[按]：本证寒热似疟，易与小柴胡汤证混淆。然小柴胡汤证寒热往来，口苦、咽干、目眩、呕而不食，苔多薄白，脉景多弦。泰例患者，寒热大汗，冷如冰雪，热如抱火，且神气大衰，脉又沉细无根，与少阳证之寒热迥然有别，而前医曾用治少阳症之小柴胡汤，柴胡一升再升，致气机外越；黄苓一清再清，致中阳不宁，故大汗如洗而热不退。俗话说：“前事不忘，后事之师”。为医者，要善于从别人的教训中吸取经验。因为前医之用药，对接诊者颇有帮助，临证之际，须细心审查，不可疏忽。此例由综合四诊所得及以前服药情况，认定系“中气暴脱，元气不收”，虽见寒热如疟，始终未用清降退热之剂，本“甘温除热”法，用甘温益气之理中汤加减，竟收热退之效。
温
疟
刘××，男，二十一岁，在元江一带工作，平时身体壮实。1950年夏初，身感不适，饮食减少，逐渐消瘦。每日午后微恶寒，继则发热，无汗，次晨热始退。如此迁延二十余日，精神疲惫不堪。乃来昆治疗，曾服用奎宁无效，又服过中药小柴胡汤等亦未效。
查其脉弦而滑，舌苔白而腻。问其每日发作寒热之状，知其为温疟，病机在于湿邪壅滞，脾肺二脏之气机不和。弦为疟之本脉，滑为有痰积，故用小柴胡汤不能见效。因拟下方：
此叶天士之半贝散，功在清火泻热，润肺祛痰，燥湿降逆，开郁调中。方中贝母润肺燥，半夏燥脾湿，党参补中气，刚柔相济，又得补中之运转，故只服三剂，二十余日之寒热竟退，不再发作。次日再诊，症虽消失，然舌苔仍自腻，脾湿尚盛，投以大桔皮汤二剂(方见“癃闭”案)，再以陈夏六君汤调理，以图巩固，竟收痊愈之功。
黄疸三例
例一：
吴××，男，四十余岁。发热、恶寒，目黄，小便短赤。头昏，不思饮食，腹胀，肝区疼痛已十余日。经西医检查，肝肿大肋下二横指，肝功有改变，诊断为急性黄疸型传染性肝炎，转我所诊治。察其脉弦，舌红，苔黄腻，此系脾失踺运，外有表邪，湿热内蕴，发为黄疸。证属阳黄。宜解表宣肺，清热利湿为治，方用《伤寒论》麻黄连翘赤小豆汤加茵陈。处方：
此方为“外疏通，内畅遂”之表里两解法。方中用麻黄、杏仁宣肺解表，桑白皮代梓白皮泻肺，赤小豆、连翘、茵陈清热利湿，草、姜、枣辛甘相合健脾和中。诸药相配，使肺气得宣，不仅能解除在外之表邪，而且能通调水道，下输膀胱，湿热可由小便分利。
二诊：上方服二剂后，发热稍退，已不恶寒，腻苔亦减，能饮食。但所摄不多，仍觉头昏，目黄，小便短赤。此系湿减热存，继用仲景栀子柏皮汤去甘草加茵陈。处方：
此方继续清降在里之湿热。
三诊：服二剂后，目黄全退，小便转清，惟仍有腹胀，食欲不振。拟方用茵陈六君汤健运脾阳为治。处方：
连服三剂后，腹胀消失，饮食好转。为巩固疗效，建议守方服十余剂，以作调治。
例二：
黄××，女，六十四岁。初病微热，头眩身痛，午后恶寒，不思饮食，脘腹闷胀。曾服白术、巴戟、果杞等补脾肾药，发热增高，两目发黄，转余诊治。症见：舌质红，苔黄厚腻，小便短赤，有灼热感，大便秘结，心烦，脉弦数。呈现一派湿热内蕴之象。治宜清利湿热、表里同治。方用麻黄连翘赤小豆汤合茵陈蒿汤加减。处方：
二诊：服上方一剂后，发热减轻，再剂热退，两目发黄已退，肝区痛及舌腻均减，小便转清，仍感胁腹闷胀。此乃肝气郁滞，湿热未尽，仍以清热利湿、舒肝理气为主，改用自拟方柴葛连苡汤加味。处方：
柴胡9克连翘10克葛根15克 苡仁20克 藿香6克
杏仁10克赤芍15克 杭芍10克茵陈9克 枳实10克 甘草3克
三诊：上方服二剂后，舌腻退净，大便畅通，胸闷心烦亦止，惟口苦唇干，夜间虚烦不眠。拟方予温胆汤加味。处方：
服上方后，虚烦止，能安眠，继予《金匮要略》酸枣仁汤(枣仁、茯神、知母、川芎、甘草)加山萸肉调治而愈。
例三：
张××，女，初生五个月。初病发热，咳嗽，三日后出现两目发黄。西医诊断为传染性肝炎。症见：舌苔黄腻．脉浮数。此为表邪未解，里有湿热，肺失肃降，胆气上逆。予麻黄连翘赤小豆汤加茵陈。处方：
二诊：服上方一剂后，微汗出，热退，咳减。惟舌苔尚腻，是湿热未尽，予自拟方三仁化湿汤加茵陈。处方：
胁肋（月真）胀疼痛
陈××，男，三十五岁。患胁肋（月真）胀疼痛，已月余，西医诊断为无黄疸型肝炎，肝、脾均肿大三横指，转余诊治。症见：胁痛，口苦，心烦，食欲不振。脉弦，舌苔薄腻。此乃肝气郁滞，脾运失常，治宜理气解郁，健脾养肝，活血祛瘀之剂。方用丹栀逍遥散加减。处方：
乌梅3个
胀满不食甘，故去甘草，加乌梅以养肝，再加丹参和血祛瘀生新，解除胁下瘀滞。
二诊：服药二剂后，胁肋疼痛减轻。再就上方去乌梅，加香附9克，胡黄连6克，以理气解郁，养肝清热。
三诊：服药二剂后，胁肋疼痛大减。继用下方以疏肝止痛，化瘀破积为治。处方：
甘草6克
四诊：服药四剂后，肝脾肿大缩小，仅余一横指。再参合前法，以舒肝化积佐升举脾阳为治，用张锡纯升陷汤加昧。处方：
牡蛎15克
上方连服三荆，胁痛全止，肝脾肿大消失。继用张锡纯活络效灵丹加味调治，以巩固疗效。处方：
鼻衄三例
例一：
刘××，男，四十二岁。素有高血压史，经常头痛失眠。一日，忽鼻衄频频量多，色鲜红。急送往某医院五官科治疗，血暂止，回家后又流血不已，延余诊治。症见：头胀目眩，舌紫苔略黄燥，脉弦。此系肝阳上亢，迫血妄行所致。宜滋阴凉血止血，急以自拟方生地侧柏叶汤加童便。方如下：
服一剂，衄血减少，再剂全止。
上方生地甘寒，滋阴养血，并有凉血清热、养肝肾、益心肺，通血脉之功。侧柏叶苦涩微寒，凉血止血，主治血热妄行引起的各种出血。麦冬甘寒，生津养液，润肺清火。杭芍苦酸微寒，敛阴和血，养肝润燥。心主血，肝藏血，肺主气，心血得养，肝血得藏，肺气得清，则出血易止。复得炙艾之苦温，能温经止血，用于凉血药中，可免凉药腻膈碍胃之弊。藕节涩平，散瘀通络而止血，此药收涩止血而不留瘀，为血证常用之品。尤有妙者，炮姜、甘草二味，苦甘化阴，不仅入阴止血，且能暖脾补中，而恢复脾之统血机能，脾能统血．则血自归经。唐容川说：“治血者，必以脾为主”。余止血之方．多加此二味，其义在此。此二药相伍，功用颇多，此再言之，望勿疏忽。
继以原方加白洋参9克(另煎兑服)，清补气血，生津润燥。连服三剂后，改用三才封髓丹调理善后。
例二：
张××，男，三十五岁，患鼻衄不止。症见；心烦，口渴饮冷，精神不衰。舌质红，苔黄腻，脉滑数。患者平素嗜酒成癖。四诊合参，证属肺胃火郁，治当清肺火，解郁热。投以仲景大黄黄连泻心汤。方用：
大黄9克 黄连6克 黄芩9克
方中三味药合用开水浸泡，取汁分三次服。衄止则停服。
上方服一剂，鼻衄即止。
例三：
李××，男，六十二岁。向有吸食鸦片嗜好，素禀虚弱，1950年4月24日，患鼻衄不止。来所求诊时，面色惨淡苍白，两鼻孔塞以纸卷，血仍不断渗出，不能由鼻孔出者，遂由口中吐出，旁观者均为之色变。且诉头晕、目花、气短。因其症状险恶，余诊视毕，立案书方。案中注云：“鼻衄颇甚，脉来浮大无根，气不统血。急宜固气摄血，并兼外治。”处方如下：
茯苓9克 甘草6克
外治方：附片60克捣细醋炒，加麦面少许，调匀，包两足心涌泉穴。
翌日傍晚，患者复来，高兴异常，言衄止，仅痰中微带血也。诊后复立案，并书方如下：
脉转平和，血溃已止，神倦微呕，痰稍带血，继以复元纳气。方用：
后方理中汤加砂半苓也，复元纳气，舍此莫属，其温中扶蜱之力，较昨方更专，杜渐防微，今痰中带血，防其复作也。
此症鼻衄之甚，而前方未用止血之品，因此症之鼻衄，全系气虚不能统血，气既虚，脾遂困，故其病在气不纳，非在血也。本《内经》“血随气行，气随血附”之义，立方以扶脾为主。方中参，术、姜、草，理中汤也，加法夏、茯苓降逆燥湿健脾；归，芍补血养血，香、砂醒脾舒郁，使脾能统血，炮姜、甘草既能苦甘化阴，亦能辛甘化阳，化阴则生血，化阳则生气。炮姜色黑入阴，又能引血归经。两足心涌泉穴，其经脉上通咽喉，包以附子，温经止血，引气下行。此症若不明气不统血之理，再用生地、丹皮、茅根、栀子，或犀角地黄汤之类凉血泻火，不仅中气败绝甚或阴盛阳消，一线残阳即败，若加恶寒，即阳随阴亡矣!此类失血以扶脾为主者，“先以崇土为先，土厚则浊阴不升，而血患必止。万物以土为根，元气以土为宅。”故内服方不急于用附片，用附片则入肾，而非脾药也，亦不用止血之品，盖重在补气摄血。治病要在明辨病机，病机既明，则针对病机治疗，投方选药，焉有不效者。
[整理者按]上述三例，亦因人、因病而有不同。治疗本病的主要经验是。先诊察患者阴阳气血之有余与不足，再区别病情之新久微甚，然后立法遣方，故见效卓著。值得注意的是，临床上对于鼻衄，大多治以凉血清火，确属肺胃有热者，此法诚不可废。但征诸临床，显然不够全面，若用之过甚或正气不足者，则债事矣!喻嘉言说：“凡用凉血清火药者，皆以水治火之常法，施之于阴火，未有不转助其虐者也。”徐灵胎亦说：“阴气上竭，而肾中龙雷之火随水而上，若以寒凉折之其火愈炽。”故治疗此症，不可专事寒凉。余听鸿先生又说：“若专取寒凉京，是沸油中泼水，激之使怒。”由此可见，后世医家对本症的处理方法，并非专主寒凉。若不明辨证型，偏以凉血清火为治，势必有损胃气。胃气既损，则脾胃随之而表，统血机能相应削弱。因此戴老医师多年用于鼻衄及咯血的效方——“生地侧柏叶汤” (见案一)，纠正了偏用寒凉的缺点。是方清心润肺， 滋肾养肝，培土补中，诸法悉备，凡一般鼻衄和咯血，寒热不显或证见热象者，均可施用。诚然，对于脾土衰败，气不摄血之鼻衄，则应本喻氏之法，以“崇土为先”，照第三例之法施治。如遇阴火上腾，失血过多，应惕防突发寒战，恐阳随阴亡，应当用大剂潜阳汤(附片、龟板、砂仁、炙甘草)，潜阳固阴，使阴火下潜，安其本位。此又不可不知者也。
失
眠
黄××，男，四十岁。患心烦，盗汗、失眠、头晕、目眩、精神疲倦，历时已久。每日晚必须服西药“眠尔通”等安眠药，始能入睡。今见其舌紫，脉虚。显系肝肾两虚，心神不宁，浮热上扰使然。治当滋养肝肾，宁心安神，兼清浮热。处以下方：
[Commentary]: This syndrome presents with alternating chills and fever, resembling malaria (Malaria), and is easily confused with the Shaoyang Syndrome (Syndrome of the Shaoyang channel) treated by Xiao Chai Hu Tang (Minor Bupleurum Decoction). However, the characteristics of Xiao Chai Hu Tang syndrome include alternating chills and fever, bitter taste in the mouth, dry throat, vertigo, vomiting with inability to eat, a thin white tongue coating, and a wiry pulse. In this case, the patient presented with alternating chills and fever accompanied by profuse sweating, feeling cold as ice and hot as fire, with significant depletion of spirit and vital energy, and a deep, fine, rootless pulse. This is distinctly different from the chills and fever of the Shaoyang syndrome. The previous physician used Xiao Chai Hu Tang, which treats Shaoyang syndrome; the repeated use of high doses of Chai Hu (Bupleuri Radix) caused the Qi mechanism to float outward, and the repeated clearing action of Huang Qin (Scutellariae Radix) disturbed the Middle Jiao Yang, resulting in profuse sweating without resolution of the fever. As the saying goes: "The lessons of the past are the guides for the future." Physicians should be good at learning from others' mistakes. Because the medication history of the previous physician provides valuable reference for the attending physician, careful examination is required during clinical practice to avoid negligence. Based on the comprehensive information from the Four Diagnostic Methods (Inspection, Auscultation-Olfaction, Inquiry, Palpation) and the previous medication history, this case was identified as "Sudden Collapse of Middle Qi, Failure of Yuan Qi to Retain." Although chills and fever resembling malaria were present, no heat-clearing and descending antipyretic agents were used. Instead, following the principle of "Sweet-Warm Method to Remove Fever" (Gan Wen Chu Re), Gan Wen Yi Qi (Sweet-Warm Qi Tonification) formulas such as Lizhong Tang (Regulate the Middle Decoction) were modified, achieving the effect of reducing fever.
Warm Malaria
Liu XX, Male, 21 years old, working in the Yuanjiang area, generally robust. In early summer of 1950, he felt unwell, had reduced appetite, and gradually emaciated. Every afternoon, he experienced slight aversion to cold, followed by fever, without sweating; the fever subsided only the next morning. This persisted for more than twenty days, leaving him extremely fatigued. He came to Kunming for treatment. Quinine had been ineffective, and traditional Chinese medicine formulas such as Xiao Chai Hu Tang also failed.
Examination revealed a wiry and slippery pulse, and a white, greasy tongue coating. Inquiry into the daily pattern of chills and fever indicated Warm Malaria. The pathogenesis lies in dampness obstructing and stagnating, causing disharmony of the Qi mechanism between the Spleen and Lung. The wiry pulse is the fundamental pulse for malaria, and the slippery pulse indicates phlegm accumulation; therefore, Xiao Chai Hu Tang was ineffective. The following prescription was formulated:
Fritillariae Thunbergii Bulbus (Chuan Bei Mu) 9g
Prepared Pinellia Rhizome (Fa Ban Xia) 9g
Codonopsis Radix (Lu Dang Shen) 9g
This is Ban Bei San (Half-Bellerwort Powder) from Ye Tianshi, whose function is to clear fire and drain heat, moisten the lungs and dispel phlegm, dry dampness and direct rebellious Qi downward, open depression and regulate the middle. In the formula, Fritillaria moistens lung dryness, Pinellia dries spleen dampness, and Codonopsis tonifies middle Qi. They complement each other (hard and soft), aided by the transformation of the middle, so after only three doses, the chills and fever lasting over twenty days subsided and did not recur. At the second visit, although symptoms had disappeared, the tongue coating remained greasy, indicating persistent spleen dampness. Da Ju Pi Tang (Large Citrus Peel Decoction) was administered for two doses (see "Lin Bi" case), followed by Chen Xiang Liu Jun Tang (Aged Tangerine Peel Six-Gentlemen Decoction) for regulation to consolidate the effect, ultimately achieving a cure.
Three Cases of Jaundice
Case 1:
Wu XX, Male, over 40 years old. Fever, aversion to cold, yellow eyes, short dark urine. Dizziness, anorexia, abdominal distension, and liver area pain for over ten days. Western medical examination showed hepatomegaly (liver enlarged two finger-widths below the costal margin) and abnormal liver function tests. Diagnosed with acute icteric infectious hepatitis, referred to our institute for treatment. Examination revealed a wiry pulse, red tongue, and yellow greasy coating. This is due to Spleen failing in transportation and transformation, external exterior pathogens, and internal accumulation of damp-heat, manifesting as jaundice. The syndrome belongs to Yang Jaundice. Treatment should focus on releasing the exterior and diffusing the Lungs, clearing heat and promoting diuresis to remove dampness. The formula used is Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) from *Shanghan Lun* (Treatise on Cold Damage Disorders) plus Yin Chen (Artemisiae Scopariae Herba). Prescription:
Ephedra Stalk (Ma Rong) 6g
Forsythiae Fructum (Lian Qiao) 10g
Phaseolus Angularis Seed (Hong Fan Dou) 15g
Prunus Armeniaca Seed (Xing Ren) 10g
Artemisiae Scopariae Herba (Yin Chen) 10g
Morus Alba Root Bark (Sang Bai Pi) 10g
Licorice Root (Gan Cao) 5g
Fresh Ginger (Sheng Jiang) 3 slices
Jujube (Da Zao) 3 pieces
This formula represents a method of resolving both exterior and interior ("External unblocking, internal smoothing"). Ephedra and Prunus Armeniaca Seed diffuse the Lungs and release the exterior; Morus Alba Root Bark replaces Catalpa Root Bark to drain the Lungs; Phaseolus Angularis Seed, Forsythiae Fructum, and Artemisiae Scopariae Herba clear heat and promote diuresis to remove dampness; Licorice, Ginger, and Jujube combine acrid-sweet to strengthen the Spleen and harmonize the middle. The combination of these herbs allows Lung Qi to diffuse, not only resolving external exterior pathogens but also regulating water passages, transmitting fluids downward to the Bladder, allowing damp-heat to be eliminated via urination.
Second Visit: After two doses, fever slightly subsided, aversion to cold ceased, and greasy coating decreased; appetite improved. However, intake remained low, and dizziness, yellow eyes, and short dark urine persisted. This indicates dampness has decreased but heat remains. Continue with Zhongjing's Zhi Zi Bai Pi Tang (Gardenia, Phellodendron, and Bark Decoction) minus Licorice plus Yin Chen. Prescription:
Gardenia Fruit (Zhi Zi) 6g
Phellodendri Cortex (Huang Bo) 10g
Artemisiae Scopariae Herba (Yin Chen) 10g
This formula continues to clear and descend internal damp-heat.
Third Visit: After two doses, yellow eyes completely resolved, urine turned clear, but abdominal distension and anorexia persisted. The formula used is Yin Chen Liu Jun Tang to strengthen and transport Spleen Yang. Prescription:
Codonopsis Radix (Lu Dang Shen) 15g
Atractylodis Macrocephalae Rhizoma (Bai Zhu) 9g
Prepared Pinellia Rhizome (Fa Xia) 9g
Poria (Fu Ling) 15g
Citrus Reticulata Pericarpium (Chen Pi) 9g
Artemisiae Scopariae Herba (Yin Chen) 9g
Licorice Root (Gan Cao) 6g
Cyperi Rhizoma (Xiang Fu) 9g
Fresh Ginger (Sheng Jiang) 3 slices
After taking three consecutive doses, abdominal distension disappeared, and diet improved. To consolidate efficacy, it was advised to continue the same formula for over ten doses for regulation.
Case 2:
Huang XX, Female, 64 years old. Initially suffered slight fever, dizziness, body ache, afternoon aversion to cold, anorexia, and epigastric/abdominal fullness. Previously took Atractylodis Rhizoma (Bai Zhu), Morinda Officinalis Root (Ba Ji), and Lycium Barbarum Fruit (Gou Qi) to tonify Spleen and Kidney. Fever increased, eyes turned yellow, referred to me for treatment. Symptoms: Red tongue body, thick yellow greasy coating, short dark burning urine, constipation, irritability, wiry rapid pulse. Presents a picture of internal damp-heat accumulation. Treatment should focus on clearing and draining damp-heat, treating both exterior and interior simultaneously. Formula: Ma Huang Lian Qiao Chi Xiao Dou Tang combined with Yin Chen Hao Tang modified. Prescription:
Ephedra Stalk (Ma Rong) 6g
Forsythiae Fructum (Lian Qiao) 10g
Phaseolus Angularis Seed (Hong Fan Dou) 15g
Prunus Armeniaca Seed (Xing Ren) 10g
Artemisiae Scopariae Herba (Yin Chen) 9g
Gardenia Fruit (Zhi Zi) 6g
Immature Bitter Orange (Zhi Shi) 8g
Medicated Leaven (Shen Qu) 10g
Charred Hawthorn Fruit (Jiao Zha) 10g
Scutellariae Radix (Huang Qin) 6g
Elsholtziae Herba (Xiang Ru) 3g
Citrus Reticulata Pericarpium (Chen Pi) 6g
Licorice Root (Gan Cao) 3g
Bamboo Shavings (Zhu Ru) 3g
Second Visit: After one dose, fever lessened; after two doses, fever subsided, yellow eyes resolved, liver area pain and greasy tongue coating decreased, urine cleared, but hypochondriac/abdominal fullness persisted. This is Liver Qi stagnation and incomplete resolution of damp-heat. Focus remains on clearing heat, draining dampness, soothing Liver, and regulating Qi. Changed to self-formulated Chai Ge Lian Yi Tang (Bupleurum, Pueraria, Scutellaria, and Coix Decoction) added. Prescription:
Bupleuri Radix (Chai Hu) 9g
Forsythiae Fructum (Lian Qiao) 10g
Puerariae Radix (Ge Gen) 15g
Coicis Semen (Yi Ren) 20g
Agastaches Herba (Huo Xiang) 6g
Prunus Armeniaca Seed (Xing Ren) 10g
Red Peony Root (Chi Shao) 15g
White Peony Root (Hang Shao) 10g
Artemisiae Scopariae Herba (Yin Chen) 9g
Immature Bitter Orange (Zhi Shi) 10g
Licorice Root (Gan Cao) 3g
Third Visit: After two doses, greasy tongue coating completely resolved, bowel movements became smooth, chest tightness and irritability stopped, but bitter taste in mouth, dry lips, and nighttime deficiency irritability with insomnia persisted. Formula: Wen Dan Tang (Warm Gallbladder Decoction) added. Prescription:
Citrus Reticulata Pericarpium (Chen Pi) 10g
Prepared Pinellia Rhizome (Fa Xia) 10g
Poria (Fu Ling) 10g
Immature Bitter Orange (Zhi Shi) 10g
Bamboo Shavings (Zhu Ru) 6g
Artemisiae Annuae Herba (Qing Hao) 6g
Gardenia Pericarpium (Zhi Pi) 6g
Loquat Flower Stamen (Jie Luo) 6g
Dendrobii Caulis (Shi Hu) 10g
After taking this formula, deficiency irritability ceased, sleep normalized. Subsequently treated with Suan Zao Ren Tang (Ziziphus Seed Decoction) from *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) [Ziziphus Seed, Poria Spirit, Anemarrhenae Rhizoma, Ligusticum Wallichii Rhizoma, Licorice] added with Corni Fructus (Shan Yu Rou) for regulation, resulting in recovery.
Case 3:
Zhang XX, Female, 5 months old. Initially fever and cough; two days later, yellow eyes appeared. Western diagnosis: Infectious Hepatitis. Symptoms: Yellow greasy tongue coating, floating rapid pulse. This is unresolved exterior pathogen, internal damp-heat, Lung failing in descending, and Gallbladder Qi rebelling upward. Prescribed Ma Huang Lian Qiao Chi Xiao Dou Tang plus Yin Chen. Prescription:
Ephedra Herb (Ma Huang) 5g
Forsythiae Fructum (Lian Qiao) 6g
Phaseolus Angularis Seed (Hong Fan Dou) 10g
Prunus Armeniaca Seed (Xing Ren) 6g
Artemisiae Scopariae Herba (Yin Chen) 5g
Morus Alba Root Bark (Sang Bai Pi) 5g
Licorice Root (Gan Cao) 3g
Fresh Ginger (Sheng Jiang) 2 slices
Jujube (Da Zao) 1 piece
This formula resolves both exterior and interior, an effective prescription for jaundice caused by external exterior pathogens and internal damp-heat steaming.
Second Visit: After one dose, slight sweating occurred, fever subsided, cough decreased. Tongue coating still greasy, indicating incomplete resolution of damp-heat. Prescribed self-formulated San Ren Hua Shi Tang (Three Seeds Dampness-Resolving Decoction) plus Yin Chen. Prescription:
Prunus Armeniaca Seed (Xing Ren) 5g
Coicis Semen (Yi Ren) 6g
Amomi Fructus Rotundus (Bo Kou Ren) 3g
Pinellia Rhizome (Jing Xia) 6g
Poria (Fu Ling) 9g
Tetrapanacis Medulla (Tong Cao) 3g
Magnoliae Officinalis Cortex (Hou Po) 3g
Artemisiae Scopariae Herba (Yin Chen) 5g
Citrus Reticulata Pericarpium (Chen Pi) 3g
Bamboo Shavings (Zhu Ru) 3g
After two doses, cough stopped, coating receded. Subsequently treated with Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Magna Powder) plus Yin Chen for regulation, resulting in recovery.
Hypochondriac Distending Pain
Chen XX, Male, 35 years old. Suffered from hypochondriac distending pain for over a month. Western diagnosis: Non-icteric Hepatitis. Liver and spleen enlarged three finger-widths. Referred to me. Symptoms: Hypochondriac pain, bitter taste, irritability, anorexia. Wiry pulse, thin greasy tongue coating. This is Liver Qi stagnation and Spleen dysfunction. Treatment should focus on regulating Qi, resolving depression, strengthening Spleen, nourishing Liver, invigorating Blood, and removing stasis. Formula: Dan Zhi Xiao Yao San (Moutan and Gardenia Free Wanderer Powder) modified. Prescription:
Angelica Sinensis Radix (Dang Gui) 15g
White Peony Root (Hang Shao) 9g
Bupleuri Radix (Chai Hu) 9g
Atractylodis Macrocephalae Rhizoma (Bai Zhu) 9g
Poria (Fu Ling) 9g
Hordei Fructus Germinatus (Mai Ya) 9g
Menthae Haplocalycis Herba (Bo He) 6g
Moutan Cortex (Dan Pi) 6g
Gardenia Fruit (Zhi Zi) 6g
Salviae Miltiorrhizae Radix et Rhizoma (Dan Shen) 15g
Corni Fructus (Wu Mei) 3 pieces
Since the patient could not tolerate sweet flavor, Licorice was removed. Wu Mei was added to nourish the Liver, and Salviae Miltiorrhizae Radix et Rhizoma was added to harmonize Blood, remove stasis, generate new tissue, and resolve hypochondriac stasis.
Second Visit: After two doses, hypochondriac pain lessened. Removed Wu Mei from the previous formula, added Cyperi Rhizoma (Xiang Fu) 9g and Picrorhizae Rhizoma (Hu Huang Lian) 6g to regulate Qi, resolve depression, nourish Liver, and clear heat.
Third Visit: After two doses, hypochondriac pain significantly reduced. Continued with the following formula to soothe Liver, relieve pain, transform stasis, and break accumulations. Prescription:
Toosendan Fructus (Chuan Lian Zi) 6g
Frankincense (Ru Xiang) 6g
Myrrh (Mo Yao) 9g
Sparganii Rhizoma (San Leng) 9g
Curcumae Rhizoma (E Zhu) 6g
Licorice Root (Gan Cao) 6g
Fourth Visit: After four doses, liver and spleen enlargement shrank to one finger-width. Combining with previous methods, treatment focused on soothing Liver, resolving accumulations, assisting in raising Spleen Yang. Used Zhang Xichun's Sheng Xian Tang (Ascending Deficiency Decoction) added. Prescription:
Astragali Radix (Sheng Huang Qi) 15g
Anemarrhenae Rhizoma (Chao Zhi Mu) 6g
Bupleuri Radix (Chai Hu) 9g
Platycodonis Radix (Jie Geng) 3g
Angelica Sinensis Radix (Dang Gui) 15g
Ligusticum Wallichii Rhizoma (Chuan Xiong) 6g
Dried Ginger (Gan Jiang) 9g
Frankincense (Ru Xiang) 6g
Myrrh (Mo Yao) 6g
Dragon Bone (Long Gu) 15g
Oyster Shell (Mu Li) 15g
After taking the above formula for three consecutive doses, hypochondriac pain completely ceased, and liver/spleen enlargement disappeared. Subsequently treated with Zhang Xichun's Huo Luo Xiao Ling Dan (Meridian-Unblocking Efficacious Spirit Pill) added for regulation to consolidate efficacy. Prescription:
Salviae Miltiorrhizae Radix et Rhizoma (Dan Shen) 15g
Angelica Sinensis Radix (Dang Gui) 10g
Frankincense (Ru Xiang) 3g
Myrrh (Mo Yao) 6g
Curcumae Radix (Yu Jin) 6g
Mung Bean (Lv Dou) 15g
White Peony Root (Hang Shao) 15g
Bupleuri Radix (Chai Hu) 6g
Corni Fructus (Shan Yu Rou) 15g
Corni Fructus (Wu Mei) 3 pieces
Three Cases of Epistaxis
Case 1:
Liu XX, Male, 42 years old. History of hypertension, frequent headaches and insomnia. One day, sudden frequent and heavy epistaxis with bright red blood. Urgently sent to ENT department of a certain hospital; bleeding temporarily stopped, but resumed heavily upon returning home. Consulted me. Symptoms: Head distension, dizziness, purple tongue with slightly yellow dry coating, wiry pulse. This is Hyperactivity of Liver Yang forcing Blood to move recklessly. Treatment should focus on nourishing Yin, cooling Blood, and stopping bleeding. Urgently prescribed self-formulated Di Huang Ce Bai Ye Tang (Rehmannia and Biota Top Decoction) plus Tong Bian (Child's Urine). Formula:
Rehmanniae Radix Preparata (Di Huang) 30g
Biota Tops (Ce Bai Ye) 9g
Roasted Mugwort Leaf (Zhi Ai Ye) 6g
Ophiopogonis Radix (Mai Dong) 9g
White Peony Root (Hang Shao) 9g
Lotus Rhizome Node (Ou Jie) 5 pieces
Charred Prepared Ginger (Pao Jiang Tan) 9g
Roasted Licorice Root (Zhi Gan Cao) 6g (with Child's Urine as guide)
After one dose, bleeding reduced; after two doses, it stopped completely.
In the above formula, Rehmanniae Radix Preparata is sweet and cold, nourishing Yin and Blood, with functions of cooling Blood, clearing heat, nourishing Liver/Kidney, benefiting Heart/Lungs, and unblocking vessels. Biota Tops are bitter/astringent and slightly cold, cooling Blood and stopping bleeding, mainly treating various hemorrhages caused by reckless movement of Heat-Blood. Ophiopogonis Radix is sweet and cold, generating fluids, nourishing liquids, moistening Lungs, and clearing fire. White Peony Root is bitter/sour and slightly cold, astringing Yin, harmonizing Blood, nourishing Liver, and moistening dryness. Heart governs Blood, Liver stores Blood, Lung governs Qi. When Heart Blood is nourished, Liver Blood is stored, and Lung Qi is clear, bleeding stops easily. Additionally, Roasted Mugwort Leaf is bitter and warm, warming meridians and stopping bleeding; when used with cooling Blood herbs, it prevents the弊端 of cold herbs cloying the diaphragm and harming the Stomach. Lotus Rhizome Node is astringent and neutral, dispersing stasis, unblocking collaterals, and stopping bleeding; this herb stops bleeding through astringency without retaining stasis, commonly used in blood disorders. Particularly ingenious are Charred Prepared Ginger and Licorice Root; bitter and sweet transform into Yin, not only entering Yin to stop bleeding but also warming Spleen and tonifying Middle, restoring Spleen's function of controlling Blood. When Spleen controls Blood, Blood returns to its vessels. Tang Rongchuan said: "In treating blood disorders, one must prioritize the Spleen." My hemostatic formulas often add these two herbs, which is their meaning. These two herbs combined have many functions, discussed further here, please do not neglect.
Subsequently, original formula added with Codonopsis Radix (Bai Yang Shen) 9g (decocted separately and mixed in) to clear and tonify Qi and Blood, generate fluids, and moisten dryness. After taking three consecutive doses, changed to San Cai Feng Sui Dan (Three Talents Sealing Marrow Pill) for regulation and follow-up.
Case 2:
Zhang XX, Male, 35 years old, suffering from continuous epistaxis. Symptoms: Irritability, thirst for cold drinks, undiminished spirit. Red tongue body, yellow greasy coating, slippery rapid pulse. Patient has a habit of excessive alcohol consumption. Combining Four Diagnostic Methods, syndrome belongs to Lung-Stomach Fire Depression. Treatment should clear Lung Fire and resolve depressed Heat. Administered Zhongjing's Da Huang Huang Lian Xie Xin Tang (Rhubarb, Coptis, and Scutellaria Heart-Draining Decoction). Formula:
Rhei Radix et Rhizoma (Da Huang) 9g
Coptidis Rhizoma (Huang Lian) 6g
Scutellariae Radix (Huang Qin) 9g
The three herbs in the formula are soaked in boiling water, juice extracted, divided into three doses. Stop administration once bleeding stops.
After one dose of the above formula, epistaxis stopped immediately.
Case 3:
Li XX, Male, 62 years old. Long-term opium smoking habit, constitutionally weak. On April 24, 1950, suffered from continuous epistaxis. Upon arrival for consultation, face was pale and sallow, nostrils stuffed with paper rolls, blood still seeping continuously; blood that could not exit through nostrils was spat out from mouth, shocking bystanders. Also complained of dizziness, blurred vision, and shortness of breath. Due to dangerous symptoms, after diagnosis, I recorded the case and wrote the prescription. Note in case: "Epistaxis is severe, pulse is floating, large, and rootless; Qi fails to control Blood. Urgently need to secure Qi and grasp Blood, combined with external treatment." Prescription:
Codonopsis Radix (Bai Yang Shen) 9g (decocted separately and mixed in)
Atractylodis Macrocephalae Rhizoma (Bai Zhu) 12g
Prepared Ginger (Pao Jiang) 15g
Amomi Fructus (Sha Ren) 6g
Prepared Pinellia Rhizome (Fa Ban Xia) 9g
Angelica Sinensis Radix (Dang Gui) 12g
Stir-fried White Peony Root (Chao Hang Shao) 9g
Costus Root (Guang Mu Xiang) 3g
Poria (Fu Ling) 9g
Licorice Root (Gan Cao) 6g
External Treatment: Aconite Processed Slice (Fu Pian) 60g, pounded fine, stir-fried with vinegar, mixed with a little wheat flour, applied to cover both Yongquan points (KI1) on the soles of feet.
Next day evening, patient returned, extremely happy, stating bleeding stopped, only slight blood traces in sputum. After diagnosis, recorded case again and wrote prescription:
Pulse turned peaceful, bleeding stopped, fatigue and slight nausea, sputum slightly bloody. Continue to restore vitality and absorb Qi. Formula:
Codonopsis Radix (Bai Yang Shen) 9g (decocted separately and mixed in)
Atractylodis Macrocephalae Rhizoma (Bai Zhu) 12g
Prepared Ginger (Pao Jiang) 15g
Amomi Fructus (Sha Ren) 6g
Prepared Pinellia Rhizome (Fa Ban Xia) 9g
Poria (Fu Ling) 15g
Licorice Root (Gan Cao) 4.5g
The latter formula is Lizhong Tang (Regulate the Middle Decoction) plus Amomi Fructus, Pinellia Rhizome, and Poria. To restore vitality and absorb Qi, none can compare. Its power to warm Middle and support Spleen is more specific than yesterday's formula, preventing gradual worsening. Since there is now blood in sputum, prevention of recurrence is key.
After taking the above formula for two consecutive doses, bleeding completely stopped, spirit gradually improved, and recovered.
This case of severe epistaxis did not use hemostatic agents in the previous formula because this epistaxis is entirely due to Qi deficiency failing to control Blood. Since Qi is deficient, Spleen becomes troubled; thus, the pathology lies in Qi failing to absorb, not in Blood itself. Based on the principle from *Neijing* ("Blood follows Qi, Qi attaches to Blood"), the formula focuses on supporting the Spleen. Ginseng, Atractylodis Macrocephalae Rhizoma, Ginger, and Licorice constitute Lizhong Tang; adding Pinellia Rhizome and Poria directs rebellious Qi downward, dries dampness, and strengthens Spleen; Angelica Sinensis Radix and White Peony Root tonify and nourish Blood; Costus Root and Amomi Fructus awaken Spleen and relieve depression, enabling Spleen to control Blood. Prepared Ginger and Licorice can transform bitter-sweet into Yin (generating Blood) and acrid-sweet into Yang (generating Qi). Prepared Ginger is black and enters Yin, also guiding Blood back to its vessels. The Yongquan points (KI1) on the soles of feet have meridians connecting upwards to the throat; wrapping them with Aconite warms meridians, stops bleeding, and guides Qi downward. If the principle of Qi failing to control Blood is not understood in this case, and Rehmanniae Radix, Moutan Cortex, Imperatae Rhizoma, Gardenia Fruit, or Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) type cooling-blood and purging-fire formulas are used, not only will Middle Qi collapse, but Yin excess and Yang decline may occur, destroying the last ray of residual Yang. If aversion to cold is added, Yang will perish with Yin! For such blood loss prioritizing Spleen support: "First, emphasize strengthening Earth; if Earth is thick, turbid Yin will not ascend, and blood disorders will surely stop. All things take Earth as root, Yuan Qi takes Earth as residence." Therefore, internal formulas do not urgently use Aconite Processed Slice; using Aconite enters Kidney, not Spleen. Nor do they use hemostatic agents, focusing instead on tonifying Qi to grasp Blood. Treating diseases requires clear differentiation of pathogenesis. Once pathogenesis is clear, targeted treatment, formula selection, and herb choice will inevitably be effective.
[Compiler's Commentary]: The above three cases differ based on individual and disease factors. The main experience in treating this disease is: first examine the excess or deficiency of Yin, Yang, Qi, and Blood in the patient; then distinguish the newness, duration, mildness, or severity of the condition; then establish principles and prescribe formulas, hence achieving remarkable results. It is worth noting that clinically, epistaxis is mostly treated with cooling Blood and purging Fire. For cases clearly belonging to Lung-Stomach Heat, this method is indeed indispensable. However, clinical evidence shows this is obviously not comprehensive enough. If used excessively or in patients with insufficient Zheng Qi, it will cause failure. Yu Jiayan said: "Using cooling Blood and purging Fire drugs is the normal method of using Water to control Fire. Applied to Yin Fire, it invariably exacerbates the disorder." Xu Lingtai also said: "When Yin Qi exhausts upwards, the Dragon-Lei Fire in Kidney ascends with Water. If suppressed with cold-cooling, the fire burns even fiercer." Therefore, treating this syndrome should not rely solely on cold-cooling. Mr. Yu Tinghong also said: "If relying solely on cold-cooling, it is like splashing water into boiling oil, provoking it to rage." Thus, later physicians' handling methods for this syndrome are not exclusively cold-cooling. If syndrome differentiation is unclear and treatment leans solely towards cooling Blood and purging Fire, it will inevitably damage Stomach Qi. Once Stomach Qi is damaged, Spleen and Stomach decline accordingly, and the function of controlling Blood is correspondingly weakened. Therefore, Dr. Dai's effective formula for epistaxis and hemoptysis over many years—"Di Huang Ce Bai Ye Tang" (see Case 1)—corrects the drawback of overusing cold-cooling. This formula clears Heart, moistens Lungs, nourishes Kidney, nourishes Liver, strengthens Earth, and tonifies Middle, possessing all methods. It can be used for general epistaxis and hemoptaxis where cold/heat signs are not obvious or heat signs are present. Certainly, for epistaxis due to Spleen Earth decay and Qi failing to grasp Blood, one should follow Yu's method, prioritizing "strengthening Earth," and treat according to Case 3. In cases of Yin Fire surging and excessive blood loss, one must beware of sudden chills, fearing Yang perishing with Yin. Large doses of Qian Yang Tang (Aconite Processed Slice, Turtle Shell, Amomi Fructus, Roasted Licorice) should be used to subdue Yang, secure Yin, make Yin Fire descend, and stabilize its origin. This is another point that must not be ignored.
Insomnia
Huang XX, Male, 40 years old. Suffered from irritability, night sweats, insomnia, dizziness, vertigo, and mental fatigue for a long time. Every night, must take Western sedatives like "Miltown" to fall asleep. Currently, purple tongue, deficient pulse. Clearly due to dual deficiency of Liver and Kidney, restless Heart Spirit, and floating Heat disturbing upwards. Treatment should nourish Liver and Kidney, calm Heart and tranquilize Spirit, and simultaneously clear floating Heat. Prescribed the following formula:
Longan Aril (Gui Yuan Rou) 15g
Stir-fried Ziziphus Seed (Chao Zao Ren) 15g
Lycium Barbarum Fruit (Gou Qi Zi) 15g
Bamboo Shavings (Zhu Ru) 9g
Juncus Effusus Spike (Deng Xin) 1 bundle