某医云：余用诸种止痛剂而痛不止，师不用止痛之药而反止，其故何也?答曰：《素问·举痛论篇》言痛者有13条．其中言寒者12条，热者1条，然论及病机则日：泣而不行。故后世以活血、虫类治痛证者恒多，然而忘其泣而不行，非仅为瘀血，亦且有气滞耳，寒凝耳，实滞耳。本证脉证明系既有肝气郁滞，又有痰凝气滞，寒气凝滞，反从血治，病位、病性不同，岂能取效。
5．但知散寒，不审经络，久治不效
柳××，女，60岁。
左牙龈、面颊疼痛5年，加重1年。医诊三叉神经痛。先以西药治疗4年不减，最近1年多来，疼痛尤为剧烈，几乎昼夜持续不止，若稍触摸、说话、吃饭、刷牙则疼痛更是难忍。为此又服中药活血止痛、祛风散寒、滋补肝肾等80余剂，仍然不见寸效。邀余以柴胡加龙骨牡蛎汤、左归丸、芎菊茶调散加减治之，虽时有小效，亦不解决根本问题。细思其病主要在面颊、牙龈，又脉见弦紧，乃寒邪客于阳明经也。予牵正散加味。处方：白附子10克，僵蚕10克，全蝎10克，细辛3克。
不料，5剂疼痛消减80％；继服5剂而愈。
6．胶滞活血，泥于病名，久治不效
章××，女，65岁。
牙龈、耳内、巅顶疼痛阵发性加剧，胸满气短2年多。医诊三叉神经痛、冠状动脉硬化性心脏病。先以西药治疗时减时剧，继以中药活血化瘀、通阳行痹、补气养血之剂治之亦不效。细审其证，牙龈、耳内、巅顶阵阵作痛，有时象闪电，有时象攻冲上逆，胸满胸痛，心胸烦热，有时烦热上冲，冲则气短心悸，汗出，易怒易恐，嘈杂泛酸，手冷而麻，口苦咽干，失眠乏力，手足憋胀，大便不畅，小便不利，舌苔白，脉弦紧涩偶见结象。综合脉证，诊为心阳不足，肝木失达，水饮停聚。治予温阳化饮，疏肝理气，调理三焦。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，生姜3片，大枣5个，桂枝15克，茯苓15克，大黄4克，龙骨15克，牡蛎15克。
服药6剂，头、耳、牙痛明显减少，胸满胸痛，手麻，四肢憋胀等证好转，饮食增加，精神好转；继服6剂，诸证消失，乃停药疗养。但停药2个月以后，突然上症又作，但较从前程度为轻。某医以治冠心病药治之，7日后，诸证加剧。不得已，再次住院，住院后以中、西药混合治之，病情日甚1日。邀余会诊。细审其证脉与前同，宗效不更方之意，复与柴胡加龙骨牡蛎汤加减为方，2个月后，诸证全失。
某医问：余久用中药治此患者，然多治此而彼甚，治彼而此甚，今用柴胡加龙骨牡蛎汤二者皆愈者，其故何也?余不得其要领也。答曰：《素问·脉要精微论》云：“微妙在脉，不可不察，察之有纪，从阴阳始，始之有经，从五行生，生之有度，四时为宜，补泻勿失，与天地如一，得一之精，以知死生。”言疑难复杂问题的诊断在脉，在于从脉中辨阴阳，在于从脉中辨五行的生克制化，并结合四时的阴阳去补泻，此证之用柴胡加龙骨牡蛎汤加减为方而取效者，就在于此。否则见病治病，见症治症，愈治愈坏，难于挽回也。
面神经炎
1．不审病因，不察脉证，但求验方，其病难治
苗××，男，54岁。
左侧口眼喁斜3个多月。医诊面神经炎。先用西药、理疗治疗1个多月不效，后又配合针灸、中药牵正散等治疗1个多月效果亦不够显著。审其除左侧口眼喁斜，左眼不能完全闭合，口不能鼓气，喝水吃饭从口角漏出外，并见舌苔薄白，脉浮弦紧而数。综合脉证，思之：脉浮紧者，风寒客表也；数者，热也；弦者，肝脉也。综合脉证，乃风寒客表，寒郁化热也。又思：其虽有化热之象，然紧浮之脉仍在，实风寒闭郁较甚之故也。正如仲景《伤寒论》所云：“脉浮数者，法当汗出而愈。”当以辛温解表。处方：僵蚕10克，蝉蜕10克，菊花10克，川芎10克，荆芥10克，防风10克，细辛4克，白芷10克，薄荷6克，甘草6克，羌活10克。
某医云：牵正散亦辛温祛风之剂，为何不效?答曰：牵正散由全蝎、白附子、僵蚕三药所组成，从其组成药物的性味功用来看的确如你所说是一个辛温之剂，祛风之剂，但是这种说法颇有些勉强，因为严格来讲，全蝎、僵蚕主要是熄风而不是祛风，也就是说牵正散疏散之力很小，若风寒闭郁于表者实难有效；而芎菊茶调散者，川芎、防风、细辛、羌活、白芷均辛散疏解表邪之药，故风寒闭郁者尤宜用之。正如《素问．至真要大论》所说，不但要善于“寒者热之，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者温之，逸者行之，惊者平之，上之，下之，摩之，浴之，薄之，劫之，开之，发之。”而且要“适事为故。”芎菊茶调散之用之者，就在于适于风寒客表也。
服药1剂，面颊、口角、眼睑发僵发紧之状大减；继服3剂，口眼喁斜之状消失，愈。
2．但求验方，不审脉证，不知随证，治之乏效
贺××，男，40岁。
右侧口眼喁斜5个多月。医诊面神经炎。先用西药、理疗治疗3个多月，不但不效，反见加重，后又配合中药牵正散、乌药顺气汤加减、针灸2个多月，亦无明显改善。细审其证，除口眼喁斜之外，并见经常口苦口干，舌苔黄白，脉弦滑，寸脉尤甚。综合脉证，思之：脉弦者，寒也，肝也；滑者，痰也，热也。合之与症，乃痰火内扰为本，风寒外客为标也。．治宜化痰泻火以治本，疏风散寒以治标。处方：黄柏10克，苍术10克，制南星10克，桂枝10克，防己10克，威灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。某医云：此方乃丹溪先生之上中下痛风方也，吾未闻其能治偏风也?答曰：此方确系丹溪为湿热痹证所设之方。然余观其药味，一方面有除湿热之二妙散；二有化痰泻火之南星、龙胆草、黄柏；三有活血通络之桃仁、红花、桂枝；四有祛风散寒之羌活、威灵仙、白芷、桂枝。综合诸药观之，本方泻火而不甚凉，疏风而不甚散，实有祛邪之中，寓有调其气之意，故用于寒热、表里夹杂之证尤宜。今本病脉证合参，实属痼疾与新感同存，寒热与表里同在之证，故采本方予之。又牵正散、乌药顺气汤主为风寒外客而设，不可用于夹杂之证，故投本方也。
服药4剂，口眼喁斜明显好转，眼、口均亦能闭合。再审其脉弦大紧数。综合脉证，思之：脉弦大紧数者，气阴两虚，风邪郁表之脉也。治宜补气养阴，疏风解表。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，愈。
某医云：此东垣清暑益气汤也。清暑益气汤者，东垣用于伤暑，鞠通之用于暑温，未闻其能治口眼㖞斜也，为何先生用于口眼喁斜?答曰：本病之发生于夏季微感风寒之后，故前用上中下痛风方，今风寒与痰热均己蠲除，而气阴两虚之脉已显露于外，清暑益气汤者，既补气阴，又祛暑邪，故采用之。此即仲景“观其脉证，知犯何逆，随证治之”之义也。
3．固于验方，不求脉证，不审病机，延误病期
苏××，女，35岁。
