血虚辨证重在辨其主症，结合病因及全身症状，并与各部类似症详细对比分析而确立。其治疗以补虚为主，兼祛瘀。补虚之法有补血、补气、健脾、补肾、滋阴及益阳之法，分述如下：
补血：虚则补之，为逆其证候属性施治。
补气：气属阳，血属阴，气具有推动、沮煦、化生、统摄血液之功，补气可生血、摄血，故对血虚甚者及气血两虚者补血必补气。
健脾：调补脾胃，增加饮食，血者水谷之精气，脾胃为气血生化之源，饮食营养及脾胃功能正常直接影响着血液的化生，故补脾胃以健运化，增加饮食以资化源。
补肾：精血同源，肾藏精而主骨生髓，补肾可资造血充足。
滋阴：肾阴为元阴，血虚甚者，久必致元阴亏耗，故补肾阴以资阴血。
益阳：阴从阳化，故凡血病当以甘苦之药以助阳气、生阴血。
祛瘀：瘀血不祛，新血不生，故活血祛瘀以达间接补血之目的。
内伤发热
虚火证治
火，《内经》云：“南方生热，热生火。”朱丹溪谓：“气有余便是火。”其形成原因颇多，从五脏论之，有醉饱火起于胃，大怒火起于肝，悲哀火起于肺，房劳火起于肾，五脏火炽，心火自焚，他如风、寒、暑、湿、燥等五气在一定条件下都能化火，而自身机体病机转变也可以导致火盛，如阴虚则火盛，血虚则火盛，郁久则化火等。
根据火证．临床表现性质的不同，又可分为实火、虚火，其中实火是实证兼火证的证候，程钟龄称之为“賊火”，虚火是虚证兼火证的证候，程氏称之为“子火”。实火宜泻，众人皆知，但虚火之治则宜补，故有“补火”之说。李老曾对虚火作过较详细的论述，兹整理如下：
一、什么是虚火
虚火就是不足之火，也就是虚证兼火证的证候。程氏谓： “虚火者，七情色欲，劳役耗神，自内而发，热犹子也。”故又叫子火。李老认为程氏将“虚火”名为“子火”，有好处，也有缺点。好的方面是能够启发学者对于虚火的具体治法有一个明确的概念，“子宜养而不可害”，不致误犯虚虚的错误；缺点是容易使学者把七情形成的火证都误认为是虚火，这样对于大怒形成的适用当归龙荟丸一类的肝火实证，难免迟疑审顾，不敢大胆使用泻药，甚者或有犯实实之虞。
虚火由于劳损而来，五脏皆有。一般说来，焦虑生心火，仇怒生肝火，劳倦生脾火，忧愁生肺火，房劳生肾火。但总的原因大部分是伤及各脏的阴分及血分，所谓阴虚火盛，血虚火盛，还有从阳虚或阴虚而来者，所谓虚阳外越，及阴盛于内，格阳于外，或阴盛于下，格阳于上等。
例如肾精不足，虚火上炎，其症见腰膝痿软，骨节疼痛，足跟痛，小便淋沥或不禁，遗精，梦泄，水泛为痰，自汗盗汗，失血，消渴，头目眩晕，耳鸣，齿摇，尺脉虚大。
二、如何治疗虚火
何梦瑶认为虚火之治有二：①可用温热，如内寒外热，下寒上热等证是也；②亦可甘寒，水虚火炎之证是也。程钟龄认为虚火又名子火，并说：“子宜养而不可害……养子火有四法：一曰达。肝经气结，五郁相因，当顺其性而升之，所谓木郁则达之。如逍遥散之类是也。此以一方治木郁而诸郁皆解也。二曰滋。虚火上炎，必滋其水，所谓壮水之主，以制阳光。如六味地黄汤之类是也。三曰温。劳役神疲，元气受伤，阴火乘其土位，经曰：劳者温之。即‘甘温除大热’。补中益气之类是也。四曰引。肾气虚寒，逼其无根失守之火浮游于上，当以卒热杂于壮水药中，导之下行。所谓导龙人海。引火归原。如金匮肾气丸之类是也。”
(一)虚火的治法
李老把虚火之治总结为以下四法：
1．滋阴降火
这种方法多采用生地、元参、天冬、麦冬等甘寒之品组方，对于由阴虚、血虚形成的虚火上逆之证最为相宜，但对由于火盛而致阴虚之证就不甚适合。因为前者以滋阴为主，阴足而火白降也；后者以泻火为主，火清而阴自复也。即便滋阴清热的药品同时并用，在药味和用量的多寡上也应该有所区别，即阴虚较重者以滋阴为主，佐以清热，反之，以清热为主，佐以滋阴。此法的代表方有大补阴丸，知柏地黄汤，甘露饮，四物汤加知母、黄柏等。
2．引火归原
这是治疗阴盛于下，逼阳于上之假热证的方法。
主要见症有：面赤烦躁，口渴，或口中溃疡，舌上有苔。但临床需要注意的是，患者虽口渴却不欲饮水，苔虽有而舌必滑软，并兼见足冷过膝，小便清长，右尺脉必沉小而迟，或浮大无根。李老还特别提出，高血压病服凉性药物则血压愈高者也宜用此法。
禁忌证：水涸火炎之证忌之。例如虚劳之证，肾水真阴虚极，水不济火，火因上炎而致面赤唇红、口鼻出血、齿痛齿衄等种种上焦虚热之证，虽亦是龙火上炎，但与虚阳上浮不同，纵有下部恶寒足冷，此因虚火上升所致，非真阳衰而然，故小便必黄赤，脉必带数，有内热之证可据，若误用此法，是抱薪救火，上焦愈热而咳喘燥渴、咽痛喉烂诸症益甚。
方剂：
