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Xiao Ke 3 (Diabetes Mellitus)
Patient Li, Male, 47 years old
First Visit
Diabetes mellitus discovered for over three years. Fasting blood glucose: 180-200 mg/dl; Urine sugar: + to +++. Oral administration of Western medicine Glibenclamide and Traditional Chinese Medicine (TCM) Xiaoman Wan yielded poor results. The patient complains of dry mouth and tongue, a desire for hot drinks, general fatigue and weakness, a plump physique, a pulse that is soggy (Ru), soft, and large. The tongue body is enlarged with a white, moist coating. There is soreness and pain in the lower back, and frequent urination at night. The pattern is identified as Qi and Yin deficiency with dual deficiency of the Liver and Kidneys. The initial treatment strategy employs tonifying Qi and nourishing Yin, along with replenishing the Lower Yuan (Lower Burner/Essence).
Raw Astragali Radix (Huangqi) 30g, Raw and Prepared Rehmanniae Radix (Sheng/Di Shudi) 20g each, Glehniae Radix (Shashen) 15g, Ophiopogonis Tuber (Maidong) 15g, Schisandrae Fructus (Wuweizi) 10g, Rosa laevigata Fruit (Jinyingzi) 10g, Eucommiae Cortex (Duzhong) 10g, Dipsaci Radix (Chuanxuduan) 10g, Psoraleae Fructus (Buguzhi) 10g. Seven doses.

Second Visit
After taking the herbs, thirst decreased, energy levels improved compared to before, and lower back pain significantly improved. Pulse is soggy and soft; tongue is plump with a moist coating. Continue the previous method with modifications. Advice: Carefully control diet, avoid sweets. Appropriately increase protein intake. Daily exercise is the foundation of treatment and cannot be ignored.
Raw Astragali Radix (Huangqi) 30g, Glehniae Radix (Shashen) 15g, Ophiopogonis Tuber (Maidong) 15g, Raw and Prepared Rehmanniae Radix (Sheng/Di Shudi) 20g each, Schisandrae Fructus (Wuweizi) 10g, Rosa laevigata Fruit (Jinyingzi) 10g, Eucommiae Cortex (Duzhong) 10g, Psoraleae Fructus (Buguzhi) 10g, Dipsaci Radix (Chuanxuduan) 10g, Corni Fructus (Shanzhuyu) 10g. Seven doses.

Third Visit
The patient reported significant enhancement in spirit and physical strength after medication. Following medical advice, he drove to the suburbs every morning to climb mountains, breathe fresh air, and felt very comfortable. Pulse is soggy, soft, and slippery; tongue is red with a white, moist coating. Continue the method of replenishing the Lower Yuan. Persist in exercise, and there will surely be gains.
Raw Astragali Radix (Huangqi) 30g, Glehniae Radix (Shashen) 15g, Ophiopogonis Tuber (Maidong) 15g, Schisandrae Fructus (Wuweizi) 10g, Raw Dioscoreae Rhizoma (Shanyao) 15g, Paefloris Radix (Huafen) 15g, Raw and Prepared Rehmanniae Radix (Sheng/Di Shudi) 10g each, Eucommiae Cortex (Duzhong) 10g, Dipsaci Radix (Chuanxuduan) 10g, Psoraleae Fructus (Buguzhi) 10g, Corni Fructus (Shanzhuyu) 10g, Lycii Fructus (Gouqizi) 10g. Seven doses.

Fourth Visit
Continuous administration of formulas tonifying Qi, nourishing Yin, and replenishing the Lower Yuan has revitalized the spirit and increased strength. Despite heavy labor, fatigue is no longer felt. Daily hiking has gradually increased to two mountain peaks. The combination of exercise and treatment shows initial effectiveness. Recent lab tests show blood glucose has dropped to normal levels, and urine sugar is negative. Continue the previous method to consolidate results; exercise is indispensable, which is strongly advised.
Raw Astragali Radix (Huangqi) 30g, Glehniae Radix (Shashen) 15g, Ophiopogonis Tuber (Maidong) 15g, Schisandrae Fructus (Wuweizi) 10g, Polygonati Odorati Rhizoma (Yuzhu) 10g, Paefloris Radix (Huafen) 10g, Raw and Prepared Rehmanniae Radix (Sheng/Di Shudi) 10g each, Raw Dioscoreae Rhizoma (Shanyao) 10g, Eucommiae Cortex (Duzhong) 10g, Rosa laevigata Fruit (Jinyingzi) 10g, Psoraleae Fructus (Buguzhi) 10g, Morinda Officinalis Root (Bajitian) 10g. Seven doses.