右侧口眼㖞斜3年多。医诊面神经炎。先以西药、理疗治疗半年不效，继又配合中药牵正散、乌药顺气汤、补阳还五汤、再造丸、大活络丹，针灸等治疗数年，亦无明显效果。细审其证，除右侧口眼㖞斜，右眼不能闭合，右侧口角不能鼓颔，吃饭、喝水外漏外，并见头晕头痛，心烦失眠，舌苔薄白，脉弦细。综合脉证，思之：脉弦细者，血虚也。合之于证，乃血虚生风，筋脉失养也。治宜养血润筋，柔肝熄风，处方：天麻10克，菊花10克，钩藤15克，龙骨15克，牡蛎15克，当归10克，川芎10克，白芍10克，熟地15克，薄荷3克。
服药10剂，口眼㖞斜大减，审其右眼已能闭合，右口角已不流饭、漏水；继服40剂，愈。
某医云：补阳还五汤、牵正散、再造丸、大活络丹均为治疗口眼喁斜的名方、名药，针灸亦被诸医称为治疗口眼㖞斜之妙法，然余用之却不效，其故何也?答曰：补阳还五汤为补气活血之方，牵正散为祛风化痰之方，针灸为活络之法，这些方法都各有其各自的适应证，今本证脉弦细，为血虚不能养肝之证，故只可养血，不可补气，不可温经，不可太活血，否则不效也。今重用四物汤之养血柔肝，再佐平降熄风之品，即在于养血也。
4.胶执验方，不察脉证，不审病机，不知随证，延误病期
赵××，女，33岁。
左侧口眼㖞斜8个多月。医诊面神经炎。先予西药、理疗治疗3个多月不效，后又配合针灸、按摩、中药牵正散、补阳还五汤、再造丸等治疗半年多，亦不见好转。细审其证，除左侧口眼Ⅱ呙斜，不能鼓颔，不能闭眼，吃饭、饮水均外漏外，并见头晕头痛，心烦失眠，时或心悸，烦热上冲，冲则汗出，口苦口干，左臂憋胀，舌苔黄白，脉弦紧。综合脉证，思之：脉弦者，肝脉也；紧者，寒也，结滞不化也。合之于证，此乃肝郁气结也，寒饮内郁，郁而化热，上热下寒，心肾失交之证也。治拟疏肝理气，辛升苦降，交通心肾。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓15克，大黄3克，龙骨15克，牡蛎15克。
服药6剂，左侧面颊发紧感好转，继服10剂，口眼喁斜明显改善，眼可闭合，咀嚼食物正常，口角已不漏饭、漏水，继服20剂，愈。
某医问：用验方而不验，用不治此证之方而反愈，其何故也?答曰：面瘫者，筋脉弛缓不收所致也，筋者，肝之所主也，今柴胡加龙骨牡蛎汤者，乃以治肝胆之方治肝胆所致之病也，实属正治，非不治此病之方治本证也。至于为什么验方不验，依余之见，乃药不对症所致耳。
5．但求验方，不分寒热，证药不符，久久不效
张××，女，29岁。
左侧口眼㖞斜3个多月。医诊面神经炎。先用针法、中药牵正散加减不效，后又用灸法、乌药顺气汤加减而更甚。审其证见左侧口眼喁斜，眼不能闭合，口不能鼓颔，吃饭、喝水即从口角流出，头晕头痛，口干咽燥，舌苔薄白，脉浮数。综合脉证，思之：脉浮者，病在表也；数者，热也。合之于症，乃风热客于表也。拟用疏散风热为方。蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，防风10克。
服药2剂，诸证大减；继服10剂，诸证消失，愈。
某医云：牵正散、乌药顺气汤治口眼喁斜，我久已知也，然用之却不效，而升降散用于口眼喁斜吾未闻也，请师明示。答曰：升降散用于治疗口眼㖞斜吾亦闻所未闻也，而桑菊饮用于口眼㖞斜却有明示耳。已故名老中医秦伯未先生在给我们讲课时即曾介绍此种经验。其后又经数十年的临床探索才知其要点耳。经验证明口眼㖞斜之病主要分两大类，其一为风寒型，此类较多，可根据情况分别采用牵正散、乌药顺气汤、川芎茶调散。其二为风热型，此类较少，可根据情况分别采用桑菊饮、升降散。两型病久者可形成传经，风寒型者常向少阳经发展形成柴胡加龙骨牡蛎汤证，而风热型者则多向伤阴伤血发展形成血虚风动的麻菊散证、阴虚风动的镇肝熄风汤证、羚羊钩藤汤证、杞菊地黄丸证。本病之用升降散者即因其为风热外客耳。
内耳眩晕病
1.不审脉证，胶于平降，阳气下陷，痰湿内阻，眩晕更甚
张××，女，29岁。
头晕头旋阵发性加剧3年多。医诊内耳眩晕病。医始予西药治之不效，继又配合中药化痰熄风、养阴平肝、平肝潜阳、养心安神平肝等治疗亦无效。细审其证，从产后至今已经3年有余，头晕头旋一直不断，整天都有要摔倒的感觉，严重时即感天旋地转，不敢睁眼，不敢翻身，恶心呕吐不止，并时时左耳鸣响不止，疲乏无力，食欲不振，口干心烦，舌苔薄白，面色皓白，脉虚大弦滑数。综合脉证，思之：脉虚大者，气血或气阴俱虚也；弦脉者，肝脉也，寒湿也，阳气不升也；滑数者，痰热也。合之于症、色，知其乃气阴俱虚，痰湿郁滞，清气不升，浊气不降耳。又思黄芪、当归补气生血；人参、麦冬、五味子补气养阴，苍术、白术、青皮、陈皮、神曲、泽泻除湿化痰，调理肝脾，以助中焦轮轴之斡旋，黄柏、泽泻清泻相火，以降浊阴；升麻、葛根升肝脾之清阳，破浊阴之蒙蔽。诸证合用，．补气养阴，化痰除湿，升清降浊。处方：人参10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10克，白术10克，升麻10克，泽泻10克。
某位医生说：我使用各种止痛药，疼痛却不止；老师您不用止痛药，反而止住了痛，这是什么原因呢？回答说：《素问·举痛论篇》中论述了疼痛有十三条。其中提到寒邪致痛的有十二条，热邪致痛的有一条。然而讨论病机时指出：“泣而不行”（气血凝滞不通畅）。所以后世医生治疗痛证多用活血药和虫类药，然而忘记了“泣而不行”不仅仅指瘀血，还有气滞、寒凝、实邪阻滞等情况。本病例的脉象证明既有肝气郁滞，又有痰凝气滞、寒气凝滞。如果反过来从血分去治疗，病位和病性都不同，怎么能见效呢？
5．只知道散寒，不审察经络，久治不效
柳××，女，60岁。
左牙龈、面颊疼痛5年，加重1年。医生诊断为三叉神经痛。先用西药治疗4年没有减轻，最近一年多来，疼痛尤为剧烈，几乎昼夜持续不止，如果稍微触摸、说话、吃饭、刷牙，疼痛更是难以忍受。为此又服用中药活血止痛、祛风散寒、滋补肝肾等方剂80多剂，仍然不见丝毫效果。邀请我用柴胡加龙骨牡蛎汤、左归丸、川芎茶调散加减治疗，虽然有时有一点小效，也不能解决根本问题。仔细思考其病主要在面颊、牙龈，且脉象见弦紧，这是寒邪客居于阳明经所致。给予牵正散加味。处方：白附子10克，僵蚕10克，全蝎10克，细辛3克。
没想到，服用5剂后疼痛减轻了80%；继服5剂而痊愈。
6．拘泥于活血，固守病名，久治不效
章××，女，65岁。
牙龈、耳内、头顶疼痛阵发性加剧，胸闷气短2年多。医生诊断为三叉神经痛、冠状动脉硬化性心脏病。先以西药治疗时轻时重，继以中药活血化瘀、通阳行痹、补气养血之剂治疗也不见效。仔细审查其证候，牙龈、耳内、头顶阵阵作痛，有时像闪电，有时像攻冲上逆，胸闷胸痛，心胸烦热，有时烦热上冲，冲则气短心悸，出汗，易怒易恐，胃中嘈杂泛酸，手冷而麻，口苦咽干，失眠乏力，手足憋胀，大便不畅，小便不利，舌苔白，脉弦紧涩偶见结象。综合脉证，诊断为心阳不足，肝木失达，水饮停聚。治疗予温阳化饮，疏肝理气，调理三焦。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，生姜3片，大枣5个，桂枝15克，茯苓15克，大黄4克，龙骨15克，牡蛎15克。
服药6剂，头、耳、牙痛明显减少，胸闷胸痛、手麻、四肢憋胀等症状好转，饮食增加，精神好转；继服6剂，诸证消失，于是停药疗养。但停药2个月以后，突然上述症状又发作，但较从前程度为轻。某医生用治疗冠心病的药治疗，7日后，诸证加剧。不得已，再次住院，住院后以中、西药混合治疗，病情日益加重。邀请我会诊。仔细审查其证脉与之前相同，遵循有效就不更换方子的意思，再次给予柴胡加龙骨牡蛎汤加减为方，2个月后，诸证全部消失。
某医生问：我长久用中药治疗这位患者，然而多是治此病彼病更甚，治彼病此病更甚，现在用柴胡加龙骨牡蛎汤两者都痊愈了，这是什么原因呢？我没有抓住要领。回答说：《素问·脉要精微论》说：“微妙在脉，不可不察，察之有纪，从阴阳始，始之有经，从五行生，生之有度，四时为宜，补泻勿失，与天地如一，得一之精，以知死生。”意思是疑难复杂问题的诊断在于脉象，在于从脉中辨别阴阳，在于从脉中辨别五行的生克制化，并结合四时的阴阳进行补泻，此证使用柴胡加龙骨牡蛎汤加减而取效，就在于此。否则见病治病，见症治症，越治越坏，难于挽回。
面神经炎
1．不审病因，不察脉证，只求验方，其病难治
苗××，男，54岁。
左侧口眼歪斜3个多月。医生诊断为面神经炎。先用西药、理疗治疗1个多月无效，后又配合针灸、中药牵正散等治疗1个多月效果也不够显著。审查其除了左侧口眼歪斜，左眼不能完全闭合，口不能鼓气，喝水吃饭从口角漏出外，并见舌苔薄白，脉浮弦紧而数。综合脉证，思考：脉浮紧者，是风寒客居体表；数者，是热；弦者，是肝脉。综合脉证，乃是风寒客居体表，寒郁化热。又思考：其虽然有化热之象，然而紧浮之脉仍在，实在是风寒闭郁较甚的缘故。正如仲景《伤寒论》所说：“脉浮数者，法当汗出而愈。”应当用辛温解表法。处方：僵蚕10克，蝉蜕10克，菊花10克，川芎10克，荆芥10克，防风10克，细辛4克，白芷10克，薄荷6克，甘草6克，羌活10克。
某医生说：牵正散也是辛温祛风的方剂，为什么无效？回答说：牵正散由全蝎、白附子、僵蚕三药组成，从其组成药物的性味功用来看的确如你所说是一个辛温之剂，祛风之剂，但是这种说法颇有些勉强，因为严格来讲，全蝎、僵蚕主要是熄风而不是祛风，也就是说牵正散疏散之力很小，若风寒闭郁于表者实在难以有效；而川芎茶调散中，川芎、防风、细辛、羌活、白芷均是辛散疏解表邪的药物，故风寒闭郁者尤其适宜使用。正如《素问·至真要大论》所说，不但要善于“寒者热之，热者寒之，微者逆之，甚者从之，坚者削之，客者除之，劳者温之，结者散之，留者攻之，燥者濡之，急者缓之，散者收之，损者温之，逸者行之，惊者平之，上之，下之，摩之，浴之，薄之，劫之，开之，发之。”而且要“适事为故”（根据具体情况处理）。川芎茶调散之所以使用它，就在于适于风寒客居体表。
服药1剂，面颊、口角、眼睑发僵发紧的状态大减；继服3剂，口眼歪斜的状态消失，痊愈。
2．只求验方，不审脉证，不知随证变化，治疗缺乏效果
贺××，男，40岁。
右侧口眼歪斜5个多月。医生诊断为面神经炎。先用西药、理疗治疗3个多月，不仅无效，反而加重，后又配合中药牵正散、乌药顺气汤加减、针灸2个多月，也没有明显改善。仔细审查其证候，除了口眼歪斜之外，并见经常口苦口干，舌苔黄白，脉弦滑，寸脉尤其严重。综合脉证，思考：脉弦者，是寒，是肝；滑者，是痰，是热。合之与症状，乃是痰火内扰为本，风寒外客为标。治疗宜化痰泻火以治本，疏风散寒以治标。处方：黄柏10克，苍术10克，制南星10克，桂枝10克，防己10克，威灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。某医生说：此方是丹溪先生的上中下痛风方，我没听说它能治偏风（面瘫）？回答说：此方确实系丹溪为湿热痹证所设之方。然而我观察其药味，一方面有除湿热的二妙散；二有化痰泻火的南星、龙胆草、黄柏；三有活血通络的桃仁、红花、桂枝；四有祛风散寒的羌活、威灵仙、白芷、桂枝。综合诸药观之，本方泻火而不甚凉，疏风而不甚散，实在有祛邪之中，寓有调其气之意，故用于寒热、表里夹杂之证尤其适宜。如今本病脉证合参，实属痼疾与新感同存，寒热与表里同在之证，故采用本方给予治疗。另外牵正散、乌药顺气汤主要为风寒外客而设，不可用于夹杂之证，故投以此方。
服药4剂，口眼歪斜明显好转，眼、口均也能闭合。再审其脉弦大紧数。综合脉证，思考：脉弦大紧数者，是气阴两虚，风邪郁表的脉象。治疗宜补气养阴，疏风解表。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，痊愈。
某医生说：这是东垣的清暑益气汤。清暑益气汤，李东垣用于伤暑，吴鞠通用于暑温，没听说它能治口眼歪斜，为什么先生用于口眼歪斜？回答说：本病的发生于夏季微感风寒之后，故前用上中下痛风方，如今风寒与痰热均已消除，而气阴两虚之脉已显露于外，清暑益气汤，既补气阴，又祛暑邪，故采用之。这就是仲景“观其脉证，知犯何逆，随证治之”的意义。
3．固守验方，不求脉证，不审病机，延误病期
苏××，女，35岁。
右侧口眼歪斜3年多。医生诊断为面神经炎。先以西药、理疗治疗半年无效，继又配合中药牵正散、乌药顺气汤、补阳还五汤、再造丸、大活络丹，针灸等治疗数年，也没有明显效果。仔细审查其证候，除了右侧口眼歪斜，右眼不能闭合，右侧口角不能鼓颔，吃饭、喝水外漏外，并见头晕头痛，心烦失眠，舌苔薄白，脉弦细。综合脉证，思考：脉弦细者，是血虚。合之于证，乃是血虚生风，筋脉失养。治疗宜养血润筋，柔肝熄风。处方：天麻10克，菊花10克，钩藤15克，龙骨15克，牡蛎15克，当归10克，川芎10克，白芍10克，熟地15克，薄荷3克。
服药10剂，口眼歪斜大减，审查其右眼已能闭合，右口角已不流饭、漏水；继服40剂，痊愈。
某医生说：补阳还五汤、牵正散、再造丸、大活络丹均为治疗口眼歪斜的名方、名药，针灸也被诸医称为治疗口眼歪斜之妙法，然而我使用它们却不效，这是什么原因呢？回答说：补阳还五汤为补气活血之方，牵正散为祛风化痰之方，针灸为活络之法，这些方法都各有其各自的适应证，如今本证脉弦细，为血虚不能养肝之证，故只可养血，不可补气，不可温经，不可太活血，否则不效也。如今重用四物汤之养血柔肝，再佐平降熄风之品，即在于养血也。
4．胶执验方，不察脉证，不审病机，不知随证变化，延误病期
赵××，女，33岁。
左侧口眼歪斜8个多月。医生诊断为面神经炎。先予西药、理疗治疗3个多月无效，后又配合针灸、按摩、中药牵正散、补阳还五汤、再造丸等治疗半年多，也不见好转。仔细审查其证候，除了左侧口眼歪斜，不能鼓颔，不能闭眼，吃饭、饮水均外漏外，并见头晕头痛，心烦失眠，时或心悸，烦热上冲，冲则汗出，口苦口干，左臂憋胀，舌苔黄白，脉弦紧。综合脉证，思考：脉弦者，是肝脉；紧者，是寒，是结滞不化。合之于证，此乃肝郁气结也，寒饮内郁，郁而化热，上热下寒，心肾失交之证也。治疗拟疏肝理气，辛升苦降，交通心肾。处方：柴胡10克，半夏10克，党参10克，黄芩10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓15克，大黄3克，龙骨15克，牡蛎15克。
服药6剂，左侧面颊发紧感好转，继服10剂，口眼歪斜明显改善，眼可闭合，咀嚼食物正常，口角已不漏饭、漏水，继服20剂，痊愈。
某医生问：用验方而不验，用不治此证之方而反愈，这是什么缘故？回答说：面瘫者，是筋脉弛缓不收所致，筋者，是肝之所主也，如今柴胡加龙骨牡蛎汤，是以治肝胆之方治肝胆所致之病，实属正治，非不治此病之方治本证也。至于为什么验方不验，依我之见，乃是药不对症所致耳。
5．只求验方，不分寒热，证药不符，久久不效
张××，女，29岁。
左侧口眼歪斜3个多月。医生诊断为面神经炎。先用针法、中药牵正散加减无效，后又用灸法、乌药顺气汤加减而更甚。审查其证见左侧口眼歪斜，眼不能闭合，口不能鼓颔，吃饭、喝水即从口角流出，头晕头痛，口干咽燥，舌苔薄白，脉浮数。综合脉证，思考：脉浮者，病在表；数者，是热。合之于症，乃是风热客于表。拟用疏散风热为方。蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，防风10克。
服药2剂，诸证大减；继服10剂，诸证消失，痊愈。
某医生说：牵正散、乌药顺气汤治口眼歪斜，我久已知晓，然而使用它们却不效，而升降散用于口眼歪斜我没听说过，请老师明示。回答说：升降散用于治疗口眼歪斜我也闻所未闻，而桑菊饮用于口眼歪斜却有明示。已故名老中医秦伯未先生在给我们讲课时即曾介绍此种经验。其后又经数十年的临床探索才知其要点。经验证明口眼歪斜之病主要分两大类，其一为风寒型，此类较多，可根据情况分别采用牵正散、乌药顺气汤、川芎茶调散。其二为风热型，此类较少，可根据情况分别采用桑菊饮、升降散。两型病久者可形成传经，风寒型者常向少阳经发展形成柴胡加龙骨牡蛎汤证，而风热型者则多向伤阴伤血发展形成血虚风动的麻菊散证、阴虚风动的镇肝熄风汤证、羚羊钩藤汤证、杞菊地黄丸证。本病之用升降散者即因其为风热外客耳。
内耳眩晕病
1．不审脉证，胶于平降，阳气下陷，痰湿内阻，眩晕更甚
张××，女，29岁。
头晕头旋阵发性加剧3年多。医生诊断为内耳眩晕病。医生始予西药治之无效，继又配合中药化痰熄风、养阴平肝、平肝潜阳、养心安神平肝等治疗也无效。仔细审查其证候，从产后至今已经3年有余，头晕头旋一直不断，整天都有要摔倒的感觉，严重时即感天旋地转，不敢睁眼，不敢翻身，恶心呕吐不止，并时时左耳鸣响不止，疲乏无力，食欲不振，口干心烦，舌苔薄白，面色皓白，脉虚大弦滑数。综合脉证，思考：脉虚大者，是气血或气阴俱虚；弦脉者，是肝脉，是寒湿，是阳气不升；滑数者，是痰热。合之于症、色，知其乃气阴俱虚，痰湿郁滞，清气不升，浊气不降。又思黄芪、当归补气生血；人参、麦冬、五味子补气养阴，苍术、白术、青皮、陈皮、神曲、泽泻除湿化痰，调理肝脾，以助中焦轮轴之斡旋，黄柏、泽泻清泻相火，以降浊阴；升麻、葛根升肝脾之清阳，破浊阴之蒙蔽。诸证合用，补气养阴，化痰除湿，升清降浊。处方：人参10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10克，白术10克，升麻10克，泽泻10克。
A certain physician said: "I have used various analgesics, yet the pain persists; Master, you did not use analgesic herbs, yet the pain stopped. What is the reason?" I replied: "The *Suwen* (Basic Questions), Chapter 'Discourse on Pain' (*Ju Tong Lun*), states that there are thirteen types of pain. Among them, twelve are attributed to cold and one to heat. However, regarding the pathogenesis, it says: 'Qi and blood flow sluggishly and do not circulate freely' (Qi and blood stagnation). Therefore, later physicians often treated pain syndromes with blood-activating and insect-based herbs. However, they forgot that 'sluggish flow and non-circulation' refers not only to blood stasis but also to Qi stagnation, cold coagulation, and excess obstruction. The pulse evidence in this case clearly shows both Liver Qi stagnation and phlegm-Qi stagnation, as well as cold-Qi stagnation. If one were to treat it from the perspective of blood, the disease location and nature would be incorrect, so how could it be effective?
5. Knowing only to disperse cold, without examining the meridians, leading to long-term ineffectiveness
Liu XX, female, 60 years old.
Left gingiva and cheek pain for 5 years, aggravated for 1 year. Diagnosed by a doctor as trigeminal neuralgia. Treated with Western medicine for 4 years with no reduction. For the past year or so, the pain has been particularly severe, almost continuous day and night. Slight touching, speaking, eating, or brushing teeth makes the pain unbearable. Consequently, she took over 80 doses of Chinese herbal medicines for activating blood and stopping pain, dispelling wind and dispersing cold, and nourishing Liver and Kidney, yet saw no effect whatsoever. I was invited to treat her using modified Chaihu Jia Longgu Muli Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell), Zuogui Wan (Left Restoring Pill), and Xiongju Chatiao San (Ligusticum and Chrysanthemum Powder for Regulating the Head) modifications. Although there was occasional slight improvement, the root problem was not resolved. Upon careful reflection, the disease is mainly located in the cheek and gingiva, and the pulse is wiry and tight, indicating Cold Evil lodging in the Yangming Meridian. I prescribed modified Qianzheng San (Straightening Powder). Prescription: Bai Fuzi (Typhonii Rhizoma) 10g, Jiangcan (Bombyx Batryticatus) 10g, Quanxie (Scorpio) 10g, Xixin (Asari Radix et Rhizoma) 3g.
Unexpectedly, after 5 doses, the pain decreased by 80%; after another 5 doses, she recovered.
6. Sticking to blood activation, rigidly adhering to the disease name, leading to long-term ineffectiveness
Zhang XX, female, 65 years old.
Paroxysmal aggravation of pain in the gingiva, ear, and vertex for over 2 years, accompanied by chest fullness and shortness of breath. Diagnosed as trigeminal neuralgia and coronary arteriosclerotic heart disease. Initially treated with Western medicine, symptoms fluctuated. Subsequently treated with Chinese herbal medicines for activating blood and resolving stasis, unblocking Yang and moving bi-syndrome, tonifying Qi and nourishing blood, but also ineffective. Careful examination of the syndrome revealed paroxysmal pain in the gingiva, ear, and vertex, sometimes like lightning, sometimes like attacking upward reversal, chest fullness and pain, vexation and heat in the chest and heart, sometimes heat rushing upward causing shortness of breath and palpitations, sweating, irritability and fearfulness, stomach discomfort with acid regurgitation, cold and numb hands, bitter taste and dry throat, insomnia and fatigue, distension in hands and feet, unsmooth bowel movements, difficult urination, white tongue coating, and wiry, tight, choppy pulse occasionally showing a knotted image. Synthesizing pulse and syndrome, diagnosed as Heart Yang insufficiency, Liver Wood failing to spread, and fluid retention. Treatment involved warming Yang and transforming fluids, soothing Liver and regulating Qi, and regulating the Triple Burner. Prescription: Chaihu (Bupleuri Radix) 10g, Banxia (Pinelliae Rhizoma Preparatum) 10g, Dangshen (Codonopsis Radix) 10g, Huangqin (Scutellariae Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Dazao (Jujubae Fructus) 5 pieces, Guizhi (Cinnamomi Ramulus) 15g, Fuling (Poria) 15g, Dahuang (Rhei Radix et Rhizoma) 4g, Longgu (Fossilia Ossis Mastodi et Scapulae) 15g, Muli (Concha Ostreae) 15g.
After 6 doses, head, ear, and tooth pain decreased significantly, chest fullness/pain, hand numbness, and limb distension improved, appetite increased, and spirit improved. After another 6 doses, all symptoms disappeared, and medication was stopped for convalescence. However, 2 months after stopping medication, the above symptoms suddenly recurred, though less severe than before. A certain doctor treated her with coronary heart disease medications, and after 7 days, symptoms worsened. Forced to readmit to the hospital, where mixed Chinese and Western medicine treatment was administered, the condition deteriorated daily. I was invited to consult. Careful examination of pulse and syndrome showed consistency with previous findings. Following the principle of 'if effective, do not change the formula,' I again prescribed modified Chaihu Jia Longgu Muli Tang. After 2 months, all symptoms vanished.
The doctor asked: "I have used Chinese medicine for this patient for a long time, yet treating one aspect made another worse, and vice versa. Now, using Chaihu Jia Longgu Muli Tang cured both. What is the reason? I have not grasped the key point." I replied: "The *Suwen*, Chapter 'Essential and Subtle Discourse on Pulse' (*Mai Yao Jing Wei Lun*) states: 'Subtlety lies in the pulse, which must not fail to be examined. Examination has its principles, starting from Yin and Yang... regulation according to the four seasons... supplementation and drainage should not be lost... matching heaven and earth... obtaining the essence allows knowing life and death.' This means that diagnosing difficult and complex problems relies on the pulse, distinguishing Yin and Yang from the pulse, distinguishing the generation and restriction of Five Elements from the pulse, and combining seasonal Yin-Yang for supplementation and drainage. The effectiveness of modified Chaihu Jia Longgu Muli Tang in this case lies precisely in this. Otherwise, treating disease by disease and symptom by symptom leads to worsening conditions that are hard to reverse.
Facial Neuritis
1. Not examining the cause, not observing pulse and syndrome, seeking only proven formulas, making the disease difficult to treat
Miao XX, male, 54 years old.
Left-sided facial paralysis (deviation of mouth and eye) for over 3 months. Diagnosed as facial neuritis. Initially treated with Western medicine and physiotherapy for over 1 month with no effect. Then combined with acupuncture and Chinese herbal medicine Qianzheng San for over 1 month, with insufficient results. Examining him, besides left-sided facial paralysis, inability to fully close the left eye, inability to puff out cheeks, and leakage of water/food from the corner of the mouth, he presented with thin white tongue coating and floating, wiry, tight, and rapid pulse. Synthesizing pulse and syndrome: Floating and tight pulse indicates Wind-Cold lodging in the exterior; Rapid indicates Heat; Wiry indicates Liver pulse. Synthesizing pulse and syndrome, it is Wind-Cold lodging in the exterior, with Cold stagnation transforming into Heat. Further thought: Although there are signs of Heat transformation, the tight and floating pulse remains, indicating severe closure and stagnation of Wind-Cold. As Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) states: 'If the pulse is floating and rapid, sweating should occur for recovery.' One should use Acrid-Warm Exterior-Releasing method. Prescription: Jiangcan (Bombyx Batryticatus) 10g, Chantui (Cicadae Periostracum) 10g, Juhua (Chrysanthemi Flos) 10g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 10g, Jingjie (Schizonepetae Spica) 10g, Fangfeng (Saposhnikoviae Radix) 10g, Xixin (Asari Radix et Rhizoma) 4g, Baizhi (Angelicae Dahuricae Radix) 10g, Bohe (Menthae Haplocalycis Herba) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Qianghuo (Notopterygii Rhizoma et Radix) 10g.
The doctor said: "Qianzheng San is also an Acrid-Warm Wind-Dispelling formula. Why was it ineffective?" I replied: "Qianzheng San consists of Quanxie (Scorpio), Bai Fuzi (Typhonii Rhizoma), and Jiangcan (Bombyx Batryticatus). Judging by the properties and functions of these ingredients, it is indeed an Acrid-Warm, Wind-Dispelling formula. However, this view is somewhat forced. Strictly speaking, Quanxie and Jiangcan primarily extinguish Wind rather than dispel Wind. Thus, Qianzheng San has little dispersing power and is unlikely to be effective for exterior closure and stagnation of Wind-Cold. In contrast, Xiongju Chatiao San contains Chuanxiong, Fangfeng, Xixin, Qianghuo, and Baizhi, all of which are Acrid-Dispersing herbs that resolve exterior pathogens. Therefore, it is especially suitable for Wind-Cold closure. As stated in *Suwen*, Chapter 'Great Truths and Essential Needs' (*Zhi Zhen Yao Da Lun*), one must not only be good at 'Treating Cold with Heat, Heat with Cold...' but also 'adapt to the situation.' The reason for using Xiongju Chatiao San is that it suits Wind-Cold lodging in the exterior.
After 1 dose, stiffness in the cheek, mouth corner, and eyelid greatly reduced. After another 3 doses, facial deviation disappeared, and she recovered.
2. Seeking only proven formulas, not examining pulse and syndrome, not adapting to changes, resulting in lack of efficacy
He XX, male, 40 years old.
Right-sided facial paralysis for over 5 months. Diagnosed as facial neuritis. Initially treated with Western medicine and physiotherapy for over 3 months, not only ineffective but worsened. Then combined with Chinese herbal medicine Qianzheng San, Wuyao Shunqi Tang (Wuyao Qi-Regulating Decoction) modifications, and acupuncture for over 2 months, with no obvious improvement. Careful examination revealed, besides facial deviation, frequent bitter taste and dry mouth, yellow-white tongue coating, wiry-slippery pulse, especially at the Cun position. Synthesizing pulse and syndrome: Wiry indicates Cold and Liver; Slippery indicates Phlegm and Heat. Combined with symptoms, the root is Internal Disturbance by Phlegm-Fire, and the branch is Exterior Lodging of Wind-Cold. Treatment should transform Phlegm and drain Fire to treat the root, and disperse Wind and scatter Cold to treat the branch. Prescription: Huangbai (Phellodendri Cortex) 10g, Cangzhu (Atractylodis Rhizoma) 10g, Zhi Nanxing (Arisaematis Rhizoma Preparatum) 10g, Guizhi (Cinnamomi Ramulus) 10g, Fangji (Stephaniae Tetrandrae Radix) 10g, Weilingxian (Syneilesidis Herba) 10g, Taoren (Persicae Semen) 10g, Honghua (Carthami Flos) 10g, Longdancao (Gentianae Radix) 10g, Qianghuo (Notopterygii Rhizoma et Radix) 10g, Baizhi (Angelicae Dahuricae Radix) 10g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 10g, Shenqu (Massa Medicata Fermentata) 10g.
The doctor said: "This is Danxi's Shangzhongxia Gutong Fang (Upper, Middle, Lower Gout Formula). I have never heard it treats hemiplegia/facial palsy?" I replied: "This formula was indeed designed by Danxi for Damp-Heat Bi Syndrome. However, observing its ingredients: first, Ermiào San (Two Marvels Powder) for removing Damp-Heat; second, Nanxing, Longdancao, Huangbai for transforming Phlegm and draining Fire; third, Taoren, Honghua, Guizhi for activating blood and unblocking collaterals; fourth, Qianghuo, Weilingxian, Baizhi, Guizhi for dispelling Wind and scattering Cold. Synthesizing these herbs, this formula drains Fire without being too cooling, disperses Wind without being too dispersing, and truly contains the intent of regulating Qi while expelling pathogens. Thus, it is especially suitable for mixed Cold-Heat and Interior-Exterior syndromes. Here, pulse and syndrome indicate coexistence of chronic disease and new sensation, Cold-Heat, and Interior-Exterior. Hence, this formula was chosen. Qianzheng San and Wuyao Shunqi Tang are mainly set for Exterior Wind-Cold and cannot be used for mixed syndromes, hence this prescription.
After 4 doses, facial deviation improved significantly, eyes and mouth could close. Re-examining the pulse: wiry, large, tight, rapid. Synthesizing pulse and syndrome: Wiry-large-tight-rapid indicates Qi and Yin deficiency with Wind Evil stagnating in the exterior. Treatment should tonify Qi and nourish Yin, disperse Wind and release the exterior. Prescription: Dangshen (Codonopsis Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 6g, Maidong (Ophiopogonis Radix) 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, she recovered.
The doctor said: "This is Dongyuan's Qingshu Yiqi Tang (Clear Summerheat and Tonify Qi Decoction). Li Dongyuan used it for Summerheat injury, Wu Jutong used it for Summerheat Warmth. I've never heard it treats facial deviation. Why did you use it?" I replied: "This disease occurred after slight Wind-Cold contraction in summer. Hence, Shangzhongxia Gutong Fang was used previously. Now that Wind-Cold and Phlegm-Heat are eliminated, the Qi-Yin deficiency pulse is exposed. Qingshu Yiqi Tang tonifies Qi and Yin and expels Summerheat, hence it was adopted. This embodies Zhongjing's principle: 'Observe the pulse and syndrome, know what deviation has occurred, and treat according to the syndrome.'"
3. Adhering rigidly to proven formulas, not seeking pulse and syndrome, not examining pathogenesis, delaying the course of disease
Su XX, female, 35 years old.
Right-sided facial paralysis for over 3 years. Diagnosed as facial neuritis. Initially treated with Western medicine and physiotherapy for half a year with no effect. Then combined with Chinese herbal medicine Qianzheng San, Wuyao Shunqi Tang, Buyang Huanwu Tang (Tonifying Yang and Restoring Five Tenths Decoction), Zaizao Wan (Revive Pill), Da Huoluo Dan (Great Unblocking Meridian Pill), and acupuncture for several years, with no obvious effect. Careful examination revealed, besides right-sided facial paralysis, inability to close right eye, inability to puff right cheek, leakage of food/water, dizziness and headache, vexation and insomnia, thin white tongue coating, and wiry-thin pulse. Synthesizing pulse and syndrome: Wiry-thin indicates Blood deficiency. Combined with syndrome, it is Blood deficiency generating Wind, with sinews and vessels losing nourishment. Treatment should nourish Blood and moisten sinews, soften Liver and extinguish Wind. Prescription: Tianma (Gastrodiae Rhizoma) 10g, Juhua (Chrysanthemi Flos) 10g, Gouteng (Uncariae Ramulus cum Uncis) 15g, Longgu (Fossilia Ossis Mastodi et Scapulae) 15g, Muli (Concha Ostreae) 15g, Danggui (Angelicae Sinensis Radix) 10g, Chuanxiong (Ligustici Chuanxiong Rhizoma) 10g, Baishao (Paeoniae Radix Alba) 10g, Shudi (Rehmanniae Radix Preparata) 15g, Bohe (Menthae Haplocalycis Herba) 3g.
After 10 doses, facial deviation greatly reduced; right eye could close, right mouth corner stopped leaking food/water. After another 40 doses, she recovered.
The doctor said: "Buyang Huanwu Tang, Qianzheng San, Zaizao Wan, Da Huoluo Dan are famous formulas/herbs for facial deviation. Acupuncture is also called a miraculous method by many doctors. Yet my use of them was ineffective. Why?" I replied: "Buyang Huanwu Tang tonifies Qi and activates blood; Qianzheng San dispels Wind and transforms Phlegm; Acupuncture unblocks collaterals. These methods each have their own indications. Here, the wiry-thin pulse indicates Blood deficiency failing to nourish the Liver. Thus, one can only nourish Blood, not tonify Qi, not warm meridians, not overly activate blood, otherwise it will be ineffective. Here, heavy use of Siwu Tang (Four Substances Decoction) to nourish Blood and soften Liver, assisted by herbs that calm and extinguish Wind, focuses on nourishing Blood.
4. Rigidly sticking to proven formulas, not observing pulse and syndrome, not examining pathogenesis, not adapting to changes, delaying the course of disease
Zhao XX, female, 33 years old.
Left-sided facial paralysis for over 8 months. Diagnosed as facial neuritis. Initially treated with Western medicine and physiotherapy for over 3 months with no effect. Then combined with acupuncture, massage, Chinese herbal medicine Qianzheng San, Buyang Huanwu Tang, Zaizao Wan for over half a year, with no improvement. Careful examination revealed, besides left-sided facial deviation, inability to puff cheeks, close eyes, leak food/water, dizziness and headache, vexation and insomnia, occasional palpitations, heat rushing upward causing sweating, bitter taste and dry mouth, left arm distension, yellow-white tongue coating, and wiry-tight pulse. Synthesizing pulse and syndrome: Wiry indicates Liver pulse; Tight indicates Cold and stagnation. Combined with syndrome, this is Liver Qi depression and knotting, internal stagnation of Cold-Fluid, transforming into Heat, Upper Heat and Lower Cold, and failure of Heart-Kidney communication. Treatment proposed: Soothe Liver and regulate Qi, Acrid-Ascending and Bitter-Descending, communicate Heart and Kidney. Prescription: Chaihu (Bupleuri Radix) 10g, Banxia (Pinelliae Rhizoma Preparatum) 10g, Dangshen (Codonopsis Radix) 10g, Huangqin (Scutellariae Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Shengjiang (Zingiberis Rhizoma Recens) 3 slices, Dazao (Jujubae Fructus) 5 pieces, Guizhi (Cinnamomi Ramulus) 10g, Fuling (Poria) 15g, Dahuang (Rhei Radix et Rhizoma) 3g, Longgu (Fossilia Ossis Mastodi et Scapulae) 15g, Muli (Concha Ostreae) 15g.
After 6 doses, tightness in left cheek improved. After another 10 doses, facial deviation significantly improved, eyes could close, chewing normal, mouth corner stopped leaking. After another 20 doses, she recovered.
The doctor asked: "Using proven formulas failed, yet using a formula not intended for this condition succeeded. Why?" I replied: "Facial paralysis is caused by flaccidity and laxity of sinews and vessels. Sinews are governed by the Liver. Chaihu Jia Longgu Muli Tang is a formula for treating Liver-Gallbladder diseases applied to a disease caused by Liver-Gallbladder issues. This is correct treatment, not using a wrong formula. As for why proven formulas failed, in my opinion, it is because the medicine did not match the syndrome.
5. Seeking only proven formulas, not distinguishing Cold-Heat, syndrome and medicine mismatch, long-term ineffectiveness
Zhang XX, female, 29 years old.
Left-sided facial paralysis for over 3 months. Diagnosed as facial neuritis. Initially treated with acupuncture and modified Qianzheng San with no effect. Then treated with moxibustion and modified Wuyao Shunqi Tang, which worsened symptoms. Examining the syndrome: left-sided facial deviation, inability to close eye, puff cheek, leak food/water, dizziness and headache, dry mouth and throat, thin white tongue coating, floating-rapid pulse. Synthesizing pulse and syndrome: Floating indicates disease in the exterior; Rapid indicates Heat. Combined with symptoms, it is Wind-Heat lodging in the exterior. Proposed formula for dispersing Wind-Heat: Chantui (Cicadae Periostracum) 10g, Jiangcan (Bombyx Batryticatus) 10g, Pian Jianghuang (Curcumae Longae Rhizoma) 10g, Dahuang (Rhei Radix et Rhizoma) 3g, Fangfeng (Saposhnikoviae Radix) 10g.
After 2 doses, symptoms greatly reduced. After another 10 doses, all symptoms disappeared, and she recovered.
The doctor said: "I have long known Qianzheng San and Wuyao Shunqi Tang treat facial deviation, yet they were ineffective. I have never heard of Shengjiang San (Ascending and Descending Powder) treating facial deviation. Please explain." I replied: "I have also never heard of Shengjiang San treating facial deviation, but Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction) has explicit records for this. The late renowned senior TCM practitioner Mr. Qin Bowei introduced this experience in his lectures. It took decades of clinical exploration to grasp the key points. Experience proves facial deviation mainly divides into two categories: First, Wind-Cold type, more common, treated with Qianzheng San, Wuyao Shunqi Tang, or Xiongju Chatiao San depending on circumstances. Second, Wind-Heat type, less common, treated with Sangju Yin or Shengjiang San. If prolonged, transmission occurs: Wind-Cold often develops into Shaoyang meridian syndrome (Chaihu Jia Longgu Muli Tang pattern), while Wind-Heat often develops into Yin-Blood damage, forming patterns of Blood deficiency generating Wind (Maju San), Yin deficiency generating Wind (Zhen Gan Xi Feng Tang, Lingyang Gouteng Tang, Qiju Dihuang Wan). The use of Shengjiang San here is due to external Wind-Heat.
Inner Ear Vertigo Disease
1. Not examining pulse and syndrome, rigidly adhering to descending/subduing methods, sinking of Yang Qi, internal obstruction by Phlegm-Damp, vertigo worsens
Zhang XX, female, 29 years old.
Paroxysmal aggravation of dizziness and spinning sensation for over 3 years. Diagnosed as Meniere's disease (Inner Ear Vertigo). Initially treated with Western medicine with no effect. Then combined with Chinese herbal medicine for transforming Phlegm and extinguishing Wind, nourishing Yin and calming Liver, subduing Liver and anchoring Yang, nourishing Heart and calming Spirit/calming Liver, also ineffective. Careful examination revealed, since postpartum, over 3 years ago, dizziness and spinning have been continuous, feeling like falling all day. Severe cases feel like the sky and earth are spinning, dare not open eyes, dare not turn over, incessant nausea and vomiting, constant left tinnitus, fatigue, poor appetite, dry mouth and vexation, thin white tongue coating, pale complexion, and deficient-large, wiry-slippery-rapid pulse. Synthesizing pulse and syndrome: Deficient-large indicates Qi-Blood or Qi-Yin deficiency; Wiry indicates Liver pulse, Cold-Damp, or failing rising of Yang Qi; Slippery-Rapid indicates Phlegm-Heat. Combined with symptoms and complexion, it is Qi-Yin deficiency, Phlegm-Damp stagnation, Clear Qi failing to rise, Turbid Qi failing to descend. Thought: Huangqi and Danggui tonify Qi and generate Blood; Renshen, Maidong, Wuweizi tonify Qi and nourish Yin; Cangzhu, Baizhu, Qingpi, Chenpi, Shenqu, Zexie remove Dampness and transform Phlegm, regulate Liver and Spleen to assist the pivot function of the Middle Jiao; Huangbai, Zexie clear and drain Minister Fire to descend Turbid Yin; Shengma, Gegen raise Clear Yang of Liver and Spleen, break the obscuration of Turbid Yin. Combined, these tonify Qi and nourish Yin, transform Phlegm and remove Dampness, raise Clear and descend Turbid. Prescription: Renshen (Ginseng Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Huangqi (Astragali Radix) 15g, Danggui (Angelicae Sinensis Radix) 6g, Maidong (Ophiopogonis Radix) 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) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Shengma (Cimicifugae Rhizoma) 10g, Zexie (Alismatis Rhizoma) 10g.