肖××，女，36岁。四川广汉县某小学教员。
[病史]小便不畅已十余年，重则尿黄窘迫，欲解不出。尿道灼痛，淋漓不尽。经多方检查治疗，疗效不显。1960年8月来诊。
(诊治]每昼夜小便数十次，量极少，有时仅数滴，涩痛，腰及小腹亦觉疼痛；下阴糜烂，白带多；四肢不温；舌尖边红，苔白滑。此为少阴阳郁，气机不利。法宜宣通气机，化阴通腑。以四逆散加味主之。
处方：
柴胡24克 白芍24克 枳实24克甘草9克桔梗30克茯苓30克四剂
另以自制九成丹涂下阴患部。
服后，小便通利，诸证悉解。下阴糜烂已好转。再以少量丹药涂于患处，半月后获愈。
(分析]《伤寒论》云： “少阴病，四逆，其人或咳，或悸，或小便不利，或腹中痛……四逆散主之。”本例之小便不利，四肢不温，并腹中痛，为邪入少阴，阳为阴郁。少阴为三阴之枢，邪气滞于中，清浊不分。加之患者久病不愈，郁积而气机阻滞日甚。投四逆散举下陷之阳邪，疏不宣之气机。以柴胡启达阳气，兼解郁滞；芍药养真阴，调解肝脾，俾土木和而气机流畅；柴枳同用，一升一降，清浊分行。仲景原方注：小便不利加茯苓。恐其力缓，仅渗湿不足以畅气机。肺为水之上源，行呼吸，主一身之气，喜清肃，取下行为顺。今外邪固束，则水道难于通调，故重用桔梗，辛开苦降；茯苓利水，与桔梗之开提相合，亦为一升一降。水邪消，诸证自平矣。
[按语]《素问·灵兰秘典论篇》日：“膀胱者，州都之官，津液藏焉，气化则能出矣。”可见小水虽由膀胱所司，若无气机之转化，焉能排出而为溺?故小便之病变，与肾、肝、脾、肺、三焦之气化，关系密切。在临证中，对各种原因之小便失利或不禁，往往以相关脏腑经络全面考虑。范老认为，凡尿频、尿急，欲出不尽，或闭塞不通，排尿涩痛；小腹、两胁、腰部或胀或痛或酸；上述诸证，不必悉具，皆可以四逆散辨证加减论治。
少阴证淋病
王××，女，67岁。山东省荣城县居民。
[病史]患者十多年来，经常小便频急，重则淋漓涩痛，点滴不尽。曾多次验小便，均属正常。先后服大量抗菌素和利尿药，并以补肾气、除湿热等法论治，时好时坏。近来病情加重，转来求诊。
[诊治]1978年12月5日。近一月来，约隔半小时解小便一次，量极少，一昼夜排尿总量仅300多毫升，色黄如浓茶。小便灼热，欲解不尽；四肢不温，少腹胀满疼痛，日夜不宁。舌质淡红稍暗，苔白滑。此为邪入少阴．阳郁不伸，水气不化。法宜宣通气机，化阴通腑。以四逆散加味主之。
处方：
柴胡10克 白芍10克枳实10克甘草3克桔梗15克茯苓20克四剂
服后小便通利，病遂获愈。
1979年5月15日随访：其女告之，病愈后， 已回山东原籍。最近来信，病未复发。
[按语]肖、王二例少阴证淋病，病因、病情和病程大体相似。仅囚王例年逾花甲、证状较轻，故药量稍减。均投四逆散加茯苓、桔梗为治。皆一诊而愈。
少阴证淋病
(肾盂肾炎)
周××，女，40岁。成都某厂职工。
[病史]1973年5月，患腰痛，小便不利。先后经两处医院检查：尿液混浊，有大量白细胞，少许红细胞，少量尿蛋白，血象白细胞计数增高。均诊断为“肾盂肾炎”。服中西药三月余，病势未减。同年8月来诊。
[初诊]1973年8月29日。近月来病情逐渐加重：小便短涩，频数，色黄，欲解不尽，点滴刺痛，并痛引小腹，腰痛尤甚。头痛恶寒，无汗，手足不温，面色略萎黄，舌质淡红，苔薄黄。此为淋病，证属少阴，兼太阳伤寒之邪，交织蕴积。法宜先从太阳入手，发表散寒，开腠逐邪，以甘草麻黄汤加味主之。
处方：
麻黄10克甘草30克葱白60克二剂
[二诊]头痛、恶寒明显好转，腰痛减轻，小便短涩频数略减。余证如前。薄黄苔已退，太阳之寒邪已解。宜抓住少阴之枢，宣通气机，化阴通腑，以四逆散加味主之。
处方：
柴胡10克枳实12克 白芍12克甘草3克茯苓30克桔梗30克三剂
连服三剂，小便通畅，尿转阴性，余证皆平。1979年11月随访，几年来坚持重体力劳动，病未复发。
[按语]《金匮要略》云： “淋之为病，小便如粟状，小腹弦急，痛引脐中”。本例小便频数短涩，滴沥刺痛，痛则腰酸，实属淋病之主要临床特征，而其基本病变为下焦气化不利，属少阴四逆散证。但，本案为何首用甘草麻黄汤?
