阳虚里寒胃痛(胃下垂)
周××，女，四十四岁，新疆省某机关干部。1968年6月。
初诊：胃痛多年，时发时止，发则吞酸呕吐，饮食不下，胸膈胀闷，腹中雷鸣，大便稀溏、日数行。体质日渐消瘦，气短自汗，胃部自觉下坠作痛。稍事劳动，则身倦乏力。已在新疆地区中西医诊断及住院治疗，曾经一度好转，后又复发，故远道来昆求治。经西医确诊：胃下垂。患者邀余为之诊治。时值盛夏，而患者手足厥冷，面色苍白，形体消瘦。六脉沉细，濡弱无力，舌淡白。此系病久阳虚里寒，中气不足，肠胃消化不良而引起。治当以温中回阳，健脾益气，和胃止痛，拟方如下：
红人参9克(另煨兑服) 口芪24克 白术12克 茯苓12克
川附片30克(开水先煨透) 上肉桂6克(开水兑服) 西砂
仁9克 炒黑固脂9克 甘草3克 川干姜9克 大枣5个
炒玉、老米各15克
二诊：上方服五剂后，患者便溏、腹痛轻减，手足厥冷渐回，可进少量饮食。腹部仍下坠，有时作痛。此脾胃渐调，中阳尚弱，气虚下坠。上方已现略效，故守原意加重剂量以治。处方：
红人参12克 口芪30克 土炒白木12克 茯神15克 川附
片30克(开水先煨透) 上肉桂6克炙升麻4．5克炒柴胡6克
黑固脂9克甘草3克川干姜9克大枣5个
三诊：上方连服十剂后，患者食欲增加，精神好转，脸色转红，腹痛便溏日渐减轻，身冷肢厥渐回暖，只腹中偶然不适，微感下坠。经医院复查，胃部下垂已有显著改善。脉转调和有力，舌苔红润。阳虚及中气下陷之象已渐好转，现属气血不足，冲任两虚，改用温补之剂，嘱其多服调治。处方：
口芪24克 当归12克 炒杭芍9克 茯苓15克 菟丝子15克
炒黑固脂9克 白术12克 炙升麻3克鹿胶15克(烊化兑服)
西砂仁6克 炙草6克川附片30克(开水先煨透) 干姜9克
大枣5个
四诊：上方服十余剂后，患者身体好转，已能步行数里。腹中亦无下坠感觉，精神充沛，食眠均佳，胃下垂症基本痊愈。特来复诊．要求给予常服方调理，回乡工作。诊脉：两手调和，舌红润，此病症已退，气血渐充，拟用下方嘱服十数剂后，常服补中益气丸以资巩固。处方：
熟地15克秦归15克炒杭芍9克 川芎6克 党参15克
白术12克茯苓15克炙草3克 口芪18克 肉桂6克 烧
姜2片大枣5个
[按]此例根据李东垣“脾胃论”升阳益胃、补中益气之理，并重温中回阳和补血调肝之法，结合患者体质，灵活用药。先以参、术、芪、附、治其虚寒，姜、桂、砂、苓，止痛止泻，固脂濇其虚寒滑脱，升麻、柴胡升提下陷之气，菟丝子、炒玉、老米温肾益胃，甘草、大枣健脾调中。以后配入鹿胶、归、芍、熟地、川芎、补血调肝。似此重视全面、综合论治，易收良效。
肝胆气滞湿热不化(胆囊炎)
张× ×，男，三十六岁，干部。时在1972年。
初诊：患者胁下及胸膈疼痛已数年，西医诊为“慢性胆囊炎”。此病时发时止，发作重时，疼痛难忍，汗出如珠，呕吐酸苦，面黄唇青，饮食不下，夜难安卧。虽多方医治，病情依然。诊脉象左关弦硬，右弦细．舌苔黄白厚腻微干。此属湿热内蕴，胆气郁结，肝木犯胃，病久脾肾两虚，心神不宁。治则先宜疏肝利胆，清化湿热，拟柴胡、温胆、左金复方化裁：
炒柴胡9克细枳实6克(炒冲) 广陈皮6克 吴萸4．5克
云连3克(与吴萸同炒) 陈佛手9克 广木香3克 法半
夏9克 茯苓15克 醋郁金9克(冲) 烧鸡金2个
二诊：服上方五剂后，疼痛较减，呕吐已止。舌苔黄腻渐退，口中仍苦。脉左关弦硬较软，右现细弱。稍能进食。
大便间日一行，仍不爽畅，小便短黄。夜卧未安，痛时仍气短汗出。此系肝胆火邪及湿热蕴积日久，鲜易骤化，况脾胃失调，气血两虚。拟下方为治：
炒柴胡6克 醋法夏9克 茯苓15克 当归尾9克 广木
香3克 台乌片6克 炒枳壳9克 净竹茹6克 川栋肉
9克(酒炒) 陈佛手9克 烧鸡金2个 吴萸4．5克 云连
3克二味同炒
三诊：上方服五剂，胸胁胀满疼痛日渐减轻，呼吸舒畅，呕吐心泛全止，口中微苦，能进饮食。大便日一行，小便清长。脉象左弦渐平，右尚细弱，舌淡黄而润。此系肝胆湿热渐化，气机转舒，而因胆病日久，伤及心脾，故夜多幻梦。处方：
当归12克 炒杭芍9克 茯苓15克炒枣仁15克(冲) 广木
香3克 西砂仁6克 陈佛手9克生甘草3克净竹茹6克
法半夏9克 广陈皮6克 烧鸡金1个
四诊：上方服五剂，痛全止，口中和，食增眠加，二便正常。唯气虚神疲，尚多梦境，时仍自汗。脉调，两尺偏弱，舌淡苔薄。此病退正虚，心肾不交，气血未复之候，再服下方调理而愈。处方：
白人参6克(另煨分次兑服) 淮枣仁15克(炒冲) 茯神15克
炒杭芍9克 当归15克 炙远志6 g 广木香2．4克 炙甘
草3克沙吉力9克建莲子15克小红枣9个荷叶顶3个
[按]“胆囊炎”相当于《内经》上的“胆胀”和“肝胀”。盖肝胆相为表里。发病机理，系属湿热内壅，气化郁结。此例病久，正虚而邪实，先用舒通轻导，祛湿化热，后予调肝健脾，养心安神，胆病自愈。
妇 科
调 经
李××，女，二十八岁，教师。1970年。
初诊：患者结婚已五年，不孕，平日月经常前期，五至十日不等。每月经行时，多感腰酸腹痛，经色紫黑有块，量少。头昏神倦，胸胁胀满，易怒烦躁，口干思饮，颜面及手足心午后潮热。脉象弦数有力，舌质红，苔薄黄。证属气血不调，兼有郁热，冲任受病。治宜理气解郁，清经化热。方用丹栀逍遥散加减。处方：
楚薄荷4．5克 炒柴胡9克 当归12克 川芎6克 炒杭
芍9克 粉丹皮6克炒山栀6克广陈皮6克炙香附6克
生甘草3克生姜2片 小枣9个多服数剂
二诊：上方服五剂，月经来潮，日期仍提前三、四天，经色深红而紫，块状已减少，量增多。午后颜面及手足心潮热减轻。口干、思饮、胸闷、善怒，亦有显著好转。仍觉头昏神倦，心烦，梦多易醒，腰腹不时作隐痛。复诊脉象细弦而软，舌苔淡黄而润。此气郁较舒，血热未净，续以加味清经汤(古方两地汤)调治。处方；
干生地12克地骨皮12克当归12克炒杭芍9克川芎6克
粉丹皮6克 茯神15克 炙香附6克 炒续断9克 炒柴
胡6克生甘草3克多服数剂
三诊：上方连服两月，共十余剂，至第三、四月来诊，经期及数量已接近正常，色转正红。腰酸、腹痛、心烦、性躁、眠差多梦等症消失。脉象调和，舌苔红润。拟加味八珍汤调理：
大熟地12克 全当归12克炒杭芍9克川芎6克白术9克
茯神15克 上党参12克 炙香附6克 粉丹皮4．5克 建莲
子15克生甘草3克
上方每于月经前后服三至五剂。1971年春，来院复诊，已怀孕二月，至冬季分娩，母子均安。
[按]姚老诊治妇科月经病，颇注重调理肝脾气血及冲任。
如本例，先去郁热并舒肝以调顺气机，继则清经养血，至三诊才取气血双补，加入香附、丹皮等品，补而不滞，且补中有清。
经闭四年
周××，女，30岁，思茅专区干部。1958年8月。
初诊：结婚近十年，从未生育，平时月经常过期，量少，色紫黑，有块状，经期当中，感腰酸腹胀。腹中有块，往来流动，胀痛无常。平时头昏神倦，饮食不思，睡卧不宁，夜尿频数，渐至身体孱弱，肌肤消瘦。曾经当地中医多方诊治，或行攻破，或用温补，效果不明。又经西医检查，认为有子宫肌瘤及卵巢囊肿可能。注射黄体酮、卵巢素、链霉素等针水，亦未好转。后又改用草药十余次，月经遂闭止不通，迄今已四年余。患者精神极感痛苦，乃专程来昆，往我院治疗。
