饮邪之诊断，除上述主要症状而外，其脉象亦较特殊，痰、悬、溢、支四饮多以弦脉为据，而留饮则“脉沉”。至于饮证之治疗，仲景示其大法曰：“病痰饮者，当以温药和之”。
余临证所见饮邪为患诸证，其症状、脉象之辨别，不离于仲景，亦不尽拘于仲景。今举饮蓄中焦一例以作说明。(饮在上焦者见小青龙汤治咳喘条)
干部宋某，男，年逾知命，形极肥胖。于1976年4月初来诊。据云病起于二月之前，中脘胀满，心胸瞀闷异常。须不时以手抚摩，仍觉终日不适。饱餐后胀满略有增加，并不疼痛。切其脉，沉而细。先哲每谓瘦人多火，肥人多痰多湿，亦多气虚。姑从虚胀立论，投香砂六君汤，三剂未验。余反复推究其病情原委：得食则胀满有加者，非虚证，乃实象也；触按患处不适反甚者，亦非虚证而是实象也；服健脾运中之剂不见好转者，更非虚证之征也。复为细检，脘中虽满，而按之仍软，亦不见有积块；饮食能进，不见阻碍，胃中必非有形之物，疑是痰饮为患。疏平陈汤加生姜。方为：
厚朴9g制苍术9g陈皮6g炙甘草3g半夏9g茯苓9g生姜三片服一帖后，脘中大舒。晚间兴至，抱孙看戏，胃部久受压迫，又觉难受。次日复来询问，嘱原方再进，服至第二帖，脘中攻撑作胀，泛泛欲吐。移时竟得大吐，吐出水液半面盆，不杂食物。心中惧甚，速往区中心医院急诊，因已无症状可见，仅予注射葡萄糖一支，嘱回家休息。一宵后自觉脘中异常舒适，通体轻快，即放弃病假继续上班。复以健脾和胃之剂以善其后，直至退休后病逝，将近二十年病未再作。
按：患者呕吐痰饮之前日，余曾诊其脉。原本沉细之中，却见左寸关浮滑，一时不解其意。其实饮邪已有上逆、外行之势，是故阳脉既浮且滑也。患者饮踞胃腑，理当胃气逆上而后呕吐随之，脉象之预兆，亦应见于胃部方是，何以见于左手寸关?夫左关乃肝胆之位，脉由沉细而变浮滑，是少阳胆气受药物冲动，发越而逆行向上所致。土受木制，胆木逆甚则胃气随之。故由胆气先逆而随之以呕吐，饮邪吐去则胃脘畅达，木气舒展而病愈矣。
肝炎杂说
肝炎之病无论属于何证，多与湿浊内蕴相关。故其治疗，亦无不以理湿为之重点。有症状不明显，由化验而确诊之肝炎患者，四诊亦无明显湿浊见征，以清化湿热为治多能获效。
此症西医名日肝炎，而中医定其病位不全在肝。其中黄疸型者与肝胆关系较为密切，明代《景岳全书》“黄疸”篇中已云：“胆伤则胆气败，而胆液泄，故为此证。”已初识黄疸与肝胆损害有关。
无黄疸型所蕴湿浊，虽亦不离于肝，然多关乎脾胃。《内经》论脾胃之生理功能曰：“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱。”则脾胃为人体水液代谢之关键脏器。若脾胃运化水湿之功能稍有障碍，于氤氲弥漫之湿浊不能廓清时，则易敛本病。故余治肝炎，除急性期湿热较盛者及不宜健脾者外，于辨证方中均加白术，脾胃健运则湿浊易化，湿浊化尽则肝复其常矣。且仲圣曰：“见肝之病，知肝传脾，当先实脾。”而张景岳之见解更为直捷：“肝脾俱实，单平肝气可也；肝强脾弱，舍肝而救脾可也。”此法对于甲型慢迁肝而现中气不足者更为有效。中气虚甚者，党参、黄芪、苡仁、扁豆之属亦可酌情加入，无须过虑“湿热不可补”之说。盖此时虽有湿邪留着，已是“强弩之末”，难穿鲁缟矣。正须扶其正气，以除余邪。倘患者中土犹健，而气血阴阳有所不足，或肝肾心肺功能有亏，亦宜于辨证方中参入相关调理之品。经曰：正气存内，邪不可干，犹此之谓也。
姜春华老师生前曾授余治慢性肝炎恢复转氨酶方，药物甚简，仅七味：
师嘱曰：连服2～3月，转氨酶渐可复常。
初得此方余未着意，至八十年代初有卫姓干部前来咨询，谓其子两年前高中毕业，报考大学成绩合格，不意体检时查得GPT高达100以上，昔年曾患肝炎，当时已经治愈，后未复查。由是名落孙山，不得不边服药，边复习，边打工。一年后再度报考，成绩确佳，体检又因GPT升高被黜。及至第三年离高考仅有一月时，先自行至医院化验，GPT为70u以上，其父急来商治。当时余未见患者，无法面诊，询知肝功能化验时除GPT以外，其余项目基本正常。患者体力尚可，三年来打工不辍，有时稍感疲劳而已，并无其他见症。余思患者病已多年，惟姜老师此方最为合拍。方中垂盆单、田基黄、白花蛇舌草，均具化湿清热、恢复肝功能之功。久病肝炎中气必亏，肝肾易伤，党参、太子参、黄芪、杞子以益气健脾、滋养肝肾。全方扶正祛邪、虚实兼顾，可谓的对之良方。于是录方与之。一星期后其父来告：GPT已降至50余。又一周降至40余，第三周恢复正常。患者坚持服药至高考体验时，顺利通过化验关，高榜题名而得遂升学之愿。
由此病例治疗得效，余始识此方看似寻常实非寻常，以后用治慢性肝炎多节节应手，故告之同好。
大柴胡汤出《伤寒论》，为治少阳阳明兼病之方。当今辨证治疗胆道疾患如胆囊炎、胆结石、胆道蛔虫症等，每收捷效。肝胆相为表里，甲胆乙肝同属于木，不仅于病理上可互相影响，且治法与谴方用药亦多相通之处。如大柴胡汤治黄疸肝炎，其利胆退黄之力恒在诸方之上。乃因黄疸肝炎不仅热郁肝胆，且兼肠胃湿浊蕴结。木士同病。或竟缘脾胃湿热、熏蒸肝胆，反侮其所不胜而成病，故治法亦宜兼顾肝胆脾胃，既行清肝解郁，亦泻阳明里实。据于此种机理，则大柴胡汤自属不易之方。
余治陈媪，曾患无黄疸型肝炎，经西医治后因症状消失，遂不介意。越数年忽发黄疸，全身色黄如染柏汁，急送某医院，入院仅数日即通知出院。于是转入专科医院，化验血清胆红素为567μmol／L，GPT150u／ml(其余化验数据不详)，该院诊断为阻塞性黄疸肝炎。经用多种最新高效药物及激素，黄疸持续不下。病房主任谓乃夫曰：“进来容易出去难，生还希望仅50％。”佣工为其擦身，盆水色呈深黄，家属深为忧虑到处奔走求治。得余友人之助，一再强余为治。余允勉为尽力，未许必效。诊见患者全身肤色金黄，神疲乏力，愠愠泛恶，胃纳尚可而脘腹不舒，头痛心烦，右胁痞满，大便数日一行，情绪压抑，畏恐特甚。左脉大而兼迟涩，右脉按之软，舌淡苔白而干，中心至舌根呈灰黑色。据此脉证为肝胆湿热蕴结，疏泄之令不行，以致肝郁气滞，犯胃则脘胀便秘，侵脾则中气消损，运化失健。治法当疏肝清热、利湿消黄、兼益气扶中、健脾化浊。拟大柴胡汤加减。方为：
生黄芪15g太子参9g柴胡9g生大黄6g(后下)赤芍9g炒枳实9g姜半夏9g郁金9g茵陈30g厚朴6g黄芩9g白英30g
上方服6贴后血清胆红素由567下降至480。皮肤黄染明显消退，眼结膜黄色消退过半。胃纳转佳，精神愉悦，舌上灰黑之苔亦除。惟上下腹胀满不适。在上方中加入莱菔子、苏梗、山豆根(9g)等，服7帖后胆红素下降203。但见两手振颤难以持物，于原方中减去山豆根，振颤即止。以后随证加减，服16帖胆红素降至9r7，以后逐渐下降。
患者于治疗期间曾出现较为严重之中枢神经症状，头痛、失眠、心烦易怒、惊恐畏惧，甚至闻及雷声而钻入床下。因而不得不更方予服数周。神经症状控制后，右眼球结膜充血严重，又经三星期始得渐消。黄疸消退后胃纳极佳，难免进食海鲜，致化验数据曾多次波动于正常值上下。总之该患者之治疗颇费周折，方药之中大黄有斩关夺隘之应，药后大便日行二、三次，成形而质软，通畅无阻，则自觉胸腹宽转，舒适异常，一日不便则腹中闷瞀。曾有一度大黄用至9g也不更衣，不得已加芒硝1．5g冲服，大便即畅，如芒硝加至3g则觉腹痛。
山豆根一药，医刊报道加入对证方中消除黄疸极有效用。本例患者两次加用皆见大效，然两次均见双手振颤，停用后振颤即止，其中原因尚待探索。此外，方中白英不惟清热解毒，亦擅利胆退黄。
四、草药治肝病
俗语云“草药一味，气死名医”，草头方药简效宏者真有不可思议之妙。《本草推陈》载有治肝炎方，仅用神仙对坐草、三白草、积雪草三物。因余习惯使用传统中药，此方虽屡见之而终不曾用。
今年元旦甫过，有某单位孙科长之子忽患肝炎，GPT329，γ一谷氨酰转肽酶155(正常值为0～50)。总胆红质20，二对半化验中三个阳性：表面抗原、e抗原和c抗体均为阳性。孙科长家境清寒，爱子而立之年尚无正式工作，因而用药务求效高价廉，余即思及上方，三白草药店无货，改用垂盆草，更加茵陈、平地木、方为：
平地木20g
服药3剂复查GPT71，γ-谷氨酰转肽酶77，其余项目均已正常。又服10剂，再次复查，所有化验项目全部正常。患者脉略弦，舌偏红，苔则薄白。即于原方加生地12g、麦门冬9g嘱服一周以资巩固，从此竟愈。
五、茵陈四苓散的应用
传统中医治黄疸，有通利大小便之法，已早为医家所习用。仲景之茵陈蒿汤为化湿祛浊之代表方剂，现制成“茵栀黄”成药，于甲肝流行期间业已建立功勋，蜚声医林矣。至于利尿祛湿以治肝炎之代表方，可借用仲景之五苓散加茵陈，热重者去桂枝之温热，即用茵陈四苓散也。据三十年代太仓名医王雨三汝霖氏之经验，用此方之指征，须见“身热口渴，小便赤涩，左脉沉弦者”始为合辙
余于1989年夏诊一高中男学生，于大考后即得甲肝，自觉倦怠纳差，小便色黄如染，其区中心医院嘱其住院治疗三个月，而其暑假仅四十天，为不影响学业谢绝住院，至余处门诊，并要求于暑期内将其治愈。余诊其脉恰巧左脉沉弦，但无身热之象，故去桂枝，仅投茵陈四苓汤方，药仅五味，服及一周，体力复原，小便转清，服三十剂复查，肝功能恢复正常，后即安然无恙。
六、慢性肝炎的治疗
慢性肝炎病人，可见肝肾阴虚兼以湿浊留滞，故治法亦须兼顾，既护肝肾之阴以固其本，又祛湿浊之邪以除其标，本固标清，病多可愈。然育阴祛湿之方王道无近功，不可急于求成，但使药病相当，久服自效。
余治盛女士，年仅三十又三。于1987年2月生育后即患肝炎，GPT200u以上，经住院治疗三月后降至正常。而其余化验指标几乎全部失常，医嘱长服益肝灵及维生素E，迁延两年，病情依旧，屡欲复工而不能。1989年3月27日余处初诊。自诉患病二年，两胁之痛缠绵不已，夜寐则盗汗淋漓；梦扰纷纭；白昼，巅顶及两太阳穴疼痛常作，夜间则疼痛转向心口；体倦乏力，口干饮水不解，胃纳极差；大便干结艰涩，非服通便之药不能行；月经数月未至；面色灰黄，呈明显慢性病容。脉左小弦带滑，右脉细软。舌偏红，苔薄而腻。据此脉证，为湿热郁于中土脾胃，反侮其所不胜，致肝木受殃，湿热久蕴伤及肝肾阴分，遂至调治两难。盖纳差、便结、面浊、苔腻，均为湿热蕴蓄中焦使然。而胁痛、盗汗、头疼、舌边色红，为肝胆湿热之象。体倦、口干、经汛衍度，乃属肝肾阴亏。至于脉象，右脉细软为痰饮湿浊留蓄肠胃，左脉小弦为肝肾阴虚内热，弦滑为痰热，于此则主湿热伤肝。及其治法，当以芳化湿浊与育阴护肝并重。拟方苡仁、茯苓、佩兰、川朴花、蔻仁、半夏以芳香化湿兼扶脾胃；以石斛、女贞、鳖甲、牡蛎养阴护肝，合郁金、川楝子软坚散结、疏肝解郁。其方即为：
佩兰12g生炒米仁各15g茯苓15g川朴花3g蔻仁3g半夏9g石斛12g炙鳖甲15g(先)生牡蛎30g(先)女贞子12g川楝子9g郁金9g
以上方加减先后服用五十余剂，诸症递解。肝功能化验多次正常，遂于六月上班复工，随访四年未有反复。
七、肝病胁胀的治疗
Diagnosis of Yin Pathogen (Fluid Retention): In addition to the aforementioned main symptoms, the pulse is also relatively special. The four types of fluid retention—Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging-Fluid), Yi Yin (Overflowing-Fluid), and Zhi Yin (Supporting-Fluid)—are mostly based on a Wiry Pulse (Xian Mai). However, Liu Yin (Stagnant-Fluid) presents with a "Deep Pulse" (Chen Mai). Regarding the treatment of Fluid Retention diseases, Zhang Zhongjing proposed the general principle: "For diseases of Phlegm-Fluid, one should use warm herbs to harmonize."
