On May 28, 2017, I was seeing patients at Heniantang Chinese Medicine Hospital. Around ten in the morning, an elderly woman passed by the clinic door and stopped in to see me. She placed great trust in me.
Her chief complaint was abdominal bloating. She felt hungry and wanted to eat, but even a few bites left her unbearably full — to the point where she could manage only one meal a day. When the bloating flared up, she could feel a hard mass below her xiphoid process that wouldn’t ease until the following morning. Her bowel movements and urination were normal. She had suffered from nervous exhaustion for years and had been taking sedative medications for over three decades; her sleep quality was poor. On examination, her pulse was wiry and thready, her tongue body was dark, and her coating was white, thick, and slightly dusky.
I diagnosed this as a classic pi syndrome — spleen deficiency with impaired transportation, complicated by internal stagnation of blood stasis. The plan was to modify Zhi Zhu Wan (Atractylodes and Atractylodes Macrocephala Pill). I had treated many similar cases before; typically, patients showed noticeable improvement after three or four days of herbs. I was confident.
But reality was harsh. Early the next morning, the woman called to tell me that after taking the medicine, her stomach felt even more distended. She hadn’t eaten dinner, slept poorly, and woke up feeling unwell — her whole body weak and limp. My first instinct was to suggest she eat some fresh ginger, but she told me she couldn’t tolerate ginger; it made her dizzy and flushed. All I could do was offer reassurance and advise her to take smaller doses while we observed.
Disappointingly, she didn’t come back the following week. She was probably very disillusioned.
I spent the rest of the day studying the case and discussing it with four or five colleagues, but none of us could arrive at a satisfactory explanation. After thinking it over again and again, the only possibility I could identify was that I had used too high a dose of San Leng (Sparganium) and E Zhu (Curcuma), causing excessive breaking of qi.
It also brought to mind something my teacher Feng Xingzhong once told me in the outpatient clinic: use Zhi Qiao (Immature Bitter Orange, the younger, milder fruit) and avoid Zhi Shi (the mature, stronger-acting fruit), because Zhi Shi breaks qi too forcefully. In hindsight, there was real wisdom in those words.
The truth is, this elderly woman had likely been ill for a long time and her body was genuinely depleted. Even though the prescription included tonifying herbs, they weren’t enough to offset the damage. If I had reduced the dose of the qi-breaking medicinals even slightly, or added a little more honey-roasted Huang Qi (Astragalus), would the outcome have been different?
All in all, this was a profound lesson. “Fools rush in where angels fear to tread” — several of my teachers have warned me against being too reckless. Yet here I was, facing a condition I thought I had completely under control, acting with overconfidence, carelessly writing a prescription without careful deliberation, and causing the patient to suffer. That is a serious failing. I must take this as a stern warning and never again act with such rashness.
中文原文 / Chinese Original
2017年5月28日，我在鹤年堂中医院出诊，上午十时许，一老太在门前经过，想找我看病，非常信任我。
老太太主诉为胃胀，想吃东西，觉得饿，但是吃一点就涨的不行，甚至一天只能吃一顿饭，涨起来就觉得剑突下有一块东西，必须等到第二天早上才能有所缓解，二便可，常年神经衰弱，服用安定类药物三十多年，睡眠质量较差。刻诊为弦细脉，舌质黯，苔白厚略暗。
当时我认为这是典型的痞证，证属脾虚不运，淤血内阻，应当用枳朮丸加减，此类疾病治过很多，一般吃个三四天就能明显好转，我很有信心。
然而现实很残酷，第二天一早，老太太给我打电话说昨天吃了药之后觉得肚子更胀了，晚上没吃东西，觉也没睡好，早上也不舒服，浑身软软的。。。我当时第一反应是应该吃点姜，但是老太太说她不能吃姜，一吃姜就头晕脑热，于是乎只能安慰安慰，让她少吃一点再观察观察。令人叹息的是，第二周她并没有再来找我，估计是很失望吧。。。。。。
我研究了半天，跟四五位同道讨论过，最后都没有给出一个合理的解释。我思前想后，唯一的可能就是三棱莪术用量过大，破气过甚。又回想起冯兴中老师曾在门诊上对我说，要用枳壳，少用枳实，因为枳实破气，现在想来，好像也有那么点意思。毕竟，老太太可能确实病久体虚，虽然方中有补益之品，但无济于事，如果我把破气药量稍微减一些，或者再加点炙黄芪进去，是不是就会好了呢？
总而言之，这是个极大的教训，初出茅庐不怕虎，不能过于孟浪是多位老师常常叮嘱我的，如今我面对一个自认为手到擒来的病症就过于骄傲，没有好好拿捏就轻易下药，造成了病人的痛苦，真是罪过大焉，今后必引以为戒，不可冒然行事。
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