头晕头胀，心烦心悸，阵发性晕厥7～8年。经数个医院检查诊断为预激综合征。先用西药治疗3～4年不效，乃再请中医配合治疗。近3～4年来，有云肝阳上亢而予养阴平肝者，有云心血不足而予补气养血者，有云心血不足而予养心安神者，虽服药近千剂而效果仍不显著。细审其证，头晕头胀，心烦心悸均呈阵发性，发时先感胃脘部有空虚感，继而热气向上冲逆，冲至心胸则心烦心悸，冲至咽喉则窒塞呼吸困难，冲至头则头晕目眩不能站立，甚或突然人事不知而晕倒在地，汗出后即清醒如常人，轻时一月左右一发，重时一日数发，其后经常口苦口干，尤其是劳累，特别是心情不愉快时容易发作，舌苔白，脉弦滑。综合脉证，思之：此仲景《金匮》所说奔豚证也，奔豚一证，《金匮》论治有奔豚、桂枝加桂、苓桂甘枣三方。此证脉弦而滑，弦脉者肝脉也，滑脉者痰热也，合之于症，乃痰火郁结之奔豚汤证也，此证虽与《金匮》所论之奔豚汤证不尽吻合，然其病机相同，故用之可也。为处：川芎10克，当归10克，黄芩10克，白芍10克，葛根15克，半夏10克，桑皮15克，甘草6克，麦冬10克，党参10克，五昧子10克。
服药10剂，证减六七；继服4剂，效不再著。再察脉象已转弦紧而数，因思弦紧之脉者寒饮凝聚于三焦，中焦阻塞，寒热并见，乃拟柴胡加龙骨牡蛎汤加减为剂。柴胡10克，半夏10克，黄芩10克，人参10克，生姜3片，大枣5个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克。
服药1剂，诸证又减，乃连服百剂，诸证全失。
2．胶于《金匮》诸方，不知随证之治，虚者不补，实者不泻，因循误治，难于奏功
尚××，男，40岁。
2年多来，头晕失眠，胸满胸痛，心烦心悸。医诊预激综合征。先用西药治之不效，后又配合中药养血活血、养心安神等剂仍不效，某医询治于余，曰：可参考《金匮》奔豚气篇。2个月后，该医领患者来诊，云：余遍用仲景诸方均无效，其故何也?细审患者，除头晕失眠，胸满胸痛，心烦心悸之外，并见气短乏力，脘腹胀满，纳呆食减，舌苔薄白，脉沉弦细涩。因思其脉沉者郁证也，弦脉者肝脉也，涩脉者滞也瘀也。合之于症，乃气血俱虚为本，气滞血瘀为标。乃予补气养血以治本，理气活血以治标。处方：黄芪30克，当归10克，丹参30克，人参10克，苍术15克，白术10克，青皮10克，陈皮10克，生地10克，黄精10克，薄荷3克，柴胡10克，三棱10克，莪术10克，夜交藤30克。
服药4剂，头晕失眠，胸满胸痛，心烦心悸，纳呆食减均减，但继续服药至第8剂时，症状不但不再继续改善，至第12剂时症状又见加重。询之：除上证之外，并见咽喉有异物阻塞感，舌苔白，脉濡缓。因思脉濡缓者，气阴两虚，痰气郁结之脉。仲景辨证随证治之者，首重脉耳。治当随脉治之。黄芪15克，当归6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，生地10克。
连续服药20剂，诸证消失。但停药1个月以后，又因生气而突然头晕胸满，心烦心悸，口苦咽干，舌苔白，脉弦而滑。思之：脉弦者肝脉也，滑者痰热也。综合脉证，乃肝郁气结，痰热不化。处方：柴胡10克，半夏10克，人参10克，黄芩10克，生姜3片，大枣5个，甘草6克，瓜蒌15克。
服药6剂，诸证消失，心电图正常。
该医云：老师告诉我用奔豚证治法治此病，而老师治之却改弦易辙何也?答曰：根据临床经验来看很多预激综合征可用奔豚证法治疗，但本患者无奔豚证之表现，所以不用奔豚证之治法。最近杂志中经常报道某某西医病名相当于中医某某证，此种说法虽近有理，但不可拘泥也。
急性风湿热与风湿性关节炎
1．见热攻热，不知除湿，不知经络，久治不效
吴××，女，29岁。
发热汗出，关节肿痛半年多。医诊风湿热。先予西药治疗4个多月不效，’后又配合中药清热解毒，滋阴清热、清热凉血等药2个多月仍不效。细审其证，发热汗出，体温38．9℃，疲乏无力，膝、踝、肘、腕、肩关节红肿热痛，行动不便，面色萎黄，舌苔灰，脉滑数。综合脉证，思之：关节肿痛者，湿热也；脉滑数者，痰热也。综合脉证，乃风湿热痹之痰热较盛证也。治宜清热通络，化痰除湿。处方：防己15克，杏仁15克，滑石15克，连翘10克，栀子10克，生薏米15克，半夏10克，晚蚕砂10克，赤小豆10克，片姜黄6克，海桐皮6克。
服药2剂，发热汗出好转，体温38cc，继服10剂，体温正常，发热汗出消失，关节肿痛亦明显消退，又服10剂，诸证全失，查血沉亦恢复正常，后果愈。
某医云：既为风湿热，何用祛风除湿清热而热不减?既见汗出身热何用白虎、银翘而热更炽?答曰：此证乃湿痰胶滞生热，热迫津出之证，前用祛风除湿而过散，后用白虎、银翘虽凉之有余，而化痰除湿不足。今用吴塘宣痹汤取效者，在于其用防己急走经络之湿，杏仁开肺气化痰湿，连翘清气分之湿热，赤小豆清血分之湿热，滑石利窍而清热中之湿，栀子肃肺而泻湿中之热，薏米淡渗除挛痹，半夏化痰利气，蚕砂化浊道之清气，片姜黄、海桐皮宣络而止痛。
2．但知祛邪，不知正虚，散风伤气，除湿伤阴，久不得治
薛××，女，55岁。
两膝肿痛，发热汗出3个月。医诊风湿热。先用西药治疗2个多月不效，后配中药祛风除湿清热而痛、汗均甚。细审其证，发热汗出，体温38℃，两膝肿痛，疲乏无力，舌苔灰白，脉虚大滑数。综合脉证，思之：脉虚大者，气阴俱虚也；滑数者，痰热也。关节肿痛者，湿热也。治宜补气养阴，除湿清热。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，石斛10克，黄柏10克，苍术10克，川牛膝10克。
服药7剂，汗出发热均减，精神增加，继服20剂，关节肿痛、发热汗出均消失，又服20剂，愈。
某医云：既为风湿热，何用祛风除湿清热而病剧?答曰：本病脉大，正虚邪实，且以正虚为主，故只可重用扶正，不可重用除邪以伤正也。
3．固于风湿，不管兼证，久久郁甚，风从内生
苏××，女，21岁。
9个月前，在劳动的过程中，突然发热全身疼痛，其后日渐加重。经查血沉30毫米/小时，抗“O”阳性，诊为风湿性关节炎。先用西药治疗3个月不效。后又改请中医以除湿散风药治疗6个月，不但不效，反见加重。细审其证，纳呆食减，胸满心烦，头晕失眠，神情抑郁，易哭，全身关节疼痛，舌苔白，脉沉。综合脉证，思之：此虽有风寒湿邪，然以肝郁气滞，郁而化风为主。故当以疏肝理气以治。处方：柴胡10克，枳壳10克，白芍10克，甘草10克，香橼10克，佛手10克，黄芩6克，玫瑰花10克，代代花10克，合欢花15克。先用开水浸泡半小时，再置火上煎煮10分钟即可。
服药4剂，诸证均减；继服40剂，诸证尽失，愈。
4．但知祛风除湿，不知伤血损阴，追虚逐实，血气难复
沈××，女，30岁。
产后关节疼痛10个月。医诊风湿性关节炎。始以西药治之，疼痛不但不减，反而出现胃痛，恶心呕吐，头晕头痛。继而又请中医治疗。虽然胃痛，恶心呕吐消失，但却出现汗出加剧。特别是近2个月来，指、趾、踝、腕、肘、膝、肩、颈项关节都痛，屈伸关节困难，行动不便，且汗出很多，疲乏无力，口舌干燥。细审其所用之药除西药外，中药多为祛风散寒除湿之剂。舌苔白，脉沉弦细。综合脉证，思之：此病发于产后，又久用祛风除湿之剂治疗以伤阴血。经云：肝主筋，肝藏血，诸筋者皆会于节。肝血不足，筋失所养，故关节不利而痛。治宜养血理筋，佐以祛风除湿清热。处方：秦艽5克，羌活3克，独活3克，生地40克，熟地15克，防风4克，川芎10克，白芷3克，细辛1克，生石膏15克，当归12克，白芍12克，茯苓6克，甘草10克，白术12克。