(1)八味丸之属。应冰凉与饮，下咽之后，冷性既除，热性始了，浮游之火可引之归原。
(2)十全大补汤吞八味丸。汪昂曰： “肾虚火不归经，大热烦渴，目赤唇裂，舌上生刺，喉如烟火，足心如烙，脉洪大无伦，按之微弱者，宜十全大补汤吞八味丸。”
(3)地黄丸加肉桂、五味子治三消证，也是此法的精神。
(4)十味地黄丸：治上热下寒服凉性药更甚等证。
3．甘温除热
凡用人参、黄芪等甘温药品解除身热的方法就叫甘温除热法。这种治法对于因饮食饥饱不时、劳倦过度、内伤元气致阳气下陷的虚热之证最为相宜，其他一切发热诸证绝不宜用。主要方剂有补中益气汤、保元汤等。曾有一妇人因服丹梔逍遥散后身热如炽，脉数无力，用温经汤一服而愈，也属甘温除热的一种类型。
4．补血降火
这是治久病阴火上升、津液生痰不生血的治火方法。
(二)补火的药品
总结起来，补火的药品大致有以下几种：
]．附子：补命门之火。
2．乌头：补命门之火。
3．仙茅：入命门补火助阳，暖精散寒除痹。若相火炽盛者反致助火为害。
4．胡芦巴：入肾补命门之火，壮元阳，暖丹田。补火须兼附子、硫黄、茴香、吴萸等药同用。相火盛、心血虚者忌用．
5．淫羊藿：入肾、肝，补命火，逐冷散风。
6．蛇床子：入肾补命火。下部有热者忌之。
7．肉桂：入命门与肝，直透肝肾血分，大补命门相火，凡属肝郁克土而无火者用之最妙，能引无根之火降而归原。精虚血少，肝盛火起者忌之。
8．沉香：补火降气，治上热下寒，气逆喘急。阴虚火旺者忌用。
9．硫黄：大补命门相火，虚火上浮、阳被阴格者服无不效。
10．阳起石：补火散寒，温暖命门。
11．钟乳石：入肺肾，温肺壮阳，下乳。阴虚有热者忌之，不可久服多用，恐伤人气。
12．鹿茸：补肾阳，生精血，强筋健骨。
13．虾：补火助风动气。阴虚火动者忌之。
14．蛤蚧：补命门相火，温肺火，治喘乏。
15．雄蚕蛾：入命门，补肾阳，起阳痿。阴虚火盛者忌之，误用则阴愈竭，火愈旺。 三、验案二则 案一 赵某，男，30岁。门诊号：51167。 1962年4月6日初诊：头晕目眩，脱发，腰痛，午后烦热，喜冷饮，大便干。证属肾阴虚之虚火上炎。治宜补火，具体而言宜滋阴降火。处方：
六味地黄丸10丸 杭菊花30克
每次杭菊3克，煎水冲服六味地黄丸1丸。每日早晚各1丸。连服半月而愈。
按：本案以肾阴虚、虚火上炎为主，同时兼有肝阴虚，肝火上炎。六味地黄丸虽云专补肾阴，实则肝、脾之阴兼顾，其中山萸肉重在养肝阴，丹皮又重在清泻肝火。另加菊花清肝明目，与丹皮配伍可平肝火，止眩晕。另外，用单味药煎汤送服丸药之用药方法，也反映了李老不拘成方应用之定式，灵活配伍的特点。
案二 朱某，女，30岁。门诊号：23005。
]959年6月12日初诊：头晕，脱发，手足心灼热，月经期加重。于经期过后5日就诊，苔薄白，脉细数。证属阴亏血虚之虚火。治宜补火，滋阴补血以降火。处方：
杭菊花9克 天麻4．5克 生白芍9克 生地9克 当归7．5克 川芎4。5克 丹皮6克 地骨皮6克 知母4．5克 黄柏3克
二诊：服上方2剂，头晕、手足心热明显减轻。继服上方4剂而愈。
按：本案属于阴血亏虚、阴虚火旺之证，故以四物补其阴血之不足，丹皮、地骨皮、知母、黄柏退虚热，辅以杭菊花、天麻辛润而不燥，平肝熄风以治头晕。
虫
证
虫证辨
虫证系由寄生于人体内的各种虫类所引起的证候。历代文献对虫证的记载较为详实，分类亦较为复杂，许多医学文献有“九虫”或“诸虫”等记载。但临床辨治虫证，首先应该掌握各种虫证所具有的带共性的一般症状，即：面色萎黄，或青或白，或生白斑，或见赤丝，齘齿，腹痛，胃中嘈杂时作时止，痛而能食，或肠中虫形或聚或散，起伏无常，或呕吐清水，舌苔剥落，脉乍大乍小或见洪大。
具体到各种虫证，尚有其特殊表现，需加以细辨。如肌肉消瘦，目睛无光，肚大青筋，这是小儿虫证日久失治而成的疳痨、疳积的证候；耳鼻作痒，鼻下有黑气，唇内侧有红白点，吐涎，心痛发作有时，静而时烦，这是蛔虫的症状；肛门作痒，是蛲虫的症状；便下白色节片，或阴道作痒，是绦虫的见症；大便有虫卵，嗜食异物，如米、纸、茶叶、泥土、炭、煤油等，是钩虫、蛔虫所共有的症状。身痛有寒热，眼中赤壅，恐怖，是虫在肝的症状；心中烦躁，舌燥，是虫在心的症状；四肢肿急，泄泻频频，是虫在脾的症状；咳嗽气喘，是虫在肺的症状；腰酸腿软，耳鸣，是虫在肾的症状；胃脘绞痛，呕吐涎沫，面目乍赤乍黑乍白，是虫在胃的症状；肠腹部绞痛，面有白点如蟹爪纹，是虫在肠的症状；状如伤寒，默默欲眠，目不得闭，卧起不安，不欲饮食，恶闻食臭，面目乍赤乍黑乍白，是狐惑病的症状。诸虫不同，尤当明辨之。大黄附子汤治愈胆道蛔虫症医案一则
