老师：可以。还是按照常见的内伤头痛分类逐一为大家介绍口巴。①气虚头痛：清晨头痛，悠悠忽忽，有空洞感，面色皓白无神，四肢倦怠嗜卧，食少纳呆便溏，畏寒少气懒言，舌淡苔薄白，脉沉弱无力。常因久病或疲劳过度而诱发。气属阳，清晨为阴阳交会之时，由于气虚阳不足故痛作。劳则气伤，故劳累易引起发作。余症皆为脾胃气虚之象。其主要机制为中气虚而清阳不升。治宜补气升阳，方用补中益气汤(黄芪、人参、白术、炙甘草、陈皮、当归、升麻、柴胡)加细辛、川芎。亦可用顺气和中汤(黄芪、人参、白术、陈皮、当归、白芍、炙甘草、升麻、柴胡、蔓荆子、川乌、细辛)。②血虚头痛：头痛多在晚上，时作时止，痛时目眩，自眉梢亡攻，面色苍白，体倦头晕，心悸不宁，唇舌色淡，脉细弱无力(，多由失血或大病后及产后等引起。血属阴，夜亦属阴，故血虚头痛常夜晚明显加重。血虚不能养心，故心悸不宁，不能上荣于脑，故头痛。治宜养血疏风，方用加味四物汤(当归、川芎、熟地、白芍、白芷、羌活、独活、细辛、蔓荆子、甘草)或清上蠲痛汤(当归、川芎、防风、苍术、白芷、羌活、独活、麦冬、黄芩、菊花、蔓荆子、干姜、细辛)。③血瘀头痛：头痛反复发作，经久不愈，痛处固定，痛如针刺，舌质紫黯或有瘀斑，脉弦涩或细涩。或有头部外伤史。久病入络，气血凝滞，瘀血阻塞络脉，不通则痛。治宜活血化瘀，方用通窍活血汤(赤芍、川芎、桃仁、红花、老葱、红枣、麝香、黄酒)。④肝阳头痛：中午头痛加重，怕见阳光，痛偏两侧，眩晕如仆，耳鸣目胀，喜静恶烦，泛恶欲吐，睡眠不宁，严重者巅顶如有物重压，兼麻木感，舌质红，脉弦有力。中午为阳盛之时，又肝阳偏亢，两阳相迫，故而头痛加重。肝血不足，阴不敛阳，肝阳上扰横逆，则生诸症。治宜滋阴潜阳，方用建瓴汤(山药、怀牛膝、生赭石、生龙骨、生牡蛎、生地、生杭芍、柏子仁)或用驯龙汤(生地、当归、白芍、羚羊角、真珠母、龙齿、菊花、薄荷、桑寄生、钩藤、独活、沉香)。⑤肝火头痛：头痛且胀，头热面红目赤，头筋突起，心烦易怒，口苦咽干，便秘溲赤，严重者两耳暴聋，舌红苔薄黄，脉弦数或弦紧。常因恼怒而引起发作。怒气伤肝，肝火-上逆，则生诸症。属实火。治宜清肝泻火，方用龙胆泻肝汤(龙胆草、黄芩、栀子、泽泻、木通、车前子、生地、当归、柴胡、甘草)加夏枯草。⑥肝郁头痛：头痛胸闷不适，精神抑郁，情绪不宁，善叹息，神疲食少，女子多有月经不调，乳房作胀，脉弦而虚。常田情志不遂引起或加重。肝喜条达而恶抑郁，若情志所伤，肝气不能调畅，则郁而生诸症。治宜疏肝解郁，方用逍遥散(柴胡、当归、白芍、白术、茯苓、煨姜、薄荷、炙甘草)加川芎、白芷、蔓荆子。⑦痰浊头痛：头重胀痛，常伴眩晕，胸门满闷，呕吐恶心，舌苔白厚腻，脉弦滑。多见于素体痰湿偏盛者。痰浊属阴邪，上扰清窍，则清阳不得舒展而头痛。余皆为痰湿内阻之象。治宜健脾化痰、理气利湿，方用加味二陈汤(半夏、陈皮、茯苓、甘草、川芎、蔓荆子、细辛)或半夏白术天麻汤(半夏、天麻、白术、茯苓、橘红、甘草、生姜、大枣)加苍术、泽泻、麦芽。⑧寒厥头痛：头痛畏风怕冷，常欲蒙被而睡，面容惨淡忧郁，微带青晦，呕吐清涎粘沫，四肢不温，舌苔白滑，脉沉弦紧。本证又称"厥阴头痛"，乃肝经寒气上逆所致。寒气横犯脾胃，故吐清涎而肢冷。治宜暖肝降逆，方用吴茱萸汤(吴茱萸、人参、大枣、生姜)加当归、肉桂。⑨肾虚头痛：可分为肾阴虚和肾阳虚两种。肾阴虚头痛，头脑空痛，眩晕耳鸣，腰膝酸软无力，虚烦不眠，舌红少苔，脉细无力。肾虚精髓不足，不能上荣于脑，故头痛且空。余症皆为肾水不足之象。治宜滋养肾阴，方用杞菊地黄丸(熟地、山萸肉、山药、茯苓、泽泻、丹皮、菊花、枸杞)加牛膝、白芍。肾阳虚头痛，头痛从巅顶连及前额，特别怕冷，见风如直入脑户，得温则痛减，故热天也带厚帽，四肢不温，舌淡，脉沉细弱。肾阳不足，命门火衰，督脉虚寒，阳明脉亦衰，故巅顶前额冷痛。治宜温肾扶阳，方用右归饮(熟地、山药、山茱萸、枸杞、炙甘草、杜仲、肉桂、制附子)加天麻。
四川省乐山市人民医院中医研究室主任余国俊
患者，女，35岁。患慢性肝炎3年，经常胁肋掣痛、刺痛，伴胸闷腹胀、呕恶、暖气。选用中、西药物，症状改善不明显，舌质偏红，边尖满布紫暗小点，苔薄黄微腻，脉弦细。体验：肝肋下3cm，GPT60u，TTT9u。辨证为悬饮阻塞肝络。投以香附旋复花汤加减：香附(醋制)10g，旋复花10g(包煎)，法夏10g，茯苓15g，陈皮10g，杏仁10g，薏苡仁20g，瓜萎仁10g，降香15g，桔梗10g。2日1剂。病人服至15剂，胁肋掣痛消失，刺痛及其余诸症亦减轻。乃守前方，去法夏、陈皮，加丹参15g、丹皮10g、茜草15g、赤芍10g、广虫3g(炙，轧细吞服)、葱茎9根。病人又服15剂，胁肋刺痛消失，舌质转淡红，边尖已无紫暗小点，苔薄白，脉弦缓。遂疏柴芍六君子汤加味以善后。前后服药3个月余，除偶感纳差、乏力、易疲劳外，一如常人。病人经复查，肝肋下1．5cm，肝功能正常(此案已载入《中日青年中医论文选》)。
学员甲这则医案，看似平淡无奇。但在参加对日交流，收入《论文选)公开出版后，又被《秘方治疗17种顽固病》一书转载，说明具有一定的启发意义。
老师：哪里是什么"秘方"!明明是《温病条辨》中的香附旋复花汤。
学员乙虽不是秘方，但本例慢性肝炎胁痛，是在长期使用疏肝理气、清热利湿、活血化瘀、养阴柔肝等治法而症状改善不明显的情况下，转用涤饮通络的香附旋复花汤加减治愈的，说明本方具有推广使用的价值。据我所知，临床治疗胁痛，确有忽视涤饮通络这一治法的。
老师：我认为首先是忽视了悬饮阻塞肝络引起胁痛这一特殊证型。大家知道，肝居胁下，经脉布于胁叻，故胁痛为肝病之确征。《灵枢·五邪篇》说，"邪在肝，则两胁中痛"。此"邪"字当包括饮邪在内，前贤早有明训。如《金匮要略》说，"饮后水流在胁下，咳唾引痛，谓之悬饮"。(温病条辨)下焦篇第41条说，"伏暑、湿温胁痛，或咳或不咳，无寒但潮热，或竟寒热如症状，不可误认柴胡证，香附旋复花汤主之"。吴鞠通认为此种胁痛，即(金匮)水在肝尚用十枣汤之证。因其为患尚轻，仅用香附旋悬复花汤涤饮通络即可。
实习生甲古书上说的是饮后、伏暑、湿温引起的胁痛，但本例是肝炎引起的胁痛呀!
老师：据临床观察，饮邪胁痛来路多端，非仅限于饮后、伏暑、湿温等，但饮邪阻塞肝络，不通则痛的病机则一。近代认为此证类似于西医学的渗出性胸膜炎、胸腔积液。我近年所治的一些急性肝炎、慢性肝炎、慢性胆囊炎、哮喘等病，亦有如此者。不过，为了准确无误地使用本方，最关键的是要掌握这种胁痛的特征·陆症状--掣痛。请注意不是胀痛、刺痛或隐痛，而是牵掣作痛。即体位固定时不痛或仅微痛，--旦移动体位，如翻身、转侧、俯仰、走路等，便牵掣疼痛不已。此皆得之于问诊，故疏于问诊者戒之!而此证初起，易被误诊为柴胡证者，亦缘于未尝掌握其特征性症状之故。
进修生甲：老师是怎样发现这一特征性症状并悟出特殊治法的呢?
老师：古云"三折肱乃良医"，我早年哪有这样的慧眼和悟性!这完全是江老传授的。而江老早年是在生病自疗、陷入困境时被其业师陈鼎三老先生点破迷团的。江老20岁寸，仲秋月，偶感寒，咳嗽，胁肋掣痛，寒热如疟。自书小柴胡汤加减不效，其业师笑曰，"此非柴胡证，乃香附旋复花汤证也"。即书原方(生香附、旋复花、苏子、广陈皮、茯苓各9g，法夏、苡仁各15g)。江老颇恶药味之苦涩难咽，咽下便呕，半日许，断续呕出粘涎碗许，不意胁痛、寒热竟完全消失。江老暗喜本方之妙，乃请教先师。先师出示(温病条辨)下焦篇第41条时，江老才茅塞顿开：原来是误认了柴胡证!但既非柴胡证，其胁痛、寒热又当作何解?吴鞠通自注，"此因时令之邪，与里水新搏……"，真是一语破的!待到江老阅历渐多，乃复取柴胡证与香附旋复花汤证对照合勘，益知二证之寒热虽相似，而胸胁之症状却大异之。柴胡证为胸胁苦满，或兼痛，但绝非牵掣作痛，乃无形邪气郁于少阳，偏于半表；香附旋复花汤证为胸胁牵掣作痛，而非苦满，乃有形水饮停聚胸胁，偏于半里。二证之鉴别诊断，关键即在于此。
学员丙这就无法完全回避一件古今医学聚讼纷纭的"悬案"--少阳病的病位问题。
老师：虽说无法完全回避，但至少可以避开纯理论方面的纠缠，而把眼光移向临床。江老认为，柴胡证与香附旋复花汤证是临床上少阳病最为常见的两大证型。而确定少阳病位，归根到底就是确定腠理与胸胁归属于哪一个脏腑的问题。《金匮要略》说，"腠者，是三焦通会元真之处，为血气所注；理者，是皮肤脏腑之文理也"。可见腠理是归属于三焦的。而胸胁即是胸腹腔，处于躯壳之里，脏腑之外，亦是三焦部位。所以陈修园说，"少阳内主三焦，外主腠理"。这就是少阳病的病位。
进修生乙：我认为尤其不应回避的是，本例慢性肝炎胁痛，并无寒热往来或寒热如疟等外症，若严格遵守"方证对应"的原则，就不应使用香附旋复花汤。
老师：不一定要有外症才可使用本方，这一点也是江老从自身体验中总结出来的。用他的话说，叫做"如鱼饮水，冷暖自知"。他年届6旬时，患面神经炎初愈，亦在仲秋，偶着凉，外症不显，惟右胁掣痛，未介意。至夜，胁掣痛加重，牵引肾区。夜半，胁痛增剧，不敢翻身和深呼吸。家人扶坐，亦难支持。次晨，西医诊为"小叶性肺炎"，欲用抗生素。江老自书本方加降香、白芥子、瓜蒌仁，服直剂，至傍晚，胁痛大减；又服1剂痛止。数十年来，江老曾用本方治愈过不少胸膜炎、胸腔积液病人，亦大多无外症。一般用2-4剂，便可止住胸胁掣痛。而将本方扩大运用于治疗慢性肝炎、慢性胆囊炎、哮喘等属于饮邪阻滞肝络者，亦大多无外症。而在守法守方的基础上随症加减，坚持服用，亦可默收敏效。所以江老提倡读古书时，一不要以文害辞，以辞害意；二不要脱离临床，死于句下。
实习生乙我看本方药物较为平淡，而疗效却不同凡响，其中必有加减秘诀，才能化平淡为神奇，是这样的吗?
老师：大多数经方或著名的时方，其药物组成都较为平淡。依我看，只要准确地针对病因病机，疗效显著且经得起重复，"平淡"又何妨：吴鞠通自注本方，"香附、旋复，善通肝络而逐胁下之饮；苏子、杏仁(原方无杏仁--笔者注)，降肺气而化饮，所谓建金以平术；广皮、半夏，消痰饮之正；茯苓、薏仁，开太阳而阎阳明，所谓治水者必实上，中流涨者开支河也"。以临床效验视之，吴氏自注毫无溢美之辞。
实习生乙吴氏说，"香附、旋复，善通肝络而逐胁下之饮……"，但旋复花根本不入肝经。
老师：香附主入肝经，可以引领旋复花入肝通络。若伴邪阻腠理，乍寒乍热，可加青莴、柴胡开腠透邪；伴饮邪上逆，眩冒，可合苓桂术甘汤化饮降逆；伴脾虚失运，脘痞腹胀，可合香砂六君子汤健脾助运；伴湿浊困脾，舌苔厚腻，纳呆，可重加石菖薄、佩兰、广藿香化浊醒脾；伴瘀血凝络，胁肋刺痛，可加降香、丹参、茜草、庶虫等祛瘀通络。此非秘诀，观其脉证，洋察兼夹，随证化裁而已。谈谈运用麻黄附子细辛汤的几种思维方法四川省乐山市人民医院中医研究室主任余国俊《伤寒论》麻黄附子细辛汤，乃治疗太阳、少阴两感证的高效方。原书谓，"少阴病始得之，反发热，脉沉者，麻黄附子细辛汤主之"。(汤头歌诀)曰，"麻黄附子细辛汤，发表温经两法彰；苦非表里相兼治，少阴发热曷能康"?因太阳、少阴两感证的基本病机为心肾阳虚，复感寒邪，表里同病，故用麻黄发表散寒，附子温肾强心，细辛搜剔、温散深入少阴之寒邪。本方药仅3味，配伍精当，功专效宏，临床运用机会颇多，远远超出了原书的适应范围，而可广泛运用于内、外、妇、儿、五官科等多种病证。
目前临床上存在的主要问题是：有的医者畏惧麻辛附而不敢使用；有的即使遇到适应证，亦不愿单独或仅稍事加味使用(仅加一二味)，而必加减得面目全非，或喧宾夺主。若此者疗效自然降低，其至无效。适至反思之时，不咎思维方法之误，反怨经方难用。俗语云，"工欲善其事，必先利其器"。兹结合若干病例，谈谈运用本方的几种思维方法，以期抛砖引玉。
老师：可以。还是按照常见的内伤头痛分类逐一为大家介绍吧。
①气虚头痛（Qi Deficiency Headache）：清晨头痛，感觉悠悠忽忽，有空洞感，面色苍白无神，四肢倦怠嗜卧，食少纳呆便溏，畏寒少气懒言，舌淡苔薄白，脉沉弱无力。常因久病或疲劳过度而诱发。气属阳，清晨为阴阳交会之时，由于气虚阳不足故痛作。劳则气伤，故劳累易引起发作。余症皆为脾胃气虚之象。其主要机制为中气虚而清阳不升。治宜补气升阳，方用补中益气汤（黄芪、人参、白术、炙甘草、陈皮、当归、升麻、柴胡）加细辛、川芎。亦可用顺气和中汤（黄芪、人参、白术、陈皮、当归、白芍、炙甘草、升麻、柴胡、蔓荆子、川乌、细辛）。
②血虚头痛（Blood Deficiency Headache）：头痛多在晚上，时作时止，痛时目眩，自眉梢攻向太阳穴，面色苍白，体倦头晕，心悸不宁，唇舌色淡，脉细弱无力，多由失血或大病后及产后等引起。血属阴，夜亦属阴，故血虚头痛常夜晚明显加重。血虚不能养心，故心悸不宁，不能上荣于脑，故头痛。治宜养血疏风，方用加味四物汤（当归、川芎、熟地、白芍、白芷、羌活、独活、细辛、蔓荆子、甘草）或清上蠲痛汤（当归、川芎、防风、苍术、白芷、羌活、独活、麦冬、黄芩、菊花、蔓荆子、干姜、细辛）。
③血瘀头痛（Blood Stasis Headache）：头痛反复发作，经久不愈，痛处固定，痛如针刺，舌质紫黯或有瘀斑，脉弦涩或细涩。或有头部外伤史。久病入络，气血凝滞，瘀血阻塞络脉，不通则痛。治宜活血化瘀，方用通窍活血汤（赤芍、川芎、桃仁、红花、老葱、红枣、麝香、黄酒）。
④肝阳头痛（Liver Yang Hyperactivity Headache）：中午头痛加重，怕见阳光，痛偏两侧，眩晕如仆，耳鸣目胀，喜静恶烦，泛恶欲吐，睡眠不宁，严重者巅顶如有物重压，兼麻木感，舌质红，脉弦有力。中午为阳盛之时，又肝阳偏亢，两阳相迫，故而头痛加重。肝血不足，阴不敛阳，肝阳上扰横逆，则生诸症。治宜滋阴潜阳，方用建瓴汤（山药、怀牛膝、生赭石、生龙骨、生牡蛎、生地、生杭芍、柏子仁）或用驯龙汤（生地、当归、白芍、羚羊角、真珠母、龙齿、菊花、薄荷、桑寄生、钩藤、独活、沉香）。
⑤肝火头痛（Liver Fire Headache）：头痛且胀，头热面红目赤，头筋突起，心烦易怒，口苦咽干，便秘溲赤，严重者两耳暴聋，舌红苔薄黄，脉弦数或弦紧。常因恼怒而引起发作。怒气伤肝，肝火上逆，则生诸症。属实火。治宜清肝泻火，方用龙胆泻肝汤（龙胆草、黄芩、栀子、泽泻、木通、车前子、生地、当归、柴胡、甘草）加夏枯草。
⑥肝郁头痛（Liver Qi Stagnation Headache）：头痛胸闷不适，精神抑郁，情绪不宁，善叹息，神疲食少，女子多有月经不调，乳房作胀，脉弦而虚。常因情志不遂引起或加重。肝喜条达而恶抑郁，若情志所伤，肝气不能调畅，则郁而生诸症。治宜疏肝解郁，方用逍遥散（柴胡、当归、白芍、白术、茯苓、煨姜、薄荷、炙甘草）加川芎、白芷、蔓荆子。
⑦痰浊头痛（Phlegm-Turbidity Headache）：头重胀痛，常伴眩晕，胸脘满闷，呕吐恶心，舌苔白厚腻，脉弦滑。多见于素体痰湿偏盛者。痰浊属阴邪，上扰清窍，则清阳不得舒展而头痛。余皆为痰湿内阻之象。治宜健脾化痰、理气利湿，方用加味二陈汤（半夏、陈皮、茯苓、甘草、川芎、蔓荆子、细辛）或半夏白术天麻汤（半夏、天麻、白术、茯苓、橘红、甘草、生姜、大枣）加苍术、泽泻、麦芽。
⑧寒厥头痛（Cold Jue Headache）：头痛畏风怕冷，常欲蒙被而睡，面容惨淡忧郁，微带青晦，呕吐清涎粘沫，四肢不温，舌苔白滑，脉沉弦紧。本证又称“厥阴头痛”，乃肝经寒气上逆所致。寒气横犯脾胃，故吐清涎而肢冷。治宜暖肝降逆，方用吴茱萸汤（吴茱萸、人参、大枣、生姜）加当归、肉桂。
⑨肾虚头痛（Kidney Deficiency Headache）：可分为肾阴虚和肾阳虚两种。肾阴虚头痛，头脑空痛，眩晕耳鸣，腰膝酸软无力，虚烦不眠，舌红少苔，脉细无力。肾虚精髓不足，不能上荣于脑，故头痛且空。余症皆为肾水不足之象。治宜滋养肾阴，方用杞菊地黄丸（熟地、山萸肉、山药、茯苓、泽泻、丹皮、菊花、枸杞）加牛膝、白芍。肾阳虚头痛，头痛从巅顶连及前额，特别怕冷，见风如直入脑户，得温则痛减，故热天也带厚帽，四肢不温，舌淡，脉沉细弱。肾阳不足，命门火衰，督脉虚寒，阳明脉亦衰，故巅顶前额冷痛。治宜温肾扶阳，方用右归饮（熟地、山药、山茱萸、枸杞、炙甘草、杜仲、肉桂、制附子）加天麻。
四川省乐山市人民医院中医研究室主任 余国俊
患者，女，35岁。患慢性肝炎3年，经常胁肋掣痛、刺痛，伴胸闷腹胀、呕恶、嗳气。选用中、西药物，症状改善不明显，舌质偏红，边尖满布紫暗小点，苔薄黄微腻，脉弦细。体检：肝肋下3cm，GPT 60u，TTT 9u。辨证为悬饮阻塞肝络。投以香附旋复花汤加减：香附（醋制）10g，旋复花10g（包煎），法夏10g，茯苓15g，陈皮10g，杏仁10g，薏苡仁20g，瓜蒌仁10g，降香15g，桔梗10g。2日1剂。病人服至15剂，胁肋掣痛消失，刺痛及其余诸症亦减轻。乃守前方，去法夏、陈皮，加丹参15g、丹皮10g、茜草15g、赤芍10g、广虫3g（炙，轧细吞服）、葱茎9根。病人又服15剂，胁肋刺痛消失，舌质转淡红，边尖已无紫暗小点，苔薄白，脉弦缓。遂疏柴芍六君子汤加味以善后。前后服药3个月余，除偶感纳差、乏力、易疲劳外，一如常人。病人经复查，肝肋下1.5cm，肝功能正常（此案已载入《中日青年中医论文选》）。
学员甲：这则医案，看似平淡无奇。但在参加对日交流，收入《论文选》公开出版后，又被《秘方治疗17种顽固病》一书转载，说明具有一定的启发意义。
老师：哪里是什么“秘方”！明明是《温病条辨》中的香附旋复花汤。
学员乙：虽不是秘方，但本例慢性肝炎胁痛，是在长期使用疏肝理气、清热利湿、活血化瘀、养阴柔肝等治法而症状改善不明显的情况下，转用涤饮通络的香附旋复花汤加减治愈的，说明本方具有推广使用的价值。据我所知，临床治疗胁痛，确有忽视涤饮通络这一治法的。
老师：我认为首先是忽视了悬饮阻塞肝络引起胁痛这一特殊证型。大家知道，肝居胁下，经脉布于胁肋，故胁痛为肝病之确征。《灵枢·五邪篇》说，“邪在肝，则两胁中痛”。此“邪”字当包括饮邪在内，前贤早有明训。如《金匮要略》说，“饮后水流在胁下，咳唾引痛，谓之悬饮”。《温病条辨》下焦篇第41条说，“伏暑、湿温胁痛，或咳或不咳，无寒但潮热，或竟寒热如疟状，不可误认柴胡证，香附旋复花汤主之”。吴鞠通认为此种胁痛，即《金匮》水在肝尚用十枣汤之证。因其为患尚轻，仅用香附旋复花汤涤饮通络即可。
实习生甲：古书上说的是饮后、伏暑、湿温引起的胁痛，但本例是肝炎引起的胁痛呀！
老师：据临床观察，饮邪胁痛来路多端，非仅限于饮后、伏暑、湿温等，但饮邪阻塞肝络，不通则痛的病机则一。近代认为此证类似于西医学的渗出性胸膜炎、胸腔积液。我近年所治的一些急性肝炎、慢性肝炎、慢性胆囊炎、哮喘等病，亦有如此者。不过，为了准确无误地使用本方，最关键的是要掌握这种胁痛的特征性症状——掣痛。请注意不是胀痛、刺痛或隐痛，而是牵掣作痛。即体位固定时不痛或仅微痛，一旦移动体位，如翻身、转侧、俯仰、走路等，便牵掣疼痛不已。此皆得之于问诊，故疏于问诊者戒之！而此证初起，易被误诊为柴胡证者，亦缘于未尝掌握其特征性症状之故。
进修生甲：老师是怎样发现这一特征性症状并悟出特殊治法的呢？
老师：古云“三折肱乃良医”，我早年哪有这样的慧眼和悟性！这完全是江老传授的。而江老早年是在生病自疗、陷入困境时被其业师陈鼎三老先生点破迷团的。江老20岁时，仲秋月，偶感寒，咳嗽，胁肋掣痛，寒热如疟。自书小柴胡汤加减不效，其业师笑曰，“此非柴胡证，乃香附旋复花汤证也”。即书原方（生香附、旋复花、苏子、广陈皮、茯苓各9g，法夏、苡仁各15g）。江老颇恶药味之苦涩难咽，咽下便呕，半日许，断续呕出粘涎碗许，不意胁痛、寒热竟完全消失。江老暗喜本方之妙，乃请教先师。先师出示《温病条辨》下焦篇第41条时，江老才茅塞顿开：原来是误认了柴胡证！但既非柴胡证，其胁痛、寒热又当作何解？吴鞠通自注，“此因时令之邪，与里水新搏……”，真是一语破的！待到江老阅历渐多，乃复取柴胡证与香附旋复花汤证对照合勘，益知二证之寒热虽相似，而胸胁之症状却大异之。柴胡证为胸胁苦满，或兼痛，但绝非牵掣作痛，乃无形邪气郁于少阳，偏于半表；香附旋复花汤证为胸胁牵掣作痛，而非苦满，乃有形水饮停聚胸胁，偏于半里。二证之鉴别诊断，关键即在于此。
学员丙：这就无法完全回避一件古今医学聚讼纷纭的“悬案”——少阳病的病位问题。
老师：虽说无法完全回避，但至少可以避开纯理论方面的纠缠，而把眼光移向临床。江老认为，柴胡证与香附旋复花汤证是临床上少阳病最为常见的两大证型。而确定少阳病位，归根到底就是确定腠理与胸胁归属于哪一个脏腑的问题。《金匮要略》说，“腠者，是三焦通会元真之处，为血气所注；理者，是皮肤脏腑之文理也”。可见腠理是归属于三焦的。而胸胁即是胸腹腔，处于躯壳之里，脏腑之外，亦是三焦部位。所以陈修园说，“少阳内主三焦，外主腠理”。这就是少阳病的病位。
进修生乙：我认为尤其不应回避的是，本例慢性肝炎胁痛，并无寒热往来或寒热如疟等外症，若严格遵守“方证对应”的原则，就不应使用香附旋复花汤。
老师：不一定要有外症才可使用本方，这一点也是江老从自身体验中总结出来的。用他的话说，叫做“如鱼饮水，冷暖自知”。他年届6旬时，患面神经炎初愈，亦在仲秋，偶着凉，外症不显，惟右胁掣痛，未介意。至夜，胁掣痛加重，牵引肾区。夜半，胁痛增剧，不敢翻身和深呼吸。家人扶坐，亦难支持。次晨，西医诊为“小叶性肺炎”，欲用抗生素。江老自书本方加降香、白芥子、瓜蒌仁，服1剂，至傍晚，胁痛大减；又服1剂痛止。数十年来，江老曾用本方治愈过不少胸膜炎、胸腔积液病人，亦大多无外症。一般用2-4剂，便可止住胸胁掣痛。而将本方扩大运用于治疗慢性肝炎、慢性胆囊炎、哮喘等属于饮邪阻滞肝络者，亦大多无外症。而在守法守方的基础上随症加减，坚持服用，亦可默收敏效。所以江老提倡读古书时，一不要以文害辞，以辞害意；二不要脱离临床，死于句下。
实习生乙：我看本方药物较为平淡，而疗效却不同凡响，其中必有加减秘诀，才能化平淡为神奇，是这样的吗？
老师：大多数经方或著名的时方，其药物组成都较为平淡。依我看，只要准确地针对病因病机，疗效显著且经得起重复，“平淡”又何妨！吴鞠通自注本方，“香附、旋复，善通肝络而逐胁下之饮；苏子、杏仁（原方无杏仁——笔者注），降肺气而化饮，所谓建金以平木；广皮、半夏，消痰饮之正；茯苓、薏仁，开太阳而阖阳明，所谓治水者必实上，中流涨者开支河也”。以临床效验视之，吴氏自注毫无溢美之辞。
实习生乙：吴氏说，“香附、旋复，善通肝络而逐胁下之饮……”，但旋复花根本不入肝经。
老师：香附主入肝经，可以引领旋复花入肝通络。若伴邪阻腠理，乍寒乍热，可加青蒿、柴胡开腠透邪；伴饮邪上逆，眩冒，可合苓桂术甘汤化饮降逆；伴脾虚失运，脘痞腹胀，可合香砂六君子汤健脾助运；伴湿浊困脾，舌苔厚腻，纳呆，可重加石菖蒲、佩兰、广藿香化浊醒脾；伴瘀血凝络，胁肋刺痛，可加降香、丹参、茜草、庶虫等祛瘀通络。此非秘诀，观其脉证，详察兼夹，随证化裁而已。
谈谈运用麻黄附子细辛汤的几种思维方法
四川省乐山市人民医院中医研究室主任 余国俊
《伤寒论》麻黄附子细辛汤，乃治疗太阳、少阴两感证的高效方。原书谓，“少阴病始得之，反发热，脉沉者，麻黄附子细辛汤主之”。《汤头歌诀》曰，“麻黄附子细辛汤，发表温经两法彰；若非表里相兼治，少阴发热曷能康”？因太阳、少阴两感证的基本病机为心肾阳虚，复感寒邪，表里同病，故用麻黄发表散寒，附子温肾强心，细辛搜剔、温散深入少阴之寒邪。本方药仅3味，配伍精当，功专效宏，临床运用机会颇多，远远超出了原书的适应范围，而可广泛运用于内、外、妇、儿、五官科等多种病证。
目前临床上存在的主要问题是：有的医者畏惧麻辛附而不敢使用；有的即使遇到适应证，亦不愿单独或仅稍事加味使用（仅加一二味），而必加减得面目全非，或喧宾夺主。若此者疗效自然降低，甚至无效。适至反思之时，不咎思维方法之误，反怨经方难用。俗语云，“工欲善其事，必先利其器”。兹结合若干病例，谈谈运用本方的几种思维方法，以期抛砖引玉。
Teacher: Very well. Let us proceed to introduce the common classifications of internal injury headaches one by one.
① Qi Deficiency Headache (Qi Xu Tou Tong): Headache occurs in the early morning, feeling vague and hollow. The complexion is pale and spiritless; limbs are fatigued with a desire to lie down; appetite is poor with loose stools; aversion to cold, shortness of breath, and reluctance to speak. The tongue is pale with a thin white coating, and the pulse is deep, weak, and powerless. It is often triggered by chronic illness or excessive fatigue. Qi belongs to Yang; early morning is the time when Yin and Yang intersect. Due to Qi deficiency and insufficient Yang, pain arises. Labor injures Qi, hence exertion easily triggers an attack. The remaining symptoms are all manifestations of Spleen and Stomach Qi deficiency. Its main mechanism is deficiency of Middle Qi leading to failure of Clear Yang to ascend. Treatment should tonify Qi and raise Yang. Formula: Buzhong Yiqi Tang (Huangqi, Renshen, Baizhu, Zhigancao, Chenpi, Danggui, Shengma, Chaihu) plus Xixin and Chuanxiong. Alternatively, Shunqi Hezhong Tang (Huangqi, Renshen, Baizhu, Chenpi, Danggui, Baishao, Zhigancao, Shengma, Chaihu, Manjingzi, Chuanwu, Xixin) may be used.
② Blood Deficiency Headache (Xue Xu Tou Tong): Headache mostly occurs at night, coming and going intermittently. During pain, there is dizziness. Pain radiates from the end of the eyebrows towards the temples. Complexion is pale, body is tired with dizziness, palpitations and restlessness. Lips and tongue are pale; pulse is fine, weak, and powerless. It is often caused by blood loss, severe illness, or postpartum conditions. Blood belongs to Yin, and night also belongs to Yin; thus, Blood Deficiency headache often worsens significantly at night. Blood deficiency fails to nourish the Heart, causing palpitations and restlessness; it fails to nourish the Brain, causing headache. Treatment should nourish Blood and disperse Wind. Formula: Jiawei Siwu Tang (Danggui, Chuanxiong, Shudi, Baishao, Baizhi, Qianghuo, Duhuo, Xixin, Manjingzi, Gancao) or Qing Shang Juan Tong Tang (Danggui, Chuanxiong, Fangfeng, Cangzhu, Baizhi, Qianghuo, Duhuo, Maidong, Huangqin, Juhua, Manjingzi, Ganjiang, Xixin).
③ Blood Stasis Headache (Xue Yu Tou Tong): Headache recurs repeatedly and persists for a long time. The painful area is fixed, feeling like needle pricks. The tongue body is purple-dark or has ecchymosis spots; the pulse is wiry-choppy or fine-choppy. There may be a history of head trauma. Chronic disease enters the collaterals, causing Qi and Blood stagnation. Blood stasis blocks the collaterals, leading to pain due to obstruction. Treatment should invigorate Blood and resolve stasis. Formula: Tongqiao Huoxue Tang (Chishao, Chuanxiong, Taoren, Honghua, Laocong, Hongzao, Shexiang, Huangjiu).
④ Liver Yang Hyperactivity Headache (Gan Yang Tou Tong): Headache worsens at noon, sensitivity to sunlight, pain偏向 sides, vertigo as if falling, tinnitus, distending eyes, preference for quietness and aversion to annoyance, nausea and urge to vomit, restless sleep. In severe cases, the vertex feels heavy pressure with numbness. Tongue is red, pulse is wiry and forceful. Noon is the time of peak Yang; combined with hyperactive Liver Yang, the two Yangs clash, worsening the headache. Liver Blood is insufficient, Yin fails to contain Yang, and Liver Yang harasses and rebels upwards, generating these symptoms. Treatment should nourish Yin and subdue Yang. Formula: Jianling Tang (Shanyao, Huainiuxi, Sheng Zheishi, Sheng Longgu, Sheng Muli, Shengdi, Sheng Hangshao, Baiziren) or Xunlong Tang (Shengdi, Danggui, Baishao, Lingyangjiao, Zhenzhumu, Longchi, Juhua, Bohe, Sangjisheng, Gouteng, Duhuo, Chenxiang).
⑤ Liver Fire Headache (Gan Huo Tou Tong): Headache with distension, heat in the head, red face and eyes, prominent scalp veins, irritability, bitter taste in mouth, dry throat, constipation, and dark urine. In severe cases, sudden deafness in both ears. Tongue is red with thin yellow coating; pulse is wiry-rapid or wiry-tight. Often triggered by anger. Anger injures the Liver, causing Liver Fire to rebel upwards, generating symptoms. This is Excess Fire. Treatment should clear Liver and purge Fire. Formula: Longdan Xiegan Tang (Longdancao, Huangqin, Zhizi, Zexie, Mutong, Cheqianzi, Shengdi, Danggui, Chaihu, Gancao) plus Xiakucao.
⑥ Liver Qi Stagnation Headache (Gan Yu Tou Tong): Headache with chest tightness and discomfort, mental depression, emotional instability, frequent sighing, fatigue, poor appetite. Women often have irregular menstruation and breast distension. Pulse is wiry and deficient. Often triggered or worsened by emotional frustration. The Liver prefers free flow and dislikes depression. If injured by emotions, Liver Qi cannot flow smoothly, leading to stagnation and symptoms. Treatment should soothe the Liver and relieve stagnation. Formula: Xiaoyao San (Chaihu, Danggui, Baishao, Baizhu, Fuling, Wei Jiang, Bohe, Zhigancao) plus Chuanxiong, Baizhi, and Manjingzi.
⑦ Phlegm-Turbidity Headache (Tan Zhuo Tou Tong): Heavy and distending headache, often accompanied by vertigo, chest and epigastric fullness, vomiting and nausea. Tongue coating is white, thick, and greasy; pulse is wiry-slippery. Common in those with constitutive Phlegm-Dampness excess. Phlegm-Turbidity is a Yin pathogen harassing the clear orifices, preventing Clear Yang from extending, causing headache. The rest are signs of internal Phlegm-Dampness obstruction. Treatment should strengthen the Spleen, transform Phlegm, regulate Qi, and promote diuresis. Formula: Jiawei Erchen Tang (Banxia, Chenpi, Fuling, Gancao, Chuanxiong, Manjingzi, Xixin) or Banxia Baizhu Tianma Tang (Banxia, Tianma, Baizhu, Fuling, Juhong, Gancao, Shengjiang, Dazao) plus Cangzhu, Zexie, and Maiya.
⑧ Cold Jue Headache (Han Jue Tou Tong): Headache with aversion to wind and cold, desire to sleep covered with blankets. Complexion is bleak and depressed, slightly bluish-dull. Vomiting of clear saliva and sticky foam, cold limbs. Tongue coating is white and slippery; pulse is deep-wiry-tight. This syndrome is also called "Jueyin Headache," caused by Cold Qi rebelling upwards along the Liver Meridian. Cold Qi attacks the Spleen and Stomach horizontally, causing vomiting of clear saliva and cold limbs. Treatment should warm the Liver and direct rebellious Qi downwards. Formula: Wuzhuyu Tang (Wuzhuyu, Renshen, Dazao, Shengjiang) plus Danggui and Rougui.
⑨ Kidney Deficiency Headache (Shen Xu Tou Tong): Divided into Kidney Yin Deficiency and Kidney Yang Deficiency.
Kidney Yin Deficiency Headache: Empty headache in the head, vertigo and tinnitus, soreness and weakness of waist and knees, empty vexation and insomnia. Tongue is red with little coating; pulse is fine and powerless. Kidney Essence deficiency fails to nourish the Brain, causing empty headache. Remaining symptoms indicate insufficiency of Kidney Water. Treatment should nourish Kidney Yin. Formula: Qiju Dihuang Wan (Shudi, Shanzhuyu, Shanyao, Fuling, Zexie, Danpi, Juhua, Gouqi) plus Niuxi and Baishao.
Kidney Yang Deficiency Headache: Headache extends from the vertex to the forehead, extreme aversion to cold. Feeling wind as if entering directly into the brain; warmth relieves pain, so thick hats are worn even in hot weather. Limbs are cold, tongue is pale, pulse is deep-fine-weak. Kidney Yang insufficiency leads to decline of Mingmen Fire, deficiency-cold of the Du Meridian, and decline of the Yangming Meridian, causing cold pain at the vertex and forehead. Treatment should warm the Kidney and support Yang. Formula: Yougui Yin (Shudi, Shanyao, Shanzhuyu, Gouqi, Zhigancao, Duzhong, Rougui, Zhifuzi) plus Tianma.
Treating Hypochondriac Pain by Draining Fluids and Unblocking Collaterals — Introduction to Xiangfu Xuanfuhua Tang
Director of TCM Research Office, Leshan People's Hospital, Sichuan Province: Yu Guojun
Patient: Female, 35 years old. Suffered from chronic hepatitis for 3 years, frequently experiencing pulling and stabbing pain in the hypochondrium, accompanied by chest tightness, abdominal distension, vomiting/nausea, and belching. Symptoms improved insignificantly after using Chinese and Western medicines. Tongue body was slightly red with purple-dark spots covering the edges and tip; coating was thin-yellow and slightly greasy; pulse was wiry-fine. Physical examination: Liver palpable 3cm below the costal margin; GPT 60u, TTT 9u. Syndrome differentiation: Xuan Yin (suspended fluid) obstructing Liver collaterals. Prescribed modified Xiangfu Xuanfuhua Tang: Xiangfu (vinegar-processed) 10g, Xuanfuhua 10g (wrapped), Faxia 10g, Fuling 15g, Chenpi 10g, Xingren 10g, Yiyiren 20g, Gualouren 10g, Jiangxiang 15g, Jiegeng 10g. One dose every two days. After taking 15 doses, hypochondriac pulling pain disappeared, and stabbing pain along with other symptoms alleviated. Maintained the previous formula, removed Faxia and Chenpi, added Danshen 15g, Danpi 10g, Qiancao 15g, Chishao 10g, Guangchong 3g (roasted, finely ground and swallowed), and Congjing 9 roots. After another 15 doses, hypochondriac stabbing pain disappeared, tongue turned light red with no purple spots on edges/tip, coating became thin-white, pulse wiry-slow. Subsequently prescribed Chaishao Liujunzi Tang with modifications for consolidation. After more than 3 months of medication, except for occasional poor appetite, fatigue, and easy tiredness, the patient was normal as before. Follow-up examination showed liver palpable 1.5cm below costal margin, liver function normal (this case is recorded in *Selected Papers of Chinese and Japanese Young TCM Practitioners*).
Student A: This medical case seems ordinary. However, after participating in exchanges with Japan and being published in *Selected Papers*, it was reprinted in *Secret Formulas for Treating 17 Stubborn Diseases*, indicating certain inspirational value.
Teacher: What secret formula! It is clearly Xiangfu Xuanfuhua Tang from *Wenbing Tiaobian*.
Student B: Although not a secret formula, this case of chronic hepatitis hypochondriac pain was cured by switching to modified Xiangfu Xuanfuhua Tang (draining fluids and unblocking collaterals) after long-term use of soothing Liver, regulating Qi, clearing Heat, draining Dampness, invigorating Blood, resolving stasis, nourishing Yin, and softening Liver methods yielded insignificant improvement. This shows the formula has value for promotion and use. As far as I know, clinical treatment of hypochondriac pain indeed neglects this method of draining fluids and unblocking collaterals.
Teacher: I believe the primary oversight is ignoring the special syndrome type of hypochondriac pain caused by Xuan Yin obstructing Liver collaterals. Everyone knows the Liver resides under the hypochondrium, and its meridians distribute to the hypochondrium; thus, hypochondriac pain is a definitive sign of Liver disease. *Ling Shu · Wu Xie Pian* states, "When pathogens are in the Liver, there is pain in the middle of both hypochondria." This "pathogen" includes Fluid pathogens, as ancient sages clearly instructed. For example, *Jin Gui Yao Lue* says, "After drinking, water flows under the hypochondrium, coughing and spitting induce pain, called Xuan Yin." Article 41 of the Lower Jiao Chapter in *Wenbing Tiaobian* states, "For hypochondriac pain due to latent summerheat or damp-warmth, with or without cough, no chills but tidal fever, or even chills and fever like malaria, do not mistakenly diagnose as Chaihu syndrome; Xiangfu Xuanfuhua Tang governs it." Wu Jutong believed this type of hypochondriac pain corresponds to the *Jin Gui* case of water in the Liver where Shizao Tang would still be used. Because the pathology is relatively mild, simply using Xiangfu Xuanfuhua Tang to drain fluids and unblock collaterals suffices.
Intern A: Ancient texts mention hypochondriac pain caused by drinking, latent summerheat, or damp-warmth, but this case is caused by hepatitis!
Teacher: Clinical observation shows that hypochondriac pain due to Fluid pathogens has diverse origins, not limited to drinking, latent summerheat, or damp-warmth. However, the pathogenesis of Fluid pathogens obstructing Liver collaterals causing pain due to obstruction remains consistent. Modern medicine considers this syndrome similar to exudative pleurisy and pleural effusion. In recent years, some cases of acute hepatitis, chronic hepatitis, chronic cholecystitis, asthma, etc., that I treated presented similarly. Nevertheless, to use this formula accurately, the key is to master the characteristic symptom of this hypochondriac pain—pulling pain (Che Tong). Please note, it is not distending, stabbing, or dull pain, but pulling pain. When body position is fixed, there is no pain or only slight pain; once the body position moves, such as turning over, twisting, bending, or walking, pulling pain becomes unbearable. This is obtained through inquiry, so those negligent in inquiry must beware! Early in this syndrome, it is easily misdiagnosed as Chaihu syndrome because the characteristic symptom was not mastered.
Advanced Student A: How did you discover this characteristic symptom and deduce the special treatment?
Teacher: The ancients said, "Three broken arms make a good doctor." Did I have such insight and understanding in my early years? No, this was entirely taught by Elder Jiang. Elder Jiang himself, in his youth, while treating his own illness and facing difficulties, had his confusion resolved by his teacher, Mr. Chen Dingsan. When Elder Jiang was 20 years old, in mid-autumn, he caught a cold, coughed, experienced hypochondriac pulling pain, and chills/fever like malaria. He self-prescribed modified Xiao Chaihu Tang without effect. His teacher smiled and said, "This is not Chaihu syndrome, but Xiangfu Xuanfuhua Tang syndrome." He immediately wrote the original formula (Sheng Xiangfu, Xuanfuhua, Suzi, Guang Chenpi, Fuling each 9g; Faxia, Yiren each 15g). Elder Jiang disliked the bitter taste, vomiting upon swallowing. Within half a day, he intermittently vomited about a bowl of sticky saliva. Unexpectedly, the hypochondriac pain and chills/fever completely disappeared. Secretly pleased with the formula's efficacy, he consulted his teacher. When his teacher showed him Article 41 of the Lower Jiao Chapter in *Wenbing Tiaobian*, Elder Jiang suddenly understood: he had mistakenly diagnosed Chaihu syndrome! But since it was not Chaihu syndrome, how to explain the hypochondriac pain and chills/fever? Wu Jutong's self-note says, "This is due to seasonal pathogens newly combining with interior fluids..." Truly hitting the nail on the head! As Elder Jiang gained experience, he compared Chaihu syndrome with Xiangfu Xuanfuhua Tang syndrome, realizing that although their chills/fever were similar, their chest/hypochondrium symptoms were vastly different. Chaihu syndrome presents with chest/hypochondriac fullness and distress, or pain, but absolutely not pulling pain; it is formless pathogen stagnating in Shaoyang,偏向 half-exterior. Xiangfu Xuanfuhua Tang syndrome presents with chest/hypochondriac pulling pain, not fullness/distress; it is formed fluid retention in chest/hypochondrium,偏向 half-interior. The differential diagnosis lies precisely here.
Student C: This makes it impossible to completely avoid a longstanding medical controversy—the location of Shaoyang disease.
Teacher: Although it cannot be completely avoided, we can at least avoid pure theoretical entanglements and focus on clinical practice. Elder Jiang believed that Chaihu syndrome and Xiangfu Xuanfuhua Tang syndrome are the two most common syndromes of Shaoyang disease clinically. Determining the location of Shaoyang disease ultimately comes down to determining which Zang-Fu organs the Couli (pores/collaterals) and hypochondrium belong to. *Jin Gui Yao Lue* states, "Cou refers to the place where the Triple Burner connects with Yuan Zhen (original Qi), where Blood and Qi flow; Li refers to the texture of skin and Zang-Fu organs." Thus, Couli belongs to the Triple Burner. The hypochondrium is the thoracic and abdominal cavity, inside the body shell but outside the Zang-Fu organs, also belonging to the Triple Burner region. Therefore, Chen Xiuyuan said, "Shaoyang internally governs the Triple Burner and externally governs Couli." This is the location of Shaoyang disease.
Advanced Student B: I believe what should especially not be avoided is that this case of chronic hepatitis hypochondriac pain lacks external symptoms like alternating chills/fever or malaria-like fever. If strictly adhering to the principle of "formula-syndrome correspondence," Xiangfu Xuanfuhua Tang should not be used.
Teacher: External symptoms are not required to use this formula. This point was also summarized by Elder Jiang from his personal experience. He described it as "Like a fish drinking water, knowing whether it is warm or cold oneself." When he was nearly 60, after recovering from facial neuritis, also in mid-autumn, he caught a chill. External symptoms were not obvious, only right hypochondriac pulling pain, which he ignored. By night, the pulling pain intensified, radiating to the kidney area. At midnight, pain worsened, unable to turn over or breathe deeply. Supported by family, he could hardly endure. Next morning, Western medicine diagnosed "lobar pneumonia" and wanted to use antibiotics. Elder Jiang self-prescribed this formula plus Jiangxiang, Baijiezi, and Gualouren. After one dose, pain greatly reduced by evening; after another dose, pain stopped. Over decades, Elder Jiang used this formula to cure many patients with pleurisy and pleural effusion, mostly without external symptoms. Generally, 2-4 doses stop hypochondriac pulling pain. Expanding this formula to treat chronic hepatitis, chronic cholecystitis, asthma, etc., caused by Fluid pathogens blocking Liver collaterals, also mostly lacked external symptoms. By maintaining the method and formula, modifying according to symptoms, and persisting in administration, rapid effects could be silently achieved. Therefore, Elder Jiang advocated when reading ancient books: first, do not let words harm meaning; second, do not detach from clinical practice and die by the text.
Intern B: I see the herbs in this formula are quite plain, yet the efficacy is extraordinary. There must be secrets in modification to turn plain into magical. Is this true?
Teacher: Most Jingfang (classical formulas) or famous Shifang (contemporary formulas) have relatively plain herb compositions. In my view, as long as they accurately target the etiology and pathogenesis, yield significant efficacy, and withstand repetition, what does "plain" matter! Wu Jutong's self-note on this formula states, "Xiangfu and Xuanfuhua excel at unblocking Liver collaterals and driving out fluid under the hypochondrium; Suzi and Xingren (originally no Xingren in the formula—note by author) descend Lung Qi and transform fluid, known as building Metal to calm Wood; Guangpi and Banxia eliminate phlegm-fluid; Fuling and Yiren open Taiyang and close Yangming, known as 'those who treat water must solidify the upper, and divert branches when the main stream floods'." Judging by clinical efficacy, Wu's self-note contains no exaggeration.
Intern B: Wu said, "Xiangfu and Xuanfuhua excel at unblocking Liver collaterals and driving out fluid under the hypochondrium...", but Xuanfuhua fundamentally does not enter the Liver Meridian.
Teacher: Xiangfu primarily enters the Liver Meridian and can guide Xuanfuhua into the Liver to unblock collaterals. If accompanied by pathogen blocking Couli with alternating chills/fever, add Qinghao and Chaihu to open Couli and vent pathogens; if accompanied by rebellious Fluid pathogens causing dizziness/dizziness, combine with Linggui Zhugan Tang to transform fluid and direct rebellion downwards; if accompanied by Spleen deficiency failing to transport, epigastric fullness/distension, combine with Xiangsha Liujunzi Tang to strengthen Spleen and assist transport; if accompanied by turbid Dampness trapping Spleen with thick greasy coating and poor appetite, heavily add Shichangpu, Peilan, and Guang Huoxiang to transform turbidity and awaken Spleen; if accompanied by Blood stasis凝 collaterals with stabbing hypochondriac pain, add Jiangxiang, Danshen, Qiancao, and Shuchong to remove stasis and unblock collaterals. This is not a secret; it is merely observing pulse and symptoms, carefully examining concurrent factors, and modifying according to the syndrome.
Discussing Several Thinking Methods for Using Mahuang Fuzi Xixin Tang
Director of TCM Research Office, Leshan People's Hospital, Sichuan Province: Yu Guojun
*Mahuang Fuzi Xixin Tang* from *Shanghan Lun* is a highly effective formula for treating simultaneous Taiyang and Shaoyin diseases. The original text states, "In early Shaoyin disease, contrary to expectation, there is fever and a deep pulse; Mahuang Fuzi Xixin Tang governs it." *Tangtou Gejue* says, "Mahuang Fuzi Xixin Tang, revealing exterior and warming meridians, two methods are manifest; if not treating exterior and interior simultaneously, how can Shaoyin fever recover?" The basic pathogenesis of simultaneous Taiyang and Shaoyin diseases is Heart-Kidney Yang deficiency compounded by Cold pathogen invasion, affecting both exterior and interior. Thus, Mahuang is used to release the exterior and scatter cold, Fuzi to warm the Kidney and strengthen the Heart, and Xixin to search out and warm-scatter Cold pathogens penetrating deeply into Shaoyin. This formula contains only three herbs, with precise compatibility, specific function, and grand efficacy. It has many clinical applications, far exceeding the scope of the original text, and can be widely used in Internal Medicine, Surgery, Gynecology, Pediatrics, and Otorhinolaryngology.
The main problem currently existing in clinical practice is: some physicians fear Mahuang, Xixin, and Fuzi and dare not use them; others, even when encountering indications, are unwilling to use it alone or with slight modifications (adding only one or two herbs), but must modify it beyond recognition or let secondary herbs overshadow the principal ones. In such cases, efficacy naturally decreases, even becoming ineffective. When reflecting, instead of blaming errors in thinking methods, they complain that classical formulas are difficult to use. As the proverb goes, "To do a good job, one must first sharpen one's tools." Here, combining several cases, I discuss several thinking methods for using this formula, hoping to throw a brick to attract jade.