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1 Xi Xin Formulas Discussions and Case Studies Chinese Wild Ginger Asarum X X n Formulas Case Studies and Discussions Translated and compiled by Sharon Weizenbaum Unless otherwise noted Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

2 Xi Xin Formulas Discussions and Case Studies Dang Gui Si Ni Tang and Dang Gui Si Ni Tang Jia Wu Zhu Yu Sheng Jiang Tang 3 Original text 4 Formula explanation 4 Cases 5 Case 1 Vaginal contraction 5 Case 2 Painful menstruation 7 Case 3 Amenorrhea 8 Case 4 Dysmenorrhea and Myoma 10 Case 5 Dysmenorrhea 12 Case 6 Late Menstruation 14 Case 7 Amenorrhea and Myoma 16 Case 8 Amenorrhea and Polycystic Ovaries 18 Case 9 Ovarian Cyst 19 Case 10 Cold lower abdominal pain 21 Case 11 Postpartum body pain and numbness 23 Gui Zhi Shao Yao Zhi Mu Tang 26 Case 1 Bi Syndrome 26 Ling Gan Wu Wei Jiang Xin Family Formulas 30 Ling Gan Wu Wei Jiang Xin Tang 30 Cases 31 Case Study 1 Phlegm Rheum 31 Gui Ling Wu Wei Gan Cao Qu Gui Jia Jiang Xin Xia Tang 33 Cases 34 Case Study 1 Phlegm Rheum 34 Case Study 2 Panting pattern 35 Discussion 35 Ling Gan Wu Wei Jiang Xin Ban Xia Xing Ren Tang 36 Cases 37 Case Study 1 Phlegm Rheum 37 Case Study 2 Phelgm Cough 38 Case Study 3 Cough 39 Discussion 41 Ling Gan Wu Wei Jiang Xin Ban Xia Xing Ren Da Huang Tang 42 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

3 Xi Xin Formulas Discussions and Case Studies Cases 43 Case Study 1 Propping Fluids 43 Case 2 Phlegm Rheum 44 Discussion 45 Table of Formulas 46 Ma Huang Fu Zi Xi Xin Tang 47 Case 1 Thyroid Cyst 47 Case 2 Shaoyin presentation nosebleed 49 Case 3 serious blepheroptosis 51 Huang Huang on Ma Huang Fu Zi Xi Xin Tang gynecology cases 55 Case 1 Polycystic Ovarian Syndrome 55 Case 2 Endometrial Cancer 57 Case 3 Anal Prolapse 58 By Dr Fan Zhong Lin 60 Case 4 Taiyang Shaoyin Pattern Chest Bi 60 Wu Pei Heng Gynecology Cases 64 Case 8 Breast Abscess Mastitis 64 Case 9 Amenorrhea 66 Case 10 Menstrual flooding with continuous nosebleed 68 Case 11 Breast Abscess mastitis 72 Xiao Qing Long Tang 74 Formula Explanation 74 Discussion 75 Dang Gui Si Ni Tang and Dang Gui Si Ni Tang Jia Wu Zhu Yu Sheng Jiang Tang Dang Gui 3 liang 12 gm Gui Zhi 3 liang 9 gm Shao Yao 3 liang 12 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

4 Xi Xin Formulas Discussions and Case Studies Xi Xin 3 liang 1 5 gm Gan Cao 2 liang 5 gm Tong Cao 2 liang 3 gm Da Zao 25 dates 8 dates Sheng Jiang jin 15 gm Wu Zhu Yu 2 sheng 5 gm Clear alcohol Original text Line 351 When the arms and legs have reversal cold and the pulse is thin and about to expire Dang Gui Si Ni Tang rules If the person has chronic cold on the interior then it is appropriate to use Dang Gui Si Ni Tang Jia Wu Zhu Yu Sheng Jiang Tang Formula explanation 1 This is a deficiency cold reversal pattern that is related to blood deficiency The cause is a cold evil that congeals and stagnates The Qi and blood then do not flow smoothly The result is that the four limbs are without warmth and nourishment The special points of this presentation are that the hands and feet have reversal cold and the pulse is thin and about to expire The hands and feet reversal cold only refers to the lack of warmth from fingers up to the palm and wrist and the toes and soles up to the ankle The degree of reversal cold is relatively light The disease mechanism for this illness is Yang Qi deficiency on the exterior with Yin and blood deficient on the interior In addition a cold evil congeals and stagnates This is why one simultaneously warms the channels to scatter cold and nourishes the blood to open through the vessels Dang Gui Si Ni Tang uses Gui Zhi Tang but without Sheng Jiang It uses three times the amount of Da Zao and added 1 Sh ng H n M ng Y Y n n J ng X an Selected Cases from Famous Physicians in the Shang Han Tradi tion Ed Che nM ng Zh ngY n Sh ng Xu Yu n Publishing Company B ij ng China 1998 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

5 Xi Xin Formulas Discussions and Case Studies Dang Gui In addition it adds Xi Xin and Tong Cao It is able to make the Yin and blood effulgent and dispel the cold guest The Yang Qi is stimulated and so the hands and feet get warm The channels and vessels open through and the vessel Qi recovers If the person s stomach Qi has old cold and accumulated cold one can add Sheng Jiang and Wu Zhu Yu Sheng Jiang warms the middle and scatters cold while down bearing and harmonizing the stomach Qi Clear alcohol is added while cooking to assist in the blood vitalizing and cold scattering strength The foundation of the pathology of this presentation is congealed cold but the location of the congealed cold can vary and the presentation can vary as well If cold congeals in the channels and collaterals you can see joint pain in the limbs or body or abdominal pain If cold congeals in the uterus you could see late menstruation that is scanty and painful For any type of blood deficiency with cold congealed on can use this formula In addition one can use this formula to treat frostbite or Reynaud s syndrome very effectively Cases2 Case 1 Vaginal contraction3 Dr Zhao Shouzhen Ms Liu was of an emaciated body type One day she worked too hard at the farm and at nightfall she was caught in the rain on her way home Her clothes and shoes were soaked so she changed only when she got home That night she had sexual intercourse It was windy and rainy that night as well as extremely cold At midnight she got up to go to the toilet Before long she got extremely cold She had many blankets but could not get warm She felt a gripping pain in her lower abdomen that got worse and worse She Sh ng H n M ng Y Y n n J ng X an Selected Cases from Famous Physicians in the Shang Han Tradi tion Ed Che nM ng Zh ngY n Sh ng Xu Yu n Publishing Company B ij ng China 1998 pg 500 2 3 1962 88 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

6 Xi Xin Formulas Discussions and Case Studies waited until morning and by that time her vagina had become tight and contracted She was aware of a pulling toward her abdomen She had a cold sweat and her hands and feet had reversal cold Her spirit was not good and she was unable to stand up She had herbs but they were not effective Her husband invited me to treat her Her pulses were minute and thin and her tongue was moist and without warmth This was a Yin cold pattern Her husband said her vagina is contracted It appears like an empty cup and there is a clear liquid coming out Seeing it makes me afraid I replied though this disease is strange treating it will be easy I saw a woman with disease in the nearby village of Wei The formula cured it Don t be afraid I gave her Dang Gui Si Ni Tang Jia Wu Zhu Yu Sheng Jiang Tang She took two big formulas in one day This was combined with more than 10 cones of moxa on Qi Hai and Guan Yuan In addition I had them press a tin pot filled with boiled water onto her lower abdomen I saw her the next day and she was beaming with smiles She was working in the kitchen and was only a bit tired Discussion 4 When shrinkage of Yang occurs it is when a man s penis contracts into his belly When shrinkage of Yin occurs it is when a woman s vagina contracts into her belly Both of these are due to liver and kidney weakness and damage Both are due either to a cold draft entering or to cold entering during the bedroom affairs The Lingshu chapter on channels and vessels says the liver Jueyin channel passes over the genitals and arrives at the belly The Suwen says All cold contracting belongs to the kidneys This woman had intercourse after being in the rain After this she went to the toilet and so cold violated her liver and kidney This was the cause of the vaginal contraction Dang Gui Si Ni Tang Jia Wu Zhu Yu Sheng Jiang Tang was used to warm the liver and kidneys and scatter the cold evil The results were very satisfying 4 I983 227 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

7 Xi Xin Formulas Discussions and Case Studies Case 2 Painful menstruation5 Dr Chen Chen Sheng Ms Wan age 22 This patient had abdominal pain already for 5 years She had taken Wen Jing Tang and other regulate menstruation herbs but the effect was very slight so she came to me for a consultation and treatment Her body generally felt cold including her four limbs and lower abdomen Her menstruation was repressed and she had clear leucorrhea Each time she menstruated she had severe abdominal pain during which time her hands and feet became very cold She did not have thirst though she vomited clear liquid and urinated abundantly Her tongue was pale and dark and the moss was thin Her pulse was deep slow thin and weak This was deficiency cold with reversal menstruation It was appropriate to give Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang 5 Dang Gui 15 Gui Zhi 12 Bai Shao stirfried in wine 15 Xi Xin 6 gm Da Zao 18 gm Mu Tong 9 gm Zhi Gan Cao 6 gm Guan Gui 9 gm Tai Wu Wu Yao 9 gm Ai Ye 6 gm Wu Zhu Yu 9 gm Sheng Jiang 9 gm Bai Jiu 1 cup 1978 3 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

8 Xi Xin Formulas Discussions and Case Studies Before the start of her menstruation she took three packages and then three more as her menstruation began There was a cure after 6 packages Discussion This case related to blood deficiency and liver Yang deficiency allowing a sneak attack of Yin cold It was Jueyin channel cold with congealed stasis in the blood vessels so that they did not open through The result was pain Dang Gui Si Ni Tang is constructed especially for Jueyin cold damage For women the Jueyin represents the preheaven The Jueyin vessels coil around the genitals and reach to the lower abdomen Regardless of the pulse picture this was a Jueyin deficiency cold pattern There was in addition a lack of thirst and vomiting of clear spittle This helped us know that there was also stomach cold This is why Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang could warm and scatter supplementing while opening through Case 3 Amenorrhea6 Dr Yu Chang Rong Ms Chen was age 40 Her menstruation up to recently came late The amount was scanty and the color was dark red Recently she had not had her menstruation for 4 months At first she thought it was pregnancy but over time there was no movement in her lower abdomen She often had lower abdominal pain so she knew that this was amenorrhea and not pregnancy This is why she came to visit For the last 10 days the abdominal pain had gradually increased In the beginning it had been just at night but then it was day and night Thought the pain was constant every day 3 5 times she would experience acute episodes She often felt stomach and chest blockage and her mouth had lots of clear spittle At times she felt like vomiting and her extremities were often cold with a pale white color Her lips and face below her eyes was a dark purplish color Her tongue moss was a white and slippery and her pulse was deficient and rough This was cold obstructing the middle Jiao with Qi and blood congealed and static The treatment principle was to warm and circulate the central Yang and open through the Qi and blood 6 1964 167 169 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

9 Xi Xin Formulas Discussions and Case Studies Dang Gui 9 gm Gui Zhi 9 gm Bai Shao from Hang 6 gm Zhou stir fried in wine Xi Xin 2 gm Da Zao 3 dates Mu Tong 9 gm Zhi Gan Cao 6 gm Ban Xia 9 gm Sheng Jiang 9 gm Wu Zhu Yu 6 gm I gave her three packages to take every other day After just these three bags her menstruation flowed Discussion Amenorrhea with abdominal pain dark lips and cold limbs is blood deficiency cold congealing the channels type amenorrhea The doctor knows that the source of Qi and blood is the middle Jiao Here there was blockage in the stomach and chest with abundant clear spittle so he knew there was cold in the middle Jiao The ceaseless pathology could not be separated from the fact that the Qi and blood could not be inspired to transform and generate This increased day by day Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang was used to warm and scatter vitalize the blood and open through the menses The earth s warm Qi turned the cold was dispelled and the blood moved The vessels flowed smoothly through so the menstruation spontaneously moved Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

10 Xi Xin Formulas Discussions and Case Studies Case 4 Dysmenorrhea and Myoma7 Initial visit January 6 2005 Ms Dong age 24 was not married Her first menstruation arrived when she was age 11 She had a history of dysmenorrhea When she was in pain her hands and feet suffered reversal cold When her menstrual cycle was regular and the amount was relatively profuse finishing in 3 4 days On November 21 2004 she went to the hospital due to extreme pain and it resolved On January 4 an ultrasound revealed several uterine fibroids sized 8mm 4mm 12mm 8mm and 9mm 6mm There was hyperplasia of the endometrium up to 19 mm Her last menstruation was on December 27th The western doctor proposed a dilation and curettage but the patient refused Her tongue was pale red with thin white moss Her pulse was thin The treatment method was to warm the menses and open through the vessels vitalize the blood and stop pain The formula was modified Dang Gui Si Ni Tang Dang Gui 9 gm Chao Bai Shao 9 gm Gui Zhi 6 gm Tong Cao 4 gm Zhi Gan Cao 6 gm Xi Xin 5 gm Da Zao 6 gm Yi Mu Cao 20 gm Pu Huang 10 gm Xue Jie 4 gm Yan Hu Suo 10 gm Jiu Xiang Chong 10 gm 7 packages Second visit 1 13 2005 After the herbs she was completely comfortable Her tongue and pulse were as above Dang Gui 7 9 gm Case 4 10 from http www laozhongyi net bbs viewthread php tid 2460 extra page 3D1 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

