腰腿疼痛5个多月。医诊坐骨神经痛。先以西药、理疗、按摩、针灸治疗有所好转，但憋痛一直存在，后又配合中药活血养血、祛风散寒、培补肾气等疗效亦不显著。细审其证，除腰腿憋痛之外，并见头晕心烦，舌苔薄白，脉沉弦细涩。综合脉证，思之：脉沉弦细者，血虚肝郁也；涩脉者，寒也。合之于症，乃肝郁血虚，寒湿伤筋也。治拟疏肝养血，温经除湿。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，干姜3克，薄荷3克，甘草10克，狗脊30克。
某医云：应用逍遥散治坐骨神经痛吾未闻之也，请述其理?答曰：从经验来看，坐骨神经痛常见者有三型。一者风寒湿，二者瘀血，三者肾虚。而本病前医均已用过，然其不效也，何故?筋挛也。筋挛者，常见者有四因。一者寒湿，二者瘀血，三者血虚，四者肝郁。本病从脉证来看乃血虚、肝郁、寒湿三邪合至，故以逍遥散合肾着汤为方治之。
服药4剂，疼痛好转，继服20剂，疼痛全失，行走如常。
3．肾阳亏损，血络瘀滞，但以活血，其病不治
于××，男，35岁。
腰腿疼痛3个多月。医诊坐骨神经痛。先用理疗、按摩、针灸、西药治疗剧痛消退，但从左侧腰部至左腿循膀胱经憋痛一直不见改善。后又配合中药活血逐瘀止痛之剂，诸证亦不见改善。细审其证，除左侧腰、腿循膀胱经至小腿、足部疼痛之外，别无所苦，舌苔白，脉弦紧，尺大。综合脉证，思之：脉弦紧者，寒也；尺脉大者，肾阳亏损也。合之于症，乃肾气亏损，寒湿不化，血络瘀滞也。治宜培补肾气、温阳散寒，佐以活血。处方：熟地20克，山药10克，肉苁蓉15克，茯苓10克，泽泻10克，丹皮10克，附子10克，肉桂10克，五味子10克，怀牛膝10克，车前子10克，乳香10克，没药10克，蜂房10克。
服药7剂，疼痛明显好转，宗效不更方之旨，继服30剂，疼痛消失。
某医云：本病是一个椎间盘脱出症，椎间盘脱出诸医均推崇按摩合并活血药，今师反用补肾者何也?答曰：椎间盘脱出以按摩为第一可信方法，此余亦信之不疑也。然本病已用此法治之而不愈，此必但用活血之法不能痊之证，其因为何?肾虚也。肾虚当补，故以上法治之。
4．死于病名，不知辨证，胶于病灶，不知气郁，焉能取效
朱××，女，55岁。
腿痛4个多月。医诊椎间盘脱出。予牵引、按摩、针灸、西药、中药等治之均不效。细审其证，左腿疼痛难忍，每次翻身都得他人帮助才能翻转，且见经常胸满叹气，食欲不振，严重失眠，消瘦乏力，舌苔薄白，脉沉而弦。再询其发病的诱因。云：由于受四人帮迫害，使心理受到了极大的伤害，再加以强迫劳动感受风寒而发此病。再察其所用药物除西药外，中药大都是祛风散寒除湿，活血止痛、补益肝肾的药物。综合脉证，思之：此乃肝郁血滞，复感寒湿之证也。治宜养血疏肝，温阳化湿。处方：柴胡10克，白芍10克，当归10克，白术10克，甘草10克，生姜3片，干姜4克，薄荷3克，白芥子3克。
服药2剂，疼痛大减，食欲增加，睡眠已可睡5小时。继服6剂，疼痛消减大半。但当又服2剂时，疼痛不但不减，反见加重。因思肝者肾之子也，肝病及肾，子盗母气所致耳。乃于上方加狗脊30克，服药20剂，愈。
某医云：用逍遥散治坐骨神经痛吾未闻也，然此方用之神效，何故也?答曰：《素问》在说明为什么有的病治疗措施正确而却无效的问题时，明确说明是精神因素作祟之故。《素问·疏五过论》日：“凡未诊病者，必问尝贵后贱，虽不中邪，病从内生。”所以治以解郁之法而愈也。
5．肝郁血虚，郁而化火者，非解其郁而不得除其邪
白××，女，44岁。
右腿疼痛3个月。医诊坐骨神经痛。予按摩、理疗、针灸及中药独活寄生汤加减方无效。细审其证，右腿外侧腓肠肌部疼痛难忍，既不敢翻身，也不敢走路，且头晕头痛，胸满心烦，食欲不振，月经失调，月经前1天腿痛更重，手心烦热，舌苔白，脉沉弦。综合脉证，诊为肝郁血虚，郁而化火。因拟养血疏肝，解郁泻火。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草10克，干姜6克，薄荷3克，丹皮10克，栀子10克，生地10克。
服药2剂，疼痛大减，继服8剂愈。
6．病机改变，治当随证，泥于经验，固于效方，久治难效
郜××，男，46岁。
在前两年的时候，因腰腿剧烈疼痛，服独活寄生汤10剂，即愈。去年夏天生气后又发现腰腿疼痛，予逍遥散加减6剂，愈。今年又因搬动东西而突然腰部剧烈疼痛，再以独活寄生汤、逍遥散加减治之却无寸效。后经多次拍片检查诊为腰椎问盘脱出。予按摩牵引治疗半月不见效果，不得不靠吗啡、度冷丁度日。细审其证，痛甚于夜，且疼痛之时小腿呈挛缩状，舌苔白，脉沉弦。综合脉证，诊为阴虚血滞，筋脉失养。为拟养阴活血。处方：丹参30克，当归15克，白芍15克，乳香10克，没药10克，狗脊30克，鹿角胶10克。
服药1剂，疼痛大减，继服16剂，疼痛全失。
7．风寒湿痹，不予祛风散寒除湿，反予活血补益，祛邪扶正本末倒置，其何能愈?
张××，男，56岁。
腰腿疼痛半年多。医诊坐骨神经痛。始用西药、理疗不效，继请中医以补肾活血止痛之剂20多付不见好转。细审其证见腰酸腿痛，左腿循膀胱经至足疼痛，舌苔白，脉浮弦紧。因思久病者尤当宗脉也。脉弦紧者寒也，浮者风邪在表也。寒风湿痹阻于筋脉者，宜祛风散寒，除湿行痹。拟独活寄生汤加减。处方：独活10克，桑寄生15克，秦艽10克，防风10克，细辛4克，川芎10克，当归10克，白芍10克，肉桂10克，茯苓10克，杜仲10克，川牛膝10克，党参10克，甘草6克。
