腰腿困僵而冷，站立，行走均感困难7～8年。医诊侧索硬化症。先用西药治疗数年，不但效果不显，反见日益加重，后又配合中药补肾之剂、针灸按摩治疗2年多，诸证亦不见改善。细审其证，除腰腿困重冷僵，走路、站立困难，在别人搀扶下才能走路100米左右外，并见面色萎黄，神疲纳呆，头晕头胀，咳嗽，舌苔白，脉沉弦细缓。思之：脉弦细缓者，寒湿郁阻经络，筋脉失养也。治宜宣肺除湿通阳。处方：杏仁10克，薏米10克，桂枝1．5克，生姜3片，厚朴3克，半夏4．5克，防己5克，白蒺藜6克，木瓜9克，淫羊藿3克。
服药8剂后，神疲纳呆，头晕头胀，腰腿困僵好转。继服28剂，两腿走路较前明显有力，在别人的搀扶下可走路200米左右，自己走路亦可走50多米，体重增加4千克。再审其脉弦细而尺大。因思两尺脉者，肾与命门也，尺脉大者，肾与命门虚衰也。治宜补肾益肝，强筋壮骨。处方：生地15克，山萸肉10克，石斛10克，麦冬10克，五味子10克，菖蒲10克，远志10克，茯苓10克，肉苁蓉12克，附子6克，肉桂6克，巴戟天10克，薄荷3克。
某医云：此刘完素《医学六书》治瘖痱方也。余曾以此方80剂不效，老师何以再用?余思吾久用地黄饮子治之不效，乃误用之也，及至老师用鞠通杏仁薏苡汤而取效，余更坚信不移也，今老师又突改地黄饮子为方，实有不解?请明示之。答日：你前用地黄饮子而不效乃因湿邪阻滞也，今所以用地黄饮子者，乃湿邪已除，尺脉大而肾虚也。仲景著《金匮要略》列先后为诸章之首，乃言杂病先后治法之重要也，今先用宣肺通阳除湿，邪气已除，当治其本耳。故治从补肾为主之地黄饮子。然患者仍疑信参半。
服药50剂，走路较前明显稳健，言语近于正常。再服30剂，诸证消失，愈。
3．不分主次，或求补而助邪，或治邪而忽补，方不合拍，徒施不效
赵××，男，40岁。
两腿发僵，日渐加重6年多。医诊侧索硬化。先以西药治疗3年多，不但不效，反见加重，后又配合中药杏仁薏苡汤，地黄饮子加减，针灸等治疗2年多亦无明显效果。审其除两腿发僵，走路困难之外，并见其疲乏无力，自汗盗汗，面色皓白而两颊微嫩红，舌苔白，舌质嫩红，脉虚大弦滑。因思脉虚大者气阴俱虚也；舌质嫩红，阴虚有热也；弦滑脉者，痰湿郁热也。综而论之，乃气阴两虚，湿热蕴结也。治宜补气养阴，除湿清热。处方：黄芪15克，当归6克，党参10克，麦冬10克，五味子10克，生地15克，苍术10克，茯苓10克，泽泻10克，丹皮10克，石斛10克。
某医云：老师见此症多用杏仁薏苡汤，地黄饮子为方，其取效者甚多，然本例却用之而不效，其故何也?答曰：杏仁薏苡汤主用于脉濡缓模糊者，即所谓湿郁证；地黄饮子主用于脉弦细尺脉大者，即所谓肝肾俱虚证。今本证脉虚大弦滑，两方均不可用，只可补气养阴为主，佐以除湿清热为方；故今以芪麦地黄汤法治之。
服药30剂，精神倍增，走路较前有力；继服60剂，愈。
4．知其筋病，治从养阴除湿舒筋得愈
弓××，女，40岁。
右腿酸困六七年，右膝抽筋，肌肉萎缩3年多。医诊侧索硬化。先以针灸、按摩、西药、中药等久治不效。细审其证，右腿酸困，右侧膝后肌腱时而突然抽动而从自行车上摔到地下，小腿肌肉稍见萎缩，精神、食欲正常，舌苔白，脉弦缓。综合脉证，思之：筋者、肝之所主，宜柔忌刚；弦缓脉者，肝阴不足，湿邪复伤。治宜养肝阴，除湿舒筋。处方：白芍10克，赤芍10克，五加皮9克，晚蚕砂9克，木瓜15克，甘草9克。
服药12剂，下肢酸困明显好转，且1月来没有出现抽筋现象，继服上方30剂，追访半年，未见任何症状出现，愈。
脊柱裂
1．不审脉证，胶于活血，思想僵化，不知辨证，久施药饵，反见不效
欧××，男，12岁。
小便失禁或遗尿7年多。医诊脊柱裂。先以西药治疗数年不效，后又以中药活血逐瘀和针灸配合仍无效果。审其除小便失禁或遗尿外，并见右腿疼痛，肌肉萎缩，走路困难拖拉有时跌跤，右足不能上举，纳呆食减，趾指厥冷，舌苔薄白，脉沉细弦。证脉合参，诊为肝肾阴阳俱虚。治拟培补肝肾。处方：生地10克，石斛10克，麦冬6克，肉苁蓉6克，肉桂2克。附子2克，木瓜6克。
其父知医，乃云：患者腿痛肌痿非瘀血乎?然何用活血逐瘀而不效?答曰：疼痛自有瘀血所致者，故临床上常用活血药以止痛。然疼痛并不是都由瘀血所致，故中医止痛有祛风止痛者，有理气止痛者，有温经止痛者，有补气止痛者，有补血止痛者。此证所以用活血而不能止痛者，乃因本证之痛非瘀血所致耳。又问：医家多云小儿乃纯阳之体，而先生却用附子、肉桂纯阳之品，何谓也?答曰：小儿纯阳之见，后人多纠正之日：稚阴稚阳之体，稚者，幼稚也，随拨随应也，易虚易实也，非不可用温热之药也。本病腿痛、肌痿、遗溺显系肾之阴阳俱虚，故以上方治之。然用药稍久恐阳热浮动，故不用熟地之温，而用生地之凉以佐治之。
服药6剂，腿痛好转，走路亦较前有力。继服上方40剂，腿痛尽失，肌肉亦较前丰满，且一个月未见遗尿，又服60剂，诸证消失，果愈。
2．正气亏损，阴阳乖违，徒施补益，不调阴阳，精气不固
何××，男，10岁。
夜间遗尿，白天失禁近10年。医诊隐性脊柱裂。先以西药治之不效，后以针灸、按摩及中药缩尿止遗之剂仍无功。审其精神、食欲、体力、智力发育均正常。舌苔薄白，脉弦缓。思之：症少而脉缓必阴阳荣卫失调所致。治宜调和营卫阴阳，敛摄脬气。处方：桂枝6克，白芍6克，生姜3片，甘草6克，大枣7个，龙骨10克，牡蛎10克，益智仁3克。
某医日：尿失禁，非虚乎?何不用补?尿失禁者，脬气不能固摄也，自应属虚，虚者，自当用补，然补之不效者何?答日：阴阳失调也，失调者当调其阴阳，不可用补以助其失调之阴阳再失调也，故《内经》称“因而和之，是为圣度。”仲景于《金匮要略》虚劳篇诸虚极之遗精用桂枝加龙骨牡蛎汤者，就在于调之也。本病之虚证少而遗尿却甚，必因阴阳失调所致，故以桂枝汤调阴阳，加龙骨、牡蛎以敛之而效如神也。服药3剂，一周未遗，继服4剂，愈。
血管性头痛
1．不审方病之因，不察脉象之见，但凭武断意测，徒施药饵，怎能取效?
