Achieving Remarkable Results with Minimal Dosage — A Case of Small Doses of Powdered Medicine Treating Costal PainAuthor/Xing Bin
Every time I read the medical texts of renowned practitioners, I am often in awe of their courage. In critical situations, using potent and heavy dosages to turn the tide is indeed something that ordinary practitioners dare not attempt. If one relies on common medications and standard dosages, this certainly belongs to the realm of conventional methods. However, within the realm of change, there exists both the constant and the variable.
The use of potent and heavy dosages can be considered a constant within change; whereas using light dosages to treat difficult diseases and significant symptoms is regarded as a variable within change. A representative figure in this regard is the late master from Shanxi, Li Hanqing. He used extremely small dosages (often in the range of a few grams) of Zhen Wu Decoction to treat severe heart failure, a feat that seems unprecedented throughout history, leaving me in deep admiration.
However, the variable within the variable, while ingenious, is extremely difficult to learn. Many people are skeptical, thinking it is child’s play; or they are half-convinced but dare not use it, as treating diseases with such small dosages requires the same courage as using excessively large dosages, and it absolutely requires confidence. Even if one humbly wishes to learn, it is not an easy task. After Li, his disciple Zhu Jinzong inherited his unique skills and also became a prominent figure, yet after Zhu’s passing, I have not heard of any successors.
Although both Li and Zhu have written works, and the latter has many publications, I have read their books for over twenty years, often taking them out to review, always hoping to learn, yet I often find it difficult to grasp. One reason is that writing is not easy; it is challenging to clearly articulate the doubts in the reader’s mind, and such books are rare. Secondly, the diseases we encounter today have changed compared to 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 dosages of medicine can treat diseases, even difficult and critical conditions, has already taken root in my heart, and whenever there is an opportunity, it will be triggered.
The following medical case occurred earlier this year. An elderly lady, after initial treatment with no effect, suddenly grasped Li’s philosophy during her second consultation and changed her approach, achieving significant results.
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Medical Case Record
Patient L, female, 85 years old.
1. Initial Consultation on January 8, 2022
Chief Complaint: Right costal distension and pain for over 2 months.
Medical History:
The patient was treated at another hospital over two months ago for fatigue, taking tonifying Chinese herbs. Although her fatigue improved, she developed right costal distension and pain, sometimes accompanied by back pain, which began to appear every afternoon and relieved only before sleep, with a sensation of qi stagnation.
An MRI showed lumbar disc herniation; chest X-ray: bilateral lung markings thickened, enlarged cardiac silhouette; ultrasound: fatty liver, rough gallbladder wall; thyroid function normal.
She spoke softly, was in fair spirits, had a dry mouth, and did not want to drink water. She had taken Chinese medicine for several weeks with no significant effect. The tongue was pale red, with a thin white coating, slippery, and the pulse was choppy.
Prescription: Poria (Fu Ling) 20g, Polyporus (Zhu Ling) 20g, Atractylodes (Bai Zhu) 20g, Alisma (Ze Xie) 8g, Cinnamon (Rou Gui, added later) 6g, Bupleurum (Chai Hu) 9g, Fried White Peony (Bai Shao) 9g, Bitter Orange (Zhi Ke) 9g, Licorice (Gan Cao) 6g, Codonopsis (Dang Shen) 30g, Gecko (Ge Jie) 2g, 7 doses, decocted in water for oral administration.
2. Second Consultation on January 15, 2022
The symptoms remained the same, tongue pale red, thin white coating, pulse choppy.
Prescription: Bupleurum 2g, Bitter Orange 2g, Fried White Peony 2g, Licorice 1g, Cyperus (Xiang Fu) 2g, Chuanxiong (Chuan Xiong) 2g, Codonopsis 2g, 7 doses, powdered for oral administration.
3. Third Consultation on January 22, 2022
After taking the medicine for two to three days, the right costal 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 had been somewhat dry. The tongue was pale red, with a thin white coating, and the pulse was choppy.
Prescription: Maintain the second consultation formula, adding Gecko 2g and Angelica (Dang Gui) 2g, 7 doses, powdered for oral administration.
4. Fourth Consultation on January 29, 2022
The right costal distension and back pain had basically disappeared.
In June 2022, after recovering from a mental breakdown, the patient returned seeking treatment for other conditions, reporting that the right costal distension and back pain had not recurred since January.
