员××，女，35岁。
紫斑反复出现4个多月。医诊过敏性紫癜。先用西药治疗2个多月不效，后又配合中药归脾汤加减、犀角地黄汤加减、化斑汤加减仍不效。审其斑疹虽然全身都见，但以两小腿为最多，其中大者如黄豆，小者仅如小米，且按之平坦，不退色。并微有痒感，舌苔薄白，脉弦细。综合脉证，思之：斑有阴阳两种，阴斑者稀少而淡红，阳斑者其色红而多；又有胃肺之别，其发于肺者斑小或兼见痒，其发于胃者大而红且无痒感，至若侵及于肾者则见紫蓝或黑色。本病斑出粒小而密布，且有痒感，乃热毒侵及血络，且病在肺也。前方之用归脾补益，犀角地黄、化斑等清胃均非其治也。治宜拟清热解毒，凉血活血。处方：丹参15克，川芎10克，生地10克，白芍10克，当归10克，银花10克，连翘10克，薄荷3克。
服药4剂，斑疹大部消退；继服10剂，愈。
2.但知清热凉血，不知分辨表里，攻伐无过，终非其治
柳××，男，32岁。
紫斑遍布2个多月。医诊过敏性紫癜。先以西药治疗1个多月无效。后又配合清热凉血之剂治之仍不效。审其全身，特别是腰以下，尤是小腿部有大量密集的小出血点，身微痒，时见少量鼻衄，舌苔白，脉浮。综合脉证，思之：此病热在肺也，治宜从肺论治。拟疏风清热，凉血消斑。处方：银花15克，连翘15克，荆芥6克，薄荷10克，赤芍10克，丹参15克，生地15克，元参15克。
服药1剂，诸证大减，继服7剂，愈。
某医云：清热凉血乃治病大法，且朱老亦用清热解毒，其效何故不同?答曰：病位有别也，前方重在治胃，今方重在治肺，故其效有异也。
3.胶于归脾，泥于建中，以热作寒，久治病重
向××，女，45岁。
小腿满布出血点，大者成片，小者成点2年余。医诊过敏性紫癜。先以西药治疗1年多不效，后以中药归脾、建中、一味大枣等近1年，不但诸证不减，反见日渐加重。细审其证，两小腿满布出血点，小者成点如小米，大者成片，几乎看不到健康的皮肤，若走路稍多时加重，平卧休息后好转，口微干，舌苔黄白，脉弦滑数。综合脉证，反复思考：脉滑数者，肺胃热盛也。叶天士云：“若斑色紫，小点者，心包热也；点大而紫，胃中热也。黑斑而光亮者，热胜毒盛，虽属不治，若其人气血充者，或依法治之，尚可救；若黑而晦者必死；若黑而隐隐，四旁赤色，火郁内伏，大用清凉透发，间有转红成可救者。若夹斑带疹，皆是邪之不一，各随其部而泄。然斑属血者恒多，疹属气者不少。”此肺胃俱热，不可以温热为方也。治宜清肺胃，凉血清斑。处方：犀角10克(现代水牛角代替)，生地10克，白芍10克，丹皮10克，生石膏20克，知母10克，元参20克。
服药6剂，斑疹明显减少，且见大片大片的健康皮肤出现；但继服6剂之后，小的出血点又见增多。细审其舌苔薄白，舌质稍暗，脉沉紧而数。反复思考：前之用化斑汤加减有效者，方、证合拍也，今之不效者，方、证有误也。其误者何?今脉已转弦紧而数，即病在血分，血络瘀滞之故也。治宜拟活血祛瘀。处方：桃仁10克，甘草10克，大黄6克，桂枝10克，丹皮15克，生地15克。
服药10剂，斑疹全部消失；继服20剂，愈。
某医云：前用清气凉营始效而后不效者何也?答曰：前用清气凉营始效者，脉滑数而肺胃热炽也，后用不效者乃瘀血阻滞所为也，若瘀血阻滞较重而过用寒凉则瘀血难除，故诸家祛瘀者多佐温散，以气行则血行也。
4．邪火炽盛，迫血妄行，反作凉血止血，病非所在，血不得止
张××，女，13岁。
4个多月来，吐血衄血，尿血紫斑。医诊过敏性紫癜。先以西药治疗2个多月无效，继又配合中药凉血止血之剂亦不效。细审其证，全身紫斑，尤以下肢为甚，其斑在小腿片片相联，问有小的出血点，很少健康皮肤，鼻衄，牙衄，耳衄，尿血，便血，尿常规除大量红细胞外，并有尿蛋白(++)，舌苔黄燥，舌红，脉滑数有力。综合脉证，诊为心胃实火，迫血妄行。治拟泻火解毒。处方：大黄6克，黄连10克，黄芩10克。
服药4剂，出血停止，斑疹消退七八；当服至第8剂时，又发现少量鼻衄，加生地15克；服药8剂，诸证全消。为了巩固效果，又服土大黄叶、小蓟适量1个月，痊愈。
