发作性四肢瘫痪，疲乏无力。医诊周期性麻痹。发病开始，只要休息一天即可缓解，后来，每次发病非用氯化钾不能缓解，但最近一年虽用氯化钾也不象从前那样很快缓解，为此又加用中药补肾强筋壮骨之剂配合治疗，至今无明显效果。近一月来，症状一直不见改善，为此不得不每天输钾以减轻症状。细询其证，除四肢瘫痪，疲乏无力外，并见烦渴多饮，自汗盗汗，心烦心悸，舌苔薄白，脉弦大而数。综合脉证，思之：舌苔薄白，脉弦大而数者，气血俱虚也；弦数者，湿热郁结，清升浊降失职也；口渴喜饮，汗多者，里热而津伤复耗于气也。治宜补气养阴，燥湿清热，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10克，苍术10克，白术10克，升麻10克，泽泻10克。
服药4剂，精神倍增，口渴喜饮，汗出乏力消失，四肢活动正常。其后又间断服药3个月，追访7年，未见复发。
3．谨察其脉，随证施治，前后分明，毫不混淆，终获奇效。
文××，男，30岁。
体育运动后即全身软弱，瘫痪7—8年。医诊正常血钾性周期性麻痹。发病开始，先感突然全身特别软弱，迅即四肢全瘫而不能活动，至6个小时后逐渐恢复，1天之后即恢复正常。为此先后应用中、西药治疗5～6年，但至今不见一点进展。特别是最近1年多以来，常常稍劳即突然发病。细审其证，除四肢瘫痪，疲乏无力，不能稍许活动外，并见其心烦失眠，或失眠与嗜眠交替出现，气短口干，舌苔白，脉沉弦稍滑。综合脉证，思之：脉沉者，郁证也；沉弦者，肝气郁滞也；滑者，痰火也。合之于症，乃肝郁气结，痰热不化也。治拟疏肝理气，化痰泻火。处方：柴胡10克，枳壳10克，半夏10克，瓜萎15克，青皮10克，郁金10克，黄芩10克，甘草6克。
服药6剂，精神好转，四肢活动较前有力，继服15剂后，不但诸证不减，反见发作次数又有增加。舌苔薄白，脉濡缓。综合脉证，思之：脉濡缓者，气阴两虚，痰气郁结也。治宜补气养阴，理气化痰。处方：黄芪15克，当归6克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，菖蒲10克，远志10克，生地10克。
服药14剂，诸证大减，且在服第8剂后作过一次较重的体力劳动，仅曾出现一时性的疲乏无力；在服至30剂时，虽因过劳出现了一次全身瘫痪，但时间也很短；7天之后，又连续瘫痪4天，服用上方则无明显改善。细审其脉濡而稍数。思之：痰热之邪较甚也，不宜再加补益。处方：白蔻仁10克，藿香10克，茵陈15克，滑石10克，木通10克，菖蒲10克，黄芩10克，连翘10克，川贝母10克，射干10克，薄荷l克。
服药10剂，诸证消失。后追访10年，未见复发。
肌强直综合征
谨察色脉，随证治之，实为上策
韩××，男，45岁。
眼、颊、颈、臂、咽喉肌肉僵硬，活动困难1年多。医诊肌强直综合征。先用西药治疗半年效不明显，继用中药养血柔肝、熄风解痉之剂配合亦无效验。细审其证，两眼球、眼睑经常痉挛发僵不能随意活动，两颊、咽喉肌肉发紧不能随意张口、说话、吞咽，并感到阵阵呼吸困难，颈项发紧发硬不能随意扭转头部，两臂发僵发紧不能随意活动上肢，头晕失眠，烦躁易怒，舌苔白，脉弦紧而数。综合脉证，思之：弦脉者，肝脉也；紧脉者，寒脉也；数脉者，热脉也。然弦紧数相兼者，为寒、饮、气胶结不化，郁而化风。故拟疏肝化饮，平肝理筋。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，熟军3克，龙骨15克，牡蛎15克。
服药4剂，面颊肌肉紧僵好转，呼吸、吞咽困难稍有改善。继服2剂，诸证非但不减，且感有所加重。细审其脉舌，苔薄白，脉濡缓。综合脉色思之：脉濡缓者，气阴两虚，痰郁气结也。治拟补气养阴，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬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10克，菖蒲10克，远志10克，生地10克。
服药4剂，呼吸、吞咽、说话均较前畅利。继服2剂，上证不再改善，且面颊、颈项肌肉发僵发紧的感觉又恢复至未用中药以前。细审其脉弦紧而涩。思之：弦紧之脉者，肝郁气结，寒饮内郁之脉也；涩脉者，寒湿结滞也。治宜疏肝化饮，温经平肝。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草10克，生姜3片，大枣5个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克，白术10克。
服药8剂，面颊、咽喉、颈项、两眼周围发紧发僵的情况明显改善，有时1～2个小时不紧不僵不抽。又服2剂，诸证不但不减，且又有所加重。细审脉舌，苔白，脉濡缓。思之：脉濡缓者，气阴两虚，痰郁气结也。治拟补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草6克，远志10克，菖蒲10克，生地10克。
其后但见脉濡缓即予补气养阴，理气化痰；但见弦紧即予疏肝化饮，平肝理筋。前后共服药近4个月，达100余剂，愈。
僵人征群
1．谨察其脉，验之与证，随证治之，终获缓解
郝××，男，45岁。
全身肌肉僵直、痛性痉挛1年多。医诊僵人征群。先用西药治疗不效，继又以中药活血通络、熄风解痉之剂与针灸相配合亦无功。细询其证，两眼肌肉痉挛抽搐不能随意睁眼，两颊、咽喉肌肉发紧发僵不能随意张口、咀嚼、吞咽、说话，并且感到一阵阵的气短而呼吸困难，颈项发紧发硬不能随意扭转头项，两臂发僵发紧不能随意运动，舌苔薄白，心烦失眠，脉弦紧而数。综合脉证，思之：弦脉者、肝脉也；紧脉者，寒脉也；弦紧相兼者，寒饮凝结，郁于肝胆之经也；弦紧数脉并见者，寒痰凝结，郁于胆肝，久郁化风也。治拟疏肝化饮，平肝理筋。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，熟军3克，龙骨15克，牡蛎15克。
服药6剂，眼、面颊肌肉僵紧好转，呼吸困难，吞咽困难稍有改善。继服6剂，诸证非但不减，亦且有较上次就诊时加重的感觉。再审其脉，两脉由弦紧而数转为濡缓，舌苔白。因思脉濡缓者，气阴两虚，痰郁气结也。治宜补气养阴，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬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10克，菖蒲10克，远志10克，生地10’克。
