肝炎痊愈后4年多来，经常腹满胀痛，大便不解。医先用西药缓泻剂有效，但久用之后不再见效。后又改请中医以行气消胀、除湿清热，理气通便之剂治疗3年多，其效亦不显著。细审其腹满胀痛以午后至夜间为甚，上午轻减，大便一般3。7天一次，大便不甚于结，疲乏无力，下肢沉重微肿，舌苔薄白，脉濡缓。综合脉证，思之：腹胀下午至夜间加重者寒湿也，阳虚也；疲乏无力，下肢沉重者气虚也，湿也；脉濡缓者气虚寒湿也。证脉合参而论之，乃阳气虚衰，湿郁不化，升降失职所为也。因拟健脾益气，升阳降阴。处方：厚朴1克，附子0．3克，当归0．2克，吴茱萸1克，麻黄0．1克，半夏l克，毕澄茄0．2克，升麻0．1克，木香0．2克，干姜0．2克，草果0．2克，黄芪3克，党参2克，茯苓0．1克，益智仁0．1克。
服药1剂，腹胀腹痛好转，大便一行；继服3剂，大便转为正常。
某医云：何用此小剂?答曰：《内经》曾大倡壮火散气，少火生气之论，故东垣治虚实夹杂之虚劳证常以小剂予之，以恐药物过剂而伤正气耳。本证正虚邪微但宜微扶正气，稍佐祛邪，故以小剂予之。事实证明，药少力宏，果然得愈。
7．湿凝气阻，三焦俱闭，反以寒凉滋腻，经久不愈
廖××，女，30岁。
从l岁开始即经常大便秘结，开始时每隔3天服一次缓泻药即可排便，其后效果越来越不明显，改用麻仁滋脾丸以后，有1—2年大便比较通畅。但最近2年以来，大便秘结越来越重，每次排便不用大承气汤，即用灌肠法，才能暂时缓解。细审其证，除大便秘结者外，并见其面色萎黄，舌苔薄白，脉濡缓。综合脉证思之：此乃湿凝气阻，三焦俱闭之证也，治宜拟补火除湿通便。处方：半硫丸，1次3克，1日2次。后果愈。
因思吴鞠通《温病条辨》云：“湿伤气者，肺主天气，脾主地气，俱属太阴湿土，湿气太过，反伤本脏化气，湿久浊凝，至于下焦，气不惟伤而且阻矣。气为湿阻，故二便不通，今人之通大便，悉用大黄，不知大黄性寒，主热结有形之燥粪；若湿阻无形之气，气既伤而且阻，非温补真阳不可。硫黄热而不燥，能理大肠，半夏能人阴，燥胜湿，辛下气，温开郁，三焦通而二便利矣……盖肾司二便，肾中真阳为湿所困，久而弥虚，失其本然之职，故助以硫黄；肝主疏泄，风湿相为胜负，风胜则湿行，湿凝则风息，而失其疏泄之能，故通之以半夏。”
腹泻
1．气阴俱虚，肝木失达，反作虚寒，久施温化
张××，女，52岁。
腹泻20年左右。医诊慢性胃炎、慢性肠炎。先用西药治疗数年不效，继又配合中药健脾温中，疏肝健脾，温补脾肾、消食和胃等剂与参苓白术散、四神丸、附子理中丸、补中益气丸等进行治疗数年亦不效。细审其证见大便一日10余次，粪质稀溏呈不消化状，胸胁时痛，胃脘痞满，胸闷心烦，舌苔薄白，脉弦而大，左脉大于右脉。综合脉证，思之：久泻近20年，可谓久矣，久泻多为虚寒，或为脾，或为肾，然脾肾俱治反而不愈，其故何也?何不求之于脉。因而又思脉大者气阴俱虚也，右脉大于左脉者虚也，今左脉反大于右脉，左脉者肝邪也，综而论之，此病既虚且实，既有气阴之不足，又有肝实之乘脾。因拟补气养阴以扶正，疏肝抑肝以祛邪。处方：党参30克，麦冬10克，生地30克，苍术15克，白术10克，陈皮10克，青皮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3剂，大便转为1日2行，他证亦减；继服上方10剂，不但大便转为1日1次，且他证亦大部消失。
某医云：久泻者诸书均云宜用健脾，补肾，久秘者诸书均云宜养阴润便，而今反用其反者何也?答曰：久泻者补脾肾，久秘者养阴增液此法之常也，养阴益气者法之变也，变者为何?宗脉证也。今脉大，大者或为气阴俱虚，或为气血俱虚，其阴虚、血虚因何而起，久泻也，用药也。本病既已阴伤就当补其阴，然又恐滋之太过而加健脾燥湿，使其扶阴之正而不生湿邪也。又且肝脾同病，故再酌治肝邪以助脾。
2．兼症不明，比例不分，或补或泻，或温或寒，其效遥期
邢××，女，41岁。
腹泻2年，医始诊为细菌性痢疾，予西药治疗10天后明显好转，但继续治疗时反而日渐加重。半年后，改请中医治疗，始以清热止痢不效，继予健脾温中、健脾和胃、温补脾肾、补中益气等亦不效。细察其证，除泄泻，一日3。5次外，并见有里急后重，纳呆食减，脘腹隐隐作痛，疲乏无力，舌苔白，脉细缓。综合脉证，诊为脾胃虚衰，治以健脾益气。处方：党参10克，茯苓10克，白术10克，扁豆10克，陈皮10克，山药15克，甘草6克，莲子10克，砂仁10克，炒苡米15克，桔梗6克，大枣5个。
服药10剂，寸效未见。再查前医诸方有用四神者，有用真人养脏者，有用参苓白术者，有用连理汤者，有用健脾者，然均不效。再询其证，除上述者外，并见有食后脘腹胀满加剧，吃冷食后腹痛即作，吃热药一久即口干舌燥，舌苔黄白，面色萎黄，脉细缓。综合脉证，思之：证脉均系脾虚无疑，然兼挟食滞不化，寒热交结，寒多热少之证耳。又思：治病虽要主要看主流用方，但兼证不可不顾及耳。因拟健脾益气为主，酌加消食和胃，苦辛通降之品。党参10克，茯苓10克，白术10克，扁豆10克，陈皮10克，山药15克，甘草6克，莲子10克，砂仁10克，蔻仁6克，炒苡米15克，桔梗6克，枳实6克，焦三仙各10克，吴茱萸6克，黄连4克，大枣3个，补骨脂3克。
服药4剂，大便次数减为每日1次，里急后重感消减90％，饮食增加，继服20剂，愈。
因忆《毛泽东选集》曾云：党委会的工作方法犹如弹钢琴者，中药处方亦应弹奏合适耳。
肝硬化
1．寒热胶结、水饮停聚，但用攻逐，或用利水，斡旋不能，水聚不散
邹××，男，50岁。
腹胀腹水2个多月。医诊肝硬化腹水。先用西药治疗曾一度明显好转，但不久又复发如初，其后再用西药治疗就不继续好转。乃改为中药治疗，始用利水不效，继又用攻逐之法亦不效。细审其证见腹部胀大，但按之不硬不痛，下肢轻度浮肿，舌质稍红，舌苔黄腻，脉弦紧。综合脉证，思之：脉弦紧者寒饮停聚也，舌质红而苔黄腻者湿热蕴结也。合之于证，此乃寒饮蕴结，久蕴化热，水气结聚于中。治宜辛温通阳，苦寒燥湿，斡旋阴阳，利其水湿。处方：防己40克，桂枝12克，苍术30克，白术15克，生石膏20克，茯苓15克。
某医云：甘遂、芫花、大戟均峻厉之剂，尚且无功，其用轻淡之品能取功乎?答曰：本方虽无攻逐之剧药，然却有上清肺金之石膏，中有苍术、白术之燥湿，下有茯苓之利水，且防己苦寒有斡旋气机之功，桂枝配防己有激荡水气之力，故胶结之痰饮、水气非此不解。
服药2剂，腹胀、浮肿均减；继服4剂，尿量明显增多；又服10剂，腹胀浮肿消失。
