医生不能对患者各种症状进行综合的、整体的分析处理，而是把各种症状割裂开来，正如患者所讲述的那样，那么其结果只能是头痛医头，脚痛医脚。由于不能对疾病有整体、有机、正确的认识，所以不可能达到辨证求因，审因论治的地步，效果也…-定不会理想。即或有人能识得此证为胃气不降，但由于用药不当，疗效也不会满意。我们根据张锡纯的经验，以赭石为治疗此证的主药。张氏在《医学衷中参西录》中说，"愚数十年经验以来，治此证者，不识凡几，知欲治此证非重用赭石不能奏效也。盖赭石对于此证，其特长有六：其重镇之力能引胃气下行，一也；既能引胃气下行，更能引胃气直达肠中而通大便，二也；因其饶有重坠之力，兼能镇安冲气使不上冲，三也；能制肝木之横恣，使其气不上千，四也；更能引浮越之相火下行，而胸膈烦热，头目眩晕自除，五也；其力能降胃通便，引火下行，而性非寒凉开破，分毫不伤气分，转能有益于血分，六也。是以愚治胃气逆而不降之证，恒但重用赭石，即能随手奏效也"。此患之治即以赭石为君，辅半夏、竹茹以增其降胃之功；山药、玄参益肾阴而敛冲气；麦冬滋肺阴而助肃降；归、芍养阴血而柔肝体，麦芽、茵陈疏肝气而畅肝用；加牛膝引气血下行。如此，则胃、肺、冲气下降而气血下行，肝气疏达而火郁自散。从而收到大便通，胀满消，头目清的功效。
医生丙脑立清是降压药，老师为何用它治疗此证呢?
老师：脑立清丸是由赭石、半夏、牛膝、磁石、珍珠母、胆汁、冰片、薄荷冰、酒曲等药制成。其中赭石用量最多，占全方(除酒曲)总量的28％以上。再加半夏、牛膝(皆为本患者之主要药物)之重占全方的54％多。其他如磁石、珍珠母等，也都是平肝潜阳，重镇降逆之药，对于诸气逆上者正属对证。虽然脑立清之药物与患者之证情尚不能完全吻合，但从大体上看，也可算作方证基本相符。在现有的中成药中，也只能以此为首选了。
长春中医学院教授肖永林
金XX，女，53岁，1981年8月来诊。患者数年来，经常头目晕眩，腰膝酸软无力，走路脚下无根，并有心悸、失眠、气短等症。血压经常在22．6／13．3kPa左右，需经常服用降压药。也曾用过中药汤剂及脑立清、清眩丸等。用过之药物系：石决明、珍珠母、龙骨、牡蛎、菊花、白芍、生地、玄参、龟板、夏枯草、牛膝、代赭石、钩藤、龙胆草等。由于效果不佳，且体力越来越弱，故此前来就医。
询其病史与症情，患者于三四年前月经开始紊乱，时有时无，有时漏下不止，持续很长时间，逐渐出现头晕眼花，身疲无力，尤其觉得两膝酸软，两脚走路时无根，颇有头重脚轻之感，并有心悸、失眠、健忘、气短等症。以后月经渐少，终至断绝，但上述症情并不见轻。到医院检查，血压高于正常，服一段时间降压药，症状即见好转，停药后即复发。虽曾服过中药也不见效，且出现食欲减退，大便稀溏。细问其病情，发病初期心中时有烦热，头面部时时有升火之感，手足心有时也出现发热，以后-卜述症状渐渐减少，继之以全身疲乏无力，时时畏寒，手足在天冷时常常发凉怕冻，小腹常觉发凉，小便清长，次数增多，尤其是夜间尿更频数。绝经期以前每夜小便1次或不起夜，现在每夜可达3-5次之多，且有尿意紧迫不能自禁之感。口不渴，即或饮水，也只饮热水，如饮冷水则胃部不适，全身发冷。患者面色苍白，口唇淡润，眼胞虚浮，舌淡红体胖，苔白而滑润，脉沉弱。
据其发病年龄，病后之变化，与其症情分析，此证属肝肾不足，阴(血)阳(气)两虚之侯。治以补肝益肾，双培阴阳之法。用二仙汤加减。仙茅10g，淫羊藿10g，巴戟天]0g，益智仁15g，狗脊15g，寄生20g，川续断20g，当归15g，白芍20g，生山药20g，白菊花15g，生地15g，陈皮15g。水煎，日1剂，分3次服。3剂后，觉头目眩晕减轻，腿脚略觉有力。又3剂后，大见好转。这时，有位老中医为其处方，服2剂后，症状加重，又来求治于余。视其方，乃镇肝息风汤加减。仍用前二仙汤加减之方。9剂后，头晕目眩明显好转，腰膝也无酸软，脚下已无飘浮之感。尤其明显好转的是，小腹、四肢已不发凉，全身已不畏寒，且有温暖感。小便次数也减小，每夜1-2次，其紧迫不禁之感已无。后用人参养荣丸、金匮肾气丸等巩固疗效。其血压量过几次，大致在18．6／12，0kPa左右。
医生甲高血压所致之头晕目眩，-般多用平肝潜阳法，老师为何用补肾壮阳法?
老师：高血压病是西医根据患者的动脉血压长期持续性偏高(尤其是舒张压)而定名的全身性、慢性血管疾病。据其临床表现，中医可按眩晕、头痛等进行辨证论治。(内经)云，"诸风掉眩，皆属于肝"。是以此证之证治多不离乎肝。认为此证多由肝阳上亢或肝火偏旺所致。导致阳亢或火旺的原因很多，或由恚怒不解而肝阳暴张，或因忧郁不已而气郁化火，或由肝血不足而肝阳失濡，或因肾阴亏损而肝木失涵。故张山雷在《中风斠诠》中力主此证应重用滋阴潜镇之法，用金石介类药，重坠潜降，以干肝阳。张锡纯在此基础-亡，进一步提出，滋阴养血、重镇潜阳与肃肺、降胃、疏肝之法结合应用。其所制之镇肝息风汤，即重用地黄、萸肉、白芍等滋阴血之虚以涵木；龙骨、牡蛎、龟板等重镇以潜阳；玄参、麦冬清肃肺气，使肺气肃降下行，自能镇制肝木；赭石降胃气而安冲气。以上诸药能降诸脏腑逆上之气，再加牛膝之引气血下行，以利于亢阳之平降。但肝为将军之官，其性喜条达而恶抑郁。其气刚暴，尤恶强制平降，故加茵陈、生麦芽等升发之品以疏达肝气，再加川栋子引肝气下行，使不上逆。故此方诚为治阴虚阳亢之良方，现代临床中应用较广。但从临床实践看，高血压之属阴虚阳亢者固多，而属于其他证者也不少。如本患既无阴虚火旺之五心烦热，面红如醉；也无冲、胃之气上逆的气从少腹上冲：也无便秘、嗳气；更无肝阳上亢、气血逆上之头中胀痛发热，目胀耳鸣，脉弦长有力。却有身疲乏力、心悸失眠、气短健忘等气血两虚证；又有腰膝酸软、脚下无根等肝肾不足，筋骨软弱之象。更现面白、畏寒、肢冷、小腹发凉、夜尿频数难禁等阳气虚衰、肾关失固之征。况其在服用滋阴潜镇等寒凉药后，出现食欲减退，大便溏稀等症，说明药不对证，其人中阳不振。从上述一系列症状看，其证不仅阴血不足，更兼阳气衰弱，特别是肾阳虚衰之象尤为明显。中医治病，药为证发，有是证则用是药。故我们据其症情采用了补阴血、助肾阳之法，收到了较满意的疗效。
医生乙请老师谈一下此证的病机与治疗。
老师：本患者之病大约起子三四年之前。开始时月经紊乱，经漏不上而且持续时间较长。之后才出现头晕目眩，身疲乏力，腰膝酸软、脚下无根等感觉，并伴有心悸、失眠、气短、健忘等症。除-上述症状外，开始时有心中烦热，头面部升火等症。以后才逐渐出现畏寒、手足发凉、小腹发冷、夜尿增多的现象。从上述的疾病发生发展的全部过程看，其病以先伤阴血开始，初起时表现为阴(血)伤有热证，而后逐渐出现阳虚则寒的局面，是为阴损及阳，阴(血)阳(气)两虚证。《内经)说，"年四十而阴气自半也，起居衰矣"。一般来讲，人当40岁前后，人体的阴血与阳气都开始虚衰，生机逐渐减退。特别是女人，在七七(49岁)前后，大多肾气虚衰，冲任亏损，天癸竭，地道不通，月经断绝。本患者初病之时正属七七之际，加之长期经漏不止，阴血损耗。阴虚则热，故初起有五心烦热、头面升火之症。此种热象为虚热，乃由阴血虚损不足以配阳，而阳气相对亢盛所致。由于阴血之耗伤过多，则阳气必然因之而虚乏。盖阳以阴为宅，阴以阳为根，阴阳互为生养之前提。阴虚太甚，必然导致阳气之生化无源，而相继出现阳气虚的情况，是为阴损及阳，此时多为阴阳两虚证。其所以出现头晕目眩，一由血虚气弱，不能-上升而濡养于头；二由肾阴肾阳亏损，精髓不充。盖肾主骨而生髓，脑为髓海。"髓海有余则轻劲多力，自过其度；髓海不足则脑转耳鸣，胫酸眩冒，目无所见"。(《灵枢·海论篇》)故在治疗此证时，既要"壮水之主，以生精血"，又要"益火之原，以生阳气"。((医学会心录))阴阳并补，既于阴中生阳，又于阳中生阴。方中所用当归、白芍、生地、山药在于滋养阴血之虚；仙茅、仙灵脾、巴戟天以扶助阳气之弱；寄生、川断、狗脊补肝肾，强筋骨以生髓益脑；益智仁合山药，有益脾肾之阳而收摄阴液之功，对于脾肾阳虚而阴液不摄之证最宜。综观此方补阴而不伤阳，助阳而不灼阴，阴阳并补，相得益彰。二仙汤原方有知母、黄柏，因此证已无内热之象，放去之，恐其苦寒，有碍于阳气。
医生丙眩晕证应如何辨证治疗。
老师：眩晕是患者之自觉症状。"眩者，言视物皆黑；晕者，言视物皆转。-二者相兼，方曰眩晕。若甚而良久方醒者，又名郁冒"。(《证治汇补))从临床来看，"外感六淫，内伤七情，皆能眩晕"。外感证引起的眩晕，大抵其人素无此症，只是在外感的同时出现，病见于暂，随着感证的治愈而眩晕自除。若无表证而经常眩晕，则多为内伤所致。内伤眩晕，大抵不外火晕、痰晕与虚晕三者。所谓火晕，是指火热亢盛所致之眩晕，以肝阳上亢及肝经热盛为多见。其证或因五志过急而化火，或由阴血虚衰而阳亢。症见眩晕耳鸣，头胀而痛，每因劳累或恚怒而加剧，面时潮红，急躁易怒，口苦，舌红苔黄，脉弦或数。如属肝火盛者，可用龙胆泻肝汤或当归龙荟丸；若属肝阳上亢者，可用镇肝息风、三甲复脉、大定风珠等滋阴而潜阳。若实热太甚而眩晕不可当者，丹溪用大黄酒炒为末，每服5-10g，茶水服下。痰晕，多由痰浊中阻，清阳不升所致。其症头重如蒙，胸闷脘痞，恶心，呕吐清水痰涎，少食，身重，舌体多胖，苔白而粘腻。宜以二陈汤为主方。其加减方如半夏天麻白术汤、温胆汤皆较常用。中焦湿盛加藿香、白蔻；下焦湿盛加泽泻；痰郁化热可加黄芩、黄连等。虚晕是指因虚而眩晕，临床较为多见。属气血虚者，症见面色苍白，唇甲无华，少气懒言，倦怠嗜卧，心悸失眠，动则加剧，遇劳即发。宜补气养血，可用当归补血、归脾、八珍等。若气虚较甚者，可用补中益气。其因于肾虚者，多因色欲太过，或遗泄无度，致肾精亏损，髓海不足。其症腰膝酸软，神疲健忘。偏于阴虚者，多见酸心烦热、尿赤、舌红，宜六味、杞菊、左归辈滋补肾阴；偏阳虚者，多四末不温，畏寒，尿频而清白，舌淡，可用肾气、右归类益火助阳。若眩晕因下虚甚者，可用鹿茸25g，酒煎去渣，入麝香少许，顿服，以峻补之。
咳嗽连声、干咳无痰已月余
长春中医学院教授肖永林
长春铁路医院徐铁梅
患者王X，男，43岁，1987年12月14日初诊。
该患咳嗽已月余，曾多次就医，服用过各种中西药物，始终无效，故前来求治。其发病过程，大约于1个月前偶感全身不适，微恶风寒，喉痒咳嗽，鼻塞不通。曾去卫生所就医，诊为感冒。给予VC银翘片、止咳片、速效感冒胶囊等药，之后，全身不适、畏寒、鼻塞等症逐渐好转，但咳嗽却不见好转，其咳嗽为干咳无痰，或有时咯出少量痰块。每于晚卜睡觉时及早晨起床时连声咳嗽，声音重浊，且每因风冷则咳嗽加剧。若室内比较温暖则不咳嗽。自患病以来，未曾发烧，汗不出，口不渴，心不烦，小便清利，大便正常，饮食如故。细询其症情：口唇发干但不渴饮，咽喉发干而痒，痒甚则咳嗽不上。舌质淡红，苔薄白而略少津。自病后曾先后服过速效感冒胶囊、感冒清、克感敏、甘草片、VC银翘片、川贝精片、蛇胆陈皮末及桑菊感冒片等，效皆不显。听说吃梨可以止咳嗽，但用后咳嗽依然。咳甚则胸胁疼痛。
据其症情，发病过程及服药情况，综合分析，此证为寒燥伤肺，肺气不利而致咳嗽。治以辛开温润法。用《医学心悟》之止嗽散加减：荆芥10g，陈皮10g，甘草10g，桔梗10g，百部30g，紫菀20g，款冬花20g，紫苏叶10g杏仁15g，生姜10g。水煎服，日2-3次。2剂后，咳嗽大减，又4剂而愈。
医生甲：请老师谈一下诊治此证的思路。
医生若不能对患者各种症状进行综合的、整体的分析与处理，而是将各种症状割裂开来，仅像患者描述的那样头痛医头、脚痛医脚，那么结果必然不理想。由于无法对疾病形成整体、有机且正确的认识，就不可能达到“辨证求因”（通过辨析证候来探究病因）、“审因论治”（根据病因制定治疗方案）的境界，疗效也一定不会理想。即使有人能识别出此证为胃气不降（胃气应下行而反上逆），但如果用药不当，疗效也不会令人满意。我们根据张锡纯的经验，以赭石（代赭石）作为治疗此证的主药。张氏在《医学衷中参西录》中说：“愚数十年经验以来，治此证者，不识凡几，知欲治此证非重用赭石不能奏效也。盖赭石对于此证，其特长有六：其重镇之力能引胃气下行，一也；既能引胃气下行，更能引胃气直达肠中而通大便，二也；因其饶有重坠之力，兼能镇安冲气使不上冲，三也；能制肝木之横恣，使其气不上千，四也；更能引浮越之相火下行，而胸膈烦热，头目眩晕自除，五也；其力能降胃通便，引火下行，而性非寒凉开破，分毫不伤气分，转能有益于血分，六也。是以愚治胃气逆而不降之证，恒但重用赭石，即能随手奏效也。”此患者的治疗即以赭石为君药（主药），辅以半夏、竹茹以增强其降胃气的功效；山药、玄参益肾阴而收敛冲气；麦冬滋肺阴而助肃降；当归、白芍养阴血而柔润肝体；麦芽、茵陈疏肝气而畅达肝用；加牛膝引气血下行。如此，则胃气、肺气、冲气下降，气血下行，肝气疏达而郁火自散。从而收到大便通畅、胀满消除、头目清爽的功效。
医生丙问：脑立清是降压药，老师为何用它治疗此证呢？
老师回答：脑立清丸是由赭石、半夏、牛膝、磁石、珍珠母、胆汁、冰片、薄荷冰、酒曲等药物制成。其中赭石用量最多，占全方（除酒曲外）总量的28%以上。再加上半夏、牛膝（皆为本患者的主要药物）的重量，占全方的54%多。其他如磁石、珍珠母等，也都是平肝潜阳（平息肝风，潜降阳气）、重镇降逆的药物，对于诸气逆上的病症正属对症。虽然脑立清的药物组成与患者的具体证情尚不能完全吻合，但从大体上看，也可算作方证基本相符。在现有的中成药中，也只能以此为首选了。
长春中医学院教授肖永林
金XX，女，53岁，1981年8月来诊。患者数年来，经常头目晕眩，腰膝酸软无力，走路脚下无根（感觉脚下不实），并有心悸、失眠、气短等症状。血压经常在22.6/13.3kPa左右，需经常服用降压药。也曾用过中药汤剂及脑立清、清眩丸等。用过之药物包括：石决明、珍珠母、龙骨、牡蛎、菊花、白芍、生地、玄参、龟板、夏枯草、牛膝、代赭石、钩藤、龙胆草等。由于效果不佳，且体力越来越弱，故此前来就医。
询问其病史与症情，患者于三四年前月经开始紊乱，时有时无，有时漏下不止（非经期阴道出血持续不断），持续时间很长，逐渐出现头晕眼花，身疲无力，尤其觉得两膝酸软，两脚走路时无根，颇有头重脚轻之感，并有心悸、失眠、健忘、气短等症状。以后月经渐少，终至断绝，但上述症情并不见轻。到医院检查，血压高于正常，服一段时间降压药，症状即见好转，停药后即复发。虽曾服过中药也不见效，且出现食欲减退，大便稀溏。细问其病情，发病初期心中时有烦热，头面部时时有升火之感，手足心有时也出现发热，以后上述症状渐渐减少，继之以全身疲乏无力，时时畏寒，手足在天冷时常常发凉怕冻，小腹常觉发凉，小便清长，次数增多，尤其是夜间尿更频数。绝经期以前每夜小便1次或不起夜，现在每夜可达3-5次之多，且有尿意紧迫不能自禁之感。口不渴，即或饮水，也只饮热水，如饮冷水则胃部不适，全身发冷。患者面色苍白，口唇淡润，眼胞虚浮，舌淡红体胖，苔白而滑润，脉沉弱。
据其发病年龄，病后之变化，与其症情分析，此证属肝肾不足，阴（血）阳（气）两虚之候。治以补肝益肾，双培阴阳之法。用二仙汤加减。仙茅10g，淫羊藿10g，巴戟天10g，益智仁15g，狗脊15g，寄生20g，川续断20g，当归15g，白芍20g，生山药20g，白菊花15g，生地15g，陈皮15g。水煎，日1剂，分3次服。3剂后，觉头目眩晕减轻，腿脚略觉有力。又3剂后，大见好转。这时，有位老中医为其处方，服2剂后，症状加重，又来求治于余。视其方，乃镇肝息风汤加减。仍用前二仙汤加减之方。9剂后，头晕目眩明显好转，腰膝也无酸软，脚下已无飘浮之感。尤其明显好转的是，小腹、四肢已不发凉，全身已不畏寒，且有温暖感。小便次数也减小，每夜1-2次，其紧迫不禁之感已无。后用人参养荣丸、金匮肾气丸等巩固疗效。其血压量过几次，大致在18.6/12.0kPa左右。
医生甲问：高血压所致之头晕目眩，一般多用平肝潜阳法，老师为何用补肾壮阳法？
老师回答：高血压病是西医根据患者的动脉血压长期持续性偏高（尤其是舒张压）而定名的全身性、慢性血管疾病。据其临床表现，中医可按眩晕、头痛等进行辨证论治。《内经》云：“诸风掉眩，皆属于肝”。是以此证之证治多不离乎肝。认为此证多由肝阳上亢或肝火偏旺所致。导致阳亢或火旺的原因很多，或由恚怒不解而肝阳暴张，或因忧郁不已而气郁化火，或由肝血不足而肝阳失濡，或因肾阴亏损而肝木失涵。故张山雷在《中风斠诠》中力主此证应重用滋阴潜镇之法，用金石介类药，重坠潜降，以平肝阳。张锡纯在此基础上，进一步提出，滋阴养血、重镇潜阳与肃肺、降胃、疏肝之法结合应用。其所制之镇肝息风汤，即重用地黄、萸肉、白芍等滋阴血之虚以涵木（滋养肝木）；龙骨、牡蛎、龟板等重镇以潜阳；玄参、麦冬清肃肺气，使肺气肃降下行，自能镇制肝木；赭石降胃气而安冲气。以上诸药能降诸脏腑逆上之气，再加牛膝之引气血下行，以利于亢阳之平降。但肝为将军之官，其性喜条达而恶抑郁。其气刚暴，尤恶强制平降，故加茵陈、生麦芽等升发之品以疏达肝气，再加川楝子引肝气下行，使不上逆。故此方诚为治阴虚阳亢之良方，现代临床中应用较广。但从临床实践看，高血压之属阴虚阳亢者固多，而属于其他证者也不少。如本患既无阴虚火旺之五心烦热，面红如醉；也无冲、胃之气上逆的气从少腹上冲；也无便秘、嗳气；更无肝阳上亢、气血逆上之头中胀痛发热，目胀耳鸣，脉弦长有力。却有身疲乏力、心悸失眠、气短健忘等气血两虚证；又有腰膝酸软、脚下无根等肝肾不足，筋骨软弱之象。更现面白、畏寒、肢冷、小腹发凉、夜尿频数难禁等阳气虚衰、肾关失固之征。况其在服用滋阴潜镇等寒凉药后，出现食欲减退，大便溏稀等症，说明药不对证，其人中阳不振。从上述一系列症状看，其证不仅阴血不足，更兼阳气衰弱，特别是肾阳虚衰之象尤为明显。中医治病，药为证发，有是证则用是药。故我们据其症情采用了补阴血、助肾阳之法，收到了较满意的疗效。
医生乙请老师谈一下此证的病机与治疗。
老师回答：本患者之病大约起于三四年之前。开始时月经紊乱，经漏不止而且持续时间较长。之后才出现头晕目眩，身疲乏力，腰膝酸软、脚下无根等感觉，并伴有心悸、失眠、气短、健忘等症状。除上述症状外，开始时有心中烦热，头面部升火等症。以后才逐渐出现畏寒、手足发凉、小腹发冷、夜尿增多的现象。从上述的疾病发生发展的全部过程看，其病以先伤阴血开始，初起时表现为阴（血）伤有热证，而后逐渐出现阳虚则寒的局面，是为阴损及阳，阴（血）阳（气）两虚证。《内经》说：“年四十而阴气自半也，起居衰矣”。一般来讲，人当40岁前后，人体的阴血与阳气都开始虚衰，生机逐渐减退。特别是女人，在七七（49岁）前后，大多肾气虚衰，冲任亏损，天癸竭，地道不通，月经断绝。本患者初病之时正属七七之际，加之长期经漏不止，阴血损耗。阴虚则热，故初起有五心烦热、头面升火之症。此种热象为虚热，乃由阴血虚损不足以配阳，而阳气相对亢盛所致。由于阴血之耗伤过多，则阳气必然因之而虚乏。盖阳以阴为宅，阴以阳为根，阴阳互为生养之前提。阴虚太甚，必然导致阳气之生化无源，而相继出现阳气虚的情况，是为阴损及阳，此时多为阴阳两虚证。其所以出现头晕目眩，一由血虚气弱，不能上升而濡养于头；二由肾阴肾阳亏损，精髓不充。盖肾主骨而生髓，脑为髓海。“髓海有余则轻劲多力，自过其度；髓海不足则脑转耳鸣，胫酸眩冒，目无所见”。（《灵枢·海论篇》）故在治疗此证时，既要“壮水之主，以生精血”，又要“益火之原，以生阳气”。（《医学会心录》）阴阳并补，既于阴中生阳，又于阳中生阴。方中所用当归、白芍、生地、山药在于滋养阴血之虚；仙茅、仙灵脾、巴戟天以扶助阳气之弱；寄生、川断、狗脊补肝肾，强筋骨以生髓益脑；益智仁合山药，有益脾肾之阳而收摄阴液之功，对于脾肾阳虚而阴液不摄之证最宜。综观此方补阴而不伤阳，助阳而不灼阴，阴阳并补，相得益彰。二仙汤原方有知母、黄柏，因此证已无内热之象，故去之，恐其苦寒，有碍于阳气。
医生丙问：眩晕证应如何辨证治疗？
老师回答：眩晕是患者之自觉症状。“眩者，言视物皆黑；晕者，言视物皆转。二者相兼，方曰眩晕。若甚而良久方醒者，又名郁冒”。（《证治汇补》）从临床来看，“外感六淫，内伤七情，皆能眩晕”。外感证引起的眩晕，大抵其人素无此症，只是在外感的同时出现，病见于暂，随着感证的治愈而眩晕自除。若无表证而经常眩晕，则多为内伤所致。内伤眩晕，大抵不外火晕、痰晕与虚晕三者。所谓火晕，是指火热亢盛所致之眩晕，以肝阳上亢及肝经热盛为多见。其证或因五志过急而化火，或由阴血虚衰而阳亢。症见眩晕耳鸣，头胀而痛，每因劳累或恚怒而加剧，面时潮红，急躁易怒，口苦，舌红苔黄，脉弦或数。如属肝火盛者，可用龙胆泻肝汤或当归龙荟丸；若属肝阳上亢者，可用镇肝息风、三甲复脉、大定风珠等滋阴而潜阳。若实热太甚而眩晕不可当者，丹溪用大黄酒炒为末，每服5-10g，茶水服下。痰晕，多由痰浊中阻，清阳不升所致。其症头重如蒙，胸闷脘痞，恶心，呕吐清水痰涎，少食，身重，舌体多胖，苔白而粘腻。宜以二陈汤为主方。其加减方如半夏天麻白术汤、温胆汤皆较常用。中焦湿盛加藿香、白蔻；下焦湿盛加泽泻；痰郁化热可加黄芩、黄连等。虚晕是指因虚而眩晕，临床较为多见。属气血虚者，症见面色苍白，唇甲无华，少气懒言，倦怠嗜卧，心悸失眠，动则加剧，遇劳即发。宜补气养血，可用当归补血、归脾、八珍等。若气虚较甚者，可用补中益气。其因于肾虚者，多因色欲太过，或遗泄无度，致肾精亏损，髓海不足。其症腰膝酸软，神疲健忘。偏于阴虚者，多见酸心烦热、尿赤、舌红，宜六味、杞菊、左归辈滋补肾阴；偏阳虚者，多四末不温，畏寒，尿频而清白，舌淡，可用肾气、右归类益火助阳。若眩晕因下虚甚者，可用鹿茸25g，酒煎去渣，入麝香少许，顿服，以峻补之。
咳嗽连声、干咳无痰已月余
长春中医学院教授肖永林
长春铁路医院徐铁梅
患者王X，男，43岁，1987年12月14日初诊。
该患咳嗽已月余，曾多次就医，服用过各种中西药物，始终无效，故前来求治。其发病过程，大约于1个月前偶感全身不适，微恶风寒，喉痒咳嗽，鼻塞不通。曾去卫生所就医，诊为感冒。给予VC银翘片、止咳片、速效感冒胶囊等药，之后，全身不适、畏寒、鼻塞等症逐渐好转，但咳嗽却不见好转，其咳嗽为干咳无痰，或有时咯出少量痰块。每于晚上睡觉时及早晨起床时连声咳嗽，声音重浊，且每因风冷则咳嗽加剧。若室内比较温暖则不咳嗽。自患病以来，未曾发烧，汗不出，口不渴，心不烦，小便清利，大便正常，饮食如故。细询其症情：口唇发干但不渴饮，咽喉发干而痒，痒甚则咳嗽不止。舌质淡红，苔薄白而略少津。自病后曾先后服过速效感冒胶囊、感冒清、克感敏、甘草片、VC银翘片、川贝精片、蛇胆陈皮末及桑菊感冒片等，效皆不显。听说吃梨可以止咳嗽，但用后咳嗽依然。咳甚则胸胁疼痛。
据其症情，发病过程及服药情况，综合分析，此证为寒燥伤肺，肺气不利而致咳嗽。治以辛开温润法。用《医学心悟》之止嗽散加减：荆芥10g，陈皮10g，甘草10g，桔梗10g，百部30g，紫菀20g，款冬花20g，紫苏叶10g，杏仁15g，生姜10g。水煎服，日2-3次。2剂后，咳嗽大减，又4剂而愈。
医生甲问：请老师谈一下诊治此证的思路。
If a physician fails to conduct a comprehensive and holistic analysis and treatment of the patient's various symptoms, but instead isolates each symptom and treats them merely as described by the patient (i.e., treating the head for headache and the foot for foot pain), the result will inevitably be unsatisfactory. Due to the inability to form a holistic, organic, and correct understanding of the disease, it is impossible to reach the stage of "Bian Zheng Qiu Yin" (identifying the etiology through syndrome differentiation) and "Shen Yin Lun Zhi" (formulating treatment based on the etiology), and the therapeutic effect will certainly not be ideal. Even if someone can identify this syndrome as "Wei Qi Bu Jiang" (rebellious Stomach Qi failing to descend), if the medication is inappropriate, the efficacy will not be satisfactory. Based on the experience of Zhang Xichun, we use Hematitum (Dai Zhe Shi) as the principal herb for treating this syndrome. Zhang stated in *Yi Xue Zhong Zhong Can Xi Lu* (Records of Traditional Chinese Medicine Combined with Western Medicine): "In my decades of experience, I have treated countless cases of this syndrome, and I know that heavy doses of Hematitum are indispensable for its efficacy. Hematitum has six special advantages for this syndrome: First, its heavy sedative power can guide Stomach Qi downward; Second, besides guiding Stomach Qi downward, it can further guide it directly into the intestines to promote bowel movement; Third, due to its heavy and sinking nature, it can also calm and stabilize Chong Qi (Penetrating Vessel Qi) to prevent it from rushing upward; Fourth, it can restrain the rampant Liver Wood, preventing its Qi from rising excessively; Fifth, it can guide floating and hyperactive Ministerial Fire downward, thereby eliminating chest and diaphragm irritability, heat, dizziness, and vertigo; Sixth, its power descends Stomach Qi and promotes bowel movements, guides fire downward, yet its nature is neither cold nor piercing, so it does not damage Qi at all, but rather benefits Blood. Therefore, when I treat syndromes of rebellious Stomach Qi that fails to descend, I often rely solely on heavy doses of Hematitum, achieving immediate results." The treatment for this patient uses Hematitum as the Jun (Emperor/Monarch) herb, assisted by Pinellia Rhizome (Ban Xia) and Bamboo Shavings (Zhu Ru) to enhance its stomach-descending function; Chinese Yam (Shan Yao) and Scrophularia Root (Xuan Shen) nourish Kidney Yin and constrain Chong Qi; Ophiopogon Tuber (Mai Dong) nourishes Lung Yin and assists in descending and purifying functions; Angelica Sinensis Root (Dang Gui) and White Peony Root (Bai Shao) nourish Yin-Blood and soften the Liver body; Malt (Mai Ya) and Capers Fruit (Yin Chen) soothe Liver Qi and facilitate Liver function; adding Achyranthes Root (Niu Xi) to guide Qi and Blood downward. In this way, Stomach Qi, Lung Qi, and Chong Qi descend, Qi and Blood move downward, Liver Qi becomes smooth and dispersed, and stagnant fire dissipates naturally. Thus, the effects achieved are unobstructed bowel movements, reduction of distension, and clarity of the head and eyes.
Doctor C asked: Naoliqing is an antihypertensive drug; why did the teacher use it to treat this syndrome?
Teacher answered: Naoliqing Wan is made from Hematitum, Pinellia Rhizome, Achyranthes Root, Magnetitum, Mother-of-Pearl Shell, Bile, Borneolum Syntheticum, Menthol, and Yeast. Among them, Hematitum has the largest dosage, accounting for more than 28% of the total formula (excluding yeast). Adding Pinellia Rhizome and Achyranthes Root (both main herbs for this patient) accounts for more than 54% of the total formula. Others such as Magnetitum and Mother-of-Pearl Shell are also herbs that pacify the Liver and subdue Yang, and heavily sedate and direct rebellious Qi downward, which is precisely indicated for syndromes where various types of Qi rebel upward. Although the composition of Naoliqing does not completely match the patient's specific syndrome, broadly speaking, it can be considered basically consistent with the syndrome. Among existing patent Chinese medicines, it can only be chosen as the first option.
Dizziness and vertigo, soreness and weakness of the waist and knees, frequent nocturia
Professor Xiao Yonglin, Changchun University of Chinese Medicine
Jin XX, female, 53 years old, consulted in August 1981. For several years, the patient has frequently experienced dizziness and vertigo, soreness and weakness of the waist and knees, a feeling of instability when walking, along with palpitations, insomnia, and shortness of breath. Her blood pressure has been around 22.6/13.3 kPa, requiring frequent use of antihypertensive drugs. She has also used decoctions of Chinese herbal medicine, as well as Naoliqing and Qingxuan Wan. The medications used included: Abalone Shell (Shi Jue Ming), Mother-of-Pearl Shell (Zhen Zhu Mu), Dragon Bone (Long Gu), Oyster Shell (Mu Li), Chrysanthemum Flower (Ju Hua), White Peony Root (Bai Shao), Rehmannia Root (Sheng Di Huang), Scrophularia Root (Xuan Shen), Tortoise Plastron (Gui Ban), Prunella Vulgaris (Xia Ku Cao), Achyranthes Root (Niu Xi), Hematitum (Dai Zhe Shi), Uncaria Ramulus cum Uncis (Gou Teng), and Gentiana Root (Long Dan Cao). Due to poor efficacy and decreasing physical strength, she came for medical attention.
Upon inquiry into her medical history and symptoms, the patient's menstruation began to become irregular three or four years ago, sometimes present, sometimes absent, and sometimes with continuous metrorrhagia lasting a long time. Gradually, dizziness and blurred vision, fatigue, and weakness appeared, especially soreness and weakness in both knees, and a feeling of instability when walking, resembling a sensation of heaviness in the head and lightness in the feet, accompanied by palpitations, insomnia, forgetfulness, and shortness of breath. Later, menstruation decreased gradually until it ceased, but the aforementioned symptoms did not alleviate. Hospital examination showed blood pressure higher than normal. Symptoms improved after taking antihypertensive drugs for a period but relapsed upon discontinuation. Although she had taken Chinese herbal medicine before, it was ineffective and led to loss of appetite and loose stools. Detailed inquiry revealed that at the onset of the illness, there was occasional internal irritability and heat, a sensation of fire rising to the head and face, and sometimes heat in the palms and soles. Later, these symptoms gradually decreased, followed by general fatigue and weakness, aversion to cold, cold and fear of freezing in the hands and feet during cold weather, a cold sensation in the lower abdomen, clear and profuse urination with increased frequency, especially frequent nocturia. Before menopause, she urinated once per night or did not wake up at night; now she wakes up 3-5 times per night, with a sense of urgency and incontinence. There is no thirst; even if drinking water, she only drinks hot water. Drinking cold water causes gastric discomfort and whole-body chills. The patient has a pale complexion, pale and moist lips, puffy eyelids, a pale red and enlarged tongue with a white, slippery coating, and a deep, weak pulse.
Based on her age, the changes after the illness, and an analysis of her symptoms, this syndrome belongs to deficiency of Liver and Kidney, and dual deficiency of Yin (Blood) and Yang (Qi). The treatment principle is to tonify the Liver and benefit the Kidney, and simultaneously cultivate Yin and Yang. A modified Erxian Tang was used: Curculigo Rhizome (Xian Mao) 10g, Epimedium Herb (Yin Yang Huo) 10g, Morinda Root (Ba Ji Tian) 10g, Alpinia Oxyphylla Fruit (Yi Zhi Ren) 15g, Cibotium Rhizome (Gou Ji), Dendrobium Stem (Ji Sheng) 20g, Cyathula Root (Chuan Xu Duan) 20g, Angelica Sinensis Root (Dang Gui) 15g, White Peony Root (Bai Shao) 20g, Chinese Yam (Shan Yao) 20g, White Chrysanthemum Flower (Bai Ju Hua) 15g, Rehmannia Root (Sheng Di Huang) 15g, Tangerine Peel (Chen Pi) 15g. Decocted in water, one dose per day, divided into three servings. After three doses, dizziness and vertigo were reduced, and legs and feet felt slightly stronger. After another three doses, significant improvement was seen. At this time, an old TCM practitioner prescribed a formula for her. After two doses, symptoms worsened, and she sought treatment from me again. Examining his prescription, it was a modified Zhen Gan Xi Feng Tang. We continued using the previously mentioned modified Erxian Tang. After nine doses, dizziness and vertigo improved significantly, and soreness and weakness of the waist and knees disappeared, with no longer a floating sensation under the feet. Most notably, the lower abdomen and limbs were no longer cold, and the whole body no longer felt cold, but rather warm. Urination frequency decreased to 1-2 times per night, and the sense of urgency and incontinence disappeared. Subsequently, Renshen Yangrong Wan and Jin Gui Shenqi Wan were used to consolidate the curative effect. Blood pressure was measured several times, roughly around 18.6/12.0 kPa.
Doctor A asked: For dizziness and vertigo caused by hypertension, the Ping Gan Qian Yang method is generally used. Why did the teacher use the method of tonifying the Kidney and strengthening Yang?
Teacher answered: Hypertension is named by Western medicine as a systemic, chronic vascular disease based on persistently elevated arterial blood pressure (especially diastolic pressure) over a long term. According to its clinical manifestations, TCM can perform syndrome differentiation and treatment according to dizziness/vertigo (Xuan Yun) and headache (Tou Tong). The *Neijing* states: "All wind-induced tremors and dizziness belong to the Liver." Therefore, the treatment of this syndrome mostly revolves around the Liver. It is believed that this syndrome is mostly caused by Hyperactive Liver Yang or Excess Liver Fire. The causes leading to Yang hyperactivity or Fire excess are numerous: they may arise from unresolved anger causing sudden expansion of Liver Yang, from prolonged depression causing Qi stagnation transforming into Fire, from insufficient Liver Blood causing Liver Yang to lose nourishment, or from Kidney Yin deficiency causing Liver Wood to lose containment. Thus, Zhang Shanlei strongly advocated in *Zhong Feng Qiao Quan* that this syndrome should be treated with heavy doses of methods to nourish Yin and subdue/sedate, using minerals, shells, and fossils, which are heavy and sinking to subdue and descend, thereby calming Liver Yang. Building on this foundation, Zhang Xichun further proposed combining methods to nourish Yin and Blood, heavily sedate and subdue Yang, purify the Lung, descend Stomach Qi, and soothe the Liver. His prepared Zhen Gan Xi Feng Tang heavily uses Rehmannia Root, Cornus Fruit, and White Peony Root to nourish Yin-Blood deficiency to contain Liver Wood; Dragon Bone, Oyster Shell, and Tortoise Plastron to heavily sedate and subdue Yang; Scrophularia Root and Ophiopogon Tuber to purify Lung Qi, allowing Lung Qi to descend and naturally suppress Liver Wood; Hematitum to descend Stomach Qi and calm Chong Qi. The above herbs can descend the rebellious Qi of various organs, plus Achyranthes Root to guide Qi and Blood downward, facilitating the peaceful descent of hyperactive Yang. However, the Liver is the General Officer; its nature prefers free flow and detests depression. Its Qi is fierce and violent, especially resisting forced suppression. Therefore, Artemisia Capillaris (Yin Chen) and Raw Malt (Sheng Mai Ya) are added as ascending and dispersing agents to soothe and facilitate Liver Qi, plus Toosendan Fruit (Chuan Lian Zi) to guide Liver Qi downward, preventing rebellion. Thus, this formula is indeed an excellent prescription for treating Yin deficiency with Yang hyperactivity and is widely used in modern clinical practice. However, from clinical practice, although many cases of hypertension belong to Yin deficiency with Yang hyperactivity, many others do not. This patient lacks the five-center heat and flushed face like drunkenness of Yin deficiency with Fire excess; lacks the sensation of Qi rushing from the lower abdomen upward due to rebellious Chong and Stomach Qi; lacks constipation and belching; and lacks the head distending pain, heat, eye distension, tinnitus, and string-taut long-forceful pulse of Liver Yang hyperactivity with rebellious Qi and Blood. Instead, she presents with Qi and Blood deficiency symptoms such as fatigue, palpitations, insomnia, shortness of breath, and forgetfulness; signs of Liver and Kidney deficiency with weak sinews and bones such as soreness and weakness of the waist and knees, and instability underfoot; and signs of Yang deficiency decline and failure of the Kidney gate to secure, such as pale face, aversion to cold, cold limbs, cold lower abdomen, and difficult-to-control frequent nocturia. Moreover, after taking cold-natured herbs for nourishing Yin and subduing Yang, she developed loss of appetite and loose stools, indicating that the medication did not match the syndrome and that her Middle Jiao Yang is not vigorous. From the series of symptoms above, her syndrome involves not only insufficient Yin-Blood but also weakened Yang, with particularly obvious signs of Kidney Yang deficiency. TCM treats diseases based on the syndrome; if there is a syndrome, use the corresponding medicine. Therefore, based on her symptoms, we adopted the method of nourishing Yin-Blood and assisting Kidney Yang, achieving satisfactory results.
Doctor B asked the teacher to discuss the pathogenesis and treatment of this syndrome.
Teacher answered: This patient's illness likely began three or four years ago. Initially, menstruation became irregular, with continuous metrorrhagia lasting a long time. Afterwards, sensations of dizziness and vertigo, fatigue, soreness and weakness of the waist and knees, and instability underfoot appeared, accompanied by palpitations, insomnia, shortness of breath, and forgetfulness. Besides the above symptoms, initially there was internal irritability and heat, and a sensation of fire rising to the head and face. Later, symptoms of aversion to cold, cold hands and feet, cold lower abdomen, and increased nocturia gradually appeared. Looking at the entire process of the disease's occurrence and development, the illness began by damaging Yin-Blood. Initially, it manifested as a syndrome of Yin (Blood) deficiency with heat, and later gradually presented a situation of Yang deficiency with cold. This is known as Yin damage affecting Yang, resulting in dual deficiency of Yin (Blood) and Yang (Qi). The *Neijing* says: "At forty, Yin Qi is halved, and daily activities decline." Generally speaking, around the age of forty, human Yin-Blood and Yang Qi begin to decline, and vitality gradually diminishes. Especially for women, around the age of七七 (49 years old), Kidney Qi mostly declines, Chong and Ren vessels are depleted, Tian Gui (menstrual essence) exhausts, the menstrual pathway closes, and menstruation ceases. When this patient first fell ill, she was exactly at the age of七七, and combined with long-term continuous metrorrhagia, Yin-Blood was damaged. Yin deficiency generates heat, hence the initial symptoms of five-center heat and fire rising to the head and face. This heat manifestation is deficient heat, caused by insufficient Yin-Blood to balance Yang, leading to relative Yang hyperactivity. Due to excessive consumption of Yin-Blood, Yang must consequently become deficient. Yang resides in Yin, and Yin is rooted in Yang; they are prerequisites for mutual generation and nourishment. If Yin deficiency is too severe, it inevitably leads to a lack of source for Yang generation, subsequently appearing as Yang deficiency. This is Yin damage affecting Yang, at which point it is mostly dual deficiency of Yin and Yang. The reasons for dizziness and vertigo are twofold: first, due to Blood deficiency and Qi weakness, unable to ascend and nourish the head; second, due to Kidney Yin and Yang deficiency, causing insufficiency of Essence and Marrow. The Kidney governs bones and generates marrow, and the brain is the Sea of Marrow. "If the Sea of Marrow is sufficient, one is agile and strong, exceeding normal limits; if the Sea of Marrow is insufficient, the head spins, ears ring, shins ache, dizziness and vertigo occur, and vision is impaired." (*Ling Shu: Hai Lun Pian*). Therefore, in treating this syndrome, one must both "strengthen the master of Water to generate Essence and Blood" and "benefit the origin of Fire to generate Yang Qi." (*Yi Xue Hui Xin Lu*) Supplementing both Yin and Yang, generating Yang within Yin, and generating Yin within Yang. The Dang Gui, Bai Shao, Sheng Di Huang, and Shan Yao in the formula are used to nourish Yin-Blood deficiency; Xian Mao, Yin Yang Huo, and Ba Ji Tian are used to assist weak Yang; Ji Sheng, Chuan Xu Duan, and Gou Ji tonify Liver and Kidney, strengthen sinews and bones to generate Marrow and benefit the Brain; Yi Zhi Ren combined with Shan Yao benefits Spleen and Kidney Yang and has the function of securing Yin fluids, most suitable for syndromes of Spleen-Kidney Yang deficiency with insecure Yin fluids. Overall, this formula nourishes Yin without damaging Yang, assists Yang without scorching Yin, supplements both Yin and Yang, and complements each other. The original Erxian Tang contains Anemarrhena Rhizome (Zhi Mu) and Phellodendron Bark (Huang Bo); however, since this syndrome no longer shows internal heat, they were removed to avoid their bitter-cold nature hindering Yang Qi.
