Traditional Chinese Medicine Case Studies / Medical Discussions / Reference Articles for Learning Clinical TCM
Introduction: Some difficult diseases, such as systemic lupus erythematosus and Behçet’s syndrome, can initially manifest as skin lesions. How can we understand the treatment of these diseases through the lens of Yin and Yang? Let’s explore the clinical experience of Dr. Zhao Bingnan!
Dermatological diseases encompass a wide range and are closely related to various clinical specialties. Traditional Chinese Medicine (TCM) emphasizes the integrity and unity of the human body, with the theory of Yin and Yang being one of the foundational theories of Chinese medicine.
Here, I will share my personal insights on the application of harmonizing Yin and Yang in dermatology.
1
Symptoms of Yin-Yang Imbalance and Their Manifestations in Dermatology
The imbalance of Yin and Yang is primarily manifested as an excess or deficiency of either.
According to the general principles of Yin-Yang excess and deficiency, when Yin is excessive, Yang becomes diseased; when Yang is excessive, Yin becomes diseased. An excess of Yang leads to heat, while an excess of Yin leads to cold.
In terms of dermatological clinical symptoms, based on my years of practical experience, many diseases are related to Yin-Yang imbalance. These cases of Yin-Yang imbalance often share some common characteristics:
Intermittent headaches, dizziness, cold hands and feet with warm palms;
Feeling cold with five hearts heat (palms, soles, chest, and back), and lower back pain;
Occasionally presenting symptoms of heart-kidney disharmony and water-fire imbalance, such as palpitations, irritability, insomnia, forgetfulness, dizziness, tinnitus, fatigue, night sweats, or experiencing poor sleep with many dreams and fright, sometimes presenting with heat above and cold below, excess above and deficiency below, such as mouth sores, thirst, and cracked lips, while frequently experiencing abdominal distension, diarrhea, and abdominal pain;
Female patients often have irregular menstruation, excessive vaginal discharge, or young girls may experience white discharge even before menstruation begins;
Male patients may experience nocturnal emissions, premature ejaculation, impotence, and coldness in the scrotum due to kidney deficiency and cold;
Even insomnia with many dreams, irritability, forgetfulness, confusion, and unclear vision may occur.
The pulse often presents as a wiry and slippery pulse at the cun and guan positions, with the chi position being deep and thin, or a hollow pulse with a solid pulse beside it, or a rough pulse with an irregular rhythm.
On the skin, manifestations can be diverse, such as butterfly-shaped erythema or butterfly-shaped hyperpigmentation on the face, nodular erythema, skin itching, and hair loss.
The most common diseases include fox disease (similar to Behçet’s syndrome) and red butterfly (similar to systemic lupus erythematosus), especially after treatment with high doses of corticosteroids.
Additionally, skin pruritus, alopecia areata, dermatomyositis, and scleroderma are also not uncommon.
In summary, if the above symptoms appear in dermatological diseases, Yin-Yang imbalance should be considered first.
2
Treatment of Yin-Yang Imbalance
The principle of treating Yin-Yang imbalance is to harmonize Yin and Yang.
Based on clinical experience, commonly used herbs include: Tianxian Teng (Heavenly Immortal Vine), Jixueteng (Chicken Blood Vine), Shouwuteng (Fleeceflower Stem), and Gouteng (Uncaria).
Tianxian Teng is bitter and warm, entering the liver, spleen, and kidney meridians. Its bitterness promotes dispersal, and its warmth facilitates the flow of meridians, thus invigorating blood circulation and ensuring that water is unobstructed, blood is active, and wind is eliminated, allowing for smooth circulation throughout the body;
Jixueteng is warm, slightly bitter, and sweet, entering the heart and spleen meridians. It invigorates blood and relaxes tendons, can dispel stasis and generate new blood, and is a tonic among blood-invigorating herbs, treating symptoms like lower back and knee soreness, numbness, paralysis, and irregular menstruation. Long-term use can regulate the flow of Qi and blood;
Shouwuteng is neutral, slightly sweet and bitter, entering the heart, liver, spleen, and kidney meridians. It nourishes blood and calms the spirit, dispels wind and unblocks meridians, can tonify middle Qi, promote meridian flow, and unblock blood vessels, guiding Yang into Yin;
Gouteng is cool and sweet, entering the liver and pericardium meridians. Its lightness can disperse, and its cooling nature can clear heat, thus calming the liver, extinguishing wind, and relieving dizziness.
The combination of these four herbs can circulate the twelve meridians, invigorate Qi and blood, regulate blood vessels, relax tendons, and harmonize Yin and Yang.
In clinical applications, if the patient presents with kidney deficiency symptoms, additional herbs such as Tu Si Zi (Cuscuta), Gou Qi Zi (Goji Berries) can be added to tonify kidney Qi and nourish Yang, Nu Zhen Zi (Ligustrum) to nourish the kidney and benefit the liver, and Che Qian Zi (Plantago Seed) to promote urination without harming Yin, and without disturbing its fire.
The combination of these four herbs can generate essence and Qi, nourish the liver and kidneys, strengthen bones and muscles, and promote urination, achieving the effect of harmonizing Yin and Yang.
If there is heart-kidney disharmony and water-fire imbalance, Zishi Ying (Amethyst) can be used to calm the heart and nourish the liver, its nature is gentle and tonifying, treating anxiety, insufficient liver blood, paired with Lv E Mei (Green Plum Blossom) to alleviate dizziness and anxiety.
If there is slow heart rate and low blood pressure, Long Yan Rou (Longan), Li Zhi Rou (Lychee), He Huan Hua (Mimosa Flower), He Huan Pi (Mimosa Bark), and Shi Lian Zi (Lotus Seed) can be added to nourish blood, strengthen the spleen, benefit the liver, calm the heart, and ensure the five organs are harmonious and the spirit is relaxed.
If there are oral ulcers that have not healed for many years, with Yin deficiency and Yang fire in excess, add a small amount of Zi You Rou Gui (Purple Oil Cinnamon) to guide fire back to its source, and can also combine with symptomatic herbs such as Jin Lian Hua (Lotus Flower), Ma Lin Zi (Lantana), and Jin Deng Long (Chinese Lantern) for comprehensive treatment.
If it is a case of both spleen and stomach deficiency, Shan Yao (Chinese Yam), Shan Zhu Yu (Cornus), Sheng Di (Rehmannia), Shu Di (Cooked Rehmannia), and Ze Xie (Alisma) can be used to strengthen the spleen and benefit the kidneys.
3
Case Examples
Here are some case examples to illustrate:
Example 1: Zhang XX, male, 54 years old, case number: 458909
The patient presented with intermittent high fever and joint pain for over two years.
He had received long-term treatment at a certain hospital with no significant effect, ultimately diagnosed with systemic lupus erythematosus, and was treated with high doses of hormones, with slight relief of symptoms.
Upon arrival at the hospital, he was still taking 60 mg of prednisone daily, but persistent low-grade fever, palpitations, weakness, dizziness, night sweats, irritability, and poor sleep were reported.
The tongue was slightly dark, and the pulse was deep and wiry at the cun and guan positions, with the chi position being deep and thin.
Diagnosis: Yin-Yang imbalance, heart-kidney disharmony
Treatment: Harmonize Yin and Yang, connect heart and kidney
Herbs: Tianxian Teng 15g, Jixueteng 15g, Shouwuteng 15g, Gouteng 10g, Zishi Ying 15g, He Huan Hua 10g, He Huan Pi 10g, Lian Zi Rou 12g, Li Zhi Rou 10g
The above herbs were taken as one dose daily for thirty-five doses, with prednisone reduced to 40 mg daily, and general symptoms significantly improved, with the condition stabilized.
Example 2: Li XX, female, 40 years old, case number: 609591
The patient had recurrent oral ulcers for seven years, previously diagnosed with Behçet’s syndrome at a certain hospital, taking 20 mg of prednisone daily, along with Chinese medicine, with symptoms fluctuating and never stabilizing.
Upon arrival at the hospital, she reported cold hands and feet, leg pain, occasional dizziness and headaches, and continuous oral ulcers, along with frequent loose stools, diarrhea, and lower back pain.
The tongue was enlarged, with a white coating, and the pulse was wiry at the cun position and deep and thin at the chi position.
Diagnosis: Yin-Yang imbalance, heat above and cold below
Treatment: Harmonize Yin and Yang, nourish Yin and reduce fire
Herbs: Tianxian Teng 15g, Jixueteng 15g, Gouteng 10g, Sha Shen 30g, Tu Si Zi 12g, Nu Zhen Zi 15g, Che Qian Zi 15g, Ma Lin Zi 10g, Jin Lian Hua 15g
The above herbs were taken as one dose daily for forty-nine doses, with the condition stabilized, and oral ulcers only occasionally flaring up, with a significant reduction in the duration of the illness.
Both cases of systemic lupus erythematosus and Behçet’s syndrome are serious systemic diseases that are difficult to treat, and currently, there is no effective treatment.
Western medicine uses corticosteroids (hereinafter referred to as hormones), and some patients can temporarily relieve symptoms, while others find it difficult to control even with high doses; some patients, after controlling with large doses of hormones, find it challenging to reduce the dosage, and during the reduction process, symptoms often recur, and the condition worsens. Long-term use of hormones can lead to a series of side effects and complications, often being a major cause of patient mortality.
For example, the first patient was taking 60 mg of prednisone daily, and the condition was still uncontrolled, with persistent low fever, palpitations, weakness, dizziness, and night sweats. According to general principles, the hormone dosage should be increased, but we not only did not increase the hormone dosage but also gradually reduced it, with the condition improving gradually, which certainly reflects the effect of treating according to syndrome differentiation and harmonizing Yin and Yang.
The second patient was taking 20 mg of prednisone daily, with recurrent symptoms. After using the method of harmonizing Yin and Yang, the condition stabilized after only nineteen doses, and the hormone was discontinued, which also demonstrates the effect of harmonizing Yin and Yang.
4
Precautions
In summary, Yin-Yang imbalance presents complex clinical manifestations and can be encountered in various diseases, with diverse manifestations in dermatological diseases.
Furthermore, during the treatment process, the following situations should be noted:
First, for the treatment of skin diseases, it is essential to carefully analyze the symptoms. If the skin manifestations are caused by Yin-Yang imbalance, a comprehensive treatment approach should be adopted, addressing both the root and the symptoms, both internally and externally, to achieve faster therapeutic effects.
Second, Yin-Yang imbalance is the internal factor causing pathological changes in the skin, while the pathological changes in the skin are the external manifestations of internal Yin-Yang imbalance.
The transition from Yin-Yang imbalance to skin pathological changes requires a certain process. Therefore, after medication treatment, the internal harmonization of Yin and Yang leading to improvement and healing of skin diseases also requires a certain process.
Both the physician and the patient must have sufficient understanding of this, maintain close cooperation, and adhere to patient treatment with patience.
Physicians should avoid changing treatment plans too frequently, and patients should not seek treatment from multiple sources without adhering to the treatment plan. Only through a course of treatment over time can the internal Yin-Yang imbalance gradually improve, leading to gradual improvement in skin disease symptoms and therapeutic effects.
Note:This article is excerpted from “Complete Compilation of Famous Old TCM Doctors’ Experiences,” published by Beijing Publishing House in August 1994.Recommended Reads, click to read the original text:Zhang Zuozhou: The “Xia Ku Cao Fang” with only five herbs can treat several types of skin diseasesClinical Experience Collection of Zhao Bingnan: Selected Cases of Herpes Zoster (Four Cases)//////////[Read Previous Highlights]#Introduction to TCM Collection #Explanation of the Twelve Meridians #Donghai Medical Collection #Experience of Old TCM Doctors #Wonderful TCM Formulas #Proven Secret Formulas #National Medical Masters#Famous Cases of Cold Damage #Selected Famous Cases from the Golden Cabinet#Four Gentlemen Decoction #Etiology Assignment #Herbal Properties Assignment #Herbal Properties Song of 400 Herbs #Medical Three-Character Classic #Daily Insights from Mentorship in Medicine#Daily Insights on Principles, Methods, Formulas, and Herbs#TCM Serialized CollectionMaster He Ren: What is the essence of using Warming Meridian Decoction?Master Zhou Zhongying: Insights and Techniques from 60 Years of TCM Diagnosis (All Essentials)Master Ding Guangdi: Qianghuo Shengshi Decoction for Treating “Five Morning Diarrhea”Unexpectedly, “Qinggu San” really is the remedy for fever after bone fractures!Dan Zha San for Treating Hyperlipidemia (with Four Hyperlipidemia Formulas)Shen’s 600-Year Family Secret Formula for Women’s DiseasesMagical! The Wonderful Experience of Using Ancient Formulas to Treat Tooth Decay!The Ancient Formula “San Liang Ban” Quickly Treats Lumbar Muscle Strain![Collect] Eight Formulas from Nanjing Masters for Treating Insomnia, Hypertension, and Gastrointestinal Diseases!