2．脉见弦紧而数，知其为肝郁气结，寒饮内郁，寒邪上冲，治以疏肝化饮，温肝降逆，愈
和××，男，55岁。
头脑胀痛，恶心呕吐，视力突然下降8天。医诊良性颅内压增高症。先以腰穿放液、静脉滴注甘露醇等治疗，头痛曾一度好转，但不解决根本问题。细审其症，除头痛，两眼失明外，并见恶心呕吐，头晕耳鸣，心烦心悸，舌苔白，脉弦紧而数。综合脉证，思之：脉见弦紧而数者，肝郁气滞，寒饮内郁，寒气上冲也。治拟疏肝理气，温肝化饮。处方：柴胡10克，半夏10克，人参10克，黄芩10克，生姜10克，大枣7个，桂枝10克，茯苓10克，吴茱萸10克，熟军3克，龙骨15克，牡蛎15克。
服药2剂，头痛大减，恶心呕吐，心烦失眠俱减，视力增加，并能在5米内清楚的看见人影，继服10剂，诸证几近消失，又服6剂，愈。
某医云：吴茱萸汤、柴胡加龙骨牡蛎汤均治头痛，余坚信不移也，然其能降低脑压未闻之也，请师明示之。答曰：中药方中哪个能降低颅内压吾亦未闻之也，今临床验之，颅内压增高以中药治之有效者甚多，当仔细研讨之。
3．知经络，分寒热，其病始解
齐×，女，19岁。
剧烈头痛，恶心呕吐20多天。医诊良性颅内压增高症。医先以腰穿放液、降低颅压药及其他西药虽曾一时好转但不巩固，后又配合中药滋阴平肝、降逆止呕等亦无明显效果。细审其症，头部闷痛，视力减退已近半年，近20多天来，突然加重，并合并有恶心呕吐，复视，眩晕，耳鸣，心烦心悸，手足厥冷，舌苔白，脉弦紧而数。综合脉证，思之：脉弦紧而数者，寒饮停聚，肝寒上逆也。治宜疏肝化饮，温肝降逆。处方：柴胡10克，半夏10克，黄芩10克，人参10克，吴茱萸10克，生姜10克，大枣7个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克。
服药1剂，头痛头晕，恶心呕吐大减，继服1剂，诸证消失。
某医云：如此之重证，应用腰穿屡次放液，并配合中、西药物而不效，而用此方竞如此之神而速，吾不敢想也。请明示之。答曰：吴茱萸汤者，医家多云其常覆杯而效，我开始亦疑信参半也。其后验之临床果然如此也。医家称：吴茱萸厥阴专药也，专病专药，其效尤宏，不可不注意也。
小舞蹈病
1．八纲不辨，脏腑不明，但从症治，胶于熄风，终非其治
索××，女，14岁。
手足乱动，挤眉弄眼，走路不稳6个月。医诊小舞蹈病。先予西药、针灸治疗2个多月不效，后又配合中药平肝熄风、养血化痰熄风治疗4个月仍不效。细审其证，病发于感冒生气之后，发病之始仅见烦躁，不久即见项强头摇，手足不断地乱动，挤眉弄眼，走路不稳，纳呆食减，烦躁易怒，舌苔白，脉弦紧。综合脉证，思之：弦脉者，少阳经脉也，胆脉也，肝脉也；紧者，寒也，结也，饮也；弦紧相合，寒饮凝结也，化风也。合之于症，乃少阳枢机不利，痰饮内结，郁而化风也。治拟和解少阳，调理枢机，化痰熄风。处方：柴胡3克，桂枝6克，白芍6克，黄芩6克，半夏6克，党参6克，茯苓6克，龙骨6克，牡蛎6克，甘草6克，生姜3片，大枣3个。
服药3剂，手足乱动，挤眉弄眼，走路不稳大见好转，继服30剂，愈。
某医云：余曾遍用熄风化痰之法治之而不效，先生用之反效者何也?答：寒热不同，经络有异，升降有别耳。细看你之所用方药虽为化痰熄风，然你方中全用寒凉，余佐桂枝；此其一也；你方中全用熄风沉降，而余佐用升达之品，此其二也；你方中虽用化痰熄风而重用甘酸柔肝，而余则重用辛温而佐用酸甘之味，此其三也。三者不同，效自迥异。
2．刚柔不分，升降不别，气血不清，胶于血分，固于平熄，久治不愈
惠××，女，55岁。
手足乱动，挤眉弄眼，项背僵硬3个多月。医诊脑动脉硬化、小舞蹈病。先以西药治疗1个多月无明显效果，继又配合中药平肝熄风、养血活血熄风，针灸等治疗1个多月仍无明显改变。细审其证，发病伊始，先见左半身拘急不适，次日即出现不由自主的手足乱动，项背发僵，挤眉弄眼，心烦易怒，耳鸣耳聋，口苦咽干，失眠心悸，舌苔黄白，脉弦紧。综合脉证，诊为少阳枢机不利，痰湿蕴结，郁而化风。治拟和解少阳，化痰熄风。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓10克，酒军4克，龙骨15克，牡蛎15克。
