【按】此病初起曾经战栗，说明有表证，表解而后身热目赤，小便短赤，为湿热之邪未得透泄。治用导赤散加茵陈、白薇、苡仁清热利尿；草决明、茺蔚子既能清肝热，又能配合郁李仁通大便。二诊两目充血，溲赤而痛，为湿热蕴结之征。治疗主要用三妙九合栀子柏皮汤加茵陈，清热泻火利湿。方中用滋液凉血的二至、生地于利湿药中，其义在于：①以救热邪灼伤之阴；②可免燥湿坚利太过而耗伤阴液。三诊出现黄疸、高热、烦躁、呕哕诸症，为湿热化火而邪炽阴伤。急用茵陈、栀子、连翘，清热利湿退黄；辅以冬葵子、泽泻、石苇清热利尿，引导湿热从小便而出；更用大剂量生地配白薇，滋液益阴，凉血清热祛邪。四诊热退，续用凉血，退热利湿，两相兼顾。五诊诸症悉减，续用凉肝解郁，利尿渗湿，以清余邪而巩固疗效。
5．张男。其人素患胃扩张，但胃扩张则不发热；今发热，小溲黄赤异常，两国白亦不清楚，为热之原因所在。嫩白薇12克，绵茵陈15克，泽泻9克，冬葵子12克，赤猪苓各9克，车前子15克，马鞭草12克，粉萆薢12克，瓜萎仁9克，玄明粉9克（同捣）【按】此从"小便黄赤异常，两目白亦不清楚"上，判断出发热的原因，似属黄疸性肝炎。其病虽然难以完全断定，但湿热蕴结则无疑义，故用通利二便、清利湿热之法。
6．张男。热2日不退，察其目自微黄，小搜浑赤，此湿热熏蒸于内，遇诱因发作，与湿热证不同；湿热症为天行时病，此则起于伤食嗜酒。绵茵陈12克，青蒿9克，白薇12克，草决明9克，连翘12克，枳实9克，莱菔英9克，全瓜萎12克，玄明粉9克。二诊：大便通利，而黄不退。食积从大便导之，其效速；酒积从小便利之，其效缓。绵茵陈15克，赤猪苓各9克，泽泻9克，冬葵子9克，白薇12克，马鞭草12克，广郁金9克，连翘12克，地龙9克。
三诊：诸症皆见轻减，热之所以不退，与平日体质有关。绵茵陈9克，青蒿9克，白薇12克，连翘12克，黄柏4．5克，地龙9克，粉丹皮9克，赤猪苓各9克，泽泻9克，冬葵子9克，活芦根30厘米。
【按］黄疸的常见成因大致有二：一为感染（天行时疫）；一属内伤（伤食嗜酒）。此案属酒食内伤，即《金匮》所谓谷疸、酒疸之类。一旦黄疸既成，不论其起因为何，肝胆受损则相同，所以治法均以清利湿热、利尿、通便为主。
7．王男。肝区压痛，小搜浑赤如血者俱见减轻，故热不若前日之甚。察其两目发黄，由于肝脏发炎者居多。桑白皮9克，白薇12克，赤白茯苓各9克，广郁金4．5克，小蓟9克，地骨皮9克，茵陈9克，蒲公英9克，玄明粉9克。
【按】发热，两目发黄，尿赤如血，肝区触痛，先生直称为肝炎，甚切临床实际。先生于30年代即打破中西医界限，提倡辨证与辨病相结合，其精神是难能可贵的。本案治用茵陈、蒲公英、桑白皮、地骨皮泄热利胆；二苓、泽泻利尿；小蓟凉血散瘀；玄明粉泄热通便；郁金行气散瘀，善治肝痛。
8．戴女。寒热罢，吐止，呕血亦不再作，而胃部按之仍痛，两目发黄，痛即因黄而来。茵陈15克，黑栀子12克，生大黄6克，芒硝12克（分2次冲），广郁金2．4克（研分2次吞），黄柏9克，桃仁18克，芦根30克，竹叶12克。
【按］此病人虽曾有呕吐、呕血，胃病病史，但从寒热退后，两目发黄来看，病属黄疸无疑。因黄疸而肝胆受损，其痛固属意中事。方用茵陈蒿汤合桅子柏皮汤加味，着重于清利湿热；郁金、桃仁，能疏肝祛瘀，活络止痛。
9．张男。神倦脉迟，旬日不更衣，目白黄，此当温泄之。炮附块9克，绵茵陈12克，炮姜4．5克，生苍术9克，生锦纹9克，玄明粉9克（分冲），泽泻9克，粉甘草6克。【按】神倦脉迟，脾阳不振之象；旬日不更衣，大肠积滞之征。此等证候，不宜凉下，只宜温泄。所谓"温泄"，用姜、附振奋中阳，增强功能，以助硝、黄通便除积，导邪下行，乃两相兼顾之法。
肿胀
1．王男。因心脏衰弱而脚肿，因肿而心脏更衰。往年白昼肿，入夜则消，今则浸寻益肿不消。如不积极治疗，将来肿势弥漫于腹部即难治矣。熟地18克，山药9克，肉桂0．9克（研分2次吞），炮附块6克，山萸肉9克，丹皮9克，茯苓9克，泽泻9克，破故纸9克，葫芦瓢18克。【按］心衰脚肿，由于右心功能不全所致。按中医辨证，此为肾阳不振，阴水泛滥。金匮肾气丸是温补肾阳的主要方剂，故先生采用之。其中附、桂按现代药理研究，小剂量具有强心．增强血液循环的作用。实是治疗心衰水肿的常用之药。
2．张女。透视心脏扩大，常心跳、面肿、两足亦肿，当治其心肾之本。附块4．5克，萸肉9克，山药12克，带皮苓18克，黄芪18克，党参9克，陈皮6克。二诊：面肿略消，心跳，登楼尤甚，有用力呼吸之状，脉亦不整调。党参9克，麦冬9克，五味子9克，黄芪12克。带皮苓18克，陈皮6克，破故纸12克，炙草6克，龙眼肉12克。
三诊：面部皮肤有紧急感，下肢按之凹陷。黄芪18克，五味子9克，破故纸12克，生白术12克，葫芦巴9克，带皮苓18克，陈皮6克，龙眼肉12克，潞党参9克，清炙草4．5克。四诊：心跳大定，面浮亦减。黄芪9克，党参9克，带皮苓18克，附子4．5克，破故纸9克，葫芦巴9克，五味子9克，白术18克，龙眼肉12克，清炙草4．5克。
【按】此心悸、面浮、足肿，属气阳两虚，故一方面用附子温用强心，一方面用参、芪补中益气；再佐以英肉补肝肾；山药、茯苓、陈皮健脾化湿；二诊心悸，脉律不整，抽去附子以防心阳过激而耗伤心气，主用生脉散加龙眼肉，补心气、养心血；并用参、芪、炙草补气，破故纸温肾，陈皮、苓皮行滞消肿。三诊更加葫芦巴温肾助阳，最终以益气。健脾、温肾，以善其后。
3．陈男。转动则气急，两足浮肿，阴囊亦肿大，两脉沉细。肾虚水气泛滥，非大剂温运不为功，予真武汤加味。炮附子9克，生苍术9克，旋覆花9克（包），细辛2．4克，毕澄茄9克，葫芦瓢30克，干蟾皮9克，车前子30克，带皮苓18克，白芍9克，淡姜皮2．4克。
【按］肾阳虚不能化气行水，则水气溢于肌肤，而为水肿。真武汤以附子温振肾阳；苓、术健脾利湿；生姜温胃利水；复以白芍制姜、附之燥热。实践证明，本方对肺源性心脏病、慢性肾炎、心力衰竭的水肿，确有良效。今以苍术易白术，燥湿之力益胜；加细辛、毕澄茄、干蟾皮之温化，车前子、葫芦瓢之利尿，作用更强。
4．王男。咳呛气逆而肿，入夜不能平卧，其病多在心脏。炮附片4．5克，杭白芍9克，生白术12克，带皮苓12克，远志肉9克，白芥子9克（打），炙紫菀9克，生姜2片，玉壶丹9克（分2次吞）。【按】用真武汤壮脾肾之阳（强心），为治本之法。紫菀祛疾，白芥子化寒痰，远志祛疾而兼宁心，是治喘咳之标。玉壶丹（局方）由南星、半夏、天麻组成，主治风痰吐逆，头痛头眩，亦治其痰疾。
