(4)大便溏泻。
3．肾阴虚
(1)腰脊腿胫酸痛。
(2)梦交失精。
(3)足心干热．
(4)脚跟作痛。
(5)小便淋闭。
(6)耳鸣耳聋。
(7)牙齿浮动。
(8)骨蒸内热。
注意：以上三种阴虚证，不是完全固定的，也不是截然 分界的，总有互相穿插的情形，但我们可以根据各部分病势 的轻重来决定治疗上的主次。
五、阴虚的诊断
关于这种病的诊断方法，和其他病一样，就是利用望、闻、问、切四诊和其他各种经验方法进行各项诊查。
1．．从主症方面去认识。这是一切病开始最主要的诊断法，因为任何病都有它固定的主症。
2．从类似症状去对比。有了主症后为了避免错误，需要把类似主症的症状互相对比，这样比较更确当些。
例如：阴虚的主症，第一主症是午后身热，但我们不可一看到午后身热的现象即认为是阴虚，必须先和温病的“午后身热”对比一下，有无气候变化时常外感的现象，这样对比之后，就可能少犯错误了。从治疗方面分析，古人云：“凉之不凉是无水也。”又： “内热不解，屡清，清而火不退者，阴不足也。”又云：“表邪不解，屡散，散而汗不出者，阴气不能达也。”又云：“虚劳病，不能服参芪，所谓虚不受补者，血燥阴虚也。”从病的比例上去参考，顾氏云：“阴虚者十之八九，阳虚者十之一二。”这个方法 ，只用在阳虚阴虚二病，在用任何方法均判断不清的时候，作为一种帮助，而不是泛用的。 六、阴虚的治法 阴虚的治法主要有三部分： (一)肺阴虚的治法 1．清肺润燥(清金润肺)：这是治帅阴虚的主要方法，如清金汤、八仙玉液等方。久服的时候，注意不要过于单纯，以防引起泄泻或减食等症。
2．清肺滋肾：这是治肺虛兼肾阴虚的方法，如二冬二地同用的方子(固本丸等)，或早用清肺药(如清金汤)，晚用滋肾药(如六味地黄丸)等，但重点是在肺脏。肺阴虚到了最重的时候，不论肾阴虚的症状显与否。必须兼滋肾阴，因为肾是先天的根本，同时还须注意不要伤脾。
3。清肺补脾：这是治肺阴虚兼脾阴虚的方法，如加味清宁膏。两经兼治较困难，因肺喜润，脾喜燥，补脾则碍肺，补肺则碍脾，如润肺药过多，则食欲减少，或大便溏泻加重，补脾药太过，而燥咳等症又加。所以。治肺阴虚，不论有无脾虚现象，必须时时要注意预防引起脾虚。
(二)．肾阴虚的治法
1．滋阴补肾(补水制火)：这是治肾阴虚有火的普通方法，如六味地黄丸、左归饮等方。阴虚一定是有火，阴愈虚而火愈盛，但这种火与实火不同，不能用苦寒药去治疗，因为一用苦寒，不但不能取效，有的反而加重了。所以，凡用苦寒药不能取效或反加重的火证，用此法最为相宜。
2．滋阴降火(滋阴潜阳)：这是治肾阴虚而火上逆，或稍兼实火现象的方法，如知柏地黄丸、大补阴丸或六味地黄丸加减等方。因为火盛没有不上逆的，也往往兼有实火，但较轻的只用补水制火的大法而火白熄了，较重的非用这个方法不能取效。
3．滋阴清肺：这是治肾阴虚兼肺阴虚的方法，如麦味地黄丸方。因为．肾阴虚最易波及肺脏引起咳嗽等症。
4．滋肾理脾：这是治肾阴虚兼脾阴虚的方法。这两经阴虚兼见的时候，以治脾为主，不然的话，脾虚不能吸收，虽有灵丹妙药亦是不会取效的。所以治肾阴虚的时候，必须注意饮食。
(三)脾阴虚的治法
主要的治法，须要不燥不润的药品，因为脾喜燥恶润，阴虛喜润恶燥，这种病最难用药。李老据经验认为，最有效的莫如川山药、莲肉、扁豆、苡仁这一类的药品．或兼用百合、冬花、杷叶、麦冬，以治兼肺阴虚的证候，如加味清宁膏。或待泻止后，早晚和六味地黄丸间服，以治兼肾阴虚的证候。
总的说来，阴虚病宜用甘寒药，不宜用苦寒药，因为苦寒药性燥，反能伤阴；并须要多煎久服，因为阴虚病药宜重浊，所以须要多煎，阴虚无速补法，所以须要久服。前人有主张用大剂补阴的，李老在实际中试之，认为不如用小剂频服久服，有利无弊。因为服滋阴药，最怕伤及脾阳，引起泄泻不食等症，大剂最容易犯这样的毛病。在治疗上，灸法是不可用的。仲景说过： “火气虽微，内攻有力，焦骨伤筋，血难复也。”在用药上，升麻、紫苏最不可用。顾氏说过：“阴虚误用，则阴火上逆，喘咳频增，吐衄交至、” 七、阴虚的方剂 李老常用的补阴方剂如下： (一)治肺阴虚的方剂 1．清金汤：治肺阴虚咳嗽，或多痰，或干咳，或痰红，或纯红。桑皮7．5克，地骨皮6克，麦冬6克，鲜百合30克，冬花6克，川贝6克，杏仁6克，炙杷叶6克，炙草3克。有血加白茅根9克，藕汁、童便各半茶盅，水煎服。
2．八仙玉液：治肺阴虚咳嗽痰血。藕汁2杯，梨汁、甘蔗浆、芦根汁、白茅根煎浓汁各1杯，人乳、童便各1杯，生鸡子白3枚，和匀频服，如用苡仁、山药、麦冬各30克，白花百合60克．杷叶10片，煎浓汁1碗冲入玉液，再加川贝末、柿霜各15克。和匀频服更好。
3．固本丸：治老人阴虚咳嗽便秘。天冬、麦冬、生地、熟地各60克，人参30克。共研末为蜜丸。每服9克，开水送下。此方中人参的作用是预防引起减食作泻。
