（二诊）：服前方七剂后，大部分皮损显著变薄，略见脱屑，痒减。继以前方加红花9克以活血消风，眼药十剂后，病情略见起伏，此后断续治疗约两个月，在前方中加熟地12克何首乌9克，以养血润燥，消风止痒，局部外搽苦参酒而治愈。苦参酒：苦参310克百部90克野菊花90克凤眼草90克樟脑125克将前四种药装入大口瓶内，加入75％酒精（或白酒）5000毫升，泡七天后去渣，加樟脑溶化后备用。（《朱仁康临床经验集》）
【评按】此案西医诊断为泛发性神经性皮炎，辨证为血热内盛，风胜化燥。治以凉血清热、消风止痒为大法，立法切合此证的病因，病理变化。所用皮癣汤加减为朱氏经验方，局部外搽苦参酒，有灭菌止痒之效。此酒外用尚能治脂溢性皮炎、皮肤搔痒症、单纯糠疹等病。
（三十三）白疤风
例一张××，男，31岁。初诊日期81970年5月31日。周身泛发皮疹鳞屑已三年。近二月来又加重。三年来全身遍见红斑和银白色鳞屑，曾在外地医院治疗，未见疗效。二月来皮疹明显增多，瘙痒难忍。检查：头皮、手臂、双下肢播散性大片皮损，呈对称性分布，浸润肥厚，基底暗红色，覆盖鳞屑。在躯干、前臂等处，可见大批点滴状红色皮疹，上有轻度鳞屑。脉弦滑，舌质紫红，苔薄白。辨证：风热郁久，化火伤营，复受外风（中医诊断：白疕风，西医诊断：银屑病）。治法：凉血清热，活血祛风。方药：生地30克生槐花30克当归15克知母9克生石膏30克紫草30克桃仁9克红花9克荆芥9克防一4ol一风6克蝉衣6克水煎服。6月5日
（二诊）：服5剂后，部分皮损已明显消退，痒感亦显著减轻，未见新起皮疹。嘱服前方10剂。1970年8月随访：未见复发。（《朱仁康临床经验集》）
例二包××，女，52岁。住院号：29458。寻常型银屑病，十八年来反复发作，初冬重、夏轻，以后皮损夏季也不消退，曾经多方治疗，效果均不明显。于1972年2月住院，全身遍发红斑，先服凉血清热解毒之剂。生地18克赤芍12克丹皮9克草河车15克蒲公英30克山豆根9克紫草12克仙灵脾、补骨脂、菝葜各30克生甘草9克三周后皮损变平，瘙痒减轻。苔薄、舌体胖，脉濡。前方去草河车、山豆根，加补肝肾之肉苁蓉、菟丝子、白蒺藜各15克。又服一月：皮损几乎全退，仅留少数损害。苔薄舌红，脉濡细。拟养阴清热，调补肝肾兼顾。生地30克肥玉竹、小胡麻各12克菝葜30克紫草9克蛇舌草30克补骨脂12克肉苁蓉9克锁阳12克加服外科蟾酥丸5粒，每日之次，以巩固疔效。《顾伯华《外科经验选》）
【评按】白疕风或称松皮癣，西医名为银屑病，亦即牛皮癣。中医认为系由风邪客于皮肤，血燥不能营养所致。其症皮损状如松皮，或形如疹疥，搔起白皮，缠绵难愈。
例一风热郁久、化火伤营，近二月来加重，为复受外风新邪之征。患者症现血热瘀滞，治疗除重用凉血清热，兼用活血化瘀之药外，以其有外风，故佐用疏风清热之品，审因察病，至为精细，立方颇周到熨贴。例二病已十八年，求诊时因全身遍发红斑，血热毒盛是其主要矛盾，故先治以凉血清热解毒，此为基本治法，因患者兼有肝肾不足，复诊时兼补肝肾，后又参入养阴清热法。案中方药加减变化，缜密合拍。蟾酥丸（《外科正宗》方）原为治疗疔痈名方，此处用以配合治顽癣，亦属经验用方。
（三十四）白癜风王××，女，23岁。门诊号：759784。初诊日期1975年7月12日。患者额上一处白斑已3～4年，近6个月来逐渐发展，向两面颊漫延扩大，目前已有掌大一片。其他无不适。苔薄，脉平。豨莶草9克苍耳草9克浮萍草9克补骨脂12克川芎9克红花9克白芷4．5克桂枝3克赤芍12克8月11日
（二诊）：服药1月，无显效，白癜风四周色稍紫，苔薄舌红，脉平。久病入络，加重活血法瘀，祛风通络之品。当归尾9克赤芍15克川芎9克丹皮9克桂枝9克乌梢蛇9克白藓皮9克地肤子9至豨莶草9克10月6日
（三诊）：药后1月，中间已有色素岛出现，目前已有70％色素沉着。前方续服。1月后痊愈。（顾伯华《外科经验选》
【评按】白癜风又名白驳凤。由风湿搏于肌肤，久而不去，以致血气失和所致，临床以局限住皮肤脱色变白为特征。治疗当以法风湿，调和气血营卫为主，久病者参入通络祛瘀之品。此病除内服方药外，再以25％补骨脂酊外涂，则能增强疗效。
（三十五）扁平苔癣张某、女，30岁。初诊日期：1972年8月4日。患者从1971年4月开始，全身骤然出现紫红色斑片，呈蚕豆大小，以两下肢为多，痊痒较甚，部分尚起水疱或血疤，日益增多。曾用氯喹及激素治疗，药后明显减轻，但停药三天后又加重，故来我院门诊治疗。皮肤检查：全身可见散在之紫红色斑片，如蚕豆大小，以两下肢为多。口腔颊粘膜和舌边亦见紫色损害，病理检查诊断为扁平苔癣。脉弦细，苔薄白。辨证：风湿热郁于肌腠，气滞血瘀（西医诊断：急性泛发性扁平苔癣）。治法：先以法风、除湿、清热。方药：乌蛇9克蝉衣6克羌活9克荆芥9克防风9克白芷6克马尾连9克黄芩9克银花9克连翘9克生甘草6克嘱服7剂。9月8日
（二诊）：药后皮损曾见趋退，停药后又有少起，而感瘙痒，脉苔同前。仍宗前法加减。前方去连翘，加全蝎6克，桃仁9克，活血去风。服5剂。1974年8月10日
（三诊）：称药后两年未犯，近半月来，全身又起散在之类似损害。仍嘱服上方6剂。8月24日
（四诊）：药后减轻，皮损已少，痒已不甚，继服前方6剂。1975年4月追踪来院复查：前证迄今来犯。（《朱仁康临床经验集》）