5．吴男。古籍所称之气虚肿满，以现代观之，多属心脏病。今两脉有歇止，此气不足以息，是其候也。炮附块15克，山萸肉9克，党参18克，五味子9克，黄芪24克，砂仁拌熟地24克，云苓24克，怀牛膝24克，肉桂9克，升麻9克，破故纸12克，泽泻15克，仙灵脾15克，全蛤蚧1对，干蟾皮15克，为末，蜜丸，每服9克。【按］本方用附、桂温阳强心；参、芪补气；蛤蚧、萸肉、五味、熟地补心肾纳气；余为温阳助运、化湿之品。
6奚男。足肿而见脉大者，重在静养，以防震动。神疲冷汗，多其候也。炮附子4．5克，当归9克，黄芪9克，防风6克，白术9克，怀牛膝9克，黑大豆18克，杭芍9克（桂枝2．4克拌），木瓜9克，浮小麦12克，生姜3片，大枣5枚，粉甘草2．4克。
二诊：足肿消于清晨，剧于日暮，营养不足是主因，疲劳是诱因。当归9克，秦艽9克，料豆衣18克，怀牛膝9克，仙鹤草12克，绵杜仲9克，云苓12克，杜赤豆30克，黄芪皮9克，淡姜皮1．8克。另：健步虎潜丸90克，分10次服。【按］神疲为气虚，冷汗为心阳不足。用药以益气团表，温补心阳为主。此类足肿本质属虚，只宜补之温之，而切不可见肿治肿，妄用利导之品，徒伤正气。
7．邵女。在南京诊断为慢性肝炎，今以腹部胀满，肝区隐隐作痛为苦，大便不畅，小溲短少，而经常头晕欲仆，舌淡，脉弦细。此正虚邪实之候，古人有攻补兼施之法。幸胃纳尚佳，一面消肿通络，一面补益肝肾，方为万全。
（互）地鳖虫、蜣螂虫、五灵脂、参三七、广郁金、片姜黄。全当归、炙甲片、洗地龙、制黑丑、蝼蛄、将军干各9克。共研细末，每服1．5克，可渐加至3．0克，且日3次。（2）生黄芪18克，白芍9克，甘枸杞9克，五味子9克，云苓18克，炙草6克，炒麦芽9克，鳖甲胶9克（烊冲）。原注：每日1剂。服上药后，患者得以迅速改善症状，并控制了肝肿的发展。
【按］慢性肝炎和肝硬化的肝大腹胀，中医统称为鼓胀。正如《内经》所描述："膨胀者，腹胀身皆大，大与肤胀等也。色苍黄，腹筋起，此其候也。"此病往往本虚标实，攻之伤正，补之碍邪，施治颇为棘手。本案取攻补兼施之法，标本两顾。散剂用地鳖虫、蜣螂等虫药，攻坚散结；姜黄、郁金、三七、当归、五灵脂，山甲祛瘀止痛；黑丑、蝼蛄、将军干（即蟋蟀）行水通便。每服回．5克，且日3次，是取"猛药缓投"之意。汤剂用参、芪、苓、草建中补气；地、芍、杞。味、鳖甲胶滋益肝肾，是为治本之图。
笔者曾根据先生经验，制定"复肝散"（太子参30克，鸡内金24克，紫河车、广姜黄、炙地鳖虫、广郁金各18克，参三七15克，共研细末，每服3克，日2次）治疗慢性肝炎及早期肝硬化，服后能缩小肝肿，改善肝质，恢复肝功，增加食欲，并有提高血浆蛋白，纠正白、球蛋白倒置之功。
8．邵女。肝硬化，肝肿大3指，腹部胀痛，上至脘部，下至腿部，胀痛部时起水泡。胃纳不振，无饥饿感。大便2天二次，便后腹满略松。月经每三四个月来1次，量不多，四五天干净；来前腰痛，净后即定；白带多，无腥味。本方着重祛瘀消胀。（1）地鳖虫16克，郁金20克，青皮18克，绿萼梅30克，七厘散9克。共研细末，分作42包，每次1包，且日3次。（2）党参膏210克，鳖甲胶60克（烊化和入），淮山药15克（研末加入）。每次半茶匙，日3次。
二诊：肝按之疼痛，疲乏。食欲增进，食而知味，但腹胀未除。（1）地鳖虫15克，青皮30克，石柱参15克，郁金18克，七厘散9克，鸡内金18克。共研细末，每服1．8克，日3次。（2）黄芪膏210克，党参膏210克，鳖甲胶（烊化）120克，淮山药60克（研末和人）。每次半茶匙，日3次。
【按］此为肝硬化。综观其症状，显系正气不足而气滞血瘀，水湿内停而致气、血、水互阻。方用参芪、山药益气补脾；鳖甲胶滋阴、软坚；散剂善于祛瘀舒肝。瘀去则气血可望畅通，脾旺则水湿不复内聚，亦为攻补兼施之法。方中七厘散原系伤科常用成药，因其善于活血散瘀、止血定痛，乃借用之。石柱参是产于辽宁石柱沟地方的人参，经蒸制而成，药性偏温，功同移山参而作用较强，适用于阳虚气弱之体。
9．张男。肿从足部起，逐渐波及腹部，其形如箕，按之石硬。其人嗜酒多年，疑是肝脏性腹水。脉无变异，不类心脏病；面目不浮肿，亦不类肾脏病。海南片9克，制黑丑9克，莱菔子9克，昆布15克，五灵脂9克，桃仁泥12克（冲），粉丹皮9克，粉萆薢9克，泽泻9克，土牛膝15克。
【按】此肝性腹水属实，治以攻坚破结为主，方用槟榔、黑丑、莱菔子行滞破结；革＊、泽泻利尿行水；桃仁、灵脂、昆布、丹皮活血化瘀、攻坚散结；土牛膝引浊阴下行。
10．朱男。肿之情态，当然属于肝脏。何以有此肝脏病？原因非慢性痢疾，则非肝脓疡。尿中既无蛋白，则刺激性利尿剂无所顾虑。商陆9克，海南片9克，冬葵子9克，黑白丑各9克，毕澄茄9克，石韦9克，大戟末9克（3次服完），葶苈子9克，桑皮12克，怀牛膝18克。
二诊：以经验言，肾脏病尿有蛋白者，目胞必肿；心脏之肿，两脉多沉细无力；病者无此现象，当然是肝脏性之腹水。舟车丸9克（分3次吞），黑白丑各9克，木防己12克，海南片9克，商陆9克，茵陈12克，猪苓9克，毕澄茄9克，粉丹皮9克，桃仁泥12克。
三诊：迭进猛下，体力已感不支，故予温脾法。炮附片9克，潞党参9克，干蟾皮9克，生黄芪12克，益智仁9克，云苓12克，肉豆蔻9克，补骨脂9克，炙草4．5克，淡姜皮3克，肉桂末1．8克（分3次吞）。
【按语】此病初起曾出现寒战，说明存在表证；表证解除后出现身热、目赤、小便短少且色红，这是湿热之邪未能透发宣泄的表现。治疗采用导赤散加茵陈、白薇、薏苡仁以清热利尿；草决明、茺蔚子既能清肝热，又能配合郁李仁通导大便。二诊时双眼充血，小便赤痛，这是湿热蕴结的征象。治疗主要用三妙丸合栀子柏皮汤加茵陈，以清热泻火利湿。方中使用具有滋阴凉血作用的二至丸和生地黄，在利湿药中加入它们的用意在于：①救治被热邪灼伤的阴液；②避免燥湿坚利太过而耗伤阴液。三诊时出现黄疸、高热、烦躁、呕吐呃逆等症状，这是湿热化火且邪气炽盛、阴液受损的表现。急用茵陈、栀子、连翘，清热利湿退黄；辅以冬葵子、泽泻、石韦清热利尿，引导湿热从小便排出；更用大剂量生地黄配伍白薇，滋阴益阴，凉血清热祛邪。四诊时热退，继续采用凉血、退热、利湿的方法，两者兼顾。五诊时诸症悉减，继续采用凉肝解郁、利尿渗湿的方法，以清除余邪并巩固疗效。