少阴证虽有发汗之禁，复有淋家不可发汗之戒；但此例兼有太阳伤寒表实证，故不在此禁戒之例。少阴发汗之禁，乃指“病为在里”而言，一是少阴寒化，阳气已虚；一是少阴热化，阴虚内热。本例不仅表邪郁闭，阻滞气机，加重气化功能失调；而且此证虽属少阴，既非四逆汤证，又非热化证；病虽入里，而阳气未虚。虽属淋病，但既非湿热蓄于膀胱，又非膀胱津液先虚。实属少阴病四逆散证之阳为阴郁，气机不利。今首用《金匮要略》甘草麻黄汤，既可发表散寒，又能通利小便。重用甘草以托之、缓之。再加葱白，通上下阳气，调畅气机。故此方似峻而实稳，内外兼顾，以为前驱。后投四逆散加味，借少阴之转枢，并邪居内外之间，可进可退、时上时下之势，和解而分消之，病遂告愈。
少阴证经闭
胡××，女，38岁。四川郫县团结乡，农民。
(病史]经闭四年，经治疗其效不显，发至形寒，肢冷，颤抖，全身水肿，行动须人搀扶。1953年4月来诊。
[初诊]全身皆水肿，下肢尤甚，按之凹陷，遍体肌肉轻微颤抖。头昏，畏寒，不欲食，神疲倦卧，四肢清冷，声低气短。面色青暗无泽，舌淡，体胖，有齿痕，苔薄白，脉伏。此为少阴证经闭，阳虚水肿，法宜通阳渗湿，暖肾温中，以茯苓四逆汤加味主之。
处方：
茯苓30克 潞党参15克炙甘草30克干姜60克制附片120克(久煎) 桂枝12克炒白术12克[二诊]服完第一剂，小便清长，肿胀略有减轻，每餐可进食米饭一两。继服二剂后，肿胀明显好转，颤抖停止。嘱其原方再进三剂，并以炮姜易干姜，加血余炭30克，返家后续服。月余病愈。
1979年7月追访，患者已63岁，自从二十六年前病愈后，直到经绝，月经一直正常，身体健康。
(辨证]患者系中年农妇，原体强健，后几年停经，一蹶不振。初诊时，病已沉重，究其原因，一则常年耕耘，历尽风霜雨露，积冷伤湿，而致寒凝血滞。正如《金匮要略》所云： “妇人之病，因虚、积冷、结气，为诸经水断绝。”二则久病精气衰惫，加之前服中药大多破淤攻下之品，挫伤脾肾之阳，以致肾水泛滥，脾不制水，全身肿胀。经云： “诸寒收引，皆属于肾”， “诸湿肿满，皆属于脾”。故此证属脾肾阳虚，阴寒内积，而以少阴虚衰为主。畏寒、肢冷、神疲倦卧，声低气短，面色青暗，舌淡脉伏，皆一派少阴寒化之明症。治以茯苓四逆汤，姜附回阳逐阴，甘草缓中，茯苓渗利，党参扶正。加白术补脾燥湿，增桂枝以通心阳而化膀胱之气；加炮姜易干姜，取其温经助血之行；再加血余炭，既有去淤生新之效，又具利小便之功，以促其肿胀之消除。
(按语]本例患者，血寒凝滞，误用攻下，一以致阴阳两伤，经闭水肿，复因失治而致阴阳两虚；故取茯苓四逆汤，善消阳虚水肿之效，兼顾其阴。加温经散寒，逐淤生新之炮姜、血余炭，突破经阻之要害，诸症迎刃而解。
少阴证不孕
黄××，女，34岁。四川某机关干部。
[病史]已婚七年未孕，男女双方经检查生理正常。1959年冬开始，自觉头昏、乏力，早晨脸肿，下午脚肿，月事不调。1965年春，病情发展严重。同年7月20日来诊。
肖××，女性，36岁。四川广汉县某小学教师。
[病史]小便不畅已十余年，严重时尿色黄且窘迫急迫，想解却解不出。尿道有灼热疼痛感，淋漓不尽。经过多方检查治疗，疗效不明显。1960年8月前来就诊。
[诊治]每昼夜小便数十次，尿量极少，有时仅有几滴，排尿涩痛，腰部及小腹部也感觉疼痛；外阴部糜烂，白带多；四肢不温暖；舌尖和边缘红，舌苔白而滑润。这是少阴阳气郁结，气机运行不利。治法应当宣通气机，化阴通腑。以四逆散（调和肝脾、透邪解郁的方剂）加味为主方。
处方：
柴胡24克 白芍24克 枳实24克 甘草9克 桔梗30克 茯苓30克 四剂
另外用自制的九成丹涂抹于外阴患处。
服药后，小便通畅，所有症状全部解除。外阴糜烂已有好转。再用少量丹药涂抹患处，半个月后痊愈。
[分析]《伤寒论》说：“少阴病，四肢厥冷，或者咳嗽，或者心悸，或者小便不利，或者腹中痛……用四逆散主治。”本例的小便不利，四肢不温，以及腹中痛，是邪气侵入少阴，阳气被阴寒所郁遏。少阴是三阴经的枢纽，邪气停滞在中焦，清浊之气不分。加上患者久病不愈，郁积导致气机阻滞日益严重。投用四逆散举起下陷的阳邪，疏通不通畅的气机。用柴胡升发阳气，兼解郁滞；白芍滋养真阴，调解肝脾，使土木和谐而气机流畅；柴胡与枳实同用，一升一降，清浊各行其道。张仲景原方注解说：小便不利加茯苓。担心其药力缓慢，仅靠渗湿不足以畅通气机。肺为水之上源，主持呼吸，统摄一身之气，喜好清肃，以下行为顺。如今外邪束缚，水道难以通调，所以重用桔梗，辛开苦降；茯苓利水，与桔梗的开提作用相合，也是一升一降。水邪消除，各种症状自然平息。
[按语]《素问·灵兰秘典论篇》说：“膀胱者，州都之官，津液藏焉，气化则能出矣。”可见小便虽然由膀胱主管，如果没有气机的转化，怎么能排出成为尿液呢？因此小便的病变，与肾、肝、脾、肺、三焦的气化功能关系密切。在临床诊疗中，对于各种原因引起的小便失利或失禁，往往从相关脏腑经络全面考虑。范老认为，凡是尿频、尿急，想解出不尽，或者闭塞不通，排尿涩痛；小腹、两胁、腰部或胀或痛或酸；上述诸证，不必全部具备，都可以用四逆散辨证加减来治疗。
少阴证淋病（指以小便频数短涩、滴沥刺痛为主症的疾病）
王××，女性，67岁。山东省荣城县居民。
[病史]患者十多年来，经常小便频急，严重时淋漓涩痛，点滴不尽。曾多次验小便，结果均属正常。先后服用大量抗菌素和利尿药，并以补肾气、除湿热等方法治疗，时好时坏。近来病情加重，转来求诊。
[诊治]1978年12月5日。近一个月来，大约每隔半小时解一次小便，尿量极少，一昼夜排尿总量仅300多毫升，颜色黄如浓茶。小便灼热，想解不尽；四肢不温，小腹胀满疼痛，日夜不安宁。舌质淡红稍暗，舌苔白滑。这是邪气侵入少阴，阳气郁结不能伸展，水气不能化行。治法应当宣通气机，化阴通腑。以四逆散加味为主方。
处方：
柴胡10克 白芍10克 枳实10克 甘草3克 桔梗15克 茯苓20克 四剂
服药后小便通畅，病症于是痊愈。
1979年5月15日随访：其女儿告知，病愈后，已回到山东原籍。最近来信，病未复发。
[按语]肖、王两例少阴证淋病，病因、病情和病程大体相似。仅仅因为王例年过花甲、症状较轻，所以药量稍减。均投用四逆散加茯苓、桔梗进行治疗。都是一诊而愈。
少阴证淋病
(肾盂肾炎)
周××，女性，40岁。成都某厂职工。
[病史]1973年5月，患腰痛，小便不利。先后经两处医院检查：尿液混浊，有大量白细胞，少许红细胞，少量尿蛋白，血象白细胞计数增高。均诊断为“肾盂肾炎”。服用中西药三月余，病势未减。同年8月前来就诊。
[初诊]1973年8月29日。近一个月来病情逐渐加重：小便短涩，频数，色黄，想解不尽，点滴刺痛，并且疼痛牵引小腹，腰痛尤其严重。头痛恶寒，无汗，手足不温暖，面色略萎黄，舌质淡红，舌苔薄黄。这是淋病，证属少阴，兼有太阳伤寒之邪，交织蕴积。治法应当先从太阳经入手，发表散寒，开泄腠理驱逐邪气，以甘草麻黄汤（发汗解表、宣肺利水的方剂）加味为主方。
处方：
麻黄10克 甘草30克 葱白60克 二剂
[二诊]头痛、恶寒明显好转，腰痛减轻，小便短涩频数略微减少。其余症状如前。薄黄苔已退，太阳之寒邪已解。应当抓住少阴的枢纽，宣通气机，化阴通腑，以四逆散加味为主方。
处方：
柴胡10克 枳实12克 白芍12克 甘草3克 茯苓30克 桔梗30克 三剂
连续服用三剂，小便通畅，尿检转阴性，其余症状皆平复。1979年11月随访，几年来坚持重体力劳动，病未复发。
