针砂白矾绿矾麦芽广香木通
硼砂神曲甘草
白矾50克，余药各30克，共碾细末，以红糖一斤拌之为丸，如梧桐子大。日二服，每服二粒。
连服二十余日，遂痊愈。 1979年6月24日追访，从病愈以来，未再复发，体重增加儿斤，身体健康。
[按语]《素问·阴阳应象大论篇》云： “清气在下，则生飧泄”，又云： “湿胜则濡写”。泄泻一证，虽有急性多实，实则泻之；久泻多虚，虚则补之之说，但临证不可拘泥。本例病程虽久，但仍以实邪为主，即风寒湿邪，久郁不得外泄，水湿内聚肠胃之间。加之“水反为湿，谷反为滞，精华之气，不能输化，致合污下降而泻利作矣”。应属太阳表证与阳明里证同病，而以水湿实邪为重。即使有伤正之象，亦不可补。虽有里实，因表证尚重，更不可下。太阳为开，阳明为阖。诸泄之成，多原于湿。故以麻黄之峻，开其表实；继以针砂之方，推荡里湿。湿邪去而泄泻止。
太阳阳明证结胸
钟××，男，45岁。成都市某厂工人。
[病史]有胃痛病史。月余前曾感受风寒，自觉身不适。面部及全身浮肿，皮肤明显变黄。胃脘及胸胁胀痛，大便秘结，曾按胃痛治疗，病势不减。1960年10月来诊。
[一诊]胸胁及胃脘疼痛，胸脘之间，触之微硬而痛甚，胸部如塞，呼吸不利，口渴不欲多饮，大便已三日未行。舌质红，苔白黄腻。此为太阳阳明证结胸，法宜泄热逐水，破结通腑，以大陷胸汤主之。
处方：
大黄3克芒硝3克甘遂3克(冲服)
一剂，日分三服，得快利，止后服。
[二诊]服二次，得微利；三次后，得快利。胸胁及胃脘胀痛顿减，浮肿及余证明显好转。遂停服上方，少进清热、化湿之品，以善其后。约半月病愈。半年后追访，身体已康复。
[按语]《伤寒论》关于阳明一证，曾有太阳阳明、正阳阳明、少阳阳明之分。历代医家对此分类，见解很不一致。通常认为，正阳阳明，为阳明自病；太阳阳明、少阳阳明，是太阳或少阳误治而来；其胃家实则一也。但据范老临床经验：太阳阳明、少阳阳明，不经误治，亦可传经转实。本例太阳阳明证，未经汗下，故属未误治之传经。
少阳证发热
杨××，男，54岁。成都市居民。
[诊治]1960年10月来诊。近两年来，每日早餐后发热，体温38。c左右，汗出较多，持续约两小时，热退汗止，即觉畏寒。每日如此。头晕眩， 口苦咽干，胸胁满，心中烦躁。舌质红，苔白微黄腻，脉弦数。经××医院检查，发热原因不明，治疗未见好转。此为少阳证发热，法宜和解少阳，以小柴胡汤加减主之。
处方：
柴胡24克黄芩10克法夏15克沙参1 5克甘草10克知母15克石膏30克牡蛎24克陈皮9克茯苓12克一剂
上方服一剂，热退，诸证悉减。嘱其停药，调养数日而愈。其后，患者与范老常来往，知其病未复发。
[按语]此证口苦咽干，头晕眩，往来寒热，胸胁苦满，心烦，脉弦，少阳脉证十分明显。病虽迁延两年，正如《伤寒论》所称“柴胡证仍在者，先与小柴胡汤”。又发热汗出，口渴，舌红，为兼有郁热之象，故去姜。枣，加知母、石膏以清之。又因胸胁苦满较甚，夹有湿邪，加牡蛎、陈皮、茯苓，以渗湿，化滞、散结。
少阳证癫狂
吴××，女，43岁。四川省郫县团结乡小学，教员。
[病史]长期失眠多梦，易动怒，多气郁，偶有神志惚恍之象。××医院曾诊断为“神经官能症”。1974年9月，因工作与同志争吵，一怒之下， 突然昏倒。苏醒后，神志不清，语言错乱，亲疏不分，见人詈骂不休。急来求诊，按少阳证癫狂论治，两诊而愈。
[初诊]刚进诊室，就将医生和病人大骂一通，语无伦次。胸满，阵阵呃气，眼神微呆滞，面赤，唇红，便秘。脉弦数，舌质红，苔微黄而腻。此为少阳证癫狂，法宜和解泄热，重镇安神，以柴胡加龙骨牡蛎汤加减主之。
处方：
柴胡12克龙骨60克(先煎) 黄芩12克党参12克桂枝6克茯苓12克法夏12克生大黄10克(后下) 牡蛎60克(先煎)
大枣15克赭石60克(先煎)
[辨证]患者初起病轻，仅有失眠易怒，心神浮越，微现癫病之象。由于失治而病情加重： 旰气郁结，热久化火；偶遇感情激动，胆火上冲；心气不镇，神志顿为之昏乱，遂发为癫狂。其面赤、舌红、脉弦数，参之上述诸证，可确诊无疑。 《伤寒论》柴胡加龙骨牡蛎汤，本用治太阳伤寒因误下后，胸满惊烦、谵语等证。后世常以此方，治狂痫诸病，今验之临床，确有效验。
[二诊]服两剂，夜可安睡，神志渐清，呃逆亦止。守原法加减续服。
处方：
柴胡10克龙骨30克(先煎) 黄芩10克党参10克 茯苓12克法夏12克牡蛎30克(先
煎) 赭石30克(先煎) 钩藤12克枯花12克甘草3克上方服三剂，病愈。1979年7月24日追访： 从病愈以来，再未复发。
[按语]《素问·通评虚实论篇》云： “癫疾、厥狂，久逆之所生也。” 《素问·宣明五气篇》云：“邪入于阳则狂……搏阳则为巅疾。”以柴胡加龙骨牡蛎汤，治癫痫狂证，历史久矣!过去有人认为：本方既有龙骨、牡蛎之收涩，复有大黄、茯苓之通利；又有大黄之攻，兼有人参之补；以其方意杂揉，疑其不可用，或谓系他方加龙牡之误。经临床实践检验，上说均不可信。
太阳少阳证胁痛
(慢性肝炎、早期肝硬化)
薛××，男，42岁。成都市某厂干部。
[病史]自1969年患慢性肝炎，1971年肝大肋下3厘米，剑突下5厘米，肝区胀痛，经治疗病情未控制。于1972年春，开始全休。同年5月27日来诊。
[初诊]肝区胀痛，食欲日益减退，进食后腹胀，坐立不安。腰部如重带紧束，难以蹲下。头疼恶寒，面色青黄，两颊瘦削，眼胞与双足微现浮肿。舌质暗淡，边缘稍红，苔淡黄夹白，根部稍厚腻。此为少阳证，兼太阳伤寒，宜先开郁闭，散寒除湿，以麻黄汤加味主之。
处方：
麻黄10克桂枝lO克 杏仁12克炙甘草15克法夏18克服四剂后，头痛与肝区胀痛略减，余证无明显变化。为增强散寒除湿，通阳行气之力，继用甘草麻黄汤，再服五剂。舌质渐转红，苔腻稍退，现寒湿风热交织之象。为引邪外出，选用荆防败毒散，、去川芎、羌活、独活，酌加桑叶、黄芩、牛蒡等，辛温发汗与辛凉清解之品相配伍，服二十余剂。
[二诊]胁、腰部紧束沉重之感稍减，眼胞浮肿渐消，全身初觉松动。舌苔仍腻而紧密，根部较厚。风寒湿邪积聚已久，蕴结于肝胃，气机阻滞，故胸胁中脘仍觉胀满。今乘表邪已解之机，又据邪实而主证在上之理，因势利导， “其高者，因而越之”，运用吐法，两月之内，先后用自制“二妙丹”引吐两次，呕出大量痰涎泫液，并配合服用针砂散。
处方一： “二妙丹”
绿矾3克 白矾3克硼砂1克炼制成丹，空腹用温开水送服1克。
处方二： “针砂散”
针砂 硼砂绿矾 白矾神曲麦芽
木通 广香甘草各10克，共为细末。
第一周，每日晨空腹用米汤冲服一次，每次3克；其后，每三日服一次。
[三诊]自觉证状著减，纳增。活动时，肝区仍觉坠胀、疼痛。少阳证未解。以自制回生丹加味，配合针砂散疏肝行气，开窍止痛，缓缓服之。 处方： “回生丹” 藿香丁香 广香辽细辛 巴豆牙皂 雄黄朱砂 白矾蟾酥麝香 炼制成丸，如绿豆大，痛时服2—3粒，每日一次。针砂散每周服一次，每次服3克。上方服用两月。
前后治疗五个月，病情基本好转。遂停服汤药，继服回生丹，针砂散，又调养五个月。重返工作岗位，坚持全日工作。
