迨服药之后，病者即渐觉痛势微减，而肿则如故。二小时后，觉腹内蠕动而雷鸣，无何，即大泻干溏夹杂之粪便，有干硬如球者，有湿粘如酱者。于是续服二煎，至夜间又连解大便二次，则如球之硬者，由少而无，而如粘酱者，则更多矣。次日一觉醒来，自视其患处，已肿消其半，复招余诊。余再扪之，亦觉肝肿部之抵抗大减，肋下之皮肤，已可扭撮成皱，余亦大喜。因西医谓非经开刀不可，而竟以中药消散之，岂非一治疗之奇迹哉。乃只将大黄、芒硝，各减一钱，嘱再服一剂。迨服后于一日夜间，大便又续下四五次，肿痛消去七八。再次日复延余诊，特为之加入益气养血之品，减大黄、胆草，去芒硝。续服二帖，而完全治愈。
牡丹汤合龙胆泻肝汤加减方牡丹皮六钱锦纹军五钱元明粉五钱生黄芩四钱桃仁泥四钱龙胆草三钱(酒炒)春柴胡三钱生地黄六钱当归尾四钱(酒洗)均木通三钱夏枯草三钱金银花一两再诊方前方锦纹军、元明粉，均减为四钱。
三诊方前方各药，减大黄、胆草，去桃仁、芒硝、木通，加赤芍三钱，茯苓三钱，白术三钱，薏仁四钱，连服二帖。
肠痈(肠痈化脓证)患者初觉腹内隐痛，继则身有寒热，腹内更形拘急，渐至结于右腹下方，固定作痛，而放射至腰肋。再进则内部肿突如拳，便秘溺赤。以红藤丹皮大黄汤主之，续为加减，以竟全功。今述此治案之前，当先述此方之起源。先是1941年，南汇张工六教授，述及其乡有一刘姓者，善治肠痈症，能治医院断为必须开刀之蚓突炎(即阑尾炎)，使之内消内溃，脓从大便而出。其方即红藤一两，单方一味，煎服立瘥。当即询其端倪，张则娓娓言之，余即默默识之，以待将来之治验。张教授谓其乡中，初有吴姓少年，患生肠痈，经医治之无效，后来上海至宏仁医院就诊。经医师诊断，确为蚓突炎，佥谓非开刀剖腹，割除其蚓突不为功。其父母以爱子之切，不肯开刀，而其子更惧，拒绝医师之劝告。医师亦无如之何，只好令其出院。
回至乡间，则亲友聚议，主见纷纭。有谓此证不开刀，是自弃也。有谓此证即开刀，医院亦不保险也。有谓既已不开刀而回，当另延医诊治。适有一人言邻乡有刘姓者，善治肠痈之证。立即倩人去请，不数小时，刘君已至。经其诊察之后，断为内已有脓，但服药可内溃下泄而消也。立出药一包，片色带红。人问其名，刘云“此红藤也。”但此不常用之药，众觉名似未闻，遂亦置之，且观其效何如也。
讵一服之后，是夜即腹中雷鸣，有时痛更加甚。续服二煎，至天将明时，即连续大便二次。粪中有干有稀，夹杂脓血，其粘滞及污垢之物，一鼓而下。疼痛大减，腹侧肿胀，立即消去大半。次日再请续诊，仍以红藤六钱，加薏仁一两煎服。续下脓血颇多，疼痛更轻，已能思食，食之亦能安。
后经调理，不旬日而全愈。闻工六先生言，余默识之，以待有机会临床验证。
后阅杨玉衡《伤寒温疫条辨》，偶于第四卷中，见亦有肠痈秘方一则。其文云：肠痈秘方，凡肠痈生于小肚角，微肿，而小腹阴痛不止者，是毒气不散，渐大，内攻而溃，则成大患矣，急以此方治之。
先用红藤一两，酒二碗，煎一碗，午前二服，醉卧之。
午后用紫花地丁一两，酒二碗，煎一碗，服之。服后，痛必渐止为效。
由此观之，则此刘姓之方。即《伤寒温疫条辨》之方也。于是更坚我试用此药之信心。
至1943年4月间，有船户曹海洪者，年32岁，经营内河之航运。忽而江南，忽而江北。时船泊于造币厂桥西苏州河岸，忽患肠痈之疾，诸医罔效。右腹盲肠部，疼痛肿胀，右足亦不能伸直。后入沪西平民医院，医者亦云：非开刀不可。病者为经济能力所限，即最低之开刀医药费，亦不能筹措。时余与附近之中药店，有为贫病施诊、施药之设，刊诸报端。患者闻而求治。据诊察之下，确系肠痈无疑，盲肠部肿如拳大。按之抗力颇强，时发寒热。大便已五日未解，小溲赤涩，舌根腻，其脉沉紧而微迟。
余思红藤之方，今可试矣。且病势甚急，大便不解已多日。设红藤解毒力有余，而泻下力不足，反致迟延时日。何不以红藤为主，合《金鉴》丹皮大黄汤法，以一试之，庶可面面俱到也。主张既定，遂为之处方如下，定名曰红藤丹皮大黄汤，令其加酒如法煎服。迨头煎服后，不四小时，即腹中咕咕作响，无何，大解一次。先之以燥矢，继之以溏粪，与脓血夹杂而下，腹痛大减，腿亦较能得伸。续服二煎，又大便两次。均为脓血粪便夹杂之物，于是一夜安眠，盲肠部已无大痛苦，只隐隐微痛而已。次日复诊，余见病已大减，心喜无量。乃将大黄、桃仁等减量，去元明粉，加紫花地丁六钱，银花藤六钱。连服两帖，脓水渐少，并令以薏仁红枣粥时时服之。一星期后，脓血已极淡，大便亦转淡黄，小溲渐清，改服调理之剂而愈。
此后余于肠痈之证，均用此法收功。连前共有四例，均未有其他危险。然此方之治，有讨论之必要矣。
(一)工六教授告我之方，仅云红藤一味，水煎服，并无加酒之说。而《伤寒温疫条辨》谓须用酒二碗，煎至一碗，且醉卧之，是非酒不为功也。余今加酒一杯，行其药力，未敢以单味酒煎服之也。
(二)《伤寒温疫条辨》谓午前二服红藤，午后一服地丁，彼以二药分午前午后。余以第二帖减大黄，加地丁、银花藤，亦通权达变之方也。
(三)红藤一药，一般小药店中无有，非大药行不备。
《中国医学大辞典》不载。《中国药学大辞典》谓红藤即省藤之俗称，《本草纲目拾遗》谓亦名赤藤，但谓其杀虫治风，未言其治肠痈也。
(四)书谓肠有内外两层。如内层生痈，能下之使穿破而下泄。如外层生痈，则必外穿，而溃脓入腹。然以余意推测之，肠内生痈，多由食物中有硬杂物质所刺激而发炎，当然内层化脓为多，而外层者必较少，此可肯定者。但红藤之治肠痈，单味即有效，若加酒或酒煮，仍须有机会再试之也。
红藤丹皮大黄汤红藤一两粉丹皮五钱锦纹大黄五钱桃仁泥四钱元明粉四钱(分冲)瓜蒌仁四钱京赤芍三钱加酒一杯煎服红藤丹皮大黄汤加减方红藤一两粉丹皮四钱锦纹军三钱桃仁泥三钱瓜蒌仁三钱京赤芍三钱紫花地丁六钱银花藤六钱加酒一杯煎服附言：《余无言医案》，原名《翼经经验录》，系先父无言先生生前自撰稿，建国后曾将此医稿与先大父奉仙公遗著——《医方经验汇编》(原中华书局出版，中医书局重印)合编自费刊印分赠亲友、同道和学生。现将《翼经经验录》重予点校、整理以飨读者。