某医云：柴胡加龙骨牡蛎汤为仲景《伤寒论》方，其原用于“伤寒八九日，下之，胸满烦惊，小便不利，谵语，一身尽重，不可转侧。”今先生反用于脑动脉硬化、小舞蹈病者何也?答曰：柴胡加龙骨牡蛎汤者，为邪热内陷，弥漫全身，表里俱病，虚实互见证方也。今本病虽非伤寒误治之疾，而其病机却系邪热内郁，表里俱病，虚实互见，故以柴胡加龙骨牡蛎汤治之也。又问：余用熄风之药而风症不熄者何也?答曰：风症应熄风，此治法之常也。然风之起有种种，若血虚风动者必予养血熄风，若阴虚风动者必养阴平肝熄风方可，若痰火化风者必化痰熄风方可，若脾虚风动之慢脾风则必予健脾才能熄风，其如逐寒荡惊汤治风即此意耳。今本症之风既有痰，又有寒，故以桂枝配龙骨、牡蛎以治风也。本病者，郁证也，寒痰也，湿证也，郁证当舒，不可抑郁；寒证当温，不可过凉；湿证当燥，不可柔润，此即刚柔必分，升降必别，气血必分也。
服药7剂，手足乱动，挤眉弄眼等大见好转，继服30剂，诸证均失。后果愈。
痉挛性斜颈
1．寒热不分，气血不明，胶滞熄风，终无效应
柴××，男，48岁。
左侧颈肌阵发性的不自主收缩，引起头向左侧扭转或阵挛性倾斜2年。医诊痉挛性斜颈。先以西药治疗半年多不见好转，后又配合中药养血平肝熄风，养阴熄风，针灸等治疗1年多亦不见改善。细审其左侧颈肌不自主的收缩，引起头向左侧扭转，并阵挛性倾斜，张口咀嚼亦感困难，精神紧张时更加严重，说话亦感费力，但睡眠后诸证均消失，心烦易怒，头晕脑胀，口干口苦，舌苔黄白，脉弦紧。综合脉证，诊为肝郁气结，痰湿不化，郁而化风证。治拟疏肝理气，化痰熄风。处方：柴胡10克，半夏10克，党参10克，桂枝10克，黄芩10克，生姜3片，大枣5个，茯苓15克，熟军4克，甘草10克，龙骨15克，牡蛎15克。
服药30剂，诸证大减。某医云：此方熄风之力不足也，宜加蜈蚣、全蝎。服药10剂，诸证加剧。再邀余诊。云：本证虽风证较多，但从脉看以寒证为主，饮证为主，故应重在化痰温经，不可重予熄风也。去蜈蚣、全蝎，加人参10克。服药60剂，诸证果失，愈。
2．肝胃同病，复夹内风，调其肝胃，佐以熄风，其证果痊
何××，女，60岁。
胃脘满胀，嗳气频作3年。扭颈咬牙2年。医诊慢性浅表性胃炎、痉挛性斜颈。先以西药久治不效，后又配合中药熄风解痉等治疗亦无功。细审其证，头晕脑胀，失眠心烦，胸满背痛，右侧颈肌阵发性不自主的收缩，头向左侧扭转，不断的咬牙而喀喀有声、张口困难，特别是越想张口说话时牙咬的更为严重，为此，经常影响咀嚼吃饭，且纳呆食减，胃脘胀满，口苦咽干，消瘦乏力，常因疲乏无力和颈部痉挛而影响走路，为此不得不靠他人搀扶才能走路，舌苔黄白厚腻，脉弦紧。综合脉证，思之；此病虚实并见，寒热并存，且治法往往相互抵触，实难措手。又思：仲景、丹溪在复杂证候的分析上尤重脉象，东垣在治法上尤重升降，在具体措施上尤重脾胃。今脉弦紧，尤当先从肝胃论治。处方：柴胡10克，半夏10克，人参10克，黄芩10克，生姜3片，大枣5个，甘草6克，苍术10克，厚朴10克，陈皮10克，桂枝10克，茯苓10克。
服药6剂，胸脘胀痛好转，食欲好转，每日可进食约5两左右。但左颈肌收缩、咬牙、心烦失眠不见改善。细审其脉仍弦紧。因思脉弦紧，痉抽者，痰饮内郁，郁而化风者。治拟疏肝理气，化痰熄风。处方：柴胡10克，半夏10克，人参10克，甘草10克，生姜3片，大枣5枚，黄芩10克，桂枝10克，茯苓15克，大黄3克，龙骨15克，牡蛎15克。
服药4剂，颈肌收缩，咬牙减少，且入睡后已不咬牙。但食欲、脘腹胀满较前加重。再予柴平汤加减为方4剂，复改柴胡加龙骨牡蛎汤4剂，交替用方。两月之后，诸证消失，愈。
某医云：为何交替用方?答曰：本病有两个不相干的病证，主治此证时对另一证不太有利，主治彼证时对此证不太有利，如采用诸证均治之法，常常延误病情，故采用此法治之。
重症肌无力
1．知其兼挟，佐以除湿，其病始解
史××，男，34岁。
两眼睑下垂不能抬起8个多月。医诊重症肌无力。先以西药治疗曾一度好转，但一停药就又不能抬起，续又配合中药补中益气汤加减为方治疗5个多月，症状亦未明显改善。细询其证，除两眼睑下垂影响视力外，并感头身困重，疲乏思睡，舌苔黄白稍腻，脉濡缓。综合脉证，思之：全身困重，眼睑不能抬起者，脾湿为标，气虚为本也。治宜益气升阳，除湿清热。处方：蔓荆子10克，升麻10克，葛根15克，党参10克，黄芪15克，黄柏10克，白芍10克，炙甘草10克。
