处方：
猪苓6克茯苓6克泽泻6克 白术6克桂枝6克上肉桂3克上方服一剂，肿胀消，疼痛止。
(按语]疝病之名，始于《内经》。但与今日西医所谓之疝气，涵义不尽相同。后世医家对疝病的命名更加繁多，但对其发病尤侧重于厥阴肝经，故有“诸疝皆归肝经”之说，治法多以温肝疏木为主。本例小儿水疝，主要为寒湿凝滞阴器，膀胱气化失常，气之所积，久而不散，水液停聚，致阴囊肿痛。故投以五苓散，以除水蓄之疝颇效。不仅小儿或男子水疝可用，妇女类似之病变亦可移用。如一青年妇女，小腹凉麻，下阴重坠，阵阵抽引疼痛。范老从手足太阳同时入手，以五苓散加重二桂于利水之中，大宣阳气，药服两剂亦愈。
阳明证呕吐
(食管癌待查)
席××，男，52岁。成都某厂干部。
[病史]1972年3月，自觉外感不适，胸膈闷胀，不思饮食，食入即吐。急入××医院，住院治疗十余日，经抽取胃液，并食管镜取下活组织病理检查，诊为“食管癌待查”。后转入××医院，经半个多月检查治疗，仍未确诊，终日靠输液维持，思想负担益重。再转××医院，由中医诊治，改服大量补气降逆止呕之剂，病势犹未减。1972年4月，遂请范老至家中急诊。
[初诊)饮食不下，食入即吐，历时月余，形体日益消瘦。心烦、胸闷、身疼、发热、汗出、微喘、溺少，上腹部时时隐痛，下肢微肿。面色黧黑，唇乌，舌质深红，苔黄厚腻浊，系太阳表邪未尽，传入阳明。正如《伤寒论》所、兑： “伤寒、发热、无汗、呕不能食，而反汗出濈濈然者，是转属阳明也。”法宜散寒泄热，降逆和中，以麻杏石甘汤加味主之。
处方：
麻黄12克杏仁18克石膏60克甘草10克桑皮30克黄芩12克六剂
(二诊]t方连进六剂后，自觉身痛、发热、心烦、汗出均减，全身稍觉轻快。惟仍不能进食，食入即吐。此阳明邪热内结，痰湿与宿食相胶着，堵塞胃脘，致胃气上逆而呕吐。本《素问·阴阳应象大论篇》“其高者，因而越之”之意，以吐法为治。 处方：硼砂2克 用温开水一次冲服。 疏方以后，有关医院认为，此药有毒，不可误服。但本人和家属均坚持服用。为了慎重，领导遂令住院试服，以防不测。服药前，开始输液。上方服后数分钟，即涌吐出大量灰黑色粘液、泫痰，以及其它污浊之物。阵阵涌吐，持续约两小时，吐出秽物盈盂。顿觉上腹部明显舒适。当晚睡眠良好。次日晨，试进稀粥一小碗，呕吐竟未发作。
[三诊]精神好转。七腹部痛，胸闷，喘息等证消失，苔浊腻减。为清余邪，以自制九成丹，清热解毒，化淤通窍，缓服之。
处方：
真牛黄半份原麝香半份血琥珀一份
人中白二份花蜘蛛二份蒲公英二份
上梅片半份血余炭一份
按上述比例，共研细末，隔日服一次，每次一克，月余后痊愈。1979年6月30日追访，患者高兴地说： “自病愈后，七年来，能坚持上班，饮食如常，身体健康。”
[按语]《素问·至真要大论篇》云： “诸逆冲上，皆属于火。”又云： “诸痿喘呕， 皆属于上。”但此证不能单纯治以清火。因为痰浊夹邪化热，乃其致病机转，故涌吐痰食，则气机通畅，热结亦解。所谓“土郁则夺之”者是。范老面临此证，遵经之旨，敢于用峻猛之剂，使月余饮食不进，病势危急之候，迅速奏效。其独到之处在于：先用麻杏石甘汤加味，重用石膏，连服六剂，虽呕吐未止，却为吐法奠定了基础。继用硼砂一味，取其功入上除热，荡涤垢腻积块，并能刺激胃液分泌，借饮入于胃即吐之机，因势利导而越之。令在上之痰涎宿食等胶着异物，一涌而出。此所谓毕其功于一役也。
阳明证高热痿蹙
张××，女，24岁。四川郫县红光乡，农民。
[病史]1960年10月某日于田间劳动后，自觉身热头痛，周身不适，入夜尤甚。次日，××医院按感冒论治，后改服中药，反复汗出，而热势不减。十余日后，忽感下肢痿弱无力，难以移步，遂来就诊。按阳明经证论治，一诊而痊愈。
[诊治]蒸蒸发热已十余日。几天前，突然下肢痿软，步履维艰，甚至难以站立。自觉口干烦渴，身热汗多，不恶寒，反恶热。面赤，舌质鲜红少津，无苔，脉洪大。此系阳明高热不退，肺胃津气两伤，以致筋骨失养成痿。法宜泄热润燥，补气生津，以大剂白虎人参汤加味主之。
处方：
知母60克生石膏120克生甘草15克粳米30克北沙参60克 竹茹30克灯心草1克为引
二剂
连服两剂，一剂热势衰，二剂高热退，渐能独自行走。遂停药，嘱其注意调养，旬日痊愈。
[辨证]患者来诊时，身大热、汗大出、大烦渴、脉洪大，所谓“四大”俱备。脉洪大为阳明内热炽盛，热邪扰于内则作烦，热盛耗滓则口大渴。加以患者面赤、舌红、口燥，皆为病邪在里，阳明热盛之象。
或问：患者阳明证高热仅一、二十日，何以突然致痿?因其阳旺邪盛，津液大伤，致使筋弛不收。同时，足阳明胃之津液亏耗，则脾不能为胃行其津液，而脾之大络络予肺，自不足以濡润手太阴肺，正如《素问·痿论篇》所谓： “肺热叶焦，发为痿躄”。 。阳明经证热盛伤津， 《伤寒论》提出以白虎加入参汤主之。本例重用石膏，清阳明独盛之热；佐知母之苦寒而凉润，既清炽盛之邪热，又复亏耗之真阴；用北沙参，取其养胃生津之功；加竹茹，增强除胃热止烦渴之效。再以灯芯草少许，引上部郁热下行。
[按语]仲景之白虎汤及白虎加人参汤，因于寒凉清肃之中，寓有通宣之效，退热而无滞邪之弊，甘寒并用而不伤胃，其使用范围曾有较大之扩展。如《金匮·痉湿喝病脉证治》以白虎加人参汤主治太阳中喝。《资生篇》以人参白虎治气分有热。 《保赤全书》用以解麻疹斑疹。 《活人辨疑》之化斑汤，也即此方。《证治准绳》治温邪湿重，则以白虎加苍术。唐容川用白虎加味治白痢。张锡纯对白虎汤及石膏之应用，也大有开拓。近年来以白虎汤治疗流行性乙型脑炎(偏燥者)和脑溢血等颇效。由此可见，古今对白虎汤之运用不断扩展。但以白虎加人参汤治疗痿证者则罕见。范老严格按照六经辨证，用此方治疗痿躄之经验，是值得重视和研究的。
阳明证臌胀
范××，女，22岁。成都市龙泉区长风乡，农民。
[病史’j两岁时开始患腹胀，其后发展到全身皆肿，肌肉变硬。下阴常流黄水，臭味异常。十多年来，病魔缠身，其父为之四处求医，未见显效。1969年8月，前来就诊，按阳明腑证论治， 服药两剂后基本治愈。
[诊治]腹胀如鼓，胸胁满闷，皮色苍黄；全身肌肤胀硬。大便常秘结，所下如羊粪，已四日未行；下阴不断渗出臭黄水。舌质深红，苔黄燥，脉沉实有力。此为阳明腑证兼水热互结。法宜峻下热结，兼逐积水，以大承气并大陷胸汤加味主之。
处方：
生大黄18克 厚朴30克枳实30克芒硝30克甘遂15克(冲服) 芫花15克(冲服) 桑皮60克先服一剂，泻下燥屎十余枚，并臭秽黄水甚多，腹部硬胀消失大半。续服一剂，胸腹肿胀皆消，全身肌肤变软，下阴外渗之黄水亦止。因自觉病势顿减，加以客居成都，经济困难，遂自行停药回家。不久患者邻友来告，已康复如常。1979年7月追访，病愈结婚，并生一子。十年来身体一直很好。
