综上所述，断为脾虚肺燥之证。当以扶脾燥湿为主，兼以润肺降逆之品。用《清宫秘方》八珍散加减：
方中，山药补虚扶弱，益肾强阴，且能益脾肺，清虚热，治虚，长肌肉。芡实扶脾益肾，收敛肺气。莲肉、茯苓健脾利湿而补肺，且能交通心肾。苡仁除湿消肿，健脾补肺。沙参养阴清肺，祛痰止咳。桔梗开肺气，利胸膈，引药上升。陈皮燥湿理气，降逆和中，免除诸药之壅滞。百部、冬花、苏子俱能治久咳，又能降逆化痰而润肺。加以白糖和中补虚，润肺生津。诸药相合，共同发挥扶脾燥湿，润肺降逆之功。
嘱服三剂后，症情见减，但心悸眠差尚存。药已中病，仍踵前法加减：
服三剂，眠安，精神渐好，惟面足浮肿未全消，改用张锡纯升陷汤加味：
此方原治胸中大气下陷之症。张氏云：“大气者，充满胸中，以司肺呼吸之气也。”又谓：“大气即宗气”，“其能撑持全身，为诸气之纲领”。余又据张氏引《金匮》水气门桂枝加黄芪汤下“大气一转，其气乃散”之语，而借用此方加昧治大气下陷之虚性水肿颇验。
白蜜(每次调入一匙)
服二剂，咳即全止。为巩固疗效，又用升陷汤(口芪、知母、升麻、柴胡、桔梗)加龙骨、牡蛎收敛肺气，苏子、牛蒡子理肺祛痰，杭芍养肝，法半夏降逆。连服五剂，诸症缓解，继之，临床症状消失。病情控制未发。
[按]：脾属土，肺属金，土能生金。在生理功能上．脾主运化，水谷精微之气由脾上输于肺以充养全身，故二者关系至为密切，临床上常见脾气不足、肺气虚弱的脾肺两虚江。本例在脾虚湿滞的情况下，不仅肺气虚弱，且兼肺燥干咳，湿与燥成为一大矛盾。因而在用药上的难度亦大：燥脾湿则肺燥增，润肺燥则脾湿盛，所谓棘手之证。经分析病情后，乃借用八珍散加清润益气之品，既健脾燥湿，又润肺降逆，使药扣病机，两全兼顾。药虽平淡无奇，但疗效显著。
阴寒浮肿烦喘
王××，女，七十岁。患全身浮肿，发热，身痛，喘息，烦躁，胸闷胀，大便秘结。病已多日，经治未效，延余往诊。症见：面青无神，舌白滑，脉弦滑。询其起病之因，系由风寒侵袭，兼有积滞。前医不分表里，以致表邪未除，积滞已成，阻遏气机，阴霾满布。当今施治，应分三步：先解表宣肺，兼调营卫；继而表里两解，兼消积滞，后予温壮阳气而治本。一诊先用麻桂各半汤加味。处方：
二诊：服一剂，发热身痛即见减轻，表邪渐解。但胸闷张如故，此里气未和，积滞未消。宜表里两解，兼消积化滞。用自拟方藿香桂枝汤加减。处方：
三诊：上方服一剂，胸闷胀减轻，喘息亦减，惟大便多日不通。以面青无神、舌白滑观之，此因年高，阳气不足，阴寒凝结。宜温壮阳气，单刀直入，交通上下，使陷者得升，浊者自降。方用《伤寒论》干姜附子汤。处方：
服后大便通，烦喘止，惟吐酸频作。是由于阴邪太甚，服阳药而离照当空，坚冰见融之佳象。今大便虽通，而肿势未消。此脾肾阳虚，阴寒尚盛。宜温阳祛寒，健脾利水。继用白通汤、真武汤各三剂后，浊阴化而水归壑，肿胀消而身轻健。
[按]：“先表后里”，是《伤寒论》重要治则之一，临证时必须牢记。本案既有脾肾阳虚，又有风寒外束，且有肠胃积滞。根据《伤寒论》“太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘者，麻黄汤主之”，及“太阳与阳明合病．喘而胸满者。不可下，宜麻黄汤。”后者所云阳明，系指里证。记明表里并见时，不可用下，应以解表为主。故首先用麻桂各半汤加味，使病邪得以外出。第二步用藿香桂枝汤表里两解，兼化积滞。使表邪解，积滞消，为第三步的用药创造了条件。孰先孰后，应做到胸有成竹。只有这并，用药才有准则，能收到预期的效果。
痹证发黄神识错乱
何××，男，六十一岁。平素嗜酒，过去曾患风湿关节炎及风湿性心脏病。今发热，全身疼痛，面浮肢肿，小便不利．咳嗽心悸。西医诊断为风湿性心脏病伴上呼吸道感染、心力衰竭。住某医院，经治疗效果不显，且病情日益严重，延余会诊。查其脉沉紧，苔白腻，面浮，两手及足背浮肿，触之发凉，压之有凹陷，断为风寒湿三邪并犯太阴、少阴之虚寒证。法当温扶肾阳、祛风寒湿。投以自拟方附子桂枝独活寄生汤。处方：
黑附片60克 桂枝12克 炒杭芍12克 法夏9克 茯苓15克
连服二剂，发热退，身痛亦减。肿胀仍未消，小便不利。此脾肾阳虚，寒湿不运。治当温补脾肾，运化寒湿，用《伤寒论》大剂苓桂术甘汤加附片。处方，
黑附片90克 茯苓30克 漂白术18克 桂枝24克 甘草9克
方中附片温肾阳以强心，茯苓、白术、甘草健脾除湿以利水，桂枝通阳化气，使膀胱气化得行，三焦水道通利，则小便自可畅行，水肿渐消。服后，果获预期之效。宜进一步温肾助阳，祛寒化湿，扶持正气，恢复体功。用《伤寒论》大剂附子汤。处方：
漂白术30克
此方乃仲景治“少阴病，口中和，背恶寒”及“身体痛，手足寒、骨节痛、脉沉者”之主方。用治此症，乃以白术和中、调气、祛湿，茯苓行痰利水，杭芍育阴。敛藏相火；附子温肾助阳。肾为胃之关，肾气蒸动，关门得开，更得苓术之淡渗苦降，助水下行，潞党参培补脾肺之气，肺气不虚，治节得行，方能化精利尿。
服二剂，水肿全消，身痛若失。但不料出现黄疸，小便又复不利。面目、爪甲、周身俱黄，色泽不鲜。用附子理中汤加味。处方：
黑附片60克 潞党参18克 漂白术15克 干姜15克茵陈9克
服后病如前，且增心烦。系水湿停滞、郁热内蕴。改用通阳行水、清热除烦为主，以茵陈五苓散、栀豉汤和温胆汤合方化裁。处方：
茵陈15克 茯苓15克 猪苓12克 白术12克 炒泽泻18克
上方五苓散助脾转输，通阳利水，茵陈清热利湿以退黄，栀豉汤除烦热。再以温胆汤降胆除痰而安神，加干姜顾护中阳，并制茵陈、栀子之寒。服后心烦减，尿清长，黄疸渐消。
在治疗过程中，忽见右手食指弯曲不能伸，疼痛难忍。谢映庐《得心集》称此病为“肝风撮指”，并指出病因系木强土弱．肝风为病，“肝阴被火所劫，是以筋急而牵引撮紧。但肝为肝脏。一切逐风辛散之药，反能助火劫阴，岂非愈加其病。”乃处以谢氏治此症之效方：
干姜15克
服一剂，痛稍减，指稍伸。再服二剂，则指屈伸如常。然圈中阳大虚，脾湿不化，症现胸闷，腹胀，大便泄泻。用四逆汤加茯苓，一剂泻止。但又出现精神错乱。查其脉，两手六部散大无根，舌苔青滑。此系心肾升降失调、神识散越所致。症属不足而非有余，当治以交通阴阳，收纳元气为主。盖心主神明，若心阳不衰，神不涣散，则神识自不错乱。先投四逆汤加肉桂、猪胆汁、童便。服一剂，神稍安，继用补坎益离汤(附片、肉桂、蛤粉、炙甘草、生姜)专补心阳，兼滋肾阴。服四剂，神识清明，如大梦初醒，身心大快，仅肢体微现浮肿。再以白通、四逆收纳元气，而诸症消失。最后以济生肾气丸调理，体渐康复而出院。
