胃脘痛1(浅表性胃炎)
陈某某，女，39岁。
初诊
胃脘作痛5年余，胃镜检查确诊为浅表性胃炎。现症食后胃脘即痛，嗳气不舒，脘腹胀满，面部色暗花斑。脉象弦细且沉，舌红苔白，肝郁日久，横逆犯胃。先用疏调气机方法。
旋复花10克，代赭石10克(先煎)，青陈皮各10克，蝉衣6克，僵蚕10克，片姜黄6克，炒枳壳6克，白芷6克，防风6克，茅芦根各10克，七付
二诊
药后胃痛渐止。自觉消化欠佳，食后胃脘堵满，暖气不舒。
脉仍沉弦，仍用疏调气机方法。
川楝子6克，元胡6克，苏叶10克，藿香10克，香附10
克，炒枳壳6克，苦桔梗10克，焦三仙各10克，水红花子10克，太黄1克，七付
三诊
胃痛已愈。脘腹胀满亦减。自觉一身乏力，困倦嗜睡。脉象弦细。按之沉濡，舌红苔白，肝胆湿热未清，仍用清泄肝胆方法。
荆芥炭10克，防风6克，川楝子6克，元胡6克，炒山栀6克，茵陈10克，佩兰10克(后下)，藿香10克(后下)，焦三仙各10克，水红花子10克，七付
四诊
药后嗜睡明显减轻，精神转佳，惟下肢困乏无力，大便干结。肝胆热郁渐减，仍用原方进退。
佩兰10克(后下)，藿香10克(后下)，苏叶10克，青陈皮各10克，炒山栀6克，茵陈10克，焦兰仙各10克，水红花子10克，大腹皮10克，槟榔10克，大黄3克，七付。
五诊
大便干结难下，每周始便一次。心烦梦多。胃痛脘胀皆愈，精神亦佳。肝胆郁热已久，正值长夏，湿热偏盛，仍用清化湿热方法。
茵陈10克，栀子6克，柴胡6克，黄苓6克，川楝子6克，佩兰10克(后下)，藿香10克(后下)，大腹皮10克，青陈皮各10克，滑石10克，大黄5克。
药后大便畅行，食眠均佳，脉舌如常，胃痛始终来发，遂停药观察。并嘱其慎饮食，加强锻炼，以增强体质。
[按]：胃痛5年余，屡服中西药物疗效欠佳。赵师根据其脉象沉弦，嗳气不舒，面色花斑等脉证，断为肝气郁结日久，横逆犯胃。投以升降散疏调气机，以解肝郁，立收止痛之效。且初诊之后，胃脘始终未再发生。在辨证上，脉象沉弦乃典型的肝郁脉象，下手脉沉，便知是气，弦主肝郁，其面色花斑亦为气机郁滞的确征，此征多见于见于性格内向，爱生闷气之人，女性多见，当从肝郁治之。方中防风等风药的运用，更有深意，一则除湿，所谓湿盛者，助风以平之；二则升阳，使清阳上升则脾运；三则疏肝，风药以辛为用，乃肝之所喜，所谓“肝欲散，急食辛以散之”也。方中未用传统的止疼之药，而收止痛之效者，治在其本也。
胃脘痛2(十二指肠球部溃疡)
韩某，男，39岁。
初诊
胃脘疼痛6年余，疼痛每于饥饿或劳累时发作，疼处不移，得食稍缓。诊脉沉弦细。按之沉滞不起，舌质暗舌苔白根厚。气郁日久，必及血分，痛久入络，此之谓也。拟用活血化瘀方法，以定其痛。
川楝子10克，元胡6克，生蒲黄10克，炒五灵脂10克，青陈皮各6克，炒枳壳6克，焦三仙各10克，水红花子10克，七剂。
二诊
药后胃痛未作，脉弦舌红，大便偏干，时有嗳酸，继用疏调木土，合以左金丸方法。
川楝子6克，元胡6克，生蒲黄10克，炒五灵脂10克，青陈皮各6克，吴茱萸3克，黄连2克，生牡蛎15克，焦三仙各10克，大黄1克，七剂。
三诊
胃痛未作，嗳酸亦止，二便已调，食眠均佳。停药饮食消息，辛辣刺激皆忌，尤当戒烟为要，否则仍易复发也。
[按]：十二指肠溃疡一症，多表现为饥时痛作，似乎中虚不足之症。但本案患者病已延久，6年不愈，痛处不移，舌质色暗，已现瘀血之征，正合叶天士“久病入络”之论，故从络病调治，用活血化瘀方法，方用金铃子散合失笑散加减，疏肝理气，化瘀止痛。服之即效。凡瘀血作痛者，用之极效。此先生临床常用之经验方，治疗胃溃疡、胃炎、十二指肠球部溃疡等，凡有瘀血见症，皆可用此法治疗。若兼见胀满气滞，加青陈皮、香附、术香、枳壳等；若挟食滞胀满活苔垢厚，加焦三仙，水红花子、大腹皮、槟榔等；若暖气吞酸，肝郁化热，可合用左金丸，即吴茱萸、黄连，再加生牡蛎、海螵蛸之类。溃疡病的治疗，饮食调理极为重要，忌食辛辣刺激性食物，戒酒忌烟。凡烟客，嗜烟如命者，治之无功。故一定嘱咐患者密切配合，戒绝烟酒，方保证治疗达到预期效果。
胃脘痛3(食道裂孔疝)
杨某，女，71岁。患糖尿病10余年，一直由赵师用中药调治，病情尚属稳定。近困胃脘部疼痛，经某医院钡餐拍片确诊为食道裂孔疝，服药不效，遂求治于师。1991年9月初诊，见其面色苍白，形肥体胖，上腹部持续性饱胀，疼痛时作，口干不欲饮，脉象沉软。舌淡苔白且润。脉证合参，辨为中阳不足，气虚下陷，治以益气补中、升阳举陷法。用补中益气汤加减：生黄芪15克，党参6克，白术10克，生熟地各20克，柴胡6克，升麻10克，当归10克，青陈皮各10克趣p枳壳6克，防风6克。
上方7剂，复诊胃脘胀痛已止，复行钡餐×线检查：胃内壁光滑，未见龛影，扩张良好。说明食道裂孔疝已消失，转方用益气和胃法调理而安。
