头晕目眩，不能站立，甚或晕厥2个多月。医诊原发性直立性低血压。始以西药治疗不效，继又配用中药补中益气汤加减而更甚。察其头晕目眩，不能坐立，坐立时非但头晕，而且血压下降至60／38mmHg，有时一从沙发上站立于地即突然面色苍白，汗出恶心，而晕倒在地，且见胸满心烦，纳呆食减。舌苔白，脉沉弦细数。综合脉证，思之：脉沉者，郁证也；脉细者，血虚也；数者，热也，火也。合之与症，乃肝郁血虚，郁而化火也。治拟疏肝理气，养血泻火。处方：柴胡10克，当归10克，枳实10克，白芍10克，郁金10克，青皮10克，薄荷6克，栀子10克，甘草6克。
服药4剂，头晕大减，食纳，精神倍增，继服10剂，诸证消失，血压正常，愈。
3．脉弦而数，知其为肝胆实火，予清肝泻火，愈
郝××，女，45岁。
头晕乏力，不敢站立半年多。医诊原发性直立性低血压。先予西药治疗3个多月不效，后又配合中药补中益气汤加减而头晕更甚。察其头晕不敢站立，血压坐位时45／30mmHg，平卧位时56／38mmHg，胸满心烦，时或头脑胀痛，舌苔黄白，脉弦数。综合脉证，思之脉弦而数者，肝胆实火也。合之与症，乃肝胆实火夹湿所致。拟用泻肝胆实火，清三焦湿热。处方：龙胆草10克，柴胡10克，泽泻10克，车前子(布包)10克，木通10克，生地10克，当归10克，栀子10克，黄芩10克，甘草10克。
服药2剂，头晕大减，继服6剂，诸证消失，愈。
某医云：血压低乃中气下陷不升所致，何先生反用龙胆泻肝汤之苦降泻火?答曰：血压低就是气虚清阳不升所致的论点，不但论据不足，而且与事实不符，所以以推理、想象为基础的结论也是不正确的。本证从脉证来看均是肝胆实火证，故以龙胆泻肝汤治之而获效。
4．脉见弦滑而数，知其为痰火郁于肝胆，予疏肝、化痰，泻火而愈
周××，女，35岁。
头晕乏力，不敢站立1年多。医诊原发性直立性低血压。先予西药治疗不效，后又配合中药补中益气汤加减而症状反见加重。细审其证，除头晕乏力，不敢站立外，并见失眠心烦，口苦口粘，舌苔白，脉弦滑而数。综合脉证，思之：脉弦数者，肝胆实火也；滑数者，痰火也。合之与症，乃肝胆实火，痰火相合之证也。治拟化痰、理肝、泻火。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹10克，枳实10克，半夏10克，滑石10克，竹叶10克，夜交藤30克。
服药4剂，头晕乏力，失眠心烦诸证均减，且血压亦由70／50mmHg升至120／80mmHg，继服6剂，诸证消失，愈。
某医云：本例曾久用补中益气而血压反见下降者何也?答日：低血压病之因于气虚清阳失升者，补中益气汤自为最佳处方，然因痰火所致者，非但用补中益气汤不效，亦且会使其加剧也。
自发性多汗症
1．胶着补益，湿热反盛，耗气伤阴，汗出溱溱
曹××，男，43岁。
下肢沉重乏力7—8年，经常汗出5～6年。医诊自发性多汗症。先予西药治疗3年多不效，后又配合中药敛汗固表之剂，而汗出更甚。细询其证，从腰以下至足特别沉重乏力，甚至感到难于抬腿，汗出溱溱，甚或汗出如豆，而上半身却不汗出，纳呆食减，口干不欲饮，或见烦渴多饮，虽饮2～3暖瓶水亦难解渴，胃脘痞满，舌苔黄白而腻，脉濡缓。因思脉濡缓而下肢沉重者湿热蕴结也。合之与舌、症，乃湿热郁滞，清升浊降失职耳。因拟：防己10克，桂枝10克，党参10克，生石膏15克，生薏米15克，木瓜10克，滑石10克。
服药4剂，汗出大减，下肢沉重明显减轻。继服10剂，汗出得止，下肢沉重亦随之消失。
某医云：前用敛汗固表而汗出反甚，后用除湿清热而汗出反愈者，何也?答曰：自汗盗汗者固以虚证者为多，因此多用敛汗固表法进行治疗。但本证之自汗却非虚证之自汗，而是蕴热之蒸汗，故当治湿热之蕴蒸，湿热除则汗自止。至于为什么用敛汗固表法而反剧，实因敛汗固表以助邪气之蕴热耳。
2．不遵脉证，但守补益，郁火反炽，汗出更剧
靳××，女，49岁。
阵发性汗出5年。医诊自发性多汗症。先予西药治疗2年多不效，后予中药敛汗固表之剂治疗3年仍不效。且近年来汗出较前更加频繁，为此经常影响工作和生活。细询其证，汗出多发生在白天，每次发病，先感腹部有股热气上冲，冲至胸头则感全身烦热，继而全身大汗，约1～2秒钟后，即烦热消失，汗出亦止，且时时头晕头痛，胸满心烦，舌苔白，脉弦而滑。综合脉证，思之：脉弦者，肝病也；滑者，痰火也。合之于症，乃痰火郁结在肝胆也。治拟疏肝泻火，化痰解郁。处方：柴胡6克，当归9克，白芍15克，白术9克，茯苓9克，甘草6克，薄荷4克，栀子10克，生姜3片，龙胆草10克，元参15克，丹皮9克，黄芩9克，瓜蒌15克，丝瓜络9克。
某医云：如此汗出之重证，岂可不用敛汗固表者也?答日：敛汗固表实为治疗汗证之第一大法，故诸医都遵之。然本证虽遍用固表止汗之剂，却由一日汗出一次增至每日汗出十余次，这种事实说明敛汗固表之剂不可予也。张景岳《景岳全书》云：“汗由血液本乎阴也，《经》日：阳之汗以天地之雨名之。其义可知。然汗发于阴而出于阳，此其根本则由阴中之营气，而其启闭则由阳中之卫气，故凡欲疏汗而不知营卫之盛衰，欲禁汗而不知橐龠之牝牡，亦猫荡舟于陆，驾车于海耳，吾知其不败不已也。”汗既为发于阴而出于阳，那么影响发于阴而出于阳的因素是什么呢?今从其脉证来看为痰火郁结在肝胆，而非卫气之不固，故治宜疏肝解郁，化痰泻火，而不可予补益敛汗以助火邪。
服药4剂，汗出减少，继服6剂，汗出消失，他证亦减七八。
3．半身汗出，非瘀则郁，反与补益，壅其气血，汗出必剧
康××，男，40岁。
阵发性半身汗出半个多月。医诊自发性多汗症。先予西药治之不效，后以中药敛汗固表仍不效。细询其汗出之状，发病伊始先感全身一阵烦热，继而瞬间左半身汗出如珠，2～3秒钟后瞬间即热止汗消。1日数次。别无所苦，舌苔薄白，脉弦涩不调。综合脉证，思之：脉弦者，肝脉也；涩者，滞也、瘀也、寒也；弦涩并见者，寒饮内郁，肝木失达也。合之于症，乃寒饮内郁，肝木失达，水逆上冲也。治拟温阳化饮，疏肝降逆。处方：柴胡10克，半夏9克，黄芩9克，党参9克，生姜3片，大枣5个，桂枝9克，茯苓15克，甘草6克，龙骨15克，牡蛎15克，熟军3克。
服药2剂，烦热上冲、汗出的次数明显减少，继服8剂，诸证尽失，愈。
某医云：本例患者为何先用敛汗固表之剂不但汗出不减，而反全身憋胀僵抽?答曰：本证之汗首在于郁，而不在于虚，郁者当疏当散，今反用敛用固，致使气血，水饮更加壅滞而难解，故而汗不减而全身憋胀僵抽。
孙××，男，成。
左侧半脸汗出1年多。医诊自发性多汗症。先用西药治之不效，继又配用益气固表敛汗之中药亦不效。细审其证，除半脸汗出如珠外，并见全身拘急不适，舌苔白，脉弦。综合脉证，诊为肝郁气滞，寒饮不化。拟予柴胡加龙骨牡蛎汤去铅丹法，7剂，获愈。
4．正虚邪实，寒热并见，补虚泻实，调之可愈
姚××，女，52岁。
阵发性汗出3年多。医诊自发性多汗症。先予西药治疗1年多不效，后又配合中药敛汗固表、益气固表、调和营卫、疏肝解郁等亦不效。细审其证，每次汗出之前先感心烦心悸，继而烦热上冲，冲至头项则汗出，其汗或仅出于左，或仅出于右，很少出现全身汗出，此外尚见下肢轻度浮肿，失眠，舌苔薄白，脉虚而弦细。综合脉证，思之：脉虚者，气血俱虚也；弦者，肝脉也，寒也；细者，血虚也。合之于症，乃气血俱虚为本，气滞血瘀，湿郁不化为标。治拟补气养血以培本，理气活血，燥湿化痰以治标。处方：黄芪30克，党参10克，丹参30克，当归10克，黄精10克，生地10克，柴胡10克，苍术15克，白术10克，青皮10克，陈皮10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药2剂，汗出减少，继服10剂，汗出消失，失眠、浮肿俱解。
5．胶于正虚，过施补益，郁火炽盛，迫津外出
苏××，女，28岁。
五六年来，经常汗出。医诊自发性多汗症。先以西药治疗数年不效，后又以固表止汗之剂数百剂仍无效。细询其证见：经常一阵一阵的出汗，有时坐着不动即突然感到心烦心悸，继而全身一阵发热而汗出全身，有时因着急而突然感到一阵心烦，热气从心胸上冲，冲至头后即突然汗出；有时一到新的工作场所，即突然感到心烦热，全身烘热一阵即全身汗出。这种情况在月经期间特别严重。若服中药固表止汗之剂，不是不效，就是感到心烦心悸，全身憋胀，有时因全身憋胀难受，每天必须让人不断的捶打，舌苔黄白，脉弦稍数。综合脉证，思之：汗出全身有气虚不固之自汗，亡阴亡阳之绝汗，阴虚火旺之盗汗，然气虚自汗多因劳动而发，阴虚盗汗多睡眠中出，绝汗则必有绝证，此证皆不具备。此证之汗发于烦乱之后，医之称为躁汗者也。此乃肝郁血虚，郁而化火，火邪欲伸，迫津外出所致。故治宜养血疏肝，化痰泻火。处方：川芎10克，当归10克，黄芩10克，白芍10克，葛根15克，半夏10克，桑皮15克，甘草10克。
服药1剂，汗出即减，继服4剂，诸证大减，共服30剂，愈。
某医云：此证余久用敛汗固表之剂，非但汗出不减，亦且全身憋胀难忍，其故何也?答曰：汗与血者同源也，肝者藏血之脏也，肝经郁火欲伸之而不能则迫津外出而为汗也，今肝经郁火非达之不得伸，故只可以解郁泻火之法治之，若以敛摄之剂抑其条畅之性则郁者更郁，故全身憋胀难忍而汗出不止，此所以以解郁之法而效，以摄敛之法不愈之理也。
6．郁火迫津，反予敛摄，郁者更郁，火者更火
郝××，男，40岁。
左前额约鸡蛋大一片汗出一年。前后经数十医诊治未确诊。医先予西药治之不效，继又以中药敛汗固涩之剂近百帖而未功。细审其证，左前额约鸡蛋大一片汗出，有时汗出如珠，有时仅微似有汗，每日少则三四次，多则七八次，且往往在精神紧张的一刹那间出现，而其他部位却点滴不出，胸满心烦，舌苔白，脉弦细。综合脉证，思之：虚证之汗为全身汗出，而此汗出则仅见局部，必非虚证。且脉弦细而胸满心烦，必肝肾不足，郁火所为，故治以养阴疏肝，解郁泻火。处方：柴胡10克，当归10克，白芍10克，生地18克，山药12克，山萸肉10克，茯苓10克，泽泻10克，丹皮10克，栀子10克，薄荷3克，炒枣仁15克。
服药3剂，汗出减少，继服24剂，竟愈。
一氧化碳中毒性精神病
1.知其脏腑，明其气血，分其寒热，其病获愈
周××，男，56岁。
在菜窖中劳动时，不慎煤气中毒，神志昏迷2个多月，经过抢救虽然神志已经清醒，但1年多来，神情一直呆痴，不知饥饱，不知二便，不知亲友，且步态不稳。医诊一氧化碳中毒性精神病。先以西药治疗半年多不效。后又服用中药清心开窍之剂4个多月，仍无明显改变。细审其证，除上述者外，并见舌质红绛少苔，脉沉数而涩，寸滑。综合脉证，思之：脉沉数者，里热也；涩者，瘀血阻滞也；寸滑者，痰火阻于上焦也。舌质红绛者，营血热炽也。脉舌相参，诊为营血热炽，血络瘀滞，痰火蒙窍也。仿吴鞠通温病热人心包、血分意。拟凉血活血，化痰开窍。处方：丹参30克，当归10克，乳香6克，没药6克，连翘10克，至宝丹2丸(另服)。
服药3剂，神情呆痴之状明显好转，当别人问其饥饱时已能明确回答，并能自动去厕所大小便，继服20剂，神情呆痴之状消失，并能作其力所能及的体力与脑力劳动。
某医云：为什么前用西药，并配合安宫牛黄丸近百丸而不效?答曰：热入营血而以瘀血为主者应主以活血逐瘀治之，今先医重用凉血而轻活血则心血涩滞不通，此其所以无效者一也。神情呆痴为窍闭为主，应以开窍为主治之，今先医反重用清凉，此其所以无效者二也。
2.谨守病机，各司其属，法同药异，疗效相同
和××，男，39岁。
煤气中毒抢救脱险后，10个多月来，神识一直呆痴，不知二便，不知饥渴，时或自吃其二便，或将锅盆作便盆用，或将其妻子作父母，或将子女作妻子，走路不稳。医诊一氧化碳中毒性精神病。先予西药治疗7个月不效，后又配合中药安宫牛黄丸，每日3丸，治疗3个多月亦无效。细审其证，除上述者外，并见其四肢僵硬屈伸不利，舌质红绛，舌苔黄白厚腻，脉弦滑数。综合脉证，思之：舌质红绛者，热人血分也；舌苔黄白厚腻者，痰热阻滞也。脉弦者，肝火也；滑数者，痰火阻滞也。脉舌相参，痰热内阻，血络瘀滞也。治宜活血通络，清热化痰。处方：黄柏10克，苍术10克，南星10克，防己10克，桃仁10克，红花10克，龙胆草10克，丹参15克。
Dizziness and vertigo, inability to stand, or even syncope for more than 2 months. The physician diagnosed primary orthostatic hypotension. Initially treated with Western medicine without effect, subsequently combined with modified Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), yet the condition worsened. Examination revealed dizziness and vertigo, inability to sit or stand; when sitting or standing, not only was there dizziness but blood pressure dropped to 60/38 mmHg. Sometimes, upon standing up from a sofa, sudden pallor, sweating, nausea, and fainting occurred. Additionally, chest fullness, irritability, poor appetite, and reduced food intake were observed. The tongue coating was white, and the pulse was deep, wiry, thin, and rapid. Synthesizing the pulse and symptoms: a deep pulse indicates stagnation (Yu Zheng); a thin pulse indicates Blood deficiency; a rapid pulse indicates Heat and Fire. Combined with the symptoms, this is Liver Qi stagnation and Blood deficiency, transforming into Fire due to stagnation. The treatment principle was to soothe the Liver and regulate Qi, nourish Blood, and purge Fire. Prescription: Chai Hu 10g, Dang Gui 10g, Zhi Shi 10g, Bai Shao 10g, Yu Jin 10g, Qing Pi 10g, Bo He 6g, Zhi Zi 10g, Gan Cao 6g.
After taking 4 doses, dizziness decreased significantly, appetite returned, and spirit increased greatly. After continuing for 10 doses, all symptoms disappeared, blood pressure normalized, and the patient recovered.
3. Pulse is wiry and rapid, indicating Excess Fire of the Liver and Gallbladder; treated with clearing Liver and purging Fire, resulting in recovery.
Patient Hao XX, Female, 45 years old.
Dizziness and fatigue, fear of standing for over half a year. Diagnosed with primary orthostatic hypotension. Treated with Western medicine for over 3 months without effect, then combined with modified Buzhong Yiqi Tang, causing worse dizziness. Examination showed dizziness and fear of standing; blood pressure was 45/30 mmHg in sitting position and 56/38 mmHg in supine position. Chest fullness, irritability, occasional head distending pain, yellow-white tongue coating, and wiry-rapid pulse were observed. Synthesizing pulse and symptoms: a wiry and rapid pulse indicates Excess Fire of the Liver and Gallbladder. Combined with symptoms, this is Excess Fire of the Liver and Gallbladder complicated by Dampness. The treatment principle was to purge Excess Fire of the Liver and Gallbladder and clear Damp-Heat of the San Jiao. Prescription: Long Dan Cao 10g, Chai Hu 10g, Ze Xie 10g, Che Qian Zi (wrapped in cloth) 10g, Mu Tong 10g, Sheng Di 10g, Dang Gui 10g, Zhi Zi 10g, Huang Qin 10g, Gan Cao 10g.
After 2 doses, dizziness decreased significantly. After continuing for 6 doses, all symptoms disappeared, and the patient recovered.
A certain doctor asked: "Hypotension is caused by sinking of Middle Qi failing to ascend; why did Mr. He use the bitter-cold descending and fire-purging Long Dan Xie Gan Tang?" The answer was: "The argument that hypotension is caused by Qi deficiency and failure of Clear Yang to ascend lacks sufficient evidence and contradicts facts; therefore, conclusions based on reasoning and imagination are incorrect. From the pulse and symptoms, this case belongs to Excess Fire of the Liver and Gallbladder; thus, treating with Long Dan Xie Gan Tang was effective."
4. Pulse is wiry, slippery, and rapid, indicating Phlegm-Fire stagnating in the Liver and Gallbladder; treated with soothing Liver, resolving Phlegm, and purging Fire, resulting in recovery.
Patient Zhou XX, Female, 35 years old.
Dizziness and fatigue, fear of standing for over 1 year. Diagnosed with primary orthostatic hypotension. Treated with Western medicine without effect, then combined with modified Buzhong Yiqi Tang, causing worsening symptoms. Detailed examination revealed, besides dizziness, fatigue, and fear of standing, insomnia, irritability, bitter taste, sticky mouth, white tongue coating, and wiry-slippery-rapid pulse. Synthesizing pulse and symptoms: wiry-rapid pulse indicates Excess Fire of the Liver and Gallbladder; slippery-rapid pulse indicates Phlegm-Fire. Combined with symptoms, this is a syndrome of Excess Fire of the Liver and Gallbladder combined with Phlegm-Fire. The treatment principle was to resolve Phlegm, regulate Liver, and purge Fire. Prescription: Chai Hu 10g, Huang Qin 10g, Long Dan Cao 10g, Zhu Ru 10g, Zhi Shi 10g, Ban Xia 10g, Hua Shi 10g, Zhu Ye 10g, Ye Jiao Teng 30g.
After 4 doses, dizziness, fatigue, insomnia, and irritability decreased, and blood pressure rose from 70/50 mmHg to 120/80 mmHg. After continuing for 6 doses, all symptoms disappeared, and the patient recovered.
A certain doctor asked: "Why did blood pressure drop after long-term use of Buzhong Yiqi Tang in this case?" The answer was: "For hypotension caused by Qi deficiency and failure of Clear Yang to ascend, Buzhong Yiqi Tang is indeed the best prescription. However, for cases caused by Phlegm-Fire, using Buzhong Yiqi Tang is not only ineffective but also exacerbates the condition."
Spontaneous Hyperhidrosis
1. Clinging to tonification leads to flourishing Damp-Heat, consuming Qi and injuring Yin, resulting in profuse sweating.
Patient Cao XX, Male, 43 years old.
Heaviness and fatigue in lower limbs for 7-8 years, frequent sweating for 5-6 years. Diagnosed with spontaneous hyperhidrosis. Treated with Western medicine for over 3 years without effect, then combined with herbs to consolidate the exterior and stop sweating, causing worse sweating. Detailed inquiry revealed extreme heaviness and fatigue from waist to feet, difficulty lifting legs, profuse sweating like beans, while the upper body did not sweat. Poor appetite, dry mouth without desire to drink, or irritability and thirst with excessive drinking (2-3 thermoses of water failed to quench thirst). Epigastric fullness, yellow-white greasy tongue coating, and soggy-slow pulse. Analysis: Soggy-slow pulse with lower limb heaviness indicates accumulation of Damp-Heat. Combined with tongue and symptoms, this is Damp-Heat stagnation with failure of Clear Yang to ascend and Turbid Yin to descend. Prescription: Fang Ji 10g, Gui Zhi 10g, Dang Shen 10g, Sheng Shi Gao 15g, Sheng Yi Mi 15g, Mu Gua 10g, Hua Shi 10g.
After 4 doses, sweating decreased significantly, and lower limb heaviness improved. After continuing for 10 doses, sweating stopped, and lower limb heaviness disappeared.
A certain doctor asked: "Why did consolidating the exterior increase sweating, while removing Dampness and clearing Heat cured it?" The answer was: "Spontaneous and night sweats are mostly due to deficiency, so consolidating the exterior is commonly used. However, this case's spontaneous sweating is not due to deficiency but to steaming from accumulated Heat. Therefore, treating the Damp-Heat steaming is correct; once Damp-Heat is removed, sweating stops. Using consolidating herbs exacerbated the condition because they aided the accumulation of pathogenic Heat."
2. Ignoring pulse and symptoms, adhering solely to tonification, leading to intensified Stagnant Fire and worse sweating.
Patient Jin XX, Female, 49 years old.
Paroxysmal sweating for 5 years. Diagnosed with spontaneous hyperhidrosis. Treated with Western medicine for over 2 years without effect, then with herbs to consolidate the exterior for 3 years without effect. In recent years, sweating became more frequent, affecting work and life. Sweating mostly occurs during the day. Before each episode, a sensation of hot air rising from the abdomen to the chest and head causes whole-body irritability and heat, followed by profuse sweating. After 1-2 seconds, heat and sweating cease. Occasional dizziness, headache, chest fullness, and irritability. White tongue coating, wiry-slippery pulse. Analysis: Wiry pulse indicates Liver disease; slippery pulse indicates Phlegm-Fire. Combined with symptoms, this is Phlegm-Fire stagnating in the Liver and Gallbladder. Treatment principle: Soothe Liver, purge Fire, resolve Phlegm, and relieve stagnation. Prescription: Chai Hu 6g, Dang Gui 9g, Bai Shao 15g, Bai Zhu 9g, Fu Ling 9g, Gan Cao 6g, Bo He 4g, Zhi Zi 10g, Sheng Jiang 3 slices, Long Dan Cao 10g, Yuan Shen 15g, Dan Pi 9g, Huang Qin 9g, Gua Lou 15g, Si Gua Luo 9g.
A certain doctor asked: "For such severe sweating, can we not use methods to consolidate the exterior?" The answer was: "Consolidating the exterior is the primary method for treating sweating syndromes, followed by many doctors. However, in this case, despite using these methods, sweating increased from once daily to over ten times daily. This fact shows that consolidating herbs are inappropriate. Zhang Jingyue stated in *Jing Yue Quan Shu*: 'Sweat originates from Blood, which is fundamentally Yin... Sweat arises from Yin and exits through Yang... If one seeks to induce or stop sweating without knowing the rise and fall of Ying and Wei Qi, or the opening and closing mechanisms, it is like sailing on land or driving a cart at sea; I know it will fail.' Since this case involves Phlegm-Fire stagnating in the Liver and Gallbladder, not insecurity of Wei Qi, treatment should focus on soothing Liver, relieving stagnation, resolving Phlegm, and purging Fire, rather than tonifying and consolidating which would aid Fire."
After 4 doses, sweating decreased. After continuing for 6 doses, sweating disappeared, and other symptoms reduced by 70-80%.
3. Hemihidrosis (sweating on one side) is due to stasis or stagnation; using tonification obstructs Qi and Blood, making sweating severe.
Patient Kang XX, Male, 40 years old.
Paroxysmal hemihidrosis for over half a month. Diagnosed with spontaneous hyperhidrosis. Treated with Western medicine and herbs to consolidate the exterior without effect. Onset involved a sudden whole-body irritability and heat, followed by instantaneous sweating on the left side like beads, ceasing after 2-3 seconds. Occurred several times a day. No other discomfort. Thin-white tongue coating, wiry-choppy irregular pulse. Analysis: Wiry pulse indicates Liver; choppy pulse indicates stagnation, stasis, or cold. Wiry and choppy together indicate internal stagnation of Cold-Fluid and failure of Liver Wood to flow freely. Combined with symptoms, this is internal stagnation of Cold-Fluid, failure of Liver Wood to flow, and counter-flow of Water Qi. Treatment principle: Warm Yang, transform Fluid, soothe Liver, and direct rebellious Qi downward. Prescription: Chai Hu 10g, Ban Xia 9g, Huang Qin 9g, Dang Shen 9g, Sheng Jiang 3 slices, Da Zao 5 pieces, Gui Zhi 9g, Fu Ling 15g, Gan Cao 6g, Long Gu 15g, Mu Li 15g, Shu Jun 3g.
After 2 doses, frequency of heat rushing upward and sweating decreased significantly. After continuing for 8 doses, all symptoms disappeared, and the patient recovered.
A certain doctor asked: "Why did using herbs to consolidate the exterior not only fail to reduce sweating but cause whole-body distension and stiffness?" The answer was: "The key to this sweating is 'stagnation,' not 'deficiency.' Stagnation requires dispersal and unblocking. Using consolidating and astringent methods instead caused further obstruction of Qi, Blood, and Fluid, preventing resolution. Hence, sweating did not decrease, and whole-body distension and stiffness occurred."
Patient Sun XX, Male, Adult.
Sweating on the left half of the face for over 1 year. Diagnosed with spontaneous hyperhidrosis. Treated with Western medicine and Qi-tonifying/herbs to consolidate the exterior without effect. Besides bead-like sweating on the left face, there was whole-body stiffness and discomfort. White tongue coating, wiry pulse. Diagnosis: Liver Qi stagnation and failure to transform Cold-Fluid. Prescription: Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) minus Qian Dan, 7 doses, resulting in recovery.
4. Deficiency of Righteous Qi and Excess of Pathogen, simultaneous Cold and Heat; tonifying deficiency and purging excess restores balance.
Patient Yao XX, Female, 52 years old.
Paroxysmal sweating for over 3 years. Diagnosed with spontaneous hyperhidrosis. Treated with Western medicine for over 1 year without effect, then combined with herbs to consolidate the exterior, tonify Qi, harmonize Ying and Wei, and soothe Liver without effect. Before each sweating episode, there was irritability and palpitations, followed by heat rushing upward to the head and neck, causing sweating either on the left or right, rarely whole-body. Mild edema in lower limbs, insomnia. Thin-white tongue coating, deficient-wiry-thin pulse. Analysis: Deficient pulse indicates Qi and Blood deficiency; wiry pulse indicates Liver and Cold; thin pulse indicates Blood deficiency. Combined with symptoms, the root is Qi and Blood deficiency, while the branch is Qi stagnation, Blood stasis, and Dampness stagnation. Treatment principle: Tonify Qi and nourish Blood to support the root; regulate Qi, invigorate Blood, and dry Dampness/resolve Phlegm to treat the branch. Prescription: Huang Qi 30g, Dang Shen 10g, Dan Shen 30g, Dang Gui 10g, Huang Jing 10g, Sheng Di 10g, Chai Hu 10g, Cang Zhu 15g, Bai Zhu 10g, Qing Pi 10g, Chen Pi 10g, San Leng 10g, E Zhu 10g, Bo He 3g, Ye Jiao Teng 30g.
After 2 doses, sweating decreased. After continuing for 10 doses, sweating disappeared, and insomnia and edema resolved.
5. Clinging to deficiency and overusing tonification leads to flourishing Stagnant Fire, forcing fluids out.
Patient Su XX, Female, 28 years old.
Frequent sweating for 5-6 years. Diagnosed with spontaneous hyperhidrosis. Treated with Western medicine for years without effect, then with hundreds of doses of herbs to consolidate the exterior without effect. Sweating occurs in paroxysms. Sitting still may trigger sudden irritability and palpitations, followed by whole-body heat and sweating. Anxiety triggers heat rushing from chest to head, causing sudden sweating. New work environments trigger heat and sweating. Symptoms worsen during menstruation. Taking consolidating herbs causes no effect or results in irritability, palpitations, and whole-body distension, sometimes requiring constant beating to relieve discomfort. Yellow-white tongue coating, slightly rapid wiry pulse. Analysis: Whole-body sweating includes spontaneous sweating from Qi deficiency, collapse sweating from Yin/Yang exhaustion, and night sweats from Yin deficiency with Fire hyperactivity. However, this case does not fit these patterns. This sweating follows mental agitation, known as "Zao Han" (Restless Sweating). It is caused by Liver stagnation and Blood deficiency transforming into Fire, where Fire desires to extend and forces fluids out. Treatment principle: Nourish Blood, soothe Liver, resolve Phlegm, and purge Fire. Prescription: Chuan Xiong 10g, Dang Gui 10g, Huang Qin 10g, Bai Shao 10g, Ge Gen 15g, Ban Xia 10g, Sang Bai Pi 15g, Gan Cao 10g.
After 1 dose, sweating decreased. After continuing for 4 doses, symptoms greatly reduced. Total 30 doses resulted in recovery.
A certain doctor asked: "Why did long-term use of consolidating herbs fail to reduce sweating and caused unbearable whole-body distension?" The answer was: "Sweat and Blood share the same source; the Liver stores Blood. When Liver channel stagnant Fire desires to extend but cannot, it forces fluids out. This Fire must be allowed to extend via dispersing and purging. Using astringents suppresses its free-flowing nature, causing deeper stagnation and unbearable distension. This explains why dispersing methods work while astringent methods fail."
6. Stagnant Fire forces fluids out; using astringents makes stagnation deeper and Fire fiercer.
Patient Hao XX, Male, 40 years old.
Sweating on an egg-sized area on the left forehead for 1 year. Seen by dozens of doctors without diagnosis. Treated with Western medicine and nearly 100 doses of herbs to consolidate and astringe without success. Sweating on the left forehead occurs 3-7 times daily, often triggered by momentary mental tension. Other areas do not sweat. Chest fullness, irritability. White tongue coating, wiry-thin pulse. Analysis: Deficiency sweating is usually whole-body; local sweating is not deficiency. Wiry-thin pulse with chest fullness and irritability indicates Liver-Kidney insufficiency and Stagnant Fire. Treatment principle: Nourish Yin, soothe Liver, relieve stagnation, and purge Fire. Prescription: Chai Hu 10g, Dang Gui 10g, Bai Shao 10g, Sheng Di 18g, Shan Yao 12g, Shan Yu Rou 10g, Fu Ling 10g, Ze Xie 10g, Dan Pi 10g, Zhi Zi 10g, Bo He 3g, Chao Zao Ren 15g.
After 3 doses, sweating decreased. After continuing for 24 doses, complete recovery was achieved.
Carbon Monoxide Poisoning Psychosis
1. Knowing the Zang-Fu, understanding Qi and Blood, distinguishing Cold and Heat leads to recovery.
Patient Zhou XX, Male, 56 years old.
Unconscious for over 2 months due to accidental carbon monoxide poisoning while working in a vegetable cellar. Although consciousness was restored after rescue, for over 1 year, the patient remained dull and stupid, unaware of hunger/thirst, bowel/bladder functions, or relatives, with unstable gait. Diagnosed with carbon monoxide poisoning psychosis. Treated with Western medicine for over 6 months without effect, then with herbs to clear Heart and open orifices for over 4 months without significant change. Examination revealed red-purple tongue with little coating, deep-rapid-choppy pulse, and slippery Cun pulse. Analysis: Deep-rapid pulse indicates Interior Heat; choppy pulse indicates Blood stasis obstruction; slippery Cun pulse indicates Phlegm-Fire obstructing the Upper Jiao. Red-purple tongue indicates blazing Heat in Ying and Blood levels. Combining pulse and tongue, the diagnosis is blazing Heat in Ying and Blood, blood vessel stasis, and Phlegm-Fire obscuring the orifices. Following Wu Juzhong's concept of warm diseases entering the Pericardium and Blood level. Treatment principle: Cool Blood, invigorate Blood, resolve Phlegm, and open orifices. Prescription: Dan Shen 30g, Dang Gui 10g, Ru Xiang 6g, Mo Yao 6g, Lian Qiao 10g, Zhi Bao Dan 2 pills (taken separately).
After 3 doses, dullness improved significantly; the patient could answer questions about hunger/thirst and use the toilet independently. After continuing for 20 doses, dullness disappeared, and the patient could perform力所能及 physical and mental labor.
A certain doctor asked: "Why did Western medicine and nearly 100 pills of Angong Niuhuang Wan fail?" The answer was: "When Heat enters Ying and Blood with Blood stasis as the main factor, activating Blood and dispelling stasis should be the primary treatment. The previous doctor heavily used cooling but lightly activated Blood, causing heart blood stasis and obstruction—this is reason one for ineffectiveness. Dullness is primarily due to orifice closure, requiring opening of orifices. The previous doctor heavily used cooling instead—this is reason two for ineffectiveness."
2. Strictly observing the pathogenesis, assigning responsibilities to respective organs, same method but different drugs yield similar efficacy.
Patient He XX, Male, 39 years old.
After rescue from carbon monoxide poisoning, for over 10 months, the patient remained mentally dull, unaware of bowel/bladder functions, hunger/thirst, occasionally eating feces, using pots/pans as urinals, mistaking wife for parents, or children for wife, with unstable gait. Diagnosed with carbon monoxide poisoning psychosis. Treated with Western medicine for 7 months without effect, then combined with Angong Niuhuang Wan (3 pills daily) for over 3 months without effect. Examination revealed stiff limbs with limited flexion/extension, red-purple tongue, yellow-white thick-greasy coating, and wiry-slippery-rapid pulse. Analysis: Red-purple tongue indicates Heat entering Blood level; yellow-white thick-greasy coating indicates Phlegm-Heat obstruction. Wiry pulse indicates Liver Fire; slippery-rapid pulse indicates Phlegm-Fire obstruction. Combining pulse and tongue, the diagnosis is internal obstruction of Phlegm-Heat and blood vessel stasis. Treatment principle: Invigorate Blood, unblock collaterals, clear Heat, and resolve Phlegm. Prescription: Huang Bo 10g, Cang Zhu 10g, Nan Xing 10g, Fang Ji 10g, Tao Ren 10g, Hong Hua 10g, Long Dan Cao 10g, Dan Shen 15g.