1964年生第二胎后不久即经常感到气短乏力，但没有引起注意，其后即经常感冒，有时发现咯血数日，于是才到医院检查。经过x线拍片、心电图、超声心动图等的检查，确诊为肥厚型心肌病、心力衰竭、心源性肝硬化。住院治疗1年多，虽然感冒、咯血等症已经消失，但腹胀、浮肿、心悸、气短、纳呆食减却不但不减反而加重。审其瘦削神乏，颜面、手足、唇舌均紫黯，下肢可凹性浮肿，腹大脐突，气短心悸，尿赤尿少，舌苔黄白，脉虚数促兼见结涩弦紧。综合脉证，思之：脉虚者，气血俱虚也；促结兼见者，阴阳俱不足也；弦紧者，寒凝气结也；结涩者，气滞血瘀也。脉证合参，当为气血大衰，气滞血瘀，水湿停聚。乃拟补气养血以培本，理气活血，除湿行水以治标。处方：黄芪30克，当归10克，人参10克，丹参30克，生地10克，黄精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，大腹皮10克，香附10克，莱菔子10克，砂仁10克。
服药7剂后，腹满、心悸、气短、浮肿均好转。继服上方60剂，腹胀腹水消失，精神、食欲大增，紫绀明显改善；又连续服药3个月，进药约70剂，精神、食欲几近正常，体重增加7．5千克，肺部瘀血消失，心脏扩大改善，并上班工作。
某医云：患者腹水腹胀几近2年而不减，今师用中药而获愈者何也?答曰：患者的腹胀腹水系肝硬化引起的。肝硬化腹水医者多用攻逐、利水两法进行治疗。(医者插语问患者云：是否如此?答曰：是。)攻逐之法用于一般的肝硬化腹水实证尚可，而此证则不可也。此证气血大衰，气滞血瘀，水湿停聚，若仅治其水，而不顾及气血的虚实，即所谓：一不治疾病所在的位置，二不治疾病的原因，那当然就无效了。至于为什么不用利水而用理气活血，补气养血，因其病主要在气虚、血虚、血瘀、气滞也。且其病程已久，只可缓图。
多发性大动脉炎
1．气阴俱虚，痰郁气结，但予活血，病势转甚
过××，女，34岁。
5～6年来，经常头晕头痛，近3年来左眼视力逐渐下降，近一年来，左眼视力基本丧失。遍请太原、天津、北京等地医院检查治疗，确诊为多发性大动脉炎。先在某院进行手术治疗，诸证曾一度好转，但半年以后，诸证又复如前。最近7～8个月以来，头痛异常剧烈，经常因头痛难忍而不能入睡，为此除每日数次服西药外，又加用了中药清热泻火、活血逐瘀之剂及针灸，但至今仍日甚一日。细审其证，除剧烈的头痛时轻时重之外，并见左脉沉伏欲绝，右脉虚缓，舌苔薄白，左眼在O．3米之内可见人影晃动，右眼视力正常，左脸肌肉明显萎缩，右脸正常，且时时胸满心烦，咽喉有异物阻塞感。综合脉证，思之：右脉大于左脉者，气血俱虚也；左脉沉伏欲绝者，气滞血瘀也；虚缓者，痰湿阻滞也。脉证合参论之，乃气阴两虚，痰气郁结，郁而化火之证。治宜补气养阴，理气化痰，泻火为法。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，半夏10克，陈皮10克，甘草6克，菖蒲10克，远志10克，元参15克。
服药4剂，头痛、失眠骤然好转；继服8剂，头痛10日未作，其后头痛虽时有发，但很轻微；继服40剂，头痛消失，左眼视力较前明显增加，在5米以上的距离内已能清楚的看见任何物体，且能在短时间内看书读报。此后，恐再反复，又服药3个月，果愈。
患者家属云：多发性大动脉炎，诸医均云从血分论治，而先生却主用气药，其故何也?答曰：任何科学都不能脱离实践是检验真理的标准这一规律。此病前已久用血药而加剧，可见其用血药是不正确的，因此舍而不用。今按脉象主病论治果然效如桴鼓，可见气分乎!血分乎!不可早日断言。
2．虚实夹杂，或但用活血以祛实，或但用补气养血以扶正，君臣不分，佐使不明，久治不愈
和××，女，48岁。
5年多来，右上肢酸痛麻木，头晕头痛，健忘，时而突然昏厥。近3年来，视力日差。某医在普查身体时，突然发现右上肢血压不能测出，桡动脉不见跳动。其后又经呼和浩特，大同、北京等多个医院进行检查，确诊为多发性大动脉炎，并进行手术治疗。手术后，诸证均有所减轻，但半年以后，情况又复如前。不得已，又改请中医以活血化瘀、温经通阳、养阴益气等进行治疗半年，诸证不但不减，反而更加严重。细审其证，除头晕头痛，右臂酸痛麻木，视力下降，健忘之外，并见胸满胸痛，心烦心悸，肩背酸痛，下肢麻木，手足厥冷，舌苔白，脉右侧全无，左虚大。因思：无脉者，气滞血瘀也；虚大者，气血俱虚也；左脉大于右脉者，肝邪也。综合脉证论之，乃气血俱虚为本，气滞血瘀，湿郁不化为标也。治拟补气养血以培本，理气活血，燥湿和胃以治标。处方：黄芪30克，当归10克，丹参30克，党参10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，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药10剂，诸证均减；又服药20剂，诸证大部消失，右脉沉细，左脉弦大；服药40剂，两侧血压均可测出，惟右脉仍较左脉为小。
某医问：为什么前用活血化瘀、温经通阳、养阴益气而加剧，而后老师仍用上法而反效也?答曰：本证是一个气血俱虚、气滞血瘀、湿郁不化俱在的虚实夹杂证。夹杂证处理的一个重要原则是既需照顾其虚，又需照顾其实，既需顾及其寒。又需顾及其热。本证既然属虚实夹杂证，那么当然应该在处方时既要补又要疏，前方之不效恐在但补不疏或但疏不补耳。又问：前用温经通阳不但四肢未温。而老师却未用温经通阳而四肢却转温者何也?答：四肢冷属于广泛的厥证，厥证的原因很多，其中既有阳虚，亦有阳郁，阳虚者当温经通阳，阳郁者但通即可。此证之厥乃气滞血瘀所为，故治以理气活血而厥回也。
3．气阴两虚，痰湿郁滞，但用活血化痰，其病不愈
章××，女，36岁。
头晕头痛，失眠健忘，视力下降，时作昏厥抽搐，左眼底出血8年多。医诊多发性大动脉炎。先用西药治疗1年不效，后又用中药、针灸、按摩、气功等治疗数年，不但不效，反而日渐加剧。不得已，乃赴北京某院手术治疗。术后半年诸证大部消失，但半年多之后，诸证又复发如初。头痛昼夜不止，失眠，经常昼夜难于人睡片刻，右眼视力下降至仅能在0．3米左右看见人影晃动，时时恶心呕吐，疲乏无力，心烦不安。为此不得不再次住院，但住院半年多以后，不但右眼完全失明，而且左眼几近失明。细审其证，除上述诸证外，并见舌苔薄白，脉濡缓。因思脉濡缓者，气阴两虚，痰气郁结，郁而化热也。合于脉证论之，乃气阴俱虚，痰气郁结，郁而化火之证也。因拟补气养阴，理气化痰，泻火为剂。处方：黄芪15克，当归6克，人参10克，麦冬10克，五昧子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，元参10克。
服药4剂，头痛突然停止，睡眠增加，呕吐几减80％；继服上方加减3个多月，诸证消失，视力恢复几近常人。
4．只求症状，但靠推理，不从脉论，治之无功
要××，男，59岁。
2年多来，右臂麻木酸痛，头晕头痛，失眠健忘，胸满心悸，视力下降，右手桡动脉搏动日益减弱。某院诊为多发性大动脉炎。先用西药、针灸等治疗半年多不效，后又配合中药活血通阳之剂达200余剂仍无明显效果。特别是近3个月来，不但上证不见减轻，而且日渐发现呼吸困难，胸满腹胀，甚至夜间突因呼吸困难而不得不坐起两三个小时才能继续平卧睡眠。经某院检查诊断为左心增大，左心衰竭。治疗1个多月后，呼吸困难明显好转，而其他症状却不见改善。审其除上述诸证外，并见两脉沉伏而涩，舌苔薄白。综合脉证，诊为气血俱虚为本，气滞血瘀，湿郁不化为标。治以补气养血以培本，理气活血，燥湿和胃以治标。黄芪30克，当归10克，丹参30克，人参10克，生地10克，黄精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，莱菔子10克，砂仁10克。
服药4剂后，头晕头痛，胸满腹胀，心悸气短等证均好转，继服上方4个月，药近110剂，诸证消失，双侧血压均能明显测出。
某医云：余用活血逐瘀治之不效，活血通阳亦不效，而老师仍用活血之剂，却效果甚好其故何也?答曰：本病脉既沉伏而又涩，说明此病气滞与血瘀均较甚，你所用的活血药为活血而无理气之药，我所用的活血药是既破气又破血的药，也就是说是气血双治之药，此所以取效者一也。本病病程很久，气血两伤，你所用的药只有活血，我所用的药还有补气养血，此所以取效者二也。
雷诺病
久病痼疾，不审脉象，但用药饵，焉能取效
洛××，女，38岁。
在7个多月以前的一次洗衣服过程中，突然发现手痛难忍，皮肤颜色变为紫黯，休息1个多小时以后疼痛才消失，皮肤颜色恢复正常。其后两手一遇冷就变得青紫疼痛。为此先后在某院住院5个多月，诊为雷诺病。除先后采用了西药、针灸等进行治疗外，还内服了活血通阳的中药120剂，但至今不但没有减轻，反而更加严重。细审其证，除两手遇冷紫黯疼痛外，并有两臂疼痛酸困，头晕乏力，舌苔薄白，脉濡缓。综合脉证，思之：脉濡缓者，乃气阴两虚，痰郁气结之脉也。拟用补气养阴，理气化痰为方。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，黄芪15克，当归6克，麦冬10克，党参10克，五味子10克。
服药12剂，头晕臂痛，手指冷痛好转；继服40剂后，虽反复用冷水洗衣亦无任何痛苦；又服20剂，愈。
反流性食管炎
1．本为阴虚，反用消炎解毒，虚从实治，经久难愈
沈××，女，29岁。
2年多来，食管灼痛，吞咽困难。医诊反流性食管炎。先用西药治疗稍事有效，但应用十几天后不再显著，数月之后，不得不改请中医治疗。然不管是用疏肝理气，还是应用清热解毒，活血通络，都不见效。近因病情日渐加重，中、西药物不效，医生急劝手术治疗。患者惧怕手术，故再请中医试之。细审其证，除食管疼痛，吞咽困难之外，并见头晕头痛，胸满心烦，胸胁窜痛，纳呆食减，失眠健忘，口苦咽干，手足心烦热，腰背酸痛，舌质嫩红，苔净，脉沉细弦数，右大于左。因思脉沉者气郁也，细者阴虚或血虚也，弦数者肝郁化火也，细数者阴虚有热也，右脉大于左脉者气血俱虚也。合之于症，乃气阴俱虚，肝郁气结，久入血络之疾。治用补气养阴，理气活血。处方：沙参30克，麦冬10克，生地30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，食管灼痛竟然大减；继服25剂，诸证大减，食管灼痛消失；服药20剂，诸证消失，果愈。
某医云：食管炎既为炎症，何用清热解毒之剂久久不效?答曰：炎症并不等于中医所说的火证、热证，因此不能一概用清热解毒药进行治疗。临床所见的慢性炎症，若气虚当补气，血虚当养血，阳虚当温阳，阴虚当养阴。本证既属阴虚，那当然应该用养阴进行治疗了。
2．阴虚当柔，反用燥药，其病不减
郝××，女，64岁。
3年多来，胃脘、食管、胸胁疼痛。医诊食管憩室、反流性食管炎、溃疡病。先用西药治疗1年多效果不明显，后又配合中药健脾和胃、疏肝和胃、苦辛通降等治疗1年多仍无效果。特别是近7～8个月以来，病情更加严重，几乎无时无刻的疼痛，为此外科医生要求手术治疗，但因病情复杂，难于决定，故再请中医诊治。细查其证，除胃脘、食管、胸胁疼痛之外，并见其头晕头痛，失眠心烦，胸胁苦满，胃脘胀痛，纳呆食减，口干咽燥，昼轻夜剧，心悸时作，舌苔黄白，舌质红，脉弦大数，右脉大于左脉，面色萎黄。因思脉弦大者气阴俱虚肝邪反胜也，数者热也火也，右脉大于左脉者气虚多于阴虚也，舌苔黄白者胃中湿热也。综合脉证，此乃气阴两虚，湿热内郁，肝木失达。因拟养阴益气，燥湿清热，疏肝活血。处方：西洋参10克，沙参20克，麦冬10克，生地30克，苍术15克，白术10克，三棱10克，莪术10克，柴胡10克，薄荷3克，夜交藤30克。
服药4剂，食管、胃脘、胸胁疼痛均减，宗效不更方之旨，继服药2月多，愈。
某医云：本例患者余前已用药百剂以上，然其诸剂不效，亦或有加剧者，其故何也?答曰：脾胃之疾多用辛苦，因其多湿、多寒、多饮故也?然本证则素有阴虚，阴虚烧心嘈杂与寒证、寒热夹杂证最不易分，故医者仍多用辛苦之伤阴药治之，岂知阴愈伤而病愈甚，病愈甚愈加重辛苦之量，故病情愈重也。
1964年生育第二胎后不久，患者便经常感到气短、乏力，但未引起重视。此后频繁感冒，有时出现数日的咯血症状，这才前往医院检查。经X线拍片、心电图、超声心动图等检查，确诊为肥厚型心肌病（Hypertrophic Cardiomyopathy）、心力衰竭（Heart Failure）和心源性肝硬化（Cardiac Cirrhosis）。住院治疗一年多，虽然感冒、咯血等症状消失，但腹胀、浮肿、心悸、气短、食欲不振且食量减少等症状不仅未减轻，反而加重。诊察发现患者形体消瘦、精神疲惫，颜面、手足、嘴唇及舌色均呈紫暗色，下肢有可凹性浮肿，腹部膨大且肚脐突出，伴有气短、心悸，小便黄赤且量少，舌苔黄白相间，脉象虚数促，兼见结、涩、弦、紧之象。综合脉证分析思考：脉虚者，是气血俱虚；促脉与结脉并见者，是阴阳俱不足；脉弦紧者，是寒凝气结；脉结涩者，是气滞血瘀。脉证合参，判断为气血大衰，气滞血瘀，水湿停聚。于是拟定补气养血以培补根本，理气活血、除湿行水以治疗标症。处方：黄芪30克，当归10克，人参10克，丹参30克，生地10克，黄精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，大腹皮10克，香附10克，莱菔子10克，砂仁10克。
服药7剂后，腹满、心悸、气短、浮肿均有好转。继服上方60剂，腹胀腹水消失，精神、食欲大增，紫绀明显改善；又连续服药3个月，进药约70剂，精神、食欲几近正常，体重增加7.5千克，肺部瘀血消失，心脏扩大情况改善，并能上班工作。
某医生说：患者腹水腹胀近2年不减轻，如今老师用中药治愈，这是什么原因呢？回答说：患者的腹胀腹水是由肝硬化引起的。治疗肝硬化腹水，医生多用攻逐、利水两种方法。（医生插话问患者：是否如此？患者回答：是的。）攻逐法用于一般的肝硬化腹水实证尚可，但此证则不可用。此证气血大衰，气滞血瘀，水湿停聚，如果只治其水，而不顾及气血的虚实，即所谓：一不治疾病所在的位置，二不治疾病的原因，那当然就无效了。至于为什么不用利水而用理气活血、补气养血，是因为病主要在气虚、血虚、血瘀、气滞。而且病程已久，只能缓缓图治。
