例三徐ｘｘ、男，30岁，初诊日期：1971年4月25日。头痛偏左已一年，发作时痛甚剧(脑部检查未发现异常），兼有重压感。血压有时偏高。平时多用脑力，夜寐较短，病久不愈，此次连续作痛，已有月余(服西药可暂时缓解）。舌质红，苔薄黄，脉弦。辨证：肝阳扰动，络有宿瘀。治法：平肝潜阳，活血通络。方药：天麻4．5克石决明30克钩藤15克赤白芍各9克蔓荆子12克桑叶9克菊花9克桃仁9克全蝎粉1．5克(吞服，另装胶囊）7剂。头痛剧烈时，另吞羚羊角粉0．9克。5月2日
(二诊）：头痛大减，全蝎改用1．5克，加北沙参15克，共服14剂。5月16日
(三诊）：头痛已少发作，痛时亦较轻微，但精神较差，饮食如常，睡眠有时不安，舌质红，脉弦。肝阳渐平，气阴未复，再与清养气阴，平肝潜阳之法，以防复发。北沙参12克赤白芍9克石决明12克钩藤12克麦冬9克菊花9克桃仁9克鸡血藤12克夜交藤30克为了防止发作，嘱于停药后常服菊花、麦冬、北沙参各9克，煎汤饮之，以巩固疗效。
(《黄文东医案》）
例四周ｘｘ，女，45岁。头部冷痛10余年，终年戴皮帽，还需以帛裹之，寒冬尤甚，四肢不温，间见足肿，夜间尿多。爰因产后感受风寒，当时失治，尔后虽常服药，终难获愈。舌淡苔白，脉安无力。辨证：产后气血虚弱，风寒入髓海所致。治法：温阳散寒，补益气血。方药：黄芪18克当归12克肉桂6克附片15克天麻10克藁本6克荷叶15克上方服15剂后，头部冷痛已好转，数年皮帽裹帛已除，诸证悉减，寒凝已散，气血未复，仍宜益气养血，方药如下：黄芪15克白术10克升麻10克柴胡10克晒党15克当归10克陈皮6克炙草5克川芎6克北辛3克连服10剂而获痊愈。
(《湖南省老中医医案选》廖仲颐医案）
例五×××夫人，41岁。印尼人。婚后已20年，初次妊娠为左侧宫外孕，手术治疗后，始终未能受孕，经检查诊为手术后左侧输卵管阻塞，月经来潮时左侧头面作痛，两乳发胀，此等症状已有多年，经治不愈。平时白带不多，舌正常，脉弦细有力。尺脉带涩象，眼睑下晦暗。辨证：肝郁气滞夹热。治法：调肝解郁。方药：丹栀逍遥散加减。柴胡3克白芍6克茯苓6克甘草1．5克当归6克白术4．5克生姜3克丹皮4．5克黑栀子6克青皮3克薄荷1克陈皮3克半夏4．5克萸连3克香附6克服上方6剂，此后经期无头痛，经血亦畅，量中等，除左脉稍滑大外，无其它异常，嘱照此方，于下次来潮前再服3剂，以巩固后效。
(《岳美中医案集》）
例六黄ｘｘ，男，45岁。先患太阳头痛，渐至全部头痛，凡祛风散寒温补之剂，无不尝试，历医十余人，经时五、六岁，病仍依然，遂置不问近来上午头觉隐隐微痛，午后则痛如锥如刺，经脉突起，热敷可少安，然无如之何。……诊脉弦涩，而证状则如昔。本病午后痛剧，晚尤剧热敷则略减，是血虚挟瘀之证。盖头为诸阳之之会，贼风久客，瘀塞经隧，与气相搏，遏而为痛，即古人病久入络之义。所以前投温补凉泻之药，皆非所宜，而祛陈寒疏经络实为要着。初用金匮桂苓丸以治之、数剂亦不效。乃思及王清任善于治血者，方多奇中，因改用通窍活血汤：川芎4．5克、桃仁、红花各6克赤芍9克老葱六根生姜3片大枣3枚麝香0.15克
(后冲）加归尾、牛膝各9克连服3剂，头痛顿减，是瘀血化行，已著微效：前方更进2剂，痛遂全止。如是知风邪之首犯头经，若不及时宣发，则经络瘀闭，又非疏解温通所能已，故今以祛瘀疏络获效。然病无定型，治当随证而变，若拘拘一格，陋矣！
(赵守真《治验回忆录》）
【评按】头为诸阳之会，五脏六腑之清阳和气血等精华，均上会于此。六淫外袭上犯巅顶可致头痛。内伤诸疾或亦可致。本组类案均系以头痛为主证，且多以此为久苦者。
例一为阳阴头痛，阳明证头痛，其始在阙上，甚则满头皆痛。满头剧痛，其病多在于脑。此案观其证，身虽无热、但坐则满头痛甚，咳引腹痛拒按，脉虽微弱，但恶见火光，口中燥，即所谓阳明悍热之气上循入脑为害。方用承气辈一下而愈，则说明其病本在胃腑肠腔，曹氏辨证之细腻用方之胆识，颇堪临床借鉴。
例二证属肝阳头痛，兼见风阳化火，劫阴伤津，营血两燔，故先用羚角钩藤汤平熄风阳鸱张之势，继以三甲复脉、犀角地黄，以及大剂养阴之品，育阴潜镇、凉血化瘀。
例三系因烦劳过度而致肝阳上升，即《内经》所谓“阳气者，烦劳则张”，因其兼见血瘀，故于平肝潜阳之中加入活血化瘀之品，使方治更为熨贴。
例四为阳虚头痛，爰因产后感受风寒，由于产后气血虚弱，风寒直入髓海，当时失于治疗，日久寒凝血滞，阳气枝遏、以致头部冷痛，故于温阳散寒之中兼补气血，方能奏效，
例五证属肝郁气滞夹热，多年经治不愈，方用丹栀逍遥舒肝解郁，甚为合拍。
例六为血瘀头痛，证属血虚挟瘀，屡用温补凉泻皆非所宜，妙用通窍清血之品，则药到病除，颇堪令人玩味。
(四十三）胸痛
例一林ｘｘ，男，初诊日期：1976年2月13日。三年前即患心痛，经检查确诊为冠心病，合并高脂血症，现症心痛彻背，胸闷气短，头晕头昏，心累心跳，烦躁失眠，周身乏力，食少腰痛，膝以下肿，体态肥胖，脉细弱，两尺尤弱，舌体胖嫩，质红少苔。辨证：心阳不宣，心脉失养。治法：补心之气阴，安神镇静，兼顾其肾。方药：党参、柏子仁、炒枣仁、茯神、远志肉、天冬、生地、当归、元参各9克丹参12克五味子6克甘草3克
(段荣书整理：董德懋医疗经验琐谈，《中医杂志》、2：11，1981）
例三郑××，女，23岁。住院号：73／1820，初诊日期：1973年3月9日。昨日中午过食油荤，入夜上腹部剧烈疼痛，拒按，并向腰部放射，恶心欲吐，口干便秘，今起发热38℃，白细胞17100／立方毫米，中性82％，血淀粉酶1600单位，脉小弦，苔薄黄腻。湿热积滞，互阻中焦，延及胰腺，不通则痛，急拟清热解毒通腑法，方以大承气汤加减。生大黄9克(后下）元明粉9克(冲）枳实12克生山楂15克(红藤30克、败酱草30克，两味煎汤代水煎上药）服1剂腹痛减，2剂腹痛除，热退，化验检查均正常。
(《张伯臾医案》）
