Case 11
Shao, female, 67 years old. Initial diagnosis on October 23, 2014.
Chief complaint: Diarrhea for more than 3 months.
Medical history: For more than 3 months, bowel movements more than 3 times a day, loose stools, no abdominal pain, previously treated with Chinese medicine without effect. Poor appetite, spontaneous sweating. Abdominal distension before passing gas, relief after passing gas, sometimes with borborygmi. No dry mouth, drinks little water. Sleep at night is good, no athlete’s foot, no back pain. Tongue coating is thin and white, with a thin tongue body, pulse is weak.
Prescription: Fu Ling (Poria) 20g, Zhu Ling (Polyporus) 20g, Ze Xie (Alisma) 20g, Bai Zhu (White Atractylodes) 20g, Rou Gui (Cinnamon) 6g (added later), Cang Zhu (Atractylodes) 9g, Hou Po (Magnolia Bark) 9g, Chen Pi (Dried Tangerine Peel) 9g, Xiao Hui Xiang (Fennel) 3g, Wu Yao (Lindera) 9g, Sheng Gu Ya (Barley Sprout) 30g, Sheng Mai Ya (Wheat Sprout) 30g, Ji Nei Jin (Chicken Gizzard Lining) 9g, Shen Qu (Fermented Barley) 9g. 7 doses.
Second diagnosis on October 30, 2014: After taking 2 doses of the above medicine, bowel movements returned to normal, and borborygmi ceased. However, in the past two days, small amounts of unformed stool were passed during urination. Tongue is light red, pulse is weak.
Prescription: Maintain the initial prescription, add Chi Shi Zhi (Red Stone) 30g, 7 doses.
One month later, a friend of the patient came for consultation and reported that Shao’s diarrhea had completely resolved after taking the medicine.
Explanation:
Previously discussed constipation, now we have a case of diarrhea. This patient had also taken Chinese medicine before, but it was ineffective. It actually seems quite simple; the key is to recognize the syndrome. Using Wu Ling San and Ping Wei San, which is also known as Wei Ling Tang, after two days, bowel movements returned to normal. Therefore, recognizing the syndrome can make some things quite simple.
Case 12
Wu, female, 70 years old. Initial diagnosis on October 25, 2013.
Chief complaint: Cracked lips for 2 weeks.
Medical history: Cracked and painful lips for 2 weeks. Accompanied by dry and bitter mouth, dizziness, insomnia, irritability, recurrent oral ulcers, poor appetite, bowel movements are acceptable. Tongue is light red and swollen, with a thin white coating slightly greasy, with small cracks, pulse is thin.
Prescription: Chai Hu (Bupleurum) 6g, Huang Qin (Scutellaria) 6g, Ban Xia (Pinellia) 12g, Tian Hua Fen (Trichosanthes Root) 24g, Lu Gen (Reed Rhizome) 30g, Dang Shen (Codonopsis) 18g, Jujube Seed (Ziziphus) 80g, Bai Zi Ren (Platycladus) 40g, Ye Jiao Teng (Polygoni Multiflori) 60g, Chang Pu (Acorus) 40g, Yuan Zhi (Polygala) 10g, 7 doses.
Second diagnosis on November 1, 2013: Cracked lips, dry and bitter mouth, poor sleep, fear of heat. Tongue is light red and swollen, with a thin white coating slightly greasy, with small cracks, pulse is thin.
Prescription: Sheng Di Huang (Rehmannia) 18g, Shu Di Huang (Rehmannia) 18g, Shan Zhu Yu (Cornus) 18g, Shan Yao (Dioscorea) 18g, Fu Ling (Poria) 100g, Mu Dan Pi (Moutan) 10g, Goji Berries (Lycium) 30g, Jujube Seed (Ziziphus) 100g, Bai Zi Ren (Platycladus) 40g, Ye Jiao Teng (Polygoni Multiflori) 60g, Zhi Mu (Anemarrhena) 10g, Huang Bai (Phellodendron) 10g, Mao Gen (Imperata) 30g, Zhi Bie Jia (Soft-shelled Turtle Shell) 30g, Zhi Gui Ban (Tortoise Shell) 30g, 7 doses.
Third diagnosis on November 8, 2013: Condition unchanged. Upon further inquiry into the medical history, it was found that although the patient had cracked lips and a dry mouth, she did not like to drink, urinated infrequently and in small amounts, and had loose stools. Tongue and pulse as before.
