肝病无论急慢性肝炎抑或肝肿大，恒见右胁痞胀疼痛一症。推其机理，总以湿热阻滞于肝经、肝郁气滞或由气及血，血行不畅而致瘀结肝络等，最为临床所习见。急性期间投以疏肝清热、化湿和中之剂，肝功能恢复则肝痛亦渐消失。慢性及迁延性肝区疼痛常多持续缠绵。至于用药，气滞者无非柴胡、香附、川楝子、青陈皮、枳壳之类，而血瘀又不外丹参、郁金、延胡、川芎、桃仁之属。理虽如此而其效终难。某年，余治一慢性肝炎患者，因消化道溃疡发作较甚，先拟理其脾胃，方中用瓜蒌薤白展中阳以化痰浊滞气，不意服后肝区疼痛稍然消失，且历久不发。自此余治肝病而见右胁疼痛之患者，每于对证方中加入前药，常收药到病除、立竿见影之效。盖肝病之肝区疼痛，有与胸痹相类似之机理。余亦曾治一顽固性胸中塞闷病人，诸药罔效，参人蒌皮、枳实．胸闷顿解。可见一症自有一症的对之药，亦属医家着意之处。然《重庆堂随笔》虽云“瓜萎最润肝燥”，而傅青主则曰胸中虚而用之者，“心如遗落”，余尝见虚证胸痹误投瓜蒌而自觉胸中荡然无物、吸吸少气而不知心之所在者。一物而有利弊如此，此非药物自身之过，全在医家之学识技巧而已。
八、肝病愈后
肝病日久或病虽愈而体质未复，人身气血阴阳失于平衡，每易渐入损途。患者常症状繁多而不知其主症何在，纳差神疲，倦怠乏力，心情抑郁，沉默寡欢。惟宜详参四诊，仔细推究五脏六腑之虚实，气血阴阳之盛衰，以及病情进退，服药机变，综合考虑用药方案，始能投剂合辙。
如余治某公司陈经理之室胡氏，45岁。1988年曾患甲肝，愈后十年间多次复查，除乙肝表面抗原阳性外，其余项目均属正常。虽然，而常自感不适，时或中脘作胀，时或肝区疼痛，时或腰酸特甚，时或经汛衍期，时或夜寐欠安。胃纳尚可而乏力懒言，稍稍动作，则感体力不支，面萎色黄，精神困倦。视其脉小而不畅，两尺均弱而右关稍强。舌质淡红，苔薄微带浊腻。余辨其病位虽涉及心肝肾脾胃诸脏腑，而主要在于脾胃中土气阴两虚，痰食阻滞，肝胃湿浊未净，而先天肾元已伤。因而用参术健脾，沙参养胃，夏贝蠲痰，楂菔消食，川断、狗脊益肾强腰，佐丹参、半枝莲、蒲公英清热化浊兼通肝络，方为：
党参20g炒白术9g南北沙参各20g姜半夏9g象贝母15g山楂9g莱菔子9g狗脊9g川断9g丹参9g半枝莲30g蒲公英15g
服三帖，六脉涩象已解，舌上浊苔自除，时觉面热升火。原方加生地15g枸杞子12g元参9g。服一月后至上海铁道大学附属甘泉医院复查，乙肝表面抗原转阴，其余项目均正常。而自觉症状已逐渐消失，纳佳神旺，轻劲多力，面色红润，心情开朗。以后稍有月事不调，予以调理即愈。
某机关干部张某，于三十开外时，曾患轻度十二指肠球部溃疡。1985年起常有胸闷叹息．腰酸腹胀。1986年3月间，上腹及左右少腹隐隐作痛，有明显压痛及轻度叩击痛。初起时作时止，继则持续不解，且痛势递增，并伴神疲乏力，腰酸肢软，大便失序(或日行一、二次，或日行三、四次，无有规律。所下之粪或如蛋花，或如发酵之物，或如泡沫。)多方检查，病源难明。中西医药日啜不离，其效沓然。不得已，四处求医问药。路边草药亦不惜高价购服，病终不减。渐见形消面黑，两眶四周青黄不泽，呈现明显慢性病容。
同年6月25日来诊。余诊其脉左弦细而劲，右弦大而软，舌淡润，苔薄腻，余证一如上述。据四诊而论，此证乃肝肾精血亏损，肝木失其所养，寒邪乘虚留滞于肝经，伤犯中州而发为本病。治法当益肝肾、散寒滞、兼扶脾土。为疏一方：
当归9g赤芍9g肉桂3g(后下)川楝子9g延胡索9g青皮6g茴香3g木香3g菟丝子9g补中益气丸30g(包)
服三帖后腹即不痛，惟短气乏力依然，改以左、右归丸调本扶元，诸证稳定，半年后至12月间腹痛又作，而大便如常。诊得左脉细而软，右脉弦细带涩，因思罗谦甫《卫生宝鉴》之“治疝当归四逆汤”方，恰与此证相当，遂以此方加菟丝子。
肉桂3g淡附片3g小茴香3g柴胡4．5g炒白芍9g泽泻9g当归9g延胡索9g川楝子9g茯苓9g菟丝子9g
上方共服二十三帖，偶与补中益气汤及逍遥散(改汤)间服，竟得腹痛冰释。至今十有余年，从未复发。
按：本案前后两方辨证用药一以贯之，第次方温散止痛之力强于首方，故见效更佳。罗氏之：“治疝当归四逆汤方”药物组成为：肉桂、附子、茴香、柴胡、芍药、元胡索、当归、川楝子、茯苓、泽泻。张氏之病以腹痛为主症，腹痛部位在上腹及左右少腹。腹痛特点为绵绵隐痛，时作时止。根据中医理论大腹属脾，少腹属肝，患者之病位当在肝脾两经。据其疼痛特点，可判断非气虚即寒邪，而于患者实属寒邪为多。病久正气渐衰，从脉见弦细软涩而不呈紧象，症兼神疲腰酸，即可推断。故于方中加当归、菟丝子以扶肝肾，即为扶本计也。
中医治肠痈之方，首推《金匮要略》之大黄牡丹皮汤，谓之经方。此方用药简练而配伍精当，然病势重至有穿孔危险者，则大黄重用恐挺而走险，故恒常多以清热解毒、活血化瘀、消肿止痛之方以治之。六十年代中，余得族前辈邹云翔先生(生前任南京中医学院院长)编校之《中医验方交流集》，书中有治盲肠炎一方，药极简易，而煎服之法稍稍特殊。其文曰：
“红藤一两，黄酒两茶杯煎服。此方是三年前偶然得之，因乡人患盲肠炎，……听说有此灵方，就照方三、四服，结果得全生命而愈，近两年患此病者，都是服用红藤一两、酒水各半煎服，确实有效，已治过四个病人，都是痊愈。”
历年来，余以此方治肠痈或急或缓者十余例，均能药到病除应手取效，是以知其为堪经重复之有效良方。或问：何以此方红藤用量不多，而疗效极高?盖关键在于酒煎，酒能行药势，透经络，行瘀滞，去脓肿。在此方中，恰与红藤相须为用，相得益彰，以建大功。若遇滴酒不饮之人，纯以水煎红藤服则多无效，此等患者宜改用别法治之，以免贻误病机而致偾事。是故不善饮酒者，如酒水各半犹嫌酒多，可少加黄酒一、二匙，多服几剂，亦能有效，现附验案一则，以供参考。
女干部单某，三十七岁。有慢性阑尾炎史，右下腹小痛常作。1982年11月17日疼痛剧发，一下午连往区、市三家医院急诊，血检白细胞逐次递增至一万以上，建议手术治疗，患者惧而不就。每日仅注射庆大霉素二次，连续三日，腹痛依然不减。21日上午来就余诊。余知单素与杜康有缘，迳予酒煎红藤饮方：
红藤30g，用黄酒250毫升，浸泡半小时，加适量自来水，然后加热煎煮，待煎开后三、五分钟，即倒出乘热饮服，只服头煎，不服二汁。下午另以红藤30g，如法继续煎服一次。至翌日上午又服一次，服三次后，疼痛消失。为巩固疗效，续服三次(每日一次共服三日)，从此痊愈。
