6个多月来，鼻衄、齿衄，全身到处紫斑，医诊再生障碍性贫血。先予西药、输血等治疗2个多月不效，后又配合中药补气养阴、补气养血等2个多月，非但诸证不见好转，反而更加严重。2个多月前，因上呼吸道感染在臀部注射青霉素不吸收而续发脓肿，持续高热不退，经反复检查，诊为臀部脓肿，菌血症。予激素、抗生素、输血，并配合中药补气养血法治疗2个月，诸证非但不减，而且更甚。审其面色皓白，神志时躁时寐，齿鼻不断的有少量衄血，全身到处是大片大片的紫斑，高热，体温达39．8℃，便秘溲赤，臀部脓肿约7厘米×8厘米，红肿热痛，并时时有脓汁从手术切口中排出，色黄而臭，舌苔黄干，舌质红，脉滑而数。综合脉证，思之：面色皓白，血色素仅4克，可谓之极虚。而脉滑而数，舌苔黄干，舌质红，便秘溲赤则谓之实。其何以治?当以脉、舌论主次。脉、舌之象既为实，自当以实论治。又思：实者，何部之实?若从舌苔黄干，便秘溲赤来论则谓之病在阳明，若从斑、热而论则为病在血分，若从脓肿红肿则为热毒。综而论之，乃阳明实热，热入营血之证也。因拟清营凉血，通腑泻火，解毒消痈。处方：犀角10克(现用水牛角代替)，生地30克，白芍15克，丹皮10克，大黄4克，连翘10克，银花10克，茅根30克。
服药30剂后，发热、紫斑、衄血消失，脓肿明显好转；加阿胶10克，继服30剂，血色素由4克增至9克，脓肿痊愈。为巩固疗效，又服上药10个月，愈。
某医云：前医用补阴益气、补气养血之剂血色素不见上升，而先生用清营凉血，通腑泻火解毒血色素反见上升，其故何也?答曰：病有因虚致病者，有因病致虚者。病因虚致病者，当予补益，若因病而致虚者，补益则邪愈炽，必予祛邪方可，正如张从正《儒门事亲》所说：“攻其邪，邪去而元气自复也。”
4．病在肺肾，不审其脉，但求治脾，或求肾治，延误病期
巨××，男，22岁。
半年多来，齿鼻俱衄，全身紫斑，疲乏无力。医诊再生障碍性贫血。始予西药、输血治疗无功，再配中药归脾汤、大菟丝子丸加减仍不效。审其齿鼻少量衄血，面色皓白，自汗盗汗，疲乏无力，时而烦躁不安，舌苔薄白，脉虚大而数。综合脉证，思之：脾有统血、生血之功，故医家治贫血者多从脾胃论治，然本病并无脾病之证，故不可治脾也。脉虚大数而不沉，浮脉为肺非在肾也，故但治其肾而无功也。法宜肺肾双补，养阴益气以泻相火。处方：黄芪15克，当归10克，麦冬10克，党参10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10剂，诸证均减，血色素由4克增至6克；继服上药30剂，自汗盗汗，衄血消失，紫斑明显减少；又服50剂，诸证消失，血色素15克，愈。
某医云：前医用补，先生亦补，何效果不同也?答曰：归经不同耳。前医之补，或从补脾，或从补肾，而愚之补则重在肺肾耳；又且前方之补，或但治脾，或但治肾，而本病肺肾俱虚，心亦不足，药未兼治故耳。
5.精气亏损，任督俱衰，不补精髓，但益气血，终非其治
贺××，男，22岁。
再生障碍性贫血4年多。医与西药与中药补气养血之剂久治不效。细审其面色皓白，疲乏无力，血色素4克，头汗多，脉细弱。综合脉证，思之：脉细弱而久病者，精气俱衰，任督不足也，非补其任督精髓不可。治宜拟填精补髓，阴阳俱补。处方：龟甲30克，党参10克，枸杞子12克，鹿角胶10克(烊化)，菟丝子15克。
服药35剂，精神、食欲好转，血色素增至7克；又续服80剂，血色素增至11克。乃以上方为丸，每次6克，每日3次，调理4个月，愈。
某医问：前用诸药补气养血而不效，今用龟鹿二仙胶治之获效者何也?答曰：本病非但衰于气血，亦且精血俱亏耳。伤于精血者，非至阴至阳者不得填补耳。龟鹿二仙胶者，《证治准绳》名之日大补精髓之品，严苍山云之：“鹿得天地之阳气最全，善通督脉，足于精者，故能多淫而寿。龟得天地之阴气最厚，善通任脉，足于气者，故能伏息而寿。二物气血之属，又得造化之微，异类有情，竹破竹补之法也。人参清食气之壮火，所以补气中之怯，枸杞滋不足之真阴，所以养心神之液，一阴一阳，无偏胜之忧，入气入血，有和平之美。”故其用之得效也。
6．正虚邪实，但知补益，壅其气血，助其邪气
杜××，女，35岁。
患再生障碍性贫血3年多。医先以西药、输血等治疗不效，后又配合中药补气养血，填精补髓仍无功。审其除血色素经常保持在4～5克外，并见其面色萎黄微透青色，手足烦热，心烦易怒，胸胁苦满，时时叹气，舌苔白，脉沉弦细。综合脉证，思之：弦脉者，肝脉也；沉脉者，郁证也；细脉者，血虚也。合之于证，乃肝郁血虚之证也。因拟养血疏肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜3片，薄荷3克，生地10克。
服药3剂，胸满心烦，手足烦热，疲乏无力等证好转，饮食明显增加；继服20剂后，诸证竟失，血色素亦增至14克。
某医云：前用补气养血，填精补髓而不效，后用逍遥疏肝而获全功，其故何也?答曰：肝者，藏血之脏也；肝者，喜调达而恶郁滞也，肝脉条达则诸脏升降正常而气血得生，郁则害脾伤胃，新血不生。前方之药补益有余，而理气不足，肝木失达者必壅其气而助其邪，故其不愈而反剧。今用黑逍遥而取效者，在于补血之中稍佐理肝之品耳。
缺铁性贫血
1．虚实夹杂，不求脉证，胶于补益，其病不愈
阮××，男，24岁。
缺铁性贫血5年多。医始以西药治疗稍有好转，但3个月后不再继续改善，后又配合中药补气养血之剂治之，亦无明显效果。细询其证，3年多来，不管用药与不用药，但至夏季则血色素降至4克左右，至秋季逐步好转，冬季则血色素增至10克左右，而且精神、食欲亦明显改善。今年春天突然血色素降至3-5克，且头晕头痛，疲乏无力，心烦心悸，食欲不振尤较往年为重，舌苔黄白而腻，脉弦滑数。综合脉证，思之：贫血如此之甚，脉当见沉细而弱，今反见弦滑而数，脉证相违，必夹实邪。实邪者，痰热郁于肝胆之经也。治宜先除痰热，调理肝胆。处方：柴胡10克，黄芩6克，黄连4克，竹茹10克，半夏10克，陈皮10克，滑石10克，竹叶10克。夜交藤30克。
服药6剂，诸证竟然大减；继服10剂，血色素增至13克；又服30剂，诸证全失，血色素15克，后果愈。
某医问：本病为何夏剧冬减?答曰：夏季者，暑令也，火令也。此病内蕴痰火，复得夏季暑火之助则火邪更炽，暑火者，伤气伤阴之邪也，火邪炽盛，内耗气阴，故夏季反剧，因此治从化痰泻火。
