A Qin Bowei Case Study

Here's a case study I translated and wrote some comments on for an article in the JCM that was published a few years ago... I thought a case study would be a nice way to kick off the holiday weekend.

Qin Bo Wei was one of the premier Chinese physicians of the 20th century and played an instrumental role in bringing Chinese medicine into the modern era. He was however profoundly steeped in classical thinking, and utilized a wide variety of traditional formula preparation methods. In his own published case studies he records his use of medicinal syrups with many patients. Here is one of his cases translated from his text of case studies.

Patient: Lu (Female, age not recorded). In 1939 Ms. Lu saw Dr. Qin complaining of an inability to use her right arm, mental dullness, palpitations, headache, abdominal fullness and poor appetite. The initial presenting symptom that preceded everything was dizziness. Her body was full and round. Qin surmised that Liver yang was effulgent with the Kidney root having been depleted for a long time. Spleen qi was vacuous and weak, leading to phlegm-damp retention obstructing the network vessels. Thus the patient had counterflow yang transforming into wind-phlegm-damp obstructing the network vessels. Dr. Qin’s strategy was therefore to calm the Liver, strengthen the Spleen, transform phlegm and free the network vessels.

Formula: Ren Shen Shu (Ginseng Radix whiskers) [cooked separately then added to the syrup] 30g, Chao Bai Zhu (Dry-fried Atractylodis macrocephalae Rhizoma) 30g, Chao Dang Gui (Dry-fried Angelicae sinensis Radix) 60g, Jiu Chao Bai Shao (Wine-fried Paeoniae Radix alba) 45g, Zhi Shou Wu (Polygoni Radix Preparata) 90g, Duan Shi Jue Ming (Calcined Haliotidis Concha) 120g, Wei Tian Ma (Simmered Gastrodiae Rhizoma) 45g, Lu Dou Yi (Glycinis Testa) 45g, Xian Ban Xia (Pinelliae Rhizoma preparatum) 60g, Ting Ji Li [i.e. Sha Yuan Zi (Semen Astragali Complanati)] 90g, Bai Ji Li (Tribuli Terrestris Fructus) 90g, Qing Zhi Qi (clear fried Astragali Radix) 90g, Fu Shen (Poriae Sclerotium pararadicis) 120g, Yuan Zhi (Polygalae Radix preparata) 45g, Chao Suan Zao Ren (Dry-fried Ziziphi spinosae Semen) 90g, Long Chi (Dens Draconis) 150g, Guang Ju Hong (Guandong Citri reticulatae Exocarpium rubrum) 45g, Guang Ju Luo (Guandong Citri Fructus Fasciculus Vascularis) 45g, Bai Zi Ren (Platycladi Semen) 90g, Huo Ma Ren (Cannibis Semen) 90g, Chao Zhi Ke (Dry-fried Aurantii Fructus) 45g, Chao Su Zi (Dry-fried Fructus Perillae Frutescentis) 90g, Xing Ren (Armeniacae Semen [peeled]) 90g, Chuan Duan Rou [i.e. Xu Duan (Dipsaci Radix)] 90g, Sang Ji Sheng (Taxilli Herba) 90g, Fu Ze Xie [e.g. Fujian Ze Xie (Alismatis Rhizoma)] 90g, Gan Ge Pu (Pueraria thomsonii) 45g, Jiu Chao Nen Sang Zhi [Wine-fried tender Sang Zhi (Mori Ramulus)] 120g, Long Yan Rou (Longan Arillus) 120g and He Tao Rou (i.e. He Tao Ren, Juglandis Semen) 120g.

The cooking method was to decoct the above ingredients twice, then strain the liquid and add E Jiao (Asini Corii Colla) 120g, beef extract (Xia Tian Gao) 120g and sugar 180g. The formula was then made into a syrup.

Dr. Qin’s discussion: If the Liver is effulgent there must be yin depletion. If the Spleen is weak dampness will accumulate. Yin depletion leads to counterflow yang transforming into wind. Damp accumulation congeals into phlegm. In previous years during the transition from spring into summer, the patient would experience headache, palpitations and abdominal fullness. This year her presenting signs were inability to use her left arm, mental dullness and sluggishness, difficulty breathing due to copious phlegm and poor appetite. The pulse image was bowstring and slippery, and the tongue coating was white and greasy in the center and rear. The plan then was to calm the Liver and extinguish wind so as to regulate the San Jiao’s upwards and downwards mechanism. Also, treatment was aimed at fortifying the Spleen and transforming phlegm so as to smooth the circulation of qi in the channels and network vessels. Because of the significant root condition of the disease it is by no means easy to treat. So, in setting up a formula to treat the origin of this condition, a Gao Zi is used as a substitute for a decoction, and the plan is to treat the condition slowly, little by little.

Comment: The formula presented here encompasses several complementary treatment strategies to treat both ben (root) and biao (tip) of the patient’s condition. In his commentary, Qin notes the complexity of the case, acknowledging that it will be a long and difficult treatment, and as such opts for a Gao Zi as the method of administering herbs. Gao Zi are easy to use long-term, and milder than bulk decoctions, making them suitable for long-term treatment, especially when the root of the pathology is a significant and long-standing vacuity patterns.

Case taken from: Qin, BW (2003). Qin Bo Wei Yi Xue Ming Zhao Quan Shu. Beijing: Chinese Medicine Antiquarian Book Publishers