某医云：前用藿香正气何故不效?答曰：藿香正气虽亦有芳香化浊之药与神曲，然其总以化浊为主，今用苏神煎者，消食化浊之力等也，复加针刺之导滞，其导滞之力大于化浊，故得愈也。医又云：余临证处方但注意大而不注意小，但注意宏观而不注意微观，失败者甚多，今后尤当熟记之。
慢性胃炎
1．寒热不分、病位不明，以热作寒，以胃作肝，难于奏效
索××，男，45岁
胃脘胀痛7～8个月。医诊慢性肥厚性胃炎。先用西药治疗4个多月未见明显效果，继又配合中药健脾和胃、温中健脾，疏肝健脾等亦无明显改变。细审其证，疼痛以剑突以下的上腹部为主，按之则痛甚，舌苔白，脉浮滑。因思脉浮者上焦病也，滑者痰实凝结也。合之于证，乃痰热之邪结于胃脘也。仲景《伤寒论》云：“小结胸病，正在心下，按之则痛，脉浮滑者，小陷胸汤主之。”《医宗金鉴》云：“黄连涤热，半夏导饮，瓜萎润而下行。合之以涤胸膈痰热，开胸膈气结。”此病正相合拍。乃拟清热涤痰散结。处方：瓜蒌40克，半夏10克，黄连6克，枳实10克。
服药1剂，诸证大减；继服4剂，诸证消失，愈。
某医云：慢性胃炎为什么用治胃病法而不效，而老师用小陷胸取效呢?答曰：此证从西医的诊断看是慢性肥厚性胃炎，其治疗的规律是有的，但是由于兼杂证甚多，故治疗起来就很复杂了。因此我们必须随时注意随证治之，只有这样才能提高疗效。又问：为什么小陷胸汤又加枳实?答曰：小陷胸汤加枳实方本为鞠通《温病条辨》方，其本用于“脉洪滑，面赤身热头晕，不恶寒，但恶热，舌上黄滑苔，渴欲冷饮，饮不解渴，得水则呕，按之胸下痛，小便短，大便闭者，阳明暑温，水结在胸也。”而余根据其黄连、瓜蒌清在里之热痰，半夏除水痰而养胃，加枳实者，取其苦辛通降，开幽门而引水下行也，故加枳实，实践证明其效确实优于单纯的小陷胸汤。
2.寒热夹杂，不审比例，以热作寒或以寒作热，杂药乱投，始终不愈
支××，男，成。
嘈杂泛酸1年多。医诊慢性胃炎。始以西药止酸剂有效，但一停药即复如初，后又请中医以瓦楞、螵蛸、浙贝之属治之，亦时有减，但一停药即复如初。再改请某医诊治，云为胃寒，服1剂烧心即减，然再服则口舌生疮，后云其为胃热，然服药口疮减而烧心嘈杂则甚。细审其除嘈杂泛酸之外，并见口苦而干，舌苔薄白，脉弦涩不调。综合脉证，思之：此乃寒热夹杂，寒多热少之证也。为拟苦辛通降，热多寒少之剂。处方：半夏10克，黄连10克，干姜10克，肉桂10克，党参10克，甘草6克，大枣7个。
服药1剂，嘈杂泛酸即减；继服10剂，诸证消失，愈。
何××，女，46岁。
一年来，嘈杂泛酸，口苦口干。医诊慢性胃炎。先用西药治疗症稍减，但稍一停药，证复如初。又改用中药乌贼骨、瓦楞子之属治之，亦与西药相差无几。其后又遍请中医治疗，有云寒者，有云热者，但诸药仍不见效果。细审其证，除泛酸烧心外，并见口干，脉滑。因予半夏泻心汤。处方：半夏10克，黄连10克，黄芩10克，干姜10克，党参10克，甘草6克，大枣7个。服药4剂，诸证大减，继服20剂，愈。患者云：此方之药前医所开方中俱有，然其不效者何也?答曰：本病系寒热夹杂，热多寒少之证，故用寒多热少之药相伍为用，至于你所用方不效者，恐未顾及寒热多少之比例也。
3．但知从病，不知从证，久治不效战××，男，45岁。5年前，发现胃脘疼痛，食欲不振。医诊慢性胃炎，胃窦部溃疡。住院治疗1年多稍有好转而出院。出院后仍然时痛时止。在2年前的一次劳动过程中，突然胃脘疼痛不止，胸闷气短。急住某院。诊为慢性胃炎、溃疡病、冠心病、心绞痛。住院后，不管应用什么西药均引起恶心呕吐，服用什么中药都感到心烦难于忍受。细审其证，胸脘俱痛，腹微烦满，胸满气短，头晕头痛，心烦失眠，时时叹气，面色呈忧郁状，舌苔薄白，脉弦细而涩。综合脉证，思之：此肝脾不和，血虚气滞之证也。治宜疏肝养血，健脾和胃。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，干姜3克，薄荷4克，丹参15克，砂仁10克，檀香10克。
服药2剂，胃脘疼痛消减七八，头晕头痛，胸满胸痛，心烦气短等证亦减，继服上药30剂，诸证竟然均失。
某医云：本病治此伤彼，治彼伤此，难治之病也。而先生既不治胃，又不治心，而两者皆愈者何也?答曰：中医古代本无胃炎、溃疡病、冠心病之病名，而其治疗皆愈者何也?辨证论治也。此病从证、脉来看实属肝郁、血虚、脾虚三者为病，且有寒热夹杂，故以调和肝脾，养血之品得愈。
4．但知寒热，不知经络，病在厥阴，反治阳明，其病不愈
要××，女，65岁。
头胃俱痛，频繁呕吐6个月。医诊慢性胃炎急性发作，神经血管性头痛。先用西药治疗1个多月不效，后又邀中医以小柴胡汤、半夏泻心汤、二陈汤加减治疗5个月左右，亦无明显改善。细审其证，除头痛、胃痛、呕吐外并见足冷如冰，烦躁不安，视物不清，舌苔白，脉弦紧。综合脉证，思之：此厥阴头痛吴茱萸汤证也。治以温肝和胃，降逆止吐。处方：吴茱萸10克，人参10克，生姜10克，大枣12个。
服药1剂，头痛、胃痛、呕吐竞基本消失，继服2剂，愈。
某医云：喻嘉言《医门法律》云：不明脏腑经络，开口动手便错，即在此耳。余久久不信经方能治病，今视之果然神效也。
5．不知阴阳，不审气血，不知夹杂，不别虚实，难于奏效
戈××，男，40岁。
胃脘胀痛，纳呆食减，日渐消瘦3年多。医诊慢性胃炎、胃窦部溃疡。先用西药治疗其效不显，后又配合健脾和胃、温中健脾、活血逐瘀等剂，其效不著。细审其证，胃脘满痛，烦热嘈杂，食欲不振，疲乏无力，头晕头痛，心烦失眠，口燥咽干，形体瘦削，体重35千克，面色皓白，舌质嫩红，舌苔薄白，脉弦紧而重按无力。综合脉证，思之：此气阴两虚为本，气滞血瘀，脾湿不化为标。治以补气养阴以培本，理气活血，健脾燥湿以治标。处方：党参30克，麦冬12克，生地30克，苍术15克，白术10克，青皮10克，陈皮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6剂，胃脘胀痛，烧心嘈杂，心烦心悸．头晕失眠均减；继服上方26剂，诸证消失，体重增加。
消化性溃疡
1．谨察舌脉，辨证求因，知其病位，病始得治
郭××，男，成。