服药10剂，愈。
某医云：既云气虚，为何用补中益气汤不效?答曰：本证非但气虚，亦挟湿热，故但用补中益气之补气无功耳。又问：益气聪明汤者，东垣聪耳明目方也，其为何用于重症肌无力?答曰：眼睑者，脾之所主也，益气聪明汤者，既益气，又升阳，又除湿，故可用之也。
2．气阴两虚，痰热阻滞者，不但要补其气阴，而且要化其痰湿
闻××，女，成。
吞咽、咀嚼困难，语言无力，时或饮水从鼻孑L中呛出2年多。医诊重症肌无力。先以西药治疗稍效，但不能控制其发展，后又配合中药补气养阴之剂，仍然日甚1日。细审其证，说话、咀嚼无力，饮水即从鼻孔呛出，吞咽困难，面部表情淡漠，下颌下垂不能闭合，头不能抬起，眼睑下垂不能睁眼，疲乏无力，饮食乏味，舌苔白，脉濡缓。综合脉证，思之：此乃气阴两虚，痰湿阻滞所致。治宜拟补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五昧子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。
服药6剂，呼吸、说话、咀嚼、吞咽均较前有力，饮水已不呛。继服药4月，诸证消失，愈。
某医问：本证曾用补中益气、六味地黄治之，然其木效者何也?答曰：补有余而化痰之力不足耳。痰不除则诸证不减，故必予养阴益气，化痰理气同施。
3．气血两虚，心脾不足者，必予补气养血，养心安神
国××，女，成。
全身肌肉极度疲乏，进食、吞咽、呼吸、翻身困难2年多。医诊重症肌无力。先用西药有暂时减轻的作用，但停药数小时后，诸证又见加重，继又配合中药补中益气汤亦无明显效果。细审其证，除全身极度疲乏无力，进食、吞咽、咀嚼均困难外，并见纳呆食减，心烦失眠，心悸，舌苔薄白，脉细弱而缓。综合脉证，诊为气血俱虚，心脾不足。治以补气养血，养心安神。处方：人参10克，白术10克，黄芪15克，当归6克，茯苓10克，远志10克，炒枣仁10克，木香6克，龙眼肉10克，生姜3片，大枣5个。
服药4剂，诸证俱减，饮食、睡眠增加，继服100剂，诸证消失。
某医云：余亦应用归脾汤治疗，然其效果不著者何也?答日：你用党参，余用人参有别耳。人参者大补元气，益气养阴，养心助脾，而党参则仅补脾肺之气耳。
周期性麻痹
1．以脉审辨，佐以色症，立方遣药，坚持始愈
周×x，女，36岁。
发作性瘫痪5年多。医诊周期性麻痹。每次发病一用氯化钾等治疗，即可很快恢复，但就是不能彻底治愈，为此不得不配合中药治之，然而效果仍不明显。特别是近1年来，不但不见好转，反见日渐发作频繁，仅只近3个月即发病达14次之多。细审其证，除全身肢体软弱无力，活动极端困难外，并见口干咽燥，烦渴多饮，心烦失眠，咽喉不利，汗多气短。再询其发病过程，云：发病之始，先是突然感到烦渴多饮，肢体酸痛，接着不久即出现咽喉发憋，疲乏无力，下肢行动困难，终至全身瘫痪。舌苔白，脉濡缓。综合脉证，思之：脉濡缓者，气阴两虚，痰郁气结之证也。且夫全身软弱沉重亦为脾湿，阵发自属肝胆。故治拟益气养阴，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，陈皮10克，甘草6克，菖蒲10克，远志10克，生地10克。
服药6剂，精神倍增，汗多烦渴，疲乏无力，咽喉不利均减，继服6剂，诸证消失。为巩固疗效，改用3日1剂，服药3个月，停药，观察4年，未见复发。
2．谨察诸脉，详予辨证，色脉合参，审慎方药，终获痊愈
龚××，男，23岁。
2. The pulse presents as wiry (Xian), tight (Jin), and rapid (Shu), indicating the pathogenesis of Liver Qi stagnation, internal retention and depression of Cold-Fluid (Han Yin), and upward rushing of Cold Evil. The treatment should focus on soothing the Liver to resolve fluids, warming the Liver to direct rebellious Qi downward.
