4年前，一次偶然的机会，发现左下腹部有一如核桃大的肿块，经某院外科检查诊断为纤维瘤，并进行第1次手术，术后很快恢复了健康。1年之后，在原来的部位又长出2个如核桃大的肿块，又进行了第2次手术切除，术后，经病理学检查仍诊为纤维瘤，术后又很快恢复了健康。1年后，在原来发病的部位又长出如鸡蛋大的4个肿块，乃进行第3次手术切除，术后病理学检查仍为纤维瘤。半年后，在原发部位，又长出6个如核桃大的肿块。再经数个医院检查，诊断，一致认为系纤维瘤，并都主张手术切除。但患者考虑每次手术后均复发，且复发1次增多1次，乃改请中医治之。细审其除上证外，并见下腹疼痛，阴天时疼痛加重，疲乏无力，面色微青，舌苔白，舌质稍暗，脉沉涩。综合脉证，思之：脉沉涩者，寒凝血滞也。治宜温经活血散结。处方：丹参30克，当归10克，赤芍10克，乳香6克，没药6克，三棱3克，莪术3克，肉桂1克。
服药30剂，腹痛减轻，肿块变软缩小；继服上药1年，获愈。
某医云：同是反复发作的纤维瘤，一用化痰清热，佐以活血，一用温经活血散结；一用大剂，一用小剂，其故何也?答日：一者因脉滑数故以化痰清热，一者因脉沉涩故以温经活血，因其病因有异者，至于为什么一者用大剂，一者用微量，乃因其一者脉滑数为热实，一者因其脉沉涩为正虚邪实，故以缓图之法治之，即仲景所倡导之缓中补虚法也。
淋巴结炎
谨遵其脉，稍兼其症，主次分明，病始得解
刁××，女，20岁。
颈部淋巴结肿大半年多。医诊慢性淋巴结炎。始予西药抗结核药、抗生素治疗4个多月不效，继又配合中药软坚散结消瘰之剂2个多月仍不效。细审其证，颈部淋巴结肿大，小者如豆，大者如杏者18个，不红，不痛，舌苔白，脉沉弦。综合脉证，思之：沉脉者，气郁也；弦脉者，肝脉也；结核皮色不变者，痰核也。治宜疏肝理气，化痰散结。处方：柴胡10克，赤芍10克，青皮10克，瓜蒌15克，橘叶10克，甘草6克，当归6克。
服药6剂，有的淋巴结肿大者消失，有的淋巴结明显缩小；继服20剂，肿大之淋巴结全部消失。
某医云：何用软坚散结者不效，而不用软坚散结者反效?答曰：软坚散结乃治结核的一种有效方法，故诸医多宗之。然本证脉不但不滑而且沉弦，说明当前本证乃气郁为主，既然气郁为主，就当以理气为先，故前以软坚散结不效，而今用疏肝理气，化痰散结而瘳。
淋巴管炎
但予解毒，不察其脉，痰滞血瘀，病延时日
索××，女，60岁。左上肢内侧输液感染后发现一条红线1个月。医诊淋巴管炎。先以西药治之效果不著，继以中药清热解毒之剂治之，亦无明显效果。细审其证，除原有的糖尿病、结节病外，并见左前臂内侧约如苹果大一片红肿疼痛，从腕至腋一条红线，按之痛，身微热，腋下、肘窝、颈部、腹股沟淋巴结肿大，口干口苦，咳嗽，舌苔白，脉滑。综合脉证，思之：脉滑者，痰火也。有红线久久不愈者，瘀血也。治宜除湿化痰，活血清热。处方：黄柏10克，苍术10克，制南星10克，桂枝10克，防己10克，灵仙10克，桃仁10克，红花10克，龙胆草10克，川芎10克。
服药4剂，前臂肿痛明显好转，红线明显消退，其他诸证亦减，继服6剂，愈。
某医云：急性淋巴管炎诸医均主张清热解毒、活血消肿、清热利湿，而前已久用不效者何也?答曰：急性淋巴管炎中医称为红丝疔，多主张应用清热解毒，活血消肿、清热利湿进行治疗，这无疑是十分正确的。但是，本例患者，正虚邪实，突予冰雪，凝固气血，聚湿生痰，胶固难解，非予温化不能消，故今反用佐以温化而解。
淋巴结结核
察其病证，审其病位，参之脉象，知其为气郁痰凝，治用理气化痰得愈
弓××，男，成。
颈项、耳下、两腋结块，大者如杏，小者如豆者1年多。医诊淋巴结结核。先用西药治疗3个多月无效，后又配合中药猫爪草、消瘰丸等治疗2个多月亦无明显效果。细审其证，颈项两侧、耳下、腋下有结核30多个，大者如杏枣，小者如豆，不红，不热，不痛，推之可动，舌苔白，脉沉。综合脉证，思之：核者，痰核也；脉沉者，肝郁气结也。治宜疏肝理气，化痰散结。处方：夏枯草30克，白蒺藜9克，赤芍9克，橘叶9克，青皮9克，连翘9克，牡蛎9克，瓜萎15克。
服药24剂，颈项、耳下、腋下结核大部消失；又连续服药1个月，结核全部消失。胸x片：未见异常，愈。
某医云：为什么原用软坚散结的消瘰丸无效?答曰：本病脉沉，乃以气郁为主的疾病，气郁者，当以理气为主要治法，然而消瘰丸是一个以软坚散结为主的方药，所以治之不效，其后经过反复考虑，改予以理气为主，所以才取得了较好的效果。
急性乳腺炎
1．不审其脉，但予解毒，气血壅郁，其病不解
邹××，女，成。
乳房肿痛，发热15天。医诊急性乳腺炎。先用西药、热敷治疗1周不效，后又配合大剂清热解毒，活血消痈之剂，昼夜连进1周亦不见改善。细审其证，右侧乳房红肿热痛，肿痛部的中心微软，按之有波动感，寒热，体温39．8℃，烦躁喜哭，恶心呕吐，食欲不振，舌苔白，脉沉弦滑数。综合脉证，思之：脉沉弦者，肝胆郁结也；滑数者，痰热也。脉证相参，乃肝郁气结，郁而化火，热毒壅郁，化而为脓。治宜疏肝解郁，化痰散结，清热解毒。处方：柴胡15克，赤芍12克，当归12克，青皮12克，橘叶12克，瓜蒌60克，桔梗30克，蒲公英30克，银花15克。
服药1剂，乳房肿痛好转，体温38．8℃；继服7剂，诸证消失，愈。
某医云：乳痈者乃热毒壅郁所致，为什么前用大剂清热解毒，活血消痈剂不效?而先生仅用蒲公英、银花等的1／4量却霍然而愈?答曰：本证脉沉弦滑数，说明郁乃是本病的主要问题，故急需理气、化痰、稍佐清热解毒之品即可，此时若过于冰郁其气，则气血愈壅，而病邪难解，所以但用解毒活血而不解。
2．冷热不同，效果迥异
商××，女，28岁左乳房红肿疼痛，发热10天。医诊急性乳腺炎。先以不断的热敷、西药治疗10天而加重，后以配合中药清热解毒剂而更甚。细审其证，左乳房红肿疼痛，高热，体温39．9℃，舌苔黄白，脉滑数。综合脉证，思之：药证合拍，何故不效?偶读《理瀹骈文》“外治之理，即内治之理，外治之药，亦即内治之药，所异者，法。”《素问·至真要大论》“热者寒之，寒者热之”语，乃悟：此久用热敷之误耳。乃急令患者去热敷改为冷水毛巾频频敷之，1小时后，热退，肿减。5日后，肿消，热退，愈。
某医云：诸医均强调热敷而先生独主张冷敷其故何也?答日：乳痈初起无身热者可用热敷以助消散，若红肿，甚或已化脓者应冷敷以使其局限，若再身热炽盛者必须冷敷，否则使热人营血或热人心包而成危证矣。某医又云：冷敷、热敷尚有如此之不同?答曰：健康之人，冷热无甚差异，若正虚火炽者，治法稍有差异，则会立刻有变，正如仲景所说：“火邪虽微，内攻有力，焦骨伤筋，血难复也。”
男性乳房发育症
察其病位，参之于脉，知其病机，予理气疏肝，化痰散结，愈
李××，男，20岁。
乳房肿大，隐隐作痛2个多月。医诊男性乳房发育症。先以西药治之不效，后以中药软坚散结之剂治之亦无功。细审其证，两个乳房均肿大如核桃，用手触摸或衣服碰触时疼痛，不红，不热，舌苔白，脉沉。综合脉证，思之：脉沉者，肝郁也。肿核而皮色不变者，痰凝也。治宜疏肝理气，化痰散结。处方：柴胡10克，赤芍10克，当归10克，青皮10克，橘叶10克，瓜蒌15克。
服药3剂，肿块缩小，疼痛减轻；继服10剂，诸证俱失。愈。
某医问：为什么前医用软坚散结之剂不效，今却用此法而取效?答曰：《素问·至真要大论》曾说“坚者削之……结者散之……适事为故。”“逆者正治，从者反治，从少从多，观其事也……逆之，从之，逆而从之，从而逆之，疏令气调，则其道也。”也就是说制方之法，非但要注意大的原则，亦且应该注意治法中的从逆多少，只有这样才能恰到好处，才能真正的疏令气调。前用诸方重用化痰散结，而缺理气疏肝，而本证却是一个脉沉气郁为主的证候，所以前方重用化痰散结而不效，今方重用疏肝理气而得愈。
胸壁结核
正虚邪实，补之不应，治从缓中补虚，其病始愈
柯××，女，35岁。
左侧胸部腋下与乳房之间有一小指大的溃破口，反复流脓6年多。医诊胸壁结核。先用西药、理疗治疗1年多不效，继又配合中药阳和汤、托里透脓汤等药加减3年多，亦不见明显改善。细察其证，在左侧腋前第三肋间有一豆大的溃破口，时时流出稀而白的脓汁，不痛，局部皮色微见紫黯色，平坦而不肿胀。一般深吸气时脓汁即出，呼气时脓汁即无，咳嗽严重时即有气泡不断从破口出逸出，消瘦乏力，皮肤干燥，纳呆食减，舌苔白，脉沉弦。综合脉证，思之：沉脉者，气郁也；弦脉者，肝也。局部紫黯者，寒也，瘀也。流稀脓者，痰也。治宜理气疏肝，活血化痰。处方：柴胡6克，枳壳6克，白芍6克，橘叶7克，白芥子3克，当归6克，青皮6克，远志4克。服药40剂，精神、食欲好转，脓汁减少；继服100剂，共计5个月，诸证消失，体重增加10千克，愈。
某医问：胸壁结核已经化脓者，诸家多主张补益之法进行治疗，然而本证却久治不效，其故何也?答曰：正如你所说的胸壁结核已经化脓者一般均应采用补益之法以使其托疮生肌得愈。然而本病脉见沉弦，沉弦之脉者为以肝郁气滞为主之脉，即所谓实邪为主之脉，所以只可以祛邪之法进行治疗。又问：如此久病竞用此小方小剂治之，不解也?答曰：仲景在《金匮要略》一书中曾阐明了一个重要原则，若虚极而脉证俱实者，治疗之时只可采用缓去其邪的方法，即所谓“缓中补虚”，“安中益气”法。否则则很容易补正留邪，祛邪伤正，病情延宕而不愈。
深静脉血栓形成
察其脉证，知其瘀血痰热，治以活血化瘀，化痰清热，始愈
高××，男，55岁。
左下肢肿胀疼痛1个月。医诊髂股静脉血栓形成。先以西药治疗半月效果不著，继又配合中药清热利湿之剂亦无明显效果。细审其证，左下肢从腹股沟区至足部均肿胀疼痛，按压腹股沟至小腿的内侧均痛，左腿较右腿为热，且身热(体温38．4℃)，舌苔白腻，脉弦紧滑数。综合脉证，思之：脉滑数者，痰热蕴结也；弦紧者，寒也，结也。肿胀者，湿热也。合而论之，乃瘀血阻滞，痰热不化也。治拟除湿化痰，清热活血，佐以温化。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6克，桃仁10克，红花10克，龙胆草10克，川芎10克，神曲10克。外涂：牛黄解毒丸，冷水化开，涂。
服药1周，肿痛消失，继服4剂，愈。
某医云：何以用清热解毒利湿之剂不效，而用上中下痛风方而病解?答曰：前后之方，用药相同者有二：一者清热，二者除湿；不同者亦有二：一日活血，二日温化。因其病在血分，痰血凝滞，非通阳不得行痹，非活血不得通络，而前用诸方无有也，故今以上中下痛风方而愈。
血栓性浅静脉炎
1．审其昼夜有别，知其阴虚相火，滋阴降火始愈
汪××，男，60岁。
右侧乳下有一索条状物，疼痛2个多月。医诊血栓性浅静脉炎。如予西药治疗40多天不见好转，继以中药清热解毒，利湿通络之剂20多天亦不见改善。细审其证，除右乳内侧有一索条状物约10厘米长，疼痛，发热外，并时见心烦，舌苔黄腻，脉弦滑。综合脉证，思之：胸胁者，肝肺所主之位也，脉弦滑者，痰火郁结于筋脉也。治拟疏肝理气，化痰泻火。处方：柴胡15克，半夏15克，瓜蒌40克，苏木6克，赤芍15克，黄芩10克，青皮10克，橘叶10克，夏枯草30克。
服药2剂，诸证不减，且出现夜间牙痛。思之：夜间牙痛者，阴虚相火炽盛也。加元参30克以滋阴降火。
服药6剂，肿痛大减，继服10剂，果愈。
2．审病位，知所主，察脉象，知病性，予疏肝理气，化痰泻火而愈
于××，男，56岁。
左乳下至左上腹一条索状物，疼痛，发热1个多月。医诊血栓性浅静脉炎。先以西药治疗20天不见好转，继又以中药清热除湿，活血化瘀14天亦无效。细审其证，除左侧胸胁至上腹部有一索条状物，疼痛，发热外，并见心烦头晕，口苦咽干，舌苔白，脉弦滑。综合脉证，思之：脉弦滑者，痰郁气结也，胸胁之位者肝肺所主也。治宜疏肝、化痰、清热、散结。处方：柴胡10克，半夏10克，赤芍10克，青皮10克，橘叶10克，瓜蒌30克，黄芩10克，当归10克，夏枯草15克，连翘10克。同时外用：牛黄解毒丸，冷水化开，外涂。
服药4剂，肿痛大减，继服10剂，愈。
Four years ago, by chance, a walnut-sized mass was discovered in the left lower abdomen. It was diagnosed as a fibroma (fibrous tumor) after surgical examination at a certain hospital, and the first surgery was performed, with rapid recovery post-operation. One year later, two more walnut-sized masses grew at the original site, leading to a second surgical excision. Pathological examination post-surgery still diagnosed them as fibromas, and health was quickly restored again. Another year later, four egg-sized masses appeared at the original site of onset, prompting a third surgical excision, with pathological examination again confirming fibromas. Half a year later, six walnut-sized masses grew at the primary site. After examinations and diagnoses at several hospitals, it was unanimously agreed that they were fibromas, and all advocated surgical excision. However, considering that recurrence occurred after every surgery and increased with each recurrence, the patient sought Traditional Chinese Medicine (TCM) treatment instead. Upon careful examination, besides the aforementioned symptoms, there was lower abdominal pain, aggravated on cloudy days, fatigue, slightly bluish complexion, white tongue coating, slightly dark tongue body, and a deep, choppy pulse (Chen Se Mai). Synthesizing the pulse and symptoms: a deep, choppy pulse indicates cold coagulation and blood stasis. The treatment should focus on warming the meridians, invigorating blood, and dissipating nodules. Prescription: Danshen 30g, Danggui 10g, Chishao 10g, Ruxiang 6g, Moyao 6g, Sanleng 3g, Ezhu 3g, Rougui 1g.
After taking thirty doses, abdominal pain decreased, and the masses softened and shrank; continuing the above prescription for one year led to complete recovery.
A certain doctor asked: Why did one case of recurrent fibroma respond to resolving phlegm and clearing heat with blood-invigorating herbs, while another responded to warming meridians, invigorating blood, and dissipating nodules? Why was one treated with a large dose and the other with a small dose? The answer is: One case had a slippery and rapid pulse (Hua Shu Mai), hence resolving phlegm and clearing heat was used; the other had a deep and choppy pulse, hence warming meridians and invigorating blood was used, due to different etiologies. As for why one used a large dose and the other a minute dose, it is because the former presented with heat excess (Re Shi) indicated by the slippery-rapid pulse, while the latter presented with deficiency of healthy qi and excess of pathogenic factors (Zheng Xu Xie Shi) indicated by the deep-choppy pulse, thus requiring a gradual approach, i.e., the method of "gradually tonifying deficiency" advocated by Zhang Zhongjing.
Lymphadenitis
Adhering strictly to the pulse, incorporating symptoms, distinguishing primary from secondary, the disease was resolved.
Diao XX, Female, 20 years old.
Swollen lymph nodes in the neck for over half a year. Diagnosed as chronic lymphadenitis by physicians. Initially treated with anti-tuberculosis drugs and antibiotics for over four months without effect, followed by TCM prescriptions for softening hardness and dissipating nodules for over two months, still ineffective. Careful examination revealed swollen lymph nodes in the neck, ranging from bean-sized to apricot-sized, totaling 18, non-red, non-painful, white tongue coating, and deep-wiry pulse (Chen Xian Mai). Synthesizing pulse and symptoms: a deep pulse indicates Qi stagnation; a wiry pulse relates to the Liver meridian; subcutaneous nodules with unchanged skin color are Phlegm nodules (Tan He). Treatment should focus on soothing the Liver, regulating Qi, resolving phlegm, and dissipating nodules. Prescription: Chaihu 10g, Chishao 10g, Qingpi 10g, Gualou 15g, Juye 10g, Gancao 6g, Danggui 6g.
After six doses, some swollen lymph nodes disappeared, others shrank significantly; continuing for twenty doses resulted in the complete disappearance of all swollen lymph nodes.
A certain doctor asked: Why was the method of softening hardness and dissipating nodules ineffective, while omitting it proved effective? The answer is: Softening hardness and dissipating nodules is an effective method for treating tubercles, so most doctors follow it. However, this case's pulse was not only not slippery but also deep and wiry, indicating that Qi stagnation is the primary issue. Since Qi stagnation is primary, regulating Qi should come first. Thus, the previous use of softening hardness failed, while the current use of soothing the Liver, regulating Qi, resolving phlegm, and dissipating nodules succeeded.
Lymphangitis
Merely providing detoxification without examining the pulse leads to Phlegm stagnation and Blood stasis, prolonging the illness.
Suo XX, Female, 60 years old. A red line appeared on the inner side of the left upper arm one month after intravenous infusion infection. Diagnosed as lymphangitis. Initial Western medicine treatment showed little effect, followed by TCM prescriptions for clearing heat and detoxifying, also with no obvious effect. Careful examination revealed, besides existing diabetes and sarcoidosis, a red, swollen, painful area the size of an apple on the inner left forearm, a red line from wrist to armpit, tender upon pressure, slight fever, swollen lymph nodes in axilla, elbow fossa, neck, and groin, dry mouth and bitter taste, cough, white tongue coating, and slippery pulse (Hua Mai). Synthesizing pulse and symptoms: a slippery pulse indicates Phlegm-Fire; a persistent red line indicates Blood stasis. Treatment should focus on removing dampness, resolving phlegm, invigorating blood, and clearing heat. Prescription: Huangbai 10g, Cangzhu 10g, Zhi Nanting 10g, Guizhi 10g, Fangji 10g, Lingxian 10g, Taoren 10g, Honghua 10g, Longdancao 10g, Chuanxiong 10g.
After four doses, forearm swelling and pain improved significantly, the red line faded markedly, and other symptoms decreased; continuing for six doses led to recovery.
A certain doctor asked: Acute lymphangitis is generally treated with clearing heat, detoxifying, invigorating blood, reducing swelling, clearing heat, and promoting diuresis. Why did previous long-term use fail? The answer is: Acute lymphangitis is known in TCM as "Red Thread Ding," often treated with clearing heat, detoxifying, invigorating blood, reducing swelling, clearing heat, and promoting diuresis, which is undoubtedly correct. However, this patient suffered from deficiency of healthy qi and excess of pathogenic factors. Sudden administration of cold/natured herbs (like ice/snow) congeals Qi and Blood, gathers dampness to form Phlegm, making it sticky and hard to resolve. Only warming transformation can eliminate it, hence the success with added warming transformation.
Lymph Node Tuberculosis
Observing disease signs, assessing location, referencing pulse, identifying Qi stagnation and Phlegm condensation, treatment with regulating Qi and resolving Phlegm led to cure.
Gong XX, Male, Adult.
Lumps in neck, below ears, and both axillae, apricot-sized to bean-sized, for over a year. Diagnosed as lymph node tuberculosis. Western medicine treatment for over three months was ineffective, followed by TCM herbs like Maozhua Cao and Xiaoluo Wan for over two months with no obvious effect. Careful examination revealed over 30 tubercles on both sides of the neck, below ears, and in axillae, ranging from apricot-date sized to bean-sized, non-red, non-hot, non-painful, movable upon pushing, white tongue coating, and deep pulse (Chen Mai). Synthesizing pulse and symptoms: nodules are Phlegm nodules; a deep pulse indicates Liver Qi stagnation and knotting. Treatment should focus on soothing the Liver, regulating Qi, resolving phlegm, and dissipating nodules. Prescription: Xiakucao 30g, Baijili 9g, Chishao 9g, Juye 9g, Qingpi 9g, Lianqiao 9g, Muli 9g, Gualou 15g.
After twenty-four doses, most tubercles in neck, below ears, and axillae disappeared; continuing for one month led to complete disappearance. Chest X-ray: normal, cured.
A certain doctor asked: Why was the previously used softening-hardness-and-dissipating-nodules formula Xiaoluo Wan ineffective? The answer is: This disease presents with a deep pulse, indicating it is primarily caused by Qi stagnation. For Qi stagnation, regulating Qi is the main treatment. However, Xiaoluo Wan focuses mainly on softening hardness and dissipating nodules, hence its ineffectiveness. After repeated consideration, changing to a Qi-regulating approach yielded better results.
Acute Mastitis
1. Not examining the pulse, merely providing detoxification leads to Qi and Blood congestion and stagnation, preventing resolution.
Zou XX, Female, Adult.
Breast swelling, pain, and fever for 15 days. Diagnosed as acute mastitis. Western medicine and hot compresses for one week were ineffective, followed by large doses of clearing-heat, detoxifying, invigorating-blood, and abscess-resolving herbs for a week day and night, with no improvement. Careful examination revealed redness, swelling, heat, and pain in the right breast, soft center in the swollen/painful area, fluctuation upon pressure, aversion to cold and fever, temperature 39.8°C, irritability and crying, nausea and vomiting, poor appetite, white tongue coating, and deep-wiry-slippery-rapid pulse (Chen Xian Hua Shu Mai). Synthesizing pulse and symptoms: deep-wiry pulse indicates Liver-Gallbladder Qi stagnation; slippery-rapid indicates Phlegm-Heat. Pulse and signs combined indicate Liver Qi stagnation transforming into Fire, Heat-Toxin congestion transforming into pus. Treatment should focus on soothing the Liver, relieving depression, resolving phlegm, dissipating nodules, clearing heat, and detoxifying. Prescription: Chaihu 15g, Chishao 12g, Danggui 12g, Qingpi 12g, Juye 12g, Gualou 60g, Jiegeng 30g, Pugongying 30g, Yinhua 15g.
After one dose, breast swelling and pain improved, temperature dropped to 38.8°C; continuing for seven doses led to resolution of all symptoms and cure.
A certain doctor asked: Ru Yong (breast abscess) is caused by Heat-Toxin congestion. Why did large doses of clearing-heat, detoxifying, invigorating-blood, and abscess-resolving herbs fail, while using only 1/4 dose of Pugongying and Yinhua led to sudden cure? The answer is: The deep-wiry-slippery-rapid pulse indicates that stagnation is the main problem. Therefore, regulating Qi and resolving Phlegm, with slight addition of clearing-heat and detoxifying herbs, is urgent. If too much cold/natured herb is used to suppress Qi, Qi and Blood become more congested, and pathogens are harder to resolve. Hence, merely using detoxification and blood-invigorating herbs failed.
2. Different temperatures yield vastly different effects.
Shang XX, Female, 28 years old. Redness, swelling, pain, and fever in the left breast for 10 days. Diagnosed as acute mastitis. Continuous hot compresses and Western medicine for 10 days worsened the condition; adding clearing-heat and detoxifying TCM herbs made it worse. Careful examination revealed redness, swelling, pain in the left breast, high fever, temperature 39.9°C, yellow-white tongue coating, and slippery-rapid pulse (Hua Shu Mai). Synthesizing pulse and symptoms: Why was the medication mismatched despite apparent correspondence? Reading *Li Yue Pian Wen*: "The principle of external treatment is the same as internal treatment; the medicines are the same, differing only in the method." And *Suwen·Zhi Zhen Yao Da Lun*: "Heat is treated with Cold, Cold is treated with Heat." Realization: The error lay in prolonged hot compresses. Urgently ordered removal of hot compresses and frequent application of cold water towels. After one hour, fever subsided, swelling reduced. After five days, swelling disappeared, fever gone, cured.
A certain doctor asked: Most doctors emphasize hot compresses, why do you advocate cold compresses? The answer is: For early-stage Ru Yong without systemic fever, hot compresses can aid dispersion. If red/swollen or even suppurated, cold compresses should be used to localize. If systemic fever is intense, cold compresses are mandatory; otherwise, Heat may enter Ying-Blood or Pericardium, causing critical conditions. Another doctor asked: Is there such a difference between cold and hot compresses? The answer is: In healthy individuals, cold/hot differences are minimal. But in cases of Healthy Qi deficiency and blazing Fire, slight differences in treatment cause immediate changes, as Zhongjing said: "Although Fire Evil is minor, its internal attack is powerful, scorching bones and injuring sinews, making blood difficult to restore."
Gynecomastia
Observing disease location, referencing pulse, understanding pathogenesis, treatment with regulating Qi, soothing Liver, resolving Phlegm, and dissipating nodules led to cure.
Li XX, Male, 20 years old.
Breast enlargement and dull pain for over two months. Diagnosed as gynecomastia. Western medicine was ineffective; TCM prescriptions for softening hardness and dissipating nodules were also useless. Careful examination revealed both breasts enlarged to walnut size, painful upon touch or clothing contact, non-red, non-hot, white tongue coating, and deep pulse (Chen Mai). Synthesizing pulse and symptoms: deep pulse indicates Liver Qi stagnation; enlarged nodules with unchanged skin color indicate Phlegm condensation. Treatment should focus on soothing the Liver, regulating Qi, resolving phlegm, and dissipating nodules. Prescription: Chaihu 10g, Chishao 10g, Danggui 10g, Qingpi 10g, Juye 10g, Gualou 15g.
After three doses, masses shrank, pain decreased; continuing for ten doses led to resolution of all symptoms and cure.
A certain doctor asked: Why did the previous doctor's softening-hardness-and-dissipating-nodules prescription fail, while this method succeeded? The answer is: *Suwen·Zhi Zhen Yao Da Lun* states: "Hardness is削 (scraped/reduced)... Knots are dispersed... Adapt to the situation." "Reverse is standard treatment, following is counter-treatment... Observe the situation... Reverse it, follow it, reverse then follow, follow then reverse, regulate Qi smoothly, and this is the way." Formulating prescriptions requires not just major principles but also attention to the degree of reversal or following in treatment methods. Previous formulas heavily emphasized resolving Phlegm and dissipating nodules but lacked Liver-soothing and Qi-regulating herbs. This case was primarily characterized by deep pulse and Qi stagnation. Hence, heavy emphasis on Phlegm resolution failed, while heavy emphasis on Liver-soothing and Qi-regulation succeeded.
Chest Wall Tuberculosis
Healthy Qi deficiency and Pathogenic Excess, tonification ineffective, treatment follows "gradually tonifying deficiency," disease resolves.
Ke XX, Female, 35 years old.
A thumb-sized ulcerative opening between the left chest axilla and breast, repeatedly discharging pus for over six years. Diagnosed as chest wall tuberculosis. Western medicine and physiotherapy for over a year were ineffective; TCM modifications of Yanghe Tang and Tuoli Tonpu Tang for over three years showed no significant improvement. Detailed observation revealed a bean-sized ulcerative opening in the left anterior axillary third intercostal space, constantly discharging thin white pus, non-painful, local skin slightly purplish-dark, flat without swelling. Pus exudes during deep inspiration, stops during expiration; bubbles escape during severe coughing, emaciation and fatigue, dry skin, poor appetite, white tongue coating, and deep-wiry pulse (Chen Xian Mai). Synthesizing pulse and symptoms: deep pulse indicates Qi stagnation; wiry pulse relates to the Liver. Local purplish-darkness indicates Cold and Stasis. Thin pus indicates Phlegm. Treatment should focus on regulating Qi, soothing the Liver, invigorating blood, and resolving phlegm. Prescription: Chaihu 6g, Zhike 6g, Baishao 6g, Juye 7g, Baijiezi 3g, Danggui 6g, Qingpi 6g, Yuanzhi 4g. After forty doses, spirit and appetite improved, pus decreased; continuing for one hundred doses (total five months), all symptoms disappeared, weight increased by 10 kg, cured.
A certain doctor asked: Suppurated chest wall tuberculosis is usually treated with tonification. Why did this case resist long-term treatment? The answer is: As you said, suppurated chest wall tuberculosis generally uses tonification to promote tissue regeneration. However, this case's deep-wiry pulse indicates primary Liver Qi stagnation, i.e., Pathogenic Excess. Thus, only expelling pathogens is appropriate. Asked: How can such a chronic disease be treated with small formulas/doses? The answer is: Zhongjing clarified in *Jin Gui Yao Lue*: When deficiency is extreme but pulse and signs indicate excess, only gradual expulsion of pathogens is suitable, i.e., "gradually tonifying deficiency" and "stabilizing middle and boosting Qi." Otherwise, tonifying Healthy Qi may retain Pathogens, and expelling Pathogens may injure Healthy Qi, prolonging the illness.
Deep Vein Thrombosis
Observing pulse and signs, identifying Blood stasis and Phlegm-Heat, treatment with invigorating blood, resolving Phlegm, clearing heat, and promoting circulation led to cure.
Gao XX, Male, 55 years old.
Left lower limb swelling and pain for one month. Diagnosed as iliofemoral vein thrombosis. Western medicine for half a month showed little effect; TCM clearing-heat and promoting diuresis for a similar period was also ineffective. Careful examination revealed swelling and pain from inguinal region to foot in the left leg, tenderness from inguinal to medial calf, left leg hotter than right, systemic fever (temperature 38.4°C), white-greasy tongue coating, and wiry-tight-slippery-rapid pulse (Xian Jin Hua Shu Mai). Synthesizing pulse and symptoms: slippery-rapid indicates Phlegm-Heat accumulation; wiry-tight indicates Cold and knotting. Swelling indicates Damp-Heat. Combined, this is Blood stasis obstruction and unresolved Phlegm-Heat. Treatment plan: remove dampness, resolve phlegm, clear heat, invigorate blood, assisted by warming transformation. Prescription: Huangbai 10g, Cangzhu 10g, Zhi Nanting 10g, Guizhi 10g, Fangji 10g, Weilingxian 6g, Taoren 10g, Honghua 10g, Longdancao 10g, Chuanxiong 10g, Shenqu 10g. External application: Niuhuang Jiedu Wan dissolved in cold water, applied topically.
After one week, swelling and pain disappeared; continuing for four doses led to cure.
A certain doctor asked: Why did clearing-heat, detoxifying, and promoting diuresis fail, while Shang Zhong Xia Tong Feng Fang succeeded? The answer is: Both prescriptions share two actions: clearing heat and removing dampness. They differ in two: invigorating blood and warming transformation. Since the pathology is in the Blood level, with Phlegm-Blood stagnation, unblocking Yang is needed to move Bi, and invigorating blood is needed to unblock collaterals. Previous formulas lacked these, hence the success with Shang Zhong Xia Tong Feng Fang.
Superficial Thrombophlebitis
1. Examining day-night differences, identifying Yin deficiency and Ministerial Fire, nourishing Yin and descending Fire led to cure.
Wang XX, Male, 60 years old.
Cord-like structure under the right breast, painful for over two months. Diagnosed as superficial thrombophlebitis. Western medicine for over 40 days showed no improvement; TCM clearing-heat, detoxifying, promoting diuresis, and unblocking collaterals for over 20 days also failed. Careful examination revealed a ~10cm cord-like structure on the inner right breast, painful, febrile, accompanied by occasional mental restlessness, yellow-greasy tongue coating, and wiry-slippery pulse (Xian Hua Mai). Synthesizing pulse and symptoms: Chest and hypochondrium are governed by Liver and Lung; wiry-slippery pulse indicates Phlegm-Fire stagnating in sinews/collaterals. Treatment plan: soothe Liver, regulate Qi, resolve phlegm, drain Fire. Prescription: Chaihu 15g, Banxia 15g, Gualou 40g, Sumu 6g, Chishao 15g, Huangqin 10g, Qingpi 10g, Juye 10g, Xiakucao 30g.
After two doses, symptoms persisted, and nocturnal toothache appeared. Reasoning: Nocturnal toothache indicates blazing Ministerial Fire due to Yin deficiency. Added Yuanshen 30g to nourish Yin and descend Fire.
After six doses, swelling and pain greatly reduced; continuing for ten doses led to cure.
2. Examining disease location, knowing governing organs, observing pulse, determining nature, treatment with soothing Liver, regulating Qi, resolving Phlegm, and draining Fire led to cure.
Yu XX, Male, 56 years old.
Cord-like structure from under left breast to left upper abdomen, painful, febrile for over a month. Diagnosed as superficial thrombophlebitis. Western medicine for 20 days showed no improvement; TCM clearing-heat, removing dampness, invigorating blood, resolving stasis for 14 days was also ineffective. Careful examination revealed a cord-like structure from left chest/hypochondrium to upper abdomen, painful, febrile, accompanied by mental restlessness, dizziness, bitter taste, dry throat, white tongue coating, and wiry-slippery pulse (Xian Hua Mai). Synthesizing pulse and symptoms: wiry-slippery pulse indicates Phlegm stagnation and Qi knotting; chest/hypochondrium is governed by Liver and Lung. Treatment should focus on soothing Liver, resolving Phlegm, clearing heat, and dissipating nodules. Prescription: Chaihu 10g, Banxia 10g, Chishao 10g, Qingpi 10g, Juye 10g, Gualou 30g, Huangqin 10g, Danggui 10g, Xiakucao 15g, Lianqiao 10g. Simultaneously external: Niuhuang Jiedu Wan dissolved in cold water, applied topically.
After four doses, swelling and pain greatly reduced; continuing for ten doses led to cure.