胃脘胀痛，食欲不振，疲乏无力，日渐消瘦3年多。医诊慢性胃炎、胃窦部溃疡。先以西药治疗1年多，效果不著，继又配合中药健脾温中亦未取得明显效果。细审其证，除胃脘满痛，烦热嘈杂，食欲不振，疲乏无力外，并见其头晕头痛，心烦失眠，口燥咽干，体瘦如柴(35千克)，面色皓白，舌质红，舌苔自，脉弦大紧重按无力。综合脉证，思之：面色皓白者，气阴两虚也；久痛胀满者，气滞血瘀也；脉弦大紧者，气阴俱虚，肝木失达，寒湿不化也。治宜补气养阴以治其本，理气活血，健脾燥湿以治其标。处方：党参30克，麦冬12克，生地30克，苍术15克，白术10克，陈皮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6剂，胃脘胀痛，烧心嘈杂，心烦心悸好转，继服24剂，诸证消失。
2．察其脉证，健脾温中，大补气血，病始得解
牛××，女，48岁。
胃脘疼痛8年。医诊溃疡病，慢性胃炎。发病开始，应用西药治疗有所改善，但半年之后不再继续有效，且日渐食欲不振，恶心呕吐，乃配合中药黄芪建中汤进行治疗，进药开始疼痛稍减，但不久疼痛又剧。又经某院检查治疗，诊为溃疡病、慢性胃炎、胃下垂。中、西药配合治疗2年多未见明显效果。近5年来，不但胃脘经常疼痛，而且月经经常淋漓不断，时见衄血、紫斑，血色素下降至5克％。某院诊为血小板减少性紫癜。3年前，又因生气而突发休克，其后每2～3个月即发生一次，这种情况虽然经过医院抢救可以转危为安，但病情却日重一日。最近一个多月来，胃脘持续不止的疼痛，衄血，崩漏，连续两次发生休克。细审其证，除上述之证外，并见面色萎黄，瘦削，形销骨立(26千克)，神志时昧时清，四肢厥冷，鼻尖、额、下颚亦冷，舌质淡暗，血压60／20mmHg，脉微欲绝。综合脉证，思之：病发于脾虚木乘，气血阴阳大衰，非健脾温中，补气养血，回阳救逆不可。乃拟健脾温中，大补气血，回阳救逆。处方：黄芪15克，肉桂10克，人参10克，白术10克，茯苓10克，炙甘草10克，当归10克，川芎10克，熟地10克，白芍10克，麦冬10克，半夏10克，附子10克，肉苁蓉15克，干姜3克，大枣5个。
服药1剂，神志转清，腹痛、呕吐、食纳好转；继服20剂，精神大增，食纳改善，出血停止；继服40剂，脘腹疼痛消失，体重增加5千克。为巩固效果，以上方加鹿茸3克。炼蜜为丸，每日3次，每次18克，共服1年，诸证全失，体重增至55千克。
某医云：为了抢救休克何不用四逆或人参四逆汤?答曰：本方已具人参四逆之药也，然何故不用单纯之人参四逆汤?因本病气血阴阳俱衰，若但补其阳，恐伤其阴，恐伤其血，故不仅以人参四逆以回阳救逆，且以大补气血之十全大补汤以益气血阴阳，故收效明显。
3．不审虚实，但胶于虚，久施补益，其病增剧
芮××，男，61岁。
胃脘疼痛10年多，耳鸣耳聋7年多。医诊慢性胃炎、溃疡病、神经性耳聋。为此曾反复住院治疗，但迄今无甚效果。细审其证，胃脘胀痛，吃l～2块饼干可稍缓和，吃4～5块即胀痛加甚，按之亦甚，心烦易怒，头晕头痛，两耳胀闷而聋，舌苔黄白，脉弦紧而数。综合脉证，思之：胃脘有压痛者，实也；稍食而痛减者，虚也；脉弦紧而数者，肝胃不和，实滞不化也。合而论之，乃肝胃不和，寒积不化。治宜疏肝和胃，温中导滞。处方：柴胡10克，半夏10克，党参10克，黄芩10克，干姜3克，甘草10克，大枣5个，枳实10克，厚朴10克，大黄3克。
服药3剂，脘痛停止，食纳增加，耳聋减轻。其后改为每周2剂，服药40天，诸证均失。
某医云：何如此之速效也?答曰：此病之所以延误病期者，乃未注意夹实之一证也，实邪一去，病即解也。
十二指肠壅积症
1．脾肾同病，阴阳俱损，当治子母，宜培阴阳，益一损二，终非其治
公××，男，45岁。
胃脘满痛，食后加重十几年。医诊胃窦部溃疡、十二指肠壅积症、慢性浅表性胃炎。某医始用西药疼痛好转，但久用以后不再见效；后又配合中药健脾温中，逐瘀散寒等治疗，仍是时轻时重；尤甚是近半年来，胃脘满痛更加严重。细审其证，除胃脘满痛之外，并见头晕脑胀，心烦心悸，口苦咽干。因思其证乃肝胃不和之证。拟予疏肝和胃。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜4片，大枣5枚，苍术10克，厚朴10克，陈皮10克。
服药4剂，诸证不减。再细寻其脉右见弦大而紧，尺脉尤大，左弦紧。因思久病者，尤当遵脉去辨证。脉弦大者阳虚寒甚也，右大于左脉者肺脾之虚而肝邪来乘也，尺脉者-肾与命门也，尺脉弦大紧者肾阳虚而寒水上冲也。两胁属肝，肝病者两胁满，而寒邪冲逆者亦见胁满此仲景早有论说。综其脉证论之，乃脾肾阳虚，寒水阻郁。前方之治或从脾，或从肝胃之不效者，乃未顾及肾命之故。脾与肾命为子母，为先后天，但治其子，不益其母，或益脾而损肾，非其治也。因拟温脾肾，利水湿。处方：附子10克，肉桂10克，党参10克，白术10克，干姜10克，甘草10克，生地10克，山药10克，山茱萸10克，泽泻10克，丹皮10克，茯苓10克。
服药3剂，诸证均减，继服10剂，脘腹胀痛消失，又服20剂，愈。
2．胃病治胃，不知标本，但从治标，延误病期
郑××，男，40岁。
4～5年来，胃脘胀痛，痛彻腰背，呕恶嗳气。医诊慢性胃炎、十二指肠壅积症。先用西药治疗效果不著，改请中医以疏肝和胃、健脾温中、降逆止呕、苦辛通降，以及甘淡辛平、大辛大热、芳香醒脾等法治之，亦无明显效果。细审其证，除胃脘胀痛，时轻时重，或痛彻腰背，或腰酸腰困之外，并见其形销骨立(体重30．5千克)，神疲烦乱，时或腹部悸动，恶心呕吐，舌苔白润，脉弦大紧，尺脉尤甚，手足厥冷。综合脉证思之：胃脘者脾胃之部也，腰者肾之腑也，此脾肾之疾俱在也。且见其肢冷，脉弦大紧，尺脉尤甚。脉证合参，脾肾虚寒，寒饮中阻之证也。拟温脾益肾，化饮利水。处方：生地10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，人参10克，白术10克，干姜10克，甘草10克。
服药3剂，脘腹胀痛，腰酸腰困俱减，恶心呕吐消失，继服30剂，诸证消失，体重增至45千克。
某位医生说：之前使用藿香正气散为什么没有效果？我回答说：藿香正气散虽然也有芳香化浊的药物和神曲，但其主要功效在于化浊。现在使用苏神煎，其消食化浊的力量相当，再加上针刺以导滞，其导滞的力量大于化浊，所以病就好了。医生又说：我在临床处方时只注重整体大局而不注重细节，只注重宏观而不注重微观，失败的情况很多，今后一定要牢记这一点。
慢性胃炎
1．寒热不分、病位不明，将热证误作寒证，将胃病误作肝病，难以见效
患者索某某，男，45岁。