[按语]《金匮要略》说：“淋之为病，小便如粟状，小腹弦急，痛引脐中”。本例小便频数短涩，滴沥刺痛，痛则腰酸，实属淋病的主要临床特征，而其基本病变为下焦气化不利，属于少阴四逆散证。但是，本案为何首先使用甘草麻黄汤？
少阴证虽然有发汗的禁忌，又有淋家不可发汗的戒律；但此例兼有太阳伤寒表实证，所以不在此禁戒之列。少阴发汗之禁，是指“病在里”而言，一是少阴寒化证，阳气已虚；一是少阴热化证，阴虚内热。本例不仅表邪郁闭，阻滞气机，加重气化功能失调；而且此证虽属少阴，既非四逆汤证，又非热化证；病虽入里，而阳气未虚。虽属淋病，但既非湿热蓄积于膀胱，又非膀胱津液先虚。实属少阴病四逆散证的阳气被阴寒郁遏，气机不利。现在首先使用《金匮要略》中的甘草麻黄汤，既可发表散寒，又能通利小便。重用甘草以托举、缓和药性。再加葱白，通达上下阳气，调畅气机。故此方看似峻猛实则稳妥，内外兼顾，作为先导。随后投用四逆散加味，借助少阴的转枢作用，并利用邪气居于内外之间，可进可退、时上时下之势，和解而分消之，病症于是告愈。
少阴证经闭（月经停止）
胡××，女性，38岁。四川郫县团结乡，农民。
[病史]经闭四年，经治疗其效不显，发展至形寒肢冷，颤抖，全身水肿，行动须人搀扶。1953年4月前来就诊。
[初诊]全身皆水肿，下肢尤其严重，按压出现凹陷，遍体肌肉轻微颤抖。头昏，畏寒，不想进食，神疲倦卧，四肢清冷，声音低微气短。面色青暗无光泽，舌淡，舌体胖大，有齿痕，舌苔薄白，脉伏。这是少阴证经闭，阳虚水肿，治法应当通阳渗湿，暖肾温中，以茯苓四逆汤（回阳救逆、益气健脾的方剂）加味为主方。
处方：
茯苓30克 潞党参15克 炙甘草30克 干姜60克 制附片120克（久煎） 桂枝12克 炒白术12克
[二诊]服完第一剂，小便清长，肿胀略有减轻，每餐可进食米饭一两。继服二剂后，肿胀明显好转，颤抖停止。嘱咐其原方再进三剂，并用炮姜替换干姜，加血余炭30克，回家后续服。月余病愈。
1979年7月追访，患者已63岁，自从二十六年前病愈后，直到绝经期，月经一直正常，身体健康。
[辨证]患者系中年农妇，原本体质强健，后来几年停经，一蹶不振。初诊时，病已沉重，究其原因，一则常年耕耘，历尽风霜雨露，积冷伤湿，而导致寒凝血滞。正如《金匮要略》所说：“妇人之病，因虚、积冷、结气，为诸经水断绝。”二则久病精气衰惫，加之前服中药大多破瘀攻下之品，挫伤脾肾之阳，以致肾水泛滥，脾不制水，全身肿胀。医经说：“诸寒收引，皆属于肾”，“诸湿肿满，皆属于脾”。故此证属脾肾阳虚，阴寒内积，而以少阴虚衰为主。畏寒、肢冷、神疲倦卧，声低气短，面色青暗，舌淡脉伏，都是一派少阴寒化证的明确征象。治以茯苓四逆汤，姜附回阳逐阴，甘草缓中，茯苓渗利，党参扶正。加白术补脾燥湿，增桂枝以通心阳而化膀胱之气；加炮姜替换干姜，取其温经助血之行；再加血余炭，既有去瘀生新之效，又具利小便之功，以促进其肿胀之消除。
[按语]本例患者，血寒凝滞，误用攻下，一以致阴阳两伤，经闭水肿，复因失治而致阴阳两虚；故取茯苓四逆汤，善消阳虚水肿之效，兼顾其阴。加温经散寒，逐瘀生新之炮姜、血余炭，突破经阻之要害，诸症迎刃而解。
少阴证不孕
黄××，女性，34岁。四川某机关干部。
[病史]已婚七年未孕，男女双方经检查生理正常。1959年冬开始，自觉头昏、乏力，早晨脸肿，下午脚肿，月事不调。1965年春，病情发展严重。同年7月20日来诊。
Xiao XX, female, 36 years old. A primary school teacher in Guanghan County, Sichuan.
