痹证1(风湿热)
刘某某，女，27岁
初诊
患者为一矿工家属，两月前足月顺产一女孩，在产假期间，不慎感受风寒，发热咳嗽咽痛，数日而愈。一周前又冒风寒，发热，关节痛，化验：血沉40mm/h、时，抗“O”1：800，西医诊为风湿热。因患者吃西药烧心胃痛，故请中医诊治。身热口渴，饮水不多，头胸腹有汗而下肢无汗，两膝关节红肿而痛，扪之则有灼热感，苔白而干，脉弦数。此为热痹，治当清热通痹，白虎加桂枝汤主之。
生石膏30克，知母10克，梗米15克，生甘草15克，穿山龙15克，三付
二诊
药后热退，关节红肿已消，但仍觉痛，再以原方五剂。
三诊
诸症皆平，化验正常，停药自养，嘱其千万预防感冒，否则易致反复。
[按]：本案为热痹热痹乃风寒湿邪久客不去，郁而化热，阻滞经络不通，故尔以红肿热痛为特征，治当清其郁热而通其经络。本案以白虎汤清阳明经热，加穿山龙通络止痛，收效迅速。二诊仍用原方续服，诸证虽除，而病根未全拔，故嘱其小心将息，预防感冒，否则仍不免复发。
痹症2(干燥综合征
赵某某，女，23岁
初诊
病发半年余，一身关节入夜作痛，晨起即愈。曾查得类风湿因子阳性。口腔溃疡经常发作，此起彼伏，经某医院检查，认为属干燥综合征。诊脉弦糈，按之沉数，舌红且干，心烦急躁，夜寐梦多。肝胆郁热已久，先用清泄肝胆方法。
荆芥6克，防风6克，柴胡6克，黄芩6克，川楝子6克，丹参10克，茜草10克，木瓜10克，黄连2克，桑枝10克，丝瓜络10克，七付
二诊
药后疼痛略减，心烦稍平，夜梦亦稀，脉仍弦滑数，舌红且干，继用前法进退。
荆芥6克，防风6克，柴胡6克，黄芩6克，川楝子6克，丹参10克，茜草10克，木瓜10克，大豆卷10克，秦艽10克，丝瓜络10克，桑枝10克，七付
三诊
药后疼痛续减。近日感冒新凉，午后低烧，体温37.2℃，一身乏力，周身酸围，胯膝关节疼痛加重。咽喉怍{#敞咳。诊脉浮滑且弦，舌红苔白。新感外邪，先以宣法退热为譬。
淡豆豉10克，炒山栀6克，大豆卷10克，桑枝10克，前胡6克，杏仁10克，苏叶梗各10克，荆芥6克，防风6克，苦桔梗10克，生甘草6克，茅芦根各10克，三付
四诊
药后发热即退，身感轻舱。入夜关节仍痛，口腔溃疡又起。感冒之后，余热未清，仍以清化方法：
荆芥6克，伤风6克，前胡6克，淡豆豉10克，炒山栀6克，生地榆10克，丹参10克，茜草10克，茅芦根各10克?丝瓜络10克，桑枝10克，七付
五诊
口腔溃疡已愈，再以疏风通络方法以止其痛。
荆芥6克，防风6克，白芷6克，独活6克，威灵仙10克，秦艽10克，丝瓜络10克，桑枝10免，海风藤10克，络石藤10克，七付
六诊
疼痛渐减，再依前法进退。
荆芥6克，防风6克，独活6克，威灵仙1O克，大豆卷10克，秦艽10克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，炙乳没各2克，七付
药后疼痛基本消失，原方继进七剂，以善其后。
[按]：本案患者以关节疼痛为主证，故辨为痹证，经言“风寒湿三气杂至合而为痹，”其风气盛者为行痹，寒盛为痛痹，湿盛为着痹。虽有如此分辨，但总属外邪入侵，留而来去，痹阻经络，故令疼痛，昕谓不通卿藉是也。今治疗以祛风化湿通络止痛为主。因患者年纪尚尚轻，病程未久。救不必责求肝肾之虚而投补药。治疗中因新感发热，即先疏卫以退其热，热退复治其痹。亦《金匿》所谓“痼疾加以卒病，当先治其卒病，而后治其痼疾”之法也。
痹症3(类风湿性关节炎)
张某，女，z9岁
初诊
病发两年余，双手指关节疼痛，遇寒加甚，近来发现指关节肿胀明显，以食指、中指和无名指关节肿大较甚，略呈梭形，触之疼甚，色暗红，屈曲不利。经查类风湿因子阳性。确诊为类风湿性关节炎。诊脉弦滑而数。舌红苔白略腻。此外受风寒湿邪，留而不去，蕴郁化热，邪阻经络，津液不运，变生痰浊，四末气血不达之所，转为痰浊巢穴，故为肿胀。治以涤痰消肿方法。食忌肥甘，并防寒凉刺激。
大豆卷10克，秦艽10克，戚灵仙10克，苏子10克，莱菔子10克，白芥于6克，冬瓜子10克，皂角子6克，丝瓜络10克，桑枝10克，七付
二诊
药后疼痛有减，肿胀未见明显消退。久病络脉痹阻，非旬日不足以见功。脉仍沉滑，为痰郁之征，继用涤痰通络方法。
苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，天仙藤10克，片姜黄6克，七付
三诊
关节肿胀见消，疼痛大减，脉仍沉滑，舌白苔润。前法进退。
苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，生苡仁30克，丝瓜络10克，桑桂10克，海风藤10克，络石藤10克，天仙藤10克，焦三仙各10克，水红花子10克。
四诊
关节肿痛消之大半，脉象濡软以滑，舌白苔润，继用前法以涤余痰。谨防冷水刺激为要。
苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，生苡仁O克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，焦三仙各10克，七付
[按]：类风湿性关节炎以关节肿大为特征，赵师辨其为痰滞经络，所用五子涤痰汤为其临床治疗类风湿关节炎的基本方。今将赵师从痰论治类风湿性关节炎的独到经验整理附后。
附：赵绍琴从痰辨治粪风漫性关节炎的经验。
类风湿性关节炎属中医痹证范畴。其发病多因素体虚弱，风寒湿热等外邪乘虚侵袭，内客经络骨节，久留不去，痹阻气血而成。吾师赵绍琴教授对本病有独到见解。他认为本病之初，关节尚未肿大，可按一般痹证辨治}若关节肿大疼痛一旦形成，则应从痰论治。凡关节肿大疼痛多属有形之邪留滞其间，痰浊、水饮、瘀血皆其类也。类风湿之关节肿大，或为梭形肿大，如指关节病变；或为程肿凸起一块，如腕踝关节病变，然其并无骨质增生，但有关节腔水肿或软组织增生。况其肿胀可反复发作，其为痰饮甚明。此皆因外邪久留，经络闭阻，致气血津液停滞而为痰为饮。此等痰饮生于经络之中，留于关节之内，徒以健脾燥湿化痰亦不能速去。当治以涤痰通络之法，选用性滑利善走蹿之品，组成开窍通关之猛剂，以涤除骨节问之留痰浊饮。方名五子涤痰汤(自拟)，即三子养亲汤加冬瓜子、皂角子而成。方用苏子10克，白芥子6克，莱菔子10克，冬瓜子10克，皂角子6克(或用皂角代皂角子亦可)。
若病在早期，表现为四肢关节游走性疼痛，关节并无肿胀，或略显微肿，其痛忽作忽止，倏忽往来者，皆是痰饮流注欲作窠穴之象，治宜祛风胜湿通络剂中加入三子养亲汤，以祛除经络中流痰，方用大豆卷10克，秦艽10克，威灵仙10克，丝瓜络10克，桑枝10克，苏子10克，莱菔子10克，白芥子6克。方中白芥子用量虽小，却是重要的引经药，因其性通利透达，善祛皮里膜外之痰，走于经络之中，故为必用之药。
若其病已成，四肢关节肿胀明显，疼痛较剧，触之痛甚。此为痰饮留蓄于骨节间，已成窠穴之势。舌苔白腻水滑，脉象沉细滑或濡滑皆是痰饮深伏之象。此时痰饮聚于骨节，聚成窠穴，难于速去，三子养亲汤已力所不及，可用五子涤痰汤加味。方用苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，海风藤10克，络石藤10克，天仙藤10克，丝瓜络10克，桑枝10克。方中五子合用，善能涤除骨节问痰饮湿浊，合以三藤及桑枝、丝瓜络，更能通利经络，祛风胜湿，mq痰饮不致复留为患。方中皂角一味，至为重要，其味辛辣猛烈，走窜力强，善开窍通关涤痰除垢，与白芥子协力，领诸药直达痰饮窠穴，而奏涤痰消肿之功
若证见关节肿胀迅速增加，疼痛剧烈，手不可近，是痰饮之势猖厥，非峻剂无以遏其势，宜用上方合控涎丹，装胶囊吞服z～3分，服后泻下痰水样便，即收肿消痛止之效。
若证属阳气衰微，寒痰凝滞，漫肿作痛，屈伸不利，六脉沉微，舌淡苔白水滑，面色觥白，形寒畏冷，是阳衰不能温化所致。宜上方合三淡汤，即淡干姜、淡附片、淡吴萸各6克，重者各用10克，以温阳逐饮。
若肾阳不足，虚弱症现，伴见腰膝酸软，神疲乏力，头晕耳鸣，腰以下玲感明显，舌淡胖大，苔白且润，脉沉弱无力者，可于方中加入杜仲10克，川续断10克，补骨脂10克，以补肾壮骨。
病至晚期，症见关节肿大变形，周围肌肉萎缩，屈伸不利，运动受限。此属痰瘀互结，治疗较为棘手。治宜涤痰化瘀并举。上方参入补阳还五汤意，加生黄芪30克，炒地龙10克，再酌用乳香、没药、桃仁、红花、赤芍、当归、川芎、茜草等化瘀之品。或为丸服，以图缓效。
依赵师之经验，从痰辨治类风湿可获良效，但临床上尚需要求病人加强患部功能锻炼和走路运动，避免寒冷刺激，注意清淡饮食等。
淋证1(慢性肾盂肾炎)
郝某，女，43岁，1993年10月1s日初诊。自10年前患“急性肾盂肾炎”，此后一直未彻底治愈，时好时坏，每遇感冒、着凉、饮食不慎、劳累等均能发作。近几年来，发作时各种抗菌素、消炎药等均无效激服中药，开始几次有效果，现已无济于事。前天下午困气候变化又突然发作，尿痛，尿急，尿频，尿赤，同时伴有发冷发热，腰痛乏力，又去医院检查；尿蛋白(+)，尿红细胞10～15个／高倍视野，尿白细胞30～50个／高倍视野，拟诊为“慢性肾盂肾炎急性发作。”又开药氟哌酸之类药品未服，本已失去信心，但又痛苦难忍，求赵老一治。刻下，除泌尿刺激症外，伴见口渴欲饮，心烦急躁，大便偏干，舌红苔黄，脉滑细且数，体温37 6℃。证属湿热蕴郁膀胱，气化不利。治拟先以清化湿热，疏调气机，佐以凉血通淋方法。药用：前胡6克，杏仁10克，浙贝母10克，枇杷叶10克，荆芥炭10克，防风6克，白茅根10克，芦根20克，木通色克，扁蓄10克，冬葵子20克，大黄1克，独活6克，生地榆10克。服药7制，发热未作，尿路症状减轻，余症缓解，仍以前法进退。药用：荆芥炭10克，防风6克，苏叶10克，白芷6克，独活6克，生地榆10克，炒槐花10克，茅芦根各10克，小蓟10克，川楝子6克，冬葵子20克。服药7剂，膀胱刺激症状消失，尿检正常，精神好转，二便正常，唯腰痛酸楚，疲乏无力。改用凉血育阴，益气固肾方法。药用：荆芥炭10克，防风6克，丹参10克，赤芍10克，生地榆10克，炒槐花10克，冬葵子20克，杜仲10克，川断10克，丝瓜络10克，桑枝10克，黄芪10克。服药14剂，精神振作，症状皆除。调整方药以巩固疗效。药用：荆芥炭10克，防风6克，丹参10克，赤芍10克，生地榆10克，旱连草10克，女贞子10克，补骨脂10克，茅芦根各10克，焦三仙各10克，水红花子10克。隔日服1剂，连服4周。半年后追访除因春节时过服辛辣并劳累而轻度反复外未出现大的发作。
[按]：淋症在临床上一般分为气淋、石淋、血淋、膏淋、劳淋等类型，与肺、脾、肾三脏有密切关系。本病案病程10年之久，每因劳累或饮食不慎等抗病能力下降时病可发作，相当中医的劳淋。劳淋是由于五脏受损，遇劳而发的一种淋病。临床表现为病程较长，缠绵难愈，劳倦之后而发等。发作期用清化湿热，凉血通淋方法，但用药时切不可过度寒凉，以防克伐脏气+阻滞气机；也不可因脏气受损，过早滋补，以防气机受阻，闭门留寇之弊。在病情稳定期宜益气固肾，凉血育阴。但始终注意保持气机的通畅与膀胱的气化功能。另外注意饮食调养与功能锻炼。饮食宜清淡，忌宴辣厚腻之品以及寒凉之属；适当加强体育锻炼以增强体质与抗病能力，如走路，爬山，跳舞等；女同志尤期注意经期、妊娠、产后外阴部的卫生，对于防止淋症的发生与复发有重要意义。
痹证1（风湿热）
刘某某，女性，27岁。
初诊
患者为一名矿工家属，两个月前足月顺产一女婴，在产假期间，不慎感受风寒，出现发热、咳嗽、咽痛，数日后痊愈。一周前再次冒受风寒，出现发热和关节疼痛，化验检查显示：血沉40mm/h，抗“O”滴度1:800，西医诊断为风湿热。因患者服用西药后出现烧心胃痛，故请中医诊治。症见身热口渴，但饮水不多，头、胸、腹部有汗而下肢无汗，双膝关节红肿疼痛，触摸时有灼热感，舌苔白而干燥，脉象弦数。此为热痹，治疗应当清热通痹，以白虎加桂枝汤为主方。
生石膏30克，知母10克，粳米15克，生甘草15克，穿山龙15克，三付。
二诊
服药后热退，关节红肿已消，但仍感觉疼痛，继续服用原方五剂。
三诊
所有症状均平复，化验指标正常，停药自行调养，嘱咐其千万预防感冒，否则容易复发。
[按语]：本案属于热痹。热痹是由于风寒湿邪久留不去，郁结而化热，阻滞经络不通，因此以红肿热痛为特征，治疗应当清除郁热并疏通经络。本案使用白虎汤清泄阳明经的热邪，加入穿山龙以通络止痛，疗效迅速。二诊仍用原方续服，虽然诸证消除，但病根未完全拔除，因此嘱咐其小心调摄，预防感冒，否则仍不免复发。
痹证2（干燥综合征）
赵某某，女性，23岁。
初诊
发病半年多，全身关节夜间疼痛，晨起即愈。曾检查发现类风湿因子阳性。口腔溃疡经常发作，此起彼伏，经某医院检查，认为属于干燥综合征。诊脉弦细，重按之沉数，舌红且干，心烦急躁，夜间睡眠多梦。肝胆郁热已久，先用清泄肝胆的方法。
