Wang Yueting's Case: Treating Lymph Node Tuberculosis with Modified Wen Dan Tang

The Hunan Journal of Traditional Chinese Medicine published a case report in its 1988 issue 3, describing Dr. Wang Yueting's treatment of a patient with lymph node tuberculosis using a modified Wen Dan Tang (Gallbladder-Warming Decoction). The outcome was remarkable and offers valuable clinical reference.

The patient, Ling, was a 38-year-old teacher who first consulted Dr. Wang on April 7, 1985. Chief complaint: multiple nodules had appeared under the jaw for one year, gradually worsening over the past six months. Initially the nodules were soybean-sized, movable on palpation, and only mildly tender, so the patient paid little attention. Later the nodules enlarged, accompanied by distending pain, cough, sputum, loose stools, and poor appetite.

Examination revealed an obese patient with a floating and moderate pulse, a pale enlarged tongue with watery white greasy coating, and a sallow complexion. On palpation, the submandibular nodules had grown to broad bean size. Chest X-ray showed no abnormalities.

Dr. Wang differentiated the pattern as phlegm-dampness with phlegm depression transforming into heat, which accumulated and formed scrofula (luo li). The treatment principle was to clear heat and resolve phlegm, combined with softening hardness and dispersing nodules.

Initial prescription: processed Pinellia 12g, Poria 12g, tangerine peel 5g, bamboo shavings 10g, immature bitter orange 10g, licorice 5g, Bupleurum 5g, white peony 15g, calcined clam shell 15g, self-heal spike 15g, Scutellaria 10g. 7 doses, decocted in water.

After 7 doses, at the second visit on April 14, the patient reported reduced nodule pain and the cough had resolved; other symptoms were unchanged.

Second prescription: processed Pinellia 12g, Poria 12g, tangerine peel 5g, bamboo shavings 10g, Bupleurum 5g, white peony 15g, calcined clam shell 15g, self-heal spike 15g, Sargassum 12g, Ecklonia 12g. 21 doses.

After taking 21 doses of the second formula, the submandibular nodules had disappeared and all symptoms resolved. To consolidate the therapeutic effect, Dr. Wang made slight adjustments.

Third prescription: processed Pinellia 12g, Poria 12g, tangerine peel 5g, Bupleurum 5g, white peony 15g, Sargassum 12g, Ecklonia 12g, Codonopsis 15g, Atractylodes 10g. 15 doses, decocted in water.

After completing the 15 doses of the third formula, the patient stopped medication. Follow-up for two years showed no recurrence.

Wen Dan Tang originates from the Song Dynasty text "Systematic Compendium of Medicine and Treatment" by Chen Yan. The original formula: Pinellia, bamboo shavings, and immature bitter orange (fried in wheat flour) each 2 liang, tangerine peel 3 liang, honey-fried licorice 1 liang, Poria 1.5 liang. The above were ground into powder; each dose used 4 qian, boiled with 1.5 bowls of water, 5 ginger slices, and 1 jujube, reduced to 70% volume, strained, and taken before meals.

Chen Yan described the indications: "Treats irritability and insomnia after serious illness, which is due to gallbladder cold; this formula governs it. Also treats palpitations and fright."

The modern physician Qin Bowei further elaborated: "This formula primarily treats earth obstruction with wood depression, disharmony of the gallbladder and stomach, and internal harassment by phlegm-heat." Qin Bowei explained that the formula uses Er Chen (tangerine peel, Pinellia) to transform stomach phlegm-dampness, bamboo shavings to clear stomach heat, and immature bitter orange to eliminate stomach phlegm stagnation, thereby harmonizing the gallbladder and stomach. It treats irritability and insomnia by relieving the condition described as "when the stomach is disharmonious, sleep is restless."

This explanation is reasonable. Wen Dan Tang has the effect of relieving digestive stagnation and distension. Although the patient in this case had lymph node tuberculosis from a Western medical perspective, the clinical symptoms were those of typical digestive stagnation. Dr. Wang therefore treated primarily based on pattern differentiation according to clinical symptoms, while also incorporating disease-specific treatment by adding calcined clam shell, self-heal spike, Sargassum, and Ecklonia to soften hardness and disperse nodules.

From a modern medicine perspective, this therapeutic approach may modulate the immune system and alleviate inflammatory responses, which may explain the complete recovery in this case.