【评按】腹痛系指以腹部疼痛为主的证候。引起腹痛的原因很多，涉及的科别不一，本组所载三例，均属内科范畴，例一反复发作腹痛三年，曾剖腹探查无阳性发现，诊断为血紫质病。发作时腹痛如绞，证属血瘀腹痛，初用活血法瘀为法，又因气血不足，继以泰山盘石饮为主方，取其于气血双补之中又能补肾。病之本乃属先天不足，肾为先天之本，补肾实为治本之法。例二腹痛感凉，喜按喜温，脾阳不足，发热亦为脾胃阳气虚弱之象，泻后痛减，为阳虚寒凝气滞、肝木妨土之征。方用理中汤加味，培补脾胃元气，兼以开胃进食，以上两例西医诊断虽同，而证候有别，治法同中有异。所同者均需补气血，不同者例一偏于补肾，例二偏于补脾。盖肾为先天之本，脾为后天之本，先天济后天，后天养先天。故前贤有“补脾不如补肾”与“补肾不如补脾”之争，实当根据具体病情而定。例三确诊为急性胰腺炎，类似中医的“胃心痛”。从六经辨证则属少阳阳明合病，即大柴胡汤证。经过实践，精选药味，药少而力专，效如桴应。
(四十六）胁痛
例一马××，男，70岁。脘胀胁痛，左侧较甚，微觉发热，吸气时及饮食后胁痛更甚，脉沉滞。辨证：气滞血凝作痛。治法：活血理气。方药：归须15克红花3克赤白芍各9克没药6克丹皮6克炮甲珠4．5克元胡4．5克郁金3克枳壳3克黄芩4．5克云苓9克天麦冬各15克朴花2．4克二诊：已不发热，胁痛腹胀均减轻，仍觉口干。前方去炮甲珠、黄芩，加花粉15克。三诊：诸症均减，前方去丹皮、赤白芍改白芍12克。
(时振声整理：时逸人医案，《江苏中医》11：11，1965）
例二王××9女，42岁。患慢性肝炎3年，胸胁痛，经常卧床休息，吃高营养食物，半年来身体渐胖，头晕胸闷，胸胁疼痛加剧，食欲好，大使秘结，身倦不愿活动。检查：体质肥胖，肝大肋下四横指，质软，化验肝功能正常。腹腔镜肝活检：肝细胞脂肪浸润，诊为脂肪肝。脉弦滑。舌质淡红，苔黄腻。辨证：肝郁气滞，痰湿阻络。治法：舒肝理气，祛痰通络。方药：丹参15克青皮12克栀子、枳实、郁金、乳香、没药、五灵脂、三棱、沉香各9克甘草6克二诊：连服5剂，胸胁疼痛减轻，脉音如前。仍依前方治疗、加礞石、大黄、皂刺、丹皮、减栀子、没药、沉香、丹参。又服5剂，每日溏便3～4次，便中有油腥物，胁痛大减、胸闷消失，脉沉缓。舌质淡，苔薄黄。是瘀浊下行，气血畅通之象。方药：钩藤；丹参各15克礞石、皂刺、三棱、莪术、郁金：乳香、“五灵脂个南星各9克、甘草6克连服5剂，症状消失；肝肋缘下二横指，质软；仍以前方配成丸药，又服一个月，肝肋缘下一横指、体童较前咸20）市斤。肝功能化验正常。
(《邢锡波医案选》）
例三陈ｘｘ，女，34岁。1960年8月因纳减乏力，肝痛、肝大，肝功能异常诊为慢性肝炎。经西药治疗有好转，1963年1月开始加用中药，症见头晕目眩，神疲乏力，两胁胀痛，午后低热，口燥咽于，舌苔根黄腻，前半薄，质红带紫。脉象细数。辨证：肝邪久羁，瘀凝气滞，营阴耗伤。治法：养阴柔肝，调气活血。方药：太子参18克麦冬9克生鳖甲18克生地黄12克生白芍12克、当归9克枸杞子12克黑山栀12克、制香附9克制甘草4．5克以上方加减，持续服用80余剂，至3月底、复查肝功能正常，症状消失，观察二年，肝功能均在正常范围。
(潘澄廉：传染性肝炎辨证和治疗体会，《新医药杂志》1：13，1973）
例四肖××，男，46岁，门诊号：1163初诊日期：1977年1月29日。患者肝痛、腹胀已四年余，四年前因恶心厌油胃胀，谷丙转氨酶680单位，麝浊20单位，开始中西药治疗，以后肝功能反复波动。至1977年1月15日做肝吸虫皮试(＋），复查谷丙转氨酶570单位，麝浊20单位，白蛋白3．34克％，球蛋白4.32克％／脾大肋下1.5厘米。1月25日十二指肠胆汁引流：三管全部胆汁总量70毫升中，共有肝吸虫卵1535个。追询1963年曾在北京ｘｘ饭馆多次吃过生鱼片。西医诊断，①肝吸虫病；②慢性肝炎(稳定型）。当时症见：肝区疼，胃疼，腹胀，尿黄，大便干稀不调，肝掌，鼻衄，腰疼，舌质稍红，苔白中心有裂。脉象沉滑辨证：脾虚湿困，胃失和降，热蕴血分。治法：健脾和胃，凉血利湿。方药：党参15克沙苍白术、木香、旋复花
(包）、生储石各9克木瓜、冬瓜皮、茵陈各12克赤白芍、生地炭、小蓟、泽兰各15克草寇6克另：乌鸡白凤丸，每午服一丸。明矾30克、鸦胆子15克(去皮），研粉，装一号胶囊，每次饭后服一粒(每粒约含鸦胆子183毫克，明矾365毫克），日服三次。上方及丸药常服，胶囊粉剂间断5天。4月25日住某医院，继服上方汤剂、丸剂、胶囊粉剂。4月29日复查胆汁引流：肝吸虫卵共15个。谷丙转氨酶206单位，麝浊11单位，麝絮(卅），白蛋白3．23克％，球蛋白2．76克％。5月11日再诊，前方加百部9克，大枣10枚；丸剂、胶囊粉剂同前，又服十天。5月23日复查胆汁引流：肝吸虫空泡变形虫卵共22个／100毫升胆汁。肝功能全部正常，继服胶囊粉剂，10天以后复查胆汁引流：变形肝吸虫卵18个／40毫升胆汁。1978年3月追访，曾二次胆汁引流未见虫卵，肝功能全部正常。
(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）
【评按】胁痛系指一侧或双侧胁肋疼痛为主的证候。主要与肝胆疾病有关。多因肝郁气滞、肝郁血滞、肝阴不足等所致。西医所谓慢性肝病而致胁痛，大致属于上述病理状况。
例一证属气滞血凝作痛。患者脘胀胁痛，左侧为甚，乃肝气郁结，血行不畅，瘀阻经络，着而不行以致疼痛。治用活血理气法，梢佐养阴之品而获效。
例二西医诊断为肝炎后肝脂肪性变(脂肪肝）。肝郁气滞则胁肩，脾受肝制，运化失职，过食厚味则湿聚生痰，痰血凝聚，以致胁下痞块，故用舒肝理气、祛痰通络之法，因其体肥脉滑，故用涤荡湿痰，活血破瘀峻剂，如礞石、胆星、大黄、皂刺、三棱、莪术等。体弱者不宜用。
例三为慢性肝炎，两胁肋痛，午后低热，肝功能异常。证属肝邪久羁，营阴耗仿。虽同有胁痛，证情与例二迥然不同。故宜养阴柔肝，调气活血为法，以一贯煎为主方加减，效果尚好。
[Background Information]
Book: Compilation of Verified Cases by Famous Modern Doctors Chapter: Main Text (25/53) Category: Medical Discussion
[Original Text to be Processed]
