一久泻患者，男性，39岁。泄泻2年多，每日排便10～30余次，并兼里急后重，体重渐减轻，疲乏无力。医始诊为慢性痢疾，予西药治之微效；易医诊为溃疡性结肠炎，再以中西药合用而不效；又请某医，诊为直肠癌，治之仍不效。余审其形销骨立，腹痛下利，里急后重，脉象弦细，先予乌梅丸为汤煎服10剂不效。再察其脉弦细而涩，诊为寒积不化，易温中导滞法治之，处方：附子12克，肉桂12克，党参12克，白术12克，干姜12克，炙甘草12克，枳实12克，厚朴12克，大黄9克，焦山楂30克，炒山药45克。服药一煎之后，腹部绞痛难止，泄泻加重，难于离厕。急请某医以阿托品、吗啡治之。3天后再邀余治，详审病情，思考再三，治则无误，何故病情加重?此非《内经》所云壮火、少火未加注意乎?附、桂、干姜量大则为壮火可耗气，大黄苦寒又损阳耗阴，不可再予。当用小量以补少火，稍佐大黄以祛邪，遂处方：附子0．9克，肉桂0．9克，木香0．3克，干姜O．9克，人参0．9克，白术0．9克，炙甘草0．9克，大黄O．3克，焦山楂3克，炒山药3克。并嘱其隔日服1剂。4日后来诊，云：服上药1剂后，腹痛渐止，饮食稍进，大便减为1日5—6次，服第2剂后，精神大增，大便减为1日3次。
某患者，男性，50岁。胆囊切除术后，腹满胀痛持续不断3年多，先用西药、理疗治之不效，后又配合中药理气消胀之剂仍不效。审其两脉弦紧，夜间胀痛尤剧，诊为脾胃虚寒，予健脾温中之剂治之，处方：附子6克，肉桂6克，党参6克，白术6克，木香6克，砂仁6克，乌药6克。服药10剂，寸效不见。改由白清佐先生治之，处方：黄芪15克，党参13克，附子30克，肉桂30克，干姜15克，小茴香15克，木香15克，砂仁15克，沉香9克，毕澄茄15克，白术15克，苍术15克。服药1剂，诸证大减。患者问：你与白老均诊为脾胃虚寒，均用附、桂之大辛大热，何故你所处方无效，而白老之方有效?余答日：《内经》谓“壮火散气，少火生气。”白老之用附、桂达30克，且有小茴香、毕澄茄之助乃壮火也，壮火散气有余，故气滞得行；余所用附、桂仅6克，乃少火也，少火生气，故胀满不减，而甚或胀满更甚。患者说：服你的药后确见胀痛加重，所以才请白老治疗。
近两年来，研制宝宝一贴灵治疗小儿泄泻、食欲不振，经常遇见一些食欲不振而长期便秘的患儿，频用通下之剂不效．及至改用宝宝一贴灵贴脐之后，非但食欲大增，且大便亦转为正常。某医问：小儿乃纯阳之体，又见便秘纳呆，你却用温热之品的宝宝一贴灵取效，其故安在?答日：宝宝一贴灵虽为健脾温中之品，但其量小热微则为少火，《内径》云：少火之气壮，少火生气。大肠者，传道之官，变化出焉。其能变化者在于阳气。小儿为稚阴稚阳之体，随拨随应，过用克伐则阳衰，补阳不当则助火而为邪。小儿便秘久用克伐之品而损阳气，则非但纳呆，而便更难矣。故用宝宝一贴灵微益阳气以补少火，纳呆、便秘俱愈。
肝与疑难疾病
所谓疑难疾病，我认为应该包括两个概念：一是久治不愈的疾病，二是前人缺乏恰当治疗方法的疾病。笔者经过数十年的临床研究，发现肝在疑难疾病的发生发展中有着举足轻重的作用，在治疗时只要抓住肝这个环节即常常可以使久治不愈的疾病获得转机，甚或步入彻底痊愈的坦途。
一、从肝在人体的重要性看肝与疑难疾病的关系
肝是人体中的一个重要脏腑，前人称其为五脏的特使，将军之官，与少阳胆相表里，而少阳胆为十一脏生化的关键，所以肝在生化气血、协调脏腑、抵御外邪方面起着重要的作用，并对疑难疾病的形成有很大的关系。
1．生化气血脏腑，宣通脏腑气机肝属木，应春阳升发之气，与少阳胆相表里，而少阳胆为五脏六腑生化之主宰，所以脏腑气血经络的生化无不依赖于肝胆，正如李东垣所说：“胆者，少阳春升之气，春气升则万化安，故胆气春升，则余脏从之。”若肝气郁滞，或亢或衰，则诸脏受累而发生气血生化失职，出现各种复杂的疾病，正如沈金鳌所说：“故一阳发生之气，起于厥阴，而一身上下，其气无所不乘，肝和则生气，发育万物，为诸脏之生化，若衰与亢，则能为诸脏之残贼。”所以《素问》在大声疾呼主不明则十二官危的同时，又强调指出：“凡十一脏取决于胆也。”2．协调脏腑气机，调节三焦水道肝与胆相表里，胆之经为足少阳，少阳之气上连于肺，下连于肾，少阳胆气通泰则肾气升，肺气降，若有郁滞，或亢或衰，则肾气不升，肺气不降，故《灵枢·本输》篇说：“少阳属肾，肾上连肺，故将两脏。”心为君火，肝为相火，在五行之中，心属火，肝属木，木火相生，称为母子，故肝气通则心气通，肝气郁则心气结，肝火亢则心火旺，肝气衰则心气虚，正如徐用诚所说：“肝气通则心气和，肝气滞则心气乏，此心病先求于肝，清其源也。”三焦与胆同属少阳，少阳与厥阴相表里，厥阴属肝，三焦为上中下三焦水谷之道路，故肝气调和则水谷之道路调达，津液得以敷布，正如沈金鳌所说：“上焦如雾者，状阳明化物之升气也，云中焦如沤，又云如沥者。状化时沃溢之气也；云下焦如渎者，状挤泌流水之象也，古人诚见乎三焦之气化，一皆胃之气化，一皆相火之所成功耳。”所以历代医学家在强调气化的时候，无不注重肝的升发、郁结，无不重视因郁而生的疾病，正如朱震亨所说：“气血冲和，百病不生，一有怫郁，百病生焉。”
3．抵抗外邪侵入，和调表里营卫肝为将军之官，出卫气，以抵抗外邪的侵入，正如《素问·灵兰秘典论》所说：“肝者，将军之官。”《灵枢·营卫生会》篇：“人受气于谷，谷人于胃，以传于肺，五脏六腑，皆以受气，其清者为营，浊者为卫，营在脉中，卫在脉外。”“营出中焦，卫出下焦。，，下焦者，肝肾也，所以肝气失调则卫气从之。卫气是一种运行于脉外的气，它的主要功能有三点：一是护卫肌表，防御外邪的侵入；二是温养脏腑、肌肉、皮毛；三是调节控制腠理的开合、汗液的排泄，维持体温的相对稳定。《灵枢·本脏》篇说：“卫气者，所以分肉解利，皮肤润柔，腠理致密矣。”所以肝气调和则外邪不得侵入，表里得以协调而无疾。反之，则外邪得人，表里失和而发生感冒、身痛、汗出之病。
4．促进脾胃运化，协调脾胃升降肝主疏泄，肝主升降。脾胃一主水谷之运化，二主升清降浊，三主统摄血液，而其运化、升降、统摄无不依赖于肝的疏泄，升清，正如唐容川所说：“木之性主于疏泄，食气入胃，全赖肝木之气以疏泄之，而水谷乃化；设肝之清阳不升，则不能疏泄水谷，渗泄中满之症在所难免。”所以肝气郁滞，或清阳失升，或肝木亢盛太过则出现脾胃的升降失常，运化失职，而产生腹满、胁痛、恶心、泄泻、便秘。
5．贮存血液，调节血量《灵枢·本神》篇说：“肝藏血。”就是说具有贮藏、调节血量的作用，正如王冰所说：“肝藏血，心行之，人动则血运行于诸经，人静则血归于肝脏。，，通过肝的调节，使脏腑、经络、肌肉等的血量达到相对的恒定。血是构成人体和维持人体生命活动的基本物质，它循行于脉中，内至脏腑，外达肌肉筋骨皮毛，则可使脏腑、经络、肌肉、皮毛得到营养，而其营养运行又靠肝去调节，所以血虚、瘀血等疾病多求之于肝。
