【主治】肝气郁滞证。阴道流血，夹有瘀块，白带稍多(宫颈局部轻度糜烂，或呈小菜花样损害)，情绪郁闷或心烦易怒，少腹胀感，胸胁胀满，全身窜痛，口苦咽干，舌质稍暗或正常，苔薄白或微黄，脉弦。
【制法】上药共为细末，水调为丸，梧桐子大。
【用法】每日早晚各服7．5克，开水送服。同时配合用宫颈癌外用第三号方，或选用宫颈癌外用第一号方、第二号方。
宫颈癌辨证论治为前提
以毒攻毒方可却
子宫颈癌是妇科常见生殖器恶性肿瘤之一，临床以阴道分泌物增多、不规则出血、疼痛等为主要症状，属中医学崩漏、带下、瘕瘕等范畴。疼痛是宫颈癌晚期症状，为癌瘤浸润宫旁组织，侵蚀压迫神经血管，癌瘤感染，以及放疗后纤维化粘连所致。西医采用对症止痛治疗。中医在整体观念指导下辨证论治，从而在改善患者全身状况、增强机体免疫能力、减轻症状、延长生命等方面发挥出其独特的作用。临证有气滞血瘀、湿热壅毒及肾虚等证型。
气滞血瘀者，为七情所伤，冲任郁滞，积久成癥，或瘀阻冲任，血不归经，而成崩漏。症见阴道不规则出血，或有癥块，精神抑郁，少腹胀痛，牵及胸胁，舌暗，苔白，脉弦涩或沉涩。治宜行气活血为主，方用活络效灵丹或加味乌药散。
湿热壅毒者，因于生活不洁，或经期产后胞脉空虚之时感染邪毒，壅于冲任。症见带下量多，味臭，色黄或如米泔，口苦咽于，尿黄便秘，舌红，苔黄厚，脉滑数。治宜清热化湿解毒，方用五味消毒饮合四妙散。
肾虚者，因于婚育过早，房劳多产，致肝肾阴虚或脾肾阳虚。症见带下量多清稀，或漏下淋沥，头晕耳鸣，腰膝酸痛，形瘦畏寒，纳少便溏，舌淡红，脉细弱或虚数。治宜补肾，方用六味丸或八味丸。
癌症为恶性病变，为“癌毒”在体内增生蓄积的结果，治疗在辨证求因，调整机体阴阳平衡的基础上，以毒攻毒，如用全蝎、蜈蚣之类，祛除癌毒，使正气得复，疾病向愈。
附案：
张某，女，57岁。门诊号：63415。
1963年5月20日初诊：右下腹疼痛拒按月余，外院诊断为“宫颈癌”。患者精神抑郁，舌质暗，苔薄，脉弦滑。处方：
丹参15克 当归9克 乳香7．5克 生白芍9克 五灵脂7．5克甘草3克
水煎服。
二诊：服上药2剂后，腹痛减轻，于上方中加入蜈蚣2条，全蝎9克，继服。
按：本病以腹痛为主症，可能属宫颈癌晚期，宫旁有浸润，压迫神经所致，主症右下腹疼痛拒按属实。纵观脉症属气滞血瘀证，为冲任瘀滞而成。治宜理气活血，通络止痛。方用活络效灵丹之丹参、当归、乳香及五灵脂活血行气止痛，白芍、甘草酸甘缓急止痛并养血和中，制攻逐太过。全方攻邪而不伤正。二诊加入蜈蚣、全蝎，均有毒，具有解毒散结之功，取其以毒攻毒之意，李老用此专以其毒攻癌肿之毒，可谓“有故无殒，亦无殒也”之意。
泌尿系感染
急性期有发热无热之分
慢性期有阴虚阳虚之别
对于泌尿系感染，李老根据急性、慢性、复发性的不同，分别采用不同的治疗方法。在急性阶段分为两大类型，一类以发热为主者，分为表寒里热、半表半里、少阳兼湿浊、表热、肝胆湿热五种；一类无发热者，分为肝胆湿热、膀胱湿热、湿热阻滞、膀胱气滞四种。 1．发热为主型 (1)表寒里热证：恶寒发热，头痛身痛，口渴心烦，脉浮滑数或紧数。治宜解表清里，柴葛解肌汤加减：
柴胡12克 葛根9克 羌活9克 白芷9克 生石膏15克生姜9克大枣5枚黄芩9克 白芍9克桔梗9克
(2)半表半里证：寒热往来，头晕头胀，胸胁苦满，恶心呕吐，脉弦数。治宜和解表里，小柴胡汤加减：
柴胡18克半夏10克黄芩10克生姜10克陈皮10克党参10克大枣5枚
(3)少阳兼湿浊证：寒热往来，胃脘或腹部痞满，口苦干而不欲饮，舌苔白腻或黄白而腻，脉沉弦滑或弦缓。治宜和解表里，化湿清热，柴胡达原饮加减：
柴胡9～12克厚朴9克草果9克槟榔9克黄芩9克知母9克菖蒲9克
若身痛者，加羌活9克，白芷9克，防风9克；大便干燥者，加大黄3～6克。
(4)表热证：发热不恶寒，或微恶风寒，全身酸困而不痛，口干，脉浮数。治宜辛凉解表，银翘散加减：
银花15克连翘15克大青叶15克 竹叶10克荆芥10克薄荷10克豆豉10克甘草6克
(5)肝胆湿热证：发热或轻微恶寒发热，头晕胀痛，心烦易怒，口苦口干，尿热尿痛，舌质红，舌苔黄，脉弦数。治宜清肝泻胆，利湿清热，龙胆泻肝汤加减：
龙胆草9克栀子9克黄芩9克柴胡9克生地9克车前子9克泽泻9克木通9克甘草9克 当归9克
若大便干燥者，去木通、车前子、泽泻，加大黄4克。
2．无发热型
无发热而仅有尿急、尿频、尿痛，或有微热者，常见以下几种：
(1)肝胆湿热证：头晕头痛，心烦急躁，口苦口干，尿热尿频，尿急尿痛，舌质红，舌苔黄白腻，脉弦。治宜清肝泻胆，利湿清热，龙胆泻肝汤加减。
(2)膀胱湿热证：尿热尿频，尿急尿痛，小腹急痛，脉数。治宜利水通淋，八正散加减：
萹蓄10克瞿麦10克车前子10克木通10克滑石10克大黄10克灯心草3克甘草6克
(3)湿热阻滞证：胸闷腹胀，身热酸痛，尿频尿痛，口粘不爽，舌苔白腻，脉濡或濡数。治宜化湿清热，甘露消毒丹加减：
滑石15克茵陈12克黄芩10克菖蒲10克木通10克连翘10克 白蔻仁10克 乌药10克 香附10克薄荷2克
若恶心欲吐者，去香附、乌药，加藿香10克。
(4)膀胱气滞证：尿急尿频，尿热尿痛，小腹坠胀，二便不爽，脉沉。治宜理气通淋，理气通淋方加减：
香附9克乌药9克木香9克槟榔9克苏叶9克陈皮9克黄芩9克
若大便干者，加冬葵子9克；若口干较重者，改用当归贝母苦参丸(《金匮要略》方)。
在慢性和复发阶段，大致可分低热和仅有尿频、尿痛两大类。在低热型中常见的有阴虚、气阴两虚、肝郁血虚三种。仅见尿频、尿痛型中常见的有脾胃湿热、膀胱气滞、肝郁血虚、肾阳亏损、气阴两虚五种。
3．低热为主型
(1)阴虚火旺证：骨蒸劳热，五心烦热，午后发热加重，疲乏无力，偶有盗汗，尿热尿痛，舌苔薄白，脉沉细无力或沉细而数。治宜滋阴清热，青蒿鳖甲散加减：
青蒿10克秦艽10克地骨皮10克银柴胡lO克当归9克知母10克乌梅10克
若脉细数，口苦口干，腰酸腰痛，尿热，尿频，尿急，尿痛，舌尖红，肾阴亏损，湿热较甚者，治宜知柏地黄丸加减：
熟地15克山药12克 淡大云10克 泽泻8克茯苓9克知母9克黄柏9克丹皮9克
若脉涩者，加肉桂4克。
