太阳证发热
(长期低热)
郭××，女，24岁。北京某医院医务人员。
[病史)近三年来，常间歇性低热。1976年3月，感冒发烧，曾服用感冒冲剂、四环素等药。其后经常自觉畏寒发热，常患扁桃体炎和关节痛。腋温，一般在37．4～38℃，偶尔在38℃以上。曾查血沉25毫米／小时，其它如白血球和基础代谢均正常。注射卡那霉素后，热暂退，但始终呈间歇性发作。自1978年初以后，每日皆发热两次，体温在37．5℃上下。虽经治疗，未愈。1979年3月来诊，按太阳伤寒证发热论治，两诊热退。
[初诊]3月1日。今晨自觉畏寒发热，测体温37．4℃ ，畏寒发热、身无汗，两膝关节疼痛，面色正常，唇淡红，舌质淡红而润、微紫暗，苔黄挟白较腻，脉浮紧。此为太阳伤寒表实证，法宜开腠发汗、安中攘外，以麻黄汤主之。
处方：
麻黄10克桂枝6克甘草18克杏仁15克二剂
[辨证]《伤寒论》云： “太阳病， 头痛发热，身疼腰痛，骨节疼痛，恶风，无汗而喘者，麻黄汤主之。”此为太阳伤寒之主证。柯韵伯曾指出： “麻黄八证……重在发热身疼，无汗而喘。本例患者未致肺气郁闭，故无喘证，其余麻黄汤之主证皆备。舌质淡红润，苔白，为有寒象，这种舌质，再加淡黄色苔，参之舌微现紫暗，为陈寒郁滞已久之征。脉浮，病在表，紧则为寒。寒邪外束，身之阳气不得宣散，故令发热。此非阳明实热，故虽发热而不甚，虽间歇性发热而非潮热可比。寒主闭藏，使皮毛闭，故身无汗。营卫阻滞，失正常之卫外机能，故畏寒。寒邪郁于经脉之间，阳气不舒，故令骨节疼痛。
此病之初，原为外感风寒之邪，虽迁延三载，但始终缠绵未解，并未传经。转来初诊时，病仍属太阳伤寒表实，麻黄证具，故不拘其日，仍当发其汗。
[二诊]3月3日。服药后，身觉微汗出，恶寒减，舌紫暗渐退，苔白滑根部微黄，脉细微缓。尚有轻微发热，病仍在太阳。服麻黄汤后，发热恶寒皆减，但现身汗出，脉微缓，营卫失和之象。法宜通阳解表，调和营卫，以桂枝汤加味主之。
处方：
桂枝10克 白芍1O克炙甘草6克生姜60克大枣10枚白薇12克三剂
[三诊]3月8日。上方服三剂后热退。两日来未再低热．试体温36．7。c。膝关节偶尔有短瞬疼痛，微觉头昏，梦多，此外身无明显不适，舌脉均转正常。再少进调和营卫之剂，巩固疗效，并嘱其注意饮食起居，避免病情反复。
7月17日随访，患者说：自第二诊服药后低热退，至今未再复发，自觉一直良好。
[按语]从祖国医学看，发热的原因，可归纳为外感和内伤两类。在外感热病即伤寒病中，发热为主要见证之一。如太阳病多恶寒发热；阳明病多蒸蒸发热或潮热；少阳病为往来寒热；少阴病发热则有寒化热化之别，还有兼证及阳气渐复发热之异；厥阴病发热主要表现在阴阳胜复过程中，有正胜于邪及阳复太过发热等不同；唯太阴为至阴，所谓“两阴相合，无热可发”。上述诸发热证，虽性质各不相同，并且不论高热低热，均有一定规律性，皆可按六经辨证施治。
本例患者间歇性低热反复发作，已三年之久，但未传经。这样长的时间，始终属太阳表证，似乎不好理解。实际上，后世《伤寒论》注家，对此已有阐发，认为太阳病传变与否，应凭脉证，计日传经之说，不可拘泥。不过，此证虽未犯他经，却在太阳经内变化；所谓表虚表实．常可相互转化。因此，关键在于严格掌握六经及其传变规律。本例辨证准确，抓住太阳病恶寒发热这一基本特征，灵活使用麻黄汤和桂枝汤，先后有别，分寸恰当，故使三年缠绵之疾，数日内迎刃而解。
太阳证偏头痛
(三叉神经痛)
邢××，女，67岁。河北省任丘县马家坞乡，农民。
[病史]1975年春节，左面部疼痛， 其后逐渐转为剧痛，阵阵发作，持续三年之久。任丘××医院，北京××医院等诊断为“三叉神经痛”。经针灸、中西药物治疗，未明显好转。1978年12月18日来诊，按太阳证偏头痛论治，两诊而愈。
[初诊]12月18日。近日来疼痛加剧，痛甚时脸肿发亮，眼不能睁，夜不能眠，坐卧不宁，生活无法自理。微恶寒，无汗，舌质淡红，苔淡黄润夹白，根稍厚腻。此为太阳伤寒表实证偏头痛，风寒挟湿侵袭，无从达泄，法宜解表开闭，散寒除湿，以麻黄汤加味主之。
处方：
