四诊：蟾皮多能作呕，刺激力强故也。此方非攻非补，和胃而有利尿之意。云苓15克，泽泻9克，生白术9克，淮山药9克，猪苓9克，冬瓜子皮各9克，杏苡仁各15克，潞党参9克，炙草2．4克，谷麦芽各9克。
五诊：和胃中复加攻剂，以免中土疲惫。淮山药9克，生白术12克，扁豆衣12克，云苓15克，潞党参12克，炙草4．5克，谷麦芽各9克，生熟米仁各12克，舟车丸6克（分2次吞，以药汁送）。
【按］此为肝硬化腹水。开始迭进峻剂逐水利尿，因正虚体力不支，至三诊改为温脾扶正之法。然而病邪不去，徒补无益，故于四诊一面补益中气，一面用淡渗利尿；五诊用益气健脾之品合舟车丸逐水，清理水湿余邪。此案或用攻，或用补：或攻补兼施，均为随症应变之需要。
11．潘男。肾脏水肿之治法，有温肾、逐水、利尿之别，亦有三法参合用之者。今患者面色苍白，舌淡，脉软，二便俱少，腹部绷结，邪实正虚，治法不可偏执一端。炮附块9克，生白术12克，云苓12克，杭白芍9克，淡干姜6克，葫芦瓢30克，舟车丸4．5克（分2次吞）。【按】方用真武汤，以干姜易生姜，回阳化气而消阴水，乃治本之图；舟车丸为逐水峻剂，是治标之法。
12郭男。一身悉肿，二便皆少，其病在肾。阅前方多逐水药，而肿不消。按其脉软无力，不可再攻。黄芪皮30克，白术12克，云苓12克，炮附块9克，泽泻12克，车前子9克，花槟榔9克，怀牛膝9克，冬葵子12克。【按］此病系脾肾阳虚，非温补不为功。方用大量黄芪补气利尿，白术益气培中，附子温阳行水，苓、泽、车前、牛膝化湿利尿。
13冯男。发热，周身浮肿，尿少，用利尿剂。冬葵子12克，赤猪苓、泽泻各9克，车前子12克，萆薢12克，制黑丑4．5克，葫芦瓢30克。
二诊：肾脏性水肿，用利尿药，小溲点滴全无；其水泛滥横溢，无怪其然。当严禁盐。黑白丑各9克，摈榔9克，续随子9克，冬葵子15克，制甘遂2．4克，制芜花4．5克，甜葶苈12克，泽泻12克。三诊：用芫花、甘遂，佐以西瓜汁，小溲得通，肿亦渐消。去邪务尽，前方再进。制甘遂2．4克，制芫花2．4克，大戟3克，商陆9克，续随子9克，车前子30克，泽泻12克，将军干3克（研分2次吞），冬葵子12克，赤猪苓各9克。
四诊：服利尿峻剂后，小溲通畅，浮肿大消，病人自觉诸恙霍然若失，勿药在望矣。冬葵子9克，泽泻9克，萆薢9克，篇蓄草12克，车前子12克，葫芦瓢15克，赤小豆30克。【按】初诊用利尿剂不应，乃水湿泛滥横溢，而病重药轻。二诊以后改用峻剂逐水，小溲得通，浮肿大消。虚当补，实当泻，丝毫不可差误。肿胀忌盐之说，本自《千金方》，与西医之说相符。四诊谓"勿药在望"是针对肿消，诸症若失而言。在今则须检验小便，如未达正常，仍须继续治疗。
14．姚女。浮肿起于面部，小溲短赤，两目充血，视物模糊。其人体质丰腴，两脉弦硬。此肾炎而兼血压亢进者，可以变生仓淬，如用温燥刺激之药，不异抱薪救火矣。鲜生地30克，桑白皮12克，泽泻12克，冬葵子15克，飞滑石9克，冬青子9克，旱莲草9克，怀牛膝9克，粉萆薢12克，密蒙花9克。
【按】此是肾炎高血压型。按照辨证，体丰脉弦硬，为肝肾阴虚，肝阳上亢；其目赤，视力模糊，亦属肝火上炎之征。方用生地、二至丸、怀牛膝滋养肝肾之阴；冬葵子、滑石、萆薢以利尿消肿；密蒙花润肝明目。
15．陈女。两脉弦硬有力，下肢浮肿而见此脉，多属肾脏病，予知柏八味丸。知母9克，熟地18克，粉丹皮9克，黄柏2．4克，云苓12克，泽泻9克，淮山药9克，山萸肉9克。先服上药，下药次之。猪苓9克，冬葵子9克，篇蓄12克，泽泻9克，粉萆薢9克淮牛膝9克，桑白皮9克，西茵陈9克，杜赤豆30克。?【按】此系肾阴虚而湿热下注，故先予知柏地黄汤剂，以滋养肾阴为主，次予清热化湿利尿之属。
6．丁男。目窠如卧蚕状，此唯肾脏病有之；足跗亦肿，小溲短?而频，色浑，肾脏病之端倪。平时嗜酒，肾脏受其刺激，为时久矣。葫芦瓢24克，冬瓜皮子各12克，黄柏4．5克，杜赤豆24?克，冬葵子9克，知母9克，淮牛膝9克，白薇9克，桑皮9克，生侧柏叶30克（煎汤代水）【按】肾炎浮肿用苦寒坚阴，化湿利尿，是常用治法之一。
7．蓝男。面部足背有浮肿状，主因在二便皆少。予茵陈五苓?散、附子大黄汤。绵茵陈12克，赤猪苓各9克，生苍术9克，川桂枝3克（后下），泽泻9克，炮附子6克，熟锦纹9克，葫芦瓢24克?【按】用茵陈五苓散化湿利水，附子大黄汤温下通便。盖二便通畅，湿邪随之而出，则面足浮肿自可消退。
8．曹男。少腹胀大如箕，两腿亦浮肿。既然小溲点滴而下，其?病总是在肾脏，不易治。葫芦瓢30克，冬葵子9克，生米仁30克，泽泻12克，炒车前18克，猪苓9克，两头尖15克。另：将军干1对，研分2次吞服。
【按］腹大坚满，两腿浮肿，小溲点滴难下，为湿热互结，水浊停聚，乃鼓胀之实证。方中重用苡仁、葫芦瓢等益脾利水。两头尖（即牡鼠粪），叶天士曾用以治疗淋浊，有化瘀利水之功。所谓病在肾不易治，实是经验之谈。此用利尿剂，亦急则治标之意。
19．周幼。其肿起于疮疡之后，尿少。俗谓"湿毒关进"，不尽?谬也。苦参片3克，茅根1扎，豨莶草6克，生米仁15克，泽泻9，白鲜皮6克，白薇6克，绿豆衣6克，生甘草6克，三妙丸6克。
20．吴幼。其肿先见于面部，今两足、腹部亦肿，小便短赤，颇疑肾脏炎；高热如烙，不可忽视。桑白皮12克，细生地12克，大腹皮9克，白薇12克，冬瓜子皮各9克，带皮苓12克，泽泻9克，葫芦瓢24克，地骨皮15克。[按］急性肾炎大都属阳水范畴。周案由皮肤感染引起，用利水清热而兼解毒；吴案全身浮肿，尿短赤，兼见高热，以清热凉血、利尿立方。
21方幼。一身悉肿，时轻时剧，剧则小溲短少、腹胀，此方侧重利水。猪苓各9克，冬葵子6克，车前子15克，摈榔6克，杜赤豆24克，泽泻9克，粉萆薢9克，牛膝9克，黑丑6克，葫芦瓢30克。诊；一药而面肿大退，小溲混，口臭，此皆肾脏排泄功能能障碍，与浮肿之当用温药者有别。黄柏4．5克，泽泻9克，石韦9克，白丑6克，知母9克，冬葵子12克，赤猪苓各9克，车前子12克。
【按】《丹溪心法.肿》云："遍身肿，烦渴，小便赤涩，大便秘，此属阳水……若遍身肿，不烦渴，小便少，不涩赤，此属阴水。"本例患者一身悉肿而伴口臭、小便混浊短少等症，其为阳水无疑。阳水属热、属实，用药宜寒凉渗泄，故案中指出："与浮肿之当用温药者有别。"
