Cough – Exhausted yin (YTS)

Original Case by: Ye Tian-Shi (叶天士)

(Case 5) – from Understanding Case Records Pt. 2

There was exhausted yin existing in conjunction with contraction of a warm pathogen. There was a cough and head distention. It is suitable to use a light formula.

sang ye (Mori Folium)
xing ren (Armeniacae Semen)
chuan bei mu (Fritillariae cirrhosae Bulbus)
bei sha shen (Glehniae Radix)
sheng gan cao (Glycyrrhizae Radix)
tian shui li pi (Pyri Exocarpium) (pear peel)

Qin Bo-Wei’s Commentary:

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Cough – warm pathogen (YTS)

Original Case by: Ye Tian-Shi (叶天士)

A warm pathogen assaulted the outer body. There was a cough and head distention. It is appropriate to clear the upper burner. [The prescription given was]

Xing Ren (Armeniacae Semen)
Sang Bai Pi (Mori Cortex)
Jie Geng (Platycodi Radix)
Zhe Bei Mu (Fritillariae Thunbergii Bulbus)
Tong Cao (Tetrapanacis Medulla)
Lu Gen (Phragmitis Rhizoma)

Qin Bo-Wei’s Commentary: This case’s only presenting symptoms are cough and head distention, making it difficult to come up with a clear diagnosis. However since we are given the diagnosis of “warm pathogen assaulting the outer body” we can deduce additional symptoms that are related to wind warmth. From the section of Ye Tian-Shi’s text entitled “Externally-contracted Warm Heat” we get a better idea of what this means. For example,

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Wind-stroke – qi & blood xu (YTS)

Original Case by: Ye Tian-Shi (叶天士)

[The patient’s] pulse was thin and rapid. The thin [pulse] indicates visceral yin exhaustion and the rapid [pulse] indicates nutritive yin-fluid depletion. The previous summer and fall the patient was ill. Following this, there was a contraction of winter warmth leading to failure to store. In the spring when the earth’s qi started to ascend, there was Liver wood stirring wind, resulting in right-sided atrophy. The collaterals at the root of the tongue were stiff leading to difficult speech. All of this was caused by a root base exhaustion pattern. The common treatment to drain qi, descend phlegm, and discharge, disperse, and attack wind [was given], which removed the true yin by force and the spirit gradually became muddled as if asleep. If it had worsened, there would have been clouding inversion and then how can one treat this? Zhang Zhong-Jing’s Fu Mai Tang (Restore the Pulse Decoction) method was used. [This was a pattern of] yin fluid deficiency with stirring wind.

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Wind Stroke-Blood Deficiency (YTS)

Original Case by: Ye Tian-Shi (叶天士)

[The patient] had blood loss for many years with chronic damage to the yin qi. There was a relapse due to worry, sadness, and melancholy, where yang linked with internal wind which led to a great uprushing to the head (da mao 大冒). The blood residence became empty and qi overwhelmed the left side of the body, producing a deviated mouth, numbness and tingling in the limbs, dark tongue, inability to speak, and foot atrophy with an inability to walk. Obviously the Liver and Kidneys were deficient and famished, the yin qi was unable to govern the bearing upwards. It was important to nurture the lower to extinguish wind. A method [designed by] Liu He-Jian was used.

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Hemilateral withering (YTS)

Original Case by: Ye Tian-Shi (叶天士)

[The patient] had hemilateral withering on the left side of the body. [There was] blood deficiency not nourishing the sinews and bones, [leading to] internal wind assaulting the collaterals. The left pulse was moderate and large.

Zhi Shou Wu (Polygoni Multiflori Radix Preparata) (baked) 4 liang
Gou Qi Zi (Lycii Fructus) (stems removed) 2 liang
Dang Gui Shen (Angelicae Sinensis Radix) (use that with a single stalk, remove the tips) 2 liang
Huai Niu Xi (Achyranthis Bidentatae Radix) (steamed) 2 liang
Tian Ma (Gastrodiae Rhizoma) (roasted) 2 liang
Chong Wei Zi (Leonuri Fructus) (crushed, water rinsed ten times, then baked) 2 liang

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