癥3(多发性子宫肌瘤)
张某某，女，41岁
初诊：1991年7月10日
子多发性子宫肌瘤确诊三年余，近日作B超确定最大的一个肌瘤直径约7，9cm。月经量多，经期延长至10余天。每次月经后一身疲乏无力，面色萎黄，血色素降至7克。诊脉濡滑且数，舌红苔白，夜寐梦多。肝胆郁热，血分瘀滞，先用清泄肝胆，并活血化瘀，以消其瘤。
柴胡6克，黄芩10克，川楝子6克，荆芥炭10克，防风6克，生地榆10克，赤芍10克，丹参10克，三棱6克，七付
二诊；1991年12月16日
上方服后自觉适舒，夜寐安稳，烦躁减轻，月经量减少。患者每月服上方约20付。近日B超检查，肌瘤缩小，最大者直径为6，7cm。微党疲乏无力，诊脉濡滑，按之力弱，舌红苔白且润，络脉瘀阻，气分不足，改用益气化瘀方法。
黄芪20克，党参15克，丹参15克，赤芍10克，莪术10克，茜草10克，大黄1克，水红花子10克，七付
三诊：1992年元月11日
上方服20余付，自觉气力有增，精神好转，近日夜梦较多。诊脉弦滑，按之濡数，舌红苔白，仍用益气化瘀方法。
黄芪20克，丹参10克，赤芍10克，茜草10克，夏枯草10克，苏术10克，马鞭草10克，水红花子10克，七付
四诊：1992年元月18日
近日B超复查，丑发现一个肌瘤，直径为3. 1cm，其余肌瘤均已消失。患者自述原有乳腺增生，两乳房胀痛，药后也显著减轻。诊脉濡滑，舌白苔腻，仍用前法进退。
黄芪20克，牛膝10克，丹参10克，赤芍10克，马鞭草10克，苏术10克，焦三仙各10克，水红花子10克，瓜蒌30
克，七付
五诊
上方续服至今，经B超复查，肌瘤直径已缩至2，6cm。脉仍濡滑，继用益气活血通络方法。
黄芪20克，马鞭草10克，苏木10克，丹参10克，茜草10克，水红花子10克，瓜萎仁30克，丝瓜萎10克，桑枝10克?七付
六诊：1992年6月20日
上方续服1月，一切感觉良好，月经时间经量均已正常。脉仍濡滑，继用前法增损。
黄芪30克，苏木10克，赤芍10克，丹参10克，茜草10克，焦三仙各10克，水红花子10克，三棱6克，七付
七诊：1992年8月15日
近日复查B超，肌瘤全消。月经复常，食眠均佳，脉象濡滑。病已向愈，再以前法加减，以资巩固。
黄芪30克，马鞭草10克，苏术10克，赤芍10克，丹参10克，茜草10克，焦三仙各10克，水红花子10克，当归10克，10付
[按]：多发性子宫肌瘤，最大者直径7×9cm，经过近一年的中药治疗，肌瘤全消。本案的治疗可分为两个阶段，第一阶段即初诊用清肝热与活血化瘀并重，用药5个月，瘤体已明显缩小。此后为第二阶段，根据脉象满软，以及病情需长期治疗这一情况，决定改用益气活血通络方法。主用黄芪与活血化瘀药配伍，使气充则血得行，活瘀而不伤正。收到了明显的治疗效果。瘤体日渐缩小，直至全消。其所用活血药物并不多，出入于丹参、茜草、赤芍、马鞭草、苏木、三棱、当归等药之间，每诊必变换数药，而基本治法益气活血化瘀不变。体现了治法不变而用药灵活的特点。总之，象子宫肌瘤这样实质性瘤体的消除需要一个较长的过程，患者必须有耐心坚持治疗。医生则在把握其病机的基础上，确定一个基本的治法，不能朝三暮四。若是打一枪换一个地方，恐怕难以取得理想的效果。
瘿(良性甲状腺囊肿)
崔某，女，33岁
初诊
颈下结喉部左侧有肿物隆起，约鸭蛋大小，推之可移，按之有弹性，无压痛。心烦急躁，夜寐梦多。诊脉沉精，舌红苔白，气机失畅，血络瘀滞，先用清化方法。
苦桔梗10克，牛蒡子10克，山慈菇10克，夏枯草10克，益母草10克，赤芍10克，丹参10克，茜草10克，焦三仙各10
克，水红花子10克，大黄1克，七付
二诊
药后睡眠好转，精神见好。脉仍弦滑，舌红苔白，仍用前法，佐以咸寒散结。
白芷6克，防风6克，苦桔梗10克，生甘草6克，牛蒡子10克，山慈菇10克，夏枯草10克，郁金10克，杏仁10克，水红花子10克，焦三仙各10克，海藻1O克，昆布10克，七付