[Medical History] Difficulty in urination for over ten years; in severe cases, urine is yellow and the urge to void is urgent but difficult to initiate. There is a burning pain in the urethra with dribbling and incomplete emptying. After examinations and treatments by various parties, the efficacy was not obvious. She sought medical consultation in August 1960.
[Diagnosis and Treatment] Urination occurs dozens of times per day and night, with extremely small volume, sometimes only a few drops. There is painful and difficult urination, and pain is felt in the lower back and hypogastrium. The external genitalia are eroded with excessive leukorrhea; the four limbs are not warm; the tip and edges of the tongue are red, and the coating is white and slippery. This is Shaoyin Yang depression with Qi mechanism dysfunction. The treatment principle should be to promote the circulation of Qi, transform Yin, and unblock the Fu organs. The main prescription is Sini San (Cinnamon Twig Decoction variant for harmonizing Liver and Spleen and resolving depression) with modifications.
Prescription:
Chai Hu (Bupleuri Radix) 24g, Bai Shao (Paeoniae Radix Alba) 24g, Zhi Shi (Aurantii Fructus Immaturus) 24g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g, Jie Geng (Platycodonis Radix) 30g, Fu Ling (Poria) 30g. Four doses.
Additionally, self-made Jiucheng Dan was applied topically to the affected area of the external genitalia.
After taking the medicine, urination became smooth, and all symptoms resolved. The erosion of the external genitalia improved. Applying a small amount of the pill to the lesion led to recovery after half a month.
