Library

Preparation: Except for Moschus (Shexiang, 麝香), first grind all other herbs into fine powder, add Moschus and mix evenly, then prepare pills with refined honey, sized like Sophora japonica seeds (Wuzi).
Administration: Take 3–4.5 g per dose, taken orally with warm water on an empty stomach in the morning and evening.
Additionally, for masses that are superficial and patients who are physically weak and not suitable for long-term use of aggressive resolving drugs, external plaster can be applied: Draconis Sanguis (Xuejie, 血竭) 9 g, Camphora (Zhangnao, 樟脑) 6 g, Rosin (Songxiang, 松香) 9 g, Cinnabar (Yinzhu, 银珠) 9 g, Moschus (Shexiang, 麝香) 0.06 g (separately ground). Grind the first four ingredients into fine powder, boil with water to form a paste, add Moschus when warm, mix well, and apply to the affected area.

"Where there is pathology, there is no injury; thus no injury occurs."
In the shock stage of ectopic pregnancy, bold application of Natrii Sulfas (Xiaoshuang, 硝) and Rheum Palmatum (Dahuang, 大黄) is the key to emergency rescue. Because ectopic pregnancy itself is an excess syndrome, excess should be purged, and unblocking is necessary; if accompanied by gastrointestinal obstruction and constipation, this approach is even more appropriate. I once treated a patient with ectopic pregnancy shock. Initially, the First Affiliated Hospital of Shanxi Medical University's Obstetrics and Gynecology Department used Ginseng Radix et Rhizoma (Renshen, 人参) for rescue without improvement. After consulting, I urgently prescribed Natrii Sulfas and Rheum Palmatum to purge and unblock, rapidly reversing the condition. However, it is important to supplement with Ginseng Radix et Rhizoma because although this disease is essentially excess, it often contains deficiency. Simultaneously, one must further distinguish between cold and heat and their degrees, modifying the prescription according to symptoms to achieve comprehensive treatment.

Appendicitis
Discussion on the Treatment of Appendicitis
Old Li believes that acute appendicitis can be treated according to Zhang Zhongjing’s methods. *Jingui Yaolue* states: "The disease of intestinal abscess (Changyong, 肠痈) presents with rough skin resembling scales, tense abdominal wall, soft upon pressure, appearing swollen, without accumulation in the abdomen, no fever, and rapid pulse. This indicates pus within the intestine. It is primarily treated with Yiyi Fuzi Baijiang San." "For swelling and abscess, there is swelling and stiffness in the lower abdomen, pain upon pressure resembling strangury, normal urination, frequent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not yet formed, and purgation can be used; if the pulse is surging and rapid, pus has formed, and purgation is contraindicated. It is primarily treated with Dahuang Mudan Tang." These two passages illustrate the differentiation between presence and absence of pus, as well as treatment methods. A slow and tight pulse is generally considered cold, but in intestinal abscess, it indicates an excess-heat syndrome before pus formation; a rapid pulse indicates heat, but in intestinal abscess, it signifies that pus has formed. The presence or absence of tenderness in abdominal palpation is an important method for differentiating excess and deficiency. Tense abdominal wall, soft upon pressure, and appearance of swelling indicate formed pus, representing heat mixed with cold signs; treatment requires heavy use of heat-clearing and detoxifying herbs, supplemented by warming and unblocking agents. Swelling and stiffness in the lower abdomen, pain upon pressure resembling strangury, indicate unfomed pus and stagnation of excess heat; treatment requires eliminating abscesses, clearing heat, detoxifying, and invigorating blood, supplemented by guiding-out stagnation agents. Otherwise, the stagnant heat-toxin will not be eliminated, and the disease will be difficult to cure. In Dahuang Mudan Tang, Rheum Palmatum and Natrii Sulfas are cold and purgative, effectively removing excess heat and accumulation; Persicae Semen (Taoren, 桃仁), Moutan Cortex (Danpi, 丹皮), Benincasa hispida seed (Dongguazi, 冬瓜子), and Rheum Palmatum invigorate blood and clear heat/toxins. When Qi moves, Blood moves; adding Aurantii Fructus Immaturus (Zhishi, 枳实) and Lonicerae Japonicae Flos (Yinhua, 金银花) improves efficacy. In Yiyi Fuzi Baijiang San, Coicis Semen (Yimi, 薏米) eliminates abscesses and discharges pus; Patriniae Herba (Baijiangcao, 败酱草) clears heat, detoxifies, invigorates blood, and discharges pus, effectively treating abdominal abscesses; Aconiti Lateralis Radix Praeparata (Fuzi, 附子) promotes Qi and Blood circulation, disperses cold stagnation, and aids in the resolution of abscesses. Adding Lonicerae Japonicae Flos and Sinapis Semen (Baijiezi, 白芥子) further improves efficacy. For abdominal distension and pain, Paonong San is effective. The original formula consists of 16 pieces of Aurantii Fructus Immaturus, 6 fen of Paeoniae Radix Alba, and 2 fen of Platycodonis Radix, pounded into powder. Mix equal parts of powder with one egg yolk, knead until uniform, and take with water. Clinically, this is often modified to Aurantii Fructus Immaturus 15–30 g, Platycodonis Radix 24–30 g, and Paeoniae Radix Rubra (Chishao, 赤芍) 15 g, plus Lonicerae Japonicae Flos 30 g and Sinapis Semen 3–6 g.