脉象乍按弦细而紧，重取沉濇无力，舌苔薄腻少津，中医诊断：长期闭经，攻补针药杂投，气血两虚，肝脾受病，冲任损伤，属血症气瘕之候。
先宜滋养冲任，调达肝脾，再行气活血，舒络通经。处方：
苏条参15克 炒柴胡9克 鹿角霜15克 炙别甲15克 当
归15克川芎6克茯神15克 炒杭芍9克 川续断9克
炙香附6克西砂仁6克生甘草3克
二诊：前方服五剂后，腰酸腹胀稍减。仍感头昏，神倦，食欲欠佳，夜卧不宁。腹中痛胀如故，仍无定处。夜尿尚数。此闭经日久，血症气瘕，兼而有之。脉转弦缓，重取细濇，舌仍薄白微腻。续用前方加减：
苏条参15克 当归18克川芎6克炒柴胡9克炙别甲15克
鹿角霜9克 紫丹参9克 炙香附6克 元胡索9克 西砂
仁6克 生甘草3克 炒小茴香6克 荔枝7枚
三诊：上方连服十余帖后，患者腰腹部瘕积未散，有时大如鸡卵，有时缩如蚕豆，忽胀忽消，痛无定处，发无定时。
食眠渐好，大便正常，尿仍频，头尚晕。此服药后，冲任渐得滋养，肝脾较为调和，而体弱气虚，不能行血。脉象弦细，尺部沉渣，舌淡红。续用原方化裁，兼佐通经活血之剂。处方：
苏条参15克炒柴胡6克全当归15克老川芎6克元胡
索9克炙香附6克生三七粉4．5克(分次兑服) 紫丹参9克
郁金6克 川续断9克 粉丹皮6克 生甘草3克 打荔
枝7枚 紫苏叶4．5克
四诊：前方续服十余剂，患者腰腹部有阵发性酸痛，饮食渐思，睡眠尚可。腹中瘕积转动频作，夜尿已减，大便正常。此服药后，肝脾调达，气渐行，血渐活之兆。脉弦而软，舌红苔润。宜趁此时机，宣络通经，行气活血，使经汛早通。拟方：
炒柴胡6克 当归15克川芎6克京三棱9克蓬莪术9克
炙香附6克 元胡索9克 炒川断9克 紫丹参9克 桃仁
泥9克生三七粉4．5克(分次冲兑)红花4．5克每服点清酒少
许为引。
五诊：上方服至第三剂，患者于当日晚间，觉腹中疼痛不休，至午夜时，闭止近五年之月经，忽然来潮，色紫黑，有块者数枚。翌晨，余往查房，闻而为之庆慰，当为复诊；脉息转现柔缓调和，弦象已减，舌如前。余无不适，即为续用下方：
炒柴胡6克 当归15克川芎6克炒杭芍9克炙香附6克
炒荆芥4．5克 紫丹参9克 丹皮6克 川断9克 元胡
索6克 桑寄生12克 生三七粉4．5克(分次冲兑)
六诊：患者连服上方五剂，月经续得畅下，至七、八日乃止。经期中食眠均佳，二便正常。自紫黑血块下后，腹中硬块若失。脉象调和弱缓，舌如前。患者因工作关系，不能在昆耽搁，当为拟常用药方，并嘱常服八珍丸，逍遥散等药，以资巩固。至1960年因公来昆，到院自述，回原单位后常服汤丸方剂，月经均按期而至，并无其它不适云。常服处方：
炒柴胡6克 当归15克 炒杭芍9克 川芎6克 茯苓12克
白术9克 炙香附6克 粉丹皮6克 西砂仁6克 桑寄
生12克甘草3克生姜2片小枣12枚
[姚按]此证是我医治妇女长期闭经证中比较突出之一例，原因是患者冷热不匀，饮食不节，引起经闭。后经当地中医多人使用攻破温补药物不效，遂形成妇科中的“症瘕”。
我根据内经的论述“石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当泻不泻，杯以留止，……月亨不以时下，皆生于女子，可导而下”的记载，认为本病虽未到石瘕的“日以益大，状如怀子”程度，但是经闭日久，再发展下去，就更难着手了！根据辨证施治的精神，认为攻破过猛，既损伤了冲任，温补杂进，又引起气血壅滞。所以在治疗方面，首先认定治痛“必求其本”，先宜调和冲任，滋养肝脾，如人参、归、芎、鹿角、别甲、香、砂等味，然后再理气活血，宣络通经，如元胡、丹参、三棱、莪术、桃仁、红花、三七等味，总之，先肯定治疗的程序，再确定逐步的处方用药，最后月经畅通，诸病痊愈。
周××，女，四十四岁，新疆省某机关干部。1968年6月。
初诊：胃痛多年，时发时止，发作时吞酸呕吐，饮食难进，胸膈胀闷，腹中肠鸣如雷，大便稀溏，每日数次。体质日渐消瘦，气短自汗，自觉胃部下坠作痛。稍事劳动，则身倦乏力。已在新疆地区经中西医诊断及住院治疗，曾经一度好转，后又复发，故远道来昆明求治。经西医确诊为：胃下垂。患者邀请余为之诊治。时值盛夏，而患者手足厥冷，面色苍白，形体消瘦。六脉沉细，濡弱无力，舌淡白。此系病久阳虚里寒，中气不足，肠胃消化不良而引起。治当以温中回阳，健脾益气，和胃止痛，拟方如下：
红人参9克（另煨兑服） 口芪24克 白术12克 茯苓12克
川附片30克（开水先煨透） 上肉桂6克（开水兑服） 西砂仁9克 炒黑固脂9克 甘草3克 川干姜9克 大枣5个
炒玉竹、老米各15克
二诊：上方服五剂后，患者便溏、腹痛轻减，手足厥冷渐回，可进少量饮食。腹部仍下坠，有时作痛。此脾胃渐调，中阳尚弱，气虚下坠。上方已现略效，故守原意加重剂量以治。处方：
红人参12克 口芪30克 土炒白术12克 茯神15克 川附片30克（开水先煨透） 上肉桂6克 炙升麻4.5克 炒柴胡6克
黑固脂9克 甘草3克 川干姜9克 大枣5个
三诊：上方连服十剂后，患者食欲增加，精神好转，脸色转红，腹痛便溏日渐减轻，身冷肢厥渐回暖，只腹中偶然不适，微感下坠。经医院复查，胃部下垂已有显著改善。脉转调和有力，舌苔红润。阳虚及中气下陷之象已渐好转，现属气血不足，冲任两虚，改用温补之剂，嘱其多服调治。处方：
口芪24克 当归12克 炒杭芍9克 茯苓15克 菟丝子15克
炒黑固脂9克 白术12克 炙升麻3克 鹿胶15克（烊化兑服）
西砂仁6克 炙草6克 川附片30克（开水先煨透） 干姜9克
大枣5个
四诊：上方服十余剂后，患者身体好转，已能步行数里。腹中亦无下坠感觉，精神充沛，食眠均佳，胃下垂症基本痊愈。特来复诊，要求给予常服方调理，回乡工作。诊脉：两手调和，舌红润，此病症已退，气血渐充，拟用下方嘱服十数剂后，常服补中益气丸以资巩固。处方：
熟地15克 秦归15克 炒杭芍9克 川芎6克 党参15克
白术12克 茯苓15克 炙草3克 口芪18克 肉桂6克 烧姜2片 大枣5个
[按]此例根据李东垣“脾胃论”升阳益胃、补中益气之理，并重温中回阳和补血调肝之法，结合患者体质，灵活用药。先以参、术、芪、附、治其虚寒，姜、桂、砂、苓，止痛止泻，固脂濇其虚寒滑脱，升麻、柴胡升提下陷之气，菟丝子、炒玉、老米温肾益胃，甘草、大枣健脾调中。以后配入鹿胶、归、芍、熟地、川芎、补血调肝。似此重视全面、综合论治，易收良效。
张× ×，男，三十六岁，干部。时在1972年。
初诊：患者胁下及胸膈疼痛已数年，西医诊为“慢性胆囊炎”。此病时发时止，发作重时，疼痛难忍，汗出如珠，呕吐酸苦，面黄唇青，饮食不下，夜难安卧。虽多方医治，病情依然。诊脉象左关弦硬，右弦细．舌苔黄白厚腻微干。此属湿热内蕴，胆气郁结，肝木犯胃，病久脾肾两虚，心神不宁。治则先宜疏肝利胆，清化湿热，拟柴胡、温胆、左金复方化裁：
炒柴胡9克 细枳实6克（炒冲） 广陈皮6克 吴萸4.5克
云连3克（与吴萸同炒） 陈佛手9克 广木香3克 法半夏9克 茯苓15克 醋郁金9克（冲） 烧鸡金2个