[按]：中医痹症，范围甚广，非单指风寒湿痹而言。此案表现多端，变化无常，堪称疑难杂症。其病机自始至终似以湿邪为主。其内蕴之湿时从寒化，时从热化，对方药之反应亦颇敏感。若不抓住病机辨证施治，随症遣方，焉能适应其变化。可见，只要掌握中医原理及辨证论治方法，抓住不同时期之主要矛盾，灵活处理，则病邪自无遁形，而险症亦可转危为安。
风寒湿痹
陈××，男，十四岁。患发热恶寒，头痛，身困．腰酸，恶心欲吐。初服桂枝汤后症状未减，次日出现舌苔微腻，恶寒少而发热增高，症似风温，又改服银翘散与葱豉汤合方，药后日晡发热如疟状。又服西药阿的平无效，竟转全日发热，下肢剧烈疼痛，夜间发热尤盛，体温39．5℃，卧床不起，烦乱呻吟，不得安寐。起病至今已半月余，症情混杂，寒热莫辨，乃延余诊治。细审之，患者初因气候突变，感受寒邪而发病。症见：舌质青滑，舌苔薄腻，脉浮而无力，面色及口唇发青。病已多日，今仍发热，脉浮为表邪尚’在，由于寒湿阻滞经络“不通则痛”，故下肢疼痛。脉症合参，证属阳虚感寒兼湿邪内滞。先予温经散寒、调和营卫兼理气机之法。处以桂枝加附子汤加味。处方：
方中用附片温太阳之经脉；桂枝汤以发表解肌、调和营卫；合香附、麦芽以行太阳之滞气，开太阳气机。
二诊：服上方一剂后，较前安静，但发热未减，下肢仍痛，且出现呕恶，舌脉同前。此乃寒湿凝滞、胃浊不化、浊阴上犯所致。法当以温经通络，驱风散湿，行滞、降逆。处以自拟附子桂枝独活寄生汤：
方中附片、桂枝、杭芍、甘草、生姜、大枣用以温经散寒通络；陈皮理气健脾燥湿；合与茯苓增强健脾利湿之功，法夏降逆止呕，燥湿化痰；台乌行气、散寒，川芎活血行气，二者合用增强行气止痛之功，防风、独活祛风胜湿、行痹止痛；桑寄生补肝肾、除风湿。
三诊；服上方二剂后，夜问发热稍减，体温渐降，呕止，烦定，已不似前之呻吟，口渴思饮而不多。此系下焦元阳虚衰，阴寒内盛。宜温阳祛寒，处以《伤寒论》吴萸四逆汤：
方中吴萸温中散寒，疏肝暖脾，善解厥阴肝经的郁滞而行气止痛，且能降逆止呕，合四逆汤峻扶元阳之不足。
四诊：服上方一剂后，发热大减，口渴亦止，多日卧床不起，现已能起床便溺，溺色稍赤。但仍感下肢疼痛，不能移步，苔转白腻，脉仍濡。此系中阳虚衰，以致寒湿凝滞，气机不畅。宜交通阴阳，散寒祛湿。处方：
第一方：
第二方。
生苡仁9克
第二方即《金匮要略》麻黄加术汤及麻杏苡甘汤合方用以温散化湿。
五诊：上二方交叉各服二剂后，发热全退，惟觉下肢仍有疼痛，脉濡缓，舌苔薄腻。此乃脾湿不化，阻滞经络，故下肢仍有疼痛。法当健脾燥湿，祛风通络为治。处方：
方中猪苓、泽泻利水渗湿，苡仁，白术健脾利水、燥湿，萆薢祛风除湿，合桑枝能利关节除风寒湿痹。丝瓜络通筋络、舒血脉，与桑枝合用增强其通利血脉关节的作用，防风、独活祛风胜湿，疗风痹诸痛，黄柏坚肾、益阴而燥湿，淮牛膝益肾、引药力下达，善治肾虚腰腿疼痛或膝痛不能屈伸。
六诊：服上方一剂后，小便清长，下肢疼痛大减，已能移步。脉已平和，舌心微黄腻。此湿欲化热，处以原方减去萆薜、桑枝、丝瓜络、甘草，加沙参15克、元参9克、知母6克滋阴降火，再加筠姜散寒、除湿以开气血之凝滞。
七诊：服上方二剂后，竟能自由行走，惟步行时感轻微疼痛。考虑患者素禀不足，经此病后，元阳更虚，继以术附、参附、吴萸四逆、白通汤等更番调理而愈。
湿热两膝肿痛
综上所述，诊断为脾虚肺燥之证。治疗应以健脾燥湿为主，兼用润肺降逆的药物。使用《清宫秘方》八珍散加减：
方中，山药补虚扶弱，益肾强阴，且能益脾肺，清虚热，治虚劳，长肌肉。芡实扶脾益肾，收敛肺气。莲肉、茯苓健脾利湿而补肺，且能交通心肾。苡仁除湿消肿，健脾补肺。沙参养阴清肺，祛痰止咳。桔梗开肺气，利胸膈，引药上升。陈皮燥湿理气，降逆和中，免除诸药之壅滞。百部、冬花、苏子俱能治久咳，又能降逆化痰而润肺。加以白糖和中补虚，润肺生津。诸药相合，共同发挥扶脾燥湿，润肺降逆之功。
嘱服三剂后，症状减轻，但心悸失眠尚存。药已中病，仍沿前法加减：
服三剂，睡眠安稳，精神渐好，惟面足浮肿未全消，改用张锡纯升陷汤加味：
此方原治胸中大气下陷之症。张氏云：“大气者，充满胸中，以司肺呼吸之气也。”又谓：“大气即宗气”，“其能撑持全身，为诸气之纲领”。余又据张氏引《金匮》水气门桂枝加黄芪汤下“大气一转，其气乃散”之语，而借用此方加味治大气下陷之虚性水肿颇验。
白蜜（每次调入一匙）
服二剂，咳即全止。为巩固疗效，又用升陷汤（口芪、知母、升麻、柴胡、桔梗）加龙骨、牡蛎收敛肺气，苏子、牛蒡子理肺祛痰，杭芍养肝，法半夏降逆。连服五剂，诸症缓解，继之，临床症状消失。病情控制未发。
[按]：脾属土，肺属金，土能生金。在生理功能上，脾主运化，水谷精微之气由脾上输于肺以充养全身，故二者关系至为密切，临床上常见脾气不足、肺气虚弱的脾肺两虚证。本例在脾虚湿滞的情况下，不仅肺气虚弱，且兼肺燥干咳，湿与燥成为一大矛盾。因而在用药上的难度亦大：燥脾湿则肺燥增，润肺燥则脾湿盛，所谓棘手之证。经分析病情后，乃借用八珍散加清润益气之品，既健脾燥湿，又润肺降逆，使药扣病机，两全兼顾。药虽平淡无奇，但疗效显著。
阴寒浮肿烦喘
王××，女，七十岁。患全身浮肿，发热，身痛，喘息，烦躁，胸闷胀，大便秘结。病已多日，经治未效，延余往诊。症见：面青无神，舌白滑，脉弦滑。询其起病之因，系由风寒侵袭，兼有积滞。前医不分表里，以致表邪未除，积滞已成，阻遏气机，阴霾满布。当今施治，应分三步：先解表宣肺，兼调营卫；继而表里两解，兼消积滞，后予温壮阳气而治本。一诊先用麻桂各半汤加味。处方：
二诊：服一剂，发热身痛即见减轻，表邪渐解。但胸闷胀如故，此里气未和，积滞未消。宜表里两解，兼消积化滞。用自拟方藿香桂枝汤加减。处方：
三诊：上方服一剂，胸闷胀减轻，喘息亦减，惟大便多日不通。以面青无神、舌白滑观之，此因年高，阳气不足，阴寒凝结。宜温壮阳气，单刀直入，交通上下，使陷者得升，浊者自降。方用《伤寒论》干姜附子汤。处方：
