但是由于临床时不注意脉证，拘于成方成法，而常有长期得不到治愈者：例如：刘××，女，成。1962年在两膝、踝关节附近发现20多个紫红色结节，疼痛，发热，阴天时加重，小腿轻度浮肿。天津某医院诊为结节性红斑。先用激素治疗曾一度消退，一个月后又复发如初，继用上法治疗一个多月效果则不明显，乃改用中药治疗。某医认为本病系湿毒流注，予清热利湿、化瘀散结治之，一个月后即大部消退，但两个月后又复发如前，再请该医以上法治之而无效。邀余诊视。察其除膝、踝关节附近有20多个紫红色结节，按之柔韧疼痛，下肢轻度凹陷性浮肿外，并见胸满心烦，头晕头痛，舌苔薄白，脉沉细涩。思之，既然属于湿热流注，血络瘀滞，为何不效呢?反复审脉，又习古人之见，始而有悟。陈光淞说：“按营分有热，至于斑点隐隐，急以透斑为要。透斑之法，不外凉血清热，甚者下之，所谓炀灶减薪，去其壅塞，则光焰自透，若金汁、人中黄所不能下者，大黄、元明粉亦可加入。在学者见证施治，神而明之，细玩烦躁，大便不通之语，自得之矣。”乃云：气滞血瘀，痰热结滞，阳明实热不散之故。为拟理气活血，清热通下，复元活血汤加减：柴胡1O克，赤芍9克，枳实9克，花粉12克，白芥子6克，丹参15克，甘草6克。服药6剂结节大部消退，头晕头痛胸满心烦亦减，乃继服上方45剂而诸症俱失，为巩固疗效，又改用一周2剂，一年而痊愈。
阳痿
阳痿是青壮年男性的一种常见病，多发病，也是严重影响男女性生活正常进行的疾病。因此从古至今各代医家都把这种疾病作为医学研究中的重要课题。
一、有关阳痿病因病机的问题
《内经》称阳痿为“阴痿”、“阴器不用”、“宗筋弛纵”，并认为其病的主要原因是“气大衰”和“热”。隋、唐时代，通过研究，明确提出它的病因是劳伤和肾虚，例如：巢元方《诸病源候论》说：“劳伤于肾，肾虚不能荣于阴器，故萎弱也。”并明确指出所谓的劳是指的房劳，即性生活过度所致；王焘《外台秘要》指出：“病源肾开窍于阴，若劳伤于肾，肾虚不能荣于阴气故痿弱也。”“五劳七伤阴痿，十年阴不起，皆由少小房多损阳。”宋明诸代医家对本病病因病机的认识日见深入。如宋．严用和《济生方》更明确的说明了本病乃真阳疲惫所致，称：“五劳七伤，真阳衰惫……阳事不举。”明．王纶《明医杂著》指出阳痿之病除命门火衰之外，还有郁火所致者，说：“男子阴痿不起，古方多云命门火衰，精气虚冷，固有之矣，然亦有郁火甚而致痿者。”明．张介宾著《景岳全书》认为阳痿之病不但有命门火衰所致者，而且有湿热、惊恐、思虑等所致者，说：“(阳痿)多由命门火衰，精气虚冷，或以七情劳倦，损伤生阳之气……亦有湿热炽盛，以致宗筋弛纵。”“凡思虑焦劳，忧郁太过者，多致阳痿。”明确指出了劳之含义还包括思虑忧郁的一面。清代医家通过研究，认为阳痿的病因除了前代医家所述的房劳、七情、郁火、湿热之外，还有忍房事、失志、肝郁、胆郁等。清·沈金鳌著《杂病源流犀烛》云：“有精出非法，或就忍房事，有伤宗筋……又有失志之人，抑郁伤肝，肝木不能疏达，亦致阴痿不起。”华岫云在《临证指南医案》按语中指出：“有色欲伤及肝肾而致者……亦有因恐惧而得者……有因思虑烦劳而成者……有郁损生阳者，必从胆治，盖经云凡十一脏皆取决于胆，又云少阳为枢，若得胆气舒展，何郁之有；更有湿热为患者，宗筋必弛纵而不坚举……又有阳明虚，则宗筋纵，盖胃为水谷之海，纳食不旺，精气必虚，况男子外肾，其名为势，若谷气不充，欲求其势之雄壮坚举，不亦难乎。”近世医家多宗以上诸说，而尤重视肾阳不足。余在数十年的临床过程中发现仅遵以上诸家之说还不能解决临床中的所有问题，经过反复探索发现阳痿一病还有肺之阴虚、气虚所致者，郁证之中不但有火郁，而且还有湿郁、寒郁、血郁、痰郁者，于是先后在拙著《中医内科证治备要》(1983年)《难病奇治》(1989年)加以阐述，并取得较好的回响，称“实开医家之新的法门。”
二、有关阳痿治疗中的几个问题
自从隋唐时代称阳痿主要是肾虚所致以来，历代医家莫不重视此说，甚至有的医药学家称补肾阳的药物为治阳痿的专药，一些临床医家一见患者说是阳痿病，即以鹿茸、巴戟天、肉苁蓉、仙茅、淫羊藿、杜仲、续断、狗脊、补骨脂、冬虫夏草、蛤蚧、枸杞子、紫河车、菟丝子、锁阳、韭子、阳起石、熟地、山萸肉、附子、肉桂，甚至雄蚕娥、鹿肾、驴肾、黄狗肾、海狗肾等治之。有的药物专家甚至集补肾药之大成而组成药物，称补肾之良药。张景岳作为明代的大临床家看到这种认识之弊病，提出“命门火衰，精气虚寒而阳痿者，宜右归丸、赞育丹、石刻安肾丸之类主之；若火不甚衰，而止因血气薄弱者，宜左归丸、斑龙丸、全鹿丸之类主之。”“凡思虑惊恐以致脾肾亏损而阳道痿者，必须培养心脾……宜七福饮、归脾汤之类主之……；其有忧思恐惧太过者，每多损抑阳气，若不益火，终无生意，宜七福饮加桂附枸杞之类主之”，“凡肝肾湿热以致宗筋弛纵者，亦为阳痿，治宜清火以坚肾，然必有火证火脉内外相符者方是其证，宜滋阴八味丸或丹溪大补阴丸、虎潜丸之类主之。”清·华岫云在《临证指南医案》按语中指出：“有色欲伤及肝肾而致者，先生立法，非峻补真元不可，盖因阳气既伤，真阴必损，若纯乎刚热燥涩之补，必有偏胜之害，每兼血肉温润之品缓调之；亦有因恐惧而得者，盖恐则伤肾，恐则气下，治宜固肾，稍佐升阳；有因思虑烦劳而成者，则心脾肾兼治；有郁损生阳者，必从胆治，盖经云凡十一脏皆取决于胆，又云少阳为枢，若得胆气舒展，何郁之有；更有湿热为患者，宗筋必弛纵而不坚举，治用苦味坚阴，淡渗去湿，湿去热清而病退矣；又有阳明虚，则宗筋纵，盖胃为水谷之海，纳食不旺，精气必虚，况男子外肾，其名为势，若谷气不充，欲求其势之雄壮坚举，不亦难乎，治唯有通补阳明而已。”1985年版《中医内科学》称“(阳痿)涉及肝肾阳明三经。”并列①命门火衰者，证见“阳痿，面色皓白，头晕目眩，精神萎靡，腰膝发软，舌淡苔白，脉多沉细，治宜补肾壮阳，用五子衍宗丸，或赞育丹加减。”②心脾受损者，证见“阳痿，精神不振，夜寐不安，面色不华，苔薄腻，舌质淡，脉细，治宜补益心脾，用归脾汤加减。”③恐惧伤肾者，证见“阳痿，精神苦闷，胆怯多疑，心悸失眠，脉弦细，苔薄腻，治宜益气宁神，用大补元煎。”④湿热下注者，证见“阳痿，小便短赤，下肢发困，苔黄，脉沉滑，或濡滑而数，治宜清化湿热，用知柏地黄丸加减。”1985年版《实用中医内科学》称①命门火衰者，治法：温补下元，用右归丸之类；②心脾受损者，治法：补益心脾，用归脾汤加减；③恐惧伤肾，治法：补肾安神，用达郁汤；④湿热下注，治法：清化湿热，用龙胆泻肝汤。余在临床时虽然注重前人诸法、诸方的使用，但不效者亦甚多，久久深思，综其诸因，多与①病性病位不明，②标本不分，③比例不明有重要关系。
三、有关阳痿辨证论治时的几个问题
《实用中医内科学》一书指出：“(阳痿)辨证要点：①辨别有火无火；阳痿而兼见面色皓白，畏寒肢冷，舌淡苔白，脉沉细者，是为无火；阳痿而兼见烦躁易怒，小便黄赤，苔黄腻，脉濡数或弦数者，是为有火。其中辨证的依据，以脉象、舌苔为主。②分清脏腑虚实：由于恣情纵欲、思虑、忧郁、惊恐所伤者，多为脾肾亏虚，命门火衰，属于虚证；由于肝郁化火，湿热下注，宗筋弛纵者，属于实证。“治疗原则：阳痿属虚者宜补，属实者宜泻，有火者宜清，无火者宜温。命门火衰者，阳气既虚，真阴多损，且肾恶燥，故温补之法，忌纯用刚热燥涩之剂，宜血肉温润之品。湿热下注者，治用苦味坚阴，淡渗去湿。”
余在临床时发现纯虚、纯实、纯寒、纯热，或在一脏一腑，或在一经一络者甚少，所以但予补、予泻、子清、予温而鲜有见效，即或注意了补阳之时必予滋阴，除湿之时“苦味坚阴，淡渗去湿”亦常不效。综其原因大多如上所述为①病性病位不明，②标本不分，③比例不明有关。那么如何辨别这三因呢?通过反复探索，发现主要有以下五种方法：
1．按照中医基本理论的基本观点，对所有问题进行一元化的分析。例如：阳事不举，精薄清冷，头晕耳鸣，面色咣白，精神萎靡，腰膝酸软，畏寒肢冷，舌淡苔白，脉沉细者，应尽量以命门火衰的一个诊断去解释，而不要再拿肺、脾等证去解释。
2．按照基本理论所述脏腑、经络、气血、阴阳，尽量应用一元化的观点去分析。例如：阳痿、头晕头痛、心烦易怒、口苦口干，小便黄赤，脉弦数，尽量以一个肝脏去解释。
3．症状繁多，诸种表现很难应用一种原因解释，甚或相互矛盾时，在解释标本、比例时一定要以脉象为主。例如：症见头晕头痛，口苦咽干、尿黄便秘，阳痿者，若见脉弦就应考虑兼寒，就应考虑以寒为主；若见脉滑数者，就应考虑以痰热为主；若脉弦数者，就应考虑以肝胆实火为主。
4．症状复杂，虚实并见时，应以脉、色为主去分辨虚实的多少．例如：素有强阳不倒，交接反萎软，且时见尿热尿痛，口干，而若见脉弦尺大而涩者则应为肾阳不足，反之尺脉数者则以相火妄动为主。又如：阳痿，尿黄身热，舌红苔黄，而面见皓白，脉虚大而数者，则应诊为以气阴俱虚为主，湿热为次。
5．辨证难明时，要认真分析用药后的效果，结合脉证要审慎分析。应建立一个凡是不效的即是不对的，有效的就是对的概念，只要是用药不效，就应考虑用药至少是有缺点，只有这样才能找出它的原因。
四、治案简介
1．何××，男，30岁。阳痿3年，前医频用补肾壮阳之汤丸与西药治疗不效。审其除时有感冒之证外，别无所苦，脉弦缓。因思仲景营卫失调者用桂枝汤，“失精家少腹弦急，阴头寒”宜桂枝加龙骨牡蛎汤。勉予桂枝加龙骨牡蛎汤，不料却10剂而愈。
2．牛××，男，61岁。
阳痿20多年，前医云肾阳不足，治用八味地黄丸、男宝、三肾丸、蜂皇浆等不效。细询其除阳事不举，或偶举即遗泻之外，并时时小腿沉重，甚或轻度浮肿，或见尿热尿痛，头晕脑胀，别无所苦，舌苔黄白而腻，脉虚大弦紧稍滑。综合脉证，反复思之：仲景、叔和均称脉虚大者气血、气阴俱虚之质也，紧者寒也，稍滑者痰热相兼也。其虽证有热而仍宜处补气养血之黄芪、当归；益肺滋肾之麦冬、五味子、生地；燥湿利湿之苍术、茯苓、泽泻；交通心肾之黄连、肉桂等。服药2月，诸证恢复正常。并云：蛋白尿亦消退净尽。
3．霍××，男，28岁。
结婚半年来，发现或者阳势不举，或者举而不坚，或者稍事接触即早泄，为此其妇甚不满意。医先予补肾壮阳，并配合西药治疗不效，后又配合针灸亦无功。查其除阳痿之外，别无他证，惟时见咽干，舌苔薄白，脉浮缓。综合脉证，思之浮脉者心肺之脉也，且其咽干，乃肺阴亏损不得生肾水之故也。因拟滋肾水，助肾阳，处以天冬、麦冬以滋肺养阴，淫羊藿、蛇床子、肉苁蓉以助肾阳，3剂效，20剂愈。
4．贺××，男，29岁。
结婚3年多，或者阳势不举，或者举而不坚，前后服男宝、三肾丸、肾气丸、六味地黄丸、鹿茸精近3年不效。近半年来，经常出现牙痛、头痛、烦躁、失眠等，尤其是近两个多月几乎每天发现鼻衄、齿衄，为此不得不予泻火之药，然服药之后却出现阳势麻木不适，而它证不减。审其舌苔黄白而腻，脉弦紧而数。因思脉弦者肝脉也，紧数者寒饮郁久化热也，且牙痛、头痛、烦躁、失眠亦为肝证。乃拟柴胡加龙骨牡蛎汤去铅丹，加甘草、玄参为法。服药4剂，头痛、牙痛、烦躁、鼻衄减，继服30剂，竟愈。
虚劳
虚劳者何?有云是指造血系统疾病者，有云是指营养缺乏病者。何者为是?何者为非?难于定夺。及至读到方药中等主编之《实用中医内科学》才算稍有全面的了解。云：“虚劳的范围甚广，几乎涉及西医的各个系统的疾病，包括自身免疫低下或免疫功能稳定失调，内分泌腺体功能紊乱，造血功能障碍，代谢紊乱，营养缺乏，神经功能低落或过分抑制(非保护性)引起的疾病，以及其他器官系统功能衰退性疾病，凡以慢性功能减退或虚性亢奋为主要临床表现的病症。”然而由于这一说法过于笼统，缺乏具体所指，又常常使读者难于应用于学习中医古典著作和应用于临床实践之中。
然而，在临床实践中，如果忽视脉象与症状的辨证，拘泥于固定的方剂和治法，常导致疾病长期无法治愈。例如：患者刘××，女性，成年。1962年，在其双膝、踝关节附近发现20多个紫红色结节，伴有疼痛和发热，阴天时症状加重，小腿有轻度浮肿。天津某医院诊断为结节性红斑（Erythema Nodosum）。起初使用激素治疗，症状曾一度消退，但一个月后复发如初；继续采用相同方法治疗一个多月，效果不明显，于是改用中药治疗。某位医生认为此病属于湿毒流注（湿热毒邪流窜积聚），采用清热利湿、化瘀散结的方法治疗，一个月后大部分结节消退，但两个月后又像以前一样复发；再次请该医生用同样的方法治疗却无效。邀请我诊治。观察发现，除了膝、踝关节附近有20多个紫红色结节，按压时感觉柔韧且疼痛，下肢有轻度凹陷性浮肿外，还见胸中胀满、心烦意乱、头晕头痛，舌苔薄白，脉象沉细涩。思考之后，既然属于湿热流注、血络瘀滞，为何治疗效果不佳呢？反复审视脉象，又回顾古人的见解，才有所领悟。陈光淞说：“按营分有热，以至于斑点隐隐出现，急需以透发斑疹为要务。透斑的方法，不外乎凉血清热，严重的甚至需要攻下，这就是所谓的‘炀灶减薪’（比喻清除体内的壅塞，使阳气自然透发），去除壅塞，光芒自然透出，如果是金汁、人中黄等药不能攻下的情况，大黄、元明粉也可以加入。学者应根据见证施治，神而明之，仔细玩味‘烦躁、大便不通’的话语，自然就能明白了。”于是我判断：这是气滞血瘀、痰热结滞，以及阳明实热不散的缘故。于是拟定理气活血、清热通下的方剂，以复元活血汤加减：柴胡10克，赤芍9克，枳实9克，花粉12克，白芥子6克，丹参15克，甘草6克。服用6剂后，结节大部分消退，头晕、头痛、胸满、心烦等症状也减轻，于是继续服用上方45剂，所有症状消失。为了巩固疗效，又改为每周服用2剂，一年后痊愈。
阳痿
阳痿是青壮年男性的一种常见病、多发病，也是严重影响男女性生活正常进行的疾病。因此，从古至今，历代医家都将这种疾病作为医学研究中的重要课题。
一、有关阳痿病因病机的问题
《内经》将阳痿称为“阴痿”、“阴器不用”、“宗筋弛纵”，并认为其主要病因是“气大衰”和“热”。隋、唐时代，通过研究，明确提出其病因是劳伤和肾虚。例如：巢元方在《诸病源候论》中说：“劳伤于肾，肾虚不能荣养阴器，所以萎弱。”并明确指出所谓的“劳”指的是房劳，即性生活过度所致；王焘在《外台秘要》中指出：“病源肾开窍于阴，若劳伤于肾，肾虚不能荣养阴气，所以痿弱也。”“五劳七伤导致的阴痿，十年阴茎不起，都是因为年少时房事过多损伤阳气。”宋、明各代医家对本病病因病机的认识日益深入。如宋代严用和在《济生方》中更明确地说明本病乃真阳疲惫所致，称：“五劳七伤，真阳衰惫……阳事不举。”明代王纶在《明医杂著》中指出，阳痿之病除了命门火衰之外，还有因郁火所致者，说：“男子阴痿不起，古方多说是命门火衰，精气虚冷，这固然存在，然而也有因郁火甚重而导致痿废的。”明代张介宾著《景岳全书》认为，阳痿之病不仅有因命门火衰所致者，还有因湿热、惊恐、思虑等所致者，说：“(阳痿)多由命门火衰，精气虚冷，或因七情劳倦，损伤生阳之气……也有因湿热炽盛，以致宗筋弛纵。”“凡是思虑焦劳，忧郁太过的人，多导致阳痿。”明确指出了“劳”的含义还包括思虑忧郁的一面。清代医家通过研究，认为阳痿的病因除了前代医家所述的房劳、七情、郁火、湿热之外，还有忍房事、失志、肝郁、胆郁等。清代沈金鳌著《杂病源流犀烛》云：“有精出非法，或强忍房事，有伤宗筋……又有失志之人，抑郁伤肝，肝木不能疏达，也导致阴痿不起。”华岫云在《临证指南医案》按语中指出：“有色欲伤及肝肾而致者……也有因恐惧而得者……有因思虑烦劳而成者……有郁损生阳者，必须从胆治疗，盖经云凡十一脏皆取决于胆，又云少阳为枢，如果胆气舒展，有什么郁结呢；更有湿热为患者，宗筋必然弛纵而不坚举……又有阳明虚，则宗筋纵，盖胃为水谷之海，纳食不旺，精气必虚，何况男子外肾，名为势，如果谷气不充，想要求得势的雄壮坚举，不是很难吗。”近世医家多遵循以上诸家之说，而尤其重视肾阳不足。我在数十年的临床过程中发现，仅遵循以上诸家之说还不能解决临床中的所有问题，经过反复探索，发现阳痿一病还有因肺之阴虚、气虚所致者，郁证之中不但有火郁，而且还有湿郁、寒郁、血郁、痰郁者，于是先后在拙著《中医内科证治备要》(1983年)、《难病奇治》(1989年)加以阐述，并取得较好的反响，被称为“实开医家之新的法门。”
二、有关阳痿治疗中的几个问题
自从隋唐时代称阳痿主要是肾虚所致以来，历代医家无不重视此说，甚至有的医药学家称补肾阳的药物为治阳痿的专药，一些临床医家一见患者说是阳痿病，即以鹿茸、巴戟天、肉苁蓉、仙茅、淫羊藿、杜仲、续断、狗脊、补骨脂、冬虫夏草、蛤蚧、枸杞子、紫河车、菟丝子、锁阳、韭子、阳起石、熟地、山萸肉、附子、肉桂，甚至雄蚕娥、鹿肾、驴肾、黄狗肾、海狗肾等治之。有的药物专家甚至集补肾药之大成而组成药物，称其为补肾之良药。张景岳作为明代的大临床家看到这种认识的弊病，提出“命门火衰，精气虚寒而阳痿者，宜右归丸、赞育丹、石刻安肾丸之类主之；若火不甚衰，而只因血气薄弱者，宜左归丸、斑龙丸、全鹿丸之类主之。”“凡是思虑惊恐以致脾肾亏损而阳道痿者，必须培养心脾……宜七福饮、归脾汤之类主之……；那些忧思恐惧太过的人，每多损抑阳气，如果不益火，终无生意，宜七福饮加桂附枸杞之类主之”，“凡是肝肾湿热以致宗筋弛纵者，也为阳痿，治宜清火以坚肾，然而必须有火证火脉内外相符者才是其证，宜滋阴八味丸或丹溪大补阴丸、虎潜丸之类主之。”清代华岫云在《临证指南医案》按语中指出：“有色欲伤及肝肾而致者，先生立法，非峻补真元不可，盖因阳气既伤，真阴必损，若纯用刚热燥涩之补，必有偏胜之害，每兼血肉温润之品缓调之；也有因恐惧而得者，盖恐则伤肾，恐则气下，治宜固肾，稍佐升阳；有因思虑烦劳而成者，则心脾肾兼治；有郁损生阳者，必从胆治，盖经云凡十一脏皆取决于胆，又云少阳为枢，如果胆气舒展，有什么郁结呢；更有湿热为患者，宗筋必然弛纵而不坚举，治用苦味坚阴，淡渗去湿，湿去热清而病退矣；又有阳明虚，则宗筋纵，盖胃为水谷之海，纳食不旺，精气必虚，何况男子外肾，名为势，如果谷气不充，想要求得势的雄壮坚举，不是很难吗，治唯有通补阳明而已。”1985年版《中医内科学》称“(阳痿)涉及肝肾阳明三经。”并列①命门火衰者，证见“阳痿，面色皓白，头晕目眩，精神萎靡，腰膝发软，舌淡苔白，脉多沉细，治宜补肾壮阳，用五子衍宗丸，或赞育丹加减。”②心脾受损者，证见“阳痿，精神不振，夜寐不安，面色不华，苔薄腻，舌质淡，脉细，治宜补益心脾，用归脾汤加减。”③恐惧伤肾者，证见“阳痿，精神苦闷，胆怯多疑，心悸失眠，脉弦细，苔薄腻，治宜益气宁神，用大补元煎。”④湿热下注者，证见“阳痿，小便短赤，下肢发困，苔黄，脉沉滑，或濡滑而数，治宜清化湿热，用知柏地黄丸加减。”1985年版《实用中医内科学》称①命门火衰者，治法：温补下元，用右归丸之类；②心脾受损者，治法：补益心脾，用归脾汤加减；③恐惧伤肾，治法：补肾安神，用达郁汤；④湿热下注，治法：清化湿热，用龙胆泻肝汤。我在临床时虽然注重前人诸法、诸方的使用，但不效者亦甚多，久久深思，综其诸因，多与①病性病位不明，②标本不分，③比例不明有重要关系。
三、有关阳痿辨证论治时的几个问题
《实用中医内科学》一书指出：“(阳痿)辨证要点：①辨别有火无火；阳痿而兼见面色皓白，畏寒肢冷，舌淡苔白，脉沉细者，是为无火；阳痿而兼见烦躁易怒，小便黄赤，苔黄腻，脉濡数或弦数者，是为有火。其中辨证的依据，以脉象、舌苔为主。②分清脏腑虚实：由于恣情纵欲、思虑、忧郁、惊恐所伤者，多为脾肾亏虚，命门火衰，属于虚证；由于肝郁化火，湿热下注，宗筋弛纵者，属于实证。“治疗原则：阳痿属虚者宜补，属实者宜泻，有火者宜清，无火者宜温。命门火衰者，阳气既虚，真阴多损，且肾恶燥，故温补之法，忌纯用刚热燥涩之剂，宜血肉温润之品。湿热下注者，治用苦味坚阴，淡渗去湿。”
我在临床时发现纯虚、纯实、纯寒、纯热，或在一脏一腑，或在一经一络者甚少，所以但予补、予泻、予清、予温而鲜有见效，即或注意了补阳之时必予滋阴，除湿之时“苦味坚阴，淡渗去湿”亦常不效。综其原因大多如上所述为①病性病位不明，②标本不分，③比例不明有关。那么如何辨别这三因呢？通过反复探索，发现主要有以下五种方法：
1．按照中医基本理论的基本观点，对所有问题进行一元化的分析。例如：阳事不举，精薄清冷，头晕耳鸣，面色㿠白，精神萎靡，腰膝酸软，畏寒肢冷，舌淡苔白，脉沉细者，应尽量以命门火衰的一个诊断去解释，而不要再拿肺、脾等证去解释。
2．按照基本理论所述脏腑、经络、气血、阴阳，尽量应用一元化的观点去分析。例如：阳痿、头晕头痛、心烦易怒、口苦口干，小便黄赤，脉弦数，尽量以一个肝脏去解释。
3．症状繁多，诸种表现很难应用一种原因解释，甚或相互矛盾时，在解释标本、比例时一定要以脉象为主。例如：症见头晕头痛，口苦咽干、尿黄便秘，阳痿者，若见脉弦就应考虑兼寒，就应考虑以寒为主；若见脉滑数者，就应考虑以痰热为主；若脉弦数者，就应考虑以肝胆实火为主。
4．症状复杂，虚实并见时，应以脉、色为主去分辨虚实的多少．例如：素有强阳不倒，交接反萎软，且时见尿热尿痛，口干，而若见脉弦尺大而涩者则应为肾阳不足，反之尺脉数者则以相火妄动为主。又如：阳痿，尿黄身热，舌红苔黄，而面见皓白，脉虚大而数者，则应诊为以气阴俱虚为主，湿热为次。
5．辨证难明时，要认真分析用药后的效果，结合脉证要审慎分析。应建立一个凡是不效的即是不对的，有效的就是对的概念，只要是用药不效，就应考虑用药至少是有缺点，只有这样才能找出它的原因。
四、治案简介
1．何××，男，30岁。阳痿3年，前医频用补肾壮阳之汤丸与西药治疗不效。审其除时有感冒之证外，别无所苦，脉弦缓。因思仲景营卫失调者用桂枝汤，“失精家少腹弦急，阴头寒”宜桂枝加龙骨牡蛎汤。勉予桂枝加龙骨牡蛎汤，不料却10剂而愈。
2．牛××，男，61岁。
阳痿20多年，前医云肾阳不足，治用八味地黄丸、男宝、三肾丸、蜂皇浆等不效。细询其除阳事不举，或偶举即遗泻之外，并时时小腿沉重，甚或轻度浮肿，或见尿热尿痛，头晕脑胀，别无所苦，舌苔黄白而腻，脉虚大弦紧稍滑。综合脉证，反复思之：仲景、叔和均称脉虚大者气血、气阴俱虚之质也，紧者寒也，稍滑者痰热相兼也。其虽证有热而仍宜处补气养血之黄芪、当归；益肺滋肾之麦冬、五味子、生地；燥湿利湿之苍术、茯苓、泽泻；交通心肾之黄连、肉桂等。服药2月，诸证恢复正常。并云：蛋白尿亦消退净尽。
3．霍××，男，28岁。
结婚半年来，发现或者阳势不举，或者举而不坚，或者稍事接触即早泄，为此其妇甚不满意。医先予补肾壮阳，并配合西药治疗不效，后又配合针灸亦无功。查其除阳痿之外，别无他证，惟时见咽干，舌苔薄白，脉浮缓。综合脉证，思之浮脉者心肺之脉也，且其咽干，乃肺阴亏损不得生肾水之故也。因拟滋肾水，助肾阳，处以天冬、麦冬以滋肺养阴，淫羊藿、蛇床子、肉苁蓉以助肾阳，3剂效，20剂愈。
4．贺××，男，29岁。
结婚3年多，或者阳势不举，或者举而不坚，前后服男宝、三肾丸、肾气丸、六味地黄丸、鹿茸精近3年不效。近半年来，经常出现牙痛、头痛、烦躁、失眠等，尤其是近两个多月几乎每天发现鼻衄、齿衄，为此不得不予泻火之药，然服药之后却出现阳势麻木不适，而它证不减。审其舌苔黄白而腻，脉弦紧而数。因思脉弦者肝脉也，紧数者寒饮郁久化热也，且牙痛、头痛、烦躁、失眠亦为肝证。乃拟柴胡加龙骨牡蛎汤去铅丹，加甘草、玄参为法。服药4剂，头痛、牙痛、烦躁、鼻衄减，继服30剂，竟愈。
虚劳
虚劳是什么？有人说是指造血系统疾病，有人说是指营养缺乏病。哪种说法正确？哪种错误？难以定夺。直到读到方药中等主编之《实用中医内科学》才算稍有全面的了解。书中云：“虚劳的范围甚广，几乎涉及西医的各个系统的疾病，包括自身免疫低下或免疫功能稳定失调，内分泌腺体功能紊乱，造血功能障碍，代谢紊乱，营养缺乏，神经功能低落或过分抑制(非保护性)引起的疾病，以及其他器官系统功能衰退性疾病，凡以慢性功能减退或虚性亢奋为主要临床表现的病症。”然而由于这一说法过于笼统，缺乏具体所指，又常常使读者难于应用于学习中医古典著作和应用于临床实践之中。
However, in clinical practice, if the differentiation of pulse and symptoms is neglected and one adheres rigidly to fixed prescriptions and methods, diseases often remain uncured for a long time. For example: Patient Liu XX, female, adult. In 1962, more than 20 purplish-red nodules were found near both knees and ankles, accompanied by pain and fever, with symptoms worsening on cloudy days, and mild edema in the lower legs. A hospital in Tianjin diagnosed this as Erythema Nodosum (Jie Jie Xing Hong Ban). Initially, hormone therapy was used, and symptoms receded once, but relapsed exactly as before after one month; continuing the same method for over a month yielded insignificant results, so traditional Chinese medicine (TCM) treatment was adopted. A certain physician believed this disease belonged to Damp-Toxin Flowing Accumulation (Shi Du Liu Zhu), treating it with methods to clear heat, promote diuresis to remove dampness, resolve stasis, and dissipate nodules. After one month, most nodules receded, but two months later, they relapsed as before; re-treatment by the same physician using the same method proved ineffective. I was invited to examine the patient. Observation revealed that besides the more than 20 purplish-red nodules near the knees and ankles, which felt tough and painful upon pressure, and mild pitting edema in the lower limbs, there were also chest fullness, irritability, dizziness, headache, a thin white tongue coating, and a deep, fine, and choppy pulse. Upon reflection, since it belongs to Damp-Heat Flowing Accumulation and blood vessel stasis, why was the treatment ineffective? Repeatedly examining the pulse and recalling ancient insights, I finally gained understanding. Chen Guangsong said: "When heat exists in the Ying (Nutrient) level, leading to faintly visible macules, the urgent priority is to vent the macules. The method for venting macules involves cooling the blood and clearing heat; in severe cases, purgation may be necessary. This is akin to 'reducing the firewood in the furnace' (Yang Zao Jian Xin), removing blockages so that light naturally shines through. If substances like Jin Zhi (Gold Juice) or Ren Zhong Huang (Human Excrement Yellow) cannot purge, Da Huang (Rhei Radix et Rhizoma) and Yuan Ming Fen (Mirabilitum) can be added. Scholars should treat based on observed signs, applying divine clarity, and by carefully pondering the words 'irritability and constipation,' one will naturally understand." Thus, I determined: This was due to Qi stagnation and Blood stasis, Phlegm-Heat binding, and the persistence of Yangming Excess Heat. Therefore, I prescribed a formula to regulate Qi, invigorate Blood, clear heat, and promote purgation, modifying Fuyuan Huoxue Tang (Restore Vitality to Invigorate Blood Decoction): Chai Hu (Bupleuri Radix) 10g, Chi Shao (Paeoniae Rubra Radix) 9g, Zhi Shi (Aurantii Fructus Immaturus) 9g, Hua Fen (Trichosanthis Radix) 12g, Bai Jie Zi (Sinapis Semen) 6g, Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g. After taking 6 doses, most nodules receded, and symptoms such as dizziness, headache, chest fullness, and irritability decreased. Subsequently, the patient continued taking the above prescription for 45 doses, after which all symptoms disappeared. To consolidate the curative effect, the dosage was changed to 2 doses per week, resulting in complete recovery after one year.
Impotence (Yang Wei)
Impotence is a common and frequent disease among young and middle-aged men, significantly affecting normal sexual life between men and women. Therefore, from ancient times to the present, physicians of all dynasties have regarded this disease as an important subject in medical research.
I. Issues Concerning the Etiology and Pathogenesis of Impotence
The *Neijing* (Classic of Internal Canon) refers to impotence as "Yin Wei" (Yin Flaccidity), "Yin Qi Bu Yong" (Genitals Not Functioning), and "Zong Jin Chi Zong" (Slackening of the Sinews). It believes the main causes are "severe Qi deficiency" and "heat". During the Sui and Tang dynasties, through research, it was explicitly stated that the etiology was labor injury and Kidney deficiency. For example, Chao Yuanfang in *Zhubing Yuanhou Lun* (Treatise on the Pathogenesis and Symptoms of All Diseases) said: "Labor injury to the Kidney, where Kidney deficiency fails to nourish the genitals, leads to flaccidity." He explicitly clarified that "labor" referred to sexual exhaustion caused by excessive sexual activity. Wang Tao in *Waitai Miyao* (Essential Prescriptions Worth a Thousand Gold for Emergencies) pointed out: "The source of the disease lies in the Kidney opening into the Yin. If labor injures the Kidney, and Kidney deficiency fails to nourish Yin Qi, flaccidity occurs." "Yin Wei caused by Five Labors and Seven Injuries, where the penis does not rise for ten years, is all due to damaging Yang in youth through excessive sexual intercourse." Physicians of the Song and Ming dynasties deepened their understanding of the etiology and pathogenesis of this disease. For instance, Yan Yonghe in Song Dynasty's *Jisheng Fang* (Prescriptions for Saving Lives) more clearly explained that this disease was caused by the exhaustion of True Yang, stating: "Five Labors and Seven Injuries, True Yang is exhausted... sexual function fails to arise." Wang Lun in Ming Dynasty's *Mingyi Zazu* (Miscellaneous Writings of Famous Doctors) pointed out that besides Mingmen Fire Decline, impotence could also be caused by Depressed Fire, saying: "Men suffering from impotence, ancient formulas often attribute it to Mingmen Fire Decline and deficiency-cold of Essence and Qi, which is indeed true; however, there are also cases caused by severe Depressed Fire." Zhang Jiebin in Ming Dynasty's *Jingyue Quanshu* (Complete Works of Jingyue) believed that impotence was not only caused by Mingmen Fire Decline but also by Damp-Heat, fright, and overthinking, stating: "(Impotence) mostly arises from Mingmen Fire Decline, deficiency-cold of Essence and Qi, or damage to the generating Qi of Yang due to Seven Emotions and labor fatigue... There are also cases where Damp-Heat is flourishing, causing the sinews to slacken." "Those who worry excessively, toil mentally, or suffer from deep depression often develop impotence." This explicitly indicated that the meaning of "labor" also included mental worry and depression. Qing Dynasty physicians, through research, believed that besides the previously mentioned causes such as sexual exhaustion, Seven Emotions, Depressed Fire, and Damp-Heat, there were also causes such as restraining sexual intercourse, loss of will, Liver Qi Stagnation, and Gallbladder Depression. Shen Jin'ao in Qing Dynasty's *Zabing Yuanliu Xizhu* (Sharp Candle of the Source and Flow of Miscellaneous Diseases) wrote: "There are those whose semen is emitted illegally, or who restrain sexual intercourse, injuring the sinews... There are also those who have lost their will, whose depression injures the Liver, preventing Liver Wood from dispersing freely, also leading to Yin flaccidity and non-arising." Hua Xiuyun, in the commentary of *Linzheng Zhinan Yian* (Guiding Manual of Clinical Experience Records), pointed out: "There are cases caused by sexual desire injuring the Liver and Kidney... There are also cases caused by fear... There are cases formed by mental worry and fatigue... There are cases where depression damages the generation of Yang, which must be treated from the Gallbladder, for the classics state that all eleven Zang-Fu organs depend on the Gallbladder, and also that Shaoyang acts as the pivot; if Gallbladder Qi expands freely, what depression would there be? Furthermore, when Damp-Heat is the pathogen, the sinews must slacken and fail to become firm and erect... When Yangming is deficient, the sinews slacken, for the Stomach is the sea of water and grain; if food intake is poor, Essence and Qi must be deficient. Moreover, the male external genitalia are called 'Shi' (Power); if Grain Qi is insufficient, seeking a powerful and firm erection is indeed difficult." Modern physicians mostly follow these previous theories, especially emphasizing Kidney Yang deficiency. In my decades of clinical practice, I found that merely following these theories could not solve all clinical problems. Through repeated exploration, I discovered that impotence could also be caused by Lung Yin deficiency and Qi deficiency. Among Depressive Disorders, there is not only Fire Depression but also Damp, Cold, Blood, and Phlegm depressions. I elaborated on these in my works *Zhongyi Neike Zhengzhi Beiyao* (Essentials of TCM Internal Medicine Diagnosis and Treatment, 1983) and *Nanbing Qizhi* (Strange Cures for Difficult Diseases, 1989), receiving a good response and being called "truly opening a new gate for physicians."
II. Several Issues Concerning the Treatment of Impotence
Since the Sui and Tang dynasties attributed impotence mainly to Kidney deficiency, physicians of all generations have attached great importance to this view. Some even called Kidney-Yang tonifying drugs as specific medicines for treating impotence. Some clinicians, upon hearing a patient complain of impotence, immediately used Deer Antler (Lurong), Morinda Officinalis Root (Bajitian), Cistanche Stem (Roucongrong), Curculigo Rhizome (Xianmao), Epimedium Herb (Yinyanghuo), Eucommia Bark (Duzhong), Dipsacus Root (Xuduan), Dog Spine (Gouji), Psoralea Fruit (Buguzhi), Cordyceps Sinensis (Dongchongxiacao), Gecko (Gejie), Goji Berry (Gouqizi), Placenta Humanis (Ziheche), Dodder Seed (Tusizi), Cynomorium Herb (Suoyang), Leek Seed (Jiuizi), Lepidolite (Yangqishi), Prepared Rehmannia Root (Shudi), Cornus Fruit (Shanzhuyu), Aconite Lateral Root (Fuzi), and Cinnamon Bark (Rougui), and even Silkworm Moth (Xiongcan'e), Deer Kidney, Donkey Kidney, Yellow Dog Kidney, and Sea Dog Kidney. Some pharmacological experts even compiled a comprehensive Kidney-tonifying formula, calling it a fine medicine for tonifying the Kidney. Zhang Jingyue, a great clinician of the Ming Dynasty, seeing the弊端 (drawbacks) of this understanding, proposed: "For impotence caused by Mingmen Fire Decline and deficiency-cold of Essence and Qi, Right Restoration Pill (Yougui Wan), Zanyu Pill (Zanyu Dan), or Stone-Carved Kidney-Tonifying Pill (Shike Anshen Wan) should be used. If the fire is not severely declined, but only due to weak Blood and Qi, Left Restoration Pill (Zuogui Wan), Banlong Pill (Banlong Wan), or Whole Deer Pill (Quanlu Wan) should be used." "For impotence caused by spleen and Kidney deficiency due to overthinking and fright, one must nourish the Heart and Spleen... Seven Blessings Decoction (Qifu Yin) or Guipi Decoction (Guipi Tang) should be used... For those who suffer too much from worry, thought, and fear, Yang Qi is often suppressed; without benefiting Fire, there will be no vitality, so Seven Blessings Decoction plus Cinnamon and Aconite and Goji Berry should be used." "For impotence caused by Liver and Kidney Damp-Heat leading to sinew slackening, it is also treated by clearing fire to firm the Kidney, but one must ensure that Fire signs and pulses match internally and externally to confirm the diagnosis, using Eight Flavor Rehmannia Pill for Nourishing Yin (Ziyin Bawei Wan), Danxi Great Tonifying Yin Pill (Danxi Dabu Yin Wan), or Tiger Hiding Pill (Hujian Wan)." Hua Xiuyun in Qing Dynasty's *Linzheng Zhinan Yian* commentary pointed out: "For cases caused by sexual desire injuring Liver and Kidney, the master's method requires vigorous tonification of True Yuan, because since Yang Qi is injured, True Yin must also be damaged; if purely using hot, dry, and astringent tonics, there will be harm from excess; thus, warm and moist animal-derived products are often combined for slow regulation. For cases caused by fear, since fear injures the Kidney and causes Qi to sink, treatment should firm the Kidney and slightly assist rising Yang. For cases formed by mental worry and fatigue, Heart, Spleen, and Kidney should be treated simultaneously. For cases where depression damages the generation of Yang, treatment must start from the Gallbladder... For cases where Damp-Heat is the pathogen, causing sinew slackening, treatment uses bitter flavors to firm Yin and light permeating agents to remove dampness; once dampness is removed and heat cleared, the disease retreats. For Yangming deficiency causing sinew slackening... treatment lies only in unblocking and tonifying Yangming." The 1985 edition of *Zhongyi Neike Xue* (TCM Internal Medicine) stated: "(Impotence) involves the Liver, Kidney, and Yangming meridians." It listed: ① Those with Mingmen Fire Decline presenting with "impotence, pale complexion, dizziness, vertigo, listlessness, soft waist and knees, pale tongue with white coating, mostly deep fine pulse, treated by tonifying Kidney and strengthening Yang, using Wuzi Yanzong Pill (Wuzi Yanzong Wan) or modified Zanyu Dan." ② Those with Heart and Spleen damage presenting with "impotence, lack of spirit, restless sleep, dull complexion, thin greasy coating, pale tongue body, fine pulse, treated by tonifying and benefiting Heart and Spleen, using modified Guipi Tang." ③ Those with Kidney injury from fright presenting with "impotence, mental distress, timidity and suspicion, palpitations and insomnia, string-tight fine pulse, thin greasy coating, treated by benefiting Qi and calming Spirit, using Dabu Yuanjian (Great Tonify Origin Decoction)." ④ Those with Damp-Heat pouring downward presenting with "impotence, short yellow urine, heavy lower limbs, yellow coating, deep slippery pulse, or soggy slippery rapid pulse, treated by clearing and transforming Damp-Heat, using modified Zhibai Dihuang Wan." The 1985 edition of *Shiyong Zhongyi Neike Xue* (Practical TCM Internal Medicine) stated: ① Mingmen Fire Decline: Method is warming and tonifying Lower Origin, using Yougui Wan etc.; ② Heart and Spleen Damage: Method is tonifying and benefiting Heart and Spleen, using modified Guipi Tang; ③ Kidney Injury from Fright: Method is tonifying Kidney and calming Spirit, using Dayu Tang; ④ Damp-Heat Pouring Downward: Method is clearing and transforming Damp-Heat, using Longdan Xiegan Tang. Although I paid attention to the use of previous methods and formulas in clinical practice, many were ineffective. After long and deep reflection, synthesizing the causes, it was largely related to: ① Unclear nature and location of the disease, ② Failure to distinguish root and branch, ③ Unclear proportion.
III. Several Issues Concerning Syndrome Differentiation and Treatment of Impotence
The book *Shiyong Zhongyi Neike Xue* points out: "(Impotence) Key points of syndrome differentiation: ① Distinguish presence or absence of Fire; Impotence accompanied by pale complexion, aversion to cold and cold limbs, pale tongue with white coating, deep fine pulse is 'No Fire'; Impotence accompanied by irritability and anger, yellow-red urine, yellow greasy coating, soggy rapid or string-tight rapid pulse is 'Has Fire'. The basis for differentiation relies mainly on pulse and tongue coating. ② Distinguish deficiency and excess of Zang-Fu organs: Damage caused by unrestrained desires, thinking, depression, and fright mostly leads to Spleen and Kidney deficiency, Mingmen Fire Decline, belonging to deficiency syndromes; Cases caused by Liver Depression transforming into Fire, Damp-Heat pouring downward, and sinew slackening belong to excess syndromes. 'Treatment Principles: Deficiency-type impotence should be tonified, excess-type should be purged, those with Fire should be cleared, those without Fire should be warmed. For Mingmen Fire Decline, since Yang Qi is deficient and True Yin is mostly damaged, and the Kidney dislikes dryness, the method of warming and tonifying should avoid purely using hot, dry, and astringent agents; warm and moist animal-derived products are suitable. For Damp-Heat pouring downward, treatment uses bitter flavors to firm Yin and light permeating agents to remove dampness.'"
In my clinical practice, I found that pure deficiency, pure excess, pure cold, or pure heat, or conditions confined to one Zang-Fu organ or one meridian/collateral, are rare. Therefore, simply applying tonification, purgation, clearing, or warming rarely yields results. Even if attention was paid to nourishing Yin when tonifying Yang, or using "bitter flavors to firm Yin, light permeating agents to remove dampness" when removing dampness, it was often ineffective. Synthesizing the reasons, it is mostly related to the aforementioned: ① Unclear nature and location of the disease, ② Failure to distinguish root and branch, ③ Unclear proportion. So how to distinguish these three factors? Through repeated exploration, I found five main methods:
1. According to the basic viewpoints of TCM theory, analyze all issues with a monistic perspective. For example: Non-arising of sexual function, thin and cold semen, dizziness and tinnitus, pale complexion, listlessness, sore and weak waist and knees, aversion to cold and cold limbs, pale tongue with white coating, deep fine pulse should be explained primarily by the single diagnosis of Mingmen Fire Decline, rather than invoking Lung or Spleen syndromes.
2. According to the Zang-Fu organs, meridians, Qi and Blood, Yin and Yang described in basic theory, try to apply a monistic viewpoint for analysis. For example: Impotence, dizziness and headache, irritability, bitter taste and dry mouth, yellow-red urine, string-tight rapid pulse should be explained primarily by a single Liver pathology.
3. When symptoms are numerous and various manifestations are hard to explain by a single cause, or even contradictory, when explaining root/branch and proportion, one must prioritize the pulse. For example: Symptoms include dizziness and headache, bitter taste and dry throat, yellow urine and constipation, impotence. If the pulse is string-tight, consider concomitant Cold and prioritize Cold; if the pulse is slippery and rapid, consider Phlegm-Heat as primary; if the pulse is string-tight and rapid, consider Liver-Gallbladder Excess Fire as primary.
4. When symptoms are complex and deficiency and excess appear together, differentiate the degree of deficiency and excess primarily by pulse and complexion. For example: Usually having strong erections that do not subside, but becoming flaccid during intercourse, occasionally experiencing hot and painful urination, dry mouth. If the pulse is string-tight, large at the Chi position, and choppy, it should be Kidney Yang deficiency; conversely, if the Chi pulse is rapid, it is primarily Hyperactive Ministerial Fire. Again: Impotence, yellow urine, body heat, red tongue with yellow coating, but pale complexion, empty-large and rapid pulse should be diagnosed primarily as Qi and Yin deficiency, with Damp-Heat as secondary.
5. When syndrome differentiation is difficult, carefully analyze the effects after medication administration, combining pulse and symptoms for prudent analysis. One should establish the concept that anything ineffective is incorrect, and anything effective is correct. If medication is ineffective, one should consider that the prescription has at least some flaws; only then can the cause be identified.
IV. Brief Introduction to Treatment Cases
1. He XX, Male, 30 years old. Impotence for 3 years, previous doctors frequently used Kidney-tonifying and Yang-strengthening decoctions and pills along with Western medicine without effect. Examining him, aside from occasional cold symptoms, he had no other discomfort, pulse was string-tight and moderate. Recalling that Zhang Zhongjing used Guizhi Tang (Cinnamon Twig Decoction) for disharmony of Ying and Wei, and "those who lose essence with tight hypogastrium and cold glans penis" should use Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell), I tentatively prescribed Guizhi Jia Longgu Muli Tang. Unexpectedly, he recovered after 10 doses.
2. Niu XX, Male, 61 years old.
Impotence for over 20 years, previous doctor claimed Kidney Yang deficiency, treating with Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill), Nanbao (Male Treasure), San Shen Wan (Three Kidneys Pill), Royal Jelly etc., without effect. Detailed inquiry revealed that besides non-arising of sexual function, or occasional emission upon slight arousal, he constantly felt heaviness in his calves, sometimes mild edema, or hot/painful urination, dizziness and head distension, with no other discomfort. Tongue coating was yellow-white and greasy, pulse was empty-large, string-tight, tight, and slightly slippery. Synthesizing pulse and symptoms, reflecting repeatedly: Both Zhang Zhongjing and Wang Shuhe stated that an empty-large pulse indicates constitution of Qi and Blood deficiency, or Qi and Yin deficiency; tight indicates Cold; slightly slippery indicates Phlegm-Heat combination. Although signs showed Heat, it was still appropriate to prescribe Huang Qi (Astragali Radix) and Dang Gui (Angelicae Sinensis Radix) to benefit Qi and nourish Blood; Mai Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), and Sheng Di Huang (Rehmanniae Radix) to benefit Lung and nourish Kidney; Cang Zhu (Atractylodis Rhizoma), Fu Ling (Poria), and Ze Xie (Alismatis Rhizoma) to dry dampness and promote diuresis; Huang Lian (Coptidis Rhizoma) and Rou Gui (Cinnamomi Cortex) to communicate Heart and Kidney. After 2 months of medication, all symptoms returned to normal. He also reported that proteinuria had completely disappeared.
3. Huo XX, Male, 28 years old.
After half a year of marriage, he found that either sexual function did not arise, or arose but was not firm, or premature ejaculation occurred upon slight contact, causing great dissatisfaction in his wife. Doctors first gave Kidney-tonifying and Yang-strengthening treatments, combined with Western medicine, without effect; later combined with acupuncture, also without merit. Examination showed that apart from impotence, he had no other symptoms, only occasional dry throat, thin white tongue coating, and floating-moderate pulse. Synthesizing pulse and symptoms, reflecting: Floating pulse is the pulse of Heart and Lung. His dry throat was due to Lung Yin deficiency failing to generate Kidney Water. Therefore, I planned to nourish Kidney Water and assist Kidney Yang, prescribing Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix) to nourish Lung and Yin, Yinyanghuo (Epimedii Herba), Shechuangzi (Cnidii Fructus), and Roucongrong (Cistanches Herba) to assist Kidney Yang. Effective after 3 doses, cured after 20 doses.
4. He XX, Male, 29 years old.
Married for over 3 years, either sexual function did not arise, or arose but was not firm. Took Nanbao, San Shen Wan, Shenqi Wan (Kidney Qi Pill), Liushen Dihuang Wan (Six-Ingredient Rehmannia Pill), Deer Antler Essence for nearly 3 years without effect. For the past half year, frequently experienced toothache, headache, irritability, insomnia, especially in the last two months, almost daily epistaxis and gingival bleeding, forcing the use of fire-purging drugs. However, after taking them, sexual numbness and discomfort appeared, while other symptoms did not decrease. Examining tongue coating: yellow-white and greasy; pulse: string-tight and rapid. Reflecting: String-tight pulse is Liver pulse; tight and rapid indicates Cold-Fluid retention transformed into Heat after long stagnation. Toothache, headache, irritability, and insomnia are also Liver syndromes. Therefore, I prescribed Chaihu Jia Longgu Muli Tang (Bupleurum Decoction plus Dragon Bone and Oyster Shell) removing Lead Calx (Qian Dan), adding Gan Cao (Glycyrrhizae Radix et Rhizoma) and Xuanshen (Scrophulariae Radix) as the method. After 4 doses, headache, toothache, irritability, and epistaxis decreased; continuing for 30 doses resulted in complete cure.
Xu Lao (Deficiency Consumption)
What is Xu Lao? Some say it refers to hematopoietic system diseases, others say it refers to nutritional deficiency diseases. Which is correct? Which is wrong? It is difficult to decide. Until reading *Shiyong Zhongyi Neike Xue* (Practical TCM Internal Medicine) edited by Fang Yaodeng et al., I gained a somewhat comprehensive understanding. It states: "The scope of Xu Lao is very broad, almost involving various systems of Western medicine, including autoimmune deficiency or immune function stability disorders, endocrine gland dysfunction, hematopoietic dysfunction, metabolic disorders, nutritional deficiencies, neurological dysfunction or excessive inhibition (non-protective) induced diseases, and other organ system functional decline diseases, any condition whose main clinical manifestation is chronic functional decline or virtual hyperexcitability." However, since this statement is too general and lacks specific reference, it often makes it difficult for readers to apply it to studying classical TCM texts and clinical practice.