李老认为，胆道蛔虫症类属于中医的蛔厥虫注痛。其治法有二：一，杀虫，此法如乌梅丸；二，改变虫痛环境，如甘草粉蜜汤、米醋等。临床所见胆道蛔虫病，以寒热夹杂证中的寒多热少证较多见，因此可以根据其病机重新处方，如大黄附子汤。 《金匮要略》云： “胁下偏痛，发热，其脉紧弦，此寒也，以温药下之，宜大黄附子汤。” 《温病条辨》云：“寒疝脉弦紧，胁下偏痛，发热，大黄附子汤主之。”而临床用于胆道蛔虫症往往比乌梅丸效果为优。例如：李某。女，75岁，右胁下绞痛阵发性加剧，偶呕吐，并曾于数天前吐出蛔虫1条。此次发病以后，虽用乌梅丸改汤剂服4剂无明显效果，急予大黄4．5克，附子9克，细辛4．5克，1剂而痛止，并便出蛔虫2条。
崩
漏
崩漏四证 寒热虚瘀
夹杂难识 宜取腹脉
崩漏是一种常见的妇科疾病，在治疗时首先应注意辨证。其辨证方法的先后次序与方法是：
1．脉象：数者为热，沉者为气滞，滑者为热，细数者为阴虚有热，沉细弱者为气血俱虚，虚大者为气血大衰，涩者为瘀血、寒滞。
2。腹部症状：小腹冷者为寒，小腹坠痛者为瘀血，小腹空虚感者为虚，小腹坠胀感者为气滞。
3．大便：大便稀溏者为脾虚，大便秘结者为胃肠实热兼瘀血。
4．经色：鲜红者多热，淡红者多寒，大量血块者为瘀血。
5．全身症状：疲乏无力、心悸失眠、头晕头痛为肝郁气结，身热尿黄赤为热。
崩漏的治疗，一般病因比较简单者容易治愈，复杂者治之则较难，而临床上又以复杂者为多见，因此必须注意兼夹证。如虚证中要特别注意其中的实证，实证中要特别注意其中的虚证，寒证中要特别注意其中的热证，热证中要特别注意其中的寒证。总之要特别注意所谓的独处藏奸，只有这样才能取得较好的疗效。
常见的证候有四：
一、心脾两虚
崩漏不止，或来势急而量多，或量少而淋沥不断，面色皓白无华，疲乏无力，失眠多梦，心悸纳呆，时或轻度浮肿，舌质淡，苔薄白，脉沉细缓或濡缓或沉细弱。治宜补气养血，健脾安神。方用归脾汤加减：
党参9克 黄芪15克 白术9克 当归6克 炙甘草4克 茯苓9克 广木香3克 鸡冠花30克
若失眠严重加炒枣仁10克，远志6克；腹痛严重，下紫黑血块，加三七39克，甚者加桃仁9克，红花9克；面色皓白，气短者，加人参10克，去党参。
夹杂证以瘀血、气滞、热证、脱证为多，当治之无效时，可根据情况适当加入活血药、理气药、祛寒药、固涩药。 二、血热妄行 崩漏不止，或来势急而量多，或来热缓而淋沥不断，血色鲜红或紫红，身热或无明显身热，舌质红，舌苔薄黄，脉滑数。治宜凉血止血。方用芩连四物汤加减：
川芎9克 当归9克 白芍12克 生地12克 黄芩炭12克 黄连炭12克 地榆炭12克
若下血量很少可用荆芥四物汤。
若五心烦热，体瘦，经期口干口苦，脉滑数，用固经丸加减：
龟板30克 黄芩9克 黄柏9克 白芍9克 椿根皮9克 香附6克 海螵蛸9克
The differentiation of Blood Deficiency focuses on identifying its main symptoms, combined with the etiology and systemic symptoms, and conducting detailed comparative analysis with similar symptoms in various parts to establish the diagnosis. Its treatment is primarily based on tonifying deficiency, supplemented by removing blood stasis. Methods of tonifying deficiency include tonifying Blood, tonifying Qi, strengthening the Spleen, tonifying the Kidney, nourishing Yin, and benefiting Yang, as detailed below:
Tonifying Blood: For deficiency syndromes, use tonification methods; this treats against the nature of the syndrome (i.e., "tonify what is deficient").
Tonifying Qi: Qi belongs to Yang, Blood belongs to Yin. Qi has the functions of promoting, warming, generating, and controlling Blood. Tonifying Qi can generate and control Blood; therefore, for severe Blood Deficiency or simultaneous Qi and Blood Deficiency, tonifying Qi must be included when tonifying Blood.
Strengthening the Spleen: Regulate and tonify the Spleen and Stomach, and increase dietary intake. Blood is derived from the essence of food and water; the Spleen and Stomach are the source of Qi and Blood generation. Normal dietary nutrition and Spleen-Stomach function directly affect Blood generation. Thus, tonifying the Spleen strengthens transportation and transformation, and increasing diet provides resources for generation.
Tonifying the Kidney: Essence and Blood share the same origin. The Kidney stores Essence and governs bones and marrow generation. Tonifying the Kidney supports sufficient hematopoiesis.
Nourishing Yin: Kidney Yin is the Primordial Yin. Severe Blood Deficiency, if prolonged, inevitably leads to depletion of Primordial Yin. Therefore, tonifying Kidney Yin supports Yin and Blood.
Benefiting Yang: Yin transforms through Yang. Therefore, in treating Blood diseases, sweet and bitter herbs should be used to assist Yang Qi and generate Yin Blood.
Removing Blood Stasis: If blood stasis is not removed, new Blood cannot be generated. Thus, invigorating Blood and removing stasis achieves the purpose of indirect Blood tonification.
Internal Injury Fever
Treatment of Deficient Fire Syndromes
Fire: The *Neijing* states, "The South generates Heat, and Heat generates Fire." Zhu Danxi said, "Excess Qi becomes Fire." There are many causes for its formation. From the perspective of the Five Zang organs: fire arises from the Stomach after overeating and drinking; from the Liver after great anger; from the Lung after grief; from the Kidney after sexual exhaustion. When fire blazes in the five Zang organs, Heart Fire burns itself. Additionally, Wind, Cold, Summerheat, Dampness, and Dryness can transform into Fire under certain conditions. Changes in the body's pathogenesis can also lead to excessive Fire, such as Yin Deficiency leading to Fire Excess, Blood Deficiency leading to Fire Excess, or long-standing stagnation transforming into Fire.
Based on the nature of clinical manifestations, Fire syndromes are divided into Excess Fire and Deficient Fire. Excess Fire is a syndrome combining Excess patterns with Fire patterns, which Cheng Zhongling called "Thief Fire" (Zei Huo). Deficient Fire is a syndrome combining Deficiency patterns with Fire patterns, which Cheng referred to as "Child Fire" (Zi Huo). It is well known that Excess Fire should be purged, but Deficient Fire should be treated with tonification, hence the term "Tonifying Fire." Li Laohu provided a detailed discussion on Deficient Fire, summarized here:
I. What is Deficient Fire?
Deficient Fire refers to insufficient Fire, i.e., a syndrome combining Deficiency with Fire. Cheng stated: "Deficient Fire arises internally due to seven emotions, lust, and labor exhausting the Spirit; its heat is like a child." Hence it is also called Child Fire. Li Laohu believed that naming Deficient Fire as "Child Fire" has both advantages and disadvantages. The advantage is that it clarifies the specific treatment method for scholars: "A child should be nurtured, not harmed," preventing the error of tonifying deficiency further (violating the principle "do not treat deficiency as excess"). The disadvantage is that it may lead scholars to mistakenly classify all Fire syndromes caused by the seven emotions as Deficient Fire. This could cause hesitation in using purgative drugs like Danggui Longhui Wan for Excess Liver Fire caused by great anger, potentially committing the error of treating excess as excess.
