6天前，在长途拉练的过程中，突患感冒，医予APC2片进行治疗，当夜感冒症状不但没有减轻，反而更重，并出现浮肿尿少，医未引起注意，复与APc2片、长效磺胺2片进行治疗，十几分钟后，病情更加严重，高热持续不退，时时少量鼻衄，全身紫斑片片出现，高度浮肿。急转县医院进行治疗。诊断为急性肾炎。予青霉素、中药清热解毒利尿剂等治疗2天后，不但浮肿更加严重，而且出现大片大片的紫斑，鼻衄齿衄，吐血咳血，尿血便血，时时烦躁不安，时或神昏谵语，恶心呕吐。再次转院治疗。诊为急性肾功能衰竭、心包炎。医除予纠正水电解质紊乱和酸碱平衡失调、控制感染、对症处理外，并采用中药清热解毒利水消肿等中药治疗3天，仍然无明显效果。查其证见吐血、咳血、鼻衄、齿衄、便血、尿血、耳衄、崩漏，高度水肿，尿少尿闭，全身见大片大片的紫斑，烦躁不安，身热如炭，舌质红绛，脉滑数。综合脉证，思之：此病虽非温病所致，然其证系热毒入于营血，故宜清营凉血治之。又思斑色紫点大者胃中热也，非但以清营凉血所能治，宜于清营凉血方中加清泻胃火之品。前方之用清热解毒非治其病之所在耳，故不效。方拟：犀角10克(现已禁用，常用水牛角代替)，生地30克，白芍10克，丹皮10克，大黄6克，茅根30克，茜草10克，小蓟炭10克。
服药1剂，衄血、吐血、便血，身热，神烦俱稍减，体温由40．2℃降至38．9℃，且小便微出；继服1剂，吐衄、便血大减，身热、烦躁亦减，体温降至38．5℃，小便增多；再服上药4剂，吐衄俱止，尿量增加，饮食可进。
某医云：既见尿闭、呕吐何不利尿?答曰：辨证论治的一个核心问题是辨复杂问题中的主要问题，即在目前起主导作用的问题。本病从脉、舌来看，热入营血和热在阳明是主要的问题，所以首先采用凉血活血、泻胃通腑的方法进行治疗。
2．表里不分，脏腑不明，阴阳不清，但施解毒清热，胶于经验，病情加剧
麻××，男，14岁。
5个月前，突然发现浮肿。某院诊为急性肾小球肾炎。住院治疗2个多月，浮肿不但不减，反见加重。2个多月以前，又突然发现持续的高热不退，咳喘不得平卧，大腹水肿，尿闭，经过反复检查，确诊为肺炎、肺源性心脏病、心力衰竭、慢性肾小球肾炎急性发作，急性肾功能衰竭。先用西药治疗1个多月不见改善，继又配合中药补气养血，活血利水，清热解毒20余日，病情更加严重。细审其证见高度浮肿，两眼因浮肿而不能露睛，腹大如鼓，滴尿全无，高热(40．1℃)，烦躁不安，频频恶心呕吐，呼吸极度困难，口唇、面颊、手指均紫黯，舌质淡黯，舌苔黄白，脉浮紧数促涩。综合脉证，思之：仲景《金匮要略》云：“脉得诸沉，当责有水，身体肿重。水病脉出者，死。”又云：“太阳病，脉浮而紧，法当骨节疼痛，反不痛，身体反重而酸，其人不渴……此为风水。”今本证脉浮是脉出，还是脉浮，是表证，还是死证，尤当鉴别。又思：脉出者乃浮大无根，而此脉见浮紧，浮紧相兼者为表证也。表证者当解表散寒。前用诸药予补气养血者，意其脉出故以补益之药耳，显系有误，此邪实正虚之不明耳。浮紧而数者，紧为寒，数为热，是寒也，热也，仲景《伤寒论》有解云：“脉浮而数者，可发汗，宜麻黄汤。”言其主要为表寒闭郁耳。促脉者何?是热?还是寒?仲景《伤寒论》云：“脉促胸满者，桂枝去芍药汤主之。”言其阳虚；而白虎加人参汤之脉促则言其热也，今促与涩兼见者当为阳虚之极，非热极也。舌苔黄者，里热也。脉证相参，综而论之，乃心肾阳虚，水饮积留心下，表里合邪，郁而化热所致。治宜温阳散寒，通利气机。处方：麻黄6克，附子6克，细辛3克，桂枝10克，生姜3片，大枣7个，甘草6克，防己10克，茅根30克，大腹皮10克。
服药1剂，咳喘、发热均减，体温39℃；继服2剂，呼吸困难明显好转，恶心呕吐消失，尿量增多，体温38·1℃；又服7剂，浮肿全消，体温37．1℃。除尿常规尿蛋白++++，红细胞5—10个外，尿素氮、二氧化碳结合力均恢复正常。
3.阳虚阴凝，饮留心下，表里合邪，反以苦寒攻下，病势更甚
张××，女，67岁。
糖尿病15年，经西、中药物治疗曾一度好转，但近6年来，不但不再好转，且在尿中出现了大量蛋白尿。2个多月前，又突然出现头晕头胀，心烦心悸，恶心呕吐，食纳甚差，某医始作急性胃炎论治，不效，又改请中医以柴平汤2剂，诸证均减，停药10天后，诸证又剧，再作柴平汤4剂，不效。乃住某院进行治疗。住院10天后，血压、血糖、尿糖等明显好转，饮食亦稍增加。但至14天时，突然感到咳喘气短不能平卧，发热，微恶风寒。经过详细检查确诊为肺炎。经过用大剂量抗生素与清热解毒、宣肺定喘中药治疗10天，诸证不但不减，反而更加严重，且出现浮肿尿少，腹水，恶心呕吐。再经详细检查确诊为糖尿病、糖尿病性酸中毒、高血压病、糖尿病性肾病、急性肾功能衰竭、心肌炎、肺炎、心力衰竭。医除继续采用西药抢救外，并配合清热解毒，大黄灌肠等中药治疗5天，因其病情日渐加重，在家属的反复要求下，再求中医会诊。察其高热(39．5℃)咳喘，不得平卧，浮肿尿少，腹大如鼓，频频恶心呕吐，口唇紫黯，面色萎黄而肿，口苦口干，欲饮不能饮，指趾厥冷，心烦失眠，舌苔黄白而腻，脉浮紧促数。综合脉证思之：此病乃素有气阴大衰，痰湿阻滞，今复外感风寒，阳虚阴凝之证耳。攻之，泻之均所不宜；补之，散之均有所难。又思小剂量祛邪多不伤正，小剂量扶正多不留邪。故先以小剂桂枝去芍加麻辛附子汤治之。处方：附子1克，桂枝1克，甘草1克，生姜1片，大枣3枚，麻黄1克，细辛0．5克，生石膏2克，防己1克。
服药1剂，喘咳稍减，腹胀稍轻；继服1剂，喘咳大减，稍能平卧，尿量增多，恶心呕吐基本消失，体温降至38℃；又服3剂，体温降至37．5℃，咳喘大部消失，水肿腹水几近消退。某医云：如此之重疾，竞用如此之小药，岂能济事，应以上药10倍量予之。服药2剂，病情骤剧，浮肿尿少，腹胀咳喘，恶心欲吐俱见。某医又云：此用附、桂、麻黄、细辛之误也，尿毒症岂敢用附、桂!宜大剂大黄灌肠治之。2天后，病情更剧，腹大浮肿，发热咳喘，恶心呕吐，心烦失眠。再邀余诊视。察其除上述诸证外，并见指趾微厥，舌质淡黯，苔黄白，脉浮紧数促。因思其证仍为表里合邪，外寒内饮，心肾阳虚，水饮射肺，郁而化热为主。再拟温阳散寒，通彻表里，通利气机为法。处方：附子1．5克，桂枝3克，生姜3片，甘草3克，大枣5个，细辛1克，麻黄1．5克，生石膏5克，防己3克，腹皮3克。
服药2剂，诸证又减；继服6剂，诸证消失。尿素氮、二氧化碳结合力等亦恢复正常。
某医问：大黄为治疗尿毒症之药，何本症用之反剧?答曰：微阳之躯岂能胜重剂之苦寒，不可也，不可也。
4．邪人膜原，三焦俱病，斡旋不能，升降不利，反用寒凉，败胃闭邪，病势更甚
张××，男，2岁。
高热(39．9℃)不退，尿少尿频，恶心呕吐1个月。医诊左肾发育不全，右肾囊肿，肾盂肾炎、急性肾功能衰竭。予西药治疗20天后，又配合中药补气养血、活血利尿、清热解毒治疗10天，不但不效，反而加重。细审其证，除发热，尿少尿频，恶心呕吐外，并见其腹满胀痛，按之更甚，舌质淡黯，舌苔黄白，面色青黑，脉弦紧滑数。综合脉证，思之：腹满胀痛，按之尤甚者，有积也；面色青黑者，肝肾湿热也；脉弦者，少阳或膜原之有邪也；紧脉者，寒也，积也。因忆吴又可《温疫论》云：“温疫初起，先憎寒而后发热，嗣后但热而不憎寒也。初得之二三日，其脉不浮不沉而数，昼夜发热，日晡益甚，头疼身痛，其时邪在伏膂之前，肠胃之后，虽有头痛身痛，此邪热浮越于经，不可认为伤寒表证，辄用麻黄桂枝之类，强发其汗，此邪不在经，汗之徒伤卫气，热亦不减；又不可下，此邪不在里，下之徒伤胃气，其渴愈甚，宜达原饮主之。”“按槟榔能消磨，除伏邪，为疏利之药……厚朴破戾气所结，草果辛烈气雄，除伏邪蟠踞。三味协力，直达其巢穴，使邪气溃散，速离膜原，是以名为达原散也。”吴氏所论虽非肾盂肾炎、急性肾功能衰竭，而其理则一也。综合脉证，正合吴又可达原散证也。乃拟宣透膜原法。处方：厚朴3克，草果3克，槟榔3克，黄芩3克，知母3克，苏叶3克，神曲3克，柴胡6克，菖蒲4克。
服药2剂，发热、恶心呕吐等症稍减；继服4剂，体温正常，恶心呕吐消失；再服10剂，尿素氮、二氧化碳结合力，肌酐均恢复正常。
某医云：何用大剂抗生素与中药清热解毒剂而证不减?答曰：病邪在膜原耳。病既在膜原，又挟湿邪，岂寒凉冰伏所能治，此正犯湿热之禁忌法耳。可在治湿温法中求之。
慢性肾功能衰竭
1．固执经验，胶于病名，不知随证，不知辨证，延误病期
孙××，女，63岁。
7～8个月来，疲乏无力，食欲不振，时见鼻衄。医诊多囊肾、慢性肾小球肾炎、慢性肾功能衰竭。先用西药治之不效，后又配合中药健脾补肾、活血利水、清热解毒、降逆止呕、通利泻下等治疗4个多月仍不效。近2个月来，更加疲乏无力，神志时清时昧，说话均感无力，轻度浮肿，且饮食人口，甚或稍闻食昧即恶心呕吐，面色萎黄。细审其证，除上述者外，并见脘腹微满，舌质淡，舌苔黄白厚腻，脉弦紧滑数。综合脉证，思之：面色萎黄，血色素仅40克／L，且神疲乏力，言语低微，可见气血阴阳已经大虚，然大虚之脉应沉细无力，本病却脉见弦紧滑数，证脉不符，其脉必为邪气之实脉也。又思：弦紧之脉者，寒也，结也；数滑相兼者，痰也，热也。既有寒，又有热，既有气结，又有痰凝，综而论之，为寒热交结，痰积气滞，湿郁化热，三焦水道不通，凌犯脾胃之证。然虚实寒热俱见者，何从治之?李东垣《脾胃论》云：“谷气通于脾，六经为川，脾胃为海，九窍为水注之气，九窍者五脏主之，五脏皆得胃气，乃能通利……凡十一脏皆取决于胆也。胆者少阳春升之气，春气升则万化安，故胆气春升则余脏从之。”乃处达原饮加减，理少阳，化湿浊，调脾胃。厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，菖蒲10克，甘草6克，紫苏6克，白芷10克。
服药2剂，恶心呕吐稍减，饮食稍进，舌质淡，舌苔白，：脉沉弦细涩。综合脉证，思之：面色萎黄，脉沉弦细涩者，中气不足，木邪犯土，气血大衰也。治宜健脾抑肝，补气养血。处方：黄芪10克，当归3克，桂枝10克，白芍20克，甘草6克，生姜3片，大枣7个。
服药1剂，精神好转，食欲增加，但服至第2剂时，诸证又见加重，恶心呕吐，精神疲惫，口苦咽干，舌尖疼痛，心烦不安。再审其舌苔黄白厚腻，脉虚大弦紧而数。综合脉证，思之：脉虚大者，气阴俱虚也；弦紧者，寒也，积也；滑者，痰也，积也，热也；数者，热也。弦紧滑数俱见者，寒热胶结，三焦不通，清升浊降失职耳。稍予温药则火炽，稍予凉药则阳亡，稍予补药则壅邪，稍予泻药则正不支，实难措手施治。因建议另请高明者治之，然患者云：曾在北京、太原、西安等地医院治之无效，再请朱老拟方。乃予清暑益气汤加减。黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，甘草6克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术15克，白术10克，升麻10克，泽泻10克。
处方刚毕。某医云：此方能治尿毒症?此方能纠正电解质平衡?此方何药能降血压?答曰：本病既为脉虚大弦紧而数，那就应该从补虚泻实，升清降浊上人手。
服药4剂，精神、食欲明显好转，气短心悸，恶心呕吐，头晕头胀稍有改善，血压亦由200／100mmHg降至180／90mmHg。继服上药2个多月，心包积液消失，二氧化碳结合力、尿素氮竟恢复正常。
2．仅注意大的趋势，不注意兼挟的小问题，久久难解
邱××，女，66岁。
多囊肾、慢性肾盂肾炎、慢性肾功能衰竭。经过西药和血透治疗半年多以后，虽然症状已明显改善。但时至今日，仍然时而恶心呕吐，纳呆食减，疲乏无力，心悸气短，下肢浮肿，尿少尿频，身热，且血色素、尿素氮、二氧化碳结合力、肌酐均一直异常。为此不得不采用西药配合中药补气养血、清热解毒、活血利水，以及大黄定期灌肠法进行治疗。然而治疗已近2个月，服药近50剂，不见效果。审其面色萎黄，疲乏无力，恶心呕吐，尿少尿热，下肢浮肿，心悸气短，舌苔白黄而稍腻，脉虚大弦紧数而时涩。因思症脉合参，乃气阴俱虚，湿热内蕴之证也。为拟补气养阴以培本，燥湿清热以治标。处方：黄芪20克，当归6克，人参10克，麦冬10克，五味子10克，生地30克，苍术10克，茯苓10克，泽泻10克，丹皮10克，防己10克，黄连10克。
1. 表里不分，脏腑不明，阴阳不清，只知解毒清热，拘泥于经验，导致病情加重
