方中以自虎汤泻热降火，加党参益气生津。用山药代粳米者，张锡纯谓：“盖粳米不过调和胃气，而山药兼能固摄下焦元气，使元气素虚者不至因服石膏，知母而作泻。且山药多含有蛋白汁，最善滋阴。白虎汤得此，既祛实火又清虚热，内伤外感，须臾同愈。愚用此方救人多矣。”
古之产后三症三方不能尽其病之变。总之，治病不能墨守成规，必须根据客观实际仔细辨证，灵活处理，方可应万变而不穷。前人虽有许多经验记录值得取法，但必须通过自己进一步的实践而加以检验，才可得出正确结论，用以指导临床。
[整理者按]：产后发热，虽有外感、食滞、瘀血、血虚、阴虚，蒸乳等不同，治法亦异。历代医家各有不同见解。如《丹溪心法》有“产后无令得虚，当大补气血为先，虽有杂证，以末治之。”张子和有“产后慎不可作诸虚不足治之”之说。《医宗金鉴》所说“古云胎前无不足，产后无有余，此其常也。然胎前虽多有余之证，亦当详察其亦有不足之时，产后虽多不足之病，亦当详审其每挟有余之证也。”(见《妇科心法要决·胎前诸证门》)。
综上所述，丹溪所言者，言其常也，张氏所言者，言其变也。《金鉴》所言者，既言其常，也言其变。总之，临床治疗既要知常，更要知变，不可拘执，方不致犯虚虚实实之戒。
戴老医师日常临证，对产后诸病虽不忘百脉空虚，元气易耗这一特点，但亦不囿于“产后无有余之证”的说法，而是本着有是证，立是法，用是药。审因论治，因人、因病制宜。
金××，男，二月婴儿。先天不足，素秉赢弱。因发热、咳嗽，西医诊断为小儿肺炎，曾服退热等西药，病情转危。来诊时，症见。神迷、发热，目闭不开，颜面发青，唇色淡白。喉间痰鸣，咳嗽气喘，冷汗淋漓。舌淡润，苔薄白，脉沉小而紧。余观患儿，素禀本亏，元阳稚弱，忽感寒邪外侵，又经药物克伐，遂至浊阴上逆，中阳不守。若不急扶元阳，速驱浊阴，势将出现元气暴脱之危候。急用四逆汤加味。处方，
炙甘草3克
四逆汤回阳救逆，温脾肾之阳，加桂枝宣通心肺阳气，茯苓健脾利湿而和中，炙南星祛风痰。
次日来诊，发热减轻，冷汗已收，面转红润， 目开神清。喉间痰鸣已无，危象悉除。继用桂枝加附子汤。处方；
连服二剂，诸症消失而愈。
[按]：此症虽系阳虚感受外寒而致，而不用麻黄附子细辛汤者，是因患儿冷汗淋漓不止，已有阳气欲脱之危象，故不能再用麻辛之辛散，必须急用四逆汤加味以回阳救逆，驱逐寒疾为治，使患儿元阳得扶，危证消除。继用桂枝加附子汤以扶阳和阴，调和营卫，巩固疗效。
李××，女，八岁。患发热，面青、神迷，脉沉，舌润、耳后起核，大如拇指。病已一周。脉症合参，证为阴邪上犯，寒滞太阳经脉。今患儿面青无神，法当扶阳以祛寒。处予麻辛附子汤。处方：
此方之效用在于温经散寒。方中附片辛热、扶阳，麻黄、细辛辛温散寒，使客邪外散，耳后之核可消，发热亦当随之而解。
此桂枝汤加附片，再加香附、麦芽。方中附片温经散寒，香附、麦芽行滞散结。桂枝汤调和营卫，兼散风寒。
服后，面色唇口均转红润，核已消三分之二，但出现鼻衄，身出红斑。此乃阳气通达之象。继用封髓丹(黄柏10克、砂仁3克，炙甘草6克)三剂调理，诸症全消而愈。
袁××，男，五岁。原患肺结核未愈，后感风寒，症现发热、畏寒、咳嗽等。住某医院按肺结核治疗未见好转，邀余会诊。查其脉浮紧，舌淡润，苔薄白。脉症合参，此系表证失解，致邪郁肺卫。宜解表调和营卫，使病邪得出，则有转机。用加味桂麻各半汤。处方：
二诊：服一剂，寒热即退，咳嗽亦减。继以健脾补肺，脾肺并治之剂，使土旺金生，可望康复。尤以幼年生机旺盛，若能药证相符，恢复并不困难。处以如下二方：
第一方，参苏饮加减：
炒枳壳4．5克 桔梗4．5克 葛根6克 川贝母6克 甘草3克
第二方，参苓自术散： (改为汤剂)
甘草3克 大枣2枚
上二方交替服，二日服一剂，各服六剂后，饮食增进，精神转佳，面色红润，病体康复。
[按]：《内经》云“知标本者，万举万当”。此症虽以肺结核为本病，而症见寒热，脉现浮紧，则为表邪之征。本“急则治标，先表后里”之原则，以解表为先。待标病解除，则以培土生金而治本，使饮食增进，抗力增强，其病自愈。病有先后，治分缓急，治本治标，应以当前所现病机为根据。
加味桂麻各半汤，原系平淡之剂，竟能应手取效者，实由于明辨证情，把握标本缓急得宜。中医不以病名为主，而以辨证为中心者，即此义也。
顿咳(百日咳)
戴××，女，六岁。顿咳不止，夜间尤甚，每日发作数十次，病已经月。西医诊断为“百日咳”。剧咳时口鼻出血，甚或手足抽搐。屡经治疗，未见好转。且食欲减退，精神不振。来诊时，症见面白无华，舌苔自燥，脉细数无力。此症久咳不止，阴虚液涸，肺失清肃。伤则金不制木，血失敛藏，故剧咳时手足抽搐，口鼻出血。胃阴既枯，所以食欲渐减以致精神不振。治法当从滋阴养液，肃降肺气入手。方用炮姜甘草汤加味治之。处方：