[辨证]患者虽病程颇长，因正值青春，素体阳旺。胸腹胀满，皮色苍黄，大便秘结，舌红苔燥，脉沉实有力，显然属阳、属热、属里、属实。正所谓“大实有赢状”。再观之大便硬结如羊屎，几日未行，应为阳明腑实，痞满燥实俱备无疑。然此证又现全身肌肤肿胀，从心下连及少腹，胀满尤甚，同时下阴流黄水而恶臭，皆为热结水积之象，即燥热结胸之证。由此形成阳明腑实为主，太阳结胸相兼，邪实病深，错综复杂之局面。热结须峻下，积水宜攻逐，病重不可药轻。因此，大承气与大陷胸汇成一方，大剂猛攻之，取其斩关夺隘之力。
[按语]臌胀系内科之重证。论治之关键，首在辨其虚实。一般而言，臌胀初起，气实病实，宜峻剂攻逐；若久病脏气日虚，则不宜峻消其胀。本例患者，虽病久而形瘦弱，但邪实而阳旺，故不可按久病多虚之常规论治。
太阳阳明证泄泻
(过敏性结肠炎)
姚××，男，46岁。四川成都某厂干部。
(病史]曾于1970年夏患阿米巴痢疾，经医院治疗，痊愈出院。因饮食不节，过食生冷，病又复发。中西医治疗月余，腹泻止。但其后因工作劳累，饮食不慎，又出现腹部隐痛，腹泻便稀，口三、四次，1971年经四川省××医院确诊为“过敏性结肠炎”、“慢性肠炎”。在成都先后经多处医疗单位治疗，服中药一百余剂，时好时坏，夏秋更重，迁延五年之久。1975年11月2日来诊，按太阳阳明证泄泻论治，月余而愈。
(初诊]腹泻每日三、四次，胃腹胀满隐痛，大便时稀时秘，无脓血。头昏，身痛，神疲面黄，肢体消瘦。舌质暗红，苔黄白而润，脉浮紧。此为外感风寒郁闭，寒湿留滞肠中，交织不解，迁延日久。属太阳阳明泄泻。宜先开腠理，除寒湿，以麻黄汤加味主之。
处方：
麻黄10克桂枝10克杏仁18克甘草30克法夏18克二剂，忌油腻、生冷。
[辨证]患者几年前曾患痢疾，后又泄泻。虽排便次数较多，但无里急后重，下利赤白之主证；再参之西医诊断，当不再属痢疾。今头昏，身痛，苔黄白而润，脉浮紧，为太阳风寒束表之象。舌暗红，面萎黄，神倦体瘦，为病邪入里已久，邪实伤正之征。胃腹胀痛泄泻，表明外邪不解，内迫阳明，影响大肠而令传导失职。所以，此病应属太阳阳明合病泄泻。《伤寒论》云： “太阳与阳明合病者，必自下利，葛根汤主之。”病机与此相似，为何不用葛根汤?因此证历时久，寒邪重，表实郁闭，水湿内聚，故须用麻黄汤解表散寒；加半夏燥湿，首开腠理，使邪仍从太阳而解。
[二诊]服药后，食纳增加，余证未减，舌脉同前。虑其久病邪实，兼之既往所服药中，参芪归地等滋补药较多，致寒湿胶着，一时难以奏效。原方加生姜，温散以助之，再进两剂。
[三诊]头身略有微汗，疼痛减轻。苔腻稍减。腹痛、泄泻等尚无明显变化。继上方去桂枝，再服两剂。
[四诊]太阳表实已解，时泻时秘虽减，但尚未根除。本自制针砂散方意，重用白矾，以攻其里，推荡阳明之湿浊。
处方：
Prescription:
Polyporus 6g, Poria 6g, Alisma 6g, Atractylodes Macrocephala 6g, Cinnamon Twig 6g, Upper Cinnamon Bark 3g. After taking one dose of the above prescription, the swelling subsided and the pain stopped.
