第四节儿科
小儿肺炎
1．谨察其证，参之脉腹二诊，予理气化湿，温化寒痰而愈
龚××，女，5岁。
发热，咳嗽1个多月。医诊肺炎。先以西药治疗20多天不见好转。后又配合中药麻杏石甘汤加味治疗7天亦不见改善。细审其证，发热，体温37．8℃，咳嗽，腹微痛微满，舌苔白，脉弦缓。综合脉证，思之：脉弦缓者，寒湿郁滞也。腹满，咳嗽者，肺与大肠气滞，宣降失常也。治宜理气化湿，温化寒痰。处方：旋覆花5克(布包)，细辛1克，半夏3克，甘草1克，紫苏2克，香附3克，陈皮3克，茯苓3克。
服药1剂，诸证消失，继服3剂，愈。
某医问：肺炎诸医均云宜用麻杏石甘汤辈治之，然先生却弃之不用者何也?答曰：患者前已久用此类方剂不效者一也，脉见缓而腹满者二也。又问：为何腹满，脉缓者不宜用麻杏石甘辈?答曰：肺炎而见腹满脉缓者，《伤寒论》有桂枝加厚朴杏子汤一法，言其腹满者大肠气滞也。大肠气滞，肺气不得肃降者，非理其气不得喘定也。今之所以用金沸草散加理气之品，因其腹胀，因其肺与大肠相表里。
2．审其喘逆之声，参之寸口之脉，不胶病名，但予宣肺化饮而愈
贺××，男，8岁。
发热咳喘20多天。医诊支气管肺炎。先以西药治疗十几天不效，继又配合中药清热解毒，宣肺定喘之剂9天仍不效。细察其证，发热，体温37．6℃，咳喘，喉中有水鸡声，舌苔白，脉弦紧。综合脉证，喉中水鸡声者，寒痰也。脉弦紧者，风寒也，寒饮也。合而论之，乃寒饮蕴肺于里，复感风寒也。治宜温肺化饮，宣肺解表。处方：射干6克，麻黄3克，紫菀4克，细辛1克，五昧子1克，款冬花3克，半夏4克，甘草1克，生姜1片，大枣3个。
服药2剂，诸证消失，继服4剂，愈。
某医云：射干麻黄汤，乃仲景《金匮要略》方也，其本为治疗哮喘而设，今先生反用肺炎者何也?答曰：仲景射干麻黄汤为“咳逆上气，喉中有水鸡声”而设，而并未云其为哮喘病而专设者也。今医诊肺炎而证见“咳逆上气，喉中有水鸡声”，其证之表现与所论者相同，故亦用之。
3．谨察其脉，合之腹诊，参之于舌，知其秋季凉燥，予杏苏饮，愈
欧阳×，男，3岁。
发热，咳嗽20多天。医诊肺炎。先以西药治疗十几天不效，继又配合中药麻杏石甘汤加味治疗8天亦无功。细审其证，病于秋末，久咳不止，腹微满，身微热，体温37．6℃，舌苔白，脉浮缓。综合脉证，思之：秋季咳嗽者，秋燥为病也，治宜甘润辛凉，今反见腹微满，脉缓而浮，乃肺胃俱病，寒湿气滞也。治宜杏苏饮理气宣肺，解表止嗽。处方：杏仁3克，苏叶3克，陈皮3克，枳壳3克，前胡3克，半夏3克，葛根4克，木香3克，甘草1克，桔梗3克，茯苓1克。
服药2剂，诸证消失，继服4剂，愈。
某医问：杏苏饮乃吴鞠通《温病条辨》治秋燥方也，其用于感冒、支气管炎犹可，先生何用其治肺炎也?答曰：杏苏散为鞠通治秋燥而设之方，而未定其为治感冒、支气管炎之方。今脉证均符合鞠通所设之证，故用之而效。
厌食
1．不审病因，但予健脾消食，终难取效
和××，男，8岁。
食欲不振7～8个月。医诊厌食症。先予西药治疗3～4个月不效，继又改用中药健脾消食和胃、消食导滞之汤、丸剂3～4个月亦无效。细察其证，患者久嗜冰糕，舌苔白，脉弦紧，纳呆不渴，手足微冷。综合脉证，思之：小儿者，稚阴稚阳之体也，稍冷则阳伤，稍热则火炽，故小儿之病多或见寒盛之慢脾风和热炽所致之急惊风。今患者久嗜冰冷之品，损其脾胃阳气而脾不得磨谷，故纳呆食减，且脉、舌均可征验也。治宜拟温中散寒。然小儿稚阳稍过则伤，故只可少量服之。处方：丁香1克，苏叶1克，神曲3克，肉桂0．1克。
服药3剂，饮食大增，嘱其再用一周内服2剂，果愈。
2．稚阴稚阳，随拨随应，不可过用，过则为病
梁××，女，2岁。
饮食不佳半年多。医诊厌食症。始用西药治之不效，继用中药健脾和胃，消积导滞之剂亦不效。询治于余。云：脾胃虚寒。其父遵意予附子理中汤2剂，效仍不著。再邀余治。察其纳呆，苔白，脉弦缓。综合脉证，思之：此乃脾胃虚寒证也。治宜温中健脾。处方：宝宝一贴灵，贴脐部。一贴，贴3天后，食欲正常，愈。某医云：余遵师意用附子理中汤2剂，然仍不效者何也?答曰：小儿稚阴稚阳之体，随拨随应，不可过也。脾胃虚寒者，但用温热微助阳气尚可，若过剂则壅热不散，故你采用附子10克，党参10克，干姜10克，炙甘草10克，肉桂10克，丁香10克，砂仁10克不效，余仅小量温热之剂以助少火则愈也。