Commentary:
The patient developed right costal distension and pain after taking tonifying herbs for fatigue, which improved her fatigue but caused a sensation of qi stagnation, likely due to excessive tonification obstructing the flow of qi.
The initial prescription of Wu Ling San combined with Si Ni San had no significant effect. During the second consultation, 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. How to use the medicine appropriately was a challenge.
Both masters Li Hanqing and Zhu Jinzong have cases and discussions on treating difficult diseases with extremely small dosages of medicine with remarkable effects. Inspired by them, I used Chai Hu Shu Gan San, removed Chen Pi, and added Dang Shen, the entire formula weighed 13g, powdered and taken orally, with minimal dosage, unexpectedly achieving remarkable results, with just two to three doses showing effect, continuing treatment until recovery, and no recurrence.
Reading without seeking deep understanding, Tao Yuanming said this, and I believe this is inherently incorrect. Reading should indeed seek understanding; however, due to various reasons, if one cannot seek understanding at the moment, it can only be buried in the heart, without needing to think about it every day. But after a period, it is also necessary to surface, waiting for time and experience to ferment, perhaps one day there will be an insight.
This article is adapted from “Reading, Writing, and Clinical Reflection,” by Xing Bin. If there is any infringement, please contact us for deletion.
Can 0.5g of Aconite, Asarum, Sichuan Pepper, Dried Ginger, and Cinnamon treat diseases?
Author/Xing Bin
Two months ago, I had a case of burning palms and soles for thirty years. Would I dare to use Aconite? This was reprinted for the “Chinese Medicine Book Friends Association,” and at that time, a reader commented, asking if using only 3g of Aconite in the case could be effective?
In fact, in recent years, I have used very small dosages of Aconite in certain situations, often using 3g, and even only 0.5g, yet achieving excellent results, with many cases to share. Previous cases need to be organized gradually. Let me present two recent examples.
In both cases, I used Wu Mei Wan to treat a specific state of poor sleep and disharmony of cold and heat.
The second case not only used Aconite at only 0.5g, but also the dosages of Asarum, Sichuan Pepper, Dried Ginger, Cinnamon, Huang Lian, and Huang Bai were also extremely small.
Case 1
Z, male, 37 years old. Initial consultation on November 7, 2017.
Chief Complaint: Insomnia for 3 years.
Medical History: Difficulty falling asleep, shallow sleep, initially feeling hot and sweating, gradually feeling cold, becoming colder by morning, and feeling cold during the day. Generally fatigued, irritable, with halitosis, sticky mouth, belching, normal appetite, prone to cough, and sweating in hands. Bowel movements mostly normal but prone to diarrhea when cold. Pale complexion, tongue swollen and purple with teeth marks, yellow-white greasy coating, cracks, and slippery pulse.
Prescription: Bupleurum 9g, Huang Qin 9g, Ginger (Sheng Jiang) 9g, Codonopsis 30g, Licorice 6g, Fresh Ginger 9g, Poria 20g, Polyporus 20g, Alisma 12g, Atractylodes 20g, Cinnamon 3g (added later), Asarum 3g, Huang Lian 3g, Sichuan Pepper 2g, Dried Ginger 2g, Wu Mei 6g, Huang Bai 9g, Angelica 6g, Aconite 3g, and Sun Dried Ginseng Powder 6g (swallowed), 10 doses.
On November 21, 2017, during the second consultation: Sleep improved, the initial symptoms of heat followed by cold significantly improved, and sweating had ceased. Tongue and pulse as before.
Prescription: Maintain the initial prescription, remove Aconite, change Ginger (Sheng Jiang) to 20g, Huang Lian to 2g, and add Acorus (Shi Chang Pu) 30g, 10 doses.
On December 3, 2017, during the third consultation: Sleep further improved, the symptoms of heat followed by cold had resolved. Halitosis resolved, and there was yellow phlegm in the morning. Complexion improved, tongue and pulse as before.
Prescription: Maintain the initial prescription, remove Sichuan Pepper and Aconite, change Ginger (Sheng Jiang) to 20g, Huang Lian to 2g, Huang Bai to 6g, Angelica to 3g, and add Acorus (Shi Chang Pu) 30g, Winter Melon Seeds 30g, Job’s Tears 30g, and Dipsacus 20g, 7 doses.