1978年12月，患者来信说： “六年来，一直坚守岗位，心情愉快。今年检查，肝肿大已消失，触肝肋下1．5厘米，剑突下2．5厘米，质软，基本上无痛感。即使繁重的工作也能胜任”。
[按语]根据范老临床经验，此种胁痛，单纯属少阳证者较少，而常见少阳与太阳伤寒相兼，互相交织．且多由外感风寒湿邪，反复缠绵，历久不解，邪传少阳，两经同病。又因寒湿积滞益深，更增气机郁结，肝失条达，日久则气滞血凝，阻塞胁络，以致变证丛生。因此，针对本案少阳之枢转无权，必须首开太阳，发表开闭，散寒除湿。太阳一开，邪有出路，然后根据病情轻重缓急，逐一突破，以竟全功。
太阳少阳证腰痛
江××，男，39岁。四川省某局工作人员。
[病史]患者素有腰酸痛史。因天气变化，常轻度发病。1974年4月，自觉头昏，腰酸痛，发热恶寒。某日，当用凉水浣洗时，转身接水，突觉腰部剧烈疼痛，僵直不能转动。几人抬上车，送至××医院外科检查，诊断疑似：一、腰椎错位；二、风湿。经服药、按摩，电针，理疗二十余日，未见显效。遂来求诊，按太阳少阳合病论治而愈。
[诊治]几人搀扶前来就诊，腰部凉而痛甚，难以转侧，全身酸痛，头目晕眩，口干，不欲饮食，间歇发作低热，微恶寒。舌质偏淡，苔白腻，根部微黄，脉弦微浮。此原为风寒湿邪，郁久不解，积聚于腰部。后太阳之邪未罢，复传少阳，致两经同病。法宜祛寒除湿，和解少阳。本柴胡桂枝汤与肾着汤方意用之。
处方：
柴胡10克桂枝10克泡参10克法夏15克白芍12克大枣15克甘草6克 白术15克干姜12克茯苓15克二剂
服药半小时，自觉全身开始轻松。连进两剂后，腰部即能自由转动。再服四剂，腰痛遂止。1979年7月7日追访：自从获愈以来，至今未再复发。
[辨证]此证本太阳受邪，由于失治，病情急剧转化，表现在以下两个方面：
首先，太阳外证未除．又出现某些少阳证，太少二经同病，其证相互交错。患者此次发病，即觉发热恶寒，全身酸痛，显系太阳表证。少阳受病后，仍有间歇性低热，微恶寒；此不属少阳之往来寒热，仍为太阳表证未解之象。另一方面，口苦为少阳受邪，热蒸胆气上溢；头目晕眩，为风火循经上扰空窍；不欲饮食，乃胆气犯胃；参之脉弦，此皆属少阳证候，其邪在半表半里。《伤寒论》云：“伤寒六、七日，发热微恶寒，支节烦疼，微呕，心下支结，外证未去者，柴胡桂枝汤主之。”此例基本上符合本条之病证。再则，此证腰觉凉而沉重，为寒湿侵袭腰部；其病不在肾之本脏，而在肾之外腑。正如《金匮要略》所谓：“肾著之病，其人身体重，腰中冷……甘姜苓术汤主之。”可见，此例除有柴胡桂枝证以外，兼有肾着之病，故本柴胡桂枝与甘姜苓术汤方意，合而用之。
[按语]《素问·阴阳离合论篇》云： “太阳为开，阳明为阖，少阳为枢。”仲景根据这一原理，治太阳表证，据其主开之特点，立汗解之法，制桂枝等方，使邪“汗出而散”。治阳明腑实，据其主阖之特点，立攻下之法，制大、小承气等方，以泻下肠胃燥实。惟少阳主枢，司一身腠理之开阖，禁汗禁下，故制小柴胡汤，为少阳枢机之剂，和解表里之总方。可见此方之任重不拘于经也。
少阳经主上下内外之转枢，在柴胡证发展过程中，或全归少阳，或兼表兼里。若邪之偏于表者，可借太阳之途径，使邪随汗而外解；邪之偏于里者，可借阳明之途径，使邪从泻下而清解。尤其对太少合病之证，单纯用小柴胡托邪外出，则嫌不足。故仲景又立两阳双解之法。将柴、桂合制为一方。取柴胡之半，解少阳之邪为主；取桂枝之半，散太阳之兼，使邪外达。但以本例而言，既有太阳外证未罢，而病机又见少阳；且肾为寒湿所伤，病在肾之外腑。故临证效法柴胡桂枝合剂之意，并甘草干姜茯苓白术汤燠土而胜水，亦为使太少合病之证兼而收效之义。
太阴证视歧
(复视、双目动脉硬化性网膜病变)
刘××，男，54岁。成都某公园职工。
[病史]主诉：1972年冬，我在公园茶馆售茶。某日下班清帐时，总算不清楚，反复多次还是算不清。我走出屋去，看到迎面不远的小桥上，站着两个人，好象有点反常；我闭眼休息片刻，再看，却又成了一个人!这时我才意识到，自己的眼睛出了毛病。当时又感到身上疲乏不适，以为一天工作劳累所致，于是提前就寝。
第二天早晨刚起床，看见我家的单门也变成两扇，行人、车辆都是成双成对，房屋成了白色……当即到××医院诊治，经眼科检查后，确诊为“双目动脉硬化性网膜病变”。服鱼肝油并注射VB12，治疗一段时间，病情如故。又去医院，医生说： “你的眼睛已经坏了，眼底血管硬化了，好象机器已经坏了一样，修不好了……以后来注射一个时期针药，再吃些鱼肝油吧!”按此办法，拖了一段时间。同时，又服了一些中药，诸如珍珠母、石决明之类，仍无效。
两月以后，来范老处求诊。按太阴证视歧论治，服药六剂而愈。
[诊治]两月前突然发病，视一为二，有时视物变白色。除此，全身无明显不适和既往病史。舌淡红，苔白黄微腻、稍紧密。白睛微现淡红血丝。此为寒湿之邪入侵手太阴肺经，形成视歧。法宜散寒湿，利肺气，通经脉，以麻黄汤加减主之。
处方：
针砂、白矾、绿矾、麦芽、广香、木通、硼砂、神曲、甘草。
白矾50克，其余药物各30克，共同研磨成细末，用一斤红糖拌和制成丸药，大小如梧桐子。每日服用两次，每次两粒。
连续服用二十多天后，疾病痊愈。1979年6月24日随访，自病愈以来，未再复发，体重增加了几斤，身体健康。
[按语]《素问·阴阳应象大论篇》说：“清气在下，则产生完谷不化的泄泻”，又说：“湿气胜则导致濡泄”。泄泻这一证候，虽然有急性多属实证，实证应当泻下；久泻多属虚证，虚证应当补益的说法，但在临证时不可拘泥于此。本例病程虽然长久，但仍以实邪为主，即风寒湿邪，长期郁结不得外泄，水湿内聚于肠胃之间。加上“水反变成湿，谷物反变成滞，精华之气不能输布转化，致使污浊之物下降而引发泄泻”。这属于太阳表证与阳明里证同时发病，而以水湿实邪为重。即使有伤正的表现，也不可进补。虽然有里实，但因表证尚重，更不可攻下。太阳主开，阳明主阖。各种泄泻的形成，多源于湿邪。因此用麻黄的峻烈之性，打开表实的闭塞；继而又用针砂的方剂，推荡体内的湿邪。湿邪去除后泄泻停止。
太阳阳明证结胸
钟××，男，45岁。成都市某厂工人。
[病史]有胃痛病史。一个多月前曾感受风寒，自觉身体不适。面部及全身浮肿，皮肤明显变黄。胃脘及胸胁胀痛，大便秘结，曾按胃痛治疗，病情未见减轻。1960年10月来就诊。
[一诊]胸胁及胃脘疼痛，胸脘之间，触摸感觉微硬且疼痛剧烈，胸部如有堵塞感，呼吸不畅，口渴但不想多喝，大便已经三天未行。舌质红，苔白黄腻。这是太阳阳明证结胸，治法宜泄热逐水，破结通腑，以大陷胸汤为主方。
处方：
大黄3克 芒硝3克 甘遂3克（冲服）
一剂，分三次服用，得到快速通便后，停服剩余药物。
[二诊]服用两次后，得到轻微通便；服用三次后，得到快速通便。胸胁及胃脘胀痛顿时减轻，浮肿及其他症状明显好转。于是停用上方，少量服用清热、化湿的药物，以善后调理。约半个月病愈。半年后随访，身体已康复。
[按语]《伤寒论》关于阳明一证，曾有太阳阳明、正阳阳明、少阳阳明之分。历代医家对此分类，见解很不一致。通常认为，正阳阳明，是阳明自病；太阳阳明、少阳阳明，是太阳或少阳误治而来；其胃家实则是一样的。但据范老临床经验：太阳阳明、少阳阳明，不经误治，也可传经转实。本例太阳阳明证，未经汗下，故属于未误治的传经。
