一日，读《医旨绪余》有关“胁痛”条，思索之间，猛然省悟。书中所叙胁痛之状，实带状疱疹无疑。其文曰：其弟“忽左胁痛，皮肤上一片红如碗大，发水泡疮三、五点，脉七至而弦，夜重于昼。医作肝经火郁治之，以黄连、青皮、香附、川芎、柴胡之类进一服，其夜痛极，且增热。次早看之，其皮肤上红大如盘，水疱疮又加至三十余粒。医教以白矾研末，井水调敷，仍于前药加青黛、龙胆草进之。其夜痛苦不已，叫号之声彻于四邻，胁中痛如钩摘之状。次早观之，其红已及半身矣，水泡疮又增至百数。”以文中所叙症状加以推断，此证不仅是带状疱疹，且症情严重。孙氏之师黄古潭以肝经燥郁立论，且“为订一方，以大瓜蒌一枚，重一、二两者，连皮捣烂，加粉草二钱，红花五分。”其方与论，别出心裁，不同凡响，堪称两绝。故服后收疮敛痛消“一剂而愈”之效余得此方，喜不自禁。盖“医家之病，病道少。”为医者能多一治病法门，则病家少一分痛苦，此方无确定之方名，余据方中药物之组成，暂名“瓜蒌草红汤”。未几疱疹流行，余于数日内接治五、六人，无论症之轻重，皆以上方加板蓝根15g予服。惟全瓜蒌不用如许之多，改为重者30g，轻者15g，中者21～24g。其收效之速，“真可谓之神矣”。轻者二、三日，重者四、五日，率皆痊可。后凡遇此症者，概以此方投之，无一例不效者。余所治病例中，病灶面积最大者几达胸部之半，理疗一月未愈，服上方一周即退净。而其得效之迟速，与瓜蒌用量极有关系。故凡体质壮实者，瓜蒌用量宜适当加重，药后若轻泻一、二次，则见效尤速。若体质不壮。瓜蒌不便重用者，多服数日，效亦可期。
《重庆堂随笔》云：“瓜蒌实润燥开结，荡热涤痰，夫人知之，而不知其舒肝郁、润肝燥、平肝逆、缓肝急之功有独擅也。”黄古潭可谓善识斯症者矣，可谓善用瓜蒌者矣。是知读医书不可刻舟求剑，当别具只眼，触类而旁通之。
关于甘草，余有时仅用3g，同样有效。而红花每以1．5g为率，并不多用，而屡收捷效。余用药不尚其多，药量不尚其重，并非矫揉造作，而是因病投药，适事为故。由是一端，余亦屡为人所贬斥，然余终不悔。余生而不敏，但欲速去病人之疾苦。至于其他，则非余所问矣。
药食过敏二例
一、清解脱敏皮疹净
退休工人钱某，同事小唐之岳丈也。年已古稀，有生以来从未发生饮食过敏现象。而于1994年春节前，饭前食带鱼一块，饭后半小时许，躯干及头面间骤发云片状丘疹，奇痒难忍，且愈发愈多，并相互融合成大片。某医院诊断为“过敏性皮炎”，屡经内服药片及注射针剂．如水投石。迨至2月18日始邀余诊治。病已将匝月矣。余视其舌无异常，而脉见滑数，左带弦，右兼软。以小柴胡汤合过敏煎化裁一方：
柴胡6g党参12g生甘草6g姜半夏9g黄芩9g五味子3g生地12g黄柏9g防风9g白藓皮9g板蓝根15g乌梢蛇9g蜈蚣一条
服后渐见瘙痒减，丘疹消、共服十五帖证解。
不意病愈甸余，又因食香菇一块，皮疹勃然复作。余视患者胸背、头面几无完肤。脉象滑大有力。谛思前方虽效，而解除过敏犹未彻底，患者体内必有余毒未清，故仅食香菇一块，即发至如此之剧烈，且一触即发，势若燎原。治法仍宗前意加味而加重清解抗敏。
银柴胡9g防风9g五味子3g乌梅9g黄芩9g炒山栀9g黄柏9g黄连3g乌梢蛇9g蜈蚣6g赤芍15g丹参15g银花30g绿豆衣30g生甘草15g
服十帖，疹消几净，仅额部有硬核二枚，如奕棋子大，面中有虫行蚁走之感。于原方中加入白蒺藜9g，再服七剂，皮疹尽消。以后未闻复发。
