腻苔由秽浊盘居中宫，上达舌本而然。论其主病，无非湿浊、痰饮、食积、瘀血之类所结成，此等阴邪阻遏阳气，中焦阳用不灵，秽浊弥漫熏蒸，上升而为腻苔。治法当健运脾土，兼化秽浊。然偶有真阴亏虚而致浊秽不化者。余于一九八六年治一病人．已忘其姓氏，系中年男子，身材魁梧，五年前曾患肝炎，经他医治疗早获良效，但肝功能化验单上总有一、二“慢性指标”波动起伏，因而仍与药罐终年为伴。
一日就余诊，方坐下，便张口伸舌以示余，云肝病以后，苔终未化，茵陈用至30g，服数十剂，巍然不动，求为化除之。余细审其苔，灰白微黄，较为厚腻，与临证常见之腻苔无别。问其症，除肝区小有痞胀外，余无不适，胃纳二便、体力均无异常。余细视其脉，六脉除左尺外，皆现小滑，左尺独见沉细而软，按之即遁，显然真阴不足。余推敲再三，因思腻苔宣化，必籍中宫阳气运转之力，而中阳振动，须赖肾中真阳之助。人身水火交融、阴阳互根。《内经》云“阴在内阳之守也，阳在外阴之使也。”阴阳维系始能致用，今肾中真阴不足．纵然阳气不匮，终因阳失阴涵而震撼无力。舌上腻苔焉有化机?余毅然予其健脾疏肝之原疗中，加炒松熟地一两(30g)，予七帖。彼亦知医，见处方面有难色。余告之以理，彼即首肯。一周后如约前来复诊，喜形于色，极赞药效之佳。盖服药之后，苔渐化除，余察其舌，仅有薄白一层，已如常人之苔。腻苔化去，后未复生。由是可知轩岐之学秘奥深邃，岂泛泛然所能望其项背哉？
蓝色舌，本文仅举女性两例，皆为癌症患者，俱呈淡浅蓝色，舌边较深于他处。其中一例为黄姓教师，当时住某医院肿瘤病房。余因友人之邀去彼诊一淋巴痛转移病人，猛听背后有人呼余昔年曾用名，竟是旧时同学，不幸患乳腺癌，手术后，肺仍转移，服浙江某医之中草药，并由所住医院给予化疗。阔别数十年，不意相逢于此情此境，悲恻之心，能不怆然涕下乎!余应邀为之诊，见其舌色浑然淡蓝，两侧较中心略深。临别时相约云：过些时当请余为之诊治，惜其病情变化极速，不多时日即广泛转移，发热不休，全身肿块如拳大者，四肢、躯干皆有。未几即告别人生，溘然长逝，甚为可惜。
另一例为胰腺癌转肝癌，为四十开外之干部。症见肝区及脘腹胀满不适，时作疼痛。频频泛恶，纳食呆钝，大便日行溏粪五、七次，便后腹中略舒。全身黄疸，脉小数，舌色一如上例，浑然淡蓝，舌边较深。《辨舌指南》云：“有微蓝而不满舌者，法宜平肝、熄风、化毒。”与癌症之治法，大体适合。据患者脉证，系肝郁气滞、瘀血内阻。即予疏肝解郁、活血化瘀，解毒制癌。三天后复诊，患者舌现红色，苔则薄白，原先之蓝色全已不见。由此推测：蓝色舌系热郁于肝，因滞气、瘀血阻塞经隧，致使热不能泄而然。是故一经宣通，热邪循经而出，则舌转红色。
黄糙苔为胃热津亏、秽浊上蒸之候。而余诊陆氏惊伤心胆例(见本书“惊恐重症赖补养”篇)，则与众不同：不仅苔现淡黄干糙，且舌质通体呈淡姜黄色，略现僵硬而欠柔和。此种舌象，余遍阅舌诊诸书，皆不见载。不得已，以意揣摩，合四诊而推断用药。初时因病源难明，曾用生津、清热、化痰、通窍诸法，随机取舍，因证立方，皆如泥牛人海，沓无信息。后经反复论证，遍参历代名贤论述，投以益气养血之方，服之渐效。不仅症状递减，神思渐复，且舌色亦转淡红，舌体柔软，糙苔自化。按理而论，如此苔舌，应属脾胃津亏热结，何以对证之药反不见效，而却收效于益气养血?今以意逆之：舌黄苔糙虽属有热，而热有虚实之分，色深者热甚而证实，色淡者热微而证虚。固然，尚须结合脉证。今苔舌之色均淡，纵有痰热属虚可知。苔质干糙虽有津伤之因，而血亦阴类，阴血既虚亦呈燥象。且“饮入于胃，游溢精气”，须得“脾气散精”，始能“上归于肺”而并行于五经。今则元气耗伤、脾土不运，即使胃有津液，谁与输布全身?津既不布，燥象必见。补益气血正所以滋化源、助脾运、养精血、益肝肾。治兼先、后天，根本既立，诸病自已。
舌根肉芽高突、光莹无皮，不见于经传，亦不载于诸子百家之书。临诊间余数见之，患者所述病种非止一端，然皆逢场作戏，偶一过诊而已。因而难揣病源，莫能测其主病。其中一例于舌根出现肉芽后数月，患胃癌逝世。舌根肉芽与癌肿有否内在联系?有待继续探索。《辨舌指南》未有专论，仅于“裂纹”舌条内，述及“舌根高起，累累如豆，中露人字纹深广者，胃有积也。”而余所见患者均无人字纹，然胃中之积与肿瘤当属同类之病。第肿瘤有良性、恶性之分，而癥积则为笼统浑称之名。
汗吐下法亲历记
我国历代医家中，善用汗吐下法治病者，子和之后，未之闻也。谓之千古绝响，似不为过。近今医家处方用药多尚稳健，能绍子和之箕裘者，盖亦寡矣。余数读子和之书，欣慕子和之法，而不敢一试焉。虽非全由谈虎色变，闻雷落箸，畏惧之而不敢用，实为医家肩负救死扶伤之责。先贤胆大心细智园行方之训，历历在心，故未尝敢有一药浪投也。于是求索善用子和之法者，每思以一睹为快，而竟亦了不可得。直至数年前，得遇川沙陈英俊医师，始知子和之法尚有传人在。且亲服其所授吐下之药，而体验益深也，故记其始末，以飨同好。
余于十年前，一度身体不舒，痰气阻塞于中，心肝火炽于上，而脾肾不足于内。服清火顺气消痰之药，兼扶脾土，有效而无大效。商之名家，计无所出。欲用吐下之法，而虑其峻烈。因思丹溪有“倒仓法”，乃以黄牛肉二十斤，熬其汁成琥珀色，空腹饮之。病在上则吐，病在下则泻，上下兼病则吐泻交作，祛病如扫。且牛肉补土，病去速而正不伤也。愚意先以小量试之。于是购买牛肉五斤，熬汁去渣，浓缩其汁，仅得大半碗。因数量太少，服后仅泛恶而不吐，更不致泻。而中焦倍觉阻塞益甚，上下之气，似被痞隔，头胀胸闷，眼热心悸，足胫酸软，皮肤干糙若砂纸。时时自觉气机上冒而不能下达，神情亦稍呆钝。每日临证，仅能勉力支持。屡请名家投剂，方证得当，效终不显，病则日益加甚。四个月后，有缘得见陈英俊先生于其诊室。先生年逾古稀，形丰而神采奕然。无论男女童叟，凡来诊者，皆先诊脉，而后据脉言证，多能若合符节。脉证既符则于其自备之数十味丸药中选定一种丸药或处以汤药，并随即煎煮使当即服下，服后或吐或不吐，过半小时后再复诊脉，然后予另一种丸药或汤剂，带回服用。服后必致吐泻，吐泻过后，继以“先清后调”两法以善其后。清法乃多以丸药清未尽之内热。调则开处方两张，一为寒热并用之剂，每以桂附与硝黄同投；一为消补兼清之方。先服前者一帖，停药一日再服后者一帖，复停药一日再服前者。如此交替服至各四、五剂，再前往诊脉吐下，继以清调，周而复始直至病愈。余被诊脉后，谓是五脏积热，所言症情凿凿。先予“紫葛丸”如梧桐子大者六十粒，下咽即觉辛辣异常，旋感胸中热辣，愠愠欲吐而未能吐。半小时后复诊脉，予“十补丸”六十粒暨清调方药，嘱带回服用。因路途遥远，3小时后始到家，已下午3时矣。立即将十补丸服下，入口味甘，带有人参气。服药后1小时，开始剧吐。所吐物尽是褐色粘腻之液，因先服之药有辛昧，故吐时满口辛辣，直吐至辣味渐消则吐自止。继而大泻数十次，始犹带粪，后者纯为稀水。至夜半尚不能止，以针灸针刺足三里、内庭二穴，立时止泻。次日身肢疲软，而胃纳不减，休息一日即体力恢复，吐泻之后，顿觉胸腹宽畅，三焦通达，神清气爽而诸症去矣。数月之病，除于一旦，正有不可思议者。陆放翁有句云：“纸上得来总觉浅，绝知此事要躬行”，诚见道之言也。余亲服吐下之药而效立见，以切身之体验，益知为人司命者，子和之书不可不读，子和之法不可偏废也。
