Wang Yueting's Case of Treating Tuberculous Lymphadenitis with Modified Wendan Tang

The 3rd issue of Hunan Journal of Traditional Chinese Medicine (1988) published a case report by Dr. Wang Yueting on treating tuberculous lymphadenitis. In this case, Dr. Wang used a modified Wendan Tang (Warm Gallbladder Decoction) with remarkable results, making it highly valuable for reference.

The patient, Ms. Ling, 38 years old and a teacher, first visited Dr. Wang on April 7, 1985. Chief complaint: multiple nodules under the jaw for one year, progressively worsening over the past six months. Initially, the nodules were only the size of soybeans, movable upon palpation with mild tenderness, and the patient paid little attention. Later, the nodules gradually enlarged, accompanied by distending pain, cough, sputum production, loose stools, and poor appetite.

Examination revealed the patient was obese, with a floating and moderate pulse, a pale and enlarged tongue with a slippery white and greasy coating, and a sallow complexion. Palpation showed the submandibular nodules had grown to the size of broad beans. A chest X-ray showed no abnormalities.

Dr. Wang's syndrome differentiation identified this as a phlegm-dampness pattern, where phlegm stagnation transforms into heat and accumulates to form scrofula (luoli). The treatment principle should combine clearing heat and resolving phlegm with softening hardness and dissipating nodules.

First visit prescription: Fa Banxia (processed Pinellia) 12g, Fuling (Poria) 12g, Chenpi (Citrus reticulata peel) 5g, Zhuru (Bamboo shavings) 10g, Zhishi (Immature bitter orange) 10g, Gancao (Licorice) 5g, Chaihu (Bupleurum) 5g, Baishao (White peony) 15g, Duan Walengzi (Calcined ark shell) 15g, Xiakucao (Prunella) 15g, Huangqin (Scutellaria) 10g. Seven doses, decocted in water.

After taking seven doses, at the second visit on April 14, the patient reported that the nodule pain had decreased and the cough had resolved; other symptoms remained unchanged.

Second visit prescription: Fa Banxia 12g, Fuling 12g, Chenpi 5g, Zhuru 10g, Chaihu 5g, Baishao 15g, Duan Walengzi 15g, Xiakucao 15g, Haizao (Sargassum) 12g, Kunbu (Kelp) 12g. Twenty-one doses.

After taking the above 21 doses, the submandibular nodular swelling disappeared and all symptoms resolved. To consolidate the therapeutic effect, Dr. Wang made slight adjustments to the formula.

Third visit prescription: Fa Banxia 12g, Fuling 12g, Chenpi 5g, Chaihu 5g, Baishao 15g, Haizao 12g, Kunbu 12g, Dangshen (Codonopsis) 15g, Baizhu (Atractylodes macrocephala) 10g. Fifteen doses, decocted in water.

After completing the 15 doses of the third visit, the patient stopped medication. A two-year follow-up showed no recurrence.

Wendan Tang originates from Sanyin Jiyi Bingzheng Fanglun (Three Causes and Extremes: Treatise on Disease Patterns and Formulas) by Chen Yan of the Song Dynasty. The original formula consists of: Banxia (Pinellia), Zhuru (Bamboo shavings), Zhishi (Immature bitter orange, stir-fried with flour) — two liang each; Chenpi (Citrus peel) — three liang; Zhi Gancao (Honey-fried licorice) — one liang; Fuling (Poria) — one and a half liang. The above ingredients are ground into powder. Four qian is taken each time, boiled in one and a half bowls of water with five slices of ginger and one jujube until reduced to seven-tenths of a bowl, strained, and taken before meals.

Chen Yan described the indications of this formula as follows: "Treats vexation and inability to sleep after a serious illness — this is due to gallbladder cold; this medicine governs it. It also treats palpitations due to fright."

Contemporary physician Mr. Qin Bowei further elaborated on the indications of Wendan Tang, believing that "this formula primarily treats the pattern of earth stagnation and wood constraint, gallbladder-stomach disharmony, and internal disturbance of phlegm-heat." Qin Bowei held that the formula uses Er Chen (Chenpi and Banxia) to transform stomach phlegm-dampness, Zhuru to clear stomach heat, and Zhishi to eliminate stomach phlegm stagnation — thereby achieving the effect of soothing the gallbladder and harmonizing the stomach. Its ability to treat vexation and inability to sleep stems from alleviating the symptom of "when the stomach is in disharmony, one cannot rest peacefully."

This explanation is quite reasonable. Wendan Tang has the effect of relieving digestive tract stagnation and distension. Although the patient in this case presented with tuberculous lymphadenitis from a Western medical perspective, the clinical symptoms were typical of digestive tract stagnation. Therefore, in treating this patient, Dr. Wang primarily based the treatment on the patient's clinical symptoms through syndrome differentiation (bianzheng shizhi), while also incorporating the approach of disease differentiation (bianbing shizhi) by adding Duan Walengzi, Xiakucao, Haizao, and Kunbu to soften hardness and dissipate nodules.

From the perspective of modern medicine, this treatment approach may regulate the patient's immune system and alleviate the inflammatory response. The eventual cure of this patient may be related to these effects.