Patient Yu He XX, Male, 55 years old.
Chief complaint: Distending pain in the head, nausea, vomiting, and sudden decrease in vision for 8 days. Western medical diagnosis: Benign intracranial hypertension. Initially treated with lumbar puncture fluid drainage and intravenous infusion of Mannitol, etc. Headache improved temporarily but the root problem was not solved. Careful examination of symptoms revealed, besides headache and blindness in both eyes, also nausea, vomiting, dizziness, tinnitus, irritability, palpitations, white tongue coating, and a wiry, tight, and rapid pulse. Synthesizing the pulse and symptoms: A wiry, tight, and rapid pulse indicates Liver Qi stagnation, internal retention of Cold-Fluid, and upward rushing of Cold Qi. The treatment principle is formulated as soothing the Liver and regulating Qi, warming the Liver to transform fluids. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 10g, Da Zao (Jujubae Fructus) 7 pieces, Gui Zhi (Cinnamomi Ramulus) 10g, Fu Ling (Poria) 10g, Wu Zhu Yu (Evodiae Fructus) 10g, Shu Jun (Prepared Rheum Palmati Radix et Rhizoma) 3g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
After taking 2 doses, headache significantly decreased, nausea, vomiting, irritability, and insomnia all reduced, vision increased, and he could clearly see human figures within 5 meters. After continuing for 10 doses, almost all symptoms disappeared. After another 6 doses, he recovered.
A certain doctor said: "Both Wuzhuyu Tang (Evodia Decoction) and Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) treat headaches, which I firmly believe. However, I have never heard that they can lower intracranial pressure. Please clarify."
Answer: "I have also never heard of any Chinese herbal formula that directly lowers intracranial pressure. However, clinically verified cases using Chinese medicine to treat elevated intracranial pressure are numerous; this deserves careful study."
3. Understanding the meridians and distinguishing cold from heat allows the disease to be resolved.
Patient Qi X, Female, 19 years old.
Severe headache, nausea, and vomiting for over 20 days. Western medical diagnosis: Benign intracranial hypertension. Initially treated with lumbar puncture fluid drainage, intracranial pressure-lowering drugs, and other Western medicines. Although there was temporary improvement, it was not stable. Subsequent combination therapy with Chinese medicine for nourishing Yin, pacifying the Liver, directing rebellious Qi downward, and stopping vomiting showed no obvious effect. Careful examination of symptoms revealed dull pain in the head, decreased vision for nearly half a year, suddenly aggravated in the past 20+ days, accompanied by nausea, vomiting, diplopia, vertigo, tinnitus, irritability, palpitations, cold hands and feet, white tongue coating, and a wiry, tight, and rapid pulse. Synthesizing the pulse and symptoms: A wiry, tight, and rapid pulse indicates retention of Cold-Fluid and upward reversal of Liver Cold. The treatment principle should be soothing the Liver to resolve fluids and warming the Liver to direct rebellious Qi downward. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Wu Zhu Yu (Evodiae Fructus) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 10g, Da Zao (Jujubae Fructus) 7 pieces, Gui Zhi (Cinnamomi Ramulus) 10g, Fu Ling (Poria) 15g, Shu Jun (Prepared Rheum Palmati Radix et Rhizoma) 3g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
After taking 1 dose, headache, dizziness, nausea, and vomiting significantly decreased. After continuing for 1 dose, all symptoms disappeared.
A certain doctor said: "For such a severe condition, repeated lumbar punctures combined with Chinese and Western medicines were ineffective, yet this prescription worked so miraculously and quickly. I cannot imagine why. Please explain."
Answer: "Wuzhuyu Tang (Evodia Decoction) is often said by physicians to be effective 'as soon as the cup is overturned' (i.e., very rapidly). I myself was initially skeptical. Later clinical verification proved this true. Physicians call Wu Zhu Yu (Evodiae Fructus) a specific drug for the Jueyin channel. Specific disease, specific drug, yields particularly grand effects; this must not be overlooked."
Sydenham's Chorea
1. Failure to distinguish the Eight Principles, ignorance of Zang-Fu organs, treating only based on symptoms, adhering rigidly to extinguishing wind, ultimately fails.
Patient Suo XX, Female, 14 years old.
