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.