服药4剂，腰痛腿痛顿消八九；继服4剂，竞愈。
某医云：为什么用乳香、没药、元胡等止痛药不能止痛?为什么用杜仲、川断、熟地等腰腿疼痛不减?答曰：风寒湿者外邪也，必去风寒湿邪而始解，若风寒湿不除，而徒用活血、补肾以止腰腿疼痛则不可也。
8．寒湿者，不去温阳除湿；肝郁者，不去理肝，其病难解
欧××，女，55岁。
左腿疼痛难忍4个多月。医诊椎间盘脱出。医予牵引、西药治疗一直不效。审其左腿疼痛难忍，每次翻身均需他人帮助才能翻转，且时时嗳声叹气，神情呈抑郁状，食欲不振，严重失眠，消瘦乏力。再询其发病原因，答曰：其夫系领导干部，文化大革命初期被定为走资派，自己及孩子亦被牵连而备受摧残，又因劳动时受寒而突发此病。再审所用中药除活血化瘀外，并有独活寄生汤等方。细察其脉见沉弦，舌苔薄白。综合脉证，思之：脉沉者郁也，弦者肝也，此必肝郁血滞筋脉失养，复感寒湿所致也。治宜疏肝养血舒筋以培本，温经散寒除湿以治标。处方：柴胡10克，白芍10克，当归10克，白术10克，甘草10克，干姜4克，薄荷3克，狗脊30克。
服药4剂后，疼痛大减，并能在他人不帮忙的情况下翻身，继服10剂，果愈。
9．知其病因，不辨病位，不识归经，投药不效
乔××，女，51岁。
右腿疼痛酸重1年多。医诊坐骨神经痛。前后以针灸、按摩、理疗、西药、中药治疗效果不明显。细审其痛从腰髋起至小腿沿膀胱经而下，每至阴天则疼痛加重，舌苔白，脉浮弦紧。综合脉证思之：此必风寒湿痹所致也。拟用独活寄生汤加减。处方：独活10克，桑寄生15克，秦艽10克，防风10克，细辛4克，川芎10克，当归10克，生地10克，白芍10克，肉桂10克，茯苓10克，杜仲10克，川牛膝10克，党参10克，甘草10克。
服药4剂，腰腿酸痛好转。患者因见其已效，又急欲求余再诊，然因余恰恰外出，不能再诊。患者亦知医。急察原方出处，《备急千金要方》云：“治腰背痛，独活寄生汤。夫腰背痛者，皆由肾气虚弱，卧冷湿地当风所得也，不时速治，喜流入脚膝，为偏枯冷痹缓弱疼重或腰痛挛脚重痹，宜急服此方。”自思方证合拍，但祛风湿之力不足，乃于方中加入了羌活10克以增祛风除湿之力。
服药4剂，腰腿疼痛酸重较前加重。患者反复思考不得其解，乃再邀余诊治。诊其脉仍浮紧。乃云：此证仍为风寒湿痹。宜去羌活再服之。
服药4剂，疼痛又减。患者乃求余论其缘故。答曰：“嘉言《医门法律》云：“凡治病不明脏腑经络，开口动手便错。”前方之加羌活者，因其羌活人太阳膀胱之上而不入下也，不入下则治腰、膝、下肢之力减，故效反减也。继服10剂，愈。
尺神经麻痹
不审其脉，但知活血，本为阴虚，反予补气，久延病期
申××，女，48岁。
左手拇、食二指麻木，手指屈伸困难，小鱼际、部分大鱼际和骨间肌萎缩，手掌凹陷5年多。医诊尺神经麻痹。医以针灸、西药、中药益气活血等均无效。2年前，又突然左半身不遂。医诊脑血栓形成。经用针灸、西药、中药益气活血、活血通络之剂与人参再造丸等治疗半年后，左下肢活动虽已基本恢复，但左上肢仍活动不便。细审其证，左上肢酸困不适，手腕不能抬起，手指不能屈伸，手部肌肉明显萎缩，手指呈爪形，神疲乏力，舌謇，面色皓白，舌质红，少苔，脉弦大。综合脉证，思之：脉弦大者，气阴两虚也。治宜补阴益气。处方：炙甘草10克，党参10克，麦冬10克，白芍12克，阿胶10克(烊化)，生地15克，桑枝30克。
服药10剂，上肢活动度较前明显增大，可由原上抬30度增至90度，手腕稍能抬起，手指稍能屈伸。但出现头晕头胀，失眠。思之：此阴虚阳亢所致。酌加龟甲、龙骨、牡蛎各15克、五味子10克。
服药2周，精神大增，头晕消失，手腕能抬起，手指能屈伸，并能从地上拾起钱币。宗效不更方之旨，继服30剂，诸证消失，肌肉萎缩大部恢复。
运动神经元疾病
1．固胶西医之名，不敢知难而上，不审时令，不审脉象，何者能治?
孙××，男，40岁。
2年多以前的夏天在地中劳动时，突然感到两下肢发僵，步行困难，但并没有引起注意，但其后日渐感到走路不稳，走路时足尖着地，跌跤，且四肢亦感发僵。乃至某院检查治疗。诊为侧索硬化。先以西药治疗近一年不效，后又配合养阴补肾之剂近7个月亦无明显效果。特别是近4个月来，不但四肢僵硬，活动困难，而且日渐感到吞咽不利，言语不清，经常出现强哭强笑的情绪变化。察其两下肢不能走路迈步，但能屈伸，两足瘫软。两上肢能上抬10度，两手十指均不能活动，言语不清，强哭强笑，纳呆食减，舌苔薄白，脉濡缓。因思病起暑湿之季，且脉见濡缓，必为湿热伤筋所致。乃予宣气通阳除湿。处方：半夏15克，杏仁10克，薏米15克，桂枝10克，厚朴10克，通草10克，五加皮10克。
