烧咳伤阴经闭
李××，女，廿九岁，住昆明市沙朗巷。1936年春。
初诊：病经数月，始因烧热咳嗽，服发散、止咳及敛肺之方而症不减，寒热往来，月经闭止，咳嗽不宣，痰凝。后又复感风寒，头疼身痛，再进滋阴解表及止咳退热剂，仍无效验。
症见两颧发赤，形体消瘦，恶寒、潮烧，头疼身痛，喉干口燥，胸痛。大便秘，小便短黄。月经停闭四月，时感腰楚腹痛。诊脉右浮弦兼滑数，左细弦，尺部沉涩。舌质红，苔黄燥。
此虽烧咳日久，肝肺之阴及气血受损，冲任失调，但少阳证未罢。因本内经“急则治标”法拟和解、宣肺。然后再议调理冲任气血。处方：
醋炒柴胡6克 醋法夏9克 炒黄芩6克 生杭芍9克 楚
薄荷6克 光杏仁9克 苏梗片9克 生甘草3克嫩生姜
2片小红枣11枚 二剂
二诊：右脉弦滑而数，左细弦，尺部滞涩，苔仍黄燥。
恶寒较减，潮烧未退，头目眩晕，余症如前。此病久阴虚，气血两亏，缓图调治，嘱服下方三剂。
醋炙别甲12克 银柴胡9克 醋炒青蒿6克 炒黄芩6克
醋法夏9克 光杏仁6克 苏梗6克 炒知母4．5克 嫩生
姜2片小红枣9个鲜京竹叶20为引
三诊：恶寒已罢，潮烧亦减，两颧仍赤，手足心热，口燥思饮。夜卧不宁，咳嗽痰凝，食少，身软无力，微汗。诊脉右滑数，左细弦。苔黄少津。此少阳之邪渐解，肝肺郁热未清，气弱阴虚。再拟下方：
醋炙别甲12克 银柴胡9克 细生地12克 粉丹皮4．5克
地骨皮9克炒杭芍9克大寸冬9克京半夏9克藕干
3克广桔络9克 净杷叶3片
四诊：上方服三剂。脉细弦，尺弱。舌润苔薄。潮烧退，颧微赤，咳嗽胸痛轻减，痰凝渐化。饮食增加，二便转正常。
唯神倦乏力，经闭未行，腰腹时觉酸痛。此系邪热退后，肝肾阴虚，气血不足，冲任失调，以下方调治。
全当归9克 细生地9克赤芍药9克粉丹皮4．5克地骨
皮9克 炙香附6克 川芎片4．5克 白茯苓12克 桑寄生
12克京半夏9克黑小豆12克净杷叶3片
五诊：上方服五剂，诸症悉退，正气未复，经仍未行。
腰楚，少腹时痛。脉细微弦，两尺仍弱，舌淡苔薄。此冲任两虚，经脉气滞之侯，续宜调达滋养。处方：
生熟地各9克 全当归9克 赤芍药9克 川芎片6克粉
丹皮6克炙香附6克紫丹参9克炒续断9克淮牛夕
6克小红枣9枚净杷叶3片 大寸冬9克
六诊：上方进七、八剂后，经行，量少，色紫黑，腰腹微痛。舌红润，脉弱，续拟调和气血以凑全功。处方：
全当归15克细生地9克炒杭芍9克 白茯苓15克老川
芎6克 粉丹皮6克 空沙参9克生口芪12克炒续断9克
炙香附6克 生甘草3克 小枣7个荷叶顶3个 嘱兼服
十珍香附丸
[按]此例患者，病情复杂，本“急则治其标”之旨，首以枢转少阳为主，柴胡、杏、苏，宣疏清化。继拟滋养肝阴，清热理肺，意再枢托。少阳证罢，血弱阴虚内热，乃重滋血齐阴。潮热全退，即为养血调经，气血冲任得养，经讯复来。
内经云：“仅察阴阳所在而调之，以平为期”。妇科机理，错综若斯，在确定其治疗之标本缓急步骤上，必须审慎。
子午潮烧经闭
郑××，女，三十八岁，干部。1970年11月。
初诊：患者病已数月，形体消瘦，呼吸气短，动则喘促，胸胁疼痛，咳嗽痰凝带血。自汗，盗汗，烦躁，夜难入寐。每于子、午时，体温增高，37．5～38。c，手心、足心及两颧烘热。逾时，热如潮退。月经闭止三月。经西医诊断为“肺结核”，多方治疗，其效不显。
诊脉虚滑而数，沉候无力，舌绛，干燥少津。古代医家谓：“虚劳深重者为痨瘵，其形赢败凋敝。”患者因潮烧日久，血虚肺燥，宗气损伤，现痨瘵之征。法当先养阴润肺，化痰止血，继可益气滋血，调达肝脾，循序而进。处方：
醋炙别甲18克 京元参一克 大寸冬9克 醋煅牡蛎12克
地骨皮12克 白茅根30克 炙紫苑9克 炙冬花9克 广桔
络9克 粉丹皮6克 生甘草3克 点梨、藕汁每次各一
匙为引。
二诊：上方服七剂，咯血已减，咳嗽仍频，自汗、盗汗稍敛，食纳略增，渴饮较少，但子午潮热未退。脉舌同前。拟原方化裁。处方：
醋别甲18克 醋青蒿9克 干地黄12克地骨皮15克 白茯
神15克炙冬花9克醋牡蛎15克京半夏9克广桔络9克
生甘草3克 净杷叶3片白茅根15克点梨、藕汁各一
匙。
三诊：上方服七剂，脉虚滑数象渐平，舌绛转红，渐布津液。咯血已止，胸胁痛减，痰凝较涤，自汗、盗汗及潮烧均减。仍以养阴化热，润肺祛痰。处方：
醋别甲15克 干地黄15克 银柴胡9克地骨皮12克 炒杭
芍9克 炙冬花9克粉丹皮6克生甘草3克当归身12克
白薇4．5克 藕干6克净杷叶3片
四诊：上方服十剂，子午潮热大减，自汗、盗汗已收。
胸胁痛止，咳稀痰少，烦躁消除。夜能安卧，食纳增加。但精神尚差，月经未行。脉象细数，舌红润有津。此阴液渐复，肺燥得润，而气血未充，肝脾失调。宜养肝、润肺、调脾为治。处方：
全当归15克炒杭芍9克空沙参9克干地黄12克大寸
冬9克 白茯神15克粉丹皮6克地骨皮12克广桔络9克
桑寄生15克 生甘草3克 藕干6克
五诊：上方连进五剂，子午潮热及烦躁、自汗、盗汗、胸胁痛、咳嗽等诸症消失。脉转细缓，舌苔红润。但病久，阴伤血耗，肝脾失养，冲任不足，至经闭未行。法当益气调血，滋养冲任。血海充盈，经讯可至。
全当归15克 炒杭芍9克 川芎片6克 空沙参9克 干地
黄129克 苏条参12克粉丹皮6克大寸冬9克桑寄生15克
黑小豆15克 建莲子15克 甘草3克 龟鹿胶各9克(烊化兑
服)
六诊：上方服十五剂后，饮食、睡眠尤佳，面色转华，形体渐丰，已能恢复半日工作。脉和，舌润。经讯未至。此大病后，气血真阴渐复，而冲任血海犹亏。再拟下方调理，至1971年春季，经讯复潮，尔后周期正常，结核症悉未再作。处方：
炙口芪15克全当归15克炒杭芍9克 川芎片6克苏条
参15克漂白术12克 西砂仁4．5克 粉丹皮6克 白茯神
15克炙香附6克桑寄生15克 生甘草3克 小红枣11个
[按]久病气血真阴受损，每当子、午阴阳交合之时，邪热相乘，阴不制阳，故现潮烧。热邪耗津，血海干涸，月事闭止。宗气损伤，自汗、盗汗，又复伤阴液。热自阴来，当谧真阴。别甲、元、麦、牡蛎、地黄等皆为滋固肝肾肺阴要药。病退尤虚，再以归、芍、地黄、龟、鹿二胶、参、芪，补其精血，滋益冲任。
虚 痨(童子痨)
董××，男，五岁，住昆明市西郊。时在1940年。