Subsequently, the formula was modified and administered for half a year. Blood glucose remained normal, urine sugar stayed negative, all symptoms disappeared, and physical strength greatly increased. During treatment, the patient persisted in hiking every morning regardless of weather, covering 30 li round trip, which became a habit. He expressed special gratitude to Master Zhao for teaching him the way of fitness.

[Commentary]: This patient had diabetes for over three years without cure due to fatigue leading to a lifestyle focused on rest with little physical activity. Based on his plump physique, soggy pulse, enlarged tongue, and white moist coating, Master Zhao diagnosed Liver and Kidney insufficiency. He prescribed formulas to replenish the Lower Yuan while tonifying Qi and nourishing Yin, addressing both middle and lower burners, yielding immediate results. However, success did not rely solely on medication but required the patient's autonomous exercise, prioritizing movement as part of the treatment. Initially skeptical, the patient eventually experienced the benefits of exercise, gaining strength and vitality until it became an addiction. The greatest benefit of exercise is promoting the circulation of Qi and Blood and enhancing Zang-Fu organ function. Qi and Blood are essential for sustaining life. Disease arises from the stagnation of Qi and Blood. Whether deficiency or excess patterns, this principle holds. Only through free-flowing Qi and Blood can the Five Zang organs harmonize and the Six Fu organs receive proper distribution, ensuring robust organ function. Zhang Zihe stated, "The Neijing values the free flow of Qi and Blood above all." This is profound truth. Modern medicine attributes diabetes to insufficient insulin secretion by pancreatic islet cells and low function. Although TCM differentiates deficiency/excess and cold/heat, there is invariably stagnation of Qi and Blood leading to dysfunction. To restore flow, one must use herbs to regulate Qi and Blood (first step) and require patients to exercise to promote systemic circulation (second step). In this case, diagnosed as Qi/Yin deficiency and Liver/Kidney depletion, large doses of tonics were needed. Tonics can cause stagnation, yet tonification is necessary for deficiency. How to resolve this? Exercise therapy moves Qi and Blood and facilitates the action of the herbs. Thus, exercise is indispensable. Additionally, for large tonic doses, decoction method matters: add ample water, decoct 2-3 times, combine liquids to obtain 3-4 liters, and have the patient drink it like tea whenever thirsty, without time restrictions. This differs from treating other diseases and is one of Master Zhao's unique experiences.

Hei Dan (Addison's Disease)
Patient Yan, Male, 40 years old
First Visit
Complexion is dark black like lacquer, progressively worsening, especially on the cheekbones. Illness duration: over two years. Examined at a major hospital, confirmed as Addison's disease. Complains of mental exhaustion, general fatigue, soreness and weakness of waist and knees, severe weakness in both lower limbs, nausea with urge to vomit, and poor appetite. Pulse is deep, fine, and weak, barely palpable upon pressure. Tongue is pale with a slippery coating. The presentation indicates Yang deficiency with Water overflowing. Treatment should first warm Kidney Yang to address the root, known as "benefiting the source of Fire to eliminate Yin shadows."
Processed Aconiti Lateralis Radix Praeparata (Fupian) 6g, Processed Zingiberis Rhizoma (Ganjiang) 6g, Processed Evodiae Fructus (Wuzhuyu) 6g, Cinnamomi Cortex (Rougui) 6g, Eucommiae Cortex (Duzhong) 10g, Dipsaci Radix (Chuanxuduan) 10g, Psoraleae Fructus (Buguzhi) 10g, Prepared Rehmanniae Radix (Shudi) 20g. Seven doses.

Second Visit
After medication, spirit improved, fatigue reduced, other symptoms remain. Continue previous method with heavier dosage.
Processed Aconiti Lateralis Radix Praeparata (Fupian) 10g, Processed Zingiberis Rhizoma (Ganjiang) 10g, Processed Evodiae Fructus (Wuzhuyu) 10g, Cinnamomi Cortex (Rougui) 10g, Eucommiae Cortex (Duzhong) 15g, Dipsaci Radix (Chuanxuduan) 15g, Psoraleae Fructus (Buguzhi) 10g, Prepared Rehmanniae Radix (Shudi) 20g. Seven doses.

Third Visit
Spirit further improved, strength increased. Still feels nausea and poor appetite. Pulse remains deep and fine; tongue pale with moist coating. Warm and tonify the Lower Yuan, simultaneously moving Middle Yang.
Processed Aconiti Lateralis Radix Praeparata (Fupian) 10g, Processed Zingiberis Rhizoma (Ganjiang) 10g, Processed Evodiae Fructus (Wuzhuyu) 10g, Cinnamomi Cortex (Rougui) 10g, Eucommiae Cortex (Duzhong) 10g, Dipsaci Radix (Chuanxuduan) 10g, Psoraleae Fructus (Buguzhi) 10g, Fried Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Pinelliae Tuber (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Amomi Fructus Rotundus (Bai Kou Ren) 6g (added later). Seven doses.

Fourth Visit
Nausea reduced but not eliminated. Dark complexion shows signs of fading. Plan to advance warming and tonifying the Lower Yuan; hope exists for reviving Kidney Yang. Continue previous method, tonifying Mingmen Fire to warm the Middle Earth.
Processed Aconiti Lateralis Radix Praeparata (Fupian) 10g, Processed Zingiberis Rhizoma (Ganjiang) 10g, Processed Evodiae Fructus (Wuzhuyu) 10g, Cinnamomi Cortex (Rougui) 10g, Eucommiae Cortex (Duzhong) 10g, Dipsaci Radix (Chuanxuduan) 10g, Psoraleae Fructus (Buguzhi) 10g, Fried Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Epimedii Folium (Xinyianpi) 10g, Corni Fructus (Shanzhuyu) 10g, Huai Dioscoreae Rhizoma (Shanyao) 15g, Lycii Fructus (Gouqizi) 10g, Prepared Rehmanniae Radix (Shudi) 20g. Seven doses.

Fifth Visit
Spirit greatly revived, appetite increased, dark complexion continues to fade. However, long-standing Kidney Yang decline cannot be cured overnight; pills should be used for slow recovery. Follow previous method with additions.
Processed Aconiti Lateralis Radix Praeparata (Fupian) 30g, Processed Zingiberis Rhizoma (Ganjiang) 30g, Processed Evodiae Fructus (Wuzhuyu) 30g, Cinnamomi Cortex (Rougui) 30g, Eucommiae Cortex (Duzhong) 30g, Dipsaci Radix (Chuanxuduan) 30g, Psoraleae Fructus (Buguzhi) 30g, Fried Atractylodis Macrocephalae Rhizoma (Baizhu) 30g, Red Ginseng Radix et Rhizoma (Renshen) 30g, Lycii Fructus (Gouqizi) 30g, Corni Fructus (Shanzhuyu) 30g, Epimedii Folium (Xinyianpi) 30g, Prepared Rehmanniae Radix (Shudi) 60g, Huai Dioscoreae Rhizoma (Shanyao) 60g, Citri Reticulatae Pericarpium (Chenpi) 30g, Pinelliae Tuber (Banxia) 30g, Poria (Fuling) 50g, Cornu Cervi Corneum (Lujiaojiao) 100g.
Preparation: Grind all herbs except Lujiaojiao into fine powder. Melt Lujiaojiao and mix with appropriate amount of refined honey. Form pills the size of marbles, weighing approx. 10g each. Take one pill morning and evening.
After one course of these pills, the dark complexion gradually faded, spirit and physical strength improved, and most other symptoms disappeared.

[Commentary]: Addison's disease, also known as chronic adrenal cortical insufficiency, is a syndrome resulting from severe damage to the adrenal cortex due to various causes. Its characteristic clinical manifestation is significant hyperpigmentation (described in TCM as a dark black complexion), accompanied by multi-system symptoms such as nausea, vomiting, poor appetite, emaciation, fatigue, and dizziness. Western hormone therapy has some effect. Ancient TCM literature lacks an exact corresponding disease name, so there are no established treatment protocols. Master Zhao analyzed this disease based on TCM theory, identifying the main symptom of dark complexion as indicative of衰竭 of Primordial Yang and Mingmen Fire decline. Accompanying symptoms include mental fatigue, weakness, sore waist/knees, dizziness, tinnitus, and potentially impotence in men, all signs of Yang decline. Therefore, treatment focuses on warming the Kidney and strengthening Yang. Based on Zhang Zhongjing's Sini Tang (Four Reversal Decoction), adding Processed Evodiae Fructus creates San Dan Tang. Further additions of Cinnamomi Cortex, Eucommiae Cortex, Dipsaci Radix, Psoraleae Fructus, and Prepared Rehmanniae Radix provide warming and tonifying effects for the Lower Yuan, yielding obvious results for this disease.

Pang Fei (Hyperlipidemia)
Patient Shen, Male, 51 years old, tall and stout, weight over 90 kg. High blood lipids detected during check-up; Western lipid-lowering drugs yielded poor results. Consulted in December 1990.
Observation: Flushed face, oily and shiny skin. Tongue is red with thick, greasy yellow coating. Pulse is wiry, slippery, and rapid, forceful upon pressure. Blood biochemistry test shows Triglycerides as high as 18.86 mmol/L. Pattern differentiation identifies Phlegm-Dampness and Blood Stasis obstruction. Long-term risk of Stroke (Zhong Feng). Treatment requires clearing Phlegm and invigorating Blood to remove stasis. Formula: San Zi Yang Qin Tang (Three Seeds Nourishing Elderly Decoction) modified. Ingredients: Perillae Fructus (Suzi) 10g, Raphani Fructus (Laifuzi) 10g, Mustard Seed (Baijiezi) 6g, Benincasae Semen (Dongguazi) 10g, Gleditsiae Sinensis Spina (Zaojiaoren) 6g, Paefloris Radix (Chishao) 10g, Salviae Miltiorrhizae Radix (Danshen) 10g, Rubiae Cordifoliae Radix et Rhizoma (Qiancao) 10g. Decoct in water. One dose daily. Recheck after half a month: Triglycerides dropped to 12.64 mmol/L. Patient's confidence increased. Continue previous formula adding Bupleuri Radix (Chaihu) 6g, Meliae Semen (Chuanlianzi) 6g, Jiao San Xian (Fried Hawthorn, Medicated Leaven, Barley Sprout) 10g each. Recheck after 1 month: Triglycerides dropped to 7.56 mmol/L. Advised to persist in dietary control and strengthen exercise to conclude treatment.

[Commentary]: Hyperlipidemia has no ancient name, so no fixed herbal protocol exists. Based on obesity, slippery tongue, and greasy coating, Master Zhao diagnosed Phlegm-Dampness and Blood Stasis. Borrowing San Zi Yang Qin Tang (used for Phlegm-Wheeze) and adding Benincasae Semen and Gleditsiae Sinensis Spina, he named it Wu Zi Di Tan Tang (Five Seeds Phlegm-Clearing Decoction) to clear Phlegm and reduce grease. Clinical application allows modifications: add Chishao, Danshen, Qiancao for Blood Stasis; add Chaihu, Huangqin, Chuanlianzi to drain Liver Heat; add Jiao San Xian, Hydrocotylis Herba (Shuihonghua), Dahuang to regulate the Triple Burner. This approach yields good results for hyperlipidemia and simple obesity.

