病史摘要：患者素来体健，偶感外邪，发热，头痛，体倦，咳嗽。曾间断服用中、西药物，诸症已经缓解，未尝介意。谁知于丑4天前使用压水机抽水时，渐感双下肢酸软、麻木，约4小时后双下肢完全失去知觉(神志清楚)，伴小便不通。急送当地县医院。西医抽取脑脊液检查，发现蛋白含量及白细胞增高，遂诊断为"急性脊髓炎"。立即使用肾上腺皮质激素、维生素和多种营养神经的药物，以及对症治疗；同时配合服中药，曾用过大秦艽汤、三痹汤各3剂，补阳还五汤4剂，疗效不佳。刻下双下肢仍呈弛缓性瘫痪，肌张力缺乏，腱反射消失，不能自动排尿，大便艰涩。因患者转院困难，家属仅带来病历，要求我室开一方试服。根据以上病史，中医诊断为"风痱"。予(金匮要略)所载(古今录验)续命汤原方：麻黄9g，桂枝9g，当归9g，潞党参9g，生石膏9g，干姜9g，生甘草9g，川芎4．5g，杏仁丑2go上方仅服2剂，双下肢即恢复知觉，且能下床行走，大小便亦较通畅。改子八珍汤合补阳还五汤化裁，连服10剂后，康复如常人。
进修生甲：这个案例有点新奇，如不是亲身经历，很难相信。现在病人已康复，我心中的疑团更多。首先是诊断问题，病人未亲自来诊，老师仅凭病历及西医诊断的"急性脊髓炎"，就诊断为中医的"风痱"，我实在不明白此中奥妙何在。
老师：本例诊断为"风痱"，不是没有依据。什么叫风痱?历代中医文献都有记载。如(灵枢，热病篇)说，"痱之为病也，身无痛者，四肢不收，智乱不堪"。(医学纲目)说，"痱，废也。痱即偏枯之邪气深者……以其手足废而不收，故名痱。或偏废或全废，皆曰痱也"。(圣济总录)说，"病痱而废，肉非其肉者，以身体无痛，四肢不收而无所用也"。这些记载说明，古代医家对风痱的认识是一致的：风痱之为病，以突然瘫痪为特征(偏瘫或截瘫)，身无痛，多无意识障碍(或仅有轻微意识障碍)。本例患者在劳动时渐感双下肢酸软、麻木，约4小时后双下肢完全失去知觉，但神志清楚，完全符合风痱的发病及症侯特征。这样的突然截瘫，与"脑血管意外"、癔病、风湿、类风湿等疾病引起的瘫痪，是迥然不同的。
进修生甲：风痱的诊断我算明白了。但老师使用那样奇怪的方药，依据是什么呢?
老师：本例用的是(金匮要略)所载(古今录验)续命汤原方。书中记载本方"治中风痱，身体不能自收持，口不能言，冒昧不知痛处，或拘急不得转侧"。使用本方的依据是方证对应，即张仲景所创立的"有是证用是方"的原则，只要证侯相符就可大胆使用，不受后世创立的诸种辨证方法的限制。
进修生乙：我一一分析过本方中9味药物的性味功效，实在看不出本方的作用机制。这样的处方，怎么可能迅速治愈截瘫?说得坦率些，这样的高效，是否属于偶然或幸中?
老师：这个问题提得很尖锐。我现在把使用本方治疗风痱的历史背景做一简介，让大家来评议一下是否属于偶然或幸中。30年代，江尔逊导师初学医时，有唐X，男，年5旬，体丰，嗜酒。一日，闲坐茶馆，忽然四肢痿软，不能自收持，呈弛缓性瘫痪而仆地，但神清语畅。诸医不知何病。江老的业师陈鼎三先生诊之曰："此病名为风痱，治宜(古今录验)续命汤"。服原方1剂，次日顿愈。那时候，市售食盐为粗制雪花盐，含氯化钡较重，不少人长期食用后，往往突然四肢瘫痪，世人不解其故。陈老亦授以此方，效如桴鼓，活人甚多。1950年，有乔X，正当盛年，一日，忽然双下肢动弹不得，不痛不痒，卧床不起，急请江老诊治。江老投以此方，服2剂即能下床行走。1965年8月，江老使用本方配合针刺，抢救成功1例风痱证。患者，男，18岁，患"急性脊髓炎"、"上行性麻痹"。除了上下肢麻木，不完全瘫痪之外，当时最急迫的是呼吸、吞咽十分困难。西医在抗感染、输液及维生素治疗的同时，不断注射洛贝林、樟脑水并吸氧进行抢救，前后救治6天，患者仍出现阵发性呼吸困难，呈吞咽式呼吸，有气息将停之象，时而瞳孔反射消失，昏昏似睡，呼之不应，全身深浅反射均缺失。西医遂断其难以救治，多次叮咛家属：命在旦夕。家属亦电告家乡准备后事。但为遂家属要求，以尽人事，才勉邀江老会诊。江老亦投以本方，配合针刺。仅服药1剂，危急之象顿除；守眼5剂，诸症消失。继以调补气血收功。我们治疗本例风痱，便是师承陈鼎三--江尔逊经验，取得了预期的高效，不存在偶然和幸中的因素。
进修生丙如此说来，本方治疗的"风痱"，并不限于"急性脊髓炎"一种疾病?
