1．方证对应法方证对应，又称方证相应、方剂辨证、汤证辨证等，乃张仲景著作的一大特色。按照方证对应原则，只要临床特征性症侯与仲景书中的描述相符合，就可将经方信手拈来，而不必受后世创立的诸种辨证方法的限制。直而言之，这实际上是在重复仲景当年的临床实践，堪称运用经方的一条捷径。如1992年3月曾治我院某男，62岁。患者周身恶寒，背部尤甚，困倦欲眠，但卧床又难成寐，已历3日。其人形瘦色苍，嗜烟多年，宿患肺气肿。3年前曾摄胸片发现肺部有一阴影，初疑为肿瘤，经抗炎治疗后阴影消失。但3年来每年均发病3～4次，每次症状均以恶寒思睡为主，且必须住院0.5～1个月，叠经输液(药用抗生素、维生素、肌苷等)、输血方能渐渐缓解。西医每次诊断均为"肺气肿"、"重感冒"。这次本应住院，但患者一想起历次输液时手背肿胀难忍，便心有余悸，故欲先服中药一试，如不效再住院。刻诊：体温36．8℃，精神萎靡，困倦思睡，纳尚可，舌淡苔薄白，脉沉细。《伤寒论》少阴病篇提纲证是"少阴之为病，脉微细，但欲寐也"。今患者发病伊始，便周身恶寒，困倦思睡，脉沉细，显系寒邪直中少阴，而与提纲证基本符合。故笔者不受本医历次的同一诊断与治疗的任何束缚，而拟使用方证对应法，投麻黄附子细辛汤温经解表。但虑其年老体虚，且发病已3日，恐汗多伤正，故不用生麻黄而用炙麻黄，再加炙甘草以匡扶正气。处方：炙麻黄10g，熟附片15g(先煎半小时)，北细辛6g，炙甘草6g。服1剂，并无汗出，但周身恶寒，困倦欲眠等症渐渐消失，精神转佳。随访1年未复发。可见方证对应法，实为准确运用麻黄附子细辛汤的一条捷径。
2．病机推求法《内经》要求医者"谨守病机，各司其属，有者求之，无者求之"。而"谨守病机"的前提是准确地推求病机，即在尽可能详尽地审疾察症，完整地占有四诊资料的基础-匕，通过由此及彼、由表及里的归纳概括，分析综合，最后作出病机诊断，以利于遣选高效方药。如前所述，在(伤寒论)中，麻黄附子细辛汤证的基本病机是心肾阳虚，复感寒邪，表里同病。这是就外感时病而言。若系内伤杂病，其基本病机则为阳虚寒凝。实践证明，临证时只要细心体察，准确地推求出这样的病机并不困难。然而在四诊资料不全时(病人函诊时经常遇到)，就比较麻烦了。如《中国乡村医生》1993年第7期刊出拙文(左小腿剧痛25天)之后，于9月初收到江苏省张家港市化肥厂卫生所范医生来信称：其妻右膝关节疼痛多年(有右膝外伤史10余年)，经X光摄片，诊断为"右副韧带损伤伴胫骨上端轻度骨质增生"。该市一医院曾动员其手术治疗，但患者已44岁，估计手术效果欠佳，便予以封闭治疗。因经常复发，特函诊求服中药。笔者读信数遍，茫然无从下手，连拟数方，皆不中意。不得已勉力从俗，寄去习用治疗久痹的桂枝芍药知母汤加活血通络药物；并告以四诊资料不全，无法推求病机以明确中医诊断，希望补充云云。范氏于10月13日来信说：眼药6剂乏效。患者双下肢酸重，局部肿胀，压痛明显，右膝肌肉轻度萎缩，近2天因参加田间劳动，顿觉行走不便……中医四诊：面色少华，舌淡红，根部有少量白苔，脉濡缓，痛处喜温怕冷。笔者据此推求其病机可能属于阳虚寒凝，遂寄去重剂麻黄附子细卒汤加味：生麻黄30g，熟附片50g(先煎1小时)，北细辛20g，熟地60g。嘱服6剂，范氏于12月30日来信说，"您寄给我的处方，我爱人服后效果很好!共服6剂，右膝疼痛全部消失，同原来一样。经剧烈的体力活动，或劳动亦无任何不适"。又说"经多次病例验证，麻黄附子细辛汤对治疗腰腿痛病例有特效"。所谓"特效"，故为偏激的美誉，但功；足以说明推求病机法对于遣选高效方药的重要性。而遣方不谙病机，犹如盲子夜行。
3．体质辨证法人之体质，禀于先天，成于后天。而人禀五行，各有偏重。早在《内经》．上就记载着太阴之人、少阴之人、太阳之人、少阳之人、阴阳和平之人以及木形之人、火形之人、土形之人、金形之人、水形之人的心理、生理、病理特征与治疗宜忌等内容。《伤寒论》上提到的"酒客"、"淋家"、"疮家"、"衄家"、"亡血家"等，亦属于体质辨证的范畴。历代医家大多重视体质辨证，如近代名医张锡纯关于体质辨证的论说更为确切具体，且经得起临床验证。他在(医学衷中参西录)中写道，"外感之著人，恒视人体之禀赋为转移，有如时气之流行，受病者或同室同时，而其病之偏凉偏热，或迥有不同。盖人脏腑素有积热者，外感触动之则其热益甚；其素有积寒者，外感触动之则其寒益甚也"。而麻黄附子细辛汤证的体质病理便是素体阳虚。故笔者治疗风寒外感，常存一"素体阳虚"之念于胸中，使麻黄附子细辛汤大有用武之地。如1991年冬治一男患，47岁。其人反复感冒1个月余，曾用过人参败毒散、小柴胡汤、桂枝汤合玉屏风散等，均无显效。刻诊：眠食尚可，能坚持工作。惟下午及晚上背心发冷，头面畏风，流清涕，舌淡红苔薄白，脉稍弱。似无明显阳虚之象，缘何以上方药无显效呢?细询之，方知其人经常腰痛绵绵，脾胃素畏寒凉，夏季也不敢吃生冷之物，属于阳虚体质无疑。乃投以麻黄附子细辛汤：生麻黄15g，熟附片30g(先煎半小时)，北细辛15g。仅服1剂，诸恙霍然。
回忆30年前，笔者在成都读书时，我校刘教授颇善医道，惟自身常年失眠一证，遍用诸方，疗效平平，深以为苦。因闻城里一老中医一年四季治病，无论男女老幼，亦无论所患何病，开手便是麻黄附子细辛汤，竟尔门庭若市，门诊人次逾百，且经年不衰，于是"火神菩萨"声名鹊起，便往一试之。既至，老医令其伸舌，随口吟曰"麻黄附子细辛汤"。助手立即抄方与之。刘教授悻悻然，又转思不姑妄从之，遂抓药2剂。不意服完l剂，当夜竟然安睡!笔者因讶其异，曾访问过一些病者。据说此老中医经年累月如此开方，债事者偶尔有之，但有效率仍然很高。至于其观舌之"诀窍"则是：凡舌质不现明显热象者，便一律使用麻黄附子细辛汤。此与明代张介宾治病，凡无热象者便赏用温补药物，岂非如出一辙?笔者附记及此，绝非欣赏这种置四诊八纲的简单化、公式化的所谓"绝招"，只不过是说明麻黄附子细辛汤适应范围广，运用机会多而已。若能讲究临证思维方法，其效必彰!
