“Yang Deficiency and Yin Congestion – Thirst Due to Congested Fluids” Case by Tao Zhengshuan: Chen, male, 43 years old. Suffering from diabetes, previously diagnosed by another physician as middle yang dysfunction and lower jiao yang deficiency. Treated with warming and tonifying spleen and kidney methods, using modified Li Zhong Tang and Jin Gui Shen Qi Wan, but without effect, instead feeling fullness in the abdomen and poor appetite. He came to my clinic for treatment. Upon examination, he presented with thirst, frequent drinking, dry mouth, and dry nose without nasal discharge. His breath felt cold, tongue pale with little moisture, and pulse slightly floating, slow, and thin. The diagnosis indicated lung cold and qi stagnation, with cold fluids congested.
Proposed treatment: 10g of Gan Cao (Licorice) and 10g of Gan Jiang (Dried Ginger), decocted in the usual drinking amount and stored in a bottle, to be used as a substitute for tea.
Follow-up after ten days: Thirst significantly controlled, drinking amount decreased, nose moist with discharge, breathing improved. No change in the prescription, advised to continue taking until fully recovered.
Comment: The disease was in the upper jiao but treated in the middle and lower, hence the lack of recovery. This shows that the same warming method should be clinically applied in conjunction with organ differentiation for better results. It also proves that Gan Cao and Gan Jiang Decoction is effective for lung cold and qi stagnation.
“Yang Deficiency and Yin Congestion – Thirst Due to Congested Fluids” Case by Chen Peijian: Xu, male, 53 years old, first diagnosed on April 21, 1983. He reported dryness in the mouth and throat for nearly two months, requiring frequent drinking, and if delayed, he experienced severe thirst, even feeling bloated after drinking, consuming about seven to eight warm bottles of water daily. His urine was clear and long, tongue slightly red, with a white greasy coating, and pulse moist and rapid. Upon examination: fasting blood sugar 108mg%, urine sugar negative. He had previously taken over 50 doses of heat-clearing, yin-nourishing, and fluid-generating herbal medicine without effect. I believe this condition is due to damp-heat, and should be treated with drying and transforming methods, thus selecting Ping Wei San and San Ren Tang for modification. After taking three doses, he returned for follow-up, reporting increased dryness and thirst, requesting a different treatment. I proposed Ling Gui Zhu Gan Tang as the main treatment: 30g of Fu Ling (Poria), 9g of Gui Zhi (Cinnamon Twig), 9g of Bai Zhu (White Atractylodes), and 3g of Gan Cao (Licorice). I instructed him to take one dose first and observe the condition. The next day he reported a slight reduction in thirst, continued with four more doses, and the symptoms resolved.
Comment: The initial treatment misdiagnosed the condition; after detailed inquiry, it was found that the unceasing thirst and bloating were due to water dampness not being transformed; the thirst and dry throat with a non-yellow tongue coating indicated no heat. This was due to middle jiao yang being weak, unable to transform qi and move fluids, leading to fluids not ascending to the mouth. However, due to no difficulty in urination, I did not use Wu Ling San to promote urination but instead used Ling Gui Zhu Gan Tang to assist middle yang, warm and transform water dampness, strengthen the earth to transform dampness, and gradually alleviate thirst.
“Yang Deficiency and Yin Congestion – Constipation Due to Congested Fluids” Case by Yu Changrong: Huang, female, 35 years old. Recently recovered from edema, still with slight facial swelling, pale complexion, and unremarkable lips. Recently experiencing continuous stomach pain, dryness in the mouth, and not having a bowel movement for three days. Pulse was deep and rough, tongue white and dry. I proposed a dose of Li Zhong Tang, using: 12g of Dang Shen (Codonopsis), 9g of Bai Zhu (White Atractylodes), 6g of Gan Jiang (Dried Ginger), and 9g of Zhi Gan Cao (Honey-fried Licorice).
A disciple asked: Using Li Zhong Tang for dry mouth and constipation, is there not a fear of worsening dryness and constipation? I replied: This condition is due to spleen deficiency and middle yang not being vigorous, leading to loss of transportation and distribution of fluids. Fluids do not ascend, hence the dry mouth and tongue; they do not descend, hence the constipation. This is a case of Tai Yin deficiency cold, not Yang Ming excess heat. From the patient’s past medical history and current complexion and pulse, it can be seen that the pain is continuous, the abdomen is not hard, and there is no resistance to pressure, indicating a deficiency pain. Therefore, I used Li Zhong Tang to warm the middle and strengthen the spleen, invigorating spleen yang, allowing fluids to circulate, thus alleviating all symptoms.
The next day upon follow-up, the bowel movement had occurred, the mouth and tongue were moist, and the stomach pain had decreased, thus I prescribed Liu Jun Zi Tang to improve the recovery.
