5. Heart and Kidney Deficiency

5. Heart and Kidney Deficiency The main symptoms include pale face, palpitations, chest tightness, a pale tongue with a white coating, and a pulse that is either weak and slow or rapid and forceful. Treatment focuses on nourishing yin, restoring the pulse, replenishing qi, and strengthening the body’s defenses. The formula chosen is “Zhi Gan Cao Tang,” with modifications: 15g of Dang Shen, 15g of Zhi Gan Cao, 12g of A Jiao (dissolved in warm water), 12g of Mai Dong, 20g of Sheng Di, 15g of Ma Ren, 15g of Gua Ling, 12g of Xie Bai, 10g of Wu Wei Zi. Brew with water and take once daily.

6. Toxicity Spreading Through the Meridians: The main symptoms include speech impairment, throat obstruction, choking cough, or facial asymmetry, limb paralysis, a pale red tongue with a white coating, and a fine pulse. Treatment focuses on nourishing blood, replenishing qi, relaxing muscles, and activating the meridians. The formula used is “Nourishing Zheng Tang,” with modifications: 20g of Sheng Di, 15g of Shou Wu, 12g of Yu Zhu, 12g of Mai Dong, 30g of Shan Yao, 12g of Bai Shao, 10g of Rou Zhi, 12g of Mu Gua, 15g of Jie Teng, 20g of Dan Shen. Brew with water and take once daily.

In the above classifications and treatments, although there have been historical views that “diphtheria should avoid external treatment,” when external symptoms are prominent, one should dispel exterior factors, often adding Mulberry Leaves and Kudzu Root; for high fever, add Stone Nettle, and for those with rapidly spreading pseudomembranes and neck swelling, add Ban Lan Gen, Tuo Niu Xi, and Shan Dou Gen; for those with a cough, add Zhi Mu; for constipation, add Da Huang, Mang Xiang, or Fire Hemp Seeds; for those with difficulty breathing, add Ling Zi and fresh Bamboo Juice; for those who are weak, add Ginseng and Astragalus; for severe dryness of the mouth, add Sha Shen and Mai Dong; for severe cough, add Bei Mu; for those with severe pain, add Chicken Blood and Shen Qu.

(4) Traditional Chinese Medicine Resources on Diphtheria Differentiation and Treatment Different regions have developed various classifications of diphtheria based on different criteria. Summarizing them, we find three main types: ① Classifying according to the internal organs and meridians into five types:

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Practical Internal Medicine Combined with Western Medicine | Such as | Zhu Huo Hua Du Tang: Lung Qi Obstruction type, treated with clearing heat, resolving stagnation, and harmonizing the qi; the main formula Heat Clearing and Detoxification method, with the main formula being Blue… | > 18g of Le, 30g each of Chrysanthemum and Coptis, 12g of Barley Frost); Yin Deficiency and Lung Hardness type | > (Kidney Meridian Syndrome) Treatment +-------------------+-----------------------------------------------------:+ (Ammonium Sulphate, Zhebei Mu, Ban Dian… | > Treats with methods to strengthen the spleen and eliminate phlegm, using modified Si Jun and Er Chen Tang as the main formulas; the spleen | > Should nourish and restore the pulse, and nourish the lungs. | > For the Heart and Kidney Deficiency type (Heart Meridian Syndrome), treat with methods to clear heat, resolve stagnation, and nourish the lungs. | > Use Tian Fu Mei Tang, and modify with Gui Fu Ba Wei Wan, Liu Wei San, etc.; for the Heart and Kidney Deficiency type (Heart Meridian Syndrome), use Tian Fu Mei Tang, and modify with Gui Fu Ba Wei Wan, etc. ② Classifying according to the Wei Qi, Qi, and Blood: For example, in the Wei Qi syndrome (Wind-Heat syndrome), add Sheng Xi; in the Qi syndrome, limit Disperse (remove light soybean paste, add Niu Xi, Chan Yi, Xuan Shen, Shan Dou Gen) and Sang Ju Yin, also use Li Hou San; for Yin Deficiency, treat with methods to clear heat, resolve toxicity, and reduce swelling, using Xian Fang Huo Ming Yin, or Ma Xing Shi Gan Tang, or modify with Lian Bo Tang, also use Li Hou San at 0.8–1.2g for oral administration; for Yin Deficiency (Dry Heat) type, treat with methods to nourish yin, clear the lungs, and detoxify, using Nourishing Yin Clearing Lung Tang with Niu Xi. Qin Bowen and others believed that in cases where the disease leans toward Wind-Heat, many patients also experience cold and heat headaches, with a floating, rapid pulse; treatment begins with dispersing the exterior, clearing heat, and detoxifying, using Sang Ge Tang in combination with “Chu Yao San”; after the exterior symptoms subside, proceed with Nourishing Yin Clearing Lung Tang with Tuo Niu Xi for treatment; for those who lean toward Yin Deficiency, if there are no exterior symptoms at the onset, but the pulse is rapid and weak, it is advisable to nourish yin, clear heat, and detoxify, using Nourishing Yin Clearing Lung Tang with Tuo Niu Xi, combined with “Chu Yao San.” Both methods use cooling herbs to cleanse the throat. There are also methods that focus on clearing heat, detoxifying, nourishing yin, and dissolving phlegm, using Ma Xing Shi Gan Tang. Sang Ju Yin, Yin Qiao San, Nourishing Yin Clearing Lung Tang (also use Bing Xiong San to cleanse the throat simultaneously). ③ Classifying according to the relationship between evil and vital energy: For example, dividing into types such as “Vital Energy Excess, Evil Excess,” “Vital Energy Deficiency, Evil Excess,” and “Vital Energy Deficiency, Evil Excess.” Nantong Medical College classified this disease into two types: “Evil Excess” and “Deficiency of Vital Energy.” Evil Excess is further divided into Dry Heat type, Wind-Heat type, Wind-Cold type, and Wind-Toxin type; “Deficiency of Vital Energy” mainly refers to complications and secondary diseases of diphtheria, such as myocarditis and nerve paralysis. Myocarditis is classified into Heart Yin Deficiency type and Heart Yang Deficiency type. Changzhou Traditional Chinese Medicine Hospital classified this disease according to the nature of the pathogen into types such as “Seasonal Epidemic Diphtheria,” “Hidden Evil Diphtheria,” “Diphtheria Transforming into Fire,” “Diphtheria Heat,” “Yangming,” and “Diphtheria Heat Disrupting the Pericardium,” among others. Other classifications include those based on “etiology,” “Three Jiao,” and “disease stage,” though their meanings and treatment approaches are similar. Some scholars have offered differing perspectives on earlier discussions, pointing out that “Diphtheria should avoid external treatment; improper sweating can be dangerous” (Diphtheria Treatment: Avoid External Treatment and Support Vital Energy), referring to cases where there were no concurrent illnesses or complications in diphtheria, nor any secondary diseases; “For epidemic diphtheria, external treatment is recommended; sweating can lead to complications” (“Hou Sha Zheng”), meaning that during the early stages of epidemic diphtheria, when the rash has not yet broken through, it is essential to grasp the stage of the disease and its underlying mechanisms, and to treat appropriately in order to achieve effective results. It is recommended that those who initially present with external symptoms use modified Jie Jing Tang, Zhu Huo Hua Du Tang, or Shen Dong Bi Xie San for treatment; for those with Wind-Heat, use modified Yin Qiao San; for those with lung heat and Yin damage, use Nourishing Yin Clearing Lung Tang; for those with heat and dampness in the lungs and stomach, use Xian Fang Huo Ming Yin combined with Clear Throat and Diaphragm Tang for treatment; if there is no high fever but residual toxins have not yet been cleared, use Clear Heart and Detoxify Tang, Nourishing Zheng Tang, or modified Four Gentlemen Tang with