On January 21, 2018, during the fifth consultation: Recently, due to busy work and frequent business trips, I was unable to return for a timely consultation, and fatigue and worry caused insomnia, but the symptoms of heat followed by cold during sleep did not occur. Tongue swollen and purple with teeth marks, thin white greasy coating, cracks, and slippery pulse.
Prescription: Maintain the initial prescription, remove Asarum, Huang Lian, Dried Ginger, Sichuan Pepper, Huang Bai, Angelica, and Aconite, change Ginger (Sheng Jiang) to 25g, and add Acorus (Shi Chang Pu) 30g, Atractylodes 20g, Bai Zi Ren 40g, Suan Zao Ren 50g, Eucommia 30g, and Dipsacus 30g, 14 doses.
Case 2
W, male, 45 years old. Initial consultation on February 25, 2018.
Chief Complaint: Cold and heat disharmony during sleep for one week.
Medical History: Recently, due to busy work and high stress, feeling fatigued. In the past week, initially feeling just right when falling asleep, but waking up cold around 2 AM, feeling hot again after covering with a blanket, but without sweating. Bowel movements and appetite were acceptable. Tongue purple, thin white coating, teeth marks, and pulse wiry.
Prescription: Wu Mei 6g, Asarum 0.5g, Cinnamon 0.5g (added later), Huang Lian 1g, Huang Bai 1g, Angelica 3g, Codonopsis 12g, Sichuan Pepper 0.5g, Dried Ginger 0.5g, Aconite 0.5g, Sun Dried Ginseng Powder 6g (swallowed), 7 doses.
On March 11, 2018, I was informed: After taking 3 doses, the symptoms disappeared, and energy improved.
Commentary: The first case had a more complex symptomatology, with liver stagnation and spleen deficiency, internal dampness, and disharmony of yin and yang, using Xiao Chai Hu Decoction, Wu Mei Wan, and Wu Ling San with modifications, without using any sedative or symptomatic medications, the initial consultation was effective due to the underlying pathology. However, the patient was starting a business, was very busy, and overly worried, and after stopping the medication at the end of 2017, insomnia gradually recurred, but the symptoms of heat followed by cold during sleep did not occur.
The second case had relatively simple and mild symptoms, thus I used Wu Mei Wan in its original form, with Aconite, Dried Ginger, Sichuan Pepper, Asarum, and Cinnamon only at 0.5g, Huang Lian and Huang Bai only at 1g, and after taking 3 doses, the symptoms of cold and heat disharmony during sleep were eliminated. In fact, patients with cold and heat disharmony during sleep are not uncommon; readers should pay attention to this in clinical practice.
The dosage of clinical medications should be based on the actual condition of the patient, using more when necessary and less when appropriate, without being rigid. I have used Aconite in dosages as high as one or two hundred grams, but as low as only 0.5g, using Astragalus as much as 200g, Ban Xia as much as 120g, Atractylodes as much as 60g, Ma Huang as much as 30g, and Gui Zhi as much as 30g…
Achieving Remarkable Results with Minimal Dosage | Adding One More Herb to the Prescription Greatly Enhances Efficacy
Leeches are a powerful medicine for breaking blood stasis and dispelling stagnation. I selectively use them in clinical practice, often achieving unexpectedly rapid effects, as introduced below: Example 1: Bi Syndrome G, female, 38 years old, had swelling and pain in finger joints for over a year. Treated by both Chinese and Western medicine with no significant effect. Initial diagnosis: swelling and pain in both sides of finger joints, difficulty in flexion and extension, pain worsened with cold water stimulation or at night. Blood sedimentation 20mm/h, anti-“0” <250u, rheumatoid factor negative. Tongue pale red, slightly greasy white coating, pulse deep and slow. Diagnosis: cold dampness obstructing blood stasis. Used Juan Bi Decoction with modifications: 20g each of Jiang Huo and Du Huo, 12g each of Jiang Huang, Angelica, Red Peony, Fang Feng, and Cinnamon, 7g of prepared Chuan Wu, and 5g of Licorice. Five doses, decocted in water for one dose per day. After taking the medicine, the pain in the finger joints slightly reduced, but the swelling remained the same. During the follow-up, I added 8g of leeches to the original prescription and continued for five more doses. During the third consultation, the patient reported significant reduction in swelling and pain in the finger joints. Continued with the original prescription for ten more doses, and after several months, the stubborn bi syndrome was cured. Follow-up in winter showed no recurrence with exposure to cold water. Commentary: Although the initial diagnosis was accurate, the condition was stubborn, and the prescription lacked sufficient strength. Adding leeches to the original prescription greatly enhanced the efficacy. The pathology of bi syndrome, whether due to wind, cold, or dampness, fundamentally involves obstruction of qi and blood flow. As the saying goes, “Bi means obstruction.” Activating blood is the foundational treatment for this condition. It is precisely on the basis of activating blood that the pathogenic factors of wind, cold, and dampness can be more easily eliminated.