5．张姓男子。他平时患有胃扩张，但单纯的胃扩张不会发热；如今发热，小便黄赤异常，两眼巩膜也不清晰，这是发热的病因所在。嫩白薇12克，绵茵陈15克，泽泻9克，冬葵子12克，赤茯苓与猪苓各9克，车前子15克，马鞭草12克，粉萆薢12克，瓜蒌仁9克，玄明粉9克（同捣碎）。【按语】此处从“小便黄赤异常，两目巩膜也不清晰”判断出发热的原因，似乎属于黄疸性肝炎。其病虽然难以完全断定，但湿热蕴结是无疑的，因此采用通利二便、清利湿热的方法。
6．张姓男子。发热2日不退，观察其眼睛微黄，小便浑浊赤红，这是湿热熏蒸于内，遇到诱因发作，与一般的湿热证不同；湿热证属于天行时病（流行性疾病），此病则起因于饮食不节和嗜酒。绵茵陈12克，青蒿9克，白薇12克，草决明9克，连翘12克，枳实9克，莱菔子9克，全瓜蒌12克，玄明粉9克。二诊：大便通畅，但黄色未退。食积通过大便疏导，效果迅速；酒积通过小便利出，效果缓慢。绵茵陈15克，赤茯苓与猪苓各9克，泽泻9克，冬葵子9克，白薇12克，马鞭草12克，广郁金9克，连翘12克，地龙9克。
三诊：诸症皆见减轻，热之所以不退，与平日体质有关。绵茵陈9克，青蒿9克，白薇12克，连翘12克，黄柏4.5克，地龙9克，粉丹皮9克，赤茯苓与猪苓各9克，泽泻9克，冬葵子9克，活芦根30厘米。
【按语】黄疸的常见成因大致有二：一是感染（天行时疫）；二是内伤（伤食嗜酒）。此案属于酒食内伤，即《金匮要略》所谓谷疸、酒疸之类。一旦黄疸形成，不论其起因如何，肝胆受损是一样的，所以治法均以清利湿热、利尿、通便为主。
7．王姓男子。肝区压痛，小便浑浊如血的症状均见减轻，故发热不如前几天严重。观察其两目发黄，多数由于肝脏发炎引起。桑白皮9克，白薇12克，赤茯苓与白茯苓各9克，广郁金4.5克，小蓟9克，地骨皮9克，茵陈9克，蒲公英9克，玄明粉9克。
【按语】发热，两目发黄，尿赤如血，肝区触痛，先生直接称为肝炎，非常切合临床实际。先生在20世纪30年代即打破中西医界限，提倡辨证与辨病相结合，这种精神难能可贵。本案治疗使用茵陈、蒲公英、桑白皮、地骨皮泄热利胆；二苓、泽泻利尿；小蓟凉血散瘀；玄明粉泄热通便；郁金行气散瘀，善于治疗肝痛。
8．戴姓女子。寒热停止，呕吐止住，呕血也不再发生，但胃部按压仍疼痛，两目发黄，疼痛即因黄疸而来。茵陈15克，黑栀子12克，生大黄6克，芒硝12克（分2次冲服），广郁金2.4克（研末分2次吞服），黄柏9克，桃仁18克，芦根30克，竹叶12克。
【按语】此病人虽曾有呕吐、呕血，有胃病病史，但从寒热退后，两目发黄来看，病属黄疸无疑。因黄疸导致肝胆受损，其疼痛自然在意料之中。方用茵陈蒿汤合栀子柏皮汤加味，着重于清利湿热；郁金、桃仁，能疏肝祛瘀，活络止痛。
9．张姓男子。神疲乏力，脉象迟缓，十天未排便，眼白发黄，这应当用温法泄下。炮附块9克，绵茵陈12克，炮姜4.5克，生苍术9克，生锦纹（大黄）9克，玄明粉9克（分次冲服），泽泻9克，粉甘草6克。【按语】神疲脉迟，是脾阳不振的表现；十天未排便，是大肠积滞的征象。此类证候，不宜用寒凉攻下，只宜用温法泄下。所谓“温泄”，是用干姜、附子振奋中焦阳气，增强功能，以助芒硝、大黄通便除积，引导邪气下行，这是两相兼顾的方法。
肿胀
1．王姓男子。因心脏衰弱而导致脚肿，因脚肿又使心脏更加衰弱。往年白天肿，入夜则消退，现在则逐渐加重且不消退。如果不积极治疗，将来肿胀弥漫到腹部就难治了。熟地黄18克，山药9克，肉桂0.9克（研末分2次吞服），炮附块6克，山茱萸肉9克，丹皮9克，茯苓9克，泽泻9克，补骨脂9克，葫芦瓢18克。【按语】心衰脚肿，是由于右心功能不全所致。按中医辨证，此为肾阳不振，阴水泛滥。金匮肾气丸是温补肾阳的主要方剂，故先生采用之。其中附子、肉桂按现代药理研究，小剂量具有强心、增强血液循环的作用。实为治疗心衰水肿的常用药物。
2．张姓女子。透视显示心脏扩大，常有心跳感、面部浮肿、双足亦肿，当治其心肾之本。附块4.5克，山茱萸肉9克，山药12克，带皮茯苓18克，黄芪18克，党参9克，陈皮6克。二诊：面部浮肿略消，心跳，登楼时尤为严重，有用力呼吸的样子，脉象也不整齐。党参9克，麦冬9克，五味子9克，黄芪12克。带皮茯苓18克，陈皮6克，补骨脂12克，炙甘草6克，龙眼肉12克。
三诊：面部皮肤有紧绷感，下肢按压有凹陷。黄芪18克，五味子9克，补骨脂12克，生白术12克，葫芦巴9克，带皮茯苓18克，陈皮6克，龙眼肉12克，潞党参9克，清炙甘草4.5克。四诊：心跳基本安定，面部浮肿也减轻。黄芪9克，党参9克，带皮茯苓18克，附子4.5克，补骨脂9克，葫芦巴9克，五味子9克，白术18克，龙眼肉12克，清炙甘草4.5克。
【按语】此心悸、面浮、足肿，属于气阳两虚，故一方面用附子温阳强心，一方面用人参、黄芪补中益气；再佐以山茱萸补肝肾；山药、茯苓、陈皮健脾化湿；二诊时心悸，脉律不整，去掉附子以防心阳过激而耗伤心气，主用生脉散加龙眼肉，补心气、养心血；并用参、芪、炙甘草补气，补骨脂温肾，陈皮、茯苓皮行滞消肿。三诊增加葫芦巴温肾助阳，最终以益气、健脾、温肾，来善后调理。
3．陈姓男子。转动身体则气急，双足浮肿，阴囊亦肿大，两脉沉细。肾虚水气泛滥，非大剂量温运不能奏效，给予真武汤加味。炮附子9克，生苍术9克，旋覆花9克（包煎），细辛2.4克，荜澄茄9克，葫芦瓢30克，干蟾皮9克，车前子30克，带皮茯苓18克，白芍9克，淡姜皮2.4克。
【按语】肾阳虚不能化气行水，则水气溢于肌肤，而为水肿。真武汤以附子温振肾阳；茯苓、白术健脾利湿；生姜温胃利水；再用白芍制约姜、附的燥热。实践证明，本方对肺源性心脏病、慢性肾炎、心力衰竭的水肿，确有良效。今以苍术代替白术，燥湿之力更强；加细辛、荜澄茄、干蟾皮的温化作用，以及车前子、葫芦瓢的利尿作用，效力更强。
4．王姓男子。咳嗽气逆而肿，夜间不能平卧，其病多在心脏。炮附片4.5克，杭白芍9克，生白术12克，带皮茯苓12克，远志肉9克，白芥子9克（打碎），炙紫菀9克，生姜2片，玉壶丹9克（分2次吞服）。【按语】用真武汤壮脾肾之阳（强心），为治本之法。紫菀祛痰，白芥子化寒痰，远志祛痰而兼宁心，是治喘咳之标。玉壶丹（局方）由南星、半夏、天麻组成，主治风痰吐逆，头痛头眩，也治其痰疾。