以药测证，此例之肿，乃因湿热蕴结下焦，肾与膀胱失其开阖、气化之职，以致水液潴留，泛溢肌肤所致。观先生用药，取苦寒以清热，淡以渗湿，参以通利之品，确属简洁可法。
22．陆女。因皮肤病而出现浮肿，肾脏已受影响可知。近来舌上破碎少苦，身热起伏，脉细数，当予清热育阴之属。小生地12克，嫩白薇9克，金银花12克，桑白皮9克，粉萆薢9克，泽泻9克，冬瓜皮12克，怀牛膝9克，绿豆衣9克，白茅根1扎。
【按］方中育阴用生地，清热用白薇，解毒用银花、绿豆，余为大队利尿药。从药测证，病以浮肿为主。
23．朱男。用仲景之蒲灰散兼汤剂，其肿大退。自觉气上冲咽喉则咳，乃肾虚水寒上逆也。炮附块6克，杭白芍9克，白术9克，淡姜皮2．4克，带皮苓15克，泽泻9克，防风9克，桂枝3克，葫芦瓢15克
【按］蒲灰散由蒲灰（蒲草即今用制蒲包者）、滑石二味组成，为利尿、清热治标之剂。今用之其肿大退，而觉气上冲咽喉作咳，为肾虚水寒上边，用真武汤加味以治其本。
1．梁男。夜难成寐，多梦，心悸，古人以为肝虚，以肝藏魂故也。凡补肝之药，大多有强壮神经之功能。明天麻9克，杭白芍9克，料豆衣12克，大熟地12克，当归身9克，炙远志5克，炒枣仁9克，抱茯神9克，潼沙苑9克，柏子仁9克，黑芝麻12克二诊：寐为之酣，悸为之减，但多梦则如故。大熟地18克，当归身9克，杭白芍9克，山萸肉9克，五味子5克，菟丝子9克，炙远志5克，抱茯神9克，潼沙苑9克，夜交藤12克，左牡蛎30克。另：首乌延寿丹90克，分10日服完。
【按】肝血虚一方面可导致心失供养，另一方面，又可使肝阳偏亢，上扰心神，而为心悸、失眠、多梦等症。初诊用地、芍、归、沙苑、芝麻养肝阴，补肝血；天麻平肝镇静；枣仁、柏子仁、茯神、远志养心宁神。古人有"乙癸同源，肝肾同治"之说，故二诊在上方基础上加补肾药，加强强壮调整作用，以巩固疗效。
2．姚男。头昏，夜难安寐，口干唇碎，服西药七八月无效。每夜必饮水数次，否则口干不可名状，影响睡眠。察其舌色淡白无华，按其脉沉细无力，不能以为热证而投凉。附块6克，生白术12克，熟地30克，五味子5克，党参12克，怀牛膝12克，麦冬12克。二诊：很有效，口干没有从前严重，夜寐也较安。原方去牛膝，加当归、枣仁。
【按】本案失眠而兼口干、唇碎、每晚渴饮，似为热证，但据脉象、舌色，非实火而为虚火，即肾水亏不能上济于心，心火内炽。方用熟地、牛膝补肾阴，麦冬、五味养心阴，参、术益脾气，主用大辛大热之附子引火归源，与熟地合为温益肾阳之剂。
3．谢男。胃不和则卧不安，多见于思虑过度而胃肠功能衰弱者。《内经》半夏林米汤非安眠之方，健胃整肠，自然遂之入梦。法半夏9克，北秫米15克，山萸肉6克，炒枣仁9克，云苓神各12克，怀山药9克，白芍9克，夜交藤12克，柏子仁12克，太子参9克。【按】此用半夏秫米汤和胃化痰，兼用养心神、补肝阴之品。
4．周女。病失眠已久，最近时时作哕，苔白腻满布。因其以往叠用滋阴安神剂无效，《内经》有云："胃不和则卧不安"，当先从治胃入手。炮附块9克，大川穹9克，姜半夏24克，北秫米12克，香甘松9克，炙甘草3克，肉桂末1．8克（分3次吞）。注：服此方2剂，即得安寐。
【按】"胃不和则卧不安"，为胃有宿食，或变生痰浊、痰热，影响心神所致。此病人苔白腻，作哕，为脾阳虚不能运化水湿，生痰壅遏于胃，以致胃不和。方用桂、附温阳，阳气充足则湿可化；姜夏、秫米、甘松和胃除痰，胃和则心神安。川芎一味，王好古谓其能"搜肝气，补肝血，润肝燥，补风虚"。现代药理研究证实，该品能抑制自发活动，还能延长戊巴比妥钠的睡眠时间，有良好的安眠作用。辨证准确，施方中肯，疗效自然得心应手。
5．周男。苦失眠，头晕时痛，梦多。此方乃中医之镇静剂，神经衰弱之失眠宜之。附块5克，天麻9克，川芎3克，五味子9克，当归9克，延胡索9克，枣仁9克，珍珠母12克。
【按】方用宁心安神之品，加熄风、镇静、镇痛药。其中川芎兼补肝血，治血虚头痛；延胡镇痛，且具良好的催眠安定作用。先生曾指出："根据实践经验，有些失眠患者，单纯用养阴、安神、镇静药效果不佳时，适当地加人桂、附一类兴奋药，每可奏效。"这个经验可供今后进一步验证。
6．雷女。夜晚难以人睡，服安眠药亦无济于事；偶尔人睡，则乱梦纷纭；因而白昼疲惫不堪，每晚饭后则其精神特别兴奋。此属虚火。川连3克，黄芩6克，生白芍18克，阿胶30克（分冲），枣仁18克，茯神18克，鸡子黄2枚（分冲）。二诊：连服5剂，失眠情况已有显著改善，晚上精神不如前之兴奋；头胀，有时昏沉。枣仁30克，川芎9克，知母12克，茯神18克，远志9克，清炙草3克。另：归脾丸120克，每睡前服9克。
【按】证属阴虚火旺，治以黄连阿胶汤滋阴降火，佐以养心安神。药证相合，收效甚捷。二诊用酸枣仁汤，清肝宁心，安神镇静；更以归脾汤两补心脾，扶助根本。
7吴女。产后思虑劳烦，脑力受其打击者良巨，以致辗转难以入眠。酸枣仁9克，知母9克，煅牡蛎30克（打），北秫米9克，粉甘草2．4克，大川芎5克，抱木神9克，仙鹤草15克，怀山药9克，川雅连0．6克，上安桂0．6克（研吞）。【按］酸枣仁汤适用于肝郁日久化火，上扰心神之失眠。此案起于产后思虑劳烦，故甚为惬当。黄连、肉桂同用，名交泰丸；黄连清心火，肉桂温肾阳，引火归源
8．冯男。失眠已历1个月，平素胃肠不健。酸枣仁12克，川芎6克，知母9克，柏子仁12克，当归9克，抱茯神12克，夜交藤9克，煅牡蛎24克（先煎），炮附子2．4克，炙甘草3克。【按】方用酸枣仁汤宁心除烦以治失眠。用少量附子振奋中阳，以健胃肠。
Fourth visit: Toad skin often induces vomiting due to its strong irritant properties. This prescription is neither purgative nor tonifying; it harmonizes the stomach with a diuretic intent. Yunling (Poria) 15g, Zexie (Alisma Rhizome) 9g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 9g, Huai Shanyao (Chinese Yam) 9g, Zhuling (Polyporus) 9g, Dongguazi (Benincasa hispida Seed) and Dongguapi (Benincasa hispida Peel) each 9g, Xingren (Armeniacae Semen) and Yiyiren (Coicis Semen) each 15g, Lushen (Codonopsis Radix) 9g, Zhigancao (Prepared Licorice Root) 2.4g, Guya (Hordei Fructus Germinatus) and Meya (Setariae Fructus Germinatus) each 9g.