麻黄10克桂枝10克炙甘草18克杏仁18克 法夏15克二剂 (辨证]此证头面左侧剧痛，病属偏头痛。 头居人之首，位高而属阳。手足三阳经脉，以及脏腑清阳之气，皆会于此。舌质淡红而润，苔淡黄夹白不燥，即为风寒夹湿，入侵肌腠，郁闭不解之象；参之头一侧痛甚，微恶寒无汗，显系邪犯太阳经脉；再参之无阳明、少阳病情，更无三阴之候，亦可以佐证。因此，本例偏头痛，不必拘于头痛偏侧多属少阳，或头痛日久，多属内伤之常规。而应从实际出发，按六经辨证，太阳伤寒表实之证具，邪无达泄之路而上扰，以致多年头痛不愈，急用麻黄汤以开之。
[二诊]服药二剂，疼痛明显减轻，余证亦随之好转。原方再服二剂。
[三诊]剧痛消失，夜能安睡， 精神顿觉清爽，多年痛楚若失，不胜欣喜。舌质正常，苔黄腻退。头部微觉恶风，头左侧尚有轻微阵痛。风邪未尽，尚有病后营卫不和之象。宜祛风解肌，桂枝汤和之，以善其后。
处方：
桂枝10克 白芍12克炙甘草10克生姜15克大枣20克二剂
服二剂，病愈，遂停药。嘱其免受风寒。观察约一月，情况良好。患者说：“头痛三年，真是痛苦极了，花了二、三百元，还是不好。范老看了三次，每付药只四、五味，一共只花了一元零一分钱，病就治好了，真使我感动。”遂返回家乡。其后，向其亲属追访，知病未复发。
[按语]“三叉神经痛”，目前病因还不十分清楚。老年人患此病尤多，可能与神经传导功能障碍有关。西医治疗，多采用镇痛剂、酒精封闭等法，无效时则考虑开颅行三叉神经根切手术。这样虽能解除剧痛之苦，但术后面部易出现后遗症，且不易为患者所接受。
祖国医学认为，举凡风寒暑湿等外邪，气血痰郁之内伤，均可以引起头痛。本例按仲景六经辨证，应属太阳经证，伤于风寒雾露所致。故急投开表、逐邪、发汗之峻剂麻黄汤，直达病所；继而以桂枝汤和之。用麻黄汤加法夏者， “其用有四：除湿化痰涎，大和脾胃气，痰厥及头疼，非此莫能治”。
太阳证眩晕
(美尼尔氏综合症)
罗××，女，34岁。成都市某场工人。
(病史]1976年5月，突感眩晕，如坐舟中，卧床不起。成都市××医院内科确诊为“美尼尔氏综合症”。数日后转来求诊。
[初诊)四天前，下班回家，自觉头胀痛，眩晕甚，颇欲吐。次日上班，到厂后片刻即晕倒。呕吐频繁，吐出大量清涎，头晕似天旋地转。恶寒、咳嗽、无汗。舌质偏淡，苔微黄。此太阳证，寒邪闭阻，水饮内停而致眩晕。法宜先从温化寒饮，祛痰降逆入手，以半夏干姜散加味主之。
处方：
法夏18克 干姜18克云苓30克甘草3克[二诊]干呕消失，头胀痛、眩晕减轻。 再宜表里同治，散外寒，涤内饮，以小青龙汤加减主之。
处方：
麻黄10克法夏15克千姜10克甘草15克二剂
[三诊]头晕、咳嗽进一步好转，痰涎减。 表邪未尽，阳气尚虚，继以麻黄细辛附子汤，助阳解表。
处方：
麻黄10克制附片60克(久煎) 辽细辛6克桂枝10克干姜60克甘草30克四剂
服药后，自己单独乘公共汽车前来诊病，尚有头晕胀之感，舌淡红，苔薄白微黄。又少进散寒除湿，安中攘外之品，数日后病愈。1979年10月26日追访，三年来坚持上班，病未复发。
[按语]《金匮要略》云： “干呕、吐逆、 吐涎沫，半夏干姜散主之”。故首用此温中止呕之法。重加茯苓，取其健脾利水渗湿，既能扶正，又可祛邪，且为治痰主药。服药两剂，病情好转。次用小青龙汤与麻黄细辛附子汤，取其善涤内饮，助阳驱邪之功。
太阳证咳嗽
(支气管扩张)
常××，女，22岁。中国人民解放军某部学员。
[病史]患者五岁出麻疹时，曾合并肺炎。其后常吐浓痰，并转为咳血。1970年，经北京几家医院会诊，诊断为“支气管扩张”。先后在北京、上海、山西等地治疗，咳血基本控制，但经常头痛，时发高烧。医院多次建议手术治疗，患者家属未接受。病情逐渐加重，终于不能坚持学习，从某军医学校休学。1978年5月2日来诊，按太阳证温病论治，两月余基本治愈。
[初诊]头昏头痛，身热而不恶寒； 手心灼热，汗出，心烦，渴喜凉饮。咳嗽，频频吐大量浓黄稠痰，便秘，睡眠不安。面红亮，双颧有明显黑斑，唇绛红，舌质鲜红，苔黄厚腻而紧密，脉洪数。此系温病伏邪为外感所触发，并上犯肺经所致。法宜宣肺泄热，降逆止咳。以麻杏石甘汤加味主之。
