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Xiao Ke (Diabetes Mellitus) (II)

Patient Tao XX, female, 36 years old, worker in a certain factory. Date of visit: March 1970.

First Visit: The patient has always had a robust physique. The illness has persisted for ten months. She experiences daily dryness of the mouth and throat, with intense thirst and desire to drink water. Each time she drinks, she finishes several cups, and shortly thereafter, she suffers from urinary incontinence. She is restless day and night. Her appetite remains unchanged, but she feels mentally fatigued. Her sleep at night is disturbed by many dreams. Her nose is dry with slight epistaxis; she coughs with scanty sputum. She has been diagnosed with diabetes mellitus at a certain hospital. Insulin and other medications were previously administered, but the efficacy was unclear. The pulse is deep and rapid. The tongue body is crimson red, with a white, dry coating that is slightly greasy and lacks fluids. The syndrome is classified as Xiao Ke (Wasting-Thirst Syndrome), caused by damp-heat lurking in the Middle and Upper Jiao (Middle and Upper Burners), Yin deficiency with Lung dryness, and Spleen failure to transform and transport fluids. The treatment principle should be to clear heat, generate fluids, relieve irritability, and quench thirst. The prescribed formula is as follows:
Puerariae Lobatae Radix Cum Amylo (Tian Fen Ge) 9g, Trichosanthis Radix (Tian Hua Fen) 9g, Ophiopogonis Radix (Mai Men Dong) 9g, Gardeniae Fructus Carbonized (Jiao Zhi Tan) 6g, Paeoniae Radix Alba Raw (Sheng Hang Shao) 9g, Poria (Fu Shen) 15g, Ficus Carica Leaf Purified (Jing Pa Ye) 3 leaves, Lophatheri Herba (Dan Zhu Ye) 9g, Anemarrhenae Rhizoma Stir-fried (Chao Zhi Mu) 6g, Fritillariae Cirrhosae Bulbus (Chuan Bei Mu) 9g, Citri Reticulatae Pericarpium Viride Retinervium (Guang Ju Luo) 6g, Nelumbinis Plumula Dry (Gan Ou Jie) 3 pieces.

Second Visit: After taking five doses of the above prescription, the dryness of the mouth gradually moistens, thirst and drinking decrease, and epistaxis has stopped.
The mouth remains dry, and mental fatigue persists. Urination frequency decreases during the day but remains frequent at night. There are occasional mild coughs with little sputum, allowing for some quiet rest. The pulse and tongue remain as before. This indicates prolonged illness leading to Yin deficiency, weak Spleen and dry Lung, with residual damp-heat failing to nourish fluids. A continued prescription is formulated below:
Scrophulariae Radix Bai (Bai Yuan Shen) 9g, Ophiopogonis Radix (Mai Men Dong) 9g, Trichosanthis Radix (Tian Hua Fen) 9g, Puerariae Lobatae Radix Cum Amylo (Fen Ge Gen) 9g, Paeoniae Radix Alba Raw (Sheng Hang Shao) 9g, Anemarrhenae Rhizoma Stir-fried (Chao Zhi Mu) 6g, Moutan Cortex (Fen Dan Pi) 6g, Poria (Fu Shen) 12g, Fritillariae Cirrhosae Bulbus (Chuan Bei Mu) 9g, Mori Folium (Dong Sang Ye) 9g, Ficus Carica Leaf Purified (Jing Pa Ye) 3 leaves, Nelumbinis Semen (Lian Zi) 9g.

Third Visit: After continuing the above prescription for fifteen doses, thirst and drinking are significantly reduced, urinary frequency becomes sparse, and coughing diminishes. Occasional phlegm stagnation occurs, but she can sleep peacefully at night. Her complexion turns sallow-yellow, and her body has become thinner compared to before. The pulse is fine, and the tongue is red. This signifies that damp-heat in the Lung and Stomach is gradually clearing, revealing weak Spleen, Yin deficiency, and insufficiency of the Liver and Kidney. Continuing with the following prescription for twenty doses to regulate the condition eliminates all symptoms. Prescription:
Rehmanniae Radix Preparata (Gan Di Huang) 12g, Dioscoreae Hypoglaucae Rhizoma (Huai Shan Yao) 12g, Poria (Fu Shen) 12g, Moutan Cortex (Fen Dan Pi) 4.5g, Corni Fructus (Shan Yu Rou) 6g, Alismatis Rhizoma (Ze Xie) 6g, Paeoniae Radix Rubra Stir-fried (Chao Hang Shao) 9g, Citri Reticulatae Pericarpium Viride Retinervium (Guang Ju Luo) 6g, Benincasae Semen (Dong Gua Ren) 9g, Ficus Carica Leaf Purified (Jing Pa Ye) 2 leaves.