按：祝谌予先生之过敏煎仅防风、银柴胡、乌梅、五味子四物组成，各用10g，药味极简，而其效用却不同凡响。“祝氏运用于临床几十年，属于过敏性疾患的，均获得满意疗效。”本例系食物过敏，前后二发，均以过敏煎为主方以获脱敏。首次患者热毒未盛，兼有气虚，故合小柴胡汤益气兼以清泄肝胆，药证相当，故以见效甚速。再发则热毒大盛，前方有鞭长莫及之嫌，改以过敏煎合黄连解毒汤及绿豆甘草汤，更加大剂银花，以迅扫热毒，乌梢蛇、蜈蚣，最善解毒搜风，抗痒止痛。采入方中既使用药更臻完备，又使疗效明显提高。全方具解毒祛风脱敏之良能，因而药到病除，痒止疹消。
二、绿豆甘草汤善巧消药疹
晚辈阿明，年甫十岁时，忽患外症。外科以青链霉素连续注射二十余日，外症得愈。
数日后，四肢现红色丘疹。大如蚕豆瓣，略高于皮肤，色红而紫，形如小丘，中心高周围低，疹面无皮，故红紫而光亮。初起仅见数枚，以后逐渐增多，竟至数十枚，痒不可忍。屡就专科治疗，经数月后，仍然未有好转，及至第二年春，始问治于余余为仔细推究，虑为慢性药物中毒所致，非解毒之品久服不为功。嘱以绿豆十份，生甘草一份之比例，各取适量慢火煮汤，日日与服之，服后疹渐隐退，以至全消。计服绿豆十余斤，甘草亦将盈斤矣。
按：李时珍曰：“绿豆肉平皮寒，解金石、砒霜、草木一切诸毒。”甘草则善和中、泻火、解毒、疗疮，并能调和百药。两者相伍，则解毒之功更进一筹，遂成千古名方。李时珍于《本草纲目》绿豆条下云：“解毒宜连皮生研水服。”此为毒重病急者说法，本例受毒不甚，病势缓慢，虽欲急治，恐亦无与，只能小量缓图，故取煎汤饮服法。
又：绿豆煮酥以后，其味甘美，少佐调味，可恣口腹，然其清火解毒之力似反潜匿。不若急火急煎，煮之数十沸，豆尚未熟，取其清汁饮服，则其清火解毒之功，常可立见。
五官科类
风热乳蛾恃银翘
腭扁桃体，中医渭之喉核，位于喉关之两侧，左右各一。如遇风热邪毒侵犯则红肿胀大，形似蚕蛾，故名乳蛾或喉蛾。病发于一侧者谓之单蛾，两侧均发为双蛾。此即西医所谓急性扁桃体炎也。
此证初起以乳蛾红肿疼痛为主症。因感受风热邪毒而病，故发病迅速，疼痛逐渐加剧，吞咽不利，咽喉干燥灼热。并见外症如发热恶寒、头痛鼻塞、咳嗽吐痰。脉象浮数，舌质偏红，苔薄白或薄黄等。
咽喉为肺胃之门户，叶天士云：“温邪上受，首先犯肺，”肺中风热之邪循经上达于咽喉，搏结于喉核，邪阻络脉，热灼肌膜，遂致喉核红肿胀痛而发为本病。故其治法当疏风清热、解毒利咽。余习用银翘散加减以治此证。
银翘散方见于《温病条辨》上焦篇，由银花、连翘、桔梗、薄荷、竹叶、生甘草、荆芥、淡豆豉、牛蒡子、鲜芦根组成。为治温邪袭肺、邪在肺卫之方，而乳蛾初起，发热恶寒、头痛鼻塞、咳嗽咽痛等证，与银翘散证极为相类，病机亦似，只是病邪所犯部位不同：一在于肺，一在咽喉。故乳蛾初起有表症者，亦宜用银翘散治之。且清肺即所以利咽，表解热清，乳蛾自消。但方中芦根虽清肺热，然性甘寒，嫌其力逊而入浅。喉蛾屡发，必有伏热深踞肺脏之单。黄芩苦寒，泻肺火有单刀直入之功，故以黄芩易芦根。盖肺热不清则乳蛾不消，蛾不消则发热不退也。黄芩实为此方之“将”药。伏热清解则病根除，是故后即不发也。元参善养阴、解毒、清火、利咽，可助诸药共建大功，故于方中加入元参，全方药量甚轻而复杯即应，是知药贵对症，不贵蛮用。对症者轻灵即效，蛮用者重投反伤。吴鞠通谓“治上焦如羽，非轻不举。”亦此之谓欤?
