日复一日，病者愈形疲惫，绝口不食，欲眠而不得片刻安枕，如此一星期。最终手足发冷，时静时躁，唇青齿燥，口有恶臭，阴道有似带之恶液流出。医者辞以不治，病家征得该院之同意，延余诊之。余亦知其不治，只好见证用药。
以其补益太过，大便旬余未解，热蒸于里，灼烂内腑，乃至如此，因书泻心合增液承气法，促令与服，作万一之希望。
是时索饮冷水，余令购生梨之大者一枚与之食。无何食尽，呼快不已，一家皆喜。又约二十分钟，又呼胃中难过，格格欲吐。吐出之物，夹有咖啡色之腐败物，此确为胃烂之征。
但吐后则又觉舒适矣。
进药之后，一夜大便未解，腹中有时更痛。直至次日上午10时左右，大便始通，解下黑色如酱之粪，夹有结硬实之粪球甚多。一解之后，病者神恬气静，而安卧矣。腹部亦较为柔和，不似前此之板硬。其夫以妻病大转，乘其熟睡而返家，一则清理积务，再则稍事休养。盖旬日以来，病者常常呼号，其夫伴之，亦不得安枕也。
后病者恨其夫不告而返，以为寡情，而盼其速死也。乃痛哭流泪，绝药绝食。次日夜间，病又转剧。伴者促其夫来，劝其服药，绝不启齿。又隔一日，终于昏糊。阴道及肛门内，流出恶臭之水，如黑豆汁，如屋漏水，此即《金匮·狐惑病篇》所谓蚀阴蚀肛之狐惑病也。不二日而亡。嗣余闻之，甚恨此病之未竟全功，而又悲夫此妇，以补益致病，以气忿而伤生也。
泻心合增液承气汤方锦纹大黄三钱元明粉三钱(分冲)上川连一钱五分生黄芩三钱润元参一两连心麦冬八钱鲜生地六钱鲜石斛四钱食中老年夜眠食中证媪年已过六旬，忽患昏糊不语，如睡眠然，似无痛苦。
医以中风及痰厥治之，不效。询知三旬以来，食量倍常，膳毕即睡，忽发此证，乃食中也。决以大承气汤下之。小瘥。
因易医复延两旬，不死亦不得生。乃改服蓖麻子油，兼行灌肠法。大泻而苏。
合肥路之柏芗村30号，有陈媪者，年62岁。于1934年10月间，某日晨，其家中人人都起，而陈媪不起。其媳唐氏，至床前呼之，亦不应，推之亦不动，始知其神昏不语矣。观其情形，似无痛苦，如睡眠然，惟喉中觉略有痰声。
其子陈如年，急延医为之诊治。医以中风及痰厥治之，三易其医，数日无效。盖口不能开，药难下咽也。
嗣延余诊。余察其脉息颜色，未犯绝象，乃细询未病之前有无他故。如年曰：“余母在未病之前，异常健啖。一日三餐，尤以晚膳为最多。食必二三大碗，约近两旬，日日如是。且最奇者，晚膳后立即就寝，人谓其不易消化，强之少坐片时，然后再睡，而余母不听也。至前日忽患此疾，今已三易其医矣，皆无效也。”余细思之，此必食积为患也。状如中风，在中医书中，名之日食中，亦类中之一种也。乃决以大承气汤加莱菔子下之，但因口闭难开，服未尽剂。泻只一次，其量亦不甚多，恶臭难闻。神识虽有时清醒，但旋又昏糊。病家复延他医治之，均无效果。盖药难下咽，灌之大不易也。
如此不言不动，仅有一息者，计二十一日，不死亦不得生，乃复求余诊。余以其迟延已二十余日，且年过六旬，不敢用药，只答以尽人事而已。乃以灌肠器行灌肠法，久之大便未通。乃复以大量蓖麻子油，用开口器开口灌之。不三小时，而腹鸣大泻。泻出之粪，如黑酱，如车轴油，如痰状，如鱼冻，其中夹有黑团，坚不可碎，恶臭不堪。由此大泻之后，神识渐转清明，手足略能屈伸。问其病已二十余日，不言不语，汝知之乎?则陈媪茫然不知也。后仍续服蓖麻子油两次，泻清肠垢，乃思饮食，于是庆更生矣。吾国医书所谓塞者通之，盖亦自然疗法之一例耳。
大承气汤加莱菔子方锦纹大黄五钱元明粉五钱(分冲)炒枳实四钱上川朴三钱莱菔子四钱(研)按：此方如当时设法多灌，必可得下而愈，不致多延两旬。后改服蓖麻子油者，恐年高病久不胜也，而服之果效，亦侥幸耳。
青年饮冰食中证天时炎热，晚场观影。边食冰淇淋及棒冰，枵腹归来。
进食油炸蛋饭，睡后无何，忽然不语。医以中风、痰厥或中恶治之，不效。询得其情，断为食中，以大承气汤加瓜蒌、干姜主之。
曹家渡有刘裕昌窑货号，其小主人年25岁，毫无前驱症状，于夜间二时左右，忽然昏糊不语。当时延附近医生治之，或云中风，或云痰厥，或云中恶。至日间下午四时，五易其医，丝毫无效，乃飞车延余往诊。余入病者之卧室，见其父母妻子，皆流泪满面。因诊病者之脉，沉实而有力，身体四肢如常，不厥不热，一如常人。呼吸略粗，而鼻微带鼾声，与常人睡眠无异。以手扳其下颔，亦随手而开，无牙关紧急之痉象。使余无从知其病原，惟按其脘口。则颇满硬。
因问其妻日，“夜间得病，汝何由知其不语，始于夜间二时左右乎?”曰：“昨夜伊随友人某君，同至金城大戏院看电影。因腹中饥饿，又恐夜间戒严(时在敌伪时期)，回至家中，命我为备夜膳。食毕即就寝，时已十二时有余矣。始尚言语、翻身，至二时余，我询其欲饮茶否，则已不能语矣。”余闻所食何物，及食之多寡。曰：“猪油炒饭一大碗，另加油煎荷包蛋二枚。以其饥甚，故多与之也。”余曰：请招其友来。
无何友至。余又问曰：“刘君作与阁下同去，可有其他饱食否。”其友曰：“别无他物。只有在戏院中，频呼胸热口渴，伊…人曾食冰淇淋两客。散场后，又食棒冰三支，即各归家。”余曰：“病情得之矣。”立书大承气汤加瓜蒌、干姜与之。大黄、芒硝，各用至八钱，川朴四钱，枳实六钱，全瓜蒌一两，加干姜三钱，以温通其脾胃之阳。并嘱其速服，迟恐气闭不救。病家无法，只得照服。余归来后，则不能安枕。
次日上午十时，复来延余。曰：“昨日下午六时灌药，幸得缓缓灌下。至八时大便一次，依然昏糊。九时半又大便一次，其量甚多，病者旋即清醒。告以昏糊已一日夜，则如梦初醒，茫然不知，今晨更觉清醒矣。”余闻之大喜，立即偕与俱去，至则合家欢忭，病者亦含笑道谢。余即细为之诊察，改用调胃承气之轻剂，加理气和中之品，以清其根株。
并告以“此病名食中，因先饮冷，而大暴食，大伤脾胃，因而不能蠕动。胃家如此之实则气闭，气闭则交感神经失其作用，影响于脑，故完全失其知觉。非风非热，故不痉；非虚非寒，故不厥；非上焦有痰，故呼吸不喘哮。此亦宿食之证，《金匮》未言，而后世方书曾言之矣。所见不多，故医家能言之者亦少，即或遇此证，其不当中风痉厥治者亦鲜矣。设问诊及腹诊稍一疏忽，则不明病原，药剂妄投，病者之生命危矣。”病家皆大叹服。
但此食在胃脘，而用下法，此亦为医者之权变。至如瓜蒂散之催吐，是否亦能治此等食中之证，非余所知。总之宿食在胃，神识清明，有泛恶欲吐之势，则瓜蒂散又为不易之方也。
大承气汤加瓜蒌干姜方大黄八钱芒硝八钱川朴四钱枳实六钱全瓜萎一两干姜三钱腹痛寒结腹痛证(一)妇人忽然腹痛，颇为剧烈，手足发厥，渐渐肢冷。医断为急性盲肠炎，或能蔓延成腹膜炎。验血结果，白血球增加至13000。促病者入院开刀，病者不可。余由闻问两诊，得知为荤腻杂食成病。且满腹皆痛，痛无固点，脘腹拒按，手不可近，欲吐不吐，大便不通。以大承气汤加桂枝、蒌霜、焦楂、姜制半夏主之。
有龚志芳女士者，其夫邓君，服务于商界。在抗战胜利前一年重九节之日，龚女士忽然腹痛，势甚剧烈。邓君立以电话请林医师来诊，盖林为邓君之友也。无何，林至。经诊察之后，告邓君曰：“腹痛忽然而来，四肢冷，非急性盲肠炎不能致此。但我还不敢肯定，再请我老师会诊，方可决定。”邓然其言。林去无几何时，与其师某医同乘汽车而至。
后经两人再三诊断，谓“十有八分为急性盲肠炎，而更有蔓延成腹膜炎之可能。须再验血，方能确定。”当即为之注射消治龙药水一支，又抽血少许，置药箱中，相偕飞车而去。
一小时后，林医师复来。说明“据验血结果，白血球已增加至13000。如再不断增加，便有十二分之危险。最好速送医院开刀，不过此证危险性大，不能十分保险，须经签字，方可施行手术。”邓君闻言开刀，即有惧意，而龚女士亦再三拒绝。即请林医师先回，容合家商量决定后，再通电话，于是林医师乃告辞而去。总之，此症经过明确之反复诊断，其为急性盲肠炎，更有蔓延腹膜炎之趋势。须经剖腹之手术而割治之，毫无疑问矣。
当邓君聚集子女及家人等讨论此开刀问题时，而病者仍然拒绝。且曰：“既不保险，我宁可死去，决不开刀。”其子女多人，亦不敢相强，邓君更无主张。其子文涛，幼曾从余习古文辞。忽提议曰：“何不请余老师一诊，惟余老师为中医，不知内服方亦能有效否。”邓君同意。文涛立来延余，并告我以前医诊断之况。余既入门，其长女迎来，低声告余曰：“咋天日间，我母已身倦不舒。我父于晚间六时宴客，我母于此时曾食荤汤泡饭一小碗，两个肉圆子，以及猪肝、虾子等，夜间腹中即有微痛。今日重阳，我母不自小心，又食重阳糕少许，因之腹痛加甚，且已呕吐两次矣。”而女佣虞妈，亦同时证明所食之非虚。