【评按】扁平苔癣属于“乌癞风”或“紫癜风”范畴，多由风湿热毒郁于肌腠，气滞血瘀而成。故此案治以祛风、除湿、清热，其中祛风药除荆、防、羌活等药外，更以乌蛇、蝉衣搜风化毒为主药；二诊时并揉入活血之品。方药的配伍加减，斟酌合宜，是以效验较为巩固。
（三十六）玫瑰糠疹梅××，男，40岁。初诊日期81972年10月26日。患者一周前发现躯干两胁部起两块环形皮疹，色红，有薄鳞屑，痒感明显，两天以后发现前胸后背、四肢密布同样皮损。经××医院诊为“玫瑰糠疹”。用葡萄糖酸钙静脉注射，内服扑尔敏、维生素等药，效果不明显，遂来我院门诊。检查：躯干、四肢皮损呈环形、椭圆形皮疹，色红浸润，表面有微薄细鳞屑，胸背部皮损长轴与肋骨平行。脉弦滑，苔薄白稍腻。辨证：血热，外受风毒湿邪。治法：清热凉血，解毒除湿。方药：白茅根30克干生地30克大青叶15克粉丹皮12克尾连6Q克黄芩9克紫丹参15克白藓皮30克猪苓9克泽泻9克车前子（包）12克10月30日：服上方四剂后，皮损红色明显消退，痒感减轻。于上方中加地肤子30克，继服5剂。11月6日：大部分皮损消退，呈现淡红色半环状皮损，中心消退，边缘稍有浸润，痒感已不明显，脉缓，苔薄白。改用养阴凉血，除湿止痒为法：干生地30克粉丹皮12克白藓皮30克地肤子30克紫丹参30克苦参9克花粉15克二冬12克生苡米30克车前子（包）12克泽泻9克全当归15克11月13日：上方连续服6剂，皮损全部消退，呈现色素沉着，临床痊愈。（《赵炳南临床经验集》）
【评按】玫瑰糠疹多由风热血燥闭塞腠理所致。此案辨证为血热，外受风毒湿邪。赵氏治以清热凉血，解毒除湿为主，方治的重点明确，药物的用量、配伍均有特色。
（三十七）瓜藤缠李某，男，36岁。初诊日期：1963年7月10H。患者6个月前，发现两胫部有赤豆大小的肿块4～5个，因胀痛而行走不便。曾诊为“结节性红斑”。就诊时，患者两目红丝攀晴，且有作胀之感。两足胫跗及足背、足底均有紫褐色肿块7～8个，如黄豆大小，轻按头形尖而硬，重按则感热痛，履地重滞，胀痛兼作，午后足跗肿胀。脉弦数，舌苔根部浊腻。辨证：湿热下注，气血凝滞。治法：清热利湿，理气活血。方药：赤白芍各4．5克桃苡仁各9克杜红花2．4克丹皮0克紫丹参4．5克黄柏4．5克川牛膝9克制苍术4．5克忍冬藤12克板蓝根9克丝瓜络9克碧玉散12克（包煎）3剂。7月13日
（二诊）：足部肿块热痛略减，唯大便稀薄，泛吐酸水。上方加陈皮4．5克再服5剂。7月20日
（三诊）：两足跗红斑肿块尚有续起，且感胀痛。泛吐酸水已减。乃瘀湿不化也。仍宗前意出入。赤芍4．5克白芍4．5克桃仁9克苡仁9克杜红花2．4至丹皮6至紫丹参4．5克黄柏4．5克川牛膝9克制苍术4．5克陈皮4。5克忍冬藤12克板蓝根9至丝瓜络9克6剂。7月27日～8月3日
（四～五诊）：迭进清营化瘀利湿之剂，两足跗、胫红斑肿块日见轻减，入暮足肿亦退，唯舌苔根腻、化而未尽。再予原方继服10剂。8月10日
（六诊）：两足腔跗红斑肿块均已消散，仅留褐色斑痕，按之亦无痛楚，鼻准及两颧焮赤亦见轻减。脉弦数较缓，舌质红，苔根部略腻。赤芍4．5克白芍4．5克桃仁6克苡仁6克川牛膝9克焦白术6克丹皮6克杜红花2。4克紫丹参4．5克忍冬藤6克丝瓜络6克黄柏4．5克板蓝根12克服5剂后，继以丸药作善后调治。三妙丸90克，日服两次，每次4．5克，用温开水送服。（《上海老中医经验选编》张赞臣医案，郑昌雄等整理）
【评按】瓜藤缠为湿毒流注之绕腔而发者，与西医所称之“结节性红斑”相类似。此
例辨证属湿热下注，气血凝滞。治以清热利湿、行气活血法瘀，方中黄柏、苍术、牛膝、苡仁、碧玉散、板篮根等清热除湿以治其因；赤芍、桃仁、红花、丹参等活血法癖以治其果。若局部溃破，可配合外刷“龙马丹”（《外科真诠》方，地龙粪、炒黄丹、赤克脂各9克，马齿克、伏龙肝、陈石灰各6克，生黄柏15克，扫盆粉3——JO7】一克，上四六1．2克。先研细未，用桐油调刷）。
（三十八）硬皮病邱××，女，52岁。住院号：29161。住院日期：1972克12月30日至1973年5月17日。患者子1965年秋，发现两手指端发冷、发白、发绀，伴有关节酸痛和全身不适。1966年秋，症状加重，前臂皮肤浮肿、紧张、按之无凹陷，皮肤呈淡褐色，有搔痒针刺感，额颊也发生“浮肿”。某医院皮肤科诊断为“硬皮病”1967春，皮损扩展到胸背、腹部，且不出汗。1970年起，每逢冬季，手指尖发生溃疡，以食、中指为主，并且足趾也发白、发冷、发紫，偶有胸闷。1972年春，两大腿发生褐色肿胀之皮损。检查：血压140／80毫米汞柱，呼吸76次／分。面部、颈、额之皮肤硬肿，间杂有色素减退斑点。两手臂硬肿，以前臂到腕部显著。手指肿胀发亮，食、中指尖有黄豆大小之凹陷溃疡。胸背、两胁、腋下皮肤绷紧，颈，腹两大腿硬肿，四肢关节活动不利。实验室检查无特殊。初诊：硬皮病6～7年，皮损以四肢末端、额、颈、胸、背为主，不出汗，吞咽顺利，呼吸尚可，腰脊关节活动不利，伴有酸痛。苔薄舌淡，脉沉细。辨证：肾阳不足，卫外不固，风寒之邪，阻于肌肤，络脉痹塞不通，营卫不和。治法：温经散寒，补肾阳，和营卫，开腠理。方药：净麻黄9克大熟地18克川桂枝9克杜红花9克全当归9克仙灵脾15克肉苁蓉15克锁阳15克补骨脂15克菝葜30克生甘草9克外用：川楝子60克花椒30克食盐炒后布包，乘热时熨。二诊：眼药1月，病情稳定，考虑经期发病，与冲任不调有关。前方加鹿角粉30克（分吞）。复方当归注射液（4毫升）肌肉注射，日一次。三诊：服中药2个月，自觉肌肤发热，额部出汗较多，胸、腋下、手背皮肤较前柔软，身体汗出，以药后为明显。肢端动脉痉挛现象好转，唯关节仍酸痛，乃血脉失养，风邪仍留之故。仿“治风先治血，血行风自灭”之意。前方去锁阳、蒙英。加丹参15克，炙地龙9克，加用低分子右旋醣酐500毫升，静脉滴注，每周2次。又一周，手指溃疡愈合，各种症状均好转，出院门诊随访。