初诊：患儿已病数月，卧床不起，形容枯槁，肌肤消瘦。干咳声嘶，痰中带血。渴饮食少，日晡潮烧，夜间烦躁，自汗盗汗，溺黄便稀。脉虚数无力，左关稍大，右寸兼滑，舌淡红，苔薄少津。病属气弱阴虚，肝旺肺燥，脾不健运，日久症势纠缠。法当养阴清热，润肺、健脾平肝，不宜克散，拟方缓缓调治。
银柴胡6克 醋炒青蒿6克 白茯苓9克 地骨皮9克
空沙参9克 炒杭芍6克 京半夏6克 光杏仁6克 炙冬
花6克 生甘草3克 浮小麦9克小红枣7枚
二诊：上方服五剂，潮热盗汗略减，它症同前。脉、舌尚无变化，仍守原意出入。处方：
广玉竹9克 天门冬9克 炒杭芍6克 白茯苓9克 炙冬
花6克 银柴胡6克 醋炒青蒿4．5克 炙枇杷叶2片黑
小豆9克甘草3克 炙桑皮4．5克 浮小麦12克 小红枣
9枚 白茅根9克
三诊：上方服用十剂，痰血已止。潮烧、盗汗、咳嗽减轻，它症亦有显著好转。但易怒。脉细弦，舌淡红。是阴虚肺燥渐润，脾弱肝旺。再拟滋阴润肺，健脾平肝。处方。
银柴胡6克 苏条参9克 广玉竹9克 天门冬6克 炒杭
芍9克 炙冬花6克 百合6克 浮小麦12克 烧乌梅2个
小红枣7枚
上方连服十余剂，潮热全退，其它症状均渐消失。饮食增加，二便正常。面色转润，肌肤浙充，能下床活动，脉弱缓，舌红润。再为拟方，滋养肝脾，调补气血。
苏条参9克空沙参6克广玉竹6克天门冬6克百合
6克淮山药9克 白茯苓9克 炒杭芍9克 京半夏9克
广陈皮6克炙甘草3克莲子9克(去心) 小红枣7枚
[姚按]这种症候，不宜骤用温补，更不可专事寒凉。应本内经：“燥者濡之”，“损者益之”的道理，先用滋润调达，然后平和补益。具体方法就是平肝、润肺，化痰止咳，养阴清热，健脾固中，后再补益气血。对于潮烧，要重视枢转少阳，调和营卫。兼有虫积，则忌“打虫”，宜用“化虫”之方，以免损伤元气。总之，用药不宜过急过猛，须缓缓调治，方能获得预期疗效。
[按]患儿脏腑娇嫩，况因素日少于荣养，感邪之后，治疗失机，其气留连，而致内伤。一脏先病，累及其它，脾弱阴虚，精气受损，而肝旺肺燥，虚热羁缠。形体赢瘦，即民间俗称“童子痨”也，治之难许速效。是案本内经“燥者濡之，损者益之”，谨守清润调达，平和补益，乃治虚损之要领．
眩 晕(高血压)
外宾××，男，五十六岁。1956年夏。
初诊：患者形体高大肥胖，颜面赤红，平素嗜烟酒，喜肥甘，因自寒带初来我省参加工程设施，由于水土不服，加之工作疲劳，用脑过度，近二、三月来，感头目眩晕，四肢麻木作胀，夜眠不安，多梦易醒，时出自汗，食欲不佳，精神疲乏，影响工作。已经找省医院检查，发现血压升高200／100毫米汞柱，并确诊系神经性高血压。曾服降压、镇静等药多次未见明显效果。一周后，病情更加严重，耳鸣脑响，心神不安。起则昏眩欲仆，终日恍恍然如坐舟中，极度疲乏，已不能坚持工作。有关单位极为重视，延余前往会诊，中西医结合治疗，使之早日恢复健康。
中医辨证：舌质红、苔薄腻，脉象弦滑。证属肝肾不足，阴虚阳方，风火上千，心神不宁，发为眩晕之症。年龄较高，慎防中风，速宜滋阴潜阳，化风舒络，养心安神为治。拟方：
干地黄12克 白茯神15克酸枣皮6克炒泽泻6克粉丹
皮6克炒淮药12克 淮枣仁15克(冲)生石决明9克生龙
骨12克 生杜仲12克 夏枯草6克 荷叶顶3个
嘱尽量控制烟酒腥腻肥甘之物。
二诊：服上方四剂后，血压下降为150／100毫米汞柱，睡眠渐安，自汗收敛，眩晕、耳鸣、脑响等自觉症状豁然若失，且能外出散步。诊脉弦滑而软，舌红润，食欲增加，二便正常。仍以原方加减：
干地黄12克 白茯神15克酸枣皮6克粉丹皮6克炒泽
泻6克 淮枣仁15克(冲) 明天麻9克 石决明9克 桑寄
生15克生龙骨12克生杭芍9克
上方连进八剂，患者血压稳定在130／90毫米汞柱，精神好转，诸症消失，已能恢复工作。
[按]内经云：“诸风掉眩，皆属于肝”。叉云；“肝者，罢极之本也”。本麦惠者，由于肝肾不足，阴虚阳亢，风火上干，心神不宁，导致眩晕。法拟育阴潜阳，方用六味加生龙骨、石决明。以生杜仲、桑寄生、夏枯草、荷叶顶、宣舒肝肾及脑络，天麻熄风，枣仁养心安神，再佐芍药，配伍丹皮、枣皮，酸敛柔肝。不重寒凉而火自平，不专驱散而风自化，体现了祖国医学辨证论治的特点。
肝风虚眩(高血压)
外宾某，男 四十二岁。1964年8月。
初诊：据云平素身体尚可，近来因工作繁重，昼夜书写、审阅文件持续一周之久，未得休息。当工作完成之后，即感头晕、目花 耳鸣，彻夜失眠，心烦食少。经检查，发现电压上压至190／120毫米汞柱。拟定中西医药配合治疗。
中医辨证：机体之肝脏，具贮藏血液、调节血量之功能。当在较长时间思维、精力、视觉等官能高度集中应用于某一事物之上，由此耗散肝经气血。内经云：“肝受血而能视”又云“久视伤血”。肝脏体阴而用阳，当肝血耗散，肝气失濡，致虚风上逆作眩，遂成“血虚生风”诊脉细弦而数，舌质红，苔薄黄。治则本“急者缓之”之意，滋养肝血，兼佐安镇，平熄虚风。处方：
全当归12克炒白芍12克 茯神木15克 大寸冬9克 明天
麻9克 石决明12克炒黑豆15克健莲子15克黑芝麻12克
净竹茹6克 云母石12克(醋煅)(嘱：以玉米须煎汤代水
煨药)
上方浓煎，温服二剂，并配合西药降压、镇静等药治疗。三日后复诊，血压下降至130／90毫米汞柱。患者已能起床活动，头晕、心烦、思饮、便干诸症消除，食眠恢复正常。
脉现和缓，舌质红，苔薄有津。
此属肝血得养，虚风平定，病势向愈。续用滋阴降火丸调理巩固。服法：滋阴降火丸七丸，每日一丸，空腹以温开水送服，连服一周，病痊愈。
[按]正确的治则，来源于正确的诊断，而正确的诊断，必然基于对机体证候客观的病理病机分析。本例肝血耗散，肝气失濡，虚风上逆，干扰清空，而发眩晕。对证投以养血、柔盱、安神、熄风之品，井同西药配合，获效甚捷。
【背景信息】
书名：姚贞白医案 章节：正文(5/20) 类别：医论
烧咳伤阴经闭
患者李××，女性，29岁，居住于昆明市沙朗巷。时间是1936年春季。
初诊：患病已数月，起初因发热咳嗽，服用发散、止咳及敛肺的方剂后症状未减，出现寒热往来（忽冷忽热），月经闭止，咳嗽不畅，痰液凝结。后又感受风寒，出现头痛身痛，再服用滋阴解表及止咳退热的药剂，仍然无效。
症见两颧发红，形体消瘦，恶寒（怕冷）、潮热（定时发热），头痛身痛，咽喉干燥口舌燥渴，胸痛。大便秘结，小便短少色黄。月经停闭四个月，时常感到腰部酸痛腹部疼痛。诊脉右手浮弦兼滑数，左手细弦，尺部沉涩。舌质红，苔黄燥。
此病虽因长期发热咳嗽导致肝肺之阴及气血受损，冲任失调，但少阳证（半表半里之邪）尚未解除。根据《内经》“急则治其标”的原则，拟定和解少阳、宣通肺气的方法。然后再商议调理冲任气血。处方：
醋炒柴胡6克 醋制法半夏9克 炒黄芩6克 生杭白芍9克 薄荷6克 光杏仁9克 苏梗片9克 生甘草3克 嫩生姜2片 小红枣11枚 二剂
二诊：右脉弦滑而数，左手细弦，尺部滞涩，苔仍黄燥。
恶寒较前减轻，潮热未退，头目眩晕，其余症状如前。此病日久致阴虚，气血两亏，宜缓慢图谋调治，嘱咐服用下方三剂。
醋炙鳖甲12克 银柴胡9克 醋炒青蒿6克 炒黄芩6克
醋制法半夏9克 光杏仁6克 苏梗6克 炒知母4.5克 嫩生姜2片 小红枣9个 鲜京竹叶20克为引
三诊：恶寒已罢，潮热亦减，两颧仍赤，手足心热，口燥想喝水。夜间睡眠不安宁，咳嗽痰凝，食欲少，身体软弱无力，微汗。诊脉右手滑数，左手细弦。苔黄少津。此少阳之邪逐渐解除，肝肺郁热未清，气弱阴虚。再拟下方：
醋炙鳖甲12克 银柴胡9克 细生地12克 粉丹皮4.5克
地骨皮9克 炒杭白芍9克 大寸冬9克 京半夏9克 藕干
3克 广桔络9克 净枇杷叶3片
四诊：上方服三剂。脉细弦，尺部弱。舌润苔薄。潮热退去，颧部微赤，咳嗽胸痛减轻，痰凝逐渐化解。饮食增加，二便转正常。
唯独神疲倦怠乏力，经闭未行，腰腹时常觉得酸痛。这是邪热退后，肝肾阴虚，气血不足，冲任失调，以下方调治。
全当归9克 细生地9克 赤芍药9克 粉丹皮4.5克 地骨
皮9克 炙香附6克 川芎片4.5克 白茯苓12克 桑寄生
12克 京半夏9克 黑小豆12克 净枇杷叶3片
五诊：上方服五剂，诸症悉退，正气未复，经血仍未行。
腰部酸痛，少腹时常疼痛。脉细微弦，两尺部仍弱，舌淡苔薄。这是冲任两虚，经脉气滞的候象，继续适宜调达滋养。处方：
生熟地黄各9克 全当归9克 赤芍药9克 川芎片6克 粉
丹皮6克 炙香附6克 紫丹参9克 炒续断9克 淮牛膝
6克 小红枣9枚 净枇杷叶3片 大寸冬9克
六诊：上方进七、八剂后，月经来潮，量少，色紫黑，腰腹微痛。舌红润，脉弱，继续拟定调和气血以完成治疗。处方：
全当归15克 细生地9克 炒杭白芍9克 白茯苓15克 老川
芎6克 粉丹皮6克 空沙参9克 生黄芪12克 炒续断9克
炙香附6克 生甘草3克 小枣7个 荷叶顶3个 嘱咐兼服
十珍香附丸
[按]此例患者，病情复杂，本着“急则治其标”的宗旨，首先以枢转少阳为主，用柴胡、杏仁、苏梗，宣散疏泄清化。接着拟定滋养肝阴，清热理肺，意在再次枢转托举。少阳证罢除，血弱阴虚内热，乃重用滋血齐阴。潮热全退，即为养血调经，气血冲任得到滋养，月经复来。
《内经》说：“仅察阴阳所在而调之，以平为期”。妇科机理，错综如此，在确定其治疗的标本缓急步骤上，必须审慎。
子午潮热经闭
患者郑××，女性，38岁，干部。时间是1970年11月。
初诊：患者患病已数月，形体消瘦，呼吸气短，动则喘促，胸胁疼痛，咳嗽痰凝带血。自汗，盗汗，烦躁，夜间难以入睡。每于子时、午时，体温增高，37.5～38℃，手心、足心及两颧烘热。过一时辰，热如潮水般退去。月经闭止三个月。经西医诊断为“肺结核”，多方治疗，效果不显。
诊脉虚滑而数，沉取无力，舌绛，干燥少津。古代医家说：“虚劳深重者为痨瘵，其形赢败凋敝。”患者因潮热日久，血虚肺燥，宗气损伤，现出痨瘵的征象。治法应当先养阴润肺，化痰止血，继可益气滋血，调达肝脾，循序渐进。处方：
醋炙鳖甲18克 京元参一克 大寸冬9克 醋煅牡蛎12克
地骨皮12克 白茅根30克 炙紫菀9克 炙款冬花9克 广桔
络9克 粉丹皮6克 生甘草3克 点梨、藕汁每次各一
匙为引。
二诊：上方服七剂，咯血已减，咳嗽仍频，自汗、盗汗稍收敛，食纳略增，渴饮较少，但子午潮热未退。脉舌同前。拟原方化裁。处方：
醋鳖甲18克 醋青蒿9克 干地黄12克 地骨皮15克 白茯
神15克 炙款冬花9克 醋牡蛎15克 京半夏9克 广桔络9克
生甘草3克 净枇杷叶3片 白茅根15克 点梨、藕汁各一
匙。
三诊：上方服七剂，脉虚滑数象渐平，舌绛转红，渐布津液。咯血已止，胸胁痛减，痰凝较涤除，自汗、盗汗及潮热均减。仍以养阴化热，润肺祛痰。处方：
醋鳖甲15克 干地黄15克 银柴胡9克 地骨皮12克 炒杭
白芍9克 炙款冬花9克 粉丹皮6克 生甘草3克 当归身12克
白薇4.5克 藕干6克 净枇杷叶3片
四诊：上方服十剂，子午潮热大减，自汗、盗汗已收。
胸胁痛止，咳稀痰少，烦躁消除。夜间能安卧，食纳增加。但精神尚差，月经未行。脉象细数，舌红润有津。此阴液渐复，肺燥得润，而气血未充，肝脾失调。宜养肝、润肺、调脾为治。处方：
全当归15克 炒杭白芍9克 空沙参9克 干地黄12克 大寸
冬9克 白茯神15克 粉丹皮6克 地骨皮12克 广桔络9克
桑寄生15克 生甘草3克 藕干6克
五诊：上方连进五剂，子午潮热及烦躁、自汗、盗汗、胸胁痛、咳嗽等诸症消失。脉转细缓，舌苔红润。但病久，阴伤血耗，肝脾失养，冲任不足，至经闭未行。法当益气调血，滋养冲任。血海充盈，月经可至。
全当归15克 炒杭白芍9克 川芎片6克 空沙参9克 干地
黄129克 苏条参12克 粉丹皮6克 大寸冬9克 桑寄生15克
黑小豆15克 建莲子15克 甘草3克 龟鹿胶各9克(烊化兑
服)
六诊：上方服十五剂后，饮食、睡眠尤佳，面色转华，形体渐丰，已能恢复半日工作。脉和，舌润。月经未至。此大病后，气血真阴渐复，而冲任血海犹亏。再拟下方调理，至1971年春季，月经复潮，尔后周期正常，结核症悉未再作。处方：
炙黄芪15克 全当归15克 炒杭白芍9克 川芎片6克 苏条
参15克 漂白术12克 西砂仁4.5克 粉丹皮6克 白茯神
15克 炙香附6克 桑寄生15克 生甘草3克 小红枣11个
[按]久病气血真阴受损，每当子、午阴阳交合之时，邪热相乘，阴不制阳，故现潮热。热邪耗津，血海干涸，月事闭止。宗气损伤，自汗、盗汗，又复伤阴液。热自阴来，当谧真阴。鳖甲、元参、麦冬、牡蛎、地黄等皆为滋固肝肾肺阴要药。病退尤虚，再以归、芍、地黄、龟、鹿二胶、参、芪，补其精血，滋益冲任。
虚痨(童子痨)
患者董××，男性，5岁，居住于昆明市西郊。时间在1940年。
初诊：患儿已病数月，卧床不起，形容枯槁，肌肤消瘦。干咳声嘶，痰中带血。口渴饮食少，日晡（下午3-5点）潮热，夜间烦躁，自汗盗汗，溺黄便稀。脉虚数无力，左关稍大，右寸兼滑，舌淡红，苔薄少津。病属气弱阴虚，肝旺肺燥，脾不健运，日久症势纠缠。治法应当养阴清热，润肺、健脾平肝，不宜克伐疏散，拟方缓缓调治。
银柴胡6克 醋炒青蒿6克 白茯苓9克 地骨皮9克
空沙参9克 炒杭白芍6克 京半夏6克 光杏仁6克 炙款
冬花6克 生甘草3克 浮小麦9克 小红枣7枚
二诊：上方服五剂，潮热盗汗略减，其他症状同前。脉、舌尚无变化，仍守原意出入。处方：
广玉竹9克 天门冬9克 炒杭白芍6克 白茯苓9克 炙款
冬花6克 银柴胡6克 醋炒青蒿4.5克 炙枇杷叶2片 黑
小豆9克 甘草3克 炙桑皮4.5克 浮小麦12克 小红枣
9枚 白茅根9克
三诊：上方服用十剂，痰血已止。潮热、盗汗、咳嗽减轻，其他症状亦有显著好转。但易怒。脉细弦，舌淡红。是阴虚肺燥渐润，脾弱肝旺。再拟滋阴润肺，健脾平肝。处方：
银柴胡6克 苏条参9克 广玉竹9克 天门冬6克 炒杭
白芍9克 炙款冬花6克 百合6克 浮小麦12克 烧乌梅2个
小红枣7枚
上方连服十余剂，潮热全退，其它症状均渐消失。饮食增加，二便正常。面色转润，肌肤渐充，能下床活动，脉弱缓，舌红润。再为拟方，滋养肝脾，调补气血。
苏条参9克 空沙参6克 广玉竹6克 天门冬6克 百合
6克 淮山药9克 白茯苓9克 炒杭白芍9克 京半夏9克
广陈皮6克 炙甘草3克 莲子9克(去心) 小红枣7枚
[姚按]这种症候，不宜骤用温补，更不可专事寒凉。应本《内经》：“燥者濡之”，“损者益之”的道理，先用滋润调达，然后平和补益。具体方法就是平肝、润肺，化痰止咳，养阴清热，健脾固中，后再补益气血。对于潮热，要重视枢转少阳，调和营卫。兼有虫积，则忌“打虫”，宜用“化虫”之方，以免损伤元气。总之，用药不宜过急过猛，须缓缓调治，方能获得预期疗效。
[按]患儿脏腑娇嫩，况因素日少于荣养，感邪之后，治疗失机，其气留连，而致内伤。一脏先病，累及其它，脾弱阴虚，精气受损，而肝旺肺燥，虚热羁缠。形体赢瘦，即民间俗称“童子痨”也，治之难许速效。是案本《内经》“燥者濡之，损者益之”，谨守清润调达，平和补益，乃治虚损之要领．
眩晕(高血压)
外宾××，男性，56岁。时间是1956年夏季。
初诊：患者形体高大肥胖，颜面赤红，平素嗜烟酒，喜肥甘，因自寒带初来我省参加工程设施，由于水土不服，加之工作疲劳，用脑过度，近二、三月来，感头目眩晕，四肢麻木作胀，夜眠不安，多梦易醒，时出自汗，食欲不佳，精神疲乏，影响工作。已经找省医院检查，发现血压升高200／100毫米汞柱，并确诊系神经性高血压。曾服降压、镇静等药多次未见明显效果。一周后，病情更加严重，耳鸣脑响，心神不安。起则昏眩欲仆，终日恍恍然如坐舟中，极度疲乏，已不能坚持工作。有关单位极为重视，延余前往会诊，中西医结合治疗，使之早日恢复健康。
中医辨证：舌质红、苔薄腻，脉象弦滑。证属肝肾不足，阴虚阳亢，风火上干，心神不宁，发为眩晕之症。年龄较高，慎防中风，速宜滋阴潜阳，化风舒络，养心安神为治。拟方：
干地黄12克 白茯神15克 酸枣皮6克 炒泽泻6克 粉丹
皮6克 炒淮药12克 淮枣仁15克(冲) 生石决明9克 生龙
骨12克 生杜仲12克 夏枯草6克 荷叶顶3个
嘱咐尽量控制烟酒腥腻肥甘之物。
二诊：服上方四剂后，血压下降为150／100毫米汞柱，睡眠渐安，自汗收敛，眩晕、耳鸣、脑响等自觉症状豁然若失，且能外出散步。诊脉弦滑而软，舌红润，食欲增加，二便正常。仍以原方加减：
干地黄12克 白茯神15克 酸枣皮6克 粉丹皮6克 炒泽
泻6克 淮枣仁15克(冲) 明天麻9克 石决明9克 桑寄
生15克 生龙骨12克 生杭白芍9克
上方连进八剂，患者血压稳定在130／90毫米汞柱，精神好转，诸症消失，已能恢复工作。
[按]《内经》说：“诸风掉眩，皆属于肝”。又说：“肝者，罢极之本也”。本患者，由于肝肾不足，阴虚阳亢，风火上干，心神不宁，导致眩晕。法拟育阴潜阳，方用六味加生龙骨、石决明。以生杜仲、桑寄生、夏枯草、荷叶顶，宣舒肝肾及脑络，天麻熄风，枣仁养心安神，再佐芍药，配伍丹皮、枣皮，酸敛柔肝。不重寒凉而火自平，不专驱散而风自化，体现了祖国医学辨证论治的特点。
肝风虚眩(高血压)
外宾某，男性，42岁。时间是1964年8月。
初诊：据云平素身体尚可，近来因工作繁重，昼夜书写、审阅文件持续一周之久，未得休息。当工作完成之后，即感头晕、目花 耳鸣，彻夜失眠，心烦食少。经检查，发现血压上压至190／120毫米汞柱。拟定中西医药配合治疗。
中医辨证：机体之肝脏，具贮藏血液、调节血量之功能。当在较长时间思维、精力、视觉等官能高度集中应用于某一事物之上，由此耗散肝经气血。《内经》说：“肝受血而能视”又说“久视伤血”。肝脏体阴而用阳，当肝血耗散，肝气失濡，致虚风上逆作眩，遂成“血虚生风”。诊脉细弦而数，舌质红，苔薄黄。治则本“急者缓之”之意，滋养肝血，兼佐安镇，平熄虚风。处方：
全当归12克 炒白芍12克 茯神木15克 大寸冬9克 明天
麻9克 石决明12克 炒黑豆15克 健莲子15克 黑芝麻12克
净竹茹6克 云母石12克(醋煅)(嘱：以玉米须煎汤代水
煨药)
上方浓煎，温服二剂，并配合西药降压、镇静等药治疗。三日后复诊，血压下降至130／90毫米汞柱。患者已能起床活动，头晕、心烦、思饮、便干诸症消除，食眠恢复正常。
脉现和缓，舌质红，苔薄有津。
此属肝血得养，虚风平定，病势向愈。续用滋阴降火丸调理巩固。服法：滋阴降火丸七丸，每日一丸，空腹以温开水送服，连服一周，病痊愈。
[按]正确的治则，来源于正确的诊断，而正确的诊断，必然基于对机体证候客观的病理病机分析。本例肝血耗散，肝气失濡，虚风上逆，干扰清空，而发眩晕。对证投以养血、柔肝、安神、熄风之品，并同西药配合，获效甚捷。
Background Information
Book: Yao Zhenbai's Medical Cases Chapter: Main Text (5/20) Category: Medical Discussion
Cough due to Heat Damaging Yin with Amenorrhea
Patient Li XX, Female, 29 years old, residing at Shalang Alley, Kunming City. Spring, 1936.
First Visit: The illness has lasted for several months. Initially caused by fever and cough, the patient took formulas for releasing the exterior, stopping cough, and astringing the lung, but symptoms did not subside. There was alternating chills and fever (Hantre Wanglai), amenorrhea, unrelieved cough, and condensed phlegm. Subsequently, wind-cold was contracted again, causing headache and body pain. Further treatment with yin-nourishing, exterior-releasing, and antitussive-antipyretic agents yielded no effect.
Symptoms: Redness of both malar eminences, emaciation, aversion to cold, tidal fever, headache, body pain, dry throat and mouth, chest pain. Constipation, scanty dark yellow urine. Menstruation stopped for four months, with occasional soreness in the lower back and abdominal pain. Pulse: Right floating, wiry, slippery, and rapid; Left fine and wiry, Chi position deep and choppy. Tongue: Red body, yellow dry coating.
Although prolonged heat and cough have damaged the yin of the liver and lung as well as qi and blood, leading to disharmony of the Chong and Ren vessels, the Shaoyang syndrome has not yet resolved. Following the principle from the *Neijing* ("In acute cases, treat the branch/symptom first"), the method proposed is to harmonize Shaoyang and diffuse the lung. Afterwards, regulation of the Chong and Ren vessels and qi-blood will be considered. Prescription:
Vinegar-fried Bupleurum Radix (Chaihu) 6g, Vinegar-processed Pinellia Rhizome (Fabanxia) 9g, Fried Scutellaria Root (Huangqin) 6g, Raw Hangzhou White Peony Root (Hangshaoyao) 9g, Mint (Bohe) 6g, Apricot Seed (Xingren) 9g, Perilla Stem (Sugeng) 9g, Raw Licorice Root (Gancao) 3g, Tender Ginger 2 slices, Small Red Dates 11 pieces. Two doses.
Second Visit: Right pulse wiry, slippery, and rapid; Left fine and wiry, Chi position stagnant and choppy; coating remains yellow and dry.
Aversion to cold is reduced, tidal fever persists, dizziness of head and eyes, other symptoms remain as before. Prolonged illness has led to yin deficiency and dual deficiency of qi and blood. Slowly plan for regulation. Prescribed the following formula for three doses:
Vinegar-calcareous Bivalve Shell (Biejia) 12g, Silver Bupleurum Root (Yinchaihu) 9g, Vinegar-fried Artemisia Annua Herb (Qinghao) 6g, Fried Scutellaria Root (Huangqin) 6g, Vinegar-processed Pinellia Rhizome (Fabanxia) 9g, Apricot Seed (Xingren) 6g, Perilla Stem (Sugeng) 6g, Fried Anemarrhena Rhizome (Zhimu) 4.5g, Tender Ginger 2 slices, Small Red Dates 9 pieces, Fresh Bamboo Leaves (Zhuyeqing) 20g as guide.
Third Visit: Aversion to cold has ceased, tidal fever is reduced, malar eminences still red, heat in palms and soles, dry mouth desiring drink. Restless sleep at night, cough with condensed phlegm, poor appetite, weakness, slight sweating. Pulse: Right slippery and rapid, Left fine and wiry. Coating yellow with little moisture. Shaoyang pathogen is gradually resolving, but liver-lung constrained heat is not cleared, qi is weak and yin is deficient. Prescribed the following:
Vinegar-calcareous Bivalve Shell (Biejia) 12g, Silver Bupleurum Root (Yinchaihu) 9g, Fine Rehmannia Root (Shengdihuang) 12g, Powdered Moutan Cortex (Danpi) 4.5g, Lycium Bark (Digupi) 9g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Large Ophiopogon Tuber (Dacunmen) 9g, Beijing Pinellia Rhizome (Jingbanxia) 9g, Dried Lotus Rhizome (Ougan) 3g, Tangerine Network (Guojuluo) 9g, Cleaned Loquat Leaf (Piyeye) 3 leaves.
Fourth Visit: After three doses of the above prescription. Pulse fine and wiry, Chi position weak. Tongue moist, thin coating. Tidal fever subsided, slight redness of cheeks, cough and chest pain alleviated, phlegm condensation gradually dissipated. Appetite increased, bowel and bladder functions normalized.
Only mental fatigue and weakness persist, menstruation has not resumed, occasional soreness in waist and abdomen. This indicates liver-kidney yin deficiency, insufficiency of qi and blood, and disharmony of Chong and Ren after the decline of pathogenic heat. Regulated with the following:
Whole Angelica Sinensis Radix (Danggui) 9g, Fine Rehmannia Root (Shengdihuang) 9g, Red Peony Root (Chishaoyao) 9g, Powdered Moutan Cortex (Danpi) 4.5g, Lycium Bark (Digupi) 9g, Roasted Cyperus Rhizome (Xiangfu) 6g, Ligusticum Rhizome (Chuanxiong) 4.5g, White Poria (Baifuling) 12g, Mulberry Root (Sangjisheng) 12g, Beijing Pinellia Rhizome (Jingbanxia) 9g, Black Soybean (Heixiaodou) 12g, Cleaned Loquat Leaf (Piyeye) 3 leaves.
Fifth Visit: After five doses of the above prescription, all symptoms receded, upright qi has not recovered, menstruation still absent.
Waist soreness, occasional lower abdominal pain. Pulse fine and wiry, both Chi positions still weak, tongue pale with thin coating. This is deficiency of both Chong and Ren vessels, with qi stagnation in meridians. Continue with regulating and nourishing. Prescription:
Raw and Prepared Rehmannia Root (Shengshudi) 9g each, Whole Angelica Sinensis Radix (Danggui) 9g, Red Peony Root (Chishaoyao) 9g, Ligusticum Rhizome (Chuanxiong) 6g, Powdered Moutan Cortex (Danpi) 6g, Roasted Cyperus Rhizome (Xiangfu) 6g, Salvia Root (Danshen) 9g, Fried Drynaria Rhizome (Xuduan) 9g, Achyranthes Root (Niuxi) 6g, Small Red Dates 9 pieces, Cleaned Loquat Leaf (Piyeye) 3 leaves, Large Ophiopogon Tuber (Dacunmen) 9g.
Sixth Visit: After seven or eight doses of the above prescription, menstruation occurred, scanty flow, purple-black color, slight waist and abdominal pain. Tongue red and moist, pulse weak. Continue to harmonize qi and blood to complete the treatment. Prescription:
Whole Angelica Sinensis Radix (Danggui) 15g, Fine Rehmannia Root (Shengdihuang) 9g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, White Poria (Baifuling) 15g, Old Ligusticum Rhizome (Chuanxiong) 6g, Powdered Moutan Cortex (Danpi) 6g, Ampelopsis Radix (Kongshashen) 9g, Raw Astragalus Root (Huangqi) 12g, Fried Drynaria Rhizome (Xuduan) 9g, Roasted Cyperus Rhizome (Xiangfu) 6g, Raw Licorice Root (Gancao) 3g, Small Dates 7 pieces, Lotus Leaf Tip (Heteding) 3 pieces. Advised to also take Shizhen Xiangfu Wan.
[Commentary] This patient's condition was complex. Adhering to the principle "treat the branch in acute cases," the primary approach was to pivot Shaoyang, using Bupleurum, Apricot Seed, and Perilla Stem to diffuse, vent, clear, and transform. Subsequently, nourishing liver yin, clearing heat, and regulating the lung were planned to pivot again. Once the Shaoyang syndrome resolved, addressing blood weakness, yin deficiency, and internal heat required heavy nourishment of blood and yin. With the complete resolution of tidal fever, the focus shifted to nourishing blood and regulating menstruation. Once qi, blood, Chong, and Ren were nourished, menstruation returned.
The *Neijing* states: "Observe where yin and yang are located and regulate them, aiming for balance." Gynecological mechanisms are intricate; determining the steps of treating root versus branch and urgency requires caution.
Tidal Fever at Zi and Wu Hours with Amenorrhea
Patient Zheng XX, Female, 38 years old, cadre. November, 1970.
First Visit: The patient has been ill for several months, emaciated, short of breath, panting upon exertion, chest and hypochondriac pain, cough with condensed phlegm and blood. Spontaneous sweating, night sweats, irritability, difficulty sleeping at night. At Zi (11 PM - 1 AM) and Wu (11 AM - 1 PM) hours, body temperature rises to 37.5–38°C, with flushing of palms, soles, and malar eminences. After an hour, the fever recedes like a tide. Menstruation has been absent for three months. Diagnosed with "Pulmonary Tuberculosis" by Western medicine; multiple treatments showed little effect.
Pulse: Deficient, slippery, and rapid; powerless on deep pressure. Tongue: Crimson, dry with little moisture. Ancient physicians stated: "Severe consumptive disease is called Laozai (TB), characterized by emaciation and decay." Due to prolonged tidal fever, blood deficiency and lung dryness have damaged Zong Qi (Pectoral Qi), presenting signs of Laozai. The method should first be to nourish yin and moisten the lung, resolve phlegm and stop bleeding, then tonify qi and nourish blood, regulate liver and spleen, proceeding step by step. Prescription:
Vinegar-calcareous Bivalve Shell (Biejia) 18g, Beijing Scrophularia Root (Yuanshen) 1g, Large Ophiopogon Tuber (Dacunmen) 9g, Vinegar-calcined Oyster Shell (Muli) 12g, Lycium Bark (Digupi) 12g, White Imperata Rhizome (Baimaogen) 30g, Roasted Aster Root (Ziwan) 9g, Roasted Kolkwitzia Flower (Donghua) 9g, Tangerine Network (Guojuluo) 9g, Powdered Moutan Cortex (Danpi) 6g, Raw Licorice Root (Gancao) 3g. Pear juice and Lotus Rhizome juice, one spoon each per dose, as guide.
Second Visit: After seven doses of the above prescription, hemoptysis decreased, cough remained frequent, spontaneous and night sweats slightly reduced, appetite slightly increased, thirst/drinking desire decreased, but tidal fever at Zi and Wu hours persisted. Pulse and tongue unchanged. Modify original prescription. Prescription:
Vinegar Bivalve Shell (Biejia) 18g, Vinegar Artemisia Annua Herb (Qinghao) 9g, Dry Rehmannia Root (Gadihuang) 12g, Lycium Bark (Digupi) 15g, White Poria Spirit (Baifushen) 15g, Roasted Kolkwitzia Flower (Donghua) 9g, Vinegar Oyster Shell (Muli) 15g, Beijing Pinellia Rhizome (Jingbanxia) 9g, Tangerine Network (Guojuluo) 9g, Raw Licorice Root (Gancao) 3g, Cleaned Loquat Leaf (Piyeye) 3 leaves, White Imperata Rhizome (Baimaogen) 15g. Pear juice and Lotus Rhizome juice, one spoon each.
Third Visit: After seven doses of the above prescription, the deficient, slippery, rapid pulse image gradually flattened, crimson tongue turned red, moisture gradually appeared. Hemoptysis stopped, chest/hypochondriac pain reduced, phlegm condensation largely cleared, spontaneous/night sweats and tidal fever reduced. Continue nourishing yin, clearing heat, moistening lung, dispelling phlegm. Prescription:
Vinegar Bivalve Shell (Biejia) 15g, Dry Rehmannia Root (Gadihuang) 15g, Silver Bupleurum Root (Yinchaihu) 9g, Lycium Bark (Digupi) 12g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Roasted Kolkwitzia Flower (Donghua) 9g, Powdered Moutan Cortex (Danpi) 6g, Raw Licorice Root (Gancao) 3g, Angelica Sinensis Body (Dangguishen) 12g, Siegesbeckia Herba (Baiwei) 4.5g, Dried Lotus Rhizome (Ougan) 6g, Cleaned Loquat Leaf (Piyeye) 3 leaves.
Fourth Visit: After ten doses of the above prescription, tidal fever at Zi and Wu hours greatly reduced, spontaneous and night sweats ceased.
Chest/hypochondriac pain stopped, cough with scanty thin sputum, irritability eliminated. Able to sleep peacefully at night, appetite increased. But spirit is still poor, menstruation has not resumed. Pulse fine and rapid, tongue red and moist with fluid. Yin fluids are gradually recovering, lung dryness is moistened, but qi and blood are not yet sufficient, liver-spleen is disharmonious. Treatment should nourish liver, moisten lung, regulate spleen. Prescription:
Whole Angelica Sinensis Radix (Danggui) 15g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Ampelopsis Radix (Kongshashen) 9g, Dry Rehmannia Root (Gadihuang) 12g, Large Ophiopogon Tuber (Dacunmen) 9g, White Poria Spirit (Baifushen) 15g, Powdered Moutan Cortex (Danpi) 6g, Lycium Bark (Digupi) 12g, Tangerine Network (Guojuluo) 9g, Mulberry Root (Sangjisheng) 15g, Raw Licorice Root (Gancao) 3g, Dried Lotus Rhizome (Ougan) 6g.
Fifth Visit: After five consecutive doses of the above prescription, tidal fever at Zi/Wu, irritability, spontaneous/night sweats, chest/hypochondriac pain, cough, etc., all disappeared. Pulse turned fine and slow, tongue coating red and moist. However, due to prolonged illness, yin injury and blood consumption, liver-spleen lost nourishment, Chong and Ren were insufficient, hence amenorrhea. Method: Tonify qi, regulate blood, nourish Chong and Ren. When the Sea of Blood is full, menstruation can arrive.
Whole Angelica Sinensis Radix (Danggui) 15g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Ligusticum Rhizome (Chuanxiong) 6g, Ampelopsis Radix (Kongshashen) 9g, Dry Rehmannia Root (Gadihuang) 129g, Codonopsis Pilosula (Sutiaoshen) 12g, Powdered Moutan Cortex (Danpi) 6g, Large Ophiopogon Tuber (Dacunmen) 9g, Mulberry Root (Sangjisheng) 15g, Black Soybean (Heixiaodou) 15g, Jian Lotus Seed (Lianzi) 15g, Licorice Root (Gancao) 3g, Tortoise and Deer Glue (Gui Lu Jiao) 9g each (melted and mixed).
Sixth Visit: After fifteen doses of the above prescription, diet and sleep were excellent, complexion became lustrous, body shape gradually filled out, able to resume half-day work. Pulse harmonious, tongue moist. Menstruation had not arrived. After severe illness, true qi, blood, and yin gradually recovered, but Chong and Ren Sea of Blood were still deficient. Prescribed the following for regulation. By Spring 1971, menstruation returned, cycles normalized thereafter, and tuberculosis symptoms did not recur. Prescription:
Roasted Astragalus Root (Huangqi) 15g, Whole Angelica Sinensis Radix (Danggui) 15g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Ligusticum Rhizome (Chuanxiong) 6g, Codonopsis Pilosula (Sutiaoshen) 15g, Bleached Atractylodes Macrocephala Rhizome (Baizhu) 12g, Amomum Fruit (Sharen) 4.5g, Powdered Moutan Cortex (Danpi) 6g, White Poria Spirit (Baifushen) 15g, Roasted Cyperus Rhizome (Xiangfu) 6g, Mulberry Root (Sangjisheng) 15g, Raw Licorice Root (Gancao) 3g, Small Red Dates 11 pieces.
[Commentary] Prolonged illness damages true qi, blood, and yin. Whenever Zi and Wu hours occur (yin-yang intersection), pathogenic heat takes advantage, yin fails to control yang, thus tidal fever appears. Heat pathogen consumes fluids, Sea of Blood dries up, menstruation stops. Damage to Zong Qi causes spontaneous and night sweats, further injuring yin fluids. Heat originates from yin; thus, quieting true yin is necessary. Bivalve Shell, Scrophularia, Ophiopogon, Oyster Shell, and Rehmannia are key herbs for nourishing and securing liver-kidney-lung yin. After the disease retreats, when deficiency prevails, Angelica, Peony, Rehmannia, Tortoise/Deer Glue, Codonopsis, and Astragalus are used to tonify essence and blood, nourishing Chong and Ren.
Consumptive Disease (Childhood TB)
Patient Dong XX, Male, 5 years old, residing in the western suburbs of Kunming City. Year 1940.
First Visit: The child has been ill for several months, bedridden, haggard appearance, emaciated skin and muscles. Dry cough with hoarse voice, blood in sputum. Thirsty, poor appetite, tidal fever in late afternoon (Ribu), nighttime irritability, spontaneous and night sweats, yellow urine, loose stools. Pulse deficient, rapid, and powerless; Left Guan slightly large, Right Cun slippery; Tongue pale red, thin coating with little moisture. The disease belongs to weak qi and yin deficiency, hyperactive liver and dry lung, spleen failing to transport. Prolonged entanglement of symptoms. Method: Nourish yin, clear heat, moisten lung, strengthen spleen, calm liver. Avoid harsh dispersing methods; prescribe gentle regulation.
Silver Bupleurum Root (Yinchaihu) 6g, Vinegar-fried Artemisia Annua Herb (Qinghao) 6g, White Poria (Baifuling) 9g, Lycium Bark (Digupi) 9g, Ampelopsis Radix (Kongshashen) 9g, Fried Hangzhou White Peony Root (Hangshaoyao) 6g, Beijing Pinellia Rhizome (Jingbanxia) 6g, Apricot Seed (Xingren) 6g, Roasted Kolkwitzia Flower (Donghua) 6g, Raw Licorice Root (Gancao) 3g, Floating Wheat (Fuxiaomai) 9g, Small Red Dates 7 pieces.
Second Visit: After five doses of the above prescription, tidal fever and night sweats slightly reduced, other symptoms same as before. Pulse and tongue unchanged, maintaining original intent with modifications. Prescription:
Polygonatum Odoratum Rhizome (Yuzhu) 9g, Asparagus Fern Root (Tianmendong) 9g, Fried Hangzhou White Peony Root (Hangshaoyao) 6g, White Poria (Baifuling) 9g, Roasted Kolkwitzia Flower (Donghua) 6g, Silver Bupleurum Root (Yinchaihu) 6g, Vinegar-fried Artemisia Annua Herb (Qinghao) 4.5g, Roasted Loquat Leaf (Piyeye) 2 leaves, Black Soybean (Heixiaodou) 9g, Licorice Root (Gancao) 3g, Roasted Mulberry Bark (Sangpishi) 4.5g, Floating Wheat (Fuxiaomai) 12g, Small Red Dates 9 pieces, White Imperata Rhizome (Baimaogen) 9g.
Third Visit: After ten doses of the above prescription, blood in sputum stopped. Tidal fever, night sweats, and cough reduced, other symptoms significantly improved. But prone to anger. Pulse fine and wiry, tongue pale red. Yin deficiency and lung dryness are gradually moistening, spleen is weak and liver is hyperactive. Again prescribe nourishing yin, moistening lung, strengthening spleen, calming liver. Prescription:
Silver Bupleurum Root (Yinchaihu) 6g, Codonopsis Pilosula (Sutiaoshen) 9g, Polygonatum Odoratum Rhizome (Yuzhu) 9g, Asparagus Fern Root (Tianmendong) 6g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Roasted Kolkwitzia Flower (Donghua) 6g, Lily Bulb (Baihe) 6g, Floating Wheat (Fuxiaomai) 12g, Charred Mume Fruit (Wumei) 2 pieces, Small Red Dates 7 pieces.
After more than ten consecutive doses, tidal fever completely receded, other symptoms gradually disappeared. Appetite increased, bowel and bladder functions normalized. Complexion became lustrous, skin/muscles filled out, able to get out of bed and move. Pulse weak and slow, tongue red and moist. Prescribed again to nourish liver-spleen, regulate and tonify qi-blood.
Codonopsis Pilosula (Sutiaoshen) 9g, Ampelopsis Radix (Kongshashen) 6g, Polygonatum Odoratum Rhizome (Yuzhu) 6g, Asparagus Fern Root (Tianmendong) 6g, Lily Bulb (Baihe) 6g, Chinese Yam (Huaiyshao) 9g, White Poria (Baifuling) 9g, Fried Hangzhou White Peony Root (Hangshaoyao) 9g, Beijing Pinellia Rhizome (Jingbanxia) 9g, Tangerine Peel (Chenpi) 6g, Roasted Licorice Root (Gancao) 3g, Lotus Seed (Lianzi) 9g (heart removed), Small Red Dates 7 pieces.
[Yao's Commentary] Such syndromes should not be treated with sudden warming tonification, nor exclusively with cold-cooling methods. One should follow the *Neijing* principles: "For dryness, moisten it"; "For deficiency, benefit it." First use moistening and regulating methods, then mild tonification. Specific methods include calming liver, moistening lung, resolving phlegm and stopping cough, nourishing yin and clearing heat, strengthening spleen and consolidating middle, followed by tonifying qi and blood. For tidal fever, importance should be placed on pivoting Shaoyang and harmonizing Ying and Wei. If accompanied by intestinal parasites, avoid "killing worms"; instead use "transforming worms" formulas to prevent damaging primal qi. In short, medication should not be too urgent or harsh; gradual regulation is required to achieve expected efficacy.
[Commentary] Children's zang-fu organs are delicate. Due to lack of proper nourishment daily, after contracting pathogens and missing treatment opportunities, the qi lingers, causing internal injury. One organ falls ill first, affecting others; spleen weakness and yin deficiency damage essence and qi, while liver hyperactivity and lung dryness trap deficient heat. Emaciation is commonly known as "Childhood TB" in folk terms; treatment rarely yields quick results. This case follows the *Neijing* "moisten dryness, benefit deficiency," strictly adhering to clearing-moistening regulation and mild tonification, which is the key to treating consumptive diseases.
Vertigo (Hypertension)
Foreign Guest XX, Male, 56 years old. Summer, 1956.
First Visit: The patient is tall and obese, with a ruddy face. He habitually smokes and drinks alcohol, prefers rich and sweet foods. Having recently come from a cold zone to our province for engineering construction, he suffered from maladaptation to the local environment, combined with work fatigue and excessive mental strain. For the past two to three months, he experienced vertigo and dizziness, numbness and distension in limbs, restless sleep, vivid dreams and easy awakening, spontaneous sweating, poor appetite, and mental fatigue, affecting his work. Examination at the Provincial Hospital revealed blood pressure elevated to 200/100 mmHg, diagnosed as neurogenic hypertension. Multiple courses of antihypertensive and sedative drugs showed no obvious effect. One week later, the condition worsened: tinnitus, brain buzzing, mental unrest. Upon rising, severe dizziness threatening collapse; all day feeling disoriented as if on a boat, extreme fatigue, unable to continue working. Relevant authorities attached great importance, inviting me for consultation. Integrated Chinese and Western medicine treatment was adopted to restore health early.
TCM Syndrome Differentiation: Tongue red, thin greasy coating, pulse wiry and slippery. Syndrome belongs to liver-kidney insufficiency, yin deficiency with yang hyperactivity, wind-fire attacking upward, heart-mind unsettled, manifesting as vertigo. Given advanced age, stroke must be guarded against. Urgent treatment should nourish yin, subdue yang, transform wind, relax collaterals, nourish heart, and calm mind. Prescription:
Dry Rehmannia Root (Dihuang) 12g, White Poria Spirit (Baifushen) 15g, Sour Jujube Kernel (Suanzaoren) 6g, Fried Alisma Rhizome (Zexie) 6g, Powdered Moutan Cortex (Danpi) 6g, Fried Chinese Yam (Huaiyao) 12g, Huai Sour Jujube Kernel (Huai Zaoren) 15g (decocted separately), Raw Concha Heterodonis (Shijueming) 9g, Raw Os Draconis (Shenglonggu) 12g, Raw Eucommia Bark (Shengduzhong) 12g, Prunella Spike (Xiakucao) 6g, Lotus Leaf Tip (Heteding) 3 pieces.
Advised to strictly control intake of tobacco, alcohol, fishy, greasy, and rich sweet foods.
Second Visit: After four doses of the above prescription, blood pressure dropped to 150/100 mmHg, sleep gradually stabilized, spontaneous sweating收敛 (stopped), subjective symptoms of vertigo, tinnitus, and brain buzzing vanished, able to go out for walks. Pulse wiry, slippery, and soft; tongue red and moist, appetite increased, bowel and bladder functions normal. Still modify original prescription:
Dry Rehmannia Root (Dihuang) 12g, White Poria Spirit (Baifushen) 15g, Sour Jujube Kernel (Suanzaoren) 6g, Powdered Moutan Cortex (Danpi) 6g, Fried Alisma Rhizome (Zexie) 6g, Huai Sour Jujube Kernel (Huai Zaoren) 15g (decocted separately), Tianma (Gastrodia Rhizome) 9g, Concha Heterodonis (Shijueming) 9g, Mulberry Root (Sangjisheng) 15g, Raw Os Draconis (Shenglonggu) 12g, Raw Hangzhou White Peony Root (Hangshaoyao) 9g.
After eight consecutive doses of the above prescription, patient's blood pressure stabilized at 130/90 mmHg, spirit improved, all symptoms disappeared, able to resume work.
[Commentary] The *Neijing* states: "All wind-induced tremors and vertigo belong to the Liver." It also says: "The Liver is the root of endurance." This patient, due to liver-kidney insufficiency, yin deficiency with yang hyperactivity, wind-fire attacking upward, and heart-mind unrest, developed vertigo. The method proposes nourishing yin and subduing yang. Formula uses Liuwei Dihuang Wan plus Raw Os Draconis and Concha Heterodonis. Raw Eucommia Bark, Mulberry Root, Prunella Spike, and Lotus Leaf Tip soothe liver-kidney and brain collaterals; Tianma extinguishes wind; Sour Jujube Kernel nourishes heart and calms mind; assisted by Peony, paired with Moutan Cortex and Cornus Fruit, sour and astringent to soften liver. Fire calms without relying heavily on cold-cooling; wind transforms without specializing in dispersing, reflecting the characteristics of TCM syndrome differentiation and treatment.
Liver Wind Deficient Vertigo (Hypertension)
Foreign Guest, Male, 42 years old. August, 1964.
First Visit: According to reports, health was generally acceptable previously. Recently, due to heavy workload, writing and reviewing documents day and night for a week without rest. Upon completion of work, felt dizzy, blurred vision, tinnitus, insomnia all night, irritability, poor appetite. Examination revealed systolic blood pressure up to 190/120 mmHg. Planned integrated Chinese and Western medical treatment.
TCM Syndrome Differentiation: The liver stores blood and regulates blood volume. When thinking, energy, and visual functions are highly concentrated on one task for a long time, liver meridian qi and blood are consumed. The *Neijing* states: "The Liver receives blood and enables vision" and "Prolonged viewing injures blood." The Liver's substance is yin, its function is yang. When liver blood is consumed and liver qi loses nourishment, deficient wind rises upward causing vertigo, forming "Blood Deficiency Generating Wind." Pulse fine, wiry, and rapid; tongue red, thin yellow coating. Treatment principle follows "For urgency, use soothing": nourish liver blood, assist with calming and anchoring, level and extinguish deficient wind. Prescription:
Whole Angelica Sinensis Radix (Danggui) 12g, Fried White Peony Root (Baishaoyao) 12g, Fomes Wood (Fushenmu) 15g, Large Ophiopogon Tuber (Dacunmen) 9g, Tianma (Gastrodia Rhizome) 9g, Concha Heterodonis (Shijueming) 12g, Fried Black Soybean (Heidou) 15g, Healthy Lotus Seed (Jianlianzi) 15g, Black Sesame Seed (Heizhima) 12g, Cleaned Bamboo Sap (Zhuru) 6g, Cloud Mother Stone (Yunmushi) 12g (vinegar calcined) (Instruction: Decoct corn silk to replace water for decocting herbs).
Above prescription decocted strongly, taken warm, two doses, combined with Western antihypertensive and sedative drugs. Revisit after three days, blood pressure dropped to 130/90 mmHg. Patient able to get up and move, symptoms of dizziness, irritability, thirst, dry stool eliminated, diet and sleep normalized.
Pulse harmonious and slow, tongue red, thin coating with moisture.
This indicates liver blood is nourished, deficient wind is pacified, disease trend is improving. Continue with Ziyin Jianghuo Wan for regulation and consolidation. Dosage: Seven pills of Ziyin Jianghuo Wan, one pill daily, taken with warm water on empty stomach, for one week. Disease cured.
[Commentary] Correct treatment principles stem from correct diagnosis, which must be based on objective pathological analysis of syndrome manifestations. This case involves liver blood consumption, liver qi losing nourishment, deficient wind rising upward, disturbing the clear orifices, causing vertigo. Administering blood-nourishing, liver-softening, mind-calming, and wind-extinguishing herbs对症 (symptomatically), combined with Western medicine, achieved very rapid effects.