Fifth visit: Harmonizing the stomach while adding purgatives to prevent exhaustion of the Middle Jiao (Spleen and Stomach). Huai Shanyao (Chinese Yam) 9g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 12g, Biandouyi (Lablab Album Coat) 12g, Yunling (Poria) 15g, Lushen (Codonopsis Radix) 12g, Zhigancao (Prepared Licorice Root) 4.5g, Guya (Hordei Fructus Germinatus) and Meya (Setariae Fructus Germinatus) each 9g, Sheng Renshen (Raw Coicis Semen) and Shu Renshen (Processed Coicis Semen) each 12g, Zhouche Wan (Boat Cart Pill) 6g (taken in two doses, swallowed with decoction).
[Commentary] This case involves Liver Cirrhosis with Ascites (Hepatic Cirrhosis with Abdominal Fluid Accumulation). Initially, harsh agents were repeatedly administered to purge water and promote urination. However, due to deficiency of healthy Qi and physical weakness, by the third visit, the treatment was changed to warming the Spleen and supporting healthy Qi. Since the pathogenic factor remained, mere tonification was unhelpful. Thus, at the fourth visit, while tonifying Middle Qi, light permeating diuretics were used simultaneously. At the fifth visit, Qi-tonifying and Spleen-strengthening herbs were combined with Zhouche Wan (Boat Cart Pill) to purge water and clear residual damp-water pathogens. This case employed purgation, tonification, or both concurrently, all necessitated by adapting to symptom changes.
11. Male Patient Pan. Treatment methods for Renal Edema include warming the Kidney, purging water, and promoting urination; sometimes these three methods are combined. The patient currently presents with pale complexion, pale tongue, soft pulse, oliguria and constipation, and a tense, knotted abdomen. This indicates excess pathogen and deficiency of healthy Qi; treatment must not be biased towards one approach. Paofuku (Prepared Aconite Lateralis Radix) 9g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 12g, Yunling (Poria) 12g, Hangbaishao (White Peony Root) 9g, Dan Jiangpi (Dried Ginger Peel) 6g, Hulupiao (Lagenaria Siceraria Pulp) 30g, Zhouche Wan (Boat Cart Pill) 4.5g (taken in two doses). [Commentary] The formula uses Zhenwu Tang (True Warrior Decoction), substituting dried ginger for fresh ginger to restore Yang, transform Qi, and eliminate Yin-cold water; this addresses the root. Zhouche Wan (Boat Cart Pill) is a harsh agent for purging water, addressing the branch.
