处方：
制附片60克(久煎) 干姜片30克炙甘草30克[三诊]上方服三剂，眼肌颤动消失，眼胞浮肿稍减。左眼睑仍重垂无力。宜温补脾肾，助阳驱阴，拟四逆并理中加减再进。
处方：
制附片60克(久煎) 干姜片30克炙甘草15克炒白术25克茯苓25克上肉桂lO克(冲服)
生姜60克[四诊]原方出入增减，每日一剂，坚持服二月余。至1979年1月1日，左眼睑有两次短暂开裂，前后持续约一小时。仍遵原法，四逆、理中交替使用，或合为一方。当月经不调．夹紫黑血块，则加炮姜、血余炭；兼有表证，则加麻黄、桂枝等，又服两月余。
[五诊]1979年3月初，左眼上胞下垂明显好转，眼睑已能睁开，比正常略小，双眼胞尚有轻度浮肿。左右眼视物，常不能协调。面额部湿疹明显消退。经色转为正常，但有少量淤血块。食纳尚可，舌质稍转淡红润，苔薄白。逐渐阳复阴消，仍有脾肾阳虚之象。以理中汤并桂枝去芍药加附子汤损益调理。
处方：
桂枝10克 炙甘草15克 生姜30克红枣30克炒白术20克茯苓20克制附片30克(久煎)
上方随证加减，并用苓桂术甘汤、小半夏汤、针砂散等配合使用。1979年4月以后，偶有双眼视物不协调，双眼上胞轻微浮肿。继续调理，以期巩固。
[按语]文例与本例，西医辨病均属“重症肌无力眼肌型”；但按六经辨证，则有所不同，故其立法处方，也随之而异。
前例睑废，证属太阴，脾困于湿，主要病机在于水湿溢于经络肌肤，不得外泄，而上串于眼胞，以致眼睑肿垂。此例属太少二阴合病，脾肾阳虚，病在于脾，根在于肾。其眼睑下垂，眼胞浮肿，面色萎白，月经色暗而有淤块，舌现齿痕而苔灰白厚腻，均为脾阳衰弱，脾虚湿胜，运化失权，下不能温经血于胞宫，上不能输精微于眼睑；而精神萎靡，四肢不温，舌淡脉沉微，显系肾阳衰惫，阴气弥漫，五脏之伤，穷必及肾；肾气之伤，又令脾失温养。虽辨病均属睑废，但辨证论治同中有异。因此，本例不仅不能重复补益中州，升阳举陷之常规；而且不能简单再遵文例“太阴病亦可从外而解之变法”。必须峻补元阳，温肾健脾为治。这正体现了祖国医学辨证施治，辨证与辨病相结合，同病异治，异曲同工之妙。
太阴少阴证痉病
郝××，女，22岁。重庆市某厂管理员。
[病史]1959年7月，因高热昏迷。送往某医院急诊。经用退热药，高烧不减，再以物理降温，仍无效。未明确诊断。遂出院，请中医治疗，当日服药两剂热退，渐清醒。但次日晚又陷入昏迷。送××医院抢救，当即下病危通知，亦未能确诊，急邀某老中医会诊，服中药后，病情又逐渐好转。老中医认为，脑中有淤滞。转××医学院检查拍片，果然发现颅内确有淤血，遂手术脱险。一月后，手足抽搐，下半身发凉；出院用中药医治，断续有五．六年之久，其效不显。1965年专程来蓉求诊，治疗三月基本痊愈。
[初诊]右半身手足抽掣，发作时口眼歪斜。每月约五、六次，抽搐前有预兆，先觉右侧身麻。近几年来，特别畏寒，六月炎暑，身穿毛衣，四肢仍厥冷。月经不定期，色暗淡。视力减退，恍惚不清，记忆与反应力均显著减弱、迟钝。神疲，纳呆。舌淡，少苔而灰白，脉沉细。此为大病之后，气血亏损而致痉，病属太、少二阴，宜先温中健脾，调和气血，以小建中汤主之。
处方：
桂枝12克炙甘草6克 白芍15克生姜30克红枣15克饴糖60克(兑服)
六剂
[二诊]服上方六剂，十日来，手足抽掣只发作过一次，发作前身麻减轻，精神和食欲均有好转。仍畏寒，肢冷，经水不调，阳气不通达于四肢。为除血虚寒凝，宜温经宣络，通脉养血为治，以当归四逆汤加味主之。
处方：
当归10克桂枝12克白芍10克辽细辛15克甘草6克 木通6克 大枣20克吴茱萸6克炮姜15克八剂
(三诊]上方进八剂，半月内抽搐未再复发。畏寒肢冷减轻，食欲稍增。月信刚至，色暗淡夹紫黑色血块较多，小腹痛。宜温脾肾，散寒滞。
处方：
炮姜60克 血余炭30克炙甘草30克制附片30克(久煎) 当归12克吴茱萸6克六剂
(四诊]服六剂后，病情稳步好转，以理中汤加味，继续调治。
处方：