原企业家邹某之孙，幼年乳蛾屡发，发则高热鸱张，咽喉痛剧肿甚。打针服药，总须六、七日，甚至及旬方愈。1979年12月1日晚高热又作，体温达39℃。次日由余诊治，查见双侧扁桃体Ⅱ度肿胀，尚未化脓。触其肌肤，身躯热而无汗，扪及额头与四肢，均无明显热象。自觉恶寒较甚，咽中干痛，妨碍饮食。且往昔发作时，俱是下午热盛，半夜后热衰，上午热轻。脉浮数有力，舌淡红，苔薄黄。夫咽喉为肺胃之门户，风热之邪侵犯肺卫，稽留咽喉，以致乳蛾高突，寒热频作。法当清解肺卫之邪，泻火利咽。方拟银翘散去芦根、竹叶、加黄芩、元参。方为：
金银花6g连翘3g荆芥6g薄荷2g生甘草2g桔梗2g牛蒡子4g豆豉6g黄芩6g元参6g
日间服完一帖，傍晚体温降至37．4℃，夜间又进一服，次日清晨热即退清。再进一帖，以撤余邪。以后再发之时，均以此方服一、二帖即解。复作二次后，病竟解除。今已二十余岁，乳蛾一症，自治愈后从未再作。
银翘散去竹叶、芦根加黄芩、元参，为余治疗风热乳蛾之经效方，屡用有效，此方暂名为“银翘利咽汤”。
阴虚咽痛药忌夹杂例
马书记(女)，年方而立时，正1976年也。于10月间患感冒，服解表药，诸症均退而咽痛末已。旬日后，入夜辄痛，夜半更甚，睡梦中亦常因痛而醒，及至鸡鸣则咽痛若失。病发后夜夜如此，深受其累，脉细而弦．据此特征，显是阴虚火动、虚火上炎所致。盖患者体质本属阴亏血弱，兼以平日劳心过度，心火易于炎上。加之夜间阴气用事之时，阴中伏火，易随阴气升逆而达于咽喉。夜半子时一阳初生，至鸡鸣阳气渐盛，阴气退位，阴火亦随之暂时伏匿，是以时至凌晨则咽反不痛。于是投以养阴清火之剂，药用生地、麦冬、白薇、丹皮、银花、桔梗、甘草之属，投之不应。仍服西药亦：不应。因循至12月初，病已两月，又复感冒，咽痛更烈，将解表、养阴、凉血诸品，参合而为一方。方为：
荆芥9g豆豉6g白薇9g生地9g玉竹9g麦冬9g元参9g丹皮9g赤芍6g甘草1．5g
服两帖，表即得解，而咽痛依然。余反复推敲历次所用之方，无不合辙，何以不见效果。一日读医书而得触类旁通，悟知初方非法不对，乃用药不精。既是虚火上炎，而用桔梗，反使升提上行，致阴火气浮焰烈；邪火既在营阴，用银花毕竟清气之物，是分散药势，反致力不专一。上方虽已不用桔梗、银花，但有荆芥、豆豉，发越升散，依然易引伏火升腾。于是俱摈杂药，专治阴分，即于前方中撤去荆豉，再服三帖，咽痛如失。越数年后询之，仅劳累时偶有微痛，稍事休息即可自解。
按：由此案而反思之，临证时选用药物，亦大有学问在。一药之善，沉疴立起；一药之差，危殆即至；一药之当，久病随消；一药之杂，便觉掣肘。是以知为医者不仅须精研医理，还须熟读本草。理、法、方、药环环紧扣，件件精当，方不愧称良医也。
“泻心”善治口糜泻
《医宗金鉴》载有“口糜泄”一证，并自注曰：“口疮糜烂泄泻一证，古经未载。以理推之，虽云属热，然其上发口糜，下泻即止，泻泄方止，口糜即生。观其上下相移之情状，亦必纯实热之所为也。心之窍开于舌，脾之窍开于口，心脾之热，故上发于口舌疮赤糜烂。胃主消化水谷，小肠盛受消化。心脾之热下移小肠胃腑，则运化之职失矣，故下注泄泻也。”其治法，口糜发时则用导赤散，泄泻发时则用参苓白术散。如上述上下移易、交替为病者余未之见，但余曾治一口疮糜烂及泄泻同时存在、屡药不愈之患者，投以泻心汤化裁即愈。虽证情治法与上述之证稍有差异，而其心火内炽、脾虚湿热之理则同也。
患者系潘姓男子，三十二岁。于数年前口腔内粘膜上出现少量溃疡，近年逐渐加多加重，妨碍语言饮食，服药经久，终难见效。来诊时持他医所开一方，亦取泻心汤大意，方用党参、黄连、黄芩、黄柏、肉桂、附片、甘草、生姜、大枣之类，谓服后泄泻更甚，口疮勃发，一日三餐如食针毡，刺痛难禁。经其亲友介绍来就余诊。
余诊时口腔症状一如上述，询知大便溏薄，一日二、三次．几与口疮同时发生。原有胃窦炎史，平素脘痛时作，矢气频仍。左脉沉细，左关带弦，右脉小弦，三部分按不衰。舌质淡，舌边及颊粘膜均有多处溃疡，苔薄白微腻。参合四诊为中气素亏、脾经湿热留滞，故治拟扶中健脾兼清理湿热，取诸泻心汤意增损为方，补清兼行、寒热并用。方为：
党参24g炒白术15g茯苓9g炙甘草9g黄连3g炒黄柏9g炮姜炭3g姜半夏9g当归9g炒白芍9g每日一剂，水煎服。
另予西瓜霜一支，掺于溃疡处，一日三、四次。
服第一帖后疮疼及泄泻更甚，服至第二帖即均见明显好转，服完三帖，上下唇内溃疡已消，惟颊粘膜与舌上溃点依旧。于原方加细辛1g，再服三剂，除右颊内尚有两处溃疡外，其余各处均已消失，大便日行一次，已成形，但稍软。原方又服五剂，口内溃疡痊愈，大便正常。
One day, while reading the entry on "Hypochondriac Pain" (胁痛) in *Yi Zhi Xu Yu* (Further Remains of Medical Intentions), I was suddenly enlightened through reflection. The symptoms described in the book were undoubtedly those of Herpes Zoster (带状疱疹). The text stated: His younger brother "suddenly experienced pain in the left hypochondrium, with a patch of redness on the skin as large as a bowl, accompanied by three or five blister-like sores. The pulse was rapid (seven beats per breath) and wiry, with symptoms worsening at night compared to daytime. Physicians treated it as Liver Meridian Fire Stagnation (肝经火郁), administering one dose of a decoction containing Coptidis Rhizoma (黄连), Citri Reticulatae Pericarpium (青皮), Cyperi Rhizoma (香附), Chuanxiong Rhizome (川芎), and Bupleuri Radix (柴胡). That night, the pain became extreme, and fever increased. The next morning, the redness on the skin had expanded to the size of a plate, and the number of blister-like sores increased to over thirty. The physician advised applying Alum powder (白矾) mixed with well water externally, and adding Indigo Naturalis (青黛) and Gentianae Radix (龙胆草) to the previous prescription. That night, the suffering was unbearable, with cries heard by neighbors; the pain in the hypochondrium felt like being hooked and pulled. The next