The issues with chronic appendicitis are three: stasis, Qi stagnation, and cold. Clinically, formulas can be selected based on the proportion of stasis, stagnation, and cold. If stasis is predominant, Huoluo Xiaoling Dan with modifications is suitable; if Liver Qi stagnation is predominant, Xiaoyao San with Sinapis Semen, Zingiberis Rhizoma Recens (Ganjiang, 干姜), and Trogopteri Dung (Wulingzhi, 五灵脂) is suitable; if cold coagulates and causes stagnation, Shaofu Zhuyu Tang is suitable. This method can also be used if intestinal adhesions are present.
For appendiceal abscess or peritonitis, Lonicerae Japonicae Flos 120 g, Sinapis Semen 9 g, and Glycyrrhizae Radix et Rhizoma Praeparata (Zhigancao, 炙甘草) 9 g is effective. I once treated a male patient whose abdomen was distended like a drum. Western and Chinese medicines were ineffective initially. After using the above formula, he expelled a large chamber pot full of thick yellow pus from the umbilicus and subsequently recovered.

Intestinal Obstruction
Clinical Experience in Treating Cold-Excess Type Intestinal Obstruction
Old Li believes that intestinal obstruction is generally an excess syndrome, categorized into heat-excess, cold-excess, blood stasis, and Qi stagnation. Additionally, attention should be paid to Qi-deficiency type and strangulated intestinal obstruction. As this is an acute and severe condition where the main complaint is abdominal pain, distinguishing its nature is difficult. Generally, consideration should be given to the history of onset and treatment course. For example, sudden pain after anger suggests Qi stagnation; onset after consuming cold foods suggests cold-excess; a history of intestinal adhesions implies accompanying blood stasis; a habitual inability to tolerate cold foods indicates cold-excess. Case: A male patient suddenly suffered severe abdominal pain. A surgeon diagnosed intestinal obstruction and prescribed Compound Dachengqi Tang without effect. Upon inquiry about his intolerance to cold foods, he was diagnosed with cold-excess and treated with Jiutong Wan (Nine Pain Pill), 12 pills, resulting in recovery. Another case: A 72-year-old male suffered continuous abdominal pain and was diagnosed with intestinal obstruction at a hospital. Due to his advanced age, weakness, and coronary heart disease, surgery was risky, so conservative treatment was advised. Given his intolerance to cold foods and frailty, he was given Jiutong Wan, 20 pills divided into two doses, resulting in recovery. Another case: A boy suddenly developed intestinal obstruction. Radish and Natrii Sulfas Decoction was ineffective. Observation revealed it was caused by eating ice pops. He was treated with Foeniculum Vulgare (Xiaohuixiang, 小茴香), Cinnamon Twig (Rougui, 肉桂), Eugeniae Flos (Dingxiang, 丁香), Aucklandiae Radix (Muxiang, 木香), and Aquilariae Lignum Resinatum (Chenxiang, 沉香), each 6 g, resulting in recovery. Another case: An 80-year-old male had intestinal obstruction caused by incarcerated hernia, diagnosed as Qi deficiency with failure of transportation. He was treated with Magnoliae Officinalis Cortex (Houpo, 厚朴) 24 g, Ginseng Radix et Rhizoma (Renshen, 人参) 9 g, Pinelliae Rhizoma (Banxia, 半夏) 9 g, and Glycyrrhizae Radix et Rhizoma Praeparata 9 g, resulting in recovery.