老师：是的。本方治疗的风痱，除了上面提到的急性脊髓炎、氯化钡中毒之外，还有"多发性神经炎"。有一位西医学习江老经验，使用本方治疗了10余例多发性神经炎，疗效亦佳。
学员甲本方的药物组成奇特，其作用机制很不好理解。不知当年陈鼎三老先生是怎样理解的?
老师：江老当年目睹本方功效，亦大异之，便向陈老请教方解。陈曰："脾主四肢，四肢瘫痪，病在脾胃。此方石膏、干姜并用，为调理脾胃阴阳而设"。江老又问，"医家都说此方以麻、桂发散外来的风寒，石膏清风化之热，干姜反佐防寒凉之太过。今老师独出心裁处，我仍不明白"。陈老笑曰，"此方有不可思议之妙，非阅历深者不可明也"。江老遂不便继续追问了。
学员甲江老以后悟出了"不可思议之妙"处了吗?
老师：悟出了。江老解释风痱的基本病机，本于《素问·太阴阳明论》"脾病而四肢不用，何也?歧伯曰：四肢皆禀气于胃，而不得至经，必因于脾，乃得养也。今脾病不能为胃行其津液，四肢不得禀水谷气，气日以衰，脉道不利，筋骨肌肉，皆无气以生，故不用焉"。
学员乙但是常识告诉我们，脾胃久虚，四肢才会不得禀水谷之气而痿废，病必起于缓；今风痱起病如此急骤，四肢迅速瘫痪，却也责之脾胃，不是有点牵强附会吗?
老师：看来还得全部推出江老金针度人之处。江老认为，经言"脾病而四肢不用"，不言"脾虚而四肢不用"，"病"字与"虚"字，一宇之差，含糊不得。可惜今之医家大多在"虚"字-仁大做文章，是囿于李东垣脾胃内伤学说。江老指出，脾病而四肢不用至少有两种情形：一是脾胃久虚，四肢渐渐不得禀水谷之气；二是脾胃并非虚弱，却是突然升降失调，风痱就是如此。
学员丙既然如此，就应调理脾胃，复其升降之权。但方中并无升脾降胃药物，换言之，治法与方药是脱节的。这又当怎样解释?
老师：你所说的"方中并无升脾降胃药物"，大概是指李东垣升脾降胃的常用药物吧?
学员丙是的。
老师：那是另一条思路。现在继续谈江老的见解。江老认为，治疗风痱，应当依顺脾胃各自的性情。脾喜刚燥，当以阳药助之使升；胃喜柔润，当以阴药助之使降。干姜辛温刚燥，守而能散，大具温升宣通之力；石膏辛寒柔润，质重而具沉降之性。本方以此2味为核心，调理脾胃阴阳，使脾长胃降，还其气化之常，四肢可禀水谷之气矣，此治痱之本也。由此看来，若能透析脾胃的生理病理特性，以及干姜＼石膏寒热并用的机制，则本方的神妙，便不是不可思议的了。至于方中的参、草、芎、归，乃取八珍汤之半(芎、归组成佛手散，活血力大于补血力)。因风痱虽非脏腑久虚所致，但既已废，便不能禀水谷之气。气不足，血难运，故补气活血，势在必行。方中麻、桂、杏、草，确是麻黄汤。风痱之因于风寒者，麻黄汤可驱之出表；其不因于风寒者，亦可宣畅肺气。"肺主一身之气"，肺气通畅，不仅使经脉运行滑利(肺朝百脉)，而且有助于脾胃的升降。况"还魂汤"(麻、杏、草)治疗猝死，古有明训。若拘泥单味药的功效，则很难解释本方的精义。
泄泻5个月
四川省乐山市人民医院中医研究室主任余国俊
吴XX，女，7个月余，1990年2月8日下午诊。患儿出生后2个月之内大便比较正常。后因喂养不当，而致泄泻。初为水样便，夹不消化之食物。服藿香正气散2剂未效，改服西药、打针、输液，亦无显效，又改服中药。5个月来，选用保和丸、参苓亡?术散、附子理中汤、真人养脏汤、四神丸等汤剂，并用中药轧细敷脐，仍然泄泻不止，9天前因病情加重，昼夜泻下无度，收住某院儿科病房，诊断为"单纯性消化不良"。经连续输液、抗感染、服收敛止泻药9天，病情仍无好转。