In my clinical practice, the differentiation of symptoms and pulses for various conditions caused by the Yin Pathogen neither departs from Zhang Zhongjing's theories nor strictly adheres to them. I will now illustrate this with a case of fluid accumulation in the Middle Jiao (Middle Burner). (For fluid retention in the Upper Jiao, see the section on Xiao Qing Long Tang treating cough and asthma.)
Patient Song, a cadre, male, over 50 years old, extremely obese. He presented for consultation in early April 1976. He reported that the illness began two months prior, characterized by distension in the Zhongwan region (CV12) and extreme mental oppression and confusion in the chest and heart. He felt compelled to constantly rub the area with his hands but still felt uncomfortable all day long. The distension increased slightly after full meals, but there was no pain. Palpation revealed a Deep and Fine Pulse. Ancients often stated that thin people tend to have excess Fire, while fat people tend to have Phlegm and Dampness, as well as Qi Deficiency. Tentatively diagnosing this as Distension due to Deficiency, I prescribed Xiang Sha Liu Jun Tang (Aromatic and Amomum Six Gentlemen Decoction). After three doses, there was no improvement. I repeatedly analyzed the origin of the condition: Distension worsening after eating indicates not Deficiency, but Excess; discomfort worsening upon palpation indicates not Deficiency, but Excess; lack of improvement after taking herbs to strengthen the Spleen and promote transformation indicates further evidence against Deficiency. Upon re-examination, although the epigastrium was full, it remained soft upon pressure, with no masses detected; food intake was unobstructed, suggesting no tangible solid matter in the Stomach. I suspected Phlegm-Fluid pathology. I prescribed Ping Chen Tang (Level the Aged Decoction) plus fresh ginger. The formula consisted of:
Hou Po (Magnolia Bark) 9g, Zhi Cang Zhu (Processed Atractylodes Rhizome) 9g, Chen Pi (Tangerine Peel) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 3g, Ban Xia (Pinellia Tuber) 9g, Fu Ling (Poria) 9g, Sheng Jiang (Fresh Ginger) 3 slices.
After one dose, the patient experienced significant relief in the epigastrium. That evening, feeling energetic, he held his grandson and went to watch a play. The prolonged compression on his stomach caused discomfort again. He returned the next day for inquiry. I advised continuing the original prescription. After the second dose, the epigastrium felt distended and pressing, accompanied by nausea. Shortly after, he vomited profusely, expelling half a basin of clear fluid without any food particles. Fearing greatly, he rushed to the emergency department of the District Central Hospital. As no obvious symptoms were present at that moment, he was given only one injection of glucose and instructed to rest at home. Overnight, he felt exceptionally comfortable in his epigastrium and light throughout his body, so he abandoned his sick leave and resumed work. Subsequently, he took herbs to strengthen the Spleen and harmonize the Stomach to conclude the treatment. Until his death after retirement, nearly twenty years passed without recurrence.
Commentary: The day before the patient vomited the Phlegm-Fluid, I palpated his pulse. Amidst the originally Deep and Fine quality, a Floating and Slippery quality appeared at the Left Cun and Guan positions. At the time, I did not fully understand its meaning. Actually, the Yin Pathogen had already shown a tendency to move upward and outward, hence the Yang pulses were both Floating and Slippery. With fluid stagnating in the Stomach, it is logical for Stomach Qi to rebel upward leading to vomiting, and the pulse indication should theoretically appear at the Stomach position. Why did it appear at the Left Cun and Guan? The Left Guan position corresponds to the Liver and Gallbladder. The change from Deep/Fine to Floating/Slippery indicated that the Shaoyang Gallbladder Qi was stimulated by the medication, causing it to surge and reverse upward. Wood controlling Earth: when Gallbladder Wood rebels severely, Stomach Qi follows. Thus, the rebellion of Gallbladder Qi preceded the vomiting. Once the fluid was expelled, the epigastrium became clear, Wood Qi舒展 (smoothly extended), and the disease resolved.
Miscellaneous Notes on Hepatitis
I. Traditional Chinese Medicine Believes Hepatitis is Mostly Related to Internal Accumulation of Turbid Dampness
Regardless of the syndrome type, hepatitis is mostly related to the internal accumulation of turbid dampness. Therefore, treatment invariably focuses on resolving dampness. Some patients with hepatitis diagnosed via laboratory tests show no obvious signs of turbid dampness in the Four Diagnostic Methods, yet clearing and transforming damp-heat often yields effective results.