6．藏魂主怒，调节情志情志活动虽然主要由心所主导，但由于肝藏魂，主怒，情志活动又主要依赖于气血，肝主疏泄，而藏血，且能宣通三焦气机，故肝气郁结，或亢或衰，则五脏情志随之而抑郁；或亢或衰，发生易怒、易惊、易烦等症。
二、从疑难疾病的症状表现看疑难疾病与肝的关系疑难疾病的症状表现尽管是多种多样的，但从总体上看大都具有以下特征：
1．症状异常复杂，难于抓住重点如有的患者既有头晕头痛，纳呆食减，心烦心悸，又有腹部悸动，逆气上冲，烦热汗出；既有口苦咽干，燥躁失眠，尿热尿痛，又有少腹冰冷，白带量多；既有脉象的紧，又有脉象的兼数，很难用一脏一腑，一经一络，一虚一实，一寒一热去说明。又如有的患者既有疲乏无力、自汗畏风，又有腹满纳呆、发热、恶心欲吐；既有大便秘结、小便黄赤，又有气短神疲；既有脉象之虚，又兼缓而且滑等，这些不但症状复杂，而且很难用哪一种病因病机去解释。
2．症状多变，或冷或热，或上或下，或有或无如有的患者在叙述症状过程中，当说到头痛时，又说不痛；当说到左侧头痛时，又说好象在右侧；当说到头痛异常剧烈时，很快又说不清；有的患者说到关节痛时，又说好象在肌肉，好象在胸胁；当说到灼热疼痛时，又说好象有时象冰块触及样冷等。
3．症状甚少，固定而持久有的患者主诉的症状甚少，或者仅有一个症状，或者没有什么自觉症状，仅是别人的一个偶然发现，才使患者引起注意。如有的患者仅感气短，别无任何自觉症状，但用宽胸理气、补气益肺等法治疗后却一直不见好转；又如有的患者仅感疲乏无力，别无任何自觉症状等。
4．症状常突然出现而又很快消失，不久又出现相同的症状如有的眩晕患者，突然发作站立不稳，或恶心呕吐，但不久症状消失，数日或数月后又重复出现；有的某个部位的疼痛突然发作，但不久又停止，其后又在其他部位或原部位重复发牛。
5．诸气诸血诸脏诸腑诸经诸络的症状共存有的患者从其症状来看几乎所有的脏腑、经络、气血等均有表现。如有的术后肠粘连，既有少腹疼痛不移，又有胸胁胀满，气短纳呆，头晕头痛；既有心烦，又有心悸等。
6．治疗过程极长，用药又非常复杂有的患者既长期应用过西药，又长期应用过中药；既长期应用过理疗、针灸，又长期应用过气功、按摩。在西药中既长期应用过治疗剂，又长期应用过安慰剂。在中药中，既长期应用过寒凉剂，又长期应用过温热剂；既长期应用过补益剂，又长期应用过泻下剂等，但临床效果却不够理想。
疑难疾病的表现尽管是多方面的，但从病机上看大多具有一个共同的特点——气机升降的失常，而气机升降失常的关键脏腑是肝胆，所以说从疑难疾病的症状表现看都与肝有不可分割的关系。
牛黄解毒丸新用
牛黄解毒丸是一个治疗火热内盛，咽喉肿痛、牙龈肿痛、口舌生疮、目赤肿痛的市售内服中成药。由牛黄、雄黄、石膏、大黄、黄芩、桔梗、冰片、甘草等组成。余根据其功用具有清热、燥湿、解毒，又根据外用即内治之理，广泛用于疖肿、丹毒、（月扁）病、肛裂、痔、湿疮等疾病，常获奇效。例如：刘××，男，21岁。项部多发性疖肿，此起彼伏，少则2～3个，多则5～6个，近一个月。前用抗生素治疗20多天，曾有数天消失。近一周来，又在项部发生4个疖肿，红肿疼痛，其中2个已自行溃破流出白色脓汁，另外2个也已化脓，发热，脉滑数。牛黄解毒丸，冷水溶化，外涂。委中放血。10分钟后，疼痛消失，次日愈。袁××，女，40岁。8天前，突然发现两足食趾、中趾红肿疼痛，寒战高热，次日即两腿均红肿疼痛。医诊丹毒。8日后，体温虽然稍退，但仍红肿疼痛，体温39℃，邀余诊治。思其前医之药均称合拍。乃嘱其冷水溶化牛黄解毒丸外涂患处。干则易之，一日数次。4小时后，肿痛大减，体温降至38．1℃，8小时后，体温降至37．1℃，3天后，肿痛消失，体温正常，愈。原××，男，57岁。左腿肿胀疼痛20多天，医诊血栓性深静脉炎。先以抗生素、中药清热解毒之剂，效果不佳。察其左腿从臀以下至足均肿胀疼痛，舌苔白腻，脉弦紧数。综合脉证，诊为湿热蕴阻。嘱其除再服原药外，外以牛黄解毒丸冷水溶化外涂，干则易之，一日数次。次日，疼痛、浮肿均减，一周后，诸证消失，愈。朱××，男，60岁。5日来，肛门肿痛，便血。医诊混合痔。先以痔根断一天，诸证不减。乃停药，改用牛黄解毒丸，以l／3丸用手捻作挺子，塞肛中，5分钟后，疼痛消失，次日，诸证俱失。储××，男，59岁。便血，大便时呈撕裂样疼痛3天。医诊肛裂。嘱其以牛黄解毒丸为挺子，塞肛中，3分钟后，疼痛消失，次日诸证俱解。
宝宝一贴灵新用
余所研制，经山西省芮城制药厂生产的宝宝一贴灵外贴药，原用于小儿的急、慢性腹泻和厌食症。余根据其药味具有温中散寒，化浊和胃之功和外治即内治之理，试用于虚寒证的痛经、腹痛及晕船晕车症，常获卓效。例如：患者高××，女，成。脘腹突然剧烈疼痛。经查无任何阳性体征，因无其他药物，急贴宝宝一贴灵于脐部，1分钟后，疼痛消失。
朱××，女，35岁。素有晕车船之疾，所以每次外出时均需服用晕车药以减轻晕车之苦，但每次药后均感全身不适，疲乏无力，且1～2天后才能恢复体力，为此不得不拒绝外出坐车。嘱其外贴宝宝一贴灵于脐部，每次坐车均未发现头晕呕吐症。
一位长期腹泻的患者，男性，39岁。腹泻两年多，每天排便10～30多次，并伴有里急后重（腹痛窘迫，时时欲便，肛门重坠，便出不爽），体重逐渐减轻，疲乏无力。医生初诊为慢性痢疾（Chronic Dysentery），给予西药治疗，效果微弱；换医诊断为溃疡性结肠炎（Ulcerative Colitis），再用中西药合用仍无效；又请另一位医生，诊断为直肠癌（Rectal Cancer），治疗仍然无效。我审视其形体消瘦、腹部疼痛下利、里急后重、脉象弦细，先给予乌梅丸（Wumei Pill）煎汤服用10剂，无效。再观察其脉象弦细而涩，诊断为寒积不化（Cold accumulation failing to transform），改用温中导滞法（Warming the middle and guiding out stagnation）治疗，处方：附子（Aconite Lateralis Radix Preparata）12克，肉桂（Cortex Cinnamomi）12克，党参（Codonopsis Radix）12克，白术（Atractylodis Macrocephalae Rhizoma）12克，干姜（Zingiberis Rhizoma）12克，炙甘草（Glycyrrhizae Radix et Rhizoma Preparata cum Melle）12克，枳实（Aurantii Fructus Immaturus）12克，厚朴（Magnoliae Officinalis Cortex）12克，大黄（Rhei Radix et Rhizoma）9克，焦山楂（Crataegi Fructus Preparatus）30克，炒山药（Dioscoreae Rhizoma）45克。服药一煎之后，腹部绞痛难止，泄泻加重，难于离开厕所。急忙请某医生以阿托品（Atropine）、吗啡（Morphine）治疗。3天后再邀请我诊治，详细审查病情，思考再三，治则无误，为何病情加重？这难道不是《内经》所说的壮火（Exuberant Fire）和少火（Ministerial Fire）未加注意吗？附子、肉桂、干姜量大则为壮火，可耗气，大黄苦寒又损阳耗阴，不可再予。当用小量以补少火（Nourish Ministerial Fire），稍佐大黄以祛邪，于是处方：附子0.9克，肉桂0.9克，木香（Aucklandiae Radix）0.3克，干姜0.9克，人参（Ginseng Radix）0.9克，白术0.9克，炙甘草0.9克，大黄0.3克，焦山楂3克，炒山药3克。并嘱咐其隔日服1剂。4日后来诊，说：服上药1剂后，腹痛渐止，饮食稍进，大便减为1日5—6次，服第2剂后，精神大增，大便减为1日3次。
另一位患者，男性，50岁。胆囊切除术后，腹满胀痛持续不断3年多，先用西药、理疗（Physiotherapy）治疗无效，后又配合中药理气消胀之剂仍无效。审视其两脉弦紧（String-tight pulse），夜间胀痛尤剧，诊断为脾胃虚寒（Deficiency-cold of Spleen and Stomach），给予健脾温中之剂治疗，处方：附子6克，肉桂6克，党参6克，白术6克，木香6克，砂仁（Amomi Fructus）6克，乌药（Linderae Radix）6克。服药10剂，寸效不见。改由白清佐先生诊治，处方：黄芪（Astragali Radix）15克，党参13克，附子30克，肉桂30克，干姜15克，小茴香（Foeniculi Fructus）15克，木香15克，砂仁15克，沉香（Aquilariae Lignum Resinatum）9克，毕澄茄（Piperis Kadsurae Fructus）15克，白术15克，苍术（Atractylodis Rhizoma）15克。服药1剂，诸证大减。患者问：你与白老均诊断为脾胃虚寒，均用附子、肉桂之大辛大热，为何你的处方无效，而白老的方有效？我回答说：《内经》说“壮火散气，少火生气”（Exuberant fire dissipates Qi, Ministerial fire generates Qi）。白老使用附子、肉桂达30克，且有小茴香、毕澄茄的辅助，乃是壮火，壮火散气有余，故气滞得行；我所用附子、肉桂仅6克，乃是少火，少火生气，故胀满不减，甚至胀满更甚。患者说：服你的药后确实见胀痛加重，所以才请白老治疗。
近两年来，研制宝宝一贴灵（Baobao Yitie Ling）治疗小儿泄泻、食欲不振，经常遇见一些食欲不振而长期便秘的患儿，频用通下之剂（Purgatives）无效。及至改用宝宝一贴灵贴脐之后，非但食欲大增，且大便亦转为正常。某医问：小儿乃纯阳之体（Pure Yang constitution），又见便秘纳呆，你却用温热之品的宝宝一贴灵取效，其故安在？回答说：宝宝一贴灵虽为健脾温中之品，但其量小热微则为少火，《内经》云：少火之气壮，少火生气。大肠者，传道之官，变化出焉。其能变化者在于阳气。小儿为稚阴稚阳之体（Immature Yin and Yang constitution），随拨随应，过用克伐则阳衰，补阳不当则助火而为邪。小儿便秘久用克伐之品而损阳气，则非但纳呆，而便更难矣。故用宝宝一贴灵微益阳气以补少火，纳呆、便秘俱愈。
肝与疑难疾病
所谓疑难疾病，我认为应该包括两个概念：一是久治不愈的疾病，二是前人缺乏恰当治疗方法的疾病。笔者经过数十年的临床研究，发现肝（Liver）在疑难疾病的发生发展中有着举足轻重的作用，在治疗时只要抓住肝这个环节即常常可以使久治不愈的疾病获得转机，甚或步入彻底痊愈的坦途。
一、从肝在人体的重要性看肝与疑难疾病的关系
肝是人体中的一个重要脏腑，前人称其为五脏的特使，将军之官（General Officer），与少阳胆（Shaoyang Gallbladder）相表里，而少阳胆为十一脏生化的关键，所以肝在生化气血、协调脏腑、抵御外邪方面起着重要的作用，并对疑难疾病的形成有很大的关系。
1．生化气血脏腑，宣通脏腑气机
肝属木，应春阳升发之气，与少阳胆相表里，而少阳胆为五脏六腑生化之主宰，所以脏腑气血经络的生化无不依赖于肝胆，正如李东垣所说：“胆者，少阳春升之气，春气升则万化安，故胆气春升，则余脏从之。”若肝气郁滞（Liver Qi Stagnation），或亢或衰，则诸脏受累而发生气血生化失职，出现各种复杂的疾病，正如沈金鳌所说：“故一阳发生之气，起于厥阴，而一身上下，其气无所不乘，肝和则生气，发育万物，为诸脏之生化，若衰与亢，则能为诸脏之残贼。”所以《素问》在大声疾呼主不明则十二官危的同时，又强调指出：“凡十一脏取决于胆也。”
2．协调脏腑气机，调节三焦水道
肝与胆相表里，胆之经为足少阳，少阳之气上连于肺，下连于肾，少阳胆气通泰则肾气升，肺气降，若有郁滞，或亢或衰，则肾气不升，肺气不降，故《灵枢·本输》篇说：“少阳属肾，肾上连肺，故将两脏。”心为君火（Monarch Fire），肝为相火（Ministerial Fire），在五行之中，心属火，肝属木，木火相生，称为母子，故肝气通则心气通，肝气郁则心气结，肝火亢则心火旺，肝气衰则心气虚，正如徐用诚所说：“肝气通则心气和，肝气滞则心气乏，此心病先求于肝，清其源也。”三焦（Sanjiao/Triple Burner）与胆同属少阳，少阳与厥阴相表里，厥阴属肝，三焦为上中下三焦水谷之道路，故肝气调和则水谷之道路调达，津液得以敷布，正如沈金鳌所说：“上焦如雾者，状阳明化物之升气也，云中焦如沤，又云如沥者。状化时沃溢之气也；云下焦如渎者，状挤泌流水之象也，古人诚见乎三焦之气化，一皆胃之气化，一皆相火之所成功耳。”所以历代医学家在强调气化的时候，无不注重肝的升发、郁结，无不重视因郁而生的疾病，正如朱震亨所说：“气血冲和，百病不生，一有怫郁，百病生焉。”
3．抵抗外邪侵入，和调表里营卫
肝为将军之官，出卫气（Wei Qi/Defensive Qi），以抵抗外邪的侵入，正如《素问·灵兰秘典论》所说：“肝者，将军之官。”《灵枢·营卫生会》篇：“人受气于谷，谷入于胃，以传于肺，五脏六腑，皆以受气，其清者为营（Ying Qi/Nutritive Qi），浊者为卫，营在脉中，卫在脉外。”“营出中焦，卫出下焦。”下焦者，肝肾也，所以肝气失调则卫气从之。卫气是一种运行于脉外的气，它的主要功能有三点：一是护卫肌表，防御外邪的侵入；二是温养脏腑、肌肉、皮毛；三是调节控制腠理（Cou Li/Pores and Intercellular Spaces）的开合、汗液的排泄，维持体温的相对稳定。《灵枢·本脏》篇说：“卫气者，所以分肉解利，皮肤润柔，腠理致密矣。”所以肝气调和则外邪不得侵入，表里得以协调而无疾。反之，则外邪得人，表里失和而发生感冒、身痛、汗出之病。
4．促进脾胃运化，协调脾胃升降
肝主疏泄（Free Flow of Qi），肝主升降。脾胃一主水谷之运化，二主升清降浊，三主统摄血液，而其运化、升降、统摄无不依赖于肝的疏泄，升清，正如唐容川所说：“木之性主于疏泄，食气入胃，全赖肝木之气以疏泄之，而水谷乃化；设肝之清阳不升，则不能疏泄水谷，渗泄中满之症在所难免。”所以肝气郁滞，或清阳失升，或肝木亢盛太过则出现脾胃的升降失常，运化失职，而产生腹满、胁痛、恶心、泄泻、便秘。
5．贮存血液，调节血量
《灵枢·本神》篇说：“肝藏血。”就是说具有贮藏、调节血量的作用，正如王冰所说：“肝藏血，心行之，人动则血运行于诸经，人静则血归于肝脏。”通过肝的调节，使脏腑、经络、肌肉等的血量达到相对的恒定。血是构成人体和维持人体生命活动的基本物质，它循行于脉中，内至脏腑，外达肌肉筋骨皮毛，则可使脏腑、经络、肌肉、皮毛得到营养，而其营养运行又靠肝去调节，所以血虚、瘀血（Blood Stasis）等疾病多求之于肝。
6．藏魂主怒，调节情志
情志活动虽然主要由心所主导，但由于肝藏魂（Hun/Soul），主怒，情志活动又主要依赖于气血，肝主疏泄，而藏血，且能宣通三焦气机，故肝气郁结，或亢或衰，则五脏情志随之而抑郁；或亢或衰，发生易怒、易惊、易烦等症。
二、从疑难疾病的症状表现看疑难疾病与肝的关系
疑难疾病的症状表现尽管是多种多样的，但从总体上看大都具有以下特征：
1．症状异常复杂，难于抓住重点
如有的患者既有头晕头痛，纳呆食减，心烦心悸，又有腹部悸动，逆气上冲，烦热汗出；既有口苦咽干，燥躁失眠，尿热尿痛，又有少腹冰冷，白带量多；既有脉象的紧，又有脉象的兼数，很难用一脏一腑，一经一络，一虚一实，一寒一热去说明。又如有的患者既有疲乏无力、自汗畏风，又有腹满纳呆、发热、恶心欲吐；既有大便秘结、小便黄赤，又有气短神疲；既有脉象之虚，又兼缓而且滑等，这些不但症状复杂，而且很难用哪一种病因病机去解释。
2．症状多变，或冷或热，或上或下，或有或无
如有的患者在叙述症状过程中，当说到头痛时，又说不痛；当说到左侧头痛时，又说好象在右侧；当说到头痛异常剧烈时，很快又说不清；有的患者说到关节痛时，又说好象在肌肉，好象在胸胁；当说到灼热疼痛时，又说好象有时象冰块触及样冷等。
3．症状甚少，固定而持久
有的患者主诉的症状甚少，或者仅有一个症状，或者没有什么自觉症状，仅是别人的一个偶然发现，才使患者引起注意。如有的患者仅感气短，别无任何自觉症状，但用宽胸理气、补气益肺等法治疗后却一直不见好转；又如有的患者仅感疲乏无力，别无任何自觉症状等。
4．症状常突然出现而又很快消失，不久又出现相同的症状
如有的眩晕患者，突然发作站立不稳，或恶心呕吐，但不久症状消失，数日或数月后又重复出现；有的某个部位的疼痛突然发作，但不久又停止，其后又在其他部位或原部位重复发生。
5．诸气诸血诸脏诸腑诸经诸络的症状共存
有的患者从其症状来看几乎所有的脏腑、经络、气血等均有表现。如有的术后肠粘连（Postoperative intestinal adhesions），既有少腹疼痛不移，又有胸胁胀满，气短纳呆，头晕头痛；既有心烦，又有心悸等。
6．治疗过程极长，用药又非常复杂
有的患者既长期应用过西药，又长期应用过中药；既长期应用过理疗、针灸（Acupuncture and Moxibustion），又长期应用过气功、按摩。在西药中既长期应用过治疗剂，又长期应用过安慰剂。在中药中，既长期应用过寒凉剂，又长期应用过温热剂；既长期应用过补益剂，又长期应用过泻下剂等，但临床效果却不够理想。
疑难疾病的表现尽管是多方面的，但从病机上看大多具有一个共同的特点——气机升降的失常，而气机升降失常的关键脏腑是肝胆，所以说从疑难疾病的症状表现看都与肝有不可分割的关系。
牛黄解毒丸新用
牛黄解毒丸（Niuhuang Jiedu Wan）是一个治疗火热内盛，咽喉肿痛、牙龈肿痛、口舌生疮、目赤肿痛的市售内服中成药。由牛黄（Calculus Bovis）、雄黄（Realgar）、石膏（Gypsum Fibrosum）、大黄、黄芩（Scutellariae Radix）、桔梗（Platycodonis Radix）、冰片（Borneolum Syntheticum）、甘草等组成。余根据其功用具有清热（Clearing Heat）、燥湿（Drying Dampness）、解毒（Detoxification），又根据外用即内治之理，广泛用于疖肿（Furuncle）、丹毒（Erysipelas）、瘭病（Phlegmon? Note: Text says 月扁病, likely typo for 瘭疽 or similar soft tissue infection）、肛裂（Anal Fissure）、痔（Hemorrhoids）、湿疮（Eczema）等疾病，常获奇效。例如：刘××，男，21岁。项部多发性疖肿，此起彼伏，少则2～3个，多则5～6个，近一个月。前用抗生素治疗20多天，曾有数天消失。近一周来，又在项部发生4个疖肿，红肿疼痛，其中2个已自行溃破流出白色脓汁，另外2个也已化脓，发热，脉滑数。牛黄解毒丸，冷水溶化，外涂。委中（Weizhong BL40）放血。10分钟后，疼痛消失，次日愈。袁××，女，40岁。8天前，突然发现两足食趾、中趾红肿疼痛，寒战高热，次日即两腿均红肿疼痛。医诊丹毒。8日后，体温虽然稍退，但仍红肿疼痛，体温39℃，邀余诊治。思其前医之药均称合拍。乃嘱其冷水溶化牛黄解毒丸外涂患处。干则易之，一日数次。4小时后，肿痛大减，体温降至38．1℃，8小时后，体温降至37．1℃，3天后，肿痛消失，体温正常，愈。原××，男，57岁。左腿肿胀疼痛20多天，医诊血栓性深静脉炎（Thrombophlebitis）。先以抗生素、中药清热解毒之剂，效果不佳。察其左腿从臀以下至足均肿胀疼痛，舌苔白腻，脉弦紧数。综合脉证，诊为湿热蕴阻（Damp-Heat Accumulation and Obstruction）。嘱其除再服原药外，外以牛黄解毒丸冷水溶化外涂，干则易之，一日数次。次日，疼痛、浮肿均减，一周后，诸证消失，愈。朱××，男，60岁。5日来，肛门肿痛，便血。医诊混合痔（Mixed Hemorrhoids）。先以痔根断一天，诸证不减。乃停药，改用牛黄解毒丸，以l／3丸用手捻作挺子，塞肛中，5分钟后，疼痛消失，次日，诸证俱失。储××，男，59岁。便血，大便时呈撕裂样疼痛3天。医诊肛裂。嘱其以牛黄解毒丸为挺子，塞肛中，3分钟后，疼痛消失，次日诸证俱解。
宝宝一贴灵新用
余所研制，经山西省芮城制药厂生产的宝宝一贴灵外贴药，原用于小儿的急、慢性腹泻和厌食症（Anorexia）。余根据其药味具有温中散寒，化浊和胃之功和外治即内治之理，试用于虚寒证的痛经（Dysmenorrhea）、腹痛及晕船晕车症（Motion Sickness），常获卓效。例如：患者高××，女，成。脘腹突然剧烈疼痛。经查无任何阳性体征，因无其他药物，急贴宝宝一贴灵于脐部，1分钟后，疼痛消失。
朱××，女，35岁。素有晕车船之疾，所以每次外出时均需服用晕车药以减轻晕车之苦，但每次药后均感全身不适，疲乏无力，且1～2天后才能恢复体力，为此不得不拒绝外出坐车。嘱其外贴宝宝一贴灵于脐部，每次坐车均未发现头晕呕吐症。
A patient with chronic diarrhea, male, 39 years old. Diarrhea for over two years, defecating 10–30+ times daily, accompanied by tenesmus (urgent need to defecate with a feeling of incomplete evacuation), gradual weight loss, fatigue, and weakness. The initial physician diagnosed chronic dysentery and prescribed Western medicine with minimal effect; another physician diagnosed ulcerative colitis, and combined Chinese and Western medicines without success; yet another physician diagnosed rectal cancer, but treatment remained ineffective. I examined his emaciated body, abdominal pain with diarrhea, tenesmus, and a string-tight and fine pulse. Initially, I prescribed Wumei Decoction (Wumei Tang) for 10 doses, but it was ineffective. Re-examining his string-tight, fine, and choppy pulse, I diagnosed cold accumulation failing to transform and changed the treatment to warming the middle and guiding out stagnation. The prescription included: Aconite Lateralis Radix Preparata (Fu Zi) 12g, Cortex Cinnamomi (Rou Gui) 12g, Codonopsis Radix (Dang Shen) 12g, Atractylodis Macrocephalae Rhizoma (Bai Zhu) 12g, Zingiberis Rhizoma (Gan Jiang) 12g, Glycyrrhizae Radix et Rhizoma Preparata cum Melle (Zhi Gan Cao) 12g, Aurantii Fructus Immaturus (Zhi Shi) 12g, Magnoliae Officinalis Cortex (Hou Po) 12g, Rhei Radix et Rhizoma (Da Huang) 9g, Crataegi Fructus Preparatus (Jiao Shan Zha) 30g, Dioscoreae Rhizoma (Chao Shan Yao) 45g. After one dose, severe abdominal colic persisted, diarrhea worsened, and he could hardly leave the toilet. An emergency visit was made to another doctor who administered Atropine and Morphine. Three days later, I was invited again. After carefully reviewing the condition and pondering deeply, although the therapeutic principle was correct, why did the condition worsen? Was this not due to neglecting the distinction between Exuberant Fire (Zhuang Huo) and Ministerial Fire (Shao Huo) as stated in the *Neijing*? Large doses of Aconite, Cinnamon Twig, and Dried Ginger constitute Exuberant Fire, which can consume Qi; Da Huang is bitter and cold, damaging Yang and consuming Yin, so it should no longer be used. Instead, small doses should be used to nourish Ministerial Fire, with a slight addition of Da Huang to expel pathogens. Thus, the new prescription was: Aconite Lateralis Radix Preparata 0.9g, Cortex Cinnamomi 0.9g, Aucklandiae Radix (Mu Xiang) 0.3g, Zingiberis Rhizoma 0.9g, Ginseng Radix (Ren Shen) 0.9g, Atractylodis Macrocephalae Rhizoma 0.9g, Glycyrrhizae Radix et Rhizoma Preparata cum Melle 0.9g, Rhei Radix et Rhizoma 0.3g, Crataegi Fructus Preparatus 3g, Dioscoreae Rhizoma 3g. He was instructed to take one dose every other day. Four days later, he reported that after the first dose, abdominal pain gradually ceased, appetite slightly improved, and bowel movements reduced to 5–6 times daily; after the second dose, energy significantly increased, and bowel movements reduced to 3 times daily.
Another patient, male, 50 years old. Persistent abdominal fullness and distending pain for over three years following cholecystectomy. Initial treatment with Western medicine and physiotherapy failed; subsequent combination with Chinese medicine for regulating Qi and reducing distension also failed. Examination revealed string-tight pulses in both wrists, with worse pain at night. Diagnosed as deficiency-cold of the Spleen and Stomach, I prescribed a formula to strengthen the Spleen and warm the Middle: Aconite Lateralis Radix Preparata 6g, Cortex Cinnamomi 6g, Codonopsis Radix 6g, Atractylodis Macrocephalae Rhizoma 6g, Aucklandiae Radix 6g, Amomi Fructus (Sha Ren) 6g, Linderae Radix (Wu Yao) 6g. After 10 doses, there was no effect. Treatment was then taken over by Mr. Bai Qingzuo, who prescribed: Astragali Radix (Huang Qi) 15g, Codonopsis Radix 13g, Aconite Lateralis Radix Preparata 30g, Cortex Cinnamomi 30g, Zingiberis Rhizoma 15g, Foeniculi Fructus (Xiao Hui Xiang) 15g, Aucklandiae Radix 15g, Amomi Fructus 15g, Aquilariae Lignum Resinatum (Chen Xiang) 9g, Piperis Kadsurae Fructus (Bi Cheng Qie) 15g, Atractylodis Rhizoma (Cang Zhu) 15g. After one dose, symptoms greatly subsided. The patient asked: "Both you and Mr. Bai diagnosed deficiency-cold of the Spleen and Stomach and used large amounts of hot herbs like Aconite and Cinnamon. Why was your prescription ineffective while Mr. Bai's was effective?" I replied: "The *Neijing* states, 'Exuberant fire dissipates Qi, Ministerial fire generates Qi.' Mr. Bai used 30g of Aconite and Cinnamon, assisted by Fennel and Black Pepper Berry, constituting Exuberant Fire. This strongly disperses Qi, thereby resolving Qi stagnation. My use of only 6g constituted Ministerial Fire, which generates Qi but may not sufficiently resolve stagnation, hence the persistent or worsening distension." The patient admitted that his pain indeed worsened after taking my medication, prompting him to seek Mr. Bai's help.
In recent years, while developing Baobao Yitie Ling (Baby Patch) for pediatric diarrhea and anorexia, I frequently encountered children with long-term constipation and poor appetite who did not respond to frequent use of purgatives. However, after applying Baobao Yitie Ling to the umbilicus, their appetite significantly increased, and bowel movements normalized. A colleague asked: "Children are considered to have a pure Yang constitution. Given their constipation and poor appetite, why does using the warm-natured Baobao Yitie Ling yield results?" I answered: "Although Baobao Yitie Ling strengthens the Spleen and warms the Middle, its small dosage and mild heat constitute Ministerial Fire. The *Neijing* says, 'The Qi of Ministerial Fire is robust; Ministerial fire generates Qi.' The Large Intestine is the official responsible for transmission and transformation, which depends on Yang Qi. Children have immature Yin and Yang constitutions and respond quickly to stimulation. Overuse of draining methods leads to Yang deficiency, while improper tonification of Yang can generate pathogenic fire. Long-term use of draining agents for constipation damages Yang Qi, leading to not only poor appetite but also harder stools. Therefore, using Baobao Yitie Ling to mildly benefit Yang Qi and nourish Ministerial Fire resolves both anorexia and constipation."
**Liver and Intractable Diseases**
I believe "intractable diseases" encompass two concepts: diseases that do not heal despite prolonged treatment, and diseases for which predecessors lacked appropriate treatment methods. Through decades of clinical research, I have found that the Liver plays a pivotal role in the occurrence and development of intractable diseases. In treatment, grasping the Liver aspect often turns around stubborn diseases, potentially leading to complete recovery.
**1. The Importance of the Liver in Relation to Intractable Diseases**
The Liver is a vital organ. Ancients called it the "Envoy of the Five Zang Organs" and the "General Officer." It has a exterior-interior relationship with the Shaoyang Gallbladder, which is key to the metabolism of the eleven organs. Thus, the Liver is crucial in generating Qi and Blood, coordinating Zang-Fu organs, and resisting external pathogens, significantly influencing the formation of intractable diseases.
1. **Generating Qi and Blood, Promoting Qi Mechanism:** The Liver belongs to Wood and corresponds to the ascending Qi of Spring. As the master of metabolic generation for all organs, the generation of Qi, Blood, and meridians depends on the Liver and Gallbladder. As Li Dongyuan said, "The Gallbladder possesses the ascending Qi of Shaoyang Spring. When Spring Qi ascends, all transformations are peaceful. Thus, when Gallbladder Qi ascends in Spring, the other organs follow." If Liver Qi stagnates, becomes hyperactive, or deficient, other organs are affected, leading to complex diseases due to failure in Qi and Blood generation. As Shen Jin'ao stated, "The initiating Qi of Yang originates from Jueyin. Its Qi permeates the entire body. When the Liver is harmonious, it generates Qi and nurtures all things... if deficient or hyperactive, it becomes a destroyer of other organs." Hence, *Suwen* emphasizes, "All eleven organs depend on the Gallbladder."
2. **Coordinating Organ Qi Mechanism, Regulating Sanjiao Waterways:** The Liver and Gallbladder are exterior-interior partners. Shaoyang Qi connects upward to the Lung and downward to the Kidney. Smooth Gallbladder Qi allows Kidney Qi to ascend and Lung Qi to descend. Stagnation or imbalance disrupts this, as noted in *Lingshu*: "Shaoyiel belongs to the Kidney, which connects upward to the Lung, thus governing two organs." The Heart is Monarch Fire, the Liver is Ministerial Fire. In Five Elements, Wood generates Fire (Mother-Child relationship). Thus, smooth Liver Qi ensures smooth Heart Qi; stagnation causes Heart Qi knotting; hyperactivity causes Heart Fire flaring; deficiency causes Heart Qi deficiency. Xu Yongcheng said, "Smooth Liver Qi harmonizes Heart Qi; stagnant Liver Qi depletes Heart Qi. For Heart disease, seek the Liver first to clear the source." The Sanjiao shares the Shaoyael category with the Gallbladder. Harmonious Liver Qi ensures smooth pathways for water and grain and distribution of Body Fluids. Shen Jin'ao described the Sanjiao functions as mist, fermentation, and drainage, all dependent on Stomach Qi and Ministerial Fire. Therefore, physicians emphasize Liver ascending and stagnation, noting that "When Qi and Blood are harmonious, no disease arises; once depressed, myriad diseases occur" (Zhu Zhenheng).
3. **Resisting External Pathogens, Harmonizing Exterior and Interior Ying and Wei:** The Liver, as General Officer, produces Wei Qi (Defensive Qi) to resist external pathogens. *Suwen* states, "The Liver is the General Officer." *Lingshu* explains that clear Qi becomes Ying Qi (Nutritive Qi) inside vessels, and turbid Qi becomes Wei Qi outside vessels. Wei Qi originates from the Lower Jiao (Kidney/Liver). If Liver Qi is disordered, Wei Qi is affected. Wei Qi protects the body surface, warms organs and muscles, and regulates pores and sweating. Harmonious Liver Qi prevents external invasion and maintains interior-exterior harmony. Conversely, external pathogens invade, causing colds, body pain, and sweating disorders.
4. **Promoting Spleen-Stomach Digestion, Coordinating Ascending and Descending:** The Liver governs free flow and ascending-descending movements. The Spleen and Stomach digest food, ascend clear and descend turbid, and control blood. These functions rely on Liver free flow. Tang Rongchuan said, "Wood nature is free flow. Food entering the Stomach relies on Liver Wood Qi to dredge it for digestion. If Liver Clear Yang fails to ascend, it cannot dredge food/water, leading to fullness and leakage." Thus, Liver stagnation or excessive hyperactivity causes Spleen-Stomach dysfunction, resulting in abdominal fullness, hypochondriac pain, nausea, diarrhea, and constipation.
5. **Storing Blood, Regulating Blood Volume:** *Lingshu* states, "The Liver stores Blood." Wang Bing explained, "The Liver stores Blood, the Heart moves it. Movement sends blood to meridians; stillness returns it to the Liver." This regulation maintains constant blood volume in organs and tissues. Since blood nourishes these structures under Liver regulation, conditions like Blood Deficiency and Blood Stasis are often treated via the Liver.
6. **Storing Hun, Governing Anger, Regulating Emotions:** Although the Heart主导 emotions, the Liver stores Hun and governs anger. Emotions depend on Qi and Blood. Liver free flow and blood storage regulate Sanjiao Qi. Liver Qi stagnation or imbalance causes emotional depression or irritability, fright, and anxiety.
**2. Symptoms of Intractable Diseases and Their Relationship with the Liver**
Symptoms vary but share common features:
1. **Complex Symptoms, Hard to Pinpoint:** Patients may have dizziness, headache, poor appetite, palpitations, abdominal throbbing, rising Qi, fever, sweating, bitter taste, dry throat, insomnia, painful urination, cold lower abdomen, leukorrhea, tight pulse, rapid pulse, etc. These defy simple single-organ or single-meridian explanations. Other cases show fatigue, spontaneous sweating, wind aversion, abdominal fullness, fever, nausea, constipation, dark urine, shortness of breath, weak/slow/sliding pulses. Etiology and pathogenesis are hard to explain simply.
2. **Variable Symptoms:** Pain may shift locations (head, left/right side, joints, muscles, chest/hypochondrium). Sensations may change from burning to cold. Symptoms may appear and disappear rapidly.
3. **Few, Fixed, Persistent Symptoms:** Some patients report only shortness of breath or fatigue without other subjective symptoms, unresponsive to standard treatments like Qi-regulating or Lung-tonifying methods.
4. **Sudden Onset and Disappearance:** Vertigo, nausea, vomiting, or localized pain may appear suddenly, vanish, and recur days or months later in different or same locations.
5. **Coexistence of Multi-Organ/Multi-Meridian Symptoms:** Post-operative intestinal adhesions may present with fixed lower abdominal pain, chest/hypochondriac fullness, shortness of breath, poor appetite, dizziness, headache, irritability, and palpitations, involving almost all organs and meridians.
6. **Long Treatment Course, Complex Medication:** Patients often have long histories of Western medicine, Chinese medicine, physiotherapy, acupuncture, Qigong, massage, tonics, purgatives, cold/heat formulas, with unsatisfactory results.
Despite diverse manifestations, the common pathological mechanism is abnormal ascending and descending of Qi, key to which is the Liver and Gallbladder. Thus, intractable diseases are inseparably linked to the Liver.
**New Uses of Niuhuang Jiedu Wan**
Niuhuang Jiedu Wan is a patent medicine for internal heat excess, sore throat, swollen gums, mouth ulcers, and red/swollen eyes. Ingredients include Calculus Bovis (Niu Huang), Realgar (Xiong Huang), Gypsum Fibrosum (Shi Gao), Rhei Radix et Rhizoma (Da Huang), Scutellariae Radix (Huang Qin), Platycodonis Radix (Jie Geng), Borneolum Syntheticum (Bing Pian), and Glycyrrhizae Radix et Rhizoma (Gan Cao). Based on its heat-clearing, damp-drying, and detoxifying properties, and the principle that external application treats internal conditions, I widely use it for furuncles, erysipelas, phlegmon, anal fissures, hemorrhoids, and eczema, often with miraculous effects.
* Case 1: Liu XX, Male, 21. Multiple furuncles on the neck for one month. Antibiotics failed. New outbreak: red, swollen, painful, some suppurating, fever, slippery-rapid pulse. Applied dissolved Niuhuang Jiedu Wan externally. Bleeding at Weizhong (BL40). Pain vanished in 10 minutes; cured next day.
* Case 2: Yuan XX, Female, 40. Sudden redness, swelling, pain in toes, chills, high fever (39°C). Diagnosed with erysipelas. Previous meds ineffective. Applied dissolved Niuhuang Jiedu Wan externally. Swelling/pain reduced greatly in 4 hours; temp dropped to 38.1°C. In 8 hours, temp 37.1°C. Cured in 3 days.
* Case 3: Yuan XX, Male, 57. Left leg swelling/pain for 20 days. Diagnosed with thrombophlebitis. Antibiotics and heat-clearing herbs ineffective. White greasy coating, string-tight-rapid pulse. Diagnosed as Damp-Heat Accumulation. Continued oral meds + external Niuhuang Jiedu Wan. Pain/swelling reduced next day; cured in one week.
* Case 4: Zhu XX, Male, 60. Anal swelling/pain and bleeding for 5 days. Mixed hemorrhoids. Previous med ineffective. Inserted 1/3 pill into anus. Pain vanished in 5 minutes; cured next day.
* Case 5: Chu XX, Male, 59. Rectal bleeding, tearing pain during defecation for 3 days. Anal fissure. Inserted pill into anus. Pain vanished in 3 minutes; cured next day.
**New Uses of Baobao Yitie Ling**
Baobao Yitie Ling, produced by Ruicheng Pharmaceutical Factory, Shanxi, originally for pediatric acute/chronic diarrhea and anorexia. Based on its ability to warm the Middle, dispel cold, transform turbidity, and harmonize the Stomach, and the external-internal treatment principle, I tested it for dysmenorrhea, abdominal pain, and motion sickness due to deficiency-cold, achieving excellent results.
* Case 1: Gao XX, Female. Sudden severe epigastric/abdominal pain. No positive signs on exam. Applied Baobao Yitie Ling to umbilicus. Pain vanished in 1 minute.
* Case 2: Zhu XX, Female, 35. History of motion sickness. Oral meds caused fatigue and malaise, requiring 1-2 days recovery. Applied Baobao Yitie Ling to umbilicus before travel. No dizziness or vomiting occurred.