Jin Yin Hua. Ouyang Qi pointed out that the key issue in treating diphtheria is: ① controlling and managing suffocation caused by pseudomembranes in the throat; it is advisable to add ingredients like Ling Zi, Xing Ren, Bai Jie Zi, and Zhu Li to descend qi and clear phlegm, while avoiding herbs like Sheng Ma, Kudzu Root, and Chrysanthemum to elevate qi; it is also advisable to employ methods of vomiting (if necessary, perform tracheostomy). ② Regarding the prevention and treatment of myocarditis, see below for details—combining control of myocarditis with detoxification and supporting vital energy. For treatment of associated complications, such as myocarditis, most cases involve heat-toxins infiltrating the heart and kidneys, exhausting the heart, liver, and kidneys, causing Yin damage, Yang weakness, and blood depletion; treatment focuses on nourishing yin, replenishing blood, benefiting qi, strengthening yang, and restoring the pulse while reinforcing the body’s defenses. Common formulas include Eight Flavor Sixty-Two Tang, modified Repulse Tang, Three-Element Repulse Tang, Fuzi Lizhong Tang, Shenfu Tang, Guibi Tang, Shengmai San, Zhigan Cao Tang, and Dushan Tang. For cases of throat obstruction and throat paralysis, treatment for throat obstruction involves methods to eliminate phlegm, open the airways, and clear toxins, using “Xiong Huang Jie Du Wan” (30g of Xiong Huang, 3g of Yu Jin, 14 peeled and oil-free Barley Frost seeds, ground into fine powder and made into vinegar-based pills, 1.5g per dose, halved for children, taken with hot water), “Jie Bai San” (7 red Barley Frost seeds, flying Xiong Huang, Zhebei Mu, Chrysanthemum, Yu Jin each 15g, ground into fine powder, 1–8 years old, 1–2g per dose), Li Hou San, Xi Xian San, Saponaria Bitter Wine Decoction, and Chrysanthemum White Powder. In recent years, there have been reports of late-stage diphtheria cases involving nerve paralysis; for example, Xia Yue Wen recently reported treating soft palate paralysis in diphtheria with a specialized formula: 6–12g of Chan Yi, 6–15g of Jiang Can, 10–20g of Ren Dong, 10–15g of Sheng Di, 6–18g of Si Gua Luo and Dan Pi, 3–6g of Quan Xie and Chrysanthemum, 6–10g of Gan Cao, taken once daily in decoction, with 22 cases recovering, and 3 cases discontinuing treatment (Shanghai Journal of Traditional Chinese Medicine, 1987.1). Additionally, during the recovery phase, 30g of Sheng Di, 15g of Mai Dong, 15g of Xuan Shen, 15g of Fresh Dendrobium, 15g of Huang Ling, 15g of Jin Yin Hua, plus 9g of Tianma, 15g of Xuduan, 15g of Sang Ji Sheng, 6g of Tian Nan Xing. Some used the post-recovery Nourishing Zheng Tang to treat soft palate paralysis, using Yu Zhu, Shan Yao, Sheng Di, Sheng Di, Dazhong, Dajue, Shaoshang, along with paired acupoints like Tian Tu, Lian Quan, Xia Guan, Qia Che, He Gu, Shaoshang, and even paired acupoints like Feng Fu, Feng Chi, Feng Long, Feng Zhong, Jian Yu, and Qian Yu. Some used Tian Tu as the main acupoint, paired with He Gu and Shaoshang, while others used Tian Tu, Tian Qu, Shaoshang, paired with Fu Qu, Fu Tong, Fu Long, Fu Zhong, Fu Xue, Fu Yuan, Fu Cheng, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Zhen, Fu Z......Task output rules: Translate this markdown block from Chinese to English. 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2. The poison of the disease is felt, directly affecting the lungs and stomach, flowing through the meridians and ultimately reaching the upper part of the body. At that time, the pathogen's toxins cause inflammation and lead to false connections, forming a blocked or obstructed pathway. The toxin resides within the internal organs, causing damage to the heart and bones, resulting in yin deficiency and yang weakness—approximately equivalent to diphtheria-induced myocarditis. As the heat-toxin flows, yin is damaged and the meridians are injured, leading to paralysis. The toxin causes phlegm and turbidity to accumulate in the throat and trachea, disrupting the normal ascending and descending functions of lung qi. In mild cases, patients may experience fever, wheezing, cough, dry cough like barking, hoarseness, and other symptoms of phlegm and turbidity; in severe cases, they may develop pale complexion, noisy phlegm, cyanosis of the lips, difficulty breathing, and other signs of airway obstruction. Some scholars believe that diphtheria often occurs in late autumn and early spring, falling under the category of latent heat illness or latent heat triggered by new infections. The root cause of diphtheria lies in the Hand Taiyin Lung Meridian, while its manifestations originate from the Hand Shaoyin Heart and Foot Shaoyang Gallbladder Meridians; these meridians are also involved in the process of fire-toxin spreading and transforming into five internal organs and six viscera. If the dry fire in the lungs persists without being resolved, and the three meridians remain unbalanced, it can further lead to overall organ deficiency. Therefore, the entire course of diphtheria can be divided into two stages: the stage of excess evil and the stage of deficiency of righteous qi. The first two stages represent excess evil, while the latter two stages indicate deficiency of righteous qi. However, in recent years, diphtheria has tended to become milder, and severe cases are becoming less common.