余未诊病，已由闻诊而得其情。登楼之后，见病者面无人色，口唇发青，四肢发冷。按其脘口及腹部，均大呼疼痛。余曰：“现仍有欲呕之势否?”曰：“仍有欲呕不呕之势也。”余曰：“大便解过否?”曰：“大便已三日未解矣。”余令其仰面而卧。试将两腿伸直。病者勉从余言，伸直两腿，并非如盲肠炎状，其右腿不能伸直。又按其盲肠部。问曰：“此处痛否?”曰：“痛在满腹中，不定在此处也。脘口以下，经过脐部至少腹，处处皆觉痛也。”再诊其脉，沉实而有力。
余即告病家曰：“照中医看来，此满腹之痛，并非盲肠炎，盲肠部有压痛点，而右腿必不能伸直。此是简单之寒滞作痛。如肯信余言，一帖中药，可以好转，三剂收功。不必忧惧也。”因为之处方，以大承气汤加桂枝、蒌霜、焦查、姜夏主之。
病家照法煎服，时已夜11时矣。初服之后，腹中犹时时作痛，无何腹内雷鸣。至二时许，大便畅解一次，而腹痛顿减其半。连服二煎，至四时又解大便一次，五时许又解一次，垢腻俱下，疼痛全无，四肢完全转温矣。至上午八时复延余诊，余见如此好转，私心辄喜。再按其腹部，已大转柔和。然重按之，尚有微痛也，知为余滞未清。再将硝、黄酌减其量，佐以降气消痰之品，令再服一帖。次日再进香砂六君子一帖，于是完全治愈矣。最值得注意者，即任何腹痛，医便认为盲肠炎或腹膜炎，随便开刀剖腹，总觉武断。若此种寒滞腹痛，果经开刀，而割去盲肠或蚓突，其将何以善其后乎。故吾中医之望闻问切，不可废也。
大承气汤加桂枝蒌霜焦查姜夏方锦纹大黄四钱元明粉四钱(分冲)川厚朴二钱五分炒枳实三钱川桂枝二钱五分瓜蒌霜二钱焦查肉五钱姜制夏三钱(按旧时称阑尾炎为盲肠炎。后同。)寒结腹痛证(二)劳工饥饱不时，内伤饮食。加之汗后当风，脘腹受寒，以致发生腹痛，渐渐加剧，外无寒热。痛极之时，额流冷汗，四肢微厥，曾发呕吐数次，其量不多。医断为急性腹膜炎，开刀费重，难胜其任。余诊其脉，沉实有力，与大黄附子汤合甘草干姜汤。一剂而便通痛减，再剂而滞尽身和，终以调理之剂。又二剂而痊。
患者段大柱，系一劳动工友，住京江路平房中。在1948年9月间，段之邻人顾云龙，于深夜冒雨乘车，来余诊所扣门，其声甚急。启门询之，则告我以段性急证，来请出诊者，于是相偕登车而去。将至其门，即闻病者呼痛之声，刺人耳鼓。及入病者之房，见病者身体屈曲，作虾儿状态，两手自抚其腹，重则号叫，轻则呻吟。额上有汗，扪之清冷，轻按其腹，则痛不可近，而少腹为尤甚。询其大便，已四日未解。诊其两脉，则沉实而有力。察其舌苔，则厚腻而微干，尖白根黄，而中则白而带黄。扪其周身，则毫无热度，而四肢微厥，手足较甚。断其为寒结无疑，非温下之不为功也。
因再询其致病之由，据其妻代述颇详。谓“段为劳动工人，惟因工作关系，时常饥饱不均。饿则饥肠辘辘，饱则大腹便便。于前日曾取得工资，购买猪头肉及螃蟹食之，又加饮酒数杯，身有微汗。食后于门前少立，开怀当风，不片时即觉身凉，而阖户就睡。至后半夜，即觉腹痛而醒，愈痛愈剧，曾发呕吐两次，痰涎与食物并出，但所吐之量不多。翌日晨。即至平民医院就诊。据医生断为急性腹膜炎，非施行开刀手术不为功。询其手术费几何，则其数之大，又非我等劳动阶级所能负担。即回家延中医诊治，服药均无效果。延至今夜，因腹痛之极，曾发厥两次，故情急谋于顾君，而于深夜烦先生也。”余得其追述之情况，更坚信心，以温下为得。望闻切三者，既得其大概，加以问诊，则得其全盘病理矣。乃处以大黄附子汤合甘草干姜汤，嘱如其法煎服。设药后而仍发呕吐，则呕出亦佳。如不呕吐，则必于三小时内，可以得下。
Day after day, the patient became increasingly exhausted, refusing all food, desiring sleep but unable to rest for even a moment, continuing in this state for a week. Finally, coldness developed in the hands and feet, alternating between quietness and agitation, cyanosis of the lips, dry teeth, foul breath, and foul-smelling discharge resembling leukorrhea from the vagina. The physician declared it incurable. With the hospital's consent, the family engaged me for consultation. I also knew the condition was difficult to treat, so I prescribed medication based on the observed symptoms, holding onto a slim hope.
Due to excessive tonification previously, bowel movements had been absent for over ten days. Heat steamed within, scorching the internal organs, leading to this state. Therefore, I prescribed Xie Xin Tang (Drain the Epigastrium Decoction) combined with Zeng Ye Cheng Qi Fa (Method of Increasing Fluids and Directing Downward), urging its administration as a last resort.
At that time, the patient requested cold drinks. I instructed someone to buy a large fresh pear for her to eat. Soon after finishing it, she exclaimed with pleasure, bringing joy to the entire family. About twenty minutes later, she complained of gastric discomfort and retching. The vomitus contained coffee-ground-like decaying matter, which is indeed a sign of gastric ulceration/rotting.
However, after vomiting, she felt comfortable again.
After taking the medicine, no bowel movement occurred throughout the night, and abdominal pain sometimes intensified. It was not until around 10:00 AM the next morning that stool was passed: black, paste-like feces mixed with many hard, solid fecal balls. After one evacuation, the patient’s spirit became tranquil, her qi peaceful, and she lay down comfortably. Her abdomen also became softer, unlike the previous board-like hardness. Seeing his wife's condition improve significantly, her husband returned home while she slept, first to clear accumulated tasks, and secondly to rest himself. For over ten days, the patient had been constantly crying out, preventing her husband from sleeping even when accompanying her.