11 Xi Xin Formulas Discussions and Case Studies Chao Bai Shao 9 gm Gui Zhi 6 gm Tong Cao 4 gm Zhi Gan Cao 6 gm Xi Xin 5 gm Da Zao 6 dates Wu Ling Zhi 10 gm Pu Huang 10 gm Xue Jie 4 gm Yan Hu Suo 10 gm Jiu Xiang Chong 10 gm Chuan Lian Zi 10 gm Third visit January 25 2005 Her menstruation arrived on January 19th and was painless The cold was gone too Her tongue and pulse were as before The treatment method was now to vitalize blood transform stasis clear heat and disperse the mass The formula used was 14 packages of an experiential formula Xiao Zheng Tang Ban Zhi Lian 15 gm Bai Hua She She Cao 15 gm Zhi Ru Xiang 4 gm Zhi Mo Yao 4 gm Zao Jiao Ci 15 gm Shi Jian Chuan 15 gm Li Zhi Ke 12 gm Ju He 12 gm Mu Li pre cooked 20 gm Hai Zao 20 gm San Leng 10 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

12 Xi Xin Formulas Discussions and Case Studies E Zhu 10 gm 4th visit February 8 2005 Her menstruation was impending and she was without discomfort Her tongue and pulse were as above She was given 14 packages of the 1 13 formula with the addition of 20 gms of Yi Mu Cao Fifth visit February 24 2005 Her menstruation came on February 19 and was without pain The amount was moderate She finished bleeding within four days She continued treatment after that and a year later it was observed that she did not have painful menstruation again Case 5 Dysmenorrhea Initial visit June 14 2005 Ms Ye age 16 was not married She began her menstruation at age 12 and so up to now has had dysmenorrhea for 4 years Her cycle is about 26 days and she bleeds for 5 days The color is dark and clots are mixed with the blood On day 1 and 2 she has dysmenorrhea that is difficult to bear Her lower abdomen craves warmth During the pain it is difficult for her to attend classes In the past she had taken Chinese herbs but there was no result Her appetite was poor and each day she usually had diarrhea in the morning Her last menstruation was May 21 Her tongue was pale with thin white moss and her pulses were thin The western medical diagnosis was dysmenorrhea Treatment principle Warm the menses scatter cold and stop pain Formula was Dang Gui Si Ni Tang and Jin Ling Zi San From the and Shi Xiao San from the with added flavors Dang Gui 9 gm Chao Bai Shao 10 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

13 Xi Xin Formulas Discussions and Case Studies Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Da Zao 6 dates Yan Hu Suo 10 gm Chuan Lian Zi 10 gm Pu Huang 10 gm Wu Ling Zhi 10 gm Jiu Xiang Chong 10 gm Yi Mu Cao 20 gm 7 packages Second visit July 11 2005 Her menstruation was June 16 and the dysmenorrhea had clearly decreased She did have spastic pain and still had diarrhea Her tongue was pale red with thin white moss and her pulses were thin Treatment principle Warm the menses fortify the spleen scatter cold and stop pain Formula Dang Gui Si Ni Tang with Chi Wan and Li Zhong Tang Dang Gui 9 gm Chao Bai Shao 10 gm Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Fu Ling 10 gm Zhi Chuan Wu 10 gm Dang Shen 15 gm Bai Zhu 10 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

14 Xi Xin Formulas Discussions and Case Studies Gan Jiang 3 gm Ban Xia 10 gm 5 packages Third visit July 16 2005 Her menses arrived on July 14 and there was no pain and her stool had changed for the better It was now formed Her appetite was poor Her tongue was pale red with thin white moss and her pulses were thin Treatment principle warm the middle scatter cold fortify the spleen and assist its movement Formula Li Zhong Tang and Gui Zhi Fu Zi Tang with added flavors Da Zao 6 dates Dan Fu Pian 6 gm Dang Shen 10 gm Chao Bai Zhu 10 gm Pao Jiang 5 gm Ban Xia 10 gm Chi Shi Zhi 15 gm Chao Gu Ya 10 gm Gui Zhi 6 gm Chao Mai Ya 10 gm 3 packages Case 6 Late Menstruation First visit March 25 2005 Ms Ye age 32 In December of 2005 after removing an IUD her menstruation became irregular Her last menstruation was on January 20 and up to this visit it had been 65 days She had red leukorrhea for the last half month The color was dark She had spasming pain in her back and lower abdomen The urine test was negative for pregnancy Her menstrual cycle usually was regular a normal amount for 5 days crimson with clots She did not have Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

15 Xi Xin Formulas Discussions and Case Studies dysmenorrhea Her pregnancy history was 1 0 2 1 Her tongue was pale red with thin white moss Her pulse was thin Gynecology exam genitals were normal vagina open through glossy cervix retroverted uterus normal size texture and movement There was no pain with pressure though there was some pressure pain on the fallopian tubes The western diagnosis was sparse menstruation and salpingitis Treatment principle warm the menses vitalize blood and move the menses Formula Dang Gui Si Ni Tang modified Dang Gui 12 gm Chi Shao 6 gm Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Da Zao 6 dates Yi Mu Cao 20 gm Ze Lan 10 gm Wang Bu Liu Xing 12 gm 5 packages Second visit April 4 2006 She took 1 package of herb every two days On March 29 she bled a small amount of blood Her tongue and pulse were as before 10 gm of Di Bei Chong were added to the above formula 7 packages Third visit April 13 2006 She now had red leukorrhea back soreness and pain and distention and pain of the breast Her tongue and pulse were as before Dang Gui 9 gm Chi Shao 10 gm Gui Zhi 6 gm Tong Cao 5 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

16 Xi Xin Formulas Discussions and Case Studies Xi Xin 5 gm Zhi Gan Cao 6 gm Dan Shen 30 gm Yi Mu Cao 30 gm Di Bei Chong 10 gm Chuan Niu Xi 30 gm 7 packages Forth visit April 27 2006 Her menstruation arrived on April 25 and the amount was relatively profuse The color was bright red without clots She had spastic pain of the lower abdomen Her tongue and pulse were as before Treatment principle harmonize blood regulate menstruation Formula Modified Si Wu Tang from the Dang Gui 9 gm Chi Shao 10 gm Shu Di Huang 12 gm Chuan Xiong 5 gm Yi Mu Cao 12 gm E Jiao add as draft 10 gm Hai Piao Xiao 20 gm Jing Jie Tan 10 gm 5 packages Case 7 Amenorrhea and Myoma Initial visit November 15 2006 Ms Yu age 43 Her last menstruation had been August 15 She was generally fatigued Her menstruation had generally be regular and of a normal amount and bright red color She bled for 5 days Premenstrually she had breast Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

17 Xi Xin Formulas Discussions and Case Studies distention and pain no profuse leukorrhea good appetite and peaceful sleep She has tidal fever at night Her bowels and urine are normal Her chorionic gonadotropin was tested which indicated that she was not pregnant The ultrasound showed that her endometrium was 4 mm and that there was a 6 X 4 X 5 mm myoma Her pregnancy history was 1 0 2 1 Her IUD was removed Her tongue was pale red with thin white moss Her pulses were thin Gyn exam genitals were normal vagina was open through cervix was inflamed uterus retroverted normal size and movement There was no uterine pressure pain but there was pain on the adenexis The western diagnosis was amenorrhea uterine myoma chronic cervicitis and salpingitis Treatment principle Warm the menses vitalize the blood and boost the kidneys Formula Modified Dang Gui Si Ni Tang Dang Gui 9 gm Chao Bai Shao 10 gm Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Da Zao 5 dates Yi Mu Cao 20 gm Dan Shen 12 gm Xiang Fu 10 gm Tu Si Zi 12 gm Ba Ji Tian 12 gm 5 packages Second visit November 11 2006 After 4 packages of the herbs her menses arrived and the amount was moderate for 5 days She had back pain Her pulses and tongue were as before Treatment method Vitalize blood transform stasis soften hardness and scatter mass Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

18 Xi Xin Formulas Discussions and Case Studies Formula Gui Zhi Fu Ling Wan modified Gui Zhi 6 gm Fu Ling 10 gm Bai Shao 10 gm Dan Pi 10 gm Tao Ren 10 gm San Leng 10 gm E Zhu 10 gm Zao Jiao Ci 12 gm Shi Jian Chuan 15 gm Mu Li 30 gm Hai Zao 15 gm 7 packages Case 8 Amenorrhea and Polycystic Ovaries Initial Visit May 16 2007 Ms Lin age 24 Her last menstruation was May 26 2006 She had amenorrhea for a year already Her menstruation began when she was 15 and it was always late She menstruated once every 1 6 months The amount was normal and premenstrually she had no discomfort She bled for 7 days She did not have much leukorrhea Her stomach was cold and her appetite was normal The ultrasound showed that her endometrium was 8 mm and not well distributed A small dark area was shown and 10 small ovarian cysts could be seen Her tongue was pale red with thin white moss and her pulses were thin The western diagnosis was polycystic ovarian syndrome Treatment principle warm the menses vitalize blood and move the menses Formula modified Dang Gui Si Ni Tang Dang Gui 15 gm Chao Bai Shao 10 gm Gui Zhi 6 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

19 Xi Xin Formulas Discussions and Case Studies Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Da Zao 5 dates Yi Mu Cao 30 gm Dan Shen 30 gm 5 packages Second visit May 22 2005 Her menstruation came on May 20 and was of a normal amount and without discomfort Her pulse and tongue were as before Treatment principle Harmonize blood regulate menstruation Shu Di Huang 12 gm Chao Bai Shao 10 gm Dang Gui 6 gm Chuan Xiong 5 gm Xiao Hui Xiang 3 gm Yan Hu Suo 10 gm Chong Wei Zi 10 gm Xiang Fu 10 gm Tu Si Zi 10 gm 5 packages Case 9 Ovarian Cyst Initial visit April 28 2006 Ms Cai age 27 Menstrual history she began menstruating at age 14 and she flowed every 30 180 days for 7 days The amount was moderate and the color was bright red She had some cold lower abdominal pain with her menstruation but in recent years this had decreased Premenstrually she had breast distention and pain as well as lower abdominal distention The ultra sound showed that there was a mixed type cyst on her right adenexis that was 35 X 18 X 26 mm Her appetite was adequate and her Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

20 Xi Xin Formulas Discussions and Case Studies bowels and urination were normal Her tongue was pale red with thin white moss and her pulses were thin Treatment method warm the menses scatter cold vitalize blood and scatter knotting Formula Dang Gui Si Ni Tang modified Dang Gui 9 gm Chi Shao 10 gm Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Chuan Niu Xi 30 gm Yi Mu Cao 20 gm Dan Shen 20 gm Ji Nei Jin 9 gm Xiang Fu 10 gm 7 packages plus Bie Jia Jian Wan 3 gm day Second visit May 8 2006 The ultrasound showed that the cyst was now 22X12X15 mm A fetoprotein was 2 97ng ml in the normal range carbohydrate antigen CA125 was 261 53u ml normal is 0 35u ml Her tongue and pulse were as before She was given 21 packages of the same formula with the addition of 30 gm Bai Jiang Cao and 15 gm Pu Gong Ying She was also told to continue the Bie Jia Jian Wan Third visit May 29 2006 Her stool was sticky Her tongue and pulse were as before She was given 7 packages of the same herbs with 10 gm Shen Qu Fourth visit June 6 2006 The ultrasound showed that the cyst was now 14X9X11mm Tongue and pulse were as before She continued with 7 packages of the May 29 formula with Yi Mu Cao and Dan Shen increased to 30 gm and 30 gm of Ji Xue Teng added Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

21 Xi Xin Formulas Discussions and Case Studies Her menstruation came on June 17 and lasted 5 days The ultrasound on June 28 showed that the cyst was gone Case 10 Cold lower abdominal pain Initial visit November 28 2006 Ms Li age 25 had been married for 2 years and had not become pregnant She came seeking help with fertility She reported 2 years of having cold in her lower abdomen with pain and distention Her last menstruation was November 9 The ultrasound showed that her uterus was 10 4 cm diameter Her genitals vagina were normal cervix glossy and her uterus was retroverted moveable and slightly small There was no pressure pain Her tongue was pale red with thin white moss and her pulses were thin Her western diagnosis was primary infertility small uterus and chronic pelvic inflammation Treatment principle warm the menses scatter cold vitalize blood and scatter knotting Formula Dang Gui Si Ni Tang and Bai Tong Tang Dang Gui 9 gm Chao Bai Shao 6 gm Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Da Zao 6 dates Dan Fu Pian 6 gm Gan Jiang 5 gm Cong Bai 4 stalks 14 packages Second visit December 14 2006 Her menstruation had come on December 12 and had not finished yet The cold in her abdomen had decreased and she felt tight pain in her back and abdomen Her tongue and pulse were as before Treatment principle warm the menses scatter cold vitalize blood and scatter knotting Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