党参15克 干姜12克炒白术12克甘草10克制附片30克(久煎) 茯苓12克砂仁10克白蔻10克枸杞15克菟丝子20克桂枝10克上方加减，约服两月余，身体基本康复。1979年7月，闻范老从京返蓉休息，专程来访致谢。自述病愈后，回家调养约两年，逐渐巩固至今，未曾复发。
(按语]本例发病之初，病情危重复杂，未明确诊断，几经数家医院中西医治疗，度过危险而余证迁延数年不愈。转来就诊时，按其证，神疲，畏寒，四肢厥冷，半身及手足抽引，舌淡，脉沉细，应属太阴、少阴脾肾阳虚；按其病，大病之后，气血皆虚，筋脉抽动拘急，发为痉病。正如《素问·至真要大论篇》云：“诸寒收引，皆属于肾”。 《灵枢·经筋第十三》云：“足少阴之筋”，其病“主痫瘛及痉”。本例辨证施治，体现了六经分证与辨病相结合；抓住主证，明晰病机；分清主次缓急，论治有先后。因而使迁延多年之宿疾，迅速向愈。
太阴少阴证崩漏
(功能性子宫出血并发失血性贫血症)
吴××，女，43岁。新华社工作人员。
[病史]自1971年，因失眠与低血压时而昏倒，当时未予重视。1975年以后，发病频繁；尤其是经量多、间隔短，长期大量失血，不能坚持工作。先后经北京数家医院均诊断为“功能性子宫出血”并发“失血性贫血症”。曾转外地医院，诊断如前，经治疗无效。1978年6月12日来诊，按太阴少阴同病论治。前后治疗四个月，诸证痊愈，恢复工作。
[初诊]行经不定期，停后数日复至，淋漓不断，色暗淡，夹乌黑淤块甚多。头痛、浮肿．纳呆、踡卧，失寐惊悸，气短神疲，肢软腹冷，恶寒身痛。面色苍白，形容憔悴。舌质淡，苔白滑，根部微腻。脉沉而微细。乃太阴少阴证崩漏。法宜温经散寒，复阳守中，以甘草干姜汤主之。
处方：
炮姜30克炙甘草30克三剂
[辨证]患者面色苍白，少腹冷痛，食少纳呆，舌淡苔白，皆足太阴脾亏损之证。脾主中气，统摄血液。脾气既亏，则血溢下流。且脾为生化之源，后天之本。脾气虚，则不能正常消化吸收营养物质。故本例崩漏，首责太阴虚寒，不能摄血归经。
崩漏失血，与足少阴肾关系尤为密切。因少阴肾为冲任之本，专司封藏。封藏不固，则冲任失守。患者恶寒踏卧，四肢清冷，脉沉微细，皆命门火衰，阴寒内盛之象。肾阳虚损，固摄无权，故月事不定而下，持续不断。阳气不振，不能温化血液，故下血暗淡，淤块甚多。腰为肾之外府，肾虚并湿寒阻滞，故腰背骨节酸痛。肾生髓，脑为髓海，肾虚则髓海不足，故头昏目眩。同时病入少阴，损及手少阴心，故心悸怔忡，气短神疲，睡卧不安。加以漏下失治，失血耗血过多，妇女本以血为本，长此以往，终于病卧难支。此病关键在于心肾阳衰，阴寒内盛，脾肾虚寒，中阳不振。法宜扶阳祛阴，引血归经，从崩漏之根本入手，投以甘草干姜汤施治。
(二诊]服药后胃口略开，仍恶寒身痛。继以甘草干姜汤合麻黄附子细辛汤，温经散寒，表里兼治。
处方：
炮姜30克 炙甘草30克麻黄9克制附片60克(久煎) 辽细辛3克上方随证加减，附片加至每剂120克，炮姜120克，共服二十五剂。
[方义]甘草干姜汤， 《伤寒论》原治太阳病阴阳两虚之变证， 《金匮要略》以主肺痿之属于虚寒者；后贤借治失血，引血归经。干姜辛温，辛与甘和，则从阳化；干姜炮黑，其味即苦，苦与甘和，则从阴化。今取其甘以化热，守中而复阳，阳升则能统血；取其苦甘以化阴，则阴血得养。 《直指方》说：“甘草干姜汤，治男女诸虚出血，胃寒，不能引气归源，无以收约其血。”故本例选用此方。今合麻黄附子细辛汤，因有寒中少阴之象，而复连太阳之邪。以附子、细辛，专温少阴之经；麻黄得附子之助阳托里，俾外邪之深入者可出，而阳气亦不致随汗而越。再与甘草干姜汤合而用之，更有相得益彰之妙。
[三诊]全身浮肿渐消，畏寒踡卧、头痛身痛均好转。崩漏止，月事趋于正常，淤块显著减少。舌质转红，仍偏淡，苔白滑，根腻渐退。病已明显好转，阳气渐复，阳升则阴长；但仍有脾湿肾寒之象。法宜扶阳和阴，补中益气。以甘草干姜汤并理中汤加味主之，随证增减，共服四十余剂。
处方：
制附片60克(久煎) 干姜15克 炙甘草30克党参30克 炒白术24克 茯苓20克炮姜30克血余炭30克上肉桂10克(冲服)
鹿角胶6克(烊化)
至1978年10月中旬，月经周期、经量、经色已正常，诸证悉愈，恢复全日工作。春节前后，因任务急迫，每日坚持工作十二小时以上，自觉精力旺盛。1979年3月临出国体检时，均属正常。
(按语] “妇人之生，有余于气，不足于血，以其数脱血也”。患者长期漏下，大量失血，已虚衰难支。必须从病根入手，方能奏效。李东垣云： “凡下血证，无不由于脾胃之首先亏损，不能摄血归源”。张景岳云： “凡见血脱等证，必当用甘药先补脾胃以益发生之气……则阳升阴长，而血自归经矣”。结合患者舌象脉证，其长期漏下失血，首“属太阴，以其脏有寒故也”。为此，始终以温脾为主，连用甘草干姜汤，守中而复阳，以摄血而生血。
再者，三阴证虽无合病、并病之名；但临床所见，三阴经证亦多交叉出现。本例患者即由脾胃虚寒性之太阴证未愈，进而发展为全身虚寒性之少阴证。肾阳虚衰，封藏无权，导致冲任不固而崩漏下血不止。为此，复以太阴少阴同病辨证论治。
又患者少阴里寒，并外连太阳之证；阴阳两经，表里皆病。里寒宜温，表实当解；而三阴表法，又与三阳不同。 “三阴必以温经之药为表，而少阴尤为紧关”。故以散邪温经之剂主之，并重用附子至120克。《金匮要略》曾载：一妇人怀娠六、七月，脉弦发热，似有表证。而其少腹恶寒之状，如扇风之侵袭。所以然者，因其人阳虚子藏开．寒邪侵入。故仲景以“附子汤”温子藏而驱寒。但可惜此方早已失传，现存经文亦不纯，必有残缺。李彣注：按子藏即子宫。尤怡曰：附子汤未见，然温里散寒之意概可推矣(《订正仲景全书》)。关于本例漏下诊治，一再重用附子者，亦即仿效仲景佚方之意。
太阴少阴证嘴眼畸形
傅×，男，15岁。重庆市某中学学生。
[病史]患儿从小身体较好，在校一直为“三好”学生，喜爱文体活动。1974年春，家长发现患儿时常噘嘴，眼珠略向外鼓，性急躁。同学见之，或说故装怪象，或取“翘嘴”、 “八戒”等绰号。虽经家长、老师一再纠正，患儿反变得日益畸形怪状：双唇外翻，越翘越高，两眼稍突，不愿平视。白日想方设法遮其丑。入睡嘴唇仍高努不收，并逐渐发展到睡眠减少，食欲下降，记忆力显著减退。尤其畏惧他人视其面，出门则紧压帽沿，戴大口罩。如有人指点其状，则忿忿不已，忧心忡忡。对医生之检查、询问，异常反感，稍有触犯，则拒绝就诊。其后，病情益重，神情举止异常：时伫立窗前，盲目向外凝视；甚至以嘴唇触室内墙壁，直至出血染印。低处尽染，再爬上桌椅，登高用嘴唇触之，室内满墙竟染成斑斑血印。家人见此，为之骇然。
开始在重庆××医院，经内科、口腔科、神经内科、脑外科、新医科和精神科等科检查，皆无结果，病因不明。1974年8月，曾转数处中医院求诊，分别按“风毒”、 “邪风入络”、 “肝火”及“水湿伤肾”论治，服药百余剂，均未获效。1975年初，转成都××中医院，诊其病因，一日风，二日脾． “脾僵则唇翻眼鼓”。同年1月底，遂转来求诊。
[初诊]1975年7月25日。患儿嘴唇翻翘， 高高努起。双眼上胞浮肿，眼珠微突，似睁似闭。神情忧郁，沉默寡言，坐立不安。纳差，便溏，四肢清冷，面色萎黄，舌质淡，边缘有齿痕，少苔。范老沉思良久日：此病罕见，应属足太阴寒邪凝滞，脾阳受戕；并因失治误治，损及少阴心肾，试投四逆汤以温之。
处方：
制附片30克(久煎) 干姜30克炙甘草18克四剂
[辨证]祖国医学认为：眼胞属脾，脾主肌肉，肌肉之精为“约束” (即眼轮匝肌)。 《素问·五脏生成篇》又明确指出： “脾之合肉也，其荣唇也”。《素问·六节脏象论篇》云： “其华在唇四白”。今患儿眼睑浮肿，嘴唇翻翘高努，参看食欲不振，面色萎黄，少苔，显系脾阳衰败，阴寒凝聚，外现为眼胞与嘴唇之病变，甚则呈僵鼓之异状，不能收缩自如。故证属足太阴。
Prescription:
Zhi Fupian (Prepared Aconite Root) 60g (decocted for a long time), Ganjiang Pian (Dried Ginger Slice) 30g, Zhi Gancao (Honey-fried Licorice Root) 30g.
[Third Visit] After taking three doses of the above prescription, the muscle twitching of the eye disappeared, and the edema of the eyelid decreased slightly. However, the left upper eyelid remains heavy, drooping, and weak. It is appropriate to warm and tonify the Spleen and Kidney, assist Yang to dispel Yin pathogens. The formula Si Ni Tang (Frigid Extremities Decoction) combined with Li Zhong Tang (Regulate the Middle Decoction) with modifications is prescribed for continued use.
Prescription:
Zhi Fupian (Prepared Aconite Root) 60g (decocted for a long time), Ganjiang Pian (Dried Ginger Slice) 30g, Zhi Gancao (Honey-fried Licorice Root) 15g, Chao Baizhu (Stir-baked Atractylodes Macrocephala Rhizome) 25g, Fuling (Poria) 25g, Shang Rougui (Top-quality Cinnamon Bark) 10g (dissolved in the decoction), Shengjiang (Fresh Ginger) 60g.
[Fourth Visit] Based on the original formula, adjustments were made. One dose per day was taken continuously for over two months. By January 1, 1979, the left upper eyelid cracked briefly twice, lasting about one hour each time. The original method was still followed, alternating between Si Ni Tang (Frigid Extremities Decoction) and Li Zhong Tang (Regulate the Middle Decoction), or combining them into one formula. If menstrual irregularity occurred with dark purple-black blood clots, Paojiang (Charred Ginger) and Xueyutan (Charred Human Hair) were added; if exterior syndrome was present, Mahuang (Ephedra Stem) and Guizhi (Cinnamon Twig) were added. This regimen continued for another two months.
[Fifth Visit] In early March 1979, the ptosis of the left upper eyelid improved significantly, allowing the eyelid to open, though slightly smaller than normal. Mild edema remained in both upper eyelids. Coordination between the left and right eyes when viewing objects was often uncoordinated. Eczema on the forehead and cheeks had clearly subsided. Menstrual color returned to normal, but with a small amount of blood stasis clots. Appetite was acceptable. The tongue body became slightly pale and reddish, with a thin white coating. Yang Qi gradually recovered while Yin pathogens diminished, yet signs of Spleen-Kidney Yang Deficiency persisted. Li Zhong Tang (Regulate the Middle Decoction) combined with Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Aconite) with modifications was used for regulation.
Prescription:
Guizhi (Cinnamon Twig) 10g, Zhi Gancao (Honey-fried Licorice Root) 15g, Shengjiang (Fresh Ginger) 30g, Hongzao (Jujube) 30g, Chao Baizhu (Stir-baked Atractylodes Macrocephala Rhizome) 20g, Fuling (Poria) 20g, Zhi Fupian (Prepared Aconite Root) 30g (decocted for a long time).
The above formula was adjusted according to symptoms, and Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction), Xiao Banxia Tang (Minor Pinellia Decoction), and Zhensha San (Needle Sand Powder) were used in combination. After April 1979, occasional uncoordinated vision in both eyes and mild edema of the upper eyelids occurred. Regulation continued to consolidate the effect.
[Commentary] Both the previous case and this case are diagnosed by Western medicine as "Myasthenia Gravis Ocular Type"; however, according to Six Meridian differentiation, they differ, so their therapeutic principles and prescriptions also vary.
The previous case of blepharoptosis belonged to Taiyin Syndrome, where the Spleen was trapped by Dampness. The main pathogenesis was water-dampness overflowing into the meridians and skin, unable to be excreted externally, and ascending to the eyelids, causing swelling and drooping. This case belongs to the concurrent disease of Taiyin and Shaoyin, with Spleen-Kidney Yang Deficiency. The pathology lies in the Spleen, but the root is in the Kidney. Eyelid drooping, eyelid edema, sallow complexion, dark menstrual blood with clots, teeth marks on the tongue, and thick gray-white coating all indicate Spleen Yang decline, Spleen deficiency with excessive Dampness, loss of transportation and transformation authority, inability to warm the uterine vessels below, and inability to transport essence to the eyelids above. Mental fatigue, cold limbs, pale tongue, and deep, faint pulse clearly indicate Kidney Yang exhaustion, pervasive Yin Qi, and that damage to the five Zang organs eventually reaches the Kidney. Kidney Qi damage further causes the Spleen to lose warmth and nourishment. Although both are diagnosed as blepharoptosis, differentiation and treatment show similarities and differences. Therefore, this case cannot simply repeat the routine of tonifying the Middle Jiao (Spleen and Stomach) and raising Yang to lift sinking, nor can it simply follow the previous text's variation that "Taiyin disease can also be resolved from the exterior." Severe tonification of Primordial Yang and warming the Kidney to strengthen the Spleen are required. This reflects the brilliance of Traditional Chinese Medicine in syndrome differentiation and treatment, combining syndrome differentiation with disease differentiation, treating different syndromes with the same disease, and achieving similar results through different methods.