胃脘部胀痛7～8个月。医生诊断为慢性肥厚性胃炎。先用西药治疗4个多月未见明显效果，随后又配合中药健脾和胃、温中健脾、疏肝健脾等法，也无明显改变。仔细审查其症状，疼痛以上腹部剑突下为主，按压时疼痛加剧，舌苔白，脉象浮滑。我想脉浮说明病在上焦，脉滑说明有痰实凝结。结合症状来看，这是痰热之邪结聚在胃脘部。张仲景《伤寒论》说：“小结胸病，病位正在心下（胃脘），按压则痛，脉浮滑的，用小陷胸汤主治。”《医宗金鉴》说：“黄连清除热邪，半夏引导水饮，瓜蒌滋润且下行。合用这些药物可以涤除胸膈间的痰热，开通胸膈的气机郁结。”这个病例正与此相符。于是拟定清热涤痰散结的治法。处方：瓜蒌40克，半夏10克，黄连6克，枳实10克。
服用1剂后，各种症状大幅减轻；继续服用4剂，所有症状消失，痊愈。
某位医生说：慢性胃炎为什么用治疗胃病的方法无效，而老师用小陷胸汤却取效呢？我回答说：从西医诊断看，此证是慢性肥厚性胃炎，其治疗规律是存在的，但由于兼杂症状很多，所以治疗起来就很复杂。因此我们必须随时注意随证施治，只有这样才能提高疗效。又问：为什么在小陷胸汤中加入枳实？我回答说：小陷胸汤加枳实的方子原本出自吴鞠通《温病条辨》，它原本用于“脉洪大滑数，面红身热头晕，不怕冷只怕热，舌上黄滑苔，口渴想喝冷饮，喝水不能解渴，得水则呕吐，按压胸下疼痛，小便短少，大便闭塞的，属于阳明暑温，水气结聚在胸膈。”而我根据其中黄连、瓜蒌清泄在里的热痰，半夏去除水痰并养胃，加入枳实，是取其苦辛通降的作用，开通幽门并引导水液下行，所以加入枳实。实践证明，其效果确实优于单纯的小陷胸汤。
2. 寒热夹杂，不审察比例，将热证误作寒证或将寒证误作热证，杂乱用药，始终不愈
患者支某某，男，成年。
嘈杂泛酸1年多。医生诊断为慢性胃炎。起初用西药止酸剂有效，但一停药就恢复如初，后来又请中医用瓦楞子、海螵蛸、浙贝母等药物治疗，也是时有减轻，但一停药就恢复如初。再改请另一位医生诊治，说是胃寒，服1剂烧心感即减轻，然而再服则口舌生疮，后来又说他是胃热，服药后面疮减轻但烧心嘈杂反而加重。仔细审查其症状，除了嘈杂泛酸之外，还见口苦而干，舌苔薄白，脉象弦涩不调。综合脉证思考：这是寒热夹杂，寒多热少的证候。于是拟定苦辛通降、针对热多寒少的方剂。处方：半夏10克，黄连10克，干姜10克，肉桂10克，党参10克，甘草6克，大枣7个。
服用1剂，嘈杂泛酸即减轻；继续服用10剂，所有症状消失，痊愈。
患者何某某，女，46岁。
一年来，嘈杂泛酸，口苦口干。医生诊断为慢性胃炎。先用西药治疗症状稍减，但稍一停药，症状又恢复如初。又改用中药乌贼骨、瓦楞子等治疗，也与西药相差无几。其后又遍请中医治疗，有的说是寒证，有的说是热证，但诸药仍不见效果。仔细审查其症状，除了泛酸烧心外，还见口干，脉滑。于是给予半夏泻心汤。处方：半夏10克，黄连10克，黄芩10克，干姜10克，党参10克，甘草6克，大枣7个。服用4剂，所有症状大幅减轻，继服20剂，痊愈。患者说：这个方子的药物前医开的方子中都有，为什么不生效呢？我回答说：本病属于寒热夹杂，热多寒少的证候，所以用寒多热少的药物相伍使用。至于你所用的方子不生效，恐怕是没有顾及寒热多少的比例吧。
3．只知道从病名治疗，不知道从证候治疗，久治不效
患者战某某，男，45岁。
5年前，发现胃脘疼痛，食欲不振。医生诊断为慢性胃炎，胃窦部溃疡。住院治疗1年多稍有好转而出院。出院后仍然时痛时止。在2年前的一次劳动过程中，突然胃脘疼痛不止，胸闷气短。急忙住进某医院。诊断为慢性胃炎、溃疡病、冠心病、心绞痛。住院后，不管应用什么西药均引起恶心呕吐，服用什么中药都感到心烦难于忍受。仔细审查其症状，胸脘俱痛，腹部微烦满，胸满气短，头晕头痛，心烦失眠，时时叹气，面色呈忧郁状，舌苔薄白，脉象弦细而涩。综合脉证思考：这是肝脾不和，血虚气滞的证候。治宜疏肝养血，健脾和胃。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，干姜3克，薄荷4克，丹参15克，砂仁10克，檀香10克。
服用2剂，胃脘疼痛消减七八成，头晕头痛，胸满胸痛，心烦气短等症状也减轻，继服上述药物30剂，所有症状竟然全部消失。
某位医生说：本病治这里伤那里，治那里伤这里，是难治的病。而先生既不治胃，又不治心，而两者都痊愈了，为什么呢？我回答说：中医古代本来没有胃炎、溃疡病、冠心病的病名，而其治疗皆痊愈的原因是什么呢？是因为辨证论治。此病从证、脉来看实属肝郁、血虚、脾虚三者致病，且有寒热夹杂，故以调和肝脾、养血的药物得以痊愈。
4．只知道寒热，不知道经络，病在厥阴经，反而治疗阳明经，病不愈
患者要某某，女，65岁。
头胃俱痛，频繁呕吐6个月。医生诊断为慢性胃炎急性发作，神经血管性头痛。先用西药治疗1个多月不效，后又邀中医用小柴胡汤、半夏泻心汤、二陈汤加减治疗5个月左右，也无明显改善。仔细审查其症状，除头痛、胃痛、呕吐外还见足冷如冰，烦躁不安，视物不清，舌苔白，脉象弦紧。综合脉证思考：这是厥阴头痛的吴茱萸汤证。治以温肝和胃，降逆止吐。处方：吴茱萸10克，人参10克，生姜10克，大枣12个。
服用1剂，头痛、胃痛、呕吐竟基本消失，继服2剂，痊愈。
某位医生说：喻嘉言《医门法律》说：不明脏腑经络，开口动手便错，就是指这种情况。我长久以来不相信经络能治病，现在看来果然神效。
5．不知阴阳，不审气血，不知夹杂，不别虚实，难于见效
患者戈某某，男，40岁。
胃脘胀痛，纳呆食减，日渐消瘦3年多。医生诊断为慢性胃炎、胃窦部溃疡。先用西药治疗其效不显，后又配合健脾和胃、温中健脾、活血逐瘀等剂，其效不著。仔细审查其症状，胃脘满痛，烦热嘈杂，食欲不振，疲乏无力，头晕头痛，心烦失眠，口燥咽干，形体瘦削，体重35千克，面色皓白，舌质嫩红，舌苔薄白，脉象弦紧而重按无力。综合脉证思考：这是气阴两虚为本，气滞血瘀，脾湿不化为标。治以补气养阴以培本，理气活血，健脾燥湿以治标。处方：党参30克，麦冬12克，生地30克，苍术15克，白术10克，青皮10克，陈皮10克，三棱10克，莪术10克，柴胡10克，薄荷3克，夜交藤30克。
服用6剂，胃脘胀痛，烧心嘈杂，心烦心悸，头晕失眠均减轻；继服上方26剂，所有症状消失，体重增加。
消化性溃疡
1．谨察舌脉，辨证求因，知其病位，病始得治
患者郭某某，男，成年。
