Case 2

Case 2

Mr. Chen, male, 68 years old, retired worker, first visit on April 7, 1983. The patient experienced sudden chest tightness, shortness of breath, and coughing one day prior, followed by massive hemoptysis—bright red blood mixed with foam. Over the past day, he has continued to cough up blood, totaling about half a spittoonful. He was previously diagnosed at another hospital as having "bronchiectasis complicated by massive hemorrhage." He has a history of chronic bronchitis, but no history of tuberculosis, heart disease, or liver and stomach ailments.

Physical Examination: Body temperature 38°C, respiration 20 times per minute, pulse 102 beats per minute, blood pressure 13.3/8.7 kPa (100/65 mmHg). The patient is thin and pale, with clear consciousness. The chest is symmetrical, slightly barrel-shaped, with deformed intercostal spaces. Percussion reveals hyperresonance, and both sides show deep respiratory movement. Lung sounds are coarse, with scattered dry rales. The cardiac border is not enlarged, and no obvious murmurs are heard in any valve area. A2 > P2, with A2 slightly accentuated. The abdomen is flat and soft, with no tenderness in the gastric region. The liver and spleen are not palpable, and there is no ascites (-).

Chest X-ray: Both lungs show markedly thickened lung markings, increased translucency, and widened lung fields, indicating chronic bronchitis complicated by emphysema and bronchiectasis.

Laboratory Tests: White blood cells 18,600/mm³, neutrophils 82%, lymphocytes 18%, ESR 2 mm/h.

Western Medical Diagnosis: Bronchiectasis and emphysema complicated by massive hemoptysis.

Traditional Chinese Medicine Diagnosis: The patient's tongue is red with a thick, greasy yellow coating, pulse is large and rapid, stools are dry and hard, chest and diaphragm feel full and oppressed, coughing is labored, phlegm is abundant and foamy, with bloody sputum. The pattern indicates excess heat in the lungs and stomach, with fire raging and forcing blood. The treatment should focus on clearing heat from the lungs and stomach and cooling the blood to stop the bleeding.

Prescription: Modified Liang Ge San. Decocted in water, one dose per day (along with intramuscular injection of penicillin 800,000 units every 8 hours and streptomycin 0.5 g every 12 hours), for a total of four doses.

+-------+------:+-------+------+--------+------+--------+------+--------+------+
| Da Huang  | > 10  | Mang Xiao  | > 10 | Yun Qiao   | > 10 | Huang Qin   | > 10 | Shan Zhi   | > 10 |
| Bai Ji  | > g   | Gua Yao  | > g  | Ju Hong   | > g  | Huang Lian   | > g  | Bei Mu   | > g  |
| Gan Cao  | > 10g | Bo He  | >    |        | >    |        | > 6g |        |      |
|       |       |       | > g  |        | > g  |        |      |        |      |
|       |       |       | > 3g |        |      |        |      |        |      |
|       |       |       |      |        |      | +------+--------+------+ |      |
|       |       |       |      |        |      |        |      |        |      |

Follow-up Visit: Hemoptysis has stopped, the tongue coating has become thinner, though yellow and greasy coating remains. Chest fullness and shortness of breath have also eased compared to before, but phlegm is still abundant, now thick and purulent, with brown-black, foul-smelling, watery diarrhea occurring 2–3 times daily. The pulse is wiry and rapid.

The previous formula has removed Mang Xiao and Bai Ji, and five additional doses are being administered.

Third Follow-up Visit: Except for chest fullness and shortness of breath, all symptoms have subsided. The pulse is wiry and weak in the cun position, and the tongue is pale with a slight yellow and greasy coating. The patient is instructed to take Mai Wei Di Huang Wan twice daily, one pill each time, to consolidate the effects.

Two Reflections

In the above cases, although Western medicine was used in conjunction during treatment, the application of bowel-regulating therapy undoubtedly played an important role in controlling the condition.

In Case 1, using bowel-regulating therapy can promote pancreatic juice drainage, enhance pancreatic duct flow, and potentially facilitate the resolution of congestion and edema.

In Case 2, bowel-regulating therapy appears to help resolve pulmonary edema and congestion, thereby aiding in the alleviation of pulmonary hemorrhage.

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Furthermore, Sanhuang Xiexin Tang is a well-known fire-clearing and hemostatic formula, highly effective in treating pulmonary hemorrhage. Traditional Chinese medicine holds that "the lungs and large intestine are exterior-interior counterparts," so purging the stomach and intestines is akin to "removing the fuel from under the pot." Adding Coptis chinensis further embodies the principle that "purging the heart is purging fire, and purging fire is stopping bleeding." The method of unblocking the bowels is indeed effective in treating various acute conditions; however, the key indicator for using this method in emergency treatment should be "internal accumulation of excess heat," which is entirely consistent with traditional concepts. The author believes that "internal accumulation of excess heat" can lead to yang excess obstructing yin (shock), or excessive heat causing wind movement (convulsions), or even blood rushing out uncontrollably (hemorrhage), or heat invading the pericardium (coma). All these critical conditions have heat accumulation as their pathological basis, thus providing a broad scope for using the bowel-unblocking method in emergency treatment. The application of this method should be stopped once the disease is cured, to prevent excessive diarrhea and subsequent complications; in other words, once the syndrome of "internal accumulation of excess heat" changes, treatment should be adjusted according to the new condition to ensure complete recovery.

(Chinese Journal of Integrated Traditional and Western Medicine, June 1986)

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Combining Macroscopic and Microscopic Differentiation to Enhance TCM Diagnostic and Therapeutic Standards

Pei Zhengxue

Over the past century, modern science and technology have advanced at an astonishing pace, shifting humanity's understanding of disease from the macroscopic to the microscopic level. As a natural science dedicated to combating disease, Traditional Chinese Medicine should naturally become part of the modern scientific network and progress in tandem with modern science and technology. However, due to historical constraints, our predecessors were unable to make greater strides in this area. This historic mission now falls squarely on the shoulders of us, the practitioners of TCM. To achieve this goal, the author proposes the integration of macroscopic and microscopic differentiation, and seeks readers' opinions; any shortcomings are welcome to be criticized and corrected.

[Pei Zhengxue's TCM—Theory and Clinical Case Studies]{.underline}

Published by Heji Suxue Publishing House

After the Industrial Revolution in Britain, Western medicine began to develop, with experimental research replacing traditional logical reasoning and microscopic understanding supplementing medieval macroscopic reasoning. Thus, Western medicine emerged in a completely new form, establishing a microscopic system based on physiological and pathological changes in organs, tissues, cells, body fluids, and nerves. Every link in this system, as well as the corresponding clinical treatments and prescriptions, is closely related to the advancement of modern natural sciences. It also interpenetrates and mutually benefits from other fields of modern natural science, such as physics, chemistry, microbiology, meteorology, and geology, advancing in sync. For example, liver function tests, protein electrophoresis, and alpha-fetoprotein tests for liver diseases; gastroscopy and histopathological sectioning for stomach diseases—these examination methods and microscopic data are all products of experimental research and results of mutual penetration among various fields of modern natural science.

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On the Method of Strengthening the Spleen and Tonifying the Kidneys

Pei Zhengxue

The spleen governs middle qi, while the kidneys govern primordial qi; middle qi is also called spleen qi, and primordial qi is also called kidney qi. Together, they are referred to as righteous qi. The "Plain Questions: Discussion on Acupuncture Techniques" states: "When righteous qi resides within, evil cannot invade." The "Plain Questions: Discussion on Fever" further says: "Wherever evil gathers, qi must be deficient." Clearly, the presence of righteous qi in the human body is crucial for preventing illness. Based on this, TCM regards "deficiency of righteous qi" as the root cause of disease and has proposed the great method of reinforcing righteous qi and consolidating the foundation. Since righteous qi is composed of both middle qi and kidney qi, strengthening the spleen and tonifying the kidneys are undoubtedly the two most important aspects in reinforcing righteous qi and consolidating the foundation.

Pei Zhengxue's TCM—Theory and Clinical Case Studies

Published by Hepei Tutu Publishing House