5．吴姓男子。古籍所称的气虚肿满，以现代观点看，多属心脏病。如今两脉有歇止，这是气不足以息，是其征候。炮附块15克，山茱萸肉9克，党参18克，五味子9克，黄芪24克，砂仁拌熟地黄24克，云茯苓24克，怀牛膝24克，肉桂9克，升麻9克，补骨脂12克，泽泻15克，仙灵脾15克，全蛤蚧1对，干蟾皮15克，研为末，蜜丸，每服9克。【按语】本方用附子、肉桂温阳强心；人参、黄芪补气；蛤蚧、山茱萸、五味子、熟地黄补心肾纳气；其余为温阳助运、化湿之品。
6．奚姓男子。足肿而脉大者，重在静养，以防震动。神疲冷汗，多为其征候。炮附子4.5克，当归9克，黄芪9克，防风6克，白术9克，怀牛膝9克，黑大豆18克，杭白芍9克（与桂枝2.4克拌），木瓜9克，浮小麦12克，生姜3片，大枣5枚，粉甘草2.4克。
二诊：足肿清晨消退，傍晚加剧，营养不足是主因，疲劳是诱因。当归9克，秦艽9克，料豆衣18克，怀牛膝9克，仙鹤草12克，绵杜仲9克，云茯苓12克，杜赤豆30克，黄芪皮9克，淡姜皮1.8克。另：健步虎潜丸90克，分10次服。【按语】神疲为气虚，冷汗为心阳不足。用药以益气固表，温补心阳为主。此类足肿本质属虚，只宜补之温之，而切不可见肿治肿，妄用利导之品，徒伤正气。
7．邵姓女子。在南京诊断为慢性肝炎，如今以腹部胀满，肝区隐隐作痛为苦，大便不畅，小便短少，而经常头晕欲倒，舌淡，脉弦细。这是正虚邪实的征候，古人有攻补兼施的方法。幸好胃纳尚佳，一面消肿通络，一面补益肝肾，方为万全之策。
（1）地鳖虫、蜣螂虫、五灵脂、参三七、广郁金、片姜黄。全当归、炙甲片、洗地龙、制黑丑、蝼蛄、将军干（蟋蟀）各9克。共研细末，每服1.5克，可渐加至3.0克，每日3次。（2）生黄芪18克，白芍9克，甘枸杞9克，五味子9克，云茯苓18克，炙甘草6克，炒麦芽9克，鳖甲胶9克（烊化冲服）。原注：每日1剂。服上药后，患者得以迅速改善症状，并控制了肝肿的发展。
【按语】慢性肝炎和肝硬化的肝大腹胀，中医统称为鼓胀。正如《内经》所描述：“膨胀者，腹胀身皆大，大与肤胀等也。色苍黄，腹筋起，此其候也。”此病往往本虚标实，攻之伤正，补之碍邪，施治颇为棘手。本案取攻补兼施之法，标本两顾。散剂用地鳖虫、蜣螂等虫药，攻坚散结；姜黄、郁金、三七、当归、五灵脂、穿山甲祛瘀止痛；黑丑、蝼蛄、将军干（即蟋蟀）行水通便。每服1.5克，每日3次，是取“猛药缓投”之意。汤剂用人参、黄芪、茯苓、甘草建中补气；地黄、白芍、枸杞、五味子、鳖甲胶滋益肝肾，是为治本之图。
笔者曾根据先生经验，制定“复肝散”（太子参30克，鸡内金24克，紫河车、广姜黄、炙地鳖虫、广郁金各18克，参三七15克，共研细末，每服3克，每日2次）治疗慢性肝炎及早期肝硬化，服后能缩小肝肿，改善肝质，恢复肝功能，增加食欲，并有提高血浆蛋白，纠正白、球蛋白倒置之功。
8．邵姓女子。肝硬化，肝肿大3指，腹部胀痛，上至脘部，下至腿部，胀痛部位时起水泡。胃纳不振，无饥饿感。大便2天二次，便后腹满略松。月经每三四个月来1次，量不多，四五天干净；来前腰痛，净后即定；白带多，无腥味。本方着重祛瘀消胀。（1）地鳖虫16克，郁金20克，青皮18克，绿萼梅30克，七厘散9克。共研细末，分作42包，每次1包，每日3次。（2）党参膏210克，鳖甲胶60克（烊化和入），淮山药15克（研末加入）。每次半茶匙，每日3次。
二诊：肝按之疼痛，疲乏。食欲增进，食而知味，但腹胀未除。（1）地鳖虫15克，青皮30克，石柱参15克，郁金18克，七厘散9克，鸡内金18克。共研细末，每服1.8克，每日3次。（2）黄芪膏210克，党参膏210克，鳖甲胶（烊化）120克，淮山药60克（研末和人）。每次半茶匙，每日3次。
【按语】此为肝硬化。综观其症状，显系正气不足而气滞血瘀，水湿内停而致气、血、水互阻。方用参芪、山药益气补脾；鳖甲胶滋阴、软坚；散剂善于祛瘀舒肝。瘀去则气血可望畅通，脾旺则水湿不复内聚，亦为攻补兼施之法。方中七厘散原系伤科常用成药，因其善于活血散瘀、止血定痛，乃借用之。石柱参是产于辽宁石柱沟地方的人参，经蒸制而成，药性偏温，功效同移山参而作用较强，适用于阳虚气弱之体。
9．张姓男子。肿从足部起，逐渐波及腹部，其形如箕，按之石硬。其人嗜酒多年，疑是肝脏性腹水。脉无变异，不类心脏病；面目不浮肿，亦不类肾脏病。海南片9克，制黑丑9克，莱菔子9克，昆布15克，五灵脂9克，桃仁泥12克（冲服），粉丹皮9克，粉萆薢9克，泽泻9克，土牛膝15克。
【按语】此肝性腹水属实，治以攻坚破结为主，方用槟榔、黑丑、莱菔子行滞破结；萆薢、泽泻利尿行水；桃仁、五灵脂、昆布、丹皮活血化瘀、攻坚散结；土牛膝引浊阴下行。
10．朱姓男子。肿之情态，当然属于肝脏。何以有此肝脏病？原因非慢性痢疾，则非肝脓疡。尿中既无蛋白，则刺激性利尿剂无所顾虑。商陆9克，海南片9克，冬葵子9克，黑白丑各9克，荜澄茄9克，石韦9克，大戟末9克（3次服完），葶苈子9克，桑白皮12克，怀牛膝18克。
二诊：以经验言，肾脏病尿有蛋白者，目胞必肿；心脏之肿，两脉多沉细无力；病者无此现象，当然是肝脏性之腹水。舟车丸9克（分3次吞服），黑白丑各9克，木防己12克，海南片9克，商陆9克，茵陈12克，猪苓9克，荜澄茄9克，粉丹皮9克，桃仁泥12克。
三诊：迭进猛下，体力已感不支，故予温脾法。炮附片9克，潞党参9克，干蟾皮9克，生黄芪12克，益智仁9克，云茯苓12克，肉豆蔻9克，补骨脂9克，炙甘草4.5克，淡姜皮3克，肉桂末1.8克（分3次吞服）。
[Commentary] The disease initially presented with chills, indicating the presence of a Exterior Syndrome (Biao Zheng). After the exterior was resolved, fever, red eyes, and short, dark red urine appeared, signifying that Damp-Heat pathogens had not been thoroughly vented and excreted. Treatment employed Dao Chi San (Guide Out the Red Powder) added with Yin Chen Hao (Artemisiae Scopariae Herba), Bai Wei (Cynanchi Atrati