[Commentary] The term "hernia disease" (Hernia Disease) originated in the *Huangdi Neijing* (Yellow Emperor's Inner Canon). However, its meaning is not entirely identical to what modern Western medicine refers to as "hernia." Later physicians coined numerous names for hernia diseases, but they particularly emphasized the Jueyin Liver Meridian in their pathogenesis analysis, hence the saying "all hernias belong to the Liver Meridian." Treatment methods mostly focused on warming the Liver and soothing the Wood element. This case of pediatric hydrocele (Hydrocele), characterized by fluid accumulation, was primarily caused by cold-dampness stagnating in the genitalia, leading to dysfunction of Bladder Qi transformation. Qi accumulated and failed to disperse over time, causing fluid retention and resulting in scrotal swelling and pain. Therefore, Wuling San (Five-Ingredient Powder with Poria) was administered, which proved quite effective for eliminating hernias caused by water retention. It can be used not only for pediatric or male hydroceles but also for similar conditions in women. For instance, a young woman presented with cold numbness in the lower abdomen, a heavy dragging sensation in the external genitalia, and intermittent pulling pain. Master Fan approached the treatment from both the Hand-Taiyang and Foot-Taiyang meridians simultaneously, using Wuling San with increased dosages of Cinnamon Twig to vigorously promote Yang Qi within the context of diuresis. Two doses cured her.
Yangming Syndrome Vomiting
(Suspected Esophageal Cancer)
Xi XX, Male, 52 years old. Cadre at a factory in Chengdu.
[Medical History] In March 1972, he felt discomfort from an exogenous pathogen, chest and diaphragm fullness and distension, loss of appetite, and immediate vomiting after eating. He urgently entered Hospital XX for hospitalization. After more than ten days of treatment, gastric juice aspiration and esophagoscopy with biopsy were performed, leading to a diagnosis of "Suspected Esophageal Cancer." He was then transferred to Hospital XX. After more than half a month of examination and treatment, no definitive diagnosis was made. He relied on intravenous infusions day and night, and his psychological burden increased. He was transferred again to Hospital XX for Traditional Chinese Medicine (TCM) consultation. He switched to large doses of Qi-tonifying, counterflow-subduing, and anti-emetic agents, but the disease progression did not subside. In April 1972, Master Fan was invited to his home for emergency treatment.
[First Visit] Inability to ingest food, immediate vomiting after eating, lasting for over a month, with progressive emaciation. Restlessness, chest tightness, body ache, fever, sweating, slight panting, oliguria, occasional dull pain in the upper abdomen, and slight edema in the lower limbs. Dark complexion, dark lips, deep red tongue body, thick yellow greasy turbid coating. This indicates that Taiyang exterior pathogens have not yet resolved and have transmitted to the Yangming stage. As stated in the *Shanghan Lun* (Treatise on Cold Damage): "In cold damage, if there is fever, no sweat, vomiting, inability to eat, but instead profuse continuous sweating, this indicates transmission to Yangming." The treatment principle should be to dispel cold and purge heat, descend counterflow and harmonize the middle. Ma Xing Shi Gan Tang (Ephedra, Apricot Seed, Gypsum, and Licorice Decoction) with modifications was prescribed as the main formula.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 12g, Armeniacae Semen Amarum (Xingren, 杏仁) 18g, Gypsum Fibrosum (Shigao, 石膏) 60g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 10g, Morus Cortex (Sangpi, 桑皮) 30g, Scutellariae Radix (Huangqin, 黄芩) 12g. Six doses.
