b．乌头细辛类：乌头细辛类药为辛热透窍止痛之要药，外可祛除风寒，内可温散阴寒之邪。乌头配细辛有很强的止痛作用，个人师传经验，治疗阴寒痛结，关节冷痛的顽痹患者，常用三生活血酒：生二乌3-5枚，生南星1-2枚，当归15g，红花10g，桃仁10g，细辛30g，田七log，秦艽30g，甘草log。曾随师治疗数例顽固性寒痹疼痛患者，收到很好疗效。用法：上方泡酒1．5kg，每次服5-lOml，如有涩口感则加重甘草剂量，每日2次，早晚服。有报道重用细辛治疗类风湿性关节炎100例，结果痊愈76例，显效14例，有效10例，平均治愈时间30～60天。基本方：细辛30～60g，制附子10～30g，稀莶草30～lOOg。每剂水煎2次，每次40分钟，分4次服。作者认为凡患者无严重心血管病，本方可服半年之久，无任何不良反应。笔者临床一般细辛用量在10～15g左右，水煎30～40分钟，未发现任何毒副作用。上海研究，细辛的主要有毒成分为黄樟酮，若水煎30分钟，可大大降低毒性。这为加大剂量运用本品提供了依据。
6．虚痹用药
痹症日久不愈，可致人体正气亏损，临床常见以下两种情况：
①气血亏损，特征：关节肌肉疼痛伴气血两亏之象，可用(医学衷中参西录>之加味黄芪桂枝五物汤益气养血通络，药用黄芪、当归、白芍、桂枝、秦艽、白术、陈皮、生姜。
②肝肾精血亏损，特征：腰膝酸软，肢体关节屈伸不利，舌质光红少苔。本证可由过用温燥之剂或长期大量使用肾上腺皮质激素而致，全身状况较差，用一般祛风散寒除湿之晶症状反而加重，此时可宗张景岳治久痹之法，"只宜峻补真阴，宣通脉络，使气血得以流行，不得过用祛风等药，再伤阴气，反增其病"。
其代表方为三气饮：当归、栀子、杜仲各60g，熟地9-15g，牛膝、茯苓、酒芍药、肉桂各3g，细辛、白芷、炙甘草各3g，附片6g。笔者经验，方中常加上川断、寄生，下肢痛加防己，上肢痛加姜黄、威灵仙，脊柱痛加鹿角片，疗效满意。
7．痹证外治法
无论哪种类型的痹证，除上述内服药物治疗外，常常配合中医外治诸法，可以提高疗效，现介绍几种：
熏蒸法：用于风寒湿痹患者，无论初起或久病均可。方法：首先将桑枝300g，垂柳枝(柽柳最好)300-500g，二活、防风各30g，威灵仙300g，全紫草300g等放入锅内煎煮，待煮沸后约5分钟，趁热滤除药汁(约5000m1)，倒入浴盆内，置于密室或浴罩中，患者随即脱衣坐于浴盆上熏蒸，待盆内药汁不烫时，再入盆中浸泡，至全身汗出为度，患者浴后要保暖，忌风，躺卧30-60分钟，隔日1次，1次为1疗程，患者浴后往往感到全身肌肉松缓，疼痛明显减轻，但体质太弱者及饥饿时不可施此法，以免发生昏晕。
热熨法：用于风寒湿痹，关节肌肉局部痛甚，遇寒加重点，可用烧砖热熨法，将红砖置火中烧烫，先以干毛巾裹紧患者局部，然后医者戴帆布手套持烧砖在患者局部来回熨烫，动作迅速流利，以不烫伤患者为度，往往术后患者即痛势顿减，轻者2-3次可愈。如烫起水泡者，可外擦紫药水即可。
药管拔法：首先将10-30mm粗的竹管截为10cm长，一头带节，管口削光滑，然后取中药麻黄、桂枝、苍术、二活、防风、生乌头、细辛等以水煎沸，约30分钟后去药渣，取药汁继续煎开，将药管放此药液内浸煮，约5分钟，趁热起管，快速甩掉管内药液，迅速拔于患处(特别是关节周围肌肉较少处适合)，每次3-5分钟，1次可拔数管，连续拔3-5次，本法常与针刺合用，如针后即拔管，疗效更理想。
药棒疗法：取桑枝(66cm长)用丝绒扎成约1cm粗的柔软药棒，临用时给患者局部涂以红花虎杖酒(红花、虎杖各30g，泡酒0．5kg)或其他风湿药酒，然后医者持棒击打患者病体，以病人能耐受为度，每次连续30分钟，0．5-1个月1疗程，本法能促进局部血液循环，明显缓解患者症状。
北京中医学院一附院内科博士江杨清
朱某，男，58岁，退休老中医。住院号：48070。
患者因面色苍白，头晕，乏力半年余，伴恶心呕吐，不能进食5天，门诊以"贫血原因待查"、"溃疡病"?于1988年4月8日收住院。
患者近半年来常感头晕，疲乏无力，未作任何检查治疗。5天前自觉头晕加剧，伴心悸，周身疲软乏力，恶心，食入即吐，纳谷减少。呕吐为胃内容物，由急诊室转入我区。
刻症：面色苍白，头晕，疲乏无力，心悸，纳欠，恶心呕吐，口干思冷饮，饮入即吐。大便量少干燥，3日1行，尿黄赤，舌淡少苔，脉细无力。
1981年曾在某医院钡透提示十二指肠球部溃疡。有嗜酒史20余年，痔疮数十年，经常便鲜血。查体：T37．0℃，P80次／分，R18次／分，BPl0．64／5．32／kPa(80／40mmHg)。贫血貌，慢性病容，消瘦明显，皮肤干燥弹性差。心肺(-)，余(-)。
入院时检：血红蛋白6g，血小板1．3万，红细胞压积0．3(30容积％)，血清总铁结合力53．7μg(300p~g／d1)，血清铁22p．mol／L(123ug／d1)，铁饱和度0．41(41％)。血钾3．5mmol(3．5mEq／L)血钠132mmol(132mEq／L)，血氯87．5mmol／L(312．5mg／dl)。肝功(-)。蛋白电泳：白蛋白49．1％，γ球蛋白25．9％，白蛋白／球蛋白0．96。肝扫描：肝普遍略增大，未见占位性变，B超提示慢性胆囊炎、月巨结石、脂肪肝，上消化道钡透未见明显器质性病变。骨髓穿刺涂片示：幼稚细胞较少，中性分叶核和淋巴细胞数不少，巨核偶见，血小板可见散在。因涂片不佳，未能明确诊断，考虑巨幼贫血可能性大，并发缺铁性贫血。