[Commentary]: Pathogenic damp-phlegm transforms into heat internally, causing hyperactivity of Spleen and Stomach Yang, leading to unaltered appetite. However, food entering the interior fails to transform into essence to nourish and benefit the organs, resulting in scorching dryness of the Zang-Fu organs. Drinking water is a self-rescue mechanism, but the water flows directly downward, hence "one drink results in one urination," ceasing neither day nor night.

Lin Zhuo (Strangury and Turbid Urine)

Patient Zhou XX, female, 28 years old, employee in a certain factory. Date of visit: September 1969.

First Visit: She reports that the illness began over a month ago, accompanied by lower back pain, body heaviness, and mental fatigue. Urination is frequent with small volume, turbid, dark yellow, burning, and stinging pain, occurring dozens of times day and night, sometimes only able to excrete a few drops. This severely affects work and sleep. She previously took Shen Qi Wan (Kidney Qi Pill) and Bu Zhong Yi Qi Tang, which aggravated her symptoms. Diagnosed by Western medicine as "urinary tract infection." Inquiry reveals: the patient is naturally irritable, menstruation often arrives early, prefers aromatic and dry foods, and has a strong liking for "oil chili peppers." Pulse at both Guan positions is wiry and stagnant; Chi position is fine and weak. Tongue is crimson with scanty coating. This belongs to damp-heat pouring downward from the Heart and Gallbladder, dysfunction of Qi transformation, manifesting as Lin Zhuo (Strangury and Turbid Urine). Treatment should focus on clearing the Heart, cooling blood, promoting bladder diuresis, resolving heat, and removing dampness. Prescription:
Rehmanniae Radix (Xi Sheng Di) 12g, Poria Cocos with Polyporus (Chi Fu Ling) 15g, Paeoniae Radix Rubra (Chi Shao Yao) 9g, Phellodendri Cortex Carbonized (Jiao Huang Bo) 6g, Anemarrhenae Rhizoma Stir-fried (Chao Zhi Mu) 4.5g, Smilacis Glabrae Rhizoma (Chuan Bi Xie) 9g, Akebiae Caulis (Xiao Mu Tong) 6g, Descurainiae Semen (Hai Jin Sha) 9g (wrapped in cloth and roasted), Scutellariae Radix et Isatidis Folium (Guang Lian Zhao Qiao) 6g, Plantaginis Semen (Che Qian Zi) 9g, Thunbergiae Herba (Deng Xin) 1.5g, Bamboo Shavings (Zhu Ru) 6g, Dipsaci Radix Stir-fried (Chao Xu Duan) 9g. Advice: Avoid fishy, spicy, and aromatic-dry foods.

Second Visit: After taking ten doses of the above prescription, urinary frequency decreases, volume increases, color lightens, and burning pain disappears. This indicates gradual resolution of damp-heat in the Heart and Gallbladder, and patency of the Bladder. Pulse is slightly wiry; tongue turns pale and moist. Continue modifying the above prescription for regulation and consolidation. Prescription:
Rehmanniae Radix (Xi Sheng Di) 12g, Dioscoreae Hypoglaucae Rhizoma (Huai Shan Yao) 12g, Poria Cocos with Polyporus Red and White (Chi Bai Ling) each 12g, Angelicae Sinensis Radix Quan (Quan Dang Gui) 12g, Moutan Cortex (Fen Dan Pi) 6g, Paeoniae Radix Rubra and Alba (Chi Bai Shao) each 9g, Akebiae Caulis (Mu Tong) 6g, Plantaginis Semen (Che Qian Ren) 9g, Smilacis Glabrae Rhizoma (Chuan Bi Xie) 9g, Coicis Semen (Yi Ren) 15g, Vigna Angularis Seed Red (Hong Fan Dou) 15g, Scutellariae Radix (Huang Qin) 4.5g.
Grind the fourteen ingredients of the above prescription into powder with five times the amount, form pills the size of Sophora japonica seeds. Take 6g per dose, three times daily, with warm water. Stop during colds or diarrhea. Avoid meat, raw/cold, spicy, and aromatic foods.