某医云：如此重症之紫癜，西药称为神效者几乎均已用遍，中药水牛角、羚羊、生地、阿胶亦皆全用，而却无效，老师竞嘱停用其他中西药饵，但用泻心汤小剂，吾不敢想，不敢用也。而药后竞如此之效，其故何也?答曰：从舌、脉来看，前用诸药与证甚相抵触，若不去除恐用泻心汤不得效也，故嘱暂停全部中、西药饵。今证脉相参，实乃邪火有余，逼血妄行所致的吐衄，紫斑，故以泻心汤苦寒清泻，直折其热，使其火降血止。某医又云：余见其神疲气短，思其如此之虚，岂敢用大黄也?答曰：壮火食气，故令气短乏力，正如仲景《金匮要略》所说：“心气不足，吐血，衄血，泻心汤主之。”
成年人腺脑垂体功能减退症
正虚反作风邪，胶于祛风，徒伤阳气
章××，女，40岁。
分娩大出血后6年多来，全身经常窜痛麻木，畏风恶寒，纳呆食减，毛发干脆脱落，虽在酷暑犹需着棉衣棉裤保暖，并严闭门窗以防受风，且疲乏无力，自汗盗汗。医诊席汉病。先予西药久治不效，继又聘请某中医以补气养血，祛风散寒配合治之，数年后，效果仍不显著。细审其证，除上述诸证之外，并见面色萎黄，皮肤干燥，消瘦乏力，手足心烦热，而夏季反手足厥冷，舌苔白，脉弦细涩。综合脉证，思之：脉弦者，肝也，寒也；细者，气血俱虚也；涩者，滞也，寒也。合之于症，乃症见于脾，脉见于肝，合而论之，乃脾虚木乘，气血阴阳俱虚证也。前方之于祛风量虽小而损正之力则大，正如仲景所说：“火邪虽微，内攻有力。”故久治不效。治宜健脾抑木，补气养血，益阴助阳。处方：黄芪15克，当归10克，肉桂10克，川芎10克，生地10克，白芍10克，党参10克，白术10克，茯苓10克，甘草10克，附子10克，麦冬10克，半夏10克，肉苁蓉15克，生姜3片，大枣5个。
服药2剂，精神、食欲好转，身痛，畏风恶寒均减；继服上方30剂，诸证大部消失，虽至秋季犹可在户外活动；又服30剂，至春节期间，诸证全消。
某医云：始用诸方几与后方药物相同，而多一些祛风散寒药，然其效果不著者何也?答曰：此气血阴阳大衰之躯不可稍投损正之药也。再问：先生所云本方有健脾抑肝之功，不解也?答曰：小建中汤与理中汤均称温中之方，其区别在于小建中乃温中健脾抑肝，理中为温中散寒，其区别在于小建中汤中有桂枝的温肝伐肝，白芍的柔肝理肝；理中汤中有干姜的温中散寒，白术的健脾燥湿。本方虽非桂枝配白芍，而却有肉桂配白芍，肉桂者温肝而伐肝邪，白芍者柔肝而理肝，两药相合，既健脾而又抑肝，故云十四味建中汤有健脾抑肝之功也。
前(腺)脑垂体功能亢进症
虚实并见，寒热俱存，或但扶正，或但祛邪，或温之甚。或凉之过，不知协调，因之无效
赵××，女，35岁。
从20岁左右开始，即经常感到头晕头痛，疲乏无力，口渴喜饮，手足憋胀，腰背酸痛，但并没有引起注意，其后逐渐发现手足厚大，面貌粗陋，嘴唇增厚，耳鼻长大，烦躁易怒。乃开始请中医治疗，但始终效果不够明显。又去县医院检查治疗1年多，虽服西药很多亦不见效，不得已，转赴上海求治。诊为肢端肥大症。并要求手术治疗，因种种原因未予手术。细审其证，除面貌粗陋，嘴唇厚大，耳鼻厚大，手足厚大之外，并见其腰背酸痛，疲乏无力，口干而粘，舌体胖大而厚，舌苔白而稍腻，脉虚而滑稍数。综合脉证，思之：腰背酸痛，脉滑稍数，且与气候变化有关，必内有痰热，外受风寒湿也。乃予丹溪上中下痛风方。处方：黄柏10克，苍术10克，制南星10克，桂枝10克，防己10克，威灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。
服药1剂后，全身酸痛好转，但继续服用则非但无效，反见加重。又思脉虚稍大者虚也。因拟补气养阴之剂。处方：黄芪15克，当归6克，党参10克，麦冬10克，五味子10克，生地15克，山药10克，山萸肉10克，茯苓10克，泽泻10克，丹皮10克。
