(chapter61)Yang Deficiency with Blood Heat Misdiagnosed as Rash Syndrome

In our village, people often mistakenly refer to all bedridden patients as having “Cold Damage Fever Illness (伤寒热病),” while physicians routinely diagnose them with “Sweating Syndrome (汗症).” Few understand the fundamental differences between two distinct conditions:

1. ​Cold Damage : Caused by genuine exposure to cold pathogens, requiring warm dispersing therapies per Zhang Zhongjing’s (张仲景) methods.
2. ​Heat Illness: May arise from external factors (wind, cold, summerheat, heat) or internal imbalances (dietary errors/excessive desires). Improper (used in traditional contexts) can be fatal.

• Spring-warmth & summer-heat conditions: Liu Hejian’s approaches excel.
• Dietary/desire-related disorders: Combine Li Dongyuan  and Zhu Danxi’s  methods.

  

Clinical Case Report

Patient: Newlywed daughter-in-law (married 10+ days) with high fever, agonized crying, and restlessness.

First Misdiagnosis

Physician A: Local scholar (passed 1846 imperial exam)

• Diagnosis: Sha Syndrome (acute eruptive fever)
• Prescription: Rhinoceros Horn Detoxification Decoction ( Xijiao Jiedu Tang)
  Contained Rhinoceros Horn (Xi Jiao; modern use prohibited)
• Outcome: No eruptions appeared; fever persisted

Second Misdiagnosis

Physician B: Herb merchant from Wu’an, Henan

• Diagnosis: Sha Syndrome + Stomach Cold
• Prescription: Stomach-Calming Powder (Pingwei San)
  • Contained Magnolia Bark (Hou Po), Tangerine Peel ( Chen Pi)
• Outcome: Fever intensified with delirium

Successful Treatment

My Diagnosis:

• Pulse: Extremely deep and rapid
• Differentiation:
  • Not Sha Syndrome (no eruptions after 10 days)
  • True pattern: Yin deficiency with blood heat

Treatment Protocol:

1. Modified Rehmannia Decoction (Dihuang Tang)
   • Replaced Prepared Rehmannia (Shu Dihuang) with Fresh Rehmannia (Sheng Dihuang)
2. Combined with Three Yellows Decoction (Sanhuang Tang)
   • Scutellaria Baicalensis (Huang Qin)
   • Coptis Chinensis (Huang Lian)
   • Phellodendron Bark (Huang Bai)

Results:

• 9 PM: Patient fell into deep sleep
• Added Cicada Molt ( Chan Tui) & Juncus Effusus ( Deng Xin Cao) for residual heat
• Consolidation: Ophiopogon-Schisandra Rehmannia Pill (Maiwei Dihuang Wan) for 15 days

Prescription Glossary

• ​Xi Jiao Jie Du Tang: Historical formula using rhinoceros horn (now ethically prohibited)
• ​Pingwei San: Stomach-regulating formula containing Atractylodes (Cang Zhu)
• ​Sanhuang Tang: Classical heat-clearing combination of three “yellow” herbs