白蜜10克
此方系炮姜甘草汤与当归补血汤合方。方中炮姜、甘草苦甘化阴，专培脾胃之阴，加天冬、白蜜以济肺燥，合当归补血汤以益气生血。全方为治疳积肺胃阴枯之方。
二诊：上方服三剂后咳止，潮热退，大便恢复正常，一目一次。惟腹大坚硬如故。处以芜荑化疳汤。处方：
方中苦楝根皮、芜荑杀虫消疳，百部润肺止咳杀虫。白术、苡仁健脾利湿，青蒿、胡连、杭芍、山土瓜清热平肝。青皮、木香，焦楂消积化瘀，行滞理气。本方具有一般化疳“汤之效验，又能平肝清热，故对“小儿疳积”腹大坚硬者尤效。
三诊：上方服五剂后，·腹胀大减，且腹部逐渐柔软。为巩固疗效，拟方用参苓白术散加银柴胡、杭芍、乌梅，调理．肝脾。嘱服十余剂渐愈。
例二：
施××，女，十五岁。形体消瘦，腹胀大已二月。曾用破气药后，腹胀日增，且逐渐不欲食。胸闷，神倦，思睡乏力，转余诊治。察其脉濡，舌质淡润，苔白腻。《内经》云：“诸湿肿满，皆属于脾”。按此症即属脾湿痰积，气机郁滞。法当化湿理气，温肝舒郁。处方：
乌梅3枚
二诊：上方连服三剂，腹胀大减，胸闷渐舒，能进食。继以健脾理气为治。处方：
三诊：上方连服五剂后，腹胀全消，食欲增进。为巩固疗效，继以六君汤加淮山药、扣仁、香附，麦芽、枣皮、乌梅，健脾柔肝调理而愈。
[按]：疳积之成因多由脾胃虚损所致。如断乳过早或乳食不节，恣食肥甘生冷油腻，停滞中焦，日久成积，积久成疳。或久病吐泻，或久热不退，或久痢久疟之后，津液耗竭。脾主运化、散精，并为胃行其津液。今脾阳虚衰，则胃阴枯竭，肺失滋源，不能充身润肤，积渐成疳。《幼幼集成》所谓“疳之为病，皆虚所致，虚为积之本，积为虚之标也。”所谓虚，证之临床，应指脾阳不足、胃阴枯竭、肺失滋源、津枯肺燥为主要原因。
一般疳积临床症状大多表现为面色萎黄，肌肉消瘦，腹大坚硬，青筋暴露，毛发焦枯，皮肤干燥；或午后潮热．烦渴困倦，多食易饥，食不为肌肤，大便溏泻，小便混浊，间有嗜食生米泥土等物，种种症象。一般方书只重现象，不重本质，罗列许多名目，如心、盱、脾、肺、肾疳以及蛔、眼、脑、鼻、矛疳等等。而且各列治法，舍本逐末，使后学者无所适从，徒乱人意。余治小儿疳积紧紧掌握脾肺二脏。由于脾胃相表里，扶脾阳、固胃液、滋肺阴、佐养肝和血等珐疗效甚佳。
鹤膝风
周姓女孩，九岁。患左膝关节肿大，住某医院，诊断为：“骨结核”。治疗二月，前后开刀五次，病情如故，请余会。诊。症见：患儿面色皓白，左膝关节肿大且僵冷，不能站．立。开刀之处涔涔流下清稀黑水，无疼痛感觉。终日嗜睡，舌润无苔，脉沉迟无力。详询病史，知发病是由于冬令玩雪而引起。寒邪侵入经脉，治不得法，迁延日久，郁而不解。脉症合参，当用通阳化滞和血之法。用加味阳和汤。处方：
麻绒6克熟地15克白芥子9克 鹿角霜15克’桂枝6克
方中熟地、肉桂、鹿角霜温肾阳固肾阴。麻绒开腠理。白芥子消痰化积，消皮里膜外之痰。熟地得麻绒则不凝滞．麻绒得熟地则不表散。此方重用鹿角霜一味，取温补而不粘滞。肉桂、桂枝并用者，取其温心、肺、肾之阳。加当归以补血、活血。全方配合有扶阳固阴之功。
二诊：上方服五剂后，面色由皓白渐转红润，左膝关节稍转温，肿势渐消。用原方去鹿角霜，每剂加服鹿茸1．5兑，再服五剂。取鹿茸补精髓，壮元阳，大补督脉，强筋健骨。因肾主骨生髓，督脉为周身骨节之主；肾强，精髓足，则督脉盛，寒邪化，经脉通，而关节肿大可望渐消。
三诊：上方服五剂后，膝关节转温，且能站立。面色红润，食欲增进，精神转佳，患部所流之清稀黑水转为黄色脓液。此肾阳虽复，尚须补气活血、生肌。方用张锡纯内托生肌散加减：
生口芪30克天花粉10克乳香6克没药6克山萸肉15克
此方重用口芪，取其性温、味甘，《本经》谓“主痈疽日久败疮”。以其补气而能生肌，其溃脓自可排除。花粉治痈肿疮毒，配合黄芪更能增强生肌排毒之功。乳香、没药一能调血中之气，一可调气中之血。乳、没合用，宣畅脏腑，疏通经络，善治疮痈，能去瘀滞。山萸肉温肝、补肝以通九窍。全方共呈益气生肌、排脓疏络、解毒之功。服用七剂，后。创口逐渐愈合。