2．正虚邪实，但知攻伐，其病反复
郭××，男，50岁。
腹胀腹水2个多月，医诊肝硬化腹水。先用西药治疗10天无明显效果，继又配合中药攻逐利水等剂，仍然时轻时重。审其腹大如鼓，青筋外露，按之硬，脉弦缓。综合脉证，思之：此证虽兼虚而大实为主，宜先攻逐以除水邪。处方：甘遂4．5克，芫花4．5克，大戟4．5克。
共为细末，荞面糊为丸，大枣10个煎汤送服。
患者云：此类方药已经服过，然仅能痛快于一时，难道医生无他法救治吾病乎?答曰：从现在的病证来看仍以实证为主，故仍宜攻逐之剂，至于他法问题，．可随证观察之。
上药服后不久即微恶心欲吐，但没有吐出，数小时后开始泄泻，前后泻下6次，泻后次日即见腹胀好转。再察其脉仍为弦缓。因思脉弦者肝脉也，缓者脾虚湿盛也，合之于证，乃气血俱虚为本，气滞血瘀，水湿不化为标。宜补气养血以培本，理气活血，燥湿利水以治其标。处方：黄芪30克，人参10克，丹参30克，当归10克，苍术15克，白术10克，三棱10克，莪术10克，生地10克，黄精10克，青皮10克，陈皮10克，柴胡10克，薄荷3克，夜交藤30克，莱菔子10克，砂仁10克。
服药3剂后，精神好转，腹胀加重。因思水邪仍剧耳。再以攻逐之法治之。(上方)服药1剂，又泻下6—7次，乃再改予补气养血，理气活血、燥湿利水。如此这般循环往复20次，果愈。
患者云：为何此次未见反复?答曰：正气得补，邪气得除耳。
胆囊炎胆石症
1.寒实内结，反作热实，久用苦寒，其痛不止
苏××，男，28岁。
右胁下绞痛，痛彻腰背，时轻时重，时作时止2个多月。医诊胆囊炎、胆石症。予利胆排石之剂治之不效。近3天来。胁下疼痛持续不止，轻则隐隐，重则如绞。虽然针、中西药俱用亦不见功。然因患者畏惧手术，再求中药试之。细审其证见右胁下剧痛，痛彻腰背，发热，目珠微黄，舌苔薄白，脉紧而弦。综其脉证，思之：胆石症、胆囊炎之黄疸虽湿热夹实者为多，但不能说所有胆石症、胆囊炎均为湿热夹实者，且其脉紧弦，紧弦脉者寒实证也。寒实者宜温下，正如仲景《金匮要略》所云：“胁下偏痛，发热，其脉紧弦，此寒也，以温药下之，宜大黄附子汤。”又思其尚兼胃脘胀满，按之痛，宜加枳实、厚朴。乃处：枳实10克，厚朴10克，大黄3克，附子10克，细辛4克。
昼夜24小时连服2剂，次日来诊。云：痛止，继服2剂，热退，症消。后经超声波探查正常。
2.少阳表里微结，反予攻下除湿，虚实不分，寒热不明，久延病期
弓××，女，50岁。
右胁胀痛，胃脘灼热烦乱1年多。医诊胆石症、胆囊炎。先后以利胆排石中药近400剂未见明显效果。细审其证见胁下痞硬，时或胀痛，疲乏无力，纳呆食减，舌苔白，脉濡缓。综合脉证，思之：胁下者肝胆少阳之位也，濡缓之脉者湿痰郁结也，肝胆之部见脾湿之脉乃脾土反侮肝木之象。故治宜散水饮理肝胆。又思柴胡桂枝干姜汤之柴胡配黄芩以和解少阳之邪；桂枝、干姜、炙草补脾散寒，温通阳气，瓜蒌根生津止渴，配牡蛎以软坚散结。共奏和解少阳之邪，温寒通阳而行气化。乃处：柴胡10克，干姜4克，桂枝10克，花粉15克，黄芩10克，牡蛎10克，甘草6克，枳实10克。
服药4剂，胁下痞硬，纳呆乏力均好转。某医云：此治少阳证方也。仲景云：“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝干姜汤主之。”即如《金匮要略》亦仅云：“治疟寒多微有热，或但寒不热。”未闻其能治胆石症、胆囊炎，而利胆排石则为诸家称道之药方，宜急改用利胆排石之剂，否则不可为也。乃复用利胆排石汤。药后痛又大作。患者再邀诊治。复审其脉仍为濡缓。乃云：此病之位仍居少阳肝胆之部，且仍为饮邪之郁结。乃再处柴胡桂枝干姜汤。3剂后，痛又大减；继服12剂，诸证俱失；又服10剂，B超探查报告云：肝胆正常。
3．肝胃不和，食积不化，反作湿热结滞，当和反攻，病邪不解
鲁××，女，60岁。
胆囊切除术后4年多来，精神、食欲一直正常。但近半年多来，右胁、胃脘又发现时或隐痛，时或绞痛，时或懊侬烦乱，纳呆食减，体重很快下降20千克。经过某院反复检查，诊断为肝胆管结石、肝胆管炎。某医予利胆排石之中药4个多月，非但诸证不减，亦且日渐加重。细审诸证，除上述者外，并见消瘦乏力，面色黧黑，巩膜黄染，心烦懊侬，口苦口粘，发热，尿色黄赤，舌苔黄白厚腻，脉弦滑紧数。思之：滑脉者食积也，弦滑并见者食积与湿痰结于肝胆也，数滑紧脉并见者积热也。合之与症，乃痰食积滞，肝胃不和也。又思：丹溪越鞠丸治诸郁，保和丸消食化痰，合之为方不但解郁，亦且消积，可与之。处方：川芎10克，苍术15克，香附10克，栀子10克，神曲30克，焦山楂30克，茯苓10克，半夏10克，陈皮10克，连翘10克，莱菔子10克，麦芽30克。
服药2剂，诸证均减，饮食增加，继服40剂，诸证全失；又服20剂，某院B超检查肝正常。
某医云：越鞠保和丸治结石，治黄疸，吾未闻也?答曰：吴鞠通《温病条辨》即以此方治黄疸，请审知便可也。
急性肾功能衰竭
1.热入血分，反治气分，胶于西医病名，不知随证论治，其病日重
何××，女，15岁。
肝炎痊愈后4年多来，经常腹满胀痛，大便不通。医生先用西药缓泻剂有效，但久用之后不再见效。后又改请中医以行气消胀、除湿清热、理气通便之剂治疗3年多，其效亦不显著。仔细审查其腹满胀痛以午后至夜间为甚，上午轻减，大便一般3到7天一次，大便不甚干结，疲乏无力，下肢沉重微肿，舌苔薄白，脉濡缓。综合脉证，思之：腹胀下午至夜间加重者，乃寒湿也，阳虚也；疲乏无力，下肢沉重者，乃气虚也，湿也；脉濡缓者，乃气虚寒湿也。证脉合参而论之，乃阳气虚衰，湿郁不化，升降失职所为也。因此拟定健脾益气，升阳降阴之法。处方：厚朴1克，附子0.3克，当归0.2克，吴茱萸1克，麻黄0.1克，半夏1克，毕澄茄0.2克，升麻0.1克，木香0.2克，干姜0.2克，草果0.2克，黄芪3克，党参2克，茯苓0.1克，益智仁0.1克。
服药1剂，腹胀腹痛好转，大便一行；继服3剂，大便转为正常。
某医云：何用此小剂？答曰：《内经》曾大倡壮火散气，少火生气之论，故东垣治虚实夹杂之虚劳证常以小剂予之，以恐药物过剂而伤正气耳。本证正虚邪微，但宜微扶正气，稍佐祛邪，故以小剂予之。事实证明，药少力宏，果然得愈。
廖××，女，30岁。
从1岁开始即经常大便秘结，开始时每隔3天服一次缓泻药即可排便，其后效果越来越不明显，改用麻仁滋脾丸以后，有1—2年大便比较通畅。但最近2年以来，大便秘结越来越重，每次排便不用大承气汤，即用灌肠法，才能暂时缓解。仔细审查其证，除大便秘结者外，并见其面色萎黄，舌苔薄白，脉濡缓。综合脉证思之：此乃湿凝气阻，三焦俱闭之证也，治宜拟补火除湿通便。处方：半硫丸，1次3克，1日2次。后果愈。