4．加味清宁膏：治肺阴虚咳嗽痰血，兼食少泄多者。麦冬120克，鲜百合300克，款冬花60克，薄荷末15克，炙杷叶150克，橘红15克，川贝(研末)60克，茯苓30克，苡仁120克，桂圆肉60克，炒白芍60克，炙草15克。除薄荷川贝外其他诸药用水熬成膏，将薄荷、川贝二药末加入，再入饴糖360克溶化搅匀。每服一茶匙，开水冲服。
(二)治肾阴虚的方剂
1．六味地黄丸：治肾阴虚一切证候。熟地240克，山萸肉120克，生山药120克，粉丹皮90克，茯苓90克，泽泻90克。共为细末，蜜丸梧桐子大。每服9克，开水送下。也可作汤服。加减法：发热作渴加生鳖甲、花粉、二冬，气壅加沉香、砂仁、麦冬，痰嗽加贝母、百合、麦冬，咽喉舌痛加生鸡子、元参、麦冬，齿缝牙龈出血加麦冬、童便，或再加人中白、麦冬，齿牙不固加人参、麦冬、五味子、鹿茸、猪髓、龙齿、牡蛎，腿胫酸疼加牛膝、杜仲、枸杞、龟板，血淋去山萸加二冬、牛膝、藕汁、甘草梢，阴茎时举，溺管胀痛，加知母、黄柏、甘草梢，尿血加人参、寸冬、五味子、白芍、莲须、藕汁、旱莲草，失音加麦冬、生鸡子，足心干热加二冬、牛膝、龟板。(说明：任何加减法，都不可能俱备，都不可能完全，也都不可固执不变。必须对证用药。方为合拍。)
2．左归饮：治证同六味丸，补阴力较优，即六味地黄丸去泽泻、丹皮，加枸杞、炙草。加减法：肺热而烦者加麦冬，肺热多嗽者加百合，血少者加当归，血滞而热者加丹皮，阴虚不宁者加女贞子，血热妄动者加生地，脾热易饥及多汗者加白芍，心热多燥者加元参，肾热骨蒸者加地骨皮，津枯热渴者加花粉，上实下虚者加牛膝。
3。知柏地黄丸：治骨痿髓枯，劳热盗汗耳聋，阳易举，溺管痛，一切阴虚火盛火逆等证。即六味地黄丸加知母、黄柏。蜜丸每服9克，开水送下。
4．大补阴丸：治一切阴虚火盛火逆等证。黄柏(盐炒)、知母(盐炒)、熟地、炙龟板共为细末，猪脊髓和，炼蜜为丸，如梧桐子大。每服15克，开水送下。
5．麦味地黄丸：治阴虚久咳嗽或痰中带血丝。即六味地黄丸加麦冬、石斛、生山药、生于术、生扁豆、生苡仁、生莲肉、西洋参、麦冬、金石斛、炙草。用量随证酌加，水煎服。 八、阴虚的药品 现将李老常用的补阴药品述之如下： (一)肺阴虚的药品择要 天冬：滋肺阴，润肺燥，清肺热。性寒滑，脾虚食少便溏者不宜用。
麦冬：滋肺阴，润肺燥，清肺热。便溏者也不可用，但同苡仁、山药、茯苓等同用不忌。
百合：咳嗽用之。白花鲜者更好。
炙杷叶：降气止咳嗽。气逆者可用。
桑皮：泻肺火。肺虚无火及风寒咳嗽者勿用。
川贝：有浊痰白沫者可用，清痰或无痰者不可用。
薄荷：散热清肺。稍兼风热者用之。
沙参：补肺阴。
梨：润肺清热。
五味子：敛肺气，敛肾气。咳久气耗，汗腺不固，或肾气上逆者都可用。
冬花：有咳嗽者可用。
柿霜：清热化痰。
白茅根：甘寒除内热，止血消瘀。
藕根：清热，止血消瘀。
童便：滋阴降火。有出血症者最宜，骨蒸服一般药不效者也效。阴虚无火，食不消化，肠不实者忌之。
知母：清肺滋肾。痰有臭味者可用。同黄柏能滋阴降火。但久服有引起泄泻的可能，所以脾虚食少便溏者都不可用。
人参：肺虚补肺之要药。但肺阴虚热盛者忌之。同二冬、二地用之可防止伤脾，食少泄泻之患脾肾虚者也可取用。
西洋参：性较寒，对于阴虚有热者比人参为优。
(二)肾阴虚的药品择要
熟地：补肾益阴。此为补肾阴的要药，对于精虚、髓虚、血虚都能治。但性稍温而滞，对于阴虚有热者，须与生地和其他滋阴药品同用。阴虚而兼痰多气郁胸满者，或不用，或与沉香、砂仁、麦冬、川贝等药同用。
生地：补阴凉血。有热者可用，食少泻多者不可用。
鳖甲：补阴潜阳。阴虚寒热往来，或骨蒸内热者，都可用。脾胃热，呕恶泄泻者，不宜用。
龟板：补阴潜阳，退骨蒸。肾虚无热者不用。
丹皮：五心烦热、骨蒸内热都可用。无汗者用之，清肝肾之虚热。
地骨皮：五心烦热、骨蒸内热都可用。有汗者用之，降肺中之伏火。
枸杞、杜仲：治肾虚腰痛。
猪腰子、猪脊髓：煎汤煎药，治腰脊疼痛．
莲须：精不固者用之。
紫河车：峻补精血。虚共者可用。
女贞子：肾阴虚有热者宜之。久服可致腹痛作泻．
山萸肉：补阴药。对于精不固、汗不止、尿不禁者都可用。膀胱有热，小便不利者，不可用。
(三)脾阴虚的药品择要
生山药：补脾补肺补肾。阴虚溏泻不食者最宜．，
茯苓：便溏尿少者可用。阴虚者不可多用，因渗利恐伤水分。
薏苡仁、莲肉、扁豆：泻者都可用。
生白术：补脾的正药。泄泻食少者最宜，但阴虚甚有嫌其燥者，或用于术，或以苡仁、石斛代之。
生白芍：有中满(夜剧昼静之满)、腹痛、出汗、泄痢、气不舒等症者可用。中寒腹痛泄泻，肠胃中觉冷者，不可用。
石斛：胃中或肌肉有虚热者宜之。
九、阴虚一切禁忌
在疗养当中，必须严守禁忌，否则影响治疗，兹择其要者如下：
1．烟、酒要绝对忌。
2．至于姜、葱、蒜，为了增进饮食，用少许调些味，病轻者偶然用之也可，但重病也须注意。
3．一切辛辣性食物(辣椒、花椒、胡椒、芥花面)绝对忌。
4．一切生冷、滑肠或硬性食物，恐伤肠胃，必须忌。性欲，这是造成阴虚最主要的原因，须绝对禁忌，甚至不可有欲念。顾氏说过：“欲心一动，相火翕然而起，虽不交会，精已暗耗。”甚者须绝欲3年。