22 Xi Xin Formulas Discussions and Case Studies Formula Dang Gui Si Ni Tang modified Dang Gui 9 gm Chao Bai Shao 6 gm Gui Zhi 6 gm Tong Cao 5 gm Xi Xin 5 gm Zhi Gan Cao 6 gm Da Zao 6 dates Yi Mu Cao 12 gm Xiang Fu 10 gm Xiao Hui Xiang 4 gm Yan Hu Suo 10 gm 5 packages Third visit December 19 2006 Then night before she got up with watery diarrhea and intestinal noise Her tongue and pulse were as before Treatment principle warm the Yang and seep dampness move Qi and benefit movement Formula Modified Wu Ling San and Ping Wei San from the Gui Zhi 6 gm Fu Ling 12 gm Chao Bai Zhu 12 gm Zhu Ling 10 gm Ze Xie 10 gm Zhi Gan Cao 6 gm Cang Zhu 10 gm Hou Po 10 gm Chen Pi 10 gm Zhi Gan Cao 5 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

23 Xi Xin Formulas Discussions and Case Studies Shen Qu 10 gm Pao Jiang 10 gm Chao Gu Ya 10 gm Chao Mai Ya 10 gm Shan Zha 10 gm 4 packages Fourth visit December 23 2006 After one package of these herbs the diarrhea stopped and her lower abdomen became warm Her tongue and pulse were as before She continued with 3 packages of the same formula with 15 gm of Tu Si Zi and 12 gm Ba Ji Tian added Fifth visit December 26 2006 After this she got 9 more packages of these herbs and the cold did not return to her lower abdomen Case 11 Postpartum body pain and numbness8 From Huo Shen Pia Gynecology Book pg 430 Ms Wang age 30 peasant came for her consultation on July 20 2007 Ms Wang was unable to rest during the postpartum time Moreover she moved about too much and got soaked by cold water Gradually she developed whole body numbness At first she didn t take it seriously but later it increased in intensity Over the years she saw many western and Chinese doctors and took medicines but there was no clear improvement The trend was toward worsening Examination The four limbs were numb cold and painful It clearly got worse on cloudy rainy days and in the winter She had an aversion to cold and cold limbs She wore more clothes than others Her tongue was pale with white slippery moss Her pulse was deep thin and without strength This was Yang deficiency with Yin accumulation causing 8 pg 430 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

24 Xi Xin Formulas Discussions and Case Studies paralysis The treatment was to warm the channels and vitalize blood The formula was Dang Gui Si Ni Tang modified Dang Gui 30 g Gui Zhi 30 g Bai Shao 15 g Xi Xin 10 g Zhi Gan Cao 10 g Tong Cao 6g Wu Zhu Yu 10 g Mu Gua 30 g Ji Xue Teng 30 g Fu Zi 10 g 3 packages decocted in water 1 package for 1 day Second visit After taking the herbs the treatment effect was mediocre The disease was heavy and the herbs were light I gave 6 packages of the same formula increasing the Fu Zi to 30 g and adding Quan Chong 10 g and Wu Gong 2 bugs Third visit The symptoms greatly decreased I gave her 6 more packages Forth visit September 22 The pathology had dispersed She occasionally felt very slight numbness She requested treatment to consolidate the result Dang Gui 30 g Gui Zhi 50 g Bai Shao 15 g Xi Xin 10 g Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

25 Xi Xin Formulas Discussions and Case Studies Zhi Gan Cao 10 g Tong Cao 6g Wu Zhu Yu 10 g Mu Gua 30 g Ji Xue Teng 30 g Fu Zi pre cook 30 g Quan Chong 10 g Wu Gong 2 bugs 1 package for every other day Discussion Postpartum women have great deficiency and great stasis Moreover this woman was unable to rest She was over worked and this gave rise to lack of smooth flow of the blood vessels In the beginning it was not obvious but later it gradually got more serious Her Zheng Qi had not recovered and her blood vessels became seriously stagnant and congealed The lack of smooth flow of the blood vessels also prevented her from really recovering The symptom was most notable on the tips of her limbs This corresponded to Zhang Zhongjing s Dang Gui Si Ni Tang pattern However this illness was chronic Yin had accumulated Yang was depleted and the congealed blockage was extreme This is why a large dose of Fu Zi was used In addition Wu Gong and Quan Chong were used to increase the strength of warming and opening through the blood vessels The formula and pattern corresponded In the beginning the results were mediocre so the dosage of Fu Zi was increased Only then was the illness mitigated In order to strengthen her and consolidate the effect I gave her more herbs to take every other day Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

26 Xi Xin Formulas Discussions and Case Studies Gui Zhi Shao Yao Zhi Mu Tang Case 1 Bi Syndrome Translated by Per Scott Mr Gao 61 years of age retired First visit January 23rd 2007 The inner side of his right knee had been achy and painful for more than one year resulting in limping and difficulty getting up In the past he had been diagnosed with degenerative arthritis His mouth was harmonious For the last few days he has had a stuffy runny nose canker sores and normal stool His face is red the tongue is cracked with tooth marks on the sides and a white coating The pulse is thin and wiry He has had hypertension for years and takes western medications inconsistently and he tends to use alcohol Pattern differentiation and discussion of treatment There is no heat and joint pain this is exterior yin pattern The patient s course of illness is long also we see his mouth was harmonious this is interior yin pattern The pattern differentiation is a combination of Shaoyin and Taiyin disease One treats the above using modification of Gui Zhi Shao Yao Zhi Mu Tang Ma Huang 10g Gui Zhi 10g Zhi Mu 10g Cang Zhu 10g F L ng 12g Fang Feng 10g Fang Ji 10g Zhi Gan Cao 6g Chuan Fu Zi 10g Da Zao 4 pieces Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

27 Xi Xin Formulas Discussions and Case Studies Qin Jiao 10g Xian Ling Pi 10g Da Gong Lao Ye 12g Ilex cornuta Lindl Sheng Jiang 12g Seven Packets Question Since you diagnose a Shaoyin Bi pattern from a six channel differentiation perspective why do you not use Ma Huang Fu Zi Xi Xin Tang Answer The classical formula pattern differentiation s procedure is to first differentiate with eight principles so as to determine the six channels and then differentiate the formula pattern To differentiate the formula pattern one first wants to attend to the writings of Zhang Zhongjing second to rely on the transmission of masters and third the clinical exploration and thought of one s own gradually accumulating experience Thus it is said To differentiate the six channels is relatively easy yet to differentiate a particular formula pattern is relatively difficult Gui Zhi Shao Yao Zhi Mu Tang and Ma Huang Fu Zi Xi Xin Tang are both Shaoyin Taiyin combined disease formulas but their particular formula patterns are not the same The differentiation depends on each person s experience and skill at formula pattern differentiation Question At the time of diagnosis the patient s pain was quite serious why did you not add medicinals that stop pain Answer Within Chinese medicine there are not so called stop pain medicinals all are used according to entire condition of the patient and adjusted Rigid attachment to the concept of stopping pain medicinals will not lead to a result of stopping pain Question Xiang Yuan Hu Suo and Ru Xiang are not stop pain medicinals Answer They have the functions of blood enlivening and stasis eliminating and if one has blood stasis only then should they be used Like Mr Hu said regarding unilateral pain pain on one side use blood enlivening medicinals As in this case if the result after using these medicinals is that the symptoms are not resolved it could be suitable to add blood enlivening medicinals Question Xian Ling Pi plays what role in this formula Does it supplement the kidney Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

28 Xi Xin Formulas Discussions and Case Studies Answer Xian Ling Pi is a Taiyin medicinal also it enhances Fu Zi s Yang warming and strengthening functions so as to eliminate evils Second visit February 6th 2007 The sweating and the stuffy runny nose had stopped the left knee pain had decreased there was thirst there were normal bowel movements the tongue coat was white and the pulse was thin and wiry Question For two visits there has been thirst is there a combined Yangming pattern or not Answer There is not Yangming disease This is a pattern in which mistaken sweating damaged the fluids There is an external evil and internal fluids so that the fluids are not being born upwards Because of this one should treat according to Taiyin theory Note From third visit one can see that sweat inducing Ma Huang has been removed with an increase in the amount of Fu Zi used and the thirst contrarily declined The master said The six channel differentiation pertains to Shaoyin Taiyin combined illness sweating and the external evils are lessened and the fluids are diminished so one ought to remove Ma Huang the treatment is change to modified Gui Zhi jia Fu Zi Tang Gui Zhi 10g Cang Zhu 15g Zhi Gan Cao 6 Chaun Fu Zi 12g Da Zao 4 pieces Sheng Jiang 12g Bai Shao 12g F L ng 12g Fang Feng 10g Fang Ji 10g QIn Jiao 10g Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

29 Xi Xin Formulas Discussions and Case Studies Xian Ling Pi 12g Seven Packets Third visit March 3rd 2007 The nose was not stuffy nor was there a runny nose The left knee pain had basically disappeared there was no difficulty with getting from sitting to standing and his walking was not restricted in any way now there was still right foot and heel pain the mouth was not dry the cold sores had resolved the stool was normal the tongue coating white the pulse thin and wiry The formula pattern is as it was previously and the formula remains as above increasing the dose of Chuan Fu Zi to 15g for another seven packets Question On the first visit the formula worked and as the saying goes ten thousand formulas but the one that if effective is hard to get Shouldn t you continue to use the original formula Answer After the first visit after sweating was used to eliminate evils and the fluids were already damaged The Shaoyin illness formula patterns are divided into two large categories one kind is Taiyang cold damage pattern with Ma Huang Tang based formulas adding Fu Zi and the like to enhance the formula treating a patient with Shaoyin disease without sweating The second is Taiyang wind strike pattern using Gui Zhi Tang based formulas adding Fu Zi to enhance the effect of the formula treating those with Shaoyin disease with sweating In this case by mildly warming Yang to induce sweating the exterior is made weaker thus we change to the second kind of formula pattern That meant using the Gui Zhi Tang pattern as a base adding Fu Zi to enhance thus becoming Gui Zhi jia Fu Zi Tang At the third visit his illness had taken a turn for the better yet there was still has the heel pain and there was still cold damp inside Therefore I continued treating the cold damp giving a modification of the previous formula Question Regarding the use of Fu Zi in the formula it is not cooked first why Answer In the Beijing area when we use Fu Zi it was causing problems this is often due to the medicinal not matching the pattern so it is not reasonable for the patient to take it and the doses were more than 30g In general I use less than 15g and never precook but I always soak it in water for one hour Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

30 Xi Xin Formulas Discussions and Case Studies Notes This case was chronic arthritis in an elderly person and from a Chinese medicine perspective the patient has a Bi pattern Because the first visit clearly showed a combined Shaoyin and Taiyin disease and a pattern pertinent to the formula pattern of modified Gui Zhi Shao Yao Zhi Mu Tang after taking the medicinals there was sweating and the exterior pattern lessened but the fluids were damaged Thus at the second visit Ma Huang was removed from the formula At the third visit the joint pain was gone yet there was heel pain It was thus only then that a heavy eliminate cold and warming treatment was added to the above methods A chronic Bi pattern in the elderly was treated using only fourteen doses of Chinese medicinals to obtain a clear effect One cannot but attribute the effectiveness to medicinal selection of the classical formulas and their strength and greatness and the precision of the formula differentiation Ling Gan Wu Wei Jiang Xin Family Formulas Ling Gan Wu Wei Jiang Xin Tang F L ng 4 Liang 12 gm G n Ji ng 3 Liang 9 gm Gan Cao 3 Liang 9 gm Wu Wei Zi 1 2 Sheng 6 gm X X n 3 liang 9 gm Cooking Method Cooking Boil the above 5 ingredients in 8 Sheng of water to get three Sheng Remove the dregs Take half a Sheng warm 3 times each day Original text 12 37 When the surging Qi has been reduced but there is again Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