少阳证发热
杨××，男，54岁。成都市居民。
[诊治]1960年10月来就诊。近两年来，每天早餐后发热，体温38℃左右，出汗较多，持续约两小时，热退汗止，随即感到畏寒。每天如此。头晕眩，口苦咽干，胸胁满闷，心中烦躁。舌质红，苔白微黄腻，脉弦数。经××医院检查，发热原因不明，治疗未见好转。这是少阳证发热，治法宜和解少阳，以小柴胡汤加减为主方。
处方：
柴胡24克 黄芩10克 法夏15克 沙参15克 甘草10克 知母15克 石膏30克 牡蛎24克 陈皮9克 茯苓12克
一剂。
上方服用一剂后，热退，诸症悉减。嘱其停药，调养数日而愈。此后，患者与范老常来往，得知其病未复发。
[按语]此证口苦咽干，头晕眩，往来寒热，胸胁苦满，心烦，脉弦，少阳脉证十分明显。病虽迁延两年，正如《伤寒论》所称“柴胡证仍在者，先与小柴胡汤”。又发热汗出，口渴，舌红，为兼有郁热之象，故去掉姜、枣，加知母、石膏以清解。又因胸胁苦满较甚，夹有湿邪，加牡蛎、陈皮、茯苓，以渗湿、化滞、散结。
少阳证癫狂
吴××，女，43岁。四川省郫县团结乡小学教员。
[病史]长期失眠多梦，易动怒，多气郁，偶有神志恍惚之象。××医院曾诊断为“神经官能症”。1974年9月，因工作与同志争吵，一怒之下，突然昏倒。苏醒后，神志不清，语言错乱，亲疏不分，见人詈骂不休。急来求诊，按少阳证癫狂论治，两诊而愈。
[初诊]刚进诊室，就将医生和病人大骂一通，语无伦次。胸满，阵阵呃逆，眼神微呆滞，面赤，唇红，便秘。脉弦数，舌质红，苔微黄而腻。这是少阳证癫狂，治法宜和解泄热，重镇安神，以柴胡加龙骨牡蛎汤加减为主方。
处方：
柴胡12克 龙骨60克（先煎） 黄芩12克 党参12克 桂枝6克 茯苓12克 法夏12克 生大黄10克（后下） 牡蛎60克（先煎） 大枣15克 赭石60克（先煎）
[辨证]患者初起病轻，仅有失眠易怒，心神浮越，微现癫病之象。由于失治而病情加重：肝气郁结，热久化火；偶遇感情激动，胆火上冲；心气不镇，神志顿为之昏乱，遂发为癫狂。其面赤、舌红、脉弦数，参之上述诸证，可确诊无疑。《伤寒论》柴胡加龙骨牡蛎汤，本用于治太阳伤寒因误下后，胸满惊烦、谵语等证。后世常以此方，治狂痫诸病，今验之临床，确有效验。
[二诊]服用两剂后，夜间可安睡，神志渐清，呃逆亦止。守原法加减续服。
处方：
柴胡10克 龙骨30克（先煎） 黄芩10克 党参10克 茯苓12克 法夏12克 牡蛎30克（先煎） 赭石30克（先煎） 钩藤12克 枯花12克 甘草3克
上方服用三剂，病愈。1979年7月24日随访：自病愈以来，再未复发。
[按语]《素问·通评虚实论篇》说：“癫疾、厥狂，久逆之所生也。”《素问·宣明五气篇》说：“邪入于阳则狂……搏阳则为巅疾。”用柴胡加龙骨牡蛎汤，治癫痫狂证，历史久矣！过去有人认为：本方既有龙骨、牡蛎之收涩，复有大黄、茯苓之通利；又有大黄之攻，兼有人参之补；以其方意杂揉，疑其不可用，或谓系他方加龙牡之误。经临床实践检验，上说均不可信。
太阳少阳证胁痛
(慢性肝炎、早期肝硬化)
薛××，男，42岁。成都市某厂干部。
[病史]自1969年患慢性肝炎，1971年肝大肋下3厘米，剑突下5厘米，肝区胀痛，经治疗病情未控制。于1972年春，开始全休。同年5月27日来就诊。
[初诊]肝区胀痛，食欲日益减退，进食后腹胀，坐立不安。腰部如重带紧束，难以蹲下。头疼恶寒，面色青黄，两颊瘦削，眼胞与双足微现浮肿。舌质暗淡，边缘稍红，苔淡黄夹白，根部稍厚腻。这是少阳证，兼太阳伤寒，宜先开郁闭，散寒除湿，以麻黄汤加味为主方。
处方：
麻黄10克 桂枝10克 杏仁12克 炙甘草15克 法夏18克
服用四剂后，头痛与肝区胀痛略减，余症无明显变化。为增强散寒除湿，通阳行气之力，继用甘草麻黄汤，再服五剂。舌质渐转红，苔腻稍退，现寒湿风热交织之象。为引邪外出，选用荆防败毒散，去川芎、羌活、独活，酌加桑叶、黄芩、牛蒡等，辛温发汗与辛凉清解之品相配伍，服用二十余剂。
[二诊]胁、腰部紧束沉重之感稍减，眼胞浮肿渐消，全身初觉松动。舌苔仍腻而紧密，根部较厚。风寒湿邪积聚已久，蕴结于肝胃，气机阻滞，故胸胁中脘仍觉胀满。今乘表邪已解之机，又据邪实而主证在上之理，因势利导，“其高者，因而越之”，运用吐法，两月之内，先后用自制“二妙丹”引吐两次，呕出大量痰涎泫液，并配合服用针砂散。
处方一：“二妙丹”
绿矾3克 白矾3克 硼砂1克 炼制成丹，空腹用温开水送服1克。
处方二：“针砂散”
针砂 硼砂 绿矾 白矾 神曲 麦芽 木通 广香 甘草 各10克，共为细末。
第一周，每日晨空腹用米汤冲服一次，每次3克；其后，每三日服一次。
[三诊]自觉症状显著减轻，食欲增加。活动时，肝区仍觉坠胀、疼痛。少阳证未解。以自制回生丹加味，配合针砂散疏肝行气，开窍止痛，缓缓服之。
处方：“回生丹”
藿香 丁香 广香 辽细辛 巴豆 牙皂 雄黄 朱砂 白矾 蟾酥 麝香 炼制成丸，如绿豆大，痛时服2—3粒，每日一次。
针砂散每周服一次，每次服3克。
上方服用两个月。
前后治疗五个月，病情基本好转。遂停服汤药，继服回生丹，针砂散，又调养五个月。重返工作岗位，坚持全日工作。
1978年12月，患者来信说：“六年来，一直坚守岗位，心情愉快。今年检查，肝肿大已消失，触肝肋下1.5厘米，剑突下2.5厘米，质软，基本上无痛感。即使繁重的工作也能胜任”。
[按语]根据范老临床经验，此种胁痛，单纯属少阳证者较少，而常见少阳与太阳伤寒相兼，互相交织，且多由外感风寒湿邪，反复缠绵，历久不解，邪传少阳，两经同病。又因寒湿积滞益深，更增气机郁结，肝失条达，日久则气滞血凝，阻塞胁络，以致变证丛生。因此，针对本案少阳之枢转无权，必须首开太阳，发表开闭，散寒除湿。太阳一开，邪有出路，然后根据病情轻重缓急，逐一突破，以竟全功。
太阳少阳证腰痛
江××，男，39岁。四川省某局工作人员。
[病史]患者素有腰酸痛史。因天气变化，常轻度发病。1974年4月，自觉头昏，腰酸痛，发热恶寒。某日，当用凉水浣洗时，转身接水，突觉腰部剧烈疼痛，僵直不能转动。几人抬上车，送至××医院外科检查，诊断疑似：一、腰椎错位；二、风湿。经服药、按摩，电针，理疗二十余日，未见显效。遂来求诊，按太阳少阳合病论治而愈。
[诊治]几人搀扶前来就诊，腰部凉而痛甚，难以转侧，全身酸痛，头目晕眩，口干，不欲饮食，间歇发作低热，微恶寒。舌质偏淡，苔白腻，根部微黄，脉弦微浮。此为风寒湿邪，郁久不解，积聚于腰部。后太阳之邪未罢，复传少阳，致两经同病。治法宜祛寒除湿，和解少阳。本柴胡桂枝汤与肾着汤方意用之。
处方：
柴胡10克 桂枝10克 泡参10克 法夏15克 白芍12克 大枣15克 甘草6克 白术15克 干姜12克 茯苓15克
二剂。
服药半小时，自觉全身开始轻松。连进两剂后，腰部即能自由转动。再服四剂，腰痛遂止。1979年7月7日随访：自从获愈以来，至今未再复发。
[辨证]此证本太阳受邪，由于失治，病情急剧转化，表现在以下两个方面：