[按]：阳和汤一方，为治阴疽内陷方，因具有通阳化滞和血的作用，故命名“阳和”，取其如日光一照，寒邪悉解之意。惟原方剂量过轻，不能胜病。故用时应师其意而不泥其方。本病无常形，医无常方，药无常品，顺逆进退，存乎其时，神圣工巧存乎其人。君臣佐使，存乎其用。如墨守成规，妄用成方，或执不变之方，以治变动不居之证，虽属效方，亦难取胜。
中 耳 炎
童××，男，五岁。左耳流脓，且发高热，体温39．7℃，西医诊断为中耳炎，曾用青霉素等药，发热未减，流脓依然，延余诊治。症见：左耳中有清稀脓液渗出，精神萎顿，有“但欲寐”之势。二便通畅。舌质青滑苔薄白，脉沉细。四诊合参，断为寒邪入子少阴肾经。肾开窍子耳，经气相通，今寒邪侵入肾经，滞子耳窍，故现上述诸症。治法先宜温经散寒，鼓邪外出。方用《伤寒论》麻黄附子细辛汤。处方：
二诊：服上方一剂后，发热即退，体温正常。患儿面色唇口转红，脓液转稠，脉转弦数，舌质转红。病已由寒化热，所谓“阴证转阳”，其病易治。宜用清肝降火之剂。乃予龙胆泻肝汤加减。处方：
服三剂后，耳中流脓渐止而愈。
[按]：此症治愈之关健在于认清“阳气重于阴气”、“体功重于病邪”之理。凡遇寒邪抑遏，宜先予温经散寒，待阴证转阳，方施以清凉之剂，自易见效。若不知此理，初诊即以寒凉泻火，则寒邪凝滞，变生他证，病难速愈。
本例因系小儿，生机旺盛，易虚易实，故一剂温扶即见韩阳。若系成人或久病，虽数剂温扶，亦难有此明显转机。临证之际，宜注意患者年龄、体质、病程新、久及服药情况。证变药变，一切均从患者客观实际出发，力避主观武断。只有这样，才能收到预期的效果。
外宾××××，男，五十余岁。患内外痔年久，到中国后痔发红肿疼痛，坐卧不安，因体力欠佳，不愿割治。余往会诊，处以内服、外治法。内服处方：
加适量猪胆汁调匀(如软膏状)，涂于纱布上作外敷，一日
换药二次。
五倍子外搽可散疮肿，冰片通窍散郁火，消肿止痛，胆汁苦寒滑润清血。如此内外并治，表里兼顾，服方三剂，外治三日，痛止肿消。离昆前，曾要求外治药二百克携行备用，以防复发。）
李××，男，四十岁。患头面漫肿，耳后尤甚，时流黄水，初经西医诊断为“颜面丹毒”，病至第七日转我所就诊。自诉；心中烦热，咽干，便秘。舌微黄腻，脉洪数，断为湿毒外浸，肺胃郁热所致。治以清热利湿解毒。处方：
紫草6克 生石膏30克 绿豆10克 黑豆10克 淡竹叶10克
此方升清降浊、清肺胃郁热，分解毒邪。生石膏清肺胃郁热以消头面之肿，余皆清热泻火、解毒之品。加淡竹叶以清心胃之热，导邪热由小便而出。加蜜、酒为引导，杨栗山在升降散中说：“酒性无处不到，伐邪辟恶，故为引。”“蜜主丹毒斑疹，清热润燥，故为导。”
二诊：上方服三剂后，肿消大半，耳后黄水已止，继用清热解毒利湿之剂。处方：
生石膏30克 银花10克 紫草10克 红饭豆15克 黑豆10克
三诊：上方服五剂后，肿势全消，大便畅通，黄腻苔已退，脉转弦细，惟颜面发痒，但无红肿，拟驱风除湿再清余热为治。处方：
生石膏30克 知母10克 连翘10克 淡竹叶10克 蝉蜕6克
甘草6克
服二剂，颜面发痒全止，渐脱皮屑而愈。
斑
秃
党××，男，三十五岁。病后头部发痒，随即头发成片脱落，已二月余。现头皮发红光亮，痒如虫行，自疑是“麻风”，曾用西药外治未效，来所求治。症见：面色憔悴，精神不振，舌紫，脉细数。此症由于血虚生风，营卫不畅，《医宗金鉴》称为“油风”，俗名“鬼剃头”，并指出病因系“由毛孔开张，邪风乘虚袭入，风盛血燥，不能荣养毛发”而引起。然以本患者症情观之，不仅营血亏虚，风盛血燥，且气血不足，发失濡养，以致头发脱落。治宜补益气血，养阴润燥。处以下方：
生口芪30克 当归15克 潞党参15克 旱莲草9克 元肉15克
外用生姜揉擦脱发处。
方中黄芪一味，为腠理开罔之总司，生用可以鼓舞卫气，通调血脉，开畅经络，与当归、元肉并用，更能补血养心。潞党参补脾胃益肺气，配当归则气血双补。黑豆、枸杞、早莲草、桑椹子均有养阴益血、滋补肝肾之功，合用则能生发乌发，侧柏叶养阴凉血而泻肺。皆本前人“治风先治血，血行风自灭’’之义。又用黑芝麻滋养润燥。．如此组方，则风邪可灭，血燥可润，何患“油风”之不除，秃发之不生。生姜外擦使风邪外散。