(2)气阴两虚，湿热内蕴证：疲乏无力，骨蒸劳热，自汗盗汗，面色皓白，或烦躁易怒，胸脘痞满，尿热尿痛，舌质淡，苔白，脉虚大或虚大滑数。治宜补气养阴，理气清热，黄芪鳖甲散加减：
黄芪15克鳖甲15克地骨皮10克党参10克茯苓10克柴胡10克 半夏10克知母10克生地10克麦冬10克 肉桂10克 白芍10克陈皮10克
(3)肝郁血虚，湿热内蕴证：五心烦热或寒热往来，头晕头痛，胸胁苦满或窜痛，心烦易怒，尿热尿痛，脉弦细数。治宜养血舒肝，清热除湿，丹栀逍遥散加减：
柴胡10克 当归10克 白芍10克茯苓10克 白术10克薄荷5克生姜3片丹皮10克栀子10克
4．反复发作尿热尿痛型
(1)脾胃湿热，下注膀胱证：胃脘或腹胀满，甚或腹满痛，纳呆口苦，食后腹满加重，尿热尿痛，尿急尿频，脉濡缓或濡滑。治宜理气化湿清热，理气通淋方加减：
木香6克香附6克苏叶6克乌药6克陈皮9克槟榔9克黄芩9克 枳壳9克莱菔子9克
若胃脘有压痛者，去枳壳，加枳实10克，于姜1．5克，大黄3克。
(2)膀胱气滞，湿热不化证：小腹坠胀，大便不爽，尿热尿频尿痛，脉沉或沉滑。治宜理气化湿清热，理气通淋方加减：
木香10克香附10克乌药10克 陈皮10克苏叶10克槟榔10克 黄芩10克冬葵子10克
(3)肝郁血虚，湿热不化证：除无寒热往来外，余症与上相同。治宜丹栀逍遥散。
(4)肾气不足，湿热不化证：腰困腰痛非常严重，小腹冷胀或无明显冷胀，尿热尿痛，指趾厥冷，脉沉细无力。治宜补肾气利湿热，济生肾气丸加减：
生地15克 山药12克 大云10克土茯苓10克泽泻10克丹皮10克车前子10克 五味子10克 附子5克 肉桂5克怀牛膝10克
(5)气阴两虚证：腰背困痛，疲乏无力，尿热尿痛，面色皓白，舌苔白，脉虚大或虚大弦滑。治宜补气养阴，补阴益气煎加减：
升麻6克柴胡6克 黄芪15克 党参9克 白术9克 当归9克陈皮9克 木香6克生地9克 山药9克五味子9克泽泻9克茯苓9克丹皮9克
若腰痛轻微，舌尖红者，宜清心莲子饮。
肾炎的临床诊治 一、关于阳水与阴水 肾炎与中医的水病多相关涉。经云：善诊者察色按脉先别阴阳。在李老关于肾炎的资料中，对阴水、阳水的论述内容虽少，却反映出李老严谨的学风和提倡中西医合流的学术思想。
阳水有三种说法：
1．水肿病小便数而短者为阳水；
2．风水和皮水为阳水：
3．急性肾炎与亚急性肾炎为阳水。
李老说：“这三种说法从意义上说都有一定的道理，但为了易于诊断、治疗，易于各医者步调一致，避免分歧现象，我认为还是第一项的说法较优，不然的话阳水的名称就没有存在的价值。”其治法为清热利水。可选方剂有五皮饮加木通、防己、赤小豆，或地肤子，或连翘、黄柏、黄芩，或海蛤、知母等，及大圣浚川散(由煨大黄、牵牛子、郁李仁、木香、芒硝、甘遂等药组成)、河间神佑丸(药物组成有甘遂、芫花、大戟、大黄、黑牵牛、轻粉等)。
阴水亦有三种说法：
1．水肿病小便清利者为阴水；
2．正水和石水为阴水；
3．慢性肾炎为阴水。
李老说：“为了易于诊断和治疗，易于医者步调一致，避免分歧现象，我认为还是以第一项的说法为优，否则阴水的名称就没有存在的必要了。”阴水盛，重桂、姜。李老常用的方剂有：真武汤、禹功散、金匮肾气丸、实脾饮、防己黄芪汤。 二、肾炎的治疗方法 李老将肾炎的治法按病、症、方、药的体系总结概括为以下几种： 1．宣肺发表法 病：凡风水、皮水有脉浮、恶风寒等症状，或上半身发肿者适用。
症：脉浮，恶风寒，上半身发肿。
方：五皮饮加苏叶、杏仁，小青龙汤，越婢汤，越婢加术汤，杏子汤，麻黄附子汤，麻黄附子细辛汤，桂甘姜枣麻辛附子汤。
药：麻黄、桂枝、生姜、苏叶、防风、细辛等。
2．渗湿利水法
病：各种水肿病都适用之，不过有多少的差别。
症：小便不利，尿量短少，下身发肿。
方：五皮饮加车前、木通，五苓散，防己茯苓汤，真武汤，四苓散，蒲灰散。
药：茯苓、猪苓、泽泻、防己、滑石、萆薜、车前、木通、蒲蓄、瞿麦、葫芦等。 3．培补脾土法 病：凡脾虚的水肿病都宜用之。 症：大便溏泄，饮食减少或消化不良，面色萎黄或觥白，言语轻微，四肢无力，脉象虚弱。
方：四君子汤，六君子汤，异功散，理中汤，实脾饮，附子理中汤，参苓白术散，五苓散。
药：人参、白术、山药、扁豆、莲肉、苡仁等。
4．温化肾阳法
病：适用于肾阳虚的水肿病。
症：畏寒，足冷，脉沉而迟，大便溏泄，小便不利。
方：金匮肾气丸，温通汤(椒目、威灵仙、小茼香)。
药：附子、紫河乍、肉桂等。
5．滋阴补肾法
病：适用于阴虚的水肿病。
症：喜冷，脉数乏力，服温热药不效或小便更少、肿势更增者。
方：六味地黄汤加车前、牛膝，白茅根汤，济阴汤。
药：熟地、生杭芍、白茅根、生山药、羊乳等。
6．补气法
病：适用于气虚的水肿病。
症：面色苍白，言语轻微，四肢疲倦，少气不足以息，脉象无力或洪大无力。
方：升麻黄芪汤，补中益气汤。
药：生口芪、人参、党参等。
总而言之，肾炎治疗的关键在于肺、脾、肾三脏。肾炎以水肿为主要临床表现，而肺为水之上源，上源清则下源自清。脾居中央，能转输上下运行水气。一说脾为水之堤防，堤防利则水道自利。肾承水之下流。一说肾为水之主，肾气行则水行也。但这三方面不是截然分界的，也不是齐头并进、漫无标准的，都是依据客观证据，该轻的轻，该重的重，该分的分，该合的合，是辨证论治的。 三、肾炎的调养 (一)药物调补 肾炎水肿消失后，可用黄芪粥或胃苓汤调理脾胃，或用理中汤、理中丸温补脾胃，或用金匮八味丸温暖命门，或用六味地黄丸加牛膝、车前子，或再加文蛤、牡蛎，或再加黄柏，滋肾水清余热。
(二)饮食禁忌
忌冒风；忌食盐3～6个月，开始食盐也只能吃低盐调味，急性者愈后仍戒1月左右；忌食酱油；忌食厚味盐猪肉，忌食牛肉；忌食生冷食品。
慢性肾盂肾炎治则
