又如患者骆××，女，10岁。从一周岁开始即经常在身上乱抓，睡眠不安，几乎每夜都需父母在身上搔抓半小时才能安然入睡，睡眠过程中仍见其手到处乱抓，有时因奇痒难忍而突然痛哭不止，不再入睡。稍长之后，见其经常诉说全身奇痒难忍，昼夜难于入睡。几乎每夜入睡之前均需抓得血迹斑斑。为此曾经到处求医诊治，但一直效果不明显。细察其所用药物，除西药外，中药大都均为祛风除湿清热之剂。细察其证，除上述者外，并见舌苔薄白，脉沉弦细。综合脉证，思之：血属阴，肝藏血，血虚燥热生风，则夜间痒甚，以手搔抓而证减者泄其风也。治拟养血活血，凉血散风。处方：丹参15克，银花10克，连翘10克，当归10克，川芎10克，白芍10克；，生地15克，薄荷3克。服药6剂，其痒大减，且有时不抓亦可入睡。继服上药24剂，身痒消失，愈。某医云：前代医家反复告诫说：痒为风，故痒当从风治。然前医屡用祛风之剂不但不效，反见加重者何也?老师今仅用薄荷一味散风，且其量仅仅3克，祛风之力明显不足，而其疗效反著者何也?答曰；风者，有内、外之别。外风者，当疏散风邪，如桂枝、麻黄、消风等汤方者可也。内风者，尤当治内风之因，若血中燥热面生风者，当养血活血凉血，此即所谓养血祛风，冶风先治血，血行风自灭意。反之，血中燥热者，不去养血、活血、凉血；但去散风以伤血，必使燥甚而风生，诸证加剧。该医再问：疥疮、皮炎夜间奇痒者可用养血凉血活血法治愈，它病如此者亦可用此方乎?答曰：可以。
例如：患者耿××，女，成。全身皮疹瘙痒十几年。某院诊为慢性湿疹。先用西药治疗数年不效，后又请某中医以中药祛风除湿清热治疗3年仍不效。不得已，又用中、西药联合治疗半年，其证更剧。邀余治疗。细审其证：全身满布皮疹，小者如针尖，大者如高梁，奇痒难忍，夜间尤甚，有时非抓至出血不能减轻症状，舌苔白，脉沉细。综合脉证，诊为湿邪久久不解，人于血络，久损阴血所致。治以养血活血凉血。处用方：丹参15克，当归10克，川芎10克，生地10克，白芍10克兄，银花10克，连翘10克，薄荷3克。服药4剂，其痒即减。继服10剂，诸证消失，愈。该医又问：皮炎之用养血活血，凉血解毒尚且可以理解，今湿疹之用清热除湿散风不效，而用养血活血凉血反效者，吾不得而解也?答曰：《素问·至真要大论》说：“气有高下，病有远近，证有中外，治有轻重，适其至所为故也。”今本病已由气分人于血分，且夫见有血中燥热，故治气分之湿热不效，治血分反愈也。又问：辨证之法何如？答曰：《灵枢·顺气一日分为四时》言不入脏者宜从一日分为四时辨之，人于五脏者宜从脏气之所不胜时者甚辨之。云：“夫百病者，多以旦慧，昼安，夕加，夜甚，何也?岐伯曰：四时之气使然。黄帝曰：愿闻四时之气。岐伯曰：春生、夏长、秋收、冬藏，是气之常也，人亦应之。以一日分为四时，朝则为春，日中为夏，日人为秋，夜半为冬。朝则人气始生，病气衰，故旦慧；日中人气长，长则胜邪，故安；夕则人气始衰，邪气始生，故加；夜半人气人脏，邪气独居于身，故甚也。”
昼夜的推移与辨证
数千年来，我国劳动人民和科学工作者发现某些生物的活动特性和人的病理生理学变化，具有明显的时间性特征。例如：公鸡按时呜啼，合欢、首乌的茎叶按时开合，人体的疾病多以旦慧昼安，夕加夜甚。
那么这种现象是怎么发生的呢?古人认为在自然界中存在着一种既对立而又统一的气，这种气的相对静止部分称为阴，相对活动部分称为阳，并认为天地之间的阴阳和人体的阴阳之间有着一种相互感应的关系，这种感应常因人的体质和自然界的变化程度而有所谓的恍惚之数或严重程度的改变。正如《素问·金匮真言论》所说：“平旦至日中，天之阳，阳中之阳也；日中至黄昏，天之阳，阳中之阴也；合夜至鸡鸣，天之阴，阴中之阴也；鸡鸣至平旦，天之阴，阴中之阳也。”人亦应之，而发生“昼则阳气在外也，平旦人气生，以日初生也；日中阳气隆，以日当午也；日西阳气虚，以日渐落也。”
古人还认为，不但自然界的阴阳和人体的阴阳有着相互感应的关系，而且昼夜的五行变化和人体病理生理上也有相互感应的关系。《素问·玉机真脏论》说：“一日一夜五分之，此所以占死生之蚤暮也。”《类经》说：“五分者，朝主甲乙，昼主丙丁，四季土主戊己，晡主庚辛，夜主壬癸。”“人亦应之……朝则人气加，夜半人气人脏，邪气独居于身，故甚也。”
既然昼夜的阴阳、五行变化和人体病理生理的阴阳、五行变化是相互感应的，那么可以不可以利用这种变化去辨证论治呢?回答是肯定的。例如：发热中的长期低热不退，一般都认为是阴虚发热，但是治疗时又长期应用滋阴清热药不退，这是为什么呢?此时若能结合昼夜阴阳、五行的相互感应性常可获得解决。例如：郑××，男，成。前臂外伤感染后发热持续不退已有两个多月，虽用青霉素、链霉素、四环素、红霉素、卡那霉素和中药大剂清热解毒药治疗仍一直不效。经察其热甚于日晡，并兼胃脘痞满，舌苔白腻，脉濡缓。诊为湿热蕴结。予除湿清热，甘露消毒丹加减2剂后，身热乏力好转；10剂后，发热消失，愈。吴××，男，成。慢性支气管炎、肺气肿20多年。最近两个多月以来，感冒一直不解，除咳嗽气短外，并见长期低热不退。前医遍用抗生素及中药滋阴清热之品，一直不效。细察其证，除上述者外，并见五心烦热，夜间口干加重，心烦，上午身热乏力尤甚，脉虚大弦滑。综合脉证，思之：此证非但具有阴虚，亦且兼有气虚与痰气郁结。乃拟黄芪鳖甲散加减，补气养阴，化痰行气。2剂，发热即减，6剂，诸证均失七八。
长期不愈的咳嗽，一般均认为与痰饮、肺气不得宣降，或阴虚、气虚有关，但在临床上却长期采用此类针对性的药物)C效。为什么呢?若能结合昼夜阴阳、五行的相互感应性，常叫使我们迎刃而解。例如：虞××，女，3岁。咳嗽一个多月，遍用中、西药物治之不效。细审其咳尤甚于下午至前半夜，咳时喉中有回声，且伴有呕吐，舌苔白，脉弦滑。因思日晡属胃，子夜属肾，知其乃痰阻三焦为病，子薄荷、紫苏、半夏、陈皮、大黄、黄芩、杏仁、丝瓜络、神曲、百部。2剂后，咳嗽好转，8剂后咳嗽消失。王××，女，成。咳嗽气短，胸满胸痛，心烦心悸，头晕纳差，口苦口干两个多月。某院诊为心肌炎、急性支气管炎。久用中、西药物治之不效。细审其咳尤甚于夜间刚刚平卧人睡之时，且脉见弦滑而涩。诊为少阳枢机不利，痰饮阻肺。治拟柴胡、半夏、黄芩、干姜、五味子、紫菀。2剂后，咳嗽气短大减；12剂后，诸证俱失。赵××，女，成。咳嗽气短，吐黄痰，身热乏力三个多月。某院诊为左肺中下肺不张。久用中、西药治疗不效。细审上午疲乏无力尤甚，五心烦热，口干甚于夜间，脉虚大弦滑。诊为气阴俱虚，痰热不化。治拟《济生》桔梗汤加减补气养阴，化痰清热。2剂后，诸证稍减；20剂后，诸证俱失，后果愈。
长期不愈的眩晕，医家多从阴虚阳亢沦治，其见效者虽多，而不效者亦不少。如何分析?常常难难，此时若结合昼夜阴阳、五行的相互感应性常可明了。例如：张××，男，成。脑外伤经过抢救虽已大部恢复。但半年多以来，头脑一直眩晕不止，既不能起床，亦不能站立，有时勉强在床上坐起，即因眩晕太甚而摔至地下。医予西药与中药200余剂不效。细审其晕以早晨至上午10时为甚，中午至下午好转，脉虚大。诊为气虚清阳失升。治拟补中益气汤益气升阳。2剂后，头晕乏力大减；30剂后，诸证全失，愈。刘X，男，成。头晕失眠，记忆力衰退七八年。中、西药久治不效。细审其晕，常常早晨严重得不能坐起，随着太阳的升起而逐渐好转，晚上通宵失眠，早晨疲乏思睡，脉沉细弦尺大。诊为肾督亏损，髓海不足。治拟补肾益督。参茸卫生丸、全鹿丸，一日各1丸。20天后，诸证俱失，愈。
烦乱而躁多从火论治，然亦有久治不效者。如何分析：察其昼夜阴阳，五行之感应关系，常可迎刃而解：例如：高XX，男，成。脑血管意外，失语、偏瘫两年多。中、西药久治非但不减，且近三个多月以来又见烦躁不安，虽频用各种中、西药物不见好转。细察其证，烦躁不安均发于下午4-7时．发时掀被露体，不欲近衣被，怒目而视，至上午、夜间即安静而可以入睡。脉弦滑。综合脉证，诊为热炽阳明。拟予白虎承气汤清热通腑。1剂后，烦躁顿减；4剂后，诸证俱失。薛XX，男，成。精神分裂症半年多。中、西药久治不效。细审其证，每至夜间即狂躁不安，力大无伦，甚至呼叫乱跑，毁物击人，有时一夜即跑出一百余里，至次晨即稍省人事，甚至可以入睡。脉弦滑稍数。综合脉证，诊为痰瘀互结，瘀热发狂。治拟抵当、陷胸合方通腑泄热，逐瘀。1剂后，狂躁顿减；6剂后，诸证全失，愈。
头痛一证，虚实俱见，阴阳并存，外感易治，内伤难疗，常常中、西药久用而毫无起色如何辨证?若结合昼夜阴阳、五行之相应，常可使心脑赫然开朗。例如：柳××，男，成。头痛8年多。医诊血管神经性头痛。遍用中西药物治疗始终不效。细审其痛均发于早晨起床后半个多小时，其后自然缓解。舌苔白，脉弦大。综合脉证，诊为气虚清阳失升。拟补中益气汤加细辛、蔓荆子补气升阳。2剂后，头痛好转，30剂后，头痛消失，高××，女，成。头痛数年。医诊神经性头痛。频用中、西药治疗，不见改善。细审其头痛尤以下午为甚，且面色萎黄，舌苔白，脉沉细。综合脉证，诊为血虚阳亢。治拟四物汤加钩藤、龙骨、牡蛎、薄荷养血平肝。2剂后，头痛好转；20剂后，头痛尽失。
喘哮一证，虽痰饮所致者很多，然久治不愈者，虚证者亦不少，且五脏俱有，虚实常兼，故治之恒难。然若结合昼夜阴阳、五行感应之理，常可使病证得明，治疗有法。例如：张XX，女，成。高血压病十几年，高血压性心脏病4—5年。中、西药久治不效：细审其喘每于早晨起床至10时发作，头晕亦以早晨至10时为重，其他时间明显改善，脉虚大弦数。综合脉证，诊为气虚清阳失升。治拟补中益气汤加麦冬、五味子益气升阳。2剂后，气短而喘，头晕乏力好转；30剂后，喘而短气消失，头晕乏力大减。血压由220／120mmHg降至180／90mmHg。石××，男，成。慢性支气管炎十几年，肺气肿，肺心病三年多。中、西药久治不效。细审其三年来，一直咳喘不能平卧，夜间加重，浮肿尿少，发绀，舌苔白，舌质紫黯。综合脉证，诊为心肾阳虚，表寒内饮之证。治拟小青龙汤加附子、茯苓温阳化饮，宣肺定喘。2剂后，咳喘好转；12剂后，咳喘大减，浮肿好转；20剂后，咳喘、浮肿均消失。
胃脘疼痛久久难解者，若能结合昼夜阴阳、五行之相应，常可辨明其病位与病性。例如：杨××，男，成。胃脘疼痛2年多。中、西药久治始终效果不著。经察其痛均发于夜间，有时夜间突然痛醒而不能人睡，且不能吃冷性饮食。脉沉弦。综合脉证，诊为寒凝血滞。冶拟少腹逐瘀汤活血化瘀，温经止痛。1剂后，疼痛大减；10剂后，疼痛消失，愈。
腰腿疼痛以风寒湿痹为多，故常以独活寄生汤取效。然亦有久久不愈，补肾无功，活血难效者。何故?若能结合昼夜阴阳、五行之相应关系，常可一辨即明。例如：郜××，女，成。腰腿疼痛3年多，翻身活动均极困难。中、西药物、针灸、按摩久治不效。细审其痛尤以早晨起床时为甚，随着天之渐渐明亮而逐渐好转。脉弦细尺大。综合脉证，诊为肝郁血虚，寒湿着于腰肾。治拟逍遥散加干姜、狗脊养血疏肝，温肾。1剂后，疼痛大减；6剂后，疼痛大部消失，后果愈。邢××，女，成。肺癌骨转移后腿痛难忍半年多：中、西药并用不能减轻一时之痛苦。细审其疼痛昼轻夜剧，尤以半夜为甚，口干，舌苔白，脉弦大而紧。综合脉证，诊为肾气不足。治拟十味地黄汤益肾补阳加淫羊藿、蜂房。2剂后痛减，10剂后疼痛竟失。
又如患者骆××，女性，10岁。从一周岁起便经常在身上乱抓，睡眠不安稳，几乎每晚都需要父母在身上搔抓半小时才能安然入睡，睡眠过程中仍见其双手到处乱抓，有时因奇痒难忍而突然痛哭不止，不再入睡。稍大一些后，见她经常诉说全身奇痒难忍，昼夜难以入睡。几乎每夜入睡之前均需抓得血迹斑斑。为此曾经到处求医诊治，但一直效果不明显。仔细考察其所用药物，除西药外，中药大多均为祛风除湿清热之剂。仔细考察其证候，除上述症状外，还见舌苔薄白，脉象沉弦细。综合脉象与证候，思考分析：血属于阴，肝藏血，血虚导致燥热生风，则夜间瘙痒加重，用手搔抓后症状减轻是因为泄去了风邪。治疗拟定养血活血，凉血散风。处方：丹参15克，银花10克，连翘10克，当归10克，川芎10克，白芍10克；生地15克，薄荷3克。服用6剂后，其瘙痒大幅减轻，且有时不抓也可以入睡。继续服用上方24剂，身痒消失，痊愈。某医生说：前代医家反复告诫说：痒即为风，所以治痒应当从风论治。然而前医屡用祛风之剂不仅无效，反而使病情加重，这是为什么呢？老师如今仅用薄荷一味药来散风，而且用量仅仅3克，祛风之力明显不足，而其疗效却显著，这是为什么呢？回答说：风邪，有内风、外风的区别。外风者，应当疏散风邪，如桂枝汤（调和营卫）、麻黄汤（发汗解表）、消风散（疏风养血）等方剂即可。内风者，尤其应当治疗产生内风的病因，若因血中燥热而生风者，应当养血活血凉血，这就是所谓的“养血祛风”，即“治风先治血，血行风自灭”的意思。反之，若血中有燥热，不去养血、活血、凉血，却只去散风以伤血，必然使燥热更甚而风邪内生，诸证加剧。该医生再问：疥疮、皮炎夜间奇痒者可用养血凉血活血法治愈，其他疾病如此者也可用此方吗？回答说：可以。
例如：患者耿××，女性，成年。全身皮疹瘙痒十几年。某医院诊断为慢性湿疹。先用西药治疗数年无效，后又请某中医以中药祛风除湿清热治疗3年仍无效。不得已，又用中、西药联合治疗半年，其症状更加剧烈。邀请我治疗。仔细审查其证候：全身满布皮疹，小的如针尖，大的如高粱粒，奇痒难忍，夜间尤其严重，有时非抓至出血不能减轻症状，舌苔白，脉象沉细。综合脉象与证候，诊断为湿邪久久不解，侵入血络，久损阴血所致。治疗以养血活血凉血。处用方：丹参15克，当归10克，川芎10克，生地10克，白芍10克，银花10克，连翘10克，薄荷3克。服用4剂，其瘙痒即减轻。继续服用10剂，诸证消失，痊愈。该医生又问：皮炎之用养血活血、凉血解毒尚且可以理解，今湿疹之用清热除湿散风无效，而用养血活血凉血反而有效，我无法理解？回答说：《素问·至真要大论》说：“气有高下，病有远近，证有中外，治有轻重，适其至所为故也。”如今本病已由气分进入血分，且发现有血中燥热，故治疗气分之湿热无效，治疗血分反而痊愈。又问：辨证的方法如何？回答说：《灵枢·顺气一日分为四时》言不入脏者宜从一日分为四时辨之，入于五脏者宜从脏气之所不胜时者甚辨之。云：“夫百病者，多以旦慧，昼安，夕加，夜甚，何也？岐伯曰：四时之气使然。黄帝曰：愿闻四时之气。岐伯曰：春生、夏长、秋收、冬藏，是气之常也，人亦应之。以一日分为四时，朝则为春，日中为夏，日人为秋，夜半为冬。朝则人气始生，病气衰，故旦慧；日中人气长，长则胜邪，故安；夕则人气始衰，邪气始生，故加；夜半人气入脏，邪气独居于身，故甚也。”
昼夜的推移与辨证
数千年来，我国劳动人民和科学工作者发现某些生物的活动特性和人的病理生理学变化，具有明显的时间性特征。例如：公鸡按时鸣啼，合欢、首乌的茎叶按时开合，人体的疾病多以早晨清醒、白天安宁、傍晚加重、夜间严重为特点。
那么这种现象是怎么发生的呢？古人认为在自然界中存在著一种既对立而又统一的气，这种气的相对静止部分称为阴，相对活动部分称为阳，并认为天地之间的阴阳和人体的阴阳之间有著一种相互感应的关系，这种感应常因人的体质和自然界的变化程度而有所谓的恍惚之数或严重程度的改变。正如《素问·金匮真言论》所说：“平旦至日中，天之阳，阳中之阳也；日中至黄昏，天之阳，阳中之阴也；合夜至鸡鸣，天之阴，阴中之阴也；鸡鸣至平旦，天之阴，阴中之阳也。”人亦应之，而发生“昼则阳气在外也，平旦人气生，以日初生也；日中阳气隆，以日当午也；日西阳气虚，以日渐落也。”
古人还认为，不但自然界的阴阳和人体的阴阳有着相互感应的关系，而且昼夜的五行变化和人体病理生理上也有相互感应的关系。《素问·玉机真脏论》说：“一日一夜五分之，此所以占死生之蚤暮也。”《类经》说：“五分者，朝主甲乙，昼主丙丁，四季土主戊己，晡主庚辛，夜主壬癸。”“人亦应之……朝则人气加，夜半人气入脏，邪气独居于身，故甚也。”
既然昼夜的阴阳、五行变化和人体病理生理的阴阳、五行变化是相互感应的，那么可不可以利用这种变化去辨证论治呢？回答是肯定的。例如：发热中的长期低热不退，一般都认为是阴虚发热，但是治疗时又长期应用滋阴清热药不退，这是为什么呢？此时若能结合昼夜阴阳、五行的相互感应性常可获得解决。例如：郑××，男性，成年。前臂外伤感染后发热持续不退已有两个多月，虽用青霉素、链霉素、四环素、红霉素、卡那霉素和中药大剂清热解毒药治疗仍一直无效。经察其热甚于日晡（下午3-5点），并兼胃脘痞满，舌苔白腻，脉象濡缓。诊断为湿热蕴结。予除湿清热，甘露消毒丹加减2剂后，身热乏力好转；10剂后，发热消失，痊愈。吴××，男性，成年。慢性支气管炎、肺气肿20多年。最近两个多月以来，感冒一直不解，除咳嗽气短外，并见长期低热不退。前医遍用抗生素及中药滋阴清热之品，一直无效。仔细考察其证候，除上述症状外，还见五心烦热，夜间口干加重，心烦，上午身热乏力尤甚，脉象虚大弦滑。综合脉象与证候，思考分析：此证非但具有阴虚，亦且兼有气虚与痰气郁结。乃拟黄芪鳖甲散加减，补气养阴，化痰行气。2剂，发热即减，6剂，诸证均失七八。
长期不愈的咳嗽，一般均认为与痰饮、肺气不得宣降，或阴虚、气虚有关，但在临床上却长期采用此类针对性的药物无效。为什么呢？若能结合昼夜阴阳、五行的相互感应性，常可使我们迎刃而解。例如：虞××，女性，3岁。咳嗽一个多月，遍用中、西药物治之不效。仔细审查其咳尤甚于下午至前半夜，咳时喉中有回声，且伴有呕吐，舌苔白，脉象弦滑。因思日晡属胃，子夜属肾，知其乃痰阻三焦为病，予薄荷、紫苏、半夏、陈皮、大黄、黄芩、杏仁、丝瓜络、神曲、百部。2剂后，咳嗽好转，8剂后咳嗽消失。王××，女性，成年。咳嗽气短，胸满胸痛，心烦心悸，头晕纳差，口苦口干两个多月。某医院诊断为心肌炎、急性支气管炎。久用中、西药物治疗无效。仔细审查其咳尤甚于夜间刚刚平卧入睡之时，且脉见弦滑而涩。诊断为少阳枢机不利，痰饮阻肺。治疗拟定柴胡、半夏、黄芩、干姜、五味子、紫菀。2剂后，咳嗽气短大减；12剂后，诸证俱失。赵××，女性，成年。咳嗽气短，吐黄痰，身热乏力三个多月。某医院诊断为左肺中下肺不张。久用中、西药治疗无效。仔细审查上午疲乏无力尤甚，五心烦热，口干甚于夜间，脉象虚大弦滑。诊断为气阴俱虚，痰热不化。治疗拟定《济生》桔梗汤加减补气养阴，化痰清热。2剂后，诸证稍减；20剂后，诸证俱失，后果痊愈。
长期不愈的眩晕，医家多从阴虚阳亢论治，其见效者虽多，而不效者亦不少。如何分析？常常难难，此时若结合昼夜阴阳、五行的相互感应性常可明了。例如：张××，男性，成年。脑外伤经过抢救虽已大部恢复。但半年多以来，头脑一直眩晕不止，既不能起床，亦不能站立，有时勉强在床上坐起，即因眩晕太甚而摔至地下。医予西药与中药200余剂无效。仔细审查其晕以早晨至上午10时为甚，中午至下午好转，脉象虚大。诊断为气虚清阳失升。治疗拟定补中益气汤益气升阳。2剂后，头晕乏力大减；30剂后，诸证全失，痊愈。刘X，男性，成年。头晕失眠，记忆力衰退七八年。中、西药久治无效。仔细审查其晕，常常早晨严重得不能坐起，随着太阳的升起而逐渐好转，晚上通宵失眠，早晨疲乏思睡，脉象沉细弦尺大。诊断为肾督亏损，髓海不足。治疗拟定补肾益督。参茸卫生丸、全鹿丸，一日各1丸。20天后，诸证俱失，痊愈。
烦乱而躁多从火论治，然亦有久治不效者。如何分析？察其昼夜阴阳，五行之感应关系，常可迎刃而解：例如：高XX，男性，成年。脑血管意外，失语、偏瘫两年多。中、西药久治非但不减，且近三个多月以来又见烦躁不安，虽频用各种中、西药物不见好转。仔细考察其证候，烦躁不安均发于下午4-7时，发时掀被露体，不欲近衣被，怒目而视，至上午、夜间即安静而可以入睡。脉象弦滑。综合脉象与证候，诊断为热炽阳明。拟定予白虎承气汤清热通腑。1剂后，烦躁顿减；4剂后，诸证俱失。薛XX，男性，成年。精神分裂症半年多。中、西药久治无效。仔细审查其证候，每至夜间即狂躁不安，力大无伦，甚至呼叫乱跑，毁物击人，有时一夜即跑出一百余里，至次晨即稍省人事，甚至可以入睡。脉象弦滑稍数。综合脉象与证候，诊断为痰瘀互结，瘀热发狂。治疗拟定抵当汤、陷胸汤合方通腑泄热，逐瘀。1剂后，狂躁顿减；6剂后，诸证全失，痊愈。
头痛一证，虚实俱见，阴阳并存，外感易治，内伤难疗，常常中、西药久用而毫无起色如何辨证？若结合昼夜阴阳、五行之相应，常可使心脑豁然开朗。例如：柳××，男性，成年。头痛8年多。医诊血管神经性头痛。遍用中西药物治疗始终无效。仔细审查其痛均发于早晨起床后半个多小时，其后自然缓解。舌苔白，脉象弦大。综合脉象与证候，诊断为气虚清阳失升。拟定补中益气汤加细辛、蔓荆子补气升阳。2剂后，头痛好转，30剂后，头痛消失，高××，女性，成年。头痛数年。医诊神经性头痛。频用中、西药治疗，不见改善。仔细审查其头痛尤以下午为甚，且面色萎黄，舌苔白，脉象沉细。综合脉象与证候，诊断为血虚阳亢。治疗拟定四物汤加钩藤、龙骨、牡蛎、薄荷养血平肝。2剂后，头痛好转；20剂后，头痛尽失。
喘哮一证，虽痰饮所致者很多，然久治不愈者，虚证者亦不少，且五脏俱有，虚实常兼，故治之恒难。然若结合昼夜阴阳、五行感应之理，常可使病证得明，治疗有法。例如：张XX，女性，成年。高血压病十几年，高血压性心脏病4—5年。中、西药久治无效：仔细审查其喘每于早晨起床至10时发作，头晕亦以早晨至10时为重，其他时间明显改善，脉象虚大弦数。综合脉象与证候，诊断为气虚清阳失升。治疗拟定补中益气汤加麦冬、五味子益气升阳。2剂后，气短而喘，头晕乏力好转；30剂后，喘而短气消失，头晕乏力大减。血压由220／120mmHg降至180／90mmHg。石××，男性，成年。慢性支气管炎十几年，肺气肿，肺心病三年多。中、西药久治无效。仔细审查三年来，一直咳喘不能平卧，夜间加重，浮肿尿少，发绀，舌苔白，舌质紫黯。综合脉象与证候，诊断为心肾阳虚，表寒内饮之证。治疗拟定小青龙汤加附子、茯苓温阳化饮，宣肺定喘。2剂后，咳喘好转；12剂后，咳喘大减，浮肿好转；20剂后，咳喘、浮肿均消失。
胃脘疼痛久久难解者，若能结合昼夜阴阳、五行之相应，常可辨明其病位与病性。例如：杨××，男性，成年。胃脘疼痛2年多。中、西药久治始终效果不著。经察其痛均发于夜间，有时夜间突然痛醒而不能入睡，且不能吃冷性饮食。脉象沉弦。综合脉象与证候，诊断为寒凝血滞。治疗拟定少腹逐瘀汤活血化瘀，温经止痛。1剂后，疼痛大减；10剂后，疼痛消失，痊愈。
腰腿疼痛以风寒湿痹为多，故常以独活寄生汤取效。然亦有久久不愈，补肾无功，活血难效者。何故？若能结合昼夜阴阳、五行之相应关系，常可一辨即明。例如：郜××，女性，成年。腰腿疼痛3年多，翻身活动均极困难。中、西药物、针灸、按摩久治无效。仔细审查其痛尤以早晨起床时为甚，随着天之渐渐明亮而逐渐好转。脉象弦细尺大。综合脉象与证候，诊断为肝郁血虚，寒湿着于腰肾。治疗拟定逍遥散加干姜、狗脊养血疏肝，温肾。1剂后，疼痛大减；6剂后，疼痛大部消失，后果痊愈。邢××，女性，成年。肺癌骨转移后腿痛难忍半年多：中、西药并用不能减轻一时之痛苦。仔细审查其疼痛昼轻夜剧，尤以半夜为甚，口干，舌苔白，脉象弦大而紧。综合脉象与证候，诊断为肾气不足。治疗拟定十味地黄汤益肾补阳加淫羊藿、蜂房。2剂后痛减，10剂后疼痛竟失。
Furthermore, consider the patient Luo XX, female, 10 years old. Starting from one year of age, she frequently scratched her body indiscriminately, experienced restless sleep, and almost every night required her parents to scratch her body for half an hour before she could fall asleep peacefully. Even during sleep, her hands were seen scratching everywhere; sometimes, due to unbearable itching, she would suddenly cry uncontrollably and stop sleeping. As she grew slightly older, it was observed that she often complained of unbearable itching all over her body, making it difficult to sleep day or night. Almost every night before falling asleep, she had to scratch until her skin bled. For this reason, she sought medical treatment everywhere, but the results were consistently unsatisfactory. Upon careful examination of the medications used, apart from Western medicines, most Chinese herbal prescriptions were agents for dispelling wind, removing dampness, and clearing heat. Upon careful examination of her syndrome, in addition to the above symptoms, her tongue coating was thin and white, and her pulse was deep, wiry, and fine. Synthesizing the pulse and syndrome, analysis reveals: Blood belongs to Yin, and the Liver stores blood. Blood deficiency leads to dryness-heat generating wind, causing intensified itching at night. Scratching with hands alleviates the condition by venting the wind. The treatment principle is formulated as nourishing blood and invigorating blood, cooling blood and dispersing wind. Prescription: Danshen (Salvia miltiorrhiza Radix et Rhizoma) 15g, Yinhua (Lonicerae Japonicae Flos) 10g, Lianqiao (Forsythiae Fructus) 10g, Danggui (Angelicae Sinensis Radix) 10g, Chuanxiong (Chuanxiong Rhizoma) 10g, Baishao (Paeoniae Radix Alba) 10g; Shengdi (Rehmanniae Radix) 15g, Bohe (Menthae Haplocalycis Herba) 3g. After taking 6 doses, the itching decreased significantly, and sometimes she could fall asleep without scratching. Continuing to take the above prescription for 24 doses, the body itching disappeared, and she recovered. A certain doctor said: Previous generations of physicians repeatedly warned that "itching is wind," therefore treating itching should focus on wind. However, why did previous doctors' repeated use of wind-dispelling agents not only fail but also exacerbate the condition? Why does the teacher's current use of only Bohe (Menthae Haplocalycis Herba) to disperse wind, with a mere dose of 3g, which clearly lacks strong wind-dispelling power, yield such remarkable efficacy? The answer is: Wind pathogens are distinguished into internal wind and external wind. For external wind, one should disperse the wind pathogen, using formulas such as Guizhi Tang (Cinnamon Twig Decoction), Mahuang Tang (Ephedra Decoction), or Xiaofeng San (Wind-Dispersing Powder). For internal wind, it is especially important to treat the cause of the internal wind. If wind is generated due to dryness-heat in the blood, one should nourish, invigorate, and cool the blood. This is what is meant by "nourishing blood to dispel wind," i.e., "to treat wind, first treat the blood; when blood flows, wind extinguishes itself." Conversely, if there is dryness-heat in the blood, failing to nourish, invigorate, and cool the blood, but instead merely dispersing wind which damages the blood, will inevitably intensify the dryness and generate more wind, aggravating all symptoms. The doctor asked again: Nighttime severe itching in scabies and dermatitis can be cured by nourishing, cooling, and invigorating blood therapy. Can this formula be used for other diseases presenting similarly? The answer is: Yes.
For example, patient Geng XX, female, adult. She has suffered from whole-body rash and itching for over ten years. A certain hospital diagnosed chronic eczema. Western medicine treatment for several years was ineffective. Subsequently, a certain Traditional Chinese Medicine (TCM) doctor treated her with TCM herbs for dispelling wind, removing dampness, and clearing heat for 3 years, still without effect. Out of desperation, combined TCM and Western medicine treatment was used for half a year, yet her condition worsened. I was invited to treat her. Careful review of her syndrome revealed: Whole-body covered with rashes, small ones like pinpoints, large ones like sorghum grains, unbearable itching, especially severe at night; sometimes symptoms could only be relieved by scratching until bleeding occurred. Tongue coating was white, pulse was deep and fine. Synthesizing pulse and syndrome, the diagnosis was prolonged unresolved dampness invading the blood collaterals, causing long-term damage to Yin and blood. Treatment focused on nourishing, invigorating, and cooling blood. Prescription: Danshen 15g, Danggui 10g, Chuanxiong 10g, Shengdi 10g, Baishao 10g, Yinhua 10g, Lianqiao 10g, Bohe 3g. After 4 doses, itching decreased. Continuing for another 10 doses, all symptoms disappeared, and she recovered. The doctor asked again: Using blood-nourishing, blood-invigorating, and blood-cooling detoxification for dermatitis is understandable. However, why did clearing heat, removing dampness, and dispersing wind fail for eczema, while blood-nourishing, blood-invigorating, and blood-cooling succeeded? I cannot understand. The answer is: *Suwen: Zhenshi Yao Da Lun* states: "Qi has high and low positions, diseases have distant and near origins, syndromes have exterior and interior locations, treatments have light and heavy degrees; the key is to reach the target accurately." Currently, this disease has progressed from the Qi level to the Blood level, and blood dryness-heat is evident. Therefore, treating damp-heat at the Qi level failed, while treating the Blood level resulted in recovery. He asked again: What is the method for syndrome differentiation? The answer is: *Ling Shu: Shun Qi Yi Ri Fen Wei Si Shi* states that for diseases not entering the Zang organs, differentiation should follow the division of one day into four seasons; for diseases entering the five Zang organs, differentiation should focus on times when the Zang qi is overcome. It says: "Among hundreds of diseases, many show clarity in the morning, peace during the day, worsening in the evening, and severity at night. Why?" Qibo replied: "This is caused by the Qi of the four seasons." Huangdi said: "I wish to hear about the Qi of the four seasons." Qibo said: "Spring generates, Summer grows, Autumn harvests, Winter stores; this is the constant pattern of Qi, and humans correspond to it. Dividing one day into four seasons, morning is Spring, noon is Summer, sunset is Autumn, midnight is Winter. In the morning, human Qi begins to grow, disease Qi declines, hence clarity in the morning; at noon, human Qi grows, growth overcomes evil, hence peace; in the evening, human Qi begins to decline, evil Qi begins to generate, hence worsening; at midnight, human Qi enters the Zang organs, evil Qi resides alone in the body, hence severity."
The Progression of Day and Night and Syndrome Differentiation
For thousands of years, the working people and scientific workers of our country have discovered that the activity characteristics of certain organisms and the pathophysiological changes in humans exhibit distinct temporal features. For example: Roosters crow at regular times, the stems and leaves of Albizia julibrissin (Hehuan) and Polygonum multiflorum (Shouwu) open and close at specific times, and human diseases often manifest as clear in the morning, peaceful during the day, worsening in the evening, and severe at night.
How does this phenomenon occur? The ancients believed that in nature exists a Qi that is both opposing and unified. The relatively static part of this Qi is called Yin, and the relatively active part is called Yang. They believed that there is a mutual resonance relationship between the Yin-Yang of heaven and earth and the Yin-Yang of the human body. This resonance often varies in degree or severity due to individual constitution and the extent of natural changes. As stated in *Suwen: Jingui Zhenyan Lun*: "From dawn to noon, it is Heaven's Yang, Yang within Yang; from noon to dusk, it is Heaven's Yang, Yin within Yang; from twilight to rooster-crow, it is Heaven's Yin, Yin within Yin; from rooster-crow to dawn, it is Heaven's Yin, Yang within Yin." Humans correspond to this, resulting in "Yang Qi is outside during the day; at dawn, human Qi generates because the sun is rising; at noon, Yang Qi is robust because the sun is at its zenith; in the west, Yang Qi is deficient because the sun is setting."
The ancients also believed that not only do the Yin-Yang of nature and the human body resonate, but the Five Elements changes of day and night also resonate with human pathophysiology. *Suwen: Yuji Zhenzang Lun* states: "Divide one day and night into five parts; this is how to predict early or late death." *Leijing* states: "The five parts refer to: Morning governs Jia and Yi (Wood), Day governs Bing and Ding (Fire), Four Seasons Earth governs Wu and Ji (Earth), Late Afternoon governs Geng and Xin (Metal), Night governs Ren and Gui (Water)." "Humans correspond... In the morning, human Qi increases; at midnight, human Qi enters the Zang organs, evil Qi resides alone in the body, hence severity."
Since the Yin-Yang and Five Elements changes of day and night resonate with those of human pathophysiology, can we utilize these changes for syndrome differentiation and treatment? The answer is affirmative. For example: Persistent low-grade fever in fever cases is generally considered Yin-deficiency fever. However, long-term application of Yin-nourishing and heat-clearing drugs often fails. Why? At this time, combining the mutual resonance of Yin-Yang and Five Elements of day and night often resolves the issue. For instance, patient Zheng XX, male, adult. After infection from a forearm trauma, fever persisted for over two months. Despite treatment with Penicillin, Streptomycin, Tetracycline, Erythromycin, Kanamycin, and large doses of TCM heat-clearing and detoxifying herbs, it remained ineffective. Observation showed fever was worse in the late afternoon (Shen hour), accompanied by epigastric fullness, white greasy tongue coating, and soggy-slow pulse. Diagnosed as Damp-Heat accumulation. Prescribed Ganlu Xiaodu Dan (Sweet Dew Detoxifying Powder) modified for dampness removal and heat clearing. After 2 doses, fever and fatigue improved; after 10 doses, fever disappeared, and he recovered. Patient Wu XX, male, adult. Chronic bronchitis and emphysema for over 20 years. For the past two months, colds have not resolved. Besides cough and shortness of breath, persistent low-grade fever occurred. Previous doctors used antibiotics and Yin-nourishing heat-clearing TCM without effect. Careful examination revealed five-center heat, aggravated nighttime dry mouth, irritability, severe morning fever and fatigue, and a deficient-large-wiry-slipping pulse. Synthesizing pulse and syndrome, analysis indicated this syndrome involved not only Yin deficiency but also Qi deficiency and Phlegm-Qi stagnation. Prescribed Huangqi Biejia San (Astragalus Softshell Turtle Shell Powder) modified to tonify Qi, nourish Yin, resolve phlegm, and move Qi. After 2 doses, fever decreased; after 6 doses, 70-80% of symptoms vanished.
Chronic unresolving cough is generally associated with Phlegm-Fluid retention, failure of Lung Qi to diffuse and descend, or Yin/Qi deficiency. However, targeted drugs often fail clinically. Why? Combining the mutual resonance of Yin-Yang and Five Elements of day and night often provides solutions. For example, patient Yu XX, female, 3 years old. Cough persisted for over a month, unresponsive to various TCM and Western medicines. Careful review showed cough was worse from afternoon to early night, with echoing sounds in the throat during coughing, accompanied by vomiting. Tongue coating was white, pulse was wiry-slippery. Considering Shen hour belongs to Stomach and Zi hour belongs to Kidney, it was known as Phlegm obstructing the Triple Burner. Prescribed Bohe, Zisu, Banxia, Chenpi, Dahuang, Huangqin, Xingren, Sigualuo, Shenqu, Baibu. After 2 doses, cough improved; after 8 doses, cough disappeared. Patient Wang XX, female, adult. Cough, shortness of breath, chest fullness/pain, irritability, palpitations, dizziness, poor appetite, bitter/dry mouth for over two months. Diagnosed with myocarditis and acute bronchitis. Long-term TCM/Western treatment failed. Careful review showed cough was worst just upon lying flat to sleep, with wiry-slippery-choppy pulse. Diagnosed as Shaoyang pivot dysfunction, Phlegm-Fluid obstructing Lung. Treatment prescribed Chaihu, Banxia, Huangqin, Ganjiang, Wuweizi, Ziwan. After 2 doses, cough and shortness of breath greatly reduced; after 12 doses, all symptoms vanished. Patient Zhao XX, female, adult. Cough, shortness of breath, yellow sputum, fever/fatigue for over three months. Diagnosed with left lower lung atelectasis. Long-term treatment failed. Careful review showed severe morning fatigue, five-center heat, worse nighttime dry mouth, deficient-large-wiry-slippery pulse. Diagnosed as dual Qi-Yin deficiency, Phlegm-Heat not transforming. Prescribed Jisheng Jiegeng Tang modified to tonify Qi, nourish Yin, resolve phlegm, clear heat. After 2 doses, symptoms slightly reduced; after 20 doses, all symptoms vanished, eventually recovering.
Chronic unresolving vertigo is mostly treated as Yin deficiency with Yang hyperactivity. While many respond, many do not. How to analyze? Often difficult. Combining the mutual resonance of Yin-Yang and Five Elements of day and night often clarifies. For example, patient Zhang XX, male, adult. Partially recovered from traumatic brain injury. However, for over half a year, continuous vertigo prevented getting up or standing. Sitting up in bed caused falls due to severe vertigo. Over 200 doses of Western and TCM medicines failed. Careful review showed vertigo was worst from morning to 10 AM, improving noon to afternoon, with deficient-large pulse. Diagnosed as Qi deficiency with failure of Clear Yang to ascend. Prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to tonify Qi and raise Yang. After 2 doses, dizziness and fatigue greatly reduced; after 30 doses, all symptoms vanished, recovering. Patient Liu X, male, adult. Dizziness, insomnia, memory decline for 7-8 years. Long-term TCM/Western treatment failed. Careful review showed severe morning dizziness preventing sitting up, improving with sunrise, all-night insomnia, morning fatigue/sleepiness, deep-fine-wiry pulse with large Chi position. Diagnosed as Kidney and Du vessel deficiency, insufficiency of Marrow Sea. Prescribed Kidney-tonifying and Du-mending therapy: Shenrong Weisheng Wan and Quanlu Wan, 1 pill each daily. After 20 days, all symptoms vanished, recovering.
Restlessness and agitation are often treated as Fire, yet some resist long-term treatment. How to analyze? Observing the Yin-Yang and Five Elements resonance of day and night often solves it. For example, patient Gao XX, male, adult. Stroke sequelae: aphasia, hemiplegia for over two years. Long-term TCM/Western treatment failed, and for the past three months, restlessness increased. Frequent use of various medicines showed no improvement. Careful observation showed restlessness occurred between 4-7 PM, with kicking off blankets, exposing body, aversion to clothing/bedding, glaring eyes; quiet and able to sleep in the morning and night. Pulse was wiry-slippery. Synthesizing pulse and syndrome, diagnosed as Intense Heat in Yangming. Prescribed Baihu Chengqi Tang (White Tiger and Major Order the Interior Decoction) to clear heat and purge bowels. After 1 dose, restlessness instantly reduced; after 4 doses, all symptoms vanished. Patient Xue XX, male, adult. Schizophrenia for over half a year. Long-term treatment failed. Careful review showed nightly mania, immense strength, shouting, running, destroying objects, attacking people, running over 100 li in one night; regaining consciousness slightly next morning, able to sleep. Pulse was wiry-slippery slightly rapid. Synthesizing pulse and syndrome, diagnosed as Phlegm-Blood stasis intermingling, Blood-Heat causing madness. Prescribed Didang Tang and Xiongxiong Tang combined to purge bowels, drain heat, and remove stasis. After 1 dose, mania instantly reduced; after 6 doses, all symptoms vanished, recovering.
Headache presents both deficiency and excess, Yin and Yang coexisting. Exterior attacks are easy to treat, internal injuries hard. Long-term TCM/Western treatment often yields no result. How to differentiate? Combining Yin-Yang and Five Elements resonance of day and night brings clarity. For example, patient Liu XX, male, adult. Headache for over 8 years. Diagnosed with vascular-neurotic headache. Various TCM/Western medicines failed. Careful review showed pain started half an hour after waking, then naturally relieved. White tongue coating, large-wiry pulse. Synthesizing pulse and syndrome, diagnosed as Qi deficiency with failure of Clear Yang to ascend. Prescribed Buzhong Yiqi Tang plus Xixin and Manjingzi to tonify Qi and raise Yang. After 2 doses, headache improved; after 30 doses, headache disappeared. Patient Gao XX, female, adult. Headache for years. Diagnosed with neurotic headache. Frequent TCM/Western treatment showed no improvement. Careful review showed headache worst in afternoon, sallow complexion, white tongue coating, deep-fine pulse. Synthesizing pulse and syndrome, diagnosed as Blood deficiency with Yang hyperactivity. Prescribed Siwu Tang plus Gouteng, Longgu, Muli, Bohe to nourish Blood and calm Liver. After 2 doses, headache improved; after 20 doses, headache completely vanished.
Wheezing and asthma are often caused by Phlegm-Fluid, but chronic cases often involve deficiency, affecting all five Zang organs, mixing deficiency and excess, making treatment difficult. However, combining the principle of Yin-Yang and Five Elements resonance of day and night clarifies the syndrome and guides treatment. For example, patient Zhang XX, female, adult. Hypertension for over ten years, hypertensive heart disease for 4-5 years. Long-term treatment failed. Careful review showed wheezing occurred from morning wake-up to 10 AM, dizziness also worst in this period, improving otherwise, deficient-large-wiry-rapid pulse. Synthesizing pulse and syndrome, diagnosed as Qi deficiency with failure of Clear Yang to ascend. Prescribed Buzhong Yiqi Tang plus Maidong and Wuweizi to tonify Qi and raise Yang. After 2 doses, shortness of breath/wheezing and dizziness/fatigue improved; after 30 doses, wheezing/shortness of breath vanished, dizziness/fatigue greatly reduced. Blood pressure dropped from 220/120 mmHg to 180/90 mmHg. Patient Shi XX, male, adult. Chronic bronchitis for over ten years, emphysema, cor pulmonale for over three years. Long-term treatment failed. Careful review showed inability to lie flat due to cough/wheezing for three years, worsening at night, edema, oliguria, cyanosis, white tongue coating, purple-dark tongue body. Synthesizing pulse and syndrome, diagnosed as Heart-Kidney Yang deficiency, Exterior Cold with Internal Fluid retention. Prescribed Xiao Qinglong Tang plus Fuzi and Fuling to warm Yang, transform fluid, diffuse Lung, and calm wheezing. After 2 doses, cough/wheezing improved; after 12 doses, greatly reduced, edema improved; after 20 doses, cough/wheezing and edema both vanished.
Epigastric pain resistant to resolution can be clarified regarding location and nature by combining Yin-Yang and Five Elements resonance of day and night. For example, patient Yang XX, male, adult. Epigastric pain for over 2 years. Long-term TCM/Western treatment ineffective. Observation showed pain occurred at night, sometimes waking him abruptly, unable to eat cold foods. Deep-wiry pulse. Synthesizing pulse and syndrome, diagnosed as Cold congealing and Blood stasis. Prescribed Shaofu Zhuyu Tang to invigorate Blood, remove stasis, warm meridians, and stop pain. After 1 dose, pain greatly reduced; after 10 doses, pain vanished, recovering.
Waist and leg pain is mostly Wind-Cold-Damp Bi syndrome, often responding to Duhuo Jisheng Tang. However, some cases persist despite Kidney-tonifying and Blood-invigorating efforts. Why? Combining Yin-Yang and Five Elements resonance of day and night clarifies immediately. For example, patient Gao XX, female, adult. Waist/leg pain for over 3 years, extreme difficulty turning/moving. Long-term TCM/Western/Acupuncture/Massage failed. Careful review showed pain worst upon waking, improving as daylight brightens. Wiry-fine pulse with large Chi position. Synthesizing pulse and syndrome, diagnosed as Liver Qi stagnation and Blood deficiency, Cold-Damp adhering to waist/Kidneys. Prescribed Xiaoyao San plus Ganjiang and Gouji to nourish Blood, soothe Liver, and warm Kidneys. After 1 dose, pain greatly reduced; after 6 doses, mostly vanished, eventually recovering. Patient Xing XX, female, adult. Unbearable leg pain for over half a year due to bone metastasis from lung cancer. Combined TCM/Western medicine failed to relieve temporary pain. Careful review showed pain light by day, severe by night, worst at midnight, dry mouth, white tongue coating, large-tight-wiry pulse. Synthesizing pulse and syndrome, diagnosed as Kidney Qi insufficiency. Prescribed Shiwei Dihuang Tang to tonify Kidney and supplement Yang, plus Yinyanghuo and Fengfang. After 2 doses, pain reduced; after 10 doses, pain vanished.