While Western medicine names this condition "hepatitis," TCM does not locate the disease site solely in the Liver. Among these, the jaundice type is closely related to the Liver and Gallbladder. Ming Dynasty's *Jing Yue Quan Shu* (Complete Works of Jingyue), in the "Jaundice" chapter, states: "If the Gallbladder is injured, its Qi fails, and bile leaks out, thus causing this condition." This shows an early recognition of the relationship between jaundice and Liver/Gallbladder damage.
For non-jaundice types, although the accumulated turbid dampness is not unrelated to the Liver, it is more closely concerned with the Spleen and Stomach. *Nei Jing* (Inner Canon) discusses the physiological functions of the Spleen and Stomach: "When drink enters the Stomach, its essence floats and overflows, moving up to the Spleen; the Spleen disperses the essence, sending it up to the Lungs; [the Lungs] regulate the water passages, sending it down to the Bladder." Thus, the Spleen and Stomach are key organs in the body's water metabolism. If the Spleen and Stomach's function of transporting and transforming water-dampness is slightly impaired, and they cannot clear the pervasive turbid dampness, it easily leads to this disease. Therefore, in my treatment of hepatitis, except for cases in the acute phase with severe damp-heat or those unsuitable for strengthening the Spleen, I always add Bai Zhu (Atractylodes Macrocephala Rhizome) to the syndrome-based formulas. When the Spleen and Stomach transport and transform effectively, turbid dampness is easily resolved; once the dampness is cleared, the Liver returns to normal. Furthermore, Zhang Zhongjing said: "When seeing Liver disease, knowing that the Liver transmits to the Spleen, one should first solidify the Spleen." Zhang Jingyue's view is even more direct: "If both Liver and Spleen are Excess, calming Liver Qi alone suffices; if Liver is Strong and Spleen is Weak, abandon the Liver and rescue the Spleen." This method is particularly effective for chronic persistent Hepatitis A presenting with Middle Qi Deficiency. For severe Middle Qi Deficiency, Dang Shen (Codonopsis Root), Huang Qi (Astragalus Root), Yi Yi Ren (Coix Seed), and Bian Dou (Lablab Bean) can be added酌情 (as appropriate), without excessive worry about the saying "damp-heat cannot be tonified." At this stage, although damp pathogenic factors remain, they are like "an arrow at the end of its flight," unable to penetrate fine silk. It is precisely then that one must support Righteous Qi to eliminate residual pathogens. If the patient's Middle Earth is still robust but there is insufficiency in Qi, Blood, Yin, or Yang, or deficiencies in Liver, Kidney, Heart, Lung, or Heart functions, it is appropriate to incorporate relevant regulating items into the syndrome-based formula. The Classics state: "When Righteous Qi exists within, pathogens cannot invade," which refers to this principle.
II. Teacher Jiang Chunhua's Formula for Restoring Transaminases in Chronic Hepatitis
Teacher Jiang Chunhua once taught me a formula for restoring transaminases in chronic hepatitis. The drugs were very simple, consisting of only seven ingredients:
Dang Shen (Codonopsis Root), Tai Zi Shen (Pseudostellaria Root), Huang Qi (Astragalus Root), Qi Zi (Goji Berry), Chui Pen Cao (Sedum Sarmentosum Herb), Tian Ji Huang (Picria Fel-Terrae Herb), Bai Hua She She Cao (Hedyotis Diffusa Herb).
The teacher instructed: Take continuously for 2–3 months, and transaminases will gradually return to normal.
Initially, I did not pay much attention to this formula. In the early 1980s, a cadre surnamed Wei consulted me. His son had graduated from high school two years prior, qualified for university admission, but during the physical examination, his GPT (Alanine Aminotransferase) was found to be over 100. He had suffered from hepatitis in previous years, which was cured at the time, but he had not rechecked afterward. Consequently, he failed to enter university and had to take medicine, study, and work part-time simultaneously. One year later, he applied again, performed excellently, but was rejected again due to elevated GPT. By the third year, only one month before the college entrance exam, he tested himself at a hospital, finding GPT above 70u. His father urgently came to discuss treatment. At that time, I had not seen the patient and could not conduct a face-to-face consultation. Inquiry revealed that besides GPT, other liver function test items were basically normal. The patient's physical strength was acceptable; he had worked continuously for three years, feeling only slight fatigue occasionally, with no other symptoms. I thought the patient had been ill for many years, and only Teacher Jiang's formula fit best. In the formula, Chui Pen Cao, Tian Ji Huang, and Bai Hua She She Cao all possess the functions of resolving dampness, clearing heat, and restoring liver function. Chronic hepatitis inevitably depletes Middle Qi and injures the Liver and Kidneys; Dang Shen, Tai Zi Shen, Huang Qi, and Qi Zi are used to benefit Qi, strengthen the Spleen, and nourish the Liver and Kidneys. The entire formula supports Righteous Qi and eliminates pathogens, addressing both Deficiency and Excess, making it an excellent specific formula. I copied the prescription for him. One week later, his father reported: GPT had dropped to over 50. Another week later, it dropped to over 40, and in the third week, it returned to normal. The patient persisted in taking the medicine until the college entrance exam physical, passing the lab tests smoothly, achieving success in the exams and fulfilling his wish to pursue higher education.