12. Male Patient Guo. Generalized edema, oliguria and constipation; the disease resides in the Kidney. Previous prescriptions contained many water-purging herbs, yet edema did not subside. Palpation reveals a soft, powerless pulse; further purgation is contraindicated. Huangqipi (Astragali Cortex) 30g, Baizhu (Atractylodes Macrocephala Rhizome) 12g, Yunling (Poria) 12g, Paofuku (Prepared Aconite Lateralis Radix) 9g, Zexie (Alisma Rhizome) 12g, Cheqianzi (Plantaginis Semen) 9g, Hua Binglang (Areca Seed) 9g, Huai Niuxi (Achyranthis Bidentatae Radix) 9g, Dongkuizi (Abutilonis Semen) 12g. [Commentary] This disease is due to Spleen-Kidney Yang Deficiency; only warming and tonification can achieve efficacy. The formula uses large doses of Astragalus to tonify Qi and promote urination, Atractylodes to tonify Qi and strengthen the Middle, Aconite to warm Yang and move water, and Poria, Alisma, Plantago, and Achyranthes to transform dampness and promote urination.
13. Male Patient Feng. Fever, generalized edema, oliguria; treated with diuretics. Dongkuizi (Abutilonis Semen) 12g, Chi Zhuling (Red Polyporus) and Zexie (Alisma Rhizome) each 9g, Cheqianzi (Plantaginis Semen) 12g, Bibie (Dioscoreae Hypoglaucae Rhizoma) 12g, Zhi Heichou (Prepared Pharbitis Seed) 4.5g, Hulupiao (Lagenaria Siceraria Pulp) 30g.
Second visit: For Renal Edema, diuretics resulted in anuria; water flooding freely is expected. Strict salt restriction is required. Hei Bai Chou (Black and White Pharbitis Seeds) each 9g, Binglang (Areca Seed) 9g, Xuisui Zi (Euphorbia Lathyris Seed) 9g, Dongkuizi (Abutilonis Semen) 15g, Zhi Gansui (Prepared Kansui Root) 2.4g, Zhi Yuanhua (Prepared Genkwa Flos) 4.5g, Tian Tingli (Sweet Descurainiae Semen) 12g, Zexie (Alisma Rhizome) 12g. Third visit: Using Yuanhua (Genkwa Flos) and Gansui (Kansui Root), assisted by watermelon juice, urination became patent, and edema gradually subsided. Pathogens must be thoroughly eliminated; continue the previous prescription. Zhi Gansui (Prepared Kansui Root) 2.4g, Zhi Yuanhua (Prepared Genkwa Flos) 2.4g, Daji (Euphorbia Pekinensis Root) 3g, Shanglu (Phytolaccae Radix) 9g, Xuisui Zi (Euphorbia Lathyris Seed) 9g, Cheqianzi (Plantaginis Semen) 30g, Zexie (Alisma Rhizome) 12g, Jiangjungan (Dried Rhubarb) 3g (powdered, taken in two doses), Dongkuizi (Abutilonis Semen) 12g, Chi Zhuling (Red Polyporus) each 9g.
Fourth visit: After taking harsh diuretics, urination is smooth, edema has significantly subsided. The patient feels all symptoms have vanished; discontinuation of medication seems imminent. Dongkuizi (Abutilonis Semen) 9g, Zexie (Alisma Rhizome) 9g, Bibie (Dioscoreae Hypoglaucae Rhizoma) 9g, Pianchucao (Polygoni Cuspidati Herba) 12g, Cheqianzi (Plantaginis Semen) 12g, Hulupiao (Lagenaria Siceraria Pulp) 15g, Chixiaodou (Vigna Angularis Seed) 30g. [Commentary] Initial use of diuretics failed because water-dampness was flooding freely, and the pathology was severe while the medication was mild. From the second visit onwards, harsh agents were used to purge water, resulting in patent urination and significant reduction of edema. Deficiency requires tonification, excess requires purgation; no error is permissible. The prohibition of salt for swelling originates from *Qianjin Fang* (*Essential Prescriptions Worth a Thousand Gold*), consistent with Western medicine. The statement "discontinuation of medication seems imminent" at the fourth visit refers to the resolution of edema and disappearance of symptoms. In modern practice, urine tests are necessary; if normal levels are not reached, treatment must continue.
14. Female Patient Yao. Edema began on the face, short red urine, congested eyes, blurred vision. The patient has a robust constitution and wiry, hard pulses. This is Nephritis accompanied by hypertension, which may lead to dangerous complications. Using warming, drying, or stimulating herbs would be like carrying firewood to save a fire. Xian Shengdi (Fresh Rehmanniae Radix) 30g, Sangbaipi (Mori Cortex) 12g, Zexie (Alisma Rhizome) 12g, Dongkuizi (Abutilonis Semen) 15g, Fei Hushi (Prepared Talcum) 9g, Dongqingzi (Ilicis Fructus) 9g, Hanliancao (Ecliptae Herba) 9g, Huai Niuxi (Achyranthis Bidentatae Radix) 9g, Fen Bibie (Powdered Dioscoreae Hypoglaucae Rhizoma) 12g, Mimenghua (Myrtilli Flos) 9g.
[Commentary] This is the Nephritis-Hypertension type. Based on syndrome differentiation, robust constitution and wiry-hard pulses indicate Liver-Kidney Yin Deficiency with Hyperactive Liver Yang; red eyes and blurred vision also indicate Liver Fire flaming upward. The formula uses Shengdi (Rehmanniae Radix), Erzhi Wan (Two Winter Pill), and Huai Niuxi (Achyranthis Bidentatae Radix) to nourish Liver-Kidney Yin; Dongkuizi (Abutilonis Semen), Hushi (Talcum), and Bibie (Dioscoreae Hypoglaucae Rhizoma) to promote urination and reduce edema; Mimenghua (Myrtilli Flos) to moisten the Liver and brighten the eyes.
