对八法的发挥。八法是中医的治疗大法，是战胜各种疾病必须掌握的不可移易的准则。但是，以他多年临床体会，逐步认识汗、吐、下、和、温，清、消、补的具体运用，还需注意分寸，要有一分为二的观点。任何一种方法，当用而用得其法，自然应手取效。若当用不用则为失治，不当用而用则为误治，这尚较易觉察；唯当用而用之不得其法，病情往往不见改善，医家病家均认为用法无误，但终不解其何故。观《伤寒论》桂枝汤条下载：温覆令一时许，遍身漐漐，微似有汗者益佳，不可令如水流离，病必不除。寥寥数语，已道出汗法效与不效的机理。因为微似有汗为用法得当故益佳；如水流离为用法不当故病不除。先师由此悟出一个很重要的问题，即矛盾对立统一的法则。他明确提出，善用八法者必须是汗而勿伤，下而勿损，温而勿燥，寒而勿凝，消而勿伐，补而勿滞，和而勿泛，吐而勿缓。这是医学方面的两点论和辩证法。比如说：汗法用于外感疾病，能收到很好的发汗解表作用，但汗之太过，则会发生大汗亡阳的危险；补法用于虚弱病人，有增强体质恢复健康的作用，但补之不当，则引起胸腹胀满甚至衄血便燥等不良反应。他对补的意义还有进一步的见解：气以通为补，血以和为补，不用补药而达到补之目的。八法之蕴，至此大备。
精通内科尤擅温病
先师治内科病，首崇仲景学说，常谓《金匮》、《伤寒论》二书，理详法备，为方书之祖，临床医疗的准绳。下遵历代各家流派，博采刘河间之寒凉，张子和之攻下，李东垣之温阳，朱丹溪之滋阴，冶众长于一炉，以补仲景所未备，开后学之法门。他毫无偏见，集思广益，撷取精华，扬弃糟粕。大力倡导治疗以辨证论治为主，不必斤斤于经方派、时方派之争。
他说内科是临床医学的基础。古时中医虽有十三科之分，而内科向称为大方脉，包括的范围很广，加之他所治内科的病例又多为疑难大症，欲获高效不易，但由于他理论精通，学识雄厚，经验丰富，故都能把握病机，得心应手。举例如下：
(一)冠状动脉粥样硬化性心脏病(简称冠心病)
冠心病在他看来，其证心脏功能不足为虚，营卫阻滞作疼为实，但毕竟虚多实少，故治法当以补为主，通为用。自制益气和血之双和散，临床证实安全有效，是通补兼施的良方。不宜胶执活血化瘀一法，以免蹈虚虚之戒。此种创见，如同犀烛。
例一，张xx，男，年逾耳顺。体质素弱，头晕健忘，神怠思睡，胸膺闷胀，心区隐痛，气短懒言，自汗畏风，腿软作痛，不耐坐立，胃纳欠佳，口干欲饮，小便偏少，脉象两寸沉细，两关弦急左甚，两尺沉弱，舌质淡无苔。某医院确诊冠心病，师分析脉证，属心气不足，肾气亦衰，髓海渐虚，虚阳欲越，急用附子汤加减，强心益气，滋肾潜阳：西洋参、制川附于、云茯神、白芍药、制龟板、山萸肉，枸杞子、炒杜仲，怀牛膝。
阅三诊后，头晕、胸闷、隐痛、思睡、自汗等症皆明显减轻或消失，食欲略增，二便正常，脉转弦缓，左关亦不急，舌质正，苔白。原方加女贞子、五味子继续调理，日见功效。
例二，刘xx，男，花甲又二。因心肌梗塞合并心力衰竭住某医院，经抢救逐渐平稳，出院后一年中，三次发作心绞痛，常觉疲倦无力，四肢关节酸痛，心悸隐痛，足浮肿，脉象左沉细，右弦缓，舌质正，苔薄白，师诊为心气不足，兼见风湿。方用参麦散加远志，枣仁以益气养心，佐以天麻、桑枝，松节以祛风胜湿：北沙参、麦门冬、五味子、炙远志、炒枣仁、生龙骨、明天麻，嫩桑枝、干松节、化橘红、大红枣。
上方服后，患者云疗效很好，遂按此法出入，坚持服用较长时间，而病情日趋进步。
例三，于x，男，年过知非。某医院确诊冠心病。心电图检查：冠状动脉供血不足，陈旧性心肌梗塞。自觉症状，四年多来一直胸闷气短，心前区疼痛彻背，向左腋下及臂部放散，每日发作频繁，隔十余天即有类似休克样发病，兼见头昏头痛，睡眠不佳，时短易醒，易汗出，下肢浮肿，心绞痛重时则胃纳亦差，曾服中药五百余剂，多为瓜蒌薤白半夏汤或炙甘草汤加减，以及西医长期心脏用药，诸症不见改善。诊其脉左关微弦，余均沉细，舌正唇紫，微有苔薄黄，此由营卫不调，心气不足、痰湿阻滞，治宜调营卫、通心气、化痰湿，方以十味温胆汤加减：西洋参、云茯神、炒枣仁，炙远志，九节菖蒲、法半夏、化橘红、炒枳实、淡竹茹、柏子仁、紫丹参、川芎、大红枣。
二诊：头昏痛减轻，饮食略改善，咯少量黄而灰痰。此痰湿欲化之征，仍睡眠不佳，并见耳鸣，左关微弦细数，余脉同前，原方去丹参加石决明、桑寄生。
三诊：诸症悉减，心前区疼痛亦大减，每日发作次数已不频，未再发生类似休克样的表现。睡眠不实，脉象沉细，舌中心有薄黄苔。原方去大枣加宣木瓜，琥珀粉(冲)。
四诊：一般情况很好心前区偶有闷痛，脉沉细，舌苔薄白，唇已不紫，属心气已通，营卫渐和，原方略予增损，除感冒外可常服。此后病情遂趋稳定。
先师对冠心病的辨证论治，着眼于心脏功能不足。三例均属心气不足之证，但一见肾虚阳越，一兼风湿痹痛，一有痰湿阻滞，故又根据兼症不同决定治疗方法。或用经方附子汤，或用时方参麦散和十味温胆汤，加减进退各有法度，不能稍有迷惑。
(二)胃、十二指肠溃疡(简称溃疡病)先师对消化性溃疡的治疗，不单纯侧重在局部病变，而特别着眼于整体病情，往往按仲景随证治之的原则，屡获奇效。例如：
段xx，男，三十八岁。素有胃溃疡和胃出血史，大便检验潜血阳性。近因过度劳累，加之公出途遇大雨受凉，饮冷葡萄酒一杯后，突然吐血不止，精神萎靡，急送某医院救治，诊断胃溃疡大出血，经对症处理两日，大吐血仍不止，恐导致胃穿孔，决定立即施行手术，迟则将失去手术机会，患者家属有顾虑，夜半要求处方止血。师曰：吐血虽已两昼夜，若未穿孔，尚可以服中药止之。询其原因，由劳累，受寒、冷饮致血上溢，未可以凉药止之，宜用《金匮》侧柏叶汤，温通胃阳，消瘀止血；侧柏叶、炮干姜、艾叶浓煎汁，兑童便频频服之。复诊：次晨吐血渐止，脉象沉细涩，舌质淡，无苔。原方加西洋参益气止血，三七和血消瘀，仍如前法。
三诊：止血奏效，神安欲寐，知饥思食，并转矢气，脉两寸微，关尺沉弱，舌质淡无苔，此乃气弱血虚之象，但在大失血之后，脉证相符为吉。治宜温运脾阳，并养荣血，佐以消瘀，改用理中汤。加归、芍补血，佐三七消瘀。服后微觉头晕耳鸣,脉细数，为虚热上冲所致，于前方加地骨皮、生藕节，浓煎取汁，兑童便继服。
四诊；诸症悉平，脉亦和缓，渐能纳谷，但转矢气而大便不下，继宜益气补血，兼养阴润燥消瘀之品：白人参、柏子仁、肉苁蓉、火麻仁、全当归、生藕节、清阿胶(烊化)、新会皮、山楂肉，兑童便温服。
服后宿粪下。化验：潜血阴性，嘱停药，以饮食调摄，逐渐恢复健康，溃疡亦愈合，二十余年未再发。
吴xx，男，四十二岁。患十二指肠溃疡已十三年，秋、冬，春季节之交，易发胃脘疼痛，钡餐照片十二指肠球部有龛影，大便潜血阳性。近来脘腹疼痛，尤以空腹时加重，精神较差，小便黄，脉弦急，舌质红，苔亦黄，此属肝失疏泄，横逆犯胃，用四逆散合左金丸加味以疏肝和胃治之：北柴胡、白芍药、炒枳实、炙甘草、川黄连、吴茱萸、扣青皮,广木香、高良姜、大红枣。
二诊：脘痛减轻，睡眠仍差，大便不爽，小便稍黄，舌质红，苔转黄腻，脉仍弦数，乃肝胃未和，湿热渐露，改用越鞠加味，调肝胃，利湿热：炒苍术、制香附、焦栀子、川芎、建神曲、川厚朴、炒枳壳、绵茵陈、广郁金、干石斛、白通草、广木香、鸡内金。
三诊：脘腹痛消失，大便潜血阴性，食纳增加，脉缓不弦，舌质不红，苔薄黄微腻，议用散剂缓调以资巩固：赤石脂、乌贼骨、陈香橼、炙甘草、鸡内金。共为细末，每服1.5克，日两次，白开水送下。
两例溃疡病的冶则，是从病情需要决定的。当胃溃疡大出血时，急应止血，但考虑因为过劳、受寒、饮冷引起，不同于一般血热妄行，故不采用凉血止血的方法，而用温通胃阳，佐以消瘀，继之以理中温养脾阳以统其血。盖脾胃为中州之司，而甘温具固血之用。避免了一次手术，这种无创伤性医疗，给临床有所启示，无怪乎许多急腹症也用中医疗法取得成功。另一例十二指肠溃疡，由于肝胃不调，兼有湿热，故又直接以调肝胃，利湿热之法为治，与前例一温一清，形成对照，各有妙用。尤其值得探索的是先师在柏叶汤中以童便代马通，童便咸寒之性，不仅能制姜、艾之温燥，而且能止血以化瘀。在吴xx调理善后时，用赤石脂、乌贼骨于养胃中巩固收涩止血之功，并促进局部溃疡之修复，做到温而毋燥，止而不瘀，既重视整体，又注意局部，他技术娴热，运用灵活，实臻炉火纯青的高深境地。
《蒲辅周医案》中内科案例，尽皆准此。以《内经》、《金匮》为理论基础，渗透历代各家之长，善用经方，又不受经方药味的拘束，往往经方时方并用，又不失配伍的准绳。认为临床治病，总是有常有变。一般是治常易，治变难，其实善治常者，亦善治其变。他所诊疗的病人，变证较多，面对疑难症候，总是细心观察，周密思考，甚至查阅文献，务求至当，故能处变不惊，知难而进，医律愈细，疗效愈高，形成有创造性的医疗特色。
先师对于温病的经验是：
①屏弃温病学派与伤寒学派的论争。他说，伤寒、温病首见于《内经》，谓热病皆伤寒之类，《难经》则曰伤寒有五，直接把温病系于伤寒之下。《伤寒论》总结汉以前治疗外感病的经验，创立六经辨证的学说，为汉以后所宗，伤寒、温病并未严格分开，至金元开始提出温病不同于伤寒，明清两代温病学说已正式形成，叶，吴倡卫气营血和三焦辨证，于是伤寒与温病分为两大派，各立门户，各行其是，甚至互相攻讦。先师则极力屏弃此种偏见，主张扬长避短，伤寒学说开温病学说之先河，温病学说补伤寒学说之未备，应当互为充实，并行不悖。
②辨清伤寒与温病的同异。前人有始异终同之说，先师则谓始异中同终仍异。伤寒初起，寒邪侵犯太阳，其病在表，治法以辛温解表为主，温病初起时，温邪首先犯卫，其病亦在表，但治法以辛凉透邪为主。可见二者之始，病因异，病症异，治则亦异，绝对不可混同。若伤寒入里，证属阳明，寒邪化热，治宜白虎、承气；温病顺传，证属气分热邪益炽，治法自然一致。故二者之中，证治均相同，无须寻求其异。至于伤寒传人三阴，虚寒已见，则宜温宜补，温病热入营血，阴伤津灼，则宜清宜润。故二者之终，又见证治迥异，理应细加区别。
③以表与透为第一要义，以存津液为治疗根本。因为伤寒、温病，皆外因为病，邪自外入，自应驱之外出。吴鞠通说得好，伤寒非汗不解……温病亦宜汗解。唯温病以透达得汗更适宜，不可直接发汗。说明表与透是伤寒、温病的两大法门，是临床的第一要义。前贤还指出：一部《伤寒论》，不外存津液三字为根本。津液的存亡，关系温病的安危。保存一分津液，即增加一分生机。由于先师理论汇集伤寒、温病学说之所长，辨证分清伤寒、温病之区别，论治注意表与透和存津液之要领，故在温病学术上能有所建树。临床实例，以辨证较多。
例如：
朱xx，男，二十九岁。某医院确诊：流行性乙型脑炎。发病后曾服大剂辛凉苦寒及犀、羚、牛黄、至宝之品，而高烧持续不退，神识如蒙，时清时昏，目能动，口不能言，胸腹濡满，大便稀溏，口唇干，板齿燥，舌质淡，苔白，脉象寸尺弱，关沉弦，属湿温。分析脉证虚实互见，邪陷中焦之象，与邪入心包不同，用吴鞠通湿热上焦未清，里虚内陷的治法，主以人参泻心汤，去枳实加半夏，辛通苦降为法：白人参、炮干姜、川黄连、枯黄芩、法半夏、白芍药。
服后，尿多利止，胸腹满减，周身得微汗而热退。但此时邪热虽却，元气大伤，而见筋惕内瞤，肢厥汗清，脉微欲绝，有阳脱之危，急以参麦散加附子、龙牡回阳固阴：台党参、麦门冬、五味子、熟川附子、生龙骨、生牡蛎。
浓煎徐服，不拘时，渐见安睡，肢厥浙回，战栗渐止，神识略清，汗亦减少，舌齿转润，阳回阴生，脉搏徐复，后以养阴益胃法缓缓调养而愈。
此例本暑湿为病，因寒凉过甚，由热中变为寒中，邪热被遏，格拒中焦，故取泻心法。辛通苦降，病机一转，邪热顿折而大虚之候尽露，急用回阳固阴之剂，中阳以复，阴敕以存。综观治疗法度，方宗仲景，法取鞠通，伤寒、温病学说共存，经方时方并用，非先师胆识过人，曷克臻此。
Elaboration on the Eight Methods. The Eight Methods are the fundamental therapeutic principles of Traditional Chinese Medicine (TCM), which must be mastered as immutable criteria for overcoming various diseases. However, based on his years of clinical experience, he gradually realized that the specific application of sweating (Diaphoresis), vomiting (Emesis), purging (Purgation), harmonizing (Harmonization), warming (Warming), clearing (Clearing Heat), reducing (Reducing Stagnation), and tonifying (Tonification) requires attention to proportion and a dialectical perspective of "one divided into two." For any method, if it is used when indicated and applied correctly, it will naturally yield effective results. If it should be used but is not, it constitutes missed treatment; if it is used when not indicated, it constitutes erroneous treatment, both of which are relatively easy to detect. However, when a method is used inappropriately despite being indicated, the condition often fails to improve, leading both doctor and patient to believe the method was correct, yet failing to understand why. Observing the entry for Guizhi Tang (Cinnamon Twig Decoction) in *Shanghan Lun* (Treatise on Cold Pathogenic Diseases): "Cover with warm blankets for about an hour until a slight, continuous perspiration covers the whole body; this is best. Do not allow profuse sweating like water flowing away, or the disease will certainly not be cured." In just a few words, the mechanism of efficacy versus inefficacy of the sweating method is explained. Slight perspiration indicates correct application and thus efficacy; profuse sweating indicates incorrect application and thus failure to cure. From this, my former teacher grasped a very important issue: the law of unity of opposites. He explicitly stated that those who skillfully use the Eight Methods must ensure: sweating without damaging healthy Qi, purging without injuring vital energy, warming without causing dryness, clearing heat without causing stagnation, reducing without attacking healthy Qi, tonifying without causing stagnation, harmonizing without being too diffuse, and inducing vomiting without being too slow. This represents the two-point theory and dialectics in medicine. For example: the sweating method used for exterior syndromes can achieve good diaphoretic and exterior-resolving effects, but excessive sweating can lead to the danger of massive sweating and collapse of Yang; the tonifying method used for deficient patients can enhance constitution and restore health, but improper tonification can cause chest and abdominal fullness, epistaxis, or dry stool. He had further insights into the meaning of "tonification": Qi is tonified by promoting its free flow, Blood is tonified by promoting its harmony, achieving the purpose of tonification without using tonifying herbs. The connotation of the Eight Methods is thus fully prepared.
Proficient in Internal Medicine, Especially Warm Diseases
My former teacher's treatment of internal medicine first advocates the theories of Zhang Zhongjing, often stating that *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet) and *Shanghan Lun* are detailed in theory and complete in methods, serving as the ancestors of prescription books and the standards for clinical practice. He followed various schools of later generations, extensively adopting Liu Wansu's cold-cooling school, Zhang Zihe's purgative school, Li Dongyuan's warming-tonifying school, and Zhu Danxi's yin-nourishing school, melting these strengths into one furnace to supplement what Zhang Zhongjing lacked and open new paths for students. He held no prejudices, gathered wisdom from many sources, extracted essences, and discarded dregs. He vigorously advocated that treatment should focus on syndrome differentiation and treatment, avoiding petty disputes between the Classical Formula School and the Contemporary Formula School.
He said internal medicine is the foundation of clinical medicine. Although ancient TCM had thirteen departments, internal medicine was traditionally called "Da Fang Mai" (Great Pulse Department), covering a wide range. Given that his cases were mostly difficult and critical, achieving high efficiency was not easy. However, due to his profound theoretical knowledge, rich scholarship, and extensive experience, he could always grasp the pathogenesis and handle cases with ease. Examples follow:
(I) Coronary Atherosclerotic Heart Disease (Coronary Heart Disease)
In his view, the syndrome of coronary heart disease involves deficiency of heart function (deficiency) and obstruction of Ying and Wei (Nutritive and Defensive levels) causing pain (excess). However, deficiency predominates over excess, so the treatment principle should prioritize tonification, with unblocking as the application. He self-formulated Shuanghe San (Double Harmony Powder) to benefit Qi and harmonize Blood, which proved safe and effective clinically, making it an excellent formula combining unblocking and tonifying. One should not rigidly adhere only to blood-activating and stasis-resolving methods, to avoid the error of "making deficiency more deficient." This creative insight was as clear as light piercing darkness.
Case 1: Zhang xx, Male, over sixty years old. Constitutionally weak, suffering from dizziness, poor memory, mental fatigue and sleepiness, chest oppression, dull pain in the heart region, shortness of breath and reluctance to speak, spontaneous sweating and aversion to wind, weak and painful legs, inability to sit or stand comfortably, poor appetite, dry mouth with desire to drink, scanty urine. Pulse: deep and fine at both Cun (inch) positions, wiry and rapid at both Guan (middle) positions (more pronounced on the left), deep and weak at both Chi (cubit) positions. Tongue: pale with no coating. Diagnosed with coronary heart disease by a hospital. My former teacher analyzed the pulse and symptoms as insufficiency of Heart Qi, decline of Kidney Qi, gradual emptiness of the Marrow Sea, and floating of deficient Yang. Urgently prescribed Fuzi Tang (Aconite Decoction) modified to strengthen the heart, benefit Qi, nourish the Kidney, and anchor Yang: American Ginseng, Processed Chuanwu (Aconite Root), Yun Shen (Poria), White Peony Root, Processed Tortoise Shell, Cornus Fruit, Goji Berry, Stir-fried Du Zhong (Eucommia Bark), Huai Niu Xi (Achyranthes Root).
After three consultations, dizziness, chest tightness, dull pain, sleepiness, and spontaneous sweating significantly decreased or disappeared. Appetite slightly increased, bowel movements and urination normalized, pulse became wiry and moderate, left Guan position no longer rapid, tongue color normal with white coating. Added Nu Zhen Zi (Ligustrum Fruit) and Wu Wei Zi (Schisandra Berry) to the original formula for continued regulation, showing daily improvement.
Case 2: Liu xx, Male, sixty-two years old. Hospitalized for myocardial infarction complicated by heart failure, stabilized after rescue. Within one year post-discharge, experienced angina pectoris three times, often feeling fatigued and weak, soreness and pain in limbs and joints, palpitations and dull pain, foot edema. Pulse: left deep and fine, right wiry and moderate. Tongue: normal color, thin white coating. Diagnosed by my former teacher as insufficiency of Heart Qi combined with Wind-Dampness. Prescribed Shenmai San (Ginseng and Ophiopogon Decoction) plus Yuan Zhi (Polygala Root) and Zao Ren (Ziziphus Seed) to benefit Qi and nourish the Heart, assisted by Tian Ma (Gastrodia Rhizome), Sang Zhi (Mulberry Twig), and Song Jie (Pinus Node) to dispel Wind and overcome Dampness: Bei Sha Shen (Glehnia Root), Mai Men Dong (Ophiopogon Tuber), Wu Wei Zi, Roasted Yuan Zhi, Stir-fried Zao Ren, Raw Long Gu (Dragon Bone), Ming Tian Ma, Tender Sang Zhi, Dry Song Jie, Hua Ju Hong (Citrus Peel), Large Red Date.
After taking the above prescription, the patient reported good efficacy. Continued taking variations of this method for a long time, with progressive improvement.
Case 3: Yu x, Male, over fifty years old. Diagnosed with coronary heart disease. ECG showed coronary artery insufficiency and old myocardial infarction. Subjective symptoms for over four years: persistent chest tightness and shortness of breath, pain in the precordial area radiating to the back, left axilla, and arm, frequent daily attacks, shock-like episodes every ten-plus days, accompanied by dizziness and headache, poor sleep, frequent waking, easy sweating, lower limb edema, poor appetite during severe angina. Had taken over five hundred doses of Chinese medicine, mostly Gua Lou Xie Bai Ban Xia Tang (Trichosanthes, Macrostemon, and Pinellia Decoction) or Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) modified, along with long-term Western cardiac medications, with no improvement. Pulse: left Guan slightly wiry, others deep and fine. Tongue: normal color, purple lips, thin yellow coating. Attributed to disharmony of Ying and Wei, insufficiency of Heart Qi, and obstruction by Phlegm-Dampness. Treatment aimed to harmonize Ying and Wei, unblock Heart Qi, and resolve Phlegm-Dampness. Prescribed Shiwei Wendan Tang (Ten-Ingredient Gallbladder-Warming Decoction) modified: American Ginseng, Yun Shen, Stir-fried Zao Ren, Roasted Yuan Zhi, Jiu Jie Chang Pu (Acorus Rhizome), Fa Ban Xia (Pinellia Tuber), Hua Ju Hong, Stir-fried Zhi Shi (Immature Bitter Orange), Dan Zhu Ru (Bamboo Shavings), Bai Zi Ren (Biota Seed), Zi Dan Shen (Salvia Miltiorrhiza), Chuan Xiong (Ligusticum Rhizome), Large Red Date.
Second consultation: Dizziness and headache reduced, diet slightly improved, expectorated small amount of yellow-gray sputum. Sign of resolving Phlegm-Dampness. Still poor sleep and tinnitus. Left Guan pulse slightly wiry, fine, and rapid, others same as before. Removed Dan Shen from original formula, added Shi Jue Ming (Abalone Shell) and Sang Ji Sheng (Taxillus Branch).
Third consultation: All symptoms significantly reduced, precordial pain greatly decreased, attack frequency lowered, no more shock-like episodes. Sleep remains unsettled, pulse deep and fine, thin yellow coating in center of tongue. Removed Large Red Date from original formula, added Xuan Mu Gua (Papaya Fruit) and Hu Po Fen (Amber Powder, taken with liquid).
Fourth consultation: General condition very good, occasional dull pain in precordial area, pulse deep and fine, tongue coating thin white, lips no longer purple. Indicates Heart Qi is unblocked, Ying and Wei gradually harmonized. Slightly adjusted original formula, can be taken regularly except during colds. Condition subsequently stabilized.
My former teacher's syndrome differentiation and treatment of coronary heart disease focused on insufficient heart function. All three cases belonged to Heart Qi insufficiency, but one presented with Kidney deficiency and floating Yang, one combined with Wind-Damp Bi pain, and one with Phlegm-Damp obstruction. Thus, treatment methods were determined according to accompanying symptoms. Used either the classical formula Fuzi Tang, or contemporary formulas Shenmai San and Shiwei Wendan Tang, with modifications following strict rules, leaving no room for confusion.
(II) Gastric and Duodenal Ulcers (Peptic Ulcer Disease)
My former teacher's treatment of peptic ulcer disease did not solely focus on local lesions but particularly emphasized the overall condition, often achieving remarkable effects by following Zhang Zhongjing's principle of treating according to the syndrome. For example:
Duan xx, Male, thirty-eight years old. History of gastric ulcer and gastrointestinal bleeding, fecal occult blood positive. Recently, due to overwork, exposure to rain and cold while traveling, and drinking a glass of cold wine, suddenly began vomiting blood continuously, spirit listless, urgently sent to hospital. Diagnosed with massive gastric ulcer bleeding. After two days of symptomatic treatment, massive hematemesis continued. Fearful of gastric perforation, immediate surgery was decided; delay would mean losing the surgical opportunity. Family members had concerns, requested a prescription for hemostasis at midnight. My former teacher said: Although vomiting blood has lasted two days and nights, if perforation has not occurred, Chinese medicine can still stop it. Inquiry revealed the cause was overwork, cold exposure, and cold drinks causing blood to overflow upward. Cooling medicines should not be used. Should use Ce Bai Ye Tang (Platycladus Leaf Decoction) from *Jinkui Yaolue* to warmly unblock Stomach Yang, dissipate stasis, and stop bleeding: Ce Bai Ye (Platycladus Leaf), Pao Gan Jiang (Roasted Ginger), Ai Ye (Mugwort Leaf) decocted strongly, mixed with Tong Bian (Child's Urine), taken frequently. Follow-up: Next morning, vomiting blood gradually stopped. Pulse: deep, fine, and choppy. Tongue: pale, no coating. Added American Ginseng to original formula to benefit Qi and stop bleeding, San Qi (Notoginseng Root) to harmonize Blood and dissipate stasis, continuing previous method.
Third consultation: Hemostasis effective, spirit calm, desiring sleep, aware of hunger and food, passing flatus. Pulse: faint at both Cun, deep and weak at Guan and Chi. Tongue: pale, no coating. Image of Qi deficiency and Blood deficiency, but after massive blood loss, pulse and symptoms matching is auspicious. Treatment should warmly transport Spleen Yang, nourish Ying Blood, assist with dissipating stasis. Changed to Lizhong Tang (Regulate the Middle Decoction). Added Dang Gui (Angelica Root) and Bai Shao (White Peony Root) to tonify Blood, assisted by San Qi to dissipate stasis. After taking, felt slight dizziness and tinnitus, pulse fine and rapid, caused by deficient heat rushing upward. Added Di Gu Pi (Lycium Bark) and Sheng Ou Jie (Raw Lotus Node) to the front formula, decocted strongly, mixed with Child's Urine to continue taking.
Fourth consultation: All symptoms resolved, pulse harmonious and moderate, gradually able to eat, but passing flatus without defecation. Continue benefiting Qi and tonifying Blood, combined with Yin-nourishing, moistening, and stasis-resolving agents: Bai Ren Shen (White Ginseng), Bai Zi Ren, Rou Cong Rong (Cistanche Stem), Huo Ma Ren (Hemp Seed), Quan Dang Gui, Sheng Ou Jie, Qing E Jiao (Donkey-Hide Gelatin, melted), Xin Hui Pi (Tangerine Peel), Shan Zha Rou (Hawthorn Flesh), mixed with Child's Urine, taken warm.
After taking, accumulated stool passed. Lab test: Occult blood negative. Advised to stop medication, regulate diet, gradually recover health. Ulcer healed, no recurrence for over twenty years.
Wu xx, Male, forty-two years old. Suffering from duodenal ulcer for thirteen years. Prone to epigastric pain at transitions of Autumn, Winter, and Spring seasons. Barium meal X-ray showed niche in duodenal bulb, fecal occult blood positive. Recently, epigastric and abdominal pain, worsened on empty stomach, poor spirit, yellow urine, wiry and rapid pulse, red tongue, yellow coating. Belonged to Liver failing to course freely, invading Stomach horizontally. Used Si Ni San (Frigid Extremities Powder) combined with Zuo Jin Wan (Left Metal Pill) modified to soothe Liver and harmonize Stomach: Bei Chai Hu (Bupleurum Root), Bai Shao, Stir-fried Zhi Shi, Roasted Gan Cao (Licorice Root), Chuan Huang Lian (Coptis Rhizome), Wu Zhu Yu (Evodia Fruit), Kou Qing Pi (Green Tangerine Peel), Guang Mu Xiang (Vladimiria Root), Gao Liang Jiang (Galangal Rhizome), Large Red Date.
Second consultation: Epigastric pain reduced, sleep still poor, bowel movement unsatisfactory, urine slightly yellow, tongue red, coating turned yellow and greasy, pulse still wiry and rapid. Liver and Stomach not harmonized, Damp-Heat emerging. Changed to Yueju San modified to regulate Liver and Stomach, promote Damp-Heat resolution: Stir-fried Cang Zhu (Atractylodes Rhizome), Zhi Xiang Fu (Cyperi Rhizome), Jiao Zhi Zi (Gardenia Fruit), Chuan Xiong, Jian Shen Qu (Medicated Leaven), Chuan Hou Po (Magnolia Bark), Stir-fried Zhi Qiao (Bitter Orange), Mian Yin Chen (Artemisia Capillaris), Guang Yu Jin (Curcuma Root), Gan Shi Hu (Dendrobium Stem), Bai Tong Cao (Tetrapanax Pith), Guang Mu Xiang, Ji Nei Jin (Chicken Gizzard Lining).
Third consultation: Epigastric and abdominal pain disappeared, fecal occult blood negative, appetite increased, pulse moderate and not wiry, tongue not red, thin yellow and slightly greasy coating. Proposed powder form for slow regulation to consolidate: Chi Shi Zhi (Red Halloysite), Hai Piao Xiao (Cuttlefish Bone), Chen Xiang Yuan (Citron), Roasted Gan Cao, Ji Nei Jin. Pulverized finely, take 1.5g each time, twice daily, with plain boiled water.
The treatment principles for these two ulcer cases were determined by clinical needs. When facing massive gastric ulcer bleeding, urgent hemostasis was required. Considering it was caused by overwork, cold exposure, and cold drinks, different from general reckless bleeding due to Blood-Heat, cooling-blood hemostatic methods were not adopted. Instead, warming and unblocking Stomach Yang, assisting with stasis resolution, followed by Lizhong Tang to warmly nourish Spleen Yang to control Blood was used. Since Spleen and Stomach are the pivot of the Middle Jiao, sweet-warm herbs have the function of consolidating Blood. This avoided one surgery. This non-traumatic medical approach offers inspiration to clinical practice, explaining why many acute abdominal conditions also succeed with TCM therapy. The other case of duodenal ulcer, due to Liver-Stomach disharmony combined with Damp-Heat, was directly treated by regulating Liver and Stomach and promoting Damp-Heat resolution. Contrasting with the previous case (one warming, one clearing), each had its unique efficacy. Particularly worth exploring is my former teacher's substitution of Tong Bian (Child's Urine) for Ma Tong (Horse Dung Juice) in Bai Ye Tang. The salty-cold nature of Tong Bian not only counteracts the warming-dryness of Ginger and Mugwort but also stops bleeding while resolving stasis. During Wu xx's recovery phase, Chi Shi Zhi and Hai Piao Xiao were used to consolidate astringent hemostatic effects within Stomach-nourishing measures, promoting local ulcer repair, achieving warmth without dryness, stopping bleeding without causing stasis, valuing both the whole body and local aspects. His technique was skilled and flexible, reaching a state of perfection.
Internal medicine cases in *Pu Fuzhou Yi An* (Medical Cases of Pu Fuzhou) all conform to this. Based on *Neijing* (Inner Canon) and *Jinkui Yaolue*, penetrating the strengths of various schools through history, skillfully using classical formulas without being constrained by their ingredients, often combining classical and contemporary formulas while maintaining compatibility standards. He believed clinical treatment always involves constancy and change. Generally, treating constancy is easy, treating change is difficult; however, those skilled in treating constancy are also skilled in treating change. Patients he diagnosed had many variable syndromes. Facing difficult symptoms, he always observed carefully, thought meticulously, even consulted literature, striving for appropriateness. Thus, he remained calm amidst changes, advanced despite difficulties, refined his medical laws, increased efficacy, forming a creative medical characteristic.
My former teacher's experience with Warm Diseases is:
① Discarding the debate between the Warm Disease School and the Cold Damage School. He said, Cold Damage and Warm Diseases first appeared in *Neijing*, stating all febrile diseases are types of Cold Damage. *Nanjing* states there are five types of Cold Damage, directly classifying Warm Diseases under Cold Damage. *Shanghan Lun* summarized Han dynasty experiences in treating exogenous diseases, established Six Meridian Syndrome Differentiation, becoming the model for post-Han times. Cold Damage and Warm Diseases were not strictly separated. Starting from Jin-Yuan dynasties, it was proposed that Warm Diseases differ from Cold Damage. By Ming-Qing dynasties, Warm Disease theory formally formed. Ye Tianshi and Wu Jutong advocated Wei-Qi-Ying-Blood and San Jiao (Triple Burner) syndrome differentiation. Thus, Cold Damage and Warm Diseases split into two major schools, establishing separate gates and acting independently, even attacking each other. My former teacher vigorously discarded such prejudice, advocating leveraging strengths and avoiding weaknesses. Cold Damage theory paved the way for Warm Disease theory; Warm Disease theory supplemented what Cold Damage theory lacked. They should mutually enrich each other and coexist without contradiction.
② Clarifying similarities and differences between Cold Damage and Warm Diseases. Predecessors had the saying "start different, end same." My former teacher said "start different, middle same, end still different." Cold Damage onset: Cold Evil invades Taiyang, disease is in the Exterior, treatment primarily uses Acrid-Warm Exterior-Resolving methods. Warm Disease onset: Warm Evil first attacks Wei level, disease is also in the Exterior, but treatment primarily uses Acrid-Cool Expelling-Evil methods. Thus, at the start, etiology, symptoms, and treatment principles differ; they absolutely cannot be confused. If Cold Damage enters the Interior, syndrome belongs to Yangming, Cold Evil transforms into Heat, treatment should use Baihu Tang (White Tiger Decoction) and Chengqi Tang (Order the Qi Decoction). If Warm Diseases transmit smoothly, syndrome belongs to Qi Level with intensified Heat Evil, treatment naturally becomes consistent. Thus, in the middle stage, syndrome and treatment are identical, no need to seek differences. As for Cold Damage transmitting to Three Yin, deficiency-cold appears, requiring warming and tonification. Warm Diseases entering Ying and Blood levels, Yin injury and fluid scorching appear, requiring clearing and moistening. Thus, at the end, symptoms and treatments are vastly different, requiring careful distinction.
③ Prioritizing Exterior and Unblocking, regarding preserving Body Fluids as the fundamental treatment goal. Because Cold Damage and Warm Diseases are caused by external factors, evils enter from outside and should be driven out. Wu Jutong said well: Cold Damage cannot be resolved without sweating... Warm Diseases should also be resolved by sweating. However, for Warm Diseases, obtaining sweat through unblocking is more suitable; direct sweating should not be used. This shows Exterior and Unblocking are the two major gates for Cold Damage and Warm Diseases, the primary concern in clinical practice. Predecessors also pointed out: *Shanghan Lun* essentially revolves around the three characters "preserve Body Fluids" as the root. The survival or loss of Body Fluids relates to the safety or danger of Warm Diseases. Preserving one unit of Body Fluids increases one unit of vitality. Since my former teacher's theory collected the strengths of both Cold Damage and Warm Disease schools, differentiated Cold Damage and Warm Diseases in syndrome differentiation, and noted the essentials of Exterior/Unblocking and preserving Body Fluids in treatment, he achieved achievements in Warm Disease academia. Clinical examples are mostly based on syndrome differentiation.
For example:
Zhu xx, Male, twenty-nine years old. Hospital diagnosed: Epidemic Encephalitis B. After onset, took large doses of Acrid-Cool Bitter-Cold herbs and Rhinoceros Horn, Antelope Horn, Bovine Gallstone, Zhibao Wan (Treasure Pill), but high fever persisted, consciousness clouded, alternating clarity and coma, eyes could move, mouth could not speak, chest and abdomen soft and full, loose stools, dry lips, dry teeth, pale tongue, white coating, pulse weak at Cun and Chi, deep and wiry at Guan. Belonged to Damp-Warmth. Analyzing pulse and symptoms, deficiency and excess intermixed, image of Evil sinking into Middle Jiao, different from Evil entering Pericardium. Used Wu Jutong's treatment method for Damp-Heat in Upper Jiao not cleared, interior deficiency with internal sinking. Mainly used Renshen Xiexin Tang (Ginseng Drain the Heart Decoction), removed Zhi Shi, added Ban Xia, using Acrid-Unblocking and Bitter-Descent method: Bai Ren Shen (White Ginseng), Pao Gan Jiang, Chuan Huang Lian, Ku Huang Qin (Scutellaria Root), Fa Ban Xia, Bai Shao.
After taking, urine increased, diarrhea stopped, chest and abdominal fullness largely reduced, slight sweat over body, heat subsided. But at this time, although evil heat receded, Yuan Qi was severely damaged, presenting with muscle twitching and internal tremors, cold extremities, clear sweat, pulse faint and nearly absent, danger of Yang collapse. Urgently used Shenmai San plus Fuzi (Aconite), Long Gu (Dragon Bone), Mu Li (Oyster Shell) to return Yang and secure Yin: Tai Dang Shen (Codonopsis), Mai Men Dong, Wu Wei Zi, Shu Chuan Fu Zi, Raw Long Gu, Raw Mu Li.
Decocted strongly, taken slowly, anytime. Gradually saw peaceful sleep, extremities warmed, tremors stopped, consciousness slightly cleared, sweat decreased, tongue and teeth moistened, Yang returned, Yin generated, pulse slowly recovered. Later, slowly regulated and healed using Yin-nourishing and Stomach-benefiting method.
This case originally involved Summerheat-Dampness disease. Due to excessive cold-cooling, it changed from Heat-center to Cold-center. Evil heat was suppressed, rejecting in the Middle Jiao, hence the Xiexin method was taken. Acrid-unblocking and bitter-descent turned the pathogenesis, evil heat abruptly broke, and signs of great deficiency were fully exposed. Urgently used agents to return Yang and secure Yin, restoring Middle Yang and preserving Yin. Viewing the treatment methods comprehensively, formulas followed Zhongjing, methods adopted Jutong, Cold Damage and Warm Disease theories coexisted, classical and contemporary formulas combined. Without my former teacher's extraordinary courage and insight, how could this be achieved?