（顾伯华《外科经验选》）
【评按】硬皮病是胶元病中的一种，西医属于内科病范畴。此例发病以肾阳不足，卫外不固为重要内因，复有风寒阻于肌肤，络脉闭塞不通，营卫不和诸证。故用鹿角、苁蓉、灵脾、锁阳温补肾阳，丹参、当归、红花、地龙活血通脉；麻、桂温散风寒。方药主治明确，照顾全面。并配合低分子右旋醣酐以增加血流量，改善末梢循环，在一定程度上体现了中西医结合的优越性。
（三十九）红斑性狼疮
(Second Visit): After taking the previous prescription for seven doses, most skin lesions significantly thinned, with slight desquamation and reduced itching. Continue with the previous prescription plus Honghua (Carthamus tinctorius) 9g to invigorate blood and dispel wind. After ten doses of eye medicine (note: likely a typo in original text for 'prescription' or specific topical, context implies oral/continued treatment), the condition fluctuated slightly. Subsequent intermittent treatment lasted about two months. Shudi (Rehmanniae Radix Preparata) 12g and Heshouwu (Polygoni Multiflori Radix) 9g were added to the previous prescription to nourish blood, moisten dryness, dispel wind, and stop itching. Local application of Kushen Wine resulted in cure. Preparation of Kushen Wine: Kushen (Sophorae Flavescentis Radix) 310g, Baibu (Stemonae Radix) 90g, Yejuhua (Chrysanthemi Indici Flos) 90g, Fengyancao (Euphorbiae Humifusae Herba) 90g. Place the first four herbs in a large-mouthed bottle, add 5000ml of 75% alcohol (or white liquor), soak for seven days, remove dregs, add Zhaonao (Borneolum Syntheticum) until dissolved, and set aside. (From *Clinical Experience Collection of Zhu Renkang*)
[Commentary]: This case was diagnosed by Western medicine as generalized neurodermatitis. In Traditional Chinese Medicine (TCM), it is differentiated as excessive internal blood heat with wind dominance transforming into dryness. The treatment principle focuses on cooling blood, clearing heat, dispelling wind, and stopping itching. This approach aligns with the etiology and pathological changes of this syndrome. The modified Pixuan Tang (Skin Plaque Decoction) used is Dr. Zhu's empirical formula. Local application of Kushen Wine has effects of sterilization and anti-pruritus. This wine can also be used externally to treat seborrheic dermatitis, pruritus cutis, and pityriasis alba.
