然有为读者告者,即此方之治,并不神奇。在经方中,此常方耳,此常法耳。惜时医不读《伤寒》、《金匮》,以致不解其理,不用其方。《金匮》呕吐哕病篇不云乎:“哕而腹满,视其前后,知何部不利,利之愈。”今病者因气闷而致郁结,因停食而致不消,食气相搏,合而为病,且大便不解五日,此后部不利之的证也。因以调胃为主,佐以疏肝醒脾,而成相需相济之功耳。用之果然有效,仲景岂欺余哉。
调胃承气汤加柴郁术金方锦纹军元明粉各三钱炙甘草二钱春柴胡二钱广郁金三钱焦白术鸡内金(炙)各三钱痰滞结实哕证高年稍觉违和,并无寒热,胸脘作阻,气闷颇甚,医治无效,渐至食不得下。延及半月之久,体惫神糊。按其脘腹,满硬且痛,时有呃逆。舌苔灰黄厚腻,小便黄赤。询其大便,已旬余不通。断为结于中焦,有气闭之险。拟以黄龙汤加瓜蒌、苏子、莱菔子、木通主之。
有陈阿汇者,年69岁,住志丹路甘泉一村。其子女皆劳动工人,家境颇宽,此古稀之老人,坐享其成。老人年事虽高,而向少疾病。在1954年11月间,初觉身体小有违和,并无寒热外感之候。只觉胸脘气闷作阻,时轻时重,如嗳气则较宽,此时尚能勉强行动。厂医治之无效,延他医治之,亦无效。渐至气不得嗳,胸脘满闷更甚,食不得下,只稍饮白开水而已,体惫神糊,卧床不起。
其家属闻厂中其他工人言,延余诊之。时在12月4日下午,距起病时已半月矣。登楼入室,见病者平面仰卧,气息已微喘。诊其脉,沉细而弦。察其舌,苔满腻黄而干。扪其腹,满硬而痛。问其大小便,则病已半月,只于旬日前解得少许,小便初为深黄,近则黄赤也。询其有无呃逆,则于两日前已有之,约二三小时发一次,若断若续也。询其有无谵语,则于夜间偶有之,声低而语乱不清,心知此为呓语,而非谵语矣。盖谵语属实,呓语属虚也。且在七旬之人,呓语其宜也。不独老人之呓语为险症,即壮年之呓语,亦危证也,何况呃逆已间作,胃气将闭而绝矣。因为踟蹰者片时,盖处方须周详考虑也。
当告以“病之危险,已达极度。依病论之,不得不下。
以年论之,下之颇险。故其难在此。姑拟一方,试之何如。”病家同意,遂为之处方。用黄龙汤方,再加益气、降气、祛痰之品。令煎成汤满碗,以徐徐灌之。如头煎服之,四小时后,大便不解,则连服二煎。如四小时前已解,则二煎于翌晨服之,其伸缩在此。盖不得不下,而又不得不顾全其体力也。并嘱大便每解一次,须看一次,看其干湿如何,夹杂如何,色泽如何,次数多少。使明日复诊,用药之增减有把握也。即至登车南返时,沿途已灯火万家矣。
次日下午三时,果有电话来请复诊。当询其大便解否,日已解矣。神识清否,日尚未全清也。余即再度前往,细察病者之神情,已较为清晰。其家人告余以服药后之情形,曰:“自昨晚九时服头煎,至十二时后,大便始解。初则干硬异常,其色黑,夹有稠白之痰状物,着于其上。二次所解,则为球状之粪块,与酱色之糊状粪夹杂而下。至今晨天将明时,又解一次,均为糊状粪便。七时左右,始服二煎。
午前午后,又各解一次,但色仍粘稠如酱也。神识虽未全清,然呓语呃逆,已不作矣。余再诊其脉,沉已较起,而细已较大,知已有转机矣。因将前方之党参去之,易以茯苓、白术,去木通易以滑石,并去瓜蒌、苏子霜,令其再服一帖。
第三日复延三诊。则神识完全清明,已自能翻身转侧,舌苔退去大半。询其大便,已转淡黄,小便已较清畅,略思米饮矣。因嘱病家以薄粥及藕粉,与服旬日,禁食他物。由少而多,不可过量,否则必致食复也。再为之处以清理肠胃、益气生津之方,而获全愈。
黄龙汤加瓜蒌苏子莱菔子木通方锦纹军三钱元明粉四钱(分冲)川厚朴三钱炒枳实四钱潞党参四钱生地黄四钱全当归三钱全瓜萎三钱苏子霜三钱莱菔子霜三钱均木通二钱五分再诊方(即前方加减)锦纹军三钱元明粉三钱(分冲)川厚朴三钱炒枳实三钱云茯苓三钱焦白术三钱莱菔子霜三钱生地黄三钱全当归三钱飞滑石三钱头风儿童头风重证儿童九龄,初病头痛,继愈加剧,他无所苦,厂医治之无效。痛之间歇时间更短,发则头不能举,卧床作嗜眠状态,唤之则神识尚清,与昏睡又不同。嗣入医院诊疗,内服注射,四旬而无效。更于头侧开刀,注入药液,不但无效,痛更加剧,改延余诊。详问既往症状,断为头风。投以羚羊清肝汤,一剂知,二剂减,六剂全愈。
陈姓工友,住杨树浦路鸿德坊内之平房中。有独子年方九龄,初患头痛之病,无大寒热,以为常事,未加注意。经三四日,渐觉加重,始延医疗治。数易其医,而皆无效。即就厂中劳保医师诊治,打针服药,两皆无效。而痛之间歇时间则更短,发作时则如钻如刺,头不能举,倒于床上,成嗜眠状态。惟此嗜眠状态,不是昏睡状态,只是因头痛而头不能举,只好著枕睡眠耳。唤之则亦强应,问之亦觉明白,与昏睡之不省人事者不同。在头痛间歇之时,或较轻之时,强之倚卧,亦可倚卧一二刻钟。强之饮食,亦可勉食半碗至一碗稀饭。二便亦调,惟大便或隔日一解。总之他无所苦,惟有一头痛之顽固症状而已。
唯是独养之子,父母珍爱,可想而知。乃法外设法,改入金陵中路某医院住院疗治。在几位医师联合诊断之下,经验血、验便、验尿后,依次用药疗治,以及注射、电疗,均无效果。住院一月有余,病儿之父母,因厂中工作颇忙,只好隔日到院看儿一次。不独医药及住院费可观,即车费一项,因路远亦觉不支。在一月有余中,已用去旧人民币100余万元,而病则依然如旧,丝毫未减。其后经治医师得病家同意,为之作最后疗法,以冀作背城之战,所谓成败在此一举也。其法于病儿头部右旁脑盖骨与颞骨之合缝处,将皮屑割开,用某种药水,由骨缝中注入脑膜,再将头皮缝好。经过一夜,至第二日,头痛不但不减,反而更形加重。医师仍欲作第二次脑膜注射,而病家信心已失,坚决不肯,随请出院。医师无奈,遂令其填写自愿出院书,签名盖章。乃出院返家,以待其子之死亡。鸿德坊之楼房中,有韩师母者,闻知病儿未愈,已由医院归来,前往询问。见病儿如此情形,因贡献意见曰:“大医院中既治之未愈,汝之独养子,将听其死耶。何不请中医一治,治之而有效,则拾到一个儿子;设治之不效而死,汝夫妇是为父母者,亦算尽到最大之人事,而对得起这无知孩子。”病儿之父母,同接受其意,由韩以电话招余往诊。余既至病家,备询过去之情形,细察现在之症状,以及开刀之处,逐一看过,觉甚无把握。当即告之曰:“此头风之证,若未经开刀注射脑膜,则较有希望。
今既经过注射,且又痛更加剧,脑膜是否受伤,不得而知。
即使有法治疗,亦只一试,以尽人事而已。今为处一方,先服一帖,有效则再招复诊,否则听之而已。”后思肝热为此症之源,息肝风、清肝热者,惟羚羊角尚矣。因以羚羊角为主,为之处方如后,名日羚羊清肝汤。所以配以石膏者,因羚羊角价贵,贫苦之温热病者,每以石膏代犀、羚,且能清表里之热。配以葛根者,因葛根能清解经枢之热也。他如丹、地之平肝凉血,而泻伏火;天麻之疏肝通脉,除诸风掉眩;僵蚕之散风轻升;蝉衣之除风散热,各有专长,相因为用。并令其先以冷开水服下羚羊角粉之过半,一刻钟后,再服下汤药。并嘱汤药只须五六分热即可,不可太热,恐减低羚羊角效力也。过四小时后,再服二煎。
仍是先服羚羊角粉之小半后,再服下汤药。于是病家至达仁堂配方,照法再服。
次日上午十一时,忽接电话,即病儿之父,告知服药之后,情形好转。头痛已减十分之三,嗜卧状态亦稍减,精神亦较为清醒,大小便增多自动解过,能食一碗米粥,下午还请复诊。余闻之,心喜无量。下午复至病家,病儿正在睡觉。轻轻唤醒,睁开两眼,似乎目光亦较佳。问其头痛减否,儿答“已减轻矣。”问其有无其他苦楚,儿答“别无苦楚,头痛一愈,我无病矣。”余心暗喜过望,知是羚羊角之功。便告知病家,病情确已好转。如能逐渐进步,不再反复,便可高枕无忧矣。乃于原方上再加香白芷二钱,甘菊花二钱,令其如法再服。
至第三日上午,陈姓自来余所。告我病情更减二分,扶坐于床上,时间可以较久,两眼睁开时间亦较长,不似以前,唤之则勉开两眼,开过则眼又闭合,此方真灵。惟是羚羊角太贵,每分三万元,六分便是十八万元。两月来已所费不支,而此两剂方子,便靠近四十万元(按:至1955年始发行新币,改一万元为一元)。现借贷为难,如之奈何。余因劝告之曰:“经济是你的问题。照病情而论,既已大见减轻,此后羚羊角可减少为四分。药既对证,余可不去复诊。
速服二剂,病再轻减,羚羊角可再减为二分。以完全治愈,一点不痛为止。病不见效,余不劝汝。病既见效到如此地步,切不可功亏一篑也。”陈某欣从余言而去。此后人既未来,电话亦未通,病之好坏,不得而知。后又一月有余,韩师母偕一李师母,带其孙儿来诊。入门即欣然告余曰:“前月陈姓之儿,为先生六帖羚羊角,治愈大医院不治之证矣。”余再细询其情况,即陈姓回家以后,东借西贷,先减羚羊角为四分,再减羚羊角为二分,共服四帖。连前共六帖,完全就痊矣。
羚羊清肝汤方羚羊角粉六分生石膏二两(先煎)粉葛根三钱粉丹皮三钱干地黄四钱明天麻一钱五分炒僵蚕三钱净蝉衣一钱五分按:此方,至再诊时,减羚羊角为四分,加香白芷二钱,甘菊花二钱。
青年头风重证船厂工友,患生感冒。诸症退后,独遗头痛不痊,时减时剧。厂医治之,多日无效。改就仁济医院门诊,内服注射,亦未见功。发则头痛目眩,间歇时较轻,夜间常至失眠,病者苦之。嗣就余诊,断为头风。治以清肝凉血散风汤,五次加减,两阅月而始痊。
患者阴景琢,年24岁,住中兴路397弄,为造船厂工友。在劳动汗出之时,致患感冒。寒热头痛,肢节酸楚。嗣经厂中劳保医师治疗,寒热已除,肢酸亦痊。独遗头痛之候,久治不效。特向厂中请求,改送仁济医院诊治。院中以病房人满,令其每日门诊。内服注射,亦久久不痊。前后约三月有余,不但毫无寸效,且头痛更形深沉,有时如钻如刺,有时减轻,呈间歇之候,稍有精神刺激,立即疼痛如初,甚至牵及颈项,下连肩背。以致饮食渐少,大便亦于燥,小溲更深黄,病者自分难愈矣。时劳保医院,尚无中医参加,在外就诊,厂中不予负担。
有季子甫者,与阴某为同乡。询知其久病未愈,介就余诊。并告余以治疗不效之经过,且云:“在外延医,不就指定之医院,则厂方于医药费用,即不肯负担。且患者父老多病,家中人口众多,向外借贷为难”云。余乃细察其现在症状,详询其既往症状,知非用羚羊角决不为功。告知病家,亦颇以为苦。无已,为其酌处一方,定名清肝凉血散风汤,令服两帖,再来复诊。讵服后约减百分之十,盖见效甚微也。因于原方加藁本、白芷,令其再服两帖。此两帖服后,痛又减百分之十。总之较前为减轻,尚不能大见减退也。然方已对证,是乃毫无疑义,因令续服四帖。并告以病近四月,根蒂已深,但求缓效,而不反复,即可达治愈之目的矣。
迨至四帖服后,而病者觉似减非减,惟大便不爽如前。
因于方中加锦纹军一钱五分,目的使大便通畅,导热下泄,必可稍减也。乃服药之后,大便果爽,而头痛果减,巅顶及后脑,痛几减去一半。即全盘计之,约减百分之五十也。惟两太阳即鬓部仍觉未减,且时聂聂作痛。因于原方去大黄、羌活、藁本,加白蒺藜三钱,春柴胡三钱,龙胆草二钱。令其连服三帖,两鬓痛亦大减。至复诊之时,则见病者入门,已去其包头之巾,而健步笑容而入。余谓诸生曰:阴姓头痛已大减矣。诸生曰:何以知之?余曰:见其头巾已去。故知之也。及坐定问之,果然,于是相与大笑。略再诊察,即将原方诸药减量,去龙胆、柴胡,加茯苓、白术以益气。连服五剂,而完全就愈。
清肝凉血散风汤方夏枯草三钱粉丹皮四钱生地黄八钱生黄芩四钱生石膏二两粉葛根五钱川羌活三钱甘菊花四钱冬桑叶四钱净蝉衣三钱再诊方即前方加藁本三钱,白芷四钱。
三诊方即再诊方中,加锦纹军一钱五分。
四诊方即三诊方中,去锦纹军、羌活、藁本,加白蒺藜三钱,春柴胡三钱,龙胆草二钱。
五诊方即四诊方中,去龙胆、柴胡,加云茯苓四钱,焦白术四钱,其他诸药,为酌减分量。
按:此证于二月中旬就诊,至四月中旬始痊。
痉病儿童食积痉病八龄儿童,身体素壮,学校归来,顿然发热。至下午四时,忽发急惊病证。角弓反张,项背均强,两目上耸,手足拘挛,牙关紧急,欲呕不出,口角流涎,有时行脑膜炎之疑。余询知其端阳之节,食角黍、鱼肉颇多。此食积胃脘,酿生内热,反射于脑也。以硝黄蒌葛汤一下而愈。
然而,我要向读者说明的是,这个方子的疗效,并不神奇。在经方中,这只是一个普通的方子,一种常规的治疗方法罢了。可惜当时的医生不读《伤寒论》和《金匮要略》,以至于不理解其中的医理,不使用这些方剂。《金匮要略·呕吐哕病篇》不是说过吗:“呃逆且腹部胀满,观察前后二便,知道哪一部分不通利,通利它就能痊愈。”现在的病人因为气机郁闷导致气结,因为停食导致消化不良,食物与气机相互搏结,合而为病,而且大便五天未解,这是后部(大便)不利的确凿证据。因此以调理胃气为主,辅以疏肝醒脾,从而起到相辅相成、互相促进的作用。用了果然有效,张仲景难道会欺骗我吗?
调胃承气汤加柴胡、郁金、白术、鸡内金方:锦纹大黄三钱、元明粉三钱、炙甘草二钱、春柴胡二钱、广郁金三钱、焦白术三钱、炙鸡内金三钱。
痰滞结实导致的呃逆证,高龄老人稍觉身体不适,并没有恶寒发热的症状,胸脘部感觉阻塞,气闷非常严重,医治无效,逐渐发展到食物无法下咽。拖延了半个月之久,身体疲惫,神志模糊。按压他的脘腹,又满又硬而且疼痛,时有呃逆。舌苔灰黄厚腻,小便黄赤。询问他的大便情况,已经十多天没有通畅了。诊断为邪结于中焦,有气机闭塞的危险。拟定用黄龙汤加瓜蒌、苏子、莱菔子、木通为主方。
有一位叫陈阿汇的病人,69岁,住在志丹路甘泉一村。他的子女都是劳动工人,家境相当宽裕,这位古稀之年的老人坐享其成。老人虽然年事已高,但向来很少生病。在1954年11月间,起初觉得身体稍有不适,并没有恶寒发热等外感症状。只感觉胸脘气闷堵塞,时轻时重,如果能打嗳气就会稍微舒缓,此时还能勉强行动。厂里的医生治疗无效,换其他医生治疗,也无效。逐渐发展到不能打嗳气,胸脘满闷更加严重,食物无法下咽,只能稍微喝点白开水,身体疲惫,神志模糊,卧床不起。
家属听工厂里其他工人说,请我去诊治。时间是12月4日下午,距离发病已经半个月了。上楼进屋,看见病人平躺仰卧,气息已经微弱喘息。诊脉,脉象沉细而弦。看舌苔,苔满腻黄而干。摸腹部,满硬且痛。问大小便,病人已经病了半个月,只在十天前解出少许,小便起初是深黄色,最近变成黄赤色。询问是否有呃逆,回答说两天前已经有了,大约两三个小时发作一次,断断续续。询问是否有谵语(胡言乱语),回答说夜间偶尔有,声音低微且言语混乱不清,心里知道这是呓语(梦话),而不是谵语。因为谵语属于实证,呓语属于虚证。而且在七十岁的人身上,出现呓语是适宜的。不只是老人的呓语是险症,即使是壮年人的呓语,也是危重证候,何况呃逆已经间歇发作,胃气将要闭绝了。因此我犹豫了片刻,因为处方需要周详考虑。
当时告诉家属:“病的危险程度,已经达到极致。依病情来看,不得不使用攻下法。依年龄来看,使用攻下法很危险。所以难点就在这里。暂且拟定一方,试试如何?”病家同意,于是为他处方。使用黄龙汤方,再加益气、降气、祛痰的药物。让煎成药汤满一碗,慢慢地灌服。如果头煎服用后,四小时后大便仍未解,就连续服用二煎。如果四小时前已经解大便,那么二煎在第二天早晨服用,灵活性就在这里。因为不得不下法,但又不得不顾全病人的体力。并嘱咐每次解大便,都要查看一次,看它的干湿情况,夹杂物情况,色泽情况,次数多少。以便明天复诊时,对药物的增减有把握。等到上车南返时,沿途已经是万家灯火了。
次日下午三点,果然有电话来请复诊。当即询问大便是否解出,回答说已经解了。神识是否清醒,回答说还没有完全清醒。我随即再次前往,仔细观察病人的神情,已经比较清晰。他的家人告诉我服药后的情形,说:“从昨晚九时服头煎,到十二时后,大便才解出。初解出的大便干硬异常,颜色黑,夹杂着稠白的痰状物,附着在上面。第二次解出的,则是球状的粪块,与酱色的糊状粪便夹杂而下。到今天早晨天将亮时,又解了一次,都是糊状粪便。七时左右,开始服用二煎。午前午后,又各解出一次,但颜色仍然粘稠如酱一样。神识虽然没有完全清醒,但是呓语和呃逆,已经不发作了。我再诊脉,沉脉已经比之前浮起一些,细脉已经比之前粗大一些,知道已经有转机了。因此将前方中的党参去掉,换成茯苓、白术,去掉木通换成滑石,并去掉瓜蒌、苏子霜,让他再服一帖。
第三天又去进行第三次诊治。则神识完全清明,已经能自己翻身转侧,舌苔退去大半。询问他的大便,已经转为淡黄色,小便已经比较清畅,略微想吃米汤了。因此嘱咐病家用薄粥及藕粉,配合服用十天,禁止食用其他食物。由少到多,不可过量,否则必然导致因饮食不当而复病。再为他处方清理肠胃、益气生津的方子,从而获得痊愈。
黄龙汤加瓜蒌、苏子、莱菔子、木通方:锦纹大黄三钱、元明粉四钱(分两次冲服)、川厚朴三钱、炒枳实四钱、潞党参四钱、生地黄四钱、全当归三钱、全瓜蒌三钱、苏子霜三钱、莱菔子霜三钱、均木通二钱五分。
再诊方(即前方加减):锦纹大黄三钱、元明粉三钱(分两次冲服)、川厚朴三钱、炒枳实三钱、云茯苓三钱、焦白术三钱、莱菔子霜三钱、生地黄三钱、全当归三钱、飞滑石三钱。
头风儿童头风重证:儿童九岁,起初患病头痛,随后加剧,没有其他痛苦,工厂医生治疗无效。疼痛的间歇时间更短,发作时头不能抬起,卧床呈嗜睡状态,唤醒则神识尚清,与昏睡又不同。后来进入医院诊疗,内服注射,四十天都没有效果。又在头部侧面开刀,注入药液,不但无效,疼痛更加剧烈,改请我诊治。详细询问既往症状,诊断为头风。投以羚羊清肝汤,一剂见效,二剂减轻,六剂痊愈。
姓陈的工友,住在杨树浦路鸿德坊内的平房中。有一个独生子年仅九岁,起初患头痛病,没有大的寒热症状,以为是常事,没有注意。经过三四天,逐渐觉得加重,才开始请医生治疗。换了几个医生,都无效。就到工厂的劳保医师处诊治,打针服药,两者都无效。而疼痛的间歇时间则更短,发作时如同钻刺,头不能抬起,倒在床上,呈嗜睡状态。只是这种嗜睡状态,不是昏睡状态,只是因为头痛导致头不能抬起,只好枕着枕头睡觉而已。唤醒也能勉强应答,问话也觉得明白,与昏睡不省人事者不同。在头痛间歇的时候,或者较轻的时候,强行让他倚靠躺着,也可以躺一二刻钟。强行让他进食,也可以勉强吃半碗至一碗稀饭。大小便也正常,只是大便或隔日解一次。总之没有其他痛苦,只有一个顽固的头痛症状而已。
只是因为是独养之子,父母珍爱,可想而知。于是设法之外再想办法,改为送入金陵中路某医院住院治疗。在几位医师联合诊断之下,经验血、验便、验尿后,依次用药治疗,以及注射、电疗,均无效果。住院一月有余,病儿的父母,因为工厂工作很忙,只好隔天到医院看孩子一次。不仅医药及住院费可观,就是车费一项,因为路远也觉得难以支撑。在一个多月里,已经用去旧人民币100余万元,而病却依然如旧,丝毫未减。其后经治医师得到病家同意,为之做最后疗法,希望作背城一战,所谓成败在此一举。其方法是在病儿头部右侧脑盖骨与颞骨的合缝处,将皮屑割开,用某种药水,由骨缝中注入脑膜,再将头皮缝好。经过一夜,到第二天,头痛不但没有减轻,反而更加严重。医师仍欲作第二次脑膜注射,而病家信心已失,坚决不肯,随即请求出院。医师无奈,遂令其填写自愿出院书,签名盖章。于是出院回家,等待儿子的死亡。鸿德坊的楼房中,有一位韩师母,听说病儿未愈,已由医院归来,前去询问。看见病儿如此情形,便贡献意见说:“大医院中既然治疗未愈,你的独养儿子,将听任他死吗?为什么不请中医治疗一下,治疗有效,就捡到一个儿子;假如治疗无效而死,你们作为父母,也算尽了最大的人事,而对得起这个无知的孩子。”病儿的父母,一同接受她的意见,由韩师母打电话招我去诊治。我既到了病家,详细询问过去的情形,仔细观察现在的症状,以及开刀之处,逐一看过,觉得甚无把握。当即告诉他们:“这个头风的证候,如果未经开刀注射脑膜,则比较有希望。现在既然经过注射,而且疼痛更加剧烈,脑膜是否受伤,不得而知。即使有办法治疗,也只是试一试,以尽人事而已。现在为你们处方一方,先服一帖,有效则再招复诊,否则听之而已。”后来想肝热是这个病症的根源,平息肝风、清肝热的药物中,只有羚羊角最好。因此以羚羊角为主,为他们处方如下,名叫羚羊清肝汤。之所以配伍石膏,是因为羚羊角价格昂贵,贫困的温热病患者,常用石膏代替犀角、羚羊角,而且能清表里之热。配伍葛根,是因为葛根能清解经枢之热。其他的如丹皮、生地之平肝凉血,而泻伏火;天麻之疏肝通脉,除诸风掉眩;僵蚕之散风轻升;蝉衣之除风散热,各有专长,相互为用。并让他们先用冷开水服下过半的羚羊角粉,一刻钟后,再服下汤药。并嘱咐汤药只需五六分热即可,不可太热,恐怕减低羚羊角的效力。过四小时后,再服二煎。仍然是先服羚羊角粉的小半部分后,再服下汤药。于是病家到达仁堂配方,照法再服。
次日上午十一时,忽然接到电话,即病儿的父亲,告知服药之后,情形好转。头痛已减轻十分之三,嗜卧状态也稍减,精神也较为清醒,大小便增多自动解出,能吃一碗米粥,下午还请复诊。我听了,心中欢喜无量。下午再次到病家,病儿正在睡觉。轻轻唤醒,睁开两眼,似乎目光也较好。问他头痛减轻否,孩子回答“已经减轻了。”问他有无其他痛苦,孩子回答“别无痛苦,头痛一愈,我就没病了。”我心里暗自惊喜过望,知道是羚羊角的功效。便告知病家,病情确实已好转。如果能逐渐进步,不再反复,便可高枕无忧了。于是在原方上再加香白芷二钱,甘菊花二钱,让他们照法再服。
到第三日上午,姓陈的亲自来到我这里。告诉我病情更减轻二分,扶坐于床上,时间可以较久,两眼睁开时间也较长,不像以前,唤醒则勉强睁开两眼,开过后眼睛又闭合,这个方子真灵。只是羚羊角太贵,每分三万元,六分便是十八万元。两个月来已经所费不支,而这两剂方子,便靠近四十万元(按:至1955年始发行新币,改一万元为一元)。现在借贷为难,怎么办。我于是劝告他说:“经济是你的问题。照病情而论,既然已经大见减轻,此后羚羊角可减少为四分。药既对证,我可以不去复诊。速服二剂,病再轻减,羚羊角可再减为二分。以完全治愈,一点不痛为止。病不见效,我不劝你。病既然见效到如此地步,切不可功亏一篑也。”陈某欣然听从我的话而去。此后人既未来,电话也未通,病的好坏,不得而知。后又一月有余,韩师母偕同一位李师母,带着她的孙儿来诊治。进门就欣然告诉我:“上个月姓陈的儿子,被先生用六帖羚羊角,治愈了大医院不治之证矣。”我再详细询问其情况,即姓陈的回家以后,东借西贷,先减羚羊角为四分,再减羚羊角为二分,共服四帖。连前共六帖,完全痊愈了。
羚羊清肝汤方:羚羊角粉六分、生石膏二两(先煎)、粉葛根三钱、粉丹皮三钱、干地黄四钱、明天麻一钱五分、炒僵蚕三钱、净蝉衣一钱五分。
按:此方,至再诊时,减羚羊角为四分,加香白芷二钱,甘菊花二钱。
青年头风重证:船厂工友,患生感冒。诸症退后,唯独遗留头痛不愈,时轻时剧。工厂医生治疗,多日无效。改到仁济医院门诊,内服注射,也未见功效。发作时头痛目眩,间歇时较轻,夜间常至失眠,病人对此很苦恼。后来找我诊治,诊断为头风。治以清肝凉血散风汤,五次加减,两个多月才痊愈。
患者阴景琢,24岁,住中兴路397弄,为造船厂工友。在劳动出汗之时,导致患感冒。寒热头痛,肢节酸楚。后来经过工厂中劳保医师治疗,寒热已除,肢体酸痛也痊愈。唯独遗留头痛的症状,久治不效。特别向工厂请求,改送仁济医院诊治。医院因为病房人满,令其每日门诊。内服注射,也久久不愈。前后约三月有余,不但毫无寸效,而且头痛更加深沉,有时如钻如刺,有时减轻,呈间歇的状态,稍有精神刺激,立即疼痛如初,甚至牵及颈项,下连肩背。以致饮食渐少,大便也干燥,小便更深黄,病人自己认为难以痊愈了。当时劳保医院,尚无中医参加,在外就诊,工厂不予负担。
有一位季子甫,与阴某是同乡。询问知道他久病未愈,介绍他来找我诊治。并告诉我治疗不效的经过,还说:“在外面延请医生,如果不就指定之医院,则工厂方面对于医药费用,就不肯负担。而且患者父老多病,家中人口众多,向外借贷为难”等等。我于是仔细察看他的现在症状,详细询问他的既往症状,知道非用羚羊角决不能成功。告知病家,也很为此苦恼。没有办法,为他斟酌处方一方,定名为清肝凉血散风汤,令服两帖,再来复诊。岂料服用后约减轻百分之十,大概见效甚微。因此在原方中加入藁本、白芷,令其再服两帖。这两帖服用后,疼痛又减轻百分之十。总之较前为减轻,尚不能大见减退。然而方已对证,这是毫无疑义的,因此令继续服用四帖。并告诉他病近四月,根蒂已深,但求缓效,而不反复,即可达到治愈的目的。
等到四帖服用后,而病人觉得似减非减,只是大便不爽如前。因此在方中加入锦纹大黄一钱五分,目的是使大便通畅,导热下泄,必定可以稍减。乃服药之后,大便果然通畅,而头痛果然减轻,巅顶及后脑勺,疼痛几乎减去一半。全盘计算,约减轻百分之五十。只是两侧太阳穴即鬓部仍觉得未减,而且时常隐隐作痛。因此在原方中去掉大黄、羌活、藁本,加入白蒺藜三钱、春柴胡三钱、龙胆草二钱。令其连服三帖,两鬓疼痛也大大减轻。到复诊之时,则看见病人进门,已经去掉了包头之巾,而健步笑容而入。我对学生们说:姓阴的头痛已经大减了。学生们说:怎么知道的?我说:看见他头巾已去。所以知道的。等到坐定问之,果然,于是相与大笑。略微再诊察,即将原方诸药减量,去掉龙胆、柴胡,加入茯苓、白术以益气。连服五剂,而完全痊愈。
清肝凉血散风汤方:夏枯草三钱、粉丹皮四钱、生地黄八钱、生黄芩四钱、生石膏二两、粉葛根五钱、川羌活三钱、甘菊花四钱、冬桑叶四钱、净蝉衣三钱。
三诊方:即再诊方中,加锦纹大黄一钱五分。
四诊方:即三诊方中,去掉锦纹大黄、羌活、藁本,加白蒺藜三钱,春柴胡三钱,龙胆草二钱。
五诊方:即四诊方中,去掉龙胆、柴胡,加云茯苓四钱,焦白术四钱,其他诸药,酌情减少分量。
按:此证于二月中旬就诊,至四月中旬始痊愈。
痉病儿童食积痉病:八龄儿童,身体素来强壮,学校归来,突然发热。到下午四时,忽然发生急惊病证。角弓反张,项背均强直,两目上视,手足拘挛,牙关紧急,想吐吐不出,口角流涎,有时怀疑是脑膜炎。我询问得知他在端午节期间,吃了许多角黍(粽子)、鱼肉。这是食积胃脘,酿生内热,反射于脑部所致。用硝黄蒌葛汤一下而愈。
However, I must inform the readers that the treatment of this formula is not miraculous. Among the classic formulas (Jingfang), this is merely a common formula and a routine method. It is regrettable that contemporary physicians do not study the *Shanghan Lun* (Treatise on Cold Pathogenic Diseases) and the *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet), thereby failing to understand its principles and not using these formulas. Does it not say in the "Chapter on Vomiting, Hiccups, and Eructation" of the *Jinkui Yaolue*: "In cases of hiccups accompanied by abdominal fullness, observe the anterior and posterior orifices; determine which part is obstructed, and unblocking it will lead to cure." The current patient suffers from qi stagnation leading to constraint, and food retention leading to indigestion. Food and qi struggle with each other, combining to cause disease. Moreover, the bowels have not moved for five days, which is definitive evidence of posterior obstruction (constipation). Therefore, the treatment focuses on regulating the Stomach Qi, assisted by soothing the Liver and awakening the Spleen, achieving a synergistic effect. Its efficacy was indeed confirmed; would Zhang Zhongjing deceive me?
**Formula: Tiaowei Chengqi Tang (Regulate the Stomach Decoction) modified with Chai Hu, Yu Jin, Bai Zhu, Ji Nei Jin:**
Da Huang (Rhei Radix et Rhizoma) 3 qian, Ming Fan (Natrii Sulfas) 3 qian, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 2 qian, Chun Chai Hu (Bupleuri Radix) 2 qian, Guang Yu Jin (Curcumae Longae Rhizoma) 3 qian, Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma) 3 qian, Zhi Ji Nei Jin (Galli Gigerii Endothelium Corneum) 3 qian.
**Case: Hiccups due to Phlegm-Stasis and Solidification in an Elderly Patient**
An elderly patient felt slightly unwell without aversion to cold or fever. He experienced chest and epigastric obstruction with severe qi stagnation. Medical treatment failed, and gradually he could not swallow food. After half a month, his body was exhausted and spirit confused. Palpation of the epigastrium and abdomen revealed fullness, hardness, and pain, with intermittent hiccups. The tongue coating was grey-yellow, thick, and greasy; urine was yellow and red. Bowel movements had been absent for over ten days. The diagnosis was accumulation in the Middle Jiao with a risk of qi closure. The proposed prescription was Huanglong Tang (Yellow Dragon Decoction) plus Gua Lou (Trichosanthis Fructus), Su Zi (Perillae Fructus), Lai Fu Zi (Radish Seed), and Mu Tong (Akebiae Caulis).
**Case: Chen Ahui, Head Wind (Headache)**
Patient Chen Ahui, aged 69, lived at Ganzhun Village No. 1, Zhidan Road. His children were laborers, and the family was well-off. In November 1954, he initially felt slight discomfort without exterior symptoms like aversion to cold or fever. He felt chest and epigastric qi stagnation and obstruction, varying in severity, relieved somewhat by belching. Factory doctors' treatments failed. Gradually, he could not belch, chest/epigastric fullness worsened, and he could only drink plain water. His body became exhausted, spirit confused, and he was bedridden.
On December 4th afternoon, half a month after onset, I visited. The patient lay supine with weak, panting breath. Pulse was deep, fine, and wiry. Tongue coating was full, greasy, yellow, and dry. Abdomen was full, hard, and painful. Urination had been scanty for ten days, urine dark yellow turning reddish. Hiccups occurred every 2-3 hours intermittently. Occasional mumbling speech (Yiyu) at night, low voice and unclear, identified as dream-talk (Yiyu) rather than delirious speech (Zhanyu), indicating deficiency rather than excess. Given his age and intermittent hiccups suggesting closing Stomach Qi, the condition was critical. I hesitated but prescribed cautiously.
I informed the family: "The danger is extreme. Medically, purgation is necessary; given his age, it is risky. I will try a formula." Agreed, I prescribed Huanglong Tang plus herbs to tonify Qi, descend Qi, and resolve phlegm. One bowl of decoction was administered slowly. Instructions: If no bowel movement after 4 hours, take the second decoction; if movement occurs earlier, take the second decoction next morning. This flexibility balances the need for purgation with preserving physical strength. Bowel movements were to be monitored for consistency, content, color, and frequency to guide future adjustments.
By 3 PM the next day, a call reported bowel movement. Spirit was not fully clear. Upon re-examination, spirit was clearer. Family reported: First decoction taken at 9 PM previous night; bowel movement at midnight, initial stool dry, black, with white phlegm-like substance. Second stool ball-shaped feces mixed with sauce-colored paste. Morning stool pasty. Second decoction taken at 7 AM. More stools passed, still sticky/sauce-colored. Dream-talk and hiccups ceased. Pulse deepening less, finer pulse becoming larger, indicating turnaround. Prescription modified: Removed Dang Shen, added Fu Ling and Bai Zhu; removed Mu Tong, added Hua Shi; removed Gua Lou and Su Zi.
Third visit: Spirit completely clear, able to turn over. Tongue coating largely receded. Bowel movements pale yellow, urine clear, appetite returning for rice soup. Advised thin porridge and lotus root starch for ten days, avoiding other foods to prevent relapse. Final prescription cleared intestines/stomach, tonified Qi, and generated fluids. Cure achieved.
**Formula: Huanglong Tang Modified**
Da Huang 3 qian, Ming Fan 4 qian (divided), Hou Po 3 qian, Zhi Zhi Shi 4 qian, Dang Shen 4 qian, Sheng Di Huang 4 qian, Dang Gui 3 qian, Gua Lou 3 qian, Su Zi 3 qian, Lai Fu Zi 3 qian, Mu Tong 2.5 qian.
**Second Visit Formula:**
Da Huang 3 qian, Ming Fan 3 qian (divided), Hou Po 3 qian, Zhi Zhi Shi 3 qian, Fu Ling 3 qian, Bai Zhu 3 qian, Lai Fu Zi 3 qian, Sheng Di Huang 3 qian, Dang Gui 3 qian, Hua Shi 3 qian.
**Case: Pediatric Head Wind Severe Case**
A nine-year-old boy suffered from worsening headache, unable to lift his head, lying in a lethargic state but conscious when called. Hospital treatments (internal, injection, surgery) failed, worsening pain. Diagnosed as Head Wind (Tou Feng). Prescribed Lingyang Qinggan Tang (Antelope Horn Clearing Liver Decoction). One dose improved, two reduced, six cured.
**Case: Chen's Son, Pediatric Head Wind**
Chen, living in Hongde Fang, Yangshupu Road, had a nine-year-old son. Initial headache without significant fever. Worsened over 3-4 days. Factory doctor injections/meds failed. Pain intervals shortened, severe stabbing pain, head unable to lift, lethargic but conscious. Not coma-like. Parents spent heavily at Jinling Middle Road Hospital (blood/stool/urine tests, meds, injections, electrotherapy) for over a month with no improvement. Surgery (injection into meninges via skull suture) worsened pain. Parents refused further injection and discharged. Mrs. Han suggested consulting Traditional Chinese Medicine (TCM).
I examined the boy, noting the surgical site. Uncertain due to potential meningeal injury from injection. Prescribed Lingyang Qinggan Tang as a trial. Etiology identified as Liver Heat generating Wind. Lingyang Jiao (Antelope Horn) was primary for clearing heat/extinguishing wind. Shi Gao (Gypsum) substituted for expensive Xijiao/Ralingjiao to clear interior/exterior heat. Ge Gen (Puerariae Radix) cleared channel pivot heat. Dan Pi (Moutan Cortex), Di Huang (Rehmanniae Radix) cooled blood/cleared latent fire. Tian Ma (Gastrodiae Rhizoma) soothed liver/unblocked vessels. Jiang Can (Bombyx Batryticatus) dispersed wind. Chan Yi (Cicada Molt) dispelled wind/heat.
Administration: Half the Lingyang Jiao powder taken with cold water, followed by decoction 15 mins later. Decoction warm, not hot. Second decoction 4 hours later. Same protocol.
Next day 11 AM: Father reported 30% pain reduction, less lethargy, clearer spirit, increased bowel/urine, eating rice porridge. Afternoon visit: Boy awake, eyes better, confirmed pain relief. Added Bai Zhi (Angelicae Dahuricae Radix) and Ju Hua (Chrysanthemi Flos) to original formula.
Third day: Chen reported another 20% reduction. Sat longer, eyes open longer. Complained of high cost of Lingyang Jiao (30,000 old yuan per fen). Advised reducing dosage based on efficacy: reduce to 4 fen, then 2 fen if continuing to improve, aiming for complete cure without pain. Emphasized not to give up now.
One month later: Mrs. Han reported the boy cured after 6 doses total (reducing dosage from 6 fen to 4 fen to 2 fen).
**Formula: Lingyang Qinggan Tang**
Lingyang Jiao Fen (Antelope Horn Powder) 6 fen, Sheng Shi Gao (Raw Gypsum Fibrosum) 2 liang (decoct first), Ge Gen 3 qian, Dan Pi 3 qian, Di Huang 4 qian, Tian Ma 1.5 qian, Jiang Can 3 qian, Chan Yi 1.5 qian.
*Note: At second visit, Lingyang Jiao reduced to 4 fen, added Bai Zhi 2 qian, Ju Hua 2 qian.*
**Case: Young Adult Head Wind Severe Case**
Yin Jingzhuo, 24, shipyard worker. Caught cold during sweating from labor. Fever/headache/body ache resolved with factory doctor, but headache persisted. Renji Hospital outpatient treatment (internal/injection) failed for 3 months. Pain deepened, stabbing, intermittent, triggered by emotion, radiating to neck/shoulders. Diet decreased, constipation, dark urine. Factory did not cover external medical costs. Fellow townsman Ji Zifu introduced him to me.
Diagnosis required Lingyang Jiao. Prescribed Qinggan Liangxue Sanfeng Tang (Clear Liver Cool Blood Dispel Wind Decoction) for 2 doses. Only 10% reduction. Added Gao Ben (Ligustici Rhizoma et Radix) and Bai Zhi. Next 2 doses: another 10% reduction. Continued 4 more doses. Improvement slow but steady.
After 4 doses, bowel movement remained unsatisfactory. Added Da Huang 1.5 qian to promote bowel movement and drain heat. Result: Bowel movement smooth, headache reduced by 50% (vertex/back of head). Temples still painful. Modified formula: Removed Da Huang, Qiang Huo, Gao Ben; added Bai Ji Li (Tribuli Fructus), Chai Hu, Long Dan Cao (Gentianae Radix). 3 doses: temple pain greatly reduced.
At follow-up, patient entered smiling, headband removed. Pulse/tongue checked. Reduced dosages, removed Long Dan Cao, Chai Hu; added Fu Ling, Bai Zhu to tonify Qi. 5 doses: Complete cure.
**Formula: Qinggan Liangxue Sanfeng Tang**
Xia Ku Cao (Prunellae Spica) 3 qian, Dan Pi 4 qian, Sheng Di Huang 8 qian, Huang Qin (Scutellariae Radix) 4 qian, Shi Gao 2 liang, Ge Gen 5 qian, Qiang Huo (Notopterygii Rhizoma et Radix) 3 qian, Ju Hua 4 qian, Sang Ye (Mori Folium) 4 qian, Chan Yi 3 qian.
**Second Visit Formula:** Add Gao Ben 3 qian, Bai Zhi 4 qian.
**Third Visit Formula:** Add Da Huang 1.5 qian.
**Fourth Visit Formula:** Remove Da Huang, Qiang Huo, Gao Ben; add Bai Ji Li 3 qian, Chai Hu 3 qian, Long Dan Cao 2 qian.
**Fifth Visit Formula:** Remove Long Dan Cao, Chai Hu; add Fu Ling 4 qian, Bai Zhu 4 qian; reduce others.
*Note: Treated mid-Feb, cured mid-Apr.*
**Case: Pediatric Spasm due to Food Accumulation**
Eight-year-old boy, strong constitution. Returned from school with sudden fever. At 4 PM, acute convulsion syndrome developed: opisthotonos, stiff neck/back, upward staring eyes, limb spasms, locked jaw, retching inability, drooling. Suspected meningitis. History: Ate many zongzi (sticky rice dumplings) and fish/meat during Dragon Boat Festival. Diagnosis: Food accumulation in Stomach/Intestines generating internal heat, reflecting to the brain. Cured with Xiaoyao Wan modified (Xiao Huang Lou Ge Tang - likely referring to a purgative formula containing Da Huang, Mang Xiao, Gua Lou, Ge Gen) with one dose.