典藏书目

The young daughter of a family surnamed Dong in Tianjin, aged three, suffered from convulsions.

Etiology: In late spring, the weather was warm, and she wore too many clothes. While playing in the courtyard, she sweated and caught wind, leading to the onset of convulsions at night.

Symptoms: During severe episodes, her eyes were closed, she was unconscious, her body arched backward, and her hands were tightly clenched. During milder episodes, she was conscious, but her tongue was swollen, preventing her from suckling milk; she could only drink tea or formula milk powder. She had loose stools two to three times daily. This condition persisted for three days and nights without improvement. Her spirit gradually became depleted, her skin felt hot, and her pulse indicated heat.

Diagnosis: This was caused by wearing heavy clothing in warm spring weather, resulting in liver heat stagnation. External pathogenic factors stimulated this heat, causing it to rush upward to the brain, displacing the spinal marrow and nerves, thereby disrupting their normal motor functions and inducing convulsions. The treatment method should clear liver heat, disperse external pathogens, and simultaneously use herbs to calm the nerves. The disease would then resolve spontaneously.

Prescription: Raw Huai Shan Yao (Dioscoreae Rhizoma) 1 liang, Hua Shi (Talcum) 8 qian, Raw Hang Shao (Paeoniae Radix Alba) 6 qian, Lian Qiao (Forsythiae Fructus) 3 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3 qian, Quan Wu Gong (Scolopendra) 2 large specimens, Zhu Sha (Cinnabaris) 2 fen, finely powdered.
There are seven ingredients in total. Decoct the first six ingredients to obtain one cup of decoction. Administer the Zhu Sha powder slowly with warm water in divided doses.

Outcome: After one dose, the convulsions ceased. However, her head remained tilted backward, and her left hand remained curled and stiff. The tongue swelling subsided by more than half, allowing her to suckle milk, and the loose stools resolved. The prescription was modified by reducing the amount of Hua Shi by half and adding Xuan Shen (Scrophulariae Radix) 6 qian. After taking this, the left hand uncurled, though the head still tended to tilt backward. Consequently, Hua Shi was removed entirely, and Quan Xie (Scorpio) 3 specimens were added. After one dose, she recovered completely.

The young son of a family surnamed Hou in Liaoning, aged seven, developed Slow Pi Wind (Man Pi Feng) in late autumn.

Etiology: He suffered from malaria in early autumn, which lasted over a month before resolving. After recovery, he felt fullness and hardness under his left hypochondrium. Subsequent administration of multiple blood-stasis-resolving agents led to deficiency-cold of the spleen and stomach, impairing food digestion. This progressed to alternating vomiting and diarrhea, accompanied by limb jerking.

Symptoms: He experienced tidal fever daily, with redness on both cheeks. He slept deeply with his eyes partially open (exposed pupils). His limbs frequently jerked. During severe episodes, the Du Meridian tightened, causing opisthotonos (head bent backward, commonly known as "bowstring tension"). Any food or medicine taken was vomited within half an hour, often bringing up phlegm-saliva. He suffered from frequent diarrhea. His pulse was fine, rapid, and forceless.

Diagnosis: Malaria is a pathogen affecting the liver and gallbladder. Wood pathology insulting Earth implies that prolonged malaria often damages the spleen and stomach. The previous fullness and hardness under the left hypochondrium resulted from spleen injury and distension. Repeated use of digestive and dispersing agents further damaged the Qi transformation of the middle jiao, leading to the accumulation of cold-phlegm and retained fluids overflowing upward. This forced the Yang Qi of the heart and lungs to float upward, causing facial redness, outward floating, and body heat, while the root of the disease remained cold. The inability to retain food was due to obstruction by cold-phlegm. The accompanying diarrhea was due to insecure Qi transformation in the lower jiao. The limb jerking was due to blood deficiency failing to nourish the tendons and liver, causing internal stirring of liver wind and tendon contraction. The severe backward head tilt occurred not only because the Du Meridian contracted due to cold but also because the Du Meridian connects to the nerves; thus, Du Meridian pathology affected the spinal marrow and nerves, altering their normal function. It was proposed to first use the Zhan Han Dang Jing Tang (Expel Cold and Sway Fear Decoction) from *Fu You Bian* to open up the cold-phlegm, enabling him to eat, which is the priority.

Prescription: Hu Jiao (Piperis Longi Fructus) 1 qian, Gan Jiang (Zingiberis Rhizoma) 1 qian, Rou Gui (Cinnamomi Cortex) 1 qian, Ding Xiang (Caryophylli Flos) 10 buds (these four ingredients are crushed together into coarse particles), Gao Li Shen (Panax ginseng C.A.Mey.) 1 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) 1 qian.
First, decoct 3 liang of Zao Xin Tu (Caulis Fornacis) in water until clear, using this water instead of plain water. Decoct the Ren Shen and Gan Cao for seven or eight boils. Then add the previous four ingredients and decoct for three or four boils. Strain to obtain 0.8 cups of clear decoction, and administer slowly via gavage.
This formula is the original Zhan Han Dang Jing Tang plus Ren Shen and Gan Cao. In the original formula, Gan Jiang was processed (pao). However, processing makes its Qi light and floating, turning its pungency into bitterness, and drastically reducing its power to open and descend. Therefore, raw Gan Jiang is superior. Yet, raw Gan Jiang is excessively pungent and irritating, so Gan Cao is added to harmonize it and prolong its action. Ren Shen is added to boost the Great Qi in the chest to facilitate the transformation of the other herbs, as stated by Master Zhongjing: "When the Great Qi rotates, the knots (phlegm-fluids) dissipate."
Furthermore, Hu Jiao is the main herb in this formula. If cold-phlegm is extremely severe, the dosage can be increased to 1.5 qian. Note that Hu Jiao in pharmacies is often old stock, losing potency over time; it is best purchased from spice shops.

Second Visit: After taking the medicine, vomiting stopped immediately, and jerking ceased. Tidal fever and diarrhea seemed to alleviate. It was decided to continue with the Jia Wei Li Zhong Di Huang Tang (Modified Regulate the Middle and Rehmannia Decoction) from *Fu You Bian*, with slight modifications.

Prescription: Shu Huai Di Huang (Rehmanniae Radix Praeparata) 5 qian, Raw Huai Shan Yao (Dioscoreae Rhizoma) 5 qian, Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma Carbonized) 3 qian, Da Gan Gou Qi (Lycii Fructus) 3 qian, Ye Dang Shen (Codonopsis Radix) 2 qian, Zhi Jian Qi (Astragali Radix Honey-fried) 2 qian, Gan Jiang (Zingiberis Rhizoma) 2 qian, Raw Hang Shao (Paeoniae Radix Alba) 2 qian, Jing Yu Rou (Corni Fructus) 2 qian, Rou Gui (Cinnamomi Cortex) 1 qian (added later), Hong Zao (Jujubae Fructus) 3 pieces (split), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Honey-fried) 1 qian, Hu Tao (Juglandis Semen) 1 piece (kernel crushed).
Decoct all ingredients in a large cup of water. Administer warm in divided doses slowly.

Formula Analysis: This formula combines heat-inducing and warming herbs. Heat herbs tonify Yang, while warming herbs nourish Yin. Since the root of the disease is cold, the herbs should be warm/hot. However, Shao Yao, which is cool in nature, is included because the cold here resides in the spleen and stomach, not the liver and gallbladder. If one only warms the spleen and stomach without cooling the liver and gallbladder, the liver and gallbladder may generate fire from the hot herbs, or stir up the ministerial fire residing therein, leading to difficult urination and worsened diarrhea. Shao Yao cools the liver and gallbladder, promotes diuresis, and specifically averts floating Yang to reduce tidal fever, hence its specific inclusion.
In *Fu You Bian*, Gan Jiang in this formula is processed. In the previous prescription, I changed it from processed to raw because raw Gan Jiang is better at stopping vomiting. Now that vomiting has stopped, why use raw Gan Jiang again? Indeed, the other herbs in the formula are cloying and sticky, risking phlegm formation. The pungency of raw Gan Jiang opens and resolves these sticky substances. Moreover, the excessive pungency of raw Gan Jiang is moderated when combined with cloying herbs. This mutual transformation of drug properties enhances efficacy.
Originally, this formula used Zao Xin Tu decoction as the solvent. Since vomiting has now stopped, it is no longer necessary. However, note that Zao Xin Tu contains high alkaline content. Alkaloids from wood ash concentrate in the hearth soil, making the decoction bitter, salty, and hard to swallow. I usually substitute it with red soil from the kiln pit. Zao Xin Tu is also called Fu Long Gan. Lei Xiao warned against using soil from under the stove, recommending red soil from the stove's forehead instead. This is similar to the red soil in the kiln pit. I had not seen this explanation before; upon finding it later, I rejoiced that my humble view coincidentally aligned with ancient wisdom.

Outcome: After two consecutive doses, tidal fever and diarrhea resolved, and the pulse became stronger. Bai Zhu was removed, and Gan Jiang dosage was reduced to 1 qian. After two more doses, she recovered completely.