Case 3 Xu XX, Male, 30 years old, First visit date: April 25, 1971. Left-sided headache has persisted for one year; during attacks, the pain is severe (brain examination showed no abnormalities), accompanied by a heavy pressing sensation. Blood pressure is sometimes elevated. He usually engages in mental work, has short night sleep, and the disease has not healed for a long time. This time, continuous pain has lasted for more than a month (Western medicine can temporarily relieve it). Tongue body red, coating thin yellow, pulse wiry. Syndrome differentiation: Liver Yang disturbing, collateral vessels contain old blood stasis. Treatment method: Calm Liver Yang, invigorate blood and unblock collaterals. Prescription: Tianma (Gastrodiae Rhizoma) 4.5g, Shijueming (Haliotidis Concha) 30g, Gouteng (Uncariae Ramulus cum Uncis) 15g, Chishao (Radix Paeoniae Rubra) and Baishao (Radix Paeoniae Alba) 9g each, Manjingzi (Vittaginis Fructus) 12g, Sangye (Mori Folium) 9g, Juhua (Chrysanthemi Flos) 9g, Taoren (Persicae Semen) 9g, Quanxie powder (Scorpio powder) 1.5g (swallowed, packed separately in capsules), total 7 doses. When headache is severe, swallow Lingyangjiao powder (Saiga Tataricae Cornu powder) 0.9g separately. May 2
(Second visit): Headache significantly reduced, Quanxie changed to 1.5g, added Beishashen (Glehniae Radix) 15g, total 14 doses taken. May 16
(Third visit): Headache attacks decreased, pain was also milder when occurring, but spirit was poor, diet normal, sleep sometimes restless, tongue body red, pulse wiry. Liver Yang gradually calmed, Qi and Yin not yet restored, again use methods to clear and nourish Qi and Yin, calm and subdue Liver Yang, to prevent recurrence. Beishashen 12g, Chishao and Baishao 9g, Shijueming 12g, Gouteng 12g, Maidong (Ophiopogonis Radix) 9g, Juhua 9g, Taoren 9g, Jixueteng (Spatholobi Caulis) 12g, Yejiaoteng (Polygoni Multiflori Caulis Praeparatus) 30g. To prevent recurrence, instructed to commonly take Juhua, Maidong, and Beishashen 9g each after stopping medication, decocted as soup to drink, to consolidate efficacy.
(From "Medical Cases of Huang Wendong")
Case 4 Zhou XX, Female, 45 years old. Cold pain in the head for over 10 years, wearing a fur hat all year round, needing to wrap it with cloth, especially severe in cold winter, four limbs not warm, occasionally foot swelling, frequent urination at night. Due to contracting wind-cold after childbirth, which was not treated at that time, although often taking medicine afterwards, it was difficult to cure eventually. Tongue pale, coating white, pulse deep and weak. Syndrome differentiation: Postpartum Qi and Blood deficiency, wind-cold