morning, the redness had spread to half the body, and the blisters numbered over a hundred." Inferring from these symptoms, this condition was not only Herpes Zoster but also severe. Sun's teacher, Huang Gutan, based his theory on Dryness-Stagnation of the Liver Meridian (肝经燥郁) and "prescribed a formula using one large Trichosanthis Fructus (瓜蒌), weighing one or two taels, smashed whole with the peel, added with Glycyrrhizae Radix et Rhizoma (粉甘草) two qian, and Carthami Flos (红花) five fen." This formula and theory were original and outstanding, worthy of praise. Consequently, after taking it, the sores healed, and the pain subsided, achieving a cure "with one dose." I obtained this formula with great joy, thinking, "The disease of physicians is that their methods are few." If a physician has one more method to treat disease, patients suffer less. This formula had no specific name, so I tentatively named it "Gualou Caohong Decoction" (瓜蒌草红汤) based on its ingredients. Soon after, herpes zoster became epidemic. Within a few days, I treated five or six patients. Regardless of severity, I administered the above formula plus Isatidis Radix (板蓝根) 15g. However, I did not use such a large amount of whole Trichosanthis Fructus; instead, I adjusted the dosage: 30g for severe cases, 15g for mild cases, and 21-24g for moderate cases. The speed of efficacy was "truly miraculous." Mild cases resolved in two or three days, severe cases in four or five days, all recovering. Later, whenever I encountered this condition, I used this formula without exception. Among my cases, the largest lesion area covered nearly half of the chest; despite one month of physical therapy, it cleared completely within one week of taking this formula. The speed of efficacy was closely related to the dosage of Trichosanthis Fructus. Therefore, for patients with strong constitutions, the dosage of Trichosanthis Fructus should be appropriately increased; if mild diarrhea occurs after administration, efficacy is even faster. For those with weaker constitutions who cannot tolerate heavy doses, taking it for a few more days can still yield results.
*Chongqing Tang Suibi* states: "Trichosanthis Fructus moistens dryness, resolves accumulation, clears heat, and eliminates phlegm. Everyone knows this, but few know its unique ability to soothe Liver Qi stagnation, moisten Liver dryness, calm Liver counterflow, and relieve Liver tension." Huang Gutan could indeed be said to be skilled at recognizing this condition and utilizing Trichosanthis Fructus. Thus, we learn that studying medical books requires avoiding rigid adherence to precedents; one must have unique insights and apply knowledge analogously.
Regarding Glycyrrhizae Radix et Rhizoma (甘草), I sometimes use only 3g, which is equally effective. Carthami Flos (红花) is typically used at 1.5g, rarely more, yet consistently yields quick results. My approach does not favor numerous herbs or heavy dosages; this is not affectation but rather prescribing according to the disease and appropriateness. Despite criticism for this approach, I do not regret it. Though not naturally gifted, my sole desire is to quickly alleviate patients' suffering. Other matters are not my concern.
