案一 芦某，女，38岁。门诊号：69026。
1963年10月2日初诊：右腿疼痛3个月，下肢浮肿及身肿，舌苔薄白，脉滑。证属虚寒夹湿型。治宜温经散寒，祛风除湿。处方：
木瓜15克 独活7。5克 秦艽6克 防己9克 怀牛膝6克 陈皮7．5克 茯苓皮7．5克
2剂，水煎服。
二诊：服药后疼痛减轻，小便次数增多，继服上方2剂．
三诊：服药后诸症无显著变化，且出现口苦眼涩等症，舌苔薄白，脉滑。上方加生苡仁15克，羌活4．5克，2剂，水煎服。
四诊：服药后腿痛明显减轻，但小便时自觉尿道有灼热感。上方加威灵仙4。5克，2剂，水煎服。
五诊：服上药后，诸症均有明显减轻，但又出现头晕。上方加菊花9克。
继服2剂后，诸症基本消失。
按：此案属虚寒夹湿的久痹。方中重用木瓜，因其酸温，善能温通，为舒筋活络之要药，又兼除湿之功，与独活、秦艽、防己等配伍其祛风湿之力更强。因风寒阴湿之邪久留不去，困遏阳气，故难见速效。所以从二诊起加入羌活以增强独活通络散风寒并祛湿止痛之效，加生苡仁甘淡以增强茯苓皮、防己渗湿利水、疏导下焦之功。继服数日，随症加减，使经络温通，风寒湿除，痹痛自止。
案二 刘某，女，29岁。门诊号：35456。
1961年1．1月17日初诊：4年前产后自觉腰痛以及肘关节、膝关节、足跟疼痛，时轻时重，每遇阴雨寒冷天而加剧。下腹部胀满，喜热饮食。苔薄白，脉沉细．证属虚寒夹湿型。治宜温经散寒，祛风除湿。处方：
木瓜15克 独活4．5克 秦艽4．5克 怀牛膝6克防己7．5克 生白芍6克 陈皮6克
2剂，水煎服。
服上药后，主症有所减轻。守上方继服]2剂而诸症悉除。
按：此案虽亦为虚寒夹湿之痹，但与案一相比，因无下肢及周身浮肿之症，故去茯苓皮；又因此案源起于产后，因产后血虚感受风湿之邪而致，故加白芍养血敛阴以治其本虚。
(四)脾肾阳虚，水湿泛溢案
案一 薛某，男，32岁。门诊号：70218。
1963年11月8曰初诊：右侧腰痛，两手发胀、麻木1年余，喜热饮食，舌苔薄白，脉沉迟。证属脾肾阳虚，水湿泛溢型。治宜渗湿利水，温阳化气。方用五苓散加味：
猪苓4．5克 泽泻4．5克 生白术7．5克 茯苓6克桂枝9克 生白芍9克 陈皮7．5克
2剂，水煎服。
二诊：服药后麻木消失，但仍浮肿，有时胸憋，舌苔薄白，脉沉迟。上方去猪苓，加附子3克，瓜蒌7．5克，以助肾阳温脾阳，宽胸理气化痰。
2剂，水煎服。
三诊：浮肿较前明显减轻，其余症状均消失。
以金匮肾气丸每日早晚各服1丸善其后，服药2周而诸症悉除。
按：本案先用五苓散加味温阳化气，利水祛湿而消肿。方中二苓、泽泻、白术健脾利水，配桂枝既可内助心阳，温化水饮，又可温经通络，祛风寒，横通肢节，桂枝善能引诸药横行肩、臂、手指，故临床上常用此作为治疗上肢麻木疼痛之引经药。加陈皮理气健脾温中，白芍柔肝止痛。全方可使气化宣通，小便通利，故能使麻木消失，肿胀减轻。二诊去猪苓加附子、瓜蒌，附子补肾阳以温脾阳，加强温阳化湿消肿之功；瓜蒌宽胸理气，化痰浊而治胸憋。三诊诸症基本消失，故改用成药肾气丸补肾阳温脾阳而善其后。
案二 曹某，男，35岁。门诊号：50323。
1962年3月2日初诊：背困，四肢麻木，黎明泄泻，已有]0余年，有时下腹部隐痛，食欲不振，舌苔白腻，脉缓。证属脾肾阳虚，水饮不化型。治宜温补．肾阳，健脾益气，涩肠止泻。处方：
肉桂4．5克 党参9克 白术9克 茯苓7．5克 熟地7．5克 炒白芍7．5克 生黄芪9克 五味子7．5克 陈皮4．5克 炙甘草3克
、
2剂，水煎服。
二诊：服上药后背困、四肢麻木有所减轻，但仍有黎明泄泻。上方加附子4．5克，继服。
共服上方1月而基本痊愈。
按：本案属脾肾阳虚、命火不足、水湿不化之虚痹，同时兼有五更泻，故方用四君子汤加黄芪以益气健脾祛湿，肉桂、附子补命门之火，补肾阳而温脾阳，熟地、白芍滋阴，意在阴中求阳。诸药配伍，脾肾双补，温阳利湿，以治病之本。五味子酸涩收敛止泻，陈皮理气开胃防诸药补益之腻。本案特点是以治本为主，并未用一味祛风湿、通经活络之品，同样达到治愈痹证的目的。
(五)瘀痹案
案一 朱某，男，29岁。门诊号：84249。
1965年1月]2日初诊：胯关节疼痛数月，左颊部有脓肿1块，红枣大小，红肿热痛，舌质暗红少苔，脉涩。证属瘀痹。治宜逐瘀活血，通经止痛。方用活血效灵丹加味：
丹参]5克 赤芍9克 乳香9克 没药9克 归尾9克
服上药后关节疼痛明显减轻，脓肿块缩小一半，后嘱其遵守原方继服1周。1周后追访，诸症基本痊愈。
案二 梁某，女。38岁。门诊号：85345。
1965年2月19日初诊：患者因工作不慎，从楼梯上摔下，腰部疼痛数月，经X线拍片诊断为腰椎骶化。腰部畏寒，舌苔薄白，脉沉而紧。此证总属瘀痹之证。治宜活血化瘀为主，兼以补肝肾，强筋骨。方用活血效灵丹加味：
丹参60克 当归尾30克 赤芍30克 乳香15克 没药15克 麝香O．3克 杜仲15克 牛膝15克 续断15克
上药共研细末，炼蜜为丸，每丸重5克，每日早晚各服1丸，开水或黄酒送下，连服半月。
二诊：服上方半月后，腰部疼痛明显减轻，活动较前自如，但仍怕冷，脉沉而涩。嘱其按上方比例再配制3个月丸药，并连续服用。