某医云：此非鞠通《温病条辨》杏仁薏苡汤乎?《温病条辨》云：“风暑寒湿，杂感混淆，气不主宣，咳嗽头胀，不饥舌白，肢体若废，杏仁薏苡汤主之。”又云：“杂感混淆，病非一端，乃以气不主宣四字为扼要，故以宣气之药为君。既兼雨湿中寒邪，自当变辛凉为辛温。”即统而言之此方乃治风暑寒湿，杂感混淆之瘫，而其何能治运动神经元病?运动神经元病乃选择性损害脊髓前角、脑干运动神经元和锥体束的慢性疾病，也就是说其主要损害的部位在脊髓和脑，中医均称由肾所主，然先生何不用补肾，而反施宣气除湿之药乎?答曰：辨证论治的一个重要内容是标本的问题，这个问题在《素问·标本病传论》中有较详细的论述。本病究竟何者为本?何者为标?标本不明，治必大错。若从起病时的季节和脉象来看，应为湿邪是主，而其他诸证均是衍化发展而来的问题，所以仍应以宣气除湿为主要治法。至于为什么采用《温病条辨》之方，我认为还是注意它的实质为好，而不要管它的出处。至于为什么不用补肾之法，我有两点想法：一不要以西医的理论推导中医的理论，因为中、西医理论是两种概念不同的理论，如果强拉在一起进行讨论，常常铸成大错。二前医的实践已经证明了采用补肾法是行不通的，实践是衡量正确、错误的标准吗。
服药20剂后，精神、食欲明显好转，两臂、两腿活动较前有力，且偶而在他人的搀扶下能走10步左右，言语也较前稍清楚。舌苔白，脉濡缓。处方：半夏10克，厚朴10克，桂枝10克，通草6克，白蒺藜6克，薏米15克，晚蚕砂10克。
某医云：如此小方微剂，岂能挽此危疾重症?答曰：君不知少火生气，壮火食气之训乎?此病正衰邪实，祛邪则易伤正，补正则容易留邪，才以小方小剂以除邪，恐其过用伤正耳。其后，服药近一年，果愈。
2．先后不分，标本不清，徒施补肾，反壅其邪
贺××，男，24岁。
Lumbar and leg pain persisted for over 5 months. The physician diagnosed sciatica. Initially, treatment with Western medicine, physical therapy, massage, and acupuncture yielded some improvement, but the distending pain remained. Subsequently, Chinese herbal medicine was added to invigorate blood, nourish blood, dispel wind, scatter cold, and tonify kidney qi, yet the efficacy was not significant. Careful examination of the syndrome revealed that, in addition to lumbar and leg distending pain, there were accompanying dizziness, irritability, a thin white tongue coating, and a deep, wiry, fine, and choppy pulse. Synthesizing the pulse and symptoms: a deep, wiry, and fine pulse indicates blood deficiency and liver qi stagnation; a choppy pulse indicates cold. Combined with the symptoms, this is liver qi stagnation and blood deficiency, with cold-dampness injuring the sinews. The treatment principle was to soothe the liver, nourish blood, warm the meridians, and eliminate dampness. Prescription: Chai Hu (Bupleuri Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Fu Ling (Poria), Gan Jiang (Zingiberis Rhizoma), Bo He (Menthae Haplocalycis Herba) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Gou Ji (Cibotii Rhizoma) 30g.
A certain physician said: "I have never heard of using Xiaoyao San (Free and Easy Wanderer Powder) to treat sciatica. Please explain the rationale." I replied: "From clinical experience, sciatica commonly presents in three types: one is wind-cold-dampness, the second is blood stasis, and the third is kidney deficiency. Previous physicians had already used these methods for this case, yet they