Chinese Medicine Book Club Issue 3214
Daily updates to accompany the growth of TCM practitioners
IIntroduction：This case involves an elderly patient, who has experienced right hypochondriac distension and pain for over two months. The initial diagnosis showed no significant effect, but during the second diagnosis, the formula Chai Hu Shu Gan San (Bupleurum Powder to Spread the Liver) was used, with a total of 13g, taken as a powder, in a very small amount, yet only two to three doses resulted in noticeable improvement.
—This article is approximately1600 words long, expected reading time4 minutes—
Four Taels Move a Thousand Pounds, A Change Within Change — A Small Dose Powder Cures Hypochondriac Pain CaseAuthor/Xing Bin
Every time I read the works of renowned doctors, I often admire their courage. In critical situations, using strong and heavy doses to turn the tide is indeed something ordinary practitioners dare not do. If one uses common medications and standard doses as a norm, this certainly belongs to the realm of change. However, within change, there are both constants and variations.
The use of strong and heavy doses can be considered a constant within change; while using light doses to treat difficult diseases, achieving significant results, is considered a variation within change. The representative figure in this regard must be the late master from Shanxi, Li Hanqing. He used extremely small doses (often in the range of a few grams) of Zhen Wu Tang (True Warrior Decoction) to treat severe heart failure, a feat rarely seen throughout history, which left me in awe.
However, the variation within change, while brilliant, is extremely difficult to learn. Many people do not believe it, thinking it is child’s play; or they are half-convinced but dare not use it, because treating diseases with such small doses requires the same courage as using extremely large doses, and it absolutely requires confidence; even if one humbly accepts and wants to learn, it is not an easy task. After Li, his disciple Zhu Jinzong inherited his unique skills and also became a great figure, yet after Zhu’s passing, I have not heard of any successors.
Although both masters have written works, and the latter has written extensively, I have read their books for over twenty years, often taking them out to review, always wanting to learn, yet I often find it difficult to grasp. One reason is that writing is not easy; it is challenging to clarify the doubts in the reader’s mind proactively, and such books are extremely rare. Another reason is that the diseases we encounter today have changed from those in the past, and I rarely encounter the types of diseases described in the works of Li and Zhu.
Nevertheless, the concept that extremely small doses of medication can treat diseases, even difficult and critical conditions, has already taken root in my mind, and whenever there is an opportunity, it will be triggered.
The following case occurred earlier this year. An elderly lady, initially treated without effect, suddenly grasped Li’s philosophy during the second diagnosis and changed her approach, achieving significant results.
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Case Record
L, female, 85 years old.
1. Initial Diagnosis on January 8, 2022
Main Complaint: Right hypochondriac distension and pain for over two months.
Medical History:
The patient was treated at another hospital over two months ago for fatigue, taking tonifying Chinese herbs. Although fatigue improved, right hypochondriac distension and pain appeared, sometimes accompanied by back pain, occurring every afternoon and alleviating only before sleep, with a sensation of qi not flowing smoothly.
Previous examinations showed MRI indicating lumbar disc herniation; chest X-ray: increased lung markings, enlarged heart shadow; ultrasound: fatty liver, rough gallbladder wall; thyroid function normal.
Her voice was low, mood was fair, mouth was not dry, and she did not want to drink water. She had taken Chinese medicine for several weeks without significant effect. Tongue was pale red, with thin white coating, slippery, pulse was choppy.
Prescription: Fu Ling (Poria) 20g, Zhu Ling (Polyporus) 20g, Bai Zhu (White Atractylodes) 20g, Ze Xie (Alisma) 8g, Rou Gui (Cinnamon) 6g (added later), Chai Hu (Bupleurum) 9g, Chao Bai Shao (Fried White Peony) 9g, Zhi Ke (Bitter Orange) 9g, Gan Cao (Licorice) 6g, Dang Shen (Codonopsis) 30g, Ge Jie (Gecko) 2g, 7 doses, decocted in water.
2. Second Diagnosis on January 15, 2022
Symptoms as before, tongue pale red, thin white coating, pulse choppy.
Prescription: Chai Hu 2g, Zhi Ke 2g, Chao Bai Shao 2g, Gan Cao 1g, Xiang Fu (Cyperus) 2g, Chuan Xiong (Ligusticum) 2g, Dang Shen 2g, 7 doses, taken as powder.
3. Third Diagnosis on January 22, 2022
After taking the medicine for two to three days, the right hypochondriac distension and pain significantly reduced, and her voice became louder. Additional medical history: The patient had difficulty walking for three to four years, shortness of breath for one to two years, and often experienced lower back soreness. Recently, her stools have been somewhat dry. Tongue was pale red, thin white coating, pulse choppy.
Prescription: Same as the second diagnosis, adding Ge Jie 2g, Dang Gui (Angelica) 2g, 7 doses, taken as powder.
4. Fourth Diagnosis on January 29, 2022
The right hypochondriac distension and pain, as well as back pain, had basically disappeared.
The patient returned in June 2022 after recovering from another condition, reporting that the right hypochondriac distension and back pain had not recurred since January.
Commentary:
The patient took tonifying herbs due to fatigue; although fatigue improved, the right hypochondriac distension and pain appeared, along with a sensation of qi not flowing smoothly, likely due to excessive tonification, which obstructed the flow of qi.
The initial diagnosis used Wu Ling San (Five Ingredient Powder) combined with Si Ni San (Frigid Extremities Powder) with no significant effect. During the second diagnosis, reflecting on the patient’s advanced age, on one hand, there was qi deficiency, and on the other hand, qi stagnation; tonifying could not obstruct, and dispersing could not break through, making it a challenge to use medication appropriately.
Both masters Li Hanqing and Zhu Jinzong have cases and discussions on using extremely small doses of medication to treat difficult diseases with excellent results. Inspired by this, I used Chai Hu Shu Gan San, removed Chen Pi (Aged Tangerine Peel), added Dang Shen, with a total of 13g, taken as powder, in a very small amount, unexpectedly achieving remarkable results, with only two to three doses leading to improvement, continuing treatment until recovery, and no recurrence.
Reading should not be done without seeking understanding; Tao Yuanming said this, and I believe it is inherently incorrect. Reading should indeed seek understanding, but due to various reasons, if one cannot seek understanding at the moment, it can only be buried in the heart, without needing to worry about it daily, but after a period, it is also necessary to let it surface, waiting for time and experience to ferment, perhaps one day there will be an insight.
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Today, I learned from Japanese scholars: such small doses have cured allergic rhinitis.
Only 0.5 grams, can such a small dose treat diseases?
—Copyright Statement—
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This article is a commissioned piece丨Author/Xing Bin丨Editor/Qian Cheng
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This article is copyrighted by the rights holder. For learning and exchange purposes only, please do not use medications indiscriminately.
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