(Thirty-three) Bai Pi Feng (Psoriasis)
Case 1: Zhang XX, Male, 31 years old. First visit date: May 31, 1970. Generalized rash with scales for three years. Aggravated over the past two months. For three years, red spots and silver-white scales have been seen all over the body. Treatment at hospitals outside the locality yielded no effect. Over the past two months, rashes increased significantly, with unbearable itching. Examination: Large scattered skin lesions on the scalp, arms, and both lower limbs, symmetrically distributed, infiltrated and thickened, with a dark red base covered by scales. On the trunk and forearms, numerous pinpoint red rashes with mild scaling were visible. Pulse was wiry and slippery; tongue body was purple-red with thin white coating. Differentiation: Wind-heat stagnating for a long time, transforming into fire and injuring the Ying (Nutritive) level, compounded by external wind (TCM Diagnosis: Bai Pi Feng; Western Diagnosis: Psoriasis). Therapeutic Method: Cool blood, clear heat, invigorate blood, and dispel wind. Prescription: Shengdi (Rehmanniae Radix) 30g, Sheng Huaihua (Sophorae Flos) 30g, Danggui (Angelicae Sinensis Radix) 15g, Zhi Mu (Anemarrhenae Rhizoma) 9g, Sheng Shigao (Gypsum Fibrosum) 30g, Zicao (Lithospermi Radix) 30g, Tao Ren (Persicae Semen) 9g, Honghua (Carthami Flos) 9g, Jingjie (Schizonepetae Spica) 9g, Fangfeng (Saposhnikoviae Radix) 6g, Chan Yi (Bombyx Batryticatus) 6g. Decoct in water and take orally. June 5.
(Second Visit): After five doses, some lesions had significantly receded, itching was markedly reduced, and no new rashes appeared. Advised to take the previous prescription for 10 more doses. Follow-up in August 1970: No recurrence. (From *Clinical Experience Collection of Zhu Renkang*)
Case 2: Bao XX, Female, 52 years old. Hospital No.: 29458. Vulgar psoriasis, recurring for 18 years. Severe in early winter, mild in summer; later, lesions persisted even in summer. Multiple treatments elsewhere were ineffective. Admitted to hospital in February 1972. Generalized red spots. Initially treated with formulas to cool blood, clear heat, and resolve toxicity. Shengdi (Rehmanniae Radix) 18g, Chishao (Paeoniae Radix Rubra) 12g, Mudanpi (Moutan Cortex) 9g, Caoheche (Arisaematis Cum Bile) 15g, Gongying (Taraxaci Herba) 30g, Shandougen (Sophorae Tonkinensis Radix) 9g, Zicao (Lithospermi Radix) 12g, Xianlingpi (Epimedii Folium), Buguzhi (Psoraleae Fructus), Babao (Smilacis Glabrae Rhizoma) each 30g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 9g. After three weeks, lesions flattened, itching decreased. Coating thin, tongue body fat, pulse soggy. Remove Caoheche and Shandougen from the previous prescription; add Rourongrong (Cynomorchii Herba), Tusizi (Cuscutae Semen), and Baijili (Tribuli Fructus) to tonify Liver and Kidney, each 15g. Taken for another month: Lesions almost completely resolved, leaving only a few minor damages. Coating thin, tongue red, pulse soggy and fine. Plan: Nourish Yin, clear heat, while regulating and tonifying Liver and Kidney. Shengdi (Rehmanniae Radix) 30g, Fei Yuzhu (Polygonati Odorati Rhizoma), Xiaohuma (Sesami Fructum) each 12g, Babao (Smilacis Glabrae Rhizoma) 30g, Zicao (Lithospermi Radix) 9g, Sheyeshe (Hedyotis Diffusae Herba) 30g, Buguzhi (Psoraleae Fructus) 12g, Rourongrong (Cynomorchii Herba) 9g, Suoyang (Cynomorchii Herba) 12g. Also take Waike Chansu Wan (External Surgery Toad Venom Pills) 5 pills, once daily, to consolidate efficacy. (From *Gu Bohua's Selected External Medicine Experiences*)
[Commentary]: Bai Pi Feng, also known as Song Pi Xuan (Pine Bark Tinea), is called Psoriasis in Western medicine, also referred to as Neurodermatitis (Niu Pi Xuan). TCM believes it is caused by Wind pathogen lodging in the skin, and Blood dryness failing to nourish. Symptoms include lesions resembling pine bark or papules/scales, scratching off white skin, lingering and difficult to cure.