按：此方源出何书，余未加考证。然《景岳全书》早有记载。该书“新方八阵·因阵”载“肠痈秘方”曰：患肠痈后，“先用红藤一两许，以好酒两碗，煎一碗，午前一服醉卧之。午后用紫花地丁一两许，亦如前煎服，服后痛必渐止为效。”此方至简，服法至易，而效至宏，可谓验方达药矣。而今时惟用红藤，不必地丁，是简之又简也。是故余试步《陋室铭》而戏言曰：“药不在多，有效则灵；方不在峻，愈病则名也。”
例一职员薛某，年近四旬。1972年3月间患泄泻。一日三、四次，便下稀溏，腹鸣之声隔衣可闻。且不可进食荤腥，稍涉油腻，则便泄次数立增。某医院断为慢性肠炎，服药未效。余见其面色苍白带青，脉象弦细。初以为脾虚，予健脾之剂数帖亦未好转。后改由他医给予脾。肾双补汤药，连服一月病证依旧。仍来余处索方，余仔细推敲，反复揣摩。见患者情志反常，多郁易怒。且询知便泄之前，腹中胀急绞痛，刻不容缓；便泄之时，一倾而出，气屎俱下；泄后腹痛全失。过～、二小时，腹又渐痛，痛又渐重，重极则复泻。由此悟及本病为精神性大肠功能紊乱所致，中医所渭肝旺犯脾之候。即投痛泻要方：
嘱服三剂，并暂戒荤腥房帏。服二帖后，病情大减，自以为久泻之后，需补营养，大吃油腻荤物，竟亦未见增病。服毕又予三帖，仍嘱淡食以调之，清心以守之。从此安然矣。
例二某局党委徐副书记，初受其职即重任独肩，辛苦劳碌自不待言。渐觉腹中气胀作呜，时或疼痛急迫，痛辄欲便，得便则痛缓胀减，移时复作如初。是故大便日行五、六次，然皆成形，并不稀溏。曾在某区中心医院诊断为肠炎，服抗生素二十余日，病不少减。于1973年5月5日来诊。脉细软而弦，略偏于浮，指下澄清不浊，舌质淡红带嫩，苔薄净。审证合脉，显系木盛犯土，脾受肝制之象。肝为将军之官，藏血之脏，体阴而用阳。谋虑太过，不仅心脾受损．抑且肝气必滞，肝血必伤。血虚不能濡养其体，气滞不能条畅其志，则其用必亢。犯胃乘脾，势所宜然。因疏痛泻要方：
服二帖，诸证如失。
按：痛泻要方乃刘草窗治肝脾不和、肝旺犯脾而致泄泻之名方。余临证中每遇此证，即用此方，投剂辄应。然所见症状及术芍用量，诸书不一，与余临证所见亦不全同。欲明此二者，先须识得本方治病之机理。江西中医学院张海峰顾问分析本方极为透彻：“本方配伍的重点是抑木，本方主治腹痛泄泻，痛则欲便，便则痛减，肠鸣脉弦，一派肝气横逆、乘克脾土的症状，脾土受害是明显的，但不一定是虚象”。
据此认识，方中诸药之用量，应以抑木止痛之白芍为君，制肝解痉，使骄者挫，横者平。以疏调脾胃滞气之陈皮为臣，白术、防风佐之；若兼风气内盛，郁滞不散者，则以防风为臣，白术、陈皮佐之；如脾虚之象显著者，则臣以白术。
《成方切用》引吴鹤皋(景岳同)方用白术三两，白芍二两，陈皮两半，防风一两。白术重于自芍，似与肝旺犯脾、木强而中土受制之机理不合。当属土虚为甚、木旺次之者所宜。虽同是土虚与木旺，而病之因果不同，而用药之分量亦随之不同，是谓随机应变者也。
《汤头歌诀》用白芍四两，白术三两，陈皮两半，防风一两。适用于木气强盛而兼脾虚之证候。
本方证候特点首在于痛与泻。初起腹中绵绵作痛，肠鸣回转，愈痛愈剧。痛甚则泻，泻下极爽，有时气屎俱下，一倾而出。泻后腹痛显减，移时复作如前，痛甚再泻。如此周而复始，循环往复。一日数次，多则十余次。此因肝气郁而不伸故痛，郁甚则痛甚，郁极从大肠夺路而出故便泄。泄则肝气暂疏，故腹痛顿挫而暂缓。此其一。
其二，此病之起因，每与精神情志关系密切，故患者发病前，往往具有精神情志变动过程。
其三，痛与泻虽甚虽久，而患者每每胃纳不减，体力不衰。自有别于中土虚弱之慢性腹泻。
便秘不通原因甚多，治法也因之而异。如热秘用麻子仁丸，气秘宜六磨汤，气虚须黄芪汤，血虚则润肠丸，阳虚投济川煎等。其中肝火内郁而致大便不通者，古方有更衣丸，以芦荟，朱砂为剂，药性较峻，易伤脾胃，且朱砂内藏汞质，久服非宜。而决明子味甘性微寒，炒焦后甘香悦脾，具清肝明目、解暑通便之效，可久服无虞，允为便秘不通之良剂。还能清肝热、降血压、化脂质、消肥胖，则开通地道仅为其诸般功效之一端而已。且决明子于通便诸药中，性味平和，无明显副反应，虚人、老人及稚童皆可服用，亦不仅限于肝热便秘。
肝病，无论是急性或慢性肝炎，还是肝肿大，通常都会出现右胁部痞闷、胀满和疼痛的症状。推究其机理，总归是湿热阻滞于肝经，或者肝气郁结导致气机滞涩，进而由气分影响到血分，造成血行不畅而形成瘀结在肝络中，这些在临床上最为常见。在急性发作期间，使用疏肝清热、化湿和中的方剂治疗，肝功能恢复后，肝痛也会逐渐消失。而慢性及迁延性的肝区疼痛往往持续缠绵难愈。至于用药方面，对于气滞者，无非是用柴胡、香附、川楝子、青皮陈皮、枳壳这类药物；而对于血瘀者，不外乎用丹参、郁金、延胡索、川芎、桃仁这一类药材。道理虽然如此，但疗效终究难以理想。某一年，我治疗一位慢性肝炎患者，因为消化道溃疡发作较为严重，先打算调理他的脾胃，方剂中使用了瓜蒌薤白来展布中焦阳气以化痰浊滞气，没想到服用后肝区疼痛竟然消失了，而且长久没有复发。从此以后，我在治疗肝病且伴有右胁疼痛的患者时，每在对症的方剂中加入前面的药物（瓜蒌、薤白等），常常收到药到病除、立竿见影的效果。大概是因为肝病引起的肝区疼痛，有着与胸痹（胸部憋闷疼痛）相似的机理。我也曾治疗过一位顽固性胸中塞闷的病人，各种药物都无效，加入瓜蒌皮、枳实之后，胸闷立刻缓解。可见一种症状自然有一种针对它的特效药，这也是医生需要用心钻研的地方。然而，《重庆堂随笔》虽然说“瓜蒌最润肝燥”，但傅青主则说如果胸中虚损的人使用它，会感到“心如遗落”（心中空虚失落）。我曾见过虚证胸痹误投瓜蒌，导致病人自觉胸中荡然无物、呼吸微弱不知心在何处的情况。一味药竟有如此利弊，这并非药物本身的过错，全在于医生的学识和技巧罢了。
八、肝病痊愈后的调治
肝病日久，或者病虽已愈但体质尚未恢复，人体气血阴阳失去平衡，很容易逐渐进入虚损的途径。患者常症状繁多却不知主要症状在哪里，食欲差、精神疲倦，倦怠乏力，心情抑郁，沉默寡欢。这时只宜详细参考四诊（望、闻、问、切），仔细推究五脏六腑的虚实，气血阴阳的盛衰，以及病情的进退变化、服药的机变，综合考虑用药方案，才能投药准确合辙。
比如我治疗某公司陈经理的妻子胡氏，45岁。1988年曾患甲型肝炎，痊愈后十年间多次复查，除了乙肝表面抗原阳性外，其余项目均属正常。虽然如此，但她常自感不适，有时中脘部作胀，有时肝区疼痛，有时腰酸特别严重，有时月经延期，有时夜间睡眠不安稳。胃纳尚可但乏力懒言，稍微活动，就感到体力不支，面色萎黄，精神困倦。看她的脉象小而不畅，两尺脉均弱而右关脉稍强。舌质淡红，苔薄微带浊腻。我辨别她的病位虽然涉及心、肝、肾、脾、胃诸脏腑，而主要在于脾胃中土气阴两虚，痰食阻滞，肝胃湿浊未净，而先天肾元已伤。因此用党参、白术健脾，沙参养胃，半夏、贝母蠲除痰浊，山楂、莱菔子消食，川断、狗脊益肾强腰，佐以丹参、半枝莲、蒲公英清热化浊兼通肝络，方剂为：
党参20g 炒白术9g 南北沙参各20g 姜半夏9g 象贝母15g 山楂9g 莱菔子9g 狗脊9g 川断9g 丹参9g 半枝莲30g 蒲公英15g
服用三帖后，六脉涩象已解，舌上浊苔自除，时常觉得面部发热升火。原方加生地15g、枸杞子12g、玄参9g。服用一个月后到上海铁道大学附属甘泉医院复查，乙肝表面抗原转阴，其余项目均正常。而自觉症状已逐渐消失，食欲佳精神旺，轻劲多力，面色红润，心情开朗。以后稍有月事不调，予以调理即愈。
某机关干部张某，三十开外时，曾患轻度十二指肠球部溃疡。从1985年起常有胸闷叹息、腰酸腹胀。1986年3月间，上腹及左右少腹隐隐作痛，有明显压痛及轻度叩击痛。初起时作时止，继则持续不解，且痛势递增，并伴有神疲乏力，腰酸肢软，大便失序（或日行一、二次，或日行三、四次，无有规律。所下之粪或如蛋花，或如发酵之物，或如泡沫。）多方检查，病源难明。中西医药日日不离口，其效杳然。不得已，四处求医问药。路边草药也不惜高价购服，病终不减。渐见形体消瘦面色黑，两眼眶四周青黄不泽，呈现明显慢性病容。
同年6月25日来诊。我诊其脉左弦细而劲，右弦大而软，舌淡润，苔薄腻，其他证候一如上述。据四诊而论，此证乃肝肾精血亏损，肝木失其所养，寒邪乘虚留滞于肝经，伤犯中州而发为本病。治法当益肝肾、散寒滞、兼扶脾土。于是开具一方：
当归9g 赤芍9g 肉桂3g（后下） 川楝子9g 延胡索9g 青皮6g 茴香3g 木香3g 菟丝子9g 补中益气丸30g（包煎）
服用三帖后腹部即不痛，惟短气乏力依然，改以左归丸、右归丸调本扶元，诸证稳定，半年后至12月间腹痛又发作，而大便如常。诊得左脉细而软，右脉弦细带涩，因而想到罗谦甫《卫生宝鉴》中的“治疝当归四逆汤”方，恰与此证相当，遂以此方加菟丝子。
肉桂3g 淡附片3g 小茴香3g 柴胡4.5g 炒白芍9g 泽泻9g 当归9g 延胡索9g 川楝子9g 茯苓9g 菟丝子9g
上方共服二十三帖，偶尔配合补中益气汤及逍遥散（改为汤剂）间服，竟得腹痛冰释。至今十有余年，从未复发。
按语：本案前后两方辨证用药一以贯之，第二次方温散止痛之力强于首方，故见效更佳。罗氏的“治疝当归四逆汤方”药物组成为：肉桂、附子、茴香、柴胡、芍药、元胡索、当归、川楝子、茯苓、泽泻。张氏的病以腹痛为主症，腹痛部位在上腹及左右少腹。腹痛特点为绵绵隐痛，时作时止。根据中医理论大腹属脾，少腹属肝，患者的病位当在肝脾两经。据其疼痛特点，可判断非气虚即寒邪，而对于患者实属寒邪为多。病久正气渐衰，从脉见弦细软涩而不呈紧象，症兼神疲腰酸，即可推断。故于方中加当归、菟丝子以扶肝肾，即为扶本计也。
中医治疗肠痈（阑尾炎）的方剂，首推《金匮要略》的大黄牡丹皮汤，称之为经方。此方用药简练而配伍精当，然而病势重至有穿孔危险者，则重用大黄恐怕挺而走险，故恒常多以清热解毒、活血化瘀、消肿止痛的方剂来治疗。六十年代中期，我得到族前辈邹云翔先生（生前任南京中医学院院长）编校的《中医验方交流集》，书中有治盲肠炎一方，药极简易，而煎服之法稍稍特殊。其文曰：
“红藤一两，黄酒两茶杯煎服。此方是三年前偶然得之，因乡人患盲肠炎，……听说有此灵方，就照方三、四服，结果得全生命而愈，近两年患此病者，都是服用红藤一两、酒水各半煎服，确实有效，已治过四个病人，都是痊愈。”
历年来，我用此方治疗肠痈或急或缓者十余例，均能药到病除应手取效，是以知其为堪经重复之有效良方。有人问：为何此方红藤用量不多，而疗效极高？盖关键在于酒煎，酒能行药势，透经络，行瘀滞，去脓肿。在此方中，恰与红藤相须为用，相得益彰，以建大功。若遇滴酒不饮之人，纯以水煎红藤服则多无效，此类患者宜改用别法治之，以免贻误病机而致失败。是故不善饮酒者，如酒水各半犹嫌酒多，可少加黄酒一、二匙，多服几剂，亦能有效，现附验案一则，以供参考。
女干部单某，三十七岁。有慢性阑尾炎史，右下腹小痛常作。1982年11月17日疼痛剧发，一下午连往区、市三家医院急诊，血检白细胞逐次递增至一万以上，建议手术治疗，患者惧而不就。每日仅注射庆大霉素二次，连续三日，腹痛依然不减。21日上午来就余诊。我知单某素与杜康有缘（指爱喝酒），径直予酒煎红藤饮方：
红藤30g，用黄酒250毫升，浸泡半小时，加适量自来水，然后加热煎煮，待煎开后三、五分钟，即倒出乘热饮服，只服头煎，不服二汁。下午另以红藤30g，如法继续煎服一次。至翌日上午又服一次，服三次后，疼痛消失。为巩固疗效，续服三次（每日一次共服三日），从此痊愈。
按语：此方源出何书，我未加考证。然而《景岳全书》早有记载。该书“新方八阵·因阵”载“肠痈秘方”曰：患肠痈后，“先用红藤一两许，以好酒两碗，煎一碗，午前一服醉卧之。午后用紫花地丁一两许，亦如前煎服，服后痛必渐止为效。”此方至简，服法至易，而效至宏，可谓验方达药矣。而今时惟用红藤，不必地丁，是简之又简也。是故我试步《陋室铭》而戏言曰：“药不在多，有效则灵；方不在峻，愈病则名也。”
例一职员薛某，年近四旬。1972年3月间患泄泻。一日三、四次，便下稀溏，腹鸣之声隔衣可闻。且不可进食荤腥，稍涉油腻，则便泄次数立增。某医院断为慢性肠炎，服药未效。我见其面色苍白带青，脉象弦细。初以为脾虚，予健脾之剂数帖亦未好转。后改由他医给予脾肾双补汤药，连服一月病证依旧。仍来我处索方，我仔细推敲，反复揣摩。见患者情志反常，多郁易怒。且询知便泄之前，腹中胀急绞痛，刻不容缓；便泄之时，一倾而出，气屎俱下；泄后腹痛全失。过一、二小时，腹又渐痛，痛又渐重，重极则复泻。由此悟及本病为精神性大肠功能紊乱所致，中医所谓肝旺犯脾之候。即投痛泻要方：
