瞿老强调「治病求本」,他说:「鲧湮洪水,医之禁忌。」并结合自己的临床经验,反复讲述治病必求其本的道理。先生说:「今之医家,不审标本,不论八纲,用补药为病家之所喜,每每错补误温,病者无怨。每见火证必凉,并言热则寒之。不知火之初起,最忌攻泄。火郁当发,以导引为贵。疮疡外症,每用调和气血,后期再吼活瘀通络,不留后患。切不可早用凉法。以寒则涩而不流,温则消而祛之。」瞿老的这些学术见解和经验,对我以后的临床有很大影响。
瞿老对温病的治疗强调宣畅气机,不可一派寒凉。他说「温虽热疾,切不可简单专事寒凉。治温虽有卫、气、营、血之别,阶段不同,方法各异,但必须引邪外出。若不治邪,专事寒凉,气机闭涩,如何透热?又如何转气?轻则必重,重则无法医矣。方书虽有牛黄丸、至宝丹、神犀丹等,但必须用之得当,早则引邪入里,后期正虚之时,又无能运药治病,只有用之得当,才能见效。」瞿老此论,我在临床中体会,正是叶天士「在卫汗之可也」,「到气才能清气」、「入营犹可透热转气」韵含意。
瞿老这一学术恿想贯串在他整个临床实践中。特别是他对跟疾治疗有独特见解和丰富经验。他说;「眼疾治疗不当,多导致瞎。「世人每以耳为火户,当属多热。不知病有新久,新病多热多火,虽是火证亦不可单纯用寒凉之药,因寒则涩而不流,温则消而祛之。」「肝开窍于目,虽为火户,但非宴火也,亦不尽是虚火。肝为藏血之脏,血不足,则肝阴失养,阴不足则阳必亢,亢则主热。热者种类繁多,有圆郁而致者,有因湿阻滞络脉者,有暴怒之后,血瘀气滞者,有外因而引起内伤者……必须详辨,再行施治。俗医见风火赤眼,每用黄连苦寒之极,最遣后患。不知当须先治风热,养血熄风。」其慢性眼疾,瞿老则多从肾水考虑。
一次瞿老治一暴发火眼病人,其眼球突然增大,疼痛难忍。先生谓「郁当散,肝热当清」,以独活、川芎、羚羊角等,一剂病减,继则以龙胆草、大黄等苦泻,又一剂其病若失。
凡郁皆当开。气血痰饮食湿,均可致郁,郁久化火,都是热证,岂可一派寒凉?并言「治热以寒」,遏阻气机,病焉有不复加重之理?瞿老之论,源于《内》、《难》,出之于自己多年实践,用之于临床,每多效验。韩一斋先生(1874~1953),名善长,字一斋,号梦新,北京人。受业于清太医院院判(副院长)李子余,后为太医院御医。先生熟读中医经典,博览群籍,对叶氏温病理论最有心得。擅治内科诸证,对肝病、虚损、血证等均有独到之处。在京行医五十余载,每日门庭若市,活人无算。
1934~1940年,我每日定时去韩老处学习。先生治学严谨,诲人不倦。平时诊余,即指导我们学习,并经常结合临床实践讨论疑难病例。他认为凡志于医者,必须在中医经典著作上打好基础,对《内经》、《难经》、《金匮》、《伤寒》、《本草经》等书,皆须熟读精通,后博览历代医家著述,勤学必须多思,既要领会其意,又要举一反三。他尝兑:「熟读经典,博览群籍,贵精善悟,于无文处求文,无字处求字,得其弦外之音,旨外之旨,阴阳在握,玄妙在心,庶几寡过。」在临证中,先生教导我们要细诊详参,权衡病情,立法选药,要合乎规矩,且要灵活应变,师古而不泥古,才能出奇制胜。他说:「事无定体,治有定理,制方必本权衡规矩。虽先圣示我以法,教我以方,当不离于古,不泥于古,以病为务。」
先生治病,重视肝郁。因肝为藏血之脏,体阴而用阳,其在志为怒,怒易伤肝。故一般情志不遂,多导致肝郁。郁久或从阳化,或从阴化,两者不同,治宜区别。
肝气横逆,易于克脾犯胃。证见胸胁刺痛、暖噫不舒、烦躁不宁、不欲饮食、脉象弦急,治宜疏肝理气。肝气郁结,脾土受克,又有挟湿,挟食、挟痰之别。挟湿则宜宣郁化湿,挟食则宜开郁消食,挟痰则宜行气化痰。
肝郁久化火,火性炎上,其面红而热,头晕耳呜,口干口苦,恶心泛呕,便结溲赤,甚则舌绛脉弦实有力,宜苦寒泄肝折热之法。
肝阳。为肝气上逆,冲犯清窍,头晕耳鸣,甚则络脉失和四肢麻术,胸腹胀满呕逆,急烦不宁,脉多弦劲有力,宜平肝镇逆。
若从阴化,则表现为肝体方面,有阴虚肝热和郁热化火伤阴引起血虚风动。
阴虚肝热则心烦失眠,急躁口渴,舌红而千,脉弦急细数,治宜清肝育阴。
若郁热化火伤阴,络脉失莽,四肢瘦疵,脉弦小细数,则宜养血柔肝熄风宁络。
先生治疗虚损,必分阴阳、别五脏、论气血、顾脾胃,并考虑母于生克关系。阳虚多见外寒,总从维护阳气入手}阴虚每见内热,必用益水制火之法。
先生治血证,主张降逆化瘀。他认为凡血证暴吐势猛,稠粘结块者多属热,清稀零星、过劳即发者多属虚;血色深紫光滑者多属热,黑暗浊晦或_炎淡稀者多属不足}面唇红赤,舌绛且干,脉细数者属热,面黄唇淡,肢冷不温,脉迟缓虚软者为虚。血随气行,若气虚则血无以固,热郁气迫则血妄行。先生认为血证见犬实太热者甚少,苟若属实,吐血日久,未有不伤及气【血者,又何能言其为实证。所以先生说:「治血证以降逆为本,不可独持苦寒泄热,恐其邪热不净,留阻为瘀,此乃寒则涩而不流,温则消而去之之理。」
先生治病,必详审病情,细别标本,升降补泻,常兼顾并用。标本皆虚者,当补』标本皆实者,宜泻。其有标实而本虚或标虚而本实者,必须详审细察,权衡急缓,或舍标从本,或舍本从标。先生日:「几降者,必先升,但升者不使过高,降者宜求其缓。降其蕴邪,驱其滞热,升其不足,以补其正,斯为得之。」先生认为升降宜适度,若升之太过,易使其虚热上越,而致跌仆晕厥。久病虚弱者,用通降法时尤应注意使其缓和稳妥为要,防其病去正伤。先生说;「若久病正气大虚,当须用补,但因内蕴积滞,攻补不易,必须审察标本虚实,采用兼顾并筹之法,灵活运用,多能取效。』随先生学习时,每见重病,正虚邪实,攻补两难,他医束手,先生屡用此法,速取趣效。
汪逢春先生(1882~1948),名朝甲,号风椿,苏州人,吴门望族也。悬壶北京五十年。先生博学多才,善书能文,勤学苦读,毅力过人。受业于昊中名医艾步蟾老先生之门。精究医学,焚膏继咎,三更不辍,泊卒业,复博览群籍,虚怀深求,壮岁游京,述职法曹。。
先生诊疾论病,循规前哲,而应乎气候方土体质,诚谓法古而不泥于古也。每有奇变百出之病,他医束手者,先生则临之自若,手挥目送,条理井然,处方治病,辄取奇效。一九三七至一九四0年,我随先生学习,先生论病处方,每多撮录,兼参以己见,次日先生必亲自圈阅批点。关键之处,多浓笔重点。
如一次治一妇人妊娠三月,患疾喘咳,首方以苏子、莱菔子、杏仁、贝母、枇杷叶等宣肺化痰降逆之品。汪老看后批之日:「苏子降逆力强,胎儿受伤,甚则引起堕坠;莱菔子昧辛性烈,弱人尚不可用,况孕妇乎?」又一次,一猩红热病人,我处方中用了薄荷,饪老批之日;「温疹乃热郁于内,一涌即发,发则无以制止,方中何以还用薄荷?恐其不速耶?」并告诫道:「脉数有力,斑出深紫,高热心烦,咽红肿痛,皆是发出之极矣,切不可再行发之,只宜清气凉营,以缓其速。」
先生每于望朔之日,便令组织同砚小集,受课之余,互相研讨,凡《内》、《难》、《伤寒》、《金匮》等书,皆要求次第理渣。且时于节假之日,携渚弟子,登北海琼岛,假揽翠轩(洼.北海白塔之饭店),杯酒言欢,讲授诸书}或共载一舟荡漾于太渣池(北海)中,l师生同游,其乐无穷。
先生每日患者盈门,活人无算。对湿温伤寒尤有心得,誉为京都四大名医之一。我随汪老学习,结合自已临床体会,将汪老治疗湿温病的经验总结为十法,以体现其学术观点。
(一)芳香宣化法(上焦)暑湿之邪迫于外,湿热秽浊蕴于中,头晕身热,漾漾泛恶,舌苔白腻而滑,胸中气塞,脘闷咳嗽,周身酸沉乏力,小溲黄赤,湿热初起之证,宜芳香宣化法。
鲜佩兰5克(后下),鲜菖蒲5克,大豆卷10克,鲜藿香5克(后下),嫩前胡3克,川郁金6克,自蒺藜、姜竹茹各10克,制厚朴6克,川黄连、通草各3克。
(二)芳香疏解法(上焦)暑湿外受,表气不畅,形寒头晕,周身酸楚,身热肌肤干涩,恶心呕吐,腹中不舒,中脘满闷,脉象濡精,法当芳香疏解,以退热止呕。
佩兰叶12克(后下),广藿香10克(后下),陈香薷5克(后下),大豆卷10克,制厚朴6克,新会皮3克,制半夏10克,苦桔梗、枳壳各6克,白蔻仁5克,煨鲜姜3克,杏仁泥6克,太乙玉枢丹1克(研细分冲)。