不思食案
北京中医药大学教授刘兴志
案1方XX，男，70岁，四川人，干部。患者于1980年7月28日因心窝部疼痛而住某院，入院诊为冠心病、慢性胃炎。因服药效果不显，于1980年7月30日邀中医诊治。询之口淡无味，不思饮食，胃脘疼痛，喜温喜按，恶心便溏，伴有头昏乏力，精神欠充，少气懒言。舌淡红白苔，脉弦。证系中焦虚寒，法当温中散寒，宜理中汤。方中人参、白术、炙甘草补益中气，干姜温中散寒，加广木香、元胡行气止痛。全方共奏振奋阳气，消除阴寒。1980年8月9日二诊：服上方仅2剂脘痛止，精神渐充，还食少纳呆，饮食不馨，舌淡苔白，脉缓无力。系脾胃气虚，健运失司，用健脾开胃香砂六君子汤加焦四仙、草果。1980年8月16日三诊：服上方4剂恶心除，胃中舒适，胸中豁朗，精神爽，思食有味，食量恢复正常每日300-350g(6-7两)，二便调和。携带上方，愈而出院。
学生：老师，患者有冠心病，为何只治中焦脾胃，不治上焦心脏?为何选理中汤?
老师：中焦脾胃乃气血生化之源，病者中焦虚寒，脾不健运而致气血化源匮乏，心失所养，故治在中。《金匮要略·胸痹心痛短气篇》云，"胸痹心中痞，留气结在胸，胸满，胁下逆抢心，枳实薤白桂枝汤主之；人参汤亦主之。"人参汤即理中汤，因其本方具有温运中阳，调理中焦的治疗作用，故取名"理中"，此正合(伤寒论>所云"理中者，理中焦"之意。中阳得运，气血化生之源充足，心有所养，因此抓住中焦论治，就抓住了疾病的根本，内经所谓"治病必求其本"即是这个道理。
案2刘XX，男，76岁，干部。患者因头昏，不思食，下肢浮肿1周，于1982年7月26MA．院。入院诊断为：①脑动脉硬化；②震颤麻痹；③膀胱结石术后；④双下肢浮肿待查。服药效果不理想，而请中医会诊。1982年7月28日患者表现：头昏眼花，下肢浮肿，无力行走，纳呆食少、腹胀，舌淡苔白、脉缓。脉证合参，系阳不化气，水湿停滞。治以温阳化气，利水消肿。方用五苓散加味：肉桂9g，白术15g，茯苓30g，泽泻30g，猪苓15g，陈皮9g，大腹皮log，炙甘草6g，当归15g，川芎log。1982年7月31日诊：服上方3剂，浮肿明显消减，余症同前，唯食纳不佳，使患者忧心仲仲，急求开胃以解决饮食问题。故相继投用健脾燥湿、理气和胃之香砂六君子汤和胃风汤等类方治疗，服用10剂腹胀减轻，但仍食欲不馨、纳食少进，且头昏，倦怠无力，大便排泄无力而干，舌淡白水滑，脉沉。
学生：老师，香砂六君子汤及胃风汤是开胃良药，为何患者服药无效?
老师：从一诊得知患者水肿，内停水湿，湿与脾关系极为密切，应该弄清楚脾不健运，胃失受纳，是脾阳虚呢?还是脾气虚?若脾气虚则选用健脾益气，芳香醒胃的香砂六君子汤即可奏效。为何不效?应从湿邪特征分析，湿为阴邪，最伤人阳气，遇寒则凝，得温则化，得阳始运，故当以理中汤温热之剂以助阳温运，犹如"离照发空，阴霾自散"。脾阳久虚，损及肾阳，命火不足，脾失温煦，故加附子、肉桂补火以助脾运，脾阳得运则胃能受纳。附方如下：附子30g(先煮30分钟，不麻为度)，肉桂6g(另兑)，党参15g，白术15g，干姜log，炙甘草6g，当归9g，茯苓15g。1982年8月13日诊：服温肾回阳，健脾益气之剂，果然奏效。患者知饥，饮食顿增，头脑清晰，大便爽快，肢肿亦消，已能下床行走。上方得效，加陈皮9g，续服3剂，渴望速效。1982年8月21日诊：患者饮食如常人，精神振，诸恙若失，上方连服6剂愈而出院。
案3梁XX，男，65岁，演员，北京人。患者于1980年9月4日因心痛短气汗出而入院，经治心痛缓解，汗出止，但服西药后脘腹饱闷不舒、纳呆便溏、厌食油腻，口干尿多，舌红苔白，脉弦。服西药助消化药无效，又服健脾益气、养阴和胃之六君于汤，人参健脾丸(汤)加麦冬、乌梅、鸡内金、炒谷麦芽，健脾燥湿、解郁消食开胃之乎胃散，越鞠保和丸(汤)加焦槟榔、红豆蔻，仍不能取效。于1980年9月17日邀我诊治，观其脉证，知泄下已止，但仍食少纳呆，脘腹饱闷，得矢气及呃逆稍舒，素厌荤腥，口干思冷饮，夜间尤著，甚则令其寤，大便于，舌绛无苔如镜面，脉弦偶见结代。
学生：老师，从这一诊患者的表现阴虚比较明显，为什么前医从健脾燥湿、理气开胃方面论治?您是如何分析?
老师：这就是临床问题的复杂性。前医生诊视病人时，症情的反映尚不典型，经过上述治疗阴虚证表现逐渐比较突出了，也不能说前医毫无考虑，在方中加入麦冬、乌梅之类，但认为津液不足是水不化气，津不上承，况且运用上述方法也是治疗不思食的常用治法，而世人胃阳虚者居多。从本案病人具体情况分析，梁XX是X省著名京剧演员，工作繁忙，长期罹患陈旧性心肌梗塞、Ⅲ期高血压、慢性支气管炎，饮食稍有不慎即作泄，因此，患者素体阴虚，木火偏盛，阴津暗耗，乃致胃液不足，导引偏盛之肝阳，克犯阳明。清·叶天士曾提出"胃汁竭，肝风动"、"厥阴之气上千，阳明之气失降"的理论。况胃为阳土，喜润而恶燥，上述所用方药以燥为主，燥则伤津，胃中津液更显不足；肝属风脏，体阴而用阳，故呈现"阳常有余，阴常不足"的特点。叶氏认为"厥阴为风脏，阳明为盛阳"，二者最易缺乏阴液的滋润，相互影响而为病，从而鲜明地提出了脾胃阴虚之肝胃不和的证因。据此理论与现症，本案属肝胃阴虚，胃失和降之证。因肝胃阴虚，则如釜中无水，不能熟谷，故见纳呆。治疗上不宜辛散、温燥之晶，宗(内经)"损者益之"，"燥者润之"的治疗原则，选择甘凉、濡润之晶滋胃柔肝，这种治法与叶氏所云一致，叶氏云"所谓宜降则和，非用辛开苦降，也非苦寒下夺以损胃气，不过甘乎或甘凉濡润，以养胃阴则津液来复，使之通降而已矣"。试拟一方如下：沙参15g，石斛12g，玉竹10g，白芍10g，郁金10g，甘草6g，佛手6g，菖蒲3g，鸡内金10g，炒稻芽15g，荷叶5go1980年9月20日诊：服上方3剂，胃纳渐开，睡眠略安，口干减，二便通调，尚觉胃中不舒，继宜甘凉滋润之品，原方加红豆蔻6g，续服3剂。
学生：老师，为何上方效果这样明显，请您讲一讲。
1. 方证对应法
方证对应，又称方证相应、方剂辨证、汤证辨证等，是张仲景著作的一大特色。遵循方证对应的原则，只要临床特征性症状与张仲景书中的描述相符，就可以直接运用经方（经典方剂），而不必受后世创立的各种辨证方法的限制。直白地说，这实际上是在重复张仲景当年的临床实践，堪称运用经方的一条捷径。例如，1992年3月曾治疗我院一名62岁男性患者。患者全身怕冷，背部尤为严重，困倦想睡觉，但躺在床上又难以入睡，病程已持续3天。该患者形体消瘦，面色苍老，吸烟多年，患有慢性肺气肿。3年前胸部X光片发现肺部有阴影，起初怀疑为肿瘤，经抗炎治疗后阴影消失。但这3年来每年发病3～4次，每次症状均以怕冷和嗜睡为主，且必须住院0.5～1个月，经过多次输液（使用抗生素、维生素、肌苷等药物）、输血才能逐渐缓解。西医每次诊断均为“肺气肿”、“重感冒”。这次本应住院，但患者一想起历次输液时手背肿胀难忍，便心有余悸，故想先服用中药试一试，如果无效再住院。就诊时：体温36.8℃，精神萎靡，困倦思睡，食欲尚可，舌质淡苔薄白，脉沉细。《伤寒论》少阴病篇的提纲证是“少阴病的表现，脉象微细，只想睡觉”。现在患者发病伊始，就出现全身怕冷，困倦思睡，脉沉细，显然是寒邪直接侵入少阴经，与提纲证基本符合。因此，笔者不受以往同一诊断和治疗方案的束缚，而采用方证对应法，投用麻黄附子细辛汤以温经解表。但考虑到患者年老体虚，且发病已3天，恐怕发汗过多损伤正气，所以不用生麻黄而用炙麻黄，再加炙甘草以扶助正气。处方：炙麻黄10克，熟附片15克（先煎半小时），北细辛6克，炙甘草6克。服用1剂后，并无汗出，但全身怕冷、困倦欲眠等症状渐渐消失，精神转佳。随访1年未复发。可见方证对应法，实为准确运用麻黄附子细辛汤的一条捷径。
2. 病机推求法
《黄帝内经》要求医者“谨慎地把握病机，各司其所属，有的病机要探究，没有的病机也要探究”。而“谨慎把握病机”的前提是准确地推求病机，即在尽可能详尽地审查疾病和察看病症，完整地占有四诊（望、闻、问、切）资料的基础上，通过由此及彼、由表及里的归纳概括，分析综合，最后作出病机诊断，以利于选择高效方药。如前所述，在《伤寒论》中，麻黄附子细辛汤证的基本病机是心肾阳虚，复感寒邪，表里同病。这是就外感时令病而言。如果是内伤杂病，其基本病机则为阳虚寒凝。实践证明，临证时只要细心体察，准确地推求出这样的病机并不困难。然而在四诊资料不全时（病人函诊时经常遇到），就比较麻烦了。例如，《中国乡村医生》1993年第7期刊出拙文《左小腿剧痛25天》之后，于9月初收到江苏省张家港市化肥厂卫生所范医生的来信称：其妻右膝关节疼痛多年（有右膝外伤史10余年），经X光摄片，诊断为“右副韧带损伤伴胫骨上端轻度骨质增生”。该市一医院曾动员其手术治疗，但患者已44岁，估计手术效果欠佳，便予以封闭治疗。因经常复发，特函诊求服中药。笔者读信数遍，茫然无从下手，连拟数方，皆不中意。不得已勉力从俗，寄去习用治疗久痹（慢性风湿痹痛）的桂枝芍药知母汤加活血通络药物；并告知四诊资料不全，无法推求病机以明确中医诊断，希望补充相关信息。范氏于10月13日来信说：服药6剂乏效。患者双下肢酸重，局部肿胀，压痛明显，右膝肌肉轻度萎缩，近2天因参加田间劳动，顿觉行走不便……中医四诊：面色少华，舌淡红，根部有少量白苔，脉濡缓，痛处喜温怕冷。笔者据此推求其病机可能属于阳虚寒凝，遂寄去重剂麻黄附子细辛汤加味：生麻黄30克，熟附片50克（先煎1小时），北细辛20克，熟地60克。嘱服6剂，范氏于12月30日来信说，“您寄给我的处方，我爱人服后效果很好！共服6剂，右膝疼痛全部消失，同原来一样。经剧烈的体力活动，或劳动亦无任何不适”。又说“经多次病例验证，麻黄附子细辛汤对治疗腰腿痛病例有特效”。所谓“特效”，固为偏激的美誉，但足以说明推求病机法对于遣选高效方药的重要性。而遣方不谙病机，犹如盲人夜行。
3. 体质辨证法
人的体质，禀受于先天，形成于后天。而人禀受五行之气，各有偏重。早在《黄帝内经》上就记载着太阴之人、少阴之人、太阳之人、少阳之人、阴阳和平之人以及木形之人、火形之人、土形之人、金形之人、水形之人的心理、生理、病理特征与治疗宜忌等内容。《伤寒论》上提到的“酒客”（长期饮酒者）、“淋家”（患淋证者）、“疮家”（患疮疡者）、“衄家”（易鼻出血者）、“亡血家”（失血者）等，亦属于体质辨证的范畴。历代医家大多重视体质辨证，如近代名医张锡纯关于体质辨证的论说更为确切具体，且经得起临床验证。他在《医学衷中参西录》中写道，“外感之邪侵袭人体，恒视人体之禀赋为转移，有如时气之流行，受病者或同室同时，而其病之偏凉偏热，或迥有不同。盖人脏腑素有积热者，外感触动之则其热益甚；其素有积寒者，外感触动之则其寒益甚也”。而麻黄附子细辛汤证的体质病理便是素体阳虚。故笔者治疗风寒外感，常存一“素体阳虚”之念于胸中，使麻黄附子细辛汤大有用武之地。例如1991年冬治疗一男性患者，47岁。其人反复感冒1个月余，曾用过人参败毒散、小柴胡汤、桂枝汤合玉屏风散等，均无显效。就诊时：眠食尚可，能坚持工作。惟下午及晚上背心发冷，头面畏风，流清涕，舌淡红苔薄白，脉稍弱。似无明显阳虚之象，缘何以上方药无显效呢？细询之，方知其人经常腰痛绵绵，脾胃素畏寒凉，夏季也不敢吃生冷之物，属于阳虚体质无疑。乃投以麻黄附子细辛汤：生麻黄15克，熟附片30克（先煎半小时），北细辛15克。仅服1剂，诸恙霍然。
回忆30年前，笔者在成都读书时，我校刘教授颇善医道，惟自身常年失眠一证，遍用诸方，疗效平平，深以为苦。因闻城里一老中医一年四季治病，无论男女老幼，亦无论所患何病，开手便是麻黄附子细辛汤，竟尔门庭若市，门诊人次逾百，且经年不衰，于是“火神菩萨”声名鹊起，便往一试之。既至，老医令其伸舌，随口吟曰“麻黄附子细辛汤”。助手立即抄方与之。刘教授悻悻然，又转思不妨姑妄从之，遂抓药2剂。不意服完1剂，当夜竟然安睡！笔者因讶其异，曾访问过一些病者。据说此老中医经年累月如此开方，误事者偶尔有之，但有效率仍然很高。至于其观舌之“诀窍”则是：凡舌质不现明显热象者，便一律使用麻黄附子细辛汤。此与明代张介宾治病，凡无热象者便赏用温补药物，岂非如出一辙？笔者附记及此，绝非欣赏这种置四诊八纲的简单化、公式化的所谓“绝招”，只不过是说明麻黄附子细辛汤适应范围广，运用机会多而已。若能讲究临证思维方法，其效必彰！
不思食案
北京中医药大学教授刘兴志
案1
方XX，男，70岁，四川人，干部。患者于1980年7月28日因心窝部疼痛而住某院，入院诊为冠心病、慢性胃炎。因服药效果不显，于1980年7月30日邀中医诊治。询之口淡无味，不思饮食，胃脘疼痛，喜温喜按，恶心便溏，伴有头昏乏力，精神欠充，少气懒言。舌淡红白苔，脉弦。证系中焦虚寒，法当温中散寒，宜理中汤。方中人参、白术、炙甘草补益中气，干姜温中散寒，加广木香、元胡行气止痛。全方共奏振奋阳气，消除阴寒。1980年8月9日二诊：服上方仅2剂脘痛止，精神渐充，还食少纳呆，饮食不馨，舌淡苔白，脉缓无力。系脾胃气虚，健运失司，用健脾开胃香砂六君子汤加焦四仙、草果。1980年8月16日三诊：服上方4剂恶心除，胃中舒适，胸中豁朗，精神爽，思食有味，食量恢复正常每日300-350g(6-7两)，二便调和。携带上方，愈而出院。
学生：老师，患者有冠心病，为何只治中焦脾胃，不治上焦心脏？为何选理中汤？
老师：中焦脾胃乃气血生化之源，病者中焦虚寒，脾不健运而致气血化源匮乏，心失所养，故治在中。《金匮要略·胸痹心痛短气篇》云，“胸痹心中痞，留气结在胸，胸满，胁下逆抢心，枳实薤白桂枝汤主之；人参汤亦主之。”人参汤即理中汤，因其本方具有温运中阳，调理中焦的治疗作用，故取名“理中”，此正合《伤寒论》所云“理中者，理中焦”之意。中阳得运，气血化生之源充足，心有所养，因此抓住中焦论治，就抓住了疾病的根本，内经所谓“治病必求其本”即是这个道理。
案2
刘XX，男，76岁，干部。患者因头昏，不思食，下肢浮肿1周，于1982年7月26日入院。入院诊断为：①脑动脉硬化；②震颤麻痹；③膀胱结石术后；④双下肢浮肿待查。服药效果不理想，而请中医会诊。1982年7月28日患者表现：头昏眼花，下肢浮肿，无力行走，纳呆食少、腹胀，舌淡苔白、脉缓。脉证合参，系阳不化气，水湿停滞。治以温阳化气，利水消肿。方用五苓散加味：肉桂9克，白术15克，茯苓30克，泽泻30克，猪苓15克，陈皮9克，大腹皮10克，炙甘草6克，当归15克，川芎10克。1982年7月31日诊：服上方3剂，浮肿明显消减，余症同前，唯食纳不佳，使患者忧心忡忡，急求开胃以解决饮食问题。故相继投用健脾燥湿、理气和胃之香砂六君子汤和胃风汤等类方治疗，服用10剂腹胀减轻，但仍食欲不馨、纳食少进，且头昏，倦怠无力，大便排泄无力而干，舌淡白水滑，脉沉。
学生：老师，香砂六君子汤及胃风汤是开胃良药，为何患者服药无效？
老师：从一诊得知患者水肿，内停水湿，湿与脾关系极为密切，应该弄清楚脾不健运，胃失受纳，是脾阳虚呢？还是脾气虚？若脾气虚则选用健脾益气，芳香醒胃的香砂六君子汤即可奏效。为何不效？应从湿邪特征分析，湿为阴邪，最伤人阳气，遇寒则凝，得温则化，得阳始运，故当以理中汤温热之剂以助阳温运，犹如“离照发空，阴霾自散”。脾阳久虚，损及肾阳，命火不足，脾失温煦，故加附子、肉桂补火以助脾运，脾阳得运则胃能受纳。附方如下：附子30克（先煮30分钟，不麻为度），肉桂6克（另兑），党参15克，白术15克，干姜10克，炙甘草6克，当归9克，茯苓15克。1982年8月13日诊：服温肾回阳，健脾益气之剂，果然奏效。患者知饥，饮食顿增，头脑清晰，大便爽快，肢肿亦消，已能下床行走。上方得效，加陈皮9克，续服3剂，渴望速效。1982年8月21日诊：患者饮食如常人，精神振，诸恙若失，上方连服6剂愈而出院。
案3
梁XX，男，65岁，演员，北京人。患者于1980年9月4日因心痛短气汗出而入院，经治心痛缓解，汗出止，但服西药后脘腹饱闷不舒、纳呆便溏、厌食油腻，口干尿多，舌红苔白，脉弦。服西药助消化药无效，又服健脾益气、养阴和胃之六君于汤，人参健脾丸（汤）加麦冬、乌梅、鸡内金、炒谷麦芽，健脾燥湿、解郁消食开胃之平胃散，越鞠保和丸（汤）加焦槟榔、红豆蔻，仍不能取效。于1980年9月17日邀我诊治，观其脉证，知泄下已止，但仍食少纳呆，脘腹饱闷，得矢气及呃逆稍舒，素厌荤腥，口干思冷饮，夜间尤著，甚则令其寤，大便于，舌绛无苔如镜面，脉弦偶见结代。
学生：老师，从这一诊患者的表现阴虚比较明显，为什么前医从健脾燥湿、理气开胃方面论治？您是如何分析？
老师：这就是临床问题的复杂性。前医生诊视病人时，症情的反映尚不典型，经过上述治疗阴虚证表现逐渐比较突出了，也不能说前医毫无考虑，在方中加入麦冬、乌梅之类，但认为津液不足是水不化气，津不上承，况且运用上述方法也是治疗不思食的常用治法，而世人胃阳虚者居多。从本案病人具体情况分析，梁XX是X省著名京剧演员，工作繁忙，长期罹患陈旧性心肌梗塞、Ⅲ期高血压、慢性支气管炎，饮食稍有不慎即作泄，因此，患者素体阴虚，木火偏盛，阴津暗耗，乃致胃液不足，导引偏盛之肝阳，克犯阳明。清·叶天士曾提出“胃汁竭，肝风动”、“厥阴之气上千，阳明之气失降”的理论。况胃为阳土，喜润而恶燥，上述所用方药以燥为主，燥则伤津，胃中津液更显不足；肝属风脏，体阴而用阳，故呈现“阳常有余，阴常不足”的特点。叶氏认为“厥阴为风脏，阳明为盛阳”，二者最易缺乏阴液的滋润，相互影响而为病，从而鲜明地提出了脾胃阴虚之肝胃不和的证因。据此理论与现症，本案属肝胃阴虚，胃失和降之证。因肝胃阴虚，则如釜中无水，不能熟谷，故见纳呆。治疗上不宜辛散、温燥之品，宗《内经》“损者益之”，“燥者润之”的治疗原则，选择甘凉、濡润之品滋胃柔肝，这种治法与叶氏所云一致，叶氏云“所谓宜降则和，非用辛开苦降，也非苦寒下夺以损胃气，不过甘乎或甘凉濡润，以养胃阴则津液来复，使之通降而已矣”。试拟一方如下：沙参15克，石斛12克，玉竹10克，白芍10克，郁金10克，甘草6克，佛手6克，菖蒲3克，鸡内金10克，炒稻芽15克，荷叶5克。1980年9月20日诊：服上方3剂，胃纳渐开，睡眠略安，口干减，二便通调，尚觉胃中不舒，继宜甘凉滋润之品，原方加红豆蔻6克，续服3剂。
学生：老师，为何上方效果这样明显，请您讲一讲。
1. Method of Syndrome-Prescription Correspondence
Syndrome-prescription correspondence, also known as syndrome-formula correspondence, formula differentiation, or decoction-syndrome differentiation, is a major characteristic of Zhang Zhongjing's works. Following the principle of syndrome-prescription correspondence, as long as the clinical characteristic symptoms match the descriptions in Zhang Zhongjing's books, classical formulas (Jingfang) can be applied directly, without being restricted by various differentiation methods established in later generations. To put it bluntly, this is essentially repeating the clinical practice of Zhang Zhongjing at that time and can be regarded as a shortcut for applying classical formulas. For example, in March 1992, I treated a 62-year-old male patient from our hospital. The patient suffered from generalized aversion to cold, especially severe in the back, fatigue, and drowsiness, yet difficulty falling asleep when lying down, with the condition persisting for 3 days. The patient was thin, had an aged complexion, had smoked for many years, and suffered from chronic emphysema. Three years prior, a chest X-ray revealed a shadow in the lungs, initially suspected to be a tumor, which disappeared after anti-inflammatory treatment. However, he had fallen ill 3 to 4 times each year for the past 3 years, with symptoms primarily consisting of aversion to cold and somnolence, requiring hospitalization for 0.5 to 1 month each time. Gradual relief was only achieved after repeated intravenous infusions (using antibiotics, vitamins, inosine, etc.) and blood transfusions. Western medicine diagnosed him each time with "emphysema" and "severe cold." Although hospitalization was indicated this time, the patient, recalling the unbearable swelling of his hands during previous infusions, remained traumatized and wished to try traditional Chinese medicine first, planning to be hospitalized only if ineffective. Upon examination: body temperature 36.8°C, listless spirit, drowsiness, fair appetite, pale tongue with thin white coating, and deep, fine pulse. The outline syndrome of Shaoyin disease in the *Treatise on Cold Damage Disorders* (*Shanghan Lun*) states, "The manifestation of Shaoyin disease is a faint and fine pulse, and a desire to sleep." Now, from the onset of the illness, the patient exhibited generalized aversion to cold, drowsiness, and a deep, fine pulse, clearly indicating that cold pathogenic factors had directly invaded the Shaoyin channel, matching the outline syndrome basically. Therefore, not bound by previous identical diagnoses and treatments, I adopted the method of syndrome-prescription correspondence and administered Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite Root, and Asarum Decoction) to warm the channels and resolve the exterior. However, considering the patient's advanced age and deficiency, and that the illness had persisted for 3 days, fearing that excessive sweating might damage healthy Qi, I used processed Ephedra (*Ephedrae Herba Praeparata cum Melle*) instead of raw Ephedra, and added processed Licorice Root (*Glycyrrhizae Radix et Rhizoma Praeparata cum Melle*) to support healthy Qi. Prescription: Processed Ephedra 10g, Prepared Aconite Root 15g (decocted first for half an hour), Northern Asarum 6g, Processed Licorice Root 6g. After one dose, there was no sweating, but symptoms such as generalized aversion to cold and drowsiness gradually disappeared, and the spirit improved. Follow-up for one year showed no recurrence. Thus, the method of syndrome-prescription correspondence is indeed a shortcut for accurately applying Mahuang Fuzi Xixin Tang.
2. Method of Pathogenesis Deduction
The *Inner Canon of the Yellow Emperor* (*Huangdi Neijing*) requires physicians to "carefully grasp the pathogenesis, assign each to its category, investigate what exists, and investigate what does not exist." The prerequisite for "carefully grasping the pathogenesis" is accurately deducing the pathogenesis. This involves comprehensively collecting data from the four diagnostic methods (inspection, auscultation/olfaction, inquiry, palpation) through detailed examination of diseases and symptoms, and then using induction from the particular to the general and from the superficial to the profound, followed by analysis and synthesis, to finally make a pathogenesis diagnosis. This facilitates the selection of highly effective formulas and herbs. As mentioned earlier, in the *Treatise on Cold Damage Disorders*, the basic pathogenesis of Mahuang Fuzi Xixin Tang syndrome is Heart and Kidney Yang deficiency compounded by external cold invasion, involving both interior and exterior levels. This refers to exogenous seasonal diseases. If it concerns endogenous miscellaneous diseases, the basic pathogenesis is Yang deficiency with cold coagulation. Practical experience demonstrates that, provided careful observation, accurately deducing such pathogenesis is not difficult. However, when data from the four diagnostic methods are incomplete (a common occurrence in mail consultations), it becomes more troublesome. For instance, after my article "Severe Pain in the Left Lower Leg for 25 Days" was published in Issue 7, 1993 of *China Rural Doctor*, in early September, I received a letter from Dr. Fan of the Health Clinic at the Fertilizer Factory in Zhangjiagang City, Jiangsu Province. He stated that his wife had suffered from right knee joint pain for many years (with a history of right knee trauma for over 10 years). An X-ray diagnosis was "right collateral ligament injury accompanied by mild bone hyperplasia at the upper end of the tibia." A local hospital recommended surgery, but given her age of 44 and estimated poor surgical outcome, block therapy was chosen. Due to frequent recurrences, she sought herbal medicine via mail consultation. After reading the letter several times, I felt at a loss and drafted several prescriptions, none of which satisfied me. Reluctantly following convention, I sent Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony Root, and Anemarrhena Decoction), commonly used for chronic Bi syndrome (chronic rheumatic arthralgia), with added blood-invigorating and collaterals-unblocking herbs; and informed him that due to incomplete diagnostic data, I could not deduce the pathogenesis to clarify the TCM diagnosis, requesting supplementary information. Dr. Fan wrote back on October 13 stating that six doses were ineffective. The patient experienced soreness and heaviness in both lower limbs, local swelling, obvious tenderness, and mild atrophy of the right knee muscles. In the past two days, due to field labor, walking became inconvenient... TCM four diagnostics: sallow complexion, pale red tongue with a small amount of white coating at the root, soggy and slow pulse, preference for warmth and aversion to cold at the painful site. Based on this, I deduced the pathogenesis might belong to Yang deficiency with cold coagulation, and thus sent a heavy-dose modified Mahuang Fuzi Xixin Tang: Raw Ephedra 30g, Prepared Aconite Root 50g (decocted first for 1 hour), Northern Asarum 20g, Prepared Rehmannia Root 60g. Instructed to take six doses. Dr. Fan wrote back on December 30 saying, "The prescription you sent was very effective for my wife! After taking six doses, the right knee pain completely disappeared, just like before. Even after strenuous physical activity or labor, there was no discomfort." He also said, "Verified by multiple cases, Mahuang Fuzi Xixin Tang has a special effect on treating low back and leg pain." The term "special effect" is admittedly an exaggerated compliment, but it suffices to illustrate the importance of the pathogenesis deduction method for selecting highly effective formulas. Prescribing without understanding pathogenesis is like a blind man walking at night.
3. Constitution Differentiation Method
Human constitution is endowed by congenital factors and formed by postnatal factors. Humans inherit the Five Elements, each with specific biases. As early as the *Inner Canon of the Yellow Emperor*, records exist regarding the psychological, physiological, and pathological characteristics, as well as treatment indications and contraindications, of Taiyin persons, Shaoyin persons, Taiyang persons, Shaoyang persons, Yin-Yang balanced persons, Wood-type persons, Fire-type persons, Earth-type persons, Metal-type persons, and Water-type persons. Terms mentioned in the *Treatise on Cold Damage Disorders* such as "wine drinkers," "Lin syndrome patients," "Chuang syndrome patients," "Nu hemorrhage patients," and "Wangxue (blood loss) patients" also fall under the scope of constitution differentiation. Most physicians in history have valued constitution differentiation. For example, the modern famous physician Zhang Xichun's discussions on constitution differentiation are more precise and concrete, and withstand clinical verification. He wrote in *Records of Traditional Chinese Medicine Integrated with Western Medicine*: "Exogenous pathogens invading the human body constantly depend on the person's innate constitution for their transformation, similar to the spread of seasonal qi. Those who fall ill in the same room at the same time may exhibit diseases that are distinctly cool or hot. This is because those whose internal organs have accumulated heat will see their heat intensify when touched by external pathogens; those with accumulated cold will see their cold intensify." The constitutional pathology of Mahuang Fuzi Xixin Tang syndrome is inherent Yang deficiency. Therefore, when treating wind-cold exogenous diseases, I always keep the concept of "inherent Yang deficiency" in mind, allowing Mahuang Fuzi Xixin Tang to play a significant role. For example, in winter 1991, I treated a 47-year-old male patient. He had suffered from recurrent colds for over a month. Previous treatments with Renshen Baidu San (Ginseng and Toxin-Expelling Powder), Xiaochaihu Tang (Minor Bupleurum Decoction), Guizhi Tang combined with Yupingfeng San (Jade Windscreen Powder) were all ineffective. Upon examination: sleep and appetite were acceptable, able to continue working. However, his back felt cold in the afternoon and evening, head and face feared wind, and he had clear nasal discharge. Tongue was pale red with thin white coating, pulse slightly weak. There seemed to be no obvious signs of Yang deficiency. Why were the above prescriptions ineffective? Upon detailed inquiry, I learned that he frequently suffered from lingering lower back pain, his spleen and stomach naturally feared cold and coolness, and he dared not eat raw or cold foods even in summer. He undoubtedly belonged to a Yang deficiency constitution. I therefore prescribed Mahuang Fuzi Xixin Tang: Raw Ephedra 15g, Prepared Aconite Root 30g (decocted first for half an hour), Northern Asarum 15g. After only one dose, all ailments vanished.
Recalling 30 years ago, when I was studying in Chengdu, Professor Liu from my university was quite skilled in medical arts. However, he suffered from chronic insomnia, and despite trying various prescriptions, the efficacy was mediocre, causing him great distress. Hearing that an old TCM doctor in the city treated patients throughout the year, regardless of gender, age, or disease, starting immediately with Mahuang Fuzi Xixin Tang, resulting in bustling business with over a hundred outpatients daily and sustained popularity year-round, earning him the reputation of "Bodhisattva Huoshen" (Fire God), I went to try it. Upon arrival, the old doctor asked him to stick out his tongue and casually recited "Mahuang Fuzi Xixin Tang." The assistant immediately copied the prescription. Professor Liu, somewhat resentful, thought he might as well try it blindly, so he obtained two doses of medicine. Unexpectedly, after finishing one dose, he slept soundly that night! Surprised by this anomaly, I interviewed some patients. It was said that this old doctor prescribed in this manner for years; although mistakes occasionally occurred, the efficacy rate remained high. His "trick" in observing the tongue was: for any tongue quality not showing obvious heat signs, he uniformly used Mahuang Fuzi Xixin Tang. Is this not exactly the same as Zhang Jiebin of the Ming Dynasty, who rewarded warming and tonifying drugs for all cases without heat signs? I record this here not to appreciate such simplistic, formulaic so-called "ultimate skills" that disregard the four diagnostics and eight principles, but merely to illustrate that Mahuang Fuzi Xixin Tang has a wide range of indications and many opportunities for application. If one pays attention to clinical thinking methods, the efficacy will surely be prominent!
Case of Loss of Appetite
Professor Liu Xingzhi, Beijing University of Chinese Medicine
Case 1
Fang XX, Male, 70 years old, from Sichuan, cadre. The patient was admitted to a certain hospital on July 28, 1980, due to epigastric pain. Admission diagnosis: Coronary Heart Disease, Chronic Gastritis. Due to unsatisfactory effects of medication, TCM consultation was invited on July 30, 1980. Inquiry revealed: bland taste in mouth, loss of appetite, epigastric pain, preference for warmth and pressure, nausea, loose stools, accompanied by dizziness, fatigue, lack of mental vigor, shortness of breath, and reluctance to speak. Tongue: pale red with white coating; Pulse: wiry. Syndrome: Deficiency-cold of the Middle Jiao. Treatment principle: Warm the middle and dispel cold. Suitable formula: Lizhong Tang (Regulate the Middle Decoction). In the formula, Ginseng, Atractylodes Macrocephala, and Processed Licorice Root tonify Middle Qi; Dried Ginger warms the middle and dispels cold; Added Aucklandia and Corydalis move Qi and relieve pain. The entire formula jointly stimulates Yang Qi and eliminates Yin cold. Second visit on August 9, 1980: After taking only 2 doses of the above prescription, epigastric pain stopped, spirit gradually recovered, but still poor appetite and food refusal, unappetizing diet, pale tongue with white coating, slow and powerless pulse. Syndrome: Spleen and Stomach Qi deficiency with failure of transportation and transformation. Formula: Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) to invigorate the spleen and open the stomach, plus Charred Four Immortals and Black Cardamom. Third visit on August 16, 1980: After taking 4 doses of the above prescription, nausea ceased, stomach felt comfortable, chest felt clear, spirit refreshed, desire for food returned, appetite normalized to 300-350g (6-7 liang) per day, urination and defecation harmonious. Discharged cured, carrying the prescription.
Student: Teacher, the patient has coronary heart disease. Why treat only the Middle Jiao (Spleen and Stomach) and not the Upper Jiao (Heart)? Why choose Lizhong Tang?
Teacher: The Spleen and Stomach of the Middle Jiao are the source of Qi and Blood generation. The patient's Middle Jiao deficiency-cold causes the Spleen's failure in transportation, leading to a scarcity of Qi and Blood sources, resulting in the Heart losing nourishment. Therefore, treatment focuses on the Middle. The *Essential Prescriptions of the Golden Cabinet* (*Jingui Yaolue*), Chapter on Chest Bi, Heart Pain, and Shortness of Breath, states: "In Chest Bi, there is stagnation in the heart, Qi accumulation in the chest, chest fullness, and rebellious Qi rushing up from below the hypochondrium. Zhishi Xiebai Guizhi Tang (Aurantium, Macrostemon, and Cinnamon Twig Decoction) governs it; Renshen Tang (Ginseng Decoction) also governs it." Renshen Tang is Lizhong Tang. Because this formula has the therapeutic effect of warming and moving Middle Yang and regulating the Middle Jiao, it is named "Lizhong" (Regulate the Middle). This aligns with the statement in the *Treatise on Cold Damage Disorders*: "Lizhong means regulating the Middle Jiao." When Middle Yang is moved and the source of Qi and Blood generation is sufficient, the Heart is nourished. Therefore, grasping the Middle Jiao in treatment grasps the root of the disease. This is the principle stated in the *Inner Canon*: "In treating diseases, one must seek the root."
Case 2
Liu XX, Male, 76 years old, cadre. The patient was admitted on July 26, 1982, due to dizziness, loss of appetite, and lower limb edema for one week. Admission diagnoses: ① Cerebral Arteriosclerosis; ② Parkinsonism; ③ Post-operative Bladder Stone; ④ Bilateral Lower Limb Edema Pending Investigation. Medication effects were unsatisfactory, so TCM consultation was requested. On July 28, 1982, the patient presented with: dizziness and blurred vision, lower limb edema, weakness in walking, poor appetite, abdominal distension, pale tongue with white coating, and slow pulse. Combining pulse and symptoms, the syndrome is Yang failing to transform Qi, with water-dampness stagnation. Treatment: Warm Yang to transform Qi, promote diuresis to reduce edema. Formula: Wuling San (Five-Ingredient Powder with Poria) modified: Cinnamon Bark 9g, Atractylodes Macrocephala 15g, Poria 30g, Alisma 30g, Polyporus 15g, Tangerine Peel 9g, Areca Peel 10g, Processed Licorice Root 6g, Angelica Sinensis 15g, Ligusticum Chuanxiong 10g. Diagnosis on July 31, 1982: After taking 3 doses of the above prescription, edema significantly reduced, other symptoms remained the same, only poor appetite caused the patient great anxiety, urgently seeking to open the stomach to solve dietary problems. Consequently, Xiangsha Liujunzi Tang (Aucklandia and Amomum Six-Gentlemen Decoction) and Weifeng Tang (Stomach Wind Decoction), which invigorate the spleen, dry dampness, regulate Qi, and harmonize the stomach, were sequentially administered. After taking 10 doses, abdominal distension decreased, but appetite remained poor, food intake was low, and dizziness, fatigue, and weak, dry bowel movements persisted. Tongue: pale, white, slippery; Pulse: deep.
Student: Teacher, Xiangsha Liujunzi Tang and Weifeng Tang are good medicines for opening the stomach. Why did the patient not respond effectively?
Teacher: From the first visit, we know the patient had edema and internal water-dampness stagnation. Dampness is closely related to the Spleen. One must determine whether the Spleen's failure in transportation and the Stomach's failure in reception is due to Spleen Yang deficiency or Spleen Qi deficiency. If it were Spleen Qi deficiency, Xiangsha Liujunzi Tang, which invigorates Spleen Qi and awakens the stomach with aromatic properties, would be effective. Why was it ineffective? Analysis should be based on the characteristics of Dampness pathogen. Dampness is a Yin pathogen, most damaging to Yang Qi, congealing with cold, transforming with warmth, and moving only with Yang. Therefore, one should use the warming agent Lizhong Tang to assist Yang and promote movement, like "the sun shining in the sky, dispersing the haze." Long-term Spleen Yang deficiency damages Kidney Yang, leading to insufficient Mingmen Fire and loss of Spleen warming. Thus, Aconite and Cinnamon Bark are added to supplement Fire to assist Spleen transport. When Spleen Yang moves, the Stomach can receive. Supplementary formula: Aconite 30g (boiled first for 30 minutes until numbness disappears), Cinnamon Bark 6g (added separately), Codonopsis 15g, Atractylodes Macrocephala 15g, Dried Ginger 10g, Processed Licorice Root 6g, Angelica Sinensis 9g, Poria 15g. Diagnosis on August 13, 1982: Indeed, the agents warming the Kidney and restoring Yang, invigorating the Spleen and benefiting Qi, were effective. The patient felt hunger, diet increased suddenly, mind became clear, bowel movements were smooth, limb swelling subsided, and he could get out of bed to walk. Adding Tangerine Peel 9g to the effective formula, continued for 3 doses, eager for rapid results. Diagnosis on August 21, 1982: Patient's diet was like normal, spirit revived, all ailments disappeared. Continued taking the formula for 6 doses and was discharged cured.
Case 3
Liang XX, Male, 65 years old, actor, from Beijing. The patient was admitted on September 4, 1980, due to heart pain, shortness of breath, and sweating. After treatment, heart pain relieved, sweating stopped. However, after taking Western medicine, he experienced epigastric and abdominal fullness and discomfort, poor appetite, loose stools, aversion to greasy food, dry mouth, and polyuria. Tongue: red with white coating; Pulse: wiry. Western digestive aids were ineffective. Subsequently, Liujunzi Tang (Six-Gentlemen Decoction) to invigorate the Spleen and benefit Qi, nourish Yin, and harmonize the Stomach, Ren Shen Jian Pi Wan/Tang (Ginsen Strengthen Spleen Pill/Decoction) plus Ophiopogon, Mume Fruit, Chicken Gizzard Lining, and Fried Grain Sprouts, Pingwei San (Calm the Stomach Powder) to invigorate the Spleen, dry dampness, resolve depression, digest food, and open the stomach, Yueju Baohe Wan/Tang (Yueju Harmonize Interior Pill/Decoction) plus Charred Areca Nut and Red Cardamom, still failed to achieve efficacy. Invited me for consultation on September 17, 1980. Observing pulse and symptoms, knowing diarrhea had stopped, but still poor appetite, epigastric and abdominal fullness, slightly relieved by flatus and hiccups, naturally averse to meat and fish, dry mouth desiring cold drinks, worse at night, even disturbing sleep, dry large bowel movements, crimson tongue without coating like a mirror, pulse wiry occasionally presenting knotted and intermittent beats.
Student: Teacher, from this visit, the patient's Yin deficiency appears quite obvious. Why did previous doctors treat from the perspective of invigorating the Spleen, drying dampness, regulating Qi, and opening the stomach? How do you analyze this?
Teacher: This is the complexity of clinical issues. When previous doctors examined the patient, the symptom reflection was not typical. After the aforementioned treatments, Yin deficiency manifestations gradually became more prominent. It cannot be said that previous doctors had no consideration; they added Ophiopogon and Mume Fruit in the formula, believing that insufficient Jin-Ye (body fluids) was due to water failing to transform into Qi and Jin failing to ascend. Moreover, using the above methods is also a common treatment for loss of appetite, and most people suffer from Stomach Yang deficiency. Analyzing the specific situation of this patient, Liang XX is a famous Peking Opera actor from Province X, busy with work, suffering long-term from old myocardial infarction, Stage III hypertension, and chronic bronchitis. Any slight dietary impropriety leads to diarrhea. Therefore, the patient inherently possesses Yin deficiency, with Wood-Fire bias prevailing, secretly consuming Yin-Jin (fluids), leading to insufficient Stomach fluid, guiding the prevailing Liver Yang to attack the Yangming. Qing dynasty's Ye Tianshi proposed theories such as "When Stomach juice is exhausted, Liver wind moves" and "Jueyin Qi rises upward, Yangming Qi fails to descend." Furthermore, the Stomach is Yang Earth, preferring moisture and detesting dryness. The aforementioned prescriptions mainly focused on drying, which injures Jin, making Stomach fluid deficiency even more apparent. The Liver belongs to the Wind organ, having Yin substance and Yang function, thus presenting the characteristic of "Yang often excess, Yin often deficient." Ye believed that "Jueyin is the Wind organ, Yangming is the盛 (abundant) Yang." These two are most prone to lacking Yin fluid nourishment, affecting each other to cause disease, thereby vividly proposing the syndrome etiology of Liver-Stomach disharmony due to Spleen-Stomach Yin deficiency. Based on this theory and current symptoms, this case belongs to Liver-Stomach Yin deficiency with Stomach failing to descend. Due to Liver-Stomach Yin deficiency, it is like a pot without water, unable to cook grains, hence poor appetite. Treatment should avoid acrid-dispersing and warming-drying agents. Following the *Inner Canon* principles of "tonify the deficient" and "moisten the dry," select sweet-cool and moistening agents to nourish the Stomach and soften the Liver. This treatment method is consistent with Ye's words: "What is meant by descending harmony is not using acrid-opening and bitter-descending, nor bitter-cold purging to damage Stomach Qi, but merely sweet or sweet-cool moistening to nourish Stomach Yin, so that Jin-Ye returns, facilitating descending and unblocking." Tentatively prescribing a formula as follows: Glehnia 15g, Dendrobium 12g, Polygonatum Odoratum 10g, White Peony Root 10g, Curcuma Aromatica 10g, Licorice Root 6g, Bergamot 6g, Acorus Tatarinowii 3g, Chicken Gizzard Lining 10g, Fried Rice Sprout 15g, Lotus Leaf 5g. Diagnosis on September 20, 1980: After taking 3 doses of the above prescription, stomach appetite gradually opened, sleep slightly improved, dry mouth reduced, urination and defecation regulated, still feeling gastric discomfort. Continue with sweet-cool and moistening agents. Add Red Cardamom 6g to the original formula, continue for 3 doses.
Student: Teacher, why was the effect of the above prescription so obvious? Please explain.