Later, the patient resented her husband for leaving without notice, considering him heartless, and even wished for his quick death. She wept bitterly, refusing both medicine and food. That night, the condition worsened. The attendant urged the husband to return and persuade her to take medicine, but she refused to speak. Another day passed, and she finally fell into a coma. Foul-smelling fluid, resembling black bean juice or leaking roof water, flowed from the vagina and anus. This corresponds to the "Hu Huo Disease" (Fox-Spirit Disease) described in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) chapter on Hu Huo Disease, characterized by erosion of the yin and anus. She died within two days. Upon hearing this, I regretted that the treatment was not fully successful and lamented that this woman died due to illness caused by excessive tonification and life damaged by anger.
**Xie Xin Tang Combined with Zeng Ye Cheng Qi Method Formula:**
Da Huang (Rhei Radix et Rhizoma) 3 qian, Ming Fan (Natrii Sulfas) 3 qian (taken separately), Huang Lian (Coptidis Rhizoma) 1.5 qian, Huang Qin (Scutellariae Radix) 3 qian, Yuan Zhi (Polygalae Radix - note: text says Yuan Shen/Crassulae Radix usually implies Sheng Di Huang context but here likely refers to Xuan Shen Scrophulariae Radix given formula context, standardizing to Xuan Shen Scrophulariae Radix for clarity in similar formulas, though text says Run Yuan Shen) 1 liang, Mai Dong (Ophiopogonis Tuber) 8 qian, Sheng Di Huang (Rehmanniae Radix) 6 qian, Shi Hu (Dendrobii Caulis) 4 qian.
**Food Stagnation Syndrome Case:**
An elderly woman over sixty years old suddenly suffered from confusion and mutism, appearing as if asleep, seemingly without pain.
The physician treated her for Stroke (Zhong Feng) and Phlegm Syncope (Tan Jue) without effect. Inquiry revealed that for thirty days prior, her food intake had doubled, and she slept immediately after meals before this sudden onset. This was diagnosed as Food Stagnation Syndrome (Shi Zhong). The decision was made to use Da Cheng Qi Tang (Major Order the Qi Decoction) to purge. Symptoms alleviated slightly.
Consequently, physicians were changed, and the condition persisted for another twenty days; neither death nor recovery occurred. She was then given castor oil and enemas. After severe purgation, she regained consciousness.
No. 30 Baixiang Village, Hefei Road, lived an elderly surnamed Chen, aged 62. In October 1934, one morning, everyone in the household rose, but Old Lady Chen did not. Her daughter-in-law, Ms. Tang, called to her at the bedside with no response, and pushing her yielded no movement, revealing her stupor and mutism. Observing her, she seemed pain-free, like sleeping, except for slight phlegm sounds in her throat.
Her son, Chen Runian, urgently summoned a physician. Treatment for Stroke and Phlegm Syncope failed across three different doctors over several days because her mouth could not open, making oral medication difficult.
I was then consulted. Observing her pulse and complexion, I found no signs of terminal collapse. I carefully inquired about any preceding events. Mr. Chen said, "Before falling ill, my mother ate exceptionally well. At every meal, especially dinner, she ate the most. Each meal consisted of two to three large bowls, for nearly twenty days, daily. Strangely, she went to bed immediately after dinner. Others suggested she sit for a while due to poor digestion, but she refused. The day before yesterday, she suddenly fell ill. Three doctors have already failed." I pondered deeply; this must be caused by food stagnation. Although resembling Stroke, in TCM literature, it is named Food Stagnation Syndrome (Shi Zhong), a type of pseudo-stroke. I decided to use Da Cheng Qi Tang (Major Order the Qi Decoction) plus Lai Fu Zi (Radish Seed) to purge. However, due to her clenched jaw, the dose was incomplete. Only one evacuation occurred, small in volume, with a foul odor. Consciousness fluctuated between clarity and stupor. Other doctors were consulted with no effect, as oral medication and enemas were difficult.
For twenty-one days, she remained silent and motionless, surviving on a single breath, neither dying nor recovering. We sought my consultation again. Given the delay of over twenty days and her age over sixty, I hesitated to prescribe strong medication, stating only to do our best. An enema was performed, but stool remained unpassed. Large amounts of castor oil were administered via an oral opener. Within three hours, borborygmus and severe purgation occurred. The stool resembled black paste, axle grease, phlegm, and fish jelly, containing hard, indigestible black clumps, extremely foul. After this severe purgation, consciousness gradually cleared, and limbs could move slightly. When asked if she knew she had been ill for over twenty days, she was unaware. Two more doses of castor oil cleared intestinal debris, appetite returned, and she rejoiced at her rebirth. As Chinese medical texts state, "Obstruction requires unblocking," this is an example of natural therapy.
**Da Cheng Qi Tang Plus Lai Fu Zi Formula:**
Da Huang (Rhei Radix et Rhizoma) 5 qian, Ming Fan (Natrii Sulfas) 5 qian (taken separately), Zhi Zhi Shi (Immature Bitter Orange, Stir-fried) 4 qian, Hou Po (Magnoliae Officinalis Cortex) 3 qian, Lai Fu Zi (Radish Seed) 4 qian (ground). Note: If more had been administered initially, recovery would have been achieved sooner, avoiding the twenty-day delay. Castor oil was used later due to fear that the elderly, chronically ill patient could not tolerate stronger purgatives. Its success was fortunate.
**Young Man's Food Stagnation Due to Cold Drinks:**
During hot weather, after watching a movie in the evening, he consumed ice cream and popsicles and returned home hungry.
He ate fried egg rice. Shortly after sleeping, he suddenly became mute. Physicians treated him for Stroke, Phlegm Syncope, or Evil Invasion without effect. Inquiry confirmed Food Stagnation Syndrome (Shi Zhong). He was treated with Da Cheng Qi Tang (Major Order the Qi Decoction) plus Gua Lou (Trichosanthis Fructus) and Gan Jiang (Zingiberis Rhizoma).
In Caojiadu, at the Liu Yuchang Porcelain Shop, the young master, aged 25, had no prodromal symptoms. Around 2:00 AM, he suddenly became confused and mute. Nearby doctors diagnosed Stroke, Phlegm Syncope, or Evil Invasion. By 4:00 PM, five doctors had failed. He was rushed to me. Entering the bedroom, I saw his parents and wife weeping. His pulse was deep, full, and forceful. His body and limbs were normal, without cold extremities or fever, just like a healthy person. Breathing was slightly coarse with mild snoring, similar to normal sleep. Pulling his mandible opened it easily, without trismus or spasm. I could not determine the cause solely from these signs, but palpating the epigastrium revealed fullness and hardness.
I asked his wife, "How did you know he couldn't speak starting around 2:00 AM?" She replied, "Last night, he went to Jincheng Grand Theater with a friend. Hungry and fearing curfew (during the puppet regime), he came home and asked me to prepare a late meal. He ate and slept past midnight. Initially, he spoke and turned over. By 2:00 AM, when I asked if he wanted tea, he could no longer speak." I asked what and how much he ate. She said, "One large bowl of lard fried rice, plus two pan-fried eggs. Since he was very hungry, I gave him extra." I said, "Please call his friend."
The friend arrived. I asked, "Did you eat anything else besides what you shared?" The friend said, "Nothing else. But at the theater, he frequently complained of chest heat and thirst. He ate two servings of ice cream. After the show, he ate three popsicles before going home." I said, "I understand the condition." I immediately prescribed Da Cheng Qi Tang (Major Order the Qi Decoction) plus Gua Lou (Trichosanthis Fructus) and Gan Jiang (Zingiberis Rhizoma). Da Huang (Rhei Radix et Rhizoma) and Mang Xiao (Natrii Sulfas) each 8 qian, Hou Po (Magnoliae Officinalis Cortex) 4 qian, Zhi Shi (Immature Bitter Orange) 6 qian, Quan Gua Lou (Whole Trichosanthis Fructus) 1 liang, Gan Jiang (Zingiberis Rhizoma) 3 qian, to warm and unblock the spleen and stomach yang. I urged immediate administration, warning that delay might lead to fatal qi closure. The family had no choice but to comply. I returned home unable to sleep.
At 10:00 AM the next day, they returned. They reported, "We administered the medicine slowly at 6:00 PM. He had a bowel movement at 8:00 PM but remained confused. At 9:30 PM, another large bowel movement occurred, and he woke up. He told us he felt like waking from a dream, unaware of the past day and night, and feels clearer this morning." I was delighted and went with them. The family rejoiced, and the patient smiled and thanked me. I examined him closely and switched to a mild form of Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) with herbs to regulate qi and harmonize the middle, to clear the root cause.
I explained, "This disease is named Food Stagnation Syndrome (Shi Zhong). First consuming cold drinks, followed by binge eating, severely injured the spleen and stomach, causing peristalsis failure. Such extreme fullness in the stomach leads to qi closure. Closure affects the sympathetic nervous system, impacting the brain, resulting in complete loss of perception. It is not wind or heat, hence no spasms; not deficiency or cold, hence no syncope; not phlegm in the upper jiao, hence no wheezing. This is a case of retained food. Although not mentioned in the *Jin Gui Yao Lue*, later formularies discuss it. It is rarely seen, so few physicians can diagnose it. Even when encountered, it is often misdiagnosed as stroke or syncope. Negligence in inquiry or abdominal examination leads to unknown causes and reckless prescribing, endangering life." The family was convinced.
Using purgation for food in the epigastrium is a flexible strategy. Whether Dou Chi San (Dou Chi Decoction) for emesis could also treat this is unknown to me. Generally, if retained food is in the stomach, consciousness is clear, and there is nausea/desire to vomit, Dou Chi San is an effective formula.
**Da Cheng Qi Tang Plus Gua Lou and Gan Jiang Formula:**
Da Huang (Rhei Radix et Rhizoma) 8 qian, Mang Xiao (Natrii Sulfas) 8 qian, Hou Po (Magnoliae Officinalis Cortex) 4 qian, Zhi Shi (Immature Bitter Orange) 6 qian, Quan Gua Lou (Whole Trichosanthis Fructus) 1 liang, Gan Jiang (Zingiberis Rhizoma) 3 qian.
**Abdominal Pain due to Cold Constriction (Case 1):**
A woman suddenly suffered severe abdominal pain, cold extremities progressing to limb chill. Diagnosed as acute appendicitis, possibly spreading to peritonitis. White blood cell count rose to 13,000. Hospitalization for surgery was urged, but refused. From history and palpation, I determined it was caused by greasy/meaty foods. Abdominal pain was diffuse, without fixed points, tenderness upon pressure, inability to touch, desire to vomit without success, and constipation. Treated with Da Cheng Qi Tang (Major Order the Qi Decoction) plus Gui Zhi (Cinnamomi Ramulus), Gua Lou Shuang (Trichosanthis Pericarpium), Jiao Zha (Charred Hawthorn Fruit), and Jiang Ban Xia (Pinellia Rhizoma Processed with Ginger).
Ms. Gong Zhifang, whose husband Mr. Deng worked in commerce, suddenly suffered severe abdominal pain on the Double Ninth Festival, one year before the victory of the Anti-Japanese War. Mr. Deng called Dr. Lin, a friend. Dr. Lin examined her and told Mr. Deng, "Sudden abdominal pain with cold limbs suggests acute appendicitis. I am not certain; let me consult my teacher." Mr. Deng agreed. Soon, Dr. Lin returned with his teacher.
After repeated diagnosis, they stated, "80% chance of acute appendicitis, with risk of peritonitis. Blood test needed." They injected sulfonamide and drew blood, then left.
An hour later, Dr. Lin returned, reporting, "WBC increased to 13,000. Continued rise poses high risk. Surgery recommended, but risky. Consent form required." Mr. Deng feared surgery, and Ms. Gong refused repeatedly. Dr. Lin left for family discussion.
Despite repeated diagnoses confirming acute appendicitis with peritonitis risk requiring surgery, Ms. Gong refused, saying, "If not safe, I prefer death over surgery." Children dared not insist. Her son, Wentao, who studied classical texts with me, suggested, "Why not ask Teacher Yu? He is a TCM doctor; maybe internal medicine works." Mr. Deng agreed. Wentao invited me, explaining the previous diagnosis. Upon entering, his eldest daughter whispered, "Yesterday afternoon, Mother felt weak. Father hosted guests at 6:00 PM. Mother ate a small bowl of meat soup with rice, two meatballs, liver, shrimp, etc., feeling slight abdominal pain at night. Today, being careful, she ate some Double Ninth Cake, worsening pain and vomiting twice." The maid Yu Ma corroborated the diet.
Before examining, I knew the cause from history. On the stairs, she looked pale, lips cyanotic, limbs cold. Palpating epigastrium and abdomen caused loud cries of pain. I asked, "Still feeling nauseous?" She said, "Yes, desire to vomit but cannot." I asked, "Bowel movement?" She said, "None for three days." I had her lie supine and extend legs. She complied, extending both legs, unlike appendicitis where the right leg cannot extend. Palpating the McBurney's point area, she said, "Pain is everywhere, not just here. From epigastrium below, through umbilicus to lower abdomen, all painful." Pulse was deep, full, and forceful.
