高xx，男，七岁。住某医院已三日，诊为流行性乙型脑炎，患儿高烧躁扰，腹满下利，呕恶，予水则拒，爪甲青，面青，日夜不安睡，时而狂叫，亦不食，苔黄少津，唇干，脉象沉数弦急，昏用寒凉重剂及犀羚、牛黄、至宝等病势不减，乃热邪内陷阴中，从太阴寒化，厥阴蛔欲动之象。予以椒梅汤去黄芩、法夏:台党参，川黄连、白芍药、乌梅肉、川花椒、炮干姜，炒枳实。
浓煎温服，一剂热退，睡安躁减。再剂利止，胀消烦除，并下蛔虫一条。续以温脾和胃调治以竟其功。
此亦因服用寒凉太早、太过，已成寒中变证，而苔黄、唇干，脉弦数且急，仍与热中相似，其间仅爪甲青、面青、拒水之差。在疏方时去黄芩、半夏，原因曾服苦寒重坠之剂过多，故减其制，有枳实之苦降，黄连之苦泄，已适中病机。不执成方不变。且椒梅汤系仲景乌梅汤化裁而来，与前例寒中之见证不同，故选方亦异。
梁xx，男，二十八岁。住某医院，诊断为流行性乙型脑炎。病已六日，曾连用清热、解毒、养阴之剂，而病势有增无减，体温高达40．3摄氏度，脉象沉数有力，腹满微硬，哕声连续，目赤不闭，无汗，神昏谵语，烦躁不宁，四肢妄动，有欲狂之势，手足微厥，昨日已见下利纯青黑水，此属热邪羁于阳明、热结旁流之证，但未至大实满，且苔秽腻，色不老黄，未可与大承气汤，乃以小承气汤微和之。服后，哕止便通，汗出厥回，神清热退，改用生津益胃，续清余邪之剂以资恢复。
一般认为乙型脑炎，多属暑温范畴，清热、解毒、养阴，是正治法，何以本例用之无效?盖因患者已见阳明里热，谵语欲狂，身热无汗，目赤肢厥，脉沉数有力，此乃里闭表郁之征，而且热结旁流，非清热，解毒、养阴所能解，必须下之，下之则里通而表自和。若泥于温病忌下之禁，当下不下，里愈结，表愈郁，热炽津伤，造成内闭外脱者有之。先师对用下法极端审慎，但只要病情急需，又毫不犹疑，非独具匠心，处重果断，岂足望其端倪。
先师既精内科，尤擅温病，已散见于《蒲辅周医案》等书中。其不传之秘，完全自勤奋治医得来。以《内经》、《伤寒论》的理论为经，以刘河间、叶天土、吴鞠通、王孟英各家学说为纬。并对余师愚、杨栗山等有关瘟疫论著，亦悉得其奥。同时，还重视中西医结合，从西医的学术中吸取营养，促成了他在温病学方面的创造和发展。
兼长妇儿独具特点
先师非止精内科，还兼长妇、儿。对昔贤宁医十男子，毋医一妇人；宁医十妇人，毋医一小儿之说，认为不切实际。似乎妇、儿较内科难，其实只有见证的异同，并无本质的区别。由于妇、儿的生理，病理特性，妇科有经、带、胎、产，儿科有麻、痘、惊、疳等证外，其余疾病常与内科同。他不囿于分科的局限，而是综合具体情况，进行具体分析，根据辨证论治的理论原则，既有区别，又有同一，形成与内科并行不悖，独具特点的妇、儿医疗经验。
他对妇科疾病的诊治，颇多独到之处。积累的心得体会主要有三点：
(一)妇科以调理气血为主女子二七天癸至，七七天癸绝，乃生理之常。生理失常则月事不以时下，故医家论妇人疾病之治，首重血分，采用寒则温之，热则清之，虚则补之，实则泻之(瘀者行之，滞者通之)等原则，亦治疗的常法。但是，血为气母，气为血帅，气行则血行，气滞则血瘀，气通血和则诸病不起。故治血必须理气。所以，妇科以调理气血为主。
(二)妇女病以舒肝和脾为重要环节《内经》指出，百病皆生于气。尤其妇女在中年时期，由于各种因素，情志怫郁为多，往往肝气郁结，气郁则血滞，而致月经不调、痛经和经闭等症。《内经》又说，二阳之病发心脾，有不得隐曲，女子不月。这又说明了月经病与脾的关系密切。脾不统血则可引起崩漏，脾湿下困则可导致带下，妊娠脾气不足而食减则胎失所养，产后脾阳不振则影响乳汁分泌等，莫不与脾有关。故舒肝和脾是治疗妇人病的重要环节。
(三)妇人杂病仍以辨证论治为根本原则《金匮》论妇人病凡三篇，除妊娠、产后外，则以杂病目之。所谓杂病，即其证情比较错综复杂，又与妇科有联系，如中风、伤寒而月经适来，热入血室者，可与小柴胡汤和之，亦可以刺期门，随其实而取之；有与妇科无联系而属内科的，如喉间炙脔之梅核气者，可用半夏厚朴汤调之，证夹虚寒而腹中痛者，可用小建中汤温之，有与外科相似的，如阴中蚀疮烂者，则以狼牙汤外洗之，等等。诸凡妇人杂病，总离不开辨证论治这一根本原则。
他的妇科治验，不越这三条心得体会。
徐xx，女，二十九岁。多年来月经愆期，每次经行时间长而量多，有黑色血块，小腹凉痛，脉象沉迟微涩，舌质稍暗，苔薄白，属气血不调，肝郁夹瘀。治宜调理气血为主，佐以舒肝化瘀，全当归、川芎、官桂、吴茱萸、荆三棱、蓬莪术、制香附、川楝子、延胡索、大茴香。水煎服，日两次。香附丸，每晚睡前白开水送服6克。
阅二月余，月经略有改善，虽仍有小黑血块，小腹已无不适。脉象沉缓不清，舌正，苔薄白。
首次汤方，经期继服。经过后，临睡前服定坤丹9克，化症回生丹(梧桐子大)1～2丸。
又半年后，月经周期较准，量不多，血块很少，经行五天即净。脉沉缓，舌正苔白，仍宗前法，继进一月，以资巩固。
李xx，女，三十八岁。半年来经水零星不断，上半月较多，下半月较少，色紫，时有小块。小腹痛，恶凉喜热，月前于某医院行刮宫术治疗，仍不断流血，血色时紫时红，腰及小腹疼痛，口干喜大量热饮，食纳极差，胃脘堵塞，大便秘，三、四日一行，小便正常，心慌，眠差，多恶梦，疲乏无力，曾服中药和蜂王浆等，效不显，脉象两寸尺弱，两关革，舌质淡微暗，无苔，此属经漏，由气血损伤，兼瘀结。治宜调补气血，温化窃结：炒艾叶、清阿胶(烊化)、全当归、川芎，白芍药、干地黄、川续断、炮干姜，海螵蛸、嫩桂枝、炒白术、柏子仁、茜草。
复诊：前方服三剂，心慌减轻，胃脘胀塞亦轻，食纳见增，阴道流血似多些，有黑色血块，余症同前，脉象舌苔亦无变化，原方去柏子仁加杜仲、黑豆继服。
三诊、四诊；仍加减施治，而病情小有进步。
五诊：因劳累阴道流血又稍多，脉寸尺弱，关弦虚，舌淡无苔。因失血过久，冲任不固，小有操劳，血即失御。治宜强肝肾，固冲任；热地黄、炒白术、鹿角霜、阿胶珠、炒杜仲、川续断、山萸肉、肉苁蓉、炮干姜。
六诊：加地榆。七诊：流血已基本停止，尚有少量粉色液体，胃纳仍欠佳，偶有心悸，余症均消失，脉寸尺弱，两关沉细，据病程长，流血多，心肝脾俱虚，以人参归脾丸缓缓补益，继服一月，血止经调。
黄xx，女，三十岁。半年前曾因月经流血过多，施行刮宫术一次，术后又因淋漓不止，住院治疗两月之久。以后每次经行，仍然大量出血，常致休克，必须至医院进行急救，注射止血针等。月经周期不准，有时为半年一次，有时二十多天，来时有鲜红血块，四肢酸痛难移，头痛，头眩，耳鸣，心慌，面色苍白，食欲不振。诊其脉象右微左涩，舌中心裂如镜。由去血过多，气血两亏，而止之过急，络中瘀滞，因而脉证虚实互见。但毕竟虚多实少，虚者当补，实者当消，拟益血养荣为主，消瘀为佐；鹿角霜、制龟板、红人参、川续断，炒白术、补骨脂、海螵蛸、炒杜仲、龙眼肉。每晨并服化瘀回生丹20丸。
复诊，服后腰痛、腹痛均见减轻，精神亦转佳，因其经前心中紧张喜哭，脉沉迟无力，有脏燥现象，原方参入甘麦大枣汤意：制龟板、川附于、巴戟天、补骨脂、炙甘草、浮小麦、炒杜仲、炒白术、大红枣。
三诊：因其腰痛月半未愈，自腰部至两大腿中部有时酸痛，有时刺痛，改进温补肾阳而强腰膂之法：黄附片，炒白术，炒杜仲、补骨脂、大熟地、枸杞子、桑寄生，川牛膝、鹿角胶(烊化)。
四诊：症状虽有好转，但尚未见显著进步，总由失血过多，气亦大伤，内不足荣脏腑，外不足濡筋骨而利关节，继宜培气血，强心肾，建中气：西洋参，炙甘草、广陈皮、炒白术、云茯神、龙眼肉、淮山药、淡苁蓉、制龟板、阳春砂仁，加姜、枣煎服。
连服十剂，症状大好，全身亦不感太累，又按原方再进，另用参茸卫生丸，每日2丸，分早晚两次开水送下。四十日后，月经来潮五日，血量仅较一般略多，腰腿痛均减大半，并能停止一切西药，给予黄芪建中汤加术、附，早晚另服右归丸。经过两个月，经行已趋正常，月经逾期十六天未来，青蛙试验阳性，已怀孕矣。
以上三例，不难看出，妇人之病，大要以气血为主。徐案月经愆期，故直接调和气血，佐以化瘀而收效甚速。李案经漏半载，除调气、化瘀结外，又继以强肝肾而固冲任，终则心肝脾并调而竟其功。黄案为血崩大症，甚则休克，其气血两亏可知。但止之过急，往往留血成瘀，故第一步以益气补血为主，消瘀为佐，血虚则肝失所养，欲作脏燥，肝苦急，急食甘以缓之，故第二步参入甘麦大枣，气为血帅，血虚则气无所附，故第三步建立中气以统血，则气血调而月事以时下，二五媾精而孕以成。
至若虽属月经为病，而病因不同，有从内科角度辨证论治的，如：
何xx，女，二十一岁，未婚。三年前因寒夜室外大便，感受寒风晕倒，此后每次月经来潮时，即发生麻木抽摘，经后始平。经行腹痛，量多，有紫血块。曾经各医院治疗二年余，未见显效。诊其脉象弦虚，舌正无苔，乃本体血虚，风冷之气乘虚自于户而入，邪气附着，营卫失和，以致经期抽搐。治宜调和营卫，祛风散寒，方用当归四逆汤加减；全当归、桂枝尖，吴茱萸、北细辛、生黄芪，白芍药，北防风，川芎、桑寄生，加姜、枣。
下月行经，即无抽搐，但觉麻木未除，仍用前法。经净后，即停汤剂，早晚各眼十全大补丸6克。再至下月经期，麻木亦微，唯腹部仍有不适感，已不似从前疼痛，经期仍服汤剂，经后早晚各服十全大补丸6克，晚服虎骨木瓜丸6克。数月后诸症平，经期已复正常。
此例某医院检查，血中之磷、钙均较正常人减少，自服中药后，不仅症状逐渐消失，且血中磷，钙亦转正常，这里是由病愈而磷，钙自动恢复，抑药物有促进磷，钙之增长作用，是值得探索的。
吕xx，女，成年，已婚。月经不准已十余年，周期或早或迟，血量亦或多或少，平时小腹重坠作痛，经前半月即痛渐加剧，既行痛止，经后流黄水十余天。结婚十年，从未孕育。近三个月月经未行，按脉沉数，舌苔黄腻，面色不泽。曾用温脾化湿、和血调经法治疗两次，未见疗效，因之仔细询其病因：冬令严寒，适逢经期，又遇大惊恐，黑夜外出，避居风雪野地，致经水突然停止，从此月经不调，或数月一行，血色带黑，常患腰痛、四肢关节痛、白带多等症。据此由内外二因成病，受恐怖而气乱，感严寒而血凝，治法亦宜内调气血。外去风寒。遂予虎骨木瓜丸，早晚各服6克，不数日月经见而色淡挟块，小腹觉胀，脉象沉迟，汤用；金铃子散、四物去地黄加桂枝、吴萸、藁本、细辛。经净后仍予虎骨木瓜丸，经行时再予金钤子散和四物汤加减。如此更迭使用，经过三个多月的调理，经行而色正常，量亦较多，改用桂枝汤加味调和营卫。因病情基本好转，一段时间用八珍丸调补。
此后或因劳动，或其他因紊，仍有痛经症状。治法不离调经和血，平时又兼见胃痛、腰痛和腹泻等症，则另用温中化浊、活络等法，随证施治。由于病史较长，症状复杂，经过一年多诊治，逐渐平静，并获妊娠，足月顺产。
本例病程历十二年之久，经中西医治疗，恒以神经衰弱、气血两虚进行调理，但始终未中病机，卒无成效。先师初诊，亦以温脾化湿，和血调经，不见改善。乃详溯病因，得知由经期突遭大恐，受严寒冰雪侵袭，因而经乱渐停，诸症丛生。《内经》：恐则气下……惊则气乱。正在经期，气乱血亦乱，兼受严寒，以致血涩气滞。明其所因后，改用内调气血、外祛风寒之法，病情逐渐好转，调理一年，而十二年之沉痼，竟获根除，婚后九年不孕，终得有子。病家传颂先师为妇科大师，回春有术，诚非过誉。
儿科昔称小方脉，又曰哑科。先师则谓儿科应学居首位，不可目之为小方脉，且婴儿包括儿童不能主诉病苦，或述之不详不确，全赖医者之细心体察，分析病家代诉，方能做到辨证论治精确无误。由于他深明儿科的重要性，加之临床阅历深，见识广，经验丰富，从实践到理论，再从理论到实践，心得良多。
Gao XX, male, seven years old. Hospitalized in a certain hospital for three days, diagnosed with epidemic encephalitis B. The child had high fever and restlessness, abdominal distension with diarrhea, vomiting and nausea, refused water, cyanotic nails, dark blue complexion, unable to sleep peacefully day or night, occasionally screaming, not eating, yellow tongue coating with little fluid, dry lips, pulse deep, rapid, wiry, and urgent. Previously treated with heavy cold-cooling agents as well as rhinoceros horn, antelope horn, realgar, and Zhibao pills, but the disease condition did not subside. This indicates that heat pathogen has sunk into the Yin aspect, transforming from Taiyin cold transformation, showing signs of Ascaris moving in Jueyin. Prescribed Jiaomei Tang (Pepper and Plum Decoction), removing Scutellariae Radix (Huangqin) and Pinelliae Rhizoma Preparatum (Faxia); adding Codonopsis Radix (Taidangshen), Coptidis Rhizoma (Chuanlianzhong), Paeoniae Radix Alba (Baishao), Prunus mume flesh (Wumei rou), Zanthoxylum Pericarpium (Chuanhuajiao), dried ginger prepared with sand (Paoganjiang), and Stemonae Rhizoma stir-fried with bran (Chaozhishi).
Decocted thickly and taken warm. After one dose, fever subsided, sleep became peaceful, restlessness decreased. After another dose, diarrhea stopped, distension resolved, thirst eliminated, and one Ascaris was expelled. Subsequently continued treatment with spleen-warming and stomach-harmonizing medications to complete the cure.
This is also due to the premature and excessive use of cold-cooling drugs, resulting in a cold-middle syndrome variation. Although the tongue coating is yellow, lips are dry, and pulse is wiry, rapid, and urgent, resembling heat syndrome, the difference lies only in cyanotic nails, dark blue complexion, and water refusal. When prescribing, Huangqin and Faxia were removed because the patient had already taken too many bitter-cold and heavy-sinking agents, so their dosage was reduced. With the bitter-descending action of Zhishi and the bitter-draining action of Chuanlian, it already fits the pathogenesis. One should not rigidly adhere to established formulas without change. Moreover, Jiaomei Tang is derived from Zhang Zhongjing's Wumei Wan, which differs from the previous case of cold-middle syndrome; hence, the formula selection is different.
Liang XX, male, twenty-eight years old. Hospitalized in a certain hospital, diagnosed with epidemic encephalitis B. Ill for six days, previously treated continuously with heat-clearing, detoxifying, and yin-nourishing agents, but the disease progressed rather than improved. Body temperature reached 40.3°C. Pulse was deep and rapid with force. Abdominal distension with slight hardness, continuous hiccups, red eyes unable to close, no sweat, coma with delirious speech, irritability, restless limbs, showing signs of mania, slight coldness in hands and feet. Yesterday, pure black-green watery stool appeared. This belongs to heat pathogen lingering in Yangming, heat binding with side-flow (heat binding internally forcing fluids out). However, it has not reached extreme fullness, and the tongue coating is turbid and greasy, not old yellow. Da Chengqi Tang cannot be used; instead, Xiao Chengqi Tang was used to gently harmonize. After taking it, hiccups stopped, bowel movement畅通, sweating occurred, hands and feet warmed, consciousness cleared, fever subsided. Then switched to fluids-generating, stomach-nourishing, and residual-heat-clearing agents to aid recovery.
It is generally believed that epidemic encephalitis B mostly falls under the category of Summer-heat Warmth, where heat-clearing, detoxifying, and yin-nourishing are the correct treatments. Why was this ineffective in this case? Because the patient already showed Yangming interior heat, delirium with desire for mania, body heat without sweat, red eyes and cold limbs, deep rapid forceful pulse—these are signs of interior closure and exterior constraint. Furthermore, heat binding with side-flow cannot be resolved by heat-clearing, detoxifying, or yin-nourishing alone; purgation is necessary. Purging opens the interior, allowing the exterior to harmonize naturally. If one sticks to the taboo against purging in Warm Diseases, failing to purge when indicated, the interior binding worsens, exterior constraint deepens, heat flares up damaging fluids, leading to internal closure and external collapse. My predecessor was extremely cautious about using purgatives, but when urgently needed, he acted without hesitation. Only with unique insight and decisive action could one glimpse his methods.
My predecessor excelled in Internal Medicine and especially in Warm Disease theory, as seen in "Pu Fuzhou Medical Cases" and other books. His secret knowledge came entirely from diligent clinical practice. He used the theories of Neijing and Shanghan Lun as the warp, and the doctrines of Liu Hejian, Ye Tianshi, Wu Jutong, and Wang Mengying as the weft. He also thoroughly mastered the mysteries in works on Plague by Yu Shiyu and Yang Lushan. At the same time, he valued integration of Chinese and Western medicine, drawing nourishment from Western academic studies, which promoted his creativity and development in Warm Disease theory.
Specialties in Gynecology and Pediatrics with Unique Characteristics
My predecessor not only excelled in Internal Medicine but also specialized in Gynecology and Pediatrics. Regarding the ancient saying "Better to treat ten men than one woman; better to treat ten women than one child," he considered it impractical. It seems gynecology and pediatrics are harder than internal medicine, but there is only a difference in manifestations, no essential difference. Due to the physiological and pathological characteristics of women and children, aside from menstruation, leukorrhea, pregnancy, and childbirth in gynecology, and measles, smallpox, convulsions, and malnutrition in pediatrics, other diseases are often the same as in internal medicine. He did not confine himself to departmental limitations but comprehensively analyzed specific situations based on the principles of syndrome differentiation and treatment, forming gynecological and pediatric medical experiences that run parallel to internal medicine yet possess unique characteristics.
He had many unique insights into the diagnosis and treatment of gynecological diseases. His accumulated experiences mainly include three points:
(1) Gynecology focuses primarily on regulating Qi and Blood. Women experience Tian Gui at age fourteen and cease at forty-nine, which is normal physiology. Physiological abnormalities lead to irregular menstruation. Therefore, physicians emphasize blood aspects in treating women's diseases, adopting principles such as warming cold, clearing heat, tonifying deficiency, and draining excess (moving stasis, unblocking stagnation). These are standard methods. However, blood is the mother of Qi, and Qi is the commander of blood. Qi moves then blood moves; Qi stagnates then blood stasis forms. When Qi flows and blood harmonizes, diseases do not arise. Thus, treating blood requires regulating Qi. Therefore, gynecology focuses primarily on regulating Qi and Blood.
(2) Soothing Liver and Harmonizing Spleen is an important link in treating women's diseases. Neijing states that all diseases arise from Qi. Especially in middle-aged women, due to various factors, emotional depression is common, often leading to Liver Qi stagnation. Qi stagnation causes blood stasis, resulting in menstrual disorders, dysmenorrhea, and amenorrhea. Neijing also says, "Diseases of the two Yang organs originate in Heart and Spleen; having hidden grievances, women may not menstruate." This explains the close relationship between menstrual diseases and the Spleen. Spleen failing to control blood can cause metrorrhagia; Spleen dampness sinking downward can lead to leukorrhea; insufficient Spleen Qi during pregnancy causing poor appetite leads to fetal malnourishment; weak Spleen Yang postpartum affecting milk secretion—all relate to the Spleen. Thus, soothing Liver and Harmonizing Spleen is crucial in treating women's diseases.
(3) For miscellaneous gynecological diseases, syndrome differentiation and treatment remain the fundamental principle. Jingui Yaolue discusses women's diseases in three chapters. Except for pregnancy and postpartum, they are classified as miscellaneous diseases. Miscellaneous diseases are complex and connected to gynecology. For example, wind-stroke or cold damage occurring during menstruation with heat entering the Blood Chamber can be treated with Xiaochaihu Tang to harmonize, or by puncturing Qimen acupoint according to excess. Some have no connection to gynecology but belong to internal medicine, such as plum-pit qi (globus hystericus) caused by phlegm-qi obstruction, treatable with Banxia Houpo Tang. Cases with deficiency-cold and abdominal pain can be warmed with Xiaojianzhong Tang. Those resembling surgical conditions, such as erosive ulcers in the vagina, can be washed externally with Langya Tang. All miscellaneous gynecological diseases cannot depart from the fundamental principle of syndrome differentiation and treatment.
His successful gynecological cases do not exceed these three insights.
Xu XX, female, twenty-nine years old. Menstrual periods delayed for many years. Each period lasted long with heavy flow and black clots. Cold pain in lower abdomen. Pulse deep, slow, slightly choppy. Tongue body slightly dark, thin white coating. Belongs to Qi and Blood disharmony, Liver stagnation with blood stasis. Treatment should focus on regulating Qi and Blood, assisted by soothing Liver and resolving stasis. Quan Danggui, Chuanxiong, Guigui, Wuzhuyu, Sanleng, Ezhu, Zhixiangfu, Chuanlianzi, Yanshusu, Dahuixiang. Decoct in water, take twice daily. Xiangfu Wan, take 6 grams with plain water before bed each night.
After more than two months, menstruation improved slightly. Small black clots remained, but lower abdomen discomfort disappeared. Pulse deep and slow, unclear. Tongue normal, thin white coating.
The initial decoction was continued during menstruation. After the period ended, Dingkun Dan 9 grams was taken before bed, along with 1-2 pills of Huazheng Huisheng Dan (size of Sophora japonica seeds).
Half a year later, menstrual cycle was regular, flow moderate, very few clots, lasting five days. Pulse deep and slow, tongue normal with white coating. Still following previous method, continuing for one month to consolidate.
Li XX, female, thirty-eight years old. Intermittent spotting for half a year. More in first half of cycle, less in second half. Color purple, occasional small clots. Lower abdominal pain, aversion to cold, preference for warmth. Underwent curettage at a certain hospital a month ago, but bleeding continued. Blood color alternated between purple and red. Waist and lower abdominal pain, dry mouth preferring large amounts of hot drinks, very poor appetite, epigastric blockage, constipation once every three to four days, normal urination, palpitations, poor sleep, frequent nightmares, fatigue. Previously took Chinese medicine and royal jelly with little effect. Pulse weak at Cun and Chi positions on both sides,革 (Ge) pulse at Guan positions. Tongue pale slightly dark, no coating. This is menstrual leakage due to Qi and Blood injury combined with stasis accumulation. Treatment should tonify and regulate Qi and Blood, warm and transform stasis: Chao Aiyè, Qing Ejiao (melted), Quan Danggui, Chuanxiong, Baishao, Gan Dihuang, Chuan Xuduan, Paoganjiang, Haipiaoxiao, Neng Guizhi, Chao Baizhu, Baiziren, Qiancao.
Follow-up visit: After three doses of the previous prescription, palpitations decreased, epigastric bloating lightened, appetite increased. Vaginal bleeding seemed heavier with black clots. Other symptoms unchanged. Pulse and tongue coating unchanged. Original prescription minus Baiziren, add Duzhong and Heidou, continue taking.
Third and fourth visits: Continued adjusting treatment, with slight progress in condition.
Fifth visit: Due to fatigue, vaginal bleeding increased slightly. Pulse weak at Cun and Chi, wiry and deficient at Guan. Tongue pale, no coating. Due to prolonged blood loss, Chong and Ren vessels unstable, slight exertion caused loss of blood control. Treatment should strengthen Liver and Kidney, secure Chong and Ren: Shu Dihuang, Chao Baizhu, Lujiaoshuang, Ejiaozhu, Chao Duzhong, Chuan Xuduan, Shanzhuyu, Roushoucong, Paoganjiang.
Sixth visit: Added Diyü. Seventh visit: Bleeding basically stopped, only small amount of pink fluid remaining. Appetite still poor, occasional palpitations. Other symptoms disappeared. Pulse weak at Cun and Chi, deep and fine at Guan. Given long course and heavy bleeding, Heart, Liver, and Spleen are all deficient. Use Ren Shen Guipi Wan to slowly tonify, continue for one month. Bleeding stopped, menstruation regulated.
Huang XX, female, thirty years old. Half a year ago, underwent curettage once due to excessive menstrual bleeding. Post-operation, dripping continued, requiring two months of hospitalization. Since then, each period involved heavy bleeding, often leading to shock, requiring emergency hospital treatment and hemostatic injections. Menstrual cycle irregular, sometimes once every six months, sometimes every twenty-plus days. Fresh red clots upon onset. Limbs sore and painful, difficult to move. Headache, dizziness, tinnitus, palpitations, pale complexion, loss of appetite. Pulse right微弱 (wei) left choppy (se). Center of tongue cracked like a mirror. Due to excessive blood loss, Qi and Blood both deficient. Stopping bleeding too hastily led to collateral stasis. Hence pulse and symptoms show both deficiency and excess. But deficiency outweighs excess. Deficiency should be tonified, excess should be drained. Plan to nourish Blood and enrich Ying primarily, assist with draining stasis: Lujiaoshuang, Zhi Guiban, Hong Renshen, Chuan Xuduan, Chao Baizhu, Buguzhi, Haipiaoxiao, Chao Duzhong, Longyanrou. Take 20 pills of Huayu Huisheng Dan every morning.
Follow-up visit: Lower back and abdominal pain relieved, spirit improved. Before menstruation, felt tense and prone to crying. Pulse deep, slow, and weak. Signs of Zang Zao (Visceral Agitation). Modified original prescription incorporating Ganmai Dazao Tang intent: Zhi Guiban, Chuan Fuzi, Bajitian, Buguzhi, Zhi Gancao, Fuxiaomai, Chao Duzhong, Chao Baizhu, Dazao.
Third visit: Lower back pain unresolved after half a month. From waist to mid-thigh, sometimes sore pain, sometimes stabbing pain. Improved method to warm Kidney Yang and strengthen waist: Huang Fupian, Chao Baizhu, Chao Duzhong, Buguzhi, Da Shudi, Gouqizi, Sangjisheng, Chuan Niuxi, Lu Jiao Jiao (melted).
Fourth visit: Symptoms improved but not significantly. Overall due to excessive blood loss greatly injuring Qi. Internally insufficient to nourish Zang-Fu, externally insufficient to moisten sinews and bones, benefiting joints. Continue cultivating Qi and Blood, strengthening Heart and Kidney, establishing Middle Qi: Xiyangshen, Zhi Gancao, Guang Chenpi, Chao Baizhu, Yun Fushen, Longyanrou, Huaishanyao, Dan Rongrong, Zhi Guiban, Yangchun Sharen. Decoct with Ginger and Jujube.
Taken consecutively for ten doses, symptoms greatly improved, whole body not feeling too tired. Continue original prescription. Also use Shenrong Weisheng Wan, 2 pills daily, divided morning and evening with boiled water. Forty days later, menstruation arrived for five days, volume slightly more than usual. Waist and leg pain reduced by more than half. Able to stop all Western medicines. Given Huangqi Jianzhong Tang plus Baizhu and Fuzi. Take Yougui Wan separately morning and evening. After two months, menstruation tended toward normal. Delayed sixteen days, frog test positive, pregnant.
From these three cases, it is clear that women's diseases largely center on Qi and Blood. Xu's case of delayed menstruation was directly harmonizing Qi and Blood, assisting with resolving stasis, achieving rapid effect. Li's case of half-year leakage, besides regulating Qi and resolving stasis, continued strengthening Liver and Kidney to secure Chong and Ren, finally harmonizing Heart, Liver, and Spleen to complete the cure. Huang's case was severe blood flooding, even shock, indicating severe Qi and Blood deficiency. But stopping bleeding too hastily often leaves blood to form stasis. Thus, step one focused on tonifying Qi and Blood, assisting with draining stasis. Blood deficiency means Liver loses nourishment, predisposing to Zang Zao. Liver hates urgency, quickly eat sweet to relieve tension. Thus step two incorporated Ganmai Dazao. Qi is commander of Blood; Blood deficiency means Qi has no attachment. Thus step three established Middle Qi to control Blood. Then Qi and Blood harmonized, menstruation timed correctly, essence united, pregnancy formed.
Regarding menstrual diseases with different etiologies, some are differentiated and treated from an internal medicine perspective, such as:
He XX, female, twenty-one years old, unmarried. Three years ago, defecated outdoors on a cold night, caught cold wind and fainted. Since then, every menstrual period brought numbness and convulsions, resolving only after the period. Dysmenorrhea, heavy flow, purple clots. Treated in various hospitals for over two years with no obvious effect. Pulse wiry and deficient. Tongue normal, no coating. Constitutionally Blood deficient. Wind-cold entered through pores due to deficiency, pathogen attached, Ying and Wei disharmony, causing menstrual convulsions. Treatment should harmonize Ying and Wei, dispel wind and cold. Formula: Danggui Sini Tang modified. Quan Danggui, Guizhi Jian, Wuzhuyu, Beixixin, Sheng Huangqi, Baishao, Beifangfeng, Chuanxiong, Sangjisheng. Add Ginger and Jujube.
Next month, menstruation occurred without convulsions, but numbness remained. Continued previous method. After period clean, stopped decoctions, took Shiquan Dabu Wan 6 grams morning and evening. Next menstrual period, numbness slight, only abdominal discomfort, no longer painful as before. Took decoction during period, Shiquan Dabu Wan 6 grams morning and evening after period, Hugu Mugua Wan 6 grams at night. After several months, all symptoms平息, menstrual cycle normalized.
In this case, hospital tests showed blood phosphorus and calcium lower than normal. After taking Chinese medicine, not only symptoms disappeared gradually, but blood phosphorus and calcium returned to normal. Whether this is automatic recovery due to cure or drug promotion of phosphorus and calcium growth is worth exploring.
Lv XX, female, adult, married. Irregular menstruation for over ten years. Cycle early or late, volume more or less. Usually heavy dragging pain in lower abdomen. Pain intensifies half a month before period, stops after flow begins. Yellow discharge for ten days after period. Married ten years, never conceived. No menstruation for last three months. Pulse deep and rapid. Tongue coating yellow and greasy. Complexion lusterless. Previously treated twice with Spleen-warming, damp-resolving, blood-harmonizing, menstruation-regulating methods with no effect. Carefully inquired etiology: Winter extreme cold, coinciding with menstruation, encountered great fright, went out at night, sheltered in snowy field. Menstrual flow suddenly stopped. Since then, irregular menstruation, sometimes once every few months, blood color blackish. Often suffers lower back pain, limb joint pain, abundant leukorrhea. Based on this, disease caused by internal and external factors. Fright causes Qi chaos, cold causes Blood coagulation. Treatment should internally regulate Qi and Blood, externally dispel wind and cold. Prescribed Hugu Mugua Wan, 6 grams morning and evening. Within days, menstruation appeared, pale color with clots, lower abdomen felt bloated. Pulse deep and slow. Decoction: Jinlingzi San, Siwu Tang minus Dihuang, add Guizhi, Wuyu, Gaoben, Xixin. After period clean, continued Hugu Mugua Wan. During menstruation, Jinlingzi San and Siwu Tang modified. Alternating use like this, after over three months regulation, menstruation color normal, volume relatively large. Switched to Guizhi Tang modified to harmonize Ying and Wei. Condition basically improved, used Bazhen Wan for tonification for a period.
Thereafter, due to labor or other disturbances, dysmenorrhea symptoms persisted. Treatment did not leave regulating menstruation and harmonizing blood. Usually accompanied by stomach pain, lower back pain, diarrhea, etc., used warming middle, transforming turbidity, activating collaterals methods, treating according to syndrome. Due to long history and complex symptoms, after over a year of diagnosis and treatment, gradually stabilized, achieved pregnancy, full-term normal delivery.
This case lasted twelve years. Treated by Chinese and Western medicine, always regulated as neurasthenia and Qi-Blood deficiency, but never hit the pathogenesis, ultimately ineffective. Predecessor's initial diagnosis also used Spleen-warming, damp-resolving, blood-harmonizing, menstruation-regulating, no improvement. Then traced etiology in detail, learned that sudden great fright during menstruation, invasion of extreme cold and ice/snow, caused menstrual disorder and gradual cessation, myriad symptoms arose. Neijing: Fear causes Qi to sink... Fright causes Qi to chaos. During menstruation, Qi chaos leads to Blood chaos, combined with extreme cold, causing Blood sluggishness and Qi stagnation. Clarifying the cause, changed to internally regulating Qi and Blood, externally dispelling wind and cold. Condition gradually improved. Regulated for one year, twelve-year chronic illness finally eradicated. Nine years infertility after marriage, finally had a son. Patients praised predecessor as master of gynecology, skilled in restoring spring youth, truly not an exaggeration.
Pediatrics was formerly called "Small Pulse Diagnosis" or "Mute Department". My predecessor said pediatrics should be studied first, not regarded as minor pulse diagnosis. Infants and children cannot complain of suffering, or descriptions are inaccurate. Relies entirely on physician's careful observation, analyzing surrogate reports from family, to achieve precise syndrome differentiation and treatment. Due to his deep understanding of pediatrics' importance, plus rich clinical experience, broad vision, and extensive experience, from practice to theory, then theory to practice, he gained much insight.