附一：陈先生为余所开“清”方
大黄9g黄芩9g黄连6g槟榔16g木香9g附子9g肉桂6g白术9g神曲18g茯苓16g泽泻12g当归9g延胡6g青陈皮各9g半夏9g南星6g
附二：陈先生为余所开“调”方
黄芪18g党参16g白术9g陈皮9g升麻9g柴胡16g甘草6g当归6g木香9g槟榔16g
按：服吐下等烈性药物后，常见“瞑眩”现象，亦即药物反应之一端也。孟子曰：“若药不瞑眩，则厥疾不瘳。”然则“瞑眩”现象，益欤?害欤?何以别之?余于临证之中，药物反应者数数见之，其状各不相同。要凡反应之时，对病者之精神状态无明显影响者，则为药病相当，是药力祛病之应也。反应之后，自有效验可见，孟子所说者，即此之谓也。若反应之时，病者之精神状态明显受其影响者，如见精神萎顿、正气不支；或心绪烦乱、意不自守；或言语错乱、神识不清等，则属药不应病，或是药重伤身之害，速宜设法补救，不可掉以轻心。凡服重药剧药者，宜加慎焉。
内科类
感症小议
一、温病亦有“热入血室”证
《伤寒论》有热入血室一证，而温病学中，同样颇多论述，如《临证指南》、《温热经纬》、《温病条辨》均有明文。何为“热入血室”?“所谓热入血室，就是妇人月经期间，正遇外感，邪热与血互相搏结所造成的病变。由于病体有强弱，邪陷有深浅的不同，所以表现的症状也不同，而治法当然也随之而异。”(《伤寒论教育参考资料》)
依据上述定义，当为：①患者适遇外感。②正值妇人月经期。③外感邪热与经血互结，以致造成月经紊乱(经水适来、适断、或自行。)④可见胸胁下满、寒热往来、谵语等症状。然前三条为辨证之主要依据，而症状须结合患者具体情况而定，《伤寒论》热入血室共四条，所见症状亦各不同。关于谵语一症，考《伤寒论》中热入血室证，除216条(属阳明病)有谵语外，第143，144，145三条为少阳病，其中144条无谵语。是故可以推论热入血室一证不以谵语为必见症状，只须在“妇人月经期间。适遇外感，邪热与血相搏结所造成的病变。”即可成立诊断。
孙文垣于《生生子医案》中，载有治“元素侄妇”热入血室一案，“乃春温后经水适止，证见余热不退，口中甚渴，胸胁痛而耳聋。经用柴胡、人参、甘草、天花粉、黄芩、白芍、红花、当归、丹皮、知母而瘥。”此案因于春温，症状中不见谵语，恰为上述讨论之极好注脚。
关于热入血室之治疗，胸胁下满者刺期门以泻瘀热，证轻而表邪仍在者可待自愈。邪在少阳者，钱天来以小柴胡汤加牛膝、丹皮、桃仁；许叔微以小柴胡汤加生地黄；杨士瀛则以小柴胡汤加五灵脂。无不旨在和解达邪为主，实证佐以活血化瘀，使外邪解、经隧通而病得愈。虚证佐以养血凉血，俾邪解同时阴血得充，则血室自清。以上为伤寒治法，而温热病热入血室治法略有不同。如叶子雨眉评《温病条辨》云：“其经水适来而病温热，病虽发而经水照常自行者，不必治其经血，但治其病而自愈。”余据此义曾治一例属外感风热而致崩漏，参考前贤治法，祛邪为主，佐以调血。以银翘散辛平疏解，以达表邪，加益母草活血通经，血结得开，经络通畅，则内外之邪俱解而病即愈。某厂技校女学牛陈某，年方二九。1991年夏前偶患感冒发热，适值汛至，热退后经漏不止，每日点滴而下，逾月不净。迭进行气活血、通经止漏及益气养血、固本收涩等法，半月未应。改请某妇科前辈诊治，服药一周病仍依然。复来余处诊治，余仔细推详四诊。患者病起于感冒发热之后，感冒时月经适行，热退经血不止，当是邪热乘经行血室空疏而入于胞宫，阻碍经血正常运行而致。同时细勘脉象，患者脉形虽小，而气口脉明显强于他部，且略偏于浮，此症当是风热外感，邪尚未解，热扰血室，以致漏下不止。试投银翘散加益母草，方为：
金银花9g连翘9g荆芥9g竹叶9g薄荷3g桔梗4．5g甘草3g牛蒡子9g豆豉9g益母草15g
服药三帖，经漏即止，外感亦解，以后月经正常，按期而至。现已成婚育子俨然慈母矣。
二、风寒外感亦可“战汗”
“战汗”一词首见于危亦林《世医得效方》，但书中未加详述。直至晚清温病学家叶天士在舟中对其学生顾景文口述“外感温热篇”，将战汗作为正气达邪外出之自愈机制后，“战汗”一词始为杏林常用之语，医家每多采用。然何谓“战汗”?即是于外感热病之某一阶段，突然发生战栗，继而全身出汗，症随汗解者即为“战汗”。此为机体邪正相争之表现，正胜邪则汗出病解，正不敌邪则战而无汗。外感热病无论伤寒、温病皆可发生战汗，但以温病为多见。温病有卫、气、营、血等不同阶段，而战汗则见于邪在气分之时。叶氏曰：“若其邪始终在气分流连者，可冀其战汗透邪。”
腻苔是由于秽浊之气盘踞在中焦，向上蔓延至舌根而形成的。论述其主病，无非是湿浊、痰饮、食积、瘀血等阴邪结聚而成。这些阴邪阻遏阳气，导致中焦阳气功能不灵，秽浊弥漫熏蒸，上升而形成腻苔。治疗方法应当健运脾土，兼以化解秽浊。然而偶尔也有因真阴亏虚而导致浊秽无法化解的情况。我在一九八六年治疗一位病人，已忘记他的姓氏，是一位中年男子，身材魁梧，五年前曾患肝炎，经其他医生治疗早已获得良效，但肝功能化验单上总有一两个“慢性指标”波动起伏，因此仍常年与药罐为伴。
有一天来找我诊治，刚坐下，便张口伸舌给我看，说肝病之后，舌苔始终没有化除，茵陈蒿用到30克，服了数十剂，依然纹丝不动，请求我为他化解去除。我仔细审视他的舌苔，灰白微黄，较为厚腻，与临证常见的腻苔没有区别。询问他的症状，除了肝区稍有痞胀外，其余没有不适，胃纳、二便、体力均无异常。我仔细诊察他的脉象，六脉除了左尺脉之外，都呈现小滑之象，唯独左尺脉沉细而软，按之即散，显然是真阴不足。我反复推敲，想到腻苔需要化解，必须依赖中宫阳气的运转之力，而中阳的振动，须赖肾中真阳的帮助。人身水火交融、阴阳互根。《内经》说：“阴在内，为阳之守也；阳在外，为阴之使也。”阴阳维系才能发挥作用，现在肾中真阴不足，纵然阳气不匮乏，终因阳气失去阴液的涵养而震撼无力。舌上的腻苔又怎么会有化除的机理呢？我毅然在健脾疏肝的原方基础上，加入炒松熟地黄一两（30克），给予七帖。他也懂医，看到处方时面露难色。我向他解释其中的道理，他便点头同意。一周后如约前来复诊，喜形于色，极力称赞药效之佳。原来服药之后，舌苔逐渐化除，我再观察他的舌头，仅有一层薄白苔，已经像正常人的舌苔一样。腻苔化去后，后来没有再生。由此可知，岐黄之学的奥秘深邃，岂是一般人能望其项背的呢？
