Li Xu carefully reviewed Ms. Zhu’s dical records.
"This case is a classic," Li Xu said, pointing to the consultation notes. "A dark red tongue with a white, greasy coating, plus a deep, wiry pulse—it’s a textbook case of Yang Qi deficiency with water retention and blood stasis. Ten years of edema, diagnosed by Western dicine as thrombophlebitis but with no effective treatnt. This is the perfect opportunity to test the efficacy of True Martial Soup."
Guo Yu nodded, his fingers tapping lightly on the desk. "The key is the Aconite. In True Martial Soup, Aconite is the monarch herb, used to warm the kidney’s Yang Qi to transform Qi and promote water tabolism. The Aconite used before was soaked in Daban Liquid, which is why it wasn’t effective. Now we can use the Aconite you brought..."
"However..."
Guo Yu’s tone shifted. "The patient also has a history of cerebral hemorrhage and her blood pressure is on the high side. Isn’t it risky to use Aconite?"
Li Xu thought for a mont, then picked up a pen and jotted down a few herbs on a notepad. "I’ve carefully examined the Aconite. After processing, its toxicity is minimal. If we’re careful during decoction, we can remove ninety-nine percent of the toxins. Furthermore, we’ll pair it with Poria Cocos and Atractylodes to invigorate the spleen and drain dampness, and add red peony to cool the blood and disperse stasis. This way, we can warm the Yang Qi without it being too harsh or drying."
"Brilliant!" Guo Yu slapped his thigh. "What about adding so herbs to invigorate blood and promote urination? As the saying goes, ’When blood does not flow freely, it turns to water.’"
Li Xu nodded and continued writing on the paper. "Eupatorium, motherwort, Red Flower, and Chuan Xiong. These herbs can both invigorate blood and promote urination, perfectly aligning with the principle of treating blood and water simultaneously."
The two of them enthusiastically discussed the prescription.
A mont later, the complete prescription was ready. "Ephedra Decoction to ventilate the lungs and promote urination, True Martial Soup to warm the Yang Qi and transform Qi, plus these blood-invigorating and diuretic herbs—it should be effective."
Guo Yu took the prescription, his eyes lighting up. "This combination is exquisite! Ephedra and almond to ventilate the lungs; Cinnamon Bark and licorice to harmonize the Ying and Wei; Aconite to warm the kidney’s Yang; Poria Cocos and Atractylodes to invigorate the spleen... Advisor Li, you’ve truly brought the classic formulas to life!"
Li Xu shook his head humbly. "I just happened to be reading a book by Zhang Zhongjing recently, which is how I ca up with this combination."
The *Jingyue Complete Book: Swelling* clearly states that edema is closely related to the lungs, spleen, and kidneys, saying: "Water is of the Ultimate Yin, so its root is in the kidneys. Water is transford by Qi, so its manifestation is in the lungs. Water fears only earth, so its control lies in the spleen. Now, if the lungs are deficient, Qi fails to transform essence and instead becos water. If the spleen is deficient, earth fails to control water and is instead overco by it. If the kidneys are deficient, water loses its master and runs rampant."
This shows that edema is intimately connected to the three organs: the lungs, spleen, and kidneys.
If the lungs are deficient and cannot regulate the water passages, the acquired spleen is deficient and cannot transport and transform fluids, and the congenital kidneys are deficient and cannot steam and transform Qi, the Qi transformation of the Triple Burner will be impeded. This leads to an accumulation of fluid that overflows into the skin.
In this case, due to the long and protracted course of the illness, the patient’s lungs, spleen, and kidneys have lost control over water tabolism. This has resulted in edema in both lower limbs that pits on pressure, a cold lower back, fatigue, a pale complexion, and other signs of yin-type edema. This points to a pattern of spleen and kidney Yang Qi deficiency, failure of the lungs to disperse and descend, and an internal accumulation of water and cold.
Therefore, the treatnt principle is to warm the kidneys and assist the Yang Qi, ventilate the lungs, and promote urination. The formula used is a modified combination of True Martial Soup and Ephedra Decoction. Processed Aconite warms the kidneys and assists the Yang; Poria Cocos and Fried Atractylodes invigorate the spleen and drain dampness; red peony cools the blood and disperses stasis; Mu Fangji promotes urination and reduces swelling; and raw ephedra, fried almond, Cinnamon Bark, and baked licorice ventilate the lungs, induce sweating, and promote urination.
Imdiately after, Guo Yu contacted the patient himself.
The illness, which had gone uncured for over a decade, had naturally been tornting her all this ti.
Upon hearing about a new treatnt plan, the patient arrived quickly.
Ms. Zhu looked much older than her actual age. Her eyes were dull, her lower limbs were noticeably swollen, and her pant legs were stretched taut.
"Ms. Zhu, please have a seat," Guo Yu said gently. "This is Dr. Li, a highly skilled consultant at our hospital. He will be diagnosing you today."
"Him?"
Ms. Zhu looked at the young Li Xu with a hint of doubt in her eyes.
’But since I’m already here, I might as well see what he has to say,’ she thought. She had already lost all hope.
During the consultation that followed, Li Xu carefully asked Ms. Zhu about the changes in her symptoms, her diet, and her daily habits. He also took her pulse and examined her tongue.
Guo Yu took notes at the side, occasionally adding a few questions of his own.
"Do you usually feel cold? Especially in your lower back?" Li Xu’s fingers rested lightly on Ms. Zhu’s wrist, feeling the deep, wiry pulse.