From the effectiveness of this case, I realized this formula seemed ordinary but was truly extraordinary. Thereafter, using it for chronic hepatitis yielded consistent results, so I shared it with colleagues.
III. Da Chai Hu Tang Treating Jaundice Hepatitis
Da Chai Hu Tang (Major Bupleurum Decoction) originates from *Shang Han Lun* (Treatise on Cold Damage Disorders) and is a formula for treating concurrent Shaoyang and Yangming diseases. In contemporary syndrome differentiation, it often achieves rapid results in treating biliary tract diseases such as cholecystitis, gallstones, and biliary ascariasis. The Liver and Gallbladder are interior-exterior partners; Gallbladder (Jia) and Liver (Yi) both belong to Wood. Not only do they influence each other pathologically, but their treatment methods and prescription choices also share similarities. For instance, Da Chai Hu Tang treats jaundice hepatitis with a gallbladder-promoting and jaundice-resolving power superior to most other formulas. This is because jaundice hepatitis involves not only heat stagnation in the Liver and Gallbladder but also accumulation of intestinal and gastric turbid dampness. Wood and Earth diseases coexist. Or, it may arise from Spleen-Stomach damp-heat steaming and steaming the Liver and Gallbladder, counter-rebelling against what it cannot overcome, causing disease. Therefore, the treatment method should also consider both Liver-Gallbladder and Spleen-Stomach, performing Liver-clearing and depression-resolving actions while purging Yangming interior excess. Based on this mechanism, Da Chai Hu Tang is undoubtedly a suitable formula.
I treated an elderly woman, Mrs. Chen, who had previously suffered from non-jaundice hepatitis. After Western medical treatment eliminated her symptoms, she neglected it. Several years later, jaundice suddenly appeared. Her whole body turned yellow like dyed cypress juice. She was rushed to a certain hospital but was discharged after just a few days. She then transferred to a specialized hospital. Laboratory tests showed serum bilirubin at 567 μmol/L and GPT at 150 u/ml (other data unknown). The hospital diagnosed obstructive jaundice hepatitis. Despite using various latest high-efficiency drugs and hormones, the jaundice persisted. The ward director told her husband, "It is easy to get in but hard to get out; the hope of survival is only 50%." The maid's bathwater for wiping her body was deep yellow. The family was deeply worried and sought treatment everywhere. With the help of a friend, they repeatedly urged me to treat her. I agreed to try my best but did not promise efficacy. Examination revealed the patient's skin was golden yellow, spirit was fatigued, she felt mild nausea, appetite was acceptable but epigastric-abdominal discomfort existed, headache and irritability were present, right hypochondriac fullness occurred, bowel movements happened once every few days, mood was depressed, and fear was extreme. The Left Pulse was Large with Slowness and Choppy qualities; the Right Pulse was Soft upon pressure. The tongue was pale with dry white coating, turning gray-black from the center to the root. Based on these pulse and symptom patterns, it was determined to be Liver-Gallbladder damp-heat accumulation, failure of dispersion and descent, leading to Liver Qi stagnation. Invading the Stomach caused epigastric distension and constipation; invading the Spleen depleted Middle Qi and impaired transformation. The treatment method should soothe the Liver, clear heat, resolve dampness to reduce jaundice, concurrently boost Qi and support the Middle, and strengthen the Spleen to transform turbidity. I modified Da Chai Hu Tang. The formula was:
Sheng Huang Qi (Raw Astragalus Root) 15g, Tai Zi Shen (Pseudostellaria Root) 9g, Chai Hu (Bupleurum Root) 9g, Sheng Da Huang (Raw Rhubarb Root) 6g (added later), Chi Shao (Red Peony Root) 9g, Chao Zhi Shi (Fried Immature Bitter Orange) 9g, Jiang Ban Xia (Ginger-processed Pinellia Tuber) 9g, Yu Jin (Curcuma Tuber) 9g, Yin Chen (Artemisia Capillaris Herb) 30g, Hou Po (Magnolia Bark) 6g, Huang Qin (Scutellaria Root) 9g, Bai Ying (Solanae Caulis) 30g.
After taking 6 doses of the above formula, serum bilirubin decreased from 567 to 480. Skin jaundice faded significantly, and scleral yellowing reduced by more than half. Appetite improved, spirits lifted, and the gray-black coating on the tongue disappeared. Only upper and lower abdominal distension and discomfort remained. Radish seed, Perilla stem, and Shan Dou Gen (Sophora Tonkinensis Root Bark, 9g) were added to the original formula. After 7 doses, bilirubin dropped by 203. However, tremors in both hands made holding objects difficult. Shan Dou Gen was removed from the original formula, and the tremors stopped. Subsequent modifications led to bilirubin dropping to 97 after 16 doses, followed by gradual decline.
During treatment, the patient experienced relatively severe central nervous system symptoms: headache, insomnia, irritability, panic, and fear, even hiding under the bed upon hearing thunder. The formula had to be changed for several weeks. After neurological symptoms were controlled, severe congestion of the right eyeball conjunctiva occurred, taking another three weeks to subside. After jaundice resolution, appetite was excellent. Seafood consumption inevitably caused fluctuations in lab data around normal values. In summary, the treatment of this patient was quite tortuous. In the formula, Da Huang (Rhubarb) has the effect of breaking through barriers. After administration, bowel movements occurred twice or thrice daily, formed and soft, smooth and unobstructed, resulting in a sensation of chest and abdomen expansion and exceptional comfort. If no bowel movement occurred for a day, the abdomen felt stuffy and confused. At one point, Da Huang was increased to 9g without inducing defecation. Mang Xiao (Mirabilite) 1.5g was added and taken in solution, resulting in smooth defecation. If Mang Xiao was increased to 3g, abdominal pain was felt.
Shan Dou Gen, a single herb, has been reported in medical journals to be extremely effective in eliminating jaundice when added to appropriate formulas. In this case, adding it twice yielded great effects, but both times hand tremors occurred. Tremors ceased upon discontinuation. The reason remains to be explored. Additionally, Bai Ying in the formula not only clears heat and detoxifies but is also proficient in promoting bile flow and resolving jaundice.
IV. Herbal Remedies for Liver Diseases
The proverb says, "One herbal remedy can make famous doctors furious." Grass-head prescriptions with simple ingredients and profound effects truly possess miraculous properties. *Ben Cao Tui Chen* records a hepatitis formula using only Shen Xian Dui Zuo Cao (Centella Asiatica Herb), San Bai Cao (Houttuynia Cordata Herb), and Ji Xue Cao (Centella Asiatica Herb). Since I am accustomed to using traditional Chinese medicines, although I saw this formula frequently, I never used it.
Shortly after New Year's Day this year, the son of Section Chief Sun from a certain unit suddenly contracted hepatitis. GPT was 329, γ-glutamyl transferase was 155 (normal range 0–50). Total bilirubin was 20. Three markers were positive in the "Two-and-a-Half" panel: surface antigen, e-antigen, and core antibody. Section Chief Sun's family was poor, and his son, in his thirties, had no formal job. Therefore, drug treatment needed to be highly effective and low-cost. I recalled the aforementioned formula. Since San Bai Cao was unavailable at the pharmacy, I substituted Chui Pen Cao (Sedum Sarmentosum Herb) and added Yin Chen (Artemisia Capillaris Herb) and Ping Di Mu (Liquidambar Formosana Tree). The formula was:
Shen Xian Dui Zuo Cao 30g, Chui Pen Cao 20g, Ji Xue Cao 20g, Yin Chen 20g, Ping Di Mu 20g.
After 3 doses, recheck showed GPT 71, γ-glutamyl transferase 77, and other items normal. After another 10 doses, recheck showed all lab items normal. The patient's pulse was slightly wiry, tongue slightly red, coating thin and white. Sheng Di Huang (Rehmannia Root) 12g and Mai Men Dong (Ophiopogon Tuber) 9g were added to the original formula, instructed to take for one week for consolidation. From then on, he was completely cured.
V. Application of Yin Chen Si Ling San
Traditional Chinese Medicine treats jaundice by promoting urination and defecation, a method long practiced by physicians. Zhang Zhongjing's Yin Chen Hao Tang (Artemisia Capillaris and Barley Decoction) is a representative formula for resolving dampness and removing turbidity. It is now produced as "Yin Zhi Huang" patent medicine, having established merit during the Hepatitis A epidemic and gaining fame in the medical community. As for the representative formula for diuresis and dampness resolution to treat hepatitis, one can borrow Zhang Zhongjing's Wu Ling San (Five Ingredient Powder with Poria) plus Yin Chen. For severe heat, remove the warming property of Gui Zhi (Cinnamon Twig), resulting in Yin Chen Si Ling San. According to the experience of Wang Yusan Rulin, a famous physician from Taicang in the 1930s, the indications for using this formula require seeing "body heat, thirst, red and scanty urine, and a Deep-Wiry Left Pulse" to be appropriate.
In summer 1989, I treated a high school male student who contracted Hepatitis A immediately after final exams. He felt fatigued with poor appetite, and his urine was yellow like dye. The District Central Hospital advised three months of hospitalization, but his summer vacation was only forty days. To avoid affecting his studies, he declined hospitalization and came to my outpatient clinic, requesting a cure within the summer vacation. My palpation coincidentally revealed a Deep-Wiry Left Pulse, but no body heat. Thus, I removed Gui Zhi and prescribed only Yin Chen Si Ling Tang (Decoction). The medicine consisted of only five ingredients. After one week, physical strength recovered, and urine cleared. After thirty doses, recheck showed normal liver function, and he remained healthy thereafter.
VI. Treatment of Chronic Hepatitis
Patients with chronic hepatitis often present with Liver-Kidney Yin Deficiency combined with stagnant turbid dampness. Therefore, treatment must address both: protecting Liver-Kidney Yin to secure the root, and eliminating turbid dampness pathogens to clear the branch. When the root is secured and the branch cleared, the disease often resolves. However, formulas that nourish Yin and resolve dampness follow the "King's Way" (gentle approach) without quick results. One must not seek immediate success. As long as the medicine matches the disease, long-term use will yield effects.
I treated Ms. Sheng, aged 33. She developed hepatitis after giving birth in February 1987. GPT was over 200u. After three months of hospitalization, it dropped to normal. However, almost all other lab indicators remained abnormal. Medical advice was to take Yi Gan Ling (Essential Phospholipids) and Vitamin E long-term. Two years passed, the condition remained unchanged, and repeated attempts to return to work failed. On March 27, 1989, she first consulted me. She reported being ill for two years, with lingering pain in both hypochondriac regions, drenching night sweats during sleep, and frequent disturbing dreams. During the day, pain frequently occurred at the vertex and bilateral temporal arteries; at night, the pain shifted to the heart region. She felt tired and weak, dry mouth unrelieved by drinking, extremely poor appetite, dry and difficult stools requiring laxatives, amenorrhea for several months, grayish-yellow complexion indicating obvious chronic disease appearance. The Left Pulse was Small, Wiry, and Slippery; the Right Pulse was Fine and Soft. The tongue was slightly red with thin, greasy coating. Based on these pulse and symptom patterns, it was determined that damp-heat was stagnating in the Middle Earth (Spleen-Stomach), counter-rebelling against what it cannot overcome, causing harm to Liver Wood. Long-standing damp-heat injury affected Liver-Kidney Yin, making regulation difficult. Poor appetite, constipation, turbid complexion, and greasy coating were all due to damp-heat accumulating in the Middle Jiao. Hypochondriac pain, night sweats, headache, and red tongue edges were signs of Liver-Gallbladder damp-heat. Fatigue, dry mouth, and delayed menstruation belonged to Liver-Kidney Yin Deficiency. Regarding the pulse, the Right Fine-Soft pulse indicated Phlegm-Fluid and turbid dampness stagnating in the intestines and stomach; the Left Small-Wiry pulse indicated Liver-Kidney Yin Deficiency with internal heat; Wiry-Slippery indicated Phlegm-Heat. Here, it primarily indicated damp-heat injuring the Liver. The treatment method should prioritize aromatic transformation of turbid dampness and nourishing Yin to protect the Liver equally. I prescribed Yi Yi Ren (Coix Seed), Fu Ling (Poria), Pei Lan (Eupatorium Leaf), Chuan Pu Hua (Magnolia Flower), Kou Ren (Amomum Fruit), and Ban Xia (Pinellia Tuber) to aromatically transform dampness and support the Spleen-Stomach; Shi Hu (Dendrobium Stem), Nu Zhen Zi (Ligustrum Fruit), Bie Jia (Turtle Shell), and Mu Li (Oyster Shell) to nourish Yin and protect the Liver, combined with Yu Jin (Curcuma Tuber) and Chuan Lian Zi (Melia Fruit) to soften hardness, dissipate nodules, soothe the Liver, and relieve depression. The formula was:
Pei Lan 12g, Raw and Fried Yi Yi Ren 15g each, Fu Ling 15g, Chuan Pu Hua 3g, Kou Ren 3g, Ban Xia 9g, Shi Hu 12g, Zhi Bie Jia 15g (decocted first), Sheng Mu Li 30g (decocted first), Nu Zhen Zi 12g, Chuan Lian Zi 9g, Yu Jin 9g.
Modifying the above formula, she took over fifty doses in total, and all symptoms gradually resolved. Liver function tests were normal multiple times. She returned to work in June. Follow-up for four years showed no recurrence.
VII. Treatment of Hypochondriac Distension in Liver Diseases