Restless movements of hands and feet, grimacing, unsteady gait for 6 months. Western medical diagnosis: Sydenham's Chorea. Initially treated with Western medicines and acupuncture for over 2 months without effect. Subsequently combined with Chinese medicine for pacifying the Liver and extinguishing wind, nourishing Blood and resolving Phlegm to extinguish wind for 4 months, still without effect. Careful examination of the syndrome reveals onset after a cold and emotional anger. Initially only irritability was seen, soon followed by neck stiffness and head shaking, continuous restless movements of hands and feet, grimacing, unsteady gait, poor appetite, irritability, white tongue coating, and a wiry, tight pulse. Synthesizing the pulse and symptoms: The wiry pulse belongs to the Shaoyang meridian, Gallbladder meridian, and Liver meridian; the tight pulse represents Cold, knotting, and Fluid retention. Wiry and tight combined indicate congealing of Cold-Fluid, transforming into Wind. Combined with symptoms, this is dysfunction of the Shaoyang pivot, internal binding of Phlegm-Fluid, depression transforming into Wind. The treatment principle is harmonizing Shaoyang, regulating the pivot, resolving Phlegm, and extinguishing wind. Prescription: Chai Hu (Bupleuri Radix) 3g, Gui Zhi (Cinnamomi Ramulus) 6g, Bai Shao (Paeoniae Radix Alba) 6g, Huang Qin (Scutellariae Radix) 6g, Ban Xia (Pinelliae Rhizoma) 6g, Dang Shen (Codonopsis Radix) 6g, Fu Ling (Poria) 6g, Long Gu (Fossilia Ossis Mastodi) 6g, Mu Li (Ostreae Concha) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
After taking 3 doses, restless movements, grimacing, and unsteady gait greatly improved. After continuing for 30 doses, she recovered.
A certain doctor said: "I used various methods to extinguish wind and resolve Phlegm without success, yet yours worked. Why?"
Answer: "Cold and Heat differ, meridians vary, and ascending/descending mechanisms differ. Looking closely at your prescriptions, although intended to resolve Phlegm and extinguish wind, you used entirely cooling herbs, whereas I added Gui Zhi (Cinnamomi Ramulus); this is the first difference. Your formulas used entirely descending and settling wind-extinguishing herbs, while I added ascending and dispersing herbs; this is the second difference. Although you used Phlegm-resolving and wind-extinguishing herbs with heavy use of sweet and sour liver-softening agents, I heavily used pungent-warm herbs assisted by sweet-sour flavors; this is the third difference. These three differences lead to vastly different results."
2. Failure to distinguish rigid/soft, ascending/descending, clear/turbid Qi, adhering to the Blood level, rigidly focusing on calming/extinguishing, leading to prolonged non-recovery.
Patient Hui XX, Female, 55 years old.
Restless movements of hands and feet, grimacing, neck and back stiffness for over 3 months. Western medical diagnosis: Cerebral arteriosclerosis, Sydenham's Chorea. Initially treated with Western medicines for over 1 month with no obvious effect. Subsequently combined with Chinese medicine for pacifying the Liver and extinguishing wind, nourishing Blood and activating Blood to extinguish wind, and acupuncture for over 1 month, still no obvious change. Careful examination of the syndrome reveals initial discomfort and spasm in the left half of the body, followed the next day by involuntary restless movements of hands and feet, neck and back stiffness, grimacing, irritability, tinnitus, deafness, bitter taste in mouth, dry throat, insomnia, palpitations, yellow-white tongue coating, and a wiry, tight pulse. Synthesizing the pulse and symptoms, diagnosed as dysfunction of the Shaoyang pivot, accumulation of Phlegm-Dampness, depression transforming into Wind. Treatment principle: Harmonize Shaoyang, resolve Phlegm, and extinguish wind. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Dang Shen (Codonopsis Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Gui Zhi (Cinnamomi Ramulus) 10g, Fu Ling (Poria) 10g, Jiu Jun (Rheum Palmati Radix et Rhizoma processed with wine) 4g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
A certain doctor said: "Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) is a formula from Zhang Zhongjing's *Shanghan Lun*, originally used for 'after eight or nine days of Taiyang disease, purged, resulting in chest fullness, irritability and fright, difficulty urinating, delirium, heaviness of the whole body, inability to turn.' Why do you now use it for cerebral arteriosclerosis and Sydenham's Chorea?"
Answer: "Chaihu Jia Longgu Muli Tang is indicated for patterns where evil heat has sunk inward, permeating the whole body, involving both exterior and interior, presenting with mixed deficiency and excess. Although this current disease is not caused by mis-treatment of Taiyang disease, its pathogenesis involves internal depression of evil heat, involvement of both exterior and interior, and mixed deficiency and excess, hence Chaihu Jia Longgu Muli Tang is used."
Asked again: "Why did my wind-extinguishing medicines fail to calm the wind?"