[按]：食遭裂孔疝以胀痛为主，患者素患糖尿病，面白、形胖、短气、乏力，乃气虚中阳不足之象，虽病胀痛，然舌淡脉软，全无邪气之征，况其胃壁陷入食道裂孔为疝，亦因气虚陷之也。《内经》言“陷者升之”，此之谓也。故治以益气补中、升阳举陷法而能痛止疝痛消。中医辨证施治，贵在求本，不必见症治症。
胃脘痛4(胃及十二指肠球部溃疡
陈某，男，34岁。素嗜烟酒，患胃及十二指肠溃疡5年余，疼痛经常发作，中西药治疗效果不佳，1992年7月求治于师。
诊其脉沉左弦右涩，舌红苔黄根厚，舌背脉络粗大紫黑。其证胃脘隐痛持续，刺痛时作，痛处不移，拒按，大便色黑，小溲黄赤。辨为痛久入络，血分瘀滞，用活血化瘀法治之。药用金铃子10克，延胡素10克，生蒲黄10克，赤芍10克，炒五灵脂10克，柴胡6克，香附10克，青陈皮各10克，焦三仙各10克，水煎服，7剂。复诊，药后痛止纳增。嵌上方加减治疗1个月，疼痛未再发作，遂停药观察，并嘱其戒烟酒厦刺激性食物，以防复发。
[按]：胃脘疼痛数年不愈，刺痛不移、拒按、黑便、脉沉涩，据此脉证不难辨别其为瘀血之证。然赵师辨瘀，另有一法，即视其舌背脉络，若紫黑粗大者必为血分瘀滞无疑。治用金铃子散合失笑散，两方俱为化癖止痛之名方，合用则其效现宏，再加行气之品，离活血必先行气之意。配伍精当，故投之即效。
胁痛1(神经性胁痛)
阮某某，女，57岁暴怒之后，两胁气串作痛，心烦不寐。脉来弦急滑数，舌红且干，尖部起刺。怒伤肝，木郁化火，气分郁结，先用越鞠丸方法。
川芎6克，苍术3克，香附10克，枳壳10克，竹茹6克，川楝子10克，片姜黄6克，杏仁10克，元胡6克，炒山栀6克，三剂。
上方服后疼痛即止。遂停汤药，令服成药越鞠丸，并戒恼怒，以善其后。
[按]：暴怒伤肝，气郁化火，故投越鞠丸，以调气机为主，气郁解则火郁散。所加之药，用杏仁、枳壳疏理气机，川楝子、竹茹泄肝胃之热，片姜黄、元胡活血利气止痛。胁痛暴作，治标为急，故以汤剂治之，药后痛止，则以丸药消息善后。更戒之以和情志，为根本之计。
胁痛2(慢性肝炎)
全某某，男，56岁
初诊
素嗜烟酒肥甘，体丰痰多，舌红苔腻垢厚，脉象弦滑有力，按之急数，大便不畅小便色黄。久患肝炎未愈，每于恼怒则胁痛必作。痰湿积滞互阻，少阳络脉失和。先以清化痰浊，少佐开郁止痛方法。
旋复花10克，郁金6克，杏仁10克，莱菔子10克，苏子梗各10克，白芥子6克，茜草10克，焦三仙各10克，大黄1
克，三剂
二诊
药后大便畅行，胁痛已止，脉仍弦滑，舌红苔垢，湿热积滞已久，非旦夕可以根除。若能戒绝烟酒，坚持素食，并运动锻炼，可保身体康复。
苏子10克，莱菔子10克，白芥子6克，焦三仙各10克，水红花子10克，郁金6克，片姜黄6克，赤芍10克，茜草10克，丹参10克，十剂。
[按]：形肥、痰多，脉滑而有力、苔垢厚，此四者定其为痰浊阻络，故尔胁痛。凡具此征者，可用五子涤痰汤，即苏子、莱菔子、白芥子、冬瓜子、皂角子。以此为基础方，加理气活血，疏风胜湿，消食导滞之品，治疗范围大大扩展，不独治胁痛而然也。
胁痛3(肺结棱)
王某，女，54岁，
初诊
形体削瘦，面色褐浊，患肺结核有年。经常胁痛，按之稍缓，舌红且干苔白少津，脉象弦细小数。久病阴伤，络脉失养，养血和阴，以缓胁痛。
炙鳖甲12克，勾藤10克，木瓜10克，白芍10克，生牡蛎z0克，熟地黄10克，丝瓜络10克，桑枝10克，何首乌10克，乳香2克，七剂
二诊
药后胁痛稍缓，干咳少疲，咳时牵引胸胁作痛。舌千脉细，阴分久伤难复，仍用前法加减。
炙鳖甲10克。麦门冬10克，自芍10克，浙贝母1O克，川贝母6克，知母6克，木瓜10克，生牡蛎20克，熟地黄20克，
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丝瓜络10克，片姜黄10克，七剂
药后咳减痛止。
[按]：形瘦、脉细、舌红且干，为阴伤之象，张介宾有云，察形体之衰与不衰，知阴之伤与未伤。脉细主脏阴之亏，舌红且干为阴伤津乏之征，再结合素患结核，阴虚之体明矣，故用药专以养阴，兼以通络。二诊又增入麦门冬、浙1【1贝母，知母等清养肺阴，而收止咳定痛之效。
胁痛4(神经衰弱)
孙某，女，21岁
初诊
左胁下隐隐作痛，病已半年有余痿}医院检查未有阳性发现。然心怀疑虑，夜不成寐，入睡则恶梦纷纭。素体薄弱，抑郁不乐有年，素有神经衰弱之苦。诊脉弦细且数，舌红且干，此木郁化火，日久灼伤心阴，络脉失养，养心阴以复其本。调郁结，以缓胁痛。若能宽怀自解，百日当可康复。
麦门冬10克，沙参10克，五睐子6克，蝉衣6克，僵蚕10
克，片姜黄6克，柴胡6克，黄芩6克，川樟子10克，竹叶茹各6克，七剂
二诊
药后心情较为舒畅，睡眠改善，恶梦减少，自觉胁痛减轻。继用前方进退。
麦门冬10克，沙参10克，五味子6克，蝉衣6克，僵蚕10
克，片姜黄6克，柴胡6克，黄芩6克，白芍10克，夏枯草10
克，七剂
