六味地黄汤为治肝肾不足、真阴亏损之名方。此例即为肝肾阴虚是病之本，故用此方加蔓荆子搜风凉血，且止脑鸣；柴胡疏肝达郁，畅达气血，并升举清气，钩藤平肝熄风；三味加入六味地黄汤中，则有滋水养肝，熄风之效。
上方服五剂，各证均减。
例二：
王××，女，三十余岁，患头痛，目眩且胀，尤以眉棱骨胀甚。脉弦兼数，口干，舌略红。脉症合参，此系血虚生风。法当养血祛风为治。处方：
肝藏血，血虚即是肝虚。本方黄芪、当归为补血汤。补气益血，佐枸杞滋肾补肝，为治本之图。加柴胡达木郁以调畅气血，白芷祛风止痛，钩藤、刺蒺藜、菊花平肝熄风，天麻独入肝经，尤增强治虚风内动之效。菊花一味《本经》称其“主诸风肿痛，目欲脱泪出”。此方组合对血虚生风之头痛，尤为切合，乃本“治风先行血，血行风自灭”之旨。
二诊：上方服三剂后，头痛止，眉棱骨胀亦减轻。仍守原方去黄芪加黑豆10克、荷顶1O克再服三剂，诸证悉除。
例三：
武××，男，四十五岁，患头痛引左颈麻木疼痛不能转侧已十余年，曾经多方治疗，效未显，转余诊治。按其脉濡滑，舌淡苔白腻。自诉：痛甚时欲呕，常感四肢酸困。证属寒湿不化所致，拟温阳化湿通络为治。予自拟小白附子汤。处方：
小白附子30克 天麻15克 法夏10克 茯苓15克 葳蕤仁20克
嘱患者守方服用，共服至三十余剂，十余年之顽固疾患竞愈。至今多年未发。
[按]：小白附子一方，为余多年临床常用有效方剂。举几体功不足，阳虚外感，或寒湿阻滞经络所致之头痛，用之均有疗效。
余曾以此方治一李姓妇女，四十余岁，患两下肢剧烈疼痛，且出现对称性红斑。诊为营卫阻滞，气机不调，用小白附子汤加羌活、秦艽五剂而愈。
例四：
李××，男，四十余岁，患头顶疼痛，已历数月之久，兼见失眠、耳鸣，心烦，不能任劳。某医以肾阳虚论治，用附片、狗脊、白术、吴萸、肉桂、寄生、黄芪、党参和干姜等药治之。服二剂后，头顶疼痛加剧，转余诊治。查其脉弦滑，舌苔白腻。详细询问，曾因长期工作劳烦，脾阳不足，痰厥生风所致。拟方以李东垣半夏白术天麻汤加味。处方：
痰厥头痛，非半夏不能疗；虚风眩晕非天麻不能除。党参、黄芪甘温益气健脾，白术、苍术，甘、苦、温，健脾燥湿，补益脾阳，陈皮理气化痰；神曲、麦芽消食和胃，去胃中积滞。干姜温中散寒，黄柏坚肾益阴而退虚热，泽泻利水渗湿，茯苓渗湿健脾。加蔓荆子、菊花疏散风热。诸药共呈健脾燥湿、祛痰宣散风热之功。
二诊：服上方二剂，头顶疼痛大减，惟尚眩晕，耳鸣。午后心烦，唇舌略紫。此乃湿郁化热，加之元阴不足，相火浮动。拟“水中置介”法。方用自拟首乌黑芝麻散加减。处方：
龟板15克 首乌00克 黑芝麻15克 龙骨15克 牡蛎15克
方中首乌、黑芝麻补肝肾益气血，龙骨、牡蛎重镇安神；石斛清虚热，栀子苦寒泻火、凉血清心；桑叶、菊花、钩藤平肝熄风以治头眩。
三诊：服二剂后，头顶疼痛消失，仍有心烦失眠。用龙虎丹以交心肾。处方：
川附片30克 上肉桂6克 云黄连5克 龙骨15克 牡蛎15克
附片、枣仁以强心，黄连、肉桂即交泰丸以交心肾，任心火下注于肾；肾水温则上济于心，水火相济则神安。桂枝、甘草、龙骨、牡蛎即《伤寒论》桂枝甘草龙骨牡蛎汤。桂枝和营血而扶心阳，龙、牡收浮越之阳而复阴，茯神宁心安神，甘草、干姜温中阳。
四诊：服一剂后，心烦大减，竞已得寐。嘱用原方再进二剂，并用龟龄集二瓶作调理而愈。
龟龄集系我国最早的升炼剂之一，采用多种珍贵的动、植物药材炼制而成，有强身健脑，固肾补气，调整肝肾之功。
例五：
胡××，男，二十五岁，患头痛且胀，痛引前额，午后尤剧，病已月余。曾服止痛药效未显，转余诊治。其脉弦数，舌质红苔黄腻，心烦，口干。脉症合参诊为胆胃郁热、风热上乘所致。选用自拟菊花粉葛汤加味。处方：
荷顶10克
二诊：上方服二剂后，头胀痛遂止，脉已不数尚弦，苔黄腻略减，尤感心烦。用温胆汤加味，继清胆胃郁热。处方：
吴芷6克夏枯花6克 甘草3克 竹茹3克荷顶10克 桑叶1o克上方服三剂，诸证消失而愈。
例六：
张××，女，四十余岁，经期前即感头痛绵绵不休，历时已年余。诊脉细弦，舌淡润无苔。此系血虚生风兼肝气不舒。本《内经》木郁达之，法当养血舒肝解郁。用逍遥散加味。处方：
当归、杭芍补血和营养肝，茯苓、白术健脾补中。柴胡、香附和薄荷疏肝解郁，加天麻、吴芷、川芎活血祛风止痛。炙甘草、炮姜苦甘化阴，与归、芍合用有调和气血之功。诸药共呈健脾养血、祛风解郁止痛之效。仅服三剂而痛即止。嘱每月经期前守方服三剂。服三月，多年经前头痛即未再发。
例七：
王××，女，二十七岁。病由产后血虚受寒，致头痛隐隐，持续一年，遇风更甚。经多方治疗，疼痛虽有所减轻，但未根治，每遇风头痛即发。诊其脉沉细，舌淡无苔，畏风特甚。脉症合参，系肝血不足，血虚生风。法当补血养肝祛风。用加味愈风散。处方：
方解见本书“产后发热”治案。
临床实践证明，本方药昧虽简而功效显著，曾用本方治疗产后血虚生风所致之头痛，或产后血虚受寒所致之发热头身痛，无不药到病除。治案较多，不再另举。
例八：
杨××，女，三十八岁，产后曾大流血，服药血止后．即现头痛，时作眩晕，面赤灼热。脉细，舌淡润。此为阴血暴虚，阳无所附，故面赤灼热，乃假热征象也，气血不能上荣于脑，故头痛；血虚生风，故时作眩晕。拟方以补水汤合当归补血汤，大补气血而滋水为治。处方：
白洋参15克 当归15克 口芪20克 焦黄柏6克 白蜜15克
方中白洋参、黄柏、白蜜为补水汤，有大滋肾水之功。白洋参大补心气。黄柏苦以坚肾，合白蜜之甘，苦甘化阴．阴得化生而血液不竭。加当归补血汤，补气补血，使气充血旺，浮阳得以潜纳。
二诊：上方服二剂后，头痛眩晕好转，阳气收纳，面赤灼热转为苍白。拟归脾汤去木香、白术加天麻、法夏、杭芍继补心脾。上方续服三剂，头痛眩晕悉除。
[按]：头居人体最高往。手足三阳经和主一身阳气的督脉及足厥阴肝经均上会于头。所以说“头为诸阳之会”，凡五脏精华之血，六腑清阳之气皆上会于此。头痛一证，有内伤与外感之分。外感头痛不外六淫之邪循经上犯，治疗关健在于分清六淫之性质，体质之强弱，掌握经络循行部位，则不难辨也。所难辨者，内伤头痛，证情较复杂。纯虚与纯实者易治，虚实互见，寒热相兼者，则较为难治，非一方、一法所能取效。宜方随证变，尤其掌握体质因素最关重要。治病必求其本，非见痛止痛所能见效。上逆八例，均属临床所常见，特为立案，以备参考。
张××，女，四十岁。初病发热身痛，旋即风痰上涌，颈项强直，不能转侧，面青神迷，口噤不开，舌不能伸，脉沉细而紧。脉证合参，显系太阳经脉为寒邪所滞而引起。因太阳与少阴互为表里，少阴主里，今寒邪入于阴分，正邪相搏，浊阴上逆，蒙蔽清窍，故法当温经散寒，祛风化痰。方用《伤寒论》麻黄附子细辛汤加味。处方：
方中用麻黄附子细辛汤固元阳，开腠理，散寒邪而退热，加雄黄以辟百毒。胆炒半夏降上逆之浊阴，配南星、姜汁以化散风痰。全蝎、僵蚕祛风化痰而开窍，既引诸药上行，又能升清降浊。如此组合成方，俾能药证相符。
二诊：上方服二剂，热渐退，神渐清，口能微开，舌可半伸。惟面色尚青，身犹困重，颈项仍不能转侧，脉弦紧．舌苔白腻。此太阳气机闭塞，寒湿阻滞，改以自拟方小白附子汤加减。处方：
三诊：上方服二剂，口已能开七八，舌能伸出，脉转缓和。发热全退，痰涎减少，神志已清。宜扶心肺之阳，以化未净之痰。方用郑钦安姜桂汤。处方：
四诊：上方服三剂，口全开，舌体伸缩自如，面色复常。是方能升扶上焦阳气。因阳气不足于上，则上焦之阴邪弥漫，以致风痰上涌而闭塞脏腑经络气机。故服后阳气得升，阴邪得散，痰涎得化，余症亦减，仅觉头部微痛，是上逆之浊阴未净，仍宜扶阳抑阴，宣散阴邪。方用《伤寒论》四逆汤加味。处方：
上方服二剂，诸症痊愈。
[按]：此案病名，系原稿所用，所谓“捻颈风”，大体上是指感受外邪后，出现风痰上涌，颈项强直，如有人捻，口噤不开，舌不能伸等症状而言。关键仍在辨证。证既明，有是证而用是药。本例属于虚寒阴证，故先以温经散 寒，继以活络祛风，终以温扶阳气而愈。
李××，女，十八岁。因感寒后发热四十余日不退，曾经中西医治疗，症状如故，前来就诊。症见：胸满、食少，日晡发热，恶寒踡卧，不思水饮，二便自利。面色晦暗而黑，舌润滑，脉沉细如丝。查阅所服中医处方，有按阳虚治者，曾用四逆汤、白通汤；有按阴虚治者，曾用青蒿、地骨皮、鳖甲之类及甘露饮等，均无效。按脉症分析，显系不足之阴症。滋阴固非所宜，但为何用扶阳之四逆、白通亦无效?反复思之，此症之发热，系太阳气机被寒邪郁闭，未能及时解散。太阳之里为少阴(足太阳膀胱与足少阴肾相表里)，寒邪入里，真阳失运，此为伤寒太阳、少阴两感之重症。四逆汤虽能扶阳，但不能驱邪外出；白通汤亦交阴阳之方，但所交者系心肾之阴阳(葱白引心中之阴下交于肾，附子引肾中之阳上交于心)，不能交表里之阴阳，故无效。此症之治，全在交表里之阴阳，温经解表，乃用《伤寒论》麻黄附子细辛汤；处方：
黑附片60克 麻绒6克北细辛3克
此方，据清代医家郑钦安云：“乃交阴阳之方，亦温经散寒之方也。夫附子辛热，能助太阳之阳而内交于少阴。麻黄苦温，细辛辛温，能启少阴之精而外交于太阳。仲景取微发汗以散邪，实以交阴阳也。阴阳相交，邪自立解。”
翌日复诊：服药一剂，发热竟退，余症亦减。宜扶阳抑阴，交通心肾阴阳，处以下二方： 第一方，四逆汤： 黑附片60克 干姜12克 甘草6克 第二方，白通汤： 黑附片60克 干姜15克 葱白3个 上二方，交叉各服三剂后，精神大佳，饮食增进而愈。 [按]：《内经》谓：“其两感于寒而病者，必‘不免于死。” (《素问·热论》)所谓“两感”，指阳经与阴经同时感受寒邪而致病，亦有表里同病之意。在《内经》时代．尚无完善治法，故列为“死症”。至仲景时代，则发展了《内经》理论，丰富了临床治疗方法。这是一大进步。《伤寒论》就说：“少阴病，始得之，反发热而脉沉者，麻黄附子细辛汤主之。”发热为太阳经感受寒邪，脉沉为少阴阳气不足，两感症也，故创麻黄附子细辛汤，交表里之阴阳，温经散寒，扶正祛邪，使邪祛而正不伤，扶正而不碍邪。药仅三味，配伍周详，效采很好。
六味地黄汤是治疗肝肾不足、真阴亏损的著名方剂。本例中，肝肾阴虚是疾病的根本原因，因此使用此方加入蔓荆子以搜风凉血，并缓解脑鸣；柴胡疏肝解郁，通畅气血，并升举清气；钩藤平肝熄风。这三味药加入六味地黄汤中，具有滋水养肝、熄风的功效。
上方服用五剂后，各种症状均减轻。
二诊：脉搏已不再急促，舌色转为红润。拟定三才封髓丹以育阴滋肾，作为巩固疗效的措施。
病例二：
王某某，女性，三十多岁，患有头痛，眼睛眩晕且胀痛，尤其是眉棱骨处胀痛严重。脉象弦而兼数，口干，舌略红。结合脉象和症状分析，这属于血虚生风。治疗方法应当养血祛风。处方如下：
肝藏血，血虚即是肝虚。本方中黄芪、当归组成补血汤。补气益血，辅以枸杞滋肾补肝，这是治本的方法。加入柴胡以疏通肝气郁结，调畅气血；白芷祛风止痛；钩藤、刺蒺藜、菊花平肝熄风；天麻独入肝经，特别增强治疗虚风内动的效果。菊花一味，《神农本草经》称其“主治各种风邪引起的肿痛，目痛欲脱，流泪”。此方组合对于血虚生风引起的头痛尤为切合，遵循了“治风先治血，血行风自灭”的宗旨。
二诊：上方服用三剂后，头痛停止，眉棱骨胀痛也减轻。仍守原方，去掉黄芪，加入黑豆10克、荷顶10克再服三剂，所有症状全部消除。
病例三：
武某某，男性，四十五岁，患有头痛牵连左侧颈部麻木疼痛，不能转头，病程已十余年，曾经多方治疗，效果不明显，转来找我诊治。按其脉象濡滑，舌淡苔白腻。自述：疼痛严重时想呕吐，常感到四肢酸困。证候属于寒湿不化所致，拟定温阳化湿通络的治疗方法。给予我自拟的小白附子汤。处方如下：
小白附子30克 天麻15克 法半夏10克 茯苓15克 葳蕤仁20克
嘱咐患者守方服用，共服用三十余剂，十余年的顽固疾病竟然痊愈。至今多年未复发。
[按语]：小白附子一方，是我多年临床常用的有效方剂。举几个例子，体质不足，阳虚外感，或寒湿阻滞经络所致的头痛，用此方均有疗效。
我曾以此方治疗一位李姓妇女，四十多岁，患两下肢剧烈疼痛，且出现对称性红斑。诊断为营卫阻滞，气机不调，用小白附子汤加羌活、秦艽，五剂而愈。
病例四：
李某某，男性，四十多岁，患有头顶疼痛，已持续数月之久，兼见失眠、耳鸣，心烦，不能从事体力劳动。某医生以肾阳虚论治，使用附片、狗脊、白术、吴茱萸、肉桂、寄生、黄芪、党参和干姜等药物治疗。服用两剂后，头顶疼痛加剧，转来找我诊治。查其脉象弦滑，舌苔白腻。详细询问得知，曾因长期工作劳烦，导致脾阳不足，痰厥生风所致。拟定方剂以李东垣的半夏白术天麻汤加味。处方如下：
痰厥头痛，非半夏不能治疗；虚风眩晕，非天麻不能消除。党参、黄芪甘温益气健脾，白术、苍术，味甘、苦、性温，健脾燥湿，补益脾阳，陈皮理气化痰；神曲、麦芽消食和胃，去除胃中积滞。干姜温中散寒，黄柏坚肾益阴而退虚热，泽泻利水渗湿，茯苓渗湿健脾。加入蔓荆子、菊花疏散风热。诸药共同呈现健脾燥湿、祛痰宣散风热的功效。
二诊：服用上方两剂后，头顶疼痛大减，但仍有眩晕、耳鸣。午后心烦，唇舌略紫。这是由于湿郁化热，加之元阴不足，相火浮动。拟定“水中置介”法。方用我自拟的首乌黑芝麻散加减。处方如下：
龟板15克 首乌30克 黑芝麻15克 龙骨15克 牡蛎15克
方中首乌、黑芝麻补肝肾益气血，龙骨、牡蛎重镇安神；石斛清虚热，栀子苦寒泻火、凉血清心；桑叶、菊花、钩藤平肝熄风以治疗头眩。
三诊：服用两剂后，头顶疼痛消失，但仍有心烦失眠。使用龙虎丹以交通心肾。处方如下：
川附片30克 上肉桂6克 云黄连5克 龙骨15克 牡蛎15克
附片、枣仁以强心，黄连、肉桂即交泰丸以交通心肾，使心火下注于肾；肾水温则上济于心，水火相济则神安。桂枝、甘草、龙骨、牡蛎即《伤寒论》中的桂枝甘草龙骨牡蛎汤。桂枝调和营血而扶助心阳，龙、牡收敛浮越之阳而复阴，茯神宁心安神，甘草、干姜温中阳。
四诊：服用一剂后，心烦大减，竟然能够入睡。嘱咐用原方再进两剂，并用龟龄集两瓶进行调理而愈。
龟龄集是我国最早的升炼剂之一，采用多种珍贵的动、植物药材炼制而成，有强身健脑，固肾补气，调整肝肾的功效。
病例五：
胡某某，男性，二十五岁，患有头痛且胀，痛引前额，午后尤其严重，病程已月余。曾服用止痛药效果不明显，转来找我诊治。其脉象弦数，舌质红苔黄腻，心烦，口干。结合脉象和症状诊断为胆胃郁热、风热上乘所致。选用我自拟的菊花粉葛汤加味。处方如下：
荷顶10克
二诊：上方服用两剂后，头胀痛随即停止，脉已不数尚弦，苔黄腻略减，尤感心烦。用温胆汤加味，继续清泄胆胃郁热。处方如下：
吴白芷6克 夏枯花6克 甘草3克 竹茹3克 荷顶10克 桑叶10克
上方服用三剂，所有症状消失而愈。
病例六：
张某某，女性，四十多岁，经期前即感头痛绵绵不休，历时已年余。诊脉细弦，舌淡润无苔。这属于血虚生风兼肝气不舒。依据《内经》“木郁达之”的理论，治疗方法应当养血舒肝解郁。使用逍遥散加味。处方如下：
当归、杭白芍补血和营养肝，茯苓、白术健脾补中。柴胡、香附和薄荷疏肝解郁，加入天麻、吴白芷、川芎活血祛风止痛。炙甘草、炮姜苦甘化阴，与归、芍合用有调和气血之功。诸药共同呈现健脾养血、祛风解郁止痛的效果。仅服用三剂而痛即止。嘱咐每月经期前守方服用三剂。服用三个月，多年的经前头痛即未再发。
病例七：
王某某，女性，二十七岁。病由产后血虚受寒，导致头痛隐隐，持续一年，遇风更甚。经多方治疗，疼痛虽有所减轻，但未根治，每遇风头痛即发。诊其脉沉细，舌淡无苔，畏风特甚。结合脉象和症状分析，系肝血不足，血虚生风。治疗方法应当补血养肝祛风。使用加味愈风散。处方如下：
方解见本书“产后发热”治案。
临床实践证明，本方药味虽简而功效显著，曾用本方治疗产后血虚生风所致的头痛，或产后血虚受寒所致的发热头身痛，无不药到病除。治案较多，不再另举。
病例八：
杨某某，女性，三十八岁，产后曾大流血，服药血止后，即现头痛，时作眩晕，面赤灼热。脉细，舌淡润。此为阴血暴虚，阳无所附，故面赤灼热，乃假热征象也，气血不能上荣于脑，故头痛；血虚生风，故时作眩晕。拟定方剂以补水汤合当归补血汤，大补气血而滋水为治。处方如下：
西洋参15克 当归15克 黄芪20克 焦黄柏6克 白蜜15克
方中西洋参、黄柏、白蜜为补水汤，有大滋肾水之功。西洋参大补心气。黄柏苦以坚肾，合白蜜之甘，苦甘化阴，阴得化生而血液不竭。加入当归补血汤，补气补血，使气充血旺，浮阳得以潜纳。
二诊：上方服用两剂后，头痛眩晕好转，阳气收纳，面赤灼热转为苍白。拟定归脾汤去木香、白术，加入天麻、法半夏、杭白芍，继续补益心脾。上方续服三剂，头痛眩晕悉除。
[按语]：头部位于人体最高处。手足三阳经和主一身阳气的督脉及足厥阴肝经均上会于头。所以说“头为诸阳之会”，凡五脏精华之血，六腑清阳之气皆上会于此。头痛一证，有内伤与外感之分。外感头痛不外六淫之邪循经上犯，治疗关键在于分清六淫之性质，体质之强弱，掌握经络循行部位，则不难辨也。所难辨者，内伤头痛，证情较复杂。纯虚与纯实者易治，虚实互见，寒热相兼者，则较为难治，非一方、一法所能取效。宜方随证变，尤其掌握体质因素最重要。治病必求其本，非见痛止痛所能见效。上述八例，均属临床所常见，特为立案，以备参考。
张某某，女性，四十岁。初病发热身痛，旋即风痰上涌，颈项强直，不能转侧，面青神迷，口噤不开，舌不能伸，脉沉细而紧。脉证合参，显系太阳经脉为寒邪所滞而引起。因太阳与少阴互为表里，少阴主里，今寒邪入于阴分，正邪相搏，浊阴上逆，蒙蔽清窍，故法当温经散寒，祛风化痰。方用《伤寒论》麻黄附子细辛汤加味。处方如下：
方中用麻黄附子细辛汤固元阳，开腠理，散寒邪而退热，加雄黄以辟百毒。胆炒半夏降上逆之浊阴，配南星、姜汁以化散风痰。全蝎、僵蚕祛风化痰而开窍，既引诸药上行，又能升清降浊。如此组合成方，俾能药证相符。
二诊：上方服用两剂，热渐退，神渐清，口能微开，舌可半伸。惟面色尚青，身犹困重，颈项仍不能转侧，脉弦紧，舌苔白腻。此太阳气机闭塞，寒湿阻滞，改以自拟方小白附子汤加减。处方如下：
三诊：上方服用两剂，口已能开七八，舌能伸出，脉转缓和。发热全退，痰涎减少，神志已清。宜扶心肺之阳，以化未净之痰。方用郑钦安姜桂汤。处方如下：
四诊：上方服用三剂，口全开，舌体伸缩自如，面色复常。是方能升扶上焦阳气。因阳气不足于上，则上焦之阴邪弥漫，以致风痰上涌而闭塞脏腑经络气机。故服后阳气得升，阴邪得散，痰涎得化，余症亦减，仅觉头部微痛，是上逆之浊阴未净，仍宜扶阳抑阴，宣散阴邪。方用《伤寒论》四逆汤加味。处方如下：
上方服用两剂，所有症状痊愈。
[按语]：此案病名，系原稿所用，所谓“捻颈风”，大体上是指感受外邪后，出现风痰上涌，颈项强直，如有人捻，口噤不开，舌不能伸等症状而言。关键仍在辨证。证既明，有是证而用是药。本例属于虚寒阴证，故先以温经散寒，继以活络祛风，终以温扶阳气而愈。
李某某，女性，十八岁。因感寒后发热四十余日不退，曾经中西医治疗，症状如故，前来就诊。症见：胸满、食少，日晡发热，恶寒踡卧，不思水饮，二便自利。面色晦暗而黑，舌润滑，脉沉细如丝。查阅所服中医处方，有按阳虚治者，曾用四逆汤、白通汤；有按阴虚治者，曾用青蒿、地骨皮、鳖甲之类及甘露饮等，均无效。按脉症分析，显系不足之阴症。滋阴固非所宜，但为何用扶阳之四逆、白通亦无效?反复思之，此症之发热，系太阳气机被寒邪郁闭，未能及时解散。太阳之里为少阴(足太阳膀胱与足少阴肾相表里)，寒邪入里，真阳失运，此为伤寒太阳、少阴两感之重症。四逆汤虽能扶阳，但不能驱邪外出；白通汤亦交阴阳之方，但所交者系心肾之阴阳(葱白引心中之阴下交于肾，附子引肾中之阳上交于心)，不能交表里之阴阳，故无效。此症之治，全在交表里之阴阳，温经解表，乃用《伤寒论》麻黄附子细辛汤；处方如下：
黑附片60克 麻绒6克 北细辛3克
此方，据清代医家郑钦安云：“乃交阴阳之方，亦温经散寒之方也。夫附子辛热，能助太阳之阳而内交于少阴。麻黄苦温，细辛辛温，能启少阴之精而外交于太阳。仲景取微发汗以散邪，实以交阴阳也。阴阳相交，邪自立解。”
翌日复诊：服药一剂，发热竟退，余症亦减。宜扶阳抑阴，交通心肾阴阳，处以下二方：第一方，四逆汤：黑附片60克 干姜12克 甘草6克 第二方，白通汤：黑附片60克 干姜15克 葱白3个 上二方，交叉各服三剂后，精神大佳，饮食增进而愈。 [按语]：《内经》谓：“其两感于寒而病者，必‘不免于死。” (《素问·热论》)所谓“两感”，指阳经与阴经同时感受寒邪而致病，亦有表里同病之意。在《内经》时代，尚无完善治法，故列为“死症”。至仲景时代，则发展了《内经》理论，丰富了临床治疗方法。这是一大进步。《伤寒论》就说：“少阴病，始得之，反发热而脉沉者，麻黄附子细辛汤主之。”发热为太阳经感受寒邪，脉沉为少阴阳气不足，两感症也，故创麻黄附子细辛汤，交表里之阴阳，温经散寒，扶正祛邪，使邪祛而正不伤，扶正而不碍邪。药仅三味，配伍周详，效采很好。
Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) is a famous formula for treating deficiency of the Liver and Kidneys and loss of True Yin. In this case, Liver-Kidney Yin deficiency is the root of the disease; therefore, this formula was used with additions: Manjingzi (Vernoniae Semen, 蔓荆子) to dispel wind and cool blood, alleviating tinnitus in the brain; Chaihu (Bupleuri Radix, 柴胡) to soothe the Liver and resolve stagnation, promoting the free flow of Qi and Blood, and raising clear Yang; Gouteng (Uncariae Ramulus cum Uncis, 钩藤) to calm the Liver and extinguish wind. Adding these three herbs to Liuwei Dihuang Tang produces the effect of nourishing Water to nurture the Liver and extinguishing wind.
After taking five doses of the above prescription, all symptoms subsided.
Second visit: The pulse is no longer rapid, and the tongue has turned red and moist. Sancai Fengsui Dan (Three Immortals Sealing the Marrow Pill) was prescribed to nourish Yin and tonify the Kidney as a consolidating treatment.
Case 2:
Wang XX, female, over thirty years old, suffered from headache, dizziness, and distending pain, especially severe in the supraorbital ridge. The pulse was wiry and rapid; mouth was dry; the tongue was slightly red. Combining pulse and symptoms, this was diagnosed as Wind generated by Blood deficiency. The method should be to nourish Blood and dispel Wind. Prescription:
Huangqi (Astragali Radix, 黄芪) 15g, Danggui (Angelicae Sinensis Radix, 当归) 12g, Chaihu (Bupleuri Radix, 柴胡) 6g, Cijili (Tribuli Fructus, 刺蒺藜) 10g, Baizhi (Angelicae Dahuricae Radix, 白芷) 6g
Gouteng (Uncariae Ramulus cum Uncis, 钩藤) 10g, Tianma (Gastrodiae Rhizoma, 天麻) 15g, Gouqi (Lycii Fructus, 枸杞) 15g, Sangye (Mori Folium, 桑叶) 6g, Juhua (Chrysanthemi Flos, 菊花) 6g
The Liver stores Blood; Blood deficiency is equivalent to Liver deficiency. Huangqi and Danggui in this formula constitute a Blood-tonifying decoction. Tonifying Qi and benefiting Blood, assisted by Gouqi to nourish the Kidney and benefit the Liver, constitutes the fundamental treatment. Chaihu was added to unblock Liver Qi stagnation and regulate Qi and Blood; Baizhi dispels Wind and relieves pain; Gouteng, Cijili, and Juhua calm the Liver and extinguish Wind; Tianma enters the Liver meridian specifically, enhancing the effect of treating internal stirring of deficient Wind. Juhua alone is described in the *Shennong Bencao Jing* (Divine Farmer's Materia Medica) as "mainly treating various Wind-induced swelling and pain, eyes feeling like they will fall out, and tearing." This combination is particularly suitable for headaches caused by Wind generated from Blood deficiency, following the principle that "to treat Wind, one must first treat Blood; when Blood flows, Wind naturally extinguishes."
Second visit: After three doses of the above prescription, the headache stopped, and the distending pain in the supraorbital ridge subsided. The original formula was retained, but Huangqi was removed, and Heidou (Phaseoli Semen Nigrum, 黑豆) 10g and Heting (Nelumbinis Petalum, 荷顶) 10g were added for another three doses. All symptoms disappeared completely.
Case 3:
Wu XX, male, forty-five years old, suffered from headache radiating to the left neck with numbness and pain, unable to turn the head, for over ten years. Multiple treatments had shown little effect, so he sought my consultation. His pulse was soggy and slippery; the tongue was pale with a white greasy coating. He reported that during severe pain, he felt nauseous and often experienced soreness and heaviness in the limbs. The syndrome belongs to transformation failure of Cold-Dampness. The method is to warm Yang, transform Dampness, and unblock collaterals. I prescribed my own Xiaobai Fuzi Tang (Minor White Aconite Decoction). Prescription:
Xiaobai Fuzi (Aconiti Kusnezoffii Radix Praeparata, 小白附子) 30g, Tianma (Gastrodiae Rhizoma, 天麻) 15g, Fa Xia (Pinelliae Rhizoma Praeparatum, 法半夏) 10g, Fuling (Poria, 茯苓) 15g, Weirui Ren (Polygonati Rhizoma, 葳蕤仁) 20g
Chuanxiong (Ligustici Chuanxiong Rhizoma, 川芎) 6g, Gaoben (Ligustici Wallichii Rhizoma, 藁本) 6g, Duohuo (Angelicae Pubescentis Radix, 独活) 6g, Wu Baizhi (Angelicae Dahuricae Radix, 吴白芷) 6g, Fangfeng (Saposhnikoviae Radix, 防风) 6g
Guizhi (Cinnamomi Ramulus, 桂枝) 10g, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 3g, Shengjiang (Zingiberis Rhizoma Recens, 生姜) 10g, Dazao (Jujubae Fructus, 大枣) 10g
The patient was instructed to take the prescription consistently. After taking more than thirty doses, his stubborn disease of over ten years was cured. It has not recurred for many years.
[Commentary]: Xiaobai Fuzi Tang is an effective formula frequently used in my clinical practice over the years. For example, in cases of constitutional insufficiency, exterior Cold due to Yang deficiency, or Headache caused by Cold-Dampness blocking collaterals, this formula is effective.
I once treated a Mrs. Li, over forty years old, who suffered from severe pain in both lower limbs accompanied by symmetrical erythema. Diagnosed as obstruction of Ying and Wei with dysfunctional Qi mechanism, she was cured in five doses using Xiaobai Fuzi Tang with additions of Qianghuo (Notopterygii Rhizoma et Radix, 羌活) and Qinjiao (Gentianae Macrophyllae Radix, 秦艽).
Case 4:
Li XX, male, over forty years old, suffered from vertex headache lasting several months, accompanied by insomnia, tinnitus, irritability, and inability to endure physical labor. A previous physician treated it as Kidney Yang deficiency using Fupian (Aconiti Lateralis Radix Praeparata, 附片), Gouji (Cibotii Rhizoma, 狗脊), Baizhu (Atractylodis Macrocephalae Rhizoma, 白术), Wuyu (Evodiae Fructus, 吴萸), Rougui (Cinnamomi Cortex, 肉桂), Jisheng (Taxilli Herba, 寄生), Huangqi (Astragali Radix, 黄芪), Dangshen (Codonopsis Radix, 党参), and Ganjiang (Zingiberis Rhizoma, 干姜). After two doses, the vertex headache worsened, and he sought my consultation. His pulse was wiry and slippery; the tongue coating was white and greasy. Upon detailed inquiry, it was found that long-term work fatigue had led to Spleen Yang insufficiency, resulting in Phlegm-Jue generating Wind. The prescription was based on Li Dongyuan's Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) with modifications. Prescription:
Fa Xia (Pinelliae Rhizoma Praeparatum, 法半夏) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) 9g, Tianma (Gastrodiae Rhizoma, 天麻) 15g, Chenpi (Citri Reticulatae Pericarpium, 陈皮) 6g, Fuling (Poria, 茯苓) 10g
Lu Dangshen (Codonopsis Radix, 潞党参) 15g, Huangqi (Astragali Radix, 黄芪) 15g, Zexie (Alismatis Rhizoma, 泽泻) 9g, Jiao Huangbai (Phellodendri Cortex Praecocius, 焦黄柏) 6g, Cangzhu (Atractylodis Rhizoma, 苍术) 9g
Maiya (Hordei Fructus Germinatus, 麦芽) 6g, Ganjiang (Zingiberis Rhizoma, 干姜) 9g, Shenqu (Massa Medicata Fermentata, 神曲) 15g, Juhua (Chrysanthemi Flos, 菊花) 6g, Manjingzi (Vernoniae Semen, 蔓荆子) 9g
For Phlegm-Jue headache, only Banxia can treat it; for dizziness caused by deficient Wind, only Tianma can eliminate it. Dangshen and Huangqi are sweet and warm, benefiting Qi and strengthening the Spleen; Baizhu and Cangzhu are sweet, bitter, and warm, strengthening the Spleen, drying Dampness, and tonifying Spleen Yang; Chenpi regulates Qi and transforms Phlegm; Shenqu and Maiya digest food and harmonize the Stomach, removing gastric stagnation. Ganjiang warms the Middle and disperses Cold; Huangbei strengthens the Kidney, benefits Yin, and clears deficient heat; Zexie promotes urination and leaches out Dampness; Fuling leaches out Dampness and strengthens the Spleen. Manjingzi and Juhua were added to disperse Wind-Heat. Together, these herbs strengthen the Spleen, dry Dampness, resolve Phlegm, and disperse Wind-Heat.
Second visit: After two doses of the above prescription, the vertex headache decreased significantly, but dizziness and tinnitus remained. Irritability occurred in the afternoon, and the lips and tongue were slightly purple. This indicated Dampness transforming into Heat, combined with insufficiency of Primordial Yin and floating Ministerial Fire. The method "placing shell in water" was adopted. The prescription was my self-formulated Shouwu Heima San (Polygonum Multiflorum and Black Sesame Powder) with modifications. Prescription:
Guiban (Testudinis Carapax et Plastrum, 龟板) 15g, Shouwu (Polygoni Multiflori Radix, 首乌) 30g, Heima (Sesami Nigris Semen, 黑芝麻) 15g, Longgu (Fossilia Ossis Mastodi, 龙骨) 15g, Muli (Concha Ostreae, 牡蛎) 15g
Gouteng (Uncariae Ramulus cum Uncis, 钩藤) 10g, Fushen (Poria cum Radice Pinelli, 茯神) 15g, Shihu (Dendrobii Caulis, 石斛) 10g, Sangye (Mori Folium, 桑叶) 9g, Juhua (Chrysanthemi Flos, 菊花) 6g
Zhizi (Gardeniae Fructus, 栀子) 6g, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 6g
In this formula, Shouwu and Heima tonify the Liver and Kidney and benefit Qi and Blood; Longgu and Muli heavily settle and calm the Spirit; Shihu clears deficient heat; Zhizi is bitter and cold, purging fire, cooling blood, and clearing the Heart; Sangye, Juhua, and Gouteng calm the Liver and extinguish Wind to treat vertigo.
Third visit: After two doses, the vertex headache disappeared, but irritability and insomnia persisted. Longhu Dan (Dragon-Tiger Pill) was used to communicate between the Heart and Kidney. Prescription:
Chuan Fupian (Aconiti Lateralis Radix Praeparata, 川附片) 30g, Shang Rougui (Cinnamomi Cortex, 上肉桂) 6g, Yun Huanglian (Coptidis Rhizoma, 云黄连) 5g, Longgu (Fossilia Ossis Mastodi, 龙骨) 15g, Muli (Concha Ostreae, 牡蛎) 15g
Chao Zaoren (Ziziphi Spinosae Semen, 炒枣仁) 15g, Fushen (Poria cum Radice Pinelli, 茯神) 15g, Ganjiang (Zingiberis Rhizoma, 干姜) 9g, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 6g, Guizhi (Cinnamomi Ramulus, 桂枝) 9g
Fupian and Zaoren strengthen the Heart; Huanglian and Rougui constitute Jiaotai Wan (Interlocking Heaven Pill) to communicate between the Heart and Kidney, allowing Heart Fire to descend to the Kidney; Kidney Water ascends to nourish the Heart. When Water and Fire interact harmoniously, the Spirit is calmed. Guizhi, Gancao, Longgu, and Muli constitute Guizhi Gancao Longgu Muli Tang (Cinnamon Twig, Licorice, Dragon Bone, and Oyster Shell Decoction) from the *Shanghan Lun*. Guizhi harmonizes Ying and Blood and supports Heart Yang; Longgu and Muli gather floating Yang and restore Yin; Fushen calms the Heart and Spirit; Gancao and Ganjiang warm Middle Yang.
Fourth visit: After one dose, irritability decreased significantly, and sleep was achieved. The patient was instructed to take two more doses of the original formula and use Guilingji (Guiling Concentrate) for two bottles for conditioning, leading to recovery.
Guilingji is one of China's earliest sublimated preparations, refined from various precious animal and plant materials. It strengthens the body and brain, consolidates the Kidney, tonifies Qi, and regulates the Liver and Kidney.
Case 5:
Hu XX, male, twenty-five years old, suffered from headache with distension, radiating to the forehead, worse in the afternoon, for over a month. Analgesics showed little effect, so he sought my consultation. His pulse was wiry and rapid; the tongue body was red with a yellow greasy coating; he felt irritable and had a dry mouth. Pulse and symptom analysis diagnosed Gallbladder-Stomach Stagnant Heat and Wind-Heat attacking upwards. My self-formulated Juhua Fenge Tang (Chrysanthemum and Kudzu Decoction) with modifications was selected. Prescription:
Juhua (Chrysanthemi Flos, 菊花) 6g, Fenge (Puerariae Lobatae Radix, 粉葛) 20g, Wu Bai Zhi (Angelicae Dahuricae Radix, 吴芷) 10g, Chuanxiong (Ligustici Chuanxiong Rhizoma, 川芎) 6g, Manjingzi (Vernoniae Semen, 蔓荆子) 9g
Chao Jingjie (Schizonepetae Spica Praeparata, 炒荆芥) 6g, Bohe (Menthae Haplocalycis Herba, 薄荷) 6g, Lianqiao (Forsythiae Fructus, 连翘) 10g, Ku Qin (Scutellariae Radix, 枯芩) 6g, Jiao Zha (Crataegi Fructus Praecocius, 焦楂) 15g
Heting (Nelumbinis Petalum, 荷顶) 10g
Second visit: After two doses, the head distending pain stopped. The pulse was no longer rapid but still wiry; the yellow greasy coating slightly reduced; irritability remained. Wendan Tang (Warm the Gallbladder Decoction) with modifications was used to continue clearing Gallbladder-Stomach stagnant heat. Prescription:
Chenpi (Citri Reticulatae Pericarpium, 陈皮) 10g, Fa Xia (Pinelliae Rhizoma Praeparatum, 法半夏) 10g, Fuling (Poria, 茯苓) 15g, Zhishi (Aurantii Fructus Immaturus, 枳实) 9g, Qinghao (Artemisiae Annuae Herba, 青蒿) 6g
Wu Bai Zhi (Angelicae Dahuricae Radix, 吴芷) 6g, Xiaku Hua (Prunellae Spica, 夏枯花) 6g, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 3g, Zhuru (Bambusae Caulis in Taenia, 竹茹) 3g, Heting (Nelumbinis Petalum, 荷顶) 10g, Sangye (Mori Folium, 桑叶) 10g
After three doses of the above prescription, all symptoms disappeared, and recovery was achieved.
Case 6:
Zhang XX, female, over forty years old, suffered from continuous mild headache before menstruation for over a year. The pulse was fine and wiry; the tongue was pale, moist, and without coating. This was diagnosed as Wind generated by Blood deficiency combined with Liver Qi stagnation. Following the *Neijing* principle "when Wood is stagnant, unblock it," the method was to nourish Blood, soothe the Liver, and resolve stagnation. Xiaoyao San (Rambling Powder) with modifications was used. Prescription:
Danggui (Angelicae Sinensis Radix, 当归) 20g, Chaihu (Bupleuri Radix, 柴胡) 9g, Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) 10g, Fuling (Poria, 茯苓) 10g, Bohe (Menthae Haplocalycis Herba, 薄荷) 6g
Gaoben (Ligustici Wallichii Rhizoma, 藁本) 6g, Tianma (Gastrodiae Rhizoma, 天麻) 15g, Wu Bai Zhi (Angelicae Dahuricae Radix, 吴芷) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma, 川芎) 6g, Hang Shao (Paeoniae Radix Alba, 杭芍) 10g
Zhi Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle, 炙甘草) 6g, Pao Jiang (Zingiberis Rhizoma Praeparatum, 炮姜) 6g, Heting (Nelumbinis Petalum, 荷顶) 10g
Danggui and Hang Shao nourish Blood and benefit the Liver; Fuling and Baizhu strengthen the Spleen and tonify the Middle. Chaihu, Xiangfu (Cyperi Rhizoma, 香附 - *Note: Text mentions Xiangfu in explanation but not in prescription list explicitly, though implied in standard Xiaoyao San context or potentially omitted in specific variant here, sticking to text provided*), and Bohe soothe the Liver and resolve stagnation; Tianma, Wu Bai Zhi, and Chuanxiong invigorate Blood, dispel Wind, and relieve pain. Zhi Gancao and Pao Jiang transform bitterness and sweetness into Yin; combined with Danggui and Shaoyao, they harmonize Qi and Blood. The herbs collectively strengthen the Spleen, nourish Blood, dispel Wind, resolve stagnation, and relieve pain. Pain ceased after just three doses. The patient was instructed to take three doses before each menstrual period. After three months, her chronic pre-menstrual headache did not recur.
Case 7:
Wang XX, female, twenty-seven years old. The illness originated from postpartum Blood deficiency and Cold invasion, causing dull headache lasting one year, worsening upon exposure to wind. Despite multiple treatments reducing pain slightly, it was not cured; every exposure to wind triggered headache. The pulse was deep and fine; the tongue was pale without coating; aversion to wind was extreme. Pulse and symptom analysis indicated Liver Blood insufficiency and Wind generated by Blood deficiency. The method was to tonify Blood, nourish the Liver, and dispel Wind. Jiawei Yufeng San (Modified Wind-Dispelling Powder) was used. Prescription:
Danggui (Angelicae Sinensis Radix, 当归) 20g, Heidou (Phaseoli Semen Nigrum, 黑豆) 10g, Chao Jingjie (Schizonepetae Spica Praeparata, 炒荆芥) 6g, Duohuo (Angelicae Pubescentis Radix, 独活) 6g, Heting (Nelumbinis Petalum, 荷顶) 10g
See "Postpartum Fever" case in this book for formula analysis.
After taking more than ten doses, the headache and aversion to wind disappeared, and recovery was achieved.
Clinical practice proves that although this formula contains few ingredients, its efficacy is significant. It has been used to treat headaches caused by postpartum Blood deficiency generating Wind, or fever and body pain caused by postpartum Blood deficiency and Cold invasion, with consistent success. There are many such cases, so they are not listed separately.
Case 8:
Yang XX, female, thirty-eight years old. After a massive postpartum hemorrhage, bleeding stopped with medication, but headache ensued, accompanied by intermittent dizziness, flushed face, and burning sensation. The pulse was fine; the tongue was pale and moist. This was sudden deficiency of Yin-Blood, leaving Yang without attachment, hence the flushed face and burning sensation (a false heat sign); Qi and Blood could not nourish the brain, causing headache; Wind generated by Blood deficiency caused intermittent dizziness. The prescription combined Bushui Tang (Nourish Water Decoction) and Danggui Buxue Tang (Danggui Tonifies Blood Decoction) to greatly tonify Qi and Blood while nourishing Water. Prescription:
Bai Yangshen (Panacis Quinquefolii Radix, 白洋参) 15g, Danggui (Angelicae Sinensis Radix, 当归) 15g, Huangqi (Astragali Radix, 黄芪) 20g, Jiao Huangbai (Phellodendri Cortex Praecocius, 焦黄柏) 6g, Baimi (Mel, 白蜜) 15g
In this formula, Bai Yangshen, Huangbai, and Baimi constitute Bushui Tang, which greatly nourishes Kidney Water. Bai Yangshen greatly tonifies Heart Qi. Huangbei is bitter and strengthens the Kidney; combined with the sweetness of Baimi, bitterness and sweetness transform into Yin, generating Yin so that Blood does not exhaust. Adding Danggui Buxue Tang tonifies Qi and Blood, making Qi abundant and Blood vigorous, allowing floating Yang to be submerged.
Second visit: After two doses, headache and dizziness improved, Yang was contained, and the flushed face turned pale. Guipi Tang (Restore the Spleen Decoction) without Muxiang (Costi Radix, 木香) and Baizhu, with additions of Tianma (Gastrodiae Rhizoma, 天麻), Fa Xia (Pinelliae Rhizoma Praeparatum, 法半夏), and Hang Shao (Paeoniae Radix Alba, 杭芍), was prescribed to continue tonifying the Heart and Spleen. After three more doses of the above prescription, headache and dizziness disappeared completely.
[Commentary]: The head is the highest part of the body. The Hand and Foot Triple Burner Yang meridians, the Du Meridian governing all Yang Qi, and the Foot Jueyin Liver Meridian all converge at the head. Thus, it is said that "the head is the meeting place of all Yang meridians." The essence Blood of the Five Zang organs and the Clear Yang Qi of the Six Fu organs all ascend here. Headache is divided into internal injury and external contraction. External headache is caused by the six Excess pathogens invading along the meridians; treatment key lies in distinguishing the nature of the pathogens, the strength of the constitution, and mastering the meridian pathways. Internal headache is harder to differentiate because the syndrome is complex. Pure deficiency or pure excess cases are easy to treat; mixed deficiency-excess and combined Cold-Heat cases are difficult and cannot be cured by a single formula or method. Formulas must change according to the syndrome, and understanding constitutional factors is crucial. Treating disease requires addressing the root, not just stopping pain. The above eight cases are common in clinical practice; they are recorded here for reference.
Nie Jing Feng (Neck-Twisting Wind)
Zhang XX, female, forty years old. Initially suffering from fever and body pain, followed rapidly by upward surging of Wind-Phlegm, stiff neck unable to turn, blue complexion, confused spirit, locked jaw unable to open, tongue unable to extend, pulse deep, fine, and tight. Pulse and symptom analysis clearly indicated stagnation of the Taiyang meridian by Cold pathogen. Since Taiyang and Shaoyin are interior-exterior partners, and Shaoyin governs the interior, now Cold pathogen has entered the Yin level. Zheng (Upright Qi) and Pathogen struggle, turbid Yin rises upward, clouding the clear orifices. The method should be to warm the meridians, disperse Cold, dispel Wind, and transform Phlegm. Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) from the *Shanghan Lun* with modifications was used. Prescription:
Hei Fupian (Aconiti Lateralis Radix Praeparata, 黑附片) 30g, Ma Rong (Ephedrae Herba, 麻绒) 6g, Xixin (Asari Radix et Rhizoma, 细辛) 3g, Zhi Nanxing (Arisaematis Rhizoma Praeparatum, 炙南星) 9g, Quanxie (Scorpio, 全蝎) 6g
Xionghuang (Realgar, 雄黄) 6g, Shengjiang Zhi (Zingiberis Rhizoma Recens Juice, 生姜汁) 2 spoons, Jiangcan (Bombyx Batryticatus, 僵蚕) 6g, Dan Chao Banxia (Pinelliae Rhizoma Praeparatum cum Bile, 胆炒半夏) 9g
Ma Huang Fu Zi Xi Xin Tang secures Yuan Yang, opens the pores, disperses Cold pathogen, and reduces fever; Xionghuang wards off myriad toxins. Dan Chao Banxia descends rising turbid Yin; paired with Nanxing and Ginger Juice to transform and disperse Wind-Phlegm. Quanxie and Jiangcan dispel Wind, transform Phlegm, and open orifices, guiding other herbs upward and ascending Clear while descending Turbid. This combination ensures the formula matches the syndrome.
Second visit: After two doses, fever gradually subsided, spirit cleared, mouth could open slightly, tongue could extend halfway. However, complexion remained blue, body heavy, neck still unable to turn, pulse wiry and tight, tongue coating white and greasy. This indicated closure of Taiyang Qi mechanism and Cold-Dampness stagnation. Modified Xiaobai Fuzi Tang was prescribed. Prescription:
Zhi Xiaobai Fuzi (Aconiti Kusnezoffii Radix Praeparata, 炙小白附子) 30g, Tianma (Gastrodiae Rhizoma, 天麻) 9g, Fuling (Poria, 茯苓) 15g, Weirui Ren (Polygonati Rhizoma, 葳蕤仁) 9g
Fa Banxia (Pinelliae Rhizoma Praeparatum, 法半夏) 9g, Chuanxiong (Ligustici Chuanxiong Rhizoma, 川芎) 6g, Fangfeng (Saposhnikoviae Radix, 防风) 9g, Baizhi (Angelicae Dahuricae Radix, 白芷) 6g, Qianghuo (Notopterygii Rhizoma et Radix, 羌活) 9g
Guizhi (Cinnamomi Ramulus, 桂枝) 9g, Chao Hang Shao (Paeoniae Radix Alba Praeparata, 炒杭芍) 9g, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 6g, Shao Shengjiang (Zingiberis Rhizoma Praeparatum, 烧生姜) 3 slices, Dazao (Jujubae Fructus, 大枣) 3 pieces
Third visit: After two doses, mouth opened 70-80%, tongue extended, pulse became moderate. Fever completely subsided, phlegm saliva reduced, spirit clear. Supporting Lung and Heart Yang was appropriate to transform remaining Phlegm. Zheng Qin'an's Jiang Gui Tang (Ginger and Cinnamon Decoction) was used. Prescription:
Shengjiang (Zingiberis Rhizoma Recens, 生姜) 15g, Guizhi (Cinnamomi Ramulus, 桂枝) 9g
Fourth visit: After three doses, mouth fully opened, tongue moved freely, complexion returned to normal. This formula raises and supports Upper Jiao Yang. Due to insufficient Yang in the upper part, Yin Evil diffuses in the Upper Jiao, causing Wind-Phlegm to surge and block Zang-Fu and collateral Qi mechanisms. After administration, Yang rose, Yin Evil dispersed, Phlegm transformed, and residual symptoms decreased, leaving only slight head pain, indicating incomplete clearance of rising turbid Yin. Supporting Yang and suppressing Yin, and disseminating Yin Evil remained necessary. Si Ni Tang (Four Reversal Decoction) from the *Shanghan Lun* with modifications was used. Prescription:
Hei Fupian (Aconiti Lateralis Radix Praeparata, 黑附片) 60g, Jun Jiang (Zingiberis Rhizoma, 筠姜) 12g, Guizhi (Cinnamomi Ramulus, 桂枝) 9g, Xixin (Asari Radix et Rhizoma, 细辛) 2g, Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) 6g
After two doses, all symptoms were cured.
[Commentary]: The disease name "Nie Jing Feng" comes from the original manuscript. It generally refers to symptoms appearing after contracting external pathogens, such as upward surging of Wind-Phlegm, stiff neck, feeling as if someone is twisting the neck, locked jaw, and inability to extend the tongue. The key remains syndrome differentiation. Once the syndrome is clear, use medicine corresponding to the syndrome. This case belongs to Deficient-Cold Yin syndrome; thus, treatment began with warming meridians and dispersing Cold, followed by unblocking collaterals and dispelling Wind, and finally warming and supporting Yang to achieve cure.
Shanghan Taiyang-Shaoyin Lianggan Syndrome (Simultaneous Contraction of Cold in Taiyang and Shaoyin)
Li XX, female, eighteen years old. After contracting Cold, fever persisted for over forty days without subsiding despite Western and Chinese medical treatments. Symptoms remained unchanged. Presenting symptoms: chest fullness, poor appetite, afternoon fever, aversion to Cold with curling up, no desire for water or drink, normal urination and defecation. Complexion was dark and black; tongue was smooth and moist; pulse was deep and fine like a thread. Reviewing previous Chinese prescriptions, some treated it as Yang deficiency using Si Ni Tang (Four Reversal Decoction) and Bai Tong Tang (White Pass Decoction); others treated it as Yin deficiency using Qinghao (Artemisiae Annuae Herba, 青蒿), Digupi (Lycopersici Radix, 地骨皮), Biejia (Testudinis Carapax, 鳖甲), and Ganlu Yin (Sweet Dew Drink), all ineffective. Pulse and symptom analysis clearly indicated a Deficient Yin syndrome. Nourishing Yin is definitely inappropriate. But why was supporting Yang with Si Ni Tang and Bai Tong Tang also ineffective? After repeated consideration, the fever in this case resulted from Taiyang Qi mechanism being constrained by Cold pathogen, failing to dissipate in time. The interior of Taiyang is Shaoyin (Foot Taiyang Bladder and Foot Shaoyin Kidney are interior-exterior partners). Cold pathogen entering the interior causes loss of movement of True Yang. This is a severe case of simultaneous contraction of Cold in Taiyang and Shaoyin. Although Si Ni Tang can support Yang, it cannot expel pathogens outward; Bai Tong Tang also communicates Yin and Yang, but it communicates Heart-Kidney Yin-Yang (Congbai guides Heart Yin down to Kidney, Fuzi guides Kidney Yang up to Heart), not Exterior-Interior Yin-Yang, hence ineffective. Treatment of this case relies entirely on communicating Exterior-Interior Yin-Yang, warming meridians, and releasing the exterior. Ma Huang Fu Zi Xi Xin Tang from the *Shanghan Lun* was used. Prescription:
Hei Fupian (Aconiti Lateralis Radix Praeparata, 黑附片) 60g, Ma Rong (Ephedrae Herba, 麻绒) 6g, Bei Xixin (Asari Radix et Rhizoma, 北细辛) 3g
According to Qing Dynasty physician Zheng Qin'an: "This is a formula to communicate Yin and Yang, and also to warm meridians and disperse Cold. Fuzi is pungent and hot, assisting Taiyang Yang to internally communicate with Shaoyin. Mahuang is bitter and warm, Xixin is pungent and warm, enabling Shaoyin Essence to externally communicate with Taiyang. Zhongjing uses mild sweating to disperse pathogens, truly to communicate Yin and Yang. When Yin and Yang communicate, pathogens resolve spontaneously."
Next day second visit: After one dose, fever subsided, and other symptoms decreased. Supporting Yang and suppressing Yin, communicating Heart-Kidney Yin-Yang was appropriate. Two formulas were prescribed: First Formula, Si Ni Tang: Hei Fupian 60g, Ganjiang 12g, Gancao 6g. Second Formula, Bai Tong Tang: Hei Fupian 60g, Ganjiang 15g, Congbai 3 pieces. After alternating three doses of each, spirit greatly improved, appetite increased, and recovery was achieved. [Commentary]: The *Neijing* states: "Those who contract Cold simultaneously in both layers will inevitably die." (*Suwen: Re Lun*). "Simultaneous contraction" refers to Yang and Yin meridians contracting Cold pathogen simultaneously, implying exterior-interior disease coexistence. In the *Neijing* era, there was no perfect treatment method, so it was listed as a "fatal syndrome." By Zhongjing's era, *Neijing* theory was developed, and clinical treatment methods enriched. This was a major progress. *Shanghan Lun* states: "Shaoyin disease, initially obtained, with contrary fever and deep pulse, Ma Huang Fu Zi Xi Xin Tang governs it." Fever indicates Taiyang meridian contracting Cold pathogen; deep pulse indicates Shaoyin Yang Qi insufficiency. This is a simultaneous contraction syndrome, hence Ma Huang Fu Zi Xi Xin Tang was created to communicate Exterior-Interior Yin-Yang, warm meridians and disperse Cold, support Righteousness and expel Pathogens, ensuring pathogen expulsion without damaging Righteousness, and supporting Righteousness without hindering Pathogen expulsion. Only three herbs, meticulously compounded, yield excellent results.