5．恼怒伤肝，忧思伤脾，须要时常注意。
6．劳动应注意减少。烦劳则气张于外，精绝于内，但轻微运动还是很需要的。
寒证小议
什么是“寒”?从人体上来说，寒就是热量不足的一种综合表现。什么是“寒证”?寒证就是人体热量不足导致的各种证候。从全身整体方面说，有表寒，有里寒，有阴邪直中之实寒，有阳虚所致之虚寒，有“火中内伏之寒”及“火郁似寒”、“虚阳外越”之“假寒”。在表寒之中。又有“风寒”、“寒湿”、“阴暑”、“凉燥”、“伤寒”、“冒寒”之分；在里寒之中，除了阳虚所生内寒、火中内伏之寒及火郁似寒、虚阳外越的假寒外，比较常见的就是由于饮食生冷，或服凉性药物过度，或居处高寒地区，衣被不能适体等而引起的五脏六腑之寒。
寒证的症状，表寒证可见全身肌肤肌肉恶风恶寒，发热，喜近衣被，头痛项强，身痛腰疼，骨节疼痛，舌上无苔，或舌苔淡白而薄润，口不干，不苦，不渴，不喜冷性饮食，或鼻鸣干呕，或咳喘吐稀痰，脉浮而紧；里寒证则见腹痛腹满，呕吐下利，四肢厥逆，喜热恶寒，不敢服冷性饮食，勉强服食，则腹症加剧，脉沉紧或沉迟，在一年之中，夏季病减，冬季病增，在一日之间，午前轻而午后加重。单纯的表寒证或里寒证，实寒证或虚寒证，并不难辨识，但临床上寒热往往多以错杂的情况相间出现，因而寒热夹杂，孰多孰少，寒热真假，孰真孰伪，就成为考验医生辨证诊断水平，和影响患者疾病转归的关键。
如曾治一经西医诊断为副鼻窦炎的患者，穿刺有脓，头痛剧烈，鼻涕黄稠，口不干，不喜冷性食物，腹满，胁肋胀痛，舌淡苔薄，脉弦紧，为寒热夹杂，兼有气郁之证。给予逍遥散加银花、连翘、川芎、白芷、黄芩、干姜，1剂病减，3剂而愈。又如曾治一例咳嗽，就诊时病已迁延20多天，症见两胁胀满，痰多易咯出，咽干，口苦，但不喜饮，兼见头痛。诊为肝气郁结，上热下寒之寒热错杂证。治以寒温并用之法，给予桑皮、贝母、柴胡、香附、橘红、半夏、茯苓、杏仁、干姜、黄芩，以清肺，温脾化痰，解郁，平调其寒热。1剂即见好转。
(4) Loose and watery stools.
3. Kidney Yin Deficiency
(1) Soreness and pain in the lower back, spine, legs, and calves.
(2) Nocturnal emission during sexual dreams (Mengjiao Shijing).
(3) Dryness and heat in the soles of the feet.
(4) Pain in the heels.
(5) Dysuria or urinary retention.
(6) Tinnitus or deafness.
(7) Loose teeth.
(8) Bone-steaming internal heat (Guzheng Nei Re).
Note: The above three types of Yin deficiency syndromes are not completely fixed nor strictly separated; they often intermingle. However, we can determine the primary and secondary aspects of treatment based on the severity of symptoms in each area.
V. Diagnosis of Yin Deficiency
The diagnostic methods for this disease are the same as for other diseases, utilizing the four diagnostic methods of observation (Wang), listening and smelling (Wen), inquiry (Wen), and palpation (Qie), along with various other empirical examination methods.
1. Recognition from main symptoms. This is the most important initial diagnostic method for all diseases, as every disease has its fixed main symptoms.
2. Comparison with similar symptoms. After identifying the main symptoms, to avoid errors, one must compare them with similar symptoms. This comparative approach is more accurate.
