气血，全赖水谷之所化。当宜理胃健脾，顺气化痰，取虚则补母之意，金匮薯蓣丸加减。
淮山药（三钱） 炙甘草（五分） 仙半夏（一钱五分） 旋复花（包，一钱五分） 潞党参（二钱） 云茯苓
（三钱） 炙苏子（一钱五分） 川贝母（三钱） 野于术（一钱） 薄橘红（五分） 甜光杏（三钱） 炙远志（
五分）
核桃肉（二个）
封右 温病后，阴液已伤，虚火烁金，肺热叶焦，则生痿 。两足不能任地，咳呛咯痰不爽，谷食减少，咽
喉干燥，脉濡滑而数，舌质红苔黄，延经数月，恙根已深。姑拟养肺阴，清阳明，下病治上，乃古之成法。
南沙参（三钱） 川石斛（三钱） 天花粉（三钱） 生甘草（五分） 川贝母（三钱） 嫩桑枝（三钱）
冬瓜子（三钱） 怀牛膝（二钱） 络石藤（三钱） 甜光杏（三钱） 栝蒌皮（三钱） 肥知母（一钱五分）
活芦根（去节，一尺）
二诊 前进养肺阴清阳明之剂，已服十帖，咳呛内热，均见轻减。两足痿软不能任地，痿者萎也，如草木
之萎，无雨露以灌溉，欲草木之荣茂，必得雨露之濡润，欲两足之不痿，必赖肺液以输布，能下荫于肝肾，肝得
血则筋舒，肾得养则骨强，阴血充足，络热自清。治痿
独取阳明，清阳明之热，滋肺金之阴，以阳明能主润宗筋而流利机关也。
大麦冬（二钱） 北沙参（三钱） 抱茯神（三钱） 淮山药（三钱） 细生地（四钱） 肥知母（一钱五分）
川贝母（二钱） 天花粉（三钱） 络石藤（二钱） 怀牛膝（二钱） 嫩桑枝（三钱）
三诊 五脏之热，皆能成痿，书有五痿之称，不独肺热叶焦也。然而虽有五，实则有二，热痿也，湿痿也。
如草木久无雨露则萎，草木久被湿遏亦萎，两足痿 ，亦犹是也。今脉濡数，舌质红绛，此热痿也。叠进清阳
明滋肺阴以来，两足虽不能步履，已能自行举起之象，药病尚觉合宜。仍守原法，加入益精养血之品，徐图功效。
北沙参（三钱） 大麦冬（二钱） 茯神（三钱） 淮山药（三钱） 川石斛（三钱） 小生地（三钱）
肥知母（一钱五分） 怀牛膝（二钱） 络石藤（三钱） 茺蔚子（三钱） 嫩桑枝（三钱） 猪脊髓（酒洗入煎，
两条） 虎潜丸（清晨淡盐汤送服，三钱）
程左 初病香港脚浮肿，继则肿虽消而痿软不能步履，舌淡白，脉濡缓，谷食衰少，此湿热由外入内，由肌
肉而入筋络，络脉壅塞，气血凝滞，此湿痿也。经云∶湿热不攘，大筋软短，小筋弛长，软短为拘，弛张为痿是
也。湿性粘腻，最为缠绵。治宜崇土逐湿，去瘀通络。
连皮苓（四钱） 福泽泻（一钱五分） 木防己（三钱） 全当归（二钱） 白术（一钱五分） 苍术（一钱）
陈皮（一钱） 川牛膝（二钱） 杜红花（八分） 生苡仁（四钱） 陈木瓜（三钱） 西秦艽（一钱五分）
紫丹参（二钱） 嫩桑枝（三钱）
另茅山苍术（一斤），米泔水浸七日，饭锅上蒸九次，晒干研细末。加苡仁米（半斤），酒炒桑枝（半斤），
煎汤泛丸。每服（三钱），空心开水吞下。
原注∶服此方五十余剂，丸药两料，渐渐而愈。
李左 两足痿软，不便步履，按脉尺弱寸关弦数，此乃肺肾阴亏，络有蕴热，经所谓肺热叶焦，则生痿
是也。阳明为十二经之长，治痿独取阳明者，以阳明主润宗筋，宗筋主束骨而利机关也。症势缠绵，非易速痊。
南北沙参（各一钱五分） 鲜生地（三钱） 川黄柏（一钱五分） 丝瓜络（二钱） 川石斛（三钱）
生苡仁（三钱） 肥知母（一钱五分） 大麦冬（三钱） 陈木瓜（二钱） 络石藤（三钱） 虎潜丸（包煎，三钱）
杨右 手足痹痛微肿，按之则痛更剧，手不能招举，足不能步履，已延两月余。脉弦小而数，舌边红，苔
腻黄，小溲短少，大便燥结。体丰之质，多湿多痰，性惰
躁急，多郁多火，外风引动内风，挟素蕴之湿痰入络，络热、血瘀不通，不通则痛。书云∶阳气多，阴气少，则为
热痹，此症是也。专清络热为主，热清则风自熄，风静则痛可止。
羚羊片（先煎，一钱） 鲜石斛（三钱） 嫩白薇（一钱五分） 生赤芍（二钱） 生甘草（五分） 茺
蔚子（三钱） 鲜竹茹（二钱） 丝瓜络（二钱） 忍冬藤（四钱） 夜交藤（四钱） 嫩桑枝（四钱） 大地龙（酒
洗，二钱）
复诊 前清络热，已服十剂，手足痹痛十去六七，肿势亦退，风静火平也。惟手足未能举动，舌质光红，
脉数渐缓，口干欲饮，小溲短少，腑行燥结。血不养筋，津液既不能上承，又无以下润也。前方获效，毋庸更张。
原方去大地龙，加天花粉（三钱）。
又服十剂，痹痛已止，惟手足乏力。去羚羊片、白薇、鲜石斛，加紫丹参（二钱）、全当归（三钱）、西秦
艽（一钱五分）、怀牛膝（二钱）。
严右 腰髀痹痛，连及胯腹，痛甚则泛恶清涎，纳谷减少，难于转侧。腰为少阴之府，髀为太阳之经，胯
腹为厥阴之界。产后血虚，风寒湿乘隙入太阳、少阴、厥阴之络，营卫痹塞不通，厥气上逆，挟痰湿阻于中焦，
胃失下顺之旨。脉象尺部沉细，寸关弦涩，苔薄腻。书云∶风胜为行痹，寒胜为痛痹，湿胜为着痹。痛为寒痛，
寒郁湿着，显然可见。恙延两月之久，前师谓肝气入络者，又谓血不养筋者，理亦近是，究未能审其致病之源。
鄙拟独活寄生汤合吴茱萸汤加味，温经达邪，泄肝化饮。
紫丹参（二钱） 云茯苓（三钱） 全当归（二钱） 大白芍（一钱五分） 川桂枝（六分） 青防风（一钱）
浓杜仲（二钱） 怀牛膝（二钱） 熟附片（一钱） 北细辛（三分） 仙半夏（三钱） 淡吴萸（五分）