胃脘胀痛，食欲不振，疲乏无力，日渐消瘦3年多。医生诊断为慢性胃炎、胃窦部溃疡。先以西药治疗1年多，效果不著，继又配合中药健脾温中亦未取得明显效果。仔细审查其症状，除胃脘满痛，烦热嘈杂，食欲不振，疲乏无力外，还见其头晕头痛，心烦失眠，口燥咽干，体瘦如柴(35千克)，面色皓白，舌质红，舌苔白，脉象弦大紧重按无力。综合脉证思考：面色皓白者，是气阴两虚；久痛胀满者，是气滞血瘀；脉弦大紧者，是气阴俱虚，肝木失达，寒湿不化。治宜补气养阴以治其本，理气活血，健脾燥湿以治其标。处方：党参30克，麦冬12克，生地30克，苍术15克，白术10克，陈皮10克，三棱10克，莪术10克，柴胡10克，薄荷3克，夜交藤30克。
服用6剂，胃脘胀痛，烧心嘈杂，心烦心悸好转，继服24剂，所有症状消失。
2．察其脉证，健脾温中，大补气血，病始得解
患者牛某某，女，48岁。
胃脘疼痛8年。医生诊断为溃疡病，慢性胃炎。发病开始，应用西药治疗有所改善，但半年之后不再继续有效，且日渐食欲不振，恶心呕吐，乃配合中药黄芪建中汤进行治疗，进药开始疼痛稍减，但不久疼痛又剧。又经某院检查治疗，诊为溃疡病、慢性胃炎、胃下垂。中、西药配合治疗2年多未见明显效果。近5年来，不但胃脘经常疼痛，而且月经经常淋漓不断，时见衄血、紫斑，血色素下降至5克％。某院诊断为血小板减少性紫癜。3年前，又因生气而突发休克，其后每2～3个月即发生一次，这种情况虽然经过医院抢救可以转危为安，但病情却日重一日。最近一个多月来，胃脘持续不止的疼痛，衄血，崩漏，连续两次发生休克。仔细审查其症状，除上述之证外，还见面色萎黄，瘦削，形销骨立(26千克)，神志时昧时清，四肢厥冷，鼻尖、额、下颚亦冷，舌质淡暗，血压60／20mmHg，脉微欲绝。综合脉证思考：病发于脾虚木乘，气血阴阳大衰，非健脾温中，补气养血，回阳救逆不可。于是拟定健脾温中，大补气血，回阳救逆。处方：黄芪15克，肉桂10克，人参10克，白术10克，茯苓10克，炙甘草10克，当归10克，川芎10克，熟地10克，白芍10克，麦冬10克，半夏10克，附子10克，肉苁蓉15克，干姜3克，大枣5个。
服用1剂，神志转清，腹痛、呕吐、食纳好转；继服20剂，精神大增，食纳改善，出血停止；继服40剂，脘腹疼痛消失，体重增加5千克。为巩固效果，以上方加鹿茸3克。炼蜜为丸，每日3次，每次18克，共服1年，所有症状全失，体重增至55千克。
某位医生说：为了抢救休克为何不用四逆汤或人参四逆汤？我回答说：本方已具备人参四逆汤的药物。然而为何不用单纯的人参四逆汤？因为本病气血阴阳俱衰，若只补其阳，恐怕伤其阴，恐怕伤其血，所以不仅用人参四逆汤来回阳救逆，且以大补气血的十全大补汤来益气血阴阳，故收效明显。
3．不审虚实，只固执于虚证，长期施用补益，其病增剧
患者芮某某，男，61岁。
胃脘疼痛10年多，耳鸣耳聋7年多。医生诊断为慢性胃炎、溃疡病、神经性耳聋。为此曾反复住院治疗，但迄今无甚效果。仔细审查其症状，胃脘胀痛，吃1～2块饼干可稍缓和，吃4～5块即胀痛加甚，按之亦甚，心烦易怒，头晕头痛，两耳胀闷而聋，舌苔黄白，脉象弦紧而数。综合脉证思考：胃脘有压痛者，属实；稍食而痛减者，属虚；脉弦紧而数者，是肝胃不和，实滞不化。合而论之，乃是肝胃不和，寒积不化。治宜疏肝和胃，温中导滞。处方：柴胡10克，半夏10克，党参10克，黄芩10克，干姜3克，甘草10克，大枣5个，枳实10克，厚朴10克，大黄3克。
服用3剂，脘痛停止，食纳增加，耳聋减轻。其后改为每周2剂，服药40天，所有症状均消失。
某位医生说：为何如此速效？我回答说：此病之所以延误病期，是因为未注意夹实这一证候，实邪一去，病即解也。
十二指肠壅积症
1．脾肾同病，阴阳俱损，当治子母，宜培阴阳，益一损二，终非其治
患者公某某，男，45岁。
胃脘满痛，食后加重十几年。医生诊断为胃窦部溃疡、十二指肠壅积症、慢性浅表性胃炎。某医生始用西药疼痛好转，但久用以后不再见效；后又配合中药健脾温中，逐瘀散寒等治疗，仍是时轻时重；尤甚是近半年来，胃脘满痛更加严重。仔细审查其症状，除胃脘满痛之外，还见头晕脑胀，心烦心悸，口苦咽干。我想其证乃是肝胃不和之证。拟予疏肝和胃。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜4片，大枣5枚，苍术10克，厚朴10克，陈皮10克。
服用4剂，所有症状不减。再仔细寻查其脉右脉见弦大而紧，尺脉尤其大，左脉弦紧。我想久病者，更应当遵循脉象去辨证。脉弦大者是阳虚寒甚，右脉大于左脉者是肺脾之虚而肝邪来乘，尺脉对应肾与命门，尺脉弦大紧者是肾阳虚而寒水上冲也。两胁属肝，肝病者两胁满，而寒邪冲逆者也见胁满，这仲景早有论述。综其脉证论之，乃是脾肾阳虚，寒水阻郁。前方之治或从脾，或从肝胃的不效，是因为未顾及肾命的原因。脾与肾命为子母关系，为先后天，但治其子，不益其母，或益脾而损肾，都不是正确的治法。于是拟定温脾肾，利水湿。处方：附子10克，肉桂10克，党参10克，白术10克，干姜10克，甘草10克，生地10克，山药10克，山茱萸10克，泽泻10克，丹皮10克，茯苓10克。
服用3剂，所有症状均减轻，继服10剂，脘腹胀痛消失，又服20剂，痊愈。
2．胃病治胃，不知标本，但从治标，延误病期
患者郑某某，男，40岁。
4～5年来，胃脘胀痛，痛彻腰背，呕恶嗳气。医生诊断为慢性胃炎、十二指肠壅积症。先用西药治疗效果不著，改请中医以疏肝和胃、健脾温中、降逆止呕、苦辛通降，以及甘淡辛平、大辛大热、芳香醒脾等法治之，也无明显效果。仔细审查其症状，除胃脘胀痛，时轻时重，或痛彻腰背，或腰酸腰困之外，还见其形销骨立(体重30．5千克)，神疲烦乱，时或腹部悸动，恶心呕吐，舌苔白润，脉象弦大紧，尺脉尤其甚，手足厥冷。综合脉证思考：胃脘是脾胃之部，腰是肾之腑，这是脾肾之疾俱在。且见其肢冷，脉弦大紧，尺脉尤其甚。脉证合参，是脾肾虚寒，寒饮中阻之证。拟温脾益肾，化饮利水。处方：生地10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，人参10克，白术10克，干姜10克，甘草10克。
服用3剂，脘腹胀痛，腰酸腰困俱减，恶心呕吐消失，继服30剂，所有症状消失，体重增至45千克。