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三诊
眠安痛缓，前方去夏枯草，加丝瓜络，桑枝以定其痛。七剂
药后胁痛消失。
[按]：此病胁痛与其神经衰弱有关，长期睡眠欠佳，思虑过度，心情抑郁，木郁化火，灼伤心阴，故治疗以养心阴、解肝郁为主，用生脉饮合升降散，加柴胡、黄芩、川楝子、竹叶茹，首先改善其睡眠，眠安则情绪安定，故胁痛得以渐愈。
胁痛5(胆囊炎)
李某，女，65岁
于1993年10月17日初诊
患右胁胀痛4年余，时轻时重，近半年来又增之发冷发热时作，“B”超提示“慢性胆囊炎”，曾服中药，西药等，疗效不佳。现右胁及右上腹部胀痛，痛及肩胛，饮食不佳，自觉恶寒发热，心烦急躁，梦多失眠，大便干结，数日未行小便黄少，舌红苔糙垢厚，质红且干，脉弦滑而数，体温37.2℃。此属胆热郁滞，气机不畅。治拟清泻胆热，疏调气机方法。药用：柴胡6克，黄芩6克，川楝子，元胡6克，片姜黄6克，旋复花10克，香附10克，木香6克，生蒲黄10克，炒五灵脂10克，焦三仙各10
克，7剂，水煎服，忌食辛辣油腻，宜清淡，每日早昨各走路锻炼1小时。
二诊
10月24日，服药之后，疼痛渐轻，发热未作，精神转佳，仍大便干结如球状。仍以前法佐以消食导滞方法。柴胡6克，黄芩6克，川楝子6克，旋复花10克，片姜黄6克，大黄2克，
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元明粉2克(冲服)，炒枳壳6克，焦三仙各10克，炒菜菔子10克，水红花子10克，7剂。
三诊
10月31日，服药2剂，大便泻下，心情舒畅，疼痛消失，余证皆除，7剂服完，大便由日3～4次，转为每日一次，舌红苔薄黄，脉弦细，改为养血柔肝，疏调木土方法。药用：当归10
克，白芍10克，香附10克，郁金10克，木瓜10克，竹茹6克，炒枳壳6克，柴胡6克，龙胆草2克，焦三仙各10克，炒莱菔子10克，14剂。
四诊
服上方二周，无其他不适，改服为龙胆泻肝丸与加味逍遥丸效替服用。饮食当慎，防其复发。
[按]：引起胁痛的原因很多，胆囊炎致右胁痛较为常见。
本病案属于胆热郁滞，气机不畅所致，故用清泻胆热，疏调气机，以缓其痛。以金铃子散与失笑散合方化裁，7剂药后，发热退，疼痛减轻，唯大便干结，又以前法进退，用前方合大承气汤，又服7剂疼痛消失，余症皆除。最后用养血柔肝，疏调木土方法咀巩固疗效。本症除用药要切合病机外，赵师非常强调饮食养调与走路锻炼，患者若能密切配合，则可收预期之效。
Epigastric Pain 1 (Superficial Gastritis)
Chen XX, female, 39 years old.
First Visit
Epigastric pain for over 5 years, diagnosed as superficial gastritis by gastroscopy. Current symptoms include epigastric pain immediately after eating, unsatisfactory belching, abdominal distension and fullness, and dark mottled complexion on the face. The pulse is wiry, fine, and deep; the tongue is red with a white coating. This indicates long-standing liver Qi stagnation invading the stomach horizontally. Initially, use the method of regulating and adjusting Qi mechanism.
Inula Flower (Xuanfu Hua) 10g, Hematite (Daizhe Shi) 10g (decocted first), Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 10g each, Cicada Slough (Chan Yi) 6g, Silkworm (Jiang Can) 10g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Fried Bitter Orange (Chao Zhi Qiao) 6g, Angelica Dahurica (Bai Zhi) 6g, Saposhnikovia Root (Fang Feng) 6g, Imperata Rhizome (Mao Gen) and Reed Rhizome (Lu Gen) 10g each, 7 doses.