多发性大动脉炎（Takayasu Arteritis）
1．气阴俱虚，痰郁气结，仅予活血，病势转甚
过某某，女，34岁。
5～6年来，经常头晕头痛，近3年来左眼视力逐渐下降，近一年来，左眼视力基本丧失。遍请太原、天津、北京等地医院检查治疗，确诊为多发性大动脉炎。先在某院进行手术治疗，诸证曾一度好转，但半年以后，诸证又复如前。最近7～8个月以来，头痛异常剧烈，经常因头痛难忍而不能入睡，为此除每日数次服西药外，又加用了中药清热泻火、活血逐瘀之剂及针灸，但至今仍日甚一日。细审其证，除剧烈的头痛时轻时重之外，并见左脉沉伏欲绝，右脉虚缓，舌苔薄白，左眼在0.3米之内可见人影晃动，右眼视力正常，左脸肌肉明显萎缩，右脸正常，且时时胸满心烦，咽喉有异物阻塞感。综合脉证，思之：右脉大于左脉者，气血俱虚也；左脉沉伏欲绝者，气滞血瘀也；虚缓者，痰湿阻滞也。脉证合参论之，乃气阴两虚，痰气郁结，郁而化火之证。治宜补气养阴，理气化痰，泻火为法。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，半夏10克，陈皮10克，甘草6克，石菖蒲10克，远志10克，玄参15克。
服药4剂，头痛、失眠骤然好转；继服8剂，头痛10日未作，其后头痛虽时有发，但很轻微；继服40剂，头痛消失，左眼视力较前明显增加，在5米以上的距离内已能清楚地看见任何物体，且能在短时间内看书读报。此后，恐再反复，又服药3个月，果愈。
患者家属说：多发性大动脉炎，众医均云从血分论治，而先生却主用气药，其故何也？回答说：任何科学都不能脱离实践是检验真理的标准这一规律。此病前已久用血药而加剧，可见其用血药是不正确的，因此舍而不用。今按脉象主病论治果然效如桴鼓，可见气分乎！血分乎！不可早日断言。
2．虚实夹杂，或但用活血以祛实，或但用补气养血以扶正，君臣不分，佐使不明，久治不愈
和某某，女，48岁。
5年多来，右上肢酸痛麻木，头晕头痛，健忘，时而突然昏厥。近3年来，视力日差。某医在普查身体时，突然发现右上肢血压不能测出，桡动脉不见跳动。其后又经呼和浩特、大同、北京等多个医院进行检查，确诊为多发性大动脉炎，并进行手术治疗。手术后，诸证均有所减轻，但半年以后，情况又复如前。不得已，又改请中医以活血化瘀、温经通阳、养阴益气等进行治疗半年，诸证不但不减，反而更加严重。细审其证，除头晕头痛，右臂酸痛麻木，视力下降，健忘之外，并见胸满胸痛，心烦心悸，肩背酸痛，下肢麻木，手足厥冷，舌苔白，脉右侧全无，左虚大。因思：无脉者，气滞血瘀也；虚大者，气血俱虚也；左脉大于右脉者，肝邪也。综合脉证论之，乃气血俱虚为本，气滞血瘀，湿郁不化为标也。治拟补气养血以培本，理气活血，燥湿和胃以治标。处方：黄芪30克，当归10克，丹参30克，党参10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，柴胡10克，三棱10克，莪术10克，薄荷3克，夜交藤30克。
服药10剂，诸证均减；又服药20剂，诸证大部消失，右脉沉细，左脉弦大；服药40剂，两侧血压均可测出，惟右脉仍较左脉为小。
某医问：为什么前用活血化瘀、温经通阳、养阴益气而加剧，而后老师仍用上法而反效也？回答说：本证是一个气血俱虚、气滞血瘀、湿郁不化俱在的虚实夹杂证。夹杂证处理的一个重要原则是既需照顾其虚，又需照顾其实，既需顾及其寒，又需顾及其热。本证既然属虚实夹杂证，那么当然应该在处方时既要补又要疏，前方之不效恐在但补不疏或但疏不补耳。又问：前用温经通阳不但四肢未温，而老师却未用温经通阳而四肢却转温者何也？答：四肢冷属于广泛的厥证（Jue Syndrome, characterized by cold extremities），厥证的原因很多，其中既有阳虚，亦有阳郁，阳虚者当温经通阳，阳郁者但通即可。此证之厥乃气滞血瘀所为，故治以理气活血而厥回也。
3．气阴两虚，痰湿郁滞，但用活血化痰，其病不愈
章某某，女，36岁。
头晕头痛，失眠健忘，视力下降，时作昏厥抽搐，左眼底出血8年多。医诊多发性大动脉炎。先用西药治疗1年不效，后又用中药、针灸、按摩、气功等治疗数年，不但不效，反而日渐加剧。不得已，乃赴北京某院手术治疗。术后半年诸证大部消失，但半年多之后，诸证又复发如初。头痛昼夜不止，失眠，经常昼夜难以入睡片刻，右眼视力下降至仅能在0.3米左右看见人影晃动，时时恶心呕吐，疲乏无力，心烦不安。为此不得不再次住院，但住院半年多以后，不但右眼完全失明，而且左眼几近失明。细审其证，除上述诸证外，并见舌苔薄白，脉濡缓。因思脉濡缓者，气阴两虚，痰气郁结，郁而化热也。合于脉证论之，乃气阴俱虚，痰气郁结，郁而化火之证也。因拟补气养阴，理气化痰，泻火为剂。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，半夏10克，陈皮10克，茯苓10克，甘草10克，石菖蒲10克，远志10克，生地10克，玄参10克。
服药4剂，头痛突然停止，睡眠增加，呕吐几减80％；继服上方加减3个多月，诸证消失，视力恢复几近常人。
4．只求症状，但靠推理，不从脉论，治之无功
要某某，男，59岁。
2年多来，右臂麻木酸痛，头晕头痛，失眠健忘，胸满心悸，视力下降，右手桡动脉搏动日益减弱。某院诊为多发性大动脉炎。先用西药、针灸等治疗半年多不效，后又配合中药活血通阳之剂达200余剂仍无明显效果。特别是近3个月来，不但上证不见减轻，而且日渐发现呼吸困难，胸满腹胀，甚至夜间突因呼吸困难而不得不坐起两三个小时才能继续平卧睡眠。经某院检查诊断为左心增大，左心衰竭。治疗1个多月后，呼吸困难明显好转，而其他症状却不见改善。审其除上述诸证外，并见两脉沉伏而涩，舌苔薄白。综合脉证，诊为气血俱虚为本，气滞血瘀，湿郁不化为标。治以补气养血以培本，理气活血，燥湿和胃以治标。黄芪30克，当归10克，丹参30克，人参10克，生地10克，黄精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，莱菔子10克，砂仁10克。
服药4剂后，头晕头痛，胸满腹胀，心悸气短等证均好转，继服上方4个月，药近110剂，诸证消失，双侧血压均能明显测出。
某医生说：我用活血逐瘀治之不效，活血通阳亦不效，而老师仍用活血之剂，却效果甚好，其故何也？回答说：本病脉既沉伏而又涩，说明此病气滞与血瘀均较甚，你所用的活血药为活血而无理气之药，我所用的活血药是既破气又破血的药，也就是说是气血双治之药，此所以取效者一也。本病病程很久，气血两伤，你所用的药只有活血，我所用的药还有补气养血，此所以取效者二也。
雷诺病（Raynaud's Disease）
久病痼疾，不审脉象，但用药饵，焉能取效
洛某某，女，38岁。
在7个多月以前的一次洗衣服过程中，突然发现手痛难忍，皮肤颜色变为紫黯，休息1个多小时以后疼痛才消失，皮肤颜色恢复正常。其后两手一遇冷就变得青紫疼痛。为此先后在某院住院5个多月，诊为雷诺病。除先后采用了西药、针灸等进行治疗外，还内服了活血通阳的中药120剂，但至今不但没有减轻，反而更加严重。细审其证，除两手遇冷紫黯疼痛外，并有两臂疼痛酸困，头晕乏力，舌苔薄白，脉濡缓。综合脉证，思之：脉濡缓者，乃气阴两虚，痰郁气结之脉也。拟用补气养阴，理气化痰为方。竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，石菖蒲10克，远志10克，黄芪15克，当归6克，麦冬10克，党参10克，五味子10克。
服药12剂，头晕臂痛，手指冷痛好转；继服40剂后，虽反复用冷水洗衣亦无任何痛苦；又服20剂，愈。
反流性食管炎（Reflux Esophagitis）
1．本为阴虚，反用消炎解毒，虚从实治，经久难愈
沈某某，女，29岁。
2年多来，食管灼痛，吞咽困难。医诊反流性食管炎。先用西药治疗稍事有效，但应用十几天后不再显著，数月之后，不得不改请中医治疗。然不管是用疏肝理气，还是应用清热解毒，活血通络，都不见效。近因病情日渐加重，中、西药物不效，医生急劝手术治疗。患者惧怕手术，故再请中医试之。细审其证，除食管疼痛，吞咽困难之外，并见头晕头痛，胸满心烦，胸胁窜痛，纳呆食减，失眠健忘，口苦咽干，手足心烦热，腰背酸痛，舌质嫩红，苔净，脉沉细弦数，右大于左。因思脉沉者气郁也，细者阴虚或血虚也，弦数者肝郁化火也，细数者阴虚有热也，右脉大于左脉者气血俱虚也。合之于症，乃气阴俱虚，肝郁气结，久入血络之疾。治用补气养阴，理气活血。处方：沙参30克，麦冬10克，生地30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，食管灼痛竟然大减；继服25剂，诸证大减，食管灼痛消失；服药20剂，诸证消失，果愈。
某医生说：食管炎既为炎症，何用清热解毒之剂久久不效？回答说：炎症并不等于中医所说的火证、热证，因此不能一概用清热解毒药进行治疗。临床所见的慢性炎症，若气虚当补气，血虚当养血，阳虚当温阳，阴虚当养阴。本证既属阴虚，那当然应该用养阴进行治疗了。
2．阴虚当柔，反用燥药，其病不减
郝某某，女，64岁。
3年多来，胃脘、食管、胸胁疼痛。医诊食管憩室、反流性食管炎、溃疡病。先用西药治疗1年多效果不明显，后又配合中药健脾和胃、疏肝和胃、苦辛通降等治疗1年多仍无效果。特别是近7～8个月以来，病情更加严重，几乎无时无刻的疼痛，为此外科医生要求手术治疗，但因病情复杂，难于决定，故再请中医诊治。细查其证，除胃脘、食管、胸胁疼痛之外，并见其头晕头痛，失眠心烦，胸胁苦满，胃脘胀痛，纳呆食减，口干咽燥，昼轻夜剧，心悸时作，舌苔黄白，舌质红，脉弦大数，右脉大于左脉，面色萎黄。因思脉弦大者气阴俱虚肝邪反胜也，数者热也火也，右脉大于左脉者气虚多于阴虚也，舌苔黄白者胃中湿热也。综合脉证，此乃气阴两虚，湿热内郁，肝木失达。因拟养阴益气，燥湿清热，疏肝活血。处方：西洋参10克，沙参20克，麦冬10克，生地30克，苍术15克，白术10克，三棱10克，莪术10克，柴胡10克，薄荷3克，夜交藤30克。
服药4剂，食管、胃脘、胸胁疼痛均减，宗效不更方之旨，继服药2月多，愈。
某医生说：本例患者余前已用药百剂以上，然其诸剂不效，亦或有加剧者，其故何也？回答说：脾胃之疾多用辛苦，因其多湿、多寒、多饮故也？然本证则素有阴虚，阴虚烧心嘈杂与寒证、寒热夹杂证最不易分，故医者仍多用辛苦之伤阴药治之，岂知阴愈伤而病愈甚，病愈甚愈加重辛苦之量，故病情愈重也。
1. Shortly after giving birth to her second child in 1964, the patient frequently felt shortness of breath and fatigue but did not pay attention to it. Subsequently, she suffered from frequent common colds (Ganmao) and occasionally experienced hemoptysis (coughing up blood) for several days, at which point she went to the hospital for examination. After examinations including X-ray, electrocardiogram, and echocardiogram, she was diagnosed with hypertrophic cardiomyopathy, heart failure, and cardiac cirrhosis. After more than one year of hospitalization, although symptoms such as common cold and hemoptysis disappeared, symptoms such as abdominal distension, edema, palpitations, shortness of breath, poor appetite, and reduced food intake not only failed to subside but worsened. Upon examination, the patient was found to be emaciated and listless, with a purplish-dark complexion on the face, hands, feet, lips, and tongue. Pitting edema was present in the lower limbs, the abdomen was distended with an everted umbilicus, accompanied by shortness of breath and palpitations. Urine was dark red and scanty. The tongue coating was yellow and white, and the pulse was deficient, rapid, and hurried (Cu), with concurrent knotted (Jie), choppy (Se), wiry (Xian), and tight (Jin) qualities. Synthesizing the pulse and symptoms: a deficient pulse indicates deficiency of both Qi and Blood; the presence of hurried and knotted pulses together indicates insufficiency of both Yin and Yang; a wiry and tight pulse indicates cold stagnation and Qi binding; a knotted and choppy pulse indicates Qi stagnation and Blood stasis. Considering pulse and symptoms together, the diagnosis is severe depletion of Qi and Blood, Qi stagnation and Blood stasis, and accumulation of water-dampness. Therefore, the treatment principle was to tonify Qi and nourish Blood to support the root, and to regulate Qi, invigorate Blood, remove dampness, and promote urination to treat the branch. Prescription: Huangqi (Astragali Radix) 30g, Danggui (Angelicae Sinensis Radix) 10g, Renshen (Ginseng Radix) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Shengdi (Rehmanniae Radix) 10g, Huangjing (Polygonati Rhizoma) 10g, Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Chaihu (Bupleuri Radix) 10g, Sanleng (Sparganii Rhizoma) 10g, Ezhu (Curcumae Rhizoma) 10g, Bohe (Menthae Haplocalycis Herba) 3g, Yejiaoteng (Caulis Polygoni Multiflori) 30g, Dafupi (Arecae Pericarpium) 10g, Xiangfu (Cyperi Rhizoma) 10g, Laifuzi (Radishi Semen) 10g, Sharen (Amomi Fructus) 10g.
After taking 7 doses, abdominal fullness, palpitations, shortness of breath, and edema all improved. Continuing with the same prescription for 60 doses, abdominal distension and ascites disappeared, spirit and appetite increased significantly, and cyanosis improved markedly. After continuous medication for 3 months (approximately 70 additional doses), spirit and appetite were nearly normal, body weight increased by 7.5 kg, pulmonary blood stasis resolved, cardiac enlargement improved, and she returned to work.
A certain doctor asked: The patient had abdominal ascites and distension for nearly two years without relief. Why did the teacher cure this with Chinese herbal medicine? The answer was: The patient's abdominal distension and ascites were caused by liver cirrhosis. Doctors often use purging and diuretic methods to treat liver cirrhosis with ascites. (The doctor interjected, asking the patient: Is this correct? The patient answered: Yes.) Purging methods may be suitable for excess patterns of general liver cirrhosis with ascites, but are inappropriate for this case. This pattern involves severe depletion of Qi and Blood, Qi stagnation and Blood stasis, and water-dampness accumulation. If one treats only the water without considering the deficiency or excess of Qi and Blood, it is said that: one does not treat the location of the disease, nor the cause of the disease; thus, naturally, there would be no effect. As for why diuretics were not used but rather methods to regulate Qi, invigorate Blood, tonify Qi, and nourish Blood were chosen, it is because the pathology primarily lies in Qi deficiency, Blood deficiency, Blood stasis, and Qi stagnation. Moreover, since the disease course has been long, slow and gradual treatment is required.
Takayasu Arteritis
1. Deficiency of both Qi and Yin, Phlegm stagnation and Qi binding; using only Blood-invigorating herbs worsened the condition
Patient Guo XX, female, 34 years old.
For 5-6 years, she frequently suffered from dizziness and headache. For the past 3 years, vision in the left eye gradually declined, and for the past year, vision in the left eye was almost lost. She sought medical examination and treatment in hospitals in Taiyuan, Tianjin, Beijing, etc., and was diagnosed with Takayasu arteritis. She first underwent surgical treatment at a certain hospital, and symptoms improved temporarily, but half a year later, symptoms recurred. In the recent 7-8 months, headaches have been extremely severe, often preventing sleep due to unbearable pain. Besides taking Western medicine several times daily, she also used Chinese herbal medicines for clearing heat and purging fire, invigorating Blood and removing stasis, along with acupuncture, yet the condition worsened day by day. Careful examination revealed that besides severe, fluctuating headaches, the left pulse was deep, hidden, and nearly imperceptible, while the right pulse was deficient and moderate. Tongue coating was thin and white. Vision in the left eye could only detect moving shadows within 0.3 meters, while vision in the right eye was normal. Facial muscles on the left side were significantly atrophied, while the right side was normal. She frequently experienced chest fullness, irritability, and a sensation of foreign body obstruction in the throat. Synthesizing pulse and symptoms: A right pulse larger than the left indicates deficiency of both Qi and Blood; a left pulse that is deep, hidden, and nearly imperceptible indicates Qi stagnation and Blood stasis; a deficient and moderate pulse indicates Phlegm-dampness obstruction. Considering pulse and symptoms together, the diagnosis is deficiency of both Qi and Yin, Phlegm-Qi stagnation, and stagnation transforming into Fire. The treatment method should be to tonify Qi and nourish Yin, regulate Qi and resolve Phlegm, and purge Fire. Prescription: Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 6g, Renshen (Ginseng Radix) 10g, Maidong (Ophiopogonis Radix) 10g, Wuweizi (Schisandrae Chinensis Fructus) 10g, Zhuru (Bambusae Caulis in Taeniam) 10g, Zhishi (Aurantii Fructus Immaturus) 10g, Banxia (Pinelliae Rhizoma Preparatum) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shichangpu (Acori Tatarinowii Rhizoma) 10g, Yuanzhi (Polygalae Radix) 10g, Xuanshen (Scrophulariae Radix) 15g.
After 4 doses, headache and insomnia improved abruptly; after another 8 doses, no headache occurred for 10 days; subsequently, although headaches occasionally recurred, they were very mild. After another 40 doses, headaches disappeared, vision in the left eye improved significantly compared to before, allowing clear vision of any object at distances over 5 meters, and enabling reading books and newspapers in a short time. Fearing recurrence, she continued medication for 3 months, resulting in complete recovery.
The patient's family member asked: For Takayasu arteritis, doctors generally advocate treating from the Blood aspect, but you primarily use Qi-regulating herbs. What is the reason? The answer was: Any science cannot deviate from the principle that practice is the criterion for testing truth. This disease had previously worsened with prolonged use of Blood-invigorating herbs, indicating that using Blood herbs was incorrect, hence discarded. Now, treating according to the pulse indications yielded immediate results like a drumstick striking a drum, proving the focus on the Qi aspect! Whether it is Qi or Blood, one cannot make premature judgments.
2. Mixed excess and deficiency; using only Blood-invigorating herbs to dispel excess, or only Qi-tonifying and Blood-nourishing herbs to support righteousness, without distinguishing sovereign, minister, assistant, and courier roles, led to chronic non-response
Patient He XX, female, 48 years old.
For over 5 years, she suffered from soreness, numbness, dizziness, and headache in the right upper limb, forgetfulness, and occasional sudden syncope. For the past 3 years, vision deteriorated daily. During a physical examination, it was suddenly discovered that blood pressure in the right upper limb could not be measured, and the radial artery showed no pulsation. Subsequent examinations in Hohhot, Datong, Beijing, and other hospitals confirmed the diagnosis of Takayasu arteritis, followed by surgical treatment. Post-surgery, symptoms alleviated somewhat, but half a year later, the situation reverted to previous states. Reluctantly, she consulted Traditional Chinese Medicine (TCM) practitioners for 6 months using methods such as invigorating Blood and resolving stasis, warming meridians and unblocking Yang, nourishing Yin, and benefiting Qi. Symptoms not only failed to improve but worsened. Careful examination revealed, besides dizziness, headache, right arm soreness/numbness, vision decline, and forgetfulness, chest fullness/pain, irritability, palpitations, shoulder/back soreness, lower limb numbness, cold extremities, white tongue coating, absence of pulse on the right side, and a large, deficient pulse on the left. Thinking: Absence of pulse indicates Qi stagnation and Blood stasis; a large and deficient pulse indicates deficiency of both Qi and Blood; a left pulse larger than the right indicates Liver pathogenic factors. Synthesizing pulse and symptoms, the root is deficiency of both Qi and Blood, while the branch is Qi stagnation, Blood stasis, and stagnant Dampness failing to transform. The treatment plan was to tonify Qi and nourish Blood to support the root, and regulate Qi, invigorate Blood, dry Dampness, and harmonize the Stomach to treat the branch. Prescription: Huangqi (Astragali Radix) 30g, Danggui (Angelicae Sinensis Radix) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Dangshen (Codonopsis Radix) 10g, Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Shengdi (Rehmanniae Radix) 10g, Huangjing (Polygonati Rhizoma) 10g, Chaihu (Bupleuri Radix) 10g, Sanleng (Sparganii Rhizoma) 10g, Ezhu (Curcumae Rhizoma) 10g, Bohe (Menthae Haplocalycis Herba) 3g, Yejiaoteng (Caulis Polygoni Multiflori) 30g.
After 10 doses, all symptoms decreased; after another 20 doses, most symptoms disappeared, the right pulse became deep and fine, and the left pulse became wiry and large; after 40 doses, blood pressure could be measured on both sides, though the right pulse remained smaller than the left.
A doctor asked: Why did previous treatments using Blood-invigorating/stasis-resolving, meridian-warming/Yang-unblocking, and Yin-nourishing/Qi-benefiting methods exacerbate the condition, while your continued use of similar methods proved effective? The answer was: This case is a mixed excess-deficiency pattern involving deficiency of both Qi and Blood, Qi stagnation, Blood stasis, and stagnant Dampness. An important principle in handling mixed patterns is to address both deficiency and excess, and both cold and heat. Since this is a mixed pattern, the prescription must include both tonification and dispersal. The ineffectiveness of the previous formula likely lay in tonifying without dispersing, or dispersing without tonifying. Another question: Why did previous meridian-warming treatments fail to warm the limbs, whereas your lack of such treatment resulted in warmed limbs? The answer: Cold limbs belong to Jue syndrome (cold extremities). Causes of Jue syndrome are numerous, including Yang deficiency and Yang depression. Yang deficiency requires warming meridians and unblocking Yang; Yang depression requires only unblocking. This case's Jue syndrome was caused by Qi stagnation and Blood stasis; thus, regulating Qi and invigorating Blood restored warmth.
3. Deficiency of both Qi and Yin, Phlegm-dampness stagnation; using only Blood-invigorating and Phlegm-resolving herbs failed to cure
Patient Zhang XX, female, 36 years old.
Dizziness, headache, insomnia, forgetfulness, vision decline, occasional syncope and convulsions, and left fundus hemorrhage for over 8 years. Diagnosed with Takayasu arteritis. Western medicine treatment for 1 year was ineffective. Subsequent TCM, acupuncture, massage, and Qigong treatments for several years were ineffective and the condition worsened. Surgery was performed at a Beijing hospital. Half a year post-surgery, most symptoms disappeared, but recurred fully after another half-year. Headaches persisted day and night, insomnia prevented sleep, vision in the right eye dropped to detecting shadows only within 0.3 meters, frequent nausea/vomiting, fatigue, and irritability. Hospitalized again for over half a year, resulting in complete blindness in the right eye and near-blindness in the left. Careful examination revealed, besides these symptoms, thin white tongue coating and soggy-moderate (Ru-Huan) pulse. Thinking: A soggy-moderate pulse indicates deficiency of both Qi and Yin, Phlegm-Qi stagnation, and stagnation transforming into Heat. Combining pulse and symptoms, the diagnosis is deficiency of both Qi and Yin, Phlegm-Qi stagnation, and stagnation transforming into Fire. The prescription aimed to tonify Qi and nourish Yin, regulate Qi and resolve Phlegm, and purge Fire. Prescription: Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 6g, Renshen (Ginseng Radix) 10g, Maidong (Ophiopogonis Radix) 10g, Wuweizi (Schisandrae Chinensis Fructus) 10g, Zhuru (Bambusae Caulis in Taeniam) 10g, Zhishi (Aurantii Fructus Immaturus) 10g, Banxia (Pinelliae Rhizoma Preparatum) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Fuling (Poria) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Shichangpu (Acori Tatarinowii Rhizoma) 10g, Yuanzhi (Polygalae Radix) 10g, Shengdi (Rehmanniae Radix) 10g, Xuanshen (Scrophulariae Radix) 10g.
After 4 doses, headaches stopped abruptly, sleep increased, and vomiting reduced by nearly 80%. After modifying and continuing the prescription for over 3 months, all symptoms disappeared, and vision recovered to near-normal levels.
4. Seeking only symptoms, relying solely on reasoning, ignoring pulse analysis, leading to therapeutic failure
Patient Yao XX, male, 59 years old.
For over 2 years, he suffered from numbness and soreness in the right arm, dizziness, headache, insomnia, forgetfulness, chest fullness, palpitations, vision decline, and increasingly weak pulsation of the right radial artery. Diagnosed with Takayasu arteritis at a certain hospital. Western medicine and acupuncture treatments for over half a year were ineffective. Subsequent addition of Chinese herbal medicines for invigorating Blood and unblocking Yang (over 200 doses) yielded no obvious effect. Especially in the last 3 months, not only did symptoms not alleviate, but dyspnea developed, with chest fullness and abdominal distension. At night, he had to sit up for 2-3 hours due to dyspnea before resuming supine sleep. Examination diagnosed left ventricular enlargement and left heart failure. After over a month of treatment, dyspnea improved significantly, but other symptoms did not change. Examination revealed, besides the above, deep-hidden-choppy pulses on both sides and thin white tongue coating. Synthesizing pulse and symptoms, the diagnosis was root deficiency of Qi and Blood, with branch manifestations of Qi stagnation, Blood stasis, and stagnant Dampness. Treatment aimed to tonify Qi and nourish Blood for the root, and regulate Qi, invigorate Blood, dry Dampness, and harmonize the Stomach for the branch. Prescription: Huangqi (Astragali Radix) 30g, Danggui (Angelicae Sinensis Radix) 10g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 30g, Renshen (Ginseng Radix) 10g, Shengdi (Rehmanniae Radix) 10g, Huangjing (Polygonati Rhizoma) 10g, Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Chaihu (Bupleuri Radix) 10g, Sanleng (Sparganii Rhizoma) 10g, Ezhu (Curcumae Rhizoma) 10g, Bohe (Menthae Haplocalycis Herba) 3g, Yejiaoteng (Caulis Polygoni Multiflori) 30g, Laifuzi (Radishi Semen) 10g, Sharen (Amomi Fructus) 10g.
After 4 doses, dizziness, headache, chest fullness, abdominal distension, palpitations, and shortness of breath improved. Continuing the prescription for 4 months (nearly 110 doses), all symptoms disappeared, and bilateral blood pressure became clearly measurable.
A doctor asked: My use of Blood-invigorating/stasis-resolving and Blood-invigorating/meridian-warming methods failed, yet your continued use of Blood-invigorating agents yielded excellent results. Why? The answer was: The pulse being deep-hidden and choppy indicates severe Qi stagnation and Blood stasis. Your Blood-invigorating herbs lacked Qi-regulating properties, whereas my Blood-invigorating herbs possessed both Qi-breaking and Blood-breaking properties, effectively treating both Qi and Blood. This is the first reason for efficacy. The disease course is long, causing dual injury to Qi and Blood. Your herbs only invigorated Blood, while mine included Qi-tonifying and Blood-nourishing agents. This is the second reason for efficacy.
Raynaud's Disease
Chronic stubborn diseases: Without examining the pulse and relying solely on medication, how can efficacy be achieved?
Patient Luo XX, female, 38 years old.
Over 7 months ago, while washing clothes, she suddenly experienced unbearable hand pain, with skin turning purplish-dark. Pain subsided and skin color normalized after resting for over an hour. Thereafter, hands turned blue-purple and painful upon exposure to cold. Hospitalized for over 5 months and diagnosed with Raynaud's disease. Besides Western medicine and acupuncture, she took 120 doses of Chinese herbal medicines for invigorating Blood and unblocking Yang, yet the condition worsened. Careful examination revealed, besides cold-induced purple-dark painful hands, arm pain/soreness/fatigue, dizziness, weakness, thin white tongue coating, and soggy-moderate (Ru-Huan) pulse. Synthesizing pulse and symptoms: A soggy-moderate pulse indicates deficiency of both Qi and Yin, and Phlegm-Qi stagnation. The prescription aimed to tonify Qi and nourish Yin, regulate Qi and resolve Phlegm. Prescription: Zhuru (Bambusae Caulis in Taeniam) 10g, Zhishi (Aurantii Fructus Immaturus) 10g, Banxia (Pinelliae Rhizoma Preparatum) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Fuling (Poria) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Shichangpu (Acori Tatarinowii Rhizoma) 10g, Yuanzhi (Polygalae Radix) 10g, Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 6g, Maidong (Ophiopogonis Radix) 10g, Dangshen (Codonopsis Radix) 10g, Wuweizi (Schisandrae Chinensis Fructus) 10g.