白蜜3匙(分三次兑入)
方中，姜炭味苦，甘草味甘，苦与甘合，则能化阴。阴者，血也。血能润燥，又能濡筋。合以白蜜，则补益脾胃，滋胃阴而降肺逆。五味子酸能敛肺，主咳逆上气。天冬入肺
，以清燥热，又能利痰宁嗽。诸药相合，则为肺胃同治，标本兼顾之方，于阴虚液涸之症颇为相宜。
患者服三剂后，咳嗽次数大减，口鼻已不再出血。但因久咳，不仅阴液亏损，血亦不足。再就原方加北口芪15克、当归9克(即当归补血汤)，以补气生血。连服五剂，咳即全止，食欲渐佳而愈。
[按]：百日咳，古称顿咳，是小儿常见的以阵发性咳嗽为主而且病程较长的一种呼吸道传染病，也是小儿传染病中较为痛苦的疾病之一。由于久咳不止，往往导致阴虚液涸．碑胃伤损。此时的治疗，若纯用滋阴，则有碍胃气，若辛香燥脾，则更伤肺阴。有见于此，故借用《金匮》治肺痿吐涎沫之甘草干姜汤，此方原治“肺中冷”，有温肺复气之功。但在用时，姜改用炮姜炭，则辛温之性大减，苦味大增．与甘草合用则有苦甘化阴之妙。再合以白蜜之润肺燥、补脾胃，济以天冬、五味之益阴敛肺，则于肺胃阴虚、脾胃伤损之症即无妨碍，且有刚柔相济之妙。
此方不仅用治小儿百日咳久咳不止而现阴虚液涸者．亦用于男、妇成人阴虚久咳，干咳无痰，或咳即遗尿等。
患者×××，九岁。其父代诉：“病已三日，呕吐发一热，手足时冷，腹痛不能按”。某医院曾考虑手术，因家人反对，故转余急诊。症见：腹痛剧烈，患儿直挺其胸，两眼上翻，烦乱不安，频频以手抓唇。诊其脉则闭伏异常，视其舌，苔黄而燥，舌体满布槟榔状之花点，唇赤面黄。显系湿热积滞，胃浊不化。至于舌现槟榔状花点，则属蛔虫之征。蛔虫为患，故腹痛不能忍。气机郁滞，故脉闭伏。今发热实非外感，热深厥深，故见手足厥冷。先其所急，应予清肠胃湿热，兼以安虫治之。用自拟方安蛔止痛汤。处方：
盖虫之寄生肠胃，赖湿热而繁殖。茵陈专清肠胃湿热，苍术燥湿健胃以安脾。川芎行气开郁，杭芍和肝养血而缓急迫，青皮、厚朴散积消痞而宽中，均有疗腹痛之功。砂仁行滞气，焦山楂消胀散结，更用苦楝皮，黄柏、乌梅以泄热杀虫。加炮姜辛温反佐，以制苦寒。
二诊：上方服后，吐蛔二条，腹痛稍缓，烦乱亦减，呕逆渐定。但不时仍有腹痛，脉仍闭伏，发热未退，大便已四日未解。此营卫失和，里热积滞。本“通则不痛”之旨，用桂枝汤加大黄。处方：
仲景桂枝加大黄汤，原方芍药量为桂枝的两倍。余今用为等量，为桂枝汤原方，目的在和营卫。加大黄以泄里热，通其便而不伤中，与仲景重用芍药配大黄以治里实腹痛者有异。
三诊；服药一剂，大便得通，热稍退，手足转温。多日来闭伏之脉，今转弦数满指，是病情向愈之征。但舌仍黄燥，脉证俱实，虽经用下，但积热未消，仍应再下。方用杨栗山升降散和仲景四逆散合方化裁：
方中僵蚕、蝉蜕、大黄、蜜酒，乃升降散去姜黄也。僵蚕、蝉蜕驱风散热，大黄泄热通腑。酒引诸药上达，蜜导诸药下行。柴、枳、芍、草四逆散也。柴胡散肝胆经热邪，合枳实消心腹、肠胃中结气，且可升清降浊。芍药、甘草并用，可缓急止痛，加芩，连清热除湿。全方主旨，清热导滞，升清降浊，疏肝泄热，且解表和里，荡滞通便。
四诊：上方服后，下燥粪甚多，热势又减，脉由弦数转缓，身体已能俯仰，烦乱已除，腹中有时隐痛，舌苔黄燥稍退。此积热未尽，仍应清热导滞。用升降散加甘草：
蜂蜜(每次一匙，点酒少许分三次兑入)
五诊：服上方后，续下燥粪，病者神态安宁，发热全退，腹部微隐痛，惟小便短赤。此湿热未尽，宜清热利湿。仿叶氏治湿热法。处以下方：
连翘4．6克 焦栀仁3克 焦黄柏4．5克 杏仁4．5克藿香4．5克
滑石6克
方中栀仁、苡仁、茵陈，茯苓，清热利湿，木通、通草导热下行，杏仁利气、宣肺，藿香行气、助胃，止心腹之痛，滑石利湿，黄柏滋水清热。
六诊：服一剂后，患者神清气爽，六脉平和，腹已不痛，小便清长。继予甘露饮，清湿热，养阴液而愈。
[按]：本证初诊，颇似仲景乌梅丸证。然乌梅丸证所治之蛔厥，是因脏寒，蛔上入胃所致。本证虽由虫积引起，但湿热积滞，大便燥结。故先用安虫止痛，继用清热导滞。复经数次攻下，才使病势由重转轻。若不及时议下，则变生他症。
小儿风痉频发
刘××，男，二岁。患抽搐，已三月余，日发四、五次，若受惊则发作更甚。经某医院治疗已二月，邀余会诊。见患儿两目直视，舌绛、面赤、唇紫，脉弦数。证属热郁生风，肝风内动。先以通络、养肝、清热熄风为治。用加味三豆饮。处方：
另加服猴枣散，一瓶分二次服，日服一次。
方中三豆，专以养肝、润燥、和胃，银花、连翘清热解毒，桔络、丝瓜络化痰通络，钩藤清热平肝、熄风镇痉。再以猴枣散清热化痰，镇惊熄风。