2.不审脉证，但知补益，以实作虚，以热作寒，终不获效
贺××，女，45岁。
疲乏无力，面色萎黄3年多。医诊缺铁性贫血。前医以铁剂等西药治之，非但诸证不减，亦且胃痛呕吐，不能饮食。后医以中药补气养血，健脾温中药治之，胃痛减，而血色素反见下降，且心烦不安，时见鼻衄。细审其证，面色萎黄，结膜苍白，疲乏无力，食纳甚差，口干舌燥，手心烦热，胃脘胀满，舌苔黄白，脉虚大弦数。综合脉证，思之：脉虚大弦数者，气阴俱虚也；面色萎黄，纳呆口干，胃脘胀满者，脾胃湿热蕴结脾胃也。治宜补气养阴以培其本，燥湿清热，升阳益胃以治其标。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10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。
服药6剂，精神大增，饮食好转，血色素由5克增至9．5克；继服12剂，饮食、精神近于正常，血色素12克。当服至30剂时，查血色素15克，精神、食欲正常，体重增至60千克。
某医云：前用健脾温中，补气养血之剂而不效者何也?答曰：血虚者当补血，此千古不破之真理。然怎么补血则有很大问题，若仅泥于血虚补血之一见则误也。因为血之生从脏腑来讲有心主血、肝藏血、脾统血和肾精转化成血的不同，其中若因心血虚而血虚者当补心血，若心火灼血而致虚者则当泻心火。若肝之阴虚而血虚者当养肝阴，若肝胆实火灼血而血虚者则当泻肝火。若脾虚不能生血而血虚者当健脾，若脾胃湿热、积滞而致脾胃不能生血者则当健脾燥湿清热，食滞不化而致脾胃不能生血者当燥湿健脾，消食导滞。若。肾精亏损而致血虚者，当益精填髓。血之生从气血论，若气虚不能生血者当补气，若因实热者当泻热，若因阴血不足所致者当养阴补血。血之生从阴阳论，若阴虚者当养阴清热，若阳虚者当温阳。血之生从寒热论，若寒者当温，热者当凉。如此等等。今察其脉证，一者气阴两虚也，二者脾胃有热也，三者升降失职也。今病在气阴而但用补血，阴虚有热而用温药，升降失职积滞内停反用腻膈，故不得而效也。
阵发性睡眠性血红蛋白尿
虚实并见，寒热并存，不审脉证，但予补益，其证不解
汪××，男，18岁。
尿血、乏力1年多。医诊阵发性睡眠性血红蛋白尿。先以西药治疗半年多不效。后又配合中药补气养血之剂半年多仍不效。审其面色皓白无华，每天早晨小便均呈深酱油色，一到下午则尿色几近正常，疲乏无力，食欲不振，舌质淡黯，舌苔薄白，脉沉细。综合脉证，思之：面色皓白，疲乏无力者，气阴俱虚也；上午尿赤，午后尿清者，肝胆郁热，湿热下注于膀胱也；舌质淡黯者，瘀血阻滞也；脉沉者，气滞血瘀也；细者，血虚也。合而论之，乃气阴俱虚，气滞血瘀，湿热下注也。治宜拟补气养阴，理气活血，除湿清热。处方：黄芪30克，生山药30克，红花3克，龟甲12克，黄柏5克，丹皮10克，当归6克，三七粉3克，怀牛膝9克，琥珀粉6克，土茯苓60克。
服药4剂，尿血的次数与时间均明显减少；继服6剂，尿血消失，精神、食欲几近正常；又服上药30剂，诸证消失，愈。
失血后贫血
泥于补益，不知祛邪，气血郁滞，生血不能
靳××，女，35岁。
头晕头痛，心悸气短，疲乏无力3年多。医诊失血后贫血。先用输血、西药治疗，使血色素升至8克，但其后不再改善，后医加用中药补气养血之剂治疗2年，血色素亦不见上升。细审其证，面色萎黄微透青色，手心烦热，心烦易怒，胸胁苦满，时时叹气，舌苔白，舌质稍淡，脉弦细。综合脉证。思之：此证非但有虚，亦且有实，实者肝郁也。治宜疏肝养血。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜3片，薄荷3克，生地10克。
服药3剂，头晕头痛，心烦心悸，疲乏无力，手心烦热等证大减，饮食增加，血色素升至9克；继服20剂，诸证大部消失，饮食正常，血色素升至15克。后果愈。
某医云：患者久用补气养血之剂不效，而改用疏肝养血之剂后却迅速好转，其故何也?答曰：从中医基础理论来看，肝主疏泄，肝藏血，肝若不得条达则非但不能藏血生血，亦且伤脾害胃而不能统血生血。今本病患者补而又补，使其郁而又郁，故得疏达而速效也。
嗜酸性肉芽肿
不别内外，不分痰湿，熄散混用，久治不效
唐××，女，38岁。
两下肢结节、出血、关节肌肉疼痛7个多月。医诊嗜酸性肉芽肿。先用西药治疗5个多月，发热虽然好转，但弥漫性紫红色结节、出血点不见减少，且激素的用量稍有减少即发热亦复如初；后又配合中药祛风除湿清热之剂治疗2个多月，不但诸证不减，且见发热身痛，结节、出血点更加增多。细审其证，双下肢出血点满布，尤以两膝以下更加严重，并问有很多的紫红色结节，关节肌肉酸痛，发热，午后加重，体温38．5℃，舌苔薄白，舌尖红，脉弦滑。综合脉证，思之：脉滑者，痰热也；关节肌肉均痛者，痰热化风也；结节、出血点者，斑疹也，痰热入于血络也。治宜化痰清热，散结通络。处方：钩藤15克，枳壳10克，地龙10克，连翘10克，香橼10克，佛手10克，桑枝30克，丝瓜络10克。
服药10剂，关节肌肉酸痛，发热均减，体温37．5℃，结节、出血点减少。继服上药50剂，诸证消失，愈。
某医云：为何不用凉血活血，除湿散风清热之剂治疗?答曰：前已应用此类药物治之不效也。又问：防风、羌活、苍耳子、钩藤、地龙之类皆为风药，何独取钩藤、地龙，而不用羌、独、防?答曰：羌活、防风、独活、苍耳子、细辛、白芷、威灵仙等皆疏散风湿之品，即所谓辛温行散药也，若血虚、痰热凝结者，尤当慎用，以防散血、凝痰而难解。而钩藤、地龙、桑枝等虽亦风药，但其为熄风镇定之药，故用于血热、痰热胶凝成核者尤宜。此外祛湿热之药乃祛弥漫之湿热，连翘、枳壳、香橼、佛手、地龙者可祛胶凝之痰而不伤血，故湿热弥漫者宜化湿燥湿利湿，痰核胶凝者宜化痰软坚散结，所以改用此方治之。
过敏性紫癜
1．胶于补益，不审寒热，以实作虚，病证不愈
【背景信息】
书名：中医临证经验与方法 章节：正文(48/94) 类别：方剂
【待处理原文】
6个多月来，鼻衄、齿衄，全身到处紫斑，医诊再生障碍性贫血。先予西药、输血等治疗2个多月不效，后又配合中药补气养阴、补气养血等2个多月，非但诸证不见好转，反而更加严重。2个多月前，因上呼吸道感染在臀部注射青霉素不吸收而续发脓肿，持续高热不退，经反复检查，诊为臀部脓肿，菌血症。予激素、抗生素、输血，并配合中药补气养血法治疗2个月，诸证非但不减，而且更甚。审其面色皓白，神志时躁时寐，齿鼻不断的有少量衄血，全身到处是大片大片的紫斑，高热，体温达39．8℃，便秘溲赤，臀部脓肿约7厘米×8厘米，红肿热痛，并时时有脓汁从手术切口中排出，色黄而臭，舌苔黄干，舌质红，脉滑而数。综合脉证，思之：面色皓白，血色素仅4克，可谓之极虚。而脉滑而数，舌苔黄干，舌质红，便秘溲赤则谓之实。其何以治?当以脉、舌论主次。脉、舌之象既为实，自当以实论治。又思：实者，何部之实?若从舌苔黄干，便秘溲赤来论则谓之病在阳明，若从斑、热而论则为病在血分，若从脓肿红肿则为热毒。综而论之，乃阳明实热，热入营血之证也。因拟清营凉血，通腑泻火，解毒消痈。处方：犀角10克(现用水牛角代替)，生地30克，白芍15克，丹皮10克，大黄4克，连翘10克，银花10克，茅根30克。
服药30剂后，发热、紫斑、衄血消失，脓肿明显好转；加阿胶10克，继服30剂，血色素由4克增至9克，脓肿痊愈。为巩固疗效，又服上药10个月，愈。
某医云：前医用补阴益气、补气养血之剂血色素不见上升，而先生用清营凉血，通腑泻火解毒血色素反见上升，其故何也?答曰：病有因虚致病者，有因病致虚者。病因虚致病者，当予补益，若因病而致虚者，补益则邪愈炽，必予祛邪方可，正如张从正《儒门事亲》所说：“攻其邪，邪去而元气自复也。”
4．病在肺肾，不审其脉，但求治脾，或求肾治，延误病期
巨××，男，22岁。
半年多来，齿鼻俱衄，全身紫斑，疲乏无力。医诊再生障碍性贫血。始予西药、输血治疗无功，再配中药归脾汤、大菟丝子丸加减仍不效。审其齿鼻少量衄血，面色皓白，自汗盗汗，疲乏无力，时而烦躁不安，舌苔薄白，脉虚大而数。综合脉证，思之：脾有统血、生血之功，故医家治贫血者多从脾胃论治，然本病并无脾病之证，故不可治脾也。脉虚大数而不沉，浮脉为肺非在肾也，故但治其肾而无功也。法宜肺肾双补，养阴益气以泻相火。处方：黄芪15克，当归10克，麦冬10克，党参10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10剂，诸证均减，血色素由4克增至6克；继服上药30剂，自汗盗汗，衄血消失，紫斑明显减少；又服50剂，诸证消失，血色素15克，愈。
某医云：前医用补，先生亦补，何效果不同也?答曰：归经不同耳。前医之补，或从补脾，或从补肾，而愚之补则重在肺肾耳；又且前方之补，或但治脾，或但治肾，而本病肺肾俱虚，心亦不足，药未兼治故耳。
5.精气亏损，任督俱衰，不补精髓，但益气血，终非其治
贺××，男，22岁。
再生障碍性贫血4年多。医与西药与中药补气养血之剂久治不效。细审其面色皓白，疲乏无力，血色素4克，头汗多，脉细弱。综合脉证，思之：脉细弱而久病者，精气俱衰，任督不足也，非补其任督精髓不可。治宜拟填精补髓，阴阳俱补。处方：龟甲30克，党参10克，枸杞子12克，鹿角胶10克(烊化)，菟丝子15克。
服药35剂，精神、食欲好转，血色素增至7克；又续服80剂，血色素增至11克。乃以上方为丸，每次6克，每日3次，调理4个月，愈。
某医问：前用诸药补气养血而不效，今用龟鹿二仙胶治之获效者何也?答曰：本病非但衰于气血，亦且精血俱亏耳。伤于精血者，非至阴至阳者不得填补耳。龟鹿二仙胶者，《证治准绳》名之日大补精髓之品，严苍山云之：“鹿得天地之阳气最全，善通督脉，足于精者，故能多淫而寿。龟得天地之阴气最厚，善通任脉，足于气者，故能伏息而寿。二物气血之属，又得造化之微，异类有情，竹破竹补之法也。人参清食气之壮火，所以补气中之怯，枸杞滋不足之真阴，所以养心神之液，一阴一阳，无偏胜之忧，入气入血，有和平之美。”故其用之得效也。
6．正虚邪实，但知补益，壅其气血，助其邪气
杜××，女，35岁。
患再生障碍性贫血3年多。医先以西药、输血等治疗不效，后又配合中药补气养血，填精补髓仍无功。审其除血色素经常保持在4～5克外，并见其面色萎黄微透青色，手足烦热，心烦易怒，胸胁苦满，时时叹气，舌苔白，脉沉弦细。综合脉证，思之：弦脉者，肝脉也；沉脉者，郁证也；细脉者，血虚也。合之于证，乃肝郁血虚之证也。因拟养血疏肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜3片，薄荷3克，生地10克。
服药3剂，胸满心烦，手足烦热，疲乏无力等证好转，饮食明显增加；继服20剂后，诸证竟失，血色素亦增至14克。
某医云：前用补气养血，填精补髓而不效，后用逍遥疏肝而获全功，其故何也?答曰：肝者，藏血之脏也；肝者，喜调达而恶郁滞也，肝脉条达则诸脏升降正常而气血得生，郁则害脾伤胃，新血不生。前方之药补益有余，而理气不足，肝木失达者必壅其气而助其邪，故其不愈而反剧。今用黑逍遥而取效者，在于补血之中稍佐理肝之品耳。
缺铁性贫血
1．虚实夹杂，不求脉证，胶于补益，其病不愈
阮××，男，24岁。
缺铁性贫血5年多。医始以西药治疗稍有好转，但3个月后不再继续改善，后又配合中药补气养血之剂治之，亦无明显效果。细询其证，3年多来，不管用药与不用药，但至夏季则血色素降至4克左右，至秋季逐步好转，冬季则血色素增至10克左右，而且精神、食欲亦明显改善。今年春天突然血色素降至3-5克，且头晕头痛，疲乏无力，心烦心悸，食欲不振尤较往年为重，舌苔黄白而腻，脉弦滑数。综合脉证，思之：贫血如此之甚，脉当见沉细而弱，今反见弦滑而数，脉证相违，必夹实邪。实邪者，痰热郁于肝胆之经也。治宜先除痰热，调理肝胆。处方：柴胡10克，黄芩6克，黄连4克，竹茹10克，半夏10克，陈皮10克，滑石10克，竹叶10克。夜交藤30克。
服药6剂，诸证竟然大减；继服10剂，血色素增至13克；又服30剂，诸证全失，血色素15克，后果愈。
某医问：本病为何夏剧冬减?答曰：夏季者，暑令也，火令也。此病内蕴痰火，复得夏季暑火之助则火邪更炽，暑火者，伤气伤阴之邪也，火邪炽盛，内耗气阴，故夏季反剧，因此治从化痰泻火。
2.不审脉证，但知补益，以实作虚，以热作寒，终不获效
贺××，女，45岁。
疲乏无力，面色萎黄3年多。医诊缺铁性贫血。前医以铁剂等西药治之，非但诸证不减，亦且胃痛呕吐，不能饮食。后医以中药补气养血，健脾温中药治之，胃痛减，而血色素反见下降，且心烦不安，时见鼻衄。细审其证，面色萎黄，结膜苍白，疲乏无力，食纳甚差，口干舌燥，手心烦热，胃脘胀满，舌苔黄白，脉虚大弦数。综合脉证，思之：脉虚大弦数者，气阴俱虚也；面色萎黄，纳呆口干，胃脘胀满者，脾胃湿热蕴结脾胃也。治宜补气养阴以培其本，燥湿清热，升阳益胃以治其标。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10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。
服药6剂，精神大增，饮食好转，血色素由5克增至9．5克；继服12剂，饮食、精神近于正常，血色素12克。当服至30剂时，查血色素15克，精神、食欲正常，体重增至60千克。
某医云：前用健脾温中，补气养血之剂而不效者何也?答曰：血虚者当补血，此千古不破之真理。然怎么补血则有很大问题，若仅泥于血虚补血之一见则误也。因为血之生从脏腑来讲有心主血、肝藏血、脾统血和肾精转化成血的不同，其中若因心血虚而血虚者当补心血，若心火灼血而致虚者则当泻心火。若肝之阴虚而血虚者当养肝阴，若肝胆实火灼血而血虚者则当泻肝火。若脾虚不能生血而血虚者当健脾，若脾胃湿热、积滞而致脾胃不能生血者则当健脾燥湿清热，食滞不化而致脾胃不能生血者当燥湿健脾，消食导滞。若。肾精亏损而致血虚者，当益精填髓。血之生从气血论，若气虚不能生血者当补气，若因实热者当泻热，若因阴血不足所致者当养阴补血。血之生从阴阳论，若阴虚者当养阴清热，若阳虚者当温阳。血之生从寒热论，若寒者当温，热者当凉。如此等等。今察其脉证，一者气阴两虚也，二者脾胃有热也，三者升降失职也。今病在气阴而但用补血，阴虚有热而用温药，升降失职积滞内停反用腻膈，故不得而效也。
阵发性睡眠性血红蛋白尿
虚实并见，寒热并存，不审脉证，但予补益，其证不解
汪××，男，18岁。
尿血、乏力1年多。医诊阵发性睡眠性血红蛋白尿。先以西药治疗半年多不效。后又配合中药补气养血之剂半年多仍不效。审其面色皓白无华，每天早晨小便均呈深酱油色，一到下午则尿色几近正常，疲乏无力，食欲不振，舌质淡黯，舌苔薄白，脉沉细。综合脉证，思之：面色皓白，疲乏无力者，气阴俱虚也；上午尿赤，午后尿清者，肝胆郁热，湿热下注于膀胱也；舌质淡黯者，瘀血阻滞也；脉沉者，气滞血瘀也；细者，血虚也。合而论之，乃气阴俱虚，气滞血瘀，湿热下注也。治宜拟补气养阴，理气活血，除湿清热。处方：黄芪30克，生山药30克，红花3克，龟甲12克，黄柏5克，丹皮10克，当归6克，三七粉3克，怀牛膝9克，琥珀粉6克，土茯苓60克。
服药4剂，尿血的次数与时间均明显减少；继服6剂，尿血消失，精神、食欲几近正常；又服上药30剂，诸证消失，愈。
失血后贫血
泥于补益，不知祛邪，气血郁滞，生血不能
靳××，女，35岁。
头晕头痛，心悸气短，疲乏无力3年多。医诊失血后贫血。先用输血、西药治疗，使血色素升至8克，但其后不再改善，后医加用中药补气养血之剂治疗2年，血色素亦不见上升。细审其证，面色萎黄微透青色，手心烦热，心烦易怒，胸胁苦满，时时叹气，舌苔白，舌质稍淡，脉弦细。综合脉证。思之：此证非但有虚，亦且有实，实者肝郁也。治宜疏肝养血。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，生姜3片，薄荷3克，生地10克。
服药3剂，头晕头痛，心烦心悸，疲乏无力，手心烦热等证大减，饮食增加，血色素升至9克；继服20剂，诸证大部消失，饮食正常，血色素升至15克。后果愈。
某医云：患者久用补气养血之剂不效，而改用疏肝养血之剂后却迅速好转，其故何也?答曰：从中医基础理论来看，肝主疏泄，肝藏血，肝若不得条达则非但不能藏血生血，亦且伤脾害胃而不能统血生血。今本病患者补而又补，使其郁而又郁，故得疏达而速效也。
嗜酸性肉芽肿
不别内外，不分痰湿，熄散混用，久治不效
唐××，女，38岁。
两下肢结节、出血、关节肌肉疼痛7个多月。医诊嗜酸性肉芽肿。先用西药治疗5个多月，发热虽然好转，但弥漫性紫红色结节、出血点不见减少，且激素的用量稍有减少即发热亦复如初；后又配合中药祛风除湿清热之剂治疗2个多月，不但诸证不减，且见发热身痛，结节、出血点更加增多。细审其证，双下肢出血点满布，尤以两膝以下更加严重，并问有很多的紫红色结节，关节肌肉酸痛，发热，午后加重，体温38．5℃，舌苔薄白，舌尖红，脉弦滑。综合脉证，思之：脉滑者，痰热也；关节肌肉均痛者，痰热化风也；结节、出血点者，斑疹也，痰热入于血络也。治宜化痰清热，散结通络。处方：钩藤15克，枳壳10克，地龙10克，连翘10克，香橼10克，佛手10克，桑枝30克，丝瓜络10克。
服药10剂，关节肌肉酸痛，发热均减，体温37．5℃，结节、出血点减少。继服上药50剂，诸证消失，愈。
某医云：为何不用凉血活血，除湿散风清热之剂治疗?答曰：前已应用此类药物治之不效也。又问：防风、羌活、苍耳子、钩藤、地龙之类皆为风药，何独取钩藤、地龙，而不用羌、独、防?答曰：羌活、防风、独活、苍耳子、细辛、白芷、威灵仙等皆疏散风湿之品，即所谓辛温行散药也，若血虚、痰热凝结者，尤当慎用，以防散血、凝痰而难解。而钩藤、地龙、桑枝等虽亦风药，但其为熄风镇定之药，故用于血热、痰热胶凝成核者尤宜。此外祛湿热之药乃祛弥漫之湿热，连翘、枳壳、香橼、佛手、地龙者可祛胶凝之痰而不伤血，故湿热弥漫者宜化湿燥湿利湿，痰核胶凝者宜化痰软坚散结，所以改用此方治之。
4. Disease in the Lung and Kidney, failing to examine the pulse, seeking only treatment of the Spleen or Kidney, delaying the disease course.
Patient Ju XX, male, 22 years old.
For over half a year, bleeding from teeth and nose, purple spots all over the body, fatigue and weakness. Diagnosed by doctors as Aplastic Anemia (再生障碍性贫血). Initially treated with Western medicine and blood transfusion without effect; later combined with Chinese medicine Guipi Tang (Restore the Spleen Decoction) and Da Tussizi Wan (Large Cuscuta Pill) modified, still ineffective. Examination revealed slight bleeding from teeth and nose, pale complexion, spontaneous sweating (自汗 - natural sweating during the day not due to activity) and night sweats (盗汗 - sweating during sleep), fatigue and weakness, occasional irritability, thin white tongue coating, and a deficient, large, and rapid pulse. Synthesizing the pulse and symptoms: The Spleen has the function of controlling blood and generating blood, so doctors often treat anemia from the perspective of the Spleen and Stomach. However, this disease presents no signs of Spleen pathology, thus treating the Spleen is inappropriate. The pulse is deficient, large, and rapid but not deep; a floating pulse belongs to the Lung, not the Kidney, thus treating only the Kidney is also ineffective. The method should be dual tonification of the Lung and Kidney, nourishing Yin and Qi to clear Ministerial Fire (相火 - abnormal fire arising from deficiency). Prescription: Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 10g, Maidong (Ophiopogonis Tuber) 10g, Dangshen (Codonopsis Radix) 10g, Wuweizi (Schisandrae Fructus) 10g, Shengdi (Rehmanniae Radix) 18g, Cangzhu (Atractylodis Rhizoma) 10g, Fuling (Poria) 10g, Zexie (Alismatis Rhizoma) 10g, Danpi (Moutan Cortex) 10g.
After taking 10 doses, all symptoms decreased; hemoglobin increased from 4g to 6g. Continuing the above prescription for 30 doses, spontaneous sweating, night sweats, and epistaxis disappeared, and purple spots significantly reduced. After another 50 doses, all symptoms disappeared, hemoglobin reached 15g, and the patient recovered.
Another doctor asked: The previous physician used tonification, and you also used tonification, why were the effects different? I replied: It lies in the different meridians entered by the drugs. The previous physician's tonification focused either on the Spleen or the Kidney, whereas my tonification focused primarily on the Lung and Kidney. Furthermore, the previous prescriptions treated either only the Spleen or only the Kidney, while this disease involves deficiency of both Lung and Kidney, and insufficiency of the Heart. Since the medication did not address these comprehensively, the result was as such.
5. Essence and Qi depletion, decline of the Ren and Du vessels, failing to replenish essence and marrow, merely supplementing Qi and Blood, ultimately incorrect treatment.
Patient He XX, male, 22 years old.
Suffering from Aplastic Anemia for over 4 years. Long-term treatment with Western medicine and Chinese medicine formulas for supplementing Qi and Blood yielded no effect. Careful examination revealed pale complexion, fatigue and weakness, hemoglobin 4g, excessive head sweating, and a fine, weak pulse. Synthesizing the pulse and symptoms: A fine and weak pulse in chronic illness indicates depletion of both Essence and Qi, and insufficiency of the Ren and Du vessels. It is necessary to replenish the essence and marrow of the Ren and Du vessels. The treatment should focus on filling essence and tonifying marrow, balancing both Yin and Yang. Prescription: Guijia (Testudinis Carapax et Plastrum) 30g, Dangshen (Codonopsis Radix) 10g, Gouqizi (Lycii Fructus) 12g, Lujiao Jiao (Cervi Cornus Colla) 10g (melted), Tusizi (Cuscutae Semen) 15g.
After taking 35 doses, spirit and appetite improved, hemoglobin increased to 7g. Continuing for another 80 doses, hemoglobin increased to 11g. The above formula was then made into pills, 6g per dose, three times daily, taken for 4 months for regulation, resulting in recovery.
An inquiry was made: Why did previous treatments with various drugs to supplement Qi and Blood fail, while Guilu Erxian Jiao (Tortoise and Deer Two Immortals Glue) succeeded? I replied: This disease involves not only Qi and Blood deficiency but also depletion of Essence and Blood. For injuries to Essence and Blood, only medicines of extreme Yin and extreme Yang can fill and replenish them. Guilu Erxian Jiao is described in *Zhengzhi Zhunsheng* as a major tonic for essence and marrow. Yan Cangshan stated: "Deer obtains the most complete Yang Qi of Heaven and Earth, excels in unblocking the Du vessel, possesses abundant essence, hence capable of frequent mating and longevity. Tortoise obtains the thickest Yin Qi of Heaven and Earth, excels in unblocking the Ren vessel, possesses abundant Qi, hence capable of resting quietly and longevity. These two substances belong to Qi and Blood, yet obtain the subtleties of creation; they are sentient beings of different species, employing the method of 'repairing bamboo with bamboo.' Ginseng clears the vigorous fire caused by food stagnation, thereby supplementing the timidity within Yuan Qi; Goji berry nourishes the insufficient True Yin, thereby nurturing the fluid of the Spirit Heart. One Yin and one Yang, avoiding excess of either; entering Qi and Blood, possessing the beauty of harmony." Thus, its efficacy is achieved.
6. Deficient Zheng Qi (Upright Qi) and Excess Pathogenic Factors, knowing only to tonify, causing congestion of Qi and Blood, aiding pathogenic factors.
Patient Du XX, female, 35 years old.
Suffering from Aplastic Anemia for over 3 years. Initial treatment with Western medicine and blood transfusion failed; subsequent combination with Chinese medicine for supplementing Qi and Blood, filling essence and tonifying marrow also proved ineffective. Examination showed that besides hemoglobin remaining at 4-5g, the complexion was sallow with a hint of cyanosis, heat sensation in hands and feet, irritability, fullness and oppression in the chest and hypochondrium, frequent sighing, white tongue coating, and a deep, wiry, and fine pulse. Synthesizing the pulse and symptoms: The wiry pulse corresponds to the Liver; the deep pulse indicates constraint syndromes; the fine pulse indicates Blood deficiency. Combined with symptoms, this is a syndrome of Liver Qi Stagnation and Blood Deficiency. Therefore, the method of nourishing Blood and soothing the Liver was adopted. Prescription: Chaihu (Bupleuri Radix) 10g, Danggui (Angelicae Sinensis Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Bohe (Menthae Haplocalycis Herba) 3g, Shengdi (Rehmanniae Radix) 10g.
After 3 doses, chest fullness, irritability, heat sensation in hands and feet, and fatigue improved, and diet significantly increased. After continuing for 20 doses, all symptoms disappeared, and hemoglobin increased to 14g.
Another doctor asked: Why did previous treatments with Qi and Blood supplementation, essence filling and marrow tonification fail, while Xiaoyao San (Free and Easy Wanderer Powder) for soothing the Liver achieve complete success? I replied: The Liver is the organ that stores Blood; it prefers smooth flow and dislikes stagnation. When Liver Qi flows smoothly, the ascending and descending functions of all organs are normal, and Qi and Blood are generated. Stagnation harms the Spleen and Stomach, preventing the generation of new Blood. The previous prescriptions had excessive tonification but insufficient regulation of Qi. When Liver Wood fails to flow freely, it inevitably congests Qi and aids pathogenic factors, leading to worsening rather than improvement. The current use of Hei Xiaoyao San (Black Free and Easy Wanderer Powder) succeeds because it adds herbs to regulate the Liver within the context of nourishing Blood.
Iron Deficiency Anemia
1. Mixed Excess and Deficiency, failing to examine pulse and symptoms, adhering rigidly to tonification, disease does not resolve.
Patient Ruan XX, male, 24 years old.
Suffering from Iron Deficiency Anemia for over 5 years. Initial Western medicine treatment showed slight improvement, but after 3 months, no further improvement occurred. Subsequent combination with Chinese medicine for supplementing Qi and Blood also showed no obvious effect. Detailed inquiry into symptoms revealed that for over 3 years, regardless of medication, hemoglobin dropped to around 4g in summer, gradually improved in autumn, and rose to around 10g in winter, with significant improvement in spirit and appetite. In spring this year, hemoglobin suddenly dropped to 3-5g, accompanied by dizziness, headache, fatigue, palpitations, and severe loss of appetite compared to previous years. Tongue coating was yellow-white and greasy; pulse was wiry, slippery, and rapid. Synthesizing the pulse and symptoms: Such severe anemia should present a deep, fine, and weak pulse, but here it is wiry, slippery, and rapid. The pulse contradicts the symptom, indicating the presence of Excess pathogens. The Excess pathogen is Phlegm-Heat constrained in the Liver and Gallbladder meridians. The treatment should first eliminate Phlegm-Heat and regulate the Liver and Gallbladder. Prescription: Chaihu (Bupleuri Radix) 10g, Huangqin (Scutellariae Radix) 6g, Huanglian (Coptidis Rhizoma) 4g, Zhuru (Bambusae Caulis in Taenia) 10g, Banxia (Pinelliae Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Huashi (Talcum) 10g, Zhuye (Phyllostachys Folium) 10g, Yejiaoteng (Polygoni Multiflori Caulis) 30g.
After 6 doses, symptoms significantly decreased. After continuing for 10 doses, hemoglobin increased to 13g. After another 30 doses, all symptoms disappeared, hemoglobin reached 15g, and the patient subsequently recovered.
An inquiry was made: Why does this disease worsen in summer and improve in winter? I replied: Summer is the season of Summer-Heat and Fire. This disease harbors internal Phlegm-Fire, which is aided by the Summer-Heat and Fire of the season, making the Fire pathogen more intense. Summer-Heat and Fire are pathogens that injure Qi and Yin. With intense Fire pathogen consuming Qi and Yin internally, the condition worsens in summer. Therefore, treatment focuses on resolving Phlegm and purging Fire.
2. Failing to examine pulse and symptoms, knowing only to tonify, mistaking Excess for Deficiency, Heat for Cold, ultimately failing to achieve efficacy.
Patient He XX, female, 45 years old.
Fatigue and weakness, sallow complexion for over 3 years. Diagnosed with Iron Deficiency Anemia. Previous treatment with Western iron agents not only failed to alleviate symptoms but also caused stomach pain, vomiting, and inability to eat. Later treatment with Chinese medicine for supplementing Qi and Blood, strengthening the Spleen, and warming the Middle Jiao reduced stomach pain, but hemoglobin dropped further, accompanied by irritability and occasional epistaxis. Careful examination revealed sallow complexion, pale conjunctiva, fatigue, poor appetite, dry mouth and tongue, heat sensation in palms, epigastric distension, yellow-white tongue coating, and a deficient, large, wiry, and rapid pulse. Synthesizing the pulse and symptoms: A deficient, large, wiry, and rapid pulse indicates Qi and Yin deficiency. Sallow complexion, poor appetite, dry mouth, and epigastric distension indicate Damp-Heat accumulation in the Spleen and Stomach. The treatment should tonify Qi and nourish Yin to support the root, and dry Dampness, clear Heat, raise Yang, and benefit the Stomach to treat the branch. Prescription: Dangshen (Codonopsis Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 6g, Maidong (Ophiopogonis Tuber) 10g, Wuweizi (Schisandrae Fructus) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Shenqu (Massa Medicata Fermentata) 10g, Huangbai (Phellodendri Cortex) 10g, Gegen (Puerariae Lobatae Radix) 15g, Cangzhu (Atractylodis Rhizoma) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Shengma ( Cimicifugae Rhizoma) 10g, Zexie (Alismatis Rhizoma) 10g.
After 6 doses, spirit greatly improved, diet improved, and hemoglobin increased from 5g to 9.5g. After continuing for 12 doses, diet and spirit were near normal, and hemoglobin reached 12g. Upon reaching 30 doses, hemoglobin was 15g, spirit and appetite were normal, and weight increased to 60 kg.
Another doctor asked: Why did previous treatments with Spleen-strengthening, Middle-warming, Qi-supplementing, and Blood-nourishing agents fail? I replied: It is an eternal truth that Blood deficiency requires Blood tonification. However, the method of tonification is crucial. Merely adhering to the view of tonifying Blood for Blood deficiency is erroneous. From the perspective of Zang-Fu organs, Blood generation involves the Heart governing Blood, the Liver storing Blood, the Spleen controlling Blood, and Kidney Essence transforming into Blood. If Blood deficiency arises from Heart Blood deficiency, Heart Blood should be tonified; if it arises from Heart Fire scorching Blood, Heart Fire should be purged. If it arises from Liver Yin deficiency, Liver Yin should be nourished; if it arises from Liver/Gallbladder Excess Fire scorching Blood, Liver Fire should be purged. If it arises from Spleen deficiency failing to generate Blood, the Spleen should be strengthened; if it arises from Spleen/Stomach Damp-Heat or stagnation preventing Blood generation, the Spleen should be strengthened, Dampness dried, and Heat cleared; if it arises from Food Stagnation preventing Blood generation, Dampness should be dried, the Spleen strengthened, and Food Stagnation resolved. If it arises from Kidney Essence depletion, Essence should be benefited and Marrow filled. From the perspective of Qi and Blood, if Qi deficiency fails to generate Blood, Qi should be tonified; if due to Excess Heat, Heat should be purged; if due to Yin-Blood insufficiency, Yin should be nourished and Blood tonified. From the perspective of Yin and Yang, if Yin deficiency, Yin should be nourished and Heat cleared; if Yang deficiency, Yang should be warmed. From the perspective of Cold and Heat, if Cold, warm it; if Heat, cool it. Observing the current pulse and symptoms: First, Qi and Yin are both deficient; second, there is Heat in the Spleen and Stomach; third, ascending and descending functions are impaired. Treating Qi and Yin deficiency with only Blood tonification, treating Yin deficiency with Heat using warming herbs, and treating impaired ascending/descending with cloying herbs that obstruct the Diaphragm leads to inefficacy.
Paroxysmal Nocturnal Hemoglobinuria
Mixed Excess and Deficiency, coexistence of Cold and Heat, failing to examine pulse and symptoms, merely providing tonification, symptoms do not resolve.
Patient Wang XX, male, 18 years old.
Hematuria and fatigue for over 1 year. Diagnosed with Paroxysmal Nocturnal Hemoglobinuria. Initial Western medicine treatment for over half a year was ineffective. Subsequent combination with Chinese medicine for supplementing Qi and Blood for over half a year was also ineffective. Examination revealed pale lusterless complexion, dark soy-sauce colored urine every morning, urine color nearly normal in the afternoon, fatigue, poor appetite, pale-dark tongue body, thin white tongue coating, and a deep, fine pulse. Synthesizing the pulse and symptoms: Pale complexion and fatigue indicate Qi and Yin deficiency. Dark urine in the morning and clear urine in the afternoon indicate Liver/Gallbladder constrained Heat and Damp-Heat pouring downward into the Bladder. Pale-dark tongue body indicates Blood stasis obstruction. Deep pulse indicates Qi stagnation and Blood stasis. Fine pulse indicates Blood deficiency. Comprehensive analysis reveals Qi and Yin deficiency, Qi stagnation and Blood stasis, and Damp-Heat pouring downward. The treatment should tonify Qi and nourish Yin, regulate Qi and invigorate Blood, and remove Dampness and clear Heat. Prescription: Huangqi (Astragali Radix) 30g, Sheng Shanyao (Dioscoreae Rhizoma) 30g, Honghua (Carthami Flos) 3g, Guijia (Testudinis Carapax et Plastrum) 12g, Huangbai (Phellodendri Cortex) 5g, Danpi (Moutan Cortex) 10g, Danggui (Angelicae Sinensis Radix) 6g, Sanqi Fen (Notoginseng Radix Powder) 3g, Huainiu Xi (Achyranthis Bidentatae Radix) 9g, Hupo Fen (Electrum Powder) 6g, Tufuling (Smilacis Glabrae Rhizoma) 60g.
After 4 doses, frequency and duration of hematuria significantly decreased. After continuing for 6 doses, hematuria disappeared, and spirit and appetite were nearly normal. After another 30 doses, all symptoms disappeared, and the patient recovered.
Post-hemorrhagic Anemia
Adhering rigidly to tonification, failing to know how to dispel pathogens, Qi and Blood stagnation, failure to generate Blood.
Patient Jin XX, female, 35 years old.
Dizziness, headache, palpitations, shortness of breath, and fatigue for over 3 years. Diagnosed with Post-hemorrhagic Anemia. Initial treatment with blood transfusion and Western medicine raised hemoglobin to 8g, but no further improvement occurred. Subsequent addition of Chinese medicine for supplementing Qi and Blood for 2 years also failed to raise hemoglobin. Careful examination revealed sallow complexion with a hint of cyanosis, heat sensation in palms, irritability, fullness and oppression in the chest and hypochondrium, frequent sighing, white tongue coating, slightly pale tongue body, and wiry, fine pulse. Synthesizing the pulse and symptoms: This syndrome involves both Deficiency and Excess; the Excess component is Liver Qi Stagnation. The treatment should soothe the Liver and nourish Blood. Prescription: Chaihu (Bupleuri Radix) 10g, Danggui (Angelicae Sinensis Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Bohe (Menthae Haplocalycis Herba) 3g, Shengdi (Rehmanniae Radix) 10g.
After 3 doses, dizziness, headache, palpitations, fatigue, and palm heat significantly decreased, diet increased, and hemoglobin rose to 9g. After continuing for 20 doses, most symptoms disappeared, diet normalized, and hemoglobin rose to 15g. The patient subsequently recovered.
Another doctor asked: Why did long-term use of Qi and Blood supplementation fail, while switching to Liver-soothing and Blood-nourishing agents resulted in rapid improvement? I replied: According to basic Traditional Chinese Medicine theory, the Liver governs free flow and stores Blood. If Liver Qi does not flow smoothly, it cannot store and generate Blood, nor can it control Blood, as it harms the Spleen and Stomach. In this patient, repeated tonification led to increased stagnation. Therefore, achieving smooth flow resulted in rapid efficacy.
Eosinophilic Granuloma
Failing to distinguish interior and exterior, failing to differentiate Phlegm and Dampness, mixing wind-extinguishing and wind-dispersing methods, long-term treatment ineffective.
Patient Tang XX, female, 38 years old.
Nodules, bleeding, joint and muscle pain in both lower limbs for over 7 months. Diagnosed with Eosinophilic Granuloma. Initial Western medicine treatment for over 5 months improved fever, but diffuse purplish-red nodules and petechiae did not decrease; reducing hormone dosage slightly caused fever to return. Subsequent combination with Chinese medicine for dispelling Wind, removing Dampness, and clearing Heat for over 2 months not only failed to alleviate symptoms but also presented with fever, body pain, and increased nodules and petechiae. Careful examination revealed widespread petechiae on both lower limbs, worse below the knees, numerous purplish-red nodules, joint and muscle soreness, fever worsening in the afternoon, temperature 38.5°C, thin white tongue coating, red tongue tip, and wiry, slippery pulse. Synthesizing the pulse and symptoms: Slippery pulse indicates Phlegm-Heat. Joint and muscle pain indicates Phlegm-Heat transforming into Wind. Nodules and petechiae are macules/rashes, indicating Phlegm-Heat entering the Blood collaterals. The treatment should resolve Phlegm, clear Heat, dissipate nodules, and unblock collaterals. Prescription: Gouteng (Uncariae Ramulus cum Uncis) 15g, Zhike (Aurantii Fructus Immaturus) 10g, Dilong (Pheretima) 10g, Lianqiao (Forsythiae Fructus) 10g, Xiangyuan (Citri Medicae Fructus) 10g, Foshou (Citri Sarcodactylis Fructus) 10g, Sangzhi (Mori Ramulus) 30g, Sigualuo (Luffae Fructus Retinervus) 10g.
After 10 doses, joint/muscle soreness and fever decreased, temperature 37.5°C, nodules and petechiae reduced. After continuing for 50 doses, all symptoms disappeared, and the patient recovered.
Another doctor asked: Why not use cooling Blood, invigorating Blood, removing Dampness, dispersing Wind, and clearing Heat agents? I replied: Such drugs have already been applied previously without effect. Another question: Fangfeng, Qianghuo, Cang'erzi, Gouteng, Dilong, etc., are all Wind-dispensing drugs. Why choose only Gouteng and Dilong, and not Qianghuo, Duhuo, and Fangfeng? I replied: Qianghuo, Fangfeng, Duhuo, Cang'erzi, Xixin, Baizhi, Weilingxian, etc., are all Wind-Damp dispelling agents, specifically acrid-warm dispersing drugs. For cases of Blood deficiency and Phlegm-Heat condensation, they must be used with caution to avoid scattering Blood and consolidating Phlegm. Gouteng, Dilong, and Sangzhi, although also Wind drugs, are Wind-extinguishing and calming agents, making them particularly suitable for Blood Heat and Phlegm-Heat condensing into nodules. Additionally, herbs for removing Damp-Heat target diffuse Damp-Heat. Lianqiao, Zhike, Xiangyuan, Foshou, and Dilong can resolve condensed Phlegm without injuring Blood. Therefore, for diffuse Damp-Heat, dampness-drying and diuresis are appropriate; for condensed Phlegm nodules, Phlegm-resolving, softening hardness, and dissipating nodules are appropriate. Hence, this formula was adopted.
Allergic Purpura
1. Adhering rigidly to tonification, failing to examine Cold and Heat, mistaking Excess for Deficiency, disease does not resolve.