又越三日，病者来三诊，神色更爽于前，扶梯而上，已无甚喘急之状。询之，答谓盗汗悉除。恶风已罢，日间喜起坐，不嗜卧矣。饭量由一盅加至一盅有半。而其最佳之象，则尤为脉数由百二十至，减为百十有四至，咳嗽亦大稀，舌苔渐如常人。余乃改用润肺养阴宁咳化痰之剂，如象贝、杏仁、款冬、紫苑、麦冬、沙参之属。五剂竟无进退。后有老医诏余曰：子之弃建中而用贝杏者，误也。若是之证，当换笺不换方，虽服之百日，不厌其久也。余谨志而谢之。
于此有一重要问题之发生，不容搁置而勿论焉，问题维何？即所谓阳虚虚劳，阴虚虚劳之辨是也。后贤多谓古时所患虚劳多属阳虚虚劳，宜建中剂。今世所患虚劳，多属阴虚虚劳，宜养阴剂。二者误用，祸如反掌云云。而《兰台轨范》之说，则较为近理。《轨范》曰：古人所云虚劳，皆是纯虚无阳之证，与近日之阴虚火旺，吐血咳嗽者，正相反，误治必毙。今日吐血咳嗽之病，乃血证，虽有似虚劳，其实非虚劳也。又曰：小建中汤治阴寒阳衰之虚劳，正与阴虚火旺之病相反，庸医误用，害人甚多，此咽干口燥，乃津液少，非有火也。又汤本氏云：余往年误认师论及诸家学说，用黄耆建中剂于肺结核。常招失败。当时学识尚浅，不知其故。及读《兰台轨范》诸书，乃始晓然。惧后之人蹈余覆辙，故表而出之，盖胶饴性大温，有助长炎症之弊。芍药之收敛，又有抑遏皮肤肺肠肾脏排泄机能之作用。故误用本方于肺结核时，一方面助长炎症，他方面阻止结核菌毒素之排泄，故令病势增恶耳。
按以上诸家之说，诚足为吾人参考之资，请重以余浅薄之经验衡之。本案王女士所患之病，确为肺结核，使汤本氏之说而信，又安能六服轻剂建中汤，而得大效耶？推求其得效之故何在，亦无非此肺结核者，适有建中汤之证耳。使其无建中汤证，则其不效，当如汤本氏所期矣。诚以结核之范围至广，结核之病期至久，其间变化万端，岂某一方所能主治，又岂必无某一方所适治之证？故曰建中汤不得治肺结核，犹曰桂枝汤不能治太阳病，（适为脉紧无汗之麻黄证）其失维一。
至《轨范》所云阴虚火旺，吐血咳嗽，确为肺痿，为肺痈，为血证，要略自有正治。请检本书肺痈案所载，即可得其一隅。其案内附记之曹夫人恶寒盗汗，与阳虚虚劳几无以异。然卒能以甘寒之药愈之，其不混淆为一者，辨证之功也。
后人误称此等证亦曰虚劳，于是有阳虚虚劳，阴虚虚劳之辨。实则古今人同有此所谓二种虚劳之证，后人既误其名称，复化其药味，驯至古今判然，学者大惑。
负整理中医之责者，又安可不揭其秘也哉？曹颖甫曰：通俗医界莫不知培土生金之说，然往往不能用之适当者，不通仲师之医理故也。夫阳浮阴弱则汗自出，汗常出则脾病，而肺亦病。肺病则气短矣，汗常出则恶风矣，故桂枝汤本方原为扶脾阳作用，仲师不曰系在太阴乎？病积既久，脾阳益虚，肝胆之气乘之，乃至胸胁腹中俱病，故加饴糖以补脾，饴糖者麦精所煎也。但使脾阳既动，饮食入胃，自能畅适。当归黄耆亦补脾之药也，加龙骨牡蛎，则《金匮》虚劳盗汗之方治也。要而言之，不过是培土生金之用。苟得其精理所在，幸无为群言所乱也。
【又按】本案拙见意谓肺痨病者确有时属建中汤证，而谭次仲先生之卓识，则更进一步，确定建中汤为治虚痨之主方，且阐述其义，无不与西医学相吻合。
其言曰：盖治肺痨，最重要的对症疗法为健胃与营养，以使体重增加，肺之局部症状，因而轻快之一法。考《金匮·虚劳篇》，首立小建中汤。本汤以桂枝生姜为君，此即西药中所谓芳香辛辣之健胃剂也。方中配以饴糖，即西药中之滋养品也。三味均西医所同备者。而证以中医之解释，亦无丝毫违异焉。陈修园云：建中者，建立其中气也。尤在泾云：治虚劳而必以建中者，何也？盖中者，脾胃也。盖虚劳不足，纳谷者昌，故必立其中气，中气之立，必以建中也。余谓古人以建中汤谓健胃剂，此非其明证欤？且桂枝之芳香，能缓解气管支神经之痉挛，有排痰镇咳之效，已于痰饮篇之苓桂术甘汤开其端，所以仲景立小建中汤为治虚劳之主方也（但痰多者嫌其太甜，燥多者嫌其太热，可用他药代之，而师其健胃营养之法可也）。其余若发热盗汗，失精梦交，则有二加龙牡汤，及桂枝加龙牡汤，失眠则有酸枣仁汤，腰痛有肾气丸，补虚有黄耆建中汤，此皆仲圣治虚劳之正法，俱载《金匮·虚劳篇》中。考西医对肺结核之药物疗法，若合符节焉。（见《中西医药》二卷二期）高瞻远瞩，弥足钦也！
芍药甘草汤证其一
四嫂十一月十三日足遇多行走时则肿痛，而色紫，始则右足，继乃痛及左足。天寒不可向火，见火则痛剧。故虽甚恶寒，必得耐冷。然天气过冷，则又痛。眠睡至浃晨，而肿痛止，至夜则痛如故。按历节病足亦肿，但肿常不退，今有时退者，非历节也。惟痛甚时筋挛，先用芍药甘草汤以舒筋。
赤白芍各一两生甘草八钱
拙巢注：二剂愈。
芍药甘草汤证其二（附列门人治验）
京赤芍八钱生甘草四钱