患儿服上方三剂后，抽搐已止。但一周后，又复发，次数较前减少。继以熄风、镇惊潜阳之剂，用《金匮要略》风引汤。处方：
酒军3克 甘草6克
方中赤石脂、白石英、紫石英皆能镇痉熄风。赭石平肝镇逆，龙骨收敛元气，牡蛎滋阴潜阳，更以桂枝、干姜为反佐。酒军、生石膏清化伏热。如此制方，全面兼顾。
服两剂，抽搐全止。为巩固疗效，嘱用鹿茸9克，分十次服，一周服二次，以扶元阳。继用陈夏六君汤加麦冬调理而愈。追踪观察三年，未复发。
疳积二例
例一：
李××，男，五岁，患病已半年。症见：面色皓白，起蟹爪纹，唇赤。肌肉消瘦，腹大坚硬，毛发焦枯，皮肤干燥，微咳，午后潮热。多食善饥，大便溏泻，每日约2至3次，小便混浊。经治未愈而转我所。查得脉象弦细，舌淡润无苔。病属疳积，证为脾胃虚衰，津液损耗。处以下方：
In this prescription, Baihu Tang (White Tiger Decoction) is used to purge heat and descend fire, with Dangshen added to tonify qi and generate fluids. The reason for using Shanyao (Dioscorea Rhizome) instead of Jingmi (Rice) is that Zhang Xichun stated: "Jingmi merely harmonizes stomach qi, whereas Shanyao can simultaneously secure the primordial qi of the lower jiao, preventing those with deficient primordial qi from suffering diarrhea due to the cold nature of Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhenae Rhizoma). Moreover, Shanyao contains abundant protein juice, which is excellent at nourishing yin. With the addition of Shanyao, Baihu Tang can both dispel excess fire and clear deficiency heat, curing both internal injury and external contraction rapidly. I have used this prescription to save many people."
After taking one dose of this prescription, symptoms reduced by half, and consciousness became clear. After another dose, all symptoms disappeared.
The ancient saying regarding three specific postpartum syndromes treated with three specific prescriptions cannot exhaustively cover the variations of disease. In summary, treating disease requires not adhering rigidly to conventions; one must carefully differentiate syndromes based on objective reality and handle them flexibly to respond to myriad changes without exhaustion. Although there are many records of experience from predecessors worth emulating, they must be verified through one's own further practice before drawing correct conclusions to guide clinical work.
