天津崔××，年三十八岁，得脑充血兼两腿痿弱证。
病因 出门采买木料，数日始归，劳心劳力过度，遂得斯证。
证候 其初常觉头疼，时或眩晕，心中发热，饮食停滞，大便燥结，延医治疗无效。一日早
起下床，觉痿弱无力，痿坐于地，人扶起坐床沿休息移时，自扶杖起立，犹可徐步，然时
恐颠仆。其脉左部弦而甚硬，右部弦硬且长。
诊断 其左脉弦硬者，肝气挟火上升也。右脉弦硬且长者，胃气上逆更兼冲气上冲也。因其脏腑间
之气化有升无降，是以血随气升充塞于脑部作疼作眩晕。其脑部充血过甚，或自微细血管溢血于
外，或隔血管之壁，些些渗血于外，其所出之血，若着于司运动之神经，其重者可使肢体痿废，其轻
者亦可使肢体软弱无力。若此证之忽然痿坐于地者是也。至其心中之发热，饮食之停滞，大便之
燥结，亦皆其气化有升无降之故，此宜平肝、清热、降胃、安冲，不使脏腑之气化过升，
且导引其脑中过充之血使之下行，则诸证自愈矣。
处方 生赭石（一两轧细） 怀牛膝（一两） 生怀地黄（一两） 生珍珠母（六钱捣碎）
生石决明（六钱捣碎） 生杭芍（五钱） 当归（四钱） 龙胆草（二钱）
茵陈（钱半） 甘草（钱半）
共煎汤一大盅，温服。
复诊 将药连服七剂，诸病皆大见愈，脉象亦大见缓和，惟其步履之间仍须用杖，未能复常，心中
仍间有发热之时。拟即原方略为加减，再佐以通活血脉之品。
处方 生赭石（一两轧细） 怀牛膝（一两） 生怀地黄（一两） 生杭芍（五钱）
生珍珠母（四钱捣碎） 生石决明（四钱捣碎） 丹参（四钱） 生麦芽（三钱）
土鳖虫（五个） 甘草（一钱）
共煎汤一大盅温服。
效果 将药连服八剂，步履复常，病遂全愈。
Cui XX, aged thirty-eight, from Tianjin, suffered from cerebral hyperemia (brain congestion) accompanied by flaccidity and weakness of both legs.
Etiology He went out to purchase timber and returned only after several days. The excessive physical and mental exertion led to this condition.
Symptoms Initially, he frequently experienced headache, occasional vertigo (dizziness), a sensation of heat in the heart region, food stagnation, and dry, constipated stools. Medical treatment proved ineffective. One morning, upon rising from bed, he felt his legs were weak and powerless, causing him to collapse onto the floor. After being helped up to sit on the edge of the bed for a while, he managed to stand up with the aid of a cane and could walk slowly, though he constantly feared falling. His pulse was wiry (Xian) and very hard on the left side, and wiry, hard, and long on the right side.
Diagnosis The wiry and hard quality of the left pulse indicates Liver Qi ascending with fire. The wiry, hard, and long quality of the right pulse indicates rebellious Stomach Qi combined with surging Chong Mai (Penetrating Vessel) Qi. Because the physiological transformation (Qi mechanism) within the Zang-Fu organs ascends without descending, blood follows the ascending Qi and congests in the brain, causing pain and vertigo. When cerebral congestion is severe, blood may extravasate from minute vessels or seep slightly through the vessel walls. If this extravasated blood affects the nerves governing movement, it may result in severe limb paralysis or mild limb weakness. The sudden collapse described above is an example of this. Furthermore, the heat in the heart region, food stagnation, and dry constipation are all due to the same cause: the Qi mechanism ascending without descending. Therefore, the treatment should focus on pacifying the Liver, clearing Heat, directing Stomach Qi downward, and calming the Chong Mai, preventing excessive upward movement of Zang-Fu Qi, and guiding the excessive blood in the brain to descend. In this way, all symptoms will resolve spontaneously.
Prescription Raw Hematite (Shi Gao, Ochre) [Hematitum] (1 liang, finely ground) Huai Achyranthes Root (Huai Niuxi) [Achyranthis Bidentatae Radix] (1 liang) Raw Rehmannia Root (Sheng Di Huang) [Rehmanniae Radix] (1 liang) Raw Mother-of-Pearl (Zhen Zhu Mu) [Margaritifera Concha] (6 qian, crushed) Raw Abalone Shell (Shi Jue Ming) [Haliotidis Cortex] (6 qian, crushed) Raw White Peony Root (Sheng Bai Shao) [Paeoniae Radix Alba] (5 qian) Angelica Sinensis Root (Dang Gui) [Angelicae Sinensis Radix] (4 qian) Gentian Root (Long Dan Cao) [Gentianae Radix et Rhizoma] (2 qian) Yin Chen (Artemisia Capillaris Herb) [Artemisiae Scopariae Herba] (1.5 qian) Licorice Root (Gan Cao) [Glycyrrhizae Radix et Rhizoma] (1.5 qian)
Decoct together in a large bowl of water and take warm.
Second Visit After taking the medicine continuously for seven doses, all diseases improved significantly, and the pulse became much more relaxed. However, walking still required the use of a cane, and full recovery had not yet been achieved; there were still intermittent episodes of heat in the heart region. It was decided to slightly modify the original prescription and add herbs that promote blood circulation and remove blood stasis.
Prescription Raw Hematite (Shi Gao, Ochre) [Hematitum] (1 liang, finely ground) Huai Achyranthes Root (Huai Niuxi) [Achyranthis Bidentatae Radix] (1 liang) Raw Rehmannia Root (Sheng Di Huang) [Rehmanniae Radix] (1 liang) Raw White Peony Root (Sheng Bai Shao) [Paeoniae Radix Alba] (5 qian) Raw Mother-of-Pearl (Zhen Zhu Mu) [Margaritifera Concha] (4 qian, crushed) Raw Abalone Shell (Shi Jue Ming) [Haliotidis Cortex] (4 qian, crushed) Salvia Miltiorrhiza Root (Dan Shen) [Salviae Miltiorrhizae Radix et Rhizoma] (4 qian) Raw Barley Sprout (Sheng Mai Ya) [Hordei Fructus Germinatus] (3 qian) Eupolyphaga Steleophaga (Tu Bie Chong) [Eupolyphaga] (5 specimens) Licorice Root (Gan Cao) [Glycyrrhizae Radix et Rhizoma] (1 qian)
Decoct together in a large bowl of water and take warm.
Outcome After taking the medicine continuously for eight doses, walking ability returned to normal, and the disease was completely cured.