服后大便通，烦喘止，惟吐酸频作。是由于阴邪太甚，服阳药而离照当空，坚冰见融之佳象。今大便虽通，而肿势未消。此脾肾阳虚，阴寒尚盛。宜温阳祛寒，健脾利水。继用白通汤、真武汤各三剂后，浊阴化而水归壑，肿胀消而身轻健。
[按]：“先表后里”，是《伤寒论》重要治则之一，临证时必须牢记。本案既有脾肾阳虚，又有风寒外束，且有肠胃积滞。根据《伤寒论》“太阳病，头痛发热，身疼腰痛，骨节疼痛，恶风无汗而喘者，麻黄汤主之”，及“太阳与阳明合病．喘而胸满者。不可下，宜麻黄汤。”后者所云阳明，系指里证。记明表里并见时，不可用下，应以解表为主。故首先用麻桂各半汤加味，使病邪得以外出。第二步用藿香桂枝汤表里两解，兼化积滞。使表邪解，积滞消，为第三步的用药创造了条件。孰先孰后，应做到胸有成竹。只有这并，用药才有准则，能收到预期的效果。
痹证发黄神识错乱
何××，男，六十一岁。平素嗜酒，过去曾患风湿关节炎及风湿性心脏病。今发热，全身疼痛，面浮肢肿，小便不利．咳嗽心悸。西医诊断为风湿性心脏病伴上呼吸道感染、心力衰竭。住某医院，经治疗效果不显，且病情日益严重，延余会诊。查其脉沉紧，苔白腻，面浮，两手及足背浮肿，触之发凉，压之有凹陷，断为风寒湿三邪并犯太阴、少阴之虚寒证。法当温扶肾阳、祛风寒湿。投以自拟方附子桂枝独活寄生汤。处方：
黑附片60克 桂枝12克 炒杭芍12克 法夏9克 茯苓15克
连服二剂，发热退，身痛亦减。肿胀仍未消，小便不利。此脾肾阳虚，寒湿不运。治当温补脾肾，运化寒湿，用《伤寒论》大剂苓桂术甘汤加附片。处方：
黑附片90克 茯苓30克 漂白术18克 桂枝24克 甘草9克
方中附片温肾阳以强心，茯苓、白术、甘草健脾除湿以利水，桂枝通阳化气，使膀胱气化得行，三焦水道通利，则小便自可畅行，水肿渐消。服后，果获预期之效。宜进一步温肾助阳，祛寒化湿，扶持正气，恢复体功。用《伤寒论》大剂附子汤。处方：
漂白术30克
此方乃仲景治“少阴病，口中和，背恶寒”及“身体痛，手足寒、骨节痛、脉沉者”之主方。用治此症，乃以白术和中、调气、祛湿，茯苓行痰利水，杭芍育阴。敛藏相火；附子温肾助阳。肾为胃之关，肾气蒸动，关门得开，更得苓术之淡渗苦降，助水下行，潞党参培补脾肺之气，肺气不虚，治节得行，方能化精利尿。
服二剂，水肿全消，身痛若失。但不料出现黄疸，小便又复不利。面目、爪甲、周身俱黄，色泽不鲜。用附子理中汤加味。处方：
黑附片60克 潞党参18克 漂白术15克 干姜15克茵陈9克
服后病如前，且增心烦。系水湿停滞、郁热内蕴。改用通阳行水、清热除烦为主，以茵陈五苓散、栀豉汤和温胆汤合方化裁。处方：
茵陈15克 茯苓15克 猪苓12克 白术12克 炒泽泻18克
上方五苓散助脾转输，通阳利水，茵陈清热利湿以退黄，栀豉汤除烦热。再以温胆汤降胆除痰而安神，加干姜顾护中阳，并制茵陈、栀子之寒。服后心烦减，尿清长，黄疸渐消。
在治疗过程中，忽见右手食指弯曲不能伸，疼痛难忍。谢映庐《得心集》称此病为“肝风撮指”，并指出病因系木强土弱．肝风为病，“肝阴被火所劫，是以筋急而牵引撮紧。但肝为肝脏。一切逐风辛散之药，反能助火劫阴，岂非愈加其病。”乃处以谢氏治此症之效方：
干姜15克
服一剂，痛稍减，指稍伸。再服二剂，则指屈伸如常。然圈中阳大虚，脾湿不化，症现胸闷，腹胀，大便泄泻。用四逆汤加茯苓，一剂泻止。但又出现精神错乱。查其脉，两手六部散大无根，舌苔青滑。此系心肾升降失调、神识散越所致。症属不足而非有余，当治以交通阴阳，收纳元气为主。盖心主神明，若心阳不衰，神不涣散，则神识自不错乱。先投四逆汤加肉桂、猪胆汁、童便。服一剂，神稍安，继用补坎益离汤（附片、肉桂、蛤粉、炙甘草、生姜）专补心阳，兼滋肾阴。服四剂，神识清明，如大梦初醒，身心大快，仅肢体微现浮肿。再以白通、四逆收纳元气，而诸症消失。最后以济生肾气丸调理，体渐康复而出院。
[按]：中医痹症，范围甚广，非单指风寒湿痹而言。此案表现多端，变化无常，堪称疑难杂症。其病机自始至终似以湿邪为主。其内蕴之湿时从寒化，时从热化，对方药之反应亦颇敏感。若不抓住病机辨证施治，随症遣方，焉能适应其变化。可见，只要掌握中医原理及辨证论治方法，抓住不同时期之主要矛盾，灵活处理，则病邪自无遁形，而险症亦可转危为安。
风寒湿痹
陈××，男，十四岁。患发热恶寒，头痛，身困．腰酸，恶心欲吐。初服桂枝汤后症状未减，次日出现舌苔微腻，恶寒少而发热增高，症似风温，又改服银翘散与葱豉汤合方，药后日晡发热如疟状。又服西药阿的平无效，竟转全日发热，下肢剧烈疼痛，夜间发热尤盛，体温39．5℃，卧床不起，烦乱呻吟，不得安寐。起病至今已半月余，症情混杂，寒热莫辨，乃延余诊治。细审之，患者初因气候突变，感受寒邪而发病。症见：舌质青滑，舌苔薄腻，脉浮而无力，面色及口唇发青。病已多日，今仍发热，脉浮为表邪尚在，由于寒湿阻滞经络“不通则痛”，故下肢疼痛。脉症合参，证属阳虚感寒兼湿邪内滞。先予温经散寒、调和营卫兼理气机之法。处以桂枝加附子汤加味。处方：
方中用附片温太阳之经脉；桂枝汤以发表解肌、调和营卫；合香附、麦芽以行太阳之滞气，开太阳气机。
二诊：服上方一剂后，较前安静，但发热未减，下肢仍痛，且出现呕恶，舌脉同前。此乃寒湿凝滞、胃浊不化、浊阴上犯所致。法当以温经通络，驱风散湿，行滞、降逆。处以自拟附子桂枝独活寄生汤：
方中附片、桂枝、杭芍、甘草、生姜、大枣用以温经散寒通络；陈皮理气健脾燥湿；合与茯苓增强健脾利湿之功，法夏降逆止呕，燥湿化痰；台乌行气、散寒，川芎活血行气，二者合用增强行气止痛之功，防风、独活祛风胜湿、行痹止痛；桑寄生补肝肾、除风湿。
三诊；服上方二剂后，夜问发热稍减，体温渐降，呕止，烦定，已不似前之呻吟，口渴思饮而不多。此系下焦元阳虚衰，阴寒内盛。宜温阳祛寒，处以《伤寒论》吴萸四逆汤：
方中吴萸温中散寒，疏肝暖脾，善解厥阴肝经的郁滞而行气止痛，且能降逆止呕，合四逆汤峻扶元阳之不足。
四诊：服上方一剂后，发热大减，口渴亦止，多日卧床不起，现已能起床便溺，溺色稍赤。但仍感下肢疼痛，不能移步，苔转白腻，脉仍濡。此系中阳虚衰，以致寒湿凝滞，气机不畅。宜交通阴阳，散寒祛湿。处方：
第一方：
第二方。
生苡仁9克
第二方即《金匮要略》麻黄加术汤及麻杏苡甘汤合方用以温散化湿。