荆芥6克，防风6克，柴胡6克，黄芩6克，川楝子6克，丹参10克，茜草10克，木瓜10克，黄连2克，桑枝10克，丝瓜络10克，七付。
二诊
服药后疼痛略减，心烦稍平，夜梦亦减少，脉仍弦滑数，舌红且干，继续使用前方加减。
荆芥6克，防风6克，柴胡6克，黄芩6克，川楝子6克，丹参10克，茜草10克，木瓜10克，大豆卷10克，秦艽10克，丝瓜络10克，桑枝10克，七付。
三诊
服药后疼痛继续减轻。近日因新感凉邪感冒，午后低烧，体温37.2℃，全身乏力，周身酸痛，胯部和膝关节疼痛加重。咽喉作痒咳嗽。诊脉浮滑且弦，舌红苔白。为新感外邪，先以宣散法退热为主。
淡豆豉10克，炒山栀6克，大豆卷10克，桑枝10克，前胡6克，杏仁10克，苏叶梗各10克，荆芥6克，防风6克，苦桔梗10克，生甘草6克，茅根芦根各10克，三付。
四诊
服药后发热即退，身体感到轻快。入夜关节仍痛，口腔溃疡又起。感冒之后，余热未清，仍以清化方法治疗：
荆芥6克，防风6克，前胡6克，淡豆豉10克，炒山栀6克，生地榆10克，丹参10克，茜草10克，茅根芦根各10克，丝瓜络10克，桑枝10克，七付。
五诊
口腔溃疡已愈，再以疏风通络的方法来止其痛。
荆芥6克，防风6克，白芷6克，独活6克，威灵仙10克，秦艽10克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，七付。
六诊
疼痛逐渐减轻，再依前法加减。
荆芥6克，防风6克，独活6克，威灵仙10克，大豆卷10克，秦艽10克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，炙乳香没药各2克，七付。
服药后疼痛基本消失，原方继进七剂，以善其后。
[按语]：本案患者以关节疼痛为主证，故辨为痹证。经文说“风寒湿三气杂至合而为痹”，风气盛者为行痹，寒盛为痛痹，湿盛为着痹。虽有如此分辨，但总属外邪入侵，留连往来，痹阻经络，故令疼痛，所谓不通则痛是也。如今治疗以祛风化湿通络止痛为主。因为患者年纪尚轻，病程未久，就不必责求肝肾之虚而投补药。治疗中因新感发热，即先疏卫以退其热，热退后再治其痹。这也是《金匮要略》所谓“痼疾加以卒病，当先治其卒病，而后治其痼疾”的方法。
痹证3（类风湿性关节炎）
张某，女性，29岁。
初诊
发病两年多，双手指关节疼痛，遇寒加重，近来发现指关节肿胀明显，以食指、中指和无名指关节肿大较甚，略呈梭形，触之疼痛剧烈，色暗红，屈曲不利。经查类风湿因子阳性。确诊为类风湿性关节炎。诊脉弦滑而数。舌红苔白略腻。此乃外受风寒湿邪，留而不去，蕴郁化热，邪阻经络，津液不运，变生痰浊，四肢末梢气血不达之处，转为痰浊巢穴，故为肿胀。治以涤痰消肿方法。饮食忌肥甘，并防寒凉刺激。
大豆卷10克，秦艽10克，威灵仙10克，苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角子6克，丝瓜络10克，桑枝10克，七付。
二诊
服药后疼痛有减，肿胀未见明显消退。久病络脉痹阻，非旬日不足以见功。脉仍沉滑，为痰郁之征，继用涤痰通络方法。
苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，天仙藤10克，片姜黄6克，七付。
三诊
关节肿胀见消，疼痛大减，脉仍沉滑，舌白苔润。前方加减。
苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，生苡仁30克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，天仙藤10克，焦三仙各10克，水红花子10克。
四诊
关节肿痛消之大半，脉象濡软以滑，舌白苔润，继用前法以涤余痰。谨防冷水刺激为要。
苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，生苡仁30克，丝瓜络10克，桑枝10克，海风藤10克，络石藤10克，焦三仙各10克，七付。
[按语]：类风湿性关节炎以关节肿大为特征，赵师辨其为痰滞经络，所用五子涤痰汤为其临床治疗类风湿关节炎的基本方。现将赵师从痰论治类风湿性关节炎的独到经验整理附后。
附：赵绍琴从痰辨治类风湿性关节炎的经验。
类风湿性关节炎属中医痹证范畴。其发病多因素体虚弱，风寒湿热等外邪乘虚侵袭，内客经络骨节，久留不去，痹阻气血而成。吾师赵绍琴教授对本病有独到见解。他认为本病之初，关节尚未肿大，可按一般痹证辨治；若关节肿大疼痛一旦形成，则应从痰论治。凡关节肿大疼痛多属有形之邪留滞其间，痰浊、水饮、瘀血皆其类也。类风湿之关节肿大，或为梭形肿大，如指关节病变；或为隆肿凸起一块，如腕踝关节病变，然其并无骨质增生，但有关节腔水肿或软组织增生。况其肿胀可反复发作，其为痰饮甚明。此皆因外邪久留，经络闭阻，致气血津液停滞而为痰为饮。此等痰饮生于经络之中，留于关节之内，徒以健脾燥湿化痰亦不能速去。当治以涤痰通络之法，选用性滑利善走窜之品，组成开窍通关之猛剂，以涤除骨节间之留痰浊饮。方名五子涤痰汤（自拟），即三子养亲汤加冬瓜子、皂角子而成。方用苏子10克，白芥子6克，莱菔子10克，冬瓜子10克，皂角子6克（或用皂角代皂角子亦可）。
若病在早期，表现为四肢关节游走性疼痛，关节并无肿胀，或略显微肿，其痛忽作忽止，倏忽往来者，皆是痰饮流注欲作窠穴之象，治宜祛风胜湿通络剂中加入三子养亲汤，以祛除经络中流痰，方用大豆卷10克，秦艽10克，威灵仙10克，丝瓜络10克，桑枝10克，苏子10克，莱菔子10克，白芥子6克。方中白芥子用量虽小，却是重要的引经药，因其性通利透达，善祛皮里膜外之痰，走于经络之中，故为必用之药。
若其病已成，四肢关节肿胀明显，疼痛较剧，触之痛甚。此为痰饮留蓄于骨节间，已成窠穴之势。舌苔白腻水滑，脉象沉细滑或濡滑皆是痰饮深伏之象。此时痰饮聚于骨节，聚成窠穴，难于速去，三子养亲汤已力所不及，可用五子涤痰汤加味。方用苏子10克，莱菔子10克，白芥子6克，冬瓜子10克，皂角6克，海风藤10克，络石藤10克，天仙藤10克，丝瓜络10克，桑枝10克。方中五子合用，善能涤除骨节间痰饮湿浊，合以三藤及桑枝、丝瓜络，更能通利经络，祛风胜湿，使痰饮不致复留为患。方中皂角一味，至为重要，其味辛辣猛烈，走窜力强，善开窍通关涤痰除垢，与白芥子协力，领诸药直达痰饮窠穴，而奏涤痰消肿之功。
若证见关节肿胀迅速增加，疼痛剧烈，手不可近，是痰饮之势猖獗，非峻剂无以遏其势，宜用上方合控涎丹，装胶囊吞服2～3分，服后泻下痰水样便，即收肿消痛止之效。
若证属阳气衰微，寒痰凝滞，漫肿作痛，屈伸不利，六脉沉微，舌淡苔白水滑，面色㿠白，形寒畏冷，是阳衰不能温化所致。宜上方合三淡汤，即淡干姜、淡附片、淡吴萸各6克，重者各用10克，以温阳逐饮。
若肾阳不足，虚弱症现，伴见腰膝酸软，神疲乏力，头晕耳鸣，腰以下冷感明显，舌淡胖大，苔白且润，脉沉弱无力者，可于方中加入杜仲10克，川续断10克，补骨脂10克，以补肾壮骨。
病至晚期，症见关节肿大变形，周围肌肉萎缩，屈伸不利，运动受限。此属痰瘀互结，治疗较为棘手。治宜涤痰化瘀并举。上方参入补阳还五汤意，加生黄芪30克，炒地龙10克，再酌用乳香、没药、桃仁、红花、赤芍、当归、川芎、茜草等化瘀之品。或为丸服，以图缓效。
依赵师之经验，从痰辨治类风湿可获良效，但临床上尚需要求病人加强患部功能锻炼和走路运动，避免寒冷刺激，注意清淡饮食等。
淋证1（慢性肾盂肾炎）
郝某，女性，43岁，1993年10月15日初诊。自10年前患“急性肾盂肾炎”，此后一直未彻底治愈，时好时坏，每遇感冒、着凉、饮食不慎、劳累等均能发作。近几年来，发作时各种抗菌素、消炎药等均无效，改服中药，开始几次有效果，现已无济于事。前天下午因气候变化又突然发作，尿痛，尿急，尿频，尿赤，同时伴有发冷发热，腰痛乏力，又去医院检查：尿蛋白(+)，尿红细胞10～15个／高倍视野，尿白细胞30～50个／高倍视野，拟诊为“慢性肾盂肾炎急性发作。”又开药氟哌酸之类药品未服，本已失去信心，但又痛苦难忍，求赵老一治。刻下，除泌尿刺激症外，伴见口渴欲饮，心烦急躁，大便偏干，舌红苔黄，脉滑细且数，体温37.6℃。证属湿热蕴郁膀胱，气化不利。治拟先以清化湿热，疏调气机，佐以凉血通淋方法。药用：前胡6克，杏仁10克，浙贝母10克，枇杷叶10克，荆芥炭10克，防风6克，白茅根10克，芦根20克，木通6克，扁蓄10克，冬葵子20克，大黄1克，独活6克，生地榆10克。服药7剂，发热未作，尿路症状减轻，余症缓解，仍以前法进退。药用：荆芥炭10克，防风6克，苏叶10克，白芷6克，独活6克，生地榆10克，炒槐花10克，茅芦根各10克，小蓟10克，川楝子6克，冬葵子20克。服药7剂，膀胱刺激症状消失，尿检正常，精神好转，二便正常，唯腰痛酸楚，疲乏无力。改用凉血育阴，益气固肾方法。药用：荆芥炭10克，防风6克，丹参10克，赤芍10克，生地榆10克，炒槐花10克，冬葵子20克，杜仲10克，川断10克，丝瓜络10克，桑枝10克，黄芪10克。服药14剂，精神振作，症状皆除。调整方药以巩固疗效。药用：荆芥炭10克，防风6克，丹参10克，赤芍10克，生地榆10克，旱连草10克，女贞子10克，补骨脂10克，茅芦根各10克，焦三仙各10克，水红花子10克。隔日服1剂，连服4周。半年后追访除因春节时过服辛辣并劳累而轻度反复外未出现大的发作。
[按语]：淋症在临床上一般分为气淋、石淋、血淋、膏淋、劳淋等类型，与肺、脾、肾三脏有密切关系。本病案病程10年之久，每因劳累或饮食不慎等抗病能力下降时病可发作，相当中医的劳淋。劳淋是由于五脏受损，遇劳而发的一种淋病。临床表现为病程较长，缠绵难愈，劳倦之后而发等。发作期用清化湿热，凉血通淋方法，但用药时切不可过度寒凉，以防克伐脏气，阻滞气机；也不可因脏气受损，过早滋补，以防气机受阻，闭门留寇之弊。在病情稳定期宜益气固肾，凉血育阴。但始终注意保持气机的通畅与膀胱的气化功能。另外注意饮食调养与功能锻炼。饮食宜清淡，忌辛辣厚腻之品以及寒凉之属；适当加强体育锻炼以增强体质与抗病能力，如走路，爬山，跳舞等；女同志尤其注意经期、妊娠、产后外阴部的卫生，对于防止淋症的发生与复发有重要意义。
Bi Syndrome 1 (Rheumatic Fever)
Liu XX, female, 27 years old.
First Visit
The patient is the wife of a miner. Two months ago, she gave birth to a baby girl at full term via normal delivery. During her maternity leave, she inadvertently contracted wind-cold, presenting with fever, cough, and sore throat, which resolved after a few days. One week ago, she was exposed to wind-cold again, resulting in fever and joint pain. Laboratory tests showed an erythrocyte sedimentation rate (ESR) of 40 mm/h and an antistreptolysin O (ASO) titer of 1:800. Western medicine diagnosed rheumatic fever. Because the patient experienced heartburn and stomach pain after taking Western medicines, she sought traditional Chinese medicine (TCM) treatment. Symptoms included body heat and thirst, but with little desire to drink; sweating on the head, chest, and abdomen but no sweating on the lower limbs; redness, swelling, and pain in both knee joints with a burning sensation upon palpation; white and dry tongue coating; and wiry and rapid pulse. This is Re Bi (Heat Bi), and the treatment should focus on clearing heat and unblocking the bi syndrome, using Baihu Jia Guizhi Tang (White Tiger plus Cinnamon Twig Decoction) as the main formula.
