1
Case Overview
Li Moumou, male, 11 years old.
Main Complaint: Nasal congestion and runny nose for 1 week, worsened with fever for 3 days.
Current Symptoms: The patient has been ill for 1 week, experiencing nasal congestion and runny nose, general discomfort, chills 3 days ago, high fever with a temperature of 39-40°C, no sweating, worse at night, headache, body aches, bitter mouth, nausea, poor appetite, cough, yellow urine, and dry stool.
Four Examinations: Facial complexion is flushed, conjunctiva is congested, tongue coating is yellow, pulse is floating and rapid.
Diagnosis: Exogenous wind-cold, lung and stomach heat accumulation.
Treatment Method: Induce sweating to release the exterior, clear heat from the lung and stomach.
Prescription: Ma Huang (Ephedra) 9g, Gui Zhi (Cinnamon Twig) 9g, Qiang Huo (Notopterygium) 9g, Chai Hu (Bupleurum) 9g, Bai Shao (White Peony) 12g, Xing Ren (Apricot Kernel) 12g, Zhu Ru (Bamboo Shavings) 12g, Shan Yao (Chinese Yam) 30g, Zhi Mu (Anemarrhena) 30g, Sheng Shi Gao (Gypsum) 24g (crushed), Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube) 5 pieces, Gan Cao (Licorice) 6g.
Doctor’s Advice: Decoction twice, take warm in two doses before bedtime. After taking the first dose, drink a small bowl of hot rice soup, and take the second dose half an hour later, aiming for slight sweating.
After 2 doses, the patient’s father reported: After taking 1 dose, sweating occurred and fever subsided, general discomfort has significantly improved. After taking 1 more dose, body temperature returned to normal, but there is still a slight cough. This is due to residual heat in the lung meridian.
Modified Prescription: Ma Huang 3g, Bai Shao 9g, Gui Zhi, Gan Jiang (Dried Ginger), Wu Wei Zi (Schisandra) (crushed) Shan Yao each 6g, Zhi Mu, Gua Lou Ren (Trichosanthes Fruit) each 12g, Zhi Sang Bai Pi (Fried Mulberry Bark) 6g, Gan Cao 3g, Sha Shen (Adenophora) 15g.
Decoction method is the same as before, and after taking 2 more doses, the patient recovered.
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Notes
This is a medical case by Dr. Liu Huimin.
This case is caused by wind-cold binding the exterior and lung-stomach heat accumulation, thus the prescription is modeled after Ma Huang Tang (Ephedra Decoction) combined with Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) for treatment, applying both methods of releasing the exterior and clearing the interior.
During the follow-up, the focus was on clearing the heat from the lung meridian, hence Sha Shen, Sang Bai Pi, and Gua Lou Ren were used to clear heat, moisten the lung, and transform phlegm, while Gan Jiang and Wu Wei Zi were used to restrain the lung and stop cough. Over two consultations, 4 doses of medicine were taken, and the illness was resolved.
The characteristic of this case is the addition of herbs that tonify the spleen and nourish the stomach in the formula for releasing the exterior and clearing the interior, along with drinking rice soup to help generate fluids in the stomach, promoting the expulsion of pathogens through sweating. Additionally, the treatment considered the patient’s constitution and the natural climate, emphasizing the importance of quickly expelling pathogens in treating exogenous diseases, attacking the pathogens without harming the righteous qi, which is Dr. Liu’s unique experience in treating exogenous diseases.
3
Dr. Liu’s Experience in Treating Exogenous Diseases
Dr. Liu Huimin’s experience in treating exogenous diseases is as follows:
(1) Proficient in Releasing the Exterior and Clearing the Interior
Dr. Liu believes: According to the discussion in the “Shang Han Lun” (Treatise on Cold Damage) that “if the disease is in the exterior, sweating can be induced,” he advocates for early exterior release, believing that in the early stages of such diseases, it is not limited to exterior symptoms, and many cases also show varying degrees of interior heat. If the exterior-releasing medicine is taken and the heat does not subside, it is because the exterior pathogen has entered the interior and transformed into heat. Therefore, treatment should simultaneously release the exterior and clear the interior to achieve the effect of resolving both.
For example, Ma Huang and Gui Zhi release the exterior, while Shi Gao and Zhi Mu clear the interior, using prescriptions like Ma Xing Gan Shi Tang and Da Qing Long Tang (Major Blue Dragon Decoction) with modifications.
He also believes that the heat accumulated internally can be cleared from the interior and simultaneously released from the exterior.
Thus, releasing the exterior and clearing the interior is his most commonly used method for treating exogenous diseases. Releasing the exterior aids in clearing the interior, and clearing the interior aids in releasing the exterior; the two complement each other.
In clinical practice, he particularly excels in using Sheng Shi Gao, and he deeply admires Zhang Xichun’s statement that “Shi Gao can reduce heat and expel heat from the exterior… it can make the internal heat dissipate through the pores.” He believes Sheng Shi Gao is spicy, sweet, cold, and cool in nature, adept at clearing heat from the qi level and also good at dispersing and releasing the muscles. Therefore, Shi Gao is the most ideal medicine for releasing the exterior and clearing the interior.
(2) Emphasizes Holistic Treatment
During treatment, Dr. Liu emphasizes the impact of natural changes on the onset and treatment of diseases. Regarding the causes of colds and influenza, he not only focuses on the deficiency of the righteous qi but also pays great attention to the pathogenic effects of the six qi (liu yin), thus in diagnosis, treatment principles, prescriptions, and medication, he considers geographical and climatic variations.
For example, in spring, he prefers to use small doses of Ge Gen (Kudzu), Bo He (Mint), and Ma Huang, in summer he often uses Xiang Ru (Elsholtzia), Hua Shi (Talc), in autumn he commonly uses Mai Dong (Ophiopogon) and Sha Shen, and in winter he must use Jiang (Ginger), Gui (Cinnamon), and Ma Huang.
Moreover, for patients with colds and other exogenous diseases, the constitution of southern and northern people differs, and the medication should also vary. Southern patients often use light and clear medicines like Dou Chi (Fermented Soybeans), Su Ye (Perilla Leaf), Jing Jie (Schizonepeta), and Fu Ping (Duckweed) for releasing the exterior, even when using Ma Huang, the dosage is often below 6g, while northern patients must use Ma Huang, with dosages often above 9g, sometimes even combining Ma Huang and Gui Zhi.
Children are pure Yang in constitution, and exogenous diseases can easily stir up liver wind, hence he often uses Gou Teng (Uncaria) and Bo He to clear heat, pacify the liver, and stop spasms.
(3) Focuses on the Function of the Spleen and Stomach
While using strong medicines to release the exterior and clear the interior, Dr. Liu places great importance on the spleen and stomach, emphasizing that the spleen and stomach are the foundation of postnatal life and the source of fluid generation.This viewpoint is reflected in his prescriptions, medication, and methods of taking medicine.
For example, when using Ma Huang, Sheng Shi Gao, and other medicines for releasing the exterior and clearing the interior, he often combines them with Shan Yao(Chinese Yam). According to the “Shen Nong Ben Cao Jing” (Shen Nong’s Classic of Materia Medica), Shan Yao has the effects of “tonifying deficiency, eliminating cold and heat evil qi, tonifying the middle and benefiting qi strength, and promoting muscle growth,” thus it can nourish yin and tonify the spleen and stomach.
Additionally, when taking medicine, he often follows the method of Gui Zhi Tang (Cinnamon Twig Decoction),“After taking, shortly after, drink a bowl of hot thin porridge to assist the medicinal effect.” He emphasizes that after taking the first dose, drink a bowl of hot rice soup to help the qi of the grain assist in sweating and also benefit the stomach qi to expel the evil externally.
This article is excerpted from: Wang Yunfu, Li Junyan. Dr. Liu Huimin’s Experience in Treating Exogenous Diseases. Zhejiang Journal of Traditional Chinese Medicine, 1996, 31(11): 507.Edited by Lan Zi, for learning and exchange purposes only. Please indicate the source when reprinting.
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