二诊：服上方五剂后，疼痛较减，呕吐已止。舌苔黄腻渐退，口中仍苦。脉左关弦硬较软，右现细弱。稍能进食。
大便间日一行，仍不爽畅，小便短黄。夜卧未安，痛时仍气短汗出。此系肝胆火邪及湿热蕴积日久，鲜易骤化，况脾胃失调，气血两虚。拟下方为治：
炒柴胡6克 醋法夏9克 茯苓15克 当归尾9克 广木香3克 台乌片6克 炒枳壳9克 净竹茹6克 川栋肉9克（酒炒） 陈佛手9克 烧鸡金2个 吴萸4.5克 云连3克二味同炒
三诊：上方服五剂，胸胁胀满疼痛日渐减轻，呼吸舒畅，呕吐心泛全止，口中微苦，能进饮食。大便日一行，小便清长。脉象左弦渐平，右尚细弱，舌淡黄而润。此系肝胆湿热渐化，气机转舒，而因胆病日久，伤及心脾，故夜多幻梦。处方：
当归12克 炒杭芍9克 茯苓15克 炒枣仁15克（冲） 广木香3克 西砂仁6克 陈佛手9克 生甘草3克 净竹茹6克
法半夏9克 广陈皮6克 烧鸡金1个
四诊：上方服五剂，痛全止，口中和，食增眠加，二便正常。唯气虚神疲，尚多梦境，时仍自汗。脉调，两尺偏弱，舌淡苔薄。此病退正虚，心肾不交，气血未复之候，再服下方调理而愈。处方：
白人参6克（另煨分次兑服） 淮枣仁15克（炒冲） 茯神15克
炒杭芍9克 当归15克 炙远志6g 广木香2.4克 炙甘草3克 沙吉力9克 建莲子15克 小红枣9个 荷叶顶3个
[按]“胆囊炎”相当于《内经》上的“胆胀”和“肝胀”。盖肝胆相为表里。发病机理，系属湿热内壅，气化郁结。此例病久，正虚而邪实，先用舒通轻导，祛湿化热，后予调肝健脾，养心安神，胆病自愈。
**妇科调经**
李××，女，二十八岁，教师。1970年。
初诊：患者结婚已五年，不孕，平日月经常前期，五至十日不等。每月经行时，多感腰酸腹痛，经色紫黑有块，量少。头昏神倦，胸胁胀满，易怒烦躁，口干思饮，颜面及手足心午后潮热。脉象弦数有力，舌质红，苔薄黄。证属气血不调，兼有郁热，冲任受病。治宜理气解郁，清经化热。方用丹栀逍遥散加减。处方：
楚薄荷4.5克 炒柴胡9克 当归12克 川芎6克 炒杭芍9克 粉丹皮6克 炒山栀6克 广陈皮6克 炙香附6克
生甘草3克 生姜2片 小枣9个 多服数剂
二诊：上方服五剂，月经来潮，日期仍提前三、四天，经色深红而紫，块状已减少，量增多。午后颜面及手足心潮热减轻。口干、思饮、胸闷、善怒，亦有显著好转。仍觉头昏神倦，心烦，梦多易醒，腰腹不时作隐痛。复诊脉象细弦而软，舌苔淡黄而润。此气郁较舒，血热未净，续以加味清经汤（古方两地汤）调治。处方：
干生地12克 地骨皮12克 当归12克 炒杭芍9克 川芎6克
粉丹皮6克 茯神15克 炙香附6克 炒续断9克 炒柴胡6克 生甘草3克 多服数剂
三诊：上方连服两月，共十余剂，至第三、四月来诊，经期及数量已接近正常，色转正红。腰酸、腹痛、心烦、性躁、眠差多梦等症消失。脉象调和，舌苔红润。拟加味八珍汤调理：
大熟地12克 全当归12克 炒杭芍9克 川芎6克 白术9克
茯神15克 上党参12克 炙香附6克 粉丹皮4.5克 建莲子15克 生甘草3克
上方每于月经前后服三至五剂。1971年春，来院复诊，已怀孕二月，至冬季分娩，母子均安。
[按]姚老诊治妇科月经病，颇注重调理肝脾气血及冲任。如本例，先去郁热并舒肝以调顺气机，继则清经养血，至三诊才取气血双补，加入香附、丹皮等品，补而不滞，且补中有清。
**经闭四年**
周××，女，30岁，思茅专区干部。1958年8月。
初诊：结婚近十年，从未生育，平时月经常过期，量少，色紫黑，有块状，经期当中，感腰酸腹胀。腹中有块，往来流动，胀痛无常。平时头昏神倦，饮食不思，睡卧不宁，夜尿频数，渐至身体孱弱，肌肤消瘦。曾经当地中医多方诊治，或行攻破，或用温补，效果不明。又经西医检查，认为有子宫肌瘤及卵巢囊肿可能。注射黄体酮、卵巢素、链霉素等针水，亦未好转。后又改用草药十余次，月经遂闭止不通，迄今已四年余。患者精神极感痛苦，乃专程来昆，往我院治疗。
脉象乍按弦细而紧，重取沉涩无力，舌苔薄腻少津，中医诊断：长期闭经，攻补针药杂投，气血两虚，肝脾受病，冲任损伤，属血症气瘕之候。
先宜滋养冲任，调达肝脾，再行气活血，舒络通经。处方：
苏条参15克 炒柴胡9克 鹿角霜15克 炙别甲15克 当归15克 川芎6克 茯神15克 炒杭芍9克 川续断9克
炙香附6克 西砂仁6克 生甘草3克
二诊：前方服五剂后，腰酸腹胀稍减。仍感头昏，神倦，食欲欠佳，夜卧不宁。腹中痛胀如故，仍无定处。夜尿尚数。此闭经日久，血症气瘕，兼而有之。脉转弦缓，重取细涩，舌仍薄白微腻。续用前方加减：
苏条参15克 当归18克 川芎6克 炒柴胡9克 炙别甲15克
鹿角霜9克 紫丹参9克 炙香附6克 元胡索9克 西砂仁6克 生甘草3克 炒小茴香6克 荔枝7枚
三诊：上方连服十余帖后，患者腰腹部瘕积未散，有时大如鸡卵，有时缩如蚕豆，忽胀忽消，痛无定处，发无定时。
食眠渐好，大便正常，尿仍频，头尚晕。此服药后，冲任渐得滋养，肝脾较为调和，而体弱气虚，不能行血。脉象弦细，尺部沉渣，舌淡红。续用原方化裁，兼佐通经活血之剂。处方：
苏条参15克 炒柴胡6克 全当归15克 老川芎6克 元胡索9克 炙香附6克 生三七粉4.5克（分次兑服） 紫丹参9克
郁金6克 川续断9克 粉丹皮6克 生甘草3克 打荔枝7枚 紫苏叶4.5克
四诊：前方续服十余剂，患者腰腹部有阵发性酸痛，饮食渐思，睡眠尚可。腹中瘕积转动频作，夜尿已减，大便正常。此服药后，肝脾调达，气渐行，血渐活之兆。脉弦而软，舌红苔润。宜趁此时机，宣络通经，行气活血，使经汛早通。拟方：
炒柴胡6克 当归15克 川芎6克 京三棱9克 蓬莪术9克
炙香附6克 元胡索9克 炒川断9克 紫丹参9克 桃仁泥9克 生三七粉4.5克（分次冲兑） 红花4.5克 每服点清酒少许为引。
五诊：上方服至第三剂，患者于当日晚间，觉腹中疼痛不休，至午夜时，闭止近五年之月经，忽然来潮，色紫黑，有块者数枚。翌晨，余往查房，闻而为之庆慰，当为复诊；脉息转现柔缓调和，弦象已减，舌如前。余无不适，即为续用下方：
炒柴胡6克 当归15克 川芎6克 炒杭芍9克 炙香附6克
炒荆芥4.5克 紫丹参9克 丹皮6克 川断9克 元胡索6克 桑寄生12克 生三七粉4.5克（分次冲兑）
六诊：患者连服上方五剂，月经续得畅下，至七、八日乃止。经期中食眠均佳，二便正常。自紫黑血块下后，腹中硬块若失。脉象调和弱缓，舌如前。患者因工作关系，不能在昆耽搁，当为拟常用药方，并嘱常服八珍丸，逍遥散等药，以资巩固。至1960年因公来昆，到院自述，回原单位后常服汤丸方剂，月经均按期而至，并无其它不适云。常服处方：
炒柴胡6克 当归15克 炒杭芍9克 川芎6克 茯苓12克
白术9克 炙香附6克 粉丹皮6克 西砂仁6克 桑寄生12克 甘草3克 生姜2片 小枣12枚
[姚按]此证是我医治妇女长期闭经证中比较突出之一例，原因是患者冷热不匀，饮食不节，引起经闭。后经当地中医多人使用攻破温补药物不效，遂形成妇科中的“症瘕”。
我根据内经的论述“石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当泻不泻，杯以留止，……月亨不以时下，皆生于女子，可导而下”的记载，认为本病虽未到石瘕的“日以益大，状如怀子”程度，但是经闭日久，再发展下去，就更难着手了！根据辨证施治的精神，认为攻破过猛，既损伤了冲任，温补杂进，又引起气血壅滞。所以在治疗方面，首先认定治痛“必求其本”，先宜调和冲任，滋养肝脾，如人参、归、芎、鹿角、别甲、香、砂等味，然后再理气活血，宣络通经，如元胡、丹参、三棱、莪术、桃仁、红花、三七等味，总之，先肯定治疗的程序，再确定逐步的处方用药，最后月经畅通，诸病痊愈。
**Stomachache due to Yang Deficiency and Interior Cold (Gastroptosis)**
Zhou XX, Female, 44 years old, a cadre from a certain organ in Xinjiang Province. June 1968.
First Visit: Stomachache for many years, intermittent. During attacks, there is acid regurgitation and vomiting, inability to eat, chest and diaphragm distension and stuffiness, borborygmus in the abdomen, loose stools occurring several times a day. The physique has gradually become emaciated, with shortness of breath and spontaneous sweating. She feels a dragging pain downwards in the stomach. Slight labor causes fatigue and weakness. She had been diagnosed and treated by both Chinese and Western medicine in the Xinjiang region, improved temporarily but relapsed later, hence she traveled far to Kunming for treatment. Diagnosed by Western medicine as: Gastroptosis. The patient invited me to treat her. It was midsummer, yet her hands and feet were cold, complexion pale, body emaciated. All six pulses were deep and fine, soggy, weak, and powerless; tongue pale white. This is caused by long-standing illness leading to Yang deficiency and interior cold, insufficiency of Middle Qi, and indigestion of the stomach and intestines. Treatment should focus on warming the middle and restoring Yang, strengthening the spleen and replenishing Qi, harmonizing the stomach and relieving pain. The prescription is as follows:
Red Ginseng 9g (simmered separately and mixed in) Astragalus 24g Atractylodes Macrocephala 12g Poria 12g
Prepared Aconite Root 30g (simmered thoroughly in boiling water first) Cinnamon Bark 6g (mixed in boiling water) Amomum Villosum 9g Prepared Bolbitis Head 9g Licorice 3g Dried Ginger 9g Jujube 5 pieces
Polygonatum Odoratum 15g and Rice 15g
Second Visit: After taking five doses of the above prescription, loose stools and abdominal pain decreased slightly, hands and feet warmed up gradually, and she could take small amounts of food. Abdominal dragging sensation persists, with occasional pain. The spleen and stomach are gradually regulated, but Middle Yang is still weak, and Qi deficiency causes sinking. The previous prescription showed slight effect, so I maintained the original intent but increased the dosage. Prescription:
Red Ginseng 12g Astragalus 30g Earth-fried Atractylodes Macrocephala 12g Poria with Hostwood 15g Prepared Aconite Root 30g (simmered thoroughly in boiling water first) Cinnamon Bark 6g Roasted Cimicifuga Rhizome 4.5g Stir-fried Bupleurum Root 6g
Prepared Bolbitis Head 9g Licorice 3g Dried Ginger 9g Jujube 5 pieces
