July 30, 2013

Rén Yīng Qiū- A Zhēn Wǔ Tāng (True Warrior Decoction) Case


A thirty-two year old male patient presented with headaches, which occur every evening.  Lately the headaches have been getting quite severe and are only slightly alleviated when he pounds on his head or after taking analgesics. When asked when the headaches started he mentioned that he works as a driver, and last summer when the weather was extremely hot, he would often drink iced soft drinks or beer on his breaks. Initially there was no problem but once the autumn arrived, the headaches began. I asked aside from the headaches, where else he felt discomfort. He mentioned that he also had black spots in his vision, and would get disorientated at times.  His complexion was soot black, his tongue was pale and tender with a wet, slippery coating, and his pulse was deep, wiry, and moderate. This is a pattern of yáng vacuity with water exuberance, and turbid yīn scurrying upwards. When clear yáng is clouded there is dizziness, and when there is struggle between yīn and yáng, this will result in headaches.

Formula:

fù zǐ (Aconiti Radix lateralis preparata) 12g
shēng jiāng (Zingiberis Rhizoma recens) 12g
fú líng (Poria) 18g
bái zhú (Atractylodis macrocephalae Rhizoma) 9g
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
bái sháo (Paeoniae Radix alba) 9g
guì zhī (Cinnamomi Ramulus) 6g

After six packages of the above formula his headaches had decreased substantially. He was then given four packages of líng guì zhú gān tāng (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) to consolidate the treatment, and afterwards his condition completely resolved.

July 23, 2013

Dr. Hú Xī-Shù (胡希恕) -Chest Pain


On May 28th, 1965, a 67 year-old male presented at the clinic suffering from shortness of breath, chest pain, and chest oppression for over a month. On April 23rd he was diagnosed with a myocardial infarction, and was administered both nitroglycerine and aminophylline, which were ineffective. He also sought out Chinese medical treatments and was given various qi boosting, blood invigorating, phlegm transforming, and collateral freeing medicinals (such as rén shēn, huáng qí, mù guā, chì sháo, jiàng xiāng, táo rén, xiè bái, and yù jīn), which he had been taking for the last month but no obvious improvement was observed.  Currently he was experiencing a burning hot pain in the left side of his chest, shortness of breath, which was exacerbated with movement, he was occasionally cold and hot, had a stifling sensation below his heart, a bitter taste in the mouth, occasional head distention, insomnia, and dry stools. He had a yellow tongue coating, and a wiry, slippery pulse.  

Dr. Hú administered a modified version of dà chái hú tāng (Major Bupleurum Decoction) combined with guì zhī fú líng wán (Cinnamon and Poria Pill).

chái hú (Bupleuri Radix) 4 qián
bàn xià (Pinelliae Rhizoma preparatum) 3 qián
huáng qín (Scutellariae Radix) 3 qián
bái sháo (Paeoniae Radix alba) 3 qián
zhǐ shí (Aurantii Fructus immaturus) 3 qián
shēng jiāng (Zingiberis Rhizoma recens) 3 qián
dà zǎo (Jujubae Fructus) 4 pieces
guì zhī (Cinnamomi Ramulus) 3 qián
fú líng (Poria) 4 qián
táo rén (Juglandis Semen) 3 qián
dà huáng (Rhei Radix et Rhizoma) 2 qián
shí gāo (Gypsum fibrosum) 1 liǎng
zhì gān cǎo (Glycyrrhizae Radix preparata) 1 qián

Second consultation (June, 1st): After taking three packages of the formula most of his symptoms had improved, but he was still feeling suffocated in the evenings, had heartburn after meals, and his stools were still dry. His tongue coat was still yellow, and his pulse was wiry, slippery, and slightly rapid.  The same formula was administered but the dà huáng was increased to 3 qián.

Third consultation (December 23rd): After taking two packages of the formula, the suffocating feeling in the evenings disappeared, and while he still experienced some shortness of breath on exertion, it would gradually resolve after a little bit of rest. Afterwards he did not return for a follow up.  He was currently being treated for a weeklong cough with a modified version of bàn xià hòu pò tāng (Pinellia and Magnolia Bark Decoction).

Commentary:  In regards to the treatment of this case, the previous physicians had used blood invigorating, qi regulating medicinals, however they all failed to provide any relief for the patient, while Dr. Hú was able to offer a good effect by grasping the crucial aspect of the condition.  The previous physician paid little attention to whether the condition involved heat, cold, repletion, or vacuity, while Dr. Hú recognized this to be a repletion heat pattern stuck in the half exterior half interior portion of the body.  In addition, he recognized this as a dà chái hú tāng and guì zhī fú líng wán formula presentation, which is the reason why his treatment worked so well.