砸伤头部后3年多来，头晕头痛一直不止。医诊外伤性头痛。先用西药治疗1年多不效，后又配合中药活血逐瘀，针灸仍不效。细审其证，除头痛头晕，失眠健忘之外，并见舌苔薄白，脉沉细弱。综合脉证，思之：脉沉细弱者，气血阴阳俱虚，髓海不足也。治宜大补阴阳气血，填精补髓。处方：龟甲30克，鹿角胶10克(烊化)，人参10克，枸杞子10克。参茸卫生丸2丸。
服药4剂，头晕头痛，失眠健忘俱减，继服40剂，诸证消失，愈。
动脉硬化性脑梗死
1.神昏舌短，邪闭心包，内窍不通，但用开窍不愈者，必予通腑
关××，男，60岁。
神昏，口喁，半身不遂4天。医诊脑血栓形成。每日除予西药外，并鼻饲安宫牛黄丸3丸，然其效果始终不够显著。细审其证，除神昏，口眼㖞斜，半身不遂外，并见其脘腹胀满，大便5日未行，舌苔黄燥，脉沉滑数。综合脉证，思之：神昏者，心包之疾也，其痰火蒙蔽者，安宫牛黄丸为必用之药，然其已用13丸而尚不减，其故何也?又思鞠通《温病条辨》日：“阳明温病，下之不通，其证有五……邪闭心包，神昏舌短，内窍不通，饮不解渴者，牛黄承气汤主之。”此“其因邪闭心包，内窍不通……较前条仅仅谵语，则更急而又急，立刻有闭脱之虞，阳明大实不通，有消亡肾液之虞，其势不可少缓须臾，则以牛黄丸开手少阴之闭，以承气急泻阳明，救足少阴之消，此两少阴合治法也。”本病非但神昏，亦且便秘，舌黄而燥，脉沉滑数，故非通腑不得解也。再思下法有二：一日牛黄丸加大黄，二日牛黄丸加小承气。若腹满便秘者宜小承气，仅口渴者宜大黄，今患者腹满、便秘、脉滑并见，自宜小承气也。因拟通腑泻热，开窍化痰。处方：大黄10克，枳实10克，厚朴10克，安宫牛黄丸2丸(另化开服)。
服药1剂，大便通，神稍清，继服1剂，神志全清。
2．神昏之因气郁者，必予理气方效
由××，男，68岁。
在睡眠的过程中突然神志昏迷。医诊脑血栓形成。先用西药治疗2周不效，继又配合中药安宫牛黄丸、苏合香丸治疗2周亦不效。细审其证，除神志昏迷外，并见其痰涎壅盛，舌苔白腻，脉沉缓稍滑。询其发病之因，日：近1个月连续不断的生气，为此长期唉声叹气，不食亦不能睡。综合脉证，思之：脉沉者，郁证也；缓而滑者，湿痰蕴郁不化也。痰湿上逆，上蒙心窍，故神昏也。因拟疏肝理气，化痰开窍。处方：柴胡10克，枳实10克，桔梗10克，陈皮10克，青皮10克，郁金10克，赤芍10克，杏仁10克，菖蒲10克，栀子10克，苏叶6克，瓜蒌15克，生姜4片，苏合香丸2丸(另溶化冲服)。
服药1剂，神志略清，继服4剂，神志全清。
某医云：开窍乃治昏迷之大法，而未闻其用疏肝始解者也?答曰：《内经》称木郁者达之，称因而和之是为圣度。此病既与肝之郁有关，且属不和所引起，岂能不与和之，达之乎1
3．神昏之闭、脱并见者，必予祛邪扶正两施，才可挽生命于万一
董××，男，70岁。
神昏不语3个多月。医诊脑血栓形成。先以西药治疗20天不效，继又配合中药安宫牛黄丸、至宝丹2个多月仍不效。细审其证，除神昏不语外，并见其眼合口张，鼻鼾，肢体软瘫，二便自遗，舌苔黄白厚腻，脉虚大弦滑。综合脉证，思之：目合口张，鼻鼾，二便自遗，脉虚大者，正气大虚也，五脏欲绝也。脉弦滑者，尚有阳气也，痰热蒙蔽也。综合脉证．论之乃五脏欲绝而尚有阳气之复也，痰湿邪气阻郁也。治宜大补气阴以扶正回元，稍佐化痰开窍以除其邪。处方：黄芪15克，当归10克，人参10克，麦冬10克，五味子10克，竹茹10克，枳壳10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克，知母6克。
并嘱除支持疗法外，停用任何药物。
连续服药15剂，神志稍清，并时有睁眼，开口及示意他人接大小便的动作。此时某医嫌药效过慢，乃加入安宫牛黄丸，每日2丸服之，两日后，神志更加不清，且大便转为失禁。再邀会诊。云：此五脏大衰之候，岂能容克伐之药进之乎。急去安宫牛黄丸、知母等药。服药15剂，神志果清。
4．舌瘖不语，风痰阻络者，必分阴阳寒热
赵××，男，54岁。
脑血栓形成后，经过中、西药，针灸等治疗后，虽然神志、偏瘫已经基本恢复正常，但仍健忘、失语。细审其证，除言语不能，伸舌偏歪外，并见口涎不断的由口角流出，嘱其张口看舌则满口尽涎，舌苔白而水滑状，指冷，脉沉弦细涩。综合脉证，云：此风痰阻络证也。治宜熄风化痰，开窍通络。余语刚停。某医云：余用解语丹、资寿解语汤加减已百余剂矣，然其不效也。余云：恐用方寒热有别也。为疏：羌活3克，竹沥15克(冲)，生姜10克，天麻10克，附子10克，肉桂10克，茯苓10克，制南星10克，全蝎6克，菖蒲10克，远志10克。
针：通里、哑门、大陵
服药10剂，开始可以说一些简单的词语；继服40剂，言语基本恢复正常。
某医云：此证所处之方仅附子、肉桂不同，而再加羚羊角、钩藤、连翘也，何其效不同者若此?答曰：温化与冰固天壤之别也，岂可不注意也。
5．偏瘫失语，正虚邪实者，非扶正祛邪而不解
苏××，男，60岁。脑血栓形成后，经过中、西医，针灸配合治疗，虽然神志已清，偏瘫稍解，但直至今天已1年多仍然不能说话。细审其证，除舌喑不语外，并见舌苔黄白厚腻，脉虚大弦滑。因思脉虚大者，气阴两虚也。弦滑者，痰热也。合之于症，乃气阴两虚为本，痰热不化为标也。拟用补气养阴，理气化痰。处方：黄芪15克，当归6克，麦冬10克，人参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克，元参15克。针：哑门、涌泉、通里连续服药70剂，言语恢复正常。
高血压性脑出血
1．阴脱宜固，不可祛邪，虚实不辨，治焉不错
栗××，男，75岁。
在一次会议的发言过程中，突然昏仆不省人事。医诊脑溢血。先以西药治疗8天无效，继又配合中药化痰开窍，平肝熄风治之约2个月，不见好转。细审其证，除神昏不语外，并见右侧偏瘫，面赤如妆，鼻鼾遗尿，汗出，舌质红绛少苔，脉虚大而数。综合脉证，诊为阴脱之证。治拟养阴固脱。处方：龟甲30克，牡蛎15克，龙骨15克，鳖甲15克，甘草10克，白芍15克，五味子12克，阿胶10克，麦冬10克，生地15克。
某医云：脑溢血证，中医之中风病也。张山雷《中风斟铨》云其为肝阳上亢血冲脑神经所致者也，故多以平肝潜阳为法，张锡纯著《医学衷中参西录》列镇肝熄风汤，治内中风证，其脉弦长有力，面色如醉，颠仆不知人，肢体痿废，而先生独不用其法、其方，其故何也?答曰：本证舌绛，汗出，面赤如妆，神昏，脉虚大而数，显系阴脱而非阳亢，脱者宜固宜敛，故重用益阴敛摄之龙、牡、五味、阿胶，而不用代赭、钩藤也。且前医已告知安宫牛黄、石决、钩藤、竹沥之属均不可再用也。
服药3剂，神志稍清，继服30剂，汗止，神清，且时有言语可以发出。
2．虚实必辨，阴阳必分，证脉分清，始能判明
李××，男，77岁。
脑溢血病，经过中、西药的治疗，半年多来，神志虽然已经恢复正常，偏瘫亦明显好转。但至今仍完全失语。细审其证，除仍偏瘫、失语外，尚见舌质红绛无苔，脉虚大而数。证脉合参，诊为阴虚金破。拟滋阴润肺，养心益肾。处方：龟甲30克，鳖甲30克，牡蛎15克，甘草10克，白芍15克，生地15克，麦冬15克，阿胶10克，元参10克，五味子10克。
针：哑门、涌泉、通里。
某医云：中风不语，医家多云为风痰阻络所致，故但见风痰上阻者用解语丹、资寿解语汤，若肾虚精亏者用地黄饮子。若肝阳上亢者用天麻钩藤、镇肝熄风加菖蒲、胆星、竺黄、全蝎，而先生却弃而不用，其故何也?答曰：中风不语确实以风痰阻络者为多见，故诸医多以化痰祛风治之，即如虚证之肾虚精亏证亦因其兼风痰而予菖蒲、远志，今本病久用除痰熄风而阴液大亏，即所谓金破不鸣之谓也，故必须但用养阴之品，且其脉虚大而数，只可用养阴敛摄不可用升散，以防厥脱再现而命丧黄泉也。服药70剂，言语果然恢复如常。
蛛网膜下腔出血
1．胶于安宫，泥于再造，过用补阳还五，不审脉证而不愈
苏××，男，59岁。
在讲课的过程中，突然感到全身不适，说话困难，继而昏迷，半身不遂。急至某院，诊为蛛网膜下腔出血。先以西药治疗15天，神志逐渐清醒，但右半身不遂，口眼喁斜，言謇语涩不见改善，又配合中药安宫牛黄丸，一日2次，一次1丸；再造丸，一日3次，1次l丸；补阳还五汤加减，1日1剂；针灸等治疗5个多月，半身不遂明显好转。但右半身依然发僵，屈伸不利，口眼喁斜，失语，伸舌偏歪，且饮水即呛而出，舌苔黄白厚腻，脉弦紧滑数。综合脉证，思之：前用补阳还五汤、安宫牛黄丸、再造丸均称合拍，然其不愈者何也?又思脉虽滑数而却兼弦紧，滑数之脉为痰热，其用安宫牛黄丸亦称合拍，然其又兼紧弦，紧弦之脉，当属寒属肝，自当温化寒痰相佐，而安宫牛黄者，但除热痰也，即如再造丸虽有祛痰之味，然其总为补益通络为主，补阳还五汤者亦补气活血之方，而化痰均有不足，终不合拍，故失语，饮水即呛而出。治宜疏风散寒，化痰通络。处方：黄柏10克，苍术10克，南星10克，桂枝10克，防己10克，威灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。
某医云：此乃丹溪上中下痛风方。上中下痛风方者，丹溪治痛风之方也，治痛痹之方也，今先生反用其治中风不语者何也?答曰：仲景《金匮要略》列中风、历节病于一篇，言其病因有相同者也，言其治法有相同者也。今从脉证来看，本证痰、风、瘀俱在也，故以祛风、化痰、活络三法于一炉而治此疾也。
服药4剂，口眼㖞斜竟几近恢复，说话有声音可以发出，肢体活动几近正常，继服40剂，诸证消失，愈。
2．谨察舌色，脉证合参，虚实可辨，扶正始愈
李××，男，78岁。
在一次开会发言的过程中，由于过度激动，突然昏仆不省人事。急至某院，诊为蛛网膜下腔出血。先用西药抢救10天不效，后又配合中药化痰熄风开窍之剂治疗近50多天亦无明显效果。细审其证，除神志昏迷外，并见左侧偏瘫，面赤如妆，鼻鼾遗尿，汗出，舌质红绛无苔，脉虚大而数。综合脉证，思之：面赤如妆，鼻鼾遗尿，神昏，汗出，脉虚大而数者，阴液将脱证也。治宜滋阴敛阳固脱。处方：龟甲30克，鳖甲15克，牡蛎15克，龙骨15克，甘草10克，白芍15克，五味子12克，阿胶10克(烊化)，生地15克，麦冬10克。
某医云：此吴塘《温病条辨》下焦方也。《温病条辨》者，吴塘论温病之大著也，何其方药反用于中风?答曰：上方确为《温病条辨》之下焦篇方，具体的说确为三甲复脉汤加减方。《温病条辨》云：“风温、温热、温疫、温毒、冬温，邪在阳明久羁，或已下，或未下，身热面赤，口干舌燥，甚则齿黑唇裂……脉虚大，手足心热甚于手足背者，加减复脉汤主之。”“温病误表，津液被劫，心中震震，舌强神昏，宜复脉法复其津液，舌上津回则生，汗自出，中无所主者，救逆汤主之。”“温病已汗而不得汗，已下而热不退，六七日以外，脉尚躁盛者，重与复脉汤。”“热邪深入，或在少阴，或在厥阴，均宜复脉。”“热邪久羁，吸烁真阴，或因误表，或因妄攻，神倦瘛疚，脉气虚弱，舌绛苔少，时时欲脱者，大定风珠主之。，，此病虽非温病之误表所致，然其所谓邪气已去八九，真阴仅存一二，时时阴液欲脱则相似也，故以大队浓浊填阴塞隙，介属潜阳镇定，使阴得安其位，阳可立根基。正如叶天士所云：阳气不交于阴，勿谓痰火，议与潜阳之义也。
服药2剂，神志稍清；继服30剂，神志全清，偏瘫、失语减。
良性颅内压增高症
1．察脉辨证，脉弦滑数，知其为痰火上扰，与疏肝泻火化痰得愈
朱××，女，45岁。
头脑胀痛，恶心呕吐，两眼失明3天。医诊良性颅内压增高症。先以腰穿放液、甘露醇静脉滴注诸证稍有好转，但一直不解决根本问题。细审其证，除头脑胀痛，恶心呕吐，两眼失明外，并见烦躁易怒，口苦而干，失眠，昼夜不能入睡片刻，舌苔黄白，脉弦滑而数。综合脉证，思之：脉弦数者，肝火上冲也；滑数者，痰热蕴结也。合之与症，乃肝胆实火，痰热内郁也。治从疏肝泻火，化痰安神。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹10克，枳实10克，半夏10克，滑石10克，竹叶10克，夜交藤30克。
服药3剂，头痛顿减六七，恶心呕吐消失，视力增加，并能在1米内清楚的看见手指。继服10剂，诸证尽失，愈。追访10年，一直正常。
【背景信息】
书名：中医临证经验与方法 章节：正文(57/94) 类别：方剂
砸伤头部后3年多来，头晕头痛一直不止。医生诊断为外伤性头痛。先用西药治疗1年多无效，后又配合中药活血逐瘀（通过促进血液循环以消除瘀血），针灸仍不效。仔细审查其症状，除头痛头晕、失眠健忘之外，并见舌苔薄白，脉象沉细弱。综合脉象和症状，思考认为：脉象沉细弱，是气血阴阳俱虚，髓海（指脑，因脑为髓之海）不足所致。治疗宜大补阴阳气血，填精补髓。处方：龟甲30克，鹿角胶10克（烊化，即将胶类药材放入热药液中溶化），人参10克，枸杞子10克。参茸卫生丸2丸。
服药4剂，头晕头痛、失眠健忘均减轻，继服40剂，所有症状消失，痊愈。
动脉硬化性脑梗死
1. 神志昏迷、舌体短缩，邪气闭阻心包，内窍不通，若仅用开窍法不愈者，必须予以通腑泄热
关××，男，60岁。
神志昏迷，口眼歪斜，半身不遂4天。医生诊断为脑血栓形成。每日除给予西药外，并鼻饲安宫牛黄丸3丸，然而效果始终不够显著。仔细审查其症状，除神志昏迷、口眼歪斜、半身不遂外，并见脘腹胀满，大便5日未行，舌苔黄燥，脉象沉滑数。综合脉证，思考认为：神志昏迷，是心包受病，若是痰火蒙蔽心窍，安宫牛黄丸是必用之药，然而已用13丸而症状尚不减，原因何在？又想到吴鞠通《温病条辨》中说：“阳明温病，下法不通，有五种证候……邪气闭阻心包，神志昏迷舌体短缩，内窍不通，饮水不能解渴的，用牛黄承气汤主治。”此“因邪气闭阻心包，内窍不通……比前条仅仅谵语的情况，更为急迫，立刻有闭脱（闭证转为脱证）的危险，阳明大肠实热不通，有消亡肾阴的危险，病势不可稍缓片刻，所以用牛黄丸开通手少阴心包的闭阻，用承气汤急泻阳明大肠实热，救足少阴肾经的耗损，这是两少阴合治的方法。”本病不仅神志昏迷，而且便秘，舌苔黄而干燥，脉象沉滑数，所以非通腑泄热不能解决。再考虑下法有两种：一是牛黄丸加大黄，二是牛黄丸加小承气汤。若腹满便秘者宜用小承气汤，仅口渴者宜用大黄，现患者腹满、便秘、脉滑并见，自然适宜用小承气汤。因此拟定通腑泄热，开窍化痰。处方：大黄10克，枳实10克，厚朴10克，安宫牛黄丸2丸（另溶化冲服）。
服药1剂，大便通畅，神志稍清，继服1剂，神志完全清醒。
2．神志昏迷由气郁引起者，必须予以理气方有效
由××，男，68岁。
在睡眠过程中突然神志昏迷。医生诊断为脑血栓形成。先用西药治疗2周无效，继又配合中药安宫牛黄丸、苏合香丸治疗2周也无效。仔细审查其症状，除神志昏迷外，并见痰涎壅盛，舌苔白腻，脉象沉缓稍滑。询问发病原因，说：近1个月连续不断生气，为此长期唉声叹气，不吃饭也不能睡觉。综合脉证，思考认为：脉沉，是郁证；缓而滑，是湿痰蕴结郁滞不化。痰湿上逆，上蒙心窍，所以神志昏迷。因此拟定疏肝理气，化痰开窍。处方：柴胡10克，枳实10克，桔梗10克，陈皮10克，青皮10克，郁金10克，赤芍10克，杏仁10克，石菖蒲10克，栀子10克，苏叶6克，瓜蒌15克，生姜4片，苏合香丸2丸（另溶化冲服）。
服药1剂，神志略清，继服4剂，神志完全清醒。
某医生说：开窍是治疗昏迷的大法，但未听说用疏肝法始能解决的？回答说：《内经》称木郁者达之（疏通宣泄），称因而和之是为圣度（顺应病势调和是最高准则）。此病既然与肝之郁有关，且属不和所引起，岂能不与之调和、疏通呢？
3．神志昏迷表现为闭证、脱证并见者，必须予以祛邪扶正两施，才可挽回生命于万一
董××，男，70岁。
神志昏迷不语3个多月。医生诊断为脑血栓形成。先以西药治疗20天无效，继又配合中药安宫牛黄丸、至宝丹2个多月仍无效。仔细审查其症状，除神志昏迷不语外，并见眼合口张，鼻鼾，肢体软瘫，二便自遗（大小便失禁），舌苔黄白厚腻，脉象虚大弦滑。综合脉证，思考认为：目合口张，鼻鼾，二便自遗，脉虚大，是正气大虚，五脏欲绝的表现。脉弦滑，说明尚有阳气，是痰热蒙蔽的表现。综合脉证，论述乃是五脏欲绝而尚有阳气回复的迹象，痰湿邪气阻郁所致。治疗宜大补气阴以扶正回元，稍佐化痰开窍以除其邪。处方：黄芪15克，当归10克，人参10克，麦冬10克，五味子10克，竹茹10克，枳壳10克，半夏10克，陈皮10克，茯苓10克，甘草10克，石菖蒲10克，远志10克，知母6克。
并嘱咐除支持疗法外，停用任何药物。
连续服药15剂，神志稍清，并时有睁眼、开口及示意他人接大小便的动作。此时某医嫌药效过慢，乃加入安宫牛黄丸，每日2丸服用，两日后，神志更加不清，且大便转为失禁。再邀会诊。说道：这是五脏大衰的征候，岂能容许攻伐之药进入体内？急忙去掉安宫牛黄丸、知母等药。再服药15剂，神志果然清醒。
4．舌喑不语，风痰阻络者，必须分阴阳寒热
赵××，男，54岁。
脑血栓形成后，经过中、西药，针灸等治疗后，虽然神志、偏瘫已经基本恢复正常，但仍健忘、失语。仔细审查其症状，除言语不能、伸舌偏歪外，并见口涎不断的由口角流出，嘱其张口看舌则满口尽涎，舌苔白而水滑状，手指冷，脉象沉弦细涩。综合脉证，说道：这是风痰阻络证。治疗宜熄风化痰，开窍通络。我的话刚停。某医生说：我用解语丹、资寿解语汤加减已百余剂了，然而无效。我说：恐怕是用方寒热有别。于是开具：羌活3克，竹沥15克（冲服），生姜10克，天麻10克，附子10克，肉桂10克，茯苓10克，制南星10克，全蝎6克，石菖蒲10克，远志10克。
针刺：通里穴、哑门穴、大陵穴。
服药10剂，开始可以说一些简单的词语；继服40剂，言语基本恢复正常。
某医生说：此证所处的方子仅附子、肉桂不同，而再加羚羊角、钩藤、连翘，为何效果如此不同？回答说：温化与冰固有天壤之别，岂可不注意呢。
5．偏瘫失语，正虚邪实者，非扶正祛邪而不解
苏××，男，60岁。脑血栓形成后，经过中、西医，针灸配合治疗，虽然神志已清，偏瘫稍解，但直至今天已1年多仍然不能说话。仔细审查其症状，除舌喑不语外，并见舌苔黄白厚腻，脉象虚大弦滑。因为思考脉虚大，是气阴两虚。弦滑，是痰热。合之于症，乃是气阴两虚为本，痰热不化为标。拟定用补气养阴，理气化痰。处方：黄芪15克，当归6克，麦冬10克，人参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，石菖蒲10克，远志10克，玄参15克。针刺：哑门穴、涌泉穴、通里穴。连续服药70剂，言语恢复正常。
高血压性脑出血
1．阴脱宜固，不可祛邪，虚实不辨，治焉不错
栗××，男，75岁。
在一次会议的发言过程中，突然昏仆不省人事。医生诊断为脑溢血。先以西药治疗8天无效，继又配合中药化痰开窍，平肝熄风治疗约2个月，不见好转。仔细审查其症状，除神志昏迷不语外，并见右侧偏瘫，面赤如妆（面色红艳如化妆般），鼻鼾遗尿，汗出，舌质红绛少苔，脉象虚大而数。综合脉证，诊为阴脱之证。治疗拟养阴固脱。处方：龟甲30克，牡蛎15克，龙骨15克，鳖甲15克，甘草10克，白芍15克，五味子12克，阿胶10克，麦冬10克，生地15克。
某医生说：脑溢血证，中医之中风病也。张山雷《中风斟铨》云其为肝阳上亢血冲脑神经所致者也，故多以平肝潜阳为法，张锡纯著《医学衷中参西录》列镇肝熄风汤，治内中风证，其脉弦长有力，面色如醉，颠仆不知人，肢体痿废，而先生独不用其法、其方，其故何也？回答说：本证舌绛，汗出，面赤如妆，神昏，脉虚大而数，显系阴脱而非阳亢，脱者宜固宜敛，故重用益阴敛摄之龙、牡、五味、阿胶，而不用代赭、钩藤也。且前医已告知安宫牛黄、石决明、钩藤、竹沥之属均不可再用也。
服药3剂，神志稍清，继服30剂，汗止，神清，且时有言语可以发出。
2．虚实必辨，阴阳必分，证脉分清，始能判明
李××，男，77岁。
脑溢血病，经过中、西药的治疗，半年多来，神志虽然已经恢复正常，偏瘫亦明显好转。但至今仍完全失语。仔细审查其症状，除仍偏瘫、失语外，尚见舌质红绛无苔，脉象虚大而数。证脉合参，诊为阴虚金破（肺阴虚，喻声音不出如金器破裂）。拟定滋阴润肺，养心益肾。处方：龟甲30克，鳖甲30克，牡蛎15克，甘草10克，白芍15克，生地15克，麦冬15克，阿胶10克，玄参10克，五味子10克。
针刺：哑门穴、涌泉穴、通里穴。
某医生说：中风不语，医家多云为风痰阻络所致，故但见风痰上阻者用解语丹、资寿解语汤，若肾虚精亏者用地黄饮子。若肝阳上亢者用天麻钩藤、镇肝熄风加菖蒲、胆星、竺黄、全蝎，而先生却弃而不用，其故何也？回答说：中风不语确实以风痰阻络者为多见，故诸医多以化痰祛风治之，即如虚证之肾虚精亏证亦因其兼风痰而予菖蒲、远志，今本病久用除痰熄风而阴液大亏，即所谓金破不鸣之谓也，故必须但用养阴之品，且其脉虚大而数，只可用养阴敛摄不可用升散，以防厥脱再现而命丧黄泉也。服药70剂，言语果然恢复如常。
蛛网膜下腔出血
1．胶于安宫，泥于再造，过用补阳还五，不审脉证而不愈
苏××，男，59岁。
在讲课的过程中，突然感到全身不适，说话困难，继而昏迷，半身不遂。急至某院，诊为蛛网膜下腔出血。先以西药治疗15天，神志逐渐清醒，但右半身不遂，口眼歪斜，言謇语涩不见改善，又配合中药安宫牛黄丸，一日2次，一次1丸；再造丸，一日3次，1次1丸；补阳还五汤加减，1日1剂；针灸等治疗5个多月，半身不遂明显好转。但右半身依然发僵，屈伸不利，口眼歪斜，失语，伸舌偏歪，且饮水即呛而出，舌苔黄白厚腻，脉象弦紧滑数。综合脉证，思考认为：前用补阳还五汤、安宫牛黄丸、再造丸均称合拍，然而其不愈者何也？又思脉虽滑数而却兼弦紧，滑数之脉为痰热，其用安宫牛黄丸亦称合拍，然而其又兼紧弦，紧弦之脉，当属寒属肝，自当温化寒痰相佐，而安宫牛黄者，但除热痰也，即如再造丸虽有祛痰之味，然其总为补益通络为主，补阳还五汤者亦补气活血之方，而化痰均有不足，终不合拍，故失语，饮水即呛而出。治疗宜疏风散寒，化痰通络。处方：黄柏10克，苍术10克，南星10克，桂枝10克，防己10克，威灵仙10克，桃仁10克，红花10克，龙胆草10克，羌活10克，白芷10克，川芎10克，神曲10克。
某医生说：此乃丹溪上中下痛风方。上中下痛风方者，丹溪治痛风之方也，治痛痹之方也，今先生反用其治中风不语者何也？回答说：仲景《金匮要略》列中风、历节病于一篇，言其病因有相同者也，言其治法有相同者也。今从脉证来看，本证痰、风、瘀俱在也，故以祛风、化痰、活络三法于一炉而治此疾也。
服药4剂，口眼歪斜竟几近恢复，说话有声音可以发出，肢体活动几近正常，继服40剂，所有症状消失，痊愈。
2．谨察舌色，脉证合参，虚实可辨，扶正始愈
李××，男，78岁。
在一次开会发言的过程中，由于过度激动，突然昏仆不省人事。急至某院，诊为蛛网膜下腔出血。先用西药抢救10天无效，后又配合中药化痰熄风开窍之剂治疗近50多天亦无明显效果。仔细审查其症状，除神志昏迷外，并见左侧偏瘫，面赤如妆，鼻鼾遗尿，汗出，舌质红绛无苔，脉象虚大而数。综合脉证，思考认为：面赤如妆，鼻鼾遗尿，神昏，汗出，脉虚大而数者，阴液将脱证也。治疗宜滋阴敛阳固脱。处方：龟甲30克，鳖甲15克，牡蛎15克，龙骨15克，甘草10克，白芍15克，五味子12克，阿胶10克（烊化），生地15克，麦冬10克。
某医生说：此吴塘《温病条辨》下焦方也。《温病条辨》者，吴塘论温病之大著也，何其方药反用于中风？回答说：上方确为《温病条辨》之下焦篇方，具体的说确为三甲复脉汤加减方。《温病条辨》云：“风温、温热、温疫、温毒、冬温，邪在阳明久羁，或已下，或未下，身热面赤，口干舌燥，甚则齿黑唇裂……脉虚大，手足心热甚于手足背者，加减复脉汤主之。”“温病误表，津液被劫，心中震震，舌强神昏，宜复脉法复其津液，舌上津回则生，汗自出，中无所主者，救逆汤主之。”“温病已汗而不得汗，已下而热不退，六七日以外，脉尚躁盛者，重与复脉汤。”“热邪深入，或在少阴，或在厥阴，均宜复脉。”“热邪久羁，吸烁真阴，或因误表，或因妄攻，神倦瘛疚，脉气虚弱，舌绛苔少，时时欲脱者，大定风珠主之。”此病虽非温病之误表所致，然其所谓邪气已去八九，真阴仅存一二，时时阴液欲脱则相似也，故以大队浓浊填阴塞隙，介属潜阳镇定，使阴得安其位，阳可立根基。正如叶天士所云：阳气不交于阴，勿谓痰火，议与潜阳之义也。
服药2剂，神志稍清；继服30剂，神志全清，偏瘫、失语减。
良性颅内压增高症
1．察脉辨证，脉弦滑数，知其为痰火上扰，与疏肝泻火化痰得愈
朱××，女，45岁。
头脑胀痛，恶心呕吐，两眼失明3天。医生诊断为良性颅内压增高症。先以腰穿放液、甘露醇静脉滴注诸证稍有好转，但一直不解决根本问题。仔细审查其症状，除头脑胀痛，恶心呕吐，两眼失明外，并见烦躁易怒，口苦而干，失眠，昼夜不能入睡片刻，舌苔黄白，脉象弦滑而数。综合脉证，思考认为：脉弦数者，肝火上冲也；滑数者，痰热蕴结也。合之与症，乃肝胆实火，痰热内郁也。治疗从疏肝泻火，化痰安神。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹10克，枳实10克，半夏10克，滑石10克，竹叶10克，夜交藤30克。
服药3剂，头痛顿减六七，恶心呕吐消失，视力增加，并能在1米内清楚的看见手指。继服10剂，所有症状尽失，痊愈。追访10年，一直正常。
[Background Information]
Book Title: Clinical Experience and Methods of Traditional Chinese Medicine
Chapter: Main Text (57/94)
Category: Formulas
For over three years since the head was smashed, dizziness and headache have persisted. The physician diagnosed it as traumatic headache. Western medicine treatment for over a year was ineffective, followed by traditional Chinese medicine (TCM) promoting blood circulation and removing blood stasis, along with acupuncture, which also proved ineffective. Careful examination of the syndrome revealed that besides headache, dizziness, insomnia, and forgetfulness, there was a thin white tongue coating and a deep, fine, and weak pulse. Synthesizing the pulse and symptoms, it was reasoned that a deep, fine, and weak pulse indicates deficiency of Qi, Blood, Yin, and Yang, and insufficiency of the Marrow Sea (referring to the brain, as the brain is the sea of marrow). The treatment should focus on greatly tonifying Yin, Yang, Qi, and Blood, and filling essence and nourishing marrow. Prescription: Testudinis Carapax et Plastrum (Guijia) 30g, Cornu Cervi Pavonini Colla (Lujiao Jiao) 10g (melted separately), Ginseng Radix et Rhizoma (Renshen) 10g, Lycii Fructus (Gouqizi) 10g. Shenrong Weisheng Wan (Ginseng and Deer Antler Health Pill) 2 pills.
After taking 4 doses, dizziness, headache, insomnia, and forgetfulness all decreased. After continuing for 40 doses, all symptoms disappeared, and the patient recovered.
Atherosclerotic Cerebral Infarction
1. In cases of coma and short tongue due to pathogenic factors closing the Pericardium and blocking the internal orifices, if opening the orifices alone fails, purging the bowels must be employed.
Patient Guan XX, Male, 60 years old.
Coma, facial paralysis, and hemiplegia for 4 days. Diagnosed with cerebral thrombosis. Besides Western medicine, An Gong Niu Huang Wan (Calculus Bovis Pill for Emergency Use) was administered via nasogastric tube, 3 pills daily, yet the effect remained insignificant. Careful examination of the syndrome revealed that besides coma, facial paralysis, and hemiplegia, there was abdominal distension and fullness, no bowel movement for 5 days, a yellow and dry tongue coating, and a deep, slippery, and rapid pulse. Synthesizing the pulse and symptoms, it was reasoned: Coma is a disease of the Pericardium; if caused by phlegm-fire obscuring the orifices, An Gong Niu Huang Wan is essential. However, after using 13 pills, symptoms did not subside. Why? Recalling Wu Jutong's *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases): "In Yangming warm disease, if purgation fails to work, there are five syndromes... If pathogenic factors close the Pericardium, causing coma and short tongue, blocking internal orifices, and drinking does not quench thirst, Niuhuang Chengqi Tang (Bovis Calculus Cathartic Decoction) should be used." This "due to pathogenic factors closing the Pericardium and blocking internal orifices... is more urgent than merely delirium mentioned earlier, carrying an immediate risk of closure turning into collapse. Yangming excessive excess and blockage risks consuming Kidney Yin. The situation cannot be delayed for a moment. Thus, use Niuhuang Wan to open the closure of Hand-Shaoyin (Heart), and use Chengqi to urgently purge Yangming (Large Intestine) to save Foot-Shaoyin (Kidney) from consumption. This is the combined treatment of the two Shaoyin meridians." This case involves not only coma but also constipation, a yellow and dry tongue coating, and a deep, slippery, rapid pulse. Therefore, purging the bowels is necessary to resolve it. Considering purgative methods, there are two options: adding Rhubarb (Dahuang) to Niuhuang Wan, or adding Xiao Chengqi Tang (Minor Order the Qi Decoction) to Niuhuang Wan. For abdominal fullness and constipation, Xiao Chengqi Tang is suitable; for thirst alone, Rhubarb is suitable. Since this patient presents with abdominal fullness, constipation, and a slippery pulse, Xiao Chengqi Tang is appropriate. Therefore, the method of purging the bowels to clear heat, opening orifices, and resolving phlegm was adopted. Prescription: Rheum Palmatum Radix et Rhizoma (Dahuang) 10g, Aurantii Fructus Immaturus (Zhishi) 10g, Magnoliae Officinalis Cortex (Houpo) 10g, An Gong Niu Huang Wan 2 pills (dissolved separately and taken with liquid).
After 1 dose, bowel movement occurred, and consciousness slightly cleared. After another dose, consciousness fully cleared.
2. For coma caused by Qi stagnation, regulating Qi is essential for efficacy.
Patient You XX, Male, 68 years old.
Sudden loss of consciousness during sleep. Diagnosed with cerebral thrombosis. Western medicine treatment for 2 weeks was ineffective. Subsequently, An Gong Niu Huang Wan and Su He Xiang Wan (Styrax Pill) were added for another 2 weeks, also without effect. Careful examination of the syndrome revealed that besides coma, there was abundant salivary phlegm, a white and greasy tongue coating, and a deep, slow, slightly slippery pulse. Inquiry into the cause revealed: continuous anger for the past month, leading to long-term sighing, loss of appetite, and inability to sleep. Synthesizing the pulse and symptoms, it was reasoned: A deep pulse indicates stagnation; slow and slippery indicates damp-phlegm accumulation and stagnation failing to transform. Phlegm-dampness reversing upward and obscuring the Heart orifice causes coma. Therefore, the method of soothing the Liver, regulating Qi, resolving phlegm, and opening orifices was adopted. Prescription: Bupleuri Radix (Chaihu) 10g, Aurantii Fructus Immaturus (Zhishi) 10g, Platycodonis Radix (Jiegeng) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Citri Reticulatae Pericarpium Viride (Qingpi) 10g, Curcumae Radix (Yujin) 10g, Paeoniae Radix Rubra (Chishao) 10g, Armeniacae Semen Amarum (Xingren) 10g, Acori Tatarinowii Rhizoma (Shichangpu) 10g, Gardeniae Fructus (Zhizi) 10g, Perillae Folium (Ziyesu) 6g, Trichosanthis Fructus (Gualou) 15g, Zingiberis Rhizoma Freshum (Shengjiang) 4 slices, Su He Xiang Wan 2 pills (dissolved separately and taken with liquid).
After 1 dose, consciousness slightly cleared. After 4 doses, consciousness fully cleared.
One doctor asked: Opening orifices is the major method for treating coma, but I have never heard of using liver-soothing methods to resolve it. Reply: The *Neijing* states that for Wood stagnation, one should disperse it (Da Zhi), and harmonizing according to the pattern is the sage's standard. Since this disease is related to Liver stagnation and disharmony, how can we not harmonize and disperse it?
3. For coma presenting with both closure and collapse syndromes, expelling pathogens and supporting healthy Qi must be applied simultaneously to save life.
Patient Dong XX, Male, 70 years old.
Coma and mutism for over 3 months. Diagnosed with cerebral thrombosis. Western medicine for 20 days was ineffective. An Gong Niu Huang Wan and Zhibao Dan (Treasure of Life Pill) were added for over 2 months, still ineffective. Careful examination of the syndrome revealed that besides coma and mutism, there was closed eyes and open mouth, snoring, flaccid paralysis of limbs, incontinence of urine and feces, a thick yellow-white greasy tongue coating, and a deficient-large, wiry-slippery pulse. Synthesizing the pulse and symptoms, it was reasoned: Closed eyes, open mouth, snoring, incontinence, and deficient-large pulse indicate severe deficiency of Healthy Qi and impending failure of the Five Zang organs. Wiry-slippery pulse indicates remaining Yang Qi and obstruction by phlegm-heat. Synthesizing the pulse and symptoms, it is concluded that while the Five Zang organs are nearing failure, there is a recovery of Yang Qi, obstructed by damp-phlegm pathogenic factors. The treatment should greatly tonify Qi and Yin to support Healthy Qi and restore Yuan Qi, with slight assistance from phlegm-resolving and orifice-opening herbs to eliminate pathogens. Prescription: Astragali Radix (Huangqi) 15g, Angelicae Sinensis Radix (Danggui) 10g, Ginseng Radix et Rhizoma (Renshen) 10g, Ophiopogonis Radix (Maidong) 10g, Schisandrae Fructus (Wuweizi) 10g, Bambusae Medulla (Zhuru) 10g, Aurantii Fructus Immaturus (Zhike) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Poria (Fuling) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Acori Tatarinowii Rhizoma (Shichangpu) 10g, Polygalae Radix (Yuanzhi) 10g, Anemarrhenae Rhizoma (Zhimu) 6g.
It was instructed to stop all other medications except supportive therapy.
After 15 consecutive doses, consciousness slightly cleared, with occasional eye-opening, mouth-opening, and gestures indicating the need for toileting. At this time, another doctor complained of slow efficacy and added An Gong Niu Huang Wan, 2 pills daily. Two days later, consciousness worsened, and fecal incontinence developed. Consultation was requested again. It was stated: This is a sign of severe decline of the Five Zang organs; how can harsh/purgative drugs be allowed inside? An Gong Niu Huang Wan and Zhimu were urgently removed. After 15 more doses, consciousness indeed cleared.
4. For muteness due to wind-phlegm obstructing collaterals, Yin-Yang and cold-heat must be differentiated.
Patient Zhao XX, Male, 54 years old.
After cerebral thrombosis, despite basic recovery of consciousness and hemiplegia through TCM, Western medicine, and acupuncture, forgetfulness and aphasia persisted. Careful examination of the syndrome revealed inability to speak, deviation of the tongue upon extension, continuous drooling from the corner of the mouth, excessive saliva when asked to open the mouth and show the tongue, a white and watery-slippery tongue coating, cold fingers, and a deep, wiry, fine, and choppy pulse. Synthesizing the pulse and symptoms, it was said: This is a Wind-Phlegm obstructing collaterals syndrome. The treatment should extinguish wind, resolve phlegm, open orifices, and unblock collaterals. Before I finished speaking, another doctor said: I have used Jieyu Dan and Zishou Jieyu Tang with modifications for over a hundred doses, yet it was ineffective. I replied: Perhaps the formulas differ in cold and heat properties. So I prescribed: Notopterygii Rhizoma et Radix (Qianghuo) 3g, Phytolaccae Radix Juice (Zhuli) 15g (mixed in), Zingiberis Rhizoma Freshum (Shengjiang) 10g, Gastrodiae Rhizoma (Tianma) 10g, Aconiti Lateralis Radix Preparata (Fuzi) 10g, Cinnamomi Cortex (Rougui) 10g, Poria (Fuling) 10g, Pinelliae Rhizoma Preparatum (Nanxing) 10g, Scorpio (Quanxie) 6g, Acori Tatarinowii Rhizoma (Shichangpu) 10g, Polygalae Radix (Yuanzhi) 10g.
Acupuncture: Tongli (HT5), Yamen (GV15), Daling (PC7).
After 10 doses, the patient could start saying simple words. After 40 more doses, speech basically returned to normal.
Another doctor asked: The only difference in the formula here is Fuzi and Rougui instead of adding Lingyangjiao (Antelope Horn), Gouteng (Uncaria), and Lianqiao (Forsythia). Why is the efficacy so different? Reply: There is a world of difference between warming-transforming and ice-like solidification; one must pay attention to this.
5. For hemiplegia and aphasia with Healthy Qi deficiency and Pathogenic Excess, supporting Healthy Qi and expelling pathogens is the only way to resolve it.
Patient Su XX, Male, 60 years old.
After cerebral thrombosis, despite recovery of consciousness and slight improvement in hemiplegia through integrated TCM/Western medicine and acupuncture, the patient has been unable to speak for over a year. Careful examination of the syndrome revealed aphasia, a thick yellow-white greasy tongue coating, and a deficient-large, wiry-slippery pulse. Reasoning: Deficient-large pulse indicates Qi and Yin deficiency. Wiry-slippery pulse indicates phlegm-heat. Combined with symptoms, this is Qi and Yin deficiency as the root, and unresolved phlegm-heat as the branch. The method of tonifying Qi and nourishing Yin, regulating Qi and resolving phlegm was adopted. Prescription: Astragali Radix (Huangqi) 15g, Angelicae Sinensis Radix (Danggui) 6g, Ophiopogonis Radix (Maidong) 10g, Ginseng Radix et Rhizoma (Renshen) 10g, Schisandrae Fructus (Wuweizi) 10g, Bambusae Medulla (Zhuru) 10g, Aurantii Fructus Immaturus (Zhishi) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Citri Reticulatae Pericarpium (Chenpi) 10g, Poria (Fuling) 10g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Acori Tatarinowii Rhizoma (Shichangpu) 10g, Polygalae Radix (Yuanzhi) 10g, Scrophulariae Radix (Yuanshen) 15g. Acupuncture: Yamen (GV15), Yongquan (KI1), Tongli (HT5). After 70 consecutive doses, speech returned to normal.
Hypertensive Intracerebral Hemorrhage
1. For Yin collapse, consolidation is required; expelling pathogens is contraindicated. Without distinguishing deficiency and excess, treatment will inevitably fail.
Patient Li XX, Male, 75 years old.
During a meeting speech, sudden collapse and unconsciousness occurred. Diagnosed with cerebral hemorrhage. Western medicine for 8 days was ineffective. TCM for resolving phlegm, opening orifices, calming Liver Yang, and extinguishing wind for about 2 months showed no improvement. Careful examination of the syndrome revealed coma and mutism, right-sided hemiplegia, flushed face like makeup, snoring, urinary incontinence, sweating, red-crimson tongue body with little coating, and a deficient-large, rapid pulse. Synthesizing the pulse and symptoms, it was diagnosed as Yin Collapse. The treatment aimed to nourish Yin and consolidate collapse. Prescription: Testudinis Carapax et Plastrum (Guijia) 30g, Ostreae Concha (Muli) 15g, Ossis Femoris (Longgu) 15g, Trionycis Carapax (Biejia) 15g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Paeoniae Radix Alba (Baishao) 15g, Schisandrae Fructus (Wuweizi) 12g, Ecolloa Corii Asini (Ejiao) 10g, Ophiopogonis Radix (Maidong) 10g, Rehmanniae Radix Preparata (Shengdi) 15g.
One doctor asked: Cerebral hemorrhage is a stroke syndrome in TCM. Zhang Shanlei's *Zhongfeng Zhenquan* attributes it to Hyperactive Liver Yang and blood rushing to the brain nerves, thus usually treating with calming Liver and subduing Yang. Zhang Xichun's *Yixue Zhongzhong Canxi Lu* lists Zhen Gan Xi Feng Tang for internal stroke with wiry-long-forceful pulse, flushed face like drunkenness, collapse, unconsciousness, and limb flaccidity. Why did you not use his method or formula? Reply: This case presents with crimson tongue, sweating, flushed face like makeup, coma, and deficient-large rapid pulse, clearly indicating Yin collapse rather than Yang hyperactivity. For collapse, consolidation and astringency are needed. Thus, Longgu, Muli, Wuweizi, and Ejiao, which nourish Yin and astringe, are heavily used, while Daizhe Stone and Gouteng are avoided. Moreover, previous doctors indicated that An Gong Niu Huang, Shijueming (Haliotidis Concha), Gouteng, and Zhuli should not be used.
After 3 doses, consciousness slightly cleared. After 30 more doses, sweating stopped, consciousness cleared, and occasional speech emerged.
2. Deficiency and excess must be distinguished, Yin and Yang must be separated. Only by clarifying syndrome and pulse can judgment be accurate.
Patient Li XX, Male, 77 years old.
After cerebral hemorrhage, treated with TCM and Western medicine, consciousness normalized and hemiplegia improved significantly over half a year. However, complete aphasia persists. Careful examination of the syndrome revealed persistent hemiplegia and aphasia, red-crimson tongue body with no coating, and a deficient-large, rapid pulse. Combining syndrome and pulse, it was diagnosed as Yin Deficiency with "Broken Metal" (metaphor for voice loss due to Lung Yin deficiency). The method of nourishing Yin, moistening the Lung, nourishing the Heart, and benefiting the Kidney was adopted. Prescription: Testudinis Carapax et Plastrum (Guijia) 30g, Trionycis Carapax (Biejia) 30g, Ostreae Concha (Muli) 15g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Paeoniae Radix Alba (Baishao) 15g, Rehmanniae Radix Preparata (Shengdi) 15g, Ophiopogonis Radix (Maidong) 15g, Ecolloa Corii Asini (Ejiao) 10g, Scrophulariae Radix (Yuanshen) 10g, Schisandrae Fructus (Wuweizi) 10g.
Acupuncture: Yamen (GV15), Yongquan (KI1), Tongli (HT5).
One doctor asked: Aphasia in stroke is often attributed to Wind-Phlegm obstructing collaterals. Thus, for Wind-Phlegm obstruction, Jieyu Dan or Zishou Jieyu Tang is used; for Kidney Essence deficiency, Dihuang Yinzi is used; for Liver Yang hyperactivity, Tianma Gouteng San or Zhen Gan Xi Feng Tang plus Shichangpu, Dansheng (Arisaematis Cum Bile), Zhuhuang (Bambusae Concretio Silicea), and Quanxie is used. Why did you discard these? Reply: Indeed, Wind-Phlegm obstructing collaterals is common in stroke aphasia, so most doctors treat with resolving phlegm and dispelling wind. Even for Kidney Essence deficiency, Shichangpu and Yuanzhi are added due to accompanying Wind-Phlegm. However, in this case, prolonged use of phlegm-resolving and wind-extinguishing herbs has severely depleted Yin fluids, known as "Broken Metal Cannot Ring." Thus, only Yin-nourishing herbs should be used. Furthermore, the deficient-large rapid pulse indicates that only Yin-nourishing and astringent methods are suitable, avoiding ascending and dispersing methods to prevent recurrence of Jue-collapse and death. After 70 doses, speech indeed recovered normally.
Subarachnoid Hemorrhage
1. Clinging to An Gong, stuck on Zaizao, overusing Buyang Huanwu Tang, without examining pulse and syndrome leads to non-recovery.
Patient Su XX, Male, 59 years old.
During a lecture, sudden general discomfort, difficulty speaking, followed by coma and hemiplegia. Rushed to a hospital, diagnosed with subarachnoid hemorrhage. Western medicine for 15 days gradually cleared consciousness, but right hemiplegia, facial paralysis, slurred speech did not improve. Added An Gong Niu Huang Wan (2 times/day, 1 pill/time), Zaizao Wan (3 times/day, 1 pill/time), modified Buyang Huanwu Tang (1 dose/day), and acupuncture for over 5 months. Hemiplegia improved significantly, but right side remained stiff, flexion-extension difficult, facial paralysis, aphasia, tongue deviation, and choking on water. Tongue coating was thick yellow-white greasy, pulse wiry-tight-slippery-rapid. Synthesizing pulse and symptoms, it was reasoned: Previous use of Buyang Huanwu Tang, An Gong Niu Huang Wan, and Zaizao Wan seemed appropriate, yet why no recovery? Reasoning further: Although the pulse is slippery-rapid, it is also wiry-tight. Slippery-rapid indicates Phlegm-Heat, making An Gong Niu Huang Wan appropriate. However, the presence of tight-wiry suggests Cold and Liver involvement, requiring warming and transforming Cold-Phlegm. An Gong Niu Huang Wan only clears Heat-Phlegm. Zaizao Wan contains phlegm-resolving herbs but mainly tonifies and unblocks collaterals. Buyang Huanwu Tang tonifies Qi and invigorates Blood but lacks sufficient phlegm-resolving power. Ultimately, they did not match the syndrome, causing aphasia and choking. The treatment should dispel wind, scatter cold, resolve phlegm, and unblock collaterals. Prescription: Phellodendri Cortex (Huangbai) 10g, Atractylodis Rhizoma (Cangzhu) 10g, Pinelliae Rhizoma (Nanxing) 10g, Cinnamomi Ramulus (Guizhi) 10g, Stephaniae Tetrandrae Radix (Fangji) 10g, Syneilesis Rhizoma (Weilingxian) 10g, Persicae Semen (Taoren) 10g, Carthami Flos (Honghua) 10g, Gentianae Radix (Longdancao) 10g, Notopterygii Rhizoma et Radix (Qianghuo) 10g, Angelicae Dahuricae Radix (Baizhi) 10g, Chuanxiong Rhizoma (Chuanxiong) 10g, Massae Fermentatae Medicinatae (Shenqu) 10g.
One doctor asked: This is Danxi's Shang-Zhong-Xia Tongfeng Fang (Upper-Middle-Lower Gout Formula). Danxi used it for gout and painful bi syndrome. Why do you use it for stroke aphasia? Reply: Zhang Zhongjing's *Jin Gui Yao Lue* groups Stroke and Li Jie (Joint Pain) diseases together, stating their etiologies and treatments share similarities. From the pulse and syndrome, this case involves Phlegm, Wind, and Blood Stasis. Thus, dispelling wind, resolving phlegm, and unblocking collaterals are combined to treat this disease.
After 4 doses, facial paralysis nearly recovered, speech sounds emerged, and limb activity nearly normalized. After 40 more doses, all symptoms disappeared, and the patient recovered.
2. Carefully observe tongue color, combine pulse and syndrome, distinguish deficiency and excess, supporting Healthy Qi leads to recovery.
Patient Li XX, Male, 78 years old.
During a meeting speech, due to excessive excitement, sudden collapse and unconsciousness occurred. Rushed to a hospital, diagnosed with subarachnoid hemorrhage. Western medicine resuscitation for 10 days was ineffective. TCM for resolving phlegm, extinguishing wind, and opening orifices for nearly 50 days showed no obvious effect. Careful examination of the syndrome revealed coma, left hemiplegia, flushed face like makeup, snoring, urinary incontinence, sweating, red-crimson tongue body with no coating, and a deficient-large, rapid pulse. Synthesizing pulse and symptoms, it was reasoned: Flushed face like makeup, snoring, incontinence, coma, sweating, and deficient-large rapid pulse indicate impending Yin fluid collapse. The treatment should nourish Yin, restrain Yang, and consolidate collapse. Prescription: Testudinis Carapax et Plastrum (Guijia) 30g, Trionycis Carapax (Biejia) 15g, Ostreae Concha (Muli) 15g, Ossis Femoris (Longgu) 15g, Glycyrrhizae Radix et Rhizoma (Gancao) 10g, Paeoniae Radix Alba (Baishao) 15g, Schisandrae Fructus (Wuweizi) 12g, Ecolloa Corii Asini (Ejiao) 10g (melted separately), Rehmanniae Radix Preparata (Shengdi) 15g, Ophiopogonis Radix (Maidong) 10g.
One doctor asked: This is Wu Tang's Lower Jiao formula from *Wen Bing Tiao Bian*. *Wen Bing Tiao Bian* is Wu Tang's major work on warm diseases. Why is this formula used for stroke? Reply: The above formula is indeed from the Lower Jiao chapter of *Wen Bing Tiao Bian*, specifically a modification of Sanjia Fumai Tang. *Wen Bing Tiao Bian* states: "For Fengwen, Wenre, Wenyi, Wendu, Dongwen, if pathogen lingers in Yangming for a long time, or after purgation or not, with fever, flushed face, dry mouth and tongue, even black teeth and cracked lips... deficient-large pulse, heat in palms/soles greater than dorsum, Ji Jian Fu Mai Tang is used." "If warm disease treatment with exterior-releasing was mistaken, fluids robbed, heart palpitations, stiff tongue, coma, use Fu Mai method to restore fluids; if fluids return to tongue, life is saved. If spontaneous sweating and central lack of control, Jiuni Tang is used." "If warm disease sweating fails to produce sweat, purgation fails to reduce heat, beyond 6-7 days, pulse still restless/excessive, repeat Fu Mai Tang." "If heat pathogen enters deeply, whether in Shaoyin or Jueyin, Fu Mai is suitable." "If heat pathogen lingers long, consuming True Yin, or due to mistaken exterior treatment or reckless purgation, mental fatigue, convulsions, weak pulse, crimson tongue with little coating, frequent desire to collapse, Da Ding Feng Zhu is used." Although this case was not caused by mistaken exterior treatment of warm disease, the situation where pathogen is 80-90% gone, True Yin is only 10-20%, and Yin fluids frequently threaten to collapse is similar. Thus, a large group of heavy, turbid, Yin-filling, gap-sealing, shell-type (Jieshu) Yang-subduing and stabilizing herbs are used to let Yin rest in its position and Yang establish its foundation. As Ye Tianshi said: When Yang Qi does not interact with Yin, do not attribute it to Phlegm-Fire; discuss the meaning of subduing Yang.
After 2 doses, consciousness slightly cleared. After 30 more doses, consciousness fully cleared, hemiplegia and aphasia decreased.
Benign Intracranial Hypertension
1. Observe pulse and differentiate syndrome. Wiry-slippery-rapid pulse indicates Phlegm-Fire harassing upwards. Recovery occurs with soothing Liver, clearing fire, and resolving phlegm.
Patient Zhu XX, Female, 45 years old.
Headache and distending pain, nausea, vomiting, blindness in both eyes for 3 days. Diagnosed with benign intracranial hypertension. Lumbar puncture drainage and IV Mannitol provided slight improvement, but did not solve the fundamental problem. Careful examination of the syndrome revealed headache, nausea, vomiting, blindness, irritability, anger, bitter and dry mouth, insomnia, inability to sleep day or night, yellow-white tongue coating, and wiry-slippery-rapid pulse. Synthesizing pulse and symptoms, it was reasoned: Wiry-rapid pulse indicates Liver Fire rushing up. Slippery-rapid pulse indicates Phlegm-Heat accumulation. Combined with symptoms, this is Excess Fire of Liver and Gallbladder with internal stagnation of Phlegm-Heat. The treatment focused on soothing Liver, clearing fire, resolving phlegm, and calming Spirit. Prescription: Bupleuri Radix (Chaihu) 10g, Scutellariae Radix (Huangqin) 10g, Gentianae Radix (Longdancao) 10g, Bambusae Medulla (Zhuru) 10g, Aurantii Fructus Immaturus (Zhishi) 10g, Pinelliae Rhizoma Preparatum (Banxia) 10g, Talcum (Huashi) 10g, Lophatheri Herba (Zhuye) 10g, Polygoni Multiflori Caulis (Yejaoteng) 30g.
After 3 doses, headache reduced by 60-70%, nausea and vomiting disappeared, vision increased, able to see fingers clearly within 1 meter. After 10 more doses, all symptoms disappeared, and the patient recovered. Follow-up for 10 years showed normal health.