蓝色舌，本文仅举女性两例，都是癌症患者，都呈现淡浅蓝色，舌边比其他部位颜色较深。其中一例是姓黄的教师，当时住在某医院肿瘤病房。我因朋友邀请去那里诊治一位淋巴转移的病人，猛然听到背后有人呼唤我昔日的曾用名，竟是旧时的同学，不幸患了乳腺癌，手术后肺部仍有转移，服用浙江某位中医的中草药，并由所在医院给予化疗。阔别数十年，没想到在此情此景相逢，悲恻之心，怎能不让人泪流满面呢！我应邀为她诊治，见她的舌色浑然淡蓝，两侧比中心略深。临别时约定说：过些时候再请我诊治，可惜她病情变化极快，没过多久就广泛转移，发热不退，全身肿块如拳头大者，四肢、躯干都有。不久便告别人生，溘然长逝，非常可惜。
另一例是胰腺癌转肝癌，是一位四十多岁的干部。症状表现为肝区及脘腹胀满不适，时常疼痛。频频恶心，食欲呆钝，大便每天稀溏五、七次，便后腹中略微舒适。全身黄疸，脉小数，舌色如同上一例，浑然淡蓝，舌边较深。《辨舌指南》说：“有微蓝而不满舌的，治法宜平肝、熄风、解毒。”这与癌症的治疗方法大体适合。根据患者的脉证，属于肝郁气滞、瘀血内阻。于是给予疏肝解郁、活血化瘀、解毒制癌的方药。三天后复诊，患者舌现红色，苔则薄白，原先的蓝色全已不见。由此推测：蓝色舌是因为热郁于肝，因滞气、瘀血阻塞经络，致使热不能宣泄所致。所以一经宣通，热邪循经而出，则舌转为红色。
黄糙苔是胃热津亏、秽浊上蒸的表现。而我诊治陆氏惊伤心胆的案例（见本书“惊恐重症赖补养”篇），则与众不同：不仅舌苔呈淡黄干糙，且舌质通体呈淡姜黄色，略显僵硬而欠柔和。这种舌象，我遍阅舌诊诸书，都没有记载。不得已，凭心意揣摩，结合四诊推断用药。起初因病源难明，曾用生津、清热、化痰、通窍等方法，随机取舍，因证立方，都像泥牛入海，毫无消息。后经反复论证，遍参历代名贤论述，投以益气养血之方，服用后逐渐见效。不仅症状递减，神思渐复，而且舌色也转为淡红，舌体柔软，糙苔自化。按理而论，如此苔舌，应属脾胃津亏热结，为什么对证的药反而不见效，却收效于益气养血？今凭心意逆推：舌黄苔糙虽属有热，而热有虚实之分，色深者热甚而证实，色淡者热微而证虚。固然，尚须结合脉证。如今苔舌之色均淡，纵有痰热也属虚可知。苔质干糙虽有津伤的原因，而血也属阴类，阴血既虚也呈燥象。且“饮入于胃，游溢精气”，须得“脾气散精”，始能“上归于肺”而并行于五脏。如今元气耗伤、脾土不运，即使胃有津液，谁来输布全身？津液既不布散，燥象必然出现。补益气血正是为了滋生化之源、助脾运、养精血、益肝肾。治疗兼顾先天、后天，根本既立，诸病自愈。
舌根肉芽高突、光莹无皮，不见于经典著作，也不载于诸子百家之书。临诊间我多次见到，患者所述病种不止一端，但都是逢场作戏，偶尔经过诊治而已。因而难以揣测病源，不能测定其主病。其中一例在舌根出现肉芽后数月，患胃癌逝世。舌根肉芽与癌肿是否有内在联系？有待继续探索。《辨舌指南》未有专论，仅在“裂纹”舌条内，述及“舌根高起，累累如豆，中露人字纹深广者，胃有积也。”而我所见的患者均无人字纹，然而胃中之积与肿瘤当属同类之病。只是肿瘤有良性、恶性之分，而癥积则是笼统浑称之名。
汗吐下法亲历记
我国历代医家中，善用汗、吐、下法治病者，自张子和之后，就没听说过了。称之为千古绝响，似乎不为过。近今医家处方用药多崇尚稳健，能继承张子和衣钵的，大概也很少了。我多次读张子和的书，欣慕张子和的方法，但不敢尝试。虽然不全是因为谈虎色变、闻雷落箸般的畏惧而不敢用，实在是因为医者肩负救死扶伤的责任。先贤胆大心细、智圆行方的教诲，历历在心，所以不敢有一味药随意投用。于是寻求善用张子和方法的人，每每想一睹为快，竟然也求之不得。直到数年前，遇到川沙的陈英俊医师，才知道张子和的方法还有传人。并且亲自服用他所传授的吐下药，体验更加深刻，故记录始末，以飨同好。
我在十年前，一度身体不舒服，痰气阻塞于中，心肝火炽于上，而脾肾不足于内。服用清火顺气消痰的药，兼扶脾土，有效但没有大效。咨询名家，计无所出。想用吐下之法，又顾虑其峻烈。想到朱丹溪有“倒仓法”，乃用黄牛肉二十斤，熬其汁成琥珀色，空腹饮之。病在上则吐，病在下则泻，上下兼病则吐泻交作，祛病如扫。且牛肉补土，病去速而正气不伤。我愚意先用小量试之。于是购买牛肉五斤，熬汁去渣，浓缩其汁，仅得大半碗。因数量太少，服后仅泛恶而不吐，更不致泻。而中焦倍觉阻塞益甚，上下之气，似被痞隔，头胀胸闷，眼热心悸，足胫酸软，皮肤干糙若砂纸。时时自觉气机上冒而不能下达，神情亦稍呆钝。每日临证，仅能勉力支持。屡请名家投剂，方证得当，效终不显，病则日益加甚。四个月后，有缘在陈英俊先生的诊室见到他。先生年逾古稀，形体丰满而神采奕奕。无论男女童叟，凡来诊者，皆先诊脉，而后据脉言证，多能若合符节。脉证既符则于其自备之数十味丸药中选定一种丸药或处以汤药，并随即煎煮使当即服下，服后或吐或不吐，过半小时后再复诊脉，然后予另一种丸药或汤剂，带回服用。服后必致吐泻，吐泻过后，继以“先清后调”两法以善其后。清法乃多以丸药清未尽之内热。调则开处方两张，一为寒热并用之剂，每以桂附与硝黄同投；一为消补兼清之方。先服前者一帖，停药一日再服后者一帖，复停药一日再服前者。如此交替服至各四、五剂，再前往诊脉吐下，继以清调，周而复始直至病愈。我被诊脉后，说是五脏积热，所言症情确凿。先予“紫葛丸”如梧桐子大者六十粒，下咽即觉辛辣异常，旋感胸中热辣，愠愠欲吐而未能吐。半小时后复诊脉，予“十补丸”六十粒暨清调方药，嘱带回服用。因路途遥远，3小时后始到家，已下午3时矣。立即将十补丸服下，入口味甘，带有人参气。服药后1小时，开始剧吐。所吐物尽是褐色粘腻之液，因先服之药有辛味，故吐时满口辛辣，直吐至辣味渐消则吐自止。继而大泻数十次，始犹带粪，后者纯为稀水。至夜半尚不能止，以针灸针刺足三里、内庭二穴，立时止泻。次日身肢疲软，而胃纳不减，休息一日即体力恢复，吐泻之后，顿觉胸腹宽畅，三焦通达，神清气爽而诸症去矣。数月之病，除于一旦，正有不可思议者。陆放翁有句云：“纸上得来总觉浅，绝知此事要躬行”，诚见道之言也。余亲服吐下之药而效立见，以切身之体验，益知为人司命者，子和之书不可不读，子和之法不可偏废也。
附一：陈先生为我所开的“清”方
大黄9g 黄芩9g 黄连6g 槟榔16g 木香9g 附子9g 肉桂6g 白术9g 神曲18g 茯苓16g 泽泻12g 当归9g 延胡索6g 青皮陈皮各9g 半夏9g 南星6g
附二：陈先生为我所开的“调”方
黄芪18g 党参16g 白术9g 陈皮9g 升麻9g 柴胡16g 甘草6g 当归6g 木香9g 槟榔16g
按：服用吐下等烈性药物后，常见“瞑眩”现象，亦即药物反应之一端也。孟子曰：“若药不瞑眩，则厥疾不瘳。”然则“瞑眩”现象，有益吗？有害吗？如何辨别？我在临证之中，药物反应者屡屡见到，其状各不相同。总之，凡反应之时，对病人的精神状态无明显影响者，则为药病相当，是药力祛病之应也。反应之后，自有效验可见，孟子所说的，即此之谓也。若反应之时，病人的精神状态明显受其影响者，如见精神萎顿、正气不支；或心绪烦乱、意不自守；或言语错乱、神识不清等，则属药不应病，或是药重伤身之害，速宜设法补救，不可掉以轻心。凡服重药剧药者，宜加慎焉。
内科类
感症小议
一、温病亦有“热入血室”证
《伤寒论》有热入血室一证，而温病学中，同样颇多论述，如《临证指南》、《温热经纬》、《温病条辨》均有明文。何为“热入血室”？“所谓热入血室，就是妇人月经期间，正遇外感，邪热与血互相搏结所造成的病变。由于病体有强弱，邪陷有深浅的不同，所以表现的症状也不同，而治法当然也随之而异。”（《伤寒论教育参考资料》）
依据上述定义，当为：①患者适遇外感。②正值妇人月经期。③外感邪热与经血互结，以致造成月经紊乱（经水适来、适断、或自行）。④可见胸胁下满、寒热往来、谵语等症状。然前三条为辨证之主要依据，而症状须结合患者具体情况而定，《伤寒论》热入血室共四条，所见症状亦各不同。关于谵语一症，考《伤寒论》中热入血室证，除216条（属阳明病）有谵语外，第143、144、145三条为少阳病，其中144条无谵语。是故可以推论热入血室一证不以谵语为必见症状，只须在“妇人月经期间，适遇外感，邪热与血相搏结所造成的病变。”即可成立诊断。
孙文垣于《生生子医案》中，载有治“元素侄妇”热入血室一案，“乃春温后经水适止，证见余热不退，口中甚渴，胸胁痛而耳聋。经用柴胡、人参、甘草、天花粉、黄芩、白芍、红花、当归、丹皮、知母而瘥。”此案因于春温，症状中不见谵语，恰为上述讨论之极好注脚。
关于热入血室之治疗，胸胁下满者刺期门以泻瘀热，证轻而表邪仍在者可待自愈。邪在少阳者，钱天来以小柴胡汤加牛膝、丹皮、桃仁；许叔微以小柴胡汤加生地黄；杨士瀛则以小柴胡汤加五灵脂。无不旨在和解达邪为主，实证佐以活血化瘀，使外邪解、经隧通而病得愈。虚证佐以养血凉血，俾邪解同时阴血得充，则血室自清。以上为伤寒治法，而温热病热入血室治法略有不同。如叶子雨眉评《温病条辨》云：“其经水适来而病温热，病虽发而经水照常自行者，不必治其经血，但治其病而自愈。”我据此义曾治一例属外感风热而致崩漏，参考前贤治法，祛邪为主，佐以调血。以银翘散辛平疏解，以达表邪，加益母草活血通经，血结得开，经络通畅，则内外之邪俱解而病即愈。某厂技校女学生陈某，年方二九。1991年夏前偶患感冒发热，适值汛至，热退后经漏不止，每日点滴而下，逾月不净。迭进行气活血、通经止漏及益气养血、固本收涩等法，半月未应。改请某妇科前辈诊治，服药一周病仍依然。复来余处诊治，我仔细推详四诊。患者病起于感冒发热之后，感冒时月经适行，热退经血不止，当是邪热乘经行血室空疏而入于胞宫，阻碍经血正常运行而致。同时细勘脉象，患者脉形虽小，而气口脉明显强于他部，且略偏于浮，此症当是风热外感，邪尚未解，热扰血室，以致漏下不止。试投银翘散加益母草，方为：
金银花9g 连翘9g 荆芥9g 竹叶9g 薄荷3g 桔梗4.5g 甘草3g 牛蒡子9g 豆豉9g 益母草15g
服药三帖，经漏即止，外感亦解，以后月经正常，按期而至。现已成婚育子俨然慈母矣。
二、风寒外感亦可“战汗”
“战汗”一词首见于危亦林《世医得效方》，但书中未加详述。直至晚清温病学家叶天士在舟中对其学生顾景文口述“外感温热篇”，将战汗作为正气达邪外出之自愈机制后，“战汗”一词始为杏林常用之语，医家每多采用。然何谓“战汗”？即是于外感热病之某一阶段，突然发生战栗，继而全身出汗，症随汗解者即为“战汗”。此为机体邪正相争之表现，正胜邪则汗出病解，正不敌邪则战而无汗。外感热病无论伤寒、温病皆可发生战汗，但以温病为多见。温病有卫、气、营、血等不同阶段，而战汗则见于邪在气分之时。叶氏曰：“若其邪始终在气分流连者，可冀其战汗透邪。”
The greasy coating (greasy tongue coating) is formed because turbid filth (turbid pathogenic factors) lodges in the middle jiao (middle burner, primarily referring to the spleen and stomach) and extends upward to the root of the tongue. Regarding its primary pathology, it is nothing but the accumulation of damp-turbidity, phlegm-fluid retention, food stagnation, or blood stasis. These yin pathogens obstruct yang qi, causing the functional activity of middle jiao yang to become ineffective. The turbid filth diffuses and steams upward, resulting in a greasy coating. The treatment method should focus on strengthening and transporting spleen earth (strengthening spleen function), while simultaneously resolving turbid filth. However, occasionally there are cases where true yin deficiency leads to the failure to transform turbid filth. In 1986, I treated a patient whose surname I have forgotten; he was a middle-aged man with a burly physique. Five years prior, he had suffered from hepatitis. Although other physicians had achieved good results in his treatment, one or two "chronic indicators" on his liver function test reports fluctuated continuously, so he remained accompanied by medicine jars year-round.
One day, he came for consultation. As soon as he sat down, he opened his mouth and extended his tongue for me to see, stating that after his liver disease, the tongue coating had never resolved. He had used Yinchen Hao (Artemisiae Scopariae Herba) up to 30g, taking dozens of doses, yet it remained unchanged. He requested my help to resolve it. I carefully examined his tongue coating; it was grayish-white with a slight yellow tint, relatively thick and greasy, indistinguishable from common greasy coatings seen in clinical practice. Upon asking about his symptoms, aside from slight fullness and distension in the liver area, he had no other discomforts. His appetite, bowel movements, and physical strength were all normal. I carefully palpated his pulse; except for the left chi (kidney) position, all six positions presented a small slippery (xiao hua) quality. Only the left chi position was deep, fine, and soft, disappearing upon pressure, clearly indicating insufficient true yin. After repeated deliberation, I reasoned that resolving a greasy coating requires the driving force of middle jiao yang qi movement. The vibration of middle yang relies on the assistance of true yang in the kidney. In the human body, water and fire blend, and yin and yang are mutually rooted. The *Neijing* states: "Yin within serves as the guard for yang; yang outside serves as the agent for yin." Only through the maintenance of yin and yang can functions be realized. Now, with insufficient true yin in the kidney, even if yang qi is not deficient, it ultimately lacks the power to vibrate effectively due to the loss of yin nourishment. How could there be any mechanism for the resolution of the greasy coating on the tongue? I resolutely added Chao Song Shu Di Huang (Fried Prepared Rehmannia Root, 30g) to the original prescription for strengthening the spleen and soothing the liver, prescribing seven doses. He also understood medicine and showed hesitation upon seeing the prescription. I explained the rationale to him, and he agreed. One week later, he returned for follow-up as scheduled, visibly pleased, highly praising the efficacy of the medication. After taking the medicine, the coating gradually resolved. Upon re-examining his tongue, only a thin white layer remained, resembling that of a normal person. The greasy coating did not recur afterward. From this, we can see that the profound mysteries of the learning of Qi Bo and Huang Di (traditional Chinese medicine) are far beyond the reach of ordinary people.
Blue Tongue: This article cites only two female cases, both cancer patients, presenting with a pale light blue color, darker at the edges than elsewhere. One case was a teacher surnamed Huang, who was then hospitalized in the oncology ward of a certain hospital. Invited by a friend to treat a patient with lymph node metastasis there, I suddenly heard someone behind me calling my former name; it turned out to be an old classmate. Unfortunately, she had breast cancer. After surgery, lung metastasis occurred. She was taking Chinese herbal medicine from a doctor in Zhejiang and receiving chemotherapy from her hospital. Having been separated for decades, meeting under such circumstances evoked profound sorrow, bringing tears to my eyes! I accepted the invitation to examine her and saw her tongue was uniformly pale blue, slightly darker on the sides than the center. At parting, we agreed that I would treat her again later. Regrettably, her condition changed rapidly. Within a short time, widespread metastasis occurred, accompanied by persistent fever. Tumors the size of fists appeared on her limbs and trunk. Soon after, she passed away, which was very regrettable.
Another case involved pancreatic cancer metastasizing to the liver, affecting a cadre in his forties. Symptoms included fullness and discomfort in the liver area and epigastrium, with intermittent pain. Frequent nausea, dull appetite, and loose stools five to seven times daily, with slight relief after defecation. Generalized jaundice, a small rapid pulse, and a tongue color identical to the previous case—uniformly pale blue, darker at the edges. The *Bian She Zhi Nan* (Guide to Tongue Diagnosis) states: "For those with slight blue color not covering the whole tongue, the method should be to soothe the liver, extinguish wind, and resolve toxicity." This generally aligns with the treatment principles for cancer. Based on the patient's pulse and symptoms, the pattern was liver qi stagnation with internal blood stasis. I prescribed herbs to soothe the liver, relieve depression, invigorate blood, resolve stasis, detoxify, and inhibit cancer. Three days later at follow-up, the patient's tongue was red with a thin white coating; the previous blue color had completely disappeared. From this, I inferred that the blue tongue results from heat constrained in the liver, blocked by stagnant qi and blood stasis in the meridians, preventing heat from dissipating. Once unblocked, the heat pathogen exits via the meridians, turning the tongue red.
Yellow rough coating indicates stomach heat with fluid depletion and steaming turbid filth upward. However, in my case of Lu Shi suffering from fright damaging the heart and gallbladder (see the chapter "Severe Fright Illness Relies on Nourishment" in this book), the presentation was different: not only was the coating pale yellow, dry, and rough, but the tongue body itself was pale ginger-yellow throughout, slightly stiff and lacking flexibility. I reviewed various books on tongue diagnosis but found no record of this appearance. Forced to rely on my own reasoning, I combined the four diagnostic methods to infer the treatment. Initially, due to the unclear etiology, I used methods such as generating fluids, clearing heat, resolving phlegm, and opening orifices, adjusting prescriptions according to symptoms, but they yielded no results, like mud cows entering the sea. After repeated discussion and studying the writings of past famous experts, I administered a formula to tonify qi and nourish blood, which gradually proved effective. Not only did symptoms decrease and mental clarity return, but the tongue color also turned pale red, the tongue body became soft, and the rough coating resolved naturally. Theoretically, such a tongue and coating should belong to spleen and stomach fluid depletion with heat binding. Why did the corresponding medicines fail, yet tonifying qi and blood succeeded? Reasoning backwards: although a yellow rough coating indicates heat, heat has deficiency and excess types. Deep color indicates severe heat and excess syndrome; pale color indicates mild heat and deficiency syndrome. Of course, this must be combined with pulse and symptoms. Since the tongue and coating colors here are both pale, even if there is phlegm-heat, it belongs to deficiency. Although the dry and rough texture suggests fluid injury, blood is also a yin substance; when yin-blood is deficient, dryness appears. Furthermore, "when drink enters the stomach, it overflows with essence," which requires "spleen qi to scatter the essence" to "return to the lungs" and circulate through the five zang organs. Now, with consumed primordial qi and non-functioning spleen earth, even if the stomach has fluids, who will distribute them to the whole body? Without fluid distribution, dryness inevitably appears. Tonifying qi and blood aims to nourish the source of transformation, assist spleen transport, nourish essence and blood, and benefit the liver and kidneys. Treating both congenital and acquired foundations, once the root is established, diseases heal themselves.
Hyperplastic tissue (fleshy protuberance) at the root of the tongue, smooth and devoid of mucosa, is not found in classics nor in the works of the hundred schools of thought. I have seen it several times in clinical practice. Patients reported various diseases, but these were merely incidental findings during occasional consultations. Thus, it is difficult to ascertain the etiology or determine the primary pathology. One case died of gastric cancer months after the appearance of fleshy protuberance at the tongue root. Is there an intrinsic connection between tongue root hyperplasia and tumors? Further exploration is needed. The *Bian She Zhi Nan* does not have a specific discussion, only mentioning under the "cracked tongue" section: "When the tongue root rises, nodular like beans, with deep and wide ren-shaped cracks in the middle, it indicates accumulation in the stomach." None of the patients I observed had ren-shaped cracks, however, gastric accumulation and tumors belong to similar pathological categories. Tumors are classified as benign or malignant, whereas "zheng ji" (masses/accumulations) is a general term.
Personal Experience with Sweating, Vomiting, and Purgative Methods
Among physicians throughout Chinese history, those skilled in using sweating, vomiting, and purgative methods were rare after Zhang Zihe. Calling it a lost art for millennia seems appropriate. Modern physicians tend to prescribe conservative medications; few inherit Zhang Zihe's legacy. I have read Zhang Zihe's books many times, admiring his methods, but dared not try them myself. This was not solely due to fear akin to hearing a tiger or thunder dropping chopsticks, but rather because physicians bear the responsibility of saving lives. The teachings of ancient sages to be bold yet cautious, wise yet principled, remain vivid in my mind, so I never dared to throw a single herb carelessly. I sought practitioners skilled in Zhang Zihe's methods, eager to witness them, but could find none. Until a few years ago, I met Dr. Chen Yingjun from Chuansha, discovering that Zhang Zihe's methods still had successors. I personally took the vomiting and purgative medicines he taught me, deepening my experience. Therefore, I record the beginning and end to share with enthusiasts.
Ten years ago, I felt unwell. Phlegm and qi were obstructed in the middle, heart and liver fire blazed above, while spleen and kidney were deficient inside. Medications to clear fire, regulate qi, and resolve phlegm, along with spleen support, were effective but not significantly so. Consulting renowned experts yielded no solutions. I wanted to use vomiting and purgative methods but feared their harshness. Recalling Zhu Danxi's "Dou Cang Fa" (Stomach Emptying Method), which involves boiling twenty catties of yellow beef until the juice turns amber, and drinking it on an empty stomach. If the disease is above, vomiting occurs; if below, purgation occurs; if both, both occur, sweeping away disease. Beef tonifies earth, removing disease quickly without injuring healthy qi. I foolishly decided to try a small amount first. I bought five catties of beef, boiled the juice, removed dregs, and concentrated it to obtain only half a bowl. Due to the small quantity, after ingestion, I only felt nauseous without vomiting, let alone purging. My middle jiao obstruction worsened significantly. Qi above and below seemed blocked, causing head distension, chest tightness, hot eyes, palpitations, sore legs, and rough skin like sandpaper. I constantly felt qi rushing upward without descending, and my demeanor became somewhat dull. Daily clinical work was barely manageable despite efforts. Repeated consultations with experts resulted in appropriate prescriptions, yet efficacy was poor, and the illness worsened daily. Four months later, I had the fortune of meeting Mr. Chen Yingjun in his clinic. Over seventy years old, he was robust and radiant. Regardless of gender or age, he always diagnosed the pulse first, then discussed symptoms based on the pulse, often matching perfectly. Once pulse and symptoms matched, he selected one of his prepared dozen pill formulas or prescribed decoctions, brewed immediately for instant consumption. Depending on whether vomiting occurred, he re-palpated the pulse half an hour later, then prescribed another pill or decoction to take home. Consumption invariably led to vomiting and purging. Afterwards, he employed "clearing then regulating" methods to conclude treatment. Clearing mainly used pills to remove residual internal heat. Regulation involved two prescriptions: one combining cold and hot herbs (often Guizhi and Fuzi with Xiaoshuang and Dahuang); another combining elimination, tonification, and clearing. The patient took the former for one dose, stopped for a day, took the latter for one dose, stopped for a day, alternating until four or five doses of each were taken. Then, they returned for pulse diagnosis and vomiting/purgation, followed by clearing and regulating, repeating until cured.
After diagnosing my pulse, Mr. Chen stated I had accumulated heat in the five zang organs, confirming my symptoms accurately. He first gave sixty "Zige Wan" (Purple Vine Pill), sized like paulownia seeds. Swallowing it felt extremely pungent, followed by burning heat in the chest, urging vomiting but unable to do so. Half an hour later, upon re-pulse diagnosis, he gave sixty "Shibu Wan" (Ten Tonic Pills) and regulation prescriptions, instructing me to take them home. Due to the long journey, I arrived home three hours later, at 3 PM. I immediately took the Shibu Wan. It tasted sweet with a ginseng aroma. One hour after ingestion, violent vomiting began. Vomit consisted entirely of brown viscous fluid. Because the previous medicine was pungent, my mouth was filled with spiciness during vomiting. Vomiting continued until the spiciness faded, then stopped spontaneously. This was followed by massive purging dozens of times. Initially, stool contained feces; later, it was purely watery. By midnight, purging had not stopped. Acupuncture at Zusanli (ST36) and Neiting (ST44) stopped it immediately. The next day, my limbs were weak, but appetite remained unchanged. Resting for one day restored my strength. After vomiting and purging, I felt immediate relief in the chest and abdomen,畅通 (unobstructed) san jiao, clear spirit, and all symptoms vanished. Months of illness were cured overnight, truly miraculous. Lu You wrote: "Knowledge gained from paper feels shallow; one must practice personally to truly understand." This is indeed a profound truth. Personally experiencing the immediate efficacy of vomiting and purgative medicines, through firsthand experience, I further realize that those responsible for life must read Zhang Zihe's books and cannot neglect his methods.
Appendix 1: "Clearing" Prescription Prescribed by Mr. Chen for Me
Dahuang (Rhubarb Radix et Rhizoma) 9g, Huangqin (Scutellariae Radix) 9g, Huanglian (Coptidis Rhizoma) 6g, Binglang (Arecae Semen) 16g, Muxiang (Aucklandiae Radix) 9g, Fuzi (Aconiti Lateralis Radix Praeparata) 9g, Rougui (Cinnamomi Cortex) 6g, Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Shenqu (Massa Medicata Fermentata) 18g, Fuling (Poria) 16g, Zexie (Alismatis Rhizoma) 12g, Danggui (Angelicae Sinensis Radix) 9g, Yanhusuo (Corydalis Rhizoma) 6g, Qingpi and Chenpi (Citri Reticulatae Pericarpium Viride / Citri Reticulatae Pericarpium) 9g each, Banxia (Pinelliae Rhizoma) 9g, Nanxing (Arisaematis Rhizoma) 6g.
Appendix 2: "Regulating" Prescription Prescribed by Mr. Chen for Me
Huangqi (Astragali Radix) 18g, Dangshen (Codonopsis Radix) 16g, Baizhu (Atractylodis Macrocephalae Rhizoma) 9g, Chenpi (Citri Reticulatae Pericarpium) 9g, Shengma (Cimicifugae Rhizoma) 9g, Chaihu (Bupleuri Radix) 16g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Danggui (Angelicae Sinensis Radix) 6g, Muxiang (Aucklandiae Radix) 9g, Binglang (Arecae Semen) 16g.
Note: After taking harsh drugs like vomiting and purgatives, "ming xuan" (medication reaction/dizziness) phenomena are common, representing one aspect of drug response. Mencius said: "If the medicine does not cause ming xuan, the serious disease will not be cured." So, is the "ming xuan" phenomenon beneficial or harmful? How to distinguish? In clinical practice, I frequently observe drug responses, varying in manifestation. Generally, if the reaction does not significantly affect the patient's mental state, it indicates the medicine matches the disease, reflecting the curative power of the drug. Effective results follow the reaction, which is what Mencius referred to. However, if the reaction significantly affects the patient's mental state, such as lethargy, inability to sustain healthy qi; or mental agitation, lack of self-control; or confused speech, unclear consciousness, it indicates the medicine does not match the disease or causes severe harm to the body. Immediate remedial measures are necessary; one must not be careless. Caution is required when taking heavy or drastic medicines.