服药4剂，呼吸困难、吞咽困难、发音困难均好转，但继服2剂后，非但呼吸困难、吞咽困难、发音困难不再继续好转，而且眼、颊颈部肌肉发僵发紧的感觉有些加重。再审其脉弦紧而涩。因思涩脉者滞也。因拟疏肝化饮，温经平肝。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10、克，生姜10克，大枣5个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克，白术10克。
服药8剂，眼、面颊、颈项、咽喉、腹部发紧发僵的情况明显好转，有时2—3个小时几乎与常人无有不同。再服2剂，诸证非但不减，且有轻度反复之状。察其脉转濡缓，舌苔白，再予补气养阴，理气化痰治之。处方：黄芪15克，当归6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10克，菖蒲10克，远志10克，生地10克。
其后，但见脉濡缓，即予补气养阴，理气化痰方；但见弦紧，即予疏肝化饮，平肝理筋方，如此治疗3个多月，服药87剂，诸证消失，愈。
2．难证审脉，辨脉论治，随脉用方，不可拘泥
贺××，男，60岁。肌肉僵直、痉挛抽搐2年多。医诊僵人征群。先用西药治疗7个多月不效，后又配合针灸、按摩、中药活血通络、熄风解痉等治疗亦不见改善。细审其证，头、脸、颈项发僵发紧，呼吸、发音、吞咽、睁眼、张嘴均感困难，头项不能随意活动，两臂、两手发僵发抽，时时全身抽痛，头脑烦乱不安，失眠健忘，两耳鸣响，听力下降，舌苔白，脉弦紧数。综合脉证，思之：脉弦紧而数者，肝郁气结，寒饮内郁，郁而化风也。治宜疏肝解郁，化痰熄风。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜3片，大枣7个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克。
服药10剂，诸证不见进退。再审其脉虚大弦紧。综合脉证，思之：脉虚大弦紧者，气阴两虚，湿热不化，清升浊降失职耳。治拟益气养阴，燥湿清热，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。
服药10剂，除精神稍有好转外，他证均无改变。察其脉弦滑而数，舌苔白。思之：脉滑数者，痰火也；弦数者，肝火也。综而论之，乃痰火郁结在肝胆也。治宜疏肝解郁，化痰泻火。处方：柴胡10克，半夏10克，竹茹10克，枳实10克，滑石15克，竹叶10克，龙胆草10克，黄芩10克，夜交藤30克。
服药6剂，诸证大减，继服20剂，诸证尽失，愈。
某医云：既然前用诸方无效，何不径直用柴芩温胆汤治之?答曰：柴芩温胆汤者，疏肝解郁，化痰泻火之方也，只可用于证见脉弦滑而数之证，不可用于他证也，故不能径直应用柴芩温胆汤进行治疗，此其原因之一也。本病之始见脉弦紧而数，弦紧而数之脉乃肝郁气结、寒饮内郁之脉，寒者当温热，今虽用柴胡加龙骨牡蛎汤而证未见减，而脉却转为虚大弦紧，说明寒饮已微除也，不除邪焉能扶正，此其原因之二也。本病应用柴胡加龙骨牡蛎汤后，邪微除，而正见大虚，故以扶正为主以治之，致正稍复而后始能驱邪，此其原因之三也。
原发性直立性低血压
1．察脉沉弦细涩，知其为肝郁气结，寒饮阻滞，予疏肝理气，温阳化饮而愈
李××，男，45岁。
头晕，阵发性晕厥1年多。医诊原发性直立性低血压。先以西药治之不效，后又配合中药补中益气汤治之，不但血压不见上升，反而头晕更加严重。特别是最近半年多以来，经常感到头重脚轻，疲乏无力，有时一站立即突然面色苍白，汗出恶心，继而突然晕厥，血压下降至68／45mmHg。尤其是最近一周以来，头晕乏力特别严重，并曾在站立的一瞬间晕厥过2次。细审其证，除眩晕，疲乏无力之外，并见心悸心烦，时或逆气上冲，纳呆食减，胸胁苦满，口苦咽干。舌苔薄白，脉沉弦细涩。综合脉证，思之：脉沉者，气郁也；弦脉者，肝脉也；细涩者，阳气不足，寒饮内停也。合之于症，知其乃肝郁气结，寒饮内停，郁而化热，上热下寒之证也。治拟疏肝理气，温阳化饮，清上温下。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜3片，大枣5个，桂枝10克，茯苓15克。
服药3剂，头晕，心烦心悸，胸胁苦满等证均减，且6日内未见晕厥现象发生，继服20剂，诸证消失，站立时血压不见降低，愈。
某医云：诸家之报道和部分中医教材均云：低血压用补中益气汤进行治疗，何本病用之非但不效，而反剧也?诸家未见其有用疏肝理气治低血压病，而用之反倒显效者又何也?答日：作为一个科学工作者，最重要的莫过于实事求是，最重要的莫过于紧紧抓住实践是检验真理的原则不放。作为中医、西医两条理论体系怎么结合?我认为我们考虑问题时也应按照以上两条原则去考虑。对于应用中医理论容易说明，而在实践中又有卓越疗效，但用西医理论不能解释的，我们只能在发展中去认识，去发现其未发现的机制。对于应用西医理论容易解释，而在实践中却无效果，但用中医理论不能够解释的，也应在科学研究中逐步发现其真正的科学原理。我认为在科学的研究中，切切需要忌讳的一条是单纯的凭想象和推理去处理问题。本病患者，从诸医书的病例来看，都说是脉沉弦细涩。沉脉诸代脉书均云为气郁之脉，这也是每个医生都承认的。可是治疗用方时偏偏还用补中益气汤，郁证用补，岂能不郁，因此血压不但不见上升，而反下降。
2．肝郁血虚，郁而化火，治宜疏肝，养血泻火
黎××，男，50岁。
发作性四肢瘫痪，疲乏无力。医生诊断为周期性麻痹（Periodic Paralysis）。发病初期，只要休息一天即可缓解；后来，每次发病非使用氯化钾不能缓解；但最近一年，虽然使用了氯化钾，也不像从前那样很快缓解，因此又加用中药补肾强筋壮骨之剂配合治疗，至今无明显效果。近一个月来，症状一直未见改善，为此不得不每天输注钾以减轻症状。详细询问病情，除四肢瘫痪、疲乏无力外，并见烦渴多饮，自汗盗汗，心烦心悸，舌苔薄白，脉弦大而数。综合脉象与证候，思考如下：舌苔薄白，脉弦大而数，是气血俱虚的表现；脉弦数，是湿热郁结，清阳不升、浊阴不降功能失职的表现；口渴喜饮，汗多，是里热而津液受伤，且因气耗散而进一步消耗的表现。治疗宜补气养阴，燥湿清热，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10克，苍术10克，白术10克，升麻10克，泽泻10克。
服药4剂后，精神倍增，口渴喜饮、出汗乏力消失，四肢活动恢复正常。其后又间断服药3个月，随访7年，未见复发。
