Here’s the translation with key TCM terms contextualized for international readers:
Medical Case Record from Shaanxi Jingyang County
The incident occurred in the household of Magistrate Zhou Beisan of Jingyang County. His mother-in-law (traditionally honored as “Taishui”) and widowed sister-in-law (his wife’s elder brother’s widow), two generations of widows, both relied on Magistrate Zhou’s support. After concluding official business at the county office one day, Magistrate Zhou urgently requested: “The two ladies in my household have fallen gravely ill. I implore you to examine them.” I immediately accompanied him.
Diagnostic Process:
Before pulse-taking, I noted their symptoms:
- The elderly matriarch presented with persistent high fever, parched mouth, profuse sweating, accompanied by chest tightness, abdominal distension, constipation, and abdominal pain.
- The widowed sister-in-law exhibited abdominal fullness with intermittent dull pain. Though afebrile, she showed limb weakness, mental fatigue, and complete loss of appetite.
Pulse diagnosis revealed striking contrasts:
- The matriarch’s pulse was deep and rapid, with exceptionally strong pulsations at the right guan position (spleen-stomach pulse zone).
- The sister-in-law’s pulses were uniformly slow and weak, particularly feeble at the right guan position.
Differential Diagnosis:
I explained to Magistrate Zhou: “Though sharing the same household, their conditions differ fundamentally. Your Taishui suffers from excessive stomach fire (gastrointestinal heat excess), while your sister-in-law exhibits deficient spleen yang (digestive system hypofunction). In TCM, we ‘cool heat syndromes with cold herbs and warm cold syndromes with hot herbs’—vigorous heat-clearing is required here, while yang reinforcement is essential there.”
I prescribed two diametrically opposed formulas:
- For the matriarch: Tiaowei Chengqi Decoction (a heat-purging formula containing rhubarb root/magnesium sulfate)
- For the sister-in-law: Gui Fu Lizhong Decoction (a yang-warming formula with cinnamon bark/aconite)
Treatment Controversy:
Magistrate Zhou hesitated: “These formulas contradict each other like fire and ice. Could we use milder alternatives?” I urgently clarified: “Without clearing your Taishui’s excess heat, delirium will ensue. Without warming your sister-in-law’s deficiency, severe diarrhea will develop. We’re racing against pathological progression—no delay is permissible!”
Treatment Outcome:
Three days later, Zhou reported partial improvement. Startled, I demanded: “No bowel movement after purgatives? No warming effect after tonics? This defies medical principles!” The magistrate then confessed: “I reduced the doses—removed magnesium sulfate from the purgative formula, halved the aconite in the tonic. I thought ‘better slow recovery than risks’…”
Medical Principle Reinforcement:
I admonished: “TCM formulas follow strict jun-chen-zuo-shi compatibility principles (herbal synergy like precision-engineered keys). Altering doses is like using broken keys—they won’t unlock healing.” Upon implementing original prescriptions:
- The matriarch passed hardened stools with subsequent fever resolution
- The sister-in-law’s pain alleviated, restoring appetite
Follow-up adjustments:
- Matriarch: Dietary regulation
- Sister-in-law: Extended yang-tonic regimen
Epilogue:
When Magistrate Zhou later arrived with generous gifts, I declined as befitting colleagues. This case exemplifies TCM’s core tenets:
- Bianzheng lunzhi (syndrome differentiation/(used in traditional contexts) customization)
- Jun-chen-zuo-shi (strategic herb combination)
Clinical Note: This historical case demonstrates TCM’s personalized (used in traditional contexts) philosophy and precise herbal formulation principles, maintaining relevance in modern practice particularly for functional gastrointestinal disorders requiring tailored therapeutic strategies.
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