例一气冲上逆，呕吐不止，面赤苔厚，胸中如焚，乃胃热之徵，治以舒气降逆，清胃止呕，一剂而其患若失，后以前法结合理气疏肝以巩固疗效。
例二为上热下寒，虚实兼见，先用半夏泻心汤加味以和胃降逆，开结除满，治重清上温下，后专温其中下二焦，方用桂附理中加味益火生土，温肾健脾，兼以和中，诸证痊愈。此案治分先后，虚实兼顾，对于益火生土之法的运用颇有心得。
(三十一)泄泻
例一房XX，男，39岁，病历号：2566，初诊日期：1963年7月。患者二年来经常腹泻，便前腹部坠痛，大便稀，每日3～5次，甚者日达十数次。食纳欠佳，小便正常。明显消瘦，体重减轻20市斤。大便常规检查：红细胞40—50个／高倍视野，人肠毛滴虫满视野。曾服中西药未效。诊为人肠毛滴虫性肠炎。舌苔白腻，脉象沉弦滑。辨证；脾胃虚弱，湿热内蕴，肠胃不和。治法：清热利湿，调和肠胃，导滞杀虫。方药：酒军、秦皮、香附、赤白芍、六一散(包)各9克白头翁、马齿苋、银花各15克五倍子4．5克紫蔻、木香、生姜、乌梅各3克另以鸦胆子20粒(去皮)装胶囊，分早晚二次，随汤药同时分吞。服上方20剂，诸症基本消失，大便检查：外观无粘液，镜检：红、白细胞均为0～1个／高倍视野，未见滴虫。以后数次大便检查均属正常。(关幼波主治，钱英整理：临床应用鸦胆子一得，《新医药杂志》7：23，1978)
例二邢X，男，33岁，初诊日期：1975年4月。自述腹痛已半年有余，其症环脐腹痛，喜按喜温，常屈身以缓之。痛则即有便意，但又不能爽下，下重如痢，多夹粘液，日便多则七、八次，少亦二、三次。诊为结肠炎，结肠过敏。服中西药未效。脉沉细而弦，舌质淡红，苔薄腻，两年前有急性痢疾史，宿疾有支气管炎，时咳，动则心悸，余则眠食尚可，体亦未衰，每日午睡后，全身似觉冷气四彻，啬啬恶寒，且必待汗出后其症乃止。辨证；阳为阴郁，不能宣达。治法：疏达表里，周旋内外。方药：柴胡15克白芍24克枳实9克甘草6克薤白18克附片(先煎)6克海螵蛸粉4．5克上方服3剂后，腹痛顿缓，便次渐少，下重亦轻，守方不更，连进十数剂，腹痛已微，粘液亦净，大便初硬后溏，诸症亦均向安。(魏龙骧；续医话四则，《新医药杂志》12，14，1978)
例三男，4l岁，1961年10月以来，每日腹泻，有时失禁遗裤，初为水泻，一天20多次，近变为鹜溏，一天四至七次不等。便前肠鸣漉漉，无腹痛感，纳食尚佳。脉细带弦，舌质红，苔黄白厚腻。诊断为脾阳不运而湿不化，直趋大肠为泻，泻久伤阴，阴虚生热，且现水不涵木现象。治法仍宜温养中焦为主，稍佐升清，如果因舌红而用苦寒，势必脾阳更伤而下陷。方药：党参、黄芪、山药、诃子，炮姜、炙草、红枣、葛根、升麻。服4剂后，苔腻化薄，舌质不红，肠鸣减少，原方去升、葛，加破故纸。又服八剂，自觉周身有力，粪便转厚，但一天仍有四，五次，接用附子理中合赤石脂禹余粮汤复方。(秦伯未：《谦斋医学讲稿》)
例四陆XX，男，52岁，初诊日期：1952年8月2日。溏泻已月余，色先黑后黄，腹鸣一痛则泻，日夜行五，六次不等，并无红白，但有不消化之物，此乃脾湿肾虚之故，为日已久，当从本治。台党参9克焦冬术6克炒枳壳4．5克赤白苓芍各9克大腹皮9克焦鸡金9克佛手片9克金毛狗脊9克生熟苡仁各12克芡实12克怀山药12克炙甘草6克生藕节6克大枣3枚陈仓米一勺微灼8月4日(--诊)：服昨方，腹泻次数已减，肢体亦和，仅腹部尚疼耳。当依法加减。米炒党参9克土炒白术6克炒枳壳6克桑寄生12克生熟稻芽各9克焦鸡金9克佛手片9克盐杜仲9克亦白苓各9克盐泽泻9克生甘草6克生藕节5枚8月12日(三诊)：素体肝阳太旺，脾肾两虚，故头时发眩而作声，溏泄日行二、三次不等，粪色黑多黄少。当属内热为患，仍从本治。’台党参12克珍珠母30克(先煎)真龙齿18克(先煎)沉香曲9克生熟苡仁各9克生熟稻芽各9克炒扁豆12克灵磁石15克(先煎)大腹皮9克川牛膝6克甘草6克生白芍12克炒陈仓米9克芡实米12克8月14日(四诊)：头昏大减，大便已变黄，惟作溏恭日行一、二次。内热巳轻，肝脾未和，当从本治。台党参9克炒冬术6克炒枳壳9克灵磁石12克(先煎)生熟苡仁各9克芡实米12克怀山药12克扁豆衣12克盐炒砂仁6克大腹皮6克茯苓块9克甘草6克陈仓米9克8月16日(五诊)，服方尚安，惟腹中仍作堕痛，日夜尚泻二三次，中有不消化之物。中气略虚，当调理肠脾兼和肺胃以为治。生黄芪9克米炒党参9克土炒白术9克炒枳壳6克生熟稻芽各9克焦鸡金9克佛手片9克大腹皮6克炒白扁豆12克芡实米12克赤白芍苓各9克甘草6克陈仓米9克烧枣3枚：8月19日(六诊)：腹泻虽止，脉见弦虚，血压极高，乃湿热上攻为患，热极恐成风，亟当从事清降。(以下均为治疗湿热上攻之法，与泄泻无关，故略)(张绍重整理：萧龙友医案，《中医杂志》2：115，1958)
例五郑XX，42岁，初诊日期：1938年?月’14日。患泄利数次。医与胃苓汤泄止后，遂胸腹发热，舌苔白燥，口出白沫，渴欲饮冷，溺赤，与滋阴清热，恶热反甚，自汗出欲乘风或入井，自觉脚心如焚，病延半月。……切脉沉涩，舌根黑腻，渴不欲饮，时自烦恶热，汗出扇之，汗干后热。余予清热化湿药，连服五剂，每日仍有五六次恶热汗出，喉间白沫极粘不能出，舌苔转白而燥，不渴。又予麦冬、沙参养阴诸药，恶热欲甚。细思久之，无乃真阳欲脱无根之火游走乎?予党参、白术、白芍、云苓、柏子仁各6克，麦冬、生牡蛎各15克，淡附片2．4克为剂，冷服探之，五剂，切脉愈细，面时戴阳，四逆冷汗出，头眩以热掌按头上则快；不按则欲脱，虽仍恶热而不欲扇，虚阳欲脱之象露矣。乃予东洋参、白术、白芍各6克，淡附片(先煎)、炮姜各3克，肉桂1．2克，枣仁(炒)15克，煎服2剂，戴阳渐戢，冷汗欲收，脉转细迟而思食矣。前方加黄芪、当归各6克，熟地9克，甘草2．4克，助阳摄阴，补气养血而愈。(朱不远整理：朱颜医案医话选(续)，《中医杂志》2：15，1：980)
例六索XX，男，45岁。初诊日期；1960年1月4日。．腹泻已五年之久，每日黎明前肠鸣腹泻4～5次，排泄物水谷不化，腹部隐隐作痛，喜按，食少倦怠，腰瘦腿软，腹凉肢冷，体质削瘦，面色苍白，舌淡苔白，脉沉细。经钡餐透视西医诊为肠结核。辨证：脾胃虚寒，肾阳虚。治法：补脾胃，温中助阳涩肠法。方药：三味止泻散加味。山药150克诃子肉60克石榴皮60克肉桂30克煨豆蔻30克共为细末，每次4．5克，空腹服，白开水送下，忌食腥冷硬食物，服药一周后，逐渐好转，连服二剂而愈。(《老中医经验汇编》第一集，郑桥医案)
例七何XX，女，24岁，病例号：78762，会诊日期：1966年4月29日。患者足月妊娠，不规则宫缩及自然破水3天，胎动消失一天入院，当时体温39．5℃，入院当天急诊行剖腹产，术后禁食，用青霉素、链霉素、四环素等药，发热未退，并开始腹泻，大便稀水样，日解4～5次，培养结果为金黄色葡萄球菌，诊断为足月妊娠横位死胎，宫内感染，继发伪膜性肠炎。当时症见：术后4天，发热不恶寒，两颧红赤，口干不欲饮，食纳尚可，大便日解四次，呈糊状，无腹痛，尿黄短，恶露未尽，量少，舌质稍红，苔白滑，脉弦数。辨证：阴血大伤，毒热未尽，清浊不分，以致泄利。治法：养阴补血，清热解毒，分利清浊。方药：生地15克元参12克石斛12克当归9克青蒿15克丹皮12克银花30克连翘15克公英18克败酱草18克赤芍12克酒芩9克栀子6克车前子12克(包)通草6克每日2剂，分4次服。5月3日，服上方后，体温正常，食纳转佳，但自觉身热，口干思饮，时有汗出，少腹左侧疼痛拒按，大便日解一次，质稠，小便稍黄，尿道有灼热感，舌质淡红，苔黄褐。阴血耗伤，里热仍盛，继以养阴清热解毒，佐以分利为法，曾加减使用过熟地，当归，白芍、地丁、太子参、花粉、桃仁，柴胡、地骨皮、鳖甲、黑荆芥、乳没等。5月14日恶露已尽，创面浓汁减少。5月29日一般情况良好，痊愈出院。(郗霈龄主治，高益民整理：伪膜性肠炎中医辨证施治的体会，《中医杂志》3：12，1980)
例八高XX，男，51岁，病例号，72872，会诊日期；1965年7月31日。患者因严重贫血待查入院，7月8日开始高烧(40℃)，腹泻日40多次，伴有休克，疑为中毒性痢疾，使用痢特灵、黄连素，四环素等治疗，大便次数反而增多，涂片检查为革兰氏阳性球菌，培养为金黄色葡萄球菌，致病性试验阳性。诊为继发性伪膜性肠炎。曾用大肠杆菌液灌肠，口服红霉素、收敛药未效。7月13日会诊：当时证见：患者精神萎靡，嗜睡，体温38．3~C，四肢逆冷，大便黄绿色胆汁样稀水，顺肛门向外流泻，不欲进食，伴有恶心，两足浮肿，舌卷囊缩，舌质淡，无苔，脉微欲绝。辨证：脾肾虚衰，阳虚欲脱。治法：温补脾肾，回阳固脱。方药；党参9克茯苓15克炒白术9克肉豆蔻6克吴茱萸6克官桂4．5克附片3克炮姜3克煨葛根4．5克?月14日：护士代述，昨晚8时开始服药，11时大便即转为黄色，夹有块状粪便，夜间共计八次。今日病情明显好转，体温36．6℃，食欲有增，大便白天5～6次，呈黄色稀便，继服上方至7月19日，体温一直正常，大便已成形，化验检查正常，伪膜性肠炎已愈，续治原发病。8月15日基本痊愈出院。(郗霈龄主治，高益民整理：伪膜性肠炎中医辨证施治的体会，《中医杂志》3；12，1980)[评按l泄泻系指排便次数增多，粪便清稀，甚而如水样。多因外邪、伤食、情志、脾胃虚弱或肾阳虚衰所致。脾虚湿胜则是发病的重要因素。
例一证属脾胃虚弱，湿热内蕴，病程虽长，正气已衰，但湿热未清，岂能闭门留寇，且有虫疾内伏，当以“通因通用”为上策。法用清热利湿，导滞杀虫，邪去则正安。方中加用鸦胆子，取其有解毒杀虫之效。
例二系因阳为阴郁不能宣达而致腹痛下利，方用四逆散而治愈。本方出自《伤寒论》“少阴病，四逆，其人或咳，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。”四逆散证以四肢厥逆为主治重点，本例苦于腹痛下利，午睡后自觉冷气四彻，亦即阳为阴郁而欲求阳通之象，本方功能和解表里，疏畅阳气，使之透达。另加薤白以泄气滞，附子温阳补虚，海螵蛸能治环脐腹痛(《别录》)，认真把握病机则效如桴鼓。
例三证属脾虚湿盛，治以温养中焦为主，秦氏提示，医者不能因见舌红而徒用苦寒，以防更伤脾阳而致下陷。
例四证属脾湿肾虚，兼有肺胃失和、湿热上攻之证，本证、标证俱现，当以健脾补肾为治本之法，而治标每随证而变，治本则贯彻始终。
例五患泄利数次，医者“屡败屡战”，朱氏细思之余，始悟出乃真阳欲脱之象，遂予四逆理中之辈放胆投之，并加用助阳摄阴、补气养血之剂而愈。本例曾现黑苔，苔黑色皆伤寒危证，然亦有辨，若黑苔剥之颇硬或如刺，脉伏或实而有力，为阳证而可下。本例其黑苔在舌根，似浮润而实干枯，此属阴证，切忌泄下，当须识此，勿失病机。
例六为五更泄，用三味止泻散(山药、诃子肉、石榴皮)补脾胃，涩肠固脱，加肉豆蔻温中助阳，肉桂补火助阳，服用散剂疗效亦佳。
例七、
例八均为伪膜性肠炎，系因大量使用广谱抗菌素所引起的肠道菌群失调而致泄泻，病情颇重。
例七证属阴血大伤，毒热未尽，清浊不分而致泄利，治以养阴补血、清热解毒，分利之法在所必行。
例八证属脾肾虚衰，阳虚欲脱。若与上述例七相较，治疗侧重于温补脾肾，回阳固脱。然而疏方仍注重于分利清浊之法。遇“危”不惧，辨证论治两相契合。
(三十二)痢疾
Case 1: Qi rebels upward, causing incessant vomiting, flushed face, thick tongue coating, and a sensation of burning in the chest. This is a sign of Stomach Heat. Treatment focuses on soothing Qi, descending rebellion, clearing Stomach Heat, and stopping vomiting. After one dose, the symptoms disappeared. Subsequently, the previous method was combined with regulating Qi and soothing the Liver to consolidate the curative effect.
Case 2: Manifests as Upper Heat and Lower Cold, with both deficiency and excess patterns present. Initially, Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) with modifications was used to harmonize the Stomach, descend rebellion, open congestion, and relieve fullness. The treatment emphasized clearing the Upper and warming the Lower. Later, specific warming of the Middle and Lower Jiao was employed using Guifu Lizhong Tang (Cinnamon Twig and Aconite Pill Regulating the Middle) with modifications to benefit Fire generating Earth (warming Kidney and Spleen), warm the Kidney and strengthen the Spleen, while also harmonizing the Middle Jiao. All symptoms resolved. This case demonstrates a sequential treatment approach addressing both deficiency and excess, showing considerable expertise in applying the "benefiting Fire to generate Earth" method.
(31) Diarrhea
Case 1: Fang XX, Male, 39 years old, Medical Record No.: 2566, First Visit Date: July 1963. For two years, the patient has suffered from frequent diarrhea, with abdominal dragging pain before defecation, loose stools, 3-5 times daily, sometimes up to ten or more times. Poor appetite, normal urination. Significant weight loss of 10 kg (20 Jin). Routine stool examination showed 40-50 red blood cells/high power field, and Entamoeba histolytica (human intestinal amoeba) filling the field. Previous Chinese and Western medicines were ineffective. Diagnosed as Entamoeba histolytica enteritis. Tongue coating white and greasy, pulse deep, wiry, and slippery. Syndrome differentiation: Spleen and Stomach deficiency with internal accumulation of Damp-Heat, disharmony of Intestines and Stomach. Treatment method: Clear Heat and drain Dampness, harmonize Intestines and Stomach, guide out stagnation, and kill parasites. Prescription: Wine-processed Rhubarb (Jiu Jun), Bark of Qinpi (Qin Pi), Cyperus Rhizome (Xiang Fu), Red and White Peony Root (Chi Bai Shao), Liu Yi San (Six-One Powder, wrapped) each 9g; Pulsatilla Root (Baitouweng), Purslane (Machixian), Honeysuckle Flower (Yin Hua) each 15g; Chinese Gallnut (Wubeizi) 4.5g; Amomum Fruit (Zi Kou), Aucklandia Root (Mu Xiang), Fresh Ginger (Sheng Jiang), Mume Fruit (Wu Mei) each 3g. Additionally, 20 seeds of Brayera Semen (Yadanzi, peeled) were encapsulated, taken twice morning and evening along with the decoction. After 20 doses, symptoms basically disappeared. Stool examination: no mucus visible, microscopy showed 0-1 RBC/WBC per high power field, no amoebae found. Subsequent stool examinations were normal. (Chief Physician Guan Youbo, compiled by Qian Ying: One Experience in Clinical Application of Brayera Semen, New Medicine Magazine, 7:23, 1978)
Case 2: Xing X, Male, 33 years old, First Visit Date: April 1975. Complained of abdominal pain for over half a year. Pain surrounds the umbilicus, relieved by pressure and warmth, often relieved by curling up. Pain triggers the urge to defecate, but passage is not smooth, with a heavy sensation in the rectum like dysentery, often mixed with mucus. Bowel movements range from 7-8 times to 2-3 times daily. Diagnosed as Colitis and Colon Hypersensitivity. Previous treatments failed. Pulse deep, fine, and wiry; tongue body pale red, coating thin and greasy. History of acute dysentery two years ago; chronic bronchitis with occasional cough; palpitations upon exertion. Sleep and appetite are generally okay, constitution not weak. However, after afternoon nap, feels cold air penetrating all over, aversion to cold, which only stops after sweating. Syndrome differentiation: Yang Qi constrained by Yin, unable to circulate and reach. Treatment method: Unblock exterior and interior, coordinate inside and outside. Prescription: Bupleurum Root (Chai Hu) 15g, White Peony Root (Bai Shao) 24g, Immature Bitter Orange (Zhi Shi) 9g, Licorice Root (Gan Cao) 6g, Shallot Bulb (Xie Bai) 18g, Prepared Aconite Root (Fu Pian, pre-decocted) 6g, Cuttlefish Bone (Haipiaoxiao) powder 4.5g. After 3 doses, abdominal pain eased significantly, bowel frequency decreased, rectal heaviness lightened. Continued same prescription for over ten doses. Abdominal pain minimal, mucus cleared, stool initially hard then loose, all symptoms stabilized. (Wei Longxiang: Four More Medical Conversations, New Medicine Magazine, 12, 14, 1978)
Case 3: Male, 41 years old. Since October 1961, daily diarrhea, sometimes incontinence. Initially watery diarrhea, >20 times/day, recently changed to duck-like loose stools (Wu Tang), 4-7 times/day. Borborygmus before defecation, no abdominal pain, good appetite. Pulse fine and slightly wiry; tongue body red, coating yellow-white and thick/greasy. Diagnosis: Spleen Yang fails to transport, Dampness does not transform, directly rushing to Large Intestine causing diarrhea. Prolonged diarrhea injures Yin, Yin deficiency generates Heat, and Water failing to nourish Wood phenomenon appears. Treatment should primarily warm and nourish the Middle Jiao, slightly assisting in raising clear Yang. If bitter-cold herbs are used merely because the tongue is red, Spleen Yang will be further injured and sink. Prescription: Codonopsis Root (Dang Shen), Astragalus Root (Huang Qi), Dioscorea Rhizome (Shan Yao), Chebula Fruit (He Zi), Processed Ginger Root (Pao Jiang), Honey-fried Licorice Root (Zhi Gan Cao), Red Date (Hong Zao), Kudzu Root (Ge Gen), Cimicifuga Rhizome (Sheng Ma). After 4 doses, greasy coating thinned, tongue no longer red, borborygmus reduced. Removed Sheng Ma and Ge Gen from original formula, added Psoralea Fruit (Po Gu Zhi). After another 8 doses, felt strength throughout body, stool thickened, but still 4-5 times/day. Then used Fuzi Lizhong Tang combined with Chishizhi Yuyuli Tang compound. (Qin Bowei: Qianzhai Medical Lectures)
Case 4: Lu XX, Male, 52 years old, First Visit Date: August 2, 1952. Loose stools for over a month, color first black then yellow. Borborygmus followed by pain and diarrhea, 5-6 times day and night. No red/white pus/blood, but undigested food present. Cause: Spleen Dampness and Kidney Deficiency. Chronic condition, treat from root. Tai Dang Shen 9g, Charred Atractylodes Macrocephala Rhizome (Jiao Dong Zhu) 6g, Stir-fried Aurantium Fructus Immaturus (Chao Zhi Ke) 4.5g, Red/White Poria (Chi Bai Ling) and Red/White Peony Root (Chi Bai Shao) each 9g, Greater Cnidium Fruit (Da Fu Pi) 9g, Charred Chicken Gizzard Lining (Jiao Ji Jin) 9g, Bergamot Peel (Fo Shou Pian) 9g, Gold-haired Dogtail Fern Rhizome (Jin Mao Gou Ji) 9g, Raw/Cooked Coix Seed (Sheng Shu Yi Ren) each 12g, Euryale Seed (Qian Shi) 12g, Huai Yam (Huai Shan Yao) 12g, Honey-fried Licorice Root (Zhi Gan Cao) 6g, Fresh Lotus Node (Sheng Ou Jie) 6g, 3 Red Dates (Da Zao), 1 spoon of aged rice (Chen Cang Mi) lightly roasted. Aug 4 (2nd visit): Diarrhea frequency reduced, limbs comfortable, only slight abdominal pain remains. Modify according to method. Rice-stir-fried Dang Shen 9g, Earth-stir-fried Atractylodes Macrocephala Rhizome (Tu Bai Zhu) 6g, Stir-fried Zhi Ke 6g, Mulberry Root Bark (Sang Ji Sheng) 12g, Raw/Cooked Oryza Sativa Sprout (Sheng Shu Dao Ya) each 9g, Charred Ji Jin 9g, Fo Shou Pian 9g, Salt-processed Eucommia Bark (Yan Du Zhong) 9g, Bai Ling each 9g, Salt-processed Alisma Rhizome (Yan Ze Xie) 9g, Raw Gan Cao 6g, 5 Sheng Ou Jie. Aug 12 (3rd visit): Constitution has excessive Liver Yang, Spleen/Kidney deficiency, hence dizziness and tinnitus. Loose stools 2-3 times/day, stool mostly black/yellow. Internal heat pathogenic, still treat root. Tai Dang Shen 12g, Mother-of-Pearl Shell (Zhen Zhu Mu, pre-decocted) 30g, True Dragon Teeth (Zhen Long Chi, pre-decocted) 18g, Agarwood Curd (Chen Xiang Qu) 9g, Sheng/Shu Yi Ren each 9g, Sheng/Shu Dao Ya each 9g, Stir-fried Broad Bean (Chao Bian Dou) 12g, Spirit Magnetite (Ling Ci Shi, pre-decocted) 15g, Da Fu Pi 9g, Achyranthes Bidentata Root (Chuan Niu Xi) 6g, Gan Cao 6g, Raw Bai Shao 12g, Stir-fried Chen Cang Mi 9g, Qian Shi Mi 12g. Aug 14 (4th visit): Dizziness greatly reduced, stool turned yellow, loose 1-2 times/day. Internal heat mild, Liver/Spleen not harmonized, treat root. Tai Dang Shen 9g, Stir-fried Dong Zhu 6g, Chao Zhi Ke 9g, Ling Ci Shi 12g (pre-decocted), Sheng/Shu Yi Ren each 9g, Qian Shi Mi 12g, Huai Shan Yao 12g, Bian Dou Yi 12g, Salt-stir-fried Amomum Fruit (Yan Sha Ren) 6g, Da Fu Pi 6g, Poria Block (Fu Ling Kuai) 9g, Gan Cao 6g, Chen Cang Mi 9g. Aug 16 (5th visit): Formula stable, but abdominal dragging pain persists, diarrhea 2-3 times/day with undigested food. Middle Qi slightly deficient, regulate Intestine/Spleen and harmonize Lung/Stomach. Raw Huang Qi 9g, Rice-stir-fried Dang Shen 9g, Tu Bai Zhu 9g, Chao Zhi Ke 6g, Sheng/Shu Dao Ya each 9g, Jiao Ji Jin 9g, Fo Shou Pian 9g, Da Fu Pi 6g, Stir-fried Bian Dou 12g, Qian Shi Mi 12g, Chi Bai Shao/Ling each 9g, Gan Cao 6g, Chen Cang Mi 9g, Roasted Zao 3 pieces. Aug 19 (6th visit): Diarrhea stopped, pulse wiry and deficient, blood pressure extremely high. Damp-Heat attacking upward, extreme heat may generate Wind, urgently need clearing and descending. (Following text concerns treating Damp-Heat attacking upward, unrelated to diarrhea, omitted.) (Compiled by Zhang Shaozhong: Medical Cases of Xiao Longyou, Chinese Medicine Journal, 2:115, 1958)
Case 5: Zheng XX, 42 years old, First Visit Date: ? Month 14, 1938. Had diarrhea several times. Doctor gave Weiling Tang, diarrhea stopped, then chest/abdomen became hot, tongue coating white/dry, mouth foaming, thirst for cold drinks, dark urine. Given Yin-nourishing and Heat-clearing herbs, aversion to heat worsened, spontaneous sweating, desire to go into wind or well, soles of feet felt burning. Illness lasted half a month... Pulse deep and choppy, tongue root black/greasy, thirst without desire to drink, occasionally irritable and averse to heat, sweating cools when fanned, heat returns after sweat dries. I gave Heat-clearing and Damp-draining herbs, 5 doses, still 5-6 episodes/day of heat/sweating, sticky white foam in throat difficult to expectorate, tongue coating turned white/dry, no thirst. Then given Ophiopogon Tuber (Mai Dong) and Glehnia Root (Sha Shen) to nourish Yin, aversion to heat worsened. Thought deeply: Could it be True Yang about to collapse with rootless Fire wandering? Prescribed Dang Shen, Bai Zhu, Bai Shao, Cloud Poria (Yun Ling), Biota Seed (Bai Zi Ren) each 6g, Mai Dong, Raw Oyster Shell (Sheng Mu Li) each 15g, Light Aconite Slice (Dan Fu Pian) 2.4g. Taken cold to test. After 5 doses, pulse finer, face shows floating Yang (Dai Yang), four extremities cold, cold sweat, dizziness; pressing head with hot palms feels good; removing hands feels like collapsing. Still averse to heat but doesn't want fanning, signs of deficient Yang collapse revealed. Then gave Japanese Ginseng (Dongyang Shen), Bai Zhu, Bai Shao each 6g, Dan Fu Pian (pre-decocted), Pao Jiang each 3g, Cinnamon Bark (Rou Gui) 1.2g, Sour Jujube Seed (Zao Ren, stir-fried) 15g. Decocted and taken 2 doses. Floating Yang gradually subsided, cold sweat stopped, pulse turned fine/slow, appetite returned. Added Huang Qi, Dang Gui each 6g, Cooked Rehmannia Root (Shu Di) 9g, Gan Cao 2.4g to original formula. Assisting Yang to secure Yin, tonifying Qi and nourishing Blood. Cured. (Compiled by Zhu Bu Yuan: Selected Medical Cases and Conversations of Zhu Yan (Continued), Chinese Medicine Journal, 2:15, 1980)
Case 6: Suo XX, Male, 45 years old. First Visit Date: January 4, 1960. Diarrhea for five years. Daily predawn borborygmus and diarrhea 4-5 times, undigested food in excrement, dull abdominal pain, prefers pressure, poor appetite, fatigue, thin waist/weak legs, cool abdomen/cold limbs, emaciated, pale complexion, pale tongue with white coating, deep/fine pulse. Barium meal fluoroscopy diagnosed by Western medicine as Intestinal Tuberculosis. Syndrome differentiation: Spleen/Stomach deficiency-cold, Kidney Yang deficiency. Treatment method: Tonify Spleen/Stomach, warm Middle, assist Yang, astringe Intestines. Prescription: Sanwei Zhixie San (Three-Ingredient Stop-Diarrhea Powder) modified. Shan Yao 150g, He Zi Rou 60g, Shi Liu Pi 60g, Rou Gui 30g, Wei Dou Kou 30g. Pulverized finely, 4.5g per dose, taken empty stomach with plain water. Avoid raw/cold/hard foods. Gradual improvement after one week, cured after two courses. (Old TCM Doctors' Experience Compilation Vol. 1, Zheng Qiao Case)
Case 7: He XX, Female, 24 years old, Case No.: 78762, Consultation Date: April 29, 1966. Full-term pregnancy, irregular contractions and spontaneous rupture of membranes for 3 days, fetal movement ceased for 1 day upon admission. Temperature 39.5°C. Emergency cesarean section performed on admission day. Post-op fasting, administered Penicillin, Streptomycin, Tetracycline. Fever persisted, started diarrhea, watery stools 4-5 times/day. Culture positive for Staphylococcus aureus. Diagnosed as Full-term pregnancy transverse lie dead fetus, intrauterine infection, secondary pseudomembranous enterocolitis. Symptoms at that time: 4 days post-op, fever without chills, flushed malar area, dry mouth without desire to drink, decent appetite, stools 4 times/day pasty, no abdominal pain, short yellow urine, lochia not finished, scant amount, tongue body slightly red, coating white/slippery, pulse wiry/rapid. Syndrome differentiation: Severe injury to Yin-Blood, toxic heat not exhausted, failure to separate clear/turbid, leading to diarrhea. Treatment method: Nourish Yin and tonify Blood, clear Heat and detoxify, separate clear from turbid. Prescription: Sheng Di Huang 15g, Xuan Shen 12g, Dendrobium Stem (Shi Hu) 12g, Angelica Sinensis Root (Dang Gui) 9g, Artemisia Annua Herb (Qing Hao) 15g, Moutan Cortex (Dan Pi) 12g, Yin Hua 30g, Forsythia Fruit (Lian Qiao) 15g, Dandelion (Gong Ying) 18g, Patrinia Rhizome (Baijiang Cao) 18g, Chi Shao 12g, Wine-processed Scutellaria Root (Jiu Qin) 9g, Gardenia Fruit (Zhi Zi) 6g, Plantago Seed (Che Qian Zi, wrapped) 12g, Tetrapanax Pith (Tong Cao) 6g. 2 doses/day, divided into 4 servings. May 3: Temp normal, appetite improved, but feels body heat, thirsty for drinks, occasional sweating, left lower abdominal pain refusing pressure, stool once/day thick, urine slightly yellow, urethral burning sensation, tongue pale red, coating yellow-brown. Yin-Blood consumed, interior heat still strong. Continue nourishing Yin, clearing Heat, detoxifying, assisting separation. Modified with Shu Di, Dang Gui, Bai Shao, Zi Hua Di Ding (Di Ding), Pseudostellaria Root (Tai Zi Shen), Trichosanthes Root (Hua Fen), Peach Kernel (Tao Ren), Bupleurum (Chai Hu), Groundsel Root (Di Gu Pi), Turtle Carapace (Bie Jia), Black Schizonepeta Spike (Hei Jing Jie), Frankincense and Myrrh (Ru Mo). May 14: Lochia finished, wound pus reduced. May 29: General condition good, discharged cured. (Chief Physician Xi Peiling, compiled by Gao Yimin: Experience in TCM Syndrome Differentiation and Treatment of Pseudomembranous Enterocolitis, Chinese Medicine Journal, 3:12, 1980)
Case 8: Gao XX, Male, 51 years old, Case No.: 72872, Consultation Date: July 31, 1965. Admitted for severe anemia investigation. High fever (40°C) starting July 8, diarrhea >40 times/day, accompanied by shock. Suspected toxic bacillary dysentery. Treated with Nitrofurazone, Berberine, Tetracycline. Stool frequency increased. Smear showed Gram-positive cocci, culture Staphylococcus aureus, pathogenicity test positive. Diagnosed as secondary pseudomembranous enterocolitis. Enema with E. coli liquid, oral Erythromycin, astringents ineffective. July 13 consultation: Patient listless, lethargic, temp 38.3°C, cold extremities, yellow-green bile-like watery stool flowing out of anus, anorexia, nausea, bilateral foot edema, curled tongue and contracted scrotum, pale tongue, no coating, pulse faint almost imperceptible. Syndrome differentiation: Spleen/Kidney exhaustion, Yang deficiency about to collapse. Treatment method: Warm and tonify Spleen/Kidney, restore Yang and secure collapse. Prescription: Dang Shen 9g, Poria (Fu Ling) 15g, Stir-fried Atractylodes Rhizome (Chao Bai Zhu) 9g, Nutmeg (Rou Dou Kou) 6g, Evodia Fruit (Wu Zhu Yu) 6g, Official Cinnamon (Guan Gui) 4.5g, Fu Pian 3g, Pao Jiang 3g, Stir-fried Kudzu Root (Wei Ge Gen) 4.5g. July 14: Nurse reported medication started 8 PM last night, stool turned yellow at 11 PM with chunky feces, total 8 times at night. Condition significantly improved today, temp 36.6°C, appetite increased, stool 5-6 times/day yellow loose. Continued same prescription until July 19. Temp normal, stool formed, lab tests normal, pseudomembranous enterocolitis cured, continued treating primary disease. August 15 basically recovered and discharged. (Chief Physician Xi Peiling, compiled by Gao Yimin: Experience in TCM Syndrome Differentiation and Treatment of Pseudomembranous Enterocolitis, Chinese Medicine Journal, 3:12, 1980) [Commentary] Diarrhea refers to increased frequency of defecation with loose or watery stools. It is mostly caused by external pathogens, food retention, emotional factors, Spleen/Stomach deficiency, or Kidney Yang exhaustion. Spleen deficiency with Dampness excess is a key factor in pathogenesis.
Case 1 syndrome belongs to Spleen/Stomach deficiency with internal Damp-Heat. Although the course is long and healthy Qi is depleted, Damp-Heat is not cleared. How can one close the door and leave the thief inside? With parasitic disease lurking internally, "treating obstruction with unblocking methods" (Tong Yin Yong Tong) is the best strategy. Method uses clearing Heat and draining Dampness, guiding out stagnation and killing parasites. Once pathogens are removed, healthy Qi is secured. Brayera Semen (Yadanzi) is added to the formula for its efficacy in detoxification and parasite elimination.
Case 2 results from Yang constrained by Yin unable to circulate, causing abdominal pain and diarrhea. Si Ni San (Frigid Extremities Powder) cured this. This formula originates from Shanghan Lun: "Shaoyin disease, frigid extremities, if there is cough, palpitations, difficulty urinating, abdominal pain, or diarrhea with rectal heaviness, Si Ni San governs." Si Ni San syndrome focuses on frigid extremities. This case suffered from abdominal pain and diarrhea, feeling cold air penetrating after naps, indicating Yang constrained seeking unblocking. This formula harmonizes exterior/interior, unblocks Yang Qi allowing penetration. Added Xie Bai to vent Qi stagnation, Fu Zi to warm Yang and tonify deficiency, Haipiaoxiao treats peri-umbilical pain (Ben Cao Bie Lu). Carefully grasping the pathogenesis yields immediate results.
Case 3 syndrome belongs to Spleen deficiency with Dampness excess. Treatment primarily warms/nourishes Middle Jiao. Mr. Qin points out that physicians must not use bitter-cold herbs merely due to a red tongue, preventing further injury to Spleen Yang leading to sinking.
Case 4 syndrome belongs to Spleen Dampness and Kidney deficiency, accompanied by Lung/Stomach disharmony and Damp-Heat attacking upward. Both root and branch manifestations exist. Tonifying Spleen and Kidney is the root treatment, while branch treatment varies with symptoms. Root treatment runs throughout.
Case 5 had diarrhea several times. Physicians "fought repeatedly despite defeats." After careful thought, Mr. Zhu realized it was a sign of True Yang about to collapse. Thus, he boldly prescribed Si Ni and Li Zhong category formulas, adding agents to assist Yang securing Yin, tonifying Qi and nourishing Blood. Cured. This case showed a black tongue coating. Black coating is a critical Shanghan sign, but differentiation is needed. If black coating is rough/spiny, pulse hidden or solid/powerful, it is Yang syndrome suitable for purging. Here, black coating is at tongue root, seemingly floating/moist yet actually dry/dead. This is Yin syndrome. Purging is strictly contraindicated. Must recognize this, do not miss pathogenesis.
Case 6 is Wugeng Diarrhea (Morning Diarrhea). Used Sanwei Zhixie San (Shan Yao, He Zi Rou, Shi Liu Pi) to tonify Spleen/Stomach, astringe Intestines and secure collapse. Added Rou Dou Kou to warm Middle and assist Yang, Rou Gui to supplement Fire and assist Yang. Powder form also effective.
Cases 7 and 8 are both pseudomembranous enterocolitis, caused by intestinal flora imbalance due to extensive broad-spectrum antibiotic use, leading to diarrhea. Condition is severe.
Case 7 syndrome belongs to severe Yin-Blood injury, toxic heat not exhausted, failure to separate clear/turbid causing diarrhea. Treatment uses nourishing Yin/Blood, clearing Heat/detoxifying. Separating clear/turbid method is essential.
Case 8 syndrome belongs to Spleen/Kidney exhaustion, Yang deficiency about to collapse. Compared to Case 7 above, treatment focuses on warming/tonifying Spleen/Kidney, restoring Yang and securing collapse. However, prescription still emphasizes separating clear/turbid. Facing "crisis" without fear, syndrome differentiation and treatment match perfectly.
(32) Dysentery