Example 2: Lower Limb Erysipelas H, male, 35 years old, had recurrent redness and swelling in the left calf for over six months. Each episode was accompanied by fever, and the condition was acute, easily spreading to the thigh. Previously treated with antibiotics during episodes, but after controlling the condition, it easily recurred, causing great distress to the patient. This time, after one day of onset, symptoms included significant redness and pain in the left calf above the ankle, T38.9°C, swollen and painful left inguinal lymph nodes, accompanied by dry mouth and bitterness, dark red tongue with thin yellow coating, and choppy rapid pulse. Diagnosed as lower limb erysipelas. Diagnosis: damp-heat descending, blood stasis and heat obstruction. Treatment aimed at detoxifying, promoting dampness, cooling blood, and dispersing stasis. Prescription: 4g of leeches, 30g of Hu Zhang, 15g each of Red Vine, Dandelion, Purple Ground Beet, and Huang Bai, 12g of Honeysuckle, and 10g each of Atractylodes and Dan Pi. Five doses, decocted in water for one dose per day. During follow-up, significant reduction in redness and swelling of the left calf, pain alleviated, fever subsided, and the left inguinal lymph nodes had resolved, with the tongue turning pale red. The medicine was effective, and the original prescription was continued for half a month. Several months later, follow-up showed no recurrence. Commentary: Erysipelas of the lower limb is an acute infectious pain of the lymphatic vessels, characterized by rapid onset and recurrent episodes. Traditional treatment primarily focuses on clearing heat, promoting dampness, and detoxifying. In this case, I also adopted traditional treatment principles, adding small doses of leeches to leverage their unique ability to break stasis and open the vessels, achieving enhanced efficacy, reducing recurrence, and ultimately curing the condition.
Example 3: Pelvic Inflammatory Disease D, female, 25 years old, had dull pain in the lower abdomen for one and a half years. Diagnosed with chronic pelvic inflammatory disease by Western gynecology, she had not seen improvement after Western treatment, so she came to consult me. Symptoms included lower abdominal pain, tenderness (+), especially pronounced tenderness in the left lower abdomen; pain worsened during menstruation, accompanied by lumbar and sacral discomfort, delayed menstruation, scanty menstrual flow, and dark menstrual blood with clots. Pale yellow complexion, fatigue, dark tongue with thin white coating, and wiry thin pulse. Gynecological examination: vagina patent; increased white discharge; smooth cervix, normal uterine body; left adnexa enlarged, soft, with tenderness (++). Ultrasound showed enlarged left adnexa and a small amount of pelvic fluid. Diagnosis: invasion of external pathogens, stasis accumulation in the uterus. Treatment plan: activating blood, dispelling stasis, warming the uterus, promoting qi, and alleviating pain. Prescription: 12g of leeches, 20g each of Angelica and Wu Yao, 10g each of Peach Kernel, Red Flower, Red Peony, and Cyperus, 30g of Red Vine, 6g of Wu Yao, and 25g of Motherwort. Seven doses, decocted in water for one dose per day. During follow-up, the patient reported reduced lower abdominal pain and significant improvement in energy. The medicine was effective, and the original prescription was continued. After one month, all symptoms disappeared, and during gynecological and ultrasound examinations, the enlarged left adnexa and pelvic fluid had completely resolved, indicating full recovery. Commentary: Chronic pelvic inflammatory disease often results from inadequate treatment during the acute phase, leading to chronicity. Prolonged illness leads to deficiency and cold, with cold invading the uterus, causing blood stagnation. Therefore, in this case, I heavily relied on leeches as the main herb, which not only activated blood and dispelled stasis but also aimed to warm the uterus and eliminate the cold pathology.
Disclaimer: This article is reprinted from the internet and published materials. If there is any infringement, please contact us for deletion. The various prescriptions and remedies mentioned are for informational sharing only and do not constitute medical advice, recommendations, or guidance. Please use them under the guidance of a physician.
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