failed. Why? Because of sinew spasm. Sinew spasm commonly has four causes: one is cold-dampness, two is blood stasis, three is blood deficiency, and four is liver qi stagnation. Based on the pulse and symptoms, this case involves the combination of blood deficiency, liver qi stagnation, and cold-dampness. Therefore, Xiaoyao San combined with Shen Zhuo Tang (Kidney-Attending Decoction) was prescribed."
After taking 4 doses, the pain improved. After continuing for 20 doses, the pain completely disappeared, and walking returned to normal.
3. Kidney yang deficiency with blood collateral stasis: treating only with blood-invigorating methods will not cure the disease.
Patient XX, Male, 35 years old.
Lumbar and leg pain for over 3 months. Diagnosed as sciatica. Initial treatment with physical therapy, massage, acupuncture, and Western medicine relieved the severe pain, but the distending pain along the Bladder Meridian from the left waist to the left leg did not improve. Subsequent use of Chinese herbs to invigorate blood, drive out stasis, and relieve pain also showed no improvement. Careful examination of the syndrome revealed pain along the Bladder Meridian from the left waist and leg down to the calf and foot, with no other discomforts. The tongue coating was white, and the pulse was wiry-tight, with a large chi (kidney) position. Synthesizing the pulse and symptoms: a wiry-tight pulse indicates cold; a large chi pulse indicates kidney yang deficiency. Combined with the symptoms, this is kidney qi deficiency, failure to transform cold-dampness, and blood collateral stasis. The treatment should tonify kidney qi, warm yang, scatter cold, and assist with blood invigoration. Prescription: Shu Di Huang (Rehmanniae Radix Preparata) 20g, Shan Yao (Dioscoreae Rhizoma) 10g, Rou Cong Rong (Cynomorii Folium) 15g, Fu Ling (Poria) 10g, Ze Xie (Alismatis Rhizoma) 10g, Dan Pi (Moutan Cortex) 10g, Fu Zi (Aconiti Lateralis Radix Preparata) 10g, Rou Gui (Cinnamomi Cortex) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Huai Niu Xi (Achyranthis Bidentatae Radix) 10g, Che Qian Zi (Plantaginis Semen) 10g, Ru Xiang (Olibanum) 10g, Mo Yao (Myrrha) 10g, Feng Fang (Vespa) 10g.