川独活（一钱） 桑寄生（二钱）
服药五剂，腰髀胯腹痹痛大减，泛恶亦止，惟六日未更衣，饮食无味。去细辛、半夏，加砂仁（七分），半
硫丸（一钱五分）吞服。又服两剂，腑气已通，谷食亦香。
去半硫丸、吴萸，加生白术（一钱五分）、生黄 （三钱），服十剂，诸恙均愈，得以全功。足见对症用药，其效必
速。
汪翁 腰痛偏左如折，起坐不得，痛甚则四肢震动，形瘦骨立，食少神疲，延一月余。诊脉虚弦而浮，浮
为风象，弦为肝旺。七秩之年，气血必虚，久坐电风入肾，气虚不能托邪外出，血虚无以流通脉络，故腰痛若
此之甚也。拙拟大剂玉屏风，改散为饮。
生黄 （五钱） 青防风（五钱） 生白术（三钱） 生甘草（六分） 全当归（二钱） 大白芍（二钱）
浓杜仲（三钱） 广木香（五分） 陈广皮（一钱）
原注∶此方服后，一剂知，二剂已。方中木香、陈皮二味，止痛须理气之意也。
黄左 髀部痹痛，连及腿足，不能步履，有似痿 之状，已延两月之久。痿 不痛，痛则为痹。脉左弦滑，
右濡滑，风寒湿三气杂至，合而为痹，痹者闭也，气血不能流通所致。拟蠲痹汤加减，温营去风，化湿通络。
全当归（二钱） 大白芍（一钱五分） 桂枝（六分） 清炙草（六分） 紫丹参（二钱） 云茯苓（三钱）
秦艽（二钱） 牛膝（二钱） 独活（一钱） 海风藤（三钱） 防己（二钱） 延胡索（一钱） 嫩桑枝（三钱）
陈木瓜（三钱）
陈左 风为阳邪，中人最速，其性善走，窜入经络，故肢节作痛，今见上下左右无定，名曰行痹。脉弦
细而涩，阴分素亏，邪风乘虚入络，营卫不能流通。当宜和营去风，化湿通络。
全当归（二钱） 大川芎（八分） 威灵仙（一钱五分） 嫩桑枝（四钱） 大白芍（二钱） 晚蚕沙（包，三钱）
海风藤（三钱）
西秦艽（二钱） 青防风（二钱） 甘草（八分）
汪左 风寒湿三气杂至，合而为痹，风胜为行痹，寒胜为痛痹，湿胜为着痹。髀骨酸痛，入夜尤甚，亦痹
之类。脉象沉细而涩，肝脾肾三阴不足，风寒湿三气入络，与宿瘀留恋，所以酸痛入夜尤甚也。拟独活寄生汤加味。
全当归（二钱） 西秦艽（二钱） 浓杜仲（三钱） 云茯苓（三钱） 大白芍（二钱） 青防风（一钱）
川独活（一钱） 五加皮（三钱） 紫丹参（二钱） 川桂枝（四分） 桑寄生（三钱） 嫩桑枝（四钱） 炙甘草
（五分） 小活络丹（入煎，一粒） 怀牛膝（二钱）
沈左 脉滑而有力，舌苔薄腻，胸痛彻背，夜寐不安，此乃痰浊积于胸中，致成胸痹。胸为清阳之府，如
离照当空，不受纤翳，浊阴上僭，清阳被蒙，膻中之气，窒塞不宣，症属缠绵。当宜金匮栝蒌薤白半夏汤加味，
辛开苦降，滑利气机。
栝蒌皮（四钱） 仙半夏（二钱） 云茯苓（三钱） 薤白头（酒炒，一钱五分） 江枳壳（一钱）
广陈皮（一钱） 潼蒺藜（三钱） 广郁金（一钱五分）
谢左 左肩髀痹痛已久，连投去风之剂，依然如故。经云∶邪之所凑，其气必虚。气阴两亏，痰湿留恋
经络，营卫不能流通。拟玉屏风散加味，益气养阴，化
痰通络。
生黄 （三钱） 细生地（三钱） 西秦艽（二钱） 竹沥半夏（二钱） 青防风（二钱） 甘菊花（三钱）
广陈皮（一钱） 炒竹茹（二钱） 生白术（二钱） 京玄参（二钱） 煨木香（八分） 嫩桑枝（四钱）
大地龙（酒洗，二钱） 指迷茯苓丸（包煎，三钱）
钱左 初起寒热，继则脐腹膨胀，右髀部酸痛，连及腿足，不能举动，小溲短赤，腑行燥结，舌苔腻黄，脉
象濡滑而数。伏邪湿热挟滞，互阻募原，枢机不和。则生寒热。厥阴横逆，脾失健运，阳明通降失司，则生
胀。痹痛由于风湿，经络之病，连及脏腑，弥生枝节。姑拟健运分消，化湿通络，冀其应手为幸！
清水豆卷（四钱） 茯苓皮（四钱） 枳实炭（一钱） 嫩白薇（一钱五分） 冬瓜子（三钱） 通草（八分）
全栝蒌（切，四钱） 郁李仁（研，三钱） 西秦艽（一钱五分） 大麻仁（研，四钱） 木防己（二钱）
肥知母（二钱） 地枯萝（三钱）
二诊 腑气通，脐腹胀势亦减。纳少，渴不多饮，小溲短赤，右髀部痹痛，连及腿足，不便步履，苔薄腻
黄，脉象濡数。阴液本亏，湿热气滞互阻募原之间，肝失疏泄，脾失健运，络中风湿留恋，营卫不得流通，还虑
缠绵增剧。再拟健运分消，化湿通络。
清水豆卷（三钱） 连皮苓（四钱） 枳实炭（一钱） 益元散（包，三钱） 天花粉（二钱） 猪苓（二钱）
陈广皮（一钱） 西秦艽（二钱） 生熟苡仁（各三钱） 通草（八分） 大腹皮（三钱） 地枯萝（三钱）
小温中丸（吞服，一钱五分） 冬瓜皮（三钱）
三诊 腑气通而溏薄，脐腹胀势已能渐消，小溲亦利，右髀部漫肿，痹痛大轻，但不便步履耳。脉象虚弦
而数，舌边红，苔薄腻。阴分本亏，肝脾气滞，蕴湿浊气，凝聚募原，络中痰瘀未楚，营卫不能流通。效不更
方，仍宗原意出入。
川石斛（三钱） 西秦艽（三钱） 地枯萝（三钱） 冬瓜子（三钱） 连皮苓（四钱） 陈广皮（一钱）
木防己（二钱） 川牛膝（二钱） 生白术（一钱五分） 大腹皮（二钱） 藏红花（八分） 炒苡仁（三钱）
嫩桑枝（三钱）
朱左 诊脉三部弦小而数，右寸涩，关濡、尺细数，舌苔腻黄，见症胸痹痞闷，不进饮食，时泛恶，里热
口干不多饮，十日未更衣，小溲短赤混浊，目珠微黄面，色灰暗无华，良由肾阴早亏，湿遏热伏，犯胃贯膈，
