5个月前，因心情不痛快而突感胸闷气短，出汗，头晕，继而晕倒约1分多钟而清醒。经某院住院检查治疗近4个月，诊为冠状动脉硬化性心脏病、心房纤颤、窦房传导阻滞，但疗效始终不够满意。又配合中药活血养血、宽胸通阳，补气养血等进行治疗亦无明显改善。细审其证，除胸满气短，心悸心烦之外，并见其头晕，不敢坐或立，软弱乏神，阵阵汗出，汗出之始，先感心胸烦热，继而上冲，冲至心胸则心悸而恐，冲至咽喉则呼吸极端困难，冲至头则头晕失去知觉，不久即清醒而全身汗出，汗出后全身极其软弱，并时或寒热往来，舌苔白，脉弦紧滑数。综合脉证，思之：此正如仲景所论奔豚气之证也。因拟奔豚汤养血平肝，和胃降逆。处方：甘草10克，川芎10克，当归10克，半夏12克，黄芩10克，白芍10克，生姜4片，桑皮15克，葛根15克。
服药4剂诸证好转，阵发性逆气上冲由一日4～5次，减为隔日1次，而且时间也较前减少，并能下地走动而不感头晕。某医云：余始活血不效，后又用生脉散亦不效。其故何也?答曰：病呈阵发性，又发于惊恐之后，显系奔豚之证，奔豚证，仲景云：气从少腹起，上冲咽喉，发作欲死，复还止。其治法列有三条：一曰：奔豚气上冲胸，腹痛，往来寒热，奔豚汤主之。二曰：气从少腹上至心，桂枝加桂汤主之。三曰：脐下悸，欲作奔豚，苓桂甘枣汤主之。也就是说均可用于发作欲死者。三方之中无一味人参，可见用人参不对证。此证之软弱乏力为痰阻所致，故不用人参。其后又服30剂，诸证消失，心电图恢复正常。
3．气阴俱虚，膈间支饮，或但祛饮而不知扶正，或但知扶正而不知化饮，久久不愈
马××，男，78岁。
患糖尿病近40年，糖尿病性肾病30多年，肾病性高血压20多年，脑血栓后遗症偏瘫15年，高血压性心脏病，冠状动脉粥样硬化性心脏病，心房纤颤15年。前后住院达6年之久，虽然症状不见明显改善，但尚能控制病情发展。最近3个多月来，病情日渐加重，体重锐减，行动困难，心悸气短，饮食甚差。细审其证，肌肉瘦削，(体重34千克)，行动困难，神疲纳呆，心悸气短，腰酸腰困，语言无力，舌苔薄白，脉虚大弦紧而数。综合脉证，思之：心肝脾肺肾五脏俱病也，气血俱衰也，膈间支饮也。治宜补气阴，益脾肾，化痰饮，降冲逆，交心肾。处方：黄芪15克，人参10克，当归10克，麦冬10克，五昧子10克，生地20克，茯苓10克，泽泻10克，丹皮10克，苍术10克，肉桂10克，防己10克，生石膏15克。
服药7剂，精神、食欲好转，心悸气短明显改善，在他人搀扶下已能走100多步远；继服上药60剂，精神、食欲大增，体重恢复至55千克，尿常规阴性，心电图正常。
4．肝郁血虚，不予疏肝养血，惟从活血化痰论治，久久不效
郝××，男，49岁。
冠心病、心房纤颤、左束支传导阻滞1年多。医除予西药外，并予活血化瘀之中药治之，效不著。审视其证见心悸气短，心前区憋痛，急予小柴胡加瓜蒌方10剂治之，不效。再审其脉弦细而涩，舌苔薄白。因思：弦细之脉者肝郁血虚也；涩者，气滞血瘀也。前方之用活血、化痰不效者，其一为未养血，其二为未治血故耳。乃拟养血疏肝。逍遥散加味：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草10克，生姜3片，薄荷3克，青皮10克。
服药7剂，诸证大减，继服上药3个月，共服药80剂，愈。
5．气血俱虚，气滞血瘀，湿郁不化，不识夹杂多少，但或补或泻，其病难愈
薛××，男，65岁。
冠心病，心房纤颤8年多。曾反复住院治疗达4年余，然其效不著。审其除西药外，仅用中药养心安神、活血通脉、宽胸通阳等方即达近千剂。细询其近半年来，心悸心烦尤甚，有时心跳有暂停之感，有时心前区刺痛，有时胸微满，精神、食欲正常。舌苔薄白，舌质微暗，脉虚弦涩结或数促兼见。综合脉证，诊为气血俱虚为本，气滞血瘀，湿郁不化为标。拟用补气养血以培本，理气活血，燥湿健脾以治标。处方：黄芪30克，当归10克，丹参30克，党参10克，黄精10克，生地10克，苍术15克，白术10克，青皮10克，陈皮10克，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药6剂后，心悸胸满胸痛等证明显好转，继服上方18剂心悸胸痛未作，继服15剂，心电图复查3次未见异常。为巩固疗效，以上方为丸，每日3次，每次9克，服药4个月，愈。
患者问：心悸乃心病的症状，自应从心论治，而前用炙甘草汤、天王补心丹等不效，其故何也?答曰：心悸一症属心之证我想是正确的。但是为什么用补心丹、炙甘草汤不效，这个问题就复杂了。张仲景列心悸的表现有心下悸、心中悸、心’悸。本病之悸发生于胸部偏左，乃肝郁犯心之悸，故治宜从肝而不从心，此所以用补心不效，而用参芪丹归取效也。
6．肝郁气结，寒饮阻滞，不化其饮，而养其血，祛其瘀．故其不效
陈××，男，65岁。
心烦心悸，心前区刺痛3年多。某院诊为冠心病、心房纤颤、左束支传导阻滞。住院治疗一年多不见好转。尤其是最近一年来，胸满胸痛，心悸气短较前更加严重，并见阵发性逆气上冲，冲至心胸、头部则头晕汗出，汗出之后烦热之气时减，失眠纳呆。又邀中医以活血养血、清热泻火、养心安神之中药治之，亦证不减。细审其证，除上述者外，并见其舌苔薄白，脉弦紧结涩。因思：阵发性烦热上冲，冲则心悸气短者，奔豚也，奔豚之烦热起两胁者肝火也，心下悸者，心脾虚也；脐下悸者，肾虚也。再问其悸状，云：心下悸，心下悸逆气上冲循胸胁而上至胸咽，至头则热散汗出。综合脉证，乃云：此肝郁气结，心阳不振，水饮上犯，上热下寒之证也。前用诸法或肝病从心治，或气滞从活血，或阳虚从阴虚，或阳虚水饮而泻火，或饮邪而滋阴，皆误也。因拟疏肝理气，温阳化饮，平降冲逆，调理三焦。柴胡加龙骨牡蛎汤加减。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，茯苓10克，桂枝15克，生姜3片，大枣5枚，龙骨15克，牡蛎15克，大黄3克。
服药6剂，心悸心烦，胸满胸痛，身热汗出，失眠头痛等证均减；继服上方18剂，诸证若失；又服20剂以善后，果愈。
患者本人亦系医生，乃云：余自用养心安神，补气养血之剂而不效，而师用柴胡加龙骨牡蛎汤20剂病即愈，且心电图亦转正常，其故何也?答曰：柴胡加龙骨牡蛎汤方，既有小柴胡之疏肝利胆，又有苓桂姜枣汤之强心阳化水饮降冲气；既有龙骨牡蛎之镇降以防疏达太过而水气上冲，又有柴胡、桂枝、大黄三味上中下调理以解三焦之滞塞，故用于寒热并见，虚实并存者，常效如桴鼓。又云：余学习中医，应用中药治病已近20年，但长期存在着一种想法：西医、西药效果快，能治真正的病，中医、中药效果慢，且只能治功能性的病，从我本人的病来看，中药效果不但不慢，而且很能使改变了的心电图纠正过来。
高血压病
1．气血俱虚，肝火上冲，但降其火，血压不降
安××，男，65岁。
3年多来，血压一直持续在200／150mmHg左右不见下降。医先以多种西药治疗不见好转，继又配中药平肝潜阳，滋阴平肝，平肝泻火等治疗，仍然不见改善。近1年来，又逐渐出现胸满胸痛，心悸气短，经数个医院检查诊断确诊为冠心病、期前收缩，I度左束支传导阻滞。虽经西药治疗半年多，不但不见好转，反见加重。又配合中药活血养血，宽胸通阳，仍日甚一日。细审其证，除头晕头痛，胸满胸痛，心悸气短之外，并见心烦纳呆，口苦咽干，舌苔白，脉沉弦滑。综合脉证，思之：脉滑者，痰热也，沉弦者，肝郁气滞也。合之于症，乃痰郁气结，少阳枢机不利也。为拟和解少阳，化痰泻火。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个，瓜蒌15克。
服药4剂，胸满胸痛，心悸气短，纳呆食减，头晕头胀均减；继服30剂，不但胸满胸痛，心悸气短，纳呆食减，头晕头胀俱解，而且心电图也恢复正常。但一测血压仍然维持在原来的水平不见改善。察脉弦大稍数，舌苔白，血压195／150mmHg。因思弦大之脉者，气血俱虚也，弦数者肝火上冲也。拟用补气养血以扶正，平肝泻火以治标。处方：夏枯草30克，黄芪40克，当归10克，茺蔚子10克，赤芍10克，地龙10克，龙胆草10克，丹参10克。
服药4剂，精神大增，血压开始下降至170／130mmHg，继服10剂，诸证消失，血压正常；又服20剂，数次检查血压达2个月，一直维持在120～125／80～85mmHg。追访一年，血压一直正常。
患者问：余曾先后应用多种降压的西药一直不见好转，后来又加用了如牛黄降压丸，以及平肝潜阳、滋阴平肝的中药一直不见好转，后来又患了冠心病，再用中、西药仍然不见好转，为此思想负担非常严重。及至请朱先生治疗，开始服用小柴胡汤，我感到非常担心，用药后不但血压未见升高，反而胸满胸痛得到了改善。于是我产生了一个想法，我们西医学习中医的非常重视人参、生姜能够升压，但事实证明没有升压，可见用中药必须按照中医理论去辨证，而绝不可硬套西医理论。及至后来，又用补药治高血压，我更感到担心，但一服药不但血压未上升，反而下降了，于是我想前用诸法之不效，在于只注意了症状，而未考虑脉象，当补反用泻法。
2．心阳不振，寒水上冲，阴霾弥漫，清阳被蒙，反用滋阴平肝，以助寒水，久病不愈
郑××，男，67岁。
头晕头胀，心烦心悸3年多。医诊高血压病。先用西药降压药治疗近2年不见效果，后又配合中药滋阴平肝、平肝潜阳、平肝泻火等中药治之，不但症状不减，反见日渐加重。近2个多月来，不但头晕的经常不敢走路，而且有时连坐都不敢坐，并时时心悸心烦，时或烦热之气上冲，冲至胸则烦乱不安，冲至咽喉则感窒息欲死，冲至头则头晕呕吐，甚或暂时人事不知，汗出，时或恐惧欲死。经查心电图发现sT段下降，T波倒置，心房纤颤，为此又加用了扩张冠状动脉的药物，但症状却仍日甚一日。为此不得不请教高明之师指教之。此时恰遇刘渡舟老师在我所带实习，乃邀会诊。云：脉沉弦紧而促，乃心阳不振，寒水上冲之候，宜苓桂剂。处方：茯苓15克，白术6克，桂枝9克，炙甘草10克。
服药4剂，诸证大减，血压亦由190／100mmHg降至120／90mmHg，继服10剂，诸证大部消失。
问曰：老师何故应用苓桂术甘汤而不用养阴平肝?桂枝辛甘而温多数医家认为其能升高血压，何老师反用也?答曰：高血压病并不都是肝阳证，绝对不可认为高血压病即是肝阳上亢，本证之加剧就在于此，而有效亦在于此。
3．肝阳上亢，镇降力薄，病重药轻，其功不著
雷××，女，40岁。
4个月来，头重脚轻，如坐舟船，站立不稳。医诊高血压病。先以西药降压药治之，开始有效，但1周后效果再不显著。又以中药滋阴平肝之药治之，亦是开始有效，一周后再不见效。细审其证，除血压高外，并见眩晕，印堂穴部红赤，面部红晕上冲，舌苔白，脉弦长上入鱼际。综合脉证，思之：张寿甫《医学衷中参西录》云：“风名内中，言风自内生，非风自外束也，《内经》谓诸风掉眩皆属于肝，盖肝为木脏，于卦为巽，巽原主风，且中寄相火，征之事实，木火炽盛，亦自有风，此因肝木失和，风自肝起，又加以肺气不降，肾气不摄，冲气胃气又复上逆，于斯脏腑之气化，皆上升太过，而血之上注于脑者亦因之太过……是以方中重用牛膝以引血下行，此治标之主药。而复深究病之本源，用龙骨、牡蛎、龟甲、芍药以镇熄肝风，赭石以降胃降冲，元参、天冬以清肺气，肺中清肃之气下行，自能镇制肝木……间有初次将药服下转觉气血上攻而病加剧者，于斯加生麦芽、茵陈、川楝子即无斯弊。盖肝为将军之官，斯性刚果，若但用药强制或转激发其反动之力，茵陈为青蒿之嫩者，得初春少阳生发之气；与肝木同气相求，泻肝热兼疏肝郁，实能将顺肝木之性；麦芽为谷之萌芽，生用之亦善将顺肝木之性，使不抑郁；川楝子善引肝气下达，又能折其反动之力。方中加此三昧，而后用此方者，自无化虞也。”又思前用滋阴平肝之药不效者：一重镇之力不足，病重药轻也；二未予降肺胃之气也；三未予疏肝也；四未予泻火也。因拟镇肝熄风汤。处方：怀牛膝15克，生赭石30克，生龙骨15克，生牡蛎15克，生龟甲15克，生白芍15克，元参15克，天冬15克，川楝子6克，生麦芽6克，茵陈6克，甘草3克。
服药4剂，其证全失，血压亦恢复正常。为痊愈计，又服药30剂，其病果愈。
慢性肺源性心脏病
1．膈间支饮，但从肺治，病位不同，焉治有效
霍××，男，38岁。
5个月前，因心情不舒畅而突然感到胸闷、气短、出汗、头晕，随后晕倒约1分多钟后清醒。在某医院住院检查治疗近4个月，诊断为冠状动脉硬化性心脏病（冠心病）、心房纤颤、窦房传导阻滞，但疗效始终不够满意。又配合中药进行活血养血、宽胸通阳、补气养血等治疗，亦无明显改善。仔细审查其证候，除胸满、气短、心悸、心烦之外，还见头晕，不敢坐或站立，身体软弱、精神疲惫，阵阵出汗。汗出之初，先感到心胸烦热，继而上冲，冲到心胸则心悸且恐惧，冲到咽喉则呼吸极端困难，冲到头部则头晕失去知觉，不久即清醒并全身出汗，汗出后全身极其软弱，并时而出现寒热往来。舌苔白，脉象弦紧滑数。综合脉象与证候，思考：这正如张仲景所论述的奔豚气病之证候。因此拟定奔豚汤以养血平肝、和胃降逆。处方：甘草10克，川芎10克，当归10克，半夏12克，黄芩10克，白芍10克，生姜4片，桑皮15克，葛根15克。
服药4剂后诸证好转，阵发性逆气上冲由一日4～5次，减为隔日1次，而且时间也较前减少，并能下地走动而不感头晕。某医生说：我起初用活血法无效，后又用生脉散也无效。这是什么原因呢？回答说：病情呈阵发性，又发于惊恐之后，显系奔豚之证。张仲景说：气从少腹起，上冲咽喉，发作时痛苦欲死，过后又停止。其治法列有三条：一曰：奔豚气上冲胸，腹痛，往来寒热，奔豚汤主之。二曰：气从少腹上至心，桂枝加桂汤主之。三曰：脐下悸，欲作奔豚，苓桂甘枣汤主之。也就是说三方均可用于发作欲死者。三方之中无一味人参，可见用人参不对证。此证之软弱乏力为痰阻所致，故不用人参。其后又服30剂，诸证消失，心电图恢复正常。
3．气阴俱虚，膈间支饮，或只祛饮而不知扶正，或只知扶正而不知化饮，久久不愈
马××，男，78岁。
患糖尿病近40年，糖尿病性肾病30多年，肾病性高血压20多年，脑血栓后遗症偏瘫15年，高血压性心脏病，冠状动脉粥样硬化性心脏病，心房纤颤15年。前后住院达6年之久，虽然症状不见明显改善，但尚能控制病情发展。最近3个多月来，病情日渐加重，体重锐减，行动困难，心悸气短，饮食甚差。仔细审查其证候，肌肉瘦削（体重34千克），行动困难，神疲纳呆，心悸气短，腰酸腰困，语言无力，舌苔薄白，脉虚大弦紧而数。综合脉证，思考：心肝脾肺肾五脏俱病也，气血俱衰也，膈间支饮也。治宜补气阴，益脾肾，化痰饮，降冲逆，交心肾。处方：黄芪15克，人参10克，当归10克，麦冬10克，五味子10克，生地20克，茯苓10克，泽泻10克，丹皮10克，苍术10克，肉桂10克，防己10克，生石膏15克。
服药7剂，精神、食欲好转，心悸气短明显改善，在他人搀扶下已能走100多步远；继服上药60剂，精神、食欲大增，体重恢复至55千克，尿常规阴性，心电图正常。
4．肝郁血虚，不予疏肝养血，惟从活血化痰论治，久久不效
郝××，男，49岁。
冠心病、心房纤颤、左束支传导阻滞1年多。医生除予西药外，并予活血化瘀之中药治之，效果不显著。审视其证见心悸气短，心前区憋痛，急予小柴胡加瓜蒌方10剂治之，不效。再审其脉弦细而涩，舌苔薄白。因思：弦细之脉者肝郁血虚也；涩者，气滞血瘀也。前方之用活血、化痰不效者，其一为未养血，其二为未治血故耳。乃拟养血疏肝。逍遥散加味：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草10克，生姜3片，薄荷3克，青皮10克。