三诊
上方续服一月，颈下肿物明显见小，触之较软，若核桃大。
脉仍弦滑，前法继进。
白芷6克，防风6克，苦桔梗10克，生甘草10克，山慈菇10克，夏枯草10克，浙贝母10克，郁金10克，杏仁10克，焦三仙各10克，水红花子10克，海藻10克，昆布10克，七付
四诊
上方又服一个半月，颈下肿物已消。前法小制其剂，以善其后。更须戒恼怒忧思，宽怀自解，以防复发。
白芷6克，防风6克，夏枯草10克，浙贝母10克，海藻10克，昆布10克，生牡蛎20克，焦三仙各10克，水红花子10克，七付
后停药观察，随访未复发。
[按]：甲状腺囊性肿物，虽为良性，却有迅速增大之可能。
中医辨之为痰气交阻，血络瘀滞，故用活血化瘀、调畅气机、咸寒软坚之法。若能持之以恒，必能消之于无形。更须患者调畅情志，增加运动，勿食辛辣及烟酒刺激之物，方可根治。
消渴1(糖尿病)
田某某，女，22岁
初诊
糖尿病发现半年余。血糖280mg／dl，尿糖+++。现症口渴引饮，多食易饥，食毕即饥，饥而再食。一日夜可食主食3000克以上。心胸烦热，大便干结，数日一行小便黄赤，舌红，苔黄干燥，脉象弦滑数，按之振指有力。证属胃火炽盛灼津。急予釜底抽薪之法。
生石膏30克，知母10克，麦门冬15克，生地黄15克，大黄3克，芒硝6克，枳实6克，厚朴6克，七付
二诊
药后口渴稍减，仍饥而欲食，大便干结，心烦灼热。病重药轻，再以原方重投。
生石膏100克，知母20克，大黄10克，芒硝10克，枳实10克，厚朴10克，生地黄20克，麦门冬20克，七付
三诊
药后大便畅通，日行数次，口渴及食量大减，胸中灼热亦平。脉象槽数，舌红苔黄。药已中病，原法继进。
生石膏100克，知母15克，大黄8克，芒硝8克，枳实6克，厚朴6克，生地黄20克，麦门冬20克，七付
四诊
口微渴，食已不多。胸中烦热消失，睡眠甚安。大便日二、三行，不干。脉滑数，舌红苔薄黄略干。火热渐清，津液不足，前法进退。
生石膏60克，知母10克，大黄6克，芒硝6克，枳实6克，厚朴6克，生熟地黄各15克，天麦门冬各10克，七付
五诊
舌红口干，脉细数，改用养血育阴方法。
生熟地黄各15克，天麦门冬各10克，知母10克，花粉10克，五味子10克，竹叶茹各6克，枇杷叶10克，石斛10克，女贞子10克，七付
六诊
食眠如常，二便畅通。舌红苔薄白，脉象孺软，按之略数。
继用前法加减。
生熟地黄各15克，天麦门冬各10克，沙参20克，五味子10克，花粉10克，石斛10克，批杷叶10克，女贞子10克，旱莲草10克，白芍药10克，七付
后以上药加减，续服月余，查血糖降至120mg／dl.尿糖为+～士，诸症悉平。
[按]：本案为中消重症。所谓中消，以多食易饥为特征，饮食不为叽肤，故患者形体消瘦。渴欲冷饮，便干溲赤，一派胃火炽盛之象。故初诊即采用釜底抽薪，用大承气合白虎汤，服后症略减，减不足言，是病重药轻，故二诊便投以重剂。重用生石膏至1[10克，直清胃火，硝黄重用以泻热。药后大便畅行，火热得以下行，其症立减。三诊四诊继用原法+++、制其剂以清余热。
五诊改用养阴生津之法，使阴足则能制火。后均以此法调理，不但症状逐渐消失，血糖也稳步下降。凡消渴实热症，具可下之症者，可仿此治疗。
消渴2(糖尿病)
彭某某，女，53岁
初诊
糖尿病发现3年余。血糖230n培／dl，尿糖+～+++。一身疲乏无力，少气懒言，面白形肥，脉象濡软，按之缓大而虚，舌白体胖质嫩且润。口渴不甚明显小便数多而色清白。中阳不足，先用益气补中方法。
黄芪30克，沙参15克，麦门冬15克，五味子10克，生熟地黄各15克，杜仲10克，川续断10克，补骨脂10克，金樱子10克，芡实米10克。七付
二诊
药后气力有增，脉仍濡软，舌白苔润，再以前法进退。
