服药6剂，症不见减，且恶心呕吐，心烦心悸似有加重之势。综合脉证思之：紧涩相合之脉必兼阳虚，前方补气养阴，燥湿清热虽尽皆备至，而未重视兼挟之微疾耳。乃于上方中加肉桂10克。
服药6剂，诸证均减，恶心呕吐不但消失，而且食欲亦明显增加。继服2个月，尿素氮、二氧化碳结合力、肌酐均正常。
某医云：加肉桂何有如此之效?答曰：加肉桂者，非仅因兼阳虚而加之，亦且为与黄连相合而交通心肾，与人参、黄连、防己相合化膈间支饮耳。
急性肾小球肾炎
固执病名，不审脉证，久治不愈
侯××，男，15岁。
在5个月以前，突然发现眼睑浮肿，尿蛋白卅，红细胞5～10个，白细胞3～7个。医诊急性肾小球肾炎。急以西药治疗近3个月，除浮肿全部消失外，其他诸证俱不改善，后又请中医以利水消肿、滋阴补肾、清热解毒、活血利水治之近2个月，诸证亦不见好转。细审其证，除咽干咽痛，尿色黄赤之外，别无所苦，舌苔薄白，脉浮数。综合脉证，思之：脉浮者，表也，肺也，上焦也；数者，热也。咽喉干痛者，上焦风热者。尿黄赤者，心与小肠火也。治宜疏风解表，清热泻火。处方：蝉蜕10克，苏叶10克，僵蚕10克，连翘10克，茅根30克，元参15克，牛蒡子10克。
服药4剂，咽干咽痛好转，尿检各项指标明显好转，由蛋白卅、红细胞5一10个，白细胞3—7个、透明管型1个减为蛋白+，红细胞0～4个、白细胞O～3个。继服6剂，诸证消失，尿常规(一)。后果愈。
隐匿性肾小球肾炎
1．泥于效方，固于成方，不予辨证，久治不效
索××，男，30岁。
4年前，在1次检查身体的过程中，偶然发现尿蛋白++，其后连续复查多次均见尿蛋白在+一++之间。医诊隐匿性肾小球肾炎。始医以西药治疗1年多不效，后医以中药活血化瘀、益气利水、清热解毒、滋阴补肾等治疗2年多仍无功。细察其证，除尿蛋白在++之外，别无所苦，舌苔白，脉弦大尺脉尤甚。综合脉证，思之：脉弦大者，气阴俱虚也；尺脉大者，肾虚也。治宜补气养阴。处方：黄芪15克，当归6克，麦冬10克，党参10克，五昧子10克，生地20克，苍术10克，茯苓10克，泽泻10克，丹皮10克，黄连10克，肉桂6克。同时配服：肾康灵，1次4粒，1日3次。
服药6剂，尿蛋白(+)，继服10剂，愈。
2．泥于活血，胶于补肾，久不得愈
周×，男，19岁。
在1次体格检查的过程中，突然发现尿蛋白+，其后虽经多次复查亦无明显改变。医诊隐匿性肾小球肾炎。始医以西药治疗半年不效，后医以六味地黄丸、活血化瘀、清热解毒中药治疗近一年亦不见效果。细审脉证，除经常咽干外，别无所苦，舌苔白，脉浮数。综合脉证，思之：脉浮数者，上焦有热也。治以疏散风热。处方：蝉蜕10克，僵蚕10克，连翘10克，苏叶6克，牛蒡子10克，片姜黄10克，元参10克。
服药10剂，尿蛋白消失，愈。
慢性肾小球肾炎
1.夹杂微疾，不分性质，以寒作热，以寒作虚，久治不愈
宋×，男，14岁。
慢性肾小球肾炎，时肿时消，反复感冒4年多。医始以西药治疗2年多效果不著，后又配合中药治疗1年多仍无明显效果。特别是近1年来，身体特别虚弱，汗出畏风，纳呆食减，疲乏无力，睡眠时经常汗透枕巾，稍有不慎即发生感冒，一感冒少则20天，多则1—2个月不愈。审视其证，头汗渍渍而出，疲乏无力，纳呆食减，口干咽痛，脘腹微满，尿蛋白++，红细胞少许。审视所用之药，除西药外，中药有补气养血、清热解毒、活血利水、敛汗固表等，然不是不效，就是使病情加重。综合脉证，思之：自汗者多为气虚，然补气补阳均不济事，又思本病之汗出仅多见于头，头汗者，医家多称灯笼头。论其虚者虽有，而论其实者多见，实者或为瘀血，或为积滞，今见其胃脘痞满者当为食积，且其食后即汗出亦符合食积之证耳。内有食滞，则脾胃失其斡旋升降之能事，升降失职则肺不敷布，而卫气不固，故治者应先消积、理气、解表。处方：苏叶6克，桔梗10克，枳壳10克，陈皮10克，蝉衣10克，槟榔10克，黄芩6克，甘草3克，神曲10克。
服药1剂，感冒已愈，且头汗亦减，复与升阳益胃调理，精神、食欲逐渐好转。其后乃遵此法，感冒则予上方，不感冒则用升阳益胃，调理半年，果愈。
2．表里合邪，三焦郁热，反作虚治，久久不愈
刘×，男，15岁。
在1年前的一个下午，突然出现全身不适，眼睑轻度浮肿。家属认为是感冒，用了一些感冒药即症状消失。但1个月之后，又突然发现全身浮肿，尿少。经某院检查发现尿蛋白(卅)，红细胞3—5个，白细胞1—3个，诊为急性肾小球肾炎。经中、西药治疗10个多月后，浮肿虽已消退，但尿蛋白却一直维持在(+++一++++)之间不见改善。细审其证，除咽喉干痛之外，余无任何不适感，舌苔白，脉浮稍数。再询其所用中药有补气养阴者，有活血逐瘀者，有清热解毒者，有养阴补肾者，有收涩固精者，然其效均不著。综合脉证，思之：久病者多虚，久病者多瘀，此病之常也，故多以补益、活血而获愈。本病证之变也，故以补益、活血而不效。其变者何?从脉、舌辨也。又思：本病气色、症状均无虚证，说明经过治疗已不虚也。脉浮者，病在表也，在心肺也；数者，热也。咽喉者，肺胃所主也。证脉合参，乃肺胃郁热，表里同病耳。为拟解表清里，疏理三焦。处方：蝉蜕10克，僵蚕10克，连翘10克，片姜黄10克，大黄1克，紫苏6克。
服药30剂，咽喉干痛消失，尿蛋白降至(+一++)，红细胞消失；继服25剂，诸证消失，愈。
3．气阴两虚，湿热内蕴，但从补正，其效不著
晋××，女，32岁。
慢性肾小球肾炎反复急性发病5年多。医予西药治疗后，浮肿虽然已经大部消退，但下肢浮肿，腰酸腰困却一直不见改善，为此又配合中药补肾之剂治疗2年多，不但症状不见改善，反而急性发作更加频繁。细审其证，除典型的库欣综合征的特点外，并见其下肢浮肿，舌苔黄白而腻，脉虚大滑数。综合脉证，思之：虚大之脉者，气阴俱虚也；滑数者，里热也。舌苔黄白腻者，湿热也。合之于症，乃气阴俱虚，湿热内蕴也。前方之不效者，补肾有余而补气不足，补益有余而除邪不足。因拟补气养阴，利湿清热。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，生地15克，苍术10克，土茯苓10克，泽泻10克，丹皮10克。
在一方面逐步减少激素用量的情况下，服药2个月，下肢浮肿，腰酸腰困好转，但尿蛋白不见改善；至服药4个月时，曾感冒1次，但尿蛋白却减至(+)；服药5个月时，尿蛋白消失，愈。
肾病综合征
1．标本不明，缓急不分，前后不清，以缓作急，以急作缓，前后不分，乱施药饵
么×，男，30岁。