胃气不得下降。脉症合参，证属缠绵，阴伤既不可滋，湿甚又不可燥，姑拟宣气泄肝，以通阳明，芳香化浊，而和
枢机。
栝蒌皮（三钱） 赤茯苓（三钱） 江枳实（一钱） 荸荠梗（一钱）
五分） 薤白头（酒炒，一钱） 福泽泻（一钱五分） 炒竹茹（一钱五分） 鲜枇杷叶（三片） 绵茵陈（一钱五分）
仙半夏（二钱） 通草（八分） 银柴胡（一钱） 水炒川连（四分） 鲜藿佩（各二钱） 块滑石（三钱）
二诊 脉左三部细小带弦，右寸涩稍和，关濡尺细，舌苔薄腻而黄，今日呕恶渐减，胸痞依然，不思纳
谷，口干不多饮，旬日未更衣，小溲短赤混浊，目珠微黄，面部晦色稍开。少阴之分本亏，湿热挟痰滞互阻中
焦，肝气横逆于中，太阴健运失常，阳明通降失司。昨投宣气泄肝，以通阳明，芳香化浊，而和枢机之剂，尚觉
合度，仍守原意扩充。
仙半夏（二钱） 赤茯苓（三钱） 银柴胡（一钱） 绵茵陈（一钱五分） 上川雅连（五分） 鲜藿香佩兰（各
二钱） 广郁金（一钱五分） 建泽泻（一钱五分） 栝蒌皮（三钱） 炒枳实（一钱） 生熟谷芽（各三钱）
薤白头（酒炒，一钱） 块滑石（三钱） 炒竹茹（一钱五分） 通草（八分） 鲜枇杷叶（去毛、包，三片）
鲜荷梗（一尺）
三诊 呕恶已止，湿浊有下行之势，胸痞略舒，气机有流行之渐，惟纳谷衰少，小溲浑赤，苔薄黄，右脉濡
Qi and blood rely entirely on the transformation of water and grain (nutrients). Treatment should regulate the stomach and strengthen the spleen, smooth qi and resolve phlegm, adopting the principle of "tonifying the mother when deficient" (Xu Ze Bu Mu), using a modified version of Shuyu Wan from *Jin Gui Yao Lue*.
Huai Shan Yao (Dioscoreae Rhizoma, 3 qian) Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 5 fen) Xian Ban Xia (Pinelliae Tuber Prepared with Alum, 1.5 qian) Xuan Fu Hua (Inulae Flos, wrapped, 1.5 qian) Lu Dang Shen (Codonopsis Radix, 2 qian) Yun Fu Ling (Poria, 3 qian) Zhi Su Zi (Perillae Fructus, prepared, 1.5 qian) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 3 qian) Ye Yu Zhu (Atractylodis Macrocephalae Rhizoma, wild, 1 qian) Bo Ju Hong (Citri Reticulatae Pericarpium, thin, 5 fen) Tian Guang Xing (Prunus Armeniaca Semen, sweet, 3 qian) Zhi Yuan Zhi (Polygalae Radix, prepared, 5 fen) Tao He Rou (Persicae Semen Kernel, 2 pieces)
Feng You: After a warm disease (Wen Bing), yin fluids are damaged, deficiency fire scorches metal (lungs), causing lung heat and withered leaves (Fei Re Ye Jiao), leading to flaccidity syndrome (Wei Zheng). The legs cannot support the body; coughing, wheezing, and expectoration are unsatisfactory; food intake is reduced; throat and mouth are dry; pulse is soft, slippery, and rapid; tongue is red with yellow coating. The illness has persisted for months, and the root is deep. Tentatively prescribe nourishing lung yin and clearing yangming heat. Treating lower body diseases by addressing the upper body is an ancient established method.