[Analysis] The *Shanghan Lun* states: "Shaoyin disease, characterized by cold extremities, where the patient may have cough, palpitations, difficulty in urination, or abdominal pain... Sini San is indicated." In this case, difficulty in urination, cold extremities, and abdominal pain indicate that pathogenic factors have entered the Shaoyin level, and Yang is depressed by Yin cold. Shaoyin serves as the pivot of the three Yin meridians; when pathogenic factors stagnate in the middle, clear and turbid Qi fail to separate. Furthermore, due to the chronic nature of the illness, depression has caused increasingly severe Qi stagnation. Sini San is used to raise the depressed Yang pathogen and unblock the stagnant Qi mechanism. Chai Hu promotes the ascending of Yang Qi and resolves depression; Bai Shao nourishes true Yin and regulates the Liver and Spleen, ensuring harmony between Wood and Earth so that Qi flows smoothly. The combination of Chai Hu and Zhi Shi creates one ascending and one descending action, allowing clear and turbid Qi to separate. Zhang Zhongjing's original formula notes adding Fu Ling for difficulty in urination. However, fearing its effect might be too slow, relying solely on leaching dampness is insufficient to unblock the Qi mechanism. The Lung is the upper source of water, governs respiration, controls the Qi of the whole body, prefers clarity and purity, and follows downward movement. Now, constrained by external pathogens, the water passages are difficult to regulate. Therefore, a heavy dose of Jie Geng is used for its acrid-opening and bitter-descending properties; Fu Ling promotes diuresis, which combines with the lifting action of Jie Geng to form another ascending-descending pair. Once the water pathogen is eliminated, all symptoms naturally subside.
[Commentary] The *Suwen · Linglan Midian Lun* states: "The Bladder is the official of the metropolitan area, storing fluids; it can excrete them through Qi transformation." Thus, although urination is governed by the Bladder, without Qi transformation, how can it be discharged as urine? Therefore, disorders of urination are closely related to the Qi transformation functions of the Kidney, Liver, Spleen, Lung, and Sanjiao. In clinical practice, for various causes of urinary retention or incontinence, consideration is often given comprehensively to the relevant Zang-Fu organs and meridians. Master Fan believes that for symptoms such as frequent and urgent urination, incomplete emptying, obstruction, painful urination; distension, pain, or soreness in the hypogastrium, hypochondrium, or waist; if these symptoms do not need to be fully present, they can all be treated with modified Sini San based on syndrome differentiation.
Shaoyin Syndrome Lin Disease (Dysuria)
Wang XX, female, 67 years old. A resident of Rongcheng County, Shandong Province.
[Medical History] For more than ten years, the patient has frequently experienced urgent urination; in severe cases, there is dribbling, painful urination, and incomplete emptying. Multiple urine tests were normal. She had taken large amounts of antibiotics and diuretics, and was treated with methods to tonify Kidney Qi and drain Damp-Heat, with fluctuating results. Recently, her condition worsened, leading her to seek consultation.
[Diagnosis and Treatment] December 5, 1978. For the past month, she urinates approximately every half hour, with very small volume; the total daily output is only over 300 ml, dark yellow like strong tea. There is burning sensation during urination and a feeling of incomplete emptying; the four limbs are cold, the hypogastrium is full, distended, and painful, causing restlessness day and night. The tongue body is pale red and slightly dark, with a white slippery coating. This indicates pathogenic factors entering Shaoyin, Yang depression preventing extension, and failure of Water Qi to transform. The treatment principle is to promote Qi circulation, transform Yin, and unblock Fu organs. The main prescription is Sini San with modifications.
Prescription:
Chai Hu (Bupleuri Radix) 10g, Bai Shao (Paeoniae Radix Alba) 10g, Zhi Shi (Aurantii Fructus Immaturus) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Jie Geng (Platycodonis Radix) 15g, Fu Ling (Poria) 20g. Four doses.
After taking the medicine, urination became smooth, and the disease was cured.
Follow-up on May 15, 1979: Her daughter reported that after recovery, she returned to her native place in Shandong. A recent letter confirmed no recurrence.
[Commentary] Cases Xiao and Wang both suffered from Shaoyin Syndrome Lin Disease, with similar etiologies, conditions, and courses. Only because Case Wang was over sixty and had milder symptoms were the dosages slightly reduced. Both were treated with Sini San plus Fu Ling and Jie Geng. Both recovered after the first visit.
Shaoyin Syndrome Lin Disease
(Pyelonephritis)
Zhou XX, female, 40 years old. An employee of a factory in Chengdu.
