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Book: Compilation of Verified Cases by Famous Doctors in Modern Times; Chapter: Main Text (45/53); Category: Medical Discussion

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Case 1: Xu, female, 43 years old. First consultation in May 1973. The patient suffered from residual biliary tract stones and underwent three surgeries successively. The first surgery was a cholecystectomy performed in 1952; the condition recurred in 1964; the second surgery (common bile duct stone extraction) was performed at the end of 1967; it recurred again in 1968; until another surgery was performed in April 1973 (during which stones were found remaining in the right hepatic duct, and T-tube drainage yielded considerable sludge-like stones). Previously, during attacks, jaundice, fever, and pain in the right upper abdomen and sub-xiphoid area often occurred. Currently, the patient's constitution is weak, with mental fatigue and limb weakness, occasional stuffiness and distension in the epigastrium and abdomen, bowel movements two to three times daily accompanied by loose stools. The tongue coating is thin and greasy, and the pulse is soggy and slow. The syndrome is diagnosed as long-standing illness leading to deficiency, failure of Spleen Qi to govern transportation and transformation, disharmony between Liver and Gallbladder, and loss of free flow. The treatment principle is to invigorate the Spleen and benefit Qi, and to soothe the Liver and promote Gallbladder function. Prescription: Dangshen (Codonopsis Root) 12g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Yunling (Poria), 9g, Zhike (Immature Bitter Orange) 9g, Muxiang (Vladimiria Root) 9g, Yuanhu Fen (Corydalis Powder) 4.5g (taken separately by mixing into liquid), Zhi Jun (Prepared Rhubarb) 9g, Huzhang (Polygonum Cuspidatum Rhizome and Stem) 15g, Sheng Shanzha (Raw Hawthorn Fruit) 12g, Jinqiancao (Lysimachiae Herba) 30g.

Follow-up in April 1975: After taking the above prescription with modifications for two years, no recurrence was observed. Compared with two years ago, symptoms improved as follows: 1. Weight increased, complexion improved, appetite increased, daily food intake exceeded one jin (approx. 500g), bowel movements once monthly and formed. 2. Stuffiness and discomfort in the right upper abdomen disappeared. 3. Previously prone to attacks when exposed to cold or fatigue, now even when exposed to cold or work fatigue, no attack occurred; moreover, she did not wear cotton-padded jackets last winter, indicating enhanced constitution. Continue to follow the original intent with modifications. *375—Dangshen (Codonopsis Root) 12g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Huaishanyao (Chinese Yam Rhizome) 9g, Zhike (Immature Bitter Orange) 9g, Chenpi (Tangerine Peel) 9g, Yuanming Fen (Mirabilite) 4.5g (taken separately by mixing into liquid), Huzhang (Polygonum Cuspidatum Rhizome and Stem) 12g, Sheng Shanzha (Raw Hawthorn Fruit) 12g, Zhi Jun (Prepared Rhubarb) 9g, Yanhusuo (Corydalis Rhizome) 12g.

(Gu Bohua, *Selected Surgical Experiences*)

[Commentary]
Case 1 presents a Yang excess syndrome; since the patient was young and robust, Ye used Da Chaihu Tang (Major Bupleurum Decoction) with modifications to harmonize Shaoyang and purge heat accumulation. Rhubarb was increased to 12g to purge stasis-heat, and a small amount of Mirabilite was added to soften hardness and guide stagnation out; a small amount of Bear Gallbladder was taken orally to enhance the effect of resolving jaundice. It should be noted that this case incorporated dietary therapy based on seasonal characteristics, specifically liberal consumption of watermelon, which had an auxiliary effect of clearing heat and promoting diuresis. This combination of herbal therapy and dietary therapy according to seasons reflects Ye’s flexibility in treatment approach.

