5. Formula to Treat Elderly People with Intestinal Dryness and Constipation (from “Family Treasure of Fang’s”)

Take eight liang of Asparagus cochinchinensis, four liang each of Ophiopogon japonicus, Angelica sinensis, Hemp Seed, and Rehmannia. Boil into paste, mix with honey, take 8–10 teaspoons morning and evening, mixed with plain boiled water.

In summary, both winter medicines have a wide range of clinical applications. Since neither herb is toxic and both have tonic effects, they are easily misused by physicians. Li Zhongzi of the late Ming Dynasty wrote in “Essential Notes on Materia Medica”: “Asparagus cochinchinensis is cold and slippery; if the spleen is weak and there is diarrhea or poor appetite, it is not suitable.” He also pointed out that Ophiopogon japonicus “is slightly less cold, but still should be avoided in cases of cold-induced diarrhea.” In addition, both winter medicines are often used by doctors to treat coughs and dryness-related conditions, but if the lungs have no virtual fire but instead cold phlegm or phlegm-damp, Asparagus cochinchinensis should not be used; if the stomach and lungs have internal heat, Ophiopogon japonicus should not be used. Patients with inherently cold stomachs should also use both winter medicines with caution.

(Guangxi Journal of Traditional Chinese Medicine, February 1981)

Introduction to Old TCM Doctor Pei’s Experience in Treating Aplastic Anemia

Pei Zhengxue

In recent years, Old TCM Doctor Pei has meticulously studied blood disorders and now shares his experience in treating aplastic anemia.

I. Kidneys Govern Bone Marrow, Spleen Governs Extremities

Aplastic anemia is caused by dysfunction of hematopoietic function in the red bone marrow, characterized by a decrease in the three lineages of peripheral blood cells (granulocytes, red blood cells, megakaryocytes). “Plain Questions · Yin-Yang Correspondence and Great Theory” states: “Kidneys generate bone marrow.” Based on this principle, to improve the bone marrow picture of patients with aplastic anemia, treatment should focus on tonifying the kidneys. Dr. Pei, with 50 years of clinical experience, has found that Liuwei Dihuang Tang indeed has the effect of regulating bone marrow hematopoiesis, especially with Cornus officinalis, whose dosage can be as high as 30 grams, showing a particularly noticeable effect. “Spirit Pivot · Decision Qi Chapter” says: “The middle jiao receives qi, transforms it into blood through juice, which is called blood.” “Difficult Questions · Four Plus One Difficulty” states: “Spleen wraps blood, warms the five organs.” These statements indicate that the generation and distribution of blood are closely related to the spleen. Dr. Pei believes that strengthening the spleen and tonifying qi is more effective in improving peripheral blood conditions, so the first choice should be Gui Pi Tang, with Longan meat used in large quantities—up to 30 grams—to further enhance the effect. Among the clinical manifestations of aplastic anemia, many patients exhibit sallow complexion, poor appetite, fatigue, lack of energy, and reluctance to speak, along with palpitations.

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Cardiovascular and mental disorders, insomnia, excessive dreaming, and other symptoms of deficiency in the heart and spleen: Dizziness, tinnitus, lower back pain, leg fatigue, and other symptoms of kidney qi deficiency are also commonly seen.

For such clinical manifestations, prescribing modified versions of the Six-Ingredient Rehmannia Decoction is consistent with the principle of unity among theory, prescription, and medication. In April 1978, Mr. Chen from the Logistics Department of the Lanzhou Military Region suffered from aplastic anemia for more than two years without improvement despite treatment. His symptoms included pallor, weakness, poor appetite, dizziness, low-grade fever, and gum bleeding. His hemoglobin level was 7.6 g/dL, white blood cell count 3,650/mm³, neutrophils 32%, lymphocytes 68%, and platelet count 63,000/mm³. Bone marrow examination showed a significant reduction in granulocyte, erythrocyte, and megakaryocyte lineages, with a relative increase in lymphocytes. The pulse was deep, fine, and rapid, especially prominent at the cun and chi positions. Dr. Pei initially prescribed Gui Pi Tang (with 30 g of longan pulp) plus Shou Wu, Tai Zi Shen, Ren Shen Xu, Lu Jiao Jiao, Gui Ban, Nü Zhen Zi, and Han Lian Cao, adjusting the formula as needed. After taking more than 50 doses, his condition improved day by day: his complexion became rosy, his appetite increased, gum bleeding stopped, and hemoglobin rose to 10.3 g/dL; however, bone marrow examination did not show significant improvement. He then removed Yuan Zhi, Mu Xiang, and Zao Ren from the original formula and added Sheng Di, Shan Yu Rou, Dan Pi, Rou Gui, Huang Jing, and Ji Xue Teng, totaling over 70 doses. As a result, his spirits improved, he regained strength, his hemoglobin remained between 10 and 11 g/dL, and bone marrow examination revealed an increase in all three cell lineages.

Traditional Chinese Medicine holds that "the kidneys govern the innate, while the spleen governs the acquired." In treating blood diseases, Dr. Pei has come to understand the concept that "the kidneys govern the bone marrow, while the spleen governs the periphery," because bone marrow gradually forms during fetal development, whereas peripheral blood begins to circulate after birth. The author has also applied this view in clinical treatment of aplastic anemia and often achieves satisfactory results.

II. Tangible Blood Cannot Be Generated Overnight; Intangible Qi Must Be Supplemented Urgently

The reduction of all three cell lineages is the main characteristic of aplastic anemia. Since these three types of cells are all formed elements in the blood—what is known as "tangible blood"—to generate "tangible blood," one must urgently supplement "intangible qi." This idea originates from the "yin-yang interdependence" theory in the Inner Canon of Medicine and was later developed into the "qi leads the blood" theory. Through Dr. Pei's clinical experience, this approach has proven effective in treating severe cases of aplastic anemia. Among qi-tonifying herbs, Tai Zi Shen is the first choice; Dr. Pei says, "This herb has a mild taste but strong qi, and can penetrate the blood." Other commonly used herbs include Jilin Ginseng, Bei Sha Shen, Dang Shen, and Huang Qi. Among them, Jilin Ginseng is expensive, so Ren Shen Xu is often used as a substitute. Dr. Pei notes, "Ren Shen Xu has a sharp shape and potent qi, which can directly enter the blood." "Qi is the root of yang." If qi deficiency persists for a long time, it will inevitably lead to yang deficiency; therefore, when prescribing qi-tonifying herbs, Dr. Pei always adds yang-strengthening herbs such as Yin Yang Huo, Po Gu Zi, Tu Si Zi, and Sha Yuan Zi, which complement each other well. For example, in the spring of 1979, he treated Mr. Chen, a 24-year-old male who had suffered from aplastic anemia for more than three years without improvement. His hemoglobin was 6.4 g/dL, white blood cell count 2,100/mm³, platelet count 42,000/mm³; his complexion was pale, he felt fatigued and weak, had poor appetite, dizziness, palpitations, tinnitus, lower back pain, and leg fatigue; his pulse was deep and fine, with weak chi pulses on both sides, and his tongue was pale. Dr. Pei first tried a spleen-strengthening and kidney-tonifying formula for about 20 doses, but there was no obvious improvement. He then added Tai Zi Shen, Dang Shen, Ren Shen Xu, Po Gu Zi, Tu Si Zi, and Yin Yang Huo to the original formula, adjusting the dosage as needed. After taking more than 50 doses, all symptoms subsided, hemoglobin rose to 10.6 g/dL, and he was able to return to work.

III. Slow Treatment: Strengthen Spleen and Kidney; Urgent Treatment: Clear Heat and Cool Blood

Strengthening qi and tonifying the spleen and kidneys are the fundamental methods for treating aplastic anemia, but when infections or bleeding occur, the condition often becomes acute, with many patients exhibiting signs of intense internal heat and blood being driven by the heat (some also have qi deficiency that cannot control the blood). In such cases, Dr. Pei strongly advocates clearing heat and cooling blood. He highly appreciates Tang Gu Chuan's view that "the heart is the sovereign fire, which generates blood; blood is the soul of fire, and fire is the spirit of blood. When fire rises, blood rises; when fire falls, blood falls. Knowing that blood is born from fire and that fire resides in the heart, we know that clearing the heart is clearing fire, and clearing fire is stopping bleeding." He follows Tang's method in treating acute bleeding and infection in aplastic anemia and believes that San Huang Xie Huo Tang is the preferred formula for clearing heat and stopping bleeding in such cases. This formula is bitter and cold, directly eliminating excess fire while incorporating hemostasis into the process of clearing heat. The formula often includes 20 g of Sheng Di, intended to cool the blood and enhance its hemostatic effect; frequently 30–60 g of Sheng Shi Gao are added to strengthen the heat-clearing effect, as Dr. Pei says, "Sheng Shi Gao has a mild taste and heavy nature; its mildness allows it to enter the qi, while its heaviness enables it to reach the blood. Only with this can we effectively clear the heat associated with blood-related conditions." Through long-term clinical observation, he has developed the experience of "slow treatment: strengthen spleen and kidney; urgent treatment: clear heat and cool blood." Over the years, the author has followed this approach in treatment and achieved remarkable results. For example, on June 25, 1976, he treated a patient surnamed Jiang, an 18-year-old male who had suffered from aplastic anemia for more than three years, with persistently low levels of all three cell lineages. He had received a total of 11 blood transfusions, amounting to nearly 3,000 mL, yet his condition still showed no improvement. He was pale, weak, sweaty, had poor appetite, tinnitus, palpitations, lower back pain, leg fatigue, felt cold, sweated excessively, sometimes had gum bleeding, his pulse was deep and fine, and his tongue was swollen and pale. Blood tests showed hemoglobin 6.4 g/dL, red blood cells 2.5 million/mm³, white blood cells 1.25 million/mm³, and platelets 34,000/mm³; bone marrow examination revealed a significant reduction in granulocyte, erythrocyte, and megakaryocyte lineages, with a relative increase in lymphocytes. This was a case of both spleen and kidney deficiency. After taking 36 doses of spleen-strengthening and kidney-tonifying medicine, his complexion turned rosy, his spirits improved markedly, hemoglobin rose to 9.8 g/dL, red blood cells to 3.8 million/mm³, and white blood cells to 3.15 million/mm³. On September 2, due to a cold accompanied by high fever, he suddenly began to bleed from the nose, and his hemoglobin dropped to 5.4 g/dL, with red blood cells down to 2.2 million/mm³, white blood cells to 1.85 million/mm³, and platelets to 24,000/mm³. His body temperature reached 38.6°C, with severe heat, thirst, excessive sweating, a full and rapid pulse, and a red tongue with yellow, greasy coating. It was clearly a case of internal heat and blood being driven by the heat, so he followed the urgent treatment of clearing heat and cooling blood, using 10 g each of Da Huang, Bei Sha Shen, Mai Dong, Yu Zhu, Shi Hu, Niu Xi, and Zong Tan, along with 6 g each of Huang Qin, Huang Lian, and Dan Pi, plus 30 g of Bai Mao Gen and 15 g each of Da Xiao Ji. After four doses, the fever subsided and the nosebleed stopped (during which he received another 300 mL of blood transfusion), but his complexion remained pale, he still sweated excessively, felt hot in the chest, slept poorly at night, felt weak and short of breath, experienced nausea and vomiting, and his tongue turned red with a thin, yellow, greasy coating, while his pulse remained rapid. Since residual heat had not been cleared and both qi and yin were damaged, he adopted the method of clearing heat and cooling blood while tonifying qi and nourishing yin. He removed the rhino horn, Niu Xi, Bai Mao Gen, Da Xiao Ji, and Zong Tan from the original formula and added 3 g of Wu Wei Zi, 15 g each of Ren Shen Xu, Tai Zi Shen, and Nü Zhen Zi, 20 g of Shan Yu Rou, 10 g each of Han Lian Cao and Tu Si Zi, and 6 g of Dan Zhu Ye. After eight doses, the heat had subsided, the tongue coating was thin and yellow, the pulse was deep and fine, hemoglobin rose to 7.4 g/dL, red blood cells to 2.6 million/mm³, white blood cells to 2.1 million/mm³, and platelets to 4.6 million/mm³. He then resumed the spleen-strengthening and kidney-tonifying treatment, taking a total of over 100 doses. By February 28, 1977, during follow-up, his complexion was rosy, his energy was abundant, and his blood tests showed hemoglobin 11.2 g/dL, red blood cells 4.1 million/mm³, white blood cells 4.12 million/mm³, and platelets 6.4 million/mm³. He had already returned to work.

IV. The Relationship Between Spleen and Kidney Depends on the Specific Syndrome

Whether to prioritize strengthening the spleen or tonifying the kidneys depends on clinical differentiation, but it is essential to recognize the complementary relationship between the two. Zhang Jing Yue said, "At the beginning of life, humans rely on the source of essence and blood; after birth, they depend on the nourishment from food and water. Without essence and blood, there is no foundation for the body; without food and water, the body cannot grow strong. Essence and blood are governed by the Ming Men, while food and water are governed by the spleen and stomach. Therefore, the Ming Men receives innate qi, while the spleen and stomach receive acquired qi. Thus, the sea of food and water relies primarily on innate qi, while the sea of essence and blood depends on acquired qi. Consequently, from birth to old age, if one's innate foundation is insufficient, relying solely on acquired nourishment can only compensate for half of the deficiency." In clinical practice, Dr. Pei usually adopts either "tonify the kidneys as the primary focus while also tonifying the spleen" or "tonify the spleen as the primary focus while also tonifying the kidneys," which improves efficacy compared to simply tonifying the kidneys or simply tonifying the spleen. If a patient exhibits predominantly spleen deficiency symptoms, he applies the "tonify the spleen as the primary focus while also tonifying the kidneys" method. For example, in June 1980, the author treated a patient surnamed Li whose blood tests showed a decrease in all three cell lineages, and bone marrow examination confirmed aplastic anemia. The patient presented with pale complexion, weakness, poor appetite, palpitations, dizziness, shortness of breath, and a weak pulse, with a thin tongue coating. Clearly a case of both heart and spleen deficiency. He first tried Gui Pi Tang combined with Tai Zi Shen, Ren Shen Xu, and other herbs, taking more than 40 doses without noticeable improvement. Later, he added kidney-tonifying herbs such as Sheng Di, Shan Yu Rou, Tu Si Zi, Nü Zhen Zi, and Goji berries to the original formula and took another 20-plus doses, resulting in a marked improvement in his condition: hemoglobin rose from the original 7.1 g/dL to 9.1 g/dL.

V. The Magic of Boosting White Cells by Strengthening Yang, Boosting Platelets by Nourishing Yin, and Boosting Red Blood Cells by Tonifying Qi and Nourishing Blood

Nourishing Blood

Through long-term clinical practice, Dr. Pei proposed the concept of "strengthening yang to boost 'white' cells, nourishing yin to boost 'platelets,' and tonifying qi and nourishing blood to boost 'red' cells." Although this is just a simple empirical rule, it does contain the core of clinical practice. The Su Wen, in the chapter "Great Discussion on the Correspondence of Yin and Yang," states, "Yang transforms into qi, while yin forms matter." Zhang Jing Yue commented, "Yang moves and disperses, thus transforming into qi; yin remains still and condenses, thus forming matter." From the functional attributes of white blood cells and platelets, white blood cells seem to belong to yang, while platelets seem to belong to yin; red blood cells can be considered the blood of the body, so the method to elevate them should be to tonify qi and nourish blood. Below are some of the commonly used drugs by Dr. Pei for reference in clinical trials. To boost white blood cells: cinnamon, fu pian, ku shen, dang shen, po gu zi, xue teng, huang qi, xi yang shen, ba jiao hui xiang. To boost platelets: yu zhu, huang jing, da zao, sheng di, a jiao, gui ban jiao, lu jiao jiao, lian qiao, tu da huang. To boost red blood cells: gui pai tang, ren shen yang rong tang, tai zi shen, ren shen xu, dang shen, huang shi, shou wu, shan yu rou, yuan rou, ji xue teng, nü zhen zi, han lian cao.

(Zhejiang Journal of Traditional Chinese Medicine, 1983.2)

Clinical Experience in Treating Chronic Nephritis with Traditional Chinese Medicine

Pei Zhengxue

Chronic nephritis is a common kidney disease caused by an allergic reaction to streptococcal infection, but its exact pathogenesis remains unclear, so clinical treatment outcomes are often unsatisfactory. In recent years, traditional Chinese medicine has increasingly delved into the treatment of this disease, with steadily improving efficacy. Based on the author's limited clinical experience, this article discusses the treatment of chronic nephritis with traditional Chinese medicine. Any shortcomings are welcome to be criticized and corrected.

I. Etiology and Pathogenesis

Although traditional Chinese medicine does not have a specific term for chronic nephritis, the symptoms of "edema" and "water retention" broadly correspond to this disease. The Su Wen, in the chapter "Separate Discussion on Yin and Yang," states, "When the three yin meridians are blocked, it is called water." The "three yin" refer to the lung, spleen, and kidney. Zhang Jing Yue expanded on this view, saying, "All conditions involving edema are related to the dysfunction of the lung, spleen, and kidney. Water is the ultimate yin, so its origin lies in the kidney; water transforms into qi, so its manifestation lies in the lung; water fears earth, so its control lies in the spleen. When the lung is deficient, qi cannot transform into essence but turns into water; when the spleen is deficient, earth cannot control water but instead attacks it; when the kidney is deficient, water has no master and runs wild. In short, edema arises from the deficiency of the lung, spleen, and kidney. When the spleen is deficient, it loses the ability to transform and transport; when the lung is deficient, it cannot regulate qi; when the kidney is deficient, it cannot close the gates properly. As a result, the body's water circulation and excretion are disrupted, accumulating in the skin, muscles, and tissues, leading to edema. Among the lung, spleen, and kidney, the kidney is the root, the lung is the manifestation, and the spleen is the key to treatment. Why do these three organs become deficient? Chen Wuzhe said that edema has three causes: "Internal factors include anger and worry; external factors include wind, cold, heat, and dampness; and neither internal nor external factors include diet, labor, and rest, which deviate from the normal routine." Clearly, changes in emotions, exposure to external pathogens, and dietary and lifestyle habits can all affect the lung, spleen, and kidney, leading to edema. Based on the above discussion, the author's treatment of chronic nephritis mostly follows the principle of "taking deficiency as the root and excess as the manifestation." Here, "deficiency" refers to the lack of vital qi, specifically the deficiency of the lung, spleen, and kidney; "excess" refers to the presence of pathogenic factors, specifically wind, heat, and cold. The Su Wen, in the chapter "Discussion on Acupuncture Techniques," states, "If vital qi is present, pathogenic factors cannot invade," and the Su Wen, in the chapter "Discussion on Fever," says, "Wherever pathogenic factors gather, qi must be deficient." Clearly, among the two causative factors—deficiency and pathogenic factors—traditional Chinese medicine emphasizes the importance of deficiency. The author believes that, in the case of chronic nephritis, "deficiency" mainly refers to yang deficiency, including kidney yang deficiency and spleen yang deficiency.

II. Treatment Principles