舌苔、舌质的检查常见的有：舌苔白润者，为脾虚、肺虚；白腻者，为脾虚夹湿；白干者，为脾虚或肺虚夹热；黑而润者，为肾虚兼寒湿；黄腻者，为脾湿化热或食积不化；黄干者，为胃中实热。舌质淡白者，为血虚或阴阳俱虚；舌质偏红者，为阴虚有热；舌质紫暗或兼瘀斑者，为瘀血。
3．脉象
虚大者，为气阴俱虚或气血俱虚；滑数者，为实热；沉细弱者，为气血两虚或阴阳两虚；沉弦者，为肝郁血虚；沉涩者，为气滞血瘀或血虚寒滞；促者，为心之气阴俱虚而以阴虚不能敛阳为主。此外，两尺脉大而弦者，为肾阴虚；尺大而数者，为肾阴虚而相火盛；右关独滑者，为脾胃积热；右关独弦者，为脾虚木乘；左关独弦者，为肝血虚，瘀血阻滞；右寸独见虚数者，为肺阴虚；左寸数者，为心火盛。 (二)治则治法 贫血根本病机是气血亏虚，“虚则补之”，因而贫血的治则，总地来说，离不开补法，但因本病经常夹有气滞、血瘀、痰积、食积、火热等症，所以在某些阶段常常配以和法、消法、清法，或者暂时治以和法、消法、清法。
1．补法
本法是治疗贫血的主要方法。但因本病治疗过程中容易出现壅补则实，温则生热，寒则生寒，散则动血，升则血逆，下则气陷的变证，所以补时必须温而不热，补而不滞，凉而不寒，下不伤正，升不逆血，散不动血，而升、散之药尤应慎用。
(1)补气
主要用于气虚、脾虚、肺虚证。常用的药物有黄芪、人参、党参、太子参。其中黄芪主要用于面色皓白、脉虚大，尤其是右脉虚大及脉虚缓者，亦用于兼有脾虚、肺虚之诸证；人参补气兼能养阴，主要用于脉虚缓、虚数及兼肺虚、心虚、脾虚者；党参作用与人参近似，但补气作用小于人参，且无明显的养阴作用；太子参的补气作用较以上诸药均小，但补阴作用较强，所以阴虚为主时多用之。此外，补气常用的药还有白术、山药、扁豆等，三药均以健脾见长，故兼脾虚者多用之。
(2)补阴
用于阴虚诸证。在采用补阴药时除应注意阴虚总的特性外，还应注意脏腑、火等问题。常用的补阴药有熟地、生地、阿胶、山茱萸、麦冬、沙参、天门冬、黄精、玉竹、女贞子、龟板、龟板胶、鳖甲、鳖甲胶、猪脊髓、西洋参、石斛、五味子等。其中熟地、山茱萸、五味子虽性偏温，但近于平性，补肝肾，凡阴阳俱虚者均可用。但熟地腻膈碍胃，所以，兼脾虚，食滞不化，即舌苔黄腻、白腻，舌淡白而润者，均忌用；山萸肉、五味子有补有敛，尤适用于阴阳俱虚，脉虚大无根者。生地滋阴而甘凉，用于阴虚有热、阴虚液枯和血热妄行的吐衄、斑疹。麦冬、天门冬、沙参、石斛、玉竹、西洋参养胃且清虚热；石斛养阴利关节，消痈肿；麦冬、生地、五味子、石斛养心阴。若阴虚而舌尖红，心烦者，宜麦冬；汗出心悸者，宜五昧子。龟板、龟板胶、鳖甲、鳖甲胶、甲鱼、猪脊髓补精血潜浮阳，尤以精血不足，虚阳浮动，脉细数或虚数，且面色皓白而多油光或透嫩红者用之更宜，其中猪脊髓、甲鱼、龟板胶、鳖甲胶偏补，鳖甲、龟板偏于潜阳清热。黄精、首乌其性较平，补阴而微有益气之功，若热象不明显者多用之。
(3)补阳
用于阳虚诸证。常用的药物有何首乌、菟丝子、鹿角胶、鹿茸、枸杞子、沙苑子、淡大云、锁阳、仙茅、紫河车、附子、肉桂、杜仲等。其中附子、肉桂辛热用事，善动阴血，故一般不宜应用，但若兼胃脘冷痛，手足厥冷者非附子不能收奇效，胃脘悸动，逆气上冲，脉沉涩者，非肉桂不能收卓功。何首乌、菟丝子、枸杞子、五味子、沙苑子、杜仲等性虽略温，但近于平，虽补阳而又益阴，对于肝肾俱虚，腰背酸痛，脉沉细无力或尺脉沉细弱者，尤为适宜。鹿角胶、鹿茸、鹿角补督脉，益精血，适用于阳虚而精血亏损。紫河车大补精血阴阳，凡阴阳精血亏损者皆用之。淡大云、锁阳、仙茅、沙苑子虽均补阳，但淡大云润，沙苑子涩，仙茅散。
(4)补血
主要用于血虚诸证。常用的补血药有当归、熟地、阿胶、何首乌、白芍、鸡血藤、鸡血藤膏等。其中当归、鸡血藤补血活血，善用于血虚兼瘀血之证，若脉细数者不宜多用，以防血动而出现吐、衄、斑疹。脉虚大者，宜配黄芪等补气药。阿胶养阴补血止血，尤以阴虚、血虚而兼崩漏、便血、衄血者用之为宜；鸡血藤膏补血而偏温；熟地补血而偏腻；白芍养肝阴、益阴血而偏敛。
(5)健脾
贫血而兼食欲不振者恢复较难，贫血而食欲正常者恢复较易。若食欲不振转为食欲旺盛者，虽贫血较甚而很快即可好转，若食欲旺盛转为食欲不振者，虽然病情较轻，而病情很快即可恶化，所以脾胃的运化恢复与否常常是贫血改善的关键。其健脾药常用的有人参、党参、白术、茯苓、炙甘草、扁豆、山药、薏米、莲子等。若贫血而面色萎黄，食欲不振，胃脘不适，大便微溏，舌淡，舌苔白润，脉濡缓者，尤应以此类药物治疗，且宜配入砂仁、蔻仁、陈皮等。其中人参、党参补气作用较强；白术有健脾燥湿磨积之功，若兼湿郁者尤宜采用；茯苓健脾渗湿安神；扁豆、薏米、莲子、山药补而不燥，且微有益阴之力，故脾之气阴俱虚者尤宜采用。若炙甘草、大枣非但补脾之气，亦且补脾之血，故脾虚兼血虚者均可采用。此外，脾胃虚寒而血虚者，黄芪建中汤、十四味建中汤及人参养荣汤等均可加减应用。
2．和法
此种治法在本病治疗中虽然不太重要，但在贫血久治不效而又兼有肝脾不和、气血不和时，如不采用此种治法常常使病不能获得必要的转机，从而影响本病的进一步治疗。其中脾湿郁滞或脾胃气滞者，宜在健脾药中适当配入陈皮、砂仁、蔻仁、枳壳、厚朴；若兼肝脾不和，症见胸胁苦满窜痛，心烦心悸，五心烦热，食欲不振，脉沉弦者，治宜逍遥散加减；若兼痰气郁结者，可暂用理气化痰泻火之品，如柴胡枳桔汤、柴芩温胆汤。
3．消法
此法在再生障碍性贫血的治疗中看起来是无足轻重的方法，但在临床上看在某些阶段常常是病情能不能获得转机的关键。因此，再生障碍性贫血的治疗在一定情况下必须注意消法的运用。消法主要用于再生障碍性贫血兼有气滞、血瘀、痰积、食积的证候。由于本病是一个虚中夹实的证候，所以兼气滞者用理气而不用破气；兼瘀血者用活血而不用破血；兼痰积者用化痰而不用劫痰；兼食积者，用消食而不用破积。例如：理气用枳壳、陈皮，而不用枳实、青皮，即使非用不可也只能用1～3克；消食用焦三仙、鸡内金，而不用莱菔子、槟榔、二丑、大黄，即使非用不可时也只可用l克以下；化痰用半夏、陈皮、茯苓，而不用礞石、竹沥、白芥子、葶苈子；活血用赤芍、归尾、桃仁、红花、丹皮、丹参，而不用水蛭、虻虫、三棱、莪术，即使应用活血药也只可小量，如赤芍、红花用0．5～4克等。
4．清法
本病高热时用之。本病之高热大致有三种情况：
(1)营血热炽证，症见血热或血热妄行的发热，出血，斑疹，舌质红绛，脉数。治宜清热凉血。其常用方是犀角地黄汤，常用药物有犀角、生地、白芍、丹皮、丹参、茜草、茅根、大蓟、小蓟、旱莲草、藕节、元参等。其中犀角凉血清热、消斑止血之功最优，惟其价格昂贵(国务院已宣布禁用)；生地、白芍、丹皮、元参、丹参凉血而消斑；生地、旱莲草、元参凉血而养阴，但无活血之功；丹皮、丹参、白芍不仅凉血，且兼活血；丹皮、茜草、大蓟、小蓟、白茅根、藕节凉血止血，尤宜用于出血。
(2)阴虚热盛证，症见阴虚热盛的骨蒸劳热或潮热盗汗，脉细数，或发热盗汗，脉虚大数。治宜养阴清热。常用的方剂有秦艽扶赢汤、秦艽鳖甲汤。常用的药物有龟板、鳖甲、生地、旱莲草、地骨皮、丹皮、知母、黄柏等。其中龟板、鳖甲尤适用于阴虚阳浮的发热面赤、脉虚数或虚大而数；地骨皮尤善用于兼有盗汗之骨蒸劳热；丹皮善用于无汗之骨蒸劳热；知母、黄柏用于阴虚相火妄动之脉细数、尿黄赤、舌尖红者。
(3)脉虚大数者，还应注意气虚之证，治疗之时可适当配用黄芪、人参等药。 二、出血 出血的治法较之一般的出血证为难，且较复杂。一般来讲，出血紫斑，舌质红，脉滑数者，为血热妄行，治宜凉血清热，宜犀角地黄汤加小蓟炭、白茅根、阿胶；若兼舌苔黄燥者，为兼胃腑实火，治宜上方加大黄3～4克；出血，大片大片紫斑，舌质嫩红，脉虚大数者，治宜滋阴潜阳，如大定风珠、三甲复脉汤等；若舌质淡者，为气阴两虚，治宜补气养阴，可用黄芪15克，人参10克，麦冬10克，生地15克，五味子10克，白芍10克，阿胶10克，龙骨15克，牡蛎15克，元参15克；若胃脘痞满，舌质淡黯，脉沉弦者，为寒热夹杂证，治宜乌梅10克，黄连8克，炮姜6克，生地10克，白芍10克，丹皮10克，僵蚕10克，阿胶lO克。 三、感染 感染有肺部感染和化脓性感染两种。两种感染多在气阴两虚证的基础上出现，所以在补气养阴的基础上酌加清热解毒药是本病的基本治法，其所用药物多为黄芪、当归、人参、麦冬、石斛等加银花、连翘。若血热妄行者，可在犀角地黄汤的基础上加银花、连翘。若咳喘痰多，自汗盗汗，舌质淡，脉虚大滑数者，可用黄芪鳖甲散加减。
附案：
患者张某，男，21岁。门诊号：73100。
1964年3月10日初诊：患再生障碍性贫血合并肺部感染，住院1年多无明显效果。特别是最近1个多月以来，肺部感染虽然基本控制，但右髋部又发生一个大的脓肿，高烧39*(2持续不退，时时鼻衄，神志时清时昧，甚或谵语呢喃，血色素4．8克／分升。察其面色皓白，自汗盗汗，舌质嫩红，脉滑数有力。诊为营血热炽复夹热毒证。治宜清营凉血，佐以清热解毒消痈。处方：
犀角9克生地15克 白芍10克丹皮9克茅根30克小蓟炭10克银花9克连翘9克
服药4剂后，发热稍减，继服26剂，脓肿好转，脓汁明显减少，体温降至37．5℃。继服1个月后，脓肿痊愈，血色素上升至7克／分升，精神明显改善。继治2个月，愈。
按：此例患者属再障合并感染，感染发高烧及出血成为矛盾的主要方面，辨证属于营血热炽复夹热毒之证，系由营分邪热不解，深入血分，即叶天士在《温热论》中提出“耗血动血”之证。故宜“急则治其标”，采用清法、止血法为主。方用犀角地黄汤加味。犀角地黄汤重点在于清热解毒，凉血散瘀，其中犀角咸寒，清热凉血，内平火热，用治热入营血之耗血动血，能使火平热降，毒解血宁；生地甘寒，一以佐犀角清热凉血，一以养阴生津，补阴液耗伤；赤芍、丹皮清热凉血，活血散瘀。加用茅根、小蓟炭重在凉血止血；银花、连翘以助犀角清热解毒。全方力专清解热毒，凉血止血，此为一则再障贫血合并感染，体现“急则治其标”的典型案例。
心悸怔忡
心悸证治
中医学对本病早有论述，如《红炉点雪》中说：“悸者，心卒动而不安也。惊者，心跳而怕惊也。怔忡者，心中躁动不安，惕惕然如人将捕之也。”惊悸与怔忡在程度上有轻重之分，其发病原因也有差别。因外因所引起，如突然受刺激，受到惊吓而发，心悸时作时止，谓之“惊悸”，病情轻；不因惊恐而发，心中动摇不宁，无休止时者，谓之“怔忡”，病情较重。怔忡多由内因而造成，外无引起心悸产生的任何因素，病人自觉心中惕惕，稍劳即发，全身情况较差，其发病也缓，其病情较重。
心悸怔忡发病的主要原因与精神因素有关。心动不安可由心血不足、心阳衰竭、水饮内停、瘀血阻络、痰火互结等所致，但其临床表现皆以心中动悸不安为主，中医学统称为“心悸”，可见惊悸、怔忡虽以虚者为多，但亦有实证，因而在临床时应切实掌握辨证论治，方能取得较为满意的效果，绝不可拘泥于一般的治疗方法。
附案：
案一 陈某，男，34岁。门诊号：33452。
1960年8月9日初诊：心悸失眠，疲乏无力，面色无华，前几天咳嗽、咯血，舌质暗，苔薄白，脉细无力。西医诊断为风湿性心脏病、二尖瓣狭窄与闭锁不全。处方：
炙甘草9克党参7．5克桂枝7．5克熟地9克生白芍7．5克黑芝麻7．5克阿胶4．5克(烊化) 生龙牡各9克茯神7．5克
2剂，水煎服。
按：本案风湿性心脏病、二尖瓣狭窄与闭锁不全，属中医心悸怔忡，辨证为气阴两虚证。因气阴、气血亏虚，使心失所养，而致神不守舍，心悸；疲乏无力，苔薄白，脉细无力，是气血双亏；舌质暗，是血行不畅。故用炙甘草汤加减，辛润通阳，气血并补，通利血脉，镇惊安神。方中党参、炙甘草补中益气；白芍酸敛和营，养血柔筋；桂枝通阳和营，活血通络；黑芝麻、熟地、阿胶益气补血；生龙牡、茯神镇惊安神。
案二 李某，男，40岁。门诊号：12429。
1959年1月7日初诊：心悸气短，下肢及颜面浮肿，面色萎黄，大便稀，小便黄，苔薄白，脉滑。处方：
陈皮7．5克茯苓皮6克生姜皮6克桑皮7．5克大腹皮7．5克车前子6克(另包) 怀牛膝15克 生白芍9克。
2剂．水煎服。
舌苔、舌质的检查常见的有：舌苔白润者，为脾虚、肺虚；白腻者，为脾虚夹湿；白干者，为脾虚或肺虚夹热；黑而润者，为肾虚兼寒湿；黄腻者，为脾湿化热或食积不化；黄干者，为胃中实热。舌质淡白者，为血虚或阴阳俱虚；舌质偏红者，为阴虚有热；舌质紫暗或兼瘀斑者，为瘀血。
3．脉象
脉象虚大者，为气阴俱虚或气血俱虚；滑数者，为实热；沉细弱者，为气血两虚或阴阳两虚；沉弦者，为肝郁血虚；沉涩者，为气滞血瘀或血虚寒滞；促者，为心之气阴俱虚而以阴虚不能敛阳为主。此外，两尺脉大而弦者，为肾阴虚；尺大而数者，为肾阴虚而相火盛；右关独滑者，为脾胃积热；右关独弦者，为脾虚木乘；左关独弦者，为肝血虚，瘀血阻滞；右寸独见虚数者，为肺阴虚；左寸数者，为心火盛。
(二)治则治法 贫血根本病机是气血亏虚，“虚则补之”，因而贫血的治则，总地来说，离不开补法，但因本病经常夹有气滞、血瘀、痰积、食积、火热等症，所以在某些阶段常常配以和法、消法、清法，或者暂时治以和法、消法、清法。
1．补法
本法是治疗贫血的主要方法。但因本病治疗过程中容易出现壅补则实，温则生热，寒则生寒，散则动血，升则血逆，下则气陷的变证，所以补时必须温而不热，补而不滞，凉而不寒，下不伤正，升不逆血，散不动血，而升、散之药尤应慎用。
(1)补气
主要用于气虚、脾虚、肺虚证。常用的药物有黄芪、人参、党参、太子参。其中黄芪主要用于面色皓白、脉虚大，尤其是右脉虚大及脉虚缓者，亦用于兼有脾虚、肺虚之诸证；人参补气兼能养阴，主要用于脉虚缓、虚数及兼肺虚、心虚、脾虚者；党参作用与人参近似，但补气作用小于人参，且无明显的养阴作用；太子参的补气作用较以上诸药均小，但补阴作用较强，所以阴虚为主时多用之。此外，补气常用的药还有白术、山药、扁豆等，三药均以健脾见长，故兼脾虚者多用之。
(2)补阴
用于阴虚诸证。在采用补阴药时除应注意阴虚总的特性外，还应注意脏腑、火等问题。常用的补阴药有熟地、生地、阿胶、山茱萸、麦冬、沙参、天门冬、黄精、玉竹、女贞子、龟板、龟板胶、鳖甲、鳖甲胶、猪脊髓、西洋参、石斛、五味子等。其中熟地、山茱萸、五味子虽性偏温，但近于平性，补肝肾，凡阴阳俱虚者均可用。但熟地腻膈碍胃，所以，兼脾虚，食滞不化，即舌苔黄腻、白腻，舌淡白而润者，均忌用；山萸肉、五味子有补有敛，尤适用于阴阳俱虚，脉虚大无根者。生地滋阴而甘凉，用于阴虚有热、阴虚液枯和血热妄行的吐衄、斑疹。麦冬、天门冬、沙参、石斛、玉竹、西洋参养胃且清虚热；石斛养阴利关节，消痈肿；麦冬、生地、五味子、石斛养心阴。若阴虚而舌尖红，心烦者，宜麦冬；汗出心悸者，宜五昧子。龟板、龟板胶、鳖甲、鳖甲胶、甲鱼、猪脊髓补精血潜浮阳，尤以精血不足，虚阳浮动，脉细数或虚数，且面色皓白而多油光或透嫩红者用之更宜，其中猪脊髓、甲鱼、龟板胶、鳖甲胶偏补，鳖甲、龟板偏于潜阳清热。黄精、首乌其性较平，补阴而微有益气之功，若热象不明显者多用之。
(3)补阳
用于阳虚诸证。常用的药物有何首乌、菟丝子、鹿角胶、鹿茸、枸杞子、沙苑子、淡大云、锁阳、仙茅、紫河车、附子、肉桂、杜仲等。其中附子、肉桂辛热用事，善动阴血，故一般不宜应用，但若兼胃脘冷痛，手足厥冷者非附子不能收奇效，胃脘悸动，逆气上冲，脉沉涩者，非肉桂不能收卓功。何首乌、菟丝子、枸杞子、五味子、沙苑子、杜仲等性虽略温，但近于平，虽补阳而又益阴，对于肝肾俱虚，腰背酸痛，脉沉细无力或尺脉沉细弱者，尤为适宜。鹿角胶、鹿茸、鹿角补督脉，益精血，适用于阳虚而精血亏损。紫河车大补精血阴阳，凡阴阳精血亏损者皆用之。淡大云、锁阳、仙茅、沙苑子虽均补阳，但淡大云润，沙苑子涩，仙茅散。
(4)补血
主要用于血虚诸证。常用的补血药有当归、熟地、阿胶、何首乌、白芍、鸡血藤、鸡血藤膏等。其中当归、鸡血藤补血活血，善用于血虚兼瘀血之证，若脉细数者不宜多用，以防血动而出现吐、衄、斑疹。脉虚大者，宜配黄芪等补气药。阿胶养阴补血止血，尤以阴虚、血虚而兼崩漏、便血、衄血者用之为宜；鸡血藤膏补血而偏温；熟地补血而偏腻；白芍养肝阴、益阴血而偏敛。
(5)健脾
贫血而兼食欲不振者恢复较难，贫血而食欲正常者恢复较易。若食欲不振转为食欲旺盛者，虽贫血较甚而很快即可好转，若食欲旺盛转为食欲不振者，虽然病情较轻，而病情很快即可恶化，所以脾胃的运化恢复与否常常是贫血改善的关键。其健脾药常用的有人参、党参、白术、茯苓、炙甘草、扁豆、山药、薏米、莲子等。若贫血而面色萎黄，食欲不振，胃脘不适，大便微溏，舌淡，舌苔白润，脉濡缓者，尤应以此类药物治疗，且宜配入砂仁、蔻仁、陈皮等。其中人参、党参补气作用较强；白术有健脾燥湿磨积之功，若兼湿郁者尤宜采用；茯苓健脾渗湿安神；扁豆、薏米、莲子、山药补而不燥，且微有益阴之力，故脾之气阴俱虚者尤宜采用。若炙甘草、大枣非但补脾之气，亦且补脾之血，故脾虚兼血虚者均可采用。此外，脾胃虚寒而血虚者，黄芪建中汤、十四味建中汤及人参养荣汤等均可加减应用。
2．和法
此种治法在本病治疗中虽然不太重要，但在贫血久治不效而又兼有肝脾不和、气血不和时，如不采用此种治法常常使病不能获得必要的转机，从而影响本病的进一步治疗。其中脾湿郁滞或脾胃气滞者，宜在健脾药中适当配入陈皮、砂仁、蔻仁、枳壳、厚朴；若兼肝脾不和，症见胸胁苦满窜痛，心烦心悸，五心烦热，食欲不振，脉沉弦者，治宜逍遥散加减；若兼痰气郁结者，可暂用理气化痰泻火之品，如柴胡枳桔汤、柴芩温胆汤。
3．消法
此法在再生障碍性贫血的治疗中看起来是无足轻重的方法，但在临床上看在某些阶段常常是病情能不能获得转机的关键。因此，再生障碍性贫血的治疗在一定情况下必须注意消法的运用。消法主要用于再生障碍性贫血兼有气滞、血瘀、痰积、食积的证候。由于本病是一个虚中夹实的证候，所以兼气滞者用理气而不用破气；兼瘀血者用活血而不用破血；兼痰积者用化痰而不用劫痰；兼食积者，用消食而不用破积。例如：理气用枳壳、陈皮，而不用枳实、青皮，即使非用不可也只能用1～3克；消食用焦三仙、鸡内金，而不用莱菔子、槟榔、二丑、大黄，即使非用不可时也只可用l克以下；化痰用半夏、陈皮、茯苓，而不用礞石、竹沥、白芥子、葶苈子；活血用赤芍、归尾、桃仁、红花、丹皮、丹参，而不用水蛭、虻虫、三棱、莪术，即使应用活血药也只可小量，如赤芍、红花用0．5～4克等。
4．清法
本病高热时用之。本病之高热大致有三种情况：
(1)营血热炽证，症见血热或血热妄行的发热，出血，斑疹，舌质红绛，脉数。治宜清热凉血。其常用方是犀角地黄汤，常用药物有犀角、生地、白芍、丹皮、丹参、茜草、茅根、大蓟、小蓟、旱莲草、藕节、元参等。其中犀角凉血清热、消斑止血之功最优，惟其价格昂贵(国务院已宣布禁用)；生地、白芍、丹皮、元参、丹参凉血而消斑；生地、旱莲草、元参凉血而养阴，但无活血之功；丹皮、丹参、白芍不仅凉血，且兼活血；丹皮、茜草、大蓟、小蓟、白茅根、藕节凉血止血，尤宜用于出血。
(2)阴虚热盛证，症见阴虚热盛的骨蒸劳热或潮热盗汗，脉细数，或发热盗汗，脉虚大数。治宜养阴清热。常用的方剂有秦艽扶赢汤、秦艽鳖甲汤。常用的药物有龟板、鳖甲、生地、旱莲草、地骨皮、丹皮、知母、黄柏等。其中龟板、鳖甲尤适用于阴虚阳浮的发热面赤、脉虚数或虚大而数；地骨皮尤善用于兼有盗汗之骨蒸劳热；丹皮善用于无汗之骨蒸劳热；知母、黄柏用于阴虚相火妄动之脉细数、尿黄赤、舌尖红者。
(3)脉虚大数者，还应注意气虚之证，治疗之时可适当配用黄芪、人参等药。
二、出血 出血的治法较之一般的出血证为难，且较复杂。一般来讲，出血紫斑，舌质红，脉滑数者，为血热妄行，治宜凉血清热，宜犀角地黄汤加小蓟炭、白茅根、阿胶；若兼舌苔黄燥者，为兼胃腑实火，治宜上方加大黄3～4克；出血，大片大片紫斑，舌质嫩红，脉虚大数者，治宜滋阴潜阳，如大定风珠、三甲复脉汤等；若舌质淡者，为气阴两虚，治宜补气养阴，可用黄芪15克，人参10克，麦冬10克，生地15克，五味子10克，白芍10克，阿胶10克，龙骨15克，牡蛎15克，元参15克；若胃脘痞满，舌质淡黯，脉沉弦者，为寒热夹杂证，治宜乌梅10克，黄连8克，炮姜6克，生地10克，白芍10克，丹皮10克，僵蚕10克，阿胶lO克。
三、感染 感染有肺部感染和化脓性感染两种。两种感染多在气阴两虚证的基础上出现，所以在补气养阴的基础上酌加清热解毒药是本病的基本治法，其所用药物多为黄芪、当归、人参、麦冬、石斛等加银花、连翘。若血热妄行者，可在犀角地黄汤的基础上加银花、连翘。若咳喘痰多，自汗盗汗，舌质淡，脉虚大滑数者，可用黄芪鳖甲散加减。
附案：
患者张某，男，21岁。门诊号：73100。
1964年3月10日初诊：患再生障碍性贫血合并肺部感染，住院1年多无明显效果。特别是最近1个多月以来，肺部感染虽然基本控制，但右髋部又发生一个大的脓肿，高烧39*(2持续不退，时时鼻衄，神志时清时昧，甚或谵语呢喃，血色素4．8克／分升。察其面色皓白，自汗盗汗，舌质嫩红，脉滑数有力。诊为营血热炽复夹热毒证。治宜清营凉血，佐以清热解毒消痈。处方：
犀角9克生地15克 白芍10克丹皮9克茅根30克小蓟炭10克银花9克连翘9克
服药4剂后，发热稍减，继服26剂，脓肿好转，脓汁明显减少，体温降至37．5℃。继服1个月后，脓肿痊愈，血色素上升至7克／分升，精神明显改善。继治2个月，愈。
按：此例患者属再障合并感染，感染发高烧及出血成为矛盾的主要方面，辨证属于营血热炽复夹热毒之证，系由营分邪热不解，深入血分，即叶天士在《温热论》中提出“耗血动血”之证。故宜“急则治其标”，采用清法、止血法为主。方用犀角地黄汤加味。犀角地黄汤重点在于清热解毒，凉血散瘀，其中犀角咸寒，清热凉血，内平火热，用治热入营血之耗血动血，能使火平热降，毒解血宁；生地甘寒，一以佐犀角清热凉血，一以养阴生津，补阴液耗伤；赤芍、丹皮清热凉血，活血散瘀。加用茅根、小蓟炭重在凉血止血；银花、连翘以助犀角清热解毒。全方力专清解热毒，凉血止血，此为一则再障贫血合并感染，体现“急则治其标”的典型案例。
心悸怔忡
心悸证治
中医学对本病早有论述，如《红炉点雪》中说：“悸者，心卒动而不安也。惊者，心跳而怕惊也。怔忡者，心中躁动不安，惕惕然如人将捕之也。”惊悸与怔忡在程度上有轻重之分，其发病原因也有差别。因外因所引起，如突然受刺激，受到惊吓而发，心悸时作时止，谓之“惊悸”，病情轻；不因惊恐而发，心中动摇不宁，无休止时者，谓之“怔忡”，病情较重。怔忡多由内因而造成，外无引起心悸产生的任何因素，病人自觉心中惕惕，稍劳即发，全身情况较差，其发病也缓，其病情较重。
心悸怔忡发病的主要原因与精神因素有关。心动不安可由心血不足、心阳衰竭、水饮内停、瘀血阻络、痰火互结等所致，但其临床表现皆以心中动悸不安为主，中医学统称为“心悸”，可见惊悸、怔忡虽以虚者为多，但亦有实证，因而在临床时应切实掌握辨证论治，方能取得较为满意的效果，绝不可拘泥于一般的治疗方法。
附案：
案一 陈某，男，34岁。门诊号：33452。
1960年8月9日初诊：心悸失眠，疲乏无力，面色无华，前几天咳嗽、咯血，舌质暗，苔薄白，脉细无力。西医诊断为风湿性心脏病、二尖瓣狭窄与闭锁不全。处方：
炙甘草9克党参7．5克桂枝7．5克熟地9克生白芍7．5克黑芝麻7．5克阿胶4．5克(烊化) 生龙牡各9克茯神7．5克
2剂，水煎服。
按：本案风湿性心脏病、二尖瓣狭窄与闭锁不全，属中医心悸怔忡，辨证为气阴两虚证。因气阴、气血亏虚，使心失所养，而致神不守舍，心悸；疲乏无力，苔薄白，脉细无力，是气血双亏；舌质暗，是血行不畅。故用炙甘草汤加减，辛润通阳，气血并补，通利血脉，镇惊安神。方中党参、炙甘草补中益气；白芍酸敛和营，养血柔筋；桂枝通阳和营，活血通络；黑芝麻、熟地、阿胶益气补血；生龙牡、茯神镇惊安神。
案二 李某，男，40岁。门诊号：12429。
1959年1月7日初诊：心悸气短，下肢及颜面浮肿，面色萎黄，大便稀，小便黄，苔薄白，脉滑。处方：
陈皮7．5克茯苓皮6克生姜皮6克桑皮7．5克大腹皮7．5克车前子6克(另包) 怀牛膝15克 生白芍9克。
2剂．水煎服。
Common examinations of tongue coating and tongue body include: a white and moist tongue coating indicates Spleen deficiency or Lung deficiency; a white and greasy coating indicates Spleen deficiency with dampness; a white and dry coating indicates Spleen deficiency or Lung deficiency with heat; a black and moist coating indicates Kidney deficiency combined with cold-dampness; a yellow and greasy coating indicates transformation of Spleen dampness into heat or food stagnation; a yellow and dry coating indicates excess-heat in the Stomach. A pale-white tongue body indicates Blood deficiency or simultaneous deficiency of Yin and Yang; a reddish tongue body indicates Yin deficiency with heat; a purple-dark tongue body or one with ecchymosis spots indicates blood stasis.
3. Pulse diagnosis
A deficient and large pulse indicates simultaneous deficiency of Qi and Yin or simultaneous deficiency of Qi and Blood; a slippery and rapid pulse indicates excess-heat; a deep, thin, and weak pulse indicates simultaneous deficiency of Qi and Blood or simultaneous deficiency of Yin and Yang; a deep and wiry pulse indicates Liver constraint with Blood deficiency; a deep and choppy pulse indicates Qi stagnation and blood stasis or Blood deficiency with cold stagnation; a hurried pulse indicates simultaneous deficiency of Qi and Yin of the Heart, primarily due to Yin deficiency failing to restrain Yang. Furthermore, both Chi (Cun Kou) pulses being large and wiry indicate Kidney Yin deficiency; Chi pulses being large and rapid indicate Kidney Yin deficiency with flourishing ministerial fire; only the Right Guan pulse being slippery indicates accumulated heat in the Spleen and Stomach; only the Right Guan pulse being wiry indicates Spleen deficiency with Liver Wood overacting; only the Left Guan pulse being wiry indicates Liver Blood deficiency with blood stasis obstruction; only the Right Cun pulse showing deficiency and rapidity indicates Lung Yin deficiency; the Left Cun pulse being rapid indicates flourishing Heart fire.
(II) Principles and Methods of Treatment The fundamental pathogenesis of anemia is deficiency of Qi and Blood. "When there is deficiency, tonify it." Therefore, the treatment principle for anemia generally revolves around tonification methods. However, since this disease often involves concurrent conditions such as Qi stagnation, blood stasis, phlegm accumulation, food stagnation, and fire-heat, harmonizing, reducing, and clearing methods are often employed or temporarily used in certain stages.
1. Tonification Method
This method is the primary approach for treating anemia. However, during treatment, complications may easily arise from excessive tonification leading to excess, warming generating heat, cooling generating cold, dispersing disturbing Blood, ascending causing Blood rebellion, and descending causing Qi sinking. Therefore, tonification must be warm but not hot, tonifying but not stagnant, cool but not cold, descending without damaging healthy Qi, ascending without causing Blood rebellion, and dispersing without disturbing Blood. Medicinals that ascend or disperse should be used with particular caution.
(1) Tonifying Qi
Mainly used for syndromes of Qi deficiency, Spleen deficiency, and Lung deficiency. Commonly used herbs include Huangqi (Radix Astragali), Renshen (Radix Ginseng), Dangshen (Radix Codonopsis), and Taizishen (Radix Codonopsis Pilosulae). Huangqi is mainly used for patients with a sallow complexion and a deficient-large pulse, especially when the Right pulse is deficient-large or deficient-slow, and also for various syndromes accompanied by Spleen or Lung deficiency. Renshen tonifies Qi and nourishes Yin, mainly used for deficient-slow or deficient-rapid pulses, and cases accompanied by Lung, Heart, or Spleen deficiency. Dangshen has effects similar to Renshen but its Qi-tonifying power is weaker, and it lacks obvious Yin-nourishing properties. Taizishen has weaker Qi-tonifying effects than the aforementioned herbs but stronger Yin-nourishing effects, so it is frequently used when Yin deficiency is predominant. Additionally, Baizhu (Rhizoma Atractylodis Macrocephalae), Shanyao (Rhizoma Dioscoreae), and Biandou (Semen Dolichoris) are commonly used to tonify Qi; these three herbs excel at strengthening the Spleen, so they are often used when Spleen deficiency is present.
(2) Nourishing Yin
Used for various syndromes of Yin deficiency. When using Yin-nourishing herbs, besides paying attention to the general characteristics of Yin deficiency, one must also consider Zang-Fu organs and Fire issues. Commonly used Yin-nourishing herbs include Shudi (Radix Rehmanniae Preparata), Shengdi (Radix Rehmanniae), Ejiao (Colla Corii Asini), Shanzhuyu (Fructus Corni), Maimendong (Radix Ophiopogonis), Shashen (Radix Glehniae), Tiandong (Radix Asparagi), Huangjing (Rhizoma Polygonati), Yuzhu (Rhizoma Polygonati Odorati), Nvzhenzi (Fructus Ligustri Lucidi), Guiban (Carapax et Plastrum Testudinis), Guibanjiao (Colla Carapacis et Plastri Testudinis), Biejia (Carapax Trionycis), Biejiajiao (Colla Carapacis Trionycis), Zhujingsui (Medulla Spinae Porci), Xiyangshen (Radix Panacis Quinquefolii), Shihu (Caulis Dendrobii), and Wuweizi (Fructus Schisandrae). Although Shudi, Shanzhuyu, and Wuweizi are slightly warm in nature, they are close to neutral, tonify the Liver and Kidney, and can be used for simultaneous deficiency of Yin and Yang. However, Shudi is cloying and hinders the Stomach, so it is contraindicated in cases with Spleen deficiency, food stagnation, i.e., yellow-greasy or white-greasy tongue coating, and a pale-white moist tongue body. Shanzhuyu and Wuweizi have both tonifying and astringent properties, making them particularly suitable for simultaneous deficiency of Yin and Yang with a deficient-large rootless pulse. Shengdi nourishes Yin and is sweet-cool, used for Yin deficiency with heat, exhaustion of Yin fluids, and vomiting/epistaxis or maculopapular rashes caused by reckless bleeding due to blood-heat. Maimendong, Tiandong, Shashen, Shihu, Yuzhu, and Xiyangshen nourish the Stomach and clear deficient heat; Shihu nourishes Yin, benefits joints, and reduces abscesses; Maimendong, Shengdi, Wuweizi, and Shihu nourish Heart Yin. For Yin deficiency with a red tongue tip and irritability, Maimendong is preferred; for sweating and palpitations, Wuweizi is preferred. Guiban, Guibanjiao, Biejia, Biejiajiao, Jiyu (Meat of Turtle), and Zhujingsui tonify essence and Blood and submerge floating Yang. They are especially suitable for insufficient essence and Blood, floating deficient Yang, fine-rapid or deficient-rapid pulses, and a sallow complexion with oily shine or translucent tender redness. Among them, Zhujingsui, Jiyu, Guibanjiao, and Biejiajiao lean towards tonification, while Biejia and Guiban lean towards submerging Yang and clearing heat. Huangjing and Shouwu have relatively neutral properties, nourish Yin, and slightly benefit Qi, so they are often used when heat signs are not obvious.
(3) Tonifying Yang
Used for various syndromes of Yang deficiency. Commonly used herbs include Heshouwu (Radix Polygoni Multiflori), Tusizi (Semen Cuscutae), Lujiaojiao (Colla Cornus Cervi), Lurong (Cornu Cervi Pantotrichum), Gouqizi (Fructus Lycii), Shayuanzi (Semen Astragali Complanati), Dan Dayun (Caulis Cynomorii), Suoyang (Herba Cynomorii), Xianmao (Rhizoma Curculiginis), Ziheche (Placenta Humana), Fuzi (Radix Aconiti Lateralis Preparata), Rougui (Cortex Cinnamomi), and Duzhong (Cortex Eucommiae). Fuzi and Rougui are acrid-hot and active, tending to disturb Yin-Blood, so they are generally not applied. However, if accompanied by cold pain in the epigastrium and cold extremities, only Fuzi can achieve miraculous results; for epigastric palpitations, counterflow Qi rushing upward, and a deep-choppy pulse, only Rougui can achieve outstanding efficacy. Heshouwu, Tusizi, Gouqizi, Wuweizi, Shayuanzi, and Duzhong are slightly warm but close to neutral; they tonify Yang while benefiting Yin, making them particularly suitable for simultaneous deficiency of Liver and Kidney, soreness and pain of the waist and back, and deep-thin-weak or deep-thin-weak Chi pulses. Lujiaojiao, Lurong, and Lu jiao (Cornu Cervi) tonify the Du Mai (Governing Vessel), benefit essence and Blood, and are suitable for Yang deficiency with loss of essence and Blood. Ziheche greatly tonifies essence, Blood, Yin, and Yang, and is used for any deficiency of Yin-Yang, essence, and Blood. Dan Dayun, Suoyang, Xianmao, and Shayuanzi all tonify Yang, but Dan Dayun is moistening, Shayuanzi is astringent, and Xianmao is dispersing.
(4) Tonifying Blood
Mainly used for various syndromes of Blood deficiency. Commonly used Blood-tonifying herbs include Danggui (Radix Angelicae Sinensis), Shudi, Ejiao, Heshouwu, Baishao (Radix Paeoniae Alba), Jixueteng (Caulis Spatholobi), and Jixuetenggao (Extractum Caulis Spatholobi). Danggui and Jixueteng tonify Blood and invigorate circulation, suitable for Blood deficiency with blood stasis. If the pulse is fine-rapid, they should not be used excessively to prevent Blood movement causing vomiting, epistaxis, or rashes. For a deficient-large pulse, they should be combined with Qi-tonifying herbs like Huangqi. Ejiao nourishes Yin, tonifies Blood, and stops bleeding, especially suitable for Yin and Blood deficiency with metrorrhagia, hematochezia, or epistaxis. Jixuetenggao tonifies Blood and is slightly warm; Shudi tonifies Blood but is cloying; Baishao nourishes Liver Yin, benefits Yin-Blood, and is astringent.
(5) Strengthening the Spleen
Anemia accompanied by poor appetite is difficult to recover from, while anemia with normal appetite recovers easily. If poor appetite turns into a strong appetite, recovery is quick even if anemia is severe; if strong appetite turns into poor appetite, the condition worsens quickly even if mild. Thus, the restoration of Spleen and Stomach transportation is often key to improving anemia. Common Spleen-strengthening herbs include Renshen, Dangshen, Baizhu, Fuling (Poria), Zhigancao (Radix Glycyrrhizae Preparata), Biandou, Shanyao, Yimi (Semen Coicis), and Lianzi (Semen Nelumbinis). For anemia with a sallow complexion, poor appetite, epigastric discomfort, loose stools, pale tongue, white-moist coating, and soggy-slow pulse, these herbs should be used, preferably combined with Sharen (Fructus Amomi), Kounren (Semen Cardamomi), and Chenpi (Pericarpium Citri Reticulatae). Renshen and Dangshen have strong Qi-tonifying effects; Baizhu strengthens the Spleen, dries dampness, and resolves accumulation, especially suitable for dampness stagnation; Fuling strengthens the Spleen, leaches out dampness, and calms the Spirit; Biandou, Yimi, Lianzi, and Shanyao are tonifying but not drying, and slightly benefit Yin, making them ideal for simultaneous deficiency of Qi and Yin of the Spleen. Zhigancao and Dazao (Fructus Jujubae) not only tonify Spleen Qi but also Spleen Blood, so they can be used for Spleen deficiency with Blood deficiency. Additionally, for Spleen-Stomach deficiency-cold with Blood deficiency, Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle), Shisiwei Jianzhong Tang (Fourteen-Ingredient Decoction to Establish the Middle), and Renshen Yangrong Tang (Ginseng Decoction to Nourish the Vigor) can be modified and applied.
2. Harmonizing Method
Although this method is not very important in treating this disease, when anemia persists without effect and is accompanied by disharmony between Liver and Spleen or Qi and Blood, failure to use this method often prevents necessary turning points, affecting further treatment. For Spleen dampness stagnation or Spleen-Stomach Qi stagnation, Chenpi, Sharen, Kounren, Zhike (Fructus Aurantii), and Houpo (Cortex Magnoliae Officinalis) should be appropriately added to Spleen-strengthening herbs. If accompanied by Liver-Spleen disharmony with symptoms of chest and hypochondriac fullness and wandering pain, irritability, palpitations, five-palm heat, poor appetite, and deep-wiry pulse, Xiaoyao San (Free and Easy Wanderer Powder) should be modified. If accompanied by phlegm-Qi knotting, Qi-regulating, phlegm-resolving, and fire-clearing agents like Chaihu Zhijie Tang (Bupleurum and Aurantium Decoction) or Chaiqin Wendan Tang (Bupleurum and Scutellaria Gallbladder-Warming Decoction) can be temporarily used.
3. Reducing Method
This method appears insignificant in the treatment of aplastic anemia, but clinically, it is often the key to whether the condition can turn around in certain stages. Therefore, the application of reducing methods must be noted in the treatment of aplastic anemia under certain circumstances. This method is mainly used for aplastic anemia accompanied by Qi stagnation, blood stasis, phlegm accumulation, or food stagnation. Since this disease is a syndrome of deficiency mixed with excess, for Qi stagnation, regulate Qi rather than break Qi; for blood stasis, invigorate Blood rather than break Blood; for phlegm accumulation, resolve phlegm rather than rob phlegm; for food stagnation, digest food rather than break accumulation. For example: use Zhike and Chenpi for regulating Qi, not Zhishi (Fructus Aurantii Immaturus) or Qingpi (Pericarpium Citri Reticulatae Viride); even if necessary, use only 1-3 grams. Use Jiao Sanxian (Scorched Three Immortals) and Ji Neijin (Endothelium Corneum Gigeriae Galli) for digesting food, not Laifuzi (Semen Raphani), Binglang (Areca Seed), Erchou (Semen Brayerae), or Dahuang (Radix et Rhizoma Rhei); even if necessary, use less than 1 gram. Use Banxia (Rhizoma Pinelliae), Chenpi, and Fuling for resolving phlegm, not Mengshi (Lapis Calaminaris), Zhuli (Succus Bambusae in Media), Baijiezi (Semen Sinapis Albae), or Tinglizi (Semen Lepidii seu Descurainiae). Use Chishao (Radix Paeoniae Rubra), Guiwei (Radix Angelicae Sinensis Tail), Taoren (Semen Persicae), Honghua (Flos Carthami), Danpi (Cortex Moutan), and Danshen (Radix Salviae Miltiorrhizae) for invigorating Blood, not Shuizhi (Hirudo), Mengchong (Tabanus), Sanleng (Rhizoma Sparganii), or Ezhu (Rhizoma Curcumae); even if used, only small doses, e.g., Chishao and Honghua 0.5-4 grams.
4. Clearing Method
Used when this disease presents with high fever. High fever in this disease roughly falls into three categories:
(1) Blazing Heat in Ying and Blood Syndrome: Symptoms include fever due to blood-heat or reckless bleeding, hemorrhage, maculopapular rashes, crimson-red tongue body, and rapid pulse. Treatment should clear heat and cool Blood. The common formula is Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). Common herbs include Xijiao (Cornu Rhinocerotis - banned), Shengdi, Baishao, Danpi, Danshen, Qiancao (Radix Rubiae), Maogen (Rhizoma Imperatae), Daji (Herba Taraxaci), Xiaoji (Herba Centipedae), Hanliancao (Herba Ecliptae), Ou jie (Nodus Nelumbinis Rhizomatis), and Xuanshen (Radix Scrophulariae). Xijiao has the best effect in cooling Blood, clearing heat, reducing rashes, and stopping bleeding, but it is expensive (banned by the State Council). Shengdi, Baishao, Danpi, Xuanshen, and Danshen cool Blood and reduce rashes. Shengdi, Hanliancao, and Xuanshen cool Blood and nourish Yin but do not invigorate Blood. Danpi, Danshen, and Baishao not only cool Blood but also invigorate Blood. Danpi, Qiancao, Daji, Xiaoji, Baimaogen, and Ou jie cool Blood and stop bleeding, especially suitable for hemorrhage.
(2) Flourishing Heat due to Yin Deficiency Syndrome: Symptoms include bone-steaming tidal fever or night sweats due to Yin deficiency with flourishing heat, fine-rapid pulse, or fever with night sweats and deficient-large-rapid pulse. Treatment should nourish Yin and clear heat. Common formulas include Qinjiao Fuying Tang (Gentian and Chinaberry Decoction to Support the Emaciated) and Qinjiao Biejia Tang (Gentian and Softshell Turtle Decoction). Common herbs include Guiban, Biejia, Shengdi, Hanliancao, Digupi (Cortex Lycii Radicis), Danpi, Zhimu (Rhizoma Anemarrhenae), and Huangbai (Cortex Phellodendri). Guiban and Biejia are especially suitable for fever with flushed face and deficient-rapid or deficient-large-rapid pulse due to Yin deficiency with floating Yang. Digupi is especially suitable for bone-steaming fever with night sweats. Danpi is suitable for bone-steaming fever without sweat. Zhimu and Huangbai are used for Yin deficiency with reckless ministerial fire, fine-rapid pulse, yellow-red urine, and red tongue tip.
(3) For deficient-large-rapid pulses, attention should also be paid to Qi deficiency syndromes; Huangqi and Renshen can be appropriately added during treatment.
II. Hemorrhage
The treatment of hemorrhage is more difficult and complex than general hemorrhage syndromes. Generally, purpura with a red tongue body and slippery-rapid pulse indicates reckless bleeding due to blood-heat; treatment should cool Blood and clear heat, using Xijiao Dihuang Tang plus Xiaoji Tan (Charred Herba Centipedae), Baimaogen, and Ejiao. If accompanied by a yellow-dry tongue coating, indicating Stomach organ excess-fire, add 3-4 grams of Dahuang to the above formula. For massive purpura with a tender-red tongue body and deficient-large-rapid pulse, treatment should nourish Yin and submerge Yang, using Dadongfengzhu (Great Settling Wind Pill) or Sanjia Fumai Tang (Three-Shells Pulse-Recovery Decoction), etc. If the tongue body is pale, indicating simultaneous deficiency of Qi and Yin, treatment should tonify Qi and nourish Yin, using Huangqi 15g, Renshen 10g, Maimendong 10g, Shengdi 15g, Wuweizi 10g, Baishao 10g, Ejiao 10g, Longgu (Os Costae et Fascia Scapulae) 15g, Muli (Concha Ostreae) 15g, and Xuanshen 15g. If there is epigastric fullness, a pale-dark tongue body, and a deep-wiry pulse, indicating mixed cold and heat, use Wumei (Fructus Mume) 10g, Huanglian (Rhizoma Coptidis) 8g, Paojiang (Rhizoma Zingiberis Preparatum) 6g, Shengdi 10g, Baishao 10g, Danpi 10g, Jiangcan (Bombyx Batryticatus) 10g, and Ejiao 10g.
III. Infection
Infections include pulmonary infection and suppurative infection. Both types often appear on the basis of simultaneous Qi and Yin deficiency. Therefore, adding heat-clearing and toxicity-resolving herbs to Qi-tonifying and Yin-nourishing bases is the basic treatment method. Commonly used herbs include Huangqi, Danggui, Renshen, Maimendong, and Shihu, plus Yinhua (Flos Lonicerae) and Lianqiao (Forsythiae Fructus). If there is reckless bleeding due to blood-heat, add Yinhua and Lianqiao to Xijiao Dihuang Tang. If there is coughing, wheezing, profuse sputum, spontaneous sweating, night sweats, pale tongue body, and deficient-large-slippery-rapid pulse, Huangqi Biejia San (Astragalus and Softshell Turtle Powder) can be modified.
Attached Case:
Patient Zhang, Male, 21 years old. Outpatient No.: 73100.
First visit on March 10, 1964: Suffered from aplastic anemia complicated by pulmonary infection, hospitalized for over a year with no significant effect. Especially in the past month, although pulmonary infection was basically controlled, a large abscess developed in the right hip. Persistent high fever of 39°C, frequent epistaxis, consciousness fluctuating between clear and confused, sometimes delirious murmuring. Hemoglobin 4.8 g/dL. Observation showed a sallow complexion, spontaneous and night sweats, tender-red tongue body, and powerful slippery-rapid pulse. Diagnosed as blazing heat in Ying and Blood complicated by heat-toxin. Treatment should clear Ying and cool Blood, assisted by clearing heat, resolving toxicity, and reducing abscesses. Prescription:
Xijiao 9g, Shengdi 15g, Baishao 10g, Danpi 9g, Maogen 30g, Xiaoji Tan 10g, Yinhua 9g, Lianqiao 9g.
After taking 4 doses, fever decreased slightly. Continued for 26 doses, the abscess improved, pus significantly reduced, body temperature dropped to 37.5°C. After continuing for 1 month, the abscess healed, hemoglobin rose to 7 g/dL, spirit significantly improved. Continued treatment for 2 months, cured.
Commentary: This patient had aplastic anemia complicated by infection. High fever from infection and hemorrhage became the main aspect of the contradiction. Syndrome differentiation belonged to blazing heat in Ying and Blood complicated by heat-toxin, resulting from Ying-level pathogenic heat unresolved, penetrating deeply into the Blood level, i.e., the "consumption of Blood and stirring of Blood" syndrome proposed by Ye Tianshi in *Wen Re Lun* (Treatise on Warm Diseases). Therefore, "in acute cases, treat the branch" is appropriate, primarily using clearing and hemostatic methods. The formula used is modified Xijiao Dihuang Tang. Xijiao Dihuang Tang focuses on clearing heat, resolving toxicity, cooling Blood, and dissipating stasis. Xijiao is salty and cold, clears heat and cools Blood, pacifies internal fire, and is used for consumption and stirring of Blood due to heat entering Ying and Blood, allowing fire to calm, heat to descend, toxicity to resolve, and Blood to settle. Shengdi is sweet and cold, assists Xijiao in clearing heat and cooling Blood, and nourishes Yin and generates fluids to replenish consumed Yin fluids. Chishao and Danpi clear heat and cool Blood, invigorate Blood and dissipate stasis. Added Maogen and Xiaoji Tan focus on cooling Blood and stopping bleeding; Yinhua and Lianqiao assist Xijiao in clearing heat and resolving toxicity. The whole formula specializes in clearing and resolving heat-toxin, cooling Blood and stopping bleeding. This is a typical case of aplastic anemia complicated by infection, embodying "treating the branch in acute cases."
Palpitations and Trembling
Treatment of Palpitations
Traditional Chinese Medicine has discussed this disease early on. For example, *Honglu Dianxue* states: "Palpitation is the sudden movement and unrest of the Heart. Startle is the heartbeat accompanied by fear of startle. Trembling is restless unrest in the heart, fearful as if someone were about to catch you." There is a difference in severity between Jingji (Startle Palpitations) and Zhengchong (Trembling Palpitations), and their causes differ. Caused by external factors, such as sudden stimulation or fright, where palpitations occur intermittently, it is called "Jingji," with mild condition. Not caused by fright, with continuous unrest in the heart, it is called "Zhengchong," with a heavier condition. Zhengchong is mostly caused by internal factors, with no external factors causing palpitations. The patient feels fearful internally, triggered by slight exertion, with poor overall condition, slow onset, and heavy condition.
The main cause of palpitations and trembling is related to mental factors. Restless heartbeat can be caused by insufficiency of Heart Blood,衰竭 of Heart Yang, retention of fluid-phlegm inside, blood stasis blocking collaterals, or knotting of phlegm and fire. However, their clinical manifestations are all centered on restless heartbeat in the heart, collectively called "Palpitations" in TCM. It can be seen that although Jingji and Zhengchong are mostly deficiency, there are also excess syndromes. Therefore, in clinical practice, one must truly master syndrome differentiation and treatment to achieve satisfactory results, never sticking rigidly to general treatment methods.
Attached Cases:
Case 1: Patient Chen, Male, 34 years old. Outpatient No.: 33452.
First visit on August 9, 1960: Palpitations, insomnia, fatigue, lack of luster in complexion, cough and hemoptysis in previous days, dark tongue body, thin white coating, fine-weak pulse. Western medical diagnosis: Rheumatic heart disease, mitral stenosis and insufficiency. Prescription:
Zhigancao 9g, Dangshen 7.5g, Guizhi 7.5g, Shudi 9g, Sheng Baishao 7.5g, Heimaazi 7.5g, Ejiao 4.5g (melted), Sheng Longgu and Muli 9g each, Fushen 7.5g.
2 doses, decocted in water and taken orally.
Commentary: This case of rheumatic heart disease, mitral stenosis and insufficiency, belongs to TCM Palpitations and Trembling, differentiated as simultaneous deficiency of Qi and Yin. Due to deficiency of Qi-Yin and Qi-Blood, the Heart loses nourishment, leading to unsettled Spirit and palpitations. Fatigue, thin white coating, and fine-weak pulse indicate dual deficiency of Qi and Blood. Dark tongue body indicates poor blood circulation. Therefore, modified Zhigancao Tang (Prepared Licorice Decoction) was used to unblock Yang with acrid-sweet, tonify Qi and Blood simultaneously, unblock vessels, and calm Spirit. In the formula, Dangshen and Zhigancao tonify Middle and boost Qi; Baishao is sour and astringent, harmonizes Ying, nourishes Blood and softens sinews; Guizhi unblocks Yang, harmonizes Ying, invigorates Blood and unblocks collaterals; Heimaazi, Shudi, and Ejiao boost Qi and tonify Blood; Sheng Longgu, Muli, and Fushen calm Spirit and quell fright.
Case 2: Patient Li, Male, 40 years old. Outpatient No.: 12429.
First visit on January 7, 1959: Palpitations, shortness of breath, edema of lower limbs and face, sallow complexion, loose stools, yellow urine, thin white coating, slippery pulse. Prescription:
Chenpi 7.5g, Fulingpi (Exocarpus Fuscosae) 6g, Shengjiangpi (Pericarpium Zingiberis Recens) 6g, Sangpi (Cortex Mori Radicis) 7.5g, Dafupi (Pericarpium Arecae) 7.5g, Cheqianzi (Semen Plantaginis) 6g (wrapped separately), Huainiuxi (Radix Achyranthis Bidentatae) 15g, Sheng Baishao 9g.
2 doses, decocted in water and taken orally.