[Medical History] In May 1973, she suffered from lower back pain and difficulty in urination. Examinations at two hospitals showed cloudy urine with a large number of white blood cells, a few red blood cells, a small amount of protein, and elevated white blood cell count in blood tests. Both diagnosed "Pyelonephritis." After taking Chinese and Western medicines for over three months, the condition did not improve. She sought consultation in August of the same year.
[First Visit] August 29, 1973. Over the past month, the condition gradually worsened: short and difficult urination, frequent, yellow, incomplete emptying, stinging pain in drops, radiating to the hypogastrium, with severe lower back pain. Headache, aversion to cold, anhidrosis, cold hands and feet, sallow complexion, pale red tongue with thin yellow coating. This is Lin Disease, belonging to Shaoyin syndrome, complicated by Taiyang Cold Damage pathogen intertwining and accumulating. The treatment principle should start from the Taiyang level, release the exterior and dispel cold, open the pores to drive out pathogens. The main prescription is Gancao Mahuang Tang (Licorice and Ephedra Decoction) with modifications.
Prescription:
Mahuang (Ephedrae Herba) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 30g, Cong Bai (Allii Fistulosi Bulbus) 60g. Two doses.
[Second Visit] Headache and aversion to cold improved significantly, lower back pain decreased, and short, difficult, frequent urination slightly reduced. Other symptoms remained. The thin yellow coating had disappeared, indicating the Taiyang Cold pathogen was resolved. One should seize the Shaoyin pivot, promote Qi circulation, transform Yin, and unblock Fu organs. The main prescription is Sini San with modifications.
Prescription:
Chai Hu (Bupleuri Radix) 10g, Zhi Shi (Aurantii Fructus Immaturus) 12g, Bai Shao (Paeoniae Radix Alba) 12g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g, Fu Ling (Poria) 30g, Jie Geng (Platycodonis Radix) 30g. Three doses.
After taking three consecutive doses, urination became smooth, urine tests turned negative, and other symptoms subsided. Follow-up in November 1979: She persisted in heavy physical labor for several years with no recurrence.
[Commentary] The *Jingui Yaolue* states: "In Lin disease, urine resembles millet grains, the hypogastrium is tense and acute, pain radiates to the umbilicus." This case's frequent, short, difficult urination, dribbling stinging pain, and腰酸 upon pain are indeed the main clinical features of Lin Disease. Its basic pathology is impaired Qi transformation in the Lower Jiao, belonging to the Shaoyin Sini San syndrome. However, why use Gancao Mahuang Tang first?
Although Shaoyin syndrome has contraindications for sweating, and there is a warning against sweating for patients with Lin disease, this case involves concurrent Taiyang Cold Damage excess syndrome, thus exempt from these prohibitions. The prohibition of sweating in Shaoyin refers to "disease being in the interior": either Shaoyin Cold Transformation with deficient Yang, or Shaoyin Heat Transformation with Yin deficiency and internal heat. This case not only has exterior pathogen constriction blocking Qi mechanism and worsening Qi transformation dysfunction, but although it belongs to Shaoyin, it is neither Sini Tang syndrome nor Heat Transformation syndrome; although the disease has entered the interior, Yang is not deficient. Although it is Lin disease, it is neither Damp-Heat accumulation in the Bladder nor prior deficiency of Bladder fluids. It truly belongs to the Shaoyin Sini San syndrome where Yang is depressed by Yin, causing Qi mechanism dysfunction. Using Gancao Mahuang Tang from the *Jingui Yaolue* first can release the exterior and dispel cold while promoting urination. Heavy use of Gan Cao supports and moderates the action. Adding Cong Bai connects Upper and Lower Yang Qi and smooths the Qi mechanism. Thus, this formula appears harsh but is actually stable, addressing both interior and exterior as a vanguard. Subsequently using modified Sini San leverages the Shaoyin pivot, utilizing the position of pathogens between interior and exterior, advancing and retreating, moving up and down, to harmonize and disperse, leading to cure.
Shaoyin Syndrome Amenorrhea
Hu XX, female, 38 years old. A farmer from Tuanjie Township, Pixian County, Sichuan.
[Medical History] Amenorrhea for four years; treatment was ineffective, progressing to chills, cold limbs, tremors, generalized edema, requiring assistance to walk. She sought consultation in April 1953.
[First Visit] Generalized edema, worse in the lower limbs, pitting upon pressure, slight tremors in muscles throughout the body. Dizziness, aversion to cold, poor appetite, mental fatigue and desire to lie down, cold four limbs, low voice and shortness of breath. Dark bluish complexion lacking luster, pale tongue, fat body with teeth marks, thin white coating, deep pulse. This is Shaoyin Syndrome Amenorrhea with Yang deficiency edema. The treatment principle should be to unblock Yang and leach dampness, warm the Kidney and center. The main prescription is Fuling Sini Tang (Poria and Cinnamon Twig Decoction variant) with modifications.
Prescription:
Fu Ling (Poria) 30g, Lu Dang Shen (Codonopsis Radix) 15g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 30g, Gan Jiang (Zingiberis Rhizoma) 60g, Zhi Fu Pian (Prepared Aconiti Lateralis Radix) 120g (decocted for a long time), Gui Zhi (Cinnamomi Ramulus) 12g, Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 12g.
[Second Visit] After finishing the first dose, urine became clear and copious, swelling slightly reduced, able to eat one liang of rice per meal. After continuing for two more doses, swelling improved significantly, tremors stopped. Advised to take three more doses of the original formula, replacing Gan Jiang with Pao Jiang (Roasted Zingiberis Rhizoma), adding Xue Yu Tan (Carbo Hominis) 30g, to continue at home. Recovered within a month.
Follow-up in July 1979: The patient is now 63 years old. Since recovering twenty-six years ago until menopause, her menstruation has been regular, and her health is good.
[Syndrome Differentiation] The patient is a middle-aged peasant woman, originally robust constitution. After stopping menstruation for a few years, she declined rapidly. At the first visit, the illness was severe. Reasons include: first, years of farming exposed her to wind, frost, rain, and dew, accumulating cold and injuring dampness, leading to Cold coagulation and Blood stasis. As stated in the *Jingui Yaolue*: "Women's diseases, due to deficiency, accumulated cold, and Qi stagnation, result in cessation of menstruation." Second, chronic illness depleted Essence and Qi, compounded by previous intake of mostly blood-breaking and purging Chinese medicines, damaging Spleen and Kidney Yang, causing Kidney Water to flood and Spleen failing to control water, resulting in generalized swelling. The Classics state: "All cold contraction and pulling belong to the Kidney," "All dampness, swelling, and fullness belong to the Spleen." Thus, this syndrome belongs to Spleen and Kidney Yang deficiency with internal accumulation of Yin Cold, primarily dominated by Shaoyin deficiency. Chills, cold limbs, mental fatigue, low voice, shortness of breath, dark bluish complexion, pale tongue, and deep pulse are all clear signs of Shaoyin Cold Transformation. Treatment uses Fuling Sini Tang; Ginger and Aconite restore Yang and expel Yin; Gan Cao moderates the middle; Fu Ling leaches and drains; Dang Shen supports Zheng Qi. Added Bai Zhu tonifies Spleen and dries dampness; added Gui Zhi unblocks Heart Yang and transforms Bladder Qi; replaced Gan Jiang with Pao Jiang to warm meridians and assist Blood flow; added Xue Yu Tan for removing stasis and generating new blood, and promoting diuresis to accelerate elimination of swelling.
[Commentary] In this case, Cold Blood Stasis was mismanaged with purgatives, initially injuring both Yin and Yang, causing amenorrhea and edema, and further leading to Yin-Yang dual deficiency due to lack of proper treatment. Therefore, Fuling Sini Tang was chosen for its efficacy in eliminating Yang deficiency edema while attending to Yin. Added Pao Jiang and Xue Yu Tan to warm meridians, dispel cold, remove stasis, and generate new blood, breaking through the key point of menstrual obstruction, resolving all symptoms.
Shaoyin Syndrome Infertility
Huang XX, female, 34 years old. A cadre in Sichuan Province.
[Medical History] Married for seven years without pregnancy; physiological checks for both husband and wife were normal. Starting from winter 1959, she felt dizzy and fatigued, morning facial edema, afternoon foot edema, and irregular menstruation. In spring 1965, the condition developed severely. She sought consultation on July 20 of the same year.