持续高热28天。医诊上呼吸道感染。先用西药十几天不效，继又配合中药清热解毒之剂，其效仍不显著。高热，体温39．9℃，咽喉干痛，神疲乏力，舌苔黄腻，大便于，小便赤，脉弦紧而数。综合脉证，思之：舌苔黄腻者，湿热蕴郁也。脉弦紧而数者，太少合病也。数者，热也。合之于症，乃为邪入膜原兼湿郁、表寒也。治宜达原饮加减为方。处方：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，菖蒲10克，柴胡10克，白芷10克，蝉蜕10克，大黄2克。
服药1剂，发热即退，精神、食欲好转，继服1剂，愈。
某医云：前用输液、大剂抗生素、中药清热解毒药近1个月，体温一直不降者何也?答曰：表寒闭郁者必予辛温解表才可寒解热退，正如《伤寒论》之用大青龙汤于不汗出而烦躁用大剂麻黄发汗也。今证为表寒闭郁而反用寒凉更郁其表，故解热而热反不退也。今用柴胡达原饮而一剂热退者，一者其方有辛温解表之味能发散风寒；二者有除湿调理三焦之药以鼓阳气外达；三者有通腑之味以佐解表药使闭塞得通。
2．表里俱病，但予清热，不予疏散，忽略通下，其病不愈
诸××，男，3岁。
高热不退5天。医诊上呼吸道感染。先以西药治之不效，继又配合中药清热解毒之剂仍不效。细察其证，身热如炭，体温39．9℃，神志时昧，咽干微痛，舌苔黄白，脉浮数。综合脉证，思之：脉浮数者，风热在表也；舌苔黄者，里有热也。合而议之，乃表里俱热，治宜双解可也。处方：蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，薄荷6克。服药1剂，热退，神清，继服1剂，愈。某医云：服药1剂，40分钟发热渐退，l小时退至正常，吾始怀疑中药能退热，今始信无疑。然前用中药何故其热不退，而今用小剂反退也?答曰：前用清热解毒但清卫分之热，今用升降散者，不但解表，而且清里，不但疏达，而且通腑，若邪在三焦者，此方最妙。正如《寒温条辨》所云：“温病亦杂气中之一也。表里三焦大热，其证不可名状者，此方主之。”
第五节眼科
眼外伤
审查病因，不失脉色，不拘活血，治之得愈
高××，男，22岁。
在劳动的时候，不慎钢丝刺人右眼，立刻出血不止，经眼科手术治疗后，虽然出血已经制止，但却至今不能复明，其后虽然多次手术去除瘀血，但至今视力不见一点改善，为此不得不改请中医以活血化瘀法治之，但至今已4个多月，不但不见改善，反而出现眼压增高、玻璃体轻度混浊，两眼俱痛，两眼俱赤。细审其证，除头痛眼痛，两目红赤外，并见舌苔薄白，脉右弦大，左弦缓。综合脉证，思之：脉右弦大者，气血俱虚也。外伤目赤者，瘀血也。合而论之，乃气血俱虚为本，气血瘀滞为标。治宜补气养血以培本，理气活血以治标。处方：黄芪30克，赤芍10克，当归10克，川芎10克，地龙10克，桃仁10克，红花10克，元参15克。
服药2剂，头痛眼痛目赤均减；继服6剂，头痛、眼痛、目赤均消失，且右眼在l米左右可见人影晃动；又服10剂，在5米左右可以清楚的看清人的五官。
某医云：前医应用赤芍、当归、桃仁、红花辈无效，今用赤芍、当归、桃仁、红花辈反效，其故何也?答曰：前人论述瘀血证时认为外伤后必有瘀血，故余治此病亦采用活血化瘀法进行治疗，但前医与余在如何活血化瘀上却有很大不同，前医在活血化瘀的同时又注重了清热止血，余在活血化瘀的同时又注意了补气养血与养阴泻火。所以都采用活血化瘀而疗效不同也。东垣论述杂病时力主右脉大于左脉者为气血虚，应予补益，就在于此也。
视乳头水肿
谨察其脉，从脉论证，疏肝理气，化痰泻火而愈
朱××，女，51岁。
两眼突然失明8天。医诊视乳头水肿。先请西医诊治，因一直未确定病因，故只采用一些对症治疗措施。细审其证，两眼视力完全丧失，但不红无翳障遍目，头痛失眠，烦躁易怒，口苦咽干，舌苔白，脉沉弦滑数。综合脉证，思之：脉沉者，气郁也。沉弦者，肝经郁火也。滑数者，痰火也。合而论之，乃痰火阻滞，肝胆郁火。治宜疏肝理气，化痰泻火。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹12克，半夏10克，枳实10克，滑石10克，竹叶10克，夜交藤30克。
服药4剂，视力基本恢复正常，烦躁失眠大减；继服4剂，诸证消失，愈。
某医云：何如此之效速也?答曰：近世多云中药效果慢，西药效果快，实则不然也。今所以速效者，药证相符也，病起急骤也，故不数剂而愈。
病毒性角膜炎
谨察脉色，合之与症，知其风热容于肝胆，予清肝泻肝散风而愈
钱××，女，60岁。
两眼疼痛，羞明，翳膜遍睛，视力下降1个多月。医诊急性疱疹性角膜炎。先以西药治疗20多天无明显效果，继又配合中药清热解毒之剂一周亦无明显改善。细审其证，两眼乌睛有一层薄薄的云翳遍盖，眼痛羞明，白睛微见红赤，舌苔薄白，脉浮弦。综合脉证，思之：目者，肝之窍也。弦脉者，肝脉也。浮者，风邪在表之脉也。合而论之，乃肝胆风热外客所致。治宜清肝泻火散风。处方：蝉蜕9．克，桑叶9克，连翘10克，薄荷3克，夏枯草9克。
服药4剂，诸证消失，愈。
某医云：前用清热解毒不效者何也?答曰：脉浮者，表证也，表证当予解表疏散，故以清肝泻火散风而得愈。前用清热解毒不效者，未予疏散风邪而反闭其郁热也。
青光眼
审其脉，知其证，予平肝泻火，疏散风邪而愈
郝××，女，17岁。
头痛眼痛，瞳孔散大，视力下降20多天。医诊青光眼。先以西药点眼、内服，眼珠疼痛稍减，但继续应用则无明显效果。细审其证，除头痛眼痛，瞳孔散大，视力下降，恶心欲吐外，并见舌苔薄白，脉浮弦。综合脉证，思之：脉浮者，表证也，风邪也。弦者，肝脉也，肝火也。合而论之，乃肝火内郁，风邪外客。治宜内泻肝火，外疏风邪。处方：草决明15克，菊花10克，防风6克，车前子10克(布包)，柴胡6克，薄荷6克，青葙子10克，蝉蜕9克。
服药4剂，头痛眼痛消失，视力增加，继服20剂，愈。某医云：本证余曾用龙胆泻肝汤治之，然其不效者何也?答曰：本证非但有肝火，亦且有风邪，故但予泻火不愈也。又问：青葙子者医家多云瞳孑L散大者禁用，然先生却用之而取效者何也?答曰：高等医药院校教材《中药学》云：“本品清热力强，且有扩散瞳孔的作用，肝肾虚及青光眼患者忌用。”对待这一句话，我的考虑是若肝肾虚的青光眼应忌用，若肝火夹风热者，因其清肝火血热，且有扩散瞳孔作用，若再配用疏风泻火之品非但无害，亦且有利，故用于肝火夹风热之急性青光眼常获卓效。
皮质盲
审其脉舌，知其乃精血亏损，予补肾填精始愈
郜××，女，5岁。
流行性脑炎后失明2年多。医诊皮质盲。先以西药治疗5个月无功，继配中药明目地黄丸、石斛夜光丸、黄连羊肝丸治疗半年仍无功。细审其证，除两眼已完全失明外，两眼外观无异常，精神、食欲正常，舌质嫩红无苔，脉虚数。综合脉舌，思之：目者，肝肾之所主也。舌质嫩红无苔者，阴精亏损也。脉虚数者，阴精亏损而有热也。合而论之：乃肝肾精血虚损不能上注于目所致。治宜补益肝肾，填精明目。处方：龟甲15克，鳖甲15克，何首乌10克，生地10克，白芍10克，覆盆子10克，五味子10克，牡蛎6克。
服药10剂，在近距离内可见人影晃动，继服40剂，视力恢复正常。
某医云：为何用明目地黄、石斛夜光等均无效，而改用龟甲、鳖甲之类取效耶?答曰：本病乃脑炎之后火灼阴精髓海受损所致，温病久踞下焦，消烁肝肾阴液者，非以龟、鳖、牡蛎入肝，镇潜之品不能复其肝肾阴液，故以龟、鳖、牡蛎镇潜之品，复佐滋补肝肾之品始愈也。
虹膜睫状体炎
细审脉证，知其阴虚肝郁，郁而化火，予滋补肝肾，解郁泻火，愈
朱××，男，50岁。
两眼困痛，视力下降半年余。医诊虹膜睫状体炎。先用西药治疗4个多月无效，继又配用明目地黄丸、杞菊地黄丸等治疗2个多月视力仍然不见增加。细审其证，两目微赤困痛，两眼在1尺内可以看见人影，头痛头胀，胸胁苦满，心烦易怒，舌苔薄白，脉弦。综合脉证，思之：胸胁苦满，头晕头痛者，郁证也。脉弦者，肝脉也。合而论之，乃肝郁血虚，郁而化火也。治宜养血疏肝泻火。处方：柴胡10克，当归10克，白芍10克，丹皮10克，栀子10克，生地15克，元参60克，薄荷2克，茺蔚子10克。
服药7剂，视力明显增加，在3米左右可以清楚的看清手指；继服20剂，视力恢复正常。
某医云：前用明目地黄、杞菊地黄不效，而改用上方何故取效?答曰：明目地黄、杞菊地黄从滋补肝肾来讲与上方是近似的，但在以下三点上却有根本区别：其一是本方疏肝之力胜于杞菊地黄、明目地黄。其二是本方泻火之力胜于杞菊地黄、明目地黄。其三是本方滋阴降火之力胜于杞菊地黄、明目地黄。这三个方面对于郁甚、火甚、阴虚甚者是至关重要的。所以以本方治之效，而用杞菊地黄、明目地黄不效。
持续高热28天。医生诊断为上呼吸道感染。先用西药治疗十几天无效，随后配合使用清热解毒的中药，效果仍不显著。症状表现为：高热，体温39.9℃，咽喉干燥疼痛，精神疲倦乏力，舌苔黄腻，大便干结，小便色赤，脉象弦紧而数。综合脉象和症状分析思考：舌苔黄腻，是湿热蕴结郁滞的表现。脉象弦紧而数，是太阳与少阳合病（太阳经与少阳经同时受邪）的表现。脉数，代表有热。结合症状来看，这是邪气侵入膜原（半表半里之隙）兼有湿邪郁滞、表寒束表所致。治疗适宜用达原饮（一种用于瘟疫或疟疾初起，邪伏膜原的方剂）加减作为处方。处方组成：厚朴10克，草果10克，槟榔10克，黄芩10克，知母10克，石菖蒲10克，柴胡10克，白芷10克，蝉蜕10克，大黄2克。
某医生说：之前使用输液、大剂量抗生素、清热解毒中药近1个月，体温一直不降，是什么原因呢？回答说：表寒闭郁（体表被寒邪闭塞郁滞）必须给予辛温解表（使用辛温性质的药物发散风寒以解除表证）的方法，才能寒解热退，正如《伤寒论》中使用大青龙汤治疗无汗且烦躁的症状，使用大剂量麻黄发汗一样。现在的证候是表寒闭郁，反而使用寒凉药物，更加郁遏了表气，所以虽然试图解热但热反而不退。现在使用柴胡达原饮，一剂热退的原因：一是该方中有辛温解表的药物，能够发散风寒；二是有除湿调理三焦的药物，以鼓动阳气向外通达；三是有通腑泄热的药物，辅助解表药使闭塞得以通畅。
患者诸某某，男，3岁。
高热不退5天。医生诊断为上呼吸道感染。先以西药治疗无效，随后配合使用清热解毒中药仍无效。仔细察看病证，身体热如炭火，体温39.9℃，神志时而昏昧，咽干微痛，舌苔黄白相间，脉象浮数。综合脉象和症状分析思考：脉浮数，是风热在表的表现；舌苔黄，是里有热的表现。综合讨论，乃是表里俱热，治疗适宜双解（表里同治）。处方：蝉蜕10克，僵蚕10克，片姜黄10克，大黄3克，薄荷6克。服用1剂，热退，神志清醒，继续服用1剂，痊愈。
某医生说：服药1剂，40分钟发热渐退，1小时退至正常，我开始怀疑中药能退热，现在才相信无疑。然而之前使用中药为何热不退，而现在用小剂量反而退了呢？回答说：之前使用清热解毒药，仅清除了卫分（卫气所主的浅表层次）的热，现在使用升降散（具有升清降浊、辟秽化浊功效的方剂），不仅解表，而且清里，不仅疏达气机，而且通腑泄热，如果邪气在三焦，此方最为巧妙。正如《寒温条辨》所说：“温病也是杂气中的一种。表里三焦大热，症状不可名状的，此方主治。”
第五节 眼科
眼外伤
审查病因，不失脉色，不拘泥于活血，治疗得当而愈
患者高某某，男，22岁。
在劳动时，不慎钢丝刺入右眼，立刻出血不止，经眼科手术治疗后，虽然出血已经制止，但却至今不能复明，其后虽然多次手术去除瘀血，但至今视力不见一点改善，为此不得不改请中医以活血化瘀法治疗，但至今已4个多月，不但不见改善，反而出现眼压增高、玻璃体轻度混浊，两眼俱痛，两眼俱赤。仔细审察病证，除头痛眼痛，两目红赤外，并见舌苔薄白，脉象右弦大，左弦缓。综合脉象和症状分析思考：脉右弦大，是气血俱虚的表现。外伤导致目赤，是瘀血的表现。综合论述，乃是气血俱虚为本，气血瘀滞为标。治疗适宜补气养血以培补根本，理气活血以治疗标症。处方：黄芪30克，赤芍10克，当归10克，川芎10克，地龙10克，桃仁10克，红花10克，玄参15克。
服用2剂，头痛眼痛目赤均减轻；继续服用6剂，头痛、眼痛、目赤均消失，且右眼在1米左右可见人影晃动；又服10剂，在5米左右可以清楚地看清人的五官。
某医生说：前医应用赤芍、当归、桃仁、红花等药无效，现在用赤芍、当归、桃仁、红花等药反而有效，原因何在？回答说：前人论述瘀血证时认为外伤后必有瘀血，所以我治疗此病也采用活血化瘀法进行治疗，但前医与我如何在活血化瘀上却有很大不同，前医在活血化瘀的同时又注重了清热止血，我在活血化瘀的同时又注意了补气养血与养阴泻火。所以都采用活血化瘀而疗效不同。李东垣论述杂病时力主右脉大于左脉者为气血虚，应予补益，就在于此。
患者朱某某，女，51岁。
两眼突然失明8天。医生诊断为视乳头水肿。先请西医诊治，因一直未确定病因，故只采用一些对症治疗措施。仔细审察病证，两眼视力完全丧失，但不红无翳障遍目，头痛失眠，烦躁易怒，口苦咽干，舌苔白，脉沉弦滑数。综合脉象和症状分析思考：脉沉，是气郁的表现。沉弦，是肝经郁火的表现。滑数，是痰火的表现。综合论述，乃是痰火阻滞，肝胆郁火。治疗适宜疏肝理气，化痰泻火。处方：柴胡10克，黄芩10克，龙胆草10克，竹茹12克，半夏10克，枳实10克，滑石10克，竹叶10克，夜交藤30克。
服用4剂，视力基本恢复正常，烦躁失眠大减；继续服用4剂，诸证消失，痊愈。
某医生说：为何如此速效？回答说：近世多言中药效果慢，西药效果快，实则不然。现在之所以速效，是因为药证相符，病起急骤，所以不需多剂而愈。
患者钱某某，女，60岁。
两眼疼痛，羞明（畏光），翳膜遍睛，视力下降1个多月。医生诊断为急性疱疹性角膜炎。先以西药治疗20多天无明显效果，继又配合中药清热解毒之剂一周亦无明显改善。仔细审察病证，两眼黑睛有一层薄薄的云翳遍盖，眼痛羞明，白睛微见红赤，舌苔薄白，脉浮弦。综合脉象和症状分析思考：目者，肝之窍也。弦脉者，肝脉也。浮者，风邪在表之脉也。综合论述，乃是肝胆风热外客所致。治疗适宜清肝泻火散风。处方：蝉蜕9克，桑叶9克，连翘10克，薄荷3克，夏枯草9克。
服用4剂，诸证消失，痊愈。
某医生说：前用清热解毒不效的原因是什么？回答说：脉浮者，表证也，表证当予解表疏散，故以清肝泻火散风而得愈。前用清热解毒不效，是因为未予疏散风邪而反闭其郁热也。
患者郝某某，女，17岁。
头痛眼痛，瞳孔散大，视力下降20多天。医生诊断为青光眼。先以西药点眼、内服，眼珠疼痛稍减，但继续应用则无明显效果。仔细审察病证，除头痛眼痛，瞳孔散大，视力下降，恶心欲吐外，并见舌苔薄白，脉浮弦。综合脉象和症状分析思考：脉浮者，表证也，风邪也。弦者，肝脉也，肝火也。综合论述，乃是肝火内郁，风邪外客。治疗适宜内泻肝火，外疏风邪。处方：草决明15克，菊花10克，防风6克，车前子10克（布包），柴胡6克，薄荷6克，青葙子10克，蝉蜕9克。
服用4剂，头痛眼痛消失，视力增加，继续服用20剂，痊愈。
某医生说：本证我曾用过龙胆泻肝汤治疗，然而其不效的原因是什么？回答说：本证不仅有肝火，亦有风邪，所以只予泻火不愈。又问：青葙子，医家多言瞳孔散大者禁用，然而先生却用之而取效的原因是什么？回答说：高等医药院校教材《中药学》云：“本品清热力强，且有扩散瞳孔的作用，肝肾虚及青光眼患者忌用。”对待这一句话，我的考虑是若肝肾虚的青光眼应忌用，若肝火夹风热者，因其清肝火血热，且有扩散瞳孔作用，若再配用疏风泻火之品非但无害，亦且有利，故用于肝火夹风热之急性青光眼常获卓效。
患者郜某某，女，5岁。
流行性脑炎后失明2年多。医生诊断为皮质盲。先以西药治疗5个月无功，继配中药明目地黄丸、石斛夜光丸、黄连羊肝丸治疗半年仍无功。仔细审察病证，除两眼已完全失明外，两眼外观无异常，精神、食欲正常，舌质嫩红无苔，脉虚数。综合脉舌分析思考：目者，肝肾之所主也。舌质嫩红无苔者，阴精亏损也。脉虚数者，阴精亏损而有热也。综合论述：乃是肝肾精血虚损不能上注于目所致。治疗适宜补益肝肾，填精明目。处方：龟甲15克，鳖甲15克，何首乌10克，生地10克，白芍10克，覆盆子10克，五味子10克，牡蛎6克。
服用10剂，在近距离内可见人影晃动，继续服用40剂，视力恢复正常。
某医生说：为何用明目地黄、石斛夜光等均无效，而改用龟甲、鳖甲之类取效呢？回答说：本病乃脑炎之后火灼阴精髓海受损所致，温病久踞下焦，消烁肝肾阴液者，非以龟、鳖、牡蛎入肝，镇潜之品不能复其肝肾阴液，故以龟、鳖、牡蛎镇潜之品，复佐滋补肝肾之品始愈也。
患者朱某某，男，50岁。
两眼困痛，视力下降半年余。医生诊断为虹膜睫状体炎。先用西药治疗4个多月无效，继又配用明目地黄丸、杞菊地黄丸等治疗2个多月视力仍然不见增加。仔细审察病证，两目微赤困痛，两眼在1尺内可以看见人影，头痛头胀，胸胁苦满，心烦易怒，舌苔薄白，脉弦。综合脉象和症状分析思考：胸胁苦满，头晕头痛者，郁证也。脉弦者，肝脉也。综合论述，乃是肝郁血虚，郁而化火也。治疗适宜养血疏肝泻火。处方：柴胡10克，当归10克，白芍10克，丹皮10克，栀子10克，生地15克，元参60克，薄荷2克，茺蔚子10克。
服用7剂，视力明显增加，在3米左右可以清楚地看清手指；继续服用20剂，视力恢复正常。
某医生说：前用明目地黄、杞菊地黄不效，而改用上方何故取效？回答说：明目地黄、杞菊地黄从滋补肝肾来讲与上方是近似的，但在以下三点上却有根本区别：其一是本方疏肝之力胜于杞菊地黄、明目地黄。其二是本方泻火之力胜于杞菊地黄、明目地黄。其三是本方滋阴降火之力胜于杞菊地黄、明目地黄。这三个方面对于郁甚、火甚、阴虚甚者是至关重要的。所以以本方治之效，而用杞菊地黄、明目地黄不效。
Sustained high fever for 28 days. The physician diagnosed an upper respiratory tract infection. Western medicine was used first for over ten days without effect, followed by the combination of Chinese herbal medicine with heat-clearing and detoxifying properties, yet the efficacy remained insignificant. Symptoms included: high fever with a body temperature of 39.9°C, dry and painful throat, mental fatigue and weakness, yellow and greasy tongue coating, dry stool, red urine, and a wiry, tight, and rapid pulse. Synthesizing the pulse and symptoms, I reasoned: A yellow and greasy tongue coating indicates damp-heat accumulation and stagnation (Shi Re Yun Yu). A wiry, tight, and rapid pulse indicates concurrent Taiyang and Shaoyang disease (Tai Shao He Bing), meaning simultaneous pathogen invasion of the Taiyang and Shaoyang meridians. A rapid pulse signifies heat. Combined with the symptoms, this represents pathogenic factors invading the Mo Yuan (Membrane Source, a space between the exterior and interior) accompanied by dampness stagnation and exterior cold constraint. The treatment should employ Da Yuan Yin (Origin-Reaching Decoction, a formula for pathogens lodged in the membrane source) with modifications. Prescription: Houpo (Magnolia Bark) 10g, Caoguo (Tsaoko Fruit) 10g, Binglang (Areca Seed) 10g, Huangqin (Scutellaria Root) 10g, Zhimu (Anemarrhena Rhizome) 10g, Changpu (Acorus Rhizome) 10g, Chaihu (Bupleurum Root) 10g, Baizhi (Angelica Dahurica Root) 10g, Chantui (Cicada Slough) 10g, Dahuang (Rhubarb Root) 2g.
After taking one dose, the fever subsided immediately, and spirit and appetite improved. After continuing with one more dose, the patient recovered.
Another physician asked: Why did the body temperature remain unlowered despite using intravenous fluids, large doses of antibiotics, and heat-clearing/detoxifying Chinese herbs for nearly a month? I replied: Exterior cold constraint must be treated with acrid-warm exterior-releasing methods to resolve the cold and subside the fever. This is akin to the use of Da Qing Long Tang (Major Green Dragon Decoction) in the Shanghan Lun (Treatise on Cold Damage) for cases of no sweating with irritability, where large doses of Mahuang (Ephedra) are used to induce sweating. In this case, the syndrome is exterior cold constraint; conversely, using cold-natured medicines further constrained the exterior Qi. Thus, although efforts were made to reduce fever, the heat persisted. The reason Da Chai Hu Da Yuan Yin (Bupleurum Origin-Reaching Decoction) reduced the fever in one dose is threefold: First, it contains acrid-warm exterior-releasing ingredients that can disperse wind-cold; second, it includes dampness-resolving and San Jiao-regulating herbs to stimulate Yang Qi to reach the exterior; third, it has bowel-unblocking ingredients that assist the exterior-releasing herbs to clear blockage.
2. Exterior and Interior Both Diseased: Only Clearing Heat Without Dispersing, Neglecting Purging Leads to Non-Cure
Patient Zhu XX, Male, 3 years old.
High fever persisting for 5 days. Diagnosed as upper respiratory tract infection. Initial Western medicine treatment failed, and subsequent combination with heat-clearing/detoxifying Chinese herbs also failed. Careful examination revealed: body heat like charcoal, temperature 39.9°C, intermittent clouding of consciousness, dry and slightly painful throat, yellow and white tongue coating, and floating, rapid pulse. Synthesizing pulse and symptoms: Floating and rapid pulse indicates Wind-Heat at the Exterior; yellow tongue coating indicates Heat in the Interior. Comprehensive analysis suggests Heat in both Exterior and Interior. Treatment requires simultaneous resolution of Exterior and Interior. Prescription: Chantui (Cicada Slough) 10g, Jiangcan (Bombyx Batryticatus) 10g, Pian Jianghuang (Curcuma Phaeocaulis Rhizome) 10g, Dahuang (Rhubarb Root) 3g, Bohe (Mint) 6g. After one dose, fever subsided, consciousness cleared. After another dose, recovery was achieved.
Another physician remarked: After one dose, fever gradually subsided in 40 minutes and returned to normal in one hour. I initially doubted Chinese herbs' ability to reduce fever but now believe without doubt. However, why did previous Chinese herb treatments fail to reduce fever, while this small-dose prescription succeeded? I replied: Previous heat-clearing/detoxifying herbs only cleared Wei-Fen (Defensive Level) heat. The current prescription, Sheng Jiang San (Ascending and Descending Powder), not only releases the exterior but also clears the interior, not only disperses Qi but also purges the bowels. For pathogens in the San Jiao (Triple Burner), this formula is most effective. As stated in Han Wen Tiao Bian (Differentiation of Warm and Febrile Diseases): "Warm diseases are also among miscellaneous pathogens. For severe heat in the exterior, interior, and San Jiao with indescribable symptoms, this formula governs."
Section 5: Ophthalmology
Ocular Trauma
Reviewing Etiology, Not Losing Pulse and Color Diagnosis, Not Restricted to Blood-Activating Methods, Cure Achieved Through Proper Treatment
Patient Gao XX, Male, 22 years old.
During labor, a steel wire accidentally pierced the right eye, causing immediate continuous bleeding. After ophthalmic surgical treatment, bleeding stopped, but vision did not recover. Subsequent multiple surgeries to remove blood stasis yielded no improvement in vision. Consequently, Traditional Chinese Medicine (TCM) treatment using blood-activating and stasis-resolving methods was sought. After over four months, there was no improvement; instead, intraocular pressure increased, mild vitreous opacity appeared, and both eyes became painful and red. Careful examination revealed, besides headache, eye pain, and red eyes, a thin white tongue coating, wiry and large pulse on the right, and wiry and slow pulse on the left. Synthesizing pulse and symptoms: Wiry and large right pulse indicates deficiency of both Qi and Blood. Red eyes due to trauma indicate blood stasis. Comprehensive analysis: Deficiency of Qi and Blood is the root (Ben); Qi and Blood stagnation is the branch (Biao). Treatment should tonify Qi and nourish Blood to support the root, and regulate Qi and activate Blood to treat the branch. Prescription: Huangqi (Astragalus Root) 30g, Chishao (Red Peony Root) 10g, Danggui (Angelica Sinensis Root) 10g, Chuanxiong (Ligusticum Rhizome) 10g, Dilong (Pheretima) 10g, Taoren (Peach Kernel) 10g, Honghua (Carthamus Flower) 10g, Xuanshen (Scrophularia Root) 15g.
After two doses, headache, eye pain, and redness decreased. After six more doses, all symptoms disappeared, and the right eye could perceive human shadows at about 1 meter. After another ten doses, facial features could be clearly seen at about 5 meters.
Another physician asked: Why did previous prescriptions containing Chishao, Danggui, Taoren, and Honghua fail, while the current ones succeeded? I replied: Previous theories on blood stasis assert that trauma inevitably causes stasis, so I also employed blood-activating methods. However, my approach differed significantly from previous physicians. While they focused on clearing heat and stopping bleeding alongside activating blood, I emphasized tonifying Qi and nourishing Blood, as well as nourishing Yin and draining fire alongside activating blood. Thus, although both used blood-activating methods, outcomes differed. Li Dongyuan argued in his discussions on miscellaneous diseases that a right pulse larger than the left indicates Qi and Blood deficiency, warranting tonification. This principle applies here.
Papilledema
Carefully Observing Pulse, Arguing from Pulse, Soothing Liver and Regulating Qi, Resolving Phlegm and Draining Fire Leads to Cure
Patient Zhu XX, Female, 51 years old.
Sudden blindness in both eyes for 8 days. Diagnosed as papilledema. Western medical consultation yielded no confirmed etiology, so only symptomatic treatments were administered. Careful examination revealed complete loss of vision in both eyes, without redness or corneal opacity, accompanied by headache, insomnia, irritability, bitter taste in mouth, dry throat, white tongue coating, and deep, wiry, slippery, and rapid pulse. Synthesizing pulse and symptoms: Deep pulse indicates Qi stagnation. Deep and wiry pulse indicates Liver Meridian stagnant fire. Slippery and rapid pulse indicates Phlegm-Fire. Comprehensive analysis: Obstruction by Phlegm-Fire and stagnant fire in Liver and Gallbladder. Treatment should soothe the Liver, regulate Qi, resolve phlegm, and drain fire. Prescription: Chaihu (Bupleurum Root) 10g, Huangqin (Scutellaria Root) 10g, Longdancao (Gentiana Root) 10g, Zhuru (Bamboo Shavings) 12g, Banxia (Pinellia Tuber) 10g, Zhishi (Immature Bitter Orange) 10g, Huashi (Talcum) 10g, Zhuye (Bamboo Leaf) 10g, Yejiaoteng (Polygonum Multiflorum Stem) 30g.
After four doses, vision basically normalized, and irritability/insomnia greatly reduced. After four more doses, all symptoms disappeared, achieving cure.
Another physician asked: Why such rapid efficacy? I replied: It is often said modernly that Chinese herbs act slowly while Western drugs act quickly, which is incorrect. The rapid efficacy here is due to precise matching of medicine to syndrome and the acute onset of the disease, hence cure without many doses.
Viral Keratitis
Carefully Observing Pulse and Color, Combining with Symptoms, Identifying Wind-Heat Invading Liver and Gallbladder, Treating with Clearing Liver, Draining Liver, and Dispersing Wind Leads to Cure
Patient Qian XX, Female, 60 years old.
Eye pain, photophobia, corneal opacity covering the eyes, and decreased vision for over one month. Diagnosed as acute herpes simplex keratitis. Western medicine treatment for over 20 days showed no obvious effect. Combination with heat-clearing/detoxifying Chinese herbs for one week also showed no obvious improvement. Careful examination revealed a thin layer of cloudy film covering the black part of both eyes, eye pain, photophobia, slight redness of the white part, thin white tongue coating, and floating, wiry pulse. Synthesizing pulse and symptoms: The eyes are the orifices of the Liver. Wiry pulse corresponds to the Liver. Floating pulse indicates Wind pathogen at the Exterior. Comprehensive analysis: Caused by external invasion of Wind-Heat in Liver and Gallbladder. Treatment should clear Liver, drain fire, and disperse wind. Prescription: Chantui (Cicada Slough) 9g, Sangye (Mulberry Leaf) 9g, Lianqiao (Forsythia Fruit) 10g, Bohe (Mint) 3g, Xiakucao (Prunella Spike) 9g.
After four doses, all symptoms disappeared, achieving cure.
Another physician asked: Why did previous heat-clearing/detoxifying treatments fail? I replied: Floating pulse indicates an Exterior syndrome, which requires exterior-releasing and dispersing methods. Hence, clearing Liver, draining fire, and dispersing wind led to cure. Previous failures occurred because wind-pathogens were not dispersed, thereby trapping the stagnant heat.
Glaucoma
Examining Pulse, Understanding Syndrome, Applying Calming Liver, Draining Fire, and Dispersing Wind Leads to Cure
Patient Hao XX, Female, 17 years old.
Headache, eye pain, dilated pupils, and decreased vision for over 20 days. Diagnosed as glaucoma. Western eye drops and oral medication slightly reduced eyeball pain, but continued use showed no obvious effect. Careful examination revealed, besides headache, eye pain, dilated pupils, decreased vision, nausea, and urge to vomit, a thin white tongue coating and floating, wiry pulse. Synthesizing pulse and symptoms: Floating pulse indicates Exterior syndrome and Wind pathogen. Wiry pulse indicates Liver Meridian and Liver Fire. Comprehensive analysis: Internal stagnation of Liver Fire and external invasion of Wind pathogen. Treatment should internally drain Liver Fire and externally disperse Wind pathogen. Prescription: Caojueming (Cassia Seed) 15g, Juhua (Chrysanthemum Flower) 10g, Fangfeng (Saposhnikovia Root) 6g, Cheqianzi (Plantago Seed) 10g (wrapped in cloth), Chaihu (Bupleurum Root) 6g, Bohe (Mint) 6g, Qingxiangzi (Celosia Seed) 10g, Chantui (Cicada Slough) 9g.
After four doses, headache and eye pain disappeared, vision improved. After twenty more doses, recovery was achieved.
Another physician asked: I previously used Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) for this case, but it failed. Why? I replied: This case involves not only Liver Fire but also Wind pathogen; thus, merely draining fire was insufficient. Another question: Many physicians state Qingxiangzi (Celosia Seed) is contraindicated for dilated pupils. Why did you use it successfully? I replied: The textbook *Chinese Materia Medica* states: "This herb has strong heat-clearing power and dilates pupils; it is contraindicated in patients with Liver-Kidney deficiency and glaucoma." My consideration is that if glaucoma is due to Liver-Kidney deficiency, it should be avoided. However, if it is Liver Fire combined with Wind-Heat, its ability to clear Liver Fire and Blood Heat, along with pupil dilation, becomes beneficial when combined with wind-dispersing and fire-draining herbs. Thus, it often yields excellent results in acute glaucoma with Liver Fire and Wind-Heat.
Cortical Blindness
Examining Pulse and Tongue, Identifying Essence and Blood Deficiency, Tonifying Kidney and Filling Essence Leads to Cure
Patient Gao XX, Female, 5 years old.
Blindness for over 2 years following epidemic encephalitis. Diagnosed as cortical blindness. Western medicine treatment for 5 months was ineffective. Combination with Mingmu Dihuang Wan (Brighten the Eyes Rehmannia Pill), Shihu Yeguang Wan (Dendrobium Night-Light Pill), and Huanglian Yanggan Wan (Coptis Sheep Liver Pill) for half a year also yielded no result. Careful examination revealed complete blindness in both eyes, no abnormalities in appearance, normal spirit and appetite, tender red tongue without coating, and deficient, rapid pulse. Synthesizing pulse and tongue: The eyes are governed by Liver and Kidney. Tender red tongue without coating indicates Yin-Essence deficiency. Deficient, rapid pulse indicates Yin-Essence deficiency with Heat. Comprehensive analysis: Deficiency and damage of Liver-Kidney Essence and Blood failing to ascend to nourish the eyes. Treatment should tonify Liver and Kidney, fill essence, and brighten eyes. Prescription: Guijia (Turtle Shell) 15g, Biejia (Softshell Turtle Shell) 15g, Heshouwu (Polygonum Multiflorum Root) 10g, Shengdi (Rehmannia Root) 10g, Baishao (White Peony Root) 10g, Fupenzi (Raspberry) 10g, Wuweizi (Schisandra Berry) 10g, Muli (Oyster Shell) 6g.
After ten doses, human shadows could be perceived at close range. After forty more doses, vision normalized.
Another physician asked: Why were Mingmu Dihuang Wan and Shihu Yeguang Wan ineffective, while Guijia and Biejia succeeded? I replied: This disease resulted from fire scorching Yin Essence after encephalitis, damaging the Marrow Sea. When warm pathogens linger in the Lower Jiao for a long time, consuming Liver-Kidney Yin fluids, only heavy, anchoring substances entering the Liver, such as Gui (Turtle), Bie (Softshell Turtle), and Muli (Oyster), can restore Liver-Kidney Yin. Thus, using these anchoring herbs combined with Liver-Kidney tonics led to cure.
Iridocyclitis
Carefully Examining Pulse and Symptoms, Identifying Yin Deficiency with Liver Stagnation Transforming into Fire, Tonifying Liver and Kidney, Resolving Stagnation, and Draining Fire Leads to Cure
Patient Zhu XX, Male, 50 years old.
Heavy pain in both eyes and decreased vision for over half a year. Diagnosed as iridocyclitis. Western medicine treatment for over four months was ineffective. Combination with Mingmu Dihuang Wan and Qiju Dihuang Wan (Eucommia and Chrysanthemum Rehmannia Pill) for over two months still showed no vision increase. Careful examination revealed slightly red and heavy-pain eyes, perception of human shadows within 1 chi, headache and head distension, fullness and discomfort in chest and hypochondrium, irritability, thin white tongue coating, and wiry pulse. Synthesizing pulse and symptoms: Fullness in chest/hypochondrium, dizziness, and headache indicate Stagnation Syndrome. Wiry pulse corresponds to the Liver. Comprehensive analysis: Liver Stagnation with Blood Deficiency, stagnation transforming into Fire. Treatment should nourish Blood, soothe Liver, and drain fire. Prescription: Chaihu (Bupleurum Root) 10g, Danggui (Angelica Sinensis Root) 10g, Baishao (White Peony Root) 10g, Danpi (Moutan Cortex) 10g, Zhizi (Gardenia Fruit) 10g, Shengdi (Rehmannia Root) 15g, Xuanshen (Scrophularia Root) 60g, Bohe (Mint) 2g, Chongweizi (Vitex Seed) 10g.
After seven doses, vision significantly improved, allowing clear sight of fingers at about 3 meters. After twenty more doses, vision normalized.
Another physician asked: Why did Mingmu Dihuang Wan and Qiju Dihuang Wan fail, while the above prescription succeeded? I replied: From the perspective of tonifying Liver and Kidney, these formulas are similar. However, there are three fundamental differences: First, this formula's Liver-soothing power exceeds that of Qiju Dihuang Wan and Mingmu Dihuang Wan. Second, its fire-draining power is superior. Third, its Yin-nourishing and fire-lowering power is stronger. These three aspects are crucial for severe stagnation, severe fire, and severe Yin deficiency. Therefore, this formula succeeded where the others failed.