Taiyin-Shaoyin Syndrome Spasm Disease
Hao XX, Female, 22 years old. Administrator at a factory in Chongqing.
[Medical History] In July 1959, she fell into a coma due to high fever. She was sent to the emergency room of a certain hospital. Antipyretics did not reduce the high fever, and physical cooling was also ineffective. No clear diagnosis was made. She was discharged and sought TCM treatment. After taking two doses of herbal medicine on the same day, her fever subsided, and she gradually regained consciousness. However, she fell into a coma again the next night. She was sent to Hospital XX for rescue, given a critical condition notice, but still no definitive diagnosis. An experienced TCM doctor was urgently invited for consultation. After taking Chinese medicine, her condition gradually improved. The old TCM doctor believed there was blood stasis in the brain. She was transferred to a Medical College for examination and imaging, which indeed revealed intracranial hemorrhage, and she survived surgery. One month later, she experienced convulsions of hands and feet and coldness in the lower half of her body. She was treated intermittently with TCM after discharge for five or six years, but the effect was not obvious. In 1965, she specially came to Chengdu for consultation and was basically cured after three months of treatment.
[First Visit] Convulsions of hands and feet on the right side, with deviation of the mouth and eyes during attacks. Occurred about five or six times a month. There was a prodrome before convulsions, starting with numbness on the right side of the body. In recent years, she has been particularly afraid of cold. Even in the hot weather of June, wearing a wool sweater, her four limbs remained cold. Menstruation was irregular, with dark and dim color. Vision decreased, blurred, and memory and reaction speed were significantly weakened and slow. Mental fatigue, poor appetite. Pale tongue, little coating, grayish-white, deep and fine pulse. This is spasm caused by Qi and Blood deficiency after a severe illness, belonging to Taiyin and Shaoyin. It is appropriate to first warm the Middle and strengthen the Spleen, harmonize Qi and Blood, using Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) as the main formula.
Prescription:
Guizhi (Cinnamon Twig) 12g, Zhi Gancao (Honey-fried Licorice Root) 6g, Baishao (White Peony Root) 15g, Shengjiang (Fresh Ginger) 30g, Hongzao (Jujube) 15g, Yitang (Maltose) 60g (mixed in).
Six doses.
[Second Visit] After taking six doses of the above prescription, within ten days, hand and foot convulsions occurred only once. Numbness before the attack was reduced, and spirit and appetite both improved. Still afraid of cold, cold limbs, irregular menstruation, Yang Qi not reaching the four limbs. To eliminate blood deficiency and cold coagulation, it is appropriate to warm the meridians, promote collaterals, unblock pulses, and nourish blood. Dang Gui Si Ni Tang (Angelica Sinensis Decoction for Frigid Extremities) with modifications is prescribed as the main treatment.
Prescription:
Danggui (Angelica Sinensis Root) 10g, Guizhi (Cinnamon Twig) 12g, Baishao (White Peony Root) 10g, Liao Xixin (Liaoning Asarum Root) 15g, Gancao (Licorice Root) 6g, Mutong (Akebia Stem) 6g, Dazao (Jujube) 20g, Wuzhuyu (Evodia Fruit) 6g, Paojiang (Charred Ginger) 15g.
Eight doses.
[Third Visit] After taking eight doses of the above prescription, convulsions did not recur within half a month. Fear of cold and cold limbs were alleviated, and appetite slightly increased. Menstruation just started, with dark color and many purple-black blood clots, accompanied by lower abdominal pain. It is appropriate to warm the Spleen and Kidney and disperse cold stagnation.
Prescription:
Paojiang (Charred Ginger) 60g, Xueyutan (Charred Human Hair) 30g, Zhi Gancao (Honey-fried Licorice Root) 30g, Zhi Fupian (Prepared Aconite Root) 30g (decocted for a long time), Danggui (Angelica Sinensis Root) 12g, Wuzhuyu (Evodia Fruit) 6g.
Six doses.
[Fourth Visit] After taking six doses, the condition steadily improved. Li Zhong Tang (Regulate the Middle Decoction) with modifications was used for continued treatment.
Prescription:
Renshen (Ginseng Root) [Note: Text says Dangshen, usually Codonopsis, but context implies tonifying Qi strongly, here translated as Dangshen/Codonopsis] 15g, Ganjiang (Dried Ginger) 12g, Chao Baizhu (Stir-baked Atractylodes Macrocephala Rhizome) 12g, Gancao (Licorice Root) 10g, Zhi Fupian (Prepared Aconite Root) 30g (decocted for a long time), Fuling (Poria) 12g, Sharen (Amomum Fruit) 10g, Baiko (White Cardamom) 10g, Gouqi (Goji Berry) 15g, Tusizi (Dodder Seed) 20g, Guizhi (Cinnamon Twig) 10g.
The above formula was adjusted, taken for about two months, and the body basically recovered. In July 1979, hearing that Master Fan returned from Beijing to Chengdu to rest, he visited specifically to express gratitude. He stated that after recovery, he rested at home for about two years, gradually consolidating until now without recurrence.
