人身之气无时不在升降出入，故尔生机不息。而脾胃居中，脾主升清，胃主降浊，为人体气机升降之枢。若饮食失节，劳役过度，损伤脾胃，致脾胃气虚，运化失常，气机升降阻滞，郁而生热。从患者的症状来看也说明了这一点，其胃气不降则食少，脾气不升则便溏。其倦怠乏力，气短懒言，头晕，舌淡，脉弱，乃脾虚失运，清阳不升，无以营养全身之表现。卫气资始于先天，资生于后天，今脾气虚弱，不足以充养卫气，则卫气虚，失其固密卫外之职，故常自汗出，易于感冒。其发热与诸证于劳累后加剧者，因劳则气耗，重虚其气，气愈虚而郁愈甚，故热愈盛。总之，气虚发热之机理为脾胃气虚，升降失常，气机阻滞，郁而生热。其中脾气虚弱，是主要病机之所在。医师乙：气虚发热，为什么往往会予以清热泻火及滋阴之剂呢?
老师：这是因为往往由于辨证不清，误将气虚发热，认作实热或阴虚发热而造成的。一般来讲，初病、暴病之发热多为实热。其证或由外邪束闭，或因五志过极，或为饮食、虫兽所伤，或为跌打损伤等原因，使诸般邪气，阻遏阳气之畅行，阳气郁积而为热。即《内经》之"阳盛则热"。此患者之高热不退，人们往往只注意高热一症，而疏忽了脾虚气弱之各种症情，因而将其误认为实热证。既然为实热，那么"热者寒之"为正治之法，则社区医师丛书清热泻火等寒凉之品，在所必用。但寒凉药最易损脾胃而伤阳气，因而用后症不减而热益剧。此时本应投以甘温之剂，但：临床时，往往又容易采取滋阴清热法而忘了甘温除热法。那是因为《内经》之"诸寒之而热者取之阴"，王冰的"寒之不寒，是无水也"。所以当用清热泻火之剂而热不退时，很容易改为"壮水之主，以制阳光"的方法。但气虚与阴虚虽同为虚证，而其证治截然不同，一需辛甘温补宣畅之剂，一用寒凉滋润柔静之味。二者一阴-阳，一刚一柔，绝不可误施。若阴虚者误用甘温升补宣畅之药，势必劫阴助热而火炎更炽；气虚者妄施寒凉濡润柔静之晶，必致伤脾阻气而气机愈郁。这就是本证用滋阴之剂而不见效的道理。如果我们能很仔细对病史、症情和服药效果进行综合的分析研究，是可以避免上述错误的。
医师丙：治疗气虚发热的原则是什么?
老师：前面我们讨论过，气虚发热的机理是脾气虚弱，升降失常，气机郁滞，所以治疗此证当以补其不足，利其升降，畅其郁滞为主。但此证的关键在于脾气虚而清阳不升，因而"唯当以甘温之剂补其中而升其阳"。(《脾胃论》)"甘温除热"法正是针对此证。补中益气汤则是治疗此证的主方。方中参芪术草，健脾益气，为主药。柴胡升举清阳，陈皮和降胃气。且柴、陈又具疏散解郁之功。当归辛甘温润，既能养血而缓诸药之刚燥，且其性行散而不呆腻，又有助于和调血脉，解郁散滞。综合此方之功用在于补脾益气，升清降浊，疏郁行滞，正合气虚发热之病机，是以疗效较为理想。
老师：气虚发热证，一般无加肉桂之必要。但因此患者曾屡用清热养阴之品，难免寒凉太过，中阳受伤，脾胃虚寒，故加肉桂暖脾胃而振中阳。因此证既非实热，又非阴虚，故不虑肉桂之助热与伤阴。况肉桂不唯能祛寒而暖中，且其性芳香辛窜，又有宣郁畅滞之功，对本证无害而有益。
本方加生麦芽，因其性长于升发而助脾胃，一可为参术芪诸补药之辅佐，运化其药力，不致作胀满；二是生麦芽禀春升之气，大有助于升发脾胃清阳而宣畅肝胆之气，疏郁而退热。
医师甲：在前面谈气虚发热的机理时，老师既讲到气虚，又说到气机郁滞。我的印象是，气虚和气郁似乎是矛盾的，怎么又成了因果关系呢?
老师：所谓气郁，即是气机郁滞不畅。造成气机郁滞的原因很多，归结起来，不外乎虚实两类。所谓实，是指邪气盛。或因六淫外束，或因情志不舒，或由痰湿水饮，或因宿食瘀血等原
因，阻碍气机之通畅而致郁，"六郁为病"多属此类。所谓虚，是指气血虚弱而致郁。盖人身之气，无时不在升降出入，以维持人体的生命活动。若正气充盈，推动有力，则气血畅行，津液流布，营卫调达，就不会产生郁滞。若气虚不运，不唯可形成气郁，并可导致血瘀、痰郁或水湿停郁。先贤曾把人体之气血比作江河之水。若水势浩荡，奔波宣泻，何郁之有?若一旦水势减弱，甚或枯涸，则水流不畅，处处淤积。在临床中，因虚致郁者屡见不鲜，因而，以补为通之法也是常用的。但，人们往往一见郁证便不辨虚实，而统治以疏通宣泄，这对因虚致郁者，难免不犯虚虚之过。
痹证辨治举要
湖北宜昌医专中医临床教研室王武兴
痹证指风、寒、湿、热等外邪侵袭人体，致使经脉闭阻，气血运行不畅，而出现以肌肉、筋骨、关节发生疼痛、麻木、重着、屈伸不利，甚或关节肿大灼热等为主要临床表现的病证。
1．病理演变本证若在急性期失治、误治或治不彻底，则形成慢性发病过程，病势迁延常发生以下几种病理变化：
①病邪滞留，气血运行不畅，闭阻日甚，津液凝涩不通，聚而为痰，导致顽痰死血胶结，出现皮肤瘀斑，关节周围结节，关节肿大、屈伸不利，甚至瘫痿畸形，形成"顽痹"。
②病久耗伤正气，出现气血亏损，经脉失养或肝精血亏损，虚热内生，形成"虚痹"。
③痹证不愈、复感外邪，病邪由经络而病及脏腑，形成"脏腑痹"，其中尤以心痹为常见。
2．辨证要点
①探求病因，详询患者感受外邪情况(风、寒、湿、热及居处、工作环境等)。
②辨疼痛及局部症状，问清患者疼痛的性质、部位、加重或诱发的因素、对冷热的反应，如：关节肿大灼热疼痛，汗出或无汗，或白痞，是热痹之特征，有时还可见皮肤红斑，或兼咽喉乳蛾肿痛。若局部发凉，遇寒或入水加重(对阴雨天敏感)为风寒湿痹，病久则可变为虚痹、顽痹。
③辨关节活动，关节肌肉除肿大及按之稍硬外，常见屈伸不能，功能障碍，久病可见肌肉萎缩，急性期关节内还可有积水、积脓，多见于膝关节，可见关节肿大，疼痛较甚。
3．治疗原则
由于痹证总由感受风、寒、湿、热所致，且其病理改变可由实转虚，由轻转重，故治疗时应充分考虑，现拟定12字原则："祛风、散寒、除湿、清热、通络、补虚"。总体方案应抓住以下三点：
祛除病邪--风、寒、湿、热等。{痰湿化痰除湿通络祛除病理因素{瘀血行瘀活血通络扶正补虚--养血，益气(补气固卫)，益肝肾。急性期往往热盛津伤，祛邪之中，不忘甘凉益阴；慢性期真阴亏损，精血俱耗，宜补益精血。
4．关于常用几个痹证方的用法
①防风汤方出金·刘完素(宣明论方>，本方主治风寒湿痹中之"行痹"，以肌肉关节疼痛，游走不定为特征。本方以防风为君，配麻黄祛风散寒解表，佐当归、秦艽养血通络，现代药理研究，秦艽、防风有较好的抗风湿作用，笔者经验，方中常加防己、独活，以增强祛风胜湿之效，方中赤苓以生薏仁汤之，《本经》载，米仁能治筋急，拘挛不可屈伸，赤苓虽可渗湿，但无通络之功，当归宜酒炒，以加强活血之力。本方服法是：共为粗末，每次15～30g，加生姜3大片，大枣3枚，水酒各半煎服，服后患者身可微热、汗出、全身松弛，可覆以暖被，忌风寒，病
可迅速缓解。
②乌头汤《金匮要略》方。本方主治风寒湿痹中之"痛痹"，对阴寒凝滞，经脉拘挛之关节肌肉疼痛，疗效很好。应用本方关键在于择药与煎法，方以生川乌5枚为君，切片，加入500ml蜂蜜之中，以蜜煎乌头，煎至200m1时，去掉乌头，然后用麻黄9g芍药9g黄芪9g炙甘草9g生姜汁9g，并加水1000ml，煎至300ml时，去药渣，以药汁加入乌头蜜中再煎，煎至300ml时服用，首次服2／3，第二次服完。本方用生乌头配麻黄，能破阴散寒，温经定痛，且以黄芪之补，白芍之平，甘草之缓，蜂蜜之甘证制约乌药辛热有毒之性，能使邪去而不伤正。
临症常见用此方不效者，其重要原因往往在于不敢用生乌头，不依仲景先师炮制煎服之法，这是临床应该注意的。
③桂枝芍药知母汤为治疗热痹之首选方，出自(金匮要略)。方中既有辛温之桂枝麻黄散湿于表，又有芍药、甘草、知母等除热于中，术附驱湿于下。急性风湿病热邪稽留，最易伤阴，当选用既能清热又能养阴的药物，当首推知母。现代药理研究：甘草、生地同用，有促进肾上腺皮质激素分泌的作用，有利抗炎。本方对寒郁化热型热痹疗效甚佳。临证如下焦湿热重，双踝、膝关节红肿者，可适当选加忍冬藤、木通、生甘草节等品，以加强清热通络作用。若关节红肿痛甚，甚至关节腔积液积脓者，可用重剂二妙散、苍术、黄柏各500g，研为细末，每次服50g，六一散泡水冲服，1日2次，更辅以局部针灸(犊鼻、阴陵)效验极佳，一般1周左右可使红肿消退，积液逐渐吸收。
5．顽痹用药
中药毒剧药应用：顽痹是临床较为常见的一个证型，多为久病迁延，血滞痰阻所致，症见关节肌肉疼痛，持续不减，甚则关节畸形，活动不利，乃至瘫痿。本类型痹证以常法治之常难以收效，根据国内近年来研究进展和个人师传及临证体会，对本证一般须在辨证施治基础方中加入某些特殊药物或虫类搜剔之晶方能收效。所谓特殊用药主要涉及到一部分对顽痹有特异性作用的中药毒剧药运用问题，大致介绍如下：
①乌头类(川乌、草乌、附子)：生南星、制马钱子、细辛。②虫蛇类：僵虫、全虫、山甲、土鳖、露蜂房(蜂毒)、蜣螂、地龙、蜈蚣、乌梢蛇、蕲蛇、蝮蛇、白花蛇等。
这类药物只要正确掌握其应用方法和剂量，可收到意外疗效。
黄藤、昆明山海棠：同属卫矛科、黄藤属藤本植物，国内最先由湖北省洪湖县中医院运用，本晶对类风湿性关节炎有特效，因其疗效卓著，近几年逐渐被全国采用，经有关科研单位对原生药及黄藤提取物黄藤甙进行药理实验，发现其生物碱为一较强的免疫抑制剂，后将本品移用于红斑性狼疮、狼疮性肾炎及肾病综合征亦有很好疗效。云南昆明山海棠功效与黄藤相似。本晶生药每日15g以下，水煎服或泡酒服均可，服后有嘈杂、脘闷等不适感，有胃病者宜慎用。如有中毒(恶心、呕吐、心律失常)可以即时服生羊血(50一100ml)或用乌柏树白皮煎水可解。
虫蛇类制剂：上海市光华医院从70年代起即用蝮蛇泡酒治疗类风湿性关节炎，取得很好疗效。据报道以本制剂治疗类风湿性关节炎140例，门诊随访13年，有效率为78．56％。个人师传经验，常在辨证基础方中加用乌梢蛇30g蕲蛇15g全虫9g土鳖10一12g蜈蚣3-5条，虫类药应用一般生药疗效好，但剂量要轻，我们在临床常将这类药物研成粉，装入胶囊，每次服1-2g，1日3次，比汤剂疗效要高。
蜂毒类：一般常用药为蜂巢，本晶能活血破瘀定痛，近研究，证实本晶为免疫调节剂，然疗效更佳者为活蜂毒，个人师传经验，治疗顽痹，取活蜜蜂在肿大的关节周围及按中医经络穴位点蜇，每次可蜇3～5个穴位，不能耐受者蜇1～2个穴位，其疗效快，无明显副作用。但要防止个别过敏者，可皮下注射肾-上腺素或地塞米松加入50％葡萄糖40ml推注以救急。
乌头、马钱子和细辛制剂。此类药物均为大辛大热之晶，马钱子有剧毒，乌头、细辛也有较大毒性，但运用得当，对顽痹疗效甚佳，其关键是炮制和用量、用法得当。
a．马钱子：本晶含木鳖子碱，其成分为"士的宁"，用量每日0.25～0.75g，必须炮制，一般有砂炒和油炸两种方法，可以减轻毒性。砂炒：以洗净细河砂入锅内炒烫，然后下马钱子，炒至马钱子外焦内脆为度；油炸：以香油炸马钱子，炸至焦脆为度。将制后的马钱子研粉密贮，配中药内服，用量如上。李氏曾报道用马钱子散治疗痹症1890例，结果痊愈1227例，占64．92％；好转538例，占28．47％。总有效率为93．39％。服药禁忌：凡患急慢性肾炎，肺结核，高血压，急慢性传染病者及热痹者忌服，12岁以下儿童忌服。
人身之气无时无刻不在升降出入，因此生机不息。脾胃居于中焦，脾主升清阳，胃主降浊阴，是人体气机升降的枢纽。如果饮食不节制，劳累过度，损伤了脾胃，导致脾胃气虚，运化功能失常，气机升降阻滞，郁结而生热。从患者的症状来看也说明了这一点：胃气不降则食欲减退，脾气不升则大便溏薄。其倦怠乏力、气短懒言、头晕、舌淡、脉弱，都是脾虚失于运化，清阳不能上升，无法营养全身的表现。卫气源于先天，滋养于后天，如今脾气虚弱，不足以充养卫气，导致卫气虚，失去固密和护卫体外的职能，所以经常自汗出，容易感冒。其发热及诸证在劳累后加剧，是因为劳作耗气，使气更虚，气愈虚则郁结越甚，所以热势越盛。总之，气虚发热的机理是脾胃气虚，升降失常，气机阻滞，郁结而生热。其中脾气虚弱，是主要病机的所在。
老师：这是因为往往由于辨证不清，误将气虚发热，认作实热或阴虚发热而造成的。一般来讲，初病、急病之发热多为实热。其证或因外邪束闭，或因五志过极，或为饮食、虫兽所伤，或为跌打损伤等原因，使各种邪气，阻遏阳气之畅行，阳气郁积而为热。即《内经》所说的“阳盛则热”。此患者之高热不退，人们往往只注意高热这一症状，而疏忽了脾虚气弱的各种症情，因而将其误认为实热证。既然认为是实热，那么“热者寒之”为正治之法，则社区医师丛书推荐的清热泻火等寒凉药物，在所必用。但寒凉药最易损伤脾胃而伤害阳气，因而用后症状不减而热势更剧。此时本应投以甘温的药物，但在临床时，往往又容易采取滋阴清热法而忘了甘温除热法。那是因为《内经》中的“诸寒之而热者取之阴”，以及王冰注解说“寒之不寒，是无水也”。所以当用清热泻火之剂而热不退时，很容易改为“壮水之主，以制阳光”的方法。但气虚与阴虚虽同为虚证，而其证治截然不同，一需辛甘温补宣畅之剂，一用寒凉滋润柔静之味。二者一阴一阳，一刚一柔，绝不可误施。若阴虚者误用甘温升补宣畅之药，势必劫夺阴液助长热势而火炎更炽；气虚者妄施寒凉濡润柔静之品，必致损伤脾胃阻碍气机而气机愈郁。这就是本证用滋阴之剂而不见效的道理。如果我们能很仔细对病史、症情和服药效果进行综合的分析研究，是可以避免上述错误的。
医师丙：治疗气虚发热的原则是什么？
老师：前面我们讨论过，气虚发热的机理是脾气虚弱，升降失常，气机郁滞，所以治疗此证当以补其不足，利其升降，畅其郁滞为主。但此证的关键在于脾气虚而清阳不升，因而“唯当以甘温之剂补其中而升其阳”。（《脾胃论》）“甘温除热”法正是针对此证。补中益气汤则是治疗此证的主方。方中人参、黄芪、白术、甘草，健脾益气，为主药。柴胡升举清阳，陈皮和降胃气。且柴胡、陈皮又具疏散解郁之功。当归辛甘温润，既能养血而缓诸药之刚燥，且其性行散而不呆腻，又有助于和调血脉，解郁散滞。综合此方之功用在于补脾益气，升清降浊，疏郁行滞，正合气虚发热之病机，是以疗效较为理想。
老师：气虚发热证，一般无加肉桂之必要。但因此患者曾屡用清热养阴之品，难免寒凉太过，中阳受伤，脾胃虚寒，故加肉桂暖脾胃而振中阳。因此证既非实热，又非阴虚，故不虑肉桂之助热与伤阴。况且肉桂不唯能祛寒而暖中，且其性芳香辛窜，又有宣郁畅滞之功，对本证无害而有益。
本方加生麦芽，因其性长于升发而助脾胃，一可为参、术、芪诸补药之辅佐，运化其药力，不致作胀满；二是生麦芽禀春升之气，大有助于升发脾胃清阳而宣畅肝胆之气，疏郁而退热。
医师甲：在前面谈气虚发热的机理时，老师既讲到气虚，又说到气机郁滞。我的印象是，气虚和气郁似乎是矛盾的，怎么又成了因果关系呢？
老师：所谓气郁，即是气机郁滞不畅。造成气机郁滞的原因很多，归结起来，不外乎虚实两类。所谓实，是指邪气盛。或因六淫外束，或因情志不舒，或由痰湿水饮，或因宿食瘀血等原因，阻碍气机之通畅而致郁，“六郁为病”多属此类。所谓虚，是指气血虚弱而致郁。盖人身之气，无时不在升降出入，以维持人体的生命活动。若正气充盈，推动有力，则气血畅行，津液流布，营卫调达，就不会产生郁滞。若气虚不运，不唯可形成气郁，并可导致血瘀、痰郁或水湿停郁。先贤曾把人体之气血比作江河之水。若水势浩荡，奔波宣泻，何郁之有？若一旦水势减弱，甚或枯涸，则水流不畅，处处淤积。在临床中，因虚致郁者屡见不鲜，因而，以补为通之法也是常用的。但，人们往往一见郁证便不辨虚实，而统治以疏通宣泄，这对因虚致郁者，难免不犯虚虚之过。
痹证辨治举要
湖北宜昌医专中医临床教研室 王武兴
痹证指风、寒、湿、热等外邪侵袭人体，致使经脉闭阻，气血运行不畅，而出现以肌肉、筋骨、关节发生疼痛、麻木、重着、屈伸不利，甚或关节肿大灼热等为主要临床表现的病证。
1．病理演变 本证若在急性期失治、误治或治不彻底，则形成慢性发病过程，病势迁延常发生以下几种病理变化：
①病邪滞留，气血运行不畅，闭阻日甚，津液凝涩不通，聚而为痰，导致顽痰死血胶结，出现皮肤瘀斑，关节周围结节，关节肿大、屈伸不利，甚至瘫痿畸形，形成“顽痹”。
②病久耗伤正气，出现气血亏损，经脉失养或肝精血亏损，虚热内生，形成“虚痹”。
③痹证不愈、复感外邪，病邪由经络而病及脏腑，形成“脏腑痹”，其中尤以心痹为常见。
2．辨证要点
①探求病因，详询患者感受外邪情况（风、寒、湿、热及居处、工作环境等）。
②辨疼痛及局部症状，问清患者疼痛的性质、部位、加重或诱发的因素、对冷热的反应，如：关节肿大灼热疼痛，汗出或无汗，或白痞，是热痹之特征，有时还可见皮肤红斑，或兼咽喉乳蛾肿痛。若局部发凉，遇寒或入水加重（对阴雨天敏感）为风寒湿痹，病久则可变为虚痹、顽痹。
③辨关节活动，关节肌肉除肿大及按之稍硬外，常见屈伸不能，功能障碍，久病可见肌肉萎缩，急性期关节内还可有积水、积脓，多见于膝关节，可见关节肿大，疼痛较甚。
3．治疗原则
由于痹证总由感受风、寒、湿、热所致，且其病理改变可由实转虚，由轻转重，故治疗时应充分考虑，现拟定12字原则：“祛风、散寒、除湿、清热、通络、补虚”。总体方案应抓住以下三点：
祛除病邪——风、寒、湿、热等。{痰湿化痰除湿通络 祛除病理因素 {瘀血行瘀活血通络 扶正补虚——养血，益气（补气固卫），益肝肾。急性期往往热盛津伤，祛邪之中，不忘甘凉益阴；慢性期真阴亏损，精血俱耗，宜补益精血。
4．关于常用几个痹证方的用法
①防风汤 方出金·刘完素《宣明论方》，本方主治风寒湿痹中之“行痹”，以肌肉关节疼痛，游走不定为特征。本方以防风为君，配麻黄祛风散寒解表，佐当归、秦艽养血通络，现代药理研究，秦艽、防风有较好的抗风湿作用，笔者经验，方中常加防己、独活，以增强祛风胜湿之效，方中赤苓以生薏仁汤之，《本经》载，米仁能治筋急，拘挛不可屈伸，赤苓虽可渗湿，但无通络之功，当归宜酒炒，以加强活血之力。本方服法是：共为粗末，每次15～30g，加生姜3大片，大枣3枚，水酒各半煎服，服后患者身可微热、汗出、全身松弛，可覆以暖被，忌风寒，病可迅速缓解。
②乌头汤 《金匮要略》方。本方主治风寒湿痹中之“痛痹”，对阴寒凝滞，经脉拘挛之关节肌肉疼痛，疗效很好。应用本方关键在于择药与煎法，方以生川乌5枚为君，切片，加入500ml蜂蜜之中，以蜜煎乌头，煎至200m1时，去掉乌头，然后用麻黄9g芍药9g黄芪9g炙甘草9g生姜汁9g，并加水1000ml，煎至300ml时，去药渣，以药汁加入乌头蜜中再煎，煎至300ml时服用，首次服2／3，第二次服完。本方用生乌头配麻黄，能破阴散寒，温经定痛，且以黄芪之补，白芍之平，甘草之缓，蜂蜜之甘证制约乌药辛热有毒之性，能使邪去而不伤正。
临症常见用此方不效者，其重要原因往往在于不敢用生乌头，不依仲景先师炮制煎服之法，这是临床应该注意的。
③桂枝芍药知母汤 为治疗热痹之首选方，出自《金匮要略》。方中既有辛温之桂枝麻黄散湿于表，又有芍药、甘草、知母等除热于中，术附驱湿于下。急性风湿病热邪稽留，最易伤阴，当选用既能清热又能养阴的药物，当首推知母。现代药理研究：甘草、生地同用，有促进肾上腺皮质激素分泌的作用，有利抗炎。本方对寒郁化热型热痹疗效甚佳。临证如下焦湿热重，双踝、膝关节红肿者，可适当选加忍冬藤、木通、生甘草节等品，以加强清热通络作用。若关节红肿痛甚，甚至关节腔积液积脓者，可用重剂二妙散、苍术、黄柏各500g，研为细末，每次服50g，六一散泡水冲服，1日2次，更辅以局部针灸（犊鼻、阴陵）效验极佳，一般1周左右可使红肿消退，积液逐渐吸收。
5．顽痹用药
中药毒剧药应用：顽痹是临床较为常见的一个证型，多为久病迁延，血滞痰阻所致，症见关节肌肉疼痛，持续不减，甚则关节畸形，活动不利，乃至瘫痿。本类型痹证以常法治之常难以收效，根据国内近年来研究进展和个人师传及临证体会，对本证一般须在辨证施治基础方中加入某些特殊药物或虫类搜剔之品方能收效。所谓特殊用药主要涉及到一部分对顽痹有特异性作用的中药毒剧药运用问题，大致介绍如下：
①乌头类（川乌、草乌、附子）：生南星、制马钱子、细辛。②虫蛇类：僵蚕、全蝎、山甲、土鳖、露蜂房（蜂毒）、蜣螂、地龙、蜈蚣、乌梢蛇、蕲蛇、蝮蛇、白花蛇等。
这类药物只要正确掌握其应用方法和剂量，可收到意外疗效。
黄藤、昆明山海棠：同属卫矛科、黄藤属藤本植物，国内最先由湖北省洪湖县中医院运用，本品对类风湿性关节炎有特效，因其疗效卓著，近几年逐渐被全国采用，经有关科研单位对原生药及黄藤提取物黄藤甙进行药理实验，发现其生物碱为一较强的免疫抑制剂，后将本品移用于红斑性狼疮、狼疮性肾炎及肾病综合征亦有很好疗效。云南昆明山海棠功效与黄藤相似。本品生药每日15g以下，水煎服或泡酒服均可，服后有嘈杂、脘闷等不适感，有胃病者宜慎用。如有中毒（恶心、呕吐、心律失常）可以即时服生羊血（50一100ml）或用乌桕树白皮煎水可解。
虫蛇类制剂：上海市光华医院从70年代起即用蝮蛇泡酒治疗类风湿性关节炎，取得很好疗效。据报道以本制剂治疗类风湿性关节炎140例，门诊随访13年，有效率为78．56％。个人师传经验，常在辨证基础方中加用乌梢蛇30g蕲蛇15g全蝎9g土鳖10一12g蜈蚣3-5条，虫类药应用一般生药疗效好，但剂量要轻，我们在临床常将这类药物研成粉，装入胶囊，每次服1-2g，1日3次，比汤剂疗效要高。
蜂毒类：一般常用药为蜂巢，本品能活血破瘀定痛，近研究，证实本品为免疫调节剂，然疗效更佳者为活蜂毒，个人师传经验，治疗顽痹，取活蜜蜂在肿大的关节周围及按中医经络穴位点蜇，每次可蜇3～5个穴位，不能耐受者蜇1～2个穴位，其疗效快，无明显副作用。但要防止个别过敏者，可皮下注射肾上腺素或地塞米松加入50％葡萄糖40ml推注以救急。
乌头、马钱子和细辛制剂。此类药物均为大辛大热之品，马钱子有剧毒，乌头、细辛也有较大毒性，但运用得当，对顽痹疗效甚佳，其关键是炮制和用量、用法得当。
a．马钱子：本品含木鳖子碱，其成分为“士的宁”，用量每日0.25～0.75g，必须炮制，一般有砂炒和油炸两种方法，可以减轻毒性。砂炒：以洗净细河砂入锅内炒烫，然后下马钱子，炒至马钱子外焦内脆为度；油炸：以香油炸马钱子，炸至焦脆为度。将制后的马钱子研粉密贮，配中药内服，用量如上。李氏曾报道用马钱子散治疗痹症1890例，结果痊愈1227例，占64．92％；好转538例，占28．47％。总有效率为93．39％。服药禁忌：凡患急慢性肾炎，肺结核，高血压，急慢性传染病者及热痹者忌服，12岁以下儿童忌服。
The Qi of the human body is constantly ascending, descending, exiting, and entering at all times; therefore, vitality never ceases. The Spleen and Stomach reside in the middle Jiao (Middle Burner); the Spleen governs the ascending of clear Yang, and the Stomach governs the descending of turbid Yin, serving as the pivot for the ascending and descending of Qi mechanism in the body. If dietary habits are irregular or physical exertion is excessive, damaging the Spleen and Stomach, it leads to deficiency of Spleen and Stomach Qi, dysfunction of transportation and transformation, obstruction of Qi mechanism ascending and descending, and generation of heat due to stagnation. The patient's symptoms also illustrate this point: if Stomach Qi fails to descend, appetite decreases; if Spleen Qi fails to ascend, loose stools occur. Fatigue, shortness of breath with reluctance to speak, dizziness, pale tongue, and weak pulse are manifestations of Spleen deficiency failing to transport, clear Yang not ascending, and inability to nourish the whole body. Wei Qi (Defensive Qi) originates from congenital essence and is nourished by acquired essence. Now, due to Spleen Qi deficiency, there is insufficient nourishment for Wei Qi, leading to Wei Qi deficiency and loss of its function to secure the exterior and protect against external pathogens; thus, spontaneous sweating occurs frequently, and susceptibility to colds increases. The fever and other symptoms that worsen after exertion occur because labor consumes Qi, further depleting it; the more deficient the Qi, the more severe the stagnation, and thus the fiercer the heat. In summary, the mechanism of Qi deficiency fever lies in Spleen and Stomach Qi deficiency, abnormal ascending and descending, obstruction of Qi mechanism, and generation of heat due to stagnation. Among these, Spleen Qi deficiency is the primary pathogenesis.
Physician Yi: Why is it common to prescribe herbs for clearing heat and purging fire, as well as nourishing Yin, for Qi deficiency fever?
Teacher: This is often due to unclear differentiation of syndromes, mistakenly identifying Qi deficiency fever as excess heat or Yin deficiency fever. Generally speaking, fever in early-stage or acute diseases is mostly excess heat. Such conditions may arise from external pathogens constraining the exterior, extreme emotional fluctuations, injury from diet or insects/animals, or trauma, causing various pathogenic factors to obstruct the smooth flow of Yang Qi, which accumulates and generates heat. This corresponds to the statement in *Nei Jing* (Inner Canon): "Excess Yang leads to heat." For this patient's persistent high fever, people often focus only on the symptom of high fever while neglecting various signs of Spleen deficiency and Qi weakness, thereby misdiagnosing it as an excess heat syndrome. Since it is considered excess heat, "treating heat with cold" is the correct method; thus, cooling herbs such as those for clearing heat and purging fire recommended in community physician manuals are deemed necessary. However, cold-natured herbs easily damage the Spleen and Stomach and injure Yang Qi; consequently, after administration, symptoms do not subside, and heat intensifies. At this stage, sweet-warm formulas should be administered, but in clinical practice, doctors often tend to adopt methods for nourishing Yin and clearing heat, forgetting the method of using sweet-warm herbs to remove heat. This is because of the saying in *Nei Jing*: "For those whose heat persists despite cold treatments, treat the Yin," and Wang Bing's commentary: "If cold does not resolve the heat, it indicates a lack of Water (Yin)." Therefore, when heat persists despite the use of heat-clearing and fire-purging agents, it is easy to switch to the method of "strengthening the source of Water to control the sunlight (Yang)." Although both Qi deficiency and Yin deficiency are deficiency syndromes, their treatment principles are completely different: one requires acrid-sweet-warm tonifying and unblocking agents, while the other uses cold-cool moistening and tranquilizing flavors. One is Yin, the other Yang; one is rigid, the other soft; they must absolutely not be confused. If Yin deficiency patients mistakenly use sweet-warm ascending and unblocking drugs, it will inevitably consume Yin and assist heat, making the fire burn even fiercer; if Qi deficiency patients recklessly apply cold-moistening and tranquilizing substances, it will surely damage the Spleen, obstruct Qi, and cause Qi mechanism to become more stagnant. This is why using Yin-nourishing agents fails to produce effects in this syndrome. If we carefully analyze the medical history, symptoms, and medication effects comprehensively, we can avoid the aforementioned errors.
Physician Bing: What is the principle for treating Qi deficiency fever?
Teacher: As discussed earlier, the mechanism of Qi deficiency fever is Spleen Qi deficiency, abnormal ascending and descending, and stagnation of Qi mechanism. Therefore, treating this syndrome should primarily focus on tonifying the deficiency, facilitating ascending and descending, and relieving stagnation. However, the key to this syndrome lies in Spleen Qi deficiency and the failure of clear Yang to ascend; hence, "one must solely use sweet-warm agents to tonify the center and raise the Yang" (*Pi Wei Lun* [Treatise on the Spleen and Stomach]). The method of "sweet-warm removal of heat" is precisely targeted at this syndrome. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is the main formula for treating this syndrome. In the formula, Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Bai Zhu (Atractylodes Rhizome), and Gan Cao (Licorice Root) tonify the Spleen and augment Qi, serving as the principal herbs. Chai Hu (Bupleurum Root) raises clear Yang, and Chen Pi (Citrus Peel) harmonizes and descends Stomach Qi. Furthermore, Chai Hu and Chen Pi possess the functions of dispersing stagnation and resolving constraint. Dang Gui (Angelica Sinensis Root) is acrid, sweet, warm, and moistening; it can nourish blood and mitigate the harsh dryness of other herbs, and its nature is moving and dispersing without being cloying, further helping to harmonize blood vessels, resolve stagnation, and disperse blockage. Synthesizing the functions of this formula, it tonifies the Spleen and augments Qi, raises clear Yang and descends turbid Yin, disperses stagnation and promotes movement, which perfectly matches the pathogenesis of Qi deficiency fever, resulting in relatively ideal efficacy.
Physician Yi: What is the rationale for adding Rou Gui (Cinnamon Bark) and Sheng Mai Ya (Raw Sprouted Barley) to this formula?
Teacher: For Qi deficiency fever syndrome, adding Rou Gui is generally unnecessary. However, since this patient has repeatedly used heat-clearing and Yin-nourishing agents, it is inevitable that the cold nature was excessive, injuring Middle Yang and causing Spleen-Stomach deficiency-cold; therefore, Rou Gui is added to warm the Spleen and Stomach and invigorate Middle Yang. Since this syndrome is neither excess heat nor Yin deficiency, there is no need to worry about Rou Gui assisting heat or damaging Yin. Moreover, Rou Gui not only dispels cold and warms the interior but also possesses an aromatic, acrid, and penetrating nature, having the function of venting stagnation and promoting smooth flow, which is harmless and beneficial to this syndrome.
Sheng Mai Ya is added to this formula because its nature excels in ascending and promoting, aiding the Spleen and Stomach. Firstly, it serves as an assistant to tonifying herbs like Ren Shen, Bai Zhu, and Huang Qi, helping to transform and transport their medicinal power, preventing bloating and fullness. Secondly, Sheng Mai Ya inherits the ascending Qi of Spring, greatly assisting in raising the clear Yang of the Spleen and Stomach and promoting the smooth flow of Liver and Gallbladder Qi, resolving stagnation, and reducing fever.
Physician Jia: When discussing the mechanism of Qi deficiency fever earlier, the teacher mentioned both Qi deficiency and Qi mechanism stagnation. My impression is that Qi deficiency and Qi stagnation seem contradictory; how did they become causally related?
Teacher:所谓 Qi stagnation refers to the sluggish and unsmooth flow of Qi mechanism. There are many causes for Qi mechanism stagnation, which can be summarized into two categories: excess and deficiency. Excess refers to flourishing pathogenic factors. It may be caused by external constraints of the Six Evils (Six Pathogenic Factors), emotional dissatisfaction, phlegm-dampness or fluid retention, or retained food and blood stasis, etc., obstructing the smooth flow of Qi and causing stagnation; "six types of stagnation diseases" mostly belong to this category. Deficiency refers to stagnation caused by weakness of Qi and Blood. The Qi of the human body is constantly ascending, descending, exiting, and entering to maintain life activities. If Zheng Qi (Upright Qi) is abundant and pushing force is strong, then Qi and Blood flow smoothly, fluids distribute, and Ying and Wei (Nutritive and Defensive) Qi are harmonious, so stagnation will not occur. If Qi is deficient and fails to move, it not only forms Qi stagnation but can also lead to blood stasis, phlegm stagnation, or water-dampness retention. Ancient sages compared the Qi and Blood of the human body to the water of rivers. If the water volume is vast, rushing and spreading freely, where would stagnation be? Once the water volume weakens, or even dries up, the water flow becomes unsmooth, accumulating everywhere. In clinical practice, cases of stagnation caused by deficiency are very common; therefore, the method of using tonification as unblocking is also commonly used. However, people often see stagnation syndromes without distinguishing between excess and deficiency, universally treating them with dredging and draining methods. For those with stagnation caused by deficiency, this inevitably commits the error of "depleting the deficient."
Key Points in Differentiation and Treatment of Bi Syndrome
Wang Wuxing, Department of TCM Clinical Teaching and Research, Hubei Yichang Medical College
Bi Syndrome refers to a disease condition where external pathogens such as Wind, Cold, Dampness, and Heat invade the human body, causing obstruction of meridians and channels, and poor circulation of Qi and Blood, manifesting clinically mainly as pain, numbness, heaviness, limited flexion and extension in muscles, bones, joints, and even joint swelling and burning sensation.
1. Pathological Evolution If this syndrome is untreated, mistreated, or incompletely treated during the acute phase, it forms a chronic course, with the disease process lingering and often undergoing the following pathological changes:
① Pathogenic factors remain stagnant, Qi and Blood circulation is unsmooth, obstruction worsens day by day, body fluids condense and fail to flow, gathering to form Phlegm, leading to the knotting of stubborn Phlegm and dead Blood, presenting as skin ecchymosis, nodules around joints, joint swelling, limited flexion and extension, and even paralysis, wasting, and deformity, forming "Stubborn Bi" (Chronic Refractory Bi).
② Prolonged illness consumes Zheng Qi, leading to deficiency of Qi and Blood, malnourishment of meridians and channels, or deficiency of Liver Essence and Blood, generating internal empty heat, forming "Empty Bi" (Deficiency Bi).
③ Bi syndrome persists, and external pathogens are contracted again; pathogenic factors move from meridians and channels to affect Zang-Fu organs, forming "Zang-Fu Bi," among which Heart Bi is particularly common.
2. Key Points in Differentiation
① Explore the etiology, inquire in detail about the patient's exposure to external pathogens (Wind, Cold, Dampness, Heat, living environment, working environment, etc.).
② Differentiate pain and local symptoms, ask clearly about the nature, location, aggravating or inducing factors of the patient's pain, and reaction to cold and heat. For example: swollen, hot, painful joints, with or without sweating, or white papules (white millet grains rash), are characteristics of Heat Bi. Sometimes skin erythema may also be seen, or accompanied by sore throat and tonsillar swelling/pain. If the local area feels cold, worsening upon exposure to cold or immersion in water (sensitive to rainy days), it is Wind-Cold-Damp Bi; prolonged illness can transform into Empty Bi or Stubborn Bi.
③ Differentiate joint movement. Besides swelling and slight hardness upon palpation, joints and muscles commonly show inability to flex and extend, functional impairment. Long-term illness may show muscle atrophy. In the acute phase, joint effusion or pus accumulation may occur inside the joints, mostly seen in knee joints, presenting as joint swelling and severe pain.
3. Treatment Principles
Since Bi syndrome is always caused by contracting Wind, Cold, Dampness, and Heat, and its pathological changes can transform from excess to deficiency and from mild to severe, treatment should fully consider this. The proposed 12-character principle is: "Dispel Wind, Scatter Cold, Remove Dampness, Clear Heat, Unblock Collaterals, Tonify Deficiency." The overall plan should grasp the following three points:
Eliminate Pathogenic Factors -- Wind, Cold, Dampness, Heat, etc. {Phlegm-Dampness: Resolve Phlegm, Remove Dampness, Unblock Collaterals} Eliminate Pathological Factors {Blood Stasis: Move Blood, Invigorate Blood, Unblock Collates} Support Upright Qi and Tonify Deficiency -- Nourish Blood, Augment Qi (Augment Qi to Secure Wei), Benefit Liver and Kidney. In the acute phase, heat is often excessive and damages fluids; while eliminating pathogens, do not forget sweet-cool herbs to benefit Yin. In the chronic phase, True Yin is depleted, and Essence and Blood are exhausted; it is appropriate to tonify Essence and Blood.
4. Usage of Several Common Formulas for Bi Syndrome
① Fang Feng Tang (Saposhnikovia Decoction) Originates from Jin Dynasty Liu Wansu's *Xuan Ming Lun Fang*. This formula treats "Moving Bi" (Migratory Bi) within Wind-Cold-Damp Bi, characterized by wandering pain in muscles and joints. Fang Feng (Saposhnikovia Root) is the sovereign herb, paired with Ma Huang (Ephedra Herb) to dispel Wind, scatter Cold, and release the exterior; Dang Gui (Angelica Sinensis Root) and Qin Jiao (Gentiana Macrophylla Root) are minister herbs to nourish Blood and unblock collaterals. Modern pharmacological research shows that Qin Jiao and Fang Feng have good anti-rheumatic effects. Based on my experience, Fang Ji (Stephania Root) and Du Huo (Angelica Pubescens Root) are often added to enhance the effect of dispelling Wind and overcoming Dampness. Chi Ling (Poria with Red Host) is replaced by Sheng Yi Yi Ren (Raw Coix Seed Decoction); *Ben Jing* records that Yi Ren can treat tendon tightness and spasmodic inability to flex and extend. Although Chi Ling can drain dampness, it lacks the function of unblocking collaterals. Dang Gui should be stir-fried with wine to strengthen its blood-invigorating power. The administration method of this formula is: grind into coarse powder, take 15-30g each time, add 3 large slices of Sheng Jiang (Fresh Ginger) and 3 dates (Da Zao), decoct with half water and half wine. After taking, the patient may feel slightly warm, sweat, and feel relaxed throughout the body; cover with a warm quilt, avoid Wind and Cold, and the disease can be rapidly relieved.
② Wu Tou Tang (Aconite Decoction) From *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet). This formula treats "Painful Bi" (Fixed Pain Bi) within Wind-Cold-Damp Bi, with good efficacy for joint and muscle pain caused by Yin-Cold coagulation and meridian spasm. The key to applying this formula lies in selecting herbs and decoction method. The formula uses 5 raw Chuan Wu (Aconitum Carmichaelii Deauxn. Radix) as the sovereign herb, sliced, added into 500ml honey, decocting Aconite with honey until reduced to 200ml, then removing the Aconite. Then add Ma Huang 9g, Bai Shao (White Peony Root) 9g, Huang Qi 9g, Zhi Gan Cao (Honey-fried Licorice Root) 9g, Sheng Jiang Zhi (Ginger Juice) 9g, and add 1000ml water, decoct until reduced to 300ml, discard the dregs, add the decoction to the Aconite-honey mixture, and decoct again until 300ml remains for consumption. Take 2/3 for the first dose, and finish the remaining 1/3 for the second dose. Using raw Wu Tou (Aconite) paired with Ma Huang can break Yin and scatter Cold, warm meridians, and relieve pain. Furthermore, the tonifying nature of Huang Qi, the neutralizing nature of Bai Shao, the moderating nature of Gan Cao, and the sweet nature of honey constrain the pungent, hot, toxic nature of Wu Tou, allowing the elimination of pathogens without damaging Zheng Qi.
In clinical practice, ineffective use of this formula is often due to the fear of using raw Wu Tou and not following the processing and decoction methods of Master Zhang Zhongjing, which is something clinicians should pay attention to.
③ Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, White Peony, and Anemarrhena Decoction) is the preferred formula for treating Heat Bi, originating from *Jin Gui Yao Lue*. The formula contains pungent-warm Gui Zhi (Cinnamon Twig) and Ma Huang to scatter dampness at the exterior, while Shao Yao, Gan Cao, and Zhi Mu (Anemarrhena Rhizome) clear heat in the interior; Bai Zhu and Fu Zi (Prepared Aconite Child Root) drive out dampness below. In acute rheumatism, lingering heat pathogens easily damage Yin; herbs that can both clear heat and nourish Yin should be selected, with Zhi Mu being the top choice. Modern pharmacological research: Gan Cao combined with Sheng Di Huang (Rehmannia Root) promotes the secretion of adrenal cortical hormones, benefiting anti-inflammation. This formula has excellent efficacy for Heat Bi transformed from Cold stagnation. Clinically, if lower Jiao Damp-Heat is heavy, with redness and swelling of bilateral ankles and knee joints, one can appropriately add Jin Yin Teng (Honeysuckle Stem), Tong Cao (Tetrapanax Pith), or Sheng Gan Cao Jie (Raw Licorice Knots) to strengthen heat-clearing and collateral-unblocking effects. If joint redness, swelling, and pain are severe, even with joint effusion or pus accumulation, a heavy dose of Er Miao San (Two Marvels Powder), Cang Zhu (Atractylodes Rhizome), and Huang Bo (Phellodendron Bark) 500g each, ground into fine powder, taken 50g each time, mixed with Liu Yi San (Six-to-One Powder) dissolved in water, twice a day, supplemented with local acupuncture (Du Bi [ST35], Yin Lingquan [SP9]) yields excellent results. Generally, within about 1 week, redness and swelling can subside, and effusion gradually absorbs.
5. Medication for Stubborn Bi
Application of Toxic and Potent Chinese Herbs: Stubborn Bi is a relatively common clinical syndrome, mostly caused by prolonged illness leading to blood stasis and phlegm obstruction, presenting as persistent joint and muscle pain, even joint deformity, limited movement, and eventually paralysis and wasting. Conventional treatments for this type of Bi syndrome often fail to achieve results. Based on recent domestic research progress and personal transmission and clinical experience, treating this syndrome generally requires adding certain special herbs or insect-type searching and penetrating herbs to the basic formula based on syndrome differentiation to achieve efficacy. The so-called special medication mainly involves the application of a portion of toxic and potent Chinese herbs that have specific effects on Stubborn Bi, roughly introduced as follows:
① Wu Tou Category (Chuan Wu, Cao Wu, Fu Zi): Sheng Nan Xing (Raw Arisaema Rhizome), Zhi Ma Qian Zi (Processed Strychnos Seed), Xi Xin (Asarum Root).
② Insect and Snake Category: Jiang Can (Silkworm), Quan Chong (Scorpion), Shan Jia (Tarsius Pangolin Squama), Tu Bie Chong (Ground Beetle), Lu Feng Fang (Honeycomb), Qiang Lang (Dung Beetle), Di Long (Earthworm), Wu Gong (Centipede), Wu Shao She (Zaocys), Qi She (Agkistrodon), Fu She (Protobothrops), Bai Hua She (Bungarus multicinctus), etc.
③ Huang Teng (Cyrtophyllum Caulis) and Kun Ming Shan Hai Tang (Tripterygium wilfordii). Their uses can be divided into two major categories:
Dispel Cold and Break Yin, Remove Dampness and Resolve Phlegm to Relieve Pain: Such as Er Wu (Chuan Wu and Cao Wu), Nan Xing, Fu Zi, Xi Xin, etc.
Unblock Meridians and Invigorate Blood, Dispel Wind and Remove Dampness: Huang Teng category, Insect and Snake category.
As long as the application methods and dosages of these drugs are correctly mastered, unexpected efficacy can be achieved.
Huang Teng and Kun Ming Shan Hai Tang: Both belong to the Celastraceae family and Cyrtophyllum genus vines. They were first used domestically by Honghu County Traditional Chinese Medicine Hospital in Hubei Province. This product has a special effect on Rheumatoid Arthritis. Due to its outstanding efficacy, it has been gradually adopted nationwide in recent years. Pharmacological experiments conducted by relevant scientific research units on the crude drug and Huang Teng Glycoside extract found that its alkaloids are a relatively strong immunosuppressant. Later, this product was applied to Systemic Lupus Erythematosus, Lupus Nephritis, and Nephrotic Syndrome, also showing good efficacy. Kun Ming Shan Hai Tang from Yunnan has similar efficacy to Huang Teng. The daily dosage of the crude drug of this product should be below 15g, decocted in water or soaked in wine for consumption. After taking, discomfort such as epigastric distension and stuffiness may occur; those with stomach diseases should use it with caution. In case of poisoning (nausea, vomiting, arrhythmia), fresh sheep blood (50-100ml) can be taken immediately, or decoction of Wu Bai Tree (Sapium Sebiferum) white bark can be used to detoxify.
Insect and Snake Preparations: Shanghai Guanghua Hospital has used Agkistrodon soaked in wine to treat Rheumatoid Arthritis since the 1970s, achieving good efficacy. Reports indicate that treating 140 cases of Rheumatoid Arthritis with this preparation, followed up in outpatient clinics for 13 years, yielded an effective rate of 78.56%. Personal transmission experience: Often add Wu Shao She 30g, Qi She 15g, Quan Chong 9g, Tu Bie Chong 10-12g, Wu Gong 3-5 pieces to the basic formula based on syndrome differentiation. For insect-type drugs, generally crude drugs have better efficacy, but the dosage should be light. In our clinical practice, we often grind these drugs into powder, fill them into capsules, take 1-2g each time, 3 times a day, which has higher efficacy than decoctions.
Bee Venom Category: The commonly used medicine is Honeycomb. This product can invigorate blood, break stasis, and relieve pain. Recent research confirms that this product is an immune regulator. However, the more effective one is live bee venom. Personal transmission experience: Treating Stubborn Bi, take live bees to sting around swollen joints and according to TCM meridian acupoints. Each time, 3-5 acupoints can be stung; for those who cannot tolerate it, 1-2 acupoints are sufficient. Its efficacy is fast, with no obvious side effects. However, care must be taken to prevent individual allergies; Epinephrine or Dexamethasone added to 40ml of 50% Glucose can be injected subcutaneously for emergency rescue.
Wu Tou, Ma Qian Zi, and Xi Xin Preparations. These drugs are all extremely pungent and hot. Ma Qian Zi is highly toxic, and Wu Tou and Xi Xin also have significant toxicity. However, when used properly, they have excellent efficacy for Stubborn Bi. The key lies in proper processing, dosage, and usage.
a. Ma Qian Zi (Strychnos Seed): This product contains Gelsemium Alkaloid, its component being "Strychnine". Dosage is 0.25-0.75g per day. It must be processed; generally, sand-frying and oil-frying are two methods to reduce toxicity. Sand-frying: Put cleaned fine river sand in a pot and fry until hot, then add Ma Qian Zi, frying until the outside is scorched and the inside is crisp; Oil-frying: Fry Ma Qian Zi in fragrant oil until scorched and crisp. Grind the processed Ma Qian Zi into powder, store tightly, and administer internally with Chinese herbs, with the dosage as above. Mr. Li once reported treating 1890 cases of Bi syndrome with Ma Qian Zi San, resulting in 1227 cured cases (64.92%), 538 improved cases (28.47%). The total effective rate was 93.39%. Contraindications for taking the medicine: Forbidden for patients with acute or chronic nephritis, pulmonary tuberculosis, hypertension, acute or chronic infectious diseases, and Heat Bi. Forbidden for children under 12 years old.