invading the Marrow Sea. Treatment method: Warm Yang and disperse cold, tonify Qi and Blood. Prescription: Huangqi (Astragali Radix) 18g, Danggui (Angelicae Sinensis Radix) 12g, Rougui (Cinnamomi Cortex) 6g, Fupian (Aconiti Lateralis Radix Praeparata) 15g, Tianma 10g, Gaoben (Ligustici Wallichii Rhizoma) 6g, Heye (Nelumbinis Folium) 15g. After taking the above prescription for 15 doses, cold pain in the head improved, the habit of wearing fur hats and wrapping cloth for years was removed, all symptoms reduced, cold coagulation dissipated, Qi and Blood not yet restored, still suitable to benefit Qi and nourish Blood, prescription as follows: Huangqi 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Shengma (Cimicifugae Rhizoma) 10g, Chaihu (Bupleuri Radix) 10g, Dangshen (Codonopsis Radix) 15g, Danggui 10g, Chenpi (Citri Reticulatae Pericarpium) 6g, Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) 5g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 6g, Xixin (Asari Radix et Rhizoma) 3g. Taken continuously for 10 doses resulted in cure.
(From "Selected Medical Cases of Old Chinese Medicine Doctors in Hunan Province" - Case of Liao Zhongyi)
Case 5 Mrs. XXX, 41 years old. Indonesian. Married for 20 years, first pregnancy was left ectopic pregnancy, after surgical treatment, never able to conceive again, examined and diagnosed as left fallopian tube obstruction after surgery, left side of head and face hurts during menstruation, two breasts feel distended, these symptoms have existed for many years, treated without cure. Usually little leukorrhea, tongue normal, pulse wiry, fine and strong. Chi pulse carries choppy image, lower eyelids dark. Syndrome differentiation: Liver Qi stagnation with heat. Treatment method: Regulate Liver and resolve stagnation. Prescription: Danzhi Xiaoyao San modified. Chaihu 3g, Baishao 6g, Fuling (Poria) 6g, Gancao (Licorice Root) 1.5g, Danggui 6g, Baizhu 4.5g, Shengjiang (Zingiberis Rhizoma Recens) 3g, Danpi (Moutan Cortex) 4.5g, Heizhizi (Gardeniae Fructus Carbonized) 6g, Qingpi (Citri Reticulatae Pericarpium Viride) 3g, Bohe (Menthae Haplocalycis Herba) 1g, Chenpi 3g, Banxia (Pinelliae Rhizoma) 4.5g, Yulian (Coptidis Rhizoma prepared with Alumen) 3g, Xiangfu (Cyperi Rhizoma) 6g. Taking the above prescription for 6 doses, thereafter no headache during menstruation, menstrual blood also smooth, moderate amount, except left pulse slightly slippery and large, no other abnormalities, instructed to follow this prescription, take 3 more doses before next menstruation, to consolidate subsequent efficacy.