[Commentary] At the beginning of this case, the condition was critical and complex, with no clear diagnosis. After treatment by several hospitals' internal and external medicine departments, the danger was passed, but residual symptoms persisted for years. Upon referral, based on symptoms such as mental fatigue, fear of cold, cold limbs, hemibody and hand-foot convulsions, pale tongue, and deep fine pulse, it should belong to Taiyin and Shaoyin Spleen-Kidney Yang Deficiency. Based on the disease, after a severe illness, both Qi and Blood are deficient, tendons and vessels twitch and contract, leading to spasm disease. As stated in *Su Wen: Chapter on the Most Essential Requirements*: "All cold contractions and pulling belong to the Kidney." *Ling Shu: Chapter 13 on Meridian Sinews* states: "The sinew of Foot Shaoyin," its disease "mainly involves epilepsy, spasms, and convulsions." The syndrome differentiation and treatment of this case reflect the combination of Six Meridian differentiation and disease differentiation; grasping the main symptoms, clarifying the pathogenesis; distinguishing primary and secondary, urgent and non-urgent, with sequential treatment. Thus, a chronic disease persisting for years rapidly healed.
Taiyin-Shaoyin Syndrome Metrorrhagia and Metrostaxis
(Functional Uterine Bleeding Complicated with Hemorrhagic Anemia)
Wu XX, Female, 43 years old. Staff member of Xinhua News Agency.
[Medical History] Since 1971, she occasionally fainted due to insomnia and low blood pressure, which was not taken seriously at the time. After 1975, the frequency of attacks increased; especially with heavy menstrual flow and short intervals, long-term massive blood loss prevented her from working. Several hospitals in Beijing diagnosed her with "Functional Uterine Bleeding" complicated with "Hemorrhagic Anemia." She was transferred to hospitals in other places with the same diagnosis, but treatment was ineffective. On June 12, 1978, she came for consultation and was treated according to the concurrent disease of Taiyin and Shaoyin. After four months of treatment, all symptoms were cured, and she resumed work.
[First Visit] Irregular menstruation, returning a few days after stopping, dripping continuously, with dark color and many black blood clots. Headache, edema, poor appetite, curling up in bed, insomnia, palpitations, shortness of breath, mental fatigue, soft limbs, cold abdomen, aversion to cold, body pain. Pale complexion, emaciated appearance. Pale tongue body, slippery white coating, slightly greasy at the root. Deep and very fine pulse. This is Taiyin-Shaoyin syndrome metrorrhagia and metrostaxis. The method should be to warm the meridians and dispel cold, restore Yang and guard the Middle, using Gancao Ganjiang Tang (Licorice and Ginger Decoction) as the main formula.
Prescription:
Paojiang (Charred Ginger) 30g, Zhi Gancao (Honey-fried Licorice Root) 30g.
Three doses.
[Syndrome Differentiation] The patient's pale complexion, cold pain in the lower abdomen, poor appetite, pale tongue, and white coating are all signs of Foot Taiyin Spleen deficiency. The Spleen governs Middle Qi and controls blood. Once Spleen Qi is deficient, blood overflows and flows downward. Moreover, the Spleen is the source of production and transformation, the foundation of post-heaven existence. When Spleen Qi is deficient, it cannot normally digest and absorb nutrients. Therefore, the metrorrhagia and metrostaxis in this case are primarily attributed to Taiyin deficiency-cold, failing to control blood and return it to the vessels.
Metrorrhagia and blood loss are closely related to Foot Shaoyin Kidney. Because the Shaoyin Kidney is the root of Chong and Ren vessels, specifically responsible for sealing and storing. If sealing and storing are not secure, Chong and Ren vessels lose control. The patient's aversion to cold, curling up, cold limbs, and deep faint pulse are all signs of Mingmen Fire decline and internal excess of Yin-cold. Kidney Yang deficiency leads to loss of control, causing irregular menstruation and continuous bleeding. Weak Yang Qi cannot warm and transform blood, resulting in dark bleeding and many clots. The waist is the external mansion of the Kidney; Kidney deficiency with damp-cold obstruction causes soreness and pain in the lower back and joints. The Kidney generates Marrow, and the Brain is the Sea of Marrow; Kidney deficiency leads to insufficient Sea of Marrow, causing dizziness and vertigo. Simultaneously, the disease enters Shaoyin, damaging Hand Shaoyin Heart, causing palpitations, shortness of breath, mental fatigue, and restless sleep. Added to this is the failure to treat leakage, excessive blood loss. Women are fundamentally based on Blood; over time, this eventually leads to being bedridden and unable to support oneself. The key to this disease is Heart-Kidney Yang decline, internal excess of Yin-cold, Spleen-Kidney deficiency-cold, and weak Middle Yang. The method should be to support Yang and dispel Yin, guide blood back to the vessels, addressing the root of metrorrhagia, using Gancao Ganjiang Tang (Licorice and Ginger Decoction) for treatment.
[Second Visit] After taking medicine, appetite slightly opened, but still aversion to cold and body pain. Continued with Gancao Ganjiang Tang (Licorice and Ginger Decoction) combined with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) to warm meridians and dispel cold, treating both interior and exterior.
Prescription:
Paojiang (Charred Ginger) 30g, Zhi Gancao (Honey-fried Licorice Root) 30g, Mahuang (Ephedra Stem) 9g, Zhi Fupian (Prepared Aconite Root) 60g (decocted for a long time), Liao Xixin (Liaoning Asarum Root) 3g.
The above formula was adjusted according to symptoms. Fupian was increased to 120g per dose, Paojiang to 120g, totaling twenty-five doses.
[Formula Meaning] Gancao Ganjiang Tang (Licorice and Ginger Decoction), originally in *Shanghan Lun* (Treatise on Cold Damage) to treat variations of Taiyang syndrome with dual deficiency of Yin and Yang, and in *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to treat pulmonary痿 (Flaccidity) belonging to deficiency-cold; later experts borrowed it to treat bleeding, guiding blood back to the vessels. Ganjiang (Dried Ginger) is acrid and warm. Acrid combined with Sweet transforms from Yang; when Ganjiang is charred black, its taste becomes bitter. Bitter combined with Sweet transforms from Yin. Here, we take its Sweet to generate heat, guard the Middle and restore Yang; when Yang rises, it can control blood. We take its Bitter-Sweet to transform Yin, so that Yin-Blood is nourished. *Zhizhi Fang* says: "Gancao Ganjiang Tang treats various deficiencies and bleeding in men and women, stomach cold, inability to guide Qi to its source, and inability to restrict blood." Therefore, this formula was selected for this case. Now combined with Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction), because there are signs of Cold invading Shaoyin, connected to Taiyang pathogens. Fuzi (Aconite) and Xixin (Asarum) specifically warm the Shaoyin meridian; Mahuang (Ephedra), assisted by Fuzi's Yang-supporting and interior-strengthening power, allows deeply invaded exterior pathogens to exit, and Yang Qi does not escape with sweat. Combined with Gancao Ganjiang Tang (Licorice and Ginger Decoction), there is a synergistic effect.
[Third Visit] Generalized edema gradually subsided, fear of cold, curling up, headache, and body pain all improved. Metrorrhagia stopped, menstruation tended towards normal, blood clots significantly reduced. Tongue body turned red, still slightly pale, slippery white coating, root greasiness gradually receded. The condition obviously improved, Yang Qi gradually recovered, Yang rises and Yin grows; but there are still signs of Spleen Dampness and Kidney Cold. The method should be to support Yang and harmonize Yin, tonify the Middle and benefit Qi. Gancao Ganjiang Tang (Licorice and Ginger Decoction) combined with Li Zhong Tang (Regulate the Middle Decoction) with modifications was used as the main treatment, adjusted according to symptoms, totaling over forty doses.
Prescription:
Zhi Fupian (Prepared Aconite Root) 60g (decocted for a long time), Ganjiang (Dried Ginger) 15g, Zhi Gancao (Honey-fried Licorice Root) 30g, Dangshen (Codonopsis Root) 30g, Chao Baizhu (Stir-baked Atractylodes Macrocephala Rhizome) 24g, Fuling (Poria) 20g, Paojiang (Charred Ginger) 30g, Xueyutan (Charred Human Hair) 30g, Shang Rougui (Top-quality Cinnamon Bark) 10g (dissolved in the decoction), Lujiaojiao (Deer Antler Glue) 6g (melted).
By mid-October 1978, menstrual cycle, volume, and color were normal, all symptoms were cured, and full-time work was resumed. Around the Spring Festival, due to urgent tasks, she insisted on working more than twelve hours a day, feeling energetic. In March 1979, pre-departure medical examinations were all normal.
[Commentary] "Women are born with excess Qi and deficient Blood, because they frequently lose Blood." The patient had long-term leakage and massive blood loss, already too weak to support herself. It is necessary to address the root cause to achieve efficacy. Li Dongyuan said: "All bleeding syndromes are due to the initial deficiency of the Spleen and Stomach, failing to control blood and return it to the source." Zhang Jingyue said: "When seeing blood-loss syndromes, one must first use Sweet medicines to tonify the Spleen and Stomach to benefit the generating Qi... then Yang rises and Yin grows, and blood naturally returns to the vessels." Combining the patient's tongue and pulse signs, her long-term leakage and blood loss first "belongs to Taiyin, because the Zang organ has Cold." Therefore, the treatment always focused on warming the Spleen, continuously using Gancao Ganjiang Tang (Licorice and Ginger Decoction) to guard the Middle and restore Yang, to control blood and generate blood.
Furthermore, although Three Yin syndromes do not have the names of concurrent disease and combined disease; clinically, Three Yin meridian syndromes often appear cross-wise. This patient developed from unresolved Spleen-Stomach deficiency-cold Taiyin syndrome to systemic deficiency-cold Shaoyin syndrome. Kidney Yang deficiency and loss of sealing and storing led to insecurity of Chong and Ren vessels, causing continuous metrorrhagia and bleeding. Therefore, it was again treated according to the concurrent disease of Taiyin and Shaoyin.
Also, the patient had Shaoyin interior cold, connected externally to Taiyang; both Yin and Yang meridians, interior and exterior were diseased. Interior cold should be warmed, exterior excess should be resolved; but the exterior method for Three Yin is different from Three Yang. "Three Yin must use warming meridian medicines as the exterior method, and Shaoyin is particularly critical." Therefore, a formula to dispel pathogens and warm meridians was used, heavily relying on Fuzi (Aconite) up to 120g. *Jingui Yaolue* records: A woman pregnant for six or seven months, with wiry pulse and fever, seeming to have an exterior syndrome. But her lower abdomen feels cold, like wind blowing. The reason is that her Yang is deficient, the uterus is open, and Cold pathogens invade. Therefore, Zhongjing used "Fuzi Tang" to warm the uterus and drive out cold. Unfortunately, this formula has long been lost, and the existing text is impure, likely incomplete. Li Bing notes: The uterus refers to the womb. You Yi says: Fuzi Tang is not seen, but the meaning of warming the interior and dispelling cold can be inferred (*Corrected Complete Works of Zhongjing*). Regarding the diagnosis and treatment of this case's leakage, repeatedly using heavy doses of Fuzi is also imitating the intent of Zhongjing's lost formula.
Taiyin-Shaoyin Syndrome Mouth and Eye Deformity
Fu X, Male, 15 years old. Student at a middle school in Chongqing.
[Medical History] The child had good health since childhood and was always a "Three Goods" student at school, enjoying sports and cultural activities. In the spring of 1974, parents noticed the child often pouted, with eyes bulging slightly outward, and irritable temperament. Classmates saw this, saying he was pretending to be strange, or nicknaming him "Upturned Mouth" or "Bajie." Despite repeated corrections by parents and teachers, the child反而 became increasingly deformed and strange: double lips everted, curling higher and higher, eyes slightly protruding, unwilling to look straight ahead. During the day, he tried every way to hide his ugliness. When sleeping, his lips remained curled high and unretracted, gradually developing into reduced sleep, decreased appetite, and significantly reduced memory. Especially fearful of others looking at his face, he pressed his hat brim down tightly and wore large masks when going out. If someone pointed out his condition, he would be angry and worried. He had an abnormal aversion to doctors' examinations and inquiries; if slightly offended, he refused to see the doctor. Later, the condition worsened, with abnormal demeanor and behavior: sometimes standing by the window, staring blindly outward; even touching indoor walls with his lips until bleeding stained them. Covering the lower areas, he climbed onto tables and chairs, reaching high to touch with his lips, staining the entire wall with bloody marks. The family was horrified.
Initially at Chongqing XX Hospital, examinations by Internal Medicine, Stomatology, Neurology, Neurosurgery, New Medicine, and Psychiatry yielded no results, and the cause was unknown. In August 1974, he consulted several TCM hospitals, treated respectively as "Wind-Toxin," "Evil Wind Entering Collaterals," "Liver Fire," and "Water-Dampness Damaging Kidney," taking over a hundred doses of medicine without effect. In early 1975, he was transferred to Chengdu XX TCM Hospital. Diagnosing the cause as Wind and Spleen: "When Spleen stiffens, lips flip and eyes bulge." At the end of January that year, he was transferred for consultation.
[First Visit] July 25, 1975. The child's lips flipped and curled high. Both upper eyelids edematous, eyes slightly protruding, seeming open and closed. Depressed expression, silent, restless. Poor appetite, loose stools, cold limbs, sallow complexion, pale tongue, teeth marks on edges, little coating. Master Fan pondered for a long time and said: This disease is rare, should belong to Foot Taiyin Cold Pathogen stagnation, Spleen Yang damaged; and due to missed and mistaken treatment, damaging Shaoyin Heart and Kidney. Tentatively prescribe Si Ni Tang (Frigid Extremities Decoction) to warm it.
Prescription:
Zhi Fupian (Prepared Aconite Root) 30g (decocted for a long time), Ganjiang (Dried Ginger) 30g, Zhi Gancao (Honey-fried Licorice Root) 18g.
Four doses.
[Syndrome Differentiation] Traditional Chinese Medicine believes: Eyelids belong to the Spleen, the Spleen governs muscles, the essence of muscles is "Constraint" (i.e., orbicularis oculi muscle). *Su Wen: Chapter on Generation of Five Zang Organs* explicitly states: "The Spleen combines with flesh, its luster is in the lips." *Su Wen: Chapter on Six Sections of Zang-Fu Images* says: "Its luster is in the four whites of the lips." Now the child has eyelid edema, lips flipped and curled high, combined with poor appetite, sallow complexion, and little coating, clearly indicating Spleen Yang collapse, Yin-Cold aggregation, manifesting externally as lesions of eyelids and lips, even presenting as stiff and bulging abnormalities, unable to contract freely. Therefore, the syndrome belongs to Foot Taiyin.