Pancreatitis
Syndrome Differentiation and Treatment of Pancreatitis
Old Li considers acute pancreatitis to belong to Gan Huoluan (Dry Cholera) and Shiji Tong (Food Stagnation Pain) in TCM, roughly divided into cold-excess and heat-excess types. Heat-excess type is treated with Da Chaihu Tang with modifications. Cold-excess type is treated with Dahuang Fuzi Tang plus Aurantii Fructus Immaturus and Magnoliae Officinalis Cortex, or Yibazhua (One Grab), 1 packet per time, or Jiutong Wan, 12–20 pills per time. Case: A male patient with acute pancreatitis did not improve after taking over ten doses of Compound Da Chaihu Tang. Old Li examined him, finding a string-tight pulse and severe epigastric pain refusing pressure, diagnosing cold-excess. He prescribed Rheum Palmatum 3 g, Asari Radix et Rhizoma (Xixin, 细辛) 3 g, Aconiti Lateralis Radix Praeparata 6 g, Aurantii Fructus Immaturus 9 g, and Magnoliae Officinalis Cortex 9 g. One dose showed effect, and pain disappeared after 10 doses.
Chronic pancreatitis and pancreatic cysts are mostly mixed syndromes of excess/deficiency and cold/heat. Treatment must carefully distinguish the proportions of cold, heat, excess, and deficiency. For example: deep-string or string-choppy pulse, thin-white tongue coating, epigastric distending pain refusing pressure indicates Qi stagnation predominating over cold-excess stagnation. Treat with Houpo Wenzhong Tang plus a small amount of Rheum Palmatum. This formula focuses on bitter-warm regulation of Qi, slightly assisted by purgation. Cold limbs, string-tight pulse, epigastric pain refusing pressure indicates deficiency-cold predominating over excess. Treat with Guifu Lizhong Tang combined with Xiao Chengqi Tang to warm the middle, strengthen the spleen, guide out stagnation, and resolve accumulation. Deficient-large pulse, epigastric pain refusing pressure or only tenderness indicates middle Qi deficiency predominating with cold accumulation. Treat with Buzhong Yiqi Tang plus Aurantii Fructus Immaturus, Magnoliae Officinalis Cortex, Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Aucklandiae Radix, Zingiberis Rhizoma Recens, and Rheum Palmatum to tonify middle Qi, warm the middle, and guide out stagnation. String-slippery pulse, epigastric tenderness indicates heat predominating over cold. Treat with Banxia Xiexin Tang minus Codonopsis Radix (Dangshen, 党参), plus Aurantii Fructus Immaturus, Atractylodis Macrocephalae Rhizoma, Raphani Semen (Laifuzi, 莱菔子), or Zhishi Daozhi Wan plus Zingiberis Rhizoma Recens.

Sepsis

Western Name: Sepsis; Two Corresponding TCM Syndromes
Warm Disease: Heat Entering the Blood Chamber; Surgery: Ding Du Zou Huang (Carbuncle Toxin Spreading Yellow)
Old Li believes that pyemia/sepsis belongs to Ding Du Zou Huang in surgical diseases and Re Ru Ying Xue (Heat Entering Ying and Blood) in warm diseases. Xijiao Dihuang Tang and Qingying Tang are generally effective. Case: A female patient with mastitis complicated by sepsis had persistent high fever, coma, and maculopapular rash. Antibiotics alone and TCM heat-clearing/detoxifying agents were ineffective. She recovered after switching to Xijiao Dihuang Tang. However, Xijiao Dihuang Tang and Qingying Tang are not universally effective; combinations must be made based on mixed syndromes. For example, if accompanied by large pulse, thirst, and sweating, add Gypsum Fibrosum (Shigao, 石膏) and Anemarrhenae Rhizoma (Zhimu, 知母) to clear Qi-level heat; if constipated, add Rheum Palmatum, Natrii Sulfas, and Scrophulariae Radix (Yuanshen, 元参); if comatose with yellow coating, add Angong Niuhuang Wan, 2 pills daily; if excessive phlegm, add Bamboo Juice (Zhuli, 竹沥) 15 g; if Qi and Ying levels are both blazing, switch to Qingwen Baidu Yin.
Additionally, sepsis may resemble Warm Diseases where heat enters the Lower Jiao Liver and Kidney, as described in *Wenbing Tiaobian*: "If pathogen lingers in Yangming for a long time, or has been purged or not, presenting with fever, red face, dry mouth and tongue, even black teeth and cracked lips, with deep-solid pulse, purgation can still be used. If pulse is deficient-large, palms and soles hot (more than dorsum of hands/feet), treat with Jiacheng Fumai Tang." "If Warm Disease is incorrectly treated with exterior-releasing methods, fluids are depleted, causing palpitations, stiff tongue, and coma, use Fumai method to restore fluids; life returns when moisture returns to the tongue. If spontaneous sweating occurs with central instability, treat with Jiuni Tang." "If Warm Disease has sweated but no sweat comes, or purged but fever remains, and beyond 6-7 days the pulse is still restless and vigorous, heavily administer Fumai Tang." "If Warm Disease is incorrectly treated with ascending/dispersing methods, resulting in knotted/intermittent pulse or very slow pulse, heavily restore pulse; treat other symptoms later." "If heat pathogen deeply enters Lower Jiao, pulse is deep-rapid, tongue dry with black teeth, fingers twitching, urgently prevent spasms and convulsions, treat with Erjia Fumai Tang." "Lower Jiao Warm Disease, deep heat with severe cold limbs, fine-rapid pulse, palpitations, even chest pain, treat with Sanjia Fumai Tang." "If heat pathogen lingers long, consuming True Yin, due to incorrect exterior treatment or reckless purging, leading to mental fatigue, convulsions, weak pulse, crimson tongue with little coating, and frequent impending collapse, treat with Dadingsheng Zhu." Case: A patient with peripheral neuritis and urinary tract infection complicated by sepsis presented with confusion, profuse sweating, persistent fever, intermittent limb spasms, occasional delirium, pale complexion, and deficient-rapid-palpable pulse. Western medicine and Qingwen Baidu Yin were ineffective. Switching to Sanjia Fumai Tang plus Anemarrhenae Rhizoma and Phellodendri Cortex (Huangbai, 黄柏) resulted in recovery.

Hemiplegia
Case Report on Hemiplegia
He, Female, 65 years old. Outpatient No.: 31497.
First visit, July 19, 1961: Hemiplegia for over 3 months. Diagnosed with cerebral thrombosis at another hospital, hospitalized for over a month without effect. Later treated with acupuncture and modified Buyang Huanwu Tang by TCM doctors without effect. Invited Old Li for treatment. Old Li observed a melancholic expression, reluctance to speak, deep-string pulse, and diagnosed Liver Qi stagnation with blood stasis, failing to nourish sinews. Treatment: Nourish blood, invigorate blood, soothe Liver, regulate Qi. Modified Xiaoyao San:
Bupleuri Radix (Chaihu, 柴胡) 9 g, Angelicae Sinensis Radix (Danggui, 当归) 9 g, Paeoniae Radix Alba 9 g, Luffae Fructus Retinervus (Sigualuo, 丝瓜络) 9 g, Mulberry Twig (Sangzhi, 桑枝) 9 g, Cyperi Rhizoma (Xiangfu, 香附) 7.5 g, Curcumae Radix (Yujin, 郁金) 6 g.
Visit after 7 days: Taken 7 doses, symptoms greatly reduced, left limb could move, able to turn over. Continued for 1 month and recovered.
Commentary: Old Li believes Buyang Huanwu Tang is indeed a good formula for hemiplegia, but it is a Qi-tonifying and blood-invigorating formula. If used for Liver Qi stagnation and sinew malnourishment, it may cause further Qi/Blood stagnation and sinew discomfort. The Classics state: Liver governs sinews. Liver Qi stagnation and blood stasis lead to sinew malnourishment. Thus, soothing Liver, nourishing blood, and invigorating blood led to recovery.

Liver Abscess Complicated with Subphrenic Abscess
Case Report
Zhang, Male, 50 years old. Outpatient No.: 77256.
First visit, September 12, 1964: Amoebic liver abscess complicated with subphrenic abscess, persistent high fever for over half a year. Western medicine at another hospital was ineffective. Pulse was string-slippery-rapid, with obvious tenderness/refusal to pressure in the epigastrium. Old Li believes abscesses should be treated with heat-clearing and detoxifying methods. However, experience shows that if antibiotics are effective, heat-clearing/detoxifying agents are also effective; if antibiotics fail, these agents rarely work. Thus, one cannot rely solely on heat-clearing/detoxifying methods. This case requires abdominal palpation and pulse diagnosis. If tenderness is obvious, purgation is necessary, but not drastic purgation, as drastic purgation makes pain hard to remove. Slippery-rapid pulse indicates need for phlegm resolution; string pulse emphasizes harmonization. Prescription:
Bupleuri Radix 18 g, Pinelliae Rhizoma 12 g, Scutellariae Radix (Huangqin, 黄芩) 12 g, Aurantii Fructus Immaturus 15 g, Paeoniae Radix Rubra 15 g, Sinapis Semen 9 g, Trichosanthis Fructus (Gualou, 瓜蒌) 30 g, Platycodonis Radix 15 g, Taraxaci Herba (Gongying, 蒲公英) 30 g, Lonicerae Japonicae Flos 30 g, Forsythiae Fructus (Lianqiao, 连翘) 30 g, Rheum Palmatum 3 g.
Next day, family reported temperature dropped from 39.8°C to 38.5°C, abdominal pain greatly reduced, appetite slightly increased. Advised to continue for 2 doses. After 3 doses, appetite greatly increased, temperature normalized.
Commentary: Subphrenic abscess combined with liver abscess, if only treating abscess without regulating Qi and resolving phlegm, and without pulse/syndrome differentiation, is unlikely to be effective. Old Li warns: Internal abscesses emphasize internal treatment; this must not be neglected.

Discussions on Difficult Cases: Difficulty lies in Mixed Excess/Deficiency and Cold/Heat; Solution lies in Proportional Dosage.
Old Li believes that difficult diseases, i.e., chronic, critical, and refractory diseases, are difficult mainly due to mixed excess/deficiency and cold/heat syndromes. Any disease, in terms of nature, is either cold, heat, deficiency, or excess. Simple cold, heat, deficiency, or excess, as well as excess-cold, excess-heat, deficiency-cold, deficiency-heat, are not difficult to differentiate and treat. However, clinically, simple cases are few, while mixed cases are many. This is especially true for difficult diseases, such as cold mixed with heat, heat mixed with cold, deficiency mixed with excess, excess mixed with deficiency, upper Jiao heat with lower Jiao cold, one organ excess while another is deficient, etc., all requiring special attention. Once mixed conditions are identified, further analysis of their quantitative comparison—what is more, what is less, what is primary, what is secondary—must be clarified for targeted treatment. Therefore, the ability to correctly handle mixed syndromes is often an important marker of a doctor's technical skill.
Old Li often says: "Generally, chronic and critical diseases have more mixed syndromes; acute and mild diseases have fewer mixed syndromes. Acute patients with good physical constitution have fewer mixed syndromes; those with poor constitution or concurrent chronic diseases have more mixed syndromes. Among mixed syndromes, there are exterior-interior mixing, cold-heat mixing, excess-deficiency mixing, Yin-Yang mixing, Zang-Fu intermixing, or multiple Zang/Fu/J meridians/collaterals presenting simultaneously. When evaluating mixed syndromes, the proportional relationship among them is particularly important. For example, in exterior-interior relations, there are exterior with interior involvement, and interior with exterior involvement; in cold-heat relations, cold with heat involvement, and heat with cold involvement; in excess-deficiency relations, excess with deficiency involvement, and deficiency with excess involvement; in Yin-Yang relations, Yang deficiency with insufficient Yin, and Yin deficiency with slight Yang deficit; in Zang-Fu relations, Zang deficiency with slight Fu excess, and Fu excess with Zang deficiency, etc. How to differentiate? Generally, pulse, complexion, abdomen, and symptoms are cross-referenced. If exterior and interior signs coexist, the number of symptoms distinguishes the degree of exterior vs. interior. If excess and deficiency signs coexist, combining pulse, complexion, and abdominal palpation distinguishes which is predominant. For multiple Zang/Fu/J meridians/collaterals coexisting, abundant symptoms indicate predominance, few symptoms indicate lesser involvement. Pulse qualities representing cold, heat, excess, and deficiency are important indicators for measuring mixed cold, heat, excess, and deficiency. If extreme excess mimics deficiency, or extreme deficiency mimics excess, abdominal palpation is essential for differentiation." He also said: "There are two formulas in *Shanghan Lun* for treating fullness/stuffiness: Banxia Xiexin Tang and Huanglian Tang. Based on symptoms, they are almost identical, but the former adds Scutellariae Radix, while the latter adds Cinnamon Twig. How to differentiate? By pulse. If slippery, use Banxia Xiexin Tang; if string-choppy and irregular, use Huanglian Tang." "Zhang Zhongjing is the model for differentiating and treating mixed syndromes. To understand mixed syndromes, one must carefully study *Shanghan Lun* and *Jingui Yaolue*."
For example, diarrhea involves the most mixed conditions, especially chronic non-healing diarrhea, which requires careful examination. Whenever Old Li encounters chronic diarrhea with abdominal pain, he emphasizes noting the excess component. Abdominal palpation usually reveals tenderness (often subtle, easily missed unless carefully observed), indicating deficiency mixed with excess. Treatment often involves adding Rheum Palmatum to astringent/tonifying herbs, yielding good results. However, since this is a chronic condition, deficiency usually outweighs excess. Thus, although Rheum Palmatum is used, the dose should not be too large and should be adjusted according to the condition.
Another example is constipation. While the standard method is purging excess, and Chengqi-type formulas suit excess, clinical practice requires assessing the primary excess/deficiency. Postpartum constipation, or constipation after prolonged illness or major disease, is often excess mixed with deficiency. Purging is necessary but cannot be harsh; the method should combine attacking and tonifying, i.e., adding tonifying herbs to purgatives, such as Ginseng Radix et Rhizoma or Angelicae Sinensis Radix, choosing moistening or guiding methods as appropriate. Age, constitution, pulse, and accompanying symptoms must be considered to address deficiency appropriately. For example, in clinical practice for deficiency-cold constipation or deficiency-cold with excess, Wenyi Tang or Lizhong Tang plus Rheum Palmatum is used, with dosage adjusted based on the proportion of excess/deficiency.
Another case: A postpartum patient with severe hemorrhoids, intense pain and bleeding. Due to postpartum deficiency mixed with excess, Astragali Radix (Huangqi, 黄芪) was heavily used, plus Boswelliae Resina (Ruxiang, 乳香), Myrrha (Moyao, 没药), Sophorae Flavescentis Fructus Carbonized (Huaijiaotan, 槐角炭), Lonicerae Japonicae Flos, and Sanguisorbae Radix Carbonized (Diyutan, 地榆炭). Due to constipation and fu-excess, Natrii Sulfas and Rheum Palmatum were added moderately, resulting in recovery after a few doses. Another case: An acute nephritis patient with gastric tenderness. Aurantii Fructus Immaturus and Raphani Semen were added to a diuretic formula, resulting in recovery after a few doses. Generally, in diarrhea syndromes, pain before defecation stopping after defecation indicates mixed excess, suggesting tonification with purgation. For Weiling Tang syndrome, a small amount of Rheum Palmatum and Aurantii Fructus Immaturus is also needed.