例一怀X，30余岁。初次所下之痢，赤白参半，继则纯下亦痢，继则变为腥臭，血水夹杂脂膜，或如烂炙，时时腹中切痛，心中烦躁，不能饮食。其脉弦而微数，一呼吸约五至重按有力，知其……内热，其热下移肠中，酿为痢疾。调治失宜，痢久不愈，肠中脂膜为痢所侵，变为溃疡性而下注。……当用治疮治痢之药，合并治之，以清热解毒，化瘀生肌。金银花30克生白芍18克粉甘草9克旱三七9克(细末)鸦胆子60粒(去皮，拣成实者)。共药五味，先将三七、鸦胆子，用白糖水各送服一半，即将余三味煎汤服。当日煎渣再服，亦先服所余三七及鸦胆子(此方载《衷中参西录》名解毒生化丹)。如法服药1剂，腹疼即止，脉亦缓和，所便已见粪色，次数亦减。继投以通变白头翁汤，服2剂痊愈。(《重印全国名医验案类编》张锡纯医案)
例二XX，60余岁。患痢疾，便下脓血，呕恶频作，不食数日，神识模糊，奄奄一息，弥留床上巳二日余。延先君诊治，认为症系湿热交阻，逆冲胃口，以致噤口不食，毒邪炽盛，导致神志昏迷。乃处以双炭饮方。金银花炭6克熟军炭2．4克板蓝根15克赤芍9克白术6克鸡内金9克黄芩6克连翘6克陈皮3克(朱小南c朱南山先生的医学成就，《上海中医药杂志》8：25，1962)
例三魏X，患暑温，继转赤痢，住院两月不愈。点滴坠痛，日五、六十行。中气败坏，食不得下，频频干呕，舌绛津涸，入暮仍感热潮，精神颇觉恍惚，奄奄一息。……脉沉细而数，既坚搏，又弱涩。……内伏之邪甚炽，外之余邪未净，固当权衡轻重，里急治里，寓清外于清里之中，勿使合邪内并，而以除热者救阴，坚阴者扶正。……拟方：白头翁9克青蒿梗4．5克薄荷梗1．5克黄连、苦参各4．5克厚朴6克广木香3克炒地榆9克白芍18克甘草3克服药一周平平，似效不效，惟皮肤微似汗，暮热不作。原方去青蒿，薄荷，白头翁加为12克，并加马齿苋12克，续服一周，坠痛锐减，痢减三分之一。前方加知母，瓜蒌相各9克，再服一周，痢减三分之二，脓血赤胨渐少，食思潮佳。前方去苦参，白芍改为12克，加归身12克、生苡仁18克，又服一周，痢止，病已向愈，惟倦怠乏力，不能久坐步履，前方去马齿苋，减芩连用量之半，守服10剂，精神食欲迭加，病渐愈。(《冉雪峰医案》)[评按]痢疾是以腹痛、里急后重、利下赤白脓血为特征的夏秋季常见病之一。临床分为湿热痢，疫毒痢、虚寒痢，休息痢等。严重时可形成噤口痢。
例一证情逐渐加重，以致泄下血水夹杂脂膜或如烂炙。张氏认为系因肠中脂膜为痢所侵，变为溃疡性而下注。瘀热生毒、肠中溃烂，治必化腐生肌，以救肠中之腐烂，本方药少力专，重用银花清热解毒，芍药、甘草缓急止痛，独特之处在于鸦胆子与野三七之用。他认为；“东西医治痢之药，其解毒清血之力，远不如鸭胆子，其防腐生肌之力，远不如野三七。且于挟虚之痢，而不知辅以山药、人参，于挟热之痢而不知重用石膏，宜其视赤痢为至险之症，而治之恒多不收全功也”。实属经验之谈，值得借鉴。
例二为噤口痢。朱氏认为疫痢为湿热毒邪蕴滞于肠所致。毒肆于下，则腹痛，下痢脓血，热蒸于上，则口渴烦躁，噤口呕吐。他自拟双炭饮，其中金银花炭、熟军炭，既入血分清解血中毒热，又不失“痢无补法”之意。并认为用本方治疗重笃危症效果良好，值得推荐。
例三赤痢迁延日久，中气败坏，奄奄一息。正气虽衰而内伏之邪热尚炽，外受余邪未尽，孰能闭门留寇，固当权衡轻重，里急治里，寓清外于清里之中，勿使合邪内并，除热以救阴，坚阴以扶正，病情虽已奄奄而药当通神。
(三十三)便秘
例一刘X，女，33岁。三焦蓄水，大肠结闭，形冷颇甚，腹胀而鼓，大便燥秘，小溲少，脉滑而数，当导滞利水。鲜芦根30克清宁片3克(开水泡兑)杏仁泥9克旋复花9克(包煎)生赭石9克清半夏9克嫩桑枝24克广陈皮4．5克肥知母9克大腹绒4．5克川朴花4。5克莱菔子12克元明粉2．1克(冲入)苏合香丸一粒(和入)复诊：前方连服三剂，二便俱行，形冷，腹胀均减，然食纳仍少，四肢困顿，脉弦数，右关大，再加味治之。原方加川椒目1．5克，佛手片4．5克，茵陈6克，川郁金(生白矾水浸)9克，忍冬藤12克，去元明粉、莱菔子，嘱服4齐L三诊：症象逐渐消失，精神颇健，谷化亦佳，脉六位均滑，症甫向愈之际，宜肃清湿邪。炒秫米(包煎)9克猪苓9克桑上寄生24克炒薏米(包煎)9克广木香(煨)2．1克滑石块(生)12克福泽泻9克旋复花(包煎)9克川牛膝12克生知柏各9克合欢花9克稀签草9克6剂。(孔嗣伯整理；孔伯华医案，《中医杂志》8；547，1958)
例二李X，男，19岁。于3月间发生天花，其形颇顺，饮食如常，但大便二十天未解，皮肤结痂未实，始而神志尚清，突于午后烦躁不宁，胸中气满，腹中作胀，夜卧不安，肢肿臂溃，脉难以取。观其虽在壮年，疮未结痂，胃腑结热，又系症实。实症宜攻，攻则气脱。再四思维，拟兼顾并筹之法，庶望两全。方用补中益气汤以护其中而升其气，大承气汤荡涤热邪，以下其滞，一方两法，分煎合服。方用:黄芪6克党参4．5克白术4．5克陈皮3克升麻1．5克柴胡1．5克炙草1．5克当归4．5克(另煎合服)大黄1．5克枳实2．1克厚朴3克芒硝1．5克(另煎合服)药后便通热退，而痂亦结，1剂而愈。(赵绍琴整理：韩一斋先生学术经验简介，《中医杂志》9；35，1962)
例三高，女。平素有习惯性便秘，此番六日未大便。大凡暴秘可泻，久秘不可泻。泻药只能取快于一时，停药则其秘如故。面色不华，脉软，用药以振奋肠机能。方药：全当归、杭白芍、生麦芽各12克生白术、薤白头、生鸡金各9克广木香6克半硫丸9克(分三次吞)炙草3克二诊：服上方无效，予千金温脾饮，方药：党参、熟大黄、元明粉(分冲)各9克干姜，炙草各3克熟附块(先煎)6克当归12克服后三小时见效。(朱良春整理；章次公先生生平及其学术思想简介，《新医药学杂志》10；14，1978)[评按]便秘系指以大便秘结不通，排便时间延长，或大便艰涩不畅为主的证候。多因燥热内结、气滞不行，气虚传送无力，血虚肠道干涩，以及阴寒凝结所致。本证虽属大肠传导功能失常，但与脾肾功能密切相关。在治疗上热秘宜清热润肠，气秘则顺气行滞，气血虚者，益气血而润肠，冷秘则温通开秘。然而，在临床上绝非如此单纯，往往是虚实夹杂、寒热相兼不易分辨，须予斟酌处理。如
例一，大肠结闭与三焦蓄水并见，形冷腹胀，大便燥结，小溲亦少，二便皆病，故应导滞利水兼顾，药后方能二便俱行，为了彻底治愈，孔氏在症甫向愈之际，肃清湿邪以求治本。
例二属于气虚与热结虚实夹杂。实证宜清热通下，虚证宜补，若欲双全，则应补中益气与荡涤结热同时并举，通下为要，寓泻于补，下而不伤正气，掌握了补益通下之妙。然而两方另煎合服，治法颇奇。
例三证属冷积便秘，初用健脾温通之剂，力微势弱无济于事，继以千金温脾汤，温阳通下攻逐冷积，始克奏效。
(三十四)黄疸
例一胡XX，男，31岁。入院日期：1962年6月10日。因急性黄疸型传染性肝炎(暴发型)入院，(6月12日)除西药治疗外，并邀中医会诊。面目遍身发黄，如橘子色，狂躁不宁，喜怒骂无常，齿衄，口渴引饮，且欲呕恶，纳呆，大便已3日未解，小溲黄赤，舌苔黄燥，质红绛，脉弦滑而数。辨证：湿热炽盛，肝胆郁结，腑气不通，营液灼耗，心神被扰。病起一周，证属急黄。治法：清热通腑，凉血解毒。方药：生大黄、黑山栀各12克黄柏、枳壳、郁金各9克菖蒲6克鲜生地24克茵陈30克鲜白茅根30克，先煎汤、去滓取汁代水，放入上述各药浓熬，服2剂。6月14日(二诊)，大便解过三次，色焦黄，神智略定，黄疸未见加深，呕恶已止，小便黄赤，舌苔略润，质仍红绛，脉象弦滑，前方去菖蒲加血余炭，地榆炭，2剂。6月16日(三诊):神志转清，黄疸亦见减轻，但仍懊侬，苔转黄腻，质尚红，脉象弦滑，再以清热养阴疏肝利胆。方用：生大黄6克黑山栀12克郁金，黄柏、麦冬，鸡内金各9克枳壳6克川石斛12克茵陈30克半枝莲30克先煎沸，去滓取汁代水，放入其他药再熬，服4剂。6月20日(四诊)：煎方略有加减继服。6月25日(五诊)，症状继续好转，湿热虽轻，气营未复，肝郁未舒，再以疏肝利胆，清热化湿，方用，黄柏9克黑山栀12克郁金6克茜草15克茯苓9克生地12克糯稻根30克茵陈18克夜交藤12克制香附9克再服5剂。6月30日：前方去夜交藤加太子参继服七剂。7月10日：复查肝功能已近正常，黄疸基本消退，自觉症状消失，继以疏肝利胆，益气生津之剂，用当归9克，生白芍12克，黑山栀12克，茜草16克，郁金9克，太子参18克，茵陈15克，生地12克，麦冬9克，杞子12克，鸡内金9克，加减继服20余剂，肝功能恢复正常而出院。(潘澄濂：传染性肝炎辨证和治疗的体会，《新医药杂志》1，11，1978)
例二石XX，男，24岁。因食欲减退，恶心呕吐，饮食厌油腻，小便黄亦，眼巩膜皮肤黄染，住XX院。检查；肝大肋下1厘米，质软有压痛及叩痛。脾未扪及，腹部呈鼓音，肠鸣音稍亢进。……黄疸指数70单位，谷丙转氨酶710单位，白蛋白4．13克％，球蛋白2．32克％，小便检查；三胆阳性，蛋白微量。超声波检查：肝区较密微小波型，轻度腹水。诊断为病毒性肝炎。给大量葡萄糖、维生素丙、激素、三磷酸腺甙，胰岛素、血浆、茵陈蒿汤等静滴，内服肝太乐，复方维生素B七天，除黄疸稍减退外，其余症状未见明显改善。……会诊后，逐渐停服激素和西药。症见右胁作痛，腹胀低热，头晕失眠，四肢乏力，口渴欲饮，舌质嫩红，薄白，稍干，右脉虚，躁动无力，而左脉带弦。辨证：脾虚肝郁，肝阴亏损。治法；健脾舒肝，养阴活血。方药；四君子汤合四乌贼骨——芦茹丸加味。茜根12克海螵蛸9克当归须9克炙甘草9克白芍12克橘络2．5克云苓12克白术12克党参12克葱须一撮，清水煎服，日服1剂，连服11剂。再诊；面色明净，食欲好转，右胁不胀，仍有低热，失眠多梦，自汗盗汗，头晕肢软，舌质淡红，脉比前稍好转。超声波检查腹水消失，仍用前法。方药；党参12克白术12克云苓18克炙甘草6克白芍12克首乌12克肉苁蓉9克茜根12克糯稻根15克浮小麦15克橘络1．5克清水煎服，连服17剂三诊：仍有低热，手颤，腹部微胀，口渴欲饮，脉细数带涩，舌质暗红带紫，苔微黄薄，此为肝郁脾滞，胃肠湿热，治以通络活血，化湿清热。方药；茜根24克橘络3克赤小豆30克海螵蛸12克内金9克春砂仁9克，(后下)大腹皮9克土茵陈30克泽泻12克葱须一撮清水煎服。每天1剂，共服26天。药后精神食欲良好，复查肝功能：黄疸指数4单位，谷丙转氨酶40单位，白蛋白4．15克％，球蛋白1．75克％。病已治愈，出院追踪二年半未见复发。(刘赤选主治，刘亦选整理：痰证与胁痹，《新中医》3，17，1979)
例三孙XX，男，三个月，初诊日期；1971年11月18日。患儿出生半月后，皮肤及巩膜开始发黄，大便色白，溲黄，一周来吐奶。1971年11月1日血查黄疸指数79单位，总胆红质6．82毫克％，直接胆红质6．6毫克％，凡登白氏试验，直接迅速反应，谷丙转氨酶150单位，麝浊3单位。诊为：粘液性(不全)阻塞性黄疸。治以利胆清热化湿，连服12剂，黄疸虽未加重，但也未见消退。1971年11月l…8日转诊，症见一身发黄，吐奶，溲黄。指纹深紫，舌苔白。辨证：湿热中阻，瘀热发黄。治法：清热利胆，芳化活血。方药：茵陈6克郁金3克酒芩6克土茯苓6克藿香3克杏仁3．5克橘红3克赤芍6克藕节6克泽兰6克车前子6克治疗经过：以上方为主，间断服药30剂，1972年4月?日复查：谷丙转氨酶193单位，总胆红质小于0．3毫克％，黄疸指数4单位。黄疸全部退净，食睡二便正常。1972年6月复查谷丙转氨酶正常。(《关幼波临床经验选》)，
【背景信息】
书名：近现代名医验案类编 章节：正文(21/53) 类别：医论
【待处理原文】
案例一：患者怀某，三十多岁。初次患痢疾时，大便中赤白脓血各半；随后变为纯下脓血痢；接着粪便变得腥臭，夹杂血液、水液和脂膜，有的像烂肉一样，时常腹部剧烈疼痛，心中烦躁，无法进食。其脉象弦而微数，一呼一吸间脉搏跳动约五次，重按有力，可知……体内有热，热邪下行移入肠道，酿成痢疾。因调理治疗不当，痢疾日久不愈，肠中的脂膜被痢疾邪气侵袭，转变为溃疡性病变而下注。……应当使用治疗疮疡和治疗痢疾的药物合并施治，以清热解毒，化瘀生肌。金银花30克，生白芍18克，粉甘草9克，旱三七9克（研成细末），鸦胆子60粒（去皮，挑选成熟的）。共五味药，先将三七和鸦胆子用白糖水各送服一半，然后将剩余三味药煎汤服用。当天将药渣再煎一次服用，也是先服用剩余的三七及鸦胆子（此方记载于《衷中参西录》，名为解毒生化丹）。按照这种方法服药一剂后，腹痛立即停止，脉象也变得缓和，所排大便已见粪色，次数也减少。继而又投予通变白头翁汤，服用两剂后痊愈。（出自《重印全国名医验案类编》张锡纯医案）
案例二：患者某某，六十多岁。患有痢疾，大便排出脓血，频繁呕吐恶心，几天不能进食，神志模糊，气息微弱，在床上弥留已两天多。请先父诊治，认为症状属于湿热交结阻滞，逆冲胃口，导致噤口痢（指痢疾患者饮食不进者）不能进食，毒邪炽盛，导致神志昏迷。于是处以双炭饮方。金银花炭6克，熟军炭2.4克，板蓝根15克，赤芍9克，白术6克，鸡内金9克，黄芩6克，连翘6克，陈皮3克（引自朱小南《朱南山先生的医学成就》，载于《上海中医药杂志》8:25，1962年）
案例三：魏某，患暑温病，随后转为赤痢，住院两个月未愈。肛门有坠胀疼痛感，每天排便五六十次。中气败坏，食物无法咽下，频频干呕，舌质深红津液枯竭，傍晚仍感觉潮热，精神恍惚，气息微弱。……脉象沉细而数，既坚实搏动，又虚弱涩滞。……体内潜伏的邪气非常炽盛，体表的残余邪气尚未清除，固然应当权衡轻重，里急重症优先治里，在清里的同时寓含清表之意，防止内外邪气合并在体内，通过除热来救阴，通过坚阴来扶正。……拟定方剂：白头翁9克，青蒿梗4.5克，薄荷梗1.5克，黄连、苦参各4.5克，厚朴6克，广木香3克，炒地榆9克，白芍18克，甘草3克。服药一周效果平平，似有效又似无效，只有皮肤微微出汗，傍晚的热势不再发作。原方去掉青蒿、薄荷，白头翁加量至12克，并加入马齿苋12克，继续服用一周，坠痛明显减轻，痢疾减少三分之一。前方加入知母、瓜蒌皮各9克，再服用一周，痢疾减少三分之二，脓血赤冻逐渐减少，食欲开始好转。前方去掉苦参，白芍改为12克，加入当归身12克、生薏苡仁18克，又服用一周，痢疾停止，病情趋向痊愈，只是倦怠乏力，不能久坐行走，前方去掉马齿苋，减少黄芩、黄连用量的一半，守方服用十剂，精神和食欲日益增加，病情逐渐痊愈。（出自《冉雪峰医案》）[评按]痢疾是以腹痛、里急后重、利下赤白脓血为特征的夏秋季常见病之一。临床分为湿热痢、疫毒痢、虚寒痢、休息痢等。严重时可形成噤口痢。
案例一的证情逐渐加重，以致泄下血水夹杂脂膜或如烂肉。张氏认为这是因为肠中脂膜被痢疾邪气侵袭，转变为溃疡性而下注。瘀热生毒、肠中溃烂，治疗必须化腐生肌，以拯救肠中的腐烂，本方药味少而力专，重用银花清热解毒，芍药、甘草缓急止痛，独特之处在于鸦胆子与野三七的使用。他认为：“西医治疗痢疾的药物，其解毒清血之力，远不如鸭胆子，其防腐生肌之力，远不如野三七。况且对于挟虚的痢疾，不知道辅以山药、人参，对于挟热的痢疾不知道重用石膏，难怪他们视赤痢为最危险的病症，而治疗往往难以取得完全成功。”这实属经验之谈，值得借鉴。
案例二为噤口痢。朱氏认为疫痢是由于湿热毒邪蕴滞于肠道所致。毒邪肆虐于下，则腹痛，下痢脓血；热邪蒸腾于上，则口渴烦躁，噤口呕吐。他自拟双炭饮，其中金银花炭、熟军炭，既能入血分清解血中毒热，又不失“痢无补法”的意思。并认为用本方治疗重笃危症效果良好，值得推荐。
案例三赤痢迁延日久，中气败坏，气息微弱。正气虽然衰弱但体内潜伏的邪热依然炽盛，体表受余邪未尽，谁能闭门留寇呢？固然应当权衡轻重，里急治里，在清里的同时寓含清表之意，防止内外邪气合并在体内，除热以救阴，坚阴以扶正，病情虽然已经奄奄一息但药物应当能通达神明。
(三十三)便秘
案例一：刘某，女，33岁。三焦蓄水，大肠结闭，身体寒冷很厉害，腹胀如鼓，大便干燥秘结，小便量少，脉滑而数，应当导滞利水。鲜芦根30克，清宁片3克（开水泡兑），杏仁泥9克，旋复花9克（包煎），生赭石9克，清半夏9克，嫩桑枝24克，广陈皮4.5克，肥知母9克，大腹绒4.5克，川朴花4.5克，莱菔子12克，元明粉2.1克（冲入），苏合香丸一粒（和入）。复诊：前方连续服用三剂，大小便均通畅，形冷、腹胀均减轻，然而食欲仍然很少，四肢困顿，脉弦数，右关脉大，再加味治疗。原方加川椒目1.5克，佛手片4.5克，茵陈6克，川郁金（用生白矾水浸泡）9克，忍冬藤12克，去掉元明粉、莱菔子，嘱咐服用四剂。三诊：症状逐渐消失，精神颇好，谷物消化也好，六部脉均滑，症状刚刚向愈之际，宜肃清湿邪。炒秫米（包煎）9克，猪苓9克，桑上寄生24克，炒薏米（包煎）9克，广木香（煨）2.1克，滑石块（生）12克，福泽泻9克，旋复花（包煎）9克，川牛膝12克，生知母、黄柏各9克，合欢花9克，豨签草9克，六剂。（孔嗣伯整理；孔伯华医案，《中医杂志》8:547，1958年）
案例二：李某，男，19岁。在三月份发生天花，病情形态颇为顺利，饮食如常，但大便二十天未解，皮肤结痂未实，起初神志尚清醒，突然在午后烦躁不宁，胸中气满，腹中作胀，夜卧不安，肢体肿胀手臂溃烂，脉象难以触及。观察其虽在壮年，疮未结痂，胃腑结热，又是实证。实证宜攻，攻则可能导致气脱。反复思考，拟定兼顾并筹的方法，希望两全其美。方用补中益气汤以护其中气而升提其气，大承气汤荡涤热邪，以下行其积滞，一方两法，分煎合服。方用：黄芪6克，党参4.5克，白术4.5克，陈皮3克，升麻1.5克，柴胡1.5克，炙甘草1.5克，当归4.5克（另煎合服），大黄1.5克，枳实2.1克，厚朴3克，芒硝1.5克（另煎合服）。药后大便通畅热退，而痂亦结，一剂而愈。（赵绍琴整理：韩一斋先生学术经验简介，《中医杂志》9:35，1962年）
案例三：高某，女。平素有习惯性便秘，此番六日未大便。大凡暴发性便秘可泻，久发性便秘不可泻。泻药只能取快于一时，停药则其秘如故。面色不华，脉软，用药以振奋肠机能。方药：全当归、杭白芍、生麦芽各12克，生白术、薤白头、生鸡内金各9克，广木香6克，半硫丸9克（分三次吞服），炙甘草3克。二诊：服用上方无效，给予千金温脾饮，方药：党参、熟大黄、元明粉（分冲）各9克，干姜、炙甘草各3克，熟附块（先煎）6克，当归12克。服用后三小时见效。（朱良春整理；章次公先生生平及其学术思想简介，《新医药学杂志》10:14，1978年）[评按]便秘系指以大便秘结不通，排便时间延长，或大便艰涩不畅为主的证候。多因燥热内结、气滞不行，气虚传送无力，血虚肠道干涩，以及阴寒凝结所致。本证虽属大肠传导功能失常，但与脾肾功能密切相关。在治疗上热秘宜清热润肠，气秘则顺气行滞，气血虚者，益气血而润肠，冷秘则温通开秘。然而，在临床上绝非如此单纯，往往是虚实夹杂、寒热相兼不易分辨，须予斟酌处理。如
案例一，大肠结闭与三焦蓄水并见，形冷腹胀，大便燥结，小便亦少，二便皆病，故应导滞利水兼顾，药后方能二便俱行，为了彻底治愈，孔氏在症状刚刚向愈之际，肃清湿邪以求治本。
案例二属于气虚与热结虚实夹杂。实证宜清热通下，虚证宜补，若欲双全，则应补中益气与荡涤结热同时并举，通下为要，寓泻于补，下而不伤正气，掌握了补益通下之妙。然而两方另煎合服，治法颇奇。
案例三证属冷积便秘，初用健脾温通之剂，力微势弱无济于事，继以千金温脾汤，温阳通下攻逐冷积，始克奏效。
(三十四)黄疸
案例一：胡某某，男，31岁。入院日期：1962年6月10日。因急性黄疸型传染性肝炎（暴发型）入院，（6月12日）除西药治疗外，并邀中医会诊。面目遍身发黄，如橘子色，狂躁不宁，喜怒骂无常，齿衄，口渴引饮，且欲呕恶，纳呆，大便已3日未解，小便黄赤，舌苔黄燥，质红绛，脉弦滑而数。辨证：湿热炽盛，肝胆郁结，腑气不通，营液灼耗，心神被扰。病起一周，证属急黄。治法：清热通腑，凉血解毒。方药：生大黄、黑山栀各12克，黄柏、枳壳、郁金各9克，菖蒲6克，鲜生地24克，茵陈30克，鲜白茅根30克，先煎汤、去滓取汁代水，放入上述各药浓熬，服2剂。6月14日（二诊），大便解过三次，色焦黄，神智略定，黄疸未见加深，呕恶已止，小便黄赤，舌苔略润，质仍红绛，脉象弦滑，前方去菖蒲加血余炭，地榆炭，2剂。6月16日（三诊）：神志转清，黄疸亦见减轻，但仍懊侬，苔转黄腻，质尚红，脉象弦滑，再以清热养阴疏肝利胆。方用：生大黄6克，黑山栀12克，郁金、黄柏、麦冬、鸡内金各9克，枳壳6克，川石斛12克，茵陈30克，半枝莲30克，先煎沸，去滓取汁代水，放入其他药再熬，服4剂。6月20日（四诊）：煎方略有加减继服。6月25日（五诊），症状继续好转，湿热虽轻，气营未复，肝郁未舒，再以疏肝利胆，清热化湿，方用：黄柏9克，黑山栀12克，郁金6克，茜草15克，茯苓9克，生地12克，糯稻根30克，茵陈18克，夜交藤12克制香附9克，再服5剂。6月30日：前方去夜交藤加太子参继服七剂。7月10日：复查肝功能已近正常，黄疸基本消退，自觉症状消失，继以疏肝利胆，益气生津之剂，用当归9克，生白芍12克，黑山栀12克，茜草16克，郁金9克，太子参18克，茵陈15克，生地12克，麦冬9克，杞子12克，鸡内金9克，加减继服20余剂，肝功能恢复正常而出院。（潘澄濂：传染性肝炎辨证和治疗的体会，《新医药杂志》1,11,1978年）
案例二：石某某，男，24岁。因食欲减退，恶心呕吐，饮食厌油腻，小便黄赤，眼巩膜皮肤黄染，住某某院。检查：肝大肋下1厘米，质软有压痛及叩痛。脾未扪及，腹部呈鼓音，肠鸣音稍亢进。……黄疸指数70单位，谷丙转氨酶710单位，白蛋白4.13克%，球蛋白2.32克%，小便检查：三胆阳性，蛋白微量。超声波检查：肝区较密微小波型，轻度腹水。诊断为病毒性肝炎。给大量葡萄糖、维生素丙、激素、三磷酸腺甙，胰岛素、血浆、茵陈蒿汤等静滴，内服肝太乐，复方维生素B七天，除黄疸稍减退外，其余症状未见明显改善。……会诊后，逐渐停服激素和西药。症见右胁作痛，腹胀低热，头晕失眠，四肢乏力，口渴欲饮，舌质嫩红，薄白，稍干，右脉虚，躁动无力，而左脉带弦。辨证：脾虚肝郁，肝阴亏损。治法：健脾舒肝，养阴活血。方药：四君子汤合四乌贼骨——芦茹丸加味。茜根12克，海螵蛸9克，当归须9克，炙甘草9克，白芍12克，橘络2.5克，云苓12克，白术12克，党参12克，葱须一撮，清水煎服，日服1剂，连服11剂。再诊：面色明净，食欲好转，右胁不胀，仍有低热，失眠多梦，自汗盗汗，头晕肢软，舌质淡红，脉比前稍好转。超声波检查腹水消失，仍用前法。方药：党参12克，白术12克，云苓18克，炙甘草6克，白芍12克，首乌12克，肉苁蓉9克，茜根12克，糯稻根15克，浮小麦15克，橘络1.5克，清水煎服，连服17剂。三诊：仍有低热，手颤，腹部微胀，口渴欲饮，脉细数带涩，舌质暗红带紫，苔微黄薄，此为肝郁脾滞，胃肠湿热，治以通络活血，化湿清热。方药：茜根24克，橘络3克，赤小豆30克，海螵蛸12克，内金9克，春砂仁9克，（后下）大腹皮9克，土茵陈30克，泽泻12克，葱须一撮，清水煎服。每天1剂，共服26天。药后精神食欲良好，复查肝功能：黄疸指数4单位，谷丙转氨酶40单位，白蛋白4.15克%，球蛋白1.75克%。病已治愈，出院追踪二年半未见复发。（刘赤选主治，刘亦选整理：痰证与胁痹，《新中医》3,17,1979年）
案例三：孙某某，男，三个月，初诊日期：1971年11月18日。患儿出生半月后，皮肤及巩膜开始发黄，大便色白，溲黄，一周来吐奶。1971年11月1日血查黄疸指数79单位，总胆红质6.82毫克%，直接胆红质6.6毫克%，凡登白氏试验，直接迅速反应，谷丙转氨酶150单位，麝浊3单位。诊为：粘液性（不全）阻塞性黄疸。治以利胆清热化湿，连服12剂，黄疸虽未加重，但也未见消退。1971年11月18日转诊，症见一身发黄，吐奶，溲黄。指纹深紫，舌苔白。辨证：湿热中阻，瘀热发黄。治法：清热利胆，芳化活血。方药：茵陈6克，郁金3克，酒芩6克，土茯苓6克，藿香3克，杏仁3.5克，橘红3克，赤芍6克，藕节6克，泽兰6克，车前子6克。治疗经过：以上方为主，间断服药30剂，1972年4月?日复查：谷丙转氨酶193单位，总胆红质小于0.3毫克%，黄疸指数4单位。黄疸全部退净，食睡二便正常。1972年6月复查谷丙转氨酶正常。（《关幼波临床经验选》）
Background Information
Book Title: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (21/53)
Category: Medical Discussion
Case 1: Patient Huai, over 30 years old. The initial dysentery presented with equal parts red blood and white pus in the stool; subsequently, it progressed to pure pus and blood discharge; then the stool became foul-smelling, mixed with blood, water, and mucosal membranes, resembling rotting meat at times. There was frequent severe abdominal pain, mental restlessness, and inability to eat. The pulse was wiry and slightly rapid, beating approximately five times per breath, and forceful upon deep pressure, indicating... internal heat. This heat shifted downward into the intestines, brewing into dysentery. Due to improper regulation and treatment, the dysentery persisted for a long time without healing. The intestinal mucosa was invaded by the dysentery pathogen, transforming into an ulcerative lesion that discharged downward... Medications for treating sores and dysentery should be combined to clear heat and detoxify, resolve stasis, and generate flesh. *Jinyinhua* (Honeysuckle Flower) 30g, *Sheng Baishao* (Raw White Peony Root) 18g, *Fen Gancao* (Powdered Licorice Root) 9g, *Han Sanqi* (Wild Notoginseng) 9g (finely powdered), *Yadanzi* (Brucea Fruit) 60 pills (peeled, selecting mature ones). These five herbs are taken together: first, half of the *Sanqi* and *Yadanzi* are taken separately with sugar water, while the remaining three herbs are decocted in water and drunk. On the same day, the dregs are decocted again for another dose, also taking the remaining *Sanqi* and *Yadanzi* first (this formula is recorded in *Zhongzhong Canxi Lu* under the name Jiedu Shenghua Dan). Following this method, after one dose, abdominal pain stopped immediately, the pulse became relaxed, the stool showed fecal color, and the frequency decreased. Subsequently, Tongbian Baitouweng Tang was administered for two doses, resulting in a cure. (From *Chongyin Quanguo Mingyi Anlei Bian*, Zhang Xichun's Medical Cases)
Case 2: Patient XX, over 60 years old. Suffering from dysentery with pus and blood in the stool, frequent vomiting and nausea, unable to eat for several days, confused consciousness, and barely breathing, lingering on the bed for over two days. My late father diagnosed the condition as damp-heat interlocking and obstructing, counter-flowing to the stomach, causing Jin Kou Li (Dysentery with Inability to Eat), where toxic pathogens were flourishing, leading to coma. He prescribed Shuang Tan Yin. *Jinyinhua Tan* (Charred Honeysuckle Flower) 6g, *Shu Jun Tan* (Charred Prepared Rhubarb) 2.4g, *Banlangen* (Isatis Root) 15g, *Chishao* (Red Peony Root) 9g, *Baizhu* (Atractylodes Macrocephala Rhizome) 6g, *Jineijin* (Chicken Gizzard Lining) 9g, *Huangqin* (Scutellaria Root) 6g, *Lianqiao* (Forsythia Fruit) 6g, *Chenpi* (Tangerine Peel) 3g (Cited from Zhu Xiaonan's "Medical Achievements of Mr. Zhu Nanshan", *Shanghai Journal of Traditional Chinese Medicine* 8:25, 1962).
Case 3: Wei, suffering from Summer-Warmth disease, which later transformed into red dysentery. Hospitalized for two months without recovery. There was tenesmus and pain, defecating 50-60 times daily. Middle Qi was devastated, food could not be swallowed, frequent dry retching, tongue was crimson with depleted fluids, feeling tidal fever in the evening, spirit was恍惚 (trance-like), and breath was faint... The pulse was deep, fine, and rapid, both firm and pulsating yet weak and choppy... Internal latent pathogens were extremely vigorous, while residual external pathogens were not yet cleared. It is necessary to weigh the severity, prioritize treating the interior when there is urgent interior syndrome, incorporate clearing the exterior within clearing the interior, prevent combined pathogens from merging internally, eliminate heat to save Yin, and strengthen Yin to support Zheng Qi... Proposed prescription: *Baitouweng* (Pulsatilla Root) 9g, *Qinghao Geng* (Green Wormwood Stem) 4.5g, *Bohe Geng* (Mint Stem) 1.5g, *Huanglian* (Coptis Rhizome) and *Kushen* (Sophora Root) 4.5g each, *Houpo* (Magnolia Bark) 6g, *Guang Muxiang* (Vladimiria Root) 3g, *Chao Diyü* (Stir-fried Sanguisorba Root) 9g, *Baishao* (White Peony Root) 18g, *Gancao* (Licorice Root) 3g. After one week of medication, effects were mediocre, seemingly effective yet ineffective, only slight sweating on the skin, and no evening fever. Original formula minus *Qinghao* and *Bohe*, increase *Baitouweng* to 12g, add *Machixian* (Purslane) 12g, continue for one week. Tenesmus reduced sharply, dysentery reduced by one-third. Add *Zhimu* (Anemarrhena Rhizome) and *Gualou Pi* (Trichosanthes Peel) 9g each to the previous formula, take for another week. Dysentery reduced by two-thirds, pus and blood decreased gradually, appetite began to improve. Remove *Kushen* from the previous formula, change *Baishao* to 12g, add *Guishen* (Angelica Sinensis Root Body) 12g, *Sheng Yiren* (Raw Coix Seed) 18g, take for another week. Dysentery stopped, condition trending towards recovery, but fatigue and weakness remained, unable to sit or walk for long. Remove *Machixian* from the previous formula, reduce dosage of *Huangqin* and *Huanglian* by half, continue for ten doses. Spirit and appetite increased successively, condition gradually healed. (From *Ran Xuefeng Medical Cases*) [Commentary] Dysentery is a common summer and autumn disease characterized by abdominal pain, tenesmus, and passage of red and white pus and blood. Clinically divided into Damp-Heat Dysentery, Epidemic Toxin Dysentery, Deficiency-Cold Dysentery, and Intermittent Dysentery. Severe cases can form Jin Kou Li (Dysentery with Inability to Eat).
In Case 1, the condition worsened progressively, leading to bloody watery stools mixed with mucosal membranes or resembling rotting meat. Mr. Zhang believed this was due to the intestinal mucosa being invaded by dysentery pathogens, transforming into an ulcerative discharge. Stasis-heat generating toxins and intestinal ulceration require treatment to transform putrefaction and generate flesh to save the rotting intestine. This formula has few ingredients but strong efficacy, heavily using *Yinhua* (Honeysuckle) to clear heat and detoxify, *Shaoyao* and *Gancao* to relieve urgency and pain. Its uniqueness lies in the use of *Yadanzi* and wild *Sanqi*. He stated: "Western medicines for dysentery have far less power to detoxify and clear blood than *Yadanzi*, and far less power to preserve tissue and generate flesh than wild *Sanqi*. Moreover, for dysentery with deficiency, they do not know to assist with *Shanyao* and *Renshen*; for dysentery with heat, they do not know to heavily use *Shigao*. No wonder they view red dysentery as a critical danger and often fail to achieve complete cures." This is indeed experiential wisdom worth learning.
Case 2 is Jin Kou Li. Mr. Zhu believed that epidemic dysentery is caused by damp-heat toxin pathogens stagnating in the intestines. Toxicity raging below causes abdominal pain and pus/blood dysentery; heat steaming above causes thirst, irritability, and vomiting preventing eating. He self-prescribed Shuang Tan Yin. *Jinyinhua Tan* and *Shu Jun Tan* enter the blood level to clear toxic heat in the blood, while maintaining the principle that "there is no tonification method for dysentery." He believes this formula is effective for severe critical cases and is recommended.
Case 3 involves chronic red dysentery, devastation of middle Qi, and faint breath. Although Zheng Qi is weak, internal latent heat pathogens are still vigorous, and residual external pathogens are not fully cleared. One cannot simply close the door and leave the thief inside. It is necessary to weigh severity, treat the interior urgently, incorporate clearing the exterior within clearing the interior, prevent combined pathogens from merging internally, eliminate heat to save Yin, and strengthen Yin to support Zheng Qi. Although the condition is critical, the medicine should be able to communicate with the spirit.
(Thirty-three) Constipation
Case 1: Liu, female, 33 years old. Water accumulation in the Triple Burner, large intestine obstruction, severe cold sensation, distended abdomen like a drum, dry constipation, scanty urine, slippery and rapid pulse. Treatment should guide out stagnation and promote urination. *Xian Lugen* (Fresh Reed Rhizome) 30g, *Qingning Pian* (Prepared Rhubarb Tablets) 3g (dissolved in boiling water), *Xingren Ni* (Apricot Kernel Paste) 9g, *Xuanfuhua* (Inula Flower) 9g (wrapped for decoction), *Sheng Zhesi* (Raw Hematite) 9g, *Qing Banxia* (Clear Pinellia Tuber) 9g, *Nen Sangzhi* (Young Mulberry Twig) 24g, *Guang Chenpi* (Broad-leaved Tangerine Peel) 4.5g, *Fei Zhimu* (Large Anemarrhena Rhizome) 9g, *Da Fu Rong* (Areca Pericarp) 4.5g, *Chuan Puhua* (Magnolia Flower Bud) 4.5g, *Laifuzi* (Radish Seed) 12g, *Yuanming Fen* (Mirabilite) 2.1g (mixed in), *Suhe Xiang Wan* (Styrax Pill) 1 pill (mixed in). Follow-up visit: After three doses of the previous formula, both bowel movements and urination were smooth, cold sensation and abdominal distension decreased, but appetite remained low, limbs were heavy, pulse was wiry and rapid, right Guan position was large. Add modifications to treat. Original formula plus *Chuan Jiaomu* (Sichuan Pepper Seed) 1.5g, *Foshou Pian* (Buddha's Hand Slice) 4.5g, *Yinchen* (Artemisia Capillaris) 6g, *Chuan Yujin* (Curcuma Aromatica Rhizome soaked in alum water) 9g, *Rendongteng* (Honeysuckle Vine) 12g, remove *Yuanming Fen* and *Laifuzi*, instructed to take four doses. Third visit: Symptoms gradually disappeared, spirit was good, digestion was excellent, all six pulse positions were slippery. As symptoms were just resolving, it is appropriate to肃清 (cleanse) damp pathogens. *Chao Shumi* (Stir-fried Glutinous Millet) 9g (wrapped), *Zhuling* (Polyporus) 9g, *Sangshang Jisheng* (Mulberry Mistletoe) 24g, *Chao Yimi* (Stir-fried Coix Seed) 9g (wrapped), *Guang Muxiang* (Stir-baked Vladimiria Root) 2.1g, *Huashi Kuai* (Raw Talcum Stone) 12g, *Fu Zexie* (Alisma Rhizome) 9g, *Xuanfuhua* (Wrapped) 9g, *Chuan Niuxi* (Achyranthes Root) 12g, *Sheng Zhi Mu* and *Huang Bai* (Phellodendron Bark) 9g each, *Hehuan Hua* (Silk Tree Flower) 9g, *Xixian Cao* (Siegesbeckia Herb) 9g, six doses. (Organized by Kong Sibai; Kong Bohua Medical Cases, *Chinese Journal of Traditional Chinese Medicine* 8:547, 1958)
Case 2: Li, male, 19 years old. Developed smallpox in March, condition appeared smooth, diet normal, but no bowel movement for twenty days, skin scabs not solidified. Initially conscious, suddenly restless in the afternoon, chest fullness, abdominal distension, sleepless at night, limb swelling, arm ulcers, pulse difficult to palpate. Although young, scabs not formed, stomach fu organ has accumulated heat, and it is an excess syndrome. Excess syndromes should be purged, but purging may cause Qi collapse. After much thought, a method combining supplementation and purging was devised to achieve both goals. Use Buzhong Yiqi Tang to protect middle Qi and lift Qi, Dachengqi Tang to sweep away heat pathogens and purge stagnation. One formula, two methods, decocted separately and mixed before administration. Formula: *Huangqi* (Astragalus Root) 6g, *Dangshen* (Codonopsis Root) 4.5g, *Baizhu* (Atractylodes Rhizome) 4.5g, *Chenpi* (Tangerine Peel) 3g, *Shengma* (Cimicifuga Rhizome) 1.5g, *Chaihu* (Bupleurum Root) 1.5g, *Zhi Gancao* (Honey-fried Licorice) 1.5g, *Danggui* (Angelica Sinensis Root) 4.5g (decocted separately and mixed), *Dahuang* (Rhubarb Root) 1.5g, *Zhishi* (Immature Bitter Orange) 2.1g, *Houpo* (Magnolia Bark) 3g, *Mangxiao* (Mirabilite) 1.5g (decocted separately and mixed). After medication, bowels moved, heat subsided, scabs formed, cured in one dose. (Organized by Zhao Shaoqin: Introduction to Academic Experience of Mr. Han Yizhai, *Chinese Journal of Traditional Chinese Medicine* 9:35, 1962)
Case 3: Gao, female. Habitually constipated, no bowel movement for six days this time. Generally, acute constipation can be purged, but chronic constipation should not be purged. Purgatives only provide temporary relief; upon stopping, constipation returns. Complexion is dull, pulse is soft. Medication aims to stimulate intestinal function. Formula: *Quandanggui* (Whole Angelica Root), *Hang Baishao* (Hangzhou White Peony Root), *Sheng Maiya* (Raw Sprouted Barley) 12g each, *Sheng Baizhu* (Raw Atractylodes Rhizome), *Xie Beitou* (Allium Macrostemon Bulb), *Sheng Jijin* (Raw Chicken Gizzard Lining) 9g each, *Guang Muxiang* (Vladimiria Root) 6g, *Banshou Wan* (Half-Sulfur Pill) 9g (taken in three doses), *Zhi Gancao* (Honey-fried Licorice) 3g. Second visit: Previous formula ineffective. Prescribed Qianjin Wenyin Tang. Formula: *Dangshen* (Codonopsis Root), *Shu Dahuang* (Prepared Rhubarb Root), *Yuanming Fen* (Mirabilite, mixed separately) 9g each, *Ganjiang* (Dried Ginger), *Zhi Gancao* (Honey-fried Licorice) 3g each, *Shu Fukuai* (Prepared Aconite Chunk, decocted first) 6g, *Danggui* (Angelica Root) 12g. Effective after three hours. (Organized by Zhu Liangchun: Introduction to Life and Academic Thoughts of Mr. Zhang Cigong, *New Medicine Magazine* 10:14, 1978) [Commentary] Constipation refers to a syndrome characterized by hard, dry stools, prolonged intervals between bowel movements, or difficulty passing stools. It is mostly caused by internal dryness-heat accumulation, Qi stagnation, insufficient Qi transmission, Blood deficiency causing dry intestines, and Yin-cold coagulation. Although this syndrome belongs to dysfunction of large intestine conduction, it is closely related to Spleen and Kidney functions. In treatment, Heat Constipation requires clearing heat and moistening intestines, Qi Constipation requires regulating Qi and moving stagnation, Qi-Blood deficiency requires tonifying Qi and Blood and moistening intestines, Cold Constipation requires warming and unblocking. However, clinically it is rarely simple, often involving mixed deficiency and excess, cold and heat, requiring careful handling. For example,
Case 1 shows large intestine obstruction concurrent with Triple Burner water accumulation, cold sensation, abdominal distension, dry stool, and scanty urine. Both excretions are diseased, so guiding stagnation and promoting urination must be addressed simultaneously. Only then did both excretions flow smoothly. To achieve a complete cure, Mr. Kong cleansed damp pathogens as symptoms resolved to address the root.
Case 2 involves mixed deficiency (Qi deficiency) and excess (Heat accumulation). Excess requires clearing heat and purging, deficiency requires tonification. To achieve both, tonifying middle Qi and sweeping accumulated heat must proceed simultaneously, with purging as the key, incorporating purging within tonification, purging without damaging Zheng Qi, mastering the subtleties of tonification and purging. However, decocting the two formulas separately and mixing them is a peculiar method.
Case 3 is Cold Accumulation Constipation. Initial use of Spleen-tonifying and warming-unblocking agents was too weak to be effective. Subsequently, Qianjin Wenyin Tang was used to warm Yang, unblock, and purge cold accumulation, finally achieving efficacy.
(Thirty-four) Jaundice
Case 1: Hu XX, male, 31 years old. Admission date: June 10, 1962. Admitted for acute icteric infectious hepatitis (fulminant type). On June 12, besides Western medicine treatment, a TCM consultation was invited. Face, eyes, and whole body yellow like orange peel, manic restlessness, unpredictable mood swings, gingival bleeding, thirst with desire to drink, nausea, poor appetite, no bowel movement for 3 days, dark yellow urine, yellow dry coating on tongue, crimson tongue body, wiry-slippery-rapid pulse. Syndrome differentiation: Vigorous damp-heat, Liver-Gallbladder Qi stagnation, Fu organ Qi blockage, Ying fluid consumption, Heart spirit disturbance. Disease onset one week ago, syndrome belongs to Ji Huang (Acute Jaundice). Treatment method: Clear heat and unblock Fu organs, cool blood and detoxify. Prescription: *Sheng Dahuang* (Raw Rhubarb Root), *Hei Shanzhi* (Black Gardenia Fruit) 12g each, *Huangbai* (Phellodendron Bark), *Zhiqiao* (Bitter Orange Peel), *Yujin* (Curcuma Rhizome) 9g each, *Changpu* (Acorus Rhizome) 6g, *Xian Shengdi* (Fresh Rehmannia Root) 24g, *Yinchen* (Artemisia Capillaris) 30g, *Xian Baimaogen* (Fresh Imperata Rhizome) 30g. Decoct first, remove dregs, use juice as water base, add other herbs and boil concentratedly, take 2 doses. June 14 (Second Visit): Bowel movement passed three times, dark yellow color, spirit slightly stabilized, jaundice did not deepen, vomiting stopped, urine dark yellow, tongue coating slightly moist, tongue body still crimson, pulse wiry-slippery. Remove *Changpu* from previous formula, add *Xuyutan* (Hair Charcoal), *Diyutan* (Sanguisorba Charcoal), 2 doses. June 16 (Third Visit): Spirit cleared, jaundice reduced, but still feels stifled, coating turns yellow-greasy, tongue body still red, pulse wiry-slippery. Further treatment: Clear heat, nourish Yin, soothe Liver, benefit Gallbladder. Formula: *Sheng Dahuang* 6g, *Hei Shanzhi* 12g, *Yujin*, *Huangbai*, *Maidong* (Ophiopogon Tuber), *Jineijin* (Chicken Gizzard Lining) 9g each, *Zhiqiao* 6g, *Chuan Shihu* (Dendrobium Stem) 12g, *Yinchen* 30g, *Banzhilian* (Scutellaria Barbata Herb) 30g. Boil first, remove dregs, use juice as water base, add other herbs and boil, take 4 doses. June 20 (Fourth Visit): Formula slightly modified, continued. June 25 (Fifth Visit): Symptoms continued to improve, damp-heat light, Qi-Ying not recovered, Liver Qi stagnant. Further treatment: Soothe Liver, benefit Gallbladder, clear heat, transform dampness. Formula: *Huangbai* 9g, *Hei Shanzhi* 12g, *Yujin* 6g, *Qiancao* (Madder Root) 15g, *Fuling* (Poria) 9g, *Shengdi* (Rehmannia Root) 12g, *Nuodaogen* (Glutinous Rice Root) 30g, *Yinchen* 18g, *Yejiaoteng* (Polygonum Multiflorum Vine) 12g, *Zhi Xiangfu* (Cyperus Rhizome processed with vinegar) 9g, take 5 more doses. June 30: Remove *Yejiateng* from previous formula, add *Taizishen* (Pseudostellaria Root), continue for seven doses. July 10: Liver function near normal, jaundice basically resolved, subjective symptoms disappeared. Continue soothing Liver, benefiting Gallbladder, tonifying Qi, generating fluids. Formula: *Danggui* 9g, *Sheng Baishao* 12g, *Hei Shanzhi* 12g, *Qiancao* 16g, *Yujin* 9g, *Taizishen* 18g, *Yinchen* 15g, *Shengdi* 12g, *Maidong* 9g, *Qizi* (Goji Berry) 12g, *Jineijin* 9g. Modified and continued for over 20 doses. Liver function normalized, discharged. (Pan Chenglian: Reflections on Syndrome Differentiation and Treatment of Infectious Hepatitis, *New Medicine Magazine* 1,11,1978)
Case 2: Shi XX, male, 24 years old. Reduced appetite, nausea/vomiting, aversion to greasy food, dark yellow urine, sclera and skin jaundice, admitted to XX Hospital. Examination: Liver enlarged 1cm below costal margin, soft with tenderness and percussion pain. Spleen not palpable, abdomen tympanic, bowel sounds slightly hyperactive... Jaundice index 70 units, ALT 710 units, Albumin 4.13%, Globulin 2.32%. Urine test: Three bile pigments positive, trace protein. Ultrasound: Dense micro-wave pattern in liver area, mild ascites. Diagnosed as Viral Hepatitis. Given large amounts of glucose, Vitamin C, hormones, ATP, insulin, plasma, Yinchenhao Tang IV drip, oral Hepalev, Compound Vitamin B for 7 days. Except for slight reduction in jaundice, other symptoms showed no significant improvement... After consultation, gradually stopped hormones and Western medicines. Symptoms: Right hypochondriac pain, abdominal distension, low-grade fever, dizziness, insomnia, limb weakness, thirst with desire to drink, tender-red tongue, thin-white slightly dry coating, right pulse deficient and restless/weak, left pulse wiry. Syndrome differentiation: Spleen deficiency with Liver Qi stagnation, Liver Yin deficiency. Treatment method: Strengthen Spleen, soothe Liver, nourish Yin, invigorate Blood. Prescription: Sijunzi Tang combined with Si Wumeigu-Luru Wan modified. *Qianggen* (Rubia Root) 12g, *Haipiaoxiao* (Cuttlefish Bone) 9g, *Dangguixu* (Angelica Root Tail) 9g, *Zhi Gancao* (Honey-fried Licorice) 9g, *Baishao* (White Peony Root) 12g, *Jieluo* (Citrus Network) 2.5g, *Yunling* (Poria) 12g, *Baizhu* (Atractylodes Rhizome) 12g, *Dangshen* (Codonopsis Root) 12g, *Congxu* (Green Onion Root) a pinch, decoct in clear water, take 1 dose daily, continuous 11 doses. Re-examination: Complexion bright, appetite improved, right hypochondrium not distended, still low-grade fever, insomnia/dream-disturbed sleep, spontaneous/night sweats, dizziness/limb weakness, pale-red tongue, pulse slightly better than before. Ultrasound: Ascites disappeared. Continue previous method. Formula: *Dangshen* 12g, *Baizhu* 12g, *Yunling* 18g, *Zhi Gancao* 6g, *Baishao* 12g, *Shouwu* (Polygonum Multiflorum Root) 12g, *Roucongrong* (Cistanche Stem) 9g, *Qianggen* 12g, *Nuodaogen* 15g, *Fuxiaomai* (Floating Wheat) 15g, *Jieluo* 1.5g, decoct in clear water, continuous 17 doses. Third visit: Still low-grade fever, hand tremor, slight abdominal distension, thirst with desire to drink, fine-rapid-choppy pulse, dark-red-purple tongue, thin-yellow coating. This is Liver Qi stagnation with Spleen stagnation, Stomach-Intestine damp-heat. Treatment: Unblock collaterals, invigorate Blood, transform dampness, clear heat. Formula: *Qianggen* 24g, *Jieluo* 3g, *Chixiaodou* (Adzuki Bean) 30g, *Haipiaoxiao* 12g, *Neijin* (Chicken Gizzard Lining) 9g, *Chun Sharen* (Amomum Fruit, added later) 9g, *Da Fupi* (Areca Pericarp) 9g, *Tu Yinchén* (Artemisia Capillaris) 30g, *Zexie* (Alisma Rhizome) 12g, *Congxu* (Green Onion Root) a pinch, decoct in clear water. 1 dose daily, total 26 doses. After medication, spirit and appetite good. Re-check liver function: Jaundice index 4 units, ALT 40 units, Albumin 4.15%, Globulin 1.75%. Condition cured, discharged. Follow-up for two and a half years, no recurrence. (Mainly treated by Liu Chixuan, organized by Liu Yixuan: Phlegm Syndrome and Hypochondriac Bi, *New Chinese Medicine* 3,17,1979)
Case 3: Sun XX, male, 3 months old. First visit date: November 18, 1971. Half a month after birth, skin and sclera began to yellow, stool white, urine yellow, vomiting milk for one week. Blood test on Nov 1, 1971: Jaundice index 79 units, Total Bilirubin 6.82 mg%, Direct Bilirubin 6.6 mg%, Van den Bergh test direct rapid reaction, ALT 150 units,麝浊 (Thymol Turbidity) 3 units. Diagnosed as: Mucinous (Incomplete) Obstructive Jaundice. Treatment: Benefit Gallbladder, clear heat, transform dampness. Took 12 doses continuously. Jaundice did not worsen but also did not resolve. Transferred for consultation on Nov 18, 1971. Symptoms: Whole body yellow, vomiting milk, yellow urine. Finger print deep purple, tongue coating white. Syndrome differentiation: Damp-heat obstructing middle, Stasis-heat causing jaundice. Treatment method: Clear heat, benefit Gallbladder, aromatic transformation, invigorate Blood. Prescription: *Yinchen* 6g, *Yujin* 3g, *Jiu Qin* (Wine-processed Scutellaria) 6g, *Tu Fuling* (Smilax Glabra Rhizome) 6g, *Huoxiang* (Patchouli Herb) 3g, *Xingren* (Apricot Kernel) 3.5g, *Juhong* (Citrus Peel) 3g, *Chishao* (Red Peony Root) 6g, *Oujie* (Lotus Node) 6g, *Zelan* (Lygodium Spore) 6g, *Cheqianzi* (Plantago Seed) 6g. Treatment Course: Mainly based on the above formula, intermittent medication for 30 doses. Re-check on April ?, 1972: ALT 193 units, Total Bilirubin <0.3 mg%, Jaundice index 4 units. Jaundice completely cleared, eating/sleeping/excretion normal. June 1972 re-check: ALT normal. (Selected Clinical Experience of Guan Youbo))