陈××，男，十五岁。患两膝肿痛已四年，久治未愈。来诊时，面黄肌瘦，唇口红赤，精神萎糜，足不任地。舌质红，苔薄黄，脉象细数。以脉症合参，此风寒湿痹，迁延日久，邪气留连，经脉阻滞，郁而化热，湿热之邪注于两膝关节而不散，致成湿热肿痛。证属热痹，治宜清热渗湿，疏利关节为主，兼以养液。处方：
桑枝15克
嘱服五剂，并配合外治法。
外用：生草乌90克，研细末与麦面15克混合，加入适量酸醋，调匀包患处。草乌搜风胜湿，主风痛，通经络，利关节，破积聚，用麦面以作粘合；调之以醋者，《别录》谓其“主消痈肿，散水气，杀邪毒。”李时珍亦云：“醋主酸收，又有散瘀解毒之功，曲直之性也。”
上方服五剂，并配合外治后，疼痛大减，肿消其半。改拟除湿清热，活血通络，分清去浊之剂。处以下方：
嘱服五剂。外治法如上。
经上述治疗后，痛止肿消，诸症缓解。根据“脾主四肢”、“肺热叶焦”亦能致痿的理论，继以六君汤加麦冬益气健脾，清金保肺。连服数剂，遂愈。
[按]：本例属中医“热痹”范畴。痹证一般分风痹、寒痹、湿痹、热痹四型。临床所见，以阳虚偏寒湿者较多。但素体阴虚，或素体蕴热，或寒湿郁久不散，或过用辛温，均可转化为热痹。热痹多挟湿邪，故热痹之治，宜清热渗湿，疏利关节。日久者兼以养液。关节肿痛者，配合外治亦佳。本例因病程日久，初诊即用沙参、玄参者，因患者湿热久痹，已有足不任地等象，宜予清热保肺养液，以防成痿。又因脾恶湿，主四肢，脾湿不化，下渗经络，流于下肢，故而浮肿，寒湿日久，郁而化热，则湿热互滞，故用二芩、泽泻、通草、萆薢、黄柏、淮牛膝以渗化湿热，导热下行；用桑枝、土茯芩利湿解毒，疏利关节，苍术、秦艽祛风燥湿；知母清热，苡仁、木瓜入肝舒筋， 当归活血养血。杜仲一味，王好古称其为肝经气分药，润肝燥，补肝虚，强壮腰膝，牛膝引诸药下达病所。共呈除湿清热，活血通络，分清去浊之效。
上述诸方，用治湿热痹证，疗效较佳，已治愈多例，值得推荐。但外治法，遇包后过敏(发痒或发皮疹)者，应停用。
左臂疼痛
赵××，男，二十一岁。患左臂疼痛二月余，曾用西药镇痛及中药温阳除湿祛风等剂均无效。延余诊治。症见：左上肢举动困难，疼痛较剧，无红肿。无汗，恶寒，舌质正常，苔薄白，脉浮紧。询其得病之由，因夜卧当风，风寒湿邪客于经络。法当除湿祛风散寒为治。选方用《金匮要略》麻黄加术汤合麻杏苡甘汤加桑枝。处方：
连服二剂，患者得微汗，病遂痊愈。
[按]：臂痛一证，虽系小恙，然治不得法， 则迁延难愈。本证属中医痹证。痹者，不通之谓也。“痈则不通”，用辛温微汗法宣通之，遵仲景“若治风湿者，发其汗，但微微似欲汗出者，风湿俱去也。”麻黄加术汤乃除湿祛风散寒之重剂，麻杏苡甘汤乃发汗利湿解表之轻剂，轻重合剂，善治风寒显痹。症虽恶寒，乃表阳被遏，由脉浮紧可知，非少阴病之恶寒可此，故不用大辛大热之附子，只用通阳化气的桂枝，俾卫阳振奋，则恶寒自罢。是方之中，尤妙在麻黄配白术，虽发汗而不致过汗，白术配麻黄，善祛表里之湿，同时，可达微汗而解，更加桑枝横达肢臂而通络。方虽简而效验灵。
血
痹
阎××，女，三十九岁，妊娠二月。近五日来，右下肢疼痛，继之咳嗽，痰清带血，咳引右侧肩背疼痛，胸闷痛，上气喘息，头目眩晕，尿少，食欲减退。于1956年3月7日住入昆华医院(即今省第一人民医院)，经摄胸片等检查，诊断为右下肢栓塞性静脉炎合并肺梗塞，经西药治疗一周后拟作人工流产与截肢术。因患者不同意，于3月14日转入陆军医院(即今四十三医院)，诊断同前。17日延余会诊，详询病史，患者平素工作疲劳之时常感喘息、胸闷、心悸、短气乏力；此次妊娠后，出现右下肢疼痛，逐日加剧。近半月来咳嗽痰血，一直未止。入院后小便短少，一日仅二至三次。查得舌质青润，苔薄白，脉沉，面青，神疲欲寐，右下肢轻微浮肿，但不红，自觉疼痛拒按，不能站立。脉、舌、症三者合参，系平素心肺阳虚，寒邪凝滞。万全之策，宜先复心肺之阳兼以散寒为治，以俟转机。方用自拟姜桂苓半汤加元肉。处方：
二诊：上方服三剂后，上气喘息减轻，胸、肩、背疼痛渐趋缓解，舌质由青转红，脉由沉转弦，苔白腻。但大便不通，下肢疼痛不减，头痛隐隐。用自拟天麻汤加减。处方：
明天麻10克 葳蕤仁15克 北口芪15克 桂枝9克 杭芍9克
三诊：上方服三剂后，大便畅通，下肢疼痛减轻，微咳嗽，痰中略带血丝。用《伤寒论》桂枝加芍药汤加减。处方：
桂枝汤为妊娠第一方，具有温经通阳，调和营卫气杌之功，加重芍药有利于安扶胎元。
四诊：服上方二剂后，咳血止，下肢疼痛轻微。此时寒邪已基本消除，心阳渐复，但大便又呈现不通。用《伤寒论》麻仁丸加减，以润肺养血通便。处方：
甘草3克(白蜜一匙调入)
五诊：服上方一剂，大便畅通，下肢疼痛亦随之大减，但郁热渐起，虚烦失眠，痰血虽止，仍咳嗽，痰由清转稠。用自拟三豆银翘散合栀豉汤加减。处方：
淡豆豉9克 黑豆10克 红饭豆15克 桑叶10克 连翘10克
竹茹6克
六诊：服上方三剂后，咳痰大减，烦躁止，并能安眠，下肢疼痛逐渐消失。为了巩固疗效，用黄芪桂枝五物汤、黄芪建中汤，卫外守中，调和营卫，温通气机，促进血行，以三才封髓丹纳气归肾，使虚火不致上浮，继以炙甘草汤扶心肺之阴阳，以六君子汤健运脾胃。以上五方交替服用，从本调治，至4月20日，患者已能下楼活动而出院休养，到临产期安全分娩。
[按]：此证关键在于心肺阳虚，寒邪凝滞，营卫失调，血行瘀阻。因此，出现下肢静脉栓塞、肺梗塞及咳嗽痰血等症。据此，以温散寒邪、恢复心阳为主，选用姜桂苓半汤、天麻汤等方，兼施育阴润燥，活血通便之剂(麻仁丸、三豆银翘散)，继用黄芪桂枝五物汤、黄芪建中汤、封髓丹、炙甘草汤和六君子汤等，以巩固疗效。其所以获效者，是由于在整个治疗过程中，从中医整体观念出发，本着“如常迟交”，“治本还当治标”的原则，并坚持机体的内外统一、上下统一的原理，才使错综复杂的病症得以缓解，免除了截肢，保住了胎儿。
右肢抖颤
刘××，男，六十岁。患右侧手足颤抖不止，历时二年多，曾经中西医治疗无效。症见：右手颤抖不已，右手不能取物，亦不能持物。畏寒身重，面色黯暗不泽，精神不振，甚感忧愁。舌苔滑腻，脉象三、五不整。索阅所服中药处方，多系养血祛风，清热涤痰之类。此症时日已久，若再迟延，则有“偏枯”之虞。查其病根在于脾肾阳虚，风痰郁阻。因肾阳即命火，命火不足，火不生土，则脾阳不振，水湿难运，湿痰停滞，阻碍肺胃气机之宣达。因脾主四肢，肺主一身之气，脾肺之机能受抑，木气鼓之，故手足颤抖也。因其标乃风痰，其本在脾肾，故滋阴养血，平肝熄风，非其所宜。根据以上分析，先以壮火扶阳、健脾燥湿、祛风豁痰之剂。用术附汤和郑钦安姜附茯半汤加味。处方：
上方附子配白术，名术附汤，专治肾阳虚衰、脾阳不运、湿浊停聚之证。生姜、附子、茯苓、半夏即姜附茯半汤，郑钦安谓为“回阳降逆、行水化痰之方”。生姜宣散壅滞之寒；茯苓、半夏燥湿健脾，降逆化痰；加南星祛风湿，化顽痰，天麻镇静息风，白芥子利气豁痰除寒暖中，甘草调和诸药。嘱服二剂。
二诊：药后精神较好。为求根治，宜予温肾扶阳、调和营卫、祛风散寒燥湿之剂。因此症不仅肾阳大虚，脾湿不运，而且肺胃气机郁滞，易致营卫失调，风寒湿邪阻遏经络不通。若舍疏通经络、调畅气机之剂，则治病之药不易到达病所。乃用自拟方附子桂枝独活寄生汤加南星。处方：
方解见本书“风寒湿痹”案。
三诊：服二剂，自觉颤抖有所减轻，患者颇感欣慰，要求续为根治。腻苔已退，此乃寒湿虽化而未净。由于经络疏通，脉由三五不整转为弦大，是脾肾之阳未复也。乃用附子理中汤加味。处方：
上方附子温壮脾肾之阳，理中汤大振中州，执中央以运四旁，此乃理中之旨也，加夏、苓燥湿健脾，降逆化痰，南星祛风痰；天麻、代赭石、紫石英、赤石脂镇肝息风，降逆除湿。
四诊：患者连服三剂，颤抖大减，右手已可取物，精神舒畅，情绪饱满，脉象由弦大而变柔和，舌苔薄腻。此阳气尚虚，寒湿未尽。用《伤寒论》附子汤与桂枝汤合方。处方：
此方主旨，在于温扶元阳，补脾化湿，调和营卫，通畅经络。连服三剂，症状消失而收全功。
[按]：颤抖即颤振，此病方书记载甚少，王肯堂《证治准绳·杂病》谓：“颤，摇也；振，动也。筋脉约束不住而莫能任持，风之象也。”王氏分型，有阴血不足，有气虚，有心虚，有挟痰者。临床所见，尚有湿热所致者，此多见于嗜酒之人，亦有阳虚所致者，本例即是。根据病史及以往所服方药，结合现时表现，断为脾肾阳虚，风痰郁阻。采用壮火扶阳、健脾燥湿、祛风化痰之法，竞获全愈。其关键性用药在第三诊，方中所用代赭石、紫石英、赤石脂等味，为养肝、祛痰、降逆之要药，由本及标，故见效迅速。但初诊、次诊方，是为第三诊创造条件，奠定治疗基础的。若不经过这两个步骤，开始即用第三诊处方，则不易有此功效。故临床治病，应当注意分清标本缓急，做到胸中有数。否则，欲连而不达，事倍而功半，良好的动机，未必会有良好的效果。
肝寒腹痛
赵××，男，三十二岁。患腹部疼痛，大便不解，曾用苦寒消导之药无效，随又自吃香蕉数枚，意欲通便。然大便未通，反而腹痛加剧，两胁作胀，从深夜至天明剧痛不止，冷汗淋漓，辗转呻吟，至次日午后，扶来我所就诊。
察其脉弦紧，舌质略青，苔白腻，面色青黯，表情苦楚，不思食。此系肝寒胃冷，寒湿凝滞，木不疏土之故。处以经验方“霹雳汤”：
方中，附片壮阳补火，散寒逐湿，治脾胃虚冷，吴萸温肝逐寒，散湿开郁，驱厥阴之浊邪，为治心腹疼痛要药，丁香温中、降逆、暖肾，治心腹冷痛，且有壮阳之功，木瓜平肝达郁、舒筋止痛，丝瓜络通经络，散结滞，行血脉，灶心土温中燥湿，暖胃止痛，《本草便读》说：“其功专入脾胃，有扶阳退阴散结除邪之意。”此方之用，目的在温中、疏肝、燥湿、止痛。不用甘草者，欲使药力由中焦而达丹田也。
二诊：上方服一次后，即觉腹痛减轻，尽剂则痛消失，且思饮食，面已不青，脉转缓和。形神安定，情志舒畅。但皮肤出现红色斑块。此病邪从里达表之佳象。宜因势利导，用通阳化气之剂以调畅气机。方用刘河间大橘皮汤加干姜。处方：
陈××，男性，15岁。双膝肿痛已持续四年，久治不愈。就诊时，面色萎黄，肌肉消瘦，口唇颜色红赤，精神萎靡不振，双腿无力无法支撑身体站立。舌质红，苔薄黄，脉象细数。综合脉象与症状分析，此为风寒湿痹证，病程迁延日久，邪气留恋体内，导致经脉阻滞，郁结而化热，湿热之邪注于双膝关节而无法消散，从而形成湿热引起的肿痛。证候属于热痹，治疗应以清热渗湿、疏利关节为主，兼以滋养津液。处方如下：
桑枝15克
嘱咐服用五剂，并配合外治法。
外治法：生草乌90克，研成细末，与麦面15克混合，加入适量酸醋，调匀后包裹患处。草乌能搜风胜湿，主治风痛，疏通经络，利关节，破除积聚；用麦面作为粘合剂；用醋调和，《名医别录》记载醋“主治消痈肿，散水气，杀邪毒。”李时珍也说：“醋主酸收，又有散瘀解毒之功，具有曲直之性。”
上方服用五剂，并配合外治后，疼痛大幅减轻，肿胀消退一半。改拟除湿清热、活血通络、分清去浊的方剂。处方如下：
嘱咐服用五剂。外治法同上。
经过上述治疗后，疼痛停止，肿胀消退，各种症状缓解。根据“脾主四肢”、“肺热叶焦”也能导致痿证的理论，继以六君汤加麦冬益气健脾，清金保肺。连续服用数剂，遂痊愈。
[按语]：本例属于中医“热痹”范畴。痹证一般分为风痹、寒痹、湿痹、热痹四型。临床所见，以阳虚偏寒湿者较多。但素体阴虚，或素体蕴热，或寒湿郁久不散，或过用辛温药物，均可转化为热痹。热痹多挟湿邪，故热痹的治疗，宜清热渗湿，疏利关节。病程日久者兼以养液。关节肿痛者，配合外治法效果也很好。本例因病程日久，初诊即用沙参、玄参，是因为患者湿热久痹，已有足部无力无法承重等迹象，宜予清热保肺养液，以防发展成痿证。又因脾恶湿，主四肢，脾湿不化，下渗经络，流于下肢，故而浮肿，寒湿日久，郁而化热，则湿热互滞，故用二芩（黄芩、黄柏）、泽泻、通草、萆薢、黄柏、淮牛膝以渗化湿热，导热下行；用桑枝、土茯苓利湿解毒，疏利关节，苍术、秦艽祛风燥湿；知母清热，苡仁、木瓜入肝舒筋，当归活血养血。杜仲一味，王好古称其为肝经气分药，润肝燥，补肝虚，强壮腰膝，牛膝引诸药下达病所。共呈除湿清热，活血通络，分清去浊之效。
上述诸方，用于治疗湿热痹证，疗效较佳，已治愈多例，值得推荐。但外治法，遇包扎后过敏（发痒或发皮疹）者，应停用。
左臂疼痛
赵××，男性，21岁。患左臂疼痛二月余，曾用西药镇痛及中药温阳除湿祛风等方剂均无效。邀请余诊治。症见：左上肢举动困难，疼痛较剧，无红肿。无汗，恶寒，舌质正常，苔薄白，脉浮紧。询问其得病原因，因夜间睡觉当风，风寒湿邪客于经络。治法当除湿祛风散寒。选方用《金匮要略》麻黄加术汤合麻杏苡甘汤加桑枝。处方：
连续服用二剂，患者得微汗，病遂痊愈。
[按语]：臂痛一证，虽系小恙，然治不得法，则迁延难愈。本证属中医痹证。痹者，不通之谓也。“痈则不通”，用辛温微汗法宣通之，遵仲景“若治风湿者，发其汗，但微微似欲汗出者，风湿俱去也。”麻黄加术汤乃除湿祛风散寒之重剂，麻杏苡甘汤乃发汗利湿解表之轻剂，轻重合剂，善治风寒显痹。症虽恶寒，乃表阳被遏，由脉浮紧可知，非少阴病之恶寒可比，故不用大辛大热之附子，只用通阳化气的桂枝，俾卫阳振奋，则恶寒自罢。是方之中，尤妙在麻黄配白术，虽发汗而不致过汗，白术配麻黄，善祛表里之湿，同时，可达微汗而解，更加桑枝横达肢臂而通络。方虽简而效验灵。
血痹
阎××，女性，39岁，妊娠两个月。近五日来，右下肢疼痛，继之咳嗽，痰清带血，咳引右侧肩背疼痛，胸闷痛，上气喘息，头目眩晕，尿少，食欲减退。于1956年3月7日住入昆华医院（即今省第一人民医院），经摄胸片等检查，诊断为右下肢栓塞性静脉炎合并肺梗塞，经西药治疗一周后拟作人工流产与截肢术。因患者不同意，于3月14日转入陆军医院（即今四十三医院），诊断同前。17日邀余会诊，详询病史，患者平素工作疲劳之时常感喘息、胸闷、心悸、短气乏力；此次妊娠后，出现右下肢疼痛，逐日加剧。近半月来咳嗽痰血，一直未止。入院后小便短少，一日仅二至三次。查得舌质青润，苔薄白，脉沉，面青，神疲欲寐，右下肢轻微浮肿，但不红，自觉疼痛拒按，不能站立。脉、舌、症三者合参，系平素心肺阳虚，寒邪凝滞。万全之策，宜先复心肺之阳兼以散寒为治，以俟转机。方用自拟姜桂苓半汤加元肉。处方：
二诊：上方服三剂后，上气喘息减轻，胸、肩、背疼痛渐趋缓解，舌质由青转红，脉由沉转弦，苔白腻。但大便不通，下肢疼痛不减，头痛隐隐。用自拟天麻汤加减。处方：
明天麻10克 葳蕤仁15克 北口芪15克 桂枝9克 杭芍9克
三诊：上方服三剂后，大便畅通，下肢疼痛减轻，微咳嗽，痰中略带血丝。用《伤寒论》桂枝加芍药汤加减。处方：
桂枝汤为妊娠第一方，具有温经通阳，调和营卫气杌之功，加重芍药有利于安扶胎元。
四诊：服上方二剂后，咳血止，下肢疼痛轻微。此时寒邪已基本消除，心阳渐复，但大便又呈现不通。用《伤寒论》麻仁丸加减，以润肺养血通便。处方：
甘草3克(白蜜一匙调入)
五诊：服上方一剂，大便畅通，下肢疼痛亦随之大减，但郁热渐起，虚烦失眠，痰血虽止，仍咳嗽，痰由清转稠。用自拟三豆银翘散合栀豉汤加减。处方：
淡豆豉9克 黑豆10克 红饭豆15克 桑叶10克 连翘10克
竹茹6克
六诊：服上方三剂后，咳痰大减，烦躁止，并能安眠，下肢疼痛逐渐消失。为了巩固疗效，用黄芪桂枝五物汤、黄芪建中汤，卫外守中，调和营卫，温通气机，促进血行，以三才封髓丹纳气归肾，使虚火不致上浮，继以炙甘草汤扶心肺之阴阳，以六君子汤健运脾胃。以上五方交替服用，从本调治，至4月20日，患者已能下楼活动而出院休养，到临产期安全分娩。
[按语]：此证关键在于心肺阳虚，寒邪凝滞，营卫失调，血行瘀阻。因此，出现下肢静脉栓塞、肺梗塞及咳嗽痰血等症。据此，以温散寒邪、恢复心阳为主，选用姜桂苓半汤、天麻汤等方，兼施育阴润燥，活血通便之剂(麻仁丸、三豆银翘散)，继用黄芪桂枝五物汤、黄芪建中汤、封髓丹、炙甘草汤和六君子汤等，以巩固疗效。其所以获效者，是由于在整个治疗过程中，从中医整体观念出发，本着“如常迟交”，“治本还当治标”的原则，并坚持机体的内外统一、上下统一的原理，才使错综复杂的病症得以缓解，免除了截肢，保住了胎儿。
右肢抖颤
刘××，男性，60岁。患右侧手足颤抖不止，历时二年多，曾经中西医治疗无效。症见：右手颤抖不已，右手不能取物，亦不能持物。畏寒身重，面色黯暗不泽，精神不振，甚感忧愁。舌苔滑腻，脉象三、五不整。索阅所服中药处方，多系养血祛风，清热涤痰之类。此症时日已久，若再迟延，则有“偏枯”之虞。查其病根在于脾肾阳虚，风痰郁阻。因肾阳即命火，命火不足，火不生土，则脾阳不振，水湿难运，湿痰停滞，阻碍肺胃气机之宣达。因脾主四肢，肺主一身之气，脾肺之机能受抑，木气鼓之，故手足颤抖也。因其标乃风痰，其本在脾肾，故滋阴养血，平肝熄风，非其所宜。根据以上分析，先以壮火扶阳、健脾燥湿、祛风豁痰之剂。用术附汤和郑钦安姜附茯半汤加味。处方：
上方附子配白术，名术附汤，专治肾阳虚衰、脾阳不运、湿浊停聚之证。生姜、附子、茯苓、半夏即姜附茯半汤，郑钦安谓为“回阳降逆、行水化痰之方”。生姜宣散壅滞之寒；茯苓、半夏燥湿健脾，降逆化痰；加南星祛风湿，化顽痰，天麻镇静息风，白芥子利气豁痰除寒暖中，甘草调和诸药。嘱服二剂。
二诊：药后精神较好。为求根治，宜予温肾扶阳、调和营卫、祛风散寒燥湿之剂。因此症不仅肾阳大虚，脾湿不运，而且肺胃气机郁滞，易致营卫失调，风寒湿邪阻遏经络不通。若舍疏通经络、调畅气机之剂，则治病之药不易到达病所。乃用自拟方附子桂枝独活寄生汤加南星。处方：
方解见本书“风寒湿痹”案。
三诊：服二剂，自觉颤抖有所减轻，患者颇感欣慰，要求续为根治。腻苔已退，此乃寒湿虽化而未净。由于经络疏通，脉由三五不整转为弦大，是脾肾之阳未复也。乃用附子理中汤加味。处方：
上方附子温壮脾肾之阳，理中汤大振中州，执中央以运四旁，此乃理中之旨也，加夏、苓燥湿健脾，降逆化痰，南星祛风痰；天麻、代赭石、紫石英、赤石脂镇肝息风，降逆除湿。
四诊：患者连服三剂，颤抖大减，右手已可取物，精神舒畅，情绪饱满，脉象由弦大而变柔和，舌苔薄腻。此阳气尚虚，寒湿未尽。用《伤寒论》附子汤与桂枝汤合方。处方：
此方主旨，在于温扶元阳，补脾化湿，调和营卫，通畅经络。连服三剂，症状消失而收全功。
[按语]：颤抖即颤振，此病方书记载甚少，王肯堂《证治准绳·杂病》谓：“颤，摇也；振，动也。筋脉约束不住而莫能任持，风之象也。”王氏分型，有阴血不足，有气虚，有心虚，有挟痰者。临床所见，尚有湿热所致者，此多见于嗜酒之人，亦有阳虚所致者，本例即是。根据病史及以往所服方药，结合现时表现，断为脾肾阳虚，风痰郁阻。采用壮火扶阳、健脾燥湿、祛风化痰之法，竞获全愈。其关键性用药在第三诊，方中所用代赭石、紫石英、赤石脂等味，为养肝、祛痰、降逆之要药，由本及标，故见效迅速。但初诊、次诊方，是为第三诊创造条件，奠定治疗基础的。若不经过这两个步骤，开始即用第三诊处方，则不易有此功效。故临床治病，应当注意分清标本缓急，做到胸中有数。否则，欲连而不达，事倍而功半，良好的动机，未必会有良好的效果。
肝寒腹痛
赵××，男性，32岁。患腹部疼痛，大便不解，曾用苦寒消导之药无效，随又自吃香蕉数枚，意欲通便。然大便未通，反而腹痛加剧，两胁作胀，从深夜至天明剧痛不止，冷汗淋漓，辗转呻吟，至次日午后，扶来我所就诊。
察其脉弦紧，舌质略青，苔白腻，面色青黯，表情苦楚，不思食。此系肝寒胃冷，寒湿凝滞，木不疏土之故。处以经验方“霹雳汤”：
方中，附片壮阳补火，散寒逐湿，治脾胃虚冷，吴萸温肝逐寒，散湿开郁，驱厥阴之浊邪，为治心腹疼痛要药，丁香温中、降逆、暖肾，治心腹冷痛，且有壮阳之功，木瓜平肝达郁、舒筋止痛，丝瓜络通经络，散结滞，行血脉，灶心土温中燥湿，暖胃止痛，《本草便读》说：“其功专入脾胃，有扶阳退阴散结除邪之意。”此方之用，目的在温中、疏肝、燥湿、止痛。不用甘草者，欲使药力由中焦而达丹田也。
二诊：上方服一次后，即觉腹痛减轻，尽剂则痛消失，且思饮食，面已不青，脉转缓和。形神安定，情志舒畅。但皮肤出现红色斑块。此病邪从里达表之佳象。宜因势利导，用通阳化气之剂以调畅气机。方用刘河间大橘皮汤加干姜。处方：
Chen XX, male, 15 years old. Suffering from swelling and pain in both knees for four years, unresponsive to prolonged treatment. At the time of consultation, the complexion was sallow with emaciation, lips were red, spirit was listless, and legs were too weak to support standing. The tongue body was red with a thin yellow coating, and the pulse was fine and rapid. Synthesizing the pulse and symptoms, this is Wind-Cold-Damp Bi syndrome that has persisted for a long time, with pathogenic factors lingering, causing obstruction of the meridians, stagnation transforming into heat, and Damp-Heat pouring into the knee joints without dissipating, resulting in swelling and pain due to Damp-Heat. The pattern belongs to Heat Bi; the treatment should focus on clearing heat and leaching out dampness, and unblocking the joints, while also nourishing fluids. Prescription:
Sha Shen (Glehniae Radix) 9g, Xuan Shen (Scrophulariae Radix) 9g, Zhu Ling (Polyporus) 9g, Fu Ling (Poria) 15g, Ze Xie (Alismatis Rhizoma) 9g
Tong Cao (Tetrapanacis Medulla) 6g, Bi Xie (Dioscoreae Hypoglaucae Rhizoma) 9g, Niu Xi (Achyranthis Bidentatae Radix) 6g, Huang Bo (Phellodendri Cortex) 9g, Tu Fu Ling (Smilacis Glabrae Rhizoma) 15g
Sang Zhi (Ramulus Mori) 15g
Instructed to take five doses, combined with external therapy.
External therapy: Sheng Cao Wu (Aconiti Kusnezoffii Radix) 90g, ground into fine powder and mixed with wheat flour 15g, added with appropriate amount of vinegar, mixed evenly and applied to the affected area. Cao Wu searches for wind and overcomes dampness, mainly treating wind-pain, unblocking meridians, benefiting joints, and breaking accumulations; wheat flour is used as an adhesive; vinegar is used for mixing, as recorded in *Bie Lu* ("mainly treats carbuncles and swellings, dissipates water qi, kills evil toxins"). Li Shizhen also said: "Vinegar is sour and astringent, and has the function of dissipating blood stasis and detoxifying, possessing the nature of bending and straightening."
After taking the above prescription for five doses and combining with external therapy, pain was significantly reduced, and swelling subsided by half. The prescription was changed to one for removing dampness, clearing heat, invigorating blood and unblocking collaterals, and separating clear from turbid. Prescription:
Cang Zhu (Atractylodis Rhizoma) 9g, Qin Jiao (Gentianae Macrophyllae Radix) 5g, Dang Gui (Angelicae Sinensis Radix) 9g, Du Zhong (Eucommiae Cortex) 15g, Niu Xi (Achyranthis Bidentatae Radix) 9g
Zhi Mu (Anemarrhenae Rhizoma) 9g, Bi Xie (Dioscoreae Hypoglaucae Rhizoma) 9g, Yi Ren (Coicis Semen) 15g, Mu Gua (Chaenomelis Fructus) 9g, Tong Cao (Tetrapanacis Medulla) 5g
Sang Bai Pi (Mori Cortex) 9g, Sang Zhi (Ramulus Mori) 15g
Instructed to take five doses. External therapy as above.
After the above treatment, pain stopped, swelling disappeared, and all symptoms alleviated. Based on the theory that "the Spleen governs the four limbs" and "Lung heat scorching the leaves" can also lead to Wei syndrome (flaccidity), continued with Liu Jun Tang (Six Gentlemen Decoction) plus Mai Dong (Ophiopogonis Tuber) to benefit Qi and strengthen the Spleen, clear Metal and protect the Lung. Taken continuously for several doses, then cured.
[Commentary]: This case belongs to the category of "Heat Bi" in Traditional Chinese Medicine. Bi syndrome is generally divided into four types: Wind Bi, Cold Bi, Damp Bi, and Heat Bi. Clinically, Yang deficiency with Cold-Damp predominance is more common. However, constitutive Yin deficiency, latent heat in the constitution, Cold-Damp stagnating for a long time without dissipating, or excessive use of acrid-warm drugs can all transform into Heat Bi. Heat Bi often carries Dampness, so the treatment of Heat Bi should focus on clearing heat and leaching out dampness, and unblocking the joints. For long-standing cases, nourishing fluids is also necessary. For joint swelling and pain, combining with external therapy is also excellent. In this case, due to the long duration, Sha Shen and Xuan Shen were used at the first visit because the patient had chronic Damp-Heat Bi, showing signs such as inability to bear weight on the feet. It is appropriate to clear heat, protect the Lung, and nourish fluids to prevent the development of Wei syndrome. Furthermore, since the Spleen dislikes dampness and governs the four limbs, if Spleen dampness does not transform, it seeps down into the collaterals and flows to the lower limbs, causing edema. If Cold-Damp stagnates for a long time and transforms into heat, Damp-Heat becomes interlocked. Therefore, Er Qin (Huang Qin and Huang Bo), Ze Xie, Tong Cao, Bi Xie, Huang Bo, and Huai Niu Xi are used to leach out and transform Damp-Heat, guiding heat downward; Sang Zhi and Tu Fu Ling promote dampness removal and detoxification, unblock the joints; Cang Zhu and Qin Jiao dispel wind and dry dampness; Zhi Mu clears heat; Yi Ren and Mu Gua enter the Liver to relax sinews; Dang Gui invigorates blood and nourishes blood. Du Zhong, according to Wang Haogu, is a Qi-level herb of the Liver meridian, moistens the Liver and dries dryness, tonifies Liver deficiency, and strengthens the waist and knees; Niu Xi guides the herbs to the disease site. Together, they present the effects of removing dampness, clearing heat, invigorating blood, unblocking collaterals, and separating clear from turbid.
The above prescriptions have good efficacy in treating Damp-Heat Bi syndrome and have cured many cases, worthy of recommendation. However, for external therapy, if allergy occurs after application (itching or rash), it should be stopped.
Left Arm Pain
Zhao XX, male, 21 years old. Suffering from left arm pain for over two months, ineffective with Western analgesics and Chinese medicines for warming Yang, removing dampness, and dispelling wind. Invited Yu for treatment. Symptoms: difficulty moving the left upper limb, severe pain, no redness or swelling. No sweat, aversion to cold, normal tongue body, thin white coating, floating and tight pulse. Inquiry revealed the cause was sleeping facing the wind at night, allowing Wind-Cold-Damp pathogens to lodge in the meridians. The method should be removing dampness, dispelling wind, and scattering cold. Selected formula: Ma Huang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction) from *Jin Gui Yao Lue* combined with Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) plus Sang Zhi (Ramulus Mori). Prescription:
Ma Rong (Ephedrae Herba) 6g, Gui Zhi (Cinnamomi Ramulus) 9g, Xing Ren (Armeniacae Semen Amarum) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 12g, Sheng Yi Ren (Coicis Semen) 15g
Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sang Zhi (Ramulus Mori) 15g
Taken continuously for two doses, the patient sweated slightly, and the illness was cured.
[Commentary]: Arm pain, although a minor ailment, if treated improperly, will persist and be difficult to cure. This case belongs to Bi syndrome in TCM. Bi means obstruction. "Obstruction leads to pain," using acrid-warm mild sweating method to ventilate and unblock, following Zhong Jing's saying: "If treating Wind-Damp, induce sweating, but only slightly as if wanting to sweat, then both Wind and Damp will go." Ma Huang Jia Zhu Tang is a heavy agent for removing dampness, dispelling wind, and scattering cold; Ma Xing Yi Gan Tang is a light agent for inducing sweating, promoting diuresis, and releasing the exterior. Combining heavy and light agents effectively treats obvious Wind-Cold Bi. Although there is aversion to cold, it is due to exterior Yang being constrained, known from the floating and tight pulse, not comparable to the aversion to cold in Shao Yin disease. Therefore, Da Xin Da Re (greatly acrid and greatly hot) Fu Zi (Aconiti Lateralis Radix Praeparata) is not used; only Gui Zhi (Cinnamomi Ramulus) which unblocks Yang and transforms Qi is used, so that Wei Yang (Defensive Yang) is energized, and aversion to cold disappears naturally. Among these formulas, the brilliance lies in Ma Huang pairing with Bai Zhu; although it induces sweating, it does not cause excessive sweating. Bai Zhu pairing with Ma Huang effectively removes interior and exterior dampness, achieving mild sweating and resolution. Additionally, Sang Zhi reaches horizontally to the arms and unblocks collaterals. The formula is simple but effective.
Blood Bi
Yan XX, female, 39 years old, pregnant for two months. For the past five days, right lower limb pain, followed by cough, clear sputum with blood, cough drawing pain to the right shoulder and back, chest tightness and pain, shortness of breath and wheezing, dizziness, oliguria, and decreased appetite. Admitted to Kunhua Hospital (now Provincial First People's Hospital) on March 7, 1956. After chest X-ray and other examinations, diagnosed with right lower limb thrombophlebitis complicated by pulmonary embolism. After one week of Western medicine treatment, artificial abortion and amputation were planned. Due to patient's disagreement, transferred to Army Hospital (now 43rd Hospital) on March 14, diagnosis same as before. On the 17th, invited Yu for consultation. Detailed history taking: usually feels wheezing, chest tightness, palpitations, shortness of breath, and fatigue when working tiredly; after this pregnancy, right lower limb pain appeared, worsening daily. For the past half month, coughing up bloody sputum has not stopped. After admission, urine was scanty, only two to three times a day. Examination showed bluish moist tongue body, thin white coating, deep pulse, blue complexion, listlessness and desire to sleep, slight edema in the right lower limb but not red, voluntary pain and refusal to press, unable to stand. Synthesizing pulse, tongue, and symptoms, it is constitutive Heart-Lung Yang deficiency with Cold pathogen stagnation. The best strategy is to first restore Heart-Lung Yang and scatter cold to wait for a turning point. Formula: Self-made Jiang Gui Ling Ban Tang (Ginger, Cinnamon Twig, Poria, and Pinellia Decoction) plus Yuan Rou (Longan Aril). Prescription:
Sheng Jiang (Zingiberis Rhizoma Recens) 15g, Gui Zhi (Cinnamomi Ramulus) 15g, Fu Ling (Poria) 15g, Fa Xia (Pinelliae Rhizoma Preparatum) 9g, Yuan Rou (Longani Arillus) 15g
Second Visit: After taking three doses of the above prescription, shortness of breath and wheezing alleviated, chest, shoulder, and back pain gradually relieved, tongue body turned from blue to red, pulse changed from deep to wiry, coating white and greasy. But stool was not passing, lower limb pain unchanged, dull headache. Used self-made Tian Ma Tang (Gastrodia Decoction) modified. Prescription:
Tian Ma (Gastrodiae Rhizoma) 10g, Wei Rui Ren (Polygonati Odorati Rhizoma) 15g, Bei Kou Qi (Astragali Radix) 15g, Gui Zhi (Cinnamomi Ramulus) 9g, Hang Shao (Paeoniae Radix Alba) 9g
Fa Xia (Pinelliae Rhizoma Preparatum) 9g, Fu Ling (Poria) 15g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 6g, Fang Feng (Saposhnikoviae Radix) 9g, Du Huo (Angelicae Pubescentis Radix) 6g
Gao Ben (Ligustici Wallichii Rhizoma) 6g, Qin Jiao (Gentianae Macrophyllae Radix) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 2 pieces
Third Visit: After taking three doses of the above prescription, stool passed smoothly, lower limb pain alleviated, slight cough, sputum with traces of blood. Used Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction Plus Peony Root) from *Shang Han Lun* modified. Prescription:
Gui Zhi (Cinnamomi Ramulus) 9g, Hang Shao (Paeoniae Radix Alba) 15g, Zhi Yuan Zhi (Polygalae Radix) 6g, Zhi Dong Hua (Genkwa Flos) 9g, Fu Shen (Poria Cum Radix) 15g
Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Pao Jiang (Zingiberis Rhizoma Preparatum) 9g
Gui Zhi Tang is the first formula for pregnancy, having the functions of warming meridians and unblocking Yang, harmonizing Ying and Wei. Increasing Shao Yao helps stabilize the fetus.
Fourth Visit: After taking two doses of the above prescription, hemoptysis stopped, lower limb pain was slight. At this time, Cold pathogen was basically eliminated, Heart Yang gradually restored, but stool became obstructed again. Used Ma Ren Wan (Hemp Seed Pill) from *Shang Han Lun* modified to moisten the Lung, nourish blood, and promote bowel movement. Prescription:
Huo Ma Ren (Cannabis Fructus) 15g, Xing Ren (Armeniacae Semen Amarum) 9g, Hang Shao (Paeoniae Radix Alba) 9g, Gua Lou Ren (Trichosanthis Semen) 9g, Tong Da Hai (Sterculiae Lychnophorae Semen) 3 pieces
Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g (mixed with one spoonful of white honey)
Fifth Visit: After taking one dose of the above prescription, stool passed smoothly, lower limb pain also significantly reduced, but stagnant heat gradually arose, empty vexation and insomnia. Although hemoptysis stopped, still coughing, sputum changed from clear to thick. Used self-made San Dou Yin Qiao San (Three Beans and Honeysuckle Powder) combined with Zhi Chi Tang (Gardenia and Fermented Soybean Decoction) modified. Prescription:
Dan Dou Chi (Sojae Semnis Preparatum) 9g, Hei Dou (Sojae Semen Nigrum) 10g, Hong Fan Dou (Phaseoli Radiati Semen Rubrum) 15g, Sang Ye (Mori Folium) 10g, Lian Qiao (Forsythiae Fructus) 10g
Zhe Bei Mu (Fritillariae Thunbergii Bulbus) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Fu Ling (Poria) 9g
Ku Qin (Scutellariae Radix) 6g, Deng Xin Cao (Junci Medulla) 1 bundle
Zhu Ru (Bambusae Caulis in Taenia) 6g
This formula clears the Lung and removes phlegm; "lightness can remove excess" to eliminate stagnant heat.
Sixth Visit: After taking three doses of the above prescription, cough and sputum significantly reduced, vexation stopped, able to sleep peacefully, lower limb pain gradually disappeared. To consolidate efficacy, used Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Twig Five-Substance Decoction) and Huang Qi Jian Zhong Tang (Astragalus and Middle-Warming Decoction) to defend the exterior and guard the center, harmonize Ying and Wei, warm and move Qi mechanism, promote blood circulation. Used San Tai Feng Sui Dan (Three Talents Sealing Marrow Pill) to guide Qi back to the Kidney, preventing deficient fire from floating upward. Then used Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) to support Heart-Lung Yin and Yang, and Liu Jun Zi Tang (Six Gentlemen Decoction) to strengthen and transport the Spleen and Stomach. Alternately taking the above five formulas, treating from the root, until April 20, the patient could go downstairs to activity and was discharged for rest, delivering safely at term.
[Commentary]: The key to this case is Heart-Lung Yang deficiency, Cold pathogen stagnation, disharmony of Ying and Wei, and blood stasis. Therefore, symptoms such as lower limb venous thrombosis, pulmonary embolism, and coughing up bloody sputum appear. Based on this, focusing on warming and scattering Cold pathogen and restoring Heart Yang, selected formulas like Jiang Gui Ling Ban Tang and Tian Ma Tang, combined with nourishing Yin and moistening dryness, invigorating blood and promoting bowel movement agents (Ma Ren Wan, San Dou Yin Qiao San), then continuing with Huang Qi Gui Zhi Wu Wu Tang, Huang Qi Jian Zhong Tang, Feng Sui Dan, Zhi Gan Cao Tang, and Liu Jun Zi Tang to consolidate efficacy. The reason for success is that throughout the treatment process, starting from the TCM holistic concept, adhering to the principles of "gradual progression" and "treating the root requires treating the branch," and insisting on the unity of internal and external, upper and lower parts of the body, the complex symptoms were alleviated, avoiding amputation and saving the fetus.
Right Limb Trembling
Liu XX, male, 60 years old. Suffering from continuous trembling of the right hand and foot for over two years, ineffective with Chinese and Western medicine treatments. Symptoms: right hand trembling incessantly, unable to pick up or hold objects. Aversion to cold, heavy body, dark and lusterless complexion, low spirit, feeling very worried. Tongue coating slippery and greasy, pulse irregular (three or five beats irregular). Reviewed previous Chinese medicine prescriptions, mostly for nourishing blood and dispelling wind, clearing heat and washing away phlegm. This symptom has lasted a long time; if delayed further, there is a risk of "hemiplegia." Investigating the root cause, it lies in Spleen-Kidney Yang deficiency and Wind-Phlegm stagnation. Because Kidney Yang is Ming Huo (Life Fire), if Ming Huo is insufficient, Fire does not generate Earth, so Spleen Yang is not vigorous, water-dampness is hard to transport, damp-phlegm stagnates, obstructing the dissemination of Lung-Stomach Qi mechanism. Since the Spleen governs the four limbs and the Lung governs the Qi of the whole body, if Spleen-Lung functions are suppressed, Wood Qi drums them, causing hand and foot trembling. Since the branch is Wind-Phlegm and the root is Spleen-Kidney, nourishing Yin and blood, calming Liver and extinguishing wind is not suitable. Based on the above analysis, first use agents to strengthen fire and support Yang, strengthen Spleen and dry dampness, dispel wind and resolve phlegm. Use Shu Fu Tang (Atractylodes and Aconite Decoction) and Zheng Qin An's Jiang Fu Fu Ban Tang (Ginger, Aconite, Poria, and Pinellia Decoction) modified. Prescription:
Hei Fu Pian (Prepared Aconite Slice) 60g, Piao Bai Zhu (Washed Atractylodis Rhizoma) 30g, Sheng Jiang (Zingiberis Rhizoma Recens) 30g (extract juice and add in portions)
Fu Ling (Poria) 15g, Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Zhi Nan Xing (Prepared Arisaematis Rhizoma) 15g, Ming Tian Ma (Gastrodiae Rhizoma) 9g
Bai Jie Zi (Sinapis Semen) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g
The above prescription of Fu Zi paired with Bai Zhu is named Shu Fu Tang, specifically treating Kidney Yang deficiency decline, Spleen Yang non-transport, and turbid dampness accumulation. Sheng Jiang, Fu Zi, Fu Ling, Ban Xia constitute Jiang Fu Fu Ban Tang. Zheng Qin An called it a "formula to return Yang, descend rebellion, move water, and resolve phlegm." Sheng Jiang disperses stagnant cold; Fu Ling and Ban Xia dry dampness and strengthen Spleen, descend rebellion and resolve phlegm; adding Nan Xing dispels wind-damp and resolves stubborn phlegm; Tian Ma calms and extinguishes wind; Bai Jie Zi benefits Qi, resolves phlegm, removes cold, and warms the middle; Gan Cao harmonizes the herbs. Instructed to take two doses.
Second Visit: Spirit is better after medication. To seek radical cure, should use agents to warm Kidney and support Yang, harmonize Ying and Wei, dispel wind, scatter cold, and dry dampness. Because this condition not only has severe Kidney Yang deficiency and Spleen dampness non-transport, but also Lung-Stomach Qi mechanism stagnation, easily leading to Ying-Wei disharmony and Wind-Cold-Damp pathogens obstructing meridians and blocking flow. If abandoning agents to unblock meridians and smooth Qi mechanism, medicinal ingredients for treating disease will not easily reach the disease site. Therefore, used self-made formula Fu Zi Gui Zhi Du Huo Ji Sheng Tang (Aconite, Cinnamon Twig, Angelica Pubescens, and Taxillus Decoction) plus Nan Xing. Prescription:
Hei Fu Pian (Prepared Aconite Slice) 60g, Gui Zhi (Cinnamomi Ramulus) 9g, Chao Hang Shao (Stir-fried Paeoniae Radix Alba) 9g, Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Fu Ling (Poria) 15g
Chuan Xiong (Ligustici Chuanxiong Rhizoma) 6g, Fang Feng (Saposhnikoviae Radix) 9g, Du Huo (Angelicae Pubescentis Radix) 6g, Sang Ji Sheng (Taxilli Caulis et Folium) 15g, Tai Wu (Cyperi Rhizoma) 9g
Zhi Nan Xing (Prepared Arisaematis Rhizoma) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Shao Sheng Jiang (Roasted Ginger) 3 slices, Da Zao (Jujubae Fructus) 3 pieces
Formula explanation see "Wind-Cold-Damp Bi" case in this book.
Third Visit: After taking two doses, felt trembling slightly reduced, patient was quite gratified, requested continuous radical cure. Greasy coating has retreated, indicating Cold-Damp has transformed but not completely cleared. Due to meridian unblocking, pulse changed from irregular to wiry and large, indicating Spleen-Kidney Yang has not yet recovered. Therefore, used Fu Zi Li Zhong Tang (Aconite and Center-Harmonizing Decoction) modified. Prescription:
Hei Fu Pian (Prepared Aconite Slice) 60g, Luo Dang Shen (Codonopsis Radix) 15g, Piao Bai Zhu (Washed Atractylodis Rhizoma) 15g, Gan Jiang (Zingiberis Rhizoma) 15g
Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Fu Ling (Poria) 15g, Zhi Nan Xing (Prepared Arisaematis Rhizoma) 9g, Ming Tian Ma (Gastrodiae Rhizoma) 15g
Dai Zhe Shi (Haematitum) 15g, Zi Shi Ying (Pyritum) 15g, Chi Shi Zhi (Kaolin) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g
The above prescription Fu Zi warms and strengthens Spleen-Kidney Yang; Li Zhong Tang greatly revitalizes the Central Pivot, holding the center to operate the four directions, which is the essence of Li Zhong. Added Ban Xia and Fu Ling to dry dampness and strengthen Spleen, descend rebellion and resolve phlegm; Nan Xing dispels Wind-Phlegm; Tian Ma, Dai Zhe Shi, Zi Shi Ying, and Chi Shi Zhi calm Liver and extinguish wind, descend rebellion and remove dampness.
Fourth Visit: Patient took three doses continuously, trembling significantly reduced, right hand can now pick up objects, spirit is comfortable, mood full, pulse changed from wiry-large to soft, tongue coating thin and greasy. This indicates Yang Qi is still deficient, Cold-Damp not fully exhausted. Used Fu Zi Tang (Aconite Decoction) from *Shang Han Lun* combined with Gui Zhi Tang (Cinnamon Twig Decoction). Prescription:
Hei Fu Pian (Prepared Aconite Slice) 60g, Luo Dang Shen (Codonopsis Radix) 15g, Piao Bai Zhu (Washed Atractylodis Rhizoma) 15g, Fu Ling (Poria) 15g
Chao Hang Shao (Stir-fried Paeoniae Radix Alba) 9g, Gui Zhi (Cinnamomi Ramulus) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 9g, Da Zao (Jujubae Fructus) 3 pieces
The main purpose of this formula is to warmly support Primordial Yang, tonify Spleen and transform dampness, harmonize Ying and Wei, and unblock meridians. Taken continuously for three doses, symptoms disappeared and complete success was achieved.
[Commentary]: Trembling is also called tremor. This disease is rarely recorded in medical books. Wang Kentang's *Zheng Zhi Zhun Sheng · Miscellaneous Diseases* states: "Trembling is shaking; vibration is movement. Tendons and vessels cannot restrain themselves and cannot maintain posture, which is a sign of Wind." Wang's classification includes insufficient Yin-blood, Qi deficiency, Heart deficiency, and carrying Phlegm. Clinically observed, there are also those caused by Damp-Heat, common in alcoholics, and those caused by Yang deficiency, which is this case. Based on medical history and previously taken prescriptions, combined with current manifestations, diagnosed as Spleen-Kidney Yang deficiency and Wind-Phlegm stagnation. Adopted methods of strengthening fire and supporting Yang, strengthening Spleen and drying dampness, dispelling wind and resolving phlegm, ultimately achieving complete cure. The key medication was in the third visit. The agents used in the formula, such as Dai Zhe Shi, Zi Shi Ying, and Chi Shi Zhi, are essential herbs for nourishing Liver, resolving phlegm, and descending rebellion. Treating the root to address the branch, thus见效 rapidly. However, the first and second visit formulas were to create conditions for the third visit and lay the foundation for treatment. Without going through these two steps, starting directly with the third visit prescription would not yield such efficacy. Therefore, in clinical treatment, one should pay attention to distinguishing root and branch, urgency and slackness, keeping it clear in mind. Otherwise, desiring connection but failing to reach, doubling effort for half result, good intentions may not necessarily yield good results.
Liver Cold Abdominal Pain
Zhao XX, male, 32 years old. Suffering from abdominal pain, constipation, ineffective with bitter-cold digestive medicines, then ate several bananas himself intending to promote bowel movement. But stool did not pass, instead abdominal pain intensified, hypochondriac distension, severe pain unceasing from late night to dawn, cold sweat profuse, tossing and moaning, next afternoon brought to my clinic for consultation.
Observed pulse wiry and tight, tongue body slightly blue, coating white and greasy, complexion blue-dark, expression painful, no desire to eat. This is Liver Cold and Stomach Cold, Cold-Damp stagnation, Wood failing to soothe Earth. Prescribed experience formula "Lei Ting Tang" (Thunderbolt Decoction):
Hei Fu Pian (Prepared Aconite Slice) 30g, Chao Wu Yu (Stir-fried Evodiae Fructus) 6g, Gong Ding Xiang (Syzygium aromaticum) 4g, Mu Gua (Chaenomelis Fructus) 6g
Si Gua Luo (Luffae Fibrosum Reticulum) 6g, Zao Xin Tu (Caulis Trapaehydrosites) 30g
In the formula, Fu Pian strengthens Yang and supplements fire, scatters cold and drives out dampness, treats Spleen-Stomach deficiency cold; Wu Yu warms Liver and scatters cold, dissipates dampness and opens depression, drives out turbid pathogens of Jue Yin, is an important herb for treating heart and abdominal pain; Ding Xiang warms middle, descends rebellion, warms Kidney, treats heart and abdominal cold pain, and has strong Yang function; Mu Gua levels Liver and reaches depression, relaxes sinews and stops pain; Si Gua Luo unblocks meridians, dissipates nodules and stagnation, moves blood vessels; Zao Xin Tu warms middle and dries dampness, warms Stomach and stops pain. *Ben Cao Bian Du* says: "Its function specializes in entering Spleen and Stomach, with the intention of supporting Yang, retreating Yin, dissipating nodules, and eliminating pathogens." The purpose of this formula is to warm the middle, soothe Liver, dry dampness, and stop pain. Not using Gan Cao is to allow medicinal power to reach the Dantian from the Middle Jiao.
Second Visit: After taking one dose of the above prescription, felt abdominal pain reduced immediately, finished the dose and pain disappeared, desired food, complexion no longer blue, pulse turned moderate. Form and spirit stable, emotions smooth. But red patches appeared on skin. This is a good sign of pathogen moving from interior to exterior. Should guide according to momentum, use agents to unblock Yang and transform Qi to smooth Qi mechanism. Formula used Liu He Jian's Da Ju Pi Tang (Large Tangerine Peel Decoction) plus Gan Jiang (Zingiberis Rhizoma). Prescription:
Chen Pi (Citri Reticulatae Pericarpium) 6g, Zhu Ling (Polyporus) 9g, Fu Ling (Poria) 12g, Ze Xie (Alismatis Rhizoma) 12g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 9g
Gui Zhi (Cinnamomi Ramulus) 9g, Guang Mu Xiang (Aucklandiae Radix) 4.5g, Bing Lang (Arecae Semen) 9g, Liu Yi San (Six-to-One Powder) 9g, Gan Jiang (Zingiberis Rhizoma) 9g
In the formula, Wu Ling San (Five-Ingredient Powder with Poria) transforms Qi and moves water; Gui Zhi can also unblock Yang, open Lung Qi, and scatter Wind pathogens; Chen Pi and Mu Xiang strengthen Stomach and regulate Qi; Liu Yi San clears heat and promotes diuresis; added Gan Jiang to assist Gui Zhi's power to unblock Yang.
Third Visit: After taking one dose, patches disappeared, but Cold knot not transformed, stool unsatisfactory. Dampness transformed from heat, poured into Bladder causing scanty and reddish urine. Prescribed Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) from *Jin Gui Yao Lue*. Prescription.