Comment: (Original comment) In this case, using Li Zhong Tang for dry mouth and constipation is based on the principle of “blockage due to blockage” and the reverse treatment method. The key to diagnosis lies in analyzing the cause and condition, distinguishing between cold and heat, deficiency and excess. Only those with deficiency cold can use this formula; for excess heat, one should consider using Cheng Qi Tang. The saying goes, “A slight deviation can lead to a thousand miles of error,” thus differentiation and treatment cannot be neglected!
“Yang Deficiency and Yin Congestion – Constipation” Case by Zhou Fengwu: Chen, female, 52 years old. Constipation, having a bowel movement every five to six days, stools hard as sheep droppings. Accompanied by dry mouth and thirst, but unable to drink, feeling qi rising, dizziness, palpitations, and fullness in the chest, with increased symptoms at night, and slight edema in the body, with reduced urination, facial puffiness, and bluish color under the eyes, tongue thick and pale, with bitter and slippery coating. This is a case of heart and spleen yang deficiency, with water retention, and fluids not circulating. The treatment should warm and promote yang qi, and reduce water retention. The prescription: 30g of Fu Ling (Poria), 9g of Gui Zhi (Cinnamon Twig), 6g of Bai Zhu (White Atractylodes), and 6g of Zhi Gan Cao (Honey-fried Licorice).
After taking two doses, dizziness, palpitations, and qi rising were reduced, indicating that the water retention was warmed and transformed. I then added 3g of Rou Gui (Cinnamon) and 12g of Ze Xie (Alisma) to assist yang, eliminate yin, and promote water and fluid movement. After taking two more doses, the dry mouth was alleviated, bowel movements occurred naturally, and the spirit improved, with further improvement in qi rising. I switched to Wu Ling San and Zhen Wu Tang combined, to assist yang, eliminate yin, and promote water and fluid movement.
Comment: This case of constipation accompanied by fullness in the chest and qi rising indicates that the heart and spleen yang is deficient, and water retention is present. When water retention does not transform, fluids do not distribute, leading to thirst above and constipation below. The treatment should focus on warming yang and transforming fluids, waiting for yang to recover and fluids to transform, thus constipation will resolve and thirst will disappear, which is the method of transforming yin into sweet dew. If one mistakenly uses purgatives, it will inevitably lead to severe consequences.
“Yang Deficiency and Yin Congestion – Loss of Voice” Case by Liu Duzhou: Bi, female, born October 26, 1987. Patient has lost her voice for over four months, to the extent of being unable to speak, and her family reported the condition. She had taken a large amount of yin-nourishing and heat-clearing products and Western medicine, but with no effect. The patient had a hoarse voice, a feeling of obstruction in the throat, thirst and desire to drink, and dizziness. Her bowel movements were normal, but urination was not smooth, with pale color and no yellow. The pulse was deep, and the tongue was pale and tender, with a slippery coating. The treatment must warm yang, descend qi, benefit the throat, eliminate water, and promote urination, thus the most suitable prescription is Wu Ling San: 30g of Fu Ling (Poria), 15g of Zhu Ling (Polyporus), 16g of Ze Xie (Alisma), 10g of Bai Zhu (White Atractylodes), and 10g of Gui Zhi (Cinnamon Twig).
After taking five doses, the feeling of obstruction in the throat was greatly reduced, and the long-standing difficulty in urination was also resolved. However, there was still severe nasal congestion and reduced sense of smell, so I added 0.5g of Ma Huang (Ephedra) to the original prescription, and continued with three more doses until the patient was cured. Since then, there has been no recurrence.
Comment: This is a case of water retention not transforming, fluids not circulating, and yang qi unable to warm and illuminate, with yin qi obstructing the throat. Fluids can moisten the orifices, but when water accumulates and does not transform, there will be both congestion and deficiency, leading to dry throat, thirst, desire to drink, and difficulty in urination. Water is an evil yin, and the head is the meeting place of all yang. When yin water rises, it causes dizziness. The tongue and pulse signs also indicate a case of yin congestion not transforming. The previous physician did not recognize this, seeing the dry throat and thirst, mistakenly believing it was due to insufficient fluids in the lung and stomach, and recklessly prescribed cold and sweet nourishing products, which further assisted yin and harmed yang, causing water to congeal. Therefore, Wu Ling San should be used to warm yang, transform qi, benefit the throat, and promote urination, waiting for the water to transform and distribute, leading to recovery.