Case 2 involves both gallstones and cholecystitis. Clinically, besides epigastric and abdominal stuffiness, symptoms include mental fatigue, limb weakness, and loose stools two to three times daily. The syndrome is diagnosed as long-standing illness causing deficiency, failure of Spleen to govern transportation and transformation, disharmony between Liver and Gallbladder, and loss of free flow. The pattern belongs to mixed deficiency and excess, with righteous Qi deficiency and pathogenic excess. Treatment employs methods to invigorate the Spleen, benefit Qi, soothe the Liver, and promote Gallbladder function. During Gu’s long-term treatment process, the characteristics of his medication are: ① Using Dangshen (Codonopsis Root), Shanyao (Chinese Yam Rhizome), Fuling (Poria), and Baizhu (Atractylodes Macrocephala Rhizome) to tonify Qi and strengthen the Spleen; ② Using Chaihu (Bupleurum Root), Zhike (Immature Bitter Orange), Yujin (Curcuma Longa Rhizome), Chuanlianzi (Toosendan Fruit), Chenpi (Tangerine Peel), Muxiang (Vladimiria Root), and Xiangfu (Cyperus Rhizome) to soothe the Liver and regulate Qi; ③ Using Yuanming Fen (Mirabilite), Huzhang (Polygonum Cuspidatum Rhizome and Stem), Sheng Shanzha (Raw Hawthorn Fruit), Caojueming (Cassia Seed), and Jinqiancao (Lysimachiae Herba) to promote Gallbladder function and dissolve stones; ④ Using Baishao (White Peony Root), Nvzhenzi (Ligustrum Lucidum Fruit), Hanliancao (Ecliptae Herba), and Yuzhu (Polygonatum Odoratum Rhizome) to soften the Liver and nourish Yin; ⑤ Using Hongteng (Sargentodoxa Caulis), Gongying (Taraxaci Herba), Shezhicao (Hedyotis Diffusa Herba), and Luhancao (Pyrola Decumbens Herb) to clear interior heat and reduce inflammation. The entire case demonstrates meticulous syndrome differentiation, and the coordination of prescriptions and treatments, combining soothing/purging with tonifying methods, shows profound ingenuity.

(21) Ureteral Calculi

Case 1: Shi ××, male, 53 years old, Overseas Chinese from Indonesia. First consultation on April 16, 1962: The patient reported onset of right-sided lower back pain and hematuria two months prior. X-ray examination at Hospital XX revealed a stone shadow approximately 0.8 x 0.5 cm in size at the level of the lower margin of the third lumbar vertebra in the right ureter. In March of the same year, intravenous urography was performed, showing the stone had migrated down to the pelvic cavity, estimated to be about 5 cm from the ureteral orifice, prompting him to seek medical advice. He was prescribed Zhuling Tang (Polyporus Decoction). Zhuling (Polyporus) 9g, Fuling (Poria) 9g, Zexie (Alisma Rhizome) 12g, Huashi (Talcum) 18g, Ejiao (Donkey-Hide Gelatin) 9g, decocted in water and taken orally. Follow-up on May 2: After taking 14 doses of the previous prescription, hematuria stopped, urine became short and dark red, but lower back pain persisted. One week prior, an abdominal plain film showed the stone position had not moved. Today, change to the following prescription: Jinqiancao (Lysimachiae Herba) 60g, Huashi (Talcum) 15g, Shiwei (Pyrrosiae Leaf) 12g, Dongkuizi (Malva Seeds) 9g, Haijinsha (Lygodii Spora) 12g, Cheqianzi (Plantago Seed) 12g, Zexie (Alisma Rhizome) 12g, Fuling (Poria) 9g, decocted in water and taken orally. After taking nearly 20 doses of the above prescription, the stone was expelled, all symptoms disappeared, and he recovered completely. (*Collected Medical Cases of Yue Meizhong*)