Deficient Fire arises from damage and exhaustion and can involve any of the five Zang organs. Generally, anxiety generates Heart Fire, resentment generates Liver Fire, fatigue generates Spleen Fire, sorrow generates Lung Fire, and sexual exhaustion generates Kidney Fire. However, the root cause mostly damages the Yin and Blood aspects of the organs, known as Yin Deficiency with Fire Excess or Blood Deficiency with Fire Excess. It can also arise from Yang Deficiency or Yin Deficiency, such as Floating Deficient Yang, or Yin Excess internally forcing Yang outward, or Yin Excess below forcing Yang upward.
For example, in Kidney Essence insufficiency with Deficient Fire flaming upward, symptoms include weak loins and knees, bone joint pain, heel pain, dribbling or incontinence of urine, spermatorrhea, nocturnal emission, phlegm due to water flooding, spontaneous and night sweats, bleeding, Xiao Ke (Wasting-Thirst), dizziness and vertigo, tinnitus, loose teeth, and a large, empty Chi pulse.
II. How to Treat Deficient Fire
He Mengyao believed there are two approaches to treating Deficient Fire: ① Use warm/hot herbs, as in cases of internal Cold with external Heat, or lower Cold with upper Heat; ② Use sweet/cold herbs, as in cases of Water Deficiency with Fire Flaming. Cheng Zhongling considered Deficient Fire as Child Fire and said: "A child should be nurtured, not harmed... There are four methods to nurture Child Fire: First, Dispersing. When Qi stagnates in the Liver channel, causing five types of stagnation, one should follow its nature to ascend it, known as 'when Wood is stagnant, disperse it.' Examples include Xiaoyao San. This resolves all stagnations by treating Liver Wood stagnation. Second, Nourishing. When Deficient Fire flares upward, one must nourish Water, known as 'strengthen the master of Water to control the sunlight.' Examples include Liuwei Dihuang Tang. Third, Warming. When labor exhausts the spirit and injures Yuan Qi, Yin Fire attacks the Earth position. The Classic says: 'Treat those who are exhausted with warmth.' This is 'Sweet-Warmth removes Great Heat.' Examples include Buzhong Yiqi Tang. Fourth, Guiding. When Kidney Qi is deficient and cold, forcing the rootless, unanchored Fire to float upward, sudden heat should be mixed with Water-nourishing herbs to guide it downward. Known as 'Guiding the Dragon into the Sea' or 'Guiding Fire back to its Source.' Examples include Jinkui Shenqi Wan."
(A) Treatment Methods for Deficient Fire
Li Laohu summarized the treatment of Deficient Fire into four methods:
1. Nourishing Yin and Descending Fire
This method mainly uses sweet-cold herbs such as Shengdi Huang, Xuanshen, Tiantong, and Maidong. It is most suitable for Deficient Fire flaming upward caused by Yin or Blood Deficiency, but less suitable for Yin Deficiency caused by Fire Excess. In the former, the focus is nourishing Yin; once Yin is sufficient, Fire descends naturally. In the latter, the focus is purging Fire; once Fire is cleared, Yin recovers naturally. Even if Yin-nourishing and Heat-clearing herbs are used together, their proportions should differ: for severe Yin Deficiency, prioritize Yin nourishment with minor Heat clearing; conversely, prioritize Heat clearing with minor Yin nourishment. Representative formulas include Dabu Yin Wan, Zhibai Dihuang Tang, Ganlu Yin, and Siwu Tang plus Zhimu and Huangbai.
2. Guiding Fire Back to its Source
This is a method for treating false Heat syndromes where Yin Excess below forces Yang upward.
Main symptoms include: red face, irritability, thirst, oral ulcers, and tongue coating. Clinically, note that although the patient feels thirsty, they do not desire to drink. Although there is tongue coating, the tongue must be slippery and soft. Accompanying symptoms include feet colder than the knees, clear and copious urine, and a Chen-Xiao-Chi (deep, small, slow) or Fu-Da-Wugen (floating, large, rootless) pulse at the Right Chi position. Li Laohu specifically noted that this method is suitable for hypertension patients whose blood pressure rises further after taking cooling herbs.
Contraindications: Contraindicated in cases of Water Exhaustion with Fire Flaming. For example, in Xu Lao (Consumption) syndromes where Kidney Water and True Yin are extremely depleted, failing to control Fire, leading to Fire flaming upward causing red face, red lips, epistaxis, toothache, and gingival bleeding—these are Upper Jiao Deficient Heat syndromes. Although this is also "Dragon Fire flaming upward," it differs from Floating Deficient Yang. Even if there is Cold in the lower body and cold feet, this is due to Deficient Fire rising, not True Yang decline. Thus, urine will be yellow-red, pulse rapid, with signs of internal Heat. Misusing this method is like adding firewood to save a fire, worsening cough, asthma, dryness, thirst, sore throat, and throat rot.
