Mr. Li Gengtang was a military scholar-official equivalent who served as a regional military commander in Wenzhou and later rose to become a mid-level military officer in Jiangxi. Due to the low income of his position, he retired to his hometown. His eldest son, Dongqiao, worked as an official in the Ministry of Revenue in the capital, while his second son, Lianfeng, was a well-read scholar repeatedly recommended for office but never appointed. Lianfeng and I developed a close friendship in our hometown. Though retired, Mr. Li remained straightforward and often mediated disputes, earning respect from the local community.
Progression of Illness
In the spring of Gengshen year (1860), Dongqiao was imprisoned by the Ministry of Justice due to a corruption case involving a state-run money exchange. Over a year later, with the case unresolved, Mr. Li grew increasingly anxious. By the summer of Xinyou year (1861), he developed chest tightness, loss of appetite, and swelling in his limbs.
- First Treatment: Doctors suspected edema (fluid retention) and prescribed diuretics (利水药 lishuiyao), but these failed.
- Second Treatment: Another doctor diagnosed “deficiency syndrome” and prescribed Shenqi Pills (肾气丸 shenqiwan, Kidney-Qi Tonic). The swelling worsened instead.
Diagnosis and Treatment Plan
I was invited to treat Mr. Li after meeting Lianfeng at a family funeral.
- Pulse Diagnosis: All six pulses felt strong and forceful, with the right guan pulse (indicating stomach/spleen) hard and pulsating.
- Analysis: Chronic overconsumption of rich foods caused stagnation in the stomach. In Traditional Chinese Medicine (TCM), “the stomach governs the limbs”—stomach dysfunction leads to swelling. Despite poor urination, this wasn’t true edema. Previous misuse of Rehmannia root (熟地 shudi) and Aconite (附子 fuzi) had worsened stagnation.
Treatment
I explained: “While recovery will take months due to his age and weak digestion, reducing swelling is achievable.”
- Phase 1: Shenshi Decoction (渗湿汤 shenshitang, Dampness-Resolving Formula) combined with Immature Bitter Orange (zhishi), Akebia stem (mutong), and Achyranthes root (niuxi) to clear stagnation.
- Concerns: Lianfeng worried the formula was too aggressive. I clarified this was an “emergency (used in traditional contexts)” (急则治标 jize zhibiao) to restore stomach function.
- Phase 2: Long-term use of Zisheng Jianpi Pills (资生健脾丸 zisheng jianpiwan, Spleen-Nourishing Pills) for 3-5 months.
Results
- After one dose, skin wrinkles appeared (signs of reduced swelling).
- Three doses later, 60% of the swelling subsided.
Lianfeng wrote: “Your medical skill astonishes me! As the ancients said, ‘those caring for parents must study medicine—I’m deeply ashamed.”
Complications
During follow-up, the right guan pulse remained hard. Learning urination hadn’t improved, I added Lepidium seed (tinglizi) and Pharbitis seed (qianniuzi). This triggered over a dozen urinations, resolving bloating and restoring appetite. I advised switching to pills for convenience.
Relapse
After Lianfeng left for provincial exams, Mr. Li’s daughter (with basic medical knowledge) and an elderly servant (self-proclaimed “healer”) began feeding him Rehmannia root (shudi), Ophiopogon root (maidong), Edible bird’s nest (yanwo), and Korean ginseng (gaolishen), along with daily meat-heavy meals. Within two weeks, stagnation and urinary issues recurred despite no visible swelling.
Final Decline
When Lianfeng returned and requested another consultation, Mr. Li’s pulses showed critical weakness: chi pulses (kidney/life-force) were thread-like, and the left guan pulse (liver) was erratic. I prescribed mild Liujunzi Pills (六君子丸 liujunziwan, Six Gentlemen Formula) as a palliative measure but declined further (used in traditional contexts), recognizing the terminal prognosis.
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