Yang Wei 1 (Sexual Dysfunction)
Patient Sun, Male, 24 years old
First Visit
Married for three months. Developed impotence immediately after marriage. Marital relationship deteriorated. Self-purchased Kidney-tonifying Yang-strengthening pills were ineffective. For two months, felt extremely depressed, drinking alone every night to drown sorrows, unable to extricate himself. Reports fatigue and excessive sleepiness for six months, worsening, even falling asleep at work. Physique is obese, face flushed and shiny. Pulse is soggy, soft, and slippery, rapid upon pressure, wiry and urgent when pressed deeply. Tongue coating is yellow and greasy, thick and dirty at the root. Integrating pulse, tongue, complexion, and symptoms, this belongs to Damp-Heat congestion obstructing meridians. Treatment requires clearing and transforming Damp-Heat, focusing on the Jueyin (Liver/Pericardium) channel.
Bupleuri Radix (Chaihu) 6g, Perillae Caulis (Sugeng) and Agastache Herba (Huogeng) 10g each, Angelicae Pubescentis Radix (Duohuo) 5g, Amomi Fructus (Caodoukou) 5g, Plantaginis Semen (Cheqianzi) 10g, Gardeniae Fructus (Shanzhi) 6g, Scutellariae Radix (Huangqin) 10g, Gentianae Radix (Longdancao) 6g, Vinegar-processed Rheum Palmatum Rhizoma (Dahuang) 10g (added later). Two doses.

Second Visit
After medication, bowel movements occurred freely three times, mental heat significantly reduced, erection returned, sleepiness decreased. Pulse is wiry and slippery, soggy and rapid upon pressure, deep wiry urgency largely diminished. Dirty coating transformed, tongue body still relatively red. Damp-Heat accumulation is gradually resolving, Triple Burner Qi mechanism is opening. However, long-standing Damp-Heat郁stagnation cannot be cured in one dose. Continue clearing Damp-Heat and invigorating Blood to unblock collaterals to clear residual pathogens.
Bupleuri Radix (Chaihu) 6g, Scutellariae Radix (Huangqin) 10g, Lycopodium Herb (Zelan Ye) 10g, Curcumae Radix (Pian Jianghuang) 6g, Bombyx Batryticatus (Chanyi) 6g, Uncariae Ramulus cum Uncis (Gouteng) 10g, Meliae Semen (Chuanlianzi) 10g, Saposhnikoviae Radix (Fangfeng) 6g, Armeniacae Semen Amarum (Xingren) 10g, Rhubarb Powder (Dahuang Fen) 2g, Gentianae Radix (Longdancao) 4g (last two ground fine, encapsulated, swallowed). Three doses.

After taking the above prescription, the patient reported complete cure of impotence, disappearance of other symptoms, and reconciliation with his wife. Advised to stop medication, abstain from sugar and alcohol, and avoid pungent/spicy foods like garlic, Allium macrostemon, leeks, and chili peppers. Encouraged daily exercise for health maintenance.

[Commentary]: This young, strong patient suffered from impotence not due to Kidney deficiency, hence self-administered tonics worsened his condition. His obesity, alcoholism, flushed shiny face, red tongue with greasy coating, fatigue, and sleepiness indicate Damp-Heat郁stagnation. Pulse characteristics (soggy, slippery, wiry, rapid, deep urgency) reveal the essence is Liver Channel Damp-Heat pressing downward and Liver Qi郁stagnation transforming into Fire. One must not see impotence and automatically prescribe Kidney/Liver tonics or Mingmen warming agents. Generally, young, robust men suffering from impotence often do so due to rich food consumption or excessive drinking, leading to Damp-Heat郁stagnation and blocked Triple Burner Qi. As stated, "If Damp-Heat is not cleared, large tendons become short and weak, small tendons become lax; shortness leads to spasm, laxity leads to flaccidity (impotence)." This case illustrates that principle.