[Indications] Liver Qi Stagnation Syndrome (a syndrome caused by emotional constraint leading to impaired liver dispersing and descending functions and stagnation of Qi mechanism). Vaginal bleeding with blood clots, slightly increased leukorrhea (mild cervical erosion or cauliflower-like lesions), depressed mood or irritability, distension in the lower abdomen, fullness in the chest and hypochondrium, wandering pain throughout the body, bitter taste in the mouth and dry throat, slightly dark or normal tongue body, thin white or slightly yellow coating, wiry pulse.
[Preparation] Grind the above herbs into a fine powder, mix with water to form pills, sized like sophora seeds.
[Usage] Take 7.5 grams each morning and evening, washed down with boiled water. Simultaneously use External Formula No. 3 for Cervical Cancer, or select External Formula No. 1 or No. 2 for Cervical Cancer.
Based on the syndrome differentiation and treatment of Cervical Cancer:
Using toxic substances to attack toxicity can eliminate the pathogen.
Cervical cancer is one of the common malignant tumors of the genital organs in gynecology. Clinically, its main symptoms include increased vaginal discharge, irregular bleeding, and pain. It belongs to the categories of Beng Lou (metrorrhagia and metrostaxis), Dai Xia (leukorrhea), and Zha Jia (abdominal masses) in Traditional Chinese Medicine (TCM). Pain is a symptom of late-stage cervical cancer, caused by tumor infiltration of parametrial tissues, erosion and compression of nerves and blood vessels, tumor infection, and fibrosis and adhesion after radiotherapy. Western medicine adopts symptomatic pain relief treatment. Guided by the holistic concept, TCM practices syndrome differentiation and treatment, thereby playing a unique role in improving the patient's overall condition, enhancing immune function, alleviating symptoms, and prolonging life. Common syndromes in clinical practice include Qi Stagnation and Blood Stasis, Damp-Heat Accumulation and Toxicity, and Kidney Deficiency.
Qi Stagnation and Blood Stasis: Caused by injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), leading to stagnation of the Chong and Ren meridians, accumulating over time to form masses, or blood stasis blocking the Chong and Ren meridians, causing blood to leave its channels, resulting in Beng Lou. Symptoms include irregular vaginal bleeding, presence of masses, mental depression, lower abdominal distending pain radiating to the chest and hypochondrium, dark tongue, white coating, wiry-choppy or deep-choppy pulse. Treatment should focus on promoting Qi circulation and invigorating blood. Use Huo Luo Xiao Ling Dan (Effective Decoction for Unblocking Collaterals) or Jia Wei Wu Yao San (Modified Wu Yao Powder).
