The Lesson of a Remarkable TCM Case: Treating Sudden Paralysis with a Large Dose of Ephedra

This is a case recounted by Dr. Gong Zifu, as recorded by the famous Jiangxi TCM veteran Yao Hesheng: profuse sweating with bi-syndrome treated successfully with a large dose of Mahuang (Ephedra). Both patients in the case suddenly became paralyzed, and after a large dose of Ephedra they improved rapidly.

During the Anti-Japanese War period, Yao encountered a male patient in his forties who often indulged in wine and sex. One scorching summer he went out on business; walking on the way, his two feet felt unbearably hot, and he cheerfully washed them in a clear mountain stream. In an instant his legs became flaccid and could not bear his weight, so he was carried home and Yao was called.

When old Dr. Yao arrived, he saw many towels piled by the patient's bed as he repeatedly wiped away sweat, especially on the lower limbs. But the feet were not cold, nor was he averse to wind; his mouth was slightly dry, and the cubit pulse was deep and slightly hesitant.

Based on the season and the history, Yao judged the case to be, as the Neijing says, "damp-heat not dispelled" and "settling giving rise to flaccidity-bi." But given the profuse sweating, the deep cubit pulse, and the patient's lifestyle history, there was also kidney deficiency. He used a combination of Linggui Zhugan Decoction (Poria-Cinnamon Twig-Atractylodes-Licorice Decoction) and Ermiao San (Two-Marvel Powder) to move qi and drain dampness while clearing heat without harming the healthy deficiency; he thought his reasoning thorough and was secretly pleased.

Unexpectedly, after six consecutive doses, only the sweating abated slightly and the leg flaccidity showed no improvement at all. The patient grew anxious and wanted to call a "herb doctor," but that physician often treated stubborn ailments with drastic herbs, so the family did not dare to invite him lightly; they asked Yao to decide. Feeling he himself could not produce a rapid effect—partly out of modesty and partly out of curiosity—Yao quietly watched from another room.

Before long the herb doctor arrived. Without even asking about the illness, he pointed at the patient's legs and said: "You got this by hurrying on the road in the heat and suddenly plunging into cold water." Yao marveled at the diagnostic accuracy; hearing him not only confident of a cure but even promising the patient would be out of bed walking in three days, Yao felt it necessary to watch the prescription.

Seeing the prescription, which filled a whole page with nearly twenty-some herbs, Yao studied it repeatedly; it seemed not to go beyond the Mahuang Xingren Yiyi Gancao (Ephedra-Apricot-Coix-Licorice) method. There was also an external herb application, for which no formula was shown. After seeing the prescription, the patient had deep misgivings about the two liang of Mahuang.

Noticing this, the herb doctor said: "Originally I intended four liang of Mahuang; you are afraid, but two liang today is absolutely indispensable." The patient insisted he would not dare take it unless Dr. Yao approved. Based on what he had seen, Yao reconsidered repeatedly: since the herb doctor understood the cause and his medication had no principled error, and since using Ephedra for profuse sweating had precedent in the Qianjin Fang, he only feared that profuse sweating might scatter yang, so he told them to prepare ginseng powder just in case.

The patient, feeling preparedness brings safety, immediately took the medicine and simultaneously applied the external herbs. After taking it, the profuse sweating suddenly lessened and he got out of bed walking, exactly as predicted. Admiring and convinced, Yao could only temporarily credit the unseen external herbal application.

Before long the weather grew even hotter. The sister-in-law of the family where Yao was lodging had long done work exposed to summer heat, when she was suddenly caught in a rainstorm; both legs became paralyzed. Her son carried her on his back to Yao for help.

Seeing her likewise drenched in sweat, Yao, in haste, followed the previous example and used Mahuang Xingren Yiyi Gancao Decoction plus Sanmiao San (Three-Marvel Powder). Being cautious, Yao used only 24 g of Mahuang including the nodes. One dose; by the next morning the patient could walk back for a follow-up, the effect even faster than the first case.

Yao reflected carefully: this case began more briefly than the first, yet no external herbs were used, showing that the credit he had assigned to the external application may not have been the whole reason. Now, over forty years later, he still remembers this vividly.

This is a case where a famous physician and an unlettered herb doctor treated the same illness, and the famous physician learned from the herb doctor. Old Dr. Yao was then renowned in Jiangxi TCM circles; he treated patients by TCM pattern differentiation, believing his differentiation correct, yet the clinic was completely ineffective. Later the herb doctor used drastic herbs aggressively and resolved it with a few doses. Yao was open-minded and eager to learn; afterward he applied the herb doctor's approach to similar patients and likewise got rapid results.

This case is thought-provoking. The ancients said: when the rites are lost, seek them in the countryside. TCM originally arose from various folk herb doctors; their fragmentary treatment experiences were systematized by scholars into theory, which gradually rigidified into dogma, so that clinical results became inferior to those of folk doctors.

This remains true today. Dr. Yao was broad-minded in sharing this case; it not only inspires us in treating similar flaccidity-paralysis patients but also sets an example for us TCM learners in being open-minded.

These two patients, diagnosed by modern medicine, would probably have been classified as rheumatic arthritis, ankylosing spondylitis, or femoral head necrosis. I have seen similar patients who, after being treated in hospital with various antibiotics, could not get out of bed at all and were covered in bedsores, with an abysmal quality of life.

But in traditional TCM theory, this is a typical flaccidity-paralysis caused by contraction of the six excesses (wind, cold, summerheat, dampness, dryness, fire); if the herbs are right, the patient soon walks briskly again.

From the late Qing dynasty to the present, calls to "abolish the medicine but preserve the drugs" have raged, so that many clinical TCM physicians today are unfamiliar with even TCM terminology and themselves follow the "abolish medicine, preserve drugs" path—studying Chinese herbs without studying TCM theory, with the result that TCM's overall clinical efficacy has greatly declined. This is deeply regrettable.

As far as I know, for similar patients most TCM doctors now simply prescribe herbs to fortify the spleen, tonify the kidney, strengthen bone, and activate blood; patients then naturally assume TCM works slowly, so modern people are used to TCM failing to swiftly cure stubborn illness. This is regrettable.

TCM indeed has many backward and unscientific aspects, but it also has many advanced and scientific ones. Take this case: the herb doctor prescribed according to the TCM doctrine that the six excesses cause disease.

The "six excesses" is a TCM concept. In recent years some Western doctors in Northern Europe have become enthusiastic about researching "meteorological medicine"; because Northern Europe is cold and damp, many people there have rheumatism and arthritis, so they have realized that weather relates to human health.

Our renowned veteran TCM Professor Lu Zhizheng was invited there to lecture on the principles and methods of traditional TCM treating damp diseases; his lectures have been popular in rheumatism-burdened countries such as Switzerland.

Once it is named "meteorological medicine," it instantly becomes a lofty modern medicine. Yet the plain meteorological-medicine principles contained in TCM's doctrine of the six excesses, and the rich clinical experience of TCM physicians through the dynasties, are regarded as backward.

Moreover, the herb doctor's use of Mahuang in this case was daring: two to four liang. Other doctors have recorded folk healers treating rheumatic bi-pain and paralysis whose family secret formulas used Mahuang in amounts exceeding 100 grams, some even over 200 grams.

In Zhang Zhongjing's Shanghan Lun and Jingui Yaolue, Mahuang also frequently exceeded three liang (Zhang Zhongjing lived in the Han dynasty; one Han liang was about 15 modern grams). According to the way TCM colleges teach today, no doctor would dare use Mahuang like this.

But we must not recklessly use huge doses of Mahuang. Mahuang can rapidly raise blood pressure; some patients feel very unwell after taking it, and those with pre-existing hypertension or heavy late nights risk inducing stroke. Clinical deaths from excessive Mahuang have also been reported. Today's urban population, young and old, often has the habit of staying up late and has underlying conditions like hypertension, so physicians must prescribe carefully.