Library

[Appendix 1: Treatment Case of Coma, Chest Stifling, and Inability to Speak]

The fourth younger brother of Kui Gong, Vice Minister of the Lifan Yuan (Court of Colonial Affairs), contracted epidemic plague. He presented with coma, chest stifling, and inability to speak; his body was not significantly hot, his four limbs were ice-cold, and his six pulses (cun, guan, chi on both hands) were deep, fine, and rapid. A physician unfamiliar with proper diagnosis had already administered Huayang Jiuji Tang (Decoction for Restoring Yang and Saving from Emergency). His cousin-in-law, Gong Fu, strongly argued against this treatment. Upon my arrival, I palpated his pulse—deep, fine, and rapid—and observed his physical condition: his lips were scorched and cracked. I said to Gong Fu, "This is 'Extreme Heat resembling Yin' syndrome, not true Yin syndrome. If it were true Yin cold, the pulse would necessarily be deep and slow, and the lips pale and white. How can one consider it a Yin syndrome when the pulse is rapid and the lips are scorched?" This is heat-toxin latent in the Spleen meridian, causing cold extremities (Jue Ni); the pathogen attacks the Heart and Lungs, causing coma and chest stifling with inability to speak. Moreover, the macules and rashes all over the body are purple-red; only a large dose of medicine can reverse this critical condition. Therefore, I prescribed Shi Gao (Gypsum Fibrosum) 8 liang, Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*) 6 qian, Huang Lian (Coptidis Rhizoma) 5 qian, assisted by Da Qing Ye (Isatidis Folium) and Ling Yang Jiao (Saiga Tataricae Cornu). After taking two doses, by midnight, his body became highly feverish, and his hands and feet turned warm. The next day, his pulse transformed into a surging (Hong) and large (Da) quality. After one more dose, the fever subsided, and his spirit cleared. Thereafter, the dosage was gradually reduced daily according to the symptoms, and he recovered in eight days. The whole family was ecstatic, regarding it as miraculous medical art.

In the winter of the Gui Chou year, Wu Ge, the Simye (Vice Director) of the Guozijian (Imperial Academy), reported that his second brother's daughter-in-law suffered from epidemic plague with aversion to cold, fever, headache, and vomiting. A physician was consulted who used exterior-releasing herbs, adding Huo Xiang (Agastaches Herba), Ban Xia (Pinelliae Rhizoma Praeparatum), and Cang Zhu (Atractylodis Rhizoma). Consequently, the symptoms worsened severely. Another physician was invited who used cooling agents, providing slight relief. The next day, Shi Gao (Gypsum Fibrosum) 3 qian, Xi Jiao (Rhinoceros Horn) 8 fen, and Huang Lian (Coptidis Rhizoma) 5 fen were added. However, her pulse became deep and hidden (Fu), her four limbs turned cold, and she fell into a comatose state resembling unconsciousness. The physician diagnosed this as a transformation into Yin syndrome and declined further treatment due to hopelessness. Wu Gong was filled with sorrow and paced the courtyard. His wife asked, "Who saved me years ago?" Wu Gong suddenly realized and said, "It must be this person." He invited me to explain the rationale. I palpated her pulse and examined her symptoms and complexion, stating, "This is an easy matter." Wu Gong asked, "Clearly a Heat syndrome, yet administering cooling medicines made it worse. What other method is there?" I replied, "Treating disease is like using troops; the small cannot fight the large, and the weak cannot fight the strong. When the disease is severe but the medication is light, it inadvertently boosts the pathogenic force. Following my protocol, I guarantee recovery within fourteen days." Soon after, Wu Gong's second son also fell ill. I palpated his pulse and observed his complexion, saying, "Your son's condition involves deep toxin penetration, which is heavier than your sister-in-law's." I treated him according to the same protocol. Within seven to eight days, various complicated changes occurred, too numerous to enumerate. Fortunately, after two doses, purple-red macules appeared all over his body, some tight and bound, others loose and floating. Wu Gong exclaimed in fear, "You said it was heavier than before; how accurate you are!" I immediately prescribed a large dose: Shi Gao (Gypsum Fibrosum) 8 liang, Xi Jiao (Rhinoceros Horn) 6 qian, Huang Lian (Coptidis Rhizoma) 5 qian, plus Sheng Di Huang (Rehmanniae Radix Praeparata) 1 liang, Zi Cao (Arnebiae Radix seu Lithospermi Radix) 3 qian, Gui Wei (Angelicae Sinensis Radix Caulis) 2 qian, and Da Qing Ye (Isatidis Folium) 3 qian. One dose was decocted three times, and the residue was used to decoct the next day's medicine. After taking six doses of this formula, the tight macules loosened, and the bound ones floated. However, nosebleeds gushed like a spring, accompanied by delirious speech. Wu Gong feared excessive blood loss. I said, "This is reckless movement of hot blood; the toxin is being expelled through this hemorrhage. Stopping it is very easy." I modified the original formula by adding Zong Tan (Carbonized Palm Fiber) 3 qian, Sang Bai Pi (Mori Cortex) 3 qian, and Ling Yang Jiao (Saiga Tataricae Cornu) 3 qian. After two doses, the bleeding stopped, and Sang Bai Pi, Zong Tan, and Ling Yang Jiao were removed. After another two doses, stomach qi gradually opened, the color turned pale red, and the rash began to recede. I then prescribed Shi Gao (Gypsum Fibrosum) 4 liang, Xi Jiao (Rhinoceros Horn) 4 qian, Huang Lian (Coptidis Rhizoma) 3 qian, removing Zi Cao and Gui Wei, reducing Sheng Di Huang by 5 qian, and using Da Qing Ye (Isatidis Folium) 1.5 liang. After two more doses, the macules completely disappeared. I prescribed Sheng Di Huang (Rehmanniae Radix Praeparata) 3 qian, Xi Jiao (Rhinoceros Horn) 3 qian, Huang Lian (Coptidis Rhizoma) 2 qian, and Shi Gao (Gypsum Fibrosum) 2.8 liang. After two additional doses, his appetite increased significantly, and red sand-like spots reappeared from the neck to the chest, indicating the complete emergence of residual toxins. I prescribed Sheng Di Huang (Rehmanniae Radix Praeparata) 3 qian, Xi Jiao (Rhinoceros Horn) 2 qian, Huang Lian (Coptidis Rhizoma) 1.5 qian, and Shi Gao (Gypsum Fibrosum) 1.6 liang. After two more doses, his spirit gradually strengthened. I continued with Sheng Di Huang (Rehmanniae Radix Praeparata) 3 qian, Xi Jiao (Rhinoceros Horn) 1.5 qian, Huang Lian (Coptidis Rhizoma) 0.8 qian, Yang Shen (Codonopsis Pilosula or Panax Ginseng depending on context, here likely Codonopsis) 1 qian, Mai Dong (Ophiopogonis Tuber) 3 qian, Dang Gui Shen (Angelicae Sinensis Radix Caulis) 1.5 qian, Shi Gao (Gypsum Fibrosum) 8 qian, and two sour plums. After three more doses, he stabilized. Wu Gong joyfully said, "My son's survival is thanks to your regeneration." I replied, "By treating your sister-in-law earlier, I was essentially saving your son! If ginger, banxia, cangzhu, and huoxiang had been used initially, he certainly could not have been saved. Macules are a symptom of Stomach Heat; those previous herbs are highly drying and damage Stomach Qi, adding oil to fire. How could life be expected? Subsequently, our family treated seven members consecutively, all presenting with critical danger. For me, treatment was not difficult, and Wu Gong took the medicines as a matter of course."