在过春节期间，突然发现发热咳嗽。医予抗生素、病毒唑进行治疗后，发热虽然很快好转，但咳嗽反见加剧，有时连续不断地咳嗽，不能平卧。至某院住院治疗。诊为支气管肺炎。医先用多种抗生素与其他止咳化痰药进行治疗5个多月不效，后又加用中药宣肺止咳、清热解毒配合治疗1个多月仍然无明显疗效。因其经济困难，不得不暂时出院。审其除咳嗽阵发性加剧，难于平卧外，并见胸满胸痛，头晕头痛，口苦咽于，不欲饮食，舌苔薄白，脉弦细涩。因思外感之病见脉弦者乃少阳枢机不利也；涩者，寒也，滞也。合之于证，知其乃邪在少阳，寒饮蕴肺之证也。因拟小柴胡汤加减以和枢机；干姜、五味子、紫菀以化肺饮，止咳嗽。处方：柴胡10克，半夏10克，黄芩10克，干姜4克，五味子10克，丝瓜络10克，紫菀10克。
服药4剂，诸证均减，继服15剂，诸证消失而愈。
某医云：炎症不用清热解毒去消炎，反用干姜之温热，吾不解也?余云：中医、西医是两个不同的理论体系，决不可以西医的理论硬套中医的治疗。本证既属中医的邪在少阳就当予和解，寒饮阻肺就当用温肺化饮，故治之得愈也。
4．胶于炎症，频与抗菌，复与解毒，少阳不解，岂能得减
卫××，男，42岁。
8天前突然高热达42℃。急住某院诊治。诊为肺炎。先予青霉素、链霉素、氨苄青霉素、白霉素、先锋霉素Ⅱ、先锋霉素Ⅳ、先锋必、氨噻羧单胺菌素治疗5天，体温不见下降，继又配合激素中药清热解毒之剂治疗3天，体温仍然不见改善。审其体温40．3℃，时感冷气从胁上向上冲逆，舌苔白，脉沉弦滑数。综合脉证思之：弦脉者，少阳也；滑数者，痰火胶结也。治宜从和解少阳，化痰泻火。处方：柴胡30克，黄芩10克，生姜10克，大枣12个(擘)，瓜蒌30克。
某医云：药仅3味，岂能有效。答曰：前方之用银花100克，连翘50克，生石膏250克，复加抗生素之不效者，恐不在于药力之大小，而在法之不对证耳。今病在少阳，本当和解枢机，反予冰郁其阳气，阳气郁者，热不能除也。又东垣云：热郁、火郁者，必发之方可，故列升阳散火汤以解大热。再从升阳散火之药味，药量来论，既味少，又量小，而其效却神之又神耳。余之所宗者于此耳。今《伤寒论》还云：胸中烦者，去人参、半夏，此病脉不但弦，而且滑，且有烦冷之气上冲，故暂列此五药治之。
服药1剂，4个小时后，身微汗出，热退，体温36．8℃，再服1剂，脉由滑转为弦，又服柴胡汤2剂，愈。
某医云：不用消炎之药而肺部炎症消退之快，吾未闻也，请示之。答曰：炎症是现代医学的一种说法，中医如何对待炎症，见到炎症应如何处理，实在是一个值得研究的问题。不过余认为如果一见所谓的炎症即认为是热毒所致，恐怕是不正确的。而此症之不效即在于此。
肺脓肿与脓胸
1．但知寒凉解毒，不知过凉冰郁，热毒壅郁，脓肿不除。
卫××，女，49岁。
寒战高热，汗出神疲，咳唾脓血。某院诊为肺脓肿。经用西药抗生素与中药清热解毒，化瘀排脓法治疗1个月后，寒战高热，汗出已大见好转，体温也由4l℃降至37℃，但继续应用上药1个月后，症状不再继续改善，胸部x线拍片数次均未见改变。细查其证，除咳吐脓痰之外，并见胸满胸痛，头晕头胀，心烦易怒，纳呆食减，舌苔白腻，脉弦细涩。综合脉证，反复思考：此必久用寒凉重剂，阳气被郁，肝肺之气难于升降，脓液不得排出所致。正如仲景“夫呕家有痈脓，不可治呕，脓尽自愈。”同一意耳。因拟疏肝解郁，宣肺化痰排脓。处方：柴胡10克，枳实10克，白芍10克，瓜蒌15克，青皮10克，桔梗10克，白芥子10克，橘叶10克，当归10克。
服药6剂后，头晕头胀，胸满胸痛，咳嗽吐痰均好转，继服20剂后，诸证消失，胸部x光片已正常，又服10剂，愈。
2．正虚邪实，热毒壅郁，脓汁不泄，但用解毒清热，其病不解
胡××，男，49岁。
2个多月前，在过度劳累之后，突然发现寒战高热，胸痛，咳嗽。某院诊为肺脓肿，脓胸。先用抗生素等治疗20多天不见改善，后又配合中药清热解毒，化瘀排脓法治疗20多天仍然不见好转。并在3天前从第三肋间肿痛处发现一溃破口有脓汁排出，吸气时有气泡出现。细察其证，除咳嗽气短，不断地咳吐黄稠脓痰，其味腥臭外，并见其精神极度疲惫，汗出，烦躁不安，时时恶心欲吐，头晕难于坐立，右腋下第三肋间有一黄豆大的溃破口，随吸气而不断地有脓汁和气泡排出，周围皮肤不见高起，仅见青紫色，面色皓白而微透青色，舌苔白而厚腻，脉沉弦滑数。综合脉证，思之：肺痈高热乃热毒壅滞为患也，治宜清热解毒，然久用清热解毒何故不效也?再思其证，汗出，神疲，且面色皓白，溃破处但见青紫之色，乃气血俱虚之证，虚者宜补，不扶正焉能祛邪。又思其脉沉弦滑数，肺虚之脉当见浮而虚，而本证却见沉弦肝脉，必因寒凉过用而肝木被郁所致也。因拟补气养阴以培本，疏肝理气，化痰排脓以治标。处方：柴胡18克，桔梗18克，瓜蒌30克，枳实18克，赤芍15克，黄芪20克，当归15克，青皮15克，橘叶12克，白芥子1克，麦冬10克。
昼夜连进2剂，次日寒战高热大减，体温由40．2℃降至38℃，继服4剂，寒战发热消失，体温正常。气短、咳嗽、吐脓痰，汗出均好转，胸部溃破口已愈合，局部皮肤色变浅，食欲增加，继服60剂，果愈。
3．气阴俱虚，热毒壅盛，脓不得排，但予清热解毒，正不胜邪，其病不愈
郜××，女，63岁。
发热汗出，胸满胸痛，咳吐脓血20多天。医诊肺脓肿、脓胸。先以大剂抗生素治疗10天不效。继又配合中药大剂清热解毒，祛痰排脓治疗10天仍不效。细审其证，除胸满胸痛外，并见其高热汗出，体温40．1℃，神疲乏力，气短难于接续，左乳外上方微肿，并有一破口不断随吸气而脓汁外出，且有气泡，舌苔黄白而腻，脉虚大滑数。综合脉证，思之：脉虚大而汗出，神疲气短者，气阴俱虚也；脉滑数者，痰热痈脓也。前用解毒清热，化痰排脓之剂不效者，乃因正虚而邪不却。治当补气养血以扶其正。处方：黄芪20克，当归10克，麦冬10克，银花15克，连翘15克，瓜蒌15克，桔梗10克，白芥子1克。
