咽喉肿痛，持续高热7天。医诊急性扁桃体炎。先以抗生素治疗3天其热不减，继又以中药清热解毒配合治疗4天，其热仍不见减。审其两侧扁桃体明显肿大，上罩白色脓点，舌苔薄白，体温39．8℃，脉浮数。综合脉证，思之：脉浮者，病在上也，在表也，在肺也。且咽喉者，肺胃所主，大肠与肺相表里，上以清热解毒不效者，肺胃大肠壅热不散也，非泻其腑，解其壅，佐以疏散不解。处方：蝉蜕10克，僵蚕10克，片姜黄10克，连翘10克，大黄4克。
服药3小时后，发热全退，咽喉疼痛大减继服1剂，愈。
某医云：大黄乃苦寒之泻下药，何用其治急性扁桃体炎而神效也?答曰：大黄本是苦寒泻下之品，而用于急性扁桃体炎者，因其能泻大肠与胃热也，今所以但用清热解毒而不解，乃因其肺胃大肠俱热热邪壅郁也，而大黄配姜黄、蝉蜕、僵蚕，既可散邪，又可除壅，通下，故其热得解也。
2．但知解毒利咽，不知疏散表邪，热邪闭郁，其病不解
焦××，女，28岁。
咽喉肿痛，发热头痛8天。医诊急性扁桃体炎。先用抗生素等治疗4天不效，继又配合中药清热解毒之剂治疗4天仍无’功。细审其证，除两侧扁桃体肿大，上罩白色脓点外，并见头晕头痛，寒热阵阵，舌苔白，质红，脉浮滑数。综合脉证，思之：脉浮者，表证也，舌质红者，热毒及于阴分也。治宜疏风清热，解毒养阴。处方：蝉蜕10克，僵蚕10克，薄荷10克，银花10克，连翘10克，元参15克。
服药1剂，微有汗出，头晕头痛，寒热等证俱解，咽喉肿痛亦消大半，继服3剂，愈。
某医云：余前用银花、连翘达30克，且配有板蓝根、山豆根、射干、马勃、黄连、黄芩均在15克以上，并每天注射青霉素，然治之数日不效，今先生仅用银花、连翘各10克却1剂减，4剂愈，其故何也?答曰：表邪未散者一也，阴液未补者二也。
慢性扁桃体炎
但知消炎，频予解毒，痰滞不化，凝核不散，久延时日
于××，男，20岁。
两侧扁桃体肿大，几近闭合10余年。医诊慢性扁桃体炎。在急性扁桃体炎发作之始，每次用青霉素都有很好效果，但始终没有消掉扁桃体之肿大现象。1年后，不得不配用中药清热解毒、养阴润喉进行治疗，有时有效，有时无明显改善，迟至今日扁桃体仍然明显肿大。细审其证，除两侧扁桃体明显肿大，几近闭合外，并见其舌苔薄白，两脉濡缓。综合脉证，思之：久病而脉濡缓者，气阴两虚，痰气郁结也。治宜补气养阴以扶正，化痰理气散结以除邪。处方：黄芪15克，当归10克，麦冬10克，党参10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6克，菖蒲10克，远志10克，生地10克。同时，毫针浅刺翳风后，留针3天。
服药1周后，扁桃体明显缩小；继服25剂，肿大之扁桃体完全恢复正常。
某医云：何用清热解毒之剂不但不效，反见加剧?答曰：此证之发生非仅有热毒，亦且有痰火，痰火者，不但治疗时应注意泻火，亦且应注意其用药过程中的化痰药耳，故前人的很多治疗方剂中常常配用化痰利咽的桔梗、蝉蜕、僵蚕、牛蒡子、元参等。但是由于有的医者仅注意泻火，而不注意化痰，致使痰凝成核而成慢性扁桃体炎，此即所以用清热解毒而不效之故也。
慢性咽炎
1．胶于成方，泥于解毒，时或理气，脉证不合，岂能奏效
宋××，女，40岁。
咽干、咽痛，咽部异物阻塞感10年。医诊慢性咽炎。先用喉片、抗生素治疗数年不效，继又配合中药草珊瑚、健民咽喉片、六神丸，以及中药清热解毒、理气化痰之剂6～7年亦无效。综合脉证，审之，除咽部干痛，咽部异物阻塞感外，并见脉滑数，尤以寸脉为甚。思之：寸脉者，上焦也；滑数者，痰火也。痰火蕴于上焦者，治宜清热化痰。处方：瓜蒌15克，胆南星10克，半夏10克，陈皮10克，杏仁10克，川贝母10克，黄芩10克，枳实10克，干姜1克。
服药3剂，咽部异物感消退；继服7剂，愈。
某医云：此清气化痰丸加减方也。原方原用于痰热内结之咳嗽痰黄，粘稠难咯，胸膈痞满，今何用于慢性咽炎而神效也?答曰：仲景在谈到中医的治病原则时指出：“观其脉证，知犯何逆，随证治之。”今脉既为滑数而尤显于寸，知其乃上焦痰热所致，故治以清热化痰而愈。
2．胶于四七，泥于理气，不思审脉，久延病期
商××，女，50岁。
咽干、咽痛，时时有痰阻咽部感8年多。医诊慢性咽炎。医始以西药治之不效，继又以中药喉片、草珊瑚、六神丸，以及四七汤加减配合治疗数年仍不效。细审其证，除咽部发干，有异物阻塞感外，并见头晕头痛，失眠健忘，疲乏无力，心烦意乱，胸满气短，舌苔白，脉濡缓。综合脉证，思之：病久而脉濡缓者，气阴两虚，痰郁气结也。治宜补气养阴，理气化痰。处方：黄芪15克，当归6克，麦冬10克，党参10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6克，菖蒲10克，远志10克，生地10克。
服药4剂，咽喉异物感消失，头晕头痛，失眠健忘，疲乏无力好转；继服20剂，诸证消失，愈。
某医云：此加减十味温胆汤也，近人中国中医研究院已故名老中医蒲辅周、岳美中先生，多用其治神经官能症，今先生独用其治慢性咽炎者何也?答曰：此证脉见濡缓，且又属久病，知其乃气阴两虚，痰气郁结所为，故治以补气养阴，化痰清热而愈。
3．泥于理气化痰，忽略察脉知证，虚者祛邪，热者予温，其病不愈
王××，女，45岁。
咽干咽痛时轻时重，时有异物阻塞感7年多。医诊慢性咽炎。始予西药治之不效，继又予中药喉片、草珊瑚，四七汤加减等配合治疗数年亦不效。细察其证，除咽干咽痛，咽部异物阻塞感外，并见疲乏无力，心烦心悸，舌苔黄白，脉弦大而数。综合脉证，思之：病久脉弦大而数者，痰湿内郁，气阴两虚，清升浊降失职也。治宜补气养阴，燥湿清热，升清降浊。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。
服药7剂，不但诸证均减，且咽干咽痛，咽喉阻塞感大部消退；继服10剂，愈。
某医云：既为痰湿，为何理气化痰不愈?答曰：脉弦大而数者，证为气阴两虚为主，湿热阻滞为辅，故治应宗补气养阴、燥湿清热，升清降浊之清暑益气汤而愈也。
慢性唇炎
1.但泥验方，不审脉证，不审寒热，不审比例，以寒作热，以热作寒，终归不效
弓××，女，49岁。
两唇痒痛，肿胀流水，紫黯麻木2年多。医诊慢性唇炎。先以西药治疗1年不效，继又以中药牛黄解毒丸、黄连上清丸、牛黄上清丸，以及清胃散、玉女煎、泻黄散、甘露饮加减治疗1年亦未奏效。细审其证，两唇紫黯肿胀，不断有黄水流出，外罩黄色脓痂，痒痛麻木，胃脘痞满，脐上悸动，舌苔白，脉弦紧，左脉大于右脉。综合脉证，思之：脉弦者，肝胆三焦之脉也；弦紧相兼者，寒也。唇肿湿烂者，湿热也。脐上悸动，胃脘痞满者，寒饮也。证脉合参，乃肝郁气结，寒饮内郁，上热下寒也。治宜清上温下，解郁散结，温阳化饮。处方：柴胡10克，半夏10克，黄芩10克，党参10克，干姜3克，甘草6克，大枣5个，桂枝10克，熟军3克，茯苓15克，龙骨15克，牡蛎15克。
服药4剂，口唇肿胀、痒痛、紫黯、麻木均大减；继服10剂，愈。
某医云：柴胡加龙骨牡蛎汤乃《伤寒论》治“胸满烦惊，小便不利，谵语，一身尽重，不可转侧者”方也，何甩其于治唇炎也?答曰：柴胡加龙骨牡蛎汤确为伤寒下后烦惊谵语之方。但因本方桂枝配柴胡可使内陷之邪得从外解，加龙骨、牡蛎可以镇静而潜浮阳，大黄和胃气泻邪热，桂枝配茯苓、生姜、大枣可以化寒饮，故可用之能使错杂之邪得从内外而解，唇病得愈。
2．观证察脉，知其所主，治以除湿清热，散风活血，愈
卜××，女，36岁。
上下口唇红肿，脱皮皲裂，流黄水13年。医诊慢性剥脱性唇炎。先用西药间断性治疗8年无效，继又配合中药清热解毒，清胃泻火，活血化瘀，以单方蜈蚣、全蝎、土元，中成药梅花点舌丹、锡类散等治4年多亦无明显效果。最近1年多以来，不但肿胀、脱皮、发痒、流汁水，而且经常发现皮肤皲裂，从裂口处流出血水。细察其证，上下口唇均肿胀，有的部位由黄水堆积而成一层厚厚的黄痂，有的皮肤脱落呈鲜红色，其间有多处裂口，裂口处有鲜血渗出，有黄水盖痂处奇痒难忍，有裂口处则疼痛异常，或时见麻木，舌苔白，脉弦缓。综合脉证，思之：流黄水者，湿热也；麻痒并见者，风湿热也；红肿流血水者，热人血分也；脉濡缓者，湿热也。合而论之：此湿热阻郁，郁而化风为主，血络瘀热为辅。治宜除湿清热，散风凉血。处方：藿香10克，甘草10克，栀子10克，防风10克，大黄1克。
服药6剂，肿胀痒痛好转，流水、流血消失；继服6剂，诸证均解，后果愈。
某医云：既云血络有瘀热，为何不用血分之药?答曰：栀子、大黄虽然主人气分，然亦兼人血分，以除血分湿热，故云凉血也。
慢性牙周炎
1．审其所主，思其脉证，两相参合，知其病在肝肾，予滋阴降火，佐以散风愈
支××，男，16岁。
牙痛时轻时重，牙齿全部浮动，齿间疏豁，偶而齿衄3年多。医诊慢性牙周炎。先请西医治疗2年多不效，后又配合中药清胃散、牛黄解毒丸、牛黄上清丸等治疗近1年亦未见明显效果。细察其证，除牙齿浮动，隐隐作痛，时有齿衄外，并见烦躁易怒，舌苔黄白，脉弦。综合脉证，思之：齿者，肾之所主，疏豁动摇，隐隐作痛者，阴虚相火上炎也。脉弦者，肝火也。合而论之：乃肾阴虚而火旺为主，兼有相火用事之证也。治宜滋阴降火，佐以泻肝。处方：升麻1克，白芷1克，防风2克，龙胆草13克，地骨皮40克。
服药7剂，牙齿浮动，隐隐作痛明显改善，用舌舔牙已不动摇；继服40剂，虽吃炒黄豆与花生米亦不动摇。
2．审其所主，察其昼夜，知其阴虚火旺，予滋阴降火愈
郑××，女，29岁。
齿衄时轻时重5年。医诊慢性牙周炎、维生素c缺乏症。先请西医治疗3年多不效，继又配合中药清胃泻火等剂亦无效。细察其证，除牙龈不断有鲜血渗出外，经常夜间睡醒后满口是血，且齿龈萎缩，牙根有血块，牙齿疏豁，头晕心烦，舌苔黄，脉弦细。综合脉证，思之：夜间齿血加重者，病在肾也。治宜滋阴补肾降火。处方：元参60克，石斛15克，生地15克，怀牛膝10克。
服药15剂，齿衄大减；继服20剂，诸证俱失，愈。
某医云：为何应用怀牛膝?答曰：怀牛膝者，非但补肝，亦且补肾；非但滋补，亦且引火下行。故肝肾并损而虚火上炎者多用之。
3．察脉审证，知其病在肾命，予培补肾气始愈
弓××，女，成。
牙龈肿胀衄血时轻时重13年。医诊慢性牙周炎。先请西医治疗7～8年无明显效果，继又配合中药清泻胃火，滋阴降火数年亦无改善。细察其证，上下牙龈均肿胀，不痛，牙根部有少量血痂，牙缝处有少量鲜血溢出，用手按压牙龈则出血加重，用牙刷刷牙时全刷均呈红色，用牙一咬馒头则咬的部分全变鲜红，舌苔为血染色，脉沉细尺大而弦。综合脉证，思之：牙龈属胃，牙齿属肾，且脉见尺大乃肾之阴阳俱衰，虚火上浮也。治宜补肝肾，降虚火。处方：元参15克，麦冬15克，生地15克，骨碎补15克。
服药12剂，齿衄停止；继服30剂，愈。
某医云：骨碎补乃跌打损伤药也，齿病因何用之?答曰：骨碎补苦温，归肝肾二经，非但能活血续筋，亦且能补肾，治肾虚之牙痛、衄血也，故用之。
杂论篇
绝对不能原谅自己
数十年前，作为一个临床医生，在治疗某个疾病屡屡无效，或久治不愈时，常常这样地原谅自己，说：“国内的著名医家都治不好，我能有什么办法呢?”“国际上对这病都没有办法，我怎么能治好呢?”在与一些同道的交谈中，我发现他们中的很多人也有这种看法。所以长期以来，我认为我的这种思想是对的。在一次与我院前副院长刘崇德的交谈中，他谈了他的如下观点：①没有治不好的病，只有我们治不好的病；②没有治不好的病，只有我们现在治不好的病；③只要辨证论治准确，就能治好这个病。我听后颇有非议，甚至有认为其简直是信口雌黄的想法。事隔30多年以后，我翻检了一下我的著作、论文一看，过去认为根本不可治愈的病，现在却一个一个地治愈了，有的虽然不能治愈，但却取得了可喜的苗头。这是为什么呢?归纳起来，大致有以下数条：
其一是是否把这个病人看成了自己最亲爱的人，若是，就会千方百计地想办法，就会通过千方百计地想办法，找出切实可行的办法来。
咽喉肿痛，持续高热7天。医生诊断为急性扁桃体炎。先用抗生素治疗3天，发热未退；继而又用中药清热解毒配合治疗4天，发热仍然没有减退。仔细检查发现两侧扁桃体明显肿大，表面覆盖白色脓点，舌苔薄白，体温39.8℃，脉象浮数。综合脉象和症状，思考道：脉浮，说明病位在上部，在体表，与肺有关。而且咽喉由肺和胃所主，大肠与肺互为表里。之前使用清热解毒法无效，是因为肺、胃、大肠壅滞的热邪未能消散，如果不通泻腑气，解除壅滞，并辅以疏散之法，病是无法治愈的。处方：蝉蜕10克，僵蚕10克，片姜黄10克，连翘10克，大黄4克。
服药3小时后，发热完全消退，咽喉疼痛大幅减轻。继续服用1剂，痊愈。
某医生说：大黄本是苦寒性质的泻下药，为什么用来治疗急性扁桃体炎却神效呢？回答说：大黄确实是苦寒泻下的药物，但用于急性扁桃体炎，是因为它能清泻大肠和胃的热邪。现在之所以单用清热解毒法无效，是因为肺、胃、大肠都有热，热邪壅滞郁结。而大黄配伍姜黄、蝉蜕、僵蚕，既能疏散邪气，又能消除壅滞，通过通下作用，所以热邪得以解除。
2．只知道解毒利咽，不知道疏散表邪，导致热邪闭郁，疾病无法解除
焦××，女，28岁。
咽喉肿痛，发热头痛8天。医生诊断为急性扁桃体炎。先用抗生素等治疗4天无效，继而又配合中药清热解毒之剂治疗4天仍无功效。仔细审查其证候，除了两侧扁桃体肿大，表面覆盖白色脓点外，还出现头晕头痛，阵发性恶寒发热，舌苔白，舌质红，脉象浮滑数。综合脉象和症状，思考道：脉浮，是表证的表现；舌质红，说明热毒已深入阴分。治疗应当疏风清热，解毒养阴。处方：蝉蜕10克，僵蚕10克，薄荷10克，银花10克，连翘10克，元参15克。
服药1剂后，微微出汗，头晕头痛、恶寒发热等症状全部解除，咽喉肿痛也消减大半。继续服用3剂，痊愈。
某医生说：我之前使用银花、连翘各达30克，并且配有板蓝根、山豆根、射干、马勃、黄连、黄芩均在15克以上，同时每天注射青霉素，然而治疗数日无效。现在先生仅用银花、连翘各10克，却1剂见效，4剂痊愈，这是什么原因呢？回答说：一是表邪未散，二是阴液未补。
只知道消炎，频繁给予解毒，导致痰湿停滞不化，凝结成核不散，拖延时日
于××，男，20岁。
两侧扁桃体肿大，几乎闭合10余年。医生诊断为慢性扁桃体炎。在急性扁桃体炎发作初期，每次使用青霉素都有很好的效果，但始终没有消除扁桃体的肿大现象。1年后，不得不配合中药清热解毒、养阴润喉进行治疗，有时有效，有时无明显改善，拖延至今日扁桃体仍然明显肿大。仔细审查其证候，除了两侧扁桃体明显肿大，几乎闭合外，还见舌苔薄白，两脉濡缓。综合脉象和症状，思考道：久病而脉象濡缓，是气阴两虚，痰气郁结所致。治疗应当补气养阴以扶助正气，化痰理气散结以祛除邪气。处方：黄芪15克，当归10克，麦冬10克，党参10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6克，菖蒲10克，远志10克，生地10克。同时，毫针浅刺翳风穴，留针3天。
服药1周后，扁桃体明显缩小；继续服用25剂，肿大的扁桃体完全恢复正常。
某医生说：为什么使用清热解毒之剂不仅无效，反而加重？回答说：此证的发生不仅有热毒，还有痰火。所谓痰火，在治疗时不仅要注意泻火，还要注意用药过程中的化痰药。因此前人很多治疗方剂中常常配伍化痰利咽的桔梗、蝉蜕、僵蚕、牛蒡子、元参等。但是由于有的医者只注意泻火，而不注意化痰，致使痰凝成核而形成慢性扁桃体炎，这就是使用清热解毒法无效的原因。
1．拘泥于成方，执着于解毒，偶尔调理气机，脉证不合，怎么能奏效
宋××，女，40岁。
咽干、咽痛，咽部异物阻塞感10年。医生诊断为慢性咽炎。先用喉片、抗生素治疗数年无效，继而又配合中药草珊瑚、健民咽喉片、六神丸，以及中药清热解毒、理气化痰之剂6～7年也无效。综合脉象和症状，审查道，除了咽部干痛，咽部异物阻塞感外，还见脉滑数，尤其是寸脉更为明显。思考道：寸脉对应上焦；滑数脉代表痰火。痰火蕴结于上焦，治疗应当清热化痰。处方：瓜蒌15克，胆南星10克，半夏10克，陈皮10克，杏仁10克，川贝母10克，黄芩10克，枳实10克，干姜1克。
服药3剂，咽部异物感消退；继续服用7剂，痊愈。
某医生说：这是清气化痰丸的加减方。原方原本用于治疗痰热内结引起的咳嗽痰黄、粘稠难咯、胸膈痞满，现在为什么用于慢性咽炎却神效呢？回答说：张仲景在谈到中医治病原则时指出：“观其脉证，知犯何逆，随证治之。”现在脉象既为滑数且尤显于寸，知道这是上焦痰热所致，所以用清热化痰法而愈。
2．拘泥于四七汤，执着于理气，不思考审察脉象，导致病情拖延
商××，女，50岁。
咽干、咽痛，时常有痰阻咽部感8年多。医生诊断为慢性咽炎。医生开始以西药治疗无效，继而又以中药喉片、草珊瑚、六神丸，以及四七汤加减配合治疗数年仍无效。仔细审查其证候，除了咽部发干，有异物阻塞感外，还见头晕头痛，失眠健忘，疲乏无力，心烦意乱，胸满气短，舌苔白，脉象濡缓。综合脉象和症状，思考道：病久且脉象濡缓，是气阴两虚，痰郁气结所致。治疗应当补气养阴，理气化痰。处方：黄芪15克，当归6克，麦冬10克，党参10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6克，菖蒲10克，远志10克，生地10克。
服药4剂，咽喉异物感消失，头晕头痛、失眠健忘、疲乏无力好转；继续服用20剂，所有症状消失，痊愈。
某医生说：这是加减十味温胆汤。近代中国中医研究院已故名老中医蒲辅周、岳美中先生，多用其治疗神经官能症，现在先生独用它来治疗慢性咽炎，为什么呢？回答说：此证脉象见濡缓，且属于久病，知道这是气阴两虚，痰气郁结所致，所以用补气养阴，化痰清热法而愈。
3．执着于理气化痰，忽略察脉知证，对虚证用祛邪法，对热证用温法，疾病不能痊愈
王××，女，45岁。
咽干咽痛时轻时重，时有异物阻塞感7年多。医生诊断为慢性咽炎。起初予西药治疗无效，继而又予中药喉片、草珊瑚，四七汤加减等配合治疗数年也不效。仔细察看其证候，除咽干咽痛，咽部异物阻塞感外，还见疲乏无力，心烦心悸，舌苔黄白，脉象弦大而数。综合脉象和症状，思考道：病久脉象弦大而数，是痰湿内郁，气阴两虚，清阳不升、浊阴不降功能失职所致。治疗应当补气养阴，燥湿清热，升清降浊。处方：党参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克。
服药7剂，不但所有症状均减轻，而且咽干咽痛、咽喉阻塞感大部消退；继续服用10剂，痊愈。
某医生说：既然是痰湿，为什么理气化痰不能痊愈？回答说：脉象弦大而数，证候以气阴两虚为主，湿热阻滞为辅，所以治疗应遵循补气养阴、燥湿清热、升清降浊的清暑益气汤法而愈。
1．只拘泥于验方，不审察脉证，不审察寒热，不审察药量比例，将寒作热，将热作寒，最终无效
弓××，女，49岁。
两唇痒痛，肿胀流水，紫黯麻木2年多。医生诊断为慢性唇炎。先以西药治疗1年无效，继而又以中药牛黄解毒丸、黄连上清丸、牛黄上清丸，以及清胃散、玉女煎、泻黄散、甘露饮加减治疗1年也未奏效。仔细审查其证候，两唇紫黯肿胀，不断有黄水流出，外罩黄色脓痂，痒痛麻木，胃脘痞满，脐上悸动，舌苔白，脉象弦紧，左脉大于右脉。综合脉象和症状，思考道：脉弦，是肝胆三焦的脉象；弦紧相兼，是寒象。唇肿湿烂，是湿热象。脐上悸动，胃脘痞满，是寒饮象。证脉合参，乃是肝郁气结，寒饮内郁，上热下寒。治疗应当清上温下，解郁散结，温阳化饮。处方：柴胡10克，半夏10克，黄芩10克，党参10克，干姜3克，甘草6克，大枣5个，桂枝10克，熟军3克，茯苓15克，龙骨15克，牡蛎15克。
服药4剂，口唇肿胀、痒痛、紫黯、麻木均大幅减轻；继续服用10剂，痊愈。
某医生说：柴胡加龙骨牡蛎汤是《伤寒论》中治疗“胸满烦惊，小便不利，谵语，一身尽重，不可转侧者”的方子，为什么用来治疗唇炎呢？回答说：柴胡加龙骨牡蛎汤确实是伤寒误下后出现烦惊谵语的方剂。但是因为本方中桂枝配柴胡可使内陷之邪从外解，加龙骨、牡蛎可以镇静而潜降浮阳，大黄和胃气泻邪热，桂枝配茯苓、生姜、大枣可以化解寒饮，所以可用它使错杂之邪从内外而解，唇病得愈。
2．观察证候察脉象，知道其所主，治疗以除湿清热，散风活血，痊愈
卜××，女，36岁。
上下口唇红肿，脱皮皲裂，流黄水13年。医生诊断为慢性剥脱性唇炎。先用西药间断性治疗8年无效，继而又配合中药清热解毒，清胃泻火，活血化瘀，以单方蜈蚣、全蝎、土元，中成药梅花点舌丹、锡类散等治疗4年多也无明显效果。最近1年多以来，不但肿胀、脱皮、发痒、流汁水，而且经常发现皮肤皲裂，从裂口处流出血水。仔细察看其证候，上下口唇均肿胀，有的部位由黄水堆积而成一层厚厚的黄痂，有的皮肤脱落呈鲜红色，其间有多处裂口，裂口处有鲜血渗出，有黄水盖痂处奇痒难忍，有裂口处则疼痛异常，或时见麻木，舌苔白，脉象弦缓。综合脉象和症状，思考道：流黄水，是湿热；麻痒并见，是风湿热；红肿流血水，是热入血分；脉濡缓，是湿热。综合论述：此乃湿热阻郁，郁而化风为主，血络瘀热为辅。治疗应当除湿清热，散风凉血。处方：藿香10克，甘草10克，栀子10克，防风10克，大黄1克。
服药6剂，肿胀痒痛好转，流水、流血消失；继续服用6剂，所有症状均解除，后果痊愈。
某医生说：既然说血络有瘀热，为什么不用血分药？回答说：栀子、大黄虽然主要入气分，但也兼入血分，以清除血分湿热，所以说具有凉血作用。
1．审察其所主，思考其脉证，两者参合，知道病在肝肾，给予滋阴降火，佐以散风而愈
支××，男，16岁。
牙痛时轻时重，牙齿全部浮动，齿间疏豁，偶尔齿衄3年多。医生诊断为慢性牙周炎。先请西医治疗2年多无效，后又配合中药清胃散、牛黄解毒丸、牛黄上清丸等治疗近1年也未见明显效果。仔细察看其证候，除牙齿浮动，隐隐作痛，时有齿衄外，还见烦躁易怒，舌苔黄白，脉象弦。综合脉象和症状，思考道：牙齿由肾所主，齿间疏豁动摇，隐隐作痛，是阴虚相火上炎。脉弦，是肝火。综合论述：乃是肾阴虚而火旺为主，兼有相火用事之证。治疗应当滋阴降火，佐以泻肝。处方：升麻1克，白芷1克，防风2克，龙胆草13克，地骨皮40克。
服药7剂，牙齿浮动，隐隐作痛明显改善，用舌舔牙已不动摇；继续服用40剂，虽吃炒黄豆与花生米亦不动摇。
2．审察其所主，察其昼夜变化，知道是阴虚火旺，给予滋阴降火而愈
郑××，女，29岁。
齿衄时轻时重5年。医生诊断为慢性牙周炎、维生素C缺乏症。先请西医治疗3年多无效，继而又配合中药清胃泻火等剂也无效。仔细察看其证候，除牙龈不断有鲜血渗出外，经常夜间睡醒后满口是血，且齿龈萎缩，牙根有血块，牙齿疏豁，头晕心烦，舌苔黄，脉象弦细。综合脉象和症状，思考道：夜间齿血加重，病位在肾。治疗应当滋阴补肾降火。处方：元参60克，石斛15克，生地15克，怀牛膝10克。
服药15剂，齿衄大减；继续服用20剂，所有症状俱失，痊愈。
某医生说：为什么应用怀牛膝？回答说：怀牛膝，不仅补肝，而且补肾；不仅是滋补，而且能引火下行。所以肝肾并损而虚火上炎者多用之。
弓××，女，成年。
牙龈肿胀衄血时轻时重13年。医生诊断为慢性牙周炎。先请西医治疗7～8年无明显效果，继而又配合中药清泻胃火，滋阴降火数年也无改善。仔细察看其证候，上下牙龈均肿胀，不痛，牙根部有少量血痂，牙缝处有少量鲜血溢出，用手按压牙龈则出血加重，用牙刷刷牙时全刷均呈红色，用牙一咬馒头则咬的部分全变鲜红，舌苔被血染色，脉象沉细尺大而弦。综合脉象和症状，思考道：牙龈属胃，牙齿属肾，且脉见尺大乃肾之阴阳俱衰，虚火上浮。治疗应当补肝肾，降虚火。处方：元参15克，麦冬15克，生地15克，骨碎补15克。
服药12剂，齿衄停止；继续服用30剂，痊愈。
某医生说：骨碎补是跌打损伤药，牙齿病因何用之？回答说：骨碎补苦温，归肝肾二经，不仅能活血续筋，而且能补肾，治疗肾虚之牙痛、衄血，所以使用它。
杂论篇
绝对不能原谅自己
数十年前，作为一名临床医生，在治疗某个疾病屡屡无效，或久治不愈时，常常这样地原谅自己，说：“国内的著名医家都治不好，我能有什么办法呢？”“国际上对这病都没有办法，我怎么能治好呢？”在与一些同道的交谈中，我发现他们中的很多人也有这种看法。所以长期以来，我认为我的这种思想是对的。在一次与我院前副院长刘崇德的交谈中，他谈了他的如下观点：①没有治不好的病，只有我们治不好的病；②没有治不好的病，只有我们现在治不好的病；③只要辨证论治准确，就能治好这个病。我听后颇有非议，甚至有认为其简直是信口雌黄的想法。事隔30多年以后，我翻检了一下我的著作、论文一看，过去认为根本不可治愈的病，现在却一个一个地治愈了，有的虽然不能治愈，但却取得了可喜的苗头。这是为什么呢？归纳起来，大致有以下数条：
其一是是否把这个病人看成了自己最亲爱的人，若是，就会千方百计地想办法，就会通过千方百计地想办法，找出切实可行的办法来。
Sore throat and swelling, persistent high fever for 7 days. The physician diagnosed acute tonsillitis. Antibiotics were used for 3 days initially, but the fever did not subside; subsequently, Chinese herbal medicine for clearing heat and detoxifying was combined for treatment for 4 days, yet the fever remained unchanged. Upon careful examination, both tonsils were found to be significantly enlarged with white pus points covering the surface, the tongue coating was thin and white, body temperature was 39.8°C, and the pulse was floating and rapid (Pulse Floating and Rapid). Synthesizing the pulse and symptoms, it was reasoned: A floating pulse indicates the disease is located in the upper part, on the exterior, and relates to the Lung. Moreover, the throat is governed by the Lung and Stomach, and the Large Intestine is interiorly-exteriorly related to the Lung. The previous failure of heat-clearing and detoxifying methods suggests that heat stagnation in the Lung, Stomach, and Large Intestine had not dispersed. Without purging the fu organs, resolving the stagnation, and assisting with dispersing methods, the disease cannot be cured. Prescription: Cicada Slough (Chan Tui) 10g, Silkworm (Jiang Can) 10g, Turmeric Rhizome (Pian Jiang Huang) 10g, Forsythia Fruit (Lian Qiao) 10g, Rhubarb (Da Huang) 4g.
Three hours after taking the medicine, the fever completely subsided, and throat pain decreased significantly. After continuing with one more dose, the patient recovered.
A certain physician asked: Rhubarb is a bitter-cold purgative; why does it work miraculously for acute tonsillitis? The answer is: Although Rhubarb is indeed a bitter-cold purgative, it is used for acute tonsillitis because it can purge heat from the Large Intestine and Stomach. The reason why simple heat-clearing and detoxifying failed is that heat existed in the Lung, Stomach, and Large Intestine, causing heat pathogen stagnation and constraint. Rhubarb, combined with Turmeric Rhizome, Cicada Slough, and Silkworm, can both disperse pathogens and eliminate stagnation through purgation, thus allowing the heat to resolve.
2. Knowing only to detoxify and benefit the throat, but not knowing to disperse exterior pathogens, leading to heat pathogen closure and constraint, resulting in unresolved disease
Jiao XX, Female, 28 years old.
Sore throat and swelling, fever, and headache for 8 days. Diagnosed with acute tonsillitis. Treated with antibiotics for 4 days without effect; then treated with Chinese herbal medicine for clearing heat and detoxifying for another 4 days with no efficacy. Careful review of the syndrome revealed, besides significant enlargement of both tonsils covered with white pus points, dizziness and headache, alternating chills and fever, white tongue coating, red tongue body, and a floating-slippery-rapid pulse. Synthesizing the pulse and symptoms, it was reasoned: A floating pulse indicates an exterior syndrome; a red tongue body indicates heat toxin has entered the Yin level. Treatment should focus on dispelling wind and clearing heat, detoxifying and nourishing Yin. Prescription: Cicada Slough (Chan Tui) 10g, Silkworm (Jiang Can) 10g, Mint (Bo He) 10g, Honeysuckle Flower (Yin Hua) 10g, Forsythia Fruit (Lian Qiao) 10g, Scrophularia Root (Yuan Shen) 15g.
After one dose, slight sweating occurred, and symptoms such as dizziness, headache, chills, and fever resolved. Throat pain and swelling also reduced by more than half. After continuing with three more doses, the patient recovered.
A certain physician asked: I previously used Honeysuckle Flower and Forsythia Fruit up to 30g each, combined with Isatis Root (Ban Lan Gen), Dogwood Root Bark (Shan Dou Gen), Belamcanda Rhizome (She Gan), Toad Venom (Ma Bo), Coptis Rhizome (Huang Lian), and Scutellaria Root (Huang Qin) all above 15g, along with daily Penicillin injections, yet there was no effect after several days. Now, you use only 10g of Honeysuckle Flower and Forsythia Fruit each, achieving results in one dose and recovery in four. What is the reason? The answer is: First, the exterior pathogen was not dispersed; second, the Yin fluids were not replenished.
Chronic Tonsillitis
Knowing only anti-inflammatory treatments and frequently using detoxification, leading to untransformed phlegm stasis and undispersed nodules, prolonging the illness
Yu XX, Male, 20 years old.
Significant enlargement of both tonsils, nearly closing the airway, for over 10 years. Diagnosed with chronic tonsillitis. At the onset of acute exacerbations, Penicillin was highly effective each time, but the tonsillar enlargement never disappeared. One year later, Chinese herbal medicine for clearing heat, detoxifying, nourishing Yin, and moistening the throat was added. Sometimes effective, sometimes showing no obvious improvement, leading to the current state where tonsils remain significantly enlarged. Careful review of the syndrome revealed, besides significant tonsillar enlargement nearing closure, a thin white tongue coating, and a soggy-slow pulse in both wrists. Synthesizing the pulse and symptoms, it was reasoned: A chronic illness with a soggy-slow pulse indicates Qi and Yin deficiency with Phlegm-Qi stagnation. Treatment should tonify Qi and nourish Yin to support healthy Qi, and transform phlegm, regulate Qi, and dissipate nodules to eliminate pathogens. Prescription: Astragalus Root (Huang Qi) 15g, Angelica Sinensis Root (Dang Gui) 10g, Ophiopogon Tuber (Mai Dong) 10g, Codonopsis Root (Dang Shen) 10g, Schisandra Berry (Wu Wei Zi) 10g, Bamboo Shavings (Zhu Ru) 10g, Immature Bitter Orange (Zhi Shi) 10g, Pinellia Tuber (Ban Xia) 10g, Tangerine Peel (Chen Pi) 10g, Poria (Fu Ling) 10g, Licorice Root (Gan Cao) 6g, Acorus Rhizome (Shi Chang Pu) 10g, Polygala Root (Yuan Zhi) 10g, Rehmannia Root (Sheng Di) 10g. Simultaneously, shallow acupuncture at Yifeng (TE17) with needle retention for 3 days.
After one week of medication, tonsils shrank significantly; after continuing with 25 more doses, the enlarged tonsils returned to normal completely.
A certain physician asked: Why did heat-clearing and detoxifying formulas not only fail but worsen the condition? The answer is: This condition involves not only heat toxin but also phlegm-fire. In treating phlegm-fire, one must pay attention not only to purging fire but also to using phlegm-transforming herbs during treatment. Therefore, many ancient formulas often include phlegm-transforming and throat-benefiting herbs like Platycodon Root (Jie Geng), Cicada Slough, Silkworm, Archangelica Seed (Niu Bang Zi), and Scrophularia Root. However, some physicians focused only on purging fire and neglected transforming phlegm, causing phlegm to congeal into nodules and form chronic tonsillitis. This is why heat-clearing and detoxifying methods failed.
Chronic Pharyngitis
1. Clinging to established formulas, adhering to detoxification, occasionally regulating Qi, but pulse and syndrome do not match, how can it be effective?
Song XX, Female, 40 years old.
Dry throat, sore throat, foreign body sensation in the throat for 10 years. Diagnosed with chronic pharyngitis. Treated with throat lozenges and antibiotics for several years without effect; then combined with Chinese herbal medicine including Hedyotis Diffusa (Cao Shan Hu), Jianmin Throat Lozenges, Liushen Wan, and formulas for clearing heat, detoxifying, regulating Qi, and transforming phlegm for 6-7 years, still ineffective. Synthesizing the pulse and symptoms, it was reviewed: Besides dry and sore throat with foreign body sensation, the pulse was slippery and rapid, especially prominent in the Cun (inch) position. It was reasoned: The Cun position corresponds to the Upper Jiao; a slippery-rapid pulse indicates Phlegm-Fire. Phlegm-Fire accumulating in the Upper Jiao requires heat-clearing and phlegm-transforming treatment. Prescription: Trichosanthes Fruit (Gua Lou) 15g, Arisaema Cum Bile (Dan Nan Xing) 10g, Pinellia Tuber (Ban Xia) 10g, Tangerine Peel (Chen Pi) 10g, Apricot Seed (Xing Ren) 10g, Fritillaria Bulb (Chuan Bei Mu) 10g, Scutellaria Root (Huang Qin) 10g, Immature Bitter Orange (Zhi Shi) 10g, Dried Ginger (Gan Jiang) 1g.
After three doses, the foreign body sensation in the throat subsided; after continuing with seven more doses, the patient recovered.
A certain physician asked: This is a modified formula of Qingqi Huatan Wan. Originally used for cough with yellow, sticky sputum due to Phlegm-Heat accumulation, chest oppression, and fullness, why is it miraculous for chronic pharyngitis now? The answer is: Zhang Zhongjing stated in discussing TCM treatment principles: "Observe the pulse and syndrome, understand the deviation, and treat according to the syndrome." Since the pulse is slippery and rapid, especially at the Cun, indicating Upper Jiao Phlegm-Heat, treating with heat-clearing and phlegm-transforming methods led to recovery.
2. Clinging to Siqi Decoction, adhering to Qi regulation, neglecting pulse assessment, prolonging the disease course
Shang XX, Female, 50 years old.
Dry throat, sore throat, frequent sensation of phlegm obstruction in the throat for over 8 years. Diagnosed with chronic pharyngitis. Initially treated with Western medicine without effect; then combined with throat lozenges, Hedyotis Diffusa, Liushen Wan, and modified Siqi Decoction for several years, still ineffective. Careful review of the syndrome revealed, besides dry throat and foreign body sensation, dizziness and headache, insomnia and forgetfulness, fatigue and weakness, irritability, chest fullness and shortness of breath, white tongue coating, and a soggy-slow pulse. Synthesizing the pulse and symptoms, it was reasoned: Chronic illness with a soggy-slow pulse indicates Qi and Yin deficiency with Phlegm-Qi stagnation. Treatment should tonify Qi and nourish Yin, regulate Qi and transform phlegm. Prescription: Astragalus Root (Huang Qi) 15g, Angelica Sinensis Root (Dang Gui) 6g, Ophiopogon Tuber (Mai Dong) 10g, Codonopsis Root (Dang Shen) 10g, Schisandra Berry (Wu Wei Zi) 10g, Bamboo Shavings (Zhu Ru) 10g, Immature Bitter Orange (Zhi Shi) 10g, Pinellia Tuber (Ban Xia) 10g, Tangerine Peel (Chen Pi) 10g, Poria (Fu Ling) 10g, Licorice Root (Gan Cao) 6g, Acorus Rhizome (Shi Chang Pu) 10g, Polygala Root (Yuan Zhi) 10g, Rehmannia Root (Sheng Di) 10g.
After four doses, the foreign body sensation in the throat disappeared, and dizziness, headache, insomnia, forgetfulness, and fatigue improved; after continuing with 20 more doses, all symptoms disappeared, and the patient recovered.
A certain physician asked: This is a modified Shijiu Wendan Tang. Famous senior TCM physicians Pu Fuzhou and Yue Meishan of the China Academy of Chinese Medical Sciences often used it to treat neurosis. Why do you use it exclusively for chronic pharyngitis? The answer is: The pulse is soggy-slow, and the illness is chronic, indicating Qi and Yin deficiency with Phlegm-Qi stagnation. Therefore, treating with Qi-tonifying, Yin-nourishing, phlegm-transforming, and heat-clearing methods led to recovery.
3. Adhering to Qi regulation and phlegm transformation, neglecting pulse and syndrome assessment, using expelling methods for deficiency, warming methods for heat, resulting in non-recovery
Wang XX, Female, 45 years old.
Dry and sore throat, varying in severity, with occasional foreign body sensation for over 7 years. Diagnosed with chronic pharyngitis. Initially treated with Western medicine without effect; then combined with throat lozenges, Hedyotis Diffusa, and modified Siqi Decoction for several years, still ineffective. Careful observation of the syndrome revealed, besides dry and sore throat with foreign body sensation, fatigue and weakness, irritability and palpitations, yellow-white tongue coating, and a string-taut-large-rapid pulse. Synthesizing the pulse and symptoms, it was reasoned: A chronic illness with a string-taut-large-rapid pulse indicates internal stagnation of Damp-Phlegm, Qi and Yin deficiency, and dysfunction of ascending clear and descending turbid. Treatment should tonify Qi and nourish Yin, dry dampness and clear heat, ascend clear and descend turbid. Prescription: Codonopsis Root (Dang Shen) 10g, Licorice Root (Gan Cao) 6g, Astragalus Root (Huang Qi) 15g, Angelica Sinensis Root (Dang Gui) 6g, Ophiopogon Tuber (Mai Dong) 10g, Schisandra Berry (Wu Wei Zi) 10g, Green Tangerine Peel (Qing Pi) 10g, Tangerine Peel (Chen Pi) 10g, Medicated Leaven (Shen Qu) 10g, Phellodendron Bark (Huang Bai) 10g, Kudzu Root (Ge Gen) 15g, Atractylodes Rhizome (Cang Zhu) 10g, White Atractylodes Rhizome (Bai Zhu) 10g, Cimicifuga Rhizome (Sheng Ma) 10g, Alisma Rhizome (Ze Xie) 10g.
After seven doses, all symptoms decreased, and dry/sore throat and throat obstruction largely subsided; after continuing with 10 more doses, the patient recovered.
A certain physician asked: If it is Damp-Phlegm, why did Qi regulation and phlegm transformation fail? The answer is: A string-taut-large-rapid pulse indicates the syndrome is primarily Qi and Yin deficiency, with secondary Damp-Heat obstruction. Therefore, treatment should follow the Qing Shu Yi Qi Tang method of tonifying Qi and nourishing Yin, drying dampness and clearing heat, and ascending clear and descending turbid, leading to recovery.
Chronic Cheilitis
1. Only clinging to empirical formulas, not assessing pulse and syndrome, not distinguishing cold and heat, not considering dosage ratios, mistaking cold for heat and heat for cold, ultimately ineffective
Gong XX, Female, 49 years old.
Itching and pain in both lips, swelling with exudate, purple-dark numbness for over 2 years. Diagnosed with chronic cheilitis. Treated with Western medicine for 1 year without effect; then combined with Niuhuang Jiedu Wan, Huanglian Shangqing Wan, Niuhuang Shangqing Wan, and modified formulas including Weig San, Yup Nu Jian, Xie Huang San, and Gan Lu Yin for 1 year, still ineffective. Careful review of the syndrome revealed purple-dark swollen lips, continuous yellow exudate, yellow crusts on the surface, itching, pain, numbness, epigastric fullness, pulsation above the umbilicus, white tongue coating, string-tight pulse, with the left pulse larger than the right. Synthesizing the pulse and symptoms, it was reasoned: A string pulse indicates the Liver, Gallbladder, and San Jiao; string-tight together indicates Cold. Lip swelling and wet erosion indicate Damp-Heat. Pulsation above the umbilicus and epigastric fullness indicate Cold Fluid Retention. Combining syndrome and pulse, it is Liver Qi stagnation with internal Cold Fluid Retention, Upper Heat and Lower Cold. Treatment should clear the Upper and warm the Lower, resolve stagnation and dissipate nodules, warm Yang and transform fluid. Prescription: Bupleurum Root (Chai Hu) 10g, Pinellia Tuber (Ban Xia) 10g, Scutellaria Root (Huang Qin) 10g, Codonopsis Root (Dang Shen) 10g, Dried Ginger (Gan Jiang) 3g, Licorice Root (Gan Cao) 6g, Jujube Date (Da Zao) 5 pieces, Cinnamon Twig (Gui Zhi) 10g, Prepared Rhubarb (Shu Jun) 3g, Poria (Fu Ling) 15g, Dragon Bone (Long Gu) 15g, Oyster Shell (Mu Li) 15g.
After four doses, lip swelling, itching, pain, purple-dark color, and numbness greatly reduced; after continuing with 10 more doses, the patient recovered.
A certain physician asked: Chaihu Jia Longgu Muli Tang is from Shanghan Lun for treating "chest fullness, vexation, fright, difficult urination, delirium, heaviness of the whole body, inability to turn" after Shaoyang syndrome mismanagement. Why use it for cheilitis? The answer is: Chaihu Jia Longgu Muli Tang is indeed for post-Shaoyang mismanagement with vexation, fright, and delirium. However, Cinnamon Twig combined with Bupleurum allows trapped pathogens to exit from the exterior; adding Dragon Bone and Oyster Shell calms the spirit and anchors floating Yang; Rhubarb harmonizes Stomach Qi and purges pathogenic heat; Cinnamon Twig combined with Poria, Dried Ginger, and Jujube transforms Cold Fluid. Thus, it allows complex pathogens to resolve from both interior and exterior, curing the lip disease.
2. Observing syndrome and assessing pulse, knowing the governing organ, treating with dampness-draining, heat-clearing, wind-dispelling, and blood-invigorating methods, resulting in recovery
Bu XX, Female, 36 years old.
Redness, swelling, peeling, cracking, and yellow exudate on upper and lower lips for 13 years. Diagnosed with chronic desquamative cheilitis. Intermittent Western medicine treatment for 8 years was ineffective; then combined with Chinese herbal medicine for clearing heat, detoxifying, clearing Stomach heat, purging fire, and invigorating blood, using single herbs Centipede (Wu Gong), Scorpion (Quan Xie), Ground Beetle (Tu Yuan), and patent medicines Meihua Dianshe Dan, Xi Lei San for over 4 years with no obvious effect. For the past year, besides swelling, peeling, itching, and exudate, skin cracking was frequent, with bloody discharge from cracks. Careful observation revealed swollen upper and lower lips, thick yellow crusts formed by accumulated yellow fluid in some areas, bright red exposed skin in others, multiple cracks with fresh blood oozing, unbearable itching under yellow crusts, severe pain at cracks, occasional numbness, white tongue coating, and string-slow pulse. Synthesizing the pulse and symptoms, it was reasoned: Yellow exudate indicates Damp-Heat; numbness and itching together indicate Wind-Damp-Heat; redness, swelling, and bloody exudate indicate Heat entering the Blood level; soggy-slow pulse indicates Damp-Heat. Comprehensive analysis: Primarily Damp-Heat obstruction and constraint transforming into Wind, secondarily Blood vessel stasis and Heat. Treatment should drain dampness, clear heat, disperse wind, and cool blood. Prescription: Agastache Herb (Huo Xiang) 10g, Licorice Root (Gan Cao) 10g, Gardenia Fruit (Zhi Zi) 10g, Saposhnikovia Root (Fang Feng) 10g, Rhubarb (Da Huang) 1g.
After six doses, swelling, itching, and pain improved, and fluid/blood discharge ceased; after continuing with six more doses, all symptoms resolved, and the patient recovered.
A certain physician asked: If there is stasis-heat in blood vessels, why not use Blood-level herbs? The answer is: Although Gardenia Fruit and Rhubarb primarily enter the Qi level, they also enter the Blood level to clear Damp-Heat from the Blood, hence they are considered to have blood-cooling properties.
Chronic Periodontitis
1. Assessing the governing organ, contemplating pulse and syndrome, combining both, knowing the disease is in the Kidney and Liver, treating with Yin-nourishing and fire-purging, assisted by wind-dispelling, resulting in recovery
Zhi XX, Male, 16 years old.
Tooth pain varying in severity, loose teeth throughout, gaps between teeth, occasional gingival bleeding for over 3 years. Diagnosed with chronic periodontitis. Western medicine treatment for over 2 years was ineffective; then combined with Qingwei San, Niuhuang Jiedu Wan, Niuhuang Shangqing Wan for nearly 1 year with no obvious effect. Careful observation revealed, besides loose teeth, dull pain, and occasional gingival bleeding, irritability and anger, yellow-white tongue coating, and string pulse. Synthesizing the pulse and symptoms, it was reasoned: Teeth are governed by the Kidney; gaps, mobility, and dull pain indicate Yin deficiency with Minister Fire flaming upward. String pulse indicates Liver Fire. Comprehensive analysis: Primarily Kidney Yin deficiency with hyperactive fire, accompanied by Minister Fire activity. Treatment should nourish Yin and purge fire, assisted by purging Liver. Prescription: Cimicifuga Rhizome (Sheng Ma) 1g, Angelica Dahurica Root (Bai Zhi) 1g, Saposhnikovia Root (Fang Feng) 2g, Gentian Root (Long Dan Cao) 13g, Cortex Lycii (Di Gu Pi) 40g.
After seven doses, tooth mobility and dull pain significantly improved, and teeth were stable when licked by the tongue; after continuing with 40 more doses, teeth remained stable even when eating roasted soybeans and peanuts.
2. Assessing the governing organ, observing day-night variations, knowing Yin deficiency with fire hyperactivity, treating with Yin-nourishing and fire-purging, resulting in recovery
Zheng XX, Female, 29 years old.
Gingival bleeding varying in severity for 5 years. Diagnosed with chronic periodontitis and Vitamin C deficiency. Western medicine treatment for over 3 years was ineffective; then combined with formulas for clearing Stomach heat and purging fire, still ineffective. Careful observation revealed, besides continuous fresh blood oozing from gums, waking up with a mouth full of blood at night, gum recession, blood clots at tooth roots, loose teeth, dizziness and irritability, yellow tongue coating, and string-thin pulse. Synthesizing the pulse and symptoms, it was reasoned: Worsening of gingival bleeding at night indicates the disease is in the Kidney. Treatment should nourish Yin, tonify Kidney, and purge fire. Prescription: Scrophularia Root (Yuan Shen) 60g, Dendrobium Stem (Shi Hu) 15g, Rehmannia Root (Sheng Di) 15g, Achyranthes Root (Huai Niu Xi) 10g.
After 15 doses, gingival bleeding greatly reduced; after continuing with 20 more doses, all symptoms disappeared, and the patient recovered.
A certain physician asked: Why use Achyranthes Root? The answer is: Achyranthes Root not only tonifies the Liver but also the Kidney; it is not only nourishing but also guides fire downward. Therefore, it is commonly used for Liver-Kidney damage with floating deficient fire.
3. Assessing pulse and syndrome, knowing the disease is in the Kidney and Mingmen, treating with Kidney Qi tonification, resulting in recovery
Gong XX, Female, Adult.
Gum swelling and bleeding varying in severity for 13 years. Diagnosed with chronic periodontitis. Western medicine treatment for 7-8 years showed no obvious effect; then combined with formulas for purging Stomach heat and nourishing Yin/purging fire for several years with no improvement. Careful observation revealed swollen upper and lower gums, painless, small blood scabs at tooth roots, small amounts of fresh blood oozing from gum spaces, increased bleeding upon pressing gums, entire brush turning red when brushing, biting a steamed bun turning the bitten part bright red, tongue coating stained with blood, deep-thin pulse with large and string-taut Chi position. Synthesizing the pulse and symptoms, it was reasoned: Gums belong to the Stomach, teeth belong to the Kidney; a large Chi pulse indicates decline of both Yin and Yang in the Kidney with floating deficient fire. Treatment should tonify Liver and Kidney, and descend deficient fire. Prescription: Scrophularia Root (Yuan Shen) 15g, Ophiopogon Tuber (Mai Dong) 15g, Rehmannia Root (Sheng Di) 15g, Drynaria Rhizome (Gu Sui Bu) 15g.
After 12 doses, gingival bleeding stopped; after continuing with 30 more doses, the patient recovered.
A certain physician asked: Drynaria Rhizome is for traumatic injuries; why use it for dental issues? The answer is: Drynaria Rhizome is bitter and warm, entering the Liver and Kidney meridians. It not only invigorates blood and heals tendons but also tonifies the Kidney, treating Kidney deficiency-related toothache and bleeding. Hence, it is used.
Miscellaneous Discussions
Never Excuse Oneself
Decades ago, as a clinical physician, when treating a disease repeatedly without effect or failing to cure it after long-term treatment, I often excused myself, saying: "Even famous domestic physicians cannot cure it, what can I do?" "There is no international solution for this disease, how can I cure it?" In conversations with peers, I found many shared this view. Thus, for a long time, I believed my mindset was correct. During a conversation with Liu Chongde, former Vice President of our hospital, he expressed the following views: ① There are no incurable diseases, only diseases we cannot cure; ② There are no incurable diseases, only diseases we currently cannot cure; ③ As long as syndrome differentiation and treatment are accurate, the disease can be cured. I initially disagreed strongly, even thinking it was nonsense. Over 30 years later, reviewing my own works and papers, I found that diseases once thought incurable have been cured one by one, and some, though not fully curable, show promising signs. Why is this? Summarizing, there are roughly the following reasons:
First, whether one regards the patient as one's dearest loved one. If so, one will try every possible means to find practical solutions.