服药7剂，诸证大减，继服上药3个月，共服药80剂，痊愈。
5．气血俱虚，气滞血瘀，湿郁不化，不识夹杂多少，但或补或泻，其病难愈
薛××，男，65岁。
冠心病，心房纤颤8年多。曾反复住院治疗达4年余，然其效不著。审其除西药外，仅用中药养心安神、活血通脉、宽胸通阳等方即达近千剂。细询其近半年来，心悸心烦尤甚，有时心跳有暂停之感，有时心前区刺痛，有时胸微满，精神、食欲正常。舌苔薄白，舌质微暗，脉虚弦涩结或数促兼见。综合脉证，诊为气血俱虚为本，气滞血瘀，湿郁不化为标。拟用补气养血以培本，理气活血，燥湿健脾以治标。处方：黄芪30克，当归10克，丹参30克，党参10克，黄精10克，生地10克，苍术15克，白术10克，青皮10克，陈皮10克，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药6剂后，心悸胸满胸痛等证明显好转，继服上方18剂心悸胸痛未作，继服15剂，心电图复查3次未见异常。为巩固疗效，以上方为丸，每日3次，每次9克，服药4个月，痊愈。
患者问：心悸乃心病的症状，自应从心论治，而前用炙甘草汤、天王补心丹等不效，其故何也？回答说：心悸一症属心之证我想是正确的。但是为什么用补心丹、炙甘草汤不效，这个问题就复杂了。张仲景列心悸的表现有心下悸、心中悸、心悸。本病之悸发生于胸部偏左，乃肝郁犯心之悸，故治宜从肝而不从心，此所以用补心不效，而用参芪丹归取效也。
6．肝郁气结，寒饮阻滞，不化其饮，而养其血，祛其瘀．故其不效
陈××，男，65岁。
心烦心悸，心前区刺痛3年多。某院诊为冠心病、心房纤颤、左束支传导阻滞。住院治疗一年多不见好转。尤其是最近一年来，胸满胸痛，心悸气短较前更加严重，并见阵发性逆气上冲，冲至心胸、头部则头晕汗出，汗出之后烦热之气时减，失眠纳呆。又邀中医以活血养血、清热泻火、养心安神之中药治之，亦证不减。仔细审查其证候，除上述者外，并见其舌苔薄白，脉弦紧结涩。因思：阵发性烦热上冲，冲则心悸气短者，奔豚也，奔豚之烦热起两胁者肝火也，心下悸者，心脾虚也；脐下悸者，肾虚也。再问其悸状，云：心下悸，心下悸逆气上冲循胸胁而上至胸咽，至头则热散汗出。综合脉证，乃云：此肝郁气结，心阳不振，水饮上犯，上热下寒之证也。前用诸法或肝病从心治，或气滞从活血，或阳虚从阴虚，或阳虚水饮而泻火，或饮邪而滋阴，皆误也。因拟疏肝理气，温阳化饮，平降冲逆，调理三焦。柴胡加龙骨牡蛎汤加减。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，茯苓10克，桂枝15克，生姜3片，大枣5枚，龙骨15克，牡蛎15克，大黄3克。
服药6剂，心悸心烦，胸满胸痛，身热汗出，失眠头痛等证均减；继服上方18剂，诸证若失；又服20剂以善后，果然痊愈。
患者本人亦系医生，乃云：我自用养心安神，补气养血之剂而不效，而老师用柴胡加龙骨牡蛎汤20剂病即愈，且心电图亦转正常，其故何也？回答说：柴胡加龙骨牡蛎汤方，既有小柴胡之疏肝利胆，又有苓桂姜枣汤之强心阳化水饮降冲气；既有龙骨牡蛎之镇降以防疏达太过而水气上冲，又有柴胡、桂枝、大黄三味上中下调理以解三焦之滞塞，故用于寒热并见，虚实并存者，常效如桴鼓。又云：我学习中医，应用中药治病已近20年，但长期存在着一种想法：西医、西药效果快，能治真正的病，中医、中药效果慢，且只能治功能性的病，从我本人的病来看，中药效果不但不慢，而且很能使改变了的心电图纠正过来。
高血压病
1．气血俱虚，肝火上冲，但降其火，血压不降
安××，男，65岁。
3年多来，血压一直持续在200／150mmHg左右不见下降。医生先以多种西药治疗不见好转，继又配中药平肝潜阳，滋阴平肝，平肝泻火等治疗，仍然不见改善。近1年来，又逐渐出现胸满胸痛，心悸气短，经数个医院检查诊断确诊为冠心病、期前收缩，I度左束支传导阻滞。虽经西药治疗半年多，不但不见好转，反见加重。又配合中药活血养血，宽胸通阳，仍日甚一日。仔细审查其证候，除头晕头痛，胸满胸痛，心悸气短之外，并见心烦纳呆，口苦咽干，舌苔白，脉沉弦滑。综合脉证，思考：脉滑者，痰热也，沉弦者，肝郁气滞也。合之于症，乃痰郁气结，少阳枢机不利也。为拟和解少阳，化痰泻火。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个，瓜蒌15克。
服药4剂，胸满胸痛，心悸气短，纳呆食减，头晕头胀均减；继服30剂，不但胸满胸痛，心悸气短，纳呆食减，头晕头胀俱解，而且心电图也恢复正常。但一测血压仍然维持在原来的水平不见改善。察脉弦大稍数，舌苔白，血压195／150mmHg。因思弦大之脉者，气血俱虚也，弦数者肝火上冲也。拟用补气养血以扶正，平肝泻火以治标。处方：夏枯草30克，黄芪40克，当归10克，茺蔚子10克，赤芍10克，地龙10克，龙胆草10克，丹参10克。
服药4剂，精神大增，血压开始下降至170／130mmHg，继服10剂，诸证消失，血压正常；又服20剂，数次检查血压达2个月，一直维持在120～125／80～85mmHg。追访一年，血压一直正常。
患者问：我曾先后应用多种降压的西药一直不见好转，后来又加用了如牛黄降压丸，以及平肝潜阳、滋阴平肝的中药一直不见好转，后来又患了冠心病，再用中、西药仍然不见好转，为此思想负担非常严重。及至请朱先生治疗，开始服用小柴胡汤，我感到非常担心，用药后不但血压未见升高，反而胸满胸痛得到了改善。于是我产生了一个想法，我们西医学习中医的非常重视人参、生姜能够升压，但事实证明没有升压，可见用中药必须按照中医理论去辨证，而绝不可硬套西医理论。及至后来，又用补药治高血压，我更感到担心，但一服药不但血压未上升，反而下降了，于是我想前用诸法之不效，在于只注意了症状，而未考虑脉象，当补反用泻法。
2．心阳不振，寒水上冲，阴霾弥漫，清阳被蒙，反用滋阴平肝，以助寒水，久病不愈
郑××，男，67岁。
头晕头胀，心烦心悸3年多。医生诊高血压病。先用西药降压药治疗近2年不见效果，后又配合中药滋阴平肝、平肝潜阳、平肝泻火等中药治之，不但症状不减，反见日渐加重。近2个多月来，不但头晕的经常不敢走路，而且有时连坐都不敢坐，并时时心悸心烦，时或烦热之气上冲，冲至胸则烦乱不安，冲至咽喉则感窒息欲死，冲至头则头晕呕吐，甚或暂时人事不知，汗出，时或恐惧欲死。经查心电图发现sT段下降，T波倒置，心房纤颤，为此又加用了扩张冠状动脉的药物，但症状却仍日甚一日。为此不得不请教高明之师指教之。此时恰遇刘渡舟老师在我所带实习，乃邀会诊。云：脉沉弦紧而促，乃心阳不振，寒水上冲之候，宜苓桂剂。处方：茯苓15克，白术6克，桂枝9克，炙甘草10克。
服药4剂，诸证大减，血压亦由190／100mmHg降至120／90mmHg，继服10剂，诸证大部消失。
问曰：老师何故应用苓桂术甘汤而不用养阴平肝？桂枝辛甘而温多数医家认为其能升高血压，何老师反用也？回答说：高血压病并不都是肝阳证，绝对不可认为高血压病即是肝阳上亢，本证之加剧就在于此，而有效亦在于此。
3．肝阳上亢，镇降力薄，病重药轻，其功不著
雷××，女，40岁。