服药3剂，发热明显好转，体温降至38．5℃，其他诸证亦明显减轻，继服7剂，体温正常，精神、食欲大增，胸部疮口愈。宗效不更方意，服药40剂，愈。
肺不张
正虚邪实，始不扶正，后不活络，其病不解
俞××，女，39岁。
胸闷气短，咳嗽低热1个多月。医用抗生素等药治之不效，又用中药清热化痰、养阴润肺治之亦不效。某院经过多方检查诊为肺不张。细审其证，除气短胸闷，咳嗽低热之外，并见疲乏无力，时微汗出，舌苔薄白，脉虚大弦滑。综合脉证，思之：脉虚大者，气阴俱虚也；弦滑者，痰也。合之与证，乃为气阴两虚为本，痰热蕴肺为标。为拟补气养阴以培本，清热化痰以治标。《济生》桔梗汤加减：桔梗10克，防己10克，桑皮10克，浙贝母10克，瓜蒌15克，甘草10克，当归10克，生薏米18克，杏仁10克，黄芪15克，百合15克。
服药18剂后，精神明显好转，但气短、咳嗽。胸满等不见改善。细察其舌苔薄白，脉沉。因思脉由大转沉，此正稍复而气滞血瘀之证反著耳。治拟理气活血，宣肺化痰。血府逐瘀汤加味。处方：当归10克，生地10克，桃仁10克，红花10克，甘草10克，枳壳10克，赤芍10克，柴胡10克，川芎10克，桔梗10克，牛膝10克，瓜蒌皮15克。
服药4剂，胸满气短咳嗽均好转，继服16剂，诸证消失，x线拍片：心肺膈正常。
一友云：前用化痰活血何故不效?后用活血化痰何故有效?答曰：本病始见脉大，其证以虚为主，治当扶正，其后证见脉沉，气滞血瘀为主，治宜活血理气，宣肺化痰，故始予祛邪不效，后以祛邪得效，此仲景所谓“观其脉证，知犯何逆，随证治之”之义也。
结节病
从脉辨证，因证施方，其效即著郝××，女，59岁。10年来，经常感到疲乏无力，口干汗多。医诊糖尿病。最近4个多月，疲乏无力日渐加重，且伴有咳嗽吐痰，平卧时呼吸困难，坐起后好转，胸满心烦，纳呆食减，结节性红斑，肺门淋巴结与腋下、腹股沟淋巴结肿大。医诊结节病。住院4个多月，先用西药治疗不效，后又配中药止咳化痰之品不但不效，反而出现右臂浅静脉炎。细审其证，除上述者外，并见咳而遗尿，头晕脑胀，舌苔白，脉虚大弦滑。综合脉证，思之：本病既有气阴之虚，又有痰热之滞；既有肝肺之郁，又有风邪之入络。治疗之法，必分先后，否则难治。今脉虚大弦滑，治应先以补气养阴以扶正，理气化痰止咳以除其邪。处方：柴胡10克，当归10克，白芍10克，麦冬10克，人参10克，五味子10克，半夏10克，陈皮10克，青皮10克，黄芩10克，紫菀10克。
服药4剂，胸满心烦，汗出乏力，咳而遗尿均减，然咳嗽气短，身痛，静脉炎不见改善。舌苔白，脉弦滑稍紧。综合脉证，思之：脉弦紧者风寒人络也；滑者，痰热内郁也。治宜疏风散寒，化痰通络。处方：黄柏10克，苍术10克，南星10克，桂枝10克，防己10克，威灵仙3克，桃仁10克，红花10克，龙胆草10克，羌活3克，白芷3克，川芎10克。
服药12剂，咳嗽气短，身痛，静脉炎，肺门、腋下、腹股沟淋巴结肿大均消失。继服6剂，除汗出口渴之外，诸证均失。
某医云：结节病吾未闻之也，然其应用中药却治愈者何也?答曰：结节病一名，中医著作中未见明确论述之病也，然其何以治愈?微妙在脉者一也，随证治之者二也。其脉原为虚大弦滑，故先予补气养阴以扶正，理气化痰以祛邪，后为弦滑而紧，故以疏风散寒。又问：方中仅用羌活、白芷、威灵仙至3克，其故何也?答曰：痰凝、血滞之证不可重用风药散之也，过散则血燥，痰凝难化也，故用小量以防伤正助邪。
结核性胸膜炎
1．胶于悬饮，泥于结核，久久不效
宋××，女，成。
胸满胸痛7个多月。医诊结核性胸膜炎。先以抽水、抗痨药、激素治之，胸水已明显改善，但至今仍不见全部吸收。为此曾反复穿刺以抽水，但只能抽出少量胸水。后又邀中医以攻逐水饮法治之，然10天后，诸证非但不减，且出现恶心泄泻。细审其证，右侧胸痛，气短，舌苔白，脉沉弦涩。综合脉证，思之：此久病已人血分也，不可但从气治。拟疏肝理气，活血化痰。处方：柴胡10克，赤芍10克，枳壳10克，白芥子10克，陈皮10克，降香10克，杏仁10克，甘草10克。
服药2剂，胸满胸痛，气短均减，继服10剂，诸证消失，愈。
某医云：包裹性胸水竞如此之速效，其故何也?答曰：其久治不效者乃病在血分但治气分之故也，今从血分论治，故速愈也。
2．胶于悬饮，不思辨证，久治不效
高××，男，22岁。
持续高热，汗出，胸满，气短50多天。医诊结核性胸膜炎。先以西药治疗30天不效，后又配合中药清热解毒、攻逐水饮等治疗20多天亦不效。细审其证，寒热往来，体温39．9℃，胸满气短，恶心欲吐，舌苔白，脉弦数。因思寒热往来者，少阳之证也，宜予和解少阳。处方：柴胡28克，厚朴10克，草果10克，摈榔10克，黄芩10克，知母10克，菖蒲10克，苏叶10克，甘草6克。
服药4剂，诸证大减，体温37．5cc，继服4剂，体温正常，饮食增加，胸水明显减少。审其脉弦紧小数。处方：柴胡10克，赤芍10克，白芥子6克，桔梗10克，枳实10克，陈皮10克，半夏10克，黄芩10克，甘草6克。服药30剂，诸证消失，愈。某医问：何不用攻逐水饮法?答曰：本病证见少阳，当以和解。仲景在《伤寒论》中列述少阳有三禁，其中即有禁下一条，今所以不用攻逐者即宗仲圣之训也。
3．三阳合病，反与清解，表里不和，其病难愈
于××，男，2l岁。
持续高热胸痛40多天。医始终未确诊，与西药抗生素等治疗20多天，体温一直持续在39℃左右。又于某院住院检查治疗，发现大量胸水，诊为结核性胸膜炎。继续应用西药，并配合中药大剂清热解毒之药治之，20多天后，体温仍然不见下降。细审其证，除胸痛胸满，咳嗽气短之外，并见寒热往来，头身疼痛，口苦咽干，恶心欲吐，脘腹胀满而痛，按之更甚，大便不畅，小便微黄，舌苔黄白，脉弦紧而数。综合脉证，乃太阳、少阳、阳明俱见之证。急予达原饮加减，外散风寒，中调肝胆，里攻实滞。处方：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，菖蒲10克，柴胡10克，桂枝10克，白芷10克，大黄3克。
