Dr. Hú Xī-Shù (胡希恕) -Chest Pain

On May 28^th, 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 23^rd 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, 1^st): 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 23^rd): 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.