黄芪60克，南北沙参各20克，麦门冬15克，五味子10克，生熟地黄各15克，杜仲10克，川续断10克，补骨脂10克，金樱子10克，芡实米10克。七付
三诊
患者依上方服药一月，自觉精力较前太增，诊脉仍属孺软，按之已觉有力，舌白苔腻，根部略厚。仍用前法加减。
黄芪60克，沙参15克，麦门冬10克，五味子10克，杜仲10克，川续断10克，补骨脂10克，金樱子10克，焦三仙各10克，水红花子10克，七付
服上方加减治疗半年，血糖降至110mg／dl.尿糖转阴，各种自觉症状基本消失。
[按]：本案患者渴饮不甚，疲乏无力明显，脉象虚大，舌胖淡嫩，据脉证辨为气阴两虚。气不化津，故渴。治以益气养阴与补肾壮元并举，方中重用黄芪益气，沙参、麦冬、五味子三药为生脉散，合黄芪共奏益气生津之技，杜仲，川续断、补骨脂，平补肝肾，温而不燥，补而不腻，生熟地滋阴添精。若久服朴益，恐运化不及，可加入焦三仙、水红花子助消化、运三焦，使补而不滞，则可常服以为图本之治。
[Case 3] (Multiple Uterine Leiomyomas)
Patient Zhang, Female, 41 years old.
First Visit: July 10, 1991.
Diagnosed with multiple uterine leiomyomas for over three years. Recent ultrasound examination determined the largest myoma to be approximately 7.9 cm in diameter. Menorrhagia (heavy menstrual bleeding), with the menstrual period extending to more than 10 days. After each menstruation, the patient experiences generalized fatigue and weakness, sallow complexion (withered yellow), and hemoglobin drops to 7 g/dL. The pulse is soggy, slippery, and rapid; the tongue is red with a white coating, and there are many dreams during sleep at night. The pattern is identified as Liver-Gallbladder Stagnant Heat and Blood Stasis in the Blood Level. Initially, clear and drain Liver-Gallbladder heat and invigorate blood to resolve stasis are employed to eliminate the myomas.
Chai Hu (Bupleuri Radix) 6g, Huang Qin (Scutellariae Radix) 10g, Chuan Lian Zi (Toosendan Fructus) 6g, Jing Jie Tan (Schizonepetae Spica Carbonisata) 10g, Fang Feng (Saposhnikoviae Radix) 6g, Sheng Di Yu (Sanguisorbae Radix) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, San Leng (Curcumae Zedoariae Rhizoma) 6g. Seven doses.