Third Visit: After continuously taking ten doses of the above prescription, appetite increased, spirit improved, complexion turned rosy, abdominal pain and loose stools gradually decreased, cold body and limbs warmed up gradually. Only occasional discomfort in the abdomen with a slight dragging sensation. Hospital re-examination showed significant improvement in gastroptosis. Pulses became harmonious and forceful; tongue coating reddish. The signs of Yang deficiency and sinking of Middle Qi have gradually improved. Now it belongs to insufficiency of Qi and Blood, and deficiency of Chong and Ren vessels. Changed to a warming and tonifying formula, advised to take more for regulation. Prescription:
Astragalus 24g Angelica Sinensis 12g Stir-fried White Peony Root 9g Poria 15s Dodder Seed 15g
Prepared Bolbitis Head 9g Atractylodes Macrocephala 12g Roasted Cimicifuga Rhizome 3g Deer Antler Glue 15g (melted and mixed in)
Amomum Villosum 6g Roasted Licorice 6g Prepared Aconite Root 30g (simmered thoroughly in boiling water first) Dried Ginger 9g Jujube 5 pieces
Fourth Visit: After taking more than ten doses of the above prescription, the patient's physical condition improved, able to walk several li. No longer feeling abdominal dragging, spirit energetic, eating and sleeping good, gastroptosis basically cured. Came for follow-up, requested a maintenance formula to regulate before returning home to work. Pulse diagnosis: Both hands' pulses harmonious, tongue reddish. The disease symptoms have receded, Qi and Blood are gradually filling up. Prescribed the following formula to be taken for over ten doses, followed by regular intake of Buzhong Yiqi Wan (Tonify the Middle and Augment the Qi Pill) to consolidate. Prescription:
Prepared Rehmannia Root 15g Angelica Sinensis 15g Stir-fried White Peony Root 9g Ligusticum Wallichii 6g Codonopsis Pilosula 15g
Atractylodes Macrocephala 12g Poria 15g Roasted Licorice 3g Astragalus 18g Cinnamon Bark 6g Charred Ginger 2 slices Jujube 5 pieces
[Commentary] This case is based on Li Dongyuan's theory in "Pi Wei Lun" (Treatise on the Spleen and Stomach) regarding raising Yang and benefiting the stomach, and tonifying the middle and augmenting Qi. Combined with warming the middle and restoring Yang, and nourishing blood and regulating the liver methods, medicines were flexibly used according to the patient's constitution. First, Ginseng, Atractylodes, Astragalus, and Aconite were used to treat deficiency-cold; Ginger, Cinnamon, Amomum, and Poria stopped pain and diarrhea; Bolbitis Head astringed deficiency-cold slipping down; Cimicifuga Rhizome and Bupleurum Root lifted the sinking Qi; Dodder Seed, Polygonatum Odoratum, and Rice warmed the kidney and benefited the stomach; Licorice and Jujube strengthened the spleen and regulated the middle. Later, Deer Antler Glue, Angelica Sinensis, White Peony Root, Prepared Rehmannia Root, and Ligusticum Wallichii were added to nourish blood and regulate the liver. Such comprehensive and integrated treatment easily yields good results.
**Liver-Gallbladder Qi Stagnation and Unresolved Damp-Heat (Cholecystitis)**
Zhang XX, Male, 36 years old, cadre. Year 1972.
First Visit: Pain under the ribs and in the chest/diaphragm for several years, diagnosed by Western medicine as "Chronic Cholecystitis." The disease comes and goes intermittently. During severe attacks, pain is unbearable, sweating like pearls, vomiting sour and bitter fluids, yellow face, blue lips, inability to eat, difficulty sleeping at night. Despite various treatments, the condition remained unchanged. Pulse diagnosis: Left Guan position string-taut and hard, Right Guan position string-taut and fine. Tongue coating yellow-white, thick, greasy, slightly dry. This belongs to internal accumulation of damp-heat, stagnation of Gallbladder Qi, Liver Wood attacking the Stomach, long-standing illness causing deficiency of Spleen and Kidney, and restlessness of the Heart Spirit. Treatment principle: First, soothe the Liver and benefit the Gallbladder, clear and transform damp-heat. Modified compound of Chaihu Shugan San, Wendan Tang, and Zuojin Wan:
Stir-fried Bupleurum Root 9g Fine Zedoary Rhizome 6g (stir-fried and mixed in) Tangerine Peel 6g Evodia Fruit 4.5g
Coptis Chinensis 3g (stir-fried with Evodia Fruit) Fresh Citron 9g Costus Root 3g Processed Pinellia Tuber 9g Poria 15g Vinegar-processed Curcuma Aromatica 9g (mixed in) Roasted Chicken Gizzard Lining 2 pieces
Second Visit: After taking five doses of the above prescription, pain decreased significantly, vomiting stopped. Yellow-greasy tongue coating gradually receded, mouth still bitter. Left Guan pulse string-taut and hard became softer, Right pulse appeared fine and weak. Able to eat slightly.
Bowel movement once every two days, still not smooth, urine short and yellow. Sleep uneasy at night, shortness of breath and sweating during pain. This is due to Liver-Gallbladder Fire pathogen and long-term accumulation of damp-heat, which is rarely easy to resolve suddenly. Moreover, Spleen-Stomach dysfunction leads to dual deficiency of Qi and Blood. Prescribed the following for treatment:
Stir-fried Bupleurum Root 6g Vinegar-processed Pinellia Tuber 9g Poria 15g Tail of Angelica Sinensis 9g Costus Root 3g Cyperus Rotundus 6g Stir-fried Aurantium Imperatoris 9g Clean Bamboo Shavings 6g Sichuan Madrone Bark 9g (wine-fried) Fresh Citron 9g Roasted Chicken Gizzard Lining 2 pieces Evodia Fruit 4.5g Coptis Chinensis 3g (these two stir-fried together)
Third Visit: After taking five doses of the above prescription, chest and hypochondriac fullness and pain gradually decreased, breathing smooth, vomiting and nausea completely stopped, mouth slightly bitter, able to eat. Bowel movement once a day, urine clear and abundant. Left pulse string-taut gradually flattened, Right still fine and weak, tongue light yellow and moist. This indicates Liver-Gallbladder damp-heat is gradually resolving, Qi mechanism is relaxing. However, due to long-standing gallbladder disease damaging Heart and Spleen, there are many illusory dreams at night. Prescription:
Angelica Sinensis 12g Stir-fried White Peony Root 9g Poria 15g Stir-fried Sour Jujube Seed 15g (mixed in) Costus Root 3g Amomum Villosum 6g Fresh Citron 9g Raw Licorice 3g Clean Bamboo Shavings 6g
Processed Pinellia Tuber 9g Tangerine Peel 6g Roasted Chicken Gizzard Lining 1 piece
Fourth Visit: After taking five doses of the above prescription, pain completely stopped, mouth neutral, appetite increased, sleep improved, bowel and bladder movements normal. Only Qi deficiency and mental fatigue, still many dreams, occasional spontaneous sweating. Pulse harmonious, both Chi positions weak, tongue pale with thin coating. This is a state where the disease recedes, Zheng (Upright) Qi is deficient, Heart-Kidney non-interaction, and Qi-Blood not yet restored. Take the following prescription again for regulation to cure. Prescription:
White Ginseng 6g (simmered separately, divided doses mixed in) Huai Sour Jujube Seed 15g (stir-fried and mixed in) Poria with Hostwood 15g
Stir-fried White Peony Root 9g Angelica Sinensis 15g Roasted Polygala Root 6g Costus Root 2.4g Roasted Licorice 3g Salvia Miltiorrhiza 9g Jian Lotus Seed 15g Small Red Jujube 9 pieces Lotus Leaf Tip 3 pieces
[Commentary] "Cholecystitis" corresponds to "Dan Zhang" (Gallbladder Distension) and "Gan Zhang" (Liver Distension) in the "Nei Jing". The Liver and Gallbladder are exterior-interior related. The pathogenesis involves internal congestion of damp-heat and stagnation of Qi transformation. In this case, the illness is long-standing, Zheng Qi is deficient while Pathogenic factors are excess. First, use gentle guiding methods to dispel dampness and transform heat, then regulate the Liver, strengthen the Spleen, nourish the Heart, and calm the Spirit, allowing the gallbladder disease to heal itself.
**Gynecology: Regulating Menstruation**
Li XX, Female, 28 years old, teacher. Year 1970.
First Visit: Married for five years, infertile. Usually menstruation occurs early, varying by 5 to 10 days. During menstruation, often feels lower back soreness and abdominal pain, menstrual color purple-black with clots, scanty amount. Dizziness, mental fatigue, chest and hypochondriac distension, irritability, dry mouth desiring drink, afternoon tidal fever on face and palms/soles. Pulse string-taut, rapid, and forceful; tongue body red, coating thin yellow. Syndrome belongs to irregularity of Qi and Blood, combined with stagnant heat, affecting Chong and Ren vessels. Treatment should regulate Qi and relieve stagnation, clear menstruation and transform heat. Formula: Danzhi Xiaoyao San modified. Prescription:
Bohor Mint 4.5g Stir-fried Bupleurum Root 9g Angelica Sinensis 12g Ligusticum Wallichii 6g Stir-fried White Peony Root 9g Moutan Cortex 6g Stir-fried Gardenia Fruit 6g Tangerine Peel 6g Roasted Cyperus Rotundus 6g
Raw Licorice 3g Fresh Ginger 2 slices Small Jujube 9 pieces Take several more doses
Second Visit: After taking five doses of the above prescription, menstruation arrived, date still 3-4 days early, menstrual color deep red and purple, clots reduced, volume increased. Afternoon tidal fever on face and palms/soles decreased. Dry mouth, desire to drink, chest stuffiness, anger, also significantly improved. Still feels dizziness, mental fatigue, vexation, many dreams, easily awakened, occasional dull pain in waist and abdomen. Follow-up pulse: Fine, string-taut, and soft; tongue coating light yellow and moist. Qi stagnation is relatively relieved, Blood heat not yet cleared. Continue with Jiawei Qingjing Tang (Ancient Formula: Liangdi Tang) for regulation. Prescription:
Dry Rehmannia Root 12g Cortex Lycii 12g Angelica Sinensis 12g Stir-fried White Peony Root 9g Ligusticum Wallichii 6g
Moutan Cortex 6g Poria with Hostwood 15g Roasted Cyperus Rotundus 6g Stir-fried Teasel Root 9g Stir-fried Bupleurum Root 6g Raw Licorice 3g Take several more doses
Third Visit: Continuously taking the above prescription for two months, total over ten doses. Visited in the third and fourth months, menstrual cycle and volume nearly normal, color turned bright red. Lower back soreness, abdominal pain, vexation, irritability, poor sleep with many dreams, etc., disappeared. Pulse harmonious, tongue coating reddish. Prescribed Jiawei Bazhen Tang for regulation:
Large Prepared Rehmannia Root 12g Whole Angelica Sinensis 12g Stir-fried White Peony Root 9g Ligusticum Wallichii 6g Atractylodes Macrocephala 9g
Poria with Hostwood 15g Shangdang Codonopsis 12g Roasted Cyperus Rotundus 6g Moutan Cortex 4.5g Jian Lotus Seed 15g Raw Licorice 3g
Take three to five doses around menstruation. Spring 1971, came for follow-up, pregnant for two months. Delivered in winter, mother and child safe.
[Commentary] Elder Yao pays great attention to regulating Liver-Spleen Qi-Blood and Chong-Ren vessels when treating gynecological menstrual diseases. In this case, first remove stagnant heat and soothe the Liver to regulate Qi mechanism, then clear menstruation and nourish Blood. Only in the third visit did he use dual tonification of Qi and Blood, adding Cyperus Rotundus, Moutan Cortex, etc., tonifying without stagnation, and clearing within tonification.
**Amenorrhea for Four Years**
Zhou XX, Female, 30 years old, cadre from Simao Prefecture. August 1958.
First Visit: Married for nearly ten years, never gave birth. Usually menstruation is delayed, scanty amount, purple-black color with clots. During menstruation, feels lower back soreness and abdominal distension. Mass in abdomen, moving back and forth, distending and painful unpredictably. Usually dizziness, mental fatigue, no appetite, restless sleep, frequent nocturia, gradually becoming frail and emaciated. Previously treated by local Chinese doctors with various methods, either attacking/breaking or warming/tonifying, effects unclear. Western medical examination suggested possible uterine fibroids and ovarian cysts. Injections of Progesterone, Ovarian Extract, Streptomycin, etc., also did not improve. Later changed to herbal remedies over ten times, menstruation ceased completely, lasting over four years. Patient felt extreme mental distress, specially came to Kunming to our hospital for treatment.
Pulse initially string-taut, fine, and tight upon light pressure, deep, choppy, and powerless upon heavy pressure. Tongue coating thin, greasy, lacking fluid. TCM Diagnosis: Long-term amenorrhea, mixed use of attacking and tonifying drugs/injections, dual deficiency of Qi and Blood, Liver and Spleen diseased, Chong and Ren vessels damaged, belonging to the syndrome of Xue Zheng (Blood Masses) and Qi Jia (Qi Masses).