处方：
麻黄10克杏仁24克石膏60克甘草18克葶苈子10克川贝15克[辨证]《伤寒论》云： “太阳病， 发热而渴，不恶寒者，为温病”。仲景在此提出不恶寒而渴，与恶寒而不渴，作为辨别温病与伤寒之标志。本例患者，虽身热头痛与伤寒相似，但不恶寒而渴，故当属温病。因伤寒传变化热，必传经而后渴；温邪不待传变，虽病在表而热邪伤津，故渴。同时伤寒为寒邪，故身发热而恶寒；温病为阳邪，故发热而不恶寒。此例温病，邪热壅肺，病根已深，肺失宣降，故咳甚，吐浓痰；蕴热日久，必伤血络而致咳血。参之舌象，舌质鲜红，苔黄厚腻而紧密，亦与上述印证相符；而两颧属肺，湿积于肺，日久不得宣化，内聚成痰，外现于面，故形成两颧黑斑也。据此，立法处方，服药十剂，咳嗽与浓痰减，手心灼热，头痛心烦，睡眠不宁等均有好转，面红亮亦稍退。
[二诊]痰、咳、烦、热等虽有好转， 但舌质仍鲜红，苔黄少津，便秘，时有发热，此郁热虽衰而津液未复。宜守原法，兼顾生津润燥以养阴。以麻杏石甘汤合竹叶石膏汤加减主之。
处方：
麻黄10克杏仁18克石膏60克竹叶10克麦
冬12克甘草3克桑皮15克 川贝15克黄芩
10克知母12克荷叶12克三剂
服三剂后，发热、便秘、头昏、咳吐浓痰等显著好转。原方损益又服十剂。
[三诊]舌质红、苔白润，偶尔尚吐稠痰。上述诸证悉减，两颧黑斑基本消退，病已显著好转。为祛多年余邪，宜养阴清肺，以善其后。自拟养阴清肺汤主之。
处方：
桑皮12克杏仁12克 川贝10克 橘红10克麦冬12克 白芍12克银花10克连翘10克甘草3克1979年2月25日追访患者，其家长告之， 患者已于1978年秋复学，情况一直很好。
太阳证咳嗽
晏××，女，66岁。四川郫县某乡，农民。
[病史]体质素虚，有咳嗽病史。1970年8月中旬遇风雨后，突然高烧剧咳，头痛胸痛，气紧，吐黄稠痰。急送××医院，测体温39．5℃ ，经胸透、验血，诊为“急性肺炎”。注射青、链霉素等，高热虽退，但咳嗽、气紧等证仍较重。同年9月初， 由子女抬至成都就诊。
[诊治]咳嗽不休，神疲面肿， 气逆不能平卧，喉间痰鸣如水鸡声，痰壅盛，色黄。自觉胸腹微热，间有寒战。舌尖边红，苔微黄腻。此为风寒外邪侵犯肺卫，气机阻滞，肺失清肃，兼有郁热，邪聚于胸膈。证属太阳伤寒咳嗽，法宜宣肺降逆，止咳祛痰，以射干麻黄汤加减主之。
处方：射干12克麻黄12克辽细辛3克炙紫菀12克炙冬花10克法夏12克黄芩10克川贝12克(冲) 甘草15克一剂
上方服后，自觉胸部稍宽舒，咳喘略缓。原方再进三剂，咳喘郁热减，痰仍盛。去黄芩，加桔梗、云苓，又进三剂，诸证显著好转。嘱原方再进三剂，以资巩固疗效。
1979年7月21日追访：患者现已74岁高龄， 谈及当年病势沉重，经范老治愈，九年来身体较好。现在还能步行到附近场镇赶集。
[按语]《金匮要略》云： “咳而上气，喉中水鸡声，射干麻黄汤主之”。本案病属太阳伤寒，与射干麻黄汤证相合，故以此方加减治之。因风寒郁闭，微有热象，去五味之收，大枣之腻，生姜之辛；另加黄芩、川贝，以增强清肺化痰之效。
太阳证哮喘
马××，男，3岁。四川双流县某乡。
[病史]从婴儿时起，常患感冒。两岁时，曾高热咳嗽，服药后热退，但咳嗽未愈，迁延至三岁。近因新感，病势加重，发为喘逆，哮鸣之声，邻室可闻。1965年5月来诊。
[一诊]咳嗽气喘，喉间痰鸣，痰清稀，白泡沫较多，咳时微汗出，遇风咳甚。面色萎黄，舌质淡红，苔白滑。此为太阳表虚证哮喘。法宜解肌祛风，降逆平喘，以桂枝加厚朴杏子汤加味主之。
处方：
桂枝6克炙甘草3克 白芍6克生姜10克大枣15克 厚朴4克杏仁6克紫菀6克防风3克五剂
[二诊]服上方五剂，咳喘明显减轻，夜能安睡。早晚遇风仍咳喘，痰多，汗出。风邪未尽，湿痰尚盛。上方加茯苓、陈皮、法夏，以除湿化痰。
处方：
Taiyang Syndrome Fever
(Long-term Low-grade Fever)
Guo XX, Female, 24 years old. Medical staff member at a hospital in Beijing.
[Medical History] For the past three years, she has frequently experienced intermittent low-grade fever. In March 1976, due to a cold and fever, she took cold granules, tetracycline, and other medications. Thereafter, she often felt aversion to cold and fever, and frequently suffered from tonsillitis and joint pain. Axillary temperature was generally between 37.4°C and 38°C, occasionally exceeding 38°C. Erythrocyte sedimentation rate (ESR) was checked at 25 mm/hour; white blood cell count and basal metabolic rate were otherwise normal. After injection of kanamycin, the fever temporarily subsided but always recurred intermittently. Since early 1978, she had fever twice daily, with body temperature around 37.5°C. Despite treatment, she remained unhealed. She consulted on March 1979. Treated according to Taiyang Cold Damage Syndrome (a syndrome caused by pathogenic cold and wind attacking the exterior) fever, her fever subsided after two consultations.
[First Consultation] March 1. This morning, she felt aversion to cold and fever, measured temperature 37.4°C, accompanied by aversion to cold and fever, absence of sweating on the body, and pain in both knee joints. Her complexion was normal, lips pale red, tongue body pale red and moist, slightly purplish-dark, coating yellow mixed with white and relatively greasy, pulse floating and tight. This is Taiyang Cold Damage Exterior Excess Syndrome (an exterior excess syndrome caused by external contraction of cold and wind, where defensive Yang is constrained and nutritive Yin is stagnant). The method should be to open the pores and induce sweating, stabilize the interior and repel the exterior, using Mahuang Tang (Cinnamon Twig Decoction) as the main formula.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Cinnamomi Ramulus (Guizhi, 桂枝) 6g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 18g, Armeniacae Semen Amarum (Xingren, 杏仁) 15g. Two doses.
[Differentiation] The *Shanghan Lun* states: "In Taiyang disease, headache, fever, body ache, waist pain, bone and joint pain, aversion to wind, absence of sweating, and wheezing indicate that Mahuang Tang should be used." This is the principal manifestation of Taiyang Cold Damage. Ke Yunbo once pointed out: "Among the eight manifestations of Mahuang Tang... the emphasis is on fever, body ache, absence of sweating, and wheezing. In this case, the patient did not suffer from lung Qi stagnation and closure, hence no wheezing; however, all other principal manifestations of Mahuang Tang are present. A pale red, moist tongue body with white coating indicates cold. With the addition of a pale yellow coating and slight purplish-darkness of the tongue, this signifies long-standing retention of chronic cold. Floating pulse indicates the disease is at the exterior; tightness indicates cold. External constraint by cold pathogens prevents the dispersal of Yang Qi in the body, thus causing fever. This is not Yangming Excess Heat, so although there is fever, it is not severe; intermittent fever is not comparable to tidal fever. Cold governs closure and storage, constricting the skin and hair, thus causing absence of sweating. Stagnation of Ying and Wei fluids results in loss of normal defensive functions, causing aversion to cold. Cold pathogens stagnating between meridians prevent the smooth flow of Yang Qi, thus causing bone and joint pain.
Initially, this illness was caused by external contraction of wind-cold pathogens. Although it persisted for three years, it remained lingering and unresolved, without transmitting to other meridians. At the time of the first consultation, the disease still belonged to Taiyang Cold Damage Exterior Excess, with full presentation of Mahuang indications. Therefore, regardless of the duration, sweating should still be induced.
[Second Consultation] March 3. After taking the medicine, slight sweating occurred on the body, aversion to cold decreased, purplish-darkness of the tongue gradually receded, coating became white and slippery with slight yellow at the root, pulse became fine, slow, and mild. There was still slight fever, and the disease remained in Taiyang. After taking Mahuang Tang, fever and aversion to cold both decreased, but sweating appeared, and the pulse became slightly slow, indicating disharmony of Ying and Wei fluids. The method should be to unblock Yang and release the exterior, harmonize Ying and Wei fluids, using Guizhi Tang (Cinnamon Twig Decoction) with modifications as the main formula.
Prescription:
Cinnamomi Ramulus (Guizhi, 桂枝) 10g, Paeoniae Radix Alba (Baishao, 白芍) 10g, Processed Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) 6g, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 60g, Jujubae Fructus (Dazao, 大枣) 10 pieces, Anemarrhenae Rhizoma (Baiwei, 白薇) 12g. Three doses.
[Third Consultation] March 8. After taking three doses of the above prescription, the fever subsided. For two days, there was no recurrence of low-grade fever; test temperature was 36.7°C. Knee joints occasionally had brief pains, slight dizziness, and frequent dreams. Otherwise, there was no obvious discomfort in the body, and tongue and pulse returned to normal. Administer a small amount more of the formula to harmonize Ying and Wei fluids to consolidate the curative effect, and advise attention to diet and daily routine to avoid recurrence of the condition.
Follow-up on July 17: The patient stated that since the second consultation, the low-grade fever subsided and has not recurred since then; she feels generally well.
[Commentary] From the perspective of Traditional Chinese Medicine, the causes of fever can be summarized into two categories: external contraction and internal injury. In external febrile diseases, i.e., Cold Damage diseases, fever is one of the main manifestations. For example, Taiyang disease often presents with aversion to cold and fever; Yangming disease often presents with steaming heat or tidal fever; Shaoyang disease presents with alternating chills and fever; fever in Shaoyin disease varies between cold transformation and heat transformation, and also differs in accompanying syndromes and fever due to gradual recovery of Yang Qi; fever in Jueyin disease mainly manifests during the process of Yin-Yang victory and defeat, with differences such as Zheng (healthy Qi) overcoming pathogens and excessive recovery of Yang causing fever; only Taiyin is extreme Yin, so-called "when two Yins combine, there is no heat to emit." Although the nature of these various fever syndromes differs, and whether high or low grade, they all have certain regularities and can be treated according to Six Meridian Differentiation.
This patient's intermittent low-grade fever recurred repeatedly for three years without transmitting to other meridians. It seems difficult to understand how such a long time could remain solely as an Taiyang exterior syndrome. Actually, later commentators on the *Shanghan Lun* have elaborated on this, believing whether Taiyang disease transmits depends on pulse and symptoms; the theory of transmission based on days should not be rigidly adhered to. However, although this syndrome did not invade other meridians, changes occurred within the Taiyang meridian; so-called deficiency and excess of the exterior can often transform into each other. Therefore, the key lies in strictly mastering the Six Meridians and their laws of transmission. This case was differentiated accurately, grasping the basic characteristic of Taiyang disease—aversion to cold and fever—and flexibly using Mahuang Tang and Guizhi Tang, with distinct sequence and appropriate measure, thus resolving a three-year lingering disease within a few days.
Taiyang Syndrome Migraine
(Trigeminal Neuralgia)
Xing XX, Female, 67 years old. Farmer from Majiawu Township, Renqiu County, Hebei Province.
[Medical History] During the Spring Festival of 1975, she experienced pain in the left side of the face, which gradually turned into severe pain, occurring in paroxysms, lasting for three years. Diagnosed as "Trigeminal Neuralgia" by hospitals in Renqiu and Beijing. Acupuncture and Chinese and Western medicine treatments did not show significant improvement. She consulted on December 18, 1978. Treated according to Taiyang Syndrome Migraine, cured after two consultations.
[First Consultation] December 18. Recently, the pain intensified. When severe, the face swelled and shone, eyes could not open, sleep was impossible at night, restlessness made life unable to be self-managed. Slight aversion to cold, no sweating, tongue body pale red, coating pale yellow moist mixed with white, slightly thick and greasy at the root. This is Taiyang Cold Damage Exterior Excess Syndrome Migraine, where wind-cold mixed with dampness invades, having no way to discharge. The method should be to release the exterior and open blockage, dispel cold and remove dampness, using Mahuang Tang with modifications as the main formula.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Cinnamomi Ramulus (Guizhi, 桂枝) 10g, Processed Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) 18g, Armeniacae Semen Amarum (Xingren, 杏仁) 18g, Pinelliae Rhizoma Preparatum (Faxia, 法夏) 15g. Two doses.
[Differentiation] This syndrome features severe pain on the left side of the head and face, belonging to migraine. The head resides at the top of the human body, high and belonging to Yang. The meridians of Hand and Foot Triple Burner, Yangming, and Shaoyang, as well as the clear Yang Qi of the zang-fu organs, all converge here. Pale red and moist tongue body, pale yellow mixed with white non-dry coating, indicates wind-cold mixed with dampness invading the muscle interstices, stagnating and unresolved; combined with severe pain on one side of the head, slight aversion to cold, and no sweating, it clearly indicates pathogens attacking the Taiyang meridian; further combined with absence of Yangming and Shaoyang conditions, and even absence of Three Yin signs, this serves as corroboration. Therefore, for this case of migraine, one need not rigidly adhere to the convention that lateral headache mostly belongs to Shaoyang, or that long-standing headache mostly belongs to internal injury. Instead, one should proceed from reality, differentiate according to Six Meridians. With full presentation of Taiyang Cold Damage Exterior Excess, pathogens have no route to discharge and disturb upwards, resulting in chronic headache unhealed for years. Urgently use Mahuang Tang to open it.
[Second Consultation] After taking two doses, pain significantly decreased, and other symptoms improved accordingly. Take the original prescription for another two doses.
[Third Consultation] Severe pain disappeared, able to sleep peacefully at night, spirit suddenly felt refreshed, years of pain seemed lost, indescribable joy. Tongue body normal, yellow greasy coating receded. Head slightly feels aversion to wind, slight paroxysmal pain remains on the left side of the head. Wind pathogens not yet exhausted, there is still image of disharmony of Ying and Wei fluids post-illness. Should dispel wind and release muscles, harmonize with Guizhi Tang to conclude the treatment.
Prescription:
Cinnamomi Ramulus (Guizhi, 桂枝) 10g, Paeoniae Radix Alba (Baishao, 白芍) 12g, Processed Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) 10g, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 15g, Jujubae Fructus (Dazao, 大枣) 20 pieces. Two doses.
After taking two doses, the disease was cured, and medication stopped. Advised to avoid wind and cold. Observed for about one month, condition was good. Patient said: "Headache for three years was truly painful, spent two or three hundred yuan, still not better. Old Fan saw me three times, each prescription only four or five herbs, total cost only one yuan and one cent, yet the disease was cured, truly moving me." Then returned to hometown. Later, follow-up with relatives revealed no recurrence of the disease.
[Commentary] The cause of "Trigeminal Neuralgia" is currently not very clear. Elderly people suffer from this disease particularly often, possibly related to dysfunction of nerve conduction. Western medical treatment mostly adopts analgesics, alcohol blockade, etc.; when ineffective, craniotomy for trigeminal nerve root section surgery is considered. Although this can relieve severe pain, facial sequelae are prone to appear post-surgery and are not easily accepted by patients.
Traditional Chinese Medicine believes that any external pathogens like wind, cold, summerheat, dampness, and internal injuries like Qi and Blood stasis, Phlegm, and depression can cause headache. This case, differentiated according to Zhongjing's Six Meridians, belongs to Taiyang Meridian Syndrome, caused by injury from wind, cold, fog, and dew. Thus, urgently administer the potent agent Mahuang Tang to open the exterior, expel pathogens, and induce sweating, reaching the disease site directly; subsequently harmonize with Guizhi Tang. Using Mahuang Tang with added Faxia: "Its uses are four: removing dampness and transforming Phlegm-fluids, greatly harmonizing Spleen and Stomach Qi, treating Phlegm-Jue and headache, none can treat it except this."
Taiyang Syndrome Vertigo
(Meniere's Disease)
Luo XX, Female, 34 years old. Worker at a farm in Chengdu City.
[Medical History] In May 1976, suddenly felt vertigo, as if sitting in a boat, bedridden. Internal Medicine Department of a hospital in Chengdu diagnosed "Meniere's Disease". Transferred for consultation a few days later.
[First Consultation] Four days ago, returning home from work, felt head distending pain, severe vertigo, strong desire to vomit. Next day at work, fainted shortly after arriving at the factory. Frequent vomiting, spitting out large amounts of clear saliva, dizziness as if heaven and earth were spinning. Aversion to cold, cough, no sweating. Tongue body slightly pale, coating slightly yellow. This is Taiyang Syndrome, where cold pathogens obstruct, water-fluids stagnate internally causing vertigo. The method should first start with warming and transforming cold fluids, eliminating Phlegm and descending rebellion, using Banxia Ganjiang San (Pinellia and Dried Ginger Powder) with modifications as the main formula.
Prescription:
Pinelliae Rhizoma Preparatum (Faxia, 法夏) 18g, Zingiberis Rhizoma (Ganjiang, 干姜) 18g, Poria (Yunling, 云苓) 30g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 3g.
[Second Consultation] Dry retching disappeared, head distending pain and vertigo decreased. Again suitable to treat interior and exterior simultaneously, scatter external cold, purge internal fluids, using Xiaolongtan (Minor Blue Dragon Decoction) with modifications as the main formula.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Pinelliae Rhizoma Preparatum (Faxia, 法夏) 15g, Zingiberis Rhizoma (Ganjiang, 干姜) 10g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 15g. Two doses.
[Third Consultation] Dizziness and cough further improved, Phlegm-fluids decreased. Exterior pathogens not yet exhausted, Yang Qi still deficient. Continue with Maxing Xixin Fuzi Tang (Ephedra, Asarum, and Prepared Aconite Decoction) to assist Yang and release the exterior.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Prepared Aconiti Lateralis Radix (Zhi Fupian, 制附片) 60g (long decoction), Asari Radix et Rhizoma (Liaoxixin, 辽细辛) 6g, Cinnamomi Ramulus (Guizhi, 桂枝) 10g, Zingiberis Rhizoma (Ganjiang, 干姜) 60g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 30g. Four doses.
After taking the medicine, she came to consult alone by public bus, still feeling dizziness and distension, tongue pale red, coating thin white slightly yellow. Administered a small amount more of products to scatter cold and remove dampness, stabilize interior and repel exterior. After a few days, the disease was cured. Follow-up on October 26, 1979: Persisted in working for three years, disease did not recur.
[Commentary] The *Jingui Yaolue* states: "Dry retching, vomiting, spitting saliva and foam, Banxia Ganjiang San should be used." Hence, initially used this method of warming the middle and stopping vomiting. Added heavy Poria for its ability to strengthen Spleen, promote urination, leach out dampness, supporting healthy Qi while expelling pathogens, and it is the main herb for treating Phlegm. After two doses, condition improved. Subsequently used Xiaolongtan and Maxing Xixin Fuzi Tang, leveraging their merit in purging internal fluids and assisting Yang to drive out pathogens.
Taiyang Syndrome Cough
(Bronchiectasis)
Chang XX, Female, 22 years old. Student in a unit of the Chinese People's Liberation Army.
[Medical History] When the patient had measles at age five, pneumonia was complicated. Thereafter, she often spat thick sputum, which turned into hemoptysis. In 1970, diagnosed as "Bronchiectasis" through consultation among several hospitals in Beijing. Treated successively in Beijing, Shanghai, Shanxi, etc. Hemoptysis was basically controlled, but frequent headaches and occasional high fever occurred. Hospitals repeatedly suggested surgical treatment, but family refused. Condition gradually worsened, finally unable to persist in studies, took leave from a military medical school. Consulted on May 2, 1978. Treated according to Taiyang Warm Disease (diseases caused by warm pathogenic factors), basically cured after more than two months.
[First Consultation] Dizziness and headache, body heat without aversion to cold; palms burning hot, sweating, vexation, thirst preferring cool drinks. Cough, frequently spitting large amounts of thick yellow sticky sputum, constipation, restless sleep. Face bright red, obvious black spots on both malar bones, lips crimson red, tongue body fresh red, coating yellow thick greasy and tight, pulse surging and rapid. This is Warm Disease latent pathogen triggered by external contraction, attacking Lung Meridian upwards. The method should be to diffuse Lung and drain heat, descend rebellion and stop cough. Using MaXing ShiGan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) with modifications as the main formula.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Armeniacae Semen Amarum (Xingren, 杏仁) 24g, Gypsum Fibrosum (Shigao, 石膏) 60g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 18g, Lepidii Fructus (Tinglizi, 葶苈子) 10g, Fritillariae Cirrhosae Bulb (Chuanbei, 川贝) 15g.
[Differentiation] The *Shanghan Lun* states: "Taiyang disease, fever with thirst, without aversion to cold, is Warm Disease." Zhongjing here proposes non-aversion to cold with thirst, versus aversion to cold without thirst, as the marker to distinguish Warm Disease from Cold Damage. This patient, although body heat and headache similar to Cold Damage, does not have aversion to cold but has thirst, thus belonging to Warm Disease. Because Cold Damage transmitting and changing to heat must transmit meridians before thirst occurs; Warm pathogens do not wait for transmission, although disease is at exterior, heat pathogens injure fluids, thus thirst. Meanwhile, Cold Damage is cold pathogen, thus body heats with aversion to cold; Warm Disease is Yang pathogen, thus heats without aversion to cold. This case of Warm Disease, pathogenic heat congests Lung, disease root already deep, Lung loses diffusion and descent, thus severe cough, spitting thick sputum; accumulated heat for long time must injure blood collaterals causing hemoptysis. Referencing tongue appearance, tongue body fresh red, coating yellow thick greasy and tight, also confirms the above; and both malar bones belong to Lung, dampness accumulates in Lung, for long time cannot diffuse and transform, internally gathers into Phlegm, externally appears on face, thus forming black spots on malar bones. Based on this, establish law and prescription, take ten doses, cough and thick sputum decrease, palm burning heat, headache, vexation, restless sleep all improve, face brightness also slightly recedes.
[Second Consultation] Although Phlegm, cough, vexation, heat have improved, tongue body still fresh red, coating yellow lacking fluid, constipation, occasional fever, this indicates郁热 (depressed heat) although declined, fluids not yet restored. Should maintain original method, concurrently generate fluids and moisten dryness to nourish Yin. Using MaXing ShiGan Tang combined with Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) with modifications as the main formula.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Armeniacae Semen Amarum (Xingren, 杏仁) 18g, Gypsum Fibrosum (Shigao, 石膏) 60g, Bambusae Folium (Zhuye, 竹叶) 10g, Ophiopogonis Radix (Maidong, 麦冬) 12g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 3g, Morus Cortex Sangbai Pi (Sangpi, 桑皮) 15g, Fritillariae Cirrhosae Bulb (Chuanbei, 川贝) 15g, Scutellariae Radix (Huangqin, 黄芩) 10g, Anemarrhenae Rhizoma (Zhimu, 知母) 12g, Nelumbinis Folium (Heye, 荷叶) 12g. Three doses.
After taking three doses, fever, constipation, dizziness, coughing thick sputum significantly improved. Original prescription modified and taken for another ten doses.
[Third Consultation] Tongue body red, coating white moist, occasionally still spits sticky sputum. All aforementioned symptoms reduced, black spots on malar bones basically receded, disease significantly improved. To eliminate residual pathogens of many years, should nourish Yin and clear Lung, to conclude treatment. Self-formulated Yangyin Qingfei Tang (Nourish Yin and Clear Lung Decoction) as the main formula.
Prescription:
Morus Cortex Sangbai Pi (Sangpi, 桑皮) 12g, Armeniacae Semen Amarum (Xingren, 杏仁) 12g, Fritillariae Cirrhosae Bulb (Chuanbei, 川贝) 10g, Citri Reticulatae Pericarpium (Juhong, 橘红) 10g, Ophiopogonis Radix (Maidong, 麦冬) 12g, Paeoniae Radix Alba (Baishao, 白芍) 12g, Lonicerae Japonicae Flos (Yinhua, 银花) 10g, Forsythiae Fructus (Lianqiao, 连翘) 10g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 3g.
Follow-up on February 25, 1979: Parent informed that patient resumed studies in Autumn 1978, condition has been good ever since.
Taiyang Syndrome Cough
Yan XX, Female, 66 years old. Farmer from a township in Pixian County, Sichuan.
[Medical History] Constitution originally deficient, history of cough. In mid-August 1970, after encountering wind and rain, suddenly high fever, severe cough, headache, chest pain, shortness of breath, spitting yellow sticky sputum. Rushed to hospital, measured temperature 39.5°C, diagnosed as "Acute Pneumonia" via chest fluoroscopy and blood test. Injected penicillin, streptomycin, etc. High fever subsided, but cough, shortness of breath, etc., remained severe. Early September same year, carried by children to Chengdu for consultation.
[Treatment] Cough unceasing, spirit fatigued, face swollen, Qi rebellious unable to lie flat, phlegm rattling in throat like water chicken sound, Phlegm abundant, yellow color. Feels slight heat in chest and abdomen, occasional chills. Tip and edges of tongue red, coating slightly yellow greasy. This is wind-cold external pathogens invading Lung and Defensive levels, Qi mechanism blocked, Lung loses clearing and descending, combined with depressed heat, pathogens gather in chest and diaphragm. Syndrome belongs to Taiyang Cold Damage Cough. Method should diffuse Lung, descend rebellion, stop cough and eliminate Phlegm, using Shaygan Mahuang Tang (Belamcanda and Ephedra Decoction) with modifications as the main formula.
Prescription: Belamcandae Rhizoma (Shegan, 射干) 12g, Ephedrae Herba (Mahuang, 麻黄) 12g, Asari Radix et Rhizoma (Liaoxixin, 辽细辛) 3g, Processed Asteris Radix et Rhizoma (Zhi Ziwan, 炙紫菀) 12g, Processed Kolkwitziae Flos (Zhi Donghua, 炙冬花) 10g, Pinelliae Rhizoma Preparatum (Faxia, 法夏) 12g, Scutellariae Radix (Huangqin, 黄芩) 10g, Fritillariae Cirrhosae Bulb (Chuanbei, 川贝) 12g (dissolved), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 15g. One dose.
After taking the above prescription, felt chest slightly wider and comfortable, cough and asthma slightly eased. Take original prescription for another three doses, cough, asthma, depressed heat decreased, Phlegm still abundant. Remove Huangqin, add Platycodonis Radix (Jiegeng, 桔梗) and Poria (Yunling, 云苓), take another three doses, all symptoms significantly improved. Advise taking original prescription for another three doses to consolidate curative effect.
Follow-up on July 21, 1979: Patient now 74 years old, mentioned the heavy severity of the illness back then, cured by Old Fan, body has been relatively good for nine years. Now can still walk to nearby towns to go to market.
[Commentary] The *Jingui Yaolue* states: "Cough with upward Qi, water chicken sound in throat, Shaygan Mahuang Tang should be used." This case's disease belongs to Taiyang Cold Damage, consistent with Shaygan Mahuang Tang syndrome, thus treated with modifications of this formula. Due to wind-cold stagnation and closure, slight heat image, removed Schisandra's astringency, Jujube's cloying nature, Ginger's pungency; additionally added Huangqin and Chuanbei to enhance clearing Lung and transforming Phlegm effects.
Taiyang Syndrome Asthma
Ma XX, Male, 3 years old. From a township in Shuangliu County, Sichuan.
[Medical History] From infancy, frequently suffered from colds. At age two, once had high fever and cough, fever subsided after taking medicine, but cough did not heal, lingering until age three. Recently due to new contraction, condition worsened, developing into panting and wheezing, audible in neighboring rooms. Consulted in May 1965.
[First Consultation] Cough and panting, phlegm rattling in throat, Phlegm clear and thin,较多 white foam, slight sweating when coughing, cough worsens upon exposure to wind. Sallow complexion, tongue body pale red, coating white slippery. This is Taiyang Deficiency Syndrome Asthma. Method should release muscles and dispel wind, descend rebellion and calm panting, using Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) with modifications as the main formula.
Prescription:
Cinnamomi Ramulus (Guizhi, 桂枝) 6g, Processed Glycyrrhizae Radix et Rhizoma (Zhi Gancao, 炙甘草) 3g, Paeoniae Radix Alba (Baishao, 白芍) 6g, Zingiberis Rhizoma Recens (Shengjiang, 生姜) 10g, Jujubae Fructus (Dazao, 大枣) 15g, Magnoliae Officinalis Cortex (Houpo, 厚朴) 4g, Armeniacae Semen Amarum (Xingren, 杏仁) 6g, Asteris Radix et Rhizoma (Ziwan, 紫菀) 6g, Saposhnikoviae Radix (Fangfeng, 防风) 3g. Five doses.
[Second Consultation] After taking five doses of the above prescription, cough and panting significantly decreased, able to sleep peacefully at night. Still cough and pant upon exposure to wind in morning and evening, much Phlegm, sweating. Wind pathogens not yet exhausted, damp-Phlegm still abundant. Add Poria, Citri Reticulatae Pericarpium, Pinelliae Rhizoma Preparatum to the above prescription to remove dampness and transform Phlegm.
Prescription: