Clinical case reviewed in 2015 Advanced Clinical Series with Dr. Feng

Mr. Yao, 23 years old

1st consultation on December 11th, 1965

In May 1965, the patient was diagnosed with glomerulonephritis, which was treated with hormone therapy but was not effective, current symptoms: weakness, poor appetite, palpitations, lower limb edema on both legs, dry mouth with a desire to drink, sweating with a severe aversion to wind where the patient felt wind in a closed room without any open door or window, white greasy tongue coating, a thin, wiry and slippery pulse. A routine urine analysis examination showed: specific gravity 1.020, protein (+ + +), white blood cells l ~ 3, 15 ~ 20 red blood cells.

Symptoms analysis:
Tai yang syndrome: Sweating with aversion to wind
Tai yin syndrome: Lower limb edema, fatigue, poor appetite, white greasy tongue coating, thin and slippery pulse
Yang ming syndrome: Dry mouth with a desire to drink. Here there is only a slight Yang Ming syndrome comparatively to the other syndrome and it is only secondary to the other symptoms so it is not addressed in the primarily formula pattern.

Six syndrome: Tai yang Tai yin syndrome

Formula pattern: Fang Ji Huang Qi Tang pattern

Result: After taking 3 packs of the medicine, his urination increased, his legs were less swollen, and he was sweating less. He continued taking modified versions of the same formula for a month until his edema disappeared, but he still felt fatigued, his urinary examinations showed: urine specific gravity 1.016, urine protein (+), white blood cells 0 ~ 1, red blood cell 1 ~ 10. He continued taking the same formula slightly modified, following the changing symptoms. After 3 months his urine protein levels were (+ / -).

Note: In the Jin Gui Yao Lue· On Water Qi Disorders line 20 it says:

“Wind water, if there is a floating pulse, body heaviness, sweating and aversion to wind, Fang Ji Huang Qi Tang governs.”

The pulse is floating since the pathogen is in the exterior, heaviness is due to dampness, the exterior is not consolidated, so there is sweating and aversion to wind. This wind water represents exterior deficiency and retained dampness, Fang Ji Huang Qi Tang is used to consolidate and resolve the exterior as well as expel rheum located on the exterior layer of the body.

Where there is a floating pulse, sweating and aversion to wind it will fit a Gui Zhi Tang pattern, but in this case the exterior deficiency was more severe seen in the extreme aversion to wind and sweating. Also there was a retention of rheum on the exterior aspect of the body seen in the edema which is addressed with Fang Ji and Huang Qi. Cang Zhu and Sheng Jiang address the Tai yin syndrome and Zhi Gan Cao and Da Zao protect the stomach qi.