(3) Traditional Chinese Medicine Differentiation and Classification, and Herbal Formulas

1. Epidemic Toxin Affecting the Lungs The primary symptoms include fever, chills, headache, sore throat, the presence of pseudomembranes in the throat, red tongue with a thin, white, slightly dry coating, and a floating, rapid pulse. Treatment focuses on dispersing wind, clearing heat, detoxifying, and relieving throat discomfort. The formula chosen is “Shu Feng Qing Re, Jie Du Li Yan,” with modifications: 10g of Rou Ye, 30g of Ge Gen, 20g of Sheng Di, 15g of Shan Dou Gen, 12g of Huang Qin, 12g of Bei Mu, 12g of Niu Xi, 12g of Sha Shen. Brew the herbs in water and take one dose per day.

2. Epidemic Toxin Transforming into Fire The primary symptoms include intense heart palpitations and restlessness, dry throat and pain, rapid spread of pseudomembranes, dark-colored lesions, significant neck swelling (“ox neck”), red tongue with yellow coating, and a slippery, rapid pulse. Treatment should focus on detoxifying, clearing heat, reducing fire, and restoring yin. The formula chosen is “Bai Hu, Xi Di He Pu Ji Xiao Du Yin,” with modifications: 20g of Sheng Shi Gao, 12g of Zhi Mu, 20g of Sheng Di, 10g of Shui Niu Jiao, 12g of Chi Shu, 12g of Ban Lan Gen, 15g of Xuan Shen, 15g of Jin Yin Hua, 15g of Shan Dou Gen, 12g of Niu Bang Zi, 10g of Gan Cao. Brew the herbs in water and take one dose per day.

3. Lung Qi Obstruction The primary symptoms include rapid growth of pseudomembranes, dry throat and tightness in the throat, barking-like cough, phlegm in the throat, rapid breathing, red tongue with a yellowish, greasy coating, and a slippery, rapid pulse. Treatment focuses on eliminating phlegm, clearing obstruction, detoxifying, relieving throat discomfort, and clearing heat from the lungs. The formula used is “Ma Xing Shi Gan Tang Jia Wei,” with modifications: 6g of Ma Xing, 12g of Xing Ren, 15g of Shi Gao, 9g of Gan Cao, 12g of Zhe Bei Mu, 15g of Shan Dou Gen, 10g of Yi Li Zi, 10g of Sheng Da Huang (added later), 15g of Tuo Niu Xi. Brew the herbs in water and take one dose per day. It can also be combined with Zhu Li Gao or fresh bamboo juice.

4. Yin Deficiency and Lung Dryness The primary symptoms include dry throat and mouth, dry, yellow pseudomembranes, constipation, red tongue with a thin yellow coating, and a fine, rapid pulse. Treatment involves modifying the “Yang Yin Clear Lung Decoction”: 20g of Sheng Di, 15g of Xuan Shen, 12g of Mai Dong, 12g of Chi Shu, 12g of Dan Pi, 12g of Zhe Bei Mu, 12g of Huang Qin, 15g of Shan Dou Gen, 15g of Niu Xi, 15g of Ban Lan Gen. Brew the herbs in water and take one dose per day.

5. Heart and Kidney Deficiency The primary symptoms include pale complexion, palpitations, chest tightness, pale tongue with white coating, and a weak, irregular, or rapidly beating pulse. Treatment focuses on nourishing yin, restoring pulse, replenishing qi, and consolidating depletion—using modified Zhi Gan Cao Tang: 15g of Dang Shen, 15g of Zhi Gan Cao, 12g of A Jiao (dissolved in warm water), 12g of Mai Dong, 20g of Sheng Di, 15g of Ma Ren, 15g of Gua Ling, 12g of Xie Bai, 10g of Wu Wei Zi. Brew the herbs in water and take one dose per day.