例二王XX，男，21岁，未婚。患者一年前曾患胃痛，便血，经XX医院诊治，病情有所转好，但未彻底治愈。五天前突发胃病，大便下血甚多，经治便血未止，精神极度疲乏，前来本院治疗。现症：面色苍白，唇甲无华，神疲肢倦，萎靡不振，饮食不思，心悸，失眠，眩晕，夜晚口干，胃脘不甚痛，或只感有时微痛，大便黯黑如柏油，大便隐血试验为强阳性（++++），舌质淡，苔白燥，脉弦大而无力。辨证：便血多次，气血已虚，此次下血日久未止，气血耗损更甚，察其面白唇淡，神疲肢倦，眩晕，心悸等症，纯属一派虚象，脉大无力，大便色黑，乃气血虚失统摄之征，便血而胃痛不甚乃邪少虚多之候。冶法：益气补血，养血止血为法。方药；参芪四物汤加减。潞党参24克北绵芪15克生熟地各12克杭白芍9克当归身9克侧柏叶15克粉丹皮6克阿胶9克(冲服)地榆炭9克酸枣仁9克炙甘草4．5克二诊：服上药2剂，肉眼便血不显，大便颜色转黄，大便隐血试验㈩，精神转佳，诸症显减，处理拟按上服原方，继续服2剂(每日一剂)。三诊：20天之后患者来就诊，告知上次便血服二诊药后，诸症消失，便血巳止，因事回乡，停止服药。两天前因饮食关系，昨日复视大便色黑，稀溏不成形，但精神尚好，食欲稍减，口干不欲饮水，虚烦不眠，舌边红，舌苔白，左脉弦大，右脉呈弱，睽度脉症，拟血虚肝热，气虚脾寒之候，治以养血清热、益气温中为法，仿黄土汤加减。生地15克杭芍9克黑地榆9克潞党参15克炮姜炭3克阿胶9克(冲)伏龙肝12克(荷叶包煎)炙草3克每日1剂，连服3天。服药后，大便颜色转黄、成形，再服二剂，大便正常，便血消失，大便隐血试验(—)。嘱其注意日常生活、饮食调理，继续服药巩固疗效，以防复发。(肖熙；胃出血治案，《新中医》2；18，1978)[评按]凡在大便前后下血，或单纯下血统称便血。《金匮要略》有远血，近血之分。《临证要诀》云，“血清而色鲜者为肠风，浊而黯者为脏毒。”便血多因脾虚不摄或湿热下注大肠，损伤阴络而致。
例一病程已久，便血色鲜量多，正虚邪实，急以止血清热、补中益气，标本兼顾，扶正与祛邪兼施，血止后正气仍未复，继以调补之剂常服，较为稳妥。
例二证属远血，由于失血过多而气血双亏，治以气血双补，以期获气充摄血，养血止血之效，较为贴切。
(十四)蓄血证
例一某，女，年未二十，体颇羸弱，一日外出市物，骤受惊吓，归即发狂，逢人乱殴，力大无穷。……病已七八日矣，狂仍如故……经事二月未行。……脉沉紧，少腹似胀，……此蓄血证也，下之可愈。遂疏桃核承气汤与之。桃仁30克生军15克芒硝6克炙甘草6克桂枝6克枳实9克翌日问之，知服后下黑血甚多，狂止，体亦不疲，且能啜粥，见人羞避不出，乃书一善后之方与之，不复再诊。(曹颖甫《经方实验录》)
例二某，男。少腹胀痛，小便清长，且目不识物，论证确有蓄血，而心窃疑之。乃姑投以桃核承气汤，服后片时即下黑粪，而病证如故。再投二剂，加重其量，病又依然，心更惊奇，因思此证若非蓄血，服下药三剂，亦宜变成坏病，若果属是证，何以不见少差，此必药轻病重之故也。时门人章次公左侧，曰：与抵当丸何如?余曰：考其证，非轻剂可瘳，乃决以抵当汤下之。服后，黑粪挟宿血齐下。更进一剂，病者即能伏榻静卧，腹胀平，痛亦安。知药已中病，仍以前方减轻其量，计蝱虫6克，水蛭4．5克，桃仁15克川军15克。后复减至蝱虫、水蛭各1．2克，桃仁，川军各4．5克。由章次公调理而愈。后更询诸病者，盖尝因劳力负重，致血凝而结成蓄血证也。(曹颖甫《经方实验录》)[评按]蓄血证为《伤寒论》“太阳病不解，热结膀胱”所出现的证候。内热郁结下焦膀胱，热盛血瘀者，其人如狂。
例一即为蓄血发狂案，患者经事二月未行，脉沉紧，少腹似胀，因系受惊而发，故无外邪可知，‘但少腹急结者，乃可攻之，宜桃核承气汤”，《伤寒论》原方加枳实以消痞破结，助通之力，药后下黑血甚多，狂止，体亦不疲。虽用重剂破瘀攻下之晶，而体仍不疲者，乃病者体弱不甚，而药复适中病也，即使体气过虚，或药量过剂，以致下后疲惫者，慎勿惊惶失措，仍可用补剂以调之。
例二为男子蓄血。蓄血一证多见于女子，男子殊为罕见。因其少见而识证尤当精确，否则斟酌攻法，举棋难定，反能贻误病机。始用桃核承气汤而病重药轻，后以抵当汤下之乃瘥，述案详明，颇堪玩味。
例一钟X，惊悸成病，精神恍惚，耳聋，不能言语，上肢微颤，舌红少苔微干，脉沉细数。辨证：阴虚血热，扰及神明。治法：宁心镇肝，清热育阴。方药：朱茯神12克橘红4．5克竹茹9克玄参9克莲子心4。5克龙齿9克川贝母4．5克丹参9克郁金4．5克杭菊花9克夏枯草9克生铁落90克(煮水煎药)服后能言语，诸证悉减，再诊加远志、犀角，生地，去夏枯草，后以柔肝熄风镇惊之法，调理而愈。(《沈绍九医话》)
例二许XX，男，41岁，已婚，1957年5月20日入院。头晕打呃，胃脘不适已月余，1965年12月6日中午突然发热，头晕耳鸣，听力减退，胃脘部有跳动感，掣引头胸，气上冲咽喉，饭后尤甚，腹鸣漉漉有声，动则心悸加剧，眠食欠佳，疲乏无力。曾经神经系统检查无阳性结果，诊为神经官能症。舌苔黄厚腻，口有臭味。方药；桂枝15克白术12克泽泻9克代赭石12克茯苓12克甘草6克上方?剂后，心悸胃纳正常，后服理中丸，调养月余，恢复正常。(盛国荣，关于运用桂枝的体会，《广东中医》6：10，1958)
例三刘XX，女，28岁。1960年患感冒，医者用麻桂重剂发汗，汗后遂漏不止，神虚怯，触事怔忡不宁，常欲闭户独处，或时悲伤欲哭，惟饮食尚可，随因调养失宜，续见头痛晕，怔忡，健忘，失眠诸证。诊为神经官能症。曾经治疗，久病不愈，就诊时，面如蒙尘，头晕难举，两目昏蒙(一目原有星翳)，怔忡耳鸣，梦寐不安，口苦，腕闷，时欲呕恶，脉弦滑，苔浊而腻，情绪不乐，言出泪下。辨证：浊痰入扰，痰浊不去，清阳不升。治法：舒郁降痰。方药：温胆汤加味。京半夏9克茯苓9克枳实、郁金、竹茹各6克胆南星、陈皮各4．5克甘草3克建菖2．4克服十余剂，头晕痛减轻，苔稍退，仍觉嘈杂怔忡不宁，烦热不寐，脉仍弦滑有力，仍用前方加丹皮4，5克，白芍9克，炒枣仁12克，再服七剂，饮食睡眠正常，苔已退，脉较前和缓，惟早起眩晕，触事易惊，恐邪去正虚，神虚舍空，余痰仍有入扰之机，仍与温胆汤加丹参12克，远志4．5克、龙眼肉5枚、炒枣仁12克，连服——月，病遂痊愈。(欧阳锜：治疗神经官能症的体会，《浙江中医杂志》5：11，1964)[评按]惊悸，怔仲，系指自觉心动不安，心搏数疾的病证，常兼见惊恐慌乱、不能自主等症。二者尚有程度轻重之别，惊悸多由外因引起，如突受惊吓，或恼怒而发，一般证势较轻，全身情况良好；怔忡多由内因而致，外无所惊而心中儋儋，稍劳即发，证势稍重，全身情况也较差。惊悸日久可以发展为怔忡。临床以此病为苦者颇多。但又以西医所称之神经官能症更为常见，属于心血管病症者，也占有一定的比例。
例一惊悸为病，上肢微颤，属情志之疾，心无所主，肝风欲动，舌红少苔微干，脉细数，内热伤阴之故，治以宁心镇肝，清热育阴，因其神情恍惚，恐痰热内闭，略加橘红、竹茹，川贝母、郁金等祛痰开透之晶，以防患于未然。
例二证属心阳不振、水饮上逆，故见气上冲、腹鸣漉漉，动则心悸加重等症。方用苓桂术甘汤加味，振奋心阳、益气行水镇逆，药味少而治效专。
例三属怔忡范围，因过汗伤及心阴，故见神怯怔忡不宁，又因调治失宜，而过用补气养血，反助纣为虐。病虽源于损而非心脾两虚之候，实乃痰浊为患，浊痰不去，清阳不升则难速愈，故以温胆汤加味，舒郁降痰，待痰去浊清，症现神虚舍空之象，续用调补心脾之剂，以固其本。
(十六)不寐
例一田XX，男，成年，初诊日期：1958年4月17日。水火不济，引动肝阳上亢，失眠多梦，头痛偏左，法当滋水济火，平肝潜阳。大生地12克天麦冬各9克细石斛9克珍珠母18克(先煎)煅龙齿12克(先煎)辰茯神9克炒枣仁9克夜交藤12克夜合花6克炒杭菊9克嫩钩藤9克(后下)炒丹皮4．5克(胡建华等整理：程门雪院长学术渊源与成就，《中医杂志》10：19，1979)
例二徐X，女性。大病之后，孕经数月，血分自当不敷，肝家荣养较差，气痞愈后，仍存余蒂，脉象弦滑而细数，姑予滋柔和化以畅生机。生牡蛎(包先煎)12克旋覆花(包煎)9克淡苁蓉9克桑上寄生15克生赭石9克大麻仁9克生鳖甲(先煎)9克清半夏4．5克炒枳壳实各2．4克芡实米(盐水炒)9克盐知柏各9克莲心(朱拌)6克首乌藤18克乌药6克藕30克据来函云“服15剂，头晕减，心下悸、失眠俱转轻”，是以改拟膏方调理。处方按原方量，加两倍，增入焦枣仁6克，炒远志18克、血琥珀15克，浓煎炼蜜收膏，每早晚各服一匙，约9克许，白开水化服。(孔嗣伯整理：孔伯华医案，《中医杂志》8：547，1956)
例三沈X，女，56岁，初诊日期：1965年7月18日。失眠经久不瘥，已逾五载。轰热上升，两目干涩，心悸不宁。脉虚弦，当以半夏秫米、黄连阿胶合温胆汤三方出入之。仙半夏6克(杵)北秫米12克<包)大生地12克杭白芍6克珍珠母30克(先煎)灵磁石24克(先煎)小川连1．5克藕粉炒阿胶9克朱茯苓12克炒竹茹6克小枳实3克橘皮4。5克柏子仁12克7月21日(二诊)，阳跷为病，胆失清宁，失眠经久不瘥。两目干涩，虚烦心悸，遇事惊慌，脉来虚弦。再以半夏秫米、黄连阿胶合温胆汤三方并治之。仙半夏6克(杵)北秫米12克(包)大生地12克杭白芍6克灵磁石24克(先煎)小川连1．5克藕粉炒阿胶9克朱茯苓12克炒竹茹6克小枳实3克橘皮4．5克泡远志4．5克炒枣仁12克(研)3剂。7月25日(三诊)；迭服半夏秫米、黄连阿胶合温胆汤三方之后，经久之失眠巳得安睡，心悸已宁，两目重涩，脉小弦，再循前治。仙半夏6克(杵)北秫米12克(包)大生地12克杭白芍6克珍珠母30克(先煎)灵磁石24克霜桑叶9克黑芝麻12克小川连1．5克藕粉炒阿胶9克炒竹茹6克小枳实3克橘皮4．5克泡远志4．5克炒枣仁12克(研)3剂。7月28日(四诊)：阳能入阴，得半夏秫米之交通阴阳，温胆之宁胆化痰，黄连阿胶之清心养血，故经久之失眠巳安然入睡，两目重涩巳瘥，脉小弦，再以前法治之。仙半夏6克(杵)北秫米12克(包)大生地12克杭白芍6克霜桑叶9克黑芝麻12克滁菊花9克拌炒女贞子9克小川连1，6克藕粉炒阿胶9克白茯苓12克炒竹茹6克小枳实3克橘皮4．5克泡远志4．5克炒枣仁12克(研)S剂。嗣后，仍以上述方意，再适当配苍龙齿，朱灯芯、柏子仁、合欢皮、血琥珀等，以加强养心安神作用，调治一月而收功。1975年3月随访，睡眠良好，十年来未复发。(《内科临证录》陈道隆医案)
例四XXX，男，40岁，初诊日期：1962年12月。失眠、多梦心悸，偏头痛，耳鸣，为时较久。常服用解痛片及巴比妥一类镇痛安眠药，但至今仍时时发作。胸腹胀闷，间或作痛，午后为甚。睡眠之中常有鼻阻塞，呼吸不利感。目瞀花，咽干。最感痛苦者，为大便不正常已久，坚实为多，溏泻较少，每日一、二次或二、三日一次。口臭，时有泛酸。小溲次频而滴沥不尽，时感疲倦软乏，要求冬令进补。经诊其舌苔微黄而厚，尤其于舌根部，脉细劲。辨证：胃有燥火，肺胃津伤。治法：降胃为主，甘凉濡润。方药：太子参60克麦冬90克北沙参90克杏仁(去皮尖)90克白芍60克金石斛90克玉竹60克茯神120克火麻仁60克焦六曲60克泽泻60克白扁豆60克知母60克乌玄参90克北秫米120克川贝母15克生甘草30克生地黄120克红枣90克阿胶60克龟板胶60克蜜500克，冰糖250克收膏。服上膏方后，大便十分舒畅，已能每日一次，头痛、失眠等症，均轻减若失。(何任：胃腑以通为用，《新中医》3：16，1979)
Background Information
Book Title: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (7/53)
Category: Medical Discussion
Case 2: Wang XX, Male, 21 years old, unmarried. The patient suffered from stomach pain and hematochezia (bleeding from the rectum) one year ago. After diagnosis and treatment at Hospital XX, the condition improved but was not completely cured. Five days ago, the stomach disease suddenly recurred with heavy bleeding in the stool. Despite treatment, the bleeding did not stop, and the patient experienced extreme mental fatigue, leading to a visit to our hospital. Current symptoms: Pale complexion, lips and nails lacking luster, mental fatigue and limb weakness, listlessness, loss of appetite, palpitations (restless heart), insomnia, dizziness, dry mouth at night, mild or no epigastric pain (stomach area), only occasional slight pain, black tarry stools, strong positive fecal occult blood test (++++), pale tongue body, white and dry coating, wiry, large, and forceless pulse. Syndrome differentiation: Repeated hematochezia has depleted Qi and Blood; prolonged bleeding this time has caused even greater depletion. Observing the pale face and lips, mental fatigue, limb weakness, dizziness, and palpitations, these are purely signs of deficiency. A large but forceless pulse and black stool are indicators of Qi and Blood deficiency failing to control blood retention. Hematochezia with mild stomach pain indicates a pattern where pathogenic factors are few and deficiency is predominant. Treatment method: Tonify Qi and nourish Blood, nourish Blood and stop bleeding. Prescription: Shenqi Siwu Tang modified. Radix Codonopsis (Ludangshen) 24g, Radix Astragali (Beimianqi) 15g, Raw and Prepared Rehmanniae Radix (Sheng Shudi) 12g each, Radix Paeoniae Alba (Hangbaishao) 9g, Radix Angelicae Sinensis (Dangguishen) 9g, Folium Platycladi (Cebaiye) 15g, Cortex Moutan (Fendanpi) 6g, Colla Corii Asini (Ejiao) 9g (dissolved), Radix Sanguisorbae (Diyutan) 9g, Semen Ziziphi Spinosae (Suanzaoren) 9g, Radix Glycyrrhizae Preparata (Zhigancao) 4.5g.
Second Visit: After taking 2 doses of the above medicine, visible hematochezia disappeared, stool color turned yellow, fecal occult blood test became negative (-), spirit improved, and all symptoms significantly reduced. Management plan: Continue with the original prescription for another 2 doses (one dose daily).
Third Visit: Twenty days later, the patient returned, reporting that after taking the second-visit medication, all symptoms disappeared and bleeding stopped. He went home due to personal matters and stopped taking medicine. Two days ago, due to dietary factors, he again had black, loose, unformed stools, but his spirit was good, appetite slightly decreased, mouth was dry but without desire to drink, restless and unable to sleep, red tongue edges, white coating, wiry and large left pulse, weak right pulse. Comprehensive analysis of pulse and symptoms suggests Blood deficiency with Liver Heat and Qi deficiency with Spleen Cold. Treatment method: Nourish Blood and clear Heat, tonify Qi and warm the Middle Jiao. Formula based on Huangtu Tang modified. Raw Rehmanniae Radix (Shengdi) 15g, Radix Paeoniae Alba (Huangshao) 9g, Blackened Radix Sanguisorbae (Hei Diyu) 9g, Radix Codonopsis (Ludangshen) 15g, Prepared Ginger Charcoal (Paojiangtan) 3g, Colla Corii Asini (Ejiao) 9g (dissolved), Caulis Longanae (Fulonggan) 12g (wrapped in lotus leaf and decocted), Radix Glycyrrhizae Preparata (Zhicao) 3g. One dose daily, taken for 3 days. After medication, stool color turned yellow and formed; after two more doses, stool normalized, bleeding stopped, and fecal occult blood test was negative (-). Advised to pay attention to daily life and dietary regulation, continue medication to consolidate curative effects and prevent recurrence. (Xiao Xi: "Treatment Case of Gastric Bleeding," *New Chinese Medicine* 2:18, 1978)
[Commentary] Bleeding before or after defecation, or simple bleeding from the rectum, is collectively called hematochezia. *Jingui Yaolue* distinguishes between distant blood (blood appearing after stool, indicating higher lesion) and proximal blood (blood appearing before stool, indicating lower lesion). *Linzheng Yaojue* states: "Clear and bright blood is Changfeng (Intestinal Wind); turbid and dark blood is Zangdu (Visceral Toxin)." Hematochezia is mostly caused by Spleen deficiency failing to control blood, or damp-heat pouring downward into the Large Intestine, damaging the Yin collaterals.
Case 1: The course of disease has been long, with bright red and abundant hematochezia, indicating deficiency of Zheng Qi and excess of Pathogenic Factors. Urgently treat with stopping bleeding and clearing Heat, supplementing Middle and tonifying Qi, addressing both root and branch, supporting healthy Qi and eliminating pathogens simultaneously. After bleeding stops, if Zheng Qi has not recovered, continuing with regulating and tonifying formulas is relatively safe.
Case 2: The syndrome belongs to distant blood. Due to excessive blood loss causing dual deficiency of Qi and Blood, treating with dual tonification of Qi and Blood aims to achieve the effect of Qi充盈 (filling) to control blood and Blood nourishing to stop bleeding, which is quite appropriate.
(XIV) Blood Stasis Syndrome
Case 1: Female, under twenty years old, rather emaciated. One day went out shopping, suddenly frightened, upon return became manic, fighting everyone indiscriminately, with immense strength. ... Ill for seven or eight days, mania persists. ... Menstruation has not occurred for two months. ... Pulse is deep and tight, lower abdomen seems distended. ... This is Blood Stasis Syndrome, purging can cure it. Prescribed Taohhe Chengqi Tang. Persicae Semen (Taoren) 30g, Raw Rheum Palmatum (Shengjun) 15g, Natrii Sulfas (Mangxiao) 6g, Radix Glycyrrhizae Preparata (Zhigancao) 6g, Ramulus Cinnamomi (Guizhi) 6g, Fructus Aurantii (Zhishi) 9g. Next day asked, learned that after taking it, much black blood was discharged, mania stopped, body not tired, able to drink porridge, shy avoiding people. Then wrote a follow-up formula for her, no further visits. (Cao Yingfu, *Jingfang Shiyan Lu*)
Case 2: Male. Lower abdominal distension and pain, clear and profuse urination, and visual impairment. Argument confirms Blood Stasis, but I secretly doubted it. So tentatively gave Taohuhe Chengqi Tang. After taking it, black feces were discharged after a short while, but symptoms remained. Gave two more doses, increased dosage, symptoms still remained, mind even more surprised. Thinking: If this is not Blood Stasis, taking purgatives for three doses should have caused a bad disease; if it is indeed this syndrome, why no slight improvement? This must be light medicine and heavy disease. At that time, disciple Zhang Cigong was on the left, said: "How about Didang Wan?" I said: "Examining the syndrome, light medicine cannot cure it, so decided to use Didang Tang to purge." After taking it, black feces mixed with old blood came down together. Advanced one more dose, patient could then lie quietly on the couch, abdominal distension flat, pain also calm. Knowing medicine hit the target, still used previous formula reducing dosage,计: Blatta orientalis (Machong) 6g, Hirudo (Shuizhi) 4.5g, Persicae Semen (Taoren) 15g, Rhizoma et Radix Rhei (Chuanjun) 15g. Later reduced again to Machong and Shuizhi 1.2g each, Taoren and Chuanjun 4.5g each. Recovered under Zhang Cigong's regulation. Later asked the patient, it was due to labor carrying heavy loads, causing blood coagulation forming Blood Stasis Syndrome. (Cao Yingfu, *Jingfang Shiyan Lu*)
[Commentary] Blood Stasis Syndrome is the syndrome appearing from "Taiyang disease not resolving, heat binding in the Bladder" in *Shanghan Lun*. Internal heat stagnating in the Lower Jiao Bladder, heat flourishing and blood stasis, the person becomes like manic.
Case 1 is a case of Blood Stasis causing mania. Patient's menstruation had not occurred for two months, pulse deep and tight, lower abdomen seemed distended, triggered by fright, so no external pathogen known. "Only if the lower abdomen is urgent and knotted, can it be attacked, suitable for Taohuhe Chengqi Tang." Adding Zhishi to the original *Shanghan Lun* formula to dissipate痞 (fullness) and break knots, assisting the purging power. After medicine, much black blood discharged, mania stopped, body not tired. Although using heavy agents to break stasis and purge, body still not tired, because the patient's constitution was not very weak, and medicine dosage was appropriate. Even if Qi constitution is too deficient, or medicine dosage too high, causing exhaustion after purging, do not panic, can still use tonics to regulate.
Case 2 is male Blood Stasis. Blood Stasis syndrome is mostly seen in women, rare in men. Because it is rare, identifying the syndrome must be precise, otherwise hesitating on attacking methods, indecisive, can delay the disease mechanism. Initially used Taohuhe Chengqi Tang but disease heavy medicine light, later used Didang Tang to purge then recovered. The case description is detailed, worth pondering.
(XV) Palpitations and Trembling Heart
Case 1: Zhong X, illness of palpitations, spirit vague, deaf, unable to speak, upper limbs slightly trembling, red tongue with little coating slightly dry, deep fine rapid pulse. Syndrome differentiation: Yin deficiency and Blood Heat disturbing the Spirit. Treatment method: Calm Heart and suppress Liver, clear Heat and nourish Yin. Prescription: Zhu Fushen (Cinnabar-coated Poria) 12g, Ju Hong (Tangerine Peel) 4.5g, Zhu Ru (Bamboo Shavings) 9g, Xuanshen (Scrophulariae Radix) 9g, Lian Zi Xin (Lotus Plumule) 4.5g, Longchi (Dragon Teeth) 9g, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 4.5g, Danshen (Salviae Miltiorrhizae Radix) 9g, Yujin (Curcumae Radix) 4.5g, Hang Juhua (Chrysanthemi Flos) 9g, Xiakucao (Prunellae Spica) 9g, Sheng Tielpuo (Raw Iron Filings) 90g (boil water to decoct). After taking, able to speak, all symptoms reduced. Second visit added Yuanzhi, Xijiao, Shengdi, removed Xiakucao. Later treated with softening Liver, extinguishing Wind, calming fright method, regulated and recovered. (*Shen Shaoji Yihua*)
Case 2: Xu XX, Male, 41 years old, married, admitted May 20, 1957. Dizziness and belching, epigastric discomfort for over a month. Suddenly fever on noon Dec 6, 1965, dizziness and tinnitus, hearing loss, throbbing sensation in epigastrium pulling head and chest, Qi rushing up to throat, worse after meals, borborygmus audible, palpitations exacerbated by movement, poor sleep and appetite, fatigue. Neurological examination previously showed no positive results, diagnosed as Neurasthenia. Tongue coating yellow thick greasy, foul breath. Prescription: Guizhi (Cinnamon Twig) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 12g, Zexie (Alismatis Rhizoma) 9g, Daizheshi (Haematitum) 12g, Fuling (Poria) 12g, Gancao (Licorice Root) 6g. After 7 doses of above formula, palpitations and gastric appetite normal, later took Lizhong Wan, regulated for over a month, recovered. (Sheng Guorong, "Reflections on Using Guizhi," *Guangdong Traditional Chinese Medicine* 6:10, 1958)
Case 3: Liu XX, Female, 28 years old. In 1960 suffered cold, doctor used heavy Ma Huang and Gui Zhi to induce sweating, after sweating leakage continued, spirit timid, touching things caused trembling heart unrest, often wanted to stay alone behind closed doors, sometimes sad wanting to cry, only diet okay, subsequently due to improper regulation, continued to see headache and dizziness, trembling heart, forgetfulness, insomnia. Diagnosed as Neurasthenia. Treated before, chronic illness not cured. At consultation, face like covered with dust, dizzy hard to lift, eyes dim (one eye originally had nebula), trembling heart and tinnitus, restless dreams, bitter taste, wrist stuffiness, sometimes want to vomit, wiry slippery pulse, turbid greasy coating, unhappy mood, tears when speaking. Syndrome differentiation: Turbid Phlegm invading, Phlegm turbidity not gone, Clear Yang not ascending. Treatment method: Soothe depression and descend phlegm. Prescription: Wendan Tang modified. Jing Banxia (Pinelliae Rhizoma) 9g, Fuling (Poria) 9g, Zhishi (Aurantii Fructus) 6g, Yujin (Curcumae Radix) 6g, Zhuru (Bambusae Caulis in Taeniam) 6g, Dannanxing (Arisaematis Cum Bile) 4.5g, Chenpi (Citri Reticulatae Pericarpium) 4.5g, Gancao (Glycyrrhizae Radix) 3g, Jian Changpu (Acori Tatarinowii Rhizoma) 2.4g. Took over ten doses, headache and dizziness reduced, coating slightly retreated, still felt burning and trembling heart unrest, irritability and insomnia, pulse still wiry slippery forceful, still used previous formula adding Danpi 4.5g, Baishao 9g, Chao Zaoren 12g, took seven more doses, diet and sleep normal, coating retreated, pulse more harmonious than before, only morning dizziness, easily frightened by things, fearing evil gone righteous deficient, spirit empty chamber, residual phlegm still has chance to invade, still gave Wendan Tang adding Danshen 12g, Yuanzhi 4.5g, Longyanrou 5 pieces, Chao Zaoren 12g, took continuously for one month, illness recovered. (Ouyang Qi: "Experience in Treating Neurasthenia," *Zhejiang Journal of Traditional Chinese Medicine* 5:11, 1964)
[Commentary] Jingji (Palpitations) and Zhengchong (Trembling Heart) refer to syndromes of self-perceived heart restlessness and rapid heartbeat, often accompanied by fear and panic, inability to control oneself. There is a difference in severity. Jingji is mostly caused by external factors, such as sudden fright or anger, generally milder syndrome, good general condition; Zhengchong is mostly caused by internal factors, no external fright but heart feels full, triggered by slight exertion, slightly heavier syndrome, poorer general condition. Jingji lasting long can develop into Zhengchong. Many suffer from this clinically. But Neurasthenia called by Western medicine is more common, cardiovascular diseases also account for a certain proportion.
Case 1 Jingji illness, upper limbs slightly trembling, belongs to emotional disease, Heart lacks master, Liver Wind wants to move, red tongue little coating slightly dry, fine rapid pulse, internal heat injuring Yin cause. Treat with calming Heart suppressing Liver, clearing Heat nourishing Yin. Because spirit vague, fearing Phlegm-Heat internal closure, slightly added Ju Hong, Zhuru, Chuan Beimu, Yujin etc., phlegm-resolving and orifice-opening agents, to prevent trouble before it happens.
Case 2 Syndrome belongs to Heart Yang not stirring, Water-Drink reversing upward, thus seeing Qi rushing up, borborygmus, palpitations aggravated by movement etc. Formula uses Linggui Zhugan Tang modified, stimulating Heart Yang, tonifying Qi moving Water, suppressing reversal, few medicinal flavors but specific therapeutic effect.
Case 3 belongs to Zhengchong scope, due to excessive sweating injuring Heart Yin, thus seeing spirit timid trembling heart unrest. Also due to improper regulation, overusing Qi-tonifying and Blood-nourishing,反而 helping the villain. Disease although originating from damage, not Heart-Spleen dual deficiency syndrome, actually Phlegm-Turbidity is the problem. Turbid Phlegm not gone, Clear Yang not ascending, difficult to heal quickly. Thus use Wendan Tang modified, soothe depression descend phlegm. Wait until Phlegm gone turbidity clear, syndrome shows spirit empty chamber image, continue using Heart-Spleen regulating and tonifying agents, to solidify the root.
(XVI) Insomnia
Case 1: Tian XX, Male, adult, first visit date: April 17, 1958. Water and Fire not interacting, drawing Liver Yang to hyperactivity, insomnia and many dreams, headache偏向 left. Method should nourish Water to assist Fire, level Liver and submerge Yang. Da Shengdi (Rehmanniae Radix) 12g, Tian Dong (Asparagi Radix) 9g, Mai Dong (Ophiopogonis Radix) 9g, Xi Shihu (Dendrobii Caulis) 9g, Zhenzhumu (Margarita) 18g (decoct first), Duan Longchi (Longgi Os Draconis) 12g (decoct first), Chen Fushen (Poria cum Radix Trichomanis) 9g, Chao Zaoren (Ziziphi Spinosae Semen) 9g, Yejiaoteng (Polygoni Multiflori Caulis) 12g, Yehehua (Magnoliae Flower) 6g, Chao Hangju (Chrysanthemi Flos) 9g, Nen Gouteng (Uncariae Ramulus cum Uncis) 9g (add later), Chao Danpi (Moutan Cortex) 4.5g. (Hu Jianhua et al. organized: "Academic Origin and Achievement of Dean Cheng Menxue," *Chinese Journal of Traditional Chinese Medicine* 10:19, 1979)
Case 2: Xu X, Female. After severe illness, pregnant for several months, Blood component naturally insufficient, Liver nourishment relatively poor, after Qi痞 resolved, still remaining remnants, pulse wiry slippery and fine rapid. Tentatively give nourishing softening and transforming to promote vitality. Sheng Muli (Concha Ostreae) 12g (wrap decoct first), Xuanfuhua (Inulae Flos) 9g (wrap decoct), Dan Congrong (Cistanches Herba) 9g, Sangshang Jisheng (Taxilli Herba) 15g, Sheng Zhesi (Haematitum) 9g, Dama Ren (Cannabis Semen) 9g, Sheng Biejia (Carapax Testudinis) 9g (decoct first), Qing Banxia (Pinelliae Rhizoma) 4.5g, Chao Zhike (Aurantii Fructus) 2.4g, Zhishi (Aurantii Fructus Immaturus) 2.4g, Qianshi (Euryales Semen) 9g (salt-fried), Yan Zhibo (Phellodendri Cortex) 9g each, Lianxin (Nelumbinis Plumula) 6g (Cinnabar mixed), Shouwuteng (Polygoni Multiflori Caulis) 18g, Wuyao (Linderae Radix) 6g, Ou (Nelumbinis Rhizoma) 30g. According to letter reply "took 15 doses, dizziness reduced, palpitations and insomnia both lighter," thus changed to paste formula regulation. Prescription according to original dosage, add double, add Jiao Zaoren 6g, Chao Yuanzhi 18g, Xue Hupo (Electrum) 15g, concentrated decoction refined honey to collect paste, every morning and evening take one spoon, about 9g, dissolve in boiled water. (Kong Sibai organized: *Kong Bohua Medical Cases*, *Chinese Journal of Traditional Chinese Medicine* 8:547, 1956)
Case 3: Shen X, Female, 56 years old, first visit date: July 18, 1965. Insomnia long-lasting not healed, exceeded five years. Hot flashes rising, eyes dry, palpitations restless. Pulse deficient wiry, should use Banxia Shumi, Huanglian Ejiao combined with Wendan Tang three formulas variation. Xian Banxia (Pinelliae Rhizoma) 6g (pounded), Bei Shumi (Milii Semen) 12g (wrap), Da Shengdi (Rehmanniae Radix) 12g, Hang Baishao (Paeoniae Radix Alba) 6g, Zhenzhumu (Margarita) 30g (decoct first), Ling Cishi (Magnetitum) 24g (decoct first), Xiao Chuanlian (Coptidis Rhizoma) 1.5g, Lotus Starch fried Ejiao (Colla Corii Asini) 9g, Zhu Fuling (Poria) 12g, Chao Zhuru (Bambusae Caulis in Taeniam) 6g, Xiao Zhishi (Aurantii Fructus Immaturus) 3g, Jupi (Citri Reticulatae Pericarpium) 4.5g, Baizi Ren (Platycladi Semen) 12g.
July 21 (Second Visit), Yang Qiao disease, Gallbladder loses clear tranquility, insomnia long-lasting not healed. Eyes dry, empty vexation palpitations, panicked by events, pulse comes deficient wiry. Again use Banxia Shumi, Huanglian Ejiao combined with Wendan Tang three formulas jointly treat. Xian Banxia 6g (pounded), Bei Shumi 12g (wrap), Da Shengdi 12g, Hang Baishao 6g, Ling Cishi 24g (decoct first), Xiao Chuanlian 1.5g, Lotus Starch fried Ejiao 9g, Zhu Fuling 12g, Chao Zhuru 6g, Xiao Zhishi 3g, Jupi 4.5g, Pao Yuanzhi (Polygalae Radix) 4.5g, Chao Zaoren 12g (ground), 3 doses.
July 25 (Third Visit): Successively taking Banxia Shumi, Huanglian Ejiao combined with Wendan Tang three formulas after, long-standing insomnia already got peaceful sleep, palpitations already calm, eyes heavy and dry, pulse small wiry, again follow previous treatment. Xian Banxia 6g (pounded), Bei Shumi 12g (wrap), Da Shengdi 12g, Hang Baishao 6g, Zhenzhumu 30g (decoct first), Ling Cishi 24g, Shuang Sangye (Mori Folium) 9g, Hei Zhima (Sesami Fructus) 12g, Xiao Chuanlian 1.5g, Lotus Starch fried Ejiao 9g, Chao Zhuru 6g, Xiao Zhishi 3g, Jupi 4.5g, Pao Yuanzhi 4.5g, Chao Zaoren 12g (ground), 3 doses.
July 28 (Fourth Visit): Yang can enter Yin, obtaining Banxia Shumi's communicating Yin and Yang, Wendan's calming Gallbladder resolving Phlegm, Huanglian Ejiao's clearing Heart nourishing Blood, so long-standing insomnia already peacefully asleep, eyes heavy and dry already healed, pulse small wiry, again use previous method to treat. Xian Banxia 6g (pounded), Bei Shumi 12g (wrap), Da Shengdi 12g, Hang Baishao 6g, Shuang Sangye 9g, Hei Zhima 12g, Chu Juhua (Chrysanthemi Flos) 9g, Ban Chao Nu Zhenzi (Ligustri Lucidi Fructus) 9g, Xiao Chuanlian 1.6g, Lotus Starch fried Ejiao 9g, Bai Fuling (Poria) 12g, Chao Zhuru 6g, Xiao Zhishi 3g, Jupi 4.5g, Pao Yuanzhi 4.5g, Chao Zaoren 12g (ground), 5 doses. Subsequently, still use above formula intent, additionally match Cang Longchi, Zhu Dengxin (Junci Medulla), Baizi Ren, Hehuanpi (Albiziae Cortex), Xue Hupo etc., to strengthen nourishing Heart calming Spirit effect, regulated one month to conclude. March 1975 follow-up, sleep good, ten years no recurrence. (*Neike Linzhenglu* Chen Daolong Medical Case)
Case 4: XXX, Male, 40 years old, first visit date: December 1962. Insomnia, many dreams palpitations, migraine, tinnitus, for a relatively long time. Often takes analgesic tablets and barbiturate-type analgesic hypnotics, but still occasionally attacks to this day. Chest and abdomen bloated and stifling, occasionally painful, worse in afternoon. During sleep often nasal obstruction, breathing difficulty feeling. Vision blurred, throat dry. Most painful is abnormal bowel movements for a long time, mostly firm, less diarrhea, once or twice daily or once every two or three days. Bad breath, sometimes acid regurgitation. Urination frequent and dripping incomplete, sometimes feel tired and weak, requests winter tonic. Examined tongue coating slightly yellow and thick, especially at tongue root, pulse fine and stiff. Syndrome differentiation: Stomach has Dry Fire, Lung and Stomach fluids injured. Treatment method: Descend Stomach as main, sweet cool moistening. Prescription: Taizishen (Codonopsis Radix) 60g, Maidong (Ophiopogonis Radix) 90g, Beishashen (Glehniae Radix) 90g, Xingren (Armeniacae Semen Amarum) 90g (remove skin and tips), Baishao (Paeoniae Radix Alba) 60g, Jin Shihu (Dendrobii Caulis) 90g, Yuzhu (Polygonati Odorati Rhizoma) 60g, Fushen (Poria cum Radix Trichomanis) 120g, Huomaren (Cannabis Semen) 60g, Jiao Liuqu (Massa Medicata Fermentata) 60g, Zexie (Alismatis Rhizoma) 60g, Baibian Dou (Dolichoris Semen) 60g, Zhimu (Anemarrhenae Rhizoma) 60g, Wu Xuanshen (Scrophulariae Radix) 90g, Bei Shumi (Milii Semen) 120g, Chuanbeimu (Fritillariae Cirrhosae Bulbus) 15g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 30g, Sheng Dihuang (Rehmanniae Radix Preparata) 120g, Hongzao (Jujubae Fructus) 90g, Ejiao (Colla Corii Asini) 60g, Guibanjiao (Colla Testudinis) 60g, Honey 500g, Bingtang (Saccharum) 250g to collect paste. After taking above paste formula, bowel movements very smooth, already able to once daily, headache, insomnia etc. symptoms, all lightly reduced as if lost. (He Ren: "Stomach Organ Uses Unblocking as Function," *New Chinese Medicine* 3:16, 1979)