例五徐XX，壮年。患者操劳忧虑，心神交瘁，久之酿成失眠往往终宵不能合目。西药治疗可取眠数小时，然梦魂颠倒，过后益增疲乏。今岁入夏以来，失眠变本加厉，历经医治罔效，自8月14日起至今已达3夜还未入睡，头脑懵懵，衣不知热，食不知味，……面虽皓白而神采飞扬，谈笑自若，双目隐隐现红丝，脉象两关均弦长，舌边有青纹。方药：桃仁12克红花9克当归9克川芎9克淮牛膝9克参三七9克大生地9克柴胡6克京赤芍9克炒枳壳6克炙甘草3克一剂后即夜卧贴然，连服15剂，未见再发。后此二月，复来求治，言旬日来又苦失眠，但不若前次之甚。……两关仍弦，依然实证也，因有头痛目赤，胁胀等肝火上炎症象，改用龙胆泻肝汤。方药：黄芩9克龙胆草4．5克小生地9克泽泻9克车前子9克生甘草3克柴胡6克黑山栀9克当归6克木通9克上方共服5剂而夜眠全安，肝火上炎症象亦除。(孙幼立整理：范文虎先生失眠医案一则，《中医杂志》7：15，1963)[评按]不寐即一般所谓失眠，系指以经常不易入寐为主的证候。多因思虑劳倦，损伤心脾；或心肾不交、阴虚火旺，肝阳扰动，或胃不和等因素而发病。
例一证属水火不济，肝阳上亢，法当滋阴与安神并用，涵肝木而潜浮阳，标本同治。
例二乃阴虚肝旺而致不寐。治以滋柔和化合清滋抑化，药用精当，疗效尚佳。
例三素体营阴亏损，且年逾五十，太冲脉衰，天癸竭，肾阴不足，肝阳偏亢，肝气郁结，胆气不宁，诸证悉见，病情错综复杂，故用黄连阿胶汤清心养血，温胆汤补心气、宁胆怯，半夏秫米汤交通阴阳，引阳入阴。审证求因，合理使用复方是本例取效之关键。
例四病程日久，兼症颇多，然又以大便不利为突出症状，患者口臭泛酸，苔黄而厚，脉细劲，为胃有燥火，肺胃津伤之证。经云“胃不和则卧不安”，故以降胃为主，弃用刚燥苦降下夺之晶，以甘凉濡润之剂，重在和胃，胃因和则卧而得安。
例五系因瘀血内阻而致失眠。范氏辨瘀血证重视望诊，凡见有双目红丝，舌边有青纹者，乃瘀血之征。患者爰因思虑郁结日久，气与血进而为瘀，瘀血不去则眠终不安，故连投血府逐瘀汤而获效，实乃对活血化瘀法应用之发挥。两月后复诊时证见肝火上炎，正如柯韵伯所说‘肝火旺，则上走空窍，不得睡”，改用龙胆泻肝汤而愈，是故同病异证而异治尔。
(十七)癫痫
例一张XX，男，40岁，门诊号：89155。初诊日期：1972年3月16日。(代诉)1966年间，患者因事思虑太过，久而成疾。初见精神抑郁，继则出现一侧头重痛，心中烦热，胸闷失眠，有时或喃喃乱语，或呆若木鸡。1971年昏倒一次，曾在当地中医治疗，服药未效。因症状逐渐加重，遂由家人陪同来诊。当时患者表情淡漠，神态呆滞，不欲言语，心中烦热，胸闷不适，头痛失眠，须服安眠药才能入睡，并见手颤，胁痛，牙痛，胃纳欠佳，大便秘结，小便频数。诊见脉数而沉实，舌苔霉酱色。辨证：痰火内郁，扰乱心神。治法：清心除烦，消痰化浊。方药：栀子豉汤加味；淡豆豉9克山栀子“克石菖蒲9克莱菔子9克桔梗9克橘皮6克紫金锭1．5克(冲服)3月20日(二诊)：服上药3剂后，患者自觉心胸舒畅，症状明显好转，两胁痛，头痛均减，大便已通，尚见手颤，失眠，下午仍觉烦热，脉数，苔霉酱色。前方已效，继服3齐JJ。3月23日(三诊)：患者上述各症俱已日减，病有好转，精神较开朗，已能自述病情，脉转弦数，舌苔灰黄，但痰火仍未全消，继用消痰清热法。方药：山栀子15克胆南星9克枳实9克川厚朴9克淡豆豉9克．莱菔子9克瓜萎仁15克石菖蒲9克甘草6克S剂。3月27日(四诊)：患者下午胸中仍烦热，下半夜已能入睡，头痛胁痛俱已消解，胃纳转好，脉舌如前。继用前法而加重清心除烦之品。方药：法半夏12克胆南星9克黄连3克竹茹9克枳实9克莱菔子9克川厚朴9克瓜蒌仁12克石菖蒲9克3剂。3月30日(五诊)：患者精神好，睡眠安宁，各症基本消失，惟觉时有头胀，继用前方加减，再服丸剂而愈。(刘赤选主治，何国良整理：癫证，《新中医》2：25，1974)
例二汤XX，男，38岁。初诊日期；1972年9月10日。因患血吸虫病，今春口服锑剂疑中毒，经中西医多次治疗。半年以来，多次发作，每次发作约两、三分钟，痉挛咬牙，口吐白沫。患者体格瘦长，面容忧郁，六脉沉细，舌苔白腻，舌尖红。胸胁苦满，腹肌拘挛悸动，头痛甚剧，心慌，睡眠不安，二便如常。曾经神经科检查诊为癫痫。服多种西药，虽能昏睡，但醒后头痛更甚，近一个月来连续发作四次，发病前头痛更剧，患者焦急惊怖。柴胡10克白芍10克黄芩5克制半夏5克党参8克桂枝6克甘草6克龙骨9克生牡蛎9克钩藤9克淮小麦30克大枣6枚生姜3片11月23日：服药14剂后，头痛大减，癫痫未发，略有心慌，夜梦纷扰，原方再服14剂。12月10日症状均消失，原方略事加减，随访四年，未闻复发。(叶橘泉主治，马永华整理c癫痫治验，《浙江中医学院学报》2：45，198D[评按]癫与痫均属神志失常病证。癫证沉默痴呆，语无伦次，静而多喜，痫证则为发作性神志异常(又名癫痫)，多为突然仆倒，昏不知人，口吐涎沫，两目上视，四肢抽搐，或口中如猪羊叫声，醒后如常人。癫证多因七情所伤，痰气郁结，痫证则因肾虚肝失濡养，脾虚痰涎内结，肝风挟痰随气上逆，蒙蔽清窍而突然发作。癫证经久，痰郁化火，可以出现狂证，故常癫狂并称。
例一为癫证。《灵枢·癫狂》云“癫疾始生，先不乐，头重痛，视举目赤，甚作极，已而烦心”。本案系因痰火内郁，扰乱心神而致。治以清心除烦、消痰化浊。方用栀子豉汤加胆星、莱菔子、陈皮、瓜蒌仁除痰化浊，：另用紫金锭送服，取其辟秽化浊，治法颇得要领。
例二为痫证，系因气郁痰阻而致。方用柴胡桂枝汤加味，实属经验用法。《伤寒论》柴胡桂枝汤原为太少兼病而设，功能和解太少之邪。叶氏指出：主要抓住胸胁苦满和腹肌拘挛紧张之证，前者系少阳主症之一，后者即所谓“心下支结”，亦即心下感觉有物支撑结聚之意。据报导日本人曾用柴胡桂枝汤治疗癫痫433例。125例治愈，79例显效。脑电图消失者64％。其辨证亦以上述二症为重点，列此以供临证参考。
(十八)中风
例一陈XX，男，52岁。躯体肥胖，常感眩晕。近忽口眼喁斜，舌强语涩，眼角流泪，口角流涎，手足麻木无力。脉弦滑，苔白腻。据了解因情绪抑郁而发。东垣有言；“凡人年逾四十气衰之际，或因忧思忿怒伤其气者多有此疾，若肥盛则间有之，亦是形盛气衰而如此”。今患者形体既盛，又值忧伤其气，肝郁生风，脾虚困湿，风痰内动，首中经络。东垣主气，丹溪主痰，互有因果。法当达郁调气，郁舒则风熄，气和则痰消。朱茯神10克制半夏10克瓜蒌仁(炒)10克姜竹茹10克双钩藤10克旋复花(布包)7克川郁金7克左秦艽?克胆南星5克明天麻7克远志肉(水炙)5克九节蒲3克炒枳实3克复诊：连服4剂，呕吐痰涎如丝，遂能语言，但不甚清晰，自诉头侧掣痛，面肌痉挛，手足麻木，极感不适。法当濡血熄风，“血行风自灭”。按上方去九节蒲、枳实，加当归身10克、稀签草10克。三诊：口眼牵正，语言清晰，但仍头晕，虚风夹湿，上扰清空，再拟涤痰定风法。按复诊方改远志肉3克，去瓜蒌仁、郁金，加枸杞10克、滁菊花7克。四诊：眩晕平定，舌能辨味，胃气渐复。三诊方去胆南星，加酸枣仁10克，服至数十剂而安。(《李聪甫医案》)
例二贾XX，男，67岁，门诊号；158230形盛体胖，头晕而昏，舌謇，语言不灵，口吐涎沫，四肢麻，行路略不稳，舌淡苔黄腻，两目微亦，切脉弦硬。老年水亏木旺之体，痰湿内蕴，肝阳引动浊痰闭窍所致。治以补中气、化痰湿，熄风镇静为主。半夏白术天麻汤加减。决明子15克茯神12克制半夏9克白术9克灵磁石9克钩藤9克刺蒺藜9克僵蚕9克明天麻6克石菖蒲3克复诊：服药8剂，头昏显瘥。但大便欲解时失禁，有呃逆等症，属中气不足，改用补中气和脾胃兼熄风化痰药。服九剂，四肢和，便下止。后加桃仁，红花及补肝肾活血方善后，共服药25剂病愈。(张丽珍整理：魏长春老医师治疗中风验案，《浙江中医杂志》4：27，1966)
例三林，50岁。猝然昏仆不省人事，急扶入院请西医救治，醒后左肢不遂，病已十二日，症状尚无好转。脉弦劲，头偏右痛，面红目亦，口眼喁斜，舌苔厚腻，微黄，口苦有火味，此病乃旰阳上亢，痰热蒙蔽清窍。治以平肝熄风镇逆，降火涤痰通络。栀子6克黄芩6克陈皮4．5克半夏6克胆南星6克牛膝9克元参9克羚羊汁一匙又方：石决明30克生牡蛎30克磁石30克龙骨18克龟板18克先煎代水煎药二诊：服4剂头痛已愈，面赤亦退，大便通畅，神情颇清，惟嗜食生果及澄汁，致胃胀不消，呃逆频繁，时带酸味。陈皮4．5克半夏6克川连2．1克黄芩4．5克竹茹6克枳壳4．5克莱菔子6克旋复花6克代赭石18克柿蒂6克三诊，服3剂，呃逆已上，舌苔稍退，口苦亦减，手已能举，惟左脚不用，抚摸则诸筋抽痛，食后有时暖酸，目多眵泪。白蒺藜6克木瓜6克甘菊6克陈皮4．5克半夏6克枳壳4．5克白芍6克胆南星6克川连2．1克钩藤9克(后下)竹茹6克麦芽9克羚羊汁一匙又方：代赭石18克龟板18克龙骨13克磁石20克石决明30克生牡蛎30克(先煎代水煎药)四诊；服4剂，左肢稍能转动，原方加牛膝9克，川楝9克，去竹茹、麦芽。五诊：前方服6剂，近日能由床起，行数步至椅上坐，免人扶腋，目泪未愈。熟地12克淮山药9克山茱6克牛膝9克枸杞9克甘菊6克龟板15克(先煎)磁石18克(先煎)石决明18克(先煎)白芍6克青葙子6克杜仲9克续断6克服10剂，已能扶杖而行。(《刘铁巷医案》)
例四谢X，64岁。因心中懊侬非常。旬日前即觉头疼，不以为意。一日晨起至工所，忽仆于地，状若昏厥。移时复苏，其左手足遂不能动，且觉头疼甚剧。医者投以清火通络之剂，兼法王勋臣补阳还五汤之意，加生黄芪数钱(克)，服后更甚。脑中疼如刀刺，须臾难忍，心中甚热。脉左部弦长，右洪长，皆重按有力。询其家人，谓其素性嗜酒，近因心中懊侬，益以酒浇愁，饥时恒以烧酒当饭。……其左脉之弦长，懊侬所生之热也，右脉之洪长，积酒所生之热也。二热相并，挟脏腑气血上冲脑部。……医者不知致病之由，竟投以治气虚偏枯之药，而此症此脉，岂能受黄芪之升补乎?所以服药后而头疼加剧也。治宜降血平脑。以牛膝善引上部之血下行，为治脑充血症无上之妙晶，屡经实验，故以为君。佐以龙、牡、二石、楝，芍、玄参、胆草、炙草、铁锈水等，潜镇清熄。方药；怀牛膝30克生龙骨18克(打)生牡蛎18克(打)川楝子12克生杭芍18克生石膏30克(研细)代赭石18，克(生打)乌玄参12克龙胆草9克、生甘草6克．服两剂，头疼痊愈，脉亦和平，左手足已能自动，遂改用全当归，生杭芍、玄参，天冬各15克，生黄芪，乳香，没药各9克，红花3克。连服数剂，即扶杖能走矣。方中用红花者，欲以化脑中之瘀血也。为此时脉已和平，头已不疼，可受黄芪之温补。故方中少用9克，以补助其正气，即借以助归、芍、乳、没以流通血脉，更可调玄参、天冬之寒凉也。(《重印全国名医验案类编》张锡纯医案)
例五陈XX，男，50岁，初诊日期：1973年2月4日。20天前刚睡一觉醒来，想翻动身体，即觉手足不灵活，勉强从右侧翻到左侧。可是，再想翻回来就不行了，随即口角歪斜，说话费劲，发音不清，舌头运动不自然，手足左半正常，右半呈弛缓性瘫痪，经XX医院诊断为脑血栓形成。住院半月，疗效不显，后服中药治疗。诊得脉弦细而数，舌质红，苔薄少津，胸闷心烦，咽干思饮，小便色深，乃阴虚阳亢，内风暗动，经脉血滞之候。即疏稀莶至阴汤，以治中风的阴虚证。方药：制稀莶30克干地黄9克盐知母12克当归3克枸杞子9克炒赤芍12克龟板6克牛膝6克甘菊花9克郁金9克丹参9克连翘、栀子，花粉各9克服3剂，烦热退，语言清，口角歪斜也有改善，是心经之热已退，而经筋中所滞之血热，尚未清彻也。复于方中去连翘，栀子，加橘络6克、广地龙3克，连服7剂，瘫痪恢复，手足运动正常。惟舌质尚红，脉仍弦细，阴虚尚待继续滋养，改用六味地黄丸，连服10剂完全康复。(任应秋：临证点滴，《陕西新医药》2：42，1977)
Background Information
Book Title: Compilation of Verified Cases by Famous Doctors in Modern Times
Chapter: Main Text (8/53)
Category: Medical Discussion
Case 5: Patient Xu XX, a young adult. The patient suffered from excessive labor and worry, leading to extreme exhaustion of the heart and mind (Shen). Over time, this developed into insomnia (Bu Mei), often resulting in inability to sleep all night. Western medicine treatment allowed for a few hours of sleep, but dreams were chaotic and inverted, leaving the patient even more fatigued afterward. Since entering summer this year, the insomnia has worsened significantly. Despite numerous treatments with no effect, the patient had not slept for three consecutive nights starting from August 14th. The head felt dizzy and confused; the patient was unaware of whether clothes were too hot or cold, and food tasted flavorless. ... Although the complexion was pale, the spirit was bright, and conversation was natural. Faint red streaks were visible in both eyes. The pulse at both Guan positions (middle position on radial artery) was wiry and long. There were bluish-green veins on the sides of the tongue. Prescription: Tao Ren (Persicae Semen) 12g, Hong Hua (Carthami Flos) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g, Huai Niu Xi (Achyranthis Bidentatae Radix) 9g, Shen San Qi (Notoginseng Radix et Rhizoma) 9g, Da Sheng Di (Rehmanniae Radix Preparata) 9g, Chai Hu (Bupleuri Radix) 6g, Jing Chi Shao (Paeoniae Radix Rubra) 9g, Chao Zhi Ke (Aurantii Fructus) 6g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 3g. After one dose, the patient slept peacefully that night. After taking 15 doses consecutively, there was no recurrence. Two months later, the patient returned seeking treatment, stating that he had suffered from insomnia again for ten days, though not as severely as before. ... The pulse at both Guan positions remained wiry, indicating an excess pattern. Due to symptoms such as headache, red eyes, and distension in the hypochondrium, indicative of Liver Fire flaming upward (Gan Huo Shang Yan), Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) was prescribed. Prescription: Huang Qin (Scutellariae Radix) 9g, Long Dan Cao (Gentianae Scabrae Radix et Rhizoma) 4.5g, Xiao Sheng Di (Rehmanniae Radix) 9g, Ze Xie (Alismatis Rhizoma) 9g, Che Qian Zi (Plantaginis Semen) 9g, Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Chai Hu (Bupleuri Radix) 6g, Hei Shan Zhi (Gardeniae Fructus Carbonisatus) 9g, Dang Gui (Angelicae Sinensis Radix) 6g, Mu Tong (Akebiae Caulis) 9g. After taking 5 doses of the above prescription, nighttime sleep was completely restored, and symptoms of Liver Fire flaming upward disappeared. (Organized by Sun Youli: A Case of Insomnia Treated by Mr. Fan Wenhu, *Journal of Traditional Chinese Medicine* 7:15, 1963) [Commentary] Bu Mei (Insomnia) refers generally to insomnia, characterized primarily by chronic difficulty falling asleep. It is often caused by overthinking and fatigue damaging the Heart and Spleen; or by failure of communication between Heart and Kidney, Yin deficiency with Fire hyperactivity, disturbance by Liver Yang, or disharmony of the Stomach.
Case 1: The syndrome belongs to failure of Water and Fire to interact (Heart-Kidney non-interaction) with Hyperactive Liver Yang. The treatment method should combine nourishing Yin and calming the Spirit, nurturing Liver Wood and submerging floating Yang, treating both root and branch simultaneously.
Case 2: This is insomnia caused by Yin deficiency and Liver hyperactivity. Treatment focused on nourishing, softening, harmonizing, clearing, and suppressing transformation. The medication was precise, and the efficacy was good.
Case 3: The patient had a constitution deficient in Ying-Yin (Nutritive Yin) and was over fifty years old. The Tai Chong pulse declined, Tian Gui (Essence related to reproduction) exhausted, Kidney Yin was insufficient, Liver Yang was hyperactive, Liver Qi was stagnant, and Gallbladder Qi was restless. Various symptoms appeared, making the condition complex. Therefore, Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) was used to clear the Heart and nourish Blood, Wen Dan Tang (Warm the Gallbladder Decoction) to tonify Heart Qi and calm Gallbladder fright, and Ban Xia Shu Mi Tang (Pinellia and Millet Decoction) to facilitate communication between Yin and Yang, guiding Yang into Yin. Examining the syndrome to seek the cause and reasonably using compound prescriptions was the key to success in this case.
Case 4: The disease course was long with many accompanying symptoms, but constipation was the most prominent symptom. The patient had bad breath, acid regurgitation, a yellow and thick coating, and a fine, firm pulse. This indicated Dry Heat in the Stomach and injury to Lung and Stomach fluids. The Classic states, "When the Stomach is not in harmony, sleep is uneasy." Therefore, the treatment focused on descending Stomach Qi, abandoning harsh, drying, bitter, purgative agents. Instead, sweet, cool, and moistening agents were used, emphasizing harmonizing the Stomach. When the Stomach is harmonized, sleep becomes peaceful.
Case 5: This insomnia was caused by internal obstruction of Blood Stasis. Mr. Fan emphasized inspection when diagnosing Blood Stasis patterns. Visible red streaks in the eyes and bluish-green veins on the tongue sides are signs of Blood Stasis. The patient's prolonged worry and depression led to Qi stagnation transforming into Blood Stasis. Since the stasis was not removed, sleep could not be peaceful. Thus, Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) was administered continuously with success. This represents an expansion in the application of methods for invigorating blood and resolving stasis. At the follow-up two months later, symptoms of Liver Fire flaming upward appeared. As Ke Yunbo stated, "When Liver Fire is vigorous, it moves upward to the orifices, causing insomnia." Long Dan Xie Gan Tang was then used, resulting in a cure. Thus, the same disease presents different syndromes requiring different treatments.
(XVII) Epilepsy
Case 1: Patient Zhang XX, male, 40 years old. Outpatient No.: 89155. First visit date: March 16, 1972. (Reported by proxy) In 1966, due to excessive worrying about matters, the patient became ill over time. Initially presenting with mental depression, followed by heavy pain on one side of the head, irritability in the chest and heart, chest tightness, and insomnia. Sometimes muttering incoherently or staring blankly like a wooden chicken. In 1971, he fainted once and received local TCM treatment without effect. As symptoms gradually worsened, he came for consultation accompanied by family members. At that time, the patient had a indifferent expression, dull demeanor, reluctance to speak, irritability in the chest and heart, chest tightness and discomfort, headache, and insomnia, requiring hypnotics to sleep. Tremors of the hands, hypochondriac pain, toothache, poor appetite, constipation, and frequent urination were also observed. Pulse was rapid and deep-solid; tongue coating was moldy-soy sauce colored. Syndrome differentiation: Internal depression of Phlegm-Fire disturbing the Heart Spirit. Treatment method: Clear the Heart and relieve irritability, eliminate Phlegm and transform turbidity. Prescription: Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) modified; Dan Dou Chi (Prepared Soybean) 9g, Shan Zhi Zi (Gardeniae Fructus) 9g, Shi Chang Pu (Acori Tatarinowii Rhizoma) 9g, Lai Fu Zi (Radish Seed) 9g, Jie Geng (Platycodonis Radix) 9g, Ju Pi (Citri Reticulatae Pericarpium) 6g, Zi Jin Ding (Purple Gold Pill) 1.5g (taken with decoction). March 20 (Second Visit): After taking 3 doses of the above medicine, the patient felt his chest and heart were comfortable, symptoms improved significantly, hypochondriac pain and headache decreased, stool passed, but hand tremors, insomnia, and afternoon irritability persisted. Pulse was rapid, tongue coating moldy-soy sauce colored. The previous formula was effective; continue taking 3 doses. March 23 (Third Visit): All aforementioned symptoms continued to decrease, condition improved, spirit became more open, able to describe his condition himself. Pulse turned wiry-rapid, tongue coating gray-yellow, but Phlegm-Fire was not fully eliminated. Continue with eliminating Phlegm and clearing Heat method. Prescription: Shan Zhi Zi 15g, Dan Nan Xing (Arisaema Cum Bile) 9g, Zhi Shi (Immature Bitter Orange) 9g, Chuan Hou Po (Magnoliae Officinalis Cortex) 9g, Dan Dou Chi 9g, Lai Fu Zi 9g, Gua Lou Ren (Trichosanthis Semen) 15g, Shi Chang Pu 9g, Gan Cao 6g, 5 doses. March 27 (Fourth Visit): Patient still felt irritability in the chest in the afternoon, but could fall asleep in the second half of the night. Headache and hypochondriac pain resolved, appetite improved, pulse and tongue unchanged. Continue previous method, increasing herbs for clearing Heart heat and relieving irritability. Prescription: Fa Ban Xia (Prepared Pinellia) 12g, Dan Nan Xing 9g, Huang Lian (Coptidis Rhizoma) 3g, Zhu Ru (Bambusa Caulis in Recession) 9g, Zhi Shi 9g, Lai Fu Zi 9g, Chuan Hou Po 9g, Gua Lou Ren 12g, Shi Chang Pu 9g, 3 doses. March 30 (Fifth Visit): Patient's spirit was good, sleep peaceful, various symptoms basically disappeared, only occasional head distension felt. Continue modifying the previous formula and take pills to cure. (Mainly treated by Liu Chixuan, organized by He Guoliang: Dian Syndrome, *New Chinese Medicine* 2:25, 1974)
Case 2: Patient Tang XX, male, 38 years old. First visit date: September 10, 1972. Due to schistosomiasis, oral antimony agents were taken in spring, suspected poisoning. Treated multiple times by both Western and Chinese medicine. For half a year, multiple episodes occurred, each lasting about two to three minutes, with spasms, teeth grinding, and foaming at the mouth. The patient was thin and tall, with a melancholic appearance. Six pulses were deep and fine; tongue coating was white and greasy; tongue tip was red. Chest and hypochondrium felt full and uncomfortable, abdominal muscles contracted and palpitated, severe headache, palpitations, restless sleep, bowel and bladder functions normal. Previously diagnosed with epilepsy by neurology department. Took various Western medicines; although able to fall into deep sleep, headache was worse upon waking. In the past month, four consecutive episodes occurred, with more severe headache before onset. The patient was anxious and terrified. Chai Hu (Bupleuri Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Huang Qin (Scutellariae Radix) 5g, Zhi Ban Xia (Prepared Pinellia) 5g, Dang Shen (Codonopsis Radix) 8g, Gui Zhi (Cinnamomi Ramulus) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Long Gu (Fossilia Ossis Mastodi) 9g, Sheng Mu Li (Ostreae Concha) 9g, Gou Teng (Uncariae Ramulus cum Uncis) 9g, Huai Xiao Mai (Tritici Fructus) 30g, Da Zao (Jujubae Fructus) 6 pieces, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices. November 23: After taking 14 doses, headache greatly reduced, epilepsy did not recur, slight palpitations, disturbed dreams at night. Take original formula for another 14 doses. December 10: Symptoms disappeared. Original formula slightly modified. Follow-up for four years, no recurrence reported. (Mainly treated by Ye Juquan, organized by Ma Yonghua: Successful Treatment of Epilepsy, *Journal of Zhejiang College of Traditional Chinese Medicine* 2:45, 1980) [Commentary] Dian and Xian both belong to disorders of consciousness. Dian syndrome involves silence, dementia, incoherent speech, quietness, and excessive joy. Xian syndrome involves episodic abnormal consciousness (also called epilepsy), often sudden collapse, unconsciousness, foaming at the mouth, eyes rolling up, limb convulsions, or sounds like pigs/sheep, returning to normal after waking. Dian syndrome is often caused by emotional injury leading to Phlegm-Qi stagnation. Xian syndrome is caused by Kidney deficiency failing to nourish Liver, Spleen deficiency leading to internal Phlegm-Saliva accumulation, Liver Wind carrying Phlegm upward against Qi, clouding the clear orifices, causing sudden attacks. Prolonged Dian syndrome can lead to Phlegm transforming into Fire, appearing as Kuang syndrome (Mania), hence Dian and Kuang are often mentioned together.
Case 1 is Dian syndrome. The *Ling Shu: Dian Kuang* states, "At the beginning of Dian disease, there is first unhappiness, heavy head pain, red eyes when looking up, extreme agitation, followed by vexation in the heart." This case was caused by internal depression of Phlegm-Fire disturbing the Heart Spirit. Treatment involved clearing Heart heat, relieving irritability, eliminating Phlegm, and transforming turbidity. Formula used Zhi Zi Chi Tang plus Dan Xing, Lai Fu Zi, Chen Pi, Gua Lou Ren to eliminate Phlegm and transform turbidity. Zi Jin Ding was taken separately to dispel filth and transform turbidity. The treatment method was quite apt.
Case 2 is Xian syndrome, caused by Qi stagnation and Phlegm obstruction. Formula used Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) modified, which is an empirical usage. In *Shang Han Lun*, Chai Hu Gui Zhi Tang was originally designed for concurrent Taiyang and Shaoyang diseases, functioning to harmonize pathogens in both layers. Mr. Ye pointed out: mainly grasp the symptoms of chest/hypochondriac fullness and abdominal muscle contraction/tension. The former is one of the main Shaoyang symptoms; the latter is what is called "Xia Zhi Ji" (supporting knot below the heart), meaning a sensation of something supporting and knotting below the heart. Reports indicate Japanese doctors used Chai Hu Gui Zhi Tang to treat 433 cases of epilepsy, with 125 cured, 79 showing significant effect, and EEG normalization in 64%. Their syndrome differentiation also focused on these two symptoms. Listed here for clinical reference.
(XVIII) Stroke
Case 1: Patient Chen XX, male, 52 years old. Obese body, often feeling dizzy. Suddenly developed facial deviation (mouth and eyes skewed), stiff tongue, slurred speech, tearing from eye corners, drooling from mouth corner, numbness and weakness in limbs. Pulse wiry-slippery, coating white-greasy. Learned to have been triggered by emotional depression. Dong Yuan said: "People over forty whose Qi declines, especially those injured by worry, thought, anger, often suffer this disease. If obese, it occurs occasionally, also due to robust form but weak Qi." Now the patient has a robust form, and his Qi was injured by sorrow. Liver stagnation generated Wind, Spleen deficiency trapped Dampness, Wind-Phlegm moved internally, first affecting the collaterals. Dong Yuan emphasized Qi, Dan Xi emphasized Phlegm; they have mutual causality. Treatment method should vent stagnation and regulate Qi. When stagnation relaxes, Wind extinguishes; when Qi harmonizes, Phlegm dissipates. Zhu Fu Shen (Polyporus with Hostwood) 10g, Zhi Ban Xia 10g, Gua Lou Ren (Stir-fried) 10g, Jiang Zhu Ru (Bamboo Sap with Ginger) 10g, Shuang Gou Teng (Double Hook Vine) 10g, Xuan Fu Hua (Inulae Flos wrapped in cloth) 7g, Chuan Yu Jin (Curcumae Radix) 7g, Zuo Qin Jiao (Gentianae Macrophyllae Radix) ?g, Dan Nan Xing 5g, Ming Tian Ma (Gastrodiae Rhizoma) 7g, Yuan Zhi Rou (Polygalae Radix prepared with water) 5g, Jiu Jie Pu (Acori Tatarinowii Rhizoma specific type) 3g, Chao Zhi Shi 3g. Second Visit: After taking 4 doses continuously, vomited phlegm-saliva like threads, able to speak but not clearly. Complained of pulling pain on side of head, facial muscle spasms, limb numbness, very uncomfortable. Treatment method should nourish Blood and extinguish Wind: "When Blood flows, Wind self-extinguishes." Remove Jiu Jie Pu, Zhi Shi from above formula; add Dang Gui Shen (Dong Quai Root Tip) 10g, Xi Xian Cao (Siegesbeckiae Herba) 10g. Third Visit: Mouth and eyes straightened, speech clear, but still dizzy. Deficient Wind carrying Dampness disturbs the clear upper orifices. Further propose eliminating Phlegm and stabilizing Wind method. Modify third visit formula: change Yuan Zhi Rou to 3g, remove Gua Lou Ren, Yu Jin; add Gou Qi (Lycii Fructus) 10g, Chu Ju Hua (Chrysanthemi Flos) 7g. Fourth Visit: Dizziness settled, tongue can distinguish tastes, Stomach Qi gradually recovered. Remove Dan Nan Xing from third visit formula; add Suan Zao Ren (Ziziphi Spinosae Semen) 10g. Taken for dozens of doses until stable. (*Li Congfu Medical Cases*)
Case 2: Patient Jia XX, male, 67 years old, Outpatient No.: 158230. Robust and obese, dizzy and confused, stiff tongue, inarticulate speech, foaming at mouth, limb numbness, slightly unsteady gait, pale tongue with yellow-greasy coating, eyes slightly squinted, pulse wiry-hard. Elderly constitution with Water deficiency and Wood hyperactivity, internal accumulation of Phlegm-Dampness, Liver Yang stirring turbid Phlegm to close the orifices. Treatment focuses on tonifying Middle Qi, eliminating Phlegm-Dampness, extinguishing Wind, and calming. Modified Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes, and Gastrodia Decoction). Jue Ming Zi (Cassiae Semen) 15g, Fu Shen (Poria with Hostwood) 12g, Zhi Ban Xia 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g, Ling Ci Shi (Magnetitum) 9g, Gou Teng 9g, Ci Ji Li (Tribuli Fructus) 9g, Jiang Can (Bombyx Batryticatus) 9g, Ming Tian Ma 6g, Shi Chang Pu 3g. Second Visit: After taking 8 doses, dizziness significantly alleviated. However, fecal incontinence during defecation urge, hiccups, etc., belong to Middle Qi deficiency. Change to tonifying Middle Qi, harmonizing Stomach and Spleen, combined with extinguishing Wind and eliminating Phlegm herbs. Took 9 doses, limbs relaxed, defecation stopped. Later added Tao Ren (Persicae Semen), Hong Hua, and formulas tonifying Liver/Kidney and invigorating Blood for consolidation. Total 25 doses, disease cured. (Organized by Zhang Lizhen: Old Physician Wei Changchun's Verified Case of Stroke Treatment, *Zhejiang Journal of Traditional Chinese Medicine* 4:27, 1966)
Case 3: Patient Lin, 50 years old. Sudden collapse and loss of consciousness, urgently admitted to hospital for Western medical rescue. Upon waking, left limb paralysis. Disease lasted twelve days, symptoms showed no improvement. Pulse wiry-firm, right-sided headache, red face and eyes, facial deviation, thick-greasy light-yellow tongue coating, bitter taste with fiery sensation. This disease is Liver Yang hyperactivity, Phlegm-Heat clouding clear orifices. Treatment: Pacify Liver, extinguish Wind, suppress rebellion, descend Fire, eliminate Phlegm, unblock collaterals. Zhi Zi 6g, Huang Qin 6g, Chen Pi 4.5g, Ban Xia 6g, Dan Nan Xing 6g, Niu Xi 9g, Yuan Shen 9g, Ling Yang Zhi (Antelope Horn Juice) one spoon. Another Formula: Shi Jue Ming (Haliotidis Concha) 30g, Sheng Mu Li 30g, Ci Shi 30g, Long Gu 18g, Gui Ban (Testudinis Carapax et Plastrum) 18g. Decoct first to replace water for decocting other herbs. Second Visit: After taking 4 doses, headache cured, facial redness receded, stool smooth, spirit clear. Only craving raw fruits and juices, causing stomach distension, frequent hiccups sometimes sour. Chen Pi 4.5g, Ban Xia 6g, Chuan Lian 2.1g, Huang Qin 4.5g, Zhu Ru 6g, Zhi Ke 4.5g, Lai Fu Zi 6g, Xuan Fu Hua 6g, Dai Zhe Shi (Haematitum) 18g, Shi Di (Persimmi Calyx) 6g. Third Visit: After taking 3 doses, hiccups stopped, tongue coating slightly receded, bitterness reduced, hand able to lift, but left foot useless, touching causes tendon cramping pain, belching sourness after eating, eyes produce much discharge. Bai Ji Li 6g, Mu Gua 6g, Gan Ju 6g, Chen Pi 4.5g, Ban Xia 6g, Zhi Ke 4.5g, Bai Shao 6g, Dan Nan Xing 6g, Chuan Lian 2.1g, Gou Teng 9g (added later), Zhu Ru 6g, Mai Ya 9g, Ling Yang Zhi one spoon. Another Formula: Dai Zhe Shi 18g, Gui Ban 18g, Long Gu 13g, Ci Shi 20g, Shi Jue Ming 30g, Sheng Mu Li 30g (decoct first to replace water). Fourth Visit: After taking 4 doses, left limb slightly movable. Add Niu Xi 9g, Chuan Lian 9g to original formula, remove Zhu Ru, Mai Ya. Fifth Visit: After taking previous formula for 6 doses, recently able to rise from bed, walk several steps to sit on chair, without needing support under armpits, eye tears not yet cured. Shu Di 12g, Huai Shan Yao 9g, Shan Zhu Yu 6g, Niu Xi 9g, Gou Qi 9g, Gan Ju 6g, Gui Ban 15g (decoct first), Ci Shi 18g (decoct first), Shi Jue Ming 18g (decoct first), Bai Shao 6g, Qing Xiang Zi 6g, Du Zhong 9g, Xu Duan 6g. Take 10 doses, able to walk with cane. (*Liu Tiexiang Medical Cases*)
Case 4: Patient Xie, 64 years old. Extremely distressed and irritable. Ten days ago felt headache, ignored it. One morning arriving at work, suddenly collapsed, resembling fainting. Recovered after a while, left hand and foot became immobile, and headache was severe. Doctor prescribed clearing Fire and unblocking collaterals agents, imitating Wang Xun Chen's Bu Yang Huan Wu Tang (Tonify Yang and Restore Five Tenths Decoction), adding raw Huang Qi (Astragali Radix) several qian (grams). After taking, condition worsened. Brain pain like knife stabbing, unbearable in moments, heart very hot. Left pulse wiry-long, right pulse flooding-long, both forceful on deep pressure. Asked family, learned patient loved alcohol, recently due to distress, drank more to drown sorrows, often used liquor as meal when hungry. ... The wiry-long left pulse is heat generated by distress; the flooding-long right pulse is heat accumulated from alcohol. These two heats combined, carrying Zang-Fu Qi and Blood rushing upward to the brain. ... The doctor did not know the cause of illness, actually prescribing drugs for Qi-deficiency hemiplegia. How could this syndrome and pulse tolerate the ascending tonification of Huang Qi? Hence headache intensified after taking medicine. Treatment should descend Blood and calm brain. Niu Xi is excellent at guiding Blood from upper part downward, being the supreme wonderful agent for treating cerebral congestion, tested repeatedly, thus used as Sovereign herb. Assist with Long (Dragon Bone), Mu (Oyster Shell), Er Shi (Two Stones - Magnetite and Hematite), Lian (Toosendan Fruit), Shao (Peony), Xuan Shen (Scrophulariae Radix), Dan Cao (Gentian), Zhi Cao (Prepared Licorice), Iron Rust Water, etc., to submerge, calm, clear, and extinguish. Prescription: Huai Niu Xi 30g, Sheng Long Gu 18g (crushed), Sheng Mu Li 18g (crushed), Chuan Lian Zi 12g, Sheng Hang Shao 18g, Sheng Shi Gao (Gypsum Fibrosum) 30g (finely ground), Dai Zhe Shi 18g (raw crushed), Wu Xuan Shen 12g, Long Dan Cao 9g, Sheng Gan Cao 6g. Take 2 doses, headache cured, pulse normalized, left hand and foot able to move automatically. Then change to Quan Dang Gui, Sheng Hang Shao, Xuan Shen, Tian Dong (Asparagi Radix) each 15g, Sheng Huang Qi, Ru Xiang (Olibanum), Mo Yao (Myrrha) each 9g, Hong Hua 3g. Take several doses consecutively, able to walk with cane. Hong Hua is used in the formula to resolve Blood Stasis in the brain. Because at this time pulse is normalized, head no longer painful, able to tolerate Huang Qi's warm tonification. Thus use small amount 9g in formula to assist Righteous Qi, borrowing it to help Gui, Shao, Ru, Mo to circulate Blood vessels, further adjusting the cold nature of Xuan Shen and Tian Dong. (*Reprinted Compilation of Verified Cases by Famous Doctors Nationwide*, Zhang Xichun Medical Cases)
Case 5: Patient Chen XX, male, 50 years old, First visit date: February 4, 1973. Twenty days ago, just woke up from sleep, wanted to turn body, felt limbs inflexible, barely turned from right side to left. But wanting to turn back was impossible, immediately mouth corner skewed, speaking difficult, unclear pronunciation, unnatural tongue movement. Left limbs normal, right limbs flaccid paralysis. Diagnosed with cerebral thrombosis by XX Hospital. Hospitalized half a month, efficacy not obvious, then took Chinese medicine. Pulse wiry-fine-rapid, tongue body red, coating thin lacking fluid, chest tightness, vexation, dry throat desiring drink, dark urine. This is Yin deficiency with Yang hyperactivity, latent internal Wind moving, Blood stagnation in collaterals. Prescribed Xi Xian Zhi Yin Tang (Siegesbeckia and Yin-Nourishing Decoction) to treat Yin-deficiency type stroke. Prescription: Zhi Xi Xian 30g, Gan Di Huang 9g, Yan Zhi Mu 12g, Dang Gui 3g, Gou Qi Zi 9g, Chao Chi Shao 12g, Gui Ban 6g, Niu Xi 6g, Gan Ju Hua 9g, Yu Jin 9g, Dan Shen 9g, Lian Qiao, Zhi Zi, Hua Fen each 9g. Take 3 doses, vexation-heat receded, speech clear, mouth corner skew improved. Heart channel heat has receded, but Blood-Heat stagnated in sinews/collaterals not yet thoroughly cleared. Then remove Lian Qiao, Zhi Zi from formula, add Ju Luo 6g, Guang Di Long 3g. Take 7 doses consecutively, paralysis recovered, limb movement normal. Only tongue body still red, pulse still wiry-fine, Yin deficiency still needs continuous nourishment. Change to Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), take 10 doses consecutively, completely recovered. (Ren Yingqiu: Clinical Notes, *Shaanxi New Medicine* 2:42, 1977)