4个月来，头重脚轻，如坐舟船，站立不稳。医生诊高血压病。先以西药降压药治之，开始有效，但1周后效果再不显著。又以中药滋阴平肝之药治之，亦是开始有效，一周后再不见效。仔细审查其证候，除血压高外，并见眩晕，印堂穴部红赤，面部红晕上冲，舌苔白，脉弦长上入鱼际。综合脉证，思考：张寿甫《医学衷中参西录》云：“风名内中，言风自内生，非风自外束也，《内经》谓诸风掉眩皆属于肝，盖肝为木脏，于卦为巽，巽原主风，且中寄相火，征之事实，木火炽盛，亦自有风，此因肝木失和，风自肝起，又加以肺气不降，肾气不摄，冲气胃气又复上逆，于斯脏腑之气化，皆上升太过，而血之上注于脑者亦因之太过……是以方中重用牛膝以引血下行，此治标之主药。而复深究病之本源，用龙骨、牡蛎、龟甲、芍药以镇熄肝风，赭石以降胃降冲，元参、天冬以清肺气，肺中清肃之气下行，自能镇制肝木……间有初次将药服下转觉气血上攻而病加剧者，于斯加生麦芽、茵陈、川楝子即无斯弊。盖肝为将军之官，斯性刚果，若但用药强制或转激发其反动之力，茵陈为青蒿之嫩者，得初春少阳生发之气；与肝木同气相求，泻肝热兼疏肝郁，实能将顺肝木之性；麦芽为谷之萌芽，生用之亦善将顺肝木之性，使不抑郁；川楝子善引肝气下达，又能折其反动之力。方中加此三昧，而后用此方者，自无化虞也。”又思前用滋阴平肝之药不效者：一重镇之力不足，病重药轻也；二未予降肺胃之气也；三未予疏肝也；四未予泻火也。因拟镇肝熄风汤。处方：怀牛膝15克，生赭石30克，生龙骨15克，生牡蛎15克，生龟甲15克，生白芍15克，元参15克，天冬15克，川楝子6克，生麦芽6克，茵陈6克，甘草3克。
服药4剂，其证全失，血压亦恢复正常。为痊愈计，又服药30剂，其病果愈。
Five months ago, due to emotional distress, the patient suddenly experienced chest tightness, shortness of breath, sweating, and dizziness, followed by a fainting episode lasting over one minute before regaining consciousness. After nearly four months of inpatient examination and treatment at a certain hospital, diagnoses included coronary atherosclerotic heart disease (Coronary Heart Disease), atrial fibrillation, and sinoatrial block, yet the therapeutic efficacy remained unsatisfactory. Treatment with Chinese herbal medicine aimed at invigorating blood and nourishing blood, widening the chest and unblocking yang, and tonifying qi and nourishing blood also yielded no significant improvement. Upon careful examination of the syndrome, besides chest fullness, shortness of breath, palpitations, and irritability, the patient exhibited dizziness, inability to sit or stand, physical weakness, and mental fatigue, along with intermittent sweating. At the onset of sweating, there was a sensation of vexatious heat in the chest and heart region, which then surged upward; upon reaching the chest and heart, it caused palpitations and fear; upon reaching the throat, it resulted in extreme difficulty in breathing; upon reaching the head, it caused dizziness and loss of consciousness. Shortly after, the patient regained consciousness with whole-body sweating, leaving the body extremely weak afterward. There were also occasional alternating chills and fever. The tongue coating was white, and the pulse was wiry, tight, slippery, and rapid. Synthesizing the pulse and symptoms, I reasoned: This is precisely the syndrome of Ben Tun Qi (Rushing Pig Gas) as discussed by Zhang Zhongjing. Therefore, I prescribed Ben Tun Tang (Pig Rushing Decoction) to nourish blood, calm the liver, harmonize the stomach, and direct rebellious qi downward. Prescription: Radix Glycyrrhizae Preparata (Gancao, 甘草) 10g, Rhizoma Chuanxiong (Chuanxiong, 川芎) 10g, Radix Angelicae Sinensis (Danggui, 当归) 10g, Rhizoma Pinelliae Preparata (Banxia, 半夏) 12g, Cortex Phellodendri (Huangqin, 黄芩) 10g, Radix Paeoniae Alba (Baishao, 白芍) 10g, Fresh Ginger (Shengjiang, 生姜) 4 slices, Pericarpium Citri Reticulatae Viride (Qingpi, 青皮 - Note: Text says Sangpi/Sang Bai Pi usually, but listed as Sangpi here, likely Cortex Mori (Sangbaipi)) 15g, Radix Puerariae Lobatae (Gegen, 葛根) 15g.
After taking 4 doses, all symptoms improved. The paroxysmal upward surging of rebellious qi decreased from 4-5 times a day to once every other day, and the duration was shorter. The patient could walk on the ground without feeling dizzy. A certain doctor said: "Initially, my use of blood-invigorating methods was ineffective, and later, Sheng Mai San (Generate the Pulse Powder) was also ineffective. What is the reason?" I replied: "The condition presents paroxysmally and occurred after fright, clearly indicating a Ben Tun syndrome. Zhang Zhongjing stated: 'Qi rises from the lower abdomen, surges up to the throat, the attack is agonizingly severe, and then subsides.' His treatment methods list three approaches: First, for Ben Tun Qi surging to the chest, abdominal pain, and alternating chills and fever, Ben Tun Tang governs. Second, for Qi rising from the lower abdomen to the heart, Guizhi Jia Guixin Tang (Cinnamon Twig Plus Cinnamon Bark Decoction) governs. Third, for palpitations below the navel, suggesting impending Ben Tun, Linggui Gan Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction) governs. In other words, all three can be used for attacks that are agonizingly severe. None of the three prescriptions contain Ren Shen (Radix Ginseng), indicating that using Ren Shen was inappropriate for this case. The weakness and fatigue in this case were caused by phlegm obstruction, hence Ren Shen was not used. After taking another 30 doses, all symptoms disappeared, and the electrocardiogram returned to normal.
3. Deficiency of both Qi and Yin, with fluid retention between the diaphragm; if one only dispels fluid without supporting healthy Qi, or only supports healthy Qi without resolving fluid retention, the disease will persist for a long time.
Patient Ma XX, Male, 78 years old.
Suffered from diabetes mellitus for nearly 40 years, diabetic nephropathy for over 30 years, hypertensive nephropathy for over 20 years, hemiplegia sequelae of cerebral thrombosis for 15 years, hypertensive heart disease, coronary atherosclerotic heart disease, and atrial fibrillation for 15 years. Hospitalized for a total of 6 years. Although symptoms did not show significant improvement, the progression of the disease was controlled. For the past 3+ months, the condition has worsened gradually, with sharp weight loss, difficulty moving, palpitations, shortness of breath, and poor appetite. Careful examination revealed emaciated muscles (weight 34 kg), difficulty moving, mental fatigue, poor appetite, palpitations, shortness of breath, soreness and heaviness in the lower back, weak voice, thin white tongue coating, and a pulse that was deficient, large, wiry, tight, and rapid. Synthesizing the pulse and symptoms, I reasoned: All five zang organs (Heart, Liver, Spleen, Lung, Kidney) are diseased; both Qi and Blood are depleted; there is fluid retention between the diaphragm. The treatment should focus on tonifying Qi and Yin, benefiting the Spleen and Kidney, transforming phlegm-fluid, directing rebellious qi downward, and communicating between the Heart and Kidney. Prescription: Radix Astragali (Huangqi, 黄芪) 15g, Radix Ginseng (Renshen, 人参) 10g, Radix Angelicae Sinensis (Danggui, 当归) 10g, Radix Ophiopogonis (Maidong, 麦冬) 10g, Fructus Schisandrae Chinensis (Wuweizi, 五味子) 10g, Radix Rehmanniae Preparata (Shengdi, 生地) 20g, Poria (Fuling, 茯苓) 10g, Rhizoma Alismatis (Zexie, 泽泻) 10g, Cortex Moutan (Danpi, 丹皮) 10g, Rhizoma Atractylodis Macrocephalae (Cangzhu, 苍术) 10g, Cortex Cinnamomi (Rougui, 肉桂) 10g, Radix Stephaniae Tetrandrae (Fangji, 防己) 10g, Raw Gypsum (Sheng Shigao, 生石膏) 15g.
