| title | Medical Cases of Zhao Shouzhen |
Wang, aged 48. Initially suffered from dysentery, which later turned into diarrhea. The physician failed to recognize the presence of dampness-heat, overused warming and tonifying methods, and coupled with improper diet, leading to constipation, abdominal pain. The physician then used the Purple Pill from Qianjin Fang for purgation, which resulted in loose stools but not in large quantities, and the distending pain did not subside, indicating that the retention of food remained. Another physician was consulted, who also failed to recognize this and instead believed the illness had transitioned from dysentery to diarrhea, and that the spleen and stomach had been damaged by the purgation, considering the distension and pain as signs of deficiency and cold, and treated with Middle-Regulating Decoction. Two doses a day for more than ten days worsened the condition, with diarrhea turning to watery yellow stools and undigested food in stool, further confirming the diagnosis of fire deficiency, where the medicine could not combat the illness, referencing the "Shaoyin" chapter of the "Cold-Damage Disease Treatise" on "continuous diarrhea" and "diarrhea with undigested food," and proceeded with reversal cold of limbs and Bai Tong class, not only failing to stop the undigested food but also increasing dysphoria, fortunately, his strong constitution could withstand such treatment. After more than a month, he finally sought my treatment.
The pulse was deep, rapid, and forceful, with slight red streaks in the eyeballs, much mucus, a dry, yellow, and rough tongue, dry mouth but not drinking much, abdominal distension and fullness with pain as before, tender to touch, normal diet, able to move, with several episodes of diarrhea containing undigested food and watery yellow stools daily, with a fishy smell, short and yellow urine, warm limbs, etc. From this, it was clear that the syndrome was one of heat accumulation in the interior, an excess pattern.
The transition from dysentery to diarrhea was a favorable pathological shift, which could have been resolved with timely clearing and resolving methods, but instead, warming and astringent methods were used, exacerbating the condition, hence the abdominal distension and fullness with pain. The use of the Purple Pill was inappropriate, as it could only remove the accumulation but not clear the heat, leading to dryness accumulation over time, hence the daily watery yellow stools, similar to the heat retention with watery discharge in the Yangming chapter of the Cold-Damage Disease . The syndrome was identified as Yangming internal knot, with extremely strong pathogenic heat, predominantly in the lower jiao and lighter in the upper jiao , requiring differentiated treatment. Major Purgative Decoction was used to attack the dry stool, with Bamboo Leaf and Gardenia added to resolve the dysphoric heat, treating both the upper and lower parts:Rhubarb Rhizoma 12g, Mirabilite (to be mixed), Immature Orange Fruit, Magnolia Bark, Gardenia, Bamboo Leaf, each 6g
. Considering the prolonged illness and physical deficiency, a decoction of Ginseng and Ophiopogon was prepared to prevent complications. After taking the previous medicine, abdominal pain intensified, with half a bucket of loose stools containing hard lumps, leading to the disappearance of distension and pain, and a sudden improvement in spirit, without signs of collapse, stopping the previous medicine and temporarily supporting healthy qi with the Ginseng and Ophiopogon decoction. However, the tongue was still yellow and dry, urine was particularly yellow, with occasional watery yellow stools, indicating that internal heat still needed to be cleared, so the prescription was slightly modified to enrich yin and clear heat, harmonizing the stomach, and after half a month of taking the medicine, recovery was achieved.
