天津于氏妇，年二十二岁，得脑充血头疼证。
病因 其月信素日短少，不调，大便燥结，非服降药不下行，浸至脏腑气化有升无降，因成斯证。
证候 头疼甚剧，恒至夜不能眠，心中常觉发热，偶动肝火即发眩晕，胃中饮食恒停滞不消，
大便六七日不行，必须服通下药始行。其脉弦细有力而长，左右皆然，每分钟八十至，延
医延医历久无效。
诊断 此因阴分亏损，下焦气化不能固摄，冲气遂挟胃气上逆，而肝脏亦因阴分亏损水不滋
木，致所寄之相火妄动，恒助肝气上冲。由斯脏腑之气化有升无降，而自心注脑之血为上升
之气化所迫，遂至充塞于脑中血管而作疼作晕也。其饮食不消大便不行者，因冲胃之气皆逆也；
其月信不调且短少者，因冲为血海，肝为冲任行气，脾胃又为生血之源，诸经皆失其常司，是以
月信不调且少也；《内经》谓∶“血菀（同郁）于上，使人薄厥”，言为上升之气血逼薄而厥也。此
证不急治则薄厥将成，宜急治以降胃、镇冲、平肝之剂，再以滋补真
阴之药辅之，庶可转上升之气血下行不成薄厥也。
处方 生赭石（一两轧细） 怀牛膝（一两） 生怀地黄（一两） 大甘枸杞（八钱）
生怀山药（六钱） 生杭芍（五钱） 生龙齿（五钱捣碎） 生石决明（五钱捣碎）
天冬（五钱） 生鸡内金（二钱黄色的捣） 苏子（二钱炒捣） 茵陈（钱半） 甘草（钱半）
共煎汤一大盅，温服。
复诊 将药连服四剂，诸病皆见轻，脉象亦稍见柔和。惟大便六
日仍未通行，因思此证必先使其大便如常，则病始可愈，拟
将赭石加重，再将余药略为加减以通其大便。
处方 生赭石（两半轧细） 怀牛膝（一两） 天冬（一两） 黑芝麻（八钱炒捣）
大甘枸杞（八钱） 生杭芍（五钱） 生龙齿（五钱捣碎） 生石决明（五钱捣碎）
苏子（三钱炒捣） 生鸡内金（钱半黄色的捣） 甘草（钱半） 净柿霜（五钱）
药共十二味，将前十一味煎汤一大盅，入柿霜融化温服。
三诊 将药连服五剂，大便间日一行，诸证皆愈十之八九，月信适来，仍不甚多，脉象仍有
弦硬之意，知其真阴犹未充足也。当即原方略为加减，再加滋阴生血之品。
处方 生赭石（一两轧细） 怀牛膝（八钱） 大甘枸杞（八钱） 龙眼肉（六钱）
生怀地黄（六钱） 当归（五钱） 玄参（四钱） 沙参（四钱）
生怀山药（四钱） 生杭芍（四钱） 生鸡内金（一钱黄色的捣） 甘草（二钱） 生姜（三钱） 大枣（三枚掰开）
共煎汤一大盅，温服。
效果 将药连服四剂后，心中已分毫不觉热，脉象亦大见和平，大便日行一次，遂去方中玄
参、沙参，生赭石改用八钱，生怀山药改用六钱，俾多服数剂以善其后。
Tianjin Ms. Yu, aged 22, suffered from a syndrome of cerebral congestion headache (Nao Chong Xue Tou Teng).
Etiology: Her menstruation was usually scanty and irregular. Her stool was dry and hard; without taking purgatives, it could not be discharged. Over time, this led to the Qi transformation of the Zang-Fu organs having only ascending but no descending movement, resulting in this syndrome.
Symptoms: The headache was extremely severe, often preventing sleep at night. She constantly felt heat in the heart region. Occasional flare-ups of Liver Fire caused dizziness. Food in the stomach often stagnated and failed to digest. Bowel movements did not occur for six or seven days and required laxative medications to induce passage. Her pulse was wiry, thin, forceful, and long, identical on both sides, with a rate of 80 beats per minute. Medical consultations were prolonged without effect.
Diagnosis: This condition arises from a deficiency in the Yin aspect. The Qi transformation in the Lower Jiao fails to secure and hold, causing the Chong Qi to carry Stomach Qi upward. Furthermore, due to Yin deficiency and Water failing to nourish Wood (Kidney Yin failing to nourish Liver Wood), the Ministerial Fire residing in the Liver flares up recklessly, frequently assisting the Liver Qi in rushing upward. Consequently, the Qi transformation of the Zang-Fu organs ascends without descending. The blood flowing from the Heart to the Brain is forced by this ascending Qi transformation, leading to congestion in the cerebral blood vessels, which causes pain and dizziness. The failure of digestion and bowel movement is due to the rebellious Qi of the Chong and Stomach channels. The irregularity and scantiness of menstruation occur because the Chong Mai is the Sea of Blood, the Liver governs the Qi flow of the Chong and Ren vessels, and the Spleen and Stomach are the source of blood generation; all meridians lose their normal functions, hence the menstrual irregularities. The *Nei Jing* states: "Blood stagnating in the upper part causes Bo Jue" (Thin Fainting/Syncope), meaning syncope induced by the forcing pressure of ascending Qi and Blood. If this syndrome is not treated urgently, Bo Jue will develop. It is imperative to urgently administer formulas that descend Stomach Qi, calm the Chong Qi, and level the Liver, supplemented by herbs that tonify True Yin, so as to redirect the ascending Qi and Blood downward and prevent Bo Jue.