For example: The main symptom of Yin deficiency is afternoon fever. However, one cannot immediately diagnose Yin deficiency upon seeing afternoon fever. One must first compare it with the "afternoon fever" seen in Warm Diseases (Wenbing), checking for phenomena such as external contraction due to frequent changes in climate. Such comparison reduces the likelihood of error. Analyzing from a therapeutic perspective, ancients stated: "If cooling fails to reduce heat, it indicates a lack of Water (Yin)." Also: "If internal heat persists despite repeated clearing, and the fire does not subside, it indicates insufficient Yin." And: "If exterior pathogens persist despite repeated dispersing, and sweat does not emerge, it indicates that Yin Qi cannot reach the surface." And: "In consumptive diseases, if Ginseng and Astragalus cannot be taken, referred to as 'deficiency unable to tolerate tonification,' it indicates blood dryness and Yin deficiency." Referring to disease proportions, Mr. Gu stated: "Nine out of ten cases are Yin deficiency, while only one or two are Yang deficiency." This method is used only when distinguishing between Yang and Yin deficiency is unclear by any other method, serving as an aid rather than a universal rule.
VI. Therapeutic Methods for Yin Deficiency
The therapeutic methods for Yin deficiency mainly consist of three parts:
(A) Therapeutic Methods for Lung Yin Deficiency
1. Clearing the Lung and moistening dryness (Clearing Metal and moistening the Lung): This is the main method for treating Lung Yin deficiency, using formulas such as Qingjin Tang (Clearing Metal Decoction) and Baxian Yuye (Eight Immortals Jade Fluid). When taken for a long time, care must be taken not to rely solely on these, to prevent side effects like diarrhea or loss of appetite.
2. Clearing the Lung and nourishing the Kidney: This is the method for treating Lung deficiency combined with Kidney Yin deficiency, such as formulas using both Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix) along with Sheng Di Huang (Rehmanniae Radix) and Shu Di Huang (Prepared Rehmanniae Radix), like Guben Wan (Solidify the Root Pill); or taking Lung-clearing herbs (like Qingjin Tang) in the morning and Kidney-nourishing herbs (like Liuwei Dihuang Wan) in the evening. The focus remains on the Lung. When Lung Yin deficiency reaches its heaviest stage, regardless of whether Kidney Yin deficiency symptoms are obvious, one must simultaneously nourish Kidney Yin, because the Kidney is the root of congenital constitution. At the same time, care must be taken not to injure the Spleen.
3. Clearing the Lung and tonifying the Spleen: This is the method for treating Lung Yin deficiency combined with Spleen Yin deficiency, such as Jia Wei Qingning Gao (Modified Clearing Peace Ointment). Treating both meridians simultaneously is difficult because the Lung prefers moisture while the Spleen prefers dryness; tonifying the Spleen may hinder the Lung, and tonifying the Lung may hinder the Spleen. If too many Lung-moistening herbs are used, appetite decreases or loose stools worsen; if too many Spleen-tonifying herbs are used, dry coughs may worsen. Therefore, when treating Lung Yin deficiency, one must always be vigilant to prevent inducing Spleen deficiency, regardless of existing Spleen deficiency signs.
(B) Therapeutic Methods for Kidney Yin Deficiency
1. Nourishing Yin and tonifying the Kidney (Supplementing Water to control Fire): This is the common method for treating Kidney Yin deficiency with fire, such as Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Zuoyin Yin (Left Restoring Decoction). Yin deficiency inevitably involves fire; the more deficient the Yin, the stronger the fire. However, this fire differs from Excess Fire and cannot be treated with bitter-cold herbs. Using bitter-cold herbs not only fails to produce results but may even exacerbate the condition. Therefore, for fire syndromes where bitter-cold herbs fail or worsen the condition, this method is most appropriate.
2. Nourishing Yin and descending fire (Nourishing Yin and subduing Yang): This is the method for treating Kidney Yin deficiency with flaming-upward fire, or slightly combined with Excess Fire phenomena, such as Zhibai Dihuang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill), Dabu Yin Wan (Great Tonification of Yin Pill), or modified Liuwei Dihuang Wan. Since excessive fire invariably flares upward, and often combines with slight Excess Fire, mild cases may resolve simply by supplementing Water to control Fire, but severe cases require this method to be effective.
3. Nourishing the Kidney and clearing the Lung: This is the method for treating Kidney Yin deficiency combined with Lung Yin deficiency, such as Maiwei Dihuang Wan (Lily Bulb and Schisandra Pill with Rehmannia). This is because Kidney Yin deficiency easily affects the Lung, causing coughs and other symptoms.
4. Nourishing the Kidney and regulating the Spleen: This is the method for treating Kidney Yin deficiency combined with Spleen Yin deficiency. When Yin deficiency of both meridians appears together, treatment should focus on the Spleen; otherwise, Spleen deficiency will fail to absorb nutrients, and no miraculous medicine will be effective. Therefore, when treating Kidney Yin deficiency, attention must be paid to diet.
(C) Therapeutic Methods for Spleen Yin Deficiency
The main therapeutic method requires herbs that are neither drying nor overly moistening, because the Spleen prefers dryness and dislikes moisture, while Yin deficiency prefers moisture and dislikes dryness. This disease is the most difficult to treat pharmacologically. Based on experience, Mr. Li considers herbs such as Chuan Shan Yao (Dioscoreae Rhizoma), Lian Rou (Nelumbinis Semen), Bian Dou (Lablab Album Seed), and Yi Ren (Coicis Semen) to be the most effective. Alternatively, Bai He (Lilii Bulbus), Dong Hua Hua (Farfarae Flos), Pa Ye (Eriobotryae Folium), and Mai Dong (Ophiopogonis Radix) can be combined to treat concurrent Lung Yin deficiency, such as in Jia Wei Qingning Gao. Or, after diarrhea stops, Liuwei Dihuang Wan can be taken alternately in the morning and evening to treat concurrent Kidney Yin deficiency.