章××，男，30岁。
头痛3个月来昼夜不止。医诊血管性头痛。先以西药治疗1个多月不效，继又以中药清热泻火、活血通络、滋阴平肝等剂，并配合针灸等治疗2个月，仍不效。审其方病之始于冬季装卸货物汗出之后，舌苔白，脉浮弦紧，左脉大于右脉。综合脉证，思之：东垣于内伤、外感之辨在脉之左大于右者外感也，右大于左者内伤也。今脉左大于右，且脉浮弦紧，必风寒外感也。治宜疏风散寒。处方：蝉蜕10克，僵蚕10克，川芎10克，荆芥10克，防风10克，细辛4克，白芷10克，薄荷1克，甘草6克，羌活10克。
服药2剂，头痛减半，继服4剂，头痛尽失。
某医云：前用诸药50余剂不效，今用3～4剂而痊，其故何也?答曰：药、证相符也。今脉证皆寒而反用寒凉、活血，此误也，何以故?不察因与脉也。
2．知天人相应，辨脏腑，知虚实，病始治愈
苏××，女，30岁。
左侧偏头痛3年多。医诊血管性头痛。先予西药治之不效，后又予中药平肝泻火、祛风散寒、养血活血、针灸治之，亦无功。审其头痛呈阵发性，发时或为撕裂，或为锥刺，并同时伴作恶心呕吐，或吐泻并作。再询其头痛有明显的时间性．每次发病均发生于早晨起床之后，至上午10时左右才开始缓解，这种情况连续发生2～3天后，逐渐感到极度的疲乏嗜睡，有时甚至连续睡眠3—4天，既不想吃，也不想喝，至嗜睡好转之后，又开始转为持续不断的隐痛2～3天，再突然剧痛几下，才真正的头痛消失。这种发作，开始时半年发作一次，近半年来，几乎平均一个月发作一次，每次少则7天，多则半月。此次发病与上次发病仅相隔了一周，为此半年来，根本不能再坚持工作。舌苔白，脉弦大而紧，右大于左。综合脉证，诊为气血俱虚为本，风寒外客为标。治拟益气养血，疏风散寒。处方：升麻10克，柴胡10克，黄芪15克，白术10克，人参10克，甘草6克，当归10克，羌活10克。
某医云：此病如此之剧，何仅用补中益气汤以治之?答日：此病发于每日之早晨，早晨，《内经》称为朝，即约为卯辰时，此时为阳气初生之时，阳虚挟郁者，升发不利，故疼痛大作，至午时阳气盛而痛减，乃阴阳相对平衡之所为，此证非但补之所能解，必须补中佐升佐散方为正事，故以补中益气治之。又云：疼痛如此之剧，何不用蜈蚣、全蝎?答曰：风寒闭郁，阳气闭郁者，还是以散风升阳之味较好，故加羌活、而不用蜈蚣、全蝎。君请看东垣之著，用羌活、防风、白芷、细辛、独活，而不用蜈蚣、全蝎者，亦在此耳。
服药4剂，头痛顿失，其后又服40剂，果愈。
3．察脉验证，两相比较，知比例之多少，始得全功
张××，男，40岁。
头晕头痛，时轻时重5年多。医诊血管性头痛。先以西药治疗2年多不效，后又配合中药平肝泻火、滋阴平肝、疏风散寒，以及蜈蚣、全蝎、蜂房之属与针灸等治之2年多仍不效。审其头痛之状，均呈阵发性，每次发病之前，先发现昼夜不能入睡2—3天，接着突然感到头胀头痛，进而剧烈发作，头痛如裂，恶心呕吐，心烦意乱，时时烦热向上冲逆，胃脘悸动不已，胃脘满胀，一天后头痛开始减轻，并感到特别疲乏思睡，头脑不清，思维和记忆力几乎全部丧失，这种情况约2天左右，诸证逐渐消失，并感几乎和无病一样。这种情况，开始时，约3～4个月1次，最近3个月来几乎每月都发。舌苔白，脉弦紧而数。综合脉证，诊为痰饮蕴伏，肝木失达。治拟化饮理肝。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓15克，熟军4克，龙骨15克，牡蛎15克。
服药3剂，头痛顿止，继服7剂，他证未作。其后又服30剂，停药观察半年，愈。
某医云：前用诸方之不效者，何故也?答曰：痰饮不化反用阴药之胶固也。徐灵胎、清代之大医家也，在评仲景立方，天士立法时，特别称道苦辛通降法为治胶结痰饮之大法，而前用诸药恰巧违反此一立法。今柴胡加龙骨牡蛎汤者，既有苓桂剂之化饮，又有黄芩人肺之上苦，大黄人大肠之下苦，既有生姜之辛散，又有桂枝之辛通，且有柴胡之理肝胆，故郁结之痰饮可一举而消也。所以头痛可迅速消解也。又问：余亦曾用柴胡加龙骨牡蛎治之，然其不效者，何也?答曰：大法、方剂均同而不效者，恐药物之间的比例有别也?云：其他药味药量均同，而仅大黄用量有别也。答曰：你用大黄10克、我用熟军4克，其因恐就在此耳。大黄10克重在泻下，熟军4克仅用其苦降，而不用其泻下也，如此可辛通有余而苦降不足，痰饮易化也。若用大黄10克则苦降有余，辛通不足，解郁火有余，而化饮不足，此仲景柴胡加龙骨牡蛎汤意也。
4．虚实并见，寒热共存，不审脉象，不察转变，治之不效
郑××，男，48岁。
头痛牙痛8年多。医诊血管性头痛、三叉神经痛。先以西药治疗数年效果不明显，继又配合中药龙胆泻肝、川芎茶调、归脾、补心等剂、针灸治疗数年亦无微功。审其头、眼眶、面颊、牙龈均痛，其痛时为钝痛，时为闪电样剧痛，且视物昏花，头晕耳鸣，心烦心悸，纳呆食减，口苦咽干，舌苔白，指趾厥冷，而手心反热，脉沉弦而涩。综合脉证，诊为肝郁气结，寒饮内郁，郁而化火，上热下寒证。治用疏肝理气，温阳化饮，清上温下。处方：柴胡10克，半夏10克，黄芩10克，甘草6克，生姜3片，大枣5个，桂枝15克，酒军3克，龙骨15克，牡蛎15克。
服药4剂，头痛、牙痛，头晕耳鸣俱减，继服4剂后，诸证不但不减，反有加重之势。再审其脉虚弦而滑。思之：脉虚者，气阴俱虚也；滑者，痰热也。合之于症，乃气阴两虚，痰热内郁也。治拟补气养阴，理气化痰。处方：黄芪15克，当归10克，麦冬10克，党参10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，川芎10克，知母10克。
服药6剂后，头痛消失，他证亦减；继服40剂，诸证尽失，愈。
某医云：余治此病人常常是初药有效，继服无功，此何故也?答：这种情况在疑难复杂疾病中非常多见，这主要是本病大都虚实并见，寒热共存之故，如何治?我认为一注意先后，二注意随证。怎么注意?宗脉即可。
5．寒热当分，经络当明，本末当清
徐××，女，62岁。
腰部和腿部沉重、僵硬且发冷，站立和行走均感到困难已有7到8年。医生诊断为肌萎缩侧索硬化症（ALS）。先使用西药治疗数年，不仅效果不明显，反而病情日益加重；之后又配合中药补肾方剂以及针灸按摩治疗2年多，各种症状也没有改善。仔细审查其证候，除了腰腿沉重、发冷、僵硬，走路和站立困难，需要在他人搀扶下才能行走约100米之外，还见面色萎黄无华，精神疲倦，食欲不振，头晕头胀，咳嗽，舌苔白，脉象沉弦细缓。思考认为：脉象弦细缓，是寒湿郁阻经络，导致筋脉失于濡养所致。治疗应当宣通肺气，祛除湿邪，通达阳气。处方：杏仁10克，薏苡仁10克，桂枝1.5克，生姜3片，厚朴3克，半夏4.5克，防己5克，白蒺藜6克，木瓜9克，淫羊藿3克。
服用8剂后，精神疲倦、食欲不振、头晕头胀、腰腿沉重僵硬等症状好转。继续服用28剂，双腿行走较之前明显有力，在他人搀扶下可行走约200米，自己也能走50多米，体重增加4千克。再次诊察其脉象，呈弦细而尺部脉大。思考认为：两尺脉对应肾与命门，尺脉大，提示肾与命门虚衰。治疗应当补肾益肝，强筋壮骨。处方：生地15克，山萸肉10克，石斛10克，麦冬10克，五味子10克，石菖蒲10克，远志10克，茯苓10克，肉苁蓉12克，附子6克，肉桂6克，巴戟天10克，薄荷3克。