After 7 doses, spirit and appetite improved, and palpitations and shortness of breath significantly improved; with assistance, the patient could walk over 100 steps. After continuing the same prescription for 60 doses, spirit and appetite greatly increased, weight recovered to 55 kg, urine routine test was negative, and electrocardiogram was normal.
4. Liver Qi Stagnation and Blood Deficiency; failing to soothe the Liver and nourish Blood, and only treating via invigorating blood and resolving phlegm, leads to prolonged ineffectiveness.
Patient Hao XX, Male, 49 years old.
Coronary heart disease, atrial fibrillation, and left bundle branch block for over 1 year. Besides Western medicine, the doctor treated with Chinese herbs for invigorating blood and resolving stasis, but the effect was not significant. Examination revealed palpitations, shortness of breath, and stifling pain in the precordial area. Xiao Chai Hu Tang plus Gua Lou Fang (Trichosanthes Decoction) was urgently prescribed for 10 doses, but it was ineffective. Re-examination showed a wiry, fine, and choppy pulse, and a thin white tongue coating. Reasoning: A wiry and fine pulse indicates Liver Qi stagnation and Blood deficiency; a choppy pulse indicates Qi stagnation and Blood stasis. The previous failure of blood-invigorating and phlegm-resolving methods was due to two reasons: first, Blood was not nourished; second, the root cause of Blood pathology was not addressed. Therefore, I formulated a strategy to nourish Blood and soothe the Liver. Modified Xiao Yao San (Free Wanderer Powder): Radix Bupleuri (Chaihu, 柴胡) 10g, Radix Angelicae Sinensis (Danggui, 当归) 10g, Radix Paeoniae Alba (Baishao, 白芍) 10g, Rhizoma Atractylodis Macrocephalae (Baizhu, 白术) 10g, Poria (Fuling, 茯苓) 10g, Radix Glycyrrhizae Preparata (Gancao, 甘草) 10g, Fresh Ginger (Shengjiang, 生姜) 3 slices, Folium Menthae Haplocalycis (Bohe, 薄荷) 3g, Pericarpium Citri Reticulatae Viride (Qingpi, 青皮) 10g.
After 7 doses, all symptoms greatly reduced. Continuing the medication for 3 months, totaling 80 doses, resulted in a cure.
5. Deficiency of both Qi and Blood, Qi stagnation and Blood stasis, Dampness stagnation failing to transform; failing to recognize the complexity of mixed patterns, and merely using either tonification or purgation makes recovery difficult.
Patient Xue XX, Male, 65 years old.
Coronary heart disease and atrial fibrillation for over 8 years. Repeated hospitalizations for over 4 years with little effect. Besides Western medicine, nearly a thousand doses of Chinese formulas for calming the mind, invigorating blood, unblocking collaterals, and widening the chest were used. Detailed inquiry revealed that for the past half-year, palpitations and irritability were particularly severe, with occasional sensations of heart pause, stabbing pain in the precordial area, and mild chest fullness. Spirit and appetite were normal. Tongue coating was thin white, tongue body slightly dark, and the pulse was deficient, wiry, choppy, knotted, or rapid and intermittent. Synthesizing pulse and symptoms, the diagnosis was: Root deficiency of Qi and Blood, with Branch manifestations of Qi stagnation, Blood stasis, and Dampness stagnation. The strategy was to tonify Qi and nourish Blood to support the root, regulate Qi, invigorate blood, dry dampness, and strengthen the Spleen to treat the branch. Prescription: Radix Astragali (Huangqi, 黄芪) 30g, Radix Angelicae Sinensis (Danggui, 当归) 10g, Radix Salviae Miltiorrhizae (Danshen, 丹参) 30g, Radix Codonopsis Pilosae (Dangshen, 党参) 10g, Rhizoma Polygonati Odorati (Huangjing, 黄精) 10g, Radix Rehmanniae Preparata (Shengdi, 生地) 10g, Rhizoma Atractylodis Macrocephalae (Cangzhu, 苍术) 15g, Rhizoma Atractylodis Macrocephalae (Baizhu, 白术) 10g, Pericarpium Citri Reticulatae Viride (Qingpi, 青皮) 10g, Pericarpium Citri Reticulatae (Chenpi, 陈皮) 10g, Radix Bupleuri (Chaihu, 柴胡) 10g, Rhizoma Sparganii (Sanleng, 三棱) 10g, Rhizoma Curcumae Longae (Ezhu, 莪术) 10g, Folium Menthae Haplocalycis (Bohe, 薄荷) 3g, Caulis Trichosanthis (Yejiaoteng, 夜交藤) 30g.
After 6 doses, palpitations, chest fullness, and chest pain significantly improved. Continuing for 18 doses prevented recurrence of palpitations and chest pain. After another 15 doses, three electrocardiogram reviews showed no abnormalities. To consolidate efficacy, the formula was made into pills, taken 3 times daily, 9g each time, for 4 months, resulting in a cure.
Patient asked: Palpitations are symptoms of Heart disease, so treatment should naturally focus on the Heart. Why were Zhi Gan Cao Tang (Prepared Licorice Decoction) and Tian Wang Bu Xin Dan (Emperor of Heaven's Special Pill to Tonify the Heart) ineffective? Answer: It is correct that palpitations belong to Heart syndromes. However, why these formulas failed is complex. Zhang Zhongjing listed manifestations of palpitations as palpitations under the heart, palpitations in the heart, and general palpitations. The palpitation in this case occurred in the left side of the chest, caused by Liver Qi stagnation invading the Heart. Therefore, treatment should focus on the Liver rather than the Heart. This explains why tonifying the Heart was ineffective, while using Ginseng, Astragalus, Salvia, and Angelica was effective.
6. Liver Qi Stagnation and Knotting, Cold Fluid Obstruction; failing to resolve fluid and instead nourishing blood and removing stasis leads to ineffectiveness.
Patient Chen XX, Male, 65 years old.