服五剂，并用生姜外擦后，头皮发痒渐止。连用十五剂，一月后发脱之处已逐渐有毛发长出。
[按]：“斑秃”即“油风”，俗名“鬼剃头”，谓其头发成斑状脱落也，甚者可全部头发脱光。《医宗金鉴·外科心法要诀》治此症之法，系以神应养真丹(羌活、木瓜、天麻、菟丝子、白芍、当归、熟地、川芎)内服以治本，用海艾汤(艾叶、菊花、蔓荆子、莱本、防风、薄荷、荆芥、藿香、甘松)外洗以治标。若年深月久者，还须针砭其光亮处出紫血，毛发庶可复生。这一治法与木例病机相近，特附录以供参考。
曹××，女，三十五岁。患左目红肿疼痛，羞明畏光，视物不明，牵引左侧头痛。经某医院诊断为：1．急性结膜炎伴发角膜炎。2．视神经萎缩。经治疗二月余，未见好转，因而来所就诊。症见：六脉弦涩微紧，舌淡苔白，左目引左侧头部剧痛，视物不明，头发脱落，兼见四肢酸困，腰痛。综合脉症，殆由外邪入侵，初期失于表散，以致由表入里，又兼肝肾两虚，内外相合，故现上述症状。病虽二月之久，病邪系由表而入，仍应先从表解。予解表祛风，散寒除湿、开太阳气机之剂为第一步。处以自拟方小白附子汤：
法半夏9克 茯苓15克 川芎6竞 防风9克 独活6克
大枣3枚
此方即天麻汤加小白附子。方中葳蕤仁，尚有祛风明目、滋润等作用。小自附子系天南星科多年生草本植物独角莲的块根，善于祛风痰、通经络、逐寒湿，最祛头面风邪，治偏正头痛及身肢酸痛。
证治既定，嘱患者连续服上方至头痛缓解后再诊。
复诊。上方服至十余剂，头痛大减，目痛亦随之缓减，四肢酸痛及腰痛已止。惟目红痛未全退，视物仍不明。转而专治目疾，以养肝祛风为主。方用《局方》密蒙花散加防风，改为汤剂投之：
木贼6克石决明15克
此方原治“风气攻注，两眼昏暗，眵泪羞明，睑生风粟，隐涩难开，或痒或痛，渐生翳膜，视物不明，及久患偏头痛，牵引两眼，渐觉细小，昏涩隐痛；并暴赤肿痛，并皆治之。”密蒙花为眼科专药，养肝祛风，明目退翳，主治目赤肿痛，多眵多泪，羞明畏光，目昏生翳等症。羌活、防风祛风止痛，木贼、菊花疏散风热而明目，刺蒺藜平肝疏肝、祛风明目。三药合用，善治目赤肿痛翳膜遮睛。石决明平肝清热，益阴明目，亦治目疾要药，与诸明目药相用其明目之功愈大。是方本“肝开窍于目”及“肝主风”之旨而用，使肝气得平，肝风得散，则头目痛之外症可随之消散。
Dried Ginger 9g, Licorice Root 6g, Angelica Sinensis 15g, Astragalus Membranaceus (Huangqi) 15g, Asparagus Tuber 10g.
White Honey 10g.
This formula is a combination of Paojiang Gancao Tang (Dried Ginger and Licorice Decoction) and Danggui Buxue Tang (Angelica Blood-Nourishing Decoction). In the formula, Dried Ginger and Licorice Root employ the method of "bitter-sweet transforming into yin" to specifically nourish the Yin of the Spleen and Stomach. Added Asparagus Tuber and White Honey to moisten Lung dryness, combined with Angelica Blood-Nourishing Decoction to tonify Qi and generate Blood. The entire formula is used to treat Phthisis (Ganji) resulting in exhaustion of Lung and Stomach Yin fluids.