Radix), and Yi Yi Ren (Coicis Semen) to clear heat and promote diuresis; Jue Ming Zi (Cassiae Semen) and Chong Wei Zi (Vernoniae Fructus) can both clear Liver Heat and, in combination with Yu Li Ren (Pruni Semen), facilitate bowel movement. In the second visit, bilateral eye congestion, dark red and painful urination indicated the accumulation and binding of Damp-Heat. Treatment primarily used San Miao Wan (Three Marvels Pill) combined with Zhi Zi Bai Pi Tang (Gardenia and Phellodendron Decoction) plus Yin Chen Hao to clear heat, purge fire, and drain dampness. The inclusion of Er Zhi Wan (Two Solstice Pill) and Sheng Di Huang (Rehmanniae Radix), which nourish yin and cool blood, among the damp-draining herbs serves two purposes: ① to rescue the yin damaged by heat pathogens; ② to prevent excessive dryness and harsh purgation from consuming yin fluids. In the third visit, jaundice, high fever, irritability, vomiting, and hiccups appeared, indicating that Damp-Heat had transformed into Fire, with pathogenic factors flourishing and yin damaged. Urgent treatment used Yin Chen Hao, Zhi Zi, and Lian Qiao to clear heat, drain dampness, and resolve jaundice; supplemented by Dong Kui Zi (Malvae Semen), Ze Xie (Alismatis Rhizoma), and Shi Wei (Pyrrosiae Folium) to clear heat and promote diuresis, guiding Damp-Heat out through urination; furthermore, a large dose of Sheng Di Huang paired with Bai Wei was used to nourish fluids, benefit yin, cool blood, clear heat, and expel pathogens. In the fourth visit, after the fever subsided, cooling blood, reducing fever, and draining dampness were continued, addressing both aspects. In the fifth visit, as all symptoms significantly decreased, cooling the Liver, resolving stagnation, promoting diuresis, and leaching out dampness were continued to clear residual pathogens and consolidate therapeutic effects.
5. Male, surnamed Zhang. He has a history of gastric dilation, but simple gastric dilation does not cause fever; now he has fever, urine is abnormally yellow and dark red, and the sclera of both eyes is unclear, indicating the cause of the fever. Nen Bai Wei 12g, Mian Yin Chen Hao 15g, Ze Xie 9g, Dong Kui Zi 12g, Chi Fu Ling and Zhu Ling 9g each, Che Qian Zi 15g, Ma Bian Cao 12g, Fen Bi Xie 12g, Gua Lou Ren 9g, Xuan Ming Fen 9g (pounded together). [Commentary] Judging from "abnormally yellow and dark red urine, and unclear sclera," the cause of fever seems to belong to icteric hepatitis. Although the disease cannot be definitively diagnosed, the accumulation and binding of Damp-Heat is undeniable; therefore, methods to unblock bowels and urination, and clear and drain Damp-Heat are used.
6. Male, surnamed Zhang. Fever persists for 2 days without subsiding. Observation shows slightly yellow eyes and turbid, dark red urine. This is due to Damp-Heat steaming internally, triggered by inducing factors, differing from typical Damp-Heat Syndromes; Damp-Heat syndromes are epidemic diseases, whereas this one originates from dietary indiscretion and alcohol abuse. Mian Yin Chen Hao 12g, Qing Hao 9g, Bai Wei 12g, Jue Ming Zi 9g, Lian Qiao 12g, Zhi Shi 9g, Lai Fu Zi 9g, Quan Gua Lou 12g, Xuan Ming Fen 9g. Second visit: Bowels are unblocked, but yellowness remains. Food stagnation guided out via bowels acts quickly; alcohol stagnation drained via urination acts slowly. Mian Yin Chen Hao 15g, Chi Fu Ling and Zhu Ling 9g each, Ze Xie 9g, Dong Kui Zi 9g, Bai Wei 12g, Ma Bian Cao 12g, Guang Yu Jin 9g, Lian Qiao 12g, Di Long 9g.
Third visit: All symptoms have lightened. The reason fever persists relates to his usual constitution. Mian Yin Chen Hao 9g, Qing Hao 9g, Bai Wei 12g, Lian Qiao 12g, Huang Bo 4.5g, Di Long 9g, Fen Dan Pi 9g, Chi Fu Ling and Zhu Ling 9g each, Ze Xie 9g, Dong Kui Zi 9g, Huo Lu Gen 30cm.
[Commentary] There are roughly two common causes of jaundice: one is infection (epidemic pathogens); the other is internal injury (dietary damage and alcohol abuse). This case belongs to internal injury from wine and food, i.e., Gu Dan (Grain Jaundice) and Jiu Dan (Wine Jaundice) mentioned in *Jin Gui Yao Lue*. Once jaundice is formed, regardless of the cause, the damage to the Liver and Gallbladder is the same; thus, treatments all focus on clearing and draining Damp-Heat, promoting diuresis, and unblocking bowels.
7. Male, surnamed Wang. Tenderness in the liver area, and symptoms of turbid urine like blood have both reduced, so fever is not as severe as before. Observation of yellow eyes suggests inflammation of the liver is the majority cause. Sang Bai Pi 9g, Bai Wei 12g, Chi Bai Fu Ling 9g each, Guang Yu Jin 4.5g, Xiao Ji 9g, Di Gu Pi 9g, Yin Chen 9g, Pu Gong Ying 9g, Xuan Ming Fen 9g.
[Commentary] Fever, yellow eyes, urine red like blood, and tenderness in the liver area, Mr. Zhang directly termed Hepatitis, which fits clinical reality very well. Mr. Zhang broke down boundaries between Traditional Chinese Medicine and Western Medicine in the 1930s, advocating the combination of syndrome differentiation and disease differentiation; this spirit is invaluable. This case uses Yin Chen, Pu Gong Ying, Sang Bai Pi, and Di Gu Pi to vent heat and benefit the gallbladder; Er Ling (Fu Ling) and Ze Xie to promote diuresis; Xiao Ji to cool blood and dissipate stasis; Xuan Ming Fen to vent heat and unblock bowels; Yu Jin to move qi and dissipate stasis, excellent for treating liver pain.
8. Female, surnamed Dai. Chills and fever ceased, vomiting stopped, hematemesis no longer occurs, but pressing on the stomach still causes pain, and both eyes are yellow; the pain arises from the jaundice. Yin Chen 15g, Hei Zhi Zi 12g, Sheng Da Huang 6g, Mang Xiao 12g (taken in 2 doses), Guang Yu Jin 2.4g (powdered, taken in 2 doses), Huang Bo 9g, Tao Ren 18g, Lu Gen 30g, Zhu Ye 12g.
[Commentary] Although this patient had a history of vomiting and hematemesis due to stomach disease, the appearance of yellow eyes after chills and fever subsided confirms the disease is jaundice. Due to jaundice damaging the Liver and Gallbladder, pain is expected. The formula uses Yin Chen Hao Tang combined with Zhi Zi Bai Pi Tang modified, focusing on clearing and draining Damp-Heat; Yu Jin and Tao Ren soothe the Liver, remove stasis, and relieve pain through collateral activation.
9. Male, surnamed Zhang. Mental fatigue and slow pulse, no bowel movement for ten days, white of eyes yellow. This requires warm purgation. Pao Fu Kuai 9g, Mian Yin Chen Hao 12g, Pao Jiang 4.5g, Sheng Cang Zhu 9g, Sheng Jin Wen (Da Huang) 9g, Xuan Ming Fen 9g (taken in divided doses), Ze Xie 9g, Fen Gan Cao 6g. [Commentary] Mental fatigue and slow pulse indicate Spleen Yang deficiency; no bowel movement for ten days indicates intestinal stagnation. Such conditions are unsuitable for cold purgation; only warm purgation is appropriate. "Warm purgation" uses Jiang (Ginger) and Fu (Aconite) to invigorate Middle Yang and enhance function, assisting Mang (Mang Xiao) and Huang (Da Huang) to unblock bowels and eliminate stagnation, guiding pathogens downward, a method balancing both aspects.
Swelling
1. Male, surnamed Wang. Foot swelling due to heart failure; swelling further worsens heart failure. In previous years, swelling occurred during the day and subsided at night; now it progressively worsens and does not subside. If not treated actively, swelling spreading to the abdomen will be difficult to treat later. Shu Di Huang 18g, Shan Yao 9g, Rou Gui 0.9g (powdered, taken in 2 doses), Pao Fu Kuai 6g, Shan Yu Rou 9g, Dan Pi 9g, Fu Ling 9g, Ze Xie 9g, Po Gu Zhi 9g, Hu Lu Piao 18g. [Commentary] Heart failure foot swelling is caused by right heart insufficiency. According to TCM syndrome differentiation, this is Kidney Yang deficiency with flooding of Yin Water. Jin Gui Shen Qi Wan is the main formula for warming and tonifying Kidney Yang, hence adopted by Mr. Zhang. Among them, Fu and Gui, according to modern pharmacological research, in small doses have heart-strengthening and blood circulation-enhancing effects. They are indeed commonly used drugs for treating heart failure edema.
2. Female, surnamed Zhang. Radiography shows enlarged heart, frequent palpitations, facial swelling, and swelling in both feet. Treatment should address the root of Heart and Kidney. Fu Kuai 4.5g, Yu Rou 9g, Shan Yao 12g, Dai Pi Ling 18g, Huang Qi 18g, Dang Shen 9g, Chen Pi 6g. Second visit: Facial swelling slightly reduced, palpitations persist, worse when climbing stairs, with signs of labored breathing, and irregular pulse. Dang Shen 9g, Mai Dong 9g, Wu Wei Zi 9g, Huang Qi 12g. Dai Pi Ling 18g, Chen Pi 6g, Po Gu Zhi 12g, Zhi Gan Cao 6g, Long Yan Rou 12g.
Third visit: Tight sensation on facial skin, pitting edema on lower limbs. Huang Qi 18g, Wu Wei Zi 9g, Po Gu Zhi 12g, Sheng Bai Zhu 12g, Hu Lu Ba 9g, Dai Pi Ling 18g, Chen Pi 6g, Long Yan Rou 12g, Lu Dang Shen 9g, Qing Zhi Gan Cao 4.5g. Fourth visit: Palpitations largely stabilized, facial edema also reduced. Huang Qi 9g, Dang Shen 9g, Dai Pi Ling 18g, Fu Zi 4.5g, Po Gu Zhi 9g, Hu Lu Ba 9g, Wu Wei Zi 9g, Bai Zhu 18g, Long Yan Rou 12g, Qing Zhi Gan Cao 4.5g.
