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Using Small Doses to Achieve Great Effects — A Case Study of Treating Costal PainAuthor/Xing Bin
Every time I read the medical records of renowned practitioners, I am often impressed by their courage. In critical situations, using strong and heavy doses to turn the tide is indeed something that ordinary practitioners dare not do. If one relies on common medications and standard dosages, this certainly belongs to the realm of reform. However, within reform, there are both constants and changes.
The use of strong and heavy doses can be considered a constant within change; while using light doses to treat difficult diseases is a change 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 tenths of grams) of Zhen Wu Decoction to treat severe heart failure, which has rarely been seen throughout history, leaving me in awe.
However, the change within change, while marvelous, 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 excessively 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 master, but after Zhu’s passing, I have not heard of any successors.
Although both Li and Zhu have written works, and the latter has many writings, 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 it is not easy to articulate the doubts in the reader’s mind clearly; such books are extremely rare. Secondly, the diseases we encounter now have changed from those in the past, and I rarely encounter the diseases described in the works of Li and Zhu.
Nevertheless, the concept that extremely small doses of medicine can treat diseases, even difficult and critical illnesses, 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, initially diagnosed with ineffective treatment, suddenly grasped Li’s thoughts during the 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
Main 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 medicine. Although the fatigue improved, she developed right costal distension and pain, sometimes accompanied by back pain, which appeared every afternoon and relieved only before sleep, with a sensation of qi stagnation.
An MRI showed lumbar disc herniation; chest X-ray: increased lung markings, enlarged heart shadow; ultrasound: fatty liver, rough gallbladder wall; thyroid function was 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: 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 Qiao (Bitter Orange) 9g, Gan Cao (Licorice) 6g, Dang Shen (Codonopsis) 30g, Ge Jie (Gecko) 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: Chai Hu 2g, Zhi Qiao 2g, Chao Bai Shao 2g, Gan Cao 1g, Xiang Fu (Cyperus) 2g, Chuan Xiong (Ligusticum) 2g, Dang Shen 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. Search for Xing Zhi Yi Hua on WeChat for 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, pulse choppy.
Prescription: Maintain the second consultation formula, add Ge Jie 2g, Dang Gui (Angelica) 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 for treatment of other ailments, reporting that the right costal distension and back pain had not recurred since January.
Commentary:
The patient took tonifying medicines due to fatigue; although the fatigue improved, she developed right costal distension and pain, along with a sensation of qi stagnation, likely due to excessive tonification, which obstructed the flow of qi.
The initial prescription of Wu Ling San (Five-Ingredient Powder) combined with Si Ni San (Frigid Extremities Powder) 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 Mr. Li Hanqing and Mr. Zhu Jinzong have cases and discussions on using extremely small doses of medicine to treat difficult diseases with good results. Inspired by them, I used Xiao Chai Hu Tang (Minor Bupleurum Decoction), removed Chen Pi (Aged Tangerine Peel), added Dang Shen, the total formula was 13g, powdered, and taken orally; the amount was very small, yet unexpectedly, it could achieve great effects, with just two to three doses showing results, continuing treatment led to recovery, and there was 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 think about it every day. However, 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.
This article is adapted from Reading, Writing, and Clinical Reflection, by Xing Bin. If there is any infringement, please contact for removal.
Can 0.5g of Fu Zi (Aconite), Xi Xin (Asarum), Hua Jiao (Sichuan Pepper), Gan Jiang (Dried Ginger), and Rou Gui (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 Fu Zi? For the “Chinese Medicine Book Friends Association” WeChat public account, a reader commented that in the case, only 3g of Fu Zi was used; can it be effective?
In fact, in recent years, I have used small doses of Fu Zi in certain situations; 3g is often used, and sometimes only 0.5g, yet I have achieved excellent results, with many cases to share. Previous cases need to be organized slowly. Let me present two recent ones.
In both cases, I used Wu Mei Wan (Mume Pill), treating a specific state of poor sleep and disharmony of cold and heat.
The second case not only used 0.5g of Fu Zi, but also the doses of Xi Xin, Hua Jiao, Gan Jiang, Rou Gui, Huang Lian (Coptis), Huang Bai (Phellodendron), etc., were also extremely small.
Case 1
Z, male, 37 years old. Initial consultation on November 7, 2017.
Main complaint: Insomnia for 3 years.
Medical history: Difficulty falling asleep, shallow sleep, initially feeling hot when falling asleep, sweating, gradually feeling cold, becoming colder by morning, and feeling cold during the day. Generally fatigued, irritable, with bad breath, sticky mouth, belching, normal appetite, prone to cough, and sweating in hands. Most bowel movements are normal, but prone to cold-induced diarrhea. The complexion is dull, tongue is swollen and purple with teeth marks, yellow-white greasy coating, cracks, pulse is wiry and slippery.
Prescription: Chai Hu 9g, Huang Qin (Scutellaria) 9g, Gan Ban Xia (Pinellia) 9g, Dang Shen 30g, Gan Cao 6g, Sheng Jiang (Fresh Ginger) 9g, Fu Ling 20g, Zhu Ling 20g, Ze Xie 12g, Bai Zhu 20g, Rou Gui 3g (added later), Xi Xin 3g, Huang Lian 3g, Hua Jiao 2g, Gan Jiang 2g, Wu Mei 6g, Huang Bai 9g, Dang Gui 6g, Fu Zi 3g, Sheng Bai Ren Shen (Fresh 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. The tongue and pulse remained the same.
Prescription: Maintain the initial prescription, remove Fu Zi, change Gan Ban Xia to 20g, Huang Lian to 2g, add Shi Chang Pu (Acorus) 30g, 10 doses.
On December 3, 2017, during the third consultation: Sleep further improved, the symptoms of heat followed by cold had resolved. Bad breath was gone, and there was yellow phlegm in the morning. The complexion was better, tongue and pulse remained the same.
Prescription: Maintain the initial prescription, remove Hua Jiao, Fu Zi, change Gan Ban Xia to 20g, Huang Lian to 2g, Huang Bai to 6g, Dang Gui to 3g, add Shi Chang Pu 30g, Dong Gua Zi (Winter Melon Seed) 30g, Sheng Yi Yi Ren (Job’s Tears) 30g, Guo Sui Bu (Drynaria) 15g, Bu Guo Zhi (Psoralea) 15g, 7 doses.
On January 21, 2018, during the fifth consultation: Recently, due to busy work and frequent business trips, I could not return for a timely follow-up, and fatigue and worry caused insomnia again, but the symptoms of heat followed by cold did not occur. The tongue was swollen and purple with teeth marks, thin white greasy coating, cracks, pulse was wiry and slippery.
Prescription: Maintain the initial prescription, remove Xi Xin, Huang Lian, Gan Jiang, Hua Jiao, Huang Bai, Dang Gui, Fu Zi, change Gan Ban Xia to 25g, add Shi Chang Pu 30g, Cang Zhu (Atractylodes) 20g, Bai Zi Ren (Platycladus) 40g, Suan Zao Ren (Sour Jujube Seed) 50g, Du Zhong (Eucommia) 30g, Xu Duan (Dipsacus) 30g, 14 doses.
Case 2
W, male, 45 years old. Initial consultation on February 25, 2018.
Main complaint: Cold and heat disharmony while sleeping for a week.
Medical history: Recently, due to busy work, stress, and fatigue. In the past week, when falling asleep, the temperature felt just right, but woke up around 2 AM feeling cold, and after covering with a blanket, gradually felt hot, but without sweating. Bowel movements and appetite were acceptable. The tongue was purple, thin white coating, teeth marks, pulse was wiry.
Prescription: Wu Mei 6g, Xi Xin 0.5g, Rou Gui 0.5g (added later), Huang Lian 1g, Huang Bai 1g, Dang Gui 3g, Dang Shen 12g, Chuan Jiao 0.5g, Gan Jiang 0.5g, Fu Zi 0.5g, Sheng Bai Ren Shen 6g (swallowed), 7 doses.
On March 11, 2018, I was informed: After taking 3 doses, the symptoms disappeared, and energy improved.
Commentary: Search for Xing Zhi Yi Hua on WeChat In the first case, the patient’s symptoms were relatively complex, with liver stagnation and spleen deficiency, internal dampness, and disharmony of yin and yang, using Xiao Chai Hu Tang, Wu Mei Wan, and Wu Ling San with modifications, without using any sedative or symptomatic medications, due to the pathogenesis in the medicine, it was effective from the initial consultation. However, the patient was starting a business, was very busy, and worried too much, and after stopping the medication at the end of 2017, insomnia gradually recurred, but the symptoms of heat followed by cold did not occur.
The second case had relatively simple and mild symptoms, so I used the original formula of Wu Mei Wan, with Fu Zi, Gan Jiang, Chuan Jiao, Xi Xin, and Rou Gui only at 0.5g, Huang Lian and Huang Bai only at 1g, and after taking 3 doses, the symptoms of cold and heat disharmony while sleeping 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 situation of the patient; when more is needed, use more; when less is needed, use less; do not be rigid. I have used Fu Zi, with the maximum being one or two hundred grams, but as little as only 0.5g; I have used Huang Qi (Astragalus) up to 200g, Ban Xia (Pinellia) up to 120g, Cang Zhu (Atractylodes) up to 60g, Ma Huang (Ephedra) up to 30g, Gui Zhi (Cinnamon Twig) up to 30g…
Using Small Doses to Achieve Great Effects | Adding One More Ingredient to the Prescription Greatly Increases Efficacy
Leeches are a powerful medicine for breaking blood stasis. I selectively use them in clinical practice, often achieving unexpected quick effects, as introduced below: Example 1: Bi Zheng (Bi Syndrome) Gong, 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. Current diagnosis: swelling and pain in both finger joints, difficulty bending and extending, 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: Jiang Huo (Fresh Ginger) and Du Huo (Angelica) each 20g, Jiang Huang (Turmeric), Dang Gui, Chi Shao (Red Peony), Fang Feng (Siler), Gui Zhi each 12g, Zhi Chuan Wu 7g, Gan Cao 5g. 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 took five more doses. During the third consultation, the patient reported that the swelling and pain in the finger joints had significantly reduced. Continued with the original prescription for ten more doses, and after several months, the stubborn bi syndrome was cured. During follow-up, there was no recurrence even in the cold winter with cold water. Commentary: Although the initial diagnosis was accurate, the condition was stubborn, and the prescription was insufficiently potent. Adding leeches to the original prescription greatly improved the efficacy. The pathology of bi syndrome, whether due to wind, cold, or dampness, is fundamentally due to the obstruction of qi and blood flow. As the saying goes, “Bi means obstruction.” Activating blood is the foundation of treating this condition. It is only on the basis of activating blood that the evil qi of wind, cold, and dampness can be more easily eliminated. For treating blood, leeches are the first choice. Example 2: Lower Limb Erysipelas He, 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. In the past, he was treated with antibiotics during episodes, but after controlling the condition, it easily recurred, causing great suffering to the patient. This time, the episode lasted one day, with symptoms of large areas of heat and pain in the left calf, T38.9°C, swollen left inguinal lymph nodes, painful on palpation, accompanied by dry mouth and bitterness, tongue dark red with thin yellow coating, pulse choppy and rapid. Diagnosed as lower limb erysipelas. The condition was due to damp-heat descending and blood obstruction with heat accumulation. Treated with detoxifying, damp-resolving, and cooling blood to disperse stasis. The prescription included: leeches 4g, Hu Zhang (Polygonum) 30g, Hong Teng (Sargentodoxa) and Pu Gong Ying (Dandelion) each 15g, Jin Yin Hua (Honeysuckle) 12g, Cang Zhu and Dan Pi (Moutan) each 10g. Five doses, decocted in water for one dose per day. During follow-up, the redness and swelling in the left calf significantly reduced, pain subsided, fever resolved, and the left inguinal lymph nodes had disappeared, with the tongue turning pale red. The medicine was effective, and the original prescription was continued for half a month. Months later, during follow-up, there had been no recurrence. Commentary: Erysipelas of the lower limbs is an acute infectious pain of the lymphatic vessels, characterized by rapid onset and recurrent episodes. Traditional treatments mainly focus on clearing heat, resolving dampness, and detoxifying. In this case, I also adopted traditional treatment principles, adding a small dose of leeches to take advantage of their ability to break stasis and open meridians, achieving enhanced efficacy, reducing recurrence, and ultimately curing the condition. Example 3: Pelvic Inflammatory Disease Ding, female, 25 years old, had dull pain in the lower abdomen for a year and a half. Western gynecology diagnosed chronic pelvic inflammatory disease, and after Western treatment, there was no improvement, so she came to see me. Symptoms included: lower abdominal pain, tenderness (+), especially significant tenderness in the left lower abdomen; pain worsened during menstruation, accompanied by lumbar and sacral discomfort, delayed menstruation, scanty menstrual flow, dark menstrual blood with clots. The complexion was sallow, spirit was fatigued, tongue was dark with thin white coating, pulse was wiry, thin, and deep. Gynecological examination: vagina was unobstructed; secretions were abundant and white; cervix was smooth, and the uterine body was normal; left adnexa was enlarged, soft, and tender (++). Ultrasound showed left adnexa enlargement and a small amount of pelvic fluid. The condition was due to external evil invading internally, with stasis accumulating in the uterus. The treatment plan was to activate blood, dispel stasis, warm the uterus, and regulate qi to relieve pain. The prescription included: leeches 12g, Dang Gui, Wu Yao (Lindera) each 20g, Tao Ren (Peach Kernel), Hong Hua (Safflower), Chi Shao each 10g, Hong Teng 30g, Wu Yao 6g, Yi Mu Cao (Motherwort) 25g. Seven doses, decocted in water for one dose per day. During follow-up, the patient reported a reduction in lower abdominal pain and a significant improvement in spirit. The medicine was effective, and the original prescription was continued. One month later, all symptoms disappeared, and gynecological and ultrasound examinations showed complete resolution of left adnexa enlargement and pelvic fluid, with the patient fully recovered. Commentary: Chronic pelvic inflammatory disease often results from inadequate treatment during the acute phase. Prolonged illness leads to deficiency and cold, with cold invading the uterus, causing blood stagnation. Therefore, in this case, I heavily used leeches as the main medicine, which not only activated blood and dispelled stasis but also helped to warm the uterus and eliminate the disease.
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