便秘
1．不思证脉，但予攻下，其病不解
梁××，男，4岁。
大便秘结1年多。医诊便秘。初以西药通便曾有十几天好转，然其后不再改善，继以中药七珍丹，以及攻下之剂，亦是开始有效，继再无功。细审其证，除大便秘结4～10天1次外，并见身体较瘦，食纳较差，舌苔白，脉弦紧稍数。综合脉证，思之：小儿稚阳之体，随拨随应，稍事攻伐，阳气必损，转运不能，故不通矣。治宜温阳通便。处方：厚朴3克，陈皮3克，甘草1克，香附2克，草豆蔻3克，木香1克，肉桂l克，大黄1克。
某医云：前医屡用大黄6克而不效，且久配芒硝之咸寒，软坚通便，尚见不效，你用大黄仅为1克岂能有效?答曰：《素问·灵兰秘典论》云：“大肠者，传导之官，变化出焉。”《素问·六节脏象论》云：“脾、胃、大肠、小肠、三焦、膀胱者，仓廪之本，营之居也，名日器，能化糟粕，转味而入出者也。”言其传化必赖于气。《素问·阴阳应象大论》云：“少火生气。”今以微温之火以助阳气，稍佐大黄之苦降，阳气一行，其便自通。又问：大黄、芒硝均攻下之品，因何不效?答日：久损阳气故耳。
药后，大便得行，又服1剂，大便1月内均正常。为巩固疗效，继用香砂六君加山药为方，服1周，果愈。
2．久用通下，克伐阳气，阳虚不转，其气不散
苏××，男，2岁。
大便秘结1年。医诊便秘。久用攻下，润下之品无效。审其体较瘦，纳较差，舌苔薄白，脉弦紧数。综合脉证，思之：久用通下克伐之品，阳气受损，转化不能，故大便不通也。治宜温化。其母云：患儿拒食中药怎么办?余云：患儿便秘较轻，正气尚盛，可用贴敷之药微助阳气。处方：宝宝一贴灵，外贴脐部。
贴敷后，次日大便得行，再敷3贴，果愈。
某医云：宝宝一贴灵乃治泄泻之剂，为什么用于便秘也效?答曰：泄泻、便秘全在于一阳气耳，故温阳既可通便，又可止泻。
痉挛性肠绞痛
不分寒热，不察虚实，以寒作热，以虚作实，其病不愈
安××，男，7岁。
脐腹绞痛，时轻时重1个多月。医诊痉挛性肠绞痛。始以西药治之稍效，但一停药又复如初，后以中药消食导滞等治之仍时轻时重。细察其证，脐腹疼痛，喜揉喜按，纳呆乏味，指趾欠温，舌苔白，脉弦紧。综合脉证，思之：指趾厥冷，脉弦紧者，虚寒之证也。治宜温中健脾。处方：附子1克，肉桂1克，丁香1克，小茴香1克。
服药1剂，痛减纳增，继服1剂，诸证全失，愈。
蛔虫病
1．不分寒热，不分虚实，但予驱虫，损阳伤阴，其病不愈
张××，男，8岁。
脐腹疼痛时轻时重半个月。医诊蛔虫病。先以西药治之不效，后又予中药驱虫治之仍不效。细察其证，除脐腹疼痛之外，并见胃脘疼痛，纳呆食减，舌苔薄白，脉沉弦涩。综合脉证，思之：脉沉弦涩，腹痛者，脾胃虚寒也。治宜健脾温中。处方：桂枝4克，白芍8克，炙甘草4克，生姜4片，大枣5个，丁香1克。
服药2剂，腹痛消失，食欲正常，并便出蛔虫2条，愈。
2．久用驱蛔，脾气受损，腹痛吐涎，予以甘缓，始愈
夏××，女，7岁。
脘腹绞痛7—8天。医诊蛔虫病。先以西药驱蛔杀虫其痛愈剧，后以中药乌梅汤加减3剂痛亦不减。细察其证，脘腹绞痛，时见包块起伏，恶心吐涎，纳食全废，体瘦肢厥，舌苔白，脉紧而数大。综合脉证，思之：腹痛，脉紧数大者，蛔虫病也；毒药不止者，脾虚也。正如《金匮要略》所云：“问日：病腹痛有虫，其脉何以别之?师日：腹中痛，其脉当沉若弦，反洪大，故有蛔虫。”“蛔虫之为病，令人吐涎，心痛发作有时，毒药不止，甘草粉蜜汤主之。”处方：甘草15克，大米12粒，蜂蜜10克。
服药1剂，痛止，次日便出蛔虫35条，愈。
过敏性紫癜
1．不察脉舌，不思病位，但以成方，以实作虚，以气作血，终非其治
耿××，男，6岁。
衄血便血尿血紫斑半年。医诊过敏性紫癜。先用西药治疗4个多月不效，继又配合中药清热凉血、凉血养阴治疗2个多月亦不效。细察其证，鼻衄齿衄，便血尿血，全身到处大片大片紫斑，血色素5克，面色青黄，舌苔黄燥，脉滑数有力。综合脉证，血色素5克当见脉虚大或沉细而今反见滑数有力者，实火也。热人血分者，舌当见舌质红绛少苔而今反见黄燥者，病在气分，心胃实火，迫血妄行也。治宜清心泻火。处方：黄连6克，黄芩6克，大黄4克。