[Second Visit] After taking six doses consecutively, the patient felt relief from body ache, fever, restlessness, and sweating, feeling slightly lighter overall. However, he still could not eat and vomited immediately upon ingestion. This indicated internal binding of Yangming pathogenic heat, where phlegm-dampness and retained food stuck together, blocking the stomach cavity, causing Stomach Qi to rebel upward and resulting in vomiting. Following the principle from the *Suwen: Yin-Yang Yingxiang Dalun* chapter, "For those located high, induce vomiting," emesis therapy was employed.
Prescription: Borax 2g, dissolved once in warm boiled water and taken orally.
After prescribing, relevant hospitals considered this drug toxic and advised against misuse. However, the patient and his family insisted on taking it. For caution, leadership ordered him to take it in the hospital under observation to prevent accidents. Before taking the medicine, intravenous infusion was started. Within minutes of taking the prescription, he vomited up large amounts of gray-black mucus, thin sputum, and other turbid substances. The vomiting continued intermittently for about two hours, filling basins with foul matter. He suddenly felt significant comfort in the upper abdomen. That night, he slept well. The next morning, he tried drinking a small bowl of thin porridge, and no vomiting occurred.
[Third Visit] Mental spirit improved. Abdominal pain, chest tightness, and panting disappeared; the turbid greasy coating reduced. To clear residual pathogens, the self-made Jiucheng Dan (Nine-Tenths Pill) was used to clear heat, detoxify, resolve stasis, and open orifices, taken slowly.
Prescription:
Real Calcul Bovis (Niuhuang, 牛黄) half part, Natural Moschus (Shexiang, 麝香) half part, Sanguis Succinum (Xuhupo, 血琥珀) one part, Naringinis Perispermium (Renzhongbai, 人中白) two parts, Nephilae Corpus (Huazhizhu, 花蜘蛛) two parts, Taraxaci Herba (Gongying, 蒲公英) two parts, Borneolum Syntheticum (Shepian, 梅片) half part, Capillis Carbonisatus (Xuyutan, 血余炭) one part.
Grind all ingredients into fine powder according to the above proportions. Take once every other day, 1g per dose. Recovered after more than a month. Follow-up on June 30, 1979: The patient happily reported, "Since recovery, for seven years, I have been able to work consistently, eat normally, and maintain good health."
[Commentary] The *Suwen: Zhi Zhen Yao Da Lun* states: "All rebellious upward movements belong to Fire." It also says: "All flaccidity, panting, and vomiting belong to the Upper." However, this syndrome cannot be treated solely by clearing fire. Because turbid phlegm combined with pathogens transforming into heat is the pathogenic mechanism, inducing vomiting of phlegm and food allows Qi mechanisms to flow freely, resolving heat binding. This is what is meant by "When Earth is stagnant, purge it." Facing this syndrome, Master Fan followed the classic principles and dared to use potent drugs, achieving rapid results for a critical condition where the patient had not eaten for over a month. His uniqueness lay in first using Ma Xing Shi Gan Tang with modifications, heavily weighting Gypsum, taken for six doses. Although vomiting did not stop, it laid the foundation for emesis therapy. Subsequently, using only Borax, leveraging its ability to enter the Upper Jiao to clear heat, scour away turbid accumulations, and stimulate gastric juice secretion, he utilized the mechanism of vomiting immediately after drinking to guide the pathogen out顺势. This forced the sticky foreign bodies like phlegm and retained food in the upper region to surge out in one go. This is called accomplishing the task in one stroke.
Yangming Syndrome High Fever and Flaccidity
Zhang XX, Female, 24 years old. Farmer from Hongguang Township, Pi County, Sichuan.
[Medical History] On a certain day in October 1960, after field labor, she felt feverish headache and general malaise, worse at night. The next day, Hospital XX treated her for a common cold, then switched to TCM. Despite repeated sweating, the fever persisted. More than ten days later, she suddenly felt weakness in her lower limbs, unable to walk, and sought medical attention. Treated according to Yangming Channel Syndrome, she recovered after one visit.
[Diagnosis and Treatment] Steaming fever had persisted for over ten days. A few days ago, her lower limbs suddenly became flaccid, making walking difficult, even standing hard. She felt dry mouth with irritability and thirst, body heat with profuse sweating, aversion to cold absent but aversion to heat present. Red face, fresh red tongue body with little moisture, no coating, surging pulse. This indicated unrelenting high fever in Yangming, damaging Lung and Stomach fluids and Qi, leading to malnutrition of sinews and bones resulting in flaccidity. The treatment principle should be to purge heat and moisten dryness, tonify Qi and generate fluids. A large dose of Baihu Renshen Tang (White Tiger and Ginseng Decoction) with modifications was prescribed.
Prescription:
Anemarrhenae Rhizoma (Zhimu, 知母) 60g, Raw Gypsum Fibrosum (Sheng Shigao, 生石膏) 120g, Raw Glycyrrhizae Radix et Rhizoma (Sheng Gancao, 生甘草) 15g, Oryza Sativa (Jingmi, 粳米) 30g, Glehniae Radix (Beishashen, 北沙参) 60g, Bambusae Medulla (Zhuru, 竹茹) 30g, Junci Medulla (Dengxincao, 灯心草) 1g as a guide.
Two doses.
After taking two doses consecutively, fever subsided after the first dose and high fever receded after the second. She gradually gained the ability to walk alone. Medication was stopped, and she was advised to rest and recuperate. Recovered in ten days.
[Differentiation] When the patient came for consultation, she exhibited the so-called "Four Bigs": great fever, profuse sweating, great irritability and thirst, and surging pulse. The surging pulse indicates blazing internal heat in Yangming; heat disturbing internally causes irritability, and excessive heat consuming fluids causes extreme thirst. Additionally, red face, red tongue, and dry mouth are all signs of pathogen being in the interior and blazing heat in Yangming.
One might ask: Why did sudden flaccidity occur after only ten to twenty days of high fever in Yangming syndrome? Because her Yang was vigorous and pathogens strong, leading to massive fluid damage, causing sinews to relax and fail to hold. Simultaneously, depletion of fluids in the Foot-Yangming Stomach means the Spleen cannot transport fluids for the Stomach. The great collateral of the Spleen connects to the Lung; thus, it is insufficient to moisten the Hand-Taiyin Lung. As stated in the *Suwen: Fei Lun* chapter: "Lung heat scorches leaves, leading to flaccidity." For Yangming channel syndrome with heat damaging fluids, the *Shanghan Lun* proposes Baihu Jia Renshen Tang. In this case, heavy Gypsum clears the exclusive heat of Yangming; assisted by bitter-cold and cooling-moistening Anemarrhena, it clears blazing pathogenic heat and restores depleted true Yin; Glehnia is used for its function of nourishing the Stomach and generating fluids; Bambusae Medulla enhances the effect of clearing Stomach heat and stopping irritability/thirst. A small amount of Junci Medulla guides stagnant heat from the upper downward.
[Commentary] Zhang Zhongjing's Baihu Tang and Baihu Jia Renshen Tang, due to their penetrating and dispersing effects within cold-cooling and purifying actions, reduce fever without trapping pathogens, and combine sweet-cold herbs without harming the Stomach. Their scope of application has expanded significantly. For example, *Jingui Yaolue: Jing Shi Ye Bing Mai Zheng Zhi* uses Baihu Jia Renshen Tang for Taiyang Summerheat. *Zisheng Pian* uses Ren Shen Bai Hu for Heat in the Qi Level. *Baochi Quanshu* uses it for measles rashes. *Huoren Biyi*'s Huaban Tang is essentially this formula. *Zhengzhi Zhunsheng* uses Baihu Jia Cangzhu for Warm Pathogen with heavy Dampness. Tang Rongchuan used modified Baihu for white dysentery. Zhang Xichun greatly expanded the application of Baihu Tang and Gypsum. In recent years, Baihu Tang has been effective in treating Epidemic Encephalitis B (dry type) and cerebral hemorrhage. Thus, the application of Baihu Tang has continuously expanded from ancient to modern times. However, using Baihu Jia Renshen Tang to treat flaccidity syndrome is rare. Master Fan's experience in strictly following Six-Meridian Differentiation to use this formula for treating flaccidity is worthy of attention and study.
Yangming Syndrome Distension (Ascites)
Fan XX, Female, 22 years old. Farmer from Changfeng Township, Longquan District, Chengdu.
[Medical History] Abdominal distension began at age two, progressing to whole-body edema and hardening of muscles. Yellow fluid often flowed from the external genitalia with abnormal odor. For over ten years, plagued by illness, her father sought medical help everywhere without obvious effect. In August 1969, she came for consultation. Treated according to Yangming Fu Syndrome, she was basically cured after two doses.
[Diagnosis and Treatment] Abdominal distension like a drum, chest and hypochondriac fullness, pale yellow skin color; whole-body skin and muscle hardness. Frequent constipation, stools like sheep dung, no bowel movement for four days; constant oozing of foul yellow water from external genitalia. Deep red tongue body, yellow dry coating, deep solid forceful pulse. This is Yangming Fu Syndrome complicated by Water-Heat Binding. The treatment principle should be drastic purging of heat binding and simultaneous driving out of accumulated water. Dachengqi Tang (Major Order the Qi Decoction) combined with Daxiexiong Tang (Major Trap the Chest Decoction) with modifications was prescribed.
Prescription:
Raw Rheum Palmatum (Sheng Dahuang, 生大黄) 18g, Magnolia Officinalis Bark (Houpo, 厚朴) 30g, Immature Bitter Orange (Zhishi, 枳实) 30g, Mirabilite (Mangxiao, 芒硝) 30g, Kansui Root (Gansui, 甘遂) 15g (taken with medicine), Genkwa Flower (Yuanhua, 芫花) 15g (taken with medicine), Mulberry Root Bark (Sangpi, 桑皮) 60g.
Take one dose first. Passed more than ten pieces of dry feces and much foul yellow water; abdominal hardness and distension disappeared by more than half. Continue with one more dose. Chest and abdominal swelling resolved, whole-body skin softened, and oozing yellow water from external genitalia stopped. Feeling the disease severity drastically reduced, and facing economic difficulties while living in Chengdu, she stopped medication and went home. Soon after, neighbors reported she had fully recovered. Follow-up in July 1979: Married after recovery and gave birth to a son. Health has been excellent for ten years.
[Differentiation] Although the course of disease was long, she was in her youth and constitutionally Yang-vigorous. Chest and abdominal fullness, pale yellow skin, constipation, red tongue with dry coating, deep solid forceful pulse clearly indicate Yang, Heat, Interior, and Excess. As the saying goes, "Great excess presents with deficiency-like symptoms." Observing hard stools like sheep dung with no movement for days, it is undoubtedly Yangming Fu Excess, with fullness, obstruction, dryness, and excess all present. However, this case also shows whole-body skin swelling extending from the epigastrium to the lower abdomen, with severe distension, and foul-smelling yellow water from external genitalia, all indicating Heat-Binding and Water-Accumulation, i.e., Dry-Heat Binding in the Chest. This forms a complex situation dominated by Yangming Fu Excess, combined with Taiyang Chest Binding, with deep-seated pathogens and complexity. Heat binding requires drastic purging; water accumulation needs attacking and driving out. Severe disease cannot be treated with light medicine. Therefore, Dachengqi Tang and Daxiexiong Tang are combined into one formula, attacking fiercely with large doses, utilizing their power to break through barriers.
[Commentary] Distension (Ascites) is a serious internal medicine syndrome. The key to treatment lies first in distinguishing Deficiency and Excess. Generally, early-stage distension involves Qi and Pathogen Excess, suitable for drastic purging; if long-term illness leads to daily decline of Zang-Qi, drastic reduction of distension is inappropriate. This patient, although ill for a long time and emaciated, had Excess pathogens and vigorous Yang, so it should not be treated according to the routine of "long illness implies Deficiency."
Taiyang-Yangming Syndrome Diarrhea
(Allergic Colitis)
Yao XX, Male, 46 years old. Cadre at a factory in Chengdu, Sichuan.
[Medical History] In summer 1970, he suffered from Amoebic Dysentery, treated at the hospital, and discharged cured. Due to irregular diet and excessive consumption of raw/cold foods, the disease relapsed. TCM and Western medicine treatment for over a month stopped diarrhea. However, due to work fatigue and dietary indiscretion, dull abdominal pain and loose diarrhea occurred three to four times a day. In 1971, diagnosed with "Allergic Colitis" and "Chronic Enteritis" at Hospital XX in Sichuan Province. Treated at multiple medical units in Chengdu, taking over a hundred doses of TCM, fluctuating in improvement, worsening in summer and autumn, persisting for five years. On November 2, 1975, he consulted. Treated according to Taiyang-Yangming Syndrome Diarrhea, recovered after more than a month.
[First Visit] Diarrhea three to four times daily, dull pain with gastric and abdominal fullness, stools alternating between loose and constipated, no pus or blood. Dizziness, body ache, mental fatigue, sallow complexion, emaciated limbs. Dark red tongue body, yellow-white moist coating, floating-tight pulse. This is exogenous Wind-Cold constraint, with Cold-Dampness lingering in the intestines, intertwining unresolved, persisting for a long time. Belongs to Taiyang-Yangming Diarrhea. Should first open the pores, eliminate Cold-Dampness. Mahuang Tang (Ephedra Decoction) with modifications was prescribed.
Prescription:
Ephedrae Herba (Mahuang, 麻黄) 10g, Cinnamon Twig (Guizhi, 桂枝) 10g, Armeniacae Semen Amarum (Xingren, 杏仁) 18g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 30g, Pinelliae Rhizoma Preparatum (Faxia, 法夏) 18g. Two doses. Avoid greasy and raw/cold foods.
[Differentiation] The patient suffered from dysentery years ago, followed by diarrhea. Although bowel movement frequency was high, there were no main signs of Tenesmus (Li Ji Hou Zhong) or passage of red and white discharge; combined with Western diagnosis, it is no longer Dysentery. Now, dizziness, body ache, yellow-white moist coating, and floating-tight pulse indicate Wind-Cold constraining the Exterior (Taiyang). Dark red tongue, sallow face, mental fatigue, and emaciation indicate pathogens have been in the interior for a long time, with Excess pathogens injuring Righteous Qi. Gastric/abdominal distension/pain and diarrhea indicate unresolved exterior pathogens forcing inward into Yangming, affecting the Large Intestine and causing failure of transportation. Therefore, this disease belongs to Taiyang-Yangming Combined Disease Diarrhea. The *Shanghan Lun* states: "In Combined Disease of Taiyang and Yangming, there will inevitably be spontaneous diarrhea, Gegen Tang (Kudzu Decoction) is the main formula." The pathogenesis is similar, why not use Gegen Tang? Because this syndrome has lasted long, Cold pathogens are heavy, Exterior Excess is constrained, and Water-Dampness accumulates internally. Thus, Mahuang Tang is needed to release the Exterior and scatter Cold; adding Pinellia dries Dampness, opening the pores first, allowing pathogens to resolve via Taiyang.
[Second Visit] After taking medicine, appetite increased, other symptoms unchanged, tongue and pulse same as before. Considering long-term illness with Excess pathogens, plus previous medications contained many tonics like Ginseng, Astragalus, Angelica, and Rehmannia, causing Cold-Dampness to stick together, making efficacy slow. Added Fresh Ginger to the original formula to assist with warming dispersion, take two more doses.
[Third Visit] Slight sweat on head and body, pain reduced. Greasy coating slightly reduced. Abdominal pain and diarrhea showed no obvious change. Continue with the above formula, remove Cinnamon Twig, take two more doses.
[Fourth Visit] Taiyang Exterior Excess has resolved. Alternating diarrhea and constipation reduced but not eradicated. Based on the intent of the self-made Zhensan San (Needle Sand Powder), heavily weight Alum (Bai Fan) to attack the Interior, pushing out Yangming Damp-Turbidity.
Prescription: