| Introduction:This article shares a medical case where a child presented with high fever that persisted despite taking Western medicine. Teacher Ma comprehensively considered it to be a case of San Yang He Bing (Three Yang Combined Disease) and prescribed Da Qing Long He Xiao Chai Hu Tang (Major Green Dragon Decoction combined with Minor Bupleurum Decoction), resulting in resolution after two doses…
Hu Xishu’s Classical Formula Medicine
Teacher Ma Jiajun’s Medical Case A 6-year-old male patient, initial consultation date (online consultation): January 19, 2023. Chief complaint: fever for 2 days. The patient developed a fever yesterday morning with a temperature of 38°C, no sweating, no significant chills, no thirst, and poor appetite. After taking Oseltamivir and Ibuprofen, the temperature slightly decreased but rebounded to 39°C in the afternoon. After taking Ibuprofen and Tylenol again, there was no significant decrease in temperature, leading the parents to seek online consultation. Current symptoms: fever, no sweating, no chills, no thirst, poor appetite, normal bowel and urination, with a history of easy allergies. The tongue was red with a yellow greasy coating, and the pulse was absent. Considering the diagnosis of San Yang He Bing, the prescription was: Sheng Ma Huang (Ephedra) 10g, Gui Zhi (Cinnamon Twig) 10g, Xing Ren (Apricot Kernel) 10g, Zhi Gan Cao (Honey-Fried Licorice) 10g, Sheng Shi Gao (Gypsum) 30g, Sheng Jiang (Fresh Ginger) 10g, Da Zao (Jujube) 10g, Chen Pi (Aged Tangerine Peel) 10g, Jiang Ban Xia (Pinellia) 9g, Chai Hu (Bupleurum) 15g, Huang Qin (Scutellaria) 10g, Dang Shen (Codonopsis) 10g, Lu Gen (Reed Rhizome) 15g. Two doses were decocted and taken every 6 hours.
Results: After taking two doses, the symptoms significantly alleviated. 
Author’s Note In pediatric cases, the collection of diagnostic information is often insufficient, thus it is crucial to focus on “grasping the main symptoms”. Based on limited symptoms, accurate differentiation can still be achieved. In this case, the child had a high fever, and although there were no significant chills, the absence of sweating indicated the presence of exterior cold, which should not be overlooked in Tai Yang disease; the red tongue with a yellow greasy coating, despite the absence of thirst and abnormal bowel movements, still suggested a Yang Ming interior pattern. If not treated promptly, symptoms such as thirst and dry stools may develop; poor appetite indicated the invasion of Shao Yang; the comprehensive differentiation was thus Tai Yang, Shao Yang, and Yang Ming combined disease, leading Teacher Ma to prescribe Da Qing Long He Xiao Chai Hu Tang with modifications. Children have delicate organs, making them susceptible to external pathogens and intolerant to cold and heat, hence the addition of Lu Gen to clear the lungs and generate fluids.Teacher Ma mentioned in “Classical Formulas for Exterior Syndromes”: “In Da Qing Long Tang, the combination of Ma Huang and Shi Gao is used,as noted in the Shen Nong Ben Cao Jing, Ma Huang is bitter and warm,while Shi Gao is pungent and slightly cold.However, later generations generally consider Ma Huang to be pungent and warm, and Shi Gao to be pungent, sweet, and cold.In the Shang Han Lun, Tai Yang and Yang Ming are treated together, and Zhang Zhongjing often uses Shi Gao in combination with Ma Huang.Shi Gaois pungent, and pungent substances have a dispersing effect; for example, sweating medicines are all pungent.Sheng Shi Gaoclears interior heat while also having a tendency to disperse pathogens outward,which to some extent facilitates the resolution of exterior syndromes and the smooth flow of Qi.Therefore,in cases of combined exterior and interior diseases, Zhang Zhongjing often uses Shi Gao in combination with Ma Huang,on one hand using Sheng Shi Gao to clear heat and cold, and on the other hand enhancing the exterior resolution effect; otherwise, the goal of sweating to resolve the exterior will not be achieved.“Additionally, it is important to note that if an exogenous disease presents with poor appetite, it is often no longer a simple exterior syndrome, and one should consider whether it has affected Shao Yang.
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