诊余漫话药用寒温补泻，当察患者体质我们诊治多种疾病，经常须根据辨证中之四诊八纲和患者的体质情况，以确立药用之法则与规范。寒证用温剂，热证用寒凉之品，“虚则补之，实则泻之”，几乎为临床医师所共识。但其中我们应十分重视患者的体质现状。如忽视于此，难以在施治中获得满意的疗效，往往可能产生“施治不效”或“过犹不及”，甚至产生不良的副作用或加重病情之弊。清代名医赵濂从整体出发，阐明医者在辨证后，如何掌握恰当施治时，曾分析患者的体质情况和药用之寒热、温凉、补泻之间的关系。他在《医门补要》中说：“人体质有虚实之分，禀性有寒热之异。属寒体者，病时宜用凉药中微加温和之品以监之，若太苦寒则败胃，有欲吐泻、胃寒腹痛之患。属热体者，病时宜用热药者，惟温平之品以缓治，若太燥烈，恐激起本源之火，致烦渴、狂暴、失血之患。属实体者，或因病变虚，宜用补剂，须少少与之，若太呆补，致不食、腹胀、中满、逆气之患。属虚体者，病时宜克伐，尤宜性缓之品，若太峻利，致虚脱多汗，肢冷懒言，烦躁欲入水之患。”由此不难体会，中医诊疗中辩证思维和因人制宜的圆机活法，也是衡量医者诊治水平高低的一杆标尺。希望读者能对赵濂这段名言，予以深入学习和体验。
用中西二法调治肾脏性水肿早岁，余开业于阜宁时，有东北乡王某者，年且六十有奇，患水肿证，时当七月，抬来城中求治，入北门，即询之道途中人曰：“城中医生，善于内科者为谁。”人成告之曰：“有余某者，中西医家也，盍试之。”病家即抬来求治。余察其症状，为之咋舌。腰以下肿势最盛，两腿如象足，两脚如冬瓜，阴囊如悬瓠。胸部以上则较轻，两手及头面均肿，腿皮肿如胡桃。凡肿处，均明如玻璃，弹之即可立破，扪之冷如冰，呼吸短促，喘声如哮，舌苔白滑，粘膜均呈白色，脉按之而不可得，小便甚短少，且阴茎完全缩人囊内，视之几如葫芦上一小孔耳。询其既往症，则谓“五月问，曾途行遭大雨，后即发肿，且不思食，先由两足肿起，渐次向上，而膝、而股、而会阴、而腹、而腰、而胸、而上肢、而头面，迭延多医，服药均无效，以迄于今，不食且十余日矣。先生其有良法否?”余以年高症重，有难色。病者再四乞为治疗。
余乃告之曰：“危险殊甚，中医用利水健脾诸剂，既不见效，再施类似治法，亦难见功。西药有发汗剂，名匹罗卡品(Piloarpin)者，姑试之，效则吉矣。”盖余恐患者多日不食，用此猛烈之发汗剂，恐其随汗而脱也。然病者命在朝夕，与其坐而待毙，不如含药而亡。取得病家同意，余乃为之注射匹罗卡品1毫升。无何，大汗淋漓，由头至足，无处无汗，拭之粘指，腥臭触鼻。约一句钟，汗出如洗，床下闻有滴答声。至是喘声渐微，患者似减轻苦楚，惟疲惫异常，呼之只微声应耳。无何，索便桶，小便亦大利，患者大快。
再察其全身肿势，消去一半，旋即进流动、易消化之食物少许，勿使多食，一夜甚安。次日，余即改以中医治水肿名方——实脾饮(严用和《济生方》方)与服。过五日，已能扶杖行动。余又以匹罗卡品注射0．5毫升，复又出汗，惟不若前两次之多耳。余以其病既退，不能再用猛烈之发汗剂。即以实脾饮为主方，再加重利水之品，十帖而康健如初。由此可见，中西药可以并治以提高疗效。
论湿温治法余归纳薛生白、吴鞠通二家之言，结合个人临床所见，湿温病之主证为：始恶寒，后但热不寒，头痛，身重而疼，舌白或润黄，面色淡黄，汗出，胸中痞闷，不食不饥，口渴不欲饮，午后身热，状若阴虚，脉弦细而濡。中医于湿温之治疗，约分为二门。(一)其学说以湿温为病原，故以解热利湿为主，此为其原因疗法。(二)因湿温之变证多端，险候百出，即因其变证险候而治之，此为其对证疗法。
湿温原发证治法：1．解热利湿法：湿温为湿、温两邪合并为患。温即是热，故薛生自之<湿温病篇》(又名《湿热病篇》)，其治疗即以解热祛湿为首务。湿温病邪之势均而重者，则药剂亦均重之；其势均而轻者，则药剂亦均轻之。热邪盛于湿邪者，则解热之药多，而祛湿之药少；湿邪盛于热邪者，则祛湿之药多，而解热之药少。然解热祛湿之方法，又各不同，兹分别述之。
(1)当初期病尚在表，应用微汗之法者，则微汗之，使热从体表缓缓而解，则湿为体内不洁之水分，亦得随汗而外泄。若热仍不退，或退之未尽，可仍用前法，务使热退而后已。若热已退，或退去七八分，则湿邪势孤，易于扑灭矣。
(2)湿既势孤，顿失同盟，因即清利其三焦水道，使邪汇至肾脏，输入膀胱，由小便而外出。若体气较实，或大便数日未解，或解时艰涩不爽者，并可微利。
(3)至病邪深入，热势稽留，湿滞肠中，胸闷特甚，切不可任邪气盘踞。里证已成，不可再用表药，只宜用清热及利湿之合剂，使湿从肾与膀胱外出，则热亦随之而下行，湿热并去，病可自痊。
(4)运用上法时，另有一关键不可不知，即决定“利湿清热”之方，可再问其大便之如何?脘腹之膨否?如大便已数日未解，或虽解而艰涩，脘腹膨满而不柔和，则于方中再加轻泻大便之品，则肠中湿热亦将缓缓下行。盖二便分利，则湿热之邪，行将失其根据地而无立足之所，愈易追剿消灭矣。设大便每一二日一解，解时亦爽，则轻泻剂可不加，此专从里解、清利之方法及用药之分合也。
2．扶持脾胃法：湿温之病邪，虽重在小肠，其病根仍然在胃。如胃司消化，脾能为辅，二便畅利，则必然不病湿温。今既病矣，若只解热利湿，而不健胃益脾，则药力之贷款，仍无补于生理之虚乏。则须一面贷款，一面扶持脾胃之生理功能，使之自力更生，功能渐趋恢复。故湿温经治获效后，即应加药以扶持其脾胃。
3．参用芳香法：湿温病既为热腐湿浊之邪，且病室内又多秽恶之病气，则必须以芳香逐秽之品以化之。盖芳香之品，能化浊秽之气，故不论表剂、里剂，处方均宜酌加芳香药一二味于内，虽无绝对治湿温之功能，然在辅助疗法上，未始无百分之五之小助焉。除内服药酌加者外，亦可于病室内，燃枷楠香一二支，或少焚白芷、木香、佩兰、苍术等品，以辟秽恶之气。
湿温原发证方治举要湿温相当于西医所说的“肠伤寒”，中医施治以排泄清解为主。前人的经验方颇多，我在诊疗中也创用了湿温新方，经常选用以下诸方施治。