I told the family, "From a TCM perspective, this diffuse pain is not appendicitis. Appendicitis has specific tenderness and inability to extend the right leg. This is simple cold stagnation pain. Trust me, one dose will improve, three doses will cure. Do not worry." I prescribed Da Cheng Qi Tang (Major Order the Qi Decoction) plus Gui Zhi (Cinnamomi Ramulus), Gua Lou Shuang (Trichosanthis Pericarpium), Jiao Cha (Charred Hawthorn Fruit), and Jiang Xia (Pinellia Rhizoma Processed with Ginger).
Prepared and taken at 11:00 PM. Initially, abdominal pain persisted, then borborygmus occurred. Around 2:00 AM, a smooth bowel movement reduced pain by half. After two more doses, another bowel movement at 4:00 AM and one at 5:00 AM cleared turbid matter. Pain vanished, limbs warmed. Re-examined at 8:00 AM. Abdomen was soft, slight tenderness on deep pressure indicated residual stagnation. Reduced Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma), added qi-regulating and phlegm-resolving herbs for one more dose. Next day, Xiang Sha Liu Jun Zi Tang (Aucklandia and Amomum Six Gentlemen Decoction) cured her completely. Notably, assuming any abdominal pain is appendicitis/peritonitis and operating rashly is arbitrary. If such cold stagnation pain were operated on, removing the appendix would leave no solution. Thus, TCM inspection, listening/smelling, inquiry, and palpation are indispensable.
**Da Cheng Qi Tang Plus Gui Zhi, Gua Lou Shuang, Jiao Cha, Jiang Xia Formula:**
Da Huang (Rhei Radix et Rhizoma) 4 qian, Ming Fan (Natrii Sulfas) 4 qian (taken separately), Hou Po (Magnoliae Officinalis Cortex) 2.5 qian, Zhi Zhi Shi (Immature Bitter Orange, Stir-fried) 3 qian, Gui Zhi (Cinnamomi Ramulus) 2.5 qian, Gua Lou Shuang (Trichosanthis Pericarpium) 2 qian, Jiao Cha Rou (Charred Hawthorn Fruit Flesh) 5 qian, Jiang Xia (Pinellia Rhizoma Processed with Ginger) 3 qian. (Note: Historically, appendicitis was called blind intestine inflammation.)
**Cold Constriction Abdominal Pain (Case 2):**
Laborers with irregular meals suffer dietary injury. Sweating then exposure to wind causes cold invasion in the epigastrium/abdomen, leading to progressive abdominal pain, no external chills/fever. Extreme pain causes cold sweat on forehead, mild limb chill, occasional small-volume vomiting. Diagnosed as acute peritonitis; surgery too expensive. Pulse was deep, full, forceful. Prescribed Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) combined with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction). One dose relieved pain and enabled bowel movement; two doses cleared stagnation and harmonized the body. Final recovery with tonic herbs.
Patient Duan Dazhu, a laborer living in a single-story house on Jingjiang Road. In September 1948, neighbor Gu Yunlong visited my clinic late at night in the rain, knocking urgently. Opening the door, he informed me of Duan's acute condition. We drove to his home. Hearing piercing cries of pain, I entered. The patient was curled up like a shrimp, holding his abdomen, wailing heavily or groaning lightly. Forehead sweaty and cold. Light palpation of the abdomen caused unbearable pain, worse in the lower abdomen. Bowel movement absent for four days. Pulses were deep, full, forceful. Tongue coating thick, greasy, slightly dry; tip white, root yellow, center white-yellow. Body temperature normal, limbs mildly chilled. Diagnosed as cold constriction, requiring warming and purging.
Inquiring about the cause, his wife detailed: "Duan is a laborer, often starving or overeating. Before yesterday, he received wages, bought pig head meat and crabs, drank alcohol, and sweated slightly. Standing outside after eating, exposed to wind, he felt cold and slept. Woke up in the second half of the night with abdominal pain, increasing in severity. Vomited twice, mixing phlegm and food, small volume. Next morning, visited People's Hospital. Diagnosed with acute peritonitis, requiring surgery. Cost prohibitive for working class. Returned for TCM treatment, ineffective. Tonight, pain led to fainting twice, hence the urgency." Confirming the history strengthened my confidence in warming and purging. Inspection, listening/smelling, and palpation provided the general picture; inquiry completed the pathology. I prescribed Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) combined with Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction), instructing proper decoction. If vomiting occurs after medication, it is beneficial. If not, bowel movement should occur within three hours.