Nan Sha Shen (Adenophorae Radix, 3 qian) Chuan Shi Hu (Dendrobii Caulis, 3 qian) Tian Hua Fen (Trichosanthis Radix, 3 qian) Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma, 5 fen) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 3 qian) Nen Sang Zhi (Mori Ramulus, tender, 3 qian) Dong Gua Zi (Benincasae Semen, 3 qian) Huai Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Luo Shi Teng (Trachelospermi Caulis, 3 qian) Tian Guang Xing (Prunus Armeniaca Semen, sweet, 3 qian) Gua Lou Pi (Trichosanthis Pericarpium, 3 qian) Fei Zhi Mu (Anemarrhenae Rhizoma, plump, 1.5 qian) Huo Lu Gen (Phragmitis Rhizoma, fresh, nodes removed, 1 chi)
Second visit: Having taken ten doses of the formula to nourish lung yin and clear yangming, coughing, wheezing, and internal heat have both decreased. However, the legs remain flaccid and unable to support the body. "Wei" means withering, like plants that wither without rain and dew. To make plants flourish, they must be moistened by rain and dew; to prevent leg flaccidity, one must rely on lung fluids to distribute downwards to nourish the liver and kidneys. When the liver receives blood, tendons relax; when the kidney is nourished, bones become strong. With sufficient yin and blood, collateral heat clears naturally. In treating flaccidity, one focuses exclusively on the Yangming channel. Clearing yangming heat and nourishing lung yin works because yangming governs the moistening of the zongjin (major tendons) and facilitates joint movement.
Da Mai Dong (Ophiopogonis Tuber, 2 qian) Bei Sha Shen (Glehniae Radix, 3 qian) Bao Fu Shen (Poria with Hostwood, 3 qian) Huai Shan Yao (Dioscoreae Rhizoma, 3 qian) Xi Sheng Di (Rehmanniae Radix Preparata, fine, 4 qian) Fei Zhi Mu (Anemarrhenae Rhizoma, plump, 1.5 qian) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 2 qian) Tian Hua Fen (Trichosanthis Radix, 3 qian) Luo Shi Teng (Trachelospermi Caulis, 2 qian) Huai Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Nen Sang Zhi (Mori Ramulus, tender, 3 qian)
Third visit: Heat in the five zang organs can all cause flaccidity; texts mention "five types of flaccidity," not just lung heat withering the lungs. Although there are five categories, essentially there are two: heat flaccidity and dampness flaccidity. Just as plants wither from lack of rain and dew, or from being stifled by dampness, leg flaccidity is similar. Currently, the pulse is soft and rapid, and the tongue is crimson red, indicating heat flaccidity. Since continuously administering formulas to clear yangming and nourish lung yin, although the legs cannot walk, there is a sign that they can lift themselves. The medication seems appropriate. Continue the original method, adding herbs to benefit essence and nourish blood, seeking gradual efficacy.
Bei Sha Shen (Glehniae Radix, 3 qian) Da Mai Dong (Ophiopogonis Tuber, 2 qian) Fu Shen (Poria, 3 qian) Huai Shan Yao (Dioscoreae Rhizoma, 3 qian) Chuan Shi Hu (Dendrobii Caulis, 3 qian) Xiao Sheng Di (Rehmanniae Radix Preparata, small, 3 qian) Fei Zhi Mu (Anemarrhenae Rhizoma, plump, 1.5 qian) Huai Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Luo Shi Teng (Trachelospermi Caulis, 3 qian) Chong Wei Zi (Leonuri Fructus, 3 qian) Nen Sang Zhi (Mori Ramulus, tender, 3 qian) Zhu Ji Sui (Porcine Spinal Cord, washed with wine and decocted, 2 strips) Hu Qian Wan (Tiger Crouch Pill, taken early morning with light salt water, 3 qian)
Cheng Zuo: Initially suffered from Hong Kong Foot (Gouty Arthritis/Edema of the foot) swelling, which subsided but was followed by flaccidity and inability to walk. Tongue is pale white, pulse is soft and slow, food intake is poor. This is damp-heat entering from outside to inside, from muscles into sinews/collaterals, causing collateral congestion and qi-blood stagnation; this is dampness flaccidity. The Classics state: "If damp-heat is not removed, the large sinews become soft and short, and the small sinews become lax and long. Soft and short leads to spasms; lax and long leads to flaccidity." Dampness is sticky and lingering. Treatment should strengthen earth (spleen) to expel dampness, remove stasis, and unblock collaterals.
Lian Pi Ling (Poria with Skin, 4 qian) Fu Ze Xie (Alismatis Rhizoma, 1.5 qian) Mu Fang Ji (Stephaniae Tetrandrae Radix, 3 qian) Quan Dang Gui (Angelicae Sinensis Radix, whole, 2 qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian) Cang Zhu (Atractylodis Rhizoma, 1 qian) Chen Pi (Citri Reticulatae Pericarpium, 1 qian) Chuan Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Du Hong Hua (Carthami Flos, 8 fen) Sheng Yi Ren (Coicis Semen, raw, 4 qian) Chen Mu Gua (Chaenomelis Fructus, aged, 3 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 1.5 qian) Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian) Nen Sang Zhi (Mori Ramulus, tender, 3 qian)
Separately, take Mao Shan Cang Zhu (Rhizoma Atractylodis, 1 jin), soak in rice washing water for seven days, steam nine times over a rice cooker, dry, and grind into fine powder. Add Yi Ren Mi (Coicis Semen, half jin) and Jiu Chao Sang Zhi (Mori Ramulus fried with wine, half jin), decoct in water to form pills. Take 3 qian each time, swallowing with boiled water on an empty stomach.
Original Note: After taking more than fifty doses of this prescription and two batches of pills, recovery was gradual.
