从虚证中找出夹有的实和从实证中找出夹有的虚，以及从寒证中找出夹有的热，从热证中找出夹有的寒，从表证中找出夹有的里，从里证中找出夹有的表，从阴证中找出夹有的阳，从阳证中找出夹有的阴，并从中找出它们的比例，然后按照这些不同的比例去进行处方用药，是提高疗效的重要方法。例如：脾胃病中的半夏泻心汤证和黄连汤证，都是寒热夹杂证，但由于它们有寒热多少的不同，所以有寒多热少的半夏泻心汤和热多寒少的黄连汤，温脾汤证和九痛丸证都是脾胃病中的虚实夹杂证，但由于证有虚多实少和实多虚少，所以有补多于泻的温脾汤和泻多于补的九痛丸。桂枝人参汤证和桂枝加附子汤证都是外感病中的表里夹杂证，但由于证有里多表少和表多里少，所以有里多于表散的桂枝人参汤和表散多于里的桂枝加附子汤。八味地黄丸证和十味地黄汤证，都是肾虚病中的阴阳夹杂证，但由于证有阴虚多于阳虚和阳虚多于阴虚，所以有补阳多于补阴的八味地黄丸和补阴多于补阳的十味地黄汤。
在检查、诊断虚实、寒热、表里，阴阳夹杂证时，除注意有无夹杂和它们之间的比例关系外，还应注意其所在的经络、脏腑，以及它们的比例，例如：寒热夹杂证，若是在脾胃，就可用黄连汤、半夏泻心汤，若是在肝胆则应予黄芩汤加干姜、芍药。
那么怎么检查、诊断虚证中的实，实证中的虚，寒证中的热，热证中的寒，表证中的里，里证中的表，阴证中的阳，阳证中的阴呢?根据李翰卿先生的经验和我个人的体会，大致可以归纳为如下几点：
1．应用各种检查手段进行全面检查由于脏腑、气血、阴阳等的功能很多，变化相当复杂，所以要想得出正确的诊断，必须进行全面的检查，正如喻嘉言所说：“凡治病，不合色脉，参互考验，得此失彼，得偏遗全，只名粗工，临证模糊，未具手眼，医之罪也。”
2．在检查时要特别注意发现一些微小的异常现象例如，一个从很多方面看是大实大热的证候，要特别注意其热象的特点、舌苔、舌质、脉象，假若发现有恶寒身痛，那么这就有可能是夹有一点表寒，假若发现舌质淡暗，舌苔白而润，那就是夹有里寒，假若发现有脉微欲绝，那么就是虚阳浮越，阴盛格阳等。
3．在检查复杂疾病的表现时，尤应特别注意客观指标的检查，主诉症状虽然在辨证上具有重要的价值，但它和脉象、舌象、腹诊等客观指标比较起来，确有所次要。例如：一久泻久利的患者，当你按其胃脘有压痛时，就考虑其为实滞；一个淋证患者，当你发现其脉象为细涩，舌质淡暗时，就应考虑其兼寒证；一个四肢厥逆，神昏的患者，当你发现其脉沉微欲绝，腹满压痛时，就应考虑其为实证等。
4．在分析疾病时要特别注意治疗过程中的用药反应例如，从表面看完全是一个实热证的疾病，应用寒凉药反不减，一个表面上看完全是虚寒的疾病，应用温补药反加重等。这些反应有的可能是本质的反应，有的可能是夹杂证中的表现，所以必须认真地检查。
当通过以上检查方法，发现了不同的夹杂证时，为了更正确地确定治疗措施，还应确定出各种夹杂证的比例。根据经验，归纳起来，大致有以下几点方法：
1．归纳方法在辨证时首先把相同性质的证候进行归纳，一般来讲占据多数的就是主要的，少数的就是次要的。例如：—薯蓣丸所治的感冒，从症状、面色、脉象来看都是以虚证为主，而表证则居于次要地位，所以《金匮》云：“虚劳诸不足，风气百疾，薯蓣丸主之。”而人参败毒散证，则从全身症状、脉象看，都以表证为突出，虚证表现则居于极次要地位，所以主用解表，佐以补益的方法治疗。
2．重视客观体征例如，当自觉症状、舌苔舌质、脉象、腹诊等的结果看起来没有明显的特殊时，一般以脉象、舌苔舌质、腹诊的结果为主，譬如寒热夹杂的泄泻，若脉见弦涩不调时，则为寒多热少证，脉见滑时，则为热多寒少证。
3．取多数法当症状、舌苔舌质、面色、腹诊、脉象等诸方面相一致的占多数时，即所占的比例较大，例如，胃脘冷痛，遇劳遇冷则发病，面色萎黄，舌苔白质淡，脉沉细等虚寒证为主时，兼见口苦口于，胃脘有压痛，则实热为次，治疗时就应采用补为主，攻为辅的治疗方法。
表里的辨别和应用
表里不但是伤寒、温病病位内外、浅深的标志，而且是内伤诸病病位内外、浅深，以及病势转变的标志，所以仲景在《伤寒》、《金匮要略》中，不但以大量篇幅阐述了表里证的表现，而且以大量篇幅阐述了表里的具体使用方法，后世医家以辨证总纲的形式确定其为内伤、外感渚证的总纲之一。
那么我们怎么确定病位的表里和应用这一概念去进行治疗呢?我认为：
一、表里的辨证方法主要有三条：
1．是抓症状法不管是外感，还是内伤，只要是病位在皮毛，在太阳经，在肺经，并具有这些病位症状的，都称为表证。例如《伤寒论》所称之“太阳之为病……头项强痛而恶寒”证，陈平伯《外感温病篇》所称之“风温证，身热畏风，头痛咳嗽”证。至若病位深在，在气血，在脏腑，在骨髓者，总称为里证。如张介宾《景岳全书》之“里证者，病之在内在脏也。凡病自内生，则或因七情，或因劳倦，或因饮食所伤，或为酒色所困，皆为里证，”若始为表证，而后出现在内，在脏腑症状者，则为由表人里证，《伤寒沦》说：“本太阳，初得病时，发其汗，汗先出不彻，因转属阳明也。伤寒发热无汗，呕不能食，而反汗出澉然者，是转属阳明也。”若始为里证，而后出现在表，在经症状者，则为由里出表，《温疫论》云：“里证下后，脉浮而微数，身微热，神思或不爽，此邪热浮于肌表。”一般来讲，若由表人里者，为由轻转重，若由里出于表者，为由重转轻。
2．是抓脉象法不管是外感，还是内伤，只要是脉见浮的，均称为表证，脉沉的均称为里证。正如《伤寒论》所说：“太阳之为病，脉浮。”《外感温病篇》：“风温证……脉浮数……邪在表也。”《濒湖脉学》：“脉沉主里。”《医学心悟》：“一病之表里……脉息浮，此表也……脉息沉，此里也。”
3．是抓舌象一般来讲，表证不会引起舌质的变化，舌质颜色发生变化时则为五脏发病，而舌苔的厚薄则往往是在表，在里，或由表人里，或由里出表的标志。正如邓铁涛先生所编之《中医诊断学》中所指出的那样：“其实无论外感、内伤，察其苔之厚薄，足以了解邪气之深浅轻重。如苔薄多为疾病初起，邪气尚浅，病位在表；苔厚则属病邪人里，病位较深，邪气较重；舌绛为热入营血，病位更深，病情更重。”
二、表里证的治法
表里证的治法主要的就一句话：即在表者当解表，在里者当治里。即是说，不管是外感，还是内伤，只要是病在表者，即应采用解表法，只要是病在里者即采用治里法，正如《素问·阴阳应象大论》所说：“其在皮者，汗而发之。”，也就是说不管是外感病中的伤寒、温病，还是内科、外科、妇科、儿科、眼科、耳鼻喉科、皮肤科，只要是病邪在表的，都可应用中药中的麻黄、桂枝、紫苏、生姜，荆芥、防风、羌活、白芷、藁本、苍耳子、葱白，薄荷、牛蒡子、蝉蜕、桑叶、菊花、葛根、升麻、浮萍、细辛，方剂中的麻黄汤、葛根汤、桂枝汤、大青龙汤、九味羌活汤、香薷饮、桑菊饮、银翘散、败毒散、柴葛解肌汤等进行治疗，但在具体应用上又需注意以下问题：
1．是病邪的性质即风者当予疏风解表，如采用防风、桂枝、桑叶、薄荷、菊花、蝉蜕等；寒者当予散寒解表，如采用麻黄、桂枝、细辛、独活、羌活、防风、白芷、藁本等；暑者当予祛暑解表，如采用香薷、藿香、佩兰、紫苏、薄荷等；湿者当予除湿解表，如采用羌活、独活、防风、白芷、苍术等；燥者当予辛润解表，如紫苏、薄荷等。
2．是病邪所在的部位即病邪所在的经络、上下、皮肌等。如在太阳经者治宜羌活、藁本，在阳明经者治宜升麻、白芷、葛根，在少阳经者治宜川芎、柴胡、薄荷，在皮者治宜浮萍，在肌者治宜葛根、升麻，在上者治宜羌活、白芷、藁本、蔓荆子、川芎，在下者治宜独活等。
3．是兼夹与并合即合并存在的不同邪气，以及数经同时发病的情况，此种情况《伤寒论》称为合病或并病。
4．是病邪与正气的关系这里所指的正气既指阴，又指阳，既指气，又指血，既指五脏，又指六腑，在衡量正、邪的关系时，既要区别正气的性质，又要区别正邪之间的不同关系
5．是指的表证与各种因素的比例关系例如：表寒与表湿的关系，阳虚与表邪的比例关系等。
脉弦数，有寒饮，冬夏难治
自《金匮·痰饮咳嗽病脉证并治篇》“脉弦数，有寒饮，冬夏难治”句出现之后，一些医家解释为寒饮夹热，一些医家解释为冬夏时令的冷热，而用其理论去指导临床常常难于收功。及读《内经》运气学说和田云槎先生《伏阴论》一书，始有所悟。田云槎云：“天地之道，一阴一阳，阳升则阴降，阳沉则阴浮……盖阳气升于春，浮于夏，降于秋，沉于冬。”说明邪气不但受着春夏秋冬升降浮沉的影口向，就是正气亦受着春夏秋冬升降浮沉的影响。本证所谓冬夏难治者，乃因冬季寒气外加，阳气沉潜，肺居上焦而主皮毛，故寒饮蕴肺者，冬季喘咳加剧；夏季暑热外加，阳气浮越，肺热阴伤，故肺阴不足，或气阴俱虚者，夏季加甚，所以冬季喘甚者，治宜温肺化饮；夏季喘甚者，治宜补气养阴。若三焦调适，阴阳升降有序，则痰湿不生，正如《圣济总录》所说：“三焦调适，气脉平均，则能宣通水液，行人于经，化而为血，灌溉周身，若三焦气塞，脉道壅闭，则水饮停滞，不得宣行，聚成痰饮。”冬夏俱甚之咳喘，既有气阴俱虚，又有阳虚痰饮，既有心火之盛，又有三焦之郁，因此治疗起来较之单纯的寒饮或气阴两虚者难治。临床之时有鉴于此，必须补其心肺，化其痰饮，佐以疏肝才能解。例如：赵××，女，50岁。咳喘30多年，冬夏剧，春秋瘥，发作时昼夜不能平卧，近一个月来尤为严重，先以中、西药治疗无效。审视其证，除喘咳不能乎卧外，并见胸胁苦满或窜痛，心烦易怒，心悸失眠，腰背酸痛，纳呆食减，日渐消瘦，畏寒怕热，舌苔黄白而质稍红，口苦而干，脉弦大滑数。证脉相参，诊为气阴俱虚，痰饮蕴郁，三焦失序，木火刑金。乃拟黄芪15克，党参9克以补脾肺之气，半夏9克，茯苓9克，甘草6克以化寒饮，紫菀9克以化痰通络定喘，知母9克，地骨皮9克以清热，麦冬9克，生地9克以养肺胃之阴，肉桂4克，麦冬9克相配以交心肾，柴胡9克，半夏9克，白芍9克，甘草6克相配以解肝郁，理三焦。服药2剂，喘咳略平，他证俱减，再进10剂，咳喘停止。其后，为了彻底治愈意，以上方为丸，服药2年而愈。
桂枝去芍药加蜀漆牡蛎龙骨救逆汤
《伤寒论》云：“伤寒脉浮，医以火迫劫之，亡阳，必惊狂，卧起不安者，桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。”《金匮要略》云：“火邪者，桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。”历代注释者，多以火邪来论，致使本方少见使用。余细思其组方之意，既有化痰之蜀漆，又有助心阳之桂枝去芍药汤，试用于心阳不足，痰浊阻滞的惊狂或睡中易惊者恒效。例如：患者徐××，男，5岁。10日前在玩耍的过程中，突然受惊，其后即时见胆小，惊哭不安，不敢出门，不敢离开父母，有时在睡梦中突然大哭，每昼夜约发3-5次左右，舌苔白，脉弦涩不调。综合脉证，诊为心阳不足，痰浊内阻。为拟桂枝去芍药加蜀漆牡蛎龙骨救逆汤。处方：桂枝3克，生姜2片，甘草3克，大枣5枚，常山3克，牡蛎6克，龙骨6克。药进1剂，诸证来作，继服1剂而愈。
木防己汤
曾治患者高××，男，57岁。咳喘20多年，冬季加重，夏季减，但今年七八个月来，从冬至夏一直咳喘气短不止。某院诊为慢性支气管炎合并感染，肺气肿，肺源性心脏病。曾先后住院两次，中西药遍用均未见效。审其证，除气短而喘外，并见浮肿尿少，发绀，胁下、胃脘满胀，舌质紫黯、舌苔黄白，面色黧黑、脉沉紧。综合脉证，诊为心下停饮，上逆迫肺之证，为拟苦辛并用，行水散结，木防己汤。处方：防己12克，桂枝6克，生石膏12克，党参12克。药进6剂，喘咳、短气等证大减，患者云：服药200剂没有一剂象此方之见效。某医间云：此方定喘止咳之药未见，而却效果如神者，何也?答曰：“仲景云：隔间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，医吐下之不愈，木防己汤主之。虚者即愈，实者三日复发，复与不愈者，宜木防己去石膏加茯苓芒硝汤主之。此证虽喘而短气，但患者主诉却以心下痞坚为主，心下痞坚阻遏阳气之升降，肺气不降则喘，故治宜从中焦脾胃，而不宜从肺论治，中焦痰饮一除，则清气得升，浊气得降，而后自愈，此所以以木防己汤就在于一辛一苦，助其中焦之升降，化中焦之痰饮。”药进10剂，浮肿消失，喘咳得止。
从虚证中辨别夹杂的实证，以及从实证中辨别夹杂的虚证；从寒证中辨别夹杂的热证，从热证中辨别夹杂的寒证；从表证（病位在体表）中辨别夹杂的里证（病位在脏腑），从里证中辨别夹杂的表证；从阴证（属阴的证候）中辨别夹杂的阳证（属阳的证候），从阳证中辨别夹杂的阴证。并从中找出它们的比例关系，然后按照这些不同的比例进行处方用药，是提高临床疗效的重要方法。
例如：在脾胃病中，半夏泻心汤证和黄连汤证都属于寒热夹杂证（寒邪与热邪同时存在的证候）。但由于寒热程度不同，所以有寒多热少的半夏泻心汤，和热多寒少的黄连汤。温脾汤证和九痛丸证都是脾胃病中的虚实夹杂证（正气虚弱与邪气盛实同时存在）。但由于证候有虚多实少和实多虚少之分，所以有补益多于攻泻的温脾汤，和攻泻多于补益的九痛丸。桂枝人参汤证和桂枝加附子汤证都是外感病中的表里夹杂证。但由于证候有里多表少和表多里少之分，所以有理证多于表证的桂枝人参汤，和表证多于里证的桂枝加附子汤。八味地黄丸证和十味地黄汤证都是肾虚病中的阴阳夹杂证。但由于证候有阴虚多于阳虚和阳虚多于阴虚之分，所以有补阳多于补阴的八味地黄丸，和补阴多于补阳的十味地黄汤。
在检查、诊断虚实、寒热、表里、阴阳夹杂证时，除了注意有无夹杂及其比例关系外，还应注意病变所在的经络、脏腑及其比例。例如：寒热夹杂证，若病位在脾胃，可用黄连汤或半夏泻心汤；若病位在肝胆，则应给予黄芩汤加干姜、芍药。
那么，如何检查、诊断虚证中的实证、实证中的虚证、寒证中的热证、热证中的寒证、表证中的里证、里证中的表证、阴证中的阳证、阳证中的阴证呢？根据李翰卿先生的经验和我个人的体会，大致可以归纳为以下几点：
1. 应用各种检查手段进行全面检查。由于脏腑、气血、阴阳等功能众多，变化相当复杂，因此要想得出正确的诊断，必须进行全面的检查。正如喻嘉言所说：“凡治病，不合色脉，参互考验，得此失彼，得偏遗全，只名粗工，临证模糊，未具手眼，医之罪也。”
2. 在检查时要特别注意发现一些微小的异常现象。例如，一个从多方面看是大实大热的证候，要特别注意其热象的特点、舌苔、舌质、脉象。假若发现有恶寒身痛，那么这就有可能是夹有一点表寒；假若发现舌质淡暗，舌苔白而润，那就是夹有里寒；假若发现有脉微欲绝，那么就是虚阳浮越、阴盛格阳等。
3. 在检查复杂疾病的表现时，尤应特别注意客观指标的检查。主诉症状虽然在辨证上具有重要的价值，但它和脉象、舌象、腹诊等客观指标比较起来，确有所次要。例如：一位久泻久利的患者，当你按其胃脘部有压痛时，就考虑其为实滞；一位淋证（以小便频数短涩、滴沥刺痛为主症）患者，当你发现其脉象为细涩，舌质淡暗时，就应考虑其兼有寒证；一位四肢厥逆（手脚冰冷）、神昏的患者，当你发现其脉沉微欲绝，腹满压痛时，就应考虑其为实证等。
4. 在分析疾病时要特别注意治疗过程中的用药反应。例如，从表面看完全是一个实热证的疾病，应用寒凉药反而不减；一个表面上看完全是虚寒的疾病，应用温补药反而加重等。这些反应有的可能是本质的反映，有的可能是夹杂证中的表现，所以必须认真地检查。
当通过以上检查方法，发现了不同的夹杂证时，为了更正确地确定治疗措施，还应确定出各种夹杂证的比例。根据经验，归纳起来，大致有以下几点方法：
1. 归纳法。在辨证时首先把相同性质的证候进行归纳，一般来讲占据多数的就是主要的，少数的就是次要的。例如：薯蓣丸所治的感冒，从症状、面色、脉象来看都是以虚证为主，而表证则居于次要地位，所以《金匮要略》云：“虚劳诸不足，风气百疾，薯蓣丸主之。”而人参败毒散证，则从全身症状、脉象看，都以表证为突出，虚证表现则居于极次要地位，所以主用解表，佐以补益的方法治疗。
2. 重视客观体征。例如，当自觉症状、舌苔舌质、脉象、腹诊等的结果看起来没有明显的特殊时，一般以脉象、舌苔舌质、腹诊的结果为主。譬如寒热夹杂的泄泻，若脉见弦涩不调时，则为寒多热少证；脉见滑时，则为热多寒少证。
3. 取多数法。当症状、舌苔舌质、面色、腹诊、脉象等诸方面相一致的占多数时，即所占的比例较大。例如，胃脘冷痛，遇劳遇冷则发病，面色萎黄，舌苔白质淡，脉沉细等虚寒证为主时，兼见口苦口干，胃脘有压痛，则实热为次，治疗时就应采用补为主，攻为辅的治疗方法。
表里的辨别和应用
表里不但是伤寒、温病病位内外、浅深的标志，而且是内伤诸病病位内外、浅深，以及病势转变的标志。所以仲景在《伤寒论》、《金匮要略》中，不但以大量篇幅阐述了表里证的表现，而且以大量篇幅阐述了表里的具体使用方法。后世医家以辨证总纲的形式确定其为内伤、外感诸证的总纲之一。
那么我们怎么确定病位的表里和应用这一概念去进行治疗呢？我认为：
一、表里的辨证方法主要有三条：
1. 是抓症状法。不管是外感，还是内伤，只要是病位在皮毛，在太阳经，在肺经，并具有这些病位症状的，都称为表证。例如《伤寒论》所称之“太阳之为病……头项强痛而恶寒”证，陈平伯《外感温病篇》所称之“风温证，身热畏风，头痛咳嗽”证。至若病位深在，在气血，在脏腑，在骨髓者，总称为里证。如张介宾《景岳全书》之“里证者，病之在内在脏也。凡病自内生，则或因七情，或因劳倦，或因饮食所伤，或为酒色所困，皆为里证。”若始为表证，而后出现在内，在脏腑症状者，则为由表入里证，《伤寒论》说：“本太阳，初得病时，发其汗，汗先出不彻，因转属阳明也。伤寒发热无汗，呕不能食，而反汗出濈然者，是转属阳明也。”若始为里证，而后出现在表，在经症状者，则为由里出表，《温疫论》云：“里证下后，脉浮而微数，身微热，神思或不爽，此邪热浮于肌表。”一般来讲，若由表入里者，为由轻转重；若由里出于表者，为由重转轻。
2. 是抓脉象法。不管是外感，还是内伤，只要是脉见浮的，均称为表证；脉沉的均称为里证。正如《伤寒论》所说：“太阳之为病，脉浮。”《外感温病篇》：“风温证……脉浮数……邪在表也。”《濒湖脉学》：“脉沉主里。”《医学心悟》：“一病之表里……脉息浮，此表也……脉息沉，此里也。”
3. 是抓舌象。一般来讲，表证不会引起舌质的变化，舌质颜色发生变化时则为五脏发病，而舌苔的厚薄则往往是在表、在里，或由表入里，或由里出表的标志。正如邓铁涛先生所编之《中医诊断学》中所指出的那样：“其实无论外感、内伤，察其苔之厚薄，足以了解邪气之深浅轻重。如苔薄多为疾病初起，邪气尚浅，病位在表；苔厚则属病邪入里，病位较深，邪气较重；舌绛为热入营血，病位更深，病情更重。”
二、表里证的治法
表里证的治法主要就一句话：即在表者当解表，在里者当治里。即是说，不管是外感，还是内伤，只要是病在表者，即应采用解表法；只要是病在里者即采用治里法。正如《素问·阴阳应象大论》所说：“其在皮者，汗而发之。”也就是说，不管是外感病中的伤寒、温病，还是内科、外科、妇科、儿科、眼科、耳鼻喉科、皮肤科，只要是病邪在表的，都可应用中药中的麻黄、桂枝、紫苏、生姜、荆芥、防风、羌活、白芷、藁本、苍耳子、葱白、薄荷、牛蒡子、蝉蜕、桑叶、菊花、葛根、升麻、浮萍、细辛，方剂中的麻黄汤、葛根汤、桂枝汤、大青龙汤、九味羌活汤、香薷饮、桑菊饮、银翘散、败毒散、柴葛解肌汤等进行治疗。但在具体应用上又需注意以下问题：
1. 是病邪的性质。即风者当予疏风解表，如采用防风、桂枝、桑叶、薄荷、菊花、蝉蜕等；寒者当予散寒解表，如采用麻黄、桂枝、细辛、独活、羌活、防风、白芷、藁本等；暑者当予祛暑解表，如采用香薷、藿香、佩兰、紫苏、薄荷等；湿者当予除湿解表，如采用羌活、独活、防风、白芷、苍术等；燥者当予辛润解表，如紫苏、薄荷等。
2. 是病邪所在的部位。即病邪所在的经络、上下、皮肌等。如在太阳经者治宜羌活、藁本；在阳明经者治宜升麻、白芷、葛根；在少阳经者治宜川芎、柴胡、薄荷；在皮者治宜浮萍；在肌者治宜葛根、升麻；在上者治宜羌活、白芷、藁本、蔓荆子、川芎；在下者治宜独活等。
3. 是兼夹与并合。即合并存在的不同邪气，以及数经同时发病的情况，此种情况《伤寒论》称为合病或并病。
4. 是病邪与正气的关系。这里所指的正气既指阴，又指阳；既指气，又指血；既指五脏，又指六腑。在衡量正、邪的关系时，既要区别正气的性质，又要区别正邪之间的不同关系。
5. 是指的表证与各种因素的比例关系。例如：表寒与表湿的关系，阳虚与表邪的比例关系等。
脉弦数，有寒饮，冬夏难治
自《金匮要略·痰饮咳嗽病脉证并治篇》“脉弦数，有寒饮，冬夏难治”句出现之后，一些医家解释为寒饮夹热，一些医家解释为冬夏时令的冷热，而用其理论去指导临床常常难于收功。及读《内经》运气学说和田云槎先生《伏阴论》一书，始有所悟。田云槎云：“天地之道，一阴一阳，阳升则阴降，阳沉则阴浮……盖阳气升于春，浮于夏，降于秋，沉于冬。”说明邪气不但受着春夏秋冬升降浮沉的影响，就是正气亦受着春夏秋冬升降浮沉的影响。本证所谓冬夏难治者，乃因冬季寒气外加，阳气沉潜，肺居上焦而主皮毛，故寒饮蕴肺者，冬季喘咳加剧；夏季暑热外加，阳气浮越，肺热阴伤，故肺阴不足，或气阴俱虚者，夏季加甚。所以冬季喘甚者，治宜温肺化饮；夏季喘甚者，治宜补气养阴。若三焦调适，阴阳升降有序，则痰湿不生，正如《圣济总录》所说：“三焦调适，气脉平均，则能宣通水液，行人于经，化而为血，灌溉周身，若三焦气塞，脉道壅闭，则水饮停滞，不得宣行，聚成痰饮。”冬夏俱甚之咳喘，既有气阴俱虚，又有阳虚痰饮，既有心火之盛，又有三焦之郁，因此治疗起来较之单纯的寒饮或气阴两虚者难治。临床之时，有鉴于此，必须补其心肺，化其痰饮，佐以疏肝才能解。
例如：赵××，女，50岁。咳喘30多年，冬夏剧，春秋瘥，发作时昼夜不能平卧，近一个月来尤为严重，先以中、西药治疗无效。审视其证，除喘咳不能平卧外，并见胸胁苦满或窜痛，心烦易怒，心悸失眠，腰背酸痛，纳呆食减，日渐消瘦，畏寒怕热，舌苔黄白而质稍红，口苦而干，脉弦大滑数。证脉相参，诊为气阴俱虚，痰饮蕴郁，三焦失序，木火刑金。乃拟黄芪15克，党参9克以补脾肺之气，半夏9克，茯苓9克，甘草6克以化寒饮，紫菀9克以化痰通络定喘，知母9克，地骨皮9克以清热，麦冬9克，生地9克以养肺胃之阴，肉桂4克，麦冬9克相配以交心肾，柴胡9克，半夏9克，白芍9克，甘草6克相配以解肝郁，理三焦。服药2剂，喘咳略平，他证俱减，再进10剂，咳喘停止。其后，为了彻底治愈之意，以上方为丸，服药2年而愈。
《伤寒论》云：“伤寒脉浮，医以火迫劫之，亡阳，必惊狂，卧起不安者，桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。”《金匮要略》云：“火邪者，桂枝去芍药加蜀漆牡蛎龙骨救逆汤主之。”历代注释者，多以火邪来论，致使本方少见使用。余细思其组方之意，既有化痰之蜀漆，又有助心阳之桂枝去芍药汤，试用于心阳不足，痰浊阻滞的惊狂或睡中易惊者恒效。
例如：患者徐××，男，5岁。10日前在玩耍的过程中，突然受惊，其后即时见胆小，惊哭不安，不敢出门，不敢离开父母，有时在睡梦中突然大哭，每昼夜约发3-5次左右，舌苔白，脉弦涩不调。综合脉证，诊为心阳不足，痰浊内阻。为拟桂枝去芍药加蜀漆牡蛎龙骨救逆汤。处方：桂枝3克，生姜2片，甘草3克，大枣5枚，常山3克，牡蛎6克，龙骨6克。药进1剂，诸证不作，继服1剂而愈。
曾治患者高××，男，57岁。咳喘20多年，冬季加重，夏季减，但今年七八个月来，从冬至夏一直咳喘气短不止。某院诊为慢性支气管炎合并感染，肺气肿，肺源性心脏病。曾先后住院两次，中西药遍用均未见效。审其证，除气短而喘外，并见浮肿尿少，发绀，胁下、胃脘满胀，舌质紫黯、舌苔黄白，面色黧黑、脉沉紧。综合脉证，诊为心下停饮，上逆迫肺之证，为拟苦辛并用，行水散结，木防己汤。处方：防己12克，桂枝6克，生石膏12克，党参12克。药进6剂，喘咳、短气等证大减，患者云：服药200剂没有一剂象此方之见效。某医间云：此方定喘止咳之药未见，而却效果如神者，何也？答曰：“仲景云：隔间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，医吐下之不愈，木防己汤主之。虚者即愈，实者三日复发，复与不愈者，宜木防己去石膏加茯苓芒硝汤主之。此证虽喘而短气，但患者主诉却以心下痞坚为主，心下痞坚阻遏阳气之升降，肺气不降则喘，故治宜从中焦脾胃，而不宜从肺论治，中焦痰饮一除，则清气得升，浊气得降，而后自愈，此所以以木防己汤就在于一辛一苦，助其中焦之升降，化中焦之痰饮。”药进10剂，浮肿消失，喘咳得止。
Identify the excess patterns (Excess Syndrome) embedded within deficiency patterns (Deficiency Syndrome), and identify the deficiency patterns embedded within excess patterns; identify the heat patterns (Heat Syndrome) embedded within cold patterns (Cold Syndrome), and identify the cold patterns embedded within heat patterns; identify the interior patterns (Interior Syndrome) embedded within exterior patterns (Exterior Syndrome, diseases located on the body surface), and identify the exterior patterns embedded within interior patterns; identify the yang patterns (Yang Syndrome) embedded within yin patterns (Yin Syndrome, patterns belonging to yin), and identify the yin patterns embedded within yang patterns. Determine the proportion of these mixed elements, and then prescribe medications according to these different proportions. This is an important method for improving clinical efficacy.
For example: In spleen and stomach diseases, Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) syndrome and Huanglian Tang (Coptis Decoction) syndrome both belong to cold-heat mixed patterns (patterns where cold and pathogenic heat coexist). However, due to differences in the degree of cold and heat, there is Banxia Xiexin Tang for cases with more cold than heat, and Huanglian Tang for cases with more heat than cold. Wenspi Tang (Warming Spleen Decoction) syndrome and Jiutong Wan (Nine-Pain Pill) syndrome are both deficiency-excess mixed patterns (patterns where righteous qi deficiency and pathogenic excess coexist) in spleen and stomach diseases. However, since the syndromes vary between more deficiency than excess and more excess than deficiency, there is Wenspi Tang which tonifies more than purges, and Jiutong Wan which purges more than tonifies. Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) syndrome and Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite) syndrome are both exterior-interior mixed patterns in exogenous diseases. However, since the syndromes vary between more interior than exterior and more exterior than interior, there is Guizhi Renshen Tang where interior treatment predominates over exterior resolution, and Guizhi Jia Fuzi Tang where exterior resolution predominates over interior treatment. Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) syndrome and Shiwu Dihuang Tang (Ten-Ingredient Rehmannia Decoction) syndrome are both yin-yang mixed patterns in kidney deficiency diseases. However, since the syndromes vary between more yin deficiency than yang deficiency and more yang deficiency than yin deficiency, there is Bawei Dihuang Wan which tonifies yang more than yin, and Shiwu Dihuang Tang which tonifies yin more than yang.
When examining and diagnosing deficiency-excess, cold-heat, exterior-interior, and yin-yang mixed patterns, besides noting the presence of mixing and their proportional relationships, one must also pay attention to the meridians and zang-fu organs involved and their proportions. For example: For a cold-heat mixed pattern, if the location is in the spleen and stomach, Huanglian Tang or Banxia Xiexin Tang can be used; if the location is in the liver and gallbladder, Huangqin Tang (Scutellaria Decoction) added with Ganjiang (Dried Ginger) and Shaoyao (Peony Root) should be given.
So, how does one examine and diagnose excess within deficiency, deficiency within excess, heat within cold, cold within heat, interior within exterior, exterior within interior, yang within yin, and yin within yang? Based on Mr. Li Hanqing's experience and my personal understanding, this can generally be summarized into the following points:
1. Apply various examination methods for comprehensive assessment. Since the functions of zang-fu organs, qi and blood, yin and yang are numerous and changes are quite complex, obtaining a correct diagnosis requires comprehensive examination. As Yu Jiayan stated: "In treating any disease, if color and pulse are not combined and mutually verified, resulting in gaining one aspect while losing another, or gaining partiality while neglecting the whole, such a practitioner is merely a crude worker, vague in clinical practice, lacking skill and insight; this is the fault of the physician."
2. Pay special attention to discovering subtle abnormalities during examination. For instance, in a syndrome that appears as major excess and major heat from multiple perspectives, one must pay special attention to the characteristics of the heat manifestation, tongue coating, tongue body, and pulse. If chills and body pain are found, it may indicate a slight exterior cold component; if the tongue body is pale and dark, and the coating is white and moist, it indicates an interior cold component; if the pulse is faint and almost imperceptible, it indicates floating deficient yang or yin excess repelling yang.
3. When examining manifestations of complex diseases, particular attention should be paid to objective indicators. Although chief complaint symptoms have important value in syndrome differentiation, they are indeed secondary compared to objective indicators such as pulse, tongue appearance, and abdominal palpation. For example: In a patient with chronic diarrhea and dysentery, if tenderness is found upon palpating the epigastrium, it should be considered as excess stagnation; in a patient with strangury (a syndrome characterized by frequent, short, painful urination), if the pulse is fine and choppy and the tongue body is pale and dark, a concurrent cold pattern should be considered; in a patient with cold limbs and coma, if the pulse is deep, faint, and almost imperceptible, and the abdomen is full and tender, it should be considered as an excess pattern.
4. Pay special attention to drug reactions during the treatment process when analyzing diseases. For example, a disease that appears entirely as an excess-heat pattern does not improve after applying cooling herbs; a disease that appears entirely as a deficiency-cold pattern worsens after applying warming and tonifying herbs. These reactions may reflect the essence of the disease or manifestations of mixed patterns, so careful examination is required.
After discovering different mixed patterns through the above examination methods, to determine therapeutic measures more accurately, the proportions of various mixed patterns must be established. Based on experience, this can be summarized into the following methods:
1. Inductive Method. During syndrome differentiation, first group syndromes of the same nature. Generally, the majority constitutes the primary aspect, and the minority constitutes the secondary aspect. For example: The cold treated with Shuyu Wan (Asparagus Pill) is primarily a deficiency pattern based on symptoms, complexion, and pulse, while the exterior pattern is secondary. Thus, *Jin Gui Yao Lue* states: "For various deficiencies in consumptive fatigue and hundred diseases caused by wind pathogens, Shuyu Wan is the principal formula." In contrast, in Renshen Baidu San (Ginseng Detoxification Powder) syndrome, the exterior pattern is prominent based on systemic symptoms and pulse, while deficiency manifestations are extremely secondary. Therefore, the treatment mainly uses exterior resolution, assisted by tonification.
2. Emphasis on Objective Signs. For example, when subjective symptoms, tongue coating/body, pulse, and abdominal palpation results appear non-specific, priority is generally given to pulse, tongue, and abdominal findings. For instance, in diarrhea with a cold-heat mix, if the pulse is wiry, choppy, and irregular, it indicates more cold than heat; if the pulse is slippery, it indicates more heat than cold.
3. Majority Rule. When symptoms, tongue coating/body, complexion, abdominal palpation, and pulse are consistent across most aspects, indicating a larger proportion, the treatment follows the majority. For example, when deficiency-cold signs such as cold pain in the epigastrium aggravated by exertion or cold exposure, sallow complexion, white coating with pale tongue body, and deep fine pulse predominate, while bitter taste, dry mouth, and epigastric tenderness are present as minor signs (indicating secondary excess-heat), the treatment should prioritize tonification and assist with purging.
Differentiation and Application of Exterior and Interior
Exterior and Interior are not only markers for the depth and location (internal/external) of pathogenesis in Shanghan (Cold Damage) and Wenbing (Warm Diseases), but also markers for the depth and location of pathogenesis in various internal injuries, as well as the transformation of disease progression. Therefore, Zhang Zhongjing, in *Shanghan Lun* and *Jin Gui Yao Lue*, not only elaborated extensively on the manifestations of exterior-interior patterns but also detailed the specific application of exterior-interior concepts. Later physicians established them as one of the general outlines for syndrome differentiation in both internal and exogenous diseases.
How do we determine the exterior-interior location of a disease and apply this concept to treatment? I believe:
I. There are three main methods for differentiating Exterior and Interior:
1. Grasping Symptoms. Whether exogenous or endogenous, if the disease location is in the skin/hair, Taiyang Meridian, or Lung Meridian, and presents with symptoms of these locations, it is called an Exterior Pattern. For example, the "Taiyang disease... stiff neck and headache with aversion to cold" syndrome mentioned in *Shanghan Lun*, or the "Wind-Warmth syndrome, fever with aversion to wind, headache and cough" syndrome mentioned in Chen Pingbo's *Wai Gan Wen Bing Pian*. Conversely, if the disease location is deep, in qi and blood, zang-fu organs, or bone marrow, it is collectively called an Interior Pattern. As Zhang Jianbin stated in *Jing Yue Quan Shu*: "Interior syndrome refers to disease located internally within the zang organs. Any disease arising internally, whether due to seven emotions, labor/fatigue, dietary injury, or sexual excess, is an interior syndrome." If a disease starts as exterior but later manifests internal/zang-fu symptoms, it is a transition from exterior to interior. *Shanghan Lun* says: "Originally Taiyang, at the initial stage of disease, if sweating was induced but not thorough, it transforms into Yangming. Cold damage with fever, no sweat, vomiting, inability to eat, but suddenly profuse sweating, indicates transformation into Yangming." If a disease starts as interior but later manifests exterior/meridian symptoms, it is a transition from interior to exterior. *Wen Yi Lun* states: "After purgation for interior syndrome, if the pulse is floating and slightly rapid, with slight fever and mental dullness, this indicates pathogenic heat floating on the muscle surface." Generally, transition from exterior to interior signifies worsening from mild to severe; transition from interior to exterior signifies improvement from severe to mild.
2. Grasping Pulse. Whether exogenous or endogenous, a floating pulse indicates an Exterior Pattern; a deep pulse indicates an Interior Pattern. As *Shanghan Lun* states: "Taiyang disease, the pulse is floating." *Wai Gan Wen Bing Pian*: "Wind-Warmth syndrome... pulse floating and rapid... pathogen is in the exterior." *Binhu Maixue*: "Deep pulse governs interior." *Yixue Xinwu*: "Regarding the exterior-interior of a disease... floating pulse indicates exterior... deep pulse indicates interior."
3. Grasping Tongue Appearance. Generally, exterior patterns do not cause changes in the tongue body; changes in tongue body color indicate zang organ pathology. The thickness of the tongue coating often marks whether the pathogen is in the exterior, interior, transitioning from exterior to interior, or from interior to exterior. As pointed out in Deng Tietao's *Zhongyi Zhenduanxue* (TCM Diagnostics): "Regardless of exogenous or endogenous diseases, observing the thickness of the coating is sufficient to understand the depth and severity of the pathogen. Thin coating usually indicates early disease, shallow pathogen, and exterior location; thick coating belongs to pathogen entering interior, deeper location, and heavier pathogen; crimson tongue indicates heat entering Ying and Blood levels, deeper location, and more severe condition."
II. Treatment Methods for Exterior and Interior Patterns
The treatment principle for exterior-interior patterns can be summarized in one sentence: Treat the exterior by resolving the exterior; treat the interior by managing the interior. That is, whether exogenous or endogenous, if the disease is in the exterior, use exterior resolution methods; if in the interior, use interior management methods. As *Suwen: Yin Yang Yingxiang Dalun* states: "Where it is in the skin, induce sweating to release it." This means that regardless of whether it is Cold Damage or Warm Disease in exogenous conditions, or Internal Medicine, Surgery, Gynecology, Pediatrics, Ophthalmology, ENT, or Dermatology, if the pathogen is in the exterior, Chinese herbs such as Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Zisu (Perillae Folium), Shengjiang (Zingiberis Rhizoma Recens), Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Baizhi (Angelicae Dahuricae Radix), Gaoben (Ligustici Rhizoma et Radix), Cang'erzi (Xanthii Fructus), Congbai (Allii Fistulosi Bulbus), Bohe (Menthae Haplocalycis Herba), Niubangzi (Arctii Fructus), Chantui (Cicadae Periostracum), Sangye (Mori Folium), Juhua (Chrysanthemi Flos), Gegen (Puerariae Lobatae Radix), Shengma (Cimicifugae Rhizoma), Fuping (Urticae Herba), Xixin (Asari Radix et Rhizoma), and formulas such as Mahuang Tang (Ephedra Decoction), Gegen Tang (Kudzu Decoction), Guizhi Tang (Cinnamon Twig Decoction), Da Qinglong Tang (Major Green Dragon Decoction), Jiwei Qianghuo Tang (Nine-Ingredient Notopterygium Decoction), Xiangru Yin (Elsholtzia Infusion), Sangju Yin (Mulberry Leaf and Chrysanthemum Infusion), Yinqiao San (Honeysuckle and Forsythia Powder), Baidu San (Detoxification Powder), and Chaige Jieji Tang (Bupleurum and Kudzu Muscle-Releasing Decoction) can be applied. However, specific applications require attention to the following issues:
1. Nature of the Pathogen. For Wind, use wind-dispersing exterior resolution, e.g., Fangfeng, Guizhi, Sangye, Bohe, Juhua, Chantui; for Cold, use cold-dispersing exterior resolution, e.g., Mahuang, Guizhi, Xixin, Duhuo, Qianghuo, Fangfeng, Baizhi, Gaoben; for Summerheat, use summerheat-resolving exterior resolution, e.g., Xiangru, Huoxiang, Peilan, Zisu, Bohe; for Dampness, use dampness-dispelling exterior resolution, e.g., Qianghuo, Duhuo, Fangfeng, Baizhi, Cangzhu; for Dryness, use acrid-moistening exterior resolution, e.g., Zisu, Bohe.
2. Location of the Pathogen. Referring to the meridian, upper/lower, skin/muscle, etc. For Taiyang Meridian, use Qianghuo, Gaoben; for Yangming Meridian, use Shengma, Baizhi, Gegen; for Shaoyang Meridian, use Chuanxiong, Chaihu, Bohe; for Skin, use Fuping; for Muscle, use Gegen, Shengma; for Upper body, use Qianghuo, Baizhi, Gaoben, Manjingzi, Chuanxiong; for Lower body, use Duhuo.
3. Concurrent and Combined Patterns. Refers to different pathogens existing simultaneously, or simultaneous involvement of multiple meridians. *Shanghan Lun* calls this Hebing (Combined Disease) or Bingbing (Concurrent Disease).
4. Relationship between Pathogen and Righteous Qi. Righteous Qi here refers to both Yin and Yang, Qi and Blood, Zang and Fu organs. When assessing the relationship between Righteous Qi and Pathogen, one must distinguish the nature of the Righteous Qi and the different relationships between Righteous Qi and Pathogen.
5. Proportion of Exterior Pattern and Various Factors. For example, the relationship between Exterior Cold and Exterior Dampness, or the proportion of Yang Deficiency to Exterior Pathogen.
Wiry and Rapid Pulse with Cold Fluid Retention: Difficult to Treat in Winter and Summer
Since the appearance of the sentence "Wiry and rapid pulse with cold fluid retention, difficult to treat in winter and summer" in *Jin Gui Yao Lue: Tan Yin Ke Sou Bing Mai Zheng Bing Zhi Pian* (Treatise on Phlegm-Fluids, Cough, and Panting), some physicians interpreted it as cold-fluid retention with embedded heat, while others interpreted it as the cold and heat of the winter and summer seasons. Using this theory to guide clinical practice often yields poor results. It was only after studying the Luck Theory in *Neijing* and Mr. Tian Yuncha's book *Fu Yin Lun* (Theory of Hidden Yin) that I gained insight. Tian Yuncha stated: "The way of heaven and earth is one yin and one yang. When yang rises, yin descends; when yang sinks, yin floats... Yang energy rises in spring, floats in summer, descends in autumn, and sinks in winter." This explains that not only pathogens are influenced by the rising, floating, descending, and sinking of the four seasons, but also righteous qi. The reason this syndrome is difficult to treat in winter and summer is that in winter, external cold qi adds to the sinking and hidden state of yang qi. The Lung resides in the upper jiao and governs the skin and hair; thus, for those with cold-fluid retention in the lung, wheezing and coughing worsen in winter. In summer, external summerheat adds to the floating state of yang qi, causing lung heat and yin injury; thus, for those with lung yin deficiency or joint qi-yin deficiency, symptoms worsen in summer. Therefore, for severe wheezing in winter, the treatment should warm the lung and transform fluid retention; for severe wheezing in summer, the treatment should tonify qi and nourish yin. If the Triple Burner is regulated and yin-yang rising and descending are orderly, phlegm-dampness will not generate. As *Sheng Ji Zong Lu* states: "If the Triple Burner is regulated and qi and pulses are balanced, water fluids can be disseminated and transported into the meridians, transformed into blood, and irrigate the whole body. If the Triple Burner qi is blocked and pulse channels are congested, water-fluids stagnate and cannot be disseminated, gathering into phlegm-fluids." Cough and wheezing that worsen in both winter and summer involve both joint qi-yin deficiency and yang deficiency with phlegm-fluids, as well as flourishing heart fire and stagnation of the Triple Burner. Therefore, treatment is more difficult than for simple cold-fluid retention or joint qi-yin deficiency. Clinically, recognizing this, one must tonify the heart and lungs, transform phlegm-fluids, and assist with soothing the liver to resolve the condition.
For example: Patient Zhao XX, Female, 50 years old. Cough and wheezing for over 30 years, severe in winter and summer, milder in spring and autumn. During attacks, unable to lie flat day or night. Particularly severe in the past month, unresponsive to prior Chinese and Western medicine treatments. Examining the syndrome, besides inability to lie flat due to wheezing and cough, there is chest and hypochondriac fullness or wandering pain, irritability, palpitations, insomnia, lower back and soreness, poor appetite, weight loss, aversion to cold and fear of heat. Tongue coating is yellow-white with a slightly red body; bitter and dry mouth; pulse is wiry, large, slippery, and rapid. Correlating syndrome and pulse, diagnosed as joint qi-yin deficiency, stagnant phlegm-fluids, disordered Triple Burner, and Wood-Fire insulting Metal. Prescribed: Huangqi (Astragali Radix) 15g, Dangshen (Codonopsis Radix) 9g to tonify spleen and lung qi; Banxia (Pinelliae Rhizoma) 9g, Fuling (Poria) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g to transform cold-fluids; Ziwan (Asturi Flos) 9g to transform phlegm, unblock collaterals, and stop wheezing; Zhimu (Anemarrhenae Rhizoma) 9g, Digupi (Phellodendri Cortex) 9g to clear heat; Maidong (Ophiopogonis Radix) 9g, Shengdi (Rehmanniae Radix) 9g to nourish lung and stomach yin; Rougui (Cinnamomi Cortex) 4g paired with Maidong 9g to communicate Heart and Kidney; Chaihu (Bupleuri Radix) 9g, Banxia 9g, Shaoyao (Paeoniae Radix Alba) 9g, Gancao 6g paired to soothe liver depression and regulate Triple Burner. After 2 doses, wheezing and cough slightly subsided, other symptoms decreased. After another 10 doses, cough and wheezing stopped. Subsequently, to achieve a complete cure, the above formula was made into pills. After 2 years of medication, the patient recovered.
Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang (Cinnamon Twig Decoction minus Peony Root plus Clivia Rhizome, Oyster Shell, and Dragon Bone for Saving the Rebellious)
*Shanghan Lun* states: "In cold damage with a floating pulse, if the physician forces sweating by fire therapy, leading to loss of yang, inevitably causing fright, mania, restlessness in bed and upon rising, Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang is the principal formula." *Jin Gui Yao Lue* states: "For Fire Evil, Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang is the principal formula."历代 commentators have mostly discussed this in terms of Fire Evil, leading to rare use of this formula. Upon careful consideration of its composition, it contains Shuqi (Cliviae Rhizoma) for transforming phlegm, and Guizhi Qu Shaoyao Tang to assist Heart Yang. I have found it consistently effective for fright, mania, or easy startling during sleep due to Heart Yang deficiency and turbid phlegm obstruction.
For example: Patient Xu XX, Male, 5 years old. Ten days ago, while playing, he was suddenly frightened. Immediately afterward, he became timid, cried in fright and unrest, dared not go out, and dared not leave his parents. Sometimes crying suddenly in his sleep, occurring about 3-5 times per day and night. Tongue coating is white; pulse is wiry, choppy, and irregular. Synthesizing pulse and syndrome, diagnosed as Heart Yang deficiency and internal obstruction by turbid phlegm. Prescribed Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang. Formula: Guizhi 3g, Shengjiang 2 slices, Gancao 3g, Dazao (Jujubae Fructus) 5 pieces, Changshan (Dichroae Radix) 3g, Muli (Ostreae Concha) 6g, Longgu (Fossilia Ossis Mastodi) 6g. After 1 dose, all symptoms ceased. After continuing for 1 more dose, the patient recovered.
Mufangji Tang (Stephania Tetrandra Decoction)
Treated patient Gao XX, Male, 57 years old. Cough and wheezing for over 20 years, worsening in winter, alleviated in summer. However, for the past 7-8 months from winter to summer, continuous cough, wheezing, and shortness of breath. Diagnosed at a certain hospital with chronic bronchitis complicated by infection, emphysema, and cor pulmonale. Hospitalized twice, unsuccessful with various Chinese and Western medicines. Examining the syndrome, besides shortness of breath and wheezing, there is edema with oliguria, cyanosis, fullness and distension under the ribs and in the epigastrium, purple-dark tongue body, yellow-white coating, sallow-black complexion, and deep-tight pulse. Synthesizing pulse and syndrome, diagnosed as fluid retention in the epigastrium reversing upward to oppress the lung. Prescribed Mufangji Tang using bitter and acrid methods together to move water and dissipate nodules. Formula: Fangji (Stephaniae Tetrandrae Radix) 12g, Guizhi 6g, Sheng Shigao (Gypsum Fibrosum) 12g, Dangshen 12g. After 6 doses, wheezing, cough, and shortness of breath greatly reduced. The patient said: "Having taken 200 doses of medicine, none were as effective as this formula." A certain doctor asked: "This formula lacks specific anti-wheezing and antitussive drugs, yet the effect is miraculous. Why?" I answered: "*Jing Gui* states: 'For fluid retention in the diaphragm, if the patient has panting and fullness, hardness in the epigastrium, sallow-black complexion, and deep-tight pulse, developing over dozens of days, and not cured by vomiting or purging, Mufangji Tang is the principal formula. If deficient, it heals immediately; if excess, it recurs in three days. If recurrence is not cured by re-administering, Mufangji Qu Shigao Jia Fuling Mangxiao Tang (Mufangji Tang minus Gypsum plus Poria and Mirabilite) is the principal formula.' Although this case involves wheezing and shortness of breath, the patient's chief complaint is hardness in the epigastrium. Hardness in the epigastrium obstructs the ascending and descending of yang qi; if lung qi does not descend, wheezing occurs. Therefore, treatment should focus on the middle jiao (spleen and stomach), not the lung. Once middle jiao phlegm-fluids are eliminated, clear qi ascends, turbid qi descends, and self-healing occurs. This is why Mufangji Tang works through its acrid and bitter properties, assisting the ascending and descending of the middle jiao and transforming middle jiao phlegm-fluids." After 10 doses, edema disappeared, and cough and wheezing stopped.