During the Spring Festival, fever and cough suddenly appeared. After treatment with antibiotics and Ribavirin by a physician, although the fever improved rapidly, the cough worsened, sometimes occurring continuously without interruption, making it impossible to lie flat. The patient was then hospitalized at a certain hospital and diagnosed with bronchopneumonia. The physician first used various antibiotics and other antitussive and expectorant drugs for over 5 months without effect. Later, Traditional Chinese Medicine (TCM) prescriptions for diffusing the Lung and stopping cough, and clearing heat and detoxifying were added for over 1 month, but still with no obvious efficacy. Due to financial difficulties, the patient had to be discharged temporarily. Examination revealed that besides paroxysmal worsening of cough and difficulty lying flat, there were also chest fullness and pain, dizziness and headache, bitter taste in the mouth and dry throat, loss of appetite, a thin white tongue coating, and a wiry, fine, and choppy pulse. I reasoned that an external contraction presenting with a wiry pulse indicates dysfunction of the Shaoyang pivot; a choppy pulse indicates cold and stagnation. Combining this with the symptoms, it is known as pathogenic factors in the Shaoyang stage with cold-fluid retention in the Lung. Therefore, Xiao Chai Hu Tang (Minor Bupleurum Decoction) was modified to harmonize the pivot; Gan Jiang (Dried Ginger), Wu Wei Zi (Schisandra Fruit), and Zi Wan (Aster Root) were used to transform Lung fluid and stop cough. Prescription: Chai Hu 10g, Ban Xia 10g, Huang Qin 10g, Gan Jiang 4g, Wu Wei Zi 10g, Si Gua Luo 10g, Zi Wan 10g.
After taking 4 doses, all symptoms decreased. Continuing for 15 doses, all symptoms disappeared, and the patient recovered.
A certain physician said: "For inflammation, why not use heat-clearing and detoxifying herbs to reduce inflammation, but instead use Gan Jiang (Dried Ginger), which is warm and hot? I do not understand." I replied: "TCM and Western medicine are two different theoretical systems. One must not forcibly apply Western medical theories to TCM treatment. Since this syndrome belongs to pathogenic factors in the Shaoyang stage in TCM, harmonization should be applied; since cold-fluid obstructs the Lung, warming the Lung and transforming fluid should be used. Thus, the treatment was successful."