[Commentary]: Heat transferring from the Heart and Gallbladder to the lower burner causes damp-heat pouring downward, resulting in Lin Zhuo. Mistakenly using tonifying and ascending methods causes further blockage, violating the prohibition against "reinforcing excess." The method employs Dao Chi San to clear the Heart, cool blood, and promote damp-heat diuresis, thereby resolving all symptoms.

Shi Lin (Kidney Stones)

Patient Shi XX, male, 34 years old, geological team member. Date of visit: August 1970.

First Visit: Lower back pain for several years, intermittent. Recently, pain intensified, causing day and night restlessness. Multiple examinations at a certain hospital revealed a stone the size of a corn kernel under the right kidney via renal angiography. Urine is short and red, dripping and difficult to pass, accompanied by hematuria. The condition is quite urgent, requiring hospitalization.
Pulse is deep, fine, and tight, especially at the left Chi position. Tongue coating is yellow, dry, and lacks fluids. Symptoms include headache, body heaviness, severe unbearable pain on the left side of the waist, groaning and crying out. Inability to eat, dry constipation, short and scanty urination. Has not slept for three days and nights. Complexion is sallow, body emaciated, presenting an acute painful appearance. The syndrome is Liver and Kidney Yin deficiency, with damp-heat stagnating in the lumbar collaterals, lingering for a long time without dispersing, condensing into stones.
Treatment Principle: First, resolve dampness and clear heat, expel stones and promote diuresis; subsequently, nourish Yin and secure the Kidney. Prescription:
Rehmanniae Radix (Xi Sheng Di) 15g, Paeoniae Radix Rubra (Chi Shao Yao) 9g, Akebiae Caulis (Mu Tong) 9g, Smilacis Glabrae Rhizoma (Bi Xie) 9g, Poria Cocos with Polyporus Red (Chi Fu Ling) 2.4g, Polyporus (Zhu Ling) 9g, Diantherae Herba (Qu Mai) 9g, Polygoni Cuspidati Herba (Bian Xu) 9g, Talcum (Hua Shi) 9g, Tetrapanacis Medulla (Tong Cao) 6g, Descurainiae Semen (Hai Jin Sha) 9g, Plantaginis Semen (Che Qian Zi) 9g.

Second Visit: After two doses of the above prescription, the pulse remains the same, and the yellow dry tongue coating recedes slightly. Still feeling severe lower back pain making turning difficult, continuous groaning. Combined treatment with Western analgesic injections and sedative-diuretics still yields no effect. Therefore, use the original formula plus:
Lysimachiae Herba (Jin Qian Cao) 30g, Pheretima (Guang Di Long) 9g, Cyathulae Radix (Chuan Niu Xi) 9g.
After two doses of the above prescription, the patient went to the toilet at dawn, feeling something wanting to pass down the urethra. Catching it with hand, discovered a stone the size of a corn kernel passing with urine. Bottled it up and showed it to the treating staff and fellow patients.

Third Visit: After the stone was expelled, the patient's suffering disappeared, leaving only mental fatigue and body weakness. Pulse turned weak, fine, and gentle. Tongue coating thin yellow. Gradually desiring food. Slept peacefully that night. Continued with the following prescription for three days for regulation before discharge. Prescription:
Rehmanniae Radix Preparata (Gan Di Huang) 15g, Dioscoreae Hypoglaucae Rhizoma (Huai Shan Yao) 12g, Poria (Fu Ling) 15g, Moutan Cortex (Fen Dan Pi) 6g, Corni Fructus (Shan Yu Rou) 6g, Alismatis Rhizoma (Ze Xie) 9g, Coicis Semen (Yi Ren) 15g, Vigna Angularis Seed Red (Hong Fan Dou) 12g, Dipsaci Radix (Chuan Duan) 9g, Taxilli Herba (Sang Ji Sheng) 12g, Glycyrrhizae Radix et Rhizoma (Gan Cao) 2.4g.

[Dr. Yao's Commentary]: The treatment of kidney stones adheres to the TCM principles of "If there is free flow, there is no pain; if there is pain, there is no free flow" and "For retained pathogenic factors, attack them." Since the patient underwent multiple scientific diagnoses confirming kidney stones, we had reliable basis for medication. Using the "unblocking" method to expel the stone relieved the patient's suffering.

Yang Wei (Impotence)

Patient Zhang XX, male, 32 years old, truck driver. Date of visit: April 1962.

First Visit: Complexion is sallow and emaciated. Restless sleep at night, many dreams upon falling asleep, night sweats, frequent constipation, and frequent urination. He reports congenital insufficiency, post-marital sexual excess, leading to gradual inability to achieve erection, and no children. Various treatments failed. Recently, he feels more dizzy, tinnitus, soreness and weakness in the lower back and limbs. Palpitations and unrest after slight labor, endless sweating. Pulse is soggy, weak, deep, fine, and powerless, especially at the Chi position. Tongue is pale with thin coating. The syndrome is deficiency of the Lower Origin, dual deficiency of Essence and Blood, flaccidity of the Generative Tendons. The Nei Jing states: "When Essence is insufficient, tonify with flavor." Formula proposed:
Panax Ginseng Red (Hong Ren Shen) 15g, Cynomorii Herba (Rou Cong Rong) 15g, Morinda Officinalis Root Salt-Stirfried (Yan Chao Ba Ji) 15g, Cuscutae Semen (Tu Si Zi) 15g, Lycii Fructus (Da Guo Qi) 15g, Euphorbiae Lathyris Seed Black (Hei Gu Zhi) 9g, Epimedii Herba (Xian Ling Pi) 15g, Ostreae Shell Calcined (Duan Long Gu) 12g, Amomi Fructus Salt-Stirfried (Yan Chao Sha Ren) 9g, Glycyrrhizae Radix et Rhizoma Honey-Fried (Zhi Gan Cao) 3g, Small Red Dates (Xiao Hong Zao) 10 pieces, Haematitum Calcined (Duan Yang Qi Shi) 15g, Nelumbinis Plumula Dehearted (Qu Xin Lian Zi) 15g. To assist treatment, advice: Keep the mind pure and desires few.

Second Visit: After continuously taking ten doses of the above prescription, mental and physical strength recovered somewhat, pulse rose slightly. The formula matches the syndrome. Add animal-derived flesh-and-blood products. Prescription:
Panax Ginseng Red (Hong Ren Shen) 15g, Cervicornium Antler Tender (Nen Lu Rong) 1.8g (taken in divided doses), Achyranthes Bidentatae Radix (Huai Niu Xi) 9g, Hippocampus Major (Da Hai Ma) 15g, Allii Tuberosi Semen (Jiu Cai Zi) 9g, Alpiniae Oxyphyllae Fructus Stir-fried (Chao Yi Zhi Ren) 12g, Haematitum Calcined (Duan Yang Qi Shi) 15g, Morinda Officinalis Root Salt (Yan Ba Ji) 12g, Cynomorii Herba (Guang Suo Yang) 9g, Glycyrrhizae Radix et Rhizoma Honey-Fried (Zhi Gan Cao) 3g, Cynomorii Herba (Rou Cong Rong) 15g, Amomi Fructus Salt-Stirfried (Yan Chao Sha Ren) 9g, Acronychia Pedunculata Rootlet North (Bei Xi Xin) 1.5g.

Third Visit: After continuously taking ten doses of the above prescription, mental and physical strength improved further. Sexual function gradually revived. Appetite increased. Symptoms like dizziness and night sweats gradually disappeared. Sleep became more peaceful. Pulse is gentle and stronger than before. Tongue is redder and moist. Further formulate the following prescription for continued regulation:
Panax Ginseng White (Bai Ren Shen) 9g, Cynomorii Herba (Rou Cong Rong) 15g, Morinda Officinalis Root Salt (Yan Ba Ji) 12g, Cuscutae Semen (Tu Si Zi) 12g, Achyranthes Bidentatae Radix (Huai Niu Xi) 9g, Ligustri Lucidi Fructus (Nu Zhen Zi) 12g, Lycii Fructus (Da Guo Qi) 12g, Mulberry Fruit (Sang Shen Zi) 12g, Alpiniae Oxyphyllae Fructus (Yi Zhi Ren) 12g, Amomi Fructus West (Xi Sha Ren) 6g, Glycyrrhizae Radix et Rhizoma Honey-Fried (Zhi Gan Cao) 3g, Nelumbinis Semen Jian (Jian Lian Zi) 15g, Longan Aril (Long Yan Rou) 15g.
Advice: After taking the above prescription for another half month, one can regularly take Shen Rong Bu Shen Wan (Ginseng and Deer Horn Kidney Tonifying Pill). Over a year later, happily obtained a son.

[Commentary]: Innate constitution is weak, and excessive depletion leads to deficiency. The Nei Jing states: "Due to excessive forceful exertion, Kidney Qi is injured, and high bones are damaged." It also states: "If Yang is strong but cannot consolidate, Yin Qi is exhausted." Yin and Yang are a unified whole of opposites, depending on and utilizing each other.
If one hastily seeks excitement and Yang-tonification, it反而 causes loss of Yin Essence. Purely tonifying Yin may fear Yin becoming excessive and Yang becoming deficient. The Nei Jing states: "When both Yin and Yang are insufficient, they can be regulated with sweet medicines." The formula uses animal-derived flesh-and-blood products to benefit the Kidney, generate Essence, produce Yang, and replenish Qi, securing Kidney Yang, thereby achieving the goal of balanced Yin and firm Yang!

Dian Kuang (Mania and Depression)

Patient Chen XX, male, 25 years old, resident of Kunming City. Spring 1937.

First Visit: Constitution is weak, phlegm stagnation, poor appetite, frequent insomnia, many dreams at night, mental confusion during the day. Several days before onset, due to an argument with family members and fright, mental unrest, confused speech, unpredictable laughter and crying, unable to sleep at night occurred. Occasionally screaming maniacally, suddenly discarding clothes and climbing high, or waving hands and throwing feet, uncontrollable. Invited me to diagnose. After my gentle persuasion, the patient cooperated reluctantly. Pulse is wiry, slippery, and rapid. Tongue coating is yellow and greasy, edges and tip are red. This is Yin deficiency with Liver and Gallbladder Qi stagnation, phlegm pathogens obscuring the Pericardium, combined with Wind-Heat pathogens disturbing the Clear Orifices upwards, leading to chaotic and unsettled Spirit. The syndrome belongs to Dian Kuang (Mania and Depression). Prescribe a trial formula to prevent complications. Prescription:
Aurantii Fructus Immaturus Fine (Xi Zhi Shi) 6g (stir-fried and taken with decoction), Pinelliae Tuber Vinegar-Processed (Cu Fa Xia) 9g, Bambusae Mesocarp Purified (Jing Zhu Ru) 6g, Citri Reticulatae Pericarpium (Guang Chen Pi) 6g, Curcumae Radix Vinegar-Processed (Cu Yu Jin) 9g, Gardeniae Fructus (Guang Zhi Ren) 4.5g, Sojae Semen Praeparatum (Dan Dou Chi) 4.53g, Acori Tatarinowii Rhizoma (Shi Chang Pu) 4.5g, Cloud Mica Stone Vinegar-Calcined (Cu Duan Yun Mu Shi) 9g, Poria Cinnabar-Coated (Zhu Yi Fu Shen) 15g, Glycyrrhizae Radix et Rhizoma Tip (Gan Cao Shao) 3g, Calculus Bovis (Niu Huang) 9g (taken in divided doses).

Second Visit: After two doses of the above prescription, the manic state slightly subsided. But still talking nonsense, disregarding kinship boundaries, occasionally biting tongue and oral epistaxis, sometimes grabbing hands until bleeding. Phlegm stagnation and Qi rebellion, short red urine, dry constipation. Nighttime still restless and chaotic. Pulse wiry and slippery slightly smoothed. Tongue coating yellow and greasy receded somewhat, edges and tip still red. This indicates Phlegm-Heat in the Heart, Gallbladder, and Collaterals not yet cleared. To seek a turning point, continue with the following prescription:
Aurantii Fructus Immaturus Fine (Xi Zhi Shi) 6g (stir-fried and taken with decoction), Malachiti Calcined Vinegar-Processed (Cu Duan Qing Meng Shi) 9g, Pinelliae Tuber Vinegar-Processed (Cu Fa Xia) 9g, Citri Reticulatae Pericarpium Viride Retinervium (Guang Ju Luo) 6g, Magnetitum (Dai Zhe Shi) 9g, Poria Cinnabar-Coated (Zhu Fu Shen) 15g, Bambusae Mesocarp Purified (Jing Zhu Ru) 6g, Acori Tatarinowii Rhizoma (Shi Chang Pu) 4.5g, Curcumae Radix Vinegar-Processed (Cu Yu Jin) 9g, Glycyrrhizae Radix et Rhizoma Tip (Gan Cao Shao) 3g, Saussureae Radix (Da Qin Jiao) 9g, Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) 1 pill (taken in divided doses), Succini Pulvis (Hu Po Mo) 3g (taken in divided doses).

Third Visit: After three doses of the above prescription, the Spirit gradually calmed, mania reduced, spitting much phlegm foam. Bowels moved smoothly, urine volume increased, color cleared. Could sleep two to three hours at night, still with dream talk. Self-reported dizziness, body heaviness, limb soreness and weakness, able to eat slightly. Pulse wiry and slippery gradually smoothed. Tongue crimson turned pale, coating thin. This indicates Wind-Heat and Phlegm pathogens exiting, trend improving. Continue with nourishing Heart, calming Spirit, clearing heat, resolving phlegm, opening depression, and promoting Qi movement as treatment.
Ziziphi Spinosae Semen (Zao Ren) 15g (taken with decoction), Poria (Fu Shen) 15g, Anemarrhenae Rhizoma Stir-fried (Chao Zhi Mu) 6g, Ligustici Chuanxiong Rhizoma Slice (Chuan Xiong Pian) 6g, Aurantii Fructus Immaturus Stir-fried (Chao Zhi Ke) 6g, Curcumae Radix Vinegar-Processed (Cu Yu Jin) 9g (taken with decoction), Ophiopogonis Radix Zhu-Processed (Zhu Cun Dong) 9g, Pinelliae Tuber Vinegar-Processed (Cu Fa Xia) 9g, Glycyrrhizae Radix et Rhizoma Raw (Sheng Gan Cao) 3g, Bambusae Mesocarp Purified (Jing Zhu Ru) 6g, Serpentis Bile and Citri Reticulatae Pericarpium Powder (She Dan Chen Pi Mo) 2 tubes (taken in divided doses), Succini Pulvis (Hu Po Mo) 3g (taken in divided doses).

Fourth Visit: After three doses of the above prescription, consciousness became clear and stable. Bowels and bladder normal. Desire for food, body soft and weak. Occasional spontaneous sweating, still many dreams and easy awakening. Pulse turned slow and weak. Tongue pale and moist. This indicates Wind-Heat and Phlegm pathogens transformed, disease receding, Yin deficiency, insufficiency of Heart Spirit. Regulate with the following prescription:
Rehmanniae Radix Preparata (Gan Di Huang) 12g, Scrophulariae Radix Bai (Bai Xuan Shen) 9g, Ophiopogonis Radix Large (Da Cun Dong) 9g, Poria (Fu Shen) 15g, Ziziphi Spinosae Semen (Zao Ren) 15g, Schisandrae Chinensis Fructus (Wu Wei Zi) 3g, Dragon Tooth Raw (Sheng Long Chi) 12g, Aquilariae Lignum Resinatum (Guang Mu Xiang) 2.4g, Polygalae Radix Honey-Fried (Zhi Yuan Zhi) 6g, Glycyrrhizae Radix et Rhizoma Honey-Fried (Zhi Gan Cao) 3g, Small Red Dates (Xiao Hong Zao) 9 pieces, Nelumbinis Semen (Lian Zi) 15g, dehearted.

[Commentary]: This case originates from a constitution of Yin deficiency and phlegm stagnation, compounded by anger, leading to Mania. The Nei Jing states: "Disregarding clothing propriety, speaking good and evil without avoiding kin or stranger, this is chaos of the Spirit." The Nan Jing states: "Heavy Yin is Dian, Heavy Yang is Kuang." Initially used Wendan Decoction plus Gardenia, Fermented Soybean, Acorus, Calculus Bovis, etc., to dispel wind, wash away phlegm, clear the Heart, and open orifices. Subsequently added Malachite, Magnetite, Saussurea, Succinum Powder, and Niuhuang Qingxin Wan, etc. After medication, bowels and bladder moved smoothly, Wind-Heat and Phlegm pathogens exited, consciousness cleared. With pathogen removed and healthy Qi deficient, then used Suanzaoren Tang and Rehmannia, Scrophularia, Ophiopogon, Dragon Tooth, Polygala, etc., to successively calm Spirit, stabilize will, nourish Yin, submerge Yang, and harmonize Qi and Blood. The entire course consistently followed the principle: "When pathogenic Qi is abundant, it is Excess—should be purged; when Essence and Qi are depleted, it is Deficiency—should be tonified."

Bi Jing Dian Kuang (Amenorrhea and Mania / Schizophrenia)

Patient Si XX, female, 24 years old, married, worker. Date of visit: February 1972.

First Visit: Naturally irritable and prone to anger, fond of spicy food, constitution of Liver Qi stagnation and weak Spleen.
Menstrual cycles irregular for the past year, periods arriving early or late. Due to busy work and consecutive unexpected stimuli, since last autumn, menstruation has ceased completely. Can勉强 work during the day, but restless at night, sometimes insomnia all night, mental confusion, gradually becoming sad and crying, depressed and suspicious. The hospital of the original unit gave sedative drugs, with不明显 effect. Accompanied by family to our outpatient clinic. At that time, patient spoke confusedly, cursed, swayed body, restless sitting and standing. Pulse deep and wiry with stagnant and choppy qualities. Tongue crimson, tip red, thin yellow coating.
Syndrome belongs to prolonged amenorrhea, emotional depression, pathogens affecting Heart and Gallbladder, chaotic Spirit. Treatment should soothe Liver, invigorate Blood, clear Heart, benefit Spleen. Prescription:
Angelicae Sinensis Radix Whole (Quan Dang Gui) 15g, Ligustici Chuanxiong Rhizoma (Chuan Xiong) 6g, Poria (Fu Shen) 15g, Curcumae Radix (Chuan Yu Jin) 6g (taken with decoction), Scutellariae Radix Stir-fried Yunlian (Chao Yun Lian) 3g, Cyperi Rhizoma Honey-Fried (Zhi Xiang Fu) 6g, Moutan Cortex (Fen Dan Pi) 4.5g, Bupleuri Radix Stir-fried (Chao Chai Hu) 6g, Salviae Miltiorrhizae Radix (Zi Dan Shen) 9g, Glycyrrhizae Radix et Rhizoma Raw (Sheng Gan Cao) 3g, Santali Lignum (Bai Tan Xiang) 6g, Nelumbinis Semen Jian (Jian Lian Zi) 12g, Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) 1 pill (dissolved in water, mixed into medicine in divided doses).

Second Visit: After two doses of the above prescription, patient could lie quietly for two to three hours in the evening, still restless after waking. Irritability slightly calmed, confused speech slightly reduced. Hunger felt, but appetite still low. This indicates Liver stagnation gradually soothing, Heart and Spleen relatively regulated, floating fire slightly平息.
Pulse shows wiry stagnation, tongue still crimson red. Continue with the following prescription:
Angelicae Sinensis Radix (Dang Gui) 15g, Ligustici Chuanxiong Rhizoma (Chuan Xiong) 6g, Poria (Fu Shen) 15g, Curcumae Radix Vinegar-Processed (Cu Yu Jin) 6g (taken with decoction), Cyperi Rhizoma Honey-Fried (Zhi Xiang Fu) 6g, Moutan Cortex (Fen Dan Pi) 6g, Salviae Miltiorrhizae Radix (Zi Dan Shen) 9g, Dipsaci Radix Stir-fried (Chao Xu Duan) 9g, Corydalis Rhizoma (Yan Hu Suo) 9g (taken with decoction), Acori Tatarinowii Rhizoma (Shi Chang Pu) 3g, Glycyrrhizae Radix et Rhizoma Raw (Sheng Gan Cao) 3g, Bambusae Mesocarp Purified (Jing Zhu Ru) 6g, Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) 1 pill.

Third Visit: After five doses of the above prescription continuously, restlessness gradually decreased, could sleep soundly for five to six hours at night, language clear upon waking. Body emaciated, diet still low, occasional abdominal distension and pain, soreness and ache in lower back. This indicates latent heat in Heart and Gallbladder nearly exhausted, Liver stagnation and weak Spleen, meridians not regulated, Qi not moving Blood, pulse still wiry and stagnant, tongue red with thin coating. Further formulate the following prescription:
Angelicae Sinensis Radix (Dang Gui) 15g, Ligustici Chuanxiong Rhizoma (Chuan Xiong) 6g, Poria (Fu Shen) 15g, Moutan Cortex (Fen Dan Pi) 6g, Salviae Miltiorrhizae Radix (Zi Dan Shen) 9g, Curcumae Radix (Yu Jin) 9g, Cyperi Rhizoma Honey-Fried (Zhi Xiang Fu) 6g, Persicae Semen (Tao Ren) 6g, Croci Stigma (Zang Hong Hua) 4.5g, Bambusae Mesocarp Purified (Jing Zhu Ru) 6g, Nelumbinis Semen Jian (Jian Lian Zi) 15g.

Fourth Visit: After five doses of the above prescription, lower back pain and abdominal distension increased, followed by menstruation starting, color purple-black, small volume with clots, indicating prolonged amenorrhea, Blood stasis and Qi stagnation. Afterwards, all irritability symptoms disappeared, appetite increased, sleep peaceful, pulse turned平和, tongue red with moist coating. Further formulate regulating Qi, invigorating Blood, nourishing Liver and Spleen. Prescription:
Menthae Haplocalycis Herba Chu (Chu Bo He) 4.5g, Bupleuri Radix Stir-fried (Chao Chai Hu) 6g, Angelicae Sinensis Radix (Dang Gui) 12g, Paeoniae Radix Alba Stir-fried (Chao Hang Shao) 9g, Ligustici Chuanxiong Rhizoma (Chuan Xiong) 6g, Ziziphi Spinosae Semen (Zao Ren) 15g, Poria (Fu Shen) 15g, Salviae Miltiorrhizae Radix (Zi Dan Shen) 9g, Cyperi Rhizoma Honey-Fried (Zhi Xiang Fu) 6g, Amomi Fructus West (Xi Sha Ren) 6g, Dipsaci Radix Stir-fried (Chao Xu Duan) 9g, Taxilli Herba (Sang Ji Sheng) 12g, Glycyrrhizae Radix et Rhizoma Raw (Sheng Gan Cao) 3g, Nelumbinis Semen Jian (Jian Lian Zi) 15g.
Follow-up three months later: Menstruation normal, all symptoms cured.

[Commentary]: The Jing states: "Diseases of the Two Yang originate from Heart and Spleen, having hidden difficulties, women do not menstruate..." This case first had irregular menstrual cycles, then consecutive frustrations, leading to prolonged amenorrhea, pathogens affecting Heart and Gallbladder, chaotic Spirit. Treatment principle first emphasizes soothing and clearing, then continues to clarify Heart and Gallbladder. Third visit adds breaking and moving, finally shifting to soothing, regulating, and nourishing. Principles and methods are flexible.

Bu Mei (Insomnia)

Foreign guest XX, male, 40 years old. Date of visit: March 1964.