头发、眉毛、胡须全部脱落3年多。医诊斑秃。先以西药治疗半年不效，后以姜片、补骨脂等外擦，中药清热凉血、滋养肝肾、活血化瘀、疏通经络等剂，以及斑秃丸，梅花针、耳针等仍无功。细审其证，在3年多前突然头发、眉毛、睫毛、胡须、腋毛全部脱落后，至今皆无一根生长，他无所苦，舌苔白，脉虚弦。综合脉证，思之：发者，血之余，其突见脱落者风也；皮毛者，肺之所主，肺虚则皮毛不荣也。脉虚者，肺虚也；弦者，肝血不足也。且其病久必及肾命，而肾阴亏损。故治宜补气养阴。处方：黄芪15克，党参10克，白术10克，升麻10克，柴胡10克，陈皮10克，当归10克，甘草6克，生地15克，山药10克，山茱萸10克，茯苓10克，泽泻10克，丹皮10克。
服药30剂后，有少许白色很细的毛发长出；继服30剂，白色较粗的头发、眉毛、睫毛、胡须、腋毛大部长出，并有少许黑色毛发出现；又服上药40剂，所有毛发均变为黑色，愈。
某医云：遍查诸书多云血热生风者，治以清热凉血，滋养肝肾法，方宜乌发丸化裁。肝肾不足者，治宜补肝益肾，滋养精血，方宜神应养真丹化裁。瘀血阻络者，治以活血化瘀，疏通经络，方宜通窍活血汤化裁。而先生独不用之，其效反著者，何也?答曰：中医学的核心问题是辨证论治，诸书所论治法仅取其多见者而言也，而本证却属少见且遍请诸医治之无效者，今其脉证，实属气阴俱虚，故治以补气养阴而愈也。
颈椎病
调阴阳，理枢机，和其筋脉，其病得愈
李××，女，78岁。
头晕、臂痛麻木8个多月。医诊颈椎骨质增生。先以牵引理疗治疗不效，后以按摩、中药活血化瘀之法亦无功。细审其证，头晕不能站立，右臂酸痛麻木不能写字、穿衣，失眠健忘，心烦背困，口苦口干，舌苔白，脉弦紧。综合脉证，思之：脉弦者，肝脉也；紧者，寒也。合之与症，乃痰饮内郁，肝木失达，筋脉不利。治宜调阴阳，理枢机，和筋脉。处方：柴胡10克，半夏10克，党参10克，黄芩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。
服药3剂，头晕、背困、臂痛、手麻等症均减，继服20剂，愈。
某医云：柴胡加龙骨牡蛎汤本为仲景治胸满烦惊方，何以用之于颈椎病而反效?答曰：柴胡加龙骨牡蛎汤方，一有理肝，二有化饮，三有调阴阳，四有和荣卫，五有助升降，六有和肝胆，七有镇惊止悸的功用，而本证从其病机来看，恰恰就是这些方面的问题，所以采用此方进行治疗。
颞颌关节脱位
谨遵脉证，随证治之，始获治愈
弓××，女，3l岁。
碰伤下颚后张口困难半年多。医诊颞颌关节脱位。先以整复、理疗、针灸治疗无效，继又以中药活血化瘀之剂治疗亦无功。细审其证，除张口困难，不能咀嚼，只能进流质饮食外，并见头晕头胀，心烦失眠，恶心欲吐，口苦咽干，背困而痛，舌苔薄白，脉弦紧而数。综合脉证，思之：脉弦者，肝脉也；紧者，寒也，结也；紧数相兼，寒湿凝结也。合之与症，乃肝郁气结，水饮不化，郁而化风也。治宜疏肝化饮，熄风解痉。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，熟军4克，茯苓15克，龙骨15克，牡蛎15克。
服药2剂，张口稍大，他证亦减，再服5剂，咀嚼、张口自如，继服4剂，愈。
某医云：柴胡加龙骨牡蛎汤能治颢颌关节脱位，吾未闻者也，而先生独用之而取效，其故何也?答曰：张口、闭口者，筋所主之者也，肝主筋，今湿郁肝胆，风邪因生，故从肝胆以治筋病也。
跟痛症
1．谨察脉证，知其为脾肾俱虚，予培补脾肾药始愈
汪××，男，73岁。
足跟疼痛8年多。医诊骨刺。先予西药、理疗治之不效，后予中药活血止痛，软坚散结之剂仍无功。且近4年多来，每服西药即腹痛泄泻，为此不得不用中药专治腹泻。细审其证，除足跟痛、腹痛泄泻外，并见纳呆食减，消瘦乏力，舌苔白，脉濡缓。综合脉证，思之：此脾肾俱虚，脾虚为主之疾，治宜健脾除湿，益肾壮骨。处方：党参10克，茯苓10克，白术10克，扁豆10克，陈皮10克，山药15克，甘草6克，莲子10克，砂仁10克，炒薏米15克，桔梗10克，黄连6克，干姜10克，补骨脂10克，巴戟天10克，白蔻仁10克，焦三仙各10克。
服药4剂，不但腹痛、泄泻俱减，而且足跟疼痛全部消失，继服4剂，诸证均除。
某医云：资生丸加减治疗泄泻诸家均称其有效，然何以足跟痛消失?答曰：脉证相参乃脾肾俱虚之候，故以培补脾肾而取效，因其足跟属肾也。
2．谨遵脉证，参之经络，治之得愈
文××，女，5l岁。
足跟疼痛6年多。医诊骨质增生。先以理疗、西药治之不效，继又以针灸、中药活血化瘀，软坚散结之剂亦不效。细审其证，除足跟疼痛难于着地外，并见小腿、腰、背及足跟跟腱亦痛，有时痛甚难于入睡，舌苔白，脉弦细而涩。综合脉证，思之：脉弦者，肝脉也；细者，血虚也；涩者，寒凝血滞也。合之于症，乃肝肾俱虚，寒凝气滞。治宜培补肝肾，温经理肝。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3克，薄荷3克，狗脊30克。
服药4剂，足跟、小腿、腰、背疼痛均减，继服10剂，诸证消失。
某医云：逍遥散治疗跟痛症吾未闻之也，请明示之。答日：足跟属肾，跟腱乃筋之属，隶取于肝，肝肾为病，故治肝肾而获愈也。
3．凭所主，察病位，合脉象，定病性，治之始愈
霍××，女，65岁。
两足足跟疼痛11个月。经多个医院检查未确诊。先以理疗、针灸治疗4个月不效，后又配合中药培补肾气治疗6个多月亦无明显效果。细察其证，两足足跟、跟腱均痛，走路稍远时，两腿腓肠肌部亦疼痛难忍，且心烦失眠，舌苔薄白，脉弦稍紧。综合脉证，思之：足跟属肾，跟腱与小腿腓肠肌则属肝，合之谓肝肾俱病。脉弦者，肝脉也；紧脉者，寒也。参之与证，当为肝肾俱虚，寒湿不化，肝木失达。治宜补肝益肾，舒筋理肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，干姜4克，薄荷3克，狗脊30克。
服药4剂，疼痛消失，继服2剂，愈。
某医云：逍遥散为疏肝养血之剂，其方尤为妇科医家所习用，内科疾病亦有用之者，然此足跟之痛竞用之，难解也?答日：肝主筋之意，不但指的是筋爪之筋，而且指的是其他部位之筋，即如跟部之筋亦应属之于肝，所以治肝即可治跟腱之筋，因此用逍遥散治之者，不但包括胸胁，而且包括跟腱之筋也。
4．谨察脉证，知其气阴俱虚，湿热不化，予补气养阴，除湿清热，愈
阎××，男，59岁。
足跟疼痛，不敢着地5个月。医诊骨质增生。先予西药治疗1个多月不效，后予骨刺消痛、骨刺停等多种外用擦剂、膏剂与补肾药物治疗不效。细察其证，两足足跟疼痛，不敢着地，咽干咽痛，微咳，舌苔白，脉弦大紧数。综合脉证，思之：弦大紧数并见者，气阴两虚，湿热内蕴证也。治宜补气养阴，燥湿清热。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。
服药6剂，不但咳嗽，咽干咽痛消失，而且足跟疼痛消减近80％，继服6剂，愈。
某医云：清暑益气汤治足跟痛证，不可解也，请明示之?答曰：观其脉证，随证治之，此仲景之明训也。今脉既见弦大紧数，自可用补气养阴法治之，非拘于成方成法也。
肩关节周围炎
1．谨遵脉证，不拘成法，调理气机，其病得愈
曹××，女，40岁。
右肩臂疼痛，抬举困难2年多。医诊肩关节周围炎。先以西药、理疗治之不效，后以按摩、针灸，中药祛风散寒，活血通络，补气养血之剂仍无功。细审其证，除右侧肩臂疼痛抬举困难外，并见头晕头痛，失眠健忘，心烦心悸，舌苔薄白，脉弦紧而涩。综合脉证，思之：肩臂疼痛拘急难抬者，筋之为病；筋者，肝之所主，且脉见弦，弦脉，肝之脉；紧者，寒脉；涩者，滞脉。合而论之，乃肝郁气结，寒滞肝脉也。治宜疏肝理气，温经除湿。处方：柴胡10克，半夏10克，党参10克，甘草10克，生姜3片，大枣5个，桂枝10克，茯苓10克，熟军3克，龙骨15克，牡蛎15克，黄芩10克。
服药4剂，不但头痛失眠，心悸心烦俱减，而且肩臂、项颈疼痛减半，继服10剂，愈。
2．但知其证，不知其位，其病难愈
邓××，男，45岁。
右侧肩臂疼痛，不能抬举3个多月。医诊肩关节周围炎。始以西药、理疗效不著，继又以中药补气养血，祛风散寒，针灸、按摩等仅稍效，但不解决根本问题。细审其证，除右肩不能抬举外，并见右侧颈项亦痛而不能回旋头部，舌苔薄白，脉弦大紧。综合脉证，思之：脉弦大者，气血俱虚也；弦紧之脉者，风寒湿痹阻于筋脉也。治宜补气养血，祛风散寒。然诸医以补气养血，祛风散寒不效者何也，药未达其病所也，宜加姜黄以引经。处方：黄芪20克，当归10克，独活10克，续断10克，秦艽10克，姜黄10克，防风10克，细辛4克，川芎10克，生地10克，白芍10克，桂枝10克，茯苓10克，杜仲10克，川牛膝10克，党参10克，甘草10克。
服药4剂，痛减大半，继服4剂，疼痛消失，愈。
骨关节结核
胶执病名，随病处方，不审脉证，延误治病
成××，男，34岁。
两踝关节肿痛3年多。医始诊为风湿性关节炎。先以西药治之不效，后又配合中药当归拈痛汤，上中下痛风方亦不效。再请数个医院骨科治疗。诊为骨关节结核。以西药抗结核药治疗半年，效仍不够显著。审其两踝关节肿痛，皮色不变，疲乏无力，舌苔薄白，脉虚大弦紧而数，尺脉尤甚。综合脉证，思之：脉虚大弦紧数者，气阴两虚，湿热内蕴也，尺脉大者，肾气不足也。治宜补气养阴，除湿清热，佐以益肾。处方：黄芪20克，当归10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，肉苁蓉10克。
服药7剂，肿痛大减；继服10剂，肿痛消失；加全蝎3克，再服20剂，愈。
某医云：既为骨关节结核，何不用阳和汤治之?答曰：从临床来看骨关节结核主要有两型，一为阳虚型，宜用阳和汤，一为半阴半阳证中的气阴两虚型；本证既有气阴两虚，又有湿热内蕴，故不宜阳和汤，而宜遵其脉证用补气养阴，除湿清热法治之。
痔
1．肛门灼痛，时便鲜血，知其为火，予牛黄解毒丸愈
朱××，男，6l岁。
肛门灼痛，时便鲜血1周，医诊混合痔。先以地榆槐角丸、痔根断、一次消2天，肛门灼痛略减，然而不解决根本问题。思之：牛黄解毒丸，既能燥湿清热，又能泻火解毒，何不以其作梃子塞于肛中以治之。乃将牛黄解毒丸1／3丸捏为梃子如蜜煎导法塞肛中，10分钟后，疼痛大减，20分钟后，疼痛消失，次日，诸证均解。
2．固于成法，不知审证，不知变化，久治乏效
戈××，女，20岁。
反复便血数年。医诊混合痔。先以地榆槐角丸、痔根断症状时有减轻，但仍时时反复发作，不得已，改用手术治疗，术后半年，一切情况良好。但半年后，又发现大量便血。医诊为内痔。再以痔疮膏、地榆槐角丸治之，约10天，便血不减。细审其证，除便血外，并见面色青黄如污尘状，舌质淡，苔白，脉濡缓。综合脉证，思之：脉濡缓而面污尘状者，湿热蕴结于大肠血分也。治宜活血祛瘀，除湿清热。处方：赤小豆80克，当归10克。
服药1剂，便血停止，继服10剂，追访5年，未见复发：
某医云：赤小豆当归散乃《金匮要略》治狐惑酿脓之方也，何用其治痔?答曰：《金匮要略》赤小豆当归散方，一用于治疗狐惑病，二用于治下血之先血后便之近血。今用其治痔，因其能治大肠湿热灼伤血络，正如《金匮要略心典》所说：“下血先血后便者，由大肠伤于湿热，而血渗于下也。大肠与肛门近，故曰近血。赤小豆能行水湿，解热毒，当归引血归经，且举血中陷下之气也。”
3．固于成法，胶于成方，不审脉证，久治不效
董××，男，40岁。
腹痛便血十几年。医诊结肠息肉、内痔。先以中药归脾汤、黄土汤治之不减，继又以手术治疗而便血停止半年。但半年之后，便血又作，且血量较多，血色鲜红。医察息肉较前增多，内痔较前更为严重。患者因畏惧手术，再求中医治疗。细审其证，除腹痛便血之外，并见舌苔薄白，脉弦紧而涩。综合脉证，思之：脉弦紧者，寒也；涩脉者，瘀也。合而论之，乃寒凝血滞也。治宜温经、活血，止血。处方：炒灵脂30克，生灵脂30克，红糖30克。服药1剂，便血腹痛停止；继服10剂，诸证消失，后果愈。
头发、眉毛、胡须全部脱落3年多。医生诊断为斑秃。先用西药治疗半年无效，后用姜片、补骨脂等外擦，服用中药清热凉血、滋养肝肾、活血化瘀、疏通经络等方剂，以及斑秃丸，梅花针、耳针等仍无效果。仔细审查其证候，在3年多前突然头发、眉毛、睫毛、胡须、腋毛全部脱落后，至今没有一根生长，没有其他不适，舌苔白，脉象虚弦。综合脉象和症状，思考：头发是血的余气，突然脱落是因为风邪；皮毛由肺所主，肺气虚则皮毛得不到荣养。脉象虚，说明肺气虚；弦，说明肝血不足。而且病久必累及肾命门，导致肾阴亏损。所以治疗宜补气养阴。处方：黄芪15克，党参10克，白术10克，升麻10克，柴胡10克，陈皮10克，当归10克，甘草6克，生地15克，山药10克，山茱萸10克，茯苓10克，泽泻10克，丹皮10克。
服药30剂后，长出少许白色很细的毛发；继续服用30剂，白色较粗的头发、眉毛、睫毛、胡须、腋毛大部分长出，并有少许黑色毛发出现；又服用上方40剂，所有毛发均变为黑色，痊愈。
某医生说：遍查各种书籍多说血热生风，治疗用清热凉血、滋养肝肾法，方剂适宜乌发丸加减。肝肾不足者，治疗宜补肝益肾，滋养精血，方剂适宜神应养真丹加减。瘀血阻络者，治疗用活血化瘀、疏通经络，方剂适宜通窍活血汤加减。而先生唯独不用这些方法，反而疗效显著，为什么呢？回答说：中医学的核心问题是辨证论治，各种书籍所论述的治疗方法只是针对常见情况而言，而这个病例属于少见且遍请各位医生治疗无效的情况，现在他的脉象和症状，确实属于气阴两虚，所以用补气养阴的方法而治愈。
颈椎病
调阴阳，理枢机，和其筋脉，其病得愈
李××，女，78岁。
头晕、手臂疼痛麻木8个多月。医生诊断为颈椎骨质增生。先用牵引理疗治疗无效，后用按摩、中药活血化瘀的方法也无效果。仔细审查其证候，头晕不能站立，右臂酸痛麻木不能写字、穿衣，失眠健忘，心烦背困，口苦口干，舌苔白，脉象弦紧。综合脉象和症状，思考：脉弦，是肝脉；紧，是寒邪。结合症状，乃是痰饮内郁，肝木失于疏达，筋脉不利。治疗宜调阴阳，理枢机，和筋脉。处方：柴胡10克，半夏10克，党参10克，黄芩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。
服药3剂，头晕、背困、臂痛、手麻等症状均减轻，继服20剂，痊愈。
某医生说：柴胡加龙骨牡蛎汤本是张仲景治疗胸满烦惊的方子，为什么用在颈椎病上反而有效？回答说：柴胡加龙骨牡蛎汤这个方子，一有理肝的作用，二有化饮的作用，三有调阴阳的作用，四有和荣卫的作用，五有助升降的作用，六有和肝胆的作用，七有镇惊止悸的功效，而这个病例从病机来看，恰恰就是这些方面的问题，所以采用此方进行治疗。
颞颌关节脱位
谨遵脉证，随证治之，始获治愈
弓××，女，31岁。
碰伤下颚后张口困难半年多。医生诊断为颞颌关节脱位。先用整复、理疗、针灸治疗无效，继而又用中药活血化瘀的方剂治疗也无效果。仔细审查其证候，除张口困难，不能咀嚼，只能进流质饮食外，并见头晕头胀，心烦失眠，恶心欲吐，口苦咽干，背困而痛，舌苔薄白，脉象弦紧而数。综合脉象和症状，思考：脉弦，是肝脉；紧，是寒邪，也是结滞；紧数相兼，是寒湿凝结。结合症状，乃是肝郁气结，水饮不化，郁而化风。治疗宜疏肝化饮，熄风解痉。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，熟军4克，茯苓15克，龙骨15克，牡蛎15克。
服药2剂，张口稍大，其他症状也减轻，再服5剂，咀嚼、张口自如，继服4剂，痊愈。
某医生说：柴胡加龙骨牡蛎汤能治颞颌关节脱位，我从未听说过，而先生唯独用它取得疗效，原因是什么呢？回答说：张口、闭口，是由筋所主管的，肝主筋，现在湿气郁结在肝胆，风邪因而产生，所以从肝胆来治疗筋病。
跟痛症
1．谨察脉证，知其为脾肾俱虚，予培补脾肾药始愈
汪××，男，73岁。
足跟疼痛8年多。医生诊断为骨刺。先予西药、理疗治疗无效，后予中药活血止痛，软坚散结的方剂仍无效果。且近4年多来，每服西药即腹痛泄泻，为此不得不用中药专治腹泻。仔细审查其证候，除足跟痛、腹痛泄泻外，并见纳呆食减，消瘦乏力，舌苔白，脉象濡缓。综合脉象和症状，思考：这是脾肾俱虚，以脾虚为主的疾病，治疗宜健脾除湿，益肾壮骨。处方：党参10克，茯苓10克，白术10克，扁豆10克，陈皮10克，山药15克，甘草6克，莲子10克，砂仁10克，炒薏米15克，桔梗10克，黄连6克，干姜10克，补骨脂10克，巴戟天10克，白蔻仁10克，焦三仙各10克。
服药4剂，不但腹痛、泄泻都减轻，而且足跟疼痛全部消失，继服4剂，所有症状均消除。
某医生说：资生丸加减治疗泄泻各家都称其有效，然而为什么足跟痛也消失了？回答说：脉证相参乃是脾肾俱虚的征候，所以用培补脾肾的方法而取效，因为足跟属于肾。
2．谨遵脉证，参之经络，治之得愈
文××，女，51岁。
足跟疼痛6年多。医生诊断为骨质增生。先用理疗、西药治疗无效，继而又用针灸、中药活血化瘀，软坚散结的方剂也不见效。仔细审查其证候，除足跟疼痛难于着地外，并见小腿、腰、背及足跟跟腱亦痛，有时痛甚难于入睡，舌苔白，脉象弦细而涩。综合脉象和症状，思考：脉弦，是肝脉；细，是血虚；涩，是寒凝血滞。结合症状，乃是肝肾俱虚，寒凝气滞。治疗宜培补肝肾，温经理肝。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3克，薄荷3克，狗脊30克。
服药4剂，足跟、小腿、腰、背疼痛均减轻，继服10剂，所有症状消失。
某医生说：逍遥散治疗跟痛症我从未听说过，请明示。回答说：足跟属于肾，跟腱乃筋的一类，隶属于肝，肝肾为病，所以治疗肝肾而获得痊愈。
3．凭所主，察病位，合脉象，定病性，治之始愈
霍××，女，65岁。
两足足跟疼痛11个月。经多个医院检查未确诊。先用理疗、针灸治疗4个月无效，后又配合中药培补肾气治疗6个多月亦无明显效果。仔细察看其证候，两足足跟、跟腱均痛，走路稍远时，两腿腓肠肌部亦疼痛难忍，且心烦失眠，舌苔薄白，脉象弦稍紧。综合脉象和症状，思考：足跟属于肾，跟腱与小腿腓肠肌则属于肝，合起来说是肝肾俱病。脉弦，是肝脉；紧脉，是寒邪。参考症状，应当是肝肾俱虚，寒湿不化，肝木失于疏达。治疗宜补肝益肾，舒筋理肝。处方：柴胡10克，当归10克，白芍10克，白术10克，甘草10克，干姜4克，薄荷3克，狗脊30克。
服药4剂，疼痛消失，继服2剂，痊愈。
某医生说：逍遥散是疏肝养血的方剂，其方尤为妇科医家常用，内科疾病也有用它的，然而这个足跟痛竟然也用它，难以理解吗？回答说：肝主筋的意思，不仅指的是筋爪之筋，而且指的是其他部位之筋，即如跟部之筋也应归属于肝，所以治肝即可治跟腱之筋，因此用逍遥散治疗，不仅包括胸胁，而且包括跟腱之筋。
4．谨察脉证，知其气阴俱虚，湿热不化，予补气养阴，除湿清热，愈
阎××，男，59岁。
足跟疼痛，不敢着地5个月。医生诊断为骨质增生。先予西药治疗1个多月无效，后予骨刺消痛、骨刺停等多种外用擦剂、膏剂与补肾药物治疗无效。仔细察看其证候，两足足跟疼痛，不敢着地，咽干咽痛，微咳，舌苔白，脉象弦大紧数。综合脉象和症状，思考：弦大紧数并见者，是气阴两虚，湿热内蕴证。治疗宜补气养阴，燥湿清热。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。
服药6剂，不但咳嗽，咽干咽痛消失，而且足跟疼痛消减近80％，继服6剂，痊愈。
某医生说：清暑益气汤治足跟痛证，不可理解，请明示？回答说：观其脉证，随证治之，这是张仲景的明确教导。现在脉象既见弦大紧数，自然可用补气养阴法治之，并非拘泥于成方成法。
肩关节周围炎
1．谨遵脉证，不拘成法，调理气机，其病得愈
曹××，女，40岁。
右肩臂疼痛，抬举困难2年多。医生诊断为肩关节周围炎。先用西药、理疗治疗无效，后用按摩、针灸，中药祛风散寒，活血通络，补气养血之剂仍无效果。仔细审查其证候，除右侧肩臂疼痛抬举困难外，并见头晕头痛，失眠健忘，心烦心悸，舌苔薄白，脉象弦紧而涩。综合脉象和症状，思考：肩臂疼痛拘急难抬者，是筋的病；筋者，由肝所主，且脉见弦，弦脉，是肝之脉；紧者，是寒脉；涩者，是滞脉。综合论述，乃是肝郁气结，寒滞肝脉。治疗宜疏肝理气，温经除湿。处方：柴胡10克，半夏10克，党参10克，甘草10克，生姜3片，大枣5个，桂枝10克，茯苓10克，熟军3克，龙骨15克，牡蛎15克，黄芩10克。
服药4剂，不但头痛失眠，心悸心烦都减轻，而且肩臂、项颈疼痛减半，继服10剂，痊愈。
2．但知其证，不知其位，其病难愈
邓××，男，45岁。
右侧肩臂疼痛，不能抬举3个多月。医生诊断为肩关节周围炎。开始以西药、理疗效不显著，继而又用中药补气养血，祛风散寒，针灸、按摩等仅稍有效，但不解决根本问题。仔细审查其证候，除右肩不能抬举外，并见右侧颈项亦痛而不能回旋头部，舌苔薄白，脉象弦大紧。综合脉象和症状，思考：脉弦大者，是气血俱虚；弦紧之脉者，是风寒湿痹阻于筋脉。治疗宜补气养血，祛风散寒。然而各位医生用补气养血，祛风散寒无效的原因是什么呢？药物未到达病所，宜加姜黄以引经。处方：黄芪20克，当归10克，独活10克，续断10克，秦艽10克，姜黄10克，防风10克，细辛4克，川芎10克，生地10克，白芍10克，桂枝10克，茯苓10克，杜仲10克，川牛膝10克，党参10克，甘草10克。
服药4剂，痛减大半，继服4剂，疼痛消失，痊愈。
骨关节结核
胶执病名，随病处方，不审脉证，延误治病
成××，男，34岁。
两踝关节肿痛3年多。医生起初诊断为风湿性关节炎。先用西药治疗无效，后又配合中药当归拈痛汤，上中下痛风方也无效。再请数个医院骨科治疗。诊断为骨关节结核。用西药抗结核药治疗半年，效果仍不够显著。审查其两踝关节肿痛，皮色不变，疲乏无力，舌苔薄白，脉象虚大弦紧而数，尺脉尤其明显。综合脉象和症状，思考：脉虚大弦紧数者，是气阴两虚，湿热内蕴也，尺脉大者，是肾气不足也。治疗宜补气养阴，除湿清热，佐以益肾。处方：黄芪20克，当归10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，肉苁蓉10克。
服药7剂，肿痛大减；继服10剂，肿痛消失；加全蝎3克，再服20剂，痊愈。
某医生说：既然是骨关节结核，为何不用阳和汤治疗？回答说：从临床来看骨关节结核主要有两型，一为阳虚型，宜用阳和汤，一为半阴半阳证中的气阴两虚型；本证既有气阴两虚，又有湿热内蕴，故不宜阳和汤，而宜遵循其脉证用补气养阴，除湿清热法治之。
痔
1．肛门灼痛，时便鲜血，知其为火，予牛黄解毒丸愈
朱××，男，61岁。
肛门灼痛，时便鲜血1周，医生诊断为混合痔。先用地的榆槐角丸、痔根断、一次消2天，肛门灼痛略减，然而不解决根本问题。思考：牛黄解毒丸，既能燥湿清热，又能泻火解毒，何不把它做成梃子塞于肛中以治疗。于是将牛黄解毒丸1/3丸捏为梃子如蜜煎导法塞入肛门中，10分钟后，疼痛大减，20分钟后，疼痛消失，次日，所有症状均解除。
2．固于成法，不知审证，不知变化，久治乏效
戈××，女，20岁。
反复便血数年。医生诊断为混合痔。先用地的榆槐角丸、痔根断症状时有减轻，但仍时时反复发作，不得已，改用手术治疗，术后半年，一切情况良好。但半年后，又发现大量便血。医生诊断为内痔。再用痔疮膏、地的榆槐角丸治疗，约10天，便血不减。仔细审查其证候，除便血外，并见面色青黄如污尘状，舌质淡，苔白，脉象濡缓。综合脉象和症状，思考：脉濡缓而面污尘状者，是湿热蕴结于大肠血分也。治疗宜活血祛瘀，除湿清热。处方：赤小豆80克，当归10克。
服药1剂，便血停止，继服10剂，追访5年，未见复发：
某医生说：赤小豆当归散乃《金匮要略》治疗狐惑酿脓的方子，为何用它治疗痔疮？回答说：《金匮要略》赤小豆当归散方，一用于治疗狐惑病，二用于治下血之先血后便的近血。现在用它治疗痔疮，因为它能治大肠湿热灼伤血络，正如《金匮要略心典》所说：“下血先血后便者，由大肠伤于湿热，而血渗于下也。大肠与肛门近，故曰近血。赤小豆能行水湿，解热毒，当归引血归经，且举血中陷下之气也。”
3．固于成法，胶于成方，不审脉证，久治不效
董××，男，40岁。
腹痛便血十几年。医生诊断为结肠息肉、内痔。先用中药归脾汤、黄土汤治疗不减，继而又用手术治疗而便血停止半年。但半年之后，便血又作，且血量较多，血色鲜红。医生观察息肉较前增多，内痔较前更为严重。患者因畏惧手术，再求中医治疗。仔细审查其证候，除腹痛便血之外，并见舌苔薄白，脉象弦紧而涩。综合脉象和症状，思考：脉弦紧者，是寒邪；涩脉者，是瘀血。综合论述，乃是寒凝血滞也。治疗宜温经、活血，止血。处方：炒灵脂30克，生灵脂30克，红糖30克。服药1剂，便血腹痛停止；继服10剂，所有症状消失，后果痊愈。
Hair, eyebrows, beard, and mustache all fell out for more than 3 years. The physician diagnosed alopecia areata (Bantu Tu). Initially treated with Western medicine for half a year without effect, then externally applied with ginger slices and Psoralea corylifolia L. seeds (Buguzhi) etc., taken Chinese herbal formulas for clearing heat and cooling blood, nourishing liver and kidney, invigorating blood and resolving stasis, and unblocking collaterals, as well as Bantu Wan (Alopecia Pill), plum-blossom needle, and auricular acupuncture, yet still without merit. Carefully examining the syndrome: more than 3 years ago, suddenly hair, eyebrows, eyelashes, beard, and axillary hair all fell out, and to this day not a single one has grown back. There were no other complaints. Tongue coating was white, pulse was deficient and wiry (Xu Xian). Synthesizing the pulse and symptoms, I pondered: Hair is the surplus of blood; sudden shedding indicates wind pathogen; skin and hair are governed by the Lung; Lung deficiency leads to lack of nourishment in skin and hair. A deficient pulse indicates Lung deficiency; a wiry pulse indicates Liver blood insufficiency. Moreover, prolonged illness inevitably affects the Kidney Mingmen (Gate of Vitality), leading to Kidney Yin depletion. Therefore, treatment should focus on tonifying Qi and nourishing Yin. Prescription: Astragali Radix (Huangqi) 15g, Codonopsis Radix (Dangshen) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Cimicifugae Rhizoma (Shengma) 10g, Bupleuri Radix (Chaihu) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Angelicae Sinensis Radix (Danggui) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Rehmanniae Radix (Shengdi) 15g, Dioscoreae Rhizoma (Shanyao) 10g, Corni Fructus (Shanzhuyu) 10g, Poria (Fuling) 10g, Alisma Rhizoma (Zexie) 10g, Moutan Cortex (Danpi) 10g.
After taking 30 doses, some very fine white hairs began to grow; continuing for another 30 doses, thicker white hair, eyebrows, eyelashes, beard, and axillary hair grew largely, with some black hairs appearing; after taking the above prescription for another 40 doses, all hair turned black, and the patient recovered.
Another physician asked: Various books state that blood heat generating wind is treated by clearing heat and cooling blood, nourishing liver and kidney, using formulas like Wufa Wan (Blackening Hair Pill) modified. For Liver and Kidney insufficiency, treatment should tonify Liver and benefit Kidney, nourishing essence and blood, using Shenyang Yangzhen Dan modified. For blood stasis blocking collaterals, treatment should invigorate blood and resolve stasis, unblock collaterals, using Tongqiao Huoxue Tang modified. Why did you alone not use these methods, yet achieve remarkable efficacy? Answer: The core issue in Traditional Chinese Medicine is syndrome differentiation and treatment. The treatments discussed in various books only address common cases. This case belongs to rare instances where multiple physicians failed to cure it. Given his current pulse and symptoms, it truly belongs to dual deficiency of Qi and Yin. Thus, treating with tonifying Qi and nourishing Yin led to recovery.
Cervical Spondylosis
Regulating Yin and Yang, managing the pivot, harmonizing sinews and vessels, the disease resolves.
Li XX, Female, 78 years old.
Dizziness, arm pain and numbness for over 8 months. Diagnosed as cervical spondylosis with bone hyperplasia. Initial traction physiotherapy was ineffective; later massage and Chinese herbal medicine for invigorating blood and resolving stasis also failed. Careful examination revealed dizziness preventing standing, right arm sore pain and numbness preventing writing or dressing, insomnia and forgetfulness, vexation and heart discomfort, bitter taste and dry mouth. Tongue coating white, pulse wiry and tight. Synthesizing pulse and symptoms: Wiry pulse indicates Liver; tight indicates Cold. Combined with symptoms, this is internal stagnation of phlegm-fluids, Liver Wood failing to diffuse freely, resulting in sinew and vessel dysfunction. Treatment should regulate Yin and Yang, manage the pivot, and harmonize sinews. Prescription: Bupleuri Radix (Chaihu) 10g, Pinelliae Tuber (Banxia) 10g, Codonopsis Radix (Dangshen) 10g, Scutellariae Radix (Huangqin) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Jujubae Fructus (Dazao) 5 pieces, Cinnamomi Ramulus (Guizhi) 10g, Poria (Fuling) 15g, Prepared Rheum Palmatum Root and Rhizome (Shujun) 3g, Longgu (Dragon Bone) 15g, Muli (Oyster Shell) 15g.
After 3 doses, dizziness, back heaviness, arm pain, and hand numbness all decreased. Continuing for 20 doses resulted in recovery.
Another physician asked: Chaihu Jia Longgu Muli Tang is originally Zhang Zhongjing’s formula for chest fullness, vexation, and fright. Why is it effective for cervical spondylosis? Answer: Chaihu Jia Longgu Muli Tang has seven functions: regulating Liver, transforming fluids, regulating Yin and Yang, harmonizing Ying and Wei, assisting ascending and descending, harmonizing Liver and Gallbladder, and calming fright and stopping palpitations. The pathogenesis of this case precisely involves these aspects, hence the efficacy of this formula.
Temporomandibular Joint Dislocation
Strictly following pulse and syndrome, treating according to the syndrome, cure was eventually achieved.
Gong XX, Female, 31 years old.
Difficulty opening mouth for over half a year after injury to the lower jaw. Diagnosed as temporomandibular joint dislocation. Reduction, physiotherapy, and acupuncture were initially ineffective; subsequent Chinese herbal medicine for invigorating blood and resolving stasis also failed. Careful examination revealed difficulty opening mouth, inability to chew, only able to consume liquid diet, accompanied by dizziness and head distension, vexation and insomnia, nausea and desire to vomit, bitter taste and dry throat, back heaviness and pain. Tongue coating thin white, pulse wiry, tight, and rapid. Synthesizing pulse and symptoms: Wiry indicates Liver; tight indicates Cold and knotting; wiry-tight-rapid combination indicates cold-dampness condensation. Combined with symptoms, this is Liver Qi stagnation and knotting, failure of water-fluids to transform, stagnation transforming into wind. Treatment should soothe Liver, transform fluids, extinguish wind, and relieve spasms. Prescription: Bupleuri Radix (Chaihu) 10g, Pinelliae Tuber (Banxia) 10g, Scutellariae Radix (Huangqin) 10g, Codonopsis Radix (Dangshen) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Jujubae Fructus (Dazao) 5 pieces, Cinnamomi Ramulus (Guizhi) 10g, Prepared Rheum Palmatum Root and Rhizome (Shujun) 4g, Poria (Fuling) 15g, Longgu (Dragon Bone) 15g, Muli (Oyster Shell) 15g.
After 2 doses, mouth opening slightly improved, other symptoms decreased. After another 5 doses, chewing and mouth opening became free. Continuing for 4 doses resulted in recovery.
Another physician asked: I have never heard of Chaihu Jia Longgu Muli Tang treating temporomandibular joint dislocation. Why did your exclusive use yield results? Answer: Opening and closing the mouth are governed by sinews; Liver governs sinews. Currently, dampness stagnates in Liver and Gallbladder, generating wind pathogen. Therefore, treating sinew diseases from the perspective of Liver and Gallbladder is appropriate.
Heel Pain
1. Carefully observing pulse and syndrome, knowing it is dual deficiency of Spleen and Kidney, treating with Spleen and Kidney tonification herbs led to cure.
Wang XX, Male, 73 years old.
Heel pain for over 8 years. Diagnosed as heel spur. Western medicine and physiotherapy were ineffective; Chinese herbal medicine for invigorating blood, relieving pain, softening hardness, and dissipating nodules also failed. For the past 4+ years, every dose of Western medicine caused abdominal pain and diarrhea, necessitating specific Chinese herbal treatment for diarrhea. Careful examination revealed heel pain, abdominal pain, diarrhea, poor appetite, reduced food intake, emaciation, and fatigue. Tongue coating white, pulse soggy and slow. Synthesizing pulse and symptoms: This is a disease of dual Spleen and Kidney deficiency, primarily Spleen deficiency. Treatment should strengthen Spleen, drain dampness, benefit Kidney, and strengthen bones. Prescription: Codonopsis Radix (Dangshen) 10g, Poria (Fuling) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Dolichos Lablab Seed (Bian Dou) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Dioscoreae Rhizoma (Shanyao) 15g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Nelumbinis Semen (Lian Zi) 10g, Amomi Fructus Rotundus (Sharen) 10g, Fried Coix Seed (Chao Yimi) 15g, Platycodonis Radix (Jiegeng) 10g, Coptidis Rhizoma (Huanglian) 6g, Zingiberis Rhizoma (Ganjiang) 10g, Psoraleae Fructus (Buguzhi) 10g, Morinda Officinalis Root (Bajitian) 10g, Tsaoko Fructus (Baiko Ren) 10g, Jiao Sanxian (Scorched Three Immortals) each 10g.
After 4 doses, abdominal pain and diarrhea both decreased, and heel pain completely disappeared. Continuing for 4 doses eliminated all symptoms.
Another physician asked: Zisheng Wan modified is known to be effective for diarrhea by many, but why did heel pain disappear? Answer: Pulse and syndrome indicate dual Spleen and Kidney deficiency. Treating with Spleen and Kidney tonification yielded results because the heel belongs to the Kidney.
2. Strictly following pulse and syndrome, referencing meridians, treatment led to cure.
Wen XX, Female, 51 years old.
Heel pain for over 6 years. Diagnosed as bone hyperplasia. Physiotherapy and Western medicine were ineffective; acupuncture and Chinese herbal medicine for invigorating blood, resolving stasis, softening hardness, and dissipating nodules also failed. Careful examination revealed severe heel pain making weight-bearing difficult, accompanied by pain in calves, waist, back, and Achilles tendon, sometimes so severe as to prevent sleep. Tongue coating white, pulse wiry, fine, and choppy. Synthesizing pulse and symptoms: Wiry indicates Liver; fine indicates Blood deficiency; choppy indicates Cold coagulation and Qi/Blood stagnation. Combined with symptoms, this is dual Liver and Kidney deficiency, Cold coagulation and Qi stagnation. Treatment should tonify Liver and Kidney, warm meridians, and soothe Liver. Prescription: Bupleuri Radix (Chaihu) 10g, Angelicae Sinensis Radix (Danggui) 10g, Paeoniae Radix Alba (Baishao) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Poria (Fuling) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Zingiberis Rhizoma (Ganjiang) 3g, Menthae Haplocalycis Herba (Bohe) 3g, Cibotii Rhizoma (Gouji) 30g.
After 4 doses, pain in heels, calves, waist, and back all decreased. Continuing for 10 doses eliminated all symptoms.
Another physician asked: I have never heard of Xiaoyao San treating heel pain. Please explain. Answer: Heel belongs to Kidney; Achilles tendon is a type of sinew, subordinate to Liver. Disease of Liver and Kidney requires treating Liver and Kidney to achieve cure.
3. Based on governing organs, observing disease location, combining pulse image, determining disease nature, treatment led to cure.
Huo XX, Female, 65 years old.
Pain in both heels for 11 months. Multiple hospital examinations failed to confirm diagnosis. Physiotherapy and acupuncture for 4 months were ineffective; combined with Chinese herbal medicine tonifying Kidney Qi for over 6 months showed no obvious effect. Careful observation revealed pain in both heels and Achilles tendons, unbearable pain in gastrocnemius muscles when walking far, accompanied by vexation and insomnia. Tongue coating thin white, pulse wiry and slightly tight. Synthesizing pulse and symptoms: Heel belongs to Kidney; Achilles tendon and gastrocnemius belong to Liver. Together, this indicates dual Liver and Kidney disease. Wiry pulse indicates Liver; tight pulse indicates Cold. Referencing symptoms, this should be dual Liver and Kidney deficiency, failure of Cold-Dampness to transform, Liver Wood failing to diffuse. Treatment should tonify Liver, benefit Kidney, relax sinews, and soothe Liver. Prescription: Bupleuri Radix (Chaihu) 10g, Angelicae Sinensis Radix (Danggui) 10g, Paeoniae Radix Alba (Baishao) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Zingiberis Rhizoma (Ganjiang) 4g, Menthae Haplocalycis Herba (Bohe) 3g, Cibotii Rhizoma (Gouji) 30g.
After 4 doses, pain disappeared. Continuing for 2 doses resulted in recovery.
Another physician asked: Xiaoyao San is a formula for soothing Liver and nourishing Blood, commonly used by gynecologists, and occasionally in internal medicine. Yet using it for heel pain is hard to understand? Answer: "Liver governs sinews" refers not only to tendons and nails but to sinews in all parts of the body, including those in the heel area. Therefore, treating the Liver treats the Achilles tendon sinews. Using Xiaoyao San thus covers not only hypochondrium but also the sinews of the Achilles tendon.
4. Carefully observing pulse and syndrome, knowing dual deficiency of Qi and Yin with failure of Damp-Heat to transform, treating with tonifying Qi, nourishing Yin, draining dampness, and clearing heat led to cure.
Yan XX, Male, 59 years old.
Heel pain, unable to bear weight for 5 months. Diagnosed as bone hyperplasia. Western medicine for over 1 month was ineffective; topical agents like Guci Xiaotong, Guci Ting, and Kidney-tonifying drugs also failed. Careful examination revealed pain in both heels, inability to bear weight, dry and painful throat, slight cough. Tongue coating white, pulse wiry, large, tight, and rapid. Synthesizing pulse and symptoms: Wiry, large, tight, and rapid together indicate dual deficiency of Qi and Yin with internal accumulation of Damp-Heat. Treatment should tonify Qi, nourish Yin, dry dampness, and clear heat. Prescription: Codonopsis Radix (Dangshen) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Astragali Radix (Huangqi) 15g, Angelicae Sinensis Radix (Danggui) 6g, Ophiopogonis Tuber (Maidong) 10g, Schisandrae Fructus (Wuweizi) 10g, Aurantii Fructus Viridis (Qingpi) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Massae Fermentatae Medicinatae (Shenqu) 10g, Phellodendri Cortex (Huangbai) 10g, Puerariae Radix (Gegen) 15g, Atractylodis Rhizoma (Cangzhu) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Cimicifugae Rhizoma (Shengma) 10g, Alisma Rhizoma (Zexie) 10g.
After 6 doses, cough, dry throat, and throat pain disappeared, and heel pain decreased by nearly 80%. Continuing for 6 doses resulted in recovery.
Another physician asked: Qingshu Yiqi Tang treating heel pain is incomprehensible. Please explain? Answer: Observe pulse and syndrome, treat according to the syndrome—this is Zhang Zhongjing’s clear instruction. Since the pulse shows wiry, large, tight, and rapid, treating with tonifying Qi and nourishing Yin is appropriate, rather than being rigidly bound to established formulas and methods.
Periarthritis of Shoulder Joint
1. Strictly following pulse and syndrome, not adhering rigidly to established methods, regulating Qi mechanism, the disease resolved.
Cao XX, Female, 40 years old.
Right shoulder and arm pain, difficulty lifting for over 2 years. Diagnosed as periarthritis of shoulder joint. Western medicine and physiotherapy were ineffective; massage, acupuncture, and Chinese herbal medicine for dispelling wind, scattering cold, invigorating blood, unblocking collaterals, tonifying Qi, and nourishing Blood also failed. Careful examination revealed right shoulder/arm pain and difficulty lifting, accompanied by dizziness, headache, insomnia, forgetfulness, vexation, and palpitations. Tongue coating thin white, pulse wiry, tight, and choppy. Synthesizing pulse and symptoms: Shoulder/arm pain, stiffness, and difficulty lifting indicate sinew disease; sinews are governed by Liver; wiry pulse is Liver pulse; tight is Cold pulse; choppy is Stagnation pulse. Combined, this is Liver Qi stagnation and knotting, Cold stagnation in Liver meridian. Treatment should soothe Liver, regulate Qi, warm meridians, and drain dampness. Prescription: Bupleuri Radix (Chaihu) 10g, Pinelliae Tuber (Banxia) 10g, Codonopsis Radix (Dangshen) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Zingiberis Rhizoma Recens (Shengjiang) 3 slices, Jujubae Fructus (Dazao) 5 pieces, Cinnamomi Ramulus (Guizhi) 10g, Poria (Fuling) 10g, Prepared Rheum Palmatum Root and Rhizome (Shujun) 3g, Longgu (Dragon Bone) 15g, Muli (Oyster Shell) 15g, Scutellariae Radix (Huangqin) 10g.
After 4 doses, headache, insomnia, palpitations, and vexation all decreased, and shoulder/arm/neck pain halved. Continuing for 10 doses resulted in recovery.
2. Knowing only the syndrome, not the location, makes cure difficult.
Deng XX, Male, 45 years old.
Right shoulder/arm pain, inability to lift for over 3 months. Diagnosed as periarthritis of shoulder joint. Initial Western medicine and physiotherapy had little effect; subsequent Chinese herbal medicine for tonifying Qi and nourishing Blood, dispelling wind and scattering cold, acupuncture, and massage provided only slight relief, failing to solve the root problem. Careful examination revealed inability to lift right shoulder, accompanied by right neck pain preventing head rotation. Tongue coating thin white, pulse wiry, large, and tight. Synthesizing pulse and symptoms: Wiry-large indicates dual deficiency of Qi and Blood; wiry-tight indicates Bi-syndrome of Wind-Cold-Damp obstructing sinews and vessels. Treatment should tonify Qi and Blood, dispel wind and scatter cold. However, previous treatments failed because the medicine did not reach the disease site. Adding Curcumae Longae Rhizoma (Jianghuang) as a guiding herb is suitable. Prescription: Astragali Radix (Huangqi) 20g, Angelicae Sinensis Radix (Danggui) 10g, Angelicae Pubescentis Radix (Duohuo) 10g, Dipsaci Radix (Xuduan) 10g, Gentianae Macrophyllae Radix (Qinjiao) 10g, Curcumae Longae Rhizoma (Jianghuang) 10g, Saposhnikoviae Radix (Fangfeng) 10g, Asari Radix et Rhizoma (Xixin) 4g, Chuanxiong Rhizoma (Chuanxiong) 10g, Rehmanniae Radix (Shengdi) 10g, Paeoniae Radix Alba (Baishao) 10g, Cinnamomi Ramulus (Guizhi) 10g, Poria (Fuling) 10g, Eucommiae Cortex (Duzhong) 10g, Cyathulae Radix (Chuanniuxi) 10g, Codonopsis Radix (Dangshen) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g.
After 4 doses, pain reduced by more than half. Continuing for 4 doses eliminated pain, resulting in recovery.
Tuberculosis of Bone and Joint
Rigidly adhering to disease names, prescribing based on disease without examining pulse and syndrome delays treatment.
Cheng XX, Male, 34 years old.
Swelling and pain in both ankle joints for over 3 years. Initially diagnosed as rheumatoid arthritis. Western medicine was ineffective; combined with Danggui Niantong Tang and Shangzhongxia Fengtong Fang also failed. Consulted several orthopedic departments, diagnosed as tuberculosis of bone and joint. Anti-tuberculosis Western medicine for half a year showed insufficient effect. Examination revealed swelling and pain in both ankles, unchanged skin color, fatigue. Tongue coating thin white, pulse deficient, large, wiry, tight, and rapid, especially at the Chi (Kidney) position. Synthesizing pulse and symptoms: Deficient-large-wiry-tight-rapid indicates dual deficiency of Qi and Yin with internal Damp-Heat; large Chi pulse indicates Kidney Qi insufficiency. Treatment should tonify Qi, nourish Yin, drain dampness, clear heat, assisted by benefiting Kidney. Prescription: Astragali Radix (Huangqi) 20g, Angelicae Sinensis Radix (Danggui) 10g, Codonopsis Radix (Dangshen) 10g, Ophiopogonis Tuber (Maidong) 10g, Schisandrae Fructus (Wuweizi) 10g, Rehmanniae Radix (Shengdi) 15g, Atractylodis Rhizoma (Cangzhu) 10g, Poria (Fuling) 10g, Alisma Rhizoma (Zexie) 10g, Cynomorii Herba (Roucongrong) 10g.
After 7 doses, swelling and pain greatly reduced. Continuing for 10 doses eliminated swelling and pain. Adding Scorpio (Quanxie) 3g, continuing for 20 doses resulted in recovery.
Another physician asked: Since it is tuberculosis of bone and joint, why not use Yanghe Tang? Answer: Clinically, tuberculosis of bone and joint mainly has two types: one is Yang deficiency type, suitable for Yanghe Tang; the other is Qi-Yin dual deficiency type within the semi-Yin semi-Yang syndrome. This case has both Qi-Yin dual deficiency and internal Damp-Heat, thus Yanghe Tang is unsuitable. Instead, following pulse and syndrome, treating with tonifying Qi, nourishing Yin, draining dampness, and clearing heat is appropriate.
Hemorrhoids
1. Burning pain in anus, occasional bright red blood in stool, knowing it is Fire, treating with Niuhuang Jiedu Wan led to cure.
Zhu XX, Male, 61 years old.
Burning pain in anus, occasional bright red blood in stool for 1 week. Diagnosed as mixed hemorrhoids. Diyu Huaijiao Wan, Gen Duan, and Yici Xiao for 2 days slightly reduced burning pain but did not solve the root problem. Pondering: Niuhuang Jiedu Wan can dry dampness, clear heat, purge fire, and resolve toxicity. Why not shape it into a suppository and insert it into the anus for treatment? Thus, 1/3 pill of Niuhuang Jiedu Wan was shaped into a suppository like Mi Jian Dao method and inserted into the anus. After 10 minutes, pain greatly reduced; after 20 minutes, pain disappeared. Next day, all symptoms resolved.
2. Rigidly adhering to established methods, failing to examine syndrome, lacking flexibility, long-term treatment lacks efficacy.
Ge XX, Female, 20 years old.
Recurrent blood in stool for several years. Diagnosed as mixed hemorrhoids. Diyu Huaijiao Wan and Gen Duan temporarily reduced symptoms but recurred frequently. Forced to undergo surgery; post-op half year was good. But half a year later, massive blood in stool reappeared. Diagnosed as internal hemorrhoids. Hemorrhoid ointment and Diyu Huaijiao Wan for about 10 days did not stop bleeding. Careful examination revealed blood in stool, complexion greenish-yellow like dirty dust, pale tongue body, white coating, soggy-slow pulse. Synthesizing pulse and symptoms: Soggy-slow pulse and dirty-dust complexion indicate Damp-Heat accumulating in Large Intestine blood level. Treatment should invigorate blood, resolve stasis, drain dampness, and clear heat. Prescription: Adzuki Bean (Chixiaodou) 80g, Angelicae Sinensis Radix (Danggui) 10g.
After 1 dose, bleeding stopped. Continuing for 10 doses, followed up for 5 years, no recurrence.
Another physician asked: Chixiaodou Danggui San is a formula from Jin Gui Yao Lue for treating Huo Huo disease with pus formation. Why use it for hemorrhoids? Answer: Chixiaodou Danggui San in Jin Gui Yao Lue is used for Huo Huo disease and for lower bleeding where blood precedes stool (Near Blood). Using it for hemorrhoids works because it treats Large Intestine Damp-Heat scorching blood collaterals. As stated in Jin Gui Yao Lue Xin Dian: "Lower bleeding with blood preceding stool is due to Large Intestine injured by Damp-Heat, causing blood to seep downward. Large Intestine is close to anus, hence called Near Blood. Chixiaodou moves water-dampness and resolves heat-toxicity; Danggui guides blood back to its vessels and lifts Qi sunken in the blood."
3. Rigidly adhering to established methods and formulas, failing to examine pulse and syndrome, long-term treatment fails.
Dong XX, Male, 40 years old.
Abdominal pain and blood in stool for over 10 years. Diagnosed as colon polyps and internal hemorrhoids. Guipi Tang and Huangtu Tang initially failed to reduce symptoms; surgery stopped bleeding for half a year. But half a year later, bleeding recurred with larger volume and bright red color. Doctor observed increased polyps and worsened internal hemorrhoids. Patient feared surgery, sought TCM again. Careful examination revealed abdominal pain and blood in stool, thin white tongue coating, wiry-tight-choppy pulse. Synthesizing pulse and symptoms: Wiry-tight indicates Cold; choppy indicates Stasis. Combined, this is Cold coagulation and Blood stagnation. Treatment should warm meridians, invigorate blood, and stop bleeding. Prescription: Processed Pseudolarix Seed (Chaolingzhi) 30g, Raw Pseudolarix Seed (Shenglingzhi) 30g, Brown Sugar (Hongtang) 30g. After 1 dose, bleeding and abdominal pain stopped. Continuing for 10 doses eliminated all symptoms, resulting in eventual cure.