After 12 doses, dizziness, arm pain, and cold painful fingers improved. After another 40 doses, even repeated washing with cold water caused no pain. After another 20 doses, she recovered.
Reflux Esophagitis
1. Root is Yin deficiency, but anti-inflammatory and detoxifying herbs were used, treating deficiency as excess, leading to chronic non-response
Patient Shen XX, female, 29 years old.
For over 2 years, she suffered from esophageal burning pain and dysphagia. Diagnosed with reflux esophagitis. Western medicine provided slight initial relief but ceased to be significant after ten days. Months later, TCM consultation was sought. However, neither soothing the Liver and regulating Qi, nor clearing heat and detoxifying, nor invigorating Blood and unblocking collaterals proved effective. Recently, with worsening condition and ineffectiveness of both TCM and Western medicine, doctors urgently advised surgery. Fearful of surgery, she sought TCM again. Careful examination revealed, besides esophageal pain and dysphagia, dizziness, headache, chest fullness, irritability, wandering pain in chest/hypochondrium, poor appetite, insomnia, forgetfulness, bitter taste, dry throat, heat in palms/soles, backache, tender-red tongue body, clean coating, and deep-fine-wiry-rapid pulse, right larger than left. Thinking: Deep pulse indicates Qi depression; fine pulse indicates Yin or Blood deficiency; wiry-rapid pulse indicates Liver depression transforming into Fire; fine-rapid pulse indicates Yin deficiency with Heat; right pulse larger than left indicates deficiency of both Qi and Blood. Combining with symptoms, the diagnosis is deficiency of both Qi and Yin, Liver depression and Qi binding, with pathology entering Blood collaterals over time. Treatment used tonifying Qi and nourishing Yin, regulating Qi and invigorating Blood. Prescription: Shashen (Glehniae Radix) 30g, Maidong (Ophiopogonis Radix) 10g, Shengdi (Rehmanniae Radix) 30g, Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Chaihu (Bupleuri Radix) 10g, Sanleng (Sparganii Rhizoma) 10g, Ezhu (Curcumae Rhizoma) 10g, Bohe (Menthae Haplocalycis Herba) 3g, Yejiaoteng (Caulis Polygoni Multiflori) 30g.
After 4 doses, esophageal burning pain decreased significantly; after another 25 doses, symptoms largely subsided, and burning pain disappeared; after another 20 doses, all symptoms vanished, confirming recovery.
A doctor asked: Esophagitis is an inflammation; why did clearing heat and detoxifying herbs fail for so long? The answer was: Inflammation does not equal Fire or Heat patterns in TCM; therefore, clearing heat and detoxifying herbs cannot be universally applied. Chronic inflammation seen clinically requires tonifying Qi if Qi deficient, nourishing Blood if Blood deficient, warming Yang if Yang deficient, and nourishing Yin if Yin deficient. Since this case is Yin deficiency, nourishing Yin is the appropriate treatment.
2. Yin deficiency requires softening/nourishing, but drying herbs were used, leading to no improvement
Patient Hao XX, female, 64 years old.
For over 3 years, she suffered from epigastric, esophageal, and hypochondriac pain. Diagnosed with esophageal diverticulum, reflux esophagitis, and peptic ulcer. Western medicine treatment for over a year showed little effect. Subsequent TCM treatment using spleen-strengthening/stomach-harmonizing, Liver-soothing/stomach-harmonizing, and bitter-acid descending methods for over a year also failed. Especially in the last 7-8 months, the condition worsened, with almost constant pain. Surgical intervention was requested due to complexity, but given the complexity, TCM consultation was sought again. Detailed examination revealed, besides epigastric, esophageal, and hypochondriac pain, dizziness, headache, insomnia, irritability, chest/hypochondriac fullness, epigastric distension/pain, poor appetite, dry mouth/throat, symptoms lighter by day and worse at night, occasional palpitations, yellow-white tongue coating, red tongue body, wiry-large-rapid pulse, right pulse larger than left, and sallow complexion. Thinking: Wiry-large pulse indicates Qi and Yin deficiency with Liver pathogen prevailing; rapid pulse indicates Heat/Fire; right pulse larger than left indicates Qi deficiency exceeding Yin deficiency; yellow-white coating indicates Damp-Heat in the Stomach. Synthesizing pulse and symptoms, the diagnosis is deficiency of both Qi and Yin, internal stagnation of Damp-Heat, and Liver Wood failing to disperse. The prescription aimed to nourish Yin and benefit Qi, dry Dampness and clear Heat, soothe the Liver and invigorate Blood. Prescription: Xiyangshen (American Ginseng Radix) 10g, Shashen (Glehniae Radix) 20g, Maidong (Ophiopogonis Radix) 10g, Shengdi (Rehmanniae Radix) 30g, Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Sanleng (Sparganii Rhizoma) 10g, Ezhu (Curcumae Rhizoma) 10g, Chaihu (Bupleuri Radix) 10g, Bohe (Menthae Haplocalycis Herba) 3g, Yejiaoteng (Caulis Polygoni Multiflori) 30g.
After 4 doses, pain in the esophagus, epigastrium, and hypochondrium decreased. Adhering to the principle of not changing the formula when effective, she continued medication for over 2 months and recovered.
A doctor asked: I had prescribed over a hundred doses for this patient previously, none of which were effective, some even exacerbated the condition. Why? The answer was: Spleen and Stomach disorders often use pungent and bitter herbs because they are frequently associated with Dampness, Cold, and Fluid retention. However, this patient had pre-existing Yin deficiency. Differentiating Yin deficiency-related heartburn and acid regurgitation from Cold patterns or mixed Cold-Heat patterns is difficult. Thus, doctors often continue using pungent-bitter herbs that injure Yin. Little do they know that as Yin is further injured, the disease worsens; as the disease worsens, the dosage of pungent-bitter herbs increases, leading to even greater severity.