杨×，年五十余，某年2月患胸痹心痛证，曾服桂附理中汤，重用党参、于术并加当归，服后病未见减。每于发作之时，心胸撮痛，有如气结在胸，甚则痛彻肩背，水米不进。痛急则面唇发青，冷汗淋漓，脉息迟弱，昏绝欲毙，危在旦夕。此乃土虚无以制水，阳衰不能镇阴，致下焦肝肾阴邪夹寒水上凌心肺之阳而成是状。然寒水已犯中官，骤以参术当归之峻补，有如高筑堤堰堵截水道，水邪无由所出之路，岸高浪急，阴气上游，势必凌心作痛。斯时不宜壅补过早，法当振奋心阳，使心气旺盛，则阴寒水邪自散矣。方用四逆汤合瓜蒌薤白汤加桂。
天雄片100克 干姜30克 薤白10克 瓜萎实10克 公丁10克
上肉桂1 0克(研末，泡水兑入) 甘草5克
一剂痛减其半，二剂加茯苓30克以化气行水，则痛减七、八分，三剂后胸痛若失。
寒湿 胃痛顾××，男，年四旬，云南省鲁甸县人，住上海马斯南路息庐三号。肾气虚，脾湿素重，时值酷暑炎热季节，常食西瓜凉饮，夜卧贪凉，复受冷风所袭，遂致脘腹疼痛不止，痛极则彻及心胸腰背、水米不下，汗出淋漓，辗转反侧睡卧不安，时时呻吟。余诊之，颜面青黯，舌苔白滑质含青色，脉来一息两至半，沉迟无力，手足厥冷。此乃肝肾之阴夹寒水脾湿凝聚三焦，凌心犯胃，阳不足以运行，而成是状。先以上肉桂10克研末泡水与服之。服后旋即呕吐涎沫碗许，此为寒湿外除佳兆，继以吴萸四逆汤加味治之。
附片100克干姜30克上肉桂10克(研末，泡水兑入)公丁6克
白胡椒6克(捣末，分次吞服) 吴萸10克．甘草10克
服一剂，涌吐酸苦涎水两大碗、痛减其半。再服一剂，又吐涎水两大碗，其痛大减，遂得安卧。次晚续诊，脉已一息四至，汗止厥回，渚痛俱瘥。继以桂附理中汤二剂调理而愈。
脘腹痛
张××之妻，年三十余岁，四川省会理县人。1924年6月患病，请西医治疗，病情日剧，就诊于余。余视之，舌苔白滑兼灰黑色，脉细迟欲绝，十余日来饮食不进，微喜滚饮，虽恶寒但不见发热，心痛彻背。时时感觉腹中有气上冲心胸，心中慌跳，复见呕吐，触之，腹内有症坚痞块，痛不可当。缘由前医曾予腹部注射某药一针，其后针处硬结突 起，继而扩展大如碗口。此乃肝肾阴邪为患，复因针处被寒，阴寒挟水邪上逆，凌心犯胃，如不急为驱除，绥则必殆无救。遂拟四逆苓桂丁椒汤治之。
附片130克干姜60克 茯苓26克 公丁13克 上肉桂13克(研
末，泡水兑入) 白胡椒6克(捣末，分次冲服) 甘草6克
服一剂则痛减其半，再剂则诸证渐退，痛止七、八，稍进饮食。唯呕吐未止，此乃肝肾阴寒之邪未净，拟乌梅丸方治之。
附片130克 干姜60克 当归26克 上肉桂13克(研末，泡水兑
入) 黄连13克黄柏13克北细辛6克 潞党参16克 川
椒6克(炒去汗) 乌梅3枚
服一剂后，呕吐止。服二剂后，腹痛全瘳，腹内痞块渐散。继以回阳饮(即四逆汤加肉桂)，兼吞服乌梅丸十余剂，始奏全功。
虚 寒 胃 痛
徐××，男，年四旬余，云南省大姚县人，住滇南个旧市。1923年10月来昆明治病，就诊于余。询及由来，悉知患心胃痛证已二十余年，经中西药物屡治未效，近则病情日见增剧，形体消瘦，面容不展。胸膈痞胀作痛，两胁满闷不舒，脘腹灼痛，痛极则彻于胸背，固定不移，从心下至脐腹窿起板硬如石，按之亦痛，腰背如负薄冰，饿懔而寒。时而泛酸 上冲咽喉，呕吐黄绿酸苦诞水，心中嘈杂，知饥而不能食，唯喜烫饮，饮而不多。大便干结难解、小便短涩，手足不温，少气无力，入夜难寐。舌淡苔白滑腻，脉来沉迟，息间仅两至半，且短而弱。良由病久阳虚，真火内衰，阴寒内结，脾阳不运，无力以制水邪，肝郁不舒，挟寒水上逆犯胃凌心。阳虚为病之本，寒水泛溢为病之标，乃本虚标实之证，法当扶阳温散寒水之邪治之，先拟乌梅丸方一剂。
附片100克 干姜30克 桂尖30克 细辛10克 黄连10克 焦
柏10克 当归25克 川椒3克(炒去汗) 党参3克 乌梅2枚
服上方，痛稍减，呕吐酸苦水已少。此病历经二十余载，根深蒂固，邪实而证顽矣，欲除病根，非大剂辛温连进，方能奏效。以余多年临床体验，此证每于服药之后，或见脘腹增痛，或吐酸、便泻、小便色赤而浊等征象，可一时有所表露，此乃药与病相攻，驱邪之兆，若药能胜病，犹兵能胜敌，倘畏惧不专，虽欲善其事，而器不利也，何以克服!古云： “若药不瞑眩，厥疾弗瘳”。余将此理告病者，务期早除痛苦，渠则严然信守，遂以吴萸四逆汤加味治之。
附片150克 吴萸18克 干姜60克 上肉桂18克(研末，泡水兑
入) 公丁5克 茯苓30克 白胡椒3克(研束，兑服) 甘
草15克
服药后果如余言，一剂则痛反较增，二剂则腹中气动雷鸣。三剂则涌吐大作，吐出黄绿苦水盈盂，吐后胸胃痞胀舒缓，白滑苔渐退。更照原方附片量增至200克，每日一剂，连进十剂，愈服越见吐，痛不减反有所增之势，小便色赤， 但较长，已十余日不大便，诊视则白滑苔已退尽，但舌本透白而无血色，脉转缓和稍有神，仍喜滚饮而畏寒，正邪交作，势均力敌。仍照前法，再进不怠。拟方白通汤加上肉桂。
白附片300克 生盐附子150克干姜150克 葱白9茎 上肉
桂10克(研末，泡水兑入)
连服二剂，大便始通，色黑如漆，腹痛，痞硬稍减，能略进饮食。再服数剂，大便则畅泻，色黑绿，臭不可当，脘腹疼痛及痞硬顿失其半，胃逆作酸已减少。此阴寒溃退，元阳渐复。照原方去葱白加茯苓30克，砂仁15克，白术30克，甘草18克。连进数剂，大便由稀而溏，色渐转黄，饮食渐增，舌质已略显红润之色，脉沉细一息已四至，腹中痞硬已消去八、九，唯胃脘中仍感灼辣疼痛，时而吐酸水一、二口，复主以乌梅丸方。服三剂，吐止痛减，食量增加，背寒肢厥已回温。唯形体枯瘦，正气未充，精神尚差，胃中尚时而隐痛，继以桂附理中汤加口芪，并兼服乌梅丸，每日三丸。每服均见好，连服十数余剂而愈，体健如常。
呃 逆
黄××，女，二十五岁，归国华侨，云南某大学学生。
患呃逆证已一年余，曾经多方治疗，效果不显。每于精神紧张之时，呃逆更甚。自觉胃中饱闷，时有逆气上冲，气冲有 声，声短而频，不能自制。近来逐渐加剧，以致情绪不安，心情烦闷，睡眠差，影响听课学习。1964年夏，患者来中医学院就诊于余，呃逆频作，面色少华。舌淡质嫩，苔腻微黄，脉象沉缓而弦。 《景岳全书》曰： “致呃之由，总由气逆。”此系阳虚胃寒，中焦气机升降失调，寒气上逆，胃气不降所致。治宜温中降逆，调和气机，方用旋覆代赭汤加味。
旋覆花9克 代赭石12克 法夏9克明党参15克砂仁9克
厚朴9克 生姜3片 大枣5枚 甘草6克
服二剂后，呃逆减少，间隔时问有所延长，脘闷气逆亦感减轻。患者自知服药有效，情绪亦好转，睡眠、饮食均有改善。脉沉缓，关部尚弦。腻苔已退，苔薄白而润。继以温中益气，和胃降逆治之。用前方，明党参增至30克，加入公丁3克，柿蒂6克，连服四剂，呃逆不再发作。
按： “呃逆之由，总由气逆”，乃中焦气机升降失司，逆气上冲所致。阳虚有寒者，宜温中降逆为主。阴虚有热者，宜苦寒降逆为主。总不离乎调理升降气机为原则。若久病之人，突发呃逆，则为脾肾气机将绝，宜以大剂回阳降逆，如吴萸四逆汤、白通汤、人参干姜附子汤之类，以求挽回生机。若徒治其标而忽弃其本，不但呃逆难止，生命亦难保无虞矣。
气虚便秘张××，男，三十二岁，昆明人，患便秘证已一年余。初起大便难解，凡二、三日一行，干结不爽。头昏食少，脘腹痞闷不适，时常哕气上逆，冲口而出。医者以为阴虚肠燥，胃腑有热，连续治以清热苦寒、滋润通下之剂。每服一剂，大便通泻一次，其后又复秘结如故，脘腹痞闷终不见减。如此往复施治数月之久，愈见便秘，甚者六、七日始一行。口苦咽干纳呆食减，体瘦面黄，精神倦怠。余诊其脉，沉迟而弱，舌苔厚腻，色黄少津，口气微臭，思饮不多。如此并非肠胃燥热之证，乃是气虚之便秘。因长期服用苦寒通下之品，脾肾之阳受戕，睥气虚弱，无力运化，肾气不足，难以化气生津，气机壅滞，胃肠传化失司，遂成便秘。当以温下之法，务使枢机运转，腑气自能通达。方用温脾汤加味。
附片45克 大黄9克(后放) 明党参15克 厚朴9克 杏
仁9克(捣) 干姜12克 甘草6克
煎服一次后，则腹中肠鸣，气窜胸胁，自觉欲转矢气而不得。再服二次，则矢气频作，便意迫肛，旋即解出大便许多，予黑硬结如栗，其臭无比。顿觉腹中舒缓，如释重负，呕哕已不再作。连服二剂后，大便隔日可解。口苦咽干已愈，食思转佳，腹中痞胀消去。厚腻黄苔已退，呈现薄白润苔，脉仍沉缓。遂照原方加肉桂9克增其温化运转之力，连服四剂后，大便通调如常，精神、饮食明显好转，面色呈润泽。为巩固疗效，继以吴茱萸汤加肉桂、甘松温中健胃，调理二十余日，并嘱其常服桂附理中丸。三年后相遇，询及便秘之证已痊愈，迄今未复发。 蛔厥腹痛
(胆道蛔虫证)
郑××，女，三十六岁，昆明官渡区某公社社员。1962年10月某日夜间，患者突然脘胁疼痛，宛如刀绞，彻于右侧肩背，四肢冰冷，汗出如珠，兼发恶心呕吐，吐出黄绿苦水，并吐蛔虫一条，胃中灼热嘈杂，脘腹痞胀，烦躁不宁，呻吟不止，终夜不能入眠。天明，其痛稍有减轻，方才交睫，又复作痛如前，遂由家人护送至中医学院附属医院急诊。经检查，诊断为“胆道蛔虫症”，住院治疗。余会诊之时，见患者脉沉弦而紧，舌苔白腻，舌质青黯，不渴饮。此乃厥阴脏寒，肝胆气机郁结，腹中蛔虫上扰作痛，属蛔厥之证。照伸景法，以乌梅丸主之。
附片30克 干姜15克 肉桂9克 当归15克 党参15克 黄
连6克 黄柏9克 川椒5克(炒去汗) 细辛5克 乌梅3枚
煎一服，疼痛稍减，三眼尽疼痛呕吐均止，手足已回温，夜间已能安静入睡。惟胃中仍唷杂，脘腹尚感痞闷。口苦，不思饮食。脉沉弦，已不似昨日兼有紧象，腻苔稍退，舌质仍含青色。蛔虫虽安，但肝胆寒凝之气尚未祛尽。照原方加川楝子9克，榔片9克。连服二剂后，便下蛔虫二十余条，腹中感到舒缓，饮食渐有恢复。脉缓，苔退。再以香砂理中汤加荜拨、高良姜调理二剂，气机恢复，痊愈出院。 痰饮咳 嗽
李x×，男，年四旬余，昆明市人，患痰饮咳喘病已八、九年，经中、西医屡治未愈。诊其脉左弦右滑，两尺弱，心脉细短，肺脉滑大，按之则空，舌苔白滑而腻，面色青黯，目下浮起如卧蚕。咳痰气喘而短，胸闷痰滞，头疼目眩。食少无神，畏食酸冷，渴喜热饮而不多，小便短赤，咳时则遗。入夜难眠，行卧惟艰，值阴雨天寒尤甚。良由脾肾阳虚，饮邪内泛，脾不运化，寒湿水饮上逆犯肺则作痰作咳。肾虚不纳，则短气喘息而遗溺，痰湿阻遏，清阳不升，浊阴不降，肺肾之气不相接，遂成痰饮咳喘之证。 ，(金匮要略》日；“病痰饮者，当以温药和之。”为痰饮病治本之法，禀承此意拟方小青龙汤加减主之。
附片20克 北细辛4克 麻茸3克 干姜15克 法夏15克
五味子1．5克 甘草3克
次日复诊。昨服一剂，头疼、咳痰稍减，痰较易咯，乃照原方加倍分量。服后痰多咳吐如涌，胸闷减，喘息较平。
服二剂后，头痛若失，喘息平其大半。服三剂后，稍能食，行卧已较轻便，唯痰多，气仍短，小便转长而色仍赤。盖湿痰饮邪得阳药运行，在上由咽喉气道而出，在下则随小便而去，乃病退之兆。仍照前方加减治之。
附片100克 北细辛10克 半夏1 0克 干姜40克 上肉桂10克
(研末，泡水兑入) 茯苓30克 桂尖203Z 五味子3克 甘
草1 0克
服二剂后，喘咳平，痰已少。三剂后，胸闷气短均愈，饮食倍增，弦滑之脉已平，腻苔已退。唯精神未充，后以苓桂术甘汤加附子、口芪，连进十剂，遂得痊瘳。
附片150克 口芪30克 茯苓20克 桂尖20克 自术20克 甘
草10克痰喘咳嗽兼气虚便秘
刘××之父，年过六旬。1924年9月，病已月余，六脉沉迟无力，舌苔白腻，喜热饮，咳嗽哮喘而多痰。腹胀且痛，不思食，大便秘结二十日不更衣，小便赤而长，夜难入寐，精神极弱。查前所服方药，均以清热消食降气为主，且以硝、黄峻剂通下之，仍不能便，其势较危。此系脾肾阳虚，中土失运，痰湿水饮阻逆于肺，清肃不降，致痰喘咳嗽，传导失司，无力输送。加之阳虚则气不化津，无以滋润肠道，致成气虚寒凝之便秘不通，此太阴、阳明经气不相传也。宜扶阳温化主之，拟真武汤加昧。
附片100克 茯苓30克 白术20g 杭芍10克 干姜30克 北
细辛6克五味子5克
杨×，五十多岁。某年二月患胸痹心痛证，曾服用桂附理中汤，重用党参、白术并加入当归，服药后病情未见减轻。每次发作时，心胸撮痛，感觉气结在胸，严重时疼痛放射至肩背，水米不能进。疼痛剧烈时面唇发青，冷汗淋漓，脉搏迟弱，昏厥欲死，危在旦夕。这是土虚无法制水，阳衰不能镇阴，导致下焦肝肾阴邪夹带寒水上凌心肺之阳而形成的症状。然而寒水已经侵犯中焦，此时骤用参、术、当归等峻补药物，就像高筑堤坝堵塞水道，水邪没有出路，岸高浪急，阴气上游，势必凌心作痛。此时不宜过早壅补，治法应当振奋心阳，使心气旺盛，则阴寒水邪自然消散。方用四逆汤合瓜蒌薤白汤加桂枝。
天雄片100克 干姜30克 薤白10克 瓜蒌实10克 公丁香10克
上肉桂10克（研末，泡水兑入） 甘草5克
服一剂后疼痛减半，二剂加入茯苓30克以化气行水，则疼痛减轻七八分，三剂后胸痛消失。
寒湿胃痛 顾××，男，四十岁，云南省鲁甸县人，住上海马斯南路息庐三号。肾气虚，脾湿素重，正值酷暑炎热季节，常食西瓜凉饮，夜卧贪凉，又受冷风侵袭，导致脘腹疼痛不止，痛极则放射至心胸腰背，水米不下，汗出淋漓，辗转反侧睡卧不安，时时呻吟。我诊察他，颜面青黯，舌苔白滑质含青色，脉来一息两至半，沉迟无力，手足厥冷。这是肝肾之阴夹寒水脾湿凝聚三焦，凌心犯胃，阳气不足以运行，而形成此状。先以上肉桂10克研末泡水与服。服后旋即呕吐涎沫约一碗，此为寒湿外除佳兆，继以吴茱萸四逆汤加味治疗。
附片100克 干姜30克 上肉桂10克（研末，泡水兑入） 公丁香6克
白胡椒6克（捣末，分次吞服） 吴茱萸10克 甘草10克
服一剂，涌吐酸苦涎水两大碗，疼痛减半。再服一剂，又吐涎水两大碗，疼痛大减，遂得安卧。次晚续诊，脉已一息四至，汗止厥回，诸痛俱愈。继以桂附理中汤二剂调理而愈。
脘腹痛 张××之妻，三十多岁，四川省会理县人。1924年6月患病，请西医治疗，病情日益加重，就诊于我。我看她，舌苔白滑兼灰黑色，脉细迟欲绝，十余日来饮食不进，微喜热饮，虽恶寒但不见发热，心痛彻背。时时感觉腹中有气上冲心胸，心中慌跳，复见呕吐，触之，腹内有症坚痞块，痛不可当。缘由前医曾予腹部注射某药一针，其后针处硬结突起，继而扩展大如碗口。这是肝肾阴邪为患，又因针处被寒，阴寒挟水邪上逆，凌心犯胃，如不急为驱除，稍缓则必殆无救。于是拟四逆苓桂丁椒汤治疗。
附片130克 干姜60克 茯苓26克 公丁香13克 上肉桂13克（研末，泡水兑入） 白胡椒6克（捣末，分次冲服） 甘草6克
服一剂则疼痛减半，再剂则诸证渐退，疼痛停止七八分，稍进饮食。唯呕吐未止，这是肝肾阴寒之邪未净，拟乌梅丸方治疗。
附片130克 干姜60克 当归26克 上肉桂13克（研末，泡水兑入） 黄连13克 黄柏13克 北细辛6克 潞党参16克 川椒6克（炒去汗） 乌梅3枚
服一剂后，呕吐止。服二剂后，腹痛全愈，腹内痞块渐散。继以回阳饮（即四逆汤加肉桂），兼吞服乌梅丸十余剂，始奏全功。
