女患，26岁，1992年10月13日初诊。患者3个月前淋雨受凉，鼻塞流清涕，恶寒，周身酸痛，咳嗽痰多。服荆防败毒散合杏苏散2剂，诸症显著减轻，惟咳嗽不减。因图速效，改用西药，口服病毒灵、氯化铵合剂、麦迪霉素，肌注青霉素3天，不效；又配合输液7天，亦少效。不得已复用中药，先后换医4人，服药20余剂，大多为止咳化痰之晶，并配服中成药如祛痰止咳冲剂、蛇胆川贝液、痰咳净、鲜竹沥等，仍然咳嗽不止。现症：咽喉发痒，咳嗽频频，早晚尤甚，痰少难咯，稍感气紧，时而呛咳；舌质偏淡，苔白(中根部略厚)，脉细带滑。查血、胸透及拍片均未见异常。此虽迁延3个月，仍属风邪恋肺，肺失宣肃之证。子疏散风寒、宣肃肺气之金沸草散加减：旋复花10g(包煎)，白芍12g，生甘草5g，荆芥15g，苏叶10g，前胡10g，法夏10g，杏仁10g，白芥子10g，桔梗土0g。2剂。二诊：咽痒消失，咳嗽大减，咯痰爽利。上方合止嗽散加减：旋复花10g(包煎)，白芍12g，生甘草5g，荆芥10g，桔梗10g，炙紫菀15g，炙百部10g，前胡10g，杏仁10g，仙鹤草30g。3剂。三诊：白天已不咳嗽，惟夜间偶尔咳几声。转用民间验方"止咳十一味"善后：当归，川芎，法夏，茯苓，陈皮，生甘草，桑皮，青皮，杏仁，五味子(捣碎)，川贝母(轧细吞服)。2剂，未服完而咳止。
老师：在肺系疾病中，咳嗽最为常见，但棘手者亦不少。俗云"名医不治咳喘"，是怕治不好而有损声誉。此虽有寡过之嫌，却也是阅历之言。因为有的病人总以为咳嗽都是小毛病，你连咳嗽都治不好，还治得好"大病"吗?我就有过这样的经历。而时至今日，犹不敢保其"十全"，此中甘苦事，得失寸心知!
进修生甲：咳嗽若迁延失治，有时就很难理清头绪。如本例外感咳嗽，叠用中西药物乏效，迁延3个月，很容易误诊为虚证或虚实夹杂证。但老师接诊时便断为"风邪恋肺、肺失宣肃"，有何根据呢?
老师：从病史看，初为风寒感冒兼咳嗽，服荆防败毒散合杏苏散2剂后，风寒表症显著减轻，惟咳嗽不减。此时若撤去辛温发散，而以宣疏肃降为主，辅以化痰止咳，可能会很快好转。但病人止咳心切，改用西药稀释痰液、抗菌消炎，及复用中药专事止咳化痰等，均失于宣疏肃降以逐邪外出，致令风邪恋肺，而迁延缠绵。再从现症看，咽痒则咳，气紧呛咳，痰少难咯，苔白，脉细带滑等，亦是风邪恋肺、肺失宣肃之象。治之者宜遵"咳无止法"及"不止咳而咳自止"之古训，无论病程久暂，皆宜以宣疏肃降为主。若但见病程较长便套用"久咳多虚"、"久咳多内伤"，则误诊误治矣。
进修生乙：据我所知，中医高校内科学教材所载的治疗风寒咳嗽的首选方，二版教材为金沸草散，五版教材则罗列杏苏散、三拗汤、止嗽散等，有点令人无所适从。老师何以独选金沸草散呢?
老师：一种治法可以统率很多首方剂，这就给初涉临床者带来了困惑：到底哪一首是高效方?有人说，"条条道路通罗马"，但并非每一条都是捷径呀!据我临床验证，以上诸方化裁恰当，虽皆可治疗风寒咳嗽，但是疗效有所差别，而以金沸草散疗效最佳。
进修生乙：为什么呢?
老师：金沸草散与其余诸方一样，体现了疏风散寒、宣肃肺气的治法，而其特异性在于金沸草(现代多用旋复花)、白芍、甘草3味药的关键性作用。古今阐释旋复花者，大多以为其只有消痰降气之功，是囿于"诸花皆升，旋复独降"之谚。不可否认，旋复花肃肺降气、豁痰蠲饮之功是颇宏的(病人服后往往有胸膈滞气下降之感)。但其不可埋没的功效还有：其味辛，辛者能散能横行，而能宣散肺气达于皮毛，一降一宣，便可恢复肺主制节之权；其味咸，咸者入肾，而能纳气下行以归根，使胃中的痰涎或水饮息息下行而从浊道出，不复上逆犯肺，便可恢复肺的清虚功能态。可见旋复花一味药之功，竟可使肺胃肾三脏戴泽，上中下三焦通利。而白芍配甘草为"芍药甘草汤"，酸甘化阴，能滋养肺津，舒缓肺气。现代药理研究证实其能缓解支气管平滑肌的痉挛。故用本方时，诸药均可损益，惟旋复花、白芍、甘草3味为不可挪移之晶。
进修生丙：老师是怎样悟出此中奥妙的呢?
老师：这全是江尔逊老中医传授的。江老早年体弱，经常咳嗽，每用止嗽散、杏苏散、六安煎等取效。但有一次咳嗽，遍用历验诸方，毫无寸效。咳嗽频频，咽喉发痒，痒心咳嗽，迁延旬余。他查阅方书，见陈修园《医学从众录》中说，"轻则六安煎，重则金沸草散"。便试服1剂，咳嗽、喉痒即止。他感到惊异，便用于别人，亦收捷效。几十年来，江老治疗咳嗽，无论新久，亦无论表里寒热虚实，都喜用本方化裁。有的病人咳嗽缠绵2-3个月，几乎遍用中西药物乏效，服本方数剂而安。以致病人间辗转传抄本方，竟亦屡有霍然而愈者。
进修生丁但古医书上有两个金沸草散。一见于《南阳活人书》，由金沸草、前胡、荆芥、细辛、茯苓、生姜、大枣、甘草组成；一见于《和剂局方》，方中无茯苓、细辛，而添麻黄、白芍。此外《三因极一病证方论》旋复花汤，又在《和剂局方》金沸草散的基础上添加杏仁、茯苓、五味子。不知江老临床用的是哪一个金沸草散?
老师：江老使用金沸草散，并不拘守某一方，而是综合取舍三方，以及随证合用六安煎(二陈汤加杏仁、白芥子)和桔梗汤(桔梗、甘草)。而学问之道，贵与年俱进。江老使用本方几十年，积累了--整套行之有效的加减方法，有的加减方法还方中寓方，大大地拓宽了本方的适用范围。如乍寒乍热，加柴胡、黄芩(小柴胡汤意)；高热气喘，加麻黄、生石膏(麻杏石甘汤意)；发热咽痛，加银花、连翘、射干(银翘散意)；痰多稠粘，加浙贝母、瓜蒌仁(贝母瓜蒌散意)；哮喘痰鸣，加苏子、葶苈子(葶苈大枣泻肺汤意)；发热恶风、自汗，加桂枝、厚朴(桂枝加厚朴杏子汤意)；久咳不止，加紫菀、百部、枇杷叶(止嗽散意)；体虚易感冒，加黄芪、白术、防风(五屏风散意)；脾虚食少或便溏，加党参、白术、(六君子汤意)；痰涎清稀，头眩，心下满，加桂枝、白术(苓桂术甘汤意)。
实习生甲金沸草散的化裁方法这样多，表里寒热虚实都有，初涉临床者很难全面掌握使用，能否化繁为简，使之简捷实用呢?
老师：其实江老的化裁方法还不止这些，有的是为失治或误治而设，也有照顾体质的；且均从临床实践中来，又能有效地重复使用。所以我认为，与其削足适履地"化繁为简"、，倒不如扎扎实实地把好风寒咳嗽这一关。大家知道，咳嗽一证，外感居多；外感咳嗽，风寒居多。而治疗风寒咳嗽，倘能恰当地遣选疏散风寒、宣肃肺气的方药，多能迅速获效。今人有谓"截断"者，亦是此意。果真如此，金沸草散的那么多化裁方法还有多少用武之地呢?可惜事实并非如此。江老曾秉笔直书道：有一见发热(或体温升高)便断为"风热"或"痰热"，而直用桑菊或银翘辈，或径用清热化痰药及抗生素；有因喉痒或痰少难咯便认作"风燥"或"阴伤"而恣用润燥或养阴方药；有因久咳不止便认作虚咳，而屡进补益药物者。凡此皆因失于及时疏散、宣肃，而致咳嗽迁延缠绵，甚则转成劳嗽。张景岳亦曾愤激而言，"俗云伤风不愈变成劳，夫伤风岂能成劳"?
老师：80％以上。
实习生乙治不好的改用什么方药呢?
老师：据我临床观察，服本方疗效欠佳者，约有三种情形：一是旋复花的药味苦涩难咽，有的病人服后易呕逆，因惧呕而不能竟剂；二是有的病人愈后几天又复咳(症状较轻)；三是有的病人总是遗留一个咳嗽"尾巴"偶尔咳嗽几声，如本例便属之。谚曰，"甘瓜苦蒂，物无全美"，世上岂有"十全"之方药?我的处理方法是：服之易呕逆者，可嘱其少量频服；若仍呕而惧服者，则改用陈士铎的舒肺汤(桂枝苏叶桔梗甘草茯苓天花粉)合六安煎。若愈后几天复咳者，可继服柴胡桂枝汤加炙紫菀、蝉衣、木蝴蝶。若遗留咳嗽"尾巴"者，则继服"止咳十-味"(本案三诊方)，此方流传在民间，原治肺结核咳嗽。20余年前我偶然移治1例外感咳嗽，外症已解，咳减而旬余不止者，1剂咳止。尔后治验渐多，便作为外感咳嗽的"扫尾方"来使用。本方药味十分平淡，但组合离奇，很难强为之诠解。还须说明的是，极少数外感咳嗽病人，初服金沸草散化裁，咳嗽虽减，但继服"止咳十一味"后，却不能扫尾，渐渐干咳无痰，夜间加重，舌净无苔。此时可试用我拟的"顽咳方"：玄参15g，麦冬15g，五味子6g，生甘草6g，桔梗10g，仙鹤草30g，炙紫菀30g，桃仁10g，红花6g，藕根30g，生牡蛎30g。若个别病人服本方2剂后，干咳减轻而不止者，可与清燥救肺汤交替服用，以收全功。
平卧则安，起则眩晕
浙江绍兴市中医院主任董汉良
赵XX，男74岁，退休干部，1992年4月就诊。患者长期卧床已有年余，前医按中风后遗症、心力衰竭、冠心病、高血压等中西医论治，收效甚微；经人介绍来我处求诊。心电图检查提示：冠状动脉供血不足。脑电图检查提示：脑供血不足。B超肝、胆、肾无异常。血压不稳定，时高时低。平卧则安，坐起则头晕目眩，恶心，甚者呕吐；故用双轮平板车平卧送来求医，又因不能起坐，家属要求车边应诊。症见：患者仰卧，面色皓白，神志清楚，对答满意，纳差懈怠，四肢无力，口淡无味，大便不畅行，小便能自控，四肢能随意活动，无半身不遂之象，未见明显消瘦，令家属扶持起坐，片刻，即头晕目眩，移时泛泛欲吐，随即予以平卧，卧后诸症渐消。脉迟缓，舌淡苔白、腻。血压11．6／6．6kPa，心律齐，心跳60次／分，偶有早搏，腹平软，肝脾未及，无肿块触及。下肢按压不凹陷。证属："眩晕"无疑。虽西医诊为诸多老年病，然从脉证所见为高年肝肾亏虚，气血不足，痰瘀内结，清阳不升之侯。宜养肝益肾，补气升阳治其本；治痰化瘀，疏导经络治其标。用东垣补中益气汤合景岳贞元饮加减出入。处方：葛根30g，黄芪30g，白术10g，升麻10g，水蛭10g，熟地30g，当归15g，川芎10g，荷叶30g，炙甘草5g。1日1剂，连服5剂，以观疗效。5剂后，由其子代诉传方，据云药后精神好转，纳食渐香，大便畅行，扶持坐起，眩晕不立即发生。药中肯繁，效不更方。前方加仙灵脾30S。仙茅10g，继进5剂。10天后，"起则眩晕"症状明显减轻，但因有恐惧"眩晕"的心理，不敢久坐，能起坐5～10分钟即平卧。即以前方增删调治20剂，若大便秘结3～5天加大黄5g，苁蓉10g；纳食不香加炒生山楂(各)30g，生谷芽30g；腹胀加大腹皮10g；苔根腻加泽泻15g胸闷不畅加全瓜蒌10g，薤白10g等。1日后，"起则眩晕"基本控制，但不能下床行动，只能半卧或端坐。配以灸百会，用麦粒大小艾柱，直接灸7壮，经内外合治后，效果显著，头晕目眩已平，且能下床柱杖行走，患者及家属甚为惊喜，药治亦因之停止，嘱其饮食调养，莲子汤、百合汤常服，饮食清淡，少进脂肪、糖类。现已康复如常人。
学生甲请问老师，本证"眩晕"无疑，何以方中不用天麻、钩藤之属，愿闻其故。
老师：天麻、钩藤本是祛风止晕之良药，如天麻钩藤饮，半夏白术天麻汤之类，为治眩晕之要方。眩晕一证，多责之于肝，<内经)有"诸风掉眩，皆属于肝"之说；天麻、钩藤平肝潜阳，为治疗肝阳上亢所致眩晕之佳品，故常用之；但临床并非皆然，历代医家对眩晕的论说也颇多，如朱丹溪提出"无痰不作眩"，张景岳认为"无虚不能作眩"，徐春甫以虚实分论，陈修园按风、火、痰、虚论治，虞搏补充"瘀血致眩"。故眩晕一证，按虚实分，风、火、痰、瘀致眩晕者为实；气血阴阳亏虚致晕者为虚。而临证所见，无纯虚纯实之侯，多为虚中挟实，或本虚标实之证。本案患者高年肝肾亏虚，作强无能，故长期卧床，懈怠无力；气血不足，则面色皓白，纳钝口淡；脾虚气弱，清阳不升，痰瘀阻络，气血不能上荣故平卧则安，起则眩晕。所见为本虚标实之象，治当补气升阳取用东垣补中益气汤之意(黄芪、白术、当归、升麻、炙甘草)；益气养血，滋补肝肾选用景岳贞之饮(熟地、当归、炙甘草)。并加葛根、川芎、水蛭活血化瘀，直趋头项；荷叶升清降浊，降脂杜痰，合而祛络中痰瘀，使标本同治，络道畅行，气血上荣，则不用天麻、钩藤而眩晕自除。
女患者，26岁，1992年10月13日初诊。患者3个月前淋雨受凉，出现鼻塞流清涕、恶寒（怕冷）、周身酸痛、咳嗽痰多等症状。服用荆防败毒散合杏苏散2剂后，各种症状显著减轻，唯独咳嗽没有减少。因为想追求速效，改用西药，口服病毒灵、氯化铵合剂、麦迪霉素，并肌注青霉素3天，无效；又配合输液7天，也效果甚微。不得已再次使用中药，先后更换4位医生，服药20余剂，大多为止咳化痰的药物，并配服中成药如祛痰止咳冲剂、蛇胆川贝液、痰咳净、鲜竹沥等，仍然咳嗽不止。现症见：咽喉发痒，咳嗽频繁，早晚尤其严重，痰少难咯出，稍感气紧，时而呛咳；舌质偏淡，苔白（中根部略厚），脉细带滑。查血、胸透及拍片均未见异常。此病虽迁延3个月，仍属于风邪留恋于肺，肺失宣发肃降功能的证候。采用疏散风寒、宣肃肺气的金沸草散加减：旋复花10g（包煎），白芍12g，生甘草5g，荆芥15g，苏叶10g，前胡10g，法半夏10g，杏仁10g，白芥子10g，桔梗10g。2剂。二诊：咽痒消失，咳嗽大减，咯痰爽利。上方合止嗽散加减：旋复花10g（包煎），白芍12g，生甘草5g，荆芥10g，桔梗10g，炙紫菀15g，炙百部10g，前胡10g，杏仁10g，仙鹤草30g。3剂。三诊：白天已不咳嗽，只有夜间偶尔咳几声。转用民间验方“止咳十一味”善后：当归，川芎，法半夏，茯苓，陈皮，生甘草，桑白皮，青皮，杏仁，五味子（捣碎），川贝母（轧细吞服）。2剂，未服完而咳嗽停止。
老师：在肺系疾病中，咳嗽最为常见，但棘手者也不少。俗话说“名医不治咳喘”，是怕治不好而有损声誉。这虽然有过分推脱之嫌，却也是阅历之言。因为有的病人总以为咳嗽都是小毛病，你连咳嗽都治不好，还治得好“大病”吗？我就有过这样的经历。而时至今日，犹不敢保其“十全十美”，其中的甘苦得失，只有内心自知！
进修生甲：咳嗽若迁延失治，有时就很难理清头绪。如本例外感咳嗽，叠用中西药物乏效，迁延3个月，很容易误诊为虚证或虚实夹杂证。但老师接诊时便断为“风邪恋肺、肺失宣肃”，有何根据呢？
老师：从病史看，初为风寒感冒兼咳嗽，服荆防败毒散合杏苏散2剂后，风寒表症显著减轻，惟咳嗽不减。此时若撤去辛温发散，而以宣疏肃降为主，辅以化痰止咳，可能会很快好转。但病人止咳心切，改用西药稀释痰液、抗菌消炎，及复用中药专事止咳化痰等，均失于宣疏肃降以逐邪外出，致令风邪恋肺，而迁延缠绵。再从现症看，咽痒则咳，气紧呛咳，痰少难咯，苔白，脉细带滑等，亦是风邪恋肺、肺失宣肃之象。治之者宜遵“咳无止法”及“不止咳而咳自止”之古训，无论病程久暂，皆宜以宣疏肃降为主。若但见病程较长便套用“久咳多虚”、“久咳多内伤”，则误诊误治矣。
进修生乙：据我所知，中医高校内科学教材所载的治疗风寒咳嗽的首选方，二版教材为金沸草散，五版教材则罗列杏苏散、三拗汤、止嗽散等，有点令人无所适从。老师何以独选金沸草散呢？
老师：一种治法可以统率很多首方剂，这就给初涉临床者带来了困惑：到底哪一首是高效方？有人说，“条条道路通罗马”，但并非每一条都是捷径呀！据我临床验证，以上诸方化裁恰当，虽皆可治疗风寒咳嗽，但是疗效有所差别，而以金沸草散疗效最佳。
进修生乙：为什么呢？
老师：金沸草散与其余诸方一样，体现了疏风散寒、宣肃肺气的治法，而其特异性在于金沸草（现代多用旋复花）、白芍、甘草3味药的关键性作用。古今阐释旋复花者，大多以为其只有消痰降气之功，是囿于“诸花皆升，旋复独降”之谚。不可否认，旋复花肃肺降气、豁痰蠲饮之功是颇宏的（病人服后往往有胸膈滞气下降之感）。但其不可埋没的功效还有：其味辛，辛者能散能横行，而能宣散肺气达于皮毛，一降一宣，便可恢复肺主制节之权；其味咸，咸者入肾，而能纳气下行以归根，使胃中的痰涎或水饮息息下行而从浊道出，不复上逆犯肺，便可恢复肺的清虚功能态。可见旋复花一味药之功，竟可使肺胃肾三脏戴泽，上中下三焦通利。而白芍配甘草为“芍药甘草汤”，酸甘化阴，能滋养肺津，舒缓肺气。现代药理研究证实其能缓解支气管平滑肌的痉挛。故用本方时，诸药均可损益，惟旋复花、白芍、甘草3味为不可挪移之品。
进修生丙：老师是怎样悟出此中奥妙的呢？
老师：这全是江尔逊老中医传授的。江老早年体弱，经常咳嗽，每用止嗽散、杏苏散、六安煎等取效。但有一次咳嗽，遍用历验诸方，毫无寸效。咳嗽频频，咽喉发痒，痒心咳嗽，迁延旬余。他查阅方书，见陈修园《医学从众录》中说，“轻则六安煎，重则金沸草散”。便试服1剂，咳嗽、喉痒即止。他感到惊异，便用于别人，亦收捷效。几十年来，江老治疗咳嗽，无论新久，亦无论表里寒热虚实，都喜用本方化裁。有的病人咳嗽缠绵2-3个月，几乎遍用中西药物乏效，服本方数剂而安。以致病人间辗转传抄本方，竟亦屡有霍然而愈者。
进修生丁：但古医书上有两个金沸草散。一见于《南阳活人书》，由金沸草、前胡、荆芥、细辛、茯苓、生姜、大枣、甘草组成；一见于《和剂局方》，方中无茯苓、细辛，而添麻黄、白芍。此外《三因极一病证方论》旋复花汤，又在《和剂局方》金沸草散的基础上添加杏仁、茯苓、五味子。不知江老临床用的是哪一个金沸草散？
老师：江老使用金沸草散，并不拘守某一方，而是综合取舍三方，以及随证合用六安煎（二陈汤加杏仁、白芥子）和桔梗汤（桔梗、甘草）。而学问之道，贵与年俱进。江老使用本方几十年，积累了一整套行之有效的加减方法，有的加减方法还方中寓方，大大地拓宽了本方的适用范围。如乍寒乍热，加柴胡、黄芩（小柴胡汤意）；高热气喘，加麻黄、生石膏（麻杏石甘汤意）；发热咽痛，加银花、连翘、射干（银翘散意）；痰多稠粘，加浙贝母、瓜蒌仁（贝母瓜蒌散意）；哮喘痰鸣，加苏子、葶苈子（葶苈大枣泻肺汤意）；发热恶风、自汗，加桂枝、厚朴（桂枝加厚朴杏子汤意）；久咳不止，加紫菀、百部、枇杷叶（止嗽散意）；体虚易感冒，加黄芪、白术、防风（五屏风散意）；脾虚食少或便溏，加党参、白术、（六君子汤意）；痰涎清稀，头眩，心下满，加桂枝、白术（苓桂术甘汤意）。
实习生甲：金沸草散的化裁方法这样多，表里寒热虚实都有，初涉临床者很难全面掌握使用，能否化繁为简，使之简捷实用呢？
老师：其实江老的化裁方法还不止这些，有的是为失治或误治而设，也有照顾体质的；且均从临床实践中来，又能有效地重复使用。所以我认为，与其削足适履地“化繁为简”，倒不如扎扎实实地把好风寒咳嗽这一关。大家知道，咳嗽一证，外感居多；外感咳嗽，风寒居多。而治疗风寒咳嗽，倘能恰当地遣选疏散风寒、宣肃肺气的方药，多能迅速获效。今人有谓“截断”者，亦是此意。果真如此，金沸草散的那么多化裁方法还有多少用武之地呢？可惜事实并非如此。江老曾秉笔直书道：有一见发热（或体温升高）便断为“风热”或“痰热”，而直用桑菊或银翘辈，或径用清热化痰药及抗生素；有因喉痒或痰少难咯便认作“风燥”或“阴伤”而恣用润燥或养阴方药；有因久咳不止便认作虚咳，而屡进补益药物者。凡此皆因失于及时疏散、宣肃，而致咳嗽迁延缠绵，甚则转成劳嗽。张景岳亦曾愤激而言，“俗云伤风不愈变成劳，夫伤风岂能成劳”？
老师：80％以上。
实习生乙：治不好的改用什么方药呢？
老师：据我临床观察，服本方疗效欠佳者，约有三种情形：一是旋复花的药味苦涩难咽，有的病人服后易呕逆，因惧呕而不能竟剂；二是有的病人愈后几天又复咳（症状较轻）；三是有的病人总是遗留一个咳嗽“尾巴”偶尔咳嗽几声，如本例便属之。谚曰，“甘瓜苦蒂，物无全美”，世上岂有“十全”之方药？我的处理方法是：服之易呕逆者，可嘱其少量频服；若仍呕而惧服者，则改用陈士铎的舒肺汤（桂枝苏叶桔梗甘草茯苓天花粉）合六安煎。若愈后几天复咳者，可继服柴胡桂枝汤加炙紫菀、蝉衣、木蝴蝶。若遗留咳嗽“尾巴”者，则继服“止咳十一味”（本案三诊方），此方流传在民间，原治肺结核咳嗽。20余年前我偶然移治1例外感咳嗽，外症已解，咳减而旬余不止者，1剂咳止。尔后治验渐多，便作为外感咳嗽的“扫尾方”来使用。本方药味十分平淡，但组合离奇，很难强为之诠解。还须说明的是，极少数外感咳嗽病人，初服金沸草散化裁，咳嗽虽减，但继服“止咳十一味”后，却不能扫尾，渐渐干咳无痰，夜间加重，舌净无苔。此时可试用我拟的“顽咳方”：玄参15g，麦冬15g，五味子6g，生甘草6g，桔梗10g，仙鹤草30g，炙紫菀30g，桃仁10g，红花6g，藕根30g，生牡蛎30g。若个别病人服本方2剂后，干咳减轻而不止者，可与清燥救肺汤交替服用，以收全功。
平卧则安，起则眩晕
浙江绍兴市中医院主任董汉良
赵XX，男74岁，退休干部，1992年4月就诊。患者长期卧床已有年余，前医按中风后遗症、心力衰竭、冠心病、高血压等中西医论治，收效甚微；经人介绍来我处求诊。心电图检查提示：冠状动脉供血不足。脑电图检查提示：脑供血不足。B超肝、胆、肾无异常。血压不稳定，时高时低。平卧则安，坐起则头晕目眩，恶心，甚者呕吐；故用双轮平板车平卧送来求医，又因不能起坐，家属要求车边应诊。症见：患者仰卧，面色皓白，神志清楚，对答满意，纳差懈怠，四肢无力，口淡无味，大便不畅行，小便能自控，四肢能随意活动，无半身不遂之象，未见明显消瘦，令家属扶持起坐，片刻，即头晕目眩，移时泛泛欲吐，随即予以平卧，卧后诸症渐消。脉迟缓，舌淡苔白、腻。血压11．6／6．6kPa，心律齐，心跳60次／分，偶有早搏，腹平软，肝脾未及，无肿块触及。下肢按压不凹陷。证属：“眩晕”无疑。虽西医诊为诸多老年病，然从脉证所见为高年肝肾亏虚，气血不足，痰瘀内结，清阳不升之侯。宜养肝益肾，补气升阳治其本；治痰化瘀，疏导经络治其标。用东垣补中益气汤合景岳贞元饮加减出入。处方：葛根30g，黄芪30g，白术10g，升麻10g，水蛭10g，熟地30g，当归15g，川芎10g，荷叶30g，炙甘草5g。1日1剂，连服5剂，以观疗效。5剂后，由其子代诉传方，据云药后精神好转，纳食渐香，大便畅行，扶持坐起，眩晕不立即发生。药中肯繁，效不更方。前方加仙灵脾30g，仙茅10g，继进5剂。10天后，“起则眩晕”症状明显减轻，但因有恐惧“眩晕”的心理，不敢久坐，能起坐5～10分钟即平卧。即以前方增删调治20剂，若大便秘结3～5天加大黄5g，苁蓉10g；纳食不香加炒生山楂(各)30g，生谷芽30g；腹胀加大腹皮10g；苔根腻加泽泻15g胸闷不畅加全瓜蒌10g，薤白10g等。1日后，“起则眩晕”基本控制，但不能下床行动，只能半卧或端坐。配以灸百会，用麦粒大小艾柱，直接灸7壮，经内外合治后，效果显著，头晕目眩已平，且能下床柱杖行走，患者及家属甚为惊喜，药治亦因之停止，嘱其饮食调养，莲子汤、百合汤常服，饮食清淡，少进脂肪、糖类。现已康复如常人。
学生甲：请问老师，本证“眩晕”无疑，何以方中不用天麻、钩藤之属，愿闻其故。
老师：天麻、钩藤本是祛风止晕之良药，如天麻钩藤饮，半夏白术天麻汤之类，为治眩晕之要方。眩晕一证，多责之于肝，《内经》有“诸风掉眩，皆属于肝”之说；天麻、钩藤平肝潜阳，为治疗肝阳上亢所致眩晕之佳品，故常用之；但临床并非皆然，历代医家对眩晕的论说也颇多，如朱丹溪提出“无痰不作眩”，张景岳认为“无虚不能作眩”，徐春甫以虚实分论，陈修园按风、火、痰、虚论治，虞搏补充“瘀血致眩”。故眩晕一证，按虚实分，风、火、痰、瘀致眩晕者为实；气血阴阳亏虚致晕者为虚。而临证所见，无纯虚纯实之侯，多为虚中挟实，或本虚标实之证。本案患者高年肝肾亏虚，作强无能，故长期卧床，懈怠无力；气血不足，则面色皓白，纳钝口淡；脾虚气弱，清阳不升，痰瘀阻络，气血不能上荣故平卧则安，起则眩晕。所见为本虚标实之象，治当补气升阳取用东垣补中益气汤之意（黄芪、白术、当归、升麻、炙甘草）；益气养血，滋补肝肾选用景岳贞元饮（熟地、当归、炙甘草）。并加葛根、川芎、水蛭活血化瘀，直趋头项；荷叶升清降浊，降脂杜痰，合而祛络中痰瘀，使标本同治，络道畅行，气血上荣，则不用天麻、钩藤而眩晕自除。
Female patient, 26 years old, first consultation on October 13, 1992. Three months prior to the visit, the patient caught a cold after being exposed to rain and cold, presenting with nasal congestion, runny clear nose, aversion to cold (Aversion to Cold), generalized body ache, cough with profuse sputum. After taking two doses of Jingfang Baidu San (Jing Fang Bai Du Decoction) combined with Xingsu San (Xing Su Powder), all symptoms significantly subsided, except for the cough which persisted. Seeking rapid relief, she switched to Western medicine: oral Amantadine Hydrochloride (Virus Ling), Ammonium Chloride Mixture, Midecamycin, and intramuscular Penicillin for 3 days, without effect; followed by intravenous infusion for 7 days, also with minimal effect. Reluctantly returning to Traditional Chinese Medicine (TCM), she consulted four different doctors in succession, taking over 20 doses of prescriptions, mostly consisting of antitussive and expectorant herbs, along with patent medicines such as Qutan Zhike Granules, Shedan Chuanbei Liquid, Tankejing, and Fresh Bamboo Sap. However, the cough remained unrelieved. Current symptoms: itchy throat, frequent coughing, worse in the morning and evening, scanty difficult-to-expectorate sputum, slight shortness of breath, occasional paroxysmal coughing; tongue body slightly pale, white coating (slightly thicker in the middle and root areas), fine and slippery pulse. Blood tests, chest fluoroscopy, and X-rays showed no abnormalities. Although the condition had persisted for three months, it still belonged to the pattern of Wind pathogen lingering in the Lung, with loss of the Lung's dispersing and descending functions. Treatment adopted Jinfeicao San (Jin Fei Cao Decoction) modified to disperse Wind-Cold and regulate Lung Qi: Inula Flower 10g (wrapped for decoction), White Peony Root 12g, Raw Licorice Root 5g, Schizonepeta 15g, Perilla Leaf 10g, Peucedanum Root 10g, Processed Pinellia Tuber 10g, Apricot Seed 10g, White Mustard Seed 10g, Platycodon Root 10g. Two doses. Second consultation: Throat itch disappeared, cough greatly reduced, sputum expectorated smoothly. The previous formula combined with Zhisou San (Zhi Sou Powder) modified: Inula Flower 10g (wrapped), White Peony Root 12g, Raw Licorice Root 5g, Schizonepeta 10g, Platycodon Root 10g, Honey-fried Aster Root 15g, Honey-fried Stemona Root 10g, Peucedanum Root 10g, Apricot Seed 10g, Agrimony 30g. Three doses. Third consultation: No cough during the day, only occasional coughs at night. Switched to folk prescription "Eleven Herbs for Stopping Cough" for consolidation: Angelica Sinensis, Szechwan Lovage Rhizome, Processed Pinellia Tuber, Poria, Tangerine Peel, Raw Licorice Root, Mulberry Bark, Green Citrus Peel, Apricot Seed, Schisandra Berry (crushed), Fritillaria Bulb (finely ground and swallowed). Two doses, cough stopped before completion.
Teacher: Among diseases of the Lung system, cough is the most common, yet difficult cases are not few. As the saying goes, "Famous doctors do not treat cough and asthma," fearing that failure to cure would damage their reputation. While this may seem like an excuse, it reflects experience. Some patients always consider cough a minor ailment; if you cannot even cure a cough, how can you treat "major diseases"? I have had similar experiences. Even today, I dare not guarantee "perfection" in every case; the joys and sorrows are known only to my heart!
Advanced Student A: If cough persists and is untreated, it can be hard to clarify the situation. For example, in this case of exogenous cough, repeated use of both Chinese and Western medicines failed, persisting for three months, easily leading to misdiagnosis as Deficiency or Mixed Excess-Deficiency patterns. But when you diagnosed it as "Wind pathogen lingering in the Lung, loss of Lung dispersing and descending," what was your basis?
Teacher: From the medical history, it initially presented as Wind-Cold common cold with cough. After two doses of Jingfang Baidu San combined with Xingsu San, the exterior Wind-Cold symptoms significantly subsided, but the cough remained. At this point, if one were to withdraw acrid-warm dispersing herbs and focus mainly on dispersing and descending, assisted by resolving phlegm and stopping cough, improvement might occur quickly. However, anxious to stop the cough, the patient switched to Western medicines to thin sputum and fight inflammation, and later used Chinese medicines solely for stopping cough and resolving phlegm. All these approaches lacked the action of dispersing and descending to expel pathogens, causing the Wind pathogen to linger in the Lung and become chronic. Looking at current symptoms: cough triggered by throat itch, tightness of breath with paroxysmal coughing, scanty difficult sputum, white coating, fine and slippery pulse—these are also signs of Wind pathogen lingering in the Lung and loss of Lung dispersing and descending. Practitioners should follow the ancient maxim "there is no specific method to simply stop cough" and "cough stops itself when not forcibly suppressed." Regardless of duration, treatment should prioritize dispersing and descending. If one merely sees a long duration and applies "long-term cough often indicates Deficiency" or "long-term cough often indicates internal injury," it leads to misdiagnosis and mistreatment.
Advanced Student B: According to my knowledge, the preferred formula for Wind-Cold cough in TCM Internal Medicine textbooks varies: Version 2 uses Jinfeicao San, while Version 5 lists Xingsu San, San'ao Tang, and Zhisou San, causing confusion. Why did you choose Jinfeicao San exclusively?
Teacher: One therapeutic principle can govern many formulas, bringing confusion to beginners: which one is highly effective? Some say, "All roads lead to Rome," but not every road is a shortcut! Based on my clinical verification, although all the aforementioned formulas can treat Wind-Cold cough if properly modified, their efficacy differs, with Jinfeicao San showing the best results.
Advanced Student B: Why?
Teacher: Like other formulas, Jinfeicao San embodies the principles of dispersing Wind, scattering Cold, and regulating Lung Qi. Its specificity lies in the key roles of Inula Flower (modernly often using Inulae Flos/Rotundifoliae Flos), White Peony Root, and Licorice Root. Ancient and modern interpretations of Inula Flower mostly attribute to it only the function of resolving phlegm and directing Qi downward, constrained by the proverb "all flowers ascend, but Inula descends alone." Undeniably, Inula Flower's power to descend Lung Qi, resolve phlegm, and eliminate fluid retention is significant (patients often feel a sensation of stagnation in the chest and diaphragm moving downward after ingestion). However, its overlooked efficacy includes: its Acrid taste allows it to disperse and move horizontally, thereby dispersing Lung Qi to the skin and hair; one descent and one dispersion restore the Lung's authority over regulation. Its Salty taste enters the Kidney, guiding Qi downward to return to its root, allowing phlegm-fluid or water-retention from the Stomach to descend continuously through the turbid pathways, preventing upward rebellion against the Lung, thus restoring the Lung's pure and empty functional state. Thus, the single herb Inula Flower can benefit the Lung, Stomach, and Kidney, and promote the free flow of the Upper, Middle, and Lower Jiao. White Peony Root paired with Licorice Root forms Shaoyao Gancao Tang (Peony and Licorice Decoction); Sour and Sweet generate Yin, nourishing Lung fluids and soothing Lung Qi. Modern pharmacological research confirms it can relieve bronchial smooth muscle spasms. Therefore, when using this formula, other herbs can be added or removed, but Inula Flower, White Peony Root, and Licorice Root are indispensable.
Advanced Student C: How did you realize this subtlety?
Teacher: This was entirely taught by the old TCM practitioner Jiang Erxun. In his early years, Old Jiang was weak and suffered from frequent coughing, finding relief with Zhisou San, Xingsu San, Liu'an Jian, etc. But once, despite trying all proven formulas, he achieved no effect. His cough was frequent, throat itchy, itching triggering cough, persisting for over ten days. Consulting medical books, he saw Chen Xiuyuan's *Yixue Congzhong Lu* stating, "For mild cases, Liu'an Jian; for severe cases, Jinfeicao San." He tried one dose, and the cough and throat itch stopped immediately. Astonished, he applied it to others, achieving swift results. For decades, Old Jiang favored modifying this formula for treating cough, regardless of new or old onset, exterior or interior, Cold or Heat, Excess or Deficiency. Some patients with cough lingering for 2-3 months, ineffective to various Chinese and Western medicines, found relief after a few doses of this formula. Patients copied and shared the formula among themselves, frequently resulting in sudden recovery.
Advanced Student D: But there are two Jinfeicao Sans in ancient medical texts. One appears in *Nanyang Huoren Shu*, composed of Inula Flower, Peucedanum Root, Schizonepeta, Asarum, Poria, Ginger, Jujube, Licorice; the other in *Heji Jufang*, lacking Poria and Asarum, but adding Ephedra Stem and White Peony Root. Additionally, the *Sanjin Ji Yi Bingzheng Fanglun* Xuanfu Hua Tang adds Apricot Seed, Poria, and Schisandra Berry to the *Heji Jufang* Jinfeicao San. Which version did Old Jiang use clinically?
Teacher: Old Jiang did not strictly adhere to any single formula when using Jinfeicao San. Instead, he comprehensively selected from the three versions, and combined them with Liu'an Jian (Erchen Tang plus Apricot Seed and White Mustard Seed) and Jiegeng Tang (Platycodon Root and Licorice Root) according to the syndrome. Scholarship advances with time. Over decades of using this formula, Old Jiang accumulated a complete set of effective modification methods, some incorporating formulas within formulas, greatly expanding its scope. For instance, alternating chills and fever, add Bupleurum Root and Scutellaria Root (intent of Xiaochaihu Tang); high fever and wheezing, add Ephedra Stem and Raw Gypsum (intent of Maxing Shigan Tang); fever and sore throat, add Honeysuckle Flower, Forsythia Fruit, and Belamcanda Rhizome (intent of Yinqiao San); profuse sticky sputum, add Zhejiang Fritillaria Bulb and Trichosanthes Kernel (intent of Beimu Gualou San); asthma with phlegm rattle, add Perilla Seed and Lepidium Seed (intent of Tingli Dazao Xiefei Tang); fever, aversion to wind, spontaneous sweating, add Cinnamon Twig and Magnolia Bark (intent of Guizhi Jia Houpo Xingzi Tang); persistent long-term cough, add Aster Root, Stemona Root, and Loquat Leaf (intent of Zhisou San); constitutional weakness prone to colds, add Astragalus Root, Atractylodes Macrocephala Rhizome, and Saposhnikovia Root (intent of Wuping Feng San); Spleen deficiency with poor appetite or loose stools, add Codonopsis Root and Atractylodes Macrocephala Rhizome (intent of Liujunzi Tang); clear thin saliva/drool, dizziness, fullness below the heart, add Cinnamon Twig and Atractylodes Macrocephala Rhizome (intent of Linggui Zhugan Tang).
Intern A: There are so many modifications for Jinfeicao San, covering exterior-interior, Cold-Heat, Excess-Deficiency. It is difficult for beginners to master them all. Can we simplify it to make it more practical?
Teacher: Actually, Old Jiang's modifications go beyond these. Some are designed for missed or mistaken treatments, others for constitution; all come from clinical practice and are effectively reproducible. Therefore, I believe it is better to solidly master the treatment of Wind-Cold cough rather than arbitrarily "simplify complexity." Everyone knows that most coughs are exogenous; among exogenous coughs, Wind-Cold is predominant. If one can appropriately select formulas and herbs that disperse Wind-Cold and regulate Lung Qi, rapid efficacy is often achieved. Some modern practitioners speak of "intercepting" the disease, which implies the same meaning. If this were true, how much utility would Jinfeicao San's numerous modifications have? Unfortunately, reality is different. Old Jiang wrote frankly: Some diagnose "Wind-Heat" or "Phlegm-Heat" upon seeing fever (or elevated temperature), directly using Sangju San or Yinqiao San, or even heat-clearing and phlegm-resolving drugs and antibiotics; some mistake throat itch or scanty difficult sputum for "Wind-Dryness" or "Yin Injury," indiscriminately using moistening-drying or Yin-nourishing formulas; some assume deficiency cough due to persistent long-term cough, repeatedly administering tonics. All these result from failing to timely disperse and regulate, causing cough to linger and potentially turning into consumptive cough. Zhang Jingyue also indignantly stated, "The vulgar saying goes that untreated wind-cold becomes consumption; how can wind-cold turn into consumption?"
Intern B: What is the approximate cure rate for Jinfeicao San modified to treat exogenous cough?
Teacher: Over 80%.
Intern B: What formulas are used for those not cured?
Teacher: Based on my clinical observation, about three scenarios show poor efficacy with this formula: First, Inula Flower has a bitter and astringent taste, difficult to swallow; some patients vomit easily after ingestion, so they fear vomiting and cannot complete the course. Second, some patients relapse with cough (milder symptoms) a few days after recovery. Third, some patients always leave a "tail" of occasional coughing, as seen in this case. The proverb says, "Sweet melons have bitter stems; nothing in the world is perfect." Is there a "perfect" formula? My handling methods are: For those prone to vomiting, advise small frequent doses; if vomiting persists and fear remains, switch to Chen Shiduo's Shufei Tang (Cinnamon Twig, Perilla Leaf, Platycodon Root, Licorice Root, Poria, Trichosanthes Root) combined with Liu'an Jian. For relapse after a few days, continue with Chaihu Guizhi Tang plus Honey-fried Aster Root, Cicada Slough, and Oroxylum Indicum Seed. For the lingering "tail," continue with "Eleven Herbs for Stopping Cough" (Third Consultation Formula of this case), a folk prescription originally for Tuberculosis cough. Over 20 years ago, I accidentally treated an exogenous cough case where external symptoms resolved, cough decreased but persisted for over ten days; one dose stopped the cough. Subsequently, successful cases increased, and I began using it as a "cleanup formula" for exogenous cough. This formula consists of very plain herbs but has a bizarre combination, hard to explain strongly. Furthermore, for a very small number of exogenous cough patients, initial use of modified Jinfeicao San reduces cough, but subsequent use of "Eleven Herbs" fails to clean up, gradually leading to dry cough without sputum, worsening at night, clean tongue without coating. At this time, try my proposed "Stubborn Cough Formula": Scrophularia Root 15g, Ophiopogon Tuber 15g, Schisandra Berry 6g, Raw Licorice Root 6g, Platycodon Root 10g, Agrimony 30g, Honey-fried Aster Root 30g, Peach Kernel 10g, Safflower 6g, Lotus Root Rhizome 30g, Raw Oyster Shell 30g. If individual patients have reduced but persistent dry cough after two doses, alternate with Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction) to achieve complete success.
Lying flat brings comfort, rising causes dizziness
Dong Hanliang, Director, Shaoxing Hospital of Traditional Chinese Medicine, Zhejiang Province
Zhao XX, Male, 74 years old, retired cadre, consulted in April 1992. The patient had been bedridden for over a year. Previous physicians treated him based on post-stroke sequelae, heart failure, coronary heart disease, hypertension, etc., using both Chinese and Western medicine, with minimal effect; introduced to me by acquaintances. ECG indicated: Coronary artery insufficiency. EEG indicated: Cerebral blood supply insufficiency. Ultrasound of Liver, Gallbladder, Kidneys showed no abnormalities. Blood pressure unstable, fluctuating high and low. Comfortable lying flat, dizzy and vertiginous upon sitting up, nauseous, sometimes vomiting; thus brought by double-wheel flat cart lying down, and due to inability to sit, family requested consultation beside the cart. Symptoms: Patient supine, complexion bright white, conscious, satisfactory response, poor appetite and lethargy, limb weakness, bland taste in mouth, difficult bowel movement, voluntary urination, limbs movable freely, no hemiplegia, no obvious emaciation. When family supported him to sit up, after a moment, dizziness and vertigo occurred, followed by nausea shortly after, then returned to supine position, after which symptoms gradually subsided. Pulse slow and sluggish, tongue pale with white greasy coating. Blood pressure 11.6/6.6 kPa, regular rhythm, heart rate 60 bpm, occasional premature beats, abdomen flat and soft, liver and spleen not palpable, no masses. Lower limb pressing does not pit. Syndrome belongs undoubtedly to "Vertigo." Although Western medicine diagnosed multiple geriatric diseases, based on pulse and symptoms, it presents as Liver and Kidney deficiency in the elderly, Qi and Blood insufficiency, Phlegm and Stasis congealing internally, Clear Yang failing to ascend. Suitable to Nourish Liver and Benefit Kidney, Replenish Qi and Raise Yang to treat the root; Resolve Phlegm and Invigorate Blood, Unblock Collaterals to treat the branch. Use Dongyuan's Buzhong Yiqi Tang combined with Jingyue's Zhenyuan Yin modified. Prescription: Kudzu Root 30g, Astragalus Root 30g, Atractylodes Macrocephala Rhizome 10g, Cimicifuga Rhizome 10g, Leech 10g, Prepared Rehmannia Root 30g, Angelica Sinensis 15g, Szechwan Lovage Rhizome 10g, Lotus Leaf 30g, Honey-fried Licorice Root 5g. One dose daily, taken for 5 doses to observe efficacy. After 5 doses, reported by his son via message: Spirit improved, appetite gradually increased, bowel movements smooth, supported sitting up, dizziness did not occur immediately. Medication hit the mark, efficacy achieved, do not change formula. Add Epimedium 30g, Curculigo Rhizome 10g to previous formula, continue for 5 doses. After 10 days, "dizziness upon rising" symptom significantly reduced, but due to fear of "vertigo," dared not sit long, could sit for 5-10 minutes then lie down. Adjusted previous formula with additions/deletions for 20 doses: If constipation for 3-5 days, add Rhubarb 5g, Cistanche 10g; Poor appetite, add Fried Hawthorn Fruit 30g, Raw Barley Sprout 30g; Abdominal distension, add Areca Peel 10g; Greasy root coating, add Alisma Rhizome 15g; Chest tightness and discomfort, add Whole Trichosanthes Fruit 10g, Macrostemon Rhizome 10g, etc. After one day, "dizziness upon rising" basically controlled, but unable to get out of bed, could only semi-recumbent or upright sitting. Combined with moxibustion at Baihui (GV20), using sesame-sized moxa cones, direct moxibustion 7 moxa cones. After internal and external combined treatment, effect was significant, dizziness and vertigo平息ed, able to walk with cane. Patient and family were very surprised and delighted, medication stopped accordingly, advised dietary regulation, frequent intake of Lotus Seed Soup, Lily Bulb Soup, light diet, less fat and sugar. Now recovered like a normal person.
Student A: Teacher, this syndrome is undoubtedly "Vertigo," why are Gastrodia Rhizome and Uncaria Hook not included in the formula? I wish to hear the reason.
Teacher: Gastrodia Rhizome and Uncaria Hook are indeed excellent herbs for dispelling Wind and stopping vertigo, such as Tianma Gouteng Yin and Banxia Baizhu Tianma Tang, which are important formulas for treating vertigo. Vertigo is mostly attributed to the Liver; *Neijing* states, "All Wind tremors and vertigo belong to the Liver"; Gastrodia Rhizome and Uncaria Hook calm Liver and subdue Yang, making them good choices for vertigo caused by Liver Yang rising, hence commonly used; but clinically it is not always so. Physicians throughout history have discussed vertigo extensively, such as Zhu Danxi proposing "No Phlegm, No Vertigo," Zhang Jingyue believing "No Deficiency, No Vertigo," Xu Chunpu distinguishing by Excess and Deficiency, Chen Xiuyuan treating by Wind, Fire, Phlegm, Deficiency, and Yu Bo supplementing "Blood Stasis causing Vertigo." Thus, regarding Vertigo, divided by Excess and Deficiency, Wind, Fire, Phlegm, Stasis causing vertigo are Excess; Qi, Blood, Yin, Yang deficiency causing dizziness are Deficiency. In clinical observation, there are no purely Deficient or purely Excess syndromes; mostly it is Deficiency mixed with Excess, or Root Deficiency with Branch Excess. This patient suffers from Liver and Kidney deficiency in old age, lacking strength, hence bedridden for long, lethargic and weak; Qi and Blood insufficiency leads to bright white complexion, dull appetite, bland taste; Spleen deficiency and weak Qi, Clear Yang failing to ascend, Phlegm and Stasis blocking collaterals, Qi and Blood unable to nourish the head, thus comfortable lying flat, dizzy upon rising. This presents as Root Deficiency with Branch Excess. Treatment should Replenish Qi and Raise Yang, taking the intent of Dongyuan's Buzhong Yiqi Tang (Astragalus Root, Atractylodes Macrocephala Rhizome, Angelica Sinensis, Cimicifuga Rhizome, Honey-fried Licorice Root); Replenish Qi and Nourish Blood, Tonify Liver and Kidney, selecting Jingyue's Zhenyuan Yin (Prepared Rehmannia Root, Angelica Sinensis, Honey-fried Licorice Root). And add Kudzu Root, Szechwan Lovage Rhizome, Leech to invigorate Blood and resolve Stasis, targeting the head and neck directly; Lotus Leaf raises Clear and descends Turbid, lowers lipids and prevents Phlegm, combining to remove Phlegm and Stasis in collaterals, treating both root and branch, unblocking collaterals, allowing Qi and Blood to nourish the head, thus eliminating vertigo without using Gastrodia Rhizome and Uncaria Hook.
Student B: Regarding the added herbs in the formula (Kudzu Root, Leech, Szechwan Lovage Rhizome, Lotus Leaf), what are your application insights? We hope for your guidance.