Two Cases of Drug/Food Allergy
1. Qingjie Detoxification Rash Cleanser
Mr. Qian, a retired worker and father-in-law of colleague Xiao Tang, was in his seventies and had never experienced food allergies in his life. However, before the Spring Festival in 1994, after eating a piece of hairtail fish before a meal, about half an hour later, cloud-shaped papules suddenly appeared on his trunk and face/head. They were extremely itchy, multiplied rapidly, and merged into large patches. A hospital diagnosed "Allergic Dermatitis," but repeated oral medications and injections were ineffective ("like throwing water into a stone"). He sought my treatment on February 18th, having been ill for nearly a month. His tongue was normal, but the pulse was slippery and rapid, wiry on the left, and soft on the right. I modified Xiao Chaihu Tang (小柴胡汤) combined with Guomin Jian (Allergy Decoction):
Bupleuri Radix (柴胡) 6g, Codonopsis Radix (党参) 12g, Raw Glycyrrhizae Radix et Rhizoma (生甘草) 6g, Ginger-processed Pinelliae Rhizoma (姜半夏) 9g, Scutellariae Radix (黄芩) 9g, Schisandrae Fructus (五味子) 3g, Rehmanniae Radix (生地) 12g, Phellodendri Cortex (黄柏) 9g, Saposhnikoviae Radix (防风) 9g, Dictamni Cortex (白藓皮) 9g, Isatidis Radix (板蓝根) 15g, Zaocys (乌梢蛇) 9g, One Centipede (蜈蚣).
After taking it, itching gradually decreased, and papules subsided. After fifteen doses, symptoms resolved.
Unexpectedly, over a month after recovery, eating a piece of shiitake mushroom caused a sudden recurrence of the rash. His chest, back, face, and head were almost entirely covered. The pulse was slippery, large, and forceful. Although the previous formula was effective, it did not thoroughly resolve the allergy. There must be residual toxins in the body; thus, eating just one mushroom triggered such a severe reaction, spreading rapidly like a prairie fire. The treatment strategy remained similar but emphasized clearing heat and resolving allergy more strongly.
Cynanchum Stauntonii Radix (银柴胡) 9g, Saposhnikoviae Radix (防风) 9g, Schisandrae Fructus (五味子) 3g, Mume Fructus (乌梅) 9g, Scutellariae Radix (黄芩) 9g, Stir-fried Gardenia Fructus (炒山栀) 9g, Phellodendri Cortex (黄柏) 9g, Coptidis Rhizoma (黄连) 3g, Zaocys (乌梢蛇) 9g, Six Centipedes (蜈蚣) 6g, Red Peony Root (赤芍) 15g, Salviae Miltiorrhizae Radix (丹参) 15g, Lonicerae Flos (银花) 30g, Vigna Radiata Testa (绿豆衣) 30g, Raw Glycyrrhizae Radix et Rhizoma (生甘草) 15g.
After ten doses, the rash almost disappeared, leaving only two hard nodules on the forehead, the size of chess pieces, with a sensation of insects crawling on the face. I added Tribulus Fructus (白蒺藜) 9g to the original formula and administered seven more doses, resulting in complete resolution of the rash. No recurrence was reported thereafter.
Commentary: Mr. Zhu Chenyu's Allergy Decoction (过敏煎) consists of only four herbs: Saposhnikoviae Radix (防风), Cynanchum Stauntonii Radix (银柴胡), Mume Fructus (乌梅), and Schisandrae Fructus (五味子), each 10g. The formula is simple yet highly effective. "Mr. Zhu used it clinically for decades, achieving satisfactory results for allergic diseases." This case involved food allergy, recurring twice, both times primarily treated with Allergy Decoction for desensitization. The first episode featured mild heat-toxin and Qi deficiency, so combining it with Xiao Chaihu Tang (小柴胡汤) tonified Qi and cleared Liver/Gallbladder heat, matching the syndrome perfectly and yielding rapid results. The second episode featured intense heat-toxin, making the previous formula insufficient. I switched to Allergy Decoction combined with Huanglian Jiedu Tang (黄连解毒汤) and Mung Bean & Licorice Decoction, adding a large dose of Lonicerae Flos (银花) to swiftly clear heat-toxin. Zaocys (乌梢蛇) and Centipede (蜈蚣) are excellent for detoxifying, dispelling wind, relieving itching, and stopping pain. Incorporating them made the prescription more comprehensive and significantly improved efficacy. The entire formula possesses the ability to detoxify, dispel wind, and desensitize, leading to immediate relief of itching and disappearance of the rash.
2. Mung Bean and Licorice Decoction Skillfully Eliminates Drug Rash
A junior colleague, Ah Ming, aged ten, suddenly developed a surgical condition. Surgeons treated him with continuous injections of Penicillin and Streptomycin for over twenty days, curing the external condition.
Several days later, red papules appeared on his limbs, large as broad bean seeds, slightly raised above the skin, red-purple in color, shaped like small hills, higher in the center and lower at the edges, with no epidermis on the surface, appearing shiny red-purple. Initially, only a few were seen, but they gradually increased to dozens, causing unbearable itching. He sought specialist treatment for months with no improvement. In the following spring, he came to me. Upon careful investigation, I suspected chronic drug toxicity, requiring long-term administration of detoxifying agents. I instructed him to boil Mung Beans (绿豆) and Raw Glycyrrhizae Radix et Rhizoma (生甘草) in a 10:1 ratio, preparing soup daily. After taking it, the rash gradually faded until it completely disappeared. He consumed over ten jin (approx. 5kg) of mung beans and nearly one jin (approx. 0.5kg) of licorice.
Commentary: Li Shizhen stated: "Mung bean flesh is neutral, skin is cold; it detoxifies minerals, arsenic, and all plant poisons." Glycyrrhizae Radix et Rhizoma harmonizes the middle, drains fire, detoxifies, treats sores, and harmonizes various drugs. Together, their detoxifying power is enhanced, forming a timeless famous formula. Li Shizhen noted under the Mung Bean entry in *Bencao Gangmu*: "For detoxification, grind the skin raw and take with water." This applies to acute, severe poisoning. In this case, the toxin load was low, and the disease course was slow; urgent treatment was unnecessary. Small doses taken slowly were appropriate, hence the decoction method.
Additionally: Once mung beans are boiled until soft, their taste becomes sweet and pleasant, suitable for dietary enjoyment. However, their heat-clearing and detoxifying properties may become latent. It is better to boil vigorously for a short time (dozens of boils) while the beans are still uncooked, extracting the clear juice for drinking. This method often yields immediate heat-clearing and detoxifying effects.
ENT Category
Wind-Heat Tonsillitis Relies on Yinqiao San
The palatine tonsils are known in Traditional Chinese Medicine (TCM) as "Throat Nuclei" (喉核), located on both sides of the throat gate. When invaded by Wind-Heat pathogenic factors, they become red, swollen, and enlarged, resembling silkworm moths, hence the name "Moth Throat" (乳蛾) or "Throat Moth" (喉蛾). Unilateral involvement is called Single Moth (单蛾); bilateral involvement is Double Moth (双蛾). This corresponds to Acute Tonsillitis in Western medicine.
The initial symptom is redness, swelling, and pain of the tonsils. Due to Wind-Heat invasion, onset is rapid, pain intensifies progressively, swallowing is difficult, and the throat feels dry and burning. External symptoms include fever, aversion to cold, headache, nasal congestion, cough, and expectoration. The pulse is floating and rapid; the tongue body is reddish, with thin white or thin yellow coating.
The throat is the gateway to the Lung and Stomach. Ye Tianshi said: "Warm pathogens enter from above, first attacking the Lung." Wind-Heat pathogens in the Lung ascend along the meridians to the throat, knotting at the throat nuclei. Pathogens obstruct collaterals, and heat scorches muscle membranes, causing redness, swelling, and pain of the throat nuclei. The treatment principle should be to disperse Wind, clear Heat, detoxify, and benefit the throat. I commonly use modified Yinqiao San (银翘散) for this condition.
Yinqiao San appears in the Upper Jiao Chapter of *Wenbing Tiaobian*. It consists of Lonicerae Flos (银花), Forsythiae Fructum (连翘), Platycodonis Radix (桔梗), Menthae Haplocalycis Herba (薄荷), Bambusae Folium (竹叶), Raw Glycyrrhizae Radix et Rhizoma (生甘草), Schizonepetae Spica (荆芥), Fermented Soybean (淡豆豉), Arctii Fructus (牛蒡子), and Fresh Imperatae Rhizoma (鲜芦根). It is a formula for Warm pathogens invading the Lung and affecting the Lung-Wei level. The initial symptoms of moth throat—fever, aversion to cold, headache, nasal congestion, cough, and sore throat—are very similar to Yinqiao San syndrome, with similar pathogenesis, differing only in the site of pathogen attack: one in the Lung, the other in the throat. Therefore, moth throat with exterior symptoms should also be treated with Yinqiao San. Clearing the Lung benefits the throat; once the exterior is resolved and heat cleared, the moth throat subsides. Although Fresh Imperatae Rhizoma (鲜芦根) clears Lung heat, its nature is sweet and cold, considered weak and superficial. Recurrent throat moths imply latent heat deeply rooted in the Lung. Scutellariae Radix (黄芩) is bitter and cold, penetrating directly to drain Lung fire. Thus, I replace Fresh Imperatae Rhizoma with Scutellariae Radix. If Lung heat is not cleared, moth throat will not subside, and fever will persist. Scutellariae Radix acts as the "general" of this formula. Clearing latent heat removes the root cause, preventing recurrence. Scrophulariae Radix (元参) nourishes Yin, detoxifies, clears fire, and benefits the throat, assisting other herbs. Adding it to the formula allows light dosages to work quickly. This shows that herbs must match the syndrome, not be used blindly. Matching herbs work lightly; blind heavy use causes harm. Wu Jutong said, "Treating the Upper Jiao is like feathers; only lightness can lift." This is what he meant.
The grandson of a former entrepreneur, Mr. Zou, suffered recurrent moth throat in childhood, with high fever, severe throat pain, and significant swelling. Injections and medication usually took six to ten days to resolve. On the evening of December 1, 1979, high fever returned, reaching 39°C. I examined him the next day: bilateral tonsils were Grade II swollen, not yet suppurated. His body was hot but without sweat; forehead and limbs showed no obvious heat signs. He felt significant aversion to cold, dry and painful throat, hindering eating. Previously, fevers peaked in the afternoon, subsided after midnight, and were mild in the morning. The pulse was floating, rapid, and forceful; the tongue was pale red with thin yellow coating. The throat is the gateway to the Lung and Stomach; Wind-Heat invades Lung-Wei, lingers in the throat, causing prominent moth throat and frequent chills/fever. The method should clear Lung-Wei pathogens, drain fire, and benefit the throat. I formulated Yinqiao San removing Fresh Imperatae Rhizoma and Bambusae Folium, adding Scutellariae Radix and Scrophulariae Radix:
Lonicerae Flos (金银花) 6g, Forsythiae Fructum (连翘) 3g, Schizonepetae Spica (荆芥) 6g, Menthae Haplocalycis Herba (薄荷) 2g, Raw Glycyrrhizae Radix et Rhizoma (生甘草) 2g, Platycodonis Radix (桔梗) 2g, Arctii Fructus (牛蒡子) 4g, Fermented Soybean (豆豉) 6g, Scutellariae Radix (黄芩) 6g, Scrophulariae Radix (元参) 6g.
After finishing one dose during the day, temperature dropped to 37.4°C by evening. Taking another dose at night, fever cleared by next morning. One more dose eliminated residual pathogens. Subsequent recurrences resolved with one or two doses. After two more recurrences, the disease was cured. Now in his twenties, he has never had moth throat again since healing.
Yinqiao San removing Bambusae Folium and Fresh Imperatae Rhizoma, adding Scutellariae Radix and Scrophulariae Radix, is my effective formula for Wind-Heat moth throat, used repeatedly with success. I tentatively name it "Yinqiao Throat-Benefiting Decoction" (银翘利咽汤).
Yin Deficiency Sore Throat: Avoid Mixed Medications
Secretary Ma (Female), aged thirty in 1976, caught a cold in October. After taking exterior-releasing medicines, most symptoms resolved except for persistent sore throat. Ten days later, pain started at night, worsening at midnight, waking her from sleep. By dawn, the pain vanished. This pattern continued nightly, causing great distress. The pulse was fine and wiry. These features indicate Yin Deficiency with Fire Hyperactivity (阴虚火动) and Deficient Fire flaming upward (虚火上炎). The patient had a constitution of Yin deficiency and Blood weakness, compounded by mental overwork, leading to Heart Fire flaming upward. During the night, when Yin energy dominates, latent Fire within Yin rises with Yin energy to the throat. At midnight (Zi hour), Yang begins to generate; by dawn, Yang grows strong, Yin retreats, and Yin Fire temporarily hides. Hence, no pain in the early morning. I prescribed Yin-nourishing and Fire-clearing herbs: Rehmanniae Radix (生地), Ophiopogonis Radix (麦冬), Anemarrhenae Rhizoma (白薇), Moutan Cortex (丹皮), Lonicerae Flos (银花), Platycodonis Radix (桔梗), Glycyrrhizae Radix et Rhizoma (甘草). It was ineffective. Western medicine also failed. By early December, two months later, she caught a cold again, and throat pain intensified. I combined exterior-releasing, Yin-nourishing, and Blood-cooling herbs into one formula:
Schizonepetae Spica (荆芥) 9g, Fermented Soybean (豆豉) 6g, Anemarrhenae Rhizoma (白薇) 9g, Rehmanniae Radix (生地) 9g, Polygonati Odorati Rhizoma (玉竹) 9g, Ophiopogonis Radix (麦冬) 9g, Scrophulariae Radix (元参) 9g, Moutan Cortex (丹皮) 9g, Red Peony Root (赤芍) 6g, Glycyrrhizae Radix et Rhizoma (甘草) 1.5g.
After two doses, the exterior was resolved, but throat pain persisted. I reviewed previous formulas, all logically sound, yet ineffective. Reading medical books led to insight: the initial formula was correct in principle but imprecise in herb selection. Since it was Deficient Fire flaming upward, using Platycodonis Radix (桔梗) promoted ascending movement, exacerbating the floating of Yin Fire. Since the pathogenic fire was in Ying-Yin levels, using Lonicerae Flos (银花), a Qi-clearing herb, dispersed medicinal action, reducing focus. Although the subsequent formula removed Platycodonis Radix and Lonicerae Flos, it included Schizonepetae Spica and Fermented Soybean, which are dispersing and ascending, still prone to lifting latent Fire. I discarded mixed herbs and focused solely on treating the Yin level, removing Schizonepetae Spica and Fermented Soybean from the previous formula. After three more doses, throat pain vanished. Years later, she reported only occasional slight pain when tired, resolving with rest.
Commentary: Reflecting on this case, selecting herbs in clinical practice is crucial. A good herb cures chronic illness instantly; a poor one brings danger; an appropriate herb resolves long-standing disease; a mixed/inappropriate one hinders progress. Physicians must study medical theory and materia medica thoroughly. Theory, method, formula, and herbs must link tightly and be precise to qualify as a good physician.
"Xie Xin" Effectively Treats Mouth Ulcers with Diarrhea
*Yizong Jinjian* records "Mouth Ulcer Diarrhea" (口糜泄), noting: "This syndrome of mouth ulcers and diarrhea is not recorded in ancient classics. Reasoning logically, although it belongs to Heat, when mouth ulcers appear, diarrhea stops; when diarrhea stops, mouth ulcers appear. Observing this shifting between upper and lower, it must be pure Excess Heat. The Heart opens to the tongue, the Spleen opens to the mouth. Heat from Heart and Spleen manifests as red, ulcerated mouth/tongue lesions. The Stomach digests food, the Small Intestine receives digestion. Heat from Heart and Spleen moves downward to Small Intestine and Stomach, disrupting transportation functions, causing downward diarrhea." Treatment for mouth ulcers uses Daochi San (导赤散); for diarrhea, Shenling Baizhu San (参苓白术散). I have not seen alternating upper/lower symptoms as described, but I treated a patient with simultaneous mouth ulcers and diarrhea, resistant to multiple treatments, who recovered with modified Xie Xin Tang (泻心汤). Although the syndrome and treatment differed slightly, the underlying mechanism of Internal Blazing Heart Fire and Spleen Deficiency with Damp-Heat was the same.
Patient Pan, male, 32 years old. Developed small oral mucosal ulcers several years ago, increasing in number and severity recently, interfering with speech and eating. Long-term medication was ineffective. He presented with a prescription from another doctor, also based on Xie Xin Tang principles, containing Codonopsis Radix (党参), Coptidis Rhizoma (黄连), Scutellariae Radix (黄芩), Phellodendri Cortex (黄柏), Cinnamon Bark (肉桂), Prepared Aconite Root (附片), Glycyrrhizae Radix et Rhizoma (甘草), Ginger (生姜), and Jujube (大枣). He reported that after taking it, diarrhea worsened, and mouth ulcers erupted severely, making meals feel like sitting on needles. Introduced by friends, he sought my care.
Oral symptoms matched the description. Bowel movements were loose, 2-3 times daily, occurring almost simultaneously with mouth ulcers. History of gastric antrum inflammation, occasional abdominal pain, frequent flatulence. Left pulse deep and fine, left Guan position wiry; Right pulse slightly wiry, firm upon pressing all three positions. Tongue body pale, multiple ulcers on tongue edges and buccal mucosa, coating thin white and slightly greasy. Integrating four diagnostic methods, this indicated inherent Middle Qi deficiency with Damp-Heat stagnation in the Spleen Meridian. Treatment aimed to support Middle Qi, strengthen Spleen, and clear Damp-Heat, modifying Xie Xin Tang concepts, combining tonification and clearing, Cold and Hot herbs. Formula:
Codonopsis Radix (党参) 24g, Stir-fried Atractylodis Macrocephalae Rhizoma (炒白术) 15g, Poria (茯苓) 9g, Roasted Glycyrrhizae Radix et Rhizoma (炙甘草) 9g, Coptidis Rhizoma (黄连) 3g, Stir-fried Phellodendri Cortex (炒黄柏) 9g, Charred Ginger (炮姜炭) 3g, Ginger-processed Pinelliae Rhizoma (姜半夏) 9g, Angelicae Sinensis Radix (当归) 9g, Stir-fried White Peony Root (炒白芍) 9g. One dose daily, decocted in water.
Additionally, apply one stick of Watermelon Frost (西瓜霜) to ulcers, 3-4 times daily.
After the first dose, ulcer pain and diarrhea worsened. By the second dose, significant improvement was seen. After three doses, ulcers on upper and lower lips disappeared, but buccal mucosa and tongue ulcers remained. Added Asarum Root (细辛) 1g to the original formula, administered three more doses. Except for two ulcers on the right cheek, all others disappeared. Bowel movements normalized to once daily, formed but slightly soft. Five more doses of the original formula cured oral ulcers and normalized bowel movements.