Depleted Water Cannot Moisten Wood
Wáng Xùgāo’s case reports
This week I spent time reading through some of the cases from Wáng Xùgāo (whose 30 treatment methods for the liver we looked at last time). They are recorded in Wáng Xùgāo Lín Zhèng Yī Àn (Wáng Xùgāo's Clinical Records), compiled in 1897 by Wáng’s student, Fāng Rényuān (1844-1926). Fāng annotated the cases, as can be seen in two of the examples below. The book contents span the entire spectrum of internal medicine (and some external medicine, as Wáng was originally trained as a surgeon, treating abscesses), but in the spirit of the season the cases presented are all taken from the chapter on “Liver, Wind, Phlegm and Fire” (Gān fēng tán huǒ mén). I chose three out of the two dozen or so in the chapter. The translations are a little rough but hopefully serviceable. I throw in a quick comment after each case.
朱 水虧不能涵木，陽升陰不上承。時際春深木旺陽升之候，是以寒熱，頭痛，胸痞，少寐，便結等症見也。仿趙養葵法。
大生地（砂仁拌） 茯神 丹皮 柴胡（鹽水炒） 棗仁 女貞子 麥冬（硃砂拌） 歸身 陳皮 生薑 石決明 紅棗
淵按：從逍遙散參入滋水養肝，頗有巧思。
Zhū
Depleted water cannot moisten wood, yáng ascends and yīn cannot bear upward. In spring, a time of profound flourishing of wood and rising yáng, pathoconditions such as chills and fever, headache, thoracic glomus, lack of sleep, and bound stool begin to appear. Copy Zhào Yǎngkuí’s method.
Dà Shēng Dì (Rx Rehmanniae)(mixed with Shā Rén / Fr Amomi), Fú Shén (Poriae pararadicis), Dān Pí (Cx Moutan), Chái Hú (Rx Bupleuri) (stir-fried in brine), Zǎo Rén (Sm Zizyphi Spinosae), Nǚ Zhēn Zĭ (Fr Ligustri), Mài Dōng (Rx Ophiopogonis)(mixed with Zhū Shā /Cinnabar), Guī Shēn (Rx Angelicae sinensis), Chén Pí (Pc Citri Reticulatae), Shēng Jiāng (Rz Zingiberis Recens), Shí Jué Míng (Concha Haliotidis), Hóng Zǎo (Fr Jujube rubrum)
Yuān's comment: Using Xiāo Yáo Sàn joined with enriching yīn (formulas) to emolliate the liver is quite ingenious.
Comments: Zhào Yǎngkuí is perhaps better known to us today as Zhào Xiànkě (1573-1664), author of the influential text Yī Guàn (Key Link of Medicine). Zhào had some fascinating ideas, and an extremely pragmatic prescription method which relied heavily on four formulas: Liù Wèi Wán (Six-Ingredient Rehmannia Pill), Bā Wèi Wán (Eight-Ingredient Rehmannia Pill, a.k.a. Jīn Guì Shèn Qì Wán or Golden Cabinet Kidney Qi Pill), Bǔ Zhōng Yì Qì Tāng (Center-Supplementing Qi-Boosting Decoction), and Xiāo Yáo Sàn (Free Wanderer Powder) (De Vries, 2012). Yuān's comment above, unless I miss my guess, is referring to Zhào’s combination of Xiāo Yáo Sàn with Liù Wèi Wán to treat yīn depletion with liver depression, rather than a direct comment on the formula presented above. Zhào’s combination is similar to the one we explored a couple of weeks ago.
宋 營血內虧，不能涵木，加以惱怒，肝風暗動，不時頭昏腳軟，防其跌僕。今宜養血熄風。
黨參 當歸 白芍 川貝 陳皮 茯神 棗仁 香附 橘葉 砂仁 石決明 刺蒺藜
淵按：營虛由脾不化，心不生。黨參、當歸補脾以生營，砂仁、橘葉快脾以疏肝，余亦清金制木，利氣養營者也。
Sòng
Internal depletion of yíng-blood which cannot moisten wood. When he is angered, liver wind clouds and stirs, and frequently his head gets cloudy and his legs go limp, so he needs aid to keep from falling. It is appropriate to nourish blood and extinguish wind.