First, nourish Chong and Ren, regulate Liver and Spleen, then move Qi and invigorate Blood, unblock collaterals and regulate menstruation. Prescription:
Sutiao Shen (Codonopsis) 15g Stir-fried Bupleurum Root 9g Deer Horn Frost 15g Roasted Tortoise Shell 15g Angelica Sinensis 15g Ligusticum Wallichii 6g Poria with Hostwood 15g Stir-fried White Peony Root 9g Sichuan Teasel Root 9g
Roasted Cyperus Rotundus 6g Amomum Villosum 6g Raw Licorice 3g
Second Visit: After taking five doses of the previous prescription, lower back soreness and abdominal distension slightly decreased. Still feels dizziness, mental fatigue, poor appetite, restless sleep. Abdominal pain and distension remain as before, location indefinite. Night urination still frequent. This is long-standing amenorrhea, with both Xue Zheng and Qi Jia present. Pulse turned string-taut and slow, heavy pressure fine and choppy, tongue still thin white with slight grease. Continue with modifications of the previous prescription:
Sutiao Shen 15g Angelica Sinensis 18g Ligusticum Wallichii 6g Stir-fried Bupleurum Root 9g Roasted Tortoise Shell 15g
Deer Horn Frost 9g Purple Salvia Root 9g Roasted Cyperus Rotundus 6g Corydalis Rhizome 9g Amomum Villosum 6g Raw Licorice 3g Stir-fried Little Fennel 6g Lychee 7 pieces
Third Visit: After continuously taking over ten doses of the above prescription, masses in waist and abdomen did not dissipate, sometimes as large as a chicken egg, sometimes shrunk to a bean size, swelling and shrinking alternately, pain indefinite in location, unpredictable timing.
Eating and sleeping gradually improved, bowel movements normal, urine still frequent, head still dizzy. After medication, Chong and Ren vessels gradually received nourishment, Liver and Spleen relatively harmonized, but body weak and Qi deficient, unable to move Blood. Pulse string-taut and fine, Chi position deep and muddy, tongue light red. Continue with modification of the original formula, supplemented with agents to unblock menstruation and invigorate Blood. Prescription:
Sutiao Shen 15g Stir-fried Bupleurum Root 6g Whole Angelica Sinensis 15g Old Ligusticum Wallichii 6g Corydalis Rhizome 9g Roasted Cyperus Rotundus 6g Raw Sanqi Powder 4.5g (divided doses mixed in) Purple Salvia Root 9g Curcuma Aromatica 6g Sichuan Teasel Root 9g Moutan Cortex 6g Raw Licorice 3g Crushed Lychee 7 pieces Perilla Leaf 4.5g
Fourth Visit: Continued taking the previous prescription for over ten doses. Patient had paroxysmal soreness and pain in waist and abdomen, appetite gradually returned, sleep acceptable. Movements of masses in abdomen frequent, night urination reduced, bowel movements normal. This indicates that after medication, Liver and Spleen are regulated, Qi gradually moves, Blood gradually invigorates. Pulse string-taut but soft, tongue red with moist coating. Seize this opportunity to unblock collaterals and regulate menstruation, move Qi and invigorate Blood, to induce menstruation early. Prescribed:
Stir-fried Bupleurum Root 6g Angelica Sinensis 15g Ligusticum Wallichii 6g Beijing Samphire Rhizome 9g Curcuma Zedoaria 9g
Roasted Cyperus Rotundus 6g Corydalis Rhizome 9g Stir-fried Teasel Root 9g Purple Salvia Root 9g Peach Kernel Paste 9g Raw Sanqi Powder 4.5g (divided doses mixed in) Safflower 4.5g Add a little clear wine per dose as guide.
Fifth Visit: By the third dose of the above prescription, patient felt incessant abdominal pain on the evening of that day. At midnight, menstruation closed for nearly five years suddenly started, color purple-black, with several clots. Next morning, I visited the ward, heard and congratulated, proceeded to follow-up; pulse became soft, slow, harmonious, string-taut image reduced, tongue as before. No other discomfort, continued with the following prescription:
Stir-fried Bupleurum Root 6g Angelica Sinensis 15g Ligusticum Wallichii 6g Stir-fried White Peony Root 9g Roasted Cyperus Rotundus 6g
Stir-fried Schizonepeta Spike 4.5g Purple Salvia Root 9g Moutan Cortex 6g Teasel Root 9g Corydalis Rhizome 6g Mulberry Parasite Stem 12g Raw Sanqi Powder 4.5g (divided doses mixed in)
Sixth Visit: Patient continuously took five doses of the above prescription, menstruation continued to flow smoothly, stopped after seven to eight days. Eating and sleeping excellent during menstruation, bowel and bladder movements normal. After passage of purple-black blood clots, hard mass in abdomen seemed gone. Pulse harmonious, weak and slow, tongue as before. Due to work reasons, patient could not stay in Kunming, prescribed common medicinal formula, advised regular intake of Bazhen Wan, Xiaoyao San, etc., to consolidate. In 1960, came to Kunming on official business, reported to the hospital that after returning to the original unit, regularly taking decoction and pill formulas, menstruation arrived on schedule, with no other discomfort. Maintenance Prescription:
Stir-fried Bupleurum Root 6g Angelica Sinensis 15g Stir-fried White Peony Root 9g Ligusticum Wallichii 6g Poria 12g
Atractylodes Macrocephala 9g Roasted Cyperus Rotundus 6g Moutan Cortex 6g Amomum Villosum 6g Mulberry Parasite Stem 12g Licorice 3g Fresh Ginger 2 slices Small Jujube 12 pieces
[Yao's Commentary] This case is one of the more prominent cases I treated for long-term female amenorrhea. The cause was uneven exposure to cold and heat, irregular diet, leading to amenorrhea. Subsequently, multiple local Chinese doctors used attacking/breaking and warming/tonifying drugs without effect, thus forming "Zheng Jia" (Masses) in gynecology.
Based on the Nei Jing statement: "Shi Jia arises in the uterus, cold pathogen lodges in Zi Men, Zi Men closes, Qi cannot pass, evil blood should be discharged but is not, stagnates... menstruation does not arrive on time, all arise in women, can be guided down," I believe although this disease has not reached the degree of Shi Jia "increasing daily, resembling pregnancy," long-standing amenorrhea, if developed further, would be harder to treat! Based on the spirit of syndrome differentiation and treatment, I believe overly aggressive attacking damages Chong and Ren, while mixed warming/tonifying causes Qi and Blood stagnation. Therefore, in treatment, first determine to "seek the root" in treating pain, first harmonize Chong and Ren, nourish Liver and Spleen, such as Ginseng, Angelica, Ligusticum, Deer Horn, Tortoise Shell, Cyperus, Amomum, etc. Then regulate Qi and invigorate Blood, unblock collaterals and regulate menstruation, such as Corydalis, Salvia, Samphire Rhizome, Zedoaria, Peach Kernel, Safflower, Sanqi, etc. In short, first confirm the treatment procedure, then determine step-by-step prescription and medication, finally menstruation flows smoothly, all diseases cured.