表寒里热，不与散寒，但予清热，表寒反郁，其病不解
赵××，男，50岁。
5天前，在睡卧欲眠时，突感窗缝之风吹至头部，即刻感到头痛项强，继而全身关节肌肉疼痛，十几分钟后头痛加剧，恶心呕吐，恶寒发热，急至某院住院治疗。察其体温39．8℃．颌下、颈、腋部淋巴结肿大，血白细胞数正常，淋巴细胞增高。脑脊液细胞数2500／立方毫米，淋巴细胞92％。诊为淋巴细胞脉络丛脑膜炎。医除急予西药治疗外，并配予中药清瘟败毒饮加减为方4剂不效。邀余往治。察其虽头痛、身痛甚烈，但无神昏之苦，且述除头痛身痛之外，并见恶心呕吐，恶寒发热，心烦不安，口苦口干，舌苔白，脉弦紧略浮。综合脉证，思之：仲景有云：“太阳病，或已发热，或未发热，必恶寒，体痛，呕逆，脉阴阳俱紧者，名为伤寒。…‘太阳病，发热而渴，不恶寒者，为温病。”“太阳中风，脉浮紧，发热恶寒，身疼痛，不汗出而烦躁者，大青龙汤主之。”《伤寒六书纂要辨疑》云：“羌活冲和汤，以代桂枝、麻黄、青龙各半等汤。此太阳经之神药也，治春夏秋感冒暴寒，头痛发热，恶寒脊强，无汗，脉浮紧宜发散，不与冬时正伤寒同治法。，’羌活冲和汤即俗之云九味羌活汤之药味组成方也。此病脉证似伤寒之表证而不尽表证之病耳。又思吴又可《温疫论》云：“温病初起，先憎寒而后发热，嗣后但热而不憎也。初得之二三日，其脉不浮不沉而数，昼夜发热，日晡益甚，头痛身痛，其时邪在伏膂之前，肠胃之后，虽有头痛身痛，此邪热浮越在经，不可认为伤寒表证，辄用麻黄桂枝之类，强发其汗……宜达原饮主之。”仲景云：“伤寒，脉弦细，头痛发热者，属少阳，少阳不可发汗。”本证脉非少阳而兼少阳，证兼少阳而非少阳，乃太少合病，宜主予和解兼予解表。处方：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，柴胡15克，桂枝10克，白芷10克，羌活10克。
服药1剂，头痛身痛稍减，恶心呕吐停止。脉浮紧。因思太阳为主者，宜解表散寒。九味羌活可也。处方：羌活10克，防风10克，细辛4克，苍术10克，白芷10克，川芎10克，黄芩10克，生地10克，甘草10克。
服药1剂，诸证俱失，体温正常，惟仍乏力，头晕，脉弦大。思之：气阴俱伤耳。拟清暑益气汤4剂，愈。
某医云：何脑炎而头痛高热反用辛温而愈，寒凉反剧?答：表寒者必予疏风散寒，若寒郁于表者，徒用寒凉以闭毛窍则热邪更炽，此仲景之用大青龙意也。近世有见脑炎即认热证而予寒凉致病加剧者，时有发现，慎之，慎之。
传染性单核细胞增多症
暑伤气阴，不益气阴，但清热邪，正气不复，病延日期
李××，女，9岁。十几天前，突然高热持续不退，颈部淋巴结肿大，串串成珠。急至某院住院治疗。诊为传染性单核细胞增多症。先予抗生素等西药治疗7天，其热不降，继又配合中药清热解毒之剂4天，其热虽有下降，但仍然不够显著。察其面色皓白，头身俱有汗出，颈部两侧结核串串连属约20余，按之微痛，不红，体温38．5℃，舌质嫩红，苔薄白，脉虚大数。综合脉证，思之：热者寒之，此治病之正法，何用之不效?结核串串成珠者，恐未与散结消核之故也。乃予夏枯草、连翘、蝉蜕、元参辈投入3剂，诸证不减。某医云：此病)，单核细胞增多症，中药哪个是降单核细胞的药物呢?答曰：中药典籍未见有降单核细胞的记载，杂志亦未见有报道。今思仲景《伤寒》、《金匮》两书均言脉证并治，何不求脉证以立法处方耳。汗出身热脉大者气阴俱虚，暑邪外客证也。可予东垣清暑益气汤。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克。神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。药进2剂，汗减热退，继服4剂，诸证消失，愈。
百日咳
但治其咳，未通其腑，肠实肺实，逆气作咳
韩××，男，10个月。一个多月来，阵发性痉咳，在某院住院25天，无明显效果。邀余诊治。医云：前用抗生素、多种镇咳药，以及鸡苦胆等调治，其效不著，而住院之百日咳患者中大都有效其故何也?答曰：百部、紫菀、贝母、半夏、白前、麦冬均治肺之品，其不效者，恐乃他脏之所为。细询家长，并按其腹后云：患儿其腹如鼓，目数日不便，大肠与肺相表里，大肠壅滞，肺气不降，则上逆作咳作喘，此仲景以厚朴配杏仁治咳意也。可予治肺之品加大黄少许治之。处方：紫菀3克，半夏3克，陈皮3克，薄荷2克，丝瓜络3克，杏仁3克，紫苏3克，百部12克，大黄1克。服药1剂，其证大减．再进1剂，竟咳止而愈。
伤寒
暑湿弥漫，三焦不化，但治中焦，其热难解
赵×x，男，58岁。壮热烦渴，汗出便溏8天。急住某院进行治疗，确诊为伤寒。医予西药治之，其热不减。邀治于予。审其除体温持续在39．2℃一39．5cc外，并见其身热汗出，口渴，脉滑数。因思仲景《伤寒论》云：“伤寒，脉浮滑，此表有热，里有热，白虎汤主之。”鞠通《温病条辨》云：“手太阴暑温，或已经发汗，或未发汗，而汗不止，烦渴而喘，脉洪大有力者，白虎汤主之……身重者，湿也，白虎加苍术汤主少，”此证之壮热烦渴，汗出脉滑数，显系苍术白虎汤证。乃处：苍术12克，生石膏60克，知母12克，甘草10克，粳米30克，银花15克。服药2剂，诸证不减，反见痰多，泄泻，啕闷脘痞。因忆叶天士《临证指南医案》云：“暑热必夹湿，吸气而受，先伤于上，故仲景伤寒先分六经，河问温热须究三焦，大凡暑热伤气，湿著阻气，肺主一身周行之气，位高，为手太阴经。据述病样面赤足冷，上脘痞塞，其为上焦受病显著，缘平素善饮，胃中湿热久伏辛温燥烈，不但肺病不合，而胃中湿热得燥热锢闭，下利稀水，即协热不利，故黄连苦寒，每进必利甚者，苦寒以胜其辛热，药味尚留于胃底也。然与初受之肺邪无当，此石膏辛寒，辛先入肺；知母为味清凉，为肺之母气，然不明肺邪，徒日生津，焉是至理。昔孙真人未诊先问，最不误事，再据主家说及病起两句，从无汗泄，经云：暑墨汁出勿止，气分窒塞日久。热侵入血中，咯痰带血，舌红井；，不甚渴饮。上焦不解，漫延中下，此皆急清i焦，是第一尊旨，故热病之瘀热，留络而为遗毒，注腑肠而为洞利，便为束手无策：再论湿乃重浊之邪，热为熏蒸之气，热处湿巾，蒸汗之气．．E迫清窍，耳为失聪，不与少阳耳聋同洌，青蔫减柴州一等，亦是少阳本药，H大病如大甜，选药若选将，笥非慎币．鲜克有济?议三焦分清治。从河间法，．”吴鞠通《温病条mi五：“暑温蔓延_二焦，舌滑徽黄，邪在气分者，三石汤主之”再审其舌滑微黄，问其口渴之状?言其口干而不甚渴。盯思苍术白虎汤乃治中焦之品，且无化痰利湿，调理=三焦之味，药非其治，故不效也。因拟三石汤清热利湿，宣通三焦。处方：滑石12克，生石膏20克，杏仁10克，竹茹10克，银花10克，黄芩6克，通草10克。服药2剂，热退利止，继服2剂，诸证消失，愈。