患儿父母心急如焚，束手无策之际，偶闻本室屡用中药速愈小儿久泻，背负患儿前来求治。刻诊：患儿面色苍白，精神较差，哭声低微，唇色淡而欠润泽；日泻10-20次，上午泻下次数最多，粪质如鸭溏，无特殊臭味；饮食尚可，小便略少，舌质淡，苔白少津，指纹呈淡青色。根据患儿泄泻病史、治疗经过和现症，考虑为久泻伤耗脾气、脾阴，伤及脾阳之证。宜综合七味白术散、滋阴清燥汤、理中汤、仙桔汤为--复方治之：潞党参log，白术log，茯苓12g，葛根log，藿香log，广木香6g，生甘草log，生山药60g，滑石30g，白芍30g，干姜6g，桔梗10g，仙鹤草30g。煎服法：冷水浸泡10分钟，文火煮沸1小时，滤取药液200ml，加白糖令适口，分5次喂服，每隔1小时喂1次。西医治疗措施照旧。二诊(2月9日中午)：患儿之父来诉：因药味不太苦，服药不因难，昨夜已服完。今晨第一次大便已基本成形，尔后又解3次，仍是溏类，但比以往稍干。效不更方，上方再服1剂。三诊(2月10日下午)：泄泻止。今日大便1次，完全成形。患儿之母喜孜孜道，"5个月来从未解过1次这样正常的大便"。又予善后方药：健脾膏片600片(本院自制，即参苓白术散加白糖，每片含生药0．5g)，每次服2片，嚼服，或轧细温开水吞服均可，1日3次。半年后追访，知其出院之后，泄泻一直未复发，身体渐渐胖壮。
进修生甲：本例患儿泄泻达5个月之久，除使用西药外，还反复使用过散寒、消导、健脾、温阳、止涩等中药，仍然泄泻不止。今老师用七味白术散加味，如此平淡的方药，竟然1剂知，2剂已，凭我有限的阅历，实在有点感到意外。
老师：不要理解成"七味白术散加味"。因为我用的是复方。这个复方中包含有七味白术散、滋阴清燥汤、理中汤、仙桔汤4首方子。更值得指出的是：这个复方的重心是滋阴清燥汤，而不是七味白术散。
进修生甲：但"七味白术散加味"与七味白术散合其他3首方子，说的是一回事。
老师：怎么是一回事呢?前者是指七味白术散加上一些单味药物，后者则否。大家知道，单味药物一般是针对具体症状而加用，而处方则是针对病机而设的。
进修生乙：本例久泻伤脾气及脾阳的症状是有的，如面色苍白，哭声低微，唇舌淡白，粪如鸭溏等均是。但伤阴之症几乎没有。如真的久泻伤阴，必然出现小便黄少、皮肤弹性降低、心烦、口渴、舌红绛少津等症征。
老师：伤阴之象不明显的主要原因是长时间输液。我认为，输液作为现代医学常用的一种治疗手段，确能救急扶危，增强机体耐受力，但有时又可能掩盖一些真实病情。现在临床上已很难见到温病学家所描述的温热病营血分证侯的典型舌象和体征，其主要原因也在于此。我觉得这好像给辨证论治罩上了一层迷雾，不知大家有同感否?如本例久泻患儿，除了唇欠润泽、舌苔少津之外，几乎没有伤阴的典型症征。故其存在伤脾阴的病机，主要是从病史及治疗经过来综合考虑的。
进修生丙我看过杂志上不少有关脾阴虚的文章，都说脾阴虚者大便干燥。本例脾阴既伤，为什么还泄泻不止呢?
老师：我认为，一般意义上的脾阴虚与久泻伤脾阴之间是不能划等号的。因为泄泻总不离乎湿，今脾阴虽伤，而湿邪犹存，所以仍然泄泻不止。且脾阴愈伤，脾气愈虚(经言"阴虚则无气")，则脾之运化与转输之功亦愈差，泄泻必愈甚；反之亦然。这就是恶性循环。
实习生乙按老师的思路，本例久泻的病机是个复合病机，所以要用复方来综合治疗。
老师所用的复方包含四首方子，其中只有理中汤我们比较熟悉，对七味白术散知之不多；至于滋阴清燥汤、仙桔汤，则是闻所未闻，能否讲解-下?
老师：七味白术散即四君子汤加藿香、广木香、葛根，载于宋·钱仲阳(小儿药证直诀)一书。本书谓此方"治脾胃久虚，呕吐泄泻，频作不止，精液苦竭，烦渴燥……不论阴阳虚实并宜服"。方中内寓四君子汤补脾气，藿香、广木香降泄浊阴，葛根升腾清气。因葛根又善生津止渴、止泻、解肌热，故泄泻伤脾气及脾阴者，若阴伤不甚，单用此方即可奏效。但本例久泻达5个月之久，脾阴之伤已非轻，故又令滋阴清燥汤大滋脾阴，此方载近贤张锡纯(医学衷中参西录)。至于仙桔汤……
Case History Summary: The patient was generally in good health but occasionally contracted external pathogens, presenting with fever (Fever), headache (Headache), body fatigue (Body fatigue), and cough (Cough). Intermittent use of Chinese and Western medicines had alleviated these symptoms, so no further attention was paid. Unexpectedly, 4 days prior to the Chou hour (1:00-3:00 AM), while using a hand pump to draw water, the patient gradually felt soreness and numbness in both lower limbs. Approximately 4 hours later, complete loss of sensation occurred in both lower limbs (with clear consciousness), accompanied by urinary retention. The patient was urgently sent to the local county hospital. Cerebrospinal fluid analysis revealed elevated protein content and white blood cell count, leading to a diagnosis of "Acute Myelitis" (Acute Spinal Cord Inflammation). Immediate treatment included adrenocortical hormones, vitamins, neurotrophic drugs, and symptomatic therapy; simultaneously, traditional Chinese medicine was administered. Previous prescriptions included Da Qin Jiao Tang (Great Gentian Decoction) and San Bi Tang (Three Obstructions Decoction), 3 doses each, and Bu Yang Huan Wu Tang (Tonify Yang and Restore Five Decoction), 4 doses, with poor efficacy. Currently, the patient presents with flaccid paralysis of both lower limbs, lack of muscle tone, absent tendon reflexes, inability to urinate voluntarily, and difficult defecation. Due to difficulties in transferring the patient, the family brought only the medical records and requested a prescription for trial. Based on the history, the TCM diagnosis was "Feng Fei" (Wind Paralysis, characterized by sudden paralysis). The original formula from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) recorded in *Gu Jin Lu Yan*, Xu Ming Tang (Continuing Life Decoction), was prescribed: Ephedrae Herba (Mahuang, 麻黄) 9g, Cinnamon Twig (Guizhi, 桂枝) 9g, Angelicae Sinensis Radix (Danggui, 当归) 9g, Codonopsis Radix (Ludangshen, 潞党参) 9g, Gypsum Fibrosum (Sheng Shigao, 生石膏) 9g, Zingiberis Rhizoma Recens (Ganjiang, 干姜) 9g, Glycyrrhizae Radix et Rhizoma (Sheng Gancao, 生甘草) 9g, Ligustici Chuanxiong Rhizoma (Chuanxiong, 川芎) 4.5g, and Armeniacae Semen Amarum (Xingren, 杏仁) 2g. After taking only 2 doses of this prescription, sensation returned to both lower limbs, allowing the patient to get out of bed and walk; bowel and bladder functions also improved significantly. The prescription was then modified into Ba Zhen Tang (Eight Treasures Decoction) combined with Bu Yang Huan Wu Tang, taken for 10 doses, resulting in full recovery.
Trainee A: This case is quite novel. Without personal experience, it would be hard to believe. Now that the patient has recovered, my doubts have increased. First is the diagnostic issue. The patient did not visit personally; relying solely on medical records and the Western diagnosis of "Acute Myelitis," the teacher diagnosed "Feng Fei." I truly do not understand the subtlety here.
Teacher: The diagnosis of "Feng Fei" in this case is well-founded. What is Feng Fei? It is documented in historical TCM literature. For instance, *Ling Shu: Re Bing Pian* states, "In the disease of Fei, there is no pain in the body, the four limbs cannot be controlled, and intelligence is chaotic." *Yi Xue Gang Mu* states, "Fei means dysfunction. Fei is deep-seived pathogenic factors of hemiplegia... because the hands and feet are dysfunctional and cannot be controlled, it is named Fei. Whether partial or total dysfunction, it is all called Fei." *Sheng Ji Zong Lu* states, "The disease of Fei leads to dysfunction, where flesh is no longer flesh, because the body has no pain, the four limbs cannot be controlled and are useless." These records indicate that ancient physicians had a consistent understanding of Feng Fei: it is characterized by sudden paralysis (hemiplegia or paraplegia), absence of body pain, and usually no disturbance of consciousness (or only mild disturbance). In this case, the patient gradually felt soreness and numbness in both lower limbs during labor, losing complete sensation after about 4 hours, yet remained conscious. This fully conforms to the onset and symptom characteristics of Feng Fei. Such sudden paraplegia is distinctly different from paralysis caused by "cerebrovascular accidents," hysteria, rheumatism, or rheumatoid arthritis.
Trainee A: I understand the diagnosis of Feng Fei now. But what is the basis for using such an unusual prescription?
Teacher: This case uses the original Xu Ming Tang from *Jin Gui Yao Lue*. The book records that this formula treats "stroke-induced Feng Fei, where the body cannot hold itself, speech is impaired, dizziness occurs with unknown pain locations, or stiffness prevents turning over." The basis for using this formula is the correspondence between syndrome and formula, following Zhang Zhongjing's principle of "using the specific formula for the specific syndrome." As long as the syndrome matches, it can be used boldly, without being restricted by later differentiation methods.
Trainee B: I analyzed the properties and effects of the nine herbs in this formula one by one, but I really cannot see its mechanism of action. How could such a prescription rapidly cure paraplegia? To be frank, is such high efficiency merely accidental or lucky?
Teacher: This is a sharp question. Let me briefly introduce the historical background of using this formula to treat Feng Fei, so you can evaluate whether it was accidental or lucky. In the 1930s, when my mentor Jiang Erxun was beginning his medical studies, a patient named Tang, male, aged 50, obese, and fond of alcohol, suddenly became weak in all four limbs while sitting idly in a teahouse, unable to control himself, collapsing with flaccid paralysis, yet remaining conscious and able to speak clearly. Physicians did not know the disease. Jiang’s master, Mr. Chen Dingsan, diagnosed him: "This disease is named Feng Fei; treatment should use Xu Ming Tang from *Gu Jin Lu Yan*." After one dose of the original formula, he recovered completely the next day. At that time, commercially available salt was coarse snow salt, containing heavy barium chloride. Many people who consumed it long-term suddenly developed limb paralysis, which people did not understand. Mr. Chen also prescribed this formula, with effectiveness like a drumstick striking a drum, saving many lives. In 1950, a patient named Qiao, in his prime, suddenly found his lower limbs immobile, without pain or itching, confined to bed. He urgently sought Jiang’s treatment. Jiang prescribed this formula, and after two doses, the patient could walk. In August 1965, Jiang successfully rescued a case of Feng Fei using this formula combined with acupuncture. The patient, an 18-year-old male, suffered from "Acute Myelitis" and "Ascending Paralysis." Besides numbness and incomplete paralysis of the limbs, the most urgent issue was severe difficulty in breathing and swallowing. While Western medicine provided anti-infection therapy, IV fluids, vitamins, Lobeline, camphor water, and oxygen, after six days of rescue efforts, the patient still experienced paroxysmal dyspnea, gasping respiration, signs of impending death, occasional loss of pupillary reflex, drowsiness unresponsive to calls, and absence of all deep and superficial reflexes. Western medicine deemed him incurable, repeatedly warning the family that his life was in imminent danger. The family notified their hometown to prepare for funeral arrangements. However, to fulfill the family's request and do everything possible, Jiang was invited for consultation. Jiang prescribed this formula combined with acupuncture. After just one dose, the critical condition resolved; after five more doses, all symptoms disappeared. Subsequently, tonifying Qi and Blood concluded the treatment. Our treatment of this Feng Fei case inherited the experience of Chen Dingsan and Jiang Erxun, achieving the expected high efficiency, without any element of accident or luck.
Trainee C: So, does the "Feng Fei" treated by this formula not limit itself to just "Acute Myelitis"?
Teacher: Yes. The Feng Fei treated by this formula includes, besides Acute Myelitis and Barium Chloride poisoning mentioned above, also "Polyneuritis." A Western physician learning from Jiang’s experience used this formula to treat over ten cases of Polyneuritis, with good efficacy.
Student A: The composition of this formula is peculiar, and its mechanism is hard to understand. I wonder how Mr. Chen Dingsan understood it back then?