某位医生说：这是刘完素《医学六书》中治疗喑痱（失语兼肢体痿废）的方子。我曾经用此方80剂无效，老师为何再次使用？我思考：我长期用地黄饮子治疗却无效，是因为误用了该方；直到老师用鞠通（吴鞠通）的杏仁薏苡汤才取得疗效，我对此更加坚信不移。如今老师又突然将地黄饮子作为主方，实在令人不解？请明示。回答：你之前用地黄饮子无效，是因为湿邪阻滞；现在用地黄饮子，是因为湿邪已除，尺脉大而肾虚。张仲景在《金匮要略》中将“先后”列为各章之首，是为了强调杂病治疗中先后次序的重要性。现在先用宣肺通阳除湿的方法，邪气已除，应当治其根本。因此治疗以补肾为主的地黄饮子。然而患者仍半信半疑。
服药50剂，走路较之前明显稳健，言语接近正常。再服30剂，所有症状消失，痊愈。
3．不分主次，或求补而助长邪气，或治邪而忽略补益，方剂不合拍，徒劳施治无效
赵××，男，40岁。
双腿发僵，日渐加重6年多。医生诊断为肌萎缩侧索硬化症。先以西药治疗3年多，不仅不效，反而加重；之后又配合中药杏仁薏苡汤、地黄饮子加减以及针灸等治疗2年多，也无明显效果。审查其证候，除了双腿发僵、走路困难之外，还见疲乏无力，自汗盗汗，面色皓白而两颊微嫩红，舌苔白，舌质嫩红，脉虚大弦滑。思考认为：脉虚大，是气阴俱虚；舌质嫩红，是阴虚有热；弦滑脉，是痰湿郁热。综合论述，乃是气阴两虚，湿热蕴结。治疗应当补气养阴，除湿清热。处方：黄芪15克，当归6克，党参10克，麦冬10克，五味子10克，生地15克，苍术10克，茯苓10克，泽泻10克，丹皮10克，石斛10克。
某位医生说：老师见此症多用杏仁薏苡汤、地黄饮子为方，取效者甚多，然而本例用之却不效，原因何在？回答：杏仁薏苡汤主要适用于脉濡缓模糊者，即所谓湿郁证；地黄饮子主要适用于脉弦细尺脉大者，即所谓肝肾俱虚证。如今本证脉象虚大弦滑，两方均不可用，只可补气养阴为主，佐以除湿清热为方；因此今日以芪麦地黄汤法治疗。
服药30剂，精神倍增，走路较之前有力；继服60剂，痊愈。
4．知其筋病，治从养阴除湿舒筋得愈
弓××，女，40岁。
右腿酸困六七年，右膝抽筋，肌肉萎缩3年多。医生诊断为肌萎缩侧索硬化症。先以针灸、按摩、西药、中药等久治不效。仔细审查其证候，右腿酸困，右侧膝后肌腱时而突然抽动而从自行车上摔到地下，小腿肌肉稍见萎缩，精神、食欲正常，舌苔白，脉弦缓。综合脉证，思考认为：筋由肝所主，宜柔忌刚；弦缓脉，是肝阴不足，湿邪复伤。治疗应当养肝阴，除湿舒筋。处方：白芍10克，赤芍10克，五加皮9克，晚蚕砂9克，木瓜15克，甘草9克。
服药12剂，下肢酸困明显好转，且1个月来没有出现抽筋现象，继服上方30剂，追访半年，未见任何症状出现，痊愈。
1．不审脉证，胶于活血，思想僵化，不知辨证，久施药饵，反见不效
欧××，男，12岁。
小便失禁或遗尿7年多。医生诊断为脊柱裂。先以西药治疗数年不效，后又以中药活血逐瘀和针灸配合仍无效果。审查其证候，除小便失禁或遗尿外，还见右腿疼痛，肌肉萎缩，走路困难拖拉有时跌跤，右足不能上举，纳呆食减，趾指厥冷，舌苔薄白，脉沉细弦。证脉合参，诊为肝肾阴阳俱虚。治疗拟培补肝肾。处方：生地10克，石斛10克，麦冬6克，肉苁蓉6克，肉桂2克，附子2克，木瓜6克。
其父懂医，于是说：患者腿痛肌痿，难道不是瘀血吗？然而为何用活血逐瘀而不效？回答：疼痛自有由瘀血所致者，故临床上常用活血药以止痛。然而疼痛并不是都由瘀血所致，所以中医止痛有祛风止痛者，有理气止痛者，有温经止痛者，有补气止痛者，有补血止痛者。此证之所以用活血而不能止痛，是因为本证之痛非瘀血所致耳。又问：医家多云小儿乃纯阳之体，而先生却用附子、肉桂纯阳之品，何谓也？回答：关于小儿纯阳的说法，后人多有纠正，认为是“稚阴稚阳之体”。稚者，幼稚也，随拨随应也，易虚易实也，并非不可用温热之药。本病腿痛、肌痿、遗溺显系肾之阴阳俱虚，故以上方治之。然而用药稍久恐阳热浮动，故不用熟地之温，而用生地之凉以佐治之。
服药6剂，腿痛好转，走路亦较之前有力。继服上方40剂，腿痛尽失，肌肉亦较之前丰满，且一个月未见遗尿，又服60剂，诸证消失，果然痊愈。
何××，男，10岁。
夜间遗尿，白天失禁近10年。医生诊断为隐性脊柱裂。先以西药治之不效，后以针灸、按摩及中药缩尿止遗之剂仍无功。审查其精神、食欲、体力、智力发育均正常。舌苔薄白，脉弦缓。思考认为：症少而脉缓，必是阴阳营卫失调所致。治疗应当调和营卫阴阳，敛摄脬气（膀胱之气）。处方：桂枝6克，白芍6克，生姜3片，甘草6克，大枣7个，龙骨10克，牡蛎10克，益智仁3克。
某位医生说：尿失禁，难道不是虚证吗？为何不用补法？尿失禁者，是脬气不能固摄，自然属虚，虚者，自然应当用补，然而补之不效的原因是什么？回答：是阴阳失调。失调者当调其阴阳，不可用补法以助其失调之阴阳再失调也，所以《内经》称“因而和之，是为圣度”。张仲景在《金匮要略》虚劳篇中对于诸虚极之遗精用桂枝加龙骨牡蛎汤，就在于调理阴阳。本病之虚证少而遗尿却甚，必因阴阳失调所致，故以桂枝汤调阴阳，加龙骨、牡蛎以收敛之而效如神也。服药3剂，一周未遗尿，继服4剂，痊愈。
1．不审方病之因，不察脉象之见，但凭武断意测，徒施药饵，怎能取效？
章××，男，30岁。
头痛3个月来昼夜不止。医生诊断为血管性头痛。先以西药治疗1个多月不效，继又以中药清热泻火、活血通络、滋阴平肝等剂，并配合针灸等治疗2个月，仍不效。审查发病始于冬季装卸货物汗出之后，舌苔白，脉浮弦紧，左脉大于右脉。综合脉证，思考认为：李东垣在内伤、外感之辨中，认为脉左大于右者为外感，右大于左者为内伤。如今脉左大于右，且脉浮弦紧，必是风寒外感。治疗应当疏风散寒。处方：蝉蜕10克，僵蚕10克，川芎10克，荆芥10克，防风10克，细辛4克，白芷10克，薄荷1克，甘草6克，羌活10克。
某位医生说：前用诸药50余剂不效，今用3～4剂而痊愈，原因何在？回答：药、证相符也。如今脉证皆寒而反用寒凉、活血，这是错误，为什么？因为不察病因与脉象。
2．知天人相应，辨脏腑，知虚实，病始治愈
苏××，女，30岁。
左侧偏头痛3年多。医生诊断为血管性头痛。先予西药治之不效，后又予中药平肝泻火、祛风散寒、养血活血、针灸治之，亦无功。审查其头痛呈阵发性，发作时或为撕裂样痛，或为锥刺样痛，并同时伴作恶心呕吐，或吐泻并作。再询问其头痛有明显的时间性，每次发病均发生于早晨起床之后，至上午10时左右才开始缓解，这种情况连续发生2～3天后，逐渐感到极度的疲乏嗜睡，有时甚至连续睡眠3—4天，既不想吃，也不想喝，至嗜睡好转之后，又开始转为持续不断的隐痛2～3天，再突然剧痛几下，才真正的头痛消失。这种发作，开始时半年发作一次，近半年来，几乎平均一个月发作一次，每次少则7天，多则半月。此次发病与上次发病仅相隔了一周，为此半年来，根本不能再坚持工作。舌苔白，脉弦大而紧，右大于左。综合脉证，诊为气血俱虚为本，风寒外客为标。治疗拟益气养血，疏风散寒。处方：升麻10克，柴胡10克，黄芪15克，白术10克，人参10克，甘草6克，当归10克，羌活10克。
某位医生说：此病如此之剧烈，为何仅用补中益气汤来治疗？回答：此病发于每日之早晨，早晨，《内经》称为朝，即约为卯辰时，此时为阳气初生之时，阳虚挟郁者，升发不利，故疼痛大作，至午时阳气盛而痛减，乃阴阳相对平衡之所为，此证非但补之所能解，必须补中佐升佐散方为正事，故以补中益气汤治之。又问：疼痛如此之剧烈，为何不用蜈蚣、全蝎？回答：风寒闭郁，阳气闭郁者，还是以散风升阳之味较好，故加羌活，而不用蜈蚣、全蝎。君请看李东垣之著作，用羌活、防风、白芷、细辛、独活，而不用蜈蚣、全蝎者，亦在此理耳。
服药4剂，头痛顿失，其后又服40剂，果然痊愈。
3．察脉验证，两相比较，知比例之多少，始得全功
张××，男，40岁。
头晕头痛，时轻时重5年多。医生诊断为血管性头痛。先以西药治疗2年多不效，后又配合中药平肝泻火、滋阴平肝、疏风散寒，以及蜈蚣、全蝎、蜂房之属与针灸等治之2年多仍不效。审查其头痛之状，均呈阵发性，每次发病之前，先发现昼夜不能入睡2—3天，接着突然感到头胀头痛，进而剧烈发作，头痛如裂，恶心呕吐，心烦意乱，时时烦热向上冲逆，胃脘悸动不已，胃脘满胀，一天后头痛开始减轻，并感到特别疲乏思睡，头脑不清，思维和记忆力几乎全部丧失，这种情况约2天左右，诸证逐渐消失，并感几乎和无病一样。这种情况，开始时，约3～4个月1次，最近3个月来几乎每月都发。舌苔白，脉弦紧而数。综合脉证，诊为痰饮蕴伏，肝木失达。治疗拟化饮理肝。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓15克，熟大黄4克，龙骨15克，牡蛎15克。
服药3剂，头痛顿止，继服7剂，他证未作。其后又服30剂，停药观察半年，痊愈。
某位医生说：前用诸方之不效的原因是什么？回答：痰饮不化反用阴药之胶固也。徐灵胎，清代的大医家，在评述张仲景立方、叶天士立法时，特别称道苦辛通降法为治胶结痰饮之大法，而前用诸药恰巧违反此一立法。如今柴胡加龙骨牡蛎汤，既有苓桂剂之化饮，又有黄芩入肺之上苦，大黄人大肠之下苦，既有生姜之辛散，又有桂枝之辛通，且有柴胡之理肝胆，故郁结之痰饮可一举而消也。所以头痛可迅速消解也。又问：我也曾用柴胡加龙骨牡蛎汤治之，然而不效的原因是什么？回答：大法、方剂均同而不效者，恐怕药物之间的比例有别吧？说：其他药味药量均同，而仅大黄用量有别。回答：你用大黄10克，我用熟大黄4克，原因恐怕就在此处。大黄10克重在泻下，熟大黄4克仅用其苦降，而不用其泻下也，如此可辛通有余而苦降不足，痰饮易化也。若用大黄10克则苦降有余，辛通不足，解郁火有余，而化饮不足，此乃张仲景柴胡加龙骨牡蛎汤之意也。
郑××，男，48岁。
头痛牙痛8年多。医生诊断为血管性头痛、三叉神经痛。先以西药治疗数年效果不明显，继又配合中药龙胆泻肝、川芎茶调、归脾、补心等剂、针灸治疗数年亦无微功。审查其头、眼眶、面颊、牙龈均痛，其痛时为钝痛，时为闪电样剧痛，且视物昏花，头晕耳鸣，心烦心悸，纳呆食减，口苦咽干，舌苔白，指趾厥冷，而手心反热，脉沉弦而涩。综合脉证，诊为肝郁气结，寒饮内郁，郁而化火，上热下寒证。治疗用疏肝理气，温阳化饮，清上温下。处方：柴胡10克，半夏10克，黄芩10克，甘草6克，生姜3片，大枣5个，桂枝15克，酒大黄3克，龙骨15克，牡蛎15克。
服药4剂，头痛、牙痛，头晕耳鸣俱减，继服4剂后，诸证不但不减，反有加重之势。再审其脉虚弦而滑。思考认为：脉虚者，气阴俱虚也；滑者，痰热也。合之于症，乃气阴两虚，痰热内郁也。治疗拟补气养阴，理气化痰。处方：黄芪15克，当归10克，麦冬10克，党参10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，石菖蒲10克，远志10克，川芎10克，知母10克。
服药6剂后，头痛消失，他证亦减；继服40剂，诸证尽失，痊愈。
某位医生说：我治此病人常常是初药有效，继服无功，这是什么原因？回答：这种情况在疑难复杂疾病中非常多见，这主要是本病大都虚实并见，寒热共存之故，如何治？我认为一注意先后，二注意随证。怎么注意？宗脉即可。
5．寒热当分，经络当明，本末当清
徐××，女，62岁。
Lumbar and leg heaviness, stiffness, and coldness, with difficulty in standing and walking for 7 to 8 years. Diagnosed as Amyotrophic Lateral Sclerosis (ALS). Initially treated with Western medicine for several years; not only was the effect insignificant, but the condition worsened progressively. Subsequently, Chinese herbal medicine for tonifying the Kidney (Zang-Fu organ) combined with acupuncture and massage therapy were used for over 2 years, yet no improvement was observed in any symptoms. Upon careful examination of the syndrome, besides the lumbar and leg heaviness, coldness, stiffness, difficulty in walking and standing, and the ability to walk only about 100 meters with assistance, there were also sallow complexion, mental fatigue, poor appetite, dizziness and head distension, cough, white tongue coating, and a deep, wiry, thin, and slow pulse. Reflection indicated: A wiry, thin, and slow pulse suggests Cold-Dampness obstructing the meridians, leading to malnourishment of the sinews. The treatment principle should be to diffuse Lung Qi, eliminate Dampness, and unblock Yang. Prescription: Xingren (Apricot Seed) 10g, Yiyi Ren (Coix Seed) 10g, Guizhi (Cinnamon Twig) 1.5g, Shengjiang (Fresh Ginger) 3 slices, Houpo (Magnolia Bark) 3g, Banxia (Pinellia Tuber) 4.5g, Fangji (Stephania Root) 5g, Baijili (Tribulus Fruit) 6g, Mugua (Chaenomeles Fruit) 9g, YinYanghuo (Epimedium Herba) 3g.
After taking 8 doses, mental fatigue, poor appetite, dizziness, head distension, and lumbar/leg heaviness and stiffness improved. After continuing for 28 doses, walking strength in both legs significantly improved compared to before; with assistance, he could walk about 200 meters, and independently, about 50 meters. Body weight increased by 4 kg. Re-examination of the pulse revealed it to be wiry, thin, with a large Chi (Cun-Guan-Chi position corresponding to lower body/Kidneys) position. Reflection indicated: The two Chi positions correspond to the Kidney (Zang-Fu organ) and Mingmen (Gate of Vitality); a large Chi pulse indicates deficiency and decline of the Kidney and Mingmen. The treatment principle should be to tonify the Kidney and benefit the Liver, strengthening sinews and bones. Prescription: Shengdi (Rehmannia Root) 15g, Shanzhuyu (Cornus Fruit) 10g, Shihu (Dendrobium Stem) 10g, Maidong (Ophiopogon Tuber) 10g, Wuweizi (Schisandra Berry) 10g, Changpu (Acorus Rhizome) 10g, Yuanzhi (Polygala Root) 10g, Fuling (Poria) 10g, Rongzong (Cistanche Stem) 12g, Fuzi (Aconite Lateral Root) 6g, Rougui (Cinnamon Bark) 6g, Bajitian (Morinda Root) 10g, Bohe (Mint Herb) 3g.
Another physician stated: This is the formula from Liu Wansu's "Medical Six Books" for treating aphasia and flaccidity (Yinfei). I once used this formula for 80 doses without effect; why did the teacher use it again? I reflected: My long-term use of Dihuang Yinzi (Yellow Earth Decoction) was ineffective because it was misapplied; until the teacher used Ju Tong's (Wu Jutong's) Xingren Yiyi Tang (Apricot and Coix Decoction) which achieved efficacy, my conviction strengthened. Now, the teacher suddenly changes to Dihuang Yinzi as the main formula, which is truly puzzling. Please clarify. The response was: Your previous ineffectiveness with Dihuang Yinzi was due to Damp-Evil obstruction; now using Dihuang Yinzi is because the Damp-Evil has been eliminated, and the large Chi pulse indicates Kidney deficiency. Zhang Zhongjing placed "sequence" at the beginning of chapters in "Jin Gui Yao Lue" (Essential Prescriptions of the Golden Cabinet) to emphasize the importance of treatment sequence in miscellaneous diseases. Now, after first using methods to diffuse Lung Qi, unblock Yang, and eliminate Dampness, with the pathogenic factor removed, one should treat the root. Therefore, the treatment focuses on tonifying the Kidney with Dihuang Yinzi. However, the patient remained half-believing and half-doubting.
After taking 50 doses, walking became significantly more stable, and speech approached normalcy. After another 30 doses, all symptoms disappeared, and recovery was achieved.
3. Failure to distinguish primary from secondary, or seeking tonification while aiding the pathogen, or treating the pathogen while neglecting tonification, results in mismatched formulas and futile treatment.
Zhao XX, Male, 40 years old.
Leg stiffness worsening gradually for over 6 years. Diagnosed as Amyotrophic Lateral Sclerosis. Initially treated with Western medicine for over 3 years; not only ineffective, but worsened. Subsequently, combined with Chinese herbs Xingren Yiyi Tang (Apricot and Coix Decoction), modified Dihuang Yinzi (Yellow Earth Decoction), and acupuncture for over 2 years, with no significant effect. Examination revealed, besides leg stiffness and difficulty walking, fatigue, spontaneous sweating, night sweats, bright white complexion with slightly tender red cheeks, white tongue coating, tender red tongue body, and a deficient, large, wiry, and slippery pulse. Reflection indicated: A deficient and large pulse indicates Qi and Yin deficiency; a tender red tongue body indicates Yin deficiency with Heat; a wiry and slippery pulse indicates Phlegm-Dampness with郁 Heat. Comprehensive analysis suggests Qi and Yin deficiency with Damp-Heat accumulation. Treatment principle: Tonify Qi and nourish Yin, eliminate Dampness and clear Heat. Prescription: Huangqi (Astragalus Root) 15g, Dangui (Angelica Sinensis Root) 6g, Dangshen (Codonopsis Root) 10g, Maidong (Ophiopogon Tuber) 10g, Wuweizi (Schisandra Berry) 10g, Shengdi (Rehmannia Root) 15g, Cangzhu (Atractylodes Rhizome) 10g, Fuling (Poria) 10g, Zexie (Alisma Rhizome) 10g, Danpi (Moutan Bark) 10g, Shihu (Dendrobium Stem) 10g.
Another physician asked: The teacher often uses Xingren Yiyi Tang (Apricot and Coix Decoction) and Dihuang Yinzi (Yellow Earth Decoction) for such cases with many successes, but why was it ineffective in this case? The response: Xingren Yiyi Tang (Apricot and Coix Decoction) is primarily used for patients with a soggy, slow, and indistinct pulse, i.e., Dampness Obstruction Syndrome; Dihuang Yinzi (Yellow Earth Decoction) is primarily used for patients with a wiry, thin pulse and a large Chi pulse, i.e., Liver-Kidney Deficiency Syndrome. In this case, the pulse is deficient, large, wiry, and slippery; neither formula is applicable. The treatment should focus on tonifying Qi and nourishing Yin, assisted by eliminating Dampness and clearing Heat. Thus, the Qimai Dihuang Tang method (Qi-Mei Rehmannia Decoction approach) is used today.
After taking 30 doses, spirit doubled, and walking strength improved. After continuing for 60 doses, recovery was achieved.
4. Knowing it is a sinew disease, treating by nourishing Yin, eliminating Dampness, and relaxing sinews leads to cure.
Gong XX, Female, 40 years old.
Right leg soreness and fatigue for 6-7 years, right knee cramping, muscle atrophy for over 3 years. Diagnosed as Amyotrophic Lateral Sclerosis. Long-term treatment with acupuncture, massage, Western medicine, and Chinese herbs was ineffective. Careful examination revealed right leg soreness, sudden twitching of the right posterior knee tendon causing falls from a bicycle, slight calf muscle atrophy, normal spirit and appetite, white tongue coating, and a wiry, slow pulse. Comprehensive pulse and syndrome analysis suggested: Sinews are governed by the Liver, favoring flexibility over rigidity; a wiry, slow pulse indicates Liver Yin deficiency compounded by Dampness injury. Treatment principle: Nourish Liver Yin, eliminate Dampness, relax sinews. Prescription: Baishao (White Peony Root) 10g, Chishao (Red Peony Root) 10g, Wujia Pi (Acanthopanacis Cortex) 9g, Wancansha (Silkworm Sand) 9g, Mugua (Chaenomeles Fruit) 15g, Gancao (Licorice Root) 9g.
After taking 12 doses, lower limb soreness significantly improved, and no cramping occurred for 1 month. Continuing the above prescription for 30 doses, followed up for half a year, no symptoms recurred, and recovery was achieved.
Spina Bifida
1. Failing to examine pulse and syndrome, adhering rigidly to blood-invigorating methods, rigid thinking, lacking differentiation, prolonged medication yields no effect.
Ou XX, Male, 12 years old.
Urinary incontinence or enuresis for over 7 years. Diagnosed as Spina Bifida. Initial Western medicine treatment for several years was ineffective. Subsequent combination of Chinese herbs for invigorating blood and resolving stasis with acupuncture also yielded no effect. Examination revealed, besides urinary incontinence or enuresis, right leg pain, muscle atrophy, difficult dragging gait with occasional falls, inability to dorsiflex the right foot, poor appetite, cold toes and fingers, thin white tongue coating, and a deep, fine, wiry pulse. Pulse and syndrome integration diagnosed Kidney and Liver Yin-Yang dual deficiency. Treatment plan: Cultivate and tonify Liver and Kidney. Prescription: Shengdi (Rehmannia Root) 10g, Shihu (Dendrobium Stem) 10g, Maidong (Ophiopogon Tuber) 6g, Rongzong (Cistanche Stem) 6g, Rougui (Cinnamon Bark) 2g, Fuzi (Aconite Lateral Root) 2g, Mugua (Chaenomeles Fruit) 6g.
The father, knowledgeable in medicine, asked: Leg pain and muscle atrophy—are they not caused by Blood Stasis? Why did blood-invigorating and stasis-resolving methods fail? The response: Pain can indeed be caused by Blood Stasis, so blood-invigorating herbs are commonly used clinically for pain relief. However, not all pain is caused by Blood Stasis. Therefore, TCM pain relief includes dispelling Wind, regulating Qi, warming meridians, tonifying Qi, and nourishing Blood. The reason blood-invigorating methods failed here is that this pain is not caused by Blood Stasis. Further question: Physicians often say children are bodies of pure Yang, yet you use pure Yang substances like Fuzi (Aconite Lateral Root) and Rougui (Cinnamon Bark). What does this mean? The response: The concept of children being "pure Yang" has been corrected by later generations to "tender Yin and tender Yang." "Tender" means immature, responsive to stimulation, prone to deficiency and excess. It does not mean warm/hot herbs cannot be used. This disease's leg pain, muscle atrophy, and enuresis clearly indicate Kidney Yin-Yang dual deficiency, hence the above prescription. However, prolonged use might cause Yang heat to float, so instead of the warm Shudi (Prepared Rehmannia Root), the cool Shengdi (Raw Rehmannia Root) is used to assist treatment.
After taking 6 doses, leg pain improved, and walking strength increased. Continuing the above prescription for 40 doses, leg pain completely disappeared, muscles became fuller, and no enuresis occurred for a month. Another 60 doses led to the disappearance of all symptoms, confirming recovery.
2. Righteous Qi depletion, Yin-Yang discordance, futile tonification without regulating Yin-Yang, failure to secure Essence and Qi.
He XX, Male, 10 years old.
Nocturnal enuresis and daytime incontinence for nearly 10 years. Diagnosed as Occult Spina Bifida. Initial Western medicine treatment was ineffective. Subsequent acupuncture, massage, and Chinese herbs for stopping urination and enuresis also failed. Examination showed normal spirit, appetite, physical strength, and intellectual development. Thin white tongue coating, wiry-slow pulse. Reflection indicated: Few symptoms with a slow pulse must result from Yin-Yang and Ying-Wei disharmony. Treatment principle: Harmonize Ying-Wei and Yin-Yang, astringe Bladder Qi. Prescription: Guizhi (Cinnamon Twig) 6g, Baishao (White Peony Root) 6g, Shengjiang (Fresh Ginger) 3 slices, Gancao (Licorice Root) 6g, Dazao (Jujube Fruit) 7 pieces, Longgu (Fossilized Bone) 10g, Muli (Oyster Shell) 10g, Yizhiren (Bitter Apricot Seed) 3g.
Another physician asked: Urinary incontinence—is it not deficiency? Why not tonify? Urinary incontinence is due to Bladder Qi failing to secure, naturally belonging to deficiency. Deficiency should be tonified. Why did tonification fail? The response: It is Yin-Yang disharmony. Disharmony requires regulating Yin-Yang; one cannot use tonification to further disrupt the already imbalanced Yin-Yang. Hence, "Nei Jing" states, "Harmonizing accordingly is the sage's standard." Zhang Zhongjing used Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) for extreme deficiency-related seminal emission in the "Xu Lao" chapter of "Jin Gui Yao Lue" precisely to regulate. In this disease, deficiency signs are few, but enuresis is severe, likely due to Yin-Yang disharmony. Thus, Guizhi Tang regulates Yin-Yang, adding Longgu (Fossilized Bone) and Muli (Oyster Shell) to astringe, resulting in miraculous efficacy. After 3 doses, no enuresis for a week; continuing for 4 doses, recovery was achieved.
Vascular Headache
1. Failing to investigate the cause of the disease, ignoring pulse manifestations, relying on arbitrary speculation, futile medication cannot achieve efficacy.
Zhang XX, Male, 30 years old.
Headache continuous day and night for 3 months. Diagnosed as Vascular Headache. Initial Western medicine treatment for over 1 month was ineffective. Subsequent Chinese herbs for clearing Heat and purging Fire, invigorating blood and unblocking collaterals, nourishing Yin and calming Liver, combined with acupuncture for 2 months, also failed. Examination revealed onset after sweating during winter cargo handling, white tongue coating, floating-wiry-tight pulse, left pulse larger than right. Comprehensive pulse and syndrome analysis suggested: Li Dongyuan distinguished internal injury from external contraction by pulse: left larger than right indicates external contraction; right larger than left indicates internal injury. Here, left pulse larger than right, plus floating-wiry-tight pulse, indicates Wind-Cold external contraction. Treatment principle: Dispel Wind and scatter Cold. Prescription: Chantui (Cicada Slough) 10g, Jiangcan (Bombyx Batryticatus) 10g, Chuanxiong (Ligusticum Rhizome) 10g, Jingjie (Schizonepeta Spike) 10g, Fangfeng (Saposhnikovia Root) 10g, Xixin (Asarum Root) 4g, Baizhi (Angelica Dahurica Root) 10g, Bohe (Mint Herb) 1g, Gancao (Licorice Root) 6g, Qianghuo (Notopterygium Rhizome) 10g.
After 2 doses, headache halved; continuing for 4 doses, headache completely disappeared.
Another physician asked: Previous medications for over 50 doses failed, yet 3-4 doses cured it. Why? The response: Medicine matches the syndrome. Here, pulse and syndrome indicate Cold, yet cold-cooling and blood-invigorating herbs were used erroneously. Why? Because the cause and pulse were not examined.
2. Understanding Heaven-Human Correspondence, differentiating Zang-Fu organs, knowing deficiency/excess, the disease is then curable.
Su XX, Female, 30 years old.
Left-sided migraine for over 3 years. Diagnosed as Vascular Headache. Initial Western medicine treatment was ineffective. Subsequent Chinese herbs for calming Liver and purging Fire, dispelling Wind and scattering Cold, nourishing blood and invigorating circulation, and acupuncture also failed. Examination revealed paroxysmal headache, tearing or stabbing pain, accompanied by nausea/vomiting or vomiting/diarrhea. Further inquiry showed distinct timing: onset after waking in the morning, easing around 10 AM. This pattern persisted for 2-3 days, followed by extreme fatigue and hypersomnia, sometimes sleeping continuously for 3-4 days, with loss of appetite and thirst. After hypersomnia subsided, dull pain persisted for 2-3 days, followed by sudden severe pain before true resolution. Initially occurring once every six months, recently averaging once a month, lasting 7 days to half a month. Current episode separated from the last by only one week, preventing work for half a year. White tongue coating, wiry-large-tight pulse, right larger than left. Comprehensive diagnosis: Qi and Blood deficiency as root, Wind-Cold external invasion as branch. Treatment plan: Benefit Qi and nourish Blood, dispel Wind and scatter Cold. Prescription: Shengma (Cimicifuga Rhizome) 10g, Chaihu (Bupleurum Root) 10g, Huangqi (Astragalus Root) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 10g, Renshen (Ginseng Root) 10g, Gancao (Licorice Root) 6g, Danggui (Angelica Sinensis Root) 10g, Qianghuo (Notopterygium Rhizome) 10g.
Another physician asked: Such severe disease, why only use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)? The response: This disease occurs in the morning. "Nei Jing" calls morning "Chao," approximately Mao-Chen hours (5-9 AM), when Yang Qi begins to generate. Yang deficiency with stagnation hinders ascending movement, causing severe pain. By noon, Yang Qi is abundant, pain decreases due to relative Yin-Yang balance. This syndrome cannot be solved by tonification alone; it requires tonifying the middle with ascending and dispersing agents. Hence, Buzhong Yiqi Tang is used. Further question: Such severe pain, why not use Wugong (Centipede) and Quanxie (Scorpion)? The response: For Wind-Cold closure and Yang Qi stagnation, Wind-dispelling and Yang-ascending herbs are better. Hence, Qianghuo (Notopterygium Rhizome) is added, avoiding Wugong (Centipede) and Quanxie (Scorpion). Refer to Li Dongyuan's works: using Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Baizhi (Angelica Dahurica Root), Xixin (Asarum Root), Du Huo (Angelica Pubescens Root), and avoiding Wugong (Centipede) and Quanxie (Scorpion) follows this logic.
After 4 doses, headache instantly vanished; continuing for 40 doses, recovery was confirmed.
3. Examining pulse to verify syndrome, comparing proportions, knowing the ratio determines complete success.
Zhang XX, Male, 40 years old.
