黄疸一证，《内经》早有记载。《灵枢·论疾诊尺篇》说：“身痛而色微黄，齿垢黄，爪甲上黄，黄疸也。”《素问·平人气象论》说：“溺黄赤安卧者，黄疸。”张仲景发展了《内经》的认识，提出五疸之见，他说：“风寒相搏，食谷即眩，谷气不消，胃中苦浊，浊气下流，小便不通，阴被其寒，热结膀胱，身体尽黄，名日谷疸。额上黑，微汗出，手足中热，薄暮即发，膀胱急，小便自利，名日女劳疸，腹如水状不治。心中懊侬而热，不能食，时欲吐，名日酒疸。”“酒疸下之，久久为黑疸，目青面黑，心中如啖蒜齑状，大便正黑，皮肤爪之不仁，其脉浮弱，虽黑微黄，故知之。”“黄汗之为病，身体肿，发热汗出而满，状如风水，汗沾衣，色正黄如柏汁，脉自沉。”王海藏执简驭繁，提出黄疸“宜分阴阳”。后人多宗其说，认为“阳黄多由瘀热，烦渴头汗，脉必滑数；阴黄多由寒湿，身冷汗出，脉必沉微。阳黄系胃腑湿热熏蒸与胆液泄越，上侵肺则发而为黄，其色黄明如橘子，治在胃。阴黄系脾脏寒湿不运，与胆液浸淫，外渍肌肉，则发而为黄，其色晦如烟熏，治在脾。”(《类证治裁》)张景岳认为五疸，阴阳皆不足备，主张分为阴黄、阳黄、表邪发黄、胆黄四种。近年的讲义、著作多求简化，不求深入，仅述脾胆、论阴阳。1970年版《简明中医内科学》说“黄为土之本色，太阴为湿土之脏，是以本病之发生，其因多属于湿，且与脾胃有密切的关系，至其机转，大抵由脾失健运，湿遏于中，胆汁为湿所阻，浸淫肌肉，溢于皮肤而成。由于本病性质的不同，后人又把它分为阳黄，阴黄两大类。”
黄疸的治法，仲景根据表里，寒热、燥湿，虚实的不同，来确定方剂，如湿郁在表者，用麻黄连轺赤小豆汤；湿热在里，腹满溲赤，用攻下之茵陈蒿汤，大黄硝石汤；无实可下，即尤氏所谓不表不里，当利小便，用茵陈五苓散；若热重于湿，心中懊侬，用栀子大黄汤；腹满欲吐，鼻燥，脉浮者，用吐法；若燥而偏于虚者，可用猪膏发煎；若不热不寒，不实而虚、可用小建中汤；腹痛而呕，半表半里，可用小柴胡汤，黄疽夹饮，腹满而喘，用小半夏汤等。朱丹溪拘于一偏之见，认为疸不必分为五种，同是湿热，其言因简而易晓，常被人所引用，致使一些轻浅者治愈，复杂者诸医多瞪目无计可施。喻嘉言看到这种不深入研究之风，大声呼喊：“此恃辨名定之大端，而精微要妙，惟《金匮》有独昭焉。”并制定律三条以作医人之戒，他说：“黄疸病，得之外感者，误用补法，是谓实实，医之罪也；黄疸病，得之内伤者，误用攻法，是谓虚虚，医之罪也。阴疸病，误从阳治，袭用苦寒，倒行逆施，以致极重不返者，医杀之也。”但是，有时因受机械唯物论发展观的束缚，单纯的强调后人比前人进步，不但不能认真考虑喻氏之见，反而认为他是复古倒退。余临证20余载，反复实践，失败之例甚多，未能醒悟。1978年治一患者，山西针织厂工人，刘××。黄疸两个来月，几个医院检查均未确诊。肝、胆、胰均未发现异常。食欲正常，胃脘不痛，肝脾不大，不发热，仅见巩膜皮肤深黄，尿黄赤，黄疸指数38。前医予茵陈剂数十剂不效，百思不得其解，及读至《伤寒》、《金匮》有关之论述：“诸病黄家，但利其小便，假令脉浮，当以汗解之，宜桂枝加黄芪汤主之。”“诸黄，猪膏发煎主之。”“男子黄，小便自利，当与虚劳，小建中汤。”始悟茵陈之误。细审其脉舌，苔白而有瘀斑，脉虚大，诊为气血大衰，气滞血瘀，脾土不运。为拟黄芪、党参、当归、鸡血藤、生地、黄精、白术之益气养血，苍白术、青陈皮、柴胡、薄荷之疏肝助脾，三棱、莪术、当归、丹参之活血。2剂后，黄疸竟然大减，体力大增，10剂痊愈．
呃逆
呃逆，又名吃忒，哕。因为胃寒者比较多，所以医者把丁香柿蒂汤作为治疗呃逆的唯一方剂。然因其他原因所致者，往往不被注意，致使病势缠绵。例如：郭××，女，成。呃逆频频，昼夜难止三年多。医诊膈肌痉挛，曾反复住院治疗，仅服中药丁香柿蒂汤，旋覆代赭汤加减即达140多剂。审其证见呃逆连声，逆气上冲，胸满腹胀，口淡乏味，舌苔薄白，脉沉弦缓。诊为脾胃虚衰，肝胃气逆。乃拟健脾益气，疏肝降逆。五磨汤加减：党参10克，乌药10克，槟榔10克，沉香10克，陈皮10克。连服6剂，呃逆停止，继服3剂而愈。郭×x，女，成。呃逆频作20多天，吃饭时好转，不久即复如初，咽喉不利，舌苔薄黄，脉弦寸大。证脉合参，诊为肝胃气逆。为拟降逆和胃。旋覆代赭汤加减：旋覆花12克，代赭石15克，半夏9克，陈皮9克，生姜9克，大枣5枚，党参9克。2剂证减，4剂而愈。
张景岳说：“致呃之由，总由气逆。”因此呃逆的治疗多从降气。但是阳气的循环，无升则无降，无降亦无升，因此气滞血瘀影响气之升降时也可发生呃逆。王清任说：“因血府血瘀……吸气不能下行，随上出，故呃气。”所以用血府逐瘀汤理气活血促其升降可效。例如：傅××，女，成。呃逆频作，昼夜难止8年。近来更加严重，有时嗳气、呃逆同时发作，饮食困难，久用旋覆代赭、丁香柿蒂、五磨汤、橘皮竹茹等汤加减不效。细审诸证，面赤胸痛，口干心烦，脉沉而涩。诊为气滞血瘀，升降失职所致。拟血府逐瘀汤：当归、生地、桃仁、红花、枳壳、赤芍、川芎、桔梗各9克，柴胡6克，牛膝12克，甘草6克。服药2剂嗳气竞失，呃逆大减，继服10剂呃逆仅偶作一声。但继服上方则寸效不见，乃改用五磨汤4剂而愈。
呃逆实证虽多，虚亦时有出现，虚证之中有脾、肾之别，尤以危重病人多见。例如：岳××，男，71岁。脑血栓形成一1、多月以后，仍然神志时明时迷，偏瘫，二便失禁。近来突然发现呃逆频作，食之难入。先用西药不效。舌质红苔黄稍腻，脉弦滑稍大。证脉合参，诊为气阴俱衰，胃气上逆，为拟益气养阴，降逆和胃之《济生》橘皮竹茹汤加减：竹茹15克，陈皮10克，人参10克，甘草6克，半夏12克，麦冬12克，茯苓6克。2剂呃声减，8剂而愈。
痴呆
痴呆一证，多因痰浊郁于心窍，故痴呆之治，多以化痰开窍治之，所以医者多用郁金、菖蒲、远志、贝母。然病久不愈者，多由气及血，瘀阻心窍，不佐以活血之剂则难收效。例如：刘××，男，成。煤气中毒后半年来一直痴呆少语。走路东倒西歪，或自言自语，饥饱不知，不给喝水吃饭，从不说饥渴?喂其水、饭虽吃至呕吐也不停止吞咽。四肢屈伸时不灵活，时而瞪目直视，二便有时不知，有时主动诉说要大小便，舌质红苔净，脉细数。证脉相参，诊为瘀血阻滞，邪蒙心包。故以开窍化浊，活血清热治之。当归9克，丹参30克，乳香、没药各6克，连翘9克，桑枝30克，至宝丹2丸(早、晚分服)。10天后痴呆稍有改善，有时能知饥饱，一月后，饥饱、口渴已完全知晓，连续治疗两月诸证全消。局方至宝丹是《和剂局方》中的一个方剂。主要用于治疗中暑、中风、温病之痰热内闭，神昏谵语，痰盛气粗，痉厥抽搐和小儿急惊。吴鞠通于原方稍事加减，主要用于“太阴温病……神昏谵语者”和“卒中寒湿，内夹秽浊……语乱者?”吴氏认为此方“荟萃各种灵异。皆能补心体，通心用，除邪秽，解热结，共成拨乱反正之功。”活络效灵丹是张锡纯制定的一个方剂，用于气血凝滞，痰癖癥瘕，心腹疼痛，腿痛臂痛，内外溃疡，一切脏腑积聚，经络湮淤。本病肢体不灵活，神识呆钝，舌红无苔，脉细数，正瘀血阻滞经脉，痰热秽浊扰于心神所致，故以活络效灵丹、至宝丹而获愈。
耿××，女，成。脑血栓形成后一年来，神识一直不正常，时而呢喃妄语，饮食不知饥饱香臭污秽，时而瞪目直视流涎，左侧痉挛性瘫痪。舌苔黄白厚腻，脉沉滑数。此痰火郁结蒙蔽心窍，气滞血瘀，筋脉失和之证。为拟癫狂梦醒汤：桃仁9克，香附、青皮、柴胡、半夏、木通、赤芍、腹皮、陈皮、桑皮、川芎各10克，苏子30克，甘草15克。10剂稍知饥饱，呢喃妄语减少，20剂饥饱全知，并偶尔能与客人对话，走路亦稍稳健。但此时因多种原因停止治疗，实为遗憾。
癫狂梦醒汤是《医林改错》中的一个方剂。用于“癫狂一证，哭笑不体，詈骂歌唱，不避亲疏，许多恶态，乃气血凝滞脑气，与脏腑气不接，如同做梦一样。”方中既有柴胡、香附、赤芍、青皮、陈皮、腹皮、甘草的理气疏肝，又有桃仁、赤芍的活血，半夏、青皮、陈皮、桑皮、苏子的化痰，木通的泻火，故可用于气滞血瘀，痰火郁结的痴呆、神昏、谵语等证。
咳血
曾治患者瓮××，女，成。咳血反复发作数年，近4天来反复咳血不止。某院诊为支气管扩张。与中、西药治疗无效。审其证见：咳血大口而出，一次即达半痰盂，头晕心烦，胸满胸痛，舌苔白，舌质暗而有瘀斑，脉沉弦小数。综合脉证，诊为气滞血瘀，肺热壅郁，血液妄行之证。为拟清热凉血，理气活血治之。处方：柴胡6克，枳壳9克，降香9克，茜草9克，白芍9克，黄芩9克，丹皮9克，麦冬9克。服药1剂，咳血即止，继服10剂，追查10年，一直未见复发。某医云：清热凉血，活血止血诸书均以清热解毒汤(原名犀角地黄汤)为上品，老师何不用之?前医用该方两剂治之，何故不效?答曰：清热解毒汤确实是一个凉血止血，活血通络的好方剂，但由于它从总的趋势看是一个凉血止血方，而不是一个活血止血方。本证脉见沉弦小数，证见胸满胸痛，显系一个以气滞血瘀为主的证候，气滞血瘀为主者，应以理气活血为主，不可以凉血止血为主，否则寒凉太过，血络凝滞更甚，血不归于故道，则出血更著，因此只可理气活血为主，稍佐凉血止血之品即可。”患者骆××，男，成。反复咳血两年。某院诊为肺结核。予抗痨药、止血药、三七粉内服久治无效。近一个月来咳血日渐加重，有时痰中带血，有时连续咳血数口。审其面色皓白，舌苔薄白，脉虚小数。综合脉证，诊为阴虚火旺，阴血不敛。为拟百合固金汤养阴润肺，白及收敛止血。两剂后，咳血大减，10剂后，咳血消失。某医云：咳血不止，有采用活血而止血，有的采用活血而加剧，其故何也?答曰：活血之法而取效者，其病因于瘀血；活血之法而加剧者，其病因于血脱。脱者当敛当涩；瘀者，当活当行；否则，脱者以活，瘀者以敛，其病难愈也。
多形性红斑
升麻葛根汤是由升麻、葛根、芍药、甘草等四味组成的。原用于治疗痘疹未发，或发而未透、身热头痛者。《方剂学讲义》云：“方中升麻与葛根配合，不仅解肌清热，而又最能透疹；且升麻与甘草配合，善于解毒；芍药与甘草配合，功擅和营。药虽四味，却包括着发表透疹，和营解毒的作用。故对麻疹未发，或发而不透，表有热者，及时用之，可使疹子透发。”又因升麻、葛根都是阳明升散之剂，故《汤头歌诀》云：“轻可去实，辛能达表，故用升、葛发散阳明表邪，阳邪盛则阴气虚，故加芍药、甘草敛阴和血，升麻、甘草升阳解毒，故亦治时疫……及目痛、鼻干，不得卧等症。”，由于乘虚入胃，热邪从肌而出则发斑，故用于多形性红斑常获效。例如：患者许××，男，成。三个多月来，手背、前臂、足背、小腿等处发生大量红斑，斑出之始，呈红色或紫红色，或兼水疱或大水疱，形态不一，大小不等，一天左右以后，中心部变为暗红色或浅褐色，数天后又变为紫色，斑的周围出现红色圈，有的多个环形红斑彼此融合成地图样损害，有的大小环相套，形如彩虹，消失后不留瘢痕。某院诊为多形性红斑。久治不效。邀余诊治，察其证除以上表现外，舌苔薄白，脉浮。治以升麻葛根汤：升麻15克，葛根15克，赤芍10克，甘草6克。2剂后，斑疹骤退，6剂后全部消失而愈。
挤眉弄眼
曾治患者董××，男，23岁。一年多来，不断的挤眉弄眼，面部、额部肌肉拘急不适，发时不断咬牙，张口微见困难。某院反复以西药及中药镇静安神剂治疗不效。细审其证，除1～2秒钟挤眉弄眼一次外，有时说话期间即因口噤难开而暂时停顿，面色萎黄，疲乏无力，纳呆失眠，舌苔白稍腻，脉虚大弦滑。思之，弦为肝，滑为痰，搐为风。乃拟柴胡加龙骨牡蛎汤去铅丹法6剂，药后除见泄泻数次外，未见寸效。及察前医所开之方，大多为镇静安神，或化痰熄风之剂，乃悟仲景云：脉大为劳。因予十味温胆汤加减，6剂。处方：黄芪15克，当归10克，麦冬10克，党参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克。7日后来诊，云：挤眉弄眼次数减少，精神、食欲、睡眠好转；继服6剂，食欲、睡眠正常，咬牙消失，但挤眉弄眼仍每分钟约一次左右；为巩固效果，继予原方20剂，诸证消失而愈。
蛋白尿
黄疸这一病证，《内经》早有记载。《灵枢·论疾诊尺篇》说：“身体疼痛且面色微黄，牙齿垢腻发黄，指甲上发黄，这就是黄疸。”《素问·平人气象论》说：“小便黄赤且嗜睡的人，是黄疸。”张仲景发展了《内经》的认识，提出了五疸的说法，他说：“风寒邪气相搏结，进食后即感眩晕，谷气不能消化，胃中苦于浊气内停，浊气下流，导致小便不通，阴分受寒邪侵袭，热邪结聚于膀胱，全身发黄，称为谷疸（因饮食不节引起的黄疸）。额头发黑，微微出汗，手足心发热，傍晚时分发作，膀胱急迫但小便通畅，称为女劳疸（因房劳过度引起的黄疸），若腹部胀大如水的状态则难以治愈。心中烦闷懊恼且发热，不能进食，时常想呕吐，称为酒疸（因饮酒过多引起的黄疸）。”“酒疸如果误用攻下法治疗，日久会变成黑疸，眼睛青黑面色黑，心中感觉像吃蒜泥一样辛辣难受，大便正黑，皮肤麻木抓之不仁，脉象浮而弱，虽然色黑但微带黄色，所以可以据此判断。”“黄汗病的症状，身体浮肿，发热出汗且胸腹胀满，状如风水病，汗水沾湿衣服，颜色正黄如柏树汁液，脉象自沉。”王海藏执简驭繁，提出黄疸“应当区分阴阳”。后人多遵循他的说法，认为“阳黄多由瘀热引起，表现为烦躁口渴、头部出汗，脉象必然滑数；阴黄多由寒湿引起，表现为身冷冷汗出，脉象必然沉微。阳黄系胃腑湿热熏蒸与胆液泄越，向上侵犯肺脏则发为黄色，其色黄亮如橘子皮，治疗重点在胃。阴黄系脾脏寒湿运化失常，与胆液浸淫，向外渍入肌肉，则发为黄色，其色晦暗如烟熏，治疗重点在脾。”（出自《类证治裁》）张景岳认为五疸的分类，阴阳都不能完全涵盖，主张分为阴黄、阳黄、表邪发黄、胆黄四种。近年的讲义、著作多追求简化，不求深入，仅论述脾胆、讨论阴阳。1970年版《简明中医内科学》说“黄色是土的本色，太阴脾脏属湿土之脏，因此本病的发生，原因多属于湿，且与脾胃有密切的关系，至于其机理转变，大抵是因为脾失健运，湿气遏制在中焦，胆汁被湿气所阻，浸淫肌肉，溢于皮肤而成。由于本病性质的不同，后人又把它分为阳黄、阴黄两大类。”
黄疸的治疗方法，张仲景根据表里、寒热、燥湿、虚实的不同，来确定方剂，如湿气郁滞在体表者，用麻黄连轺赤小豆汤；湿热在体内，腹部胀满小便赤红，用攻下法的茵陈蒿汤、大黄硝石汤；没有实邪可下，即尤氏所说的不表不里，应当利小便，用茵陈五苓散；若热重于湿，心中烦闷懊恼，用栀子大黄汤；腹部胀满想吐，鼻干，脉浮的，用吐法；若干燥且偏于虚证的，可用猪膏发煎；若不热不寒，不实而虚的，可用小建中汤；腹痛且呕吐，处于半表半里状态的，可用小柴胡汤，黄疸夹杂饮邪，腹部胀满且喘息的，用小半夏汤等。朱丹溪拘泥于一偏之见，认为疸不必分为五种，都是湿热，他的言论因为简单易懂，常被引用，致使一些轻浅的病治愈了，复杂的病多位医生瞪眼无计可施。喻嘉言看到这种不深入研究的风气，大声呼喊：“这是倚重辨别名称的大端，而精微奥妙之处，只有《金匮要略》有独显。”并制定三条律令以作为医生的戒律，他说：“黄疸病，得自外感的，误用补法，这叫实实（使实证更实），是医生的罪过；黄疸病，得自内伤的，误用攻法，这叫虚虚（使虚证更虚），是医生的罪过。阴疸病，误从阳证治疗，袭用苦寒药物，倒行逆施，以致病情极重无法挽回的，是医生杀死了病人。”但是，有时因为受到机械唯物论发展观的束缚，单纯强调后人比前人进步，不但不能认真考虑喻氏的观点，反而认为他是复古倒退。我临证20多年，反复实践，失败的例子很多，未能醒悟。1978年治疗一位患者，山西针织厂工人，刘××。黄疸两个来月，几家医院检查均未确诊。肝、胆、胰均未发现异常。食欲正常，胃脘不痛，肝脾不大，不发热，仅见巩膜皮肤深黄，尿黄赤，黄疸指数38。前医给予茵陈制剂数十剂无效，百思不得其解，及读到《伤寒论》、《金匮要略》有关论述：“各种患黄疸的人，只要利其小便，假如脉浮，应当以汗法解表，宜桂枝加黄芪汤主治。”“各种黄疸，猪膏发煎主治。”“男子发黄，小便自利的，应当当作虚劳病，给予小建中汤。”才领悟到之前只用茵陈的错误。仔细审查其脉舌，苔白而有瘀斑，脉虚大，诊断为气血大衰，气滞血瘀，脾土不运。于是拟定黄芪、党参、当归、鸡血藤、生地、黄精、白术以益气养血，苍白术、青陈皮、柴胡、薄荷以疏肝助脾，三棱、莪术、当归、丹参以活血。服药2剂后，黄疸竟然大减，体力大增，10剂痊愈。
呃逆
呃逆，又名打嗝、哕。因为胃寒的情况比较多，所以医者把丁香柿蒂汤作为治疗呃逆的唯一方剂。然而因其他原因所致者，往往不被注意，致使病势缠绵。例如：郭××，女，成人。呃逆频频，昼夜难止三年多。医生诊断为膈肌痉挛，曾反复住院治疗，仅服中药丁香柿蒂汤、旋覆代赭汤加减就达140多剂。审察其证见呃逆连声，逆气上冲，胸满腹胀，口淡乏味，舌苔薄白，脉沉弦缓。诊断为脾胃虚衰，肝胃气逆。于是拟定健脾益气，疏肝降逆之法。五磨汤加减：党参10克，乌药10克，槟榔10克，沉香10克，陈皮10克。连服6剂，呃逆停止，继服3剂而愈。郭××，女，成人。呃逆频作20多天，吃饭时好转，不久即复如初，咽喉不利，舌苔薄黄，脉弦寸大。证脉合参，诊断为肝胃气逆。于是拟定降逆和胃之法。旋覆代赭汤加减：旋覆花12克，代赭石15克，半夏9克，陈皮9克，生姜9克，大枣5枚，党参9克。2剂证减，4剂而愈。
张景岳说：“导致呃逆的原因，总归是气逆。”因此呃逆的治疗多从降气入手。但是阳气的循环，无升则无降，无降亦无升，因此气滞血瘀影响气之升降时也可发生呃逆。王清任说：“因为血府血瘀……吸气不能下行，随气上出，所以呃逆。”所以用血府逐瘀汤理气活血促其升降可获效。例如：傅××，女，成人。呃逆频作，昼夜难止8年。近来更加严重，有时嗳气、呃逆同时发作，饮食困难，久用旋覆代赭汤、丁香柿蒂汤、五磨汤、橘皮竹茹汤等加减不效。细审诸证，面赤胸痛，口干心烦，脉沉而涩。诊断为气滞血瘀，升降失职所致。拟定血府逐瘀汤：当归、生地、桃仁、红花、枳壳、赤芍、川芎、桔梗各9克，柴胡6克，牛膝12克，甘草6克。服药2剂嗳气竟失，呃逆大减，继服10剂呃逆仅偶作一声。但继服上方则寸效不见，乃改用五磨汤4剂而愈。
呃逆实证虽多，虚证也时有出现，虚证之中有脾、肾之别，尤以危重病人多见。例如：岳××，男，71岁。脑血栓形成一个多月以后，仍然神志时明时迷，偏瘫，二便失禁。近来突然发现呃逆频作，食之难入。先用西药不效。舌质红苔黄稍腻，脉弦滑稍大。证脉合参，诊断为气阴俱衰，胃气上逆，为拟定益气养阴，降逆和胃之《济生》橘皮竹茹汤加减：竹茹15克，陈皮10克，人参10克，甘草6克，半夏12克，麦冬12克，茯苓6克。2剂呃声减，8剂而愈。
痴呆
痴呆这一病证，多因痰浊郁闭于心窍，故痴呆的治疗，多以化痰开窍为主，所以医者多用郁金、菖蒲、远志、贝母。然而病久不愈者，多由气及血，瘀阻心窍，不佐以活血之剂则难收效。例如：刘××，男，成人。煤气中毒后半年来一直痴呆少语。走路东倒西歪，或自言自语，饥饱不知，不给喝水吃饭，从不说饥渴？喂其水、饭虽吃至呕吐也不停止吞咽。四肢屈伸时不灵活，时而瞪目直视，二便有时不知，有时主动诉说要大小便，舌质红苔净，脉细数。证脉相参，诊断为瘀血阻滞，邪蒙心包。故以开窍化浊，活血清热治之。当归9克，丹参30克，乳香、没药各6克，连翘9克，桑枝30克，至宝丹2丸（早、晚分服）。10天后痴呆稍有改善，有时能知饥饱，一月后，饥饱、口渴已完全知晓，连续治疗两月诸证全消。局方至宝丹是《和剂局方》中的一个方剂。主要用于治疗中暑、中风、温病之痰热内闭，神昏谵语，痰盛气粗，痉厥抽搐和小儿急惊。吴鞠通于原方稍事加减，主要用于“太阴温病……神昏谵语者”和“卒中寒湿，内夹秽浊……语乱者？”吴氏认为此方“荟萃各种灵异。皆能补心体，通心用，除邪秽，解热结，共成拨乱反正之功。”活络效灵丹是张锡纯制定的一个方剂，用于气血凝滞，痰癖癥瘕，心腹疼痛，腿痛臂痛，内外溃疡，一切脏腑积聚，经络湮淤。本病肢体不灵活，神识呆钝，舌红无苔，脉细数，正是瘀血阻滞经脉，痰热秽浊扰于心神所致，故以活络效灵丹、至宝丹而获愈。
耿××，女，成人。脑血栓形成后一年来，神识一直不正常，时而呢喃妄语，饮食不知饥饱香臭污秽，时而瞪目直视流涎，左侧痉挛性瘫痪。舌苔黄白厚腻，脉沉滑数。此为痰火郁结蒙蔽心窍，气滞血瘀，筋脉失和之证。为拟定癫狂梦醒汤：桃仁9克，香附、青皮、柴胡、半夏、木通、赤芍、腹皮、陈皮、桑皮、川芎各10克，苏子30克，甘草15克。10剂稍知饥饱，呢喃妄语减少，20剂饥饱全知，并偶尔能与客人对话，走路亦稍稳健。但此时因多种原因停止治疗，实为遗憾。
癫狂梦醒汤是《医林改错》中的一个方剂。用于“癫狂一证，哭笑不体，詈骂歌唱，不避亲疏，许多恶态，乃气血凝滞脑气，与脏腑气不接，如同做梦一样。”方中既有柴胡、香附、赤芍、青皮、陈皮、腹皮、甘草的理气疏肝，又有桃仁、赤芍的活血，半夏、青皮、陈皮、桑皮、苏子的化痰，木通的泻火，故可用于气滞血瘀，痰火郁结的痴呆、神昏、谵语等证。
咳血
曾治疗患者瓮××，女，成人。咳血反复发作数年，近4天来反复咳血不止。某院诊断为支气管扩张。与中、西药治疗无效。审察其证见：咳血大口而出，一次即达半痰盂，头晕心烦，胸满胸痛，舌苔白，舌质暗而有瘀斑，脉沉弦小数。综合脉证，诊断为气滞血瘀，肺热壅郁，血液妄行之证。为拟定清热凉血，理气活血治之。处方：柴胡6克，枳壳9克，降香9克，茜草9克，白芍9克，黄芩9克，丹皮9克，麦冬9克。服药1剂，咳血即止，继服10剂，追查10年，一直未见复发。某医云：清热凉血，活血止血诸书均以清热解毒汤（原名犀角地黄汤）为上品，老师何不用之？前医用该方两剂治之，何故不效？答曰：清热解毒汤确实是一个凉血止血，活血通络的好方剂，但由于它从总的趋势看是一个凉血止血方，而不是一个活血止血方。本证脉见沉弦小数，证见胸满胸痛，显系一个以气滞血瘀为主的证候，气滞血瘀为主者，应以理气活血为主，不可以凉血止血为主，否则寒凉太过，血络凝滞更甚，血不归于故道，则出血更著，因此只可理气活血为主，稍佐凉血止血之品即可。”患者骆××，男，成人。反复咳血两年。某院诊断为肺结核。予抗痨药、止血药、三七粉内服久治无效。近一个月来咳血日渐加重，有时痰中带血，有时连续咳血数口。审察其面色皓白，舌苔薄白，脉虚小数。综合脉证，诊断为阴虚火旺，阴血不敛。为拟定百合固金汤养阴润肺，白及收敛止血。两剂后，咳血大减，10剂后，咳血消失。某医云：咳血不止，有采用活血而止血，有的采用活血而加剧，其故何也？答曰：活血之法而取效者，其病因于瘀血；活血之法而加剧者，其病因于血脱。脱者当敛当涩；瘀者，当活当行；否则，脱者以活，瘀者以敛，其病难愈也。
多形性红斑
升麻葛根汤是由升麻、葛根、芍药、甘草等四味组成的。原用于治疗痘疹未发，或发而未透、身热头痛者。《方剂学讲义》云：“方中升麻与葛根配合，不仅解肌清热，而又最能透疹；且升麻与甘草配合，善于解毒；芍药与甘草配合，功擅和营。药虽四味，却包括着发表透疹，和营解毒的作用。故对麻疹未发，或发而不透，表有热者，及时用之，可使疹子透发。”又因升麻、葛根都是阳明升散之剂，故《汤头歌诀》云：“轻可去实，辛能达表，故用升、葛发散阳明表邪，阳邪盛则阴气虚，故加芍药、甘草敛阴和血，升麻、甘草升阳解毒，故亦治时疫……及目痛、鼻干，不得卧等症。”，由于乘虚入胃，热邪从肌而出则发斑，故用于多形性红斑常获效。例如：患者许××，男，成人。三个多月来，手背、前臂、足背、小腿等处发生大量红斑，斑出之始，呈红色或紫红色，或兼水疱或大水疱，形态不一，大小不等，一天左右以后，中心部变为暗红色或浅褐色，数天后又变为紫色，斑的周围出现红色圈，有的多个环形红斑彼此融合成地图样损害，有的大小环相套，形如彩虹，消失后不留瘢痕。某院诊断为多形性红斑。久治不效。邀余诊治，察其证除以上表现外，舌苔薄白，脉浮。治以升麻葛根汤：升麻15克，葛根15克，赤芍10克，甘草6克。2剂后，斑疹骤退，6剂后全部消失而愈。
挤眉弄眼
曾治疗患者董××，男，23岁。一年多来，不断的挤眉弄眼，面部、额部肌肉拘急不适，发时不断咬牙，张口微见困难。某院反复以西药及中药镇静安神剂治疗不效。细审其证，除1～2秒钟挤眉弄眼一次外，有时说话期间即因口噤难开而暂时停顿，面色萎黄，疲乏无力，纳呆失眠，舌苔白稍腻，脉虚大弦滑。思之，弦为肝，滑为痰，搐为风。于是拟定柴胡加龙骨牡蛎汤去铅丹法6剂，药后除见泄泻数次外，未见寸效。及察前医所开之方，大多为镇静安神，或化痰熄风之剂，于是悟仲景云：脉大为劳。因而给予十味温胆汤加减，6剂。处方：黄芪15克，当归10克，麦冬10克，党参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克。7日后来诊，云：挤眉弄眼次数减少，精神、食欲、睡眠好转；继服6剂，食欲、睡眠正常，咬牙消失，但挤眉弄眼仍每分钟约一次左右；为巩固效果，继予原方20剂，诸证消失而愈。
蛋白尿
Jaundice
The syndrome of jaundice has been recorded since the *Neijing* (Classic of Internal Medicine). The *Ling Shu: Lun Ji Zhen Chi Pian* (Spiritual Pivot: Chapter on Discussing Diseases and Diagnosing by Observing the Forearm) states: "Body pain with slightly yellow complexion, yellow dental plaque, yellow nails, this is jaundice." The *Su Wen: Ping Ren Qi Xiang Lun* (Basic Questions: Discussion on the Pulse Signs of Healthy People) states: "Yellow urine, red color, and a tendency to lie down indicate jaundice." Zhang Zhongjing developed the understanding from the *Neijing*, proposing the concept of five types of jaundice. He said: "When wind and cold pathogens interact, dizziness occurs immediately after eating; grain qi fails to digest, causing bitterness and turbidity in the stomach. Turbid qi flows downward, leading to blocked urination. Yin is affected by cold, heat binds in the bladder, resulting in full-body yellowing, named Grain Jaundice (Gu Dan). Black forehead, slight sweating, heat in hands and feet, onset at dusk, urgency in the bladder but free urination, named Woman-Labor Jaundice (Nu Lao Dan); if the abdomen swells like water, it is untreatable. Restlessness and heat in the heart, inability to eat, frequent desire to vomit, named Wine Jaundice (Jiu Dan)." "If Wine Jaundice is treated with purgatives, it may eventually turn into Black Jaundice (Hei Dan), characterized by blue-black eyes, black face, a sensation in the heart as if eating minced garlic, black stool, skin numbness where scratching does not elicit sensation, pulse floating and weak; although black, there is a hint of yellow, thus it can be known." "The disease of Yellow Sweat presents with body swelling, fever, sweating, and fullness, resembling Wind-Water edema. Sweat stains clothes yellow like cypress juice, pulse is sunken." Wang Haizang simplified complex matters, proposing that jaundice "should be differentiated into Yin and Yang." Later scholars mostly followed this view, believing that "Yang Jaundice is mostly due to stagnant heat, presenting with irritability, thirst, head sweating, and a slippery-rapid pulse; Yin Jaundice is mostly due to cold-dampness, presenting with cold body, cold sweat, and a deep-micro pulse. Yang Jaundice results from damp-heat steaming in the Stomach Fu organ and leakage of bile, invading the Lung upwards to cause yellowing; its color is bright like an orange peel, treatment focuses on the Stomach. Yin Jaundice results from failure of Spleen transport due to cold-dampness and infiltration of bile, soaking into muscles to cause yellowing; its color is dull like smoke-stained, treatment focuses on the Spleen." (*Lei Zheng Zhi Cai*). Zhang Jingyue believed that the classification of five jaundices could not be fully covered by Yin and Yang alone, advocating for four categories: Yin Jaundice, Yang Jaundice, Exterior Pathogen-induced Yellowing, and Gallbladder Jaundice. Recent textbooks and works often seek simplification without depth, discussing only Spleen/Gallbladder and Yin/Yang. The 1970 edition of *Concise Chinese Internal Medicine* states: "Yellow is the true color of Earth; the Taiyin Spleen is the organ of wet earth. Therefore, the occurrence of this disease is mostly due to dampness and is closely related to the Spleen and Stomach. Its mechanism generally involves failure of Spleen healthy transport, dampness obstructing the middle jiao, bile being blocked by dampness, infiltrating muscles, and overflowing into the skin. Due to different natures of the disease, later generations divided it into two major categories: Yang Jaundice and Yin Jaundice."
Regarding treatment methods for jaundice, Zhang Zhongjing determined formulas based on exterior/interior, cold/heat, dry/damp, and deficiency/excess differences. For dampness stagnating in the exterior, Mahuang Lianyao Chixiaodou Tang (Ephedra, Coptis, and Red Bean Decoction) is used; for damp-heat in the interior with abdominal fullness and red urine, purgative formulas such as Yinchen Hao Tang (Artemisiae Scopariae Decoction) and Dahuang Xiaoshi Tang (Rhubarb and Nitrostone Decoction) are used; when there is no excess to purge, i.e., neither exterior nor interior, diuresis should be employed using Yinchen Wuling San (Artemisiae Scopariae and Five-Ingredient Poria Powder); if heat outweighs dampness with heart restlessness, Zhizi Dahuang Tang (Gardeniae and Rhubarb Decoction) is used; for abdominal fullness, desire to vomit, dry nose, and floating pulse, emesis therapy is indicated; for dryness偏向 deficiency, Pig Fat and Hair Decoction (Zhigao Faxian Jian) may be used; for neither hot nor cold, neither excess nor deficiency, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is used; for abdominal pain and vomiting indicating half-exterior/half-interior status, Xiaochaihu Tang (Minor Bupleurum Decoction) is used; for jaundice complicated by fluid retention with abdominal fullness and wheezing, Xiao Banxia Tang (Minor Pinellia Decoction) is used, etc. Zhu Danxi held a biased view, arguing that jaundice need not be divided into five types, all being damp-heat. His statement was simple and easy to understand, often cited, leading to cures in mild cases but leaving physicians helpless in complex cases. Yu Jiayan criticized this lack of deep research, shouting: "This relies on distinguishing names broadly, while the subtle essence is uniquely revealed in the *Jinkui Yaolue*." He established three rules as warnings for physicians: "For jaundice acquired from external pathogens, using tonification mistakenly is called 'making excess more excessive,' which is the doctor's fault; for jaundice acquired from internal injury, using purgation mistakenly is called 'making deficiency more deficient,' which is the doctor's fault. For Yin Jaundice, treating it according to Yang symptoms and blindly using bitter-cold herbs is acting against nature, leading to irreversible severe conditions; the doctor kills the patient." However, sometimes constrained by mechanistic materialist views of development, emphasizing that later generations are superior to predecessors, people fail to seriously consider Yu's views, instead labeling him as regressive. In my 20+ years of clinical practice, I have had many failures. In 1978, I treated a patient, Liu XX, a worker at Shanxi Knitting Factory. Jaundice persisted for over two months; several hospitals failed to diagnose. Liver, gallbladder, and pancreas showed no abnormalities. Appetite was normal, epigastric region painless, liver and spleen not enlarged, no fever, only deep yellow sclera and skin, yellow-red urine, jaundice index 38. Previous doctors gave dozens of doses of Yinchen preparations without effect. Reading discussions in *Shanghan Lun* and *Jinkui Yaolue*: "For all jaundice patients, promote diuresis; if the pulse is floating, resolve via sweating, Guijia Jia Huangqi Tang (Cinnamon Twig Plus Astragalus Decoction) is indicated." "For all jaundice, Zhigao Faxian Jian (Pig Fat and Hair Decoction) is indicated." "For men with yellowing and free urination, treat as consumptive disease with Xiao Jianzhong Tang (Minor Construct the Middle Decoction)." I realized the error of relying solely on Yinchen. Careful examination of pulse and tongue: white coating with stasis spots, pulse large and deficient. Diagnosis: severe Qi and Blood deficiency, Qi stagnation and Blood stasis, Spleen Earth failing to transport. Prescribed Huangqi, Dangshen, Danggui, Jixueteng, Shengdi, Huangjing, Baizhu to tonify Qi and nourish Blood; Cangbaizhu, Qingchenpi, Chaihu, Bohe to soothe Liver and assist Spleen; Sanleng, Ezhu, Danggui, Danshen to invigorate Blood. After 2 doses, jaundice significantly decreased, energy increased greatly; cured after 10 doses.
Hiccups
Hiccups, also known as echetu or yue, are commonly treated with Dingxiang Shidi Tang (Clove and Date Seed Decoction) because gastric cold is prevalent. However, causes other than cold are often overlooked, leading to lingering illness. For example, Guo XX, female, adult. Frequent hiccups, day and night for over three years. Diagnosed with diaphragmatic spasm, hospitalized repeatedly. Took over 140 doses of Dingxiang Shidi Tang and Xuanshu Daizhe Tang (Inula and Hematite Decoction) modified. Symptoms: continuous hiccups, rebellious Qi rushing up, chest and abdominal fullness, bland taste, thin white coating, deep-wire-slow pulse. Diagnosis: Spleen-Stomach deficiency and decline, Liver-Stomach Qi rebellion. Treatment: Strengthen Spleen, tonify Qi, soothe Liver, descend rebellious Qi. Wumo Tang modified: Dangshen 10g, Wuyao 10g, Binglang 10g, Chenxiang 10g, Chenpi 10g. Taken for 6 doses, hiccups stopped; continued for 3 doses, cured. Guo XX, female, adult. Hiccups frequent for 20+ days, improved during meals, relapsed shortly after, throat discomfort, thin yellow coating, wire-pulse large at Cun position. Pulse and syndrome combined, diagnosis: Liver-Stomach Qi rebellion. Treatment: Descend rebellious Qi, harmonize Stomach. Xuanshu Daizhe Tang modified: Xuanfuhua 12g, Daizheshi 15g, Banxia 9g, Chenpi 9g, Shengjiang 9g, Dazao 5 pieces, Dangshen 9g. Symptoms reduced after 2 doses, cured after 4 doses.
Zhang Jingyue said: "The cause of hiccups is always Qi rebellion." Thus, treatment often focuses on descending Qi. However, Yang Qi circulation requires both ascending and descending; thus, Qi stagnation and Blood stasis affecting Qi movement can also cause hiccups. Wang Qingren said: "Due to Blood stasis in the Blood Mansion... inhalation cannot descend, follows Qi upward, hence hiccupping." Therefore, Xuefu Zhuyu Tang (Blood Mansion Stasis-Expelling Decoction) to regulate Qi and invigorate Blood to promote ascending/descending can be effective. For example, Fu XX, female, adult. Frequent hiccups, day and night for 8 years. Recently worsened, sometimes belching and hiccups simultaneous, difficulty eating. Long-term use of Xuanshu Daizhe, Dingxiang Shidi, Wumo, JuPi Zhuru Tangs modified ineffective. Careful review: red face, chest pain, dry mouth, vexation, deep-rough pulse. Diagnosis: Qi stagnation and Blood stasis, failure of ascending/descending functions. Prescribed Xuefu Zhuyu Tang: Danggui, Shengdi, Taoren, Honghua, Zhike, Chishao, Chuanxiong, Jiegeng each 9g, Chaihu 6g, Niuxi 12g, Gancao 6g. After 2 doses, belching ceased, hiccups greatly reduced; continued for 10 doses, hiccups occurred only occasionally. Continued same formula with no effect, switched to Wumo Tang 4 doses, cured.
Although excess-type hiccups are common, deficiency types also occur, distinguished by Spleen or Kidney, especially in critically ill patients. For example, Yue XX, male, 71 years old. One month after cerebral thrombosis, consciousness fluctuates, hemiplegia, incontinence. Suddenly frequent hiccups, difficulty eating. Western medicine ineffective. Red tongue, yellow slightly greasy coating, wire-slippery slightly large pulse. Diagnosis: Qi and Yin both deficient, Stomach Qi rebelling. Treatment: Tonify Qi, nourish Yin, descend rebellious Qi, harmonize Stomach. Jisheng JuPi Zhuru Tang modified: Zhuru 15g, Chenpi 10g, Renshen 10g, Gancao 6g, Banxia 12g, Maidong 12g, Fuling 6g. Hiccups reduced after 2 doses, cured after 8 doses.
Dementia
Dementia is mostly caused by Phlegm-Turbidity obstructing the Heart Orifices, so treatment often focuses on resolving Phlegm and opening Orifices, using Yujin, Changpu, Yuanzhi, Beimu. However, chronic cases often involve Qi affecting Blood, with Blood stasis blocking Heart Orifices; without blood-invigorating agents, efficacy is difficult. For example, Liu XX, male, adult. Dementia and mutism for half a year after carbon monoxide poisoning. Walking unsteadily, talking to self, unaware of hunger/fullness, refusing food/water despite not complaining, swallowing even when vomiting. Limbs inflexible, staring blankly, sometimes unaware of bowel/bladder, sometimes requesting toilet. Red tongue, clean coating, fine-rapid pulse. Diagnosis: Blood stasis obstruction, Evil confusing Pericardium. Treatment: Open Orifices, resolve turbidity, invigorate Blood, clear Heat. Danggui 9g, Danshen 30g, Ruxiang, Moyao each 6g, Lianqiao 9g, Sangzhi 30g, Zhibao Wan (Precious Pill of the Bureau) 2 pills (morning/evening). After 10 days, dementia slightly improved, aware of hunger/fullness sometimes; after one month, fully aware of hunger/thirst; after two months continuous treatment, all symptoms disappeared. Zhibao Wan is a formula from *Heji Jufang*, mainly used for heatstroke, stroke, warm diseases with Phlegm-Heat closing internally, coma, delirium, profuse phlegm, coarse breathing, spasms, convulsions, and pediatric acute fright. Wu Jutong modified it slightly, mainly for "Taiyin Warm Disease... coma and delirium" and "Stroke from Cold-Damp, mixed with filth... confused speech." Wu believed this formula "gathers various spiritual efficacies, nourishing Heart substance, facilitating Heart function, removing evil filth, resolving heat knots, achieving restoration of order." Huoluo Xiaoling Dan (Meridian-Unblocking Effective Lingering Decoction) is a formula by Zhang Xichun, used for Qi-Blood stagnation, Phlegm masses, abdominal pain, limb pain, ulcers, organ accumulations, and meridian blockage. This patient's limb inflexibility, mental dullness, red tongue no coating, fine-rapid pulse indicates exactly Blood stasis blocking meridians and Phlegm-Heat/Filth disturbing Heart Spirit, hence cured with Huoluo Xiaoling Dan and Zhibao Wan.
Geng XX, female, adult. One year after cerebral thrombosis, consciousness abnormal, muttering delirium, unaware of food quality/smell/filth, staring blankly with drooling, left-sided spastic paralysis. Thick yellow-white greasy coating, deep-slippery-rapid pulse. Syndrome: Phlegm-Fire stagnation confusing Heart Orifices, Qi stagnation and Blood stasis, sinews/muscles disharmony. Prescribed Diankuang Mengxing Tang (Mania-Madness Dream-Awakening Decoction): Taoren 9g, Xiangfu, Qingpi, Chaihu, Banxia, Mutong, Chishao, Fupi, Chenpi, Sangpi, Chuanxiong each 10g, Suzi 30g, Gancao 15g. After 10 doses, aware of hunger/fullness slightly, delirium reduced; after 20 doses, fully aware, occasional conversation with guests, walking steadier. Stopped treatment due to various reasons, regrettable.
Diankuang Mengxing Tang is from *Yilin Gaicuo*. Used for "mania-madness syndrome, laughing/crying uncontrollably, cursing/singing, ignoring propriety, many bad behaviors, caused by Qi-Blood stagnating Brain Qi, disconnecting from Zang-Fu Qi, like dreaming." The formula contains Chaihu, Xiangfu, Chishao, Qingpi, Chenpi, Fupi, Gancao for regulating Qi and soothing Liver; Taoren, Chishao for invigorating Blood; Banxia, Qingpi, Chenpi, Sangpi, Suzi for resolving Phlegm; Mutong for draining Fire. Thus suitable for dementia, coma, delirium due to Qi stagnation/Blood stasis and Phlegm-Fire stagnation.
Coughing Blood
Treated patient Weng XX, female, adult. Recurrent coughing blood for years, continuous for 4 days. Hospital diagnosed bronchiectasis. Chinese/Western medicine ineffective. Symptoms: large amounts of blood, half sputum basin per episode, dizziness, vexation, chest fullness/pain, white coating, dark tongue with stasis spots, deep-wire-small-rapid pulse. Diagnosis: Qi stagnation and Blood stasis, Lung Heat congestion, reckless bleeding. Treatment: Clear Heat, cool Blood, regulate Qi, invigorate Blood. Prescription: Chaihu 6g, Zhike 9g, Jiangxiang 9g, Qiancao 9g, Baishao 9g, Huangqin 9g, Danpi 9g, Maidong 9g. After 1 dose, bleeding stopped; continued 10 doses, followed up 10 years, no recurrence. A doctor asked: "Books praise Qingre Jiedu Tang (originally Xijiao Dihuang Tang) for cooling Blood/stopping bleeding and invigorating Blood/unblocking collaterals. Why didn't you use it? Previous doctor used it for 2 doses, why ineffective?" Answer: "Qingre Jiedu Tang is indeed good for cooling Blood/stopping bleeding and invigorating Blood/unblocking collaterals, but overall it is a cooling Blood/stopping Blood formula, not primarily an invigorating Blood/stopping Blood formula. This case has deep-wire-small-rapid pulse, chest fullness/pain, clearly a syndrome dominated by Qi stagnation and Blood stasis. For dominance of Qi stagnation/Blood stasis, treatment must prioritize regulating Qi and invigorating Blood, not cooling Blood/stopping Bleeding. Otherwise, excessive cold causes further collateral stagnation, blood fails to return to channels, bleeding worsens. Thus, prioritize regulating Qi/invigorating Blood, slightly assisting with cooling Blood/stopping Bleeding agents." Patient Luo XX, male, adult. Recurrent coughing blood for 2 years. Hospital diagnosed pulmonary tuberculosis. Anti-tuberculosis drugs, hemostatics, Sanqi powder ineffective long-term. Last month, worsening, sometimes blood in sputum, sometimes continuous coughing of blood. Complexion pale white, thin white coating, deficient-small-rapid pulse. Diagnosis: Yin deficiency with Fire hyperactivity, Yin Blood failing to contain. Treatment: Baihe Gujin Tang (Lily Bulb to Secure the Metal Decoction) to nourish Yin/moisten Lung, Baiji (Rhizoma Bletillae) to astringe/stop bleeding. After 2 doses, bleeding greatly reduced; after 10 doses, bleeding disappeared. A doctor asked: "Why does invigorating Blood stop bleeding in some cases but exacerbate in others?" Answer: "Invigorating Blood works when etiology is Blood stasis; it exacerbates when etiology is Blood loss. Loss requires astringing/sealing; stasis requires moving/flowing. Otherwise, moving loss or astringing stasis makes cure difficult."
Erythema Multiforme
Shengma Gegen Tang consists of Shengma, Gegen, Shaoyao, Gancao. Originally used for undischarged or incomplete rash eruption with fever/headache. *Fangjixue Jiangyi* says: "Shengma and Gegen combine to release muscle layer and clear heat, best for venting rashes; Shengma and Gancao detoxify; Shaoyao and Gancao harmonize Ying. Though four herbs, they include releasing exterior/venting rashes and harmonizing Ying/detoxifying. Thus for undischased/incomplete measles with exterior heat, timely use allows rash to vent." Since Shengma and Gegen are Yangming ascending/dispersing agents, *Tangtou Gejue* says: "Light agents remove excess, pungent reaches exterior, so Shengma/Gegen disperse Yangming exterior pathogen. Yang pathogen excess leads to Yin deficiency, so add Shaoyao/Gancao to astringe Yin/harmonize Blood. Shengma/Gancao raise Yang/detoxify, thus also treating epidemic fevers... eye pain, dry nose, insomnia." Because pathogens enter Stomach via deficiency, Heat exits via skin causing macules, it is often effective for erythema multiforme. For example, Xu XX, male, adult. Over 3 months, large red macules on dorsum of hands, forearms, dorsum of feet, calves. Initially red or purple-red, sometimes with vesicles/bullae, varying shapes/sizes. After ~1 day, center becomes dark red/light brown; after several days, purple. Red rings around macules, some merging into map-like lesions, some concentric like rainbows, no scarring after disappearance. Hospital diagnosed erythema multiforme. Untreated effectively. Consulted me. Besides above, thin white coating, floating pulse. Treated with Shengma Gegen Tang: Shengma 15g, Gegen 15g, Chishao 10g, Gancao 6g. Rash retreated sharply after 2 doses, completely disappeared after 6 doses, cured.
Blinking and Grimacing
Treated patient Dong XX, male, 23 years old. Over a year, constant blinking/grimacing, facial/frontal muscle tension/discomfort, grinding teeth during episodes, slight difficulty opening mouth. Western medicine and Chinese sedative/calming agents ineffective. Careful review: blinking every 1-2 seconds, pauses in speech due to jaw locking, sallow complexion, fatigue, poor appetite, insomnia, white slightly greasy coating, deficient-large-wire-slippery pulse. Analysis: Wire indicates Liver, Slippery indicates Phlegm, Twitching indicates Wind. Prescribed Chaihu Jia Longgu Muli Tang minus QianDan for 6 doses. Result: diarrhea several times, no effect. Reviewed previous prescriptions: mostly sedative/calming or resolving Phlegm/extinguishing Wind. Realized Zhongjing's saying: "Large pulse indicates consumption." Prescribed Shiwei Wendan Tang modified for 6 doses: Huangqi 15g, Danggui 10g, Maidong 10g, Dangshen 10g, Wuweizi 10g, Zhuru 10g, Zhishi 10g, Banxia 10g, Chenpi 10g, Fuling 10g, Gancao 10g, Changpu 10g, Yuanzhi 10g. Returned after 7 days: blinking frequency reduced, spirit/appetite/sleep improved; continued 6 doses, appetite/sleep normal, teeth grinding gone, but blinking still ~once/min; continued original formula 20 doses for consolidation, all symptoms disappeared, cured.
Proteinuria