嘱服三剂，并暂戒荤腥房帏。服二帖后，病情大减，自以为久泻之后，需补营养，大吃油腻荤物，竟亦未见增病。服毕又予三帖，仍嘱淡食以调之，清心以守之。从此安然矣。
例二某局党委徐副书记，初受其职即重任独肩，辛苦劳碌自不待言。渐觉腹中气胀作呜，时或疼痛急迫，痛辄欲便，得便则痛缓胀减，移时复作如初。是故大便日行五、六次，然皆成形，并不稀溏。曾在某区中心医院诊断为肠炎，服抗生素二十余日，病不少减。于1973年5月5日来诊。脉细软而弦，略偏于浮，指下澄清不浊，舌质淡红带嫩，苔薄净。审证合脉，显系木盛犯土，脾受肝制之象。肝为将军之官，藏血之脏，体阴而用阳。谋虑太过，不仅心脾受损，抑且肝气必滞，肝血必伤。血虚不能濡养其体，气滞不能条畅其志，则其用必亢。犯胃乘脾，势所宜然。因疏痛泻要方：
服二帖，诸证如失。
按语：痛泻要方乃刘草窗治疗肝脾不和、肝旺犯脾而致泄泻之名方。我临证中每遇此证，即用此方，投剂辄应。然而所见症状及术芍用量，诸书不一，与我临证所见亦不全同。欲明此二者，先须识得本方治病之机理。江西中医学院张海峰顾问分析本方极为透彻：“本方配伍的重点是抑木，本方主治腹痛泄泻，痛则欲便，便则痛减，肠鸣脉弦，一派肝气横逆、乘克脾土的症状，脾土受害是明显的，但不一定是虚象”。
据此认识，方中诸药之用量，应以抑木止痛之白芍为君，制肝解痉，使骄者挫，横者平。以疏调脾胃滞气之陈皮为臣，白术、防风佐之；若兼风气内盛，郁滞不散者，则以防风为臣，白术、陈皮佐之；如脾虚之象显著者，则臣以白术。
《成方切用》引吴鹤皋（景岳同）方用白术三两，白芍二两，陈皮两半，防风一两。白术重于白芍，似与肝旺犯脾、木强而中土受制之机理不合。当属土虚为甚、木旺次之者所宜。虽同是土虚与木旺，而病之因果不同，而用药之分量亦随之不同，是谓随机应变者也。
《汤头歌诀》用白芍四两，白术三两，陈皮两半，防风一两。适用于木气强盛而兼脾虚之证候。
本方证候特点首在于痛与泻。初起腹中绵绵作痛，肠鸣回转，愈痛愈剧。痛甚则泻，泻下极爽，有时气屎俱下，一倾而出。泻后腹痛显减，移时复作如前，痛甚再泻。如此周而复始，循环往复。一日数次，多则十余次。此因肝气郁而不伸故痛，郁甚则痛甚，郁极从大肠夺路而出故便泄。泄则肝气暂疏，故腹痛顿挫而暂缓。此其一。
其二，此病之起因，每与精神情志关系密切，故患者发病前，往往具有精神情志变动过程。
其三，痛与泻虽甚虽久，而患者每每胃纳不减，体力不衰。自有别于中土虚弱之慢性腹泻。
便秘不通原因甚多，治法也因之而异。如热秘用麻子仁丸，气秘宜六磨汤，气虚须黄芪汤，血虚则润肠丸，阳虚投济川煎等。其中肝火内郁而致大便不通者，古方有更衣丸，以芦荟、朱砂为剂，药性较峻，易伤脾胃，且朱砂内藏汞质，久服非宜。而决明子味甘性微寒，炒焦后甘香悦脾，具清肝明目、解暑通便之效，可久服无虞，允为便秘不通之良剂。还能清肝热、降血压、化脂质、消肥胖，则开通地道仅为其诸般功效之一端而已。且决明子于通便诸药中，性味平和，无明显副反应，虚人、老人及稚童皆可服用，亦不仅限于肝热便秘。
Liver diseases, whether acute or chronic hepatitis, or hepatomegaly (enlarged liver), invariably present with the symptom of distension, fullness, and pain in the right hypochondrium. Analyzing the mechanism, it is generally due to damp-heat obstructing the Liver meridian, Liver Qi stagnation leading to Qi constraint, or progression from Qi to Blood, causing poor blood circulation resulting in blood stasis binding in the Liver collaterals; these are the most common in clinical practice. During the acute phase, administering formulas that soothe the Liver, clear heat, resolve dampness, and harmonize the Middle Jiao allows liver function to recover, after which liver pain gradually disappears. However, hepatic pain in chronic and persistent cases often lingers and is difficult to cure. Regarding medication, for Qi stagnation, herbs such as Chai Hu (Bupleuri Radix), Xiang Fu (Cyperus Rhizome), Chuan Lian Zi (Toosendan Fruit), Qing Pi (Aurantii Fructus Immaturus) and Chen Pi (Aurantii Fructus), and Zhi Qiao (Aurantii Fructus) are used; for blood stasis, herbs such as Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Yu Jin (Curcumae Radix), Yan Hu Suo (Corydalis Rhizoma), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Tao Ren (Persicae Semen) are employed. Although the principle is sound, the efficacy is ultimately unsatisfactory. One year, I treated a patient with chronic hepatitis who suffered a severe exacerbation of digestive ulcer. Initially, I planned to regulate his Spleen and Stomach, using Gua Lou (Trichosanthis Fructus) and Xie Bai (Allii Macrostemonis Bulbus) in the formula to spread Middle Jiao Yang to transform phlegm-turbidity and stagnant Qi. Unexpectedly, after taking it, the hepatic pain disappeared completely and did not recur for a long time. Since then, when treating patients with liver disease presenting with right hypochondriac pain, I have added these previous herbs to the symptomatic formula, often achieving immediate and striking effects. This is likely because the hepatic pain caused by liver disease shares a similar mechanism with Xiong Bi (chest bi-syndrome/chest obstruction). I also once treated a patient with stubborn chest stuffiness and oppression where all medications failed; after adding Gua Lou Pi (Trichosanthis Pericarpium) and Zhi Shi (Aurantii Fructus Immaturus), the chest oppression was instantly relieved. It can be seen that each symptom has its specific counter-agent, which requires careful attention by physicians. However, although *Chongqing Tang Suibi* states that "Gua Lou best moistens Liver dryness," Fu Qingzhu said that if used in cases of deficiency in the chest, it causes a feeling of "heart being lost" (emptiness). I have seen cases of deficiency-type chest bi-syndrome where Gua Lou was mistakenly administered, resulting in the patient feeling empty in the chest, breathing weakly, and losing awareness of the heart's location. A single herb having such pros and cons is not the fault of the drug itself, but entirely depends on the physician's knowledge and skill.
VIII. Post-recovery Care for Liver Disease
If liver disease persists for a long time, or if the disease has resolved but the constitution has not recovered, the body's Qi, Blood, Yin, and Yang lose balance, easily leading to a state of deficiency and damage. Patients often present with numerous symptoms without knowing the main one: poor appetite, mental fatigue, lassitude, depression, and taciturnity. In such cases, one must carefully consult the Four Diagnostic Methods (inspection, auscultation/olfaction, inquiry, palpation), meticulously analyze the deficiency and excess of the Zang-Fu organs, the flourishing and decline of Qi, Blood, Yin, and Yang, as well as the progression of the illness and variations in medication response, to comprehensively formulate a treatment plan, thereby ensuring accurate prescription.
For example, I treated Ms. Hu, wife of Manager Chen of a certain company, aged 45. In 1988, she contracted Hepatitis A. Over the next ten years, multiple follow-up examinations showed that except for positive Hepatitis B surface antigen, all other items were normal. Nevertheless, she often felt unwell, sometimes experiencing epigastric distension, sometimes hepatic pain, sometimes severe lower back soreness, sometimes delayed menstruation, and sometimes restless sleep. Her appetite was acceptable, but she lacked energy and spoke little. Any slight movement made her feel physically exhausted; her complexion was sallow, and she was mentally fatigued. Her pulse was small and unsmooth, with both Chi pulses weak and the Right Guan pulse slightly strong. The tongue was pale red with a thin coating slightly turbid and greasy. I determined that although the disease site involved the Heart, Liver, Kidney, Spleen, and Stomach, the primary issue was Qi and Yin deficiency of the Middle Earth (Spleen/Stomach), with phlegm-food stagnation, unresolved damp-turbidity in the Liver and Stomach, and injury to the congenital Kidney Yuan. Therefore, I used Dang Shen (Codonopsis Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) to strengthen the Spleen, Sha Shen (Glehniae Radix or Adenophorae Radix) to nourish the Stomach, Ban Xia (Pinelliae Rhizoma) and Bei Mu (Fritillariae Bulbus) to eliminate phlegm, Shan Zha (Crataegi Fructus) and Lai Fu Zi (Radish Seed) to digest food, Chuan Duan (Dipsaci Radix) and Gou Ji (Cibotii Rhizoma) to tonify the Kidney and strengthen the waist, assisted by Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Ban Zhi Lian (Scutellariae Barbatae Herba), and Pu Gong Ying (Taraxaci Herba) to clear heat, resolve turbidity, and unblock Liver collaterals. The formula was:
Dang Shen 20g, Fried Bai Zhu 9g, Nan/North Sha Shen 20g each, Ginger-processed Ban Xia 9g, Xiang Bei Mu 15g, Shan Zha 9g, Lai Fu Zi 9g, Gou Ji 9g, Chuan Duan 9g, Dan Shen 9g, Ban Zhi Lian 30g, Pu Gong Ying 15g.
After three doses, the choppy quality of the six pulses resolved, and the turbid tongue coating cleared spontaneously, accompanied by occasional facial flushing. The original formula was modified by adding Sheng Di (Rehmanniae Radix) 15g, Gou Qi Zi (Lycii Fructus) 12g, and Xuan Shen (Scrophulariae Radix) 9g. After one month of administration, re-examination at Ganquan Hospital affiliated to Shanghai Railway University showed the Hepatitis B surface antigen turned negative, and all other items were normal. Self-perceived symptoms gradually disappeared; appetite improved, spirit was vigorous, strength increased, complexion became ruddy, and mood became cheerful. Subsequent minor menstrual irregularities were resolved with regulation.
Treatment of Stubborn Abdominal Pain by Warming the Liver
Mr. Zhang, a government cadre, suffered from mild duodenal bulb ulcer in his thirties. From 1985, he frequently experienced chest oppression with sighing, lower back soreness, and abdominal distension. In March 1986, he had dull pain in the upper abdomen and left/right lower abdomen, with obvious tenderness and mild percussion pain. Initially intermittent, it later became continuous, increasing in intensity, accompanied by mental fatigue, weakness, sore back and soft limbs, and irregular bowel movements (either 1-2 times or 3-4 times daily, without pattern. Stool varied like egg flowers, fermented matter, or foam.) Extensive examinations failed to identify the source. He took Chinese and Western medicines daily without effect. Desperately, he sought medical help everywhere, even buying roadside herbal remedies at high prices, but the disease persisted. He gradually became emaciated with dark complexion, blue-yellow discoloration around the orbits, presenting an obvious chronic ill appearance.
He visited me on June 25 of the same year. My diagnosis revealed a Left pulse that was wiry, fine, and forceful, and a Right pulse that was wiry, large, and soft. The tongue was pale and moist with a thin greasy coating. Other symptoms remained as described. Based on the Four Diagnoses, this condition resulted from deficiency of Essence and Blood in the Liver and Kidney, causing Liver Wood to lose nourishment, allowing Cold pathogen to linger in the Liver meridian due to deficiency, injuring the Middle Jiao and causing this disease. The treatment method should tonify Liver and Kidney, disperse Cold stagnation, and support Spleen Earth. I prescribed:
Dang Gui (Angelicae Sinensis Radix) 9g, Chi Shao (Paeoniae Radix Rubra) 9g, Rou Gui (Cinnamomi Cortex) 3g (added later), Chuan Lian Zi 9g, Yan Hu Suo 9g, Qing Pi 6g, Hui Xiang (Foeniculi Fructus) 3g, Mu Xiang (Aucklandiae Radix) 3g, Tu Si Zi (Cuscutae Semen) 9g, Bu Zhong Yi Qi Wan (Tonify the Middle and Augment the Qi Pill) 30g (wrapped).
After three doses, abdominal pain ceased, but shortness of breath and fatigue persisted. Treatment was changed to Zuo Gui Wan (Left Restoring Pill) and You Gui Wan (Right Restoring Pill) to regulate the root and support Yuan Qi. Symptoms stabilized. Between half a year and December, abdominal pain recurred, but bowel movements were normal. The Left pulse was fine and soft, and the Right pulse was wiry, fine, and slightly choppy. Recalling Luo Qianfu's "Wei Sheng Bao Jian" (Treasure Mirror of Health) formula "Gui Zhi Si Ni Tang for Treating Hernia," which matched this condition, I used this formula plus Tu Si Zi.
Rou Gui 3g, Dan Fu Pian (Prepared Aconiti Lateralis Radix) 3g, Xiao Hui Xiang 3g, Chai Hu (Bupleuri Radix) 4.5g, Fried Bai Shao (Paeoniae Radix Alba) 9g, Ze Xie (Alismatis Rhizoma) 9g, Dang Gui 9g, Yan Hu Suo 9g, Chuan Lian Zi 9g, Fu Ling (Poria) 9g, Tu Si Zi 9g.
The above formula was taken for a total of 23 doses, occasionally interspersed with Bu Zhong Yi Qi Tang and Xiao Yao San (modified to decoction). Eventually, the abdominal pain was completely resolved. For over ten years since then, it has never recurred.
Commentary: The differentiation and medication in the two formulas of this case were consistent. The second formula had stronger warming, dispersing, and pain-relieving power than the first, hence better results. Luo's "Gui Zhi Si Ni Tang for Treating Hernia" consists of: Rou Gui, Fu Zi, Hui Xiang, Chai Hu, Shao Yao, Yan Hu Suo, Dang Gui, Chuan Lian Zi, Fu Ling, Ze Xie. Mr. Zhang's main symptom was abdominal pain, located in the upper abdomen and left/right lower abdomen. The pain was dull, lingering, and intermittent. According to TCM theory, the great abdomen belongs to the Spleen, and the lower abdomen belongs to the Liver; thus, the disease site was in the Liver and Spleen meridians. Based on the pain characteristics, it could be judged as either Qi deficiency or Cold pathogen, with Cold being more likely for this patient. As the disease prolonged, righteous Qi declined; the wiry, fine, soft, and choppy pulse (without tightness) combined with mental fatigue and back soreness confirmed this. Thus, Dang Gui and Tu Si Zi were added to support Liver and Kidney, which is supporting the root.
Effective Formula for Intestinal Abscess: Wine-Decocted Hong Teng Drink
In TCM, the premier formula for treating intestinal abscess (appendicitis) is Da Huang Mu Dan Pi Tang from *Jin Gui Yao Lue*, known as a classic formula. Its medication is concise and well-composed. However, in severe cases with risk of perforation, heavy use of Da Huang might be too risky. Therefore, formulas clearing heat-toxicity, invigorating blood, resolving stasis, reducing swelling, and relieving pain are commonly used. In the mid-1960s, I obtained *Exchange Collection of Effective TCM Formulas* edited by my senior clan member, Mr. Zou Yunxiang (former President of Nanjing College of Traditional Chinese Medicine). It contained a simple formula for appendicitis with a special decoction method:
"Hong Teng (Sargentodoxae Caulis) 1 liang, decocted with two tea cups of yellow wine. I obtained this effective formula accidentally three years ago when a villager had appendicitis... Hearing of this miracle formula, I took it three or four times according to the prescription, resulting in survival and recovery. In the past two years, patients with this disease all took 1 liang of Hong Teng decocted with half water and half wine, which was indeed effective. I have treated four patients, all cured."
Over the years, I have used this formula to treat over ten cases of intestinal abscess, acute or chronic, all responding immediately to the medicine, confirming it as a reliable and effective formula. Some ask: Why is the dosage of Hong Teng not high, yet the efficacy is extremely high? The key lies in wine-decoction. Wine can promote drug potency, penetrate collaterals, move blood stasis, and remove abscesses. In this formula, it works synergistically with Hong Teng to achieve great success. For those who do not drink alcohol at all, decocting Hong Teng purely with water is mostly ineffective. Such patients should use alternative treatments to avoid missing the therapeutic window and causing failure. Therefore, for those who cannot drink well, if half-water-half-wine still seems too much wine, adding only one or two spoons of yellow wine and taking several doses can also be effective. An effective case is attached below for reference.
Female cadre Ms. Shan, 37 years old. History of chronic appendicitis with frequent mild pain in the right lower abdomen. On November 17, 1982, pain flared severely. She visited emergency rooms at district and city hospitals three times in one afternoon. White blood cell count rose progressively to over 10,000. Surgical treatment was recommended, but the patient feared surgery and refused. She received Gentamicin injections twice daily for three consecutive days, but abdominal pain persisted. She visited me on the morning of the 21st. Knowing Ms. Shan loved alcohol ("had fate with Dukang"), I directly prescribed the Wine-Decocted Hong Teng Drink:
Hong Teng 30g, soaked in 250ml yellow wine for half an hour, add appropriate amount of tap water, then heat and decoct. After boiling for 3-5 minutes, pour out and drink hot. Only take the first decoction, not the second. In the afternoon, another 30g of Hong Teng was decocted and taken in the same manner. Taken again the next morning. After three doses, pain disappeared. To consolidate efficacy, three more doses were taken (once daily for three days), resulting in complete cure.
Commentary: I did not verify the source of this formula. However, it is recorded in *Jing Yue Quan Shu*. The book's "New Formulas Eight Arrays · Cause Array" records the "Secret Formula for Intestinal Abscess": After suffering intestinal abscess, "first use about 1 liang of Hong Teng, decoct with two bowls of good wine until one bowl remains, take before noon and sleep drunk. In the afternoon, use about 1 liang of Zi Hua Di Ding (Viola Herba), decoct similarly, and take. Pain will gradually stop after taking, which indicates efficacy." This formula is extremely simple, easy to administer, and highly effective, truly an empirical formula with potent drugs. Nowadays, only Hong Teng is used, without Di Ding, simplifying it further. Thus, I jokingly say in the style of *Lou Shi Ming*: "Medicine need not be many, effective makes it spiritual; Formula need not be harsh, curing disease makes it famous."
Tong Xie Yao Fang (Painful Diarrhea Essential Formula) for Painful Diarrhea
Case 1: Clerk Mr. Xue, nearly forty. In March 1972, he suffered from diarrhea. Three to four times daily, loose stools, borborygmus audible through clothes. He could not eat meat or greasy food; any contact with grease immediately increased stool frequency. A hospital diagnosed chronic enteritis, but medication failed. I observed his pale-blue complexion and wiry-fine pulse. Initially suspecting Spleen deficiency, I gave Spleen-strengthening agents for several doses without improvement. Later, another doctor prescribed Spleen-Kidney dual tonification pills for a month, with no change. He returned to me. I carefully analyzed and pondered. I noticed abnormal emotional state, depression, and irritability. Inquiry revealed that before diarrhea, there was urgent bloating and colic; during defecation, gas and stool expelled together; after defecation, abdominal pain completely vanished. After one or two hours, abdominal pain gradually returned, intensified, and led to repeated diarrhea. I realized this disease was caused by psychogenic large intestine dysfunction, known in TCM as Liver Excess invading Spleen. I immediately prescribed Tong Xie Yao Fang:
Fried Bai Shao 18g, Charred Bai Zhu 6g, Chen Pi 9g, Fang Feng (Saposhnikoviae Radix) 4.5g.
Instructed to take three doses and temporarily abstain from meat and sexual activity. After two doses, condition greatly reduced. Believing nutrition was needed after long-term diarrhea, he ate heavily of greasy meat, yet disease did not worsen. After finishing, three more doses were given, with instructions for bland diet and calm mind. He recovered peacefully thereafter.
Case 2: Deputy Secretary Xu of a Bureau Party Committee. Upon assuming office, he bore heavy responsibilities alone, working hard. Gradually, he felt abdominal gas distension and borborygmus, sometimes urgent pain requiring defecation; relief came after defecation, but symptoms returned after a while. Thus, bowel movements occurred five to six times daily, but formed, not loose. Diagnosed with enteritis at a district central hospital, he took antibiotics for over twenty days with little reduction. He visited me on May 5, 1973. Pulse was fine, soft, and wiry, slightly floating, clear under fingers, not turbid. Tongue was pale red and tender, coating thin and clean. Examining symptoms and pulse, it clearly indicated Wood Excess invading Earth, Spleen constrained by Liver. Liver is the General Officer, stores Blood, has Yin substance and Yang function. Overthinking damages Heart and Spleen, and inevitably causes Liver Qi stagnation and Liver Blood injury. Blood deficiency fails to nourish the substance, Qi stagnation fails to smooth the will, so its function becomes hyperactive. Invading Stomach and attacking Spleen is inevitable. Therefore, I prescribed Tong Xie Yao Fang:
Fried Bai Shao 15g, Charred Bai Zhu 9g, Chen Pi 12g, Fang Feng 4.5g.
After two doses, all symptoms vanished.
Commentary: Tong Xie Yao Fang is a famous formula by Liu Caochuang for treating diarrhea caused by Liver-Spleen disharmony and Liver Excess invading Spleen. In my clinical practice, whenever I encounter this syndrome, I use this formula, and it always responds. However, symptoms and dosages of Bai Zhu and Bai Shao vary among books and differ from my clinical observations. To understand this, one must first grasp the mechanism of this formula. Consultant Zhang Haifeng of Jiangxi College of TCM analyzed it thoroughly: "The focus of this formula's composition is suppressing Wood. It treats abdominal pain and diarrhea, urgency to defecate with pain relief after defecation, borborygmus, and wiry pulse—a set of symptoms showing Liver Qi horizontal rebellion overcoming Spleen Earth. Spleen Earth damage is obvious, but not necessarily deficiency."
Based on this understanding, the dosage of herbs should prioritize Bai Shao as the Sovereign herb for suppressing Wood and relieving pain, restraining Liver and relieving spasm, calming arrogance and flattening rebellion. Chen Pi acts as the Minister to regulate stagnant Qi in Spleen and Stomach, assisted by Bai Zhu and Fang Feng; if internal Wind-Qi is abundant and stagnation does not dissipate, Fang Feng acts as Minister, assisted by Bai Zhu and Chen Pi; if Spleen deficiency signs are prominent, Bai Zhu acts as Minister.
*Cheng Fang Qie Yong* cites Wu Hegao's formula (contemporary of Jing Yue) using Bai Zhu 3 liang, Bai Shao 2 liang, Chen Pi 1.5 liang, Fang Feng 1 liang. Bai Zhu heavier than Bai Shao seems inconsistent with the mechanism of Liver Excess invading Spleen where Wood is strong and Middle Earth is constrained. It is suitable for cases where Earth deficiency is severe and Wood excess is secondary. Although both involve Earth deficiency and Wood excess, the cause-and-effect differs, so dosages vary accordingly, demonstrating adaptability.
*Tang Tou Ge Jue* uses Bai Shao 4 liang, Bai Zhu 3 liang, Chen Pi 1.5 liang, Fang Feng 1 liang. Suitable for syndromes of strong Wood Qi combined with Spleen deficiency.
The characteristic of this formula's syndrome lies primarily in pain and diarrhea. Initially, dull abdominal pain with borborygmus, worsening with pain. Severe pain leads to diarrhea, which is very satisfying, sometimes with gas and stool expelled together. Abdominal pain significantly reduces after defecation, returns after a while, and severe pain leads to further diarrhea. This cycle repeats several times a day, up to ten times. This is because Liver Qi stagnation fails to extend, causing pain; extreme stagnation causes severe pain; extreme stagnation breaks through the Large Intestine causing diarrhea. Defecation temporarily relieves Liver Qi, so abdominal pain pauses. This is point one.
Secondly, the cause of this disease is closely related to mental and emotional factors. Before onset, patients often undergo emotional changes.
Thirdly, despite severe and long-lasting pain and diarrhea, the patient's appetite and physical strength remain unchanged. This distinguishes it from chronic diarrhea due to Middle Earth deficiency.
Cassia Seed (Jue Ming Zi): A Good Medicine for Constipation
There are many causes of constipation, and treatments vary accordingly. For Heat constipation, Ma Zi Ren Wan is used; for Qi constipation, Liu Mo Tang is suitable; for Qi deficiency, Huang Qi Tang is required; for Blood deficiency, Run Chang Wan is used; for Yang deficiency, Ji Chuan Jian is administered. Among them, for constipation caused by internal Liver Fire depression, ancient formulas include Geng Yi Wan, made of Lu Hui (Aloe) and Zhu Sha (Cinnabar). The drug nature is harsh, easily damaging Spleen and Stomach, and Zhu Sha contains mercury, making long-term use inadvisable. Cassia seed (Jue Ming Zi) tastes sweet and is slightly cold. After stir-frying until scorched, it becomes fragrant and pleases the Spleen. It has effects of clearing Liver heat, brightening eyes, resolving summerheat, and promoting bowel movement. It can be taken long-term safely, making it an excellent agent for constipation. It can also clear Liver heat, lower blood pressure, metabolize lipids, and reduce obesity; opening the earthy pathway is just one of its many effects. Moreover, among laxatives, Jue Ming Zi has a mild nature and taste, with no obvious side effects. It can be taken by the deficient, elderly, and children, and is not limited to Liver-Heat constipation.