崩漏(功能性子宫出血)
王某，女，40岁
于1985年7月5日初诊
月经紊乱已年余，周期在20～70天不等，经期延长，量时多时步。10天前月经来潮，势如泉涌，用止血药以及云南白药、人参归脾丸治疗无效。刻下面色眦白，动则心慌气短，同时伴有心烦急躁，夜寐不安，口渴咽干，步腹作痛，下血不止，有血块，舌红起刺，苔黄且干，脉弦滑细数，血色素4，5g／dl。证属素体阳盛，伏热于里，扰动血海，迫血妄行。治拟宣畅三焦气机，清泻血分郁热。方药：荆芥炭10克小蓟10克，蝉表6克，僖蚕10克，片姜黄6克，川楝子6克，炒槐花10克，苎麻根10克，茅芦根各10克，太黄I克。服药2剂，血量明显减少，4剂血止，改用养血育阴，活血凉血方法。药用：蝉衣6克，郁金10克，香附10克，丹参10克，早莲草10克，赤芍10克，女贞于10克，炒枳壳6克，生地10克，僵蚕10克，焦三仙各10克，大黄1克。服药2周，饮食二便正常，睡眠转佳，血色素12g／dl.月经适来，量色正常。又以前法进退，观察治疗2个月，追访半年，月经一直正常。
[按]：崩漏是妇科常见病，其治当有虚实主次之分。患者面色皓白，动则心慌气短，血色素只有4.5g／dl。此乃血虚之征；而又有心烦急躁、夜寐不安、口渴咽干等症，应为血分郁热之象。血虚当补，血热当清，应以何为主?老师治病非常强调详诊细参，脉、舌、色、症综合分析，并以舌与脉更为见长，常谓：“虚实之辨，馓细在舌脉”。此患者舌红起刺，脉滑弦细数，足以说明下血不止的根本原因是血分郁热，气机不畅所为。因此先用清泻血分郁热、宣畅三焦气机之法，服药2剂，血量减少，4剂血止，再改用养血育阴，凉血活血治其本而疗效满意。但值得注意的是饮食当慎，如辛辣油腻之品当忌之；另外慎用温燥走窜之品，以防耗血伤血。
闭 经
袁某，女，20岁，1993年4月5日
初诊：
11岁初潮，月经一直正常，自15岁开始月经延期，逐渐发展到1年2～3次。曾用人二周期疗法以及中药治疗，效果不佳。特转诊赵老，现症面色暗浊，体质较胖，体倦乏力，精神抑郁，两胁胀痛，月经4月未至，舌红且暗，脉沉涩。证属血分郁滞，气机不畅，冲任冲受阻。治拟调冲任、化湿滞、理气机，以行其经。
方药：柴胡6克，川楝子6克，防风6克，蝉衣6克，片姜黄6克，赤芍10克，牛膝10克，香附10克，旋复花10克(包煎)，丝瓜络10克，大黄0.5克。服药3剂月经至，量多有血块，余症减轻，心情舒畅，又服5剂，月经止。更以养血为务，继续调治。第二个月35天月经来潮，3个月后月经逐渐正常，体胖亦减。
[按]：闭经是妇科常见病之一。本病案，月经紊乱已4～5年，每年有时1～2次，有时2～3次，用人工周期治疗时月经即来潮，药停月经随止。曾求几位中医大夫诊治，疗效均不理想，经友人介绍，转诊赵老。赵师辨证为气血郁滞，冲任受阻，气机不畅，用调冲任，化湿滞，理气机方法，用药3剂月经至，后又调治3个月，月经正常。
头汗(更年期缘合征)
乔某某，女，47岁
初诊
形肥面红，动即汗出，头汗为甚，头发尽湿，脉象濡滑且数，舌红苔干，心烦易怒口干，神疲乏力，夜寐纷纭。肝经郁热，上迫为汗。先议清泄肝胆方法。
柴胡6克，黄芩10克，川檩子10克，蝉衣6克，僵蚕10克，片姜黄6克，浮小麦30克，生牡蛎30克，七付
二诊
汗出渐减，心烦已止，夜寐亦安。脉仍濡数，舌红苔白。继用前法进退。
柴胡6克，黄芩10克，川楝子10克，蝉衣6克，赤白芍各10克，麦门冬15克，五味子6克，浮小麦30克，生牡蛎30克，七付
三诊
头汗已止，食眠俱安，二便如常。唯感乏力。脉象濡软，舌白苔润。仍用前法加减。
黄芪10克，麦门冬10克，五味子6克，浮小麦30克，生牡蛎30克，柴胡6克，黄芩6克，川楝子6克，茅芦根各10克，蝉衣6克。七付
药后诸证悉平。
[按]：汗出头部为甚，热盛居多。以火性炎上散也。阳明热，口谒喜饮}心火盛，舌红尖刺，心烦溲赤；肝郁热，急躁易怒，夜寐梦多。本倒即属后者，故用清泄肝胆方法，用柴胡、黄芩、川楝子泄肝热，合升降散疏调肝郁，并用浮小麦、生牡蛎养心敛汗。汗为心之液，汗出过多，必伤心气，故以浮小麦、生牡蛎，养而敛之，此二味为收汗之神剂，可加入对症方中治自汗、盗汗如神。若气分不足，重用黄芪益气固表，气阴两虚，可合用生脉饮、沙参、麦冬、五味子，若汗出不止者用麻黄根。阳明蕴热，用白虎汤、生石膏、知母等。治汗之法不外如此。
少年白发
沈某，男，15岁
初诊
中考之后，前顶突生白发，为数不少。经养血滋肾治疗未能见效。白发有增无减。心中急躁，夜寐不安，皮肤刺痒。脉象弦数，舌红步苔，热在血分，清之为宜。
生地榆10克，炒槐花10克，丹参10竟，茜草10克，生地黄10克，首乌藤10克，大黄1克，水红花子10克，七付
二诊
药后睡眠已安，夜梦显著减少。皮肤仍觉刺痒，再以清热凉血方法。
荆芥6克，防风6克，白芷6克，白鲜皮10克，地肤子10克，紫草10克，地丁草10克，蒲公英10克，生地榆10克，焦三仙各10克，大黄2克。七付
三诊
搔痒渐止。舌红脉数，仍用凉血方法。
生地榆10克，炒槐花10克，丹参10克，茜草10克小蓟10克，茅芦根各10克，紫草10克，赤芍10克，首乌藤10克，大黄1克，七付。
四诊
眠安心静，白发有减少趋势，再以前法进退。
荆芥炭10克，防风6克，白芷6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，赤芍10克，茅芦根各10克，大黄1克。
患者依上方续服月余，白发渐次减少而愈。
[按]：少年早发白发不可以血虚论治，多数系血分伏热较重，当治以清热凉血方法。本例病发于中考之后，为备考连续熬夜，情绪高度紧张，肝热化火，灼伤血分，而致自发骤生。故治以清热凉血，肝热清则寐安，寐安则血自复。若用补血补肾方法，恐其肝热愈甚，自发愈多矣。昔贤张从正主张用刺血疗法治疗少年白发，其有高人之见。刺血放血正是泄血分郁热之捷径。今用药内服，亦不离凉血清热之意。四诊方中又用荆芥炭、防风、白芷等风药，意在升发清阳，并引药上达，为用药精妙之处。
脱发(脂溢性皮炎)陶某某，女，27岁初诊近半年来，头发明显变细，每日脱发甚多，搔之即落，前头部头发明显稀疏。头皮屑多，搔痒，以白纸拭之，油透纸亮。诊脉弦细数，舌红苔白。心烦梦多。血分郁热，先用清法。
柴胡6克，黄芩6克，川楝子6克，生地榆10克，丹参10
克，炒槐花10克，茜草10克，赤芍10克，茅芦根各10克，七付
二诊
夜梦减少，余症如前矬用前法，食忌辛辣厦油腻。
荆芥6克，防风6克，白芷6克，生地榆10克，炒槐花10
克，丹参10克，茜草10克，小蓟10克，茅芦根各10克，七付
三诊
头皮搔痒减轻，皮屑减少。头发脱落较前为少。建议每晚10点以前入睡，避免熬夜，晨起运动锻炼，为治本之法，前法进退。
荆芥6克，防风6克，蝉衣6克，生地榆10克，丹参10克，赤芍10克，茜草10克，小蓟10克，茅芦根各10克，焦三仙各10克，水红花子10克，大黄1克，七付
患者依上方续服1个月，脱发逐渐减少，新发生长明显，余证皆除而愈。
[按]：脂溢性脱发较为难治。大法从血热论治，用凉血化瘀方法。患者须有耐心，并在生活上密切配合，主要是清淡饮食少食油腻肥甘之品，多吃些新鲜蔬菜水果，不吃辛辣刺激性食物。保证充分的睡眠，不熬夜。并注意增加运动锻炼。保持愉快的心情。如能认真实施，再配合适当的中药内服，是可以收到治疗效果的。
牙疳(牙周炎
王桂芬，女，49岁
初诊
牙麻微痛，齿龈糜烂七年余，时轻时重，重时不能吃饭，多方求医无效。曾屡用生石膏、公英、地丁、银花、连翘、大青叶、板兰根、元参、黄柏、苦参等苦寒解毒之品。西药用过多种维生素和抗生素。外用嗽口药为银花，生甘草各30克。均无效验，诊视见面色萎黄，齿龈肿痛轻微，糜烂色淡，牙齿麻微痛，甚则松动破溃，仅留残根，大便干燥，舌淡苔白糙老，脉濡软且数。
证属久病及肾，胃津肾液均亏，牙齿失养，虚火上炎，龈络受伤，治拟填补下元，少佐引火归源之法。处方：熟地黄20克，玉竹15克，山萸肉6克，补骨脂10克，芡实米10克，生牡蛎30克，瓦楞子30克，肉桂粉1克，牛膝3克，楮实子10克。
漱口方：毕拨10克，干姜10克，炒川椒10克，细辛6克，加醋20克，水煎漱口，不拘时候。
二次
服药六付，牙龈肿痛糜烂均减，齿微痛，舌白质淡，脉象沉软按之虚数，再拟填补下元之法。
处方，熟地黄12克，当归10克，白芍10克，山药10克，补骨脂10克，芡宴米10克，生地黄10克，丹皮10克，竹茹6克。
三诊
继进六付，龈糜齿痛均除，口唇发干，小溲色黄，仍以填补下元，甘寒育阴法。
处方：生地黄10克，沙参10克，麦冬10克，白芍10克，早莲草10克，女贞子10克，芡实米10克，茯苓10克，元参6克，六付
[按]经曰：“肾主骨”，“齿为骨之余。”叶天氏说，“齿为肾之余，龌为胃之络”。可见，齿赖肾液的填充、龈赖胃津的滋养。
齿、龈的强健与否取决于肾、胃的功能盛衰。肾精充足，胃津旺盛，则齿得其养而牢固色泽；龈得其润而红和色鲜。肾液不足，齿失所养则松动破溃，色枯不泽；胃肠热盛，胃津被伤，龈失所润则红肿疼痛，干燥不鲜。另外，胃热炽盛或水不济火，龙火上燔，均可灼伤龈络，发为溃疡，一实一虚，治当分辨。
赵老师有着丰富的临床经验，每能由局部求整体，从现象探实质，综观脉症，细察病机。据其患者年已七七，肾气自衰；又因病已七载余，胃津耗伤，必累及于肾液；加之治不得法，又伤正气；从其见症为牙麻痛轻，齿松破溃，龈糜色淡，便干且难，脉濡软而数可知，全是肾阴不足，水不制火，龙火上燔引起。故用药一反前辙，重咀滋补肾掖，使龙火归源，再拟成寒甘寒并用，使肾液充足，胃津旺盛，齿得其养，龈得其滋，诸症自除。
再议外用药，前医投大剂银花漱口，意在消炎而不效；赵师用辛温走窜之药外用漱口而得效，其理何在?盖“寒则泣而不流，温则消而去之”，寒则凝，温则通，通则气血流畅，正胜则邪退，虚火自弥，所谓“火与元气不两立，一胜则一负”也。
白疕(银屑病)
刘某某，女，32岁
初诊
患银屑病8年余，皮损散发，四肢、躯干及头皮均可见黄豆粒大小皮损。时轻时重，曾服中西药物治疗，效果欠佳。入秋以来，皮损有加重趋势，搔之有白屑脱落，基底潮红，并有新皮损发生。诊脉弦细滑数，舌红尖赤苔黄薄干。心烦急躁，夜寐梦多，，小溲色黄，大便偏干，晨起口苦，唇干舌燥。血分伏热日久，治宜凉血化瘀方法。一切辛辣发物皆忌。
荆芥6克，防风6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，紫草10克，地丁草10克，草河车10克，茅芦根各10克，大黄1克，七付
二诊
药后未出现新的皮损，心烦梦多渐减，二便已调，血热未清，舌红脉数，仍用前法。
荆芥6克，防风6克，生地榆10克，炒槐花10克，丹参10克，茜草10克，赤芍10克，白头翁10克，紫草10克，白鲜皮10克，地肤子10克，草河车10克，大黄1克，七付
三诊
上方续服一月，皮损显著减轻，躯干四肢皮损已渐平复，头皮仍有散在皮损如小豆大。诊脉弦细滑数，舌红苔白，血分郁热非朝夕可以泄越，凉血化瘀仍以为法，更须谨慎口味，以防死灰复燃。
荆芥6克，防风6克，白芷6克，生地榆10克，炒槐花10
克，丹参10克，茜草10克，茅芦根各10克，紫草10克，赤芍10克，焦三仙各10克，大黄1克，七付
上方加减续服2月，皮损完全消失。嘱其谨口味，慎起居，以防复发。
[按]：白疕，俗称牛皮癣，即现代医学之银屑病，为皮肤科之顽症。反复发作，不易根除。其属血分伏热，发为肌肤皮损。故当治以凉血化瘀之剂。又必须忌食辛辣刺激性食物、海产品及高热量高蛋白食物，以防其热增故也。若果能严格忌口，并坚持正确的中医辨证治疗，根治此病还是有可能的。
Metrorrhagia and Metrostaxis (Functional Uterine Bleeding)
Patient Wang, female, 40 years old.
First consultation on July 5, 1985.
Menstrual irregularities have persisted for over a year, with cycles varying between 20 to 70 days, prolonged menstrual periods, and fluctuating flow volume. Ten days ago, menstruation began with a gushing flow. Treatment with hemostatic agents, Yunnan Baiyao, and Renshen Guipi Wan (Ginseng and Atractylodes Macrocephala Decoction) was ineffective. Current presentation includes pale complexion, palpitations and shortness of breath upon exertion, accompanied by irritability, restless sleep at night, thirst with dry throat, lower abdominal pain, continuous bleeding with clots, red tongue with prickles, yellow and dry coating, wiry-slippery-thin-rapid pulse, and hemoglobin level of 4.5 g/dL. The pattern is identified as inherent excess Yang, latent heat within the interior, disturbing the Sea of Blood, forcing blood to move recklessly. The treatment principle is to promote the free flow of Qi mechanism in the San Jiao (Triple Burner) and clear stagnant heat in the Blood aspect. Prescription: Prepared Schizonepeta Spike 10g, Small Thistle Herb 10g, Cicada Slough 6g, Stiff Silkworm 10g, Curcuma Wenyujin Rhizome Slice 6g, Sichuan Loranthus Fruit 6g, Fried Sophora Flower 10g, Ramie Root 10g, Imperata Rhizome and Arundo Rhizome 10g each, Rhubarb 1g. After two doses, bleeding volume decreased significantly; after four doses, bleeding stopped. The method was changed to nourishing Blood and nurturing Yin, promoting Blood circulation and cooling Blood. Medicines used: Cicada Slough 6g, Turmeric Tuber 10g, Cyperus Rhizome 10g, Salvia Miltiorrhiza Root 10g, Eclipta Herb 10g, Red Peony Root 10g, Privet Fruit 10g, Fried Bitter Orange Peel 6g, Rehmannia Root 10g, Stiff Silkworm 10g, Scorch Three Immortals (Fried Hawthorn, Medicated Leaven, and Radish Seed) 10g each, Rhubarb 1g. After two weeks of medication, diet and bowel/bladder functions were normal, sleep improved, and hemoglobin rose to 12 g/dL. Menstruation occurred normally in volume and color. The previous method was adjusted and continued for observation over two months. Follow-up after six months showed regular menstruation.
[Commentary]: Metrorrhagia and metrostaxis are common gynecological diseases, requiring differentiation of deficiency and excess as primary or secondary factors. The patient's pale complexion, palpitations and shortness of breath upon exertion, and hemoglobin level of only 4.5 g/dL indicate Blood deficiency. Symptoms such as irritability, restless sleep, thirst, and dry throat suggest stagnant heat in the Blood aspect. While deficiency requires tonification and heat requires clearing, which should be prioritized? The teacher emphasizes detailed diagnosis and careful analysis, comprehensively integrating pulse, tongue, complexion, and symptoms, with particular expertise in tongue and pulse diagnosis, often stating: "The distinction between deficiency and excess lies in the subtleties of the tongue and pulse." This patient's red tongue with prickles and slippery-wiry-thin-rapid pulse sufficiently demonstrate that the root cause of continuous bleeding is stagnant heat in the Blood aspect and impaired Qi mechanism. Therefore, the initial approach was to clear stagnant heat in the Blood aspect and promote the free flow of Qi mechanism in the San Jiao. After two doses, bleeding volume decreased; after four doses, it stopped. Subsequently, the method shifted to nourishing Blood, nurturing Yin, cooling Blood, and promoting Blood circulation to treat the root, yielding satisfactory results. However, dietary caution is noted: spicy and greasy foods should be avoided. Additionally, warm-drying and moving substances should be used cautiously to prevent damaging Blood.
Amenorrhea
Patient Yuan, female, 20 years old, first consultation on April 5, 1993:
Menarche occurred at age 11, with regular menstruation thereafter. Starting at age 15, menstruation became delayed, gradually progressing to occurring only 2-3 times per year. Treatment with artificial cycle therapy and Chinese herbal medicine yielded poor results. Specifically referred to Master Zhao. Current symptoms include dark and turbid complexion, overweight constitution, fatigue, mental depression, distending pain in both hypochondria, no menstruation for four months, red and dark tongue, deep-choppy pulse. The pattern is stagnation in the Blood aspect, impaired Qi mechanism, and obstruction of the Chong and Ren vessels. The treatment principle is to regulate the Chong and Ren vessels, resolve damp-stagnation, and regulate the Qi mechanism to induce menstruation.
Prescription: Bupleurum Root 6g, Sichuan Loranthus Fruit 6g, Saposhnikovia Root 6g, Cicada Slough 6g, Curcuma Wenyujin Rhizome Slice 6g, Red Peony Root 10g, Achyranthes Root 10g, Cyperus Rhizome 10g, Inula Flower 10g (wrapped for decoction), Luffa Vine 10g, Rhubarb 0.5g. After three doses, menstruation started with heavy flow and clots; other symptoms alleviated, mood improved. After five more doses, menstruation ceased. The focus shifted to nourishing Blood, continuing regulation. Menstruation occurred on day 35 of the second month. After three months, menstruation gradually normalized, and body weight decreased.
[Commentary]: Amenorrhea is one of the common gynecological diseases. In this case, menstrual irregularity had persisted for 4-5 years, occurring 1-2 or 2-3 times annually. Menstruation occurred during artificial cycle therapy but ceased immediately after stopping medication. Several TCM physicians were consulted with unsatisfactory results. Introduced by a friend, the patient was referred to Master Zhao. Master Zhao differentiated the pattern as Qi and Blood stagnation, obstruction of the Chong and Ren vessels, and impaired Qi mechanism. Using methods to regulate the Chong and Ren vessels, resolve damp-stagnation, and regulate the Qi mechanism, menstruation started after three doses. After three months of continued regulation, menstruation normalized.
Head Sweating (Menopausal Syndrome)
Patient Qiao, female, 47 years old.
First consultation
Obese physique with red face, sweating upon slight movement, most severe on the head, soaking the hair. Pulse is soggy-slippery-rapid; tongue is red with dry coating. Irritability, anger, dry mouth, mental fatigue, and restless sleep. Liver Meridian stagnant heat forces sweating upwards. Initial discussion focuses on clearing and draining Liver and Gallbladder heat.
Chai Hu 6g, Huang Qin 10g, Chuan Lian Zi 10g, Chan Yi 6g, Jiang Can 10g, Pian Jiang Huang 6g, Fu Xiao Mai 30g, Sheng Mu Li 30g, seven doses.
Second consultation
Sweating gradually decreased, irritability ceased, sleep stabilized. Pulse remains soggy-rapid; tongue red with white coating. Continue adjusting the previous method.
Chai Hu 6g, Huang Qin 10g, Chuan Lian Zi 10g, Chan Yi 6g, Chi Shao and Bai Shao 10g each, Mai Dong 15g, Wu Wei Zi 6g, Fu Xiao Mai 30g, Sheng Mu Li 30g, seven doses.
Third consultation
Head sweating has stopped, appetite and sleep are peaceful, bowel and bladder functions normal. Only feels fatigued. Pulse is soggy-soft; tongue white with moist coating. Still adjusting the previous method.
Huang Qi 10g, Mai Dong 10g, Wu Wei Zi 6g, Fu Xiao Mai 30g, Sheng Mu Li 30g, Chai Hu 6g, Huang Qin 6g, Chuan Lian Zi 6g, Mao Gen and Lu Gen 10g each, Chan Yi 6g. Seven doses.
After medication, all symptoms resolved.
[Commentary]: Head sweating is usually due to excessive heat, as fire nature tends to flare upwards. Yangming heat presents with thirst and desire to drink; Heart fire excess presents with red tongue tip with prickles, irritability, and dark urine; Liver stagnant heat presents with irritability, anger, and dream-disturbed sleep. This case belongs to the latter, hence the use of clearing and draining Liver and Gallbladder heat. Chai Hu, Huang Qin, and Chuan Lian Zi drain Liver heat, combined with Sheng Jiang San to soothe and regulate Liver stagnation. Fu Xiao Mai and Sheng Mu Li nourish the Heart and astringe sweating. Sweat is the fluid of the Heart; excessive sweating inevitably damages Heart Qi. Thus, Fu Xiao Mai and Sheng Mu Li are used to nourish and astringe; these two are divine agents for stopping sweating and can be added to symptomatic prescriptions for spontaneous or night sweats with great effect. If Qi deficiency exists, heavily use Huang Qi to tonify Qi and secure the exterior. For Qi and Yin dual deficiency, combine with Sheng Mai Yin, Sha Shen, Mai Dong, and Wu Wei Zi. For unceasing sweating, use Ma Huang Gen. For Yangming accumulated heat, use Bai Hu Tang, Shi Gao, and Zhi Mu. These are the general methods for treating sweating.
Juvenile Premature Graying of Hair
Patient Shen, male, 15 years old.
First consultation
After the high school entrance examination, sudden appearance of significant white hair on the anterior vertex. Treatment with Blood-nourishing and Kidney-moistening methods failed. White hair increased rather than decreased. Inner irritability, restless sleep, skin prickling and itching. Pulse is wiry-rapid; tongue red with scant coating. Heat resides in the Blood aspect; clearing is appropriate.
Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Sheng Di Huang 10g, Shou Wu Teng 10g, Da Huang 1g, Shui Hong Hua Zi 10g, seven doses.
Second consultation
Sleep has stabilized, night dreams significantly reduced. Skin still feels prickling and itching. Continue with clearing heat and cooling Blood method.
Jing Jie 6g, Fang Feng 6g, Bai Zhi 6g, Bai Xian Pi 10g, Di Fu Zi 10g, Zi Cao 10g, Di Ding Cao 10g, Pu Gong Ying 10g, Di Yu 10g, Jiao San Xian 10g each, Da Huang 2g. Seven doses.
Third consultation
Itching gradually stopped. Tongue red, pulse rapid. Still using cooling Blood method.
Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Xiao Ji 10g, Mao Gen and Lu Gen 10g each, Zi Cao 10g, Chi Shao 10g, Shou Wu Teng 10g, Da Huang 1g. Seven doses.
Fourth consultation
Sleep is peaceful, mind calm, white hair shows a decreasing trend. Continue adjusting the previous method.
Jing Jie Tan 10g, Fang Feng 6g, Bai Zhi 6g, Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Chi Shao 10g, Mao Gen and Lu Gen 10g each, Da Huang 1g.
The patient continued taking the prescription for over a month, and white hair gradually decreased until resolution.
[Commentary]: Juvenile premature graying of hair should not be treated solely as Blood deficiency; it is mostly due to significant latent heat in the Blood aspect, requiring clearing heat and cooling Blood methods. This case occurred after the high school entrance exam, caused by consecutive late nights for preparation and high emotional tension, leading to Liver heat transforming into fire, scorching the Blood aspect, resulting in sudden spontaneous graying. Thus, the treatment focused on clearing heat and cooling Blood. When Liver heat clears, sleep stabilizes; when sleep stabilizes, Blood restores itself. Using Blood-tonifying and Kidney-nourishing methods might exacerbate Liver heat and increase white hair. The ancient sage Zhang Congzheng advocated bloodletting therapy for juvenile premature graying, showing profound insight. Bloodletting is indeed a direct path to drain stagnant heat in the Blood aspect. Internal medication also adheres to the principle of cooling Blood and clearing heat. In the fourth consultation prescription, wind herbs like Jing Jie Tan, Fang Feng, and Bai Zhi were used to raise clear Yang and guide medicines upwards, demonstrating exquisite prescribing skill.
Hair Loss (Seborrheic Dermatitis) Patient Tao, female, 27 years old. First consultation: Over the past half-year, hair has become noticeably thinner, with significant daily hair loss, falling off upon scratching, and obvious thinning on the front part of the scalp. Abundant dandruff, itching, leaving oily residue on white paper. Pulse is wiry-thin-rapid; tongue red with white coating. Irritability and frequent dreams. Stagnant heat in the Blood aspect; initially use clearing method.
Chai Hu 6g, Huang Qin 6g, Chuan Lian Zi 6g, Di Yu 10g, Dan Shen 10g, Fried Hua Hua 10g, Qian Cao 10g, Chi Shao 10g, Mao Gen and Lu Gen 10g each, seven doses.
Second consultation
Night dreams reduced, other symptoms remain. Continue previous method, avoid spicy and greasy foods.
Jing Jie 6g, Fang Feng 6g, Bai Zhi 6g, Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Xiao Ji 10g, Mao Gen and Lu Gen 10g each, seven doses.
Third consultation
Scalp itching reduced, dandruff decreased. Hair loss lessened compared to before. Advised to sleep before 10 PM, avoid staying up late, exercise in the morning as a fundamental treatment. Adjust previous method.
Jing Jie 6g, Fang Feng 6g, Chan Yi 6g, Di Yu 10g, Dan Shen 10g, Chi Shao 10g, Qian Cao 10g, Xiao Ji 10g, Mao Gen and Lu Gen 10g each, Jiao San Xian 10g each, Shui Hong Hua Zi 10g, Da Huang 1g, seven doses.
The patient continued taking the prescription for one month. Hair loss gradually decreased, new hair growth was obvious, and other symptoms disappeared, leading to recovery.
[Commentary]: Seborrheic alopecia is relatively difficult to treat. The general principle is to treat from Blood heat using cooling Blood and resolving stasis methods. Patients must have patience and cooperate closely in lifestyle, mainly eating a light diet, avoiding greasy and sweet foods, eating more fresh vegetables and fruits, and avoiding spicy stimulating foods. Ensure sufficient sleep, do not stay up late. Pay attention to increasing exercise. Maintain a happy mood. If implemented seriously, combined with appropriate internal Chinese herbal medicine, therapeutic effects can be achieved.
Stomatitis Gangrenosa (Periodontitis)
Wang Guifen, female, 49 years old.
First consultation
Numbness and slight pain in teeth, gingival erosion for over seven years, fluctuating in severity. During severe episodes, unable to eat. Multiple medical consultations were ineffective. Previously repeatedly used bitter-cold detoxifying herbs such as Shi Gao, Pu Gong Ying, Di Ding, Yin Hua, Lian Qiao, Da Qing Ye, Ban Lan Gen, Xuan Shen, Huang Bo, and Ku Shen. Western medications included various vitamins and antibiotics. External mouthwash consisted of Yin Hua and Gan Cao 30g each. All were ineffective. Examination revealed sallow complexion, mild gingival swelling and pain, pale erosion, tooth numbness and slight pain, even loosening and ulceration leaving only roots, dry stool, pale tongue with white rough-old coating, soggy-soft-rapid pulse.
The pattern is chronic illness affecting the Kidney, depletion of Stomach fluids and Kidney essence, teeth losing nourishment, deficient fire flaming upward, injuring gingival collaterals. The treatment principle is to tonify the Lower Yuan, with a minor addition of guiding fire back to its source. Prescription: Shu Di Huang 20g, Yu Zhu 15g, Shan Zhu Yu 6g, Gu Zhi 10g, Qian Shi Mi 10g, Sheng Mu Li 30g, Wa Leng Zi 30g, Rou Gui Fen 1g, Niu Xi 3g, Chu Shi Zi 10g.
Mouthwash Formula: Bi Bo 10g, Gan Jiang 10g, Chuan Chuan Jiao 10g, Xi Xin 6g, add vinegar 20g, decoct in water for mouthwash, anytime.
Second visit
After six doses, gingival swelling, pain, and erosion all decreased, slight tooth pain, white tongue with pale substance, deep-soft pulse, empty-rapid upon pressure. Re-plan to tonify the Lower Yuan.
Prescription: Shu Di Huang 12g, Dang Gui 10g, Bai Shao 10g, Shan Yao 10g, Gu Zhi 10g, Qian Shi Mi 10g, Sheng Di Huang 10g, Dan Pi 10g, Zhu Ru 6g.
Third visit
Continued for six doses, gingival erosion and tooth pain eliminated, dry lips, yellow urine. Still using tonifying Lower Yuan, sweet-cold nourishing Yin method.
Prescription: Sheng Di Huang 10g, Sha Shen 10g, Mai Dong 10g, Bai Shao 10g, Han Lian Cao 10g, Nu Zhen Zi 10g, Qian Shi Mi 10g, Fu Ling 10g, Xuan Shen 6g, six doses.
[Commentary]: The Classic states: "The Kidney governs bone," "Teeth are the surplus of bone." Ye Tian-shi said, "Teeth are the surplus of the Kidney, gums are the collaterals of the Stomach." Thus, teeth rely on Kidney essence filling, and gums rely on Stomach fluid nourishment.
The strength of teeth and gums depends on the prosperity of Kidney and Stomach functions. Sufficient Kidney essence and abundant Stomach fluids make teeth firm and lustrous, and gums moist and bright red. Insufficient Kidney essence leads to loose, ulcerated, dull teeth; excessive Stomach-Intestine heat damages Stomach fluids, causing swollen, painful, dry gums. Additionally, excessive Stomach heat or Water failing to control Fire, with Dragon Fire flaring upwards, can injure gingival collaterals, causing ulcers. One is excess, one is deficiency; treatment must distinguish them.
Master Zhao has rich clinical experience, often seeking the whole from the local, exploring the essence from phenomena, comprehensively observing pulse and symptoms, and carefully examining the disease mechanism. Given the patient is at age 49 (seven sevens), Kidney Qi naturally declines; having been ill for over seven years, Stomach fluids are depleted, inevitably affecting Kidney essence; plus improper treatment damaged healthy Qi. From symptoms of mild tooth numbness/pain, loose/ulcerated teeth, pale gingival erosion, dry/difficult stool, and soggy-soft-rapid pulse, it is evident that all stem from Kidney Yin deficiency, Water failing to control Fire, and Dragon Fire flaring upwards. Thus, medication reversed the previous approach, focusing on nourishing Kidney Yin to guide Dragon Fire back to its source, then combining salty-cold and sweet-cold methods to ensure sufficient Kidney essence and Stomach fluids, nourishing teeth and gums, eliminating all symptoms.
Regarding external medication, previous doctors used large doses of Yin Hua for mouthwash to reduce inflammation without effect. Master Zhao used acrid-warm penetrating herbs for mouthwash with success. What is the rationale? "Cold causes stagnation and non-flow, warmth causes dissolution and removal." Cold congeals, warmth promotes flow. When flow is smooth, healthy Qi prevails and evil retreats, deficient fire subsides. As stated, "Fire and Healthy Qi cannot coexist; when one wins, the other loses."
Bai Pi (Psoriasis)
Patient Liu, female, 32 years old.
First consultation
Suffering from psoriasis for over 8 years, lesions scattered, visible on limbs, trunk, and scalp, sized like soybeans. Fluctuating severity. Previous Chinese and Western drug treatments were suboptimal. Since autumn, lesions have worsened, shedding white scales upon scratching, with erythematous bases and new lesions appearing. Pulse is wiry-thin-slippery-rapid; tongue red tip with yellow-thin-dry coating. Irritability, frequent dreams, yellow urine, dry stool, bitter taste in mouth upon waking, dry lips and tongue. Long-standing latent heat in the Blood aspect; treatment should focus on cooling Blood and resolving stasis. All spicy and triggering foods are forbidden.
Jing Jie 6g, Fang Feng 6g, Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Zi Cao 10g, Di Ding Cao 10g, Cao He Che 10g, Mao Gen and Lu Gen 10g each, Da Huang 1g, seven doses.
Second consultation
No new lesions appeared, irritability and dreams gradually reduced, bowel and bladder regulated. Blood heat not yet cleared, tongue red, pulse rapid. Continue previous method.
Jing Jie 6g, Fang Feng 6g, Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Chi Shao 10g, Bai Tou Weng 10g, Zi Cao 10g, Bai Xian Pi 10g, Di Fu Zi 10g, Cao He Che 10g, Da Huang 1g, seven doses.
Third visit
Continued taking the above prescription for one month, lesions significantly reduced, trunk and limb lesions gradually flattened, scattered pea-sized lesions remain on scalp. Pulse wiry-thin-slippery-rapid, tongue red with white coating. Stagnant heat in the Blood aspect cannot be drained overnight. Cooling Blood and resolving stasis remains the method. Must be cautious with diet to prevent relapse.
Jing Jie 6g, Fang Feng 6g, Bai Zhi 6g, Di Yu 10g, Fried Hua Hua 10g, Dan Shen 10g, Qian Cao 10g, Mao Gen and Lu Gen 10g each, Zi Cao 10g, Chi Shao 10g, Jiao San Xian 10g each, Da Huang 1g, seven doses.
With adjustments, continued for two months, lesions completely disappeared. Advised strict diet and careful daily routine to prevent recurrence.
[Commentary]: Bai Pi, commonly known as Psoriasis, is a stubborn dermatological disease. It recurs frequently and is hard to eradicate. It belongs to latent heat in the Blood aspect, manifesting as skin lesions. Thus, it should be treated with cooling Blood and resolving stasis formulas. Strict avoidance of spicy stimulating foods, seafood, and high-calorie/high-protein foods is necessary to prevent heat exacerbation. If strict dietary restrictions are followed and correct TCM syndrome differentiation treatment is persisted in, radical cure is possible.