Case 1: Wind-heat stagnating for a long time, transforming into fire and injuring the Ying level, aggravated in the last two months, indicating re-exposure to new external Wind pathogens. The patient presents with Blood Heat and Stasis. Treatment emphasizes heavy use of blood-cooling and heat-clearing agents, combined with blood-invigorating and stasis-resolving drugs. Due to the presence of external Wind,疏风 (dispersing wind) and heat-clearing herbs are added. Etiology analysis is precise, and the prescription is comprehensive and appropriate. Case 2: Disease duration 18 years. At consultation, generalized red spots indicated that Blood Heat and Toxicity were the main contradiction. Thus, initial treatment focused on cooling blood, clearing heat, and resolving toxicity, which is the fundamental method. Since the patient also had Liver and Kidney deficiency, Liver and Kidney tonification was added at the second visit, followed by Yin-nourishing and heat-clearing methods. The modifications in the prescriptions were meticulous and harmonious. Chansu Wan (from *Waike Zhengzong*) is originally a famous formula for treating carbuncles and sores; here it is used empirically in combination to treat stubborn tinea.
(Thirty-four) Bai Dian Feng (Vitiligo) Wang XX, Female, 23 years old. Outpatient No.: 759784. First visit date: July 12, 1975. A white patch on the forehead had existed for 3-4 years, gradually spreading to both cheeks over the past 6 months, currently palm-sized. No other discomfort. Coating thin, pulse flat. Xixiancao (Siegesbeckiae Herba) 9g, Can'ercao (Xanthii Herba) 9g, Fupingcao (Lemnae Herba) 9g, Buguzhi (Psoraleae Fructus) 12g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 9g, Honghua (Carthami Flos) 9g, Baizhi (Angelicae Dahuricae Radix) 4.5g, Guizhi (Cinnamomi Ramulus) 3g, Chishao (Paeoniae Radix Rubra) 12g. August 11.
(Second Visit): One month of medication showed no significant effect; the periphery of the vitiligo patches turned slightly purple. Coating thin, tongue red, pulse flat. Long-standing disease enters the collaterals; increase blood-invigorating and stasis-resolving, wind-dispelling and collateral-unblocking herbs. Dangguiwei (Angelicae Sinensis Radix Cauda) 9g, Chishao (Paeoniae Radix Rubra) 15g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 9g, Danpi (Moutan Cortex) 9g, Guizhi (Cinnamomi Ramulus) 9g, Wushaoshe (Zaocys) 9g, Baixianpi (Dictamni Cortex) 9g, Difuzi (Kochiae Fructus) 9g, Xixiancao (Siegesbeckiae Herba) 9g. October 6.
(Third Visit): One month after medication, pigment islands appeared in the center, with 70% pigmentation currently. Continue the previous prescription. Cured after one month. (From Gu Bohua's *Selected External Medicine Experiences*)
[Commentary]: Bai Dian Feng, also known as Bai Bo Feng, is caused by Wind-Dampness clashing with the skin for a long time, leading to disharmony of Qi and Blood. Clinically characterized by localized skin depigmentation. Treatment should focus on dispelling Wind-Dampness and harmonizing Qi, Blood, Ying, and Wei. For long-standing cases, collateral-unblocking and stasis-resolving herbs should be included. Besides internal medication, applying 25% Buguzhi Tincture externally can enhance efficacy.
(Thirty-five) Bian Ping Tai Xuan (Lichen Planus) Zhang XX, Female, 30 years old. First visit date: August 4, 1972. Starting April 1971, sudden appearance of purplish-red macules all over the body, bean-sized, mostly on lower limbs, severe itching, some forming blisters or blood crusts, increasing day by day. Previously treated with Chloroquine and hormones; symptoms improved significantly but worsened three days after stopping medication, hence seeking outpatient treatment. Skin examination: Scattered purplish-red macules, bean-sized, mostly on lower limbs. Purple lesions also seen on buccal mucosa and sides of tongue. Pathological diagnosis: Lichen Planus. Pulse wiry and fine, coating thin white. Differentiation: Wind-Damp-Heat stagnating in muscle interstices, Qi stagnation and Blood stasis (Western Diagnosis: Acute Generalized Lichen Planus). Therapeutic Method: First, dispel wind, drain dampness, and clear heat. Prescription: Wushe (Zaocys) 9g, Chan Yi (Bombyx Batryticatus) 6g, Qianghuo (Notopterygii Rhizoma et Radix) 9g, Jingjie (Schizonepetae Spica) 9g, Fangfeng (Saposhnikoviae Radix) 9g, Baizhi (Angelicae Dahuricae Radix) 6g, Maweilian (Isatidis Radix) 9g, Huangqin (Scutellariae Radix) 9g, Yinhua (Lonicerae Japonicae Flos) 9g, Lianqiao (Forsythiae Fructus) 9g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 6g. Take 7 doses. September 8.
(Second Visit): Lesions regressed after medication but some reappeared upon stopping, with itching. Pulse and coating same as before. Stick to previous method with modifications. Remove Lianqiao from previous prescription, add Quanxie (Scorpio) 6g, Tao Ren (Persicae Semen) 9g to invigorate blood and dispel wind. Take 5 doses. August 10, 1974.
(Third Visit): Reported no recurrence for two years after medication. In the past half-month, similar scattered lesions appeared all over the body. Advised to take the above prescription for 6 doses. August 24.
(Fourth Visit): Symptoms alleviated, fewer lesions, less itching. Continue previous prescription for 6 doses. Follow-up in April 1975: Previous condition has not recurred since then. (From *Clinical Experience Collection of Zhu Renkang*)
[Commentary]: Lichen Planus belongs to the categories of "Wu Lai Feng" or "Zidian Feng". It is mostly formed by Wind-Damp-Heat-Toxin stagnating in muscle interstices, causing Qi stagnation and Blood stasis. Therefore, this case treats by dispelling wind, draining dampness, and clearing heat. Among the wind-dispelling herbs, besides Jingjie, Fangfeng, and Qianghuo, Wushe and Chan Yi are used as main herbs to search out wind and resolve toxin. In the second visit, blood-invigorating herbs were incorporated. The compatibility and modification of the prescription were well-considered, resulting in relatively stable efficacy.
(Thirty-six) Meijiang Kangzhen (Pityriasis Rosea) Mei XX, Male, 40 years old. First visit date: October 26, 1972. Two ring-shaped rashes found on the trunk and flanks one week ago, red with thin scales, obvious itching. Two days later, similar lesions densely covered chest, back, and limbs. Diagnosed as "Pityriasis Rosea" at XX Hospital. Intravenous Calcium Gluconate, oral Clemastine, Vitamins, etc., had little effect, so came to our clinic. Examination: Ring-shaped and elliptical rashes on trunk and limbs, red and infiltrated, surface with fine scales. Long axis of chest/back lesions parallel to ribs. Pulse wiry and slippery, coating thin white slightly greasy. Differentiation: Blood Heat, external exposure to Wind-Toxin and Dampness. Therapeutic Method: Clear heat, cool blood, resolve toxicity, and drain dampness. Prescription: Baimaogen (Imperatae Rhizoma) 30g, Gan Shengdi (Rehmanniae Radix) 30g, Daqingye (Isatidis Folium) 15g, Fen Danpi (Moutan Cortex) 12g, Weilian (Isatidis Radix) 6g, Huangqin (Scutellariae Radix) 9g, Zi Danshen (Salviae Miltiorrhizae Radix) 15g, Baixianpi (Dictamni Cortex) 30g, Zhuling (Polyporus) 9g, Zexie (Alismatis Rhizoma) 9g, Cheqianzi (Plantaginis Semen, wrapped) 12g. October 30: After four doses of the above prescription, redness of lesions significantly faded, itching reduced. Add Difuzi (Kochiae Fructus) 30g to the prescription, continue for 5 doses. November 6: Most lesions receded, presenting as pale red semi-ring lesions, center receded, edges slightly infiltrated, itching not obvious, pulse slow, coating thin white. Change method to nourish Yin, cool blood, drain dampness, and stop itching: Gan Shengdi (Rehmanniae Radix) 30g, Fen Danpi (Moutan Cortex) 12g, Baixianpi (Dictamni Cortex) 30g, Difuzi (Kochiae Fructus) 30g, Zi Danshen (Salviae Miltiorrhizae Radix) 30g, Kushen (Sophorae Flavescentis Radix) 9g, Huafen (Trichosanthis Radix) 15g, Er Dong (Ophiopogonis Radix et Asparagi Radix) 12g, Sheng Yimi (Coicis Semen) 30g, Cheqianzi (Plantaginis Semen, wrapped) 12g, Zexie (Alismatis Rhizoma) 9g, Quan Danggui (Angelicae Sinensis Radix) 15g. November 13: Continuous intake of 6 doses of the above prescription, all lesions receded, pigmentation appeared, clinical cure. (From *Zhao Bingnan's Clinical Experience Collection*)
[Commentary]: Pityriasis Rosea is mostly caused by Wind-Blood Heat and Dryness blocking the muscle interstices. This case differentiates as Blood Heat with external Wind-Toxin and Dampness. Dr. Zhao treats primarily with clearing heat, cooling blood, resolving toxicity, and draining dampness. The focus of the treatment is clear, and the dosage and compatibility of herbs are distinctive.
