Gui Zhi Jia Gui Tang. They claimed it attacks Kidney evil and drains Kidney Qi, which is inexplicable. What connection does it have with the Kidney? This is nonsense, deceiving oneself and others. Later generations blamed all lower abdominal diseases on the Kidney.

This harm stems from pulse diagnosis theories stating "Chi pulse reflects the Kidney" and "Kidney governs the Lower Jiao."

Western medicine lacks detailed records of Beng Tan. Hysterical women may feel gas surging in the abdomen, termed "Hysterical Globus." However, this is a nervous system disorder, distinct from Beng Tan. Careful consideration suggests it might correspond to Western Colica Flatulenta (Flatulent Colic). Symptoms include abdominal distension, tension, tenderness, belching, borborygmus, and flatus. However, Western descriptions do not mention the intermittent nature. Comparing the names "Beng Tan Qi" and "Flatulent Colic," both contain "Qi," suggesting similarity. Other diseases do not fit.

Mr. Yan Derun, former principal of Harbin Medical Specialized School, speculated on this syndrome from a Western perspective. He stated: "In stomach diseases, the similar symptom is idiopathic gastric dilation or gastric asthenia. In this condition, the lesser curvature is in the normal position, while the greater curvature extends below the navel to the lower abdomen. This indicates the presence of liquid and air in the stomach." He did not realize that gastric dilation and asthenia symptoms are entirely different from this disease.

This syndrome comes and goes unpredictably, like a ghost. Suddenly appearing, a band rises in the abdomen like a wooden stick; suddenly disappearing, the abdomen becomes soft as usual. Unlike gastric dilation and asthenia, which are chronic conditions with constant abdominal distension. Therefore, Mr. Yan's speculation is fundamentally invalid, as this syndrome does not reside in the substance of organs.

I have cured several cases of Beng Tan in the past using Gui Zhi Tang plus Rou Gui. The medicine worked instantly, responding like an echo, a lesson learned from family training. However, I dared not use the addition of Gui Zhi as a trial on patients. One year before the Anti-Japanese War, while serving as a professor at China College of Traditional Chinese Medicine, I debated this point with colleagues, wishing to investigate thoroughly. An appropriate case arose: a woman surnamed Zhao, over forty, who worked in a vegetable garden three days postpartum. Sitting on the ground, she contracted cold due to weakness. Initially, paroxysmal abdominal pain, followed by Qi rushing from the lower abdomen. Physicians assumed residual lochia, using blood-invigorating and knot-resolving agents, ineffective. Pain intensified. Attacks involved violent Qi rising from below the navel to the heart, thick as a forearm, hard as a stick. The patient clenched teeth, closed eyes, stopped breathing, and limbs turned cold. This lasted about 4-5 minutes, after which accumulated gas dispersed, breathing normalized, and calm returned. Occurring 7-10 times per night, this persisted for a week before she sought my consultation.