服药1剂，其证俱减，但服至第6剂时，其证又剧。综合脉证，再查诸医所用之方，或予扶正，或予祛邪，或用温经散寒，或用燥湿清热，或用苦降泻火，然均时效时剧。思之：此气阴俱虚，痰热俱见，阻滞经络证也。治之者，尤当分其虚实多少，寒热比例，始可取效。因作补气养阴为主，佐用化痰泻火，通经活络之剂。处方：黄芪15克，防己10克，桔梗10克，桑皮10克，浙贝母10克，瓜蒌15克，甘草6克，当归10克，生薏米15克，杏仁10克，百合30克，干姜1克。
服药10剂，精神增加，身痛好转；加桑枝15克，又服30剂，诸证大减；再服90剂，诸证消失八九。
后(神经)脑垂体功能减退症——尿崩症
1．寒饮凝结，水津不化，不知温化，但予生津，其病不愈
李××，男，50岁。
烦渴多饮，疲乏无力2年多。医诊尿崩症。先用西药治疗无效，后又配合中药养阴生津、清热生津、益气养阴等治疗1年多，仍无明显效果。细审其证，除烦渴，多饮，多尿，疲乏无力之外，并见其胃脘痞满，舌苔黄白，脉弦紧而数。综合脉证，思之：阴虚津亏之证当见细数之脉，胃热津伤者当见滑数之脉，气阴两虚者当见虚大而数之脉，今脉反见弦紧而数，脉证不相合也。又思：弦紧之脉者，寒也，饮也；紧数相兼者，寒饮凝滞不化之脉也。合之于证，必脾阳不足水饮不化膀胱不得化气之证。乃予温中健脾，化饮利水。处方：附子10克，肉桂10克，党参10克，白术10克，干姜10克，甘草10克，泽泻10克，猪苓10克，茯苓10克。水煎，冷服。
某医云：此病津液如此之伤而反用大热加分利，岂不危哉?答曰：《金匮要略·消渴小便利淋病脉证并治》云：“脉浮，小便不利，微热消渴者，宜利小便发汗，五苓散主之。”“渴欲饮水，水入则吐者，名日水逆，五苓散主之。”开用温阳利水治消渴病之先河，乃其方通阳利水以促膀胱之气化耳。本证非但膀胱气化失职，水不下输，不仅下焦蓄水，进而胃中亦有停水，故非以健脾温中，通阳利水不能愈其疾。至于能否津伤而危殆，依余之见非但不能伤津，亦且助其津液生耳。
服药4剂，烦渴大减，精神增加；继服20剂，诸证消失，愈。
2．胶于补益，反壅其气；固于养阴，反增痰湿，但求其脉，病始治愈
张××，女，40岁。
烦渴多饮，纳呆尿多2年多。医诊尿崩症。始予西药治疗不效，后又配合中药滋阴生津、补气养阴、养阴补肾之剂亦不效。细审其证见烦渴多饮，虽饮很多水亦难解渴，有时喝的脘腹胀满仍频频思饮，且饮水不久即小溲，纳呆食减，头晕乏力，心烦不安，日渐消瘦，舌苔黄白而润，脉濡缓而沉。综合脉证，思之：脉沉者，气郁也；濡缓者湿痰也。合于证，乃湿痰不化，肝脾气滞也。治拟疏肝理气，除湿化痰，斡旋阴阳。处方：柴胡10克，干姜6克，桂枝9克，花粉15克，黄芩10克，牡蛎10克，甘草6克，苍术3克。
服药2剂，烦渴稍减；继服上药20剂，烦减渴少，纳增。惟夜问仍口咽干燥，且近日来发现咽中有异物阻塞感。思之：病程较久，气阴俱伤，但以祛邪则不可也。因拟益气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克，生地10克。连续服药30剂，诸证消失，愈。
肾上腺皮质功能减退症不审色脉，但凭症状，粗施方药，终始不效郑××，男，65岁。头晕眼花，疲乏无力，皮肤日渐变黑1年多。医诊肾上腺皮质功能减退症。先以西药治疗精神稍有好转，但一停药诸证又见加重，后以中药健脾燥湿和胃，活血化瘀等配合应用亦无明显效果。细审其证，头晕眼花，失眠健忘，疲乏无力，纳呆食减，面部、四肢暴露部位，关节伸屈面、皱纹，以及乳头、乳晕、肩腋部，腰臀皱襞，下腹中线，指甲根部色深黑，其他皮肤棕黑色，即如口腔、唇、舌、牙龈及上颚粘膜上均有大小不等的点状、片状的蓝黑色色素沉着，舌苔薄白，脉细弱而缓。综合脉证，思之：皮肤色黑者，肾气不足也；怯冷乏力，脉细弱而缓者，阴阳俱虚也。治宜培补肾气。处方：附子4克，肉桂4克，山茱萸15克，杜仲10克，怀牛膝10克，生地15克，炙草10克，山药10克，枸杞子10克，鹿角胶10克(烊化)，肉苁蓉10克。
Patient ××, female, 35 years old.