Formulas:
(1) Ba Wei Wan type. Should be taken cool. After swallowing, the cold nature dissipates, and the hot nature begins, guiding floating Fire back to its source.
(2) Swallow Ba Wei Wan with Shiquan Dabu Tang. Wang Ang said: "For Kidney Deficiency with Fire not returning to its vessel, presenting with great Heat, irritability, thirst, red eyes, cracked lips, prickles on the tongue, throat feeling like smoke/fire, soles of feet feeling like branding iron, and a洪大 (Surging-Large) pulse without equal, weak upon pressure, use Shiquan Dabu Tang to swallow Ba Wei Wan."
(3) Dihuang Wan plus Rou Gui and Wuweizi for treating San Xiao (Three Consumptions) syndromes also embodies this method.
(4) Shiwei Dihuang Wan: For treating Upper Heat/Lower Cold syndromes worsened by cooling herbs.
3. Sweet-Warmth Removing Heat
Any method using sweet-warm herbs like Renshen and Huangqi to relieve body Heat is called the Sweet-Warmth Removing Heat method. This is most suitable for Deficient Heat caused by irregular eating/drinking, excessive labor, and internal injury to Yuan Qi leading to sinking of Yang Qi. It is absolutely unsuitable for all other febrile syndromes. Main formulas include Buzhong Yiqi Tang and Baoyuan Tang. Once, a woman developed intense body Heat and a rapid, powerless pulse after taking Danzhi Xiaoyao San. One dose of Wenjing Tang cured her, which is a type of Sweet-Warmth Removing Heat.
4. Tonifying Blood and Descending Fire
This is a method for treating Fire caused by long-term illness where Yin Fire rises, and fluids generate Phlegm instead of Blood.
(B) Herbs for Tonifying Fire
Summarizing, herbs for tonifying Fire generally include:
1. Fuzi: Tonifies Mingmen Fire.
2. Wutou: Tonifies Mingmen Fire.
3. Xianmao: Enters Mingmen to tonify Fire and assist Yang, warms Essence, dispels Cold, and removes Bi. Conversely, if Xianghuo (Minister Fire) is blazing, it may exacerbate Fire harm.
4. Hulusiba: Enters the Kidney to tonify Mingmen Fire, strengthens Yuan Yang, and warms the Dantian. When tonifying Fire, it must be used with Fuzi, Liuhuang, Huixiang, and Wuyu. Contraindicated in Xianghuo Excess and Xin Blood Deficiency.
5. Yinyanghuo: Enters Kidney and Liver, tonifies Ming Fire, drives out Cold, and disperses Wind.
6. Shechuangzi: Enters Kidney to tonify Ming Fire. Contraindicated if Heat exists in the lower part.
7. Rou Gui: Enters Mingmen and Liver, penetrates directly into Liver-Kidney Blood aspect, greatly tonifies Mingmen Minister Fire. Most excellent for Liver Stagnation overcoming Earth without Fire; can guide rootless Fire down and back to source. Contraindicated in Jing Deficiency/Blood Scarcity and Liver Excess with Fire arising.
8. Chenxiang: Tonifies Fire and directs Qi downward, treats Upper Heat/Lower Cold, rebellious Qi with panting/urgency. Contraindicated in Yin Deficiency with Fire Wang.
9. Liuhuang: Greatly tonifies Mingmen Minister Fire. Effective for Floating Deficient Fire and Yang constrained by Yin.
10. Yangqishi: Tonifies Fire, dispels Cold, warms Mingmen.
11. Zhongrushí: Enters Lung and Kidney, warms Lung, strengthens Yang, promotes lactation. Contraindicated in Yin Deficiency with Heat; do not take long-term or in large doses, fearing injury to Human Qi.
12. Lurong: Tonifies Kidney Yang, generates Essence and Blood, strengthens sinews and bones.
13. Xia: Tonifies Fire, assists Feng moving Qi. Contraindicated in Yin Deficiency with Fire movement.
14. Gejie: Tonifies Mingmen Minister Fire, warms Lung Fire, treats panting/fatigue.
15. Xiongcan'e: Enters Mingmen, tonifies Kidney Yang, treats Impotence. Contraindicated in Yin Deficiency with Fire Excess; misuse leads to greater Yin depletion and Fire exaltation.
III. Two Clinical Cases
Case 1: Zhao, Male, 30 years old. Outpatient No.: 51167.
First visit, April 6, 1962: Dizziness and vertigo, hair loss, lower back pain, afternoon vexatious Heat, preference for cold drinks, dry stool. Syndrome: Deficient Fire flaming upward due to Kidney Yin Deficiency. Treatment: Tonify Fire, specifically Nourish Yin and Descend Fire. Prescription:
Liuwei Dihuang Wan 10 pills; Hangjuhua (Chrysanthemum) 30g.