15. Female Patient Chen. Wiry, hard, and forceless pulses in both wrists; lower limb edema associated with this pulse pattern suggests Kidney disease. Prescribed Zhibai Bawei Wan (Anemarrhena and Phellodendron Eight-Ingredient Pill). Zhimu (Anemarrhenae Rhizoma) 9g, Shudi (Prepared Rehmanniae Radix) 18g, Fen Danpi (Powdered Moutan Cortex) 9g, Huangbai (Phellodendri Cortex) 2.4g, Yunling (Poria) 12g, Zexie (Alisma Rhizome) 9g, Huai Shanyao (Chinese Yam) 9g, Shanzhuyu (Corni Fructus) 9g. Take the above medicine first, then the following medicine. Zhuling (Polyporus) 9g, Dongkuizi (Abutilonis Semen) 9g, Pianchu 12g, Zexie (Alisma Rhizome) 9g, Fen Bibie (Powdered Dioscoreae Hypoglaucae Rhizoma) 9g, Huai Niuxi (Achyranthis Bidentatae Radix) 9g, Sangbaipi (Mori Cortex) 9g, Xi Yinchent (Artemisiae Scopariae Herba) 9g, Du Chidou (Vigna Angularis Seed) 30g. [Commentary] This is Kidney Yin Deficiency with Damp-Heat pouring downward. Therefore, Zhibai Dihuang Tang (Anemarrhena, Phellodendron, and Rehmannia Decoction) is given first to primarily nourish Kidney Yin, followed by heat-clearing, damp-transforming, and diuretic agents.
6. Male Patient Ding. Eye sockets resemble sleeping silkworms; this is specific to Kidney disease. Dorsum pedis is also swollen, urine is short, frequent, and turbid; these are early signs of Kidney disease. Long-term alcohol consumption has stimulated the Kidneys for a long time. Hulupiao (Lagenaria Siceraria Pulp) 24g, Dongguapi (Benincasa hispida Peel) and Dongguazi (Benincasa hispida Seed) each 12g, Huangbai (Phellodendri Cortex) 4.5g, Du Chidou (Vigna Angularis Seed) 24g, Dongkuizi (Abutilonis Semen) 9g, Zhimu (Anemarrhenae Rhizoma) 9g, Huai Niuxi (Achyranthis Bidentatae Radix) 9g, Baiwei (Clethrae Rhizoma) 9g, Sangpi (Mori Cortex) 9g, Sheng Cebeiye (Fresh Platycladi Cacumen) 30g (decocted as water substitute). [Commentary] Using bitter-cold herbs to consolidate Yin and transform dampness/promote urination for nephritic edema is one of the common treatment methods.
7. Male Patient Lan. Facial and dorsum pedis edema, primarily due to oliguria and constipation. Prescribed Yinchent Wuling San (Artemisia Capillaris and Five-Ingredient Poria Powder) and Fuzi Dahuang Tang (Aconite and Rhubarb Decoction). Mian Yinchent (Artemisiae Scopariae Herba) 12g, Chi Zhuling (Red Polyporus) each 9g, Sheng Cangzhu (Raw Atractylodis Rhizoma) 9g, Chuan Guizhi (Cinnamomi Ramulus) 3g (added later), Zexie (Alisma Rhizome) 9g, Paofuzi (Prepared Aconiti Lateralis Radix Praeparata) 6g, Shu Jinwen (Prepared Rheum Palmatum Rhizoma) 9g, Hulupiao (Lagenaria Siceraria Pulp) 24g. [Commentary] Yinchent Wuling San (Artemisia Capillaris and Five-Ingredient Poria Powder) transforms dampness and promotes water flow; Fuzi Dahuang Tang (Aconite and Rhubarb Decoction) warms the interior and promotes bowel movement. Once urination and defecation are patent, damp pathogens exit with them, and facial/foot edema will naturally subside.
8. Male Patient Cao. Lower abdominal distension like a basket, bilateral leg edema. Since urination is scanty drops, the disease lies in the Kidney and is difficult to treat. Hulupiao (Lagenaria Siceraria Pulp) 30g, Dongkuizi (Abutilonis Semen) 9g, Sheng Yiyiren (Raw Coicis Semen) 30g, Zexie (Alisma Rhizome) 12g, Chao Cheqian (Fried Plantaginis Semen) 18g, Zhuling (Polyporus) 9g, Liangtoujian (Mus Musculus Faeces) 15g. Additionally: Jiangjungan (Dried Rhubarb) 1 pair, powdered, taken in two doses.
[Commentary] Abdominal distension that is firm and full, bilateral leg edema, and difficulty passing even drops of urine indicate Damp-Heat binding together and turbid water accumulating, constituting an Excess pattern of Guzhang (Drum Distension). The formula heavily uses Yiyiren (Coicis Semen) and Hulupiao (Lagenaria Siceraria Pulp) to benefit the Spleen and promote water flow. Liangtoujian (Mus Musculus Faeces) was used by Ye Tianshi to treat strangury and turbid urine, possessing effects of resolving stasis and promoting water flow. The saying "disease in the Kidney is difficult to treat" is indeed experiential wisdom. Here, diuretics are used to address the acute symptoms (treating the branch in emergencies).
19. Child Patient Zhou. Swelling began after sores/ulcers, with oliguria. The folk saying "damp-toxin trapped inside" is not entirely baseless. Kushen Pian (Sophorae Flavescentis Radix Tablets) 3g, Maogen (Imperatae Rhizoma) 1 bunch, Xixiancao (Siegesbeckiae Herba) 6g, Sheng Yiyiren (Raw Coicis Semen) 15g, Zexie (Alisma Rhizome) 9g, Baixianpi (Dictamni Cortex) 6g, Baiwei (Clethrae Rhizoma) 6g, Lvdouyi (Phaseoli Vulgaris Seed Coat) 6g, Sheng Gancao (Raw Glycyrrhizae Radix et Rhizoma) 6g, Sanmiao Wan (Three Marvels Pill) 6g.
