Ouyang XX, male, 50 years old, first consultation on October 9, 1984. The patient has had fever and chills, body pain, dysphoria, and restlessness for 3 days. Accompanied by coughing with thin white phlegm, no sweating, no thirst, poor appetite, pale red tongue texture, thin yellow and white coating, and a deep and weak pulse. This is due to wind-cold obstruction and internal heat stagnation. The treatment should focus on the symptoms rather than the pulse, and the prescription chosen is Dyers Woad Dragon Decoction:
Ephedra 12g, Cinnamon Twig 9g, raw Gypsum 18g, Bitter Apricot Seed 9g, Prepared Liquorice Root 9g, Fresh Ginger Rhizome 9g, Chinese Date 10 pieces
. After taking one dose, the patient sweated profusely, and although the body pain decreased, the aversion to cold became more severe, with cold hands and feet, and the pulse became weaker than before. This is a sign of excessive dispersion and yang exhaustion due to excessive sweating. If not treated promptly, there is a risk of reversal cold of limbs. Immediate yang restoration is required. The prescription given is:
Cinnamon Twig 9g, prepared common monkshood daughter root 12g, Asiatic Cornelian Cherry Fruit 12g, Prepared Liquorice Root 9g, Tangshen 30g
. After taking the medicine, the cold extremities returned to normal, the sweating stopped, and the patient recovered.
Note: Regarding the use of Dyers Woad Dragon Decoction, Zhongjing repeatedly warned, "If the pulse is weak and there is sweating with aversion to wind, it should not be taken; if taken, it may lead to reversal cold of limbs, muscle twitching, and throat constriction, which is a severe adverse reaction." A deep pulse indicates internal deficiency, and a weak pulse indicates deficiency. In such cases of interior deficiency, using Dyers Woad Dragon Decoction to open the pores and induce sweating will inevitably lead to excessive sweating and yang exhaustion. In this case, a momentary lapse in judgment led to focusing on the symptoms rather than the pulse, resulting in a diagnostic error, excessive sweating, and yang exhaustion, creating a dangerous situation. Fortunately, timely treatment turned the situation around. This case should have prioritized the pulse over the symptoms, starting with Minor Center-Fortifying Decoction or Huang Jianzhong Decoction to strengthen the middle qi. Once the internal qi was restored, Dyers Woad Dragon Decoction could have been administered to resolve the condition with a single dose of sweating.