Second Visit
After taking the medicine, the epigastric pain gradually ceased. She felt poor digestion, a feeling of blockage and fullness in the epigastrium after eating, and unsatisfactory belching.
The pulse remains deep and wiry. Continue using the method of regulating and adjusting Qi mechanism.
Toosendan Fruit (Chuan Lian Zi) 6g, Corydalis Rhizome (Yuan Hu) 6g, Perilla Leaf (Su Ye) 10g, Agastache (Huo Xiang) 10g, Cyperus Rhizome (Xiang Fu) 10g, Fried Bitter Orange (Chao Zhi Qiao) 6g, Bupleurum Root (Ku Jie Geng) 10g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Vine Seed (Shui Hong Hua Zi) 10g, Tai Huang 1g, 7 doses.
Third Visit
The epigastric pain has healed. Abdominal distension and fullness have also decreased. She feels general fatigue, drowsiness, and sleepiness. The pulse is wiry and fine, deep and soft upon pressure; the tongue is red with a white coating. Damp-heat in the Liver and Gallbladder has not been cleared. Continue using the method of clearing and draining Liver and Gallbladder heat.
Charred Schizonepeta (Jing Jie Tan) 10g, Saposhnikovia Root (Fang Feng) 6g, Toosendan Fruit (Chuan Lian Zi) 6g, Corydalis Rhizome (Yuan Hu) 6g, Fried Gardenia (Chao Shan Zhi) 6g, Artemisia Capillaris (Yin Chen) 10g, Eupatorium (Pei Lan) 10g (added later), Agastache (Huo Xiang) 10g (added later), Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Vine Seed (Shui Hong Hua Zi) 10g, 7 doses.
Fourth Visit
Drowsiness has significantly reduced after medication, and spirit has improved, but lower limbs feel weak and heavy, and stool is dry. Liver-Gallbladder heat stagnation has gradually decreased. Continue with modifications to the original prescription.
Eupatorium (Pei Lan) 10g (added later), Agastache (Huo Xiang) 10g (added later), Perilla Leaf (Su Ye) 10g, Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 10g each, Fried Gardenia (Chao Shan Zhi) 6g, Artemisia Capillaris (Yin Chen) 10g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Vine Seed (Shui Hong Hua Zi) 10g, Areca Stem (Da Fu Pi) 10g, Areca Nut (Bing Lang) 10g, Rhubarb (Da Huang) 3g, 7 doses.
Fifth Visit
Stool is dry and difficult to pass, occurring only once a week. Restlessness and frequent dreams. Epigastric pain and distension have resolved, and spirit is good. Liver-Gallbladder heat stagnation has existed for a long time, and it is currently midsummer with predominant damp-heat. Continue using the method of clearing and transforming damp-heat.
Artemisia Capillaris (Yin Chen) 10g, Gardenia (Zhi Zi) 6g, Bupleurum Root (Chai Hu) 6g, Scutellaria Root (Huang Qin) 6g, Toosendan Fruit (Chuan Lian Zi) 6g, Eupatorium (Pei Lan) 10g (added later), Agastache (Huo Xiang) 10g (added later), Areca Stem (Da Fu Pi) 10g, Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 10g each, Talcum (Hua Shi) 10g, Rhubarb (Da Huang) 5g.
After taking the medicine, bowel movements became smooth, diet and sleep were excellent, and pulse and tongue returned to normal. Epigastric pain never recurred, so medication was stopped for observation. She was advised to be cautious with diet, strengthen exercise, and enhance physical constitution.
[Commentary]: Epigastric pain for over 5 years had poor response to repeated Chinese and Western medicines. Master Zhao judged based on the deep-wiry pulse, unsatisfactory belching, and mottled facial complexion that long-standing Liver Qi stagnation was invading the stomach horizontally. He prescribed Sheng Jiang San (Ascending and Descending Powder) to regulate Qi mechanism and resolve Liver stagnation, achieving immediate pain relief. After the first visit, epigastric pain never recurred. In differentiation, the deep-wiry pulse is a typical sign of Liver stagnation; "a deep pulse at the onset indicates Qi [stagnation]," and wiry indicates Liver stagnation. The mottled complexion is also a definitive sign of Qi mechanism stagnation, often seen in introverted individuals prone to suppressed anger, especially women, and should be treated from Liver stagnation. The use of wind-dispersing herbs like Fang Feng in the formula has deeper significance: first, to remove dampness ("when dampness is excessive, assist wind to calm it"); second, to raise Yang ("when clear Yang rises, Spleen transport improves"); third, to soothe the Liver ("wind herbs are pungent, which the Liver prefers," as stated in "The Liver desires dispersion, urgently eat pungent to disperse it"). The formula did not use traditional analgesics but achieved pain relief because it treated the root cause.
Epigastric Pain 2 (Duodenal Bulbar Ulcer)
Han XX, male, 39 years old.
First Visit
Epigastric pain for over 6 years, occurring during hunger or fatigue, fixed in location, slightly relieved by food. Pulse is deep, wiry, and fine. Deep pressure feels stagnant and does not rise easily; tongue body is dark with a thick white coating at the root. Long-standing Qi stagnation inevitably affects the Blood level; prolonged pain enters the collaterals, which is what this refers to. Plan to use the method of invigorating blood and resolving stasis to stabilize the pain.
