(chapter90)Shaoyang Common Cold with Heat Entering Blood Chamber (Gynecological Infec)

Wang Danwen, a fellow townsman, fell ill after his fourth remarriage. Initially attributed to depression caused by improper conduct towards his mother-in-law, physician Yin Yucang (a scholar with the title Maocai) prescribed Xiaoyao Powder (Free and Easy Wanderer Powder). Treatment showed intermittent effectiveness over a month. Subsequently, scholar-physician Li Dixian noted two months of menstrual absence (Guishui), initially suspected pregnancy before confirming consumption (tuberculosis-like wasting syndrome). His prescription—Shiquan Dabu Decoction (Ten Complete Great Tonification Decoction) with added cinnamon bark (Rougui, Cinnamomi Cortex) and prepared aconite (Fuzi, Aconiti Lateralis Radix Praeparata)—provided temporary relief but exacerbated fever upon continued use.

When summoned for consultation, I identified:

• ​Pulse characteristics: Fine and rapid with slippery quality in lung position (mai xi shuo)
• ​Diagnosis: Heat Entering Blood Chamber syndrome (re ru xue shi), originating from Shaoyang meridian exogenous pathogen
• ​Original misstep: Failure to administer Chaihu Decoction (Bupleurum Decoction) with Rehmannia Root (shengdi, Rehmanniae Radix) and Moutan Bark (mudanpi, Moutan Cortex) for blood-cooling
• ​Treatment errors:
  • Yin’s Xiaoyao Powder—marginally appropriate
  • Li’s hot-natured herbs—equivalent to “fueling fire with oil” given preexisting yin deficiency

Clinical manifestations at presentation included:

• Concurrent cough and dyspnea
• Afternoon tidal fever
• Cephalic vertigo
• Generalized fatigue

Prescribed Li Dongyuan’s Zhengyin Laoli Decoction (Yin-Rescuing Consumption-Relieving Decoction). Emphasized prognostic dependence on menstrual resumption: “Therapeutic success hinges on Guishui restoration. Without its return, temporary improvement proves futile.”

Follow-up timeline:

1. ​2 days post-(used in traditional contexts): 50% symptom reduction reported
2. ​4 days: Pulse rapidity moderated but severe deficiency persisted; switched to Ginseng Jiufei Decoction (Ginseng Lung-Rescuing Decoction)
3. ​7 days: Persistent amenorrhea led to (used in traditional contexts) discontinuation

Postscript: By the fifth lunar month’s end (Wu Yue in traditional calendar), the patient had succumbed in mid-fourth lunar month.

Terminology Clarification:

1. Maocai: Han-era scholarly title (equivalent to “xiucai”)
2. Guishui : Classical TCM term for menstruation from Yellow Emperor’s Canon
3. Heat Entering Blood Chamber: Critical gynecological syndrome from Shanghan Lun (Treatise on Cold Damage)
4. Zhengyin Laoli Decoction: Yin-nourishing formula from Lan Shi Mi Cang (Secret Treasury of the Orchid Chamber)

Pharmaceutical Components:

• Xiaoyao Powder: Bupleurum (Chaihu, Bupleuri Radix), Angelica (Danggui, Angelicae Sinensis Radix), White Peony (Baishao, Paeoniae Radix Alba), etc.
• Shiquan Dabu Decoction: Eight Treasures Combination plus Astragalus (Huangqi, Astragali Radix) and Cinnamon