某年秋，余暑假回乡休假，适邻村刘湾一吴姓壮年，患疟疾兼旬不愈。持前服方示之，为草果、黄芩等味。愚曰：间日疟发过多次，症状典型，可用截法。此方当加酒炒常山，疟发前二小时服，必效。服后，果愈。乡间医生以常山为下品毒药，不敢贸然轻用也。李士材云：“世俗畏常山发吐，不知其（治疟）有神功，但炒透则不吐耳。”可谓知言。昔清·康熙帝与曹寅书，推重金鸡纳治疟有神效，谓中土无治疟效药，并有疟疾不可妄服人参之说（见《红楼梦》附录）。愚谓金鸡纳一名金鸡勒，清·赵学敏据查慎行《人海记》所载已收入在《本草纲目拾遗》卷六木部下，此药治疟有效，自是事实。惟中医治疟效方，如汉·张仲景之《金匮要略》用蜀漆散治牝疟、温疟，唐《千金方》、《外台》以下方书用常山、蜀漆治疟之方，不胜枚举。因忆往时汉川县某小镇一药店，有治疟方多验。时至暑月，每日卖药数百剂，其药经铡过，不传方。愚托人购其药，细为检视，知为常山、草果、槟榔、乌梅、川朴、半夏、黄芩、陈皮等味，是从达原饮、截疟七宝饮诸方变化而来。故愚采用上法，泛治截疟，随证增损，极有效验。至于人参可否治疟，愚谓疟疾如夹暑湿纠缠，病邪势盛，虽露虚象，自不可服。曾见疟疾有误服人参补益，酿为臌证，以至不救者。若谓疟疾一概禁用人参，亦不尽然。曾治塾师李澍村，年愈花甲，患疟疾，服截疟药即好，但不断根，遇风冷即作，如是者两年。延诊：时方仲秋，衣尚重棉。愚视其舌苔白滑，脉象濡缓无力，肢冷恶寒，稍食生冷或油腻食物即腹痛吐泻。断为久疟中虚，虚多邪少之证。宜用露姜饮加味，治以温中固本为主而微兼散邪之法。遂与高丽参６克，苏红皮５克（愚在临床中凡用参芪白术第三卷２２５等甘温补益中焦之药，必少加陈皮、枳壳等理气快膈之品，如异功散用陈皮，枳术丸用枳实之例，则补而不滞，补而受益）。药炖好后，合入鲜生姜汁一匙，露一宿，服前加温，分两次服。服后精神即振，以后连服数次，疟不再作。是治虚疟久疟，人参间亦可用。故人参治疟之说，必须运用辨证的方法，审证而定，并非一概禁用。
中医治病，应以辨证论治的原则为指导，而其重要的一个环节，又在遣方用药方面。但时下风尚，多重医而轻药。岂知投剂不准，用药不当，不仅影响病情向好的方面转化，甚至能危及患者生命，是知一药之微，关系于临床至大。
二、误补救治琐谈中医使用补药，补血如当归、枸杞，育阴宜地黄、阿胶，益气用黄芪、人参，助阳用鹿茸、附子之类，皆为人们所熟知而为医生所习用者也。但补为八法之一，中药之用，主要是针对病情，大抵为补偏救弊而设。设或患者果属虚证，在阴阳气血某一方面已显露不足，虚者补之，借用某类补剂，调整其机能，从而促使阴阳平衡，得以早日恢复健康，斯为善治。若无病之人，妄服补药，不仅无益，反而有害。特别是在患病期间，病邪势盛，医者滥用补剂，不但留恋病邪，使病势迁延不愈；更重要的是病邪弥漫，病机恶化，往往转变为不治之证。故徐洄溪《慎疾刍言》首述补剂之害，可谓洞中时弊，独具慧心。今特本诸历来临证之肤浅体会，谈谈滥用补剂之危害。
并举病案数例，以资佐证，而供参究。
鹿茸补精髓，益不足，古方如斑龙丸、百补全鹿丸、异类有情丸等方用之。然只适用于阳气衰惫之体。考李时珍谓：“鹿茸能返向尾，能通督脉，故取其角以补命，补精、补气以养阳也。”汪庵谓：“若真阴亏损，虚火上炎者，不可轻投，恐反涸其水也。”洵为见道之言。吾乡鹿城湾李某某，２７岁，某年秋，其父偕同来诊。诊其脉弦细而数，舌苔干而黄燥。其证头胀巅痛，眼赤羞明，心烦易怒，口干畏热，小便短涩赤黄，大便干结难行，阳事易举，时有梦遗。愚讶曰：正方壮年，身体当甚健硕，何以一病至此。遂询其由，始知结婚数年，未见生育，又因有遗精，家人虑其体虚，广购参桂鹿茸丸及参茸制剂成药与服。是此病因过服温补壮阳之药，以损伤真阴，扰动相火，火势燎原，不可遏止，故见证如此。因思此时治法，当于养阴和营中，突出以清肝热，泄郁火为宜。方用龙胆泻肝汤全方，重用生地至６０克，并加生白芍１５克，酒洗大黄１０克与服。二诊：上方服三剂后，上部火热之势大减，大便通利，惟小溲仍短赤灼痛。改用知柏地黄汤加白薇、白芍、茅根、制龟板、忍冬藤，以育阴泄火为治。此方服至二十剂，诸证渐趋向愈，脉之弦数亦和。再用生料六味丸合五子衍宗丸方意，以调理收功。后其至某农场当司机，身体健壮，其爱人已生小孩。
《伤寒论》四逆汤、四逆加人参汤，为回阳救逆要方，适用于三阴虚寒四肢厥逆之证。然引起厥逆的病因多端，如四逆散治肝郁气结而见四逆，亦载于少阴篇，当应用此以与阳衰阴盛之四逆作出鉴别。实则虚寒厥冷，病因亦不只少阴一途。如厥阴血虚寒凝，主用当归四逆汤，以治手足厥寒，脉细欲绝，即是证明。是故一遇厥冷，滥用姜附，实足以偾事。回忆同乡汤某某，小学教员，体素弱。某年七月患感冒发热，初起神志昏愦，手足清冷。前医进四逆加人参汤二剂，服后患者烦躁不安，狂乱欲走。诊时视其舌苔白厚而腻，脉滑而数。其身灼热，小便短赤，大便难行，触诊胸腹部有蹙眉而感不舒之状。因断之曰：暑湿蕴隆，阳气为时令之邪所遏，故见第三卷２２６厥冷，与虚寒四逆，大相径庭。此证失于清解，又误用温补，遂至邪热披猖，扰乱神明，而为烦躁昏狂。然舌苔白厚，脉象滑数，当是病邪尚在气分而不在营分，与清营、清宫之证不同；又与阳明燥实，证见腹满、苔黄之当下证亦有区别。此时救逆之法，拟急与清宣暑湿展利枢机为治。
方用叶天士甘露消毒丹加减化裁。处方：黄芩、川贝母、炒栀子、炒香豉各１０克，茵陈、六一散、竹叶、连翘各１５克，薄荷４克（后下）。２剂。二诊：热势稍退，手足温和，神识已清，烦躁已平，前方去栀、豉、石菖蒲，加佩兰１０克。２剂。三诊：上方服完后，患者忽得战汗，全身热退，神疲思睡，改用轻宣湿热兼和胃之法，再服药数剂而病愈。
黄芪生用固表，温分肉，实腠理；多用补中，益元气，生血生肌，排脓内托，是疮疡要药，为补药之长，东垣补中益气汤、保元汤等均以此为主药。《金匮》防己黄芪汤治风水，防己茯苓汤治皮水，均用黄芪治水气病在肌肤而又兼有表虚者，若不属此种证型，似不可滥用。某年秋，本院某某级学生偕指导员王某扶掖一退休老工人柳某某来诊，自诉：年５０余，素有咳喘，近来发而加剧，更现浮肿，曾住某医院内科病房治疗五个月，断为肺心病，中西医药配合治疗无效，已下数次病危通知单，促其家属领回治疗。因此，由实习学生介绍前来。诊其脉弦缓而时有一歇止，舌苔白厚而滑腻。其证咳唾稠痰而不能畅出，呼吸迫促而不能平卧，目不交睫已数昼夜，面部、四肢均见浮肿，腹部臌胀，腰围增大，口干而不敢多饮，纳食亦少，小便短涩而黄，大便不爽。
寻视中医以前处方，大都为通阳利水之剂，惟每方中必用黄芪，每剂药量有从３０克渐增至１５０克，而药亦罔效。因思此证自属水气为病。水气内停，肺气不得宣化，三焦因而不利，故上见咳嗽喘促，下而二便不爽；水气泛于肌表四肢，则见浮肿；水气内结，心阳不宣，故脉现歇止。医者虽用宣化分消之法，而中有大量益气实表之药，遂至愈补愈涩，一发而不可措手。此时救治之法，当以对证之标实为主，徐徐疏瀹，冀其转危为安。方用五子五皮汤加减。处方：炒莱菔子、炒紫苏子、车前子、大腹皮、桑白皮各１０克，冬瓜皮３０克，茯苓皮１５克，防己、生杏仁、陈皮、生姜皮、川朴各６克，炒葶苈子５克。水煎服。二诊：服完上方三剂后，喘促渐平，已能安寐，小溲较多，大便爽利。仍守前法以治，上方去葶苈子。以后或加川贝母、紫菀、白前、枇杷叶以宣肺化痰；或加枳壳、陈香椽皮以理气消胀；或加薏苡仁、梗通草、六一散以分消水湿。前后来诊约十数次，用药大抵如上所述，惟略用参术，患者即感胀闷不舒。以后仍与小剂宣化，坚持两月，守至患者肿势渐退，咳喘亦平，能扶杖而行，惟脉之歇止，尚未恢复。
地黄、阿胶为甘寒滋润育阴养血要药，然适用于阴虚之证。若素禀阳虚及久病痰饮之体，误用足以偾事，不仅腻膈碍胃而已。同乡李某某，男，年５０余，素患咳喘，并有失血之证。医者常进熟地、阿胶、龟板、枸杞类滋润药，间用此类药熬膏与服。其病时而小愈，时而加剧。某年秋患感冒发热，引起咳喘加重，医者又用前法以治，无效。视其咳唾涎沫而顷刻盈盂，呼吸迫促而不能平卧，咳无一息之停，声音嘶哑，面部浮肿，口干而喜热饮，食欲少进，二便尚可，其脉弦紧，舌苔灰白而厚。以前有咯血史，目下尚未复发。因断之曰：此证当是痰饮为病。《金匮》谓：“咳逆倚息而不得卧，其形如肿者，谓之支饮”者是。治此证不与温化涤饮，反用滋阴腻膈药物，促使饮邪蕴积，汪洋聚于心下，肺气不得宣布，胃气不能和降，因此浊沫频唾，喘促不宁，渐至酿为危重之证，。此时救治之法，当宗《金匮》“病痰饮者，当以温药和之”，“咳逆倚息不得卧者，小青龙汤主之”为宜。因患者略识药性，又有咯血史，畏服麻、桂、细辛。愚不惜反复开导，并举前贤徐灵胎治松江王某妻医案，与此病正相类似，可为一证。幸蒙患者首肯，因与小青龙汤原方，并遵仲景之法，略加紫菀、款冬花以温润化痰，厚朴、杏仁以理气平喘。患者服头煎后，即感胸第三卷２２７廓爽朗，以后连进三剂，喘促渐平，咳痰亦稀，已能就枕安寐。随用温中宣肺化饮法调理而病愈。
综上所述，可知补剂滥用，危害甚大。愚少时曾见邻人舒某，本药材商，其妻生育过多，舒某因以为虚也，适值产后，用大量参芪伴老母鸡炖汤与服，以后产妇腹胀如鼓，目赤如金，终至不救。又见一壮年，久服参茸，头发尽脱，几至失明，皆为滥服补药致变。而今来就诊求开补益方者，比比皆是，草此一篇，以为来者之殷鉴。
三、血虚误攻救治琐谈妇科月经不调病患，其病理机制及治疗大法的重点，是以血分为主。但月经不调，有属血瘀者，亦有属于血虚者。若血瘀之证，自可采取活血祛瘀或破血逐瘀的治法。设是血虚之证，特别是误投破血逐瘀之剂，则为害甚大，甚至能促使病机恶化而危及生命。李氏遇妇科血虚误用破血逐瘀致变病例较多，兹录数例，聊举一隅，以供参究。
治陈某某，女，１６岁，汉阳县南乡人。某年８月由家属领来诊治。据云该女至１３岁月事初潮，后年余尚正常。惟近两年月事忽止，脐腹胀大如怀孕状。延医服破血通经药数剂，初有小效，经行一次，再服１０余剂，无效。特来求治。愚视其形容憔悴，面色苍白，时方初秋而怯冷畏寒，衣尚着棉，言语迟呆，目睛无神。触诊肝脾肿大，脉细如丝，舌质淡白，并间有大便带血的症状。此因患者生活于血吸虫疫区，当是因血吸虫感染而致成蛊积，正虚邪实，破血药不可滥用也。与《金匮》温经汤（吴茱萸、当归、川芎、赤芍、党参、阿胶、丹皮、法半夏、麦冬、炙草、生姜）全方。并嘱其往血吸虫防治处检视。后三月余来复诊，家属代诉，经血吸虫防治处检验阳性。服前方约２０剂后，精神渐振，即住院专治血吸虫病转阴后，又服前方约１０剂后，特来复诊。视其面色转为红活，精神较为活泼，肝脾缩小，食欲增加，脉证均有改善，惟月事仍未大至。遂于前方中去丹皮，重加益母草及丹参、制香附、乌药等药，是于温经暖血益气培本中，略参活瘀理气调经之法。后家属来换方数次，主宗前方而略为加减，调养至次春而月事正常。
治陈某某，女，农民。因事务劳顿，而性情急躁，常有心悸失眠之证。又年逾四十，而月经未至，经注射黄体酮针剂，月经方来，后亦无效。又服中医活血通经药数剂，亦无效。其夫为兽医，因闻红花泡酒服对通经有效，遂如法泡服。某次因药量过大，服后经血大至，血注如崩。适李氏回家休假，其夫丁某急邀诊治。诊时脉细如丝，舌质淡白，神情间有躁动之状。是时血虽少止，而尚漏下。李氏曰：此证当必心脾血虚之证。血虚不能上荣于心脑，故心悸失眠；血虚不能下注于胞宫，故未值经绝期而月信少至。《内经》谓“二阳之病发心脾，有不得隐曲，女子不月”，似与此证病机略同。治法不以荣养心脾固本培源为主，而见证治证，惟以逐瘀通经是图，遂至酿为血崩大证。此时救治之法，仍当以荣养心脾益气固摄为主，方用归脾汤加阿胶、乌贼骨、茜草根炭、熟地、血余炭，服药五大剂后，漏下已止，精神渐振。再诊：去血余炭、乌贼骨等止血药，仍用归脾法调理，又服药２０余剂，始能起床，而月事从此未至矣。
某年秋季，我利用暑假回到家乡休假，恰逢邻村刘湾一位姓吴的壮年男子，患疟疾二十多天未愈。他拿着之前服用的方子给我看，方中主要是草果、黄芩等药物。我说：间歇性疟疾发作多次，症状典型，可以使用截疟法。这个方子应当加入酒炒常山，在疟疾发作前两小时服用，必定有效。服药后，果然痊愈。乡间的医生认为常山是下品毒药，不敢轻易使用。李士材说：“世俗之人畏惧常山引起呕吐，不知道它治疗疟疾有神奇功效，只要炒透就不会引起呕吐。”这可以说是知理之言。昔日清朝康熙皇帝给曹寅的信中，推崇金鸡纳治疗疟疾有奇效，称中原没有治疗疟疾的有效药物，并有疟疾不可随意服用人参的说法（见《红楼梦》附录）。我认为金鸡纳又名金鸡勒，清朝赵学敏根据查慎行《人海记》所载，已将其收入《本草纲目拾遗》卷六木部下，此药治疗疟疾有效，这是事实。然而中医治疗疟疾的有效方剂，如汉代张仲景的《金匮要略》中使用蜀漆散治疗牝疟、温疟，唐代《千金方》、《外台秘要》以下医书中使用常山、蜀漆治疗疟疾的方剂，不胜枚举。因此回忆起过去汉川县某小镇的一家药店，有治疗疟疾的方子多验。正值暑月，每天卖出数百剂药，其药材经过铡碎处理，不传秘方。我托人购买其药物，仔细检查，得知含有常山、草果、槟榔、乌梅、川朴、半夏、黄芩、陈皮等药物，是从达原饮、截疟七宝饮等方剂变化而来。所以我采用上述方法，广泛治疗截疟，随证加减，极有效验。至于人参是否可以治疗疟疾，我认为如果疟疾夹杂暑湿纠缠，病邪势盛，虽然显露虚象，自然不可服用。曾见过疟疾患者误服人参补益，酿成臌胀证，以至于无法救治的情况。如果说疟疾一概禁用人参，也不尽然。曾诊治塾师李澍村，年龄超过六十岁，患疟疾，服用截疟药即好转，但不能断根，遇风冷即发作，像这样持续两年。延请诊治：时值仲秋，穿着厚重棉衣。我看他舌苔白滑，脉象濡缓无力，四肢冰冷恶寒，稍食生冷或油腻食物即腹痛吐泻。判断为久疟导致中气虚弱，虚多邪少的证候。适宜用露姜饮加味，以温中固本为主，兼微散邪的方法。于是给予高丽参6克，苏红皮5克（我在临床中凡是用参、芪、白术等甘温补益中焦的药物，必少加陈皮、枳壳等理气快膈之品，如异功散用陈皮，枳术丸用枳实的例子，则补而不滞，补而受益）。药炖好后，兑入鲜生姜汁一匙，露天放置一夜，服用前加热，分两次服用。服药后精神立即振奋，以后连续服用数次，疟疾不再发作。这是治疗虚疟、久疟，人参间或也可使用。所以人参治疗疟疾的说法，必须运用辨证的方法，审证而定，并非一概禁用。
中医治病，应以辨证论治的原则为指导，而其重要的一个环节，又在遣方用药方面。但时下风尚，多重医而轻药。岂知投剂不准，用药不当，不仅影响病情向好的方面转化，甚至能危及患者生命，由此可知一味药的细微之处，关系于临床至大。
二、误补救治琐谈
中医使用补药，补血如当归、枸杞，育阴宜地黄、阿胶，益气用黄芪、人参，助阳用鹿茸、附子之类，皆为人们所熟知而为医生所习用者也。但补为八法之一，中药之用，主要是针对病情，大抵为补偏救弊而设。设或患者果属虚证，在阴阳气血某一方面已显露不足，虚者补之，借用某类补剂，调整其机能，从而促使阴阳平衡，得以早日恢复健康，斯为善治。若无病之人，妄服补药，不仅无益，反而有害。特别是在患病期间，病邪势盛，医者滥用补剂，不但留恋病邪，使病势迁延不愈；更重要的是病邪弥漫，病机恶化，往往转变为不治之证。故徐洄溪《慎疾刍言》首述补剂之害，可谓洞中时弊，独具慧心。今特本诸历来临证之肤浅体会，谈谈滥用补剂之危害。
并举病案数例，以资佐证，而供参究。
鹿茸补精髓，益不足，古方如斑龙丸、百补全鹿丸、异类有情丸等方用之。然只适用于阳气衰惫之体。考李时珍谓：“鹿茸能返向尾，能通督脉，故取其角以补命，补精、补气以养阳也。”汪庵谓：“若真阴亏损，虚火上炎者，不可轻投，恐反涸其水也。”洵为见道之言。吾乡鹿城湾李某某，27岁，某年秋，其父偕同来诊。诊其脉弦细而数，舌苔干而黄燥。其证头胀巅痛，眼赤羞明，心烦易怒，口干畏热，小便短涩赤黄，大便干结难行，阳事易举，时有梦遗。我惊讶地说：正值壮年，身体当甚健硕，何以一病至此。遂询问其缘由，始知结婚数年，未见生育，又因有遗精，家人虑其体虚，广购参桂鹿茸丸及参茸制剂成药与服。是此病因过服温补壮阳之药，以损伤真阴，扰动相火，火势燎原，不可遏止，故见证如此。因思此时治法，当于养阴和营中，突出以清肝热，泄郁火为宜。方用龙胆泻肝汤全方，重用生地至60克，并加生白芍15克，酒洗大黄10克与服。二诊：上方服三剂后，上部火热之势大减，大便通利，惟小溲仍短赤灼痛。改用知柏地黄汤加白薇、白芍、茅根、制龟板、忍冬藤，以育阴泄火为治。此方服至二十剂，诸证渐趋向愈，脉之弦数亦和。再用生料六味丸合五子衍宗丸方意，以调理收功。后其至某农场当司机，身体健壮，其爱人已生小孩。
《伤寒论》四逆汤、四逆加人参汤，为回阳救逆要方，适用于三阴虚寒四肢厥逆之证。然引起厥逆的病因多端，如四逆散治肝郁气结而见四逆，亦载于少阴篇，当应用此以与阳衰阴盛之四逆作出鉴别。实则虚寒厥冷，病因亦不只少阴一途。如厥阴血虚寒凝，主用当归四逆汤，以治手足厥寒，脉细欲绝，即是证明。是故一遇厥冷，滥用姜附，实足以偾事。回忆同乡汤某某，小学教员，体素弱。某年七月患感冒发热，初起神志昏愦，手足清冷。前医进四逆加人参汤二剂，服后患者烦躁不安，狂乱欲走。诊时视其舌苔白厚而腻，脉滑而数。其身灼热，小便短赤，大便难行，触诊胸腹部有蹙眉而感不舒之状。因断之曰：暑湿蕴隆，阳气为时令之邪所遏，故见厥冷，与虚寒四逆，大相径庭。此证失于清解，又误用温补，遂至邪热披猖，扰乱神明，而为烦躁昏狂。然舌苔白厚，脉象滑数，当是病邪尚在气分而不在营分，与清营、清宫之证不同；又与阳明燥实，证见腹满、苔黄之当下证亦有区别。此时救逆之法，拟急与清宣暑湿展利枢机为治。
方用叶天士甘露消毒丹加减化裁。处方：黄芩、川贝母、炒栀子、炒香豉各10克，茵陈、六一散、竹叶、连翘各15克，薄荷4克（后下）。2剂。二诊：热势稍退，手足温和，神识已清，烦躁已平，前方去栀、豉、石菖蒲，加佩兰10克。2剂。三诊：上方服完后，患者忽得战汗，全身热退，神疲思睡，改用轻宣湿热兼和胃之法，再服药数剂而病愈。
黄芪生用固表，温分肉，实腠理；多用补中，益元气，生血生肌，排脓内托，是疮疡要药，为补药之长，东垣补中益气汤、保元汤等均以此为主药。《金匮》防己黄芪汤治风水，防己茯苓汤治皮水，均用黄芪治水气病在肌肤而又兼有表虚者，若不属此种证型，似不可滥用。某年秋，本院某某级学生偕指导员王某扶掖一退休老工人柳某某来诊，自诉：年50余，素有咳喘，近来发而加剧，更现浮肿，曾住某医院内科病房治疗五个月，断为肺心病，中西医药配合治疗无效，已下数次病危通知单，促其家属领回治疗。因此，由实习学生介绍前来。诊其脉弦缓而时有一歇止，舌苔白厚而滑腻。其证咳唾稠痰而不能畅出，呼吸迫促而不能平卧，目不交睫已数昼夜，面部、四肢均见浮肿，腹部臌胀，腰围增大，口干而不敢多饮，纳食亦少，小便短涩而黄，大便不爽。
寻视中医以前处方，大都为通阳利水之剂，惟每方中必用黄芪，每剂药量有从30克渐增至150克，而药亦罔效。因思此证自属水气为病。水气内停，肺气不得宣化，三焦因而不利，故上见咳嗽喘促，下而二便不爽；水气泛于肌表四肢，则见浮肿；水气内结，心阳不宣，故脉现歇止。医者虽用宣化分消之法，而中有大量益气实表之药，遂至愈补愈涩，一发而不可措手。此时救治之法，当以对证之标实为主，徐徐疏瀹，冀其转危为安。方用五子五皮汤加减。处方：炒莱菔子、炒紫苏子、车前子、大腹皮、桑白皮各10克，冬瓜皮30克，茯苓皮15克，防己、生杏仁、陈皮、生姜皮、川朴各6克，炒葶苈子5克。水煎服。二诊：服完上方三剂后，喘促渐平，已能安寐，小溲较多，大便爽利。仍守前法以治，上方去葶苈子。以后或加川贝母、紫菀、白前、枇杷叶以宣肺化痰；或加枳壳、陈香椽皮以理气消胀；或加薏苡仁、梗通草、六一散以分消水湿。前后来诊约十数次，用药大抵如上所述，惟略用参术，患者即感胀闷不舒。以后仍与小剂宣化，坚持两月，守至患者肿势渐退，咳喘亦平，能扶杖而行，惟脉之歇止，尚未恢复。
地黄、阿胶为甘寒滋润育阴养血要药，然适用于阴虚之证。若素禀阳虚及久病痰饮之体，误用足以偾事，不仅腻膈碍胃而已。同乡李某某，男，年50余，素患咳喘，并有失血之证。医者常进熟地、阿胶、龟板、枸杞类滋润药，间用此类药熬膏与服。其病时而小愈，时而加剧。某年秋患感冒发热，引起咳喘加重，医者又用前法以治，无效。视其咳唾涎沫而顷刻盈盂，呼吸迫促而不能平卧，咳无一息之停，声音嘶哑，面部浮肿，口干而喜热饮，食欲少进，二便尚可，其脉弦紧，舌苔灰白而厚。以前有咯血史，目下尚未复发。因断之曰：此证当是痰饮为病。《金匮》谓：“咳逆倚息而不得卧，其形如肿者，谓之支饮”者是。治此证不与温化涤饮，反用滋阴腻膈药物，促使饮邪蕴积，汪洋聚于心下，肺气不得宣布，胃气不能和降，因此浊沫频唾，喘促不宁，渐至酿为危重之证，。此时救治之法，当宗《金匮》“病痰饮者，当以温药和之”，“咳逆倚息不得卧者，小青龙汤主之”为宜。因患者略识药性，又有咯血史，畏服麻、桂、细辛。我不惜反复开导，并举前贤徐灵胎治松江王某妻医案，与此病正相类似，可为一证。幸蒙患者首肯，因与小青龙汤原方，并遵仲景之法，略加紫菀、款冬花以温润化痰，厚朴、杏仁以理气平喘。患者服头煎后，即感胸廓爽朗，以后连进三剂，喘促渐平，咳痰亦稀，已能就枕安寐。随用温中宣肺化饮法调理而病愈。
综上所述，可知补剂滥用，危害甚大。我年轻时曾见邻居舒某，本是药材商，其妻生育过多，舒某因以为虚也，适值产后，用大量参芪伴老母鸡炖汤与服，以后产妇腹胀如鼓，目赤如金，终至不救。又见一壮年，久服参茸，头发尽脱，几至失明，皆为滥服补药致变。而今来就诊求开补益方者，比比皆是，草此一篇，以为来者之殷鉴。
三、血虚误攻救治琐谈
妇科月经不调病患，其病理机制及治疗大法的重点，是以血分为主。但月经不调，有属血瘀者，亦有属于血虚者。若血瘀之证，自可采取活血祛瘀或破血逐瘀的治法。设是血虚之证，特别是误投破血逐瘀之剂，则为害甚大，甚至能促使病机恶化而危及生命。李氏遇妇科血虚误用破血逐瘀致变病例较多，兹录数例，聊举一隅，以供参究。
治陈某某，女，16岁，汉阳县南乡人。某年8月由家属领来诊治。据云该女至13岁月事初潮，后年余尚正常。惟近两年月事忽止，脐腹胀大如怀孕状。延医服破血通经药数剂，初有小效，经行一次，再服10余剂，无效。特来求治。我看她形容憔悴，面色苍白，时方初秋而怯冷畏寒，衣尚着棉，言语迟呆，目睛无神。触诊肝脾肿大，脉细如丝，舌质淡白，并间有大便带血的症状。此因患者生活于血吸虫疫区，当是因血吸虫感染而致成蛊积，正虚邪实，破血药不可滥用也。与《金匮》温经汤（吴茱萸、当归、川芎、赤芍、党参、阿胶、丹皮、法半夏、麦冬、炙草、生姜）全方。并嘱其往血吸虫防治处检视。后三月余来复诊，家属代诉，经血吸虫防治处检验阳性。服前方约20剂后，精神渐振，即住院专治血吸虫病转阴后，又服前方约10剂后，特来复诊。视其面色转为红活，精神较为活泼，肝脾缩小，食欲增加，脉证均有改善，惟月事仍未大至。遂于前方中去丹皮，重加益母草及丹参、制香附、乌药等药，是于温经暖血益气培本中，略参活瘀理气调经之法。后家属来换方数次，主宗前方而略为加减，调养至次春而月事正常。
治陈某某，女，农民。因事务劳顿，而性情急躁，常有心悸失眠之证。又年逾四十，而月经未至，经注射黄体酮针剂，月经方来，后亦无效。又服中医活血通经药数剂，亦无效。其夫为兽医，因闻红花泡酒服对通经有效，遂如法泡服。某次因药量过大，服后经血大至，血注如崩。适李氏回家休假，其夫丁某急邀诊治。诊时脉细如丝，舌质淡白，神情间有躁动之状。是时血虽少止，而尚漏下。李氏曰：此证当必心脾血虚之证。血虚不能上荣于心脑，故心悸失眠；血虚不能下注于胞宫，故未值经绝期而月信少至。《内经》谓“二阳之病发心脾，有不得隐曲，女子不月”，似与此证病机略同。治法不以荣养心脾固本培源为主，而见证治证，惟以逐瘀通经是图，遂至酿为血崩大证。此时救治之法，仍当以荣养心脾益气固摄为主，方用归脾汤加阿胶、乌贼骨、茜草根炭、熟地、血余炭，服药五大剂后，漏下已止，精神渐振。再诊：去血余炭、乌贼骨等止血药，仍用归脾法调理，又服药20余剂，始能起床，而月事从此未至矣。
In an autumn year, during my summer vacation when I returned to my hometown, a robust middle-aged man surnamed Wu from Liuwan village in the neighboring area was suffering from malaria that had persisted for more than twenty days without recovery. He showed me the prescription he had previously taken, which mainly consisted of Caoguo (Tsaoko Fruit) and Huangqin (Scutellaria Root). I said: For intermittent malaria that has occurred multiple times with typical symptoms, a method to intercept the malaria can be used. This prescription should be added with Jiuchao Changshan (Alkanna Root processed with wine), administered two hours before the onset of the malaria, and it will surely be effective. After taking the medicine, he indeed recovered. Doctors in the countryside considered Changshan (Alkanna Root) as a toxic drug of low grade and dared not use it lightly. Li Shicai said: "The common people fear that Changshan causes vomiting, unaware of its miraculous efficacy in treating malaria; if thoroughly fried, it will not cause vomiting." This can be considered a statement of reason. In the past, Emperor Kangxi of the Qing Dynasty, in a letter to Cao Yin, praised Cinchona (Jinjinna) for its miraculous effect in treating malaria, stating that there were no effective drugs for malaria in the Central Plains, and also mentioned that Ginseng should not be taken casually for malaria (see Appendix of *Dream of the Red Chamber*). I believe that Cinchona is also known as Jinjingle. Zhao Xuemin of the Qing Dynasty, based on the records in Cha Shenxing's *Renhai Ji*, had already included it in Volume 6, Wood Category, of *Bencao Gangmu Shiyi* (*Supplement to Materia Medica*). The fact that this drug is effective in treating malaria is undeniable. However, effective prescriptions for treating malaria in Traditional Chinese Medicine are numerous. For instance, Zhang Zhongjing of the Han Dynasty used Shuqi San (Shuqi Powder) in *Jingui Yaolue* (*Essential Prescriptions from the Golden Cabinet*) to treat Pin Malaria and Wen Malaria. Below the Tang Dynasty's *Qianjin Fang* (*Prescriptions Worth a Thousand Gold*) and *Waitai Miyao* (*Secret Essentials of the Outer Cabinet*), there are countless prescriptions using Changshan (Alkanna Root) and Shuqi (Marsdenia Vine) to treat malaria. Therefore, I recall a pharmacy in a small town in Hanchuan County where there were many effective prescriptions for treating malaria. During the hot summer months, hundreds of doses were sold daily. The herbs were chopped but the prescription was not passed down. I asked someone to purchase their medicine and examined it carefully, discovering it contained Changshan (Alkanna Root), Caoguo (Tsaoko Fruit), Binglang (Areca Seed), Wumei (Chinese Plum), Chuanpu (Aucklandiae Radix), Banxia (Pinellia Tuber), Huangqin (Scutellaria Root), and Chenpi (Citrus Reticulata Peel). It was derived from modifications of formulas such as Dayuan Yin (Origin-Reaching Decoction) and Jiemie Qibao Yin (Seven-Treasure Malaria-Intercepting Decoction). Thus, I adopted the above method to widely treat malaria interception, adding or subtracting ingredients according to the syndrome, which proved highly effective. As for whether Ginseng can treat malaria, I believe that if malaria is complicated by summerheat-dampness entanglement and the pathogenic factor is vigorous, even if deficiency signs appear, it naturally cannot be taken. I have seen cases where patients with malaria mistakenly took Ginseng for tonification, leading to abdominal distension (Gu Syndrome) and ultimately untreatable conditions. To say that Ginseng is absolutely contraindicated for all types of malaria is not entirely accurate. I once treated a tutor named Li Shucun, who was over sixty years old. He suffered from malaria; although taking malaria-intercepting medicines brought relief, it did not cure the root cause, and it would recur upon exposure to wind-cold, persisting for two years. Upon consultation: It was mid-autumn, yet he wore heavy cotton clothes. I observed his tongue coating was white and slippery, his pulse was soggy, slow, and weak, his limbs were cold and he feared cold, and eating even slightly raw/cold or greasy food caused abdominal pain, vomiting, and diarrhea. I diagnosed this as Middle Qi Deficiency resulting from prolonged malaria, a pattern characterized by predominant deficiency and scanty pathogen. It was appropriate to use Lujian Yin (Dewed Ginger Drink) with modifications, focusing on warming the middle and consolidating the root, while slightly dispersing the pathogen. I prescribed Gaolishen (Korean Ginseng) 6g and Suhongpi (Red Pericarpium Nelumbinis) 5g. (In my clinical practice, whenever I use sweet-warm tonifying middle-jiao herbs like Renshen, Huangqi, and Baizhu, I always add a small amount of Chenpi or Zhiqiao to regulate qi and open the diaphragm, similar to using Chenpi in Yigong San or Zhishi in Zhizhu Wan, so that tonification does not cause stagnation and benefits from it). After decocting, one spoonful of fresh Shengjiang juice (Fresh Ginger Juice) was mixed in, left exposed overnight, warmed before consumption, and taken in two divided doses. After taking it, his spirit immediately improved. After several consecutive doses, the malaria did not recur again. This shows that for deficiency malaria or prolonged malaria, Ginseng can occasionally be used. Therefore, the assertion that Ginseng treats malaria must be applied through differentiation of syndromes and examination of signs, rather than being absolutely contraindicated.
Treating diseases in Traditional Chinese Medicine should be guided by the principle of syndrome differentiation and treatment, and an important link lies in the selection of prescriptions and herbs. However, current trends often emphasize physicians while neglecting herbs. Who knows that inaccurate dosing and improper medication not only affect the favorable transformation of the condition but can even endanger the patient's life. Thus, the subtlety of a single herb relates greatly to clinical practice.
II. Brief Discussion on Treating Errors in Tonification
The use of tonifying drugs in Traditional Chinese Medicine, such as Danggui (Angelica Sinensis) and Gouqi (Lycium Fruit) for blood tonification, Dihuang (Rehmannia Root) and Ejiao (Donkey-hide Gelatin) for nourishing yin, Huangqi (Astragalus Root) and Renshen (Ginseng Root) for qi tonification, and Lurong (Deer Antler) and Fuzi (Aconite Root) for assisting yang, are well-known to people and commonly used by doctors. But tonification is one of the Eight Methods. The use of Chinese herbs mainly targets the condition, generally designed to correct imbalances and remedy deficiencies. If a patient truly belongs to a deficiency pattern, showing insufficiency in one aspect of Yin-Yang or Qi-Blood, the deficient should be tonified. Borrowing certain tonifying agents to adjust function can promote Yin-Yang balance and facilitate early recovery of health, which is good treatment. If healthy people take tonifying drugs blindly, it is not only useless but harmful. Especially during illness, when pathogenic factors are vigorous, doctors' abuse of tonics not only retains pathogens and prolongs the disease; more importantly, it allows pathogens to spread and worsens the pathology, often turning into untreatable conditions. Therefore, Xu Huixi's *Shenji Chu Yan* (*Cautious Words on Illness*) first describes the harm of tonics, hitting the nail on the head regarding contemporary evils, showing unique insight. Here, based on my superficial experience in clinical practice, I discuss the dangers of abusing tonics.
I present several case studies to support these points and provide material for reference.
Lurong (Deer Antler) supplements essence and marrow, benefiting insufficiency. Ancient formulas like Banlong Wan (Spotted Dragon Pill), Baibu Quanlu Wan (Hundred-Tonics Whole Deer Pill), and Yilei Youqing Wan (Pills of Different Kinds with Affinity) use it. However, it is only suitable for bodies with exhausted Yang Qi. Li Shizhen stated: "Deer antler can reverse towards the tail and unblock the Du Meridian, so its horn is taken to supplement Mingmen, replenishing essence and qi to nourish Yang." Wang Pang'an said: "If True Yin is damaged and Deficient Fire flares upward, it should not be lightly administered, lest it dry up the water." These are indeed profound words. A patient surnamed Li from Luchengwan in my hometown, aged 27, came for consultation with his father in an autumn year. His pulse was wiry, thin, and rapid; his tongue coating was dry and yellow-brown. His symptoms included head distension and vertex pain, red eyes sensitive to light, irritability, dry mouth, aversion to heat, short and turbid yellow urine, hard and difficult stool, frequent erections, and occasional nocturnal emissions. I exclaimed: At the prime of youth, the body should be robust, how could one fall ill to this extent? Upon inquiry, I learned he had been married for several years without offspring and suffered from nocturnal emissions. Worried about his weakness, his family bought extensively Can Gui Lurong Wan (Ginseng-Cinnamon-Deer Antler Pill) and other prepared medicines containing Ginseng and Deer Antler for him to take. This illness resulted from excessive intake of warm-tonifying and Yang-strengthening drugs, damaging True Yin and disturbing Ministerial Fire, causing the fire to rage uncontrollably, hence the manifestations. I thought at this time, the treatment should focus on nourishing Yin and harmonizing the Ying level, highlighting clearing Liver Heat and draining Stagnant Fire. I prescribed the complete Longdan Xiegan Tang (Gentian Liver-Draining Decoction), heavily using Shengdi (Rehmannia Root) up to 60g, adding Sheng Baishao (Raw White Peony Root) 15g and Jiuxi Dahuang (Wine-washed Rhubarb) 10g. Second visit: After three doses of the above prescription, the upper body heat significantly decreased, stool became smooth, but urine remained short, red, and burning. I changed to Zhibai Dihuang Tang (Anemarrhena, Phellodendron, and Rehmannia Pill) plus Baiwei (Cynanchum Atratum), Baishao (White Peony Root), Maogen (Imperata Rhizome), Zhi Guiban (Processed Turtle Shell), and Rendongteng (Honeysuckle Stem), to nourish Yin and drain fire. After twenty doses of this formula, various symptoms gradually improved, and the wiry-rapid pulse harmonized. Then, using the intent of Shengliao Liuwei Wan (Six-Ingredient Pill with Raw Materials) combined with Wuzi Yanzong Wan (Five-Seed Progeny-Proliferating Pill) to regulate and conclude treatment. Later, he worked as a driver at a farm, became physically robust, and his wife gave birth to a child.
*Sijing Lun* (Treatise on Cold Damage) Si Ni Tang (Four Counterflow Decoction) and Si Ni Jia Renshen Tang (Four Counterflow Decoction plus Ginseng) are crucial formulas for restoring Yang and rescuing from collapse, applicable to patterns of Three Yin Deficiency-Cold with cold extremities. However, the causes of counterflow cold are diverse. For example, Si Ni San (Four Counterflow Powder) treats counterflow cold due to Liver Qi Stagnation and Knotting, also recorded in the Shaoyin Chapter. One should apply this to differentiate it from the counterflow cold of Yang Decline and Yin Excess. In reality, the causes of deficiency-cold counterflow are not limited to the Shaoyin pathway. For instance, Jueyin Blood Deficiency with Cold Coagulation primarily uses Danggui Sini Tang (Angelica Sinensis Counterflow-Warming Decoction) to treat cold hands and feet with a fine pulse nearly imperceptible, which is proof. Therefore, encountering cold extremities and indiscriminately using Jiang (Ginger) and Fu (Aconite) is sufficient to ruin matters. I recall a fellow townsman, Mr. Tang, a primary school teacher, whose constitution was inherently weak. In July of a certain year, he contracted a cold with fever. Initially, his consciousness was clouded, and his hands and feet were cold. The previous doctor administered two doses of Si Ni Jia Renshen Tang. After taking it, the patient became restless, manic, and wanted to run away. On examination, his tongue coating was white, thick, and greasy; his pulse was slippery and rapid. His body was burning hot, urine was short and red, stool was difficult to pass, and palpation of the chest and abdomen revealed discomfort causing him to frown. I diagnosed: Summerheat and dampness were accumulating, and Yang Qi was obstructed by seasonal pathogens, hence the cold extremities, which is vastly different from deficiency-cold counterflow. This condition lacked clear resolution and was wrongly treated with warm tonification, leading to rampant pathogenic heat disturbing the Spirit, resulting in restlessness, confusion, and mania. However, the white thick tongue coating and slippery-rapid pulse indicated the pathogen was still in the Qi Level, not the Ying Level, differing from Qingying Tang (Clear Ying Decoction) or Qinggong Tang (Clear Palace Decoction) patterns; it also differed from Yangming Dry-Fullness requiring purgation, which presents with abdominal fullness and yellow coating. The rescue method at this time should urgently clear and diffuse summerheat-dampness and unblock the pivot mechanism.
I prescribed Ye Tianshi's Ganlu Xiaodu Dan (Sweet Dew Detoxifying Decoction) with modifications. Prescription: Huangqin (Scutellaria Root), Chuanbeimu (Fritillaria Cirrhosa Bulb), Chao Zhizi (Fried Gardenia), Chao Xiangchi (Fried Fermented Soybean) each 10g; Yichen (Coix Seed), Liuyisan (Six-One Powder), Zhuye (Bamboo Leaf), Lianqiao (Forsythia Fruit) each 15g; Bohe (Mint) 4g (added later). 2 doses. Second visit: Heat slightly subsided, hands and feet became warm, consciousness cleared, restlessness calmed. Removed Zhizi, Xiangchi, and Shichangpu from the previous formula, added Peilan (Eupatorium Fortunei) 10g. 2 doses. Third visit: After finishing the above prescription, the patient suddenly experienced a battle sweat, whole-body heat retreated, spirit fatigued and sleepy. Changed to a mild method to diffuse damp-heat and harmonize the Stomach, taking several more doses until cured.
Huangqi (Astragalus Root), used raw, secures the exterior, warms the muscle spaces, and solidifies the couli; used in larger amounts, it tonifies the middle, benefits Yuan Qi, generates blood and flesh, expels pus, and supports internally. It is a key herb for sores and ulcers and the leader among tonics. Dongyuan's Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) and Baoyuan Tang (Protect Origin Decoction) all use it as the main herb. *Jingui Yaolue*'s Fangji Huangqi Tang (Stephania and Astragalus Decoction) treats Wind Water, and Fangji Fuling Tang (Stephania and Poria Decoction) treats Skin Water, both using Huangqi to treat water-qis disorders in the skin and muscles accompanied by exterior deficiency. If not belonging to this syndrome type, it seems inappropriate to use indiscriminately. In an autumn year, a student of our institute accompanied Instructor Wang to bring a retired worker, Mr. Liu, for consultation. He reported: Over 50 years old, suffering from chronic cough and asthma, recently exacerbated with edema. He had been treated in the internal medicine ward of a hospital for five months, diagnosed with Cor Pulmonale. Combined Western and Chinese medicine treatment was ineffective. Several critical condition notices had been issued, urging family to take him home for care. Therefore, introduced by intern students. His pulse was string-taut and slow with occasional intermissions; tongue coating was white, thick, and slippery-greasy. Symptoms: Coughing up thick phlegm unable to be expectorated freely, rapid breathing unable to lie flat, sleepless for several days, edema on face and limbs, abdominal distension, increased waist circumference, dry mouth but afraid to drink much, poor appetite, short and turbid yellow urine, unsatisfactory stool.
Reviewing previous Chinese medicine prescriptions, most were Yang-unblocking and water-draining agents, but every prescription necessarily contained Huangqi (Astragalus Root), with dosage gradually increasing from 30g to 150g per dose, yet the medicine was ineffective. I reasoned this condition belongs to Water-Qi disorder. Water-Qi stagnates internally, Lung Qi cannot diffuse and transform, Sanjiao becomes unfavorable, hence upper cough and asthma, lower unsatisfactory urination and defecation; Water-Qi floods muscle surface and limbs, causing edema; Water-Qi knots internally, Heart Yang cannot disseminate, hence pulse intermissions. Although doctors used methods to diffuse and separate, the presence of large amounts of Qi-tonifying and exterior-solidifying drugs led to愈补愈涩 (the more tonified, the more stagnant), becoming uncontrollable. The rescue method at this time should focus on symptomatic excess, slowly dredging, hoping to turn danger into safety. I prescribed Wuzi Wupi Tang (Five-Seeds Five-Skins Decoction) with modifications. Prescription: Chao Laifuzi (Fried Radish Seed), Chao Zisuzi (Fried Perilla Seed), Cheqianzi (Plantago Seed), Dafupi (Areca Peel), Sangbaipi (Mulberry Root Bark) each 10g; Dongguapi (Winter Melon Peel) 30g; Fulingpi (Poria Peel) 15g; Fangji (Stephania Tetrandra), Sheng Xingren (Raw Apricot Seed), Chenpi (Citrus Peel), Shengjiangpi (Ginger Peel), Chuanpu (Aucklandiae Radix) each 6g; Chao Tinglizi (Fried Lepidium Seed) 5g. Decoct in water and take. Second visit: After three doses, asthma gradually calmed, able to sleep peacefully, more urine, smooth stool. Still adhering to the previous method, removed Tinglizi from the formula. Later, sometimes added Chuanbeimu, Ziwan, Baiqian, Pipaye to diffuse Lung and resolve phlegm; or added Zhiqiao, Chenxiangchuapi to regulate Qi and reduce distension; or added Yiyiren, Gengtongcao, Liuyisan to separate and drain damp-water. Visited about ten times, medications roughly as described above, except slight use of Renshen and Baizhu made the patient feel bloated and uncomfortable. Subsequently, continued with small doses of diffusion and transformation, persisting for two months, until swelling gradually receded, cough and asthma calmed, able to walk with a cane, only the pulse intermission had not recovered.
Dihuang (Rehmannia Root) and Ejiao (Donkey-hide Gelatin) are sweet-cold moistening herbs for nourishing Yin and blood, applicable to Yin Deficiency patterns. If one constitutionally has Yang Deficiency or suffers from long-term Phlegm-Fluid retention, misuse is sufficient to ruin matters, not just cloying the diaphragm and hindering the Stomach. Fellow townsman Mr. Li, male, over 50, suffered from chronic cough and asthma, and hemoptysis. Doctors frequently administered moistening drugs like Shudi (Prepared Rehmannia), Ejiao, Guiban (Turtle Shell), and Gouqi. Occasionally, these were boiled into paste for him to take. His illness fluctuated between slight improvement and exacerbation. In an autumn year, he caught a cold with fever, aggravating cough and asthma. Doctors used the previous method, ineffective. Observation: Coughing up saliva and foam filling a basin instantly, rapid breathing unable to lie flat, coughing without pause, hoarse voice, facial edema, dry mouth preferring hot drinks, poor appetite, urination and defecation acceptable, pulse wiry and tight, tongue coating gray-white and thick. History of hemoptysis, not currently recurring. I diagnosed: This condition is likely Phlegm-Fluid disorder. *Jingui Yaolue* states: "Coughing and wheezing unable to lie flat, appearance resembling swelling, is called Zhi Yin (Supporting Fluid)." Treating this condition without warming and transforming fluids, but instead using Yin-nourishing and cloying drugs, promotes fluid accumulation, gathering vast amounts in the epigastrium, Lung Qi cannot announce, Stomach Qi cannot descend, hence frequent spitting of turbid foam, restless asthma, gradually酿为危重 (brewing into critical condition). The rescue method at this time should follow *Jingui*: "For Phlegm-Fluid diseases, warm herbs should harmonize," and "For coughing/wheezing unable to lie flat, Xiao Qinglong Tang is the master formula." Since the patient knew some pharmacology and had a history of hemoptysis, he feared taking Mahuang (Ephedra), Guizhi (Cinnamon Twig), and Xixin (Asarum). I spared no effort in repeated guidance, citing the medical case of Xu Lingtai treating the wife of Mr. Wang in Songjiang, which was very similar to this disease, serving as evidence. Fortunately, the patient agreed. I prescribed the original Xiao Qinglong Tang (Minor Blue Dragon Decoction), and following Zhongjing's method, slightly added Ziwan (Asterae Caulis) and Kuandonghua (Fritillaria Thunbergii Flower) to moisten and warm while resolving phlegm, Houpo (Magnolia Bark) and Xingren (Apricot Seed) to regulate Qi and calm asthma. After the first decoction, the patient felt his chest become clear. After three consecutive doses, asthma gradually calmed, sputum became thin, able to sleep on the pillow. Followed up with warming middle, diffusing Lung, and transforming fluid methods until cured.
In summary, it is known that the abuse of tonics causes great harm. When I was young, I saw a neighbor, Mr. Shu, a herbal merchant. His wife had given birth too many times. Mr. Shu considered her deficient. Postpartum, he used large amounts of Renshen and Huangqi stewed with an old hen for her to drink. Afterwards, the puerpera developed abdominal distension like a drum, eyes red as gold, ultimately dying. I also saw a robust man who took Ginseng and Deer Antler for a long time, losing all his hair and nearly going blind. All were changes caused by abusing tonics. Today, those coming for consultations to request tonic prescriptions are everywhere. I wrote this piece as a warning for future generations.
III. Brief Discussion on Treating Errors in Attacking Blood Deficiency
For female patients with irregular menstruation, the pathological mechanism and key treatment principles focus on the Blood Level. However, irregular menstruation can belong to Blood Stasis or Blood Deficiency. If it is Blood Stasis, one can adopt methods to invigorate blood and remove stasis or break blood and purge stasis. If it is Blood Deficiency, especially misusing blood-breaking and stasis-purging agents, the harm is great, potentially worsening pathology and endangering life. Dr. Li encountered many cases of gynecological blood deficiency mishandled with blood-breaking/stasis-purging drugs leading to complications. I record a few examples here to illustrate the point for reference.
Treating Ms. Chen, female, 16 years old, from South County, Hanyang County. Brought by family in August of a certain year. It was said she started menstruating at 13, normal for over a year. But for the past two years, menstruation suddenly stopped, abdomen and umbilicus distended like pregnancy. Consulted doctors, took blood-breaking and menstruation-promoting drugs for several doses, initially slight effect, menstruated once. Took another 10+ doses, ineffective. Specifically came for treatment. I observed her emaciated, pale complexion, early autumn but fearing cold, wearing cotton, speech sluggish, eyes dull. Palpation showed hepatosplenomegaly, pulse fine as silk, tongue pale, accompanied by bloody stools. This patient lived in a Schistosomiasis endemic area, likely caused by Schistosoma infection leading to Gu Accumulation (Abdominal Mass). Righteous Qi deficient, Evil Pathogen excess, blood-breaking drugs should not be abused. Prescribed the complete Wen Jing Tang (Warm the Menses Decoction) from *Jingui Yaolue* (Wuzhuyu, Danggui, Chuanxiong, Chi Shao, Dangshen, Ejiao, Danpi, Fa Banxia, Maidong, Zhi Cao, Shengjiang). Advised her to go to the Schistosomiasis Prevention and Control Center for examination. Three months later, returned for follow-up. Family reported positive test result at the center. After taking the previous formula about 20 doses, spirit gradually revived. Hospitalized for specific Schistosomiasis treatment. After turning negative, took the previous formula about 10 more doses, specifically returned for follow-up. Observed complexion turned rosy, spirit more lively, liver and spleen shrunk, appetite increased, pulse and symptoms improved, only menstruation still not significant. Thus, removed Danpi from the previous formula, heavily added Yimucao (Motherwort), Danshen (Salvia Miltiorrhiza), Zhi Xiangfu (Processed Cyperi Rhizome), Wuyao (Lindera Root) etc. This was within warming menses, warming blood, tonifying Qi, and cultivating the root, slightly incorporating activating stasis, regulating Qi, and regulating menstruation methods. Family came to change prescriptions several times, mainly adhering to the previous formula with slight modifications, regulated until next spring when menstruation normalized.
Treating Ms. Chen, female, farmer. Due to work fatigue and irritable temperament, often had palpitations and insomnia. Also over forty, menstruation had not arrived. After injecting Progesterone, menstruation came, but later ineffective. Took several doses of Chinese medicine blood-invigorating and menstruation-promoting drugs, also ineffective. Her husband was a veterinarian. Hearing that Honghua (Safflower) soaked in wine was effective for promoting menstruation, he prepared and fed it to her accordingly. One time, due to excessive dosage, after taking it, menstrual flow was massive, bleeding like a gush. Just then, Dr. Li was on vacation at home. Her husband, Mr. Ding, urgently invited consultation. Pulse fine as silk, tongue pale, expression occasionally agitated. At this time, blood had slightly stopped but still leaking. Dr. Li said: This condition must be Heart and Spleen Blood Deficiency. Blood deficiency cannot nourish the heart and brain upwards, hence palpitations and insomnia; Blood deficiency cannot flow downwards to the Uterus, hence menstruation scarce before menopause. *Neijing* states: "Diseases of the Two Yang originate in Heart and Spleen, having hidden grievances, women do not menstruate," which seems somewhat similar to the pathology of this condition. Treatment should not focus on nourishing Heart and Spleen to consolidate the root and source, but rather treating the manifested syndrome, solely seeking to purge stasis and promote menstruation, thus brewing into a major Hematemesis/Hematochezia (Blood Collapse) syndrome. The rescue method at this time should still focus on nourishing Heart and Spleen, tonifying Qi, and securing containment. Prescribed Guipi Tang (Restore the Spleen Decoction) plus Ejiao, Haijiegu (Cuttlefish Bone), Qiancaogen Tan (Charred Rubia Root), Shudi (Prepared Rehmannia), Xuyutan (Charred Hair). After five major doses of medicine, leakage stopped, spirit gradually revived. Second visit: Removed Xuyutan, Haijiegu, and other hemostatic drugs, still using Guipi method to regulate, took another 20+ doses, finally able to get out of bed, and menstruation never came again.