服药6剂，皮肤由深黑色转为棕黑色，精神好转，食欲增加；继服上药70剂，皮肤由棕黑转为健康皮肤样的淡黄色，食欲、睡眠、精神均正常；继服上药至90剂时，诸证消失。追访1年未见复发。
甲状腺功能亢进症
1．胶于实而略其虚，囿其肝而忽治心，不知标本，忽略君臣，久治不效
宋××，男，27岁。
烦躁易怒，心悸多汗，疲乏无力，手颤8个多月。医诊甲状腺功能亢进症。医始予西药抗甲状腺药物不但效果不够明显，反而出现肝功异常、药疹，不得不改请中医治疗，但时至今日一直无明显效果。细审其证，除烦躁易怒，心悸多汗，疲乏无力，手颤之外，并见两眼外突，眼裂增宽，上下眼睑不能闭合，失眠多梦，精神紧张，身热，甲状腺弥漫性肿大，舌苔白，脉虚弦滑数而促。综合脉证，诊为气阴俱虚为本，痰火郁结为标。治以补气养阴以培本，疏肝理气，化痰散结以治标。处方：夏枯草15克，柴胡10克，当归10克，白芍10克，党参10克，麦冬10克，五味子10克，黄芩10克，半夏10克，陈皮10克，青皮10克，牡蛎10克。
服药10剂，心悸汗出，烦躁失眠俱减；去党参，加连翘10克、元参15克以清热软坚。
服药7剂，诸证又剧。思之：此清之有余，补之不足，治肝有余，治心不足之故也。为拟上方去连翘、元参，加人参10克、丹参15克。服药10剂后，诸证大减。患者为求速效又加服他巴唑。药后不但未发现任何毒副作用，而且诸证改善的更为明显。继服20剂并配用他巴唑。
服药1个月后复诊。云：汗出心悸已经消失，睡眠正常，眼球突出已不明显，身热消失。查：甲状腺肿大已基本恢复，眼可闭合，舌苔白，脉稍滑数。宗效不更方，继服60剂，愈。
某医云：本例患者，余始用化痰泻火，非但诸证不减，且见腹痛泄泻；继用养心安神，而烦躁失眠加重，又用养血镇惊，清热泻火，而更乏力。总之，左治右治，不是不效，其故何也?答曰：本例患者从总的来说是既有心肺气阴俱虚，又有痰热凝结，肝胆郁火的证候，也可以说是一个虚实夹杂，五脏俱病的证候，《金匮要略》《千金方》诸书在治疗此种疾病时，特别重视五脏之间的关系和虚实，寒热之间的比例。对于某些特殊的证候，有时也很注重标本缓急的治法，但这种治法一般只在短期内应用。本病从整个情况来看不是什么标本缓急的问题，所以但用化痰泻火或养心安神均不合适，因为如果但用化痰泻火则正气必损，但用养心安神必助邪，但用化痰则损阴，但用养心则气壅。余所用方始效而后不效，就在于始有党参配五味、麦冬的补心肺之气阴，后去党参之补气，加泻火之连翘、元参，在于扶正之不足，在于祛邪之太过，乃至加入人参之大补元气以补偏救弊，丹参之养血活血凉血，肺、心、肝同治后才逐步缓解，其理就在于注重了五脏之间的关系，注重了虚实、寒热之间的比例。
2．胶于成见，不察现状，血虚不见，胃热不看，不思脉证，久治不效
苏××，男，35岁。
7～8个月以来，心悸心烦，失眠易怒，口燥多食，日渐消瘦。某院诊为甲状腺功能亢进。医始以抗甲状腺药非但不效，亦且发生肝功明显异常，为此不得不改用中药治之，但效果不够明显。细审其证，除心悸心烦，失眠易怒，口干，消食易饥，日渐消瘦外，并见舌苔黄白，脉弦数，甲状腺弥漫肿大。思之：前曾用益气养阴，疏肝泻火，化痰软坚的方法取效，何不再采用之。处方：柴胡10克，当归10克，白芍10克，党参10克，麦冬10克，五味子10克，半夏10克，陈皮10克，青皮10克，牡蛎10克，夏枯草15克，黄芩10克。
服药6剂，寸效不见。因思前方之治，不审脉证，胶于西医病名，故不效也。再审其脉仍见数而弦且稍有沉意。又思脉弦者肝脉也，沉弦而数者，肝血不足，心血失养，虚火炽盛也。且又见消食易饥胃火炽盛。治当养血泻火，平肝潜阳，软坚散结。处方：当归10克，川芎10克，生地15克，白芍10克，天麻10克，菊花10克，龙骨15克，牡蛎15克，生石膏15克，知母10克。
服药10剂，诸证俱减；继服30剂，诸证消失。
某医云：本例患者余始用竹叶石膏不效，后用养心安神、软坚散结仍不效，后见老师用方奇特，然仍不效，其故何也?答曰：仲景在《伤寒论》一书中谆谆告诫我们要“观其脉证，知犯何逆，随证治之。”《内经》谆谆告诫我们要“适其至所”。然我们往往忘记《内经》《伤寒》的教导，或固于西医病名，或固于某些经验，或但见症状而不求其脉、色，故治之多乏效果。至于你所处方，我所处方何故不效，就在于违背了这些原则。本病既然病位主要在肝，那就应当主治其肝，而你用诸方，或主治其胃，或主治其心，病位不同，哪能取效?至于我始用之方何故不效?我认为除以上问题外，还有一个主治在气，主治在血的问题，即前方多治在气分，后方多治在血分，故前方不效，后方有效。
甲状腺功能减退症
谨遵辨证，不囿病名，补气养血，阴阳双补而痊
张××，女，35岁。
2年多以前，因甲状腺功能亢进症而采用放射性同位素碘与抗甲状腺药物联合治疗，经过治疗虽然甲状腺功能亢进症已经痊愈，但却因药物过量而引起甲状腺功能减退症，为此不得不改用甲状腺素片进行治疗，但治疗半年多，却不见明显改善，又邀某医以补气养血之剂配合治疗2个多月，亦无明显效果。细审其证见疲乏无力，行动迟缓，整日昏昏欲睡，健忘，精神难于集中，畏寒怯冷，头晕耳鸣，面色萎黄，皮肤干燥，两眼乏神，手足厥冷，舌苔薄白，脉沉细弦。综合脉证，思之：脉沉细者，气血俱虚也；弦者，寒也，肝也。合之于症，乃气血阴阳俱不足，脾虚木乘之故也。因拟健脾温中，扶脾抑木，益气养血，培补阴阳。处方：黄芪15克，肉桂10克，当归10克，川芎10克，生地10克，白芍10克，人参10克，白术10克，茯苓10克，甘草10克，半夏10克，附子10克，麦冬10克，淡大芸15克，鹿茸1克，生姜3片，大枣5个。
某医云：余曾用补气养血，养心安神之剂治疗，然其不效也?其方能否有效?答曰：归脾汤加减方与本方虽均能补气养血，虽均能健脾，但归脾汤健脾而养心，上方则不但健脾而且抑木，其不同者一也。归脾汤补气养血，而上方不但补气养血，而且补阴益阳，其不同者二也。故用上方而不用归脾汤加减。服药4剂，其症稍减，但服至20剂时其效反而不著，乃去甲状腺素片，5剂后，诸证大减，继服上方2月，诸证全失。
甲状腺炎
1．不作随波之士，不作胶着固执之人，但求脉证，紧守病机，其病始愈
柳××，女，24岁。
3年前，因没有考上学校而经常心烦心悸，某院始诊为神经官能症，予西药镇静安眠药，不但症状不减，反见日渐加重，又邀中药以养心安神药治之，亦无明显改善。后又至该院请另一医者诊治，诊为心律失常，先用西药治疗数月不效，又请中医以炙甘草汤加减、瓜蒌薤白汤加减等治之，仍不见效。不得已，又至某院内分泌科求治，诊为甲状腺功能亢进症，先用抗甲状腺药物治疗，不但不效，反而出现恶心呕吐，肝功能异常。不得已，再求中医以软坚散结之药治之，肝功能不但不见改善，反见加重。再至某院求专家治疗，诊为甲状腺炎。但治疗一个阶段后，还是没有效果，再请某医以清热解毒，软坚散结治之，迄今仍无效果。细询其证，除心悸心烦之外，并经常感到疲乏无力，胸满气短，自汗盗汗，头晕头胀，心烦欲吐，甲状腺弥漫性肿大，舌苔白，脉虚弦滑数促结。综合脉证，思之：脉虚者，气阴俱虚也；弦者，肝脉也；滑数者，痰热蕴结也；促结兼见者，虚中夹滞也。合之于症，乃气阴两虚，痰火内蕴，肝木失达之证也。为拟补气养阴，化痰泻火，疏肝理气之剂。处方：柴胡10克，当归10克，白芍10克，五味子10克，人参10克，麦冬10克，半夏10克，陈皮10克，青皮10克，黄芩10克，牡蛎10克。
服药4剂，诸证好转；继服30剂，诸证消失，愈。
某医云：本例既为甲状腺炎，为何不用清热解毒之药?既有甲状腺肿大为何不用软坚散结之药?既有肝功异常为何不用保肝之药?答曰：中药何为保肝之药尚无定论可言，怎么谈得上加入保肝之药呢?这姑且不说。至于为什么不加清热解毒药，我主要的想法是本病无热毒之证可言，至于炎症问题，是否可以说是中医的热毒，尚不敢说，因为中医所说的阳虚寒证亦有称为炎症者，既然西医称为炎症并不等于中医的热毒，那为什么一听说是甲状腺炎而用清热解毒之药治疗呢?至于为什么不加软坚散结药的问题，我认为我并不是没有加入软坚散结药，只是用药量比较小而已。由于本证既虚且实，若软坚散结之药太过则正气必伤，而病反难除，此余屡用屡败之教训也。
2．正虚邪微，湿多热少，反复权衡，始见其效
王××，女，32岁。
双侧甲状腺弥漫性肿大，咽喉憋胀，心烦气短，头晕失眠半年多。医诊甲状腺炎。先以西药治疗2个多月不效，后又以中药软坚散结之剂配合治疗3个多月亦无明显改善。细审其证，除甲状腺肿大，咽喉憋胀，心烦气短，头晕失眠之外，并见疲乏无力，舌苔薄白，脉象濡缓。综合脉证，思之：脉濡缓者，气阴两虚，痰气郁结也。治宜补气养阴，理气化痰为方。处方：黄芪15克，当归6克，党参10克，五味子10克，麦冬10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，菖蒲10克，远志10克，生地10克。
服药6剂，头晕失眠，心烦心悸，咽喉憋胀等证俱减；继服上方12剂后，咽喉憋胀消失，甲状腺肿大消减大半；又服30剂，诸证消失。
某医问：朱老在给我们讲中药时说：“在外部可见的肿块宜用软坚散结之昆布、海藻、夏枯草、牡蛎、元参、连翘等治之。”而先生却很少用之，其故何也?答曰：本证虽见甲状腺肿大，然从其脉来看却为正虚为主，所以不可以祛邪为主的药物进行治疗，此即所谓扶正即能祛邪之意也。
甲状腺肿瘤
仅知软坚，不知温散，结者更结，坚者更坚
赵××，女，29岁。
右侧甲状腺肿如核桃大1年多。医诊甲状腺良性腺瘤。审其除右侧甲状腺肿大较硬外，并见舌苔薄白，脉弦滑而涩。综合脉证，思之：脉弦者，肝脉也；滑者，痰热也。合之于症，诊为痰热互结，肝郁气滞。拟用理气化痰，软坚散结。处方：夏枯草30克，赤芍10克，橘叶10克，桔梗10克，昆布10克，海藻10克，黄药子6克，连翘10克，瓜蒌30克。
服药30剂，寸效未见。患者云：是否中药不能治此病?答曰：不然也。细思脉虽弦滑而却兼涩。涩脉者，寒也、滞也。寒者当温，正如《内经》所云：“寒者热之”，“结者散之”之谓也。乃于上方中加入干姜6克、白芥子6克。
服药6剂，肿块减少；继服16剂，肿块竞全部消失。
甲状腺结节
软坚散结，需分寒热，以寒作热，其病不解。
杨××，男，55岁。
双侧甲状腺肿大4个多月。医诊甲状腺囊肿。因患者不愿手术，改由中医治疗。某医以理气化痰，软坚散结之中药治疗两个多月不效。审其证见甲状腺肿大如核桃，吞咽时有不利感，且偶见隐隐作痛，舌苔白，脉沉。综合脉证，诊为肝郁气滞，痰血互结证，拟予疏肝理气，化痰散结。处方：柴胡10克，赤芍10克，枳壳10克，香橼10克，佛手10克，玫瑰花10克，代代花10克，元参8克，连翘15克。
服药10剂，效果不著。又思：脉沉不滑不数者，无热可言也。治当以理气化痰为先。处方：柴胡10克，赤芍10克，枳壳10克，香橼10克，佛手10克，玫瑰花10克，代代花10克，元参3克，连翘1克。
服药2剂，吞咽不利感消失；继服6剂，肿块明显缩小；又服4剂，诸证消失。
某医云：前用之方药味全同，而始用不效，后用速效，其故何也?答曰：前方偏凉，后方偏温所致也。
糖尿病
1．肺胃实火，灼津耗液，不求脉证，但予养阴，其病不解
朱××，男，60岁。
烦渴多饮多尿1年多。医诊糖尿病。先予西药内服而症减，但稍一停药即症状如初，乃邀某医以中药养阴生津治之，病情亦不见减。细审其证，除烦渴多饮，尿糖++++之外，并见疲乏无力，恶热，舌苔黄燥，脉滑而数。综合脉证，思之：此消渴之病也。消渴之病河间分其为三，故前人亦称其为三消。今其脉滑数，滑数之脉者，肺胃热炽也，实热当泻，故治宜清肺胃。处方：生石膏60克，黄连10克，黑豆250克。
服药20剂，诸证消失；又服20剂，愈。
2．胶于阴虚之见，固于滋阴生津之治，不去理气，不去化痰，延误病期
时××，男，40岁。
服用药物6剂后，皮肤颜色由深黑色转变为棕黑色，精神状态好转，食欲增加；继续服用上述药物70剂，皮肤颜色由棕黑色转变为类似健康皮肤的淡黄色，食欲、睡眠和精神状态均恢复正常；继续服用上述药物至第90剂时，所有症状消失。随访1年未见复发。
甲状腺功能亢进症
1．拘泥于实证而忽略虚证，局限于肝脏而忽视治疗心脏，不明标本关系，忽略君臣配伍原则，长期治疗无效
患者宋××，男性，27岁。
主要症状为烦躁易怒，心悸多汗，疲乏无力，手部震颤8个多月。西医诊断为甲状腺功能亢进症（Hyperthyroidism）。起初使用西药抗甲状腺药物治疗，但效果不明显，反而出现肝功能异常和药疹，不得不改为中医治疗，但至今一直无明显疗效。仔细审查其证候，除了烦躁易怒、心悸多汗、疲乏无力、手颤之外，还见双眼外突，眼裂增宽，上下眼睑不能闭合，失眠多梦，精神紧张，身体发热，甲状腺弥漫性肿大，舌苔白，脉象虚弦滑数且急促。综合脉象和症状，诊断为气阴两虚为本，痰火郁结为标。治疗方法以补气养阴以培补根本，疏肝理气，化痰散结以治疗标证。处方：夏枯草15克，柴胡10克，当归10克，白芍10克，党参10克，麦冬10克，五味子10克，黄芩10克，半夏10克，陈皮10克，青皮10克，牡蛎10克。
服用10剂后，心悸出汗、烦躁失眠均减轻；去掉党参，加入连翘10克、玄参15克以清热软坚。
服用7剂后，所有症状又加剧。思考原因：这是清热有余，补益不足，治疗肝脏有余，治疗心脏不足的缘故。于是拟定上方去掉连翘、玄参，加入人参10克、丹参15克。服用10剂后，所有症状大幅减轻。患者为了追求速效，又加服甲巯咪唑（Methimazole）。服药后不仅未发现任何毒副作用，而且症状改善更为明显。继服20剂并配合使用甲巯咪唑。
服药1个月后复诊。患者自述：出汗心悸已经消失，睡眠正常，眼球突出已不明显，身体发热消失。检查发现：甲状腺肿大已基本恢复，眼睛可以闭合，舌苔白，脉稍滑数。遵循“有效不更方”的原则，继服60剂，痊愈。
某医生说：本例患者，我起初用化痰泻火法，不但症状不减，反而出现腹痛腹泻；继用养心安神法，导致烦躁失眠加重；又用养血镇惊、清热泻火法，导致更加乏力。总之，左治右治，不是无效，这是什么缘故呢？回答说：本例患者从总体上看，既有心肺气阴俱虚，又有痰热凝结、肝胆郁火的证候，也可以说是一个虚实夹杂、五脏皆病的证候，《金匮要略》《千金方》等书在治疗此类疾病时，特别重视五脏之间的关系以及虚实、寒热之间的比例。对于某些特殊的证候，有时也很注重标本缓急的治法，但这种治法一般只在短期内应用。本病从整个情况来看，不是什么标本缓急的问题，所以单纯用化痰泻火或养心安神都不合适，因为如果单纯用化痰泻火则正气必受损，单纯用养心安神必助长邪气，单纯用化痰则损伤阴液，单纯用养心则导致气机壅滞。我所用的方子开始有效后来无效，就在于开始时用党参配伍五味子、麦冬来补心肺之气阴，后来去掉党参的补气作用，加入泻火的连翘、玄参，在于扶正不足，在于祛邪太过，乃至加入人参的大补元气以纠正偏差弥补弊端，丹参的养血活血凉血，肺、心、肝同治后才逐步缓解，其道理就在于注重了五脏之间的关系，注重了虚实、寒热之间的比例。
2．拘泥于成见，不观察现状，看不见血虚，不看胃热，不思考脉证，长期治疗无效
患者苏××，男性，35岁。
7～8个月以来，心悸心烦，失眠易怒，口燥多食，日渐消瘦。某医院诊断为甲状腺功能亢进症。医生起初用抗甲状腺药非但不效，而且发生肝功能明显异常，为此不得不改用中药治疗，但效果不够明显。仔细审查其证候，除心悸心烦、失眠易怒、口干、消谷善饥、日渐消瘦外，还见舌苔黄白，脉弦数，甲状腺弥漫性肿大。思考：先前曾用益气养阴、疏肝泻火、化痰软坚的方法取效，为何不再采用？处方：柴胡10克，当归10克，白芍10克，党参10克，麦冬10克，五味子10克，半夏10克，陈皮10克，青皮10克，牡蛎10克，夏枯草15克，黄芩10克。
服用6剂，毫无效果。因此思考前方治疗，不审察脉证，拘泥于西医病名，所以无效。再诊其脉仍见数而弦且稍有沉意。又思考脉弦者属肝脉，沉弦而数者，是肝血不足，心血失养，虚火炽盛之象。且又见消谷善饥，乃胃火炽盛。治疗应当养血泻火，平肝潜阳，软坚散结。处方：当归10克，川芎10克，生地15克，白芍10克，天麻10克，菊花10克，龙骨15克，牡蛎15克，生石膏15克，知母10克。
服用10剂，所有症状均减轻；继服30剂，所有症状消失。
某医生说：本例患者我起初用竹叶石膏汤不效，后用养心安神、软坚散结仍不效，后见老师用方奇特，然而仍不效，这是什么缘故呢？回答说：张仲景在《伤寒论》一书中谆谆告诫我们要“观其脉证，知犯何逆，随证治之。”《内经》谆谆告诫我们要“适其至所”。然而我们往往忘记《内经》《伤寒论》的教导，或固守西医病名，或固守某些经验，或只见症状而不求其脉、色，所以治疗多缺乏效果。至于你所开的方子，我所开的方子为何不效，就在于违背了这些原则。本病既然病位主要在肝，那就应当主治其肝，而你用的诸方，有的主治其胃，有的主治其心，病位不同，怎能取效？至于我起初用的方子为何不效？我认为除以上问题外，还有一个主治在气分，主治在血分的问题，即前方多治在气分，后方多治在血分，故前方不效，后方有效。
甲状腺功能减退症
谨遵辨证，不拘泥于病名，补气养血，阴阳双补而痊愈
患者张××，女性，35岁。
2年多以前，因甲状腺功能亢进症而采用放射性同位素碘与抗甲状腺药物联合治疗，经过治疗虽然甲状腺功能亢进症已经痊愈，但却因药物过量而引起甲状腺功能减退症（Hypothyroidism），为此不得不改用甲状腺素片进行治疗，但治疗半年多，却不见明显改善，又邀某医以补气养血之剂配合治疗2个多月，亦无明显效果。仔细审查其证候见疲乏无力，行动迟缓，整日昏昏欲睡，健忘，精神难于集中，畏寒怯冷，头晕耳鸣，面色萎黄，皮肤干燥，两眼乏神，手足厥冷，舌苔薄白，脉沉细弦。综合脉证，思考：脉沉细者，气血俱虚也；弦者，主寒，主肝。合之于症状，乃气血阴阳俱不足，脾虚木乘之故也。于是拟定健脾温中，扶脾抑木，益气养血，培补阴阳。处方：黄芪15克，肉桂10克，当归10克，川芎10克，生地10克，白芍10克，人参10克，白术10克，茯苓10克，甘草10克，半夏10克，附子10克，麦冬10克，淡大芸15克，鹿茸1克，生姜3片，大枣5个。
某医生说：我曾用补气养血、养心安神之剂治疗，然而其不效吗？此方能否有效？回答说：归脾汤加减方与本方虽均能补气养血，虽均能健脾，但归脾汤健脾而养心，上方则不但健脾而且抑木，其不同者一也。归脾汤补气养血，而上方不但补气养血，而且补阴益阳，其不同者二也。故用上方而不用归脾汤加减。服药4剂，其症稍减，但服至20剂时其效反而不显著，乃停用甲状腺素片，5剂后，所有症状大幅减轻，继服上方2月，所有症状全失。
甲状腺炎
1．不作随波逐流之人，不作胶着固执之人，只求脉证，紧守病机，其病始愈
患者柳××，女性，24岁。
3年前，因没有考上学校而经常心烦心悸，某医院始诊为神经官能症，予西药镇静安眠药，不但症状不减，反见日渐加重，又邀中药以养心安神药治之，亦无明显改善。后又至该院请另一医者诊治，诊为心律失常，先用西药治疗数月不效，又请中医以炙甘草汤加减、瓜蒌薤白汤加减等治之，仍不见效。不得已，又至某院内分泌科求治，诊为甲状腺功能亢进症，先用抗甲状腺药物治疗，不但不效，反而出现恶心呕吐，肝功能异常。不得已，再求中医以软坚散结之药治之，肝功能不但不见改善，反见加重。再至某院求专家治疗，诊为甲状腺炎。但治疗一个阶段后，还是没有效果，再请某医以清热解毒，软坚散结治之，迄今仍无效果。仔细询问其证候，除心悸心烦之外，并经常感到疲乏无力，胸满气短，自汗盗汗，头晕头胀，心烦欲吐，甲状腺弥漫性肿大，舌苔白，脉虚弦滑数促结。综合脉证，思考：脉虚者，气阴俱虚也；弦者，肝脉也；滑数者，痰热蕴结也；促结兼见者，虚中夹滞也。合之于症状，乃气阴两虚，痰火内蕴，肝木失达之证也。于是拟定补气养阴，化痰泻火，疏肝理气之剂。处方：柴胡10克，当归10克，白芍10克，五味子10克，人参10克，麦冬10克，半夏10克，陈皮10克，青皮10克，黄芩10克，牡蛎10克。
服用4剂，所有症状好转；继服30剂，所有症状消失，痊愈。
某医生说：本例既为甲状腺炎，为何不用清热解毒之药？既有甲状腺肿大为何不用软坚散结之药？既有肝功异常为何不用保肝之药？回答说：中药何为保肝之药尚无定论可言，怎么谈得上加入保肝之药呢？这姑且不说。至于为什么不加清热解毒药，我主要的想法是本病无热毒之证可言，至于炎症问题，是否可以说是中医的热毒，尚不敢说，因为中医所说的阳虚寒证亦有称为炎症者，既然西医称为炎症并不等于中医的热毒，那为什么一听说是甲状腺炎而用清热解毒之药治疗呢？至于为什么不加软坚散结药的问题，我认为我并不是没有加入软坚散结药，只是用药量比较小而已。由于本证既虚且实，若软坚散结之药太过则正气必伤，而病反难除，此余屡用屡败之教训也。
患者王××，女性，32岁。
双侧甲状腺弥漫性肿大，咽喉憋胀，心烦气短，头晕失眠半年多。医生诊断为甲状腺炎。先以西药治疗2个多月不效，后又以中药软坚散结之剂配合治疗3个多月亦无明显改善。仔细审查其证候，除甲状腺肿大，咽喉憋胀，心烦气短，头晕失眠之外，还见疲乏无力，舌苔薄白，脉象濡缓。综合脉证，思考：脉濡缓者，气阴两虚，痰气郁结也。治疗宜补气养阴，理气化痰为方。处方：黄芪15克，当归6克，党参10克，五味子10克，麦冬10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草6克，石菖蒲10克，远志10克，生地10克。
服用6剂，头晕失眠，心烦心悸，咽喉憋胀等症状均减轻；继服上方12剂后，咽喉憋胀消失，甲状腺肿大消减大半；又服30剂，所有症状消失。
某医生问：朱老在给我们讲中药时说：“在外部可见的肿块宜用软坚散结之昆布、海藻、夏枯草、牡蛎、玄参、连翘等治之。”而先生却很少用之，这是什么缘故呢？回答说：本证虽见甲状腺肿大，然从其脉来看却是正虚为主，所以不可以祛邪为主的药物进行治疗，此即所谓扶正即能祛邪之意也。
甲状腺肿瘤
仅知软坚，不知温散，结者更结，坚者更坚
患者赵××，女性，29岁。
右侧甲状腺肿如核桃大1年多。医生诊断为甲状腺良性腺瘤。审查其证候除右侧甲状腺肿大较硬外，还见舌苔薄白，脉弦滑而涩。综合脉证，思考：脉弦者，肝脉也；滑者，痰热也。合之于症状，诊断为痰热互结，肝郁气滞。拟用理气化痰，软坚散结。处方：夏枯草30克，赤芍10克，橘叶10克，桔梗10克，昆布10克，海藻10克，黄药子6克，连翘10克，瓜蒌30克。
服用30剂，毫无效果。患者说：是否中药不能治此病？回答说：不是这样。仔细思考脉虽弦滑却兼涩。涩脉者，主寒、主滞。寒者当温，正如《内经》所云：“寒者热之”，“结者散之”之谓也。于是在上方中加入干姜6克、白芥子6克。
服用6剂，肿块减少；继服16剂，肿块竟全部消失。
甲状腺结节
软坚散结，需分寒热，以寒作热，其病不解。
患者杨××，男性，55岁。
双侧甲状腺肿大4个多月。医生诊断为甲状腺囊肿。因患者不愿手术，改由中医治疗。某医生以理气化痰，软坚散结之中药治疗两个多月不效。审查其证候见甲状腺肿大如核桃，吞咽时有不利感，且偶见隐隐作痛，舌苔白，脉沉。综合脉证，诊断为肝郁气滞，痰血互结证，拟予疏肝理气，化痰散结。处方：柴胡10克，赤芍10克，枳壳10克，香橼10克，佛手10克，玫瑰花10克，代代花10克，玄参8克，连翘15克。
服用10剂，效果不显著。又思考：脉沉不滑不数者，无热可言也。治疗当以理气化痰为先。处方：柴胡10克，赤芍10克，枳壳10克，香橼10克，佛手10克，玫瑰花10克，代代花10克，玄参3克，连翘1克。
服用2剂，吞咽不利感消失；继服6剂，肿块明显缩小；又服4剂，所有症状消失。
某医生说：前用之方药味全同，而始用不效，后用速效，这是什么缘故呢？回答说：前方偏凉，后方偏温所致也。
患者朱××，男性，60岁。
烦渴多饮多尿1年多。医生诊断为糖尿病（Diabetes Mellitus）。先予西药内服而症减，但稍一停药即症状如初，乃邀某医以中药养阴生津治之，病情亦不见减。仔细审查其证候，除烦渴多饮，尿糖++++之外，还见疲乏无力，恶热，舌苔黄燥，脉滑而数。综合脉证，思考：此消渴之病也。消渴之病河间分其为三，故前人亦称其为三消。今其脉滑数，滑数之脉者，肺胃热炽也，实热当泻，故治宜清肺胃。处方：生石膏60克，黄连10克，黑豆250克。
服用20剂，所有症状消失；又服20剂，痊愈。
2．拘泥于阴虚之见，固于滋阴生津之治，不去理气，不去化痰，延误病期
患者时××，男性，40岁。
After taking the medication for 6 doses, the skin color changed from deep black to brownish-black, mental state improved, and appetite increased; continuing to take the above-mentioned medicine for 70 doses, the skin color changed from brownish-black to a pale yellow similar to healthy skin, and appetite, sleep, and mental state all returned to normal; upon continuing to take the above-mentioned medicine up to the 90th dose, all symptoms disappeared. Follow-up for 1 year showed no recurrence.
Hyperthyroidism
1. Clinging to excess patterns while neglecting deficiency patterns, limiting treatment to the Liver while ignoring the Heart, failing to understand the root and branch relationship, overlooking the sovereign-minister (Jun-Chen) compatibility principles, resulting in long-term ineffective treatment.
Patient Song XX, male, 27 years old.
Main symptoms included irritability and anger, palpitations with excessive sweating, fatigue and weakness, and hand tremors for over 8 months. Western medical diagnosis: Hyperthyroidism. Initially treated with Western anti-thyroid drugs, but the effect was not obvious, and liver function abnormalities and drug eruptions appeared instead, necessitating a change to Traditional Chinese Medicine (TCM). However, there has been no significant effect until now. Careful examination of the syndrome revealed that, besides irritability, anger, palpitations, sweating, fatigue, and hand tremors, there were also exophthalmos (protruding eyes), widened palpebral fissures, inability to close upper and lower eyelids, insomnia with many dreams, nervousness, body heat, diffuse goiter, white tongue coating, and a pulse that was deficient, wiry, slippery, rapid, and hurried (Cu Mai). Synthesizing the pulse and symptoms, the diagnosis was Qi and Yin deficiency as the root (Ben), and Phlegm-Fire stagnation as the branch (Biao). The treatment principle was to tonify Qi and nourish Yin to support the root, and to soothe the Liver, regulate Qi, resolve Phlegm, and dissipate nodules to treat the branch. Prescription: Prunellae Spica (Xiakucao) 15g, Bupleuri Radix (Chaihu) 10g, Angelicae Sinensis Radix (Danggui) 10g, Paeoniae Radix Alba (Baishao) 10g, Codonopsis Radix (Dangshen) 10g, Ophiopogonis Radix (Maodong) 10g, Schisandrae Fructus (Wuweizi) 10g, Scutellariae Radix (Huangqin) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Aurantii Fructus Immaturus (Qingpi) 10g, Ostreae Concha (Muli) 10g.
After taking 10 doses, palpitations, sweating, irritability, and insomnia all decreased; Dangshen was removed, and Forsythiae Fructum (Lianqiao) 10g and Scrophulariae Radix (Yuanshen) 15g were added to clear heat and soften hardness.
After taking 7 doses, all symptoms worsened. Reflection indicated: This was due to excessive clearing and insufficient tonification, excessive treatment of the Liver, and insufficient treatment of the Heart. Therefore, the prescription was modified by removing Lianqiao and Yuanshen, and adding Ginseng Radix (Renshen) 10g and Salviae Miltiorrhizae Radix et Rhizoma (Danshen) 15g. After taking 10 doses, all symptoms significantly decreased. To seek rapid effects, the patient additionally took Methimazole. After medication, not only were no toxic side effects found, but the improvement in symptoms was even more obvious. Continued taking 20 doses combined with Methimazole.
Follow-up after 1 month of medication. The patient reported: Sweating and palpitations had disappeared, sleep was normal, exophthalmos was no longer obvious, and body heat had disappeared. Examination showed: Thyroid enlargement had basically recovered, eyes could close, tongue coating was white, and the pulse was slightly slippery and rapid. Following the principle of "not changing the formula when effective," continued taking 60 doses, resulting in recovery.
Another doctor stated: In this case, I initially used methods to resolve Phlegm and purge Fire, but not only did symptoms not decrease, abdominal pain and diarrhea appeared; subsequently using methods to nourish the Heart and calm the Spirit aggravated irritability and insomnia; further using methods to nourish Blood, settle fright, clear heat, and purge Fire led to greater fatigue. In short, trying various treatments yielded no results. Why? The answer is: Generally speaking, this patient presented with both Lung and Heart Qi and Yin deficiency, and Phlegm-Heat condensation with Liver-Gallbladder Stagnant Fire. It can be described as a mixed deficiency-excess pattern involving all five Zang organs. Books such as *Jinkui Yaolue* and *Qianjin Fang* emphasize the relationships among the five Zang organs and the proportions of deficiency/excess and cold/heat when treating such diseases. For certain special syndromes, attention is sometimes paid to the treatment of root/branch and urgency/delay, but generally only for short periods. This disease, viewed holistically, is not a matter of root/branch urgency. Therefore, using only methods to resolve Phlegm and purge Fire or only methods to nourish the Heart and calm the Spirit is inappropriate. Using only Phlegm-resolving and Fire-purging methods damages righteous Qi; using only Heart-nourishing methods aids pathogenic factors; resolving Phlegm alone damages Yin; nourishing the Heart alone causes Qi stagnation. My initial formula worked then failed because initially, Dangshen was paired with Wuweizi and Maodong to tonify Lung and Heart Qi and Yin, but later Dangshen was removed, and fire-purging Lianqiao and Yuanshen were added. This reflects insufficient support of righteousness and excessive expulsion of pathogens. Only after adding Renshen to greatly tonify Yuan Qi to correct deviations and Danshen to nourish blood, activate blood, and cool blood, and treating Lung, Heart, and Liver simultaneously, did symptoms gradually alleviate. The rationale lies in emphasizing the relationships among the five Zang organs and the balance of deficiency/excess and cold/heat.
2. Clinging to preconceptions, failing to observe current conditions, missing Blood deficiency, ignoring Stomach Heat, failing to consider pulse and symptoms, resulting in long-term ineffective treatment.
Patient Su XX, male, 35 years old.
For 7–8 months, experienced palpitations, vexation, insomnia, irritability, dry mouth, polyphagia, and progressive emaciation. Diagnosed with Hyperthyroidism at a certain hospital. Initial anti-thyroid drugs were ineffective and caused significant liver function abnormalities, necessitating a switch to TCM, but with limited effect. Careful examination revealed, besides palpitations, vexation, insomnia, irritability, dry mouth, polyphagia, and emaciation, a yellowish-white tongue coating, wiry-rapid pulse, and diffuse thyroid enlargement. Reflection: Previously, methods of tonifying Qi and nourishing Yin, soothing the Liver, purging Fire, and softening hardness were effective. Why not adopt them again? Prescription: Bupleuri Radix (Chaihu) 10g, Angelicae Sinensis Radix (Danggui) 10g, Paeoniae Radix Alba (Baishao) 10g, Codonopsis Radix (Dangshen) 10g, Ophiopogonis Radix (Maodong) 10g, Schisandrae Fructus (Wuweizi) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Aurantii Fructus Immaturus (Qingpi) 10g, Ostreae Concha (Muli) 10g, Prunellae Spica (Xiakucao) 15g, Scutellariae Radix (Huangqin) 10g.
After 6 doses, no effect was seen. Reflection: The previous treatment failed because it did not examine pulse and symptoms, clinging instead to the Western disease name. Re-examination of the pulse still showed rapid and wiry qualities with a slight sinking sensation. Further reflection: A wiry pulse belongs to the Liver; a sinking, wiry, and rapid pulse indicates Liver Blood deficiency, Heart Blood malnourishment, and flourishing Deficient Fire. Additionally, polyphagia indicates flourishing Stomach Fire. Treatment should nourish Blood, purge Fire, calm the Liver, subdue Yang, soften hardness, and dissipate nodules. Prescription: Angelicae Sinensis Radix (Danggui) 10g, Chuanxiong Rhizome (Chuanxiong) 10g, Rehmanniae Radix (Shengdi) 15g, Paeoniae Radix Alba (Baishao) 10g, Gastrodiae Rhizoma (Tianma) 10g, Chrysanthemi Flos (Juhua) 10g, Longgu 15g, Ostreae Concha (Muli) 15g, Gypsum Fibrosum (Sheng Shigao) 15g, Anemarrhenae Rhizoma (Zhimu) 10g.
After 10 doses, all symptoms decreased; after continuing 30 doses, all symptoms disappeared.
Another doctor asked: In this case, I initially used Zhuye Shigao Tang without effect, then used methods to nourish the Heart and calm the Spirit, soften hardness, and dissipate nodules without effect, and finally saw the teacher use a unique formula which also failed. Why? The answer is: Zhang Zhongjing earnestly warned in *Shanghan Lun*: "Observe the pulse and symptoms, identify the deviation, and treat according to the syndrome." *Neijing* earnestly warns: "Adjust to reach the target." Yet we often forget these teachings, clinging to Western disease names, fixed experiences, or seeing only symptoms without seeking pulse and complexion, leading to frequent lack of efficacy. As for why your formulas and mine failed, it is because they violated these principles. Since the disease location is primarily in the Liver, treatment should focus on the Liver. Your formulas focused on the Stomach or Heart; different locations cannot yield efficacy. As for why my initial formula failed, besides the above, there is the issue of focusing on Qi vs. Blood. The former formula mostly treated the Qi level, while the latter mostly treated the Blood level. Hence, the former failed, and the latter succeeded.
Hypothyroidism
Strictly following syndrome differentiation, not confined by disease names, tonifying Qi and nourishing Blood, dual-tonifying Yin and Yang leads to recovery.
Patient Zhang XX, female, 35 years old.
Over 2 years ago, treated for Hyperthyroidism with radioactive iodine and anti-thyroid drugs. Although Hyperthyroidism was cured, drug overdose caused Hypothyroidism. Thyroxine tablets were used, but after over half a year, no significant improvement was seen. Another doctor prescribed Qi-tonifying and Blood-nourishing agents for over 2 months, also without obvious effect. Careful examination revealed fatigue, slow movement, drowsiness throughout the day, forgetfulness, difficulty concentrating, aversion to cold, dizziness, tinnitus, sallow complexion, dry skin, dull eyes, cold hands and feet, thin white tongue coating, and a deep, fine, wiry pulse. Synthesizing pulse and symptoms: Deep and fine pulse indicates Qi and Blood deficiency; wiry indicates Cold and Liver. Combined with symptoms, this is insufficiency of Qi, Blood, Yin, and Yang, due to Spleen deficiency allowing Wood (Liver) to encroach. Prescription: Astragali Radix (Huangqi) 15g, Cinnamon Twig (Rougui) 10g, Angelicae Sinensis Radix (Danggui) 10g, Chuanxiong Rhizome (Chuanxiong) 10g, Rehmanniae Radix (Shengdi) 10g, Paeoniae Radix Alba (Baishao) 10g, Ginseng Radix (Renshen) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu) 10g, Poria (Fuling) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Aconiti Lateralis Radix Preparata (Fuzi) 10g, Ophiopogonis Radix (Maodong) 10g, Cynomorii Herba (Danyun) 15g, Cervi Cornu Pantotrichum (Lurong) 1g, Fresh Ginger (Shengjiang) 3 slices, Jujubae Fructus (Dazao) 5 pieces.
Another doctor asked: I used Qi-tonifying and Blood-nourishing, Heart-nourishing and Spirit-calming agents, yet they were ineffective. Can this formula work? The answer is: Although the modified Guipi Tang and this formula both tonify Qi and Blood and strengthen the Spleen, Guipi Tang strengthens the Spleen and nourishes the Heart, whereas this formula not only strengthens the Spleen but also suppresses Wood. This is difference one. Guipi Tang tonifies Qi and Blood, whereas this formula not only tonifies Qi and Blood but also tonifies Yin and benefits Yang. This is difference two. Thus, this formula is used instead of modified Guipi Tang. After 4 doses, symptoms slightly decreased. At 20 doses, efficacy was not prominent, so thyroxine was stopped. After 5 doses, symptoms significantly decreased. Continuing the formula for 2 months, all symptoms disappeared.
Thyroiditis
1. Do not follow the crowd, do not be rigid and stubborn; seek only pulse and symptoms, strictly adhere to the disease mechanism, and the disease will heal.
Patient Liu XX, female, 24 years old.
Three years ago, due to failing school entrance exams, frequently experienced heart vexation and palpitations. Initially diagnosed with Neurosis at a certain hospital, treated with Western sedatives and hypnotics. Symptoms not only did not decrease but worsened daily. TCM Heart-nourishing and Spirit-calming herbs were tried without obvious improvement. Another doctor diagnosed Arrhythmia. Western medicine for several months was ineffective. TCM modified Zhigancao Tang and Gualou Xiebai Tang were tried without effect. Desperately, sought treatment in Endocrinology, diagnosed with Hyperthyroidism. Anti-thyroid drugs caused nausea, vomiting, and liver dysfunction. Then sought TCM for nodule-dissipating herbs; liver function worsened. Expert diagnosis: Thyroiditis. After a phase of treatment, no effect. Another doctor used heat-clearing, detoxifying, and nodule-dissipating methods; still no effect. Detailed inquiry revealed, besides palpitations and vexation, frequent fatigue, chest fullness and shortness of breath, spontaneous and night sweats, dizziness and head distension, vexation with urge to vomit, diffuse goiter, white tongue coating, and a pulse that was deficient, wiry, slippery, rapid, hurried, and intermittent (Cu-Jie Mai). Synthesizing pulse and symptoms: Deficient pulse indicates Qi and Yin deficiency; wiry indicates Liver; slippery-rapid indicates Phlegm-Heat accumulation; hurried-intermittent indicates deficiency with stagnation. Combined with symptoms, this is Qi and Yin deficiency, internal Phlegm-Fire accumulation, and Liver Qi stagnation. Prescription: Bupleuri Radix (Chaihu) 10g, Angelicae Sinensis Radix (Danggui) 10g, Paeoniae Radix Alba (Baishao) 10g, Schisandrae Fructus (Wuweizi) 10g, Ginseng Radix (Renshen) 10g, Ophiopogonis Radix (Maodong) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Aurantii Fructus Immaturus (Qingpi) 10g, Scutellariae Radix (Huangqin) 10g, Ostreae Concha (Muli) 10g.
After 4 doses, symptoms improved; after continuing 30 doses, all symptoms disappeared, and recovery was achieved.
Another doctor asked: Since it is Thyroiditis, why not use heat-clearing and detoxifying herbs? Since there is goiter, why not use hard-softening and nodule-dissipating herbs? Since there is liver dysfunction, why not use liver-protecting herbs? The answer is: There is no consensus on what constitutes "liver-protecting" herbs in TCM, so how can one add them? Let that pass. Regarding heat-clearing and detoxifying herbs: My main thought is that this disease lacks signs of Heat-Toxin. Whether inflammation equals TCM Heat-Toxin is debatable, as TCM Yang-Deficiency Cold patterns are sometimes called inflammation. Since Western "inflammation" does not equal TCM "Heat-Toxin," why automatically use heat-clearing and detoxifying herbs just because it is called Thyroiditis? Regarding nodule-dissipating herbs: I did include them, but in small doses. Since the syndrome is both deficient and excess, excessive use of hard-softening herbs would damage righteous Qi and make the disease harder to remove. This is a lesson from repeated failures.
2. Righteous Qi deficiency with weak pathogens, Dampness exceeding Heat; careful weighing yields efficacy.
Patient Wang XX, female, 32 years old.
Diffuse bilateral thyroid enlargement, throat tightness, heart vexation, shortness of breath, dizziness, and insomnia for over half a year. Diagnosed with Thyroiditis. Western medicine for over 2 months was ineffective. TCM hard-softening and nodule-dissipating agents for over 3 months showed no obvious improvement. Careful examination revealed, besides goiter, throat tightness, vexation, shortness of breath, dizziness, and insomnia, fatigue, thin white tongue coating, and a soggy-slow (Ru-Huan) pulse. Synthesizing pulse and symptoms: Soggy-slow pulse indicates Qi and Yin deficiency with Phlegm-Qi stagnation. Treatment should tonify Qi and nourish Yin, regulate Qi and resolve Phlegm. Prescription: Astragali Radix (Huangqi) 15g, Angelicae Sinensis Radix (Danggui) 6g, Codonopsis Radix (Dangshen) 10g, Schisandrae Fructus (Wuweizi) 10g, Ophiopogonis Radix (Maodong) 10g, Bamboo Shavings (Zhuru) 10g, Immature Bitter Orange (Zhishi) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Poria (Fuling) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 6g, Acori Tatarinowii Rhizoma (Shichangpu) 10g, Polygalae Radix (Yuanzhi) 10g, Rehmanniae Radix (Shengdi) 10g.
After 6 doses, dizziness, insomnia, heart vexation, palpitations, and throat tightness decreased; after continuing 12 doses, throat tightness disappeared, and goiter reduced by more than half; after another 30 doses, all symptoms disappeared.
Another doctor asked: Elder Zhu said when teaching us about herbs: "External visible masses should be treated with hard-softening and nodule-dissipating herbs like Kelp (Kunbu), Seaweed (Haizao), Prunella (Xiakucao), Oyster Shell (Muli), Scrophularia (Yuanshen), Forsythia (Lianqiao)." Yet you rarely use them. Why? The answer is: Although this case shows thyroid enlargement, the pulse indicates Righteous Qi deficiency is primary. Therefore, one cannot use pathogen-expelling dominant drugs. This is the meaning of "Supporting Righteous Qi expels Pathogens."
Thyroid Tumor
Knowing only to soften hardness, not knowing to warm and disperse; knots become tighter, hardness becomes harder.
Patient Zhao XX, female, 29 years old.
Right thyroid swelling walnut-sized for over 1 year. Diagnosed with Benign Thyroid Adenoma. Examination revealed, besides hard right thyroid enlargement, thin white tongue coating, and a wiry-slippery-choppy (Xian-Hua-Se) pulse. Synthesizing pulse and symptoms: Wiry indicates Liver; slippery indicates Phlegm-Heat. Combined with symptoms, diagnosed as Phlegm-Heat mutual binding and Liver Stagnation with Qi Stagnation. Plan: Regulate Qi, resolve Phlegm, soften hardness, dissipate nodules. Prescription: Prunellae Spica (Xiakucao) 30g, Red Peony Root (Chishao) 10g, Tangerine Peel (Juye) 10g, Platycodon Root (Jiegeng) 10g, Kelp (Kunbu) 10g, Seaweed (Haizao) 10g, Rhizoma Phytolaccae (Huangyaozi) 6g, Forsythiae Fructum (Lianqiao) 10g, Trichosanthis Fructus (Gualou) 30g.
After 30 doses, no effect. Patient asked: Can TCM not treat this disease? The answer is: No. Careful thought: Although the pulse is wiry and slippery, it is also choppy. Choppy pulse indicates Cold and Stagnation. Cold should be warmed, as *Neijing* states: "Cold is treated with Heat," "Knots are dispersed." Thus, Dried Ginger (Ganjiang) 6g and White Mustard Seed (Baijiezi) 6g were added to the formula.
After 6 doses, the mass decreased; after continuing 16 doses, the mass completely disappeared.
Thyroid Nodule
Softening hardness and dissipating nodules requires distinguishing Cold and Heat; treating Cold as Heat leaves the disease unresolved.
Patient Yang XX, male, 55 years old.
Bilateral thyroid enlargement for over 4 months. Diagnosed with Thyroid Cyst. Patient refused surgery, switched to TCM. Another doctor used Qi-regulating, Phlegm-resolving, hard-softening, and nodule-dissipating herbs for over 2 months without effect. Examination revealed thyroid enlargement walnut-sized, discomfort during swallowing, occasional dull pain, white tongue coating, and deep (Chen) pulse. Synthesizing pulse and symptoms, diagnosed as Liver Stagnation with Qi Stagnation and Phlegm-Blood mutual binding. Plan: Soothe Liver, regulate Qi, resolve Phlegm, dissipate nodules. Prescription: Bupleuri Radix (Chaihu) 10g, Red Peony Root (Chishao) 10g, Aurantium Fruit (Zhike) 10g, Citrus medica (Xiangyuan) 10g, Bergamia Fruit (Foshou) 10g, Rose Flower (Meiguihua) 10g, Diplocardia Flower (Daidaigua) 10g, Scrophulariae Radix (Yuanshen) 8g, Forsythiae Fructum (Lianqiao) 15g.
After 10 doses, effect was not significant. Reflection: A deep pulse that is neither slippery nor rapid indicates no Heat. Treatment should prioritize regulating Qi and resolving Phlegm. Prescription: Bupleuri Radix (Chaihu) 10g, Red Peony Root (Chishao) 10g, Aurantium Fruit (Zhike) 10g, Citrus medica (Xiangyuan) 10g, Bergamia Fruit (Foshou) 10g, Rose Flower (Meiguihua) 10g, Diplocardia Flower (Daidaigua) 10g, Scrophulariae Radix (Yuanshen) 3g, Forsythiae Fructum (Lianqiao) 1g.
After 2 doses, swallowing discomfort disappeared; after continuing 6 doses, the mass significantly shrank; after another 4 doses, all symptoms disappeared.
Another doctor asked: The previous formula had identical ingredients but failed initially and succeeded later. Why? The answer is: The former formula was biased towards Cool, while the latter was biased towards Warm.
Diabetes Mellitus
1. Excess Fire in Lung and Stomach burning fluids and consuming essence; seeking only pulse and symptoms, providing only Yin-nourishing, leaves the disease unresolved.
Patient Zhu XX, male, 60 years old.
Vexation, thirst, polydipsia, and polyuria for over 1 year. Diagnosed with Diabetes Mellitus. Initially treated with Western oral medications; symptoms decreased but returned immediately upon stopping. Sought TCM for Yin-nourishing and fluid-generating herbs; condition did not improve. Careful examination revealed, besides vexation, thirst, polydipsia, and urine sugar +++, fatigue, aversion to heat, yellow-dry tongue coating, and a slippery-rapid pulse. Synthesizing pulse and symptoms: This is Xiao Ke (Wasting-Thirst). Hejian divided Xiao Ke into three types, hence formerly called San Xiao. Current slippery-rapid pulse indicates blazing Lung and Stomach Heat. Excess Heat should be purged; thus, treatment should clear Lung and Stomach. Prescription: Gypsum Fibrosum (Sheng Shigao) 60g, Coptidis Rhizoma (Huanglian) 10g, Black Soybean (Heidou) 250g.
After 20 doses, all symptoms disappeared; after another 20 doses, recovery was achieved.
2. Clinging to the view of Yin deficiency, adhering to Yin-nourishing and fluid-generating treatment, failing to regulate Qi and resolve Phlegm, delaying the disease course.
Patient Shi XX, male, 40 years old.