Prescription:
Sheng Zhe Shi (Hematitum, raw, 1 liang, crushed)
Huai Niu Xi (Achyranthis Bidentatae Radix, 1 liang)
Sheng Huai Di Huang (Rehmanniae Radix, raw, 1 liang)
Da Gan Gou Qi Zi (Lycii Fructus, 8 qian)
Sheng Huai Shan Yao (Dioscoreae Rhizoma, raw, 6 qian)
Sheng Hang Shao (Paeoniae Radix Alba, raw, 5 qian)
Sheng Long Chi (Dentis Felis Ossiculum, raw, 5 qian, crushed)
Sheng Shi Jue Ming (Argonautae Carapax, raw, 5 qian, crushed)
Tian Dong (Asparagi Radix, 5 qian)
Sheng Ji Nei Jin (Galli Gigerii Endothelium Corneum, raw, yellow variety, 2 qian, crushed)
Su Zi (Perillae Fructus, 2 qian, stir-fried and crushed)
Yin Chen (Artemisiae Scopariae Herba, 1.5 qian)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 1.5 qian)
Decoct together in one large cup of water, take warm.
Second Visit: After taking four doses, all symptoms alleviated, and the pulse became slightly softer. However, bowel movements had not occurred for six days. Considering that this syndrome requires normal bowel function for recovery, I decided to increase the dosage of Zhe Shi and slightly modify the remaining herbs to promote bowel movement.
Prescription:
Sheng Zhe Shi (Hematitum, raw, 1.5 liang, crushed)
Huai Niu Xi (Achyranthis Bidentatae Radix, 1 liang)
Tian Dong (Asparagi Radix, 1 liang)
Hei Zhi Ma (Sesami Semen Nigrum, 8 qian, stir-fried and crushed)
Da Gan Gou Qi Zi (Lycii Fructus, 8 qian)
Sheng Hang Shao (Paeoniae Radix Alba, raw, 5 qian)
Sheng Long Chi (Dentis Felis Ossiculum, raw, 5 qian, crushed)
Sheng Shi Jue Ming (Argonautae Carapax, raw, 5 qian, crushed)
Su Zi (Perillae Fructus, 3 qian, stir-fried and crushed)
Sheng Ji Nei Jin (Galli Gigerii Endothelium Corneum, raw, yellow variety, 1.5 qian, crushed)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 1.5 qian)
Jing Shi Shuang (Frost of Persimmon Fruit, 5 qian)
Twelve ingredients in total. Decoct the first eleven ingredients in one large cup of water, dissolve the Shi Shuang, and take warm.
Third Visit: After taking five doses, bowel movements occurred every other day, and most symptoms resolved (80-90%). Menstruation arrived naturally but remained scanty. The pulse still showed wiry and hard qualities, indicating that True Yin was still insufficient. I slightly modified the original prescription and added herbs to nourish Yin and generate blood.
Prescription:
Sheng Zhe Shi (Hematitum, raw, 1 liang, crushed)
Huai Niu Xi (Achyranthis Bidentatae Radix, 8 qian)
Da Gan Gou Qi Zi (Lycii Fructus, 8 qian)
Long Yan Rou (Longan Aril, 6 qian)
Sheng Huai Di Huang (Rehmanniae Radix, raw, 6 qian)
Dang Gui (Angelicae Sinensis Radix, 5 qian)
Xuan Shen (Scrophulariae Radix, 4 qian)
Sha Shen (Glehniae Radix or Adenophorae Radix, 4 qian)
Sheng Huai Shan Yao (Dioscoreae Rhizoma, raw, 4 qian)
Sheng Hang Shao (Paeoniae Radix Alba, raw, 4 qian)
Sheng Ji Nei Jin (Galli Gigerii Endothelium Corneum, raw, yellow variety, 1 qian, crushed)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian)
Sheng Jiang (Zingiberis Rhizoma Recens, 3 qian)
Da Zao (Jujubae Fructus, 3 pieces, split)
Decoct together in one large cup of water, take warm.
Outcome: After taking four doses, the sensation of heat in the heart region completely disappeared, and the pulse became significantly harmonious. Bowel movements occurred once daily. Therefore, Xuan Shen and Sha Shen were removed from the formula. The dosage of Sheng Zhe Shi was reduced to 8 qian, and Sheng Huai Shan Yao to 6 qian, to allow for continued administration to consolidate the therapeutic effect.