Case 2: Patient, female, 36 years old. Date of first consultation: May 29, 1962. Outpatient No.: 204624. The morning before yesterday, sudden continuous colicky pain occurred in the right waist and abdomen, without radiation to other areas. Urination frequency decreased, urine was short, dark red, dribbling, with astringent pain in the urethra. Lower abdominal distending pain accompanied urination. Severe pain was accompanied by nausea and vomiting; vomitus was mostly yellow bitter fluid. For three days, there was no desire to eat, and eating immediately induced vomiting; one roundworm was vomited on the night of onset. No bowel movement for three days. No abdominal mass during pain, no aversion to cold or fever, no cough, etc. Menstruation was normal. Pain could be relieved by injections of Atropine and Morphine. No similar history previously; history of abdominal pain for 2 years. Examination: White blood cell count slightly elevated. Urine routine: slight protein, pus cells 0–2, Red Blood Cells (+). X-ray examination: Right kidney, ureter, bladder plain film showed an oval bean-sized positive stone shadow at the location corresponding to the ureter, slightly below the right transverse process of the fourth lumbar vertebra. Diagnosis: Right ureteral calculus. The patient refused surgery. Course of Traditional Chinese Medicine treatment: Symptoms as described above, pulse wiry and slippery, tongue coating yellow and slippery, urinary stabbing pain, short dark red and astringent urine. Based on pulse and symptoms, the pattern is Kidney deficiency, failure of Bladder Qi transformation, excessive Ministerial Fire, causing severe pain along the pathways of the Kidney and Bladder meridians; due to failure of Qi transformation, damp-heat accumulates, leading to stone formation. Treatment should focus on promoting urination to relieve strangury and dissolving stones, combined with soothing the Liver. Prescription: Baizhu (Atractylodes Macrocephala Rhizome) 9g, Fuling (Poria) 12g, Cheqianzi (Plantago Seed) 9g, Fei Huashi (Fly-Tossed Talcum, wrapped separately, taken by mixing into liquid) 9g, Guang Muxiang (Vladimiria Root) 3g, Lizhihe (Litchi Seed) 9g, Wuyao (Lindera Root) 6g, Xiaohuixiang (Fennel Fruit) 3g, Gancao Shao (Licorice Tip) 6g. Take one dose daily, consecutively for 5 days. June 2

(Second Consultation): On the fourth day after taking the above medicine, hypogastric pain decreased, but lower back pain did not decrease, and hypogastric distending pain remained; urination became smooth, astringent pain decreased, and yellow-white turbid proteinaceous fluid was discharged in urine; tongue coating yellow and dry, pulse wiry and slippery. This is due to stagnation and failure of dispersion of Liver Qi, and obstruction of damp-heat. Change prescription as follows: Chuan Bixie (Dioscorea Hypoglauca Rhizome) 15g, Fuling (Poria) 9g, Niuxi (Achyranthes Root) 6g, Yan Chao Duzhong (Salt-fried Eucommia Bark) 9g, Gancao Shao (Licorice Tip) 3g, Xiaohuixiang (Fennel Fruit) 3g. 3 doses. June 5

(Third Consultation): Lower back pain significantly reduced. Yesterday afternoon, severe pain occurred in the perineum, followed by the discharge of more than 20 stones the size of mung beans in urine. All symptoms suddenly resolved; although slight hypogastric distending pain remained, it was a hollow pain due to righteous Qi deficiency. Remove Huashi (Talcum) from the above prescription, add Shudi (Rehmannia Glutinosa Root Prepared with Wine) 15g to nourish and tonify Kidney Qi. Zhang Yuansu once said: "Pain below the umbilicus belongs to the Kidney meridian; only Shudi (Rehmannia Glutinosa Root Prepared with Wine) can eliminate it." June 9

(Final Consultation): All symptoms disappeared, only urine color was yellow and frequent. Use heat-clearing and Spleen-invigorating method to conclude treatment. Tracked for over a year afterwards, no recurrence was seen.

(Chief Physician Jiang Yubo, organized by Zhu Zengbo et al., Course of TCM Treatment for Ureteral Calculi, *Shanghai Journal of Traditional Chinese Medicine* 3:22, 1964)

[Commentary] Ureteral calculi roughly correspond to Shi Lin (Stone Strangury), Xiao Xue (Blood in Urine), Yao Tong (Lower Back Pain) in TCM clinical literature, with a particularly close relationship to Shi Lin (Stone Strangury). Pathologically, this disease is mostly caused by damp-heat accumulation in the Lower Jiao.

In Case 1, initial treatment used Zhuling Tang (Polyporus Decoction) to nourish Yin, clear heat, and promote diuresis, later using modified Shiwei San (Pyrrosia Powder) to clear and drain damp-heat, expel stones, and relieve pain. The prescribed herbs were well-composed with specific efficacy, demonstrating considerable skill in differentiation and treatment.