Li Zuo: Legs are flaccid and difficult to walk. Pulse: Chi (kidney area) is weak, Cun and Guan (lung/spleen-liver areas) are wiry and rapid. This indicates deficiency of lung and kidney yin with latent heat in collaterals. As the Classics say, "Lung heat withers the leaves, leading to flaccidity." Yangming is the leader of the twelve channels. Treating flaccidity by focusing on Yangming works because Yangming moistens the zongjin, which binds bones and facilitates joints. The condition is lingering and not easily cured quickly.
Nan and Bei Sha Shen (Adenophorae/Glehniae Radix, 1.5 qian each) Xian Sheng Di (Rehmanniae Radix Preparata, fresh, 3 qian) Chuan Huang Bo (Phellodendri Chinensis Cortex, 1.5 qian) Si Gua Luo (Luffae Fructus Retinervus, 2 qian) Chuan Shi Hu (Dendrobii Caulis, 3 qian) Sheng Yi Ren (Coicis Semen, raw, 3 qian) Fei Zhi Mu (Anemarrhenae Rhizoma, plump, 1.5 qian) Da Mai Dong (Ophiopogonis Tuber, 3 qian) Chen Mu Gua (Chaenomelis Fructus, aged, 2 qian) Luo Shi Teng (Trachelospermi Caulis, 3 qian) Hu Qian Wan (Tiger Crouch Pill, wrapped and decocted, 3 qian)
Yang You: Hands and feet suffer from bi pain (arthralgia) with slight swelling; pressure exacerbates pain. Hands cannot lift, feet cannot walk. Illness has lasted over two months. Pulse is wiry, small, and rapid; tongue edges are red with greasy yellow coating; urine is scant; stool is dry and hard. A robust constitution often implies much dampness and phlegm; a lazy yet irritable temperament implies much depression and fire. External wind triggers internal wind, carrying accumulated damp-phlegm into collaterals, causing collateral heat and blood stasis. Blockage causes pain. Texts say: "More yang qi, less yin qi results in hot bi." This case fits that description. Focus primarily on clearing collateral heat. When heat clears, wind extinguishes itself; when wind calms, pain stops.
Ling Yang Pian (Capricornis Cornu, sliced, decoct first, 1 qian) Xian Shi Hu (Dendrobii Caulis, fresh, 3 qian) Nen Bai Wei (Cynanchi Stauntonii Radix, tender, 1.5 qian) Sheng Chi Shao (Paeoniae Radix Rubra, raw, 2 qian) Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma, 5 fen) Chong Wei Zi (Leonuri Fructus, 3 qian) Xian Zhu Ru (Bambusae Caulis in Taenia, fresh, 2 qian) Si Gua Luo (Luffae Fructus Retinervus, 2 qian) Ren Dong Teng (Lonicerae Japonicae Caulis, 4 qian) Ye Jiao Teng (Polygoni Multiflori Caulis, 4 qian) Nen Sang Zhi (Mori Ramulus, tender, 4 qian) Da Di Long (Pheretima, washed with wine, 2 qian)
Follow-up visit: Previous treatment cleared collateral heat. After ten doses, hand and foot bi pain reduced by 60-70%, and swelling subsided, indicating wind calmed and fire leveled. However, hands and feet still cannot move. Tongue is bare and red; pulse is slowing down; mouth is dry with desire to drink; urine is scant; stool is dry. Blood fails to nourish tendons; fluids cannot ascend nor descend. The previous formula was effective, so no changes needed.
Remove Da Di Long from the original formula, add Tian Hua Fen (Trichosanthis Radix, 3 qian).
After another ten doses, bi pain stopped, but hands and feet felt weak. Remove Ling Yang Pian, Bai Wei, and Xian Shi Hu. Add Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian), Quan Dang Gui (Angelicae Sinensis Radix, whole, 3 qian), Xi Qin Jiao (Gentianae Macrophyllae Radix, 1.5 qian), and Huai Niu Xi (Achyranthis Bidentatae Radix, 2 qian).
Yan You: Bi pain in waist and thigh extends to hip and abdomen. Severe pain causes retching of clear saliva and reduced appetite, making turning difficult. Waist is the mansion of Shaoyin (Kidney); thigh belongs to Taiyang (Bladder) channel; hip/abdomen is the boundary of Jueyin (Liver). Postpartum blood deficiency allows wind-cold-dampness to invade Taiyang, Shaoyin, and Jueyin collaterals. Ying and Wei are blocked, Jueqi rebels upward, carrying phlegm-dampness to obstruct the Middle Jiao, causing stomach qi to fail to descend. Pulse: Chi is deep and fine; Cun and Guan are wiry and choppy; coating is thin and greasy. Texts say: "Wind predominance causes moving bi; cold predominance causes painful bi; damp predominance causes fixed bi." Pain indicates cold; cold stagnation with dampness is evident. Illness lasted two months. Previous doctors attributed it to liver qi entering collaterals or blood failing to nourish tendons, which is plausible but failed to identify the root cause. I propose Du Huo Ji Sheng Tang combined with Wu Zhu Yu Tang plus modifications, to warm meridians and drive out pathogens, vent liver and transform fluid retention.
Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian) Yun Fu Ling (Poria, 3 qian) Quan Dang Gui (Angelicae Sinensis Radix, whole, 2 qian) Da Bai Shao (Paeoniae Radix Alba, large, 1.5 qian) Chuan Gui Zhi (Cinnamomi Ramulus, 6 fen) Qing Fang Feng (Saposhnikoviae Radix, 1 qian) Nong Du Zhong (Eucommiae Cortex, concentrated, 2 qian) Huai Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Shu Fu Pian (Aconiti Lateralis Radix Praeparata, 1 qian) Bei Xi Xin (Asari Radix et Rhizoma, northern, 3 fen) Xian Ban Xia (Pinelliae Tuber Prepared with Alum, 3 qian) Dan Wu Yu (Evodiae Fructus, mild, 5 fen) Chuan Du Huo (Angelicae Pubescentis Radix, 1 qian) Sang Ji Sheng (Taxilli Caulis et Folium, 2 qian)
After five doses, waist/thigh/hip/abdomen bi pain greatly reduced, retching stopped. Only six days without bowel movement and loss of taste. Remove Xi Xin and Ban Xia, add Sha Ren (Amomi Fructus, 7 fen), swallow Ban Liu Wan (Half-Sulfur Pill, 1.5 qian). After two more doses, bowel movement resumed, appetite improved.