Damp-Heat Accumulation and Toxicity: Due to unclean living habits or infection of evil pathogens when the uterine collaterals are empty during menstruation or postpartum, accumulating in the Chong and Ren meridians. Symptoms include abundant foul-smelling leukorrhea, yellow or rice-water colored, bitter taste in the mouth and dry throat, yellow urine, constipation, red tongue, thick yellow coating, slippery-rapid pulse. Treatment should clear heat, resolve dampness, and detoxify. Use Wu Wei Xiao Du Yin (Five-Ingredient Decoction for Eliminating Toxins) combined with Si Miao San (Four Marvels Powder).
Kidney Deficiency: Due to early marriage and childbirth, excessive sexual activity, or multiple births, leading to Yin deficiency of the Liver and Kidney or Yang deficiency of the Spleen and Kidney. Symptoms include abundant clear and thin leukorrhea or dripping metrorrhagia, dizziness and tinnitus, soreness and weakness of the waist and knees, emaciation and aversion to cold, poor appetite and loose stools, pale-red tongue, fine-weak or deficient-rapid pulse. Treatment should tonify the Kidney. Use Liu Wei Wan (Six-Ingredient Pill) or Ba Wei Wan (Eight-Ingredient Pill).
Cancer is a malignant lesion, the result of "Cancer Toxin" proliferating and accumulating in the body. Treatment, based on syndrome differentiation to find the cause and adjust the balance of Yin and Yang in the body, uses toxicity to attack toxicity, such as using Scorpion (Quanxie, 全蝎) and Centipede (Wugong, 蜈蚣), to remove cancer toxin, allowing Zheng Qi (Upright Qi) to recover and the disease to heal.
Attached Case:
Zhang, Female, 57 years old. Outpatient No.: 63415.
First visit on May 20, 1963: Refusing pressure on right lower abdominal pain for over a month; diagnosed as "Cervical Cancer" at an external hospital. The patient was mentally depressed, with a dark tongue body, thin coating, and wiry-slippery pulse. Prescription:
Salvia Miltiorrhiza Radix et Rhizoma (Danshen, 丹参) 15g, Angelica Sinensis Radix (Danggui, 当归) 9g, Frankincense Resin (Ruxiang, 乳香) 7.5g, Raw White Peony Root (Sheng Baishao, 生白芍) 9g, Trogopterus Dung (Wulingzhi, 五灵脂) 7.5g, Licorice Root (Gancao, 甘草) 3g.
Decoct in water and take orally.
Second visit: After taking 2 doses of the above medicine, abdominal pain decreased. Added 2 Centipedes (Wugong, 蜈蚣) and 9g Scorpion (Quanxie, 全蝎) to the original prescription, continue taking.
Commentary: This disease presents mainly with abdominal pain, possibly belonging to late-stage cervical cancer with parametrial infiltration compressing nerves; the main symptom of refusing pressure on right lower abdominal pain indicates an Excess pattern. Observing the pulse and symptoms, it belongs to the Qi Stagnation and Blood Stasis syndrome, formed by stagnation of the Chong and Ren meridians. Treatment should regulate Qi and invigorate blood, unblock collaterals and relieve pain. In Huo Luo Xiao Ling Dan, Salvia Miltiorrhiza Radix et Rhizoma, Angelica Sinensis Radix, Frankincense Resin, and Trogopterus Dung invigorate blood, promote Qi circulation, and relieve pain; White Peony Root and Licorice Root, through sour and sweet flavors, relax spasms to relieve pain while nourishing blood and harmonizing the middle, restraining excessive attacking action. The whole formula attacks pathogenic factors without damaging Zheng Qi. In the second visit, Centipede and Scorpion were added; both are toxic and have the effect of resolving toxicity and dissipating nodules, taking advantage of the meaning of using toxicity to attack toxicity. Old Li used this specifically to attack the toxicity of cancerous tumors with toxicity, embodying the meaning of "If there is a disease, there will be no harm [to the healthy body], nor will there be harm."
Urinary Tract Infection
Acute stage divided into fever and non-fever types
Chronic stage differentiated into Yin deficiency and Yang deficiency
For urinary tract infections, Old Li adopted different treatment methods according to acute, chronic, and recurrent stages. In the acute stage, it is divided into two major types: one type dominated by fever is divided into five categories: Exterior Cold with Interior Heat, Half-Exterior Half-Interior, Shaoyang with Damp-Turbidity, Exterior Heat, and Liver-Gallbladder Damp-Heat; the other type without fever is divided into four categories: Liver-Gallbladder Damp-Heat, Bladder Damp-Heat, Damp-Heat Obstruction, and Bladder Qi Stagnation.
1. Fever-Dominated Type
(1) Exterior Cold with Interior Heat Syndrome: Aversion to cold with fever, headache and body ache, thirst and irritability, floating-slippery-rapid or tight-rapid pulse. Treatment should release the exterior and clear the interior. Modify Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Resolve the Muscle Layer):
Bupleurum Root (Chaihu, 柴胡) 12g, Kudzu Root (Gegen, 葛根) 9g, Notopterygium Rhizome (Qianghuo, 羌活) 9g, Angelica Dahurica Root (Baizhi, 白芷) 9g, Raw Gypsum (Sheng Shigao, 生石膏) 15g, Fresh Ginger (Shengjiang, 生姜) 9g, Jujube Fruit (Dazao, 大枣) 5 pieces, Scutellaria Root (Huangqin, 黄芩) 9g, White Peony Root (Baishao, 白芍) 9g, Platycodon Root (Jiegeng, 桔梗) 9g.
(2) Half-Exterior Half-Interior Syndrome: Alternating chills and fever, dizziness and head distension, chest and hypochondriac fullness, nausea and vomiting, wiry-rapid pulse. Treatment should harmonize the exterior and interior. Modify Xiao Chai Hu Tang (Minor Bupleurum Decoction):
Bupleurum Root (Chaihu, 柴胡) 18g, Pinellia Tuber (Banxia, 半夏) 10g, Scutellaria Root (Huangqin, 黄芩) 10g, Fresh Ginger (Shengjiang, 生姜) 10g, Tangerine Peel (Chenpi, 陈皮) 10g, Codonopsis Root (Dangshen, 党参) 10g, Jujube Fruit (Dazao, 大枣) 5 pieces.