五诊：上二方交叉各服二剂后，发热全退，惟觉下肢仍有疼痛，脉濡缓，舌苔薄腻。此乃脾湿不化，阻滞经络，故下肢仍有疼痛。法当健脾燥湿，祛风通络为治。处方：
方中猪苓、泽泻利水渗湿，苡仁，白术健脾利水、燥湿，萆薢祛风除湿，合桑枝能利关节除风寒湿痹。丝瓜络通筋络、舒血脉，与桑枝合用增强其通利血脉关节的作用，防风、独活祛风胜湿，疗风痹诸痛，黄柏坚肾、益阴而燥湿，淮牛膝益肾、引药力下达，善治肾虚腰腿疼痛或膝痛不能屈伸。
六诊：服上方一剂后，小便清长，下肢疼痛大减，已能移步。脉已平和，舌心微黄腻。此湿欲化热，处以原方减去萆薛、桑枝、丝瓜络、甘草，加沙参15克、元参9克、知母6克滋阴降火，再加筠姜散寒、除湿以开气血之凝滞。
七诊：服上方二剂后，竟能自由行走，惟步行时感轻微疼痛。考虑患者素禀不足，经此病后，元阳更虚，继以术附、参附、吴萸四逆、白通汤等更番调理而愈。
湿热两膝肿痛
In summary, the diagnosis is a syndrome of Spleen deficiency and Lung dryness (Spleen deficiency with Lung dryness). The treatment should primarily focus on strengthening the Spleen and drying dampness, supplemented by herbs that moisten the Lung and direct rebellious Qi downward. Use Ba Zhen San (Eight Treasures Powder) from *Qing Gong Mi Fang* (Secret Recipes of the Imperial Palace), modified:
Huai Shan Yao (Dioscoreae Rhizoma) 15g, Qian Shi (Euryales Semen) 15g, Lian Rou (Lotus Seed) 9g, Sheng Yi Ren (Coicis Semen) 9g
Sha Shen (Glehniae Radix) 15g, Fu Ling (Poria) 15g, Chen Pi (Citri Reticulatae Pericarpium) 6g, Jie Geng (Platycodonis Radix) 6g, Bai Bu (Stemonae Radix) 9g
Su Zi (Perillae Fructus) 9g, Zhi Dong Hua (Adenophorae Caulis) 9g, Bai Tang (White Sugar) 18g (mixed in three doses)
In this formula, Shan Yao (Dioscoreae Rhizoma) tonifies deficiency and supports weakness, benefits the Kidney and strengthens Yin, and also benefits the Spleen and Lung, clears deficient heat, treats consumptive disease, and promotes flesh growth. Qian Shi (Euryales Semen) supports the Spleen and benefits the Kidney, and astringes Lung Qi. Lian Rou (Lotus Seed) and Fu Ling (Poria) strengthen the Spleen, promote dampness drainage, and tonify the Lung, and can also facilitate communication between the Heart and Kidney. Yi Ren (Coicis Semen) removes dampness and reduces swelling, strengthens the Spleen, and tonifies the Lung. Sha Shen (Glehniae Radix) nourishes Yin, clears the Lung, dispels phlegm, and stops coughing. Jie Geng (Platycodonis Radix) opens Lung Qi, benefits the chest and diaphragm, and guides herbs upward. Chen Pi (Citri Reticulatae Pericarpium) dries dampness, regulates Qi, directs rebellious Qi downward, harmonizes the Middle Jiao, and prevents stagnation caused by other herbs. Bai Bu (Stemonae Radix), Dong Hua (Adenophorae Caulis), and Su Zi (Perillae Fructus) all treat chronic cough, direct rebellious Qi downward, transform phlegm, and moisten the Lung. White sugar harmonizes the Middle Jiao, tonifies deficiency, moistens the Lung, and generates fluids. Combined, these herbs jointly exert the effects of strengthening the Spleen, drying dampness, moistening the Lung, and directing rebellious Qi downward.
After taking three doses as instructed, symptoms decreased, but palpitations and poor sleep remained. The medicine hit the target; continue modifying the previous method:
Huai Shan Yao (Dioscoreae Rhizoma) 15g, Qian Shi (Euryales Semen) 15g, Sheng Yi Ren (Coicis Semen) 9g, Fu Ling (Poria) 15g
Guang Bai He (Lilii Bulbus) 9g, Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) 9g, Bai Zi Ren (Biota Seed) 9g
After three doses, sleep was peaceful, and spirit gradually improved, but facial and foot edema had not completely subsided. Switch to Sheng Xian Tang (Ascending Deflated Decoction) by Zhang Xichun, modified:
Bei Kou Qi (Astragali Radix) 18g, Lu Dang Shen (Codonopsis Radix) 15g, Huai Shan Yao (Dioscoreae Rhizoma) 15g, Shan Yu Rou (Corni Fructus) 9g
Sheng Ma (Cimicifugae Rhizoma) 6g, Chao Chai Hu (Bupleuri Radix) 6g, Jie Geng (Platycodonis Radix) 6g, Zhi Mu (Anemarrhenae Rhizoma) 6g
This formula originally treats the syndrome of collapse of the Great Qi in the chest. Zhang stated: "The Great Qi fills the chest and governs lung respiration." He also said: "The Great Qi is Zong Qi (Gathering Qi)," "It supports the whole body and serves as the leader of all Qi." I further borrowed this formula, modified, based on Zhang's citation from *Jin Gui Yao Lue* under the Water Gate section of Guizhi Jia Huangqi Tang: "When the Great Qi rotates, the pathogenic Qi disperses," to treat virtual edema due to collapse of the Great Qi, with good results.
After taking the above prescription for five consecutive doses, swelling disappeared completely, though occasional mild cough persisted. Switch to Pao Jiang Gan Cao Tang (Roasted Ginger and Licorice Decoction), modified:
Pao Jiang (Zingiberis Rhizoma Praeparatum) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Wu Wei Zi (Schisandrae Fructus) 6g, Su Zi (Perillae Fructus) 9g, Zhi Dong Hua (Adenophorae Caulis) 9g
Bai Mi (White Honey) (one spoonful mixed in each time)
Pao Jiang Gan Cao Tang transforms bitterness and sweetness into Yin; assisted by other herbs, it astringes the Lung and stops coughing.
After two doses, cough stopped completely. To consolidate efficacy, use Sheng Xian Tang (Kou Qi, Zhi Mu, Sheng Ma, Chai Hu, Jie Geng) plus Long Gu (Fossilia Ossis Mastodi) and Mu Li (Concha Ostreae) to astringe Lung Qi, Su Zi (Perillae Fructus) and Niu Bang Zi (Arctii Fructus) to regulate the Lung and dispel phlegm, Hang Shao (Paeoniae Radix Alba) to nourish the Liver, and Fa Ban Xia (Pinelliae Rhizoma Preparatum) to direct rebellious Qi downward. After five consecutive doses, various symptoms alleviated, followed by disappearance of clinical symptoms. Condition controlled without recurrence.
[Commentary]: The Spleen belongs to Earth, and the Lung belongs to Metal; Earth generates Metal. In physiological function, the Spleen governs transportation and transformation; the essence of water and grain is transported by the Spleen to the Lung to nourish the whole body, so their relationship is very close. Clinically, Spleen-Lung dual deficiency manifested as insufficient Spleen Qi and weak Lung Qi is common. In this case, under conditions of Spleen deficiency and dampness stagnation, there is not only Lung Qi deficiency but also Lung dryness with dry cough. Dampness and dryness become a major contradiction. Thus, medication difficulty is great: drying Spleen dampness increases Lung dryness, while moistening Lung dryness exacerbates Spleen dampness—a thorny syndrome. After analyzing the condition, I borrowed Ba Zhen San added with clearing, moistening, and Qi-tonifying herbs, both strengthening the Spleen and drying dampness, and moistening the Lung and directing rebellious Qi downward, matching the pathology and considering both aspects. Although the herbs are ordinary, the efficacy is significant.
Yin-Cold Edema and Restless Panting
Wang XX, Female, 70 years old. Suffered from generalized edema, fever, body pain, panting, irritability, chest tightness and distension, and constipation. Ill for many days, unresponsive to treatment, invited me to consult. Symptoms observed: bluish complexion lacking spirit, white slippery tongue, wiry-slippery pulse. Inquiry into onset revealed invasion of Wind-Cold combined with food stagnation. Previous physicians failed to distinguish exterior and interior, resulting in unresolved exterior pathogens and formed stagnation, obstructing Qi mechanism, filling with Yin cold. Current treatment should be divided into three steps: first, release the exterior and ventilate the Lung, simultaneously regulating Ying and Wei; second, resolve both exterior and interior, simultaneously eliminating stagnation; third, warm and strengthen Yang Qi to treat the root. First visit: Use Ma Gui Ge Ban Tang (Half-Ma Huang Half-Gui Zhi Decoction), modified. Prescription:
Ma Rong (Ephedrae Herba prepared) 6g, Xing Ren (Armeniacae Sem Amarum) 9g, Gui Zhi (Cinnamomi Ramulus) 9g, Hang Shao (Paeoniae Radix Alba) 9g, Su Ye (Perillae Folium) 6g
Fang Feng (Saposhnikoviae Radix) 9g, Du Huo (Angelicae Pubescentis Radix) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces
Second visit: After one dose, fever and body pain reduced, exterior pathogens gradually resolved. However, chest tightness and distension remained unchanged, indicating interior Qi not harmonized and stagnation not eliminated. Should resolve both exterior and interior, simultaneously eliminate stagnation. Use self-formulated Huo Xiang Gui Zhi Tang (Agastache and Cinnamon Twig Decoction), modified. Prescription:
Huo Xiang (Pogostemonis Herba) 6g, Shen Qu (Massa Medicata Fermentata) 9g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Jiao Zha (Crataegi Fructus Preparatus) 15g
Su Ye (Perillae Folium) 6g, Wu Bai Zhi (Angelicae Dahuricae Radix) 6g, Gui Zhi (Cinnamomi Ramulus) 6g, Hang Shao (Paeoniae Radix Alba) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g
Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 2 pieces
Third visit: After one dose of the above prescription, chest tightness and distension reduced, panting also decreased, only stool has not passed for many days. Observing bluish complexion lacking spirit and white slippery tongue, this is due to advanced age, insufficient Yang Qi, and Yin-cold coagulation. Should warm and strengthen Yang Qi, strike directly, facilitate communication between upper and lower, allowing sunken Qi to rise and turbid Qi to descend naturally. Use Gan Jiang Fu Zi Tang (Dry Ginger and Aconite Decoction) from *Shang Han Lun*. Prescription:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Gan Jiang (Zingiberis Rhizoma) 15g
After taking, bowel movement通畅, restless panting stopped, only frequent acid regurgitation. This is because Yin pathogens were too severe; taking Yang herbs resulted in the sun shining brightly and hard ice melting—a good sign. Now although bowel movement is clear, swelling has not subsided. This is Spleen-Kidney Yang deficiency with still prevalent Yin-cold. Should warm Yang, dispel cold, strengthen Spleen, and promote water drainage. Continue using Bai Tong Tang (White Ginger and Aconite Decoction) and Zhen Wu Tang (True Warrior Decoction), three doses each. After turbid Yin transformed and water returned to channels, swelling subsided, and body became light and healthy.
