Many Symptoms — Nosebleed and Palpitation — Soothed by Boosting Qi and Governing Blood with *Guipi Tang*
Professor Fan Zhenglun often says: TCM examines as an old clerk weighs a case — only by finding the case's root knot can one lay hands. Before a tangled disease, to cut clear with a sharp blade, one must have accurate pattern-discernment; only then comes correct treatment.
Today's patient is just such a case: many symptoms, complex condition, qi-and-blood out of accord, every storehouse deficient.
The patient, Ms. Li, 43, works at a hospital. Pale face slightly puffy; expression melancholy; build a little heavy; lips pale-red; hair faintly yellow and thin; eyes large but unwilling to open. Self-report: in 1983 she noted that on overcast and rainy days she felt chest oppression and short breath; since then she has had spells of palpitation and short breath, chest tightness and oppression, dizziness and heaviness, worse on activity. Appetite poor; after meals, stabbing stomach pain; dares not eat cold. Drink moderate; stool loose. Sleep poor and dreamful; wakes early and unrefreshed; urine normal. Frequent nosebleeds, worst in spring; legs swollen; lumbar pain; memory falling. Menses early, bright-red, lasting ten days. Generally afraid of cold. Blood pressure low 90/70 mm Hg; platelets 80,000.
History: 1983 viral myocarditis; 1988 right-breast hyperplasia surgery; 1992 sterilization surgery; April 1994 pleural effusion; 1997 bilateral knee effusion, and the same year menstrual irregularity, often early and heavy. Early 1998 cervical-vertebra 4–5 osteophytes, and the same year uterine fibroid. Western medicine has advised surgery; the patient is still considering.
By the history, though only 43, the patient's course has been winding and twisted. Beset by illness, she is exhausted in body and mind, weighed by anxiety. Softly she told me: "I work in a hospital, yet I am always ill — I have had surgery several times. Now they want surgery again — to live in this world is hard!" Seeing her pained, pessimistic look, I gently consoled her: "Taking Chinese medicines to regulate, you will get better."
So many contradictions — kidney-deficient edema, spleen-and-stomach out of accord, heart-qi insufficient, heart-spirit unnourished — where to begin? I was silently thinking.
Professor Fan paused, then said: "I think we should use Guipi Tang. The chief signs are heart-and-spleen both deficient, qi failing to contain blood — hence nosebleed and heavy menses. The spleen is the foundation acquired-after-birth, the source of qi-and-blood transformation. So we begin with boosting qi to govern blood, to gather the blood that has left its channel; the heart-and-spleen signs will improve. By the principle 'spring-summer nourish yang, autumn-winter nourish yin' — now is summer — primarily boost qi and strengthen spleen; come autumn and winter, then tonify kidney and nourish yin."
Prescription:
zhi-huangqi 30 g | dangshen 15 g | stir-fried baizhu 12 g | fushen 9 g
stir-fried suanzaoren 12 g | longyanrou 9 g | chenpi 9 g | yuanzhi 9 g
shichangpu 6 g | zhi-gancao 6 g | sanqi powder 6 g (stirred in) | chuanjiao 12 g
huanglian 6 g | 7 doses, water-decocted.
A week later the patient called to say palpitation, short breath, and chest oppression had eased; eating and sleep improved; spirit much better; no nosebleed for a week; so 7 more doses.
Another week on, she came in: face faintly red, eyes spirited; stomach no longer pained, stool sometimes formed; edema slight; vaginal discharge reduced; lumbar pain mild; dizziness, palpitation, chest oppression, short breath all gone.
Professor Fan kept her on the same formula with modifications, and made Guizhi Fuling Wan into honey-pills to treat the uterine fibroid, sparing her surgery.
This case shows: though Guipi Tang is a well-known formula, applying it nimbly and aptly is not easy. In complex clinic, one must grasp the chief contradiction and the essence — only then does the knot open. Though the patient had spleen-deficient and kidney-deficient signs, the bleeding was the urgent; grasping Guipi Tang's boost qi to retain blood, return blood to channel was to grasp the root. It embodies TCM's for the urgent treat the branch, for the chronic treat the root — and this case treats both. Spring-summer nourish yang, autumn-winter nourish yin also embodies TCM's Heaven and the human as one.
Excerpted from Family Chinese Medicine, 2000, issue 2.