Experience in Treating Two Enteritis Patients with Guizhi Jia Gegen Tang

Professor Zhang Renji, a disciple of the late Shi Jinmo—one of Beijing's four great TCM doctors—in the preface of his book A New Path in TCM Cancer Treatment, recounts his journey from Western medicine to TCM. Professor Zhang graduated early from Peking University's medical department, then went to Japan for further study, determined to make his mark in Western medicine. Unexpectedly, in 1941 he himself developed nonspecific enteritis, with nonstop daily diarrhea that left him exhausted and in great misery.

He could not solve his own problem and had to seek help from major Beijing hospitals, including the famous Peking Union Medical College Hospital, but to no avail. After two years of diarrhea, relatives and friends urged him to try Shi Jinmo. Trained in Western medicine, Zhang went to see the old master half-skeptical. Shi Jinmo prescribed only three doses of decoction, and Zhang's nonspecific enteritis was cured.

This event deeply shook Zhang, who had previously looked down on TCM; from then on he became Shi Jinmo's disciple and switched to TCM, eventually becoming a great TCM master himself. In that preface Zhang does not write what formula Shi Jinmo used, but the old master must have treated Zhang's nonspecific enteritis using TCM pattern differentiation. Judging from Zhang's own experience, TCM has great advantages in solving such difficult problems that Western medicine cannot.

I too have treated two patients with intractable enteritis, both using Guizhi Jia Gegen Tang.

The first patient was originally from Lanzhou. After his mother's cancer was effectively treated by me, she once brought him to see me. The patient had already graduated from university; he said he had been troubled by intractable colitis since middle school, repeatedly treated with both Chinese and Western medicine without effect. His most distressing problem was diarrhea: wherever he traveled, his first priority was to find a toilet.

The patient had a family history of colon cancer; several elder relatives had suffered it. The pulse was moderate, the tongue coating white, there was spontaneous sweating, no thirst, and aversion to cold with cold limbs. Judging from the pulse and the spontaneous sweating, this belonged to the Guizhi series of formulas. Guizhi Jia Gegen Tang can treat “spontaneous diarrhea,” so I prescribed the original formula of Guizhi Jia Gegen Tang without any additions or subtractions, giving the patient 7 doses.

The formula: Guizhi (Cinnamomi Ramus) 15 g, Bai Shao (Paeoniae Alba Radix) 15 g, Ge Gen (Puerariae Radix) 30 g, Zhi Gan Cao (honey-fried Glycyrrhizae Radix) 6 g, fresh Sheng Jiang 7 slices, Da Zao 7 pieces. After taking 5 doses, the enteritis that had plagued him for years was resolved, and he no longer had diarrhea. His mother continued treatment with me for a long time afterward; I repeatedly asked her about the patient, and was always told it had not recurred.

The second patient was a gastric cancer patient from Heilongjiang Province. Years earlier he had been diagnosed with ulcerative colitis, which frequently relapsed. In spring 2021, after staying a while in Sanya, possibly due to food or climate, he developed diarrhea and bloody stool. Back in Heilongjiang, he underwent colonoscopy at the Cancer Hospital of Harbin Medical University (outpatient no. 02588903, scope ID: marror39), which showed ulcerative proctocolitis and hemorrhoids. Before the examination he had already had diarrhea and bloody stool for over two months without proper treatment. Because the pandemic made in-person visits inconvenient, he sought my help via online video.

On questioning, I learned the patient averted cold, occasionally had low blood sugar, and had no body pain but abdominal pain with a constant feeling of tenesmus that resolved after defecation. Stools had no pus; he liked hot drinks and dared not drink cold water; hands and feet were cold; no acid reflux or heartburn; occasional belching; and the compound Di Yu Huai Jiao Wan had been ineffective.

This patient had previously come to me for medicine to prevent gastric cancer recurrence, so I had his earlier consultation records (also online). He had not sweated for years, with stiff painful shoulders and neck, aversion to cold, preference for hot drinks, and chronic urticaria for years; he had tried many Chinese and Western treatments without effect.

At that time I could not take his pulse, but from his series of symptoms I judged him a Ge Gen Tang indication and prescribed the patent medicine Ge Gen Tang granules (if Ge Gen Tang granules are unavailable, one can buy the herbs and decoct the original formula oneself: Ge Gen 20 g, Ma Huang (Ephedrae Herba) 15 g, Guizhi 10 g, Bai Shao 10 g, Zhi Gan Cao 10 g, Sheng Jiang 7 slices, Da Zao 7 pieces). After taking Ge Gen Tang granules, his long-standing inability to sweat, his stiff painful shoulders and neck, and his urticaria all resolved; I observed him for over half a year afterward with no reported recurrence.

So I considered this patient's constitution still the Ge Gen Tang or Guizhi Jia Gegen Tang type, and this time decided to treat his ulcerative proctocolitis with Guizhi Jia Gegen Tang combined with modified Huai Hua San, which TCM uses for intestinal-wind bleeding. The proposed formula: Guizhi 10 g, Bai Shao 10 g, Ge Gen 20 g, Zhi Gan Cao 6 g, Bai Ji (Bletillae Rhizoma) 10 g, Xian He Cao (Agrimoniae Herba) 30 g, Huai Hua (Sophorae Flos) 10 g, Ce Bai Ye (Platycladi Cacumen) 10 g, Jing Jie Sui (Schizonepetae Spica) 10 g, Sheng Jiang 5 slices, Da Zao 5 pieces, Huang Lian (Coptidis Rhizoma) 3 g, Huang Bai (Phellodendri Cortex) 3 g. 8 doses, decocted in water, morning and evening.

After finishing the 8 doses, the patient's bowel movements had dropped from three or four a day to one or two; there was no longer abdominal pain on defecation, nor tenesmus; and the cold hands and feet had markedly improved. So on the previous formula I added Ma Chi Xian (Portulacae Herba) 30 g and Qin Pi (Fraxini Cortex) 6 g, telling him to continue until the symptoms completely disappeared.

TCM has a great many formulas for treating diarrhea; Ge Gen Tang and Guizhi Jia Gegen Tang can also treat “spontaneous diarrhea.” Guizhi Jia Gegen Tang is Guizhi Tang plus Gegen; it treats not only “spontaneous diarrhea” but also “spontaneous sweating” and “aversion to wind-cold,” and moreover “stiffness and tightness of the nape and back” (i.e., stiff, painful shoulders, neck, or back). When the patient sweats spontaneously, use Guizhi Jia Gegen Tang; when there is no sweating, use Ge Gen Tang, because Ge Gen Tang additionally contains Ma Huang and has a stronger sweating force.

Both enteritis patients I treated were intractable cases: the first had a history of over ten years; the second was very refractory ulcerative colitis (former Japanese Prime Minister Abe Shinzo was himself an ulcerative colitis patient, and he resigned twice as prime minister due to relapses of the disease). Besides diarrhea, both patients had aversion to wind-cold, spontaneous sweating, and shoulder-neck discomfort—all indications for Guizhi Tang—so both were suitable for Guizhi Jia Gegen Tang. And treatment based on pattern differentiation was effective in both. This shows how important TCM pattern differentiation is.