On February 5, 2018, Mr. Chen, mentioned in the medical case, reached out again after the New Year seeking help, stating, “I have an old problem I would like you to take a look at. I feel my pulse is deep and thin, with a slippery quality. I have had yellow urine for many years, and my scrotum is damp. Recently, my vision has noticeably declined, and things appear a bit blurry. I have increased dandruff, my stool is slightly loose, and I do not feel thirsty or bitter. My eating and sleeping are normal. My lower limbs tend to feel sore by the afternoon, and my tongue has a lot of foam. I would like you to prescribe something for me.” I had already sensed that this person had damp-heat, and merely using Bai Hu Tang (White Tiger Decoction) to clear the Yangming stomach heat was not sufficient. However, he believed he had deficiency-cold, so I refrained from stating it outright. Now, with the symptoms presented, I promptly replied, “The damp-heat in the liver channel requires a combination of Long Dan Cao (Gentian) Decoction and Si Miao San (Four Marvels Powder).” The prescription was: “Chao Zhi Zi (Stir-fried Gardenia) 12g, Huang Qin (Scutellaria) 10g, Chai Hu (Bupleurum) 10g, Sheng Di Huang (Rehmannia) 12g, Che Qian Cao (Plantago) 15g, Ze Xie (Alisma) 12g, Mu Tong (Akebia) 10g, Gan Cao (Licorice) 6g, Dang Gui (Angelica) 12g, Chao Cang Zhu (Stir-fried Atractylodes) 15g, Huang Bai (Phellodendron) 10g, Yi Yi Ren (Job’s Tears) 30g, Huai Niu Xi (Achyranthes) 15g, Chuan Niu Xi (Cyathula) 15g, and Ju Hua (Chrysanthemum) 12g.” Analyzing the case, the eyes and scrotum are traversed by the foot jueyin liver channel. The blurry vision and decline in eyesight indicate liver fire rising, while the dampness in the scrotum, yellow urine, and foamy tongue surface suggest damp-heat descending in the liver channel. However, the soreness in the lower limbs by the afternoon indicates that the pathological changes have expanded to the lower jiao. The use of Long Dan Cao Decoction here is absolutely effective for “clearing damp-heat from the liver channel.” Si Miao San itself can treat damp-heat in the lower part, with short yellow urine, and adding Yi Yi Ren enhances the heat-clearing and damp-draining effect. Furthermore, adding Niu Xi helps to guide the medicine downward, combining to form Si Miao San. Finally, adding Ju Hua clears heat and brightens the eyes, which is precisely targeted treatment. He asked, “My skin is a bit loose; can I add 20 grams of Huang Qi (Astragalus)?” I replied, “No addition.”
In clinical practice, patients often feel that they are deficient in various aspects and want to supplement everything. At this time, it is essential to differentiate the disease and syndrome for treatment, and not to be misled by the patient’s subjective thinking. Two days later, I received a reply: “The effect is very good; I am on the third dose today. I feel very energetic, my eyesight is clearer than before, and my lower area is very dry, but my urine is still yellow (possibly due to the Chao Zhi Zi in the prescription). I estimate it will lighten after stopping the medication.” He also mentioned, “Actually, I could feel the improvement after taking the first dose.” I replied with a smile, “The yellow urine is due to the Zhi Zi; continue taking it.” A week later, Mr. Chen sent me a pair of sports shoes, probably not as a bribe, but I can only express my gratitude in return. He messaged me, “I should be the one thanking you. I feel very good today; I used to feel sleepy and fatigued every evening, but now it is much better! If I were still in Xi’an, I would definitely thank you in person with a banner!” The right formula, used correctly, is indeed a good prescription.