“Yang Deficiency and Yin Congestion – Blood Stasis and Amenorrhea” Case by Yu Changrong: Chen, 40 years old. Menstruation has been delayed, with scanty flow, dark red color, and has stopped for four months. Initially suspected to be pregnancy, but after a long time without signs of fetal movement, and frequent lower abdominal pain, it was known to be amenorrhea rather than pregnancy, thus seeking medical treatment. In the past ten days, the lower abdominal pain has gradually increased, initially only at night, now painful day and night, with pain occurring three to five times daily. Often feeling fullness in the stomach, increased saliva, and frequent nausea, with cold extremities, pale complexion, and dark purple lips and eyelids. The tongue coating was white and slippery, and the pulse was weak and rough. The diagnosis was cold obstructing the middle jiao, with qi and blood stagnation. The treatment plan was to warm and promote middle yang, and regulate qi and blood. The prescription: 9g of Dang Gui (Angelica), 6g of Jiu Huang Shao (Wine-fried Peony), 9g of Gui Zhi (Cinnamon Twig), 9g of Mu Tong (Akebia), 9g of Ban Xia (Pinellia), 9g of Sheng Jiang (Fresh Ginger), 6g of Wu Yao (Lindera), 6g of Zhi Gan Cao (Honey-fried Licorice), 2g of Xi Xin (Asarum), and 3 dates. After taking three doses, menstruation resumed.
Comment: Amenorrhea, abdominal pain, pale lips, and cold extremities indicate a pattern of blood deficiency and cold stagnation causing amenorrhea. Qi and blood originate from the middle jiao, and when the stomach is obstructed and cold, with increased saliva, it indicates that the middle jiao is cold, thus unable to invigorate qi and blood. Therefore, all symptoms persist and worsen. The use of Dang Gui Si Ni Tang with Wu Yao and Sheng Jiang is to warm the stomach, disperse cold, invigorate blood, and promote menstruation. Once the earth warms and qi circulates, the cold dissipates and blood flows, then menstruation will resume.
“Yang Deficiency and Yin Congestion – Dysmenorrhea” Case by Chen Yuansheng: Wan, female, 22 years old. The patient has experienced abdominal pain during menstruation for five years, previously taking warming menstrual tonics and various medications with little effect, thus seeking my treatment. She reported that she usually feels cold and dislikes cold, with weak and soft extremities, and the lower abdomen often feels cold. Menstruation is irregular, with clear and thin discharge; during menstruation, there is severe abdominal pain, with cold hands and feet, no thirst, and occasional vomiting of clear saliva; urination is frequent. The tongue is pale and dark, with a thin coating, and the pulse is deep, slow, and weak. The diagnosis is deficiency cold reversing menstruation. The treatment plan is to use Dang Gui Si Ni Tang with Wu Yao and Sheng Jiang.
The prescription: 15g of Dang Gui (Angelica), 12g of Gui Zhi (Cinnamon Twig), 15g of Bai Shao (White Peony, wine-fried), 6g of Xi Xin (Asarum), 18g of Da Zao (Jujube), 9g of Mu Tong (Akebia), 6g of Zhi Gan Cao (Honey-fried Licorice), 9g of Rou Gui (Cinnamon), 9g of Wu Yao (Lindera), 6g of Ai Ye (Mugwort), 9g of Wu Yao (Lindera), and 9g of Sheng Jiang (Fresh Ginger), with a cup of white wine added for decoction.
I instructed her to take three doses before the next menstrual period and then take three more doses before the next period. After six doses, she was cured.
Comment: The patient has a constitution of blood deficiency, with liver yang insufficient, and cold dampness invading, leading to cold in the Jue Yin meridian, with blood vessels stagnating and not flowing, thus causing pain. Dang Gui Si Ni Tang is specifically designed for Jue Yin cold damage, and since women have the liver as their innate organ, the Jue Yin meridian encircles the yin organs and reaches the lower abdomen. Based on the pulse and symptoms, this is a case of Jue Yin deficiency cold; the absence of thirst and occasional vomiting of clear saliva indicates that there is cold retained in the stomach. Therefore, using Dang Gui Si Ni Tang with Wu Yao and Sheng Jiang warms and disperses, nourishes and promotes circulation, thus achieving the desired effect.
“Spleen Yang Deficiency – Diarrhea” Case by Zhao Shuzhen: Dai, male, 35 years old. Suffered from food poisoning during the Dragon Boat Festival, and later caught a cold, resulting in fever and chills, abdominal pain, and diarrhea. After taking dispersing and digestive medications, the exterior was resolved, but the diarrhea persisted, leading to abdominal distension and pain. He came for treatment. The abdomen was gurgling, with five to six bowel movements daily, without distension or pain, with a bland taste in the mouth, tongue coating thin and white, and pulse weak and powerless. Analyzing the condition, it was determined to be due to stomach cold and spleen deficiency. It was not suitable to use Ren Shen and Bai Zhu for tonification, nor was it appropriate to use San Ren Tang for mixed cold and heat. Therefore, for this case of stomach cold and spleen weakness, I used Gan Cao and Gan Jiang to create a formula that would warm the stomach and tonify the spleen. The prescription: 24g of Zhi Gan Cao (Honey-fried Licorice) and 9g of Gan Jiang (Dried Ginger).
Decoct and take frequently, two large doses daily, with significant reduction in diarrhea. After two days, the diarrhea completely stopped, and I used Yi Gong San to regulate and stabilize.