(3) Shaoyang with Damp-Turbidity Syndrome: Alternating chills and fever, epigastric or abdominal stuffiness, bitter and dry mouth without desire to drink, white-greasy or yellow-white greasy tongue coating, deep-wiry-slippery or wiry-slow pulse. Treatment should harmonize the exterior and interior, resolve dampness and clear heat. Modify Chai Hu Da Yuan Yin (Bupleurum Decoction to Reach the Origin):
Bupleurum Root (Chaihu, 柴胡) 9–12g, Magnolia Bark (Houpo, 厚朴) 9g, Tsaoko Cardamom Fruit (Caoguo, 草果) 9g, Areca Seed (Binglang, 槟榔) 9g, Scutellaria Root (Huangqin, 黄芩) 9g, Anemarrhena Rhizome (Zhimu, 知母) 9g, Acorus Rhizome (Changpu, 菖蒲) 9g.
If body pain exists, add Notopterygium Rhizome 9g, Angelica Dahurica Root 9g, Saposhnikovia Root (Fangfeng, 防风) 9g; if stool is dry, add Rhubarb (Dahuang, 大黄) 3–6g.
(4) Exterior Heat Syndrome: Fever without aversion to cold, or slight aversion to wind-cold, general body soreness without pain, dry mouth, floating-rapid pulse. Treatment should release the exterior with acrid-cool properties. Modify Yin Qiao San (Lonicera and Forsythia Powder):
Lonicera Flower (Yinhua, 银花) 15g, Forsythia Fruit (Lianqiao, 连翘) 15g, Isatis Leaf (Daqingye, 大青叶) 15g, Bamboo Leaf (Zhuye, 竹叶) 10g, Schizonepeta Spike (Jingjie, 荆芥) 10g, Mint (Bohe, 薄荷) 10g, Fermented Soybean (Douchi, 豆豉) 10g, Licorice Root (Gancao, 甘草) 6g.
(5) Liver-Gallbladder Damp-Heat Syndrome: Fever or slight aversion to cold with fever, dizziness and distending headache, irritability, bitter and dry mouth, hot and painful urination, red tongue body, yellow tongue coating, wiry-rapid pulse. Treatment should clear the Liver and purge the Gallbladder, promote diuresis and clear heat. Modify Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver):
Gentian Root (Longdancao, 龙胆草) 9g, Gardenia Fruit (Zhizi, 栀子) 9g, Scutellaria Root (Huangqin, 黄芩) 9g, Bupleurum Root (Chaihu, 柴胡) 9g, Rehmannia Root (Shengdi, 生地) 9g, Plantago Seed (Cheqianzi, 车前子) 9g, Alisma Rhizome (Zexie, 泽泻) 9g, Akebia Stem (Mutong, 木通) 9g, Licorice Root (Gancao, 甘草) 9g, Angelica Sinensis Radix (Danggui, 当归) 9g.
If stool is dry, remove Akebia Stem, Plantago Seed, and Alisma Rhizome, add Rhubarb 4g.
2. Non-Fever Type
Cases with no fever but only urgency, frequency, and dysuria, or with slight fever, commonly present as follows:
(1) Liver-Gallbladder Damp-Heat Syndrome: Dizziness and headache, irritability, bitter and dry mouth, hot and frequent urination, urgent and painful urination, red tongue body, yellow-white greasy tongue coating, wiry pulse. Treatment should clear the Liver and purge the Gallbladder, promote diuresis and clear heat. Modify Long Dan Xie Gan Tang.
(2) Bladder Damp-Heat Syndrome: Hot and frequent urination, urgent and painful urination, acute lower abdominal pain, rapid pulse. Treatment should promote diuresis and relieve strangury. Modify Ba Zheng San (Eight-Ingredient Powder for Rectifying Strangury):
Polygonum Aviculare Herb (Bianxu, 萹蓄) 10g, Dianthus Flower (Qumai, 瞿麦) 10g, Plantago Seed (Cheqianzi, 车前子) 10g, Akebia Stem (Mutong, 木通) 10g, Talcum (Huashi, 滑石) 10g, Rhubarb (Dahuang, 大黄) 10g, Juncus Effusus Pith (Dengxincao, 灯心草) 3g, Licorice Root (Gancao, 甘草) 6g.
(3) Damp-Heat Obstruction Syndrome: Chest tightness and abdominal distension, fever and body ache, frequent and painful urination, sticky mouth and discomfort, white-greasy tongue coating, soggy or soggy-rapid pulse. Treatment should resolve dampness and clear heat. Modify Gan Lu Xiao Du Dan (Sweet Dew Detoxification Powder):
Talcum (Huashi, 滑石) 15g, Artemisia Capillaris Herb (Yinchen, 茵陈) 12g, Scutellaria Root (Huangqin, 黄芩) 10g, Acorus Rhizome (Changpu, 菖蒲) 10g, Akebia Stem (Mutong, 木通) 10g, Forsythia Fruit (Lianqiao, 连翘) 10g, White Cardamom Seed (Baokouren, 白蔻仁) 10g, Lindera Root (Wuyao, 乌药) 10g, Cyperus Rhizome (Xiangfu, 香附) 10g, Mint (Bohe, 薄荷) 2g.
If nausea and vomiting occur, remove Cyperus Rhizome and Lindera Root, add Patchouli Herb (Huoxiang, 藿香) 10g.
(4) Bladder Qi Stagnation Syndrome: Urgent and frequent urination, hot and painful urination, lower abdominal bearing-down sensation, discomfort in urination and defecation, deep pulse. Treatment should regulate Qi and relieve strangury. Modify Li Qi Tong Lin Fang (Regulate Qi and Relieve Strangury Formula):
Cyperus Rhizome (Xiangfu, 香附) 9g, Lindera Root (Wuyao, 乌药) 9g, Aucklandia Root (Muxiang, 木香) 9g, Areca Seed (Binglang, 槟榔) 9g, Perilla Leaf (Suye, 苏叶) 9g, Tangerine Peel (Chenpi, 陈皮) 9g, Scutellaria Root (Huangqin, 黄芩) 9g.