[Commentary]: "Release exterior before interior" is one of the important treatment principles in *Shang Han Lun*, which must be kept in mind during clinical practice. This case involves Spleen-Kidney Yang deficiency, external constriction by Wind-Cold, and gastrointestinal stagnation. According to *Shang Han Lun*: "Taiyang disease, headache, fever, body ache, waist pain, joint pain, aversion to wind, no sweat, and panting, Ma Huang Tang is indicated," and "Taiyang and Yangming combined disease, panting and chest fullness, cannot use purgatives, Ma Huang Tang is indicated." The latter mentions Yangming, referring to interior syndrome. When exterior and interior are present together, do not use purgatives; prioritize releasing the exterior. Therefore, first use Ma Gui Ge Ban Tang (Half-Ma Huang Half-Gui Zhi Decoction), modified, to allow pathogens to exit. Second step uses Huo Xiang Gui Zhi Tang (Agastache and Cinnamon Twig Decoction) to resolve both exterior and interior, simultaneously transforming stagnation. With exterior pathogens resolved and stagnation eliminated, conditions are created for the third step's medication. One must know what comes first and what comes later. Only then can medication have standards and achieve expected effects.
Bi Syndrome with Jaundice and Confusion
He XX, Male, 61 years old. Habitually drinks alcohol, previously suffered from rheumatoid arthritis and rheumatic heart disease. Now fever, whole-body pain, facial and limb edema, difficult urination, cough, and palpitations. Western medical diagnosis: Rheumatic heart disease accompanied by upper respiratory tract infection and heart failure. Hospitalized, treatment effect insignificant, condition worsening daily, invited me to consult. Pulse deep-tight, coating white-greasy, facial edema, edema in both hands and dorsum of feet, cool to touch, pitting upon pressure. Diagnosed as deficiency-cold syndrome where Wind-Cold-Dampness three pathogens attack Taiyin and Shaoyin simultaneously. Method should warm and support Kidney Yang, dispel Wind-Cold-Dampness. Administer self-formulated Fu Zi Gui Zhi Du Huo Ji Sheng Tang (Aconite, Cinnamon Twig, Angelica Pubescens, and Taxillus Decoction). Prescription:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Gui Zhi (Cinnamomi Ramulus) 12g, Chao Hang Shao (Paeoniae Radix Alba Preparata) 12g, Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Fu Ling (Poria) 15g
Chen Pi (Citri Reticulatae Pericarpium) 6g, Chuan Xiong (Chuanxiong Rhizoma) 6g, Fang Feng (Saposhnikoviae Radix) 9g, Du Huo (Angelicae Pubescentis Radix) 9g, Sang Ji Sheng (Taxilli Caulis et Folium) 15g
Tai Wu (Arecae Semen Preparatum) 9g, Da Zao (Jujubae Fructus) 3 pieces, Shao Sheng Jiang (Zingiberis Rhizoma Praeparatum) 5 slices
Take continuously for two doses, fever recedes, body pain also decreases. Swelling still not subsided, difficult urination. This is Spleen-Kidney Yang deficiency, Cold-Dampness not transported. Treatment should warm and tonify Spleen-Kidney, transport and transform Cold-Dampness. Use large dose Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) from *Shang Han Lun* plus Fu Pian. Prescription:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 90g, Fu Ling (Poria) 30g, Biao Bai Zhu (Atractylodis Macrocephalae Rhizoma) 18g, Gui Zhi (Cinnamomi Ramulus) 24g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 9g
Fu Pian warms Kidney Yang to strengthen Heart; Fu Ling, Bai Zhu, and Gan Cao strengthen Spleen, remove dampness, and promote water drainage; Gui Zhi unblocks Yang and transforms Qi, allowing Bladder Qi transformation to proceed, Sanjiao water passages to open, thus urine flows freely, and edema gradually subsides. After taking, indeed achieved expected effect. Should further warm Kidney, assist Yang, dispel cold, transform dampness, support righteous Qi, and restore physical function. Use large dose Fu Zi Tang (Aconite Decoction) from *Shang Han Lun*. Prescription:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 120g, Fu Ling (Poria) 30g, Chao Hang Shao (Paeoniae Radix Alba Preparata) 15g, Dang Shen (Codonopsis Radix) 15g
Biao Bai Zhu (Atractylodis Macrocephalae Rhizoma) 30g
This formula is Zhongjing's main formula for treating "Shaoyin disease, mouth feels normal, aversion to cold on back" and "body pain, cold hands and feet, joint pain, deep pulse." Using it for this symptom, Bai Zhu harmonizes Middle, regulates Qi, removes dampness; Fu Ling moves phlegm and promotes water drainage; Hang Shao nourishes Yin and stores ministerial fire; Fu Zi warms Kidney and assists Yang. Kidney is the gate of Stomach; Kidney Qi steams and activates, opening the gate; aided by Fu Ling and Bai Zhu's bland seeping and bitter descending, assisting water to flow down; Lu Dang Shen cultivates and supplements Spleen and Lung Qi; if Lung Qi is not deficient, governance and regulation proceed, only then can essence transform and urine discharge.
After two doses, edema completely subsided, body pain vanished like loss. But unexpectedly jaundice appeared, and urination again became difficult. Face, eyes, nails, and whole body yellow, color dull. Use Fu Zi Li Zhong Tang (Aconite and Four Gentlemen Decoction), modified. Prescription:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Lu Dang Shen (Codonopsis Radix) 18g, Biao Bai Zhu (Atractylodis Macrocephalae Rhizoma) 15g, Gan Jiang (Zingiberis Rhizoma) 15g, Yin Chen (Artemisiae Scopariae Herba) 9g
Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Fu Ling (Poria) 15g, Sha Ren (Amomi Fructus) 6g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) 6g
After taking, illness same as before, plus increased mental restlessness. Due to water-dampness stagnation and郁热 (depressed heat) internal accumulation. Switch to primarily unblocking Yang, promoting water drainage, clearing heat, and relieving restlessness. Combine Yin Chen Wu Ling San (Artemisia Scoparia Five-Ingredient Powder with Poria), Zhi Chi Tang (Gardenia and Soybean Paste Decoction), and Wen Dan Tang (Warm Gallbladder Decoction). Prescription:
Yin Chen (Artemisiae Scopariae Herba) 15g, Fu Ling (Poria) 15g, Zhu Ling (Polyporus) 12g, Bai Zhu (Atractylodis Rhizoma) 12g, Chao Ze Xie (Alismatis Rhizoma Preparatum) 18g
Gui Zhi (Cinnamomi Ramulus) 15g, Jiao Zhi Ren (Gardeniae Fructus Preparatus) 6g, Dan Dou Chi (Sojae Semen Preparatum) 9g, Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g, Chen Pi (Citri Reticulatae Pericarpium) 6g
Zhi Shi (Aurantii Fructus Immaturus) 9g, Zhu Ru (Bambusae Caulis in Taenia) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Gan Jiang (Zingiberis Rhizoma) 15g
Above, Wu Ling San helps Spleen transport, unblocks Yang, promotes water drainage; Yin Chen clears heat, drains dampness to reduce jaundice; Zhi Chi Tang relieves restlessness and heat. Then Wen Dan Tang descends Gallbladder, removes phlegm, and calms spirit; add Gan Jiang to protect Middle Yang, and counteract cold of Yin Chen and Zhi Zi. After taking, mental restlessness reduced, urine clear and long, jaundice gradually subsided.
During treatment, suddenly right index finger bent unable to extend, unbearable pain. Xie Yinglu's *De Xin Ji* calls this disease "Liver Wind Grasping Finger," pointing out etiology is Wood strong Earth weak, Liver Wind disease: "Liver Yin robbed by Fire, thus sinews tense and grasping. But Liver is a viscera. All wind-dispelling acrid-warm dispersing herbs instead aid Fire and rob Yin, isn't this worsening the disease?" Prescribed Xie's effective formula for this symptom:
Gui Zhi (Cinnamomi Ramulus) 9g, Chao Hang Shao (Paeoniae Radix Alba Preparata) 9g, Chao Chai Hu (Bupleuri Radix Preparata) 9g, Dan Chao Ban Xia (Pinelliae Rhizoma Preparatum) 15g
Long Dan Cao (Gentianae Radix) 9g, Chao Chuan Lian (Coptidis Rhizoma Preparatum) 4.5g, Jiao Zhi Ren (Gardeniae Fructus Preparatus) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g
Gan Jiang (Zingiberis Rhizoma) 15g
After one dose, pain slightly reduced, finger slightly extended. Take another two doses, finger flexion and extension normal. However, Middle Jiao Yang greatly deficient, Spleen dampness not transformed, symptoms appear chest tightness, abdominal distension, diarrhea. Use Si Ni Tang (Frigid Extremities Decoction) plus Fu Ling, one dose stops diarrhea. But mental confusion appears again. Check pulse, six positions of both hands scattered large without root, tongue coating blue-slippery. This is Heart-Kidney ascending-descending dysfunction causing spirit scattering. Syndrome belongs to deficiency not excess, should treat primarily by facilitating communication between Yin-Yang, gathering Yuan Qi. Heart governs Spirit; if Heart Yang does not decline, Spirit does not scatter, then consciousness will not be confused. First administer Si Ni Tang (Frigid Extremities Decoction) plus Rou Gui (Cinnamomi Cortex), Zhu Dan Zhi (Porci Bile), Tong Bian (Human Urine). After one dose, spirit slightly calm, then use Bu Kan Yi Li Tang (Tonify Kan Enrich Li Decoction) (Fu Pian, Rou Gui, Ge Fen, Zhi Gan Cao, Sheng Jiang) specifically tonifying Heart Yang, simultaneously nourishing Kidney Yin. After four doses, consciousness clear, like waking from big dream, body and mind greatly refreshed, only limbs slightly edematous. Then use Bai Tong Tang and Si Ni Tang to gather Yuan Qi, and various symptoms disappear. Finally use Ji Sheng Shen Qi Wan (Kidney Qi Pill from Ji Sheng Fang) to regulate, body gradually recovered and discharged.
[Commentary]: TCM Bi syndrome covers a wide range, not just Wind-Cold-Dampness Bi. This case presents diverse manifestations, unpredictable changes, worthy of being called difficult and complicated diseases. Its pathology seems dominated by Dampness throughout. Internal accumulated Dampness sometimes transforms from Cold, sometimes from Heat, and is quite sensitive to herbal reactions. If one does not grasp the pathology, differentiate and treat according to syndrome, prescribe formulas according to symptoms, how can one adapt to its changes? It is visible that as long as one masters TCM principles and differentiation and treatment methods, grasps main contradictions at different periods, handles flexibly, then pathogens will have nowhere to hide, and critical conditions can turn danger into safety.
Wind-Cold-Dampness Bi
Chen XX, Male, 14 years old. Suffered from fever and aversion to cold, headache, body fatigue, lower back soreness, nausea and desire to vomit. Initially took Gui Zhi Tang (Cinnamon Twig Decoction) but symptoms did not decrease; next day appeared slight greasy tongue coating, less aversion to cold but higher fever, symptoms resembling Wind-Warmth, switched to Yin Qiao San (Forsythia Powder) combined with Cong Chi Tang (Scallion and Soybean Paste Decoction); after medication, afternoon fever like malaria. Took Western medicine Atabrine ineffective, turned to all-day fever, severe lower limb pain, night fever especially intense, temperature 39.5°C, bedridden, restless groaning, unable to sleep peacefully. Onset now half month, symptoms mixed, cold and heat indistinguishable, invited me to treat. Carefully examined, patient initially contracted Cold pathogens due to sudden climate change. Symptoms observed: blue-slippery tongue body, thin-greasy tongue coating, floating pulse but powerless, face and lips bluish. Ill for many days, still fever now, floating pulse indicates exterior pathogens still present; due to Cold-Dampness blocking meridians "blockage causes pain," hence lower limb pain. Pulse and symptoms combined, syndrome belongs to Yang deficiency contracting Cold combined with internal Dampness stagnation. First give method of warming meridians, dispelling cold, harmonizing Ying and Wei, simultaneously regulating Qi mechanism. Prescribe Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction plus Aconite), modified. Prescription:
Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Gui Zhi (Cinnamomi Ramulus) 12g, Hang Shao (Paeoniae Radix Alba) 12g, Xiang Fu (Cyperi Rhizoma) 9g, Mai Ya (Hordei Fructus Germinatus) 9g
Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces
In formula, Fu Pian warms Taiyang meridians; Gui Zhi Tang releases exterior, resolves muscle layer, harmonizes Ying and Wei; combined with Xiang Fu and Mai Ya to move Taiyang stagnant Qi, open Taiyang Qi mechanism.
Second visit: After one dose of above prescription, quieter than before, but fever not reduced, lower limbs still painful, plus vomiting and nausea, tongue and pulse same as before. This is Cold-Dampness coagulation stagnation, Stomach turbidity not transformed, Turbid Yin attacking upward. Method should warm meridians, unblock collaterals, dispel Wind, scatter Dampness, move stagnation, direct rebellious Qi downward. Prescribe self-formulated Fu Zi Gui Zhi Du Huo Ji Sheng Tang (Aconite, Cinnamon Twig, Angelica Pubescens, and Taxillus Decoction):
Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Gui Zhi (Cinnamomi Ramulus) 9g, Sang Ji Sheng (Taxilli Caulis et Folium) 15g, Hang Shao (Paeoniae Radix Alba) 9g, Fa Ban Xia (Pinelliae Rhizoma Preparatum) 9g
Fu Ling (Poria) 15g, Tai Wu (Arecae Semen Preparatum) 9g, Chen Pi (Citri Reticulatae Pericarpium) 6g, Du Huo (Angelicae Pubescentis Radix) 6g, Fang Feng (Saposhnikoviae Radix) 9g
Chuan Xiong (Chuanxiong Rhizoma) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 5 slices, Da Zao (Jujubae Fructus) 3 pieces
In formula, Fu Pian, Gui Zhi, Hang Shao, Gan Cao, Sheng Jiang, Da Zao used to warm meridians, dispel cold, unblock collaterals; Chen Pi regulates Qi, strengthens Spleen, dries dampness; combined with Fu Ling enhances strengthening Spleen and draining dampness; Fa Ban Xia directs rebellious Qi downward, stops vomiting, dries dampness, transforms phlegm; Tai Wu moves Qi, dispels cold; Chuan Xiong invigorates Blood, moves Qi; combined they enhance moving Qi and stopping pain; Fang Feng and Du Huo dispel Wind, overcome Dampness, relieve Bi pain; Sang Ji Sheng tonifies Liver and Kidney, removes Wind-Dampness.
Third visit: After two doses of above prescription, night fever slightly reduced, temperature gradually dropped, vomiting stopped, restlessness settled, no longer groaning like before, thirsty for drink but not much. This is Lower Jiao Yuan Yang deficiency decline, Yin-cold internally prevalent. Should warm Yang, dispel cold, prescribe Wu Yu Si Ni Tang (Evodia and Frigid Extremities Decoction) from *Shang Han Lun*:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Chao Wu Yu (Evodiae Fructus Preparatum) 6g, Gan Jiang (Zingiberis Rhizoma) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 5g
In formula, Wu Yu warms Middle, dispels cold, soothes Liver, warms Spleen, good at resolving Jueyin Liver meridian stagnation to move Qi and stop pain, and can direct rebellious Qi downward and stop vomiting; combined with Si Ni Tang strongly supports insufficiency of Yuan Yang.
Fourth visit: After one dose of above prescription, fever greatly reduced, thirst also stopped, bedridden for many days, now able to get up and urinate/defecate, urine color slightly red. Still feel lower limb pain, unable to walk, coating turned white-greasy, pulse still soggy. This is Middle Yang deficiency decline, causing Cold-Dampness coagulation stagnation, Qi mechanism not smooth. Should facilitate communication between Yin-Yang, scatter cold, dispel dampness. Prescription:
First Formula:
Hei Fu Pian (Aconiti Lateralis Radix Praeparata) 60g, Gan Jiang (Zingiberis Rhizoma) 15g, Cong Bai (Allii Fistulosi Bulb) 3 pieces
Second Formula:
Ma Rong (Ephedrae Herba prepared) 3g, Xing Ren (Armeniacae Sem Amarum) 6g, Gui Zhi (Cinnamomi Ramulus) 6g, Bai Zhu (Atractylodis Rhizoma) 12g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 5g
Sheng Yi Ren (Coicis Semen) 9g
First formula is Zi Tong Tang (Self-Unblocking Decoction), used to facilitate communication between Heart and Kidney Yang, supplement insufficiency of Wu Yu Si Ni Tang.
Second formula is combination of Ma Huang Jia Zhu Tang (Ephedra plus Atractylodes Decoction) and Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) from *Jin Gui Yao Lue*, used to warm and scatter, transform dampness.
Fifth visit: After alternating taking two doses of above two formulas, fever completely retreated, only feel lower limbs still painful, pulse soggy-slow, tongue coating thin-greasy. This is Spleen dampness not transformed, blocking meridians, hence lower limbs still painful. Method should strengthen Spleen, dry dampness, dispel Wind, unblock collaterals for treatment. Prescription:
Zhu Ling (Polyporus) 6g, Chao Ze Xie (Alismatis Rhizoma Preparatum) 6g, Fu Ling (Poria) 15g, Yi Ren (Coicis Semen) 9g, Huai Niu Xi (Achyranthis Bidentatae Radix) 6g
Tu Fu Ling (Smilacis Glabrae Rhizoma) 6g, Bi Xie (Dioscoreae Hypoglaucae Rhizoma) 6g, Jiao Huang Bo (Phellodendri Cortex Preparatus) 6g, Si Gua Luo (Luffae Fibroreticulata Retinervus) 5g, Sang Zhi (Mori Ramulus) 9g
Fang Feng (Saposhnikoviae Radix) 6g, Du Huo (Angelicae Pubescentis Radix) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 5g
In formula, Zhu Ling and Ze Xie promote water drainage and seep dampness; Yi Ren and Bai Zhu strengthen Spleen, promote water drainage, dry dampness; Bi Xie dispels Wind and removes Dampness; combined with Sang Zhi can benefit joints, remove Wind-Cold-Dampness Bi. Si Gua Luo unblocks sinew collaterals, relaxes blood vessels; combined with Sang Zhi enhances their role in unblocking blood vessels and joints; Fang Feng and Du Huo dispel Wind, overcome Dampness, treat Wind-Bi various pains; Huang Bo solidifies Kidney, nourishes Yin, and dries dampness; Huai Niu Xi tonifies Kidney, guides medicinal power downward, good at treating Kidney deficiency waist-leg pain or knee pain unable to flex/extend.
Sixth visit: After one dose of above prescription, urine clear and long, lower limb pain greatly reduced, able to walk. Pulse already peaceful, center of tongue slightly yellow-greasy. This dampness desires to transform into heat, prescribe original formula minus Bi Xie, Sang Zhi, Si Gua Luo, Gan Cao, add Sha Shen (Glehniae Radix) 15g, Yuan Shen (Scrophulariae Radix) 9g, Zhi Mu (Anemarrhenae Rhizoma) 6g to nourish Yin and descend fire, plus Jun Jiang (likely typo for something else, possibly Jiang or similar herb contextually implied as warming/dispersing) to scatter cold, drain dampness to open Qi-Blood stagnation.
Seventh visit: After two doses of above prescription, actually able to walk freely, only feel slight pain when walking. Considering patient constitution insufficient, after this illness, Yuan Yang more deficient, continue with Shu Fu Tang, Shen Fu Tang, Wu Yu Si Ni Tang, Bai Tong Tang etc. alternately regulated and cured.
Damp-Heat Two Knees Swelling and Pain