31 Xi Xin Formulas Discussions and Case Studies and coughing and chest fullness use Gu L ng W W i G n C o T ng with Gu zh removed and G n Ji ng and Xi Xin added This will treat the cough with fullness Cases9 Case Study 1 Phlegm Rheum Dr Cheng Zu Jie 10 Mr Liao age 55 This patient came in with a fever and cough with abundant phlegm Generally this patient had chronically had abundant phlegm and an occasional cough Two days previously he had received a chill and the coughing became worse The abundant phlegm that was thin and white Due to the phlegm he was not able to lay down This was accompanied by fever The pulse was floating slippery and slightly rapid The tongue moss was white and slippery I gave him one package of the Xiao Qing Long Tang Ma Huang 9 gm Gan Jiang 9 gm Zhi Gan Cao 6 gm Wu Wei Zi 6 gm Xi Xin 3 gm Gui Zhi 9 gm Bai Shao 9 gm Zhi Ban xia 9 gm Xing Ren 9 gm 9 From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 225 10 From Cheng Zu Jie s Personal Case Records Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

32 Xi Xin Formulas Discussions and Case Studies Return visit The fever had receded and the cough had gotten slightly better His spirit was better but he still did not want to eat and had lots of phlegm Fu Ling 12 gm Gan Jiang 9 gm Zhi Gan Cao 9 gm Wu Wei Zi 12 gm Xi Xin 6 gm Third visit After 2 packages of this formula his appetite was slightly better and the phlegm had also decreased His cough had leveled His tongue moss was white and his pulse was moderate I gave him 6 packages of the following herbs Fu Ling 24 gm Gui Zhi 24 gm Zhi Gan Cao 12 gm Bai Zhu 12 gm His condition then completely improved Discussion When there is coughing with chest fullness this is a condition in which there are cold fluids hidden in the lungs The treatment should warm the lungs and transform fluids while diminishing cough This formula uses Fu Ling On the one hand Fu Ling will lead and gather the fluids so they can be removed through the urination and on the other hand it will treat the source of the generation of Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

33 Xi Xin Formulas Discussions and Case Studies fluids This is why Fu Ling is the principle herb The ministers are Gan Jiang and Xi Xin which warm the lung scatter cold and transform fluids In order to prevent the Gan Jiang and Xi Xin from squandering and scattering the lung Qi Wu Wei Zi is added as an assistant Wu Wei Zi will restrain the lung Qi and stop cough Finally there is Gan Cao which synchronizes and harmonizes all of the herbs Altogether this formula scatters while restraining and opens while closing This will cause the cold in the lungs to warm up and the phlegm to transform The cough and fullness will then be cured In this case the patient had a previous condition of fluid stoppage in the interior Consequently when he received and external wind cold influence so that there was a combined evil on the interior and exterior This cause the aversion to cold and fever as well as the cough with abundant phlegm The color of the phlegm was white and it was thin He was unable to lay down He was first given Xiao Qing Long Tang with Xing Ren After 1 package the exterior had resolved and so the fever receded The cough also decreased but the phlegm rheum had not transformed This is when the formula was changed to Ling Gan Wu Wei Jiang Xin Tang This was to warm and transform cold fluids In the end the Ling Gui Zhu Gan Tang fortified the spleen and transform the fluids and so the patient was well after that It is worth pointing out that this case first shows the use of the dual method of resolving both the exterior and interior Treating the lungs was secondary and then there was treating the spleen From the simple to the profound this treatment method was orderly and this information is worth pondering deeply Gui Ling Wu Wei Gan Cao Qu Gui Jia Jiang Xin Xia Tang Fu Ling 4 liang 12 gm Gan Jiang 2 liang 6 gm Gan Cao 2 liang 6 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

34 Xi Xin Formulas Discussions and Case Studies Wu Wei Zi 1 2 sheng 6 gm Xi Xin 2 liang 6 gm Zhi Ban Xia 1 2 sheng 6 gm Cooking Boil the above 6 ingredients in eight sheng of water to get three sheng Remove the dregs Take half a sheng warm 3 times each day Original text Chapter 12 38 After you have stopped the cough and fullness if the thirst and surging Qi arise again this due to the hot nature of Xi Xin and Gan Jiang It is normal for there to be thirst when taking them However if the thirst stops this means the thirst was due to propping rheum Where there is propping rheum there is also dizziness and the dizziness is invariably accompanied by retching When there is retching add Ban Xia Cases11 Case Study 1 Phlegm Rheum12 Dr Cao Ying Fu When I lived by the North Gate I saw a married woman named Song This patient suffered from a rather persistent dry mouth She took herbs however they were generally not outside the realm of Sheng Di Huang Shi Hu Mai Men Dong Zhu Ru Zhi Mu Tian Hua Fen and Xi Yang Shen type of medicinals I saw that she had a cough with runny clear spittle a wiry pulse and a plump body This was a case of phlegm rheum so I gave her Gu L ng W W i G n C o Qu Gui Jia Jiang Xin Xia Tang After these herbs she went all day without drinking indicating that the suffering had slightly decreased Only then did I see Master Zhong s words borne out by the evidence When instead of being thirsty the thirst stopped this was 11 From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 226 12 From Cao Ying Fu s Jin Gui Fa Wei Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

35 Xi Xin Formulas Discussions and Case Studies because the thirst was due to propping rheum Case Study 2 Panting pattern13 Dr Ou Yang Lu Qin Mr Song habitually suffered from a panting pattern Because he lay down in some cold dew the cough returned He felt anxious and unstable with chest obstruction and poor appetite Occasionally he felt like vomiting Because this had begun with an exposure to cold he was given Xiao Qing Long Tang Although the cough was mostly gone the excessive sweating had left his pores open Putting on clothing bothered him Dispelling the exterior this way had caused him to shiver with cold and then receiving wind caused his cough to return even more strongly Dr OuYang said Although this pattern was caused by cold it is not a cold damage exterior pattern The flavors of Gan Jiang and Gui Zhi will warm the lung and can be used However if Ma Huang is used with Gui Zhi this will inevitably lead to lung deficiency When one sees fluid evils in the chest area with deficiency one should use Gu L ng W W i G n C o Qu Gui Jia Jiang Xin Xia Tang with Huang Qi added to consolidate the exterior I gave 5 packages and the coughing leveled but the water still overflowed upward and so there was the desire to vomit I continued by using the Wai Tai formula Fu Ling Yin and there was a cure Discussion It is generally understood that the hot herbs Gan Jiang and Xi Xin will damage the fluids and can cause mouth thirst However this thirst was stopped when taking Gan Jiang and Xi Xin and so it was due to propping fluids When fluids are above this causes dizziness When the fluids reverse into the stomach this causes vomiting There is no thirst but there is dizziness and vomiting One only needs to 13 OuYang Lu Qin s Case Studies Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

36 Xi Xin Formulas Discussions and Case Studies treat fluids and so one uses Ling Gan Wu Wei Jiang Xin Xia Tang Fresh Zhi Ban Xia is added to dispel water stop vomiting and descend rebellion It should be pointed out that both propping fluids and surging Qi can cause dizziness however when there is propping fluids the dizziness will always be accompanied by vomiting There is no vomiting when the dizziness is due to surging Qi Surging and propping fluids are differentiated this way In the first case this woman had chronic thirst This was due to obstruction of fluid evils in which the fluids could not be carried upward So this is not true thirst This is why using herbs to clear heat and generate moisture did not work Dr Cao used Ling Gan Wu Wei Jiang Xin Xia Tang and she did not drink all day and her other symptoms felt better This illustrates that the Yang deficiency and propping fluids were the culprits This verified the use of warm herbs In the second case there was a panting pattern Although this was caused by receiving cold there was no evidence of a cold damage exterior pattern Because of this when Xiao Qing Long Tang was used this caused unnecessary and excessive sweating and hence the exterior became deficient This mistreatment lead to cough and heart palpitations along with chest fullness and poor appetite At times she also felt like vomiting This was retention of water fluids in the stomach Above this encroached on the heart Ling Gan Wu Wei Jiang Xin Xia Tang was then used to dispel water and down bear rebellion I added Huang Qi to consolidate the exterior and stop sweating How can there be rebellion when one knows how to treat according to the pattern Dr Ou Yang Lu Qin was truly good at applying the classic formulas Ling Gan Wu Wei Jiang Xin Ban Xia Xing Ren Tang Fu Ling 4 liang 12 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

37 Xi Xin Formulas Discussions and Case Studies Gan Jiang 3 liang 9 gm Gan Cao 3 liang 9 gm Wu Wei Zi 1 2 sheng 6 gm Xi Xin 3 liang 9 gm Xing Ren 1 2 sheng 9 gm Zhi Ban Xia 1 2 sheng 9 gm Cooking Boil the above 7 ingredients in one Dou of water to get three Sheng Remove the dregs Take half a Sheng warm 3 times each day Original Text Chapter 12 39 After water has been eliminated and vomiting is checked if the person displays generalized swelling add Xing Ren For this pattern Ma Huang would normally be added but since the patient presents with impediment it is not included If one acts against the condition and adds this it will cause reversal The reasoning is that the person is blood deficient and Ma Huang will act to diffuse the Yang Cases14 Case Study 1 Phlegm Rheum15 Dr Cao Ying Fu Mr Ye Rui Chu worked with make up for the Li Hua company He came for a consultation on February 17 complaining of a cough that had gone on for 4 months Sometimes he would vomit spittle His right pulse was wiry on all three positions It was appropriate to down bear this surging Qi Fu Ling 9 gm Gan Jiang 4 5 gm Gan Cao 3 gm 14 From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 228 15 Cao Ying Fu in the Jingfang Shiyan Lu 1 1979 3 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

38 Xi Xin Formulas Discussions and Case Studies Wu Wei Zi 3 gm Xi Xin 3 gm Xing Ren 12 gm Zhi Ban Xia 9 gm Second visit February 19 After this formula the cough had slightly calmed but there was still a lot of spittle When he coughed the phlegm was not easy to dispel I added Jie Geng to the original formula Fu Ling 9 gm Gan Jiang 4 5 gm Gan Cao 3 gm Wu Wei Zi 1 5 gm Xi Xin 1 8 gm Xing Ren 12 gm Zhi Ban Xia 9 gm Jie Geng 12 gm After 2 packages of this formula the illness decreased After giving this formula again He was quickly cured Case Study 2 Phelgm Cough16 Dr He Ren Mr Sun age 60 Cadre On December 29 1977 he came for a consultation He had phlegm panting asthma with cough rebellion His chest and epigastric areas were full and oppressed When it was acute his Qi would surge in an upward rebellion He had coughing fits during which his face became red and he would become dizzy He had an aversion to cold scanty urination and a puffy face His pulse was deep and his tongue moss was white and completely covered his tongue The treatment principle was to calm the Qi and reduce the fluids Gui Zhi 16 6 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

39 Xi Xin Formulas Discussions and Case Studies Fu Ling 18 gm Gan Jiang 3 gm Gan Cao 6 gm Wu Wei Zi 4 5 gm Bei Xi Xin 3 gm Xing Ren Remove peel and tip 9 gm Zhi Ban Xia 9 gm Chen Po Ke17 15 gm Chuan Bei Mu 4 5 gm Ju Hong 4 5 gm Return visit January 2 1978 After the herbs the coughing diminished and the surging qi calmed The aversion to cold also resolved and the urination was uninhibited I gave 5 packages of the original formula again Gui Zhi 6 gm Fu Ling 15 gm Gan Cao 6 gm Wu Wei Zi 4 5 gm Bei Xi Xin 3 gm Xing Ren 9 gm Jiang Xia 9 gm Chen Po Ke18 15 gm Ju Hong 4 5 gm Case Study 3 Cough19 Dr Zhang Zhi Min s 17 Is the hard cover of Cucurbitaceae 18 Is the hard cover of Cucurbitaceae 19 Zhang Zhi Min s Case Studies Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

40 Xi Xin Formulas Discussions and Case Studies Mr Zhang came for a consultation on March 13 1945 He had gotten a cold and a cough He was given 3 packages of the following herbs to moisten the lungs and transform phlegm with added herbs for resolving the exterior Jie Geng 4 5 gm Chuan Bei Mu 9 gm Zhe Bei Mu 9 gm Xing Ren 12 gm Fu Ling 12 gm Chen Pi 6 gm Jiang Ban Xia 12 gm Gan Cao 6 gm Fang Feng 6 gm Zi Su Zi 9 gm Ju Hong 6 gm Zhu Ru 9 gm Sang Ye 9 gm Return visit March 22 The cough was cured but returned again This was because the herbs were given in a lazy way The evil had actively seized the opportunity He choked if he spoke too much This was Qi reversal The treatment should downbear and so I used Ling Gan Wu Wei Jiang Xin Xia Xing Tang Fu Ling 12 gm Gan Cao 6 gm Wu Wei Zi 3 gm Xi Xin 3 gm Gan Jiang 3 gm Xing Ren 12 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

