Case Study: Professor Guo Ziguang Treating Encapsulated Pleural Effusion
Professor Guo Ziguang once treated a patient with encapsulated pleural effusion. The patient first visited Professor Guo on July 20, 1994, two months after surgery at the Chengdu Tuberculosis Hospital for a pulmonary tuberculoma; post-operatively, encapsulated effusion was found in the right lower pleural cavity.
At the visit, the patient reported pain and distension in the right chest and hypochondrium, worsened by coughing or sneezing, shortness of breath, no fever or chills, mild cough with a little thin white sputum, good appetite and normal urination and defecation. She was thin, pale, with the right chest wall bulging; vocal fremitus was absent and breath sounds were very weak. The tongue was pale with white, thick, slippery coating; the pulse was deep and slippery.
Professor Guo considered this water-rheum lodged in the chest and hypochondrium, impairing ascent and descent: a root-deficient, branch-excess pattern, belonging to xuan yin (suspended rheum). Treatment should move qi and expel rheum to regulate the patient's qi mechanism so it can ascend and descend normally. He combined Xiangfu Xuanfuhua Tang, Xiao Xianxiong Tang and Tingli Dazao Xiefei Tang, modified as follows.
Formula: Xiangfu (Cyperi Rhizoma), Xuanfuhua (Inulae Flos, in a cloth bag), Zisuzi (Perillae Fructus), Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Fabanxia (processed Pinellia), Gualoupi (Trichosanthis Pericarp), Tinglizi (Descurainiae/Lepidii Semen) each 15 g, Yiyiren (Coicis Semen) 20 g, Huanglian (Coptidis Rhizoma), Dazao (Jujube), Jiangxiang (Ligni Dalbergiae Odoriferae) each 10 g. Decoct thickly in water, take warm, one dose daily.
After over 30 doses, symptoms gradually eased. On September 6, an X-ray at the tuberculosis hospital showed the pleural effusion had disappeared, with proliferative adhesions remaining; the patient then switched to Chai Shao Liujunzi Tang to consolidate.
Xiangfu Xuanfuhua Tang is from Wenbing Tiaobian. It fortifies the spleen and drains dampness, soothes the liver and unblocks collaterals; it is indicated for latent summerheat or damp-warmth with hypochondriac pain, with or without cough, no chills but tidal fever, or alternating cold and fever like malaria. It consists of raw Xiangfu, Xuanfuhua (in a silk bag), Suzi Shuang and Fuling blocks each 9 g, Banxia and Yiyiren each 15 g, and Guangpi (Chenpi) 6 g. It drains heat, moves qi and promotes diuresis, and is one of the representative formulas for damp-warmth.
Xiao Xianxiong Tang is from Shanghan Lun. It consists of Huanglian, Banxia and Gualou; it clears heat, resolves phlegm, broadens the chest and dissipates nodules, and treats chest bind due to phlegm-heat intermingling below the heart. Tingli Dazao Xiefei Tang is from Jingui Yaolue. It consists of Tinglizi and Dazao and is a Chinese medicine formula for lung abscess; Tinglizi drains the lung and reduces swelling, with a strong water-expelling effect.
Professor Guo essentially combined these three formulas, adding Jiangxiang to make one large compound. This follows the formula-pattern school's principle: 'where the pattern is, there use the drug.'