Second Visit: December 16, 1991.
After taking the above prescription, the patient feels comfortable, sleeps soundly at night, irritability decreases, and menstrual flow reduces. The patient takes approximately 20 doses of the above prescription per month. Recent ultrasound shows the myomas have shrunk, with the largest being 6.7 cm in diameter. Mild fatigue and weakness are present. The pulse is soggy and slippery, weak upon pressure; the tongue is red with a moist white coating. Collateral vessels are obstructed by stasis, and Qi deficiency exists in the Qi level. The treatment is changed to tonify Qi and resolve stasis.
Huang Qi (Astragali Radix) 20g, Dang Shen (Codonopsis Radix) 15g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, Chi Shao (Paeoniae Radix Rubra) 10g, E Zhu (Curcumae Rhizoma) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Da Huang (Rhei Radix et Rhizoma) 1g, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g. Seven doses.
Third Visit: January 11, 1992.
After taking more than 20 doses of the above prescription, the patient feels increased energy and improved spirit, but has more dreams at night recently. The pulse is wiry and slippery, soggy and rapid upon pressure; the tongue is red with a white coating. The method of tonifying Qi and resolving stasis is continued.
Huang Qi (Astragali Radix) 20g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Xia Ku Cao (Prunellae Spica) 10g, Su Mu (Sappan Lignum) 10g, Ma Bian Cao (Verbena Herba) 10g, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g. Seven doses.
Fourth Visit: January 18, 1992.
Recent ultrasound re-examination reveals one remaining myoma, 3.1 cm in diameter, while others have disappeared. The patient reports pre-existing mammary gland hyperplasia with distending pain in both breasts, which has significantly alleviated after medication. The pulse is soggy and slippery; the tongue coating is white and greasy. The previous method is continued with modifications.
Huang Qi (Astragali Radix) 20g, Niu Xi (Achyranthis Bidentatae Radix) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Ma Bian Cao (Verbena Herba) 10g, Su Mu (Sappan Lignum) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, Gua Lou 30g. Seven doses.
Fifth Visit:
Continuing to take the above prescription until now, ultrasound re-examination shows the myoma diameter has shrunk to 2.6 cm. The pulse remains soggy and slippery. The method of tonifying Qi, invigorating blood, and unblocking collaterals is continued.
Huang Qi (Astragali Radix) 20g, Ma Bian Cao (Verbena Herba) 10g, Su Mu (Sappan Lignum) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, Gua Lou Ren (Trichosanthis Semen) 30g, Si Gua Luo (Luffae Fructus Retinervus) 10g, Sang Zhi (Mori Ramulus) 10g. Seven doses.
Sixth Visit: June 20, 1992.
After continuing the above prescription for one month, all sensations are good, and menstrual duration and volume are normal. The pulse remains soggy and slippery. The previous method is continued with additions and subtractions.
Huang Qi (Astragali Radix) 30g, Su Mu (Sappan Lignum) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, San Leng (Curcumae Zedoariae Rhizoma) 6g. Seven doses.
Seventh Visit: August 15, 1992.
Recent ultrasound re-examination shows complete disappearance of myomas. Menstruation has returned to normal, appetite and sleep are excellent, and the pulse is soggy and slippery. The disease is tending towards recovery. The previous method is continued with modifications to consolidate the effect.
Huang Qi (Astragali Radix) 30g, Ma Bian Cao (Verbena Herba) 10g, Su Mu (Sappan Lignum) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, Dang Gui (Angelicae Sinensis Radix) 10g. Ten doses.
[Commentary]: Multiple uterine leiomyomas, with the largest measuring 7x9 cm, were completely eliminated after nearly one year of Chinese herbal medicine treatment. The treatment of this case can be divided into two stages. The first stage, starting from the first visit, emphasized clearing Liver heat and invigorating blood to resolve stasis equally. After five months of medication, the tumor mass shrank significantly. This marks the second stage. Based on the soggy-soft pulse and the need for long-term treatment, the method was changed to tonifying Qi, invigorating blood, and unblocking collaterals. Astragalus (Huang Qi) is primarily used in combination with blood-invigorating and stasis-resolving herbs, so that when Qi is sufficient, blood flows, and stasis is resolved without damaging healthy Qi. Obvious therapeutic effects were achieved. The tumor mass gradually shrank until complete disappearance. The blood-invigorating herbs used were not numerous, alternating among Dan Shen, Qian Cao, Chi Shao, Ma Bian Cao, Su Mu, San Leng, and Dang Gui. Several herbs were changed at each visit, while the basic treatment method of tonifying Qi, invigorating blood, and resolving stasis remained unchanged. This reflects the characteristic of consistent treatment principles with flexible herb selection. In summary, the elimination of solid tumors like uterine leiomyomas requires a longer process, and patients must have the patience to persist in treatment. Doctors must determine a basic treatment method based on grasping the pathogenesis and avoid changing strategies frequently. If the treatment strategy changes too often, it is unlikely to achieve ideal results.
[Ying Disease] (Benign Thyroid Cyst)
Patient Cui, Female, 33 years old.
First Visit:
A lump protrudes on the left side of the larynx below the neck, about the size of a duck egg. It is movable upon pushing and elastic upon pressing, with no tenderness. The patient feels irritable and restless, with many dreams during sleep at night. The pulse is deep and wiry; the tongue is red with a white coating. Qi mechanism is unsmooth, and blood collaterals are obstructed by stasis. Initially, a clearing and transforming method is used.
Ku Jie Geng (Platycodonis Radix) 10g, Niu Bang Zi (Arctii Fructus) 10g, Shan Ci Gu (Fritillariae Cirrhosae Bulbus) 10g, Xia Ku Cao (Prunellae Spica) 10g, Yi Mu Cao (Leonuri Herba) 10g, Chi Shao (Paeoniae Radix Rubra) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qian Cao (Rubiae Cordifoliae Radix et Rhizoma) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, Da Huang (Rhei Radix et Rhizoma) 1g. Seven doses.
Second Visit:
Sleep has improved, and spirit has brightened after taking the medicine. The pulse remains wiry and slippery; the tongue is red with a white coating. The previous method is continued, assisted by salty-cold methods to dissipate nodules.
Bai Zhi (Angelicae Dahuricae Radix) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Ku Jie Geng (Platycodonis Radix) 10g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 6g, Niu Bang Zi (Arctii Fructus) 10g, Shan Ci Gu (Fritillariae Cirrhosae Bulbus) 10g, Xia Ku Cao (Prunellae Spica) 10g, Yu Jin (Curcumae Longae Radix) 10g, Xing Ren (Armeniacae Semen Amarum) 10g, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Hai Zao (Sargassum Herba) 10g, Kun Bu (Eckloniae Thallus) 10g. Seven doses.
Third Visit:
After continuing the above prescription for one month, the lump below the neck has significantly shrunk and feels softer upon touch, like a walnut.
The pulse remains wiry and slippery. Continue the previous method.
Bai Zhi (Angelicae Dahuricae Radix) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Ku Jie Geng (Platycodonis Radix) 10g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 10g, Shan Ci Gu (Fritillariae Cirrhosae Bulbus) 10g, Xia Ku Cao (Prunellae Spica) 10g, Zhe Bei Mu (Fritillariae Thunbergii Bulbus) 10g, Yu Jin (Curcumae Longae Radix) 10g, Xing Ren (Armeniacae Semen Amarum) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g, Hai Zao (Sargassum Herba) 10g, Kun Bu (Eckloniae Thallus) 10g. Seven doses.
Fourth Visit:
After taking the above prescription for another one and a half months, the lump below the neck has disappeared. The previous method is continued with a smaller dosage to conclude the treatment. The patient must also avoid anger and worry, maintain a broad-minded attitude to resolve emotions, to prevent recurrence.
