Dr. Xiao Bai:Clinical references for TCM cases and discussions
Interpretation and Explanation of the Essentials of the Golden Chamber (3)Treatment of Spasmodic Damp Heat Disease and Pulse – Part Two ● Spasmodic Disease SectionWang Donghai【Original Text】 The patient has a hot body and cold feet, a stiff neck, aversion to cold, occasional head heat, a red face, red eyes, and a stiff mouth, with a back arching, indicating a spasmodic disease. If sweating occurs, the cold and dampness clash, and the exterior becomes more deficient, leading to severe aversion to cold. After sweating, the pulse is like a snake.【Notes】 Originally, if sweating occurs, the following six sentences do not belong to the previous text, but are related to the later eleven items where “to resolve, the pulse remains the same, but the reverse is string-like, indicating spasmodic disease”; thus, it should be separated (an error in the arrangement by later physicians).Hot body and cold feet, stiff neck, and head heat indicate symptoms of Taiyang wind-heat; a red face and stiff mouth indicate symptoms of Yangming wind-heat; back arching indicates a disease of the Du meridian.It should be known that spasmodic disease arises from internal damp-heat in Yangming, combined with external wind evil, leading to Yangming being obstructed by damp-heat, hindering the normal ascent and descent. When Yang is constrained above, it results in body heat, a red face, and head heat; when Yin is condensed below, it results in cold feet. The neck and back are the pathways of the Taiyang, Yangming, and Du meridians. The Yangming channel ascends to the face, follows the cheek, and encircles the lips. The Du meridian is connected to Yangming, and Yangming damp-heat affects the Du meridian, causing the dampness to be heavy and obstructing the flow of the meridians, leading to unyielding qi. The “Pulse Classic” states: “The Du meridian is affected, with reversed qi and urgency, the spine is stiff and there is convulsion,” hence this symptom (which Western medicine refers to as meningitis).【Original Text】 The pulse of a spasmodic patient is tight like a string, moving straight up and down.【Notes】 Tight like a string indicates the vigorous and urgent nature of wind-wood (the pulse manifestation), hence the tendons are tense and not soft. The “Pulse Classic” states: the pulse moves straight up and down. Floating indicates the Du meridian, while sinking indicates the movement of the Chong meridian.【Original Text】 The “Pulse Classic” states: “The pulse of a spasmodic patient is hidden and firm, moving straight up and down.”【Notes】 Dampness is the main cause of spasmodic disease, while wind is the main symptom (the combination of wind evil and damp evil causes spasmodic disease). Wind qi connects to the liver, which governs the tendons. When wind-heat interacts, the meridians become tense and move straight up and down (describing the pulse manifestation), indicating the Du meridian is affected (clarifying the location of the disease).【Original Text】 In Taiyang disease, if there is fever without sweating and aversion to cold, it is called rigid spasms. In Taiyang disease, if there is fever with sweating and no aversion to cold, it is called soft spasms.【Notes】 The initial onset of spasmodic disease is similar to the symptoms of Taiyang wind and cold, whether the exterior is deficient or solid (Taiyang wind-cold with exterior deficiency is the Gui Zhi syndrome, while Taiyang wind-cold with exterior solidity is the Ma Huang syndrome).【Original Text】 In Taiyang disease, if there is no sweating and urination is reduced, qi rushes up to the chest, the mouth is stiff and cannot speak, indicating the onset of rigid spasms, treated with Ge Gen Tang.【Notes】 In cases of Taiyang cold damage: fever, aversion to cold, and no sweating, with body aches and stiff neck, the exterior qi is firmly closed due to the excess of cold. Cold evil harms the body from below, causing qi to rush up to the chest; the Taiyang organ is the bladder, and the qi of the meridian is restricted by cold, leading to reduced urination; a stiff mouth indicates that the Yangming channel is obstructed by cold, hence the symptoms. In such cases, there is a tendency towards rigid spasms, and Ge Gen Tang resolves both the Yangming and Taiyang channels of wind-cold. 【Original Text】 Ge Gen Tang formula: Ge Gen 4 liang, Ma Huang 3 liang (remove the nodes), Gui Zhi 2 liang (remove the skin), Shao Yao 2 liang, Gan Cao 2 liang (roasted), Sheng Jiang 3 liang, Da Zao 12 pieces. Combine the seven ingredients with one dou of water, first boil Ma Huang and Ge Gen, reduce to two sheng, remove the white foam, add the other herbs, boil to obtain three sheng, strain, and take one sheng warm, cover to induce slight sweating, and follow the method of Gui Zhi Tang for rest and contraindications. All decoctions follow this method.【Notes】 This is a modified version of Gui Zhi Tang, reducing Gui and Shao by one liang each, adding Ge Gen 4 liang and Ma Huang 3 liang, as seen in the section on cold damage.【Original Text】 Spasmodic disease presents with fullness in the chest, a stiff mouth, inability to lie down, and cramping of the feet, which may require Da Cheng Qi Tang. Da Cheng Qi Tang: Da Huang 4 liang (washed with wine), Hou Po 0.5 jin (roasted and peeled), Zhi Shi 5 pieces (roasted), Mang Xiao 3 he. Combine the four ingredients with one dou of water, first boil the two ingredients to obtain five sheng, strain, add Da Huang, boil to obtain two sheng, strain, and add Mang Xiao, then boil again on low heat for one or two boils, and take warm in divided doses until the symptoms resolve. Refer to the “Treatise on Cold Damage” for details.【Notes】 The discussion of spasmodic disease indicates that the spasms have already formed. Fullness in the chest indicates phlegm-heat obstruction; inability to lie down indicates severe arching (describing the symptoms), which is caused by the dryness and heat of Yangming burning the tendons (explaining the cause); cramping of the feet indicates teeth grinding, which is related to the Yangming channel (explaining the cause of the symptoms). In such cases, only Da Cheng Qi Tang can purge heat and rescue Yin (the condition is urgent, requiring drastic measures).【Original Text】 In Taiyang disease, if the symptoms are complete, the body is strong, and the pulse is sinking and slow, this indicates spasms, treated with Guo Lou Gui Zhi Tang. Guo Lou Gui Zhi Tang: Guo Lou root 2 liang, Gui Zhi, Shao Yao, Sheng Jiang each 3 liang, Gan Cao 2 liang, Da Zao 12 pieces. Combine the six ingredients with nine sheng of water, boil to obtain three sheng, divide into three warm doses to induce slight sweating. If sweating does not occur, eat hot porridge to induce it.【Notes】 Complete Taiyang symptoms refer to fever, sweating, aversion to wind, and stiff neck, but the body is strong and somewhat rigid, indicating a tendency to arch. In Taiyang wind, the pulse should be floating and slow; however, this pulse is sinking and slow, indicating a cold damp pulse of the foot Taiyin. The “Treatise on Cold Damage” states: if the pulse is floating in Taiyin disease, sweating can be induced, and Gui Zhi Tang is appropriate. In this case, the symptoms are in Taiyin, but the pulse is in Taiyang, indicating that the evil has a tendency to exit. Gui Zhi Tang is used to guide the evil outward and resolve it; here, the symptoms are in Taiyang, but the spasms are caused by dampness, and the pulse is in Taiyin. Even if the body is strong and somewhat rigid, it is known to be a spasmodic disease. Spasms are the main symptom of Yangming, due to the person’s inherent cold dampness combined with Taiyang wind evil. At this time, Yangming transforms heat but has not yet fully manifested, and the external symptoms are present; thus, Gui Zhi Tang is necessary. However, there is concern that Gui Zhi, being acrid and warm, may assist Yangming’s heat and deplete fluids. Therefore, to ensure safety, Guo Lou root is added to clear Yangming and preserve fluids.【Original Text】 In Taiyang disease, if there is fever and the pulse is sinking and thin, it is called spasms and is difficult to treat.【Notes】 In Taiyang disease, the pulse should be floating and slow, indicating Taiyang wind symptoms. Now the pulse is sinking and thin, moving straight up and down, with a strong body and arching, indicating spasmodic disease (combining pulse and symptoms). This indicates that both Taiyang and Shaoyin are affected by spasms. The “Treatise on Cold Damage” in the Shaoyin section states: if there is fever and the pulse is sinking, Ma Huang Fu Zi Xi Xin Tang is appropriate. This formula warms the cold of Shaoyin, while Ma Huang resolves the exterior of Taiyang, and Xi Xin enters the Shaoyin directly. Together with Fu Zi, they disperse the cold of Shaoyin, while Ma Huang expels the cold of Taiyang, bringing the cold of Shaoyin outward to resolve it. However, spasms belong to Yangming’s main symptoms, and Yangming governs the dry heat. This cold-heat mixture makes it difficult to treat; warming the cold of Shaoyin would assist Yangming’s dry heat, while clearing Yangming’s heat would close off Shaoyin’s cold. This presents a dilemma for the physician. If encountering this condition, the physician must focus on saving the patient and cannot neglect their responsibility. If it is rigid spasms, within one or two days, if the exterior evil is still strong and has not transformed into heat, it is also possible to use Ma Huang Fu Zi Xi Xin Tang, taking one dose and observing the symptoms. If the exterior has not resolved and heat has not developed, take another dose; if the pulse has not risen but heat has developed and the exterior has not resolved, then Shaoyin is cold and Yangming is hot. One can use Ma Huang with Dou Chi and Fu Zi with Sheng Di, adding cooling herbs, following the ancient methods for treating throat diseases with white and black plasters (Liu Bao’s discussion in “Wen Re Feng Yuan” elaborates on this method). It is crucial to have extensive experience and knowledge; otherwise, acting hastily may lead to mistakes. If one takes Ma Huang Fu Zi Xi Xin Tang and the exterior resolves but heat develops, one must assess the severity of the heat and the strength of the patient, and treat according to the symptoms to clear the heat.【Original Text】 Spasmodic disease, if purged, will lead to spasms; if sweating occurs again, it will definitely lead to rigidity.【Notes】 Spasmodic disease can be caused by all six qi, primarily due to the individual’s inherent constitution being affected by external evils. Other diseases that mistakenly induce sweating or purging can also transform into spasmodic disease. For example, if there is a history of gout, wind is Yang and easily depletes blood. If purged incorrectly, the fluids will be further harmed, leading to the meridians losing nourishment, and dryness and heat will arise, resulting in spasms. If sweating occurs again, the fluids will be harmed again, leading to dryness and heat in the stomach. The “Inner Canon” states: the stomach is the sea of the five organs and six bowels, governing the nourishment of the tendons. If the stomach is dry, the tendons will lose nourishment and become rigid.【Original Text】 In Taiyang disease, excessive sweating can lead to spasms.【Notes】 In Taiyang disease, sweating should be induced, but it is best to have a slight sweat all over. If sweating is excessive (sweating like water), it will harm the Wei Yang, leading to the exterior qi being unstable; internally harming the stomach fluids will cause dryness in the stomach, leading to the tendons losing nourishment. If the exterior is deficient, wind evil can easily enter; wind qi connects to the liver, which governs the tendons. If the tendons lose nourishment, they will also become deficient, and the dryness and heat of the stomach will interact with the wind Yang, leading to spasms (two causes combined).【Original Text】 Sudden abdominal distension indicates a need for resolution. If the pulse remains the same but is string-like, it indicates spasms.【Notes】 Originally, this section should be moved to the beginning of the spasmodic disease section, as the text does not flow logically.This section on sudden abdominal distension is an extraneous text (the logic of this section is unclear, and there may be a transcription error), and no notes are provided.【Original Text】 In cases of sores, although there is body pain, sweating should not be induced; if sweating occurs, it will lead to spasms.【Notes】 In the initial stages of sores, if body pain occurs due to external evil, sweating should be resolved, but it is not advisable to use Ma Huang or Gui Zhi (which are too forceful). In cases of scabies and all types of boils, if there is excessive pus and blood loss, if sweating is induced again, it may lead to spasms (considering the inherent deficiency).【Original Text】 Spasmodic disease has moxibustion sores, which are difficult to treat.【Notes】 Moxibustion is used to warm the meridians and disperse cold; if there is no heat, it is appropriate, otherwise, it will harm the fluids and assist the heat. If the fluids are harmed, the heat will increase, and the increased heat will further harm the fluids (currently, the popularity of moxibustion should be carefully considered, as cupping follows a similar principle). If the blood is inherently deficient, then blood heat generates wind. At this time, wind-heat depletes the fluids easily, while the medicinal power nourishes the fluids, making it difficult to treat. All cases of spasms caused by fluid damage and heat are similar.The “Essentials of the Golden Chamber” interpretation and formula explanation is an excellent work by the renowned old TCM physician Wang Jisheng, compiled by his son Wang Donghai and serialized in this public account.This article is reprinted from the WeChat public account “Zeng Shi Wu Yu”; please follow.Interpretation and Explanation of the Essentials of the Golden Chamber (1) Treatment of Zangfu Meridians and Disease Pulse – Part One (Upper)Interpretation and Explanation of the Essentials of the Golden Chamber (2) Treatment of Zangfu Meridians and Disease Pulse – Part One (Lower)Recommended ReadingWang Donghai shares: TCM Reading GuideDonghai Medical Collection: Ancient and Modern Medicine, Just LuckWang Donghai teaches TCM introductory studiesOld TCM physician Wang Jisheng’s complete works on “Treatise on Cold Damage”//////////【 Read Previous Highlights 】#TCM Introductory Collection #Twelve Meridians Simplified Explanation #Donghai Medical Collection #Old TCM Experience #TCM Wonderful Formulas #Proven Secret Formulas #National Medicine Masters#Famous Cases of Cold Damage #Selected Famous Cases of the Golden Chamber#Four Gentlemen Decoction #Etiology Assignment #Herbal Properties Assignment #Herbal Properties Song of 400 Flavors #Medical Three-Character Classic #Daily Insights from Mentorship#Daily Insights on Principles, Methods, Formulas, and Herbs#TCM Serialized CollectionHe Ren Master: What is the Essence of Using Warming Meridians Decoction?Zhou Zhongying: 60 Years of Experience and Techniques in TCM Diagnosis (All Essentials)Ding Guangdi: Qiang Huo Sheng Shi Decoction for Treating “Five Morning Diarrhea”Unexpectedly, “Qing Gu San” is indeed for clearing fever after bone fractures!Dan Zha San for Treating Hyperlipidemia (with Four Hyperlipidemia Recipes)Shanghai Shen’s Women’s Medicine 600-Year Family Secret FormulaMagical! 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