(Thirty-seven) Gua Teng Chan (Erythema Nodosum) Li XX, Male, 36 years old. First visit date: July 10, 1963. Six months ago, discovered 4-5 mung-bean-sized lumps on both shins, causing walking difficulty due to distending pain. Previously diagnosed as "Erythema Nodosum". At consultation, patient had red veins in eyes with a distending sensation. Both shins, dorsum pedis, and sole had 7-8 purple-brown lumps, soybean-sized, hard and pointed when lightly pressed, hot and painful when heavily pressed, heavy gait, distending pain, afternoon swelling of ankles. Pulse wiry and rapid, root of tongue coating turbid and greasy. Differentiation: Damp-Heat pouring downward, Qi and Blood stagnation. Therapeutic Method: Clear heat, drain dampness, regulate Qi, and invigorate blood. Prescription: Chi Shao (Paeoniae Radix Rubra) and Bai Shao (Paeoniae Radix Alba) each 4.5g, Tao Ren (Persicae Semen) and Yiren (Coicis Semen) each 9g, Du Honghua (Carthami Flos) 2.4g, Danpi (Moutan Cortex) 6g, Zi Danshen (Salviae Miltiorrhizae Radix) 4.5g, Huangbo (Phellodendri Cortex) 4.5g, Chuan Niuxi (Achyranthis Bidentatae Radix) 9g, Zhi Cangzhu (Atractylodis Rhizoma) 4.5g, Rendongteng (Lonicerae Caulis) 12g, Banlangen (Isatidis Radix) 9g, Sigualuo (Luffae Fructus Retinervia) 9g, Biyu San (Jade Powder Mix) 12g (wrapped decoction). 3 doses. July 13.
(Second Visit): Heat and pain of foot lumps slightly reduced, only loose stools and acid regurgitation. Add Chenpi (Citri Reticulatae Pericarpium) 4.5g to the above prescription, take 5 more doses. July 20.
(Third Visit): Red spot lumps on ankles continued to appear, with distending pain. Acid regurgitation reduced. This is due to unresolved stasis and dampness. Still follow previous intent with modifications. Chishao (Paeoniae Radix Rubra) 4.5g, Baishao (Paeoniae Radix Alba) 4.5g, Tao Ren (Persicae Semen) 9g, Yiren (Coicis Semen) 9g, Du Honghua (Carthami Flos) 2.4g, Danpi (Moutan Cortex) 6g, Zi Danshen (Salviae Miltiorrhizae Radix) 4.5g, Huangbo (Phellodendri Cortex) 4.5g, Chuan Niuxi (Achyranthis Bidentatae Radix) 9g, Zhi Cangzhu (Atractylodis Rhizoma) 4.5g, Chenpi (Citri Reticulatae Pericarpium) 4.5g, Rendongteng (Lonicerae Caulis) 12g, Banlangen (Isatidis Radix) 9g, Sigualuo (Luffae Fructus Retinervia) 9g. 6 doses. July 27 - August 3.
(Fourth-Fifth Visits): Successive administration of formulas to clear Ying-level, resolve stasis, and drain dampness. Red spot lumps on ankles and shins gradually decreased, evening ankle swelling subsided, only root of tongue coating still greasy, not fully transformed. Continue original prescription for 10 more doses. August 10.
(Sixth Visit): Red spot lumps on ankles and shins dissipated, leaving only brown marks, no pain on pressure. Redness of nose tip and cheeks also reduced. Pulse wiry and rapid but slower than before, tongue red, root of coating slightly greasy. Chishao (Paeoniae Radix Rubra) 4.5g, Baishao (Paeoniae Radix Alba) 4.5g, Tao Ren (Persicae Semen) 6g, Yiren (Coicis Semen) 6g, Chuan Niuxi (Achyranthis Bidentatae Radix) 9g, Jiao Baizhu (Atractylodis Macrocephalae Rhizoma) 6g, Danpi (Moutan Cortex) 6g, Du Honghua (Carthami Flos) 2.4g, Zi Danshen (Salviae Miltiorrhizae Radix) 4.5g, Rendongteng (Lonicerae Caulis) 6g, Sigualuo (Luffae Fructus Retinervia) 6g, Huangbo (Phellodendri Cortex) 4.5g, Banlangen (Isatidis Radix) 12g. After 5 doses, continue with pills for convalescence. Sanmiao Wan (Three Marvels Pill) 90g, take twice daily, 4.5g each time, with warm boiled water. (From *Selected Experiences of Old Shanghai TCM Doctors*, Zhang Zancasen Cases, compiled by Zheng Changxiong et al.)
[Commentary]: Gua Teng Chan refers to Damp-Toxin flowing and accumulating around the legs, similar to Western "Erythema Nodosum". This case differentiates as Damp-Heat pouring downward and Qi-Blood stagnation. Treatment uses clearing heat, draining dampness, moving Qi, and invigorating blood to resolve stasis. Huangbo, Cangzhu, Niuxi, Yiren, Biyu San, and Banlangen in the formula clear heat and drain dampness to treat the cause; Chishao, Tao Ren, Honghua, and Danshen invigorate blood and resolve stasis to treat the result. If local ulceration occurs, apply "Longma Dan" externally (*Waike Zhenquan* formula: Dilong Fen (Earthworm excrement), Chao Huangdan (Calcined Lead Monoxide), Chishizhi (Halloysitum Rubrum) each 9g, Machixian (Portulacae Herba), Fulonggan (Dried Yellow Earth), Chen Shihui (Old Lime) each 6g, Sheng Huangbo (Phellodendri Cortex) 15g, Saopen Fen 3-10g, Shang Si Liu 1.2g. Grind into fine powder, mix with Tung Oil for brushing).
