Lessons from Two Cases With the Same Formulation Logic but Radically Different Outcomes

Case One

A little girl in Guizhou developed asthma after a cold, due to a residual latent pathogen in the lungs. Her cough and wheezing were severe, and wheezing could be heard. Her mother was an online acquaintance who knew my work quite well; in the emergency she turned to me, hoping I would write a prescription to save the day. Although I had not seen the child, her mother's description allowed me to judge the condition as essentially lung heat, so I prescribed the original Ma Xing Shi Gan Tang (Ephedra-Apricot-Stone-Gypsum Decoction):

Mahuang (Ephedra) 3 g, Xingren (Apricot Kernel) 6 g (crushed, added later), Zhi Gancao (Honey-fried Licorice) 3 g, Sheng Shigao (Unprepared Gypsum) 15 g (decoct first).

After two days on the medicine, all symptoms vanished and the child fully recovered.

Previously, after every cold the child had essentially had an asthma attack. Another elderly TCM physician had also used Ma Xing Shi Gan Tang as the base, adding Jinyinhua (Honeysuckle), Choushuqu (Paris Polyphylla) and other herbs - yet the medicine failed, and in the end the child had to be admitted to hospital for antibiotics to obtain relief.

Case Two

An elderly man, with long-standing ailments of rheumatism and pulmonary tuberculosis, now had an attack: his knee was red and swollen, and urination was difficult. He sought help from many local doctors without result. A local TCM physician then took Si Miao Wan (Four-Miracle Pill) as the base and added a variety of herbs; the treatment not only failed but worsened the condition - his knee became severely red and swollen, unbearably painful, and he could not urinate. His family was panicked and considered surgery.

The patient's daughter had long trusted my results and turned to me for help.

I judged his illness to be precisely an indication for Si Miao Wan, and advised treating it with Si Miao Wan together with Gui Pi Wan (Spleen-Restraining Pill): take Si Miao Wan during the day and Gui Pi Wan at bedtime. The family was puzzled: the previous doctor had prescribed every herb in Si Miao Wan and many more besides, and if such a comprehensive prescription had been useless, how could plain Si Miao Wan work? Nonetheless, the daughter chose to trust me and had her father take Si Miao Wan.

After two days on the medicine, the patient improved: the swelling subsided and urination normalized. Continuing the medicine brought further improvement.

In both cases the previous doctors' formulation logic was not wrong, but both physicians had grown accustomed to adding herbs on top of classical prescriptions. The result was like drawing legs on a snake - a blemish instead of an improvement - and there was no efficacy. Once their prescriptions were trimmed back, the effect was immediate.

This shows that in TCM treatment the force must be applied with perfect precision: leave out one herb and it fails, yet add one extra herb and it also fails. The classical famous formulas of TCM have been proven extraordinarily effective by the human experimentation of countless people over many generations - which is exactly why they became famous formulas. When we differentiate and select a formula, once we have chosen the therapeutic logic, it is best not to take it upon ourselves to add superfluous herbs to the original. These two cases also gave me some self-reflection: recklessly altering the proven formulas of the ancients is, I fear, one of the important reasons for the decline in TCM clinical efficacy.