A Failed Kidney Reinforcement Case

On April 22, 2018, a young woman presented at the outpatient clinic. Her chief complaints were: menstruation delayed by three weeks, lower back pain as if broken, and a heavy sensation in the body. On examination, both pulses were fine (xi mai), the left Guan pulse was deep (chen mai), the tongue body was pale with a white greasy coating, and the tongue edges were slightly red and raised.

Further questioning revealed that since early 2018, her menstrual flow had become scanty, though the cycle remained regular with few blood clots. She had recently noticed an increase in vaginal discharge, yellow-white in color and mixed, but without any unusual odor. Her bowel movements alternated between dry and loose, her appetite was normal, and her sleep was poor.

My first impression was that dampness had stagnated along the Dai vessel, disrupting the water metabolism of the lower jiao, impeding qi movement, and blocking the pathway of Tian Gui (menstrual essence) — thus producing these various symptoms.

The formula I prescribed was: a small dose of Gan Cao Gan Jiang Fu Ling Bai Zhu Tang (Licorice, Dried Ginger, Poria, Atractylodes Decoction) plus Si Wu Tang (Four Substances Decoction, with cooked Rehmannia and White Peony) plus Chuan Duan, Dan Pi, Yi Mu Cao (Dipsacus, Moutan Bark, Leonurus).

Unexpectedly, after just one dose she developed mouth ulcers, and after three doses her face broke out in acne. Although the presenting symptoms somewhat improved, her period still had not arrived and her tongue had turned red. I therefore instructed her to stop the medication and switch to a different formula.

After much reflection, I believe the approach in this case still should have leaned toward warming and supplementing. However, this formula was inadequate at clearing and draining accumulated heat. There was likely internal stagnation-heat — very possibly Liver Fire. Had I considered adding Liver-soothing herbs at the time of prescribing, this adverse reaction might have been avoided. A profound lesson learned.

2018年4月22日，门诊来了一个小姑娘，主诉月经推迟三周，腰痛如折，身重，刻下双脉细，左关沉，舌质淡，苔白腻，舌边略红凸起。

经问诊，2018年初开始月经量少，周期尚准，少有血块，近期白带增多，黄白夹杂，无异味，大便时干时稀，纳可，寐差。

我的第一反应是水湿郁结带脉，导致下焦水利失调，气机不畅，天癸之路不通，造成诸症。

方用小剂甘草干姜茯苓白术汤+四物汤（熟地白芍）+川断丹皮益母草。

谁知一副药后口舌生疮，三副药后满脸起痘，虽云诸症缓解，但天癸仍未至，舌质变红，故今日告知停药换方。

思躇良久，认为此案仍应偏为温补，但此方疏导不利，体内尤有郁热，极有可能是肝火，若处方之时酌加疏肝之品，或可避免此事，教训深刻。