Vexation, palpitations, and stabbing pain in the precordial area for over 3 years. Diagnosed at a certain hospital with coronary heart disease, atrial fibrillation, and left bundle branch block. Over a year of inpatient treatment showed no improvement. Especially in the past year, chest fullness and pain, palpitations, and shortness of breath worsened. Paroxysmal upward surging of rebellious qi occurred; when surging to the chest and head, it caused dizziness and sweating. After sweating, the vexatious heat sometimes subsided, accompanied by insomnia and poor appetite. Traditional Chinese Medicine treatment with blood-invigorating/nourishing, clearing heat/purging fire, and calming the mind/nourishing the heart herbs also failed to reduce symptoms. Careful examination revealed, besides the above, a thin white tongue coating and a wiry, tight, knotted, and choppy pulse. Reasoning: Paroxysmal vexatious heat surging upward, causing palpitations and shortness of breath, indicates Ben Tun. Vexatious heat arising from the hypochondrium in Ben Tun is Liver Fire; palpitations under the heart indicate Heart-Spleen deficiency; palpitations below the navel indicate Kidney deficiency. Further questioning about the palpitation nature revealed: Palpitations under the heart, with rebellious qi surging upward along the chest and hypochondrium to the chest-throat, and heat dissipating with sweating when reaching the head. Synthesizing pulse and symptoms: This is a syndrome of Liver Qi stagnation, Heart Yang deficiency, Water-Fluid invading upward, Upper Heat and Lower Cold. Previous methods were erroneous: treating Liver disease via the Heart, treating Qi stagnation via blood invigoration, treating Yang deficiency via Yin tonification, purging fire for Yang deficiency with water-fluid, or nourishing Yin for fluid pathogens. Therefore, I formulated a strategy to soothe the Liver, regulate Qi, warm Yang, transform fluid, calm rebellious qi, and regulate the Triple Burner. Modified Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction). Prescription: Radix Bupleuri (Chaihu, 柴胡) 10g, Rhizoma Pinelliae Preparata (Banxia, 半夏) 10g, Radix Codonopsis Pilosae (Dangshen, 党参) 10g, Cortex Phellodendri (Huangqin, 黄芩) 10g, Radix Glycyrrhizae Preparata (Gancao, 甘草) 6g, Poria (Fuling, 茯苓) 10g, Ramulus Cinnamomi (Guizhi, 桂枝) 15g, Fresh Ginger (Shengjiang, 生姜) 3 slices, Fructus Jujubae (Dazao, 大枣) 5 pieces, Os Draconis (Longgu, 龙骨) 15g, Concha Ostreae (Muli, 牡蛎) 15g, Radix et Rhizoma Rhei (Dahuang, 大黄) 3g.
After 6 doses, palpitations, vexation, chest fullness/pain, body heat/sweating, insomnia, and headache all reduced. Continuing for 18 doses eliminated all symptoms. Another 20 doses for consolidation resulted in a cure.
The patient, who is also a doctor, stated: "I used calming-nourishing-heart and qi-blood-tonifying agents myself without effect, but the teacher cured me with 20 doses of Chai Hu Jia Long Gu Mu Li Tang, and my electrocardiogram normalized. Why?" Answer: Chai Hu Jia Long Gu Mu Li Tang contains Xiao Chai Hu Tang to soothe the Liver and benefit the Gallbladder, and Ling Gui Jiang Zao Tang (Poria, Cinnamon Twig, Ginger, and Jujube Decoction) to strengthen Heart Yang, transform water-fluid, and direct rebellious qi downward. It includes Dragon Bone and Oyster Shell to anchor and descend, preventing excessive dispersal and upward surging of water-qi. It uses Bupleurum, Cinnamon Twig, and Rhubarb to regulate the Upper, Middle, and Lower Jiao and resolve stagnation. Thus, it is highly effective for conditions with simultaneous Cold and Heat, and Deficiency and Excess. He added: "I have studied TCM and used herbs for nearly 20 years, holding the belief that Western medicine acts fast and cures organic diseases, while TCM acts slow and only treats functional diseases. From my own illness, TCM acted quickly and corrected the abnormal electrocardiogram."
Hypertension
1. Deficiency of Qi and Blood, Liver Fire surging upward; merely purging fire fails to lower blood pressure.
Patient An XX, Male, 65 years old.
For over 3 years, blood pressure remained sustained around 200/150 mmHg without decline. Multiple Western antihypertensive drugs were ineffective. Subsequent TCM treatments including pacifying Liver Yang, subduing Liver Yang, nourishing Yin and pacifying Liver, and purging Liver Fire also failed to improve. In the past year, chest fullness/pain, palpitations, and shortness of breath gradually appeared. Diagnosed across several hospitals as coronary heart disease, premature beats, and first-degree left bundle branch block. Despite over half a year of Western medicine, the condition worsened. Combined TCM treatment for invigorating blood, nourishing blood, widening chest, and unblocking Yang also intensified daily. Careful examination revealed, besides dizziness/headache, chest fullness/pain, palpitations, and shortness of breath, vexation, poor appetite, bitter taste, dry throat, white tongue coating, and a deep, wiry, slippery pulse. Synthesizing pulse and symptoms: Slippery pulse indicates Phlegm-Heat; deep and wiry pulse indicates Liver Qi stagnation. Combined with symptoms, this is Phlegm-Dampness stagnation with Qi knotting, and Shaoyang pivot mechanism dysfunction. Strategy: Harmonize Shaoyang, transform phlegm, purge fire. Prescription: Radix Bupleuri (Chaihu, 柴胡) 10g, Rhizoma Pinelliae Preparata (Banxia, 半夏) 10g, Cortex Phellodendri (Huangqin, 黄芩) 10g, Radix Ginseng (Renshen, 人参) 10g, Radix Glycyrrhizae Preparata (Gancao, 甘草) 10g, Fresh Ginger (Shengjiang, 生姜) 3 slices, Fructus Jujubae (Dazao, 大枣) 5 pieces, Fructus Trichosanthis (Gualou, 瓜蒌) 15g.
After 4 doses, chest fullness/pain, palpitations, shortness of breath, poor appetite, dizziness, and head distension all reduced. After 30 doses, all symptoms resolved, and electrocardiogram normalized. However, blood pressure remained at the original level. Pulse was wiry, large, and slightly rapid; tongue coating white; BP 195/150 mmHg. Reasoning: Wiry and large pulse indicates Qi and Blood deficiency; wiry and rapid pulse indicates Liver Fire surging upward. Strategy: Tonify Qi and nourish Blood to support Healthy Qi, pacify Liver and purge fire to treat Branch. Prescription: Flos Budlejae Officinalis (Xiakucao, 夏枯草) 30g, Radix Astragali (Huangqi, 黄芪) 40g, Radix Angelicae Sinensis (Danggui, 当归) 10g, Semen Vaccariae (Chongweizi, 茺蔚子) 10g, Radix Paeoniae Rubra (Chishao, 赤芍) 10g, Drilus (Dilong, 地龙) 10g, Herba Gentianae Macrophyllae (Longdancao, 龙胆草) 10g, Radix Salviae Miltiorrhizae (Danshen, 丹参) 10g.
After 4 doses, spirit greatly increased, and BP began to drop to 170/130 mmHg. After 10 doses, all symptoms disappeared, and BP normalized. After another 20 doses, BP checks over 2 months maintained 120-125/80-85 mmHg. One-year follow-up showed BP remained normal.
Patient asked: "I used multiple Western antihypertensives without success, then added Niuhuang Jiangya Wan (Calming Yellow Pill for Hypertension) and TCM for pacifying/subduing Liver Yang and nourishing Yin, still no success. Later developing CHD, combined TCM/Western meds also failed, causing severe psychological burden. When Mr. Zhu treated me, starting with Xiao Chai Hu Tang, I was worried. Post-medication, BP did not rise, and chest symptoms improved. This led me to realize that although Western-trained TCM practitioners believe Ginseng and Ginger raise BP, facts prove otherwise. TCM must follow TCM theory for differentiation, never forcing Western theories. Later, using tonics for hypertension worried me further, but BP dropped. I realized previous failures were due to focusing only on symptoms, ignoring the pulse, and using purgation when tonification was needed."
2. Heart Yang deficiency, Cold Water surging upward, Yin-Cold pervading, Clear Yang obscured; contrary use of Yin-nourishing and Liver-pacifying methods aids Cold Water, leading to chronic non-resolution.
Patient Zheng XX, Male, 67 years old.
Dizziness, head distension, vexation, and palpitations for over 3 years. Diagnosed with hypertension. Nearly 2 years of Western antihypertensives were ineffective. Combined TCM for nourishing Yin/pacifying Liver, subduing Liver Yang, and purging Liver Fire not only failed to reduce symptoms but worsened them. For over 2 months, dizziness was so severe the patient dared not walk, and sometimes dared not sit. Frequent palpitations and vexation occurred. Occasionally, vexatious heat surged upward; to the chest causing restlessness; to the throat causing suffocation and near-death sensation; to the head causing dizziness and vomiting, or temporary loss of consciousness, sweating, and fear of death. ECG showed ST-segment depression, T-wave inversion, and atrial fibrillation. Coronary dilators were added, but symptoms worsened. Seeking expert advice, Professor Liu Duzhou was invited for consultation. Pulse was deep, wiry, tight, and hurried, indicating Heart Yang deficiency and Cold Water surging. Suitable for Ling Gui Decoctions. Prescription: Poria (Fuling, 茯苓) 15g, Rhizoma Atractylodis Macrocephalae (Baizhu, 白术) 6g, Ramulus Cinnamomi (Guizhi, 桂枝) 9g, Prepared Radix Glycyrrhizae (Zhigancao, 炙甘草) 10g.
After 4 doses, symptoms greatly reduced, and BP dropped from 190/100 mmHg to 120/90 mmHg. After 10 doses, most symptoms disappeared.
Question: "Why did you use Ling Gui Zhu Gan Tang (Poria, Atractylodes, Cinnamon Twig, and Licorice Decoction) instead of Yin-nourishing and Liver-pacifying methods? Most doctors believe Guizhi (Cinnamon Twig), being acrid, sweet, and warm, raises BP. Why did you use it?" Answer: "Not all hypertension is Liver Yang Syndrome. One must absolutely not assume hypertension equals Liver Yang Hyperactivity. The aggravation of this case lay in this misconception, and its effectiveness also lies in correcting it."
3. Liver Yang Hyperactivity, weak anchoring and descending power, heavy disease with light medication, efficacy insignificant.
Patient Lei XX, Female, 40 years old.
For 4 months, heavy head and light feet, sensation like sitting in a boat, unstable standing. Diagnosed with hypertension. Western antihypertensives worked initially but lost efficacy after 1 week. TCM for nourishing Yin and pacifying Liver also worked initially but failed after a week. Careful examination revealed high BP, vertigo, redness at Yintang point, facial flushing surging upward, white tongue coating, and a wiry, long pulse extending into the fish-mouth area. Synthesizing pulse and symptoms, referencing Zhang Shuifu's *Records of Chinese Medicine Integrating East and West*: "Internal Wind refers to wind generated internally, not externally constrained. *Neijing* states: 'All wind, tremors, and vertigo belong to the Liver.' The Liver is a Wood organ, corresponding to the Xun trigram, which governs wind and houses Ministerial Fire. Facts show excessive Wood and Fire generate their own wind. Due to Liver Wood disharmony, wind arises from the Liver. Added to this, Lung Qi fails to descend, Kidney Qi fails to secure, and Chong and Stomach Qi rebel upward. Thus, the Qi transformation of these organs rises excessively, and blood flowing to the brain also increases excessively... Therefore, the formula heavily uses Niuxi (Achyranthes Root) to guide blood downward, the main drug for treating the branch. Deeply investigating the root, Longgu (Dragon Bone), Muli (Oyster Shell), Guijia (Tortoise Shell), and Shaoyao (Peony) are used to anchor and extinguish Liver Wind; Zhishi (Magnetite) descends Stomach and Chong Qi; Xuanshen (Scrophularia) and Tiandong (Asparagus Tuber) clear Lung Qi. Descending Lung Qi naturally controls Liver Wood... If initial intake causes Qi and Blood to surge upward and worsen the disease, add Sheng Maiya (Raw Barley Sprout), Yinchen (Artemisia Capillaris), and Chuanlianzi (Toosendan Fruit) to avoid this drawback. The Liver is the General, possessing a rigid nature. Forced suppression may trigger reactive force. Yinchen, tender Artemisia, obtains early spring Shaoyang generating Qi; seeking resonance with Liver Wood, it clears Liver Heat and soothes Liver Stagnation, truly following Liver nature. Maiya, barley sprout, raw use also follows Liver nature, preventing depression. Chuanlianzi guides Liver Qi downward and breaks reactive force. Adding these three ensures safety." Reasoning previous failure of Yin-nourishing/Liver-pacifying methods: 1. Insufficient anchoring power, heavy disease/light meds; 2. Did not descend Lung/Stomach Qi; 3. Did not soothe the Liver; 4. Did not purge fire. Strategy: Zhen Gan Xi Feng Tang (Settle the Liver and Extinguish Wind Decoction). Prescription: Radix Achyranthis Bidentatae (Huai Niuxi, 怀牛膝) 15g, Raw Magnetitum (Sheng Zhe Shi, 生赭石) 30g, Raw Os Draconis (Sheng Longgu, 生龙骨) 15g, Raw Concha Ostreae (Sheng Muli, 生牡蛎) 15g, Raw Testudinis Carapax et Plastrum (Sheng Guijia, 生龟甲) 15g, Raw Radix Paeoniae Alba (Sheng Baishao, 生白芍) 15g, Radix Scrophulariae (Xuanshen, 元参) 15g, Radix Asparagi (Tiandong, 天冬) 15g, Fructus Toosendan (Chuanlianzi, 川楝子) 6g, Raw Hordeum Vulgare Germinatum (Sheng Maiya, 生麦芽) 6g, Herba Artemisiae Scopariae (Yinchen, 茵陈) 6g, Radix Glycyrrhizae Preparata (Gancao, 甘草) 3g.
After 4 doses, symptoms completely vanished, and BP normalized. For cure, 30 more doses were taken, resulting in complete recovery.
Chronic Cor Pulmonale
1. Fluid retention between the diaphragm; treating only from the Lung perspective, different disease location, how can treatment be effective?
Patient Huo XX, Male, 38 years old.