Library

Trainee Bing requested permission: Let me interrupt. I would like to further inquire about the treatment of Spleen Yin injury and have brought *Yixue Zhongzhong Canxi Lu* (Records of Chinese Medicine Integrating Eastern and Western Medicine). First, the Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction) recorded in the book, consisting of Shanyao 30g, Huashi 30g, Baishao 12g, and Gancao 9g, does not explicitly state its indication for chronic diarrhea injuring Spleen Yin; Second, TCM textbooks do not discuss chronic diarrhea injuring Spleen Yin; they discuss "Yin injury" from diarrhea, using Lianmei Tang (Coptis and Mume Decoction).

Teacher: Textbooks cannot cover every detail comprehensively; human diseases also do not perfectly match the syndromes described in textbooks. Regarding Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction), although Zhang Xichun did not explicitly state it is specifically for chronic diarrhea injuring Spleen Yin, carefully reflecting on his discussions combined with clinical cases will be enlightening. For example: "A four-year-old child contracted a warm disease, with pathogenic factors still in the exterior. The physician, unaware of the need to clear and resolve, hastily administered bitter-cold agents. After ingestion, slippery diarrhea persisted for four or five days without stopping. Upper Jiao dryness-heat caused closed eyes and wheezing, with mental confusion. Seeking diagnosis and treatment, although the condition was critical, the pulse still had root, indicating recovery was possible. Prescribed the original formula of Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction), decocted into one large teacup. Due to the child's young age, administered slowly as warm drink. Upon completion of the dose, the patient recovered." He also emphasized that for treating "chronic lower loss of Yin," "clearing dryness-heat makes slippery diarrhea worse; tonifying slippery diarrhea makes dryness-heat worse. Only this formula uses Shanyao to stop slippery diarrhea, while Shanyao truly nourishes Yin and reduces fever; Huashi clears dryness-heat, while Huashi truly promotes urination and stops diarrhea. The functions of these two complement each other. Furthermore, assisted by Shaoyao to nourish Yin-blood and promote urination, and Gancao to harmonize Yin-Yang and the Middle Jiao, these are essential for clearing heat and stopping diarrhea. Combined into a formula, its efficacy is exceptional. I have used this formula to save many people effectively, even in critical conditions, yielding results." This means that for treating chronic diarrhea injuring Spleen Yin, one should simultaneously nourish Spleen Yin and leach out dampness-water. Clinical practice proves that selecting herbs that nourish Yin without obstructing dampness and drain dampness without injuring Yin achieves a synergistic effect.

Trainee Bing: Is the use of Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction) for chronic diarrhea injuring Spleen Yin reproducible?

Teacher: It is reproducible. Frankly speaking, my use of this formula for chronic diarrhea injuring Spleen Yin comes from personal experience. In the early 1970s, I worked in mountainous areas where residents ate coarse grains year-round. Children, with delicate Spleen and Stomach, often suffered from diarrhea. Coupled with economic difficulties and lack of medical care, cases progressing to severe Yin injury were common, with typical symptoms and signs. Initially, I generally used standard Yin-nourishing formulas and herbs, with poor results. Through careful observation and reflection, I realized that due to individual constitutional differences, children could present with different syndromes such as Liver Yin injury, Spleen Yin injury, or Kidney Yin injury. Thus, I shifted to syndrome differentiation and treatment: using Jiaomei Tang (Pepper and Mume Decoction) for Liver Yin injury, Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction) for Spleen Yin injury, and Lianmei Tang (Coptis and Mume Decoction) for Kidney Yin injury, achieving high efficacy. Especially when using Ziyin Qingzao Tang (Nourish Yin and Clear Dryness Decoction), adjusting the original dosage to Shanyao 30-60g, Baishao 30g, Huashi 30g, and Gancao 9-15g yielded faster results. These experiences were compiled into an article "Syndrome Differentiation and Treatment of Chronic Diarrhea with Yin Injury in Children," published in the second issue of *New Chinese Medicine* in 1974. Later, when I moved to a city hospital, I found that simple cases of chronic diarrhea injuring Yin were rare, likely because urban patients seek early treatment and rely on intravenous fluids initially. Some children with persistent diarrhea did not appear severely ill in spirit or complexion, but many anti-diarrheal formulas were ineffective. Analyzing the history and treatment course, chronic diarrhea usually damages Spleen Qi, Spleen Yin, and Spleen Yang. Damage to Spleen Qi and Yang often presents as obvious symptoms, while damage to Spleen Yin is often hidden or latent. By grasping the essence through phenomena, we adopted a comprehensive treatment method of tonifying Spleen Qi, warming Spleen Yang, nourishing Spleen Yin, and draining dampness-water, frequently achieving rapid results.

