In TCM treatment, pulse diagnosis accounts for a very important part.It is said that“The theory of pulse diagnosis is quite sophisticated, which can hardly beexpressed in words.”Once apatient who suffered from urticaria visited my clinic.Her pulse was floating, just like a piece of wood floating on the water, which reminded me of 2 medical cases treated by Prof. Liu Duzhou and his student Dr. Hao Wanshan.They met one case of urticaria and one case of jaundice.Both of their main symptoms were itches all over the body with floating pulse. According to the pulse, Prof. Liu believed that thelocation of the disease was on the exterior, but there was dampness-heat on the interior. So, he prescribed Ma Huang Lian Qiao Chi Xiao Dou Tang for both patients, which turned out to be quite effective. Therefore, I tried this formula for my patient, which indeed had a remarkable effect.
Mrs. Zhao, 30-year-old, first visit on June 20th, 2019
Mrs. Zhao, postpartum over a month, hadrecurrent wheals and felt itchy on the skin. Her eye andface had been swollen and soles of feet swollen for 12 days. Twelve days ago, Mrs. Zhao had a fever and took Cefaclor. After that, she felt itchy andhad wheals on the skin, with the swollen face, eye and soles of feet. This day, Mrs. Zhao still had itchy wheals on her skin.Her left eyelid was red and swollen,and her soles of feet were swollen and itchy. The amount ofurination was small. She had greasy stool once a day.No abnormal taste in the mouth.Appetitewas normal.The pulse was floating and slippery with greasy coating on the root of the tongue.
Western diagnosis: Urticaria
TCM diagnosis: Hidden rash (windevil fettering the exterior anddamp-heat depressed in the interior)
Treatment principle: Dispel wind and expel pathogen through the exterior, as well as clear heat and dissolve dampness
Prescription: Modified Ma Huang Lian Qiao Chi Xiao Dou Tang
JingJie 10g, Fang Feng 9g, Xing Ren 10g, ZhiGanCao 6g, LianQiao 12g, Chi XiaoDou 30g, Yi YiRen 30g, Sang Bai Pi 12g, Zi Su 10g, Sheng Jiang 9g, Da Zao 15g, 5doses, one dose a day.Decoct it twice and take the decoction twice a day.
June 27th, 2019
After taking 5 dosages, Mrs. Zhao's itchyskin,wheals and redness-swellingon the left eyelid were recovered, yet her soles of feet were still swollen and itchy. Her urine wasincreased, andstools became much less greasy,once a day. Her eyelid was slightly swollen in the morning.No abnormal taste in the mouth.Her appetite was normal. She had floating-slippery pulse,and greasy coating on the root of the tongue.
Prescription: Modified Ma Huang Lian Qiao Chi Xiao Dou Tang
Jing Jie 10g, Fang Feng 9g, Ma Huang 6g, XingRen 10g, ZhiGan Cao 6g, Lian Qiao 12g, Chi Xiao Dou 30g, Yi YiRen 30g, Sang Bai Pi 12g, Zi Su 10g, Sheng Jiang 9g, Da Zao 15g,HuaShi 15g and CheQianCao 30g, 5 dosages.
July 5th, 2019
Two days after discontinuation of the former formula, Mrs. Zhao's itchyskinand wheals recurred, withgingival pain for 2 days. Stoolswere greasy, 2-3 times a day. She had thirst with desire to drink, good appetite and vitality. Her pulse was floating-slippery, and the coating on the root of the tongue was greasy.
Prescription: Modified Ma Huang Lian Qiao Chi Xiao Dou Tang
Jing Jie 10g, Fang Feng 9g, Ma Huang 9g,XingRen 10g, ZhiGan Cao 6g, Lian Qiao15g, Chi Xiao Dou 30g, Yi YiRen 30g, Sang Bai Pi 12g, Zi Su 10g, Sheng Jiang 9g, Da Zao 15g, Hua Shi 20g, ShiGao 15g andCheQianCao 30g, 7 dosages.
After taking the 7 dosages, Mrs. Zhao was fully recovered.
Notes: The floating pulse is a manifestation ofwind evil fettering exterior. For this patient, we should expel the wind evil through theexterior attheonsetoffever.Butthe cold-bitter medicine (antibiotics) was used at the early stage, which caused coldness covering the wind evil and made it suppressed in the exterior of the skin and muscle, unable to go out.Accompanied with interior damp-heat, they fought each other in theskin and muscle, which brought up urticaria.The floating pulse and itches on the skin were manifestations of the exterior being fettered.The red-swollen eyelid, swollen-itchy soles, little urination, greasy stools and root of coating were all manifestations of dampness-heat inside the body, that was why modifiedMa Huang Lian Qiao Chi Xiao Dou Tangwas used. In the formula, Ma Huang, JingJie, Fang Feng, Xing Ren and Sheng Jiang were acrid-warm which release the exterior, scatter wind and dissipate the pathogen. LianQiao, Sang Bai Pi and Chi Xiao Dou clear heat and eliminate dampness. Gan Cao and Da Zao were sweet and neutral which harmonize the center. Because this patient was still in lactation during her first visit, we used Jing Jie, Fang Feng and ZiSuinstead of Ma Huang to release the exterior, and later, Ma Huangwere added to obtainbettereffects.
Though it's difficult for us to master the pulse diagnosis, we should keep on studying, with which the accuracy of clinical diagnosiscan be greatly improved.