Dǎng Shēn (Rx Codonopsitis), Dāng Guī (Rx Angelicae sinensis), Bái Sháo (Rx Paeoniae alba), Chuān Bèi (Bulbus fritillariae cirrhosae), Chén Pí (Pc Citri reticulatae), Fú Shén (Scl Poriae Pararadicis), Zǎo Rén (Sm Ziziphi spinosae), Xiāng Fù (Rz Cyperi), Jú Yè (Fm Citri reticulatae), Shā Rén (Fr Amomi), Shí Jué Míng (Concha Haliotidis), Cì Jí Lí (Fr Tribuli).
Yuān's comment: Yíng deficiency is caused by the spleen failing to transform, and the heart not engendering. Dǎng Shēn and Dāng Guī supplement the spleen and engender yíng, Shā Rén and Jú Yè facilitate the spleen to course the liver, and the remainder also clear metal to restrain wood, disinhibit qì and nourish the yíng.
Comments: As Fāng points out, the treatment takes a multifaceted approach which includes supplementing qì and blood, calming the spirit, anchoring the liver, regulating qì, and transforming phlegm. Here the underlying pathology is not depleted water, but depleted earth. Liver treatment can be quite complicated indeed.
徐 喪弟悲哀太過，肝陽升動無制。初起病發如狂，今則心跳少寐，頭暈口乾，略見咳嗽。擬安神養陰、清火降氣為法。
石決明 丹皮 棗仁 茯神 川貝 北沙參 廣橘紅 麥冬 元參 竹茹 枇杷葉
Xú
Excessive grief and sorrow over the loss of a younger brother, the liver yáng rises and stirs uncontrollably. At first the disease appeared like mania, but now there is throbbing of the heart, reduced sleep, dizziness, dry mouth, and a slight cough. The plan is to quiet the spirit and nourish yīn, clear fire and downbear qì as the treatment methods.
Shí Jué Míng (Concha Haliotidis), Dān Pí (Cx Moutan), Zǎo Rén (Sm Ziziphi Spinosae), Fú Shén (Scl Poriae Pararadicis), Chuān Bèi (Bulbus Fritillariae Cirrhosae), Běi Shā Shēn (Rx Glehniae), Guǎng Jú Hóng (Pc Citri Reticulatae Rubrum Australe), Mài Dōng (Tuber Ophiopogonis), Yuán Shēn (Rx Scrophulariae) Zhú Rú (Caulis Bambusae In Taeniam), Pí Pá Yè (Fm Eriobotryae).
Comments: An example from the literature of unchecked emotion as a primary driver of illness. Another well-balanced formula that supplements yīn without heavy cloying medicinals.
Next time we will look at some further aspects of liver patterns. Thanks, as always, for reading.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
De Vries, L. (2012). The gate of life: before heaven and curative medicine in Zhao Xianke’s Yiguan. [Doctoral dissertation, Ghent University]. https://biblio.ugent.be/publication/4337151
Wáng, X.G., & Fāng, R.Y. (1897). Wáng Xùgāo lín zhèng yī àn. https://jicheng.tw/tcm/book/%E7%8E%8B%E6%97%AD%E9%AB%98%E8%87%A8%E8%AD%89%E9%86%AB%E6%A1%88/index.html Retrieved April 15, 2023.
王旭高临证医案. (n.d.). https://baike.baidu.com/item/%E7%8E%8B%E6%97%AD%E9%AB%98%E4%B8%B4%E8%AF%81%E5%8C%BB%E6%A1%88/1228564. Retrieved April 27, 2023.