After taking the medicine, the patient gradually felt a slight reduction in pain, but the swelling remained unchanged. Two hours later, peristalsis and borborygmus (rumbling sounds in the abdomen) were felt inside the abdomen. Shortly thereafter, large amounts of stool mixed with dry and loose feces were discharged; some were hard like balls, while others were wet and sticky like paste. The second decoction was then continued to be taken. By nightfall, two more bowel movements occurred. The hard, ball-like stools decreased until they disappeared, while the sticky, paste-like stools increased. Upon waking the next day, the patient observed that the swelling at the affected site had reduced by half and invited me for another examination. Palpation revealed a significant decrease in resistance in the area of liver enlargement, and the skin under the ribs could now be pinched into wrinkles. I was also greatly pleased. Since Western medicine deemed surgery indispensable, yet the condition was resolved using Chinese herbal medicine, this could indeed be considered a medical miracle. Therefore, I reduced the dosage of Radix Rheei Preparata (Dahuang, Rhubarb Root) and Natrii Sulfas (Mangxiao, Mirabilite) by one qian each, and instructed the patient to take another dose. After taking it, during the night of the following day, four or five more bowel movements occurred, and the swelling and pain subsided by seventy to eighty percent. On the third day, upon returning for consultation, I specifically added herbs to tonify Qi and nourish Blood, reduced the dosages of Radix Rheei Preparata (Dahuang, Rhubarb Root) and Radix Gentianae (Longdancao, Gentian Root), and removed Natrii Sulfas (Mangxiao, Mirabilite). After taking two more doses, complete recovery was achieved.
**Modified Mudan Tang combined with Longdan Xiegan Tang:**
Radix Paeoniae Rubra (Mudanpi, Red Peony Root) 6 qian, Radix Rheei Preparata (Jinwen Jun, Rhubarb Root) 5 qian, Natrii Sulfas (Yuanming Fen, Mirabilite) 5 qian, Raw Radix Scutellariae (Sheng Huangqin, Skullcap Root) 4 qian, Peach Kernel Paste (Taoren Ni) 4 qian, Radix Gentianae (Longdancao, Gentian Root) 3 qian (stir-fried with wine), Spring Bupleuri Radix (Chun Chaihu, Bupleurum Root) 3 qian, Raw Rehmanniae Radix (Sheng Dihuang, Rehmannia Root) 6 qian, Cauda Angelicae Sinensis (Danggui Wei, Tail of Chinese Angelica Root) 4 qian (washed with wine), Tongcao (Jun Mutong, Tetrapanacis Medulla) 3 qian, Prunellae Spica (Xiakucao, Selfheal Spike) 3 qian, Flos Lonicerae Japonicae (Jinyinhua, Honeysuckle Flower) 1 liang.
**Second Visit Prescription:**
In the previous formula, Radix Rheei Preparata (Jinwen Jun, Rhubarb Root) and Natrii Sulfas (Yuanming Fen, Mirabilite) were both reduced to 4 qian.
**Third Visit Prescription:**
In the previous formula, Radix Rheei Preparata (Dahuang, Rhubarb Root) and Radix Gentianae (Longdancao, Gentian Root) were reduced; Peach Kernel (Taoren), Natrii Sulfas (Mangxiao, Mirabilite), and Tongcao (Mutong, Tetrapanacis Medulla) were removed; Radix Paeoniae Rubra (Chishao, Red Peony Root) 3 qian, Poria (Fuling, Porii Sclerotium) 3 qian, Atractylodis Macrocephalae Rhizoma (Baizhu, Large-headed Atractylodes Rhizome) 3 qian, and Coicis Semen (Yiren, Job's Tears Seed) 4 qian were added. Taken for two doses.
**Intestinal Abscess (Suppurative Stage of Intestinal Abscess):**
Patients initially feel dull pain in the abdomen, followed by alternating chills and fever. The abdomen becomes increasingly tense, eventually forming a fixed painful mass in the lower right abdomen, radiating to the waist and ribs. As the condition progresses, an internal swelling protrudes like a fist, accompanied by constipation and dark urine. The primary prescription is Hongteng Danpi Dahuang Tang (Red Vine, Peony, and Rhubarb Decoction), with subsequent modifications to complete the treatment. Before narrating this case, the origin of this formula should be described. In 1941, Professor Zhang Gongliu from Nanhui mentioned that there was a Mr. Liu in his hometown who specialized in treating intestinal abscesses. He could cure vermiform appendicitis (which hospitals diagnosed as requiring surgery), causing it to resolve internally or rupture internally so that pus would exit through the stool. His formula consisted solely of one ounce of Hongteng (Red Vine), prepared as a single-herb decoction, which cured the patient immediately upon ingestion. When asked for details, Professor Zhang explained them, and I memorized them, waiting for future clinical verification. Professor Zhang stated that initially, a young man surnamed Wu in his hometown suffered from an intestinal abscess. Treatment failed, so he went to Shanghai Hongren Hospital. The doctors diagnosed him with appendicitis and unanimously agreed that surgical removal of the appendix via laparotomy was necessary. His parents, out of love for their son, refused surgery, and the son himself was terrified and rejected the doctors' advice. The doctors, having no other option, discharged him.
Back in the countryside, relatives and friends gathered to discuss, with differing opinions. Some said refusing surgery was abandoning oneself to death. Others said even with surgery, the hospital offered no guarantees. Still others suggested that since he returned without surgery, he should seek another doctor. Someone mentioned that a Mr. Liu in a neighboring township was skilled in treating intestinal abscesses. People were sent to invite him immediately, and within a few hours, Mr. Liu arrived. After examination, he determined that pus had already formed internally but could be resolved by medication causing internal rupture and discharge. He prepared a packet of medicine, reddish in color. When asked for its name, Mr. Liu said, "This is Hongteng (Red Vine)." However, as this was an uncommon herb, most people claimed not to have heard of it, so they set it aside to see how effective it would be.
Unexpectedly, after the first dose, borborygmus occurred that night, and sometimes the pain intensified. After taking the second decoction, just before dawn, two consecutive bowel movements occurred. The stool contained both dry and loose parts, mixed with pus and blood. The sticky and foul matter was expelled in one go. The pain decreased significantly, and the swelling on the side of the abdomen reduced by more than half. The next day, follow-up consultation was requested. The prescription still used 6 qian of Hongteng (Red Vine) plus 1 liang of Coicis Semen (Yiren, Job's Tears Seed) decocted. More pus and blood were discharged, the pain lightened further, appetite returned, and food intake was comfortable.
After subsequent conditioning, full recovery was achieved in less than ten days. Hearing Mr. Gongliu's account, I memorized it, waiting for an opportunity for clinical verification.
Later, while reading Yang Yuheng's *Shanghan Wenyi Tiaobian* (Differentiation of Cold Damage and Warm Epidemics), I偶然ly came across a secret recipe for intestinal abscess in Volume Four. The text read: Secret Recipe for Intestinal Abscess. Whenever an intestinal abscess occurs in the corner of the lower abdomen, with slight swelling and continuous Yin-area pain in the lower abdomen, it indicates that toxic qi has not dispersed, gradually enlarging, attacking inward, and ulcerating, leading to major complications. Treat urgently with this formula.
First, use 1 liang of Hongteng (Red Vine) and two bowls of wine, decoct to one bowl. Take two doses in the forenoon, drink until intoxicated, and sleep.
In the afternoon, use 1 liang of Violae Herba (Zihua Diding, Viola Flower) and two bowls of wine, decoct to one bowl, and take. If the pain gradually stops after taking it, it is effective.
From this, it can be seen that Mr. Liu's formula is the same as the one in *Shanghan Wenyi Tiaobian*. This further strengthened my confidence in trying this herb.
In April 1943, a boatman named Cao Haihong, aged 32, engaged in inland shipping, suddenly fell ill with an intestinal abscess while traveling between Jiangnan and Jiangbei. At the time, his boat was moored on the west bank of the Suzhou River near Zao Bi Chang Bridge. Various doctors failed to treat him effectively. There was pain and swelling in the right abdominal cecum area, and the right leg could not be straightened. He was later admitted to Huaxi Pingmin Hospital, where doctors also stated that surgery was mandatory. Constrained by financial ability, he could not raise even the minimum cost for surgery and medical care. At that time, I and nearby Chinese medicine pharmacies had established provisions to provide free diagnosis and medicine for the poor and sick, advertised in newspapers. Hearing this, the patient sought treatment. Upon examination, it was confirmed as an intestinal abscess, with the cecal area swollen to the size of a fist. Palpation revealed strong resistance, with intermittent chills and fever. The bowels had not moved for five days, urination was scanty and burning, the tongue coating at the root was greasy, and the pulse was deep, tight, and slightly slow.
I thought, "Now is the time to try the Hongteng formula." Moreover, the disease progression was urgent, and constipation had persisted for many days. If Hongteng (Red Vine) had sufficient detoxifying power but insufficient purgative effect, it might delay recovery. Why not use Hongteng (Red Vine) as the main ingredient, combined with the method of Danpi Dahuang Tang from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), to test it, ensuring comprehensive coverage? With this approach decided, I prescribed the following, naming it Hongteng Danpi Dahuang Tang (Red Vine, Peony, and Rhubarb Decoction), instructing the addition of wine and preparation according to standard methods. After the first decoction was taken, within four hours, gurgling sounds were heard in the abdomen. Shortly after, one bowel movement occurred. First, dry feces were passed, followed by loose stools mixed with pus and blood. Abdominal pain decreased significantly, and the leg became more flexible. After taking the second decoction, two more bowel movements occurred, consisting of mixed pus, blood, and feces. The patient slept peacefully all night, with only slight lingering pain in the cecal area and no major discomfort. On the next day's follow-up, seeing the condition had greatly improved, I was overjoyed. I reduced the dosages of Radix Rheei Preparata (Dahuang, Rhubarb Root) and Peach Kernel (Taoren), removed Natrii Sulfas (Yuanming Fen, Mirabilite), and added Violae Herba (Zihua Diding, Viola Flower) 6 qian and Lonicerae Japonicae Caulis (Yinhua Teng, Honeysuckle Stem) 6 qian. After taking two doses, the amount of pus water gradually decreased. I also advised consuming Coix Seed and Red Date Porridge frequently. One week later, the pus and blood were very pale, the stool turned pale yellow, and urination cleared up. The patient recovered after taking conditioning agents.