老师：第一次处方：西洋参3g另煎，党参15g，莲子肉10g，黄连3g，山药15g，白扁豆12g，生苡仁15g，冬瓜子15g，橘白6g，糯稻根10g，焦谷、麦芽各10g，山楂15g。3剂，并配合补液。
1988年4月11日老师查房患者精神好转，皮肤弹性恢复，恶心呕吐未作，食欲明显改善，但仍感头晕乏力、腹胀。舌脉同前。上方去冬瓜子加炮姜炭6g。
1988年4月14日老师查房患者病情渐趋稳定，呕恶已止，纳谷旺，每餐能进150g多，精神明显好转，血压恢复至11．97／6．65kPa(90／50mmHg)，舌质较前红润，脉较前有力，唯大便于结，数日1行。指示改用平补肾阴肾阳，益气养血药治：鹿角胶15g，阿胶10g，仙茅10g，仙灵脾15g，制首乌15g，生熟地各20g，当归log，枸杞子12g，党参15g，木香10g，肉苁蓉log，大枣7枚。上方连服至1988年5月3日，复查血红蛋白9．3g％，红细胞320万，血小板35.1万，红细胞压积0。39(39容积％)，白蛋白／球蛋白1．1，体重增加5kg，精神好，血压平稳。饮食二便均正常，于6月10日出院。出院时自觉口干，夜间多尿，舌质嫩红。换方嘱出院后继续服用：生熟地各30g，山萸肉1og，枸杞子12g，生晒参另煎3g，生黄芪15g，当归log，制首乌10g，煅龙牡各30g，桑螵蛸10g，莲须log，大枣7个。
实习医师甲：请老师谈谈辨证治疗的思维过程。
老师：好，先谈谈辨证思维过程。该患者的突出表现是：苍白，头晕，乏力，心悸，按时间先后分，这是"本病"，而给患者造成直接痛苦的是：恶心，食入即吐，纳谷不思，这是"标病"，根据苍白--呕吐--全身极度虚弱和病程久的主症特点，可以诊断为中医的"贫血"、"呕吐"、"虚劳"。由此，从个别症状的感性认识，上升为理性认识，得出病名的诊断。但仅由症→病，还不足以指导中医的治疗，还必须根据病因和病症特点，分析具体的病机属性，如面色苍白、头晕、疲乏无力、心悸、纳少，舌淡少苔，脉细无力--气血两亏，心脾失养；恶心呕吐、食入或饮入即吐，口于思冷饮，便干尿黄--阴虚胃失润降，腑热内结。归纳起来，其病机主要是：气阴(血)两亏，胃失润降，虚实挟杂。这其实就是"证"，难以用4个字概括，上述12个字，基本能归纳病机的核心，只有这种反映病机要点的"证"，才能更具体，更深刻地反映疾病的本质，才能成为立法用药的依据。贫血可以用养血法，或益气生血法，或温阳，阳生阴长法，呕吐可以用温胃降逆法，也可以用清热止呕，或通腑，化痰，和解平肝，苦辛通降等法；至于虚劳，更有先天后天，阴阳气血，标本缓急，治中治下等不同治法。如果按病治疗，必然杂乱无章，不得要领，无所适从。这时必须把握住病机。病虽多，证则一。至于立法用方，就见仁见智，各有千秋了。疗效的好坏，取决于治法的主次先后，轻重缓急的恰当掌握，以及巧妙合理的配伍，药物选择的精当，剂量的灵活应变。以首次处方为例，方以西洋参、党参益气阴，莲子肉、山药、白扁豆、生苡仁、冬瓜子、橘白、糯稻根、谷麦芽、山楂甘平益胃，乎补气阴，冀胃能恢复润降容纳之性，脾气得苏，食进胃强，以畅生化之源。配黄连，一能苦味健胃，二能清降胃气，和胃止呕。果然药后呕恶即止，纳增神旺，达到了治标顾本的效果。从一般理解，应当是急则治标，缓则治本，先治呕恶，再治贫血虚劳，但我们没有选择旋复代赭石汤、半夏泻心汤、二陈汤、小半夏汤等方止呕降逆，而是甘平益胃，既能润降胃气，又能顾本。因为其虚已甚，-上策应当是在能止呕逆的同时兼顾其虚。补而不壅，且能降胃。因此在治疗上，首先考虑的是"证"，兼顾其"病"，当然个别的"症"，也需对"症"治疗，如见呕恶、口干、尿黄而选用黄连、西洋参即是。
从上可见，该例辨证施治的思维层次是：辨证：从症状着手，获得病名诊断，再确立病机，关键着眼于病机，即"证"的确立；施治：先据证立法用药，再结合"病"和突出的"症"适当选用一二味药物，有主有从。这体现了多数疾病辨治层次的一般规律，辨证思维的方法学与疗效往往是一致的。
医师乙：本例如果由我处方，很可能不是一味地补脾益气，就是降胃止呕或通便泄热。
老师：并不是虚证都适用补法的，不是一见贫血就想到益气生血法。假如本例用参、术、芪等类甘温补脾药，则甘温助热，升发脾阳，壅满胃气，可加重呕逆之证。假如据口干思饮，尿黄便干而一味用生地、元参、麦冬之类养阴清热，增水行舟，又恐滋腻壅滞，影响脾胃运化，寒凉进一步损伤已衰弱极甚之元气。假如用大黄、枳实等通便泄热，伤津耗液，徒伤正气，就更属错误了。当然假如不用甘寒，而是甘凉濡润，佐以少量苦降胃气之味，如金匮麦门冬汤，以麦冬、半夏为主药，也是很得当的。总之治法要符合病机，在这种极度虚弱患者，既要突出重点，又要面面俱到，切勿麻痹疏忽，以药误人。
医师甲：当患者呕恶止，血压回升，食欲精神明显好转，唯剩大便干结时，老师用平补肾阴肾阳，益气养血法，不知出于何种考虑?
老师：标邪基本解除后，就要治本，贫血虚劳，离不开气血阴阳。但峻补元阳则暗耗阴血，峻补元阴则损伤已虚之气、阳，故采用平补法，阴中求阳，阳中求阴，更加党参、当归、阿胶等益气养血，因此治疗重点转移到了"病"(贫血、虚劳)上，实为图本之法，而且首乌、生地、当归、苁蓉兼有润肠通便之功，使药后大便得以润下。
进修医师甲：为何选择鹿角胶?