3月后来复查，自感症状全部消失，X线拍片复查，腰椎骶化现象全部消失，一切恢复正常。
按：此二案均属瘀痹，因风湿闭阻或跌打瘀肿，日久气血凝滞不通所致。故活血化瘀为瘀痹的根本治疗方法。活血效灵丹由当归、丹参、乳香、没药组成，为清代医家张锡纯《医学衷中参西录》方。本方功擅活血祛瘀，通络止痛。李老常用此方加减化裁，用于各种原因所致的气血瘀滞之证，如风湿痹痛、癥瘕积聚、心腹疼痛、腿痛臂痛、头身疼痛及各种外伤瘀痛、疮疡初起等。由李老与原山西省医学院第一附属医院于载畿教授合作发明的非手术方法治疗宫外孕的“宫外孕方”即是在此方基础上加减化裁而成。上述案一由活血效灵丹加赤芍而成，意在加强活血和凉血解毒、消肿排脓之功，故服1周余痹痛、脓肿一并消除。案二因陈旧外伤引起腰椎骶化，并兼肾虚之证，为药力短时间难达难治性疾病之一，故加入麝香，取其辛温香窜、通络透骨之性，以达开关利窍，透达骨髓，并引诸药直达病所的目的；杜仲、牛膝、续断，补肝肾，强筋骨，以顾本虚。另外，该病属器质性病变，不宜图速，故采用丸药久服的办法而取奇效。
十八种痹辨治要则
1．行痹
[释名]行痹又称风痹、走注疼痛、历节风、流火等，是因风邪较胜而形成的痹病。
[主症]四肢关节疼痛，行而不定。
[诊断]此证只要抓住风邪善行数变的本性，即疼痛部位不固定，游走不定，则不难诊断。
[治法]以散风为主，以除寒祛湿为佐，再适当地结合和血行血之品，此因治风先治血、血行风自灭之故。
[方剂]
(1)小续命汤倍防风：主治素体气虚之人患行痹者。
(2)增损五痹汤：主治气实之人患行痹者。
(3)心悟蠲痹汤加秦艽、防风：本方力三痹通治方，但加入秦艽、防风则偏治行痹。
(4)三痹汤：主治行痹日久，气血不足，肝肾亏虚者。
(5)顾氏行痹方：主治邪郁病久，风变为火之证。
2．痛痹
[释名]痛痹，又称痛风，是因寒邪较胜而形成的痹证．
[主症]疼痛较甚，痛有定处，或筋骨挛痛。
[诊断]只要抓住寒邪收引凝滞、阳气不行之特点，即痛甚，部位固定，不难诊断。
[治法]以散寒为主，疏风燥湿佐之，再参以补火之剂。因热则流通，寒则凝塞，通则不痛，痛则不通。
[方剂]
(1)小续命汤倍附子：小续命汤虽为治疗诸痹之通用方，但倍用附子温阳祛寒，则偏治痛痹。
(2)增损五痹汤重用麻黄、附子：加强原方温阳、温散之功，主治痛痹。
3．着痹
[释名]着痹又名湿痹，是因湿邪胜而形成的痹证。
[主症]其病重着不移，或肿痛，或麻木不仁，或四肢拘挛。
[诊断]本证以沉重与麻木及重着不移为特点。因湿邪重着粘滞，湿从土化，故病多发于肌肉也。
[治法]以燥湿为主，祛风散寒佐之，再参以补脾之剂，因土旺胜湿故也。
[方剂]
(1)小续命汤倍防己：倍用防己增加利水消肿之功，主治湿痹。
(2)增损五痹汤重用防己、羌活：防己利水消肿。羌活胜湿祛风，主治着痹。
4．皮痹
[释名]皮痹是秋季感受风、寒、湿邪而形成的痹证。
[主症]皮肤发麻，尚觉痒痛，抓之如隔帛，或瘾疹风疮。
[诊断]以病在皮肤，但尚觉痒痛为特点，因秋气在皮肤故也。
[治法]养血疏风。
[方剂]
(1)小续命汤加黄芪或桂枝皮：主治皮痹之气实麻木者。
(2)增损五痹汤重用黄芪、桂枝为主药：主治皮痹而麻木者。
(3)黄芪益气汤：主治气虚皮肤麻木不知痛痒者。
(4)秦艽地黄汤：养血疏风，主治皮肤抓之如隔帛或有瘾疹风疮者。
5．肌痹
[释名]肌痹是长夏即六七月之间感觉风寒湿邪而形成的痹证。
[主症]肌肉麻木，不知痛痒。
[诊断]以发于长夏、病在肌肉、麻木不知痒痛为特征，以长夏之气在肌肉故也。
[治法]解肌发表，祛邪止痛。
[方剂]
(])小续命汤加葛根或白芷：葛根解肌，白芷祛风解表，消肿止痛。主治肌痹。
(2)增损五痹汤重用葛根、白芷：以加强其解肌发表、止痛之功。主治肌痹。
6．脉痹
[释名]脉痹是夏令遇风寒湿邪而形成的一种以血脉证候为突出表现的痹证。
[主症]脉因血不能正常流行而色变。
[诊断]发在夏季，病在血脉，色变为主症，因夏气在脉故也。
[治法]活血通经。
[方剂]
(1)小续命汤加片姜黄或红花：加姜黄、红花，活血通经止痛，主治脉痹。
(2)增损五痹汤重用红花、桂枝：以活血温通经脉，主治脉痹之偏寒者。
(3)升麻汤去麻桂加萆蘚、石膏：主治脉痹之偏热者。
(4)秦艽四物汤：主治脉痹而血虚者。
(5)人参汤：主治脉痹而气虚者。
7．血痹
[释名]血痹者，乃素体气血虚弱，风寒湿邪闭着于血分之痹证。
[主症]身体不仁，如风痹状，脉阴阳俱微，寸口关上微，尺中小紧。
[治法]宣达阳气，补虚祛邪．
[方剂]
(1)黄芪桂枝五物汤：主治血痹，重在益气通阳行痹。
(2)当归汤：主治血痹血虚而风邪胜者。
8．骨痹
[释名]骨痹是指冬令时感受风寒湿邪而形成的以骨节症候为突出表现的痹证。
[主症]骨重疼痛不能举。
[治法]疏风散寒，祛瘀通痹。
[方剂]
(1)小续命汤加虎骨或狗骨：主治骨痹之虚证者。
(2)增损五痹汤重用虎骨：主治骨痹之实证者。
9．热痹
[释名]是指热毒流注关节，或内有蕴热，复感风寒湿邪，与热相搏的痹证。
[主症]关节红肿热痛，肌肉如火。
[治法]清热祛湿，宣痹止痛。
[方剂]
(1)加味升阳散火汤：即升阳散火汤加羚羊角、犀角。主治热痹关节红肿热痛，发热倦怠者。