Teacher: Witnessing the efficacy of this formula, Jiang was greatly surprised and asked Mr. Chen for the explanation. Chen said, "The Spleen governs the four limbs; limb paralysis indicates pathology in the Spleen and Stomach. This formula uses Gypsum and Dried Ginger together to regulate the Yin and Yang of the Spleen and Stomach." Jiang asked again, "Physicians say this formula uses Ephedra and Cinnamon Twig to disperse external Wind-Cold, Gypsum to clear heat transformed from wind, and Dried Ginger to counteract excessive cold. I still do not understand your unique insight." Mr. Chen smiled and said, "This formula has miraculous wonders beyond imagination, understandable only to those with profound experience." Jiang then did not press further.
Student A: Did Jiang eventually realize the "miraculous wonder"?
Teacher: He did. Jiang explained the basic pathogenesis of Feng Fei based on *Su Wen: Tai Yin Yang Ming Lun*: "Why does Spleen disease lead to non-use of the four limbs? Qibo said: The four limbs all receive Qi from the Stomach, but cannot reach the meridians directly; they must rely on the Spleen to be nourished. Now, Spleen disease cannot transport fluids for the Stomach; the four limbs cannot receive Grain Qi. Qi declines daily, meridians become obstructed, bones, sinews, muscles lack Qi to generate, hence they do not function."
Student B: Common sense tells us that chronic deficiency of Spleen and Stomach leads to limbs failing to receive Grain Qi and becoming atrophic, implying a slow onset. Here, Feng Fei starts so abruptly with rapid limb paralysis, yet we blame the Spleen and Stomach. Isn't this somewhat far-fetched?
Teacher: We must present Jiang’s key insights. Jiang believed that the classic text says "Spleen disease leads to non-use of the four limbs," not "Spleen deficiency." The difference between "disease" and "deficiency" is significant and cannot be blurred. Unfortunately, modern physicians often focus too much on "deficiency," constrained by Li Dongyuan’s theory of internal injury to Spleen and Stomach. Jiang pointed out that "Spleen disease leading to non-use of the four limbs" has at least two scenarios: one is chronic Spleen-Stomach deficiency, where limbs gradually fail to receive Grain Qi; the other is that the Spleen-Stomach is not deficient, but experiences sudden disorder of ascending and descending functions, which is the case in Feng Fei.
Student C: If so, we should regulate the Spleen and Stomach to restore their ascending and descending functions. But the formula lacks herbs that ascend Spleen Qi and descend Stomach Qi. In other words, the treatment method and the formula are disconnected. How should this be explained?
Teacher: When you say "the formula lacks herbs that ascend Spleen and descend Stomach," you probably refer to the common herbs used by Li Dongyuan for this purpose?
Student C: Yes.
Teacher: That is another line of thought. Continuing with Jiang’s view, he believed that treating Feng Fei should follow the natural dispositions of the Spleen and Stomach. The Spleen likes dryness and warmth; Yang herbs should assist it to ascend. The Stomach likes moistness and coolness; Yin herbs should assist it to descend. Dried Ginger is acrid, warm, dry, and firm, capable of dispersing, possessing strong warming, ascending, and unblocking power. Gypsum is acrid, cold, moist, heavy, and possesses sinking properties. This formula takes these two herbs as the core to regulate Spleen-Stomach Yin-Yang, allowing Spleen to ascend and Stomach to descend, restoring normal Qi transformation, so the limbs can receive Grain Qi. This is the root of treating Fei. Thus, if one understands the physiological and pathological characteristics of the Spleen and Stomach, and the mechanism of combining cold and hot herbs like Dried Ginger and Gypsum, the miracle of this formula is not unimaginable. As for Ginseng, Licorice, Ligusticum, and Angelica in the formula, they take half of Ba Zhen Tang (Angelica and Ligusticum form Fo Shou San, which has stronger blood-invigorating than blood-tonifying effects). Although Feng Fei is not caused by chronic organ deficiency, once paralyzed, the limbs cannot receive Grain Qi. With insufficient Qi, Blood circulation is difficult, so tonifying Qi and invigorating Blood is imperative. The Ephedra, Cinnamon Twig, Apricot Kernel, and Licorice in the formula indeed constitute Ma Huang Tang (Ephedra Decoction). For Feng Fei caused by Wind-Cold, Ma Huang Tang can expel it from the exterior; even if not caused by Wind-Cold, it can promote Lung Qi flow. "The Lung governs the Qi of the whole body"; smooth Lung Qi not only facilitates meridian circulation (Lung gathers all vessels) but also aids Spleen-Stomach ascending and descending. Moreover, "Huan Hun Tang" (Ephedra, Apricot Kernel, Licorice) for treating sudden death has clear ancient instructions. If one sticks strictly to the effects of single herbs, it is hard to explain the essence of this formula.
Diarrhea for 5 Months
Yu Guojun, Director of TCM Research Office, Leshan People's Hospital, Sichuan Province
Wu XX, female, slightly over 7 months old, examined on the afternoon of February 8, 1990. The infant’s stool was relatively normal within the first 2 months after birth. Later, due to improper feeding, diarrhea developed. Initially watery stools mixed with undigested food. Two doses of Huo Xiang Zheng Qi San (Agaricus Decoction) were ineffective. Switching to Western medicine, injections, and IV fluids also showed no obvious effect. Then switched back to Chinese medicine. Over 5 months, various decoctions including Bao He Wan (Preserve Harmony Pill), Shen Ling Bai Zhu San (Codonopsis, Poria, and Atractylodes Macrocephala Powder), Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction), Zhen Ren Yang Zang Tang (True Human Nourish Viscera Decoction), and Si Shen Wan (Four Spirits Pill) were selected, along with finely ground Chinese medicine applied to the umbilicus, yet diarrhea persisted. Nine days ago, due to worsening condition with incessant day and night diarrhea, the infant was admitted to the pediatric ward of a certain hospital, diagnosed as "Simple Indigestion." Despite continuous IV fluids, anti-infection treatment, and astringent antidiarrheal drugs for 9 days, the condition did not improve. Desperate parents, having tried everything, heard that our office frequently cured prolonged childhood diarrhea with Chinese medicine quickly, and carried the infant to seek treatment. Current examination: Pale complexion, poor spirit, low-pitched crying, pale and dry lips; 10-20 diarrheal episodes per day, most frequent in the morning, stool consistency like duck feces, no special odor; diet acceptable, urine slightly reduced, pale tongue body, white coating with little moisture, finger vein appearing pale cyan. Based on the history, treatment course, and current symptoms, considered as a syndrome of prolonged diarrhea damaging Spleen Qi, Spleen Yin, and affecting Spleen Yang. Suitable to combine Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder), Zi Yin Qing Zao Tang (Nourish Yin Clear Dryness Decoction), Li Zhong Tang (Regulate the Middle Decoction), and Xian Ju Tang (Immortal and Citrus Decoction) into a compound formula: Codonopsis Radix (Ludangshen, 潞党参) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) 10g, Poria (Fuling, 茯苓) 12g, Puerariae Radix (Gegen, 葛根) 10g, Pogostemonis Herba (Huoxiang, 藿香) 10g, Aquilariae Resina (Guangmuxiang, 广木香) 6g, Glycyrrhizae Radix et Rhizoma (Sheng Gancao, 生甘草) 10g, Dioscoreae Rhizoma (Sheng Shanyao, 生山药) 60g, Talcum (Huashi, 滑石) 30g, Paeoniae Radix Alba (Baishao, 白芍) 30g, Zingiberis Rhizoma Recens (Ganjiang, 干姜) 6g, Platycodonis Radix (Jiegeng, 桔梗) 10g, Agrimoniae Herba (Xianhecao, 仙鹤草) 30g. Decoction method: Soak in cold water for 10 minutes, boil gently for 1 hour, filter to obtain 200ml decoction, add sugar to taste, divide into 5 doses, feed every hour. Western medical measures continued unchanged. Second visit (noon, Feb 9): Father reported: Medicine was not too bitter, easy to administer, finished last night. First stool this morning was basically formed, followed by 3 more loose stools, slightly drier than before. Efficacy confirmed, do not change formula, take another dose of the same prescription. Third visit (afternoon, Feb 10): Diarrhea stopped. One formed stool today. Mother joyfully said, "Never had such a normal stool in 5 months." Given maintenance formula: Jian Pi Gao Pian (Spleen-Tonifying Paste Tablets) 600 tablets (hospital-made, Shen Ling Bai Zhu San plus sugar, each tablet contains 0.5g crude drug), 2 tablets per time, chewed or swallowed with warm water, 3 times a day. Follow-up half a year later revealed no recurrence of diarrhea after discharge, and the child gradually gained weight and strength.
Trainee A: This infant suffered from diarrhea for 5 months. Besides Western medicine, repeated use of cold-dispersing, digestion-promoting, spleen-tonifying, yang-warming, and astringent Chinese medicines still failed to stop the diarrhea. Today, the teacher used Qi Wei Bai Zhu San with modifications. Such a plain prescription actually worked after 1 dose and cured after 2 doses. With my limited experience, this is quite surprising.