Answer: "Wind syndromes should be treated by extinguishing wind; this is the routine method. However, the origins of wind vary. If due to Blood deficiency generating wind, one must nourish Blood and extinguish wind. If due to Yin deficiency generating wind, one must nourish Yin, calm the Liver, and extinguish wind. If due to Phlegm-Fire transforming into wind, one must resolve Phlegm and extinguish wind. If due to Spleen deficiency wind (Slow Spleen Wind), one must strengthen the Spleen to extinguish wind, as in the case of Zhuhan Dangjing Tang. In this current syndrome, the wind is associated with both Phlegm and Cold, hence Gui Zhi (Cinnamomi Ramulus) is paired with Long Gu (Fossilia Ossis Mastodi) and Mu Li (Ostreae Concha) to treat the wind. This disease belongs to Depression Syndrome, Cold-Phlegm, and Dampness. Depression syndromes require soothing, not suppressing; Cold syndromes require warming, not excessive cooling; Dampness syndromes require drying, not moistening. This is why rigid/soft, ascending/descending, and Qi/Blood must be distinguished."
After taking 7 doses, restless movements and grimacing greatly improved. After continuing for 30 doses, all symptoms disappeared. She subsequently recovered.
Spasmodic Torticollis
1. Failure to distinguish Cold/Heat, unclear Qi/Blood, adhering rigidly to wind-extinguishing, ultimately yielding no effect.
Patient Chai XX, Male, 48 years old.
Paroxysmal involuntary contraction of the left neck muscles causing head twisting to the left or paroxysmal tilting for 2 years. Western medical diagnosis: Spasmodic Torticollis. Initially treated with Western medicines for over half a year with no improvement. Subsequently combined with Chinese medicine for nourishing Blood, pacifying the Liver, and extinguishing wind, nourishing Yin and extinguishing wind, and acupuncture for over 1 year, still no improvement. Careful examination of the involuntary contraction of the left neck muscle causing head twisting and paroxysmal tilting, difficulty opening mouth and chewing, worsening with mental tension, effort in speaking, but all symptoms disappear during sleep. Symptoms include irritability, dizziness, distending head sensation, dry mouth and bitter taste, yellow-white tongue coating, and wiry, tight pulse. Synthesizing the pulse and symptoms, diagnosed as Liver Qi stagnation, failure to transform Phlegm-Dampness, depression transforming into Wind. Treatment principle: Soothe the Liver, regulate Qi, resolve Phlegm, and extinguish wind. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Dang Shen (Codonopsis Radix) 10g, Gui Zhi (Cinnamomi Ramulus) 10g, Huang Qin (Scutellariae Radix) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Fu Ling (Poria) 15g, Shu Jun (Prepared Rheum Palmati Radix et Rhizoma) 4g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
After taking 30 doses, all symptoms significantly decreased. A certain doctor said: "This prescription lacks sufficient power to extinguish wind; add Geckos (Gejie) and Scorpions (Quanxie)." After taking 10 doses, symptoms worsened. Invited me to re-evaluate. I said: "Although this syndrome has many wind manifestations, the pulse indicates Cold and Fluid retention as primary. Therefore, the focus should be on resolving Phlegm and warming the meridians, not heavily extinguishing wind." Removed Geckos and Scorpions, added Ren Shen (Ginseng Radix et Rhizoma) 10g. After taking 60 doses, all symptoms disappeared, and he recovered.
2. Simultaneous disease of Liver and Stomach, complicated by internal wind, regulating Liver and Stomach, assisting with wind-extinguishing, leads to recovery.
Patient He XX, Female, 60 years old.
Epigastric fullness and frequent belching for 3 years. Neck twisting and teeth grinding for 2 years. Western medical diagnosis: Chronic superficial gastritis, Spasmodic Torticollis. Initially treated with Western medicines for a long time without effect. Subsequently combined with Chinese medicine for extinguishing wind and relieving spasms, also without merit. Careful examination of symptoms reveals dizziness, distending head sensation, insomnia, irritability, chest fullness, back pain, paroxysmal involuntary contraction of right neck muscles, head twisting to the left, continuous teeth grinding with clicking sounds, difficulty opening mouth. Especially when trying to open mouth to speak, teeth grinding becomes more severe, frequently affecting chewing and eating. Also poor appetite, reduced food intake, epigastric distension, bitter taste in mouth, dry throat, emaciation, fatigue. Walking is often affected by fatigue and neck spasms, requiring assistance. Tongue coating is yellow-white and thick/greasy, pulse is wiry and tight. Synthesizing the pulse and symptoms: This disease presents with both deficiency and excess, Cold and Heat coexisting, and treatments often contradict each other, making it difficult to handle. Reflecting further: Zhang Zhongjing and Zhu Danxi emphasized pulse diagnosis in complex syndromes; Li Dongyuan emphasized ascending/descending mechanisms in treatment and focused on Spleen and Stomach in specific measures. With a wiry, tight pulse, treatment should primarily target the Liver and Stomach. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Cang Zhu (Atractylodis Rhizoma) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Gui Zhi (Cinnamomi Ramulus) 10g, Fu Ling (Poria) 10g.