In Case 2, symptoms included soreness and colicky pain in the waist, and short, dark red, dribbling urine. Differentiation indicated Kidney deficiency, hyperactive Ministerial Fire, unfavorable Bladder Qi transformation, and damp-heat accumulation forming stones. Treatment focused mainly on promoting urination to relieve strangury and dissolving stones, supplemented by soothing the Liver. Throughout several consultations, emphasis was placed on clearing and draining damp-heat, concluding with heat-clearing and Spleen-invigorating methods. The entire case’s prescription and treatment sought deficiency within excess, showing flexible and ingenious application.

(22) Chronic Prostatitis
Ren ××, male, 31 years old. Date of first consultation: November 7, 1972. More than a year ago, the patient felt soreness and pain in the lower back without obvious triggers, radiating to both thighs, with fullness in the lower abdomen, frequent urination, dripping of white turbid fluid at the end of urination, mild astringent pain, fatigue, dizziness, palpitations, and tinnitus. He had visited Hospital XX, where prostate massage was performed; microscopic examination of prostatic fluid showed 20 pus cells/high power field and a small amount of lecithin bodies. History of hypertension, blood pressure reaching 160–180/90–110 mmHg. Examination: Temperature 36.4°C, blood pressure 160/85 mmHg. Pale complexion, thin white tongue coating, deep and slow pulse. Differentiation: Kidney deficiency with hyperactive Yang, cold-dampness coagulation (Western diagnosis: Chronic prostatitis, Hypertension). Treatment method: Calm Liver and subdue Yang, dissipate stasis and open orifices, promote urination and remove turbidity. Prescription: Zhenzhumu (Margarita) 30g, Guiwei (Angelica Sinensis Root Tail) 9g, Chishao (Red Peony Root) 10g, Sheng Cishi (Magnetite) 30g, Changpu (Acorus Rhizome) 12g, Zhuling (Polyporus) 12g, Sheng Shijueming (Concha Haliotidis) 30g, Zexie (Alisma Rhizome) 10g, Yunling (Poria) 10g, Hupo Mian (Amber Powder) 2.4g (taken by mixing into liquid), Cheqianzi (Plantago Seed) 10g, Gancao (Licorice Root) 3g. November 20 (Follow-up): After taking 14 doses of the above prescription, dizziness, tinnitus, palpitations, and dizziness of eyes were alleviated; lower back soreness and frequent urination also improved. Still felt fatigued and weak, with dripping of white turbid fluid at the end of urination. Blood pressure 150/70 mmHg, thin white tongue coating, deep and fine pulse. Changed to method of calming Liver, warming Kidney, dispelling cold, and promoting urination. Prescription as follows: Zhenzhumu (Margarita) 30g, Juhua (Chrysanthemum Flower) 15g, Zhuling (Polyporus) 10g, Shang Rougui (Cinnamon Bark) 6g, Zexie (Alisma Rhizome) 10g, Bianxu (Polygonum Aviculare Herb) 10g, Zi Shiyong (Haematitum) 30g, Niuxi (Achyranthes Root) 10g, Guiwei (Angelica Sinensis Root Tail) 10g, Cheqianzi (Plantago Seed) 10g, Chuanxiong (Ligusticum Rhizome) 10g, Hupo Mian (Amber Powder) 2.4g (taken by mixing into liquid). December 7

(Third Consultation): After taking 14 doses of the above prescription, dizziness and visual disturbances ceased, occasional tinnitus remained, lower back still sore, but no urinary pain or white turbid fluid. Blood pressure 140/80 mmHg, thin white tongue coating, deep, fine, and weak pulse, weaker at both Chi positions. Again use method of tonifying Kidney, softening Liver, activating blood, and draining dampness to treat the root. Prescription as follows: Tusizi (Cuscuta Seed) 18g, Qianshi (Euryale Seed) 15g, Duzhong (Eucommia Bark) 10g, Gouqizi (Lycium Fruit) 24g, Guiwei (Angelica Sinensis Root Tail) 12g, Chuanduan (Drynaria Rhizome) 18g, Hang Baishao (White Peony Root) 15g, Zexie (Alisma Rhizome) 12g, Niuxi (Achyranthes Root) 10g, Shang Rougui (Cinnamon Bark) 10g, Cheqianzi (Plantago Seed) 10g, Yunling (Poria) 10g. Additionally take Shenqi Wan (Kidney Qi Pill), one pill each morning and evening. With modifications to the above prescription based on syndrome differentiation, follow-up on January 26, 1973, all symptoms resolved, and prostatic fluid examination was also normal. Followed up for three years, no recurrence. (*Surgical Experiences of Fang Zhixuan*)

[Commentary] This case has been ongoing for a year, belonging to chronic conditions. Although the main symptoms are lower back pain, frequent urination, turbid and astringent painful urination, pathologically it belongs to cold-dampness and blood stasis coagulation. However, the patient has symptoms of Kidney deficiency with hyperactive Yang and hypertension, so treatment employed methods to calm Liver and subdue Yang, dissipate stasis and open orifices, promote urination and remove stasis. After见效 (effect was achieved), it was followed by calming Liver and warming Kidney, dispelling cold and promoting urination. Since the patient presented mixed deficiency and excess, the scale and method of dispersing pathogens and supporting righteous Qi should be controlled appropriately, finally ending with tonifying Kidney, softening Liver, activating blood, and draining dampness, which is the method to treat the root.

(23) Leg Ulcer (Linchuang)
Yao ××, female, 25 years old. Outpatient No.: 78478. Came for consultation on August 13, 1962. Three years ago, a sore appeared on the dorsum of the left foot, initially with millet-grain-sized pustules, subsequently ulcerating and expanding. Immediately after onset, she went to a certain hospital for treatment; the ulcer gradually shrank, but when it reached a diameter of 2 cm, it stopped healing, occasionally discharging pus and fluid; local swelling and pain occurred after work fatigue and prolonged standing, which could be relieved by rest. Later treated at another hospital, but has not healed to date. Examination: Left foot dorsum had an ulcer measuring 1x1.5 cm, irregular edges, fresh granulation tissue on the wound surface, thickened scars around. Mild swelling of the foot dorsum, no obvious depression upon pressing. Diagnosis: Linchuang (Leg Ulcer / Chronic Lower Limb Ulcer). Treatment: Local area first blown with a hair dryer for 15 minutes, then Shengji San (Generate Flesh Powder) sprinkled on the ulcer surface. Then apply Shengji Baiyu Gao (Generate Flesh White Jade Ointment) spread on dry sterilized gauze, covering the affected area. Finally, wrap with a bandage from near the toe end of the foot dorsum to above the ankle joint. Change dressing once daily. After 7 days of treatment, the ulcer completely healed, and foot dorsum swelling disappeared. Attached Formula: Shengji Baiyu Gao (Empirical Formula) Urine-soaked Gypsum 90%, Prepared Calcined Hematite (Lu Ganshi) 10%. Gypsum must be soaked in urine for half a year (or use calcined gypsum), washed clean, then rinsed clean for two months, then roasted and ground into powder, then mixed evenly with prepared Calcined Hematite powder, adjusted into ointment with a little sesame oil, then added Yellow Vaseline (when preparing this ointment, use approximately 3/10 drugs and 7/10 oily substances). (Gu Bohua, *Selected Surgical Experiences*)

[Commentary] Linchuang (Lower Limb Ulcer) is most common on the anterior part of the tibia; this case was located on the dorsum of the foot, treated purely with external methods, evolving and developing upon ancient methods. The Shengji Baiyu Gao (Generate Flesh White Jade Ointment) used by Gu treats ulcers where putrid flesh has been exhausted and the sore mouth does not close, having effects of moistening skin, generating flesh, and astringing.

(24) Gangrene of Extremities (Tuoju)
Case 1: Wang ××, male, 45 years old, cadre. Hospitalization No.: 32243. Date of hospitalization: March 25, 1973. In the winter of 1958 while working in a certain place, both feet suffered frostbite, followed by local dull pain, worsening in cold weather. Intermittent claudication began in 1962, toes turned purple, cold, pale, with acral arterial spasm phenomenon. Although treated several times, symptoms gradually worsened. By the winter of 1965, the 2nd, 3rd, and 4th toes of the left foot had successively ulcerated. For the past half year, pain has been severe, often unable to sleep all night, sitting holding the foot. A certain place planned high-level amputation, but the patient refused, so specially came to our hospital for Traditional Chinese Medicine treatment. Examination: Muscle atrophy in both lower limbs, skin temperature significantly reduced, hair loss, toenails thickened, dorsal pedal artery pulsation disappeared, posterior tibial artery and popliteal artery pulsations also weakened. Ulceration at the ends of the 2nd, 3rd, and 4th toes of the left foot, considerable pus and water, swelling spreading to the anterior foot dorsum, surrounding skin dark red. Left index finger cannot flex or extend, fingertip shows dry necrosis, bilateral radial artery pulsations weakened. Laboratory examination: Hemoglobin 13.3 g, Red Blood Cells 4.6 million/mm³, White Blood Cells 13,500/mm³, Neutrophils 85%, bleeding and clotting time 2 minutes, Platelet count 100,000, Erythrocyte Sedimentation Rate 12 mm, Anti-"O" 333 units. Pus smear culture: Staphylococcus aureus grew, Pseudomonas aeruginosa grew. Diagnosis: Thromboangiitis Obliterans (Necrotic Stage). Treatment: Phase I (One and a half months, starting March 25, 1974): Gangrene already necrotic, wound surface weeping pus profusely, foul-smelling, severe pain, unable to sleep at night, thin tongue coating, red tongue. Only right radial artery pulsation weak, fine and rapid (88 beats/min). Cold-dampness stagnated for a long time transforming into heat, becoming fire-toxin, meridians blocked, Qi and blood stagnating. Initially plan to nourish Yin and clear heat, harmonize Ying and activate blood. Xuanshen (Scrophularia Root) 12g, Shengdi (Rehmannia Glutinosa Root) 30g, Yinhua (Lonicerae Japonicae Flos) 9g, Sijiqing (Ilex Aquifolioides Leaf) 30g, Shezhicao (Hedyotis Diffusa Herba) 30g, Chuan Niuxi (Cyathulae Radix) 12g, Danggui (Angelica Sinensis Root) 12g, Chishao (Red Peony Root) 15g, Du Honghua (Carthamus Tinctorius Flower) 9g, Ye Chidou (Vigna Umbellata Seed) 18g, Huzhang (Polygonum Cuspidatum Rhizome and Stem) 15g, Sheng Shanzha (Raw Hawthorn Fruit) 15g. External use: Soak in Gentamicin solution, then apply Hongyou Gao (Red Oil Ointment) mixed with Jiuyi Dan (Nine-One Pellets). Phase II (One and a half months, starting May 10): Clear boundary between healthy tissue and necrotic area of vasculitis obvious, putrid flesh not yet fully detached, pain greatly reduced, continue previous method with modifications. Shengdi (Rehmannia Glutinosa Root) 15g, Danggui (Angelica Sinensis Root) 12g, Chishao (Red Peony Root) 15g, Du Honghua (Carthamus Tinctorius Flower) 9g, Ye Chidou (Vigna Umbellata Seed) 18g, Chuan Niuxi (Cyathulae Radix) 12g, Fen Bixie (Dioscorea Hypoglauca Rhizome) 15g, Sheng Gancao (Raw Licorice Root) 6g. Phase III (3 months, starting July 1): Most putrid flesh on vasculitis wound surface detached, very little pus, pain stopped, fresh granulation. Thin moist tongue coating, soggy and fine pulse. Long-standing illness causing Qi and blood double deficiency, plan to add regulating and tonifying items. Sheng Huangqi (Astragalus Root) 12g, Lu Dangshen (Codonopsis Root) 12g, Quan Danggui (Whole Angelica Sinensis Root) 9g, Chishao (Red Peony Root) 15g, Du Honghua (Carthamus Tinctorius Flower) 9g, Shengdi (Rehmannia Glutinosa Root) 30g, Xuanshen (Scrophularia Root) 12g, Shezhicao (Hedyotis Diffusa Herba) 30g, Rendongteng (Lonicerae Caulis) 30g, Sheng Gancao (Raw Licorice Root) 6g. External use: Hongyou Gao (Red Oil Ointment), Jiuyi Dan (Nine-One Pellets). Total treatment duration 6 months, wound surface converged and completely healed. The patient, through functional exercise in the hospital, could walk automatically for one li (approx. 500 meters), then discharged.

(Gu Bohua, *Selected Surgical Experiences*)