Internal Medicine
Discussion on Common Cold Symptoms
I. Warm Diseases Also Have "Heat Entering the Blood Chamber" Syndrome
The *Shanghan Lun* (Treatise on Cold Damage) describes the "Heat Entering the Blood Chamber" syndrome. Warm disease literature also discusses it extensively, with explicit mentions in *Lin Zheng Zhi Nan* (Guide to Clinical Practice), *Wen Re Jing Wei* (Classic of Warm Heat), and *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases). What is "Heat Entering the Blood Chamber"? "It refers to pathological changes caused by external pathogens and blood clashing during menstruation in women. Due to differences in body strength and depth of pathogen invasion, symptoms vary, and thus treatment methods differ accordingly." (*Shanghan Lun Educational Reference Materials*)
Based on the definition, criteria include: 1. Patient encounters external contraction. 2. During menstruation. 3. External heat pathogens interact with menstrual blood, causing menstrual irregularities (menstruation starts, stops, or continues spontaneously). 4. Symptoms may include hypochondriac fullness, alternating chills and fever, and delirious speech. The first three points are main diagnostic bases, while symptoms depend on individual conditions. The *Shanghan Lun* lists four cases of this syndrome with varying symptoms. Regarding delirious speech, examining the *Shanghan Lun*, only Case 216 (Yangming disease) presents delirium among the four cases. Cases 143, 144, and 145 are Shaoyang diseases, with Case 144 lacking delirium. Therefore, it can be inferred that delirium is not a mandatory symptom for "Heat Entering the Blood Chamber." Diagnosis is established simply by "pathological changes caused by external heat pathogens clashing with blood during menstruation following an external contraction."
Sun Wen Yuan recorded a case of treating his nephew's wife with "Heat Entering the Blood Chamber" in *Sheng Sheng Zi Yi An* (Medical Cases of Sheng Sheng Zi): "Due to spring warmth, menstruation stopped abruptly. Symptoms included lingering heat, extreme thirst, hypochondriac pain, and deafness. Treated with Chai Hu, Ren Shen, Gan Cao, Tian Hua Fen, Huang Qin, Bai Shao, Hong Hua, Dang Gui, Mu Dan Pi, and Zhi Mu, resulting in recovery." This case, caused by spring warmth, lacked delirium, serving as an excellent footnote for the above discussion.
Regarding treatment for "Heat Entering the Blood Chamber": For hypochondriac fullness, puncture Qimen (LR14) to drain stasis-heat. For mild cases with remaining exterior pathogens, await spontaneous resolution. For pathogens in Shaoyang, Qian Tianlai used Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Niuxi, Mu Dan Pi, and Tao Ren; Xu Shumi used Xiao Chai Hu Tang plus Sheng Di Huang; Yang Shiying used Xiao Chai Hu Tang plus Wu Ling Zhi. All aimed at harmonizing and expelling pathogens. Excess patterns supplemented with blood-invigorating and stasis-resolving herbs to resolve exterior pathogens, open meridians, and cure the disease. Deficiency patterns supplemented with blood-nourishing and cooling herbs to replenish yin-blood while resolving pathogens, thereby clearing the blood chamber. These are Shanghan treatment methods. Warm disease treatments for "Heat Entering the Blood Chamber" differ slightly. Ye Zi Yu commented on *Wen Bing Tiao Bian*: "If menstruation occurs concurrently with warm disease, and menstruation proceeds normally despite the illness, there is no need to treat the menstrual blood; treating the disease alone leads to recovery." Based on this principle, I treated a case of menorrhagia caused by external wind-heat. Referencing past experts' methods, I focused on expelling pathogens while assisting blood regulation. Using Yinqsan (Honeysuckle and Forsythia Powder) to mildly release the exterior, adding Yimucao (Leonuri Herba) to invigorate blood and regulate menstruation. Once blood stasis opened and meridians cleared, both interior and exterior pathogens resolved, curing the disease. Ms. Chen, a 19-year-old female student at a factory technical school, caught a cold with fever before summer 1991. Coinciding with her period, after fever subsided, bleeding persisted, dripping daily for over a month. Treatments promoting qi circulation, invigorating blood, regulating menstruation, stopping leakage, tonifying qi and blood, and consolidating the root failed for half a month. A senior gynecologist treated her for a week with no improvement. She returned to me. Carefully analyzing the four diagnostics: illness started after cold and fever. Menstruation coincided with the cold. Bleeding persisted after fever subsided. Likely, heat pathogens entered the empty blood chamber during menstruation, hindering normal blood flow. Pulse examination revealed a small pulse shape, but the qi kou (cun) position was significantly stronger than others, slightly floating. This indicated unresolved wind-heat external contraction, heat disturbing the blood chamber, causing persistent leakage. I tried Yinqsan plus Yimucao:
Jinyinhua (Lonicerae Japonicae Flos) 9g, Lianqiao (Forsythiae Fructus) 9g, Jingjie (Schizonepetae Spica) 9g, Zhuye (Bambusae Folium) 9g, Bohe (Menthae Haplocalycis Herba) 3g, Jiegeng (Platycodonis Radix) 4.5g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g, Niubangzi (Arctii Fructus) 9g, Dou Chi (Sojae Semen Preparatum) 9g, Yimucao (Leonuri Herba) 15g.
After three doses, bleeding stopped, external contraction resolved, and subsequent menstruation normalized. She is now married with children, a loving mother.
II. Wind-Cold External Contraction Can Also Cause "Battle Sweat"
The term "battle sweat" (zhan han) first appeared in Wei Yilin's *Shi Yi De Xiao Fang* (Effective Formulas of Generations of Physicians), but was not detailed. It became commonly used in medical circles only after late Qing warm disease expert Ye Tianshi orally transmitted "Wai Gan Wen Re Pian" (On External Contraction Warm Heat) to his student Gu Jingwen on a boat, defining battle sweat as a self-healing mechanism where healthy qi drives pathogens out. Physicians widely adopted it. What is "battle sweat"? It occurs at a certain stage of external febrile diseases, characterized by sudden shivering followed by whole-body sweating, with symptoms resolving after sweating. It manifests the struggle between healthy qi and pathogens. If healthy qi wins, sweating occurs and disease resolves; if healthy qi loses, shivering occurs without sweating. Battle sweat can occur in both Shanghan and warm diseases, but is more common in warm diseases. Warm diseases have Wei, Qi, Ying, and Xue stages; battle sweat appears when pathogens are in the Qi stage. Ye stated: "If pathogens linger in the Qi stage throughout, one may hope for battle sweat to expel pathogens."