老师：精血同源。虚劳贫血之患者，肾气肾精已亏，选鹿角胶血肉有情之晶，冀能培植肾之根本。此例有阴阳气血并亏之候而无火旺、内热之象，故用之无禁忌，且近年许多临床研究证实，单纯使用养阴补血药对贫血仅能缓解部分症状，对血象改变不大，而健脾温肾药，不仅能改善症状，而且可使血象明显上升，尤其鹿茸、人参对提高血红蛋白方面有显著效果，故择之为君。
进修医师乙：使用温阳益阴，补气生血法治疗一段时间后，血象上升较快，出院时体重增加5kg，最后老师处以左归饮合桑螵蛸散化裁，是否考虑肾虚夜尿多之故?为什么还要用人参、黄芪呢?
老师：肾虚往往是在脾虚的基础上产生的，或兼挟脾虚，我在补肾的同时，总是要用些益气扶脾药，能加强补肾的功效。
医师甲：这个患者入院后呕恶纳欠及全身状况迅速改善，是否配用了西药?
b．乌头细辛类：乌头、细辛类药物是辛热透窍止痛的重要药物，外能祛除风寒，内能温散阴寒之邪。乌头配伍细辛具有很强的止痛作用，根据我个人师承的经验，治疗阴寒痛结、关节冷痛的顽固性痹证患者，常用三生活血酒：生川乌3-5枚，生草乌3-5枚，生天南星1-2枚，当归15g，红花10g，桃仁10g，细辛30g，田七1g，秦艽30g，甘草1g。曾跟随老师治疗数例顽固性寒痹疼痛患者，收到了很好的疗效。用法：上述药物泡酒1.5kg，每次服用5-10ml，如果有涩口感则增加甘草的剂量，每日2次，早晚服用。有报道重用细辛治疗类风湿性关节炎100例，结果痊愈76例，显效14例，有效10例，平均治愈时间30～60天。基本方：细辛30～60g，制附子10～30g，稀莶草30～100g。每剂药水煎2次，每次40分钟，分4次服用。作者认为凡患者无严重心血管病，本方可服用半年之久，无任何不良反应。笔者临床一般细辛用量在10～15g左右，水煎30～40分钟，未发现任何毒副作用。上海研究指出，细辛的主要有毒成分为黄樟酮，若水煎30分钟，可大大降低毒性。这为加大剂量运用本品提供了依据。
6．虚痹用药
痹症日久不愈，可导致人体正气亏损，临床常见以下两种情况：
①气血亏损，特征：关节肌肉疼痛伴有气血两亏之象，可用《医学衷中参西录》中的加味黄芪桂枝五物汤益气养血通络，药用黄芪、当归、白芍、桂枝、秦艽、白术、陈皮、生姜。
②肝肾精血亏损，特征：腰膝酸软，肢体关节屈伸不利，舌质光红少苔。本证可由过用温燥之剂或长期大量使用肾上腺皮质激素所致，全身状况较差，用一般祛风散寒除湿的药物症状反而加重，此时可遵循张景岳治疗久痹的方法，“只宜峻补真阴，宣通脉络，使气血得以流行，不得过用祛风等药，再伤阴气，反增其病”。
其代表方为三气饮：当归、栀子、杜仲各60g，熟地黄9-15g，牛膝、茯苓、酒芍药、肉桂各3g，细辛、白芷、炙甘草各3g，附片6g。笔者经验，方中常加上川断、桑寄生，下肢痛加防己，上肢痛加姜黄、威灵仙，脊柱痛加鹿角片，疗效满意。
7．痹证外治法
无论哪种类型的痹证，除上述内服药物治疗外，常常配合中医外治诸法，可以提高疗效，现介绍几种：
熏蒸法：用于风寒湿痹患者，无论初起或久病均可。方法：首先将桑枝300g，垂柳枝（柽柳最好）300-500g，羌活、独活各30g，防风30g，威灵仙300g，全紫草300g等放入锅内煎煮，待煮沸后约5分钟，趁热滤除药汁（约5000ml），倒入浴盆内，置于密室或浴罩中，患者随即脱衣坐于浴盆上熏蒸，待盆内药汁不烫时，再入盆中浸泡，至全身汗出为度，患者浴后要保暖，忌风，躺卧30-60分钟，隔日1次，1次为1疗程，患者浴后往往感到全身肌肉松缓，疼痛明显减轻，但体质太弱者及饥饿时不可施此法，以免发生昏晕。
热熨法：用于风寒湿痹，关节肌肉局部痛甚，遇寒加重点，可用烧砖热熨法，将红砖置火中烧烫，先以干毛巾裹紧患者局部，然后医者戴帆布手套持烧砖在患者局部来回熨烫，动作迅速流利，以不烫伤患者为度，往往术后患者即痛势顿减，轻者2-3次可愈。如烫起水泡者，可外擦紫药水即可。
药管拔法：首先将10-30mm粗的竹管截为10cm长，一头带节，管口削光滑，然后取中药麻黄、桂枝、苍术、羌活、独活、防风、生乌头、细辛等以水煎沸，约30分钟后去药渣，取药汁继续煎开，将药管放此药液内浸煮，约5分钟，趁热起管，快速甩掉管内药液，迅速拔于患处（特别是关节周围肌肉较少处适合），每次3-5分钟，1次可拔数管，连续拔3-5次，本法常与针刺合用，如针后即拔管，疗效更理想。
药棒疗法：取桑枝（66cm长）用丝绒扎成约1cm粗的柔软药棒，临用时给患者局部涂以红花虎杖酒（红花、虎杖各30g，泡酒0.5kg）或其他风湿药酒，然后医者持棒击打患者病体，以病人能耐受为度，每次连续30分钟，0.5-1个月1疗程，本法能促进局部血液循环，明显缓解患者症状。
北京中医学院一附院内科博士江杨清
朱某，男，58岁，退休老中医。住院号：48070。
患者因面色苍白，头晕，乏力半年余，伴恶心呕吐，不能进食5天，门诊以“贫血原因待查”、“溃疡病”？于1988年4月8日收住院。
患者近半年来常感头晕，疲乏无力，未作任何检查治疗。5天前自觉头晕加剧，伴心悸，周身疲软乏力，恶心，食入即吐，纳谷减少。呕吐为胃内容物，由急诊室转入我区。
刻症：面色苍白，头晕，疲乏无力，心悸，纳欠，恶心呕吐，口干思冷饮，饮入即吐。大便量少干燥，3日1行，尿黄赤，舌淡少苔，脉细无力。
1981年曾在某医院钡透提示十二指肠球部溃疡。有嗜酒史20余年，痔疮数十年，经常便鲜血。查体：T37.0℃，P80次／分，R18次／分，BP10.64／5.32／kPa（80／40mmHg）。贫血貌，慢性病容，消瘦明显，皮肤干燥弹性差。心肺（-），余（-）。
入院时检：血红蛋白6g，血小板1.3万，红细胞压积0.3（30容积％），血清总铁结合力53.7μg（300μg／d1），血清铁22μmol／L（123ug／d1），铁饱和度0.41（41％）。血钾3.5mmol（3.5mEq／L）血钠132mmol（132mEq／L），血氯87.5mmol／L（312.5mg／dl）。肝功（-）。蛋白电泳：白蛋白49.1％，γ球蛋白25.9％，白蛋白／球蛋白0.96。肝扫描：肝普遍略增大，未见占位性变，B超提示慢性胆囊炎、胆结石、脂肪肝，上消化道钡透未见明显器质性病变。骨髓穿刺涂片示：幼稚细胞较少，中性分叶核和淋巴细胞数不少，巨核偶见，血小板可见散在。因涂片不佳，未能明确诊断，考虑巨幼贫血可能性大，并发缺铁性贫血。
老师：第一次处方：西洋参3g另煎，党参15g，莲子肉10g，黄连3g，山药15g，白扁豆12g，生苡仁15g，冬瓜子15g，橘白6g，糯稻根10g，焦谷芽、焦麦芽各10g，山楂15g。3剂，并配合补液。
1988年4月11日老师查房患者精神好转，皮肤弹性恢复，恶心呕吐未作，食欲明显改善，但仍感头晕乏力、腹胀。舌脉同前。上方去冬瓜子加炮姜炭6g。
1988年4月14日老师查房患者病情渐趋稳定，呕恶已止，纳谷旺，每餐能进150g多，精神明显好转，血压恢复至11.97／6.65kPa（90／50mmHg），舌质较前红润，脉较前有力，唯大便于结，数日1行。指示改用平补肾阴肾阳，益气养血药治：鹿角胶15g，阿胶10g，仙茅10g，仙灵脾15g，制首乌15g，生熟地各20g，当归10g，枸杞子12g，党参15g，木香10g，肉苁蓉10g，大枣7枚。上方连服至1988年5月3日，复查血红蛋白9.3g％，红细胞320万，血小板35.1万，红细胞压积0.39（39容积％），白蛋白／球蛋白1.1，体重增加5kg，精神好，血压平稳。饮食二便均正常，于6月10日出院。出院时自觉口干，夜间多尿，舌质嫩红。换方嘱出院后继续服用：生熟地各30g，山萸肉10g，枸杞子12g，生晒参另煎3g，生黄芪15g，当归10g，制首乌10g，煅龙牡各30g，桑螵蛸10g，莲须10g，大枣7个。
实习医师甲：请老师谈谈辨证治疗的思维过程。
老师：好，先谈谈辨证思维过程。该患者的突出表现是：苍白，头晕，乏力，心悸，按时间先后分，这是“本病”，而给患者造成直接痛苦的是：恶心，食入即吐，纳谷不思，这是“标病”，根据苍白--呕吐--全身极度虚弱和病程久的主症特点，可以诊断为中医的“贫血”、“呕吐”、“虚劳”。由此，从个别症状的感性认识，上升为理性认识，得出病名的诊断。但仅由症→病，还不足以指导中医的治疗，还必须根据病因和病症特点，分析具体的病机属性，如面色苍白、头晕、疲乏无力、心悸、纳少，舌淡少苔，脉细无力--气血两亏，心脾失养；恶心呕吐、食入或饮入即吐，口干思冷饮，便干尿黄--阴虚胃失润降，腑热内结。归纳起来，其病机主要是：气阴（血）两亏，胃失润降，虚实挟杂。这其实就是“证”，难以用4个字概括，上述12个字，基本能归纳病机的核心，只有这种反映病机要点的“证”，才能更具体，更深刻地反映疾病的本质，才能成为立法用药的依据。贫血可以用养血法，或益气生血法，或温阳，阳生阴长法，呕吐可以用温胃降逆法，也可以用清热止呕，或通腑，化痰，和解平肝，苦辛通降等法；至于虚劳，更有先天后天，阴阳气血，标本缓急，治中治下等不同治法。如果按病治疗，必然杂乱无章，不得要领，无所适从。这时必须把握住病机。病虽多，证则一。至于立法用方，就见仁见智，各有千秋了。疗效的好坏，取决于治法的主次先后，轻重缓急的恰当掌握，以及巧妙合理的配伍，药物选择的精当，剂量的灵活应变。以首次处方为例，方以西洋参、党参益气阴，莲子肉、山药、白扁豆、生苡仁、冬瓜子、橘白、糯稻根、谷麦芽、山楂甘平益胃，平补气阴，冀胃能恢复润降容纳之性，脾气得苏，食进胃强，以畅生化之源。配黄连，一能苦味健胃，二能清降胃气，和胃止呕。果然药后呕恶即止，纳增神旺，达到了治标顾本的效果。从一般理解，应当是急则治标，缓则治本，先治呕恶，再治贫血虚劳，但我们没有选择旋复代赭石汤、半夏泻心汤、二陈汤、小半夏汤等方止呕降逆，而是甘平益胃，既能润降胃气，又能顾本。因为其虚已甚，上策应当是在能止呕逆的同时兼顾其虚。补而不壅，且能降胃。因此在治疗上，首先考虑的是“证”，兼顾其“病”，当然个别的“症”，也需对“症”治疗，如见呕恶、口干、尿黄而选用黄连、西洋参即是。
从上可见，该例辨证施治的思维层次是：辨证：从症状着手，获得病名诊断，再确立病机，关键着眼于病机，即“证”的确立；施治：先据证立法用药，再结合“病”和突出的“症”适当选用一二味药物，有主有从。这体现了多数疾病辨治层次的一般规律，辨证思维的方法学与疗效往往是一致的。
医师乙：本例如果由我处方，很可能不是一味地补脾益气，就是降胃止呕或通便泄热。
老师：并不是虚证都适用补法的，不是一见贫血就想到益气生血法。假如本例用参、术、芪等类甘温补脾药，则甘温助热，升发脾阳，壅满胃气，可加重呕逆之证。假如据口干思饮，尿黄便干而一味用生地、元参、麦冬之类养阴清热，增水行舟，又恐滋腻壅滞，影响脾胃运化，寒凉进一步损伤已衰弱极甚之元气。假如用大黄、枳实等通便泄热，伤津耗液，徒伤正气，就更属错误了。当然假如不用甘寒，而是甘凉濡润，佐以少量苦降胃气之味，如金匮麦门冬汤，以麦冬、半夏为主药，也是很得当的。总之治法要符合病机，在这种极度虚弱患者，既要突出重点，又要面面俱到，切勿麻痹疏忽，以药误人。
医师甲：当患者呕恶止，血压回升，食欲精神明显好转，唯剩大便干结时，老师用平补肾阴肾阳，益气养血法，不知出于何种考虑？
老师：标邪基本解除后，就要治本，贫血虚劳，离不开气血阴阳。但峻补元阳则暗耗阴血，峻补元阴则损伤已虚之气、阳，故采用平补法，阴中求阳，阳中求阴，更加党参、当归、阿胶等益气养血，因此治疗重点转移到了“病”（贫血、虚劳）上，实为图本之法，而且首乌、生地、当归、苁蓉兼有润肠通便之功，使药后大便得以润下。
进修医师甲：为何选择鹿角胶？
老师：精血同源。虚劳贫血之患者，肾气肾精已亏，选鹿角胶血肉有情之品，冀能培植肾之根本。此例有阴阳气血并亏之候而无火旺、内热之象，故用之无禁忌，且近年许多临床研究证实，单纯使用养阴补血药对贫血仅能缓解部分症状，对血象改变不大，而健脾温肾药，不仅能改善症状，而且可使血象明显上升，尤其鹿茸、人参对提高血红蛋白方面有显著效果，故择之为君。
进修医师乙：使用温阳益阴，补气生血法治疗一段时间后，血象上升较快，出院时体重增加5kg，最后老师处以左归饮合桑螵蛸散化裁，是否考虑肾虚夜尿多之故？为什么还要用人参、黄芪呢？
老师：肾虚往往是在脾虚的基础上产生的，或兼挟脾虚，我在补肾的同时，总是要用些益气扶脾药，能加强补肾的功效。
医师甲：这个患者入院后呕恶纳欠及全身状况迅速改善，是否配用了西药？
b. Aconite and Asarum Category: Medicines in the Aconite and Asarum category are essential herbs for their pungent, hot nature to penetrate orifices and relieve pain. Externally, they can dispel wind-cold; internally, they can warm and dissipate yin-cold pathogens. The combination of Aconite (Fuzi) and Asarum (Xixin) has a strong analgesic effect. Based on my personal experience passed down from my master, for treating patients with stubborn Bi syndrome characterized by Yin-cold pain accumulation and cold pain in joints, I commonly use "San Sheng Huo Xue Jiu" (Three Raw Blood-Invigorating Wine): 3-5 raw Radix Aconiti Lateralis Preparata (Sheng Chuanwu), 3-5 raw Radix Aconiti Lateralis Preparata (Sheng Caowu), 1-2 raw Rhizoma Arisaematis (Sheng Nanting), Angelicae Sinensis Radix (Danggui) 15g, Carthami Flos (Honghua) 10g, Persicae Semen (Taoren) 10g, Asari Herba (Xixin) 30g, Notoginseng Radix et Rhizoma (Tianqi) 1g, Gentianae Macrophyllae Radix (Qinjiao) 30g, Glycyrrhizae Radix et Rhizoma (Gancao) 1g. I once followed my master to treat several cases of patients with stubborn cold-Bi pain, achieving good curative effects. Usage: Soak the above herbs in 1.5 kg of wine. Take 5-10 ml each time. If there is an astringent taste, increase the dosage of Gancao. Take twice daily, morning and evening. There are reports on using heavy doses of Xixin to treat 100 cases of Rheumatoid Arthritis, with results showing 76 cured, 14 markedly effective, and 10 effective, with an average cure time of 30-60 days. The basic formula consists of: Asari Herba (Xixin) 30-60g, Prepared Radix Aconiti Lateralis (Zhi Fuzi) 10-30g, Siegesbeckiae Herba (Xixiancao) 30-100g. Decoct each dose in water twice, for 40 minutes each time, and divide into four doses. The author believes that as long as the patient does not have severe cardiovascular disease, this formula can be taken for up to half a year without any adverse reactions. In my clinical practice, the general dosage of Xixin is around 10-15g, decocted in water for 30-40 minutes, without discovering any toxic side effects. Research in Shanghai indicates that the main toxic component of Xixin is Safrole. If decocted in water for 30 minutes, its toxicity can be greatly reduced. This provides a basis for increasing the dosage of this herb.
6. Medication for Deficiency Bi
If Bi syndrome persists for a long time without healing, it can lead to a deficiency of the body's righteous Qi. Clinically, the following two situations are common:
① Qi and Blood Deficiency: Characteristics include joint and muscle pain accompanied by signs of both Qi and Blood deficiency. One may use the Modified Huangqi Guizhi Wuwu Tang from *Yixue Zhongzhong Canxi Lu* (Medical Records: A Combination of Chinese and Western Medicine) to tonify Qi, nourish Blood, and unblock collaterals. The herbs used are Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Cinnamomi Ramulus (Guizhi), Gentianae Macrophyllae Radix (Qinjiao), Atractodis Rhizoma (Baizhu), Citri Reticulatae Pericarpium (Chenpi), and Zingiberis Rhizoma Recens (Shengjiang).
② Liver and Kidney Essence and Blood Deficiency: Characteristics include soreness and weakness of the waist and knees, difficulty in flexion and extension of limb joints, and a red tongue with little coating. This syndrome can be caused by the overuse of warming and drying agents or the long-term, large-dose use of adrenal corticosteroids. The overall condition is poor, and symptoms may worsen with the use of general wind-dispelling, cold-resolving, and damp-draining drugs. At this time, one should follow Zhang Jingyue’s method for treating chronic Bi: "One should only vigorously tonify True Yin and promote the circulation of meridians so that Qi and Blood can flow freely. One must not overuse wind-dispelling herbs, which would further injure Yin Qi and exacerbate the disease."
The representative formula is Sanqi Yin: Angelicae Sinensis Radix (Danggui), Gardeniae Fructus (Zhizi), and Eucommiae Cortex (Duzhong) each 60g, Prepared Rehmanniae Radix (Shudi) 9-15g, Achyranthis Bidentatae Radix (Niuxi), Poria (Fuling), Wine-processed Paeoniae Radix (Jiu Shaoyao), and Cinnamon Bark (Rougui) each 3g, Asari Herba (Xixin), Peucedani Radix (Baizhi), and Honey-fried Glycyrrhizae Radix et Rhizoma (Zhi Gancao) each 3g, and Aconitum Carmichaelii Lateralis Radix Praeparata (Fupian) 6g. In my experience, it is often added with Dipsaci Radix (Chuanduan) and Taxilli Herba (Jisheng). For lower limb pain, add Saposhnikoviae Radix (Fangji); for upper limb pain, add Curcumae Longae Rhizoma (Jianghuang) and Syneilesis Herba (Weilingxian); for spinal pain, add Deer Antler Slice (Lujiaopian). The curative effect is satisfactory.