Yang Wei 2 (Prostatitis)
Patient Li, Male, 42 years old
First Visit: April 2, 1992
Suffered from prostatitis for over 10 years. For the past six months, impotence and cloudy urine. Currently obese, constipation, irritability, insomnia, vivid dreams. Tongue red with thick white greasy coating. Pulse wiry, slippery, and rapid. Pattern: Damp-Heat郁stagnation, Qi mechanism obstruction, abnormal ascending/descending. Treatment: Clear and transform Damp-Heat, regulate Qi mechanism, ascend Clear and descend Turbid.
Formula: Bombyx Batryticatus (Chanyi), Curcumae Radix (Pian Jianghuang), Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Meliae Semen (Chuanlianzi), Schizonepetae Herba (Jingjie), Saposhnikoviae Radix (Fangfeng) 6g each; Silkworm (Jiangcan), Arecae Pericarpium (Dafupi), Areca Seed (Binglang) 10g each; Rhubarb (Dahuang) 1g. Advised to avoid tobacco, alcohol, spicy/greasy foods, and strengthen exercise. After 7 doses, impotence improved, but irritability and vivid dreams persisted.
Original formula minus Jingjie, added Gouteng and Pi Xie (Bixie) 10g each, Zhi Qiao and Zhu Ru 6g each. After 2 weeks, sexual function normalized, other symptoms resolved.

[Commentary]: Obese individuals often have Dampness; combined with thick white greasy coating, Dampness is confirmed. Irritability, vivid dreams, red tongue, rapid pulse indicate Heat. Excessive Damp-Heat obstructing each other, blocking Qi mechanism and causing meridian stasis leads to impotence. Thus, Sheng Jiang San (Ascending and Descending Powder) regulates Qi and restores ascending/descending. Chaihu, Huangqin, Chuanlianzi drain Liver Heat. Jingjie, Fangfeng promote Yang Qi and resolve Liver郁stagnation. Dafupi, Binglang regulate the Triple Burner. With this, Damp-Heat clears and impotence resolves. If one sees impotence and assumes Mingmen Fire decline, prescribing warming tonics will not only fail to cure impotence but may lead to abscesses, strangury, or toxic sores.

Yang Qiang (Prostatitis)
Patient Zhao, Male, 39 years old
First Visit: January 9, 1992
Four months prior, took Yangqi Shi, Morinda Officinalis Root, Aconite, etc., for kidney-yang strengthening due to prostatitis. Resulted in persistent priapism (Yang Qiang). Nearly 100 doses of TCM ineffective. Currently: red face, red eyes, irritability, insomnia all night, dizziness, fatigue, perineal and testicular pain, dry stool, yellow-red urine. Tongue red with prickles, white and dry coating. Pulse wiry, slippery, and rapid. All indicate Liver Channel郁Heat. Treatment: Clear and purge Liver Channel郁Heat.
Formula: Bombyx Batryticatus (Chanyi), Curcumae Radix (Pian Jianghuang), Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), Meliae Semen (Chuanlianzi), Fried Gardeniae Fructus (Chao Shanzhi) 6g each; Silkworm (Jiangcan), Imperatae Rhizoma (Maigen), Ophiopogonis Tuber (Lugen), Tangerine Peel (Qingchenpi), Fried Sophora Flower (Chao Huaihua) 10g each; Gentianae Radix (Longdancao) 2g; Rhubarb (Dahuang) 1g. After 3 doses, priapism improved, able to sleep. After 10 doses, symptoms basically disappeared.

[Commentary]: Patient is in his prime. Chief complaints: lower back pain, stabbing pain in perineum. Pulse and symptoms are excess, where is the deficiency? Previous doctors misdiagnosed Kidney deficiency and heavily prescribed warming tonics, causing persistent priapism, red face/eyes, irritability, insomnia, red prickly tongue, wiry-slippery-rapid pulse—a picture of Liver Channel郁Heat. Thus, clearing and purging Liver/Gallbladder郁Heat using Sheng Jiang San plus Chaihu, Huangqin, Chuanlianzi, Longdancao, Chao Shanzhi effectively cleared Liver Heat, curing the condition. This case resulted from misusing warming tonics causing Liver/Gallbladder郁Heat manifesting as priapism. The previous case (Yang Wei 2) involved Damp-Heat blocking Jueyin meridians causing impotence. Though symptoms are opposite, the pathogenesis is similar: both show Damp-Heat signs on tongue/pulse. The Liver governs free flow (Shuxie). When blocked by Damp-Heat, free flow is impaired, Qi mechanism stalls, Jueyin meridians郁stagnate, leading either to priapism or impotence. Both should be treated from the Liver perspective, regulating Qi mechanism and restoring free flow. Hence, both cases utilized Sheng Jiang San to regulate Qi and restore ascending/descending dynamics.