服药2剂，衄血、尿血、便血俱减；继服4剂，衄血、便血、尿血全止，精神、食欲大增，血色素7克；又服20剂，诸证全失，血色素12克。后果愈。
某医云：如此重症竟敢用黄连、黄芩、大黄，且又停用其他药物而取效，吾甚不解也?答曰：为什么竟敢但用大黄、黄芩、黄连?大黄、黄连、黄芩者，仲景之泻心汤也。其所用者，“心气不足，吐血，衄血”证也。心气不足，不足者何?泻心汤者何?既云心气不足，为何又用泻心之药?经过数十年的玩味，始知当心气不足而又心胃火旺者但用微量之泻火药即可效如桴鼓也。今所治者，血色素仅5克可谓之虚，然又有心胃之火炽，故但予大黄、黄连、黄芩即可取效。至于为什么禁用其他任何药物，为排除各种干扰因素也。中医组方我们知道要有君臣佐使，其若各药均加其内，怎么知其君臣佐使，怎么知道其相反、相恶、相杀、相畏、相须、相使，故嘱其禁用他药也。
2．不审脉证，但予清热解毒，凉血止血，损气伤阴，其病不愈
古××，男，12岁。
紫癜消退后，浮肿，蛋白尿半年，发热半月。医诊过敏性紫癜性肾炎、上呼吸道感染。先用西药久治不效，继又配合中药清热解毒、凉血活血等治疗亦不效。且近3个月反复感冒，近半月来感冒后一直不愈。细察其证，除尿蛋白(+++)，红细胞10—15个外，并见咽干咽痛，疲乏无力，微咳无痰，身热，舌苔黄白，脉虚大弦紧而数。综合脉证，思之：脉虚大弦紧而数者，气阴俱虚，湿热内郁，风邪外客之脉也。治宜补气养阴，燥湿清热，疏散风邪。处方：人参3克，甘草3克，黄芪5克，当归3克，麦冬3克，五味子3克，青皮3克，陈皮3克，神曲3克，黄柏3克，葛根6克，苍术3克，白术3克，升麻3克，泽泻3克。
服药4剂，发热、咽痛、乏力均解，尿常规(一)。继服肾康灵，1次2粒，1日3次，愈。
某医云：本病系过敏性紫癜性肾病，且又发热38．5℃已半月，前医又频用西药与中药清热解毒之剂不效，老师竟仅用清暑益气汤加减治之，吾久思不解也?答曰：发热一症，从中医来看，既有风热者，也有风寒者；既有热毒者，也有气阴两虚者。若风寒者只可用疏风散寒，若气阴两虚者只可用补气养阴，绝对不可以清热解毒概治诸种发热也。今脉既见虚大弦紧数，那么自然只可采用补气养阴，除湿清热，散风之法治之，故以清暑益气汤治此证也。至于过敏性紫癜性肾病为何采用此法亦愈，因其脉证亦符合清暑益气汤证也。
阵发性睡眠性血红蛋白尿
审其脉舌，合之于色，辨证立方，治之而瘳
孙××，男，10岁。
疲乏无力，尿呈酱油样色1年多。医诊阵发性睡眠性血红蛋白尿。先以西药治疗半年，不但诸证不减，反见日渐加重，后又配合中药清热凉血之剂，诸证仍然不见改善。细察其证，面色皓白无华，体倦乏力，血色素4克％、尿夜间呈酱油色，下午尿色转清，舌质淡黯，舌苔薄白，脉沉细。综合脉证，思之：面色皓白者，气阴两虚也。舌质淡黯者，血虚夹瘀也。脉沉者，郁证也。细者，气血俱虚也。合而论之，乃气阴两虚为本，气滞血瘀，湿热下注为标。治宜补气养血以培本，理气活血，利湿清热以治标。处方：生黄芪30克，生山药30克，红花3克，龟甲12克，黄柏5克，丹皮10克，当归6克，三七参3克(另冲)，牛膝9克，琥珀粉6克(另冲)，土茯苓60克。
服药4剂，尿色稍清；服药6剂，尿色全清，食欲、精神大增；继服30剂，诸证全失，血色素增至15克％，愈。
上呼吸道感染
1．察其脉舌，审其二便，调其三焦，其病始愈
李×，男，8岁。
Section 4: Pediatrics
Pediatric Pneumonia
1. Carefully observe the syndrome, combine pulse diagnosis and abdominal examination, treat with regulating qi and resolving dampness, warming and transforming cold phlegm, resulting in cure.
Gong XX, female, 5 years old.
Fever and cough for over one month. Diagnosed with pneumonia by physicians. Treated with Western medicine for more than 20 days without improvement. Subsequently combined with modified Ma Xing Shi Gan Tang (Ephedra, Cinnamon Twig, Gypsum and Licorice Decoction) for 7 days, also without improvement. Detailed examination of symptoms: fever, body temperature 37.8°C, cough, slight abdominal pain and fullness, white tongue coating, wiry and moderate pulse. Synthesizing pulse and symptoms: a wiry and moderate pulse indicates stagnation of cold-dampness. Abdominal fullness and cough indicate stagnation of qi in the Lung and Large Intestine, with dysfunction of diffusion and descending. Treatment should regulate qi and resolve dampness, warm and transform cold phlegm. Prescription: Inula Flower 5g (wrapped in cloth), Asarum 1g, Pinellia 3g, Licorice 1g, Perilla Leaf 2g, Cyperus 3g, Tangerine Peel 3g, Poria 3g.
After taking one dose, all symptoms disappeared. Continued for 3 doses, cured.
A physician asked: Physicians generally state that pneumonia should be treated with formulas like Ma Xing Shi Gan Tang, yet you discarded them. Why? Answer: First, the patient had already used such formulas for a long time without effect. Second, the pulse was moderate and there was abdominal fullness. Asked again: Why are abdominal fullness and a moderate pulse unsuitable for Ma Xing Shi Gan Tang? Answer: For pneumonia presenting with abdominal fullness and a moderate pulse, *Shang Han Lun* offers Guizhi Houpo Zizi Tang (Cinnamon Twig, Magnolia Bark and Apricot Seed Decoction with Added Herbs), stating that abdominal fullness is due to Large Intestine qi stagnation. When Large Intestine qi stagnates, Lung qi cannot descend; without regulating qi, wheezing cannot settle. The reason for using Jin Fei Cao San (Golden Whirlweed Decoction) with qi-regulating herbs here is the abdominal distension and the exterior-interior relationship between the Lung and Large Intestine.
2. Examine the sound of wheezing and panting, reference the Cun Kou (radial artery) pulse, do not stick to disease names, but treat by diffusing the Lung and resolving fluid retention, resulting in cure.
He XX, male, 8 years old.
Fever, coughing and wheezing for over 20 days. Diagnosed with bronchopneumonia. Treated with Western medicine for over ten days without effect, then combined with Chinese medicine for clearing heat, detoxifying, diffusing the Lung and calming wheezing for 9 days, still ineffective. Careful observation of symptoms: fever, body temperature 37.6°C, coughing and wheezing, sound of a water chicken in the throat, white tongue coating, wiry and tight pulse. Synthesizing pulse and symptoms: the sound of a water chicken in the throat indicates cold phlegm. A wiry and tight pulse indicates wind-cold and cold-fluid retention. Combined, this is cold-fluid retention harbored in the Lung interior, complicated by external wind-cold. Treatment should warm the Lung and resolve fluid retention, diffuse the Lung and release the exterior. Prescription: Belamcanda Rhizome 6g, Ephedra 3g, Aster Root 4g, Asarum 1g, Schisandra Berry 1g, Farflower 3g, Pinellia 4g, Licorice 1g, Fresh Ginger 1 slice, Jujube 3 pieces.
After taking 2 doses, all symptoms disappeared. Continued for 4 doses, cured.