Sheng Shigao (Raw Gypsum Fibrosum) 30g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Jing Mi (Oryzae Fructus Glutinosa) 15g, Sheng Gancao (Glycyrrhizae Radix et Rhizoma Preparatum) 15g, Chuanshanlong (Dioscorea Nipponicae Rhizoma) 15g, 3 doses.
Second Visit
After taking the medicine, the fever subsided, and the redness and swelling of the joints disappeared, but pain persisted. Continue with the original prescription for five doses.
Third Visit
All symptoms have resolved, and laboratory results are normal. Stop medication and rest at home. She is advised to strictly prevent colds, otherwise recurrence is likely.
[Commentary]: This case belongs to Re Bi (Heat Bi). Re Bi occurs when wind-cold-damp pathogenic factors linger for a long time, stagnate, transform into heat, and block the meridians, characterized by redness, swelling, heat, and pain. The treatment should clear the stagnant heat and unblock the meridians. In this case, Baihu Tang (White Tiger Decoction) was used to clear heat from the Yangming channel, and Chuanshanlong was added to unblock the meridians and relieve pain, yielding rapid results. In the second visit, the original prescription was continued. Although symptoms were eliminated, the root cause was not fully eradicated; therefore, careful recuperation and prevention of colds were advised to avoid recurrence.
Bi Syndrome 2 (Sjögren's Syndrome)
Zhao XX, female, 23 years old.
First Visit
The illness has lasted for over half a year. Pain in all joints occurs at night and resolves upon waking in the morning. Rheumatoid factor testing was positive. Oral ulcers occur frequently, one after another. Examination at a certain hospital suggested Sjögren's syndrome. The pulse is wiry and fine, deep and rapid upon heavy pressure; the tongue is red and dry; there is mental restlessness and irritability; and sleep is disturbed with many dreams. Liver and gallbladder qi stagnation has transformed into heat for a long time. The initial treatment focuses on clearing and draining liver and gallbladder heat.
Jingjie (Schizonepetae Spica) 6g, Fangfeng (Saposhnikoviae Radix) 6g, Chaihu (Bupleuri Radix) 6g, Huangqin (Scutellariae Radix) 6g, Chuan Lianzi (Toosendan Fructus) 6g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 10g, Qiancao (Rubiae Radix et Rhizoma) 10g, Mugua (Chaenomelis Fructus) 10g, Huanglian (Coptidis Rhizoma) 2g, Sangzhi (Mori Ramulus) 10g, Sigualuo (Luffae Fructus Retinervus) 10g, 7 doses.
Second Visit
After medication, pain decreased slightly, mental restlessness subsided somewhat, and night dreams became less frequent. The pulse remains wiry, slippery, and rapid; the tongue is red and dry. Continue with the previous method, adjusting as necessary.
Jingjie 6g, Fangfeng 6g, Chaihu 6g, Huangqin 6g, Chuan Lianzi 6g, Danshen 10g, Qiancao 10g, Mugua 10g, Dadoujuan (Sojae Semen Praeparatum) 10g, Qinjiao (Gentianae Macrophyllae Radix) 10g, Sigualuo 10g, Sangzhi 10g, 7 doses.
Third Visit
Pain continues to decrease. Recently, due to a new exposure to cool pathogens causing a cold, there is low-grade fever in the afternoon, temperature 37.2°C, general fatigue, body aches, and aggravated pain in the hip and knee joints. Itchy throat and cough. The pulse is floating, slippery, and wiry; the tongue is red with a white coating. This is a new external pathogenic invasion. The priority is to use dispersing methods to reduce fever.
Dan Douchi (Sojae Semen Preparatum) 10g, Chao Shanzhi (Gardeniae Fructus Preparatus) 6g, Dadoujuan 10g, Sangzhi 10g, Qianhu (Peucedani Radix) 6g, Xingren (Armeniacae Semen Amarum) 10g, Zi Su Ye and Zi Su Geng (Perillae Folium et Caulis) 10g each, Jingjie 6g, Fangfeng 6g, Ku Jiegeng (Platycodonis Radix) 10g, Sheng Gancao 6g, Bai Mao Gen and Lu Gen (Imperatae Rhizoma et Phragmitis Rhizoma) 10g each, 3 doses.
Fourth Visit
Fever subsided immediately after medication, and the body feels lighter. Joint pain persists at night, and oral ulcers have reappeared. After the cold, residual heat remains unclear. Treatment continues with clearing and transforming methods:
Jingjie 6g, Fangfeng 6g, Qianhu 6g, Dan Douchi 10g, Chao Shanzhi 6g, Sheng Diyu (Sanguisorbae Radix) 10g, Danshen 10g, Qiancao 10g, Bai Mao Gen and Lu Gen 10g each, Sigualuo 10g, Sangzhi 10g, 7 doses.
Fifth Visit
Oral ulcers have healed. Use wind-dispersing and meridian-unblocking methods to stop pain.
Jingjie 6g, Fangfeng 6g, Baizhi (Angelicae Dahuricae Radix) 6g, Duhuo (Angelicae Pubescentis Radix) 6g, Weilingxian (Syneilesidis Rhizoma) 10g, Qinjiao 10g, Sigualuo 10g, Sangzhi 10g, Haifengteng (Sinomenii Caulis) 10g, Luoshiteng (Trachelospermi Caulis) 10g, 7 doses.
Sixth Visit
Pain gradually decreases. Adjust according to the previous method.
Jingjie 6g, Fangfeng 6g, Duhuo 6g, Weilingxian 10g, Dadoujuan 10g, Qinjiao 10g, Sigualuo 10g, Sangzhi 10g, Haifengteng 10g, Luoshiteng 10g, Zhi Ruxiang and Mozhe (Boswelliae Resina et Myrrha) 2g each, 7 doses.
After medication, pain basically disappears. Continue the original prescription for seven more doses to conclude treatment.
[Commentary]: The main symptom of this case is joint pain, so it is differentiated as Bi Syndrome. The classic text states, "Wind, cold, and dampness combine to form Bi." When wind predominates, it is called Xing Bi (Wandering Bi); when cold predominates, Tong Bi (Painful Bi); when dampness predominates, Zhuo Bi (Fixed Bi). Despite these distinctions, it always involves external pathogens invading and lingering, blocking the meridians, causing pain—what is known as "pain due to obstruction." Current treatment focuses on dispelling wind, eliminating dampness, unblocking meridians, and relieving pain. Since the patient is young and the disease course is short, there is no need to seek deficiency of liver and kidney or administer tonics. During treatment, when a new fever occurred due to external contraction, the exterior was first dispersed to reduce fever, and only after the fever subsided was the Bi treated. This follows the principle in *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet): "When a chronic disease is complicated by an acute disease, treat the acute disease first, then the chronic disease."
Bi Syndrome 3 (Rheumatoid Arthritis)
Zhang XX, female, 29 years old.
First Visit
The illness has lasted for over two years. Pain in the finger joints of both hands worsens with cold. Recently, significant swelling of the finger joints has been noticed, particularly in the index, middle, and ring fingers, appearing slightly spindle-shaped. Palpation causes severe pain, color is dark red, and flexion is difficult. Rheumatoid factor testing was positive. Diagnosed as Rheumatoid Arthritis. The pulse is wiry, slippery, and rapid. The tongue is red with a slightly greasy white coating. This is caused by external contraction of wind-cold-damp pathogens that linger and transform into heat, blocking the meridians. Fluid metabolism is impaired, generating phlegm turbidity. Areas where qi and blood do not reach well become nests for phlegm turbidity, leading to swelling. Treatment focuses on purging phlegm and reducing swelling. Diet should avoid rich and sweet foods, and protection from cold stimulation is required.
Dadoujuan 10g, Qinjiao 10g, Weilingxian 10g, Suzi (Perillae Fructus) 10g, Laifuzi (Radish Seed) 10g, Baijiezi (Mustard Seed) 6g, Dongguazi (Winter Melon Seed) 10g, Zaojiaozi (Gleditsiae Sinensis Spina) 6g, Sigualuo 10g, Sangzhi 10g, 7 doses.
Second Visit
Pain decreased after medication, but swelling did not significantly subside. Long-standing disease blocks collateral vessels; ten days are insufficient for visible results. The pulse remains deep and slippery, indicating phlegm stagnation. Continue with phlegm-purging and meridian-unblocking methods.
Suzi 10g, Laifuzi 10g, Baijiezi 6g, Dongguazi 10g, Zaocys (Zaojiao) 6g, Sigualuo 10g, Sangzhi 10g, Haifengteng 10g, Luoshiteng 10g, Tianxianteng (Akebiae Caulis) 10g, Pian Jianghuang (Curcumae Radix) 6g, 7 doses.
Third Visit
Joint swelling has decreased, and pain has greatly reduced. The pulse remains deep and slippery; the tongue has a white, moist coating. Adjust the previous prescription.
Suzi 10g, Laifuzi 10g, Baijiezi 6g, Dongguazi 10g, Zaocys 6g, Sheng Yiren (Coicis Semen) 30g, Sigualuo 10g, Sangzhi 10g, Haifengteng 10g, Luoshiteng 10g, Tianxianteng 10g, Jiao Sanxian (Prepared Hawthorn, Medicated Leaven, and Immature Bitter Orange) 10g each, Shuihonghua Zi (Alternantherae Philoxeroides Fructus) 10g.
Fourth Visit
Joint swelling and pain have largely subsided. The pulse is soft, slippery, and weak; the tongue has a white, moist coating. Continue the previous method to purge residual phlegm. Avoid cold water stimulation.
Suzi 10g, Laifuzi 10g, Baijiezi 6g, Dongguazi 10g, Zaocys 6g, Sheng Yiren 30g, Sigualuo 10g, Sangzhi 10g, Haifengteng 10g, Luoshiteng 10g, Jiao Sanxian 10g each, 7 doses.
[Commentary]: Rheumatoid arthritis is characterized by joint swelling. Master Zhao differentiates it as phlegm stagnation in the meridians. Wuzi Ditang Tang (Five-Seed Phlegm-Purging Decoction) is his basic clinical formula for treating rheumatoid arthritis. Below is a summary of Master Zhao's unique experience in treating rheumatoid arthritis from the perspective of phlegm.
Attachment: Master Zhao Shaoqin's Experience in Differentiating and Treating Rheumatoid Arthritis from Phlegm.
Rheumatoid arthritis belongs to the category of Bi Syndrome in TCM. Its onset is often due to underlying weakness, allowing external pathogens like wind, cold, damp, and heat to invade vacuously, entering the meridians and bones/joints, lingering for a long time, and blocking qi and blood. Professor Zhao Shaoqin has unique insights into this disease. He believes that in the early stage, before joint swelling, it can be treated as general Bi Syndrome. However, once joint swelling and pain form, treatment must focus on phlegm. Joint swelling and pain usually involve tangible pathogens lingering within, such as phlegm turbidity, fluid retention, and blood stasis. Rheumatoid joint swelling may be spindle-shaped (as in finger joints) or protruding lumps (as in wrist/ankle joints), without bone hyperplasia, but with joint cavity edema or soft tissue hyperplasia. Since swelling recurs frequently, it is clearly fluid/phlegm retention. This is due to long-term pathogen retention blocking meridians, causing qi, blood, and fluids to stagnate and transform into phlegm and fluid. These phlegm/fluids arise in the meridians and lodge in the joints. Simply strengthening the spleen and drying dampness to resolve phlegm cannot quickly eliminate them. Treatment should use phlegm-purging and meridian-unblocking methods, selecting slippery and penetrating herbs to form potent formulas that open orifices and unblock passages, purging retained phlegm and fluids from the joints. The formula is named Wuzi Ditang Tang (self-formulated), consisting of Sansheng Yangqin Tang plus Dongguazi and Zaojiaozi. Formula uses Suzi 10g, Baijiezi 6g, Laifuzi 10g, Dongguazi 10g, Zaojiaozi 6g (or Zaocys instead of Zaojiaozi).
If the disease is in the early stage, manifesting as wandering pain in limb joints without swelling or with slight swelling, where pain comes and goes suddenly, this indicates phlegm/fluid flowing and preparing to form nests. Treatment should add Sansheng Yangqin Tang to wind-dispersing and damp-resolving meridian-unblocking agents to remove flowing phlegm from meridians. Formula: Dadoujuan 10g, Qinjiao 10g, Weilingxian 10g, Sigualuo 10g, Sangzhi 10g, Suzi 10g, Laifuzi 10g, Baijiezi 6g. Although the dose of Baijiezi is small, it is an important guiding herb because its nature is penetrating and reaching, good at removing phlegm between skin and fascia, traveling through meridians, making it essential.
If the disease has progressed, with obvious swelling and severe pain in limb joints, touching causes intense pain. This indicates phlegm/fluid accumulating in the joints, forming nest-like structures. Tongue coating is white, greasy, and slippery; pulse is deep, fine, slippery, or soft and slippery, all signs of deeply lodged phlegm/fluid. At this point, phlegm/fluid gathers in joints, forming nests, difficult to remove quickly. Sansheng Yangqin Tang is insufficient; Wuzi Ditang Tang with modifications can be used. Formula: Suzi 10g, Laifuzi 10g, Baijiezi 6g, Dongguazi 10g, Zaocys 6g, Haifengteng 10g, Luoshiteng 10g, Tianxianteng 10g, Sigualuo 10g, Sangzhi 10g. The five seeds combined effectively purge phlegm/fluid/damp turbidity from joints. Combined with the three vines, Sangzhi, and Sigualuo, they further unblock meridians, dispel wind, overcome dampness, and prevent phlegm/fluid from re-accumulating. Zaocys is crucial; its pungent and spicy nature has strong penetrating power, good at opening orifices, unblocking passages, purging phlegm, and removing filth. Cooperating with Baijiezi, it leads other herbs directly to the phlegm/fluid nests, achieving phlegm-purging and swelling-reducing effects.
If joint swelling increases rapidly, pain is severe, and touch is unbearable, the phlegm/fluid pathogen is rampant. Only potent drugs can curb it. Use the above formula combined with Kongxian Dan (Control Saliva Pill), encapsulated and taken orally, 2-3 fen. After ingestion, passing watery stool resembling phlegm/fluid achieves swelling reduction and pain cessation.
If the syndrome belongs to yang qi decline and cold-phlegm stagnation, with diffuse swelling and pain, limited flexion/extension, deep and faint pulse all around, pale tongue with white slippery coating, pale complexion, aversion to cold, it is caused by yang decline failing to warm and transform. Combine the above formula with Sandan Tang (Three Mild Decoction): mild dried ginger, mild prepared aconite, and mild evodia fruit, each 6g (10g for severe cases), to warm yang and expel fluid.
If kidney yang is insufficient, with weakness symptoms including soreness/weakness of waist/knees, mental fatigue, dizziness/tinnitus, obvious cold sensation below the waist, pale and enlarged tongue with white moist coating, and deep weak pulse, add Duzhong 10g, Chuanxuduan 10g, Buguzhi 10g to tonify kidney and strengthen bones.
In the late stage, symptoms include deformed swollen joints, surrounding muscle atrophy, limited flexion/extension, and restricted movement. This belongs to phlegm-stasis mutual knotting, making treatment tricky. Treatment should purge phlegm and resolve stasis simultaneously. Incorporate the intent of Buyang Huanwu Tang into the above formula, adding Sheng Huangqi 30g, Chao Dilong 10g, and酌情 using Ruxiang, Mozhe, Taoren, Honghua, Chishao, Danggui, Chuanxiong, Qiancao, etc., for resolving stasis. Or make pills for slow effect.
According to Master Zhao's experience, differentiating and treating rheumatoid arthritis from phlegm yields good results. However, clinically, patients are required to strengthen functional exercise and walking in affected areas, avoid cold stimulation, and pay attention to light diet.
Lin Syndrome 1 (Chronic Pyelonephritis)
Hao XX, female, 43 years old, First Visit on October 15, 1993. Ten years ago, she suffered from "acute pyelonephritis," which was never completely cured. It fluctuated, recurring with colds, chilling, improper diet, or fatigue. In recent years, antibiotics and anti-inflammatory drugs were ineffective during attacks. TCM herbal medicine was initially effective but now useless. The day before yesterday afternoon, due to climate change, it suddenly recurred with dysuria, urgency, frequency, and hematuria, accompanied by chills, fever, backache, and fatigue. Hospital examination showed: urine protein (+), RBC 10-15/high power field, WBC 30-50/high power field. Provisional diagnosis: "Acute exacerbation of chronic pyelonephritis." Prescribed Norfloxacin but did not take it. Having lost confidence but suffering unbearable pain, she sought treatment from Master Zhao. Currently, besides urinary irritation symptoms, there is thirst with desire to drink, mental restlessness and irritability, dry stools, red tongue with yellow coating, slippery-fine-rapid pulse, and temperature 37.6°C. The syndrome is damp-heat accumulating in the bladder with impaired qi transformation. Treatment plans to first clear and transform damp-heat, regulate qi mechanism, assisted by cooling blood and promoting urination. Medicines: Qianhu 6g, Xingren 10g, Zhe Beimu (Fritillariae Thunbergii Bulbus) 10g, Pipaye (Loquat Leaf) 10g, Jingjie Tan (Charred Schizonepetae Spica) 10g, Fangfeng 6g, Bai Maogen (Imperatae Rhizoma) 10g, Lugan 20g, Mutong (Akebiae Caulis) 6g, Bianxu (Polygoni Avicularis Herba) 10g, Dongkuizi (Malvae Semen) 20g, Dahuang (Rhei Radix et Rhizoma) 1g, Duhuo 6g, Sheng Diyu 10g. After 7 doses, fever did not recur, urinary symptoms decreased, other symptoms relieved. Continue with previous method adjustments. Medicines: Jingjie Tan 10g, Fangfeng 6g, Zi Su Ye 10g, Baizhi 6g, Duhuo 6g, Sheng Diyu 10g, Chao Huaihua (Sophorae Flos Preparatus) 10g, Bai Mao Gen and Lu Gen 10g each, Xiaoji (Cirsii Herba) 10g, Chuan Lianzi 6g, Dongkuizi 20g. After 7 doses, bladder irritation symptoms disappeared, urine test normal, spirit improved, bowel/bladder functions normal, except for sore waist and fatigue. Change to cooling blood and nourishing yin, benefiting qi and consolidating kidney. Medicines: Jingjie Tan 10g, Fangfeng 6g, Danshen 10g, Chishao (Paeoniae Radix Rubra) 10g, Sheng Diyu 10g, Chao Huaihua 10g, Dongkuizi 20g, Duzhong 10g, Chuan Duan (Dipsaci Radix) 10g, Sigualuo 10g, Sangzhi 10g, Huangqi (Astragali Radix) 10g. After 14 doses, spirit invigorated, symptoms eliminated. Adjust formula to consolidate efficacy. Medicines: Jingjie Tan 10g, Fangfeng 6g, Danshen 10g, Chishao 10g, Sheng Diyu 10g, Hanliancao (Ecliptae Herba) 10g, Nvzhenzi (Ligustri Lucidi Fructus) 10g, Buguzhi 10g, Bai Mao Gen and Lu Gen 10g each, Jiao Sanxian 10g each, Shuihonghua Zi 10g. Take one dose every other day for 4 weeks. Follow-up six months later showed no major attacks, except for mild recurrence due to excessive spicy food and fatigue during Spring Festival.
[Commentary]: Lin Syndrome is generally classified clinically into Qi Lin, Shi Lin, Xue Lin, Gao Lin, and Lao Lin, closely related to the Lung, Spleen, and Kidney. This case has a 10-year history, recurring when resistance drops due to fatigue or improper diet, corresponding to Lao Lin (Fatigue Lin) in TCM. Lao Lin is a type of Lin syndrome caused by damage to the five zang organs, triggered by fatigue. Clinical manifestations include long duration, stubbornness, and onset after exhaustion. During the attack phase, use clearing-transforming damp-heat and cooling-blood-promoting urination methods. However, avoid excessive cold-natured herbs to prevent damaging organ qi and blocking qi mechanism; also avoid premature tonification due to organ damage to prevent blocking qi mechanism and "locking the thief inside." In the stable phase, benefit qi and consolidate kidney, cool blood and nourish yin. Always maintain smooth qi mechanism and bladder qi transformation function. Additionally, pay attention to dietary regulation and functional exercise. Diet should be light, avoiding spicy, rich, and cold items; appropriately strengthen physical exercise to enhance constitution and resistance, such as walking, hiking, dancing; women especially should pay attention to hygiene of the vulva during menstruation, pregnancy, and postpartum, which is significant for preventing occurrence and recurrence of Lin Syndrome.