Toosendan Fruit (Chuan Lian Zi) 10g, Corydalis Rhizome (Yuan Hu) 6g, Raw Coptis Spore (Sheng Pu Huang) 10g, Fried Trogopterus Dung (Chao Wu Ling Zhi) 10g, Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 6g each, Fried Bitter Orange (Chao Zhi Qiao) 6g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Vine Seed (Shui Hong Hua Zi) 10g, 7 doses.
Second Visit
After medication, epigastric pain did not occur. Pulse is wiry, tongue is red, stool is slightly dry, occasional acid belching. Continue regulating Wood and Earth (Liver and Spleen/Stomach), combined with the method of Zuo Jin Wan.
Toosendan Fruit (Chuan Lian Zi) 6g, Corydalis Rhizome (Yuan Hu) 6g, Raw Coptis Spore (Sheng Pu Huang) 10g, Fried Trogopterus Dung (Chao Wu Ling Zhi) 10g, Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 6g each, Evodia Fruit (Wu Zhu Yu) 3g, Coptis Rhizome (Huang Lian) 2g, Raw Oyster Shell (Sheng Mu Li) 15g, Scorch Three Immortals (Jiao San Xian) 10g each, Rhubarb (Da Huang) 1g, 7 doses.
Third Visit
Epigastric pain did not occur, acid belching stopped, bowel and bladder functions normalized, diet and sleep were excellent. Stop medication, adjust diet, avoid spicy and stimulating foods, and quitting smoking is essential, otherwise recurrence is likely.
[Commentary]: Duodenal ulcer often presents with pain when hungry, appearing as a deficiency of Middle Jiao. However, this patient's illness has persisted for 6 years without healing, pain is fixed, and tongue body is dark, showing signs of blood stasis, consistent with Ye Tianshi's theory of "chronic disease entering collaterals." Therefore, treatment focused on collateral diseases using the method of invigorating blood and resolving stasis. The formula used Jin Ling Zi San combined with Shi Xiao San with modifications to soothe the Liver, regulate Qi, and resolve stasis to stop pain. It was effective immediately. This method is extremely effective for pain caused by blood stasis. This is an empirical formula commonly used by the master in clinical practice for gastric ulcers, gastritis, duodenal bulbar ulcers, etc., applicable whenever blood stasis signs are present. If accompanied by distension and Qi stagnation, add Qingpi, Chenpi, Xiang Fu, Mu Xiang, Zhi Qiao, etc.; if complicated by food stagnation with distension or thick greasy coating, add Jiao San Xian, Shui Hong Hua Zi, Da Fu Pi, Bing Lang, etc.; if belching with acid regurgitation occurs due to Liver stagnation transforming into heat, combine with Zuo Jin Wan (Evodia and Coptis), plus Raw Oyster Shell or Cuttlefish Bone. Dietary regulation is crucial in treating ulcer disease; avoid spicy and stimulating foods, quit alcohol and smoking. For smokers addicted to tobacco, treatment is often ineffective. Therefore, patients must be instructed to cooperate closely and quit alcohol and smoking to ensure expected therapeutic results.
Epigastric Pain 3 (Hiatal Hernia)
Yang XX, female, 71 years old. Suffered from diabetes for over 10 years, consistently treated with Chinese medicine by Master Zhao, condition relatively stable. Recently suffered epigastric pain, diagnosed as hiatal hernia by barium meal X-ray at a certain hospital, medication was ineffective, so sought treatment from the master. First visit in early September 1991: pale complexion, obese and fat, continuous upper abdominal bloating and fullness, intermittent pain, dry mouth but no desire to drink, pulse is deep and soft. Tongue is pale with a moist white coating. Combining pulse and symptoms, differentiated as insufficiency of Middle Yang and sinking of Qi due to deficiency. Treatment: tonify Qi and supplement the Middle, raise Yang and lift sinking. Modified Bu Zhong Yi Qi Tang: Raw Astragalus (Sheng Huang Qi) 15g, Codonopsis (Dang Shen) 6g, Atractylodes Macrocephala (Bai Zhu) 10g, Raw and Prepared Rehmannia (Sheng Shu Di) 20g each, Bupleurum Root (Chai Hu) 6g, Cimicifuga Rhizome (Sheng Ma) 10g, Angelica Sinensis (Dang Gui) 10g, Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 10g each, Fried Bitter Orange (Chao Zhi Qiao) 6g, Saposhnikovia Root (Fang Feng) 6g.
After 7 doses of the above prescription, follow-up visit showed epigastric distension and pain had stopped. Repeat barium meal X-ray examination: gastric wall smooth, no niche shadow seen, good expansion. Indicates hiatal hernia has disappeared. Changed prescription to use the method of benefiting Qi and harmonizing Stomach for regulation and peace.
[Commentary]: Hiatal hernia mainly presents with distension and pain. The patient has long-standing diabetes, pale face, obesity, shortness of breath, and fatigue, indicating Qi deficiency and insufficiency of Middle Yang. Although suffering from distension and pain, the pale tongue and soft pulse show no signs of pathogenic factors. Moreover, the stomach wall sinking into the esophageal hiatus as a hernia is also due to Qi deficiency and sinking. The *Neijing* states "sinking conditions should be lifted," which is what this refers to. Thus, treatment with the method of tonifying Qi and supplementing the Middle, raising Yang and lifting sinking resulted in cessation of pain and resolution of hernia. TCM syndrome differentiation and treatment emphasize seeking the root, not merely treating symptoms.
Epigastric Pain 4 (Gastric and Duodenal Bulbar Ulcer)
Chen XX, male, 34 years old. Habitually indulges in tobacco and alcohol, suffered from gastric and duodenal ulcers for over 5 years, frequent pain attacks, poor response to Chinese and Western medicines, sought treatment from the master in July 1992.
Pulse is deep, wiry on the left, choppy on the right; tongue is red with yellow coating thick at the root; sublingual veins are coarse, purple, and black. Symptoms include persistent dull epigastric pain, intermittent stabbing pain, fixed location, refusal to press, black stool, and yellow-red urine. Differentiated as prolonged pain entering collaterals, blood stasis in the blood level. Treat with the method of invigorating blood and resolving stasis. Medicines: Jin Ling Zi (Toosendan Fruit) 10g, Yan Hu Suo (Corydalis Rhizome) 10g, Raw Coptis Spore (Sheng Pu Huang) 10g, Red Peony Root (Chi Shao) 10g, Fried Trogopterus Dung (Chao Wu Ling Zhi) 10g, Bupleurum Root (Chai Hu) 6g, Cyperus Rhizome (Xiang Fu) 10g, Green Tangerine Peel (Qingpi) and Aged Tangerine Peel (Chenpi) 10g each, Scorch Three Immortals (Jiao San Xian) 10g each, decocted in water, 7 doses. Follow-up: pain stopped and appetite increased after medication. Continued treatment with modifications to the above prescription for 1 month, pain did not recur, so medication was stopped for observation. Advised to quit tobacco, alcohol, and stimulate foods to prevent recurrence.
[Commentary]: Epigastric pain persisting for years without healing, fixed stabbing pain, refusal to press, black stool, and deep-choppy pulse make it easy to identify as a blood stasis syndrome based on these pulse and symptom signs. However, Master Zhao has another method for differentiating stasis: observing the sublingual veins. If they are coarse, purple, and black, it is undoubtedly blood stasis in the blood level. Treatment uses Jin Ling Zi San combined with Shi Xiao San. Both formulas are famous for resolving masses and stopping pain; combined, their effect is magnified. Adding Qi-moving agents embodies the principle that moving blood requires first moving Qi. The combination is precise, hence immediate effectiveness.
Hypochondriac Pain 1 (Neuralgic Hypochondriac Pain)
Ruan XX, female, 57 years old. After violent anger, Qi flows through both hypochondria causing pain, restlessness, and insomnia. Pulse is wiry, urgent, slippery, and rapid; tongue is red and dry, with prickles on the tip. Anger injures the Liver, Wood stagnation transforms into Fire, Qi level stagnation. Initially use the method of Yue Ju Wan.
Ligusticum Rhizome (Chuan Xiong) 6g, Atractylodes Lancea (Cang Zhu) 3g, Cyperus Rhizome (Xiang Fu) 10g, Bitter Orange (Zhi Qiao) 10g, Bamboo Shavings (Zhu Ru) 6g, Toosendan Fruit (Chuan Lian Zi) 10g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Apricot Seed (Xing Ren) 10g, Corydalis Rhizome (Yuan Hu) 6g, Fried Gardenia (Chao Shan Zhi) 6g, 3 doses.
Pain stopped immediately after taking the above prescription. Stop decoction, take patent medicine Yue Ju Wan, and avoid anger to conclude treatment.
[Commentary]: Violent anger injures the Liver, Qi stagnation transforms into Fire, so Yue Ju Wan is administered, primarily regulating Qi mechanism; when Qi stagnation resolves, Fire stagnation disperses. Added herbs: Xing Ren and Zhi Qiao to regulate Qi mechanism; Chuan Lian Zi and Zhu Ru to drain Liver-Stomach heat; Pian Jiang Huang and Yuan Hu to invigorate blood, promote Qi flow, and stop pain. Acute hypochondriac pain makes treating the branch urgent, so decoction is used. After pain stops with medicine, pill form is used for maintenance. Advising emotional harmony is the fundamental plan.
Hypochondriac Pain 2 (Chronic Hepatitis)
Quan XX, male, 56 years old.
First Visit
Habitually indulges in tobacco, alcohol, and rich/greasy foods, obese with much phlegm, tongue red with thick greasy coating, pulse wiry-slippery and forceful, urgent and rapid upon pressure, bowel movement unsmooth, urine yellow. Long-standing hepatitis unresolved, hypochondriac pain always occurs upon anger. Phlegm-dampness and stagnation obstruct mutually, Shaoyang collateral channels lose harmony. Initially clear and transform turbid phlegm, with slight addition of opening depression and stopping pain methods.
Inula Flower (Xuan Fu Hua) 10g, Curcuma Aromatica Tuber (Yu Jin) 6g, Apricot Seed (Xing Ren) 10g, Radish Seed (Lai Fu Zi) 10g, Perilla Seed (Su Zi) and Perilla Stem (Su Geng) 10g each, White Mustard Seed (Bai Jie Zi) 6g, Rubia Root (Qian Cao) 10g, Scorch Three Immortals (Jiao San Xian) 10g each, Rhubarb (Da Huang) 1g, 3 doses.
Second Visit
After medication, bowel movement became smooth, hypochondriac pain stopped, pulse remains wiry-slippery, tongue red with greasy coating. Damp-heat stagnation has existed for a long time and cannot be eradicated overnight. If tobacco and alcohol can be completely abstained from, vegetarian diet adhered to, and exercise maintained, physical recovery can be ensured.
Perilla Seed (Su Zi) 10g, Radish Seed (Lai Fu Zi) 10g, White Mustard Seed (Bai Jie Zi) 6g, Scorch Three Immortals (Jiao San Xian) 10g each, Polygonum Multiflorum Vine Seed (Shui Hong Hua Zi) 10g, Curcuma Aromatica Tuber (Yu Jin) 6g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Red Peony Root (Chi Shao) 10g, Rubia Root (Qian Cao) 10g, Salvia Miltiorrhiza (Dan Shen) 10g, 10 doses.
[Commentary]: Obese, much phlegm, forceful slippery pulse, and thick greasy coating—these four determine phlegm-turbidity obstructing collaterals, thus causing hypochondriac pain. Those with these signs can use Wu Zi Di Tan Tang (Five Seeds Phlegm-Cleansing Decoction), consisting of Su Zi, Lai Fu Zi, Bai Jie Zi, Winter Melon Seed, and Gleditsia Sinensis Thorn. Using this as a base formula, adding herbs to regulate Qi and invigorate blood, disperse wind and overcome dampness, digest food and guide out stagnation greatly expands the scope of treatment, not limited to treating hypochondriac pain alone.
Hypochondriac Pain 3 (Pulmonary Tuberculosis)
Wang XX, female, 54 years old.
First Visit
Emaciated, dark and turbid complexion, suffered from pulmonary tuberculosis for years. Frequent hypochondriac pain, slightly relieved by pressure, tongue red and dry with little fluid, thin white coating, pulse wiry-fine, small, and rapid. Chronic illness damages Yin, collateral channels lose nourishment. Nourish blood and harmonize Yin to alleviate hypochondriac pain.
Calcined Turtle Plastron (Zhi Bie Jia) 12g, Uncaria Rhynchophylla (Gou Teng) 10g, Papaya (Mu Gua) 10g, White Peony Root (Bai Shao) 10g, Raw Oyster Shell (Sheng Mu Li) 20g, Prepared Rehmannia Root (Shu Di Huang) 10g, Loofah Network (Si Gua Luo) 10g, Mulberry Twig (Sang Zhi) 10g, Fleeceflower Root (He Shou Wu) 10g, Frankincense (Ru Xiang) 2g, 7 doses.
Second Visit
Hypochondriac pain slightly relieved after medication, dry cough with little sputum, cough pulls chest and hypochondria causing pain. Tongue dry, pulse fine, Yin level damaged for a long time is hard to restore. Continue previous method with modifications.
Calcined Turtle Plastron (Zhi Bie Jia) 10g, Ophiopogon Tuber (Mai Men Dong) 10g, White Peony Root (Bai Shao) 10g, Zhejiang Fritillary Bulb (Zhe Bei Mu) 10g, Sichuan Fritillary Bulb (Chuan Bei Mu) 6g, Anemarrhena Rhizome (Zhi Mu) 6g, Papaya (Mu Gua) 10g, Raw Oyster Shell (Sheng Mu Li) 20g, Prepared Rehmannia Root (Shu Di Huang) 20g, Loofah Network (Si Gua Luo) 10g, Turmeric Tuber Slice (Pian Jiang Huang) 10g, 7 doses.
After medication, cough decreased and pain stopped.
[Commentary]: Emaciation, fine pulse, red and dry tongue are signs of Yin damage. Zhang Jiabin said, observe whether the physique is declining or not to know if Yin is damaged or not. Fine pulse indicates deficiency of Zang Yin; red and dry tongue indicates Yin damage and fluid scarcity. Combined with long-standing tuberculosis, the Yin-deficient constitution is clear. Therefore, medication focuses on nourishing Yin, supplemented by unblocking collaterals. In the second visit, Mai Men Dong, Zhe Bei Mu, and Zhi Mu were added to clear and nourish Lung Yin, achieving the effect of stopping cough and pain.
Hypochondriac Pain 4 (Neurasthenia)
Sun XX, female, 21 years old.
First Visit
Dull pain under the left hypochondrium, illness for over half a year, hospital examination showed no positive findings. However, mental suspicion, unable to sleep at night, vivid nightmares upon falling asleep. Constitutionally weak, depressed and unhappy for years, suffers from neurasthenia. Pulse is wiry-fine and rapid, tongue red and dry. This is Wood stagnation transforming into Fire, burning Heart Yin for a long time, collateral channels losing nourishment. Nourish Heart Yin to restore its root. Regulate depression to alleviate hypochondriac pain. If she can relax and resolve worries herself, recovery should be possible within 100 days.
Ophiopogon Tuber (Mai Men Dong) 10g, Glehnia Root (Sha Shen) 10g, Schisandra Berry (Wu Wei Zi) 6g, Cicada Slough (Chan Yi) 6g, Silkworm (Jiang Can) 10g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Bupleurum Root (Chai Hu) 6g, Scutellaria Root (Huang Qin) 6g, Toosendan Fruit (Chuan Lian Zi) 10g, Bamboo Leaf (Zhu Ye) and Bamboo Shavings (Zhu Ru) 6g each, 7 doses.
Second Visit
Mood more comfortable after medication, sleep improved, nightmares reduced, self-feeling of hypochondriac pain decreased. Continue with modifications to the previous prescription.
Ophiopogon Tuber (Mai Men Dong) 10g, Glehnia Root (Sha Shen) 10g, Schisandra Berry (Wu Wei Zi) 6g, Cicada Slough (Chan Yi) 6g, Silkworm (Jiang Can) 10g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Bupleurum Root (Chai Hu) 6g, Scutellaria Root (Huang Qin) 6g, White Peony Root (Bai Shao) 10g, Prunella Vulgaris (Xia Ku Cao) 10g, 7 doses.
Third Visit
Sleep peaceful, pain eased. Remove Xia Ku Cao from previous prescription, add Si Gua Luo and Sang Zhi to stabilize pain. 7 doses.
Hypochondriac pain disappeared after medication.
[Commentary]: This hypochondriac pain is related to neurasthenia. Long-term poor sleep, excessive thinking, and depressed mood cause Wood stagnation transforming into Fire, burning Heart Yin. Therefore, treatment focuses on nourishing Heart Yin and resolving Liver depression, using Sheng Mai Yin combined with Sheng Jiang San, plus Chai Hu, Huang Qin, Chuan Lian Zi, Zhu Ye, and Zhu Ru. First improve sleep; when sleep is peaceful, emotions stabilize, so hypochondriac pain gradually heals.
Hypochondriac Pain 5 (Cholecystitis)
Li XX, female, 65 years old.
First visit on October 17, 1993.
Right hypochondriac distension and pain for over 4 years, varying in severity. In the past half year, chills and fever intermittently added. "B" ultrasound indicated "chronic cholecystitis." Took Chinese and Western medicines with poor efficacy. Currently right hypochondriac and right upper abdominal distension and pain, radiating to scapula, poor diet, self-feeling of chills and fever, restlessness and irritability, frequent dreams and insomnia, dry stool not passed for several days, scanty yellow urine, tongue red with rough greasy thick coating, body red and dry, pulse wiry-slippery and rapid, temperature 37.2°C. This belongs to Gallbladder heat stagnation and unsmooth Qi mechanism. Treatment plan: clear and drain Gallbladder heat, regulate and adjust Qi mechanism. Medicines: Bupleurum Root (Chai Hu) 6g, Scutellaria Root (Huang Qin) 6g, Toosendan Fruit (Chuan Lian Zi), Corydalis Rhizome (Yuan Hu) 6g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Inula Flower (Xuan Fu Hua) 10g, Cyperus Rhizome (Xiang Fu) 10g, Aucklandia Root (Mu Xiang) 6g, Raw Coptis Spore (Sheng Pu Huang) 10g, Fried Trogopterus Dung (Chao Wu Ling Zhi) 10g, Scorch Three Immortals (Jiao San Xian) 10g each, 7 doses, decocted in water. Avoid spicy and greasy foods, prefer light diet, walk and exercise for 1 hour every morning and evening.
Second Visit
October 24. After taking medicine, pain gradually lightened, fever did not occur, spirit improved, but stool still dry and ball-like. Continue previous method assisted by food-resolving and stagnation-guiding method. Bupleurum Root (Chai Hu) 6g, Scutellaria Root (Huang Qin) 6g, Toosendan Fruit (Chuan Lian Zi) 6g, Inula Flower (Xuan Fu Hua) 10g, Turmeric Tuber Slice (Pian Jiang Huang) 6g, Rhubarb (Da Huang) 2g, Mirabilite (Yuan Ming Fen) 2g (taken with liquid), Fried Bitter Orange (Chao Zhi Qiao) 6g, Scorch Three Immortals (Jiao San Xian) 10g each, Fried Radish Seed (Chao Lai Fu Zi) 10g, Polygonum Multiflorum Vine Seed (Shui Hong Hua Zi) 10g, 7 doses.
Third Visit
October 31. After taking 2 doses, bowel movement discharged, mood comfortable, pain disappeared, other symptoms all removed. After finishing 7 doses, bowel movement changed from 3-4 times daily to once daily, tongue red with thin yellow coating, pulse wiry-fine. Change to nourishing blood and softening Liver, regulating Wood and Earth method. Medicines: Angelica Sinensis (Dang Gui) 10g, White Peony Root (Bai Shao) 10g, Cyperus Rhizome (Xiang Fu) 10g, Curcuma Aromatica Tuber (Yu Jin) 10g, Papaya (Mu Gua) 10g, Bamboo Shavings (Zhu Ru) 6g, Fried Bitter Orange (Chao Zhi Qiao) 6g, Bupleurum Root (Chai Hu) 6g, Gentian Root (Long Dan Cao) 2g, Scorch Three Immortals (Jiao San Xian) 10g each, Fried Radish Seed (Chao Lai Fu Zi) 10g, 14 doses.
Fourth Visit
After taking the above prescription for two weeks, no other discomfort. Change to alternating服用 of Long Dan Xie Gan Wan and Jia Wei Xiao Yao Wan. Diet should be cautious to prevent recurrence.
[Commentary]: There are many causes of hypochondriac pain, and cholecystitis causing right hypochondriac pain is relatively common.
This case belongs to Gallbladder heat stagnation and unsmooth Qi mechanism, so use clearing and draining Gallbladder heat, regulating and adjusting Qi mechanism to alleviate pain. Modified combination of Jin Ling Zi San and Shi Xiao San. After 7 doses, fever subsided, pain lightened, only stool was dry. Again adjusted previous method, combining previous prescription with Da Cheng Qi Tang, took another 7 doses, pain disappeared, other symptoms all removed. Finally used nourishing blood and softening Liver, regulating Wood and Earth method to consolidate curative effect. Besides medication matching the pathogenesis, Master Zhao emphasizes dietary regulation and walking exercise very much. If patients cooperate closely, expected effects can be achieved.