Prescription: Zhu Ling (Polyporus) 24g, Fu Ling (Poria) 24g, Ze Xie (Alisma) 24g, Bai Zhu (White Atractylodes) 24g, Rou Gui (Cinnamon) 10g (added later), Jujube Seed (Ziziphus) 100g, 7 doses.
Fourth diagnosis on November 15, 2013: After taking only 3 doses of the above prescription, the patient felt a reduction in dry mouth, and urination improved, but recently had difficulty expectorating phlegm. Other conditions remained the same, tongue and pulse as before.
Prescription: Maintain the November 8 prescription, add Sheng Gu Ya (Barley Sprout) 40g, Mai Ya (Wheat Sprout) 40g, Ji Nei Jin (Chicken Gizzard Lining) 10g, Xuan Shen (Scrophularia) 60g, 7 doses.
Fifth diagnosis on November 22, 2013: After finishing the November 8 prescription, continued with the November 15 prescription (4 doses remaining), dry mouth and cracked lips significantly reduced, urination improved, and phlegm was easier to expectorate than before. Tongue and pulse as before.
Prescription: Maintain the November 15 prescription, remove Gu Ya, Mai Ya, Ji Nei Jin, change to Xuan Shen (Scrophularia) 80g, Jujube Seed (Ziziphus) 120g, 5 doses.
After taking the medicine, dry mouth and cracked lips disappeared, but insomnia persisted. Continued treatment, and insomnia also improved significantly (slightly).
Explanation:
This patient had cracked lips, and I initially took a wrong turn in diagnosis. Because she had a dry mouth, bitter mouth, and dizziness, I considered Xiao Chai Hu Tang (Minor Bupleurum Decoction), but it did not work. Later, because she was also afraid of heat, I used Liu Wei Di Huang Wan (Six Flavor Rehmannia Pill), but it still did not work. Upon further inquiry, I learned that although her lips were cracked and dry, she did not like to drink, urinated infrequently and in small amounts, and had loose stools. This time I focused on these issues and used Wu Ling San, to be honest, I was quite anxious. Because I saw her lips were so severely cracked, I was worried that using Wu Ling San would make it worse! Unexpectedly, after taking 3 doses, she felt improvement, and after continuing the medication, she showed significant improvement. This is a case I saw in 2013.
Case 13
Wang, female, 28 years old. Initial diagnosis on June 3, 2016.
Chief complaint: Cracked and peeling lips for over 20 years.
Medical history: She reported that since childhood, her lips have been cracked and peeling, even in summer, and worse in winter. Lips are dry, but mouth is not dry; she drinks little water at home on weekends but drinks more at work, about 2000mL daily, and the amount of water does not correlate with the cracking and peeling of her lips. Usually feels cold, often has back pain, but her back is not cold, sometimes has heel pain. Dreams a lot at night; if she sleeps late, she experiences sleep paralysis; if she gets cold at night, she has cramps in her arms and itchy palms. Constipation, but sometimes has loose stools. Menstrual cycle is 28 days, with a small amount of dark bleeding 2-3 days before menstruation; moderate flow for 3-4 days, bright red; and 2-3 days of light dark bleeding at the end. Menstrual blood has few clots, with dysmenorrhea, lower back feels cold and sore, prefers warmth. A few months ago, there was intermenstrual bleeding, but none recently. Last menstrual period was on May 27. Usually has more leukorrhea. Has dark circles, lips are purple, and nails are pale. Tongue is swollen, purplish, with teeth marks on the edges, and thin white coating.
Prescription: Zhu Ling (Polyporus) 20g, Fu Ling (Poria) 20g, Bai Zhu (White Atractylodes) 20g, Ze Xie (Alisma) 20g, Rou Gui (Cinnamon) 6g (added later). 7 doses.
Second diagnosis on June 24, 2016: After taking the medicine, the cracking and peeling of the lips improved, but after stopping the medication, there was a recurrence in the past few days. Used the original formula plus Lu Jiao Shuang (Deer Antler Velvet) 30g, Ai Ye (Mugwort) 5g, 7 doses.
On August 18, 2016, the patient came for another condition, and her lips appeared only slightly dry, no cracking or peeling, and she felt significantly better.
Explanation:
This case is similar to the previous one from 2013; this time I was bolder. This patient is in her twenties but has been suffering for over twenty years. She also has cracked and peeling lips in summer, worse in winter, and drinks little water, only remembering to drink more at work. She feels cold, has back pain, and has a poor complexion, with significant dark circles at such a young age. I used Wu Ling San, and the next time she came, her symptoms had improved. After a while, she took another 7 doses, and by August 18, it was clear that her lips had improved significantly. She said that previously, her lips were cracked in summer, but this time they looked almost normal. These are all symptoms of water accumulation and qi deficiency.
Case 14
Wang, male, 10 years old. Initial diagnosis on February 6, 2016.
Chief complaint: Rash between fingers for 5 years.
Medical history: Small blisters in the spaces between the fingers of both hands, with a red base, not itchy. Bowel movements every 3-5 days, dry and hard. Good appetite, but prone to abdominal distension, prefers fried foods and meat. Sleep is okay, but experiences insomnia when stressed. Mouth is not dry, drinks little water. Hands are relatively cold. Tongue coating is peeled (front and right side), with some prickles on the front.
Prescription: Fu Ling (Poria) 12g, Zhu Ling (Polyporus) 12g, Ze Xie (Alisma) 12g, Bai Zhu (White Atractylodes) 12g, Rou Gui (Cinnamon) 3g (added later), Chai Hu (Bupleurum) 6g, Bai Shao (White Peony) 9g, Zhi Ke (Bitter Orange) 6g, Gan Cao (Licorice) 3g, 7 doses.
Second diagnosis on February 16, 2016: The rash between the fingers significantly reduced, with only a few blisters remaining between the left hand’s third and fourth fingers. Hands felt warmer, bowel movements every 1-3 days. Tongue is light red, tip slightly red, peeled coating has grown back, pulse is slightly weak.
Prescription: Maintain the previous formula, add Chen Pi (Dried Tangerine Peel) 2g, 7 doses.
Explanation:
This is a case of eczema. This child had eczema between his fingers, and his tongue had a peeled coating. Therefore, a peeled coating does not necessarily indicate yin deficiency; it can also indicate a need to nourish yang. This is also a case of water accumulation and qi deficiency. He had areas of water retention and appeared to have a deficiency of body fluids, which is very important. After taking Wu Ling San, the peeled coating actually grew back.
Case 15
Li, female, 34 years old. Initial diagnosis on June 6, 2014.
Chief complaint: Eczema on hands every summer for 23 years.
Medical history: Since I can remember, in preparatory school, every summer her hands would develop small blisters and itching, diagnosed as eczema by Western medicine. It is not yet summer, so the eczema has not yet appeared. She also reports frequent back pain, fear of wind, spontaneous sweating, frequent urination, difficulty breathing, irritability, poor sleep, dry mouth, and a preference for drinking, consuming 2.5-3L of water daily. Her complexion is dull, tongue has petechiae, pulse is weak.
Prescription: Fu Ling (Poria) 20g, Zhu Ling (Polyporus) 20g, Bai Zhu (White Atractylodes) 20g, Ze Xie (Alisma) 24g, Gui Zhi (Cinnamon Twig) 9g, Rou Gui (Cinnamon) 3g (added later). 7 doses.
Second diagnosis on June 13, 2014: Reduced back pain and spontaneous sweating, complexion improved, but still poor sleep at night. Tongue coating is thin and white, slightly greasy, pulse is weak.
Prescription: Maintain the initial prescription, remove Rou Gui, add Lu Jiao Shuang (Deer Antler Velvet) 30g, 7 doses.
Third diagnosis on June 20, 2014: Eczema has not appeared. Tongue coating is thin and white, pulse is weak.
Prescription: Maintain the June 13 prescription, change Gui Zhi to 12g, add Cang Zhu (Atractylodes) 12g, 7 doses.
Fourth diagnosis on July 4, 2014: There was an interruption in taking the medicine for the past two weeks; the patient did not come for a follow-up due to other reasons. Recently, there was one day of itching on the arms and back of the hands, but no rash appeared. After taking the above prescription, the itching subsided, and no rash has appeared since. Recently, the patient has been feeling a bit down, irritable, and feels a surge of energy in her body. Tongue coating is thin and white, pulse is weak.
Prescription: Maintain the initial prescription, add Chai Hu (Bupleurum) 9g, Chi Shao (Red Peony) 9g, Zhi Shi (Bitter Orange) 9g, Gan Cao (Licorice) 3g, 7 doses.
On January 23, 2015, the patient came for another condition and reported that she had not experienced eczema during the summer of 2014.
Explanation:
This is also a case of eczema. The patient has eczema every summer, and after taking Wu Ling San, she did not have any outbreaks that summer.
Case 16
Sun, male, 59 years old. Initial diagnosis on December 11, 2013.
Chief complaint: Night sweats and cold body for over 2 months.
Medical history: For more than 2 months, every night around 1 AM, he feels dry mouth, then experiences dryness and sweating, and after sweating, his whole body feels cold, accompanied by dizziness, and he feels phlegm rising from the right chest to the throat, which he can then expectorate, with a large amount of phlegm that is easy to expel. This situation occurs 3-4 times every night after 1 AM. During the day, he feels cold, fatigued, and wants to sleep, with neck and lower back pain. Usually, he does not feel thirsty during the day, drinks very little water, and has little phlegm. Urinates 2-3 times a day, with small amounts and yellow color. Bowel movements every 1-3 days, formed. Usually irritable, sometimes has a bitter mouth, poor appetite. Feet are very smelly, and in summer, he often develops small blisters on his hands, which are not itchy. Tongue is slightly pale purple, with a thin slippery coating, slightly peeled at the root, pulse is deep and slow (with a history of bradycardia, currently at 58 beats/minute).
Prescription: Zhu Ling (Polyporus) 24g, Fu Ling (Poria) 24g, Bai Zhu (White Atractylodes) 24g, Ze Xie (Alisma) 30g, Rou Gui (Cinnamon) 10g (added later), Yin Yang Huo (Epimedium) 20g, Xian Mao (Curculigo) 9g, Zhi Mu (Anemarrhena) 12g, Huang Bai (Phellodendron) 12g, Ba Ji Tian (Morinda) 9g, Dang Gui (Angelica) 9g, Chai Hu (Bupleurum) 9g, Huang Qin (Scutellaria) 9g. 7 doses.
Second diagnosis on December 15, 2013: The patient came for an early follow-up due to urgency to return home. He reported that after taking 1 dose, the dry mouth disappeared, the dryness and sweating, and the cold feeling after sweating were significantly reduced, and it only occurred twice, with no dizziness, and phlegm was also resolved. Neck and lower back felt relaxed, and he was more energetic (his son added: Dad used to be quiet and not smile, but after taking the medicine, he became talkative and cheerful). Bitter mouth disappeared, and appetite improved. Bowel movements were normal in the past few days, with 2 bowel movements, and urination increased to 4 times a day, with no yellow color. Tongue is slightly pale and tight, with slight peeling at the root, pulse is deep and slow (stronger than at the initial diagnosis).
Prescription: Maintain the original formula, change Zhi Mu to 9g, Huang Bai to 9g; add Chuan Lian (Andrographis) 1g, Lu Xian Cao (Luzula) 9g, 10 doses.
After finishing two courses of the medicine, his son reported that the condition had significantly improved. Due to being out of town, no further prescriptions were given.
Explanation:
This is a peculiar syndrome. The patient experiences dryness and sweating at night, followed by a cold body, and feels phlegm rising from the right chest to the throat, with a large amount of phlegm that is easy to expectorate, occurring 3-4 times every night. Other symptoms include cold intolerance, fatigue, and little thirst during the day, with little urination and foul-smelling feet. His tongue also shows slight peeling. Wu Ling San was used, along with Er Xian Tang (Two Immortals Decoction) and a bit of Xiao Chai Hu Tang (Minor Bupleurum Decoction). As a result, after taking just one dose, the dry mouth disappeared, and some symptoms improved, then he went home and showed significant improvement after taking the medicine. This patient is the spouse of the patient from the third case.
Well, I will stop here for today, thank you all!
Note:
On August 21, 2017, I gave this lecture at the “Traditional Chinese Medicine Classics and Modernization – Study and Application of Classic Formulas” graduate summer school in Shanghai. The “Traditional Chinese Medicine Family” team organized the text. Since some content overlaps with other articles in this book, I made some deletions and revisions.
March 10, 2020
（This article is excerpted from “Half a Day of Clinical Practice, Half a Day of Reading 2″） by Xing Bin, published by China Traditional Chinese Medicine Press, 2021 edition, pages 38-73）
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Same as the Poem of Duke Shen’s Assignment to the Imperial Water
Li He
Entering the garden, white and bright, the palace maids are just blooming yellow.
Around the dike, the dragon bones are cold, brushing the bank, the duck heads are fragrant.
Parting from the pavilion, a dream is startled, stopping the cup to float the small wine.
Fortunately, in the place of wandering, I can temporarily see He Lang.