Comment: Abdominal pain with urgency and diarrhea indicates the need to differentiate between cold and heat. If there is fever, thirst, red urine, red tongue, and yellow coating, it indicates heat diarrhea, which should be treated with Bai Tou Weng Tang. In this case, the patient had clear urine, cold extremities, thin white tongue coating, and weak pulse, indicating Tai Yin cold diarrhea. Therefore, I used Li Zhong Tang with Zhi Gan Cao to warm the middle and disperse cold, thus achieving the desired effect.
“Spleen Yang Deficiency – Constipation” Case by Yu Changrong: Huang, female, 35 years old. Recently recovered from edema, still with slight facial swelling, pale complexion, and unremarkable lips. Recently experiencing continuous stomach pain, dryness in the mouth, and not having a bowel movement for three days. Pulse was deep and rough, tongue white and dry. I proposed a dose of Li Zhong Tang, using: 12g of Dang Shen (Codonopsis), 9g of Bai Zhu (White Atractylodes), 6g of Gan Jiang (Dried Ginger), and 9g of Zhi Gan Cao (Honey-fried Licorice).
A disciple asked: Using Li Zhong Tang for dry mouth and constipation, is there not a fear of worsening dryness and constipation? I replied: This condition is due to spleen deficiency and middle yang not being vigorous, leading to loss of transportation and distribution of fluids. Fluids do not ascend, hence the dry mouth and tongue; they do not descend, hence the constipation. This is a case of Tai Yin deficiency cold, not Yang Ming excess heat. From the patient’s past medical history and current complexion and pulse, it can be seen that the pain is continuous, the abdomen is not hard, and there is no resistance to pressure, indicating a deficiency pain. Therefore, I used Li Zhong Tang to warm the middle and strengthen the spleen, invigorating spleen yang, allowing fluids to circulate, thus alleviating all symptoms.
The next day upon follow-up, the bowel movement had occurred, the mouth and tongue were moist, and the stomach pain had decreased, thus I prescribed Liu Jun Zi Tang to improve the recovery.
Comment: (Original comment) In this case, using Li Zhong Tang for dry mouth and constipation is based on the principle of “blockage due to blockage” and the reverse treatment method. The key to diagnosis lies in analyzing the cause and condition, distinguishing between cold and heat, deficiency and excess. Only those with deficiency cold can use this formula; for excess heat, one should consider using Cheng Qi Tang. The saying goes, “A slight deviation can lead to a thousand miles of error,” thus differentiation and treatment cannot be neglected!
“Spleen Yang Deficiency – Jaundice” Case by Shen Min: Zhang, male, 59 years old, diagnosed on November 25, 1976. The patient grew up in an area where schistosomiasis was prevalent, and at a young age, he was found to have splenomegaly, with a history of gastrointestinal bleeding, ascites, and treatment for schistosomiasis. He presented with yellowing of the face for half a month, poor spirit, reduced appetite, loose stools, slightly yellow urine, pale tongue with purple spots and a thin greasy coating, and a weak pulse. Examination revealed chronic illness, pale complexion, slight yellowing of the sclera, no abnormalities in the heart and lungs, and splenomegaly at grade three, with no shifting dullness in the abdomen, visible abdominal wall veins, and liver function tests indicating jaundice index of 30 units, zinc sulfate turbidity of 17 units, serum albumin of 2.05g, globulin of 3.65g, and normal alanine aminotransferase. The diagnosis was late-stage schistosomiasis with liver cirrhosis, poor liver function, and jaundice. This is a case of middle jiao deficiency cold combined with stasis leading to deficiency jaundice. I formulated a modified Dan Yin Li Zhong Tang: 10g of Dang Shen (Codonopsis), 10g of Bai Zhu (White Atractylodes), 5g of Gan Jiang (Dried Ginger), and 30g of Dan Shen (Salvia).
After taking five doses, the jaundice slightly receded, and the symptoms improved. Continuing with the original formula for half a month, the jaundice completely resolved, and the symptoms disappeared, with liver function tests showing jaundice index of 8 units, zinc sulfate turbidity of 15 units, serum albumin of 3.25g, globulin of 3.20g, and normal alanine aminotransferase.
Comment: According to the “Medical Essentials”, “Internal injury jaundice is caused by labor injury, dietary irregularities, and cold in the middle jiao, leading to jaundice.” In this case, the accumulation of worm eggs leads to liver stasis, with wood stagnating and invading the earth, causing spleen and stomach deficiency cold, with internal dampness obstructing the liver and gallbladder, leading to jaundice. The key pathogenesis is middle jiao deficiency cold and blood stasis obstructing the channels. Therefore, I used Li Zhong Tang with Dan Shen and Yin Chen to treat it.
“Spleen Yang Deficiency – Postprandial Drowsiness” Case by Xie Fujin: Deng, female, 18 years old, diagnosed on February 6, 1987. Since July 1986, without obvious cause, she began to experience drowsiness after eating, gradually leading to postprandial drowsiness, requiring at least half an hour of sleep each time, but waking up feeling normal. After treatment at a hospital, there was no significant effect. She also experienced dizziness, pale complexion, fatigue, cold extremities, occasional fever, and spontaneous sweating, with a white and slightly greasy tongue coating, and a red tongue. The pulse was soft and slow. I prescribed Gui Zhi Jia Gui Tang: 15g of Gui Zhi (Cinnamon Twig), 10g of Bai Shao (White Peony), 6g of Zhi Gan Cao (Honey-fried Licorice), 10g of Sheng Jiang (Fresh Ginger), and 5 dates.
After taking the medicine, she woke up after only 20 minutes of resting. I then prescribed five more doses, and after taking them, she was able to stay awake after eating, but still experienced some drowsiness. After taking eight more doses, all symptoms disappeared. Follow-up after one year showed no recurrence.
Comment: The relationship between wakefulness and sleep is closely related to the movement of defensive qi and the rise and fall of yang qi. The “Lingshu” states: “Defensive qi circulates during the day and yin at night, so when yang qi is exhausted, one sleeps, and when yin qi is exhausted, one wakes.” In this case, the drowsiness occurs after eating, and waking up feels normal, indicating that it is related to insufficient spleen yang affecting the movement of defensive qi. This is evident from the dizziness, pale complexion, fatigue, cold extremities, and spontaneous sweating, along with a pale tongue and white coating. Therefore, I used Gui Zhi Jia Gui Tang to invigorate yang qi and harmonize the defensive qi, leading to recovery.
“Spleen Yang Deficiency – Abdominal Distension and Hiccups” Case by Song Jianzhong: Chang, male, 51 years old, first diagnosed on February 28, 1986. He reported that five years ago, he had experienced gastric distension and discomfort, with intermittent pain, and reduced appetite. He was diagnosed with chronic gastritis at a hospital, and after treatment, his condition improved. Recently, for the past two months, he has experienced worsening gastric discomfort, and half a month ago, he caught a cold, leading to hiccups that gradually worsened, accompanied by abdominal distension, poor appetite, and fatigue. He sought treatment. Upon examination, he presented with frequent hiccups, low voice, pale complexion, and thin white tongue coating, with a slow and weak pulse. The diagnosis indicated spleen and stomach deficiency, with cold evil invading, causing stomach qi to rise. The treatment should focus on tonifying the spleen and stomach, dispelling cold evil, and descending rebellious qi. I used Gui Zhi Jia Gui Tang with modifications: 20g of Gui Zhi (Cinnamon Twig), 15g of Bai Shao (White Peony), 15g of Dang Shen (Codonopsis), 6g of Zhi Gan Cao (Honey-fried Licorice), 9g of Gan Jiang (Dried Ginger), and 7 dates.
After taking two doses, the frequency of hiccups significantly decreased, and abdominal distension and appetite improved. After taking two more doses, the hiccups disappeared. I then reduced Gui Zhi to 9g and continued with three more doses until recovery, with no recurrence.
Comment: Long-standing gastric disease indicates that the spleen and stomach are already deficient, and cold evil has directly invaded, leading to disharmony in the spleen and stomach, causing qi to rise and resulting in hiccups. Gui Zhi Tang can harmonize the defensive qi externally and regulate the spleen and stomach internally. Adding Gui Zhi is beneficial for its sweet flavor, which helps regulate the spleen and can cause the sinking of the spleen qi and the descending of rebellious qi. When the spleen and stomach are harmonized, retained fluids will be eliminated, and accumulated food will be digested.
“Lung Yang Deficiency – Diabetes” Case by Tao Zhengshuan: Chen, male, 43 years old. Suffering from diabetes, previously diagnosed by another physician as middle yang dysfunction and lower jiao yang deficiency. Treated with warming and tonifying spleen and kidney methods, using modified Li Zhong Tang and Jin Gui Shen Qi Wan, but without effect, instead feeling fullness in the abdomen and poor appetite. He came to my clinic for treatment. Upon examination, he presented with thirst, frequent drinking, dry mouth, and dry nose without nasal discharge. His breath felt cold, tongue pale with little moisture, and pulse slightly floating, slow, and thin. The diagnosis indicated lung cold and qi stagnation, with cold fluids congested.
Proposed treatment: 10g of Gan Cao (Licorice) and 10g of Gan Jiang (Dried Ginger), decocted in the usual drinking amount and stored in a bottle, to be used as a substitute for tea.
Follow-up after ten days: Thirst significantly controlled, drinking amount decreased, nose moist with discharge, breathing improved. No change in the prescription, advised to continue taking until fully recovered.
Comment: The disease was in the upper jiao but treated in the middle and lower, hence the lack of recovery. This shows that the same warming method should be clinically applied in conjunction with organ differentiation for better results. It also proves that Gan Cao and Gan Jiang Decoction is effective for lung cold and qi stagnation.
“Lung Yang Deficiency – Salivation” Case by Zhang Yingrui: Nie, female, 45 years old. In the spring of 1951, after childbirth, she experienced a loss of balance, gradually losing weight, with a pale complexion, dizziness, and frequent salivation of white foam, dry throat, and a bland taste in the mouth, unable to sleep at night. The tongue had no coating and little moisture. The previous physician mistakenly believed it was due to blood deficiency and yin injury, and prescribed large doses of blood-nourishing and yin-replenishing herbs, along with phlegm-transforming agents, for a month without improvement, and the salivation increased, with fatigue and weakness. Upon examination, her pulse was thin and weak, and the right pulse was weak. The diagnosis indicated lung atrophy, following Zhang Zhongjing’s method, I prescribed Gan Cao and Gan Jiang Decoction to warm the middle and capture fluids: 6g of Gan Jiang (Dried Ginger) and 15g of Gan Cao (Licorice).
In the morning, after taking one dose, the salivation significantly decreased by noon. After taking one more dose, the salivation stopped, and she was able to sleep peacefully, waking up the next day. I continued with lung-nourishing and qi-invigorating herbs, and after several days of care, she recovered.
Comment: Lung atrophy can be differentiated into deficiency cold and deficiency heat. In this case, the patient presented with white foam salivation, pale complexion, dizziness, and a bland taste, with a thin and weak pulse, indicating that this was a case of lung deficiency cold. Therefore, using Gan Cao and Gan Jiang Decoction was effective.
“Lung Yang Deficiency – Enuresis” Case by Zhao Shuzhen: Liu, male, 30 years old. Suffering from enuresis for a long time, with daytime leakage and frequent nighttime leakage, causing distress. Physicians believed it was due to kidney qi deficiency, and used Gui Fu Di Huang Tang to warm the kidney and nourish water; or used solidifying agents to treat kidney deficiency; or used Huang Qi Jian Zhong Tang and Bu Zhong Yi Qi Tang for spleen and stomach deficiency. Other treatments included deer antler, purple river vehicle, and other remedies, with varying effectiveness, but the condition persisted. Upon examination, the right pulse was weak, the tongue was pale and moist with no coating. The mouth was bland, with no cough or salivation, and slightly reduced appetite. The urination was clear and long, with no urgency, and the bowel movements were thin. This condition involves the kidney, spleen, and lung. However, the previously used kidney-warming and spleen-tonifying herbs had been tried repeatedly, but the lung herbs had not been used. I recalled the case of diabetes, where the lung is the high source of water. If water does not ascend due to qi transformation, it will descend to the kidneys, and the spleen and kidneys cannot control it, leading to leakage. Therefore, treating the lung is paramount, and this case is no exception. Jing Yue stated: “Although small water is beneficial to the kidneys, the kidneys are connected to the lungs. If lung qi is insufficient, then kidney water cannot be controlled.”
This case is due to kidney deficiency, so I used Gan Cao and Gan Jiang Decoction, which originally had a source of enuresis, providing a strong basis for treatment. Thus, I prescribed 24g of Zhi Gan Cao (Honey-fried Licorice) and 9g of Gan Jiang (Dried Ginger).
Two doses later, the enuresis significantly decreased, and the salivation also reduced. After taking five more doses, all symptoms disappeared. After eight days of treatment with 16 doses, this difficult case was cured, which was beyond my initial expectations.
“Kidney Yang Deficiency – Enuresis” Case by Quan Yijing: Wang, male, 14 years old, first diagnosed on November 4, 1977. The patient has suffered from bedwetting since childhood, with no improvement despite various treatments. There were no other discomforts, and there were no dreams during bedwetting.
The prescription: 3g of Fu Ling (Poria), 5g of Gan Jiang (Dried Ginger), and 6g of Zhi Gan Cao (Honey-fried Licorice), and 9g of Dang Shen (Codonopsis).
After three doses, the patient reported no more bedwetting.
Comment: The kidneys govern the two yin and control opening and closing, relying on kidney yang. If kidney yang is insufficient, opening and closing will be disordered, leading to enuresis. Clinically, it is often seen without dreams during bedwetting. According to Quan’s experience, this formula has been repeatedly effective.
“Kidney Yang Deficiency – Drowsiness” Case by Liu Duzhou: Liu, female, 66 years old, first diagnosed on January 19, 1994. The patient had a history of hypertension and cerebral thrombosis, with limited movement in the left limbs, and experienced dizziness and headaches. One morning, she suddenly became listless, with a dull expression, and fluctuating consciousness, responding slightly when called, but soon becoming confused, speaking unclearly, and sometimes appearing to be in a dream. After multiple treatments, she was diagnosed with “senile dementia” due to CT scans showing cavernous leukoaraiosis. The patient had abdominal fullness and frequent diarrhea, with 2-4 bowel movements daily, clear urine, frequent nighttime urination, cold extremities, and body aches. The tongue coating was slippery, and the pulse was deep, thin, and weak. This is a case of cold transformation in the Shao Yin, requiring urgent warming. The prescription: 12g of Fu Zi (Aconite), 10g of Zhi Gan Cao (Honey-fried Licorice), 10g of Gan Jiang (Dried Ginger), and 14g of Dang Shen (Codonopsis).
After three doses, the patient’s spirit improved significantly, with clearer consciousness and coherent speech. However, her extremities remained cold, and abdominal fullness persisted. I then combined Si Ni Tang and Li Zhong Tang to invigorate the yang of the spleen and kidneys. After nearly 20 doses, her extremities warmed, abdominal fullness disappeared, and her urination normalized, leading to gradual recovery.
Comment: The “Shang Han Lun” states: “In the case of Shao Yin disease, the pulse is thin and weak, and the patient desires to sleep.” This highlights that the basic pathological changes in Shao Yin disease are primarily due to yang deficiency. The thin pulse indicates yang deficiency, while the weak pulse indicates yin deficiency. However, when the thin pulse appears first, it suggests that yang deficiency is the primary issue. The phrase “desires to sleep” describes the patient’s state of seeming to sleep but not truly sleeping, with a spirit that is listless and unresponsive. The essence is the body, and the spirit is the function. When the essence is abundant, the spirit is naturally vibrant; when the essence is insufficient, the spirit becomes listless and weak. Shao Yin belongs to the kidneys, which govern storage. If both yin and yang are deficient, the essence is insufficient, leading to the state of “desiring to sleep.” In this case, the elderly man is over sixty, with insufficient essence, and the yang is not vibrant, leading to the manifestation of various symptoms. Therefore, the use of Si Ni Tang is necessary to warm the body; however, it cannot nourish the yin. Thus, I added Dang Shen to nourish the essence and promote yin, which is the most appropriate treatment for cases of yang deficiency and collapse.
“Kidney Yang Deficiency – Agitation” Case by Zhou Liansan: Duan, male, with a history of weakness, thin physique, and illness for over a year, with no improvement despite treatment. The patient presented with a desire to escape, agitation, and a feeling of wanting to die, often banging his head against the wall and shouting in distress. Family members reported that he initially had mild agitation and headaches, but after multiple treatments, due to his agitation, he was given cold and cooling medications, which did not help and instead worsened his condition. His complexion was dark blue, and he appeared extremely fatigued, with shortness of breath and excessive sweating, cold extremities, and a pulse that was thin and weak. I prescribed the following: 30g of Fu Ling (Poria), 30g of Ren Shen (Ginseng), 30g of Fu Zi (Aconite), 30g of Gan Jiang (Dried Ginger), and 30g of Zhi Gan Cao (Honey-fried Licorice).
After taking the medicine, the agitation ceased, and I gradually reduced the dosage, continuing treatment for over ten doses until recovery.
Comment: In cases of Shao Yin, the heart and kidney yang are lost, leading to agitation. The patient also presented with fatigue and shortness of breath, excessive sweating, and cold extremities, with a pulse that was thin and weak, indicating a severe deficiency. The fear of losing yang leads to a state of agitation. Therefore, it is crucial to use Fu Ling Si Ni Tang to warm the yang and rescue the yin, facilitating communication between the heart and kidneys. Once the yang is restored and fluids are replenished, the agitation will cease. It is essential not to use cooling agents to eliminate agitation, as this would only exacerbate the condition.
“Kidney Yang Deficiency – Yang Collapse” Case by Bai Qizong: Li, female, 35 years old. The patient usually has insufficient yang, and after being exposed to cold evil, she experienced fever and chills, with more cold than heat, especially at night, often needing extra blankets but still feeling cold. Initially, she was treated with warming and dispersing methods, followed by bitter cold purgatives, which led to a worsening condition, leaving her bedridden for two months. The current symptoms include a pale complexion, confusion, thin physique, profuse sweating, low voice, weak breath, cold extremities, and a pulse that is thin and weak. The proposed treatment: 30g of Fu Ling (Poria), 15g of Fu Zi (Aconite), 15g of Dang Shen (Codonopsis), 15g of Gan Jiang (Dried Ginger), and 15g of Zhi Gan Cao (Honey-fried Licorice).
After taking six doses, sweating ceased, and the extremities warmed, with the pulse returning. No changes were made to the prescription, and after 16 doses, the patient was cured.
Comment: Yang deficiency due to cold should be treated with warming and dispersing methods. However, the use of cold and bitter purgatives only exacerbates the condition, leading to a severe state of collapse. Therefore, it is crucial to quickly restore yang and rescue the patient from the brink of death.
