A thick, greasy, white coating on the tongue: Shenling Baizhu San (Shenling Baizhu Powder) and Erchen Wan (Erchen Pill) are ineffective!
Main complaint: Sensitivity to cold, especially in the lower back and below, frequent urination, urgency, and nocturia, with cold pain in the lower abdomen, typical of Spleen and Kidney Yang deficiency.
Excess phlegm in the throat, heavy body, lack of energy, oily face, thick greasy white tongue coating with teeth marks, typical of heavy cold-dampness.
Therefore, the treatment approach remains the same:2 points:
1. Warm and tonify the Yang of the Spleen and Kidney, using Gui Fu Li Zhong (Cinnamon and Aconite Decoction) or Fu Zi Li Zhong (Aconite Decoction), both of which are warming and tonifying for the Spleen and Kidney.
2. Transform phlegm-dampness. A close look at the patient’s thick greasy tongue coating shows it is firmly adhered to the tongue, almost covering the entire surface, indicating that phlegm-dampness has spread throughout the San Jiao (Three Burners). Therefore, Shenling Baizhu San and Erchen Wan are insufficient in strength and scope.
Thus, consider approaching from3 angles:
1. Disperse the upper Jiao (upper burner) using aromatic herbs to transform dampness, such as Huo Xiang Zheng Qi (Agastache Correct Qi) or Ping Wei San (Calm the Stomach Powder), which are both heavy-scented herbs that can awaken the Spleen and Stomach. Alternatively, use lighter aromatic herbs like Zi Su (Perilla) and Jie Geng (Platycodon) to transform dampness and open the orifices.
2. Unblock the middle Jiao (middle burner) using bitter and drying herbs, such as Cang Zhu (Atractylodes) and Erchen Wan (Erchen Pill) to strengthen the Spleen and dry dampness.
3. Promote the lower Jiao (lower burner) using sweet and diuretic herbs to drain dampness, such as Wu Ling San (Five-Ingredient Powder) and Zhen Wu Tang (True Warrior Decoction), or Liu Yi San (Six-One Powder) to expel phlegm-dampness through urination.
Overall, by dispersing the upper Jiao, unblocking the middle Jiao, and promoting the lower Jiao, we can clear the pathways of the San Jiao, as the movement of water and dampness follows the pathways of the San Jiao, allowing phlegm-dampness to be expelled from head to toe.
Of course, if the phlegm-dampness is not as severe as in this patient, San Ren Tang (Three Nut Decoction) can be adjusted to facilitate the flow of phlegm-dampness in the San Jiao!