41 Xi Xin Formulas Discussions and Case Studies Jiang Ban Xia 9 gm After 3 packages the coughing and choking was cured Discussion When there is water in the stomach this causes vomiting When one has water in the lungs this takes the form of swelling When recent vomiting has ceased and swelling takes form this means that although the stomach has been harmonized the lung Qi is occluded In this case not only is Ling Gan Wu Wei Jiang Xin Xia Tang was given Xing Ren is also added to pungently open and discharge with bitter This opens up the blockage in the lungs so that the lung Qi is open through and regulated The water will then spontaneously move and the swelling will also naturally disperse Generally when there is swelling formed like this one should add Ma Huang to induce sweat and scatter swelling However this person had blood deficiency and Ma Huang will also push out the Yang Qi making the deficiency worse Therefore it should not be used The Shanghanlun points out that When one has bleeding one mustn t have sweat induced This way of thinking is also abundantly expressed in the Jingui Yaolue In the first case the patient was coughing and vomiting spittle Dr Cao saw that the pulse was wiry and this represented a water evil and gave him Ling Gan Wu Wei Jiang Xin Xia Xing Tang Although the cough eased the phlegm was not easy to dispel He added a large amount of Jie Geng to the formula Jie Geng pungently scatters and bitterly discharges This formula was able to dispel phlegm In the second case there were propping fluids This was due to water being retained in the lungs The lungs could not disseminate and down bear and this resulted in phlegm panting with reversal cough There was chest and epigastric fullness and oppression In addition he had surging Qi with rebellion upward and a red face as if he was inebriated His urine was scanty and he had dizziness Gui Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

42 Xi Xin Formulas Discussions and Case Studies Ling Wu Wei Gan Cao Tang was used for the surging Qi and this was combined with Ling Gan Wu Wei Gan Xin Xia Xing Tang to warm the lungs and down bear fluid disinhibit water and scatter swelling Chen Po Ke was added to increase the function to disinhibit water and scatter swelling This is definitely effective to treat the facial swelling and inhibited urination The third case of cough started with a very minor cough However because the treatment did not address the root After 8 or 9 days there was a choking cough with Qi rebellion which indicated that the exterior evil had entered the interior Therefore Ling Gan Wu Wei Jiang Xin Xia Xing Tang was used and there was a cure This formula is a modification of Xiao Qing Long Tang It is actually Xiao Qing Long Tang without Ma Huang and with Fu Ling and Xing Ren added The two books Shanghanlun and Jingui Yaolue truly must be combined and not separated In modern times this formula is often used to treat acute or chronic bronchitis bronchial asthma pulmonary emphysema chronic nephritis and asthma originating from the heart Ling Gan Wu Wei Jiang Xin Ban Xia Xing Ren Da Huang Tang Fu Ling 4 liang 12 gm Gan Jiang 3 liang 9 gm Gan Cao 3 liang 9 gm Wu Wei Zi 1 2 sheng 6 gm Xi Xin 3 liang 9 gm Xing Ren remove peel and tip 1 2 sheng 9 Zhi Ban Xia 1 2 sheng 9 gm Da Huang 9 gm Cooking Boil the above 7 ingredients in one Dou of water to get three Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

43 Xi Xin Formulas Discussions and Case Studies Sheng Remove the dregs Take half a Sheng warm 3 times each day Original Text Chapter 12 40 If the face is hot as if the person were drunk this is stomach heat surging upward to smoke the face In this case add Da Huang to disinhibit Cases20 Case Study 1 Propping Fluids21 Dr Qian Tian Zong Bai 50 years previously this patient had bled profusely His face had become very dark and his lips were pale He also had edema in his four limbs and palpitations in his chest shortness of breath and an inability to walk Sometimes the bleeding would return I gave him Liu Jun Zi Tang with Xiang Fu Hou Po and Mu Xiang made into pellets The bleeding stopped and the water Qi also decreased but the blood luster did not return to normal When autumn turned into winter he developed an extreme cough with chest fullness and whole body swelling He had to lean on something to breath and could not lay down One doctor erroneously considered this the type of water swelling that needed disinhibiting urination formulas but these had no effect When I saw him I was fearful that this was propping fluids I needed to first control these fluids and then the cough and superficial swelling would spontaneously be cured I used Ling Gan Wu Wei Jian Xin Ban Xia Xing Ren Da Huang Tang with Ting Li Zi for 2 3 days and the cough and chest fullness decreased The flooding swelling also suddenly cleared I later used this method to cure water swelling in several other people You younger students should commit this to memory 20 From Appraising Jin Gui Formulas through One Hundred Cases and Discussion compiled and written by H R n Zh ng Zh m n and Li n Ji nw i Zhe Jiang science and technology press September 1991 pg 230 21 18 9 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

44 Xi Xin Formulas Discussions and Case Studies Case 2 Phlegm Rheum22 Dr Liu Wei Xin Ms Wang was 55 years of age She lived in Chongqing city middle region on Zheng Yang road 11 She was a staff person at a household goods shop at the Jie Fang monument In May of 1977 she came for a consultation She suffered from cough and panting with fatigue that recurred each winter It became very heavy in the winter and then at the awakening of insects it lightened It had recurred like this for more than 10 years She went from this hospital to hospital being hospitalized for treatment many times She was diagnosed with chronic bronchitis and with obstructive pulmonary edema and cardiopulmonary disease She took western medicines for treatment and would get better but each time she encountered and external evil it would return Her family was worried The next time the illness recurred she not only suffered the above symptoms in addition her face flushed red as if she was inebriated and her bowels had not moved for 3 days When they did move they were like sheep turds After she moved her bowels the coughing became worse Her pulse was thin and rapid and her tongue moss was thin and white and the body of her tongue had scanty fluids Based on the pulse and presentation this was determined to be water fluids harassing the lungs so that they could not be regulated or open This caused the bowel to become constipated To discharge heat and disperse fluids I used I used Ling Gan Wu Wei Jia Jiang Xin Xia Xing Da Huang Tang Fu Ling 15 gm Gan Cao 3 gm Wu Wei Zi 9 gm Gan Jiang 9 gm Xi Xin 3 gm 22 2 40 1982 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

45 Xi Xin Formulas Discussions and Case Studies Xing Ren remove peel and tip 12 gm Zhi Ban Xia 9 gm Da Huang 12 gm Quan Gua Lou 18 gm After 1 package her bowels moved and her red flushed face as if drunk resolved I repeated this formula without the Da Huang and I added 24 gm of Bei Sha Shen and gave her two more packages Her whole illness then decreased To follow up I gave her Sheng Mai Di Huang Tang and she was cured Discussion To become completely familiar with fluid retention patterns one must see the pattern in which the face becomes red as if drunk This is likened to stomach heat following the channel and surging upward and causing sweltering on the face This is because the stomach Yangming channel travels up to the face This is why Da Huang is added to Ling Gan Wu Wei Jiang Xin Xia Xing Tang This addition will open and disinhibit the stool and discharge stomach heat Although the formula includes Gan Jiang Xi Xin and Zhi Ban Xia the herbs each have their respective functions and are not mutually exclusive Moreover stomach heat surging into the face causing facial heat as if drunk is not the same as surging Qi with feather warm heat as if drunk The first is middle warmer Yangming heat and therefore bitter cold herbs should be used to purge The latter is a lower jiao surging Chong vessel illness Therefore one should use sour warm herbs to restrain in order to down bear This must be differentiated In case 1 there was cough with chest fullness with edema of the whole body He had to lean on things to breath and could not lay down This was propping fluids Dr Qian Tian used Ling Gan Wu Wei Jiang Xin Xia Xing Jia Da Huang Tang with Ting Li Zi In order to verify this formula pattern there must be inhibition of Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

46 Xi Xin Formulas Discussions and Case Studies the bowels and urination Da Huang and Ting Li Zi are used to remove the closure One must not be eager to simply treat cough and edema In case 2 there was phlegm rheum with cough and facial heat as if drunk This conforms to the Ling Gan Wu Wei Jiang Xin Xia Xing Jia Da Huang Tang as outlined in the Jingui Yaolue Zhang Zhongjing s original formula was given with Quan Gua Lou given to clear the upper and discharge below After one package the bowels moved and the face became less red Because this breathing illness was chronic with Yin deficiency the formula was changed to Sheng Mai Di Huang Wan as a way to continue to regulate This follows the treatment principle to treat the branch when acute and when it is chronic treat the branch Table of Formulas Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

47 Xi Xin Formulas Discussions and Case Studies Ma Huang Fu Zi Xi Xin Tang Case 1 Thyroid Cyst23 By Dr Fan Zhonglin Ms Song was 36 years old and was a factory worker in Cheng Du province History Her body type was weak and she often developed colds In May of 1977 she developed a cold with a cough After taking herbs to clear heat and stop cough the exterior presentation had resolved However after several days she suddenly developed a cyst on the left side of her neck It was 2X3 cm and was hard to the touch It moved when her throat moved and was not painful She was aware of her heart being tired but otherwise had no other symptoms That year she got a penicillin injection and took antibiotics and afterwards took Chinese herbs At the medical school hospital she was diagnosed with a left side thyroid gland cyst They recommended surgery as the treatment Check up She had a cyst on her neck for 2 months She was weak and fatigued and her appetite was poor It was difficult for her to fall asleep at night and her arms and legs were cold She had an aversion to cold and dizziness Her tongue was dark and pale and the moss was pale yellow and sticky This goiter disease was Shaoyin accompanied by Taiyang cold damage on the exterior The appropriate method was to return the correct dispel the evil warm the channels and resolve the exterior I used Ma Huang Fu Zi Xi Xin Tang with modifications Ma Huang 10 Zhi Fu Pian 60 cook longer Liao X X n 6 Gui Zhi 10 23 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

48 Xi Xin Formulas Discussions and Case Studies G n Ji ng 30 Gan Cao 30 3 packages Second visit After the three packages above the cyst began to change and become softer She also felt stronger The herbs conformed to the presentation and a strong formula gets a quick result I gave the same formula but doubled the Jiang Fu and Cao The cyst clearly became smaller and the tongue body turned to pale red The yellow sticky moss decreased I gave her 10 more packages of the formula from the first visit The cyst was then gone On July 13 1979 the patient came and told me the following After more than 10 packages of the herbs you gave me the cyst was gone and my appetite and sleep were greatly improved 2 years had gone by without a relapse Discussion This case of a cyst on the side of the neck that was hard to the touch There was no scaring and the color was normal It moved when she swallowed This is goiter syndrome The Lingshu Treatise on Cold and Heat says discussing cold and heat Lou Li and the types of scrofula When the disease is on the neck and in the armpit The root of the illness is all located in the Zang which exits at the neck and armpit spaces This case of goiter disease is exactly like this It was Taiyang with Shaoyin Exterior Interior mutually occurring The wind cold damp evil seeped into the Shaoyin over time This illness was on the interior and exterior The Yang Qi gradually declined and the Ying and Wei were not consolidated This caused congealed cold and Qi stagnation This got increasingly stopped up at the neck until it became a knot This case was not stubborn as goiters usually are when they are due to phlegm and qi constraint and knotting or fire congealing and damaging the Yin In this Taiyang Shaoyin presentation the theory and treatment are to warm the channels and resolve the exterior so that the qi and blood flow smoothly It is also to open through the Yang and disperse cold to open what has coalesced In this way there is the effect of softening hardness and scattering knots Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

49 Xi Xin Formulas Discussions and Case Studies Case 2 Shaoyin presentation nosebleed24 Mrs Ran was 72 years old and lived in Cheng Du History In April of 1975 she had a cold and afterwards developed bleeding from inside her nose She went to a hospital for treatment and they diagnosed Lung Heat They gave her clear heat resolve the exterior formulas and the illness became stronger rather than decreasing In her urgency the patient then stuffed some Yu Nan Bai Yao up her nose After using 3 to 4 bottles she still had ceaseless bleeding Now it was day six and she went to another hospital to the 5 sense organ department There was no effect so she came to me By the time she got to me she had had a nosebleed for 10 days Intermittently blood would ooze out of her nasal cavity The blood color was dark red and her face was dull white Food and drink was hard to get down her four limbs were cold and she had an aversion to cold and body pain and a slight cough Her tongue body was dark and pale and the moss was white and slippery The root of the tongue had slightly yellow sticky moss This was a Yang deficiency person with exogenous cold evil and correct qi weakness There was nothing to control her blood the Yang and qi stopped flowing and so the vessels and luo silted up The blood could not flow on its normal pathways and so flowed out This was Taiyang Shaoyin nosebleed The method should benefit the Yang and resolve the exterior warm the channels and restrain the blood For this I used modified Ma Huang Fu Zi Xi Xin Tang modified Ma Huang 10 g Zhi Fu Pian 60 g cooked longer Liao X X n 3 Pao Jiang 30 Ai Ye 10 stir fried in vinegar Zhi Gan Cao 20 24 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

50 Xi Xin Formulas Discussions and Case Studies 2 packages Second visit I gave her one package of the above formula and the bleeding decreased After two packages the bleeding completely stopped Because she was old and weak and it was difficult for her to recover I gave her Si Ni Tang with boosting the qi herbs to continue Zhi Fu Pian 30 Pao Jiang 15 Zhi Gan Cao 10 Dang Shen 10 Shang Rou Gui 10 taken in a draft Da Zao 30 3 packages Third visit Her spirit was much better Her food and drink intake had increased However she was anemic I advised her to take Sheng Jiang Yang Rou Tang with Dang Gui and Huang Qi to regulate and supplement February 2 1979 I tracked her down and she was already 76 Her illness was cured and she was in good shape Discussion In this case of nosebleed there was cold in the Shaoyin and which connects externally to the Taiyang The treatment was to resolve both the interior and exterior while assisting by warming the channels to restrain the blood By the third visit the bleeding had stopped Someone may ask about Zhongjing s rule that sweating is forbidden when there is bleeding and yet here we are using Ma Huang This is because the patient simultaneously Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

51 Xi Xin Formulas Discussions and Case Studies had Taiyang damage from cold on the exterior which is a Ma Huang presentation This formula heavily uses Fu Zi to warm the channels of the Shaoyin It resolves the exterior but does not damage the Yang qi Ma Huang is not combined with Gui Zhi and also simultaneously uses a good dose of Zhi Gan Cao in order to control the Ma Huang Therefore sweating is not induced but the evil is dispelled Clinically it is seen that all types of nosebleeds do not require avoiding sweating Sometimes sweating method is used to cure nosebleeds The patient s conditions are not all the same One must analyze the particulars of each case Case 3 serious blepheroptosis 25 Ms Sa was 17 years old and was a student in Beijing On April 22 1978 she could not open her eyes She could not see anything and her eyelids were swollen distended and not well She was diagnosed at the hospital and given neostigmine as an experimental drug and an electromyography test They gave her a definite diagnosis of serious lack of strength in the eye muscle She changed hospitals and took Chinese herbs for more than half a year without effects On October 18th of the same year she came to see me After 5 months her eyelid became normal again Check up Her left eyelid drooped and did not have the strength to open Both eyelids were swollen and both knee joints had pain Her menstruation was dark with black clots Her facial color was withered and pale without luster She had a rash on her forehead Her lips were pale and her tongue was pale with just a minute amount of red The sides of her tongue had teeth marks and the moss was greyish white with light yellow The root was thick and sticky and dense Her pulse was deep and thin This was Taiyin Shaoyin Illness with wasting eyelid This was accompanied by Taiyang exterior evil that had not been dispelled It was first appropriate to warm the channels and resolve the exterior so I used Ma Huang Fu Zi Xi Xin Tang modified 25 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

52 Xi Xin Formulas Discussions and Case Studies Ma Huang 10 Zhi Fu Pian 30 Liao X X n 3 Gui Zhi 6 Pao Jiang 20 Xue Yu Tan 20 Gan Cao 15 Second visit I gave her two packages of the above formula and the joint pain resolved Her eyelid had a slight pulse in it Her tongue moss had changed to greyish white and sticky The presentation was the same as before Her spirit was listless and her four limbs were not warm Though she was young her Kidney Yang was not sufficient I had to start from the foundational formula and strongly supplement the pre heaven so I gave her Si Ni Tang Zhi Fu Pian 60 G n Ji ng 30 Zhi Gan Cao 30 Third visit She took three packages of the above formula and the pulsing in her eyelid vanished The swelling in her eyelid decreased and there was some increase in her ability to lift her eyelid on the left eye It was now correct to warm and supplement the Spleen and Kidney and assist the Yang to drive out Yin I gave her Si Ni Tang with Li Zhong Wan with modifications and continued Zhi Fu Pian 60 G n Ji ng 30 Zhi Gan Cao 15 Chao Bai Zhu 25 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

53 Xi Xin Formulas Discussions and Case Studies F L ng 25 Shang Rou Gui 10 give as draft Sheng Jiang 60 Forth visit I gave her this formula with additions and subtractions one package for each day for more than 2 months On January 1 1979 Twice her left eyelid had opened somewhere around a half hour after taking the herbs I still continued with the same method using Si Ni or Li Zhong or using them together To treat the irregular menstruation with dark clots I added Pao Jiang and Xue Yu Tan When there was an exterior presentation I added Ma Huang and Gui Zhi type herbs I gave her herbs for more than 2 months 5th visit March of 1979 The opening and shutting of the eye had clearly improved The eyelid could already stay open All the symptoms were slightly less Both eyelids had less swelling Her left and right eyes could see things but they were not coordinated The rash on her forehead was gone Her menstruation had changed to normal though there was a small amount of blood clots She had her appetite back and the tongue body had changed to become pale red and moist with a thin white moss Gradually the Yang returned and the Yin dispersed though there was still Yang deficiency of the Spleen and Kidney I gave her Li Zhong Wan with Gui Zhi Qu Shao Yao Jia Fu Zi Tang to help her recuperate Gui Zhi 10 Gan Cao 15 Sheng Jiang 30 Hong Zao 30 Chao Bai Zhu 20 F L ng 20 Zhi Fu Pian 30 cooked longer Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

54 Xi Xin Formulas Discussions and Case Studies I gave this formula with additions and subtractions according to the presentation also integrating Ling Gui Zhu Gan Tang Xiao Ban Xia Tang and Zhen Sha San In April of 1979 both eyes could see but not focus The lids were just slightly swollen I continued to regulate in order to consolidate Discussion The western medical diagnosis was serious lack of strength in the eye muscle but the 6 channel differentiation of the pattern was slightly different and so the method and formula were different The preceding case was serious blepheroptosis and was a Taiyin Spleen oppressed with damp presentation The principle disease mechanism lay in water damp flowing into the channels and Luo vessels muscles and skin without being able to discharge This lead to swelling in the eye lids dull white facial complexion dark clotted menstruation tooth marks on the tongue with a grey white thick tongue moss All of these signs are indications of the Spleen Yang weakness with damp overcoming Transformation lost its power Below the uterus and menstruation could not be warmed Above the jing essence could not be transported to the eyes The Yin Qi spread everywhere The five Zang were damaged This includes the Kidneys The Kidney Qi was damaged The Spleen lost it warm nourishment Although differentiation of the disease was serious blepheroptosis this is different than the differentiation of the presentation theory and treatment Because of this one can t simply repeat convention by supplementing and boosting the middle raising the Yang and lifting what has sunken One also cannot go by the passage Taiyin illness can also come from the outside and so one should use resolving methods One must treat to strongly supplement the original Yang warm the Kidneys and fortify the Spleen This correctly reflects the differentiation of syndromes to carryout treatment that is the medical study of our homeland Differentiating the syndrome combined with differentiating the disease should be integrated This is the meaning of the wonderful wisdom that the same illness can be treated in different ways and different illnesses can be treated in the same way Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

55 Xi Xin Formulas Discussions and Case Studies Huang Huang on Ma Huang Fu Zi Xi Xin Tang gynecology cases Ma Huang Fu Xi Xi Xin Tang was mentioned in clause 301 of the Shang Han Lun When a Shaoyin disease has just started and there is fever and a sunken pulse Ma Huang Fu Zi Xi Xin Tang governs This formula is the representative formula for treating a Taiyang Shaoyin concurrent pattern I have been focusing on research into the classic formulas for many years and have expanded the scope of use of this formula It is especially good for many gynecological illnesses when combined with other formulas It can be strikingly effective I will now introduce 3 recorded cases that illustrate the diagnostic process and summarize the treatment patterns Case 1 Polycystic Ovarian Syndrome The patient was 44 years old She had suffered from late menstruation for over 10 years On December 17 2007 she came for a consultation She had a history of polycystic ovarian syndrome She had taken Chinese herbs for many years without effect At the time of her visit she presented with a robust body She was 5 6 tall and weighed 220 lbs Her skin was coarse with a yellow dark color Her menstruation was late and scanty She was sleepy during the day She felt heavy and without strength At nigh it was difficult to sleep Her lower limbs has slight swelling Her tongue body and lips were pale and dark and there was a sticky white moss on her tongue Her pulse was deep In the past she had lumbar disk syndrome Professor Huang gave her the following formula Sheng Ma Huang 10 gm Zhi Fu Pian 10 gm X X n 6 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

56 Xi Xin Formulas Discussions and Case Studies Gan Cao 3 gm G n Ji ng 10 gm Ge Gen 30 gm Chuan Xiong 12 gm Bai Zhu 20 gm F L ng 20 gm Gui Zhi 15 gm Chi Shao 15 gm Tao Ren 15 g Mu Dan Pi 15 gm She took one package of this each day divided into two doses She returned after one week Her spirit had improved Her weight had decreased I had her continue with the same formula Later she informed me that her menstruation had become regular her weariness decreased and she was comfortable Discussion Polycystic Ovarian Syndrome is a difficult to treat disease that has become more prevalent in recent years The basic characteristics of this syndrome are long term lack of ovulation scanty ovulation ovarian cysts and high androgen levels Patients often manifest with excess body hair obesity acne and amenorrhea In this case the patient had PCOS for many years This was a long term endocrine dysfunction There was a lack of regulation between the lower cerebral ganglion the pituitary and the ovaries The patient s lips were dark her complexion was pale and yellowish she was somnolent and her pulse was deep This was a Yang deficiency pattern In addition her skin was coarse and her menstruation was irregular There was also a history of lower back disk problems It was clear that the patient also had a blood stasis pattern Because of this I used Ma Huang Fu Zi Xi Xin Tang with Gui Zhi F L ng Wan to regulate her constitution After the herbs her spirit changed for the better her weariness decreased she lost weight and her menstruation became regular Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

57 Xi Xin Formulas Discussions and Case Studies Case 2 Endometrial Cancer The patient was age 50 She came for a consultation on February 26th 2008 because she was suffering from insomnia and headache After she had undergone 6 surgeries for endometrial cancer all of her tests were within the normal range At the time of her visit she presented with dark yellowish skin a slightly swollen appearance exhausted spirit reduced speech cold hands and feet insomnia and headache She felt that she could not sleep because her muscles and flesh were painful During the day she would yawn again and again Her eyelids felt heavy On the two sides of her head she felt pain that included her neck and back Her pulses beat at 60 beats minute Her lips were dark red and her tongue was dark pale and puffy with tooth marks The moss was white Her pulse was deep Professor Huang gave her Ma Huang Fu Zi Xi Xin Tang with Chai Hu Jia Long Gu Mu Li Tang Sheng Ma Huang 10 gm Zhi Fu Pian 10 gm X X n 6 gm Gan Cao 10 gm Chai Hu 20 gm Huang Qin 6 gm Zhi Ban Xia 20 gm Dang Shen 12 gm F L ng 20 gm Rou Gui 6 gm Gui Zhi 6 gm Zhi Da Huang 6 gm Long Gu 12 gm Mu Li 12 gm G n Ji ng 10 gm Hong Zao 20 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

58 Xi Xin Formulas Discussions and Case Studies This was cooked in water and one package was given for one day 2 doses per day After three packages the patient said she felt her spirit had clearly changed for the better After 8 packages the swelling had clearly decreased and her appetite had improved She took the herbs for a while with no ill effect I could see for myself that she was much lighter and relaxed After that I gradually decreased the dosage of the herbs The patient was able to sleep and her spirit was much better Discussion This patient was a 50 year old woman After she had surgery for endometrial cancer her ovaries were destroyed They shriveled up and their function declined away Her hormone levels had seriously declined The feedback function between her lower cerebral cortex and pituitary gland was diminished Her symptoms were due to a consequent hyper function of the sex hormones Case 3 Anal Prolapse The patient was a 47 year old woman who had suffered from anal prolapse for more than a year In the past month it had become more serious On August 8 2008 she came for a consultation She presented as follows Her facial complexion was dark and yellowish Her eyes looked dark and both of her cheeks had dark coloration There was mild swelling around her eyes Her spirit was not good She felt weak sluggish and somnolent Her arms were swollen and after being exposed to cold she would vomit clear liquid At times this was acidic and she had throat pain Her lower back was cold like cold water had been poured on it She had whole body aversion to cold Her lower limbs also had slight swelling Her menstruation amount color and quality was normal Urination was scanty and her bowels were pasty Her tongue was pale puffy and tender Her pulse was deep and 72 beats minute Dr Huang gave her the following formula Sheng Ma Huang 6 gm Zhi Fu Pian 6 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

59 Xi Xin Formulas Discussions and Case Studies X X n 6 gm G n Ji ng 12 gm Bai Zhu 12 gm F L ng 12 gm Gan Cao 6 gm Hong Zao 20 gm She took one package a day divided into two doses She came in a week later Her spirit was better and after the herbs the anal prolapse improved The belching and vomiting clear liquid also changed for the better She still felt fatigued and sleepy Her bowel was formed She went 1 time every two days Her tongue was pale and dark with thin moss She continued on the same formula and came back after a month The anal prolapse had improved considerably and she only had slight sleepiness The swelling of her lower limbs had dispersed Her fatigue was better and her facial complexion looked much better Discussion Anal prolapse is most often seen in deficient weak body types elderly people and emaciated people It is seen more often in women than men In the clinic herbs to boost the Qi and raise up are generally given In this case the patient was a middle aged woman Her physique was depleted This was Yang deficiency with water over flowing Based on this professor Huang used Ma Huang Fu Zi Xi Xin Tang He combined this with Gan Jiang Ling Zhu Tang to warm and transform water fluids The formula and pattern matched and so the effect was good Afterword All of the 3 cases above are different The clinical manifestations are all different However they illustrate identical patterns They each had deep thin pulse and the desire to sleep Case 1 manifests with somnolence a deep pulse and irregular menstruation Case 2 manifests with somnolence in the day and insomnia at night with a deep pulse and headache Case three manifests with somnolence deep pulse and anal Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

60 Xi Xin Formulas Discussions and Case Studies prolapse All three have somnolence and a weary spirit aversion to cold This is the Ma Huang Fu Zi Xi Xin Tang pattern All of these cases are taken from Huang Huang s clinical experience Professor Huang takes into account the patient s build and physique the patient s psychological condition and their spirit He looks at the condition of the nourishment and general health as well as at the illnesses of the family Many aspects are combined to match the body and illness Professor Huang thinks that differentiation the illness can address the issue of effectiveness while differentiating the body type can ensure safety The constitution is determined primarily from the patient s physique skin color pulse abdomen and tongue By Dr Fan Zhong Lin26 Case 4 Taiyang Shaoyin Pattern Chest Bi Translated by Katherine Loomis 2013 Female 32 years old Ms Chen Chengdu farmer Medical History In August of 1976 the patient caught a cold while pregnant Her cold symptoms included headache body aches insomnia and pain in her chest and upper back and a strong sense of fullness stuffiness in her chest At the time she did not receive treatment because she was worried that medications could cause early labor Seven days after giving birth there was an earthquake and she had to sleep out in the open Her symptoms worsened She went to several local hospitals and had chest x rays electrocardiogram ultrasounds and other diagnostic tests There were no findings and she was diagnosed with neurosis The patient came for a consult in November of 1977 1st Consult The patient had experienced chest pain for over a year with fullness 26 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

61 Xi Xin Formulas Discussions and Case Studies and distention preventing her from feeling comfortable She had hiccoughs and a sense of obstruction of her breathing In addition she had an aversion to cold dizziness ringing in the ears like cicadas joint pain a lack of appetite and excessive dreams She had menstrual pain and her menstrual flow contained many clots Tongue slightly pale yellow slippery coating These signs and symptoms indicated a condition commonly referred to as postmenstrual cold The combination of contracting a cold prior to childbirth vacuity of the sea of blood postpartum and exposure to cold and damp sleeping outdoors due to the earthquake resulted in congealed cold qi stagnation obstruction of the chest Yang chest bi and an inability of the Yang to ascend The presenting signs and symptoms included focal distention and fullness in the chest dizziness tinnitus insomnia body aches The treatment method was to assist the Yang transform qi warm the channels and disperse cold Combined Gui Zhi Qu Shao Yao Tang and Ma Huang Xi Xin Fu Zi Tang were the basis for treatment Prescription 3 packages Zhi Fu Zi Decoct first 30 gm Ma Huang 10 gm Xi Xin 6 gm Gui Zhi 10 gm Wu Zhu Yu 10 gm Da Zao 20 gm Zhi Gan Cao 15 gm 2nd Consult After taking the 3 packages of herbs the chest pain had lessened The Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

62 Xi Xin Formulas Discussions and Case Studies dizziness and tinnitus had changed for the better but the patient still experience body aches and a cold sensation in her lower abdomen before her period Shaoyin Yang vacuity and obstruction due to wind cold and dampness had not yet resolved The original formula was prescribed with modifications to regulate the menstrual cycle herbs to invigorate the blood and transform stasis Prescription take this formula till the onset of her next menstrual flow Zhi Fu Zi decoct first 30 gm Ma Huang 10 gm Xi Xin 3 gm Gui Zhi 10 gm Wu Zhu Yu 10 gm Xue Yu Tan 30 gm Zhi Gan Cao 12 gm Dang Gui 10 gm 3rd Consult The patient s menstrual flow started after taking 4 packages of the formula There were positive changes in the color and quantity of her menstrual flow along with menstrual pain Her chest pain dizziness tinnitus body aches insomnia and reduced appetite all clearly lessened The formula was prescribed removing the Pao Jiang Xue Yu Tan and Wu Zhu Yu Fu Ling was added to calm the spirit and percolate dampness Zhi Fu Zi 30 gm Ma Huang 10 gm Xi Xin 3 gm Gui Zhi 10 gm Fu Ling 15 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

63 Xi Xin Formulas Discussions and Case Studies Da Zao 20 gm Zhi Gan Cao 12 gm Dang Gui 10 gm Sheng Jiang 30 gm After taking over 10 packages of the herbs the illness was basically cured The patient returned July 20 1979 and reported that she had been well for the past few years Conclusion Jin Gui Yao Lue Shui Qi Bing Mai Zheng Bing Zhi Pian states Qi Level Disease Combined Gui Zhi Qu Shao Yao Tang and Ma Huang Xi Xin Fu Zi Tang govern when water rheum results in a sensation of hardness below the heart The hardness may feel as large as a plate with edges like an overturned cup This patient did not have the symptom of hardness below the heart as big as a plate and also did not have a simple pattern of water qi pathology So why use this formula Because this pattern consisted of insufficiency of Yang with cold and damp pathogens taking advantage of post partum Yang vacuity to cause counterflow of the clear Yang It is not necessary to strictly adhere to a symptom of hardness or plate to determine either the relative severity of water qi or the pattern identification to use this formula The formula resolves pathogens in the Taiyang as well as warm the Shaoyin channels The Yang qi ascends qi transforms and circulates congealed cold is resolved and all the symptoms of chest Bi naturally diminish Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

64 Xi Xin Formulas Discussions and Case Studies Wu Pei Heng Gynecology Cases27 Cases 8 11 Case 8 Breast Abscess Mastitis Ms Yin was 25 years old and from Kunming In the spring of 1969 she was postpartum 6 days She developed acute mastitis in her right breast so she entered the hospital for a consultation She used an antibiotic injection but did not improve She then changed to the Chinese medical external department They thought she had a heat toxin They gave her herbs to clear heat and resolve fire toxin They also gave her a paste to clear heat and disperse swelling She took five packages and was treated for more than 10 days The chills and fever did not retreat Her breast area was red swollen and painful It got worse day by day After this long time she came to me for a consultation She had a fever and aversion to cold In the morning her temperature was 37 4 and in the evening it was 39 more or less She had a headache and her whole body was sore and painful Her right breast was red and swollen It was scorching hot and hard feeling Her breast milk would not come out The pain spread to her arm pit She groaned without cease In the day she did not want to drink and at night she could not sleep Her spirit was exhausted She just wanted to sleep Her pulse was deep thin and tight Her tongue body was pale with Qing colors The tongue moss was thick and sticky This was postpartum Qi and blood deficiency She was effected by an external wind cold evil Her channels and vessels became blocked The Qi and blood congealed She then took the wrong clearing heat bitter cold formulas This damaged the correct Qi and boosted the evil This made the breast abscess more severe The formula should have returned the correct to expel the evil warm the channels and scatter cold vitalize the Luo and open through the breast I used modified Ma Huang Fu Zi Xi Xin Tang Fu Pian 30 gm Ma Huang 9 gm 27 pg 208 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

65 Xi Xin Formulas Discussions and Case Studies X X n 5 gm Gui Zhi 15 gm Chuan Xiong 9 gm Tong Cao 6 gm Wang Bu Liu Xing 9 gm Zhi Xiang Fu 9 gm Sheng Jiang 15 gm Gan Cao 6 gm The next day I returned She had taken the above formula two times and got under warm covers After a short while she broke into a whole body sweat She was then able to sleep peacefully In the morning the fever had retreated and her body cooled Her whole body was now comfortable Her head and body pain were gone Her left side breast swelling heat and pain had decreased by half She was able to take some porridge and milk She was no longer groaning and her pulses were not tight They were deep and thin but harmonious and moderate Her tongue body had changed from Qing to pale red The moss was thin white At the root it was still sticky Although the treatment had the desired effect the evil was not extinguished The Qi and blood were insufficient I continued with a method to return the Yang and warmly transform I used F L ng Gui Zhi Tang with added flavors F L ng 15 gm Gui Zhi 15 gm Chuan Xiong 9 gm Tong Cao 6 gm X X n 3 gm Zhi Xiang Fu 9 gm Yi Ren 15 gm Fu Pian 45 gm Sheng Jiang 15 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

66 Xi Xin Formulas Discussions and Case Studies She was given two packages The right side red swollen hardness dispersed and the breast milk flowed Her appetite and sleep became good Her Qi and blood were still deficient I gave her Huang Qi Jian Zhong Tang after that After 4 packages she was cured A month later the breast milk was plentiful and she was able to breastfeed normally Case 9 Amenorrhea Ms Song was age 27 She was a southerner from Kunming area and worked at the airport Her constitution was weak After marriage she did not get pregnant In the beginning her menstruation was irregular She took western medicine to treat this This prescription did cause her to bleed on time but the amount was scanty and the color was dark In addition her lower abdomen felt cold distended painful and weighed down After 2 to 3 years the amount decreased and developed into amenorrhea She then used western and Chinese medicine together to artificially induce menstruation Altogether she took more than 100 packages This was all without effect By then she had had amenorrhea for a long 6 years In July of 1959 she came to the Yunan Chinese medical hospital for a consultation Ms Song s complexion was sallow yellow without lustre Her spirit was sluggish She was reluctant to speak and short of breath Her hair was sparse and had a burnt quality Since her menstruation stopped she often felt dizzy with ear ringing heart vexation and oppression At night it was difficult for her to enter sleep while during the day she was sleepy Her mouth was tasteless and she was not interested in food and drink Her lower back and spine felt weak and sore and her legs and knees were also sore and without strength Her hands and feet felt cold Her lower abdomen also felt cold and uncomfortable Her pulse was deep and coarse Her tongue was pale and tender and of dark color and stasis This was all coming from insufficient Yang with emptiness of the Chong and Ren vessels cold blood Qi stasis and cold womb Yang deficiency leads to Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

67 Xi Xin Formulas Discussions and Case Studies cold and Qi deficiency becomes stasis easily When blood is cold it becomes congealed When blood is cold and Qi is deficient it is difficult for them to move 100 vessels cannot flourish The blood in the channels is without a source and this is why the menstruation stopped and it is also why there is infertility Therefore the treatment should warm and return the lower source warm the channels to vitalize the blood scatter cold and bake the womb She was given my own experiential formula Yi Yuan Nuan Gong Tang Fu Pian 100 gm Dang Gui 15 gm Dan Shen 15 gm Gui Zhi 12 gm Wu Zhu Yu 9 gm Zhi Xiang Fu 12 gm X X n 6 gm Chi Shao 9 gm Chao Ai Ye 12 gm G n Ji ng 12 gm Gan Cao 9 gm She returned after taking 3 packages of these herbs Her lower abdominal pain had decreased and the cold feeling in her abdomen also diminished She still had a heavy distended feeling Her desire to eat had increased her hands and feet had become warm she was not anxious or oppressed in her chest and she was able to sleep Her pulse was still deep and rough and her tongue was pale The stasis spots on her tongue had decreased and the moss was thin and white I continued with the above warming and transforming formula with the addition of 5 gm of Hong Hua to help warm and vitalize the blood I also advised her to take this with a bit of wine as a guide This improves the effect of warming and moving the blood vessels Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

68 Xi Xin Formulas Discussions and Case Studies The patient informed me that all of her symptoms changed for the better after the herbs She only felt soreness distention and pain in her low back and lower abdomen This portended the arrival of her menstruation This was undoubtedly good I gave her 8 more packages of the herbs I removed the Chi Shao and added 9 gm Chuan Xiong and 15 gm E Jiao melted in and had her take it continuously Her menstruation arrived At first it was dark with blood clots but as it continued it became red The next day the lower back and abdominal pain diminished and she bled for 5 days I then gave her Ba Zhen Wan with added Xiang Fu Yi Mu and Chao Ai Ye to regulate and supplement her Qi and blood After 10 more packages her facial color and hair became more lustrous and her spirit and appetite changed for the better Later I got a letter from her She had menstruated and after one year she had a child Case 10 Menstrual flooding with continuous nosebleed Mr Guo s wife was 35 years old She was a Henan native who lived in Kunming Her menstruation was irregular and painful so she came for a consultation and treatment She was given herbs to crack the Qi and move stasis with herbs such as Tao Ren Hong Hua San Leng Wen Zhu Chuan Xiong and Dang Gui and was advised to take them often with the hope that her menstruation would open through and regulate She had taken herbs for more than 10 years until there was a breaking through which greatly damaged the Qi and blood In the last 10 days of June of 1961 she got very angry with a child and suddenly she began to flood without cease She urgently went to the hospital for help and was treated for several days but she still continued to bleed from her uterus In addition she began to bleed from her nose and gums She developed purple spots on her body This was a serious condition On July 1 her family took the initiative to carry her out of the hospital and bring her to a Chinese medical doctor for consultation and treatment On the record it was written that her condition was blood not staying in the channels She was given two doses of the following formula Wine Fried Sheng Di 50 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

69 Xi Xin Formulas Discussions and Case Studies Crispy Fried Ce Bai Ye 30 gm Ai Ye 30 gm Stir Fried Hang Shao 30 gm Zhe Ci Dong 30 gm Jiang Pao 30 gm Ou Jie 2 pieces Sheng Cao 20 gm A small amount of child s urine was added as a guiding herb until it turned greyish She was advised to take 2 packages Externally she was given 100 gm of wine fried Fu Zi that was wrapped so it was kept at bubbling spring Ki 1 She took the herbs one time and the bleeding above and below got worse She was groaning endlessly was short of breath and wanted to escape The family was beside themselves with fear On July 2 I came to his house to see her Her complexion was pale yellow and dark Her lips and tongue were pale white and her tongue was white and slippery She had purple blisters unevenly spread around her mouth lips and tongue There was a blister the size of the end of a thumb in the center of her tongue There was blood coming from her nose and gums It was dark red and not fresh Stuffing was placed in her nostrils which made the clots block his throat She began to cough blood There were dark clots mixed into the fresh blood She had purple spots on the skin of her limbs back and chest Her facial expression was distant and aloof She did not speak out but just groaned incessantly She was confused and it was difficult to connect with her During the day she could not eat and at night she could not sleep She could only take a small mouthful of hot liquid Her six pulses were deficient like a scallion With pressure the pulse seemed to disappear There had been too much attacking so that the Qi and blood were both damaged The Qi was unable to absorb and hold blood The Yang could not watch over the Yin The deficiency of blood meant that the Qi had nothing to depend on The Yin was not attached to the Yang and so the blood did not stay in the channels Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

70 Xi Xin Formulas Discussions and Case Studies There was a flooding out The Qi followed the blood out and both were consumed There was a scattering out without restraint If the bleeding did not stop I worried that the bleeding would consume the Qi and she would die The Yin and Yang could break away from each other This was a loss of blood pattern of Qi and blood dual damage One should treat the Qi first and then the bleeding will spontaneously stop After the bleeding stops then one is able to use a supplementing and boosting method In this syndrome one must return the Yang s receiving consolidate the Qi and stop bleeding I used the following formula Hei Tian Xiong 150 gm Pao Hei Jiang 30 gm Hei Jing Jie 6 gm Shang Rou Gui powder stirred in 15 gm Fu Shen 20 gm Gui Jian 30 gm Da Zao roasted black 2 pieces On July 3 she had her second visit After taking the above formula there was the desired effect The bleeding had decreased However the Qi and blood were greatly damaged In a short time it is difficult to restore it There was still blood coming from the mouth and nose that was pale and dark There was an urge to vomit and she still did not want to eat or drink Her spirit was very weak Due to Qi and blood damage an older chronic complaint of arthritis returned Her left arm and shoulder had pain I gave her the above formula assisted with herbs to warm the channels and scatter cold Fu Pian 200 gm Pao Hei Jiang 10 gm G n Ji ng 10 gm Shang Rou Gui powder stirred in 15 gm Xi Sha Ren 10 gm Gui Jian 20 gm Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

71 Xi Xin Formulas Discussions and Case Studies Zhu Yu Wu 5 gm Bei X X n 6 gm Gan Cao 10 gm On July 4 she had her third visit Her pulses had some spirit and root The bleeding had decreased slightly The lips and tongue were red and moist The ulcers in the mouth and on the tongue had shrunk She was able to sleep at night Her urination had become long and she desired warm liquids She was able to take a small amount of food She was still dizzy and had pain Her left shoulder was painful in the tendons and flesh However there was improvement and she was out of the danger zone Fu Pian 200 gm Hei Pao Jiang 50 gm G n Ji ng 15 gm Shang Rou Gui powder stirred in 15 gm Gui Jian 30 gm Bei X X n 7 gm Fa Xia 15 gm Gong Ding 5 gm Gan Cao 10 gm Ma Huang Gen 10 gm On July 6 she had her fourth visit After taking the above formula twice the nose and mouth bleeding stopped The dark ulcers on the tongue and mouth had completely cleared The tongue body was red and moist with thin white moss There was still some scanty dark blood coming from below with a bad smell This bleeding was related to the defeated blood leaving The Yang warming herbs transformed it and moved it downward It was not new blood coming out The Qi of the hollow organs was already open through and she had been moving her bowels They were dark colored and dry Her spirit and eating had become good Her Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

72 Xi Xin Formulas Discussions and Case Studies pulses were moderate and harmonious with spirit There was still slight pulling pain in her shoulder that involved her left side head and neck I again gave her treatment to return the Yang warmly transform open through the channels and scatter cold Fu Pian 200 gm G n Ji ng 50 gm Bei X X n 10 gm Gui Jian 50 gm Qiang Huo 5 gm Du Huo 6 gm Yi Ren 15 gm Ma Huang 5 gm Rou Gui powder stirred in 15 gm Gan Cao 15 gm On July 8 she came for her fifth visit Her illness had greatly decreased Her head pain stopped Her shoulder pain had already greatly decreased I gave her the previous formula without the Ma Huang and after two packages she was cured I gave her Si Ni Tang with Huang Qi Dang Gui Bai Zhu and Yi Yi Ren to consolidate the result Case 11 Breast Abscess mastitis Ms Xie was 24 years old She was postpartum 6 or 7 days Because she got up to breast feed at night she received a cold The next day she felt uncomfortable with aversion to cold fever head and body pain Her left breast had a hard knot in it It was swollen distended and painful She went to the Shengji hospital for treatment She took Yin Qiao San and Jing Fang Jie Du San with modifications for treatment Her fever went down but she still had aversion to cold and the red swollen knot in her left breast did not disperse Actually it had gotten bigger and the pain had gotten worse A week later the wound erupted Pus and thin clear blood flowed out She went to the western medical surgical department to drain it and diminish inflammation Half a month later the opening Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

73 Xi Xin Formulas Discussions and Case Studies gradually closed However the breast lump did not disperse It was still red swollen and painful Her breast milk did not open through Her appetite was poor Every afternoon she would get a fever and she would shiver with her aversion to cold After a month she did not get better On a day in 1963 she came to see me for a consultation The illness was as above but she also had a white complexion an exhausted spirit and her pulse was deep thin and weak Her tongue body was dark Qing colored with thick sticky moss This was a cold evil due to lack of spreading and scattering This had constrained and blocked the channels vessels and blood collaterals Since it had gone on over time it had damaged and weakened the Qi and blood On the interior the Zheng Qi was deficient without the strength to drive the exterior evil out Although there was a partial hole there the root of the pus was not completely dispelled Although the wound had begun to close it had not become completely scattered outward This was as the saying goes let the abscess mature and then it can burst The method needed to be to warm and open through the interior Yang discharge pus scatter swelling scatter knotting and open through the breast Dang Gui Si Ni Tang and Bai Tong Tang was used Fu Pian 150 gm G n Ji ng 15 gm Chuan Xiong 10 gm Dang Gui 15 gm Jie Geng 10 gm Zao Jiao Ci 9 gm Chi Shao 10 gm Tong Cao 6 gm X X n 5 gm Bai Zhu 12 gm Cong Bai 3 stalks After two packages the aversion to cold fever and body warmth all became normal The knotted red swelling of the left breast had dispersed The lower right side of her nipple was still inflamed with sharp pain local redness and slight opening This improvement was due to the Yang herbs warming and transporting so that the Qi and blood gradually Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

74 Xi Xin Formulas Discussions and Case Studies returned and the blood vessels could flow and open through and the Zheng Qi could combat the evil There was now the power to discharge the pus Her pulse was deep and thin yet compared to before it was moderate and had strength The Qing color of her tongue had retreated Only the middle of the tongue had sticky moss She continued with two packages of the same formula with the addition of Xiang Fu 9 gm The rotten flesh and blood area was already ripening and the skin became a bright red After three more packages the pus burst out More than half a cup of yellow fluid came out and the pain decreased and the redness faded away In order to warm the menses return the Yang regulate and supplement the Qi she was given four packages of Si Ni Dang Gui Bu Xue Tang with Bai Zhu Hang Shao Gui Zhi and Chuan Xiong The pus dispersed and the wound healed She had recovered Xiao Qing Long Tang Formula Explanation 28 This formula is for external cold with internal rheum The Ling Shu Chapter on Zang Fu Illness and Evil Qi says The formation of cold fluids damages the lungs This refers to the disease mechanism in which the two colds interact The middle and the exterior are both damaged Xiao Qing Long Tang uses Ma Huang and Gui Zhi to resolve the exterior Jiang Xin Wei Xia and Shao transform interior fluids G n Ji ng Xi Xin and Wu Wei Zi are Zhongjing s core herbs for treating cold fluid cough and pant When these are combined with Ma Huang and Gui Zhi there is enriching within warming restraining within scattering The cold and the fluids are both resolved simultaneously through sweating Meanwhile the lung Qi is protected from being dissipated Clinically if the lung cold is serious the amount of Jiang and Xin can be bigger than the dose of Wu Wei 28 Sh ng H n M ng Y Y n n J ng X an Selected Cases from Famous Physicians in the Shang Han Tradi tion Ed Che nM ng Zh ngY n Sh ng Xu Yu n Publishing Company B ij ng China 1998 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

75 Xi Xin Formulas Discussions and Case Studies Zi If there is a chronic cough with Lung Qi deficiency the dose of Wu Wei Zi can be increased This formula heavily warms and transforms cold fluids even if there is no exterior pattern If you see a cough with shortness of breath watery spittle slippery wet tongue moss and a floating wiry or floating tight pulse you should consider using this At the same time the scattering and emitting strength of this formula is great It can increase the Lung Qi and diminish the Kidney root It is the wrong medicine for a deficient person It can cause reversal cold of the 4 limbs and make the Qi from the lower abdomen surge up into the chest and throat It can also cause the side effect of creating a feather light fever as if drunk So as soon as the symptoms stop do not continue this formula In one day the disease characteristics change and so the formula should be changed to a Ling Gui formula to warm and transform Just as the Jingui says in phlegm fluid illness one must warmly transform Discussion 29 Professor Liu Du zhou points out that one must grasp these few clinical keys to effectively use this formula in the clinic 1 Differentiation of the complexion Cold fluids are a Yin evil These easily damage the Yang When the Yang in the chest is not warm the blush of the Wei Qi is restricted and is unable to reach the face The patient s facial color becomes dark This is the water color It may also be a dark ring around the eyes This is called the water ring There may also be dark spots on the forehead pillar of the nose cheeks skin of the chin These are called water spots 2 Differentiation of cough and panting One looks to see if the coughing is heavy with light panting or if the panting is heavy with a light cough or if both the cough and pant are heavy Does the patient need to lean on something to breath or have difficulty lying down Does it become worse in the evening 29 Sh ng H n M ng Y Y n n J ng X an Selected Cases from Famous Physicians in the Shang Han Tradi tion Ed Che nM ng Zh ngY n Sh ng Xu Yu n Publishing Company B ij ng China 1998 Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019

76 Xi Xin Formulas Discussions and Case Studies 3 Differentiating the color of the spittle With lung cold the fluids are cold and with Yang deficiency the fluids congeal so that the fluids form phlegm This phlegm spittle white and thin or like foam or dripping like water Or there may be vomiting phlegm that is like egg white The tongue is cold to the touch 4 Differentiating by the appearance of the tongue When the lung Qi is cold water fluids stagnate and do not transform The tongue moss is most often watery slippery smooth The tongue body generally becomes large However if the Yang Qi is damaged the tongue may be pale and tender with a fat body 5 Differentiating by the pulse When there are cold fluid evils the pulse is most often wiry Wiry is the main pulse for fluid illness If there is exterior cold with interior fluids the pulse will be floating and wiry or floating and tight If the illness goes deeper with cold fluids hidden on the interior the pulse will most likely be deep 6 Differentiating by symptoms When water fluids have stopped on the interior many kinds of symptoms can manifest If cold water blocks the Qi there can be choking or hiccup When water harasses the stomach there can be vomiting Cold water stagnating below can cause inhibited urination Cold water flowing into the four limbs can cause swelling If exterior cold is unresolved the Taiyang Qi can be constrained and this can manifest as fever or headache These 6 points can be used as the correct objective criteria for determining when to use Xiao Qing Long Tang However all of these criteria need not be seen You may see one or two principle signs Then you can use this formula Translated and Compiled by Sharon Weizenbaum unless otherwise noted 2019