A physician asked: "Why did the previous use of Huoxiang Zhengqi San (Agaricus Decoction) fail?" I replied: "Although Huoxiang Zhengqi San contains aromatic herbs that transform turbidity and Shenqu (Medicated Leaven), its primary action is transforming turbidity. The current prescription, Suchen Jian (Perilla and Medicated Leaven Decoction), has a similar power in resolving food stagnation and transforming turbidity. However, combined with acupuncture to guide out stagnation, its power to resolve stagnation exceeds that of transforming turbidity; therefore, the patient recovered." The physician further stated: "In my clinical practice, I have focused on the macroscopic and general aspects while neglecting the microscopic and specific details, leading to many failures. I must keep this in mind henceforth."
Chronic Gastritis
1. Failure to distinguish cold from heat and unclear disease location, mistaking heat for cold and stomach disorders for liver disorders, leads to ineffectiveness.
Patient Su XX, male, 45 years old.
Epigastric distending pain for 7-8 months. Diagnosed by doctors as chronic hypertrophic gastritis. Western medicine treatment for over 4 months showed no obvious effect. Subsequent TCM treatments focusing on strengthening the spleen and harmonizing the stomach, warming the middle and strengthening the spleen, and soothing the liver and strengthening the spleen also yielded no significant changes. Upon careful examination of the symptoms, the pain was mainly located in the upper abdomen below the xiphoid process, worsening upon pressure. The tongue coating was white, and the pulse was floating and slippery. I reasoned that a floating pulse indicates pathology in the upper jiao (upper burner), and a slippery pulse indicates phlegm-solid accumulation. Correlating with the symptoms, this is phlegm-heat pathogen binding in the epigastrium. Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage Diseases) states: "In minor chest-abdominal bind disease, the location is exactly at the heart-bottom (epigastrium); pressing causes pain, and if the pulse is floating and slippery, Xiao Xianxiong Tang (Minor Chest Bind Decoction) should be used." *Yizong Jinjian* (Golden Mirror of Medical Tradition) states: "Huanglian (Coptis Rhizome) clears heat, Banxia (Pinellia Tuber) guides out fluid retention, and Gualou (Trichosanthes Fruit) moistens and descends. Combined, they clear phlegm-heat from the chest-diaphragm and open qi stagnation in the chest-diaphragm." This case fits perfectly. Thus, I prescribed clearing heat, resolving phlegm, and dissipating nodules. Prescription: Gualou 40g, Banxia 10g, Huanglian 6g, Zhishi 10g.
After one dose, all symptoms decreased significantly; after four more doses, all symptoms disappeared, and the patient recovered.
Another physician asked: "Why did standard gastric treatments fail for chronic gastritis, but your use of Xiao Xianxiong Tang succeeded?" I replied: "From a Western medical perspective, this is chronic hypertrophic gastritis, which has established treatment protocols. However, due to numerous mixed syndromes, treatment becomes complex. Therefore, we must always adapt treatment to the changing syndrome to improve efficacy. Why add Zhishi (Immature Bitter Orange) to Xiao Xianxiong Tang?" I answered: "The formula of Xiao Xianxiong Tang plus Zhishi originates from Wu Jutong's *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases). It was originally indicated for 'pulse surging, large, and slippery; red face, body fever, dizziness; aversion to cold absent but aversion to heat present; yellow and slippery tongue coating; thirst for cold drinks without relief; vomiting upon drinking; pain upon pressing the lower chest; short urine; constipation; belonging to Yangming Summerheat-Warmth, with water binding in the chest.' Based on Huanglian and Gualou clearing internal phlegm-heat, Banxia removing fluid-phlegm and nourishing the stomach, I added Zhishi for its bitter-pungent descending nature to open the pylorus and guide water downward. Clinical practice proves its efficacy superior to Xiao Xianxiong Tang alone."
2. Mixed cold and heat, failure to assess proportions, mistaking heat for cold or cold for heat, indiscriminate medication, resulting in non-healing.
Patient Zhi XX, male, adult.
Stomach discomfort with acid regurgitation for over 1 year. Diagnosed as chronic gastritis. Initially, Western antacids were effective, but symptoms returned immediately upon cessation. Later, TCM using Walengzi (Arca Shell), Piaoxiao (Cuttlebone), and Zhebeimu (Fritillaria Bulb) provided temporary relief, but symptoms recurred upon stopping medication. Another doctor diagnosed it as stomach cold; one dose reduced heartburn, but subsequent doses caused mouth and tongue ulcers. Later diagnosed as stomach heat; ulcers subsided, but heartburn and discomfort worsened. Careful examination revealed, besides discomfort and acid regurgitation, bitter taste and dryness in the mouth, thin white tongue coating, and wiry, choppy, irregular pulse. Synthesizing pulse and symptoms: this is a mixed cold-heat syndrome, predominantly cold with slight heat. I prescribed a bitter-pungent descending formula targeting slightly more heat than cold. Prescription: Banxia 10g, Huanglian 10g, Ganjiang (Dried Ginger) 10g, Rougui (Cinnamon Bark) 10g, Dangshen (Codonopsis Root) 10g, Gancao (Licorice Root) 6g, Dazao (Jujube Fruit) 7 pieces.
After one dose, discomfort and acid regurgitation decreased; after ten more doses, all symptoms disappeared, and the patient recovered.
Patient He XX, female, 46 years old.
For one year, stomach discomfort with acid regurgitation, bitter and dry mouth. Diagnosed as chronic gastritis. Western medicine provided slight relief, but symptoms recurred upon stopping. TCM using Haihesu (Cuttlebone) and Walengzi provided little difference from Western medicine. Various TCM practitioners diagnosed either cold or heat, but medications were ineffective. Careful examination revealed, besides acid regurgitation and heartburn, dry mouth and slippery pulse. I prescribed Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium). Prescription: Banxia 10g, Huanglian 10g, Huangqin (Scutellaria Root) 10g, Ganjiang 10g, Dangshen 10g, Gancao 6g, Dazao 7 pieces. After four doses, symptoms decreased significantly; after twenty more doses, the patient recovered. The patient asked: "Previous doctors prescribed these same herbs, why did they fail?" I replied: "This disease is a mixed cold-heat syndrome, predominantly heat with slight cold. Therefore, herbs with more cold than heat properties are combined. Your previous prescriptions likely failed because they did not account for the proportion of cold versus heat."
3. Knowing only to treat the disease name, not the syndrome, leading to long-term ineffectiveness.
Patient Zhan XX, male, 45 years old.
Five years ago, epigastric pain and loss of appetite appeared. Diagnosed as chronic gastritis and gastric antrum ulcer. Hospitalization for over a year brought slight improvement. Post-discharge, pain persisted intermittently. Two years ago, during labor, sudden unceasing epigastric pain, chest tightness, and shortness of breath occurred. Emergency admission led to diagnoses of chronic gastritis, peptic ulcer, coronary heart disease, and angina pectoris. In the hospital, any Western medicine caused nausea and vomiting; any TCM caused unbearable irritability. Careful examination revealed pain in both chest and epigastrium, mild abdominal irritability and fullness, chest fullness, shortness of breath, dizziness, headache, irritability, insomnia, frequent sighing, depressed facial expression, thin white tongue coating, and wiry, fine, and choppy pulse. Synthesizing pulse and symptoms: this is Liver-Spleen disharmony with blood deficiency and qi stagnation. Treatment should soothe the liver, nourish blood, strengthen the spleen, and harmonize the stomach. Prescription: Chaihu (Bupleurum Root) 10g, Danggui (Angelica Sinensis Root) 10g, Baishao (White Peony Root) 10g, Baizhu (Atractylodes Macrocephala Rhizome) 10g, Gancao 10g, Ganjiang 3g, Bohe (Mint Herb) 4g, Danshen (Salvia Miltiorrhiza Root) 15g, Sharen (Amomum Fruit) 10g, Tanxiang (Sandalwood Wood) 10g.
After two doses, epigastric pain decreased by 70-80%; dizziness, headache, chest fullness/pain, irritability, and shortness of breath also improved. After thirty more doses, all symptoms vanished.
A physician asked: "This disease is difficult to treat as treating one part harms another. How did you cure both the stomach and heart without directly targeting them?" I replied: "Ancient TCM had no names for gastritis, peptic ulcer, or coronary heart disease. The cure lies in syndrome differentiation and treatment. From the syndrome and pulse, this disease involves Liver Qi Stagnation, Blood Deficiency, and Spleen Deficiency, with mixed cold and heat. Harmonizing the Liver and Spleen and nourishing blood led to recovery."
4. Knowing only cold and heat, not meridians; disease in Jueyin Meridian treated as Yangming Meridian, resulting in non-healing.
Patient Yao XX, female, 65 years old.
Headache and stomach pain with frequent vomiting for 6 months. Diagnosed as acute exacerbation of chronic gastritis and neurovascular headache. Western medicine for over a month was ineffective. TCM with Xiaochaihu Tang (Minor Bupleurum Decoction), Banxia Xiexin Tang, and Erchen Tang (Two Aged Things Decoction) modified for about 5 months showed no obvious improvement. Careful examination revealed, besides headache, stomach pain, and vomiting, ice-cold feet, restlessness, blurred vision, white tongue coating, and wiry-tight pulse. Synthesizing pulse and symptoms: this is Jueyin headache, indicated for Wuzhuyu Tang (Evodia Decoction). Treatment: warm the liver, harmonize the stomach, direct rebellious qi downward, and stop vomiting. Prescription: Wuzhuyu (Evodia Fruit) 10g, Renshen (Ginseng Root) 10g, Shengjiang (Fresh Ginger) 10g, Dazao 12 pieces.
