某医云：如此危重之证，先生竟敢单独施用中药以挽救之，吾实不敢也。云：余所主张之单独采用中药者，并不是排斥西药，因为前已久用西药不效，且常用西药有反应。在此情况下，为了排除各种不利因素，所以主张暂时仅仅采用吾所处方药服之。某医又云：中药不效怎么办?云：要胆大，心细，及时观察。某医再问：如此之危证，竟敢予攻下之剂，难道没有危险?答曰：仲景有少阴三急下以挽生命于万一的教导，实可宗也。但危重疾病的下法尤当慎之而慎。本证是一个典型的大结胸证，但因其有柴胡证，柴胡证有三禁，即一吐，二汗，三下，故不可用大陷胸汤，只可用大柴胡汤。正如《伤寒论》所说：“伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。但结胸，无大热者，此为水结在胸胁也，但头微汗出者，大陷胸汤主之。”
肝脓肿
不察脉证，仅凭病名，久施药饵，岂能收功
郭××，男，35岁。
高热不退，恶心呕吐，肝脏肿大半年多。医诊阿米巴肝脓肿合并金黄色葡萄球菌、副大肠杆菌感染。先用西药治疗1个多月不见好转，继用中药清热解毒之剂亦不明显改善。细察其证，寒热往来，体温40．2℃，恶心呕吐，肝肋下五指，疼痛，按之更甚，消瘦乏力，烦躁不安，食纳全废，口苦口干，舌苔黄白，脉弦滑数。综合脉证，思之：寒热往来，恶心呕吐，纳呆食减，口苦咽干者，少阳半表半里证也。脘痛拒按，脉滑数者，痰实热证也。合而论之，乃少阳阳明证，兼有痰积不化证。治宜和解攻里，化痰清热。处方：柴胡18克，半夏15克，黄芩15克，枳实15克，白芥子1O克，白芍15克，大黄6克，连翘15克。
服药2剂，寒热往来，脘胁疼痛，恶心呕吐好转，体温37．5℃。继服6剂，肝区疼痛大减，肝肋下1指，精神、食欲大增，体温37．1℃。又服1月，诸证消失。
某医云：为什么先用治疗阿米巴原虫的鸭蛋子等不效，而采用不治阿米巴原虫的药却有效，其故何也?答曰：中医治病的主要特点是辨证论治，此病从患者表现的证候看是一个少阳阳明合病证，故采用和解攻里取得了效果。鸭蛋子虽能治血痢，但其不可用于少阳阳明证，故应用此药不效而病情反重。
肾扭转
脉弦细数，舌红无苔，舌脉相较，知为阴虚，予养阴疏肝，柔肝止痛，愈
赵××，男，51岁。
右胁下剧烈疼痛，痛彻少腹阴茎，尿频而数40天。医诊肾扭转。先以西药治疗不效，后以中药活血止痛，针灸等相配合，亦无明显效果。细审其证，除剧烈腹痛时轻时重，持续不止，小便频数之外，并见其烦躁不安，舌红无苔，脉弦细数。综合脉证，思之：腹虽剧痛，但不拒按，说明非实证也。舌红无苔者，阴虚有热也。脉弦者，肝脉也；细数者，阴虚有热也。合而论之，乃肝阴不足，肝脉拘挛也。治宜滋阴养肝，柔肝止痛。处方：生地15克，枸杞子10克，川楝子10克，当归10克，木瓜10克，麦冬10克，白芍10克，元胡10克。
服药1剂，其痛稍减，继进3剂，痛减六七，后改予滋水清肝饮加减10剂，愈。
某医云：肾扭转用什么办法可使其转为正常?答曰：扭转者，筋脉为病也，但取其舌、脉，知其病机，病位，而予中药治之，其筋可伸，疾病可愈也。
痤疮
1．诸病多端，繁复多杂者，治宜宗脉
文××，男，24岁。
面部疙瘩，头痛，牙痛8年多。医诊痤疮、三叉神经痛。先予西药治疗2年多不效，继又予中药除湿清热、凉血解毒、清热泻火、活血逐瘀之剂近2年亦不见效。且近4年多以来，又发现两耳疼痛，咽喉肿痛。医诊慢性卡他性中耳炎、慢性咽炎、慢性扁桃体炎。虽遍用西药、中药均不见效果。细审其证，头痛牙痛，耳痛咽痛，心烦失眠，耳鸣耳聋，口燥咽干，疲乏无力，痤疮满面，疼痛流脓，舌苔薄白，脉弦大而紧，右脉大于左脉。综合脉证，思之：《难经》云：“手太阴寸口者，五脏六腑之所终始。”何不从脉论治!因拟补气养阴，燥湿清热，升清降浊，解郁透邪。处方：黄芪15克，甘草6克，人参10克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。
服药6剂，痤疮消减近半，心烦失眠，咽干咽痛好转；继服15剂，痤疮、咽喉疼痛，头痛牙痛俱减八九；继服30剂，诸证尽失。
2．察其色脉，知其为肝郁气结，湿痰内生，复感风邪，予疏肝解郁，调理三焦，和其营卫，愈
国××，男，2l岁。
面、颈、胸、背部粉刺，丘疹、脓疱、囊肿此起彼伏3年多。医诊痤疮。先用西药治疗1年不效，继又用中药清热解毒、除湿清热、凉血活血之剂近2年亦无效果。细审其证，除脸面，颈、前胸、后背有大量的密集或散在的丘疹，其色有的呈黑色，有的呈鲜红，有的呈暗紫，其形小者如针尖，大者如豌豆，甚至如樱桃大，有的合并有白色脓点，有的数十个密集在一起，有的则比较散在，且面色红赤，头晕头痛，心烦口苦，舌苔白，脉弦紧。综合脉证，思之：青年之人生机旺盛，稍有抑郁，内燃中火，三焦不化，湿热内生，复感风寒，结于肌肤，则生痤疿。此与《素问》“汗出见湿，乃生痤疿”同一意也。处方：柴胡9克，半夏9克，黄芩9克，党参9克，桂枝9克，茯苓9克，大黄10克，甘草6克，大枣5个，龙骨15克，牡蛎15克。
服药3剂，面部丘疹、粉刺、脓疱减少；继服3剂，面部痤疮消失，胸、背、颈部痤疮稍减；又服12剂，痤疮消失，愈。
某医云：《内经》云：“汗出见湿，乃生痤疿。”王冰言其“阳气发泄，寒水制之，热怫内余，郁于皮里，甚为痤疖，微为痱疮。”其用柴胡加龙骨牡蛎汤者，何者制其寒水，何者制其热怫内余?答曰：柴胡加龙骨牡蛎汤者，既理三焦以促水湿之郁解，又调荣卫以散表寒，除热怫之内余，因此可治痤疮之病。
传染性软疣
察病位，合脉象，思病因，其病得治
冯××，男，成。
上肢、躯干、颈项大量赘疣2个多月。医诊传染性软疣。先用西药治疗十几天不效，继用中药薏米熬粥服1个多月仍不效。细审其证，见颈项、前胸、后臂、背部有大量高出皮肤的赘疣，微痒，赘疣小者如小米，大者如高粱，别无所苦，舌苔白，脉浮弦紧。综合脉证，思之：病发于肌表，其病位即在肌表，前但用薏米无效，乃治表之功不足。今脉又见弦紧，弦者，肝脉也；紧者，寒也。证脉合参，乃少阳枢机不利，寒湿郁表。治拟和解少阳，散寒除湿。处方：柴胡15克，半夏10克，黄芩10克，党参10克，甘草10克，生姜3片，大枣5枚，桂枝10克，白芍10克，生苡米30克。
服药6剂，赘疣全失，愈。
荨麻疹
1．正虚邪实，微风可除，若施巨风，助邪伤正
岳××，女，35岁。
大小不等的风团样损害，时发时止8年多。医诊荨麻疹。先以西药治疗4～5年无效，后以中药祛风散寒，燥湿活血，养血活血，清热凉血等剂治疗4～5年亦无效。细审其证，全身反复出现大小不等的风团样损害，搔抓时即片片出现，高出皮肤，奇痒，消退后不留任何痕迹，且时见胃脘满痛，舌苔白，脉浮紧。综合脉证，思之：脉浮紧者，风寒也；腹胀满者，寒湿也。表里俱病，治宜祛风散寒，理气温中同施。处方：羌活3克，防风3克，荆芥3克，川芎10克，厚朴10克，党参10克，茯苓10克，陈皮10克，甘草6克，僵蚕10克，蝉蜕10克，藿香10克，清茶l撮。
服药4剂，痒疹大减，由每日发病1～2次，减为一周发病1次，且痒疹明显减少；继服10剂。追访2年，未见复发，愈。
某医云：此病余久用消风散治之，然每次药后非但不减，而且更加严重者何也?答曰：羌活、防风、荆芥用量均在10克以上，余仅用3克以下。医云：何以知之?答曰：此病已患8年余，正虚邪实，稍予祛风则伤卫阳而风邪反人，稍多补正则郁卫气，故余仅用羌活、防风、荆芥之微剂于补剂之中，使其祛邪而不伤正。今你用消风散而使病情加剧者，必重用祛风除湿之药，故知你必用羌活、防风、荆芥均在10克以上也。医云：果如是也。
2．脉缓病脾，脾虚夹风，实邪内结，治其太阴
耿××，男，成。
遇冷或食刺激性食物、饮酒后，即全身奇痒，起疹，消退后不留任何痕迹6～7年。医诊荨麻疹。先予西药治疗数年不效，继又予中药祛风散寒、养血祛风、散风除湿清热2～3年亦无明显改善。细审其证，除荨麻疹反复发作外，并偶见胃脘痞满不适，大便时干，舌苔薄黄，脉缓。综合脉证，思之：脉缓者，湿盛脾虚之脉也，脾虚、湿盛之脉又不见脾虚湿盛之内证。必所谓之太阴表证也，仲景于《伤寒论》太阴篇列桂枝大黄汤方以治太阴外感，何不予之。处方：桂枝10克，白芍20克，甘草10克，生姜10克，大枣7个，大黄3克。
服药10剂，愈。
3．脾虚肝郁，清阳失升，风邪闭郁，寒热夹杂者，健脾疏肝，升阳益胃，疏风解郁始解
高××，女，46岁。
胃脘疼痛，荨麻疹反复发作30多年。医诊慢性胃炎、荨麻疹。先用西药久治不效，继又配合中药疏肝和胃、健脾温中、活血养血、疏风解表、燥湿清热、凉血活血等治疗亦无效果。最近3年以来，胃脘胀痛和荨麻疹的发作日渐严重，尤其是近4个月来，胃脘一直持续的胀痛不止，荨麻疹此起彼伏，从不彻底消退。细审其证，除胃脘胀痛，荨麻疹外，并见心烦心悸，口苦咽于，全身俱痛，舌苔薄白，脉浮弦紧。综合脉证，思之：久病而脉浮者，气虚也；浮紧并见者，表寒也；弦者，肝脉也；弦紧并见者，滞也。综合脉证论之，乃脾虚肝郁，清阳失升，风寒闭郁所致也。治宜健脾疏肝，升阳益胃，疏风散寒。处方：黄芪15克，甘草10克，党参10克，黄连10克，半夏10克，陈皮10克，白术10克，茯苓10克，泽泻10克，防风6克，羌活6克，独活6克，柴胡10克，白芍10克，生姜3片，大枣5个。
服药1剂，症无进退，继服第2剂后约l小时胃脘疼痛加剧，2小时后，除胃脘仍持续疼痛外，并发现全身奇痒，稍一搔抓，即皮疹连片，但至2个半小时后，突然胃脘胀痛与全身皮疹均全部消失。为巩固效果，又以上方2剂内服，愈。
某医云：患者何以药后脘痛加剧而皮疹增多?答曰：此药后正复邪却之象也。本病久病正虚邪微，正不胜邪，稍得药力，正气稍复，欲驱病邪，正邪交争，欲作战疹，乃至正复邪却，皮疹突现，病即解矣。此与战汗之作同一意也。
4．湿郁夹风，散风湿存，其病加剧
呼××，男，成。
胃脘疼痛，全身荨麻疹反复发作5年多。医诊慢性胃炎、荨麻疹。先用西药久治不效，继又配用中药祛风散寒，温中健脾等剂病情日重。细审其证，胃脘痞满，隐隐作痛，全身皮疹散在不多，舌苔薄白，脉濡缓。综合脉证，思之：脉濡缓者，脾土不足，湿郁不化，清阳失升，风邪内扰也。治宜健脾除湿，理气和胃，散风升阳。处方：羌活3克，防风3克，荆芥3克，川芎10克，厚朴10克，党参10克，茯苓10克，陈皮10克，甘草6克，僵蚕3克，蝉蜕3克，藿香10克。
服药4剂，胃脘满痛，荨麻疹均明显好转，继服20剂，诸证消失，愈。
某医云：为什么你用消风散而治愈。我用消风散而加剧?答曰：本证是一个以脾气不足，湿郁不化，清阳不升，稍兼风邪的证候，治疗起来必须以健脾和胃，理气升阳为主要治法。至于风邪问题，也只能在健脾的基础上微去风邪，否则若过用风药必使正气更虚而风邪不除。加之本证内夹湿邪，前人虽有风能胜湿之论，但过用散风则必风气去而湿气在，使风邪加剧。你所用之消风散风药量大而除湿扶正量小，故使病反剧，今余用小量之风药微祛风邪，故正复邪却而愈也。
痒疹
审其昼夜，察其抓痕，和之于脉，知其病性，治之始愈
甄××，女，35岁。
全身奇痒，昼轻夜剧3年多。医诊为痒疹。先以西药治之不效，后配中药燥湿清热散风、清热解毒散风而痒疹更剧。细审其证，在躯干和四肢伸侧有大量密集的小红疹，间有小的水疱，剧烈瘙痒，昼轻夜剧，舌苔白，脉沉细弦。综合脉证，思之：瘙痒昼轻夜剧者，血中燥热生风也。疹间水疱者，热毒夹湿也。治宜养血润燥，除湿解毒。处方：生地15克，熟地10克，生首乌10克，当归10克，元参20克，白蒺藜6克，僵蚕6克，红花10克，甘草6克，苦参15克。
服药4剂，痒疹大减，继服7剂，诸证俱失，愈。
某医云：前用散风止痒反剧者何也?答曰：昼轻夜剧者，血燥生风也，血燥生风者，自应养血润燥而风始熄也。然你之治法不去养血润燥而反予辛温散风以伤血，使血更燥热，故其痒更甚也。
头癣
配入专病专药，疗效大大提高
凌××，女，42岁。
A physician stated: "For such a critical and severe condition, how dare you, Sir, attempt to rescue the patient using only Chinese medicine? I truly would not dare." I replied: "My advocacy for using solely Chinese medicine does not imply rejecting Western medicine. Previously, Western medicines had been used extensively without efficacy, and they often caused adverse reactions. Under these circumstances, to eliminate various unfavorable factors, I advocate temporarily administering only the prescription I have formulated." The physician asked again: "What if the Chinese medicine proves ineffective?" I answered: "One must be bold yet meticulous, observing the condition promptly." The physician inquired further: "Given the critical nature of this condition, daring to administer purgative agents—does it not carry danger?" I responded: "Zhang Zhongjing provided guidance on the 'Three Urgent Purging Methods' for Shaoyin disease to save lives in desperate situations, which is indeed worthy of emulation. However, when using purgation for critical illnesses, one must exercise extreme caution. This case presents as a typical Da Jie Xiong Syndrome (Major Chest Binding Syndrome). However, since it also involves Chai Hu Syndrome (Shaoyang pattern), and Chai Hu patterns have three contraindications—namely emesis, sweating, and purgation—we cannot use Da Xian Xiong Tang (Major Chest Binding Decoction). Instead, we should use Da Chai Hu Tang (Major Bupleurum Decoction). As stated in the *Shanghan Lun* (Treatise on Cold Damage): 'In cold damage lasting over ten days, with heat binding internally and alternating chills and fever, administer Da Chai Hu Tang. If there is only chest binding, without significant external heat, this indicates water binding in the chest and hypochondrium; if there is only slight sweating on the head, Da Xian Xiong Tang is indicated.'"
Liver Abscess
Failure to observe pulse and symptoms, relying solely on disease names, and long-term medication cannot achieve success
Gu XX, Male, 35 years old.
Persistent high fever, nausea, vomiting, and hepatomegaly for over half a year. Diagnosed by physicians as amoebic liver abscess complicated by Staphylococcus aureus and paracolon bacillus infection. Western medicine treatment for over a month showed no improvement. Subsequent treatment with Chinese herbal formulas for clearing heat and detoxifying also yielded no obvious improvement. Upon detailed examination of the syndrome: alternating chills and fever, body temperature 40.2°C, nausea, vomiting, liver palpable five finger-widths below the costal margin, pain worsened by pressure, emaciation, fatigue, restlessness, complete loss of appetite, bitter taste in the mouth, dry mouth, yellowish-white tongue coating, wiry-slippery-rapid pulse. Synthesizing the pulse and symptoms: alternating chills and fever, nausea, vomiting, poor appetite, bitter taste, and dry throat indicate a Shaoyang Half-Exterior/Half-Interior syndrome. Epigastric pain with refusal to press, and slippery-rapid pulse indicate Phlegm-Excess Heat syndrome. Combined, this is a Shaoyang-Yangming Combined Disease, accompanied by unresolved phlegm accumulation. The treatment principle should be harmonizing and purging the interior, resolving phlegm and clearing heat. Prescription: Chai Hu (Bupleuri Radix) 18g, Ban Xia (Pinelliae Rhizoma) 15g, Huang Qin (Scutellariae Radix) 15g, Zhi Shi (Aurantii Fructus Immaturus) 15g, Bai Jie Zi (Sinapis Semen) 10g, Bai Shao (Paeoniae Radix Alba) 15g, Da Huang (Rhei Radix et Rhizoma) 6g, Lian Qiao (Forsythiae Fructus) 15g.
After 2 doses, alternating chills and fever, epigastric/hypochondriac pain, and nausea/vomiting improved; body temperature dropped to 37.5°C. After another 6 doses, liver area pain decreased significantly, liver reduced to 1 finger-width below costal margin, spirit and appetite greatly increased, body temperature 37.1°C. After continuing for 1 month, all symptoms disappeared.
A physician asked: "Why were drugs like Ya Dan Zi (Strychnos nux-vomica seed) used previously to treat amoeba ineffective, while drugs not targeting amoeba were effective? What is the reason?" I answered: "The main characteristic of Chinese medicine treatment is syndrome differentiation and treatment. From the manifested syndromes, this disease is a Shaoyang-Yangming Combined Disease, hence harmonizing and purging the interior achieved results. Although Ya Dan Zi can treat bloody dysentery, it is contraindicated for Shaoyang-Yangming patterns; thus, its application was ineffective and the condition worsened."
Kidney Torsion
Wiry-thin-rapid pulse, red tongue without coating; comparing tongue and pulse reveals Yin deficiency; treating with nourishing Yin, soothing Liver, and softening Liver to relieve pain led to recovery
Zhao XX, Male, 51 years old.
Severe pain in the right hypochondrium radiating to the lower abdomen and penis, frequent urination for 40 days. Diagnosed as kidney torsion. Initial Western medicine treatment was ineffective. Subsequent treatment with Chinese medicine for invigorating blood and relieving pain, combined with acupuncture, also showed no obvious effect. Detailed examination of the syndrome revealed: severe abdominal pain varying in intensity but continuous, frequent urination, restlessness, red tongue without coating, wiry-thin-rapid pulse. Synthesizing pulse and symptoms: although abdominal pain is severe, there is no refusal to press, indicating it is not an Excess syndrome. Red tongue without coating indicates Yin deficiency with internal heat. Wiry pulse corresponds to the Liver; thin-rapid indicates Yin deficiency with heat. Combined, this is Liver Yin insufficiency causing Liver meridian spasm. Treatment should focus on nourishing Yin and tonifying the Liver, softening the Liver to relieve pain. Prescription: Sheng Di Huang (Rehmanniae Radix) 15g, Gou Qi Zi (Lycii Fructus) 10g, Chuan Lian Zi (Meliae Fructus) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Mu Gua (Chaenomelis Fructus) 10g, Mai Dong (Ophiopogonis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Yuan Hu (Corydalis Rhizoma) 10g.
After 1 dose, pain slightly decreased. After 3 more doses, pain reduced by 60-70%. Later, modified Zi Shui Qing Gan Yin (Nourish Water Clear Liver Decoction) for 10 doses resulted in recovery.
A physician asked: "What method can reverse kidney torsion?" I answered: "Torsion is a disorder of the sinews and vessels. By analyzing the tongue and pulse, understanding the pathogenesis and location, and applying Chinese medicine, the sinews can relax, and the disease can heal."
Acne
1. For complex and miscellaneous diseases, treatment should follow the pulse principles
Wen XX, Male, 24 years old.
Facial papules, headache, and toothache for over 8 years. Diagnosed as acne and trigeminal neuralgia. Western medicine treatment for over 2 years was ineffective. Subsequent Chinese medicine treatments including dampness-resolving heat-clearing, cooling blood detoxifying, clearing heat purging fire, and invigorating blood removing stasis for nearly 2 years also failed. Additionally, for the past 4+ years, ear pain and sore throat/swelling appeared. Diagnosed as chronic catarrhal otitis media, chronic pharyngitis, and chronic tonsillitis. Both Western and Chinese medicines proved ineffective. Detailed examination revealed: headache, toothache, ear pain, sore throat, irritability, insomnia, tinnitus, deafness, dry mouth/throat, fatigue, widespread acne with painful pus discharge, thin white tongue coating, large-tight wiry pulse, with the right pulse stronger than the left. Synthesizing pulse and symptoms: The *Nan Jing* states, 'The Cun Kou point of the Hand Taiyin channel is where the Five Zang and Six Fu organs begin and end.' Why not treat based on the pulse? Therefore, I proposed tonifying Qi and nourishing Yin, drying dampness and clearing heat, ascending clear and descending turbid, resolving depression and expelling pathogens. Prescription: Huang Qi (Astragali Radix) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Ren Shen (Ginseng Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 6g, Mai Dong (Ophiopogonis Radix) 10g, Wu Wei Zi (Schisandrae Fructus) 10g, Qing Pi (Citri Reticulatae Pericarpium Viride) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Shen Qu (Massa Medicata Fermentata) 10g, Huang Bo (Phellodendri Cortex) 10g, Ge Gen (Puerariae Lobatae Radix) 15g, Cang Zhu (Atractylodis Rhizoma) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Sheng Ma (Cimicifugae Rhizoma) 10g, Ze Xie (Alismatis Rhizoma) 10g.
After 6 doses, acne reduced by nearly half, irritability/insomnia and dry/sore throat improved. After another 15 doses, acne, sore throat, headache, and toothache reduced by 80-90%. After another 30 doses, all symptoms disappeared.
2. Observing color and pulse reveals Liver depression with Qi stagnation, internal generation of damp-phlegm, and secondary wind-pathogen invasion; treating with soothing Liver, resolving depression, regulating San Jiao, and harmonizing Ying and Wei led to recovery
Guo XX, Male, 21 years old.
Comedones, papules, pustules, and cysts on the face, neck, chest, and back appearing continuously for over 3 years. Diagnosed as acne. Western medicine treatment for 1 year was ineffective. Subsequent Chinese medicine treatments for clearing heat detoxifying, resolving dampness clearing heat, cooling blood invigorating blood for nearly 2 years also failed. Detailed examination revealed: numerous dense or scattered papules on face, neck, anterior chest, and back; colors varied from black to bright red to dark purple; sizes ranged from pinhead to pea to cherry; some had white pus points; some clustered, others scattered; facial flushing, dizziness, headache, irritability, bitter taste, white tongue coating, tight-wiry pulse. Synthesizing pulse and symptoms: Young people have vigorous vitality; slight depression leads to internal fire, San Jiao fails to transform, generating internal damp-heat, compounded by wind-cold invading and binding to the skin, causing acne. This aligns with the *Su Wen*: 'Sweat exposed to moisture generates acne and miliaria.' Prescription: Chai Hu (Bupleuri Radix) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Huang Qin (Scutellariae Radix) 9g, Dang Shen (Codonopsis Radix) 9g, Gui Zhi (Cinnamomi Ramulus) 9g, Fu Ling (Poria) 9g, Da Huang (Rhei Radix et Rhizoma) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Da Zao (Jujubae Fructus) 5 pieces, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
After 3 doses, facial papules, comedones, and pustules decreased. After another 3 doses, facial acne disappeared, chest/back/neck acne slightly reduced. After another 12 doses, acne disappeared, recovery achieved.
A physician asked: "*Nei Jing* states: 'Sweat exposed to moisture generates acne and miliaria.' Wang Bing explained: 'Yang Qi vents out, cold water restricts it, residual heat remains internal, stagnates under the skin, causing severe acne/nodules or mild miliaria.' In using Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction), which herb restricts the cold water, and which clears the residual internal heat?" I answered: "Chai Hu Jia Long Gu Mu Li Tang regulates the San Jiao to resolve damp-water stagnation, and harmonizes Ying and Wei to dispel exterior cold and remove residual internal heat; thus, it treats acne."
Contagious Molluscum
Observing lesion location, combining with pulse, considering etiology leads to cure
Feng XX, Male, Adult.
Large number of warts on upper limbs, trunk, and neck for over 2 months. Diagnosed as contagious molluscum. Western medicine treatment for over 10 days was ineffective. Subsequent consumption of Yi Mi (Coix Seed) porridge for over 1 month also failed. Detailed examination revealed: large number of skin-protruding warts on neck, anterior chest, posterior arms, and back; slight itching; sizes ranging from millet grain to sorghum grain; otherwise no discomfort; white tongue coating, floating-wiry-tight pulse. Synthesizing pulse and symptoms: The disease manifests on the muscle surface, so the location is the exterior. Previous use of Yi Mi alone was insufficient in treating the exterior. Now the pulse shows wiry-tight; wiry indicates Liver; tight indicates cold. Combining syndrome and pulse, this is Shaoyang pivot dysfunction with cold-damp stagnating in the exterior. Treatment aims to harmonize Shaoyang, dispel cold, and resolve dampness. Prescription: Chai Hu (Bupleuri Radix) 15g, Ban Xia (Pinelliae Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Dang Shen (Codonopsis Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces, Gui Zhi (Cinnamomi Ramulus) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Sheng Yi Mi (Coicis Semen) 30g.
After 6 doses, all warts disappeared, recovery achieved.
Urticaria
1. Deficient Righteous Qi and Excess Pathogen: Mild wind can dispel it; strong wind aids the pathogen and harms the Righteous Qi
Yue XX, Female, 35 years old.
Wheals of varying sizes, recurring intermittently for over 8 years. Diagnosed as urticaria. Western medicine treatment for 4-5 years was ineffective. Subsequent Chinese medicine treatments for dispelling wind dissipating cold, drying dampness invigorating blood, nourishing blood invigorating blood, clearing heat cooling blood for 4-5 years also failed. Detailed examination revealed: recurrent wheals of varying sizes on the whole body, appearing in patches upon scratching, protruding above skin, intense itching, leaving no trace after fading; occasional epigastric fullness/pain, white tongue coating, floating-tight pulse. Synthesizing pulse and symptoms: Floating-tight pulse indicates Wind-Cold; abdominal fullness indicates Cold-Damp. Exterior and Interior both diseased; treatment should combine dispelling wind dissipating cold with regulating Qi warming Middle. Prescription: Qiang Huo (Notopterygii Rhizoma et Radix) 3g, Fang Feng (Saposhnikoviae Radix) 3g, Jing Jie (Schizonepetae Spica) 3g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Dang Shen (Codonopsis Radix) 10g, Fu Ling (Poria) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Jiang Can (Bombyx Batryticatus) 10g, Chan Tui (Bombyx Cicadae Periostracum) 10g, Huo Xiang (Agastaches Herba) 10g, Qing Cha (Green Tea) 1 pinch.
After 4 doses, pruritus significantly reduced, frequency dropped from 1-2 times daily to once weekly, and lesions markedly decreased. After another 10 doses, follow-up for 2 years showed no recurrence, recovery achieved.
A physician asked: "I have long used Xiao Feng San (Eliminate Wind Powder) for this disease, but each time after administration, instead of improving, it worsens. Why?" I answered: "You used Qiang Huo, Fang Feng, and Jing Jjie in doses over 10g; I used less than 3g. Physician: How do you know?" I answered: "This disease has persisted for over 8 years; Righteous Qi is deficient, Pathogen is Excess. Slight wind-dispelling damages Wei Yang allowing Wind to re-enter; slight tonification stagnates Wei Qi. Thus, I used minimal doses of Qiang Huo, Fang Feng, and Jing Jie within tonifying formulas to expel pathogens without harming Righteous Qi. Your use of Xiao Feng San likely involved heavy doses of wind-dispelling damp-resolving herbs, hence I deduce you used Qiang Huo, Fang Feng, and Jing Jie over 10g. Physician: Indeed so."
2. Slow pulse indicates Spleen disease; Spleen deficiency with Wind, Internal Excess binding; treat Taiyin
Geng XX, Male, Adult.
Intense itching and rash upon exposure to cold, spicy food, or alcohol, fading without trace, for 6-7 years. Diagnosed as urticaria. Western medicine treatment for years was ineffective. Subsequent Chinese medicine treatments for dispelling wind dissipating cold, nourishing blood dispelling wind, dispersing wind drying dampness clearing heat for 2-3 years showed no obvious improvement. Detailed examination revealed: recurrent urticaria, occasional epigastric stuffiness/discomfort, occasional dry stool, thin yellow tongue coating, slow pulse. Synthesizing pulse and symptoms: Slow pulse indicates Dampness Excess and Spleen Deficiency; however, no internal signs of Spleen Deficiency/Dampness Excess are seen. This must be what is called Taiyin Exterior Syndrome. Zhang Zhongjing listed Gui Zhi Da Huang Tang (Cinnamon Twig and Rhubarb Decoction) in the Taiyin chapter of *Shanghan Lun* to treat Taiyin exterior contraction; why not use it? Prescription: Gui Zhi (Cinnamomi Ramulus) 10g, Bai Shao (Paeoniae Radix Alba) 20g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 10g, Da Zao (Jujubae Fructus) 7 pieces, Da Huang (Rhei Radix et Rhizoma) 3g.
After 10 doses, recovery achieved.
3. Spleen deficiency with Liver depression, failure of Clear Yang to ascend, Wind pathogen closure, mixed Cold and Heat; strengthen Spleen, soothe Liver, raise Yang, benefit Stomach, dispel Wind, resolve depression leads to resolution
Gao XX, Female, 46 years old.
Epigastric pain and recurrent urticaria for over 30 years. Diagnosed as chronic gastritis and urticaria. Western medicine treatment was ineffective. Subsequent Chinese medicine treatments for soothing Liver harmonizing Stomach, strengthening Spleen warming Middle, invigorating blood nourishing blood, dispelling wind releasing exterior, drying dampness clearing heat, cooling blood invigorating blood also failed. In the last 3 years, epigastric distending pain and urticaria attacks have intensified. Especially in the last 4 months, persistent epigastric distending pain and continuous urticaria attacks that never fully resolve. Detailed examination revealed: epigastric distending pain, urticaria, irritability, palpitations, bitter taste, dry throat, generalized body pain, thin white tongue coating, floating-wiry-tight pulse. Synthesizing pulse and symptoms: Floating pulse in chronic illness indicates Qi deficiency; floating-tight indicates Exterior Cold; wiry indicates Liver; wiry-tight indicates stagnation. Combined, this is Spleen deficiency with Liver depression, failure of Clear Yang to ascend, caused by Wind-Cold closure. Treatment should strengthen Spleen, soothe Liver, raise Yang, benefit Stomach, dispel Wind, dissipate Cold. Prescription: Huang Qi (Astragali Radix) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Dang Shen (Codonopsis Radix) 10g, Huang Lian (Coptidis Rhizoma) 10g, Ban Xia (Pinelliae Rhizoma) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Fu Ling (Poria) 10g, Ze Xie (Alismatis Rhizoma) 10g, Fang Feng (Saposhnikoviae Radix) 6g, Qiang Huo (Notopterygii Rhizoma et Radix) 6g, Du Huo (Angelicae Pubescentis Radix) 6g, Chai Hu (Bupleuri Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 5 pieces.
After 1 dose, no change. After the 2nd dose, approx. 1 hour later, epigastric pain intensified. 2 hours later, besides persistent epigastric pain, intense generalized itching appeared; slight scratching caused confluent rash. However, at 2.5 hours, sudden disappearance of epigastric distending pain and generalized rash. To consolidate effects, 2 more doses of the same formula were taken orally, recovery achieved.
A physician asked: "Why did epigastric pain intensify and rash increase after medication?" I answered: "This is a sign of Righteous Qi recovering and Pathogen retreating. The disease has been chronic with deficient Righteous Qi and weak Pathogen; Righteous Qi could not overcome the Pathogen. With slight medicinal force, Righteous Qi recovers slightly, attempting to drive out the Pathogen. Righteous and Pathogenic Qi contend, manifesting as a battle-like rash, until Righteous Qi recovers and Pathogen retreats, the rash suddenly appears, and the disease resolves. This is similar to the mechanism of Battle Sweat."
4. Dampness stagnation with Wind; dispersing Wind leaves Dampness, worsening the disease
Hu XX, Male, Adult.
Epigastric pain and recurrent generalized urticaria for over 5 years. Diagnosed as chronic gastritis and urticaria. Western medicine treatment was ineffective. Subsequent Chinese medicine treatments for dispelling wind dissipating cold, warming Middle strengthening Spleen caused daily worsening. Detailed examination revealed: epigastric stuffiness, dull pain, sparse generalized rash, thin white tongue coating, soggy-slow pulse. Synthesizing pulse and symptoms: Soggy-slow pulse indicates Spleen Earth insufficiency, dampness stagnation failing to transform, failure of Clear Yang to ascend, and internal disturbance by Wind. Treatment should strengthen Spleen, resolve dampness, regulate Qi, harmonize Stomach, disperse Wind, raise Yang. Prescription: Qiang Huo (Notopterygii Rhizoma et Radix) 3g, Fang Feng (Saposhnikoviae Radix) 3g, Jing Jie (Schizonepetae Spica) 3g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Dang Shen (Codonopsis Radix) 10g, Fu Ling (Poria) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Jiang Can (Bombyx Batryticatus) 3g, Chan Tui (Bombyx Cicadae Periostracum) 3g, Huo Xiang (Agastaches Herba) 10g.
After 4 doses, epigastric fullness/pain and urticaria significantly improved. After another 20 doses, all symptoms disappeared, recovery achieved.
A physician asked: "Why did your use of Xiao Feng San cure it, while mine worsened it?" I answered: "This syndrome is characterized by Spleen Qi insufficiency, dampness stagnation failing to transform, failure of Clear Yang to ascend, with slight Wind involvement. Treatment must primarily focus on strengthening Spleen and harmonizing Stomach, regulating Qi and raising Yang. Regarding Wind, it can only be slightly dispersed on the basis of strengthening Spleen; otherwise, excessive wind-dispersing herbs will further deplete Righteous Qi without removing Wind. Furthermore, this syndrome contains internal Dampness. Although ancients said 'Wind can overcome Dampness,' excessive wind-dispersing removes Wind but leaves Dampness, exacerbating the condition. Your Xiao Feng San used large amounts of wind-dispersing herbs and small amounts of damp-resolving/righteous-nourishing herbs, thus worsening the disease. My use of small amounts of wind-dispersing herbs slightly removes Wind, allowing Righteous Qi to recover and Pathogen to retreat, leading to cure."
Prurigo
Observing day/night variations, examining scratch marks, harmonizing with pulse, knowing the disease nature, treatment begins to heal
Zhen XX, Female, 35 years old.
Generalized intense itching, lighter during day, worse at night for over 3 years. Diagnosed as prurigo. Western medicine treatment was ineffective. Subsequent Chinese medicine treatments for drying dampness clearing heat dispersing wind, clearing heat detoxifying dispersing wind made prurigo worse. Detailed examination revealed: large number of dense small red papules on trunk and extensor surfaces of limbs, interspersed with small vesicles, intense itching, lighter during day/worse at night, white tongue coating, deep-thin-wiry pulse. Synthesizing pulse and symptoms: Itching lighter during day/worse at night indicates Dry-Heat generating Wind in Blood. Vesicles between papules indicate Heat-Toxin with Dampness. Treatment should nourish Blood, moisten dryness, resolve dampness, detoxify. Prescription: Sheng Di Huang (Rehmanniae Radix) 15g, Shu Di Huang (Rehmanniae Radix Preparata) 10g, Sheng Shou Wu (Polygoni Multiflori Radix Preparata) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Yuan Shen (Scrophulariae Radix) 20g, Bai Ji Li (Tribuli Fructus) 6g, Jiang Can (Bombyx Batryticatus) 6g, Hong Hua (Carthami Flos) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Ku Shen (Sophorae Flavescentis Radix) 15g.
After 4 doses, prurigo significantly reduced. After another 7 doses, all symptoms disappeared, recovery achieved.
A physician asked: "Why did previous wind-dispersing anti-itch treatment make it worse?" I answered: "Lighter during day/worse at night indicates Blood Dryness generating Wind. Blood Dryness generating Wind naturally requires nourishing Blood and moistening dryness to extinguish Wind. However, your treatment did not nourish Blood/moisten dryness but instead used acrid-warm wind-dispersing herbs that damaged Blood, making Blood drier and hotter, thus increasing itching."
Tinea Capitis
Adding specific disease-specific herbs greatly improves efficacy
Ling XX, Female, 42 years old.