20. Child Patient Wu. Swelling first appeared on the face, now involving feet and abdomen, with short red urine; renal inflammation is suspected. High fever like burning cannot be ignored. Sangbaipi (Mori Cortex) 12g, Xi Shengdi (Fine Fresh Rehmanniae Radix) 12g, Dafupi (Arecae Pericarpium) 9g, Baiwei (Clethrae Rhizoma) 12g, Dongguazi (Benincasa hispida Seed) and Dongguapi (Benincasa hispida Peel) each 9g, Daipi Ling (Poria with Bark) 12g, Zexie (Alisma Rhizome) 9g, Hulupiao (Lagenaria Siceraria Pulp) 24g, Digupi (Lycii Cortex) 15g. [Commentary] Acute nephritis mostly falls under the category of Yang Water. Case Zhou was caused by skin infection, treated with water-promoting, heat-clearing, and detoxifying methods. Case Wu presented with generalized edema, short red urine, and high fever, treated with heat-clearing, blood-cooling, and diuretic principles.
21. Child Patient Fang. Generalized edema, fluctuating in severity; during exacerbations, oliguria and abdominal distension occur. This prescription focuses on promoting water flow. Zhuling (Polyporus) each 9g, Dongkuizi (Abutilonis Semen) 6g, Cheqianzi (Plantaginis Semen) 15g, Binglang (Areca Seed) 6g, Du Chidou (Vigna Angularis Seed) 24g, Zexie (Alisma Rhizome) 9g, Fen Bibie (Powdered Dioscoreae Hypoglaucae Rhizoma) 9g, Niuxi (Achyranthis Bidentatae Radix) 9g, Heichou (Pharbitidis Semen) 6g, Hulupiao (Lagenaria Siceraria Pulp) 30g. Second visit: Facial edema subsided after one dose, but urine is turbid, and there is halitosis. These indicate impaired renal excretory function, distinct from edema requiring warming herbs. Huangbai (Phellodendri Cortex) 4.5g, Zexie (Alisma Rhizome) 9g, Shiwei (Pyrosiae Folium) 9g, Bai Chou (Pharbitidis Semen) 6g, Zhimu (Anemarrhenae Rhizoma) 9g, Dongkuizi (Abutilonis Semen) 12g, Chi Zhuling (Red Polyporus) each 9g, Cheqianzi (Plantaginis Semen) 12g.
[Commentary] *Danxi Xinfa·Swelling* states: "Generalized edema, irritability, thirst, red and scanty urine, constipation—this belongs to Yang Water... If generalized edema without thirst, scanty urine, non-astringent and non-red—this belongs to Yin Water." This patient has generalized edema accompanied by halitosis and turbid, short urine, undoubtedly Yang Water. Yang Water is Heat and Excess; medication should be cold, cool, and permeating. Hence, the case notes: "Distinct from edema requiring warming herbs."
Inferring the syndrome from the herbs, this edema is caused by Damp-Heat accumulating in the Lower Jiao, causing the Kidney and Bladder to lose their opening/closing and Qi-transformation functions, leading to fluid retention and overflow into the skin. Observing the physician's medication, using bitter-cold to clear heat, light/permeating to drain dampness, and combining with unblocking agents is indeed concise and exemplary.
22. Female Patient Lu. Edema appeared due to skin disease, indicating Kidney involvement. Recently, the tongue surface is cracked with little coating, body temperature fluctuates, pulse is fine and rapid. Heat-clearing and Yin-nourishing agents are indicated. Xiao Shengdi (Small Fresh Rehmanniae Radix) 12g, Nen Baiwei (Tender Clethrae Rhizoma) 9g, Jinyinhua (Lonicerae Japonicae Flos) 12g, Sangbaipi (Mori Cortex) 9g, Fen Bibie (Powdered Dioscoreae Hypoglaucae Rhizoma) 9g, Zexie (Alisma Rhizome) 9g, Dongguapi (Benincasa hispida Peel) 12g, Huai Niuxi (Achyranthis Bidentatae Radix) 9g, Lv dou yi (Phaseoli Vulgaris Seed Coat) 9g, Baimaogen (Imperatae Rhizoma) 1 bunch.
[Commentary] The formula uses Shengdi (Rehmanniae Radix) to nourish Yin, Baiwei (Clethrae Rhizoma) to clear heat, Jinyinhua (Lonicerae Japonicae Flos) and Lv dou yi (Phaseoli Vulgaris Seed Coat) to detoxify; the rest are major diuretic herbs. Inferring the syndrome from the herbs, the primary manifestation is edema.
23. Male Patient Zhu. Used Zhang Zhongjing's Puhui San (Cattail Pollen Powder) combined with decoction; edema subsided. Sensation of Qi rushing up to the throat causing cough, indicating Kidney Deficiency with Cold-Water counterflow. Paofuku (Prepared Aconite Lateralis Radix) 6g, Hangbaishao (White Peony Root) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 9g, Dan Jiangpi (Dried Ginger Peel) 2.4g, Daipi Ling (Poria with Bark) 15g, Zexie (Alisma Rhizome) 9g, Fangfeng (Saposhnikoviae Radix) 9g, Guizhi (Cinnamomi Ramulus) 3g, Hulupiao (Lagenaria Siceraria Pulp) 15g.
[Commentary] Puhui San consists of Pu Hui (Typhae Pollen, i.e., processed Typha pollen) and Hushi (Talcum); it is a diuretic and heat-clearing agent for treating branches. Its use here reduced edema, but the sensation of Qi rushing to the throat and coughing indicates Kidney Deficiency with Cold-Water counterflow. Zhenwu Tang (True Warrior Decoction) with modifications is used to treat the root.
Insomnia
1. Male Patient Liang. Difficulty falling asleep at night, vivid dreams, palpitations. Ancients attributed this to Liver Deficiency because the Liver stores the Hun (Ethereal Soul). Most Liver-tonifying herbs have nerve-strengthening functions. Ming Tianma (Gastrodiae Rhizoma) 9g, Hangbaishao (White Peony Root) 9g, Liaodouyi (Lablab Album Coat) 12g, Da Shudi (Large Prepared Rehmanniae Radix) 12g, Danggui Shen (Angelicae Sinensis Radix Body) 9g, Zhi Yuanzhi (Prepared Polygalae Radix) 5g, Chao Zaoren (Fried Ziziphi Spinosomi Semen) 9g, Bao Fushen (Poria with Pinus Root) 9g, Tong Shayuan (Euosmi Semen) 9g, Baiziren (Platycladi Semen) 9g, Heima (Sesami Fructus Niger) 12g. Second visit: Sleep became sound, palpitations decreased, but vivid dreams persisted. Da Shudi (Prepared Rehmanniae Radix) 18g, Danggui Shen (Angelicae Sinensis Radix Body) 9g, Hangbaishao (White Peony Root) 9g, Shanzhuyu (Corni Fructus) 9g, Wuweizi (Schisandrae Chinensis Fructus) 5g, Tusizi (Cuscutae Semen) 9g, Zhi Yuanzhi (Prepared Polygalae Radix) 5g, Bao Fushen (Poria with Pinus Root) 9g, Tong Shayuan (Euosmi Semen) 9g, Yejiaoteng (Polygoni Multiflori Caulis) 12g, Zuo Muli (Left Oyster Shell) 30g. Additionally: Shouwu Yanshou Dan (He Shou Wu Longevity Pill) 90g, taken over 10 days.
[Commentary] Liver Blood Deficiency can lead to Heart malnourishment and also cause Hyperactive Liver Yang disturbing the Heart Spirit, resulting in palpitations, insomnia, and vivid dreams. First visit used Shudi (Rehmanniae Radix), Baishao (White Peony Root), Danggui (Angelicae Sinensis Radix), Shayuan (Euosmi Semen), and Heima (Sesami Fructus Niger) to nourish Liver Yin and tonify Liver Blood; Tianma (Gastrodiae Rhizoma) pacifies the Liver and calms spasms; Zaoren (Ziziphi Spinosomi Semen), Baiziren (Platycladi Semen), Fushen (Poria with Pinus Root), and Yuanzhi (Polygalae Radix) nourish the Heart and calm the Spirit. Ancients said "Yi-Gui share the same source, Liver and Kidney are treated together"; thus, the second visit added Kidney-tonifying herbs to the previous formula to strengthen adjustment and consolidate efficacy.
2. Male Patient Yao. Dizziness, difficulty sleeping at night, dry mouth, cracked lips. Seven to eight months of Western medicine ineffective. Must drink water several times nightly; otherwise, indescribable dry mouth affects sleep. Tongue is pale and lusterless; pulse is deep, fine, and powerless. Do not diagnose as Heat and administer cooling herbs. Fu Kuai (Aconite Chunk) 6g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 12g, Shudi (Prepared Rehmanniae Radix) 30g, Wuweizi (Schisandrae Chinensis Fructus) 5g, Dangshen (Codonopsis Radix) 12g, Huai Niuxi (Achyranthis Bidentatae Radix) 12g, Maidong (Ophiopogonis Radix) 12g. Second visit: Very effective; dry mouth less severe, sleep more peaceful. Remove Niuxi from original formula, add Danggui (Angelicae Sinensis Radix) and Zaoren (Ziziphi Spinosomi Semen).
[Commentary] Insomnia with dry mouth, cracked lips, and nightly thirst appears as Heat, but pulse and tongue indicate Deficient Fire rather than Excess Fire: Kidney Water Deficiency failing to ascend to nourish the Heart, leading to internal blazing of Heart Fire. Formula uses Shudi (Prepared Rehmanniae Radix) and Niuxi (Achyranthis Bidentatae Radix) to tonify Kidney Yin, Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Chinensis Fructus) to nourish Heart Yin, Renshen (Ginseng Radix) and Baizhu (Atractylodes Macrocephala Rhizome) to benefit Spleen Qi, and primarily uses large doses of acrid-hot Fuzi (Aconiti Lateralis Radix Praeparata) to guide fire back to its source, combined with Shudi (Prepared Rehmanniae Radix) to warm and tonify Kidney Yang.
3. Male Patient Xie. "When the Stomach is disharmonious, sleep is uneasy," commonly seen in those with excessive worry and weak gastrointestinal function. *Neijing*'s Banxia Shumi Tang (Pinellia and Millet Decoction) is not merely a sleeping pill; by strengthening the Stomach and regulating the intestines, sleep comes naturally. Fa Banxia (Prepared Pinelliae Rhizoma) 9g, Bei Shumi (Northern Panicum Miliaceum Granum) 15g, Shanzhuyu (Corni Fructus) 6g, Chao Zaoren (Fried Ziziphi Spinosomi Semen) 9g, Yunling Shen (Poria and Poria with Pinus Root) each 12g, Huai Shanyao (Chinese Yam) 9g, Baishao (White Peony Root) 9g, Yejiaoteng (Polygoni Multiflori Caulis) 12g, Baiziren (Platycladi Semen) 12g, Taizishen (Pseudostellariae Radix) 9g. [Commentary] Banxia Shumi Tang (Pinellia and Millet Decoction) harmonizes the Stomach and transforms phlegm, combined with herbs to nourish Heart Spirit and tonify Liver Yin.
4. Female Patient Zhou. Long-standing insomnia, recent frequent hiccups, white greasy coating covering the tongue. Since previous滋阴安神 (Yin-nourishing and Spirit-calming) agents failed, *Neijing* states: "When the Stomach is disharmonious, sleep is uneasy"; treatment should start with the Stomach. Paofu Kuai (Prepared Aconite Chunk) 9g, Da Chuanxiong (Large Ligusticum Chuanxiong Rhizoma) 9g, Jiang Banxia (Ginger-processed Pinelliae Rhizoma) 24g, Bei Shumi (Northern Panicum Miliaceum Granum) 12g, Xiang Gansong (Nardostachys Radix et Rhizoma) 9g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 3g, Rougui Mo (Cinnamomi Cortex Powder) 1.8g (taken in three doses). Note: One dose of this formula yielded sound sleep.
[Commentary] "When the Stomach is disharmonious, sleep is uneasy" is caused by food stagnation in the Stomach or transformation into phlegm/turbidity or phlegm-heat, disturbing the Heart Spirit. This patient has white greasy coating and hiccups, indicating Spleen Yang Deficiency failing to transport fluids, generating phlegm obstructing the Stomach, causing Stomach disharmony. Formula uses Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata) to warm Yang; sufficient Yang transforms dampness. Jiang Banxia (Ginger-processed Pinelliae Rhizoma), Shumi (Panicum Miliaceum Granum), and Gansong (Nardostachys Radix et Rhizoma) harmonize the Stomach and remove phlegm; when the Stomach is harmonious, the Heart Spirit calms. Chuanxiong (Ligusticum Chuanxiong Rhizoma), according to Wang Haogu, can "search Liver Qi, tonify Liver Blood, moisten Liver Dryness, tonify Wind-Deficiency." Modern pharmacology confirms it inhibits spontaneous activity and prolongs pentobarbital sodium-induced sleep time, having good hypnotic effects. Accurate differentiation and precise prescription yield natural effectiveness.
5. Male Patient Zhou. Suffering from insomnia, dizziness with intermittent pain, many dreams. This formula acts as a Chinese medicine sedative, suitable for neurosis-related insomnia. Fu Kuai (Aconite Chunk) 5g, Tianma (Gastrodiae Rhizoma) 9g, Chuanxiong (Ligusticum Chuanxiong Rhizoma) 3g, Wuweizi (Schisandrae Chinensis Fructus) 9g, Danggui (Angelicae Sinensis Radix) 9g, Yanhusuo (Corydalis Rhizoma) 9g, Zaoren (Ziziphi Spinosomi Semen) 9g, Zhenzhumu (Margarita) 12g.
[Commentary] The formula uses Heart-calming and Spirit-soothing herbs, plus wind-extinguishing, sedating, and analgesic drugs. Chuanxiong (Ligusticum Chuanxiong Rhizoma) additionally tonifies Liver Blood and treats Blood-Deficiency headache; Yanhusuo (Corydalis Rhizoma) relieves pain and has good hypnotic and calming effects. The physician once stated: "Based on practical experience, when some insomnia patients show poor response to pure Yin-nourishing, Spirit-calming, or sedating herbs, appropriately adding excitatory herbs like Guizhi (Cinnamomi Ramulus) or Fuzi (Aconiti Lateralis Radix Praeparata) often yields results." This experience warrants further verification.
6. Female Patient Lei. Difficulty falling asleep at night, sleeping pills ineffective; occasional sleep brings chaotic dreams; daytime exhaustion; special excitement after dinner nightly. This belongs to Deficient Fire. Chuanlian (Coptidis Rhizoma) 3g, Huangqin (Scutellariae Radix) 6g, Sheng Baishao (Raw White Peony Root) 18g, Ejiao (Donkey-Hide Gelatin) 30g (taken separately), Zaoren (Ziziphi Spinosomi Semen) 18g, Fushen (Poria with Pinus Root) 18g, Jizihuang (Chicken Egg Yolk) 2 pieces (taken separately). Second visit: After 5 doses, insomnia significantly improved, evening excitement reduced; head distension, occasional heaviness. Zaoren (Ziziphi Spinosomi Semen) 30g, Chuanxiong (Ligusticum Chuanxiong Rhizoma) 9g, Zhimu (Anemarrhenae Rhizoma) 12g, Fushen (Poria with Pinus Root) 18g, Yuanzhi (Polygalae Radix) 9g, Qing Zhigancao (Clear Preparing Glycyrrhizae Radix et Rhizoma) 3g. Additionally: Guipi Wan (Restore the Spleen Pill) 120g, take 9g before bed.
[Commentary] Syndrome is Yin Deficiency with Fire Hyperactivity, treated with Huanglian Ejiao Tang (Coptis and Donkey-Hide Gelatin Decoction) to nourish Yin and descend Fire, assisted by Heart-nourishing and Spirit-calming herbs. Medication matches syndrome, yielding swift results. Second visit uses Suanzaoren Tang (Sour Jujube Decoction) to clear Liver and calm Heart, soothe Spirit and sedate; additionally, Guipi Tang (Restore the Spleen Decoction) tonifies both Heart and Spleen to support the root.
7. Female Patient Wu. Postpartum worry and labor severely impacted mental energy, causing tossing and turning inability to sleep. Suanzaoren (Ziziphi Spinosomi Semen) 9g, Zhimu (Anemarrhenae Rhizoma) 9g, Duan Muli (Calcined Oyster Shell) 30g (crushed), Bei Shumi (Northern Panicum Miliaceum Granum) 9g, Fen Gancao (Powdered Glycyrrhizae Radix et Rhizoma) 2.4g, Da Chuanxiong (Large Ligusticum Chuanxiong Rhizoma) 5g, Bao Mushen (Poria with Wood) 9g, Xianhecao (Agrimoniae Herba) 15g, Huai Shanyao (Chinese Yam) 9g, Chuan Yalian (Chuan Coptis) 0.6g, Shang Angui (Top Grade Cinnamon Bark) 0.6g (powdered, swallowed). [Commentary] Suanzaoren Tang (Sour Jujube Decoction) is suitable for insomnia caused by long-term Liver Stagnation transforming into Fire disturbing the Heart Spirit. This case originated from postpartum worry and labor, making it highly appropriate. Combined Huanglian (Coptidis Rhizoma) and Rougui (Cinnamomi Cortex) forms Jiaotai Wan (Jiao-Tai Pill); Huanglian (Coptidis Rhizoma) clears Heart Fire, Rougui (Cinnamomi Cortex) warms Kidney Yang, guiding fire back to its source.
8. Male Patient Feng. Insomnia for 1 month, generally poor gastrointestinal health. Suanzaoren (Ziziphi Spinosomi Semen) 12g, Chuanxiong (Ligusticum Chuanxiong Rhizoma) 6g, Zhimu (Anemarrhenae Rhizoma) 9g, Baiziren (Platycladi Semen) 12g, Danggui (Angelicae Sinensis Radix) 9g, Bao Fushen (Poria with Pinus Root) 12g, Yejiaoteng (Polygoni Multiflori Caulis) 9g, Duan Muli (Calcined Oyster Shell) 24g (decocted first), Paofuzi (Prepared Aconiti Lateralis Radix Praeparata) 2.4g, Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma) 3g. [Commentary] Formula uses Suanzaoren Tang (Sour Jujube Decoction) to calm the Heart and remove vexation to treat insomnia. Small dose of Fuzi (Aconiti Lateralis Radix Praeparata) to invigorate Middle Yang and strengthen the gastrointestinal tract.
Deficiency Consumption