After one dose, headache, stomach pain, and vomiting basically disappeared; after two more doses, the patient recovered.
A physician commented: "Yu Jiayan's *Yimen Falv* (Medical Laws) states: 'If one does not understand the zang-fu organs and meridians, every action is wrong.' This applies here. I long disbelieved that meridians could heal diseases, but now I see their miraculous efficacy."
5. Ignorance of yin-yang, failure to assess qi-blood, unawareness of mixed pathogens, inability to distinguish deficiency-excess, leading to ineffectiveness.
Patient Ge XX, male, 40 years old.
Epigastric distending pain, poor appetite, and progressive emaciation for over 3 years. Diagnosed as chronic gastritis and gastric antrum ulcer. Western medicine was ineffective. TCM focusing on strengthening the spleen, warming the middle, invigorating blood, and eliminating stasis also lacked efficacy. Careful examination revealed epigastric fullness and pain, irritability and discomfort, poor appetite, fatigue, dizziness, headache, irritability, insomnia, dry mouth and throat, emaciated body (35 kg), pale complexion, tender-red tongue body, thin white tongue coating, and wiry-tight pulse powerless upon heavy pressure. Synthesizing pulse and symptoms: the root is Qi-Yin deficiency; the branch is qi stagnation, blood stasis, and spleen dampness failing to transform. Treatment: tonify qi and nourish yin to support the root; regulate qi, invigorate blood, strengthen spleen, and dry dampness to treat the branch. Prescription: Dangshen 30g, Maidong (Ophiopogon Tuber) 12g, Shengdi (Rehmannia Root) 30g, Cangzhu (Atractylodes Lancea Rhizome) 15g, Baizhu 10g, Qingpi (Green Tangerine Peel) 10g, Chenpi (Aged Tangerine Peel) 10g, Sanleng (Sparganium Tuber) 10g, Ezhu (Curcuma Rhizome) 10g, Chaihu 10g, Bohe 3g, Yejiaoteng (Polygonum Multiflorum Vine) 30g.
After six doses, epigastric distending pain, heartburn, irritability, palpitations, dizziness, and insomnia decreased; after twenty-six more doses, all symptoms disappeared, and weight increased.
Peptic Ulcer
1. Carefully observing tongue and pulse, differentiating syndrome to find etiology, knowing the disease location, allows treatment to succeed.
Patient Guo XX, male, adult.
Epigastric distending pain, poor appetite, fatigue, and progressive emaciation for over 3 years. Diagnosed as chronic gastritis and gastric antrum ulcer. Western medicine for over a year was ineffective. TCM strengthening the spleen and warming the middle also failed. Careful examination revealed, besides epigastric fullness/pain, irritability/discomfort, poor appetite, and fatigue, dizziness, headache, irritability, insomnia, dry mouth/throat, emaciated body (35 kg), pale complexion, red tongue body, white tongue coating, and wiry-large-tight pulse powerless upon heavy pressure. Synthesizing pulse and symptoms: pale complexion indicates Qi-Yin deficiency; long-standing pain and fullness indicate qi stagnation and blood stasis; wiry-large-tight pulse indicates dual Qi-Yin deficiency, Liver Wood failing to course freely, and cold-dampness failing to transform. Treatment: tonify qi and nourish yin for the root; regulate qi, invigorate blood, strengthen spleen, and dry dampness for the branch. Prescription: Dangshen 30g, Maidong 12g, Shengdi 30g, Cangzhu 15g, Baizhu 10g, Chenpi 10g, Sanleng 10g, Ezhu 10g, Chaihu 10g, Bohe 3g, Yejiaoteng 30g.
After six doses, epigastric distending pain, heartburn, irritability, and palpitations improved; after twenty-four more doses, all symptoms disappeared.
2. Observing pulse and syndrome, strengthening spleen and warming the middle, greatly tonifying qi and blood, allows the disease to resolve.
Patient Niu XX, female, 48 years old.
Epigastric pain for 8 years. Diagnosed as peptic ulcer and chronic gastritis. Initial Western medicine improved symptoms, but ceased being effective after half a year, accompanied by progressive poor appetite, nausea, and vomiting. Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) was added; initially reducing pain slightly, but pain intensified shortly after. Further diagnosis included peptic ulcer, chronic gastritis, and gastroptosis. Combined TCM and Western medicine for over 2 years showed no obvious effect. For the past 5 years, frequent epigastric pain was accompanied by prolonged menstrual bleeding, occasional epistaxis, purpura, and hemoglobin dropping to 5 g%. Diagnosed as thrombocytopenic purpura. Three years ago, anger triggered sudden shock, recurring every 2-3 months. Although hospital rescue stabilized the condition, the disease worsened daily. For over a month recently, continuous epigastric pain, epistaxis, metrorrhagia, and two consecutive shocks occurred. Careful examination revealed, besides above symptoms, sallow emaciated appearance (26 kg), fluctuating consciousness, cold extremities, cold nose tip/forehead/chin, pale-dark tongue body, BP 60/20 mmHg, and faint pulse nearly imperceptible. Synthesizing pulse and symptoms: the disease stems from Spleen Deficiency with Liver Overacting, severe depletion of qi, blood, yin, and yang. Only strengthening the spleen, warming the middle, tonifying qi and blood, and rescuing yang can suffice. Prescription: Huangqi (Astragalus Root) 15g, Rougui 10g, Renshen 10g, Baizhu 10g, Fuling (Poria) 10g, Zhigancao (Prepared Licorice Root) 10g, Danggui 10g, Chuanxiong (Ligusticum Rhizome) 10g, Shudi (Prepared Rehmannia Root) 10g, Baishao 10g, Maidong 10g, Banxia 10g, Fuzi (Aconite Lateral Root) 10g, Roushouyu (Cistanche Stem) 15g, Ganjiang 3g, Dazao 5 pieces.
After one dose, consciousness cleared, abdominal pain/vomiting/appetite improved; after twenty more doses, spirit greatly increased, appetite improved, bleeding stopped; after forty more doses, epigastric/abdominal pain disappeared, weight increased by 5 kg. To consolidate effects, Luzhu (Deer Antler) 3g was added to the formula, made into honey pills, taken three times daily, 18g each time, for one year. All symptoms vanished, weight reached 55 kg.
