July 26, 2010

Hu Xi-Shu (胡希恕) Case #4-Duodenal Ulcer

Mr. Wang, male, 46 years old.

Initial diagnosis on November 30, 1965: For over 10 years the patient has suffered with epigastric pain which has recently been getting worse. Treatment at a local Chinese-Western integrative clinic was unsuccessful. Chinese medicinals were used to warm the centre, rectify the Qi, quicken the blood and dispel stasis. Western medications were ineffective as well and surgery was recommended. Since the patient feared surgery, he came to the capital (BeiJing) for treatment.

Current symptoms: stabbing epigastric pain most notable when hungry, heat effusion in the back, late afternoon heat in the palms of the hands, occasional worry, palpitations, dizziness, cool body with a fear of cold, sweating and an aversion to wind. There was harmony of the mouth* with no desire to drink and slightly sloppy stools. Tongue coating was white, tongue tip was red and his pulse was thin and wiry. Barium examination revealed a 0.4cm2 postbulbar duodenal ulcer.
Dr. Hu prescribed Xiao Jian Zhong Tang (Minor construct the centre decoction)

Gui Zhi 3 qian
Bai Shao 6 qian
Sheng Jiang 3 qian
Da Zao 4 pieces
Zhi Gan Cao 2 qian
Yi Tang ½ liang (mixed into prepared decoction)

Second consultation (12.3.1965): The pain and heat in the palms had slightly decreased but overall the epigastric stabbing pain, heat in the back and daily bowel movements were still present. The following medicinals were added to the above formula;

Chao Wu Ling Zhi 2 qian
Yuan Hu Fen 5 fen (mixed into decoction)

Third consultation (12.9.1965): The epigastric pain is no longer as obvious, but after eating the patient is experiencing focal distension below the heart. In addition, his four limbs are cold and he is unable to sleep peacefully at night. At this point the patient had to return to his hometown in Dong Bei. The formula was changed to Fu Ling Yin and sent home with him where he was to take it and until recovery. The formula ingredients were as follows:

Fu Ling 5 qian
Dang Shen 3 qian
Zhi Ke 3 qian
Cang zhu 3 qian
Sheng Jiang 3 qian
Chen Pi 1 liang
Ban Xia 4 qian

Commentary: In this case the patient presented with sweating, an aversion to wind, dizziness and heart palpitations which can signify pathogens in the exterior, specifically an exterior vacuity pattern. Therefore Xiao Jian Zhong Tang was administered. After taking three packages of the formula there was already a significant effect and after nine packages, the symptoms were basically resolved. Xiao Jian Zhong Tang is essentially Gui Zhi Jia Shao Yao Tang with the addition of Yi Tang. Gui Zhi Jia Shao Yao Tang is originally a formula used to treat abdominal pain. With the addition of a large dose of sweet, warm, vacuity supplementing, spasm moderating Yi Tang we have the dual action of both treating abdominal pain and supplementing vacuity, hence the name ‘Construct the centre’.

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions.

July 12, 2010

Zhu Ren-Kang- Collection of clinical experience in dermatology (朱仁康-临床经验集-皮肤外科)

Eczema-Case #2
Tian, male, 24 years old presented on March 13, 1967.

Chief complaint: Patient has suffered with a pruritic erythematous papular eruption covering his whole body for the last month.

Disease history: Last month the patient initially noticed small red papular eruptions over his limbs and torso that when scratched exuded fluid. Currently the eruptions are generalized over the entire body being more severe over the upper arms and thighs. Several decoctions have been taken as well as injections of sodium hyposulfide all to no avail.

Inspection: Scattered over the entire body were small millet-grain like red papules with exudate, more obvious on the limbs. The papules were quite diffused and symmetrical.
Pulse was moderate and the tongue was normal with a clean coating.

Chinese medical diagnosis:
Millet sore (粟疮)

Western medical diagnosis: Generalized eczema

Pattern: Interior spleen vacuity with enduring accumulation transforming to heat, transmutation and steaming of damp-heat coupled with external wind.

Treatment principle:
Disinhibit dampness and clear heat.

Formula: 4 packages of Long Dan Xie Gan Tang with additions and subtractions were prescribed.

Second Visit (March 17): Patient reported that the condition was basically the same as before with no improvement. The itchiness was still present and his sleep was disturbed. Tongue body was now red with a thin white coat, and his pulse was wiry and thin.
The treatment principle was changed to cool the blood, clear heat, disperse wind and alleviate itching.

Sheng Di 30g
Dan Shen 9g
Chi Shao 9g
Jing Jie 9g
Ren Dong Teng 12g
Ku Shen 9g
Di Fu Zi 9g
Bai Xian Pi 9g
Er Miao Wan 9g
Liu Yi San 9g
4 Packages were administered.

Third visit (March 21): After taking the above formula, the itchiness had decreased considerably and the skin was gradually clearing up. The above formula was repeated with the additions of;
Qian Cao 9g
Chan Yi 6g
Cang Er Zi 9g
5 packages were administered.

Fourth visit (March 26): After taking the above formula, a major portion of his skin had returned to normal and no new lesions were observed. The itchiness was still present in the evenings.
9g of Chi Ling was added to the previous formula and after taking 5 packages the patients’ condition was resolved.