If stool is dry, add Okra Seed (Dongkuizi, 冬葵子) 9g; if dry mouth is severe, switch to Danggui Beimu Kushen Wan (Angelica, Belamcanda, and Sophora Pill) from *Jin Gui Yao Lue*.
In the chronic and recurrent stages, it can generally be divided into two major categories: low-grade fever and only frequent/painful urination. Among the low-grade fever type, common patterns are Yin Deficiency, Qi and Yin Dual Deficiency, and Liver Stagnation with Blood Deficiency. Among the only frequent/painful urination type, common patterns are Spleen-Stomach Damp-Heat, Bladder Qi Stagnation, Liver Stagnation with Blood Deficiency, Kidney Yang Deficiency, and Qi and Yin Dual Deficiency.
3. Low-Grade Fever-Dominated Type
(1) Yin Deficiency with Fire Hyperactivity Syndrome: Bone-steaming tidal fever, heat in the five centers (palms, soles, and chest), aggravated fever in the afternoon, fatigue, occasional night sweats, hot and painful urination, thin white tongue coating, deep-fine-weak or deep-fine-rapid pulse. Treatment should nourish Yin and clear heat. Modify Qing Hao Bie Jia San (Artemisia Annua and Turtle Shell Powder):
Artemisia Annua Herba (Qinghao, 青蒿) 10g, Gentianae Macrophyllae Radix (Qinjiao, 秦艽) 10g, Cortex Lycii (Digupi, 地骨皮) 10g, Silver Bupleurum Root (Yinchaihu, 银柴胡) 10g, Angelica Sinensis Radix (Danggui, 当归) 9g, Anemarrhena Rhizome (Zhimu, 知母) 10g, Mume Fruit (Wumei, 乌梅) 10g.
If the pulse is fine-rapid, with bitter/dry mouth, sore/waist pain, hot/frequent/urgent/painful urination, and red tongue tip indicating Kidney Yin deficiency and severe damp-heat, treatment should modify Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill):
Prepared Rehmannia Root (Shudi, 熟地) 15g, Dioscorea Rhizome (Shanyao, 山药) 12g, Cistanche Stem (Dan Dayun, 淡大云) 10g, Alisma Rhizome (Zexie, 泽泻) 8g, Poria (Fuling, 茯苓) 9g, Anemarrhena Rhizome (Zhimu, 知母) 9g, Phellodendron Bark (Huangbai, 黄柏) 9g, Moutan Cortex (Danpi, 丹皮) 9g.
If the pulse is choppy, add Cinnamon Twig (Rougui, 肉桂) 4g.
(2) Qi and Yin Dual Deficiency with Internal Damp-Heat Accumulation Syndrome: Fatigue, bone-steaming tidal fever, spontaneous and night sweats, bright white complexion, or irritability, epigastric stuffiness, hot and painful urination, pale tongue body, white coating, large-deficient or large-deficient-slippery-rapid pulse. Treatment should tonify Qi and nourish Yin, regulate Qi and clear heat. Modify Huang Qi Bie Jia San (Astragalus and Turtle Shell Powder):
Astragalus Root (Huangqi, 黄芪) 15g, Carapax et Plastrum Testudinis (Biejia, 鳖甲) 15g, Cortex Lycii (Digupi, 地骨皮) 10g, Codonopsis Root (Dangshen, 党参) 10g, Poria (Fuling, 茯苓) 10g, Bupleurum Root (Chaihu, 柴胡) 10g, Pinellia Tuber (Banxia, 半夏) 10g, Anemarrhena Rhizome (Zhimu, 知母) 10g, Rehmannia Root (Shengdi, 生地) 10g, Ophiopogon Tuber (Maidong, 麦冬) 10g, Cinnamon Twig (Rougui, 肉桂) 10g, White Peony Root (Baishao, 白芍) 10g, Tangerine Peel (Chenpi, 陈皮) 10g.
(3) Liver Stagnation with Blood Deficiency and Internal Damp-Heat Accumulation Syndrome: Heat in the five centers or alternating chills and fever, dizziness and headache, chest/hypochondriac fullness or wandering pain, irritability, hot and painful urination, wiry-fine-rapid pulse. Treatment should nourish blood and soothe the Liver, clear heat and remove dampness. Modify Dan Zhi Xiao Yao San (Moutan and Gardenia Free and Easy Wanderer Powder):
Bupleurum Root (Chaihu, 柴胡) 10g, Angelica Sinensis Radix (Danggui, 当归) 10g, White Peony Root (Baishao, 白芍) 10g, Poria (Fuling, 茯苓) 10g, Atractylodes Macrocephala Rhizome (Baizhu, 白术) 10g, Mint (Bohe, 薄荷) 5g, Fresh Ginger (Shengjiang, 生姜) 3 slices, Moutan Cortex (Danpi, 丹皮) 10g, Gardenia Fruit (Zhizi, 栀子) 10g.
4. Recurrent Hot and Painful Urination Type
(1) Spleen-Stomach Damp-Heat Pouring Downward to the Bladder Syndrome: Epigastric or abdominal distension/fullness, even abdominal fullness and pain, poor appetite with bitter taste, worsened abdominal fullness after eating, hot and painful urination, urgent and frequent urination, soggy-slow or soggy-slippery pulse. Treatment should regulate Qi, resolve dampness, and clear heat. Modify Li Qi Tong Lin Fang.
Aucklandia Root (Muxiang, 木香) 6g, Cyperus Rhizome (Xiangfu, 香附) 6g, Perilla Leaf (Suye, 苏叶) 6g, Lindera Root (Wuyao, 乌药) 6g, Tangerine Peel (Chenpi, 陈皮) 9g, Areca Seed (Binglang, 槟榔) 9g, Scutellaria Root (Huangqin, 黄芩) 9g, Aurantium Fructus Immaturus (Zhiqiao, 枳壳) 9g, Radish Seed (Laifuzi, 莱菔子) 9g.
If there is tenderness in the epigastrium, remove Aurantium Fructus Immaturus, add Aurantium Fructus (Zhishi, 枳实) 10g, Dried Ginger (Ganjiang, 干姜) 1.5g, Rhubarb 3g.