肾病综合征3年多，近年来，浮肿尿少更加严重。医先以激素、抗生素等治疗无效，后又配合中药补气养阴、养阴补肾、培补肾气、清热解毒、活血利水等治疗亦无明显效果。审其证见除典型的库欣综合征的表现外，并见浮肿尿少，咽喉疼痛，反复感冒，舌苔黄白而腻，脉浮滑数。因思浮肿、肥胖之人脉当见沉，今脉反浮，浮者为病在表，且症见咽喉疼痛，合而论之，当为病在表在上，舌苔黄白当为病在里，脉症合参，当为表里同病。乃拟解表清里。处方：蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，茅根15克，连翘10克，紫苏6克。
服药2个月，药进50剂，咽喉疼痛好转，尿蛋白由(十H{)降至(++)，管型消失。舌苔黄白腻，脉弦大紧数。综合脉证，思之：脉由浮滑数转为弦大紧数，乃因表邪得解，而气阴大衰之状仍著也，当以扶正，不可再予祛邪也。为拟补气养阴，利湿清热。处方：黄芪18克，当归6克，党参10克，麦冬10克，五味子10克，生地18克，苍术10克，茯苓10克，泽泻10克，丹皮10克。
服药60剂，在逐渐减少激素的情况下，尿蛋白降至(+)，乃停全部西药；继服上药2个多月，果愈。
医云：前医亦用补气养阴而却不效，其故何也?答曰：标本缓急，前后用药未分耳。又云：余用上方之法亦不效，其故何也?答曰：不当变而变，当变而不变所致，当久服而用药辄止，即所谓火候不到即停止用药，故不效也。
2．胶于成方，不知随证，久治不效张××，男，14岁。高度水肿，大量蛋白尿3年多。医诊肾病综合征。始以西药治疗无明显效果，继又配合中药滋阴补肾、益气利水、活血化瘀、清热解毒治疗1年亦无功。细审其证，除典型的库欣综合征外，并见下肢浮肿，尿蛋白++++，脉虚大弦滑数，舌苔黄白腻。综合脉证，思之：此气阴俱虚，湿热蕴郁也。治拟补气养阴，除湿清热。处方：肾康灵，1次4粒，1日3次，空心服。
服药1月，精神好转，尿蛋白++，继服2个月，尿(一)，浮肿消失。
3．但治肾病，不治兼证，只知局部，不知整体，治之不愈
赵××，女，40岁。
下肢浮肿，大量蛋白尿3年。医诊肾病综合征。医先予西药治之不效，继又改用中药滋阴补肾、益气利水、活血化瘀、清热解毒等治之亦无功。细审其证，除下肢浮肿，大量蛋白尿外，并见头晕乏力，胸满心烦，咽干咽痛，失眠，舌苔白，脉濡缓。综合脉证，诊为气阴两虚为本，痰郁气结，郁而化火为标。治拟补气养阴，理气化痰，清热泻火。处方：黄芪15克，当归6克，麦冬10克，太子参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，菖蒲10克，远志10克，生地10克，元参6克。
服药7剂，咽干咽痛，心烦失眠好转。尿蛋白由(++++)降至(++)。继服40剂，诸证大部消失，尿蛋白(+)，脉弦大。处方：肾康灵，1次4粒，一日3次，空心服。
服药1月，愈。
系统性红斑狼疮的肾损害
1．见热治热，不分表里，不分寒热，始终不效
邝××，女，19岁。
头痛身痛，发热乏力3年，持续高热身痛，浮肿心悸，气短恶心3个月。医诊系统性红斑性狼疮，狼疮性肾损害，狼疮性心肌炎。医先以西药治之不效，继又配合中药清热解毒、清气凉营等治疗亦无功。细审其证，头痛眼眶痛，全身关节疼痛，发热微恶寒，体温40．1℃，高度浮肿，轻度腹水，心悸气短，胃脘胀满疼痛，食纳甚差，恶心欲吐，面部少量皮疹，尿少不利，大便正常，舌苔白，脉浮紧滑数。综合脉证，思之：身痛头痛，微恶寒者，风寒表证也；心下坚满，浮肿者，水饮凝聚于心下也；心下坚满，气短心悸者，水饮上凌心肺也；高热，舌不红而苔白者，阳虚寒饮也。身热，脉滑数者，热也；脉紧者，寒也。合而论之，乃表寒、里热、寒饮共存之证。病属难治。姑拟散寒解表，温阳化饮，清热利水。处方：麻黄6克，细辛3克，附子6克，桂枝10克，生姜3片，大枣7个，生石膏30克，防己15克，茅根30克，大腹皮10克，炙甘草10克。
服药1剂，发热、身痛头痛，浮肿尿少，气短心悸俱减；继服4剂，体温降至37．2℃，浮肿消失，心悸气短消减八九，尿常规由尿蛋白(++)降至(±)，红细胞5—15个降至(一)，白细胞降至1—3，继服10剂，心电图亦恢复正常。
某医云：本病重证也，其病虽经多种西药治之不效，中药犀角(现用水牛角代)、银花、连翘、石膏均取重剂亦无效，其故何也?先生仅用石膏30克而其他清热之剂均不用，然其效却甚显著，其故又何也?答曰：本病是一个既有表寒，又有里热；既有阳虚，又有实热；既有水饮，又有表邪的复杂证。若但清其里热则表寒更加闭郁而热反甚；若但用解表则心肾阳气必然浮越而不能纳气归肾；若过用温阳则里热必炽而邪火更甚，若但用利水化饮则热邪必然更甚而炽烈。故但清不可，但温不可，但利不可，但补不可。故治疗起来必须解表兼化饮，散寒兼清热，温阳兼化水。至于但清其热而热不减者，亦在此也。
2．从脉审证，久服效宏
冯××，女，25岁。
系统性红斑性狼疮4年多，经用西药治疗后，发热浮肿已经基本得到控制，但激素一直维持在一定量或减量时，即出现发热身痛，且近2个多月来，又出现心跳加速，下肢浮肿，心烦喜哭，经查尿蛋白++，红细胞2～6个，白细胞2～7个，虽然继续增加激素用量及中药益气养阴，除湿清热之剂，仍然效果不够明显。细审其证，心胸烦乱，纳食不香，头晕头痛，下肢浮肿，舌苔白，脉滑而沉。综合脉证，思之：仲景《伤寒论》云：“若胸中烦而不呕者，去半夏人参，加瓜蒌实1枚。”脉沉滑者，痰火郁结也。治宜疏肝理气，化痰泻火。处方：柴胡15克，瓜蒌30克，生姜10克，甘草10克，大枣12个，黄芩10克。同时配服：肾康灵，1次4粒，1日3次，空心服。
服用六剂药后，症状未见减轻，反而出现恶心呕吐，心烦和心悸似乎有加重的趋势。综合脉象与证候思考：紧涩相兼的脉象必然伴有阳气虚弱，前方虽然补气养阴、燥湿清热都已完备，但未重视兼夹的微细病邪。于是于上方中加入肉桂10克。
再服用六剂药后，各种症状均减轻，恶心呕吐不仅消失，食欲也明显增加。继续服用两个月后，尿素氮、二氧化碳结合力、肌酐指标均恢复正常。
某医生说：加入肉桂为何有如此显著的效果？回答说：加入肉桂，不仅仅是因为兼有阳虚而添加，也是为了与黄连配合以交通心肾，并与人参、黄连、防己配合以化解膈间的支饮（水饮停聚胸胁）。
急性肾小球肾炎
固执于病名诊断，不审察脉证，久治不愈
侯××，男性，15岁。
五个月前，突然眼睑浮肿，尿蛋白卅（+++），红细胞5～10个，白细胞3～7个。医生诊断为急性肾小球肾炎。急用西药治疗近三个月，除浮肿全部消失外，其他症状均未改善。后又请中医以利水消肿、滋阴补肾、清热解毒、活血利水等方法治疗近两个月，症状也未见好转。仔细审查其证候，除了咽干咽痛、尿色黄赤之外，没有其他痛苦，舌苔薄白，脉浮数。综合脉证思考：脉浮，主表证，主肺，主上焦；脉数，主热证。咽喉干痛，是上焦风热所致。尿黄赤，是心与小肠火盛的表现。治疗宜疏风解表，清热泻火。处方：蝉蜕10克，苏叶10克，僵蚕10克，连翘10克，茅根30克，元参15克，牛蒡子10克。
服用四剂药后，咽干咽痛好转，尿检各项指标明显好转，由蛋白卅、红细胞5～10个、白细胞3～7个、透明管型1个，减为蛋白+，红细胞0～4个、白细胞0～3个。继服六剂药后，所有症状消失，尿常规检查阴性。随后痊愈。
隐匿性肾小球肾炎
1. 拘泥于效方，固守成方，不予辨证，久治无效
索××，男性，30岁。
四年前，在一次体检中，偶然发现尿蛋白++，其后连续复查多次，尿蛋白均在+至++之间。医生诊断为隐匿性肾小球肾炎。起初医生用西药治疗一年多无效，后医家用中药活血化瘀、益气利水、清热解毒、滋阴补肾等法治疗两年多仍无功效。仔细察视其证候，除了尿蛋白在++之外，没有其他不适，舌苔白，脉弦大，尺脉尤为明显。综合脉证思考：脉弦大，是气阴两虚的表现；尺脉大，是肾虚的表现。治疗宜补气养阴。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，生地20克，苍术10克，茯苓10克，泽泻10克，丹皮10克，黄连10克，肉桂6克。同时配服：肾康灵，一次4粒，一日三次。
服用六剂药后，尿蛋白转为(+)，继服十剂药后，痊愈。
2. 拘泥于活血，胶着于补肾，久久不能痊愈
周×，男性，19岁。
在一次体格检查中，突然发现尿蛋白+，其后虽经多次复查亦无明显改变。医生诊断为隐匿性肾小球肾炎。起初医生用西药治疗半年无效，后医家用六味地黄丸、活血化瘀、清热解毒等中药治疗近一年也不见效果。仔细审查脉证，除了经常咽干外，没有其他不适，舌苔白，脉浮数。综合脉证思考：脉浮数，说明上焦有热。治疗以疏散风热为主。处方：蝉蜕10克，僵蚕10克，连翘10克，苏叶6克，牛蒡子10克，片姜黄10克，元参10克。
服用十剂药后，尿蛋白消失，痊愈。
慢性肾小球肾炎
1. 夹杂微细病邪，不分性质，将寒作热，将寒作虚，久治不愈
宋×，男性，14岁。
患有慢性肾小球肾炎，时肿时消，反复感冒四年多。医生起初用西药治疗两年多效果不显著，后又配合中药治疗一年多仍无明显效果。特别是近一年来，身体特别虚弱，自汗畏风，食欲不振，疲乏无力，睡眠时经常汗透枕巾，稍有不慎即发生感冒，一旦感冒少则二十天，多则一至两个月不愈。审视其证候，头部出汗渍渍而出，疲乏无力，食欲不振，口干咽痛，脘腹微满，尿蛋白++，红细胞少许。审视所用药物，除西药外，中药有补气养血、清热解毒、活血利水、敛汗固表等，但要么无效，要么使病情加重。综合脉证思考：自汗多为气虚，但补气补阳均不起作用。又想到本病的出汗仅多见于头部，头汗者，医家多称为“灯笼头”。论其虚证虽有，但论其实证多见，实证或是瘀血，或是积滞，现见其胃脘痞满，应当是食积，且其进食后即汗出也符合食积之证。内有食滞，则脾胃失去斡旋升降的功能，升降失职则肺气不能敷布，卫气不固，所以治疗者应先消积、理气、解表。处方：苏叶6克，桔梗10克，枳壳10克，陈皮10克，蝉衣10克，槟榔10克，黄芩6克，甘草3克，神曲10克。
服用一剂药后，感冒已愈，且头汗也减少，再用升阳益胃汤调理，精神、食欲逐渐好转。此后便遵循此法，感冒则予上方，不感冒则用升阳益胃汤，调理半年，果然痊愈。
2. 表里合邪，三焦郁热，反当作虚证治疗，久久不愈
刘×，男性，15岁。
一年前的一个下午，突然出现全身不适，眼睑轻度浮肿。家属认为是感冒，用了一些感冒药后症状消失。但一个月之后，又突然发现全身浮肿，尿少。经某院检查发现尿蛋白(卅)，红细胞3～5个，白细胞1～3个，诊断为急性肾小球肾炎。经中西药治疗十一个多月后，浮肿虽已消退，但尿蛋白却一直维持在(+++～++++)之间不见改善。仔细审查其证候，除了咽喉干痛之外，其余无任何不适感，舌苔白，脉浮稍数。再询问其所用中药，有补气养阴者，有活血逐瘀者，有清热解毒者，有养阴补肾者，有收涩固精者，但其疗效均不显著。综合脉证思考：久病多虚，久病多瘀，这是疾病的常理，故多以补益、活血而获愈。本病证的变化，故以补益、活血而不效。其变化何在？从脉、舌辨别。又想到：本病的气色、症状均无虚证表现，说明经过治疗已不虚了。脉浮，病在表，在心肺；脉数，主热。咽喉，是肺胃所主。证脉合参，乃是肺胃郁热，表里同病。于是拟定解表清里，疏理三焦。处方：蝉蜕10克，僵蚕10克，连翘10克，片姜黄10克，大黄1克，紫苏6克。
服用三十剂药后，咽喉干痛消失，尿蛋白降至(+～++)，红细胞消失；继服二十五剂药后，所有症状消失，痊愈。
3. 气阴两虚，湿热内蕴，只从补正入手，疗效不著
晋××，女性，32岁。
慢性肾小球肾炎反复急性发病五年多。医生给予西药治疗后，浮肿虽然已经大部消退，但下肢浮肿、腰酸腰困却一直不见改善，为此又配合中药补肾之剂治疗两年多，不但症状不见改善，反而急性发作更加频繁。仔细审查其证候，除了典型的库欣综合征的特点外，并见其下肢浮肿，舌苔黄白而腻，脉虚大滑数。综合脉证思考：脉虚大，是气阴两虚的表现；脉滑数，是里热的表现。舌苔黄白腻，是湿热的表现。合之于症，乃是气阴两虚，湿热内蕴。前方不生效的原因，在于补肾有余而补气不足，补益有余而祛邪不足。因此拟定补气养阴，利湿清热。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，生地15克，苍术10克，土茯苓10克，泽泻10克，丹皮10克。
在逐步减少激素用量的情况下，服药两个月，下肢浮肿、腰酸腰困好转，但尿蛋白未见改善；至服药四个月时，曾感冒一次，但尿蛋白却减至(+)；服药五个月时，尿蛋白消失，痊愈。
肾病综合征
1. 标本不明，缓急不分，前后不清，将缓作急，将急作缓，前后不分，乱施药饵
么×，男性，30岁。
患有肾病综合征三年多，近年来，浮肿尿少更加严重。医生先用激素、抗生素等治疗无效，后又配合中药补气养阴、养阴补肾、培补肾气、清热解毒、活血利水等治疗也无明显效果。审查其证候，除典型的库欣综合征的表现外，并见浮肿尿少，咽喉疼痛，反复感冒，舌苔黄白而腻，脉浮滑数。因而思考：浮肿、肥胖之人脉当见沉，今脉反浮，浮者为病在表，且症见咽喉疼痛，合而论之，当为病在表在上，舌苔黄白当为病在里，脉症合参，当为表里同病。于是拟定解表清里。处方：蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，茅根15克，连翘10克，紫苏6克。
服药两个月，进药五十剂，咽喉疼痛好转，尿蛋白由(卅)降至(++)，管型消失。舌苔黄白腻，脉弦大紧数。综合脉证思考：脉由浮滑数转为弦大紧数，是因为表邪得解，而气阴大衰的状态仍然显著，应当扶正，不可再予祛邪。于是拟定补气养阴，利湿清热。处方：黄芪18克，当归6克，党参10克，麦冬10克，五味子10克，生地18克，苍术10克，茯苓10克，泽泻10克，丹皮10克。
服药六十剂，在逐渐减少激素的情况下，尿蛋白降至(+)，于是停用全部西药；继服上方两个多月，果然痊愈。
医生说：前医也用补气养阴却不效，原因何在？回答说：标本缓急，前后用药未分清楚罢了。又说：我用上方之法也不效，原因何在？回答说：是不当变而变，当变而不变所致，应当久服却中途停药，即所谓火候不到就停止用药，所以不效。
2. 胶着于成方，不知随证加减，久治不效
张××，男性，14岁。
高度水肿，大量蛋白尿三年多。医生诊断为肾病综合征。起初以西药治疗无明显效果，继而又配合中药滋阴补肾、益气利水、活血化瘀、清热解毒治疗一年也无功。仔细审查其证候，除典型的库欣综合征外，并见下肢浮肿，尿蛋白++++，脉虚大弦滑数，舌苔黄白腻。综合脉证思考：这是气阴两虚，湿热蕴郁。治疗拟定补气养阴，除湿清热。处方：肾康灵，一次4粒，一日三次，空腹服用。
服药一个月，精神好转，尿蛋白++，继服两个月，尿检(-)，浮肿消失。
3. 只治肾病，不治兼证，只知局部，不知整体，治之不愈
赵××，女性，40岁。
下肢浮肿，大量蛋白尿三年。医生诊断为肾病综合征。医生先予西药治疗无效，继而又改用中药滋阴补肾、益气利水、活血化瘀、清热解毒等治疗也无功。仔细审查其证候，除下肢浮肿、大量蛋白尿外，并见头晕乏力，胸满心烦，咽干咽痛，失眠，舌苔白，脉濡缓。综合脉证，诊为气阴两虚为本，痰郁气结，郁而化火为标。治疗拟定补气养阴，理气化痰，清热泻火。处方：黄芪15克，当归6克，麦冬10克，太子参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，菖蒲10克，远志10克，生地10克，元参6克。
服用七剂药后，咽干咽痛、心烦失眠好转。尿蛋白由(++++)降至(++)。继服四十剂药后，所有症状大部分消失，尿蛋白(+)，脉弦大。处方：肾康灵，一次4粒，一日三次，空腹服用。
服药一个月，痊愈。
系统性红斑狼疮的肾损害
1. 见热治热，不分表里，不分寒热，始终无效
邝××，女性，19岁。
头痛身痛，发热乏力三年，持续高热身痛，浮肿心悸，气短恶心三个月。医生诊断为系统性红斑狼疮，狼疮性肾损害，狼疮性心肌炎。医生先用西药治疗无效，继而又配合中药清热解毒、清气凉营等治疗也无功。仔细审查其证候，头痛眼眶痛，全身关节疼痛，发热微恶寒，体温40.1℃，高度浮肿，轻度腹水，心悸气短，胃脘胀满疼痛，食纳甚差，恶心欲吐，面部少量皮疹，尿少不利，大便正常，舌苔白，脉浮紧滑数。综合脉证思考：身痛头痛，微恶寒，是风寒表证；心下坚满，浮肿，是水饮凝聚于心下；心下坚满，气短心悸，是水饮上凌心肺；高热，舌不红而苔白，是阳虚寒饮。身热，脉滑数，是热；脉紧，是寒。合而论之，乃是表寒、里热、寒饮共存之证。病属难治。姑且拟定散寒解表，温阳化饮，清热利水。处方：麻黄6克，细辛3克，附子6克，桂枝10克，生姜3片，大枣7个，生石膏30克，防己15克，茅根30克，大腹皮10克，炙甘草10克。
服用一剂药后，发热、身痛头痛，浮肿尿少，气短心悸均减轻；继服四剂药后，体温降至37.2℃，浮肿消失，心悸气短消减八九成，尿常规由尿蛋白(++)降至(±)，红细胞5～15个降至(-)，白细胞降至1～3，继服十剂药后，心电图亦恢复正常。
某医生说：本病是重症，虽然经过多种西药治疗无效，中药犀角（现用水牛角代）、银花、连翘、石膏均取重剂也无效，原因何在？先生仅用石膏30克而其他清热之剂均不用，然而疗效却非常显著，原因又何在？回答说：本病是一个既有表寒，又有里热；既有阳虚，又有实热；既有水饮，又有表邪的复杂证候。如果只清其里热，则表寒更加闭郁而热反而更甚；如果只用解表法，则心肾阳气必然浮越而不能纳气归肾；如果过用温阳，则里热必炽盛而邪火更甚；如果只用利水化饮，则热邪必然更甚而炽烈。所以只清热不行，只温阳不行，只利水不行，只补益也不行。因此治疗起来必须解表兼化饮，散寒兼清热，温阳兼化水。至于只清热而热不减的情况，也是因为这个道理。
2. 从脉审证，久服疗效宏大
冯××，女性，25岁。
系统性红斑狼疮四年多，经用西药治疗后，发热浮肿已经基本得到控制，但激素一直维持在一定量或减量时，即出现发热身痛，且近两个多月来，又出现心跳加速，下肢浮肿，心烦喜哭，经查尿蛋白++，红细胞2～6个，白细胞2～7个，虽然继续增加激素用量及中药益气养阴、除湿清热之剂，仍然效果不够明显。仔细审查其证候，心胸烦乱，纳食不香，头晕头痛，下肢浮肿，舌苔白，脉滑而沉。综合脉证思考：仲景《伤寒论》云：“若胸中烦而不呕者，去半夏人参，加瓜蒌实一枚。”脉沉滑，是痰火郁结的表现。治疗宜疏肝理气，化痰泻火。处方：柴胡15克，瓜蒌30克，生姜10克，甘草10克，大枣12个，黄芩10克。同时配服：肾康灵，一次4粒，一日三次，空腹服用。
After taking six doses of the prescription, symptoms did not subside; instead, nausea and vomiting appeared, and irritability and palpitations seemed to worsen. Considering the pulse and symptoms comprehensively: a pulse that is both tight (Jin) and choppy (Se) must be accompanied by Yang deficiency. Although the previous formula fully addressed tonifying Qi and nourishing Yin, drying dampness, and clearing heat, it failed to address the concurrent minor pathogenic factors. Therefore, Rou Gui (Cinnamon Bark) 10g was added to the original formula.
After taking another six doses, all symptoms decreased. Nausea and vomiting disappeared completely, and appetite increased significantly. After continuing the medication for two months, blood urea nitrogen, carbon dioxide combining power, and creatinine levels returned to normal.
