A Case Study on the “Mingxuan” Reaction in Traditional Chinese Medicine

Chinese Medicine Book Club Issue 2501

One issue daily, accompanying the growth of TCM practitioners

IIntroduction: For the same disease, patients who experience the 瞑眩反应 (Mingxuan reaction) have better treatment outcomes than those who do not. I also share this belief. It is essential for practitioners to clearly distinguish the 瞑眩反应 from drug allergic reactions and side effects. Teacher Hao Wanshan once shared an example: a student almost misidentified a severe infusion allergic reaction as a high fever resolving with chills after listening to the teacher. (Editor/Qian Cheng)

A Case Study on the “Mingxuan” Reaction in Traditional Chinese Medicine

Author/Wang Haochen

Due to the pandemic, I have been unable to attend school and have been accompanying my father on his medical visits. Recently, I encountered an interesting case that I would like to share with all the teachers.

Wang, male, 54 years old, came for consultation on July 8, 2020, complaining of diarrhea for 5 months, with occasional abdominal pain. His stools were loose and watery, occurring 2-3 times a day, with a pale tongue, white coating, thick and greasy coating at the root, teeth marks on the sides, and a weak pulse at the right guan position.

This is a typical case of weak spleen and stomach leading to chronic diarrhea. The spleen deficiency produces dampness, which exacerbates the spleen deficiency, and the dampness is heavy and turbid, hence the prolonged illness. My father prescribed a modified Shu Feng San (Shen Ling Bai Zhu San) combined with the Tong Xie Yao Fang.

Ingredients: Dang Shen (Codonopsis pilosula) 15g, Fu Ling (Poria) 15g, Chao Bai Zhu (Atractylodes macrocephala) 15g, Chao Shan Yao (Dioscorea opposita) 15g, Chen Pi (Citrus reticulata) 6g, Chao Yi Ren (Coix lacryma-jobi) 20g, Sha Ren (Amomum villosum) 6g (added later), Lian Zi Rou (Lotus seed) 10g, Jie Geng (Platycodon grandiflorum) 10g, Fang Feng (Saposhnikovia divaricata) 10g, Bai Shao (Paeonia lactiflora) 10g, Zhi Gan Cao (Honey-fried Licorice) 6g, Yuan Hu (Corydalis yanhusuo) 10g, Ma Chi Xian (Portulaca oleracea) 15g, for 5 doses.

The Shen Ling Bai Zhu San treats spleen deficiency diarrhea, while the Tong Xie Yao Fang addresses abdominal pain. Adding Yuan Hu helps regulate qi and relieve pain, and Ma Chi Xian stops diarrhea (Ma Chi Xian is considered a wild vegetable in our area, which can be stir-fried or used as a filling in summer to prevent and treat diarrhea).

At that time, both my father and I felt this prescription was appropriate. However, two days later, the patient came back wanting to return the remaining herbal medicine, stating that after taking the medicine, his diarrhea worsened to almost four or five times a day. This was unexpected for me. I instinctively asked, “Do you feel discomfort in your abdomen when you have diarrhea? Do you feel uncomfortable after the diarrhea?” The patient replied that he felt quite comfortable after the bowel movement and that his abdomen had been gurgling frequently these past two days. My father then said this was a therapeutic reaction to the medicine, and advised him to continue taking it. If he felt any discomfort, he could call for advice. On July 14, the patient returned for a follow-up visit, happily reporting that he had not had diarrhea since the day before, his stools were normal, occurring once a day, and his abdomen was no longer gurgling or painful. We prescribed another five days for consolidation.

This patient trusted my father and came to inquire about any issues, promptly alleviating his doubts and continuing the medication. How many patients, upon noticing changes, assume there is a problem with the medicine and stop taking it without communicating with the doctor, ultimately leading to unresolved conditions and missed learning opportunities for the doctor? This highlights the importance of patient feedback and doctor-patient communication.

As stated in the Shang Shu (Book of Documents): “If the medicine does not cause 瞑眩, the disease will not heal.”

The 瞑眩反应 is a type of physical stress response that occurs in patients after receiving certain TCM treatments. Generally, for the same disease, patients who experience the 瞑眩反应 have better treatment outcomes than those who do not. In the Jin Kui Yao Lue (Essentials from the Golden Chamber), there are many records regarding the 瞑眩 after taking medicine. The Bai Zhu Fu Zi Tang (Atractylodes and Aconite Decoction) states: “After one dose, the body feels numb; after half a day, take another dose, and after three doses, if the person appears in a state of stupor, do not be alarmed; this is because the Bai Zhu and Fu Zi are driving the water qi out through the skin, and it has not yet been eliminated.” The Wu Tou Gui Zhi Tang (Aconite and Cinnamon Decoction) states: “Initially taking two doses, if unaware, take three doses, and if still unaware, increase to five doses. Those who are aware feel as if intoxicated. If one vomits, it indicates a middle disease.” These two cases describe the 瞑眩 caused by Fu Zi driving out water. However, my father mentioned that in his 24 years of practice, this was the first time he encountered a 瞑眩反应 with Shen Ling Bai Zhu San, and he had not encountered it during his training. Generally, 瞑眩反应 occurs with medicines that have distinct cold or heat properties, while Shen Ling Bai Zhu San has a mild nature, making this reaction quite rare. I believe it may be due to the restoration of the spleen and stomach’s function, allowing the dampness to be expelled in the form of stool. This is a simplistic thought, and I hope to spark further discussion. If any teachers have insights, I would appreciate your guidance!

Recommended Reading

Correctly Understanding “Sweating and Allergies”, which may also be a “瞑眩” Reaction

Submission Highlights | Discussing the Reactions to Aconite and the Xuming Decoction, etc.

I Copyright Statement This article is a submission by the author. Author/Wang Haochen, Editor/Qian Cheng, Proofread by/Zhu Mingyang, A Yan Tong Ge. The Chinese Medicine Book Club has obtained the appropriate authorization. I Submission Email [email protected]

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