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Teacher: In treating diseases, Traditional Chinese Medicine (TCM) must grasp the principle of syndrome differentiation and treatment (Bian Zheng Lun Zhi), seize the changes in the patient's condition, and treat according to the evolving syndrome. The efficacy of this prescription can be analyzed from the combination and actions of the herbs above. In the formula, Sha Shen (Glehniae Radix), Yu Zhu (Polygonati Odorati Rhizoma), and Shi Hu (Dendrobii Caulis) are sweet and cool, nourishing Stomach Yin (Wei Yin); Bai Shao (Paeoniae Radix Alba) and Fo Shou (Citri Sarcodactylis Fructus) soften the Liver (Gan) and regulate Qi without damaging Yin; Yu Jin (Curcumae Radix) resolves depression and dissipates nodules, while Shi Pu (Acori Tatarinowii Rhizoma) uses its aromatic property to regulate Qi, preventing excessive coolness from the sweet herbs; these two together treat Heart (Xin) disorders; Ji Nei Jin (Galli Gigerii Endothelium Corneum) and Chao Dao Ya (Fried Oryzae Fructus Germinatus) aid digestion and stimulate appetite; He Ye (Nelumbinis Folium) has a neutral nature, ascending clear Yang and descending turbid Yin, benefiting the Stomach without causing stagnation. The entire formula jointly achieves the effects of nourishing Stomach Yin, softening the Liver, regulating Qi and harmonizing the Stomach, promoting digestion and stimulating appetite. Since the herbs match the syndrome precisely, reaching the disease site directly, efficacy was achieved after taking 3 doses. Diagnosis on September 24, 1980: The previous prescription was effective, with results as immediate as a drumstick striking a drum. Food tastes good, returning to normal; the heart feels joyful and the epigastrium is comfortable; sleep is stable; the mouth is not dry; the tongue is crimson with a thin white coating, indicating the return of Body Fluids (Jin Ye). Add Nu Zhen Zi (Ligustri Lucidi Fructus) 10g to the previous prescription, continue taking it for 6 doses to consolidate the effect. Follow-up for 3 months showed good appetite and regular bowel movements.

Case 4: Chen XX, Male, 61 years old, cadre. The patient was admitted due to difficulty urinating and underwent prostatectomy. Fourteen days post-operation, the patient had no desire to eat, so TCM consultation was requested to regulate diet. First visit: The main manifestations were poor appetite and sweating after eating; urinary incontinence with dribbling. The tongue was red with a white coating, and the pulse was deep and fine. According to the *Nei Jing* (Inner Canon): "When food intake is excessive, sweat comes from the Stomach." Furthermore, the Kidney (Shen) controls the two lower orifices (urination and defecation); insecure Kidney Qi leads to frequent urination, and in severe cases, incontinence and dribbling. Thus, the syndrome belongs to Spleen-Stomach Qi Deficiency and insecure Kidney Qi. The treatment should strengthen the Spleen and secure the Kidney, tonify Qi, and stimulate appetite. Prescribe Liu Jun Zi Tang (Six Gentlemen Decoction) to strengthen the Spleen and tonify Qi, add Jiao Si Xian (Charred Four Immortals) and Wu Mei (Mume Fructus) to aid digestion; additionally add Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Tu Si Zi (Cuscutae Semen), and Bu Gu Zhi (Psoraleae Fructus) to secure the Kidney and reduce urination. Second visit: After taking 3 doses of the previous prescription, spirit slightly increased, and urination was somewhat controlled, but there was still no desire to eat. Observation showed an enlarged tongue body with a white coating at the root, and a deep, fine pulse. After much thought, it was concluded that the surgery damaged the Kidney, leading to decline of Ming Men Fire (Gate of Life Fire), failure of Fire generating Earth, loss of Spleen transportation, and loss of Stomach reception, resulting in reduced food intake and poor taste of food. Changed to the method of "Tonifying Fire to Generate Earth." According to the *Nei Jing*: "For insufficiency of Yang, warm it with Qi," thus selecting Jin Gui Shen Qi Tang (Kidney Qi Pill from the Golden Cabinet) combined with Yi Gong San (Yi Gong Powder). Medicinals: Fu Zi (Prepared Aconiti Lateralis Radix) 15g (boil first for 20 minutes until numbness disappears), Gui Zhi (Cinnamomi Ramulus) 15g, Shu Di Huang (Prepared Rehmanniae Radix) 15g, Shan Zhu Yu (Corni Fructus) 10g, Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma) 15g, Fu Ling (Poria) 15g, Ze Xie (Alismatis Rhizoma) 10g, Mu Dan Pi (Moutan Cortex) 9g, Dang Shen (Codonopsis Radix) 15g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 15g, Chen Pi (Citri Reticulatae Pericarpium) 6g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 6g. Third visit: After only 3 doses, appetite suddenly increased. The patient reported feeling empty in the stomach and hunger at 5 PM on the day of taking the medicine. Add Sha Ren (Amomi Fructus) 9g to the previous prescription, continue for 5 doses. Diet returned to normal, and the patient was discharged.