(From "Collected Medical Cases of Yue Mei")
Case 6 Huang XX, Male, 45 years old. Initially suffered from Taiyang headache (referring to occipital pain, due to pathogen affecting Taiyang channel), gradually spreading to whole head pain, tried all kinds of wind-dispersing, cold-dispelling, and warming-tonifying agents, consulted over ten doctors, lasting five or six years, disease remained unchanged, so abandoned inquiry. Recently, morning head feels faintly slightly painful, afternoon pain like awning or stabbing, meridians protrude, hot compress can provide slight relief, but helpless. ... Pulse wiry and choppy, symptoms same as before. This disease pain is severe in afternoon, even worse at night, slightly relieved by hot compress, indicating Blood deficiency with blood stasis. The head is the meeting place of all Yang channels, lingering evil wind causes blood stasis blocking the meridians, fighting with Qi, obstructing and causing pain, which is the ancient meaning of disease entering collaterals after a long time. Therefore, previous administration of warming-tonifying and cooling-purging medicines were not suitable, while removing old cold and unblocking meridians is indeed the key point. Initially used Jingui Guiling Wan to treat it, several doses also ineffective. Then thought of Wang Qingren who was good at treating blood, his prescriptions often hit the mark, so changed to Tongqiao Huoxue Tang: Chuanxiong 4.5g, Taoren, Honghua (Carthami Flos) 6g each, Chishao 9g, Laocong (Allii Fistulosi Bulbus) six roots, Shengjiang 3 slices, Dazao (Jujubae Fructus) 3 pieces, Shexiang (Moschus) 0.15g (added later, dissolved), add Guiwei (Angelicae Sinensis Radix tail) and Niuxi (Achyranthis Bidentatae Radix) 9g each. Taken continuously for 3 doses, headache suddenly reduced, blood stasis transformed and moved, showing slight effect; advance previous prescription by 2 more doses, pain completely stopped. Thus knowing that if wind pathogen initially attacking head meridians is not released in time, meridians become blocked by stasis, which cannot be resolved by dispersing, resolving, warming, and unblocking alone, so now obtaining efficacy by removing stasis and unblocking collaterals. However, diseases have no fixed pattern, treatment should change according to syndrome, if rigidly sticking to one style, it is vulgar!
(From Zhao Shouzhen's "Records of My Clinical Experience")
[Commentary] The head is the meeting place of all Yang channels, the clear Yang of the five Zang and six Fu organs, and the essence of Qi and Blood all converge here. External invasion of the Six Excesses attacking the crown can cause headache. Internal injuries can also cause it. This group of cases all present with headache as the main symptom, and most suffer from it for a long time.
Case 1 is Yangming headache. Yangming syndrome headache starts at Que Shang (between eyebrows), extending to whole head pain when severe. Severe whole head pain usually indicates pathology in the brain. Observing the symptoms of this case, although body has no fever, sitting makes full head pain severe, coughing draws abdominal pain and tenderness, pulse is weak, but dislikes seeing firelight, mouth is dry, which is what is called the fierce heat Qi of Yangming ascending into the brain causing harm. Using Chengqi category to purge once resulted in cure, indicating the root of the disease lies in the stomach and intestines. Cao's delicate syndrome differentiation and bold use of prescriptions are worthy of clinical reference.
Case 2 belongs to Liver Yang headache, accompanied by wind-Yang transforming into fire, consuming Yin and damaging fluids, burning Ying and Blood levels. Therefore, first use Lingjiao Gouteng Tang to calm and extinguish the rampant wind-Yang, followed by Sanjia Fumai Tang, Xijiao Dihuang Tang, and large doses of Yin-nourishing products, nurturing Yin and subduing, cooling blood and resolving stasis.
Case 3 is caused by excessive mental labor leading to rising Liver Yang, as stated in "Neijing": "When Yang Qi is subjected to excessive labor, it expands." Because it is accompanied by blood stasis, adding blood-invigorating and stasis-resolving products among calming Liver Yang and subduing makes the prescription more appropriate.
Case 4 is Yang deficiency headache, due to contracting wind-cold after childbirth. Due to postpartum Qi and Blood deficiency, wind-cold directly enters the Marrow Sea, missed treatment at that time, long-term cold coagulates and blood stagnates, Yang Qi is constrained, resulting in cold pain in the head. Therefore, combining warming Yang and dispersing cold with tonifying Qi and Blood can achieve efficacy.