A physician said: Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) is a formula from Zhang Zhongjing's *Jin Gui Yao Lue*, originally established for treating asthma. Why did you use it for pneumonia? Answer: Zhang Zhongjing's Shegan Mahuang Tang was established for "coughing, upward rushing of qi, and the sound of a water chicken in the throat," and was not stated to be exclusively for asthma. Today, although diagnosed as pneumonia, the symptoms present as "coughing, upward rushing of qi, and the sound of a water chicken in the throat." Since the symptom presentation matches the description, the formula was used.
3. Carefully examine the pulse, combine with abdominal examination, reference the tongue, identify autumn cool dryness, treat with Xing Su Yin (Apricot Kernel and Perilla Leaf Decoction), resulting in cure.
Ouyang X, male, 3 years old.
Fever and cough for over 20 days. Diagnosed with pneumonia. Treated with Western medicine for over ten days without effect, then combined with modified Ma Xing Shi Gan Tang for 8 days, also without merit. Careful examination of symptoms: onset at late autumn, persistent cough, slight abdominal fullness, slight body heat, body temperature 37.6°C, white tongue coating, floating and moderate pulse. Synthesizing pulse and symptoms: cough in autumn is often caused by autumn dryness, treatment should be sweet, moistening, acrid and cool. However, seeing slight abdominal fullness and a floating, moderate pulse indicates simultaneous disease of the Lung and Stomach with cold-damp qi stagnation. Treatment should use Xing Su Yin to regulate qi, diffuse the Lung, release the exterior and stop cough. Prescription: Apricot Kernel 3g, Perilla Leaf 3g, Tangerine Peel 3g, Aurantium Fruit 3g, Peucedanum Root 3g, Pinellia 3g, Kudzu Root 4g, Aucklandia 3g, Licorice 1g, Platycodon 3g, Poria 1g.
After taking 2 doses, all symptoms disappeared. Continued for 4 doses, cured.
A physician asked: Xing Su Yin is a formula for autumn dryness from Wu Juztong's *Wen Bing Tiao Bian*. It can be used for colds and bronchitis, why did you use it for pneumonia? Answer: Xing Su San was established by Juztong for treating autumn dryness, and was not limited to treating colds or bronchitis. Since the pulse and symptoms conform to the syndrome established by Juztong, it was effective.
Anorexia
1. Without examining the etiology, merely using spleen-fortifying and food-resolving methods ultimately fails to achieve efficacy.
He XX, male, 8 years old.
Loss of appetite for 7-8 months. Diagnosed with anorexia. Treated with Western medicine for 3-4 months without effect, then switched to Chinese medicine decoctions and pills for strengthening the spleen, resolving food stagnation, harmonizing the stomach and guiding out stagnation for 3-4 months, also ineffective. Careful observation of symptoms: patient has a long-term habit of eating ice cream, white tongue coating, wiry and tight pulse, poor appetite without thirst, slightly cold hands and feet. Synthesizing pulse and symptoms: children are bodies of immature yin and yang; slight cold damages yang, slight heat causes fire to blaze. Thus, pediatric diseases often manifest as Slow Spleen Wind due to severe cold or Urgent Convulsive Wind due to blazing heat. This patient has long consumed cold items, damaging spleen and stomach yang, so the spleen cannot grind grain, leading to poor appetite and reduced food intake, verified by pulse and tongue. Treatment should warm the middle and dispel cold. However, since a child's young yang is easily damaged if excessive, only small doses should be taken. Prescription: Clove 1g, Perilla Leaf 1g, Medicated Leaven 3g, Cinnamon Bark 0.1g.
After taking 3 doses, diet increased significantly. Advised to take 2 more doses within a week, indeed cured.
2. Immature yin and yang respond immediately to stimulation; do not overdose, as excess becomes pathology.
Liang XX, female, 2 years old.
Poor diet for over half a year. Diagnosed with anorexia. Initially treated with Western medicine without effect, then with Chinese medicine for strengthening spleen, harmonizing stomach, resolving accumulation and guiding out stagnation, also ineffective. Consulted me. I said: Spleen and stomach deficiency-cold. Her father followed my advice and gave Fuzi Lizhong Tang (Aconite and Poria Decoction) for 2 doses, but effect was still insignificant. Invited me again. Observed poor appetite, white coating, wiry and moderate pulse. Synthesizing pulse and symptoms: this is spleen and stomach deficiency-cold. Treatment should warm the middle and strengthen the spleen. Prescription: Baby One Patch Spirit (external patch), applied to the umbilicus. After one application, after 3 days, appetite normalized, cured. A physician said: I followed your advice and used Fuzi Lizhong Tang for 2 doses, yet it was ineffective. Why? Answer: Children have immature yin and yang and respond immediately to manipulation; it must not be excessive. For spleen and stomach deficiency-cold, using mild warming agents to assist yang is acceptable, but overdosing leads to stagnant heat. You used Aconite 10g, Codonopsis 10g, Dried Ginger 10g, Honey-fried Licorice 10g, Cinnamon Bark 10g, Clove 10g, Amomum 10g, which failed. I used only a small amount of warming agent to assist the "ministerial fire" (physiological warm fire), and thus cured.
Constipation
1. Without pondering syndrome and pulse, merely using purgatives, the disease does not resolve.
Liang XX, male, 4 years old.
Constipation for over 1 year. Diagnosed with constipation. Initially treated with Western laxatives with improvement for over ten days, but no further improvement later. Then treated with Chinese medicine Qizhen Dan (Seven Treasures Pill) and purgative agents; initially effective, then ineffective. Careful examination of symptoms: besides constipation once every 4-10 days, the body is thin, appetite is poor, white tongue coating, wiry, tight and slightly rapid pulse. Synthesizing pulse and symptoms: children are bodies of young yang, responding immediately to stimulation; slight purgation damages yang, transport function fails, hence obstruction. Treatment should warm yang and unblock bowels. Prescription: Magnolia Bark 3g, Tangerine Peel 3g, Licorice 1g, Cyperus 2g, Cardamom Seed 3g, Aucklandia 1g, Cinnamon Bark 1g, Rhubarb 1g.
A physician said: Previous doctors used Rhubarb 6g repeatedly without effect, and long-term combination with Mirabilite (salty-cold) to soften hardness and unblock bowels also failed. How can your use of only 1g Rhubarb be effective? Answer: *Su Wen · Ling Lan Mi Dian Lun* states: "The Large Intestine is the official of transmission, changes emerge from it." *Su Wen · Liu Jie Zang Xiang Lun* states: "Spleen, Stomach, Large Intestine, Small Intestine, San Jiao, Bladder are the foundation of granaries, the dwelling of Ying, named vessels, capable of transforming dregs and turning flavors in and out." This means transmission relies on qi. *Su Wen · Yin Yang Ying Xiang Da Lun* states: "Ministerial fire generates qi." Now, using slight warm fire to assist yang, assisted slightly by the bitter descent of Rhubarb, once yang qi moves, stool passes naturally. Asked again: Rhubarb and Mirabilite are both purgatives, why were they ineffective? Answer: Because yang qi was damaged for a long time.
After medication, bowel movement occurred. Took 1 more dose, bowel movements were normal for a month. To consolidate efficacy, continued with Xiang Sha Liu Jun Zi Tang (Amomum and Atractylodes Macrocephala Six Gentlemen Decoction) plus Yam, taken for 1 week, indeed cured.
2. Long-term use of purgatives attacks yang qi; yang deficiency prevents transport, qi does not disperse.
Su XX, male, 2 years old.
Constipation for 1 year. Diagnosed with constipation. Long-term use of purgative and lubricating agents ineffective. Examined: body relatively thin, poor appetite, thin white tongue coating, wiry, tight and rapid pulse. Synthesizing pulse and symptoms: long-term use of purgative and attacking agents damaged yang qi, transformation failed, hence constipation. Treatment should warm and transform. Mother said: The child refuses Chinese medicine. I said: Constipation is mild, righteous qi is still strong, can use topical medication to slightly assist yang. Prescription: Baby One Patch Spirit, externally applied to the umbilicus.
After application, bowel movement occurred the next day. Applied 3 more patches, indeed cured.
A physician said: Baby One Patch Spirit is a preparation for diarrhea, why is it effective for constipation? Answer: Diarrhea and constipation both depend on one yang qi. Thus, warming yang can unblock bowels and stop diarrhea.
Spasmodic Colic
Without distinguishing cold/heat, without observing deficiency/excess, treating cold as heat and deficiency as excess, the disease does not heal.
An XX, male, 7 years old.
Colicky pain in navel and abdomen, fluctuating in severity for over 1 month. Diagnosed with spasmodic colic. Initially treated with Western medicine with slight effect, but relapsed upon stopping. Later treated with Chinese medicine for resolving food and guiding out stagnation, still fluctuating. Careful observation of symptoms: navel and abdominal pain, preference for rubbing and pressing, poor appetite and lack of taste, fingers and toes not warm, white tongue coating, wiry and tight pulse. Synthesizing pulse and symptoms: cold fingers and toes, wiry and tight pulse, this is deficiency-cold syndrome. Treatment should warm the middle and strengthen the spleen. Prescription: Aconite 1g, Cinnamon Bark 1g, Clove 1g, Fennel 1g.
After taking 1 dose, pain decreased and appetite increased. Continued for 1 dose, all symptoms disappeared, cured.
Ascariasis
1. Without distinguishing cold/heat, deficiency/excess, merely using vermifuges, damages yang and injures yin, disease does not heal.
Zhang XX, male, 8 years old.
Colicky pain in navel and abdomen, fluctuating for half a month. Diagnosed with ascariasis. Initially treated with Western medicine without effect, then with Chinese medicine for expelling parasites, still ineffective. Careful observation of symptoms: besides navel and abdominal pain, epigastric pain, poor appetite and reduced food intake, thin white tongue coating, deep, wiry and choppy pulse. Synthesizing pulse and symptoms: deep, wiry, choppy pulse and abdominal pain indicate spleen and stomach deficiency-cold. Treatment should strengthen spleen and warm the middle. Prescription: Cinnamon Twig 4g, White Peony Root 8g, Honey-fried Licorice 4g, Fresh Ginger 4 slices, Jujube 5 pieces, Clove 1g.
After taking 2 doses, abdominal pain disappeared, appetite normalized, expelled 2 roundworms, cured.
2. Long-term use of vermifuges damages spleen qi; abdominal pain and salivation occur, treat with sweet and緩 (soothing) method, finally cured.
Xia XX, female, 7 years old.
Epigastric and abdominal colic for 7-8 days. Diagnosed with ascariasis. Initially treated with Western medicine to expel parasites, pain worsened. Then treated with modified Wumei Tang (Mume Decoction) for 3 doses, pain did not decrease. Careful observation of symptoms: epigastric and abdominal colic, palpable masses rising and falling, nausea and salivation, complete loss of appetite, emaciated body and cold limbs, white tongue coating, tight, rapid and large pulse. Synthesizing pulse and symptoms: abdominal pain, tight, rapid and large pulse indicates ascariasis; poison drugs fail to stop pain indicates spleen deficiency. As stated in *Jin Gui Yao Lue*: "Question: In abdominal pain with worms, how to distinguish by pulse? Master says: In abdominal pain, the pulse should be deep or wiry; if contrary large and surging, there are roundworms." "Roundworm disease causes salivation, heart pain occurring at times, if poison drugs fail, Gancao Fenmi Tang (Licorice, Rice and Honey Decoction) governs it." Prescription: Licorice 15g, Rice 12 grains, Honey 10g.
After taking 1 dose, pain stopped. Next day expelled 35 roundworms, cured.
Allergic Purpura
1. Without examining pulse and tongue, without considering disease location, merely using fixed formulas, treating excess as deficiency and qi-level disease as blood-level disease, ultimately incorrect treatment.
Geng XX, male, 6 years old.
Epistaxis, hematochezia, hematuria and purpura for half a year. Diagnosed with allergic purpura. Initially treated with Western medicine for over 4 months without effect, then combined with Chinese medicine for clearing heat, cooling blood and nourishing yin for over 2 months, also ineffective. Careful observation of symptoms: epistaxis and gingival bleeding, hematochezia and hematuria, large patches of purpura all over the body, hemoglobin 5g, bluish-yellow complexion, yellow and dry tongue coating, slippery, rapid and forceful pulse. Synthesizing pulse and symptoms: hemoglobin of 5g should present with deficient-large or deep-thin pulse, but now presents with slippery, rapid and forceful pulse, indicating excess fire. If heat enters the blood level, the tongue should be red/crimson with little coating, but now shows yellow and dry, indicating disease is at the qi level, with excess fire in Heart and Stomach forcing blood to move recklessly. Treatment should clear Heart and purge fire. Prescription: Coptis 6g, Scutellaria 6g, Rhubarb 4g.
After taking 2 doses, epistaxis, hematuria, hematochezia all decreased. Continued for 4 doses, all bleeding stopped, spirit and appetite greatly increased, hemoglobin 7g. Took another 20 doses, all symptoms disappeared, hemoglobin 12g. Finally cured.
A physician said: How dare you use Coptis, Scutellaria and Rhubarb for such severe illness, and stop other medications to achieve effect? I am very confused. Answer: Why dare to use only Rhubarb, Scutellaria, Coptis? These three constitute Zhang Zhongjing's Xiexin Tang (Gastrointestinal Heat-Relieving Decoction). It treats "insufficiency of Heart qi, vomiting blood, epistaxis." What is insufficient about Heart qi? What is Xiexin Tang? If Heart qi is insufficient, why use draining herbs? After decades of study, I realized that when Heart qi is insufficient yet Heart and Stomach fire is blazing, using a tiny amount of fire-draining herbs yields immediate results. Here, hemoglobin of 5g is considered deficiency, yet there is blazing fire in Heart and Stomach, so using only Rhubarb, Coptis, Scutellaria achieves effect. As for banning other drugs, it is to exclude interfering factors. In Chinese herbal formulation, we know there must be Sovereign, Minister, Assistant, and Envoy. If all herbs are added, how can one know their roles and interactions (contrary, antagonistic, etc.)? Hence, other drugs were banned.
2. Without examining pulse and syndrome, merely using heat-clearing, detoxifying, blood-cooling and hemostatic methods, damages qi and injures yin, disease does not heal.
Gu XX, male, 12 years old.
After purpura subsided, edema and proteinuria for half a year, fever for half a month. Diagnosed with Henoch-Schönlein purpura nephritis and upper respiratory tract infection. Initially treated with Western medicine for a long time without effect, then combined with Chinese medicine for clearing heat, detoxifying, cooling blood and activating blood, also ineffective. Moreover, repeated colds in the last 3 months, and cold has persisted for half a month. Careful observation of symptoms: besides urine protein (+++), RBC 10-15, also dry and painful throat, fatigue, slight cough without sputum, body heat, yellow-white tongue coating, deficient-large, wiry, tight and rapid pulse. Synthesizing pulse and symptoms: deficient-large, wiry, tight and rapid pulse indicates joint deficiency of qi and yin, internal stagnation of damp-heat, and external invasion of wind pathogen. Treatment should tonify qi and nourish yin, dry dampness and clear heat, disperse wind pathogen. Prescription: Ginseng 3g, Licorice 3g, Astragalus 5g, Angelica Sinensis 3g, Ophiopogon 3g, Schisandra Berry 3g, Green Tangerine Peel 3g, Tangerine Peel 3g, Medicated Leaven 3g, Phellodendron 3g, Kudzu Root 6g, Atractylodes Lancea 3g, Atractylodes Macrocephala 3g, Cimicifuga 3g, Alisma 3g.
After taking 4 doses, fever, sore throat, fatigue resolved, urinalysis (-). Continued with Shenkangling, 2 capsules per time, 3 times daily, cured.
A physician said: This disease is HSP nephritis, with fever of 38.5°C for half a month. Previous doctors frequently used Western medicine and heat-clearing, detoxifying Chinese medicine without effect. Teacher used only modified Qingshu Yiqi Tang (Heat-Relieving and Qi-Nourishing Decoction). I have pondered this for a long time without understanding. Answer: Fever, from a TCM perspective, can be wind-heat or wind-cold; toxic heat or joint qi-yin deficiency. If wind-cold, only dispersing wind and scattering cold works; if qi-yin deficiency, only tonifying qi and nourishing yin works. One absolutely cannot generalize heat-clearing and detoxifying for all fevers. Since the pulse is deficient-large, wiry, tight and rapid, naturally only tonifying qi, nourishing yin, removing dampness, clearing heat and dispersing wind can be used. Hence, Qingshu Yiqi Tang was used for this syndrome. As for why this method cured HSP nephritis, it is because the pulse and syndrome also conform to Qingshu Yiqi Tang syndrome.
Paroxysmal Nocturnal Hemoglobinuria
Examine pulse and tongue, combine with complexion, differentiate syndrome and formulate prescription, treat and recover.
Sun XX, male, 10 years old.
Fatigue and weakness, urine resembling soy sauce color for over 1 year. Diagnosed with paroxysmal nocturnal hemoglobinuria. Initially treated with Western medicine for half a year, not only did symptoms not subside, but worsened day by day. Then combined with Chinese medicine for clearing heat and cooling blood, symptoms still did not improve. Careful observation of symptoms: pale and lusterless complexion, physical fatigue and weakness, hemoglobin 4g%, urine dark like soy sauce at night, clears in afternoon, pale-dark tongue body, thin white tongue coating, deep and thin pulse. Synthesizing pulse and symptoms: pale complexion indicates joint qi-yin deficiency. Pale-dark tongue body indicates blood deficiency with stasis. Deep pulse indicates stagnation. Thin pulse indicates joint qi-blood deficiency. Combined, this is joint qi-yin deficiency as root, qi stagnation and blood stasis, downward pouring of damp-heat as branch. Treatment should tonify qi and nourish blood to support root, regulate qi and activate blood, promote diuresis and clear heat to treat branch. Prescription: Raw Astragalus 30g, Raw Yam 30g, Safflower 3g, Tortoise Shell 12g, Phellodendron 5g, Moutan Cortex 10g, Angelica Sinensis 6g, Notoginseng 3g (taken separately), Achyranthes 9g, Amber Powder 6g (taken separately), Smilax Glabra 60g.
After taking 4 doses, urine color slightly cleared. After 6 doses, urine color completely cleared, appetite and spirit greatly increased. Continued for 30 doses, all symptoms disappeared, hemoglobin increased to 15g%, cured.
Upper Respiratory Tract Infection
1. Examine pulse and tongue, inspect defecation and urination, regulate San Jiao, disease begins to heal.
Li X, male, 8 years old.