喘息性支气管炎6年多，肺心病2年多。医始以西药治疗，往往可以很快控制。2年以后，咳喘气短逐渐加重，但每次发病应用西药治疗不如以前有效，有时l～2个月才能控制，至第三年时，每次发病，应用西药几乎不起什么作用。不得已，又请中医以宣肺化痰，清热定喘或化饮宣肺等进行治疗。开始时，还算基本有效。但至近两年半以来，不管中药、西药都不见效。为此不得不住院2年之久，但时至今日，昼夜冬夏仍然天天作喘。细查其证：除喘咳短气之外，并见其神疲纳呆，颜面、口唇、舌质、爪甲、指趾、四肢均青紫，颜面、肢体浮肿，脘腹胀满，按之则痛而短气更甚，舌苔薄白，指趾厥冷，脉弦紧而数或时见促结而涩。综合脉证，因思仲景有云：“膈间支饮，其人喘满，心下痞坚，面色黧黑者，木防己汤主之。”“支饮不得息，葶苈大枣泻肺汤主之。”此病饮邪阻于膈间、胸膈，而诸医多从肺治所致也。法拟木防己汤加减苦辛并用以散结气，葶苈泻肺逐痰饮。处方：防己10克，人参10克，桂枝10克，生石膏15克，半夏10克，陈皮10克，葶苈4克，紫菀10克。
服药4剂，诸证稍减；服药20剂后，停止吸氧亦不见病情加重；服药30剂时，食欲、精神明显好转，浮肿消失，并可以自由活动。服药至60剂时，紫绀消失，一切生活均能自理，服药至90剂时，除上楼时微见气短外，别无明显不适。
2．痰饮阻肺，气阴两伤，肾气不纳，不去扶正，反予攻邪，因作危殆
刘××，女，78岁。
2年前因气胸而行左肺切除术，术后一直精神较好。4个多月前，突患支气管炎，虽遍请中、西诸医治疗不见好转。2周前又因肺部感染而病情更加严重。为此不得不住院治疗。住院3天后，突见高热达39．8℃，呼吸更加困难，全身浮肿，紫绀，尿少，神志时清时昧。急请专家会诊。诊为慢性支气管炎合并感染，肺心病，肺心脑病，数小时后，神志已完全不清。察其神昏谵语，呼吸极端困难，紫绀，浮肿，舌苔黄厚，舌质紫暗，脉虚大紧数时或见促。再察前医所用之药，除西药外，中药或为定喘，或为小青龙，或为苏子降气。因思患者年高体衰，气阴大伤，肾气不纳，若再予祛邪伤正，则不久于人世也。急处补气养阴，温阳纳气，化痰定喘。处方：黄芪15克，鳖甲15克，地骨皮10克，紫菀10克，人参10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，白芍10克，麦冬10克，肉桂10克，甘草10克，冬虫夏草15克。
药进1剂，神志转清，体温正常，喘而短气亦见好转；继进10剂，诸证大部消失。乃以丸方调理。
心肌炎
1．表里俱见，虚实俱存，或但治里，或但治虚，奏乐不和，难于成曲
邹××，女，25岁。
2～3年来，胸满胸痛，头晕脑胀，心悸气短，不敢走路，亦不敢参加简单的体力活动。医诊心肌炎、过早搏动、房室传导阻滞。先用西药治疗1年多不见明显好转，后又配合中药炙甘草汤、冠心Ⅱ号、瓜蒌薤白、天王补心等治疗8个多月亦无明显效果。细审其证，除上述者外，并见疲乏无力，口燥咽干，失眠多梦，纳呆食减，胃脘满胀，全身酸困，舌苔薄白，脉虚大弦数时见促结。思之：病起于暑，今病虽数年，然脉仍虚大弦数，说明其表邪仍未蠲除，而气阴两虚，湿热阻滞，清浊升降失职耳。因拟补气养阴，燥湿清热，升清降浊为法。黄芪15克，甘草6克，党参10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10克，苍术10克，白术10克，升麻10克，泽泻10克。
服药20剂后，诸证俱减，精神倍增，继服20剂后，诸证俱失。停药2个月后，又因感冒出现胸满胸痛，心悸气短，关节疼痛，痰多。医以治感冒药治疗2周后，感冒症状虽已大部消失，但胸满胸痛，心悸气短，关节疼痛，气短痰多仍然不见改善。审其脉滑数促结俱见。综合脉证，知其乃痰热内蕴，血络瘀滞，复感风寒湿邪。治拟化痰清热，活血通络，散寒除湿。处方：黄柏10克，苍术10克，南星10克，桂枝10克，防己10克，灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。服药12剂，诸证消失，愈。某医云：前用炙甘草汤、冠心Ⅱ号、瓜蒌薤白等汤而不愈，改用清暑益气、上中下痛风方而愈者何也?前方均治心药，后方或为清暑，或为除痹之方，反而取效者何也?答曰：清暑益气者，既能解表，又能治里，既能除邪，又能扶正，此证表里俱见，虚实共有，故以清暑益气而解。其变证见外有风湿寒邪，内有痰热阻郁，表里合邪之疾病也，而上中下痛风方者，外可除风散寒，内可化痰清热，且既能除湿，又能活血，故治复感之证获效。
2．病在气分，反治血分，痰血不同，必须细分曾××，女，40岁。冠状动脉硬化性心脏病、心肌炎、心律失常1年多。询其证见心前区憋闷隐痛，头晕心烦，心悸，时有心跳暂停的感觉，口苦口干，舌苔薄白，脉弦滑而结代。思之：脉弦者肝胆之疾也；滑者痰热阻滞也；结者，结也，郁也；代者脏气衰也。综合脉证论之，乃肝胆之气郁结，痰热不化，脏气亏损之证。拟疏肝理气，化痰补气。处方：柴胡10克，半夏10克．黄芩10克，人参10克，甘草10克，生姜5片，大枣5个．瓜蒌18克。
服药5剂，胸满心悸，头晕心烦等证好转，脉搏间歇次数亦有所减少。某医云：此方乃小柴胡汤也，小柴胡为伤寒少阳证方，岂能用于心脏病。然其证见肝郁，改予逍遥散合生脉散可也。服药5剂后，诸证反剧，不得已，再邀余诊。察其脉仍见弦滑结代，其证仍为肝胆郁结，痰热不化，脏气虚衰，乃再予小柴胡加瓜萎方，服药60剂，果愈。
3．本末不分，但治心肝，肾病治心，其病难愈
宋××，男，30岁。
心烦心悸1年多。医诊心肌炎、心房纤颤。先用西药治疗7个多月无明显效果，继又配合中药加减复脉汤、小柴胡汤、消遥散等治疗4个多月亦无明显改善。细审其脉细弱而促，舌苔净，心悸尤甚于心下(即中脘部)。因忆仲景《金匮要略》云：“水在肾，心下悸”。乃悟：此病在肾，非在肝心也。此。C)悸乃肾水凌心，即肾为本，心为标，法当从肾之本。处方：生地28克，山药10克，山茱萸10克，茯苓10克，泽泻10克．丹皮10克，附子10克，肉桂10克，元参18克，白芍10克。
服药6剂，心悸顿失，继服上药10剂，诸证消失，心电图亦恢复正常。
4．气阴俱虚，痰热内郁，胶于炎证消炎之说，而不从辨证论治，其效不著
方××，男，32岁。
头晕乏力，心烦心悸，胸满胸痛，咽干咽痛，时而声音嘶哑，时而咽喉有异物阻塞感，时而胸闷而有窒塞，呼吸困难，时而突然昏倒不省人事，已7～8个月。医诊心肌炎，心力衰竭。先用西药治疗4个多月不见改善，后又配合中药瓜蒌薤白、加减复脉、清热解毒、养血活血等治之约3个多月仍然不见好转。细审诸证，除上述者外，并见时而恶心呕吐，气短神疲，失眠健忘，舌苔薄白，脉濡缓而结涩。综合脉证，思之：此热毒之证未见，安可再予清热解毒。又思脉濡缓者气阴俱虚，痰湿郁滞也；结者，气血俱虚也，气滞血瘀也；涩者阳虚也，气滞也，瘀血也。参之诸证，乃气阴两虚，痰郁气滞之证。治宜补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，陈皮10克，茯苓10克，半夏10克，甘草10克，菖蒲10克，远志10克，生地10克。
服药4剂后，头晕乏力，心悸气短，恶心呕吐，咽喉干痛等证好转，继服上药22剂，诸证大部消失，并上班工作，其后又连续服药近3个月，果愈。
5．肝郁血虚，反从消炎解毒，失去辨证，难于奏效
么××，男，40岁。
心烦心悸9个多月。医诊心肌炎、期前收缩，心房纤颤。先用西药治疗3个多月无明显效果，继用中药养心安神、加减复脉、瓜蒌薤白，清热解毒等配合用之亦无明显改善。细审其证，除上述者外，并见心前区憋闷隐痛，心悸心烦，头晕头痛，舌苔薄白，脉沉弦而结时或兼促。因思脉弦细者肝郁血虚也，结者滞也结也；合之于汪，乃肝郁血虚，血络瘀滞也。因拟舒肝理气，养血活血。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜5片，薄荷1克，丹参15克，青皮10克。
服药4剂后，胸满胸痛，心烦心悸，头晕头痛等证均减，继服30剂，诸证消失，果愈。
6．痰火郁结，久入血络，但从血分，不与化痰泻火，其病难愈
赵××，女，24岁。
心肌炎、频发性室性期前收缩2年多。医始予西药治疗半年多不效，继又配合中药清热解毒、和解少阳、养心安神之剂400余付无功。审其证见心前区憋闷，时或隐隐作痛，失眠心悸，纳呆食减，口苦咽干，舌苔薄白，脉弦滑结代。思之：脉弦滑而不沉，乃痰热虽郁而不严重，且久病入于血络之故也。因拟奔豚汤加减疏肝解郁，化痰泻火。处方：川芎10克，当归10克，黄芩10克，白芍10克，葛根30克，半夏10克，桑皮15克，甘草10克，生姜3片。
服药10剂后，诸证俱减；继服上药30剂，诸证俱失；又服2月，心电图亦恢复正常。
某医云：何用清热解毒、和解少阳而不效?答曰：证无热毒之证，故不宜用清热解毒；至于为何用小柴胡汤加减无效，我的体会是小柴胡用于沉弦之脉者较好，因其重在气郁，奔豚汤则用于弦滑之脉者较好，因其痰热为多，且及于血分也。
肥厚型心肌病
1．肝胃气滞，湿郁不化。但从心治，其效不著
葛××，女，25岁。
3年前，在学校一次上体育课的过程中，突然呼吸极度困难，难于维持而住院治疗。住院后，经过x线、心电图、超声心动图等的检查发现左心室心房增大，肺部瘀血，而诊为肥厚型心肌病、心力衰竭。治疗3个月，浮肿消失，气短好转而自动出院。出院后，除继续服用西药外，并开始邀请中医进行治疗，至今一直不见好转。审其除气短心烦，胸满胸痛外，并见其尚有头晕头胀，纳呆食减，脘腹胀痛，口苦咽干，面色萎黄，舌苔薄白，脉沉。综合脉证，思之：脉沉者郁也；面色萎黄，气短乏力者，气血俱虚也。因拟补气养血以培本，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4剂，胸脘满痛，气短心悸均好转，继续服用至第20剂时，症状不再继续改善。细审其脉弦紧而数，苔白腻，胃脘有明显压痛。乃云：肝胃气滞，湿痰阻滞，积滞不化所致。治拟疏肝和胃，消食导滞。处方：柴胡10克，半夏10克，黄芩10克，人参10克，干姜6克，甘草10克，大枣5个，苍术10克，厚朴10克，陈皮10克，大黄4克。
服药4剂后，气短胸满，脘腹胀痛俱减，食纳大增，继服上药2月，诸证消减80％，体重由40千克增至60千克。肺瘀血消失，心界亦较前缩小。并于今年结婚。次年又生一男孩，母子均健康。
某医问：本例患者，余曾遍试中药，然均无明显效果。其中既有养心安神、益气养血，又有活血逐瘀、强心利水，或补心、炙甘草汤，或真武、生脉、瓜蒌薤白、活络效灵等。而先生却用参芪丹鸡黄精、柴平等取效，其故何也?我用治心之法不效，先生却用不是治心病的药治疗取效，其故又何也?答曰：中医治病在辨证论治，辨证论治中有一个辨什么，治什么的问题，我认为不管什么病应用中药时都应该按照中医基本理论去辨证论治，都应该去辨脏腑、经络、先后。本病从证候来看患者的主诉是胸脘胀痛，纳呆食减，气短乏力，也就是说患者告诉我们的主要是脾胃肝的气滞和胃肠的停滞，所以必须从肝脾胃去着手，只有这样才能使三焦的升降作用得到恢复，心肾相交而病愈。
2．瘀血阻滞，湿郁不化，但助其气血，邪气不除，其病不减
贺××，女，50岁。
喘息性支气管炎病史6年多，肺源性心脏病病史2年多。起初使用西药治疗，往往能迅速控制病情。两年后，咳嗽、气喘和呼吸短促逐渐加重，但每次发病时应用西药治疗的效果不如以前，有时需要1～2个月才能控制。到了第三年，每次发病，应用西药几乎不起作用。无奈之下，又请中医以宣通肺气、化痰、清热定喘或温化水饮、宣通肺气等方法进行治疗。开始时，还算基本有效。但近两年半以来，无论中药还是西药都无效。为此不得不住院长达2年，但直到今天，无论昼夜、冬夏，仍然天天发作喘息。仔细审查其证候：除了喘息、咳嗽、气短之外，还见到精神疲倦、食欲不振，颜面、口唇、舌质、指甲、指趾、四肢均呈现青紫色，颜面和肢体浮肿，胃脘及腹部胀满，按压时疼痛且气短更加严重，舌苔薄白，指趾厥冷，脉象弦紧而数，或者时而出现促脉、结脉和涩脉。综合脉象和证候，想到张仲景曾说：“膈间有支饮，患者喘息胸闷，心下痞塞坚硬，面色黧黑者，用木防己汤主治。”“支饮导致呼吸不畅，用葶苈大枣泻肺汤主治。”此病是水饮邪气阻滞于膈间、胸膈所致，而各位医生大多从肺脏论治，因此未能奏效。治法拟定为木防己汤加减，苦辛并用以散结气，葶苈子泻肺逐痰饮。处方：防己10克，人参10克，桂枝10克，生石膏15克，半夏10克，陈皮10克，葶苈子4克，紫菀10克。
服药4剂，各种症状稍减；服药20剂后，停止吸氧也未见病情加重；服药30剂时，食欲和精神明显好转，浮肿消失，并能自由活动。服药至60剂时，紫绀消失，日常生活均能自理；服药至90剂时，除上楼时轻微气短外，没有其他明显不适。
2．痰饮阻滞肺脏，气阴两伤，肾气不纳，不去扶助正气，反而攻伐邪气，导致病情危重
刘××，女，78岁。
2年前因气胸行左肺切除术，术后一直精神状态较好。4个多月前，突发支气管炎，虽然遍请中西医治疗未见好转。2周前又因肺部感染使病情更加严重。为此不得不住院治疗。住院3天后，突然高热达39.8℃，呼吸困难加剧，全身浮肿，紫绀，尿少，神志时而清醒时而模糊。急请专家会诊。诊断为慢性支气管炎合并感染，肺源性心脏病，肺性脑病，数小时后，神志完全不清。观察其神昏谵语，呼吸极端困难，紫绀，浮肿，舌苔黄厚，舌质紫暗，脉象虚大紧数，时而出现促脉。再查看前医所用的药物，除了西药外，中药或是定喘，或是小青龙汤，或是苏子降气汤。想到患者年高体衰，气阴大伤，肾气不纳，如果再给予祛邪伤正的药物，则不久于人世了。急忙处方补气养阴，温阳纳气，化痰定喘。处方：黄芪15克，鳖甲15克，地骨皮10克，紫菀10克，人参10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，白芍10克，麦冬10克，肉桂10克，甘草10克，冬虫夏草15克。
服药1剂，神志转清，体温正常，喘息和气短也见好转；继续服药10剂，各种症状大部分消失。于是改用丸方调理。
心肌炎
1．表里同病，虚实并存，如果只治里或只治虚，就像乐曲不和谐，难以成功
邹××，女，25岁。
2～3年来，胸部满闷疼痛，头晕脑胀，心悸气短，不敢走路，也不敢参加简单的体力活动。医生诊断为心肌炎、过早搏动、房室传导阻滞。先用西药治疗1年多不见明显好转，后又配合中药炙甘草汤、冠心Ⅱ号、瓜蒌薤白白酒汤、天王补心丹等治疗8个多月也无明显效果。仔细审视其证候，除上述症状外，还见到疲乏无力，口燥咽干，失眠多梦，食欲不振，胃脘满胀，全身酸困，舌苔薄白，脉象虚大弦数，时而出现促脉和结脉。思考：病起于暑天，如今患病虽数年，但脉象仍虚大弦数，说明表邪仍未清除，而气阴两虚，湿热阻滞，清浊升降功能失职。因此拟定补气养阴，燥湿清热，升清降浊为治法。处方：黄芪15克，甘草6克，党参10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10克，苍术10克，白术10克，升麻10克，泽泻10克。
服药20剂后，各种症状均减轻，精神倍增；继服20剂后，各种症状全部消失。停药2个月后，又因感冒出现胸部满闷疼痛，心悸气短，关节疼痛，痰多。医生以治疗感冒的药物连续治疗2周后，感冒症状虽已大部分消失，但胸部满闷疼痛，心悸气短，关节疼痛，气短痰多仍然没有改善。审视其脉象滑数促结并见。综合脉象和证候，知道这是痰热内蕴，血络瘀滞，又感受风寒湿邪。治法拟定为化痰清热，活血通络，散寒除湿。处方：黄柏10克，苍术10克，南星10克，桂枝10克，防己10克，威灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。服药12剂，各种症状消失，痊愈。某医生说：之前用炙甘草汤、冠心Ⅱ号、瓜蒌薤白等汤剂而未愈，改用清暑益气汤、上中下痛风方而痊愈，为什么呢？前方都是治心的药，后方或是清暑，或是除痹的方子，反而取效，为什么呢？回答说：清暑益气汤既能解表，又能治里，既能除邪，又能扶正，此证表里同病，虚实并存，所以用清暑益气汤而解。其变证表现为外有风湿寒邪，内有痰热阻郁，属于表里合邪的疾病，而上中下痛风方外可除风散寒，内可化痰清热，且既能除湿，又能活血，所以治疗复感之证获效。
2．病在气分，反而治血分，痰与血不同，必须仔细分辨
曾××，女，40岁。冠状动脉硬化性心脏病、心肌炎、心律失常1年多。询问其证候见心前区憋闷隐痛，头晕心烦，心悸，时常有心跳暂停的感觉，口苦口干，舌苔薄白，脉象弦滑而结代。思考：脉弦是肝胆的疾病；滑是痰热阻滞；结是郁结；代是脏气衰弱。综合脉象和证候论述，乃是肝胆之气郁结，痰热不化，脏气亏损的证候。拟定疏肝理气，化痰补气。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜5片，大枣5个，瓜蒌18克。
服药5剂，胸满心悸，头晕心烦等症状好转，脉搏间歇次数也有所减少。某医生说：此方是小柴胡汤，小柴胡汤是伤寒少阳证的方子，怎么能用于心脏病呢？然而其证候见肝郁，改予逍遥散合生脉散也可以。服药5剂后，各种症状反而加剧，不得已，再次邀请我诊治。观察其脉象仍见弦滑结代，其证候仍为肝胆郁结，痰热不化，脏气虚衰，于是再予小柴胡汤加瓜蒌方，服药60剂，果然痊愈。
3．本末不分，只治心肝，肾病治心，其病难愈
宋××，男，30岁。
心烦心悸1年多。医生诊断为心肌炎、心房纤颤。先用西药治疗7个多月无明显效果，继而又配合中药加减复脉汤、小柴胡汤、逍遥散等治疗4个多月也无明显改善。仔细审视其脉象细弱而促，舌苔净，心悸尤其严重于心下（即中脘部）。于是想起张仲景《金匮要略》中说：“水在肾，心下悸”。这才领悟到：此病在肾，不在肝心。这种心悸乃肾水凌心，即肾为本，心为标，治法应当从肾之本论治。处方：生地28克，山药10克，山茱萸10克，茯苓10克，泽泻10克，丹皮10克，附子10克，肉桂10克，元参18克，白芍10克。
服药6剂，心悸顿时消失，继服上方10剂，各种症状消失，心电图也恢复正常。
4．气阴俱虚，痰热内郁，拘泥于炎症消炎之说，而不从辨证论治，疗效不显著
方××，男，32岁。
头晕乏力，心烦心悸，胸满胸痛，咽干咽痛，时而声音嘶哑，时而咽喉有异物阻塞感，时而胸闷而有窒塞感，呼吸困难，时而突然昏倒不省人事，已7～8个月。医生诊断为心肌炎，心力衰竭。先用西药治疗4个多月不见改善，后又配合中药瓜蒌薤白白酒汤、加减复脉汤、清热解毒、养血活血等治疗约3个多月仍然不见好转。仔细审视各种证候，除上述症状外，还见到时而恶心呕吐，气短神疲，失眠健忘，舌苔薄白，脉象濡缓而结涩。综合脉象和证候，思考：此证未见热毒之象，怎么可以再给予清热解毒？又思考脉象濡缓者是气阴俱虚，痰湿郁滞；结者是气血俱虚，气滞血瘀；涩者是阳虚，气滞，瘀血。参考各种证候，乃是气阴两虚，痰郁气滞的证候。治宜补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，陈皮10克，茯苓10克，半夏10克，甘草10克，石菖蒲10克，远志10克，生地10克。
服药4剂后，头晕乏力，心悸气短，恶心呕吐，咽喉干痛等症状好转，继服上方22剂，各种症状大部分消失，并能上班工作，其后又连续服药近3个月，果然痊愈。
5．肝郁血虚，反从消炎解毒，失去辨证，难于奏效
么××，男，40岁。
心烦心悸9个多月。医生诊断为心肌炎、期前收缩，心房纤颤。先用西药治疗3个多月无明显效果，继用中药养心安神、加减复脉汤、瓜蒌薤白白酒汤、清热解毒等配合使用也无明显改善。仔细审视其证候，除上述症状外，还见心前区憋闷隐痛，心悸心烦，头晕头痛，舌苔薄白，脉象沉弦而结，时而兼促。思考：脉弦细者是肝郁血虚；结者是滞涩、郁结；合而言之，乃是肝郁血虚，血络瘀滞。因此拟定舒肝理气，养血活血。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜5片，薄荷1克，丹参15克，青皮10克。
服药4剂后，胸满胸痛，心烦心悸，头晕头痛等症状均减轻，继服30剂，各种症状消失，果然痊愈。
6．痰火郁结，久入血络，只从血分论治，不与化痰泻火，其病难愈
赵××，女，24岁。
心肌炎、频发性室性期前收缩2年多。医生起初予西药治疗半年多无效，继而又配合中药清热解毒、和解少阳、养心安神之剂400余付无功。审视其证候见心前区憋闷，时或隐隐作痛，失眠心悸，食欲不振，口苦咽干，舌苔薄白，脉象弦滑结代。思考：脉弦滑而不沉，乃是痰热虽郁结但不严重，且久病入于血络的缘故。因此拟定奔豚汤加减以疏肝解郁，化痰泻火。处方：川芎10克，当归10克，黄芩10克，白芍10克，葛根30克，半夏10克，桑白皮15克，甘草10克，生姜3片。
服药10剂后，各种症状均减轻；继服上方30剂，各种症状均消失；又服药2月，心电图也恢复正常。
某医生说：为什么用清热解毒、和解少阳而不效？回答说：证候无热毒之象，故不宜用清热解毒；至于为何用小柴胡汤加减无效，我的体会是小柴胡汤用于沉弦之脉者较好，因其重在气郁，奔豚汤则用于弦滑之脉者较好，因其痰热较多，且及于血分也。
肥厚型心肌病
1．肝胃气滞，湿郁不化。只从心治，疗效不显著
葛××，女，25岁。
3年前，在学校一次上体育课的过程中，突然呼吸极度困难，难以维持而住院治疗。住院后，经过X线、心电图、超声心动图等检查发现左心室心房增大，肺部瘀血，而诊断为肥厚型心肌病、心力衰竭。治疗3个月，浮肿消失，气短好转而自动出院。出院后，除继续服用西药外，并开始邀请中医进行治疗，至今一直不见好转。审视其除气短心烦，胸满胸痛外，还见到尚有头晕头胀，食欲不振，胃脘腹胀痛，口苦咽干，面色萎黄，舌苔薄白，脉象沉。综合脉象和证候，思考：脉沉者是郁结；面色萎黄，气短乏力者是气血俱虚。因此拟定补气养血以培本，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4剂，胸脘满痛，气短心悸均好转，继续服用至第20剂时，症状不再继续改善。仔细审视其脉象弦紧而数，苔白腻，胃脘有明显压痛。于是说：这是肝胃气滞，湿痰阻滞，积滞不化所致。治法拟定为疏肝和胃，消食导滞。处方：柴胡10克，半夏10克，黄芩10克，人参10克，干姜6克，甘草10克，大枣5个，苍术10克，厚朴10克，陈皮10克，大黄4克。
服药4剂后，气短胸满，胃脘腹胀痛均减轻，食欲大增，继服上方2月，各种症状消减80％，体重由40千克增至60千克。肺瘀血消失，心界亦较前缩小。并于今年结婚。次年又生一男孩，母子均健康。
某医生问：本例患者，我曾遍试中药，然而均无明显效果。其中既有养心安神、益气养血，又有活血逐瘀、强心利水，或补心、炙甘草汤，或真武汤、生脉散、瓜蒌薤白白酒汤、活络效灵丹等。而先生却用参芪丹鸡黄精、柴平等取效，其原因何在？我用治心的方法不效，先生却用不是治心病的药治疗取效，原因又何在？回答说：中医治病在于辨证论治，辨证论治中有一个辨什么、治什么的问题，我认为不管什么病应用中药时都应该按照中医基本理论去辨证论治，都应该去辨脏腑、经络、先后。本病从证候来看患者的主诉是胸脘胀痛，食欲不振，气短乏力，也就是说患者告诉我们的主要是脾胃肝的气滞和胃肠的停滞，所以必须从肝脾胃去着手，只有这样才能使三焦的升降作用得到恢复，心肾相交而病愈。
Asthmatic bronchitis for over 6 years, cor pulmonale for over 2 years. Initially treated with Western medicine, the condition could often be controlled quickly. After two years, cough, wheezing, and shortness of breath gradually worsened, but each time the disease occurred, Western medicine treatment was less effective than before, sometimes requiring 1 to 2 months to control. By the third year, each time the disease occurred, Western medicine had almost no effect. Reluctantly, traditional Chinese medicine (TCM) was consulted to treat with methods such as diffusing Lung Qi (diffusing the Qi of the Lung organ), resolving phlegm, clearing heat and stabilizing wheezing, or transforming fluid retention and diffusing Lung Qi. At first, it was basically effective. However, for the past two and a half years, neither TCM nor Western medicine has been effective. Consequently, hospitalization was required for two years, yet to this day, regardless of day or night, winter or summer, wheezing occurs daily. Careful examination of the syndrome reveals: besides wheezing, coughing, and shortness of breath, there is also mental fatigue, poor appetite, cyanosis of the face, lips, tongue body, nails, fingers, toes, and limbs, edema of the face and limbs, distension and fullness in the epigastrium and abdomen, pain upon pressure with exacerbated shortness of breath, thin white tongue coating, cold extremities of fingers and toes, and a wiry-tight and rapid pulse, or occasionally a hurried, knotted, and choppy pulse. Synthesizing the pulse and syndrome, recalling Zhang Zhongjing's statement: "When there is retained fluid between the diaphragm, the patient suffers from wheezing and fullness, hardness and obstruction below the heart, and a dark complexion; Fangji Tang (Stephania Decoction) should be used." "When retained fluid prevents breathing, Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) should be used." This disease is caused by fluid pathogens obstructing the diaphragm and chest, whereas previous physicians mostly treated from the perspective of the Lung, which led to failure. The treatment method is formulated as modified Fangji Tang, using bitter and acrid herbs together to dissipate nodulated Qi, and Tinglizi (Descurainiae Semen) to drain the Lungs and expel phlegm-fluid. Prescription: Fangji (Stephaniae Tetrandrae Radix) 10g, Renshen (Ginseng Radix et Rhizoma) 10g, Guizhi (Cinnamomi Ramulus) 10g, Sheng Shijiao (Gypsum Fibrosum) 15g, Banxia (Pinelliae Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Tingli 4g, Ziwan (Asturi Flos) 10g.