因思吴鞠通《温病条辨》云：“湿伤气者，肺主天气，脾主地气，俱属太阴湿土，湿气太过，反伤本脏化气，湿久浊凝，至于下焦，气不惟伤而且阻矣。气为湿阻，故二便不通，今人之通大便，悉用大黄，不知大黄性寒，主热结有形之燥粪；若湿阻无形之气，气既伤而且阻，非温补真阳不可。硫黄热而不燥，能理大肠，半夏能入阴，燥胜湿，辛下气，温开郁，三焦通而二便利矣……盖肾司二便，肾中真阳为湿所困，久而弥虚，失其本然之职，故助以硫黄；肝主疏泄，风湿相为胜负，风胜则湿行，湿凝则风息，而失其疏泄之能，故通之以半夏。”
张××，女，52岁。
腹泻20年左右。医诊慢性胃炎、慢性肠炎。先用西药治疗数年不效，继又配合中药健脾温中，疏肝健脾，温补脾肾、消食和胃等剂与参苓白术散、四神丸、附子理中丸、补中益气丸等进行治疗数年亦不效。仔细审查其证见大便一日10余次，粪质稀溏呈不消化状，胸胁时痛，胃脘痞满，胸闷心烦，舌苔薄白，脉弦而大，左脉大于右脉。综合脉证，思之：久泻近20年，可谓久矣，久泻多为虚寒，或为脾，或为肾，然脾肾俱治反而不愈，其故何也？何不求之于脉。因而又思脉大者气阴俱虚也，右脉大于左脉者虚也，今左脉反大于右脉，左脉者肝邪也，综而论之，此病既虚且实，既有气阴之不足，又有肝实之乘脾。因拟补气养阴以扶正，疏肝抑肝以祛邪。处方：党参30克，麦冬10克，生地30克，苍术15克，白术10克，陈皮10克，青皮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3剂，大便转为1日2行，他证亦减；继服上方10剂，不但大便转为1日1次，且他证亦大部消失。
某医云：久泻者诸书均云宜用健脾，补肾，久秘者诸书均云宜养阴润便，而今反用其反者何也？答曰：久泻者补脾肾，久秘者养阴增液此法之常也，养阴益气者法之变也，变者为何？宗脉证也。今脉大，大者或为气阴俱虚，或为气血俱虚，其阴虚、血虚因何而起，久泻也，用药也。本病既已阴伤就当补其阴，然又恐滋之太过而加健脾燥湿，使其扶阴之正而不生湿邪也。又且肝脾同病，故再酌治肝邪以助脾。
2．兼症不明，比例不分，或补或泻，或温或寒，其效遥期
邢××，女，41岁。
腹泻2年，医始诊为细菌性痢疾，予西药治疗10天后明显好转，但继续治疗时反而日渐加重。半年后，改请中医治疗，始以清热止痢不效，继予健脾温中、健脾和胃、温补脾肾、补中益气等亦不效。细察其证，除泄泻，一日3到5次外，并见有里急后重，纳呆食减，脘腹隐隐作痛，疲乏无力，舌苔白，脉细缓。综合脉证，诊为脾胃虚衰，治以健脾益气。处方：党参10克，茯苓10克，白术10克，扁豆10克，陈皮10克，山药15克，甘草6克，莲子10克，砂仁10克，炒苡米15克，桔梗6克，大枣5个。
服药10剂，寸效未见。再查前医诸方有用四神者，有用真人养脏者，有用参苓白术者，有用连理汤者，有用健脾者，然均不效。再询其证，除上述者外，并见有食后脘腹胀满加剧，吃冷食后腹痛即作，吃热药一久即口干舌燥，舌苔黄白，面色萎黄，脉细缓。综合脉证，思之：证脉均系脾虚无疑，然兼挟食滞不化，寒热交结，寒多热少之证耳。又思：治病虽要主要看主流用方，但兼证不可不顾及耳。因拟健脾益气为主，酌加消食和胃，苦辛通降之品。党参10克，茯苓10克，白术10克，扁豆10克，陈皮10克，山药15克，甘草6克，莲子10克，砂仁10克，蔻仁6克，炒苡米15克，桔梗6克，枳实6克，焦三仙各10克，吴茱萸6克，黄连4克，大枣3个，补骨脂3克。
服药4剂，大便次数减为每日1次，里急后重感消减90％，饮食增加，继服20剂，愈。
因忆《毛泽东选集》曾云：党委会的工作方法犹如弹钢琴者，中药处方亦应弹奏合适耳。
肝硬化
1．寒热胶结、水饮停聚，但用攻逐，或用利水，斡旋不能，水聚不散
邹××，男，50岁。
腹胀腹水2个多月。医诊肝硬化腹水。先用西药治疗曾一度明显好转，但不久又复发如初，其后再用西药治疗就不继续好转。乃改为中药治疗，始用利水不效，继又用攻逐之法亦不效。仔细审查其证见腹部胀大，但按之不硬不痛，下肢轻度浮肿，舌质稍红，舌苔黄腻，脉弦紧。综合脉证，思之：脉弦紧者寒饮停聚也，舌质红而苔黄腻者湿热蕴结也。合之于证，此乃寒饮蕴结，久蕴化热，水气结聚于中。治宜辛温通阳，苦寒燥湿，斡旋阴阳，利其水湿。处方：防己40克，桂枝12克，苍术30克，白术15克，生石膏20克，茯苓15克。
某医云：甘遂、芫花、大戟均峻厉之剂，尚且无功，其用轻淡之品能取功乎？答曰：本方虽无攻逐之剧药，然却有上清肺金之石膏，中有苍术、白术之燥湿，下有茯苓之利水，且防己苦寒有斡旋气机之功，桂枝配防己有激荡水气之力，故胶结之痰饮、水气非此不解。
服药2剂，腹胀、浮肿均减；继服4剂，尿量明显增多；又服10剂，腹胀浮肿消失。
2．正虚邪实，但知攻伐，其病反复
郭××，男，50岁。
腹胀腹水2个多月，医诊肝硬化腹水。先用西药治疗10天无明显效果，继又配合中药攻逐利水等剂，仍然时轻时重。审其腹大如鼓，青筋外露，按之硬，脉弦缓。综合脉证，思之：此证虽兼虚而大实为主，宜先攻逐以除水邪。处方：甘遂4.5克，芫花4.5克，大戟4.5克。
共为细末，荞面糊为丸，大枣10个煎汤送服。
患者云：此类方药已经服过，然仅能痛快于一时，难道医生无他法救治吾病乎？答曰：从现在的病证来看仍以实证为主，故仍宜攻逐之剂，至于他法问题，可随证观察之。
上药服后不久即微恶心欲吐，但没有吐出，数小时后开始泄泻，前后泻下6次，泻后次日即见腹胀好转。再察其脉仍为弦缓。因思脉弦者肝脉也，缓者脾虚湿盛也，合之于证，乃气血俱虚为本，气滞血瘀，水湿不化为标。宜补气养血以培本，理气活血，燥湿利水以治其标。处方：黄芪30克，人参10克，丹参30克，当归10克，苍术15克，白术10克，三棱10克，莪术10克，生地10克，黄精10克，青皮10克，陈皮10克，柴胡10克，薄荷3克，夜交藤30克，莱菔子10克，砂仁10克。
服药3剂后，精神好转，腹胀加重。因思水邪仍剧耳。再以攻逐之法治之。(上方)服药1剂，又泻下6—7次，乃再改予补气养血，理气活血、燥湿利水。如此这般循环往复20次，果愈。
患者云：为何此次未见反复？答曰：正气得补，邪气得除耳。
1. 寒实内结，反作热实，久用苦寒，其痛不止
苏××，男，28岁。
