临床过程中发现：应用西药治疗无效的失眠症，应用中药安神镇静药治疗亦多无效。而根据补其不足，泻其有余，调其虚实，以通其道而去其邪的原则处理，常获卓效。例如：阎××，男，成。失眠3年多，每夜仅能人睡一个多小时，前用鲁米那、速可眠、冬眠灵，安宁、安定、奋乃静无效，后又配用补心丹、安神补心丸、柏子养心丹和安神镇静之剂仍无效。有时因连续几天不能入睡而加大药量，但药后不但不能入睡，反而出现浮肿、恶心呕吐，或两眼困重的不能睁眼，亦难入睡。近日来，因连续服用大剂量的镇静药，而浮肿神疲，纳呆口苦加重。审视其证，除以上诸证外，并见胸胁苦满或胸胁腰背窜痛，舌苔薄黄，脉沉弦稍数。综合脉证，诊为肝郁血虚，郁而化火。治以养血疏肝泻火。逍遥散加减：柴胡6克，当归9克，白芍9克，白术9克，茯苓9克，丹皮9克，栀子9克，生姜9克，甘草6克，薄荷4克，丹参15克。服药2剂，睡眠增至4小时；8剂后，睡眠增至5小时。赵××，男，成。失眠3个多月，近一月来日渐加重，有时虽应用大剂西药及中药安神药亦无效果。审视其证，除失眠外，经常感到心烦急躁，有时刚刚入睡，即突然一阵热气上冲汗出而醒；有时刚刚入睡，即突然大叫一声而清醒；有时胸胁苦满，腹部悸动，舌苔白，脉弦细。综其脉证，诊为肝郁气结，痰湿不化，上热下寒。为拟柴胡加龙骨牡蛎汤加减。处方：柴胡10克．半夏10克，黄芩10克，党参10克，桂枝10克，茯苓12克．龙骨12克，牡蛎12克，甘草6克，大枣4个，干姜1．5克。服药2剂后，诸证好转，继续服药30剂，睡眠正常。张××．男，40岁。失眠数年，经常整夜不能入睡，开始时应用西药安眠药尚能人睡三四个小时，以后逐渐无效，后又配合中药养心安神治疗，开始亦稍有效，但近3年来，虽反复应用以上药物，但始终不能入睡。审视其证，除失眠外，并见胸满心烦，心悸，乃予丹栀逍遥散2剂，服药后仍然微效不见。再审其证，虽云胸满，但以心前区闷痛为主，脉沉弦细而涩。证脉合参，诊为气滞血瘀之证。拟用血府逐瘀汤加减。处方：当归10克，生地10克，桃仁10克，红花10克，甘草6克，枳壳10克，赤芍10克，柴胡10克，川芎10克，桔梗10克，牛膝15克，丹参15克。服药2剂，睡眠增加，继续服药8剂，每夜睡眠增至8小时左右，其他症状亦明显好转。贺××，男，40岁。严重失眠半年多，开始时，应用安宁、水合氯醛可安然入睡数个小时，但半个月后即无明显效果，以后又改用鲁米那、导眠能、速可眠、安定、苯海拉明、氯丙嗪、奋乃静等，每次用药均是见效半个多月，不得已，又加服一剂中药。开始一周尚称有效，但应用一个多月后，非但睡眠没有增加，而且失眠更加严重，尤其是近2个多月来，睡眠更差，刚吃饭后尚有睡意，但一躺下即再无睡意。并见胃脘痞满，五心烦热，口苦口粘，舌苔白而稍腻，脉滑。综其脉证，诊为痰热阻滞，食积不化。为拟化痰消积和胃。温胆汤加减，处方：竹茹12克，枳壳12克，神曲12克，半夏10克，陈皮10克，茯苓10克，甘草6克。服药4剂后，睡眠增至5小时左右，食欲、胃脘痞满等亦好转，继服10剂后，睡眠恢复正常。李××，男，49岁。4个多月来失眠，先用西药治疗两月无效，继用中药安神镇静丸、汤剂治疗仍无效。审视其证，除每夜仅能入睡2个小时左右外，并见疲乏无力，胃脘痞满，腹胀不适，矢气后稍缓，纳呆食减，舌苔薄白，脉濡缓。综合脉证，诊为脾湿不化，轮轴失转，心肾失交。拟用理气除湿，茵陈五苓散加减。处方：茵陈24克，桂枝10克，泽泻10克，白术10克，猪苓10克，茯苓10克，乌药10克，陈皮12克，香附6克，木香6克。服药4剂，睡眠正常。朱××，男，48岁。数年来失眠，每夜仅能人睡2小时左右，常常夜间12时左右即不能再入睡，开始时，应用少量安宁即可入睡七八个小时，以后虽用多种安眠药也仅能入睡两三小时，不得已，加用中药柏子养心丹、天王补心丹，开始时还算有效，但以后再无效果。特别是近一年多来，昼夜均难入睡，即使强迫入睡，也仅能从10时睡到12时左右，以后再不能入睡。审视其证，除失眠外，并见胃脘满闷，腹部时见悸动逆气上冲，头晕头重，大便稀溏，舌苔白，脉弦大紧。综合脉证，诊为脾胃虚寒，湿郁不化，轮轴失转，心肾不交，为拟附子理中汤合五苓散加减。处方：附子10克，肉桂10克，党参10克，白术10克，茯苓10克，干姜10克，泽泻10克，猪苓10克，甘草10克。服药4剂，胃脘痞满好转，睡眠增加，继服药10剂，胃脘痞满大减，睡眠每夜约7小时。朱××，女，40岁。数年来头晕失眠，疲乏无力，轻度浮肿，有时连续数天不能人睡，有时又连续昼夜不止的睡眠两三天，睡醒后又连续七八天不能人睡一个小时，在失眠的期间虽用多种安眠药及中药镇静安神药也难入睡片刻。细察其证，除失眠外，并见面色萎黄，疲乏无力，食欲不振，胃脘时痛，五心烦热，指趾反冷，或冬季手足冷，而夏季反五心烦热，舌苔薄白，脉弦细。综合脉证，诊为中气不足，气血俱虚。为拟健中补脾益气养血，十四味大建中汤加减。处方：黄芪15克，肉桂10克，党参10克，白术10克，茯苓10克，炙甘草10克，当归10克，川芎10克，生地10克，白芍10克，附子10克，麦冬10克，淡大云15克，半夏10克，生姜3片，大枣3个。服药4剂后，精神、食欲、胃脘疼痛、失眠均好转，每夜约睡三四个小时，继续服药半月后，除他证继续改善外，睡眠增至七八个小时。朱××，女，40岁。一个月来昼夜不能入睡，虽反复应用西药安眠药，中药安神药都不能人睡片刻。审视其证，除不能人睡外，并见头晕乏力，时时悲伤欲哭，舌苔白，脉虚大。证脉合参，诊为脾胃气虚，清气失升，肝木失达。为拟补气升阳，理肝，佐以安神。补中益气汤加味：黄芪15克，白术10克，党参10克，当归10克，陈皮10克，升麻10克，柴胡10克，甘草10克，五味子10克。药进1剂睡眠增至4个小时，继进10剂，睡眠正常。宋××，男，成。七八年来失眠，每夜仅能入睡2个小时左右，记忆力和对事物的分析能力日渐衰减，头晕而木，腰背困痛，怯冷，开始时应用安眠药尚能入睡2个小时左右，继而则无明显效果，加用中药镇静安神丸剂、汤剂后，曾经有一阶段明显好转，但不久即无明显效果。审视其证，除以上诸证外，舌苔薄白，脉虚而无力。综合脉证，诊为脑髓空虚，气阴俱衰。为拟填精补髓，益气养阴。龟鹿二仙胶加减：龟甲60克，鹿茸4克，人参10克，枸杞子10克，何首乌10克。水煎龟甲、枸杞子、何首乌；鹿茸、人参研末服。一个月后，头晕、精神均好转，睡眠恢复正常。蒋××，男，成。严重失眠4个月，每夜约睡2个小时，虽用安眠药，中药养心安神药无效。审其证除失眠外，并见夜间烦热甚烈，心烦，尿黄赤，舌苔黄质红，脉细数。治以滋阴平肝泻火。大补阴丸加减：龟甲30克，知母10克，黄柏10克，生地15克。药进2剂，睡眠增加，继进6剂睡眠正常。张××，男，45岁。摔伤后一个多月来昼夜不能入睡，有时仅能人睡半小时，头晕头胀，头痛，站立不稳，虽用多种镇静药亦无明显效果。审其脉虚大弦滑，舌苔薄白，心烦易怒，纳呆口干，胃脘痞满。诊为气阴两虚，拟补阴益气煎加减。处方：黄芪15克，党参10克，白术10克，陈皮10克，当归10克，升麻10克，柴胡10克，甘草6克，熟地15克，山药10克，山萸肉10克，茯苓10克，泽泻10克，丹皮10克。药进2剂，食欲、精神好转，6剂后睡眠增加，14剂后，睡眠恢复正常。
《内经》认为睡眠不但与心有关，而且与五脏六腑有着不可分割的联系。《灵枢·邪客篇》说：“卫气者，出其悍气之慓疾，而先行于四末分肉皮肤之间，而不休者也，昼行于阳，夜行于阴，常从足少阴之分间行于五脏六腑；今厥气客于五脏六腑，则卫气独卫其外，行于阳不得入于阴，行于阳则阳气盛，阳气盛，则阳蹻陷不得入于阴，阴虚故目不瞑。”《大惑论》篇说：“其肠胃小，皮肤滑以缓，分肉解利，卫气之留于阳也久，故少瞑焉。”并指出治疗原则是“先其脏腑，诛其小过，后调其气，盛者泻之，虚者补之，必先明其形志之苦乐，定乃取之。”余宗其论，对心神不安者，治以安神养心；肝郁气滞者，治以疏肝理气；气虚者，给以补气；肾督亏损着，给予培补肾督；痰浊阻滞者，给予化痰；瘀血者，给予活血逐瘀等，常获满意的疗效。例如：患者刘××，女，成。产后两月来，久久不能入睡。询之前用诸方均为养心安神、重镇安神之品，西药亦每日增量应用。细审其证，除昼夜难眠外，并见乏力汗多，面色皓白，舌质嫩红苔薄白，脉虚大而缓。综其脉证，诊为气阴两虚。为拟补中益气加麦冬、五味子。2剂开始入睡，10剂即睡眠正常。某医云：“前用安神镇静无效，后用补气养阴即眠者为何呢?”答云：“《内经》之论寤寐非仅指在心，而是在五脏六腑，《灵枢》论寤寐隶属于五脏六腑阴阳出入，隶属三焦之交泰，隶属于心肾之交融，隶属于肠胃之大小，隶属于皮肉之解利。此证脾肺俱虚，清阳失升、卫气留于阳者久。故以补中益气汤合生脉散益阳补阳而愈。耿××，男，成。失眠一年多，经常彻夜不眠，虽用中、西药物、针灸等无效。视之，前方多为安神镇静之方。证见胸胁烦满，头晕目眩，口苦咽干，脉弦小数。云：肝郁化火，心肝血虚所致也，前虽曾佐用养血，然疏肝解郁不足耳。故以丹栀逍遥散加丹参治之。3剂始能入睡，10剂睡眠正常。刘××，男，成。失眠健忘十几年，经常彻夜不眠，而用中、西药无效。近来诸证更加严重，除昼夜入睡片刻外，并见腰酸背困，疲乏无力，畏寒肢冷，苔薄白，脉沉细弱。证脉合参，诊为脑髓虚衰，任督不足。为拟参茸卫生丸、鹿茸精等一月恢复正常。张××，男，成。失眠十几年，遍用中、西药不效，察其胸满胁痛，脉沉细涩，为拟血府逐瘀汤4剂效，10剂恢复正常。‘
木肾
李用粹《证治汇补》云：“木肾者，外肾坚硬顽痹，不痛不痒，阴茎不垂，常如麻木，便溺之时，闷胀不顺，．此肾家虚惫，阴阳不交，水火不济，而沉细痼冷，凝滞其问，未可纯用燥药，当行温散温利以逐其邪。”又云：“间有跌扑惊恐、痰气瘀滞者，当行瘀消气。”余宗其论，试治一患者。成××，男，40岁，阴茎阴囊麻木七八年，半年来加重，曾用针灸、中药、西药治疗无效。审其脉见弦，舌苔薄黄。证脉合参，诊为肝郁气滞，寒凝不化，拟疏肝解郁，温肝之剂：柴胡6克，桂枝12克，白芍21克，生姜9克，大枣5个，龙骨30克，牡蛎30克，苡米30克，木瓜30克，紫石英15克，吴茱萸4．5克，炙甘草4．5克。药进4剂，诸证同前。再询患者，除上证外，并见头麻，牙痛，眼憋胀，心烦心悸，胃脘痞满。因思上方理气不足，中焦痞塞，升降失职，当重用理气。处方：柴胡6克，枳壳9克，白芍9克，青皮9克，陈皮9克，苏叶6克，薄荷6克，栀子4．5克，郁金9克，菖蒲9克。入药2剂，仍属妄然，并见胸满，咽喉如炙脔，咳嗽不利，除此痰湿，非以温化痰饮之剂不可。处方：柴胡6克，半夏9克，黄芩9克，桂枝9克，白芍9克，生姜3片，大枣3个，陈皮9克，苏叶9克，薄荷6克，玫瑰花9克，代代花9克。药进4剂，果然中鹊而愈。
疝
《简明中医内科学》云：“疝在古代文献中有两种含义：一种指腹中作痛，控引上下而言，如《内经》之冲疝、心疝，《金匮》之寒疝，以及巢氏《病源》之厥疝、瘕疝、寒疝、气．疝、盘疝、腑疝、狼疝等，即属于这一类型；另一种是指睾丸肿痛，控引少腹而言，此即子和所谓寒疝、水疝、筋疝、血疝、气疝、狐疝、痜疝等七疝。”又说：“总的来说，寒湿热三气之邪，实为疝的主要原因。至其病理，则于肝经有密切关系；因为肝脉循阴器，抵少腹，是以治疝大法多从肝经着手。”附睾结核肿坠属疝症，因此制方之时亦应从肝经人手，坚者消之，以入肝软坚之品治疗。曾治患者王××，男，45岁。阴囊坠胀隐痛一年多。某院诊为附睾结核。建议手术治疗。因患者拒绝手术，改用中药：夏枯草30克，山楂核30克，荔核30克，赤芍9克，青皮9克，乌药6克，橘核15克，木香3克，川楝子9克。20剂隐痛消，坠胀减，90剂愈。后又遇一例。秦××，男，38岁。附睾结核一年，复用上方，10剂坠胀减，继用30剂又复如初。细审其证，腰酸腰痛，两脉沉细尺大而弦。乃肾气不足，寒气凝滞。思原方乃疏肝软坚散结，性亦偏寒。病位不明，寒热不分所致也。乃以八味地黄丸加车前子、怀牛膝、沙苑子30剂而愈。
鞘膜积液
在临床实践中发现：对于使用西药治疗无效的失眠症患者，应用具有安神镇静作用的中药进行治疗也大多无效。然而，如果遵循“补其不足，泻其有余，调节虚实，疏通通道以祛除邪气”的原则进行处理，往往能获得显著的疗效。
例如：患者阎某某，男性，成年。失眠三年多，每晚仅能入睡一个多小时。此前使用鲁米那、速可眠、冬眠灵、安宁、安定、奋乃静等西药无效；后又配合使用补心丹、安神补心丸、柏子养心丹及各类安神镇静方剂，仍然无效。有时因连续几天无法入睡而加大药量，但服药后不仅不能入睡，反而出现浮肿、恶心呕吐，或双眼沉重难以睁开，依然无法入睡。近日，因连续服用大剂量镇静药物，导致浮肿和精神疲乏加重，食欲不振、口苦症状加剧。审视其证候，除上述症状外，还见胸胁部胀满不适，或胸胁腰背部窜痛，舌苔薄黄，脉象沉弦稍数。综合脉象与证候，诊断为肝郁血虚，郁久化火。治法为养血疏肝、清泻火热。方用逍遥散加减：柴胡6克，当归9克，白芍9克，白术9克，茯苓9克，牡丹皮9克，栀子9克，生姜9克，甘草6克，薄荷4克，丹参15克。服药2剂后，睡眠时间增加至4小时；服药8剂后，睡眠时间增加至5小时。
患者赵某某，男性，成年。失眠三个多月，近一个月来日渐加重，有时即使使用大剂量西药及中药安神药也无效果。审视其证候，除失眠外，经常感到心烦急躁，有时刚入睡，即突然一阵热气上冲、出汗而醒；有时刚入睡，即突然大叫一声而清醒；有时胸胁部胀满，腹部悸动，舌苔白，脉象弦细。综合脉证，诊断为肝郁气结，痰湿不化，上热下寒。拟方柴胡加龙骨牡蛎汤加减。处方：柴胡10克，半夏10克，黄芩10克，党参10克，桂枝10克，茯苓12克，龙骨12克，牡蛎12克，甘草6克，大枣4个，干姜1.5克。服药2剂后，诸症好转，继续服药30剂，睡眠恢复正常。
患者张某某，男性，40岁。失眠数年，经常整夜不能入睡。开始时使用西药安眠药尚能入睡三四个小时，以后逐渐无效，后又配合中药养心安神治疗，开始也稍有效，但近3年来，虽反复应用以上药物，却始终不能入睡。审视其证候，除失眠外，并见胸部满闷、心烦，心悸，于是给予丹栀逍遥散2剂，服药后仍然微效不见。再审其证候，虽然自称胸满，但以心前区闷痛为主，脉象沉弦细而涩。证脉合参，诊断为气滞血瘀之证。拟用血府逐瘀汤加减。处方：当归10克，生地10克，桃仁10克，红花10克，甘草6克，枳壳10克，赤芍10克，柴胡10克，川芎10克，桔梗10克，牛膝15克，丹参15克。服药2剂，睡眠增加，继续服药8剂，每夜睡眠增至8小时左右，其他症状亦明显好转。
患者贺某某，男性，40岁。严重失眠半年多，开始时，使用安宁、水合氯醛可安然入睡数个小时，但半个月后即无明显效果，以后又改用鲁米那、导眠能、速可眠、安定、苯海拉明、氯丙嗪、奋乃静等，每次用药均是见效半个多月，不得已，又加服一剂中药。开始一周尚称有效，但应用一个多月后，非但睡眠没有增加，而且失眠更加严重，尤其是近2个多月来，睡眠更差，刚吃饭后尚有睡意，但一躺下即再无睡意。并见胃脘部痞塞胀满，五心烦热，口苦口粘，舌苔白而稍腻，脉滑。综合脉证，诊断为痰热阻滞，食积不化。拟方化痰消积和胃。温胆汤加减，处方：竹茹12克，枳壳12克，神曲12克，半夏10克，陈皮10克，茯苓10克，甘草6克。服药4剂后，睡眠增至5小时左右，食欲、胃脘痞满等亦好转，继服10剂后，睡眠恢复正常。
患者李某某，男性，49岁。4个多月来失眠，先用西药治疗两月无效，继用中药安神镇静丸、汤剂治疗仍无效。审视其证候，除每夜仅能入睡2个小时左右外，并见疲乏无力，胃脘部痞塞胀满，腹胀不适，矢气（放屁）后稍缓，食欲不振、进食减少，舌苔薄白，脉象濡缓。综合脉证，诊断为脾湿不化，轮轴失转，心肾失交。拟用理气除湿，茵陈五苓散加减。处方：茵陈24克，桂枝10克，泽泻10克，白术10克，猪苓10克，茯苓10克，乌药10克，陈皮12克，香附6克，木香6克。服药4剂，睡眠正常。
患者朱某某，男性，48岁。数年来失眠，每夜仅能入睡2小时左右，常常夜间12时左右即不能再入睡，开始时，使用少量安宁即可入睡七八个小时，以后虽用多种安眠药也仅能入睡两三小时，不得已，加用中药柏子养心丹、天王补心丹，开始时还算有效，但以后再无效果。特别是近一年多来，昼夜均难入睡，即使强迫入睡，也仅能从10时睡到12时左右，以后再不能入睡。审视其证候，除失眠外，并见胃脘部满闷，腹部时见悸动逆气上冲，头晕头重，大便稀溏，舌苔白，脉象弦大紧。综合脉证，诊断为脾胃虚寒，湿郁不化，轮轴失转，心肾不交。拟方附子理中汤合五苓散加减。处方：附子10克，肉桂10克，党参10克，白术10克，茯苓10克，干姜10克，泽泻10克，猪苓10克，甘草10克。服药4剂，胃脘痞满好转，睡眠增加，继服药10剂，胃脘痞满大减，睡眠每夜约7小时。
患者朱某某，女性，40岁。数年来头晕失眠，疲乏无力，轻度浮肿，有时连续数天不能入睡，有时又连续昼夜不止地睡眠两三天，睡醒后又连续七八天不能入睡一个小时，在失眠的期间虽用多种安眠药及中药镇静安神药也难入睡片刻。细察其证候，除失眠外，并见面色萎黄，疲乏无力，食欲不振，胃脘时而疼痛，五心烦热，指趾反冷，或冬季手足冷，而夏季反五心烦热，舌苔薄白，脉象弦细。综合脉证，诊断为中气不足，气血俱虚。拟方健中补脾益气养血，十四味大建中汤加减。处方：黄芪15克，肉桂10克，党参10克，白术10克，茯苓10克，炙甘草10克，当归10克，川芎10克，生地10克，白芍10克，附子10克，麦冬10克，淡大云15克，半夏10克，生姜3片，大枣3个。服药4剂后，精神、食欲、胃脘疼痛、失眠均好转，每夜约睡三四个小时，继续服药半月后，除他证继续改善外，睡眠增至七八个小时。
患者朱某某，女性，40岁。一个月来昼夜不能入睡，虽反复应用西药安眠药，中药安神药都不能入睡片刻。审视其证候，除不能入睡外，并见头晕乏力，时时悲伤欲哭，舌苔白，脉象虚大。证脉合参，诊断为脾胃气虚，清气失升，肝木失达。拟方补气升阳，理肝，佐以安神。补中益气汤加味：黄芪15克，白术10克，党参10克，当归10克，陈皮10克，升麻10克，柴胡10克，甘草10克，五味子10克。药进1剂睡眠增至4个小时，继进10剂，睡眠正常。
患者宋某某，男性，成年。七八年来失眠，每夜仅能入睡2个小时左右，记忆力和对事物的分析能力日渐衰减，头晕而木，腰背困痛，怯冷，开始时应用安眠药尚能入睡2个小时左右，继而则无明显效果，加用中药镇静安神丸剂、汤剂后，曾经有一阶段明显好转，但不久即无明显效果。审视其证候，除以上诸证外，舌苔薄白，脉象虚而无力。综合脉证，诊断为脑髓空虚，气阴俱衰。拟方填精补髓，益气养阴。龟鹿二仙胶加减：龟甲60克，鹿茸4克，人参10克，枸杞子10克，何首乌10克。水煎龟甲、枸杞子、何首乌；鹿茸、人参研末服。一个月后，头晕、精神均好转，睡眠恢复正常。
患者蒋某某，男性，成年。严重失眠4个月，每夜约睡2个小时，虽用安眠药，中药养心安神药无效。审其证候除失眠外，并见夜间烦热甚烈，心烦，尿黄赤，舌苔黄质红，脉细数。治以滋阴平肝泻火。大补阴丸加减：龟甲30克，知母10克，黄柏10克，生地15克。药进2剂，睡眠增加，继进6剂睡眠正常。
患者张某某，男性，45岁。摔伤后一个多月来昼夜不能入睡，有时仅能入睡半小时，头晕头胀，头痛，站立不稳，虽用多种镇静药亦无明显效果。审其脉象虚大弦滑，舌苔薄白，心烦易怒，纳呆口干，胃脘痞满。诊断为气阴两虚，拟用补阴益气煎加减。处方：黄芪15克，党参10克，白术10克，陈皮10克，当归10克，升麻10克，柴胡10克，甘草6克，熟地15克，山药10克，山萸肉10克，茯苓10克，泽泻10克，丹皮10克。药进2剂，食欲、精神好转，6剂后睡眠增加，14剂后，睡眠恢复正常。
《内经》认为睡眠不但与心有关，而且与五脏六腑有着不可分割的联系。《灵枢·邪客篇》说：“卫气者，出其悍气之慓疾，而先行于四末分肉皮肤之间，而不休者也，昼行于阳，夜行于阴，常从足少阴之分间行于五脏六腑；今厥气客于五脏六腑，则卫气独卫其外，行于阳不得入于阴，行于阳则阳气盛，阳气盛，则阳蹻陷不得入于阴，阴虚故目不瞑。”《大惑论》篇说：“其肠胃小，皮肤滑以缓，分肉解利，卫气之留于阳也久，故少瞑焉。”并指出治疗原则是“先其脏腑，诛其小过，后调其气，盛者泻之，虚者补之，必先明其形志之苦乐，定乃取之。”我遵循其论述，对心神不安者，治以安神养心；肝郁气滞者，治以疏肝理气；气虚者，给以补气；肾督亏损者，给予培补肾督；痰浊阻滞者，给予化痰；瘀血者，给予活血逐瘀等，常获得满意的疗效。
例如：患者刘某某，女性，成年。产后两个多月来，久久不能入睡。询问之前使用的各方均为养心安神、重镇安神之品，西药亦每日增量应用。仔细审查其证候，除昼夜难眠外，并见乏力汗多，面色皓白，舌质嫩红苔薄白，脉象虚大而缓。综合脉证，诊断为气阴两虚。拟方补中益气加麦冬、五味子。2剂开始入睡，10剂即睡眠正常。某医生说：“前用安神镇静无效，后用补气养阴即眠者为何呢？”回答说：“《内经》之论寤寐非仅指在心，而是在五脏六腑，《灵枢》论寤寐隶属于五脏六腑阴阳出入，隶属三焦之交泰，隶属于心肾之交融，隶属于肠胃之大小，隶属于皮肉之解利。此证脾肺俱虚，清阳失升、卫气留于阳者久。故以补中益气汤合生脉散益阳补阳而愈。”
患者耿某某，男性，成年。失眠一年多，经常彻夜不眠，虽用中、西药物、针灸等无效。视之，前方多为安神镇静之方。证见胸胁烦满，头晕目眩，口苦咽干，脉象弦小数。认为是肝郁化火，心肝血虚所致也，前虽曾佐用养血，然疏肝解郁不足耳。故以丹栀逍遥散加丹参治之。3剂始能入睡，10剂睡眠正常。
患者刘某某，男性，成年。失眠健忘十几年，经常彻夜不眠，而用中、西药无效。近来诸证更加严重，除昼夜入睡片刻外，并见腰酸背困，疲乏无力，畏寒肢冷，苔薄白，脉沉细弱。证脉合参，诊断为脑髓虚衰，任督不足。拟方参茸卫生丸、鹿茸精等一月恢复正常。
患者张某某，男性，成年。失眠十几年，遍用中、西药不效，察其胸满胁痛，脉沉细涩，为拟血府逐瘀汤4剂效，10剂恢复正常。
【木肾】
李用粹《证治汇补》云：“木肾者，外肾坚硬顽痹，不痛不痒，阴茎不垂，常如麻木，便溺之时，闷胀不顺，．此肾家虚惫，阴阳不交，水火不济，而沉细痼冷，凝滞其间，未可纯用燥药，当行温散温利以逐其邪。”又云：“间有跌扑惊恐、痰气瘀滞者，当行瘀消气。”我遵循其论述，试治一患者。成某某，男性，40岁，阴茎阴囊麻木七八年，半年来加重，曾用针灸、中药、西药治疗无效。审其脉象见弦，舌苔薄黄。证脉合参，诊断为肝郁气滞，寒凝不化，拟疏肝解郁，温肝之剂：柴胡6克，桂枝12克，白芍21克，生姜9克，大枣5个，龙骨30克，牡蛎30克，苡米30克，木瓜30克，紫石英15克，吴茱萸4.5克，炙甘草4.5克。药进4剂，诸证同前。再询患者，除上证外，并见头麻，牙痛，眼憋胀，心烦心悸，胃脘痞满。因思上方理气不足，中焦痞塞，升降失职，当重用理气。处方：柴胡6克，枳壳9克，白芍9克，青皮9克，陈皮9克，苏叶6克，薄荷6克，栀子4.5克，郁金9克，菖蒲9克。入药2剂，仍属妄然，并见胸满，咽喉如炙脔，咳嗽不利，除此痰湿，非以温化痰饮之剂不可。处方：柴胡6克，半夏9克，黄芩9克，桂枝9克，白芍9克，生姜3片，大枣3个，陈皮9克，苏叶9克，薄荷6克，玫瑰花9克，代代花9克。药进4剂，果然中鹊而愈。
【疝】
《简明中医内科学》云：“疝在古代文献中有两种含义：一种指腹中作痛，控引上下而言，如《内经》之冲疝、心疝，《金匮》之寒疝，以及巢氏《病源》之厥疝、瘕疝、寒疝、气疝、盘疝、腑疝、狼疝等，即属于这一类型；另一种是指睾丸肿痛，控引少腹而言，此即子和所谓寒疝、水疝、筋疝、血疝、气疝、狐疝、痜疝等七疝。”又说：“总的来说，寒湿热三气之邪，实为疝的主要原因。至其病理，则于肝经有密切关系；因为肝脉循阴器，抵少腹，是以治疝大法多从肝经着手。”附睾结核肿坠属疝症，因此制方之时亦应从肝经人手，坚者消之，以入肝软坚之品治疗。曾治患者王某某，男性，45岁。阴囊坠胀隐痛一年多。某院诊为附睾结核。建议手术治疗。因患者拒绝手术，改用中药：夏枯草30克，山楂核30克，荔核30克，赤芍9克，青皮9克，乌药6克，橘核15克，木香3克，川楝子9克。20剂隐痛消，坠胀减，90剂愈。后又遇一例。秦某某，男性，38岁。附睾结核一年，复用上方，10剂坠胀减，继用30剂又复如初。细审其证候，腰酸腰痛，两脉沉细尺大而弦。乃肾气不足，寒气凝滞。思原方乃疏肝软坚散结，性亦偏寒。病位不明，寒热不分所致也。乃以八味地黄丸加车前子、怀牛膝、沙苑子30剂而愈。
【鞘膜积液】
In clinical practice, it has been observed that for patients with insomnia ineffective to Western medicine treatment, those treated with Chinese herbal medicines possessing sedative and calming properties are also mostly ineffective. However, if the principle of "tonifying deficiency, purging excess, regulating deficiency and excess, unblocking pathways, and eliminating pathogenic factors" is followed in handling these cases, remarkable efficacy is often achieved.
For example: Patient Yan XX, male, adult. Insomnia for over three years, able to sleep only about one hour per night. Previously used Western sedatives such as Luminal (Phenobarbital), Seconal (Secobarbital), Wintermin (Chlorpromazine), Miltown (Meprobamate), Valium (Diazepam), and Perphenazine without effect; subsequently combined with Buxin Dan (Heart-Nourishing Pill), Anshen Buxin Wan (Spirit-Calming Heart-Nourishing Pill), Baizi Yangxin Dan (Seed-Enriching Heart-Nourishing Pill) and various other sedative formulas, still without effect. Sometimes, due to inability to sleep for several consecutive days, the dosage was increased, but after taking the medication, not only did sleep not improve, but edema, nausea, and vomiting appeared, or the eyes felt heavy and difficult to open, yet sleep remained elusive. Recently, due to continuous intake of large doses of sedatives, edema and mental fatigue worsened, accompanied by anorexia and bitter taste in the mouth. Examination of the syndrome revealed, in addition to the above symptoms, chest and hypochondriac fullness or wandering pain in the chest, hypochondrium, waist, and back; thin yellow tongue coating; and a deep, wiry, slightly rapid pulse. Synthesizing the pulse and syndrome, the diagnosis was Liver Qi stagnation with Blood deficiency, transforming into fire due to stagnation. The treatment method was to nourish Blood, soothe the Liver, and clear heat/fire. Formula: Xiaoyao San modified: Chai Hu 6g, Dang Gui 9g, Bai Shao 9g, Bai Zhu 9g, Fu Ling 9g, Mu Dan Pi 9g, Zhi Zi 9g, Sheng Jiang 9g, Gan Cao 6g, Bo He 4g, Dan Shen 15g. After 2 doses, sleep duration increased to 4 hours; after 8 doses, sleep duration increased to 5 hours.
Patient Zhao XX, male, adult. Insomnia for over three months, worsening gradually in the last month. Even large doses of Western sedatives and Chinese herbal calming medicines were ineffective. Examination of the syndrome revealed, besides insomnia, frequent irritability and restlessness; sometimes waking up suddenly with a rush of hot qi and sweating shortly after falling asleep; sometimes waking up suddenly with a loud shout shortly after falling asleep; sometimes chest and hypochondriac fullness, abdominal palpitations; white tongue coating; and a wiry, fine pulse. Synthesizing the pulse and syndrome, the diagnosis was Liver Qi stagnation and knotting, failure of Phlegm-Dampness transformation, Upper Heat and Lower Cold. Formula: Chai Hu Jia Long Gu Mu Li Tang modified. Prescription: Chai Hu 10g, Ban Xia 10g, Huang Qin 10g, Dang Shen 10g, Gui Zhi 10g, Fu Ling 12g, Long Gu 12g, Mu Li 12g, Gan Cao 6g, Da Zao 4 pieces, Gan Jiang 1.5g. After 2 doses, all symptoms improved; continuing for 30 doses resulted in normal sleep.
Patient Zhang XX, male, 40 years old. Insomnia for several years, often unable to sleep all night. Initially, Western hypnotics allowed 3-4 hours of sleep, but gradually became ineffective. Later combined with Chinese herbs for nourishing the Heart and calming the Spirit, which initially had slight effect, but for the past 3 years, despite repeated use, sleep remained impossible. Examination of the syndrome revealed, besides insomnia, chest fullness, irritability, and palpitations. Danzhi Xiaoyao San was prescribed for 2 doses, but with minimal effect. Re-examination revealed that although the patient complained of chest fullness, the main symptom was stifling pain in the precordial region; the pulse was deep, wiry, fine, and choppy. Integrating syndrome and pulse, the diagnosis was Qi stagnation and Blood stasis. Formula: Xuefu Zhuyu Tang modified. Prescription: Dang Gui 10g, Sheng Di 10g, Tao Ren 10g, Hong Hua 10g, Gan Cao 6g, Zhi Ke 10g, Chi Shao 10g, Chai Hu 10g, Chuan Xiong 10g, Jie Geng 10g, Niu Xi 15g, Dan Shen 15g. After 2 doses, sleep increased; continuing for 8 doses resulted in approximately 8 hours of sleep per night, with significant improvement in other symptoms.
Patient He XX, male, 40 years old. Severe insomnia for over half a year. Initially, Miltown and Chloral Hydrate allowed sound sleep for several hours, but lost effectiveness after half a month. Subsequently switched to Luminal, Dao Mian Neng, Seconal, Valium, Benadryl (Diphenhydramine), Chlorpromazine, and Perphenazine. Each drug worked for about half a month before losing efficacy. Reluctantly, a dose of Chinese medicine was added. It was effective for the first week, but after more than a month, sleep did not increase, and insomnia worsened. Especially in the last two months, sleep deteriorated further; although sleepy after meals, sleepiness vanished immediately upon lying down. Symptoms included epigastric distension and fullness, five-palm heat (heat sensation in palms, soles, and chest), bitter and sticky taste in the mouth; white, slightly greasy tongue coating; and slippery pulse. Synthesizing the pulse and syndrome, the diagnosis was Phlegm-Heat obstruction and Food Stagnation. Treatment aimed at resolving Phlegm, reducing Stagnation, and harmonizing the Stomach. Formula: Wendan Tang modified. Prescription: Zhu Ru 12g, Zhi Ke 12g, Shen Qu 12g, Ban Xia 10g, Chen Pi 10g, Fu Ling 10g, Gan Cao 6g. After 4 doses, sleep increased to about 5 hours, and appetite and epigastric distension improved; continuing for 10 doses restored normal sleep.
Patient Li XX, male, 49 years old. Insomnia for over four months. Two months of Western medicine treatment were ineffective, followed by Chinese herbal pills and decoctions for calming the spirit, also ineffective. Examination of the syndrome revealed, besides sleeping only about 2 hours per night, fatigue and weakness, epigastric distension and fullness, abdominal discomfort relieved by flatus, anorexia and reduced food intake; thin white tongue coating; and soggy-slow pulse. Synthesizing the pulse and syndrome, the diagnosis was Spleen Dampness failure to transform, failure of the pivot mechanism rotation, and Heart-Kidney non-interaction. Treatment aimed at regulating Qi and removing Dampness. Formula: Yinchen Wuling San modified. Prescription: Yin Chen 24g, Gui Zhi 10g, Ze Xie 10g, Bai Zhu 10g, Zhu Ling 10g, Fu Ling 10g, Wu Yao 10g, Chen Pi 12g, Xiang Fu 6g, Mu Xiang 6g. After 4 doses, sleep normalized.
Patient Zhu XX, male, 48 years old. Insomnia for several years, sleeping only about 2 hours per night, often unable to sleep again after midnight. Initially, a small amount of Miltown allowed 7-8 hours of sleep, but later, even with various hypnotics, only 2-3 hours were possible. Reluctantly, Baizi Yangxin Dan and Tianwang Buxin Dan were added. Initially effective, but later ineffective. For the past year, difficulty sleeping day and night; even forced sleep lasted only from 10 PM to 12 AM. Examination of the syndrome revealed, besides insomnia, epigastric fullness, occasional abdominal palpitations with rebellious Qi rushing upward, dizziness and heavy head, loose stools; white tongue coating; and wiry-large-tight pulse. Synthesizing the pulse and syndrome, the diagnosis was Spleen-Stomach Deficiency-Cold, Dampness stagnation failure to transform, failure of pivot mechanism rotation, and Heart-Kidney non-interaction. Formula: Fuzi Lizhong Tang combined with Wuling San modified. Prescription: Fu Zi 10g, Rou Gui 10g, Dang Shen 10g, Bai Zhu 10g, Fu Ling 10g, Gan Jiang 10g, Ze Xie 10g, Zhu Ling 10g, Gan Cao 10g. After 4 doses, epigastric distension improved and sleep increased; continuing for 10 doses significantly reduced epigastric distension and resulted in about 7 hours of sleep per night.
Patient Zhu XX, female, 40 years old. Dizziness and insomnia for several years, fatigue, mild edema. Sometimes unable to sleep for several consecutive days; sometimes sleeping continuously for 2-3 days day and night; after waking, unable to sleep for an hour for 7-8 consecutive days. During insomnia periods, neither Western hypnotics nor Chinese sedative herbs helped. Detailed examination revealed, besides insomnia, sallow complexion, fatigue, anorexia, intermittent epigastric pain, five-palm heat, cold fingers and toes (or cold hands/feet in winter, five-palm heat in summer); thin white tongue coating; and wiry-fine pulse. Synthesizing the pulse and syndrome, the diagnosis was Middle Qi deficiency and dual deficiency of Qi and Blood. Treatment aimed at strengthening the Middle, tonifying the Spleen, benefiting Qi, and nourishing Blood. Formula: Shi Si Wei Da Jian Zhong Tang modified. Prescription: Huang Qi 15g, Rou Gui 10g, Dang Shen 10g, Bai Zhu 10g, Fu Ling 10g, Zhi Gan Cao 10g, Dang Gui 10g, Chuan Xiong 10g, Sheng Di 10g, Bai Shao 10g, Fu Zi 10g, Mai Dong 10g, Da Yun 15g, Ban Xia 10g, Sheng Jiang 3 slices, Da Zao 3 pieces. After 4 doses, spirit, appetite, epigastric pain, and insomnia improved, with about 3-4 hours of sleep per night; continuing for half a month, besides improvement in other symptoms, sleep increased to 7-8 hours.
Patient Zhu XX, female, 40 years old. Unable to sleep day and night for one month. Despite repeated use of Western hypnotics and Chinese calming herbs, no sleep was possible. Examination of the syndrome revealed, besides insomnia, dizziness and fatigue, frequent sadness and desire to cry; white tongue coating; and deficient-large pulse. Integrating syndrome and pulse, the diagnosis was Spleen-Stomach Qi deficiency, failure of Clear Yang to ascend, and Liver Wood failing to spread. Treatment aimed at tonifying Qi and raising Yang, regulating the Liver, assisted by calming the Spirit. Formula: Buzhong Yiqi Tang with additions. Prescription: Huang Qi 15g, Bai Zhu 10g, Dang Shen 10g, Dang Gui 10g, Chen Pi 10g, Sheng Ma 10g, Chai Hu 10g, Gan Cao 10g, Wu Wei Zi 10g. After 1 dose, sleep increased to 4 hours; continuing for 10 doses resulted in normal sleep.
Patient Song XX, male, adult. Insomnia for 7-8 years, sleeping only about 2 hours per night. Memory and analytical abilities declined daily; dizziness with numbness, soreness and pain in the lower back, aversion to cold. Initially, hypnotics allowed about 2 hours of sleep, then became ineffective. Adding Chinese sedative pills and decoctions brought temporary improvement, but soon lost efficacy. Examination of the syndrome revealed, besides the above, thin white tongue coating; deficient and weak pulse. Synthesizing the pulse and syndrome, the diagnosis was emptiness of Brain Marrow and dual deficiency of Qi and Yin. Treatment aimed at filling Essence and nourishing Marrow, benefiting Qi and nourishing Yin. Formula: Guilu Erxian Jiao modified. Prescription: Gui Jia 60g, Lu Rong 4g, Ren Shen 10g, Gou Qi Zi 10g, He Shou Wu 10g. Decoct Gui Jia, Gou Qi Zi, and He Shou Wu in water; grind Lu Rong and Ren Shen into powder for oral administration. After one month, dizziness and spirit improved, and sleep normalized.
Patient Jiang XX, male, adult. Severe insomnia for 4 months, sleeping about 2 hours per night. Ineffective to hypnotics and Chinese Heart-nourishing calming herbs. Examination of the syndrome revealed, besides insomnia, intense nighttime irritability and heat, irritability, yellow-red urine; yellow tongue coating with red body; and fine-rapid pulse. Treatment aimed at nourishing Yin, pacifying the Liver, and clearing Fire. Formula: Dubu Yin Wan modified. Prescription: Gui Jia 30g, Zhi Mu 10g, Huang Bo 10g, Sheng Di 15g. After 2 doses, sleep increased; continuing for 6 doses resulted in normal sleep.
Patient Zhang XX, male, 45 years old. Unable to sleep day and night for over a month after a fall, sometimes sleeping only half an hour. Dizziness, head distension, headache, instability when standing. Multiple sedatives showed little effect. Pulse was deficient-large, wiry, and slippery; tongue coating thin white; irritability, anorexia, dry mouth, epigastric distension. Diagnosis was dual deficiency of Qi and Yin. Formula: Buyin Yiqi Jian modified. Prescription: Huang Qi 15g, Dang Shen 10g, Bai Zhu 10g, Chen Pi 10g, Dang Gui 10g, Sheng Ma 10g, Chai Hu 10g, Gan Cao 6g, Shu Di 15g, Shan Yao 10g, Shan Yu Rou 10g, Fu Ling 10g, Ze Xie 10g, Mu Dan Pi 10g. After 2 doses, appetite and spirit improved; after 6 doses, sleep increased; after 14 doses, sleep normalized.
The *Neijing* holds that sleep is not only related to the Heart, but also inseparably linked to the Zang-Fu organs. The *Lingshu · Xieke Chapter* states: "Wei Qi (Defensive Qi), issuing its fierce and swift energy, moves first between the extremities, muscles, and skin, without rest. It travels through the Yang during the day and through the Yin at night, often moving among the viscera and bowels via the branches of Foot Shaoyin. Now, if Jue Qi (Rebellious Qi) lodges in the Zang-Fu organs, Wei Qi alone guards the exterior, traveling in the Yang and unable to enter the Yin. Traveling in the Yang causes Yang Qi to become excessive. When Yang Qi is excessive, the Yang Qiao vessel sinks and cannot enter the Yin. Due to Yin deficiency, the eyes remain open." The *Da Huo Lun Chapter* states: "If the intestines and stomach are small, the skin is smooth and lax, and the muscles are loose, Wei Qi remains in the Yang for a long time, hence there is little sleep." It also points out the treatment principle: "First address the Zang-Fu organs, correct minor faults, then regulate Qi. Excess is purged, deficiency is tonified. One must first understand the physical and mental suffering and joy, then determine the treatment." I follow this discussion: for those with unsettled Heart Spirit, I treat with calming the Spirit and nourishing the Heart; for Liver Qi stagnation, I treat with soothing the Liver and regulating Qi; for Qi deficiency, I provide Qi tonification; for Kidney and Du Meridian depletion, I tonify the Kidney and Du; for Phlegm-Turbidity obstruction, I resolve Phlegm; for Blood Stasis, I invigorate Blood and remove Stasis, etc., often achieving satisfactory results.
For example: Patient Liu XX, female, adult. For two months postpartum, unable to sleep for a long time. Inquiry revealed previous prescriptions were all for nourishing the Heart and calming the Spirit, or heavy sedation, and Western drugs were also increased daily. Careful examination of the syndrome revealed, besides day-night insomnia, fatigue, profuse sweating, pale complexion, tender-red tongue body with thin white coating; deficient-large and slow pulse. Synthesizing the pulse and syndrome, the diagnosis was dual deficiency of Qi and Yin. Formula: Buzhong Yiqi Tang plus Mai Dong and Wu Wei Zi. Sleep began after 2 doses; normalized after 10 doses. A certain doctor asked: "Why did previous sedatives fail, while subsequent Qi tonification and Yin nourishment induced sleep?" The answer was: "The *Neijing*'s discussion on wakefulness and sleep refers not only to the Heart, but to the Zang-Fu organs. The *Lingshu* discusses wakefulness and sleep as belonging to the Yin-Yang entry and exit of the Zang-Fu, the interaction of the Triple Burner, the fusion of Heart and Kidney, the size of the intestines and stomach, and the looseness of skin and muscles. This case involves dual deficiency of Spleen and Lung, failure of Clear Yang to ascend, and prolonged retention of Wei Qi in the Yang. Therefore, Buzhong Yiqi Tang combined with Shengmai San was used to benefit and tonify Yang, resulting in cure."
Patient Geng XX, male, adult. Insomnia for over a year, often sleepless all night. Ineffective to Chinese/Western medicines and acupuncture. Previous prescriptions were mostly sedative. Syndrome presented with chest and hypochondriac irritability and fullness, dizziness and vertigo, bitter taste and dry throat; wiry-small-rapid pulse. Considered to be caused by Liver stagnation transforming into Fire and dual deficiency of Heart and Liver Blood. Although blood-nourishing herbs were previously used, they were insufficient for soothing the Liver and resolving stagnation. Therefore, Danzhi Xiaoyao San plus Dan Shen was used. Sleep began after 3 doses; normalized after 10 doses.
Patient Liu XX, male, adult. Insomnia and forgetfulness for over ten years, often sleepless all night. Ineffective to Chinese/Western medicines. Recent symptoms worsened: besides brief sleep during day and night, soreness and heaviness in the lower back, fatigue, aversion to cold and cold limbs; thin white coating; deep, fine, and weak pulse. Integrating syndrome and pulse, the diagnosis was decline of Brain Marrow and insufficiency of Ren and Du meridians. Formula: Canrong Weisheng Wan and Deer Antler Essence were used, resulting in recovery within one month.
Patient Zhang XX, male, adult. Insomnia for over ten years, ineffective to all Chinese/Western medicines. Examination revealed chest fullness and hypochondriac pain; deep, fine, and choppy pulse. Formula: Xuefu Zhuyu Tang was prescribed. Effective after 4 doses; normalized after 10 doses.
[Muton Kidney]
Li Yongcui's *Zhengzhi Huibu* states: "Muton Kidney refers to hardness and numbness of the external genitalia, without pain or itching, the penis does not hang, often feeling numb. During urination or defecation, there is stifling distension and discomfort. This is due to Kidney deficiency and exhaustion, non-interaction of Yin and Yang, lack of mutual support between Water and Fire, and deep, fine, chronic cold stagnating within. Dry-hot herbs should not be used purely; instead, warming-dispersing and warming-promoting methods should be used to drive out the pathogen." It also states: "In some cases involving trauma, fright, Phlegm-Qi stagnation, blood-invigorating and Qi-resolving methods should be used." I followed this discussion and tried treating a patient. Cheng XX, male, 40 years old. Numbness of penis and scrotum for 7-8 years, worsening for half a year. Ineffective to acupuncture, Chinese, and Western medicines. Pulse was wiry; tongue coating thin yellow. Integrating syndrome and pulse, the diagnosis was Liver Qi stagnation and Cold coagulation failure to transform. Treatment aimed at soothing the Liver, resolving stagnation, and warming the Liver. Prescription: Chai Hu 6g, Gui Zhi 12g, Bai Shao 21g, Sheng Jiang 9g, Da Zao 5 pieces, Long Gu 30g, Mu Li 30g, Yi Mi 30g, Mu Gua 30g, Zi Shi Ying 15g, Wu Zhu Yu 4.5g, Zhi Gan Cao 4.5g. After 4 doses, symptoms remained unchanged. Further inquiry revealed, besides the above, head numbness, toothache, eye distension, irritability and palpitations, epigastric distension. Realizing the previous formula lacked sufficient Qi-regulating power, causing Middle Jiao blockage and failure of ascending/descending functions, heavy use of Qi-regulating herbs was needed. Prescription: Chai Hu 6g, Zhi Ke 9g, Bai Shao 9g, Qing Pi 9g, Chen Pi 9g, Su Ye 6g, Bo He 6g, Zhi Zi 4.5g, Yu Jin 9g, Chang Pu 9g. After 2 doses, still ineffective, with new symptoms of chest fullness, sensation of a lump in the throat (Plum-pit Qi), and difficult cough. To eliminate this Phlegm-Dampness, a warming formula to transform Phlegm-Fluid was necessary. Prescription: Chai Hu 6g, Ban Xia 9g, Huang Qin 9g, Gui Zhi 9g, Bai Shao 9g, Sheng Jiang 3 slices, Da Zao 3 pieces, Chen Pi 9g, Su Ye 9g, Bo He 6g, Mei Gui Hua 9g, Dai Dai Hua 9g. After 4 doses, indeed cured successfully.
[Shan/Hernia]
*Concise Chinese Internal Medicine* states: "In ancient literature, 'Shan' (Hernia) has two meanings: one refers to abdominal pain radiating up and down, such as Chong Shan and Xin Shan in the *Neijing*, Han Shan in *Jinkui*, and Jue Shan, Jia Shan, Han Shan, Qi Shan, Pan Shan, Fu Shan, Lang Shan in Chao Yuanfang's *Bingyuan*; this belongs to this type. The other refers to testicular swelling and pain radiating to the lower abdomen, i.e., the seven hernias mentioned by Hezi: Han Shan, Shui Shan, Jin Shan, Xue Shan, Qi Shan, Hu Shan, and Tuo Shan." It further states: "Generally speaking, pathogens of Cold, Dampness, and Heat are the main causes of Hernia. Pathologically, it is closely related to the Liver Meridian; because the Liver Meridian circulates around the genitalia and reaches the lower abdomen, the general method for treating Hernia mostly starts from the Liver Meridian." Epididymal tuberculosis with swelling and heaviness belongs to the category of Hernia. Therefore, when formulating prescriptions, one should also start from the Liver Meridian, using softening-hardness and dissipating methods with herbs entering the Liver. A patient, Wang XX, male, 45 years old, suffered from scrotal dragging pain and dull ache for over a year. Diagnosed with epididymal tuberculosis at a certain hospital. Surgery was suggested. Refusing surgery, he switched to Chinese medicine: Xia Ku Cao 30g, Shan Zha He 30g, Li He 30g, Chi Shao 9g, Qing Pi 9g, Wu Yao 6g, Ju He 15g, Mu Xiang 3g, Chuan Lian Zi 9g. After 20 doses, dull ache disappeared and dragging sensation decreased; after 90 doses, cured. Another case encountered later: Qin XX, male, 38 years old. Epididymal tuberculosis for one year. Using the same prescription, dragging sensation decreased after 10 doses; after another 30 doses, recovered. Careful examination of the syndrome revealed soreness and pain in the lower back, deep and fine pulses with large and wiry chi positions. This indicated Kidney Qi deficiency and Cold Qi stagnation. Considering the original formula was for soothing the Liver, softening hardness, and dissipating nodules, with a cold nature, the unclear disease location and undifferentiated Cold/Heat led to this outcome. Therefore, Bawei Dihuang Wan plus Che Qian Zi, Huai Niu Xi, and Sha Yuan Zi was used for 30 doses, resulting in cure.
[Hydrocele]