Second visit: After taking three doses of the above prescription, coughing ceased, tidal fever subsided, and bowel movements returned to normal, occurring once daily. Only abdominal distension remained hard and enlarged. Prescribed Wuyi Huagan Tang (Candicida Phthisis-Resolving Decoction). Prescription:
Artemisia Annua 6g, Myrobalan 6g, Green Tangerine Peel 6g, White Peony Root 10g, Atractylodes Macrocephala 10g.
Picrorhiza Rhizome 5g, Charred Hawthorn Fruit 15g, Stemona Root 10g, Aucklandia Root 3g, Trichosanthes Kirilowii Root (Shantugua) 6g.
Coix Seed 20g, Toosendan Bark (Kulian Genpi) 6g, Licorice Root 6g.
In this formula, Toosendan Bark and Myrobalan kill parasites and resolve phthisis; Stemona Root moistens the Lungs, stops coughing, and kills parasites. Atractylodes Macrocephala and Coix Seed strengthen the Spleen and drain dampness; Artemisia Annua, Picrorhiza Rhizome, White Peony Root, and Trichosanthes Kirilowii Root clear heat and calm the Liver. Green Tangerine Peel, Aucklandia Root, and Charred Hawthorn Fruit resolve accumulation and stasis, promote Qi movement and regulate Qi dynamics. This formula possesses the efficacy of general phthisis-resolving decoctions, and can also calm the Liver and clear heat, making it particularly effective for pediatric phthisis presenting with abdominal distension and hardness.
Third visit: After taking five doses of the above prescription, abdominal distension was significantly reduced, and the abdomen gradually became soft. To consolidate therapeutic effects, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) was prescribed with added Silver Wormwood Root, White Peony Root, and Chinese Plum, to regulate the Liver and Spleen. Advised to take more than ten doses for gradual recovery.
Case 2:
Patient Shi XX, Female, 15 years old. Emaciated body, abdominal distension and enlargement for two months. After taking Qi-breaking medicines, abdominal distension increased daily, accompanied by loss of appetite. Chest tightness, mental fatigue, drowsiness, and weakness. Transferred to my care. Pulse was soggy (Ru), tongue pale and moist with white greasy coating. *Neijing* states: "All dampness-induced swelling and fullness belong to the Spleen." Based on these symptoms, this condition belongs to Spleen deficiency with damp-phlegm accumulation and Qi stagnation. The treatment method should be to resolve dampness, regulate Qi, warm the Liver, and relieve depression. Prescription:
Coix Seed 10g, Atractylodes Lancea 10g, Amomum Fruit 6g, Magnolia Bark 9g, Evodia Fruit 6g.
White Peony Root 10g, Charred Hawthorn Fruit 15g, Green Tangerine Peel 6g, Licorice Root 6g, Dried Ginger 9g.
Chinese Plum 3 pieces.
Second visit: After continuously taking three doses of the above prescription, abdominal distension was significantly reduced, chest tightness gradually relieved, and appetite returned. Continued treatment focused on strengthening the Spleen and regulating Qi. Prescription:
Atractylodes Macrocephala 10g, Immature Bitter Orange 8g, Stemona Root 10g, Aucklandia Root 5g, Akebia Stem 6g, Chicken Liver one piece.
Third visit: After continuously taking five doses of the above prescription, abdominal distension completely disappeared, and appetite improved. To consolidate therapeutic effects, Liu Jun Tang (Six-Gentlemen Decoction) was continued with added Chinese Yam, [unclear specific nut/seed, likely a local term or typo], Cyperus Rhizome, Malt, Cornus Fruit, and Chinese Plum, to strengthen the Spleen and soften the Liver, leading to recovery.
[Commentary]: The etiology of Phthisis (Ganji) is mostly caused by Spleen and Stomach deficiency. For example, weaning too early or irregular diet, indulging in rich, sweet, cold, raw, fatty, and greasy foods, causing stagnation in the Middle Jiao, forming accumulation over time, which eventually becomes Phthisis. Or after prolonged vomiting and diarrhea, persistent fever, or chronic dysentery and malaria, leading to depletion of Jin-Ye (body fluids). The Spleen governs transportation and transformation, distributes essence, and transports fluids for the Stomach. Now, with Spleen Yang deficiency, Stomach Yin is exhausted, the Lung loses its source of nourishment, failing to nourish the body and moisten the skin, gradually developing into Phthisis. *Youyou Jicheng* states: "Phthisis disease is all caused by deficiency; deficiency is the root of accumulation, and accumulation is the manifestation of deficiency." Clinically, "deficiency" refers mainly to Spleen Yang insufficiency, Stomach Yin exhaustion, Lung losing its nourishing source, and fluid depletion with Lung dryness.
General clinical manifestations of Phthisis include sallow complexion, muscle emaciation, abdominal distension and hardness, visible subcutaneous veins, brittle hair, and dry skin; or afternoon tidal fever, irritability, thirst, fatigue, polyphagia with easy hunger, food not converting to flesh, loose stools, turbid urine, and sometimes pica for raw rice or soil, among various symptoms. General formularies focus only on phenomena, neglecting the essence, listing many categories such as Heart, Liver, Spleen, Lung, Kidney Phthisis, and roundworm, eye, brain, nose, spear Phthisis, etc. Each lists different treatments, abandoning the root for the branch, leaving students confused and bewildered. In treating pediatric Phthisis, I strictly focus on the Spleen and Lungs. Since the Spleen and Stomach are exterior-interior paired, methods such as supporting Spleen Yang, securing Stomach fluids, nourishing Lung Yin, and assisting with Liver-nourishing and blood-regulating methods yield excellent results.
Crane's Knee Wind (Knee Tuberculosis)
Girl Zhou, 9 years old. Swelling of the left knee joint, hospitalized at a certain hospital, diagnosed as "Bone Tuberculosis." Treated for two months, underwent surgery five times, condition unchanged. Consulted me. Symptoms: Pale white complexion, left knee joint swollen, stiff, and cold, unable to stand. Incision sites oozed clear, thin, black fluid without pain sensation. Constantly sleepy, tongue moist without coating, pulse deep, slow, and weak. Detailed history revealed onset due to playing in snow during winter. Cold pathogen invaded the meridians, improper treatment led to prolonged duration, stagnation and unresolved nature. Combining pulse and symptoms, the method should be to unblock Yang, resolve stagnation, and harmonize blood. Used Modified Yanghe Tang. Prescription:
Ephedra Floss (Mahuang Rong) 6g, Prepared Rehmannia Root 15g, White Mustard Seed 9g, Deer Antler Glue/Rime 15g, Cinnamon Twig 6g.
Cinnamon Bark (Rougui) 5g, Dried Ginger 9g, Angelica Sinensis 15g, Licorice Root 9g.
In the formula, Prepared Rehmannia Root, Cinnamon Bark, and Deer Antler Rime warm Kidney Yang and secure Kidney Yin. Ephedra Floss opens the interstices (Couli). White Mustard Seed resolves phlegm and dissipates accumulation, removing phlegm from beneath the skin and between membranes. Prepared Rehmannia Root combined with Ephedra Floss prevents cloying stagnation; Ephedra Floss combined with Prepared Rehmannia Root prevents excessive dispersal. This formula heavily uses Deer Antler Rime for its warming and tonifying properties without being cloying. Using both Cinnamon Bark and Cinnamon Twig aims to warm the Yang of the Heart, Lungs, and Kidneys. Adding Angelica Sinensis tonifies and invigorates blood. The combination of the whole formula has the function of supporting Yang and securing Yin.
Second visit: After taking five doses of the above prescription, complexion gradually turned from pale white to ruddy, left knee joint slightly warmed, and swelling gradually subsided. Used the original formula removing Deer Antler Rime, adding 1.5g Deer Antler Powder per dose, taken for another five doses. Deer Antler tonifies essence and marrow, strengthens primal Yang, greatly supplements the Du Meridian, and strengthens sinews and bones. Since the Kidney governs bones and generates marrow, and the Du Meridian is the master of all joints in the body; when the Kidney is strong and essence/marrow sufficient, the Du Meridian flourishes, cold pathogen transforms, meridians unblock, and joint swelling is expected to gradually subside.
Third visit: After taking five doses of the above prescription, knee joint warmed and standing became possible. Complexion ruddy, appetite improved, spirit enhanced, and the clear thin black fluid from the affected area turned into yellow purulent discharge. Although Kidney Yang has recovered, further treatment requires tonifying Qi, invigorating blood, and generating tissue. Prescribed Zhang Xichun's Neituo Shengji San (Internal Support Tissue-Generating Powder) modified:
Astragalus Membranaceus (Huangqi) 30g, Trichosanthes Root 10g, Frankincense 6g, Myrrh 6g, Cornus Fruit 15g.
This formula heavily uses Astragalus Membranaceus, leveraging its warm nature and sweet taste. *Benjing* states it "treats long-standing carbuncles and ulcers." By tonifying Qi, it generates tissue, allowing pus to drain naturally. Trichosanthes Root treats carbuncles and sores; combined with Astragalus, it enhances tissue generation and toxin expulsion. Frankincense and Myrrh regulate Qi in Blood and Blood in Qi respectively. Together, they promote organ function, unblock meridians, effectively treat sores, and remove stasis. Cornus Fruit warms and tonifies the Liver to open the nine orifices. The entire formula collectively presents functions of tonifying Qi, generating tissue, draining pus, unblocking collaterals, and detoxifying. After seven doses, the wound gradually healed.
[Commentary]: Yanghe Tang is a formula for treating internal sinking of Yin-type abscesses. Named "Yanghe" (Sunshine Harmony) because it has the effect of unblocking Yang, resolving stagnation, and harmonizing blood, implying that like sunlight shining, cold pathogens are completely resolved. However, the original dosage is too light to overcome severe disease. Therefore, when using it, one should follow its intent without rigidly adhering to the original formula. Diseases have no fixed shape, physicians have no fixed formulas, and medicines have no fixed forms; success depends on timing and the physician's skill. The roles of Sovereign, Minister, Assistant, and Envoy depend on their application. If one sticks to conventions, recklessly uses established formulas, or applies static formulas to dynamic conditions, even effective formulas may fail to achieve victory.
Otitis Media
Boy Tong XX, 5 years old. Pus discharge from left ear, high fever, temperature 39.7°C. Western diagnosis: Otitis Media. Treated with Penicillin etc., fever persisted, pus discharge continued. Consulted me. Symptoms: Clear thin pus exuding from left ear, listless spirit, showing signs of "only wanting to sleep" (Dan Yu Mei). Bowel and bladder movements normal. Tongue bluish-green and slippery with thin white coating, pulse deep and fine. Combining four diagnostic methods, diagnosed as Cold pathogen entering the Shaoyin Kidney Meridian. The Kidney opens into the ears, and meridian Qi connects; now Cold pathogen invades the Kidney Meridian and stagnates in the ear orifice, causing the aforementioned symptoms. Treatment method initially should warm meridians, scatter cold, and drive pathogens out. Prescribed Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) from *Shanghan Lun*. Prescription:
Prepared Aconite Root (Fupian) 30g, Ephedra Herb 6g, Asiatic Wild Ginger (Xixin) 3g.
Second visit: After one dose of the above prescription, fever subsided immediately, temperature normalized. Child's facial and lip color turned red, pus thickened, pulse became wiry and rapid, tongue turned red. The disease transformed from Cold to Heat, known as "Yin syndrome turning to Yang," making it easier to treat. Should use formulas to clear Liver and descend Fire. Prescribed Longdan Xiegan Tang (Gentiana Drain Liver Decoction) modified. Prescription:
Gentiana Root 5g, Gardenia Fruit 3g, Scutellaria Root 6g, Plantago Seed 6g, Bupleurum Root 6g.
Rehmannia Root 15g, Alisma Rhizome 6g.
After three doses, ear pus discharge gradually stopped, and the patient recovered.
[Commentary]: The key to curing this case lies in recognizing the principle that "Yang Qi is heavier than Yin Qi" and "Body's functional capacity is heavier than Pathogenic factors." Whenever Cold pathogen suppression occurs, one should first warm meridians and scatter cold. Wait for Yin syndrome to turn to Yang before applying cooling agents, which will easily show effects. If this principle is ignored and cooling/fire-draining agents are used at the first visit, Cold pathogen will stagnate, leading to other complications, making rapid recovery difficult.
This case involves a child with vigorous vitality, prone to deficiency and excess. Thus, one dose of warming support showed immediate Yang recovery. If it were an adult or chronic illness, even several doses of warming support might not yield such obvious turnaround. In clinical practice, one must pay attention to patient age, constitution, duration of illness (new vs. chronic), and medication history. Changes in syndrome require changes in medicine; everything must start from the patient's objective reality, avoiding subjective dogmatism. Only then can expected effects be achieved.
Internal and External Hemorrhoids
Foreign Guest XXXX, Male, 50+ years old. Suffered from internal and external hemorrhoids for years. After coming to China, hemorrhoids flared up with redness, swelling, and pain, causing restlessness. Due to poor physical strength, refused surgical treatment. Consulted me. Prescribed internal and external treatments. Internal prescription:
Prunella Spike 9g, Honeysuckle Flower 9g, Licorice Root 6g.
(Hemorrhoidal nodes belong to heat-pathogen accumulation in the Liver and Gallbladder meridians. Prunella Spike is pungent and bitter, enters Liver and Gallbladder meridians, dissipates heat and resolves knots. Honeysuckle Flower is a crucial herb for clearing heat and detoxifying, good for treating sore toxins and swelling/pain. Licorice Root drains fire and detoxifies, harmonizing the formula.)
External application: Galnut (Wubeizi) 10g ground to powder, mixed with 9g Borneol, finely ground together, then mixed with appropriate amount of Pig Bile to form a paste-like consistency. Apply to gauze for external dressing, changing twice daily.
Galnut externally applied dissipates sore swelling; Borneol opens orifices, scatters stagnant fire, reduces swelling, and relieves pain; Pig Bile is bitter, cold, slippery, and moistening, clearing blood. Treating internally and externally simultaneously, addressing both interior and exterior, after three doses of internal medicine and three days of external treatment, pain stopped, swelling subsided. Before leaving Kunming, requested 200g of external preparation to carry for backup to prevent recurrence.
Big Head Plague (Erysipelas)
Li XX, Male, 40 years old. Diffuse swelling of head and face, especially behind ears, occasionally flowing yellow water. Initially diagnosed by Western medicine as "Facial Erysipelas." Visited our clinic on the seventh day. Complained: Vexing heat in heart, dry throat, constipation. Tongue slightly yellow and greasy, pulse flooding and rapid. Diagnosed as Wet-Toxin external infiltration causing Lung-Stomach stagnant heat. Treatment: Clear heat, drain dampness, detoxify. Prescription:
Bombyx Batryticatus 10g, Cicada Slough 8g, Honeysuckle Flower 10g, Forsythia Fruit 10g, Gardenia Fruit 6g.
Arnebia Root/Lithospermum Root (Zicao) 6g, Gypsum Fibrosum 30g, Mung Bean 10g, Black Soybean 10g, Light Bamboo Leaf 10g.
Honey 10g, Clear Wine a little.
This formula raises clear and descends turbid, clears Lung-Stomach stagnant heat, and separates/detoxifies pathogenic factors. Gypsum Fibrosum clears Lung-Stomach stagnant heat to reduce head/face swelling; the rest are herbs that clear heat, drain fire, and detoxify. Added Light Bamboo Leaf to clear Heart-Stomach heat and guide pathogenic heat out via urination. Added Honey and Wine as guides. Yang Lisshan stated in *Shengjiang San*: "Wine penetrates everywhere, attacks evil and wards off malignancy, thus serves as a guide." "Honey treats erysipelas and macules, clears heat and moistens dryness, thus serves as a conductor."
Second visit: After three doses of the above prescription, swelling reduced by more than half, yellow water behind ears stopped. Continued with heat-clearing, detoxifying, and damp-draining agents. Prescription:
Gypsum Fibrosum 30g, Honeysuckle Flower 10g, Arnebia Root/Lithospermum Root 10g, Red Rice Bean 15g, Black Soybean 10g.
Mung Bean 10g, Bombyx Batryticatus 10g.
Third visit: After five doses of the above prescription, swelling completely subsided, bowel movements smooth, yellow greasy coating retreated, pulse became wiry and fine. Only facial itching remained, but no redness/swelling. Plan: Dispel wind, drain dampness, and clear residual heat. Prescription:
Gypsum Fibrosum 30g, Anemarrhena Rhizome 10g, Forsythia Fruit 10g, Light Bamboo Leaf 10g, Cicada Slough 6g.
Licorice Root 6g.
After two doses, facial itching completely stopped, peeling occurred gradually, and recovery ensued.
Alopecia Areata
Dang XX, Male, 35 years old. Itching on scalp after illness, followed by patchy hair loss for over two months. Scalp currently red and shiny, itching like insects crawling. Suspected "Leprosy," tried Western topical treatments without effect. Sought treatment. Symptoms: Haggard complexion, low spirit, purple tongue, fine and rapid pulse. This condition is caused by Blood deficiency generating Wind, and Ying-Wei disharmony. *Yizong Jinjian* calls it "Oil Wind" (Youfeng), commonly known as "Ghost Shaving Head," attributing etiology to "open pores allowing evil wind to invade due to deficiency, excessive Wind causing Blood dryness, failing to nourish hair follicles." However, observing this patient's condition, not only is Ying-Blood deficient and Wind/Blood dry, but Qi and Blood are insufficient, leading to lack of nourishment for hair, resulting in hair loss. Treatment: Tonify Qi and Blood, nourish Yin, moisten dryness. Prescription:
Astragalus Membranaceus (Huangqi) 30g, Angelica Sinensis 15g, Codonopsis Pilosula (Luodangshen) 15g, Eclipta Herba 9g, Longan Aril (Yuanrou) 15g.
Black Soybean 9g, Goji Berry 15g, Mulberry Fruit 15g, Black Sesame 15g, Platycladi Cacumen 9g.
Externally rub affected areas with fresh Ginger.
Astragalus Monopolizes the opening and closing of Couli (interstices). Raw use encourages Wei Qi, regulates blood vessels, unblocks meridians. Combined with Angelica Sinensis and Longan Aril, it better tonifies Blood and nourishes the Heart. Codonopsis Pilosula strengthens Spleen/Stomach and benefits Lung Qi; paired with Angelica Sinensis, it tonifies both Qi and Blood. Black Soybean, Goji Berry, Eclipta Herba, and Mulberry Fruit all nourish Yin, benefit Blood, and tonify Liver/Kidney. Combined, they promote hair growth and darkening. Platycladi Cacumen nourishes Yin, cools Blood, and drains Lung. All follow the precedent: "To treat Wind, first treat Blood; when Blood moves, Wind extinguishes." Black Sesame nourishes and moistens dryness. With this formulation, Wind pathogen can be extinguished, Blood dryness moistened, why worry about "Oil Wind" not disappearing or hair not growing? External ginger rubbing disperses Wind pathogen outward.
After five doses and external ginger rubbing, scalp itching gradually stopped. After fifteen consecutive doses, hair began to grow back in bald patches within one month.
[Commentary]: "Alopecia Areata" is "Oil Wind," commonly known as "Ghost Shaving Head," referring to patchy hair loss, potentially leading to total hair loss. *Yizong Jinjian · Waike Xinfa Yaojue* treats this with Shenying Yangzhen Dan (Notopterygium Root, Quince, Gastrodia Tuber, Dodder Seed, White Peony Root, Angelica Sinensis, Prepared Rehmannia Root, Ligusticum Chuanxiong) internally to treat the root, and Hai'ai Tang (Mugwort Leaf, Chrysanthemum, Vitex Fruit, Radish Seed, Saposhnikovia Root, Mint, Schizonepeta, Patchouli, Nardostachys) externally washed to treat the branch. For long-standing cases, need to prick the shiny areas until purple blood appears for hair to regenerate. This treatment approach is similar to the pathogenesis of this case, appended here for reference.
Blurred Vision Accompanied by Headache
Cao XX, Female, 35 years old. Left eye red, swollen, painful, photophobia, blurred vision, radiating to left-sided headache. Diagnosed at a certain hospital: 1. Acute Conjunctivitis with Keratitis. 2. Optic Atrophy. Treated for over two months without improvement. Consulted me. Symptoms: Six pulses wiry, choppy, slightly tight; tongue pale with white coating; left eye pain radiating to left head severely, blurred vision, hair loss, accompanied by limb soreness/heaviness and lower back pain. Synthesizing pulse and symptoms, likely due to external pathogen invasion, initial failure to disperse from the exterior, leading to entry into the interior, combined with Liver-Kidney dual deficiency, internal and external combining, causing these symptoms. Although lasting two months, since the pathogen entered from the exterior, still should first resolve from the exterior. Step one: Release exterior, dispel wind, scatter cold, drain dampness, open Taiyang Qi mechanism. Prescribed self-invented Xiaobai Fuzi Tang:
Processed Xiao Bai Fuzi (Arisaema Cum Bile/Giant Arum Tuber) 30g, Gastrodia Elata 9g, Ligusticum Wallichii (Gaoben) 9g, Polygonatum Odoratum (Weirui Ren) 9g.
Pinellia Tuber (Fabanxia) 9g, Poria 15g, Ligusticum Chuanxiong 6g, Saposhnikovia Root 9g, Angelica Pubescens 6g.
Angelica Dahurica (Baizhi) 6g, Cinnamon Twig 9g, Fried White Peony Root 9g, Roasted Fresh Ginger 3 slices, Licorice Root 6g.
Jujube 3 pieces.
This formula is Tianma Tang plus Xiao Bai Fuzi. Weirui Ren (Polygonatum Odoratum) has effects of dispelling wind, brightening eyes, and moisturizing. Xiao Bai Fuzi is the tuber of *Typhonium giganteum*, a perennial herb of Araceae, good at dispelling wind-phlegm, unblocking meridians, driving out cold-dampness, best for removing wind pathogen from head/face, treating migraines and body/limb soreness/pain.
Once syndrome differentiation and treatment were established, instructed patient to continuously take the above prescription until headache alleviated, then re-evaluate.
Follow-up visit. After taking more than ten doses of the above prescription, headache significantly reduced, eye pain also eased, limb soreness and lower back pain stopped. Only eye redness/pain not fully resolved, vision still unclear. Shifted focus to treating eye diseases primarily, nourishing Liver and dispelling wind. Prescribed Mimenghua San (Buddleja Powder) from *Ju Fang* with added Saposhnikovia Root, changed to decoction form:
Buddleja Flower 9g, Notopterygium Root 6g, Saposhnikovia Root 9g, Tribulus Fruit 9g, Chrysanthemum Morifolium 6g.
Equisetum Hiemale (Muzei) 6g, Abalone Shell (Shijueming) 15g.
This formula originally treated "Wind-Qi attacking, dimness in both eyes, discharge/tearing, photophobia, eyelid millet-grain bumps, difficulty opening, itching/pain, gradual formation of nebula, blurred vision, and long-term migraine radiating to eyes, gradually feeling small, dim/severe hidden pain; also acute red/swollen/painful conditions, all treated." Buddleja Flower is a specialized ophthalmic herb, nourishing Liver, dispelling wind, brightening eyes, reducing nebula, treating red/swollen painful eyes, excessive discharge/tearing, photophobia, dimness/nebula. Notopterygium Root and Saposhnikovia Root dispel wind and relieve pain; Equisetum Hiemale and Chrysanthemum Morifolium disperse wind-heat and brighten eyes; Tribulus Fruit calms Liver, soothes Liver, dispels wind, and brightens eyes. These three herbs combined are excellent for treating red/swollen painful eyes obscured by nebula. Abalone Shell calms Liver, clears heat, benefits Yin, and brightens eyes; also a key herb for eye diseases. Combined with other eye-brightening herbs, its brightening effect is greater. This formula is based on the principles "Liver opens into the Eyes" and "Liver governs Wind," calming Liver Qi, dispersing Liver Wind, so external symptoms of head/eye pain can dissipate accordingly.