服药2剂，疼痛好转，精神增加。某医云：此方祛风湿药竟如此之小，怎能治病。乃将上方中之羌活、独活、防风、白芷加至10克，细辛增至3克。
服药3剂，疼痛加剧。又邀余诊。审其脉同上。乃再将羌、独、防、芷改为1．5克，细辛1克，加当归、白芍至15克。
服药20剂，疼痛消失。乃嘱其再服2周，后果愈。
患者云：何用药均同，而一方病愈，一方加剧?答曰：本病乃阴血不足为主，故祛风湿药尤当慎用也，否则血更虚而疼痛加剧，细读东垣之治内伤诸方风药均量微而效宏即在此也。
5．见病治病，不知随证，岂能得愈
阮××，女，35岁。
人工流产后指、腕、肘关节疼痛2个多月。医诊风湿性关节炎。先用西药治疗1个多月无效，后又请中医予祛风除湿止痛药而更剧。细审其证，除指、腕、肘关节疼痛外，并见头痛，畏风，胸满心烦，舌苔白，脉沉弦。综合脉证，思之：胸满心烦，脉沉弦者，肝郁血虚也。治以养血疏肝。处方：柴胡10克，当归10克，白芍15克，白术10克，甘草10克，生姜3克，薄荷3克，丝瓜络6克，桑枝30克。
服药6剂，头痛、畏风，胸满心烦，头痛俱减，关节疼痛稍减，舌苔白，脉弦细数。综合脉证思之：此肝郁稍减，而血虚风湿之证为著也。治宜养血清热，祛风除湿。处方：秦艽3克，羌活3克，独活3克，防风3克，川芎10克，白芷3克，细辛1克，黄芩10克，生地30克，熟地15克，生石膏10克，当归10克，白芍15克，茯苓10克，甘草10克，白术10克。．
服药4剂，关节疼痛明显好转。但服至6剂时，关节疼又剧，脉沉弦小数。综合脉证，思之：此肝郁血虚也。复予养血疏肝方6剂，疼痛始减，继又不减。再予养血清热，祛风除湿方6剂。其后凡见肝郁即予养血疏肝，但见关节疼痛，即予养血清热，祛风除湿。共服40剂，果愈。
某医云：为何经常改变方药?答曰：病情复杂而多经误治者，必须根据发病情况的主次而及时改变治法，正如仲景《伤寒论》所说：“太阳病三日，已发汗，若吐，若下，若温针，仍不解者，此为坏病，桂枝不中与之也。观其脉证，知犯何逆，随证治之。”
冠状动脉粥样硬化性心脏病
1．痰郁气结，枢机不利，反与活血养血，宽胸通阳，久治不效
于××，女，42岁。
冠状动脉粥样硬化性心脏病，期前收缩、偶发心房纤颤3年多。医先以西药治疗1年多效果不著，后又以中药活血化瘀、宽胸通阳等治疗亦不见好转。细审其证，除心前区憋闷疼痛，心烦心悸之外，并见有头晕，口干，纳差，舌苔薄白，脉弦滑结代等证。综合脉证，因思：胸胁者肝之属也；弦脉者肝也；滑者痰也；结者郁结也；代者气血大衰也。合而论之，乃肝胆之气郁结，痰热内郁，正气大衰之候。因拟人参大补元气，半夏、生姜、瓜蒌清化痰热，小柴胡汤和解枢机。处方：柴胡10克，半夏10克，黄芩10克，甘草6克，大枣5个，人参10克，生姜3片，瓜蒌15克。
服药5剂，胸满胸痛，心悸气短，头晕等证均明显改善。某医检视上方乃小柴胡汤，乃云：小柴胡汤者，乃《伤寒论》治疗热病方也，不可用于冠心病，然既然有效，恐乃疏肝之功耳。逍遥散者，既有疏肝之功，又有治疗冠心病之活血药，若再加川芎、丹参等治冠心病的药物，则更为合拍。因而改用下方：柴胡10克，当归10克，赤芍10克，丹参30克，川芎10克，白术10克，茯苓10克，炙甘草10克，生姜3片，薄荷3克。
服药5剂后，胸满胸痛，心悸气短等证又见加剧。患者因本人系医生，急查数次心电图。发现除期前收缩、sT段压低、T波倒置，频发心房纤颤外，并见Ⅱ度左束支传导阻滞。又再邀余诊。查其除上证外，脉仍见弦滑结代而兼涩。乃云：仍宜小柴胡汤加减。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜3片，大枣5枚，瓜蒌15克。
服药3剂，诸证又减；继服上药50剂，诸证消失，心电图：正常。
医云：何用冠心Ⅱ号、逍遥散、瓜蒌薤白等治冠心病方药不效，而你却用小柴胡汤得愈也?答曰：本证乃痰郁、气滞，病位在肝胆之病，病位在肝胆，自当以疏达为是，病因为痰、郁者，应予疏肝、化痰，故得愈也。再问：治冠心病之药为何不效，而非治冠心病之药何故有效?答曰：此话实属武断，我们若下“治冠心病之专药的结论”，未免太早，因为这些理论和实践尚缺乏长期临床检验。实践出真知、实践是检验真理的标准，请注意这个科学大问题，切忌教条主义。
2．痰滞血瘀，郁热不化，反以活血温经，其证不解
苏××，女，53岁。
头晕、头胀，心烦、心悸，阵发性晕厥7～8年。经多家医院检查诊断为预激综合征（Pre-excitation Syndrome）。先用西药治疗3～4年无效，于是再请中医配合治疗。近3～4年来，有医生说是肝阳上亢（Liver Yang Rising）而给予养阴平肝（Nourishing Yin and Calming Liver）的方药；有医生说是心血不足（Heart Blood Deficiency）而给予补气养血（Tonifying Qi and Nourishing Blood）的方药；也有医生说是心血不足而给予养心安神（Nourishing Heart and Calming Spirit）的方药。虽然服用了近千剂药，但效果仍不显著。仔细审查其证候，头晕头胀、心烦心悸均呈阵发性，发作时先感觉胃脘部有空虚感，继而热气向上冲逆，冲到心胸则心烦心悸，冲到咽喉则窒塞呼吸困难，冲到头部则头晕目眩不能站立，甚至突然人事不知而晕倒在地，出汗后即清醒如常人。轻者一个月左右发作一次，重者一天发作数次。此后经常口苦口干，尤其是劳累，特别是心情不愉快时容易发作。舌苔白，脉弦滑（Wiry and Slippery Pulse）。综合脉象和证候，思考后认为：这是张仲景《金匮要略》中所说的奔豚证（Ben Tun Syndrome / Rushing Pig Syndrome）。关于奔豚一证，《金匮要略》论述的治疗方剂有奔豚汤、桂枝加桂汤、苓桂甘枣汤三方。此患者脉象弦而滑，弦脉属于肝脉，滑脉属于痰热（Phlegm-Heat），结合症状，乃是痰火郁结的奔豚汤证（Ben Tun Tang Syndrome）。此证虽与《金匮要略》所论之奔豚汤证不尽吻合，但其病机相同，所以可以使用。处方：川芎10克，当归10克，黄芩10克，白芍10克，葛根15克，半夏10克，桑皮15克，甘草6克，麦冬10克，党参10克，五味子10克。
服用10剂后，症状减轻六七成；继续服用4剂，效果不再明显。再次观察脉象已转为弦紧而数（Wiry, Tight, and Rapid Pulse），想到弦紧之脉是寒饮凝聚于三焦（San Jiao / Triple Burner），中焦阻塞，寒热并见，于是拟定柴胡加龙骨牡蛎汤加减（Chai Hu Jia Long Gu Mu Li Tang Modified）为方。柴胡10克，半夏10克，黄芩10克，人参10克，生姜3片，大枣5个，桂枝10克，茯苓15克，熟军3克（Rhubarb processed with wine），龙骨15克，牡蛎15克。
服用1剂后，各种症状又减轻，于是连续服用百剂，所有症状完全消失。
2．拘泥于《金匮要略》诸方，不知道随证治之，虚证不补，实证不泻，因循守旧导致误治，难以奏效
尚××，男，40岁。
2年多来，头晕失眠，胸满胸痛，心烦心悸。医生诊断为预激综合征。先用西药治疗无效，后又配合中药养血活血、养心安神等方剂仍无效。某医向我咨询，说：可以参考《金匮要略》奔豚气篇。2个月后，该医带领患者来就诊，说：我遍用张仲景的各种方剂都无效，这是什么原因呢？仔细审查患者，除了头晕失眠，胸满胸痛，心烦心悸之外，还见到气短乏力，脘腹胀满，纳呆食减（食欲不振，进食减少），舌苔薄白，脉沉弦细涩（Deep, Wiry, Fine, and Choppy Pulse）。想到其脉沉者属于郁证（Stagnation Syndrome），弦脉属于肝脉，涩脉属于滞和瘀（Stasis and Blood Stasis）。结合症状，乃是气血俱虚为本，气滞血瘀为标。于是给予补气养血以治本，理气活血以治标。处方：黄芪30克，当归10克，丹参30克，人参10克，苍术15克，白术10克，青皮10克，陈皮10克，生地10克，黄精10克，薄荷3克，柴胡10克，三棱10克，莪术10克，夜交藤30克。
服用4剂后，头晕失眠，胸满胸痛，心烦心悸，纳呆食减均减轻，但继续服药至第8剂时，症状不但不再继续改善，到第12剂时症状又见加重。询问得知：除上述症状外，还见到咽喉有异物阻塞感，舌苔白，脉濡缓（Soft and Slow Pulse）。想到脉濡缓者，是气阴两虚（Qi and Yin Deficiency），痰气郁结（Phlegm and Qi Stagnation）的脉象。张仲景辨证随证治之，首重脉象。治疗应当随脉治之。处方：黄芪15克，当归6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，生地10克。
连续服用20剂，所有症状消失。但停药1个月以后，又因生气而突然头晕胸满，心烦心悸，口苦咽干，舌苔白，脉弦而滑。思考后认为：脉弦者属于肝脉，滑者属于痰热。综合脉证，乃是肝郁气结（Liver Qi Stagnation），痰热不化。处方：柴胡10克，半夏10克，人参10克，黄芩10克，生姜3片，大枣5个，甘草6克，瓜蒌15克。
服用6剂，所有症状消失，心电图正常。
该医生说：老师告诉我用奔豚证治法治此病，而老师治之却改弦易辙（改变治疗方法）为什么呢？回答说：根据临床经验来看，很多预激综合征可用奔豚证法治疗，但本患者无奔豚证之表现，所以不用奔豚证之治法。最近杂志中经常报道某某西医病名相当于中医某某证，此种说法虽近有理，但不可拘泥也。
1．见热攻热，不知道除湿，不知道经络，久治不效
吴××，女，29岁。
发热汗出，关节肿痛半年多。医生诊断为风湿热（Rheumatic Fever）。先予西药治疗4个多月无效，后又配合中药清热解毒（Clearing Heat and Detoxifying）、滋阴清热（Nourishing Yin and Clearing Heat）、清热凉血（Clearing Heat and Cooling Blood）等药2个多月仍无效。仔细审查其证候，发热汗出，体温38.9℃，疲乏无力，膝、踝、肘、腕、肩关节红肿热痛，行动不便，面色萎黄，舌苔灰，脉滑数（Slippery and Rapid Pulse）。综合脉证，思考后认为：关节肿痛者，是湿热（Damp-Heat）；脉滑数者，是痰热。综合脉证，乃是风湿热痹（Wind-Dampness Bi Syndrome with Heat）之痰热较盛证也。治疗宜清热通络（Clearing Heat and Unblocking Collaterals），化痰除湿（Resolving Phlegm and Removing Dampness）。处方：防己15克，杏仁15克，滑石15克，连翘10克，栀子10克，生薏米15克，半夏10克，晚蚕砂10克，赤小豆10克，片姜黄6克，海桐皮6克。
服用2剂，发热汗出好转，体温38℃，继服10剂，体温正常，发热汗出消失，关节肿痛亦明显消退，又服10剂，所有症状完全消失，查血沉（Erythrocyte Sedimentation Rate）亦恢复正常，后果痊愈。
某医生说：既然是风湿热，为何用祛风除湿清热而热不减？既见汗出身热，为何用白虎汤（Bai Hu Tang）、银翘散（Yin Qiao San）而热更炽？回答说：此证乃湿痰胶滞生热，热迫津出之证，前用祛风除湿而过散，后用白虎、银翘虽凉之有余，而化痰除湿不足。今用吴塘（Wu Tang）宣痹汤（Xuan Bi Tang）取效者，在于其用防己急走经络之湿，杏仁开肺气化痰湿，连翘清气分之湿热，赤小豆清血分之湿热，滑石利窍而清热中之湿，栀子肃肺而泻湿中之热，薏米淡渗除挛痹，半夏化痰利气，蚕砂化浊道之清气，片姜黄、海桐皮宣络而止痛。
2．只知道祛邪，不知道正虚，散风伤气，除湿伤阴，久不得治
薛××，女，55岁。
两膝肿痛，发热汗出3个月。医生诊断为风湿热。先用西药治疗2个多月无效，后配中药祛风除湿清热而痛、汗均甚。仔细审查其证候，发热汗出，体温38℃，两膝肿痛，疲乏无力，舌苔灰白，脉虚大滑数（Deficient, Large, Slippery, and Rapid Pulse）。综合脉证，思考后认为：脉虚大者，是气阴俱虚也；滑数者，是痰热也。关节肿痛者，是湿热也。治疗宜补气养阴（Tonifying Qi and Nourishing Yin），除湿清热（Removing Dampness and Clearing Heat）。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，石斛10克，黄柏10克，苍术10克，川牛膝10克。
服用7剂，汗出发热均减，精神增加，继服20剂，关节肿痛、发热汗出均消失，又服20剂，痊愈。
某医生说：既然是风湿热，为何用祛风除湿清热而病剧？回答说：本病脉大，正虚邪实，且以正虚为主，故只可重用扶正（Supporting Healthy Qi），不可重用除邪（Eliminating Pathogens）以伤正也。
3．固于风湿，不管兼证，久久郁甚，风从内生
苏××，女，21岁。
9个月前，在劳动的过程中，突然发热全身疼痛，其后日渐加重。经查血沉30毫米/小时，抗“O”阳性，诊为风湿性关节炎（Rheumatoid Arthritis）。先用西药治疗3个月无效。后又改请中医以除湿散风药治疗6个月，不但不效，反见加重。仔细审查其证候，纳呆食减，胸满心烦，头晕失眠，神情抑郁，易哭，全身关节疼痛，舌苔白，脉沉。综合脉证，思考后认为：此虽有风寒湿邪，然以肝郁气滞（Liver Qi Stagnation），郁而化风（Stagnation Transforming into Wind）为主。故当以疏肝理气（Soothing Liver and Regulating Qi）以治。处方：柴胡10克，枳壳10克，白芍10克，甘草10克，香橼10克，佛手10克，黄芩6克，玫瑰花10克，代代花10克，合欢花15克。先用开水浸泡半小时，再置火上煎煮10分钟即可。
服用4剂，所有症状均减轻；继服40剂，所有症状尽失，痊愈。
4．只知道祛风除湿，不知道伤血损阴，追虚逐实，血气难复
沈××，女，30岁。
产后关节疼痛10个月。医生诊断为风湿性关节炎。始以西药治之，疼痛不但不减，反而出现胃痛，恶心呕吐，头晕头痛。继而又请中医治疗。虽然胃痛，恶心呕吐消失，但却出现汗出加剧。特别是近2个月来，指、趾、踝、腕、肘、膝、肩、颈项关节都痛，屈伸关节困难，行动不便，且汗出很多，疲乏无力，口舌干燥。仔细审查其所用之药除西药外，中药多为祛风散寒除湿之剂。舌苔白，脉沉弦细。综合脉证，思考后认为：此病发于产后，又久用祛风除湿之剂治疗以伤阴血（Injuring Yin and Blood）。经云：肝主筋，肝藏血，诸筋者皆会于节。肝血不足，筋失所养，故关节不利而痛。治疗宜养血理筋（Nourishing Blood and Regulating Tendons），佐以祛风除湿清热。处方：秦艽5克，羌活3克，独活3克，生地40克，熟地15克，防风4克，川芎10克，白芷3克，细辛1克，生石膏15克，当归12克，白芍12克，茯苓6克，甘草10克，白术12克。
服用2剂，疼痛好转，精神增加。某医生说：此方祛风湿药竟如此之小，怎能治病。乃将上方中之羌活、独活、防风、白芷加至10克，细辛增至3克。
服用3剂，疼痛加剧。又邀余诊。审其脉同上。乃再将羌、独、防、芷改为1.5克，细辛1克，加当归、白芍至15克。
服用20剂，疼痛消失。乃嘱其再服2周，后果痊愈。
患者说：何用药均同，而一方病愈，一方加剧？回答说：本病乃阴血不足为主，故祛风湿药尤当慎用也，否则血更虚而疼痛加剧，细读东垣（Li Dongyuan）之治内伤诸方风药均量微而效宏即在此也。
5．见病治病，不知道随证，岂能得愈
阮××，女，35岁。
人工流产后指、腕、肘关节疼痛2个多月。医生诊断为风湿性关节炎。先用西药治疗1个多月无效，后又请中医予祛风除湿止痛药而更剧。仔细审查其证候，除指、腕、肘关节疼痛外，并见头痛，畏风，胸满心烦，舌苔白，脉沉弦。综合脉证，思考后认为：胸满心烦，脉沉弦者，是肝郁血虚（Liver Stagnation and Blood Deficiency）也。治疗以养血疏肝（Nourishing Blood and Soothing Liver）。处方：柴胡10克，当归10克，白芍15克，白术10克，甘草10克，生姜3克，薄荷3克，丝瓜络6克，桑枝30克。
服用6剂，头痛、畏风，胸满心烦，头痛俱减，关节疼痛稍减，舌苔白，脉弦细数。综合脉证思考后认为：此肝郁稍减，而血虚风湿之证为著也。治疗宜养血清热（Nourishing Blood and Clearing Heat），祛风除湿（Expelling Wind and Removing Dampness）。处方：秦艽3克，羌活3克，独活3克，防风3克，川芎10克，白芷3克，细辛1克，黄芩10克，生地30克，熟地15克，生石膏10克，当归10克，白芍15克，茯苓10克，甘草10克，白术10克。
服用4剂，关节疼痛明显好转。但服至6剂时，关节疼又剧，脉沉弦小数。综合脉证，思考后认为：此肝郁血虚也。复予养血疏肝方6剂，疼痛始减，继又不减。再予养血清热，祛风除湿方6剂。其后凡见肝郁即予养血疏肝，但见关节疼痛，即予养血清热，祛风除湿。共服40剂，果然痊愈。
某医生说：为何经常改变方药？回答说：病情复杂而多经误治者，必须根据发病情况的主次而及时改变治法，正如张仲景《伤寒论》所说：“太阳病三日，已发汗，若吐，若下，若温针，仍不解者，此为坏病，桂枝不中与之也。观其脉证，知犯何逆，随证治之。”
于××，女，42岁。
冠状动脉粥样硬化性心脏病（Coronary Atherosclerotic Heart Disease），期前收缩（Premature Beats）、偶发心房纤颤（Occasional Atrial Fibrillation）3年多。医生先以西药治疗1年多效果不著，后又以中药活血化瘀（Invigorating Blood and Resolving Stasis）、宽胸通阳（Widening Chest and Unblocking Yang）等治疗亦不见好转。仔细审查其证候，除心前区憋闷疼痛，心烦心悸之外，并见有头晕，口干，纳差，舌苔薄白，脉弦滑结代（Wiry, Slippery, Knotted, and Intermitting Pulse）等证。综合脉证，因而思考：胸胁者肝之属也；弦脉者肝也；滑者痰也；结者郁结也；代者气血大衰也。合而论之，乃肝胆之气郁结，痰热内郁，正气大衰之候。因而拟定人参大补元气（Ren Shen greatly tonifies Yuan Qi），半夏、生姜、瓜蒌清化痰热，小柴胡汤（Xiao Chai Hu Tang）和解枢机（Harmonizing the Pivot）。处方：柴胡10克，半夏10克，黄芩10克，甘草6克，大枣5个，人参10克，生姜3片，瓜蒌15克。
服用5剂，胸满胸痛，心悸气短，头晕等证均明显改善。某医检视上方乃小柴胡汤，乃云：小柴胡汤者，乃《伤寒论》治疗热病方也，不可用于冠心病，然既然有效，恐乃疏肝之功耳。逍遥散（Xiao Yao San）者，既有疏肝之功，又有治疗冠心病之活血药，若再加川芎、丹参等治冠心病的药物，则更为合拍。因而改用下方：柴胡10克，当归10克，赤芍10克，丹参30克，川芎10克，白术10克，茯苓10克，炙甘草10克，生姜3片，薄荷3克。
服用5剂后，胸满胸痛，心悸气短等证又见加剧。患者因本人系医生，急查数次心电图。发现除期前收缩、sT段压低、T波倒置，频发心房纤颤外，并见Ⅱ度左束支传导阻滞（Second-degree Left Bundle Branch Block）。又再邀余诊。查其除上证外，脉仍见弦滑结代而兼涩。乃云：仍宜小柴胡汤加减。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜3片，大枣5枚，瓜蒌15克。
服用3剂，所有症状又减轻；继服上药50剂，所有症状消失，心电图：正常。
医生说：何用冠心Ⅱ号（Guan Xin II Hao）、逍遥散、瓜蒌薤白（Gua Lou Xie Bai）等治冠心病方药不效，而你却用小柴胡汤得愈也？回答说：本证乃痰郁、气滞，病位在肝胆之病，病位在肝胆，自当以疏达为是，病因为痰、郁者，应予疏肝、化痰，故得愈也。再问：治冠心病之药为何不效，而非治冠心病之药何故有效？回答说：此话实属武断，我们若下“治冠心病之专药的结论”，未免太早，因为这些理论和实践尚缺乏长期临床检验。实践出真知、实践是检验真理的标准，请注意这个科学大问题，切忌教条主义。
苏××，女，53岁。
Dizziness and head distension, irritability, palpitations, and paroxysmal syncope for 7 to 8 years. Diagnosed as pre-excitation syndrome after examinations in several hospitals. Western medicine treatment was ineffective for 3 to 4 years, so traditional Chinese medicine (TCM) was consulted for adjunctive therapy. Over the past 3 to 4 years, some physicians attributed the condition to liver yang rising and prescribed formulas to nourish yin and calm the liver; others attributed it to heart blood deficiency and prescribed formulas to tonify qi and nourish blood; still others attributed it to heart blood deficiency and prescribed formulas to nourish the heart and calm the spirit. Despite taking nearly a thousand doses of medicine, the effect remained insignificant. Upon careful examination of the symptoms, dizziness, head distension, irritability, and palpitations were all paroxysmal. Before an episode, the patient first felt a sensation of emptiness in the epigastrium, followed by a surge of hot qi rushing upward. When this surge reached the chest and heart, it caused irritability and palpitations; when it reached the throat, it caused suffocation and dyspnea; when it reached the head, it caused severe dizziness and vertigo making standing impossible, or even sudden loss of consciousness leading to falling to the ground. After sweating, the patient would regain consciousness and appear normal. Mild cases occurred about once a month, while severe cases occurred several times a day. Subsequently, bitter taste and dry mouth were frequent, especially triggered by fatigue or emotional distress. The tongue coating was white, and the pulse was wiry and slippery. Synthesizing the pulse and symptoms, it was reasoned: This is the Ben Tun syndrome described in Zhang Zhongjing's *Jin Gui Yao Lue*. Regarding Ben Tun syndrome, *Jin Gui Yao Lue* discusses three treatment formulas: Ben Tun Tang, Guizhi Jia Gui Tang, and Ling Gui Gan Zao Tang. The patient's pulse was wiry and slippery; a wiry pulse indicates the liver, and a slippery pulse indicates phlegm-heat. Combined with the symptoms, this is a Ben Tun Tang syndrome characterized by stagnation of phlegm-fire. Although this case does not perfectly match the Ben Tun Tang syndrome discussed in *Jin Gui Yao Lue*, the pathogenesis is identical, so its use is appropriate. Prescription: Chuanxiong Rhizome (Chuanxiong) 10g, Angelica Sinensis Root (Danggui) 10g, Scutellaria Baicalensis Root (Huangqin) 10g, White Peony Root (Baishao) 10g, Pueraria Lobata Root (Gegen) 15g, Pinellia Tuber (Banxia) 10g, Mulberry Bark (Sangpi) 15g, Licorice Root (Gancao) 6g, Ophiopogon Tuber (Maidong) 10g, Codonopsis Root (Dangshen) 10g, Schisandra Fruit (Wuweizi) 10g.
After taking 10 doses, symptoms decreased by 60-70%; continuing for another 4 doses, no further significant improvement was observed. Re-examination of the pulse revealed it had become wiry, tight, and rapid. It was reasoned that a wiry-tight pulse indicates cold-fluid retention condensing in the San Jiao (Triple Burner), with obstruction in the Middle Jiao, presenting with both cold and heat. Therefore, a modified Chai Hu Jia Long Gu Mu Li Tang was formulated. Bupleurum Root (Chaihu) 10g, Pinellia Tuber (Banxia) 10g, Scutellaria Baicalensis Root (Huangqin) 10g, Ginseng Root (Renshen) 10g, Fresh Ginger (Shengjiang) 3 slices, Jujube (Dazao) 5 pieces, Cinnamon Twig (Guizhi) 10g, Poria (Fuling) 15g, Wine-processed Rhubarb (Shujun) 3g, Dragon Bone (Longgu) 15g, Oyster Shell (Muli) 15g.
After one dose, symptoms decreased again; continuous administration for 100 doses led to complete resolution of all symptoms.
2. Adherence to formulas from *Jin Gui Yao Lue* without adapting to changing syndromes; failing to tonify deficiency and purge excess, leading to prolonged mismanagement and lack of efficacy.
Patient Shang XX, Male, 40 years old.
For over 2 years, suffered from dizziness, insomnia, chest fullness, chest pain, irritability, and palpitations. Diagnosed with pre-excitation syndrome. Western medicine treatment was ineffective initially, followed by TCM treatments aimed at nourishing blood, invigorating blood, nourishing the heart, and calming the spirit, which also failed. A physician consulted me, stating: "You may refer to the chapter on Ben Tun Qi in *Jin Gui Yao Lue*." Two months later, the physician brought the patient back, asking: "I have used all of Zhang Zhongjing's formulas without success. What is the reason?" Careful examination revealed that besides dizziness, insomnia, chest fullness/pain, and irritability/palpitations, the patient also exhibited shortness of breath, fatigue, abdominal distension, poor appetite, thin white tongue coating, and a deep, wiry, fine, and choppy pulse. It was reasoned that a deep pulse indicates stagnation; a wiry pulse relates to the liver; a choppy pulse indicates stasis and blood stasis. Combined with symptoms, the root is deficiency of both qi and blood, while the branch is qi stagnation and blood stasis. Treatment focused on tonifying qi and nourishing blood for the root, and regulating qi and invigorating blood for the branch. Prescription: Astragalus Root (Huangqi) 30g, Angelica Sinensis Root (Danggui) 10g, Salvia Miltiorrhiza Root (Danshen) 30g, Ginseng Root (Renshen) 10g, Atractylodes Macrocephala Rhizome (Cangzhu) 15g, Atractylodes Rhizome (Baizhu) 10g, Green Tangerine Peel (Qingpi) 10g, Tangerine Peel (Chenpi) 10g, Rehmannia Root (Shengdi) 10g, Polygonatum Rhizome (Huangjing) 10g, Mint (Bohe) 3g, Bupleurum Root (Chaihu) 10g, Samara (Sanleng) 10g, Curcuma Zedoaria Rhizome (Ezhu) 10g, Caulis Trichosanthis (Yejaoteng) 30g.
After 4 doses, dizziness, insomnia, chest fullness/pain, irritability/palpitations, and poor appetite improved. However, upon continuing to the 8th dose, symptoms did not improve further, and by the 12th dose, they worsened. Inquiry revealed additional symptoms: a sensation of foreign body obstruction in the throat, white tongue coating, and a soft, slow pulse. It was reasoned that a soft-slow pulse indicates deficiency of both qi and yin, along with stagnation of phlegm and qi. Zhang Zhongjing emphasized pulse diagnosis in syndrome differentiation and treatment. Treatment should follow the pulse. Prescription: Astragalus Root (Huangqi) 15g, Angelica Sinensis Root (Danggui) 6g, Ophiopogon Tuber (Maidong) 10g, Codonopsis Root (Dangshen) 10g, Schisandra Fruit (Wuweizi) 10g, Bamboo Shavings (Zhuru) 10g, Immature Bitter Orange (Zhishi) 10g, Pinellia Tuber (Banxia) 10g, Tangerine Peel (Chenpi) 10g, Poria (Fuling) 10g, Licorice Root (Gancao) 10g, Acorus Tatarinowii Rhizome (Shichangpu) 10g, Polygala Root (Yuanzhi) 10g, Rehmannia Root (Shengdi) 10g.
Continuous administration for 20 doses led to disappearance of all symptoms. However, one month after stopping medication, sudden dizziness, chest fullness, irritability, palpitations, bitter taste, and dry throat occurred due to anger. Tongue coating was white, pulse wiry and slippery. Reasoning: Wiry pulse indicates liver; slippery pulse indicates phlegm-heat. Synthesizing pulse and symptoms, this is liver qi stagnation with untransformed phlegm-heat. Prescription: Bupleurum Root (Chaihu) 10g, Pinellia Tuber (Banxia) 10g, Ginseng Root (Renshen) 10g, Scutellaria Baicalensis Root (Huangqin) 10g, Fresh Ginger (Shengjiang) 3 slices, Jujube (Dazao) 5 pieces, Licorice Root (Gancao) 6g, Trichosanthes Fruit (Gualou) 15g.
After 6 doses, all symptoms disappeared, and electrocardiogram (ECG) normalized.
The physician asked: "Teacher told me to treat this disease using Ben Tun syndrome methods, but you changed your approach. Why?" I replied: "Based on clinical experience, many cases of pre-excitation syndrome can be treated using Ben Tun syndrome methods. However, this patient lacked manifestations of Ben Tun syndrome, so those methods were not applicable. Recent journals often report that certain Western medical diagnoses correspond to specific TCM syndromes. While this reasoning has merit, it should not be rigidly adhered to."
Acute Rheumatic Fever and Rheumatoid Arthritis
1. Treating heat with heat-clearing methods without addressing dampness or understanding meridians leads to long-term ineffectiveness.
Patient Wu XX, Female, 29 years old.
Fever, sweating, and joint swelling/pain for over half a year. Diagnosed with rheumatic fever. Western medicine treatment for over 4 months was ineffective. Adjunctive TCM treatment involving clearing heat and detoxifying, nourishing yin and clearing heat, and clearing heat and cooling blood for over 2 months was also ineffective. Careful examination revealed fever, sweating, temperature 38.9°C, fatigue, redness/swelling/hotness/pain in knee, ankle, elbow, wrist, and shoulder joints, difficulty moving, sallow complexion, gray tongue coating, and slippery-rapid pulse. Synthesizing pulse and symptoms: Joint swelling/pain indicates damp-heat; slippery-rapid pulse indicates phlegm-heat. This is a case of Wind-Dampness Bi Syndrome with Heat, characterized by prominent phlegm-heat. Treatment should clear heat and unblock collaterals, resolve phlegm and remove dampness. Prescription: Stephania Tetrandra Root (Fangji) 15g, Apricot Seed (Xingren) 15g, Talcum (Huashi) 15g, Forsythia Fruit (Lianqiao) 10g, Gardenia Fruit (Zhizi) 10g, Coix Seed (Yimi) 15g, Pinellia Tuber (Banxia) 10g, Silkworm Frass (Can Sha) 10g, Adzuki Bean (Chixiaodou) 10g, Turmeric Tuber (Pian Jianghuang) 6g, Saposhnikovia Root (Haitongpi) 6g.
After 2 doses, fever and sweating improved, temperature dropped to 38°C. Continuing for 10 doses normalized temperature and resolved fever/sweating; joint swelling/pain significantly subsided. Another 10 doses led to complete resolution of symptoms, and erythrocyte sedimentation rate (ESR) returned to normal. Full recovery ensued.
The physician asked: "Since it is rheumatic fever, why did expelling wind, removing dampness, and clearing heat fail to reduce the heat? Since there is sweating and high fever, why did Bai Hu Tang and Yin Qiao San exacerbate the heat?" I replied: "This case involves heat generated by sticky damp-phlegm, forcing fluids out. Previous wind-expelling and damp-removing formulas were too dispersing. Later, Bai Hu Tang and Yin Qiao San were overly cooling but insufficient in resolving phlegm and removing dampness. The effectiveness of Wu Tang's Xuan Bi Tang lies in: Fangji rapidly clearing dampness from collaterals; Xingren opening lung qi to resolve phlegm-damp; Lianqing clearing damp-heat from the qi level; Chixiaodou clearing damp-heat from the blood level; Huashi promoting urination to clear dampness in the interior; Zhizi purging the lungs to drain heat from dampness; Yimi promoting mild diuresis to relieve spasmodic bi; Banxia resolving phlegm and benefiting qi; Can Sha transforming turbidity and benefiting clear qi; Pian Jianghuang and Haitongpi unblocking collaterals and relieving pain."
2. Knowing only to eliminate pathogens but ignoring healthy qi deficiency; wind-expelling injures qi, damp-removing injures yin, leading to chronic non-resolution.
Patient Xue XX, Female, 55 years old.
Swelling/pain in both knees, fever, and sweating for 3 months. Diagnosed with rheumatic fever. Western medicine treatment for over 2 months was ineffective. Adjunctive TCM treatment involving expelling wind, removing dampness, and clearing heat resulted in severe pain and sweating. Careful examination revealed fever, sweating, temperature 38°C, knee swelling/pain, fatigue, gray-white tongue coating, and deficient-large-slippery-rapid pulse. Synthesizing pulse and symptoms: Deficient-large pulse indicates deficiency of both qi and yin; slippery-rapid pulse indicates phlegm-heat; joint swelling/pain indicates damp-heat. Treatment should tonify qi and nourish yin, remove dampness and clear heat. Prescription: Astragalus Root (Huangqi) 15g, Angelica Sinensis Root (Danggui) 6g, Ophiopogon Tuber (Maidong) 10g, Codonopsis Root (Dangshen) 10g, Schisandra Fruit (Wuweizi) 10g, Dendrobium Stem (Shihu) 10g, Phellodendron Bark (Huangbai) 10g, Atractylodes Rhizome (Cangzhu) 10g, Cyathula Root (Chuanniuxi) 10g.
After 7 doses, sweating and fever decreased, spirit improved. Continuing for 20 doses resolved joint swelling/pain, fever, and sweating. Another 20 doses led to full recovery.
The physician asked: "Since it is rheumatic fever, why did expelling wind, removing dampness, and clearing heat worsen the disease?" I replied: "The large pulse indicates healthy qi deficiency and pathogenic excess, with healthy qi deficiency being predominant. Therefore, heavy tonification of healthy qi is required, while heavy elimination of pathogens should be avoided to prevent further injuring healthy qi."
3. Rigid adherence to wind-damp patterns without considering concurrent syndromes leads to prolonged stagnation and internal generation of wind.
Patient Su XX, Female, 21 years old.
Nine months ago, during labor, sudden fever and generalized body pain occurred, progressively worsening. ESR was 30 mm/h, Anti-Streptolysin O (ASO) positive, diagnosed with rheumatoid arthritis. Western medicine treatment for 3 months was ineffective. Subsequent TCM treatment with damp-removing and wind-expelling herbs for 6 months was ineffective and worsened symptoms. Careful examination revealed poor appetite, chest fullness, irritability, dizziness, insomnia, depressive mood, tendency to cry, generalized joint pain, white tongue coating, and deep pulse. Synthesizing pulse and symptoms: Although wind-cold-damp pathogens are present, the primary issue is liver qi stagnation transforming into wind. Treatment should soothe the liver and regulate qi. Prescription: Bupleurum Root (Chaihu) 10g, Aurantium Imperatoris (Zhiqiao) 10g, White Peony Root (Baishao) 10g, Licorice Root (Gancao) 10g, Citron (Xiangyuan) 10g, Bergamot (Foshou) 10g, Scutellaria Baicalensis Root (Huangqin) 6g, Rose Flower (Meiguihua) 10g, Citrus Grandis Flower (Daidaihua) 10g, Albizia Flower (Hehuanhua) 15g. Soak in boiling water for half an hour, then simmer on fire for 10 minutes.
After 4 doses, all symptoms decreased; continuing for 40 doses led to complete resolution and recovery.
4. Knowing only to expel wind and remove dampness without recognizing injury to blood and yin; chasing deficiency and pursuing excess makes recovery of blood and qi difficult.
Patient Shen XX, Female, 30 years old.
Joint pain for 10 months postpartum. Diagnosed with rheumatoid arthritis. Initial western medicine treatment failed to relieve pain and instead caused stomach pain, nausea, vomiting, dizziness, and headache. Subsequent TCM treatment resolved gastrointestinal symptoms but exacerbated sweating. In the last 2 months, pain affected fingers, toes, ankles, wrists, elbows, knees, shoulders, and neck, with difficulty flexing/extending joints, mobility issues, profuse sweating, fatigue, and dry mouth/tongue. Review of medications revealed extensive use of wind-expelling, cold-dispelling, and damp-removing herbs alongside western medicine. Tongue coating was white, pulse deep-wiry-fine. Synthesizing pulse and symptoms: Onset postpartum combined with long-term use of wind-damp herbs injured yin and blood. As the Classics state: "The Liver governs tendons and stores blood; all tendons converge at the joints." Insufficient liver blood fails to nourish tendons, causing joint stiffness and pain. Treatment should nourish blood and regulate tendons, assisted by expelling wind, removing dampness, and clearing heat. Prescription: Gentiana Macrophylla Root (Qinjiao) 5g, Notopterygium Rhizome (Qianghuo) 3g, Angelica Pubescens Root (Duhuo) 3g, Rehmannia Root (Shengdi) 40g, Prepared Rehmannia Root (Shudi) 15g, Saposhnikovia Root (Fangfeng) 4g, Ligusticum Chuanxiong Rhizome (Chuanxiong) 10g, Angelica Dahurica Root (Baizhi) 3g, Asarum Root (Xixin) 1g, Gypsum Fibrosum (Sheng Shigao) 15g, Angelica Sinensis Root (Danggui) 12g, White Peony Root (Baishao) 12g, Poria (Fuling) 6g, Licorice Root (Gancao) 10g, Atractylodes Rhizome (Baizhu) 12g.
After 2 doses, pain improved, spirit increased. The physician remarked: "The dosage of wind-damp herbs is so small; how can this cure the disease?" He increased Qianghuo, Duhuo, Fangfeng, and Baizhi to 10g each, and Xixin to 3g.
After 3 doses, pain intensified. Consultation revealed the same pulse. Qianghuo, Duhuo, Fangfeng, and Baizhi were reduced to 1.5g each, Xixin to 1g, and Danggui and Baishao increased to 15g each.
After 20 doses, pain disappeared. Advised continued intake for 2 weeks, resulting in full recovery.
The patient asked: "Why did identical ingredients yield different results?" I replied: "This case is primarily yin-blood deficiency. Wind-damp herbs must be used cautiously; otherwise, blood becomes more deficient, worsening pain. Studying Li Dongyuan's formulas for internal injury reveals that minimal dosages of wind herbs yield significant effects."
5. Treating the disease name without adapting to the syndrome makes recovery impossible.
Patient Ruan XX, Female, 35 years old.
Joint pain in fingers, wrists, and elbows for over 2 months following induced abortion. Diagnosed with rheumatoid arthritis. Western medicine treatment for over 1 month was ineffective. Subsequent TCM treatment with wind-expelling, damp-removing, and pain-relieving herbs worsened symptoms. Careful examination revealed joint pain, headache, aversion to wind, chest fullness, irritability, white tongue coating, and deep-wiry pulse. Synthesizing pulse and symptoms: Chest fullness, irritability, and deep-wiry pulse indicate liver stagnation and blood deficiency. Treatment should nourish blood and soothe the liver. Prescription: Bupleurum Root (Chaihu) 10g, Angelica Sinensis Root (Danggui) 10g, White Peony Root (Baishao) 15g, Atractylodes Rhizome (Baizhu) 10g, Licorice Root (Gancao) 10g, Fresh Ginger (Shengjiang) 3g, Mint (Bohe) 3g, Luffa Sponge (Sigualuo) 6g, Mulberry Twig (Sangzhi) 30g.
After 6 doses, headache, aversion to wind, chest fullness, and irritability decreased; joint pain slightly improved. Tongue coating white, pulse wiry-fine-rapid. Reasoning: Liver stagnation slightly reduced, but blood deficiency with wind-damp became prominent. Treatment should nourish blood, clear heat, expel wind, and remove dampness. Prescription: Gentiana Macrophylla Root (Qinjiao) 3g, Notopterygium Rhizome (Qianghuo) 3g, Angelica Pubescens Root (Duhuo) 3g, Saposhnikovia Root (Fangfeng) 3g, Ligusticum Chuanxiong Rhizome (Chuanxiong) 10g, Angelica Dahurica Root (Baizhi) 3g, Asarum Root (Xixin) 1g, Scutellaria Baicalensis Root (Huangqin) 10g, Rehmannia Root (Shengdi) 30g, Prepared Rehmannia Root (Shudi) 15g, Gypsum Fibrosum (Sheng Shigao) 10g, Angelica Sinensis Root (Danggui) 10g, White Peony Root (Baishao) 15g, Poria (Fuling) 10g, Licorice Root (Gancao) 10g, Atractylodes Rhizome (Baizhu) 10g.
After 4 doses, joint pain significantly improved. However, by the 6th dose, pain intensified, pulse deep-wiry-small-rapid. Reasoning: Liver stagnation and blood deficiency persisted. Prescribed blood-nourishing and liver-soothing formula for 6 doses; pain initially decreased but stalled. Prescribed blood-nourishing, heat-clearing, wind-expelling, and damp-removing formula for 6 doses. Thereafter, liver stagnation was treated with blood-nourishing/liver-soothing methods, while joint pain was treated with blood-nourishing/heat-clearing/wind-expelling/damp-removing methods. Total 40 doses led to full recovery.
The physician asked: "Why change formulas frequently?" I replied: "For complex conditions mismanaged multiple times, treatment must adapt to the primary aspects of the pathology in time. As Zhang Zhongjing stated in *Shang Han Lun*: 'If Taiyang disease persists for three days, and despite sweating, vomiting, purging, or warm needle therapy, it remains unresolved, this is a complicated disease (Huai Bing). Guizhi Tang is no longer suitable. Observe the pulse and symptoms, identify the deviation, and treat according to the syndrome.'"
Coronary Atherosclerotic Heart Disease
1. Phlegm stagnation and qi knotting with pivot dysfunction; treating with blood-invigorating and yang-unblocking methods leads to long-term ineffectiveness.
Patient Yu XX, Female, 42 years old.
Coronary atherosclerotic heart disease, premature beats, occasional atrial fibrillation for over 3 years. Western medicine treatment for over 1 year was ineffective. Adjunctive TCM treatment involving blood invigoration, stasis resolution, chest widening, and yang unblocking showed no improvement. Careful examination revealed precordial oppression/pain, irritability, palpitations, dizziness, dry mouth, poor appetite, thin white tongue coating, and wiry-slippery-knotted-intermitting pulse. Synthesizing pulse and symptoms: Chest and hypochondrium belong to the liver; wiry pulse indicates liver; slippery indicates phlegm; knotted indicates stagnation; intermitting indicates severe qi-blood depletion. Combined, this is liver-gallbladder qi stagnation with internal phlegm-heat and severe healthy qi depletion. Ren Shen was chosen to greatly tonify yuan qi; Banxia, Shengjiang, and Gualou to clear phlegm-heat; Xiao Chai Hu Tang to harmonize the pivot. Prescription: Bupleurum Root (Chaihu) 10g, Pinellia Tuber (Banxia) 10g, Scutellaria Baicalensis Root (Huangqin) 10g, Licorice Root (Gancao) 6g, Jujube (Dazao) 5 pieces, Ginseng Root (Renshen) 10g, Fresh Ginger (Shengjiang) 3 slices, Trichosanthes Fruit (Gualou) 15g.
After 5 doses, chest fullness/pain, palpitations, shortness of breath, and dizziness improved significantly. The reviewing physician noted this was Xiao Chai Hu Tang, stating: "Xiao Chai Hu Tang is for febrile diseases in *Shang Han Lun* and should not be used for coronary heart disease. Its efficacy here may be due to liver-soothing properties. Xiao Yao San also soothes the liver and contains blood-invigorating herbs for coronary disease. Adding Chuanxiong and Danshen would be more appropriate." The prescription was changed to: Bupleurum Root (Chaihu) 10g, Angelica Sinensis Root (Danggui) 10g, Red Peony Root (Chishao) 10g, Salvia Miltiorrhiza Root (Danshen) 30g, Ligusticum Chuanxiong Rhizome (Chuanxiong) 10g, Atractylodes Rhizome (Baizhu) 10g, Poria (Fuling) 10g, Honey-fried Licorice Root (Zhi Gancao) 10g, Fresh Ginger (Shengjiang) 3 slices, Mint (Bohe) 3g.
After 5 doses, chest fullness/pain, palpitations, and shortness of breath worsened. As the patient was a doctor, she urgently checked her ECG multiple times. Findings included premature beats, ST-segment depression, T-wave inversion, frequent atrial fibrillation, and second-degree left bundle branch block. Re-consultation revealed the same symptoms and a wiry-slippery-knotted-intermitting pulse with choppy qualities. It was concluded that Xiao Chai Hu Tang modification was still appropriate. Prescription: Bupleurum Root (Chaihu) 10g, Pinellia Tuber (Banxia) 10g, Scutellaria Baicalensis Root (Huangqin) 10g, Ginseng Root (Renshen) 10g, Licorice Root (Gancao) 10g, Fresh Ginger (Shengjiang) 3 slices, Jujube (Dazao) 5 pieces, Trichosanthes Fruit (Gualou) 15g.
After 3 doses, symptoms decreased; continuing for 50 doses led to complete symptom resolution and normal ECG.
The physician asked: "Why did Guan Xin II Hao, Xiao Yao San, and Gua Lou Xie Bai formulas fail, while Xiao Chai Hu Tang succeeded?" I replied: "This case involves phlegm stagnation and qi stagnation, located in the liver and gallbladder. Treatment should focus on soothing and unblocking. Since the cause is phlegm and stagnation, soothing the liver and resolving phlegm is correct, hence the success." Further questioning: "Why did coronary-specific drugs fail while non-coronary drugs succeeded?" I replied: "That assertion is dogmatic. Concluding there are 'specific drugs for coronary heart disease' is premature, as these theories and practices lack long-term clinical verification. Practice yields true knowledge; practice is the criterion for testing truth. Pay attention to this major scientific issue and avoid dogmatism."
2. Phlegm stasis and blood stasis with untransformed stagnant heat; treating with blood invigoration and meridian warming fails to resolve symptoms.
Patient Su XX, Female, 53 years old.