Take 3g Hangjuhua, decoct in water, and wash down 1 pill of Liuwei Dihuang Wan. Take once in the morning and evening. Cured after half a month of continuous use.
Commentary: This case is primarily Kidney Yin Deficiency with Deficient Fire flaming upward, accompanied by Liver Yin Deficiency and Liver Fire flaming upward. Although Liuwei Dihuang Wan is said to specifically tonify Kidney Yin, it actually considers Liver and Spleen Yin. Shan yurou focuses on nourishing Liver Yin, and Mudanpi focuses on clearing and purging Liver Fire. Adding Juhua clears Liver and brightens eyes; combined with Mudanpi, it calms Liver Fire and stops vertigo. Additionally, using a single herb decoction to wash down pills reflects Li Laohu's flexibility in applying fixed formulas.
Case 2: Zhu, Female, 30 years old. Outpatient No.: 23005.
First visit, June 12, 1959: Dizziness, hair loss, burning sensation in palms and soles, aggravated during menstruation. Visited 5 days after menstruation ended. Tongue coating thin white, pulse Fine-Rapid. Syndrome: Deficient Fire due to Yin and Blood Deficiency. Treatment: Tonify Fire, Nourish Yin and Blood to Descend Fire. Prescription:
Hangjuhua 9g, Tianma 4.5g, Shengbaishao 9g, Shengdi 9g, Danggui 7.5g, Chuanxiong 4.5g, Mudanpi 6g, Digupi 6g, Zhimu 4.5g, Huangbai 3g.
Second visit: After 2 doses, dizziness and heat in palms/soles significantly reduced. Continued with 4 more doses and was cured.
Commentary: This case belongs to Yin-Blood Deficiency and Yin Deficiency with Fire Wang. Thus, Siwu Tang supplements the deficiency of Yin and Blood; Mudanpi, Digupi, Zhimu, and Huangbai reduce Deficient Heat; assisted by Hangjuhua and Tianma, which are acrid-moist and non-drying, calming Liver and extinguishing Wind to treat dizziness.
Parasitic Syndromes
Differentiation of Parasitic Syndromes
Parasitic syndromes are conditions caused by various parasites residing in the human body. Historical texts record parasitic syndromes in detail, with complex classifications, including records of "Nine Parasites" or "Various Parasites." However, clinically differentiating and treating parasitic syndromes requires first mastering the common general symptoms shared by various parasitic conditions: sallow complexion, or blue/pale, white spots on skin, red streaks, grinding teeth, abdominal pain, intermittent gastric discomfort, pain relieved by eating, worms in intestines gathering or scattering irregularly, vomiting clear fluid, peeling tongue coating, and pulse varying suddenly between large/small or Surging-Large.
Specific parasitic syndromes have unique manifestations requiring careful differentiation. For instance, muscle emaciation, dull eyes, distended abdomen with visible veins are syndromes of Gan Lao (Gland Consumption) and Gan Ji (Gland Accumulation) resulting from long-term untreated pediatric parasitic disease. Itching in ears/nose, black qi under nose, red-white spots on inner lips, salivation, periodic heart pain, quietness with occasional irritability are symptoms of Ascaris (Roundworm). Anal itching is a symptom of Pinworm (Threadworm). Passing white segments in stool or vaginal itching are signs of Tapeworm. Eggs in stool and pica (craving foreign substances like rice, paper, tea leaves, dirt, charcoal, kerosene) are common symptoms of Hookworm and Ascaris. Body pain with chills/fever, red swelling in eyes, fearfulness are symptoms of parasites in the Liver. Vexation in heart, dry tongue are symptoms of parasites in the Heart. Swollen/tight limbs, frequent diarrhea are symptoms of parasites in the Spleen. Cough and wheezing are symptoms of parasites in the Lung. Sore/sweak loins and legs, tinnitus are symptoms of parasites in the Kidney. Colicky epigastric pain, vomiting saliva, alternating red/black/white face are symptoms of parasites in the Stomach. Colicky abdominal pain, white crab-claw-like spots on face are symptoms of parasites in the Intestines. Symptoms resembling Taiyang syndrome, silent desire to sleep, inability to close eyes, restlessness, anorexia, aversion to food odor, alternating red/black/white face are symptoms of Hu Huo Disease (Erysipelas/Mucosal Ulceration). Different parasites require distinct differentiation.