A physician asked: "Why not use Sini Tang (Reverse Cold Decoction) or Renshen Sini Tang for shock rescue?" I replied: "This formula already contains the ingredients of Renshen Sini Tang. However, why not use pure Renshen Sini Tang? Because this disease involves dual depletion of qi, blood, yin, and yang. Tonifying only yang might injure yin and blood. Thus, not only did I use Renshen Sini Tang to rescue yang, but also Shiquan Dabu Tang (Ten Complete Great Tonification Decoction) to benefit qi, blood, yin, and yang, yielding obvious results."
3. Failure to assess deficiency-excess, sticking rigidly to deficiency, long-term tonification aggravates the disease.
Patient Rui XX, male, 61 years old.
Epigastric pain for over 10 years, tinnitus and deafness for over 7 years. Diagnosed as chronic gastritis, peptic ulcer, and neural deafness. Repeated hospitalizations yielded no significant effect. Careful examination revealed epigastric distending pain, slight relief after eating 1-2 biscuits, worsening after 4-5 biscuits, tenderness upon pressure, irritability, dizziness, headache, bilateral ear fullness and deafness, yellow-white tongue coating, and wiry-tight-rapid pulse. Synthesizing pulse and symptoms: epigastric tenderness indicates excess; pain relief upon slight eating indicates deficiency; wiry-tight-rapid pulse indicates Liver-Stomach disharmony and stagnation failing to transform. Overall, this is Liver-Stomach disharmony with cold accumulation failing to transform. Treatment: soothe the liver, harmonize the stomach, warm the middle, and guide out stagnation. Prescription: Chaihu 10g, Banxia 10g, Dangshen 10g, Huangqin 10g, Ganjiang 3g, Gancao 10g, Dazao 5 pieces, Zhishi 10g, Houpo (Magnolia Bark) 10g, Dahuang (Rhubarb Root) 3g.
After three doses, epigastric pain stopped, appetite increased, deafness lessened. Thereafter, two doses per week for 40 days resulted in disappearance of all symptoms.
A physician asked: "Why such rapid efficacy?" I replied: "The delay in this disease was due to ignoring the aspect of excess pathogen. Once the excess pathogen is removed, the disease resolves."
Duodenal Obstruction
1. Simultaneous involvement of Spleen and Kidney, damage to both yin and yang, treating the child-mother relationship, cultivating yin and yang; benefiting one while damaging two is ultimately incorrect treatment.
Patient Gong XX, male, 45 years old.
Epigastric fullness and pain, worsening after meals, for over ten years. Diagnosed as gastric antrum ulcer, duodenal obstruction, and chronic superficial gastritis. Western medicine initially relieved pain but became ineffective over time. TCM strengthening the spleen, warming the middle, invigorating blood, and dispelling cold yielded fluctuating results. Recently, for half a year, epigastric fullness and pain worsened significantly. Careful examination revealed, besides epigastric fullness/pain, dizziness, brain distension, irritability, palpitations, bitter taste, and dry throat. I reasoned this was Liver-Stomach disharmony. Prescribed soothing the liver and harmonizing the stomach. Prescription: Chaihu 10g, Banxia 10g, Huangqin 10g, Dangshen 10g, Gancao 6g, Shengjiang 4 slices, Dazao 5 pieces, Cangzhu 10g, Houpo 10g, Chenpi 10g.
After four doses, symptoms did not decrease. Re-examining the pulse: right side wiry-large-tight, especially large at the chi (cun-kou) position; left side wiry-tight. I reasoned that for chronic illness, one must follow the pulse to differentiate syndrome. Wiry-large pulse indicates yang deficiency and severe cold; right larger than left indicates Lung-Spleen deficiency with Liver pathogen overacting; chi position corresponds to Kidney and Mingmen (Gate of Life); wiry-large-tight chi pulse indicates Kidney Yang deficiency with cold water rushing upward. The hypochondrium belongs to the Liver; Liver disease causes hypochondriac fullness, and cold pathogen rushing upward also causes hypochondriac fullness, as discussed by Zhang Zhongjing. Synthesizing pulse and symptoms: this is Spleen-Kidney Yang deficiency with cold-water obstruction and depression. Previous treatments focusing on Spleen or Liver-Stomach failed because they neglected the Kidney-Mingmen. Spleen and Kidney-Mingmen are mother-child and pre/post-heaven relationships. Treating only the child without benefiting the mother, or benefiting the Spleen while damaging the Kidney, is incorrect. Prescribed warming Spleen-Kidney and promoting water-dampness drainage. Prescription: Fuzi 10g, Rougui 10g, Dangshen 10g, Baizhu 10g, Ganjiang 10g, Gancao 10g, Shengdi 10g, Shanyao (Chinese Yam Rhizome) 10g, Shanzhuyu (Cornus Fruit) 10g, Zexie (Alisma Rhizome) 10g, Danpi (Moutan Cortex) 10g, Fuling 10g.
After three doses, all symptoms decreased; after ten more doses, epigastric/abdominal distending pain disappeared; after twenty more doses, the patient recovered.
2. Treating stomach disease by treating the stomach, unaware of root and branch, treating only the branch delays the disease course.
Patient Zheng XX, male, 40 years old.
For 4-5 years, epigastric distending pain radiating to the back, belching, and nausea. Diagnosed as chronic gastritis and duodenal obstruction. Western medicine was ineffective. TCM treatments including soothing liver-harmonizing stomach, strengthening spleen-warming middle, directing rebellious qi downward-stopping vomiting, bitter-pungent descending, sweet-bland-pungent-neutral, great-pungent-great-hot, and aromatic awakening spleen methods showed no obvious effect. Careful examination revealed, besides epigastric distending pain (fluctuating severity, radiating to back, or causing back soreness/heaviness), emaciated appearance (30.5 kg), mental fatigue and agitation, occasional abdominal pulsations, nausea, vomiting, white-moist tongue coating, wiry-large-tight pulse especially prominent at chi position, and cold hands and feet. Synthesizing pulse and symptoms: the epigastrium is the region of Spleen and Stomach; the waist is the mansion of the Kidney; thus, Spleen-Kidney disease is present. Coupled with cold limbs and wiry-large-tight chi pulse, this is Spleen-Kidney deficiency-cold with cold-fluid obstruction in the middle. Prescribed warming Spleen, benefiting Kidney, resolving fluid, and promoting water drainage. Prescription: Shengdi 10g, Shanyao 10g, Shanzhuyu 10g, Fuling 10g, Zexie 10g, Danpi 10g, Fuzi 10g, Rougui 10g, Renshen 10g, Baizhu 10g, Ganjiang 10g, Gancao 10g.
After three doses, epigastric/abdominal distending pain and back soreness/heaviness decreased, nausea/vomiting disappeared; after thirty more doses, all symptoms disappeared, weight increased to 45 kg.