“Kidney Yang Deficiency – Diarrhea” Case by Liu Shaowu: Qi, male, 49 years old, diagnosed on October 26, 1988. Three months ago, due to hot weather, he consumed cold foods, leading to diarrhea and abdominal pain. After treatment with herbal medicine, he recovered. However, after consuming cold foods again, diarrhea recurred. Despite treatment with both Chinese and Western medicine, there was no significant effect, and the condition persisted. The patient presented with watery diarrhea, with four to six bowel movements daily, abdominal pain around the navel, a preference for warmth and pressure, cold extremities, dry mouth, pale tongue, and thin white coating, with a weak pulse. The diagnosis indicated kidney yang deficiency combined with insufficient qi and fluids. The treatment should focus on warming and tonifying the kidney’s original yang, while also nourishing qi and fluids.
The prescription: 12g of Fu Ling (Poria), 15g of Dang Shen (Codonopsis), 15g of Fu Zi (Aconite), 6g of Gan Jiang (Dried Ginger), and 10g of Zhi Gan Cao (Honey-fried Licorice).
After five doses, the diarrhea stopped, and after ten doses, the patient was cured.
Comment: The consumption of cold foods damages the spleen yang, leading to prolonged illness. The examination of the tongue and pulse indicates kidney yang deficiency. Additionally, the prolonged illness has also harmed the fluids and qi. Therefore, the treatment should focus on warming the kidney yang while also nourishing qi and fluids, which aligns with the principles of Fu Ling Si Ni Tang, resulting in good efficacy.
“Kidney Yang Deficiency – Diarrhea” Case by Lin: Male, 60 years old. The patient experienced abdominal pain and diarrhea after consuming cold foods, with four to five bowel movements daily, accompanied by cold pain in the abdomen, cold extremities, and a pulse that was deep and weak. I initially prescribed Si Ni Tang, and after taking the medicine, the abdominal pain seemed to improve slightly. However, the diarrhea persisted, and the pulse remained unchanged. I recalled the “Shang Han Lun” stating: “In cases of Shao Yin disease with diarrhea, Bai Tong Tang is the main treatment.”
The prescription: 15g of Fu Zi (Aconite), 15g of Gan Jiang (Dried Ginger), and 5 stalks of green onion.
After taking one dose, the pulse improved, and the extremities warmed. After taking another dose, the diarrhea stopped, and the patient felt at ease.
Comment: Bai Tong Tang is derived from Si Ni Tang, removing Gan Cao and adding green onion. The green onion is warm and smooth, specifically able to promote yang qi and disperse cold evil. In warming yang formulas, it can also unblock the obstructed yang qi. Therefore, Bai Tong Tang is suitable for cases of Shao Yin cold, where the yin evil is too strong, harming the yang and obstructing its flow. In such cases, the yang cannot be secured internally or circulated through the pulse, leading to a state of both deficiency and stagnation. This condition shares similarities with simple yang deficiency, such as diarrhea and cold extremities; however, in cases of both yang deficiency and stagnation, the pulse is deep and weak. Si Ni Tang can only warm and rescue the yang but cannot unblock the stagnation. Therefore, when treating yang deficiency with diarrhea and cold extremities using Si Ni Tang proves ineffective, Bai Tong Tang should be considered.
“Kidney Yang Deficiency – Abdominal Pain” Case by Luo: Male, 50 years old. During the hot summer, he experienced excessive sweating, leading to a feeling of heat and thirst. At night, after engaging in sexual activity, he felt even thirstier, leading to excessive drinking of cold water. Soon after, he experienced urgent abdominal pain and pulling sensations in the penis. The next day, he came for treatment, with a weak pulse and a tender tongue with a white coating. This is a case of Shao Yin yang deficiency, compounded by the invasion of cold evil. Immediate warming is necessary.
The prescription: 12g of Fu Zi (Aconite), 10g of Gan Jiang (Dried Ginger), 10g of Zhi Gan Cao (Honey-fried Licorice), 6g of Xiao Hui Xiang (Fennel), and 6g of Bi Cheng Qie (Coriander).
After taking just one dose, the pain ceased, and the extremities warmed.
Comment: The kidney is the source of all yang qi in the body. When the Shao Yin true yang is exhausted, the yang qi throughout the body also declines. Therefore, when the true yang of the Shao Yin is severely depleted, the symptoms will manifest. It is crucial to quickly administer Si Ni Tang to warm and restore the true yang of the Shao Yin. In this case, the patient experienced excessive sweating during the hot summer, leading to yang deficiency, and then engaged in sexual activity, which further harmed the yang. Subsequently, he drank excessive cold water, causing cold qi to invade the Shao Yin meridian. The Shao Yin meridian encircles the yin organs and reaches the lower abdomen, leading to abdominal pain and pulling sensations. However, the pulse was weak, and the extremities were cold, indicating that the Shao Yin kidney yang had already declined. Therefore, it is essential to use Si Ni Tang to warm and restore the true yang of the Shao Yin to rescue the patient. Additionally, Xiao Hui Xiang and Bi Cheng Qie were added to disperse the cold evil in the liver meridian. The combination of the herbs was effective, leading to recovery after just one dose.