Ms. Zhu nodded. "My lower back is always chilly. Even in the sumr, I have to wear thicker clothes, or it becos very uncomfortable."
"Is your urine scant? What color is it?"
"It’s scant and clear, just like water."
Li Xu and Guo Yu exchanged a look, further confirming the diagnosis of spleen and kidney Yang Qi deficiency.
He spoke gently to Ms. Zhu, "We now have an understanding of your condition. It’s a typical case of edema, which in Traditional Chinese dicine is caused by abnormal fluid tabolism due to spleen and kidney Yang Qi deficiency. We’re going to prescribe a formula for you. You’ll need to take it for two weeks so we can see the effects."
Ms. Zhu asked worriedly, "Doctor, I’ve had this illness for over ten years. Can it really be cured?"
Li Xu didn’t offer an absolute promise. Instead, he said earnestly, "Traditional Chinese dicine emphasizes a gradual process. We will first address the edema, and then slowly treat the root cause. You must take the dicine on ti, rest well, and avoid exposure to cold."
After writing the prescription, Li Xu gave detailed instructions on how to prepare the decoction and other precautions, especially emphasizing that the Aconite needed to be decocted first to reduce its toxicity.
Ms. Zhu took the prescription and left the consultation room, accompanied by a nurse.
...
"There’s one more case."
Guo Yu produced another dical file.
Li Xu began to read it.
Mr. Chen, male, 39 years old. Initial consultation on April 28, 202x.
Chief Complaint: Diarrhea accompanied by a feeling of cold in the lower back for one year, worsening in the last three months.
The patient discovered he had high blood sugar during a physical examination ten years ago and was diagnosed with type 1 diabetes. He has been on insulin injections ever since and requires hospitalization one to two tis per year.
The patient reports regularly taking Jinshuibao capsules, Imodium, and other dications. Due to the recent worsening of his symptoms, he is unable to work and has sought consultation.
Current Symptoms: Diarrhea with lientery (undigested food in stool), occurring 3-5 tis a day. Dysuria and a feeling of incomplete urination. Emaciation and fatigue, dizziness, a general aversion to cold, and an icy-cold sensation in the lower back. Appetite is average, sleep is acceptable.
Tongue: Thin and red, with a scant, dry coating. Pulse: Wiry and rapid.
Lab Results: Urine protein 2 , urine occult blood 2 , fasting blood glucose 9.5 mmol/L, postprandial blood glucose 14.7 mmol/L.
Diagnosis: Western dicine diagnosis: Type 1 diabetes. TCM diagnosis: Wasting-thirst (Xiao Ke).
Pattern Differentiation: Spleen and kidney Yang Qi deficiency with rampant water-evil.
Treatnt Principle: Warm the kidneys and invigorate the spleen, transform Qi and promote water tabolism.
"Diabetes?"
Li Xu took this case seriously.
Modern dicine defines type 1 diabetes as a chronic autoimmune disease characterized by an absolute deficiency of insulin, requiring lifelong dependence on exogenous insulin therapy and disease managent.
If not effectively controlled, it can lead to complications such as cardiovascular disease, kidney disease, eye damage, neuropathy, and foot problems.
In this case, the patient’s long course of illness has led to spleen and kidney Yang Qi deficiency. The kidneys fail to govern water, and the "gate" cannot close properly, leading to internal retention of water and dampness. The ascending, descending, exiting, and entering of Qi have beco disordered. This manifests as diarrhea, lientery, dysuria, emaciation, fatigue, a cold lower back, and many other associated symptoms.
The *Su Wen: Discussion of the Life-giving Qi and Heaven* states: "As for Yang Qi, its essence nourishes the spirit, and its gentleness nourishes the sinews."
This demonstrates the importance of Yang Qi to the human body. Therefore, the appropriate treatnt is to warm the kidneys and invigorate the spleen, transform Qi, and promote water tabolism. The chosen formula is a modified True Martial Soup. Aconite strengthens the Yang within the kidneys, warming the Yang and dispelling cold. Poria Cocos is bland and percolating, clearing water and dampness from the Triple Burner. Atractylodes is sweet and warm, invigorating the spleen and expelling dampness. Ginger is acrid and dispersing, scattering water-qi from the stomach. Peony is sour and bitter, astringing yin and harmonizing the Ying phase.
Because the patient has chronic diarrhea, Wui and Hawthorn are added to bind the intestines and stop diarrhea. This is paired with Dodder Seed and Cynomorium to warmly tonify the kidney Yang; Mountain Yam to benefit the kidneys and invigorate the spleen; Bixie and Eupatorium to promote urination and expel dampness; as well as Fennel to warm the kidneys and disperse cold, and cinnamon to guide the fire back to its source. A prolonged illness inevitably leads to stasis, so Leech is also added to invigorate blood and transform stasis.
Wu Zhen of the Qing Dynasty wrote in the *Handbook of Cold Pathogenic Diseases*: "Use True Martial Soup to strengthen the primordial Yang and eliminate yin-water."
Therefore, using a modified True Martial Soup for this patient was perfectly suited to the diagnosis.
He had the pharmacy prepare the dicine, using the high-quality Aconite that Li Xu had brought.
After instructing the patient on the correct thod for decocting and taking the dicine, he sent him ho.
Afterward, Guo Yu found several other cases that required True Martial Soup.
This ti, however, he used the ordinary Aconite from the pharmacy.
They just had to wait a few days to compare the results and see if the Aconite was indeed the reason.
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