6天前，在长途拉练过程中，突然患上感冒，医生给予APC（阿司匹林、非那西丁、咖啡因复方制剂）2片治疗。当晚，感冒症状不仅没有减轻，反而加重，并出现浮肿、尿少。医生未引起重视，再次给予APC 2片和长效磺胺2片治疗。十几分钟后，病情更加严重，持续高热不退，不时有少量鼻出血，全身出现大片紫斑，高度浮肿。急转至县医院治疗，诊断为急性肾炎。给予青霉素、中药清热解毒利尿剂等治疗2天后，浮肿不仅更加严重，而且出现大片紫斑，伴有鼻出血、牙龈出血、吐血、咳血、尿血、便血，时时烦躁不安，时而神志昏迷、胡言乱语，恶心呕吐。再次转院治疗，诊断为急性肾功能衰竭、心包炎。医生除给予纠正水电解质紊乱和酸碱平衡失调、控制感染、对症处理外，并采用中药清热解毒利水消肿等治疗3天，仍然无明显效果。查其证见吐血、咳血、鼻出血、牙龈出血、便血、尿血、耳出血、崩漏（非经期大量阴道出血），高度水肿，尿少或尿闭，全身见大片紫斑，烦躁不安，身热如炭，舌质红绛，脉滑数。综合脉象与症状，思考：此病虽非温病（感受温热邪气所致的外感热病）所致，但其证候属于热毒深入营血分，因此适宜用清营凉血法治疗。又想到斑色紫且点大者，是胃中热盛的表现，不仅仅靠清营凉血就能治愈，应当在清营凉血方中加入清泻胃火的药物。前方使用清热解毒并非针对病机所在，所以无效。拟定方剂：犀角10克（现已禁用，常用水牛角代替），生地30克，白芍10克，丹皮10克，大黄6克，茅根30克，茜草10克，小蓟炭10克。
服药1剂后，鼻出血、吐血、便血，身热，神烦均稍减轻，体温由40.2℃降至38.9℃，且小便微通；继服1剂，吐衄、便血大减，身热、烦躁亦减轻，体温降至38.5℃，小便增多；再服上药4剂，吐衄停止，尿量增加，饮食可进。
某医生说：既然见到尿闭、呕吐，为何不采用利尿法？回答：辨证论治的一个核心问题是辨别复杂问题中的主要矛盾，即目前起主导作用的问题。本病从脉象、舌象来看，热入营血和热在阳明经是主要问题，所以首先采用凉血活血、泻胃通腑的方法进行治疗。
2. 表里不分，脏腑不明，阴阳不清，只施解毒清热，拘泥于经验，病情加剧
麻某某，男，14岁。
5个月前，突然发现浮肿。某医院诊断为急性肾小球肾炎。住院治疗2个多月，浮肿不仅不减，反而加重。2个多月以前，又突然发现持续高热不退，咳嗽气喘不能平卧，腹部高度水肿，尿闭。经过反复检查，确诊为肺炎、肺源性心脏病、心力衰竭、慢性肾小球肾炎急性发作、急性肾功能衰竭。先用西药治疗1个多月不见改善，继而又配合中药补气养血、活血利水、清热解毒治疗20余日，病情更加严重。仔细审查其证见高度浮肿，两眼因浮肿而不能露睛，腹大如鼓，滴尿全无，高热（40.1℃），烦躁不安，频频恶心呕吐，呼吸极度困难，口唇、面颊、手指均紫黯，舌质淡黯，舌苔黄白，脉浮紧数促涩。综合脉象与症状，思考：张仲景《金匮要略》说：“脉象见沉，应当责求有水气，身体肿重。水病脉反出（浮大无根）者，死。”又说：“太阳病（太阳经受邪所致的病证），脉浮而紧，按理应当骨节疼痛，反而不痛，身体反而沉重酸痛，病人不渴……此为风水（因风邪侵袭导致的水肿病）。”如今本证脉浮，是脉出（死证之兆），还是脉浮（表证），是表证，还是死证，尤其需要鉴别。又想到：脉出者是浮大无根，而此脉见浮紧，浮紧相兼者为表证。表证应当解表散寒。前用诸药予补气养血者，意在其脉出故以补益之药，显系有误，这是邪实正虚的情况不明。浮紧而数者，紧为寒，数为热，是寒也是热，张仲景《伤寒论》有解释：“脉浮而数者，可发汗，宜麻黄汤。”言其主要为表寒闭郁。促脉（脉来数而时一止，止无定数）是什么？是热？还是寒？张仲景《伤寒论》说：“脉促胸满者，桂枝去芍药汤主之。”言其阳虚；而白虎加人参汤之脉促则言其热也，如今促脉与涩脉（脉往来艰涩不畅）兼见者，应当为阳虚之极，非热极也。舌苔黄者，里热也。脉证相参，综合而论之，乃心肾阳虚，水饮积留心下（胃脘部），表里合邪，郁而化热所致。治宜温阳散寒，通利气机。处方：麻黄6克，附子6克，细辛3克，桂枝10克，生姜3片，大枣7个，甘草6克，防己10克，茅根30克，大腹皮10克。
服药1剂，咳喘、发热均减，体温39℃；继服2剂，呼吸困难明显好转，恶心呕吐消失，尿量增多，体温38.1℃；又服7剂，浮肿全消，体温37.1℃。除尿常规尿蛋白++++，红细胞5—10个外，尿素氮、二氧化碳结合力均恢复正常。
张某某，女，67岁。
糖尿病15年，经西、中药物治疗曾一度好转，但近6年来，不但不再好转，且在尿中出现了大量蛋白尿。2个多月前，又突然出现头晕头胀，心烦心悸，恶心呕吐，食纳甚差，某医始作急性胃炎论治，不效，又改请中医以柴平汤（柴胡、黄芩、半夏、人参、甘草、陈皮、茯苓、苍术、生姜、大枣）2剂，诸证均减，停药10天后，诸证又剧，再作柴平汤4剂，不效。乃住某院进行治疗。住院10天后，血压、血糖、尿糖等明显好转，饮食亦稍增加。但至14天时，突然感到咳喘气短不能平卧，发热，微恶风寒。经过详细检查确诊为肺炎。经过用大剂量抗生素与清热解毒、宣肺定喘中药治疗10天，诸证不但不减，反而更加严重，且出现浮肿尿少，腹水，恶心呕吐。再经详细检查确诊为糖尿病、糖尿病性酸中毒、高血压病、糖尿病性肾病、急性肾功能衰竭、心肌炎、肺炎、心力衰竭。医生除继续采用西药抢救外，并配合清热解毒，大黄灌肠等中药治疗5天，因其病情日渐加重，在家属的反复要求下，再求中医会诊。察其高热（39.5℃）咳喘，不得平卧，浮肿尿少，腹大如鼓，频频恶心呕吐，口唇紫黯，面色萎黄而肿，口苦口干，欲饮不能饮，指趾厥冷，心烦失眠，舌苔黄白而腻，脉浮紧促数。综合脉象与症状思考：此病乃素有气阴大衰，痰湿阻滞，今复外感风寒，阳虚阴凝之证耳。攻之，泻之均所不宜；补之，散之均有所难。又想到小剂量祛邪多不伤正，小剂量扶正多不留邪。故先以小剂桂枝去芍加麻辛附子汤（桂枝去芍药汤加麻黄、细辛、附子）治之。处方：附子1克，桂枝1克，甘草1克，生姜1片，大枣3枚，麻黄1克，细辛0.5克，生石膏2克，防己1克。
服药1剂，喘咳稍减，腹胀稍轻；继服1剂，喘咳大减，稍能平卧，尿量增多，恶心呕吐基本消失，体温降至38℃；又服3剂，体温降至37.5℃，咳喘大部消失，水肿腹水几近消退。某医生说：如此之重疾，竟用如此之小药，岂能济事，应以上药10倍量予之。服药2剂，病情骤剧，浮肿尿少，腹胀咳喘，恶心欲吐俱见。某医又说：此用附、桂、麻黄、细辛之误也，尿毒症岂敢用附、桂！宜大剂大黄灌肠治之。2天后，病情更剧，腹大浮肿，发热咳喘，恶心呕吐，心烦失眠。再邀余诊视。察其除上述诸证外，并见指趾微厥，舌质淡黯，苔黄白，脉浮紧数促。因思其证仍为表里合邪，外寒内饮，心肾阳虚，水饮射肺，郁而化热为主。再拟温阳散寒，通彻表里，通利气机为法。处方：附子1.5克，桂枝3克，生姜3片，甘草3克，大枣5个，细辛1克，麻黄1.5克，生石膏5克，防己3克，腹皮3克。
服药2剂，诸证又减；继服6剂，诸证消失。尿素氮、二氧化碳结合力等亦恢复正常。
某医问：大黄为治疗尿毒症之药，何本症用之反剧？回答：微阳之躯岂能胜重剂之苦寒，不可也，不可也。
4. 邪入膜原，三焦俱病，斡旋不能，升降不利，反用寒凉，败胃闭邪，病势更甚
张某某，男，2岁。
高热（39.9℃）不退，尿少尿频，恶心呕吐1个月。医诊左肾发育不全，右肾囊肿，肾盂肾炎、急性肾功能衰竭。予西药治疗20天后，又配合中药补气养血、活血利尿、清热解毒治疗10天，不但不效，反而加重。仔细审查其证，除发热，尿少尿频，恶心呕吐外，并见其腹满胀痛，按之更甚，舌质淡黯，舌苔黄白，面色青黑，脉弦紧滑数。综合脉象与症状，思考：腹满胀痛，按之尤甚者，有积滞也；面色青黑者，肝肾湿热也；脉弦者，少阳或膜原（半表半里之深部）有邪也；紧脉者，寒也，积也。因而回忆吴又可《温疫论》说：“温疫初起，先憎寒而后发热，嗣后但热而不憎寒也。初得之二三日，其脉不浮不沉而数，昼夜发热，日晡益甚，头疼身痛，其时邪在伏膂之前，肠胃之后，虽有头痛身痛，此邪热浮越于经，不可认为伤寒表证，辄用麻黄桂枝之类，强发其汗，此邪不在经，汗之徒伤卫气，热亦不减；又不可下，此邪不在里，下之徒伤胃气，其渴愈甚，宜达原饮主之。”“按槟榔能消磨，除伏邪，为疏利之药……厚朴破戾气所结，草果辛烈气雄，除伏邪蟠踞。三味协力，直达其巢穴，使邪气溃散，速离膜原，是以名为达原散也。”吴氏所论虽非肾盂肾炎、急性肾功能衰竭，而其理则一也。综合脉证，正合吴又可达原散证也。乃拟宣透膜原法。处方：厚朴3克，草果3克，槟榔3克，黄芩3克，知母3克，苏叶3克，神曲3克，柴胡6克，菖蒲4克。
服药2剂，发热、恶心呕吐等症稍减；继服4剂，体温正常，恶心呕吐消失；再服10剂，尿素氮、二氧化碳结合力，肌酐均恢复正常。
某医生说：何用大剂抗生素与中药清热解毒剂而证不减？回答：病邪在膜原耳。病既在膜原，又挟湿邪，岂寒凉冰伏所能治，此正犯湿热之禁忌法耳。可在治湿温法中求之。
1. 固执经验，胶于病名，不知随证，不知辨证，延误病期
孙某某，女，63岁。
7～8个月来，疲乏无力，食欲不振，时见鼻衄。医诊多囊肾、慢性肾小球肾炎、慢性肾功能衰竭。先用西药治之不效，后又配合中药健脾补肾、活血利水、清热解毒、降逆止呕、通利泻下等治疗4个多月仍不效。近2个月来，更加疲乏无力，神志时清时昧，说话均感无力，轻度浮肿，且饮食入口，甚或稍闻食味即恶心呕吐，面色萎黄。仔细审查其证，除上述者外，并见脘腹微满，舌质淡，舌苔黄白厚腻，脉弦紧滑数。综合脉象与症状，思考：面色萎黄，血色素仅40克／L，且神疲乏力，言语低微，可见气血阴阳已经大虚，然大虚之脉应沉细无力，本病却脉见弦紧滑数，证脉不符，其脉必为邪气之实脉也。又想到：弦紧之脉者，寒也，结也；数滑相兼者，痰也，热也。既有寒，又有热，既有气结，又有痰凝，综合而论之，为寒热交结，痰积气滞，湿郁化热，三焦水道不通，凌犯脾胃之证。然虚实寒热俱见者，何从治之？李东垣《脾胃论》说：“谷气通于脾，六经为川，脾胃为海，九窍为水注之气，九窍者五脏主之，五脏皆得胃气，乃能通利……凡十一脏皆取决于胆也。胆者少阳春升之气，春气升则万化安，故胆气春升则余脏从之。”于是处达原饮加减，理少阳，化湿浊，调脾胃。厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，菖蒲10克，甘草6克，紫苏6克，白芷10克。
服药2剂，恶心呕吐稍减，饮食稍进，舌质淡，舌苔白，脉沉弦细涩。综合脉象与症状，思考：面色萎黄，脉沉弦细涩者，中气不足，木邪犯土，气血大衰也。治宜健脾抑肝，补气养血。处方：黄芪10克，当归3克，桂枝10克，白芍20克，甘草6克，生姜3片，大枣7个。
服药1剂，精神好转，食欲增加，但服至第2剂时，诸证又见加重，恶心呕吐，精神疲惫，口苦咽干，舌尖疼痛，心烦不安。再审其舌苔黄白厚腻，脉虚大弦紧而数。综合脉象与症状，思考：脉虚大者，气阴俱虚也；弦紧者，寒也，积也；滑者，痰也，积也，热也；数者，热也。弦紧滑数俱见者，寒热胶结，三焦不通，清升浊降失职耳。稍予温药则火炽，稍予凉药则阳亡，稍予补药则壅邪，稍予泻药则正不支，实难措手施治。因建议另请高明者治之，然患者云：曾在北京、太原、西安等地医院治之无效，再请朱老拟方。乃予清暑益气汤加减。黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，甘草6克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术15克，白术10克，升麻10克，泽泻10克。
处方刚毕。某医生说：此方能治尿毒症？此方能纠正电解质平衡？此方何药能降血压？回答：本病既为脉虚大弦紧而数，那就应该从补虚泻实，升清降浊上人手。
服药4剂，精神、食欲明显好转，气短心悸，恶心呕吐，头晕头胀稍有改善，血压亦由200／100mmHg降至180／90mmHg。继服上药2个多月，心包积液消失，二氧化碳结合力、尿素氮竟恢复正常。
2. 仅注意大的趋势，不注意兼挟的小问题，久久难解
邱某某，女，66岁。
多囊肾、慢性肾盂肾炎、慢性肾功能衰竭。经过西药和血透治疗半年多以后，虽然症状已明显改善。但时至今日，仍然时而恶心呕吐，纳呆食减，疲乏无力，心悸气短，下肢浮肿，尿少尿频，身热，且血色素、尿素氮、二氧化碳结合力、肌酐均一直异常。为此不得不采用西药配合中药补气养血、清热解毒、活血利水，以及大黄定期灌肠法进行治疗。然而治疗已近2个月，服药近50剂，不见效果。审其面色萎黄，疲乏无力，恶心呕吐，尿少尿热，下肢浮肿，心悸气短，舌苔白黄而稍腻，脉虚大弦紧数而时涩。因思症脉合参，乃气阴俱虚，湿热内蕴之证也。为拟补气养阴以培本，燥湿清热以治标。处方：黄芪20克，当归6克，人参10克，麦冬10克，五味子10克，生地30克，苍术10克，茯苓10克，泽泻10克，丹皮10克，防己10克，黄连10克。
1. Failure to distinguish exterior from interior, organs from each other, and yin from yang; reliance solely on detoxification and clearing heat, adherence to empirical experience leading to aggravation of the condition
Six days ago, during a long-distance march, the patient suddenly contracted a common cold. The physician prescribed APC (Aspirin-Phenacetin-Caffeine compound) 2 tablets for treatment. That night, not only did the cold symptoms fail to subside, but they worsened, accompanied by edema and oliguria. The physician failed to pay attention to this and administered another 2 tablets of APC and 2 tablets of sulfadiazine (long-acting sulfa drug). Within ten minutes, the condition deteriorated further with persistent high fever, occasional mild epistaxis, widespread ecchymosis (purple spots), and severe edema. An emergency transfer to the county hospital was made, where acute nephritis was diagnosed. Treatment with penicillin and Chinese herbal medicines for clearing heat and detoxifying while promoting diuresis was continued for two days. However, the edema worsened, large patches of ecchymosis appeared, along with epistaxis, gingival bleeding, hematemesis, hemoptysis, hematuria, and melena. The patient experienced frequent restlessness and intermittent coma with delirium, nausea, and vomiting. A second hospital transfer occurred, resulting in diagnoses of acute renal failure and pericarditis. In addition to correcting water-electrolyte imbalance and acid-base disturbance, controlling infection, and symptomatic treatment, Chinese herbal medicines for clearing heat, detoxifying, and reducing edema were used for three days without significant effect. Examination revealed hematemesis, hemoptysis, epistaxis, gingival bleeding, melena, hematuria, otorrhagia (ear bleeding), metrorrhagia (profuse uterine bleeding outside menstrual periods), severe edema, oliguria or anuria, widespread ecchymosis, restlessness, body heat like charcoal, crimson tongue coating, and slippery-rapid pulse. Synthesizing the pulse and symptoms: Although this disease is not caused by warm diseases (exogenous febrile diseases caused by warm pathogenic factors), the syndrome indicates heat-toxin entering the Ying (Nutrient) and Xue (Blood) levels. Therefore, clearing the Ying level and cooling the blood is appropriate. Furthermore, purple macules with large dots indicate excessive heat in the Stomach. Clearing the Ying level and cooling the blood alone is insufficient; herbs that clear and drain Stomach fire should be added to the formula. The previous use of heat-clearing and detoxifying herbs missed the core pathology, hence the lack of efficacy. The proposed prescription is: Rhinoceros Horn 10g (now banned, commonly replaced by Water Buffalo Horn), Rehmannia Root 30g, White Peony Root 10g, Moutan Bark 10g, Rhubarb 6g, Imperata Rhizome 30g, Sanguisorba Root 10g, Small Thistle Charcoal 10g.
After one dose, epistaxis, hematemesis, melena, body heat, and mental agitation decreased slightly. Body temperature dropped from 40.2°C to 38.9°C, and urination began. After a second dose, vomiting and bleeding significantly reduced, body heat and irritability subsided, temperature fell to 38.5°C, and urine output increased. After four more doses, bleeding stopped, urine volume increased, and appetite returned.
A colleague asked: Given anuria and vomiting, why not use diuretics? The answer is: A core issue in pattern differentiation and treatment is identifying the primary problem within complex situations, i.e., the dominant factor at present. From the pulse and tongue, the primary issues are heat entering the Ying and Xue levels and heat in the Yangming channel. Thus, the initial treatment focused on cooling the blood, invigorating blood circulation, purging the Stomach, and unblocking the bowels.
2. Failure to distinguish exterior from interior, organs from each other, and yin from yang; application of only detoxification and clearing heat, adherence to experience leading to worsening condition
Ma XX, Male, 14 years old.
Five months ago, sudden onset of edema. Diagnosed with acute glomerulonephritis at a certain hospital. After over two months of hospitalization, edema did not decrease but worsened. Over two months ago, sudden persistent high fever, cough and asthma preventing supine position, massive abdominal edema, and anuria occurred. Repeated examinations confirmed pneumonia, cor pulmonale, heart failure, acute exacerbation of chronic glomerulonephritis, and acute renal failure. Western medicine treatment for over a month showed no improvement. Subsequently, Chinese herbal medicines for tonifying Qi and nourishing Blood, invigorating blood and promoting diuresis, and clearing heat and detoxifying were added for over 20 days, yet the condition worsened. Careful examination revealed severe edema (eyes unable to open due to swelling), drum-like abdomen, complete anuria, high fever (40.1°C), restlessness, frequent nausea and vomiting, extreme dyspnea, cyanosis of lips, cheeks, and fingers, pale-dark tongue body, yellow-white tongue coating, and floating-tight-numerate-hurried-choppy pulse. Synthesizing pulse and symptoms: Zhang Zhongjing’s *Jingui Yaolue* states: "When the pulse is sinking, water retention should be suspected, causing body swelling and heaviness. If the pulse in water disease emerges (floating and rootless), it is a sign of death." It also states: "In Taiyang disease (disease of the Taiyang channel), the pulse is floating and tight, typically associated with bone and joint pain. If there is no pain, but the body feels heavy and sore, and the patient has no thirst... this is Feng Shui (Wind-Water edema)." In this case, is the floating pulse an "emerging" pulse (sign of death) or a standard floating pulse (exterior syndrome)? This distinction is crucial. An emerging pulse is floating, large, and rootless, whereas this pulse is floating and tight. Floating and tight together indicate an exterior syndrome, which requires releasing the exterior and dispersing cold. The previous use of Qi-tonifying and Blood-nourishing herbs was likely based on the misinterpretation of the pulse as "emerging," which was erroneous, failing to recognize the complexity of excess pathogen and deficiency of healthy Qi. Floating, tight, and rapid: Tight indicates cold, rapid indicates heat. Zhang Zhongjing’s *Shanghan Lun* explains: "If the pulse is floating and rapid, sweating may be indicated, using Mahuang Tang." This highlights exterior cold constraint. What does a hurried pulse (pulse with irregular pauses) signify? Heat or cold? *Shanghan Lun* states: "For hurried pulse with chest fullness, Guizhi Qu Shaoyao Tang is indicated," implying Yang deficiency. Conversely, a hurried pulse in Baihu Jia Renshen Tang implies heat. Here, the combination of hurried and choppy pulses suggests extreme Yang deficiency rather than extreme heat. Yellow tongue coating indicates interior heat. Integrating pulse and symptoms, the diagnosis is Heart and Kidney Yang deficiency, accumulation of fluid-retention below the heart (epigastrium), combined exterior-interior pathogens, stagnation transforming into heat. The treatment principle is warming Yang, dispersing cold, and regulating Qi mechanism. Prescription: Ephedra Herb 6g, Aconite Lateral Root 6g, Asarum Root 3g, Cinnamon Twig 10g, Fresh Ginger 3 slices, Jujube Fruit 7 pieces, Licorice Root 6g, Stephania Root 10g, Imperata Rhizome 30g, Areca Peel 10g.
After one dose, cough/asthma and fever decreased, temperature 39°C. After two more doses, dyspnea improved significantly, nausea/vomiting ceased, urine output increased, temperature 38.1°C. After seven additional doses, edema resolved completely, temperature 37.1°C. Except for urine protein ++++ and RBCs 5-10/hpf, blood urea nitrogen and CO2 combining power returned to normal.
3. Yang deficiency with Yin coagulation, fluid retention below the heart, combined exterior-interior pathogens; counterproductive use of bitter-cold purgatives leading to worse condition
Zhang XX, Female, 67 years old.
Diabetes mellitus for 15 years. Initially improved with Western and Chinese medicine, but over the past six years, no further improvement occurred, and massive proteinuria developed. Two months ago, sudden dizziness, headache, palpitations, nausea, vomiting, and poor appetite occurred. Initially treated as acute gastritis without success. Then consulted a TCM practitioner who prescribed Chai Ping Tang (Bupleurum and Pinellia Decoction modified) for 2 doses, symptoms subsided. Ten days after stopping medication, symptoms recurred severely. Another 4 doses of Chai Ping Tang were ineffective. Hospital admission followed. After 10 days, blood pressure, blood sugar, and urine sugar improved, and diet increased slightly. On day 14, sudden cough, asthma, shortness of breath preventing supine position, fever, and slight aversion to wind/cold occurred. Detailed examination confirmed pneumonia. Ten days of high-dose antibiotics and Chinese herbs for clearing heat, detoxifying, diffusing Lung Qi, and calming asthma failed to alleviate symptoms; instead, they worsened, accompanied by edema, oliguria, ascites, nausea, and vomiting. Further examination confirmed diabetes, diabetic ketoacidosis, hypertension, diabetic nephropathy, acute renal failure, myocarditis, pneumonia, and heart failure. Besides Western rescue therapies, Chinese herbs for clearing heat/detoxifying and Rhubarb enemas were used for 5 days. Due to progressive deterioration and family request, a TCM consultation was sought. Signs included high fever (39.5°C), cough/asthma, inability to lie flat, edema/oliguria, drum-like abdomen, frequent nausea/vomiting, cyanotic lips, sallow-swollen face, bitter/dry mouth with inability to drink, cold extremities, irritability/insomnia, yellow-white greasy tongue coating, and floating-tight-hurried-rapid pulse. Synthesis: The patient has underlying severe Qi and Yin deficiency with phlegm-damp obstruction, now complicated by exogenous wind-cold, resulting in Yang deficiency and Yin coagulation. Purging or attacking is inappropriate; tonifying or dispersing is difficult. However, small doses of pathogen-resolving herbs rarely damage healthy Qi, and small doses of tonics rarely retain pathogens. Therefore, a small dose of Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Tang (Guizhi Qu Shaoyao Tang plus Ephedra, Asarum, and Aconite) was used. Prescription: Aconite Lateral Root 1g, Cinnamon Twig 1g, Licorice Root 1g, Fresh Ginger 1 slice, Jujube Fruit 3 pieces, Ephedra Herb 1g, Asarum Root 0.5g, Gypsum 2g, Stephania Root 1g.
After one dose, wheezing/cough decreased slightly, abdominal distension lightened. After another dose, wheezing/cough greatly reduced, able to lie down slightly, urine increased, nausea/vomiting mostly ceased, temperature 38°C. After three more doses, temperature 37.5°C, most cough/wheezing resolved, edema/ascites nearly gone. A colleague commented: Such a severe illness treated with such small doses? Should have used 10 times the amount. After two doses of the larger dose, condition acutely worsened with edema, oliguria, abdominal distension, cough/asthma, and nausea. Another colleague stated: Error in using Aconite, Cinnamon, Ephedra, Asarum! Uremia cannot tolerate these! Should use large-dose Rhubarb enema. Two days later, condition worsened further: massive abdominal edema, fever, cough/asthma, nausea/vomiting, irritability/insomnia. Consultation requested again. Signs included mild cold extremities, pale-dark tongue, yellow-white coating, floating-tight-rapid-hurried pulse. Analysis: Still combined exterior-interior pathogens, exterior cold with interior fluid retention, Heart-Kidney Yang deficiency, fluid rushing to Lung, stagnation transforming into heat. Revised treatment: Warm Yang, disperse cold, penetrate exterior-interior, regulate Qi mechanism. Prescription: Aconite Lateral Root 1.5g, Cinnamon Twig 3g, Fresh Ginger 3 slices, Licorice Root 3g, Jujube Fruit 5 pieces, Asarum Root 1g, Ephedra Herb 1.5g, Gypsum 5g, Stephania Root 3g, Areca Peel 3g.
After two doses, symptoms decreased. After six more doses, all symptoms disappeared. Blood urea nitrogen and CO2 combining power normalized.
Colleague asked: Rhubarb is used for uremia; why did it worsen this case? Answer: A body with微弱 Yang cannot withstand heavy doses of bitter-cold herbs. It is inadvisable.
4. Pathogen enters Mo Yuan (Membrane Source), affecting all three Jiao, failure of pivot function, impaired ascending-descending; counterproductive use of cold-cooling herbs damaging Stomach and trapping pathogen, worsening condition
Zhang XX, Male, 2 years old.
Persistent high fever (39.9°C), oliguria/frequency, nausea/vomiting for one month. Diagnosed with left renal hypoplasia, right renal cyst, pyelonephritis, acute renal failure. Western medicine for 20 days, then combined with Chinese herbs for tonifying Qi/Blood, invigorating blood/promoting diuresis, clearing heat/detoxifying for 10 days. No improvement; condition worsened. Careful examination revealed fever, oliguria/frequency, nausea/vomiting, abdominal fullness/pain worsening on pressure, pale-dark tongue, yellow-white coating, dark blue-black complexion, wiry-tight-slippery-rapid pulse. Synthesis: Abdominal fullness/pain worsening on pressure indicates accumulation; dark blue-black complexion indicates Liver/Kidney damp-heat; wiry pulse indicates pathogen in Shaoyang or Mo Yuan; tight pulse indicates cold or accumulation. Recalling Wu Youke’s *Wenyi Lun*: "Warm epidemic begins with aversion to cold followed by fever, then only fever without aversion to cold. In the first 2-3 days, pulse is neither floating nor sinking but rapid, with daytime/nighttime fever worsening at dusk, headache, body ache. At this stage, the pathogen is between the diaphragm and intestines/stomach. Despite headache/body ache, this is not Taiyang exterior syndrome; do not use Mahuang/Cinnamon to force sweat, as the pathogen is not in the channels, sweating only damages Wei Qi without reducing fever. Do not purge, as the pathogen is not in the interior, purging only damages Stomach Qi and increases thirst. Use Da Yuan Yin (Reach the Origin Decoction)." "Betel Nut can dissolve and remove latent pathogens, acting as a draining agent... Magnolia Bark breaks stagnant Qi, Litsea Fruit is pungent/aromatic, removing entrenched pathogens. These three work together to reach the nest, scattering the pathogen and expelling it from Mo Yuan, hence the name Da Yuan San." Although Wu’s discussion refers to warm epidemics, not pyelonephritis/renal failure, the principle is identical. Pulse and symptoms match Da Yuan Yin pattern. Treatment: Ventilate and penetrate Mo Yuan. Prescription: Magnolia Bark 3g, Litsea Fruit 3g, Betel Nut 3g, Scutellaria Root 3g, Anemarrhena Rhizome 3g, Perilla Leaf 3g, Medicated Leaven 3g, Bupleurum Root 6g, Acorus Rhizome 4g.
After two doses, fever, nausea, vomiting decreased slightly. After four more doses, temperature normalized, nausea/vomiting ceased. After ten more doses, blood urea nitrogen, CO2 combining power, and creatinine normalized.
Colleague asked: Why didn't large-dose antibiotics and heat-clearing/detoxifying herbs work? Answer: The pathogen is in Mo Yuan. With dampness involved, cold-cooling herbs (which freeze the pathogen) are contraindicated. This violates the principles for treating damp-warmth. One should seek methods for damp-warmth.
Chronic Renal Failure
1. Adherence to experience and disease names, ignoring symptom-based differentiation, delaying treatment
Sun XX, Female, 63 years old.
For 7-8 months, fatigue, loss of appetite, occasional epistaxis. Diagnosed with polycystic kidney disease, chronic glomerulonephritis, chronic renal failure. Western medicine ineffective. Added Chinese herbs for strengthening Spleen/kidney, invigorating blood/promoting diuresis, clearing heat/detoxifying, descending rebellious Qi/stopping vomiting, and purging for over 4 months without effect. In the last 2 months, fatigue worsened, consciousness fluctuated, speech weak, mild edema, nausea/vomiting upon eating or even smelling food, sallow complexion. Careful examination revealed slight epigastric/abdominal fullness, pale tongue, thick yellow-white greasy coating, wiry-tight-slippery-rapid pulse. Synthesis: Sallow complexion, Hemoglobin 40g/L, fatigue, weak speech indicate severe deficiency of Qi, Blood, Yin, and Yang. However, severe deficiency usually presents with deep-thin-weak pulse, yet this patient has wiry-tight-slippery-rapid pulse, contradicting the deficiency signs, suggesting the pulse reflects excess pathogen. Wiry-tight indicates cold/stagnation; rapid-slippery indicates phlegm/heat. Combined, this is cold-heat intermingling, phlegm-qi stagnation, dampness transforming into heat, blockage of Three Jiao water pathways, invading Spleen/Stomach. How to treat mixed deficiency/excess and cold/heat? Li Dongyuan’s *Pi Wei Lun* states: "Grain Qi connects to the Spleen, Six Channels are rivers, Spleen/Stomach are seas, Nine Orifices are passages for water Qi, governed by Five Zang organs. All organs rely on Stomach Qi... All eleven organs depend on Gallbladder. Gallbladder is the Spring-rising Qi of Shaoyang; when Spring Qi rises, all transformations are peaceful. Thus, when Gallbladder Qi rises, other organs follow." Prescribed Da Yuan Yin modified to regulate Shaoyang, transform damp-turbidity, harmonize Spleen/Stomach. Prescription: Magnolia Bark 10g, Litsea Fruit 10g, Betel Nut 10g, Scutellaria Root 10g, Anemarrhena Rhizome 10g, Acorus Rhizome 10g, Licorice Root 6g, Perilla Leaf 6g, Angelica Dahurica Root 10g.
After two doses, nausea/vomiting decreased slightly, diet improved slightly, tongue pale, coating white, pulse deep-wiry-thin-choppy. Synthesis: Sallow complexion, deep-wiry-thin-choppy pulse indicate Middle Qi deficiency, Wood invading Earth, severe Qi/Blood depletion. Treatment: Strengthen Spleen, suppress Liver, tonify Qi, nourish Blood. Prescription: Astragalus Root 10g, Angelica Sinensis Root 3g, Cinnamon Twig 10g, White Peony Root 20g, Licorice Root 6g, Fresh Ginger 3 slices, Jujube Fruit 7 pieces.
After one dose, spirit improved, appetite increased. But on the second dose, symptoms worsened: nausea/vomiting, fatigue, bitter taste, dry throat, tip of tongue painful, irritability. Re-examination: thick yellow-white greasy coating, deficient-large-wiry-tight-rapid pulse. Synthesis: Deficient-large pulse indicates Qi/Yin deficiency; wiry-tight indicates cold/accumulation; slippery indicates phlegm/accumulation/heat; rapid indicates heat. Wiry-tight-slippery-rapid together indicate cold-heat binding, Three Jiao blockage, failure of clear ascending/turbid descending. Slight warmth fuels fire; slight cooling destroys Yang; slight tonification traps pathogen; slight purging exhausts healthy Qi. Treatment is difficult. Recommended consulting another expert, but patient insisted on continuing with me. Prescribed Qing Shu Yi Qi Tang (Clear Summerheat and Benefit Qi Decoction) modified. Prescription: Astragalus Root 15g, Angelica Sinensis Root 6g, Ginseng Root 10g, Ophiopogon Tuber 10g, Schisandra Berry 10g, Licorice Root 6g, Green Tangerine Peel 10g, Tangerine Peel 10g, Medicated Leaven 10g, Phellodendron Bark 10g, Kudzu Root 15g, Atractylodes Macrocephala Rhizome 15g, Atractylodes Rhizome 10g, Bupleurum Root 10g, Alisma Rhizome 10g.
Just as the prescription was finished, a colleague asked: Can this formula treat uremia? Correct electrolyte balance? Lower blood pressure? Answer: Given the deficient-large-wiry-tight-rapid pulse, treatment must address tonifying deficiency, draining excess, ascending clear, and descending turbid.
After four doses, spirit and appetite significantly improved, shortness of breath/palpitations/nausea/vomiting/dizziness/head distension slightly improved, blood pressure dropped from 200/100 mmHg to 180/90 mmHg. Continued for over 2 months, pericardial effusion resolved, CO2 combining power and blood urea nitrogen normalized.
2. Focusing only on major trends, neglecting minor accompanying factors, leading to prolonged unresolved condition
Qiu XX, Female, 66 years old.
Polycystic kidney disease, chronic pyelonephritis, chronic renal failure. After over half a year of Western medicine and hemodialysis, symptoms improved significantly. However, still experiencing intermittent nausea/vomiting, anorexia, fatigue, palpitations/shortness of breath, lower limb edema, oliguria/frequency, low-grade fever. Hemoglobin, BUN, CO2 combining power, and creatinine remained abnormal. Required Western medicine combined with Chinese herbs for tonifying Qi/Blood, clearing heat/detoxifying, invigorating blood/promoting diuresis, and regular Rhubarb enemas. After nearly 2 months and ~50 doses, no effect. Examination: sallow complexion, fatigue, nausea/vomiting, oliguria/hot urine, lower limb edema, palpitations/shortness of breath, white-yellow slightly greasy tongue coating, deficient-large-wiry-tight-rapid pulse occasionally choppy. Synthesis: Qi and Yin deficiency with internal damp-heat. Treatment: Tonify Qi and nourish Yin to support the root, dry dampness and clear heat to treat the branch. Prescription: Astragalus Root 20g, Angelica Sinensis Root 6g, Ginseng Root 10g, Ophiopogon Tuber 10g, Schisandra Berry 10g, Rehmannia Root 30g, Atractylodes Rhizome 10g, Poria 10g, Alisma Rhizome 10g, Moutan Bark 10g, Stephania Root 10g, Coptis Rhizome 10g.