【按】挚友张君挚甫客居海上，雇有年老女佣一人，方来自原籍浙江黄岩，未越半月，而病已七日矣。其病右足拘急，不能行，行则勉强以跟着地，足尖上向，如躄者然。夜则呼痛达旦，阖家为之勿寐。右足踝骨处又因乘轮擦伤，溃烂不能收口。老媪早年尝有所谓疯气之疾，缠绵三年方愈，自惧此番复发，后顾堪虞，嗒然若丧，哭求归里。挚甫怜之，亟来请诊。余细察之，右胫之皮色较左胫略青，乃疏上方。方成，挚甫以为异，亲为煎煮。汤成。老媪不肯服。曰：服之无济也，吾年前之恙略同于此，三年而后已，今安有一药而瘥者？强而后进。翌日复诊，媪右足已能全部着地，惟溃烂处反觉疼痛。余即就原方加生甘草二钱，使成六钱。炙乳没各八分，外用阳和膏及海浮散贴之。又翌日访之，老媪料理杂务，行走如健时。及见余，欢颜可掬，察之，右胫青色略减，溃处亦不痛矣。挚甫率之，长揖共谢。曰：君之方，诚神方也，值廉而功捷。余逊辞曰：我不能受君谢，君当致谢于吾师，吾师尝用此而得效也。然吾师将亦曰：我不能受君谢，君当致谢于仲师。仲师曰：作芍药甘草汤与之，其脚即伸也。挚甫略知医，曰：有是哉！执此观之，今人以本汤为小方，不屑一用之者，非也。或姑信而用之，而药量欠重，不效如故，致用而失望者，亦未达一间也。然则究竟芍药之功用为如何？吾友吴君凝轩曰：芍药能活静脉之血，故凡青筋暴露，皮肉挛急者，用之无不效。善哉，一语破千古之奥谜，酸收云乎哉？芍药能令足部之静脉血上行，使青筋隐退，步履如旧者，此芍药甘草汤中芍药之功也。患桂枝汤证者服桂枝汤后，其动脉血既畅流于外，使无芍药助之内返，岂非成表实里虚之局，此桂枝汤中芍药之功也。虽有自下达上，自表返里之异，其属于静脉一也。
抑芍药甘草汤不仅能治脚挛急，凡因跌打损伤，或睡眠姿势不正，因而腰背有筋牵强者，本汤治之同效。余亲验者屡，盖其属于静脉瘀滞一也。缘动脉之血由心脏放射于外，其力属原动而强，故少阻塞。静脉之血由外内归于心脏，其力近反动而较弱，故多迟滞。迟滞甚者，名曰血痺，亦曰恶血。故《本经》谓芍药治血痺，《别录》谓芍药散恶血。可知千百年前之古语，悉合千百年后之新说，谁谓古人之言陈腐乎？曹颖甫曰：辛未之秋予家筱云四弟妇来诊，无他病，惟两足酸疼，拘急三年矣。其子荫衢问可治与否，予告以效否不可必，药甚平稳，不妨姑试之，乃为用赤白芍各一两，生草八钱。至第三日，荫衡来告曰，服经两剂，今已行步如常矣。而佐景所用，效如桴鼓者乃又如此，此可为用经方者劝矣。
芍药一昧，李时珍《本草》所引诸家之说率以为酸寒。历来医家以讹传讹，甚有疑桂枝汤方中不应用芍药。予昔教授于石皮弄中医专校，与马嘉生等向药房取赤白芍亲尝之。白芍味甘微苦，赤芍则甚苦。可见本经苦平之解甚为的当，予谓苦者善泄，能通血络之瘀，桂枝汤为解肌药，肌腠为孙络所聚，风袭肌理则血液凝闭而不宣，故必用芍药以通之。然予说但凭理想，今吴生凝轩乃有芍药活静脉之血一解，足证予言之不谬。读《伤寒论》者可以释然无疑矣。
【又按】以上自桂枝加龙骨牡蛎汤至当归建中汤凡四证，皆从桂枝汤加减。
桂枝加龙骨牡蛎汤以盗汗失精为主，炙甘草汤以心动悸为主，小建中汤以腹中痛为主，当归建中汤以妇人经产为主，黄耆建中汤以虚劳诸不足为主，皆大补之方。
余曾揭桂枝汤为补方之义，读者或不置信，今也能毋释然？仲圣于桂枝汤之加减示范独详者，留他汤为后人作隅反，不徒省笔墨已也。至芍药甘草汤与桂枝甘草汤同为组成桂枝汤之母方，并表之以彰其功。
大陷胸汤证其一
沈家湾陈姓孩年十四，独生子也。其母爱逾掌珠，一日忽得病，邀余出诊。脉洪大，大热，口干，自汗，右足不得伸屈。病属阳明，然口虽渴，终日不欲饮水，胸部如塞，按之似痛，不胀不硬，又类悬饮内痛。大便五日未通。上湿下燥，于此可见。且太阳之湿内入胸膈，与阳明内热同病。不攻其湿痰，燥热焉除？于是遂书大陷胸汤与之。
制甘遂一钱五分大黄三钱芒硝二钱返寓后，心殊不安。盖以孩提娇嫩之躯，而予猛烈锐利之剂。倘体不胜任，则咎将谁归？且《伤寒论》中之大陷胸汤证，必心下痞鞕，而自痛，其甚者或有从心下至少腹鞕满，而痛不可近为定例。今此证并未见痞鞕，不过闷极而塞，况又似小儿积滞之证，并非太阳早下失治所致。事后追思，深悔孟浪。至翌日黎明，即亲往询问。据其母曰，服后大便畅通，燥屎与痰涎先后俱下，今已安适矣。其余诸恙，均各霍然。乃复书一清热之方以肃余邪。嗣后余屡用此方治胸膈有湿痰，肠胃有热结之证，上下双解，辄收奇效。语云，胆欲大而心欲小，于是益信古人之不予欺也！
【按】余来从师前，曾遇一证。病者为一肥妇，自谓不病则已，病则恒剧。
时当炎暑，初起，微恶风寒，胸闷，医者予以解表祛暑之方，二剂而病增。改就伤寒专家诊治，予淡豆豉、黑山梔等药。三日病更剧，专家拒而勿治。病家计无所出，乃问道于余。细审病状，胸中闷热特甚，以西药消炎膏涂其胸部，则热气腾腾上冒，如蒸笼然。且苦咯痰不出，得少许，皆粘腻不堪，似二指引之，不断如线。大便不行，全身壮热，口渴引饮，病殊棘手。因思前医既汗之不解，乃予大剂白虎以清之。服后，成效渺然，胸中闷热如故。遂亟请更医，投以化痰之剂，若枳实、竹茹、象贝、杏仁之属，都为一方。服竟，得寐片刻，醒则依然。病家迫不得已，乃赉重金，敦延负时誉之名医某。医至，持脉不二分钟，辄详言病状，历历如绘，旁听者咸惊为神。于是展纸书案，洋洋大篇，积满二笺，得数百言。