Teacher: Do not understand it as "Qi Wei Bai Zhu San with modifications." Because I used a compound formula. This compound formula contains four formulas: Qi Wei Bai Zhu San, Zi Yin Qing Zao Tang, Li Zhong Tang, and Xian Ju Tang. More importantly, the focus of this compound formula is Zi Yin Qing Zao Tang, not Qi Wei Bai Zhu San.
Trainee A: But "Qi Wei Bai Zhu San with modifications" and combining Qi Wei Bai Zhu San with the other three formulas mean the same thing.
Teacher: How can they be the same? The former refers to adding some single herbs to Qi Wei Bai Zhu San, whereas the latter does not. Everyone knows that single herbs are generally added to target specific symptoms, while prescriptions are designed based on pathogenesis.
Intern A: I have been thinking about pathogenesis. What is the main pathogenesis of diarrhea in this case?
Teacher: Prolonged diarrhea damages Spleen Qi and Spleen Yin, affecting Spleen Yang.
Trainee B: There are symptoms of Spleen Qi and Yang damage in this prolonged diarrhea case, such as pale complexion, low-pitched crying, pale lips and tongue, and duck-like stool. But there are almost no signs of Yin damage. If prolonged diarrhea truly damaged Yin, there would inevitably be yellow and scanty urine, decreased skin elasticity, restlessness, thirst, red tongue with little moisture, etc.
Teacher: The main reason for unclear signs of Yin damage is prolonged IV infusion. I believe that while IV infusion, as a common modern medical treatment, can indeed save emergencies and enhance tolerance, it may sometimes mask true conditions. It is now rare to see the typical tongue images and signs of Ying-Blood level syndromes in warm diseases described by Warm Disease experts, mainly due to this. I feel this casts a fog over syndrome differentiation and treatment. Do you agree? In this prolonged diarrhea case, except for dry lips and little moisture on the tongue coating, there are almost no typical signs of Yin damage. Therefore, the existence of Spleen Yin damage pathogenesis is mainly comprehensively considered from the medical history and treatment course.
Trainee C: I have read many articles in magazines about Spleen Yin deficiency, stating that those with Spleen Yin deficiency have dry stools. Since this case’s Spleen Yin is damaged, why is there still persistent diarrhea?
Teacher: I believe that general Spleen Yin deficiency cannot be equated with Spleen Yin damage from prolonged diarrhea. Because diarrhea always involves dampness. Even though Spleen Yin is damaged, dampness remains, so diarrhea persists. Moreover, the more Spleen Yin is damaged, the weaker Spleen Qi becomes (as stated in classics, "Yin deficiency leads to lack of Qi"), making Spleen transportation and transformation functions worse, leading to more severe diarrhea; vice versa. This is a vicious cycle.
Intern B: According to the teacher’s logic, the pathogenesis of prolonged diarrhea in this case is a composite pathogenesis, so a compound formula is needed for comprehensive treatment.
Teacher: The compound formula used contains four formulas. Only Li Zhong Tang is familiar to us; we know little about Qi Wei Bai Zhu San; as for Zi Yin Qing Zao Tang and Xian Ju Tang, they are unheard of. Could you explain them?
Teacher: Qi Wei Bai Zhu San is Si Jun Zi Tang (Four Gentlemen Decoction) plus Pogostemonis Herba (Huoxiang, 藿香), Aquilariae Resina (Guangmuxiang, 广木香), and Puerariae Radix (Gegen, 葛根), recorded in Song Dynasty Qian Zhongyang’s *Xiao Er Yao Zheng Zhi Jue* (Key to Therapeutics of Pediatric Diseases). The book states this formula "treats chronic Spleen-Stomach deficiency, vomiting and diarrhea, frequent and unceasing, exhausting essence and fluids, irritability, thirst, dryness... suitable for both Yin/Yang and Deficiency/Excess syndromes." The formula internally contains Si Jun Zi Tang to tonify Spleen Qi, Huoxiang and Guangmuxiang to descend turbid Yin, and Gegen to ascend clear Yang. Since Gegen is also good at generating fluids, quenching thirst, stopping diarrhea, and releasing muscle layer heat, for diarrhea damaging Spleen Qi and Yin, if Yin damage is not severe, using this formula alone can be effective. But in this case, prolonged diarrhea lasted 5 months, and Spleen Yin damage was not slight, so Zi Yin Qing Zao Tang was added to heavily nourish Spleen Yin. This formula is recorded in modern expert Zhang Xichun’s *Yi Xue Zhong Zhong Can Xi Lu* (Records of Traditional Chinese Medicine Integrated with Western Medicine). As for Xian Ju Tang...