Ding Ganren's Clinical Medical Collection

Author: Chief Editor: Shen Zhongli
Publisher:
Publishing Date: 2000-01-01
Features:
Excerpt: A white moss appears, with a wiry and slippery, rapid pulse. The sun and Yangming patterns are unresolved, with phlegm stagnation lingering, qi stagnation in the middle jiao, and impaired transformation. The plan is to use Zhi Chi Decoction to resolve external pathogens and Wen Dan Decoction to eliminate phlegm retention, allowing pathogens to exit externally and phlegm to transform internally, thereby reducing heat and stopping vomiting.
Dried Soybean Decoction three coins,
Scutellaria root one coin and five half coins,
Pinellia ternata two coins,
Roasted Job's tears and wheat sprout (each) three coins,
Red peony root two coins,
A slice of ginger,
Cinnamon twigs four half coins,
Bamboo shoot one coin and five half coins,
Tangerine peel one coin,
Cinnabar one coin and five half coins,
Poria one coin and five half coins.
Note: This case presents unresolved external pathogens and phlegm dampness in the middle jiao. The intention is to use Zhi Chi Decoction combined with Wen Dan Decoction to resolve external pathogens externally and eliminate phlegm internally. Cinnamon twigs, peony root, and ginger are added to aid in resolving external pathogens, while Scutellaria root and Poria clear heat. Cinnabar, Job's tears, and wheat sprout harmonize the stomach and transform dampness, collectively dispelling pathogens from the sun and Yangming patterns.
Yuan You (right side): After two stages of cold damage, the sun pattern pathogens remain unresolved, while Yangming heat is intense. The heat scalds the heart, causing delirium and restlessness. The mind is confused, with thirst for drinking, slight coldness in the back, a floating and slippery, rapid pulse, and yellow tongue. Guizhi Baihu Decoction is appropriate to resolve sun pattern pathogens and clear Yangming heat.
Cinnamon twigs five half coins,
Pinellia ternata two coins,
Gancao four coins,
Forsythia three coins,
Coarse gypsum three coins,
Baked Polygala one coin,
Red Ginseng three coins,
A slice of ginger,
Jujubes two coins.
Note: This case involves concurrent sun and Yangming patterns, with heat disturbing the heart causing delirium. Guizhi Baihu Decoction is used for dual resolution of exterior and interior. In the formula, gypsum and Anemarrhena clear Yangming heat, while cinnamon twigs, Gancao, ginger, and jujubes resolve sun pattern exterior pathogens. Forsythia aids in resolving exterior and clearing heat, while Pinellia ternata, Red Ginseng, and Polygala resolve phlegm and calm the mind. This formula balances exterior and interior, resolving and clearing, and is highly effective.
Li You (left side): Cold damage with stagnation, affecting the sun and Yangming patterns, with body heat unresolved for over ten days, slight coldness in the back, a floating and slippery, rapid pulse, dry mouth with little thirst, cracked lips, a thin, greasy, yellow tongue, and no bowel movement for five days. The sun pattern pathogens remain unresolved, while Yangming heat scalds the intestines, preventing downward movement of turbid filth. Guizhi Baihu Decoction, modified, is used to resolve sun pattern pathogens, clear Yangming heat, and aid in bowel movement, as per the principle of "Yangming with stomach excess should be purged."
Cinnamon twigs five half coins,
Gancao five coins,
Anhydrous Epsom salt one coin and five half coins,
Bamboo shoot one coin and five half coins,
Coarse gypsum three coins,
Trichosanthes kirilowii three coins,
Rhubarb three half coins,
Pinellia ternata one coin and five half coins,
Two slices of ginger,
Jujubes three coins.
Note: The sun pattern pathogens remain unresolved, while Yangming bowel excess has formed, presenting concurrent sun and Yangming patterns, as well as Yangming channel and bowel disease. Guizhi Baihu Chengqi Decoction, modified, is used. In the formula, cinnamon twigs, Gancao, ginger, and jujubes resolve sun pattern exterior pathogens, while gypsum clears Yangming interior heat. Rhubarb and Anhydrous Epsom salt purge stomach excess heat, while Bamboo shoot, Pinellia ternata, and Trichosanthes kirilowii lower resistance and promote bowel movement. This formula is effective in treating sun cold damage transforming into interior heat and stagnation.
Di You (right side): After two stages of cold damage, intense heat without sweat, delirium and restlessness, a dry and cracked tongue, a deep and rapid pulse, limbs cold instead of warm, and no bowel movement for five days. The pathogens have transformed into heat, spreading from Yangming to Chiroty, with depleted yin fluids and dry stools, resembling deep heat and deep. Seizures may occur soon. An urgent plan is to nourish fluids and clear heat, promoting downward movement to preserve yin, hoping for a turning point.
Coarse gypsum four coins,
Gancao five coins,
Fatty Anemarrhena one coin and five half coins,
Fresh Rehmannia six coins,
Scrophularia three coins,
Fresh Dendrobium three coins,
Prunus amygdalus (ground) three coins,
Perilla fruit (ground) four coins,
Mimosa pudica three coins,
Mangrove and sweet flag (each) one liang,
Qingning Pill ( decocted) three coins.
Note: After taking the nourishing fluids and clearing heat formula, bowel movement improved significantly, intense heat reduced, slight sweating, limbs warmed, as per the principle of "when interior qi flows, exterior pathogens naturally harmonize." However, thirst persists, slight delirium, a dry and rough tongue, and depleted Shaoyin fluids remain, with lingering Yangming heat and a rapid pulse. Nourishing Shaoyin fluids and clearing Yangming heat is still necessary, hoping for fluid replenishment and pathogen resolution to achieve a smooth recovery.
Coarse gypsum four coins,
Fatty Anemarrhena one coin and five half coins,
Gancao five coins,
Mimosa pudica three coins,
Fresh Rehmannia six coins,
Fresh Dendrobium three coins,
Scrophularia three coins,
Fritillaria cirrhosa two coins,
Mangrove and sweet flag (each) one liang.
Note: After two doses of nourishing fluids and clearing heat, intense heat greatly reduced, delirium ceased, but the tongue remains rough and black, dry mouth, rapid pulse, and dark urine, indicating depleted fluids due to heat. A sweet and cool nourishing fluids formula is used to clear lingering heat.
Rhinoceros horn slice five half coins,
Fresh Rehmannia eight coins,
Fresh Dendrobium five coins,
Coarse gypsum four coins,
Mangrove two coins,
Scrophularia three coins,
Gancao five coins,
Fatty Anemarrhena one coin and five half coins,
Powdered two coins,
Millet (decocted) three coins,
Mangrove and sweet flag (each) one liang.
Note: Both exterior and interior pathogens have greatly reduced, the tongue turned red and purple, fluids gradually restored, and heat declining, with a more harmonious rapid pulse. Continuing sweet and cool nourishing fluids to clear lingering heat.
one coin,
Fresh Rehmannia eight coins,
Fresh Dendrobium five coins,
Fatty Anemarrhena one coin and five half coins,
Scrophularia three coins,
Millet three coins,
Mimosa pudica three coins,
Gancao five coins,
Mangrove two coins,
Powdered three coins,
Fritillaria cirrhosa two coins,
Millet (decocted) three coins,
Mangrove and sweet flag (each) one liang.
Note: This case presents intense Yangming interior heat with internal dry stool and depleted fluids, transforming into heat. Intense heat depleting fluids risks uncontrolled spread. The "Cold Damage Treatise·Chiroty Disease" states, "If a cold damage pulse is slippery and cold, there is interior heat; Baihu Decoction is used," and " should be purged." A plan of clearing and purging is adopted, with nourishing fluids added. Gypsum, Anemarrhena, and Gancao clear Yangming interior heat, while Prunus amygdalus, Perilla fruit, and Qingning Pill moisten and purge internal heat. Large doses of Rehmannia, Scrophularia, Dendrobium, Mimosa pudica, Mangrove, and sweet flag clear heat and nourish fluids. After taking the medicine, bowel movement improved, intense heat reduced, but fluids remain depleted, with lingering Yangming heat. Moistening and purging ingredients are removed, continuing Baihu Decoction with nourishing fluids to achieve efficacy. This case emphasizes clearing and purging heat, with fluids restored once heat is gone. The use of Prunus amygdalus, Perilla fruit, and Qingning Pill to moisten and purge internal heat follows Wu Jutong's "Increase Fluids Chengqi."
Zhu You (right side): After one stage of cold damage, menstrual blood arrived, with pathogens entering the blood chamber, stagnating heat and blood clots. The pathogens have no external exit or internal downward movement, with fever, aversion to cold, mild morning, severe evening, confusion, delirium, seeing ghosts, costal pain, chest tightness, bitter mouth, yellow tongue, and pain in the lower abdomen. Bowel qi does not move, a wiry and rapid pulse, and a severe condition, possibly progressing to Chiroty. A temporary plan is Xiao Chaihu Decoction, with ingredients to clear heat and resolve blood clots, to harmonize the pivot and guide stagnating heat downward, hoping for a positive response.
Bupleurum one coin,
Fried Scutellaria root one coin,
Rhinoceros horn slice eight half coins,
Safflower eight half coins,
Peach kernel (decocted) one coin,
Green tangerine peel one coin,
Red Cyperus eight half coins,
Red peony root three coins,
Qingning Pill (decocted) three coins,
Powdered Persicae Semen (decocted) two coins.
Note: This case involves pathogens entering the blood chamber. The "Cold Damage Treatise" recommends Xiao Chaihu Decoction and needling Qimen. Xu Shuwei's "Ninety Treatises on Cold Damage" uses Xiao Chaihu Decoction with Rehmannia, Ye Gui's "Warm Heat Treatise" uses Tao's Xiao Chaihu Decoction without Ginseng and Jujubes, adding Rehmannia, peach kernel, hawthorn,, or rhino horn. Ding follows the predecessors, using Bupleurum and Scutellaria to harmonize the pivot; safflower, peach kernel, red peony root, and Persicae Semen to activate blood and resolve blood clots; Rhinoceros horn slice, Red Cyperus, and green tangerine peel to clear heat and promote urination; and green tangerine peel to regulate the liver and qi, with Qingning Pill to clear heat and promote bowel movement.
Wang You (left side): Kidney yin is inherently deficient, with external cold, affecting the sun and Shaoyin patterns, with fever, slight aversion to cold, body aches, and lower back pain like broken ribs. A thin, greasy, slightly yellow tongue, and a weak pulse in the (cubit) and a floating, tight, rapid pulse in the (radial) and (ulnar). The sun governs the body's exterior, and the lower back is the of Shaoyin. Wind and cold enter through gaps, blocking qi and blood circulation, a severe condition of dual infection. A temporary plan is Yangdan Decoction to resolve exterior pathogens, hoping for rapid resolution.
Cinnamon twigs five half coins,
Perilla stem and leaf (each) one coin and five half coins,
Northern Asarum three coins,
Thick Eucommia one coin and five half coins,
Luffa fruit one coin and five half coins,
Scallions three coins,
Fried Scutellaria root one coin,
Dried Soybean Decoction three coins,
Baked Gancao five coins,
Muga (decocted) three coins,
Two slices of ginger.
Note: External pathogens with deficient kidney yin, as per the "Inner Canon," are termed "dual infection." Zhang Zhongjing uses Mahuang, Asarum, and Fu Zi Decoction, and Ding adapts this method. The formula uses cinnamon twigs, Perilla stem and leaf, Northern Asarum, scallions, Dried Soybean Decoction, fried Scutellaria root, Gancao, ginger, and Muga to resolve exterior pathogens and clear interior heat. Eucommia tonifies the kidneys and strengthens bones and tendons. Muga and Luffa fruit resolve dampness and promote circulation. This formula balances sun and Shaoyin but leans toward the former, based on pulse and symptom analysis.