Purpura (purpura) recurred repeatedly for more than 4 months. The physician diagnosed it as allergic purpura (allergic purpura). Western medicine treatment was used first for over 2 months without effect, followed by traditional Chinese medicine (TCM) modifications of Guipi Tang (Restore the Spleen Decoction), Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), and Huaban Tang (Eliminate Macules Decoction), yet still without effect. Upon examination, although macules were present all over the body, they were most numerous on both lower legs. The larger ones were like soybeans, and the smaller ones like millet grains; they were flat upon pressure and did not fade. There was also a slight sensation of itching. The tongue coating was thin and white, and the pulse was wiry and fine. Synthesizing the pulse and symptoms, I reflected: Macules can be divided into Yin macules and Yang macules. Yin macules are sparse and pale red, while Yang macules are red in color and numerous. There is also a distinction between those originating from the Lung and those from the Stomach. Those originating from the Lung are small or accompanied by itching; those from the Stomach are large, red, and without itching. If invading the Kidney, they appear purple-blue or black. In this case, the macules are small, densely distributed, and itchy, indicating that heat-toxin has invaded the blood collaterals, and the disease location is in the Lung. The previous use of Guipi Tang for tonification, and Xijiao Dihuang Tang and Huaban Tang for clearing the Stomach, were not appropriate treatments. The treatment should focus on clearing heat and detoxifying, cooling the blood and invigorating blood circulation. Prescription: Danshen 15g, Chuanxiong 10g, Shengdi 10g, Baishao 10g, Danggui 10g, Yinhua 10g, Lianqiao 10g, Bohe 3g.
After taking 4 doses, most of the macules subsided; after continuing with 10 more doses, the patient recovered.
2. Knowing only to clear heat and cool blood, but not distinguishing between exterior and interior, excessive attacking is ultimately incorrect treatment.
Patient Liu ××, male, 32 years old.
Purpura covered the whole body for more than 2 months. Diagnosed as allergic purpura. Western medicine treatment for over 1 month was ineffective. Subsequent treatment with agents for clearing heat and cooling blood also failed. Examination revealed numerous dense small hemorrhagic spots, especially below the waist, particularly on the lower legs. The body had slight itching, and occasional minor epistaxis (nosebleed) occurred. The tongue coating was white, and the pulse was floating. Synthesizing the pulse and symptoms, I reflected: The heat pathogen is in the Lung; treatment should address the Lung. The method proposed was to disperse wind and clear heat, cool the blood and eliminate macules. Prescription: Yinhua 15g, Lianqiao 15g, Jingjie 6g, Bohe 10g, Chishao 10g, Danshen 15g, Shengdi 15g, Yuan Shen 15g.
After 1 dose, major symptoms significantly reduced; after continuing with 7 more doses, the patient recovered.
A certain physician asked: Clearing heat and cooling blood is a major principle of treatment, and Master Zhu also uses clearing heat and detoxifying methods. Why are the effects different? The answer is: The disease locations differ. The former prescription focused on treating the Stomach, while the current one focuses on treating the Lung, hence the difference in efficacy.
3. Clinging to Guipi Tang, adhering to Jianzhong Tang, treating heat as cold, leading to prolonged ineffective treatment and worsening condition.
Patient Xiang ××, female, 45 years old.
