Medicine as genius

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Cases from Zhang Cong-Zheng and Zhu Dan-Xi 1

by Steven Clavey

Case History 1
(from Zhang Cong-Zheng aka Zi-He, or Dai Ren, 1156-1228):

One old man of 60, who was upset during his stint of forced labour, suddenly exhibited yang madness (fa kuang). His mouth and nose felt as if insects were crawling over and within them, and both hands scrambled and scratched at the area. This continued for several years without ceasing.

Dai Ren found the pulses of both hands to be big and strong like thick ropes, and made his diagnosis thus:

“The mouth is known as the Flying Gate, the Stomach is known as the Cardiac Gate, and the mouth is also the upper source for the Stomach. The nose is the origin of the foot Yang Ming channel, which arises from the bridge of the nose, next to — and bound to — Tai Yang, descending along the column of the nose to intersect at Ren Zhong (Du 26) then circling the lips to intersect below at Cheng Jiang (Ren 24). This is why the illness is like this.”

“This disturbance during the corvée [involving the heat of anger, the heat of exertion and the heat of the sun] belongs to fire transforming: the fire mounts the Yang Ming channel and thus yang madness results.

“This is the reason that the Classic states that Illness in Yang Ming: climbing to high places and singing, stripping off clothes and walking about, cursing and swearing without regard for relatives or strangers. 2

“Furthermore the Liver carries out planning, while the Gallbladder enacts decisiveness; a corvée involves forced urgency with no recompense of income, so that although Liver can plan, yet Gall Bladder cannot act in accordance with decisions [and is frustrated] — it is all bending and no chance to straighten, all anger and no chance to vent it. Heart fire swells, fills and mounts the Yang Ming channel.

“Thus Stomach by nature belongs to Earth while Liver belongs to Wood and Gall Bladder belongs to Ministerial Fire; Fire follows Wood qi and enters the Stomach, and therefore yang madness erupts.”

Thereupon he ordered that a room be heated [and the patient placed within]. The patient sweated copiously, and this was repeated three times. The Nei Jing says: When Wood is constrained, allow it to reach out, when Fire is constrained, then bring it out. 3 This describes this situation admirably.

Then the formula Tiao Wei Cheng Qi Tang (see below) was decocted briefly, and given to the patient in three doses, resulting in a strong purge causing 20 bowel movements. A large amount of blood, water and stagnant blood was passed all mixed together. Once this was drawn out, the patient was healthy. Then Fang Feng Tong Sheng San was given to enhance healing.

Formulas

Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction)

  • Da Huang 12g (Rhei Radix Et Rhizoma)
  • Gan Cao 6g (Glycyrrhizae Radix)
  • Mang Xiao 12g (Mirabilitum)

Fang Feng Tong Sheng San (Saposhnikoviae Powder that Sagely Unblocks)

  • Fang Feng 15g (Saposhnikoviae Radix)
  • Ma Huang 15g (Ephedrae Herba)
  • Jiu Da Huang 15g (Rhei Radix Et Rhizoma wine treated)
  • Mang Xiao 15g (Mirabilitium)
  • Jing Jie 15g (Schizonepetae Herba)
  • Bo He 15g (Menthae Haplocalycis Herba)
  • Zhi Zi 15g (Gardeniae Fructus)
  • Hua Shi 90g (Talcum)
  • Shi Gao 30g (Gypsum)
  • Lian Qiao 15g (Forsythiae Fructus)
  • Huang Qin 30g (Scutellariae Radix)
  • Jie Geng 30g (Platycodi Radix)
  • Chuan Xiong 15g (Chuanxiong Rhizoma)
  • Dang Gui 15g (Angelicae Sinensis Radix)
  • Bai Shao 15g (Paeoniae Radix Alba)
  • Bai Zhu 15g (Atractylodis Macrocephalae Rhizoma)
  • Gan Cao 60g (Glycyrrhizae Radix)

 

Case History 2

The wife of Xiang Guan-Ling refused to eat, although hungry, and often liked to shout and curse furiously, trying to kill those around her. Her vicious talk was endless. All the doctors tried various remedies and formulas, but after half a year she was still the same.

Dai Ren said: “This is difficult to treat with herbs.” He made two courtesans each paint their face with rouge, and act out an opera. 4
Mrs Xiang had a great laugh.

The next day he had them put on a wrestling match, grabbing and butting — again she laughed.

Meanwhile he had a couple of women who liked their food to rave on about how delicious it was, until the patient begged for a taste.

After several days of this, her fury had diminished and her food intake increased, and soon she was cured without medicines. She afterwards bore a son.

The practice of medicine requires genius, for without genius, how could one master the limitless changes?


One young man fell off his horse, then exhibited yang madness. He glared around, talked crazy talk and could not tell relatives from strangers. He stripped off his clothes and strode about, curses spewing forth, and his strength was such that it took more than five men to restrain him.