Thereafter, I used this method for all cases of intestinal abscess. Including this one, there were four cases in total, none of which presented other dangers. However, the treatment with this formula warrants discussion.
(1) Professor Gongliu told me that his formula only specified Hongteng (Red Vine) alone, decocted in water, with no mention of adding wine. *Shanghan Wenyi Tiaobian* states that two bowls of wine must be used, decocted to one bowl, and the patient should drink until drunk and sleep. It implies that efficacy depends on wine. Today, I add one cup of wine to promote the medicinal action, but I dare not use the single herb decocted solely in wine.
(2) *Shanghan Wenyi Tiaobian* specifies taking Hongteng (Red Vine) twice in the forenoon and Violae Herba (Zihua Diding, Viola Flower) once in the afternoon, dividing the two herbs by time. In my second dose, I reduced Radix Rheei Preparata (Dahuang, Rhubarb Root) and added Violae Herba (Zihua Diding, Viola Flower) and Lonicerae Japonicae Caulis (Yinhua Teng, Honeysuckle Stem), which is also a flexible modification.
(3) Hongteng (Red Vine) is generally unavailable in small pharmacies and is only stocked by large herbalists.
It is not recorded in *Zhongguo Yixue Da Cidian* (Comprehensive Dictionary of Chinese Medicine). *Zhongguo Yaoxue Da Cidian* (Comprehensive Dictionary of Chinese Materia Medica) states that Hongteng is the common name for Calamus Rotang (Shengteng). *Bencao Gangmu Shiyi* (Supplement to Compendium of Materia Medica) says it is also called Chiteng (Red Vine), but mentions its use for killing parasites and treating wind, not for treating intestinal abscesses.
(4) Books state that the intestine has inner and outer layers. If an abscess forms in the inner layer, purgatives can cause it to perforate and discharge downward. If it forms in the outer layer, it must perforate outward, causing pus to enter the abdominal cavity. However, based on my speculation, intestinal abscesses are mostly caused by inflammation stimulated by hard impurities in food, so suppuration in the inner layer is more common, while the outer layer is less likely, which is certain. But Hongteng (Red Vine) is effective for intestinal abscesses even as a single herb. If wine is added or it is decocted with wine, it still requires opportunities for further testing.
**Hongteng Danpi Dahuang Tang:**
Calamus Rotang (Hongteng, Red Vine) 1 liang, Radix Paeoniae Rubra (Fen Danpi, Powdered Peony Root) 5 qian, Radix Rheei Preparata (Jinwen Dahuang, Rhubarb Root) 5 qian, Peach Kernel Paste (Taoren Ni) 4 qian, Natrii Sulfas (Yuanming Fen, Mirabilite) 4 qian (dissolved separately), Trichosanthis Semen (Gualou Ren, Melon Seed) 4 qian, Radix Paeoniae Rubra (Jing Chishao, Jing Red Peony Root) 3 qian. Add one cup of wine and decoct.
**Modified Hongteng Danpi Dahuang Tang:**
Calamus Rotang (Hongteng, Red Vine) 1 liang, Radix Paeoniae Rubra (Fen Danpi, Powdered Peony Root) 4 qian, Radix Rheei Preparata (Jinwen Jun, Rhubarb Root) 3 qian, Peach Kernel Paste (Taoren Ni) 3 qian, Trichosanthis Semen (Gualou Ren, Melon Seed) 3 qian, Radix Paeoniae Rubra (Jing Chishao, Jing Red Peony Root) 3 qian, Violae Herba (Zihua Diding, Viola Flower) 6 qian, Lonicerae Japonicae Caulis (Yinhua Teng, Honeysuckle Stem) 6 qian. Add one cup of wine and decoct.
**Postscript:** *Yu Wuyan Yi An* (Medical Cases of Yu Wuyan), originally titled *Yijing Jingyan Lu* (Records of Experience from Winging Through Classics), was self-written by my late father, Mr. Wuyan. After the founding of the People's Republic of China, this manuscript was compiled with the遺著 (posthumous works) of my great-grandfather, Mr. Fengxian—*Yifang Jingyan Huibian* (Compilation of Medical Formula Experiences, originally published by Zhonghua Book Company and reprinted by Traditional Chinese Medicine Bookstore)—and privately printed to be distributed to relatives, friends, colleagues, and students. Now, *Yijing Jingyan Lu* is collated and organized anew to serve readers.