(2) Bladder Qi Stagnation with Unresolved Damp-Heat Syndrome: Lower abdominal bearing-down sensation, discomfort in defecation, hot/frequent/painful urination, deep or deep-slippery pulse. Treatment should regulate Qi, resolve dampness, and clear heat. Modify Li Qi Tong Lin Fang.
Aucklandia Root (Muxiang, 木香) 10g, Cyperus Rhizome (Xiangfu, 香附) 10g, Lindera Root (Wuyao, 乌药) 10g, Tangerine Peel (Chenpi, 陈皮) 10g, Perilla Leaf (Suye, 苏叶) 10g, Areca Seed (Binglang, 槟榔) 10g, Scutellaria Root (Huangqin, 黄芩) 10g, Okra Seed (Dongkuizi, 冬葵子) 10g.
(3) Liver Stagnation with Blood Deficiency and Unresolved Damp-Heat Syndrome: Except for the absence of alternating chills and fever, the remaining symptoms are the same as above. Treatment should use Dan Zhi Xiao Yao San.
(4) Kidney Qi Insufficiency with Unresolved Damp-Heat Syndrome: Severe waist fatigue and pain, lower abdominal cold distension or no obvious cold distension, hot and painful urination, cold fingers and toes, deep-fine-weak pulse. Treatment should tonify Kidney Qi, promote diuresis, and resolve damp-heat. Modify Ji Sheng Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet).
Rehmannia Root (Shengdi, 生地) 15g, Dioscorea Rhizome (Shanyao, 山药) 12g, Cistanche Stem (Dayun, 大云) 10g, Smilax Glabra Rhizome (Tufuling, 土茯苓) 10g, Alisma Rhizome (Zexie, 泽泻) 10g, Moutan Cortex (Danpi, 丹皮) 10g, Plantago Seed (Cheqianzi, 车前子) 10g, Schisandra Fruit (Wuweizi, 五味子) 10g, Prepared Aconite Root (Fuzi, 附子) 5g, Cinnamon Twig (Rougui, 肉桂) 5g, Achyranthes Bidentata Root (Huainiuxi, 怀牛膝) 10g.
(5) Qi and Yin Dual Deficiency Syndrome: Back and waist fatigue and pain, fatigue, hot and painful urination, bright white complexion, white tongue coating, large-deficient or large-deficient-wiry-slippery pulse. Treatment should tonify Qi and nourish Yin. Modify Bu Yin Yi Qi Jian (Tonify Yin and Boost Qi Decoction).
Bupleurum Root (Chaihu, 柴胡) 6g, Astragalus Root (Huangqi, 黄芪) 15g, Codonopsis Root (Dangshen, 党参) 9g, Atractylodes Macrocephala Rhizome (Baizhu, 白术) 9g, Angelica Sinensis Radix (Danggui, 当归) 9g, Tangerine Peel (Chenpi, 陈皮) 9g, Aucklandia Root (Muxiang, 木香) 6g, Rehmannia Root (Shengdi, 生地) 9g, Dioscorea Rhizome (Shanyao, 山药) 9g, Schisandra Fruit (Wuweizi, 五味子) 9g, Alisma Rhizome (Zexie, 泽泻) 9g, Poria (Fuling, 茯苓) 9g, Moutan Cortex (Danpi, 丹皮) 9g.
If back pain is mild and the tongue tip is red, use Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction).
Clinical Diagnosis and Treatment of Nephritis
I. Regarding Yang Edema and Yin Edema
Nephritis is closely related to Water Diseases (Shui Bing) in TCM. The Classics state: "A skilled diagnostician distinguishes Yin and Yang first by observing complexion and palpating the pulse." Although Old Li's materials on nephritis contain little discussion on Yin and Yang edema, they reflect his rigorous academic style and advocacy for integrating Chinese and Western medicine.
There are three interpretations of Yang Edema:
1. Edema disease with frequent and short urination is Yang Edema;
2. Feng Shui (Wind Water) and Pi Shui (Skin Water) are Yang Edema;
3. Acute and Subacute Nephritis are Yang Edema.
Old Li said: "All three interpretations have some merit, but for ease of diagnosis and treatment, and to ensure consistency among physicians and avoid divergence, I believe the first interpretation is superior; otherwise, the name 'Yang Edema' would lose its value." Its treatment method is clearing heat and promoting diuresis. Selectable formulas include Wu Pi Yin (Five-Peel Decoction) plus Akebia Stem, Stephania Root (Fangji, 防己), Adzuki Bean (Chixiaodou, 赤小豆), or Kochia Fruit (Difuzi, 地肤子), or Forsythia Fruit, Phellodendron Bark, Scutellaria Root, or Clam Shell (Haige, 海蛤), Anemarrhena Rhizome, etc., as well as Da Sheng Jun Chuan San (Great Sage River-Clearing Powder, composed of Roasted Rhubarb, Morning Glory Seed, Apricot Seed, Aucklandia Root, Mirabilite, Kansui Root, etc.) and He Jian Shen You Wan (He Jian Divine Protection Pill, composed of Kansui Root, Genkwa Flower, Euphorbia Root, Rhubarb, Black Morning Glory Seed, Calomel, etc.).
There are also three interpretations of Yin Edema:
1. Edema disease with clear and profuse urination is Yin Edema;
2. Zheng Shui (Regular Water) and Shi Shui (Stone Water) are Yin Edema;
3. Chronic Nephritis is Yin Edema.
Old Li said: "For ease of diagnosis and treatment, and to ensure consistency among physicians and avoid divergence, I believe the first interpretation is superior; otherwise, the name 'Yin Edema' would not need to exist." For severe Yin Edema, Cinnamon Twig and Dried Ginger are emphasized. Old Li commonly used formulas include Zhen Wu Tang (True Warrior Decoction), Yu Gong San (Yu Gong Powder), Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), Shi Pi Yin (Solidify the Spleen Decoction), and Fangji Huangqi Tang (Stephania and Astragalus Decoction).
II. Treatment Methods for Nephritis
Old Li summarized the treatment methods for nephritis according to the system of Disease, Symptom, Formula, and Herb as follows:
1. Lung-Releasing and Exterior-Resolving Method
Disease: Applicable to Feng Shui and Pi Shui with floating pulse, aversion to wind-cold, or swelling of the upper body.
Symptoms: Floating pulse, aversion to wind-cold, upper body swelling.
Formulas: Wu Pi Yin plus Perilla Leaf and Apricot Kernel, Xiao Qing Long Tang (Minor Blue Dragon Decoction), Yue Bi Tang (Yue Bi Decoction), Yue Bi Jia Zhu Tang (Yue Bi Plus Atractylodes Decoction), Xing Zi Tang (Apricot Seed Decoction), Mahuang Fuzi Tang (Ephedra and Prepared Aconite Decoction), Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite, and Asarum Decoction), Guigan Jiangzao Maxin Fuzi Tang (Cinnamon, Licorice, Ginger, Jujube, Ephedra, Asarum, and Prepared Aconite Decoction).
Herbs: Ephedra Herb (Mahuang, 麻黄), Cinnamon Twig (Guizhi, 桂枝), Fresh Ginger, Perilla Leaf, Saposhnikovia Root, Asarum Root (Xixin, 细辛), etc.
2. Damp-Draining and Diuretic Method
Disease: Applicable to all types of edema, though with varying degrees.
Symptoms: Difficult urination, scanty urine volume, lower body swelling.
Formulas: Wu Pi Yin plus Plantago Seed and Akebia Stem, Wu Ling San (Five-Ling Powder), Fangji Fuling Tang (Stephania and Poria Decoction), Zhen Wu Tang, Si Ling San (Four-Ling Powder), Puhui San (Puhui Powder).
Herbs: Poria, Polyporus (Zhuling, 猪苓), Alisma Rhizome, Stephania Root, Talcum, Dioscorea Hypoglotta Rhizome (Bibo, 萆薜), Plantago Seed, Akebia Stem, Polygonum Aviculare Herb, Dianthus Flower, Gourd, etc.
3. Spleen-Tonifying and Earth-Nourishing Method
Disease: Applicable to edema due to Spleen Deficiency.
Symptoms: Loose stools, reduced diet or indigestion, sallow or pallid complexion, faint voice, limb weakness, weak pulse.
Formulas: Si Jun Zi Tang (Four-Gentlemen Decoction), Liu Jun Zi Tang (Six-Gentlemen Decoction), Yi Gong San (Yi Gong Powder), Li Zhong Tang (Regulate the Middle Decoction), Shi Pi Yin, Fuzi Li Zhong Tang (Prepared Aconite Regulate the Middle Decoction), Shen Ling Bai Zhu San (Codonopsis, Poria, and Atractylodes Powder), Wu Ling San.
Herbs: Ginseng Root (Renshen, 人参), Atractylodes Macrocephala Rhizome, Dioscorea Rhizome, Lablab Bean (Biandou, 扁豆), Lotus Seed (Lianrou, 莲肉), Coix Seed (Yiren, 苡仁), etc.
4. Kidney-Yang-Warming and Transforming Method
Disease: Applicable to edema due to Kidney Yang Deficiency.
Symptoms: Aversion to cold, cold feet, deep-slow pulse, loose stools, difficult urination.
Formulas: Jin Gui Shen Qi Wan, Wen Tong Tang (Warming and Unblocking Decoction, composed of Pepper Eye, Clematis Root (Weilingxian, 威灵仙), Small Fennel (Xiaohuixiang, 小茴香)).
Herbs: Prepared Aconite Root, Placenta Humanis (Ziheche, 紫河车), Cinnamon Twig, etc.
5. Yin-Nourishing and Kidney-Tonifying Method
Disease: Applicable to edema due to Yin Deficiency.
Symptoms: Preference for cold, rapid-weak pulse, ineffectiveness of warm-hot medicines or decreased urination and increased swelling after taking them.
Formulas: Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) plus Plantago Seed and Achyranthes Root, White Imperata Rhizome Decoction, Ji Yin Tang (Nourish Yin Decoction).
Herbs: Prepared Rehmannia Root, Raw Hangzhou White Peony Root, White Imperata Rhizome (Baimaogen, 白茅根), Raw Dioscorea Rhizome, Goat Milk, etc.
6. Qi-Tonifying Method
Disease: Applicable to edema due to Qi Deficiency.
Symptoms: Pale complexion, faint voice, limb fatigue, shortness of breath, weak or large-weak pulse.
Formulas: Shengma Huangqi Tang (Bupleurum and Astragalus Decoction), Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction).
Herbs: Raw Astragalus Root, Ginseng Root, Codonopsis Root, etc.
In summary, the key to treating nephritis lies in the Lung, Spleen, and Kidney. Nephritis primarily manifests as edema. The Lung is the upper source of water; if the upper source is clear, the lower source naturally becomes clear. The Spleen resides in the center and can transport water qi up and down. Some say the Spleen is the dike of water; if the dike is secure, water channels flow freely. The Kidney receives the downstream flow of water. Some say the Kidney is the master of water; when Kidney Qi moves, water moves. However, these three aspects are not strictly separated, nor do they advance simultaneously without standards. They are based on objective evidence, treating lightly what should be treated lightly, heavily what should be treated heavily, separating what should be separated, and combining what should be combined, following the principle of syndrome differentiation and treatment.
III. Nursing Care for Nephritis
(A) Medicinal Tonification
After the disappearance of nephritic edema, Astragalus Rice Porridge or Wei Ling Tang (Stomach and Lingzhi Decoction) can be used to regulate the Spleen and Stomach, or Li Zhong Tang/Wan (Regulate the Middle Decoction/Pill) to warm and tonify the Spleen and Stomach, or Jin Gui Ba Wei Wan (Eight-Ingredient Pill from the Golden Cabinet) to warm the Mingmen (Gate of Life), or Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Achyranthes Root and Plantago Seed, or additionally add Clam Shell and Oyster Shell, or additionally add Phellodendron Bark, to nourish Kidney Water and clear residual heat.
(B) Dietary Taboos
Avoid exposure to wind; avoid salt for 3–6 months; initially, only low-salt seasoning is allowed; those who recovered from the acute phase should still abstain for about 1 month; avoid soy sauce; avoid rich, salty pork and beef; avoid raw and cold foods.
Treatment Principles for Chronic Pyelonephritis