After taking 4 doses, various symptoms decreased slightly; after 20 doses, stopping oxygen inhalation did not lead to worsening of the condition; at 30 doses, appetite and spirit significantly improved, edema disappeared, and free movement became possible. At 60 doses, cyanosis disappeared, and all daily activities could be self-managed; at 90 doses, except for slight shortness of breath when climbing stairs, there were no other obvious discomforts.
2. Phlegm-fluid obstructing the Lungs, dual deficiency of Qi and Yin, failing to grasp Kidney Qi, failing to support healthy Qi while attacking pathogenic factors leads to critical danger
Liu XX, Female, 78 years old.
Two years ago, left lung resection was performed due to pneumothorax, and her mental state remained good post-surgery. Over four months ago, acute bronchitis suddenly occurred; although both TCM and Western medicine doctors were consulted, there was no improvement. Two weeks ago, the condition worsened further due to pulmonary infection, necessitating hospitalization. Three days after admission, sudden high fever reached 39.8°C, breathing became extremely difficult, whole-body edema and cyanosis appeared, urine output decreased, and consciousness fluctuated between clear and confused. Expert consultation was urgently requested. Diagnosed as chronic bronchitis with infection, cor pulmonale, and pulmonary encephalopathy, her consciousness became completely unclear within a few hours. Examination revealed delirious speech, extreme difficulty in breathing, cyanosis, edema, thick yellow tongue coating, purple-dark tongue body, and a deficient-large, tight, and rapid pulse, occasionally showing a hurried pulse. Reviewing the medications used by previous doctors, besides Western medicine, TCM prescriptions included asthma-stabilizing formulas, Xiao Qinglong Tang (Minor Green Dragon Decoction), or Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction). Considering the patient's advanced age and frailty, severe damage to Qi and Yin, and failure of Kidney Qi to grasp, administering further pathogen-attacking and healthy-Qi-damaging drugs would likely result in death soon. Urgently prescribing tonifying Qi and nourishing Yin, warming Yang and grasping Qi, resolving phlegm and stabilizing wheezing. Prescription: Huangqi (Astragali Radix) 15g, Biejia (Testudinis Carapax et Plastrum) 15g, Digupi (Bark of Ground Cherry Root) 10g, Ziwan 10g, Renshen 10g, Fuling (Poria) 10g, Chaihu (Bupleuri Radix) 10g, Banxia 10g, Zhimu (Anemarrhenae Rhizoma) 10g, Shengdi (Rehmanniae Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Maidong (Ophiopogonis Radix) 10g, Rougui (Cinnamomi Cortex) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Dongchongxiacao (Cordyceps) 15g.
After one dose, consciousness cleared, temperature normalized, and wheezing with shortness of breath improved; continuing for 10 doses, most symptoms disappeared. Then, pill formula was used for regulation.
Myocarditis
1. Exterior and interior simultaneously involved, deficiency and excess coexisting; treating only interior or only deficiency results in disharmony, making success difficult
Zou XX, Female, 25 years old.
For 2-3 years, experiencing chest fullness and pain, dizziness and head distension, palpitations and shortness of breath, afraid to walk or participate in simple physical activities. Diagnosed by doctors as myocarditis, premature beats, and atrioventricular block. Treated with Western medicine for over a year without significant improvement, then combined with TCM formulas including Zhi Gancao Tang (Honey-fried Licorice Decoction), Guanxin II Hao (Coronary Heart Disease No. 2 Formula), Gualou Xiebai Baijiu Tang (Trichosanthes Fruit, Macrostemon Rhizome and White Wine Decoction), and Tianwang Buxin Dan (Emperor of Heaven's Heart-Nourishing Pill) for over 8 months without obvious effect. Carefully examining the syndrome, besides the above, there is fatigue, dry mouth and throat, insomnia with many dreams, poor appetite, epigastric fullness and distension, whole-body soreness and heaviness, thin white tongue coating, and a deficient-large, wiry, and rapid pulse, occasionally showing hurried and knotted pulses. Reflection: The illness originated in summer heat; although it has lasted for years, the pulse remains deficient-large, wiry, and rapid, indicating that exterior pathogens have not yet been eliminated, while Qi and Yin are doubly deficient, damp-heat is obstructing, and the ascending and descending functions of clear and turbid substances are impaired. Therefore, the method is formulated as tonifying Qi and nourishing Yin, drying dampness and clearing heat, ascending clear and descending turbid. Prescription: Huangqi 15g, Gancao 6g, Dangshen (Codonopsis Radix) 10g, Danggui (Angelicae Sinensis Radix) 6g, Maidong 10g, Wuweizi (Schisandrae Fructus) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Chenpi 10g, Shenqu (Massa Medicata Fermentata) 10g, Huangbai (Phellodendri Cortex) 10g, Gegen (Puerariae Lobatae Radix) 10g, Cangzhu (Atractylodis Rhizoma) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Shengma (Cimicifugae Rhizoma) 10g, Zexie (Alismatis Rhizoma) 10g.
After 20 doses, all symptoms decreased, spirit doubled; continuing for another 20 doses, all symptoms disappeared. After stopping medication for 2 months, a cold triggered chest fullness and pain, palpitations and shortness of breath, joint pain, and excessive phlegm. Treated with cold remedies for 2 weeks; although cold symptoms largely disappeared, chest fullness and pain, palpitations and shortness of breath, joint pain, and shortness of breath with excessive phlegm remained unimproved. Examining the pulse, slippery, rapid, hurried, and knotted qualities were all present. Synthesizing pulse and syndrome, it is known that internal accumulation of phlegm-heat and stasis in blood collaterals, compounded by external contraction of wind-cold-damp pathogens. Treatment method: resolve phlegm and clear heat, invigorate blood and unblock collaterals, scatter cold and remove dampness. Prescription: Huangbai 10g, Cangzhu 10g, Nanxing (Arisaematis Cum Bile) 10g, Guizhi 10g, Fangji 10g, Lingxian (Spatholobi Caulis) 10g, Taoren (Persicae Semen) 10g, Honghua (Carthami Flos) 10g, Longdancao (Gentianae Radix et Rhizoma) 10g, Qianghuo (Notopterygii Rhizoma et Radix) 10g, Baizhi (Angelicae Dahuricae Radix) 10g, Chuanxiong (Chuanxiong Rhizoma) 10g, Shenqu 10g. After 12 doses, all symptoms disappeared, and recovery was achieved. A doctor asked: Why did Zhi Gancao Tang, Guanxin II Hao, Gualou Xiebai, etc., fail, while Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction) and Shangzhongxia Fengtong Fang (Upper, Middle, and Lower Wind-Damp Pain Formula) succeeded? The former are heart-treating formulas, while the latter clear summerheat or dispel bi-syndrome, yet they worked. Answer: Qingshu Yiqi Tang can release the exterior and treat the interior, eliminate pathogens and support healthy Qi. Since this case involves both exterior and interior, deficiency and excess, it was resolved by Qingshu Yiqi Tang. The variant syndrome presents with external wind-cold-damp pathogens and internal phlegm-heat obstruction, constituting a disease where exterior and interior pathogens combine. Shangzhongxia Fengtong Fang can externally scatter wind and cold, internally resolve phlegm and clear heat, and both remove dampness and invigorate blood, thus effective for recurrent conditions.
2. Pathology in the Qi level, but treating the Blood level; phlegm and blood differ, requiring careful differentiation
Zeng XX, Female, 40 years old. Coronary atherosclerotic heart disease, myocarditis, arrhythmia for over 1 year. Inquiry into symptoms reveals precordial stifling and dull pain, dizziness and irritability, palpitations, occasional sensation of heartbeat pause, bitter and dry mouth, thin white tongue coating, and a wiry-slippery pulse with intermittent beats (knotted and alternating). Reflection: Wiry pulse indicates Liver-Gallbladder pathology; slippery indicates phlegm-heat obstruction; knotted indicates stagnation and depression; alternating indicates decline of Zang-organ Qi. Synthesizing pulse and syndrome, it is a pattern of Liver-Gallbladder Qi stagnation and depression, unresolved phlegm-heat, and depletion of Zang-organ Qi. Method: soothe the Liver and regulate Qi, resolve phlegm and tonify Qi. Prescription: Chaihu 10g, Banxia 10g, Huangqin (Scutellariae Radix) 10g, Renshen 10g, Gancao 10g, Shengjiang (Zingiberis Rhizoma Recens) 5 slices, Dazao (Jujubae Fructus) 5 pieces, Gualou (Trichosanthis Fructus) 18g.
After 5 doses, chest fullness, palpitations, dizziness, and irritability improved, and pulse intermissions decreased. A doctor said: This is Xiaochaihu Tang (Minor Bupleurum Decoction), a formula for Shaoyang syndrome in Cold Damage, how can it be used for heart disease? However, since the syndrome shows Liver depression, modifying it with Xiaoyao San (Free Wanderer Powder) combined with Shengmai San (Generate the Pulse Powder) is also feasible. After 5 doses of the modification, symptoms worsened, necessitating my consultation again. Pulse still showed wiry, slippery, knotted, and alternating qualities; syndrome remained Liver-Gallbladder depression, unresolved phlegm-heat, and Zang-organ Qi deficiency. Prescribed Xiaochaihu Tang plus Gualou again. After 60 doses, recovery was indeed achieved.
3. Confusing root and branch, treating only Heart and Liver; Kidney disease treated via Heart makes cure difficult
Song XX, Male, 30 years old.
Irritability and palpitations for over 1 year. Diagnosed as myocarditis and atrial fibrillation. Treated with Western medicine for over 7 months without obvious effect, then combined with TCM formulas including Jiawei Fumai Tang (Modified Replenish the Pulse Decoction), Xiaochaihu Tang, and Xiaoyao San for over 4 months without obvious improvement. Careful examination of the pulse showed fine, weak, and hurried qualities; tongue coating was clean; palpitations were especially severe below the heart (i.e., Zhongwan area). Recalling Zhang Zhongjing's *Jingui Yaolue* stating: "Water in the Kidney causes palpitations below the heart." Realized: This disease originates in the Kidney, not the Liver or Heart. This palpitation is due to Kidney Water overwhelming the Heart; thus, Kidney is the root, Heart is the branch, and treatment must address the Kidney root. Prescription: Shengdi 28g, Shanyao (Dioscoreae Rhizoma) 10g, Shanzhuyu (Corni Fructus) 10g, Fuling 10g, Zexie 10g, Danpi (Moutan Cortex) 10g, Fuzi (Aconiti Lateralis Radix Praeparata) 10g, Rougui 10g, Yuanshen (Scrophulariae Radix) 18g, Baishao 10g.
After 6 doses, palpitations vanished instantly; continuing for 10 doses, all symptoms disappeared, and electrocardiogram returned to normal.
4. Dual deficiency of Qi and Yin, internal depression of phlegm-heat; adhering to anti-inflammatory concepts rather than syndrome differentiation yields insignificant effects
Fang XX, Male, 32 years old.
Dizziness and fatigue, irritability and palpitations, chest fullness and pain, dry and painful throat, occasional hoarseness, sensation of foreign body obstruction in the throat, occasional chest stifling and suffocation, dyspnea, occasional sudden fainting and loss of consciousness, lasting 7-8 months. Diagnosed as myocarditis and heart failure. Treated with Western medicine for over 4 months without improvement, then combined with TCM formulas including Gualou Xiebai Baijiu Tang, Jiawei Fumai Tang, heat-clearing and detoxifying, and blood-nourishing and blood-invigorating methods for about 3 months without improvement. Careful examination of symptoms, besides the above, includes occasional nausea and vomiting, shortness of breath and mental fatigue, insomnia and forgetfulness, thin white tongue coating, and a soggy-slow pulse with knotted and choppy qualities. Synthesizing pulse and syndrome, reflection: There is no sign of heat-toxin, so heat-clearing and detoxifying should not be used. Soggy-slow pulse indicates dual deficiency of Qi and Yin with damp-phlegm depression; knotted indicates dual deficiency of Qi and Blood, Qi stagnation and Blood stasis; choppy indicates Yang deficiency, Qi stagnation, and Blood stasis. Referencing all symptoms, it is a pattern of dual deficiency of Qi and Yin with phlegm depression and Qi stagnation. Treatment: tonify Qi and nourish Yin, regulate Qi and resolve phlegm. Prescription: Huangqi 15g, Danggui 6g, Renshen 10g, Maidong 10g, Wuweizi 10g, Zhuru (Bambusae Caulis in Taenia) 10g, Zhishi (Aurantii Fructus Immaturus) 10g, Chenpi 10g, Fuling 10g, Banxia 10g, Gancao 10g, Changpu (Acori Tatarinowii Rhizoma) 10g, Yuanzhi (Polygalae Radix) 10g, Shengdi 10g.
After 4 doses, dizziness, fatigue, palpitations, shortness of breath, nausea, vomiting, and dry/painful throat improved; continuing for 22 doses, most symptoms disappeared, allowing return to work; continuous medication for nearly 3 months resulted in complete recovery.
5. Liver depression and Blood deficiency, mistakenly treated with anti-inflammatory and detoxifying methods without syndrome differentiation, making efficacy difficult
Me XX, Male, 40 years old.
Irritability and palpitations for over 9 months. Diagnosed as myocarditis, premature beats, and atrial fibrillation. Treated with Western medicine for over 3 months without obvious effect, then combined with TCM methods including Heart-nourishing and Spirit-calming, Jiawei Fumai Tang, Gualou Xiebai Baijiu Tang, and heat-clearing and detoxifying without obvious improvement. Careful examination of symptoms, besides the above, includes precordial stifling and dull pain, palpitations and irritability, dizziness and headache, thin white tongue coating, and a deep-wiry pulse with knotted quality, occasionally accompanied by hurriedness. Reflection: Deep-wiry-thin pulse indicates Liver depression and Blood deficiency; knotted indicates stagnation and depression; collectively, it is Liver depression and Blood deficiency with stasis in blood collaterals. Method: soothe the Liver and regulate Qi, nourish Blood and invigorate Blood. Prescription: Chaihu 10g, Danggui 10g, Baishao 10g, Baizhu 10g, Gancao 10g, Shengjiang 5 slices, Bohe (Menthae Haplocalycis Herba) 1g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, Qingpi 10g.
After 4 doses, chest fullness and pain, irritability and palpitations, dizziness and headache decreased; continuing for 30 doses, all symptoms disappeared, achieving recovery.
6. Phlegm-fire depression, long-term entry into blood collaterals; treating only the Blood level without resolving phlegm and purging fire makes cure difficult
Zhao XX, Female, 24 years old.
Myocarditis and frequent ventricular premature beats for over 2 years. Initially treated with Western medicine for over half a year without effect, then combined with TCM formulas for heat-clearing and detoxifying, harmonizing Shaoyang, and Heart-nourishing and Spirit-calming for over 400 doses without merit. Examination of symptoms reveals precordial stifling, occasional dull pain, insomnia and palpitations, poor appetite, bitter and dry mouth, thin white tongue coating, and wiry-slippery pulse with knotted and alternating qualities. Reflection: Wiry-slippery pulse without sinking indicates that phlegm-heat is depressed but not severe, and long-term illness has entered the blood collaterals. Method: Modified Ben Tun Tang (Running Piglet Decoction) to soothe the Liver and resolve depression, resolve phlegm and purge fire. Prescription: Chuanxiong 10g, Danggui 10g, Huangqin 10g, Baishao 10g, Gegen 30g, Banxia 10g, Sangpi (Mori Cortex) 15g, Gancao 10g, Shengjiang 3 slices.
After 10 doses, all symptoms decreased; continuing for 30 doses, all symptoms disappeared; after another 2 months of medication, electrocardiogram also returned to normal.
A doctor asked: Why did heat-clearing/detoxifying and harmonizing Shaoyang fail? Answer: The syndrome lacks heat-toxin signs, so heat-clearing and detoxifying is inappropriate. Regarding why modified Xiaochaihu Tang failed, my understanding is that Xiaochaihu Tang is better suited for deep-wiry pulses because it focuses on Qi depression, whereas Ben Tun Tang is better for wiry-slippery pulses because phlegm-heat is predominant and affects the Blood level.
Hypertrophic Cardiomyopathy
1. Liver-Stomach Qi stagnation, dampness depression unresolved; treating only the Heart yields insignificant effects
Ge XX, Female, 25 years old.
Three years ago, during a PE class at school, sudden extreme dyspnea occurred, necessitating hospitalization. Examinations including X-ray, ECG, and echocardiography revealed left ventricular and atrial enlargement and pulmonary congestion, leading to a diagnosis of hypertrophic cardiomyopathy and heart failure. After 3 months of treatment, edema disappeared, shortness of breath improved, and she was discharged voluntarily. After discharge, besides continuing Western medicine, TCM was invited for treatment, but no improvement has been seen to date. Examination reveals, besides shortness of breath and irritability, chest fullness and pain, dizziness and head distension, poor appetite, epigastric and abdominal distension and pain, bitter and dry mouth, sallow complexion, thin white tongue coating, and deep pulse. Synthesizing pulse and syndrome, reflection: Deep pulse indicates depression; sallow complexion, shortness of breath, and fatigue indicate dual deficiency of Qi and Blood. Method: tonify Qi and nourish Blood to cultivate the root, regulate Qi and invigorate Blood, dry dampness and strengthen Spleen to treat the branch. Prescription: Huangqi 30g, Danggui 10g, Danshen 30g, Dangshen 10g, Huangjing (Polygonati Rhizoma) 10g, Shengdi 10g, Cangzhu 15g, Baizhu 10g, Qingpi 10g, Chenpi 10g, Chaihu 10g, Sanleng (Sparganii Rhizoma) 10g, Ezhu (Curcumae Rhizoma) 10g, Bohe 3g, Yejiaoteng (Caulis Polygoni Multiflori) 30g.
After 4 doses, chest and epigastric fullness/pain, shortness of breath, and palpitations improved; continuing to the 20th dose, symptoms ceased to improve. Careful examination of the pulse showed wiry-tight and rapid qualities, white greasy coating, and obvious tenderness in the epigastrium. It was stated: This is caused by Liver-Stomach Qi stagnation, damp-phlegm obstruction, and unresolved accumulation. Method: soothe the Liver and harmonize the Stomach, promote digestion and guide out stagnation. Prescription: Chaihu 10g, Banxia 10g, Huangqin 10g, Renshen 10g, Ganjiang (Zingiberis Rhizoma) 6g, Gancao 10g, Dazao 5 pieces, Cangzhu 10g, Houpo (Magnoliae Officinalis Cortex) 10g, Chenpi 10g, Dahuang (Rhei Radix et Rhizoma) 4g.
After 4 doses, shortness of breath, chest fullness, and epigastric/abdominal distension/pain decreased, appetite increased significantly; continuing for 2 months, symptoms reduced by 80%, weight increased from 40kg to 60kg. Pulmonary congestion disappeared, cardiac boundary shrank compared to before. She married this year and gave birth to a boy the following year; both mother and child are healthy.
A doctor asked: For this patient, I tried various TCM formulas without obvious effect, including Heart-nourishing/Spirit-calming, Qi-tonifying/Blood-nourishing, Blood-invigorating/Stasis-resolving, Heart-strengthening/Diuretic, Heart-tonifying/Zhi Gancao Tang, Zhenwu Tang, Shengmai San, Gualou Xiebai Baijiu Tang, Huoluo Xiaoling Dan, etc. Yet you achieved success with Renqi Danshen Huangjing, Chaihu, etc. Why? Why did your heart-treating methods fail while non-heart-specific formulas succeeded? Answer: TCM treatment relies on syndrome differentiation. In differentiation, one must determine what to differentiate and what to treat. Regardless of the disease, when using TCM, one must follow basic TCM theory for syndrome differentiation, differentiating Zang-organs, meridians, and priority. From the patient's chief complaints of epigastric/chest distension and pain, poor appetite, shortness of breath, and fatigue, the primary issues presented are Qi stagnation in the Liver, Spleen, and Stomach, and gastrointestinal stagnation. Therefore, treatment must start from the Liver, Spleen, and Stomach. Only then can the ascending and descending functions of the Triple Burner be restored, Heart-Kidney interaction re-established, and the disease cured.
2. Blood stasis obstruction, dampness depression unresolved; merely assisting Qi and Blood without eliminating pathogens fails to reduce the disease
He XX, Female, 50 years old.