Gastric Fullness

Patient Li, female, 41 years old, first consultation on February 16, 2023. One month after contracting the novel coronavirus, the patient developed epigastric fullness, dry retching, and a sensation of blockage, accompanied by a bitter, sticky, and astringent taste in the mouth, phlegm in the throat, dizziness, irritability, fatigue, and worsening with exertion. Bowel movements and urination were normal. The tongue was pale red with a thin white coating, and the pulse was wiry, thin, and weak.

Diagnosis: Stomach fullness (spleen deficiency with dampness obstruction, turbid qi failing to transform).

Treatment principle: Aromatically transform dampness, awaken the spleen, and open the stomach.

Prescription: Modified Sansan Jiuqi Decoction: Agastache rugosa 10g, Eupatorium fortunei 10g, Amomum villosum 6g (added later), Citrus aurantium var. amara flower 10g, Magnolia officinalis flower 10g, Citrus medica var. sarcodactylis flower 10g, raw malt 30g, rice sprout 15g, rice seedling 10g, Astragalus membranaceus 15g, Pseudostellaria heterophylla 15g, Rhodiola rosea 15g, Ophiopogon japonicus 15g. 10 doses, decocted in water for oral administration.

After two follow-up visits, 10g of frost mulberry leaf and 10g of Platycodon grandiflorus were added according to the syndrome to clear the lungs and benefit the throat. A total of 30 doses were taken, and the symptoms basically disappeared. Subsequently, the dosage was changed to one dose every two days, and after taking it for over half a month for regulation, the condition was cured.

Note: The Three-Three-Nine Qi Decoction is an empirical formula of Mao Dexi, composed of Huoxiang Sanwei Yin (Agastache rugosa, Eupatorium fortunei, Amomum villosum), Fangxiang Sanhua Tang (Citrus aurantium var. amara, Magnolia officinalis flower, Citrus medica var. sarcodactylis flower), and Shugan Sanya Tang (Hordeum vulgare germinated, Setaria italica germinated, Oryza sativa germinated). This formula has the effects of aromatic stomach-opening, dampness-resolving, and liver-soothing. It is mainly used for syndromes such as disharmony between the spleen and stomach, non-transformation of damp turbidity, and stagnation of liver qi. This case is a "post-epidemic" gastric fullness syndrome, caused by damp pathogens obstructing the middle jiao, affecting its functions of ascending the clear and descending the turbid, as well as transporting and transforming essential substances. Therefore, aromatic dampness-resolving herbs were selected for treatment, aiming to restore the stomach's receiving and spleen's transporting functions. The Three-Three-Nine Qi Decoction has comprehensive effects such as resolving dampness, awakening the spleen, opening the stomach, and soothing the liver for gastric fullness syndrome due to dampness obstructing the middle jiao, which aligns with the syndrome pattern, making it essential for use. "Post-epidemic" conditions often damage qi and yin, leading to fatigue. Mao Dexi prefers to use the four herbs for supplementing qi and nourishing yin (Astragalus membranaceus, Pseudostellaria heterophylla, Ophiopogon japonicus, Rhodiola rosea) to tonify, which can quickly restore a person's vitality.

Cough

Patient Feng, female, 44 years old at the time, initial consultation on March 13, 2023. The patient experienced cough, wheezing, chest tightness, and fatigue for over 2 months after being infected with the novel coronavirus. The cough occurs in paroxysms, more severe at night and upon waking in the morning, with expectoration of white phlegm. The tongue is pale with thin white coating, and the pulse is wiry, thin, and weak. There is a history of asthma.

Diagnosis: Cough (wind-cold invading the lung, phlegm obstructing the lung collaterals).

Treatment Method: Disperse Lung Qi and Resolve Phlegm, Direct Rebellious Qi Downward and Relieve Cough.

Prescription: Modified Mahuang Jiuwei Tang (Ephedra Nine-Ingredient Decoction): Honey-fried Ephedra 5g, Ephedra 5g, Vinegar-processed Schisandra Chinensis 5g, Tangerine Peel 10g, Pinellia Ternata (processed) 10g, Stir-fried Bitter Apricot Kernel 10g, Poria Cocos 15g, Lepidium Seed 10g (wrapped for decoction), Honey-fried Tussilago Farfara 10g, Platycodon Root 10g, Peucedanum Praeruptorum 10g, Cicada Slough 10g, Salvia Miltiorrhiza 20g, Red Peony Root 15g, Raw Licorice Root 10g, Fresh Ginger 3 slices. 7 doses, decocted in water for oral administration.

Second Visit: After taking 7 doses, cough, wheezing, and chest tightness significantly improved, only feeling fatigued. Tongue red with thin white coating, pulse thin and weak. Added Pseudostellaria Heterophylla 10g to the previous formula to enhance the tonifying effect on the lung and spleen. Another 10 doses were prescribed to consolidate the treatment.

Note: Mahuang Jiuwei Tang is an empirical formula of Mao Dexi, commonly used in clinical practice to treat cough and wheezing of the cold-damp type. This formula consists of honey-fried ephedra, ephedra, vinegar-processed schisandra chinensis, tangerine peel, pinellia ternata (processed), stir-fried bitter apricot kernel, poria cocos, lepidium seed, honey-fried tussilago farfara, platycodon root, peucedanum praeruptorum, licorice root, etc. It is essentially composed of three small formulas: San'ao Tang, Erchen Tang, and Jiegeng Tang, with the addition of lepidium seed, honey-fried tussilago farfara, peucedanum praeruptorum, and schisandra chinensis. The entire formula has the functions of warming the lung to dispel cold, dispersing lung qi, and relieving cough. This patient had a history of chronic cough and wheezing. After contracting an epidemic pathogen, external cold triggered internal fluid retention, leading to impaired lung diffusion and descent, manifesting as cough with phlegm, chest tightness, and slight wheezing. Mahuang Jiuwei Tang was prescribed with the addition of cicada slough to disperse lung qi, calm wheezing, relieve cough, and resolve phlegm. Post-epidemic depletion of healthy qi and prolonged illness causing blood stasis in the collaterals resulted in chest tightness and fatigue. Pseudostellaria heterophylla, salvia miltiorrhiza, and red peony root were added to tonify qi, activate blood circulation, and unblock the collaterals. This formula matched the disease mechanism, hence achieving good efficacy.

Insomnia

Patient Yan, female, 29 years old, initial consultation on May 15, 2023. The patient experienced difficulty falling asleep and easy awakening after a second COVID-19 infection half a month ago, sleeping only 3–4 hours per night. Symptoms include heaviness in the head, dizziness, chest tightness, restlessness, abdominal bloating, poor appetite, bitter taste in the mouth, and sticky, uncomfortable bowel movements. Tongue: red tip with thin yellow coating. Pulse: slippery and rapid.

Diagnosis: Insomnia (phlegm-heat disturbing the heart, disharmony of the gallbladder and stomach).

Treatment principle: Resolve phlegm and clear heat, harmonize the middle and calm the spirit.

The prescription is based on Huanglian Wendan Tang with modifications: Coptis chinensis 6g, Pinellia ternata (processed) 10g, Bamboo shavings 10g, Bitter orange (stir-fried) 10g, Dried tangerine peel 10g, Poria with hostwood 15g, Licorice root 10g, Cinnamon bark 3g, Fleeceflower stem 15g, Silk tree bark 15g, Silk tree flower 15g, Patchouli 10g, Amomum villosum 10g (added later), Eupatorium 10g. Seven doses, decocted in water for oral administration.

After two follow-up visits, sleep improved significantly, and appetite recovered. During follow-up, fermented soybean 10g and radish seed 10g were added to clear heat, relieve restlessness, promote digestion, and resolve food stagnation. A total of 21 doses were taken, leading to full recovery.

Note: Huanglian Wendan Tang is Wendan Tang with the addition of Coptis chinensis. Wendan Tang originates from "Beiji Qianjin Yaofang" (Essential Formulas for Emergencies Worth a Thousand Gold) and consists of six herbs: Pinellia ternata, Bitter orange, Dried tangerine peel, Bamboo shavings, Licorice root, and Fresh ginger. It was used to treat restlessness and insomnia after severe illness due to gallbladder cold. By the Song Dynasty, Chen Wuze added Poria and Jujube to the original formula, expanding its indications to "deficiency and timidity of the heart and gallbladder, susceptibility to fright, or ominous dreams..." This case involves post-epidemic insomnia, caused by disrupted qi movement, stagnation of phlegm-dampness, prolonged stagnation transforming into heat, internal disturbance of phlegm-heat, and disharmony between the gallbladder and stomach. Mao Dexi prescribed Huanglian Wendan Tang to regulate qi, resolve phlegm, clear the heart, and calm the mind. He added Huoxiang Sanwei Yin (Patchouli, Eupatorium, and Amomum villosum) to aromatically stimulate the appetite, resolve dampness, and harmonize the middle, restoring the ascending of the clear and descending of the turbid in the middle burner. Fleeceflower stem, Silk tree bark, and Silk tree flower were added to enhance blood activation, mind calming, and depression-relieving effects. The entire formula works together to clear heat, resolve phlegm, calm the heart, and tranquilize the mind. The syndrome differentiation was precise, the medication was appropriate, and the effect was immediate and remarkable.