某医云：诸医多言急性期间，治宜清热利湿，活血化瘀，然本证用之无效，其故何也?答曰：喻昌《医门法律》日：“凡治病不明脏腑经络，开口动手便错，不学无术，急于求售，医之过也。”《素问·至真要大论》说：“近者奇之，远者偶之，汗者不以奇，下者不以偶，补上治上制以缓，补下治下治以急。急者气味厚，缓则气味薄，适其至所，此之谓也。”言制方非得要法对，而且要适其至所，前方所用之法均正确无误，然未至其病所，今余用方取效者正在于此。
血栓闭塞性脉管炎
1．泥于温阳，固于活血，胶于补益，不审其脉，不知随证，其病不解
畅××，女，35岁。
间歇性跛行，腿及两足疼痛5—6年。医诊血栓闭塞性脉管炎。先用西药、理疗治疗1年多不效，继又配合中药活血通经、温经通络、补气养血、温肾通阳等剂千余帖，不但疼痛不减，而且日渐加重。近半年来，两足颜色逐渐由苍白冰冷转为紫黯冰冷，两个月来，两足拇趾、食趾均由紫黯转紫黑，且甲角已溃烂，疼痛昼夜不已。细审其证，除上述诸证之外，并见两足趺阳脉均不能测出，舌苔白，脉弦滑数。综合脉证，思之：弦脉者，肝胆之脉也；滑数者，痰火郁结也。合之与症，乃痰火郁结，三焦阳气不得外达。治拟理肝胆，调三焦，化痰火。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹15克，枳实10克，半夏10克，陈皮10克，滑石15克，竹叶10克，夜交藤30克。
服药10剂，四肢转温，疼痛稍减；继服30剂，两足趾溃烂部已愈合，紫黑部转红润，几近正常之色，疼痛消失；又服20剂，果愈。
某医云：柴芩温胆汤治血栓闭塞性脉管炎，余从未闻之，然其效却甚著者何也?答曰：活血、温经、补益为诸医常用法也，然其不效者何也?未“观其脉证、知犯何逆，随证治之也”。又问：脱疽医家都介绍用四妙勇安汤，然本例余数用其方却无效者何也?答曰：脉弦滑数者，痰火郁于三焦、肝胆也，非用解毒养阴之法可治也，故不用四妙勇安汤而用柴芩温胆汤而愈也。
2.不察脉证，不知变化，泥于成方，固于成法，久治不愈
郑××，男，40岁。
右足冷痛1年多，色紫变黑溃烂6个多月。医诊血栓闭塞性脉管炎坏死期。先用西药治疗3个月不效，继又用中药阳和汤、当归四逆汤，以及温阳益气活血之剂不效。半年前，因左足拇指冷痛，色变紫黑，疼痛难忍，昼夜不能入睡，行拇趾截除术，术后创面2个月不但没有新的肉芽生长，而且发现足背及小腿更加疼痛难忍。细审其证，拇趾已截除，其创面无新的肉芽生出，足背微见肿胀，小腿疼痛，但不红肿，按其右足较左足为冷，头晕头痛，心烦心悸，纳呆食减，舌苔薄白，脉弦涩不调。综合脉证，思之：脉弦者，肝脉也；弦涩不调，寒滞肝脉也；心烦心悸，头晕头痛者，肝郁血虚，郁而化火也。治拟养血疏肝，活血泻火，佐以温化。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草10克，干姜3克，薄荷3克，丹皮10克，栀子10克，丹参15克。
服药4剂，头晕头痛，心烦心悸，纳呆食减，小腿疼痛均好转，但创面仍然不见新的肉芽生长；继服4剂，不但其他症状明显改善，亦且创面有新的肉芽生长；再服40剂，诸证消失，愈。
某医云：本病诸医在未出现坏死现象之前，多主张温阳活血益气，坏死以后多主张用顾步汤、四妙勇安汤，然何久用之不效，而反剧?逍遥散本非治疗本病之药，然用之效果甚佳?答曰：中医治病的特点和优点是辨证论治，仲景在《伤寒论》、《金匮要略》中强调的辨证论治依据是一脉象，二证候。而尤其重视的是脉象。今本病患者脉始终以弦涩不调为主，脉涩不调之脉为肝脉，为寒郁化热，而不是阳虚、气虚、瘀血、热毒，所以未坏死前用阳和汤、当归四逆汤等无效，坏死后用顾步汤、四妙勇安汤均无效。逍遥散者，养血疏肝之方，若再加干姜之温散，丹皮、丹参、栀子之泻火，则非但肝郁可解，亦且寒凝可散，郁热亦可得消。
急性阑尾炎
不审脉象，囿于成方，不予理气，反予寒下，治之不效
张××，男，24岁。
右下腹剧烈腹痛不止2天。医诊急性阑尾炎。先以抗生素、中药大黄牡丹汤加减治之不效，建议手术治疗。因患者拒绝手术，改请中医治疗。细审其证，右下腹剧痛，拒按，且有明显的反跳痛，舌苔白，脉沉。综合脉证，思之：脉沉者，气郁也；大肠与肺相表里。证脉合参，乃肺与大肠气郁不行所致。治宜拟理气为先。处方：桔梗30克，枳实30克，白芍15克，败酱草30克。
服药40分钟后，腹痛渐减，1小时后，矢气数次，腹痛顿失，又服1剂，愈。
某医云：大黄牡丹汤乃治阑尾炎之名方，今先生不用其方，却采用排脓散治之者何也?答曰：大黄牡丹汤乃《金匮要略》治肠痈方，《金匮要略》云：“肠痈者，少腹肿痞，按之即痛如淋，小便自调，时时发热，自汗出，复恶寒，其脉迟紧者，脓未成，可下之，当有血。脉洪数者，脓已成，不可下也。大黄牡丹汤主之。”而前医已用之无效，故不可再予之。且其脉沉，沉为气郁，气郁者，当理气，故治宜排脓散加减治之。
慢性阑尾炎
不审经络，不察病位，不审其脉，但宗活血，治之不愈
申××，女，29岁。
右侧少腹疼痛，时轻时重4年多。医诊慢性阑尾炎。先用西药治疗不效，继用中药活血化瘀止痛之剂亦无功。细审其证，除右少腹疼痛，按之更甚外，并时感心烦易怒，舌苔白，脉弦细涩。综合脉证，思之：脉沉弦者，肝郁气滞也；细涩者，气滞血瘀也，寒也。治宜疏肝理气，温经活血。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草6克，干姜4克，灵脂10克。
服药2剂，痛减七八，继服10剂，愈。
某医云：此病久予活络效灵丹而不效者何也?答曰：《内经》强调用药要适其至所，喻嘉言强调不明脏腑经络，开口动手便错。即是说若但予活血而不达其病位即疗效不佳，活络效灵丹与逍遥散加灵脂法不同者即在于此。
肠梗阻
1．寒热不分，但用攻下，其病不解
刘××，男，14岁。
腹部剧痛，包块起伏2天。医诊肠梗阻。先以复方大承气汤、萝卜芒硝汤昼夜连进各1剂，腹痛不见好转。因患者拒绝手术。邀余诊治。细审其证，病发于吃冰块之后，腹部胀大，疼痛拒按，时见包块起伏，舌苔白，脉弦紧。综合脉证，思之：脉弦紧者，寒也，结也；腹痛发于吃冰块之后，且包块起伏者，寒气凝结也。治宜温中散寒，理气导滞。处方：木香9克，肉桂9克，陈皮9克，香附9克，小茴香9克，槟榔9克。
服药1剂，矢气数次，腹胀腹痛大见好转，继服1剂，诸证全失，愈。
某医云：有报道说复方大承气汤、萝卜芒硝汤为治疗肠梗阻的有效方剂，然用之却不效者何也?答曰：寒、热未区分耳。此病得于吃冰块之后，脉见弦紧，明系寒证，却用寒药，何之能效。余用茴香、肉桂之属取效者，亦在寒者温之之意耳。
2．正虚邪实，不予扶正，但予泻实，其何能愈
戈××，男，80岁。
腹部剧痛4天。医诊肠梗阻。4天前因小肠疝气嵌顿没有托回，突然腹痛不止，频繁呕吐，急用大承气汤、黑豆油内服，肥皂水灌肠，3天后，不但大便未行，腹大如鼓，且突见精神萎靡，血压下降(由160／100mmHg降至60／50mmHg)，给服任何药物均呕吐而出，除予抗休克措施外，并邀中医会诊。细审其证，精神萎靡，腹部胀大膨隆，但按之尚柔软，前额、耳壳、四肢均冷，舌质淡，苔薄白而润，脉沉细弱几近于绝。综合脉证，思之：腹虽胀大而按之不硬，乃为虚中夹实；肢冷，脉微为阳气大虚。治宜补脾益气，行气散寒。处方：厚朴25克，人参10克，半夏15克，炙甘草9克，生姜10克。
服药1剂，8小时内，大便行，腹胀减，呕吐止，精神增．，食纳稍进，血压100／80mmHg，继服3剂，愈。
某医云：此证为什么采用治肠梗阻方无效，而采用厚朴半夏生姜甘草人参汤却1剂即愈?答曰：本证患者年高气衰，又复寒气凝滞，治应补正为先，攻邪在后。然前医囿于肠梗阻为实证，实证当六腑宜通为用，致正虚不支，腑气不行，厚朴半夏生姜甘草人参汤补气、行气、散寒三者俱备，故一药而愈。
3．不察虚实，不审寒热，屡用手术，但知通腑，其病不治
原××，男，40岁。
腹部胀大疼痛，不能排便矢气1个多月。医诊肠梗阻。在1个月前，先因突然剧烈腹痛，呕吐，腹部胀大，矢气排便不能，行手术第1次治疗。术后第一天疼痛稍减，其后胀痛更甚，频繁呕吐，矢气更不能，于第四天又行第2次手术，并禁食。但术后第五天，胀痛呕吐又剧，不得已，邀请某医以中药治之。医云：六腑以通为用，非急以通腑之法不能挽命于万一。处以厚朴三物汤，复方大柴胡汤等加味治疗10天，其病不但不减，反见腹部更加胀大，滴水难人。不得已，再次停用中药，但予胃肠减压、输液、输血维持。细察其证，腹胀大如鼓，叩之呈鼓音，胀痛，时而呕吐，纳食全废，大便不能，体瘦如柴，气短语微，腰背酸痛，舌苔白，脉弦紧而大。综合脉证，思之：尺大而弦紧者，肾阳虚也；弦紧之脉者，寒凝气滞也。治宜补肝肾以治本，理气散寒以治标。处方：枸杞子10克，熟地10克，巴戟天10克，当归10克，沉香10克，小茴香10克，肉桂10克。
服药4剂，腹胀全失，不便得行，食纳大增，继服6剂，诸证全失，愈。
某医云：肠梗阻诸医皆论非通不可，先生独不用之，何也?答曰：此病久用寒凉克伐之品所致，故不可再用。
急性胰腺炎
细察其脉，兼予诊腹，知为寒实，温下始愈
贺××，男，29岁。
胃脘疼痛3年，加重一周。医诊慢性胰腺炎急性发作。先予西药治疗3天疼痛不减，后以中药复方大柴胡汤加减2剂疼痛更剧。细察其证，胃脘疼痛，痛彻腰背，不可触近，舌苔黄白，脉弦紧而数。综合脉证，思之：痛而拒按者实也，脉弦紧而数者，寒实凝结也。合而论之，乃寒实凝滞。治宜温中导滞。处方：大黄3克，附子10克，细辛4克，枳实10克，厚朴10克。
昼夜24小时连进2剂，痛减七八，继服15剂，愈。
某医云：胰腺炎诸医介绍宜用复方大柴胡汤，清胰汤，而先生独不用之，何也?答曰：前医已久用复方大柴胡汤、清胰汤而病情加剧也，怎敢再予投之。今查其脉、腹均为寒实之证，故改用温下之大黄附子汤。此所谓寒热不同也。
盆腔脓肿
结胸热实，不予通腑，但予解毒，其病不解
赵××，女，38岁。
1年来，从胃至小腹硬满而痛，不能俯仰，阴道、尿道不断流脓，寒热往来，恶心呕吐。医诊结核性盆腔脓肿合并金黄色葡萄球菌感染，阴道、膀胱瘘，慢性胰腺炎。先用西药治疗5个多月不见好转，后又配合中药清热解毒之剂治疗1个多月，仍无明显效果。细审其证，腹胀膨隆，从剑突下至小腹均极硬而痛，不可触近，不能俯仰，亦不能翻身，寒热往来，恶心呕吐，头晕头胀，面色萎黄，全身瘦削，言语无力，阴道与尿道中不断有脓流出，大小便不畅，身热如炭，体温39．6℃，舌苔黄燥，脉滑数。综合脉证，思之：此虽正气大虚，然其脉滑数，而腹满硬痛，总以痰实为主，故治宜攻下痰实，正如仲景《伤寒论》所云：“太阳病，重发汗而复下之，不大便五六日，舌上燥而温，从心下至少腹硬满而痛不可近者，大陷胸汤主之。”然而本证，还兼寒热往来，恶心呕吐，头晕头胀之少阳证，少阳证不可下，应治以和解少阳，正如《伤寒论》所云：“伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。”因拟和解攻里，化痰解毒。处方：柴胡15克，半夏15克，赤芍15克，枳实15克，白芥子9克，蒲公英30克，大黄6克，黄芩12克。
服药2剂，腹痛大减，寒热往来，头晕头痛，恶心呕吐亦减，已能稍进饮食，体温38％，舌苔黄，脉滑数。思之：生薏米、败酱草为腹部痈脓之要药，可加之。上方加生薏米30克、败酱草30克。
继服上药8剂，阴道、尿道流脓消失，腹痛消退近2／3，恶心呕吐消失，寒热往来亦消退近9／10左右；又服20剂，诸证消失，体重亦由30千克增至46千克。为巩固效果，服用抗痨药半年，愈。
某位医生说道：许多医生都说，在急性期治疗应当清热利湿、活血化瘀，然而本证使用这些方法无效，这是什么原因呢？回答说：喻昌在《医门法律》中说：“凡是治病如果不明白脏腑经络的道理，一开口动手就会出错，这是不学无术、急于求成医生的过错。”《素问·至真要大论》说：“病位近的用奇数药味，病位远的用偶数药味；发汗不用奇数方，攻下不用偶数方；补上治上制以缓剂，补下治下制以急剂。急剂气味浓厚，缓剂气味淡薄，使药力恰好到达病所，这就叫作‘适其至所’。”意思是制定方剂不仅要有正确的方法，而且要让药力到达病所。前面所用的方法虽然都正确无误，但药力未能到达病所。如今我用的方子之所以见效，正是在于这一点。
血栓闭塞性脉管炎
1．拘泥于温阳，固守于活血，胶着于补益，不审察脉象，不知随证变法，导致疾病无法解除
患者畅某某，女性，35岁。
间歇性跛行，腿部及双足疼痛5-6年。医生诊断为血栓闭塞性脉管炎。先用西药和理疗治疗1年多无效，随后又配合中药活血通经、温经通络、补气养血、温肾通阳等方剂一千多帖，不但疼痛没有减轻，反而日渐加重。近半年来，双足颜色逐渐由苍白冰冷转为紫暗冰冷，两个月来，双足拇趾、食趾均由紫暗转为紫黑，且指甲角已溃烂，疼痛昼夜不停。仔细审查其证候，除了上述症状外，还见到双足趺阳脉均无法测出，舌苔白，脉弦滑数。综合脉象与证候，思考如下：弦脉是肝胆之脉；滑数脉代表痰火郁结。结合症状，这是痰火郁结，导致三焦阳气不能外达。治疗拟定疏理肝胆，调理三焦，化痰火。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹15克，枳实10克，半夏10克，陈皮10克，滑石15克，竹叶10克，夜交藤30克。
服药10剂后，四肢转温，疼痛稍减；继续服用30剂，双足趾溃烂处已愈合，紫黑色部分转为红润，几乎接近正常肤色，疼痛消失；再服用20剂，果然痊愈。
某位医生说：柴芩温胆汤治疗血栓闭塞性脉管炎，我从未听说过，但它疗效显著，为什么呢？回答说：活血、温经、补益是各位医生常用的方法，但它们为何无效呢？因为没有做到“观其脉证，知犯何逆，随证治之”。又问：治疗脱疽（此处指血栓闭塞性脉管炎的坏疽阶段）医家都介绍使用四妙勇安汤，然而本例我多次使用此方却无效，为什么呢？回答说：脉象弦滑数，说明痰火郁结于三焦和肝胆，不是用解毒养阴的方法可以治疗的，所以不使用四妙勇安汤而使用柴芩温胆汤从而治愈。
2. 不察脉证，不知变化，拘泥于成方，固守于成法，久治不愈
患者郑某某，男性，40岁。
右足冷痛1年多，颜色紫变黑并溃烂6个多月。医生诊断为血栓闭塞性脉管炎坏死期。先用西药治疗3个月无效，随后又用中药阳和汤、当归四逆汤，以及温阳益气活血的方剂，均无效。半年前，因左足拇指冷痛，颜色变紫黑，疼痛难忍，昼夜不能入睡，进行了拇趾截除术，术后创面2个月不但没有新的肉芽生长，而且发现足背及小腿更加疼痛难忍。仔细审查其证候，拇趾已截除，创面无新肉芽生出，足背微见肿胀，小腿疼痛，但不红肿，按其右足比左足更冷，头晕头痛，心烦心悸，食欲不振，舌苔薄白，脉弦涩不调。综合脉象与证候，思考如下：脉弦是肝脉；弦涩不调，是寒滞肝脉；心烦心悸，头晕头痛，是肝郁血虚，郁而化火。治疗拟定养血疏肝，活血泻火，佐以温化。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草10克，干姜3克，薄荷3克，丹皮10克，栀子10克，丹参15克。
服药4剂，头晕头痛，心烦心悸，食欲不振，小腿疼痛均好转，但创面仍然不见新肉芽生长；继服4剂，不但其他症状明显改善，而且创面有新肉芽生长；再服40剂，所有症状消失，痊愈。
某位医生说：本病各位医生在未出现坏死现象之前，多主张温阳活血益气，坏死以后多主张用顾步汤、四妙勇安汤，然而为何久用无效，反而加剧？逍遥散本非治疗本病的药物，为何使用效果甚佳？回答说：中医治病的特点和优点是辨证论治，张仲景在《伤寒论》、《金匮要略》中强调的辨证论治依据是一脉象，二证候。而尤其重视的是脉象。如今这位患者的脉象始终以弦涩不调为主，脉涩不调属于肝脉，为寒郁化热，而不是阳虚、气虚、瘀血、热毒，所以在未坏死前用阳和汤、当归四逆汤等无效，坏死后用顾步汤、四妙勇安汤也无效。逍遥散是养血疏肝的方子，如果再加干姜的温散，丹皮、丹参、栀子的泻火，那么不仅肝郁可解，而且寒凝可散，郁热也可消除。
急性阑尾炎
不审脉象，囿于成方，不予理气，反予寒下，治疗无效
患者张某某，男性，24岁。
右下腹剧烈腹痛不止2天。医生诊断为急性阑尾炎。先以抗生素、中药大黄牡丹汤加减治疗无效，建议手术治疗。因患者拒绝手术，改请中医治疗。仔细审查其证候，右下腹剧痛，拒按，且有明显的反跳痛，舌苔白，脉沉。综合脉象与证候，思考如下：脉沉是气郁；大肠与肺相表里。证脉合参，是肺与大肠气郁不行所致。治疗宜以理气为先。处方：桔梗30克，枳实30克，白芍15克，败酱草30克。
服药40分钟后，腹痛渐减，1小时后，排气数次，腹痛顿失，又服1剂，痊愈。
某位医生说：大黄牡丹汤是治疗阑尾炎的名方，如今先生不用此方，却采用排脓散治疗，为什么呢？回答说：大黄牡丹汤是《金匮要略》治疗肠痈的方子，《金匮要略》说：“肠痈者，少腹肿痞，按之即痛如淋，小便自调，时时发热，自汗出，复恶寒，其脉迟紧者，脓未成，可下之，当有血。脉洪数者，脓已成，不可下也。大黄牡丹汤主之。”而前医已经用过无效，所以不能再给予。且其脉沉，沉为气郁，气郁者，应当理气，所以治疗宜用排脓散加减。
慢性阑尾炎
不审经络，不察病位，不审其脉，只宗活血，治疗不愈
患者申某某，女性，29岁。
右侧少腹疼痛，时轻时重4年多。医生诊断为慢性阑尾炎。先用西药治疗无效，继用中药活血化瘀止痛的方剂也无功。仔细审查其证候，除右少腹疼痛，按之更甚外，还时常感到心烦易怒，舌苔白，脉弦细涩。综合脉象与证候，思考如下：脉沉弦是肝郁气滞；细涩是气滞血瘀，兼有寒邪。治疗宜疏肝理气，温经活血。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，甘草6克，干姜4克，灵脂10克。
服药2剂，疼痛减轻七八分，继服10剂，痊愈。
某位医生说：此病长期给予活络效灵丹而不效，为什么呢？回答说：《内经》强调用药要适其至所，喻嘉言强调不明脏腑经络，一开口动手就会错。就是说如果只给予活血而不能到达病位，疗效就不佳，活络效灵丹与逍遥散加灵脂法的不同之处就在这里。
肠梗阻
1．寒热不分，只用攻下，疾病不解
患者刘某某，男性，14岁。
腹部剧痛，包块起伏2天。医生诊断为肠梗阻。先以复方大承气汤、萝卜芒硝汤昼夜连进各1剂，腹痛不见好转。因患者拒绝手术。邀请余诊治。仔细审查其证候，病发于吃冰块之后，腹部胀大，疼痛拒按，时见包块起伏，舌苔白，脉弦紧。综合脉象与证候，思考如下：脉弦紧是寒邪，是结聚；腹痛发于吃冰块之后，且包块起伏，是寒气凝结。治疗宜温中散寒，理气导滞。处方：木香9克，肉桂9克，陈皮9克，香附9克，小茴香9克，槟榔9克。
服药1剂，排气数次，腹胀腹痛大见好转，继服1剂，所有症状全失，痊愈。
某位医生说：有报道说复方大承气汤、萝卜芒硝汤是治疗肠梗阻的有效方剂，然而使用却不效，为什么呢？回答说：寒、热未区分罢了。此病得于吃冰块之后，脉见弦紧，明显是寒证，却用寒药，怎么能有效。余使用茴香、肉桂之类取效，也是在于寒者温之的意思。
2．正虚邪实，不予扶正，只用泻实，怎能痊愈
患者戈某某，男性，80岁。
腹部剧痛4天。医生诊断为肠梗阻。4天前因小肠疝气嵌顿没有托回，突然腹痛不止，频繁呕吐，急用大承气汤、黑豆油内服，肥皂水灌肠，3天后，不但大便未行，腹大如鼓，且突见精神萎靡，血压下降(由160／100mmHg降至60／50mmHg)，给服任何药物均呕吐而出，除予抗休克措施外，并邀中医会诊。仔细审查其证候，精神萎靡，腹部胀大膨隆，但按之尚柔软，前额、耳壳、四肢均冷，舌质淡，苔薄白而润，脉沉细弱几近于绝。综合脉象与证候，思考如下：腹虽胀大而按之不硬，是为虚中夹实；肢冷，脉微为阳气大虚。治疗宜补脾益气，行气散寒。处方：厚朴25克，人参10克，半夏15克，炙甘草9克，生姜10克。
服药1剂，8小时内，大便行，腹胀减，呕吐止，精神增加，食欲稍进，血压100／80mmHg，继服3剂，痊愈。
某位医生说：此证为什么采用治肠梗阻方无效，而采用厚朴半夏生姜甘草人参汤却1剂即愈？回答说：本证患者年高气衰，又复寒气凝滞，治疗应补正为先，攻邪在后。然而前医拘泥于肠梗阻为实证，实证当六腑宜通为用，导致正虚不支，腑气不行，厚朴半夏生姜甘草人参汤补气、行气、散寒三者俱备，故一药而愈。
3．不察虚实，不审寒热，屡用手术，只知通腑，疾病不治
患者原某某，男性，40岁。
腹部胀大疼痛，不能排便矢气1个多月。医生诊断为肠梗阻。在1个月前，先因突然剧烈腹痛，呕吐，腹部胀大，矢气排便不能，行手术第1次治疗。术后第一天疼痛稍减，其后胀痛更甚，频繁呕吐，矢气更不能，于第四天又行第2次手术，并禁食。但术后第五天，胀痛呕吐又剧，不得已，邀请某医以中药治之。医云：六腑以通为用，非急以通腑之法不能挽命于万一。处以厚朴三物汤，复方大柴胡汤等加味治疗10天，其病不但不减，反见腹部更加胀大，滴水难入。不得已，再次停用中药，但予胃肠减压、输液、输血维持。细察其证，腹胀大如鼓，叩之呈鼓音，胀痛，时而呕吐，纳食全废，大便不能，体瘦如柴，气短语微，腰背酸痛，舌苔白，脉弦紧而大。综合脉象与证候，思考如下：尺大而弦紧，是肾阳虚；弦紧之脉，是寒凝气滞。治疗宜补肝肾以治本，理气散寒以治标。处方：枸杞子10克，熟地10克，巴戟天10克，当归10克，沉香10克，小茴香10克，肉桂10克。
服药4剂，腹胀全失，大便得行，食欲大增，继服6剂，所有症状全失，痊愈。
某位医生说：肠梗阻各位医生皆论非通不可，先生独不用之，为什么呢？回答说：此病是长期用寒凉克伐之品所致，所以不可再用。
急性胰腺炎
细察其脉，兼予诊腹，知为寒实，温下始愈
患者贺某某，男性，29岁。
胃脘疼痛3年，加重一周。医生诊断为慢性胰腺炎急性发作。先予西药治疗3天疼痛不减，后以中药复方大柴胡汤加减2剂疼痛更剧。细察其证，胃脘疼痛，痛彻腰背，不可触近，舌苔黄白，脉弦紧而数。综合脉象与证候，思考如下：痛而拒按是实证，脉弦紧而数是寒实凝结。合而论之，是寒实凝滞。治疗宜温中导滞。处方：大黄3克，附子10克，细辛4克，枳实10克，厚朴10克。
昼夜24小时连进2剂，疼痛减轻七八分，继服15剂，痊愈。
某位医生说：胰腺炎各位医生介绍宜用复方大柴胡汤，清胰汤，而先生独不用之，为什么呢？回答说：前医已久用复方大柴胡汤、清胰汤而病情加剧了，怎敢再给予投用。如今查其脉、腹均为寒实之证，故改用温下之大黄附子汤。这就是所谓寒热不同。
盆腔脓肿
结胸热实，不予通腑，只予解毒，疾病不解
患者赵某某，女性，38岁。
1年来，从胃至小腹硬满而痛，不能俯仰，阴道、尿道不断流脓，寒热往来，恶心呕吐。医生诊断为结核性盆腔脓肿合并金黄色葡萄球菌感染，阴道、膀胱瘘，慢性胰腺炎。先用西药治疗5个多月不见好转，后又配合中药清热解毒之剂治疗1个多月，仍无明显效果。仔细审查其证候，腹胀膨隆，从剑突下至小腹均极硬而痛，不可触近，不能俯仰，亦不能翻身，寒热往来，恶心呕吐，头晕头胀，面色萎黄，全身瘦削，言语无力，阴道与尿道中不断有脓流出，大小便不畅，身热如炭，体温39．6℃，舌苔黄燥，脉滑数。综合脉象与证候，思考如下：此虽正气大虚，然而其脉滑数，而腹满硬痛，总以痰实为主，所以治疗宜攻下痰实，正如仲景《伤寒论》所说：“太阳病，重发汗而复下之，不大便五六日，舌上燥而温，从心下至少腹硬满而痛不可近者，大陷胸汤主之。”然而本证，还兼寒热往来，恶心呕吐，头晕头胀之少阳证，少阳证不可下，应治以和解少阳，正如《伤寒论》所说：“伤寒十余日，热结在里，复往来寒热者，与大柴胡汤。”因此拟定和解攻里，化痰解毒。处方：柴胡15克，半夏15克，赤芍15克，枳实15克，白芥子9克，蒲公英30克，大黄6克，黄芩12克。
服药2剂，腹痛大减，寒热往来，头晕头痛，恶心呕吐亦减，已能稍进饮食，体温38％，舌苔黄，脉滑数。思考如下：生薏米、败酱草是腹部痈脓的要药，可以加入。上方加生薏米30克、败酱草30克。
继服上药8剂，阴道、尿道流脓消失，腹痛消退近2／3，恶心呕吐消失，寒热往来亦消退近9／10左右；又服20剂，所有症状消失，体重也由30千克增至46千克。为巩固效果，服用抗痨药半年，痊愈。
A physician stated: Many physicians claim that during the acute phase, treatment should focus on clearing heat and draining dampness, as well as invigorating blood and resolving stasis. However, these methods are ineffective for this syndrome. Why is this? The answer is: Yu Chang in *Yi Men Fa Lü* (Medical Laws of the Medical Gate) said, "If one does not understand the principles of the zang-fu organs and meridians when treating diseases, any attempt to speak or act will be erroneous. This is the fault of physicians who are unlearned and eager to sell their services." *Su Wen · Zhi Zhen Yao Da Lun* states, "For conditions near, use formulas with an odd number of ingredients; for conditions far, use formulas with an even number. For sweating, do not use odd-numbered formulas; for purging, do not use even-numbered formulas. Tonifying the upper or treating the upper requires a slow-acting formula; tonifying the lower or treating the lower requires a rapid-acting formula. Rapid-acting formulas have thick flavors and qi, while slow-acting formulas have thin flavors and qi. The goal is to ensure the medicinal force reaches precisely where it is needed; this is called 'reaching the destination'." This means that formulating a prescription requires not only correct methods but also ensuring the medicinal force reaches the site of the disease. Although the methods used previously were all correct, the medicinal force failed to reach the disease site. The reason my prescription was effective lies precisely in this point.
Thromboangiitis Obliterans
1. Clinging to warming yang, adhering to invigorating blood, being stuck on tonification, without examining the pulse, and failing to adapt to the syndrome, leading to unresolved disease.
Patient Chang XX, female, 35 years old.
Intermittent claudication, pain in the legs and both feet for 5-6 years. Diagnosed with thromboangiitis obliterans by physicians. Treated with Western medicine and physical therapy for over a year with no effect. Subsequently combined with traditional Chinese medicine prescriptions for invigorating blood and unblocking collaterals, warming meridians and unblocking collaterals, tonifying qi and nourishing blood, and warming kidney and unblocking yang, taking over a thousand doses. Not only did the pain not decrease, but it worsened day by day. For the past half year, the color of both feet gradually changed from pale and cold to purple-dark and cold. For the past two months, the big toes and second toes of both feet turned from purple-dark to purple-black, and the nail angles ulcerated. The pain persisted day and night. Carefully examining the syndrome, besides the above symptoms, the Duyang pulse on both feet could not be detected. The tongue coating was white, and the pulse was wiry, slippery, and rapid. Synthesizing the pulse and syndrome: A wiry pulse indicates the liver and gallbladder; a slippery and rapid pulse indicates phlegm-fire stagnation. Combined with the symptoms, this is phlegm-fire stagnation preventing the yang qi of the San Jiao (Triple Burner) from reaching the exterior. The treatment plan was to regulate the liver and gallbladder, adjust the San Jiao, and resolve phlegm-fire. Prescription: Chai Hu (Bupleuri Radix) 10g, Huang Qin (Scutellariae Radix) 10g, Long Dan Cao (Gentianae Radix) 10g, Zhu Ru (Bambusae Caulis in Taenia) 15g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Hua Shi (Talcum) 15g, Zhu Ye (Phyllostachys Viridis Folium) 10g, Ye Jiao Teng (Caulis Polygoni Multiflori) 30g.
After taking 10 doses, the four limbs became warm, and the pain decreased slightly. After continuing for 30 doses, the ulcerated areas on the toes healed, the purple-black areas turned reddish, approaching normal skin color, and the pain disappeared. After another 20 doses, the patient recovered completely.
Another physician asked: I have never heard of Chai Qin Wen Dan Tang (Bupleurum and Scutellaria Warming Gallbladder Decoction) treating thromboangiitis obliterans, yet its efficacy is remarkable. Why? The answer is: Invigorating blood, warming meridians, and tonification are common methods among physicians, but why are they ineffective here? Because they failed to "observe the pulse and syndrome, understand the deviation, and treat according to the syndrome." Another question: Physicians usually recommend Si Miao Yong An Tang (Four Marvels Preserving Life Decoction) for gangrene (here referring to the gangrenous stage of thromboangiitis obliterans), yet I used this prescription multiple times for this case with no effect. Why? The answer is: The wiry, slippery, and rapid pulse indicates phlegm-fire stagnation in the San Jiao and liver/gallbladder. This cannot be treated with detoxification and yin-nourishing methods. Therefore, instead of Si Miao Yong An Tang, Chai Qin Wen Dan Tang was used, resulting in recovery.
2. Failing to examine pulse and syndrome, lacking understanding of changes, clinging to established prescriptions and methods, leading to prolonged unsuccessful treatment.
Patient Zheng XX, male, 40 years old.
Cold pain in the right foot for over a year, turning purple, black, and ulcerating for over 6 months. Diagnosed with the necrotic stage of thromboangiitis obliterans. Treated with Western medicine for 3 months with no effect. Subsequently treated with Yang He Tang (Yang-Harmonizing Decoction), Dang Gui Si Ni Tang (Angelica Four Reversal Decoction), and other prescriptions for warming yang, tonifying qi, and invigorating blood, all without effect. Half a year ago, due to cold pain in the left big toe, turning purple-black, with unbearable pain preventing sleep day and night, amputation of the big toe was performed. Two months post-surgery, there was no new granulation tissue growth on the wound, and pain in the dorsum of the foot and lower leg became unbearable. Carefully examining the syndrome: The big toe had been amputated, no new granulation tissue on the wound, slight swelling on the dorsum of the foot, pain in the lower leg without redness or swelling, the right foot was colder than the left upon palpation, accompanied by dizziness, headache, restlessness, palpitations, and poor appetite. The tongue coating was thin and white, and the pulse was wiry, choppy, and irregular. Synthesizing the pulse and syndrome: A wiry pulse indicates the liver; wiry, choppy, and irregular indicates cold stagnation in the liver meridian; restlessness, palpitations, dizziness, and headache indicate liver qi stagnation with blood deficiency, transforming into fire. The treatment plan was to nourish blood and soothe the liver, invigorate blood and purge fire, assisted by warming transformation. Prescription: Chai Hu (Bupleuri Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Fu Ling (Poria) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 10g, Gan Jiang (Zingiberis Rhizoma) 3g, Bo He (Menthae Haplocalycis Herba) 3g, Mu Dan Pi (Moutan Cortex) 10g, Zhi Zi (Gardeniae Fructus) 10g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 15g.
After 4 doses, dizziness, headache, restlessness, palpitations, poor appetite, and lower leg pain improved, but no new granulation tissue appeared on the wound. After another 4 doses, other symptoms improved significantly, and new granulation tissue began to grow on the wound. After another 40 doses, all symptoms disappeared, and the patient recovered.
Another physician asked: Before necrosis occurred, physicians mostly advocated warming yang, invigorating blood, and tonifying qi; after necrosis, they advocated Gu Bu Tang (Restore Step Decoction) and Si Miao Yong An Tang. Why did long-term use fail and worsen the condition? Xiao Yao San (Free and Easy Wanderer Powder) is not typically used for this disease, yet it yielded excellent results. Why? The answer is: The characteristic and advantage of TCM treatment is pattern differentiation and treatment. Zhang Zhongjing emphasized in *Shang Han Lun* (Treatise on Cold Pathogenic Diseases) and *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) that pattern differentiation relies primarily on pulse and secondarily on syndrome, with particular emphasis on the pulse. In this patient, the pulse remained wiry, choppy, and irregular throughout. This pulse type belongs to the liver, indicating cold stagnation transforming into heat, rather than yang deficiency, qi deficiency, blood stasis, or heat toxin. Hence, Yang He Tang and Dang Gui Si Ni Tang were ineffective before necrosis, and Gu Bu Tang and Si Miao Yong An Tang were ineffective after necrosis. Xiao Yao San nourishes blood and soothes the liver. Adding Gan Jiang for warming dispersion, and Mu Dan Pi, Dan Shen, and Zhi Zi for purging fire, resolves liver stagnation, disperses cold coagulation, and clears stagnant heat.
Acute Appendicitis
Failing to examine the pulse, confined to established prescriptions, neglecting to regulate qi, and mistakenly using cold purgatives, resulting in ineffective treatment.
Patient Zhang XX, male, 24 years old.
Severe continuous abdominal pain in the right lower quadrant for 2 days. Diagnosed with acute appendicitis. Initially treated with antibiotics and modified Da Huang Mu Dan Tang (Rhubarb and Moutan Decoction) with no effect. Surgery was recommended. Due to patient refusal, TCM treatment was sought. Carefully examining the syndrome: Severe pain in the right lower quadrant, tenderness and rebound tenderness present. Tongue coating white, pulse deep. Synthesizing pulse and syndrome: A deep pulse indicates qi stagnation; the Large Intestine and Lung are interior-exterior related. Combining syndrome and pulse, this is caused by qi stagnation in the Lung and Large Intestine. Treatment prioritized regulating qi. Prescription: Jie Geng (Platycodonis Radix) 30g, Zhi Shi (Aurantii Fructus Immaturus) 30g, Bai Shao (Paeoniae Radix Alba) 15g, Bai Jiang Cao (Patriniae Herba) 30g.
Forty minutes after taking the medicine, abdominal pain gradually decreased. One hour later, flatus occurred several times, and abdominal pain vanished immediately. After one more dose, the patient recovered.
Another physician asked: Da Huang Mu Dan Tang is a famous prescription for appendicitis. Why did you not use it but instead employ Pai Nong San (Drain Pus Powder)? The answer is: Da Huang Mu Dan Tang is a prescription for intestinal abscess (*Chang Yong*) in *Jin Gui Yao Lue*. It states: "In intestinal abscess, there is swelling and distension in the lower abdomen, pain upon pressure resembling strangury, normal urination, intermittent fever, spontaneous sweating, and aversion to cold. If the pulse is slow and tight, pus has not formed, and purgation may be used, which should yield blood. If the pulse is surging and rapid, pus has formed, and purgation is contraindicated. Da Huang Mu Dan Tang governs this." Since the previous physician used it without effect, it should not be repeated. Furthermore, the deep pulse indicates qi stagnation, which requires qi regulation. Thus, Pai Nong San was used with modifications.
Chronic Appendicitis
Failing to examine meridians, disease location, and pulse, relying solely on blood-invigorating methods, resulting in non-recovery.
Patient Shen XX, female, 29 years old.
Right lower abdominal pain, fluctuating in intensity for over 4 years. Diagnosed with chronic appendicitis. Initial Western medicine treatment was ineffective. Subsequent TCM prescriptions for invigorating blood and resolving stasis to relieve pain also failed. Carefully examining the syndrome: Right lower abdominal pain, worse upon pressure, accompanied by occasional irritability and anger. Tongue coating white, pulse wiry, fine, and choppy. Synthesizing pulse and syndrome: Deep and wiry pulse indicates liver qi stagnation; fine and choppy indicates qi stagnation and blood stasis, with cold. Treatment aimed at soothing the liver, regulating qi, warming meridians, and invigorating blood. Prescription: Chai Hu (Bupleuri Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Fu Ling (Poria) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 6g, Gan Jiang (Zingiberis Rhizoma) 4g, Ling Zhi (Ligusticum Wallichii Rhizoma et Radix / Olibanum? Context suggests Yan Hu Suo or similar, but text says Ling Zhi 10g. Ling Zhi usually refers to Olibanum/Ru Xiang in some contexts or Ligusticum. Given "Huo Luo Xiao Ling Dan" context later, likely Ru Xiang or Mo Yao, but text says Ling Zhi. I will translate as Ling Zhi (Olibanum/Ligusticum depending on interpretation, but strictly Ling Zhi)). *Correction*: In many classical contexts, Ling Zhi can refer to Olibanum (Ru Xiang) or specific herbs. However, standard Ling Zhi is Ganoderma. In pain formulas, it often refers to Ru Xiang (Olibanum) or Mo Yao (Myrrha). Given the formula structure (Si Ni San variant + Ling Zhi), it resembles Huo Luo Xiao Ling Dan components. I will translate as Ling Zhi (Olibanum/Myrrha equivalent in this context, or simply Ling Zhi). Let's stick to Ling Zhi.
After 2 doses, pain reduced by 70-80%. After continuing for 10 doses, the patient recovered.
Another physician asked: Why did long-term use of Huo Luo Xiao Ling Dan (Unblocking Collaterals and Relieving Pain Decoction) fail? The answer is: *Nei Jing* emphasizes that medication must reach the disease site. Yu Jiayan emphasized that misunderstanding zang-fu and meridians leads to error. Simply invigorating blood without reaching the disease site yields poor results. This is the difference between Huo Luo Xiao Ling Dan and Xiao Yao San plus Ling Zhi.
Intestinal Obstruction
1. Confusing cold and heat, using only purgatives, leading to unresolved disease.
Patient Liu XX, male, 14 years old.
Severe abdominal pain and fluctuating masses for 2 days. Diagnosed with intestinal obstruction. Treated with Fu Fang Da Cheng Qi Tang (Compound Major Order the Qi Decoction) and Luo Bo Mang Xiao Tang (Radish and Mirabilite Decoction) continuously day and night, one dose each, with no improvement in abdominal pain. Due to patient refusal of surgery, I was invited to treat. Carefully examining the syndrome: Onset followed ingestion of ice cubes. Abdominal distension, pain with resistance to pressure, fluctuating masses visible. Tongue coating white, pulse wiry and tight. Synthesizing pulse and syndrome: Wiry and tight pulse indicates cold and binding; onset after eating ice and fluctuating masses indicate cold qi coagulation. Treatment aimed at warming the middle, dispelling cold, regulating qi, and guiding out stagnation. Prescription: Mu Xiang (Aucklandiae Radix) 9g, Rou Gui (Cinnamomi Cortex) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Xiang Fu (Cyperi Rhizoma) 9g, Xiao Hui Xiang (Foeniculi Fructus) 9g, Bing Lang (Arecae Semen) 9g.
After 1 dose, flatus occurred several times, abdominal distension and pain improved significantly. After another dose, all symptoms disappeared, and the patient recovered.
Another physician asked: Reports state Fu Fang Da Cheng Qi Tang and Luo Bo Mang Xiao Tang are effective for intestinal obstruction, yet they failed here. Why? The answer is: Cold and heat were not distinguished. This disease resulted from eating ice cubes, and the wiry-tight pulse clearly indicates a cold syndrome. Using cold medicines in a cold syndrome cannot be effective. My success with Xiao Hui Xiang and Rou Gui lies in the principle of "warming the cold."
2. Deficiency of healthy qi and excess of pathogenic factors, failing to support healthy qi, using only purgation, how can recovery occur?
Patient Ge XX, male, 80 years old.
Severe abdominal pain for 4 days. Diagnosed with intestinal obstruction. Four days prior, due to incarcerated small intestine hernia not reduced, sudden continuous abdominal pain and frequent vomiting occurred. Urgently treated with Da Cheng Qi Tang, black bean oil orally, and soap water enema. Three days later, not only was there no bowel movement and drum-like abdominal distension, but mental depression and hypotension (from 160/100 mmHg to 60/50 mmHg) suddenly appeared. Any oral medication was vomited out. Besides anti-shock measures, TCM consultation was requested. Carefully examining the syndrome: Mental depression, abdominal distension and bulging but soft upon pressure, cold forehead, ear shells, and limbs. Tongue body pale, coating thin, white, and moist. Pulse deep, fine, weak, nearly imperceptible. Synthesizing pulse and syndrome: Abdominal distension without hardness indicates deficiency mixed with excess; cold limbs and faint pulse indicate severe yang deficiency. Treatment aimed at tonifying spleen and qi, regulating qi, and dispelling cold. Prescription: Hou Po (Magnoliae Officinalis Cortex) 25g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Ban Xia (Pinelliae Rhizoma Preparatum) 15g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum) 9g, Sheng Jiang (Zingiberis Recens Rhizoma) 10g.
After 1 dose, within 8 hours, bowel movement occurred, abdominal distension decreased, vomiting stopped, mental state improved, appetite slightly returned, and blood pressure rose to 100/80 mmHg. After continuing for 3 doses, the patient recovered.
Another physician asked: Why was the standard intestinal obstruction formula ineffective, while Hou Po Ban Xia Sheng Jiang Gan Cao Ren Shen Tang (Magnolia Bark, Pinellia, Ginger, Licorice, and Ginseng Decoction) cured it in one dose? The answer is: This elderly patient has depleted qi and cold qi coagulation. Treatment should prioritize supporting healthy qi and attacking pathogens subsequently. Previous physicians, confining themselves to the view that intestinal obstruction is an excess syndrome requiring unblocking of the fu organs, caused healthy qi collapse and failure of fu organ qi movement. This decoction combines tonifying qi, regulating qi, and dispelling cold, hence curing the disease in one dose.
3. Failing to examine deficiency/excess and cold/heat, repeated surgeries, knowing only to unblock the fu organs, leading to untreatable disease.
Patient Yuan XX, male, 40 years old.
Abdominal distension and pain, inability to pass stool or flatus for over a month. Diagnosed with intestinal obstruction. One month ago, due to sudden severe abdominal pain, vomiting, abdominal distension, and inability to pass stool/flatus, the first surgery was performed. Pain decreased slightly on the first post-op day, then distending pain worsened, with frequent vomiting and complete inability to pass flatus. A second surgery was performed on the fourth day, along with fasting. On the fifth post-op day, distending pain and vomiting worsened severely. Desperately, another physician was invited for TCM treatment. The physician stated: "The fu organs function through unblocking; only urgent unblocking can save life." Prescribed Hou Po San Wu Tang (Magnolia Bark Three Substance Decoction) and Fu Fang Da Chai Hu Tang (Compound Bupleurum and Scutellaria Decoction) with modifications for 10 days. The disease not only did not improve but abdominal distension worsened, making it difficult to swallow even water. Desperately, TCM was stopped again, and gastrointestinal decompression, infusion, and blood transfusion were maintained. Carefully examining the syndrome: Abdominal distension like a drum, tympanic upon percussion, distending pain, occasional vomiting, total loss of appetite, constipation, emaciation, shortness of breath and weak voice, backache. Tongue coating white, pulse wiry, tight, and large. Synthesizing pulse and syndrome: Large and wiry-tight cun-chi pulse indicates kidney yang deficiency; wiry-tight pulse indicates cold coagulation and qi stagnation. Treatment aimed at tonifying liver and kidney to address the root, and regulating qi and dispelling cold to address the branch. Prescription: Gou Qi Zi (Lycii Fructus) 10g, Shu Di Huang (Rehmanniae Radix Preparata) 10g, Ba Ji Tian (Morindae Officinalis Radix) 10g, Dang Gui (Angelicae Sinensis Radix) 10g, Chen Xiang (Aquilariae Lignum Resinatum) 10g, Xiao Hui Xiang (Foeniculi Fructus) 10g, Rou Gui (Cinnamomi Cortex) 10g.
After 4 doses, abdominal distension disappeared, bowel movement resumed, and appetite increased significantly. After continuing for 6 doses, all symptoms disappeared, and the patient recovered.
Another physician asked: All physicians argue that intestinal obstruction must be unblocked. Why did you refuse? The answer is: This disease was caused by long-term use of cold and cooling substances that damage healthy qi. Therefore, such methods should not be used again.
Acute Pancreatitis
Carefully examining the pulse and palpating the abdomen, identifying cold-excess, and achieving recovery only with warming purgation.
Patient He XX, male, 29 years old.
Epigastric pain for 3 years, worsening for one week. Diagnosed with acute exacerbation of chronic pancreatitis. Western medicine treatment for 3 days did not reduce pain. Subsequently, modified Fu Fang Da Chai Hu Tang for 2 doses worsened the pain. Carefully examining the syndrome: Epigastric pain radiating to the back, intolerant to touch. Tongue coating yellow-white, pulse wiry, tight, and rapid. Synthesizing pulse and syndrome: Pain with resistance to pressure indicates excess; wiry, tight, and rapid pulse indicates cold-excess coagulation. Combined, this is cold-excess stagnation. Treatment aimed at warming the middle and guiding out stagnation. Prescription: Da Huang (Rhei Radix et Rhizoma) 3g, Fu Zi (Aconiti Lateralis Radix Preparata) 10g, Xi Xin (Asari Radix et Rhizoma) 4g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g.
Two doses administered continuously over 24 hours. Pain reduced by 70-80%. After continuing for 15 doses, the patient recovered.
Another physician asked: Physicians recommend Fu Fang Da Chai Hu Tang and Qing Yi Tang for pancreatitis. Why did you not use them? The answer is: Previous physicians had already used Fu Fang Da Chai Hu Tang and Qing Yi Tang extensively, worsening the condition. How could I repeat them? Upon examining the pulse and abdomen, both indicated cold-excess. Thus, Da Huang Fu Zi Xi Xin Tang (Rhubarb, Aconite, and Asari Decoction), a warming purgative, was used. This illustrates the difference between cold and heat patterns.
Pelvic Abscess
Chest-binding heat-excess, failing to unblock the fu organs, using only detoxification, leading to unresolved disease.
Patient Zhao XX, female, 38 years old.
For one year, hardness, fullness, and pain from the stomach to the lower abdomen, unable to bend forward or backward. Continuous pus discharge from vagina and urethra, alternating chills and fever, nausea, and vomiting. Diagnosed with tuberculous pelvic abscess complicated by Staphylococcus aureus infection, vesicovaginal fistula, and chronic pancreatitis. Western medicine treatment for over 5 months showed no improvement. Combined with TCM heat-clearing and detoxifying prescriptions for over a month, still no obvious effect. Carefully examining the syndrome: Abdominal distension and bulging, extreme hardness and pain from below the xiphoid process to the lower abdomen, intolerant to touch, unable to bend or turn over. Alternating chills and fever, nausea, vomiting, dizziness, head distension, sallow complexion, emaciation, weak speech. Continuous pus discharge from vagina and urethra, difficulty in urination and defecation. Body hot as charcoal, temperature 39.6°C. Tongue coating yellow and dry, pulse slippery and rapid. Synthesizing pulse and syndrome: Although healthy qi is severely deficient, the slippery-rapid pulse and abdominal fullness/hardness/pain indicate phlegm-excess as the primary factor. Treatment should attack and purge phlegm-excess. As Zhongjing stated in *Shang Han Lun*: "In Taiyang disease, after heavy sweating and subsequent purging, if there is no bowel movement for 5-6 days, dry tongue with warmth, and hardness/fullness/pain from the heart region to the lower abdomen intolerant to touch, Da Xian Xiong Tang (Major Expel the Chest Decoction) governs this." However, this case also includes Shaoyang syndrome symptoms: alternating chills and fever, nausea, vomiting, dizziness, and head distension. Shaoyang syndrome should not be purged directly; it should be treated by harmonizing Shaoyang. As *Shang Han Lun* states: "After ten days of cold damage, heat binds internally, with recurring alternating chills and fever, Da Chai Hu Tang (Bupleurum and Scutellaria Decoction) is given." Therefore, the plan was to harmonize and purge internally, resolve phlegm, and detoxify. Prescription: Chai Hu (Bupleuri Radix) 15g, Ban Xia (Pinelliae Rhizoma Preparatum) 15g, Chi Shao (Paeoniae Radix Rubra) 15g, Zhi Shi (Aurantii Fructus Immaturus) 15g, Bai Jie Zi (Sinapis Semen) 9g, Pu Gong Ying (Taraxaci Herba) 30g, Da Huang (Rhei Radix et Rhizoma) 6g, Huang Qin (Scutellariae Radix) 12g.
After 2 doses, abdominal pain decreased significantly, alternating chills and fever, dizziness, headache, nausea, and vomiting also decreased. Diet intake improved slightly. Temperature dropped to 38°C. Tongue coating yellow, pulse slippery and rapid. Thinking: Sheng Yi Mi (Coicis Semen) and Bai Jiang Cao (Patriniae Herba) are key herbs for abdominal abscesses/pus. They should be added. Added Sheng Yi Mi 30g and Bai Jiang Cao 30g to the above prescription.
After continuing for 8 doses, vaginal and urethral pus discharge ceased, abdominal pain reduced by nearly 2/3, nausea and vomiting disappeared, and alternating chills and fever reduced by nearly 9/10. After another 20 doses, all symptoms disappeared, and weight increased from 30 kg to 46 kg. To consolidate the effect, anti-tuberculosis medication was taken for half a year, resulting in recovery.