首先，太阳外证未除，又出现某些少阳证，太少二经同病，其证相互交错。患者此次发病，即觉发热恶寒，全身酸痛，显系太阳表证。少阳受病后，仍有间歇性低热，微恶寒；此不属少阳之往来寒热，仍为太阳表证未解之象。另一方面，口苦为少阳受邪，热蒸胆气上溢；头目晕眩，为风火循经上扰空窍；不欲饮食，乃胆气犯胃；参之脉弦，此皆属少阳证候，其邪在半表半里。《伤寒论》云：“伤寒六、七日，发热微恶寒，支节烦疼，微呕，心下支结，外证未去者，柴胡桂枝汤主之。”此例基本上符合本条之病证。再则，此证腰觉凉而沉重，为寒湿侵袭腰部；其病不在肾之本脏，而在肾之外腑。正如《金匮要略》所谓：“肾著之病，其人身体重，腰中冷……甘姜苓术汤主之。”可见，此例除有柴胡桂枝证以外，兼有肾着之病，故本柴胡桂枝与甘姜苓术汤方意，合而用之。
[按语]《素问·阴阳离合论篇》说：“太阳为开，阳明为阖，少阳为枢。”仲景根据这一原理，治太阳表证，据其主开之特点，立汗解之法，制桂枝等方，使邪“汗出而散”。治阳明腑实，据其主阖之特点，立攻下之法，制大、小承气等方，以泻下肠胃燥实。惟少阳主枢，司一身腠理之开阖，禁汗禁下，故制小柴胡汤，为少阳枢机之剂，和解表里之总方。可见此方之任重不拘于经也。
少阳经主上下内外之转枢，在柴胡证发展过程中，或全归少阳，或兼表兼里。若邪之偏于表者，可借太阳之途径，使邪随汗而外解；邪之偏于里者，可借阳明之途径，使邪从泻下而清解。尤其对太少合病之证，单纯用小柴胡托邪外出，则嫌不足。故仲景又立两阳双解之法。将柴、桂合制为一方。取柴胡之半，解少阳之邪为主；取桂枝之半，散太阳之兼，使邪外达。但以本例而言，既有太阳外证未罢，而病机又见少阳；且肾为寒湿所伤，病在肾之外腑。故临证效法柴胡桂枝合剂之意，并甘草干姜茯苓白术汤燠土而胜水，亦为使太少合病之证兼而收效之义。
太阴证视歧
(复视、双目动脉硬化性网膜病变)
刘××，男，54岁。成都某公园职工。
[病史]主诉：1972年冬，我在公园茶馆售茶。某日下班清帐时，总算不清楚，反复多次还是算不清。我走出屋去，看到迎面不远的小桥上，站着两个人，好象有点反常；我闭眼休息片刻，再看，却又成了一个人!这时我才意识到，自己的眼睛出了毛病。当时又感到身上疲乏不适，以为一天工作劳累所致，于是提前就寝。
第二天早晨刚起床，看见我家的单门也变成两扇，行人、车辆都是成双成对，房屋成了白色……当即到××医院诊治，经眼科检查后，确诊为“双目动脉硬化性网膜病变”。服鱼肝油并注射VB12，治疗一段时间，病情如故。又去医院，医生说：“你的眼睛已经坏了，眼底血管硬化了，好象机器已经坏了一样，修不好了……以后来注射一个时期针药，再吃些鱼肝油吧!”按此办法，拖了一段时间。同时，又服了一些中药，诸如珍珠母、石决明之类，仍无效。
两月以后，来范老处求诊。按太阴证视歧论治，服药六剂而愈。
[诊治]两月前突然发病，视一为二，有时视物变白色。除此，全身无明显不适和既往病史。舌淡红，苔白黄微腻、稍紧密。白睛微现淡红血丝。此为寒湿之邪入侵手太阴肺经，形成视歧。治法宜散寒湿，利肺气，通经脉，以麻黄汤加减为主方。
处方：
Cinnabar Sand (Zhen Sha), Alum (Bai Fan), Green Vitriol (Lv Fan), Malt (Mai Ya), Patchouli (Guang Huo Xiang), Akebia Caulis (Mu Tong), Borax (Peng Sha), Medicated Leaven (Shen Qu), Licorice Root (Gan Cao).
Alum 50g, the remaining herbs each 30g, all ground into fine powder, mixed with one jin (500g) of brown sugar to form pills, sized like sophora seeds. Take twice daily, two pills per dose.
After continuous administration for over twenty days, the disease was cured. Follow-up on June 24, 1979, showed no recurrence since recovery, weight increased by several jin, and health was good.
[Commentary] The *Su Wen: Yin Yang Ying Xiang Da Lun* states: "When clear qi sinks below, it generates undigested diarrhea," and also: "Excess dampness leads to loose stools." Regarding diarrhea, although acute cases are often excess and should be purged, while chronic cases are often deficiency and should be tonified, clinical practice should not be rigidly bound by these rules. Although this case had a long duration, it was primarily due to excess pathogens, namely wind-cold-dampness, which had been stagnant for a long time without being expelled externally, causing water-dampness to accumulate between the intestines and stomach. Furthermore, "water turns back into dampness, grain turns back into stagnation; the essence qi cannot be transported and transformed, leading to the descent of filth and the onset of diarrhea." This belongs to the simultaneous occurrence of Taiyang exterior syndrome and Yangming interior syndrome, with water-dampness excess pathogen being the primary issue. Even if there are signs of righteous qi injury, tonification is