Trainee Bing: Teacher, you were interrupted when discussing Xianjie Tang (Immortelle and Platycodon Decoction); can you continue?

Teacher: Xianjie Tang (Immortelle and Platycodon Decoction) consists of two herbs: Xianhecao (Agrimoniae Herba) and Jiegeng (Platycodi Radix). This is an empirical medication used by the renowned TCM practitioner Zhu Liangchun for treating chronic diarrhea. I borrowed it to add to appropriate compound formulas. Incidentally, adding these two herbs to formulas for treating persistent cough significantly improves efficacy; everyone can try it.

Dysentery with pus and blood, fever, abdominal distension, vomiting and inability to eat

Professor Xiong Jibo, Hunan College of Traditional Chinese Medicine

Wu XX, female, 12 years old, student. Consulted in August 1976. Inquiry into the course of illness: The child had dysentery for 7 days, passing thick sticky pus and blood, with fever and abdominal distension. After Western medicine treatment, the dysentery did not stop, but abdominal distension worsened like a drum, with continuous passage of pus and blood and persistent fever. The local hospital diagnosed "toxic dysentery" and referred to TCM. Examination revealed: the child was emaciated, exhausted, abdomen distended like a drum, body heat significant, temperature 39.7°C, continuous passage of pus and blood in stool, abdominal pain, tenesmus, defecating over 30 times a day. Frequent vomiting and inability to eat. Tongue and pulse: deep red and crimson tongue body, thick greasy yellow-black coating at the root, deep and rapid pulse. Analysis of pulse and symptoms: This syndrome involves abundant internal damp-heat, injury to Yin-blood, deficiency of healthy Qi and excess of pathogenic factors, becoming critical. First, sweep away damp-heat, eliminate pathogens to preserve Yin. Prescribed Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) combined with modified Wangshi Lianpo Yin (Mr. Wang's Coptis and Magnolia Bark Decoction), guiding the pathogen according to its trend. Prescription: Huanglian 10g, Houpo 10g, Sheng Dahuang 8g, Zhiqiao 8g, Guangmuxiang 3g, Zhuru 15g, Chao Laifuzi 10g, Diyutan 15g. Second visit: After taking 3 doses, the passage of pus and blood decreased significantly, abdominal pain and tenesmus subsided, fever dropped notably, especially abdominal distension basically eliminated, vomiting controlled, and the thick greasy yellow-black coating at the tongue root disappeared. Now only presenting dry mouth and thirst, no desire to eat, loose stools occasionally mixed with red blood streaks, defecating 4-5 times a day. Red tongue with little coating, fine and rapid pulse. Changed to Yiwei Tang (Benefit the Stomach Decoction) plus Danggui, Baishao, and Diyutan to benefit the Stomach and generate fluids, cool blood and nourish blood. Medicinals: Shengdi 15g, Baishao 15g, Danggui 10g, Yuzhu 15g, Shashen 15g, Maidong 15g, Diyutan 12g, Chao Laifuzi 15g. Taken continuously for 5 doses, the illness was cured.

Doctor Jia: Please teacher discuss your diagnostic and treatment思路 (approach) for this patient.

Teacher: The key to diagnosing and treating this disease lies in two points: First: The child has had dysentery for 7 days, presenting high fever, mental exhaustion, rapid pulse, continuous bleeding, and crimson tongue body, indicating heat entering the Ying and Blood levels, signifying intense internal heat-toxin scorching Yin-blood. Simultaneously, the child presents severe abdominal distension, vomiting, and inability to eat, with a thick greasy yellow-black coating at the tongue root, marking damp-heat accumulation in the intestines. The contradiction of the syndrome has two aspects: one is scorched Yin-blood, the other is damp-heat accumulation. Weighing the root and branch, urgency and slowness, damp-heat accumulation is the root, while scorched Yin-blood is the branch. Because damp-heat is too severe and accumulation remains, it inevitably scorches Yin-blood. The scorching of Yin-blood is caused by damp-heat accumulation. At this time, the most prominent manifestations are abdominal distension, vomiting, dysentery, and fever. Therefore, it is urgent to purge real pathogens and remove damp-heat accumulation to ensure pathogen elimination and healthy Qi peace. If limited to routine methods like clearing heat-toxin and cooling blood to stop bleeding, accumulation cannot be removed, delaying the condition. Second: Any dysentery accompanied by vomiting and inability to eat is called "Jinkou Li" (Closed-Mouth Dysentery) in TCM, a sign of failing Stomach Qi, belonging to critical syndromes. Tang Rongchuan's *Three-Character Formula for Dysentery* states, "If closed-mouth, fluids are injured; if not treated quickly, intestines and stomach rot." This patient's dysentery with abdominal distension, vomiting, and inability to eat is exactly the image of "closed-mouth." This "closed-mouth" occurs because damp-heat accumulation in the intestines attacks upward to the Stomach, causing Qi mechanism stagnation leading to abdominal distension, and Stomach failing to descend leading to vomiting and inability to eat. Therefore, the first visit used Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) to sweep intestinal accumulation, the method of "treating obstruction with unblocking" mentioned in *Neijing*; and took Huanglian paired with Houpo from Wangshi Lianpo Yin (Mr. Wang's Coptis and Magnolia Bark Decoction) to clear and drain damp-heat in intestines and Stomach, bitter-pungent descending; added Muxiang and Laifuzi to move Qi and relieve distension, Diyutan to stop bleeding and dysentery, and Zhuru to replace Banxia to direct rebellious Qi downward and stop vomiting. Since this formula focuses on descending and clearing, guiding damp-heat accumulation out through stool, all symptoms reduced after taking medicine. After pathogens were gone and excess resolved, it was necessary to quickly restore healthy Qi and protect Stomach Qi. Thus, the second visit changed to Yiwei Tang (Benefit the Stomach Decoction) added with blood-cooling and blood-nourishing herbs, benefiting Stomach and generating fluids, nourishing and cooling blood, protecting healthy Qi, and clearing residual heat, resulting in cure.

Doctor Yi: Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) and Wangshi Lianpo Yin (Mr. Wang's Coptis and Magnolia Bark Decoction) are not specific formulas for treating dysentery, yet this case uses them for severe dysentery. Please teacher further discuss their application principles.

Teacher: Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) is indeed not a specific formula for dysentery. Zhang Zhongjing created this formula to drain heat and unblock bowels, break stagnation and relieve fullness, treating gastrointestinal excess heat accumulation presenting mainly with stuffiness and fullness. Borrowing Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) in this case utilizes its function of purging excess heat and breaking stagnation. Generally, for treating dysentery, if abdominal distension, abdominal pain, tenesmus, yellow tongue coating, and strong pulse are seen, it clearly indicates excess heat accumulation requiring appropriate purging. Also, for early dysentery with exterior syndrome, release the exterior first; if no exterior syndrome but obvious excess heat, early addition of purging guides the pathogen, draining excess heat accumulation leads to early cure. If this principle is unknown, relying solely on large amounts of heat-clearing and toxin-resolving drugs often fails to achieve quick effects. Ignorant practitioners may recklessly use astringents to stop diarrhea, which not only fails to stop dysentery but also "locks the door leaving the thief inside," turning into adverse complications. *Renzhai Zhizhi* states, "No accumulation, no dysentery," believing "dysentery arises from accumulation; accumulation is material retention; stagnation is Qi stagnation." *Danxi Xinfa* points out that early dysentery should use purging, stating "In the first one or two days of dysentery, purging is the method; do not immediately use astringents. If excess, Tiaowei Chengqi Tang or Da/Xiao Chengqi Tang can be used. If heat, clear heat first; do not immediately use Renshen and Baizhu." *Bingji Huilun* explains more clearly, "For early dysentery, if constitution and Qi are strong, with distension, fullness, hardness, and pain, quickly remove accumulation; once accumulation is gone, dysentery stops naturally. This is the method of treating obstruction with unblocking, where distension decreases with dysentery." Famous Qing dynasty physician Yu Jiayan treated a severe dysentery case: "Zhu XX, contracted dysentery in summer, defecating a hundred times day and night, unable to get out of bed, placing coarse paper on mattress changing frequently, drinking water but not eating, anus burning like fire, throwing hands and feet, restless, pulse stringy, forceful, and urgent. Then used 4 liang of Dahuang, 2 liang each of Huanglian and Gancao, frequently decocted and taken, resulting in cure." The key to efficacy lay in purging. Looking at Wangshi Lianpo Yin (Mr. Wang's Coptis and Magnolia Bark Decoction), it is also not a specific formula for dysentery. This formula is bitter-pungent descending, clearing heat and resolving dampness, mainly using Huanglian for bitter-cold heat clearing, Houpo and Banxia for moving Qi and drying dampness, harmonizing Stomach and directing rebellious Qi downward. Wenbing experts use it to treat damp-warmth syndromes where damp-heat blocks intestines and Stomach presenting fever, epigastric stuffiness, abdominal distension, vomiting, and loose stools. In this case, taking Huanglian and Houpo merely borrows their function of clearing heat and resolving dampness. Originally, Banxia in the formula should be used to direct rebellious Qi downward and stop vomiting, but considering its warm-dry nature, Zhuru was substituted. Dysentery, though having deficiency and excess, clinically shows mostly damp-heat excess, especially in summer months. Generally, dysentery with red and white stool, abdominal distension and epigastric stuffiness, and yellow-greasy tongue coating is a clear sign of damp-heat, treated by clearing and transforming damp-heat, generally using Shaoyao Tang from *Baoming Ji*, while Wangshi Lianpo Yin (Mr. Wang's Coptis and Magnolia Bark Decoction) can also be used in combination.

Doctor Bing: Closed-mouth dysentery is a critical syndrome within dysentery. Please teacher briefly discuss its general diagnostic and treatment principles.

Teacher: Closed-mouth dysentery is rarely encountered in early dysentery, often occurring after prolonged neglect of dysentery, or due to physicians overusing aromatic-dry and diuretic agents, damaging intestines and Stomach, depleting fluids. Its main symptoms are dysentery accompanied by vomiting, dry tongue and throat, and inability to eat. Ancients believed the pathogenesis of this syndrome was complex. For example, Li Zhongzi in *Yizong Bidu* said, "Closed-mouth means food cannot enter, vomited upon reaching mouth. There are pathogens in upper Jiao with fire Qi rushing upward; there is Stomach deficiency with vomiting; there is insufficient Yang Qi with undigested food; there is Liver Qi vomiting; there is fluid retention; there is filth accumulation below with foul Qi steaming upward." However, clinically, it generally falls into two situations: One is dominated by excessive heat in the Stomach. Due to Stomach fire rushing upward, vomiting and inability to eat occur, possibly accompanied by fever, irritability, thirst, bitter taste, red tongue, yellow coating, and strong rapid pulse, as stated in *Neijing*: "All rebellious rushing upward belongs to fire." The treatment method urgently requires clearing and draining Stomach heat. Zhu Danxi advocated using Renshen, Huanglian, and fresh ginger slices, decocted strongly and sipped frequently; Tang Rongchuan advocated using Sanhuang Jiu (Sanhuang Wine - Dahuang, Huanglian, Huangqin decocted with water and wine) to stop vomiting; both prescriptions are selectable. If vomiting and inability to eat are accompanied by obvious abdominal distension, Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction) should be selected. Two is dominated by Stomach injury and fluid depletion. Due to heat scorching intestines and Stomach, fluids become dry, tongue dry and throat rough, inability to eat, possibly accompanied by dry mouth and throat, dry retching, red tongue with little moisture. Tang Rongchuan believed "This syndrome involves scorched and dried Stomach fluids, hence closed-mouth inability to eat.... At this time, watering the scorched earth and extinguishing the fire, if delayed, intestines and stomach will rot and death ensues. Treatment should use Jiwei Jian (Benefit Stomach Decoction - Shengdi, Baishao, Huanglian, Huangqin, Yuzhu, Huafen, Xingren, Jiegeng, Shigao, Maidong, Zhike, Houpo, Gancao) or Kaijin Tang (Open Mouth Decoction - Renshen, Maidong, Tiandong, Shigao, Zhizi, Huanglian, Huangqin, Huangbai, Shengdi, Baishao, Danggui, Shegan, Xingren, Binglang, Zhike, Huafen, Gancao, Baitouweng) to greatly generate fluids to save intestines and Stomach." Clinical use confirms effectiveness.

Taiyang Acupoint, Glabella, and Orbital Distending Pain for 2 Months

Yu Guojun, Director of TCM Research Office, Leshan People's Hospital, Sichuan Province

Male patient, 16 years old, consulted on January 2, 1988. The patient began experiencing dizziness and headache half a year ago. Two months ago, due to high fever (39°C) from a cold, the headache suddenly intensified, accompanied by lethargy, vomiting, dilated pupils, blurred vision, sore throat, and difficulty swallowing, requiring emergency admission. Western diagnosis: 1. Viral encephalitis; 2. Intracranial space-occupying lesion? (Later denied by CT scans at West China Medical University and Chengdu Army General Hospital). During a half-month hospitalization, two critical condition notices were issued. After strenuous rescue, the above critical signs disappeared, but the headache did not stop, so he was discharged to take Chinese medicine. The main symptoms at that time were: distending pain in bilateral Taiyang acupoints, glabella, and orbits; occurring 3 times a day and night, lasting about 2 hours each time, frequent vomiting of thin saliva during pain, accompanied by sore throat. Initially took modified Danzhi Xiaoyao San (Moutan and Gardenia Ramified Free Wanderer Powder) combined with Yinqiao San (Honeysuckle and Forsythia Powder) for 17 doses with no effect; changed to Erxisan (Xanthium Powder), Shengma Gegen Tang (Cimicifuga and Pueraria Decoction), Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Wuzhuyu Tang (Evodia Decoction) added (compound formula with many herbs, including Wuzhuyu and Shengjiang 3g each, Dangshen and Dazao 10g each) for 20 doses, also with no obvious effect. Current examination: Symptoms as before, recently increased restlessness, dry mouth, drinking continuously without relief, poor appetite, loose stools, red tongue body, dense small red spots on edges and tip, white slightly yellow thick greasy coating, string-slippery slightly rapid pulse. Repeatedly analyzing this syndrome, believing that headache accompanied by vomiting thin saliva is an objective indication for using Wuzhuyu Tang (Evodia Decoction), unfortunately previous doctors underestimated its dosage and mixed it into a large compound formula, hindering its effect, thus explaining its low efficacy; why not let it stand out, bearing heavy weight and specificity to achieve merit? However, combining four diagnostic methods revealed a picture of heat syndrome, how to use it? If not usable, what formula to use? Had to re-inquire medical history. The patient insisted on swimming in the river daily from March to October in recent years, often ate fruits and ice foods; due to tight study schedule, often drank strong tea to stay awake. At this point, decision made, resolutely prescribed Wuzhuyu Tang (Evodia Decoction): Wuzhuyu and Shengjiang 15g each, Dangshen and Dazao 30g each. Instructed to try 2 doses; if dry mouth and sore throat worsened after taking, must persist to finish. Second visit (January 4, author was away, treated by Teacher Jiang Ersun): After 1 dose, distending pain in Taiyang acupoints, glabella, orbits, and sore throat significantly reduced, no longer vomiting thin saliva, dry mouth and restlessness alleviated; after finishing 2 doses, pain basically disappeared. But slight abdominal fullness remained, reduced Dangshen and Dazao in original formula to 15g each, added Houpo 15g, Faxia 10g, 3 doses. Third visit (January 8): Pain completely disappeared, appetite opened, abdomen relaxed, stool turned normal. Re-examined tongue, tongue body still as before, white slightly yellow thin coating; examined pulse, no longer rapid, still stringy and slippery. Prescribed Liujunzi Tang (Six Gentlemen Decoction) plus Guizhi (containing meaning of Linggui Zhugan Tang), instructed to take more for consolidation. To date 3 years, no recurrence.

Student Jia: This case of viral encephalitis, after surviving Western rescue, left with distending pain in Taiyang acupoints, glabella, and orbits. Initially took Danzhi Xiaoyao San (Moutan and Gardenia Ramified Free Wanderer Powder) combined with Yinqiao San (Honeysuckle and Forsythia Powder) for 17 doses with no effect, changed to Erxisan (Xanthium Powder), Shengma Gegen Tang (Cimicifuga and Pueraria Decoction), Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Wuzhuyu Tang (Evodia Decoction) for 20 doses with no obvious effect, lingering for several months. Yet the teacher prescribed a heavy dose of the original Wuzhuyu Tang (Evodia Decoction) and achieved immediate effect, opening my eyes wide!