7. External Treatments for Bi Syndrome
Regardless of the type of Bi syndrome, in addition to the aforementioned internal medication, combining various Traditional Chinese Medicine external treatments can improve curative effects. Several methods are introduced below:
Moxibustion/Fumigation Method: Used for patients with Wind-Cold-Damp Bi, applicable whether in the early stage or chronic phase. Method: First, place Mulberry Twig (Sangzhi) 300g, Weeping Willow Twig (Chengliuzhi, preferably Tamarix Herba/Chengliu) 300-500g, Notopterygii Rhizoma et Radix (Qianghuo) and Saposhnikoviae Radix (Duhuo) each 30g, Saposhnikoviae Radix (Fangfeng) 30g, Syneilesis Herba (Weilingxian) 300g, and Lithospermi Herba (Quanzicao) 300g in a pot and boil. After boiling for about 5 minutes, filter out the medicinal juice (about 5000 ml) while hot, pour it into a bathtub, and place it in a sealed room or under a bath canopy. The patient then undresses and sits on the bathtub to fumigate. When the liquid in the tub is no longer scalding, the patient enters the tub to soak until sweating occurs throughout the body. After bathing, the patient must keep warm, avoid wind, and lie down for 30-60 minutes. This is done every other day, with one session constituting one course of treatment. Patients often feel relaxed muscles and significantly reduced pain after bathing. However, this method should not be used for those with very weak constitutions or when hungry, to avoid fainting.
Hot Compress/Ironing Method: Used for Wind-Cold-Damp Bi, especially when local joint and muscle pain is severe and worsens with cold. One can use the hot brick ironing method. Place a red brick in the fire until hot. First, wrap the patient's affected area tightly with a dry towel. Then, the practitioner, wearing canvas gloves, holds the hot brick and irons back and forth over the patient's local area. The movement should be swift and fluid, ensuring not to burn the patient. Often, the pain subsides immediately after the procedure, and mild cases can be cured in 2-3 sessions. If blisters form, apply gentian violet externally.
Medicinal Cupping/Pulling Method: First, cut bamboo tubes with a diameter of 10-30 mm into 10 cm lengths, keeping one end with a node and smoothing the tube opening. Then, take Chinese medicines such as Ephedrae Herba (Mahuang), Cinnamomi Ramulus (Guizhi), Atractodis Rhizoma (Cangzhu), Qianghuo, Duhuo, Fangfeng, Raw Aconite (Sheng Wutou), and Asari Herba (Xixin), boil them in water. After about 30 minutes, remove the dregs, take the medicinal juice, and continue to boil. Place the medicinal tube in this liquid and simmer for about 5 minutes. While hot, lift the tube, quickly shake off the liquid inside, and rapidly apply it to the affected area (especially suitable for areas around joints with less muscle). Keep it on for 3-5 minutes each time. Several tubes can be applied at once, continuing for 3-5 times. This method is often combined with acupuncture; for example, applying cupping immediately after needle insertion yields ideal results.
Medicinal Stick Therapy: Take a Mulberry Twig (66 cm long) and bind it with velvet to form a soft medicinal stick about 1 cm thick. Before use, apply Honghua Huzhang Jiu (Carthami Flos and Polygoni Cuspidati Rhizoma et Radix, each 30g, soaked in 0.5 kg of wine) or other rheumatic medicinal wine to the patient's local area. Then, the practitioner strikes the patient's diseased body with the stick, tolerable to the patient. Each session lasts continuously for 30 minutes, with one course lasting 0.5-1 month. This method can promote local blood circulation and significantly alleviate patient symptoms.
Pale complexion, dizziness for over half a year, nausea and vomiting for 5 days
Jiang Yangqing, PhD, Department of Internal Medicine, First Affiliated Hospital of Beijing University of Chinese Medicine
Patient Zhu, Male, 58 years old, retired senior TCM practitioner. Hospitalization No.: 48070.
The patient was hospitalized on April 8, 1988, due to pale complexion, dizziness, and fatigue for over half a year, accompanied by nausea and vomiting and inability to eat for 5 days. Outpatient diagnosis was "Anemia of unknown cause" and "Peptic Ulcer?".
For the past half year, the patient often felt dizzy and fatigued, without any examination or treatment. Five days ago, he felt the dizziness worsen, accompanied by palpitations, generalized weakness, nausea, immediate vomiting after eating, and reduced appetite. The vomitus consisted of gastric contents, and he was transferred from the emergency room to our department.
Current Symptoms: Pale complexion, dizziness, fatigue, palpitations, poor appetite, nausea and vomiting, dry mouth craving cold drinks, immediate vomiting after drinking. Small amount of dry stool, once every 3 days, yellow-red urine, pale tongue with little coating, fine and forceless pulse.
In 1981, barium meal radiography at a certain hospital suggested duodenal bulb ulcer. He has a history of alcoholism for over 20 years, hemorrhoids for decades, and frequent fresh blood in stool. Physical Examination: T 37.0°C, P 80 beats/min, R 18 breaths/min, BP 10.64/5.32 kPa (80/40 mmHg). Anemic appearance, chronic illness face, significant emaciation, dry skin with poor elasticity. Heart and lungs (-), others (-).
Admission Tests: Hemoglobin 6 g, Platelets 13,000, Hematocrit 0.3 (30 vol%), Serum Total Iron Binding Capacity 53.7 μg (300 μg/dl), Serum Iron 22 μmol/L (123 μg/dl), Iron Saturation 0.41 (41%). Blood Potassium 3.5 mmol (3.5 mEq/L), Blood Sodium 132 mmol (132 mEq/L), Blood Chloride 87.5 mmol/L (312.5 mg/dl). Liver Function (-). Protein Electrophoresis: Albumin 49.1%, γ-Globulin 25.9%, Albumin/Globulin Ratio 0.96. Liver Scan: Liver generally slightly enlarged, no space-occupying lesions. B-ultrasound suggests chronic cholecystitis, gallstones, fatty liver. Upper GI barium meal showed no obvious organic lesions. Bone marrow aspiration smear shows: few immature cells, sufficient neutrophils and lymphocytes, occasional megakaryocytes, scattered platelets visible. Due to poor smear quality, a definitive diagnosis could not be made, considering Megaloblastic Anemia likely, complicated by Iron Deficiency Anemia.
TCM Diagnosis: Vomiting; Vertigo; Xu Lao (Deficiency Consumption).
Teacher: First Prescription: American Ginseng (Yangshen) 3g decocted separately, Codonopsis Radix (Dangshen) 15g, Lotus Seed Meat (Lianzirou) 10g, Coptidis Rhizoma (Huanglian) 3g, Dioscoreae Rhizoma (Shanyao) 15g, Dolichoris Semen (Baibian Dou) 12g, Coicis Semen (Sheng Yiren) 15g, Benincasae Semen (Dongguazi) 15g, Tangerine Peel (Ju Bai) 6g, Imperatae Rhizoma (Nuodaogen) 10g, Charred Coix Seed and Hordeum Germinatum (Jiao Guya, Maiya) each 10g, Crataegi Fructus (Shanzha) 15g. 3 doses, combined with fluid replacement.
On April 11, 1988, during ward rounds, the teacher found the patient's spirit had improved, skin elasticity recovered, nausea and vomiting had ceased, and appetite had significantly improved, but he still felt dizzy, fatigued, and bloated. Tongue and pulse remained the same. Remove Dongguazi from the above prescription and add Charred Zingiberis Rhizoma (Pao Jiangtan) 6g.
On April 14, 1988, during ward rounds, the teacher found the patient's condition gradually stabilized, vomiting and nausea had stopped, appetite was vigorous, able to eat more than 150g per meal, spirit significantly improved, blood pressure recovered to 11.97/6.65 kPa (90/50 mmHg), tongue color redder than before, pulse stronger than before, only stool was dry and hard, once every few days. Instructed to switch to a formula that gently tonifies Kidney Yin and Yang, and benefits Qi and nourishes Blood: Cervus Cornu Colla (Lujiaojiao) 15g, Donkey-Hide Gelatin (Ejiao) 10g, Morindae Officinalis Radix (Xianmao) 10g, Epimedii Folium (Xianlingpi) 15g, Prepared Polygoni Multiflori Radix (Zhi Shouwu) 15g, Raw and Prepared Rehmanniae Radix (Sheng Shudi) each 20g, Angelicae Sinensis Radix (Danggui) 10g, Lycii Fructus (Gouqizi) 12g, Codonopsis Radix (Dangshen) 15g, Aucklandiae Radix (Muxiang) 10g, Cynomorii Herba (Roucongrou) 10g, Jujubae Fructus (Dazao) 7 pieces. Continue taking the above prescription until May 3, 1988. Re-examination showed Hemoglobin 9.3 g%, Red Blood Cells 3.2 million, Platelets 351,000, Hematocrit 0.39 (39 vol%), Albumin/Globulin Ratio 1.1, weight increased by 5 kg, good spirit, stable blood pressure. Diet and excretion were normal. Discharged on June 10. At discharge, he felt dry mouth and polyuria at night, tender red tongue. Changed prescription and instructed to continue taking after discharge: Raw and Prepared Rehmanniae Radix (Sheng Shudi) each 30g, Corni Fructus (Shanyurou) 10g, Lycii Fructus (Gouqizi) 12g, Sun-dried Panax Ginseng (Sheng Shaishen) 3g decocted separately, Raw Astragali Radix (Sheng Huangqi) 15g, Angelicae Sinensis Radix (Danggui) 10g, Prepared Polygoni Multiflori Radix (Zhi Shouwu) 10g, Calcined Oyster Shell and Dragon Bone (Duan Longmu) each 30g, Mantis Egg Case (Sangpiaoxiao) 10g, Lotus Stamen (Lianxu) 10g, Jujubae Fructus (Dazao) 7 pieces.
Intern Physician A: Please, Teacher, talk about the thinking process of syndrome differentiation and treatment.
Teacher: Okay, let's first discuss the syndrome differentiation thinking process. The prominent manifestations of this patient are: pallor, dizziness, fatigue, palpitations. Chronologically, this is the "Root Disease," while what causes direct suffering to the patient is: nausea, immediate vomiting after eating, loss of appetite, which is the "Branch Disease." Based on the main symptom characteristics of pallor -- vomiting -- extreme whole-body weakness and long disease course, it can be diagnosed in TCM as "Anemia," "Vomiting," and "Xu Lao" (Deficiency Consumption). Thus, moving from perceptual knowledge of individual symptoms to rational knowledge leads to the diagnosis of the disease name. However, merely going from symptoms to disease name is insufficient to guide TCM treatment. One must also analyze the specific pathogenesis attributes based on etiology and symptom characteristics. For example, pale complexion, dizziness, fatigue, palpitations, poor appetite, pale tongue with little coating, fine and forceless pulse -- indicate Qi and Blood deficiency, Heart and Spleen failing to nourish; nausea and vomiting, immediate vomiting after eating or drinking, dry mouth craving cold drinks, dry stool and yellow urine -- indicate Yin deficiency with Stomach failing to moisten and descend, and interior heat binding in the Fu organs. Summarizing, the pathogenesis is mainly: Qi and Yin (Blood) dual deficiency, Stomach failing to moisten and descend, mixed excess and deficiency. This is essentially the "Syndrome" (Zheng), which is difficult to summarize in 4 characters. The above 12 characters basically capture the core of the pathogenesis. Only this "Syndrome," reflecting the key points of pathogenesis, can more specifically and profoundly reflect the essence of the disease, and thus become the basis for establishing treatment principles and prescribing medications. Anemia can be treated with Blood-nourishing method, or Qi-benefiting and Blood-generating method, or Yang-warming, Yang-generating Yin-growing method. Vomiting can be treated with Stomach-warming and counterflow-reversing method, or Heat-clearing and vomiting-stopping method, or Fu-unblocking, Phlegm-resolving, Harmonizing and Liver-pacifying, Bitter-Sweet descending method; as for Xu Lao, there are even different treatment methods such as tonifying congenital and acquired sources, Yin and Yang, Qi and Blood, root and branch, urgency and slowness, treating middle and lower jiao. If treating according to disease alone, it will inevitably be chaotic, lacking direction, and leaving one at a loss. At this time, one must grasp the pathogenesis. Although diseases are many, the syndrome is one. As for establishing treatment principles and prescribing formulas, opinions vary. The quality of curative effects depends on the appropriate mastery of the priority and sequence of treatment methods, severity and urgency, as well as clever and reasonable compatibility, precise drug selection, and flexible dosage adjustment. Taking the first prescription as an example, the formula uses Yangshen and Dangshen to benefit Qi and Yin; Lianzirou, Shanyao, Baibian Dou, Sheng Yiren, Dongguazi, Ju Bai, Nuodaogen, Guya, Maiya, and Shanzha are sweet and neutral to benefit the Stomach, gently tonifying Qi and Yin, hoping the Stomach can restore its properties of moistening, descending, and containing, allowing Spleen Qi to recover, food intake to increase, Stomach strength to strengthen, thereby smoothing the source of production and transformation. Combined with Huanglian, firstly, bitter flavor strengthens the Stomach; secondly, it clears and descends Stomach Qi, harmonizes the Stomach, and stops vomiting. Indeed, after taking the medicine, vomiting and nausea stopped, appetite increased, and spirit became vigorous, achieving the effect of treating the branch while attending to the root. From a general understanding, one should treat the branch in acute cases and the root in chronic cases, treating vomiting first, then anemia and Xu Lao. However, we did not choose formulas like Xuanfu Daizhe Shi Tang, Banxia Xiexin Tang, Erchen Tang, or Xiao Banxia Tang to stop vomiting and reverse counterflow. Instead, we used sweet and neutral Stomach-benefiting herbs, which can both moisten and descend Stomach Qi and attend to the root. Because the deficiency is already severe, the best strategy is to attend to the deficiency while stopping vomiting and counterflow. Tonifying without stagnation, and able to descend Stomach Qi. Therefore, in treatment, the "Syndrome" is considered first, attending to the "Disease," of course, individual "Symptoms" also require symptomatic treatment, such as choosing Huanglian and Yangshen for vomiting, dry mouth, and yellow urine.
From the above, it can be seen that the thinking hierarchy of syndrome differentiation and treatment in this case is: Syndrome Differentiation: Starting from symptoms, obtaining disease name diagnosis, then establishing pathogenesis, focusing critically on the establishment of the "Syndrome"; Treatment: First, establish treatment principles and prescribe medications based on the syndrome, then appropriately select one or two herbs in combination with the "Disease" and prominent "Symptoms," having primary and secondary aspects. This reflects the general law of the hierarchy of differentiation and treatment for most diseases, and the methodology of syndrome differentiation thinking is often consistent with curative effects.
Physician B: If I prescribed for this case, it would likely be either purely tonifying Spleen and benefiting Qi, or descending Stomach and stopping vomiting, or unblocking bowels and draining heat.
Teacher: Not all deficiency syndromes are suitable for tonification methods. Seeing anemia does not automatically mean thinking of Qi-benefiting and Blood-generating methods. If this case used sweet-warm Spleen-tonifying herbs like Renshen, Baizhu, and Huangqi, the sweet-warm nature would assist heat, raise Spleen Yang, and cause fullness in Stomach Qi, potentially worsening the vomiting and counterflow. If, based on dry mouth craving drinks, yellow urine, and dry stool, one blindly used Yin-nourishing and Heat-clearing herbs like Shengdi, Xuanshen, and Maidong to "add water to move the boat," one might fear cloying stagnation, affecting Spleen and Stomach transportation, and further damaging the already extremely weakened Yuan Qi with cold-natured herbs. If one used herbs like Dahuang and Zhishi to unblock bowels and drain heat, injuring fluids and consuming Qi, it would be even more erroneous. Of course, if instead of sweet-cold, one used sweet-cool and moistening herbs, assisted by a small amount of bitter-descending Stomach Qi herbs, such as Jin Gui Maidong Tang, with Maidong and Banxia as main herbs, it would also be quite appropriate. In short, treatment methods must conform to pathogenesis. In such extremely weak patients, one must highlight key points while being comprehensive, avoiding negligence and harming people with inappropriate medication.
Physician A: When the patient's vomiting stopped, blood pressure rose, appetite and spirit significantly improved, leaving only dry stool, why did the teacher use the method of gently tonifying Kidney Yin and Yang, benefiting Qi and nourishing Blood? What was the consideration?
Teacher: After the branch pathogens are basically resolved, one must treat the root. Anemia and Xu Lao cannot be separated from Qi, Blood, Yin, and Yang. However, vigorously tonifying Yuan Yang secretly consumes Yin Blood, and vigorously tonifying Yuan Yin damages the already deficient Qi and Yang. Therefore, a gentle tonification method is adopted, seeking Yang within Yin and Yin within Yang. Additionally, Dangshen, Danggui, Ejiao, etc., are added to benefit Qi and nourish Blood. Thus, the treatment focus shifted to the "Disease" (Anemia, Xu Lao), truly aiming at the root. Moreover, Shouwu, Shengdi, Danggui, and Roucongrou also have the function of moistening intestines and unblocking bowels, allowing the stool to pass smoothly after taking the medicine.
Advanced Study Physician A: Why choose Cervus Cornu Colla (Lujiaojiao)?
Teacher: Essence and Blood share the same source. In patients with Xu Lao and anemia, Kidney Qi and Kidney Essence are already deficient. Choosing Lujiaojiao, a substance with emotional affinity (blood and flesh origin), hopes to cultivate the foundation of the Kidney. This case presents concurrent deficiency of Yin, Yang, Qi, and Blood without signs of Fire hyperactivity or interior heat, so there are no contraindications for its use. Furthermore, many clinical studies in recent years have confirmed that simply using Yin-nourishing and Blood-nourishing herbs can only alleviate some symptoms of anemia, with little change in blood indices. Whereas Spleen-tonifying and Kidney-warming herbs can not only improve symptoms but also significantly raise blood indices. Especially Luzhuru (Deer Antler) and Renshen have significant effects on improving hemoglobin levels, so they were chosen as the sovereign herbs.
Advanced Study Physician B: After a period of treatment with Yang-warming and Yin-nourishing, Qi-benefiting and Blood-generating methods, blood indices rose relatively quickly, weight increased by 5 kg at discharge. Finally, the teacher prescribed a modified Zuogui Yin combined with Sangpiaoxiao San. Was this considering the cause of nocturia due to Kidney deficiency? Why still use Renshen and Huangqi?
Teacher: Kidney deficiency often arises on the basis of Spleen deficiency, or is accompanied by Spleen deficiency. While tonifying the Kidney, I always use some Qi-benefiting and Spleen-supporting herbs, which can enhance the efficacy of Kidney tonification.
Physician A: This patient's vomiting, poor appetite, and overall condition improved rapidly after admission. Was Western medicine administered concurrently?