右胁下绞痛，痛彻腰背，时轻时重，时作时止2个多月。医诊胆囊炎、胆石症。予利胆排石之剂治之不效。近3天来，胁下疼痛持续不止，轻则隐隐，重则如绞。虽然针、中西药俱用亦不见功。然因患者畏惧手术，再求中药试之。仔细审查其证见右胁下剧痛，痛彻腰背，发热，目珠微黄，舌苔薄白，脉紧而弦。综其脉证，思之：胆石症、胆囊炎之黄疸虽湿热夹实者为多，但不能说所有胆石症、胆囊炎均为湿热夹实者，且其脉紧弦，紧弦脉者寒实证也。寒实者宜温下，正如仲景《金匮要略》所云：“胁下偏痛，发热，其脉紧弦，此寒也，以温药下之，宜大黄附子汤。”又思其尚兼胃脘胀满，按之痛，宜加枳实、厚朴。乃处：枳实10克，厚朴10克，大黄3克，附子10克，细辛4克。
昼夜24小时连服2剂，次日来诊。云：痛止，继服2剂，热退，症消。后经超声波探查正常。
2. 少阳表里微结，反予攻下除湿，虚实不分，寒热不明，久延病期
弓××，女，50岁。
右胁胀痛，胃脘灼热烦乱1年多。医诊胆石症、胆囊炎。先后以利胆排石中药近400剂未见明显效果。仔细审查其证见胁下痞硬，时或胀痛，疲乏无力，纳呆食减，舌苔白，脉濡缓。综合脉证，思之：胁下者肝胆少阳之位也，濡缓之脉者湿痰郁结也，肝胆之部见脾湿之脉乃脾土反侮肝木之象。故治宜散水饮理肝胆。又思柴胡桂枝干姜汤之柴胡配黄芩以和解少阳之邪；桂枝、干姜、炙草补脾散寒，温通阳气，瓜蒌根生津止渴，配牡蛎以软坚散结。共奏和解少阳之邪，温寒通阳而行气化。乃处：柴胡10克，干姜4克，桂枝10克，花粉15克，黄芩10克，牡蛎10克，甘草6克，枳实10克。
服药4剂，胁下痞硬，纳呆乏力均好转。某医云：此治少阳证方也。仲景云：“伤寒五六日，已发汗而复下之，胸胁满微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝干姜汤主之。”即如《金匮要略》亦仅云：“治疟寒多微有热，或但寒不热。”未闻其能治胆石症、胆囊炎，而利胆排石则为诸家称道之药方，宜急改用利胆排石之剂，否则不可为也。乃复用利胆排石汤。药后痛又大作。患者再邀诊治。复审其脉仍为濡缓。乃云：此病之位仍居少阳肝胆之部，且仍为饮邪之郁结。乃再处柴胡桂枝干姜汤。3剂后，痛又大减；继服12剂，诸证俱失；又服10剂，B超探查报告云：肝胆正常。
3．肝胃不和，食积不化，反作湿热结滞，当和反攻，病邪不解
鲁××，女，60岁。
胆囊切除术后4年多来，精神、食欲一直正常。但近半年多来，右胁、胃脘又发现时或隐痛，时或绞痛，时或懊侬烦乱，纳呆食减，体重很快下降20千克。经过某院反复检查，诊断为肝胆管结石、肝胆管炎。某医予利胆排石之中药4个多月，非但诸证不减，亦且日渐加重。仔细审查诸证，除上述者外，并见消瘦乏力，面色黧黑，巩膜黄染，心烦懊侬，口苦口粘，发热，尿色黄赤，舌苔黄白厚腻，脉弦滑紧数。思之：滑脉者食积也，弦滑并见者食积与湿痰结于肝胆也，数滑紧脉并见者积热也。合之与症，乃痰食积滞，肝胃不和也。又思：丹溪越鞠丸治诸郁，保和丸消食化痰，合之为方不但解郁，亦且消积，可与之。处方：川芎10克，苍术15克，香附10克，栀子10克，神曲30克，焦山楂30克，茯苓10克，半夏10克，陈皮10克，连翘10克，莱菔子10克，麦芽30克。
服药2剂，诸证均减，饮食增加，继服40剂，诸证全失；又服20剂，某院B超检查肝正常。
某医云：越鞠保和丸治结石，治黄疸，吾未闻也？答曰：吴鞠通《温病条辨》即以此方治黄疸，请审知便可也。
1. 热入血分，反治气分，胶于西医病名，不知随证论治，其病日重
何××，女，15岁。
For more than four years since the recovery from hepatitis, the patient has frequently experienced abdominal fullness and distending pain, with constipation. Initially, Western laxatives were effective, but lost efficacy after prolonged use. Subsequently, Traditional Chinese Medicine (TCM) treatment aimed at promoting Qi circulation to reduce distension, eliminating dampness and clearing heat, and regulating Qi to unblock bowels was administered for over three years, yet with insignificant results. Upon careful examination, the abdominal fullness and distending pain were worse from afternoon to night and lighter in the morning; bowel movements occurred once every 3 to 7 days; stools were not particularly dry; the patient felt fatigued and weak, with heavy and slightly swollen lower limbs; the tongue coating was thin and white; the pulse was soggy and slow. Synthesizing the pulse and symptoms: abdominal distension worsening from afternoon to night indicates cold-dampness and Yang deficiency; fatigue, weakness, and heaviness of the lower limbs indicate Qi deficiency and dampness; a soggy and slow pulse indicates Qi deficiency and cold-dampness. Integrating pulse and syndrome analysis, this is caused by the decline of Yang Qi, stagnation of dampness failing to transform, and dysfunction of ascending and descending mechanisms. Therefore, the method of invigorating Spleen Qi and raising Yang while descending Yin was formulated. Prescription: Magnoliae Officinalis Cortex (Houpo) 1g, Aconiti Lateralis Radix Praeparata (Fuzi) 0.3g, Angelicae Sinensis Radix (Danggui) 0.2g, Evodiae Fructus (Wuzhuyu) 1g, Ephedrae Herba (Mahuang) 0.1g, Pinelliae Rhizoma (Banxia) 1g, Galangae Fructus (Bichengqie) 0.2g, Cimicifugae Rhizoma (Shengma) 0.1g, Aucklandiae Radix (Muxiang) 0.2g, Zingiberis Rhizoma Recens (Ganjiang) 0.2g, Tsaoko Fructus (Caoguo) 0.2g, Astragali Membranacei Radix (Huangqi) 3g, Codonopsis Radix (Dangshen) 2g, Poria (Fuling) 0.1g, Alpiniae Oxyphyllae Fructus (Yizhiren) 0.1g.
After taking one dose, abdominal distension and pain improved, and a bowel movement occurred; after continuing for three doses, bowel movements normalized.
A certain physician asked: Why use such a small dosage? The answer was: The *Neijing* (*Inner Canon*) extensively advocated the theory that "vigorous fire dissipates Qi, while mild fire generates Qi." Therefore, Dongyuan often used small dosages for deficiency consumptive syndromes involving both deficiency and excess, fearing that excessive medication would damage healthy Qi. In this case, healthy Qi is deficient and pathogenic factors are minor; thus, gently supporting healthy Qi and slightly assisting in expelling pathogens is appropriate, hence the small dosage. Facts proved that few drugs with potent effects indeed led to recovery.
7. Dampness coagulates and Qi obstructs, all three Jiaos are closed; contrary use of cold and cloying remedies leads to chronic non-healing.
Liao XX, Female, 30 years old.
Since age 1, she frequently suffered from severe constipation. Initially, taking a laxative every 3 days allowed defecation, but its effect became less obvious over time. After switching to *Renzhi Zipi Wan* (Hemp Seed Pill to Nourish the Spleen), bowel movements were relatively smooth for 1–2 years. However, in the last 2 years, constipation worsened significantly; temporary relief could only be achieved using *Da Chengqi Tang* (Major Order the Yellow Decoction) or enemas. Careful examination revealed, besides severe constipation, sallow complexion, thin white tongue coating, and soggy-slow pulse. Synthesizing pulse and syndrome: this is a syndrome of dampness coagulation and Qi obstruction with closure of all three Jiaos. The treatment should focus on warming fire, eliminating dampness, and unblocking bowels. Prescription: *Banshu Wan* (Half-Sulfur Pill), 3g per dose, twice daily. Recovery ensued.
Reflecting on Wu Jutong’s *Wenbing Tiaobian* (*Systematic Differentiation of Warm Diseases*): "When dampness injures Qi, the Lung governs heavenly Qi, and the Spleen governs earthly Qi; both belong to Taiyin Damp-Earth. Excessive dampness damages the transforming Qi of the zang-organs themselves. Long-standing dampness turns into turbid coagulation, reaching the Lower Jiao, where Qi is not only injured but also obstructed. Obstructed by dampness, Qi fails to regulate the two excretions. Nowadays, people treat constipation entirely with Rhubarb (Dahuang). They do not know that Rhubarb is cold-natured and treats heat-bound, tangible dry feces; if it is formless Qi obstructed by dampness, and Qi is both injured and obstructed, warming and tonifying True Yang is indispensable. Sulfur is hot but not drying, capable of regulating the Large Intestine; Pinellia enters Yin, dries up dampness with its dryness, descends Qi with its acridity, opens depression with its warmth, thereby unblocking the three Jiaos and facilitating the two excretions... The Kidney controls the two excretions; when True Yang in the Kidney is trapped by dampness, it becomes increasingly deficient over time, losing its original function, hence Sulfur is added to assist it; the Liver governs dispersion and drainage; wind and dampness contend for dominance. When wind prevails, dampness moves; when dampness coagulates, wind ceases, and the Liver loses its dispersing ability, hence Pinellia is used to unblock it."
Diarrhea
1. Both Qi and Yin are deficient, Liver Wood fails to diffuse freely; contrary treatment as deficiency-cold with prolonged warming transformation.
Zhang XX, Female, 52 years old.
Suffering from diarrhea for about 20 years. Diagnosed with chronic gastritis and chronic enteritis. Western medicine treatment for several years was ineffective. Subsequently, TCM treatments including invigorating Spleen and warming the Middle, soothing Liver and invigorating Spleen, warming and tonifying Spleen and Kidney, digesting food and harmonizing Stomach, along with formulas like *Shenling Baizhu San*, *Six Gods Pill*, *Fuzi Lizhong Wan*, and *Buzhong Yiqi Wan*, were used for several years without effect. Careful examination revealed stool frequency of over 10 times a day, loose undigested stools, intermittent chest and hypochondriac pain, epigastric stuffiness, chest tightness, and irritability; tongue coating thin white; pulse wiry and large, with the left pulse larger than the right. Synthesizing pulse and syndrome: Diarrhea lasting nearly 20 years is long-term. Long-term diarrhea is mostly deficiency-cold, originating from the Spleen or Kidney. Yet treating both Spleen and Kidney failed. Why? One must seek answers in the pulse. A large pulse indicates both Qi and Yin deficiency. Normally, the right pulse being larger indicates deficiency. Here, the left pulse is larger than the right; the left pulse corresponds to Liver pathogenic factors. Comprehensive analysis shows this disease is both deficient and excess, featuring both insufficiency of Qi and Yin and Liver excess invading the Spleen. Therefore, tonifying Qi and nourishing Yin to support healthy Qi, and soothing/restraining the Liver to expel pathogens was planned. Prescription: Codonopsis Radix (Dangshen) 30g, Ophiopogonis Radix (Maidong) 10g, Rehmanniae Radix (Shengdi) 30g, Atractylodis Rhizoma (Cangzhu) 15g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Aurantii Fructus Viridis (Qingpi) 10g, Bupleuri Radix (Chaihu) 10g, Sparganii Rhizoma (Sanleng) 10g, Curcumae Radix (Ezhu) 10g, Menthae Haplocalycis Herba (Bohe) 3g, Polygoni Multiflori Caulis (Yejaoteng) 30g.
After 3 doses, bowel movements reduced to twice daily, and other symptoms decreased; after continuing for 10 doses, bowel movements normalized to once daily, and most other symptoms disappeared.
A certain physician asked: Texts state that long-term diarrhea should be treated by invigorating Spleen and tonifying Kidney, and long-term constipation by nourishing Yin and moistening bowels. Why use the opposite methods now? The answer is: Tonifying Spleen/Kidney for diarrhea and nourishing Yin/fluids for constipation is the standard method; nourishing Yin and benefiting Qi is the variable method. Why vary? Based on pulse and syndrome. A large pulse may indicate Qi/Yin deficiency or Qi/Blood deficiency. What causes Yin/Blood deficiency? Long-term diarrhea and medication. Since Yin is damaged, it must be supplemented. However, fearing excessive cloying nature might generate dampness, Spleen-invigorating and damp-drying herbs are added to support Yin without generating dampness. Furthermore, since Liver and Spleen are simultaneously diseased, treating Liver pathogenic factors is adjusted to assist the Spleen.
2. Unclear accompanying symptoms, indistinct proportions; alternating tonification/purgation, warming/cold, delaying effectiveness.
Xing XX, Female, 41 years old.
Diarrhea for 2 years. Initially diagnosed as bacillary dysentery; Western medicine treatment improved symptoms significantly after 10 days, but continued treatment made them worsen gradually. Six months later, TCM treatment began. Initial heat-clearing and dysentery-stopping measures failed. Subsequent Spleen-invigorating/middle-warming, Spleen-invigorating/Stomach-harmonizing, Spleen/Kidney-warming-tonifying, and Middle-supplementing/Qi-benefiting treatments also failed. Detailed observation revealed, besides diarrhea (3–5 times daily), tenesmus, poor appetite, dull abdominal pain, fatigue, white tongue coating, and fine-slow pulse. Synthesizing pulse and syndrome, diagnosed as Spleen-Stomach deficiency-declining, treated by invigorating Spleen and benefiting Qi. Prescription: Codonopsis Radix (Dangshen) 10g, Poria (Fuling) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Dolichoris Semen (Bian Dou) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Dioscoreae Rhizoma (Shanyao) 15g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Nelumbinis Semen (Lianzi) 10g, Amomi Fructus Rotundus (Sharen) 10g, Fried Coicis Semen (Chao Yimi) 15g, Platycodonis Radix (Jiegeng) 6g, Jujubae Fructus (Dazao) 5 pieces.
After 10 doses, no effect was seen. Reviewing previous prescriptions: some used *Six Gods Pill*, *Zhenren Yangzang Wan*, *Shenling Baizhu San*, *Lianli Tang*, or Spleen-invigorating formulas, all ineffective. Further inquiry revealed, besides above symptoms, postprandial abdominal distension worsened, cold food triggered abdominal pain, prolonged intake of warm medicines caused dry mouth and tongue, yellow-white tongue coating, sallow complexion, and fine-slow pulse. Synthesizing pulse and syndrome: Pulse and syndrome clearly indicate Spleen deficiency, complicated by food stagnation, intermingled cold and heat (predominantly cold, slight heat). Treating diseases requires focusing on the main pattern, but accompanying symptoms cannot be ignored. Thus, invigorating Spleen and benefiting Qi as the main approach,酌情 adding food-digesting and Stomach-harmonizing, bitter-acrid descending agents. Prescription: Codonopsis Radix (Dangshen) 10g, Poria (Fuling) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Dolichoris Semen (Bian Dou) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Dioscoreae Rhizoma (Shanyao) 15g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Nelumbinis Semen (Lianzi) 10g, Amomi Fructus Rotundus (Sharen) 10g, Cardamomi Fructus (Kou Ren) 6g, Fried Coicis Semen (Chao Yimi) 15g, Platycodonis Radix (Jiegeng) 6g, Immaturae Fructus Aurantii (Zhishi) 6g, Fried Three Immortals (Jiao Sanxian) each 10g, Evodiae Fructus (Wuzhuyu) 6g, Coptidis Rhizoma (Huanglian) 4g, Jujubae Fructus (Dazao) 3 pieces, Psoraleae Fructus (Buguzhi) 3g.
After 4 doses, bowel movements reduced to once daily, tenesmus reduced by 90%, appetite increased; after continuing for 20 doses, recovery was achieved.
Recalling *Selected Works of Mao Zedong*: The working method of party committees is like playing the piano; TCM prescriptions should also be played appropriately.
Liver Cirrhosis
1. Cold and heat knotted together, fluid retention; solely using purgation or diuresis fails to mediate, water accumulates and does not disperse.
Zou XX, Male, 50 years old.
Abdominal distension and ascites for over 2 months. Diagnosed with liver cirrhosis ascites. Western medicine treatment initially showed significant improvement, but relapsed shortly after. Subsequent Western medicine treatment did not continue to improve. Switched to TCM: initial diuretic treatment failed, followed by purgative treatment which also failed. Careful examination revealed abdominal enlargement, soft and non-tender upon pressure, mild lower limb edema, slightly red tongue body, yellow-greasy coating, wiry-tight pulse. Synthesizing pulse and syndrome: wiry-tight pulse indicates cold-fluid retention; red tongue body with yellow-greasy coating indicates damp-heat accumulation. Combined with symptoms, this is cold-fluid accumulation turning into heat over time, with water-Qi knotting in the center. Treatment should employ acrid-warm to unblock Yang, bitter-cold to dry dampness, mediate Yin and Yang, and promote water-dampness removal. Prescription: Stephaniae Tetrandrae Radix (Fangji) 40g, Cinnamomi Ramulus (Guizhi) 12g, Atractylodis Rhizoma (Cangzhu) 30g, Atractylodis Macrocephalae Rhizoma (Baizhu) 15g, Gypsum Fibrosum (Sheng Shigao) 20g, Poria (Fuling) 15g.
A certain physician asked: Kansui (Gansui), Genkwa (Yuanhua), and Euphorbia (Daji) are harsh agents and still yielded no result; how can light and bland items succeed? The answer is: Although this formula lacks harsh purgatives, it contains Gypsum to clear Lung Metal above, Cangzhu and Baizhu to dry dampness in the middle, and Fuling to promote urination below. Moreover, Fangji is bitter-cold and mediates Qi mechanism; Guizhi paired with Fangji agitates water-Qi power. Thus, knotted phlegm-fluid and water-Qi cannot be resolved otherwise.
After 2 doses, abdominal distension and edema decreased; after 4 doses, urine output increased significantly; after another 10 doses, abdominal distension and edema disappeared.
2. Healthy Qi deficient, pathogenic factor excess; knowing only attack, disease recurs.
Guo XX, Male, 50 years old.
Abdominal distension and ascites for over 2 months. Diagnosed with liver cirrhosis ascites. Western medicine treatment for 10 days showed no obvious effect. Subsequent TCM purgative and diuretic treatments resulted in fluctuating severity. Examination revealed drum-like abdomen, visible collateral veins, hardness upon pressure, wiry-slow pulse. Synthesizing pulse and syndrome: Although this syndrome involves deficiency, excess is predominant. Purging should be used first to remove water pathogen. Prescription: Kansui (Gansui) 4.5g, Genkwa (Yuanhua) 4.5g, Euphorbia (Daji) 4.5g.
Pulverized into fine powder, formed into pills with buckwheat paste, taken with decoction of 10 Jujubes.
Patient said: I have taken such formulas before; they only provide temporary relief. Does the doctor have no other method to save my illness? The answer is: Current syndrome indicates excess is predominant, so purgative agents are still appropriate. As for other methods, we will observe according to the syndrome.
Shortly after taking the medicine, slight nausea and urge to vomit occurred, but no vomiting happened. Several hours later, diarrhea started, occurring 6 times in total. The next day after diarrhea, abdominal distension improved. Re-examination of pulse remained wiry-slow. Reflection: Wiry pulse corresponds to Liver; slow pulse indicates Spleen deficiency and dampness abundance. Combined with symptoms, the root is Qi and Blood deficiency, while the branch is Qi stagnation, Blood stasis, and failure of water-dampness transformation. Tonifying Qi and nourishing Blood to cultivate the root, regulating Qi and activating Blood, drying dampness and promoting urination to treat the branch. Prescription: Astragali Membranacei Radix (Huangqi) 30g, Ginseng Radix (Renshen) 10g, Salviae Miltiorrhizae Radix (Danshen) 30g, Angelicae Sinensis Radix (Danggui) 10g, Atractylodis Rhizoma (Cangzhu) 15g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Sparganii Rhizoma (Sanleng) 10g, Curcumae Radix (Ezhu) 10g, Rehmanniae Radix (Shengdi) 10g, Polygonati Odorati Rhizoma (Huangjing) 10g, Aurantii Fructus Viridis (Qingpi) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Bupleuri Radix (Chaihu) 10g, Menthae Haplocalycis Herba (Bohe) 3g, Polygoni Multiflori Caulis (Yejaoteng) 30g, Raphani Semen (Laifuzi) 10g, Amomi Fructus Rotundus (Sharen) 10g.
After 3 doses, spirit improved, but abdominal distension worsened. Reflection: Water pathogen is still severe. Using purgative method again (above formula). After 1 dose, another 6–7 bowel movements occurred. Then switched back to tonifying Qi and nourishing Blood, regulating Qi and activating Blood, drying dampness and promoting urination. This cycle repeated 20 times, finally resulting in recovery.
Patient asked: Why no recurrence this time? Answer: Healthy Qi was replenished, pathogenic factors were eliminated.
Cholecystitis and Cholelithiasis
1. Cold-excess internal knotting, mistakenly treated as heat-excess; prolonged use of bitter-cold fails to stop pain.
Su XX, Male, 28 years old.
Colicky pain under the right hypochondrium radiating to the back, varying in intensity and intermittent for over 2 months. Diagnosed with cholecystitis and cholelithiasis. Bile-promoting and stone-expelling agents were ineffective. For the past 3 days, hypochondriac pain persisted continuously, ranging from dull ache to colic. Acupuncture and Chinese/Western medicines yielded no results. Due to fear of surgery, the patient sought TCM trial. Careful examination revealed severe pain under the right hypochondrium radiating to the back, fever, slightly yellow sclera, thin white tongue coating, tight-wiry pulse. Synthesizing pulse and syndrome: Although jaundice in cholelithiasis/cholecystitis is mostly damp-heat with excess, not all cases are damp-heat excess. Tight-wiry pulse indicates cold-excess syndrome. Cold-excess requires warm purgation, as stated in Zhang Zhongjing’s *Jingui Yaolue* (*Essential Prescriptions of the Golden Cabinet*): "Pain on one side of the hypochondrium, fever, tight-wiry pulse, this is cold; purge with warm medicines, Da Huang Fu Zi Tang is suitable." Additionally, considering epigastric fullness and tenderness, Zhishi and Houpo should be added. Prescription: Immaturae Fructus Aurantii (Zhishi) 10g, Magnoliae Officinalis Cortex (Houpo) 10g, Rheum Palmatum Radix et Rhizoma (Dahuang) 3g, Aconiti Lateralis Radix Praeparata (Fuzi) 10g, Asari Radix et Rhizoma (Xixin) 4g.
Taken continuously over 24 hours, 2 doses. Visited the next day: pain stopped. Continued for 2 more doses: fever subsided, symptoms vanished. Ultrasound examination later showed normal results.
2. Shaoyang exterior-interior slight knotting, mistakenly given purgation and damp-elimination; failure to distinguish deficiency/excess and cold/heat prolongs the disease course.
Gong XX, Female, 50 years old.
Distending pain in the right hypochondrium and burning irritability in the epigastrium for over 1 year. Diagnosed with cholelithiasis and cholecystitis. Nearly 400 doses of bile-promoting and stone-expelling TCM formulas yielded no obvious effect. Careful examination revealed hypochondriac stuffiness and hardness, intermittent distending pain, fatigue, poor appetite, white tongue coating, soggy-slow pulse. Synthesizing pulse and syndrome: The hypochondrium is the location of Liver/Gallbladder and Shaoyang. Soggy-slow pulse indicates damp-phlegm stagnation. Seeing Spleen-damp pulse in the Liver/Gallbladder region indicates Earth insulting Wood. Thus, treatment should scatter fluid-retention and regulate Liver/Gallbladder. Considering *Chaihu Guizhi Ganjiang Tang*: Chaihu paired with Huangqin harmonizes Shaoyang pathogen; Guizhi, Ganjiang, and Zhi Cao tonify Spleen, dispel cold, and warm/unblock Yang; Gualou Gen generates fluids and quenches thirst; paired with Muli to soften hardness and dissipate nodules. Together, they harmonize Shaoyang, warm-cold, unblock Yang, and move Qi. Prescription: Bupleuri Radix (Chaihu) 10g, Zingiberis Rhizoma (Ganjiang) 4g, Cinnamomi Ramulus (Guizhi) 10g, Trichosanthis Radix (Huafen) 15g, Scutellariae Radix (Huangqin) 10g, Ostreae Concha (Muli) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Immaturae Fructus Aurantii (Zhishi) 10g.
After 4 doses, hypochondriac stuffiness/hardness, poor appetite, and fatigue improved. A certain physician said: This is a formula for Shaoyang syndrome. Zhongjing said: "In the fifth or sixth day of Shanghan, after sweating and purging, chest/hypochondriac fullness with slight knotting, difficult urination, thirst without vomiting, only head sweating, alternating chills and fever, irritability—this is unresolved, Chaihu Guizhi Ganjiang Tang governs it." Even *Jingui Yaolue* only states: "Treats malaria with much cold and slight heat, or only cold." Never heard it treats cholelithiasis/cholecystitis. Bile-promoting formulas are praised by experts; urgently switch to bile-promoting formula, otherwise it is unacceptable. Resumed bile-promoting formula. Pain intensified after medication. Patient sought treatment again. Re-examination of pulse remained soggy-slow. Said: The disease location remains in Shaoyang/Liver-Gallbladder, and it is still fluid-pathogen stagnation. Prescribed *Chaihu Guizhi Ganjiang Tang* again. After 3 doses, pain greatly reduced; after 12 doses, all symptoms disappeared; after another 10 doses, B-ultrasound reported normal Liver/Gallbladder.
3. Liver-Stomach disharmony, food stagnation not transformed, mistakenly treated as damp-heat knotting; should harmonize rather than attack, pathogen remains unresolved.
Lu XX, Female, 60 years old.
Over 4 years post-cholecystectomy, spirit and appetite were normal. But for the past half-year, intermittent dull or colicky pain in the right hypochondrium and epigastrium, mental restlessness, poor appetite, rapid weight loss of 20kg. Repeated examinations at a hospital diagnosed hepatobiliary duct stones and inflammation. A physician gave bile-promoting and stone-expelling TCM for over 4 months; symptoms not only did not decrease but worsened. Careful examination revealed, besides above, emaciation/fatigue, dark complexion, scleral icterus, mental restlessness, bitter/sticky taste, fever, yellow-red urine, thick yellow-white greasy tongue coating, wiry-slippery-tight-rapid pulse. Reflection: Slippery pulse indicates food stagnation; wiry-slippery indicates food stagnation and damp-phlegm knotting in Liver/Gallbladder; rapid-slippery-tight indicates accumulated heat. Combined with symptoms, this is phlegm-food stagnation and Liver-Stomach disharmony. Considering Danxi’s *Yueju Wan* treats various depressions, and *Baohe Wan* digests food and transforms phlegm; combining them not only resolves depression but also eliminates stagnation, suitable here. Prescription: Chuanxiong Rhizome (Chuanxiong) 10g, Atractylodis Rhizoma (Cangzhu) 15g, Cyperi Rhizoma (Xiangfu) 10g, Gardeniae Fructus (Zhizi) 10g, Massae Fermentatae Medicinalis (Shenqu) 30g, Fried Crataegi Fructus (Jiao Shanzha) 30g, Poria (Fuling) 10g, Pinelliae Rhizoma (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Forsythiae Fructus (Lianqiao) 10g, Raphani Semen (Laifuzi) 10g, Maltae Fructus (Maiya) 30g.
After 2 doses, all symptoms decreased, appetite increased; after continuing for 40 doses, all symptoms vanished; after another 20 doses, B-ultrasound at the hospital showed normal Liver.
A certain physician asked: I have never heard of *Yueju Baohe Wan* treating stones or jaundice. The answer is: Wu Jutong’s *Wenbing Tiaobian* uses this formula to treat jaundice; please understand this.
Acute Renal Failure
1. Heat enters Blood level, mistakenly treated at Qi level; stuck on Western disease names, unaware of treating according to syndrome, disease worsens daily.
He XX, Female, 15 years old.