(Thirty-eight) Ying Pi Bing (Scleroderma) Qiu XX, Female, 52 years old. Hospital No.: 29161. Hospitalization dates: December 30, 1972 to May 17, 1973. Patient noticed cold, white, and cyanotic fingertips in Autumn 1965, accompanied by joint soreness and general malaise. Symptoms worsened in Autumn 1966: forearm skin edematous, tense, non-pitting, pale brown, with itching and needle-like sensations; forehead and cheeks also developed "swelling". Diagnosed as "Scleroderma" by Dermatology Dept of a certain hospital. In Spring 1967, lesions extended to chest, back, and abdomen, with anhidrosis. From 1970, every winter, ulcers occurred at fingertip tips, mainly index and middle fingers; toes also became white, cold, and purple, occasional chest tightness. In Spring 1972, brown swollen lesions appeared on both thighs. Examination: BP 140/80 mmHg, Respiration 76/min. Face, neck, forehead skin hard and swollen, interspersed with hypopigmented spots. Arms hard and swollen, prominent from forearm to wrist. Fingers swollen and shiny, index and middle fingertips had soybean-sized depressed ulcers. Chest, back, flanks, axillary skin tight; neck, abdomen, thighs hard and swollen; limb joints movement limited. Lab tests unremarkable. First Visit: Scleroderma for 6-7 years, lesions mainly at extremities, forehead, neck, chest, back; anhidrosis; swallowing smooth; respiration acceptable; lumbar/spinal joint movement limited with soreness. Coating thin, tongue pale, pulse deep and fine. Differentiation: Kidney Yang deficiency, failure of Defensive Wei to secure exterior, Cold-Wind pathogen obstructing skin, collaterals blocked, Ying-Wei disharmony. Therapeutic Method: Warm meridians, dissipate cold, tonify Kidney Yang, harmonize Ying-Wei, open muscle interstices. Prescription: Jing Mahuang (Ephedrae Herba) 9g, Da Shudi (Rehmanniae Radix Preparata) 18g, Chuan Guizhi (Cinnamomi Ramulus) 9g, Du Honghua (Carthami Flos) 9g, Quan Danggui (Angelicae Sinensis Radix) 9g, Xianlingpi (Epimedii Folium) 15g, Rourongrong (Cynomorchii Herba) 15g, Suoyang (Cynomorchii Herba) 15g, Buguzhi (Psoraleae Fructus) 15g, Babao (Smilacis Glabrae Rhizoma) 30g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 9g. External Use: Chuanlianzi (Meliae Fructus) 60g, Huajiao (Zanthoxyli Pericarpium) 30g, stir-fried with salt, wrapped in cloth, apply hot compress. Second Visit: Medication for 1 month, condition stable. Considering onset related to menstrual cycle, linked to Chong-Ren disharmony. Add Lujiaofen (Cornu Cervi Pantotrichum Powder) 30g (taken separately) to previous prescription. Compound Danggui Injection (4ml) IM, once daily. Third Visit: Taking Chinese medicine for 2 months, felt skin heating, more sweating on forehead, chest, axillae, dorsum of hands softer than before, whole body sweating, more pronounced after medication. Digital artery spasm improved, only joint soreness remained, due to vessel-blood lack of nourishment and lingering Wind pathogen. Following the principle "To treat Wind, first treat Blood; when Blood moves, Wind extinguishes itself". Remove Suoyang and Mengshi (Note: likely typo for another herb or mineral, possibly referring to a warming agent removed) from previous prescription. Add Danshen (Salviae Miltiorrhizae Radix) 15g, Zhi Dilong (Pheretima) 9g. Add Low Molecular Weight Dextran 500ml IV drip, twice weekly. One week later, finger ulcers healed, various symptoms improved, discharged for outpatient follow-up.
(From Gu Bohua's *Selected External Medicine Experiences*)
[Commentary]: Scleroderma is a type of collagen disease, categorized under Internal Medicine in Western medicine. The important internal factors for this case's onset are Kidney Yang deficiency and insecure Defensive Wei, compounded by Cold-Wind obstructing skin, blocked collaterals, and Ying-Wei disharmony. Therefore, Lujiao (Deer Horn), Rongrong (Cynomorchii), Lingpi (Epimedium), and Suoyang (Cynomorchii) are used to warm and tonify Kidney Yang; Danshen, Danggui, Honghua, and Dilong invigorate blood and unblock vessels; Mahuang and Guizhi warm and dissipate Cold-Wind. The prescription's indications are clear and comprehensive. Combined with Low Molecular Weight Dextran to increase blood flow and improve peripheral circulation, this reflects the superiority of Integrated Chinese and Western Medicine to some extent.
(Thirty-nine) Hongban Langchuang (Systemic Lupus Erythematosus)