contraindicated. Although there is interior excess, because the exterior syndrome is still heavy, purgation is further contraindicated. Taiyang governs opening, Yangming governs closing. The formation of various diarrheas mostly originates from dampness. Therefore, the potent nature of Ephedra Herb (Mahuang) is used to open the exterior excess; subsequently, the formula containing Cinnabar Sand is used to push out the interior dampness. Once the dampness pathogen is removed, the diarrhea stops.
Taiyang-Yangming Syndrome Jie Xiong (Chest Binding)
Zhong XX, Male, 45 years old. Worker at a factory in Chengdu.
[Medical History] History of stomach pain. Over a month ago, he contracted wind-cold and felt general discomfort. Facial and whole-body edema were present, and the skin turned significantly yellow. Epigastric and hypochondriac distending pain, constipation. Treated as stomach pain previously, but the condition did not improve. Consulted in October 1960.
[First Visit] Pain in the chest, hypochondrium, and epigastrium. Palpation of the area between the chest and epigastrium revealed slight hardness and severe pain. A sensation of blockage in the chest, difficulty in breathing, thirst but no desire to drink much, no bowel movement for three days. Red tongue body, white-yellow greasy coating. This is Taiyang-Yangming syndrome Jie Xiong. The treatment method should be to drain heat and expel water, break binding and unblock the fu organs, using Da Xian Xiong Tang (Major Blue Pill Decoction) as the main formula.
Prescription:
Rhubarb Root (Da Huang) 3g, Mirabilite (Mang Xiao) 3g, Kansui Root (Gan Sui) 3g (taken with decoction).
One dose, divided into three servings. Stop taking the remainder once rapid purgation occurs.
[Second Visit] After two doses, mild purgation occurred; after three doses, rapid purgation occurred. The distending pain in the chest, hypochondrium, and epigastrium decreased instantly. Edema and other symptoms improved significantly. The above prescription was stopped, and small amounts of heat-clearing and damp-resolving herbs were taken for convalescence. The disease was cured in about half a month. Follow-up six months later showed full recovery.
[Commentary] In the *Shang Han Lun*, regarding Yangming syndrome, there are distinctions between Taiyang-Yangming, Zheng Yang-Yangming, and Shaoyang-Yangming. Historically, physicians have had inconsistent views on this classification. It is generally believed that Zheng Yang-Yangming is a primary Yangming disease; Taiyang-Yangming and Shaoyang-Yangming result from mismanagement of Taiyang or Shaoyang diseases; their stomach-house excess is the same. However, based on Master Fan's clinical experience, Taiyang-Yangming and Shaoyang-Yangming can also transmit channels and transform into excess without prior mismanagement. This Taiyang-Yangming case did not undergo sweating or purging, so it belongs to channel transmission without mismanagement.