其大意曰，湿温为病，汗之不解，清之不愈，仅可用辛平一法，以宣泄之。倘发白疒咅，则吉，否则危。其方药第一味，为枇杷叶三钱，去毛包煎，余如象贝、杏仁、蝉衣、丝瓜络等，悉属王道和平之品，量亦绝轻。方成，其家人持以请教最初之医，医曰：此方和平，任何人，任何时，服均无损。于是病家遂与服。服后效否，自在阅者明鉴之中，无庸赘陈。然病家笃信名医，名医自为悉心调治。果出白疒咅，悉如预言，先后四十余日，病乃渐瘥。余深惭从前学植疏浅，及今追忆，此妇之疾，实大陷胸汤证也！现其胸中苦闷之状，如顽敌负固而守，恰无二致，不有劲旅，如甘遂硝黄等将军者，安能披坚陷阵，而底于平哉？然则陷胸二字，其义亦深长矣。《王孟英医案》云：陈赤堂令正患感，面赤不眠，烦燥谵语，口甘渴腻，溲涩而疼，顾听泉多剂清解未应。孟英切其脉，左弦洪而数，右滑而溢，胸次痞结，大解未行。肝阳上浮，肺气不降，痰热阻痺，邪乃逗留。与小陷胸汤，合温胆雪羹，加旋薤投之，胸结渐开。乃去半夏，而送当归龙荟丸，谵语止且能眠，参以通幽汤，下其黑矢。三次后，始进养阴和胃而痊。陆士谔按云：面赤不眠，烦躁谵语，口甘渴腻，溲涩而疼，脉左弦洪而数，右滑而溢，胸次痞结，大解未行，显然邪热熏灼，顽痰阻滞。与小陷胸合温胆雪羹加旋薤，破结舒气化痰，实为吃紧之治。当归龙荟丸乃是钱氏方，当归、龙胆草、山梔、川连、川柏、黄芩、大黄、芦荟、青黛、木香、麝香专治肝经实火者。通幽汤则东垣方也，当归身、升麻梢、桃仁、甘草、红花、生熟地。参其法者，吾意升麻熟地当必去也。以上王案陆按相得益彰，与上述肥妇案之名医用枇杷叶蝉衣者，实有霄壤之别。然此案设逢吾师诊治，其必用大陷胸汤无疑。其奏效之捷，吾知必较小陷胸汤加味更胜一筹也。
Three days later, the patient came for the third visit. His expression was more refreshed than before; he could climb the stairs and no longer had severe panting or shortness of breath. Upon inquiry, he replied that night sweats had completely ceased. The aversion to wind had also subsided; he now preferred to sit up during the day and was no longer lethargic. His food intake increased from one bowl to one and a half bowls. The most favorable sign, however, was that his pulse rate decreased from 120 beats per minute to 104 beats per minute. Coughing significantly reduced, and the tongue coating gradually returned to normal. I then switched to a formula for moistening the lungs, nourishing yin, calming cough, and resolving phlegm, such as Fritillariae Thunbergii Bulbus (Xiangbei), Armeniacae Semen (Xingren), Dendranthemi Flos (Kuandonghua), Asteris Radix et Rhizoma (Ziwan), Ophiopogonis Radix (Maidong), and Glehniae Radix (Shashen). After five doses, there was no improvement or deterioration. Later, an experienced physician advised me: "Your decision to abandon Xiaojianzhong Tang (Minor Construct the Middle Decoction) in favor of Fritillariae Thunbergii Bulbus and Armeniacae Semen was a mistake. For this type of syndrome, one should maintain the core therapeutic principle while adjusting the prescription; even if taken for a hundred days, it is not too long." I respectfully noted this advice and thanked him.
A significant issue arises here, which cannot be ignored: the differentiation between Yang-deficiency Xu Lao (Consumptive Disease due to Yang Deficiency) and Yin-deficiency Xu Lao. Many later physicians believe that ancient cases of Xu Lao were mostly Yang-deficiency types, suitable for Xiaojianzhong Tang formulas. In contrast, modern cases are mostly Yin-deficiency types, suitable for yin-nourishing formulas. Misusing either can lead to disastrous consequences instantly. However, the statement in *Lantai Guifan* (Standard Practices of the Imperial Medical Bureau) seems more reasonable. It states: "The Xu Lao mentioned by ancients refers to pure deficiency without Yang, which is exactly opposite to recent cases of Yin-deficiency with Fire-hyperactivity, hemoptysis, and cough. Misdiagnosis will certainly be fatal. Today's hemoptysis and cough are Blood disorders; although they resemble Xu Lao, they are not truly Xu Lao." It further says: "Xiaojianzhong Tang treats Xu Lao caused by Yin-cold and Yang-depletion, which is contrary to Yin-deficiency with Fire-hyperactivity. Quack doctors misuse it, harming many people. This dry throat and mouth is due to scanty body fluids, not Fire." Additionally, Dr. Kōmoto stated: "In past years, I mistakenly applied Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) for pulmonary tuberculosis based on my teacher's theories and other schools' doctrines, often encountering failure. My knowledge was shallow at the time, and I did not understand why. Only after reading *Lantai Guifan* and other books did I realize the truth. Fearing others would tread in my footsteps, I published this. Yi Tang (Maltose) is very warm and may exacerbate inflammation. Shaoyao (Peony Root) has astringent properties that may inhibit the excretory functions of the skin, lungs, intestines, and kidneys. Therefore, misusing this formula for pulmonary tuberculosis一方面 promotes inflammation and另一方面 blocks the excretion of tubercle bacillus toxins, worsening the condition."
Based on the above opinions, they indeed provide valuable reference material. Let me evaluate them with my humble experience. In this case, Ms. Wang suffered from pulmonary tuberculosis. If Dr. Kōmoto's view were correct, how could she have achieved great results after taking six doses of a mild Jianzhong Tang? The reason for its efficacy lies simply in the fact that this tuberculosis patient happened to present with a Xiaojianzhong Tang syndrome. Had she not presented with this syndrome, it would have been ineffective, as Dr. Kōmoto predicted. Indeed, the scope of tuberculosis is vast, and its course is long, with myriad changes. Can any single formula treat all cases? Is it possible that no formula fits certain syndromes? Thus, saying "Jianzhong Tang cannot treat pulmonary tuberculosis" is like saying "Guizhi Tang (Cinnamon Twig Decoction) cannot treat Taiyang disease (specifically Ma Huang Tang syndrome characterized by tight pulse and absence of sweating); both errors are identical."
Regarding *Lantai Guifan*'s mention of Yin-deficiency with Fire-hyperactivity, hemoptysis, and cough, these are indeed Fei Wei (Flaccidity of the Lung), Fei Yong (Lung Abscess), or Blood disorders, which have standard treatments in *Jingui Yaolue*. Refer to the Lung Abscess case in this book for examples. In the attached record of Lady Cao, her aversion to cold and night sweats were almost indistinguishable from Yang-deficiency Xu Lao. Yet she was ultimately cured using sweet-cold herbs. This distinction demonstrates the power of pattern differentiation.
Later generations mistakenly called these conditions "Xu Lao," leading to the differentiation between Yang-deficiency and Yin-deficiency Xu Lao. In reality, both ancient and modern people suffer from these two types of Xu Lao. Later generations not only misnamed them but also altered the herbal compositions, causing a sharp divide between ancient and modern practices, confusing scholars. Those responsible for organizing Traditional Chinese Medicine must uncover these secrets. Cao Yingfu said: "Everyone in the popular medical field knows the theory of 'Nourishing Earth to Generate Metal,' yet few apply it appropriately because they do not understand Zhongjing's medical principles. When Yang floats and Yin is weak, sweat occurs spontaneously. Frequent sweating damages the Spleen, which in turn affects the Lung. Lung disease causes shortness of breath, and frequent sweating causes aversion to wind. Thus, Guizhi Tang originally serves to support Spleen-Yang. Did Zhongjing not say it relates to the Taiyin channel? As the disease persists, Spleen-Yang becomes increasingly deficient, allowing Liver and Gallbladder Qi to invade, causing pain in the chest, hypochondrium, and abdomen. Therefore, Yi Tang is added to tonify the Spleen; Yi Tang is made from wheat essence. Once Spleen-Yang moves, food entering the stomach will be digested smoothly. Danggui (Angelica Sinensis Radix) and Huangqi (Astragali Radix) also tonify the Spleen. Adding Longgu (Fossilized Bones) and Muli (Oyster Shell) constitutes the formula for treating night sweats in Xu Lao from *Jingui Yaolue*. In summary, this is merely the application of 'Nourishing Earth to Generate Metal.' If one grasps the essential principle, one should not be confused by conflicting theories."
[Additional Note] My humble opinion is that patients with Tuberculosis (Fei Lao) sometimes present with a Xiaojianzhong Tang syndrome. Mr. Tan Cizhong's insight goes further, establishing Xiaojianzhong Tang as the primary formula for treating Xu Lao, explaining its rationale, which aligns perfectly with Western medicine.
He stated: "The most important symptomatic treatment for Tuberculosis is gastrointestinal health and nutrition, aiming to increase body weight and alleviate local pulmonary symptoms. Examining the *Xu Lao Chapter* of *Jingui Yaolue*, Xiaojianzhong Tang is established first. This formula uses Guizhi (Cinnamon Twig) and Shengjiang (Fresh Ginger) as sovereign drugs, corresponding to aromatic and pungent gastrointestinal tonics in Western medicine. Yi Tang (Maltose) in the formula corresponds to nutritional supplements in Western medicine. These three ingredients are common in Western pharmacology. Interpreted through TCM, there is no contradiction. Chen Xiuyuan said: 'Jianzhong means establishing the Middle Qi.' You Zaijing said: 'Why must Jianzhong be used for Xu Lao? The Middle refers to the Spleen and Stomach. In Xu Lao deficiency, good appetite leads to prosperity; thus, one must establish Middle Qi, which requires Jianzhong.' I believe the ancients referred to Jianzhong Tang as a gastrointestinal tonic, which is clear evidence. Moreover, the aroma of Guizhi can relieve spasms of the tracheal and bronchial nerves, having expectorant and antitussive effects, as seen in Ling Gui Zhu Gan Tang in the Phlegm-Fluids chapter. Hence, Zhongjing established Xiaojianzhong Tang as the primary formula for Xu Lao (However, for those with excessive phlegm, it is too sweet; for those with excessive dryness, it is too hot. Other herbs may substitute, but the method of tonifying the stomach and nourishing should be retained). For fever, night sweats, seminal emission, and nocturnal emissions, Erjia Longgu Muli Tang and Guizhi Jia Longgu Muli Tang are used. For insomnia, Suanzaoren Tang is used. For lower back pain, Shenqi Wan is used. For deficiency tonification, Huangqi Jianzhong Tang is used. These are all orthodox methods of Zhongsheng for treating Xu Lao, recorded in the *Xu Lao Chapter* of *Jingui Yaolue*. This matches Western pharmacological therapy for pulmonary tuberculosis perfectly. (See *Chinese and Western Medicine*, Vol. 2, Issue 2). His foresight is admirable!
**Shaoyao Gancao Tang Syndrome I**
Fourth Sister-in-law: On November 13th, her feet swelled and became painful and purple when walking extensively. Initially the right foot, then the left. She could not approach fire in cold weather; pain intensified upon exposure to heat. Although severely averse to cold, she had to endure cold. However, extreme cold also caused pain. Sleep until early morning relieved swelling and pain; pain returned at night. Lijie disease (Joint Bi) also causes foot swelling, but the swelling usually does not recede. Since hers receded at times, it is not Lijie. Only when pain was severe did muscle cramps occur. I first used Shaoyao Gancao Tang (Peony and Licorice Decoction) to relax the tendons.
Chi Shaoyao (Red Peony Root) and Bai Shaoyao (White Peony Root) each 1 liang, Sheng Gancao (Raw Licorice Root) 8 qian.
Zhuochao Note: Cured in two doses.
**Shaoyao Gancao Tang Syndrome II (Including Student's Case)**
Old Maid: On February 7th, her right foot walked poorly due to blood stasis. Shaoyao Gancao Tang was prescribed to dredge the meridians.
Jing Chi Shaoyao (Beijing Red Peony Root) 8 qian, Sheng Gancao (Raw Licorice Root) 4 qian.
[Note] My close friend, Mr. Zhang Zhifu, residing in Shanghai, employed an elderly female servant from Huangyan, Zhejiang. Less than half a month after her arrival, she fell ill for seven days. Her symptom was right leg stiffness and inability to walk; she could only drag her heel, with toes pointing upward, resembling a limp. She cried out in pain all night, keeping the family awake. Her right ankle had an abrasion from travel that failed to heal. She had suffered from a mental illness ("madness") for three years in her youth and feared recurrence, despairing and crying to return home. Mr. Zhang pitied her and sought my consultation. I observed that the skin color of her right shin was slightly bluer than the left, so I prescribed the above formula. Mr. Zhang found it unusual and boiled it himself. The old woman refused to take it, saying, "It won't help. My previous similar illness took three years to resolve. How can one dose cure it?" She was forced to take it. The next day, she could place her entire foot on the ground, though the ulcer was painful. I added 2 qian of Sheng Gancao to make 6 qian total, plus 8 fen of Zhi Ruxiang (Frankincense) and Mozhe (Myrrh), applying Yanghe Gao and Haifou San externally. The following day, she was managing chores and walking normally. Seeing me, she smiled brightly; the blue discoloration had faded, and the ulcer was painless. Mr. Zhang bowed in gratitude, saying, "Your prescription is miraculous, cheap, and effective." I declined, saying, "Thank my teacher, who used this successfully. But he would tell you to thank Zhongjing, who said, 'Give Shaoyao Gancao Tang, and the legs will extend.'" Mr. Zhang, knowing some medicine, remarked, "Indeed! Modern practitioners disdain this small formula or use insufficient dosages, leading to disappointment. What is the true function of Shaoyao?" My friend Wu Ningxuan said, "Shaoyao activates venous blood. Therefore, for exposed varicose veins and muscle contractures, it is always effective." This breaks the ancient mystery of its sour-astringent nature. Shaoyao promotes upward flow of venous blood in the legs, reducing varicosities and restoring gait. This is the功 (function) of Shaoyao in Shaoyao Gancao Tang. For patients with Guizhi Tang syndrome, after taking Guizhi Tang, arterial blood flows freely outward. Without Shaoyao assisting inward circulation, it would result in exterior excess and interior deficiency. This is the role of Shaoyao in Guizhi Tang. Whether moving from bottom to top or exterior to interior, it pertains to the veins.
Moreover, Shaoyao Gancao Tang not only treats leg cramps but also waist and back stiffness due to trauma or improper sleeping posture, as these involve venous stasis. Arterial blood flows outward from the heart with strong force, rarely obstructed. Venous blood returns inward with weaker force, often stagnating. Severe stagnation is called Xue Bi (Blood Bi) or E Xue (Evil Blood). Thus, *Ben Jing* states Shaoyao treats Xue Bi, and *Bie Lu* states it disperses Evil Blood. Ancient words align with modern science. Who says ancient texts are obsolete? Cao Yingfu said: "In autumn of Xinwei year, my fourth brother-in-law's wife consulted me. No other illness, only soreness and cramping in both legs for three years. Her son asked if it was curable. I said efficacy is uncertain, but the medicine is safe. I prescribed Chi/Bai Shaoyao each 1 liang, Sheng Gancao 8 qian. On the third day, her son reported she could walk normally after two doses. Zhaosheng's cases show similar rapid efficacy. This encourages the use of Jingfang."
Li Shizhen's *Bencao Gangmu* cites various authorities describing Shaoyao as sour and cold. Physicians passed down this error, some doubting Shaoyao's use in Guizhi Tang. While teaching at Shipin Lane TCM School, I tasted Chi and Bai Shaoyao with Ma Jiasheng. Bai Shaoyao is sweet and slightly bitter; Chi Shaoyao is very bitter. This confirms *Ben Jing*'s description of "bitter and neutral." Bitter herbs promote drainage and unblock blood collaterals. Guizhi Tang releases the muscle layer, where collateral vessels gather. Wind invading the muscles causes blood coagulation and obstruction; thus, Shaoyao is needed to unblock it. My theory was idealistic until Wu Ningxuan explained Shaoyao's activation of venous blood, proving my point. Readers of *Shanghan Lun* need no longer doubt.
[Additional Note] The four syndromes from Guizhi Jia Longgu Muli Tang to Danggui Jianzhong Tang are all modifications of Guizhi Tang.
Guizhi Jia Longgu Muli Tang primarily treats night sweats and seminal emission. Zhigancao Tang primarily treats palpitations. Xiaojianzhong Tang primarily treats abdominal pain. Danggui Jianzhong Tang primarily treats women's menstrual and postpartum conditions. Huangqi Jianzhong Tang primarily treats general deficiency in Xu Lao. All are major tonifying formulas.
I previously revealed that Guizhi Tang is a tonifying formula. Readers may doubt this, but now they should be convinced. Zhongjing detailed the modifications of Guizhi Tang to teach future generations举一反三 (infer other cases from one example), not just to save ink. Shaoyao Gancao Tang and Guizhi Gancao Tang are mother formulas composing Guizhi Tang; listing them highlights their importance.
**Daxiexiong Tang Syndrome I**
Chen family boy, 14 years old, only son. His mother loved him dearly. One day he fell ill. Pulse was large and flooding, high fever, dry mouth, spontaneous sweating, right leg unable to flex or extend. The disease belonged to Yangming, yet despite thirst, he did not want to drink all day. His chest felt blocked, tender on pressure, but not distended or hard, resembling Xuan Yin (Suspended Fluid) internal pain. Bowels had not moved for five days. Upper dampness and lower dryness were evident. Taiyin dampness entered the chest and diaphragm, combining with Yangming internal heat. Without attacking the damp-phlegm, how could the dry-heat be removed? I prescribed Daxiexiong Tang (Major Expel the Chest Decoction).
Zhi Gansui (Prepared Kansui Root) 1.5 qian, Dahuang (Rhubarb Root) 3 qian, Mangxiao (Mirabilite) 2 qian.
Returning home, I felt uneasy. Giving such a potent formula to a delicate child was risky. If he couldn't tolerate it, who would bear the blame? The *Shanghan Lun* specifies Daxiexiong Tang syndrome involves epigastric fullness and hardness with pain, potentially extending to the lower abdomen. This case lacked fullness/hardness, only feeling extremely stuffy, resembling pediatric food stagnation, not premature purgation of Taiyang disease. Regretting my rashness, I visited at dawn. The mother reported smooth bowel movements, expelling dry stool and phlegm-saliva. He was comfortable, and other symptoms resolved. I prescribed a clearing-heat formula to remove residual pathogens. Since then, I have frequently used this formula for chest/diaphragm damp-phlegm and intestinal/colonic heat accumulation, achieving remarkable results with dual upper-lower resolution. "Courageous yet cautious," I now trust the ancients' wisdom.
[Note] Before studying under my master, I encountered a case. A obese woman claimed she was fine unless sick, in which case she was severely ill.
During summer heat, she initially had slight aversion to wind/cold and chest oppression. The doctor gave exterior-releasing and summerheat-resolving herbs; after two doses, the condition worsened. A Shanghan specialist treated her with Danshaodouchi (Fermented Soybean) and Heishanzhi (Black Gardenia); after three days, it worsened further, and the specialist refused treatment. Desperate, they asked me. Careful examination revealed intense chest heat/stuffiness. Applying Western anti-inflammatory ointment caused heat to rise like a steamer. She struggled to expectorate sticky, thread-like phlegm. Bowels were blocked, whole-body high fever, thirst with desire to drink. The case was difficult. Thinking the previous sweating failed, I gave a large dose of Baihu Tang (White Tiger Decoction) to clear heat. With little effect, chest heat persisted. I urgently sought another doctor, prescribing phlegm-resolving herbs like Zhishi (Immature Bitter Orange), Zhuru (Bamboo Shavings), Xiangbei, and Xingren. She slept briefly but woke unchanged. Desperate, they hired a famous doctor with heavy payment. The doctor diagnosed in two minutes, describing symptoms vividly, astonishing listeners. He wrote a long prescription: "Wenwen (Warm-Damp) disease, unresponsive to sweating or clearing, requires a neutral method to vent. If white papules appear, prognosis is good; otherwise, critical. First herb: Pipaye (Loquat Leaf) 3 qian, wrapped and decocted. Others: Xiangbei, Xingcan, Chanyi (Cicada Slough), Sigualuo (Luffa Fiber), all mild and gentle, light dosage." The family showed this to the original doctor, who said, "This formula is mild; anyone can take it anytime without harm." They administered it. Outcome is for readers to judge. The family trusted the famous doctor, who treated carefully. White papules appeared as predicted. After 40+ days, she gradually recovered. I deeply regretted my shallow learning. Recalling now, this woman's illness was actually a Daxiexiong Tang syndrome! Her chest oppression was like a stubborn enemy defending a fortress. Without powerful generals like Gansui, Mangxiao, and Dahuang, how could one breach the defenses and achieve peace? Thus, "Expel the Chest" implies deep meaning. *Wang Mengying's Medical Cases* records: Lady Chen suffered from external pathogen, red face, insomnia, irritability, delirium, sweet/greasy taste, painful urination. Gu Tingquan's clearing prescriptions failed. Wang's pulse: left wiry/flooding/rapid, right slippery/excessive. Chest blockage, no bowel movement. Liver Yang floating, Lung Qi failing to descend, phlegm-heat blocking. Prescribed Xiao Xianxiong Tang combined with Wendan and Xue Geng, adding Xuanfuhua and Xiebai. Chest blockage opened. Removed Banxia, administered Danggui Longhui Wan. Delirium stopped, sleep resumed. Added Tongyou Tang to evacuate black stool. After three times, nourished Yin and harmonized Stomach to recover. Lu Shile commented: Symptoms clearly indicate evil heat scorching and stubborn phlegm blocking. Xiao Xianxiong combined with Wendan/Xue Geng/Xuan/Xie breaks blockage, soothes Qi, resolves phlegm—crucial treatment. Danggui Longhui Wan (Qian's formula) treats Liver Fire excess. Tongyou Tang (Dongyuan's formula) evacuates stagnation. Removing Shengma/Shudi is wise. Wang's case and Lu's comment complement each other, contrasting sharply with the famous doctor's use of Pipaye/Chanyi for the obese woman. If my master treated this case, he would undoubtedly use Daxiexiong Tang. Its rapid efficacy would surely surpass modified Xiao Xianxiong Tang.