(三)芳香化浊法(上、中焦)暑热湿滞,互阻中焦,身热泛恶,呕吐痰水,胸闷腹中阵痛,大便欲泄未得,心烦急躁,两目有种,舌苔白腻,口干不欲饮水。用芳香化浊法定呕降逆折热。
鲜佩兰10克(后下),藿香(后下)、制厚朴各6克,半夏曲12克,川黄连3克,大腹皮、佛手各10克,煨姜3克,保和丸12克(布包),焦麦芽10克,赤苓12克,上落水沉香末、白蔻仁末各l克。后二味共研装胶囊分两次随药送下。
(四)轻扬宣解法(上、中焦)暑湿蕴热,互阻肺胃,身热头晕,咳嗽痰多,两脉弦滑略数,按之濡软。热在肺胃,法宜宣解,湿浊中阻,叉需轻扬。香豆豉12克,炒山栀6克,嫩前胡3克,像贝母12克,杏仁泥10克,枇杷叶12克(布包),保和丸15克(布包),鲜芦根30克。
(五)宣肃疏化法(上、中焦)暑湿热郁,蕴阻肺胃,咳嗽痰多,胸中满闷,苔黄垢厚,大便不通,小溲赤黄,可用宣肃上焦,疏化畅中法。
前胡3克,像贝母12克,杏仁10克,香豆豉12克(布包),山栀3克,炙杷叶12克,黄芩10克,保和丸15克,枳壳3克,焦麦芽10克。
(六)轻宣清化法(上、中焦)暑热偏多,湿邪略少,身热咳嗽,汗出口干,意欲凉饮,舌红苔黄,脉象细弦,用清解暑热,清宣化湿法。
薄荷细枝2克(后下),佩兰叶10克(后下),连翘、『炙杷叶各12克,白蒺藜10克,前胡3克,杏仁10克,川贝母5克(研冲),鲜荷叶1角,益元散12克,鲜西瓜翠衣30克。
(七)辛开苦降法(中焦)湿热病,热郁中州,湿阻不化,头晕且胀,胸闷周身酸楚,漾漾泛恶,苔白滑腻,大便不畅,小溲黄赤,辛香开郁以利三焦,苦以降热兼燥其湿,少佐淡渗分消。
白蒺藜10克,佩兰叶12克(后下),自芷3克(后下),半夏、杏仁各D克,黄芩12克,黄连3克(研冲),炒苡米12克,白蔻仁2克,赤苓、滑石各12克。
(八)宣化通腑法(中、下焦)暑挟湿滞,互阻不化,小便艰涩,大便不通,上则恶心呕吐,下则腹胀矢气,宜宣化降逆,展气通腑,一方两法,兼顾胃肠。
鲜佩兰12克(后下),鲜藿香6克(后下),香豆豉12克,山栀、新会皮各5克,佛手片、摈榔、杏仁各10克,前胡6克,通草、煨姜各3克,酒军0.5克,太乙玉枢丹克。后两昧共研装胶囊分两次用佛手片10克、煨姜3克煎汤送下,药先服。
(九)泄化余邪、轻通胃肠法(中、下焦)湿温后期,身热已退,症状大轻,余热未除,湿热积滞退而未净,大便不通,腑气不畅,腹中不舒,苔腻根黄厚,用本法泄化余邪而通其胃肠。
白蒺藜10克,粉丹皮6克,香青蒿4克,枳实S克,鲜杷叶12克,保和丸15克(包),垒瓜蒌30克,知母6克,炒苡米12克,山楂炭、杏仁各10克,茵陈12克,白蔻仁末O.6克,生大黄末1克。后二味共研细,装胶囊分两次汤药进下。
(十)泄化余邪,甘润和中(中,下焦)湿温初愈,邪退不净,中阳来复,阴分亦虚,运化欠佳,胃纳不馨,周身乏力,舌胖而淡,脉多濡滑缓弱,用泄化余邪,甘润和中法,以善其后,病势向愈,饮食寒暖,切当留意。
川石斛12克,丹皮6克,香青蒿4克,甜杏仁10克,范志曲12克,鸡内金10克,冬瓜子20克,茯苓皮15克,生熟谷麦芽各12克,香砂枳术丸15克(布包)。
跟韩、汪老的临床学习,奠定了我临床的基础。
四祖国医学,作为一门科学,它来源于实践,而且经受了实践的检验,也必定将在实践中提高。掌握了基础理论,为临床打下了基础,但对基础理论的运用、加深理解和学术水平的提高,又必须通过临床实践。下面我通过对几个具体问题的认识,进一步说明之。
瞿老强调“治病求本”的原则,他说:“鲧用堵塞的方法治理洪水,是医学上的禁忌。”结合自己的临床经验,他反复阐述治病必须探求根本的道理。先生说:“现在的医生,不审察标本关系,不辨析八纲(阴阳、表里、寒热、虚实),因为患者喜欢补药,就随意使用补药,常常错误地进补或误用温法,而病人并不怨恨。每当见到火证(实热证)就用凉药,并声称‘热者寒之’。却不知道火证初起时,最忌讳攻下泄利。火郁结应当发散,以引导透达为贵。对于疮疡等外部病症,初期常用调和气血的方法,后期再用活血通络之法,以免留下后患。切不可过早使用寒凉方法。因为寒性凝滞会导致气血涩滞不通,温性则能消散瘀滞并祛除病邪。”瞿老的这些学术见解和经验,对我后来的临床实践产生了很大影响。
瞿老在治疗温病时强调宣畅气机,反对一味使用寒凉药物。他说:“温病虽然是热性疾病,但切不可简单地专门使用寒凉药。治疗温病虽然有卫分、气分、营分、血分的区别,阶段不同,方法各异,但必须引导病邪外出。如果不治邪气,专门使用寒凉药,会导致气机闭涩,如何能透发热邪?又如何能转化气机?轻症必转重,重症则无法医治了。医书中虽有牛黄丸、至宝丹、神犀丹等方剂,但必须使用得当。用得过早会引邪入里,用在正气虚弱的后期,又无力运化药力治病,只有使用得当,才能见效。”我对瞿老的这一论述在临床中体会,正是叶天士所说的“在卫分之汗可解”,“到气分才能清气”,“入营分犹可透热转气”的含义。
瞿老的这一学术思想贯穿在他整个临床实践中。特别是他对眼疾的治疗有独特的见解和丰富的经验。他说:“眼疾治疗不当,多导致失明。世人常认为耳朵是火的门户,应该属于多热。却不知道疾病有新久之分,新病多热多火,即使是火证也不可单纯使用寒凉药物,因为寒性凝滞会导致气血涩滞不通,温性则能消散瘀滞并祛除病邪。‘肝开窍于目’,虽然眼睛是火的门户,但并非全是实火,也不尽然是虚火。肝是藏血的脏器,血不足,则肝阴失去滋养,阴不足则阳气必然亢盛,亢盛则主热。热的种类繁多,有因郁结而致的,有因湿邪阻滞络脉的,有因暴怒之后血瘀气滞的,有因外因而引起内伤的……必须详细辨别,然后再进行治疗。庸俗的医生见到风火赤眼,每用黄连这种极苦寒的药物,最容易遗留后患。不知道应当先治疗风热,养血熄风。”对于慢性眼疾,瞿老则多从肾水(肾阴)的角度考虑。
有一次,瞿老治疗一位突发火眼的病人,其眼球突然增大,疼痛难忍。先生认为“郁结当散,肝热当清”,使用了独活、川芎、羚羊角等药物,一剂后病情减轻,继而又用了龙胆草、大黄等苦寒泻下之品,又一剂后病若失。
凡是郁结都应当开通。气、血、痰、食、饮、湿均可导致郁结,郁久化火,都是热证,岂可一味使用寒凉药?并说“以寒治热”,会遏阻气机,病焉有不复加重的道理?瞿老的论述,源于《内经》、《难经》,出自自己多年的实践,应用于临床,每每多有疗效。韩一斋先生(1874~1953),名善长,字一斋,号梦新,北京人。师从清代太医院院判(副院长)李子余,后来成为太医院御医。先生熟读中医经典,博览群书,对叶氏温病理论最有心得。擅长治疗内科各种病症,对肝病、虚损、血证等均有独到之处。在北京行医五十多年,每天门庭若市,救活的人无数。
1934~1940年,我每天定时去韩老处学习。先生治学严谨,诲人不倦。平时诊余,便指导我们学习,并经常结合临床实践讨论疑难病例。他认为凡立志从医者,必须在中医经典著作上打好基础,对《内经》、《难经》、《金匮要略》、《伤寒论》、《神农本草经》等书,都必须熟读精通,然后博览历代医家著述,勤学必须多思,既要领会其意,又要举一反三。他曾说:“熟读经典,博览群书,贵在精研善于领悟,在无文字处求文字,在无字处求字义,得其弦外之音,旨外之意,把握阴阳,玄妙在心,这样才能少有过失。”在临证中,先生教导我们要细诊详参,权衡病情,立法选药,要合乎规矩,且要灵活应变,师法古人而不拘泥于古人,才能出奇制胜。他说:“事物没有固定的形态,治疗有固定的原理,制方必须基于权衡规矩。虽然先圣示我以法,教我以方,应当不离于古,不泥于古,以治病为务。”
先生治病,重视肝郁。因为肝是藏血的脏器,体阴而用阳,其在志为怒,怒易伤肝。所以一般情志不遂,多导致肝郁。郁久或从阳化,或从阴化,两者不同,治疗宜区别对待。
肝气横逆,易于克脾犯胃。证见胸胁刺痛、嗳气不舒、烦躁不宁、不欲饮食、脉象弦急,治宜疏肝理气。肝气郁结,脾土受克,又有挟湿、挟食、挟痰之别。挟湿则宜宣郁化湿,挟食则宜开郁消食,挟痰则宜行气化痰。
肝郁久化火,火性炎上,其面红而热,头晕耳鸣,口干口苦,恶心泛呕,便结溲赤,甚则舌绛脉弦实有力,宜苦寒泄肝折热之法。
肝阳上亢,为肝气上逆,冲犯清窍,头晕耳鸣,甚则络脉失和四肢麻木,胸腹胀满呕逆,急烦不宁,脉多弦劲有力,宜平肝镇逆。
若从阴化,则表现为肝体方面,有阴虚肝热和郁热化火伤阴引起血虚风动。
阴虚肝热则心烦失眠,急躁口渴,舌红而干,脉弦急细数,治宜清肝育阴。
若郁热化火伤阴,络脉失养,四肢抽搐,脉弦小细数,则宜养血柔肝熄风宁络。
先生治疗虚损,必分阴阳、别五脏、论气血、顾脾胃,并考虑母子生克关系。阳虚多见外寒,总从维护阳气入手;阴虚每见内热,必用益水制火之法。
先生治血证,主张降逆化瘀。他认为凡血证暴吐势猛,稠粘结块者多属热,清稀零星、过劳即发者多属虚;血色深紫光滑者多属热,黑暗浊晦或淡稀者多属不足;面唇红赤,舌绛且干,脉细数者属热,面黄唇淡,肢冷不温,脉迟缓虚软者为虚。血随气行,若气虚则血无以固,热郁气迫则血妄行。先生认为血证见大实大热者甚少,苟若属实,吐血日久,未有不伤及气血者,又何能言其为实证。所以先生说:“治血证以降逆为本,不可独恃苦寒泄热,恐其邪热不净,留阻为瘀,此乃寒则涩而不流,温则消而去之之理。”
先生治病,必详审病情,细别标本,升降补泻,常兼顾并用。标本皆虚者,当补;标本皆实者,宜泻。其有标实而本虚或标虚而本实者,必须详审细察,权衡急缓,或舍标从本,或舍本从标。先生曰:“凡降者,必先升,但升者不使过高,降者宜求其缓。降其蕴邪,驱其滞热,升其不足,以补其正,斯为得之。”先生认为升降宜适度,若升之太过,易使其虚热上越,而致跌仆晕厥。久病虚弱者,用通降法时尤应注意使其缓和稳妥为要,防其病去正伤。先生说:“若久病正气大虚,当须用补,但因内蕴积滞,攻补不易,必须审察标本虚实,采用兼顾并筹之法,灵活运用,多能取效。”随先生学习时,每见重病,正虚邪实,攻补两难,他医束手,先生屡用此法,速取奇效。
汪逢春先生(1882~1948),名朝甲,号风椿,苏州人,吴门望族也。悬壶北京五十年。先生博学多才,善书能文,勤学苦读,毅力过人。受业于吴中名医艾步蟾老先生之门。精究医学,焚膏继晷,三更不辍,既卒业,复博览群籍,虚怀深求,壮岁游京,述职法曹。
先生诊疾论病,循规前哲,而应乎气候方土体质,诚谓法古而不泥于古也。每有奇变百出之病,他医束手者,先生则临之自若,手挥目送,条理井然,处方治病,辄取奇效。一九三七至一九四0年,我随先生学习,先生论病处方,每多撮录,兼参以己见,次日先生必亲自圈阅批点。关键之处,多浓笔重点。
如一次治一妇人妊娠三月,患疾喘咳,首方以苏子、莱菔子、杏仁、贝母、枇杷叶等宣肺化痰降逆之品。汪老看后批之日:“苏子降逆力强,胎儿受伤,甚则引起堕坠;莱菔子味辛性烈,弱人尚不可用,况孕妇乎?”又一次,一猩红热病人,我处方中用了薄荷,汪老批之日:“温疹乃热郁于内,一涌即发,发则无以制止,方中何以还用薄荷?恐其不速耶?”并告诫道:“脉数有力,斑出深紫,高热心烦,咽红肿痛,皆是发出之极矣,切不可再行发之,只宜清气凉营,以缓其速。”
先生每于望朔之日,便令组织同砚小集,受课之余,互相研讨,凡《内》、《难》、《伤寒》、《金匮》等书,皆要求次第理清。且时于节假之日,携诸弟子,登北海琼岛,假揽翠轩(位于北海白塔之饭店),杯酒言欢,讲授诸书;或共载一舟荡漾于太液池(北海)中,师生同游,其乐无穷。
先生每日患者盈门,活人无算。对湿温伤寒尤有心得,誉为京都四大名医之一。我随汪老学习,结合自己临床体会,将汪老治疗湿温病的经验总结为十法,以体现其学术观点。
(一) 芳香宣化法(上焦)暑湿之邪迫于外,湿热秽浊蕴于中,头晕身热,漾漾泛恶,舌苔白腻而滑,胸中气塞,脘闷咳嗽,周身酸沉乏力,小溲黄赤,湿热初起之证,宜芳香宣化法。
鲜佩兰5克(后下),鲜石菖蒲5克,大豆卷10克,鲜藿香5克(后下),嫩前胡3克,川郁金6克,白蒺藜、姜竹茹各10克,制厚朴6克,川黄连、通草各3克。
(二) 芳香疏解法(上焦)暑湿外受,表气不畅,形寒头晕,周身酸楚,身热肌肤干涩,恶心呕吐,腹中不舒,中脘满闷,脉象濡缓,法当芳香疏解,以退热止呕。
佩兰叶12克(后下),广藿香10克(后下),陈香薷5克(后下),大豆卷10克,制厚朴6克,新会皮3克,制半夏10克,苦桔梗、枳壳各6克,白蔻仁5克,煨鲜姜3克,杏仁泥6克,太乙玉枢丹1克(研细分冲)。
(三) 芳香化浊法(上、中焦)暑热湿滞,互阻中焦,身热泛恶,呕吐痰水,胸闷腹中阵痛,大便欲泄未得,心烦急躁,两目有神,舌苔白腻,口干不欲饮水。用芳香化浊法定呕降逆折热。
鲜佩兰10克(后下),藿香(后下)、制厚朴各6克,半夏曲12克,川黄连3克,大腹皮、佛手各10克,煨姜3克,保和丸12克(布包),焦麦芽10克,赤苓12克,上落水沉香末、白蔻仁末各1克。后二味共研装胶囊分两次随药送下。
(四) 轻扬宣解法(上、中焦)暑湿蕴热,互阻肺胃,身热头晕,咳嗽痰多,两脉弦滑略数,按之濡软。热在肺胃,法宜宣解,湿浊中阻,又需轻扬。香豆豉12克,炒山栀6克,嫩前胡3克,象贝母12克,杏仁泥10克,枇杷叶12克(布包),保和丸15克(布包),鲜芦根30克。
(五) 宣肃疏化法(上、中焦)暑湿热郁,蕴阻肺胃,咳嗽痰多,胸中满闷,苔黄垢厚,大便不通,小溲赤黄,可用宣肃上焦,疏化畅中法。
前胡3克,象贝母12克,杏仁10克,香豆豉12克(布包),山栀3克,炙杷叶12克,黄芩10克,保和丸15克,枳壳3克,焦麦芽10克。
(六) 轻宣清化法(上、中焦)暑热偏多,湿邪略少,身热咳嗽,汗出口干,意欲凉饮,舌红苔黄,脉象细弦,用清解暑热,清宣化湿法。
薄荷细枝2克(后下),佩兰叶10克(后下),连翘、炙杷叶各12克,白蒺藜10克,前胡3克,杏仁10克,川贝母5克(研冲),鲜荷叶1角,益元散12克,鲜西瓜翠衣30克。
(七) 辛开苦降法(中焦)湿热病,热郁中州,湿阻不化,头晕且胀,胸闷周身酸楚,漾漾泛恶,苔白滑腻,大便不畅,小溲黄赤,辛香开郁以利三焦,苦以降热兼燥其湿,少佐淡渗分消。
白蒺藜10克,佩兰叶12克(后下),白芷3克(后下),半夏、杏仁各10克,黄芩12克,黄连3克(研冲),炒苡米12克,白蔻仁2克,赤苓、滑石各12克。
(八) 宣化通腑法(中、下焦)暑挟湿滞,互阻不化,小便艰涩,大便不通,上则恶心呕吐,下则腹胀矢气,宜宣化降逆,展气通腑,一方两法,兼顾胃肠。
鲜佩兰12克(后下),鲜藿香6克(后下),香豆豉12克,山栀、新会皮各5克,佛手片、槟榔、杏仁各10克,前胡6克,通草、煨姜各3克,酒军0.5克,太乙玉枢丹1克。后两味共研装胶囊分两次用佛手片10克、煨姜3克煎汤送下,药先服。
(九) 泄化余邪、轻通胃肠法(中、下焦)湿温后期,身热已退,症状大轻,余热未除,湿热积滞退而未净,大便不通,腑气不畅,腹中不舒,苔腻根黄厚,用本法泄化余邪而通其胃肠。
白蒺藜10克,粉丹皮6克,香青蒿4克,枳实5克,鲜杷叶12克,保和丸15克(包),全瓜蒌30克,知母6克,炒苡米12克,山楂炭、杏仁各10克,茵陈12克,白蔻仁末0.6克,生大黄末1克。后二味共研细,装胶囊分两次汤药进下。
(十) 泄化余邪,甘润和中(中、下焦)湿温初愈,邪退不净,中阳来复,阴分亦虚,运化欠佳,胃纳不馨,周身乏力,舌胖而淡,脉多濡滑缓弱,用泄化余邪,甘润和中法,以善其后,病势向愈,饮食寒暖,切当留意。
川石斛12克,丹皮6克,香青蒿4克,甜杏仁10克,范志曲12克,鸡内金10克,冬瓜子20克,茯苓皮15克,生熟谷麦芽各12克,香砂枳术丸15克(布包)。
跟随韩、汪老的临床学习,奠定了我临床的基础。
祖国医学,作为一门科学,它来源于实践,而且经受了实践的检验,也必定将在实践中提高。掌握了基础理论,为临床打下了基础,但对基础理论的运用、加深理解和学术水平的提高,又必须通过临床实践。下面我通过对几个具体问题的认识,进一步说明之。
Old Master Qu emphasized the principle of "seeking the root in treating diseases." He stated, "Gun's method of blocking floods is a taboo in medicine." Combining his own clinical experience, he repeatedly expounded on the rationale that treating diseases must seek their root cause. He said, "Current physicians often fail to examine the relationship between the root and branch (biao-ben), nor do they differentiate according to the Eight Principles (Yin-Yang, Exterior-Interior, Cold-Heat, Deficiency-Excess). Because patients prefer tonics, they indiscriminately use tonifying medicines, often making errors by wrongly tonifying or misusing warming methods, yet the patients bear no resentment. Whenever a 'fire syndrome' (excess heat syndrome) is seen, cool/cold medicines are invariably used, with the claim that 'heat should be treated with cold.' However, they do not realize that at the onset of fire syndromes, purgative and draining methods are most contraindicated. When fire is constrained, it should be dispersed; guiding and venting is paramount. For external conditions such as sores and ulcers, harmonizing Qi and Blood is commonly used initially, followed by activating Blood and unblocking collaterals in the later stage to prevent sequelae. One must absolutely avoid using cooling methods too early. This is because cold causes stagnation and impedes flow, whereas warmth dissipates stasis and dispels pathogenic factors." These academic insights and experiences of Old Master Qu had a significant impact on my subsequent clinical practice.
Regarding the treatment of warm diseases (Wen Bing), Old Master Qu emphasized the importance of promoting the free flow of Qi mechanism and opposed the indiscriminate use of cold/cooling drugs. He said, "Although warm diseases are heat-related illnesses, one must not simply and exclusively rely on cold/cooling medicines. Although the treatment of warm diseases differs according to the Wei (Defensive), Qi, Ying (Nutritive), and Xue (Blood) levels, with different stages and methods, the essential requirement is to guide the pathogen outwards. If one fails to treat the pathogen and relies solely on cold/cooling medicines, the Qi mechanism will become closed and obstructed. How can heat be vented? How can Qi be transformed? Mild cases will inevitably worsen, and severe cases may become incurable. Although medical texts contain formulas such as Niuhuang Wan (Calculus Bovis Pill), Zhibao Dan (Precious Treasure Pill), and Shenxi Dan (Divine Dew Pill), they must be used appropriately. Using them too early may draw the pathogen inward; using them when Zheng Qi (Upright Qi) is deficient in the late stage renders the body unable to transport and transform the medicinal power. Only when used correctly can they be effective." My understanding of this discourse by Old Master Qu in clinical practice aligns precisely with Ye Tianshi's concepts: "Sweating is appropriate for the Wei level," "Clearing Heat is appropriate once the Qi level is reached," and "Even upon entering the Ying level, it is still possible to vent Heat and transform Qi."
This academic thought permeated Old Master Qu's entire clinical practice. In particular, he had unique insights and rich experience in treating eye diseases. He stated, "Improper treatment of eye diseases often leads to blindness. People generally consider the ears as the 'gate of fire,' assuming they are prone to heat. However, one must not ignore whether the disease is new or chronic. New diseases are often characterized by heat and fire. Even if it is a fire syndrome, one cannot purely use cold/cooling medicines, because cold causes stagnation and impedes flow, whereas warmth dissipates stasis and dispels pathogenic factors. The Liver opens into the eyes. Although the eyes are a 'gate of fire,' they are not necessarily filled with excess fire, nor are they entirely deficient fire. The Liver is the organ that stores Blood. When Blood is insufficient, Liver Yin loses nourishment; when Yin is insufficient, Yang becomes hyperactive. Hyperactivity generates heat. There are many types of heat: some arise from constraint/stagnation, some from Dampness obstructing the collaterals, some from Blood stasis and Qi stagnation following violent anger, and some from external pathogens causing internal injury... Detailed differentiation is required before treatment. Quack doctors seeing wind-fire red eyes often use Huanglian (Coptidis Rhizoma), which is extremely bitter and cold, easily leaving behind harmful consequences. They fail to realize that one should first treat Wind-Heat and nourish Blood to extinguish Wind." For chronic eye diseases, Old Master Qu often considered the issue from the perspective of Kidney Water (Kidney Yin).
Once, Old Master Qu treated a patient suffering from a sudden onset of "fire eye" (acute conjunctivitis), where the eyeballs suddenly enlarged and pain was unbearable. The Master stated, "Constraint must be scattered, Liver Heat must be cleared." He prescribed Duohuo (Angelicae Pubescentis Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), and Lingyangjiao (Saiga Tataricae Cornu). After one dose, the condition improved. Subsequently, he used Longdancao (Gentianae Radix) and Dahuang (Rhei Radix et Rhizoma), bitter-cold purgatives. After another dose, the illness disappeared.
All constraints must be opened. Qi, Blood, Phlegm, Food, Fluids, and Dampness can all lead to constraint. Prolonged constraint transforms into fire, resulting in heat syndromes. How can one rely entirely on cold/cooling medicines? He also stated that "treating heat with cold" suppresses the Qi mechanism, leading inevitably to worsening of the disease. Old Master Qu's theories originated from the *Neijing* (Inner Canon) and *Nanjing* (Classic of Difficult Issues), were derived from his own years of practice, and applied clinically, yielding frequent efficacy. Mr. Han Yizhai (1874–1953), whose given name was Shanchang, courtesy name Yizhai, and pseudonym Mengxin, was from Beijing. He studied under Li Ziyu, Vice President of the Imperial Medical Bureau during the Qing Dynasty, and later became an Imperial Physician. Mr. Han was well-versed in TCM classics and widely read, showing particular expertise in Ye Tianshi's warm disease theory. He specialized in internal medicine, offering unique approaches to liver diseases, deficiency consumptions, and blood disorders. Practicing in Beijing for over fifty years, his clinic was bustling daily, and he saved countless lives.
From 1934 to 1940, I visited Old Master Han regularly for study. Mr. Han was rigorous in scholarship and tireless in teaching. During breaks from consultations, he guided our studies and frequently discussed difficult cases combined with clinical practice. He believed that anyone aspiring to be a physician must build a solid foundation in TCM classics. Works such as the *Neijing*, *Nanjing*, *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), *Shanghan Lun* (Treatise on Cold Damage), and *Shennong Bencao Jing* (Divine Farmer's Materia Medica) must be memorized and mastered thoroughly. Afterwards, one should extensively read the works of physicians from past dynasties. Diligent study requires much thinking: one must grasp the meaning and apply it flexibly. He once said, "Memorize the classics, read widely, value precision and good comprehension. Seek meaning where there is no text, seek characters where there are no words. Understand the music beyond the strings and the intent beyond the message. Hold Yin and Yang in hand, keep mysteries in heart, and thus you will rarely err." In clinical practice, he taught us to examine carefully, weigh the condition, establish treatment principles and select herbs according to rules, while remaining flexible. We must follow ancient methods without being bound by them to achieve unexpected victories. He said, "Things have no fixed form, but treatment has fixed principles. Formulating prescriptions must be based on weighing and measuring. Although the sages showed us laws and taught us formulas, we should not depart from antiquity, nor be rigidly bound by it. Our focus must be on curing the disease."
Mr. Han valued treating Liver Constraint (Gan Yu). Since the Liver stores Blood, its substance is Yin but its function is Yang, and its emotion is anger. Anger easily injures the Liver. Therefore, general emotional frustration often leads to Liver Constraint. Prolonged constraint may transform via Yang or via Yin; these two differ, and treatment should distinguish between them.
If transforming via Yang, it manifests in Liver function, presenting as Liver Qi Stagnation, Liver Fire, or Liver Yang Rising.
Liver Qi rebelling horizontally easily attacks the Spleen and Stomach. Symptoms include stabbing pain in the chest and hypochondrium, belching with discomfort, irritability and restlessness, loss of appetite, and a wiry and rapid pulse. Treatment should soothe the Liver and regulate Qi. If Liver Qi constraint affects the Spleen Earth, it may be complicated by Dampness, Food Retention, or Phlegm. With Dampness, disperse constraint and transform Dampness; with Food, open constraint and digest food; with Phlegm, move Qi and resolve Phlegm.
If Liver constraint persists and transforms into Fire, Fire nature flares upward. Symptoms include facial redness and heat, dizziness and tinnitus, dry mouth and bitter taste, nausea and vomiting, constipation and dark urine. Severe cases present with crimson tongue and wiry, full, and forceful pulse. Bitter-cold methods should be used to drain Liver Heat.
Liver Yang Rising occurs when Liver Qi rebels upward, attacking clear orifices. Symptoms include dizziness and tinnitus, and in severe cases, disharmony of collaterals leading to numbness in limbs, abdominal distension, vomiting, irritability, and restlessness. The pulse is often wiry, strong, and forceful. Calming the Liver and subduing rebellion is indicated.
If transforming via Yin, it manifests in Liver substance, presenting as Yin Deficiency with Liver Heat, or constraint-heat transforming into fire injuring Yin, causing Blood Deficiency generating Wind.
Yin Deficiency with Liver Heat presents with vexation, insomnia, irritability, thirst, crimson and dry tongue, and wiry, rapid, thin, and fine pulse. Clearing Liver Heat and nourishing Yin is indicated.
If constraint-heat transforms into fire injuring Yin, and collaterals lose nourishment, causing limb spasms/twitching and a wiry, small, thin, and rapid pulse, nourishing Blood, softening the Liver, extinguishing Wind, and calming collaterals is indicated.
When treating deficiency consumptions, Mr. Han always differentiated Yin and Yang, distinguished the Five Zang organs, discussed Qi and Blood, protected the Spleen and Stomach, and considered the generating and controlling relationships between mother and child organs. Yang Deficiency often manifests as exterior cold; treatment always starts from protecting Yang Qi. Yin Deficiency often manifests as interior heat; treatment must employ replenishing Water to control Fire.
For blood disorders, Mr. Han advocated descending rebellion and resolving stasis. He believed that acute, vigorous bleeding with thick, clotted blood usually indicates Heat; thin, sporadic bleeding triggered by overwork usually indicates Deficiency. Deep purple, smooth blood indicates Heat; dark, turbid, or pale/thin blood indicates insufficiency. Red face and lips, crimson and dry tongue, fine and rapid pulse indicate Heat; yellow face and pale lips, cold limbs, slow and weak pulse indicate Deficiency. Blood follows Qi; if Qi is deficient, Blood cannot be contained; if Heat constrains and Qi forces, Blood flows recklessly. Mr. Han believed that blood disorders rarely present with extreme Excess and Heat. Even if it appears Excess, prolonged hematemesis inevitably injures Qi and Blood, so how can it be called an Excess syndrome? Thus, he said, "Treating blood disorders, descending rebellion is fundamental. Do not rely solely on bitter-cold heat-draining herbs, lest residual heat remain and obstruct as stasis. This follows the principle: 'Cold causes stagnation and impedes flow, warmth dissipates and removes.'"
In treating diseases, Mr. Han meticulously examined the condition, carefully distinguished root and branch, and often combined ascending/descending and tonifying/draining methods. If both root and branch are deficient, tonification is needed; if both are excess, draining is indicated. For cases where branch is excess but root is deficient, or vice versa, careful examination is required to weigh urgency. One may abandon the branch to treat the root, or abandon the root to treat the branch. He said, "Whenever descending, one must first ascend, but ascent should not be excessive; descent should be gradual. Descend accumulated pathogens, drive away stagnant heat, ascend what is lacking, and tonify upright Qi. This is correct." He believed ascending and descending should be moderate. Excessive ascent may cause deficient heat to float upward, leading to fainting or collapse. For chronically ill and weak patients using descending methods, gentleness and stability are crucial to prevent damage to Zheng Qi after the pathogen is removed. He said, "If Zheng Qi is severely deficient due to chronic illness, tonification is necessary. However, due to internal accumulation and stagnation, tonifying and draining are difficult. One must examine root and branch, deficiency and excess, adopt a method of simultaneous consideration, and use flexibility. Efficacy is often achieved." During my studies with him, I often saw critical cases where Zheng Qi was deficient and pathogens were excess, making tonification and draining difficult, leaving other physicians helpless. Mr. Han frequently used this method to achieve rapid results.
Mr. Wang Fengchun (1882–1948), whose given name was Zhaojia, pseudonym Fengchun, was from Suzhou, belonging to a prominent Wu family. He practiced in Beijing for fifty years. He was learned and talented, skilled in calligraphy and literature, diligent in study, and possessed extraordinary perseverance. He studied under Ai Buchan, a famous physician in Wu, refined his medical knowledge day and night without stopping until graduation, then extensively read various books with humility and deep inquiry. In his prime, he went to Beijing and served in the legal sector.
In diagnosing and discussing diseases, Mr. Wang followed the precedents of former sages but adapted to climate, geography, and constitution. This truly means following antiquity without being bound by it. For bizarre and complex diseases that left other physicians helpless, he remained calm, organized his thoughts clearly, and prescribed remedies that often yielded miraculous effects. From 1937 to 1940, I studied under him. He often recorded his discussions on diseases and prescriptions, adding his own comments. The next day, he would personally review and annotate them. Key points were heavily marked.
For example, once he treated a woman three months pregnant who suffered from asthma and cough. The initial prescription included Su Zi (Perillae Fructus), Laifuzi (Radish Seed), Xingren (Apricot Seed), Beimu (Fritillariae Bulbus), and Pipaye (Loquat Leaf) to diffuse Lung Qi, resolve Phlegm, and descend rebellious Qi. After reviewing it, Old Master Wang annotated: "Su Zi has strong descending power, which may injure the fetus and even cause miscarriage. Laifuzi is pungent and fierce in nature; it is unsuitable even for weak individuals, let alone pregnant women." Another time, for a scarlet fever patient, I used Bohe (Menthae Haplocalycis Herba) in the prescription. Old Master Wang annotated: "Warm rashes involve Heat constrained internally. Once erupted, it cannot be stopped. Why use Bohe in the formula? Are you afraid it won't erupt quickly?" He warned, "A rapid and forceful pulse, deep purple spots, high fever with vexation, swollen and painful throat—all indicate the peak of eruption. Do not attempt to erupt further. Only clearing Qi-level Heat and cooling Ying-level Heat to slow the process is appropriate."
On the days of the full moon and new moon, Mr. Wang would organize gatherings for fellow students. After lessons, we would discuss mutually. For classics like the *Neijing*, *Nanjing*, *Shanghan Lun*, and *Jingui Yaolue*, he required us to clarify them sequentially. On holidays, he would take disciples to climb Qionghua Island in Beihai Park, staying at Lan Cui Xuan (a restaurant near the White Pagoda in Beihai), enjoying wine and conversation while lecturing on various books. Or we would sail together on Taiye Pool (Beihai Lake), enjoying endless joy as teachers and students toured together.
Patients filled his door daily, saving countless lives. He had particular insights into Damp-Warmth and Cold Damage, earning him a place among the Four Famous Physicians of Beijing. Studying under Old Master Wang and combining it with my clinical experience, I summarized his experience in treating Damp-Warmth diseases into ten methods to reflect his academic viewpoints.
(1) Aromatic Diffusion and Transformation Method (Upper Jiao): Summer-Heat and Dampness attack externally, while Damp-Heat and turbid pathogens accumulate internally. Symptoms include dizziness, fever, nausea, white greasy and slippery tongue coating, chest oppression, epigastric fullness and cough, whole-body soreness and fatigue, and dark yellow urine. For early-stage Damp-Heat, the Aromatic Diffusion and Transformation Method is suitable.
Fresh Peilan (Eupatorii Herba) 5g (added later), Fresh Changpu (Acori Tatarinowii Rhizoma) 5g, Da Dou Juan (Sojae Semen Praeparatum) 10g, Fresh Huoxiang (Agastaches Herba) 5g (added later), Nen Qianhu (Peucedani Radix) 3g, Chuan Yujin (Curcumae Radix) 6g, Bai Jili (Tribuli Fructus) and Jiang Zhuru (Bambusae Caulis in Taeniam) 10g each, Zhi Houpo (Magnoliae Officinalis Cortex) 6g, Chuan Huanglian (Coptidis Rhizoma) and Tongcao (Tetrapanacis Medulla) 3g each.
(2) Aromatic Release Method (Upper Jiao): Summer-Dampness acquired externally, causing poor surface Qi flow. Symptoms include aversion to cold, dizziness, whole-body soreness, fever with dry skin, nausea, vomiting, abdominal discomfort, epigastric fullness, and soggy pulse. The method should be aromatic release to reduce fever and stop vomiting.
Peilan Ye (Eupatorii Folium) 12g (added later), Guang Huoxiang (Agastaches Herba) 10g (added later), Chen Xiangru (Moslae Herba) 5g (added later), Da Dou Juan (Sojae Semen Praeparatum) 10g, Zhi Houpo (Magnoliae Officinalis Cortex) 6g, Xin Hui Pi (Citri Reticulatae Pericarpium) 3g, Zhi Banxia (Pinelliae Rhizoma Preparatum) 10g, Ku Jiegeng (Platycodonis Radix) and Zhi Ke (Aurantii Fructus Immaturus) 6g each, Bai Kou Ren (Amomi Fructus Rotundus) 5g, Wei Xianjiang (Zingiberis Rhizoma Recens) 3g, Xingren Ni (Armeniacae Semen Amarum) 6g, Taiyi Yushu Dan (Taiyi Jade Pill) 1g (ground finely and taken separately).
(3) Aromatic Turbidity-Resolving Method (Upper and Middle Jiao): Summer-Heat and Damp-Stagnation mutually obstruct the Middle Jiao. Symptoms include fever, nausea, vomiting of phlegm-water, chest tightness and intermittent abdominal pain, urge to defecate but unsuccessful, vexation and irritability, bright eyes, white greasy tongue coating, and dry mouth without desire to drink. Use the Aromatic Turbidity-Resolving Method to stabilize vomiting, descend rebellion, and reduce heat.
Fresh Peilan (Eupatorii Herba) 10g (added later), Huoxiang (Agastaches Herba) (added later) and Zhi Houpo (Magnoliae Officinalis Cortex) 6g each, Banxia Qu (Pinelliae Fermentatum) 12g, Chuan Huanglian (Coptidis Rhizoma) 3g, Dafupi (Arecae Pericarpium) and Foshou (Citri Sarcodactylis Fructus) 10g each, Wei Jiang (Zingiberis Rhizoma Recens) 3g, Baohe Wan (Harmonize the Pill) 12g (wrapped in cloth), Jiao Maiya (Hordei Fructus Germinatus Carbonisatus) 10g, Chi Ling (Poria cum Ligno Rubrum) 12g, Shangluo Chenxiang Mo (Aquilariae Lignum Resinatum) and Bai Kou Ren Mo (Amomi Fructus Rotundus Powder) 1g each. The last two are ground together, filled into capsules, and taken twice with the decoction.
(4) Light Ascending Diffusion Method (Upper and Middle Jiao): Summer-Dampness accumulates heat, mutually obstructing Lung and Stomach. Symptoms include fever, dizziness, cough with profuse phlegm, wiry-slippery-slightly-rapid pulses, soft upon pressure. Heat in Lung and Stomach requires diffusion; Damp-Turbidity obstructing the middle requires light ascending action. Xiang Douchi (Sojae Semen Preparatum) 12g, Chao Shanzhi (Gardeniae Fructus) 6g, Nen Qianhu (Peucedani Radix) 3g, Xiang Beimu (Fritillariae Thunbergii Bulbus) 12g, Xingren Ni (Armeniacae Semen Amarum) 10g, Pipaye (Loquat Leaf) 12g (wrapped in cloth), Baohe Wan (Harmonize the Pill) 15g (wrapped in cloth), Fresh Lugeng (Phragmitis Rhizoma) 30g.
(5) Diffusing, Purging, and Dispersing Method (Upper and Middle Jiao): Summer-Heat-Dampness constraint accumulates and obstructs Lung and Stomach. Symptoms include cough with profuse phlegm, chest fullness, yellow-greasy-thick tongue coating, constipation, and dark yellow urine. Diffusing and purging the Upper Jiao and dispersing-transforming the Middle Jiao is applicable.
Qianhu (Peucedani Radix) 3g, Xiang Beimu (Fritillariae Thunbergii Bulbus) 12g, Xingren (Armeniacae Semen Amarum) 10g, Xiang Douchi (Sojae Semen Preparatum) 12g (wrapped in cloth), Shanzhi (Gardeniae Fructus) 3g, Zhi Pa Ye (Loquat Leaf) 12g, Huangqin (Scutellariae Radix) 10g, Baohe Wan (Harmonize the Pill) 15g, Zhi Ke (Aurantii Fructus Immaturus) 3g, Jiao Maiya (Hordei Fructus Germinatus Carbonisatus) 10g.
(6) Light Diffusion and Clearing Method (Upper and Middle Jiao): More Summer-Heat, less Dampness. Symptoms include fever, cough, sweating, dry mouth, desire for cold drinks, red tongue with yellow coating, and fine-wiry pulse. Clearing Summer-Heat and diffusing-transforming Dampness is indicated.
Bohe Xi Zhi (Menthae Haplocalycis Herba) 2g (added later), Peilan Ye (Eupatorii Folium) 10g (added later), Lianqiao (Forsythiae Fructus) and Zhi Pa Ye (Loquat Leaf) 12g each, Bai Jili (Tribuli Fructus) 10g, Qianhu (Peucedani Radix) 3g, Xingren (Armeniacae Semen Amarum) 10g, Chuan Beimu (Fritillariae Cirrhosae Bulbus) 5g (ground and taken separately), Fresh Heye (Nelumbinis Folium) 1 corner, Yi Yuan San (Benefit Origin Powder) 12g, Fresh Xigua Cuiyi (Citrulli Lanati Pericarpium) 30g.
(7) Pungent Opening and Bitter Descending Method (Middle Jiao): Damp-Heat disease, Heat constrained in the Middle, Dampness obstructed and not transforming. Symptoms include dizziness and distension, chest tightness, whole-body soreness, nausea, white slippery-greasy tongue coating, poor bowel movement, and dark yellow urine. Pungent aromatics open constraint to benefit the Triple Burner; bitter herbs descend heat and dry Dampness; lightly add bland diuretics to separate and eliminate.
Bai Jili (Tribuli Fructus) 10g, Peilan Ye (Eupatorii Folium) 12g (added later), Baizhi (Angelicae Dahuricae Radix) 3g (added later), Banxia (Pinelliae Rhizoma) and Xingren (Armeniacae Semen Amarum) 10g each, Huangqin (Scutellariae Radix) 12g, Huanglian (Coptidis Rhizoma) 3g (ground and taken separately), Chao Yimi (Coicis Semen) 12g, Bai Kou Ren (Amomi Fructus Rotundus) 2g, Chi Ling (Poria cum Ligno Rubrum) and Huashi (Talcum) 12g each.
(8) Diffusion and Bowel-Unblocking Method (Middle and Lower Jiao): Summer-Heat with Damp-Stagnation mutually obstructs and does not transform. Symptoms include difficult urination, constipation, upper nausea/vomiting, lower abdominal distension and flatulence. Diffusion, descending rebellion, expanding Qi, and unblocking the bowels are indicated. One formula, two methods, attending to both Stomach and Intestines.
Fresh Peilan (Eupatorii Herba) 12g (added later), Fresh Huoxiang (Agastaches Herba) 6g (added later), Xiang Douchi (Sojae Semen Preparatum) 12g, Shanzhi (Gardeniae Fructus) and Xin Hui Pi (Citri Reticulatae Pericarpium) 5g each, Foshou Pian (Citri Sarcodactylis Fructus) and Binglang (Arecae Semen) and Xingren (Armeniacae Semen Amarum) 10g each, Qianhu (Peucedani Radix) 6g, Tongcao (Tetrapanacis Medulla) and Wei Jiang (Zingiberis Rhizoma Recens) 3g each, Jiu Jun (Rhei Radix et Rhizoma prepared with wine) 0.5g, Taiyi Yushu Dan (Taiyi Jade Pill) 1g. The last two are ground together, filled into capsules, and taken twice with decoction of Foshou Pian 10g and Wei Jiang 3g. Take the medicine first.
(9) Draining Remaining Pathogens and Lightly Unblocking Intestines Method (Middle and Lower Jiao): Late stage of Damp-Warmth, fever has subsided, symptoms greatly relieved, residual heat remains, Damp-Heat accumulation has retreated but not cleared. Constipation, poor bowel Qi flow, abdominal discomfort, greasy tongue coating with yellow-thick root. Use this method to drain remaining pathogens and unblock intestines.
Bai Jili (Tribuli Fructus) 10g, Fen Danpi (Moutan Cortex) 6g, Xiang Qinghao (Artemisiae Annuae Herba) 4g, Zhishi (Aurantii Fructus Immaturus) 5g, Fresh Pa Ye (Loquat Leaf) 12g, Baohe Wan (Harmonize the Pill) 15g (wrapped), Quan Gualou (Trichosanthis Fructus) 30g, Zhimu (Anemarrhenae Rhizoma) 6g, Chao Yimi (Coicis Semen) 12g, Shanzhutan (Crataegi Fructus Carbonisatus) and Xingren (Armeniacae Semen Amarum) 10g each, Yichen (Copris) 12g, Bai Kou Ren Mo (Amomi Fructus Rotundus Powder) 0.6g, Sheng Dahuang Mo (Rhei Radix et Rhizoma Powder) 1g. The last two are ground finely, filled into capsules, and taken twice with the decoction.
(10) Draining Remaining Pathogens and Sweet-Moistening Harmonizing Method (Middle and Lower Jiao): Early recovery from Damp-Warmth, pathogens retreated but not fully cleared, Middle Yang recovering, Yin aspect also deficient, poor transportation, poor appetite, whole-body fatigue, fat and pale tongue, soggy-slippery-slow-weak pulse. Use draining remaining pathogens and sweet-moistening harmonizing method to conclude treatment. As the condition improves, pay attention to diet and warmth.
Chuan Shihu (Dendrobii Caulis) 12g, Danpi (Moutan Cortex) 6g, Xiang Qinghao (Artemisiae Annuae Herba) 4g, Tian Xingren (Armeniacae Semen Amarum) 10g, Fan Zhi Qu (Medicated Leaven) 12g, Ji Neijin (Galli Gigerii Endothelium Corneum) 10g, Donggua Zi (Benincasae Semen) 20g, Fuling Pi (Poria Cum Cortice) 15g, Sheng Shu Gu Mai Ya (Hordei Fructus Germinatus) 12g each, Xiang Sha Zhi Zhu Wan (Xiangsha Zhizhu Pill) 15g (wrapped in cloth).