3．谨慎诊察脉象，随证施治，前后辨证分明，毫不混淆，最终获得奇效。
文××，男，30岁。
体育运动后即全身软弱，瘫痪7—8年。医生诊断为正常血钾性周期性麻痹（Normokalemic Periodic Paralysis）。发病开始，先感觉突然全身特别软弱，迅即四肢全瘫而不能活动，至6个小时后逐渐恢复，1天之后即恢复正常。为此先后应用中、西药治疗5～6年，但至今不见一点进展。特别是最近1年多以来，常常稍劳即突然发病。仔细审查其证候，除四肢瘫痪、疲乏无力、不能稍许活动外，并见其心烦失眠，或失眠与嗜眠交替出现，气短口干，舌苔白，脉沉弦稍滑。综合脉象与证候，思考如下：脉沉，是郁证的表现；脉沉弦，是肝气郁滞的表现；脉滑，是痰火的表现。结合症状，乃是肝郁气结，痰热不化的表现。治疗拟疏肝理气，化痰泻火。处方：柴胡10克，枳壳10克，半夏10克，瓜萎15克，青皮10克，郁金10克，黄芩10克，甘草6克。
服药6剂后，精神好转，四肢活动较前有力，继服15剂后，不但诸证不减，反见发作次数又有增加。舌苔薄白，脉濡缓。综合脉象与证候，思考如下：脉濡缓，是气阴两虚，痰气郁结的表现。治疗宜补气养阴，理气化痰。处方：黄芪15克，当归6克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，菖蒲10克，远志10克，生地10克。
服药14剂后，诸证大减，且在服第8剂后作过一次较重的体力劳动，仅曾出现一时性的疲乏无力；在服至30剂时，虽因过劳出现了一次全身瘫痪，但时间也很短；7天之后，又连续瘫痪4天，服用上方则无明显改善。仔细审查其脉象濡而稍数。思考如下：痰热之邪较甚也，不宜再加补益。处方：白蔻仁10克，藿香10克，茵陈15克，滑石10克，木通10克，菖蒲10克，黄芩10克，连翘10克，川贝母10克，射干10克，薄荷l克。
肌强直综合征（Myotonia）
谨慎诊察面色与脉象，随证治疗，实为上策。
韩××，男，45岁。
眼、颊、颈、臂、咽喉肌肉僵硬，活动困难1年多。医生诊断为肌强直综合征。先用西药治疗半年效不明显，继用中药养血柔肝、熄风解痉之剂配合亦无效验。仔细审查其证候，两眼球、眼睑经常痉挛发僵不能随意活动，两颊、咽喉肌肉发紧不能随意张口、说话、吞咽，并感到阵阵呼吸困难，颈项发紧发硬不能随意扭转头部，两臂发僵发紧不能随意活动上肢，头晕失眠，烦躁易怒，舌苔白，脉弦紧而数。综合脉象与证候，思考如下：弦脉者，是肝脉；紧脉者，是寒脉；数脉者，是热脉。然而弦紧数相兼者，为寒、饮、气胶结不化，郁而化风。故拟疏肝化饮，平肝理筋。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，熟军3克，龙骨15克，牡蛎15克。
服药4剂后，面颊肌肉紧僵好转，呼吸、吞咽困难稍有改善。继服2剂后，诸证非但不减，且感有所加重。仔细审查其脉舌，苔薄白，脉濡缓。综合面色与脉象思考如下：脉濡缓者，是气阴两虚，痰郁气结的表现。治疗拟补气养阴，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬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10克，菖蒲10克，远志10克，生地10克。
服药4剂后，呼吸、吞咽、说话均较前畅利。继服2剂后，上证不再改善，且面颊、颈项肌肉发僵发紧的感觉又恢复至未用中药以前。仔细审查其脉弦紧而涩。思考如下：弦紧之脉者，是肝郁气结，寒饮内郁的脉象；涩脉者，是寒湿结滞的表现。治疗宜疏肝化饮，温经平肝。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草10克，生姜3片，大枣5个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克，白术10克。
服药8剂后，面颊、咽喉、颈项、两眼周围发紧发僵的情况明显改善，有时1～2个小时不紧不僵不抽。又服2剂后，诸证不但不减，且又有所加重。仔细审查脉舌，苔白，脉濡缓。思考如下：脉濡缓者，是气阴两虚，痰郁气结的表现。治疗拟补气养阴，理气化痰。处方：黄芪15克，当归6克，人参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草6克，远志10克，菖蒲10克，生地10克。
其后但见脉濡缓即予补气养阴，理气化痰方；但见弦紧即予疏肝化饮，平肝理筋方。前后共服药近4个月，达100余剂，痊愈。
僵人征群（Stiff-person Syndrome）
1．谨慎诊察脉象，验证与证候相符，随证治疗，最终获得缓解。
郝××，男，45岁。
全身肌肉僵直、痛性痉挛1年多。医生诊断为僵人征群。先用西药治疗不效，继又以中药活血通络、熄风解痉之剂与针灸相配合亦无功。仔细询问其证候，两眼肌肉痉挛抽搐不能随意睁眼，两颊、咽喉肌肉发紧发僵不能随意张口、咀嚼、吞咽、说话，并且感到一阵阵的气短而呼吸困难，颈项发紧发硬不能随意扭转头项，两臂发僵发紧不能随意运动，舌苔薄白，心烦失眠，脉弦紧而数。综合脉象与证候，思考如下：弦脉者，是肝脉；紧脉者，是寒脉；弦紧相兼者，是寒饮凝结，郁于肝胆之经的表现；弦紧数脉并见者，是寒痰凝结，郁于胆肝，久郁化风的表现。治疗拟疏肝化饮，平肝理筋。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，熟军3克，龙骨15克，牡蛎15克。
服药6剂后，眼、面颊肌肉僵紧好转，呼吸困难，吞咽困难稍有改善。继服6剂后，诸证非但不减，亦且有较上次就诊时加重的感觉。再审其脉，两脉由弦紧而数转为濡缓，舌苔白。因思脉濡缓者，是气阴两虚，痰郁气结的表现。治疗宜补气养阴，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬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10克，菖蒲10克，远志10克，生地10’克。
服药4剂后，呼吸困难、吞咽困难、发音困难均好转，但继服2剂后，非但呼吸困难、吞咽困难、发音困难不再继续好转，而且眼、颊颈部肌肉发僵发紧的感觉有些加重。再审其脉弦紧而涩。因思涩脉者滞也。因拟疏肝化饮，温经平肝。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10、克，生姜10克，大枣5个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克，白术10克。
服药8剂后，眼、面颊、颈项、咽喉、腹部发紧发僵的情况明显好转，有时2—3个小时几乎与常人无有不同。再服2剂后，诸证非但不减，且有轻度反复之状。察其脉转濡缓，舌苔白，再予补气养阴，理气化痰治之。处方：黄芪15克，当归6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10克，菖蒲10克，远志10克，生地10克。
其后，但见脉濡缓，即予补气养阴，理气化痰方；但见弦紧，即予疏肝化饮，平肝理筋方，如此治疗3个多月，服药87剂，诸证消失，痊愈。
贺××，男，60岁。肌肉僵直、痉挛抽搐2年多。医生诊断为僵人征群。先用西药治疗7个多月不效，后又配合针灸、按摩、中药活血通络、熄风解痉等治疗亦不见改善。仔细审查其证候，头、脸、颈项发僵发紧，呼吸、发音、吞咽、睁眼、张嘴均感困难，头项不能随意活动，两臂、两手发僵发抽，时时全身抽痛，头脑烦乱不安，失眠健忘，两耳鸣响，听力下降，舌苔白，脉弦紧数。综合脉象与证候，思考如下：脉弦紧而数者，是肝郁气结，寒饮内郁，郁而化风的表现。治疗宜疏肝解郁，化痰熄风。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜3片，大枣7个，桂枝10克，茯苓15克，熟军3克，龙骨15克，牡蛎15克。
服药10剂后，诸证不见进退。再审其脉虚大弦紧。综合脉象与证候，思考如下：脉虚大弦紧者，是气阴两虚，湿热不化，清升浊降功能失职的表现。治疗拟益气养阴，燥湿清热，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。
服药10剂后，除精神稍有好转外，他证均无改变。察其脉弦滑而数，舌苔白。思考如下：脉滑数者，是痰火；脉弦数者，是肝火。综合而论之，乃痰火郁结在肝胆也。治疗宜疏肝解郁，化痰泻火。处方：柴胡10克，半夏10克，竹茹10克，枳实10克，滑石15克，竹叶10克，龙胆草10克，黄芩10克，夜交藤30克。
某医生说：既然前用诸方无效，何不径直用柴芩温胆汤（Chaiqin Wendan Decoction）治之？回答说：柴芩温胆汤，是疏肝解郁，化痰泻火的方剂，只可用于证见脉弦滑而数的证候，不可用于其他证候，故不能径直应用柴芩温胆汤进行治疗，此其原因之一也。本病之初见脉弦紧而数，弦紧而数之脉乃肝郁气结、寒饮内郁的脉象，寒者当温热，今虽用柴胡加龙骨牡蛎汤（Chaihu Jia Longgu Muli Tang）而证未见减，而脉却转为虚大弦紧，说明寒饮已微除也，不除邪焉能扶正，此其原因之二也。本病应用柴胡加龙骨牡蛎汤后，邪微除，而正见大虚，故以扶正为主以治之，致正稍复而后始能驱邪，此其原因之三也。
原发性直立性低血压（Primary Orthostatic Hypotension）
1．察脉沉弦细涩，知其为肝郁气结，寒饮阻滞，予疏肝理气，温阳化饮而愈。
李××，男，45岁。
头晕，阵发性晕厥1年多。医生诊断为原发性直立性低血压。先以西药治之不效，后又配合中药补中益气汤（Buzhong Yiqi Tang）治之，不但血压不见上升，反而头晕更加严重。特别是最近半年多以来，经常感到头重脚轻，疲乏无力，有时一站立即突然面色苍白，汗出恶心，继而突然晕厥，血压下降至68／45mmHg。尤其是最近一周以来，头晕乏力特别严重，并曾在站立的一瞬间晕厥过2次。仔细审查其证候，除眩晕，疲乏无力之外，并见心悸心烦，时或逆气上冲，纳呆食减，胸胁苦满，口苦咽干。舌苔薄白，脉沉弦细涩。综合脉象与证候，思考如下：脉沉者，是气郁；脉弦者，是肝脉；细涩者，是阳气不足，寒饮内停的表现。结合症状，知其乃肝郁气结，寒饮内停，郁而化热，上热下寒的证候。治疗拟疏肝理气，温阳化饮，清上温下。处方：柴胡10克，半夏10克，黄芩10克，人参10克，甘草10克，生姜3片，大枣5个，桂枝10克，茯苓15克。
服药3剂后，头晕，心烦心悸，胸胁苦满等证均减，且6日内未见晕厥现象发生，继服20剂后，诸证消失，站立时血压不见降低，痊愈。
某医生说：诸家之报道和部分中医教材均云：低血压用补中益气汤进行治疗，何本病用之非但不效，而反剧也？诸家未见其有用疏肝理气治低血压病，而用之反倒显效者又何也？回答说：作为一个科学工作者，最重要的莫过于实事求是，最重要的莫过于紧紧抓住实践是检验真理的原则不放。作为中医、西医两条理论体系怎么结合？我认为我们考虑问题时也应按照以上两条原则去考虑。对于应用中医理论容易说明，而在实践中又有卓越疗效，但用西医理论不能解释的，我们只能在发展中去认识，去发现其未发现的机制。对于应用西医理论容易解释，而在实践中却无效果，但用中医理论不能够解释的，也应在科学研究中逐步发现其真正的科学原理。我认为在科学的研究中，切切需要忌讳的一条是单纯的凭想象和推理去处理问题。本病患者，从诸医书的病例来看，都说是脉沉弦细涩。沉脉诸代脉书均云为气郁之脉，这也是每个医生都承认的。可是治疗用方时偏偏还用补中益气汤，郁证用补，岂能不郁，因此血压不但不见上升，而反下降。
黎××，男，50岁。
Paroxysmal quadriplegia and fatigue. The physician diagnosed periodic paralysis. At the onset of the illness, resting for one day was sufficient to relieve symptoms; later, each episode required potassium chloride for relief; however, in the past year, although potassium chloride was used, it did not relieve symptoms as quickly as before. Therefore, traditional Chinese medicine (TCM) formulas for tonifying the kidney, strengthening tendons, and fortifying bones were added to the treatment, but with no significant effect so far. For the past month, symptoms have not improved, necessitating daily intravenous potassium infusion to alleviate symptoms. Detailed inquiry revealed that, besides quadriplegia and fatigue, the patient also exhibited irritability with excessive thirst and drinking, spontaneous sweating and night sweats, mental restlessness and palpitations, a thin white tongue coating, and a wiry, large, and rapid pulse. Synthesizing the pulse and symptoms: a thin white tongue coating and a wiry, large, rapid pulse indicate deficiency of both qi and blood; a wiry and rapid pulse indicates stagnation of damp-heat and dysfunction in the ascending of clear yang and descending of turbid yin; excessive thirst, preference for drinking, and profuse sweating indicate internal heat damaging body fluids, further consumed by qi exhaustion. The treatment principle should be to tonify qi and nourish yin, dry dampness and clear heat, and ascend the clear while descending the turbid. Prescription: Renshen 10g, Gancao 6g, Huangqi 15g, Danggui 6g, Maidong 10g, Wuweizi 10g, Qingpi 10g, Chenpi 10g, Shenqu 10g, Huangbai 10g, Gegen 10g, Cangzhu 10g, Baizhu 10g, Shengma 10g, Zexie 10g.
After taking 4 doses, spirit significantly improved, thirst, sweating, and fatigue disappeared, and limb movement returned to normal. Subsequently, intermittent medication continued for 3 months. Follow-up over 7 years showed no recurrence.
3. Carefully observe the pulse, treat according to the syndrome, maintain clear differentiation between stages without confusion, ultimately achieving remarkable efficacy.
Wen XX, Male, 30 years old.
Generalized weakness and paralysis following sports activities for 7–8 years. Diagnosed with normokalemic periodic paralysis. Initially, the patient felt sudden extreme generalized weakness, rapidly progressing to complete quadriplegia unable to move, gradually recovering after 6 hours, and returning to normal within 1 day. Treated with Chinese and Western medicines for 5–6 years with no progress. Especially in the past year, slight exertion often triggered sudden attacks. Careful examination revealed, besides quadriplegia, fatigue, and inability to move slightly, mental restlessness, insomnia, alternating insomnia and hypersomnia, shortness of breath, dry mouth, a white tongue coating, and a deep, wiry, slightly slippery pulse. Synthesizing pulse and symptoms: a deep pulse indicates stagnation; a deep-wiry pulse indicates liver qi stagnation; a slippery pulse indicates phlegm-fire. Combined with symptoms, this is liver qi stagnation and unresolved phlegm-heat. Treatment plan: soothe the liver and regulate qi, transform phlegm and purge fire. Prescription: Chaihu 10g, Zhike 10g, Banxia 10g, Gualou 15g, Qingpi 10g, Yujin 10g, Huangqin 10g, Gancao 6g.
After 6 doses, spirit improved, limb movement became stronger than before. After continuing for 15 doses, symptoms did not decrease; instead, attack frequency increased. Tongue coating was thin white, pulse was soggy and slow. Synthesizing pulse and symptoms: a soggy and slow pulse indicates dual deficiency of qi and yin, and stagnation of phlegm and qi. Treatment: tonify qi and nourish yin, regulate qi and transform phlegm. Prescription: Huangqi 15g, Danggui 6g, Zhuru 10g, Zhishi 10g, Banxia 10g, Chenpi 10g, Fuling 10g, Gancao 6g, Shichangpu 10g, Yuanzhi 10g, Shengdi 10g.
After 14 doses, symptoms greatly reduced. After the 8th dose, despite heavy physical labor, only transient fatigue occurred. At the 30th dose, general paralysis occurred due to overwork, but lasted briefly. Seven days later, paralysis persisted for 4 consecutive days, with no obvious improvement from the previous prescription. Careful examination of the pulse revealed it to be soggy and slightly rapid. Thought: pathogenic phlegm-heat is severe; tonification should not be added. Prescription: Baixiangren 10g, Huoxiang 10g, Yinchen 15g, Huashi 10g, Mutong 10g, Shichangpu 10g, Huangqin 10g, Lianqiao 10g, Chuanbeimu 10g, Shegan 10g, Bohe 1g.
After 10 doses, all symptoms disappeared. Follow-up over 10 years showed no recurrence.
Myotonia
Carefully observing complexion and pulse, treating according to the syndrome, is truly the best strategy.
Han XX, Male, 45 years old.
Stiffness and difficulty moving muscles of the eyes, cheeks, neck, arms, and throat for over 1 year. Diagnosed with myotonia. Western medicine treatment for half a year showed little effect; subsequent combination with TCM formulas for nourishing blood and softening the liver, extinguishing wind and relieving spasms, also yielded no results. Careful examination revealed frequent spasms and stiffness of both eyeballs and eyelids preventing voluntary movement; tightness of cheek and throat muscles preventing voluntary opening of mouth, speaking, and swallowing, accompanied by paroxysmal dyspnea; stiffness and hardness of the neck preventing voluntary head turning; stiffness and tightness of arms preventing voluntary upper limb movement; dizziness, insomnia, irritability, a white tongue coating, and a wiry, tight, and rapid pulse. Synthesizing pulse and symptoms: a wiry pulse corresponds to the liver; a tight pulse corresponds to cold; a rapid pulse corresponds to heat. However, the combination of wiry, tight, and rapid pulses indicates coagulation of cold, fluid retention, and qi stagnation transforming into wind. Plan: soothe the liver and resolve fluid retention, calm the liver and regulate tendons. Prescription: Chaihu 10g, Banxia 10g, Dangshen 10g, Huangqin 10g, Gancao 6g, Shengjiang 3 slices, Dazao 5 pieces, Guizhi 10g, Fuling 15g, Shujun 3g, Longgu 15g, Muli 15g.
After 4 doses, cheek muscle stiffness improved, and breathing/swallowing difficulties slightly alleviated. After continuing for 2 doses, symptoms not only failed to improve but worsened. Careful examination of pulse and tongue revealed a thin white coating and a soggy, slow pulse. Synthesizing complexion and pulse: a soggy, slow pulse indicates dual deficiency of qi and yin, and stagnation of phlegm and qi. Plan: tonify qi and nourish yin, regulate qi and transform phlegm. Prescription: Huangqi 15g, Danggui 6g, Dangshen 10g, Maidong 10g, Wuweizi 10g, Zhuru 10g, Zhishi 10g, Banxia 10g, Chenpi 10g, Fuling 10g, Gancao 10g, Shichangpu 10g, Yuanzhi 10g, Shengdi 10g.
After 4 doses, breathing, swallowing, and speech became smoother. After continuing for 2 doses, symptoms ceased to improve, and the sensation of stiffness/tightness in cheeks and neck returned to pre-TCM levels. Careful examination revealed a wiry, tight, and choppy pulse. Thought: wiry and tight pulses indicate liver qi stagnation and internal stagnation of cold-fluid; a choppy pulse indicates stagnation of cold-dampness. Treatment: soothe the liver and resolve fluid retention, warm meridians and calm the liver. Prescription: Chaihu 10g, Banxia 10g, Huangqin 10g, Dangshen 10g, Gancao 10g, Shengjiang 3 slices, Dazao 5 pieces, Guizhi 10g, Fuling 15g, Shujun 3g, Longgu 15g, Muli 15g, Baizhu 10g.
After 8 doses, stiffness/tightness around cheeks, throat, neck, and eyes significantly improved, sometimes lasting 1–2 hours without stiffness or spasms. After another 2 doses, symptoms worsened. Careful examination of pulse and tongue revealed a white coating and a soggy, slow pulse. Thought: a soggy, slow pulse indicates dual deficiency of qi and yin, and stagnation of phlegm and qi. Plan: tonify qi and nourish yin, regulate qi and transform phlegm. Prescription: Huangqi 15g, Danggui 6g, Renshen 10g, Maidong 10g, Wuweizi 10g, Zhuru 10g, Zhishi 10g, Banxia 10g, Fuling 10g, Gancao 6g, Yuanzhi 10g, Shichangpu 10g, Shengdi 10g.
Thereafter, whenever a soggy, slow pulse appeared, the formula for tonifying qi and nourishing yin, regulating qi and transforming phlegm was used; whenever a wiry, tight pulse appeared, the formula for soothing the liver, resolving fluid retention, calming the liver, and regulating tendons was used. Total treatment duration nearly 4 months, over 100 doses, resulting in cure.
Stiff-person Syndrome
1. Carefully observe the pulse, verify consistency with symptoms, treat according to the syndrome, ultimately achieving remission.
Hao XX, Male, 45 years old.
Generalized muscle stiffness and painful spasms for over 1 year. Diagnosed with stiff-person syndrome. Western medicine treatment was ineffective; subsequent combination of TCM formulas for activating blood and unblocking collaterals, extinguishing wind and relieving spasms, with acupuncture, also yielded no benefit. Careful inquiry revealed spasms/convulsions of eye muscles preventing voluntary eye opening; tightness/stiffness of cheek and throat muscles preventing voluntary mouth opening, chewing, swallowing, and speaking, accompanied by paroxysmal shortness of breath and dyspnea; stiffness/hardness of the neck preventing voluntary head turning; stiffness/tightness of arms preventing voluntary movement; thin white tongue coating, mental restlessness, insomnia, and a wiry, tight, rapid pulse. Synthesizing pulse and symptoms: a wiry pulse corresponds to the liver; a tight pulse corresponds to cold; the combination of wiry and tight indicates coagulation of cold-fluid stagnating in the liver and gallbladder meridians; the presence of wiry, tight, and rapid pulses indicates coagulation of cold-phlegm stagnating in the gallbladder and liver, long-standing stagnation transforming into wind. Plan: soothe the liver and resolve fluid retention, calm the liver and regulate tendons. Prescription: Chaihu 10g, Banxia 10g, Dangshen 10g, Huangqin 10g, Gancao 6g, Shengjiang 3 slices, Dazao 5 pieces, Guizhi 10g, Fuling 15g, Shujun 3g, Longgu 15g, Muli 15g.
After 6 doses, eye and cheek muscle stiffness improved, and breathing/swallowing difficulties slightly alleviated. After continuing for 6 doses, symptoms not only failed to improve but felt worse than the previous visit. Re-examination of the pulse showed transition from wiry-tight-rapid to soggy-slow, with a white tongue coating. Thought: a soggy, slow pulse indicates dual deficiency of qi and yin, and stagnation of phlegm and qi. Treatment: tonify qi and nourish yin, regulate qi and transform phlegm. Prescription: Huangqi 15g, Danggui 6g, Dangshen 10g, Maidong 10g, Wuweizi 10g, Zhuru 10g, Zhishi 10g, Banxia 10g, Chenpi 10g, Fuling 10g, Gancao 10g, Shichangpu 10g, Yuanzhi 10g, Shengdi 10g.
After 4 doses, breathing, swallowing, and speech difficulties improved. However, after continuing for 2 doses, these difficulties ceased to improve, and the sensation of stiffness/tightness in eyes, cheeks, and neck worsened slightly. Re-examination of the pulse revealed wiry, tight, and choppy characteristics. Thought: a choppy pulse indicates stagnation. Plan: soothe the liver and resolve fluid retention, warm meridians and calm the liver. Prescription: Chaihu 10g, Banxia 10g, Huangqin 10g, Renshen 10g, Gancao 10g, Shengjiang 10g, Dazao 5 pieces, Guizhi 10g, Fuling 15g, Shujun 3g, Longgu 15g, Muli 15g, Baizhu 10g.
After 8 doses, stiffness/tightness in eyes, cheeks, neck, throat, and abdomen significantly improved, sometimes remaining normal for 2–3 hours. After another 2 doses, symptoms not only failed to improve but showed mild relapse. Pulse turned soggy-slow, tongue coating white. Re-administered treatment for tonifying qi and nourishing yin, regulating qi and transforming phlegm. Prescription: Huangqi 15g, Danggui 6g, Maidong 10g, Dangshen 10g, Wuweizi 10g, Zhuru 10g, Zhishi 10g, Banxia 10g, Chenpi 10g, Fuling 10g, Gancao 10g, Shichangpu 10g, Yuanzhi 10g, Shengdi 10g.
Thereafter, whenever a soggy-slow pulse appeared, the formula for tonifying qi and nourishing yin, regulating qi and transforming phlegm was used; whenever a wiry-tight pulse appeared, the formula for soothing the liver, resolving fluid retention, calming the liver, and regulating tendons was used. Treatment continued for over 3 months, 87 doses, resulting in disappearance of all symptoms and cure.
2. Difficult cases require pulse analysis, treatment based on pulse differentiation, using formulas according to the pulse, avoiding rigid adherence.
He XX, Male, 60 years old. Muscle stiffness, spasm, and convulsions for over 2 years. Diagnosed with stiff-person syndrome. Western medicine treatment for over 7 months was ineffective; subsequent combination of acupuncture, massage, and TCM formulas for activating blood, unblocking collaterals, extinguishing wind, and relieving spasms also showed no improvement. Careful examination revealed stiffness/tightness of head, face, and neck; difficulty in breathing, speaking, swallowing, opening eyes, and opening mouth; inability to voluntarily move head and neck; stiffness/convulsions of arms and hands; frequent whole-body pulling pain; mental agitation, insomnia, poor memory, bilateral tinnitus, hearing loss, white tongue coating, and wiry, tight, rapid pulse. Synthesizing pulse and symptoms: a wiry, tight, rapid pulse indicates liver qi stagnation, internal stagnation of cold-fluid, and transformation into wind due to stagnation. Treatment: soothe the liver and relieve depression, transform phlegm and extinguish wind. Prescription: Chaihu 10g, Banxia 10g, Huangqin 10g, Renshen 10g, Gancao 10g, Shengjiang 3 slices, Dazao 7 pieces, Guizhi 10g, Fuling 15g, Shujun 3g, Longgu 15g, Muli 15g.
After 10 doses, symptoms showed no progression. Re-examination of the pulse revealed deficient-large, wiry, and tight characteristics. Synthesizing pulse and symptoms: a deficient-large, wiry, tight pulse indicates dual deficiency of qi and yin, failure to transform damp-heat, and dysfunction in ascending clear and descending turbid. Plan: tonify qi and nourish yin, dry dampness and clear heat, ascend clear and descend turbid. Prescription: Renshen 10g, Gancao 6g, Huangqi 15g, Danggui 6g, Maidong 10g, Wuweizi 10g, Qingpi 10g, Chenpi 10g, Shenqu 10g, Huangbai 10g, Gegen 15g, Cangzhu 10g, Baizhu 10g, Shengma 10g, Zexie 10g.
After 10 doses, except for slight improvement in spirit, other symptoms remained unchanged. Pulse was wiry-slippery and rapid, tongue coating white. Thought: a slippery-rapid pulse indicates phlegm-fire; a wiry-rapid pulse indicates liver fire. Comprehensive analysis indicates phlegm-fire stagnation in the liver and gallbladder. Treatment: soothe the liver and relieve depression, transform phlegm and purge fire. Prescription: Chaihu 10g, Banxia 10g, Zhuru 10g, Zhishi 10g, Huashi 15g, Zhuye 10g, Longdancao 10g, Huangqin 10g, Yejiaoteng 30g.
After 6 doses, symptoms greatly reduced. After continuing for 20 doses, all symptoms disappeared, resulting in cure.
A certain doctor asked: Since previous formulas were ineffective, why not directly use Chaiqin Wendan Decoction? Answer: Chaiqin Wendan Decoction is a formula for soothing the liver, relieving depression, transforming phlegm, and purging fire, applicable only to syndromes presenting with a wiry-slippery-rapid pulse, not to other syndromes; thus, direct application is inappropriate. This is reason one. The initial presentation of this disease featured a wiry-tight-rapid pulse, indicating liver qi stagnation and internal cold-fluid stagnation. Cold requires warming. Although Chaihu Jia Longgu Muli Tang was used, symptoms did not decrease, but the pulse transformed into deficient-large, wiry, and tight, indicating that cold-fluid had been slightly resolved. Without eliminating pathogens, how can healthy qi be supported? This is reason two. After applying Chaihu Jia Longgu Muli Tang, pathogens were slightly resolved, but healthy qi showed severe deficiency. Thus, treatment focused on supporting healthy qi first, allowing healthy qi to recover slightly before driving out pathogens. This is reason three.
Primary Orthostatic Hypotension
1. Observing a deep, wiry, fine, and choppy pulse reveals liver qi stagnation and cold-fluid obstruction; treatment with soothing liver, regulating qi, warming yang, and resolving fluid retention resulted in cure.
Li XX, Male, 45 years old.
Dizziness and paroxysmal syncope for over 1 year. Diagnosed with primary orthostatic hypotension. Western medicine treatment was ineffective; subsequent combination with Buzhong Yiqi Tang showed no rise in blood pressure, but rather worsened dizziness. Especially in the past half-year, frequent sensations of heaviness in the head and lightness in the legs, fatigue, sudden pallor upon standing, sweating, nausea, followed by sudden syncope, with blood pressure dropping to 68/45 mmHg. Especially in the past week, dizziness and fatigue were severe, with two episodes of syncope upon standing. Careful examination revealed, besides dizziness and fatigue, palpitations, mental restlessness, occasional upward rushing of rebellious qi, poor appetite, reduced food intake, fullness and discomfort in chest and hypochondrium, bitter taste in mouth, and dry throat. Thin white tongue coating, deep, wiry, fine, and choppy pulse. Synthesizing pulse and symptoms: a deep pulse indicates qi stagnation; a wiry pulse corresponds to the liver; fine and choppy pulses indicate insufficient yang qi and internal retention of cold-fluid. Combined with symptoms, this is liver qi stagnation, internal retention of cold-fluid, transformation into heat due to stagnation, presenting as upper heat and lower cold. Plan: soothe the liver and regulate qi, warm yang and resolve fluid retention, clear upper and warm lower. Prescription: Chaihu 10g, Banxia 10g, Huangqin 10g, Renshen 10g, Gancao 10g, Shengjiang 3 slices, Dazao 5 pieces, Guizhi 10g, Fuling 15g.
After 3 doses, dizziness, mental restlessness, palpitations, and chest/hypochondriac fullness decreased. No syncope occurred within 6 days. After continuing for 20 doses, all symptoms disappeared, blood pressure did not drop upon standing, resulting in cure.
A certain doctor asked: Reports and some TCM textbooks state that hypotension is treated with Buzhong Yiqi Tang. Why was it ineffective and even aggravating in this case? Why has no one reported success using liver-soothing and qi-regulating methods for hypotension, yet it proved effective here? Answer: As a scientific worker, the most important principles are seeking truth from facts and adhering strictly to practice as the criterion for testing truth. How to integrate TCM and Western medical theoretical systems? I believe we must consider problems according to these two principles. For phenomena easily explained by TCM theory with excellent clinical efficacy but unexplainable by Western theory, we must recognize and discover their mechanisms through development. For phenomena easily explained by Western theory but clinically ineffective and unexplainable by TCM theory, we should gradually discover their true scientific principles through scientific research. In scientific research, the utmost taboo is handling problems solely based on imagination and reasoning. Case records in various medical books describe this patient's pulse as deep, wiry, fine, and choppy. All classic pulse texts describe a deep pulse as indicative of qi stagnation, which every doctor acknowledges. Yet, when prescribing, Buzhong Yiqi Tang was still used. Applying tonification to a stagnation syndrome inevitably worsens stagnation; therefore, blood pressure did not rise but fell.
2. Liver qi stagnation and blood deficiency, stagnation transforming into fire; treatment should soothe the liver, nourish blood, and purge fire.
Li XX, Male, 50 years old.