[Editor's Note]: Postpartum fever may arise from different causes such as exterior contraction, food stagnation, blood stasis, blood deficiency, yin deficiency, or milk engorgement, each requiring different treatment methods. Physicians of past dynasties held various views. For instance, *Danxi Xinfa* states: "Postpartum women should not be allowed to become deficient; the priority should be major tonification of qi and blood. Even if other miscellaneous syndromes exist, they should be treated secondarily." Zhang Hezi said, "One must be cautious about treating postpartum conditions solely as various deficiencies and insufficiencies." *Yizong Jinjian* states: "Ancient texts say there is no deficiency in pregnancy and no excess in postpartum; this is the norm. However, although pregnancy often involves excess syndromes, one must carefully observe times of deficiency; although postpartum often involves deficiency diseases, one must carefully examine whether excess syndromes are present." (See *Fuke Xinfa Yaojue · Taiqian Zhu Zheng Men*).
In summary, Danxi spoke of the norm, Zhang spoke of variation, and *Jinjian* spoke of both. In essence, clinical treatment requires knowing both the norm and the variation; one must not be dogmatic to avoid the error of treating deficiency as excess or vice versa.
Dr. Dai, in daily clinical practice, while remembering the characteristic of empty meridians and easily depleted primordial qi in postpartum conditions, does not confine himself to the saying "there is no excess in postpartum." Instead, he follows the principle of establishing methods and using herbs according to the syndrome present. He investigates the cause for treatment, adapting to the individual and the disease.
Yang Deficiency with Middle Jiao Cold, Fever, Cough, and Asthma
Patient Jin XX, male, two-month-old infant. Congenital insufficiency, constitutionally frail. Due to fever and cough, diagnosed with pediatric pneumonia by Western medicine. After taking antipyretic Western medicines, the condition became critical. At consultation, symptoms included: coma, fever, eyes closed and unable to open, cyanotic face, pale lips. Phlegm rattle in the throat, coughing and wheezing, profuse cold sweat. Pale moist tongue, thin white coating, deep, small, and tight pulse. Observing the patient, the congenital foundation was deficient, primordial yang was tender and weak. Suddenly contracting external cold pathogen, followed by drug suppression, leading to turbid yin rising and failure of middle yang to maintain its position. If primordial yang is not urgently supported and turbid yin not quickly driven away, a critical state of sudden collapse of primordial qi will occur. Urgently use Sini Tang (Four Reversal Decoction) with modifications. Prescription:
Hei Fupian (Prepared Aconite Root Lateralis) 15g, Ganjiang (Dried Ginger) 5g, Guizhi (Cinnamon Twig) 5g, Fuling (Poria) 9g, Zhi Nanting (Prepared Arisaema Rhizoma) 5g
Zhi Gancao (Honey-fried Licorice Root) 3g
Sini Tang restores yang and rescues from collapse, warming the spleen and kidney yang. Guizhi unblocks heart and lung yang; Fuling strengthens the spleen, promotes dampness drainage, and harmonizes the middle; Zhi Nanting disperses wind-phlegm.
Next day's consultation: Fever reduced, cold sweat stopped, face turned rosy, eyes opened, consciousness clear. Phlegm rattle gone, critical signs eliminated. Continue with Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Prepared Aconite). Prescription:
Hei Fupian 15g, Guizhi 5g, Chao Hangshao (Stir-fried White Peony Root) 5g, Zhi Gancao 3g
Shao Shengjiang (Roasted Fresh Ginger) 3 slices, Dazao (Jujube) 2 pieces
Taken for two doses consecutively, all symptoms disappeared, and the patient recovered.
[Note]: This syndrome resulted from yang deficiency contracting external cold. Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction) was not used because the patient had profuse cold sweat, indicating a critical sign of impending yang collapse. Therefore, the acrid-dispersing properties of Mahuang and Xixin could not be used again. It was necessary to urgently use modified Sini Tang to restore yang and rescue from collapse, driving out cold pathogens to support the patient's primordial yang and eliminate the critical condition. Subsequently, Guizhi Jia Fuzi Tang was used to support yang and harmonize yin, regulate Ying and Wei, and consolidate efficacy.
Cold Coagulation in Meridians, Mass Behind Ear
Patient Li XX, female, eight years old. Suffering from fever, cyanotic face, coma, deep pulse, moist tongue, and a mass behind the ear as large as a thumb. Ill for one week. Combining pulse and symptoms, the syndrome is Yin pathogen attacking upward, cold stagnating in the Taiyang meridian. Given the cyanotic face and lack of spirit, the method should be supporting yang to dispel cold. Prescribe Maxing Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction). Prescription:
Hei Fupian 30g, Ma Rong (Prepared Ephedra Herb) 3g, Xixin (Asarum Root) 2.5g
The effect of this formula lies in warming meridians and dispelling cold. Fupian is acrid and hot, supporting yang; Mahuang and Xixin are acrid and warm, dispelling cold, allowing external pathogens to scatter. The mass behind the ear will dissipate, and fever will resolve accordingly.
Next day's consultation: Pulse still deep, mass slightly reduced, fever subsided. Prescribe the following:
Hei Fupian 30g, Guizhi 6g, Chao Hangshao 9g, Sheng Xiangfu (Fresh Cyperi Rhizoma) 9g
Maiya (Sprouted Hordeum Fructus) 15g, Zhi Gancao 6g, Shao Jiang 3 slices, Dazao 3 pieces
This is Guizhi Tang plus Fupian, plus Xiangfu and Maiya. Fupian warms meridians and dispels cold; Xiangfu and Maiya move stagnation and dissipate nodules. Guizhi Tang harmonizes Ying and Wei, dispersing wind-cold.
After taking, face and lips turned rosy, mass reduced by two-thirds, but epistaxis occurred, and red macules appeared on the body. This is a sign of yang qi penetrating. Continue with Fengsui Dan (Coptis Decoction) [Huangbai 10g, Sharen 3g, Zhi Gancao 6g] for three doses to regulate. All symptoms disappeared, and recovery was achieved.
Tuberculosis with Unresolved Exterior Pathogen
Patient Yuan XX, male, five years old. Previously suffered from untreated pulmonary tuberculosis, then contracted wind-cold, presenting with fever, aversion to cold, cough, etc. Treated for tuberculosis in a hospital without improvement; invited for consultation. Pulse floating and tight, pale moist tongue, thin white coating. Combining pulse and symptoms, this is an unresolved exterior syndrome causing pathogen stagnation in Lung and Wei. The method should be resolving the exterior and harmonizing Ying and Wei, allowing the pathogen to exit, offering a turning point. Use Jiawei Guima Gehan Tang (Modified Cinnamon and Ephedra Half-Decoction). Prescription:
Zhi Ma Rong 4.5g, Xingren (Apricot Seed) 6g, Guizhi 6g, Hangshao 9g, Ziye (Perilla Leaf) 4.5g
Fangfeng (Saposhnikoviae Radix) 6g, Duhuo (Angelicae Pubescentis Radix) 6g, Gancao 4.5g, Shao Shengjiang 3 slices, Dazao 5 pieces
Second visit: After one dose, chills and fever subsided, cough decreased. Continue with formulas strengthening spleen and tonifying lung, treating both spleen and lung, so that Earth flourishes and Metal generates, expecting recovery. Especially given the vigorous vitality of childhood, if the medicine matches the syndrome, recovery is not difficult. Prescribe the following two formulas:
First Formula, modified Shen Su Yin (Ginseng and Perilla Decoction):
Shashen (Glehniae Radix) 9g, Ziye 3g, Faxia (Pinellia Rhizoma Preparata) 6g, Fuling 9g, Chenpi (Citri Reticulatae Pericarpium) 4.5g
Chao Zhiqiao (Stir-fried Aurantii Fructus Immaturus) 4.5g, Jiegeng (Platycodonis Radix) 4.5g, Gegen (Puerariae Radix) 6g, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 6g, Gancao 3g
Second Formula, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder): (Converted to decoction)
Sutiaoshen (Codonopsis Radix) 9g, Baizhu (Atractylodis Macrocephalae Rhizoma) 6g, Fuling 9g, Biandou (Dolichoris Semen) 9g, Lianzi (Nelumbinis Semen) 9g
Huai Shanyao 9g, Yiren (Coicis Semen) 9g, Sharen 3g, Chenpi 3g, Jiegeng 4.5g
Gancao 3g, Dazao 2 pieces
Take these two formulas alternately, one dose every two days. After taking six doses of each, appetite increased, spirit improved, face became rosy, and the body recovered.
[Note]: *Neijing* says, "Knowing root and branch ensures success in ten thousand actions." Although pulmonary tuberculosis is the root disease here, the presence of chills/fever and floating-tight pulse indicates an exterior pathogen. Following the principle of "treating acute symptoms first, exterior before interior," resolving the exterior is prioritized. Once the branch symptom is resolved, tonifying Earth to generate Metal treats the root, improving appetite and resistance, leading to self-healing. Diseases have sequence, treatments have urgency; treating root or branch should be based on the current pathogenesis.
Jiawei Guima Gehan Tang is originally a mild formula, yet effective immediately, truly due to clear differentiation of syndrome and appropriate grasp of root/branch and urgency. Traditional Chinese Medicine focuses on syndrome differentiation rather than disease names, which is the meaning here.
Pertussis (Whooping Cough)
Patient Dai XX, female, six years old. Paroxysmal coughing incessantly, worse at night, occurring dozens of times daily, ill for one month. Diagnosed with "pertussis" by Western medicine. During severe coughing fits, bleeding from mouth and nose, even convulsions of hands and feet. Multiple treatments showed no improvement. Appetite decreased, spirit listless. At consultation, face pale without luster, dry tongue coating, fine, rapid, and forceless pulse. This syndrome of prolonged coughing leads to yin deficiency and fluid depletion, loss of Lung's clearing and descending function. Damage results in Metal failing to control Wood, blood losing containment, hence convulsions and bleeding during severe coughing. Stomach yin dried up, so appetite gradually decreased, leading to listlessness. Treatment should start with nourishing yin and fluids, descending Lung qi. Use Paoganjicao Tang (Fried Ginger and Licorice Decoction) with modifications. Prescription:
Paoganjitan (Charred Fried Ginger) 6g, Zhi Gancao 6g, Tiandong (Asparagi Radix) 9g, Wuweizi (Schisandrae Fructus) 3g
Baimi (White Honey) 3 spoons (mixed in three times)
In the formula, Charred Ginger is bitter, Licorice is sweet. Bitter and sweet combined transform into yin. Yin refers to blood. Blood moistens dryness and nourishes sinews. Combined with honey, it tonifies spleen and stomach, nourishes stomach yin, and descends rebellious Lung qi. Wuweizi is sour, astringing Lung, treating rebellious qi and cough. Tiandong enters Lung, clearing dryness-heat, benefiting phlegm, and calming cough. The combination of herbs treats both Lung and Stomach, addressing root and branch, suitable for yin deficiency and fluid depletion.
After three doses, cough frequency greatly reduced, bleeding stopped. However, due to prolonged coughing, not only yin fluids were depleted, but blood was also insufficient. Add Huangqi (Astragali Radix) 15g and Danggui (Angelicae Sinensis Radix) 9g to the original formula (i.e., Danggui Buxue Tang) to tonify qi and generate blood. Taken for five doses consecutively, cough completely stopped, appetite improved, and recovery was achieved.
[Note]: Pertussis, anciently called Dunke, is a common respiratory infectious disease in children characterized by paroxysmal coughing and long duration, one of the more painful pediatric infectious diseases. Prolonged coughing often leads to yin deficiency, fluid depletion, and spleen/stomach damage. At this stage, pure yin-nourishing hinders stomach qi, while acrid-aromatic drying harms lung yin. Seeing this, borrowing Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) from *Jingui Yaolue* for treating Lung萎 (Flaccidity) with saliva沫, which originally treats "cold in Lung" and warms Lung to restore qi. However, when used, Ginger is changed to Charred Fried Ginger, greatly reducing acrid-warm nature and increasing bitterness. Combined with Licorice, it has the wonder of bitter-sweet transforming yin. Combined with honey's moistening and tonifying, aided by Tiandong and Wuweizi's yin-nourishing and Lung-astringing, it poses no harm to Lung/Stomach yin deficiency and spleen/stomach damage, having the wonder of balancing hard and soft.
This formula is not only used for pediatric pertussis with prolonged coughing and yin deficiency/fluid depletion, but also for adult men and women with prolonged yin-deficient coughing, dry cough without phlegm, or cough-induced enuresis.
Ascariasis Colic Abdominal Pain
Patient XXX, nine years old. Father reported: "Ill for three days, vomiting, intermittent fever, cold hands and feet, abdominal pain intolerable to pressure." A hospital considered surgery, but family opposed, so transferred for emergency care. Symptoms: Severe abdominal pain, child stiffened chest, eyes rolling up, restless and uneasy, frequently scratching lips with hands. Pulse extremely hidden and suppressed; tongue yellow and dry coating, tongue body covered with betel-nut-like floral spots, red lips, yellowish face. Clearly damp-heat accumulation and stagnation, stomach turbidity not transforming. Betel-nut-like spots on tongue indicate ascariasis. Parasitic worms cause unbearable abdominal pain. Qi mechanism stagnation causes hidden pulse. Current fever is not exterior contraction; deep heat causes deep reversal, hence cold extremities. Address the urgency first: clear damp-heat in intestines and stomach, pacify worms. Use self-invented Anhui Zhitong Tang (Worm-Pacifying and Pain-Relieving Decoction). Prescription:
Yinchen (Artemisiae Scopariae Herba) 6g, Chao Cangzhu (Stir-fried Atractylodis Rhizoma) 6g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 6g, Qingpi (Citri Reticulatae Pericarpium Viride) 6g, Chao Hangshao 6g
Houpo (Magnoliae Officinalis Cortex) 6g, Sharen 4.5g, Jiao Shanzha (Charred Crataegi Fructus) 6g, Jiao Huangbai (Charred Phellodendri Cortex) 6g
Kuilan Genpi (Toosendan Cortex) 4.5g, Shao Wumei (Roasted Mume Fructus) 3 pieces, Paoganjiao (Fried Ginger) 3g
Worms parasitize intestines and stomach, relying on damp-heat for reproduction. Yinchen specifically clears damp-heat in intestines and stomach; Cangzhu dries dampness, strengthens stomach, and calms spleen. Chuanxiong moves qi and opens depression; Hangshao harmonizes liver, nourishes blood, and relieves urgency. Qingpi and Houpo dissipate accumulation, reduce fullness, and widen middle, all alleviating abdominal pain. Sharen moves stagnant qi; Jiao Shanzha reduces distension and dissipates nodules. Kuilanpi, Huangbai, and Wumei drain heat and kill parasites. Paoganjiao is added as acrid-warm counter-agent to moderate bitter-cold.
Second visit: After taking above formula, vomited two worms, abdominal pain slightly eased, restlessness reduced, vomiting stabilized. But occasional abdominal pain persists, pulse still hidden, fever not subsided, no bowel movement for four days. This is Ying-Wei disharmony, interior heat and accumulation. Based on "free flow means no pain," use Guizhi Tang plus Dahuang. Prescription:
Guizhi 6g, Chao Hangshao 6g, Dahuang (Rhei Radix et Rhizoma) 6g (added later), Gancao 3g
Shengjiang 2 slices, Dazao 2 pieces
Zhongjing's Guizhi Jia Dahuang Tang originally uses twice the amount of Shaoyao compared to Guizhi. I now use equal amounts, aiming to harmonize Ying and Wei like the original Guizhi Tang. Adding Dahuang drains interior heat and unblocks bowels without damaging middle, differing from Zhongjing's heavy Shaoyao combined with Dahuang to treat interior excess abdominal pain.
Third visit: After one dose, bowel movement achieved, fever slightly subsided, hands and feet warmed. Hidden pulse after many days now turns wiry, rapid, and full, indicating recovery trend. But tongue still yellow and dry, pulse and symptoms both excess. Although purgatives were used, accumulated heat remains, so purging should continue. Use Yang Lisshan Shengjiang San (Ascending and Descending Powder) combined with Zhongjing's Sini San (Four Reversal Powder) modified:
Jiangcan (Bombyx Batryticatus) 4.5g, Chantui (Cicadae Periostracum) 3g, Chao Chaihu (Stir-fried Bupleuri Radix) 4.5g, Chao Hangshao 6g
Chao Zhishi (Stir-fried Aurantii Fructus Immaturus) 4.5g, Gancao 3g, Chao Huanglian (Stir-fried Coptidis Rhizoma) 1.5g, Chao Huangqin (Stir-fried Scutellariae Radix) 4.5g
Dahuang 4.5g, Fengmi (Honey) (one spoon each time, with a little wine, mixed in three times)
Jiangcan, Chantui, Dahuang, honey, and wine constitute Shengjiang San minus Jianghuang. Jiangcan and Chantui disperse wind and clear heat; Dahuang drains heat and unblocks bowels. Wine guides herbs upward; honey guides herbs downward. Chai, Zhishi, Shaoyao, Gancao constitute Sini San. Chaihu disperses heat pathogen in Liver and Gallbladder meridians; combined with Zhishi, eliminates knotting qi in heart, abdomen, and intestines, ascending clear and descending turbid. Shaoyao and Gancao together relieve urgency and pain; adding Qin and Lian clears heat and drains dampness. The main theme of the whole formula is clearing heat and guiding stagnation, ascending clear and descending turbid, soothing liver and draining heat, releasing exterior and harmonizing interior, sweeping stagnation and unblocking bowels.
Fourth visit: After taking above formula, passed much dry feces, heat further reduced, pulse changed from wiry-rapid to slow, body able to bend and extend, restlessness eliminated, occasional dull abdominal pain, tongue coating yellow-dry slightly receded. Accumulated heat not fully cleared, still need to clear heat and guide stagnation. Use Shengjiang San plus Gancao:
Jiangcan 4.5g, Chantui 3g, Jianghuang (Curcumae Longae Rhizoma) 4.5g, Dahuang 4.5g, Gancao 3g
Honey (one spoon each time, with a little wine, mixed in three times)
Fifth visit: After taking above formula, continued passing dry feces, patient's demeanor calm, fever completely subsided, slight dull abdominal pain, only short reddish urine. Damp-heat not fully cleared, should clear heat and promote diuresis. Following Ye Tianshi's method for damp-heat. Prescribe:
Yinchen 6g, Fuling 9g, Yiren 6g
Tongcao (Tetrapanacis Medulla) 3g, Mutong (Akebiae Caulis) 3g
Lianqiao (Forsythiae Fructus) 4.6g, Jiao Zhiren (Charred Gardeniae Semen) 3g, Jiao Huangbai 4.5g, Xingren 4.5g, Huoxiang (Agastaches Herba) 4.5g
Huashi (Talcum) 6g
In the formula, Zhiren, Yiren, Yinchen, and Fuling clear heat and promote diuresis; Mutong and Tongcao guide heat downward; Xingren benefits qi and diffuses Lung; Huoxiang moves qi, assists stomach, stops heart/abdominal pain; Huashi promotes diuresis; Huangbai nourishes water and clears heat.
Sixth visit: After one dose, patient's spirit clear and refreshing, six pulses peaceful, abdomen no longer painful, urine clear and abundant. Continue with Ganlu Yin (Sweet Dew Drink) to clear damp-heat, nourish yin fluids, achieving recovery.
[Note]: Initial diagnosis of this case resembles Zhongjing's Wumei Wan (Mume Pill) syndrome. However, Wumei Wan treats Ascariasis Colic caused by visceral cold causing worms to ascend to the stomach. This case, although caused by worm accumulation, features damp-heat accumulation and dry stool. Thus, first pacify worms and relieve pain, then clear heat and guide stagnation. After several rounds of purging, the disease severity lightened. If purging was not timely, other complications would arise.
Frequent Pediatric Wind Spasm
Patient Liu XX, male, two years old. Suffering from convulsions for over three months, occurring four to five times daily, worsening upon fright. Treated in a hospital for two months; invited for consultation. Child staring straight ahead, crimson tongue, red face, purple lips, wiry-rapid pulse. Syndrome belongs to heat stagnation generating wind, internal stirring of Liver wind. First treat with unblocking collaterals, nourishing Liver, clearing heat, and extinguishing wind. Use Jiawei Sandou Yin (Modified Three Bean Decoction). Prescription:
Lv dou (Mung Bean) 9g, Hei dou (Black Soybean) 6g, Hong Fan dou (Red Rice Bean) 9g, Yinhua (Lonicerae Japonicae Flos) 3g, Lianqiao 3g
Jieluo (Loquat Flower Stamen) 6g, Sigualuo (Luffae Fructus Retinervus) 6g, Gouteng (Uncariae Ramulus cum Uncis) 3g
Additionally administer Houzao San (Monkey Date Powder), one bottle divided into two doses, taken once daily.
In the formula, the three beans specifically nourish Liver, moisten dryness, and harmonize stomach; Yinhua and Lianqing clear heat and detoxify; Jieluo and Sigualuo resolve phlegm and unblock collaterals; Gouteng clears heat, calms Liver, extinguishes wind, and arrests spasms. Then Houzao San clears heat, resolves phlegm, calms fright, and extinguishes wind.
After three doses of above formula, convulsions stopped. But one week later, recurred, though less frequent. Continue with wind-extinguishing, fright-calming, and yang-submerging agents, using Fengyin Tang (Wind-Driving Decoction) from *Jingui Yaolue*. Prescription:
Sheng Daizheshi (Raw Hematitum) 9g, Bai Shiying (Leucostictum) 9g, Zi Shiying (Melanostictum) 9g, Chishizhi (Halloysit Rubrum) 9g
Longgu (Fossilia Ossis Mastodi) 9g, Sheng Shigao (Gypsum Fibrosum) 9g, Muli (Concha Ostreae) 6g, Guizhi 9g, Ganjiang 9g
Jiu Jun (Wine-processed Dahuang) 3g, Gancao 6g
In the formula, Chishizhi, Bai Shiying, and Zi Shiying all arrest spasms and extinguish wind. Daizheshi calms Liver and directs rebellion downward; Longgu consolidates primordial qi; Muli nourishes yin and submerges yang; Guizhi and Ganjiang serve as counter-agents. Jiu Jun and Sheng Shigao clear transformed latent heat. Such prescription formulation comprehensively considers all aspects.
After two doses, convulsions completely stopped. To consolidate efficacy, instructed to take Luzhong (Cervi Cornus Colla) 9g, divided into ten doses, taken twice a week, to support primordial yang. Continue with Chenxia Liujun Tang (Chenpi, Pinellia, and Six Gentlemen Decoction) plus Maidong (Ophiopogonis Radix) for regulation, achieving recovery. Follow-up observation for three years showed no recurrence.
Malnutrition (Ganji) Two Cases
Case 1:
Patient Li XX, male, five years old, ill for half a year. Symptoms: Face bright white, crab-claw wrinkles, red lips. Muscle wasting, large and hard abdomen, scorched and dry hair, dry skin, slight cough, afternoon tidal fever. Polyphagia and hunger, loose stools, approx. 2-3 times daily, turbid urine. Treated without cure, transferred to my institute. Pulse wiry and fine, pale moist tongue without coating. Disease belongs to Ganji, syndrome is spleen-stomach deficiency decline, fluid consumption. Prescribe the following formula: