On August 27, 2020, a case of nasal inflammation was recorded. The patient experiences symptoms every morning upon waking, sometimes lasting the entire morning, with continuous clear nasal discharge, gradually recovering by the afternoon. The patient describes that exposure to sunlight does not cause nasal discharge, but air conditioning or fan breezes do. Bowel movements start soft and become loose, urination is normal, but at night, the urine tends to be yellow, although the volume is adequate. The patient feels little thirst and does not like drinking water.
Pulse examination: Comparing the left and right wrists, the left wrist shows deficiency. Comparing both hands, the right wrist pulse is weak and feeble. The right wrist pulse is significantly deficient upon deeper palpation, while the left wrist pulse is not deficient upon deeper palpation. The tongue coating shows a loss of coating in the middle area.
Patient description: The patient has undergone nebulization without relief, has sweated, and taking ginger and perilla leaves did not help, but rather worsened the condition. Taking the Li Zhong Wan (Regulate the Middle Pill) did not provide relief, but it did help with bowel movements. Symptoms definitely worsen the day after sexual activity. Eating watermelon triggers the symptoms.
Prescription: Jiang Ban Xia (Pinellia ternata) 15g, Sheng Jiang (Fresh Ginger) 10g, Da Zao (Jujube) four slices, Gan Jiang (Dried Ginger) 5g, Dang Shen (Codonopsis) 15g, Wu Mei (Mume fruit) 5 pieces, Chen Pi (Dried Tangerine Peel) 15g, Huang Qin (Scutellaria) 10g, Cong Rong (Cistanche) 20g, Ba Ji Tian (Morinda root) 20g, Hei Dou (Black Beans) 15g, Lu Dou (Mung Beans) 10g, a small amount of glutinous rice.
Medication rationale: It is well known that Yang Qi is precious, but fluid (Jin Ye) is also very valuable. Yang Qi can carry fluids upward, while fluids can carry Yang Qi downward, both of which are essential for smooth functioning. This formula uses mung beans to nourish the liver (Mu), black beans, glutinous rice, and mume fruit to nourish fluids downward, while fresh ginger and jujube nourish stomach fluids. These are prerequisites for supplementing the Qi of Dang Shen. Ban Xia helps to descend and open the pathways, while Gan Jiang is used lightly to warm the Yang of the middle jiao. Ba Ji Tian and Cong Rong nourish the kidney’s water and fire, and Fu Zi (Aconite) must not be used. Chen Pi regulates the Qi without descending, and can be replaced with Su Ye (Perilla Leaf), while Huang Qin clears the floating heat.
Feedback after taking the medicine: Two hours after taking the medicine, the nose felt clear, and there was a sensation of thirst. After three days of continuous use, the patient found no sneezing upon waking. The duration of sexual activity increased. The patient felt noticeably sleepy at night and had a strong desire to sleep. Eating pears and watermelon felt very comfortable.
Case reflection:
This condition is indeed due to fluid deficiency, where Qi cannot be contained, leading to a long-term deficiency of cold in the middle and lower jiao. The patient feels little thirst, and the pulse is weak and slightly floating, indicating a failure of the fire and earth elements. Therefore, eating watermelon causes cold in the middle jiao. Simply taking fresh ginger and perilla leaves will disperse Qi, making it difficult for the lungs to contain, which can lead to illness. Taking Li Zhong Wan can warm the middle and stop cold, but it cannot generate fluids and descend the lungs. This formula aims to descend the stomach, open the right descending pathway, warm and nourish the deficiency, facilitate circulation, and generate fluids while clearing heat. The clearing herbs must not be cold enough to harm the middle, and the fluid-consolidating power must exceed the floating Qi power. Finally, warm and tonifying herbs must be used to replenish the emptiness of the lower jiao. Teacher Peng’s method of using rock candy and glutinous rice porridge to relieve heat and wind is ineffective for chronic patients, as rock candy stabilizes and clogs, hindering transformation. In the Treatise on Cold Damage, fresh ginger and jujube meat paired with Ban Xia can bear heavy responsibilities. Although Ban Xia consumes fluids, isn’t it also used in Mai Men Dong (Ophiopogon) syndrome, as long as it is paired with fluids? It can create transformation and circulation.
This illness is indeed difficult to discuss; excessive use of fluids can easily generate dampness. Because of the fundamental deficiency, if too much is given at once, it can generate dampness and clog the spleen. Clearing heat cannot harm the middle, and tonifying Qi and Yang cannot be aggressive; it must be used lightly. Excessive use of Qi herbs can obstruct the downward movement of fluid herbs.
Thoughts on premature ejaculation: The leakage is governed by wood, while essence is stored in the kidney. This can be considered in this way: the left wrist is often deficient, and when Yang moves, the kidney cannot store, leading to the leakage of wood Qi. Ejaculation upon intercourse is premature ejaculation, indicating a lack of storage and weakness of metal and water.
Regarding the pulse, the strength or weakness of Qi indicates the amount of Qi present. Floating indicates surface Qi, while middle indicates central Qi, and sinking indicates root Qi. The right pulse indicates descending Qi, while the left indicates ascending Qi. The right wrist pulse is empty and weak, indicating insufficient Qi intake. Circular movement is the movement of Qi.
The above are some fragmented thoughts on an actual medical case. Any shortcomings are welcome for correction.