Generally speaking, Yin deficiency diseases should use sweet-cold herbs, not bitter-cold herbs, because bitter-cold herbs are drying and can further injure Yin. They must be decocted for a long time and taken over a long period because medicines for Yin deficiency are heavy and turbid, requiring prolonged decoction, and there is no rapid tonification method for Yin deficiency, requiring long-term administration. Ancients advocated large doses for tonifying Yin, but Mr. Li’s practical trials suggest that small doses taken frequently over a long period are beneficial without drawbacks. Taking Yin-nourishing herbs risks injuring Spleen Yang, leading to diarrhea and anorexia; large doses are most prone to this fault. Moxibustion is contraindicated in treatment. Zhang Zhongjing stated: "Although the fire energy is slight, its internal attack is powerful, scorching bones and damaging sinews, making blood recovery difficult." In medication, Sheng Ma (Cimicifugae Rhizoma) and Zi Su (Perillae Folium) are absolutely contraindicated. Mr. Gu stated: "Misuse in Yin deficiency causes Yin fire to flare upward, increasing wheezing and coughing, and causing frequent hematemesis and epistaxis."
VII. Formulas for Yin Deficiency
The following are the common Yin-tonifying formulas used by Mr. Li:
(A) Formulas for Lung Yin Deficiency
1. Qingjin Tang (Clearing Metal Decoction): Treats Lung Yin deficiency cough, with much phlegm, dry cough, red phlegm, or pure blood. Sang Pi (Mori Cortex) 7.5g, Di Gu Pi (Lycii Cortex) 6g, Mai Dong (Ophiopogonis Radix) 6g, Fresh Bai He (Lilii Bulbus) 30g, Dong Hua Hua (Farfarae Flos) 6g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) 6g, Xing Ren (Armeniacae Semen Amarum) 6g, Zhi Pa Ye (Eriobotryae Folium Praeparatum) 6g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum) 3g. Add Bai Mao Gen (Imperatae Rhizoma) 9g if bleeding occurs; mix with half a teacup of Ou Zhi (Nelumbinis Rhizomatis Juice) and Tong Bian (Urine of Healthy Child), decoct in water, and take orally.
2. Baxian Yuye (Eight Immortals Jade Fluid): Treats Lung Yin deficiency cough with bloody sputum. Mix 2 cups of Ou Zhi (Nelumbinis Rhizomatis Juice), 1 cup each of Li Zhi (Pyrri Fructus Juice), Gan Zhe Jiang (Sacchari Saccharifluviatilis Praparatam), Lu Gen (Phragmitis Rhizoma Juice), and concentrated decoction of Bai Mao Gen (Imperatae Rhizoma); add 1 cup each of Ren Ru (Human Milk) and Tong Bian (Urine of Healthy Child); add 3 raw egg whites. Mix well and take frequently. Better yet: decoct Yi Ren (Coicis Semen), Shan Yao (Dioscoreae Rhizoma), and Mai Dong (Ophiopogonis Radix) 30g each, and Bai Hua Bai He (Lilii Bulbus) 60g, Pa Ye (Eriobotryae Folium) 10 leaves, into 1 bowl of concentrated juice, pour into the Jade Fluid, then add Chuan Bei Mo (Fritillariae Cirrhosae Bulbus Powder) and Shi Shuang (Sugar Frost from Persimmon) 15g each. Mix well and take frequently.
3. Guben Wan (Solidify the Root Pill): Treats elderly patients with Yin deficiency cough and constipation. Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Sheng Di Huang (Rehmanniae Radix), and Shu Di Huang (Prepared Rehmanniae Radix) 60g each, Ren Shen (Ginseng Radix) 30g. Grind into powder, make honey pills. Take 9g each time, washed down with boiled water. The role of Ren Shen in this formula is to prevent loss of appetite and diarrhea.
4. Jia Wei Qingning Gao (Modified Clearing Peace Ointment): Treats Lung Yin deficiency cough with bloody sputum, accompanied by poor appetite and frequent diarrhea. Mai Dong (Ophiopogonis Radix) 120g, Fresh Bai He (Lilii Bulbus) 300g, Kuan Dong Hua (Farfarae Flos) 60g, Bo He Mo (Menthae Haplocalycis Powder) 15g, Zhi Pa Ye (Eriobotryae Folium Praeparatum) 150g, Ju Hong (Citri Reticulatae Pericarpium Rubrum) 15g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus Powder) 60g, Fu Ling (Poria) 30g, Yi Ren (Coicis Semen) 120g, Gui Yuan Rou (Longan Arillus) 60g, Chao Bai Shao (Paeoniae Radix Alba Praeparata) 60g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum) 15g. Except for Bo He and Chuan Bei, decoct all other herbs in water to form an ointment. Add the powders of Bo He and Chuan Bei, then dissolve Yi Tang (Malt Sugar) 360g, stir well. Take one teaspoon each time, mixed with boiled water.
(B) Formulas for Kidney Yin Deficiency
1. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia): Treats all syndromes of Kidney Yin deficiency. Shu Di Huang (Prepared Rehmanniae Radix) 240g, Shan Yu Rou (Corni Fructus) 120g, Sheng Shan Yao (Dioscoreae Rhizoma) 120g, Fen Dan Pi (Moutan Cortex) 90g, Fu Ling (Poria) 90g, Ze Xie (Alismatis Rhizoma) 90g. Grind into fine powder, make honey pills the size of mulberry seeds. Take 9g each time, washed down with boiled water. Can also be taken as a decoction. Modifications: For fever and thirst, add Sheng Bie Jia (Testudinis Carapax et Plastrum), Hua Fen (Trichosanthis Radix), and Er Dong (Tian Dong and Mai Dong); for Qi stagnation, add Chen Xiang (Aquilariae Lignum Resinatum), Sha Ren (Amomi Fructus), and Mai Dong (Ophiopogonis Radix); for phlegmy cough, add Bei Mu (Fritillariae Bulbus), Bai He (Lilii Bulbus), and Mai Dong (Ophiopogonis Radix); for sore throat and tongue pain, add Sheng Ji Zi (Avis Ovum), Xuan Shen (Scrophulariae Radix), and Mai Dong (Ophiopogonis Radix); for bleeding gums, add Mai Dong (Ophiopogonis Radix) and Tong Bian (Urine of Healthy Child), or add Ren Zhong Bai (Uris Calculus) and Mai Dong (Ophiopogonis Radix); for loose teeth, add Ren Shen (Ginseng Radix), Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), Lu Rong (Cervi Cornu Pantotrichum), Zhu Sui (Suis Medulla), Long Chi (Dentibus Draconis et Mammutis), and Mu Li (Ostreae Concha); for soreness and pain in legs and calves, add Niu Xi (Achyranthis Bidentatae Radix), Du Zhong (Eucommiae Cortex), Gou Qi Zi (Lycii Fructus), and Gui Ban (Testudinis Carapax et Plastrum); for bloody stranguria, remove Shan Yu Rou, add Er Dong (Tian Dong and Mai Dong), Niu Xi (Achyranthis Bidentatae Radix), Ou Zhi (Nelumbinis Rhizomatis Juice), and Gan Cao Shao (Glycyrrhizae Radix et Rhizoma Caudex); for spontaneous erection and painful urethra, add Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), and Gan Cao Shao (Glycyrrhizae Radix et Rhizoma Caudex); for hematuria, add Ren Shen (Ginseng Radix), Cun Dong (Mai Dong), Wu Wei Zi (Schisandrae Chinensis Fructus), Bai Shao (Paeoniae Radix Alba), Lian Xu (Nelumbinis Stamen), Ou Zhi (Nelumbinis Rhizomatis Juice), and Han Lian Cao (Ecliptae Herba); for aphonia, add Mai Dong (Ophiopogonis Radix) and Sheng Ji Zi (Avis Ovum); for dry heat in soles, add Er Dong (Tian Dong and Mai Dong), Niu Xi (Achyranthis Bidentatae Radix), and Gui Ban (Testudinis Carapax et Plastrum). (Note: Any modification cannot be exhaustive or complete, nor should it be rigidly adhered to. Medication must match the syndrome.)
2. Zuoyin Yin (Left Restoring Decoction): Treats the same syndromes as Liuwei Wan, with superior Yin-tonifying power. It is Liuwei Dihuang Wan minus Ze Xie (Alismatis Rhizoma) and Dan Pi (Moutan Cortex), plus Gou Qi Zi (Lycii Fructus) and Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum). Modifications: For Lung heat with irritability, add Mai Dong (Ophiopogonis Radix); for Lung heat with frequent cough, add Bai He (Lilii Bulbus); for blood deficiency, add Dang Gui (Angelicae Sinensis Radix); for blood stasis with heat, add Dan Pi (Moutan Cortex); for restless Yin deficiency, add Nu Zhen Zi (Ligustri Lucidi Fructus); for reckless blood heat movement, add Sheng Di Huang (Rehmanniae Radix); for Spleen heat with easy hunger and sweating, add Bai Shao (Paeoniae Radix Alba); for Heart heat with dryness, add Xuan Shen (Scrophulariae Radix); for Kidney heat with bone-steaming, add Di Gu Pi (Lycii Cortex); for fluid depletion with heat and thirst, add Hua Fen (Trichosanthis Radix); for upper excess and lower deficiency, add Niu Xi (Achyranthis Bidentatae Radix).
3. Zhibai Dihuang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill): Treats bone atrophy with marrow exhaustion, hectic fever with night sweats, deafness, easy erection, painful urethra, and all syndromes of Yin deficiency with excessive fire and flaming-upward fire. It is Liuwei Dihuang Wan plus Zhi Mu (Anemarrhenae Rhizoma) and Huang Bo (Phellodendri Cortex). Honey pills, take 9g each time, washed down with boiled water.
4. Dabu Yin Wan (Great Tonification of Yin Pill): Treats all syndromes of Yin deficiency with excessive fire and flaming-upward fire. Huang Bo (Phellodendri Cortex Salt-fried), Zhi Mu (Anemarrhenae Rhizoma Salt-fried), Shu Di Huang (Prepared Rehmanniae Radix), and Zhi Gui Ban (Testudinis Carapax et Plastrum Praeparatum) ground into fine powder, mixed with Zhu Ji Sui (Suis Medulla), made into honey pills the size of mulberry seeds. Take 15g each time, washed down with boiled water.
5. Maiwei Dihuang Wan (Lily Bulb and Schisandra Pill with Rehmannia): Treats chronic Yin deficiency cough or sputum with blood streaks. It is Liuwei Dihuang Wan plus Mai Dong (Ophiopogonis Radix), Shi Hu (Dendrobii Caulis), Sheng Shan Yao (Dioscoreae Rhizoma), Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma), Sheng Bian Dou (Lablab Album Seed), Sheng Yi Ren (Coicis Semen), Sheng Lian Rou (Nelumbinis Semen), Xi Yang Shen (American Ginseng Radix et Rhizoma), Mai Dong (Ophiopogonis Radix), Jin Shi Hu (Dendrobii Caulis), and Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum). Dosage adjusted according to syndrome, decoct in water and take orally.
VIII. Herbs for Yin Deficiency
The following are the common Yin-tonifying herbs used by Mr. Li:
(A) Selected Herbs for Lung Yin Deficiency
Tian Dong (Asparagi Radix): Nourishes Lung Yin, moistens Lung dryness, clears Lung heat. Nature is cold and slippery; unsuitable for those with Spleen deficiency, poor appetite, and loose stools.
Mai Dong (Ophiopogonis Radix): Nourishes Lung Yin, moistens Lung dryness, clears Lung heat. Unsuitable for loose stools, but safe when combined with Yi Ren (Coicis Semen), Shan Yao (Dioscoreae Rhizoma), and Fu Ling (Poria).
Bai He (Lilii Bulbus): Used for cough. Fresh white flowers are better.
Zhi Pa Ye (Eriobotryae Folium Praeparatum): Directs Qi downward and stops cough. Suitable for rebellious Qi.
Sang Pi (Mori Cortex): Drains Lung fire. Do not use for Lung deficiency without fire or wind-cold cough.
Chuan Bei Mu (Fritillariae Cirrhosae Bulbus): Usable for turbid white frothy phlegm; do not use for clear phlegm or no phlegm.
Bo He (Menthae Haplocalycis Herba): Disperses heat and clears the Lung. Use for slight Wind-Heat.
Sha Shen (Glehniae Radix): Tonifies Lung Yin.
Li (Pyrri Fructus): Moistens the Lung and clears heat.
Wu Wei Zi (Schisandrae Chinensis Fructus): Astringes Lung Qi and Kidney Qi. Usable for prolonged cough with Qi consumption, insecure sweat pores, or rebellious Kidney Qi.
Dong Hua Hua (Farfarae Flos): Usable for cough.
Shi Shuang (Sugar Frost from Persimmon): Clears heat and transforms phlegm.
Bai Mao Gen (Imperatae Rhizoma): Sweet and cold, removes internal heat, stops bleeding and resolves stasis.
Ou Gen (Nelumbinis Rhizoma): Clears heat, stops bleeding, and resolves stasis.
Tong Bian (Urine of Healthy Child): Nourishes Yin and descends fire. Most suitable for bleeding syndromes; effective for bone-steaming when general herbs fail. Contraindicated for Yin deficiency without fire, indigestion, and loose bowels.
Zhi Mu (Anemarrhenae Rhizoma): Clears Lung and nourishes Kidney. Usable for foul-smelling phlegm. Combined with Huang Bo (Phellodendri Cortex), it nourishes Yin and descends fire. Prolonged use may cause diarrhea; thus, unsuitable for Spleen deficiency with poor appetite and loose stools.
Ren Shen (Ginseng Radix): Essential herb for tonifying Lung deficiency. Contraindicated for Lung Yin deficiency with intense heat. Combined with Er Dong (Tian Dong and Mai Dong) and Er Di (Sheng Di Huang and Shu Di Huang), it prevents injury to the Spleen and avoids poor appetite and diarrhea; usable for Spleen-Kidney deficiency.
Xi Yang Shen (American Ginseng Radix et Rhizoma): Colder in nature; superior to Ren Shen for Yin deficiency with heat.
(B) Selected Herbs for Kidney Yin Deficiency
Shu Di Huang (Prepared Rehmanniae Radix): Tonifies the Kidney and benefits Yin. This is the essential herb for tonifying Kidney Yin, treating essence deficiency, marrow deficiency, and blood deficiency. However, its nature is slightly warm and cloying; for Yin deficiency with heat, it must be combined with Sheng Di Huang (Rehmanniae Radix) and other Yin-nourishing herbs. For Yin deficiency with much phlegm, Qi stagnation, and chest fullness, either do not use it or combine it with Chen Xiang (Aquilariae Lignum Resinatum), Sha Ren (Amomi Fructus), Mai Dong (Ophiopogonis Radix), and Chuan Bei Mu (Fritillariae Cirrhosae Bulbus).
Sheng Di Huang (Rehmanniae Radix): Tonifies Yin and cools blood. Usable for heat; do not use for poor appetite and frequent diarrhea.
Bie Jia (Testudinis Carapax et Plastrum): Tonifies Yin and subdues Yang. Usable for Yin deficiency with alternating chills and fever, or bone-steaming internal heat. Unsuitable for Heat in Spleen/Stomach with vomiting, nausea, and diarrhea.
Gui Ban (Testudinis Carapax et Plastrum): Tonifies Yin and subdues Yang, reduces bone-steaming. Do not use for Kidney deficiency without heat.
Dan Pi (Moutan Cortex): Usable for five-palm heat and bone-steaming internal heat. Use for absence of sweating to clear deficient heat of Liver and Kidney.
Di Gu Pi (Lycii Cortex): Usable for five-palm heat and bone-steaming internal heat. Use for presence of sweating to descend latent fire in the Lung.
Gou Qi Zi (Lycii Fructus), Du Zhong (Eucommiae Cortex): Treat Kidney deficiency lower back pain.
Zhu Yao Zi (Suis Ren) and Zhu Ji Sui (Suis Medulla): Decoct in soup or with herbs to treat lower back and spine pain.
Lian Xu (Nelumbinis Stamen): Usable for insecure essence.
Zi He Che (Placenta Humana): Strongly tonifies essence and blood. Usable for extreme deficiency.
Nu Zhen Zi (Ligustri Lucidi Fructus): Suitable for Kidney Yin deficiency with heat. Prolonged use may cause abdominal pain and diarrhea.
Shan Yu Rou (Corni Fructus): Yin-tonifying herb. Usable for insecure essence, incessant sweating, and urinary incontinence. Do not use for Heat in Bladder with difficult urination.
(C) Selected Herbs for Spleen Yin Deficiency
Sheng Shan Yao (Dioscoreae Rhizoma): Tonifies Spleen, Lung, and Kidney. Most suitable for Yin deficiency with loose stools and anorexia.
Fu Ling (Poria): Usable for loose stools and scanty urine. Yin deficiency patients should not use it in large amounts, as its draining property may injure body fluids.
Yi Ren (Coicis Semen), Lian Rou (Nelumbinis Semen), Bian Dou (Lablab Album Seed): Usable for diarrhea.
Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma): The correct herb for tonifying the Spleen. Most suitable for diarrhea and poor appetite, but for severe Yin deficiency where its dryness is objectionable, use Yu Zhu (Polygonati Odorati Rhizoma) or replace with Yi Ren (Coicis Semen) and Shi Hu (Dendrobii Caulis).
Sheng Bai Shao (Paeoniae Radix Alba): Usable for abdominal fullness (worse at night, quiet during day), abdominal pain, sweating, dysentery, and Qi stagnation. Do not use for Cold in Middle Abdominal pain and diarrhea, or feeling of cold in intestines and stomach.
Shi Hu (Dendrobii Caulis): Suitable for deficient heat in the Stomach or muscles.
IX. All Taboos for Yin Deficiency
During convalescence, strict adherence to taboos is required, otherwise treatment will be affected. Key points are as follows:
1. Tobacco and alcohol must be absolutely avoided.
2. Ginger, green onion, and garlic: To enhance appetite, a small amount for seasoning may be used occasionally for mild cases, but caution is needed for severe cases.
3. All spicy foods (chili peppers, Sichuan peppercorns, black pepper, mustard flour) are absolutely forbidden.
4. All raw, cold, intestinal-slipping, or hard foods must be avoided as they may injure the gastrointestinal tract. Sexual desire is the primary cause of Yin deficiency and must be absolutely taboo, including having such thoughts. Mr. Gu stated: "When the desire moves, Ministerial Fire rises suddenly; even without intercourse, essence is secretly consumed." Severe cases may require abstinence for 3 years.
5. Anger injures the Liver, and worry/thought injures the Spleen; constant attention is required.
6. Labor should be reduced. Overwork causes Qi to expand outward and Essence to exhaust inward, but slight exercise is still necessary.
Brief Discussion on Cold Syndromes
What is "Cold"? From a human body perspective, Cold is a comprehensive manifestation of insufficient heat. What is a "Cold Syndrome"? A Cold Syndrome refers to various syndromes caused by insufficient heat in the human body. From a whole-body perspective, there are Exterior Cold, Interior Cold, Excess Cold directly attacked by Yin pathogens, Deficient Cold caused by Yang deficiency, "Cold hidden within Fire," "Cold resembling Heat due to Fire constraint," and "False Cold" of "Deficient Yang floating outward." Among Exterior Cold, there are distinctions of Wind-Cold, Cold-Dampness, Yin Summerheat, Cool-Dryness, Taiyang Cold Damage, and exposure to Cold. Among Interior Cold, besides Internal Cold generated by Yang deficiency, Cold hidden within Fire, Cold resembling Heat due to Fire constraint, and False Cold of Deficient Yang floating outward, the more common causes are dietary intake of raw/cold foods, excessive use of cold-natured drugs, residence in high-cold regions, or inadequate clothing/bedding, leading to Cold of the Zang-Fu organs.
Symptoms of Cold Syndromes: Exterior Cold syndrome presents with aversion to wind and cold over the whole body, skin, and muscles; fever; preference for covering with clothes/bedding; headache and stiff neck; body pain, lower back pain, and joint pain; tongue with no coating, or pale white thin moist coating; mouth not dry, bitter, or thirsty; dislike for cold food/drink; possibly nasal congestion with dry retching, or cough/wheezing with thin sputum; pulse floating and tight. Interior Cold syndrome presents with abdominal pain and fullness, vomiting and diarrhea, cold limbs, preference for warmth and aversion to cold, inability to tolerate cold food/drink; forced ingestion worsens abdominal symptoms; pulse deep, tight, or slow. In a year, summer symptoms decrease, winter symptoms increase; in a day, morning symptoms are lighter, afternoon symptoms worsen. Simple Exterior or Interior Cold, Excess or Deficient Cold, are not difficult to identify. However, clinically, Cold and Heat often appear mixed, making the determination of which predominates, and distinguishing true from false Cold/Heat, key tests of a doctor's differential diagnosis skills and factors affecting patient prognosis.
For example, a patient diagnosed with sinusitis by Western medicine had pus on puncture, severe headache, thick yellow nasal discharge, no dry mouth, no preference for cold food, abdominal fullness, distending pain in hypochondrium, pale tongue with thin coating, and string-tight pulse. This was identified as a mixed Cold-Heat syndrome with Qi stagnation. Given Xiaoyao San (Free and Easy Wanderer Powder) plus Yin Hua (Jasmini Flos), Lian Qiao (Forsythiae Fructus), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Huang Qin (Scutellariae Radix), and Gan Jiang (Zingiberis Rhizoma), symptoms decreased after 1 dose and resolved after 3 doses. Another case involved a patient with cough lasting over 20 days, presenting with distending fullness in both hypochondria, abundant easy-to-expectorate phlegm, dry throat, bitter taste but no desire to drink, and headache. Diagnosed as Liver Qi stagnation with Upper Heat and Lower Cold (mixed Cold-Heat). Treated with simultaneous warming and cooling methods: Sang Pi (Mori Cortex), Bei Mu (Fritillariae Bulbus), Chai Hu (Bupleuri Radix), Xiang Fu (Cyperi Rhizoma), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Ban Xia (Pinelliae Rhizoma Praeparatum), Fu Ling (Poria), Xing Ren (Armeniacae Semen Amarum), Gan Jiang (Zingiberis Rhizoma), and Huang Qin (Scutellariae Radix), to clear the Lung, warm the Spleen to transform phlegm, resolve stagnation, and harmonize Cold and Heat. Improvement was seen after 1 dose.