A certain physician asked: Why does adding Rou Gui (Cinnamon Bark) yield such remarkable effects? The answer was: Adding Rou Gui (Cinnamon Bark) is not merely due to the concurrent Yang deficiency, but also to facilitate the communication between the Heart and Kidney when combined with Huang Lian (Coptis Rhizome), and to resolve "Zhi Yin" (fluid retention in the diaphragm) when combined with Ren Shen (Ginseng Root), Huang Lian (Coptis Rhizome), and Fang Ji (Stephania Root).
Acute Glomerulonephritis
Stubbornly adhering to the disease name without examining pulse and symptoms leads to prolonged treatment failure
Hou XX, Male, 15 years old.
Five months ago, eyelid edema suddenly appeared, with urine protein (+++), red blood cells 5–10 per high-power field, and white blood cells 3–7 per high-power field. The diagnosis was Acute Glomerulonephritis. Western medicine was urgently administered for nearly three months; while edema completely resolved, other symptoms did not improve. Subsequently, Traditional Chinese Medicine (TCM) was consulted for nearly two months using methods such as promoting urination to reduce swelling, nourishing Yin and tonifying the Kidney, clearing heat and detoxifying, and invigorating blood to promote urination, but symptoms remained unchanged. Careful examination revealed that apart from dry throat, sore throat, and yellow-red urine, there were no other complaints. The tongue coating was thin and white, and the pulse was floating (Fu) and rapid (Shu). Considering the pulse and symptoms: a floating pulse indicates an exterior syndrome, involving the Lung and Upper Jiao; a rapid pulse indicates Heat. Dry and sore throat suggests Wind-Heat in the Upper Jiao. Yellow-red urine indicates Fire in the Heart and Small Intestine. The treatment should focus on dispersing Wind and releasing the Exterior, and clearing Heat and purging Fire. Prescription: Chan Tui (Cicada Slough) 10g, Su Ye (Perilla Leaf) 10g, Jiang Can (Bombyx Batryticatus) 10g, Lian Qiao (Forsythia Fruit) 10g, Mao Gen (Imperata Rhizome) 30g, Yuan Shen (Scrophularia Root) 15g, Niu Bang Zi (Arctium Fruit) 10g.
After four doses, dry and sore throat improved, and urine test indicators significantly improved: protein reduced from (+++) to (+), red blood cells from 5–10 to 0–4, and white blood cells from 3–7 to 0–3. After continuing for six more doses, all symptoms disappeared, and routine urine examination became negative. The patient subsequently recovered.
Occult Glomerulonephritis
1. Adhering to effective formulas and rigidly sticking to established prescriptions without differentiation leads to prolonged treatment failure
Suo XX, Male, 30 years old.
Four years ago, during a physical examination, urine protein (++) was accidentally discovered. Subsequent repeated examinations consistently showed urine protein levels between (+) and (++). The diagnosis was Occult Glomerulonephritis. Initial Western medical treatment for over a year was ineffective. Subsequent TCM treatment using methods such as invigorating blood and resolving stasis, tonifying Qi and promoting urination, clearing heat and detoxifying, and nourishing Yin and tonifying the Kidney for over two years also yielded no results. Careful observation revealed that apart from urine protein at (++), there were no other discomforts. The tongue coating was white, and the pulse was wiry (Xian) and large (Da), particularly prominent in the Chi (Cun/Kun) position. Considering the pulse and symptoms: a wiry and large pulse indicates deficiency of both Qi and Yin; a large Chi pulse indicates Kidney deficiency. The treatment should focus on tonifying Qi and nourishing Yin. Prescription: Huang Qi (Astragalus Root) 15g, Dang Gui (Angelica Sinensis Root) 6g, Mai Dong (Ophiopogon Tuber) 10g, Dang Shen (Codonopsis Root) 10g, Wu Wei Zi (Schisandra Fruit) 10g, Sheng Di (Rehmannia Root) 20g, Cang Zhu (Atractylodes Rhizome) 10g, Fu Ling (Poria) 10g, Ze Xie (Alisma Rhizome) 10g, Dan Pi (Moutan Cortex) 10g, Huang Lian (Coptis Rhizome) 10g, Rou Gui (Cinnamon Bark) 6g. Concurrently administered: Shen Kang Ling, 4 pills per dose, three times daily.
After six doses, urine protein became (+). After continuing for ten more doses, the patient recovered.
2. Adhering strictly to blood-invigorating methods and Kidney-tonifying approaches prevents recovery
Zhou X, Male, 19 years old.
During a physical examination, urine protein (+) was suddenly detected. Repeated examinations thereafter showed no significant change. The diagnosis was Occult Glomerulonephritis. Initial Western medical treatment for half a year was ineffective. Subsequent TCM treatment using Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), blood-invigorating and stasis-resolving methods, and heat-clearing and detoxifying herbs for nearly a year also failed. Careful examination of pulse and symptoms revealed that apart from frequent dry throat, there were no other complaints. The tongue coating was white, and the pulse was floating (Fu) and rapid (Shu). Considering the pulse and symptoms: a floating and rapid pulse indicates Heat in the Upper Jiao. The treatment should focus on dispersing Wind and clearing Heat. Prescription: Chan Tui (Cicada Slough) 10g, Jiang Can (Bombyx Batryticatus) 10g, Lian Qiao (Forsythia Fruit) 10g, Su Ye (Perilla Leaf) 6g, Niu Bang Zi (Arctium Fruit) 10g, Pian Jiang Huang (Curcuma Longa Rhizome) 10g, Yuan Shen (Scrophularia Root) 10g.
After ten doses, urine protein disappeared, and the patient recovered.
Chronic Glomerulonephritis
1. Overlooking minor concurrent conditions, failing to distinguish nature, mistaking Cold for Heat or deficiency, leads to prolonged treatment failure
Song X, Male, 14 years old.
The patient suffered from Chronic Glomerulonephritis with intermittent swelling and recurrent colds for over four years. Initial Western medical treatment for over two years showed little effect. Subsequent combination with TCM for over a year also yielded no obvious improvement. Especially in the past year, the body became particularly weak, with spontaneous sweating, aversion to wind, poor appetite, fatigue, and heavy sweating through pillowcases during sleep. Any slight negligence led to a cold, which lasted at least 20 days or up to 1–2 months. Examination revealed sweating only on the head, fatigue, poor appetite, dry mouth and sore throat, slight abdominal fullness, urine protein (++), and a few red blood cells. Reviewing the medications used, besides Western medicine, TCM included methods for tonifying Qi and blood, clearing heat and detoxifying, invigorating blood and promoting urination, and astringing sweat and consolidating the exterior. However, these were either ineffective or exacerbated the condition. Considering the pulse and symptoms: spontaneous sweating is often due to Qi deficiency, but tonifying Qi and Yang proved useless. Furthermore, this patient’s sweating occurs mainly on the head, known in TCM as "Lantern Head." While deficiency exists, excess patterns are more prevalent, possibly due to Blood Stasis or Food Retention. Given the epigastric fullness, it is likely Food Retention, supported by sweating immediately after eating. Internal food stagnation impairs the Spleen and Stomach's ability to regulate ascending and descending functions. Failure of this regulation prevents the Lung from distributing Wei Qi (Defensive Qi), leading to insecurity of the exterior. Therefore, treatment should first focus on resolving stagnation, regulating Qi, and releasing the Exterior. Prescription: Su Ye (Perilla Leaf) 6g, Jie Geng (Platycodon Root) 10g, Zhi Ke (Aurantii Fructus) 10g, Chen Pi (Citrus Reticulata Peel) 10g, Chan Yi (Cicada Slough) 10g, Bing Lang (Areca Seed) 10g, Huang Qin (Scutellaria Root) 6g, Gan Cao (Licorice Root) 3g, Shen Qu (Medicated Leaven) 10g.
After one dose, the cold resolved, and head sweating decreased. Subsequent regulation with Sheng Yang Yi Wei Tang (Ascending Yang and Benefiting Stomach Decoction) gradually improved spirit and appetite. Following this method—using the above formula for colds and Sheng Yang Yi Wei Tang otherwise—for half a year resulted in complete recovery.
2. Exterior and Interior pathogens combined, Triple Burner stagnant Heat, mistakenly treated as deficiency leads to prolonged failure
Liu X, Male, 15 years old.
One year ago, sudden general malaise and mild eyelid edema occurred. Family members suspected a cold, and symptoms resolved after taking some cold medicine. However, one month later, generalized edema and oliguria suddenly appeared. Hospital examination revealed urine protein (+++), red blood cells 3–5, and white blood cells 1–3, diagnosing Acute Glomerulonephritis. After over ten months of combined TCM and Western medical treatment, edema subsided, but urine protein remained stubbornly high (+++ to ++++). Careful examination revealed only dry and sore throat, with no other discomforts. Tongue coating was white, and pulse was floating and slightly rapid. Reviewing previous TCM treatments, they included tonifying Qi and Yin, invigorating blood and removing stasis, clearing heat and detoxifying, nourishing Yin and tonifying the Kidney, and astringing essence, yet none were effective. Considering the pulse and symptoms: chronic illness often involves deficiency and stasis, so tonification and blood-invigoration usually work. However, this case represents a variation where these methods failed. The variation lies in the pulse and tongue. The patient’s complexion and symptoms show no signs of deficiency, indicating that prior treatment has resolved any initial deficiency. A floating pulse indicates disease in the Exterior, involving the Heart and Lung; a rapid pulse indicates Heat. The throat is governed by the Lung and Stomach. Correlating symptoms and pulse, this is Lung-Stomach Stagnant Heat with simultaneous Exterior and Interior involvement. The prescription aimed to release the Exterior and clear the Interior, and regulate the Triple Burner. Prescription: Chan Tui (Cicada Slough) 10g, Jiang Can (Bombyx Batryticatus) 10g, Lian Qiao (Forsythia Fruit) 10g, Pian Jiang Huang (Curcuma Longa Rhizome) 10g, Da Huang (Rhubarb Root) 1g, Zi Su (Perilla Leaf) 6g.
After thirty doses, dry and sore throat disappeared, urine protein dropped to (+ to ++), and red blood cells disappeared. After continuing for twenty-five more doses, all symptoms resolved, and the patient recovered.
3. Qi and Yin deficiency with internal Damp-Heat, treating only by tonifying Zheng Qi yields poor results
Jin XX, Female, 32 years old.
Chronic Glomerulonephritis with repeated acute exacerbations for over five years. After Western medical treatment, most edema subsided, but lower limb edema and sore/weak back persisted. Two years of additional TCM Kidney-tonifying treatment failed to improve symptoms and even increased the frequency of acute attacks. Careful examination revealed typical Cushing's syndrome features, lower limb edema, yellowish-white greasy tongue coating, and a deficient-large slippery rapid pulse. Considering the pulse and symptoms: a deficient-large pulse indicates Qi and Yin deficiency; a slippery-rapid pulse indicates Interior Heat. A yellowish-white greasy coating indicates Damp-Heat. Combined with symptoms, this is Qi and Yin deficiency with internal Damp-Heat. The previous formula failed because it over-tonified the Kidney but under-tonified Qi, and over-nourished while under-expelling pathogens. Therefore, the new prescription focused on tonifying Qi and nourishing Yin, promoting urination and clearing Heat. Prescription: Huang Qi (Astragalus Root) 15g, Dang Gui (Angelica Sinensis Root) 6g, Mai Dong (Ophiopogon Tuber) 10g, Dang Shen (Codonopsis Root) 10g, Wu Wei Zi (Schisandra Fruit) 10g, Sheng Di (Rehmannia Root) 15g, Cang Zhu (Atractylodes Rhizome) 10g, Tu Fu Ling (Smilax Glabra Rhizome) 10g, Ze Xie (Alisma Rhizome) 10g, Dan Pi (Moutan Cortex) 10g.
With gradual reduction of hormone dosage, after two months of medication, lower limb edema and back soreness improved, though urine protein remained unchanged. At four months, after a single cold episode, urine protein decreased to (+). By five months, urine protein disappeared, and the patient recovered.
Nephrotic Syndrome
1. Unclear distinction between root and branch, urgency and slowness, and sequence of treatment, leading to chaotic medication
Me X, Male, 30 years old.
Nephrotic Syndrome for over three years, with worsening edema and oliguria in recent years. Initial treatment with hormones and antibiotics was ineffective. Subsequent combination with TCM methods such as tonifying Qi and nourishing Yin, nourishing Yin and tonifying the Kidney, cultivating Kidney Qi, clearing heat and detoxifying, and invigorating blood and promoting urination also yielded no obvious effect. Examination revealed typical Cushing's syndrome features, edema, oliguria, sore throat, recurrent colds, yellowish-white greasy tongue coating, and a floating slippery rapid pulse. Analysis suggested that obese patients typically present with a sinking pulse; however, this patient’s pulse was floating, indicating disease in the Exterior. Combined with sore throat, the disease is located in the Exterior and Upper Jiao. The yellowish-white coating indicates Interior involvement. Thus, correlating pulse and symptoms, this is a simultaneous Exterior and Interior disease. The prescription aimed to release the Exterior and clear the Interior. Prescription: Chan Tui (Cicada Slough) 10g, Jiang Can (Bombyx Batryticatus) 10g, Pian Jiang Huang (Curcuma Longa Rhizome) 10g, Da Huang (Rhubarb Root) 3g, Mao Gen (Imperata Rhizome) 15g, Lian Qiao (Forsythia Fruit) 10g, Zi Su (Perilla Leaf) 6g.
After two months (50 doses), sore throat improved, urine protein dropped from (+++) to (++), and casts disappeared. Tongue coating remained yellowish-white and greasy, and the pulse became wiry-large-tight-rapid. Considering the pulse and symptoms: the shift from floating-slippery-rapid to wiry-large-tight-rapid indicates that Exterior pathogens have been resolved, but severe Qi and Yin deficiency remains. Treatment should now focus on supporting Zheng Qi rather than expelling pathogens. The prescription aimed to tonify Qi and nourish Yin, promote urination and clear Heat. Prescription: Huang Qi (Astragalus Root) 18g, Dang Gui (Angelica Sinensis Root) 6g, Dang Shen (Codonopsis Root) 10g, Mai Dong (Ophiopogon Tuber) 10g, Wu Wei Zi (Schisandra Fruit) 10g, Sheng Di (Rehmannia Root) 18g, Cang Zhu (Atractylodes Rhizome) 10g, Fu Ling (Poria) 10g, Ze Xie (Alisma Rhizome) 10g, Dan Pi (Moutan Cortex) 10g.
After sixty doses, with gradual reduction of hormones, urine protein dropped to (+), and all Western medicines were stopped. Continuing the above prescription for over two months resulted in complete recovery.
A physician asked: Previous doctors also used Qi-tonifying and Yin-nourishing methods but failed. Why? The answer was: They failed to distinguish between root and branch, urgency and slowness, and the sequence of medication. Another physician asked: I used the same method but failed. Why? The answer was: This resulted from changing when one should not have, and failing to change when one should have. Specifically, stopping medication prematurely before the "fire potency" (therapeutic duration) was sufficient.
2. Adhering rigidly to established formulas without adjusting to symptoms leads to prolonged failure
Zhang XX, Male, 14 years old.
Severe edema and massive proteinuria for over three years. Diagnosis: Nephrotic Syndrome. Initial Western medical treatment was ineffective. Subsequent combination with TCM methods including nourishing Yin and tonifying the Kidney, tonifying Qi and promoting urination, invigorating blood and resolving stasis, and clearing heat and detoxifying for one year also yielded no results. Careful examination revealed typical Cushing's syndrome features, lower limb edema, urine protein (++++), a deficient-large-wiry-slippery-rapid pulse, and a yellowish-white greasy tongue coating. Considering the pulse and symptoms: this is Qi and Yin deficiency with Damp-Heat accumulation. The treatment aimed to tonify Qi and nourish Yin, remove Dampness and clear Heat. Prescription: Shen Kang Ling, 4 pills per dose, three times daily, taken on an empty stomach.
After one month, spirit improved, and urine protein reduced to (++). After continuing for two more months, urine became negative, and edema disappeared.
3. Treating only the Kidney disease while ignoring concurrent conditions, focusing only on the local aspect without considering the whole body, leads to non-recovery
Zhao XX, Female, 40 years old.
Lower limb edema and massive proteinuria for three years. Diagnosis: Nephrotic Syndrome. Initial Western medical treatment was ineffective. Subsequent TCM treatment using nourishing Yin and tonifying the Kidney, tonifying Qi and promoting urination, invigorating blood and resolving stasis, and clearing heat and detoxifying also failed. Careful examination revealed lower limb edema, massive proteinuria, dizziness, fatigue, chest fullness, irritability, dry and sore throat, insomnia, white tongue coating, and a soggy-slow pulse. Correlating pulse and symptoms, the diagnosis was Qi and Yin deficiency as the root, with Phlegm stagnation and Qi knotting transforming into Fire as the branch. The treatment aimed to tonify Qi and nourish Yin, regulate Qi and transform Phlegm, and clear Heat and purge Fire. Prescription: Huang Qi (Astragalus Root) 15g, Dang Gui (Angelica Sinensis Root) 6g, Mai Dong (Ophiopogon Tuber) 10g, Tai Zi Shen (Pseudostellaria Root) 10g, Wu Wei Zi (Schisandra Fruit) 10g, Zhu Ru (Bambusa Textilis Caulis) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Ban Xia (Pinellia Tuber) 10g, Chen Pi (Citrus Reticulata Peel) 10g, Fu Ling (Poria) 10g, Gan Cao (Licorice Root) 6g, Chang Pu (Acorus Rhizome) 10g, Yuan Zhi (Polygala Root) 10g, Sheng Di (Rehmannia Root) 10g, Yuan Shen (Scrophularia Root) 6g.
After seven doses, dry/sore throat, irritability, and insomnia improved. Urine protein dropped from (++++) to (++). After continuing for forty more doses, most symptoms disappeared, urine protein was (+), and the pulse was wiry-large. Prescription: Shen Kang Ling, 4 pills per dose, three times daily, taken on an empty stomach.
After one month, the patient recovered.
Renal Damage in Systemic Lupus Erythematosus
1. Treating Heat with Heat-clearing methods without distinguishing Exterior/Interior or Cold/Heat yields no effect
Kuang XX, Female, 19 years old.
Headache and body pain, fever, and fatigue for three years; persistent high fever, body pain, edema, palpitations, shortness of breath, and nausea for three months. Diagnosis: Systemic Lupus Erythematosus, Lupus Nephritis, Lupus Myocarditis. Initial Western medical treatment was ineffective. Subsequent TCM treatment using heat-clearing and detoxifying, and clearing Qi and cooling Ying (Nutrient) levels also failed. Careful examination revealed headache and orbital pain, generalized joint pain, fever with slight aversion to cold, temperature 40.1°C, severe edema, mild ascites, palpitations, shortness of breath, epigastric distension and pain, very poor appetite, nausea, small amount of facial rash, oliguria, normal bowel movements, white tongue coating, and a floating-tight-slippery-rapid pulse. Considering the pulse and symptoms: body/head pain and slight aversion to cold indicate Wind-Cold Exterior syndrome; epigastric hardness/fullness and edema indicate Fluid Retention accumulating in the epigastrium; epigastric hardness/fullness, shortness of breath, and palpitations indicate Fluid Retention harassing the Heart and Lung; high fever with a non-red tongue but white coating indicates Yang deficiency with Cold Fluid. Body heat and slippery-rapid pulse indicate Heat; tight pulse indicates Cold. Synthesizing these, the pattern is a coexistence of Exterior Cold, Interior Heat, and Cold Fluid. This is a difficult-to-treat condition. The prescription aimed to dispel Cold and release the Exterior, warm Yang and transform Fluid, and clear Heat and promote urination. Prescription: Ma Huang (Ephedra Stem) 6g, Xi Xin (Asarum Root) 3g, Fu Zi (Aconite Lateral Root) 6g, Gui Zhi (Cinnamon Twig) 10g, Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube Fruit) 7 pieces, Sheng Shi Gao (Gypsum Fibrosum) 30g, Fang Ji (Stephania Root) 15g, Mao Gen (Imperata Rhizome) 30g, Da Fu Pi (Areca Pericarpium) 10g, Zhi Gan Cao (Honey-fried Licorice Root) 10g.
After one dose, fever, body/head pain, edema, oliguria, shortness of breath, and palpitations all decreased. After four more doses, temperature dropped to 37.2°C, edema disappeared, palpitations and shortness of breath reduced by 80–90%, urine routine changed from protein (++) to (±), red blood cells from 5–15 to (-), and white blood cells to 1–3. After continuing for ten more doses, electrocardiogram also returned to normal.
A physician asked: This is a severe case. Despite multiple Western medicines and heavy doses of TCM herbs like Xi Jiao (Rhinoceros Horn, now substituted with Water Buffalo Horn), Jin Yin Hua (Honeysuckle Flower), Lian Qiao (Forsythia Fruit), and Shi Gao (Gypsum), there was no effect. Why? You used only 30g of Shi Gao (Gypsum Fibrosum) and no other heat-clearing agents, yet the effect was significant. Why? The answer was: This disease is a complex pattern involving Exterior Cold and Interior Heat, Yang deficiency and Excess Heat, Fluid Retention and Exterior pathogens. If only Interior Heat is cleared, Exterior Cold becomes more trapped, and Heat worsens. If only the Exterior is released, Heart and Kidney Yang will float upward and fail to anchor Qi in the Kidney. If Yang is excessively warmed, Interior Heat will blaze, and Evil Fire will intensify. If only Fluid is promoted and transformed, Heat pathogens will become more intense. Therefore, clearing alone, warming alone, promoting urination alone, or tonifying alone are all inappropriate. Treatment must simultaneously release the Exterior and transform Fluid, disperse Cold and clear Heat, and warm Yang and transform Water. This explains why clearing Heat alone fails to reduce fever.
2. Examining symptoms through the pulse, long-term administration yields great efficacy
Feng XX, Female, 25 years old.
Systemic Lupus Erythematosus for over four years. After Western medical treatment, fever and edema were basically controlled. However, when maintaining or reducing hormone dosage, fever and body pain recurred. For the past two months, tachycardia, lower limb edema, irritability, and tendency to cry appeared. Urine tests showed protein (++), red blood cells 2–6, and white blood cells 2–7. Increasing hormone dosage and adding TCM for tonifying Qi and nourishing Yin, removing Dampness and clearing Heat had limited effect. Careful examination revealed mental restlessness, poor appetite, dizziness and headache, lower limb edema, white tongue coating, and a slippery-sinking pulse. Considering the pulse and symptoms: Zhang Zhongjing's *Shang Han Lun* states: "If there is vexation in the chest without vomiting, remove Ban Xia and Ren Shen, add Gua Lou Shi (Trichosanthes Fruit)." A slippery-sinking pulse indicates Phlegm-Fire stagnation. The treatment aimed to soothe the Liver, regulate Qi, transform Phlegm, and purge Fire. Prescription: Chai Hu (Bupleurum Root) 15g, Gua Lou (Trichosanthes Fruit) 30g, Sheng Jiang (Fresh Ginger) 10g, Gan Cao (Licorice Root) 10g, Da Zao (Jujube Fruit) 12 pieces, Huang Qin (Scutellaria Root) 10g. Concurrently administered: Shen Kang Ling, 4 pills per dose, three times daily, taken on an empty stomach.