例二俞XX，女，31岁，初诊日期：1963年5月10日。患肺结核三年，伴肺不张，长期用抗痨药物治疗，未见效果。经常咯血，午后潮热，咳嗽痰稠，右胸隐痛，盱区作胀，面浮神疲，形瘦色萎，不思纳谷，大便干结。舌质淡胖，尖有红刺，脉细。辨证：肺脏气阴不足，肝经气火有余，脾胃运化不健。治法：益肺气，健脾胃，佐以肃肺，顺气、清热之法。方药：炙黄芪9克炒白术9克炙甘草3克杏仁9克陈皮4．5克半夏4．5克蒸百部9克知母9克青蒿子4．5克炙鸡金4．5克服药后，症状逐步改善，此方连服50余剂。9月20日(二诊)：迭进益气养阴、清肺顺气，调和脾胃之法，低热已平，胃纳较佳，大便正常，但尚不劳累，容易引起潮热。近二，三月来，面色润泽，体重增加十余斤，乃佳象也。咳嗽减而未除，肝区有时作胀。舌淡尖红，脉细，为气阴尚亏之象。再拟滋阴清肺，疏盱和胃之法。南沙参12克炙甘草4。5克桑叶皮各9克银柴胡4．5克元参9克青蒿9克白蒺藜9克海蛤壳12克白前薇各9克淡竹茹4．5克陈皮4.5克广郁金9克(《黄文东医案》)[评按]肺痨相当于西医所谓之肺结核病。早在《内经》即有类似证候的记载。宋代《三因方》始以痨瘵定名。元·朱震亨倡“痨瘵主于阴虚之说”，突出了本病的证候机理特点，提供了有价值的见解。
例一确诊为肺结核，但无明显肺系证候，仅觉经水量少，色不正，腹中作痛，乃肝脾不调所致，治以宁肺，调肝肾，并嘱小心将护、勿过劳累，以期服药获效，充分体现重视整体的可贵的学术观点。
例二病程日久，患肺结核伴有肺不张，肺络受损而经常咯血，证属气阴不足，旰经气火有余，脾失健运，影响肺肝脾胃诸脏腑，其治除益气清肺外，颇侧重于健运脾胃，胃纳好转，体重增加，证情随之好转，是为“培土生金”之法。
(九)虚损
例一戈XX，女，12岁。因其母体弱多病，晚生此女，先天不足，累及后天，从襁褓时既发育不够好，直到现在，身矮肌瘦，稍一动作即感劳累气短，懒于玩耍，且目力非常衰弱，一读书写字，不超过10分钟，即感目抽而痛，因之休学。……切其脉虚软，舌淡、面色咣白，目自睛过白，大便有时不成条，食极少，每顿不过半两许。辨证：脾胃不足。治法：培养后天之本。方药：资生丸。人参45克茯苓30克白术45克山药30克薏仁米22．5克莲子肉30克芡实22．5克甘草15克陈皮30克神曲30克白豆蔻12克桔梗15克藿香15克川黄连6克砂仁22．5克山楂22．5克白扁豆22．5克共为粗末，每次6克，煎二次合在一处，午、晚饭后一小时左右各服一次。服20天后，食量大增，一月后，每餐可进三两，面色红润，精神焕发，喜玩乐动，目力亦见强，能看书写字持续半小时以上。因令她坚持服下去，并请眼科诊视目疾，云系远视眼，因营养不足所致，可配眼镜以帮助目力，未予开药治疗。(《岳美中医案集》)
例二陈X，女，泰国人。往岁曾患甲状腺机能亢进，有心跳，眼球突出，易倦等证象，经手术后，证状好转，不久又出现容易疲倦，食欲不振及眼眶浮肿，皮肤干燥、月事减少、色黑等证。在某医院治疗，认为甲状腺大部切除，功能低减，治以甲状腺制剂(轻量)，谓宜久服，半年余转来中医研究院门诊部诊治。查询如上经过，此病前为甲状腺机能亢进，后为甲状腺机能减退，根据现有证象为基础，调摄整个机体为斡旋，润液育阴，凉营沃燥，随病机出入加减于其间。初拟方系人参养荣丸合五子衍宗丸加昆布、海藻、桑螵蛸等，似效不效。继拟方；当归、白芍、川芎各9克，茯神12克，枣仁9克，元胡索、丹皮、茅根、泽兰叶各9克，生谷芽12克，煎服。二星期有效，四星期效著，心跳胸痹未发，手不颤，各证大半好转(前药中，或加栀子、地骨皮、山萸肉、牡蛎及威灵仙、元胡索等)。继续拟方宗前法，加重培育扶正，又四星期，一般状况甚佳，基础代谢率由—15至—20升为—2，病已向愈，体重加增，自觉无不适。末后拟方，仍宗前法，轻其制而减其量，半清半调，隔日服一剂，阅四月无变化，即偶有不适或附带他病，随治随愈，时值夏热，赴青岛避暑，病大体已愈，为拟调摄方：人参归脾丸500丸，每服3～6克，日二次。秋凉回京，尚来诊一次，一般良好，嘱仍服归脾丸缓调善后。(《冉雪峰医案》)
例三柳Xx，男，43岁，5月18日初诊。患者曾经便血，竟至昏厥，胃脘下端时常作痛，反酸，消化不良，腹中时常气鼓，睡眠欠佳，足胫微痛，但面色发红。脉象浮大，舌质红，微有白苔。此由失血而导致胃阴不足，冶法当以补益胃阴为主。方药；乌贼骨9克尖贝6克阿胶珠9克白芨9克沙参9克淮山药9克石斛9克玉竹9克牡蛎9克生谷芽12克鸡内金6克青木香9克甘草3克6月2日(二诊)：服上方10剂后，胃疼大减，腹中气鼓亦减，饮食逐渐增加，脉象如前，再宗前法。方药：乌贼骨9克尖贝6克阿胶珠9克白芨9克瓦楞子9克牡蛎9克沙参9克淮山药12克石斛9克玉竹9克生地9克麦冬9克鸡内金6克茯神9克甘草3克服上方10剂后，即基本恢复正常。(李克淦整理：李斯炽医案二则，《新医药杂志》7：22，1978)
例四吕XX，女，“岁，通信初诊日期：1975年8月31日。患者于1960年至1968年共妊娠6胎，其中流产5胎，足月分娩一胎。1969年秋冬开始，月经失调，后突然闭经，性欲减退，并有恶寒，全身无力，嗜睡，记忆力差，感情淡漠，对周围事物反应迟钝，怕冷、汗多，腰背疼痛，全身肌肉关节酸痛，面部及双手明显肿胀，按之随按随起，体重由120市斤增至140市斤，毛发脱落，眉毛稀疏，并有心悸及心前区隐痛，胸闷，脉率缓慢，血压偏高，纳呆，食后腹胀、便溏，小便量少，基础代谢低于正常，’诊为“甲状腺机能减退症”。用甲状腺素片每日90毫克维持达三年之久。舌质多淡胖，苔白润而厚，脉沉迟细。辨证：起于多次流产，冲任耗损，营血亏乏，脾肾阳气衰微。治法：固冲任，调气血，扶睥温肾。方药：(1)方：黄芪30克党参18克白术24克当归12克炙甘草、柴胡、升麻各6克巴戟天、杞子各9克陈皮3克(2)方:黄芪18克茯苓30克白术、首乌各24克泽泻、桂枝、山药，淫羊藿各9克菟丝子12克二方交替服，(1)方服3天，(2)方服1天，治疗20余天后，精神好转，胃纳增加，大便成形，颜面四肢肿胀、腰痛、伯冷等症状均减轻。仍以上方为基础加减出入，服药近一年(有时自服甲状素片，每日不超过30毫克)，恢复全日工作，仍服药巩固。(邓铁涛主治，赵立诚等整理；久病肾阳虚肿胀(甲状腺机能减退症)，《浙江中医杂志舶：363，1980)
例五胡左，6月10日。年甫弱冠，胸脘迫窄，痰涎常滞，咳呛易作，舌苔粘腻不化，遗泄频仍，初有梦而后无梦，形体羸瘦，精神颓败，心肾欠亏，君相之火不藏，肺有痰湿，未宜偏补，丸方缓调。大熟地150克煅牡蛎150克黑料豆120克女贞子30克粉丹皮45克川黄柏45克建泽泻60克(盐水炒)车前子90克(盐水炒)云茯苓60克焦白术60克菟丝子120克抱木茯神60克湘莲子(连心)150克上药共为细末，以肥玉竹60克煎汤泛丸。如梧桐子大，每晚淡盐汤送下9克。(张赞臣介绍；“谢利恒先生医学经验简介”，《上海中医药杂志》10：16，1964)[评按]虚损系指脏腑亏损，元气虚弱而致多种慢性病的总称。凡禀赋不足，后天失调，病久失养，积劳内伤，渐至元气亏耗而表现为各种虚损证候。辨证时应分辨阴，阳，气、血，何者为虚，并本着“虚则补之”、“损者益之”等原则进行调治。
例一证属先天禀赋不足累及后天，以致脾胃不足；使用资生丸治疗。原方为缪仲醇取《和剂局方》参苓白术散加味而成。重在补而辅以调，配伍相宜而补通得当。
例二证属阴血虚亏，营热血燥，投以润液育阴、凉营沃燥之剂，方药无奇而效验颇著。
例三源于大失血后，虽见胃痛，并非气滞寒凝，系因胃阴不足所致。而医者多易忽略，往往每见胃病，便予温燥行气止痛之品，反使胃痛愈甚，详读此例，实可引以为戒。
例四与
例二西医诊断虽同而中医辨证有异。治以扶脾温肾，固冲任、调气血。所用(1)、(2)二方各有侧重。(1)方偏于健脾顾肾，(9)方偏于温肾顾脾。(1)、但)方交替使用补而不燥，宜于久服，立方稳妥，如操之过急，反致债事。
例五久病虚损，治以丸剂缓图。方中诸品，有补益之功而无温燥之弊，遣方用药，较有分寸。(十)衄血
例一宋X，47岁，男。一年来头痛，眩晕，口内干热，齿鼻时衄，面色红赤，血压逐渐增高(由80／60至130／100毫米汞柱)。舌质紫黯，舌苔黄褐厚腻，脉沉弦而数。血查红细胞613万／立方毫米，血红蛋白20．5克，骨髓像增生明显活跃。诊为真性红细胞增多症。辨证：肝热上冲，瘀血内滞。治法：清肝凉血，化瘀消滞。方药：龙胆草15克黄芩15克泽泻15克川芎15克藕节30克白茅根30克鸡血藤30克山栀9克桃仁9克红花9克三棱18克莪术18克银柴胡12克银花20克丹皮5克芦荟2克青黛3克(冲)连服23剂。头痛眩晕显减，出血已止，血压降至99／60毫米汞柱，红细胞降至490万，血红蛋白降到17．9克。但出现便溏乏力，脉转沉细，前方减胆草、去芦荟，继服3个月，症状消失，血像及血压保持正常范围。(郭士魁主治，翁维良等整理；清肝化滞法治愈真性红细胞增多症，《浙江中医杂志01：38，1980)
例二卢XX，女，52岁。患者素有关节疼痛史，近一年来皮肤搔痒，搔抓后皮肤出现血斑，以后发现出血点，于四肢与胸腹为多。近三天来齿龈出血约2000毫升，晚间溢血更多。发热头痛，关节痛，尿血。用止血药及维生素等，均未控制出血。检查：神识昏惑，齿龈溢血，四肢及胸部有散在出血点。化验：血色素9．5克，红细胞396万／立方毫米，白细胞13500／立方毫米，血小板25740，出血时间15分未止，凝血时间2分。脉浮弦而数，舌质红，苔薄黄。辨证：毒热郁营，热迫血溢。治法：清热解毒，凉血止血。方药：银花、大青叶，鲜茅根、藕节各24克连翘、大蓟、小蓟各15克丹皮12克鲜菖蒲，鲜佩兰各9克黄连6克银柴胡4．5克犀角粉1．5克(冲服)二诊；前方连服2剂，汗出身热渐退，齿龈出血减轻，神识清楚，脉弦数。是外热巳清，营分之郁热尚未宣散，宜清营凉血止血。方药，鲜茅根20克银花、生地、藕节各24克丹皮、仙鹤草、龟板、茜草根，大蓟、小蓟各15克栀子、槐花、阿胶各9克黄连6克犀角粉1。5克(冲服)。三诊：前方连服5剂，身热巳退，齿龈已不出血，周身出血点已吸收，无新出血点，精神和食欲巳恢复。仍倦怠无’力，有时心悸气短。脉细软，舌淡红。是营分之热已清，而中气仍虚弱，改用健脾养阴止血法。方药，鲜茅根“克生地、龟板各15克生山药、乌贼骨、大蓟、小蓟各12克丹皮、白术、仙鹤草、茜草根各9克阿胶6克人参3克(冲服)上方连服4剂，诸症痊愈。血液检查亦恢复正常。(《邢锡波医案选》)
例三张XX，男，47岁，住院号，52046，初诊日期；1973年11月。患者上下肢及胸部出血点巳六年，经血液化验及骨髓像：显示再生不良，全血细胞减少，某医院确诊为再生障碍性贫血，兼有冠心病，继发性房颤……等多种慢性病。迭经中西医各种治疗，效果不佳，六年来输血53000余毫升。现症：头晕目眩，面色晦暗，唇甲苍白而黯，心悸怔忡，失眠少寐，性欲消失，四肢浮肿，汗出畏寒，气短懒言，腰痠腿软，两胁疼痛，胸闷纳呆，腹痛腹泻，脉缓细而滑，苔厚白而腻。辨证：五脏俱病，关键在寒湿困脾。治法：苦温燥湿，醒脾开胃。方药：佩兰叶9克苏藿梗各5克苍术10克厚朴花5克砂仁壳5克白豆蔻5克陈皮炭10克代代花5克茯苓皮10克绿萼梅6克焦薏仁12克白通草5克建神曲10克守上方每周6剂，曾随症加吴萸、干姜、附片等。服药约二个月，诸症均减，停止输血。血液化验已近正常，继服上方出入，至”74年4月1日出院。血像稳定。惟感头晕目眩，倦怠无力，脉细弱，苔白腻，舌质淡。寒湿已近清彻，正虚之像颇著，拟益气健脾，祛湿开胃，携下方服用。方药：党参15克生黄芪15克白术10克云茯苓9克陈皮炭9克炒枳壳9克厚朴花6克佩兰叶9克砂仁壳5克焦三仙18克当归10克每月10—20剂，1974年9月及1975年9月，两次骨髓像显示接近正常。1980年吕月随访，患者血象稳定，已上全日班三年余。(段荣书整理，董德懋医疗经验琐谈，《中医杂志》2：9，1981)
【背景信息】
书名：近现代名医验案类编 章节：正文(5/53) 类别：医论
例二 俞XX，女，31岁，初诊日期：1963年5月10日。患有肺结核三年，伴有肺不张，长期使用抗结核药物治疗，未见效果。经常咯血，午后潮热，咳嗽痰稠，右胸隐痛，肝区胀满，面部浮肿，精神疲乏，形体消瘦，面色萎黄，不思饮食，大便干结。舌质淡胖，舌尖有红刺，脉细。辨证：肺脏气阴不足，肝经气火有余，脾胃运化功能不健。治法：补益肺气，健运脾胃，辅以肃降肺气、顺气、清热的方法。方药：炙黄芪9克，炒白术9克，炙甘草3克，杏仁9克，陈皮4.5克，半夏4.5克，蒸百部9克，知母9克，青蒿子4.5克，炙鸡内金4.5克。服药后，症状逐步改善，此方连续服用50余剂。9月20日（二诊）：持续运用益气养阴、清肺顺气、调和脾胃的方法，低热已平复，胃纳较好，大便正常，但尚不能劳累，容易引发潮热。近两三个月来，面色润泽，体重增加十余斤，这是佳象。咳嗽减少但未除尽，肝区有时胀满。舌淡尖红，脉细，是气阴仍亏虚的表现。再拟定滋阴清肺、疏肝和胃的方法。南沙参12克，炙甘草4.5克，桑叶皮各9克，银柴胡4.5克，元参9克，青蒿9克，白蒺藜9克，海蛤壳12克，白前薇各9克，淡竹茹4.5克，陈皮4.5克，广郁金9克。（《黄文东医案》）[评按] 肺痨相当于西医所谓的肺结核病。早在《内经》中就有类似证候的记载。宋代《三因方》开始以“痨瘵”定名。元代朱震亨倡导“痨瘵主于阴虚之说”，突出了本病的证候机理特点，提供了有价值的见解。
例一 确诊为肺结核，但无明显肺系证候，仅感觉经水量少，颜色不正，腹中作痛，乃肝脾不调所致，治疗以宁肺、调肝肾为主，并嘱咐小心护理、不要过度劳累，以期服药获效，充分体现了重视整体的可贵学术观点。
例二 病程日久，患肺结核伴有肺不张，肺络受损而经常咯血，证属气阴不足，肝经气火有余，脾失健运，影响肺、肝、脾、胃诸脏腑，其治疗除益气清肺外，颇侧重于健运脾胃，胃纳好转，体重增加，证情随之好转，这是“培土生金”的方法。
(九) 虚损
例一 戈XX，女，12岁。因其母体弱多病，晚生此女，先天不足，累及后天，从襁褓时既发育不够好，直到现在，身矮肌瘦，稍一动作即感劳累气短，懒于玩耍，且目力非常衰弱，一读书写字，不超过10分钟，即感目抽而痛，因此休学。……切其脉虚软，舌淡、面色㿠白，目白睛过白，大便有时不成条，食极少，每顿不过半两许。辨证：脾胃不足。治法：培养后天之本。方药：资生丸。人参45克，茯苓30克，白术45克，山药30克，薏仁米22.5克，莲子肉30克，芡实22.5克，甘草15克，陈皮30克，神曲30克，白豆蔻12克，桔梗15克，藿香15克，川黄连6克，砂仁22.5克，山楂22.5克，白扁豆22.5克。共为粗末，每次6克，煎二次合在一处，午、晚饭后一小时左右各服一次。服20天后，食量大增，一月后，每餐可进三两，面色红润，精神焕发，喜玩乐动，目力亦见强，能看书写字持续半小时以上。因令她坚持服下去，并请眼科诊视目疾，云系远视眼，因营养不足所致，可配眼镜以帮助目力，未予开药治疗。（《岳美中医案集》）
例二 陈X，女，泰国人。往岁曾患甲状腺机能亢进，有心跳、眼球突出、易倦等证象，经手术后，证状好转，不久又出现容易疲倦、食欲不振及眼眶浮肿、皮肤干燥、月事减少、色黑等证。在某医院治疗，认为甲状腺大部切除，功能低减，治以甲状腺制剂（轻量），谓宜久服，半年余转来中医研究院门诊部诊治。查询如上经过，此病前为甲状腺机能亢进，后为甲状腺机能减退，根据现有证象为基础，调摄整个机体为斡旋，润液育阴，凉营沃燥，随病机出入加减于其间。初拟方系人参养荣丸合五子衍宗丸加昆布、海藻、桑螵蛸等，似效不效。继拟方：当归、白芍、川芎各9克，茯神12克，枣仁9克，元胡索、丹皮、茅根、泽兰叶各9克，生谷芽12克，煎服。二星期有效，四星期效著，心跳胸痹未发，手不颤，各证大半好转（前药中，或加栀子、地骨皮、山萸肉、牡蛎及威灵仙、元胡索等）。继续拟方宗前法，加重培育扶正，又四星期，一般状况甚佳，基础代谢率由-15至-20升为-2，病已向愈，体重加增，自觉无不适。末后拟方，仍宗前法，轻其制而减其量，半清半调，隔日服一剂，阅四月无变化，即偶有不适或附带他病，随治随愈，时值夏热，赴青岛避暑，病大体已愈，为拟调摄方：人参归脾丸500丸，每服3～6克，日二次。秋凉回京，尚来诊一次，一般良好，嘱仍服归脾丸缓调善后。（《冉雪峰医案》）
例三 柳Xx，男，43岁，5月18日初诊。患者曾经便血，竟至昏厥，胃脘下端时常作痛，反酸，消化不良，腹中时常气鼓，睡眠欠佳，足胫微痛，但面色发红。脉象浮大，舌质红，微有白苔。此由失血而导致胃阴不足，冶法当以补益胃阴为主。方药：乌贼骨9克，尖贝6克，阿胶珠9克，白芨9克，沙参9克，淮山药9克，石斛9克，玉竹9克，牡蛎9克，生谷芽12克，鸡内金6克，青木香9克，甘草3克。6月2日（二诊）：服上方10剂后，胃疼大减，腹中气鼓亦减，饮食逐渐增加，脉象如前，再宗前法。方药：乌贼骨9克，尖贝6克，阿胶珠9克，白芨9克，瓦楞子9克，牡蛎9克，沙参9克，淮山药12克，石斛9克，玉竹9克，生地9克，麦冬9克，鸡内金6克，茯神9克，甘草3克。服上方10剂后，即基本恢复正常。（李克淦整理：李斯炽医案二则，《新医药杂志》7：22，1978）
例四 吕XX，女，“岁，通信初诊日期：1975年8月31日。患者于1960年至1968年共妊娠6胎，其中流产5胎，足月分娩一胎。1969年秋冬开始，月经失调，后突然闭经，性欲减退，并有恶寒，全身无力，嗜睡，记忆力差，感情淡漠，对周围事物反应迟钝，怕冷、汗多，腰背疼痛，全身肌肉关节酸痛，面部及双手明显肿胀，按之随按随起，体重由120市斤增至140市斤，毛发脱落，眉毛稀疏，并有心悸及心前区隐痛，胸闷，脉率缓慢，血压偏高，纳呆，食后腹胀、便溏，小便量少，基础代谢低于正常，’诊为“甲状腺机能减退症”。用甲状腺素片每日90毫克维持达三年之久。舌质多淡胖，苔白润而厚，脉沉迟细。辨证：起于多次流产，冲任耗损，营血亏乏，脾肾阳气衰微。治法：固冲任，调气血，扶睥温肾。方药：(1)方：黄芪30克，党参18克，白术24克，当归12克，炙甘草、柴胡、升麻各6克，巴戟天、杞子各9克，陈皮3克 (2)方:黄芪18克，茯苓30克，白术、首乌各24克，泽泻、桂枝、山药，淫羊藿各9克，菟丝子12克。二方交替服，(1)方服3天，(2)方服1天，治疗20余天后，精神好转，胃纳增加，大便成形，颜面四肢肿胀、腰痛、伯冷等症状均减轻。仍以上方为基础加减出入，服药近一年（有时自服甲状素片，每日不超过30毫克），恢复全日工作，仍服药巩固。（邓铁涛主治，赵立诚等整理；久病肾阳虚肿胀(甲状腺机能减退症)，《浙江中医杂志舶：363，1980）
例五 胡左，6月10日。年甫弱冠，胸脘迫窄，痰涎常滞，咳呛易作，舌苔粘腻不化，遗泄频仍，初有梦而后无梦，形体羸瘦，精神颓败，心肾欠亏，君相之火不藏，肺有痰湿，未宜偏补，丸方缓调。大熟地150克，煅牡蛎150克，黑料豆120克，女贞子30克，粉丹皮45克，川黄柏45克，建泽泻60克（盐水炒），车前子90克（盐水炒），云茯苓60克，焦白术60克，菟丝子120克，抱木茯神60克，湘莲子（连心）150克。上药共为细末，以肥玉竹60克煎汤泛丸。如梧桐子大，每晚淡盐汤送下9克。（张赞臣介绍；“谢利恒先生医学经验简介”，《上海中医药杂志》10：16，1964）[评按] 虚损系指脏腑亏损，元气虚弱而致多种慢性病的总称。凡禀赋不足，后天失调，病久失养，积劳内伤，渐至元气亏耗而表现为各种虚损证候。辨证时应分辨阴，阳，气、血，何者为虚，并本着“虚则补之”、“损者益之”等原则进行调治。
例一 证属先天禀赋不足累及后天，以致脾胃不足；使用资生丸治疗。原方为缪仲醇取《和剂局方》参苓白术散加味而成。重在补而辅以调，配伍相宜而补通得当。
例二 证属阴血虚亏，营热血燥，投以润液育阴、凉营沃燥之剂，方药无奇而效验颇著。
例三 源于大失血后，虽见胃痛，并非气滞寒凝，系因胃阴不足所致。而医者多易忽略，往往每见胃病，便予温燥行气止痛之品，反使胃痛愈甚，详读此例，实可引以为戒。
例四与
例二 西医诊断虽同而中医辨证有异。治以扶脾温肾，固冲任、调气血。所用(1)、(2)二方各有侧重。(1)方偏于健脾顾肾，(9)方偏于温肾顾脾。(1)、但)方交替使用补而不燥，宜于久服，立方稳妥，如操之过急，反致债事。
例五 久病虚损，治以丸剂缓图。方中诸品，有补益之功而无温燥之弊，遣方用药，较有分寸。
(十) 衄血
例一 宋X，47岁，男。一年来头痛，眩晕，口内干热，齿鼻时衄，面色红赤，血压逐渐增高（由80／60至130／100毫米汞柱）。舌质紫黯，舌苔黄褐厚腻，脉沉弦而数。血查红细胞613万／立方毫米，血红蛋白20．5克，骨髓像增生明显活跃。诊为真性红细胞增多症。辨证：肝热上冲，瘀血内滞。治法：清肝凉血，化瘀消滞。方药：龙胆草15克，黄芩15克，泽泻15克，川芎15克，藕节30克，白茅根30克，鸡血藤30克，山栀9克，桃仁9克，红花9克，三棱18克，莪术18克，银柴胡12克，银花20克，丹皮5克，芦荟2克，青黛3克（冲）。连服23剂。头痛眩晕显减，出血已止，血压降至99／60毫米汞柱，红细胞降至490万，血红蛋白降到17．9克。但出现便溏乏力，脉转沉细，前方减胆草、去芦荟，继服3个月，症状消失，血像及血压保持正常范围。（郭士魁主治，翁维良等整理；清肝化滞法治愈真性红细胞增多症，《浙江中医杂志01：38，1980）
例二 卢XX，女，52岁。患者素有关节疼痛史，近一年来皮肤搔痒，搔抓后皮肤出现血斑，以后发现出血点，于四肢与胸腹为多。近三天来齿龈出血约2000毫升，晚间溢血更多。发热头痛，关节痛，尿血。用止血药及维生素等，均未控制出血。检查：神识昏惑，齿龈溢血，四肢及胸部有散在出血点。化验：血色素9．5克，红细胞396万／立方毫米，白细胞13500／立方毫米，血小板25740，出血时间15分未止，凝血时间2分。脉浮弦而数，舌质红，苔薄黄。辨证：毒热郁营，热迫血溢。治法：清热解毒，凉血止血。方药：银花、大青叶，鲜茅根、藕节各24克，连翘、大蓟、小蓟各15克，丹皮12克，鲜菖蒲，鲜佩兰各9克，黄连6克，银柴胡4．5克，犀角粉1．5克（冲服）。二诊；前方连服2剂，汗出身热渐退，齿龈出血减轻，神识清楚，脉弦数。是外热巳清，营分之郁热尚未宣散，宜清营凉血止血。方药，鲜茅根20克，银花、生地、藕节各24克，丹皮、仙鹤草、龟板、茜草根，大蓟、小蓟各15克，栀子、槐花、阿胶各9克，黄连6克，犀角粉1。5克（冲服）。三诊：前方连服5剂，身热巳退，齿龈已不出血，周身出血点已吸收，无新出血点，精神和食欲巳恢复。仍倦怠无’力，有时心悸气短。脉细软，舌淡红。是营分之热已清，而中气仍虚弱，改用健脾养阴止血法。方药，鲜茅根“克生地、龟板各15克，生山药、乌贼骨、大蓟、小蓟各12克，丹皮、白术、仙鹤草、茜草根各9克，阿胶6克，人参3克（冲服）。上方连服4剂，诸症痊愈。血液检查亦恢复正常。（《邢锡波医案选》）
例三 张XX，男，47岁，住院号，52046，初诊日期；1973年11月。患者上下肢及胸部出血点巳六年，经血液化验及骨髓像：显示再生不良，全血细胞减少，某医院确诊为再生障碍性贫血，兼有冠心病，继发性房颤……等多种慢性病。迭经中西医各种治疗，效果不佳，六年来输血53000余毫升。现症：头晕目眩，面色晦暗，唇甲苍白而黯，心悸怔忡，失眠少寐，性欲消失，四肢浮肿，汗出畏寒，气短懒言，腰痠腿软，两胁疼痛，胸闷纳呆，腹痛腹泻，脉缓细而滑，苔厚白而腻。辨证：五脏俱病，关键在寒湿困脾。治法：苦温燥湿，醒脾开胃。方药：佩兰叶9克，苏藿梗各5克，苍术10克，厚朴花5克，砂仁壳5克，白豆蔻5克，陈皮炭10克，代代花5克，茯苓皮10克，绿萼梅6克，焦薏仁12克，白通草5克，建神曲10克。守上方每周6剂，曾随症加吴萸、干姜、附片等。服药约二个月，诸症均减，停止输血。血液化验已近正常，继服上方出入，至”74年4月1日出院。血像稳定。惟感头晕目眩，倦怠无力，脉细弱，苔白腻，舌质淡。寒湿已近清彻，正虚之像颇著，拟益气健脾，祛湿开胃，携下方服用。方药：党参15克，生黄芪15克，白术10克，云茯苓9克，陈皮炭9克，炒枳壳9克，厚朴花6克，佩兰叶9克，砂仁壳5克，焦三仙18克，当归10克。每月10—20剂，1974年9月及1975年9月，两次骨髓像显示接近正常。1980年吕月随访，患者血象稳定，已上全日班三年余。（段荣书整理，董德懋医疗经验琐谈，《中医杂志》2：9，1981）
Background Information
Book Title: Compilation of Verified Cases by Famous Modern and Contemporary Physicians
Chapter: Main Text (5/53)
Category: Medical Theory
Case 2 Yu XX, Female, 31 years old, First visit date: May 10, 1963. Suffering from Pulmonary Tuberculosis (Fei Lao, Tuberculosis of the Lung) for three years, accompanied by Atelectasis (Fei Bu Zhang, collapse of lung tissue), with no effect seen from long-term use of anti-tuberculosis drugs. Frequent hemoptysis (Ge Xue, coughing up blood), afternoon tidal fever (Chao Re, low-grade fever in the afternoon), cough with thick sputum, dull pain in the right chest, distension in the liver area, facial edema, mental fatigue, emaciation, sallow complexion, anorexia, and dry stool. Tongue body pale and fat, red prickles on the tip, fine pulse. Syndrome differentiation: Insufficiency of Qi and Yin of the Lung Zang, excess of Qi and Fire of the Liver Meridian, and impaired transportation and transformation of the Spleen and Stomach. Treatment method: Tonify Lung Qi, strengthen the Spleen and Stomach, assisted by methods to descend Lung Qi, regulate Qi, and clear heat. Prescription: Roasted Huangqi (Astragali Radix) 9g, Stir-fried Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Roasted Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Xingren (Armeniacae Semen Amarum) 9g, Chenpi (Citri Reticulatae Pericarpium) 4.5g, Banxia (Pinelliae Rhizoma Preparatum) 4.5g, Steamed Bubu (Stemonae Radix) 9g, Zhimu (Anemarrhenae Rhizoma) 9g, Qinghaozi (Artemisiae Annuae Fructus) 4.5g, Roasted Jineijin (Galli Gigerii Endothelium Corneum) 4.5g. After taking the medicine, symptoms gradually improved; this prescription was taken continuously for over 50 doses. September 20 (Second visit): Continuously applying methods to tonify Qi and nourish Yin, clear the Lung and regulate Qi, and harmonize the Spleen and Stomach. The low-grade fever has subsided, appetite is better, and bowel movements are normal, but fatigue easily triggers tidal fever. In the past two or three months, the complexion is lustrous, and weight has increased by more than ten jin (approx. 5kg); this is a favorable sign. Cough has decreased but not disappeared; the liver area is sometimes distended. Tongue pale with red tip, fine pulse, indicating still deficient Qi and Yin. Further prescribe methods to nourish Yin and clear the Lung, soothe the Liver and harmonize the Stomach. Shashen (Glehniae Radix) 12g, Roasted Gancao 4.5g, Sangye and Sangbipi (Mori Folium and Mori Cortex) 9g each, Yinchaihu (Cistanches Herba) 4.5g, Yuan Shen (Scrophulariae Radix) 9g, Qinghao 9g, Baijili (Tribuli Fructus) 9g, Haigekiao (Tridacnatis Testa) 12g, Baiqian and Wei (Cynanchi Stauntonii Radix et Rhizoma and Verbenae Herba) 9g each, Danzhuru (Bambusae Caulis in Taeniam) 4.5g, Chenpi 4.5g, Guang Yujin (Curcumae Radix) 9g. (From "Medical Cases of Huang Wendong") [Commentary] Fei Lao corresponds to Western medicine's Pulmonary Tuberculosis. Records of similar syndromes exist as early as the *Neijing* (Classic of Internal Medicine). The name "Lao Zhai" was established in the Song Dynasty's *Sanyin Fang*. In the Yuan Dynasty, Zhu Zhenheng advocated the theory that "Lao Zhai is primarily due to Yin deficiency," highlighting the pathological characteristics of this disease and providing valuable insights.
Case 1 Diagnosed with Pulmonary Tuberculosis, but without obvious Lung system symptoms, only feeling scanty menstrual flow, abnormal color, and abdominal pain, caused by disharmony between the Liver and Spleen. Treatment focuses on calming the Lung and regulating the Liver and Kidney, along with advice for careful nursing and avoiding overexertion, aiming for therapeutic efficacy through medication. This fully embodies the valuable academic viewpoint of emphasizing holism.
Case 2 The course of the disease is prolonged, suffering from Pulmonary Tuberculosis with Atelectasis. Damage to Lung collaterals causes frequent hemoptysis. The syndrome belongs to insufficiency of Qi and Yin, excess of Qi and Fire in the Liver Meridian, and failure of the Spleen to transport and transform, affecting the organs of the Lung, Liver, Spleen, and Stomach. Besides tonifying Qi and clearing the Lung, treatment heavily emphasizes strengthening the Spleen and Stomach. With improved appetite and weight gain, the condition improves accordingly. This is the method of "Fortifying Earth to Generate Metal" (Pei Tu Sheng Jin).
(IX) Deficiency Damage
Case 1 Ge XX, Female, 12 years old. Due to her mother's weak constitution and frequent illness, giving birth late, she lacked congenital essence, affecting postnatal development. From infancy, development was inadequate. To this day, she is short and thin, feels tired and short of breath with slight movement, is lazy to play, and has very poor vision. Reading or writing for more than 10 minutes causes eye twitching and pain, leading to school suspension.... Pulse is empty and soft, tongue pale, complexion sallow-white, sclera overly white, stools sometimes unformed, food intake extremely low, less than half a liang per meal. Syndrome differentiation: Spleen and Stomach insufficiency. Treatment method: Cultivate the root of postnatal essence. Prescription: Zisheng Wan. Renshen (Ginseng Radix et Rhizoma) 45g, Fuling (Poria) 30g, Baizhu 45g, Shanyao (Dioscoreae Rhizoma) 30g, Yiren (Coicis Semen) 22.5g, Lianzirou (Nelumbinis Semen) 30g, Qianshi (Euryales Semen) 22.5g, Gancao 15g, Chenpi 30g, Shenqu (Medicated Leaven) 30g, Baudoukou (Amomi Fructus Rotundus) 12g, Jiegeng (Platycodonis Radix) 15g, Huoxiang (Agastaches Herba) 15g, Chuan Huanglian (Coptidis Rhizoma) 6g, Sharen (Amomi Fructus) 22.5g, Shanzha (Crataegi Fructus) 22.5g, Baibian Dou (Dolichoris Semen) 22.5g. Made into coarse powder, take 6g each time, decoct twice and combine, take once about one hour after lunch and dinner. After 20 days, appetite increased significantly. After one month, she could eat three taels per meal, complexion became ruddy, spirit refreshed, enjoyed playing and moving, and vision strengthened, able to read and write for over half an hour. Advised to continue taking it and consult an ophthalmologist for eye issues, which were diagnosed as hyperopia due to malnutrition; glasses were recommended to aid vision, no herbal medicine prescribed. (From "Collected Medical Cases of Yue Meiyi")
Case 2 Chen X, Female, Thai nationality. Previously suffered from Hyperthyroidism (Jia Zhuang Xian Ji Neng Kang Jin), with symptoms such as palpitations, exophthalmos, and easy fatigue. After surgery, symptoms improved, but soon reappeared with easy fatigue, anorexia, periorbital edema, dry skin, oligomenorrhea, and dark menstrual blood. Treated at a certain hospital where it was believed that subtotal thyroidectomy led to hypofunction, treated with thyroid preparations (light dose), advised for long-term use. Transferred to the Outpatient Department of the China Academy of Chinese Medical Sciences after more than half a year. Inquiry revealed the history of prior hyperthyroidism followed by hypothyroidism. Based on current symptoms, regulating the entire organism as the pivot, moistening fluids and nourishing Yin, cooling the Ying level and irrigating dryness, with modifications according to pathogenesis changes. Initial prescription combined Ren Shen Yang Rong Wan (Ginseng Decoction for Nourishing Qi and Blood) and Wu Zi Yan Zong Wan (Five Seeds Decoction for Procreation) plus Kunbu (Laminariae Thallus), Haizao (Sargassum Thallus), Sangpiaoxiao (Mantis Ootheca), etc., with uncertain efficacy. Subsequent prescription: Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chuanxiong (Chuanxiong Rhizoma) each 9g, Fushen (Poria with Hostwood) 12g, Zaoren (Ziziphi Spinosae Semen) 9g, Yuanhusuo (Corydalis Rhizoma), Danpi (Moutan Cortex), Maogen (Imperatae Rhizoma), Zelan Ye (Lycopus Herba) each 9g, Sheng Guya (Sprouted Grain) 12g, decocted and taken. Effective after two weeks, significant effect after four weeks; no palpitations or chest bi-syndrome, hands did not tremble, most symptoms improved (previously added Zhizi, Digupi, Shanzhuyu, Muli, Weilingxian, Yuanhusuo, etc.). Continued prescription following previous method, increasing support for Zheng Qi. After another four weeks, general condition was excellent, basal metabolic rate rose from -15 to -20 to -2, disease tending towards recovery, weight increased, felt no discomfort. Final prescription still followed previous method, lightened dosage, half-clearing half-regulating, taken every other day. No change after four months; occasional discomfort or concurrent illnesses resolved with treatment. During summer heat, went to Qingdao for vacation, disease largely recovered. Prescribed regulation formula: Renshen Guipi Wan (Ginseng Decoction for Invigorating the Spleen and Enriching the Heart) 500 pills, take 3-6g each time, twice daily. Returned to Beijing in autumn, visited once more, generally good, advised to continue taking Guipi Wan for slow adjustment and follow-up care. (From "Medical Cases of Ran Xuefeng")
Case 3 Liu Xx, Male, 43 years old, First visit May 18. Patient had melena (Bian Xue, bleeding from anus) leading to syncope, frequent pain at the lower end of the epigastrium, acid regurgitation, indigestion, frequent abdominal bloating, poor sleep, mild pain in calves/shins, but reddish complexion. Pulse floating and large, tongue red with slight white coating. This is due to loss of blood leading to insufficient Stomach Yin. Treatment should focus on tonifying Stomach Yin. Prescription: Wubei Gu (Sepiae Endoconcha) 9g, Jianbei (Fritillariae Thunbergii Bulbus) 6g, Ejiao Zhu (Colla Corii Asini Prepared) 9g, Baiji (Bletillae Rhizoma) 9g, Shashen 9g, Huaishanyao (Dioscoreae Rhizoma) 9g, Shihu (Dendrobii Caulis) 9g, Yuzhu (Polygonati Odorati Rhizoma) 9g, Muli (Ostreae Concha) 9g, Sheng Guya 12g, Jineijin 6g, Qingmuxiang (Aucklandiae Radix) 9g, Gancao 3g. June 2 (Second visit): After 10 doses of above prescription, stomach pain greatly reduced, abdominal bloating decreased, diet gradually increased, pulse same as before, continue previous method. Prescription: Wubei Gu 9g, Jianbei 6g, Ejiao Zhu 9g, Baiji 9g, Walengzi (Arcae Concha) 9g, Muli 9g, Shashen 9g, Huaishanyao 12g, Shihu 9g, Yuzhu 9g, Shengdi (Rehmanniae Radix) 9g, Maidong (Ophiopogonis Radix) 9g, Jineijin 6g, Fushen 9g, Gancao 3g. After 10 doses of above prescription, basically returned to normal. (Organized by Li Kegan: Two Medical Cases of Li Sichchi, *New Medicine Magazine* 7:22, 1978)
Case 4 Lv XX, Female, [Age obscured], Communication first visit date: August 31, 1975. Patient had 6 pregnancies from 1960 to 1968, including 5 miscarriages and 1 full-term delivery. Starting autumn/winter 1969, menstrual irregularities, then sudden amenorrhea, decreased libido, aversion to cold, general weakness, somnolence, poor memory, emotional indifference, slow reaction to surroundings, fear of cold, excessive sweating, back pain, generalized muscle and joint soreness, obvious swelling of face and hands (pitting edema), weight increased from 120 jin to 140 jin, hair loss, sparse eyebrows, palpitations and dull pain in precordial region, chest tightness, slow pulse rate, high blood pressure, anorexia, postprandial abdominal distension, loose stools, oliguria, basal metabolism below normal, diagnosed as "Hypothyroidism". Maintained on Thyroxine tablets 90mg daily for three years. Tongue body mostly pale and fat, coating white, moist and thick, pulse deep, slow, and fine. Syndrome differentiation: Arising from multiple miscarriages, depletion of Chong and Ren meridians, deficiency of Ying blood, decline of Spleen and Kidney Yang Qi. Treatment method: Secure Chong and Ren, regulate Qi and Blood, support Spleen and warm Kidney. Prescription: (1) Formula: Huangqi (Astragali Radix) 30g, Dangshen (Codonopsis Radix) 18g, Baizhu 24g, Danggui 12g, Roasted Gancao, Chaihu (Bupleuri Radix), Shengma ( Cimicifugae Rhizoma) each 6g, Bajitian (Morindae Officinalis Radix), Qizi (Lycii Fructus) each 9g, Chenpi 3g. (2) Formula: Huangqi 18g, Fuling 30g, Baizhu, Shouwu (Polygoni Multiflori Radix) each 24g, Zexie (Alismatis Rhizoma), Guizhi (Cinnamomi Ramulus), Shanyao, Yinyanghuo (Epimedii Folium) each 9g, Tusizi (Cuscutae Semen) 12g. Alternate formulas, (1) for 3 days, (2) for 1 day. After over 20 days of treatment, spirit improved, appetite increased, stools formed, swelling of face and limbs, back pain, aversion to cold, etc., all alleviated. Still based on above formula with modifications, took medicine for nearly one year (sometimes self-administered Thyroxine, not exceeding 30mg daily), resumed full-time work, continued medication for consolidation. (Mainly treated by Deng Tietao, organized by Zhao Licheng et al.; Chronic Kidney Yang Deficiency Swelling (Hypothyroidism), *Zhejiang Journal of Traditional Chinese Medicine*: 363, 1980)
Case 5 Hu Zuo, June 10. Just reached adulthood (weak crown), chest and epigastrium feel constricted, phlegm and saliva often stagnate, prone to coughing fits, tongue coating sticky and untransformed, frequent seminal emission, initially with dreams then without, emaciated body, decadent spirit, deficiency of Heart and Kidney, Ministerial Fire not concealed, Lung has phlegm-dampness, not suitable for biased tonification, pill formula for slow regulation. Da Shudi (Prepared Rehmanniae Radix) 150g, Duan Muli (Prepared Ostreae Concha) 150g, Heiliaodou (Black Soybean) 120g, Nvzhenzi (Ligustri Lucidi Fructus) 30g, Fen Danpi (Moutan Cortex) 45g, Chuan Huangbai (Phellodendri Chinensis Cortex) 45g, Jian Zexie (Alismatis Rhizoma) 60g (salt-fried), Cheqianzi (Plantaginis Semen) 90g (salt-fried), Yun Fuling (Poria) 60g, Jiao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 60g, Tusizi 120g, Baomu Fushen (Poria with Hostwood) 60g, Xiang Lianzi (Nelumbinis Semen with Plumule) 150g. All medicines made into fine powder, using Fei Yuzhu (Polygonati Odorati Rhizoma) 60g decocted soup to form pills. Size like paulownia seeds, take 9g each night sent down with light salt water. (Introduced by Zhang Zanchen; "Brief Introduction to Mr. Xie Liheng's Medical Experience", *Shanghai Journal of Traditional Chinese Medicine* 10:16, 1964) [Commentary] Xu Sun refers to the general term for various chronic diseases caused by organ deficiency and weak Yuan Qi. It includes congenital insufficiency, postnatal imbalance, prolonged illness without proper care, accumulation of labor and internal injury, gradually depleting Yuan Qi and manifesting as various deficiency damage syndromes. When differentiating syndromes, distinguish whether Yin, Yang, Qi, or Blood is deficient, and follow principles such as "Deficiency requires tonification" and "Damage requires benefit" for regulation and treatment.
Case 1 Syndrome belongs to congenital insufficiency affecting postnatal development, resulting in Spleen and Stomach insufficiency; treated with Zisheng Wan. The original formula was created by Miu Zhongchun by adding ingredients to Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) from *Heji Ju Fang*. Emphasizes tonification assisted by regulation, appropriate compatibility, and proper balance of tonifying and draining.
Case 2 Syndrome belongs to Yin and Blood deficiency, Ying blood heat and dryness. Administered agents to moisten fluids and nourish Yin, cool Ying and irrigate dryness. The prescription is unremarkable but highly effective.
Case 3 Originates from massive blood loss. Although stomach pain is present, it is not due to Qi stagnation and cold coagulation, but rather insufficient Stomach Yin. Doctors often overlook this, frequently prescribing warming, drying, Qi-regulating, and pain-relieving herbs for stomach diseases, which反而 makes stomach pain worse. Detailed reading of this case serves as a warning.
Case 4 and Case 2 Although Western medical diagnoses are the same, TCM syndrome differentiation differs. Treatment focuses on supporting Spleen and warming Kidney, securing Chong and Ren, regulating Qi and Blood. Formulas (1) and (2) have different emphases. Formula (1) leans towards strengthening Spleen and caring for Kidney; Formula (2) leans towards warming Kidney and caring for Spleen. Alternating (1) and (2) provides tonification without dryness, suitable for long-term use. The formulation is prudent; acting too hastily may lead to failure.
Case 5 Long-standing deficiency damage, treated with pill formula for slow progress. The items in the formula have tonifying benefits without warming and drying drawbacks. Prescription and medication are well-measured.
(X) Epistaxis and Bleeding
Case 1 Song X, 47 years old, Male. For one year, headache, dizziness, dry and hot mouth, intermittent epistaxis and gingival bleeding, reddish complexion, blood pressure gradually increasing (from 80/60 to 130/100 mmHg). Tongue body purple-dark, coating yellow-brown and thick-greasy, pulse deep, wiry, and rapid. Blood test: RBC 6.13 million/cubic mm, Hemoglobin 20.5g, Bone marrow image shows markedly active proliferation. Diagnosed as Polycythemia Vera. Syndrome differentiation: Liver Heat rushing upward, Blood stasis stagnating internally. Treatment method: Clear Liver and cool Blood, resolve stasis and eliminate stagnation. Prescription: Longdan Cao (Gentianae Radix) 15g, Huangqin (Scutellariae Radix) 15g, Zexie 15g, Chuanxiong 15g, Ou Jie (Nelumbinis Node) 30g, Bai Maogen (Imperatae Rhizoma) 30g, Jixueteng (Spatholobi Caulis) 30g, Shan Zhi (Gardeniae Fructus) 9g, Tao Ren (Persicae Semen) 9g, Honghua (Carthami Flos) 9g, Sanleng (Sparganii Rhizoma) 18g, Ezhu (Curcumae Rhizoma) 18g, Yinchaihu 12g, Yinhua (Lonicerae Japonicae Flos) 20g, Danpi 5g, Lvhua (Aloe) 2g, Qingdai (Indigo Naturalis) 3g (mixed in). Taken continuously for 23 doses. Headache and dizziness significantly reduced, bleeding stopped, blood pressure dropped to 99/60 mmHg, RBC dropped to 4.9 million, Hemoglobin dropped to 17.9g. But loose stools and fatigue appeared, pulse turned deep and fine. Reduced Longdan Cao and removed Lvhua from previous prescription, continued for 3 months. Symptoms disappeared, blood picture and blood pressure remained within normal range. (Mainly treated by Guo Shikui, organized by Weng Weiliang et al.; Cure of Polycythemia Vera by Clearing Liver and Resolving Stagnation, *Zhejiang Journal of Traditional Chinese Medicine* 01:38, 1980)
Case 2 Lu XX, Female, 52 years old. Patient has a history of joint pain. For the past year, skin itching, blood spots appearing on skin after scratching, later discovered bleeding points, mostly on limbs and trunk. For the past three days, gingival bleeding approx. 2000ml, more severe at night. Fever, headache, joint pain, hematuria. Hemostatics and vitamins failed to control bleeding. Examination: Confused consciousness, gingival bleeding, scattered bleeding points on limbs and chest. Lab tests: Hemoglobin 9.5g, RBC 3.96 million/cubic mm, WBC 13,500/cubic mm, Platelets 25,740, Bleeding time 15 min not stopping, Clotting time 2 min. Pulse floating, wiry, and rapid, tongue red, coating thin yellow. Syndrome differentiation: Toxic heat stagnating in Ying, heat forcing blood extravasation. Treatment method: Clear heat and detoxify, cool Blood and stop bleeding. Prescription: Yinhua, Daqing Ye (Isatidis Folium), Xian Maogen (Fresh Imperatae Rhizoma), Ou Jie each 24g, Lianqiao (Forsythiae Fructus), Daji (Leonuri Herba), Xiaoji (Cirsii Herba) each 15g, Danpi 12g, Xian Changpu (Acori Tatarinowii Rhizoma), Xian Peilan (Elsholtziae Herba) each 9g, Huanglian 6g, Yinchaihu 4.5g, Xijiao Fen (Rhinocerotis Cornu Powder) 1.5g (mixed in). Second visit: Taken previous prescription for 2 doses, sweat produced, body heat gradually receded, gingival bleeding reduced, consciousness clear, pulse wiry and rapid. External heat cleared, but Ying-level stagnant heat not yet dispersed; should clear Ying and cool Blood to stop bleeding. Prescription: Xian Maogen 20g, Yinhua, Shengdi (Rehmanniae Radix), Ou Jie each 24g, Danpi, Xianhexiao (Agrimoniae Herba), Guiban (Testudinis Carapax et Plastrum), Qiancaogen (Rubiae Radix et Rhizoma), Daji, Xiaoji each 15g, Zhizi, Huaihua (Sophorae Flos), Ejiao each 9g, Huanglian 6g, Xijiao Fen 1.5g (mixed in). Third visit: Taken previous prescription for 5 doses, body heat receded, gingival no longer bleeding, systemic bleeding points absorbed, no new bleeding points, spirit and appetite recovered. Still fatigued, occasional palpitations and shortness of breath. Pulse fine and soft, tongue pale-red. Ying-level heat cleared, but Middle Qi still weak; switch to Spleen-strengthening, Yin-nourishing, and hemostatic method. Prescription: Xian Maogen [obscured] g, Shengdi, Guiban each 15g, Sheng Shanyao, Wubei Gu, Daji, Xiaoji each 12g, Danpi, Baizhu, Xianhexiao, Qiancaogen each 9g, Ejiao 6g, Renshen 3g (mixed in). Taken previous prescription for 4 doses, all symptoms cured. Blood examination also returned to normal. (From "Selected Medical Cases of Xing Xibo")
Case 3 Zhang XX, Male, 47 years old, Hospital No. 52046, First visit date: November 1973. Patient had bleeding points on upper/lower limbs and chest for six years. Blood tests and bone marrow images showed aplasia, pancytopenia. Certain hospital diagnosed as Aplastic Anemia, complicated by Coronary Heart Disease, secondary atrial fibrillation... and other chronic diseases. Underwent various Chinese and Western treatments with poor results, transfused over 53,000 ml in six years. Current symptoms: Dizziness, dark complexion, pale and dark lips/nails, palpitations and fright, insomnia and little sleep, loss of libido, limb edema, sweating and aversion to cold, shortness of breath and reluctance to speak, sore waist and weak legs, hypochondriac pain, chest tightness and anorexia, abdominal pain and diarrhea, pulse slow, fine, and slippery, coating thick white and greasy. Syndrome differentiation: All five Zang organs diseased, key lies in Cold-Damp encumbering the Spleen. Treatment method: Bitter-warm to dry dampness, awaken Spleen and open Stomach. Prescription: Peilan Ye (Elsholtziae Herba) 9g, Suhuo Geng (Perillae Caulis) each 5g, Cangzhu (Atractylodis Rhizoma) 10g, Houpo Hua (Magnoliae Flos) 5g, Sharen Ke (Amomi Fructus Shell) 5g, Baidoukou 5g, Chenpi Tan (Charred Citri Reticulatae Pericarpium) 10g, Daidai Hua (Citri Reticulatae Flavedo Flos) 5g, Fuling Pi (Poria Cum Bark) 10g, Lvemei (Prunus Mume Flos) 6g, Jiao Yiren (Stir-fried Coicis Semen) 12g, Bai Tongcao (Tetrapanacis Medulla) 5g, Jian Shenqu (Medicated Leaven) 10g. Adhere to above prescription, 6 doses per week, occasionally added Wuzhuyu, Ganjiang (Zingiberis Rhizoma), Fupian (Aconiti Lateralis Radix Preparata) according to symptoms. After about two months of medication, all symptoms reduced, stopped transfusion. Blood tests near normal, continued with variations of above prescription, discharged April 1, 1974. Blood picture stable. Only felt dizziness, fatigue, pulse fine and weak, coating white greasy, tongue body pale. Cold-Damp nearly cleared, deficiency of Zheng Qi prominent. Prescribe Qi-tonifying, Spleen-strengthening, dampness-dispelling, Stomach-opening, take below prescription. Prescription: Dangshen 15g, Sheng Huangqi 15g, Baizhu 10g, Yun Fuling 9g, Chenpi Tan 9g, Chao Zhiqiao (Stir-fried Aurantii Fructus) 9g, Houpo Hua 6g, Peilan Ye 9g, Sharen Ke 5g, Jiao Sanxian (Stir-fried Three Immortals) 18g, Danggui 10g. 10-20 doses per month. In September 1974 and September 1975, two bone marrow images showed near-normal. Follow-up in October 1980, patient's blood picture stable, worked full-time for over three years. (Organized by Duan Rongshu, Trivial Talks on Medical Experience of Dong Demao, *Chinese Journal of Traditional Medicine* 2:9, 1981)