Bai Zhi (Angelicae Dahuricae Radix) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Xia Ku Cao (Prunellae Spica) 10g, Zhe Bei Mu (Fritillariae Thunbergii Bulbus) 10g, Hai Zao (Sargassum Herba) 10g, Kun Bu (Eckloniae Thallus) 10g, Sheng Mu Li (Ostreae Concha) 20g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g. Seven doses.
Medication was stopped afterwards for observation, and follow-up showed no recurrence.
[Commentary]: Thyroid cystic masses, although benign, have the potential to grow rapidly.
In Traditional Chinese Medicine (TCM), this is differentiated as Phlegm-Qi obstruction and blood collateral stasis. Therefore, methods of invigorating blood to resolve stasis, smoothing Qi mechanism, and using salty-cold substances to soften hardness are employed. If persisted with consistently, the nodule can certainly be dissolved invisibly. Patients must also regulate their emotions, increase exercise, and avoid spicy foods and alcohol/tobacco stimulation to achieve a radical cure.
[Xiao Ke 1] (Diabetes Mellitus)
Patient Tian, Female, 22 years old.
First Visit:
Diabetes mellitus discovered for over half a year. Blood glucose 280 mg/dL, urine sugar +++. Current symptoms include thirst with desire to drink, polyphagia and easy hunger, feeling hungry immediately after eating, and eating again when hungry. Can consume over 3000g of staple food in a day and night. Restlessness and heat in the chest and heart, dry stool passed once every few days, yellow-red urine, red tongue, dry yellow coating, wiry-slippery-rapid pulse, forceful upon pressure. The pattern belongs to Exuberant Stomach Fire scorching body fluids. Urgently apply the "drawing firewood from under the cauldron" method (clearing intense heat).
Sheng Shi Gao (Gypsum Fibrosum) 30g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Mai Men Dong (Ophiopogonis Tuber) 15g, Sheng Di Huang (Rehmanniae Radix) 15g, Da Huang (Rhei Radix et Rhizoma) 3g, Mang Xiao (Natrii Sulfas) 6g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Hou Po (Magnoliae Officinalis Cortex) 6g. Seven doses.
Second Visit:
Thirst slightly reduced after medication, but still hungry and desiring to eat, dry stool persists, restlessness and burning heat remain. The disease is severe and the medicine is light; administer the original formula with heavier dosage.
Sheng Shi Gao (Gypsum Fibrosum) 100g, Zhi Mu (Anemarrhenae Rhizoma) 20g, Da Huang (Rhei Radix et Rhizoma) 10g, Mang Xiao (Natrii Sulfas) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Sheng Di Huang (Rehmanniae Radix) 20g, Mai Men Dong (Ophiopogonis Tuber) 20g. Seven doses.
Third Visit:
Stool passage is smooth, several times a day, thirst and large food intake significantly reduced, burning heat in the chest has subsided. Pulse is wiry-rapid, tongue red with yellow coating. The medicine hits the target; continue the original method.
Sheng Shi Gao (Gypsum Fibrosum) 100g, Zhi Mu (Anemarrhenae Rhizoma) 15g, Da Huang (Rhei Radix et Rhizoma) 8g, Mang Xiao (Natrii Sulfas) 8g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Hou Po (Magnoliae Officinalis Cortex) 6g, Sheng Di Huang (Rehmanniae Radix) 20g, Mai Men Dong (Ophiopogonis Tuber) 20g. Seven doses.
Fourth Visit:
Slight thirst, food intake not large. Chest restlessness and heat have disappeared, sleep is very peaceful. Stool passed two or three times a day, not dry. Slippery-rapid pulse, red tongue with thin yellow slightly dry coating. Fire-heat is gradually cleared, fluid deficiency exists. Adjust the previous method.