(2)桂枝芍药知母汤：主治热痹而阴虚者。
10．冷痹
[释名]是指素体阳虚，复感风寒湿邪，病从寒化的一种痹证。
[主症]痹病而身寒无热，四肢厥冷。
[治法]温阳散寒，行痹止痛。
[方剂]
(])金鉴蠲痹汤：主治冷痹四肢厥冷，身寒疼痛者。
(2)通痹散：主治冷痹关节痛甚者。
11．周痹
[释名]周痹是指周身或半身疼痛之慢性痹证，此病多由真气不能周流于身，风、寒、湿客于分肉(即皮之内脏之外)而致。
[主症]周身疼痛，沉重麻木，项背拘急，或手足痛有定处，痛无歇止，或从上病及于下，或从下病及于上，有的似诸痹之痛有歇止，左右相移，流走不定，也有的或两手或两足或半身偏废不仁不用，状似中风，但口眼不歪斜而身有疼痛也。
[治法]益气和营。祛邪通痹。
[方剂]
(1)心悟蠲痹汤加桂枝、白术、狗脊、薏米：主治浑身痹痛，周身挛痛麻木并作者。
(2)太原舒筋散：主治妇女产后而发周痹者。
12．胞痹
[释名]胞痹是指痹病日久发展到膀胱之腑而以少腹、膀胱症状为突出表现的一种痹证。
[主症]少腹手按之其痛如沃汤之状，小便秘涩，鼻流清涕．
[治法]温阳利水。
[方剂]
附子五苓散：主治胞痹而阳虚者。
13．肠痹
[释名]肠痹是指痹病日久不已，发展到大小肠，以大小肠病症为特征的一种痹证。
[主症]喜饮水，便秘，泻则不胀，不泻则胀。
[治法]利尿健脾。
[方剂]
五苓散加苍术：温阳利水，燥湿健脾，治肠痹而阳虚水湿泛溢者。
14．心痹
[释名]心痹是由于脉痹日久不愈，重感外邪，内犯于心，心气痹阻，脉道不通而致的内脏痹证。
Background Information:
Book: Li Hanqing; Chapter: Main Text (15/50); Category: Comprehensive
Case 1: Patient Lu, female, 38 years old. Outpatient No.: 69026.
First visit on October 2, 1963: Pain in the right leg for 3 months, edema of the lower limbs and generalized swelling, thin white tongue coating, slippery pulse. The syndrome is classified as deficiency-cold with dampness accumulation. The treatment principle should be to warm the meridians and dispel cold, eliminate wind and remove dampness. Prescription:
* *Quince Fruit* (Mume Fructus, 木瓜) 15g
* *Angelica Pubescens Root* (Radix Angelicae Pubescentis, 独活) 7.5g
* *Gentian Macrophylla Root* (Rhizoma et Radix Gentianae Macrophyllae, 秦艽) 6g
* *Stephania Tetrandra Stem* (Rhizoma Stephaniae Tetrandrae, 防己) 9g
* *Achyranthes Bidentata Root* (Radix Achyranthis Bidentatae, 怀牛膝) 6g
* *Tangerine Peel* (Pericarpium Citri Reticulatae, 陈皮) 7.5g
* *Watermelon Peel* (Exocarpium Citruli, 茯苓皮) 7.5g
Take 2 doses, decoct in water and drink.
Second visit: After taking the medicine, the pain was relieved, and the frequency of urination increased. Continue taking the above prescription for another 2 doses.
Third visit: After taking the medicine, there was no significant change in symptoms, and symptoms such as bitter taste in the mouth and dry eyes appeared. Thin white tongue coating, slippery pulse. Add *Coix Seed* (Semen Coicis, 生苡仁) 15g and *Notopterygium Root* (Rhizoma Notopterygii, 羌活) 4.5g to the previous prescription. Take 2 doses, decoct in water and drink.
Fourth visit: After taking the medicine, the leg pain was significantly reduced, but a burning sensation was felt in the urethra during urination. Add *Clematis Root* (Radix Clematidis, 威灵仙) 4.5g to the previous prescription. Take 2 doses, decoct in water and drink.
Fifth visit: After taking the above medicine, all symptoms were significantly reduced, but dizziness appeared. Add *Chrysanthemum Flower* (Flos Chrysanthemi, 菊花) 9g to the previous prescription.
After continuing to take 2 doses, all symptoms basically disappeared.
Commentary: This case belongs to chronic Bi-syndrome (Bi Syndrome) due to deficiency-cold with dampness. Quince Fruit is heavily used in this formula because it is sour and warm, good at warming and unblocking, and is an important herb for relaxing sinews and activating collaterals. It also has the effect of removing dampness. Combined with Angelica Pubescens Root, Gentian Macrophylla Root, and Stephania Tetrandra Stem, its power to dispel wind-dampness is stronger. Because the pathogenic factors of wind-cold and yin-dampness have stayed for a long time and suppressed the Yang Qi, quick effects are difficult to achieve. Therefore, from the second visit, Notopterygium Root was added to enhance the effect of Angelica Pubescens Root in unblocking collaterals, dispelling wind-cold, removing dampness, and relieving pain. Coix Seed, which is sweet and bland, was added to enhance the function of Watermelon Peel and Stephania Tetrandra Stem in渗湿利水 (promoting diuresis and leaching out dampness) and guiding the lower Jiao. After taking the medicine for several days, modifications were made according to symptoms, allowing the meridians to become warm and unblocked, wind-cold-dampness to be eliminated, and Bi-pain to stop naturally.
Case 2: Patient Liu, female, 29 years old. Outpatient No.: 35456.
First visit on January 17, 1961: Four years ago, after childbirth, she felt lower back pain, as well as pain in the elbow joints, knee joints, and heels. The pain varied in severity and worsened on rainy and cold days. Abdominal distension and fullness, preference for hot food and drinks. Thin white tongue coating, deep and fine pulse. The syndrome is classified as deficiency-cold with dampness accumulation. The treatment principle should be to warm the meridians and dispel cold, eliminate wind and remove dampness. Prescription:
* *Quince Fruit* (Mume Fructus, 木瓜) 15g
* *Angelica Pubescens Root* (Radix Angelicae Pubescentis, 独活) 4.5g
* *Gentian Macrophylla Root* (Rhizoma et Radix Gentianae Macrophyllae, 秦艽) 4.5g
* *Achyranthes Bidentata Root* (Radix Achyranthis Bidentatae, 怀牛膝) 6g
* *Stephania Tetrandra Stem* (Rhizoma Stephaniae Tetrandrae, 防己) 7.5g
* *Raw White Peony Root* (Radix Paeoniae Alba, 生白芍) 6g
* *Tangerine Peel* (Pericarpium Citri Reticulatae, 陈皮) 6g
Take 2 doses, decoct in water and drink.
After taking the above medicine, the main symptoms were alleviated. Continuing to take the same prescription for another 2 doses resulted in the complete disappearance of all symptoms.
Commentary: Although this case is also a Bi-syndrome due to deficiency-cold with dampness, compared to Case 1, since there are no symptoms of edema in the lower limbs and whole body, Watermelon Peel was removed. Furthermore, since this case originated from postpartum condition, caused by wind-dampness pathogen attacking due to blood deficiency after childbirth, White Peony Root was added to nourish blood and preserve Yin to treat the root deficiency.
(IV) Spleen-Kidney Yang Deficiency with Overflow of Water-Dampness Cases
Case 1: Patient Xue, male, 32 years old. Outpatient No.: 70218.
First visit on November 8, 1963: Lower back pain on the right side, swelling and numbness in both hands for over 1 year, preference for hot food and drinks, thin white tongue coating, deep and slow pulse. The syndrome is classified as Spleen-Kidney Yang Deficiency with overflow of water-dampness. The treatment principle should be to promote diuresis and leach out dampness, warm Yang and transform Qi. Formula used: Wu Ling San (Five-Ingredient Powder with Poria) modified:
* *Polyporus* (Poria, 猪苓) 4.5g
* *Alisma Rhizome* (Rhizoma Alismatis, 泽泻) 4.5g
* *Atractylodes Macrocephala Rhizome* (Rhizoma Atractylodis Macrocephalae, 生白术) 7.5g
* *Poria* (Poria, 茯苓) 6g
* *Cinnamon Twig* (Ramulus Cinnamomi, 桂枝) 9g
* *Raw White Peony Root* (Radix Paeoniae Alba, 生白芍) 9g
* *Tangerine Peel* (Pericarpium Citri Reticulatae, 陈皮) 7.5g
Take 2 doses, decoct in water and drink.
Second visit: After taking the medicine, numbness disappeared, but edema remained, sometimes with chest tightness. Thin white tongue coating, deep and slow pulse. Remove Polyporus from the previous prescription, add *Aconite Lateral Root* (Radix Aconiti Lateralis Preparata, 附子) 3g and *Trichosanthes Fruit* (Fructus Trichosanthis, 瓜蒌) 7.5g, to assist Kidney Yang in warming Spleen Yang, broaden the chest, regulate Qi, and resolve phlegm.
Take 2 doses, decoct in water and drink.
Third visit: Edema was significantly reduced compared to before, and other symptoms disappeared.
Use Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) taken once in the morning and evening, one pill each time, to consolidate the cure. After taking the medicine for 2 weeks, all symptoms disappeared completely.
Commentary: In this case, Wu Ling San (Five-Ingredient Powder with Poria) modified was first used to warm Yang, transform Qi, promote diuresis, remove dampness, and reduce swelling. In the formula, Polyporus, Alisma Rhizome, and Atractylodes Macrocephala Rhizome strengthen the Spleen and promote diuresis. Paired with Cinnamon Twig, it can internally assist Heart Yang, warm and transform fluid retention, and also warm meridians, unblock collaterals, dispel wind-cold, and horizontally connect limb joints. Cinnamon Twig is good at guiding other herbs to move horizontally through the shoulders, arms, and fingers, so clinically it is often used as a guiding herb for treating upper limb numbness and pain. Tangerine Peel regulates Qi, strengthens the Spleen, and warms the middle; White Peony Root softens the Liver and relieves pain. The entire formula allows Qi transformation to be smooth and urination to be free, thus eliminating numbness and reducing swelling. In the second visit, Polyporus was removed and Aconite Lateral Root and Trichosanthes Fruit were added. Aconite Lateral Root tonifies Kidney Yang to warm Spleen Yang, strengthening the effect of warming Yang, transforming dampness, and reducing swelling; Trichosanthes Fruit broadens the chest, regulates Qi, resolves turbid phlegm, and treats chest tightness. In the third visit, since most symptoms had disappeared, the patent medicine Shen Qi Wan was changed to tonify Kidney Yang and warm Spleen Yang to consolidate the cure.
Case 2: Patient Cao, male, 35 years old. Outpatient No.: 50323.
First visit on March 2, 1962: Back fatigue, numbness in four limbs, diarrhea at dawn for over 10 years, sometimes dull pain in the lower abdomen, poor appetite, white greasy tongue coating, moderate pulse. The syndrome is classified as Spleen-Kidney Yang Deficiency with failure to transform water-fluids. The treatment principle should be to warm and tonify Kidney Yang, strengthen the Spleen and benefit Qi, astringe the intestines and stop diarrhea. Prescription:
* *Cinnamon Bark* (Cortex Cinnamomi, 肉桂) 4.5g
* *Codonopsis Root* (Radix Codonopsis, 党参) 9g
* *Atractylodes Macrocephala Rhizome* (Rhizoma Atractylodis Macrocephalae, 白术) 9g
* *Poria* (Poria, 茯苓) 7.5g
* *Prepared Rehmannia Root* (Radix Rehmanniae Preparata, 熟地) 7.5g
* *Stir-fried White Peony Root* (Radix Paeoniae Alba, 炒白芍) 7.5g
* *Raw Astragalus Root* (Radix Astragali, 生黄芪) 9g
* *Schisandra Berry* (Fructus Schisandrae Chinensis, 五味子) 7.5g
* *Tangerine Peel* (Pericarpium Citri Reticulatae, 陈皮) 4.5g
* *Honey-fried Licorice Root* (Radix Glycyrrhizae Preparata, 炙甘草) 3g
Take 2 doses, decoct in water and drink.
Second visit: After taking the above medicine, back fatigue and numbness in four limbs were alleviated, but dawn diarrhea persisted. Add *Aconite Lateral Root* (Radix Aconiti Lateralis Preparata, 附子) 4.5g to the previous prescription and continue taking.
After taking the prescription for a total of 1 month, basic recovery was achieved.
Commentary: This case belongs to deficiency-Bi syndrome due to Spleen-Kidney Yang Deficiency, insufficiency of Mingmen Fire, and failure to transform water-dampness, accompanied by five-watch diarrhea. Therefore, Si Jun Zi Tang (Four-Gentlemen Decoction) plus Astragalus Root was used to benefit Qi, strengthen the Spleen, and remove dampness. Cinnamon Bark and Aconite Lateral Root tonify the fire of the Gate of Vitality, tonifying Kidney Yang and warming Spleen Yang. Prepared Rehmannia Root and White Peony Root nourish Yin, intending to seek Yang within Yin. The combination of these herbs tonifies both Spleen and Kidney, warms Yang and promotes diuresis to treat the root of the disease. Schisandra Berry is sour and astringent to stop diarrhea; Tangerine Peel regulates Qi and opens the stomach to prevent the cloying nature of tonifying herbs. The characteristic of this case is focusing on treating the root, without using any herbs that dispel wind-dampness or unblock collaterals, yet still achieving the goal of curing the Bi-syndrome.
(V) Blood Stasis Bi-Syndrome Cases
Case 1: Patient Zhu, male, 29 years old. Outpatient No.: 84249.
First visit on January 12, 1965: Hip joint pain for several months, an abscess the size of a red date on the left cheek, red, swollen, hot, and painful, dark red tongue with little coating, choppy pulse. The syndrome is classified as Blood Stasis Bi-syndrome. The treatment principle should be to expel stasis and invigorate blood, unblock meridians and relieve pain. Formula used: Huoxue Xiaoling Dan (Blood-Invigorating Efficacy Spirit Pill) modified:
* *Salvia Miltiorrhiza Root* (Radix Salviae Miltiorrhizae, 丹参) 15g
* *Red Peony Root* (Radix Paeoniae Rubra, 赤芍) 9g
* *Frankincense* (Resina Boswelliae, 乳香) 9g
* *Myrrh* (Resina Myrrhae, 没药) 9g
* *Angelica Sinensis Tail* (Radix Angelicae Sinensis, 归尾) 9g
After taking the above medicine, joint pain was significantly reduced, and the abscess mass shrank by half. He was then instructed to continue taking the original prescription for 1 week. Follow-up after 1 week showed that all symptoms had basically recovered.
Case 2: Patient Liang, female, 38 years old. Outpatient No.: 85345.