Remove Ban Liu Wan and Wu Yu, add Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma, raw, 1.5 qian) and Sheng Huang Qi (Astragali Radix, raw, 3 qian). After ten doses, all symptoms resolved, achieving full cure. This shows that correct medication yields rapid results.
Weng Weng: Left-sided lower back pain feels like breaking, unable to sit or stand. Severe pain causes limb tremors. Emaciated, poor appetite, mental fatigue. Illness lasted over a month. Pulse is deficient, wiry, and floating. Floating indicates wind; wiry indicates liver hyperactivity. At seventy years old, qi and blood are definitely deficient. Prolonged sitting allowed wind to enter the kidney. Deficient qi cannot expel pathogens outward; deficient blood cannot circulate through collaterals, hence severe back pain. I tentatively prescribe a large dose of Yu Ping Feng San, changed from powder to decoction.
Sheng Huang Qi (Astragali Radix, raw, 5 qian) Qing Fang Feng (Saposhnikoviae Radix, 5 qian) Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma, raw, 3 qian) Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma, 6 fen) Quan Dang Gui (Angelicae Sinensis Radix, whole, 2 qian) Da Bai Shao (Paeoniae Radix Alba, large, 2 qian) Nong Du Zhong (Eucommiae Cortex, concentrated, 3 qian) Guang Mu Xiang (Costi Radix, 5 fen) Chen Guang Pi (Citri Reticulatae Pericarpium, aged, 1 qian)
Original Note: After taking this formula, improvement after one dose, resolution after two. Mu Xiang and Chen Pi in the formula aim to relieve pain by regulating qi.
Huang Zuo: Bi pain in thigh extends to legs and feet, unable to walk, resembling flaccidity. Illness lasted two months. Flaccidity does not hurt; pain indicates bi. Pulse left is wiry-slippery, right is soft-slippery. Wind, cold, and dampness mix to cause bi. Bi means blockage, caused by qi-blood stagnation. Prescribe Juan Bi Tang plus modifications to warm ying, dispel wind, resolve dampness, and unblock collaterals.
Quan Dang Gui (Angelicae Sinensis Radix, whole, 2 qian) Da Bai Shao (Paeoniae Radix Alba, large, 1.5 qian) Gui Zhi (Cinnamomi Ramulus, 6 fen) Qing Zhi Cao (Clear-fried Glycyrrhizae Radix et Rhizoma, 6 fen) Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian) Yun Fu Ling (Poria, 3 qian) Qin Jiao (Gentianae Macrophyllae Radix, 2 qian) Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Du Huo (Angelicae Pubescentis Radix, 1 qian) Hai Feng Teng (Radix Sinomeni, 3 qian) Fang Ji (Stephaniae Tetrandrae Radix, 2 qian) Yan Hu Suo (Corydalis Rhizoma, 1 qian) Nen Sang Zhi (Mori Ramulus, tender, 3 qian) Chen Mu Gua (Chaenomelis Fructus, aged, 3 qian)
Chen Zuo: Wind is a yang pathogen, enters humans rapidly, moves freely, intrudes into collaterals causing joint pain. Now pain is unpredictable in location (up/down/left/right), named Moving Bi. Pulse is wiry-thin and choppy. Yin deficiency exists inherently. Evil wind invades collaterals due to deficiency, disrupting ying and wei circulation. Should harmonize ying, dispel wind, resolve dampness, and unblock collaterals.
Quan Dang Gui (Angelicae Sinensis Radix, whole, 2 qian) Da Chuan Xiong (Ligustici Chuanxiong Rhizoma, large, 8 fen) Wei Ling Xian (Syneilesidis Rhizoma, 1.5 qian) Nen Sang Zhi (Mori Ramulus, tender, 4 qian) Da Bai Shao (Paeoniae Radix Alba, large, 2 qian) Wan Can Sha (Bombyx Batryticatus, late-season mulberry silkworm, wrapped, 3 qian) Hai Feng Teng (Radix Sinomeni, 3 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 2 qian) Qing Fang Feng (Saposhnikoviae Radix, 2 qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, 8 fen)
Wang Zuo: Wind, cold, and dampness mix to cause bi. Wind predominance causes moving bi; cold predominance causes painful bi; damp predominance causes fixed bi. Thigh bone soreness and pain, worse at night, also falls under bi category. Pulse is deep, thin, and choppy. Liver, spleen, and kidney yin are insufficient. Wind-cold-dampness enters collaterals, lingering with old stasis, causing worse soreness/pain at night. Prescribe Du Huo Ji Sheng Tang plus modifications.
Quan Dang Gui (Angelicae Sinensis Radix, whole, 2 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 2 qian) Nong Du Zhong (Eucommiae Cortex, concentrated, 3 qian) Yun Fu Ling (Poria, 3 qian) Da Bai Shao (Paeoniae Radix Alba, large, 2 qian) Qing Fang Feng (Saposhnikoviae Radix, 1 qian) Chuan Du Huo (Angelicae Pubescentis Radix, 1 qian) Wu Jia Pi (Acanthopanacis Cortex, 3 qian) Zi Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma, 2 qian) Chuan Gui Zhi (Cinnamomi Ramulus, 4 fen) Sang Ji Sheng (Taxilli Caulis et Folium, 3 qian) Nen Sang Zhi (Mori Ramulus, tender, 4 qian) Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma, 5 fen) Xiao Huo Luo Dan (Small Activate Collaterals Pill, added to decoction, 1 pill) Huai Niu Xi (Achyranthis Bidentatae Radix, 2 qian)
Shen Zuo: Pulse is slippery and forceful; tongue coating is thin and greasy. Chest pain radiating to back, restless sleep. This is turbid phlegm accumulating in the chest causing Xiong Bi (chest obstruction). The chest is the mansion of clear yang, like the sun shining brightly, tolerating no dust. If turbid yin rises and obscures clear yang, the qi of Danzhong (chest center) becomes blocked and stagnant. The condition is lingering. Use Gua Lou Xie Bai Ban Xia Tang from *Jin Gui* plus modifications to open with pungent and lower with bitter, smoothing qi mechanism.
Gua Lou Pi (Trichosanthis Pericarpium, 4 qian) Xian Ban Xia (Pinelliae Tuber Prepared with Alum, 2 qian) Yun Fu Ling (Poria, 3 qian) Xie Bai Tou (Allii Macrostemonis Bulbus, wine-fried, 1.5 qian) Jiang Zhi Ke (Aurantii Fructus Immaturus, river variety, 1 qian) Guang Chen Pi (Citri Reticulatae Pericarpium, broad, 1 qian) Tong Ji Li (Tribuli Fructus, 3 qian) Guang Yu Jin (Curcumae Radix, broad, 1.5 qian)
Xie Zuo: Left shoulder/thigh bi pain has persisted for a long time. Continuous use of wind-dispelling agents yielded no change. Classics say: "Where evil gathers, qi is necessarily deficient." Qi and yin are both deficient; phlegm-dampness lingers in collaterals, disrupting ying-wei circulation. Prescribe Yu Ping Feng San plus modifications to tonify qi, nourish yin, resolve phlegm, and unblock collaterals.
Sheng Huang Qi (Astragali Radix, raw, 3 qian) Xi Sheng Di (Rehmanniae Radix Preparata, fine, 3 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 2 qian) Zhu Li Ban Xia (Pinelliae Tuber with Bamboo Juice, 2 qian) Qing Fang Feng (Saposhnikoviae Radix, 2 qian) Gan Ju Hua (Chrysanthemi Flos, sweet, 3 qian) Guang Chen Pi (Citri Reticulatae Pericarpium, broad, 1 qian) Chao Zhu Ru (Stir-fried Bambusae Caulis in Taenia, 2 qian) Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma, raw, 2 qian) Jing Xuan Shen (Scrophulariae Radix, capital, 2 qian) Wei Mu Xiang (Costi Radix, baked, 8 fen) Nen Sang Zhi (Mori Ramulus, tender, 4 qian) Da Di Long (Pheretima, washed with wine, 2 qian) Zhi Mi Fu Ling Wan (Point-Concerning Poria Pill, wrapped and decocted, 3 qian)
Qian Zuo: Initially chills and fever, then abdominal distension, right thigh soreness/pain extending to legs/feet, inability to move, scanty dark urine, dry hard stool, greasy yellow coating, soft-slippery-rapid pulse. Latent damp-heat pathogen with stagnation blocks Moyuan (semi-interior/exterior space), disrupting pivot mechanism, causing chills/fever. Jueyin rebellion, spleen fails transportation, yangming fails descending function, causing distension. Bi pain is due to wind-dampness. Disease in collaterals involves zang-fu, creating complications. Tentatively prescribe strengthening transportation and separating/dispersing, resolving dampness and unblocking collaterals, hoping for immediate effect!
Qing Shui Dou Juan (Phaseoli Tomentosus Caulis et Folium Purified with Water, 4 qian) Fu Ling Pi (Poria with Skin, 4 qian) Zhi Shi Tan (Immature Bitter Orange Fruit Charcoal, 1 qian) Nen Bai Wei (Cynanchi Stauntonii Radix, tender, 1.5 qian) Dong Gua Zi (Benincasae Semen, 3 qian) Tong Cao (Tetrapanacis Medulla, 8 fen) Quan Gua Lou (Trichosanthis Fructus, whole, cut, 4 qian) Yu Li Ren (Pruni Semen, ground, 3 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 1.5 qian) Da Ma Ren (Cannabis Seed, ground, 4 qian) Mu Fang Ji (Stephaniae Tetrandrae Radix, 2 qian) Fei Zhi Mu (Anemarrhenae Rhizoma, plump, 2 qian) Di Ku Luo (Petrosimoniae Fructus, 3 qian)
Second visit: Bowel movement passed, abdominal distension reduced. Poor appetite, thirst but little drinking, scanty dark urine, right thigh bi pain extending to legs/feet, difficult walking, thin greasy yellow coating, soft-rapid pulse. Yin fluids were originally deficient; damp-heat and qi stagnation block Moyuan. Liver fails free flow, spleen fails transportation, wind-dampness lingers in collaterals, ying-wei cannot circulate. Fear lingering worsening. Again prescribe strengthening transportation and separating/dispersing, resolving dampness and unblocking collaterals.
Qing Shui Dou Juan (Phaseoli Tomentosus Caulis et Folium Purified with Water, 3 qian) Lian Pi Ling (Poria with Skin, 4 qian) Zhi Shi Tan (Immature Bitter Orange Fruit Charcoal, 1 qian) Yi Yuan San (Benefit Origin Powder, wrapped, 3 qian) Tian Hua Fen (Trichosanthis Radix, 2 qian) Zhu Ling (Polyporus, 2 qian) Chen Guang Pi (Citri Reticulatae Pericarpium, aged, 1 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 2 qian) Sheng Shu Yi Ren (Coicis Semen, raw and cooked, 3 qian each) Tong Cao (Tetrapanacis Medulla, 8 fen) Da Fu Pi (Arecae Pericarpium, 3 qian) Di Ku Luo (Petrosimoniae Fructus, 3 qian) Xiao Wen Zhong Wan (Small Warm Middle Pill, swallowed, 1.5 qian) Dong Gua Pi (Benincasae Exocarpium, 3 qian)
Third visit: Bowel movement passed but loose; abdominal distension gradually subsiding; urination improved. Right thigh diffuse swelling, bi pain greatly lightened, only difficulty walking remains. Pulse deficient-wiry-rapid; tongue edges red, coating thin-greasy. Yin deficiency inherent; liver-spleen qi stagnation; damp-turbid qi condenses in Moyuan; phlegm-stasis in collaterals not cleared; ying-wei cannot circulate. Effective, do not change formula, stick to original intent with adjustments.
Chuan Shi Hu (Dendrobii Caulis, 3 qian) Xi Qin Jiao (Gentianae Macrophyllae Radix, 3 qian) Di Ku Luo (Petrosimoniae Fructus, 3 qian) Dong Gua Zi (Benincasae Semen, 3 qian) Lian Pi Ling (Poria with Skin, 4 qian) Chen Guang Pi (Citri Reticulatae Pericarpium, aged, 1 qian) Mu Fang Ji (Stephaniae Tetrandrae Radix, 2 qian) Chuan Niu Xi (Achyranthis Bidentatae Radix, 2 qian) Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma, raw, 1.5 qian) Da Fu Pi (Arecae Pericarpium, 2 qian) Zang Hong Hua (Crocus Stigma, Tibetan, 8 fen) Chao Yi Ren (Coicis Semen, stir-fried, 3 qian) Nen Sang Zhi (Mori Ramulus, tender, 3 qian)
Zhu Zuo: Pulse three positions wiry-small-rapid; right Cun choppy, Guan soft, Chi thin-rapid. Tongue coating greasy yellow. Symptoms: chest bi oppression, no appetite, frequent retching, internal heat with dry mouth but little drinking, ten days without bowel movement, scanty dark turbid urine, slightly yellow sclera, dull gray complexion. Due to early kidney yin deficiency, dampness suppressing heat, invading stomach and piercing diaphragm, stomach qi fails to descend. Pulse and symptoms combined indicate lingering condition. Yin injury cannot be treated with cloying tonics; dampness excess cannot be treated with drying herbs. Tentatively prescribe promoting qi and venting liver to unblock yangming, aromatic transformation of turbidity, and harmonizing pivot.
Gua Lou Pi (Trichosanthis Pericarpium, 3 qian) Chi Fu Ling (Red Poria, 3 qian) Jiang Zhi Shi (Immature Bitter Orange Fruit, river variety, 1 qian) Bi Qi Geng (Dioscoreae Hypoglaucae Caulis, 1.5 fen - *Note: Text says 1 qian 5 fen, likely typo in source or unit confusion, assuming 1.5 qian based on context*) Xie Bai Tou (Allii Macrostemonis Bulbus, wine-fried, 1 qian) Fu Ze Xie (Alismatis Rhizoma, 1.5 qian) Chao Zhu Ru (Stir-fried Bambusae Caulis in Taenia, 1.5 qian) Xian Pi Pa Ye (Fresh Loquat Leaf, 3 leaves) Mian Yin Chen (Artemisiae Scopariae Herba, cotton-like, 1.5 qian) Xian Ban Xia (Pinelliae Tuber Prepared with Alum, 2 qian) Tong Cao (Tetrapanacis Medulla, 8 fen) Yin Chai Hu (Stellariae Radix, 1 qian) Shui Chao Chuan Lian (Coptidis Rhizoma water-fried, 4 fen) Xian Huo Pei (Fresh Agastache/Patchouli Leaves, each 2 qian) Kuai Hua Shi (Talcum, lump, 3 qian)
Second visit: Pulse left three positions thin-small-wiry; right Cun choppy slightly harmonized, Guan soft, Chi thin. Tongue coating thin-greasy-yellow. Vomiting/retching reduced today, chest oppression persists, no desire to eat, dry mouth little drinking, ten days without stool, scanty dark turbid urine, slightly yellow sclera, facial dullness slightly improved. Shaoyin deficiency inherent; damp-heat with phlegm-stagnation blocks middle jiao; liver qi rebels horizontally; taiyin transportation abnormal; yangming descending failed. Yesterday's prescription promoting qi/venting liver/unblocking yangming/aromatic transformation/harmonizing pivot seemed appropriate. Continue original intent and expand.
Xian Ban Xia (Pinelliae Tuber Prepared with Alum, 2 qian) Chi Fu Ling (Red Poria, 3 qian) Yin Chai Hu (Stellariae Radix, 1 qian) Mian Yin Chen (Artemisiae Scopariae Herba, cotton-like, 1.5 qian) Shang Chuan Ya Lian (Coptidis Rhizoma, upper Sichuan elegant, 5 fen) Xian Huo Xiang Pei Lan (Fresh Agastache/Patchouli Leaves, each 2 qian) Guang Yu Jin (Curcumae Radix, broad, 1.5 qian) Jian Ze Xie (Alismatis Rhizoma, Jian variety, 1.5 qian) Gua Lou Pi (Trichosanthis Pericarpium, 3 qian) Chao Zhi Shi (Immature Bitter Orange Fruit, stir-fried, 1 qian) Sheng Shu Gu Ya (Raw/Cooked Hordeum Vulgare Sprout, each 3 qian) Xie Bai Tou (Allii Macrostemonis Bulbus, wine-fried, 1 qian) Kuai Hua Shi (Talcum, lump, 3 qian) Chao Zhu Ru (Stir-fried Bambusae Caulis in Taenia, 1.5 qian) Tong Cao (Tetrapanacis Medulla, 8 fen) Xian Pi Pa Ye (Fresh Loquat Leaf, de-hair/wrapped, 3 leaves) Xian He Geng (Nelumbinis Nelumbo, fresh, 1 chi)
Third visit: Retching stopped, damp-turbidity has downward trend, chest oppression slightly relieved, qi mechanism beginning to flow. Only poor appetite, dark turbid urine, thin yellow coating, right pulse soft...