Incense was burned, exorcists called, shamans danced — but none could manage. Cinnabar, bezoar, rhinoceros horn, pearls, musk and all manner of expensive drugs were given until the family’s wealth was dispersed, and at their dwelling the empty chambers were filled only with the desolate wind.

Family members travelled more than two hundred miles to beg Zhang Dai-Ren to attend. hen he arrived, he planted a carriage wheel with the axle straight up into the ground, with another wheel on top, so that it was about six feet in the air. On top of this he had fixed a structure that looked like a dish, on top of which the bound patient was placed face down, then wrapped up in quilts and blankets.
Dai-Ren then ordered a man to begin to turn the wheel with a stick. After hundreds of revolutions the patient vomited several pints of a greenish-yellow frothy fluid, which formed a circle around the contraption. The patient then said: “I can’t stand it any longer — let me come down!”

As he asked, he was released; he demanded cool liquid and he was given iced water. After drinking several quarts, the madness was gone.

Translator’s comment:

This striking example of cathartic therapy, the graphic details of which will certainly excite the professional interest of the clinically minded reader, is nonetheless also consistent with Chinese medical theory. At the most basic, this is wu ji bi fan — things, reaching their extreme, turn into their opposite.
But Zhang Cong-Zheng realised that the shock of falling off the horse had scattered the Liver and Gall Bladder qi, allowing phlegm to quickly accumulate. Youth was all that was needed to provide the fire that characterises yang madness. Fire and phlegm then occupied the residence of the Shen. His novel method of producing vomiting was indeed dramatic, but the iced water that followed is also worthy of note: the final quenching of the excessive fire. Shock can also have other consequences. For the reader’s future clinical reference, Zhu Dan-Xi notes in his Dan Xi Xin Fa: “Shock damages the Gall Bladder, leading to yin madness, use worry to overcome it, and fear to release it.”

 

Case History 3 from Zhu Dan-Xi

A girl over 20 years of age became engaged, but her fiancé thereupon left for distant parts and did not return. After two years she became ill, refused to eat, and would only lie in bed, dull and unresponsive. But there were no other symptoms. No medicines had been effective.

I went to treat her, and found her sleeping under the covers, her body thin and emaciated. I thought it over, and concluded “This is an illness of knotted qi. No herbs can treat this: but fury can release it”. 5

So I went to her, and in order to stimulate her fury, gave her three good slaps to the face, then accused her of pining for a secret lover [rather than her fiancé]. As planned, she became very angry, then burst into tears. I let her cry for several hours, then had her parents go in to calm her. Two doses of herbs were taken, and her appetite improved.

But I told her parents: “Although she is better, she must further have happiness before the condition is totally relieved. If she starts to think again then the knotted qi will certainly recur.” Her parents then pretended that her fiancé had written that he was returning, setting a date for their marriage. One month later, her fiancé did in fact return: the illness was then totally cured.

Translator’s comments:

In those days, a girl over 20 years of age and not yet married had plenty to worry about; and especially so in this case. For over two years she had concentrated her thought on nothing else. The force of this concentration easily overcame any effect of herbs.

Zhu Dan-Xi by using the term qi jie’(knotted qi) is clearly signalling the passage in the Su Wen Chapter 39, which also guides his treatment. By engaging fury, he encourages Liver Wood to begin to assist Spleen transport, dispersing the concentrated knot, then supports this with herbs; by engaging happiness, he encourages Heart: Fire produces Earth.

In his Dan Xi Xin Fa, Zhu Dan-Xi explicitly states this principle: “Excessive concentration damages the Spleen and can produce epilepsy, yin madness (dian) or yang madness (kuang). Use fury to overcome it, then happiness to release it. … But only the sage can carry out such a technique.”

Endnotes

1. All cases recorded in the Gu Jin Tu Shu Ji Cheng: Yi Bu Quan Lu (Collection of Books and Illustrations, Medical Section, Chen Meng-Lei, 1725; People’s Health Publishing, 1991, pp. 1782-1783 and pp. 2217-2218.)

2Su Wen, Chapter 30. Qi Bo explains that when yang is excessive, this energy spreads to the limbs, allowing for irrepressible superhuman strength; excess yang involves heat, so that they strip off clothing and walk about to keep cool, and that the excess yang excites the shen, unmoderated by yin quietness, hence the cursing, swearing and singing.

3 Su Wen chapter 71, near the end.

4. Which, since opera is the sole province of male performers, they were manifestly unable to do — hence the humour.

5. This refers to the famous quote from the Su Wen Chapter 39:
“The Emperor said: Fine. I know that the Hundred Illnesses all arise from qi. Fury — qi rises; happiness — qi calms; grief — qi disperses; fear — qi descends; cold — qi contracts; heat — qi drains; shock — qi disorders; overexertion — qi exhausts; thinking — qi knots. These nine each cause a different illness — why?
Qi Bo answered: “When thinking, the Heart and the Shen concentrate internally, but excessive thinking will cause excessive concentration, which is why qi becomes knotted.” (The latter sentence is a paraphrase, for clarity).