[Commentary] This palpitations, facial edema, and foot swelling belong to Qi and Yang dual deficiency. Thus, on one hand, Fu Zi is used to warm Yang and strengthen the heart; on the other, Ren Shen and Huang Qi tonify Middle Qi; assisted by Yu Rou to tonify Liver and Kidney; Shan Yao, Fu Ling, and Chen Pi to strengthen Spleen and transform dampness; in the second visit, due to palpitations and irregular pulse, Fu Zi is removed to prevent excessive Heart Yang from consuming Heart Qi, primarily using Sheng Mai San plus Long Yan Rou to tonify Heart Qi and nourish Heart Blood; additionally, Ren Shen, Huang Qi, and Zhi Gan Cao tonify Qi, Po Gu Zhi warms Kidney, and Chen Pi and Fu Pi Ling move stagnation and reduce edema. In the third visit, Hu Lu Ba is added to warm Kidney and assist Yang, finally concluding with tonifying Qi, strengthening Spleen, and warming Kidney for recovery.
3. Male, surnamed Chen. Shortness of breath upon turning, bilateral foot edema, scrotal swelling, deep and fine pulses. Kidney deficiency with flooding of water qi requires large doses of warming and moving to achieve effect; given Zhen Wu Tang modified. Pao Fu Zi 9g, Sheng Cang Zhu 9g, Xuan Fu Hua 9g (wrapped), Xi Xin 2.4g, Bi Cheng Qie 9g, Hu Lu Piao 30g, Gan Chan Pi 9g, Che Qian Zi 30g, Dai Pi Ling 18g, Bai Shao 9g, Dan Jiang Pi 2.4g.
[Commentary] Kidney Yang deficiency failing to transform Qi and move water leads to water qi overflowing into skin and muscles, causing edema. Zhen Wu Tang uses Fu Zi to warm and invigorate Kidney Yang; Fu Ling and Bai Zhu strengthen Spleen and drain dampness; Sheng Jiang warms Stomach and moves water; Bai Shao controls the dryness and heat of Jiang and Fu. Practical experience proves this formula is effective for edema in pulmonary heart disease, chronic nephritis, and heart failure. Here, Cang Zhu replaces Bai Zhu to enhance drying dampness power; adding Xi Xin, Bi Cheng Qie, and Gan Chan Pi for warming transformation, and Che Qian Zi and Hu Lu Piao for diuresis, strengthens the action.
4. Male, surnamed Wang. Coughing, rebellious Qi, and swelling, unable to lie flat at night; the disease likely lies in the Heart. Pao Fu Pian 4.5g, Hang Bai Shao 9g, Sheng Bai Zhu 12g, Dai Pi Ling 12g, Yuan Zhi Rou 9g, Bai Jie Zi 9g (crushed), Zhi Zi Wan 9g, Sheng Jiang 2 slices, Yu Hu Dan 9g (taken in 2 doses). [Commentary] Using Zhen Wu Tang to strengthen Spleen and Kidney Yang (strengthen heart) is the root treatment. Zi Wan dispels phlegm, Bai Jie Zi transforms cold phlegm, Yuan Zhi dispels phlegm and calms the mind, treating the branch of wheezing and coughing. Yu Hu Dan (Ju Fang) consists of Nan Xing, Ban Xia, and Tian Ma, mainly treating wind-phlegm vomiting, headache, and dizziness, also treating its phlegm pathology.
5. Male, surnamed Wu. Qi deficiency swelling and fullness described in ancient texts mostly correspond to heart disease from a modern perspective. Now there are intermissions in both pulses, indicating insufficient Qi to breathe, which is the sign. Pao Fu Kuai 15g, Shan Yu Rou 9g, Dang Shen 18g, Wu Wei Zi 9g, Huang Qi 24g, Sha Ren mixed with Shu Di Huang 24g, Yun Ling 24g, Huai Niu Xi 24g, Rou Gui 9g, Sheng Ma 9g, Po Gu Zhi 12g, Ze Xie 15g, Xian Ling Pi 15g, Quan Ge Jie 1 pair, Gan Chan Pi 15g, powdered, honey pills, 9g per dose. [Commentary] This formula uses Fu and Gui to warm Yang and strengthen the heart; Shen and Qi to tonify Qi; Ge Jie, Yu Rou, Wu Wei Zi, and Shu Di to tonify Heart and Kidney and grasp Qi; the rest are warming Yang, aiding transport, and transforming dampness products.
6. Male, surnamed Xi. Foot swelling with large pulse emphasizes quiet rest to prevent agitation. Mental fatigue and cold sweat are typical signs. Pao Fu Zi 4.5g, Dang Gui 9g, Huang Qi 9g, Fang Feng 6g, Bai Zhu 9g, Huai Niu Xi 9g, Hei Da Dou 18g, Hang Shao 9g (mixed with Gui Zhi 2.4g), Mu Gua 9g, Fu Xiao Mai 12g, Sheng Jiang 3 slices, Da Zao 5 pieces, Fen Gan Cao 2.4g.
Second visit: Foot swelling subsides in the morning, worsens in the evening; malnutrition is the main cause, fatigue is the trigger. Dang Gui 9g, Qin Jiao 9g, Liao Dou Yi 18g, Huai Niu Xi 9g, Xian He Cao 12g, Mian Du Zhong 9g, Yun Ling 12g, Du Chi Dou 30g, Huang Qi Pi 9g, Dan Jiang Pi 1.8g. Additionally: Jian Bu Hu Qian Wan 90g, taken in 10 doses. [Commentary] Mental fatigue indicates Qi deficiency, cold sweat indicates Heart Yang insufficiency. Medication focuses on tonifying Qi and securing the exterior, warming and tonifying Heart Yang. The essence of such foot swelling is deficiency; only tonification and warming are suitable. One must never treat swelling merely by swelling, recklessly using draining agents, which would vainly injure healthy Qi.
7. Female, surnamed Shao. Diagnosed with chronic hepatitis in Nanjing, now suffering from abdominal distension, dull pain in the liver area, unsmooth bowel movements, short urine, frequent dizziness as if fainting, pale tongue, wiry and fine pulse. This is a pattern of Healthy Qi deficiency and Pathogenic factors excess. Ancients had methods of attacking and tonifying simultaneously. Fortunately, appetite is still good; simultaneously reducing swelling and unblocking collaterals, while tonifying Liver and Kidney, is the safest approach.
(1) Di Bie Chong, Qiang Lang Chong, Wu Ling Zhi, Shen San Qi, Guang Yu Jin, Pian Jiang Huang. Quan Dang Gui, Zhi Jia Pian, Xi Di Long, Zhi Hei Chou, Lou Gu, Jiang Jun Gan (cricket) each 9g. Powdered finely, 1.5g per dose, gradually increasing to 3.0g, 3 times daily. (2) Sheng Huang Qi 18g, Bai Shao 9g, Gan Gou Qi 9g, Wu Wei Zi 9g, Yun Ling 18g, Zhi Gan Cao 6g, Chao Mai Ya 9g, Bie Jia Jiao 9g (melted and taken). Original note: 1 dose daily. After taking these medicines, the patient's symptoms improved rapidly, and liver enlargement development was controlled.
[Commentary] Hepatomegaly and abdominal distension in chronic hepatitis and liver cirrhosis are collectively called Gu Zhang (Drum Distension) in TCM. As described in *Nei Jing*: "Distension means abdominal swelling and body enlargement, equal to skin distension. Complexion is greenish-yellow, abdominal veins protrude, this is its sign." This disease often involves Root Deficiency and Branch Excess; attacking injures Healthy Qi, tonifying hinders Pathogens, making treatment tricky. This case adopts simultaneous attack and tonification, addressing both Root and Branch. Powder uses insects like Di Bie Chong and Qiang Lang to break hardness and dissipate nodules; Jiang Huang, Yu Jin, San Qi, Dang Gui, Wu Ling Zhi, and Shan Jia remove stasis and relieve pain; Hei Chou, Lou Gu, and Jiang Jun Gan move water and unblock bowels. 1.5g per dose, 3 times daily, takes the meaning of "administering strong medicine slowly." Decoction uses Shen, Qi, Ling, and Gan Cao to build Middle and tonify Qi; Di, Shao, Qi, Wei, and Bie Jia Jiao nourish and benefit Liver and Kidney, aiming at treating the Root.
The author, based on Mr. Zhang's experience, formulated "Fu Gan San" (Tai Zi Shen 30g, Ji Nei Jin 24g, Zi He Che, Guang Jiang Huang, Zhi Di Bie Chong, Guang Yu Jin each 18g, Shen San Qi 15g, powdered finely, 3g per dose, 2 times daily) to treat chronic hepatitis and early-stage liver cirrhosis. After administration, it can shrink liver size, improve liver texture, restore liver function, increase appetite, and has the merit of raising plasma protein and correcting albumin/globulin inversion.
8. Female, surnamed Shao. Liver cirrhosis, liver enlarged 3 fingers, abdominal and epigastric pain extending to legs, blisters occasionally appearing in painful areas. Poor appetite, no hunger sensation. Bowel movement twice in 2 days, abdominal fullness slightly relieved after defecation. Menstruation once every 3-4 months, scanty amount, lasting 4-5 days; lower back pain before menstruation, resolves after cleaning; abundant leukorrhea, odorless. This formula focuses on removing stasis and reducing distension. (1) Di Bie Chong 16g, Yu Jin 20g, Qing Pi 18g, Lv E Mei 30g, Qi Li San 9g. Powdered finely, divided into 42 packets, 1 packet per dose, 3 times daily. (2) Dang Shen Gao 210g, Bie Jia Jiao 60g (melted and mixed), Huai Shan Yao 15g (powdered and added). Half teaspoon per dose, 3 times daily.
Second visit: Pain on pressing liver, fatigue. Appetite increased, taste of food perceived, but abdominal distension remains. (1) Di Bie Chong 15g, Qing Pi 30g, Shi Zhu Shen 15g, Yu Jin 18g, Qi Li San 9g, Ji Nei Jin 18g. Powdered finely, 1.8g per dose, 3 times daily. (2) Huang Qi Gao 210g, Dang Shen Gao 210g, Bie Jia Jiao (melted) 120g, Huai Shan Yao 60g (powdered and mixed). Half teaspoon per dose, 3 times daily.
[Commentary] This is liver cirrhosis. Synthesizing symptoms, it clearly indicates Healthy Qi deficiency with Qi stagnation and Blood stasis, water-dampness retention leading to mutual obstruction of Qi, Blood, and Water. The formula uses Shen and Qi, Shan Yao to tonify Qi and strengthen Spleen; Bie Jia Jiao to nourish Yin and soften hardness; powder excels at removing stasis and soothing Liver. Once stasis is removed, Qi and Blood flow may be smooth; once Spleen is robust, water-dampness will not accumulate internally again, also a method of simultaneous attack and tonification. Qi Li San in the formula is originally a common surgical medicine, borrowed here because it excels at activating blood, removing stasis, stopping bleeding, and relieving pain. Shi Zhu Shen is Ginseng produced in Shizhu Gou, Liaoning, steamed, with slightly warm properties, efficacy similar to Yi Shan Shen but stronger, suitable for Yang deficiency and Qi weakness constitutions.
9. Male, surnamed Zhang. Swelling starts from feet, gradually involving abdomen, shape like a basket, hard as stone on pressure. He has drunk alcohol for many years, suspected hepatic ascites. Pulse unchanged, unlike heart disease; face and eyes not swollen, unlike kidney disease. Hai Nan Pian 9g, Zhi Hei Chou 9g, Lai Fu Zi 9g, Kun Bu 15g, Wu Ling Zhi 9g, Tao Ren Ni 12g (taken with decoction), Fen Dan Pi 9g, Fen Bi Xie 9g, Ze Xie 9g, Tu Niu Xi 15g.
[Commentary] This hepatic ascites is Excess; treatment focuses on breaking hardness and dissolving nodules. Formula uses Bing Lang, Hei Chou, and Lai Fu Zi to move stagnation and break knots; Bi Xie and Ze Xie promote diuresis and move water; Tao Ren, Ling Zhi, Kun Bu, and Dan Pi activate blood, remove stasis, break hardness, and dissipate nodules; Tu Niu Xi guides turbid Yin downward.
10. Male, surnamed Zhu. The nature of swelling naturally belongs to the Liver. Why this liver disease? Cause is either chronic dysentery or liver abscess. Since urine has no protein, stimulating diuretics are without concern. Shang Lu 9g, Hai Nan Pian 9g, Dong Kui Zi 9g, Black and White Chou each 9g, Bi Cheng Qie 9g, Shi Wei 9g, Da Ji Mo 9g (finished in 3 doses), Ting Li Zi 9g, Sang Pi 12g, Huai Niu Xi 18g.
Second visit: Based on experience, kidney disease with protein in urine必然 has eyelid swelling; heart swelling usually has deep, fine, and weak pulses; the patient lacks these phenomena, certainly hepatic ascites. Zhou Che Wan 9g (taken in 3 doses), Black and White Chou each 9g, Mu Fang Ji 12g, Hai Nan Pian 9g, Shang Lu 9g, Yin Chen 12g, Zhu Ling 9g, Bi Cheng Qie 9g, Fen Dan Pi 9g, Tao Ren Ni 12g.
Third visit: Repeated strong purgation has exhausted physical strength, so Spleen-warming method is given. Pao Fu Pian 9g, Lu Dang Shen 9g, Gan Chan Pi 9g, Sheng Huang Qi 12g, Yi Zhi Ren 9g, Yun Ling 12g, Rou Dou Kou 9g, Po Gu Zhi 9g, Zhi Gan Cao 4.5g, Dan Jiang Pi 3g, Rou Gui Mo 1.8g (taken in 3 doses).