**Casual Remarks on Diagnosis and Treatment:** Regarding the use of cold, warm, tonifying, and purging herbs, one must observe the patient's constitution. In diagnosing and treating various diseases, we often need to establish principles and norms for medication based on the Eight Principles and Four Diagnostic Methods in syndrome differentiation, as well as the patient's physical constitution. Using warming agents for cold syndromes and cooling agents for heat syndromes, "tonify deficiency, purge excess," is almost a consensus among clinicians. However, we should pay special attention to the patient's current constitutional status. Ignoring this makes it difficult to achieve satisfactory results, often leading to "ineffective treatment" or "more harm than good," and potentially causing adverse side effects or worsening the condition. Qing Dynasty famous physician Zhao Lian, starting from a holistic perspective, clarified how physicians should grasp appropriate treatment after syndrome differentiation. He analyzed the relationship between patients' constitutions and the cold/heat, warm/cool, tonifying/purging properties of medicines. In *Yimen Buyao*, he said: "Human constitutions vary between deficiency and excess, and innate natures differ between cold and heat. For those with cold constitutions, when ill, cool medicines should be used with slight additions of mild/warm items to monitor them. If too bitter and cold, it damages the stomach, causing nausea, diarrhea, and cold-stomach abdominal pain. For those with heat constitutions, when ill, hot medicines should be used cautiously with only mild/warm items for gradual treatment. If too drying and fierce, it may ignite the fire of the source, causing irritability, thirst, mania, and hemorrhage. For those with solid constitutions, if the disease transforms into deficiency, tonifying agents should be used sparingly. If too rigidly tonifying, it causes loss of appetite, abdominal distension, fullness, and rebellious qi. For those with deficient constitutions, when ill, attack is suitable, especially with mild agents. If too harsh and draining, it leads to collapse, excessive sweating, cold limbs, reluctance to speak, and irritability with a desire to enter water." From this, it is easy to appreciate that dialectical thinking and individualized treatment flexibility in TCM diagnosis and treatment are also a yardstick for measuring a physician's level. I hope readers will deeply study and experience this famous quote by Zhao Lian.
**Treating Renal Edema with Integrated Chinese and Western Methods:** In my early years practicing in Funing, there was a Mr. Wang from the northeast township, aged nearly sixty, suffering from edema. It was July, and he was carried into the city for treatment. Entering the North Gate, he asked passersby, "Who is the best internal medicine doctor in the city?" A passerby told him, "There is Mr. Yu, a practitioner of both Chinese and Western medicine. Why not try him?" The patient was carried to seek treatment. Observing his symptoms, I was astounded. The swelling below the waist was most severe; both legs were like elephant feet, both feet like winter melons, and the scrotum like a hanging gourd. Above the chest, it was lighter; both hands and the face were swollen, and the skin on the legs was swollen like walnuts. All swollen areas were clear as glass, bursting easily upon tapping, and cold as ice to the touch. Breathing was short and rapid, wheezing like asthma. The tongue coating was white and slippery, mucous membranes were all white, and the pulse was imperceptible upon pressure. Urination was extremely scanty, and the penis was completely retracted into the scrotum, looking like a small hole on a gourd. Asking about past history, he said, "In May, I was caught in heavy rain while traveling. Swelling started shortly after, along with loss of appetite. It began in both feet and gradually spread upward—to the knees, thighs, perineum, abdomen, waist, chest, upper limbs, and head. I consulted many doctors, and all medications failed, continuing until now. I have not eaten for over ten days. Does your Excellency have any good methods?" Given his advanced age and severe condition, I showed hesitation. The patient begged repeatedly for treatment.
I told him, "The danger is extreme. Chinese medicine treatments using diuretics and spleen-tonifying agents have already failed. Applying similar methods is unlikely to succeed. Western medicine has a diaphoretic agent called Pilocarpine. Let us try it; if effective, it will be auspicious." I feared that since the patient had not eaten for many days, using such a potent diaphoretic might cause collapse through sweating. However, his life hung in the balance; rather than sitting and waiting for death, it was better to die with medicine in his system. Obtaining consent from the family, I injected 1 ml of Pilocarpine. Soon, profuse sweating ensued, covering the body from head to toe. The sweat was sticky and foul-smelling. After about an hour, he was drenched, and dripping sounds were heard from under the bed. At this point, the wheezing subsided, the patient seemed relieved of suffering, though extremely fatigued, responding only faintly when called. Soon after, he requested a bedpan, and urination became abundant, bringing him great relief.
Re-examining the whole-body swelling, it had reduced by half. Immediately, small amounts of liquid, easily digestible food were given, avoiding overeating. He slept peacefully through the night. The next day, I switched to a famous Chinese medicine formula for edema—Shipin Yin (Spleen-Strengthening Decoction from Yan Yonghe's *Jisheng Fang*)—to be taken concurrently. Five days later, he could walk with a cane. I again injected 0.5 ml of Pilocarpine, causing sweating again, though not as profusely as the previous two times. Since the disease had receded, I could no longer use potent diaphoretics. Using Shipin Yin as the main formula, I further increased the diuretic ingredients. After ten doses, he recovered fully. This demonstrates that Chinese and Western medicines can be used together to improve efficacy.
**On the Treatment of Damp-Warmth Disease:** Summarizing the theories of Xue Shengbai and Wu Jutong, combined with my personal clinical observations, the main symptoms of Damp-Warmth disease are: initial aversion to cold, followed by fever without chills, headache, heaviness and pain in the body, white or moist yellow tongue coating, pale yellow complexion, sweating, chest oppression, lack of appetite and hunger, thirst without desire to drink, afternoon fever resembling Yin deficiency, and a string-taut, fine, and soggy pulse. TCM treatment of Damp-Warmth is roughly divided into two categories. (1) Its theory views Damp-Warmth as the pathogen, so the main treatment is resolving heat and promoting dampness drainage; this is etiological therapy. (2) Due to the numerous variations and dangerous signs of Damp-Warmth, treatment is directed at these specific manifestations; this is symptomatic therapy.
**Treatment of Primary Damp-Warmth Syndrome:**
1. **Heat-Resolving and Damp-Draining Method:** Damp-Warmth is caused by the combination of Damp and Warm pathogens. Warm is Heat. Thus, in Xue Shengbai's *Shiwen Bing Pian* (Chapter on Damp-Warmth Disease, also known as *Shire Bing Pian*), the primary treatment is resolving heat and dispelling dampness. If the pathogenic force of Damp-Warmth is balanced and severe, the medication should be equally heavy; if balanced and mild, the medication should be equally light. If Heat pathogen dominates Damp pathogen, there are more heat-resolving herbs and fewer damp-dispelling herbs; if Damp pathogen dominates Heat pathogen, there are more damp-dispelling herbs and fewer heat-resolving herbs. However, the methods for resolving heat and dispelling dampness differ, as detailed below.
(1) Initially, when the disease is still in the exterior, the micro-sweating method should be applied to induce slight sweating, allowing heat to resolve slowly from the body surface. Dampness, being unclean moisture inside the body, will also be excreted with the sweat. If heat does not subside or is not fully resolved, the previous method can be continued until heat subsides. If heat has subsided or resolved by seventy to eighty percent, the Damp pathogen stands alone and is easier to extinguish.
(2) Once Dampness stands alone and loses its ally, clear and drain the Sanjiao waterways, directing the pathogen to the Kidneys, entering the Bladder, and exiting via urination. If the body's Qi is relatively solid, or if bowels have not moved for several days, or if defecation is difficult and unsatisfactory, mild purgation can also be used.
(3) When the pathogen penetrates deeply, heat lingers, and dampness stagnates in the intestines, causing severe chest stuffiness, do not allow the pathogen to occupy the interior. Interior syndrome is established; exterior-releasing drugs should no longer be used. Only a combination of heat-clearing and damp-draining agents is suitable, allowing dampness to exit from the Kidneys and Bladder. Heat will then descend with it, and both dampness and heat will be eliminated, leading to spontaneous recovery.
(4) When applying the above methods, another key point must not be ignored: when deciding on a "damp-draining and heat-clearing" formula, ask again about the bowels. Is the abdomen bloated? If bowels have not moved for days, or if defecation is difficult despite movement, and the abdomen is distended and not soft, add mild laxatives to the formula. Then, intestinal damp-heat will slowly descend. Since the two bowels are drained separately, the damp-heat pathogen will lose its base and foothold, making it easier to eradicate. If bowels move every one or two days and defecation is smooth, mild laxatives need not be added. This concerns the integration and separation of methods and medications for interior resolution and clearing/draining.
2. **Supporting Spleen and Stomach Method:** Although the pathogen of Damp-Warmth heavily affects the Small Intestine, its root lies in the Stomach. If the Stomach manages digestion and the Spleen assists, and the two bowels flow smoothly, Damp-Warmth will certainly not occur. Now that illness has occurred, if only heat is resolved and dampness drained, without strengthening the Stomach and benefiting the Spleen, the medicinal support remains insufficient for physiological deficiency. One must simultaneously provide support and bolster the physiological functions of the Spleen and Stomach, enabling self-reliance and gradual functional recovery. Therefore, after Damp-Warmth shows improvement with treatment, herbs should be added to support the Spleen and Stomach.
3. **Using Aromatic Methods:** Damp-Warmth disease involves pathogens of heat rotting and damp turbidity, and the patient's room often contains foul pathological qi. Therefore, aromatic substances that dispel filth must be used to transform it. Aromatic substances can transform turbid and foul qi. Thus, regardless of exterior or interior formulas, one or two aromatic herbs should be酌情 (discretionarily) added to prescriptions. Although they do not have absolute curative function for Damp-Warmth, they offer a minor 5% assistance in auxiliary therapy. Besides adding to internal medicines, burning one or two sticks of Agarwood (Jianan Xiang) or burning small amounts of Angelica Dahurica (Baizhi, Bai Zhi), Costus Root (Muxiang, Mu Xiang), Eupatorium Fortunei (Peilan, Pei Lan), or Atractylodes Lancea (Cangzhu, Cang Zhu) in the room can also dispel foul qi.
**Summary of Formulas for Primary Damp-Warmth Syndrome:** Damp-Warmth corresponds to "Typhoid Fever" in Western medicine. TCM treatment focuses on excretion and clearing/resolving. There are many empirical formulas from predecessors. In my diagnosis and treatment, I have also created new formulas for Damp-Warmth and frequently select the following formulas for treatment.