4. Clinging to the concept of inflammation, frequently using antibacterial drugs, and again using detoxifying drugs, if the Shaoyail pathogen is not resolved, how can the condition improve?
Patient Wei XX, Male, 42 years old.
Eight days ago, sudden high fever reached 42°C. Urgently admitted to a certain hospital for diagnosis and treatment. Diagnosed with pneumonia. First treated with Penicillin, Streptomycin, Ampicillin, Oleandomycin, Cephalosporin II, Cephalosporin IV, Ceftazidime, and Cefotaxime for 5 days, with no drop in temperature. Subsequently combined with hormones and TCM heat-clearing and detoxifying agents for 3 days, with no improvement in temperature. Examination showed a body temperature of 40.3°C, occasional sensation of cold air rushing upward from the hypochondrium, white tongue coating, and a deep, wiry, slippery, and rapid pulse. Synthesizing the pulse and symptoms: A wiry pulse indicates Shaoyang disease; a slippery and rapid pulse indicates phlegm-fire binding. Treatment should focus on harmonizing Shaoyang and resolving phlegm while purging fire. Prescription: Chai Hu 30g, Huang Qin 10g, Sheng Jiang 10g, Da Zao 12 pieces (split), Gua Lou 30g.
A certain physician said: "Only three ingredients, can it be effective?" Answered: "The previous prescription used Yin Hua (Honeysuckle Flower) 100g, Lian Qiao (Forsythia Fruit) 50g, Sheng Shi Gao (Gypsum Fibrosum) 250g, combined with antibiotics, yet was ineffective. This is likely not due to insufficient potency, but because the method did not match the syndrome. Now the disease is in Shaoyang, and the pivot should be harmonized. Instead, ice-cold natured drugs were used to constrain Yang Qi. When Yang Qi is constrained, heat cannot be eliminated. Furthermore, Li Dongyuan stated: For heat constraint and fire constraint, dispersion is necessary for cure, hence he listed Sheng Yang San Huo Tang (Ascending Yang and Dispersing Fire Decoction) to resolve high fever. Looking at the number and dosage of herbs in Sheng Yang San Huo Tang, although few in variety and small in dosage, the effect is miraculous. This is what I advocate. Additionally, Shang Han Lun (Treatise on Cold Damage) states: If there is vexation in the chest, remove Ren Shen (Ginseng) and Ban Xia (Pinellia). This patient's pulse is not only wiry but also slippery, accompanied by vexing cold qi rushing upward, so these five herbs are temporarily prescribed.
After one dose, after 4 hours, slight sweating occurred, fever subsided, and body temperature dropped to 36.8°C. After another dose, the pulse changed from slippery to wiry. Taking Xiao Chai Hu Tang (Minor Bupleurum Decoction) for 2 more doses resulted in recovery.
A certain physician said: "I have never heard of lung inflammation disappearing so quickly without anti-inflammatory drugs. Please explain." Answered: "Inflammation is a term from modern medicine. How TCM handles inflammation and how to treat it upon seeing inflammation is indeed a problem worth studying. However, I believe that assuming all so-called inflammation is caused by heat-toxin is likely incorrect. The ineffectiveness of this case lies precisely in this misconception."
Lung Abscess and Empyema
1. Knowing only to use cold-natured heat-clearing and detoxifying drugs, not realizing that excessive cold causes freezing and constraint, leading to heat-toxin congestion and constraint, the abscess cannot be removed.
Patient Wei XX, Female, 49 years old.
Chills and high fever, sweating with mental fatigue, coughing up pus and blood. Diagnosed with lung abscess at a certain hospital. After 1 month of treatment with Western antibiotics and TCM heat-clearing, detoxifying, blood-invigorating, and pus-draining methods, chills, high fever, and sweating improved significantly, and body temperature dropped from 41°C to 37°C. However, continuing the same medication for another month yielded no further symptom improvement, and multiple chest X-rays showed no changes. Careful examination of the syndrome revealed that besides coughing up purulent sputum, there were chest fullness and pain, dizziness and head distension, irritability, poor appetite, white greasy tongue coating, and a wiry, fine, and choppy pulse. Synthesizing the pulse and symptoms, thinking repeatedly: This must be due to prolonged use of heavy cold-natured agents, causing Yang Qi to be constrained, making the ascending and descending of Liver and Lung Qi difficult, preventing pus discharge. This aligns with Zhang Zhongjing's saying: "For patients vomiting pus from carbuncles, do not treat the vomiting; when the pus is exhausted, it will heal itself." The principle is the same. Therefore, dispersing Liver constraint, diffusing the Lung, resolving phlegm, and draining pus were planned. Prescription: Chai Hu 10g, Zhi Shi 10g, Bai Shao 10g, Gua Lou 15g, Qing Pi 10g, Jie Geng 10g, Bai Jie Zi 10g, Ju Ye 10g, Dang Gui 10g.
After 6 doses, dizziness, head distension, chest fullness and pain, and coughing up sputum improved. Continuing for 20 doses, all symptoms disappeared, chest X-ray normalized, and after another 10 doses, recovery was achieved.
2. Deficient Zheng Qi (Upright Qi) and Excess Pathogenic Factors, Heat-Toxin Congestion and Constraint, Pus Not Drained, Using Only Detoxification and Heat-Clearing Will Not Resolve the Disease.
Patient Hu XX, Male, 49 years old.
Over 2 months ago, after overwork, sudden chills, high fever, chest pain, and cough appeared. Diagnosed with lung abscess and empyema at a certain hospital. Treated with antibiotics for over 20 days with no improvement, then combined with TCM heat-clearing, detoxifying, blood-invigorating, and pus-draining methods for over 20 days, still no improvement. Three days ago, a ruptured opening was found at the swollen and painful area of the third intercostal space, discharging pus, with bubbles appearing during inspiration. Careful observation of the syndrome revealed, besides shortness of breath, continuous coughing up of yellow, thick, purulent sputum with a fishy odor, extreme mental fatigue, sweating, restlessness, frequent nausea and urge to vomit, dizziness making sitting difficult, a soybean-sized ruptured opening at the right axillary third intercostal space continuously discharging pus and bubbles with inspiration, surrounding skin not elevated but bluish-purple, pale complexion with slight bluish tint, white thick greasy tongue coating, and deep, wiry, slippery, and rapid pulse. Synthesizing pulse and symptoms, thinking: High fever in Lung Abscess is caused by heat-toxin congestion. Treatment should involve heat-clearing and detoxifying. But why has prolonged use been ineffective? Reconsidering the syndrome: Sweating, mental fatigue, pale complexion, and bluish-purple color at the rupture site indicate deficiency of both Qi and Blood. Deficiency requires tonification; without supporting Zheng Qi, how can pathogens be expelled? Considering the deep, wiry, slippery, and rapid pulse: A Lung deficiency pulse should be floating and deficient, but this case shows a deep, wiry Liver pulse, likely due to overuse of cold drugs constraining Liver Wood. Therefore, tonifying Qi and nourishing Yin to support the root, soothing the Liver and regulating Qi, resolving phlegm and draining pus to treat the branch were planned. Prescription: Chai Hu 18g, Jie Geng 18g, Gua Lou 30g, Zhi Shi 18g, Chi Shao 15g, Huang Qi 20g, Dang Gui 15g, Qing Pi 15g, Ju Ye 12g, Bai Jie Zi 1g, Mai Dong 10g.
Two doses administered day and night consecutively. The next day, chills and high fever decreased significantly, temperature dropping from 40.2°C to 38°C. Continuing for 4 doses, chills and fever disappeared, temperature normalized. Shortness of breath, cough, purulent sputum, and sweating improved. The chest rupture healed, local skin color lightened, appetite increased. Continuing for 60 doses resulted in complete recovery.
3. Qi and Yin Both Deficient, Heat-Toxin Congestion and Abundance, Pus Cannot Be Drained, Providing Only Detoxification and Heat-Clearing Means Zheng Qi Cannot Overcome Pathogens, Disease Cannot Heal.
Patient Gao XX, Female, 63 years old.
Fever with sweating, chest fullness and pain, coughing up pus and blood for over 20 days. Diagnosed with lung abscess and empyema. Treated with large doses of antibiotics for 10 days without effect. Then combined with large doses of TCM heat-clearing, detoxifying, phlegm-resolving, and pus-draining medicines for 10 days, still ineffective. Careful examination of the syndrome revealed, besides chest fullness and pain, high fever with sweating, body temperature 40.1°C, mental fatigue and weakness, shortness of breath difficult to sustain, slight swelling above the outer upper quadrant of the left breast with a ruptured opening continuously discharging pus and bubbles with inspiration, yellow-white greasy tongue coating, and deficient, large, slippery, and rapid pulse. Synthesizing pulse and symptoms, thinking: Deficient, large pulse with sweating, mental fatigue, and shortness of breath indicates Qi and Yin deficiency; slippery and rapid pulse indicates phlegm-heat and carbuncle pus. The previous ineffectiveness of detoxifying, heat-clearing, phlegm-resolving, and pus-draining agents was due to deficient Zheng Qi failing to expel pathogens. Treatment should tonify Qi and nourish Blood to support Zheng Qi. Prescription: Huang Qi 20g, Dang Gui 10g, Mai Dong 10g, Yin Hua 15g, Lian Qiao 15g, Gua Lou 15g, Jie Geng 10g, Bai Jie Zi 1g.
After 3 doses, fever improved significantly, temperature dropped to 38.5°C, other symptoms also reduced. Continuing for 7 doses, temperature normalized, spirit and appetite greatly increased, chest wound healed. Following the principle of not changing formula when effective, taking 40 doses resulted in recovery.
Atelectasis
Deficient Zheng Qi and Excess Pathogens, Failing to Support Zheng Qi Initially, Failing to Invigorate Collaterals Later, Disease Cannot Resolve.
Patient Yu XX, Female, 39 years old.
Chest tightness and shortness of breath, cough with low-grade fever for over 1 month. Treated with antibiotics etc. without effect, then with TCM heat-clearing, phlegm-resolving, and Yin-nourishing, moistening Lung methods, also without effect. Diagnosed with atelectasis after extensive examinations at a certain hospital. Careful examination of the syndrome revealed, besides shortness of breath, chest tightness, cough, and low-grade fever, fatigue and weakness, occasional slight sweating, thin white tongue coating, and deficient, large, wiry, and slippery pulse. Synthesizing pulse and symptoms, thinking: Deficient, large pulse indicates Qi and Yin deficiency; wiry and slippery pulse indicates phlegm. Combined with symptoms, this is Qi and Yin deficiency as the root, and Phlegm-Heat congesting the Lung as the branch. Therefore, tonifying Qi and nourishing Yin to support the root, clearing heat and resolving phlegm to treat the branch were planned. Modified Ji Sheng Jie Geng Tang (Platycodon Decoction from *Ji Sheng Fang*): Jie Geng 10g, Fang Ji 10g, Sang Bai Pi 10g, Zhe Bei Mu 10g, Gua Lou 15g, Gan Cao 10g, Dang Gui 10g, Sheng Yi Mi 18g, Xing Ren 10g, Huang Qi 15g, Bai He 15g.
After 18 doses, spirit improved significantly, but shortness of breath, cough, and chest fullness did not improve. Careful inspection showed thin white tongue coating and deep pulse. Thinking: Pulse changing from large to deep indicates Zheng Qi slightly recovering, but Qi stagnation and Blood stasis become more prominent. Treatment plans to regulate Qi and invigorate Blood, diffuse Lung and resolve phlegm. Modified Xue Fu Zhu Yu Tang (Blood Stasis Removing Decoction in the Chest Mansion): Dang Gui 10g, Sheng Di 10g, Tao Ren 10g, Hong Hua 10g, Gan Cao 10g, Zhi Ke 10g, Chi Shao 10g, Chai Hu 10g, Chuan Xiong 10g, Jie Geng 10g, Niu Xi 10g, Gua Lou Pi 15g.
After 4 doses, chest fullness, shortness of breath, and cough improved. Continuing for 16 doses, all symptoms disappeared. X-ray showed normal heart, lungs, and diaphragm.
A friend asked: "Why was phlegm-resolving and blood-invigorating ineffective before, but effective later?" Answered: "Initially, the pulse was large, and the syndrome was predominantly deficiency, so treatment should support Zheng Qi. Later, the pulse became deep, and the syndrome was predominantly Qi stagnation and Blood stasis, so treatment should invigorate Blood, regulate Qi, diffuse Lung, and resolve phlegm. Thus, dispelling pathogens initially was ineffective, but later it was effective. This embodies Zhang Zhongjing's principle: 'Observe the pulse and symptoms, know what deviation has occurred, and treat according to the syndrome.'"
Nodular Disease
Differentiating Syndrome from Pulse, Prescribing Formula Based on Syndrome, Efficacy is Immediate.
Patient Hao XX, Female, 59 years old. For 10 years, often felt fatigue and weakness, dry mouth, and excessive sweating. Diagnosed with diabetes. For the past 4+ months, fatigue and weakness worsened progressively, accompanied by cough with sputum, dyspnea when lying flat (improving when sitting up), chest fullness and vexation, poor appetite, nodular erythema, and enlargement of hilar lymph nodes and axillary and inguinal lymph nodes. Diagnosed with nodular disease. Hospitalized for 4+ months, Western medicine treatment was ineffective, then combined with TCM antitussive and expectorant herbs, which was not only ineffective but also caused superficial phlebitis in the right arm. Careful examination of the syndrome revealed, besides the above, cough with urinary incontinence, dizziness and head distension, white tongue coating, and deficient, large, wiry, and slippery pulse. Synthesizing pulse and symptoms, thinking: This disease involves both Qi and Yin deficiency and Phlegm-Heat stagnation; both Liver and Lung constraint and Wind pathogen entering collaterals. Treatment must be sequenced; otherwise, it is difficult to treat. Given the deficient, large, wiry, and slippery pulse, treatment should first tonify Qi and nourish Yin to support Zheng Qi, and regulate Qi, resolve phlegm, and stop cough to eliminate pathogens. Prescription: Chai Hu 10g, Dang Gui 10g, Bai Shao 10g, Mai Dong 10g, Ren Shen 10g, Wu Wei Zi 10g, Ban Xia 10g, Chen Pi 10g, Qing Pi 10g, Huang Qin 10g, Zi Wan 10g.
After 4 doses, chest fullness and vexation, sweating and fatigue, and cough with urinary incontinence decreased. However, cough, shortness of breath, body pain, and phlebitis did not improve. White tongue coating, wiry, slippery, and slightly tight pulse. Synthesizing pulse and symptoms, thinking: Wiry and tight pulse indicates Wind-Cold entering collaterals; slippery indicates internal Phlegm-Heat constraint. Treatment should disperse Wind, scatter Cold, resolve phlegm, and unblock collaterals. Prescription: Huang Bo 10g, Cang Zhu 10g, Nan Xing 10g, Gui Zhi 10g, Fang Ji 10g, Wei Ling Xian 3g, Tao Ren 10g, Hong Hua 10g, Long Dan Cao 10g, Qiang Huo 3g, Bai Zhi 3g, Chuan Xiong 10g.
After 12 doses, cough, shortness of breath, body pain, phlebitis, and enlargement of hilar, axillary, and inguinal lymph nodes all disappeared. Continuing for 6 doses, except for sweating and thirst, all symptoms vanished.
A certain physician said: "I have never heard of nodular disease, yet it was cured with TCM. Why?" Answered: "The name 'nodular disease' is not explicitly discussed in TCM classics. However, why was it cured? Firstly, subtlety lies in the pulse; secondly, treating according to the syndrome. The original pulse was deficient, large, wiry, and slippery, so initially Qi was tonified and Yin nourished to support Zheng Qi, and Qi regulated and phlegm resolved to expel pathogens. Later, the pulse became wiry, slippery, and tight, so Wind was dispersed and Cold scattered. Asked: "Why were Qiang Huo, Bai Zhi, and Wei Ling Xian used in such small doses (up to 3g) in the formula?" Answered: "For conditions of Phlegm condensation and Blood stagnation, Wind-dispersing herbs should not be heavily used. Excessive dispersion leads to dry Blood, making Phlegm condensation hard to resolve. Hence, small doses are used to prevent damaging Zheng Qi and aiding pathogens."
Tuberculous Pleurisy
1. Clinging to Xuan Yin (Suspension Fluid), Stubbornly Adhering to Tuberculosis Diagnosis, Prolonged Inefficacy.
Patient Song XX, Female, Adult.
Chest fullness and pain for over 7 months. Diagnosed with tuberculous pleurisy. Initially treated with thoracentesis, anti-tuberculosis drugs, and hormones. Pleural effusion improved significantly, but has not fully absorbed. Repeated punctures for drainage yielded only small amounts of fluid. Later invited a TCM physician to use attacking and draining water-fluid methods. However, after 10 days, symptoms not only did not decrease, but nausea and diarrhea appeared. Careful examination revealed right-sided chest pain, shortness of breath, white tongue coating, and deep, wiry, choppy pulse. Synthesizing pulse and symptoms, thinking: This chronic disease has entered the Blood level; it cannot be treated solely from the Qi level. Plan to soothe the Liver, regulate Qi, invigorate Blood, and resolve phlegm. Prescription: Chai Hu 10g, Chi Shao 10g, Zhi Ke 10g, Bai Jie Zi 10g, Chen Pi 10g, Jiang Xiang 10g, Xing Ren 10g, Gan Cao 10g.
After 2 doses, chest fullness and pain, shortness of breath decreased. Continuing for 10 doses, all symptoms disappeared, recovery achieved.
A certain physician said: "Encapsulated pleural effusion resolved so quickly. Why?" Answered: "The reason for prolonged inefficacy was that the disease was in the Blood level but treated only in the Qi level. Now treating from the Blood level, thus rapid recovery."
2. Clinging to Xuan Yin (Suspension Fluid), Neglecting Syndrome Differentiation, Prolonged Inefficacy.
Patient Gao XX, Male, 22 years old.
Continuous high fever, sweating, chest fullness, shortness of breath for over 50 days. Diagnosed with tuberculous pleurisy. Treated with Western medicine for 30 days without effect, then combined with TCM heat-clearing, detoxifying, and attacking/draining water-fluid methods for over 20 days, also ineffective. Careful examination revealed alternating chills and fever, body temperature 39.9°C, chest fullness and shortness of breath, nausea and urge to vomit, white tongue coating, and wiry, rapid pulse. Thinking: Alternating chills and fever is a Shaoyang syndrome; harmonizing Shaoyang is appropriate. Prescription: Chai Hu 28g, Hou Po 10g, Cao Guo 10g, Bing Lang 10g, Huang Qin 10g, Zhi Mu 10g, Chang Pu 10g, Su Ye 10g, Gan Cao 6g.
After 4 doses, symptoms greatly reduced, temperature 37.5°C. Continuing for 4 doses, temperature normalized, appetite increased, pleural effusion significantly reduced. Pulse examined as wiry, tight, small, and rapid. Prescription: Chai Hu 10g, Chi Shao 10g, Bai Jie Zi 6g, Jie Geng 10g, Zhi Shi 10g, Chen Pi 10g, Ban Xia 10g, Huang Qin 10g, Gan Cao 6g. After 30 doses, all symptoms disappeared, recovery achieved. Physician asked: "Why not use attacking and draining water-fluid methods?" Answered: "This syndrome presents Shaoyang signs, requiring harmonization. Zhang Zhongjing lists three prohibitions for Shaoyang in *Shang Han Lun*, one of which prohibits purging/attacking. Hence, we do not use attacking methods, following Zhang Zhongjing's instruction."
3. Combined Disease of Three Yangs, Counterproductively Using Clearing and Resolving, Exterior and Interior Disharmony, Disease Hard to Cure.
Patient Yu XX, Male, 21 years old.
Continuous high fever and chest pain for over 40 days. Physician failed to confirm diagnosis, treated with Western antibiotics etc. for over 20 days, temperature remained around 39°C. Hospitalized for examination and treatment, massive pleural effusion found, diagnosed with tuberculous pleurisy. Continued Western medicine, combined with large doses of TCM heat-clearing and detoxifying drugs for over 20 days, temperature still did not drop. Careful examination revealed, besides chest pain and fullness, cough and shortness of breath, alternating chills and fever, head and body pain, bitter taste in mouth and dry throat, nausea and urge to vomit, abdominal distension and pain worsening on pressure, incomplete bowel movements, slightly yellow urine, yellow-white tongue coating, and wiry, tight, rapid pulse. Synthesizing pulse and symptoms, it is a syndrome involving Taiyang, Shaoyang, and Yangming simultaneously. Urgently prescribe Da Yuan Yin (Origin-Reaching Decoction) modified: exteriorly dispersing Wind-Cold, centrally regulating Liver and Gallbladder, interiorly attacking excess stagnation. Prescription: Hou Po 10g, Cao Guo 10g, Bing Lang 10g, Huang Qin 10g, Zhi Mu 10g, Chang Pu 10g, Chai Hu 10g, Gui Zhi 10g, Bai Zhi 10g, Da Huang 3g.