虚寒胃痛 徐××，男，四十多岁，云南省大姚县人，住滇南个旧市。1923年10月来昆明治病，就诊于我。询问由来，悉知患心胃痛证已二十余年，经中西药物屡治未效，近则病情日益增剧，形体消瘦，面容不展。胸膈痞胀作痛，两胁满闷不舒，脘腹灼痛，痛极则彻于胸背，固定不移，从心下至脐腹隆起板硬如石，按之亦痛，腰背如负薄冰，凛冽而寒。时而泛酸上冲咽喉，呕吐黄绿酸苦涎水，心中嘈杂，知饥而不能食，唯喜烫饮，饮而不多。大便干结难解，小便短涩，手足不温，少气无力，入夜难寐。舌淡苔白滑腻，脉来沉迟，息间仅两至半，且短而弱。良由病久阳虚，真火内衰，阴寒内结，脾阳不运，无力以制水邪，肝郁不舒，挟寒水上逆犯胃凌心。阳虚为病之本，寒水泛溢为病之标，乃本虚标实之证，治法应当扶阳温散寒水之邪，先拟乌梅丸方一剂。
附片100克 干姜30克 桂尖30克 细辛10克 黄连10克 焦柏10克 当归25克 川椒3克（炒去汗） 党参3克 乌梅2枚
服上方，疼痛稍减，呕吐酸苦水已少。此病历经二十余载，根深蒂固，邪实而证顽矣，欲除病根，非大剂辛温连进，方能奏效。以我多年临床体验，此证每于服药之后，或见脘腹增痛，或吐酸、便泻、小便色赤而浊等征象，可一时有所表露，这是药与病相攻，驱邪之兆，若药能胜病，犹兵能胜敌，倘畏惧不专，虽欲善其事，而器不利也，何以克服！古云：“若药不瞑眩，厥疾弗瘳”。我将此理告知病人，务期早除痛苦，他则毅然信守，遂以吴茱萸四逆汤加味治疗。
附片150克 吴茱萸18克 干姜60克 上肉桂18克（研末，泡水兑入） 公丁香5克 茯苓30克 白胡椒3克（研末，兑服） 甘草15克
服药后果如我所言，一剂则疼痛反而增加，二剂则腹中气动雷鸣。三剂则涌吐大作，吐出黄绿苦水盈盂，吐后胸胃痞胀舒缓，白滑苔渐退。更照原方附片量增至200克，每日一剂，连进十剂，愈服越见吐，疼痛不减反有所增之势，小便色赤，但较长，已十余日不大便，诊视则白滑苔已退尽，但舌本透白而无血色，脉转缓和稍有神，仍喜热饮而畏寒，正邪交作，势均力敌。仍照前法，再进不怠。拟方白通汤加上肉桂。
白附片300克 生盐附子150克 干姜150克 葱白9茎 上肉桂10克（研末，泡水兑入）
连服二剂，大便始通，色黑如漆，腹痛，痞硬稍减，能略进饮食。再服数剂，大便则畅泻，色黑绿，臭不可当，脘腹疼痛及痞硬顿失其半，胃逆作酸已减少。这是阴寒溃退，元阳渐复。照原方去葱白加茯苓30克，砂仁15克，白术30克，甘草18克。连进数剂，大便由稀而溏，色渐转黄，饮食渐增，舌质已略显红润之色，脉沉细一息已四至，腹中痞硬已消去八九，唯胃脘中仍感灼辣疼痛，时而吐酸水一二口，复主以乌梅丸方。服三剂，吐止痛减，食量增加，背寒肢厥已回温。唯形体枯瘦，正气未充，精神尚差，胃中尚时而隐痛，继以桂附理中汤加黄芪，并兼服乌梅丸，每日三丸。每服均见效，连服十数余剂而愈，体健如常。
呃逆 黄××，女，二十五岁，归国华侨，云南某大学学生。
患呃逆证已一年余，曾经多方治疗，效果不显。每于精神紧张之时，呃逆更甚。自觉胃中饱闷，时有逆气上冲，气冲有声，声短而频，不能自制。近来逐渐加剧，以致情绪不安，心情烦闷，睡眠差，影响听课学习。1964年夏，患者来中医学院就诊于我，呃逆频作，面色少华。舌淡质嫩，苔腻微黄，脉象沉缓而弦。《景岳全书》曰：“致呃之由，总由气逆。”此系阳虚胃寒，中焦气机升降失调，寒气上逆，胃气不降所致。治宜温中降逆，调和气机，方用旋覆代赭汤加味。
旋覆花9克 代赭石12克 法半夏9克 明党参15克 砂仁9克
厚朴9克 生姜3片 大枣5枚 甘草6克
服二剂后，呃逆减少，间隔时间有所延长，脘闷气逆亦感减轻。患者自知服药有效，情绪亦好转，睡眠、饮食均有改善。脉沉缓，关部尚弦。腻苔已退，苔薄白而润。继以温中益气，和胃降逆治之。用前方，明党参增至30克，加入公丁香3克，柿蒂6克，连服四剂，呃逆不再发作。
按： “呃逆之由，总由气逆”，乃中焦气机升降失司，逆气上冲所致。阳虚有寒者，宜温中降逆为主。阴虚有热者，宜苦寒降逆为主。总不离乎调理升降气机为原则。若久病之人，突发呃逆，则为脾肾气机将绝，宜以大剂回阳降逆，如吴茱萸四逆汤、白通汤、人参干姜附子汤之类，以求挽回生机。若徒治其标而忽弃其本，不但呃逆难止，生命亦难保无虞矣。
气虚便秘 张××，男，三十二岁，昆明人，患便秘证已一年余。初起大便难解，凡二、三日一行，干结不爽。头昏食少，脘腹痞闷不适，时常哕气上逆，冲口而出。医者以为阴虚肠燥，胃腑有热，连续治以清热苦寒、滋润通下之剂。每服一剂，大便通泻一次，其后又复秘结如故，脘腹痞闷终不见减。如此往复施治数月之久，愈见便秘，甚者六、七日始一行。口苦咽干纳呆食减，体瘦面黄，精神倦怠。我诊其脉，沉迟而弱，舌苔厚腻，色黄少津，口气微臭，思饮不多。如此并非肠胃燥热之证，乃是气虚之便秘。因长期服用苦寒通下之品，脾肾之阳受戕，脾气虚弱，无力运化，肾气不足，难以化气生津，气机壅滞，胃肠传化失司，遂成便秘。当以温下之法，务使枢机运转，腑气自能通达。方用温脾汤加味。
附片45克 大黄9克（后放） 明党参15克 厚朴9克 杏仁9克（捣） 干姜12克 甘草6克
煎服一次后，则腹中肠鸣，气窜胸胁，自觉欲转矢气而不得。再服二次，则矢气频作，便意迫肛，旋即解出大便许多，予黑硬结如栗，其臭无比。顿觉腹中舒缓，如释重负，呕哕已不再作。连服二剂后，大便隔日可解。口苦咽干已愈，食欲转佳，腹中痞胀消去。厚腻黄苔已退，呈现薄白润苔，脉仍沉缓。遂照原方加肉桂9克增其温化运转之力，连服四剂后，大便通调如常，精神、饮食明显好转，面色呈润泽。为巩固疗效，继以吴茱萸汤加肉桂、甘松温中健胃，调理二十余日，并嘱其常服桂附理中丸。三年后相遇，询及便秘之证已痊愈，迄今未复发。
蛔厥腹痛
（胆道蛔虫证）
郑××，女，三十六岁，昆明官渡区某公社社员。1962年10月某日夜间，患者突然脘胁疼痛，宛如刀绞，彻于右侧肩背，四肢冰冷，汗出如珠，兼发恶心呕吐，吐出黄绿苦水，并吐蛔虫一条，胃中灼热嘈杂，脘腹痞胀，烦躁不宁，呻吟不止，终夜不能入眠。天明，其痛稍有减轻，方才交睫，又复作痛如前，遂由家人护送至中医学院附属医院急诊。经检查，诊断为“胆道蛔虫症”，住院治疗。我会诊之时，见患者脉沉弦而紧，舌苔白腻，舌质青黯，不渴饮。这是厥阴脏寒，肝胆气机郁结，腹中蛔虫上扰作痛，属蛔厥之证。照仲景法，以乌梅丸主之。
附片30克 干姜15克 肉桂9克 当归15克 党参15克 黄连6克 黄柏9克 川椒5克（炒去汗） 细辛5克 乌梅3枚
煎一服，疼痛稍减，三帖尽疼痛呕吐均止，手足已回温，夜间已能安静入睡。惟胃中仍嘈杂，脘腹尚感痞闷。口苦，不思饮食。脉沉弦，已不似昨日兼有紧象，腻苔稍退，舌质仍含青色。蛔虫虽安，但肝胆寒凝之气尚未祛尽。照原方加川楝子9克，槟榔片9克。连服二剂后，便下蛔虫二十余条，腹中感到舒缓，饮食渐有恢复。脉缓，苔退。再以香砂理中汤加荜拨、高良姜调理二剂，气机恢复，痊愈出院。
痰饮咳嗽 李××，男，四十多岁，昆明市人，患痰饮咳喘病已八、九年，经中、西医屡治未愈。诊其脉左弦右滑，两尺弱，心脉细短，肺脉滑大，按之则空，舌苔白滑而腻，面色青黯，目下浮起如卧蚕。咳痰气喘而短，胸闷痰滞，头疼目眩。食少无神，畏食酸冷，渴喜热饮而不多，小便短赤，咳时则遗。入夜难眠，行卧惟艰，值阴雨天寒尤甚。良由脾肾阳虚，饮邪内泛，脾不运化，寒湿水饮上逆犯肺则作痰作咳。肾虚不纳，则短气喘息而遗溺，痰湿阻遏，清阳不升，浊阴不降，肺肾之气不相接，遂成痰饮咳喘之证。《金匮要略》曰：“病痰饮者，当以温药和之。”为痰饮病治本之法，秉承此意拟方小青龙汤加减主之。
附片20克 北细辛4克 麻黄绒3克 干姜15克 法半夏15克
五味子1.5克 甘草3克
次日复诊。昨服一剂，头疼、咳痰稍减，痰较易咯，乃照原方加倍分量。服后痰多咳吐如涌，胸闷减，喘息较平。
服二剂后，头痛若失，喘息平其大半。服三剂后，稍能食，行卧已较轻便，唯痰多，气仍短，小便转长而色仍赤。盖湿痰饮邪得阳药运行，在上由咽喉气道而出，在下则随小便而去，乃病退之兆。仍照前方加减治之。
附片100克 北细辛10克 半夏10克 干姜40克 上肉桂10克
（研末，泡水兑入） 茯苓30克 桂尖20克 五味子3克 甘草10克
服二剂后，喘咳平，痰已少。三剂后，胸闷气短均愈，饮食倍增，弦滑之脉已平，腻苔已退。唯精神未充，后以苓桂术甘汤加附子、黄芪，连进十剂，遂得痊愈。
附片150克 黄芪30克 茯苓20克 桂尖20克 白术20克 甘草10克
痰喘咳嗽兼气虚便秘 刘××之父，年过六旬。1924年9月，病已月余，六脉沉迟无力，舌苔白腻，喜热饮，咳嗽哮喘而多痰。腹胀且痛，不思食，大便秘结二十日不更衣，小便赤而长，夜难入寐，精神极弱。查前所服方药，均以清热消食降气为主，且以硝、黄峻剂通下之，仍不能便，其势较危。这是脾肾阳虚，中土失运，痰湿水饮阻逆于肺，清肃不降，致痰喘咳嗽，传导失司，无力输送。加之阳虚则气不化津，无以滋润肠道，致成气虚寒凝之便秘不通，此太阴、阳明经气不相传也。宜扶阳温化主之，拟真武汤加味。
附片100克 茯苓30克 白术20克 杭芍10克 干姜30克 北细辛6克 五味子5克
Yang ×, male, over fifty years old. In February of a certain year, he suffered from chest bi (chest obstruction) and heart pain syndrome. He had previously taken Guizhi Fuzi Lizhong Tang (Cinnamon Twig and Aconite Root Decoction for Warming the Middle), with heavy doses of Codonopsis Radix (Dangshen), Atractylodis Rhizoma (Baizhu), and added Angelicae Sinensis Radix (Danggui). After taking it, the illness did not subside. During each attack, there was a pinching pain in the heart and chest, feeling like qi stagnation in the chest; severely, the pain radiated to the shoulders and back, and he could not take any food or water. When the pain was urgent, his face and lips turned cyanotic, cold sweat poured down, the pulse was slow and weak, he fainted and felt as if he were about to die, in critical condition day and night. This is due to deficiency of Earth failing to control Water, and Yang deficiency failing to suppress Yin, causing Yin pathogens of the Lower Jiao (Liver and Kidney) to carry Cold-Water upward to overwhelm the Yang of the Heart and Lungs. However, since Cold-Water has already invaded the Middle Jiao, suddenly using potent tonics like Ginseng (Codonopsis), Atractylodes, and Angelica is like building high dams to block waterways; the pathogenic water has no outlet, the banks are high and waves are fierce, Yin Qi rises upstream, inevitably overwhelming the Heart and causing pain. At this time, one should not tonify too early or obstructively. The treatment method should be to invigorate Heart Yang, so that when Heart Qi is vigorous, the Yin-Cold and pathogenic water will naturally dissipate. The prescription used was Sini Tang (Four Reversal Decoction) combined with Gualou Xiebai Tang (Trichosanthes Fruit and Macrostemon Rhizome Decoction) plus Cinnamon Twig.
Tianxiong Pian (Aconitum Kusnezoffii Radix Preparata) 100g, Ganjiang (Dried Ginger) 30g, Xiebai (Allium Macrostemon Bulb) 10g, Gualoushi (Trichosanthes Fruit) 10g, Gongding (Caryophylli Flos) 10g.
Shang Rougui (Cortex Cinnamomi) 10g (powdered, mixed with water and added to the decoction), Gancao (Glycyrrhizae Radix et Rhizoma) 5g.
After one dose, the pain decreased by half. After two doses, Poria (Fuling) 30g was added to transform Qi and promote water metabolism, then the pain decreased by seven or eight parts. After three doses, the chest pain disappeared completely.
Cold-Damp Stomach Pain: Gu ××, male, forty years old, from Ludian County, Yunnan Province, residing at No. 3 Xilu, Masinan Road, Shanghai. Kidney Qi was deficient, and Spleen Dampness was inherently heavy. During the hot summer season, he often ate watermelon and cold drinks, slept cool at night, and was exposed to cold wind, resulting in unceasing abdominal pain. When the pain was extreme, it radiated to the heart, chest, waist, and back; he could not eat or drink, sweated profusely, tossed and turned unable to sleep peacefully, and groaned frequently. Upon examination, his face was dark cyanotic, the tongue coating was white and slippery with a bluish tint to the substance, the pulse came at two and a half beats per respiration, deep, slow, and forceless, and his hands and feet were cold. This is due to Yin of the Liver and Kidney combining with Cold-Water and Spleen Dampness to congeal in the Sanjiao (Triple Burner), overwhelming the Heart and invading the Stomach, while Yang is insufficient to circulate, forming this condition. First, Shang Rougui (Cortex Cinnamomi) 10g was powdered and taken with water. After ingestion, he immediately vomited about a bowl of saliva and phlegm, which is a good sign of Cold-Damp being expelled externally. Subsequently, he was treated with Wuzhuyu Sini Tang (Evodia Four Reversal Decoction) modified.
Fupian (Prepared Aconite Root) 100g, Ganjiang (Dried Ginger) 30g, Shang Rougui (Cortex Cinnamomi) 10g (powdered, mixed with water and added), Gongding (Caryophylli Flos) 6g.
Baihujiao (Piperis Fructus) 6g (powdered, taken in divided doses), Wuzhuyu (Evodiae Fructus) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g.
After one dose, he vomited two large bowls of sour and bitter saliva, and the pain decreased by half. After another dose, he vomited another two large bowls of saliva, the pain greatly subsided, and he was able to lie down peacefully. On the evening of the next day, upon follow-up examination, the pulse had returned to four beats per respiration, sweating stopped, cold extremities reversed, and all pains ceased. He was then regulated with two doses of Guizhi Fuzi Lizhong Tang (Cinnamon Twig and Aconite Root Decoction for Warming the Middle) and recovered.
Epigastric and Abdominal Pain: Wife of Zhang ××, female, over thirty years old, from Huili County, Sichuan Province. She fell ill in June 1924. Western medicine treatment failed, and her condition worsened daily until she consulted me. I observed her tongue coating was white, slippery, and mixed with gray-black; the pulse was fine, slow, and nearly imperceptible. For over ten days, she had not eaten, slightly preferred hot drinks, feared cold but had no fever, and experienced heart pain radiating to the back. She constantly felt gas rushing from the abdomen to the heart and chest, palpitations, and vomiting. Palpation revealed hard masses in the abdomen, unbearable in pain. The cause was an injection given by a previous doctor into the abdomen; afterward, a hard nodule appeared at the injection site, expanding to the size of a bowl. This is caused by Yin pathogens of the Liver and Kidney, compounded by cold entering the needle site, causing Yin-Cold to carry pathogenic water upward, overwhelming the Heart and invading the Stomach. If not urgently dispelled, delay would lead to death without hope. Therefore, I prescribed Sini Linggui Dingjiao Tang (Four Reversal, Poria, Cinnamon Twig, Clove, and Sichuan Pepper Decoction).
Fupian (Prepared Aconite Root) 130g, Ganjiang (Dried Ginger) 60g, Fuling (Poria) 26g, Gongding (Caryophylli Flos) 13g, Shang Rougui (Cortex Cinnamomi) 13g (powdered, mixed with water and added), Baihujiao (Piperis Fructus) 6g (powdered, taken in divided doses), Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
After one dose, the pain decreased by half. After two doses, all symptoms gradually receded, pain stopped by seven or eight parts, and she could take some food. Only vomiting persisted, indicating that Yin-Cold pathogens of the Liver and Kidney were not yet cleared. I prescribed Wu Mei Wan (Mume Pill).
Fupian (Prepared Aconite Root) 130g, Ganjiang (Dried Ginger) 60g, Danggui (Angelicae Sinensis Radix) 26g, Shang Rougui (Cortex Cinnamomi) 13g (powdered, mixed with water and added), Huanglian (Coptidis Rhizoma) 13g, Huangbai (Phellodendri Cortex) 13g, Beixixin (Asari Radix) 6g, Lu Dangshen (Codonopsis Radix) 16g, Chuanjiao (Zanthoxyli Pericarpium) 6g (stir-fried to remove oil), Wumei (Mume Fructus) 3 pieces.
After one dose, vomiting stopped. After two doses, abdominal pain completely resolved, and the abdominal mass gradually dispersed. Subsequently, Huiyang Yin (Return to Yang Drink, i.e., Sini Tang plus Cinnamon Twig) was used, along with swallowing Wu Mei Wan (Mume Pill) for over ten doses, achieving full recovery.
Deficiency-Cold Stomach Pain: Xu ××, male, over forty years old, from Dayao County, Yunnan Province, residing in Gejiu City, Southern Yunnan. He came to Kunming for treatment in October 1923. Inquiry revealed he had suffered from heart and stomach pain for over twenty years, with repeated treatments by both Chinese and Western medicine proving ineffective. Recently, the condition worsened daily, leading to emaciation and a gloomy expression. There was distension and pain in the chest and diaphragm, fullness and discomfort in the hypochondrium, burning pain in the epigastrium and abdomen, which radiated to the chest and back when severe, fixed in location. From the epigastrium to the umbilical region, the abdomen bulged and was hard as stone, painful on pressure. The lower back felt as if carrying thin ice, chilling and cold. Occasionally, acid reflux rushed to the throat, vomiting yellow-green sour and bitter saliva, a sensation of hunger pangs without appetite, only preferring scalding hot drinks in small amounts. Stools were dry and difficult to pass, urine was scanty and astringent, hands and feet were not warm, Qi was short and strength lacking, and insomnia occurred at night. The tongue was pale with a white, slippery, and greasy coating. The pulse was deep and slow, coming only two and a half beats per respiration, short and weak. This is due to long-standing disease causing Yang deficiency, decline of True Fire, internal accumulation of Yin-Cold, failure of Spleen Yang to transport, inability to control pathogenic water, Liver Qi stagnation, carrying Cold-Water upward to invade the Stomach and overwhelm the Heart. Yang deficiency is the root of the disease, while flooding of Cold-Water is the branch, constituting a syndrome of root deficiency and branch excess. The treatment method should be to support Yang and warm-disperse the Cold-Water pathogen. Initially, one dose of Wu Mei Wan (Mume Pill) was prescribed.
Fupian (Prepared Aconite Root) 100g, Ganjiang (Dried Ginger) 30g, Guijian (Cinnamon Twig Tip) 30g, Xixin (Asari Radix) 10g, Huanglian (Coptidis Rhizoma) 10g, Jiaobai (Scorched Phellodendri Cortex) 10g, Danggui (Angelicae Sinensis Radix) 25g, Chuanjiao (Zanthoxyli Pericarpium) 3g (stir-fried to remove oil), Dangshen (Codonopsis Radix) 3g, Wumei (Mume Fructus) 2 pieces.
After taking the above prescription, the pain slightly decreased, and vomiting of sour and bitter water reduced. Having suffered from this disease for over twenty years, the root is deep and solid, the pathogen is substantial, and the syndrome is stubborn. To eradicate the root, large doses of acrid-warm herbs must be administered continuously to achieve efficacy. Based on my many years of clinical experience, after taking medicine for this syndrome, symptoms such as increased abdominal pain, vomiting acid, diarrhea, or reddish and turbid urine may appear temporarily. This is the medicine attacking the pathogen, a sign of expelling evil. If the medicine can overcome the disease, it is like soldiers overcoming enemies. If one fears and lacks focus, even if one wishes to succeed, the tools are inadequate, how can one overcome it? As the ancients said: "If the medicine does not cause dizziness and nausea, the chronic disease will not be cured." I explained this principle to the patient, aiming to relieve his suffering early. He believed and adhered strictly, so I prescribed Wuzhuyu Sini Tang (Evodia Four Reversal Decoction) modified.
Fupian (Prepared Aconite Root) 150g, Wuzhuyu (Evodiae Fructus) 18g, Ganjiang (Dried Ginger) 60g, Shang Rougui (Cortex Cinnamomi) 18g (powdered, mixed with water and added), Gongding (Caryophylli Flos) 5g, Fuling (Poria) 30g, Baihujiao (Piperis Fructus) 3g (powdered, mixed in), Gancao (Glycyrrhizae Radix et Rhizoma) 15g.
The results followed my prediction. After one dose, the pain actually increased. After two doses, movement of Qi in the abdomen sounded like thunder. After three doses, violent vomiting occurred, expounding a basin full of yellow-green bitter water. After vomiting, the distension in the chest and stomach relieved, and the white slippery coating gradually retreated. Following the original prescription, the dosage of Fupian (Prepared Aconite Root) was increased to 200g, one dose daily, taken continuously for ten doses. The more he took it, the more he vomited, and the pain did not decrease but seemed to increase. Urine was red but long in volume. He had not defecated for over ten days. Examination showed the white slippery coating had completely disappeared, but the tongue body was transparent white without blood color. The pulse became moderate and slightly spirited. He still preferred hot drinks and feared cold. Righteous Qi and Pathogenic Evil were battling, with equal strength. I continued the previous method without slackening. I prescribed Baitong Tang (White Connection Decoction) plus Shang Rougui (Cortex Cinnamomi).
Bai Fupian (White Prepared Aconite Root) 300g, Sheng Yan Fuzi (Raw Salt-Processed Aconite Root) 150g, Ganjiang (Dried Ginger) 150g, Congbai (Scallion White) 9 stalks, Shang Rougui (Cortex Cinnamomi) 10g (powdered, mixed with water and added).
After taking two doses continuously, defecation finally occurred, the stool was black like lacquer, abdominal pain and hardness slightly decreased, and he could take a little food. After several more doses, defecation was smooth, the stool was black-green and extremely foul-smelling. Epigastric and abdominal pain and hardness decreased by half, and stomach rebellion with acid secretion reduced. This indicated the retreat of Yin-Cold and gradual recovery of Primordial Yang. Following the original prescription, Congbai (Scallion White) was removed, and Fuling (Poria) 30g, Shaoren (Amomi Fructus Rotundus) 15g, Baizhu (Atractylodis Rhizoma) 30g, and Gancao (Glycyrrhizae Radix et Rhizoma) 18g were added. Taking several doses continuously, stools changed from loose to soft, color gradually turned yellow, diet increased, tongue substance showed slight redness, pulse deep and fine returned to four beats per respiration, abdominal hardness decreased by eight or nine parts. Only burning and spicy pain remained in the epigastrium, occasionally vomiting one or two mouthfuls of acid water. I again prescribed Wu Mei Wan (Mume Pill). After three doses, vomiting stopped, pain decreased, food intake increased, and cold back and limbs warmed up. Only emaciation, insufficient Zheng Qi (Upright Qi), poor spirit, and occasional dull pain in the stomach remained. Subsequently, Guizhi Fuzi Lizhong Tang (Cinnamon Twig and Aconite Root Decoction for Warming the Middle) plus Huangqi (Astragali Radix) was used, along with swallowing Wu Mei Wan (Mume Pill), three pills daily. Each dose showed improvement. After taking more than ten doses, he recovered and returned to normal health.
Hiccups: Huang ××, female, twenty-five years old, overseas Chinese returnee, student at a university in Yunnan. She had suffered from hiccups for over a year, with multiple treatments showing no obvious effect. Hiccups worsened during times of mental tension. She felt fullness in the stomach, with frequent upward rushing of Qi, making short and frequent sounds that she could not control. Recently, it gradually intensified, causing emotional unrest, irritability, poor sleep, and affecting her studies. In the summer of 1964, she came to the College of Traditional Chinese Medicine to consult me. Hiccups were frequent, complexion lacked luster. Tongue was pale and tender, coating greasy and slightly yellow. Pulse was deep, slow, and wiry. *Jing Yue Quan Shu* states: "The cause of hiccups is always Qi rebellion." This is due to Yang deficiency and Stomach Cold, dysfunction of ascending and descending of Qi mechanism in the Middle Jiao, Cold Qi rebelling upward, and Stomach Qi failing to descend. Treatment should warm the Middle, direct rebellious Qi downward, and harmonize the Qi mechanism. The prescription used was Xuanfu Daizhe Tang (Inula and Hematite Decoction) modified.
Xuanfuhua (Inulae Flos) 9g, Daizhishi (Hematitum) 12g, Fa Banxia (Prepared Pinellia Tuber) 9g, Ming Dangshen (Codonopsis Radix) 15g, Sharen (Amomi Fructus Rotundus) 9g.
Houpo (Magnoliae Officinalis Cortex) 9g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujubae Fructus) 5 pieces, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
After two doses, hiccups decreased, intervals lengthened, and epigastric fullness and Qi rebellion felt lighter. Realizing the medicine was effective, her mood improved, and sleep and diet both improved. Pulse was deep and slow, Guan position still wiry. Greasy coating had retreated, replaced by thin white and moist coating. Subsequently, treatment focused on warming the Middle, supplementing Qi, harmonizing the Stomach, and directing rebellious Qi downward. Using the previous prescription, Ming Dangshen (Codonopsis Radix) was increased to 30g, adding Gongding (Caryophylli Flos) 3g and Shidi (Kaki Calyx) 6g. After taking four doses continuously, hiccups did not recur.
Commentary: "The cause of hiccups is always Qi rebellion," resulting from dysfunction of ascending and descending of Qi mechanism in the Middle Jiao and upward rushing of rebellious Qi. For those with Yang deficiency and Cold, warming the Middle and directing rebellious Qi downward is primary. For those with Yin deficiency and Heat, bitter-cold herbs to direct rebellious Qi downward are primary. The principle always revolves around regulating the ascending and descending of Qi mechanism. If a person with a long-standing illness suddenly develops hiccups, it indicates the Qi mechanism of the Spleen and Kidney is about to cease. Large doses of herbs to Return Yang and direct rebellious Qi downward should be used, such as Wuzhuyu Sini Tang (Evodia Four Reversal Decoction), Baitong Tang (White Connection Decoction), or Renshen Ganjiang Fuzi Tang (Ginseng, Dried Ginger, and Aconite Root Decoction), to strive to restore vitality. If one only treats the branch and ignores the root, not only will hiccups be difficult to stop, but life will also be endangered.
Qi Deficiency Constipation: Zhang ××, male, thirty-two years old, from Kunming. He had suffered from constipation for over a year. Initially, bowel movements were difficult, occurring every two or three days, dry and uncomfortable. He had dizziness, poor appetite, epigastric and abdominal distension and discomfort, and frequent belching rising to the mouth. Physicians considered it Intestinal Dryness due to Yin deficiency and Heat in the Stomach, continuously treating him with bitter-cold clearing and moistening purgatives. After each dose, he had one bowel movement, but subsequently became constipated again, with epigastric and abdominal distension never decreasing. Such repetitive treatment lasted for months, worsening the constipation, sometimes requiring six or seven days for one movement. He had bitter taste in the mouth, dry throat, poor appetite, reduced food intake, emaciation, sallow complexion, and mental fatigue. I examined his pulse: deep, slow, and weak. Tongue coating was thick, greasy, yellow, and lacking fluids. Breath was slightly foul, desire for drinking was low. This is not a syndrome of intestinal dryness and heat, but Qi deficiency constipation. Due to long-term use of bitter-cold purgatives, the Yang of the Spleen and Kidney was damaged. Spleen Qi is weak, unable to transport; Kidney Qi is insufficient, unable to transform Qi and generate fluids. Qi mechanism is stagnant, gastrointestinal transmission fails, thus forming constipation. The method should be warm purgation, ensuring the pivot turns, allowing Fu organ Qi to flow freely. The prescription used was Wenpi Tang (Warm the Spleen Decoction) modified.
Fupian (Prepared Aconite Root) 45g, Dahuang (Rhei Radix et Rhizoma) 9g (added later), Ming Dangshen (Codonopsis Radix) 15g, Houpo (Magnoliae Officinalis Cortex) 9g, Xingren (Armeniacae Semen Amarum) 9g (crushed), Ganjiang (Dried Ginger) 12g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g.
After one decoction and administration, borborygmus occurred in the abdomen, Qi rushed to the chest and hypochondrium, and he felt the urge to pass flatus but could not. After taking two more doses, flatus occurred frequently, urgency to defecate pressed on the anus, and soon a large amount of stool was passed, black, hard, and nut-like, extremely foul-smelling. Immediately, abdominal comfort was felt, as if a burden was lifted, and vomiting/belching ceased. After taking two doses continuously, bowel movements could occur every other day. Bitter taste and dry throat healed, appetite improved, abdominal distension disappeared. Thick greasy yellow coating retreated, replaced by thin white moist coating. Pulse remained deep and slow. Then, following the original prescription, Rougui (Cortex Cinnamomi) 9g was added to enhance warming and transformation power. After taking four doses continuously, bowel movements were regular, spirit and diet significantly improved, and complexion became lustrous. To consolidate efficacy, Wuzhuyu Tang (Evodia Decoction) plus Rougui (Cortex Cinnamomi) and Gansong (Nardostachys Radix et Rhizoma) was used to warm the Middle and strengthen the Stomach for over twenty days, and he was instructed to regularly take Guizhi Fuzi Lizhong Wan (Cinnamon Twig and Aconite Root Pills for Warming the Middle). Three years later, upon meeting, he reported that constipation had completely healed and had not recurred.
Roundworm Jue Abdominal Pain
(Biliary Ascariasis)
Zheng ××, female, thirty-six years old, a commune member in Guandu District, Kunming. One night in October 1962, the patient suddenly experienced epigastric and hypochondriac pain, like knife twisting, radiating to the right shoulder and back. Limbs were cold, sweat beads formed, accompanied by nausea and vomiting, expelling yellow-green bitter water and one roundworm. The stomach felt burning and restless, epigastric and abdominal distension, restlessness, continuous groaning, unable to sleep all night. At dawn, pain slightly decreased, just as he was falling asleep, pain returned as before. Family members escorted him to the emergency department of the Affiliated Hospital of the College of Traditional Chinese Medicine. After examination, diagnosed as "Biliary Ascariasis," hospitalized. During my consultation, the patient's pulse was deep, wiry, and tight. Tongue coating was white and greasy, tongue substance was dark cyanotic, no thirst. This is Cold in the Jueyin Zang organs, stagnation of Qi mechanism in the Liver and Gallbladder, roundworms in the abdomen disturbing upward causing pain, belonging to the syndrome of Roundworm Jue. Following Zhongjing's method, Wu Mei Wan (Mume Pill) was primarily used.
Fupian (Prepared Aconite Root) 30g, Ganjiang (Dried Ginger) 15g, Rougui (Cortex Cinnamomi) 9g, Danggui (Angelicae Sinensis Radix) 15g, Dangshen (Codonopsis Radix) 15g, Huanglian (Coptidis Rhizoma) 6g, Huangbai (Phellodendri Cortex) 9g, Chuanjiao (Zanthoxyli Pericarpium) 5g (stir-fried to remove oil), Xixin (Asari Radix) 5g, Wumei (Mume Fructus) 3 pieces.
After one decoction, pain slightly decreased. After three doses, pain and vomiting stopped completely, hands and feet warmed, and he could sleep quietly at night. Only the stomach felt restless, and epigastric and abdominal distension remained. Bitter taste in mouth, no desire for food. Pulse was deep and wiry, no longer tight as yesterday, greasy coating slightly retreated, tongue substance still contained blue tint. Although roundworms were calmed, the Cold-congealing Qi of the Liver and Gallbladder was not yet fully dispelled. Following the original prescription, Chuanlianzi (Toosendan Fructus) 9g and Bingpian (Arecae Seed Slice) 9g were added. After taking two doses continuously, over twenty roundworms were passed in stool, abdominal comfort was felt, and diet gradually recovered. Pulse became slow, coating retreated. Subsequently, Xiangsha Lizhong Tang (Costus and Amomi Decoction for Warming the Middle) plus Bibo (Piperis Kadsurae Fructus) and Gaoliangjiang (Alpiniae Officinarum Rhizoma) was used for two doses to regulate. Qi mechanism recovered, and he was discharged cured.
Phlegm-Fluid Cough: Li ××, male, over forty years old, from Kunming City. He had suffered from Phlegm-Fluid cough and asthma for eight or nine years, with repeated treatments by both Chinese and Western medicine failing to cure. Examination of the pulse: Left was wiry, Right was slippery, both Chi positions were weak. Heart pulse was fine and short, Lung pulse was slippery and large, empty upon pressure. Tongue coating was white, slippery, and greasy. Complexion was dark cyanotic, eye bags swollen like sleeping silkworms. Cough with phlegm, asthma, and shortness of breath, chest fullness with phlegm stagnation, headache, and dizziness. Poor appetite, lack of spirit, aversion to sour and cold foods, thirsty but preferring hot drinks in small amounts, urine was scanty and red, incontinence during coughing. Insomnia at night, difficulty walking and lying down, especially severe on rainy and cold days. This is due to Spleen and Kidney Yang deficiency, internal flooding of Fluid pathogens, Spleen failing to transport, Cold-Damp and Water-Fluid rebelling upward to invade the Lungs, causing phlegm and cough. Kidney deficiency failing to grasp Qi leads to shortness of breath, wheezing, and incontinence. Phlegm-Damp obstruction prevents Clear Yang from ascending and Turbid Yin from descending, Lung and Kidney Qi do not connect, thus forming the syndrome of Phlegm-Fluid cough and asthma. *Jin Gui Yao Lue* states: "For diseases of Phlegm-Fluid, warm herbs should be used to harmonize." This is the fundamental treatment method for Phlegm-Fluid disease. Adhering to this intent, Xiao Qinglong Tang (Minor Green Dragon Decoction) modified was primarily prescribed.
Fupian (Prepared Aconite Root) 20g, Beixixin (Asari Radix) 4g, Maorong (Ephedrae Herba Velvet) 3g, Ganjiang (Dried Ginger) 15g, Fa Banxia (Prepared Pinellia Tuber) 15g.
Wuweizi (Schisandrae Fructus) 1.5g, Gancao (Glycyrrhizae Radix et Rhizoma) 3g.
Follow-up visit the next day. Yesterday, after one dose, headache and cough with phlegm slightly decreased, phlegm was easier to expectorate. Therefore, the dosage of the original prescription was doubled. After taking it, phlegm increased and was coughed up like a surge, chest fullness decreased, and breathing was calmer.
After two doses, headache disappeared, breathing calmed by more than half. After three doses, he could eat slightly, walking and lying down were lighter, only phlegm was abundant, Qi still short, urine became longer but still red. This is because Wet-Phlegm and Fluid pathogens, moved by Yang herbs, exit through the throat and airways above, and go out with urine below, a sign of disease retreat. Still following the previous prescription with modifications.
Fupian (Prepared Aconite Root) 100g, Beixixin (Asari Radix) 10g, Banxia (Pinelliae Tuber) 10g, Ganjiang (Dried Ginger) 40g, Shang Rougui (Cortex Cinnamomi) 10g (powdered, mixed with water and added), Fuling (Poria) 30g, Guijian (Cinnamon Twig Tip) 20g, Wuweizi (Schisandrae Fructus) 3g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g.
After two doses, wheezing and coughing calmed, phlegm reduced. After three doses, chest fullness and shortness of breath healed, diet doubled, wiry-slippery pulse flattened, greasy coating retreated. Only spirit was not yet sufficient. Subsequently, Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) plus Fuzi (Aconiti Lateralis Radix Praeparata) and Huangqi (Astragali Radix) was used, taken continuously for ten doses, achieving complete recovery.
Fupian (Prepared Aconite Root) 150g, Huangqi (Astragali Radix) 30g, Fuling (Poria) 20g, Guijian (Cinnamon Twig Tip) 20g, Baizhu (Atractylodis Rhizoma) 20g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g.
Phlegm-Asthma Cough Complicated with Qi Deficiency Constipation: Father of Liu ××, over sixty years old. In September 1924, he had been ill for over a month. Six pulses were deep, slow, and forceless. Tongue coating was white and greasy, preferred hot drinks, cough, asthma, and abundant phlegm. Abdominal distension and pain, no desire for food, constipation for twenty days without defecation, urine was red and long, difficult to sleep at night, spirit extremely weak. Checking previously taken prescriptions, they mainly focused on clearing heat, digesting food, and directing Qi downward, using strong purgatives like Xiaoshi (Mirabilitum) and Dahuang (Rhei Radix et Rhizoma), yet still unable to defecate, the situation was critical. This is Spleen and Kidney Yang deficiency, failure of Central Earth to transport, Phlegm-Damp and Water-Fluid obstructing and rebelling in the Lungs, Clear Purification failing to descend, causing Phlegm-Asthma cough, failure of transmission, and inability to transport. Additionally, Yang deficiency means Qi cannot transform fluids, unable to moisten the intestines, resulting in Qi deficiency and Cold-congelation constipation. This is the non-transmission of Qi between the Taiyin and Yangming meridians. The treatment should focus on supporting Yang and warming transformation. I prescribed Zhenwu Tang (True Warrior Decoction) modified.
Fupian (Prepared Aconite Root) 100g, Fuling (Poria) 30g, Baizhu (Atractylodis Rhizoma) 20g, Hangshao (Paeoniae Radix Alba) 10g, Ganjiang (Dried Ginger) 30g, Beixixin (Asari Radix) 6g, Wuweizi (Schisandrae Fructus) 5g.