Dizziness and headache, fluctuating severity for over 5 years. Diagnosed as Vascular Headache. Initial Western medicine treatment for over 2 years was ineffective. Subsequent Chinese herbs for calming Liver/purging Fire, nourishing Yin/calming Liver, dispelling Wind/scattering Cold, plus Wugong (Centipede), Quanxie (Scorpion), Fengfang (Honeycomb), and acupuncture for over 2 years also failed. Examination revealed paroxysmal headache. Before each attack, insomnia for 2-3 days, followed by sudden head distension/pain, severe cracking pain, nausea/vomiting, irritability, rising hot flashes, epigastric palpitations, fullness/bloating. Pain lessens after one day, followed by extreme fatigue, sleepiness, confusion, and near-total loss of thought/memory for about 2 days, then gradual symptom disappearance, feeling almost healthy. Initially occurring every 3-4 months, recently monthly. White tongue coating, wiry-tight-rapid pulse. Comprehensive diagnosis: Phlegm-Fluid retention hidden, Liver Wood stagnation. Treatment plan: Transform Fluids and regulate Liver. Prescription: Chaihu (Bupleurum Root) 10g, Banxia (Pinellia Tuber) 10g, Huangqin (Scutellaria Root) 10g, Dangshen (Codonopsis Root) 10g, Gancao (Licorice Root) 6g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube Fruit) 5 pieces, Guizhi (Cinnamon Twig) 10g, Fuling (Poria) 15g, Shu Jun (Prepared Rheum Root) 4g, Longgu (Fossilized Bone) 15g, Muli (Oyster Shell) 15g.
After 3 doses, headache stopped instantly; continuing for 7 doses, other symptoms did not recur. Continuing for 30 doses, observed off medication for half a year, recovery achieved.
Another physician asked: Why did previous formulas fail? The response: Phlegm-Fluids were not transformed, yet Yin-natured sticky herbs were used. Xu Lingtai, a great Qing Dynasty physician, praised the Bitter-Spicy Descending and Unblocking method as the major principle for treating sticky Phlegm-Fluids when evaluating Zhang Zhongjing's and Ye Tianshi's formulas. Previous medications violated this principle. Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) contains Ling-Gui agents to transform fluids, Huangqin (Scutellaria Root) entering Lung for upper bitterness, Da Huang (Rhubarb Root) entering Large Intestine for lower bitterness, Shengjiang (Fresh Ginger) for spicy dispersion, Guizhi (Cinnamon Twig) for spicy unblocking, and Chaihu (Bupleurum Root) regulating Liver/Gallbladder. Thus, stagnant Phlegm-Fluids are eliminated in one stroke, rapidly resolving headache. Further question: I also used Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) but failed. Why? The response: Same principles and formula, yet ineffective, likely due to differences in herb proportions. You said other herbs and dosages were identical, only Da Huang (Rhubarb Root) differed. The response: You used Da Huang (Rhubarb Root) 10g; I used Shu Jun (Prepared Rheum Root) 4g. Da Huang (Rhubarb Root) 10g focuses on purging downward; Shu Jun (Prepared Rheum Root) 4g uses only its bitter descending action, avoiding purging. This allows sufficient spicy unblocking and insufficient bitter descending, facilitating Phlegm-Fluid transformation. Using Da Huang (Rhubarb Root) 10g results in excessive bitter descending and insufficient spicy unblocking, clearing郁 Fire but failing to transform fluids. This aligns with Zhang Zhongjing's intent in Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell).
4. Deficiency and Excess coexist, Cold and Heat coexist; failing to examine pulse and observe transformation leads to treatment failure.
Zheng XX, Male, 48 years old.
Headache and toothache for over 8 years. Diagnosed as Vascular Headache and Trigeminal Neuralgia. Initial Western medicine treatment for several years had little effect. Subsequent Chinese herbs including Longdan Xiegan Tang (Gentian Liver-Draining Decoction), Chuanxiong Chatiao San (Ligusticum Tea-Promoting Powder), Guipi Tang (Restore the Spleen Decoction), Buxin Wan (Nourish Heart Pills), and acupuncture for several years also yielded no minor effect. Examination revealed pain in head, orbits, cheeks, gums; pain varying between dull and lightning-like severe; blurred vision, dizziness, tinnitus, irritability, palpitations, poor appetite, bitter taste, dry throat, white tongue coating, cold toes/fingers, yet hot palms, and deep-wiry-choppy pulse. Comprehensive diagnosis: Liver Qi stagnation and knotting, internal Cold-Fluid retention, stagnation transforming into Fire, Upper Heat Lower Cold syndrome. Treatment: Soothe Liver and regulate Qi, warm Yang and transform fluids, clear Upper and warm Lower. Prescription: Chaihu (Bupleurum Root) 10g, Banxia (Pinellia Tuber) 10g, Huangqin (Scutellaria Root) 10g, Gancao (Licorice Root) 6g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube Fruit) 5 pieces, Guizhi (Cinnamon Twig) 15g, Jiu Jun (Wine-processed Rheum Root) 3g, Longgu (Fossilized Bone) 15g, Muli (Oyster Shell) 15g.
After 4 doses, headache, toothache, dizziness, and tinnitus decreased. Continuing for 4 doses, symptoms not only failed to decrease but worsened. Re-examination revealed deficient-wiry-slippery pulse. Reflection indicated: Deficient pulse indicates Qi and Yin deficiency; slippery pulse indicates Phlegm-Heat. Combined with symptoms, it is Qi and Yin dual deficiency with internal Phlegm-Heat stagnation. Treatment plan: Tonify Qi and nourish Yin, regulate Qi and resolve Phlegm. Prescription: Huangqi (Astragalus Root) 15g, Danggui (Angelica Sinensis Root) 10g, Maidong (Ophiopogon Tuber) 10g, Dangshen (Codonopsis Root) 10g, Wuweizi (Schisandra Berry) 10g, Zhuru (Bamboo Shavings) 10g, Zhishi (Immature Bitter Orange) 10g, Banxia (Pinellia Tuber) 10g, Chenpi (Citrus Reticulata Peel) 10g, Fuling (Poria) 10g, Gancao (Licorice Root) 6g, Changpu (Acorus Rhizome) 10g, Yuanzhi (Polygala Root) 10g, Chuanxiong (Ligusticum Rhizome) 10g, Zhimu (Anemarrhena Rhizome) 10g.
After 6 doses, headache disappeared, other symptoms reduced. Continuing for 40 doses, all symptoms vanished, recovery achieved.
Another physician asked: I often find initial medication effective, but subsequent doses useless. Why? The response: This is common in difficult and complex diseases, mainly because these diseases often present with both deficiency and excess, and cold and heat. How to treat? First, pay attention to sequence; second, follow the syndrome. How to pay attention? Base it on the pulse.
5. Cold and Heat must be distinguished, meridians must be clarified, root and branch must be clear.
Xu XX, Female, 62 years old.