Shaoyang Syndrome Fever
Yang XX, Male, 54 years old. Resident of Chengdu.
[Diagnosis and Treatment] Consulted in October 1960. For the past two years, fever occurs daily after breakfast, around 38°C, with significant sweating, lasting about two hours. When the fever subsides and sweating stops, chills are felt. This happens daily. Dizziness, bitter taste in the mouth, dry throat, fullness in the chest and hypochondrium, irritability. Red tongue body, white slightly yellow greasy coating, wiry-numerous pulse. Checked at XX Hospital, cause of fever unknown, treatment ineffective. This is Shaoyang syndrome fever. The treatment method should harmonize Shaoyang, using Xiao Chai Hu Tang (Minor Bupleurum Decoction) modified as the main formula.
Prescription:
Bupleurum Root (Chai Hu) 24g, Scutellaria Root (Huang Qin) 10g, Processed Pinellia Rhizome (Fa Xia) 15g, Glehnia Root (Sha Shen) 15g, Licorice Root (Gan Cao) 10g, Anemarrhena Rhizome (Zhi Mu) 15g, Gypsum Fibrosum (Shi Gao) 30g, Oyster Shell (Mu Li) 24g, Tangerine Peel (Chen Pi) 9g, Poria (Fu Ling) 12g.
One dose.
After one dose of the above prescription, the fever subsided, and all symptoms decreased. Advised to stop medication and rest for a few days until recovered. Later, the patient frequently visited Master Fan, knowing the disease did not recur.
[Commentary] This case presents bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, fullness in the chest and hypochondrium, irritability, and wiry pulse, making the Shaoyang pulse-symptoms very obvious. Although the disease persisted for two years, as stated in the *Shang Han Lun*: "If the Chai Hu syndrome remains, first give Xiao Chai Hu Tang." Additionally, fever with sweating, thirst, and red tongue indicate accompanying stagnant heat, so Ginger and Jujube are removed, and Anemarrhena Rhizome and Gypsum Fibrosum are added to clear the heat. Due to severe fullness in the chest and hypochondrium with dampness, Oyster Shell, Tangerine Peel, and Poria are added to leach out dampness, resolve stagnation, and dissipate nodules.
Shaoyang Syndrome Dian Kuang (Mania/Epilepsy)
Wu XX, Female, 43 years old. Teacher at Tuanjie Township Primary School, Pixian County, Sichuan Province.
[Medical History] Long-term insomnia with many dreams, prone to anger, frequent Qi stagnation, occasional vague mental state. Diagnosed as "Neurosis" at XX Hospital. In September 1974, after an argument with colleagues at work, she suddenly fainted in anger. Upon waking, her mental state was unclear, speech was disordered, she could not distinguish close from distant people, and she cursed endlessly at anyone she saw. Urgently sought consultation. Treated according to Shaoyang syndrome Dian Kuang, cured after two visits.
[Initial Visit] Upon entering the consulting room, she scolded the doctor and patients indiscriminately, speaking incoherently. Chest fullness, intermittent hiccups, slightly dull eyes, red face, red lips, constipation. Wiry-numerous pulse, red tongue body, slightly yellow greasy coating. This is Shaoyang syndrome Dian Kuang. The treatment method should harmonize and drain heat, heavily sedate and calm the spirit, using Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) modified as the main formula.
Prescription:
Bupleurum Root (Chai Hu) 12g, Dragon Bone (Long Gu) 60g (decocted first), Scutellaria Root (Huang Qin) 12g, Codonopsis Root (Dang Shen) 12g, Cinnamon Twig (Gui Zhi) 6g, Poria (Fu Ling) 12g, Processed Pinellia Rhizome (Fa Xia) 12g, Raw Rhubarb Root (Sheng Da Huang) 10g (added later), Oyster Shell (Mu Li) 60g (decocted first), Jujube (Da Zao) 15g, Hematite (Zhe Shi) 60g (decocted first).
[Differentiation] Initially, the patient's illness was mild, with only insomnia and irritability, floating heart spirit, and slight signs of Dian disease. Due to lack of treatment, the condition worsened: Liver Qi stagnated, prolonged heat transformed into fire; encountering emotional agitation, Gallbladder Fire rushed upward; Heart Qi failed to settle, causing sudden confusion of the spirit, thus developing Dian Kuang. Her red face, red tongue, and wiry-numerous pulse, combined with the aforementioned symptoms, confirm the diagnosis beyond doubt. The *Shang Han Lun*'s Chai Hu Jia Long Gu Mu Li Tang was originally used for Taiyang cold damage caused by erroneous purgation, presenting with chest fullness, fright, irritability, and delirium. Later generations often used this formula to treat mania and epilepsy. Clinical verification confirms its efficacy.
[Second Visit] After two doses, peaceful sleep at night was achieved, mental clarity gradually returned, and hiccups stopped. Continued with the original method and modifications.
Prescription:
Bupleurum Root (Chai Hu) 10g, Dragon Bone (Long Gu) 30g (decocted first), Scutellaria Root (Huang Qin) 10g, Codonopsis Root (Dang Shen) 10g, Poria (Fu Ling) 12g, Processed Pinellia Rhizome (Fa Xia) 12g, Oyster Shell (Mu Li) 30g (decocted first), Hematite (Zhe Shi) 30g (decocted first), Uncaria Ramulus cum Uncis (Gou Teng) 12g, Dried Flower (Ku Hua) 12g, Licorice Root (Gan Cao) 3g.
After three doses of the above prescription, the disease was cured. Follow-up on July 24, 1979: No recurrence since recovery.
[Commentary] The *Su Wen: Tong Ping Xu Shi Lun* states: "Dian disease and Jue Kuang arise from prolonged reversal [of Qi flow]." The *Su Wen: Xuan Ming Wu Qi Pian* states: "Pathogens entering Yang lead to Kuang... contending with Yang leads to Jian Ji [head disease]." Using Chai Hu Jia Long Gu Mu Li Tang to treat Dian, Kuang, and epilepsy has a long history! Some in the past believed: This formula contains the astringent properties of Dragon Bone and Oyster Shell, yet the draining properties of Rhubarb and Poria; it has the attacking nature of Rhubarb combined with the tonifying nature of Codonopsis; due to the mixed intentions of the formula, they doubted its usability or claimed it was an error of adding Dragon Bone and Oyster Shell to another formula. Clinical practice has proven these views unreliable.
Taiyang-Shaoyang Syndrome Hypochondriac Pain
(Chronic Hepatitis, Early Cirrhosis)
Xue XX, Male, 42 years old. Cadre at a factory in Chengdu.
[Medical History] Suffered from chronic hepatitis since 1969. In 1971, liver enlargement was noted, 3cm below the costal margin and 5cm below the xiphoid process, with distending pain in the liver region. Treatment failed to control the condition. Took full leave in Spring 1972. Consulted on May 27, 1972.
[Initial Visit] Distending pain in the liver region, decreasing appetite, abdominal distension after eating, restlessness. Waist feels bound tightly like a heavy belt, difficult to squat. Headache, aversion to cold, greenish-yellow complexion, emaciated cheeks, slight edema of eyelids and feet. Dark pale tongue body, slightly red edges, pale yellow mixed with white coating, slightly thick and greasy at the root. This is Shaoyang syndrome, accompanied by Taiyang cold damage. The priority is to open depression and closure, dispel cold and dampness, using Ma Huang Tang (Ephedra Decoction) modified as the main formula.
Prescription:
Ephedra Herb (Mahuang) 10g, Cinnamon Twig (Guizhi) 10g, Apricot Seed (Xing Ren) 12g, Roasted Licorice Root (Zhi Gan Cao) 15g, Processed Pinellia Rhizome (Fa Xia) 18g.
After four doses, headache and liver region distending pain decreased slightly, other symptoms unchanged. To enhance the power of dispelling cold and dampness, and promoting Yang circulation and Qi movement, Gan Cao Ma Huang Tang (Licorice and Ephedra Decoction) was continued for five more doses. The tongue body gradually turned red, greasy coating receded slightly, showing a mix of cold-dampness and wind-heat. To guide pathogens outward, Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction to Overcome Toxicity) was selected, removing Ligusticum Rhizome (Chuan Xiong), Notopterygium Rhizome (Qiang Huo), and Angelica Pubescens Root (Du Huo),酌情 adding Mulberry Leaf (Sang Ye), Scutellaria Root (Huang Qin), and Arctium Fruit (Niu Bang Zi). Warm-acrid sweating and cool-acrid resolving herbs were combined, administered for over twenty doses.
[Second Visit] Tight and heavy sensation in the hypochondrium and waist decreased slightly, eyelid edema gradually subsided, whole body initially felt relaxed. Tongue coating remained greasy and tight, thicker at the root. Wind-cold-dampness had accumulated for a long time, storing in the Liver and Stomach, blocking Qi mechanism, hence distension in the chest, hypochondrium, and Zhong Wan persists. Taking advantage of the resolved exterior pathogen, and based on the principle that excess pathogens with upper-predominant symptoms should be treated by inducing vomiting ("Those high up should be evacuated"), the vomiting method was used. Within two months, self-made "Er Miao Dan" (Two Marvels Pill) was used twice to induce vomiting, expelling large amounts of phlegm and saliva, combined with oral administration of Zhen Sha San (Cinnabar Sand Powder).
Prescription 1: "Er Miao Dan"
Green Vitriol (Lv Fan) 3g, Alum (Bai Fan) 3g, Borax (Peng Sha) 1g. Refined into pills, take 1g with warm water on an empty stomach.
Prescription 2: "Zhen Sha San"
Cinnabar Sand (Zhen Sha), Borax (Peng Sha), Green Vitriol (Lv Fan), Alum (Bai Fan), Medicated Leaven (Shen Qu), Malt (Mai Ya), Akebia Caulis (Mu Tong), Patchouli (Guang Huo Xiang), Licorice Root (Gan Cao), each 10g, ground into fine powder.
First week, take 3g once daily on an empty stomach with rice gruel; thereafter, take once every three days.
[Third Visit] Symptoms significantly reduced, appetite increased. During activity, liver region still felt heavy and painful. Shaoyang syndrome unresolved. Self-made Hui Sheng Dan (Revival Pill) modified, combined with Zhen Sha San to soothe the Liver, move Qi, open orifices, and relieve pain, taken slowly.
Prescription: "Hui Sheng Dan"
Patchouli (Huo Xiang), Clove (Ding Xiang), Patchouli (Guang Huo Xiang), Northern Asarum (Liao Xi Xin), Croton Seed (Ba Dou), Gleditsia Spine (Ya Zao), Realgar (Xiong Huang), Cinnabar (Zhu Sha), Alum (Bai Fan), Toad Venom (Chan Su), Musk (She Xiang). Refined into pills, size of mung beans. Take 2-3 pills when painful, once daily.
Zhen Sha San taken once weekly, 3g per dose.
The above regimen lasted two months.
After five months of treatment, the condition basically improved. Decoctions were stopped, continuing with Hui Sheng Dan and Zhen Sha San, followed by five months of recuperation. Returned to work, maintaining full-time duties.
In December 1978, the patient wrote: "For six years, I have held my post steadfastly and am happy. This year's examination showed the liver swelling has disappeared; palpable liver is 1.5cm below the costal margin and 2.5cm below the xiphoid process, soft texture, basically painless. I can even handle heavy work."
[Commentary] According to Master Fan's clinical experience, such hypochondriac pain rarely belongs purely to Shaoyang syndrome; it is commonly seen as a combination of Shaoyang and Taiyang cold damage, intertwined. It is mostly caused by external contraction of wind-cold-dampness, lingering repeatedly, failing to resolve over time, transmitting to Shaoyang, resulting in simultaneous disease of both channels. Furthermore, deep accumulation of cold-dampness increases Qi stagnation, causing the Liver to lose its free flow. Over time, Qi stagnation and Blood coagulation block the hypochondriac collaterals, leading to various complications. Therefore, addressing the failure of Shaoyang pivot function in this case, one must first open Taiyang, release the exterior, open closure, and dispel cold and dampness. Once Taiyang opens, the pathogen has an exit. Then, based on the severity and urgency of the condition, breakthroughs are made one by one to achieve complete success.
Taiyang-Shaoyang Syndrome Lower Back Pain
Jiang XX, Male, 39 years old. Staff member at a bureau in Sichuan Province.
[Medical History] Patient had a history of sore and aching lower back. Mild episodes often occurred with weather changes. In April 1974, he felt dizzy, lower back soreness, fever, and aversion to cold. One day, while washing with cold water and turning to catch the water, he suddenly felt severe lower back pain, stiff and unable to turn. Carried by several people to the surgery department of XX Hospital for examination. Suspected diagnoses: 1. Lumbar vertebra displacement; 2. Rheumatism. After over twenty days of medication, massage, electroacupuncture, and physiotherapy, no significant effect was seen. He then sought consultation and was cured by treating it as a concurrent Taiyang-Shaoyang disease.
[Diagnosis and Treatment] Supported by several people, he came for consultation. Lower back felt cold and painful, difficult to turn, whole body sore, dizziness of head and eyes, dry mouth, no desire to eat, intermittent low-grade fever, slight aversion to cold. Pale tongue body, white greasy coating, slightly yellow at the root, wiry slightly floating pulse. This is wind-cold-dampness, stagnant for a long time without resolution, accumulating in the lower back. Subsequently, Taiyang pathogen did not cease, transmitted to Shaoyang, causing simultaneous disease of both channels. The treatment method should dispel cold and dampness, harmonize Shaoyang. Based on the principles of Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) and Shen Zhuo Tang (Kidney Fixation Decoction).
Prescription:
Bupleurum Root (Chai Hu) 10g, Cinnamon Twig (Guizhi) 10g, Bubble Ginseng/Pseudostellaria (Pao Shen) 10g, Processed Pinellia Rhizome (Fa Xia) 15g, White Peony Root (Bai Shao) 12g, Jujube (Da Zao) 15g, Licorice Root (Gan Cao) 6g, Atractylodes Macrocephala Rhizome (Bai Zhu) 15g, Dried Ginger (Gan Jiang) 12g, Poria (Fu Ling) 15g.
Two doses.
Half an hour after taking the medicine, he felt his whole body becoming relaxed. After two consecutive doses, the lower back could turn freely. After four more doses, lower back pain stopped. Follow-up on July 7, 1979: No recurrence since recovery.
[Differentiation] This syndrome originated from Taiyang pathogen invasion. Due to lack of treatment, the condition transformed rapidly, manifesting in two aspects:
First, the exterior Taiyang syndrome was not eliminated, and some Shaoyang symptoms appeared, causing simultaneous disease of Taiyang and Shaoyang, with interlaced symptoms. The patient felt fever and aversion to cold, whole body soreness upon onset, clearly indicating Taiyang exterior syndrome. After Shaoyang involvement, intermittent low-grade fever and slight aversion to cold persisted; this does not belong to Shaoyang's alternating chills and fever, but remains a sign of unresolved Taiyang exterior syndrome. On the other hand, bitter taste indicates Shaoyang pathogen invasion, with heat steaming Gallbladder Qi upward; dizziness indicates wind-fire disturbing the orifices along the channels; no desire to eat indicates Gallbladder Qi invading the Stomach; combined with the wiry pulse, these all belong to Shaoyang syndromes, with the pathogen in the half-exterior half-interior. The *Shang Han Lun* states: "Cold damage for six or seven days, fever with slight aversion to cold, joint pain, slight vomiting, subcardiac binding, exterior syndrome not gone, Chai Hu Gui Zhi Tang is indicated." This case basically fits this clause. Furthermore, the cold and heavy sensation in the lower back indicates cold-dampness invading the waist; the disease is not in the Kidney's proper zang organ, but in its outer fu organ. As stated in the *Jin Gui Yao Lue*: "Shen Zhuo disease, the person feels heavy, cold in the waist... Gan Jiang Ling Zhu Tang is indicated." Thus, this case, besides having Chai Hu Gui Zhi syndrome, also has Shen Zhuo disease. Therefore, the principles of Chai Hu Gui Zhi Tang and Gan Jiang Ling Zhu Tang are combined and used.
[Commentary] The *Su Wen: Yin Yang Li He Lun* states: "Taiyang is opening, Yangming is closing, Shaoyang is the pivot." Zhang Zhongjing, based on this principle, for Taiyang exterior syndrome, relying on its characteristic of opening, established the sweating method, creating formulas like Guizhi Tang, allowing pathogens to scatter through sweat. For Yangming fu excess, relying on its characteristic of closing, established the purgative method, creating Da Cheng Qi Tang and Xiao Cheng Qi Tang to purge dry excess from the intestines and stomach. Only Shaoyang governs the pivot, controlling the opening and closing of the body's pores, prohibiting sweating and purging. Thus, Xiao Chai Hu Tang was created as the pivot agent for Shaoyang and the general formula for harmonizing exterior and interior. This shows the formula's responsibility is not limited to one channel.
Shaoyang meridian governs the pivot of upper/lower and interior/exterior. In the development of Chai Hu syndrome, it may fully归于 Shaoyang, or combine with exterior or interior. If the pathogen leans toward the exterior, it can borrow the Taiyang pathway to be resolved externally through sweat; if it leans toward the interior, it can borrow the Yangming pathway to be cleared internally through purgation. Especially for concurrent Taiyang-Shaoyang cases, simply using Xiao Chai Hu Tang to push pathogens out is insufficient. Thus, Zhang Zhongjing established the method of dual resolution of both Yang channels. Combining Chai Hu and Gui Zhi into one formula. Taking half of Chai Hu to mainly resolve Shaoyang pathogens; taking half of Gui Zhi to scatter Taiyang concomitant pathogens, allowing pathogens to reach the exterior. But in this case, besides unresolved Taiyang exterior syndrome, the pathology involves Shaoyang; moreover, the Kidney is injured by cold-dampness, and the disease is in the Kidney's outer fu organ. Therefore, clinically imitating the intent of the Chai Hu Gui Zhi combination, and using Gan Cao Gan Jiang Fu Ling Bai Zhu Tang to warm Earth and overcome Water, also serves the meaning of achieving combined effects for concurrent Taiyang-Shaoyang cases.
Taiyin Syndrome Shiqi (Double Vision)
(Diplopia, Bilateral Arteriosclerotic Retinal Disease)
Liu XX, Male, 54 years old. Employee at a park in Chengdu.
[Medical History] Chief Complaint: In Winter 1972, I sold tea in a park teahouse. One day, while settling accounts after work, I couldn't calculate correctly despite multiple attempts. I walked out and saw two people standing on a nearby bridge, which seemed abnormal; I closed my eyes to rest for a moment, looked again, and they became one person! Only then did I realize something was wrong with my eyes. At that time, I also felt fatigued and uncomfortable, attributing it to a day's hard work, and went to bed early.
The next morning, just after getting up, I saw my single door had become double, pedestrians and vehicles were in pairs, and houses appeared white... I immediately went to XX Hospital for diagnosis. After ophthalmological examination, diagnosed as "Bilateral Arteriosclerotic Retinal Disease." Took cod liver oil and injected Vitamin B12. After a period of treatment, the condition remained the same. Went to the hospital again, the doctor said: "Your eyes are broken, fundus blood vessels are hardened, like a machine that is broken and cannot be repaired... Come inject medicine for a period later, and eat some cod liver oil!" Following this method, dragged on for a while. Meanwhile, took some Chinese medicines such as Mother of Pearl (Zhen Zhu Mu) and Concha Haeditis (Shi Jue Ming), still ineffective.
Two months later, sought consultation from Master Fan. Treated according to Taiyin syndrome Shiqi, cured after six doses of medicine.
[Diagnosis and Treatment] Suddenly developed symptoms two months ago, seeing one object as two, sometimes seeing objects as white. Apart from this, no obvious discomfort or past medical history. Pale red tongue, white-yellow slightly greasy and tight coating. Slight pale red blood streaks in the sclera. This is cold-dampness pathogen invading the Hand Taiyin Lung Meridian, forming Shiqi. The treatment method should dispel cold-dampness, benefit Lung Qi, unblock meridians, using Ma Huang Tang (Ephedra Decoction) modified as the main formula.
Prescription: