夫代赭石一物，《医学衷中参西录》谓“其质重坠，又善镇逆气，降痰涎，止呕吐，通燥结，用之得当，能建奇效。”观此两案，可知其于“脑震荡”、脑挫伤症之眩晕、呕吐卓具殊效，无疑是治疗脑震荡、脑挫伤之首选特效中药。此症之病机，曹氏谓为“浊气在上、清气在下”，而治疗大法取“镇胃降浊”，与通常所用之平肝潜阳、化痰熄风之法不同，迥出意表，可谓匠心独运，实为脑震荡脑挫伤病机之研究开一门径。
《续名医类案》载“许宣治一儿，十岁，从戏台倒跌而下，呕吐苦水，以盆盛之，绿如菜汁。许曰：此胆倒也，胆汁倾尽则死矣。方为温胆汤加枣仁、代赭石正其胆腑，名为正胆汤，一服吐止。昔曾见此证，不知其治，遂不救。”此案标新立异，名曰“胆倒”，方以温胆为主。然若不加代赭，必无是效，是以此方所得力者，仍属代赭也。设单用代赭一味，不合温胆枣仁，效亦可期，而“胆倒”之论却含深意，盖人体受震之后，清阳下陷，浊阴上潜，胆中浊气循经上达巅顶则眩晕，横逆胃腑则呕恶。治疗后清升浊降，胆气敛藏则诸证自已。此症胆胃同病，用代赭一物而两利之，因而速效。是故岐黄家不当固步自封于套方疲药，自当开拓进取，而求验方达药也。
又按：古人治病每以小方，简药重投，取其纯而力专也，故取效既宏且速。《旧唐书》第一百九十一卷载：“唐初许胤宗谓：‘夫病之于药，有正相当者，惟须单用一味，直攻彼病，药力既纯，病即立愈。今人不能别脉，莫识病源，以情臆度，多安药味。譬之于猎，未知兔所，多发人马，空地遮围，或冀一人偶然逢也。如此疗疾，不亦疏乎?!”许氏乃唐初名医，言虽寥寥，意则至深。余三复斯语，铭诸座右。
某商店黄姓女经理，年刚四旬。1988年3月21日，不慎于十级扶梯之上坠下水泥地，后脑着于地上，当即昏迷不醒，急送附近一区级医院抢救。翌日转送某市级医院会诊，诊断为“顶骨骨折，右颞、左额脑挫伤。”昏迷十七天后神识始清，共住院四十日，因病情好转而出院。返家后依然眩晕难支，仅能于室中扶物缓行，动作蹒跚迟钝，稍稍加快则泛恶不止，甚则呕吐。纳谷不振，二便尚调。目糊不清，视一物每见二、三重影；嗅觉丧失，但无鼻炎病史。生活起居，时刻需由家人看护扶持。至6月16日邀余诊视。诊得脉滑舌干，余症一如上述。先以代赭石100g水煎当茶饮，泛恶即止。复诊苔薄白，脉见上盛下虚之象，即以《医学衷中参西录》之镇肝熄风汤加减，以育阴潜阳，平肝熄风。方为：
代赭石30g生龙牡各30g淮牛膝15g炙龟板15g川楝子9g炒白芍9g元参9g天冬9g生麦芽9g茵陈9g炙甘草2g合欢皮15g天麻6g
服药一周，胃纳大开，嗅觉复常，仍以此方加减续进。服至二十帖，行动恢复正常，能自行乘车前来门诊。先后共服近百剂，病得痊愈。以后恢复工作，生活起居一如常人，亦无头痛眩晕，记忆减退等后遗症状。
按：头为诸阳之会，脑为元神之府。人身健康时，体内阴平阳秘，气血调畅。人体之阴阳气血升降有度，运行有序，协调均衡，则头脑清宁而灵敏觉知。一旦头颅为外力冲击，则巅中气血混杂，阴阳淆乱，清气不升，浊邪上干。阴火随冲气乘机潛位，肝阳胆气由是亢逆，逆扰于上则目眩头晕，化风走于四末则振掉而不利于行，犯胃则呕恶，旁及五官则耳、目、口、鼻、舌为之失灵。《内经》曰：“阴在内，阳之守也。”阳既化风逆上，阴阳失于维系，则真阴失固。且肝阳下吸肾阴，则阴伤更甚矣。故其治疗之法首须潜阳降逆。然真阴既伤，倘不滋填根本，欲潜其阳而阳终不潜，欲降其逆而逆必难降，是故涵育真阴，又当辅行。
据于此理，则治疗之方当以“镇肝熄风汤”最为合宜。此方虽为中风(脑充血)症而设，而其病机却与此证极为相似。如张锡纯于方后自注此方之适应机制云：“盖肝为木脏，木火炽盛，亦自有风，此因肝木失和风自肝起。又加以肺气不降，肾气不摄，冲气胃气又复上逆，于斯，脏腑之气化皆上升太过，而血之上注于脑者，亦因之太过，致充塞其血管而累及神经。”至其用药原理，是以方中重用赭石以降胃降冲，牛膝以引血下行，此为治标之主药。而复深究病之本源，用龙骨、牡蛎、龟板、白芍以填熄肝风，玄参、天冬以清肺气，肺中清肃之气下行，自能镇制肝木。余于原方中加天麻以止眩晕，合欢皮以安其神。药病相当，效验彰著。
余年弱冠，素好游泳。1966年年方二十又四，入秋参加横渡浦江训练活动，第二次已是8月秋高时节，虽未见北风怒号，然阵阵凉意袭人肌肤，仅穿游泳裤由此岸乘舢板至对岸，已是几个寒颤，入水更冷，惟有自知。及至次日即觉头重、胸闷、乏力、低热、恶心泛漾、纳谷不馨。先请西医诊治，测得体温37．4℃，经检查仅得“肝肋下触及”体征，并无其他。因彼时肝炎肆虐，医家诊病时每虑及此，似已成为定例，于是以“低热、肝大”两端，疑为肝病。但以后数年问化验肝功能将近二十次之多，全属正常，可见查无实据。当时因服西药无效，改就中医诊治。适中医痔科青年大夫林医师顶替内科门诊。林医师谦虚好学，待人和气，诊后谓余曰：这是感冒。予辛温解表药两剂，服后大效，但未痊愈。自觉为寒湿袭表而未敢肯定，故欲在上方中加入芳香化湿之品，因初识医理，而未敢造次。复诊时，林医师已因故停诊。由内科唯一之女中医诊治，彼云西医既断为肝病，当用疏肝理气法。投柴胡疏肝汤加诸行气之品，服一剂即觉胸背胁腹疼痛，询之女医，谓除此之外并无他法可施。断续诊治数次后，病情迅速加重，已至胸腹痛不可忍，腹中及右胁下有气块如拳大，常沿脐上向左胁下滚动，夜间气撑更甚，几不能入睡。白昼则精神困顿，昏昏欲寐，仅能勉强自主，神识则似明似昧。食欲全无，为维持生命计，每餐强食半两许。舌苔薄黄微腻，两手脉均呈双弦，即每手有两道弦细挺劲之脉呈形于指下。于是外出求医，凡沪上及江浙邻近之地，有缘名流率皆造访，而终归“千方易得，一效难求。”在心灰意冷，束手待毙之时，幸得药店职工张孝顺同志发慈悲怜悯之心，介绍余就诊于孟河世医巢念祖先生。巢先生德高望重，名贯乡里，医术高超，技追华扁。虑余病重体衰，不胜路途跋涉之劳，特为余通函论病，悬拟处方。先生脉案至简，仅于第一方上书“顽痰扰包络”一句，其方为：
女贞子12g百合12g青礞石30g珍珠母30g龙齿12g胆星9g郁金9g九节菖9g炙远志9g天竺黄9g鲜竹沥1支(冲)夜交藤15g合欢花9g
乍看此方似与余当时之病情风马牛不相及，然深入分析之，便知此方有出神入化之妙，不仅方意周匝，而且辨证奇特而精确。盖余之病原属感受寒湿，失于表解，腠理闭塞，邪留不去。误用疏肝行气之药，而余体质原本肝肾不足，且素多抑郁，香燥行气则愈伤肝肾之阴，引动久抑之气火，则心肝之热骤炽，而郁抑之气勃然横逆矣。心肝热则灼津为痰而神识昏愦，气机逆则克犯脾土而成瘕聚。虽自觉症状之中以腹中气块撑动最为主要，而其治法，必以清心化痰、柔肝开涤为要务。盖肝木得养则气逆自敛，心君宁谧而神识清泰。故不治其气而气自宁，不清其火而火自静。神哉乎，宜其药到而病去如归也。痰热消、肝木平、心火降、肾水升，一身之气机协调畅达，何虑气块瘕聚之不愈哉!故全方侧重于清除心肝两经之痰热，兼以开窍安神。世谓中医理论之“活的灵魂”乃“辨证论治，”观此案治法益信而有征。然此等方法似不见于轩岐古籍，惟于晚清医书中偶可窥其端倪。此病之诊治亦见巢老先生功力深厚非同一般。巢先生于女贞子、百合两昧之选用，亦极精到。盖余肝肾阴伤而心经内热，始由外感而涉及神明，故宜育阴清热养心安神，仿《金匮》百合地黄汤意为最合拍，而余肝肾虽亏而脾胃受戕，加之痰浊内恋不可更用地黄之滋腻，而先生用善于育肾阴、清虚热之女贞子以代地黄，虽平常一药之易，“而非老手不办也。”余病至此，服任何中西药均有明显药物反应，而服巢先生之方却全无不适，但初亦不见其效，坚持服用，于无形中诸症渐消。及服至七十余剂，神识顿然慧爽，犹如风卷残云，诸证尽消。服及百剂以资巩固，又得枯木逢春之喜矣，自此安然病愈。惜“世有良才天不永”先生已早归道山。先生之重恩大德余深铭肺腑而未敢一日忘怀也。
其时也，精神分裂症之患者甚多，求治者接踵而治之不易得效。一日余偶触灵机，悟及巢老先生所用之方，正可移治此病，恰合中医“异病同治”之旨。余将此方推敲再三，略事化裁，定为一方，以治心肝热郁痰凝之癫狂病证，名为“镇肝涤痰汤”，方附于下：
附：镇肝涤痰汤方
礞石30g珍珠母30g龙齿12g胆星9g郁金9g石菖蒲6g炙远志9g天竺黄9g鲜竹沥1支(冲)
记忆口诀：
镇肝涤痰礞珠龙，星金菖远沥竹黄。
上述九味乃是基本方，尚须随症加减，方显良效。近时癫狂症患者虽病因病机各有不同，然心肝痰热炽盛乃最为主要之类型。是以频年以来，余用此方治愈甚多，例如：庄老太，五十四岁。某内衣厂工人。因受严重精神刺激，于1970年初患精神分裂症。在某精防院住院两月，尚未好转。平日神情痴呆，多疑善怒，喃喃自语，喋喋不休，稍不遂心，则哭闹叫嚷。发剧之时，屡欲投河自尽，幸被邻居拦截。夜间须服四种安眠药，始睡三、四小时，少服一种，即难入睡。自诉头脑眩胀而致昏愦不清，耳鸣心慌，胸中烦扰，胃脘胀满，嗳气时作。出院后在劳保医院服药数十帖，未见效验。历观前方，非祛风通络之剂，即甘麦大枣汤加味。诊其脉则沉郁而弱，察其苔则薄且腻。余意为肝火挟痰上扰心包，以致神明失守不能自持而成斯症。遂投镇肝涤痰汤以潜镇化痰、开窍安神。以青礞石、天竺黄、郁金、竹沥、菖蒲、远志、磁石、珍珠母、龙齿、胆星等出入加减。先后十九诊服药九十帖，诸症均除。从服中药二十帖起停服西药，夜寐亦安。愈后停药观察数月，一切正常，脘胀亦愈。复工上班二年余，直至退休后又年余，病亦未发。后遭邻居频频辱骂，而致旧疾复作。狂暴躁越，数人莫制。立即一次诱服礞石滚痰丸30g，药后半小时即沉沉而睡。六小时后，连续登厕，泄泻稀便多次，于是狂躁之态全消。再予上述类似方药，服二十剂病若失，继则以养阴消痰之方善后。至今二十五载，年过八旬，康健如常人。此症乃长期忿郁而成，加之年高之体，脾肾已衰，木邪冲旺，正气莫制。近贤云：“肝木横逆则痰热蕴结，心阳独炽乃燥火易升。”痰浊随风火上冲心包，神明为之震憾，故诸症作矣。此非脏躁之比，故养心安神之甘麦大枣汤用之不效。此例病情，全是一派心肝二经痰热壅塞、气火逆上之象，故投镇肝涤痰清心安神之方，竟收全功。或问：既是心肝痰热，何以脉不弦劲弦滑而反沉弱?此乃痰浊阻塞气道，脉气不畅而然。清代许松如《诊余脞谈》曾谓弱脉多火，不可全以为虚。从治疗效果亦可反证：此种认识切合病机。癫狂一症，多由情志郁结、气郁不舒，心肝痰火扰乱神明而成。虽属难治之病，若能审察精详，投剂得当，亦多能愈。又如余于一九七四年间治一壮岁之病人，患病五年，数萌自杀之念，均获救而幸免于死。于上海、苏州等地治疗，中西医药、针灸、电疗，终鲜克效。究其症候，除癫狂见症之外，整日注目于眼前之黑点，目光到处，无论墙壁、器物、地面、天空，凡有黑点者，必立即定睛细视。若无人干涉，可终日视而不倦。入夜惧怕灯火，见光则眼皮刺痛，目珠中似有火出，甚至灯下不能合目，合则目胞瞬动异常。余投镇肝涤痰汤，用豁痰平肝、解郁清火之药治之，神识渐清，然目视黑点及羞明畏光两症终不见好。前人谓“五脏之火，惟肝最横。”苦泄甘寒均不能应，当用灵动咸寒之品，庶可得效。遂以羚羊角粉每日一支(0．3g)，于服汤药时吞服之，经二十余日，两症渐除。
癫狂症中，除心肝痰热外，尚有其他证型，略举两例，以供参证：曾治一青年，在马鞍山工作，因失恋而致狂暴异常。其戚领护来沪，途中狂不可遏。此乃气机暴郁而然，用柴胡疏肝散合四磨饮子法，不数剂获安。至今二十余年，未见复发。
1995年又诊一青年汽车司机，因与领导不合，遂郁而成病。就诊时反复申述头痛、头胀，此外并无他疾，言语重叠噜苏，见人辄点头微笑，脉弦而不畅。是属肝经气机不舒所致，治法当先“木郁达之”，而随之以消痰清火。投柴胡加龙骨牡蛎汤增损化裁，两阅月而证平。随后恢复驾车，至今安然。
中风偏枯治法刍议
代赭石这一味药，《医学衷中参西录》中说：“它的质地沉重坠降，又善于镇压逆气，降下痰涎，止住呕吐，打通燥结，如果使用得当，能建立奇效。”看这两个医案，可知它在治疗“脑震荡”、脑挫伤引起的眩晕、呕吐方面具有显著的特殊疗效，无疑是治疗脑震荡、脑挫伤的首选特效中药。这种病症的病机，曹氏认为是“浊气在上、清气在下”，而治疗大法采取“镇胃降浊”，与通常所用的平肝潜阳、化痰熄风的方法不同，出人意料，可谓匠心独运，实为研究脑震荡脑挫伤病机开辟了一条路径。
《续名医类案》记载：“许宣治一个十岁的孩子，从戏台上倒跌下来，呕吐苦水，用盆盛着，颜色绿得像菜汁。许宣说：这是胆倒下来了，胆汁倾尽就会死。于是方子用温胆汤加枣仁、代赭石来纠正胆腑的功能，命名为正胆汤，一服药后呕吐就停止了。以前曾见过这个病证，不知道治疗方法，所以没能救活。”这个案例标新立异，名为“胆倒”，方剂以温胆汤为主。然而如果不加代赭石，必定没有这种疗效，因此这个方子起效的关键，仍然在于代赭石。如果单用代赭石一味药，不合用温胆汤和枣仁，疗效也可以期待，但“胆倒”的说法却蕴含深意，大概人体受震动之后，清阳下陷，浊阴上潜，胆中的浊气循经上达头顶则眩晕，横逆犯胃则呕恶。治疗后清升浊降，胆气敛藏则诸症自愈。此症胆胃同病，用代赭石一味药而两利之，因而速效。所以中医家不应当固步自封于套方疲药，自当开拓进取，去寻求有效的方剂和药物。
又按：古人治病每用小方，简药重投，取其药性纯正而力量专一，所以取得的效果宏大且迅速。《旧唐书》第一百九十一卷记载：“唐初许胤宗说：‘病与药之间，有正好相当的，只需单用一味药，直接攻治那个病，药力既然纯正，病就能立刻痊愈。现在的人不能辨别脉象，不认识病源，凭主观臆测，多加药味。这就像打猎，不知道兔子在哪里，多发人马，在空地上遮围，或许侥幸偶然碰到一只。这样治病，不是太疏忽了吗？’”许氏是唐初的名医，话虽然少，意思却极深。我反复思考这句话，铭记在座右。
某商店黄姓女经理，刚四十岁。1988年3月21日，不慎从十级扶梯上摔到水泥地上，后脑勺着地，当即昏迷不醒，急送附近一家区级医院抢救。第二天转送到某市级医院会诊，诊断为“顶骨骨折，右颞叶、左额叶脑挫伤。”昏迷十七天后神识才清醒，共住院四十天，因病情好转而出院。回家后依然眩晕难支，只能在室内扶着物体缓慢行走，动作蹒跚迟钝，稍微加快则恶心不止，甚至呕吐。食欲不振，大小便尚调。视物模糊，看一个物体每见二、三重影；嗅觉丧失，但没有鼻炎病史。生活起居，时刻需要家人看护扶持。到6月16日邀请我诊治。诊得脉滑舌干，其他症状一如上述。先用代赭石100克水煎当茶喝，恶心即止。复诊时苔薄白，脉象呈现上盛下虚的样子，即用《医学衷中参西录》中的镇肝熄风汤加减，以育阴潜阳，平肝熄风。方剂为：
代赭石30g生龙牡各30g淮牛膝15g炙龟板15g川楝子9g炒白芍9g元参9g天冬9g生麦芽9g茵陈9g炙甘草2g合欢皮15g天麻6g
服药一周，胃口大开，嗅觉恢复正常，仍以此方加减继续服用。服至二十帖，行动恢复正常，能自行乘车前来门诊。先后共服近百剂，病得痊愈。以后恢复工作，生活起居一如常人，也没有头痛眩晕、记忆减退等后遗症。
按：头为诸阳之会，脑为元神之府。人身健康时，体内阴平阳秘，气血调畅。人体的阴阳气血升降有度，运行有序，协调均衡，则头脑清宁而灵敏觉知。一旦头颅受到外力冲击，则巅顶中气血混杂，阴阳淆乱，清气不升，浊邪上干。阴火随冲气乘机潜位，肝阳胆气由此亢逆，逆扰于上则目眩头晕，化风走于四肢末端则振掉而不利于行走，犯胃则呕恶，旁及五官则耳、目、口、鼻、舌为之失灵。《内经》说：“阴在内，阳之守也。”阳既化风逆上，阴阳失于维系，则真阴失固。且肝阳下吸肾阴，则阴伤更甚了。所以其治疗之法首先必须潜阳降逆。然而真阴既伤，如果不滋填根本，想要潜其阳而阳终究不能潜，想要降其逆而逆必定难降，所以涵育真阴，又应当辅助进行。
基于这个道理，那么治疗的方剂当以“镇肝熄风汤”最为合适。此方虽然是为中风（脑充血）症而设，但其病机却与此证极为相似。如张锡纯在方后自注此方的适应机制说：“盖肝为木脏，木火炽盛，亦自有风，这是因为肝木失和风自肝起。又加上肺气不降，肾气不摄，冲气胃气又复上逆，在此情况下，脏腑之气化皆上升太过，而血之上注于脑者，也因此太过，导致充塞其血管而累及神经。”至于其用药原理，是以方中重用赭石以降胃降冲，牛膝以引血下行，这是治标的主药。而复深究病的本源，用龙骨、牡蛎、龟板、白芍以填熄肝风，玄参、天冬以清肺气，肺中清肃之气下行，自然能镇制肝木。我在原方中加入天麻以止眩晕，合欢皮以安其神。药病相当，效验显著。
我年纪不到二十岁时，素来喜欢游泳。1966年年方二十四岁，入秋参加横渡浦江训练活动，第二次已经是8月秋高气爽时节，虽未见北风怒号，然阵阵凉意袭人肌肤，仅穿游泳裤由此岸乘舢板至对岸，已是几个寒颤，入水更冷，惟有自知。等到次日即觉得头重、胸闷、乏力、低热、恶心泛漾、食欲不佳。先请西医诊治，测得体温37.4℃，经检查仅得“肝肋下触及”体征，并无其他。因为那时肝炎肆虐，医家诊病时每虑及此，似已成为定例，于是以“低热、肝大”两端，疑为肝病。但以后数年问化验肝功能将近二十次之多，全属正常，可见查无实据。当时因服西药无效，改就中医诊治。适逢中医痔科青年大夫林医师顶替内科门诊。林医师谦虚好学，待人和气，诊后对我说：这是感冒。予辛温解表药两剂，服后大效，但未痊愈。自觉为寒湿袭表而未敢肯定，故欲在上方中加入芳香化湿之品，因初识医理，而未敢造次。复诊时，林医师已因故停诊。由内科唯一的女中医诊治，她说西医既断为肝病，当用疏肝理气法。投柴胡疏肝汤加诸行气之品，服一剂即觉得胸背胁腹疼痛，询问女医，她说除此之外并无他法可施。断续诊治数次后，病情迅速加重，已至胸腹痛不可忍，腹中及右胁下有气块如拳大，常沿脐上向左胁下滚动，夜间气撑更甚，几乎不能入睡。白昼则精神困顿，昏昏欲睡，仅能勉强自主，神识则似明似昧。食欲全无，为维持生命计，每餐强食半两许。舌苔薄黄微腻，两手脉均呈双弦，即每手有两道弦细挺劲之脉呈形于指下。于是外出求医，凡沪上及江浙邻近之地，有缘名流率皆造访，而终归“千方易得，一效难求。”在心灰意冷，束手待毙之时，幸得药店职工张孝顺同志发慈悲怜悯之心，介绍我就诊于孟河世医巢念祖先生。巢先生德高望重，名贯乡里，医术高超，技追华扁。虑我病重体衰，不胜路途跋涉之劳，特为我通函论病，悬拟处方。先生脉案至简，仅于第一方上书“顽痰扰包络”一句，其方为：
女贞子12g百合12g青礞石30g珍珠母30g龙齿12g胆星9g郁金9g九节菖蒲9g炙远志9g天竺黄9g鲜竹沥1支(冲)夜交藤15g合欢花9g
乍看此方似乎与我当时的病情风马牛不相及，然深入分析之，便知此方有出神入化之妙，不仅方意周匝，而且辨证奇特而精确。大概我的病原属感受寒湿，失于表解，腠理闭塞，邪留不去。误用疏肝行气之药，而我体质原本肝肾不足，且素多抑郁，香燥行气则愈伤肝肾之阴，引动久抑之气火，则心肝之热骤炽，而郁抑之气勃然横逆矣。心肝热则灼津为痰而神识昏愦，气机逆则克犯脾土而成瘕聚。虽自觉症状之中以腹中气块撑动最为主要，而其治法，必以清心化痰、柔肝开涤为要务。盖肝木得养则气逆自敛，心君宁谧而神识清泰。故不治其气而气自宁，不清其火而火自静。神哉乎，宜其药到而病去如归也。痰热消、肝木平、心火降、肾水升，一身之气机协调畅达，何虑气块瘕聚之不愈哉!故全方侧重于清除心肝两经之痰热，兼以开窍安神。世人谓中医理论的“活的灵魂”乃“辨证论治，”观此案治法益信而有征。然而这种方法似乎不见于轩岐古籍，惟于晚清医书中偶可窥其端倪。此病的诊治也见巢老先生功力深厚非同一般。巢先生于女贞子、百合两味的选用，亦极精到。大概我肝肾阴伤而心经内热，始由外感而涉及神明，故宜育阴清热养心安神，仿《金匮》百合地黄汤意为最合拍，而我肝肾虽亏而脾胃受戕，加之痰浊内恋不可更用地黄之滋腻，而先生用善于育肾阴、清虚热的女贞子以代地黄，虽平常一药之易，“而非老手不办也。”我病至此，服任何中西药均有明显药物反应，而服巢先生的方却全无不适，但初亦不见其效，坚持服用，于无形中诸症渐消。及服至七十余剂，神识顿然慧爽，犹如风卷残云，诸证尽消。服及百剂以资巩固，又得枯木逢春之喜矣，自此安然病愈。可惜“世有良才天不永”先生已早归道山。先生之重恩大德我深铭肺腑而未敢一日忘怀也。
其时，精神分裂症的患者甚多，求治者接踵而治之不易得效。一日我偶触灵机，悟及巢老先生所用的方，正可移治此病，恰合中医“异病同治”之旨。我将此方推敲再三，略事化裁，定为一方，以治心肝热郁痰凝之癫狂病证，名为“镇肝涤痰汤”，方附于下：
附：镇肝涤痰汤方
礞石30g珍珠母30g龙齿12g胆星9g郁金9g石菖蒲6g炙远志9g天竺黄9g鲜竹沥1支(冲)
记忆口诀：
镇肝涤痰礞珠龙，星金菖远沥竹黄。
上述九味乃是基本方，尚须随症加减，方显良效。近时癫狂症患者虽病因病机各有不同，然心肝痰热炽盛乃最为主要之类型。是以频年以来，我用此方治愈甚多，例如：庄老太，五十四岁。某内衣厂工人。因受严重精神刺激，于1970年初患精神分裂症。在某精防院住院两月，尚未好转。平日神情痴呆，多疑善怒，喃喃自语，喋喋不休，稍不遂心，则哭闹叫嚷。发剧之时，屡欲投河自尽，幸被邻居拦截。夜间须服四种安眠药，始睡三、四小时，少服一种，即难入睡。自诉头脑眩胀而致昏愦不清，耳鸣心慌，胸中烦扰，胃脘胀满，嗳气时作。出院后在劳保医院服药数十帖，未见效验。历观前方，非祛风通络之剂，即甘麦大枣汤加味。诊其脉则沉郁而弱，察其苔则薄且腻。我意为肝火挟痰上扰心包，以致神明失守不能自持而成斯症。遂投镇肝涤痰汤以潜镇化痰、开窍安神。以青礞石、天竺黄、郁金、竹沥、菖蒲、远志、磁石、珍珠母、龙齿、胆星等出入加减。先后十九诊服药九十帖，诸症均除。从服中药二十帖起停服西药，夜寐亦安。愈后停药观察数月，一切正常，脘胀亦愈。复工上班二年余，直至退休后又年余，病亦未发。后遭邻居频频辱骂，而致旧疾复作。狂暴躁越，数人莫制。立即一次诱服礞石滚痰丸30g，药后半小时即沉沉而睡。六小时后，连续登厕，泄泻稀便多次，于是狂躁之态全消。再予上述类似方药，服二十剂病若失，继则以养阴消痰之方善后。至今二十五载，年过八旬，康健如常人。此症乃长期忿郁而成，加之年高之体，脾肾已衰，木邪冲旺，正气莫制。近贤云：“肝木横逆则痰热蕴结，心阳独炽乃燥火易升。”痰浊随风火上冲心包，神明为之震憾，故诸症作矣。此非脏躁之比，故养心安神之甘麦大枣汤用之不效。此例病情，全是一派心肝二经痰热壅塞、气火逆上之象，故投镇肝涤痰清心安神之方，竟收全功。或问：既是心肝痰热，何以脉不弦劲弦滑而反沉弱?此乃痰浊阻塞气道，脉气不畅而然。清代许松如《诊余脞谈》曾谓弱脉多火，不可全以为虚。从治疗效果亦可反证：此种认识切合病机。癫狂一症，多由情志郁结、气郁不舒，心肝痰火扰乱神明而成。虽属难治之病，若能审察精详，投剂得当，亦多能愈。又如我于一九七四年间治一壮岁之病人，患病五年，数萌自杀之念，均获救而幸免于死。于上海、苏州等地治疗，中西医药、针灸、电疗，终鲜克效。究其症候，除癫狂见症之外，整日注目于眼前之黑点，目光到处，无论墙壁、器物、地面、天空，凡有黑点者，必立即定睛细视。若无人干涉，可终日视而不倦。入夜惧怕灯火，见光则眼皮刺痛，目珠中似有火出，甚至灯下不能合目，合则目胞瞬动异常。我投镇肝涤痰汤，用豁痰平肝、解郁清火之药治之，神识渐清，然目视黑点及羞明畏光两症终不见好。前人谓“五脏之火，惟肝最横。”苦泄甘寒均不能应，当用灵动咸寒之品，庶可得效。遂以羚羊角粉每日一支(0.3g)，于服汤药时吞服之，经二十余日，两症渐除。
癫狂症中，除心肝痰热外，尚有其他证型，略举两例，以供参证：曾治一青年，在马鞍山工作，因失恋而致狂暴异常。其戚领护来沪，途中狂不可遏。此乃气机暴郁而然，用柴胡疏肝散合四磨饮子法，不数剂获安。至今二十余年，未见复发。
1995年又诊一青年汽车司机，因与领导不合，遂郁而成病。就诊时反复申述头痛、头胀，此外并无他疾，言语重叠噜苏，见人辄点头微笑，脉弦而不畅。是属肝经气机不舒所致，治法当先“木郁达之”，而随之以消痰清火。投柴胡加龙骨牡蛎汤增损化裁，两阅月而证平。随后恢复驾车，至今安然。
中风偏枯治法刍议
Dai Zhe Shi (Hematitum), a single herb, is described in *Yixue Zhongzhong Canxi Lu* (Records of Medical Practice Integrating Chinese and Western Medicine) as: "Its substance is heavy and sinking; it is also good at suppressing rebellious Qi, descending phlegm-fluids, stopping vomiting, and unblocking dry constipation. When used appropriately, it can achieve miraculous effects." Observing these two cases, it is evident that Dai Zhe Shi (Hematitum) possesses remarkable efficacy in treating vertigo and vomiting associated with "concussion" and cerebral contusion. It is undoubtedly the first-choice specific Chinese herbal medicine for treating concussion and cerebral contusion. The pathogenesis of this condition, according to Mr. Cao, is "turbid Qi residing above and clear Qi residing below." The primary treatment principle adopts "calming the Stomach and descending turbidity," which differs from the commonly used methods of calming the Liver and subduing Yang, or resolving phlegm and extinguishing wind. This approach is unexpected and demonstrates unique craftsmanship, truly opening a pathway for researching the pathogenesis of concussion and cerebral contusion.
*Xu Mingyi Lei'an* (Continued Cases of Famous Physicians) records: "Xu Xuanzhi treated a ten-year-old child who fell backward from a stage, vomiting bitter fluid, which was collected in a basin and appeared green like vegetable juice. Xu said: 'This is the Gallbladder falling over; if the bile is completely exhausted, death will ensue.' He prescribed Wendan Tang (Warm the Gallbladder Decoction) supplemented with Suanzaoren (Ziziphus Seed) and Dai Zhe Shi (Hematitum) to correct the function of the Gallbladder organ, naming it Zhengdan Tang (Correct the Gallbladder Decoction). After one dose, the vomiting stopped. I had previously encountered this syndrome but did not know the treatment method, so I failed to save him." This case is innovative, named "Gallbladder Falling Over," with Wendan Tang (Warm the Gallbladder Decoction) as the main formula. However, without adding Dai Zhe Shi (Hematitum), such efficacy would certainly not be achieved. Therefore, the key effectiveness of this formula still lies in Dai Zhe Shi (Hematitum). If Dai Zhe Shi (Hematitum) were used alone, without combining it with Wendan Tang (Warm the Gallbladder Decoction) and Suanzaoren (Ziziphus Seed), efficacy could still be expected, yet the theory of "Gallbladder Falling Over" contains profound meaning. Generally, after the human body suffers vibration, Clear Yang sinks downward, and Turbid Yin rises upward. The turbid Qi in the Gallbladder ascends along the meridians to the vertex, causing vertigo; it rebels against the Stomach, causing nausea and vomiting. After treatment, Clear Qi ascends and Turbid Qi descends, and when the Gallbladder Qi gathers and stores, all symptoms resolve spontaneously. In this syndrome, both the Gallbladder and Stomach are diseased; using only Dai Zhe Shi (Hematitum) benefits both, thus achieving rapid results. Therefore, practitioners of Huangdi and Qibo (Traditional Chinese Medicine) should not remain complacent with standard formulas and ineffective drugs but should strive to explore and discover effective prescriptions and medicines.
Furthermore: Ancient physicians often treated diseases with small formulas, using few herbs in heavy doses, aiming for purity and concentrated power, thereby achieving significant and rapid results. Volume 191 of *Jiu Tangshu* (Old Book of Tang) records: "In the early Tang Dynasty, Xu Yinzong stated: 'Between disease and medicine, there are exact correspondences; one need only use a single herb to directly attack the disease. Since the medicinal power is pure, the disease will heal immediately. Nowadays, people cannot distinguish pulses nor recognize the source of disease; they guess subjectively and add many ingredients. This is like hunting: not knowing where the rabbit is, sending out many men and horses to surround an empty area, hoping to accidentally encounter one. Is such medical practice not too negligent?' Xu was a famous physician of the early Tang Dynasty. His words were few, but his meaning was profound. I have repeatedly pondered this statement and engraved it on my writing desk."
Calming the Liver and Extinguishing Wind Cures Cerebral Contusion
A female manager surnamed Huang from a certain store, just forty years old. On March 21, 1988, she accidentally fell from a ten-step escalator onto a concrete floor, striking the back of her head. She fell into immediate coma and was urgently sent to a nearby district-level hospital for rescue. The next day, she was transferred to a municipal hospital for consultation, diagnosed with "parietal bone fracture, right temporal and left frontal cerebral contusion." After seventeen days of coma, her consciousness finally cleared. She stayed in the hospital for forty days and was discharged due to improvement in her condition. Upon returning home, she still suffered from severe vertigo, able to walk slowly indoors only while holding onto objects. Her movements were clumsy and slow; any slight acceleration caused incessant nausea and even vomiting. Her appetite was poor, but bowel and bladder functions were normal. Vision was blurred, seeing double or triple images of a single object; smell was lost, though she had no history of rhinitis. Her daily life required constant care and support from family members. On June 16, I was invited to examine her. The pulse was slippery, and the tongue was dry; other symptoms remained as described. Initially, I prescribed 100g of Dai Zhe Shi (Hematitum) decocted in water to be drunk as tea, which stopped the nausea immediately. At the follow-up visit, the coating was thin and white, and the pulse showed signs of excess above and deficiency below. I then modified Zhen Gan Xi Feng Tang (Calming the Liver and Extinguishing Wind Decoction) from *Yixue Zhongzhong Canxi Lu* (Records of Medical Practice Integrating Chinese and Western Medicine) to nourish Yin and subdue Yang, calm the Liver and extinguish wind. The prescription was:
Dai Zhe Shi (Hematitum) 30g, Sheng Longgu (Dragon Bone) and Sheng Muli (Oyster Shell) 30g each, Huainiuxi (Achyranthes Root) 15g, Zhi Guiban (Tortoise Shell) 15g, Chuanlianzi (Toosendan Fruit) 9g, Chao Baishao (Fried White Peony Root) 9g, Yuanshen (Scrophularia Root) 9g, Tiandong (Asparagus Tuber) 9g, Sheng Maiya (Sprouted Barley) 9g, Yichen (Artemisia Capillaris) 9g, Zhi Gancao (Prepared Licorice Root) 2g, Hehuanpi (Acacia Bark) 15g, Tianma (Gastrodia Rhizome) 6g.
After one week of medication, her appetite greatly improved, and her sense of smell returned. She continued taking this modified formula. After twenty doses, her mobility normalized, and she could travel by car to the outpatient clinic herself. In total, she took nearly a hundred doses, and the illness was cured. She subsequently resumed work, living normally like anyone else, without sequelae such as headache, vertigo, or memory loss.
Commentary: The head is the meeting place of all Yang meridians, and the brain is the mansion of the Primordial Spirit. When the human body is healthy, Yin and Yang are balanced within, and Qi and Blood flow smoothly. When the ascending and descending of Yin, Yang, Qi, and Blood are regulated, orderly, coordinated, and balanced, the mind remains clear and perception sharp. Once the skull suffers external impact, the Qi and Blood in the vertex become mixed, and Yin and Yang are confused. Clear Qi fails to ascend, and turbid pathogens rise upward. Yin Fire takes advantage of the Chong Qi to submerge, causing Liver Yang and Gallbladder Qi to become hyperactive and rebellious. Rebellious disturbance upwards causes dizziness and vertigo; wind generated travels to the four extremities, causing tremors and difficulty walking; invading the Stomach causes nausea and vomiting; affecting the five senses renders ears, eyes, mouth, nose, and tongue dysfunctional. *Neijing* states: "Yin resides inside, serving as the guardian of Yang." When Yang transforms into wind and rebels upward, Yin and Yang lose their mutual maintenance, causing True Yin to become insecure. Furthermore, Liver Yang draws down Kidney Yin, further damaging Yin. Therefore, the treatment method must first focus on subduing Yang and descending rebellion. However, since True Yin is damaged, if the root is not nourished and filled, attempting to subdue Yang will fail, and attempting to descend rebellion will be difficult. Thus, nurturing True Yin must be conducted as an auxiliary measure.
Based on this principle, the treatment formula should ideally be "Zhen Gan Xi Feng Tang" (Calming the Liver and Extinguishing Wind Decoction). Although this formula was originally designed for stroke (cerebral congestion), its pathogenesis is extremely similar to this case. As Zhang Xichun noted in his postscript to the formula: "The Liver is a Wood organ. When Wood and Fire are blazing, wind arises naturally. Here, wind originates from the Liver due to the loss of harmony in Liver Wood. Additionally, Lung Qi fails to descend, Kidney Qi fails to grasp, and Chong Qi and Stomach Qi rebel upward. In this situation, the transformation of Qi in all organs rises excessively, and blood flowing up to the brain also becomes excessive, leading to vascular blockage and nerve involvement." Regarding the principle of medication, the formula heavily uses Hematitum (Dai Zhe Shi) to descend Stomach and Chong Qi, and Achyranthes (Niuxi) to guide blood downward; these are the main herbs for treating the branch symptoms. Delving deeper into the root of the disease, Dragon Bone (Longgu), Oyster Shell (Muli), Tortoise Shell (Guiban), and White Peony Root (Baishao) are used to fill and extinguish Liver wind, while Scrophularia (Yuanshen) and Asparagus Tuber (Tiandong) clear Lung Qi. When the clear and purifying Qi of the Lung descends, it naturally suppresses Liver Wood. I added Gastrodia (Tianma) to stop vertigo and Acacia Bark (Hehuanpi) to calm the spirit. The medicine matched the disease, resulting in significant efficacy.
Calming the Liver and Purging Phlegm Treats Mania
When I was young, under twenty, I loved swimming. In 1966, at age twenty-four, I participated in autumn training for crossing the Huangpu River. By the second session in August, although there was no howling north wind, chilling breezes brushed against my skin. Wearing only swim trunks, traveling from one bank to the other by sampan caused several shivers; entering the water was even colder, known only to myself. The next day, I felt heavy-headed, chest tightness, fatigue, low-grade fever, nausea, and poor appetite. I first consulted Western medicine; my temperature was measured at 37.4°C. Examination revealed only "palpable liver edge below the ribs," with no other findings. Since hepatitis was rampant at that time, doctors always considered this possibility during diagnosis, making it a routine. Suspecting liver disease based on "low fever and hepatomegaly," subsequent liver function tests over the next few years, nearly twenty times, were all normal, showing no factual basis. Since Western medicine was ineffective, I switched to Traditional Chinese Medicine. A young TCM proctologist, Dr. Lin, temporarily replaced the internal medicine clinic. Dr. Lin was humble, eager to learn, and amiable. After examining me, he said: "This is a cold." He prescribed two doses of acrid-warm exterior-releasing herbs. There was great effect, but the illness was not fully cured. Feeling that cold-dampness had attacked the exterior, I wanted to add aromatic damp-resolving herbs to the formula but dared not act rashly due to my limited medical knowledge. At the follow-up visit, Dr. Lin had stopped consulting for some reason. I was seen by the only female internist. She said, "Since Western medicine diagnosed liver disease, we should use the method of soothing the Liver and regulating Qi." She prescribed Chaihu Shugan San (Bupleurum Powder to Soothe the Liver) plus various Qi-regulating herbs. After one dose, I felt pain in the chest, back, hypochondrium, and abdomen. Asking the female doctor, she replied that there was no other method available. After intermittent treatments several times, the condition rapidly worsened. Chest and abdominal pain became unbearable. A fist-sized mass of Qi formed in the abdomen and right hypochondrium, rolling from above the navel to the left hypochondrium, worse at night, almost preventing sleep. During the day, mental energy was exhausted, drowsy, barely self-aware, with consciousness fluctuating between clear and obscure. Appetite was completely lost; to sustain life, I forced myself to eat about half an ounce per meal. The tongue coating was thin, yellow, and slightly greasy. Both wrists presented a "double string" pulse, meaning two wiry, fine, and stiff pulses were palpable on each hand. I sought medical help elsewhere, visiting renowned physicians in Shanghai and neighboring Jiangsu and Zhejiang regions, but ultimately found that "easy to find a thousand prescriptions, hard to find one effective remedy." Just as I was losing hope and waiting for death, Comrade Zhang Xiaoshun, a pharmacy employee, showed compassion and introduced me to Mr. Niao Nianzu, a hereditary physician from Menghe. Mr. Niao was highly respected, famous locally, with superb medical skills rivaling Hua Tuo and Bian Que. Considering my severe illness and frailty, unable to endure the journey, he specially wrote a letter discussing the disease and prescribing remotely. His pulse record was very concise, stating only "Stubborn Phlegm Disturbing the Pericardium" on the first prescription. The formula was:
Luzhenzi (Ligustrum Lucidum Fruit) 12g, Baihe (Lily Bulb) 12g, Qingmengshi (Green Calamine), 30g, Zhenzhumu (Pearl Mother-of-Pearl) 30g, Longchi (Dragon Teeth) 12g, Dansheng (Arisaema with Bile) 9g, Yujin (Curcuma Root) 9g, Jiejie Changpu (Acorus Rhizome) 9g, Zhi Yuanzhi (Polygala Root) 9g, Tianzhuhuang (Calamus Tuber) 9g, Xian Zhuli (Fresh Bamboo Juice) 1 portion (mixed in), Yejiaoteng (Polygonum Vine) 15g, Hehuanhua (Acacia Flower) 9g.
At first glance, this formula seemed unrelated to my condition, but deep analysis reveals its transcendent brilliance. Not only is the formula comprehensive, but the differentiation is also unique and precise. My original cause was contracting cold-dampness, failing to release via the exterior, leading to closed pores and lingering pathogens. Misuse of Liver-soothing and Qi-moving herbs, combined with my inherent Liver-Kidney deficiency and tendency toward depression, caused the aromatic-dry Qi-moving herbs to further damage Liver-Kidney Yin. This stirred up long-suppressed Qi-Fire, causing sudden blazing heat in the Heart and Liver, and abrupt rebellion of suppressed Qi. Heart-Liver heat scorched fluids into phlegm, clouding consciousness; rebellious Qi mechanism attacked Spleen Earth, forming masses. Although the most prominent symptom was the moving mass in the abdomen, the treatment must prioritize clearing Heart heat, resolving phlegm, softening the Liver, and purging. Nourishing Liver Wood allows rebellious Qi to收敛 (gather); calming the Heart Monarch clears consciousness. Thus, without directly treating Qi, it calms itself; without directly clearing Fire, it rests itself. Marvelous indeed, that the medicine arrived and the disease departed as if returning home. With phlegm-heat消散 (dissipated), Liver Wood pacified, Heart Fire lowered, and Kidney Water ascending, the Qi mechanism of the whole body coordinated smoothly. Why worry about the non-healing of Qi masses and tumors? Therefore, the entire formula focused on clearing phlegm-heat from the Heart and Liver meridians, accompanied by opening orifices and calming the spirit. People say the "living soul" of TCM theory is "syndrome differentiation and treatment." Observing this case's treatment confirms this truth. However, such methods seem absent from ancient texts of Huangdi and Qibo, appearing only occasionally in late Qing medical books. The diagnosis and treatment of this illness also demonstrate Mr. Niao's profound and extraordinary skill. Mr. Niao's selection of Luzhenzi (Ligustrum Lucidum Fruit) and Baihe (Lily Bulb) was extremely precise. Since my Liver-Kidney Yin was damaged and Heart meridian had internal heat, initially affected by external contraction involving the Spirit, it was appropriate to nourish Yin, clear heat, nourish the Heart, and calm the spirit, imitating the intent of Baihe Dihuang Tang (Lily and Rehmannia Decoction) from *Jinkui Yaolue*. Although my Liver-Kidney was deficient and Spleen-Stomach injured, plus internal clinging of turbid phlegm made the cloying nature of Dihuang (Rehmannia) unsuitable, Mr. Niao used Luzhenzi (Ligustrum Lucidum Fruit), which is good at nourishing Kidney Yin and clearing deficiency heat, to replace Dihuang. Such a simple substitution of an ordinary herb "requires an experienced hand." At this stage of my illness, any Chinese or Western medicine caused obvious adverse reactions, but Mr. Niao's formula caused no discomfort. Initially, no effect was seen, but persisting with it, symptoms gradually disappeared imperceptibly. After seventy-plus doses, my consciousness suddenly became bright and clear, like wind sweeping away clouds, all symptoms vanished. Taking a hundred doses consolidated the result, bringing joy akin to dead wood meeting spring. From then on, I recovered peacefully. Alas, "Heaven does not grant longevity to talented individuals"; Mr. Niao passed away early. I deeply engrave his great kindness and virtue in my heart and never forget it for a day.
At that time, patients with schizophrenia were numerous, and seekers followed one after another, yet treatment was difficult to achieve success. One day, I had a sudden inspiration, realizing that the formula used by Mr. Niao could be applied to treat this disease, perfectly aligning with the TCM principle of "treating different diseases with the same method." I pondered this formula three times, made minor modifications, established a new prescription to treat mania caused by Heart-Liver heat stagnation and phlegm coagulation, naming it "Zhen Gan Di Tan Tang" (Calming the Liver and Purging Phlegm Decoction). The formula is attached below:
Appendix: Zhen Gan Di Tan Tang (Calming the Liver and Purging Phlegm Decoction)
Mengshi (Calamine) 30g, Zhenzhumu (Pearl Mother-of-Pearl) 30g, Longchi (Dragon Teeth) 12g, Dansheng (Arisaema with Bile) 9g, Yujin (Curcuma Root) 9g, Shichangpu (Acorus Rhizome) 6g, Zhi Yuanzhi (Polygala Root) 9g, Tianzhuhuang (Calamus Tuber) 9g, Xian Zhuli (Fresh Bamboo Juice) 1 portion (mixed in).
Memory Mnemonic:
Zhen Gan Di Tan Meng Zhu Long,
Xing Jin Chang Yuan Li Zhu Huang.
These nine flavors constitute the basic formula, which must be modified according to symptoms to show excellent efficacy. Recently, although patients with mania have different etiologies and pathogeneses, the type of blazing Heart-Liver phlegm-heat is the most common. Therefore, in recent years, I have cured many with this formula. For example: Old Lady Zhuang, fifty-four years old, a worker at a certain underwear factory. Due to severe psychological stimulation, she developed schizophrenia in early 1970. She stayed in a psychiatric prevention hospital for two months without improvement. Usually, she appeared dull, suspicious, irritable, muttering to herself, talking incessantly, and crying or shouting when things did not go her way. During severe episodes, she repeatedly attempted suicide by jumping into the river, fortunately intercepted by neighbors. At night, she needed four types of sleeping pills to sleep for three or four hours; missing one made sleep difficult. She complained of dizzy and distended head causing confusion, tinnitus, palpitations, chest irritability, epigastric fullness, and occasional belching. After discharge, she took dozens of doses at a labor insurance hospital with no effect. Reviewing previous prescriptions, they were either wind-dispelling and collateral-unblocking agents or modified Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction). Her pulse was deep, depressed, and weak; her coating was thin and greasy. I believed Liver Fire carrying phlegm disturbed the Pericardium, causing the Spirit to lose control and resulting in this syndrome. I therefore administered Zhen Gan Di Tan Tang (Calming the Liver and Purging Phlegm Decoction) to subdue, transform phlegm, open orifices, and calm the spirit. Ingredients included Qingmengshi (Green Calamine), Tianzhuhuang (Calamus Tuber), Yujin (Curcuma Root), Zhuli (Bamboo Juice), Changpu (Acorus Rhizome), Yuanzhi (Polygala Root), Cishi (Magnetite), Zhenzhumu (Pearl Mother-of-Pearl), Longchi (Dragon Teeth), and Dansheng (Arisaema with Bile), adjusted as needed. After nineteen consultations and ninety doses, all symptoms disappeared. Starting from the twentieth dose of Chinese medicine, she stopped Western medicine, and night sleep became peaceful. After recovery, observing off medication for several months, everything was normal, and epigastric distension healed. She resumed work for over two years, and even more than a year after retirement, the disease did not recur. Later, frequent insults from neighbors caused a relapse. She became wildly violent, uncontrollable by several people. Immediately, she was induced to take 30g of Mengshi Guntan Wan (Calamine Rolling Phlegm Pills). Half an hour later, she slept deeply. Six hours later, she visited the toilet continuously, passing loose stools multiple times, and the manic state completely vanished. Subsequently, similar formulas were given; after twenty doses, the illness disappeared. Finally, a Yin-nourishing and phlegm-resolving formula was used for consolidation. Twenty-five years later, now over eighty, she is healthy as usual. This syndrome resulted from long-term anger and depression. Combined with her advanced age, Spleen and Kidney were declining, Wood evil surged, and righteous Qi could not control it. Recent sages said: "When Liver Wood rebels horizontally, phlegm-heat accumulates; when Heart Yang burns alone, dry fire easily rises." Turbid phlegm rushes to the Pericardium following wind-fire, shocking the Spirit, hence all symptoms arise. This is not comparable to Zang Zao (Viscera Agitation); thus, Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) for nourishing the Heart and calming the spirit is ineffective. This case presents a picture of phlegm-heat blocking the Heart and Liver meridians and Qi-Fire rebelling upward. Therefore, administering Zhen Gan Di Tan Tang (Calming the Liver and Purging Phlegm) to clear Heart heat and calm the spirit achieved complete success. Someone might ask: "If it is Heart-Liver phlegm-heat, why is the pulse not wiry, strong, or slippery, but instead deep and weak?" This is because turbid phlegm blocks the Qi channels, making pulse Qi unsmooth. Xu Songru of the Qing Dynasty wrote in *Zhenyu Suotan* (Casual Talks on Pulse Diagnosis): "Weak pulses often indicate Fire; do not assume them entirely as deficiency." Treatment efficacy also proves this understanding fits the pathogenesis. Mania is mostly caused by emotional stagnation and Qi constraint, with Heart-Liver phlegm-fire disturbing the Spirit. Although it is a difficult-to-treat disease, careful examination and appropriate prescription can often lead to cure. For instance, in 1974, I treated a young patient who had been ill for five years, frequently contemplating suicide but being saved. Treatment in Shanghai, Suzhou, etc., including Chinese and Western medicine, acupuncture, and electrotherapy, rarely yielded results. Investigating the symptoms, besides manic manifestations, he constantly stared at black spots before his eyes. Wherever his gaze went—walls, objects, ground, sky—if there was a black spot, he would fixate on it intently. Without interference, he could stare all day without fatigue. At night, he feared lights; seeing light caused stinging eyelids, and his eyeballs felt as if fire were emerging. He could not close his eyes under lamps; closing them caused abnormal blinking. I administered Zhen Gan Di Tan Tang (Calming the Liver and Purging Phlegm Decoction), using herbs to resolve phlegm, calm the Liver, relieve depression, and clear fire. Consciousness gradually cleared, but the symptoms of staring at black spots and photophobia did not improve. Predecessors said: "Among the fires of the Five Zang, Liver is the most rampant." Bitter-draining and sweet-cold herbs were ineffective; agile, salty-cold substances should be used to achieve efficacy. Thus, I prescribed Antelope Horn Powder (Lingyangjiao Fen), 0.3g daily, taken with the decoction. After twenty-plus days, these two symptoms gradually resolved.
Among mania syndromes, besides Heart-Liver phlegm-heat, there are other types. I briefly cite two examples for reference: I once treated a young man working in Ma'anshan who became violently abnormal due to a broken romance. His relative escorted him to Shanghai; on the way, his madness was unstoppable. This was due to sudden Qi stagnation. Using Chaihu Shugan San (Bupleurum Powder to Soothe the Liver) combined with Simo Yinzi (Four-Mortar Drink) method, he found relief in a few doses. For over twenty years since, he has not relapsed.
In 1995, I treated another young bus driver who became ill due to conflict with his leader. At the consultation, he repeatedly complained of headache and head distension, with no other ailments. His speech was repetitive and verbose; he nodded and smiled at everyone. His pulse was wiry but unsmooth. This belonged to Liver Meridian Qi mechanism discomfort. The treatment method should first "disperse Wood stagnation," followed by resolving phlegm and clearing fire. I prescribed Chaihu Jia Longgu Muli Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction) with modifications. After two months, the symptoms subsided. He subsequently resumed driving and remains safe today.
Discussion on Treating Stroke-Induced Hemiplegia