After taking 6 doses, chest and epigastric distending pain improved, appetite improved, able to eat about 5 liang daily. However, left neck muscle contraction, teeth grinding, irritability, and insomnia did not improve. Careful examination of the pulse remained wiry and tight. Reflecting: Wiry, tight pulse with spasms indicates internal depression of Phlegm-Fluid transforming into wind. Treatment principle: Soothe the Liver, regulate Qi, resolve Phlegm, and extinguish wind. Prescription: Chai Hu (Bupleuri Radix) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Huang Qin (Scutellariae Radix) 10g, Gui Zhi (Cinnamomi Ramulus) 10g, Fu Ling (Poria) 15g, Da Huang (Rhei Radix et Rhizoma) 3g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
After taking 4 doses, neck muscle contraction and teeth grinding decreased, and no teeth grinding occurred after falling asleep. However, appetite and epigastric distension worsened compared to before. Prescribed modified Chai Ping Tang (Bupleurum and Atractylodes Decoction) for 4 doses, then switched to Chaihu Jia Longgu Muli Tang for 4 doses, alternating. After two months, all symptoms disappeared, and she recovered.
A certain doctor asked: "Why alternate prescriptions?"
Answer: "This disease involves two unrelated conditions. Treating one condition is not favorable for the other, and vice versa. Using a method that treats all conditions simultaneously often delays recovery. Hence, this alternating method is adopted."
Myasthenia Gravis
1. Knowing the accompanying pathogens, assisting with dampness removal, the disease begins to resolve.
Patient Shi XX, Male, 34 years old.
Bilateral ptosis unable to lift for over 8 months. Western medical diagnosis: Myasthenia Gravis. Initially treated with Western medicines with temporary improvement, but upon stopping medication, ptosis returned. Subsequently combined with modified Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for over 5 months, symptoms did not significantly improve. Detailed inquiry into symptoms revealed, besides ptosis affecting vision, also feeling of heaviness in head and body, fatigue, desire to sleep, slightly greasy yellow-white tongue coating, and soggy-slow (Ru Huan) pulse. Synthesizing the pulse and symptoms: General heaviness and inability to lift eyelids indicate Spleen Dampness as the branch manifestation and Qi Deficiency as the root. Treatment should tonify Qi, raise Yang, remove dampness, and clear heat. Prescription: Man Jing Zi (Vittariae Spora) 10g, Sheng Ma (Cimicifugae Rhizoma) 10g, Ge Gen (Puerariae Lobatae Radix) 15g, Dang Shen (Codonopsis Radix) 10g, Huang Qi (Astragali Radix) 15g, Huang Bo (Phellodendri Cortex) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 10g.
After taking 10 doses, he recovered.
A certain doctor asked: "Since it is Qi Deficiency, why was Buzhong Yiqi Tang ineffective?"
Answer: "This syndrome is not only Qi Deficiency but also accompanied by Damp-Heat. Thus, merely tonifying Qi with Buzhong Yiqi Tang was ineffective."
Asked again: "Yiqi Congming Tang (Benefit Qi and Brighten Eyes Decoction) is Li Dongyuan's formula for benefiting ears and brightening eyes. Why is it used for Myasthenia Gravis?"
Answer: "The eyelids are governed by the Spleen. Yiqi Congming Tang tonifies Qi, raises Yang, and removes dampness; thus, it can be used."
2. For Qi and Yin Dual Deficiency with Phlegm-Heat obstruction, one must not only tonify Qi and Yin but also resolve Phlegm-Dampness.
Patient Wen XX, Female, Adult.
Difficulty swallowing and chewing, weak speech, occasional choking of water from nostrils for over 2 years. Western medical diagnosis: Myasthenia Gravis. Initially treated with Western medicines with slight effect, but unable to control progression. Subsequently combined with Chinese medicine for tonifying Qi and nourishing Yin, yet condition worsened day by day. Careful examination of symptoms revealed weak speech and chewing, choking of water from nostrils, difficulty swallowing, indifferent facial expression, drooping mandible unable to close, inability to lift head, ptosis unable to open eyes, fatigue, lack of interest in food, white tongue coating, and soggy-slow (Ru Huan) pulse. Synthesizing the pulse and symptoms: This is caused by Qi and Yin Dual Deficiency with Phlegm-Dampness obstruction. Treatment principle: Tonify Qi, nourish Yin, regulate Qi, and resolve Phlegm. Prescription: Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 6g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Mai Dong (Ophiopogonis Tuber) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Zhu Ru (Bambusae Caulis in Taenia) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Fu Ling (Poria) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Chang Pu (Acori Tatarinowii Rhizoma) 10g, Yuan Zhi (Polygalae Radix) 10g, Sheng Di Huang (Rehmanniae Radix) 10g.
After taking 6 doses, breathing, speech, chewing, and swallowing became stronger, and no more choking on water. After continuing for 4 months, all symptoms disappeared, and she recovered.
A certain doctor asked: "This syndrome was previously treated with Buzhong Yiqi Tang and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), yet ineffective. Why?"
Answer: "There was sufficiency in tonification but insufficiency in resolving Phlegm. Unless Phlegm is removed, symptoms will not decrease. Therefore, nourishing Yin, tonifying Qi, resolving Phlegm, and regulating Qi must be applied simultaneously."
3. For Dual Deficiency of Qi and Blood with Heart and Spleen Insufficiency, one must tonify Qi and Blood, nourish the Heart, and calm the Spirit.
Patient Guo XX, Female, Adult.
Extreme fatigue of whole-body muscles, difficulty eating, swallowing, breathing, and turning over for over 2 years. Western medical diagnosis: Myasthenia Gravis. Initially treated with Western medicines with temporary relief, but symptoms worsened hours after stopping medication. Subsequently combined with Buzhong Yiqi Tang without obvious effect. Careful examination of symptoms revealed extreme whole-body fatigue, difficulty eating, swallowing, and chewing, poor appetite, reduced food intake, irritability, insomnia, palpitations, thin-white tongue coating, and fine-weak-slow pulse. Synthesizing the pulse and symptoms, diagnosed as Dual Deficiency of Qi and Blood, Heart and Spleen Insufficiency. Treatment: Tonify Qi and Blood, nourish the Heart, and calm the Spirit. Prescription: Ren Shen (Ginseng Radix et Rhizoma) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 6g, Fu Ling (Poria) 10g, Yuan Zhi (Polygalae Radix) 10g, Chao Zao Ren (Semen Ziziphi Spinosae Praeparatum) 10g, Mu Xiang (Aucklandiae Radix) 6g, Long Yan Rou (Longan Arillus) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces.
After taking 4 doses, all symptoms decreased, diet and sleep increased. After continuing for 100 doses, all symptoms disappeared.
A certain doctor said: "I also used Guipi Tang (Restore the Spleen Decoction), yet the effect was not significant. Why?"
Answer: "You used Dang Shen (Codonopsis Radix), whereas I used Ren Shen (Ginseng Radix et Rhizoma). Ren Shen greatly tonifies Primordial Qi, benefits Qi and nourishes Yin, nourishes the Heart and assists the Spleen, whereas Dang Shen only tonifies the Qi of the Spleen and Lungs."
Periodic Paralysis
1. Examining via pulse, assisting with complexion and symptoms, prescribing formulas and drugs, persistence leads to cure.
Patient Zhou XX, Female, 36 years old.
Paroxysmal paralysis for over 5 years. Western medical diagnosis: Periodic Paralysis. Each episode responds quickly to Potassium Chloride, but complete cure is elusive, necessitating Chinese medicine combination, yet effects remain insignificant. Especially in the past year, instead of improving, attacks became more frequent, occurring 14 times in just 3 months. Careful examination of symptoms revealed general limb weakness and extreme difficulty in movement, dry mouth and throat, thirst with excessive drinking, irritability, insomnia, throat discomfort, profuse sweating, shortness of breath. Inquiry into the onset process revealed: initially sudden thirst and excessive drinking, limb soreness, followed shortly by throat oppression, fatigue, difficulty walking in lower limbs, eventually leading to whole-body paralysis. White tongue coating, soggy-slow (Ru Huan) pulse. Synthesizing the pulse and symptoms: A soggy-slow pulse indicates Qi and Yin Dual Deficiency with Phlegm depression and Qi knotting. Furthermore, general weakness and heaviness indicate Spleen Dampness, while paroxysmal nature belongs to Liver and Gallbladder. Treatment principle: Tonify Qi, nourish Yin, regulate Qi, and resolve Phlegm. Prescription: Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 6g, Dang Shen (Codonopsis Radix) 10g, Mai Dong (Ophiopogonis Tuber) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Zhu Ru (Bambusae Caulis in Taenia) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Fu Ling (Poria) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Chang Pu (Acori Tatarinowii Rhizoma) 10g, Yuan Zhi (Polygalae Radix) 10g, Sheng Di Huang (Rehmanniae Radix) 10g.
After taking 6 doses, spirit doubled, profuse sweating, thirst, fatigue, and throat discomfort all decreased. After continuing for 6 doses, all symptoms disappeared. To consolidate efficacy, changed to 1 dose every 3 days. Took medicine for 3 months, stopped, observed for 4 years, no recurrence.
2. Carefully observing pulses, detailed differentiation, combining complexion and pulse, prudent prescription, ultimately achieving cure.
Patient Gong XX, Male, 23 years old.