Lower legs covered with hemorrhagic spots, large patches and small dots, for over 2 years. Diagnosed as allergic purpura. Western medicine treatment for over 1 year was ineffective. Subsequent TCM treatment with Guipi Tang, Jianzhong Tang, and single herb Jujube Date (Dazao) for nearly 1 year not only failed to reduce symptoms but caused them to worsen progressively. Careful examination showed lower legs covered with hemorrhagic spots, small dots like millet, large patches, leaving almost no healthy skin visible. Symptoms worsened with slight walking and improved with lying down rest. The mouth was slightly dry, tongue coating yellow-white, and pulse wiry, slippery, and rapid. Synthesizing pulse and symptoms, reflecting repeatedly: A slippery and rapid pulse indicates excess heat in the Lung and Stomach. Ye Tianshi stated: "If macules are purple with small dots, it is heat in the Pericardium; if dots are large and purple, it is heat in the Stomach. Black macules that are bright indicate severe heat and toxin; although considered untreatable, if the person has sufficient Qi and Blood, proper treatment may save them. If black and dull, death is certain. If black and faint with red surroundings, fire is郁 (stagnant) internally; using strong cooling and venting methods may occasionally turn them red and salvageable. If accompanied by rashes, it indicates diverse pathogens, each draining according to its location. However, macules mostly belong to Blood, while rashes often belong to Qi." This case presents heat in both Lung and Stomach; warm-tonifying formulas are contraindicated. Treatment should clear Lung and Stomach heat, cool blood, and eliminate macules. Prescription: Xijiao 10g (substituted with Shuiniujiao/Rhino Horn substitute/Narwhal horn substitute/Buffalo horn in modern practice), Shengdi 10g, Baishao 10g, Danpi 10g, Sheng Shigao 20g, Zhi Mu 10g, Yuan Shen 20g.
After 6 doses, macules significantly decreased, and large areas of healthy skin appeared; however, after continuing another 6 doses, small hemorrhagic spots increased again. Careful examination of the tongue showed thin white coating and slightly dark tongue body; pulse was deep, tight, and rapid. Reflecting repeatedly: The previous effectiveness of Huaban Tang modification was due to formula-syndrome correspondence; current ineffectiveness is due to formula-syndrome mismatch. What is the error? The pulse has turned wiry-tight and rapid, indicating the disease is in the Blood level, caused by blood stasis in the collaterals. Treatment should invigorate blood and dispel stasis. Prescription: Taoren 10g, Gancao 10g, Dahuang 6g, Guizhi 10g, Danpi 15g, Shengdi 15g.
After 10 doses, all macules disappeared; after continuing 20 more doses, the patient recovered.
A certain physician asked: Why did clearing Qi and cooling Ying initially work but later fail? The answer is: Initial effectiveness was due to slippery-rapid pulse and intense Lung-Stomach heat; subsequent failure was due to blood stasis obstruction. If blood stasis is severe and cold-cooling herbs are overused, stasis is difficult to resolve. Therefore, practitioners who dispel stasis often add warming-dispersing herbs, as moving Qi moves Blood.
4. Excessive evil fire forcing blood to move recklessly; counterintuitively using blood-cooling and hemostatic methods misses the target, so bleeding does not stop.
Patient Zhang ××, female, 13 years old.
For over 4 months, hematemesis (vomiting blood), epistaxis, hematuria (blood in urine), and purpura. Diagnosed as allergic purpura. Western medicine treatment for over 2 months was ineffective. Subsequent TCM treatment with blood-cooling and hemostatic agents also failed. Careful examination revealed whole-body purpura, worse on lower limbs, with macules connecting in patches on calves, interspersed with small hemorrhagic spots, leaving little healthy skin. Epistaxis, gingival bleeding (epistaxis/gingivorrhagia), otorrhagia (ear bleeding), hematuria, and hematochezia (blood in stool) were present. Urinalysis showed massive red blood cells and protein (++). Tongue coating was yellow and dry, tongue body red, pulse slippery, rapid, and forceful. Synthesizing pulse and symptoms, diagnosed as excess fire in Heart and Stomach forcing blood to move recklessly. Treatment proposed: purging fire and detoxifying. Prescription: Dahuang 6g, Huanglian 10g, Huangqin 10g.
After 4 doses, bleeding stopped, and 70-80% of macules subsided; at the 8th dose, minor epistaxis reappeared, so Shengdi 15g was added. After 8 doses, all symptoms vanished. To consolidate results, Tu Dahuang Ye (Rhizoma Polygoni Cuspidati Leaf) and Xiaoji (Herba Centipedae) were taken appropriately for 1 month, resulting in recovery.
A certain physician asked: For such severe purpura, where Western medicines deemed 'miraculous' were almost exhausted, and TCM herbs like Shuiniujiao, Lingyangjiao, Shengdi, and Ejiao were fully utilized without effect, how could the teacher advise stopping all other drugs and using only a small dose of Xiexin Tang? I dared not think or use it. Yet the effect was so remarkable. Why? The answer is: Based on tongue and pulse, previous medications contradicted the syndrome significantly. Without removing them, Xiexin Tang would likely fail. Hence, I advised pausing all TCM and Western medicines. Now, correlating syndrome and pulse, it is clearly excess evil fire forcing blood recklessly, causing hematemesis, epistaxis, and purpura. Thus, Xiexin Tang was used for bitter-cold purging to directly curb the heat, lowering fire and stopping blood. Another physician said: I saw his fatigue and shortness of breath, considering such deficiency, how could I dare use Dahuang? The answer is: Strong fire consumes Qi, causing shortness of breath and weakness. As Zhongjing stated in *Jingui Yaolue*: "Heart Qi deficiency, hematemesis, epistaxis, Xiexin Tang governs."
Adult Hypopituitarism
Deficient Zheng mimicking wind pathogen; clinging to wind-dispelling, vainly damaging Yang Qi.
Patient Zhang ××, female, 40 years old.
For over 6 years following postpartum hemorrhage, the body frequently experienced wandering pain and numbness, aversion to wind and cold, poor appetite, brittle and falling hair. Even in midsummer, cotton clothes were needed for warmth, doors and windows strictly closed to prevent wind exposure. Fatigue, spontaneous sweating, and night sweats were present. Diagnosed as Sheehan's Syndrome. Western medicine treatment for a long time was ineffective. Later, a TCM practitioner combined Qi and Blood tonification with wind-dispelling and cold-scattering methods. After several years, results remained insignificant. Careful examination revealed sallow complexion, dry skin, emaciation and fatigue, heat in palms and soles, yet cold extremities even in summer. Tongue coating white, pulse wiry, fine, and choppy. Synthesizing pulse and symptoms: Wiry pulse corresponds to Liver and Cold; fine pulse indicates joint deficiency of Qi and Blood; choppy pulse indicates stagnation and Cold. Correlating with symptoms appearing in Spleen and pulse in Liver, this is Spleen deficiency with Wood overacting, joint deficiency of Qi, Blood, Yin, and Yang. The previous wind-dispelling approach, though low dosage, greatly damaged Zheng Qi, as Zhongjing said: "Though Fire Pathogen is slight, its internal attack is powerful." Hence, prolonged treatment failed. Treatment should strengthen Spleen and suppress Liver, tonify Qi and Blood, benefit Yin and assist Yang. Prescription: Huangqi 15g, Danggui 10g, Rougui 10g, Chuanxiong 10g, Shengdi 10g, Baishao 10g, Dangshen 10g, Baizhu 10g, Fuling 10g, Gancao 10g, Fuzi 10g, Maidong 10g, Banxia 10g, Roushoucong 15g, Shengjiang 3 slices, Dazao 5 pieces.
After 2 doses, spirit and appetite improved, body pain and aversion to wind/cold decreased. Continuing 30 doses led to disappearance of most symptoms, allowing outdoor activity even in autumn. Another 30 doses resulted in complete symptom resolution by Spring Festival.
A certain physician asked: Initial formulas were similar to the final one, just adding more wind-dispelling and cold-scattering herbs, yet why was efficacy lacking? The answer is: This body with severe deficiency of Qi, Blood, Yin, and Yang cannot tolerate any further damage to Zheng Qi. Question: You mentioned the formula strengthens Spleen and suppresses Liver; I don't understand. Answer: Xiaojianzhong Tang and Lizhong Tang are both warming-middle formulas. The difference is Xiaojianzhong warms middle, strengthens Spleen, and suppresses Liver, while Lizhong warms middle and scatters cold. Specifically, Xiaojianzhong contains Guizhi to warm and subdue Liver, and Baishao to soften and regulate Liver; Lizhong contains Ganjiang to warm middle and scatter cold, and Baizhu to strengthen Spleen and dry dampness. Although this formula lacks Guizhi-Baishao pairing, it uses Rougui-Baishao. Rougui warms and subdues Liver evil; Baishao softens and regulates Liver. Together, they strengthen Spleen and suppress Liver. Thus, Shisiwei Jianzhong Tang has the function of strengthening Spleen and suppressing Liver.
Previous Hyperpituitarism
Excess and deficiency coexist, cold and heat coexist. Only supporting Zheng, only expelling Evil, or excessive warming/cooling without coordination leads to inefficacy.
Patient Zhao ××, female, 35 years old.
Since around age 20, frequent dizziness, headache, fatigue, thirst with desire to drink, distension in hands and feet, backache. Initially ignored. Gradually noticed enlargement of hands and feet, coarse features, thickened lips, enlarged ears and nose, irritability. TCM treatment started but lacked obvious effect. County hospital treatment for over 1 year with many Western medicines was ineffective. Transferred to Shanghai for treatment. Diagnosed as Acromegaly. Surgery requested but declined due to various reasons. Careful examination revealed coarse features, thick lips, enlarged ears/nose/hands/feet, backache, fatigue, sticky dry mouth, swollen and thick tongue body, white and slightly greasy tongue coating, deficient, slippery, slightly rapid pulse. Synthesizing pulse and symptoms: Backache, slippery-slightly rapid pulse related to climate changes indicates internal Phlegm-Heat and external Wind-Cold-Dampness. Prescribed Danxi Shang Zhong Xia Tongfeng Fang. Prescription: Huangbai 10g, Cangzhu 10g, Zhi Nanxing 10g, Guizhi 10g, Fangji 10g, Weilingxian 10g, Taoren 10g, Honghua 10g, Longdancao 10g, Qianghuo 10g, Baizhi 10g, Chuanxiong 10g, Shenqu 10g.
After 1 dose, whole-body soreness improved, but continued use caused worsening. Reflection: Deficient and slightly large pulse indicates deficiency. Proposed Qi-tonifying and Yin-nourishing formula. Prescription: Huangqi 15g, Danggui 6g, Dangshen 10g, Maidong 10g, Wuweizi 10g, Shengdi 15g, Shanyao 10g, Shanzhuyu 10g, Fuling 10g, Zexie 10g, Danpi 10g.
After 1 dose, symptoms reduced, but by 6th dose, symptoms intensified. Reviewing previous prescriptions: some supported Zheng, some expelled Evil, some warmed meridians/scattered cold, some dried dampness/cleared heat, some bitter-descended/purged fire. All showed intermittent efficacy and exacerbation. Reflection: This is joint Qi-Yin deficiency with Phlegm-Heat obstructing meridians. Treatment must distinguish degrees of excess/deficiency and cold/heat ratio to succeed. Primary strategy: Qi-tonifying and Yin-nourishing; adjunctive: resolving Phlegm, purging fire, unblocking meridians, activating blood circulation. Prescription: Huangqi 15g, Fangji 10g, Jiegeng 10g, Sangpi 10g, Zhebeimu 10g, Gualou 15g, Gancao 6g, Danggui 10g, Sheng Yimi 15g, Xingren 10g, Baihe 30g, Ganjiang 1g.
After 10 doses, spirit increased, body pain improved. Added Sangzhi 15g, continued 30 doses, major symptoms reduced. Another 90 doses led to 80-90% symptom resolution.
Posterior (Neuro) Pituitary Hypofunction - Diabetes Insipidus
1. Cold-fluid congealing, water-jin not transforming; ignoring warming transformation, only providing Jin-sheng, disease does not heal.
Patient Li ××, male, 50 years old.
Vexing thirst, polydipsia, fatigue for over 2 years. Diagnosed as Diabetes Insipidus. Western medicine ineffective. TCM Yin-nourishing/Jin-generating, Heat-clearing/Jin-generating, Qi-tonifying/Yin-nourishing for over 1 year yielded no obvious effect. Careful examination revealed vexing thirst, polydipsia, polyuria, fatigue, plus epigastric fullness. Tongue coating yellow-white, pulse wiry-tight and rapid. Synthesizing pulse and symptoms: Yin-deficiency and Jin-depletion should show fine-rapid pulse; Stomach-Heat injuring Jin should show slippery-rapid pulse; Qi-Yin dual deficiency should show deficient-large-rapid pulse. Current wiry-tight-rapid pulse contradicts syndrome. Reflection: Wiry-tight pulse indicates Cold and Fluid retention; tight-rapid combination indicates stagnant Cold-Fluid failing to transform. Correlating with syndrome, this is Spleen-Yang insufficiency failing to transform fluids and Bladder failing to Qi-transform. Prescribed warming middle, strengthening Spleen, transforming fluid, promoting urination. Prescription: Fuzi 10g, Rougui 10g, Dangshen 10g, Baizhu 10g, Ganjiang 10g, Gancao 10g, Zexie 10g, Zhuling 10g, Fuling 10g. Decoct in water, take cold.