Student: Teacher, your keen insight allowed you to grasp the root of the disease in the second visit and achieve rapid results; this is truly wonderful. Please explain the rationale behind using Jin Gui Shen Qi Tang.

Teacher: This case involves post-operative Kidney damage. Since the Kidney controls the two lower orifices, urinary incontinence and dribbling occur. Decline of Kidney Yang (Shen Yang Xu Shuai) leads to Fire failing to generate Earth, loss of Spleen transportation, and loss of Stomach reception, resulting in no desire to eat. Treatment should focus on tonifying the Kidney and warming Yang, primarily by tonifying Yang to complement Yin. Zhang Jing Yue of the Ming Dynasty pointed out, "Those skilled in tonifying Yang must seek Yang within Yin, so that Yang receives assistance from Yin, and generation becomes endless." Selecting "Jin Gui Shen Qi Tang" fits this meaning perfectly. The case of no desire to eat achieving rapid results through specific Kidney tonification further confirms Xu Shimie's view that "tonifying the Spleen is inferior to tonifying the Kidney."

Clinical Application of "All Wind Tremors and Dizziness Belong to the Liver"

Professor Duan Chenggong, Changchun College of Traditional Chinese Medicine

Case 1: Yang XX, Male, 43 years old, cadre. Suffered from paroxysmal headache for over 10 years, worsening in the last 2 months. For over 10 years, headaches started around 2 PM daily, lasting several hours before relief, accompanied by dizziness, nausea, and irritability. Effect of Chinese and Western medicines was insignificant. Over the last 2 months, it gradually worsened; attacks were mainly at the vertex and back of the head, severe and unbearable, unable to work normally, and analgesics did not relieve it. The patient was obese, face flushed. Examination showed a red tongue, enlarged body with teeth marks on the sides, thick greasy yellow coating, and a string-taut, rapid, and weak pulse. Syndrome Differentiation: Liver Deficiency generating Wind, Wind-Heat Headache. Treatment Method: Nourish Yin and Clear Heat, Invigorate Blood and Dispel Wind. Prescription: Sheng Di Huang (Rehmanniae Radix) 50g, Wu Zhu Yu (Evodiae Fructus) 5g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 15g, Huang Qin (Scutellariae Radix) 15g, Qiang Huo (Notopterygii Rhizoma et Radix) 15g, Long Gu (Fossilia Ossis Mastodi) 50g, Mu Li (Ostreae Concha) 50g, Xia Ku Cao (Prunellae Spica) 10g, Ju Hua (Chrysanthemi Flos) 20g. Decoct in water, take once daily. Treatment Course: After 3 doses, dizziness and nausea improved significantly, and headache also relieved. After 8 doses, headache significantly reduced. Remove Qiang Huo from the previous prescription, add Shan Zha Pian (Crataegi Fructus Slice) 20g. Total 12 doses taken, basically cured. Follow-up for 5 years showed no recurrence.

Case 2: Zhang X, Female, 52 years old. Presented with paroxysmal dizziness for 3 days. One year ago, suffered sudden dizziness, diagnosed by Western medicine as "Meniere's Disease," improved after treatment. Recurred 3 days ago due to fatigue and anger. Current symptoms: dizziness and vertigo, inability to turn head, spinning sensation upon movement, nausea, vomiting, strong sense of fear. Western medicines such as Atropine, Diazepam, and Betahistine showed no significant improvement. Examination showed red tongue, yellow coating, and deep, fine, rapid, and weak pulse. Syndrome Differentiation: Liver Qi Stagnation, Internal Movement of Liver Wind. Treatment Principle: Nourish Yin and Clear Heat, Pacify Liver and Extinguish Wind. Prescription: Modified Zhen Gan Xi Feng Tang (Decoction for Subduing Liver and Extinguishing Wind). Tian Ma (Gastrodiae Rhizoma) 15g, Gou Teng (Uncariae Ramulus cum Uncis) 15g, Long Gu 50g, Mu Li 50g, Niu Xi (Achyranthis Bidentatae Radix) 15g, Gui Ban (Testudinis Carapax et Plastrum) 20g, Dai Zhe Shi (Haematitum) 20g, Tian Dong (Asparagi Radix) 15g, Mai Dong (Ophiopogonis Radix) 15g, Yin Chen (Artemisiae Scopariae Herba) 20g, Xuan Shen (Scrophulariae Radix) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Chuan Lian Zi (Meliae Fructus) 15g, Sheng Di Huang 20g, Bai Shao (Paeoniae Radix Alba) 15g. Decoct in water, one dose every 1.5 days. Treatment Course: Significant relief after 1 dose, able to sit up and eat. After 2 doses, able to walk, no more nausea/vomiting, only afraid to turn head suddenly. Continued same prescription for 5 doses, all symptoms resolved. Rested for a few days then returned to work.

Case 3: Yu XX, Female, 34 years old, chief complaint of frequent insomnia for 3 years. Three years ago, due to argument with mother-in-law, felt depressed, then developed insomnia and vivid dreams, gradually worsening. Current symptoms: dizziness, fatigue, emaciation, poor appetite, irritability, sleeping only 4-5 hours daily with many dreams, waking up very tired. Examination showed red tongue tip, thin yellow coating, fine and rapid pulse, string-taut left Guan position. Careful observation revealed slight involuntary tremors of the head, and continuous trembling of both hands. Inquiry revealed frequent "cramps" in hands and feet. Syndrome Differentiation: Internal Movement of Deficient Wind, Heat Disturbing Heart Spirit. Treatment Method: Soothe Liver and Strengthen Spleen, Calm Spirit and Extinguish Wind. Prescription: Dang Shen 15g, Qing Ban Xia (Processed Pinelliae Rhizoma) 15g, Tian Ma 15g, Gou Teng 15g, Shi Jue Ming (Haliotidis Concha) 30g, Ling Ci Shi (Magnetitum) 30g, Chai Hu (Bupleuri Radix) 15g, Bai Shao 10g, Gan Cao 10g, Fu Ling 15g, Dang Gui (Angelicae Sinensis Radix) 15g, Bai Zhu 15g, Dan Pi (Moutan Cortex) 15g. Decoct in water, once daily. Soak herbs in rusty water before decocting. Treatment Course: After 3 doses, symptoms lightened, but insomnia did not improve significantly. Remove Tian Ma and Gou Teng from previous prescription, add Ye Jiao Teng (Polygoni Multiflori Caulis) 15g, Yuan Shen (Scrophulariae Radix) 15g. Continue for 3 doses. Reported significant improvement in sleep, lightening of dizziness and fatigue. Adjust original prescription, total over 20 doses taken, all symptoms resolved, health restored. Advised to adjust life rhythm, maintain happy mood, not be anxious when facing matters. Patient followed advice, remains healthy to date.

Student A: The three examples cited above are three different syndromes: headache, dizziness, and insomnia. Why is the treatment method of "Extinguishing Wind" used for all of them?

Teacher: Good question. The reason all use Extinguishing Wind (or Dispelling Wind) as the treatment method is that although they are three different syndromes with different clinical manifestations, they all have "Wind" signs. The main method of TCM diagnosis is Syndrome Differentiation and Treatment, seeking the cause through differentiation and determining treatment principles. In TCM basic theory, pathological changes in the human body are classified using the method of analogy, considering a category of diseases similar to natural wind, extending its meaning, linking it with Spring, Wood, Liver, etc., summarizing its constant and variable manifestations. It points out that Wind is divided into External Wind and Internal Wind. External Wind is an external pathogenic factor. Internal Wind is a lesion caused by changes in Zang-Fu organs; because its characteristics are similar to wind, it is called Internal Wind, and is considered closely related to the Liver, hence the term Liver Wind. The *Nei Jing · Zhi Zhen Yao Da Lun* states: "All Wind tremors and dizziness belong to the Liver." "All Wind" refers to various Wind syndromes; "Tremor" (Diao), noted by Zhang Jiebin as "shaking," means convulsion/twitching; "Dizziness" (Xuan) means vertigo. It means that various Wind syndromes, such as convulsions and vertigo, mostly belong to the category of Liver diseases. Clinically, whenever convulsions, vertigo, etc., are seen, they can be treated based on Wind and considered in connection with the Liver. Therefore, naturally, Extinguishing Wind should be the treatment principle.

Student B: Please discuss the differentiation and treatment of "Wind" syndromes combining the three cases.

Teacher: "Wind" syndromes manifest very complexly in clinical practice. TCM believes that Wind nature is "agile and changeable," and can carry Dampness, Heat, or Cold. There is also Stroke (Zhong Feng), which is a topic studied by physicians through generations, not discussed here. The *Nei Jing* statement "All Wind tremors and dizziness belong to the Liver" has important guiding significance for the differentiation and treatment of Wind syndromes. Case 1 is headache. Ancients also called headache "Head Wind," showing its relationship with Wind. This case is characterized by timed onset, accompanied by dizziness and string-taut pulse, which can be considered Liver Deficiency generating Wind, Liver Yang Hyperactivity. Long-standing disease leads to deficiency generating Heat, Heat stagnating in collaterals, Wind-Heat stirring each other causing headache. Thus, treatment uses Nourishing Yin and Clearing Heat, combined with Invigorating Blood and Dispelling Wind. In the formula, Sheng Di Huang, Huang Qin, Xia Ku Cao, and Ju Hua nourish Yin and clear Heat; Long Gu and Mu Li pacify Liver and extinguish Wind; Chuan Xiong moves blood and resolves stasis; Qiang Huo dispels Wind to treat Taiyang Meridian headache. Additionally, Wu Zhu Yu is used to treat Jueyin headache and assist the heat-clearing herbs, making them clear heat without damaging Yang. The combined herbs achieve the purpose of dispelling Wind and relieving pain.

Case 2 is dizziness, characterized by sudden onset and severe symptoms. Its etiology is related to "Anger." Since the Liver governs Anger, it is closely related to the Liver. Overall, the syndrome is Liver Stagnation generating Heat, Heat generating Wind, Internal Movement of Liver Wind, Wind-Heat clashing, attacking the clear orifices, causing dizziness. Therefore, treatment starts from "Liver Wind," using modified Zhen Gan Xi Feng Tang by Zhang Shuhua. In the formula, Tian Ma and Gou Teng are herbs for extinguishing Wind; Long Gu, Mu Li, and Dai Zhe Shi are herbs for subduing Liver and directing rebellious Qi downward; Gui Ban, Tian Dong, Mai Dong, Xuan Shen, Sheng Di Huang, and Bai Shao are substances for nourishing Yin and softening the Liver, simultaneously clearing Liver Heat; Yin Chen and Chuan Lian Zi enter the Liver Meridian to move Qi and resolve Dampness; Niu Xi guides Qi downward; Gan Cao harmonizes the herbs. The herbs work synergistically to pacify Liver, clear Heat, and extinguish Wind, hence rapid efficacy.

Case 3 has insomnia as the main symptom, diagnosed by Western medicine as "Neurosis" (Neurasthenia). This disease has various clinical manifestations. Although not a severe illness, treatment is not easy. Careful differentiation and targeted treatment are required for efficacy. In this case, careful examination found tremors of the head and hands, consistent with the meaning of "All Wind tremors and dizziness," thus considered a syndrome of Internal Movement of Deficient Wind. The prescription was formed based on the principle of treating Wind and soothing the Liver, achieving good results, proving correct differentiation. The formula used modified Tian Ma Gou Teng Yin combined with Xiao Yao San. In the formula, Shi Jue Ming, Ling Ci Shi, and rusty water calm the Spirit; Dang Shen and Qing Ban Xia ascend and descend together, strengthening Spleen and resolving Phlegm; Xiao Yao San soothes Liver and relieves depression; Dan Pi clears deficiency Heat. The herbs jointly achieve the effects of soothing Liver, strengthening Spleen, calming Spirit, and extinguishing Wind.

Synthesizing the above three cases, since the clinical manifestations all included tremors or dizziness, they were all treated based on Wind, tracing back to the source and seeking resolution in the Liver, achieving satisfactory results. This shows that deeply understanding the guiding significance of the *Nei Jing* statement "All Wind tremors and dizziness belong to the Liver" has considerable clinical value.

Vomiting and Scanty Urination for Over 1 Month

Professors Su Ruijun and Cai Hongyan, Jilin Academy of Traditional Chinese Medicine and Materia Medica

Patient: Yin X, Female, 62 years old, cadre, consulted on December 18, 1994. The patient felt waist soreness and fatigue for 5 years. Every time catching cold, overworking, or exposed to cold, lower back pain recurred and worsened. In the last month, appeared vomiting, nausea, no desire to eat, waist soreness, aversion to cold and cold limbs, general fatigue, edema, and scanty urination, especially frequent nocturia and scanty urine, daily volume only about 300ml. Accompanied by palpitations, shortness of breath, dizziness, hot palms and soles, dry mouth without desire to drink, dry eyes, skin itching, and dry stool. Sought TCM treatment. Examination showed medium build, poor nutrition, eyelid edema, pale and puffy complexion, mental fatigue, dry skin, pale lips and nails, lower limb edema, frequent vomiting, pale tongue with little coating, deep, fine, and rapid pulses bilaterally.

TCM Diagnosis: ① Guan Ge (Obstruction and Rejection), Spleen-Kidney Yang Deficiency Syndrome, Turbid Pathogen invading Middle Jiao; ② Xu Lao (Deficiency Consumption), Qi and Blood Dual Deficiency Syndrome. Proposed treatment method: Strengthen Spleen, Benefit Kidney, Stop Vomiting, Descend Turbidity. Prescription Composition: Huang Qi (Astragali Radix) 25g, Dang Shen 20g, Fu Ling 20g, Sha Ren (Amomi Fructus) 20g, Xian Mao (Curculiginis Rhizoma) 15g, Ban Xia (Pinelliae Rhizoma) 10g, Bai Shao 15g, Huo Xiang (Agastaches Herba) 15g, Zhu Ru (Bambusae Caulis in Taenia) 10g, Ze Xie 15g, Gan Cao 10g. Decoct in water, once daily. After 7 doses, nausea and vomiting decreased, but still scanty urine and dry stool. Continued internal Chinese medicine, added Bai Mao Gen (Imperatae Rhizoma) 20g to the previous prescription. Simultaneously gave high-retention enema with Chinese herbal decoction. Prescription: Da Huang (Rhei Radix et Rhizoma) 25g, Mu Li 20g, Dang Gui 20g, Huai Hua (Sophorae Flos) 20g, Fu Zi 10g. Once daily, decoct externally for enema, retention time as long as possible. After 1 week of this treatment, symptoms significantly improved, vomiting disappeared, edema significantly reduced, urine volume increased, tongue and pulse showed no significant change. Adjusted Chinese medicine prescription: Huang Qi 25g, Dang Shen 20g, Fu Ling 20g, Sha Ren 10g, Shan Yu Rou (Corni Fructus) 20g, Bai Shao 20g, Dang Gui 15g, Pei Lan (Eupatorii Herba) 15g, Huo Xiang 15g, Rou Cong Rong (Cistanche Caulis) 15g, Ze Xie 15g, Gan Cao 15g. Decoct in water, take morning and evening, once daily. Continue high-retention enema with previous prescription. Persisting with this method for 1 month, most symptoms basically eliminated, nausea and vomiting disappeared, edema subsided, mental and physical state improved, appetite gradually increased. Tongue pale red, thin white coating, deep and fine pulses bilaterally. Mental state recovered, able to manage household chores. Follow-up for 1 year, no recurrence.

Student A: What is Guan Ge? What is the basis for diagnosing this disease as Guan Ge?

Teacher: "Guan" means closure; inability to urinate is called Guan; "Ge" means rejection; incessant vomiting is called Ge. Guan Ge refers to a syndrome where inability to urinate and incessant vomiting occur simultaneously. As Zhang Zhongjing said in *Shang Han Lun · Ping Mai Fa Chapter 2*: "Guan means inability to urinate, Ge means vomiting and regurgitation." Therefore, Guan Ge refers to a syndrome of vomiting and constipation/closure, with main clinical manifestations of oliguria, anuria, nausea, and vomiting. It is a critical illness, often seen in the late stages of Edema (Shui Zhong), Lin Bi (Difficulty in Urination), and Lin Zheng (Strangury). Diagnosing Guan Ge is not difficult. From clinical manifestations, besides the two main signs of frequent vomiting and scanty urine, there are also Spleen-Kidney Yang Deficiency and Yin-Blood Exhaustion signs. Nausea, vomiting, no desire to eat, waist soreness, aversion to cold, and cold limbs are all Spleen-Kidney Yang Deficiency signs. Dizziness, dry mouth without desire to drink, dry skin, pale lips and nails, little tongue coating, and fine rapid pulse are all Yin-Blood Exhaustion signs. Therefore, besides diagnosing "Guan Ge," this disease can also be diagnosed as "Xu Lao" (Deficiency Consumption).

Student B: What are the main etiology and pathogenesis of Guan Ge disease?

Teacher: The key to the pathogenesis of this disease lies in simultaneous involvement of Spleen and Kidney. The patient is elderly and weak. Due to Spleen Yang depletion and Kidney Qi exhaustion, Qi transformation loses authority, Water does not transform into Essence, generation has no source, Qi of Triple Burner (San Jiao) is blocked, control of water passages is lost, ascent/descent and entry/exit are unfavorable, thus Urinary Bladder fails to govern, leading to anuria; Spleen loses transportation, cannot ascend Clear and descend Turbid, loses its function of "transporting fluids for the Stomach," pathogenic turbidity invades Stomach, Stomach loses harmony and descent, thus frequent vomiting and no desire to eat. This is the pathology of Guan Ge where Turbid Pathogen invades Middle Jiao. There are many causes for Spleen-Kidney Yang Deficiency. The most common include: External invasion of Wind Pathogen, Lung Qi not diffusing, unable to regulate water passages, transport to Bladder, overflow into skin, Edema long-standing not healing, Damp-Water soaking damages Spleen Yang causing Spleen Yang Deficiency; or living long in damp places, wading in water/rain, Damp-Water internally invading, Dampness accumulating in middle, causing Spleen transportation failure, Dampness trapping Spleen Yang, long-standing not healing, resulting in Spleen Yang deficiency; or irregular diet, imbalance of fullness/hunger, injuring Spleen Qi, transportation fails, Damp-Turbidity generated internally, Dampness trapping Middle Jiao damaging Spleen Yang, resulting in Spleen Yang collapse; or excessive labor/fatigue, too many births, injuring Kidney Qi. Kidney governs water excretion, Spleen governs water metabolism. If Spleen-Kidney Yang Deficiency, water metabolism and excretion functions weaken, then Damp-Water floods, overflows into skin, forming Edema, scanty urine, severe cases anuria, leading to Guan Ge. Because Spleen Yang is not vigorous, unable to rot and cook food grains, Qi and Blood sources are insufficient. Qi insufficiency leads to general fatigue; Blood insufficiency leads to lack of luster in complexion, pale lips and nails, rough skin, pale tongue, deep fine pulse. This is a syndrome of Yin-Blood Deficiency.

Student C: Besides diagnosing Guan Ge, why diagnose Xu Lao for this patient? What is the basic pathogenesis?