痢疾
l.当留针而不留针，但求速效，其效反缓
朱××，女，28岁。3天前，突然腹痛下利，里急后里。日数十行。因条件限制，无药予治。不得已，改用针法治之。采用不留针，强刺激法，一日1次，诸证不减。求教于家父。家父云：针足三里、天枢、中脘、气海。余云：已针三日矣。家父问：你怎么针的?答曰：采用的强刺激不留针法。家父石：误也。应留针30—60分钟。余云：患者刚刚进针即欲大便怎么办?答云：不可起针。但觉腹痛欲便即捻转各针，至其腹痛欲便感停止时留针，若再腹痛欲便就再捻，至留针30。60分钟时再取针，只有这样才能一次治愈，否则不可也。痢疾者，往往与积有关，积病之治只可缓消，不可猛攻，攻之则便通腐秽不除。针刺治积亦同此理，只可缓消留针，不可刺激过强而猛攻。余遵其嘱，针后留针1小时，果然一次得愈。
2.正虚邪实，攻补宜缓，过用药饵，反增病势
耿××，男，25岁。泄利3年，一日10～20次不等。医诊慢性痢疾。始予西药治之微效，继而无功；再以中药治痢之剂治之，亦多始效，再用无功。邀治于予。审其脉弦细，腹痛F利，里急后重。思之：仲景曾言：“伤寒，脉微而厥，至七八日腹冷，其人躁无暂安时者，此为脏厥，非蛔厥也。蛔厥者，其人当吐蛔，今病者静而复时烦者，此为脏寒，蛔上入其8甬，故烦，须臾复止，得食而呕，又烦者，蛔闻食臭出，其人常自吐蛔。蛔厥者，乌梅丸主之。又主久痢。’’予乌梅丸加减为汤10剂，不效。乃求教于李师翰卿先生，云：里急后重，大便为白痢，乃寒积不化所致，宜温中导滞可也。余遵其意。处方：附子12克，肉桂12克，人参12克，白术12克，干姜12克，炙甘草12克，枳实12克，厚朴12克，大黄9克，焦山楂30克，山药45克。服药1剂后，腹痛、泄利均见加萤，又服5剂，腹痛、泄利更甚。不得不经常以阿托品等药以止痛。再求教于李先生。云：脉沉细，肢厥，痢下白粘，里急后蕈，舌苔薄白者，脾肾虚寒为本，积滞不化为标，正虚邪实，攻补两难，实难措手。阳虚者当补火，补火者当宗《内经》少火生气，绝对不可壮火食气，壮火散气，以助火邪；除积只可缓消，不可攻下，以免大便迅疾而去，积反不除。又五脏来复六日为期，不可天天以治诸脏。乃予：附子0．6克，肉桂0．6克，人参0．9克，白术0．9克，炙甘草0。6克，木香O．3克，焦山楂3克，山药3克，大黄0．3克。并嘱服药1剂后，当停药5日，且必须禁用任何药饵。6日后来诊，云：服药后无任何不良反应，但亦没有明显效果，仅见昨日大便减至每日4次。患者云：可否改为速效之药。先生云：不可也。必须候气来复，必须注意少火，必须注意缓消。再予上药每周1剂，一月之后，愈。
3．湿热夹寒，但治其热，寒积不化，久痢难愈何××，男，40岁。数年来，每至夏秋之交即患痢疾。此次发病后虽久用痢特灵、氯霉素亦时轻时重，不得已，改请某医以黄连、黄芩、黄卡自、马齿苋、木香、大黄治之，仍然效果不够明显。邀余诊视。审其里急后重，便痢脓血，腹痛时作，脉弦滑时涩。乃厶：此虽湿热下痢，然夹寒滞不化，治宜清热解毒，同和气血。芍药汤加减：白芍10克，当归10克，槟榔10克，木香10克，甘草6克，大黄3克，肉桂10克，黄连10克，黄芩10克。
服药4剂，诸证俱减，乃改为二日1剂，共服6剂，愈。
某医云：何用治痢之芩、连、柏、马齿苋不效，而用不治痢之药反有效?既然痢为湿热，何又加肉桂之大辛大热?答云：仲景曰：“小肠有寒者，其人下重便血。”乃下利下重便血者夹寒也，夹寒者必佐温散，故以肉桂治之也。
4．寒热俱见久痢阴伤，但治其痢，不护其阴，因致不愈
张××，男，46岁。
慢性痢疾3年多。医始以西药治之不效，后医以中药治之仍不效。近日以来，泄痢更加严重，里急后重，便利脓粘，时腹疼痛，一日4～5次至7～8次不等，指趾厥冷，脉沉细弦。综合脉症，思之：此脾肾虚寒也。治宜健脾温肾。宗附桂理中合四神丸。处方：附子10克，肉桂10克，党参10克，白术J()克·干姜10克，炙甘草10克，补骨脂10克，肉豆蔻10克，五味子10克，吴茱萸10克。
服药4剂后，寸效未见。思之：证脉均为脾肾虚寒，何用温补脾肾之剂不愈也?因忆景岳曾云：再参用药参机辨。细察前医用药有健脾温中者，有温补脾肾者，有温里固涩者，有温中导滞者，然均不效。乃悟：此必寒热久蕴，痢久阴伤所致。再询其证，果见夜间口干。乃拟苦辛酸法。处方：乌梅12克．肉桂10克，川椒10克，干姜10克，黄连10克，黄柏10克，附子10克，党参10克，细辛3克，当归10克，木瓜10克，．
服药6剂，诸证果减，继服6剂，诸证消失，愈。
肺结核
1.囿于肺炎消炎，结核养阴，不审脉证，久病不愈
苏××，男，38岁。
【背景信息】
书名：中医临证经验与方法 章节：正文(28/94) 类别：方剂
表寒里热，如果不疏散表寒，只给予清热治疗，表寒反而郁闭，病情无法解除。
赵××，男，50岁。
