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Book: Yao Zhenbai's Medical Cases Chapter: Main Text (2/20) Category: Medical Discussion

Radix Aconiti Lateralis Preparata 18g (simmered thoroughly in boiling water first), Radix Asari 2.4g, Herba Ephedrae 6g, Rhizoma et Radix Notopterygii 6g, Ramulus Taxilli 15g, Radix Glycyrrhizae Preparata 3g, Rhizoma Zingiberis Recens 2 slices, Fructus Jujubae 7 pieces.

Second Visit: After taking the above prescription, the patient sweated slightly, fever subsided, and aversion to cold ceased. However, lower back pain persisted with inability to turn the body, cough continued, appetite was poor, urine was scanty, and constipation was present. Western medical diagnosis: "Acute Nephritis". Pulse is wiry and slippery; tongue body is red with yellow greasy coating. This indicates that the cold pathogen has been resolved, but dampness has transformed into heat.
The treatment method should be to clear heat and dispel dampness, and unblock the Sanjiao (Triple Burner). Prescription:
Radix Stephaniae Tetrandrae 6g, Poria 15g, Rhizoma et Radix Notopterygii 6g, Ramulus Taxilli 15g, Sclerotium Polypori 9g, Semen Zeae Mays Preparatum 9g, Radix Gentianae Macrophyllae 12g, Radix Dipsaci Preparata 9g, Rhizoma Pinelliae Preparatum 9g, Semen Armeniacae Amarum 9g, Caulis Tinosporis 9g, Cortex Phellodendri Preparatus 2.4g, Herba Lycopi 15g.

Third Visit: After taking the above prescription for four doses consecutively, cough decreased, bowel movements became smooth, urine became clear and abundant, heaviness in the lower back, back, and limbs reduced, and appetite returned. Pulse is slippery and moderate; coating is thin and yellow. Damp-heat is gradually resolving; continue to modify the above prescription.
Semen Coicis 15g, Semen Armeniacae Amarum 9g, Rhizoma Pinelliae Preparatum 9g, Radix Stephaniae Tetrandrae 6g, Poria 15g, Radix Achyranthis Bidentatae 9g, Radix Dipsaci 9g, Caulis Tinosporis 6g, Ramulus Taxilli 12g, Radix Aucklandiae 3g, Radix Artemisiae Scopariae 12g, Radix Glycyrrhizae Preparata 3g.

Fourth Visit: After taking the above prescription for four doses consecutively, appetite and spirit increased. Cough stopped, edema of the face and feet disappeared, and lower back pain significantly reduced. Pulse is fine and moderate; tongue is pink and moist, coating has receded. Damp-heat has resolved, but Kidney Qi has not recovered. Prescribe the following for regulation:
Radix Rehmanniae Preparata 12g, Rhizoma Dioscoreae 12g, Poria 15g, Cortex Moutan 6g, Semen Zeae Mays Preparatum 9g, Pericarpium Corni 6g, Radix Achyranthis Bidentatae 9g, Semen Plantaginis 9g (wrapped in cloth and simmered), Ramulus Taxilli 12g.

After taking the above prescription for nearly ten doses, re-examination of urine routine by Western medicine showed all results normal. Returned to work after one month.
[Commentary] High-temperature labor consumes sweat and body fluids, leading to inherent deficiency of Qi and Yin, compounded by latent dampness. When external cold strikes directly, clashing with the Kidney mansion, administer Mahuang Xixin Fuzi Tang to first disperse the cold, after which Yin deficiency and dampness transform into heat. Then, adapt the strategy, changing to mild diuresis and unblocking methods until damp-heat is exhausted. Finally, prescribe Liuwei Dihuang Wan to restore Kidney Yin, and the illness resolves rapidly.

Shanghan Misdiagnosis Leading to Pathogen Trapping in Shaoyin
Yang XX, Female, 13 years old, residing at Qinglong Lane, Kunming City. April 1946.
First Visit: The patient had a fever for over a month without relief. She had taken Shuangjie San, Xiaochaihu Tang, Yinqiao San, Jiawei Baihu Tang, etc., but the condition worsened. The family was panicked and invited me to visit late at night in the rain.
Symptoms: Mental confusion, dry lips and scorched teeth. Diarrhea with undigested food in stool, scanty urine. Dry retching, cold limbs, spontaneous sweating. Pulse is deep, fine, and rapid; tongue body is pale with black moist coating. This is Shanghan mismanaged without proper sweating or purging, transmitting from exterior to interior, trapping the pathogen in Shaoyin, presenting with exterior heat and interior cold, indicating impending collapse of True Yang. Urgently prescribe the following for rescue:
Radix Aconiti Lateralis Preparata 60g (simmered thoroughly in boiling water first), Rhizoma Zingiberis Officinalis Preparatum 12g, Bulbus Allii Fistulosi 2 pieces, Rhizoma Pinelliae Preparatum 9g, Fructus Amomi Rotundus 9g, Poria 12g, Cortex Cinnamomi 3g (dissolved in boiling water), Radix Glycyrrhizae Preparata 3g.

Second Visit: After taking the above prescription, mental state cleared somewhat, fever gradually subsided, hands and feet warmed, but borborygmus persisted, diarrhea with undigested food continued, and urine lengthened slightly. Occasional dry retching and spontaneous sweating. Pulse is deep and fine; black tongue coating receded. This is a sign of Yang returning and cold dispersing. Continue with the following prescription:
Radix Aconiti Lateralis Preparata 45g (simmered thoroughly in boiling water first), Rhizoma Zingiberis Officinalis Preparatum 12g, Poria 12g, Cortex Cinnamomi 3g (dissolved in boiling water), Fructus Amomi Rotundus 6g, Radix Glycyrrhizae Preparata 3g, Gallus Gallus Domesticus Gizzard Membrane Roasted 6g, Bulbus Allii Fistulosi 2 pieces.

Third Visit: After taking two doses of the above prescription, fever completely subsided, sweating stopped, cold extremities reversed, and mental state was clear.
Dry retching and diarrhea ceased, appetite returned. Tongue turned pink and moist, pulse was moderate and weak. This indicates that after Shaoyin cold pathogen dispersed, Yang Qi returned, but Spleen and Stomach are weak. Prescribe the following for regulation:
Codonopsis Pilosus Stir-fried with Rice 15g, Atractylodes Macrocephala Rhizome Charred 12g, Poria Cum Radix Pini 15g, Fructus Amomi Rotundus 6g, Radix Aconiti Lateralis Preparata 30g (simmered thoroughly in boiling water first), Cortex Cinnamomi 3g, Exocarpium Citri Reticulatae Viride 6g, Radix Glycyrrhizae Preparata 6g, Rhizoma Zingiberis Officinalis Roasted 2 slices, Fructus Jujubae 3 pieces.

[Commentary] Mismanagement of Shanghan, missing the opportunity for sweating or purging, and instead using cooling agents is like adding frost to snow, leading to pathogen trapping in Shaoyin, a critical condition of exterior heat and interior cold! This case adheres to Zhang Zhongjing's method, modifying Baotong Tang to dispel haze and restore Yang, achieving quick success.

Shanghan Shaoyin Heat Transformation Syndrome
Li XX, Male, 18 years old, student, from Kunming City. Early Autumn 1938.
First Visit: The patient had a fever for over a month without relief. Initially restless thirst drinking water, later mental confusion. Hospitalized in a certain hospital, diagnosed with Enteric Typhoid. Treatment ineffective, condition critical. Family panicked, sought my consultation. Symptoms: High fever, coma, delirious speech, dark urine with incontinence, passage of black watery stool, hard and full abdomen with burning sensation. Pulse is fine, weak, almost imperceptible; tongue is crimson, coating dry yellow, center black with cracks.
This is Shanghan mismanaged without sweating or purging, disease entering Shaoyin, pathogen transforming into heat, heat binding with side-flow, Yin fluids consumed, condition critical! Due to family's earnest request, I examined the pulse carefully, feeling the pulse root was not severed, still having vitality. After much consideration, reluctantly prescribed Zhang Zhongjing's Huanglian Ejiao Jizi Huang Tang modified, hoping to save. Condition is severe and dangerous, beware of unexpected outcomes. Prescription:
Colla Corii Asini 30g (melted and taken), Cortex Scutellariae Preparatum 6g, Radix Coptidis Preparata 2.4g, Radix Paeoniae Alba Raw 30g, Fructus Gardeniae Jasminoidis Charred 6g, Radix Rheis Raw 9g, Radix Glycyrrhizae Preparata 3g, Natrii Sulfatis Crystal 9g, Fresh Egg Yolk 1 piece (mixed in three times).

Second Visit: Effect of the above prescription was not obvious, family anxious, invited me again late at night. Pulse still faint and fine, black cracked tongue coating slightly reduced but thick and dry yellow. Intense fever, coma, delirious speech, restlessness, picking at clothes and bed, throwing hands and feet. This still belongs to Huanglian Ejiao Jizi Huang Tang syndrome, pathogenic heat not removed, thus condition not improving. Continue with the following prescription, fighting with backs to the river. Prescription:
Colla Corii Asini 30g (melted and taken), Radix Rehmanniae Raw 30g, Radix Paeoniae Alba Raw 30g, Wild Radix Coptidis 3g, Fructus Gardeniae Jasminoidis Charred 6g, Cortex Scutellariae Preparatum 6g, Radix Rheis Raw 9g, Radix Glycyrrhizae Preparata 3g, Natrii Sulfatis Crystal 9g, Fructus Aurantii Immaturus Fine 4.5g (stir-fried and mixed), Fresh Egg Yolk 1 piece (mixed in three times).

Third Visit: After taking the above prescription, passed black stool with many hard dry fecal pellets, urination regained sensation. Mental state slightly clearer, delirious speech and restlessness calmed, intense fever slightly reduced. Pulse turned fine, wiry, and rapid; tongue coating thick yellow and dry, center black receding. This indicates intestinal accumulation unblocked, Yin fluids gradually returning, heart spirit relatively calm, condition trending towards improvement. Still adhere to original intent with modifications. Prescription:
Colla Corii Asini 18g (melted and taken), Radix Rehmanniae Major 15g, Radix Scrophulariae 9g, Radix Ophiopogonis Major 9g, Radix Paeoniae Alba Raw 15g, Wild Radix Coptidis 2.4g, Fructus Gardeniae Jasminoidis Charred 6g, Cortex Scutellariae Preparatum 4.5g, Radix Glycyrrhizae Preparata 3g, Fresh Egg Yolk 1 piece (mixed in three times), Oryza Sativa White Grain 30g (decocted as water to simmer herbs).

Fourth Visit: After taking the above prescription, intense fever and thirst relieved, diarrhea stopped, mental state gradually revived, pulse wiry and rapid, tongue red, thick yellow coating thinned, moisture present. But hearing is impaired. Disease has escaped danger, True Yin not yet restored. Continue with the following prescription for two doses for nourishing regulation. Prescription:
Colla Corii Asini 18g (melted and taken), Radix Rehmanniae Major 15g, Radix Scrophulariae 9g, Radix Ophiopogonis Major 9g, Radix Paeoniae Alba Raw 12g, Wild Radix Coptidis 2.4g, Herba Dendrobii Nobiles Fresh 9g, Radix Glycyrrhizae Preparata 3g, Fresh Egg Yolk 1 piece (mixed in three times), Oryza Sativa White Grain 30g (decocted as water to simmer herbs).

Fifth Visit: Pulse moderate, tongue moist, coating receded. Mental state clear, fever gone, body cool, can take thin porridge, sleep quietly at night, can sit up. Hearing still poor, body emaciated. Disease has escaped danger, trend stabilizing. Still suitable for nourishing regulation. Prescription:
Radix Rehmanniae Preparata 18g, Radix Scrophulariae 9g, Radix Paeoniae Alba Raw 9g, Poria Cum Radix Pini 15g, Herba Dendrobii Nobiles 9g, Semen Coicis 15g, Radix Ophiopogonis Major 9g, Radix Glycyrrhizae Preparata 3g, Wild Radix Coptidis 2.4g, Colla Corii Asini 15g (melted and taken).

Sixth Visit: After taking the above prescription for three doses consecutively, food intake and sleep increased, bowel and bladder functions normal. Can walk, skin moist, pulse slow, tongue moist, disease fully cured. Prescribe the following for post-recovery regulation.
Radix Rehmanniae Preparata 12g, Rhizoma Dioscoreae 12g, Poria 15g, Cortex Moutan 6g, Pericarpium Corni 4.5g, Semen Zeae Mays Preparatum 9g, Herba Dendrobii Nobiles 9g, Semen Nelumbinis Placentae 15g (heart removed).

After taking many doses of the above prescription, physical strength increased daily, hearing recovered. Patient is still alive today, maintaining contact with me.
[Commentary] For Shaoyin Heat Transformation Syndrome, using Huanglian Ejiao Jizi Huang Tang to nourish Yin and clear heat is the correct method. This case also involves heat binding with side-flow. Amidst a series of critical signs, observing that the pulse root is not severed, adding Chengqi Decoction elements to urgently purge and save Yin, pulling the boat against the current.

Jueyin Shanghan
Chen XX, Female, 34 years old, from Kunming City. March 1940.
First Visit: Initially due to food stagnation and cold invasion, fever, aversion to cold, and body pain. After taking two doses of dispersing and digesting medicines, slight sweat occurred but was incomplete. Subsequently, Qi rushed upward striking the heart, severe pain, restlessness day and night. Face flushed, dry throat and sore throat, vomiting much phlegm-saliva, upon vomiting Qi rushes up, cold limbs, coma unconscious for over ten days. Consulted several doctors, some said sweat incomplete, pathogen still in exterior, should resolve with sweating; others said Qi rebellion and vomiting indicate interior cold stagnation, should further digest and harmonize middle and stomach. Opinions differed, no consensus. Finally invited me to visit. Pulse is wiry, fine, slightly floating; tongue coating black, edges and tip red. Based on clinical symptoms, this is Jueyin Shanghan syndrome, Yin excess repelling Yang, combined with residual Taiyang exterior pathogen. Treatment principle should soothe Liver and harmonize Stomach, reverse cold extremities and stop vomiting. Urgently use Zhang Zhongjing's original Wumei Wan three pills, add three slices of Ginger and three dates, decoct and mix, administer in divided doses.

Second Visit: After taking yesterday's prescription, vomiting gradually stopped, Qi striking heart pain calmed, still occasional restlessness. Cold limbs, cold extremities reversal, red face, dry throat. Pulse and tongue as before. Liver and Stomach slightly settled, rebellious Qi calming, Jueyin latent cold still strong, repelling Yang outward. Change to the following prescription:
Radix Angelicae Sinensis 15g, Radix Paeoniae Alba Stir-fried 12g, Ramulus Cinnamomi 9g, Radix Aconiti Lateralis Preparata 24g (simmered thoroughly in boiling water first), Radix Asari 3g, Radix Glycyrrhizae Preparata 3g, Caulis Tectonae 3g, Rhizoma Pinelliae Preparatum 9g, Wild Radix Coptidis 2.4g, Fructus Evodiae 3g, Rhizoma Zingiberis Recens 3 slices, Fructus Jujubae 5 pieces (add ten drops of clear wine per dose).

Third Visit: After taking two doses of the above prescription, vomiting stopped, cold extremities reversed, rebellious Qi and painful heat in chest gradually disappeared, restlessness and phlegm-saliva reduced, face turned sallow and thin, able to eat slightly. Pulse turned moderate, black tongue coating completely receded, thin white coating appeared. Jueyin cold pathogen dispersed, Liver and Stomach gradually regulated, patient only feels dizzy and fatigued, sleepy. Prescribe still adhering to original intent with modifications:
Ramulus Cinnamomi 9g, Radix Angelicae Sinensis 12g, Radix Paeoniae Alba 9g, Wild Cortex Scutellariae Stir-fried 3g, Fructus Evodiae 3g, Codonopsis Pilosus 9g, Rhizoma Pinelliae Preparatum 9g, Fructus Amomi Rotundus 6g, Poria Cum Radix Pini 15g, Radix Glycyrrhizae Preparata 3g, Fructus Mume 3 pieces, Rhizoma Zingiberis Recens 3 slices, Fructus Jujubae 3 pieces.

After taking more than ten doses of the above prescription, cured.
[Yao's Commentary] This case is Shanghan, misused with exterior-dispersing and digesting methods, disease entered Jueyin, condition critical. If due to sore throat, red face, and restlessness, one takes cooling agents again, death is certain. Using general ordinary prescriptions or purely acrid-warm Yang-assisting agents may also fail to save. In diagnosing and treating this illness, based on clinical pulse and symptoms, I considered it disease entering Jueyin, condition critical, urgently used Zhang Zhongjing's original Wumei Wan to harmonize Liver and Stomach, calm middle and stop vomiting. Subsequently used Danggui Sini Plus Wu Zhu Yu and Ginger Decoction to restore Yang and rescue from collapse. Later modified Danggui Jianzhong Plus Ginseng and Zuo Jin formulas, turning danger to safety, achieving complete cure.

Ascariasis Cold Reversal
Zhang XX, Female, 43 years old, suburbs of Kunming City. Late Autumn 1939.
First Visit: Patient had fever for over ten days, chest and abdominal distension and pain, retching and inability to eat, diarrhea, deafness. Several days ago, after taking sweating and purging agents, vomited three roundworms, diarrhea worsened, more than twenty times a day, condition aggravated, invited me to visit late at night.
Symptoms: Pulse fine, weak, powerless; tongue body pale, coating white mixed with yellow, center dry black. Coma, unresponsive to calls. Fever, cold extremities, vomiting roundworms, diarrhea with undigested food. Analyzing cause and differentiating syndrome, this is Shanghan, disease entering Jueyin, misused sweating and purging, upper heat not resolved, lower cold increased, Middle Jiao not transporting, roundworms lacking Yang warmth, expelled with vomiting, condition belongs to Ascariasis Cold Reversal. Urgently prescribe Wumei Wan decoction.
Radix Aconiti Lateralis Preparata 30g (simmered thoroughly in boiling water first), Radix Asari 3g, Ramulus Cinnamomi 9g, Rhizoma Zingiberis Officinalis Preparatum 9g, Fructus Schisandrae Preparatum 2.4g, Wild Cortex Scutellariae Stir-fried 2.4g, Cortex Phellodendri Charred 2.4g, Radix Angelicae Sinensis Whole 12g, Codonopsis Pilosus Upper Grade 12g, Roasted Fructus Mume 10+.

Second Visit: After taking one dose of the above prescription, mental state clearer, cold extremities warmed, vomiting roundworms stopped.
But fever, retching, inability to eat, intermittent chest and abdominal distension and pain, frequent diarrhea with undigested food.
Pulse deficient and rapid, black coating gradually receding, still follow original prescription with modifications.
Radix Aconiti Lateralis Preparata 30g (simmered thoroughly in boiling water first), Radix Asari 3g, Rhizoma Zingiberis Officinalis Preparatum 9g, Radix Glycyrrhizae Preparata 3g, Ramulus Cinnamomi 9g, Radix Paeoniae Alba Stir-fried 9g, Poria 15g, Radix Angelicae Sinensis 12g, Wild Cortex Scutellariae Stir-fried 2.4g, Fructus Evodiae Honey-fried 4.5g, Roasted Fructus Mume 10 pieces.

Third Visit: After taking two doses of the above prescription, fever reduced, diarrhea only two to three times a day. Mind clear, poor appetite, retching and chest/abdominal pain stopped. Pulse fine and wiry, black coating completely receded, thin white appeared. Ascariasis Cold Reversal stabilized, Earth deficiency Wood overacting, prescribe warming transport, support Righteousness and expel Evil.
Radix Aconiti Lateralis Preparata 30g (simmered thoroughly in boiling water first), Codonopsis Pilosus Upper Grade 12g, Poria 15g, Radix Paeoniae Alba Stir-fried 9g, Fructus Amomi Rotundus 9g (mixed), Radix Asari 1.5g, Fructus Evodiae Honey-fried 6g, Radix Coptidis Stir-fried 2.4g, Ramulus Cinnamomi 6g, Radix Glycyrrhizae Preparata 3g, Rhizoma Zingiberis Officinalis Preparatum 9g, Stir-fried Old Rice 12g.

Fourth Visit: Fever completely subsided, diarrhea stopped, appetite returned. Pulse moderate, tongue pink and moist. Condition gradually healing. Continue with Guishao Liujun Decoction to regulate Spleen and strengthen Stomach, warm and nourish Qi and Blood.
Codonopsis Pilosus 12g, Atractylodes Macrocephala Rhizome 12g, Poria 15g, Radix Angelicae Sinensis 15g, Radix Paeoniae Alba Stir-fried 9g, Fructus Amomi Rotundus 6g (mixed), Exocarpium Citri Reticulatae 6g, Rhizoma Zingiberis Officinalis Roasted 2 slices, Fructus Jujubae 5 pieces, Radix Glycyrrhizae Preparata 3g.
(Instructed to also take Guifu Lizhong Pills, ten pills total, twice daily, one pill morning and evening.)

[Commentary] Disease entering Jueyin, coma, vomiting roundworms, fever, cold extremities, hence named Ascariasis Cold Reversal.
Continuously administering large doses of warming, transporting, restoring Yang, rescuing from collapse, and calming roundworms agents achieved effect. Can refer to Case Nineteen together, illustrating the flexibility of Six Meridian principles in curing diseases.