Case 5 belongs to Liver Qi stagnation with heat, untreated for many years, using Danzhi Xiaoyao Tang to soothe Liver and resolve stagnation is very appropriate.
Case 6 is blood stasis headache, belonging to Blood deficiency with stasis, repeated use of warming-tonifying and cooling-purging is not suitable, clever use of orifice-opening and blood-clearing products results in cure upon administration, quite worth pondering.
(43) Chest Pain
Case 1 Lin XX, Male, First visit date: February 13, 1976. Suffered heart pain three years ago, confirmed as coronary heart disease combined with hyperlipidemia through examination. Current symptoms: heart pain penetrating back, chest tightness and shortness of breath, dizziness, palpitations, irritability and insomnia, general fatigue, poor appetite and lower back pain, swelling below knees, obese physique, pulse fine and weak, Chi pulses especially weak, tongue body fat and tender, red body with little coating. Syndrome differentiation: Heart Yang not disseminated, Heart vessels lose nourishment. Treatment method: Tonify Heart Qi and Yin, calm mind and sedate, consider Kidney simultaneously. Prescription: Dangshen, Baiziren (Biota Seed), Chao Zaoren (Fried Sour Jujube Seed), Fushen (Poria with Hostwood), Yuanzhi (Polygalae Radix), Tiandong (Asparagi Radix), Shengdi (Rehmanniae Radix), Danggui, Yuanshen (Scrophulariae Radix) each 9g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 12g, Wuweizi (Schisandrae Fructus) 6g, Gancao 3g.
(Organized by Duan Rongshu: Brief Talk on Dong Demao's Medical Experience, "Chinese Journal of Traditional Chinese Medicine", 2:11, 1981)
Case 3 Zheng XX, Female, 23 years old. Hospital No.: 73/1820, First visit date: March 9, 1973. Ate too much oily meat at noon yesterday, severe upper abdominal pain at night, refusing pressure, radiating to waist, nausea wanting to vomit, dry mouth and constipation, fever started today 38°C, White Blood Cells 17100/cubic mm, Neutrophils 82%, Blood Amylase 1600 units, pulse small wiry, coating thin yellow greasy. Damp-heat accumulation and stagnation mutually obstructing Middle Jiao, extending to pancreas, blockage causes pain, urgently plan clearing heat and detoxifying and purging bowel method, prescription based on Dachengqi Tang modified. Shengdahuang (Rhei Radix et Rhizoma raw) 9g (added later), Yuanmingfen (Mirabilitum) 9g (dissolved), Zhishi (Aurantii Fructus Immaturus) 12g, ShengShanzha (Crataegi Fructus raw) 15g (Hongteng (Sargentodoxae Caulis) 30g, Baijiangcao (Patriniae Herba) 30g, decoct these two to replace water for decocting above medicine). Take 1 dose, abdominal pain reduces; 2 doses, abdominal pain removed, fever subsides, lab tests all normal.
(From "Medical Cases of Zhang Boyu")
[Commentary] Abdominal pain refers to syndromes mainly characterized by abdominal pain. There are many causes of abdominal pain, involving different departments. The three cases recorded in this group all belong to internal medicine. Case 1 had recurrent abdominal pain for three years, exploratory laparotomy found no positive findings, diagnosed as porphyria. During attacks, abdominal pain like twisting, syndrome belongs to blood stasis abdominal pain, initially used blood-invigorating method to remove stasis, but because of Qi and Blood deficiency, subsequently used Taishan Panshi Yin as main prescription, taking advantage of its ability to tonify both Qi and Blood and also tonify Kidney. The root of the disease belongs to congenital insufficiency, Kidney is the root of congenital constitution, tonifying Kidney is truly treating the root. Case 2 abdominal pain feels cold, likes pressure and warmth, Spleen Yang insufficient, fever is also a sign of Spleen and Stomach Yang Qi weakness, pain reduces after purging, indicating Yang deficiency cold coagulation Qi stagnation, Liver Wood offending Earth. Prescription uses Lizhong Tang modified to cultivate and supplement Spleen and Stomach primal Qi, and open appetite and promote eating. Although Western diagnoses of the above two cases are the same, syndromes are different, treatments have similarities and differences. What is common is needing to tonify Qi and Blood, what differs is Case 1 leans towards tonifying Kidney, Case 2 leans towards tonifying Spleen. Kidney is the root of congenital constitution, Spleen is the root of acquired constitution, congenital supports acquired, acquired nourishes congenital. Therefore, former sages had debates of "tonifying Spleen is better than tonifying Kidney" and "tonifying Kidney is better than tonifying Spleen", actually should be determined according to specific condition. Case 3 confirmed as acute pancreatitis, similar to TCM "Stomach Heart Pain". From Six Meridian syndrome differentiation, it belongs to Shaoyang-Yangming combined disease, i.e., Daichaihu Tang syndrome. Through practice, carefully selected medicinal ingredients, few drugs but potent, efficacy like striking a drum.
(46) Hypochondriac Pain
Case 1 Ma XX, Male, 70 years old. Epigastric distension and hypochondriac pain, left side more severe, slightly feeling fever, hypochondriac pain worse during inhalation and after eating, pulse deep and stagnant. Syndrome differentiation: Qi stagnation and blood coagulation causing pain. Treatment method: Invigorate blood and regulate Qi. Prescription: Guixu (Angelicae Sinensis Radix tail) 15g, Honghua 3g, Chishao and Baishao 9g each, Moyao (Myrrha) 6g, Danpi 6g, Paojiazhu (Phrynops Carapace processed) 4.5g, Yuanhu (Corydalis Rhizoma) 4.5g, Yujin (Curcumae Longae Radix) 3g, Zhiqiao (Aurantii Fructus) 3g, Huangqin (Scutellariae Radix) 4.5g, Yunling (Poria) 9g, Tianmaidong and Maidong each 15g, Puhua (Magnoliae Flos) 2.4g. Second visit: No longer fever, hypochondriac pain and abdominal distension both reduced, still feels dry mouth. Previous prescription remove Paojiazhu, Huangqin, add Huafen (Trichosanthis Radix) 15g. Third visit: All symptoms reduced, previous prescription remove Danpi, Chishao/Baishao change to Baishao 12g.
(Organized by Shi Zhensheng: Shi Yiren's Medical Cases, "Jiangsu Journal of Traditional Chinese Medicine" 11:11, 1965)
Case 2 Wang XX, Female, 42 years old. Suffered chronic hepatitis for 3 years, chest and hypochondriac pain, often bed rest, eat high-nutrition food, body gradually gained weight in half a year, dizziness and chest tightness, chest and hypochondriac pain intensified, good appetite, stool constipated, body tired unwilling to move. Examination: Obese physique, liver enlarged four finger-widths below rib, soft texture, liver function test normal. Laparoscopic liver biopsy: Hepatocyte fatty infiltration, diagnosed as fatty liver. Pulse wiry and slippery. Tongue body light red, coating yellow greasy. Syndrome differentiation: Liver Qi stagnation, Phlegm-Damp obstructing collaterals. Treatment method: Soothe Liver and regulate Qi, resolve Phlegm and unblock collaterals. Prescription: Danshen 15g, Qingpi 12g, Zhizi (Gardeniae Fructus), Zhishi, Yujin, Ruxiang (Frankincense), Moyao, Wulingzhi (Trogopterori Faeces), Sanleng (Sparganii Rhizoma), Chenxiang (Aquilariae Lignum Resinatum) each 9g, Gancao 6g. Second visit: Taken continuously for 5 doses, chest and hypochondriac pain reduced, pulse sound same as before. Still follow previous prescription treatment, add Mengshi (Natroaluminis Silicasulfas), Dahuang (Rhei Radix et Rhizoma), Zaoci (Gleditsiae Spina), Danpi, reduce Zhizi, Moyao, Chenxiang, Danshen. Take another 5 doses, daily loose stool 3-4 times, stool contains oily fishy matter, hypochondriac pain greatly reduced, chest tightness disappeared, pulse deep and slow. Tongue body pale, coating thin yellow. This is turbid stasis descending, Qi and Blood flowing smoothly. Prescription: Gouteng, Danshen each 15g, Mengshi, Zaoci, Sanleng, Ezhu (Curcumae Rhizoma), Yujin, Ruxiang, Wulingzhi, Nanting (Arisaematis Rhizoma Preparatum) each 9g, Gancao 6g. Taken continuously for 5 doses, symptoms disappeared; liver edge two finger-widths below rib, soft texture; still make pills from previous prescription, take another month, liver edge one finger-width below rib, body weight reduced 20 jin compared to before. Liver function test normal.
(From "Selected Medical Cases of Xing Xibo")
Case 3 Chen XX, Female, 34 years old. In August 1960, due to reduced appetite and fatigue, liver pain, hepatomegaly, abnormal liver function diagnosed as chronic hepatitis. Improved with Western medicine treatment, started adding Chinese medicine in January 1963, symptoms seen: dizziness and vertigo, mental fatigue and weakness, bilateral hypochondriac distending pain, low-grade fever in afternoon, dry mouth and throat, tongue coating root yellow greasy, front half thin, body red with purple tint. Pulse fine and rapid. Syndrome differentiation: Liver pathogen lingering for long, stasis congealing and Qi stagnation, Ying Yin consumed and damaged. Treatment method: Nourish Yin and soften Liver, regulate Qi and invigorate Blood. Prescription: Taizishen (Codonopsis Radix) 18g, Maidong 9g, ShengBiejia (Testudinis Carapax et Plastrum raw) 18g, ShengDihuang (Rehmanniae Radix raw) 12g, ShengBaishao (Radix Paeoniae Alba raw) 12g, Danggui 9g, Gouqizi (Lycii Fructus) 12g, Heishanzhi (Gardeniae Fructus carbonized) 12g, ZhiXiangfu (Cyperi Rhizoma prepared) 9g, ZhiGancao (Licorice Root prepared) 4.5g. Above prescription modified, taken continuously for over 80 doses, by end of March, re-examination liver function normal, symptoms disappeared, observed for two years, liver function always within normal range.
(Pan Chenglian: Understanding of Syndrome Differentiation and Treatment of Infectious Hepatitis, "New Medicine Magazine" 1:13, 1973)
Case 4 Xiao XX, Male, 46 years old, Outpatient No.: 1163 First visit date: January 29, 1977. Patient liver pain, abdominal distension for over four years, four years ago due to nausea, aversion to oil, gastric distension, ALT 680 units, TTT 20 units, started Chinese and Western medicine treatment, thereafter liver function fluctuated repeatedly. By January 15, 1977, liver fluke skin test (+), re-examination ALT 570 units, TTT 20 units, Albumin 3.34 g%, Globulin 4.32 g%/splenomegaly 1.5 cm below rib. January 25 duodenal bile drainage: Total 70 ml bile from three tubes contained total 1535 liver fluke eggs. Traced back, ate raw fish slices multiple times at Beijing XX restaurant in 1963. Western diagnosis, ① Liver fluke disease; ② Chronic hepatitis (stable type). At that time symptoms seen: Liver area pain, stomach pain, abdominal distension, yellow urine, irregular stool consistency, liver palms, epistaxis, lower back pain, tongue body slightly red, coating white center cracked. Pulse deep and slippery. Syndrome differentiation: Spleen deficiency damp encumbrance, Stomach losing harmonious descent, heat accumulating in Blood level. Treatment method: Strengthen Spleen and harmonize Stomach, cool blood and promote dampness. Prescription: Dangshen 15g, Shachaibaizhu (Atractylodis Rhizoma), Muxiang (Aucklandiae Radix), Xinfuluo (Inulae Flos wrapped), ShengShizhu (Ostreae Concha raw) each 9g, Mugua (Chaenomelis Fructus), Dongguapi (Benincasae Exocarpium), Yichen (Artemisiae Scopariae Herba) each 12g, Chishao, Shengditann (Rehmanniae Radix carbonized), Xiaoji (Herba Siegesbeckiae), Zelun (Leonuri Herba) each 15g, Caokou (Amomi Fructus Rotundus) 6g. Additionally: Wuji Baifeng Wan (Black Chicken White Phoenix Pill), take one pill every noon. Mingfan (Alumen) 30g, Yadanzi (Brucea Fructus) 15g (peeled), grind to powder, pack into No. 1 capsule, take one capsule after each meal (each capsule contains approx. Yadanzi 183mg, Mingfan 365mg), take three times daily. Above prescription and pills commonly taken, capsule powder intermittently for 5 days. April 25 admitted to certain hospital, continue taking above decoction, pills, capsule powder. April 29 re-examination bile drainage: liver fluke eggs total 15. ALT 206 units, TTT 11 units, TCO (flaky precipitate) (+++), Albumin 3.23 g%, Globulin 2.76 g%. May 11 second visit, previous prescription add Baibu (Stemonae Radix) 9g, Dazao 10 pieces; pills, capsule powder same as before, take another ten days. May 23 re-examination bile drainage: liver fluke vacuole amoeba eggs total 22/100ml bile. Liver function all normal, continue taking capsule powder, re-examination bile drainage 10 days later: deformed liver fluke eggs 18/40ml bile. March 1978 follow-up, twice bile drainage saw no eggs, liver function all normal.
(Mainly treated by Guan Youbo, organized by Qian Ying: One Insight into Clinical Application of Brucea, "New Medicine Magazine" 7:23, 1978)
[Commentary] Hypochondriac pain refers to syndromes mainly characterized by pain on one or both sides of the hypochondrium. Mainly related to liver and gallbladder diseases. Mostly caused by Liver Qi stagnation, Liver Blood stasis, Liver Yin deficiency, etc. Western medicine's chronic liver disease causing hypochondriac pain roughly belongs to the above pathological conditions.
Case 1 syndrome belongs to Qi stagnation and blood coagulation causing pain. Patient epigastric distension and hypochondriac pain, left side more severe, is Liver Qi stagnation, blood flow unsmooth, stasis blocking collaterals, adhering and not moving causing pain. Treatment uses blood-invigorating and Qi-regulating method, slightly assisting with Yin-nourishing products and obtained efficacy.
Case 2 Western diagnosis is post-hepatitis hepatic steatosis (fatty liver). Liver Qi stagnation causes hypochondriac pain, Spleen controlled by Liver, transportation failure, overeating rich flavors causes dampness gathering into Phlegm, Phlegm and Blood congealing, resulting in hypochondriac mass, therefore use soothing Liver and regulating Qi, resolving Phlegm and unblocking collaterals method, because body fat and pulse slippery, therefore use harsh agents to wash away damp-Phlegm, invigorate blood and break stasis, such as Mengshi, Danxing (Arisaematis Cum Bile), Dahuang, Zaoci, Sanleng, Ezhu, etc. Not suitable for weak bodies.
Case 3 is chronic hepatitis, bilateral hypochondriac pain, low-grade fever in afternoon, abnormal liver function. Syndrome belongs to Liver pathogen lingering for long, Ying Yin consumed and damaged. Although both have hypochondriac pain, condition is completely different from Case 2. Therefore suitable to nourish Yin and soften Liver, regulate Qi and invigorate Blood as method, using Yiguan Jian as main prescription modified, effect is still good.