A certain physician asked: With such severe Jin injury, using hot diuretics is dangerous, isn't it? The answer is: *Jingui Yaolue* states: "Floating pulse, difficult urination, slight fever, vexing thirst, promote urination and induce sweating, Wuling San governs." "Thirst for water, vomiting upon drinking, named Water-Reversal, Wuling San governs." This pioneered warming-Yang and promoting urination for XiaoKe (wasting-thirst). The formula promotes Yang and promotes urination to facilitate Bladder Qi-transformation. This case involves not only Bladder Qi-failure and water failing to descend, but also water retention in Lower Jiao and Stomach. Thus, only strengthening Spleen, warming middle, promoting Yang, and promoting urination can cure. Regarding Jin-injury danger, my view is it does not injure Jin but rather assists Jin generation.
After 4 doses, vexing thirst greatly reduced, spirit increased. Continuing 20 doses led to symptom resolution and recovery.
2. Clinging to tonification blocks Qi; adhering to Yin-nourishment increases Phlegm-Dampness; focusing only on pulse heals the disease.
Patient Zhang ××, female, 40 years old.
Vexing thirst, polydipsia, poor appetite, polyuria for over 2 years. Diagnosed as Diabetes Insipidus. Western medicine ineffective. TCM Yin-nourishing/Jin-generating, Qi-tonifying/Yin-nourishing, Kidney-Yin-nourishing also ineffective. Careful examination: vexing thirst, polydipsia, drinking much water fails to quench thirst, sometimes abdominal fullness persists despite frequent desire to drink. Urination occurs shortly after drinking. Poor appetite, dizziness, fatigue, restlessness, progressive emaciation. Tongue coating yellow-white and moist, pulse soggy-slow and deep. Synthesizing pulse and symptoms: Deep pulse indicates Qi-stagnation; soggy-slow indicates Phlegm-Dampness. Correlating with syndrome, this is unresolved Phlegm-Dampness and Liver-Spleen Qi-stagnation. Treatment: soothe Liver, regulate Qi, remove dampness, resolve Phlegm, mediate Yin-Yang. Prescription: Chaihu 10g, Ganjiang 6g, Guizhi 9g, Huafen 15g, Huangqin 10g, Muli 10g, Gancao 6g, Cangzhu 3g.
After 2 doses, vexing thirst slightly reduced. Continuing 20 doses reduced vexation/thirst, increased appetite. Nighttime oral/pharyngeal dryness persisted, and recent sensation of foreign body obstruction in throat emerged. Reflection: Long duration implies joint Qi-Yin injury, but expelling Evil alone is inappropriate. Proposed Qi-tonifying, Yin-nourishing, regulating Qi, resolving Phlegm. Prescription: Huangqi 15g, Danggui 6g, Renshen 10g, Maidong 10g, Wuweizi 10g, Zhuru 10g, Zhishi 10g, Banxia 10g, Chenpi 10g, Fuling 10g, Gancao 10g, Changpu 10g, Yuanzhi 10g, Shengdi 10g. Continuous 30 doses led to symptom resolution and recovery.
Adrenal Cortical Insufficiency Ignoring color and pulse, relying solely on symptoms, prescribing roughly, always ineffective.
Patient Zheng ××, male, 65 years old.
Dizziness, blurred vision, fatigue, progressive skin darkening for over 1 year. Diagnosed as Adrenal Cortical Insufficiency. Western medicine provided slight mental improvement, but symptoms worsened upon cessation. TCM Spleen-strengthening/damp-drying/stomach-harmonizing and blood-invigorating/stasis-resolving combinations showed no obvious effect. Careful examination: dizziness, blurred vision, insomnia, forgetfulness, fatigue, poor appetite. Dark pigmentation on face, exposed limbs, joint flexures/extensors, wrinkles, nipples, areolae, axillae, lumbar-gluteal folds, lower abdominal midline, nail roots. Other skin brown-black. Oral, lip, tongue, gum, and hard palate mucosa showed irregular dot-like/patchy blue-black pigmentation. Tongue coating thin white, pulse fine-weak and slow. Synthesizing pulse and symptoms: Skin blackness indicates Kidney-Qi insufficiency. Aversion to cold, fatigue, fine-weak-slow pulse indicate joint Yin-Yang deficiency. Treatment: nourish and tonify Kidney Qi. Prescription: Fuzi 4g, Rougui 4g, Shanzhuyu 15g, Duzhong 10g, Huainiuixi 10g, Shengdi 15g, Zhigancao 10g, Shanyao 10g, Gouqizi 10g, Lu Jiao Jiao 10g (melted), Roushoucong 10g.