Clinical Case: Cure of Biliary Ascariasis with Dahuang Fuzi Tang
Li Laohu considered biliary ascariasis to belong to the TCM category of "Hui Jue" (Ascaris Convulsion) and worm-related pain. There are two treatment methods: 1. Killing parasites, such as Wumei Wan; 2. Changing the environment causing worm pain, such as Gancao Fenmi Tang or vinegar. Clinically, biliary ascariasis often presents as Cold-Heat Complex syndromes with more Cold than Heat. Therefore, prescriptions can be adjusted according to pathogenesis, such as Dahuang Fuzi Tang. The *Jinkui Yaolue* states: "Pain on one side of the hypochondrium, fever, tight-string pulse indicates Cold; use warm purgatives, Dahuang Fuzi Tang is appropriate." The *Wenbing Tiaobian* states: "Cold Hernia with tight-string pulse, pain on one side of hypochondrium, fever, Dahuang Fuzi Tang governs." Clinically, Dahuang Fuzi Tang often yields better results than Wumei Wan for biliary ascariasis. Example: Li, Female, 75 years old. Paroxysmal aggravation of colicky pain in right hypochondrium, occasional vomiting, had expelled one roundworm several days prior. After taking Wumei Wan decoction for 4 doses with no obvious effect, urgently prescribed Dahuang 4.5g, Fuzi 9g, Xixin 4.5g. Pain stopped after 1 dose, and 2 roundworms were passed in stool.
Beng Lou (Metrorrhagia and Metrostaxis)
Four Syndromes of Beng Lou: Cold, Heat, Deficiency, Stasis are mixed and hard to identify; examine Abdomen and Pulse.
Beng Lou is a common gynecological disease. Differentiation is crucial in treatment. The sequence and methods of differentiation are:
1. Pulse: Rapid indicates Heat; Deep indicates Qi Stagnation; Slippery indicates Heat; Fine-Rapid indicates Yin Deficiency with Heat; Deep-Fine-Weak indicates Qi and Blood Deficiency; Large-Empty indicates severe Qi and Blood decline; Choppy indicates Blood Stasis/Cold Stagnation.
2. Abdominal Symptoms: Cold lower abdomen indicates Cold; Drooping/Painful lower abdomen indicates Blood Stasis; Empty sensation in lower abdomen indicates Deficiency; Distending/Drooping sensation indicates Qi Stagnation.
3. Bowel Movements: Loose stools indicate Spleen Deficiency; Constipation indicates Stomach-Intestine Excess Heat with Blood Stasis.
4. Menstrual Color: Bright Red indicates Heat; Pale Red indicates Cold; Large blood clots indicate Blood Stasis.
5. Systemic Symptoms: Fatigue, palpitations, insomnia, dizziness, headache indicate Liver Stagnation and Qi Knotting; Body Heat and yellow-red urine indicate Heat.
Treatment of Beng Lou: Simple etiologies are easy to cure; complex ones are difficult. Clinically, complex cases are more common, so attention must be paid to concurrent syndromes. In Deficiency syndromes, pay special attention to Excess components; in Excess syndromes, pay special attention to Deficiency components; in Cold syndromes, pay special attention to Heat components; in Heat syndromes, pay special attention to Cold components. Overall, pay special attention to "treachery hidden in isolation" (subtle conflicting signs). Only then can good efficacy be achieved.
Common syndromes include four:
I. Heart and Spleen Dual Deficiency
Unceasing Beng Lou, or sudden heavy flow, or scanty dripping continuously. Pale lusterless complexion, fatigue, insomnia/dream-disturbed sleep, palpitations, poor appetite, occasional mild edema. Pale tongue, thin white coating, Deep-Fine-Slow or Ru-Slow or Deep-Fine-Weak pulse. Treatment: Tonify Qi and Blood, strengthen Spleen and calm Spirit. Formula: Guipi Tang modified:
Dangsren 9g, Huangqi 15g, Baizhu 9g, Danggui 6g, Zhigancao 4g, Fuling 9g, Guangmuxiang 3g, Jiguanhua 30g.
If insomnia is severe, add Chao Zaoren 10g, Yuanzhi 6g; if abdominal pain is severe with dark purple-black clots, add Sanqi 3g, or Taoren 9g, Honghua 9g if severe; if pale face and shortness of breath, add Renshen 10g, remove Dangsren.
Concurrent syndromes are mostly Blood Stasis, Qi Stagnation, Heat, or Collapse. If treatment fails, appropriately add Blood-invigorating, Qi-regulating, Cold-dispelling, or Astringent herbs.
II. Blood Heat Reckless Movement
Unceasing Beng Lou, sudden heavy flow, or slow onset with continuous dripping. Blood color bright red or purple-red. Body Heat or无明显 (no obvious) body Heat. Red tongue, thin yellow coating, Slippery-Rapid pulse. Treatment: Cool Blood and stop bleeding. Formula: Qinlian Siwu Tang modified:
Chuanxiong 9g, Danggui 9g, Baishao 12g, Shengdi 12g, Huangqin Tan 12g, Huanglian Tan 12g, Diyutan 12g.
If bleeding volume is very small, use Jingjie Siwu Tang.
If five-center Heat, emaciation, dry/bitter mouth during menstruation, Slippery-Rapid pulse, use Gujing Wan modified:
Guiban 30g, Huangqin 9g, Huangbai 9g, Baishao 9g, Chun Genpi 9g, Xiangfu 6g, Haipiaoxiao 9g.