Traditional Chinese Medicine Book Club Issue 2421
One issue per day, accompanying the growth of TCM practitioners
AuthorIntroduction:Fuzi (Aconite) is known as the “first medicine for reviving yang and rescuing from reversal”. It can assist heart yang, warm spleen yang, and supplement kidney yang. According to the “Bencao Huiyan”, Fuzi is said to be effective for “any condition of yang deficiency and extreme yin, where there is no heat in the lungs and kidneys; taking it has the miraculous effect of reviving the dead.” In the “Shanghan Lun”, Fuzi is also a commonly used medicine, with formulas like Si Ni Tang and Tong Mai Si Ni Tang, which, when used appropriately, can have life-saving effects. Therefore, contemporary scholars often favor and skillfully use Fuzi. There is a current trend in clinical practice to enthusiastically use and study Fuzi!However, Fuzi is toxic and has a strong bias; improper use can lead to immediate toxicity.This is closely related to whether the syndrome differentiation is accurate and whether the compatibility is appropriate.Some patients are not suitable for Fuzi, or the physician prescribes it improperly, causing endless troubles for the patients, some of which may last for years, even up to twenty years, seeking treatment everywhere without recovery.I often encounter patients who have “misused Fuzi” in my clinic, and I would like to share four cases for reference.Here, I call for caution: although Fuzi is miraculous, it must be used based on syndrome differentiation, with a serious and responsible attitude towards patients to avoid mistakes!（Editor/Qian Cheng）
Four Cases of Misuse of Fuzi
Author/Wang Jian
(1) Case of Urinary Retention and Fever
Li, male, 80 years old, from Kunming. Diagnosed on April 1, 2015. Unable to urinate with high fever for 1 day.
The patient is an 80-year-old man, a long-time patient of mine. Half a month ago, he had a gout attack with pain in the ankle and sought treatment from a herbalist in the city, after which his condition improved. A day ago (the evening of March 31), due to mild swelling and pain in the ankle, he felt slightly chilly and came to my clinic for treatment. Initially, he intended to seek treatment from me, but upon seeing the long queue, he decided to consult another doctor with fewer patients.
After diagnosing the patient, the other doctor prescribed a formula. The patient took the prescribed medicine that night, but unexpectedly, he started to have a fever, headache, and body aches at midnight, with a high fever reaching 39.3°C. He had a history of prostate enlargement, making urination difficult. The patient’s son, who is a TCM enthusiast, knowing about medicine, boiled 80g of mung beans and 50g of kudzu root to give to his father at 5 AM. After taking it, the temperature dropped to 38°C in the morning, but by noon, the fever returned to around 39.5°C, and he was still unable to urinate, with a distended bladder, fever, and gradually becoming agitated and confused.
The patient’s son sent me a text message and WeChat message at noon, explaining: “Dr. Wang, I am eager for your help. Last night, my mother and I took your prescription and felt comfortable. But my father took the initiative to find another doctor, and now he is dry and agitated, unable to urinate, feeling weak. I want to add you on WeChat to show you the tongue image and the prescription from the other doctor for some guidance. I boiled 80g of mung beans and 50g of kudzu root four times, about 400ml, and the temperature dropped to around 38 degrees, but then it rose above 39 degrees again. This morning, I bought some Tongcao (Dichondra) to decoct, but he still cannot urinate.”
Seeing the urgency of the situation, I immediately called the family to inquire about the condition. The family sent me photos of the patient’s face and tongue coating, showing that the patient had tightly closed eyes, a weak expression, a red tongue, a large tongue body, a bright red tongue without coating, and cracks all over the tongue. The pulse was reported by the son as “flooding and large”.
Since the patient is a long-time patient of mine, I am very familiar with his usual tongue coating and pulse. His pulse is generally wiry and slippery with strength, and his tongue usually shows a pale white tongue body, a large tongue, and a thick white greasy coating. In the past, I diagnosed him with yang deficiency with cold dampness, often using warming yang and transforming dampness methods. However, at this time, the sudden appearance of a red tongue, bright red without coating, and cracks all over the tongue indicated signs of yin injury, which surprised me.
I urgently looked at the photo of the prescription from the other doctor sent by the family, which included Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite) plus cooked Rehmannia, Angelica, Codonopsis, Ephedra, and Asarum, with 30g of black Fuzi, and 30g each of cooked Rehmannia and Codonopsis. After seeing this prescription, I immediately understood the problem. The patient usually has yang deficiency but has a heavy phlegm-dampness, so although I have also used Fuzi for him in the past, I never dared to use any greasy herbs. Fuzi is purely a raging fire, moving but not retaining, like a wild horse. The other doctor used 30g of Fuzi, along with a large dose of cooked Rehmannia and Angelica, which exacerbated the dampness evil, trapping Fuzi’s fire nature, leading to the generation of fire toxicity, injuring qi and yin, causing agitation and confusion, and preventing urination. I then orally instructed the patient’s son with a prescription.
Diagnosis: Internal damp-heat, fire toxicity obstructing, injuring both qi and yin.
Treatment method: Clear qi and release heat, disperse and cool, nourish yin and generate fluids.
Prescription: Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng) combined with Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction) with modifications.
Herbs include:
Sheng Shigao (Gypsum) 60g, Zhimu (Anemarrhena) 15g, Yiren (Job’s Tears) 20g, Sheng Shashen (Fresh Ginseng) 6g, Sangye (Mulberry Leaf) 8g, Juhua (Chrysanthemum) 8g, Jiegang (Platycodon) 8g, Lianqiao (Forsythia) 6g, Xingren (Apricot Kernel) 8g, Gancao (Licorice) 5g, Bohe (Mint) 6g, Lugen (Reed Rhizome) 8g. One dose, decocted in water, one dose per day.
That afternoon, the family urgently decocted the Chinese medicine, and after taking it twice, the fever gradually subsided, and urination began to occur. By 10 PM that night, the condition had significantly improved, with the temperature returning to normal, headache, body aches, and agitation reduced, and consciousness gradually cleared. The next day, April 2, he came to my clinic for a follow-up, having taken two doses of Chinese medicine, with the condition significantly improved, the difficulty in urination basically relieved, and no more fever or agitation. The signs of yin injury on the tongue had disappeared, and the tongue returned to its usual state, pale, large, and with a thick white greasy coating. I then used Sanren Tang (Three Seed Decoction) to transform dampness, disperse and smooth the flow. Later, the family consulted a Western medicine surgeon, which I also agreed to, and the family took the patient to the hospital for prostate surgery to prevent future issues.
Comment:
The patient indeed had yang deficiency, but usually had heavy phlegm-dampness, hence the tongue showed signs of pale white tongue body, large tongue, and thick white greasy coating, while the pulse was wiry and slippery with strength. Although warming yang was needed, it was necessary to combine it with herbs that transform dampness and resolve stagnation; the medicine could not be greasy. The other doctor, not recognizing the wiry and slippery pulse, prescribed Guizhi Jia Fuzi Tang, which is not a poor prescription. However, the compatibility was inappropriate, mistakenly using large doses of cooked Rehmannia, Codonopsis, and Angelica, which nourished and obstructed dampness, blocking the flow of qi, and Fuzi’s warming yang power could not be released. Additionally, using Ephedra and Asarum added fuel to the fire, resulting in a chaotic mix of dampness, phlegm, and fire, with no outlet, boiling the fluids, leading to signs of injury to both qi and yin. The obstruction of qi and damp-heat in the bladder resulted in the inability to urinate. The fire boiling the fluids in the upper jiao caused the tongue to change to a red tongue, bright red without coating, and cracks all over the tongue. The fire disturbed the clear orifices, leading to fever and confusion.
The “Shanghan Lun” states: “If taking Guizhi Decoction, after a great sweat, if there is great thirst that does not resolve, and the pulse is flooding and large, Baihu Jia Renshen Tang is indicated.” Therefore, the prescription used Baihu Jia Renshen Tang to clear heat and generate fluids, and Sangju Yin to disperse and clear, to smooth the flow of qi inside and outside. Once the fire obstruction was resolved, the evil fire dissipated, heat retreated, and urination was smooth. The combination with Sangju Yin was to take advantage of its dispersing and cooling power, treating the upper jiao lightly, as it should be treated lightly.
(2) Case of Aversion to Cold
Li, male, 55 years old, a teacher at Yunnan Open University, diagnosed on August 12, 2017. Aversion to cold with spontaneous sweating, dizziness, and nausea for over 2 months.
The patient is a university English teacher. More than two months ago, one day, he took a school bus to the Chenggong campus for class. The air conditioning on the bus was set too low, and the patient was exposed to cold air. After that, he began to experience aversion to cold, and the symptoms gradually worsened. He also experienced spontaneous sweating, dizziness, headache, and nausea every afternoon, with a feeling of fullness in the stomach. The spontaneous sweating was severe, with sweat pouring out like washing, soaking his clothes and bedding. Dizziness and headache occurred daily, making him reluctant to go out. The most severe symptom was aversion to cold; even in summer, he had to wear two sweaters, a military coat, and two pairs of autumn pants, yet his hands and feet remained cold, and he had to sit by a heater every day.
He had previously taken prescriptions from other doctors, including “Fuzi Decoction”, “Yupingfeng San”, “Guizhi Decoction”, “Xiaochaihu Decoction”, and “Guizhi Jia Fuzi Tang”, among which Fuzi was used in large doses of several tens of grams. Taking Fuzi once provided relief for a day or two, but the symptoms quickly returned. He also took Yupingfeng San combined with Guizhi Decoction, but his condition worsened, with increased aversion to cold, spontaneous sweating, dizziness, and nausea.
The patient’s wife, a colleague at the school, called me on the evening of August 12, seeking help. She sent two photos of the tongue coating, showing that the front part of the tongue was red with little coating, while the middle and back parts had thick greasy yellow coating. The diagnosis considered obstruction of the exterior, dampness obstructing the interior, and mixed cold and heat. The treatment was to strengthen the spleen, transform dampness, harmonize the middle jiao, and smooth the flow of qi. I prescribed Banxia Xiexin Tang (Pinellia Decoction) with modifications.
Herbs include:
Banxia (Pinellia) 12g, Ganjiang (Dried Ginger) 15g, Huangqin (Scutellaria) 12g, Huanglian (Coptis) 6g, Taizishen (Codonopsis) 30g, Chaihu (Bupleurum) 12g, Baicao (Cardamom) 12g, Houpo (Magnolia Bark) 15g, Huo Xiang (Agastache) 12g, Chao Baizhu (Fried Atractylodes) 15g, Fuling (Poria) 20g, Yujin (Curcuma) 15g, Zexie (Alisma) 20g, Guizhi (Cinnamon Twig) 15g, Zhi Gancao (Honey-fried Licorice) 6g. Two doses, decocted in water, one dose every two days.
The patient went to the pharmacy that night to get the Chinese medicine, urgently decocted it, and took it once that night. The next day, he got up, and all symptoms had improved; dizziness, nausea, and fullness in the stomach disappeared, and aversion to cold and spontaneous sweating significantly reduced. After one dose, the patient exclaimed to his family how miraculous this prescription was, and in the afternoon, he happily called to inform me.
Later, I used Xiaochaihu Decoction, Jingfang Baidu San, Pingwei San, and other formulas with modifications, and after intermittent treatment for two months, his condition gradually recovered.
Comment:
The patient primarily presented with aversion to cold, even wearing winter clothes in summer, along with spontaneous sweating, sweating like washing, and nausea and fullness in the stomach, making it easy to diagnose as yang deficiency and spleen-stomach deficiency with cold. Therefore, the previous prescriptions were all warming yang and benefiting qi formulas like “Fuzi Decoction”, “Yupingfeng San”, “Guizhi Decoction”, and “Guizhi Jia Fuzi Tang”. However, the mixed warming treatment worsened the aversion to cold, indicating that Fuzi, Huangqi, and Guizhi were not the correct treatments.
Tracing back to the cause of the patient’s illness, it began more than two months ago when he was exposed to cold air on the bus. At that time, he should have been treated for the exterior condition, but due to improper treatment, the evil entered the interior, causing cold evil to invade the interior and worsen the aversion to cold. Additionally, the mistaken use of Fuzi, Huangqi, and other warming tonics further obstructed the flow of qi inside and outside. The exterior defense was unresolved, and the evil was trapped inside, transforming into damp-heat, further obstructing yang qi, causing increased aversion to cold. The dampness obstructed the clear yang, leading to daily dizziness and headache. The dampness obstructed the spleen, causing stomach discomfort.
The prescription of Banxia Xiexin Tang with modifications was used to harmonize the middle jiao, balance cold and heat, and resolve dampness, strengthening the spleen and smoothing the flow of qi. Once the qi flowed, the first dose showed effect. Banxia, known as “May Banxia grows”, is good at guiding yang into yin and yin into yang, facilitating the harmony of yin and yang, exterior and interior, cold and heat, and is a key herb for harmonizing. Ganjiang, Taizishen, Chao Baizhu, Fuling, and Zhi Gancao are the Four Gentlemen Decoction with Ganjiang added, or it can be said to be the Li Zhong Tang (Regulate the Middle Decoction) with Fuling added, to tonify the middle and strengthen the spleen. Adding Baicao, Houpo, and Huo Xiang transforms dampness and harmonizes the middle, regulating qi. Huangqin and Huanglian work together, with the pungent opening and bitter descending, to clear the damp-heat in the middle jiao. Chaihu and Huangqin, one ascending and one descending, are incorporated into the Xiaochaihu Decoction to harmonize the pivot of the exterior and interior, smoothing the flow of qi. Additionally, Guizhi, Fuling, Chao Baizhu, Zhi Gancao, and Zexie are the Linggui Zhugan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction) with Zexie added to warm and transform dampness. The combination of these herbs is a method to transform dampness and smooth the flow.
In clinical practice, when encountering aversion to cold, many practitioners immediately prescribe Fuzi without hesitation. However, in reality, a significant portion of patients with aversion to cold are not related to yang deficiency but rather to damp obstruction. Misuse of warming tonics can lead to errors. In my clinical experience, I have treated many patients with aversion to cold, and while many have benefited from Fuzi, I have also seen many patients who are not suitable for Fuzi, so caution is essential.
I once encountered a middle-aged female patient who had aversion to cold for more than four years. During those four years, she took Fuzi countless times, with some doctors prescribing Fuzi in large doses of over a hundred grams, and she would take it for a year at a time. Occasionally, her symptoms would improve, but soon she would feel cold again, dragging on for four years. After passing by my clinic, seeing the long line of patients, she decided to give it a try and registered for treatment. I diagnosed her pulse and firmly told her not to take Fuzi again, but rather to use Da Chaihu Tang (Major Bupleurum Decoction) or similar formulas to clear heat and purge. At that time, the patient and her family were skeptical and repeatedly requested me to prescribe a Fuzi formula. I earnestly advised her and calculated that over the past four years, she had taken nearly a hundred pounds of Fuzi; why had her condition not improved? The patient argued that two years ago, she took a prescription with seventy grams of Fuzi, which provided relief for half a year, but after that, it was ineffective. Her family showed skepticism and disdain. The family had lost basic trust, and I realized I could do nothing further, so I prescribed Da Chaihu Tang and instructed her not to take Fuzi again. Although the patient and her family agreed, they remained skeptical, saying they only needed two doses, and after leaving, they did not return to the clinic to get the medicine. Subsequently, they did not return for follow-up. The patient and her family were misled by Fuzi and did not realize it, lacking trust in the physician’s words, so nothing could be done.
Famous physician Zhu Danxi from the Jin-Yuan period had a similar case for reference. The “Danxi Weng Chuan” records: “Zhou, a Jinshi from Tiantai, suffered from aversion to cold, even in summer, he had to cover his head with cotton. He took Fuzi hundreds of times, which worsened his condition. The elder examined him, and the pulse was slippery and rapid, and he said: ‘This is heat and yet cold.’ He then used a pungent and cool formula, expelled about a liter of phlegm, and the cotton covering his head was reduced by half; he then used Fangfeng Tongsheng San, and he recovered. Zhou was very pleased, and the elder said: ‘After recovery, you must eat bland food to nourish the stomach and cultivate the spirit, so that water can be generated and fire can be reduced; otherwise, the toxicity of Fuzi will surely arise, and it will be difficult to save.’ He could not do so, and later developed a sore and died.” This patient was also misled by Fuzi.
(3) Case of Aversion to Cold for Twenty Years
Xie, male, 52 years old, from Yanjin, Yunnan, first diagnosed on June 17, 2018. Aversion to cold, spontaneous sweating, and body pain for 20 years.
The patient experienced aversion to cold after catching a cold in the summer twenty years ago. Local TCM practitioners treated him with Chinese medicine, which included warming tonics like deer antler. After taking the medicine, his aversion to cold not only did not improve but worsened, leading to a prolonged condition. He took Fuzi and other formulas, and his condition became more severe, requiring him to wear sweaters and autumn pants even in summer. The condition persisted for twenty years, during which he sought treatment at various hospitals in Yanjin County, Kunming City, and Sichuan Chengdu Huaxi Hospital and the affiliated hospital of Luzhou Medical College, with unclear diagnoses and no effective treatment.
For twenty years, he had almost continuously taken TCM, with countless doses of Fuzi, claiming he could fill a truck with it, yet his aversion to cold symptoms had never improved. He experienced aversion to cold, even in summer, wearing thick clothes, and even needed to sit by a heater in the sun, yet he felt colder. He also had daily spontaneous sweating, often soaking his underwear; along with body pain, weakness, fatigue, diarrhea, and stomach bloating. Recently, he heard from a TCM practitioner in Yanjin about me and was excited and hopeful, so he rushed to Kunming to seek treatment.
Upon examination, the patient was emaciated, with a weak spirit, wearing thick clothes in summer, and his skin was cool and damp. Upon examining his tongue and pulse, the tongue was pale purple, with a thick white greasy coating, and the pulse was wiry and slippery.
Diagnosis: Dampness obstructing and transforming into heat, yang qi not extending.
Treatment method: Transform dampness, resolve obstruction, and clear heat, with pungent warmth to disperse.
Prescription: Banxia Xiexin Tang combined with Mayingzhu (Mahuang and Job’s Tears) with modifications.
Herbs include:
Banxia (Pinellia) 12g, Huangqin (Scutellaria) 10g, Huanglian (Coptis) 8g, Ganjiang (Dried Ginger) 15g, Zhi Gancao (Honey-fried Licorice) 6g, Taizishen (Codonopsis) 30g, Chaihu (Bupleurum) 12g, Yujin (Curcuma) 15g, Sheng Baizhu (Fresh Atractylodes) 15g, Fuling (Poria) 20g, Sheng Mahuang (Fresh Ephedra) 8g, Xingren (Apricot Kernel) 12g, Yiren (Job’s Tears) 30g, Houpo (Magnolia Bark) 15g, Chenpi (Dried Tangerine Peel) 12g, Huo Xiang (Agastache) 15g. Four doses, decocted in water, one dose every two days.
Due to the severity of the condition and the prolonged duration of twenty years, I advised the patient not to leave Kunming for the time being and to try taking four doses of Chinese medicine to observe the effect.
On July 1, the patient returned for a follow-up, reporting that after taking four doses of Chinese medicine, there was no improvement, and the aversion to cold remained severe. Since the patient’s condition had persisted for twenty years with no improvement from various famous doctors and hospitals, he was aware that his condition was very difficult and did not have high hopes for a few doses of Chinese medicine, so he firmly requested to continue taking the medicine.
I examined his tongue and pulse again, which remained pale purple, with a thick white greasy coating, and a slightly yellowish tongue coating. I considered that the previous diagnosis was correct, as wind and dampness obstructed the yang qi, preventing it from extending. The yellow coating indicated dampness-heat obstruction. However, although there was damp-heat, the essence was not damp-heat, so Huanglian, Huangqin, and Yiren seemed too cold and cooling, and I decided not to use them this time. His aversion to cold was due to damp obstruction and qi stagnation, not yang qi deficiency, so although Ganjiang, Taizishen, and Baizhu are warming tonics, they were not necessary at this time and should also be avoided. Additionally, Mahuang’s dispersing power was slightly strong, which might lead to excessive dispersal. After careful consideration, I maintained the general direction of the diagnosis but adjusted the prescription.
Diagnosis: Dampness obstructing, yang qi not extending.
Treatment method: Transform dampness, resolve obstruction, with pungent warmth to disperse.
Prescription: Jingfang Baidu San with modifications.
Herbs include:
Jingjie (Schizonepeta) 12g, Fangfeng (Siler) 12g, Zhi Gancao (Honey-fried Licorice) 6g, Fuling (Poria) 20g, Chuanxiong (Ligusticum) 15g, Qianghuo (Notopterygium) 12g, Duhuo (Angelica) 15g, Chaihu (Bupleurum) 12g, Qianhu (Peucedanum) 12g, Zhihou (Bitter Orange) 12g, Jiegang (Platycodon) 12g, Huo Xiang (Agastache) 15g, Houpo (Magnolia Bark) 15g, Yujin (Curcuma) 15g, Peilan (Eclipta) 12g, Dangshen (Codonopsis) 15g. Four doses, decocted in water, one dose every two days.
On July 8, during the follow-up, after taking the medicine, the aversion to cold significantly reduced, and the symptoms improved by more than half. Spontaneous sweating, body pain, and fatigue also improved, and he reduced the number of thick clothes he wore. After twenty years of chronic illness, the symptoms suddenly improved after taking the medicine, and the patient was overjoyed. I then prescribed four more doses to consolidate the treatment. On July 15, during the follow-up, the symptoms had basically disappeared, and I adjusted the prescription for seven more doses, which the patient took back to Yanjin for consolidation treatment. A month later, during follow-up, the condition had not relapsed, and I used Liujunzi Tang combined with Huo Xiang Zhengqi San for treatment until he fully recovered.
Comment:
This patient was misled by warming tonics, and the long duration of the condition lasted for twenty years, with severe aversion to cold, requiring thick clothing even in summer. The illness began twenty years ago due to aversion to cold after catching a cold. If he had been treated with pungent warmth to resolve the exterior at that time, he could have recovered and not ended up like this. However, he mistakenly took deer antler, failing to differentiate between exterior and interior, misjudging the location of the illness, which was at the exterior, yet warming his kidney yang, leading to the evil penetrating deeply and closing the exterior.
If he had been treated to dispel the evil and transform dampness, it might not have lasted so long, but most practitioners, upon seeing aversion to cold, immediately prescribe Fuzi. Over the past twenty years, he has taken Fuzi enough to fill a truck. The exterior was not resolved, and taking Fuzi not only proved futile but also exacerbated the internal evil, entangling it further. Thus, the aversion to cold, spontaneous sweating, and body pain lasted for twenty years. The internal evil closed off, causing qi stagnation, and the qi transformation was obstructed, leading to internal dampness, which presented signs of yang deficiency and cold dampness, further confusing the practitioners and leading to misdiagnosis of yang deficiency, resulting in continuous use of warming tonics like Fuzi.
Upon initial diagnosis, due to accompanying diarrhea, stomach bloating, spontaneous sweating, and cold damp skin, with a pale tongue, thick white greasy coating, and wiry slippery pulse, I prioritized adjusting the middle and transforming dampness, first harmonizing the spleen and stomach, with additional pungent dispersing herbs. The evil qi had been stuck for a long time, leading to internal dampness, so I prescribed Banxia Xiexin Tang combined with Mahuang and Job’s Tears with modifications.
After four doses, the dampness began to loosen. Although the symptoms did not decrease, the patient remained confident and cooperated with me, insisting on continuing the treatment. I considered that the previous direction was correct, but Huangqin and Huanglian, although suppressed by Ganjiang, still leaned towards cold and cooling, which was not conducive to expelling the evil. Ganjiang and Taizishen, while tonifying the spleen yang, were not necessary at this time, as it was crucial to dispel the evil. The treatment should be vigorous to expel the evil. Although there was spontaneous sweating, it was due to internal dampness, and the warming tonics like Fuzi obstructed the internal fire, forcing the fluids outward, so it was not appropriate to stop the sweating; rather, the focus should be on expelling the evil first.
Considering all of the above, I changed the prescription to Jingfang Baidu San, which disperses the evil and transforms dampness, with additional herbs to regulate qi and transform dampness. The combination of these herbs allowed the evil to be expelled, and the internal and external pathways were opened, allowing the yang qi to rise, leading to a sudden reduction in the twenty-year chronic illness. Afterward, I treated him with a focus on harmonizing and strengthening the spleen and transforming dampness, advising the patient not to misuse warming tonics in the future to prevent obstruction of the exterior and ensure that the condition would not relapse.
This case was not due to yang deficiency; it was initially an exterior condition, later leading to the evil closing off the exterior defense, so deer antler and Fuzi should not be used. The twenty-year chronic illness was due to the misuse of deer antler and Fuzi.
(4) Case of Spontaneous Sweating, Aversion to Cold, Low Back Pain, and Seminal Emission
Xie, male, 19 years old, a student at Yunnan University of Traditional Chinese Medicine, first diagnosed on April 29, 2018. Spontaneous sweating, aversion to cold, low back pain, and seminal emission for 10 days.
The patient is a first-year student in the clinical program of TCM and Western medicine at Yunnan University. He has a history of physical weakness, hereditary hypertension, and reflux gastritis. In high school, he also had a cough that persisted into college, with no issues found in the lungs after multiple treatments. Last year, he sought treatment from me for a cough and was prescribed Si Ni Tang (Four Reversal Decoction), which alleviated the cough for half a year.
About ten days ago, the patient sought treatment from a certain TCM practitioner for low back pain, who prescribed a formula containing Fuzi, Banxia, and Zhimu, among other herbs. After taking the Chinese medicine, the low back pain worsened, and he began to experience frequent urination, which he initially did not think much of. During the late spring chill, one day while studying in the teaching building, he stood on the second-floor corridor reciting, and when the cold wind blew, he suddenly felt severe low back pain, accompanied by cold sweat, fever, dry mouth, dizziness, and overall weakness, with a pale complexion.
His classmates and teacher rushed him to the emergency department of Kunming City Hospital, and the next day he was transferred to the First Affiliated Hospital of Kunming Medical University for inpatient treatment. After five days in the hospital, the diagnosis was unclear, and his condition did not improve. After discharge, he still felt low back pain, weakness, and dizziness, and his condition worsened. He experienced severe aversion to cold, cold hands and feet, and needed to cover himself with four thick blankets at night, yet still felt cold and had difficulty sleeping. He had spontaneous sweating and night sweats, soaking his underwear and bedding. A slight breeze would cause low-grade fever and dry heaving, with a temperature ranging from 37°C to 37.5°C. He also experienced involuntary seminal emissions twice during the day while awake, which caused him fear. His condition was severe and unbearable, so he came to my clinic for treatment on the morning of April 29.
Upon examination, it was nearly summer, and while others were wearing shirts and T-shirts, the patient was still wearing a down jacket due to severe aversion to cold. He had low back pain, aversion to cold, low-grade fever, persistent dry heaving, and continuous spontaneous sweating, with sweat rolling down his hair and forehead. He reported that he had not had a bowel movement for a week, and finally had a loose stool yesterday. Upon examining his tongue and pulse, the tongue was pale, with a thick white greasy coating, and the pulse was wiry and slippery.
Diagnosis: Wind evil with dampness externally invading, with cold dampness obstructing the spleen and stomach, and internal fire and damp-heat in disorder.
Treatment method: Transform dampness, resolve the exterior, and harmonize the middle.
Prescription: Huo Xiang Xia Ling Tang combined with Li Zhong Tang (Regulate the Middle Decoction) with modifications.