After 7 doses, the pain significantly improved. Adhering to the principle of "not changing the formula when effective," 30 more doses were taken, and the pain disappeared.
A certain physician said: "This case is intervertebral disc herniation. Physicians generally advocate massage combined with blood-invigorating herbs for disc herniation. Why do you use kidney-tonifying methods?" I replied: "Massage is indeed the first credible method for disc herniation, and I believe it without doubt. However, since this case did not heal with this method, it must be a condition where blood-invigorating methods alone are insufficient. What is the cause? Kidney deficiency. Since the kidney is deficient, it must be tonified; hence, the above method was used."
4. Dying by disease name, not knowing syndrome differentiation, clinging to the lesion site, ignoring qi stagnation—how can efficacy be achieved?
Zhu XX, Female, 55 years old.
Leg pain for over 4 months. Diagnosed as intervertebral disc herniation. Treatment with traction, massage, acupuncture, Western medicine, and Chinese medicine all failed. Careful examination of the syndrome revealed unbearable pain in the left leg, requiring assistance to turn over during sleep. There was frequent chest fullness and sighing, poor appetite, severe insomnia, emaciation, and fatigue. The tongue coating was thin and white, and the pulse was deep and wiry. Inquiry into the onset revealed psychological trauma due to persecution, compounded by forced labor and exposure to wind-cold. Observation of previous medications showed they were mostly for dispelling wind, scattering cold, eliminating dampness, invigorating blood, relieving pain, and tonifying liver and kidney. Synthesizing the pulse and symptoms: this is liver qi stagnation with blood stasis, complicated by external wind-cold-dampness. The treatment should nourish blood, soothe the liver, warm yang, and transform dampness. Prescription: Chai Hu (Bupleuri Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Gan Jiang (Zingiberis Rhizoma) 4g, Bo He (Menthae Haplocalycis Herba) 3g, Bai Jie Zi (Sinapis Semen) 3g.
After 2 doses, pain greatly decreased, appetite increased, and sleep improved to 5 hours. After 6 more doses, pain reduced by more than half. However, after taking 2 additional doses, the pain worsened instead of improving. Considering that the Liver is the son of the Kidney, liver disease affecting the kidney leads to the "son stealing from the mother" (subduing maternal qi). Therefore, Gou Ji (Cibotii Rhizoma) 30g was added to the prescription. After 20 doses, the patient recovered.
A certain physician said: "I have never heard of using Xiaoyao San for sciatica, yet this formula worked miraculously. Why?" I replied: "The *Su Wen* explains why correct treatments sometimes fail, attributing it to mental factors. The *Su Wen · Shu Wu Gu Lun* states: 'Before diagnosing, one must ask about past status changes, such as from noble to humble; even without external pathogens, diseases arise internally.' Thus, treating with methods to resolve stagnation led to recovery."
5. Liver qi stagnation and blood deficiency transforming into fire: without resolving stagnation, the pathogen cannot be eliminated.
Bai XX, Female, 44 years old.
Right leg pain for 3 months. Diagnosed as sciatica. Treatment with massage, physical therapy, acupuncture, and modified Duhuo Jisheng Tang (Decoction for Removing Bi Syndrome with Duhuo and Taxus Twig) was ineffective. Careful examination revealed unbearable pain in the lateral gastrocnemius of the right leg, inability to turn over or walk, dizziness, headache, chest fullness, irritability, poor appetite, menstrual irregularities, worsening pain one day before menstruation, hot palms, white tongue coating, and deep-wiry pulse. Synthesizing the pulse and symptoms, the diagnosis was liver qi stagnation and blood deficiency transforming into fire. The treatment plan was to nourish blood, soothe the liver, resolve stagnation, and clear fire. Prescription: Chai Hu (Bupleuri Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Fu Ling (Poria) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Gan Jiang (Zingiberis Rhizoma) 6g, Bo He (Menthae Haplocalycis Herba) 3g, Dan Pi (Moutan Cortex) 10g, Zhi Zi (Gardeniae Fructus) 10g, Sheng Di Huang (Rehmanniae Radix) 10g.
After 2 doses, pain greatly decreased. After 8 more doses, the patient recovered.
6. Pathogenesis changes, treatment must follow the syndrome; clinging to experience and fixed formulas makes long-term treatment difficult.
Gao XX, Male, 46 years old.
Two years ago, severe lumbar and leg pain was cured by 10 doses of Duhuo Jisheng Tang. Last summer, anger triggered recurrence, cured by 6 doses of modified Xiaoyao San. This year, sudden severe back pain occurred while moving objects. Treatment with modified Duhuo Jisheng Tang and Xiaoyao San failed. Imaging confirmed lumbar disc herniation. Half a month of massage and traction failed, necessitating morphine and pethidine. Careful examination revealed worse pain at night, calf spasms during pain, white tongue coating, and deep-wiry pulse. Synthesizing the pulse and symptoms, the diagnosis was yin deficiency with blood stasis and malnourished sinews. The treatment was to nourish yin and invigorate blood. Prescription: Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Dang Gui (Angelicae Sinensis Radix) 15g, Bai Shao (Paeoniae Radix Alba) 15g, Ru Xiang (Olibanum) 10g, Mo Yao (Myrrha) 10g, Gou Ji (Cibotii Rhizoma) 30g, Lu Jiao Jiao (Cornu Cervi Corium Colla) 10g.
After 1 dose, pain greatly decreased. After 16 more doses, pain completely disappeared.
7. Wind-cold-damp bi syndrome: failing to dispel wind, scatter cold, and eliminate dampness, instead using blood invigoration and tonification reverses the priority of expelling pathogens and supporting healthy qi—how can it heal?
Zhang XX, Male, 56 years old.
Lumbar and leg pain for over half a year. Diagnosed as sciatica. Western medicine and physical therapy failed. Subsequent TCM treatment with kidney-tonifying and blood-invigorating pain-relieving formulas (over 20 doses) showed no improvement. Examination revealed soreness and pain in the waist and legs, pain along the Bladder Meridian from the left leg to the foot, white tongue coating, and floating-wiry-tight pulse. For chronic illness, the pulse is crucial. A wiry-tight pulse indicates cold; a floating pulse indicates wind pathogen in the exterior. Cold-wind-damp bi obstructing the sinews requires dispelling wind, scattering cold, eliminating dampness, and unblocking bi. Modified Duhuo Jisheng Tang was prescribed. Prescription: Du Huo (Angelicae Pubescentis Radix) 10g, Sang Ji Sheng (Taxilli Herba) 15g, Qin Jiao (Gentianae Macrophyllae Radix) 10g, Fang Feng (Saposhnikoviae Radix) 10g, Xi Xin (Asari Radix et Rhizoma) 4g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Rou Gui (Cinnamomi Cortex) 10g, Fu Ling (Poria) 10g, Du Zhong (Eucommiae Cortex) 10g, Chuan Niu Xi (Achyranthis Bidentatae Radix) 10g, Dang Shen (Codonopsis Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
After 4 doses, 80-90% of lumbar and leg pain vanished. After 4 more doses, complete recovery occurred.
A certain physician asked: "Why didn't painkillers like Ru Xiang, Mo Yao, and Yuan Hu work? Why didn't Du Zhong, Chuan Duan, and Shu Di reduce the pain?" I replied: "Wind-cold-dampness are external pathogens. They must be expelled to resolve the condition. If wind-cold-dampness remains, merely using blood invigoration and kidney tonification to stop pain is ineffective."
8. For cold-dampness, failing to warm yang and eliminate dampness; for liver stagnation, failing to regulate the liver—how can the disease be resolved?
Ou XX, Female, 55 years old.
Unbearable left leg pain for over 4 months. Diagnosed as intervertebral disc herniation. Traction and Western medicine failed. Examination revealed unbearable pain, needing help to turn over, frequent sighing, depressive demeanor, poor appetite, severe insomnia, emaciation, and fatigue. Onset was linked to political persecution of her husband, resulting in suffering for herself and children, plus cold exposure during labor. Previous Chinese medicines included blood-invigorating formulas and Duhuo Jisheng Tang. Pulse was deep-wiry, tongue coating thin-white. Synthesizing pulse and symptoms: deep pulse indicates stagnation, wiry pulse indicates liver involvement. This is likely liver qi stagnation with blood stasis causing malnourished sinews, compounded by cold-dampness. Treatment should soothe the liver, nourish blood, relax sinews to tonify the root, and warm meridians, scatter cold, and eliminate dampness to treat the branch. Prescription: Chai Hu (Bupleuri Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Gan Jiang (Zingiberis Rhizoma) 4g, Bo He (Menthae Haplocalycis Herba) 3g, Gou Ji (Cibotii Rhizoma) 30g.
After 4 doses, pain greatly decreased, allowing turning over without assistance. After 10 more doses, full recovery occurred.
9. Knowing the cause but not the location, failing to recognize meridian tropism, leading to ineffective medication.
Qiao XX, Female, 51 years old.
Right leg painful heaviness for over 1 year. Diagnosed as sciatica. Acupuncture, massage, physical therapy, Western medicine, and Chinese medicine showed little effect. Pain originated from the hip, followed the Bladder Meridian down the calf, worsened on cloudy days. Tongue coating white, pulse floating-wiry-tight. Synthesizing pulse and symptoms: this is wind-cold-damp bi. Modified Duhuo Jisheng Tang was prescribed. Prescription: Du Huo (Angelicae Pubescentis Radix) 10g, Sang Ji Sheng (Taxilli Herba) 15g, Qin Jiao (Gentianae Macrophyllae Radix) 10g, Fang Feng (Saposhnikoviae Radix) 10g, Xi Xin (Asari Radix et Rhizoma) 4g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Sheng Di Huang (Rehmanniae Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Rou Gui (Cinnamomi Cortex) 10g, Fu Ling (Poria) 10g, Du Zhong (Eucommiae Cortex) 10g, Chuan Niu Xi (Achyranthis Bidentatae Radix) 10g, Dang Shen (Codonopsis Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g.
After 4 doses, lumbar and leg soreness improved. Eager for further treatment, the patient sought me out, but I was away. Being knowledgeable in medicine, she checked the source of the formula in *Beiji Qianjin Yaofang*: "For lower back and back pain, use Duhuo Jisheng Tang. Lower back pain arises from kidney qi weakness, lying on cold/damp ground exposed to wind. If not treated promptly, it tends to flow into the feet and knees, causing hemiplegia, cold bi, weakness, heavy pain, or convulsive leg bi. Take this formula urgently." She reasoned the formula matched the syndrome but lacked strength in dispelling wind-dampness, so she added Qiang Huo (Notopterygii Rhizoma et Radix) 10g.
After 4 doses, pain and heaviness worsened. Confused, she invited me again. Pulse was still floating-tight. I stated: "This is still wind-cold-damp bi. Remove Qiang Huo and continue."
After 4 doses, pain decreased again. She asked for the reason. I replied: "Jiayan's *Yi Men Fa Lv* states: 'If one does not understand zang-fu and meridians, any action is wrong.' Qiang Huo enters the Taiyang Bladder meridian superiorly but not inferiorly. Not entering inferiorly reduces its efficacy for waist, knee, and lower limbs, thus reducing effectiveness. Continue for 10 doses, and recover."
Ulnar Nerve Palsy
Not examining the pulse, only knowing blood invigoration; originally yin deficiency, but given qi tonification, prolonging the disease.
Shen XX, Female, 48 years old.
Numbness in the thumb and index finger of the left hand, difficulty flexing/extending fingers, atrophy of hypothenar, partial thenar, and interosseous muscles, concave palm for over 5 years. Diagnosed as ulnar nerve palsy. Acupuncture, Western medicine, and Chinese medicine for qi tonification and blood invigoration failed. Two years ago, sudden left hemiplegia occurred. Diagnosed as cerebral thrombosis. After half a year of acupuncture, Western medicine, Chinese medicine for qi/blood, and Ren Shen Zai Zao Wan, left lower limb movement largely recovered, but left upper limb remained inconvenient. Examination revealed acid/distress in left upper limb, inability to lift wrist or flex/extend fingers, obvious hand muscle atrophy, claw-like fingers, fatigue, speech impediment, pale complexion, red tongue body with scant coating, and string-large pulse. Synthesizing pulse and symptoms: string-large pulse indicates qi and yin dual deficiency. Treatment should tonify yin and benefit qi. Prescription: Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 10g, Dang Shen (Codonopsis Radix) 10g, Mai Dong (Ophiopogonis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 12g, E Jiao (Colla Corii Asini) 10g (melted), Sheng Di Huang (Rehmanniae Radix) 15g, Sang Zhi (Mori Ramulus) 30g.
After 10 doses, upper limb mobility significantly increased (from 30 to 90 degrees elevation), wrist could lift slightly, fingers could flex/extend slightly. However, dizziness, head distension, and insomnia appeared. This indicated yin deficiency with yang hyperactivity. Added Gui Jia (Testudinis Carapax et Plastrum), Long Gu (Fossilia Ossis Mastodi), Mu Li (Concha Ostreae) 15g each, and Wu Wei Zi (Schisandrae Chinensis Fructus) 10g.
After 2 weeks, spirit greatly improved, dizziness disappeared, wrist lifted, fingers moved, and coins could be picked up. Adhering to "not changing formula when effective," 30 more doses were taken. All symptoms disappeared, and most muscle atrophy recovered.
Motor Neuron Disease
1. Clinging to Western disease names, afraid to face difficulties, not examining season or pulse—who can treat?
Sun XX, Male, 40 years old.
Over 2 years ago, during summer labor, sudden stiffness in both lower limbs and difficulty walking occurred, initially ignored. Gradually, gait became unstable, toe-walking, falling, and limb stiffness developed. Hospital diagnosis: Amyotrophic Lateral Sclerosis (ALS). Western medicine for nearly a year failed. Yin-nourishing and kidney-tonifying herbs for nearly 7 months showed no obvious effect. In the last 4 months, limb stiffness and activity difficulty worsened, accompanied by dysphagia, slurred speech, and emotional lability (forced crying/laughing). Examination: unable to walk but can flex/extend legs, flaccid feet; arms can lift 10 degrees, fingers immobile, slurred speech, emotional lability, poor appetite, thin-white coating, soggy-slow pulse. Considering onset in summer-damp season and soggy-slow pulse, this is damp-heat injuring sinews. Treatment: promote qi, unblock yang, eliminate dampness. Prescription: Ban Xia (Pinelliae Rhizoma) 15g, Xing Ren (Armeniacae Semen Amarum) 10g, Yi Mi (Coicis Semen) 15g, Gui Zhi (Cinnamomi Ramulus) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Tong Cao (Tetrapanacis Medulla) 10g, Wu Jia Pi (Acanthopanacis Cortex) 10g.
A certain physician asked: "Isn't this Xing Ren Yi Yi Tang from Ju Tong's *Wen Bing Tiao Bian*? It says: 'Wind, summerheat, cold, damp confusion, qi not disseminating, cough, head distension, anorexia, white tongue, limbs useless—Xing Ren Yi Yi Tang governs.' And: 'Confusion... key is qi not disseminating... use qi-promoting herbs as sovereign. With rain/damp/cold, change acrid-cool to acrid-warm.' So this formula treats paralysis from mixed pathogens. How can it treat Motor Neuron Disease? MND selectively damages anterior horn cells, brainstem motor neurons, and pyramidal tracts—mainly spinal cord and brain, governed by Kidney in TCM. Why not tonify kidney, but use qi-promoting damp-eliminating herbs?" I replied: "Syndrome differentiation includes root and branch issues, detailed in *Su Wen · Biao Ben Bing Zhuan Lun*. What is root? What is branch? Unclear root/branch leads to major errors. From season and pulse, dampness is primary; other symptoms are derivative. Thus, promoting qi and eliminating dampness is the main treatment. Regarding using *Wen Bing Tiao Bian* formula, focus on its substance, not origin. Why not tonify kidney? Two reasons: 1. Do not deduce TCM theory from Western theory; they are different concepts, forcing them together often leads to error. 2. Previous clinical practice proved kidney tonification ineffective. Practice is the criterion for correctness."
After 20 doses, spirit and appetite improved, arm/leg strength increased, could walk ~10 steps with support, speech clearer. Tongue white, pulse soggy-slow. Prescription: Ban Xia (Pinelliae Rhizoma) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Gui Zhi (Cinnamomi Ramulus) 10g, Tong Cao (Tetrapanacis Medulla) 6g, Bai Ji Li (Tribuli Fructus) 6g, Yi Mi (Coicis Semen) 15g, Can Sha (Bombyx Batryticatus) 10g.
A certain physician asked: "Such small formula and dose, how can it save this critical illness?" I replied: "Do you not know the teaching: 'Minor fire generates qi, major fire consumes qi'? Here, healthy qi is weak, pathogenic factor is strong. Expelling pathogen easily injures healthy qi; tonifying healthy qi easily retains pathogen. Small formula/dose expels pathogen fearing overuse injures healthy qi." After nearly a year of treatment, full recovery occurred.
2. Confusing sequence, unclear root and branch, merely applying kidney tonification, instead clogging the pathogen.
He XX, Male, 24 years old.