Doctor C asked how to differentiate and treat the syndrome of dizziness and vertigo.
Teacher answered: Dizziness and vertigo are subjective symptoms of the patient. "Xuan refers to seeing things as black; Yun refers to seeing things spinning. When both occur together, it is called Xuan Yun. If severe and lasting a long time before waking, it is also called Yu Mao." (*Zheng Zhi Hui Bu*). Clinically, "External contraction of the Six Evils and Internal injury of the Seven Emotions can all cause dizziness and vertigo." Dizziness and vertigo caused by external contraction syndromes usually involve patients who do not normally have this symptom, appearing only concurrently with the external contraction. The disease is temporary, and dizziness resolves spontaneously as the external contraction heals. If there is no exterior syndrome but frequent dizziness occurs, it is mostly caused by internal injury. Internal injury dizziness and vertigo mainly fall into three categories: Fire Vertigo, Phlegm Vertigo, and Deficiency Vertigo. Fire Vertigo refers to dizziness caused by excessive Heat-Fire, commonly due to Hyperactive Liver Yang and Excess Heat in the Liver Meridian. The syndrome may arise from Five Emotions becoming urgent and transforming into Fire, or from Yin-Blood deficiency leading to Yang hyperactivity. Symptoms include dizziness, tinnitus, head distension and pain, worsening with fatigue or anger, facial flushing, irritability, bitter taste in the mouth, red tongue with yellow coating, and string-taut or rapid pulse. If belonging to Excess Liver Fire, Longdan Xiegan Tang or Danggui Longhui Wan can be used; if belonging to Hyperactive Liver Yang, Zhen Gan Xi Feng, Sanjia Fumai, or Da Ding Feng Zhu can be used to nourish Yin and subdue Yang. If Excess Heat is too severe and dizziness is unbearable, Danxi used Rhubarb stir-fried with wine as powder, 5-10g per dose, taken with tea water. Phlegm Vertigo is mostly caused by Phlegm-Turbidity obstructing the Middle Jiao, preventing Clear Yang from ascending. Symptoms include head feeling heavy as if wrapped, chest fullness and epigastric stuffiness, nausea, vomiting of clear fluid and phlegm-saliva, poor appetite, heavy body, enlarged tongue body, and white sticky coating. Erchen Tang should be used as the main formula. Modified formulas such as Banxia Tianma Baizhu Tang and Wendan Tang are commonly used. Add Huoxiang and Bai Kou for dampness in the Middle Jiao; add Ze Xie for dampness in the Lower Jiao; add Huang Qin and Huang Lian if Phlegm stagnation transforms into heat. Deficiency Vertigo refers to dizziness caused by deficiency, which is clinically common. Belonging to Qi and Blood deficiency, symptoms include pale complexion, colorless lips and nails, shortness of breath and reluctance to speak, fatigue and desire to lie down, palpitations and insomnia, worsening with movement, and occurring upon exertion. Tonifying Qi and nourishing Blood is appropriate; Danggui Buxue, Guipi, or Bazhen can be used. If Qi deficiency is more severe, Buzhong Yiqi can be used. Those caused by Kidney deficiency are mostly due to excessive sexual desire or unrestrained emission, leading to Kidney Essence depletion and insufficient Sea of Marrow. Symptoms include soreness and weakness of the waist and knees, mental fatigue, and forgetfulness. Predominantly Yin deficiency manifests as acid heat in the heart, red urine, and red tongue; Liuwei Dihuang, Qiju Mingmu, or Zuogui pills can be used to nourish Kidney Yin. Predominantly Yang deficiency manifests as cold extremities, aversion to cold, frequent clear urination, and pale tongue; Shenqi Wan or Yougui Wan can be used to benefit Fire and assist Yang. If dizziness is due to severe deficiency in the Lower Jiao, Deer Antler (Lu Rong) 25g can be decocted in wine, strained, a small amount of Musk (She Xiang) added, and taken in one dose for vigorous tonification.
Continuous coughing, dry cough without sputum for over a month
Professor Xiao Yonglin, Changchun University of Chinese Medicine
Xu Tiemei, Changchun Railway Hospital
Patient Wang X, male, 43 years old, first consultation on December 14, 1987.
The patient has had a cough for over a month, visited doctors multiple times, and took various Chinese and Western medicines without effect, hence seeking treatment. The onset occurred about one month ago with occasional general malaise, slight aversion to wind and cold, itchy throat with coughing, and nasal congestion. He went to a health clinic and was diagnosed with a cold. Given VC Yinqiao Tablets, Cough Suppressant Tablets, and Rapid Cold Relief Capsules, etc., afterwards, general malaise, aversion to cold, and nasal congestion gradually improved, but the cough did not improve. The cough was dry without sputum, or occasionally expectorating small amounts of sputum clumps. Continuous coughing occurred every night while sleeping and in the morning upon waking, with a heavy sound, and worsened by wind and cold. If the room was relatively warm, there was no coughing. Since falling ill, there has been no fever, no sweating, no thirst, no irritability, clear and free urination, normal bowel movements, and normal diet. Detailed inquiry into symptoms: dry lips but no desire to drink, dry and itchy throat, severe itching causes incessant coughing. Pale red tongue body, thin white coating with slightly little moisture. Since the illness, he sequentially took Rapid Cold Relief Capsules, Ganmao Qing, Keganmin, Licorice Tablets, VC Yinqiao Tablets, Chuanbei Jing Tablets, Snake Gallbladder and Tangerine Peel Powder, and Sangju Ganmao Tablets, all with insignificant effects. Hearing that eating pears can stop coughing, he tried it, but the cough persisted. Severe coughing causes chest and hypochondriac pain.
Based on his symptoms, onset process, and medication history, comprehensive analysis indicates this syndrome is Cold-Dryness injuring the Lung, causing Lung Qi obstruction leading to coughing. The treatment principle is Acrid-Opening and Warm-Moistening method. Using Zhisou San from *Yi Xue Xin Wu* (Medical Enlightenment) modified: Schizonepeta Spike (Jing Jie) 10g, Tangerine Peel (Chen Pi) 10g, Licorice Root (Gan Cao) 10g, Platycodon Root (Jie Geng) 10g, Stemona Tuber (Bai Bu) 30g, Aster Root (Zi Wan) 20g, Farflower (Kuan Dong Hua) 20g, Perilla Leaf (Zi Su Ye) 10g, Apricot Seed (Xing Ren) 15g, Fresh Ginger (Sheng Jiang) 10g. Decocted in water, taken 2-3 times a day. After two doses, coughing greatly reduced; after four more doses, he recovered.
Doctor A asked: Please tell us your thinking process in diagnosing and treating this syndrome.