5天前，在睡卧欲眠时，突然感到窗缝的风吹到了头部，即刻感到头痛、项部僵硬，继而全身关节肌肉疼痛。十几分钟后头痛加剧，出现恶心呕吐、恶寒发热，急忙到某医院住院治疗。检查发现体温39.8℃，颌下、颈部、腋部淋巴结肿大，血白细胞计数正常，淋巴细胞比例增高。脑脊液细胞数2500/立方毫米，淋巴细胞占92%。诊断为淋巴细胞脉络丛脑膜炎。医生除了急予西药治疗外，并配合中药清瘟败毒饮加减作为处方，服用4剂后无效。邀请我前往诊治。观察其虽然头痛、身痛剧烈，但没有神志昏迷的痛苦，且自述除头痛身痛之外，还见恶心呕吐、恶寒发热、心烦不安、口苦口干，舌苔白，脉象弦紧略浮。综合脉象和症状，思考道：张仲景曾说：“太阳病（太阳经受邪所致的病证），或者已经发热，或者尚未发热，必定恶寒，身体疼痛，呕吐逆气，脉象寸关尺三部都紧的，称为伤寒。”“太阳病，发热而且口渴，不恶寒的，称为温病。”“太阳中风，脉象浮紧，发热恶寒，身体疼痛，无汗并且烦躁的，以大青龙汤主治。”《伤寒六书纂要辨疑》说：“羌活冲和汤，用来代替桂枝麻黄各半汤等方剂。这是太阳经的神药，治疗春夏秋三季感冒暴寒引起的头痛发热、恶寒脊背僵硬、无汗、脉浮紧，适宜发散解表，不与冬季正伤寒用同样的治法。”羌活冲和汤就是俗称的九味羌活汤的药物组成方剂。这个病的脉证类似伤寒的表证，但不完全是表证的病机。又想到吴又可《温疫论》说：“温病初起，先憎寒而后发热，随后只有发热而不憎寒了。刚得病二三天，脉象不浮不沉而数，昼夜发热，傍晚加重，头痛身痛，此时邪气伏藏在膂前肠胃之后，虽然有头痛身痛，这是邪热浮越在经络，不可认为是伤寒表证，就随意用麻黄、桂枝之类药物，强行发汗……适宜用达原饮主治。”张仲景说：“伤寒，脉象弦细，头痛发热的，属于少阳病，少阳病不可发汗。”本证的脉象不是纯粹的少阳脉而兼有少阳脉，证候兼有少阳证而非典型的少阳证，乃是太阴与少阳合病，适宜主要给予和解法兼以解表。处方：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，柴胡15克，桂枝10克，白芷10克，羌活10克。
服药1剂后，头痛身痛稍减，恶心呕吐停止。脉象仍浮紧。因为思考太阳经为主者，适宜解表散寒。可以用九味羌活汤。处方：羌活10克，防风10克，细辛4克，苍术10克，白芷10克，川芎10克，黄芩10克，生地10克，甘草10克。
服药1剂后，各种症状全部消失，体温正常，只是仍然乏力、头晕，脉象弦大。思考道：这是气阴两伤罢了。拟定清暑益气汤4剂，痊愈。
某医生说：为什么脑炎而头痛高热反而用辛温药物治愈，用寒凉药物反而加重？回答：表寒必须给予疏风散寒，如果寒邪郁闭在体表，徒然使用寒凉药物闭塞毛孔，则热邪更加炽盛，这是张仲景使用大青龙汤的用意所在。近代有人一见脑炎就认定为热证而给予寒凉药物导致病情加剧的情况，时常发现，务必谨慎，务必谨慎。
传染性单核细胞增多症
暑邪损伤气阴，如果不补益气阴，只清除热邪，正气不能恢复，病程延长。
李××，女，9岁。十几天前，突然高热持续不退，颈部淋巴结肿大，呈串珠状。急忙到某医院住院治疗。诊断为传染性单核细胞增多症。先予抗生素等西药治疗7天，热度未降，接着又配合中药清热解毒之剂4天，热度虽有下降，但仍然不够显著。观察其面色苍白，头身均有汗出，颈部两侧结核呈串珠状连接约20余个，按压微痛，不红，体温38.5℃，舌质嫩红，苔薄白，脉象虚大数。综合脉象和症状，思考道：热者寒之，这是治病的正法，为什么用了不效？结核呈串珠状，恐怕是没有给予散结消核药物的缘故。于是给予夏枯草、连翘、蝉蜕、玄参等投入3剂，各种症状没有减少。某医生说：这种病叫单核细胞增多症，中药哪个是降低单核细胞的药物呢？回答说：中药典籍未见有降低单核细胞的记载，杂志也未见有报道。现在思考张仲景《伤寒论》、《金匮要略》两书均言脉证并治，为什么不寻求脉证来立法处方呢？出汗后身热脉大，是气阴俱虚，暑邪外客证候。可以给予东垣的清暑益气汤。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。药进2剂，汗减热退，继服4剂，各种症状消失，痊愈。
韩××，男，10个月。一个多月来，阵发性痉咳，在某院住院25天，无明显效果。邀请我诊治。医生说：前用抗生素、多种镇咳药，以及鸡苦胆等调治，效果不显著，而住院的百日咳患者中大都有效，这是什么原因呢？回答说：百部、紫菀、贝母、半夏、白前、麦冬都是治疗肺脏的药物，其不效的原因，恐怕是其他脏腑的问题。仔细询问家长，并按压其腹部后说：患儿腹部如鼓，多日不便，大肠与肺相表里，大肠壅滞，肺气不降，则上逆作咳作喘，这是张仲景用厚朴配杏仁治疗咳嗽的用意。可以给予治疗肺的药物加大黄少许来治疗。处方：紫菀3克，半夏3克，陈皮3克，薄荷2克，丝瓜络3克，杏仁3克，紫苏3克，百部12克，大黄1克。服药1剂，症状大减，再进1剂，竟然咳止而愈。
赵×x，男，58岁。壮热烦渴，汗出便溏8天。急忙住某院进行治疗，确诊为伤寒。医生予西药治疗，热度不减。邀请我诊治。审视其除体温持续在39.2℃—39.5℃外，并见其身热汗出，口渴，脉象滑数。因为思考张仲景《伤寒论》说：“伤寒，脉象浮滑，这是表有热，里有热，用白虎汤主治。”鞠通《温病条辨》说：“手太阴暑温，或者已经发汗，或者未发汗，而汗不止，烦渴而喘，脉洪大有力者，白虎汤主治……身体沉重者，是湿邪，用白虎加苍术汤主治。”此证的壮热烦渴，汗出脉滑数，显然是苍术白虎汤证。于是处方：苍术12克，生石膏60克，知母12克，甘草10克，粳米30克，银花15克。服药2剂，各种症状不减，反见痰多，泄泻，脘闷痞塞。因为回忆叶天士《临证指南医案》说：“暑热必夹湿，吸气而受，先伤于上，所以张仲景伤寒先分六经，河间温热须究三焦，大凡暑热伤气，湿著阻气，肺主一身周行之气，位高，为手太阴经。据述病样面赤足冷，上脘痞塞，其为上焦受病显著，缘平素善饮，胃中湿热久伏辛温燥烈，不但肺病不合，而胃中湿热得燥热锢闭，下利稀水，即协热不利，故黄连苦寒，每进必利甚者，苦寒以胜其辛热，药味尚留于胃底也。然与初受之肺邪无当，此石膏辛寒，辛先入肺；知母为味清凉，为肺之母气，然不明肺邪，徒日生津，焉是至理。昔孙真人未诊先问，最不误事，再据主家说及病起两句，从无汗泄，经云：暑墨汁出勿止，气分窒塞日久。热侵入血中，咯痰带血，舌红井；，不甚渴饮。上焦不解，漫延中下，此皆急清i焦，是第一尊旨，故热病之瘀热，留络而为遗毒，注腑肠而为洞利，便为束手无策：再论湿乃重浊之邪，热为熏蒸之气，热处湿巾，蒸汗之气．．E迫清窍，耳为失聪，不与少阳耳聋同洌，青蔫减柴州一等，亦是少阳本药，H大病如大甜，选药若选将，笥非慎币．鲜克有济?议三焦分清治。从河间法，．”吴鞠通《温病条mi五：“暑温蔓延_二焦，舌滑徽黄，邪在气分者，三石汤主之”再审其舌滑微黄，问其口渴之状?言其口干而不甚渴。盯思苍术白虎汤乃治中焦之品，且无化痰利湿，调理=三焦之味，药非其治，故不效也。因拟三石汤清热利湿，宣通三焦。处方：滑石12克，生石膏20克，杏仁10克，竹茹10克，银花10克，黄芩6克，通草10克。服药2剂，热退利止，继服2剂，各种症状消失，痊愈。
痢疾
l.应当留针而不留针，只求速效，其效反而缓慢。
朱××，女，28岁。3天前，突然腹痛下利，里急后重。日数十行。因条件限制，无药予治。不得已，改用针法治之。采用不留针，强刺激法，一日1次，各种症状不减。求教于家父。家父说：针刺足三里、天枢、中脘、气海。我说：已针三日矣。家父问：你怎么针的？回答说：采用的强刺激不留针法。家父说：误也。应留针30—60分钟。我说：患者刚刚进针即欲大便怎么办？回答说：不可起针。但觉腹痛欲便即捻转各针，至其腹痛欲便感停止时留针，若再腹痛欲便就再捻，至留针30。60分钟时再取针，只有这样才能一次治愈，否则不可也。痢疾者，往往与积有关，积病之治只可缓消，不可猛攻，攻之则便通腐秽不除。针刺治积亦同此理，只可缓消留针，不可刺激过强而猛攻。我遵其嘱，针后留针1小时，果然一次得愈。
耿××，男，25岁。泄利3年，一日10～20次不等。医生诊慢性痢疾。始予西药治之微效，继而无功；再以中药治痢之剂治之，亦多始效，再用无功。邀请我诊治。审视其脉象弦细，腹痛下利，里急后重。思考道：张仲景曾言：“伤寒，脉微而厥，至七八日腹冷，其人躁无暂安时者，此为脏厥，非蛔厥也。蛔厥者，其人当吐蛔，今病者静而复时烦者，此为脏寒，蛔上入其8甬，故烦，须臾复止，得食而呕，又烦者，蛔闻食臭出，其人常自吐蛔。蛔厥者，乌梅丸主治。又主久痢。”予乌梅丸加减为汤10剂，无效。于是求教于李师翰卿先生，说：里急后重，大便为白痢，乃寒积不化所致，适宜温中导滞即可。我遵其意。处方：附子12克，肉桂12克，人参12克，白术12克，干姜12克，炙甘草12克，枳实12克，厚朴12克，大黄9克，焦山楂30克，山药45克。服药1剂后，腹痛、泄利均见加重，又服5剂，腹痛、泄利更甚。不得不经常以阿托品等药以止痛。再求教于李先生。说：脉沉细，肢厥，痢下白粘，里急后重，舌苔薄白者，脾肾虚寒为本，积滞不化为标，正虚邪实，攻补两难，实难措手。阳虚者当补火，补火者当宗《内经》少火生气，绝对不可壮火食气，壮火散气，以助火邪；除积只可缓消，不可攻下，以免大便迅疾而去，积反不除。又五脏来复六日为期，不可天天以治诸脏。于是给予：附子0．6克，肉桂0．6克，人参0．9克，白术0．9克，炙甘草0。6克，木香O．3克，焦山楂3克，山药3克，大黄0．3克。并嘱咐服药1剂后，当停药5日，且必须禁用任何药饵。6日后来诊，说：服药后无任何不良反应，但亦没有明显效果，仅见昨日大便减至每日4次。患者说：可否改为速效之药。先生说：不可也。必须候气来复，必须注意少火，必须注意缓消。再给予上药每周1剂，一月之后，痊愈。
何××，男，40岁。数年来，每至夏秋之交即患痢疾。此次发病后虽久用痢特灵、氯霉素亦时轻时重，不得已，改请某医以黄连、黄芩、黄卡自、马齿苋、木香、大黄治之，仍然效果不够明显。邀请我诊视。审视其里急后重，便痢脓血，腹痛时作，脉象弦滑时涩。于是认为：此虽湿热下痢，然夹寒滞不化，治疗适宜清热解毒，调和气血。芍药汤加减：白芍10克，当归10克，槟榔10克，木香10克，甘草6克，大黄3克，肉桂10克，黄连10克，黄芩10克。
服药4剂，各种症状俱减，于是改为二日1剂，共服6剂，痊愈。
某医生说：为什么用治痢之芩、连、柏、马齿苋不效，而用不治痢之药反而有效？既然痢为湿热，为何又加肉桂之大辛大热？回答说：张仲景说：“小肠有寒者，其人下重便血。”乃下利下重便血者夹寒也，夹寒者必佐温散，故以肉桂治之也。
4．寒热俱见久痢阴伤，只治疗其痢，不护其阴，因致不愈。
张××，男，46岁。
慢性痢疾3年多。医生始以西药治之不效，后医以中药治之仍不效。近日以来，泄痢更加严重，里急后重，便利脓粘，时腹疼痛，一日4～5次至7～8次不等，指趾厥冷，脉象沉细弦。综合脉症，思考道：此脾肾虚寒也。治疗适宜健脾温肾。宗附桂理中合四神丸。处方：附子10克，肉桂10克，党参10克，白术J()克·干姜10克，炙甘草10克，补骨脂10克，肉豆蔻10克，五味子10克，吴茱萸10克。
服药4剂后，寸效未见。思考道：证脉均为脾肾虚寒，为何用温补脾肾之剂不愈也？因为回忆景岳曾云：再参用药参机辨。细察前医用药有健脾温中者，有温补脾肾者，有温里固涩者，有温中导滞者，然均不效。于是悟到：此必寒热久蕴，痢久阴伤所致。再询问其证，果见夜间口干。于是拟定苦辛酸法。处方：乌梅12克．肉桂10克，川椒10克，干姜10克，黄连10克，黄柏10克，附子10克，党参10克，细辛3克，当归10克，木瓜10克，．
服药6剂，各种症状果减，继服6剂，各种症状消失，痊愈。
苏××，男，38岁。
[Background Information]
Book Title: Clinical Experience and Methods of Traditional Chinese Medicine Chapter: Main Text (28/94) Category: Formulas
Exterior cold with interior heat: If exterior cold is not dispersed, but only cleared, the exterior cold will instead become constrained, and the disease will not resolve.
Zhao XX, Male, 50 years old.
Five days ago, while lying down and about to sleep, he suddenly felt a draft from a window crack blowing onto his head. Immediately, he experienced headache and stiffness in the neck, followed by pain in the joints and muscles of the whole body. More than ten minutes later, the headache intensified, accompanied by nausea, vomiting, aversion to cold, and fever. He was urgently admitted to a certain hospital for treatment. Examination revealed a body temperature of 39.8°C, swelling of lymph nodes in the submandibular, cervical, and axillary regions, normal white blood cell count, and increased lymphocyte percentage. Cerebrospinal fluid cell count was 2500/mm³, with lymphocytes accounting for 92%. The diagnosis was lymphocytic choriomeningitis. In addition to urgent Western medicine treatment, the doctors prescribed modified Qingwen Baidu Yin (Clearing Plague and Resolving Toxin Decoction) as an adjunctive therapy. After taking four doses, there was no effect. I was invited to consult. Observation showed that although his headache and body pain were severe, he did not suffer from coma. He reported that besides headache and body pain, he also had nausea, vomiting, aversion to cold, fever, restlessness, bitter taste in the mouth, dry mouth, white tongue coating, and a wiry, tight, slightly floating pulse. Synthesizing the pulse and symptoms, I thought: Zhang Zhongjing said, "Taiyang disease (disease pattern caused by pathogenic factors invading the Taiyang channel), whether fever has already appeared or not, must involve aversion to cold, body pain, vomiting and regurgitation, and pulses that are tight at all three positions (Cun, Guan, Chi) are named Cold Damage (Shanghan)." "Taiyang disease, with fever and thirst, and no aversion to cold, is named Warm Disease (Wenbing)." "Taiyang Wind Strike (Zhongfeng), with floating-tight pulse, fever, aversion to cold, body pain, absence of sweating, and irritability, should be treated with Da Qing Long Tang (Major Blue-Green Dragon Decoction)." *Zhangsan Liushu Zuan Yao Bian Yi* states: "Qiang Huo Chong He Tang (Notopterygium Harmonizing Decoction) can replace Guizhi Mahuang Ban Tang (Half Combination of Cinnamon Twig and Ephedra Decoction). This is a divine herb for the Taiyang channel, treating sudden cold invasion in spring, summer, and autumn causing headache, fever, aversion to cold, stiff spine, absence of sweating, and floating-tight pulse, suitable for dispersing and releasing the exterior; it is not treated with the same method as Zheng Shanghan (True Cold Damage) in winter." Qiang Huo Chong He Tang is the herbal composition of the commonly known Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction). This disease's pulse and symptoms resemble the exterior syndrome of Cold Damage but are not entirely an exterior syndrome. I also recalled Wu Keyou's *Wenyi Lun* (Treatise on Pestilential Diseases): "Warm diseases begin with aversion to cold followed by fever; subsequently, there is only fever without aversion to cold. In the first two or three days, the pulse is neither floating nor sunken but rapid; fever persists day and night, worsening in the late afternoon; headache and body pain occur. At this time, the pathogen lies hidden before the diaphragm and behind the stomach/intestines. Although there is headache and body pain, this is pathogenic heat floating in the channels; it should not be mistaken for an exterior syndrome of Cold Damage, nor should one casually use herbs like Ephedra or Cinnamon Twig to forcibly induce sweating... It is appropriate to treat with Da Yuan Yin (Reach the Origin Decoction)." Zhang Zhongjing said, "Cold Damage with wiry-thin pulse, headache, and fever belongs to Shaoyang (Lesser Yang); Shaoyang disease should not be treated by inducing sweating." This patient's pulse is not purely Shaoyang but mixed with Shaoyang characteristics; the syndrome involves Shaoyang but is not typical Shaoyang. It is a combined disease of Taiyin and Shaoyang. Therefore, it is appropriate to primarily apply harmonizing methods combined with exterior-releasing methods. Prescription: Hou Po (Magnolia Bark) 10g, Cao Guo (Black Cardamom Fruit) 10g, Bing Lang (Areca Seed) 10g, Huang Qin (Scutellaria Root) 10g, Zhi Mu (Anemarrhena Rhizome) 10g, Chai Hu (Bupleurum Root) 15g, Gui Zhi (Cinnamon Twig) 10g, Bai Zhi (Angelica Dahurica Root) 10g, Qiang Huo (Notopterygium Rhizome) 10g.
After one dose, headache and body pain decreased slightly, and nausea and vomiting stopped. The pulse remained floating and tight. Since the Taiyang channel was predominant, it was appropriate to release the exterior and disperse cold. Jiu Wei Qiang Huo Tang could be used. Prescription: Qiang Huo (Notopterygium Rhizome) 10g, Fang Feng (Saposhnikovia Root) 10g, Xi Xin (Asarum Root) 4g, Cang Zhu (Atractylodes Rhizome) 10g, Bai Zhi (Angelica Dahurica Root) 10g, Chuan Xiong (Ligusticum Rhizome) 10g, Huang Qin (Scutellaria Root) 10g, Sheng Di (Rehmannia Root) 10g, Gan Cao (Licorice Root) 10g.
After one dose, all symptoms disappeared, body temperature normalized, but fatigue and dizziness persisted, with a wiry-large pulse. I reasoned: This is damage to both Qi and Yin. I prescribed Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) for four doses, resulting in recovery.
Another doctor asked: Why did辛温 (acrid-warm) herbs cure encephalitis with headache and high fever, while cold-cooling herbs worsened it? Answer: Exterior cold must be treated by dispersing wind and cold. If cold is constrained in the exterior, using only cold-cooling herbs will close the pores, allowing pathogenic heat to become more intense. This aligns with Zhang Zhongjing's intention in using Da Qing Long Tang. Recently, cases have been observed where encephalitis is mistakenly identified as a heat syndrome, leading to the use of cold-cooling herbs that exacerbate the condition. One must be cautious, very cautious.
Infectious Mononucleosis
Summerheat damages Qi and Yin; if Qi and Yin are not supplemented but only heat is cleared, healthy Qi will not recover, prolonging the illness.
Li XX, Female, 9 years old.
More than ten days ago, she suddenly developed persistent high fever and swelling of cervical lymph nodes, arranged in a string of beads. She was urgently admitted to a certain hospital for treatment and diagnosed with infectious mononucleosis. She was initially treated with antibiotics and other Western medicines for seven days, but the fever did not subside. Then, four doses of Chinese herbal formulas for clearing heat and detoxifying were added. Although the fever decreased somewhat, the reduction was not significant. Observation showed pale complexion, sweating on the head and body, approximately 20 cervical lymph node swellings arranged in strings, slightly painful upon pressure but not red, body temperature 38.5°C, tender-red tongue body, thin-white coating, and a deficient-large-rapid pulse. Synthesizing the pulse and symptoms, I thought: "Heat is treated with cold," which is the orthodox method of treatment. Why was it ineffective? The lymph nodes arranged in strings suggest that resolving nodules and dissipating masses was not addressed. Therefore, Xia Ku Cao (Prunella Spike), Lian Qiao (Forsythia Fruit), Chan Tui (Cicada Slough), and Yuan Shen (Scrophularia Root) were administered for three doses, but symptoms did not decrease. Another doctor asked: This disease is called infectious mononucleosis; which Chinese herb lowers mononuclear cells? I replied: There is no record in Chinese herbal classics of herbs lowering mononuclear cells, nor any reports in journals. Now, considering that Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) both emphasize treating based on pulse and symptoms, why not seek the pulse and symptoms to establish laws and prescribe formulas? Sweating after fever with a large pulse indicates deficiency of both Qi and Yin, representing an external invasion of summerheat. Dong Yuan's Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) can be used. Prescription: Dang Shen (Codonopsis Root) 10g, Gan Cao (Licorice Root) 6g, Huang Qi (Astragalus Root) 15g, Dang Gui (Chinese Angelica Root) 6g, Mai Dong (Ophiopogon Tuber) 10g, Wu Wei Zi (Schisandra Berry) 10g, Qing Pi (Citrus Unripe Peel) 10g, Chen Pi (Citrus Ripe Peel) 10g, Shen Qu (Medicated Leaven) 10g, Huang Bo (Phellodendron Bark) 10g, Ge Gen (Kudzu Root) 15g, Cang Zhu (Atractylodes Rhizome) 10g, Bai Zhu (Atractylodes Macrocephala Rhizome) 10g, Sheng Ma (Cimicifuga Rhizome) 10g, Ze Xie (Alisma Rhizome) 10g. After two doses, sweating decreased and fever subsided. After continuing for four doses, all symptoms disappeared, resulting in recovery.
Pertussis (Whooping Cough)
Treating only the cough without unblocking the Fu organs leads to intestinal and pulmonary excess, causing rebellious Qi to induce coughing.
Han XX, Male, 10 months old.
For over a month, he suffered from paroxysmal spasmodic coughing and was hospitalized for 25 days at a certain hospital with no obvious effect. I was invited to consult. The doctor said: Previous treatments included antibiotics, various antitussives, and chicken gallbladder bile, with little effect. Yet, most whooping cough patients in the hospital responded well. What is the reason? I answered: Bai Bu (Stemona Root), Zi Wan (Aster Root), Bei Mu (Fritillaria Bulb), Ban Xia (Pinellia Tuber), Bai Qian (Cynanchum Root), and Mai Dong (Ophiopogon Tuber) are all herbs treating the Lung. Their ineffectiveness suggests the problem may lie in other Zang organs. Upon detailed inquiry and abdominal palpation, I said: The infant's abdomen is drum-like, and he has not had a bowel movement for several days. The Large Intestine and Lung are exterior-interior related. Obstruction in the Large Intestine prevents Lung Qi from descending, causing rebellious Qi to induce coughing and wheezing. This aligns with Zhang Zhongjing's intention of using Hou Po (Magnolia Bark) paired with Xing Ren (Apricot Seed) to treat cough. One can add a small amount of Da Huang (Rhubarb Root) to lung-treating herbs. Prescription: Zi Wan (Aster Root) 3g, Ban Xia (Pinellia Tuber) 3g, Chen Pi (Citrus Ripe Peel) 3g, Bo He (Mint Herb) 2g, Si Gua Luo (Luffa Fiber) 3g, Xing Ren (Apricot Seed) 3g, Zi Su (Perilla Leaf) 3g, Bai Bu (Stemona Root) 12g, Da Huang (Rhubarb Root) 1g. After one dose, symptoms significantly decreased. After another dose, the cough stopped, and he recovered.
Typhoid Fever
Summer-dampness pervades, Sanjiao (Triple Burner) fails to transform; treating only the Middle Jiao makes the heat difficult to resolve.
Zhao xx, Male, 58 years old.
High fever, irritability, thirst, sweating, and loose stools for eight days. He was urgently admitted to a certain hospital for treatment and confirmed to have typhoid fever. Western medicine treatment failed to reduce the fever. I was invited to consult. Examination showed persistent body temperature between 39.2°C and 39.5°C, along with body heat, sweating, thirst, and a slippery-rapid pulse. Recalling Zhang Zhongjing's *Shanghan Lun*: "Cold Damage with floating-slippery pulse indicates heat in both the exterior and interior; Bai Hu Tang (White Tiger Decoction) should be used." Ju Tong's *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases) states: "Hand-Taiyin Summerheat, whether after sweating or not, if sweating continues incessantly, accompanied by irritability, thirst, wheezing, and a洪大 (surging-large) forceful pulse, Bai Hu Tang should be used... Body heaviness indicates dampness; Bai Hu Jia Cang Zhu Tang (White Tiger Plus Atractylodes Decoction) should be used." This patient's high fever, irritability, thirst, sweating, and slippery-rapid pulse clearly indicate a Cang Zhu Bai Hu Tang syndrome. Therefore, I prescribed: Cang Zhu (Atractylodes Rhizome) 12g, Sheng Shi Gao (Gypsum Fibrosum) 60g, Zhi Mu (Anemarrhena Rhizome) 12g, Gan Cao (Licorice Root) 10g, Jing Mi (Rice) 30g, Yin Hua (Honeysuckle Flower) 15g. After two doses, symptoms did not decrease; instead, excessive phlegm, diarrhea, and epigastric fullness/stuffiness appeared. I recalled Ye Tian Shi's *Lin Zheng Zhi Nan Yi An* (Guide to Clinical Practice Medical Cases): "Summerheat must be accompanied by dampness, entering through inhalation, injuring the Upper Jiao first. Thus, Zhang Zhongjing divides Cold Damage into Six Channels, while He Jian investigates Warm Heat through the Three Jiaos. Generally, summerheat damages Qi, and dampness obstructs Qi. The Lung governs the circulation of Qi throughout the body, is located high, and belongs to the Hand-Taiyin channel. Described symptoms include red face and cold feet, epigastric stuffiness, indicating significant Upper Jiao pathology. Due to habitual drinking, damp-heat has long been latent in the Stomach. Acrid-warm drying herbs are unsuitable for Lung disease; moreover, damp-heat in the Stomach becomes sealed by dry-heat, leading to watery diarrhea (xie re bu li). Therefore, Huang Lian (Coptis Rhizome), being bitter-cold, causes severe diarrhea when taken because its bitterness overcomes acrid-warmth, leaving residue in the stomach. However, this does not address the initial Lung pathogen. Shi Gao (Gypsum) is acrid-cold, and acridity enters the Lung first; Zhi Mu is cool and moist, acting as the mother Qi of the Lung. Yet, without understanding the Lung pathogen, merely generating fluids is not the ultimate principle. Sun Simiao asked questions before diagnosis, avoiding errors. Based on the family's description of the onset, there was never sweating. The Classics state: 'If summerheat causes profuse sweating, do not stop it; Qi obstruction in the Qi Division for a long time allows heat to invade the Blood, causing hemoptysis, red tongue, and mild thirst.' If the Upper Jiao is not resolved, it spreads to the Middle and Lower Jiaos. Urgently clearing the Upper Jiao is the primary directive. Thus, residual heat in heat diseases remains in collaterals as lingering toxins or enters Fu organs/intestines causing severe diarrhea, leaving one helpless. Furthermore, dampness is a heavy-turbid pathogen, and heat is a steaming qi. Heat within dampness steams sweat, forcing turbid qi upward to block clear orifices, causing deafness, different from Shaoyang deafness. Qing Hao (Artemisia Annua) and Chai Hu (Bupleurum Root) are also primary Shaoyang herbs. Treating major illness is like selecting generals; one must be cautious, otherwise, little success is achieved. Discuss dividing treatment according to the Three Jiaos, following He Jian's method..." Wu Juzhong's *Wen Bing Tiao Bian*: "Summerheat spreading to the Three Jiaos, with slippery-slightly yellow tongue coating, pathogen in the Qi Division, San Shi Tang (Three Stones Decoction) should be used." Re-examining his slippery-slightly yellow tongue coating and asking about thirst, he stated dry mouth but not extreme thirst. I realized Cang Zhu Bai Hu Tang treats the Middle Jiao and lacks herbs to resolve phlegm, promote dampness, and regulate the Three Jiaos. The medication was inappropriate, hence ineffective. Therefore, I proposed San Shi Tang to clear heat, promote dampness, and unblock the Three Jiaos. Prescription: Hua Shi (Talcum) 12g, Sheng Shi Gao (Gypsum Fibrosum) 20g, Xing Ren (Apricot Seed) 10g, Zhu Ru (Bamboo Shavings) 10g, Yin Hua (Honeysuckle Flower) 10g, Huang Qin (Scutellaria Root) 6g, Tong Cao (Tetrapanax Pith) 10g. After two doses, fever subsided and diarrhea stopped. After continuing for two doses, all symptoms disappeared, resulting in recovery.
Dysentery
1. Failing to retain needle retention when necessary, seeking only rapid effect, results in slower efficacy.
Zhu XX, Female, 28 years old.
Three days ago, she suddenly experienced abdominal pain and diarrhea with tenesmus (feeling of incomplete defecation). She passed stool dozens of times a day. Due to limited conditions, no medication was available. Reluctantly, acupuncture was chosen. Non-retention, strong stimulation method was used, once daily, but symptoms did not decrease. She sought advice from my father. My father said: Needle Zu San Li (ST36), Tian Shu (ST25), Zhong Wan (CV12), and Qi Hai (CV6). I said: I have been needling for three days. My father asked: How did you needle? I answered: Using strong stimulation without retention. My father said: Incorrect. Retention should be 30–60 minutes. I asked: What if the patient feels the urge to defecate immediately after insertion? He answered: Do not remove the needles. When abdominal pain and urge to defecate occur, twist each needle until the sensation stops, then retain. If the urge returns, twist again. Only retain for 30–60 minutes before removal. Only then can it be cured in one session; otherwise, it is impossible. Dysentery is often related to accumulation. Treatment of accumulation should only slowly dissipate, not aggressively attack; attacking leads to passage of stool but retention of foul matter. Acupuncture for accumulation follows the same principle: slow dissipation with retention, not strong stimulation and aggressive attack. Following his instructions, I retained the needles for one hour after needling, and indeed, he was cured in one session.
2. Healthy Qi deficiency and Pathogenic Excess: Attack and tonification should be gradual; excessive medication反而 increases the disease trend.
Geng XX, Male, 25 years old.
Diarrhea and dysentery for three years, varying from 10 to 20 times a day. Diagnosed with chronic dysentery. Initially treated with Western medicine with slight effect, then no effect; subsequently treated with Chinese herbal formulas for dysentery, mostly initial effect then no effect. I was invited to consult. Examination showed wiry-thin pulse, abdominal pain, diarrhea, and tenesmus. I thought: Zhang Zhongjing once said, "Cold Damage with faint pulse and cold extremities, progressing to seven or eight days with cold abdomen, restlessness without temporary relief, is Zang Cold Jue (Visceral Cold Reversal), not Huo Jue (Roundworm Reversal). Huo Jue patients vomit roundworms. If the patient is quiet but occasionally irritable, it is Zang Cold, roundworms moving up into the throat, causing irritation, stopping shortly after, vomiting after eating, and recurring irritation due to smell of food; these patients often vomit roundworms. Huo Jue should be treated with Wu Mei Wan (Mume Pill). It also treats chronic dysentery." I prescribed modified Wu Mei Wan decoction for ten doses, with no effect. I then sought advice from Master Li Hanqing, who said: Tenesmus and white dysentery are caused by cold accumulation failing to transform. Warming the Middle and guiding out stagnation is appropriate. Following his advice, I prescribed: Fu Zi (Aconite Lateral Root) 12g, Rou Gui (Cinnamon Bark) 12g, Ren Shen (Ginseng Root) 12g, Bai Zhu (Atractylodes Macrocephala Rhizome) 12g, Gan Jiang (Dried Ginger) 12g, Zhi Gan Cao (Honey-fried Licorice Root) 12g, Zhi Shi (Immature Bitter Orange) 12g, Hou Po (Magnolia Bark) 12g, Da Huang (Rhubarb Root) 9g, Jiao Shan Zha (Charred Hawthorn Fruit) 30g, Shan Yao (Dioscorea Rhizome) 45g. After one dose, abdominal pain and diarrhea worsened. After five more doses, they became even more severe. Atropine and other drugs had to be used frequently for pain relief. I consulted Mr. Li again. He said: Deep-thin pulse, cold extremities, white sticky dysentery, tenesmus, thin-white coating indicate Spleen-Kidney Yang Deficiency as the root and stagnation failure to transform as the branch. Healthy Qi deficiency with Pathogenic Excess makes attack and tonification difficult. For Yang deficiency, one must tonify Fire. Tonifying Fire should follow the *Neijing* principle of "Minor Fire generates Qi"; absolutely avoid "Major Fire consuming Qi" or "Major Fire scattering Qi" to aid pathogenic fire. Removing accumulation should only be done slowly, not via purgation, to prevent rapid stool passage leaving accumulation behind. Also, the recovery of the Five Zang organs takes six days; one should not treat all organs every day. Therefore, I prescribed: Fu Zi (Aconite Lateral Root) 0.6g, Rou Gui (Cinnamon Bark) 0.6g, Ren Shen (Ginseng Root) 0.9g, Bai Zhu (Atractylodes Macrocephala Rhizome) 0.9g, Zhi Gan Cao (Honey-fried Licorice Root) 0.6g, Mu Xiang (Aucklandia Root) 0.3g, Jiao Shan Zha (Charred Hawthorn Fruit) 3g, Shan Yao (Dioscorea Rhizome) 3g, Da Huang (Rhubarb Root) 0.3g. I instructed to stop medication for five days after one dose, strictly prohibiting any other medication. Six days later, he reported no adverse reactions but no obvious effect either, except stool frequency reduced to four times yesterday. The patient asked if faster-acting drugs could be used. The Master said: No. One must wait for Qi to recover, pay attention to Minor Fire, and focus on slow dissipation. Prescribe the above formula once a week. After one month, he recovered.
3. Damp-heat with Cold: Treating only heat leaves cold accumulation unresolved, making chronic dysentery hard to cure.
He XX, Male, 40 years old.
For several years, he suffered from dysentery around the transition of summer and autumn. This time, despite prolonged use of Furazolidone and Chloramphenicol, symptoms fluctuated. Reluctantly, he consulted another doctor who prescribed Huang Lian (Coptis Rhizome), Huang Qin (Scutellaria Root), Huang Bai (Phellodendron Bark), Ma Chi Xian (Purslane), Mu Xiang (Aucklandia Root), and Da Huang (Rhubarb Root), but the effect was still not obvious. I was invited to examine him. Examination showed tenesmus, pus and blood in stool, intermittent abdominal pain, and wiry-slippery sometimes choppy pulse. I reasoned: Although this is damp-heat lower dysentery, it is complicated by cold stagnation failing to transform. Treatment should clear heat and detoxify while harmonizing Qi and Blood. Modified Shao Yao Tang (Peony Decoction): Bai Shao (White Peony Root) 10g, Dang Gui (Chinese Angelica Root) 10g, Bing Lang (Areca Seed) 10g, Mu Xiang (Aucklandia Root) 10g, Gan Cao (Licorice Root) 6g, Da Huang (Rhubarb Root) 3g, Rou Gui (Cinnamon Bark) 10g, Huang Lian (Coptis Rhizome) 10g, Huang Qin (Scutellaria Root) 10g.
After four doses, all symptoms decreased. The dosage was changed to one dose every two days, totaling six doses, resulting in recovery.
Another doctor asked: Why did herbs typically used for dysentery like Qin, Lian, Bai, and Ma Chi Xian fail, while herbs not specifically for dysentery succeeded? Since dysentery is damp-heat, why add Rou Gui, a highly acrid-hot herb? I answered: Zhang Zhongjing said, "Those with Cold in the Small Intestine experience heaviness below and bloody stools." Thus, dysentery with heaviness and bloody stools involves Cold. When Cold is involved, warming and dispersing herbs must be assisted; therefore, Rou Gui is used.
4. Chronic Dysentery with Yin Damage from Mixed Cold and Heat: Treating only dysentery without protecting Yin leads to non-recovery.
Zhang XX, Male, 46 years old.
Chronic dysentery for over three years. Initially treated with Western medicine without effect; subsequent Chinese medicine treatment also failed. Recently, diarrhea and dysentery worsened, with tenesmus, pus and sticky stool, intermittent abdominal pain, occurring 4–5 to 7–8 times a day, cold fingers and toes, and deep-thin-wiry pulse. Synthesizing pulse and symptoms, I thought: This is Spleen-Kidney Cold Deficiency. Treatment should strengthen the Spleen and warm the Kidney. Following Fu Gui Li Zhong combined with Si Shen Wan (Four Spirit Pill). Prescription: Fu Zi (Aconite Lateral Root) 10g, Rou Gui (Cinnamon Bark) 10g, Dang Shen (Codonopsis Root) 10g, Bai Zhu (Atractylodes Macrocephala Rhizome) 10g, Gan Jiang (Dried Ginger) 10g, Zhi Gan Cao (Honey-fried Licorice Root) 10g, Bu Gu Zhi (Psoralea Fruit) 10g, Rou Dou Kou (Nutmeg) 10g, Wu Wei Zi (Schisandra Berry) 10g, Wu Zhu Yu (Evodia Fruit) 10g.
After four doses, no effect was seen. I thought: Both syndrome and pulse indicate Spleen-Kidney Cold Deficiency. Why did warming-tonifying Spleen-Kidney formulas fail? I recalled Jing Yue's statement: Further analyze the mechanism of medication. Carefully observing previous prescriptions, some strengthened the Spleen and warmed the Middle, some warmed and tonified Spleen-Kidney, some warmed the Interior and secured astringency, some warmed the Middle and guided out stagnation, yet none were effective. I realized: This must be due to long-standing accumulation of Cold and Heat, and Yin damage from chronic dysentery. Re-inquiring about symptoms, I indeed found dry mouth at night. Therefore, I formulated the Bitter-Acid-Pungent method. Prescription: Wu Mei (Mume Fruit) 12g, Rou Gui (Cinnamon Bark) 10g, Chuan Jiao (Sichuan Pepper) 10g, Gan Jiang (Dried Ginger) 10g, Huang Lian (Coptis Rhizome) 10g, Huang Bai (Phellodendron Bark) 10g, Fu Zi (Aconite Lateral Root) 10g, Dang Shen (Codonopsis Root) 10g, Xi Xin (Asarum Root) 3g, Dang Gui (Chinese Angelica Root) 10g, Mu Gua (Chaenomeles Fruit) 10g.
After six doses, symptoms indeed decreased. After continuing for six doses, all symptoms disappeared, resulting in recovery.
Pulmonary Tuberculosis
1. Constrained by pneumonia anti-inflammatory and tuberculosis nourishing-Yin approaches, without examining pulse and symptoms, chronic illness fails to heal.
Su XX, Male, 38 years old.