Herbs include:
Huo Xiang (Agastache) 15g, Houpo (Magnolia Bark) 15g, Banxia (Pinellia) 12g, Fuling (Poria) 20g, Chenpi (Dried Tangerine Peel) 12g, Baicao (Cardamom) 12g, Shichangpu (Acorus) 15g, Ganjiang (Dried Ginger) 15g, Taizishen (Codonopsis) 30g, Chaihu (Bupleurum) 12g, Huangqin (Scutellaria) 10g, Jingjie (Schizonepeta) 12g, Fangfeng (Siler) 12g, Yujin (Curcuma) 15g, Zhi Gancao (Honey-fried Licorice) 6g. Two doses, decocted in water, one and a half doses per day.
After taking two doses, on May 1, the patient returned for a follow-up, reporting significant improvement in his condition. He stated that after taking just one dose, the aversion to cold had decreased, and he had changed out of his down jacket, wearing a T-shirt with a thin outer jacket. The spontaneous sweating and night sweats had stopped, the fever had subsided, the dry heaving had improved, and the low back pain, dizziness, and fatigue had all lessened, with improved spirit and a reduction in the thick greasy tongue coating. I then adjusted the prescription for two more doses, and after taking six doses, the patient fully recovered, with no further involuntary seminal emissions.
Comment:
The patient had a weak constitution, with insufficient spleen and stomach yang qi. Initially, the low back pain was caused by wind and cold, so the treatment should have focused on dispersing cold and eliminating dampness. However, the patient mistakenly took Fuzi, Zhimu, and Banxia, which are incompatible. Zhimu restrains the fiery nature of Fuzi, and Fuzi’s dry and hot nature has no outlet. When dampness is present, Zhimu promotes cold dampness, obstructing Fuzi’s path, leading to a boiling of cold dampness, generating damp-heat, and stimulating the internal fire, causing low back pain and frequent urination.
Additionally, due to the late spring season and the lingering cold, standing in the cold wind while studying caused an external invasion of wind and cold, obstructing the pathways, leading to internal pressure of qi and fluids, further promoting the generation of damp-heat. With wind and cold on the exterior and damp-heat internally, both attacking the body, the pathways were obstructed, leading to severe low back pain, dizziness, fatigue, and cold sweat. After several days of hospitalization with intravenous fluids, the dampness increased, and the obstruction worsened, leading to more severe damp-heat. The internal dampness obstructed the spleen and stomach, causing persistent dry heaving and a week without a bowel movement, resulting in loose stools. The wind and cold on the exterior, combined with damp-heat internally, prevented the yang qi from expressing, leading to severe aversion to cold and requiring heavy blankets.
The internal steam and external obstruction made the cause of the illness clear, so the treatment focused on transforming dampness, resolving the exterior, and harmonizing the middle to disperse the wind, dampness, cold, and heat. The prescription included Huo Xiang, Houpo, Fuling, Shichangpu, and Bai Doukou to transform and benefit dampness. Although there were involuntary seminal emissions, I still used Shichangpu and Fuling to guide the internal fire and damp-heat outward, which is a method of addressing the root cause. Additionally, Chaihu, Huangqin, and Yujin were combined with Shichangpu to eliminate the internal fire and damp-heat. Ganjiang, Taizishen, Chao Baizhu, Banxia, Chenpi, and Zhi Gancao were used to warm the middle, benefit qi, harmonize, and transform dampness. Jingjie and Fangfeng combined with Huo Xiang and Chaihu resolved the exterior wind, cold, and dampness, opening the pathways for qi and fluids. The combination of these herbs allowed the evil to be expelled, and the internal and external pathways were opened, allowing the yang qi to rise, leading to a rapid improvement in the severe condition, responding quickly to treatment.
Recommended Reading
Submission Highlights | Discussing the Reactions to Taking Fuzi & Resuscitation Decoction, etc.
To prevent Fuzi poisoning, pay attention to these 5 aspects.
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The Secrets of Quick Effect in Acupuncture Techniques
There was an old TCM doctor who said when discussing acupuncture techniques:
“The qi must be effective; it is not effective just because the qi is obtained; the amount of stimulation is important;”
“Acupuncture is like taking medicine; it must be effective, or else change the prescription;”
“Use light needles and slow twisting; treatment begins at the skin level;”
“Do not be superstitious about tonifying or dispersing; acupoints are like switches, adjusting in both directions;”
Intention is a real existence; intention is material.”
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