Sheng Shi Gao (Gypsum Fibrosum) 60g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Da Huang (Rhei Radix et Rhizoma) 6g, Mang Xiao (Natrii Sulfas) 6g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Hou Po (Magnoliae Officinalis Cortex) 6g, Sheng Di Huang (Rehmanniae Radix) and Shu Di Huang (Rehmanniae Radix Preparata) 15g each, Tian Men Dong (Asparagi Radix) and Mai Men Dong (Ophiopogonis Tuber) 10g each. Seven doses.
Fifth Visit:
Red tongue, dry mouth, fine-rapid pulse. Change to nourishing blood and nurturing Yin method.
Sheng Di Huang (Rehmanniae Radix) and Shu Di Huang (Rehmanniae Radix Preparata) 15g each, Tian Men Dong (Asparagi Radix) and Mai Men Dong (Ophiopogonis Tuber) 10g each, Zhi Mu (Anemarrhenae Rhizoma) 10g, Hua Fen (Trichosanthis Radix) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Zhu Ye (Bambusae Folium) and Zhu Ru (Bambusae Caulis in Taeniam) 6g each, Pi Pa Ye (Loquat Leaf) 10g, Shi Hu (Dendrobii Caulis) 10g, Nu Zhen Zi (Ligustri Lucidi Fructus) 10g. Seven doses.
Sixth Visit:
Appetite and sleep are normal, urination and defecation are smooth. Red tongue with thin white coating, soggy-soft pulse, slightly rapid upon pressure.
Continue the previous method with modifications.
Sheng Di Huang (Rehmanniae Radix) and Shu Di Huang (Rehmanniae Radix Preparata) 15g each, Tian Men Dong (Asparagi Radix) and Mai Men Dong (Ophiopogonis Tuber) 10g each, Sha Shen (Glehniae Radix) 20g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Hua Fen (Trichosanthis Radix) 10g, Shi Hu (Dendrobii Caulis) 10g, Pi Pa Ye (Loquat Leaf) 10g, Nu Zhen Zi (Ligustri Lucidi Fructus) 10g, Han Lian Cao (Ecliptae Herba) 10g, Bai Shao Yao (Paeoniae Radix Alba) 10g. Seven doses.
Subsequently, with modifications to the above prescription, taken for over a month, blood glucose dropped to 120 mg/dL, urine sugar became +/-, and all symptoms resolved.
[Commentary]: This case is a severe form of Middle Xiao (Middle Burner Diabetes). Middle Xiao is characterized by polyphagia and easy hunger; food does not transform into flesh, hence the patient is emaciated. Desire for cold drinks, dry stool, and red urine present a picture of exuberant Stomach Fire. Thus, the "drawing firewood from under the cauldron" method was adopted at the first visit, combining Da Cheng Qi Tang (Major Order the Qi Decoction) and Bai Hu Tang (White Tiger Decoction). Symptoms slightly decreased after administration, but the reduction was insufficient, indicating severe disease and light medicine. Therefore, a heavy dose was administered at the second visit. Sheng Shi Gao (Gypsum Fibrosum) was heavily used up to 100g to directly clear Stomach Fire, and Mang Xiao (Natrii Sulfas) and Da Huang (Rhei Radix et Rhizoma) were heavily used to purge heat. After medication, stool passage was smooth, fire-heat descended downwards, and symptoms decreased sharply. The third and fourth visits continued the original method, controlling the dosage to clear residual heat.
At the fifth visit, the method changed to nourishing Yin and generating fluids, so that sufficient Yin can control Fire. Subsequent treatments regulated with this method, not only eliminating symptoms gradually but also steadily lowering blood glucose. For any Xiao Ke (Wasting-Thirst) excess-heat patterns with indications for purgation, this treatment can be imitated.
[Xiao Ke 2] (Diabetes Mellitus)
Patient Peng, Female, 53 years old.
First Visit:
Diabetes mellitus discovered for over 3 years. Blood glucose 230 mg/dL, urine sugar + to +++. Generalized fatigue and weakness, shortness of breath and reluctance to speak, pale face and fat body, soggy-soft pulse, slow-large and deficient upon pressure, white tongue, fat body, tender texture and moist coating. Thirst is not obvious, frequent urination with clear-white color. Middle Yang deficiency. Initially, tonify Qi and supplement the Middle method is used.
Huang Qi (Astragali Radix) 30g, Sha Shen (Glehniae Radix) 15g, Mai Men Dong (Ophiopogonis Tuber) 15g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Sheng Di Huang (Rehmanniae Radix) and Shu Di Huang (Rehmanniae Radix Preparata) 15g each, Du Zhong (Eucommiae Cortex) 10g, Chuan Xu Duan (Dipsaci Radix) 10g, Bu Gu Zhi (Psoraleae Fructus) 10g, Jin Ying Zi (Chrysanthemi Indici Fructus) 10g, Qian Shi (Euryales Semen) 10g. Seven doses.
Second Visit:
Energy increased after medication, pulse remains soggy-soft, white tongue with moist coating. Continue the previous method with adjustments.
Huang Qi (Astragali Radix) 60g, Nan Sha Shen (Glehniae Radix) and Bei Sha Shen (Adenophorae Radix) 20g each, Mai Men Dong (Ophiopogonis Tuber) 15g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Sheng Di Huang (Rehmanniae Radix) and Shu Di Huang (Rehmanniae Radix Preparata) 15g each, Du Zhong (Eucommiae Cortex) 10g, Chuan Xu Duan (Dipsaci Radix) 10g, Bu Gu Zhi (Psoraleae Fructus) 10g, Jin Ying Zi (Chrysanthemi Indici Fructus) 10g, Qian Shi (Euryales Semen) 10g. Seven doses.
Third Visit:
The patient took the above prescription for one month according to instructions, feeling greatly increased energy compared to before. The pulse is still soggy-soft, but feels forceful upon pressure. White tongue with greasy coating, slightly thick at the root. Continue the previous method with modifications.
Huang Qi (Astragali Radix) 60g, Sha Shen (Glehniae Radix) 15g, Mai Men Dong (Ophiopogonis Tuber) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Du Zhong (Eucommiae Cortex) 10g, Chuan Xu Duan (Dipsaci Radix) 10g, Bu Gu Zhi (Psoraleae Fructus) 10g, Jin Ying Zi (Chrysanthemi Indici Fructus) 10g, Jiao San Xian (Fried Sanxian: Shan Zha, Shen Qu, Mai Ya) 10g each, Shui Hong Hua Zi (Polygoni Multiflori Caulis Semen) 10g. Seven doses.
After six months of treatment with modifications to the above prescription, blood glucose dropped to 110 mg/dL, urine sugar turned negative, and various subjective symptoms basically disappeared.
[Commentary]: In this case, the patient's thirst and drinking are not significant, fatigue and weakness are obvious, the pulse is deficient-large, and the tongue is fat, pale, and tender. Based on pulse and symptoms, it is differentiated as Qi and Yin Deficiency. Qi fails to transform fluids, hence thirst. Treatment combines tonifying Qi and nourishing Yin with tonifying Kidney and strengthening Yuan. In the formula, Huang Qi (Astragali Radix) is heavily used to tonify Qi. Sha Shen, Mai Dong, and Wu Wei Zi constitute Sheng Mai San (Generate the Pulse Powder), which together with Huang Qi achieves the effect of tonifying Qi and generating fluids. Du Zhong, Chuan Xu Duan, and Bu Gu Zhi gently tonify Liver and Kidney, warm but not drying, tonifying but not cloying. Sheng Di Huang and Shu Di Huang nourish Yin and add essence. If taken for a long time, digestion might be insufficient, so Jiao San Xian and Shui Hong Hua Zi can be added to aid digestion and move the Triple Burner, ensuring tonification does not cause stagnation, allowing for long-term use as a fundamental treatment.