First visit on February 19, 1965: The patient fell from the stairs due to carelessness at work, suffering from lower back pain for several months. Diagnosed with lumbosacralization via X-ray. Fear of cold in the lower back, thin white tongue coating, deep and tight pulse. This syndrome generally belongs to Blood Stasis Bi-syndrome. The treatment principle should focus on invigorating blood and resolving stasis, while simultaneously tonifying Liver and Kidney, and strengthening sinews and bones. Formula used: Huoxue Xiaoling Dan (Blood-Invigorating Efficacy Spirit Pill) modified:
* *Salvia Miltiorrhiza Root* (Radix Salviae Miltiorrhizae, 丹参) 60g
* *Angelica Sinensis Tail* (Radix Angelicae Sinensis, 当归尾) 30g
* *Red Peony Root* (Radix Paeoniae Rubra, 赤芍) 30g
* *Frankincense* (Resina Boswelliae, 乳香) 15g
* *Myrrh* (Resina Myrrhae, 没药) 15g
* *Musk* (Moschus, 麝香) 0.3g
* *Eucommia Bark* (Cortex Eucommiae, 杜仲) 15g
* *Achyranthes Bidentata Root* (Radix Achyranthis Bidentatae, 牛膝) 15g
* *Dipsacus Root* (Radix Dipsaci, 续断) 15g
Grind the above herbs into fine powder, refine honey to make pills, each pill weighing 5g. Take one pill in the morning and evening, washed down with boiled water or yellow wine, continuously for half a month.
Second visit: After taking the above prescription for half a month, lower back pain was significantly reduced, movement was freer than before, but still afraid of cold, deep and choppy pulse. Instructed to prepare another 3 months' worth of pills according to the ratio of the previous prescription and take them continuously.
Follow-up in March: Felt that all symptoms had disappeared completely. X-ray re-examination showed that the phenomenon of lumbosacralization had completely disappeared, and everything returned to normal.
Commentary: These two cases both belong to Blood Stasis Bi-syndrome, caused by wind-dampness obstruction or traumatic bruising and swelling, leading to stagnation and blockage of Qi and blood over a long period. Therefore, invigorating blood and resolving stasis is the fundamental treatment method for Blood Stasis Bi-syndrome. Huoxue Xiaoling Dan consists of Angelica Sinensis Tail, Salvia Miltiorrhiza Root, Frankincense, and Myrrh, a formula from Zhang Xichun's "Records of Chinese Medicine Integrating Chinese and Western Medicine" in the Qing Dynasty. This formula excels at invigorating blood, resolving stasis, unblocking collaterals, and relieving pain. Old Li often uses this formula with modifications for conditions of Qi and blood stagnation caused by various reasons, such as wind-dampness Bi-pain, masses and accumulations, heart and abdominal pain, leg and arm pain, head and body pain, and various traumatic bruises and early-stage sores. The "Ectopic Pregnancy Formula," a non-surgical method for treating ectopic pregnancy invented by Old Li in cooperation with Professor Yu Zaiji of the First Affiliated Hospital of Shanxi Medical College, was developed based on modifications of this formula. The aforementioned Case 1 consists of Huoxue Xiaoling Dan plus Red Peony Root, intending to strengthen the effects of invigorating blood, cooling blood, detoxifying, reducing swelling, and draining pus. Thus, after taking it for over a week, both Bi-pain and the abscess were eliminated. Case 2 was caused by old trauma leading to lumbosacralization, accompanied by Kidney deficiency. It is one of the difficult diseases where medicinal power is hard to reach in a short time. Therefore, Musk was added for its pungent, warm, aromatic, and penetrating properties to open orifices, penetrate bones, and guide the herbs directly to the site of the disease; Eucommia Bark, Achyranthes Bidentata Root, and Dipsacus Root tonify Liver and Kidney and strengthen sinews and bones to address the root deficiency. Additionally, since this disease is an organic lesion, it is not suitable for seeking quick results, so the method of long-term intake of pills was adopted to achieve remarkable effects.
Eighteen Types of Bi-Syndrome Differentiation and Treatment Essentials
1. Moving Bi (Xing Bi)
[Name Explanation]: Moving Bi is also known as Wind Bi, wandering pain, Li Jie Feng, or flowing fire. It is a Bi disease formed due to the predominance of Wind Pathogen.
[Main Symptoms]: Pain in the joints of the four limbs, moving and not fixed.
[Diagnosis]: As long as the inherent nature of Wind Pathogen being good at moving and changing is grasped, i.e., the pain location is not fixed and wanders, diagnosis is not difficult.
[Treatment Method]: Focus on dispersing wind, assist with eliminating cold and removing dampness, and appropriately combine herbs that harmonize and move blood. This is because treating wind requires treating blood first; when blood moves, wind extinguishes itself.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) with doubled Fang Feng (Saposhnikovia Root): Indicated for patients with constitutionally deficient Qi suffering from Moving Bi.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction): Indicated for patients with excess Qi suffering from Moving Bi.
(3) Xin Wu Juan Bi Tang (Heart-Wisdom Eliminating Bi Decoction) plus Qin Jiao (Gentian Macrophylla Root) and Fang Feng (Saposhnikovia Root): This formula is a general treatment for three types of Bi, but adding Qin Jiao and Fang Feng makes it偏向 (biased towards) treating Moving Bi.
(4) San Bi Tang (Three Bi Decoction): Indicated for long-standing Moving Bi with insufficient Qi and blood, and Liver-Kidney deficiency.
(5) Gu Shi Xing Bi Fang (Gu's Moving Bi Formula): Indicated for syndromes where pathogens are stagnant for a long time, and wind transforms into fire.
2. Painful Bi (Tong Bi)
[Name Explanation]: Painful Bi, also known as gout, is a Bi syndrome formed due to the predominance of Cold Pathogen.
[Main Symptoms]: Severe pain, pain with a fixed location, or spasmodic pain in sinews and bones.
[Diagnosis]: As long as the characteristics of Cold Pathogen causing contraction, stagnation, and obstruction of Yang Qi are grasped, i.e., severe pain with a fixed location, diagnosis is not difficult.
[Treatment Method]: Focus on dispelling cold, assist with dispersing wind and drying dampness, and refer to formulas that tonify fire. Because heat leads to flow, cold leads to stagnation; if unobstructed, there is no pain; if painful, there is obstruction.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) with doubled Fu Zi (Aconite Lateral Root): Although Xiao Xu Ming Tang is a general formula for treating various Bis, doubling Fu Zi to warm Yang and dispel cold makes it biased towards treating Painful Bi.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction) with heavy use of Ma Huang (Ephedra Herb) and Fu Zi (Aconite Lateral Root): Strengthens the original formula's functions of warming Yang and warming dispersion, indicated for Painful Bi.
3. Fixed Bi (Zhuo Bi)
[Name Explanation]: Fixed Bi, also known as Damp Bi, is a Bi syndrome formed due to the predominance of Damp Pathogen.
[Main Symptoms]: The disease is heavy and fixed, or swollen and painful, or numb and insensible, or spasmodic in the four limbs.
[Diagnosis]: This syndrome is characterized by heaviness, numbness, and fixed immobility. Because Damp Pathogen is heavy, sticky, and transforms from Earth, the disease mostly occurs in muscles.
[Treatment Method]: Focus on drying dampness, assist with dispelling wind and scattering cold, and refer to formulas that tonify the Spleen, because strong Earth overcomes dampness.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) with doubled Fang Ji (Stephania Tetrandra Stem): Doubling Fang Ji increases the effect of promoting diuresis and reducing swelling, indicated for Damp Bi.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction) with heavy use of Fang Ji (Stephania Tetrandra Stem) and Qiang Huo (Notopterygium Root): Fang Ji promotes diuresis and reduces swelling. Qiang Huo overcomes dampness and dispels wind, indicated for Fixed Bi.
4. Skin Bi (Pi Bi)
[Name Explanation]: Skin Bi is a Bi syndrome formed in autumn by contracting Wind, Cold, and Damp pathogens.
[Main Symptoms]: Numbness of the skin, still feeling itching and pain, scratching feels like隔着 silk (separated by cloth), or hives and wind sores.
[Diagnosis]: Characterized by the disease being in the skin but still feeling itching and pain, because the Qi of Autumn is in the skin.
[Treatment Method]: Nourish blood and disperse wind.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) plus Huang Qi (Astragalus Root) or Gui Zhi Pi (Cinnamon Twig Bark): Indicated for Skin Bi with excess Qi and numbness.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction) with heavy use of Huang Qi (Astragalus Root) and Gui Zhi (Cinnamon Twig) as main drugs: Indicated for Skin Bi with numbness.
(3) Huang Qi Yi Qi Tang (Astragalus Qi-Boosting Decoction): Indicated for Qi deficiency with skin numbness unaware of pain and itch.
(4) Qin Jiao Di Huang Tang (Gentian Rehmannia Decoction): Nourishes blood and disperses wind, indicated for skin scratching feeling like separated by cloth or having hives and wind sores.
5. Muscle Bi (Ji Bi)
[Name Explanation]: Muscle Bi is a Bi syndrome formed during late summer (June-July) by sensing Wind-Cold-Damp pathogens.
[Main Symptoms]: Muscle numbness, unaware of pain and itch.
[Diagnosis]: Characterized by occurring in late summer, disease in muscles, numbness unaware of pain and itch, because the Qi of late summer is in the muscles.
[Treatment Method]: Resolve muscle layer and release exterior, dispel pathogens and relieve pain.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) plus Ge Gen (Kudzu Root) or Bai Zhi (Angelica Dahurica Root): Ge Gen resolves muscle layer, Bai Zhi dispels wind and releases exterior, reduces swelling and relieves pain. Indicated for Muscle Bi.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction) with heavy use of Ge Gen (Kudzu Root) and Bai Zhi (Angelica Dahurica Root): To strengthen their effects of resolving muscle layer, releasing exterior, and relieving pain. Indicated for Muscle Bi.
6. Vessel Bi (Mai Bi)
[Name Explanation]: Vessel Bi is a Bi syndrome formed in summer by encountering Wind-Cold-Damp pathogens, characterized prominently by blood vessel symptoms.
[Main Symptoms]: Vessels change color because blood cannot circulate normally.
[Diagnosis]: Occurs in summer, disease in blood vessels, color change as main symptom, because the Qi of Summer is in the vessels.
[Treatment Method]: Invigorate blood and unblock meridians.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) plus Pian Jiang Huang (Turmeric Tuber) or Hong Hua (Carthamus Flower): Adding Jiang Huang and Hong Hua invigorates blood, unblocks meridians, and relieves pain, indicated for Vessel Bi.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction) with heavy use of Hong Hua (Carthamus Flower) and Gui Zhi (Cinnamon Twig): To invigorate blood and warm-unblock meridians, indicated for Vessel Bi with cold predominance.
(3) Sheng Ma Tang (Cimicifuga Decoction) removing Ma Huang (Ephedra Herb) and Gui Zhi (Cinnamon Twig), adding Bi Xie (Dioscorea Hypoglauca Rhizome) and Shi Gao (Gypsum Fibrosum): Indicated for Vessel Bi with heat predominance.
(4) Qin Jiao Si Wu Tang (Gentian Four-Substance Decoction): Indicated for Vessel Bi with blood deficiency.
(5) Ren Shen Tang (Ginseng Decoction): Indicated for Vessel Bi with Qi deficiency.
7. Blood Bi (Xue Bi)
[Name Explanation]: Blood Bi refers to a Bi syndrome where the constitution is inherently weak in Qi and blood, and Wind-Cold-Damp pathogens close and adhere to the blood level.
[Main Symptoms]: Body insensibility, similar to Wind Bi, pulse Yin and Yang both micro, Cun Kou and Guan positions micro, Chi position slightly tight.
[Treatment Method]: Disseminate and reach Yang Qi, tonify deficiency and dispel pathogens.
[Formulas]:
(1) Huang Qi Gui Zhi Wu Wu Tang (Astragalus Cinnamon Twig Five-Substance Decoction): Indicated for Blood Bi, focusing on benefiting Qi, unblocking Yang, and moving Bi.
(2) Dang Gui Tang (Angelica Decoction): Indicated for Blood Bi with blood deficiency and predominant Wind Pathogen.
8. Bone Bi (Gu Bi)
[Name Explanation]: Bone Bi refers to a Bi syndrome formed in winter by contracting Wind-Cold-Damp pathogens, characterized prominently by bone joint symptoms.
[Main Symptoms]: Bones feel heavy and painful, unable to lift.
[Treatment Method]: Disperse wind and scatter cold, remove stasis and unblock Bi.
[Formulas]:
(1) Xiao Xu Ming Tang (Minor Continuation Life Decoction) plus Hu Gu (Tiger Bone) or Gou Gu (Dog Bone): Indicated for deficiency-type Bone Bi.
(2) Zeng Sun Wu Bi Tang (Modified Five Bi Decoction) with heavy use of Hu Gu (Tiger Bone): Indicated for excess-type Bone Bi.
9. Heat Bi (Re Bi)
[Name Explanation]: Refers to a Bi syndrome where heat-toxin flows into joints, or internal accumulated heat exists, compounded by contracting Wind-Cold-Damp pathogens, clashing with heat.
[Main Symptoms]: Joint redness, swelling, heat, and pain, muscles like fire.
[Treatment Method]: Clear heat and remove dampness, disseminate Bi and relieve pain.
[Formulas]:
(1) Jia Wei Sheng Yang San Huo Tang (Modified Ascending Yang Dispelling Fire Decoction): That is, Sheng Yang San Huo Tang plus Ling Yang Jiao (Antelope Horn) and Xi Jiao (Rhinoceros Horn). Indicated for Heat Bi with joint redness, swelling, heat, pain, fever, and fatigue.
(2) Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig Peony Anemarrhena Decoction): Indicated for Heat Bi with Yin deficiency.
10. Cold Bi (Leng Bi)
[Name Explanation]: Refers to a Bi syndrome where the constitution is inherently Yang deficient, compounded by contracting Wind-Cold-Damp pathogens, with the disease transforming from cold.
[Main Symptoms]: Bi disease with cold body and no fever, cold extremities.
[Treatment Method]: Warm Yang and scatter cold, move Bi and relieve pain.
[Formulas]:
(1) Jin Jian Juan Bi Tang (Golden Mirror Eliminating Bi Decoction): Indicated for Cold Bi with cold extremities and cold body pain.
(2) Tong Bi San (Unblocking Bi Powder): Indicated for Cold Bi with severe joint pain.
11. General Bi (Zhou Bi)
[Name Explanation]: General Bi refers to chronic Bi syndrome with pain in the whole body or half of the body. This disease is mostly caused by True Qi failing to circulate throughout the body, with Wind, Cold, and Damp lodging in Fen Rou (between skin and organs).
[Main Symptoms]: Whole body pain, heavy and numb, neck and back stiffness, or hand and foot pain with fixed location, pain without rest, or disease spreading from top to bottom or bottom to top. Some seem like various Bis with intermittent pain, shifting left and right, flowing unpredictably. Others may have both hands or feet or half-body paralysis and insensibility, resembling stroke, but with no deviation of mouth and eyes, only body pain.
[Treatment Method]: Benefit Qi and harmonize Ying, dispel pathogens and unblock Bi.
[Formulas]:
(1) Xin Wu Juan Bi Tang (Heart-Wisdom Eliminating Bi Decoction) plus Gui Zhi (Cinnamon Twig), Bai Zhu (Atractylodes Macrocephala Rhizome), Gou Ji (Cibotium Rhizome), and Yi Mi (Coix Seed): Indicated for whole-body Bi pain, whole-body spasmodic pain and numbness occurring together.
(2) Tai Yuan Shu Jin San (Tai Yuan Relaxing Sinew Powder): Indicated for women developing General Bi after childbirth.
12. Bladder Bi (Bao Bi)
[Name Explanation]: Bao Bi refers to a Bi syndrome where the disease lasts long and develops into the Bladder organ, with prominent symptoms in the lower abdomen and bladder.
[Main Symptoms]: Pressing the lower abdomen causes pain like boiling soup, difficult and scanty urination, clear nasal discharge.
[Treatment Method]: Warm Yang and promote diuresis.
[Formulas]:
Fu Zi Wu Ling San (Aconite Five-Ingredient Powder with Poria): Indicated for Bao Bi with Yang deficiency.
13. Intestine Bi (Chang Bi)
[Name Explanation]: Chang Bi refers to a Bi syndrome where the disease lasts long and develops into the Large and Small Intestines, characterized by Large and Small Intestine symptoms.
[Main Symptoms]: Desire to drink water, constipation, bloating stops after defecation, bloating occurs without defecation.
[Treatment Method]: Promote urination and strengthen Spleen.
[Formulas]:
Wu Ling San (Five-Ingredient Powder with Poria) plus Cang Zhu (Atractylodes Rhizome): Warms Yang and promotes diuresis, dries dampness and strengthens Spleen, treats Chang Bi with Yang deficiency and overflow of water-dampness.
14. Heart Bi (Xin Bi)
[Name Explanation]: Heart Bi is an internal organ Bi syndrome caused by long-standing Vessel Bi not healing, repeated exposure to external pathogens invading internally to the Heart, blocking Heart Qi, and obstructing the vessel pathway.