曾×，男，四十一岁_o素体赢弱，兼有痰饮。1951年2月来所求诊，以手按右肋部，疼痛难忍，呻吟不已。发热、咳嗽、气粗，夜不安寐，面目黧黑。脉弦紧，舌苔白腻。脉症合参，此系风寒外束，痰饮内伏，郁久酿热所致。患者素禀虚弱，综合观之，病邪有余，体功不足。用药必须固护周全，不可顾此失彼。处方：
石菖蒲6克
方中附片辛热，石膏甘寒，二药相伍，寒热并用，一以扶阳，一以清热。附片配法夏、薤白、白芥等能温宣胸阳，祛痰化饮，配枣仁以强心安神。石膏清郁热，合麻黄以开发肺气之闭。牡蛎软坚柔肝，缓急迫而解痛。郁金、菖蒲利气散结舒郁，以解右肋之痛。
服二剂诸症俱减，精神转佳，尚发热、咳嗽，续予温肾扶阳，祛风散寒，降逆化痰。用自拟方附子桂枝独活寄生汤加昧。处方：
服一剂，发热即解，除咳嗽痰多外，各症均有好转，继以宣降肺气，止咳化痰治之。方用二陈汤合三子养亲汤加减。处方：
[按]：临证治病，用寒田热，或寒热并用，全由病情而定，应遵循仲景：“观其脉证，知犯何逆，随证治之”的原则去处理。本案表里互见，虚实相兼，寒热混杂，故不僻不用附子温阳扶正，用石膏以清郁热(石膏配麻黄叉能宣发肺气之闭)。药性虽异，各有专司。此种用法，诚有所本。《金匮》越婢汤“恶风加附子”，《千金方》越婢汤等，直接以附子石膏并用者并非少见。
另；此案方中曾以附片、半夏、瓜蒌等反药并用，但未见发现任何不良反应，且似有增强通阳豁痰之功。这说明古之所谓“十八反”，亦非一成不变，实值得进一步研究。
阴虚肝气横逆二例
例一：胁肋剧痛
王××，女，五十岁。昔有鸦片嗜好，向来身体瘦弱。1951年元月，忽患胃脘及小腹疼痛难忍，大便多日未解。某医处以枳实导滞汤，因体质素弱，不耐此峻剂，服后大便虽行，但疼痛加剧，奄奄一息。该医复用逍遥散加香附、青皮，意欲调气止痛，但疼痛未减，且不能仰卧转侧。某西医断为：肝炎，胆囊炎，用西药治疗，亦未见效。因来就诊。视其唇舌紫色，舌根甚燥，脉细而弦，饮食甚少，余如上述。脉症合参，诊为阴虚、肝气横逆、中气不运。因病者体质素虚，又经消导攻下，中气已伤，虽大便多日未解，不能再用攻下，宜本仲景“见肝之病，知肝传脾，当先实脾”以及祝味菊先生“体功重于病邪”的原则，先当建运中气，扶持体功。投以《金匮要略》大建中汤。处方：
方中花椒、干姜散寒祛湿、温中快膈，合以党参、饴糖之和中益气，则有大建中气、温补脾胃之功。
服一剂，腹转矢气，胃脘及小腹痛减，精神稍好，但胁痛依然。乃转从肝治，仿叶天士肝病治法，处方用：
方中归、芍补血活血；合以花椒、乌梅则能养肝、温营血暖胃；玄胡、川楝疏肝祛瘀而止诸痛；砂仁行滞气，茯神、甘草益心脾而培中；杜仲补益肝肾，诸药又得龟板、鳖甲之益阴补血散结，则达郁、舒气、柔肝、止痛之力悉备。
服二剂后，胁痛减退七、八，大便通畅。但觉五心烦热，夜睡少眠，是阴虚之真相毕露，再于前方去玄胡、花椒、加龙骨、牡蛎、女贞子、枣仁、山萸肉以镇静安神、润燥除烦。连服二剂，烦止眠安，继又以大建中汤二剂，疼痛全除。最后，以归芍六君汤调理善后而愈。例二：颜面四肢浮肿陈××，女，五十一岁。患颜面四肢浮肿，前医曾用苓桂术甘汤和理中汤加减等，温阳利水，健脾燥湿，均未获效，反增心烦气冲，因来求诊。诊脉细数，舌紫苔腻而干，四肢虽肿但按之并无凹陷。脉症合参，亦诊为阴虚、肝气上逆。处以下方：
方中龟板、鳖甲滋阴潜阳，杭芍、乌梅活血敛阴而养肝，川楝子舒肝理气，果杞、菟丝、女贞、萸肉补益肝肾，益精柔肝，白薇清热除烦，谷芽消食健胃以防补药之壅滞。诸药合用，滋阴补血，补养肝肾，收纳耗散之肝气。
服二剂后，多日来之颜面四肢浮肿已消大半，心烦气冲亦现平缓，但突见周身发痒，皮肤干燥。此系阴血不足，津液不行，肌肤失养所致。处方：
方中鳖甲、龟板滋阴补血；炙首乌补肝肾，益精血，又能补血祛风，当归、杭芍活血养肝，丹皮清热凉血、活血祛瘀，麦冬，桑叶、菊花、乌梅、萸肉、女贞养肝阴、润肺燥、收纳肝气。
上方服后，肤痒若失，肿胀全消。
[按]：治肝诸法，以叶天士为擅长，因肝为刚脏，体阴用阳，发病时，不是“肝用太过”就是“肝体不及”。但临床上亦有肝用被损者，故用药应力戒偏激，因为偏寒偏热，皆难中病。若过温过散则伤阴而亏其本体，过寒过润，不仅伤阳而抑其升发之机，且易损伤脾胃，导致中气衰败。同时，肝脏体用之正常，全赖血液之濡、肾水之涵，肺气之敛，脾土之培，故用药时，养血、滋肾、敛肺、培土等几方面都要有所照顾，方能遂其条达舒畅之性。上述二例，在这些方面都是有所考虑的。
疟病阳气大虚
花×，男，二十八岁，在云南中越边境某地工作。解放前其地多瘴疟，花某体质素亏，又加工作过劳，于夏秋之交感染瘴疟，经当地中西医治疗无效。病势日重，转来昆明就医，经西药抗疟，中医用中药小柴胡汤加常山、槟榔等，亦无效，乃来所求治。查其脉空而无根，舌苔白而厚腻，四肢厥冷。面青，指甲乌黑，目无光泽，白睛如有蓝雾上蒙，冷汗淋漓，毛发直立。其母代诉，患者背部时时恶寒，每日午后发冷，寒战不休，牙齿鼓栗，旋即发热，热则涕泪口涎俱出，如是已二月余。其家属甚为焦虑，惴惴不安。
析其病情，脉空无根者，肾阳大虚，体质亏损之至也。舌苔白而厚腻，乃寒湿内蕴，胃浊不化也。四肢厥冷者．生阳之气不能透达于四末也。太阳之经脉行于背部，太阳与少阴相表里，今少阴之阳衰，而阴寒之气窜于太阳之经，故背部时时恶寒也。午后为阴盛之时，阴盛则阳衰，故发冷加剧，寒战不体，齿牙鼓栗，乃沉寒痼冷之候也。肾之精华皆上注于日，肾精耗损，散目无光彩，如蓝雾所蒙。肾主五液，今肾气大衰，气不摄液，故冷汗淋漓，涕泪口涎俱出也。以上症状．皆肾阳过虚，阴寒过盛元气欲脱使然也。本病关键在于肾阳大虚，尤其午后寒热交作如疟状，远较寒热往来之少阳症，病势更为凶险，此为阴阳不相维系之故也。本病虽以疟名，但不可按疟治，急应引阳归舍，整顿纲维，大固中焦，能得阴阳调和，则寒热可止。然病已拖延日久，实非易事，若再用小柴胡汤一类和解少阳，恐有阳脱之虞。宜急回阳救逆．用《伤寒论))四逆汤和白通汤。处方：
第一方：
第二方：
二诊：其母代诉，上方各服十二剂，病虽未增，亦无明显好转。家属疑惧。然此病确为阴寒重症，除四逆、白通大扶元阳外，别无他法。何以不效，非药不对症，乃病重药轻，不足以驱除阴寒之邪。仍守原方，将炙附片改用盐附子，加大剂量以增强回阳驱寒之力，嘱各服三剂。
三诊：患者自诉，服药后，犹如坚冰消融，泻下黑水甚多，冷汗渐收，手足渐温，午后寒热消失。此乃里阳得回，阳气渐充，弥漫满腹之浊阴得以消除。改以附子理中汤。处方：
黑附片90克 潞党参15克 白术15克 干姜24克 甘草9克
四诊：服十剂，诸症均减，精神大有好转，面部及指甲转现红润之色。但背部仍感恶寒，脉沉细，舌淡苔白。改予《伤寒论》附子汤与桂枝汤合方。处方：
黑附片90克 潞党参15克 白术12克 茯苓15克 桂枝15克
五诊：服四剂，背部恶寒不除，再予温阳益气，脾肾两补之方。易方用四逆汤加潞党参，嘱服五剂，并加外治配合。处方：
外用：生姜汁一斤，牛皮胶120克，二味熬成稀膏。摊于布上，贴背部肺俞穴。此膏张锡纯名为姜胶膏。原注云：“用贴肢体受凉疼痛，或有凝寒阻碍血脉，麻木不仁”。其义如张氏所云：“鲜姜之辛辣开通，热而能散，故能温暖肌肉，深透筋骨，以除其凝寒痼冷，而焕然若冰释也；用水胶(即牛皮胶)者，借其粘滞之力，然后可熬之成膏也。”此膏既能陈“凝寒痼冷”，今借用于背部恶寒难除亦当有效。
六诊：经上述内服外贴后，背部恶寒全除，仍用四逆汤、白通汤、附子理中汤等调理，以恢复体功。病乃痊愈。
本病治愈全过程历时三月之久，服药百余剂，所用附片甚多。
[按]：疟疾一病，《内经》记载颇详，经历代医家不断补充和发展，内容和治法十分丰富。然于阳虚方面，论述较少。中医治病，主要重视辨证，亦不忽略病名。如疟疾是病名，但不同的人，具体的病机不同，因而治法亦异。若只注意病名，而一再抗疟、截疟，不考虑患者体质，忽略人的机体功能，专以杀灭原虫为务，并非全面。本例虽惠疟疾，但背部恶寒珠甚，午后寒战不休，结合色脉，阳虚之象十分明显。《灵枢·口问篇》云：“寒气客于皮肤，阴气盛，阳气虚，故为振寒寒栗。补诸阳。”尤在泾亦云：“几疟疾……多寒而久不解者，其人必本阳虚，法当甘温散邪，非干姜附子桂枝人参之属，不能已也。” (见《金匮翼·疟疾统论》)尤氏此语，实为经验之谈。
此外，还可看出，治慢性病，贵在“有方有守”，既确诊为阳气大虚之阴寒重症，则回阳救逆之法不可轻易改变，一经确诊，则宜持重守方，直至见功为止。
中气暴脱寒热似疟
许××，男，二十岁。1951年1月初发病，每日午后恶寒发热，继即大汗如洗。汗后热退，至次日午后又复发作。病程持续已达二十余日之久，曾用西药奎宁等类作抗疟治疗，见效不大，改请某中医用小柴胡汤仍然无效，而症象如故，体力渐难支持，由其父扶持来就诊。细审此症，面色青暗，两眼无神而呆视，语音低微，少气懒言，脉来沉细，重按无根，舌苔滑润质淡。其父代诉云：“发病时，恶寒则冷如冰雪，发热则如抱炉火。”据其脉症，每日午后寒热，状似疟疾，但热后汗出淋漓如洗，显系中阳不能内守，元气外越，此乃辨证之关键所在。再由患者面色、眼神、舌色等综合观察，已现一派体功不足之虚象，用药不可再事发散。急应扶其中阳，收纳元气，不使外越，或可取效。法当先用理中汤加味。处方：
理中汤，本为中焦虚寒而立。党参补气养液而益脾，白术健脾燥湿，干姜温中散寒，炙草甘温，配参、术则补中益气，配干姜则辛甘化阳，阳气化行，何患寒邪不散!四味组合，功能扶中阳、固元气、健脾胃、除虚寒。加砂仁纳气归肾，茯苓燥湿健脾，法夏温健脾胃、降逆止呕。如此加减，使脾胃阳气得复，诸证自可随之而解。
次日复诊：自诉服前方后，寒热大减，汗液渐收。脉搏、呼吸、眼神均见好转之象。法当继续扶正祛邪，踵原方加附子温肾扶阳，以固命门。处方：
附片60克 潞党参15克 白术15克 干姜30克 炙甘草6克
此方之用，本王冰所谓“益火之原，以消阴翳”的原理，加附子温扶先天之阳。先天阳旺，则中焦之阳得复而寒邪自除，脾肾阳旺则阴邪消散。清代医家郑钦安说：“阳旺始能镇纳群阴，阴气始得下降，阳气始得潜藏，乃不外亡。”
三日复诊：寒热全退，汗出全止，脉象已由沉细无根转为和缓，病势大有好转。乃着重培土建中，中气健运，可望巩固。处以黄芪建中汤加味调治：
嘱服三剂后，病渐痊愈。
曾某，男性，四十一岁。平素体质虚弱，兼有痰饮（体内停聚的水液病理产物）。1951年2月来诊所就诊，用手按压右侧肋部，疼痛剧烈难忍，呻吟不止。伴有发热、咳嗽、呼吸粗重，夜间无法安睡，面色和目眶发黑。脉象弦紧，舌苔白腻。综合脉象与症状分析，此为风寒之邪束缚体表，痰饮潜伏于内，郁结日久化热所致。患者先天禀赋虚弱，综合观察，属于病邪有余而正气不足。用药必须全面固护正气，不可顾此失彼。处方：
石菖蒲6克
方中附片性味辛热，石膏性味甘寒，两药配合，寒热并用，一者扶助阳气，一者清泄热邪。附片配合法夏、薤白、白芥子等能温通宣发胸中阳气，祛除痰饮；配伍枣仁以增强心气、安定神志。石膏清泄郁热，合用麻黄以开发肺气的闭阻。牡蛎软坚散结、柔肝缓急，缓解紧迫以解除疼痛。郁金、石菖蒲理气散结、舒展郁滞，以解除右肋部的疼痛。
服用两剂后，各种症状均减轻，精神状态转佳，但仍发热、咳嗽，继续采用温补肾阳、扶助阳气、祛风散寒、降逆化痰的方法治疗。使用自拟方附子桂枝独活寄生汤加味。处方：
服用一剂后，发热即解，除咳嗽痰多外，其他症状均有好转，继以宣降肺气、止咳化痰的方法治疗。方用二陈汤合三子养亲汤加减。处方：
[按语]：临证治病，使用寒药或热药，或寒热药并用，完全由病情决定，应遵循张仲景“观其脉证，知犯何逆，随证治之”的原则去处理。本案表里同病，虚实夹杂，寒热混杂，故不避忌使用附子温阳扶正，使用石膏清泄郁热（石膏配麻黄又能宣发肺气的闭阻）。药性虽然不同，但各有专门的功效。这种用法，确实有所依据。《金匮要略》越婢汤条文中提到“恶风加附子”，《千金方》中的越婢汤等，直接以附子和石膏并用的情况并不少见。
另外，此案方中曾将附片、半夏、瓜蒌等所谓“十八反”中的相反药物并用，但未发现任何不良反应，且似乎有增强通阳豁痰的功效。这说明古之所谓的“十八反”，并非一成不变，实在值得进一步研究。
阴虚肝气横逆二例
例一：胁肋剧痛
王某某，女性，五十岁。过去有吸食鸦片的嗜好，向来身体瘦弱。1951年1月，突然患胃脘及小腹疼痛难忍，大便多日未解。某医生处以枳实导滞汤，因患者体质素来虚弱，不耐受此峻猛之剂，服药后大便虽通，但疼痛加剧，奄奄一息。该医生又复用逍遥散加香附、青皮，意图调气止痛，但疼痛未减，且不能仰卧翻身。某西医诊断为：肝炎，胆囊炎，用西药治疗，也未见效。因而来就诊。观察其唇舌呈紫色，舌根非常干燥，脉象细而弦，饮食很少，其余情况如上述。综合脉症分析，诊断为阴虚、肝气横逆、中气不运。因病者体质素虚，又经过消导攻下的治疗，中气已受伤，虽然大便多日未解，不能再使用攻下法，应当遵循张仲景“见肝之病，知肝传脾，当先实脾”以及祝味菊先生“体功重于病邪”的原则，首先应当建立运转中气，扶持机体功能。投以《金匮要略》大建中汤。处方：
方中花椒、干姜散寒祛湿、温中快膈，合以党参、饴糖的和中益气作用，则有大建中气、温补脾胃的功效。
服用一剂后，腹部转出现矢气，胃脘及小腹痛减，精神稍好，但胁痛依然。于是转而从肝脏治疗，仿效叶天士肝病治法，处方用：
方中当归、白芍补血活血；合以花椒、乌梅则能养肝、温营血暖胃；玄胡索、川楝子疏肝祛瘀而止诸痛；砂仁行滞气，茯神、甘草益心脾而培补中气；杜仲补益肝肾，诸药又得龟板、鳖甲的益阴补血散结作用，则达郁、舒气、柔肝、止痛之力全部具备。
服用两剂后，胁痛减退七八成，大便通畅。但觉得五心烦热，夜间睡眠少，这是阴虚的本质完全显露，再于前方中去掉玄胡索、花椒，加入龙骨、牡蛎、女贞子、枣仁、山萸肉以镇静安神、润燥除烦。连服两剂，烦躁停止，睡眠安宁，继而又以大建中汤两剂，疼痛全部消除。最后，以归芍六君汤调理善后而痊愈。
例二：颜面四肢浮肿
陈某某，女性，五十一岁。患有颜面四肢浮肿，前医曾用苓桂术甘汤和理中汤加减等，温阳利水，健脾燥湿，均未获效，反而增加心烦气冲的症状，因而来求诊。诊脉细数，舌紫苔腻而干，四肢虽肿但按之并无凹陷。综合脉症分析，也诊断为阴虚、肝气上逆。处以下方：
方中龟板、鳖甲滋阴潜阳，杭芍、乌梅活血敛阴而养肝，川楝子舒肝理气，枸杞、菟丝子、女贞子、山萸肉补益肝肾，益精柔肝，白薇清热除烦，谷芽消食健胃以防补药的壅滞。诸药合用，滋阴补血，补养肝肾，收纳耗散的肝气。
服用两剂后，多日来的颜面四肢浮肿已消大半，心烦气冲也现平缓，但突然见到周身发痒，皮肤干燥。这是阴血不足，津液不行，肌肤失养所致。处方：
方中鳖甲、龟板滋阴补血；炙首乌补肝肾，益精血，又能补血祛风，当归、杭芍活血养肝，丹皮清热凉血、活血祛瘀，麦冬、桑叶、菊花、乌梅、山萸肉、女贞子养肝阴、润肺燥、收纳肝气。
上方服用后，皮肤瘙痒消失，肿胀全部消除。
[按语]：治疗肝脏的各种方法，以叶天士最为擅长，因为肝为刚脏，体阴用阳，发病时，不是“肝用太过”就是“肝体不及”。但在临床上也有肝用被损伤的情况，所以用药应力戒偏激，因为偏寒偏热，都难以击中病症。如果过温过散则会伤阴而亏损肝的本体，过寒过润，不仅伤阳而抑制其升发之机，且容易损伤脾胃，导致中气衰败。同时，肝脏体用的正常，全赖血液的濡养、肾水的涵润，肺气的收敛，脾土的培补，所以用药时，养血、滋肾、敛肺、培土等方面都要有所照顾，才能顺应其条达舒畅的特性。上述两例，在这些方面都是有所考虑的。
疟病阳气大虚
花某，男性，二十八岁，在云南中越边境某地工作。解放前该地区多瘴疟，花某体质素亏，又加上工作过劳，于夏秋之交感染瘴疟，经当地中西医治疗无效。病势日益加重，转来昆明就医，经西药抗疟，中医用中药小柴胡汤加常山、槟榔等，也无效，乃来诊所求治。查其脉空而无根，舌苔白而厚腻，四肢厥冷。面色青，指甲乌黑，双目无光泽，白睛如有蓝雾上蒙，冷汗淋漓，毛发直立。其母亲代诉，患者背部时时感到恶寒，每日午后发冷，寒战不休，牙齿打颤，旋即发热，发热时鼻涕、眼泪、口涎俱出，如此已二月余。其家属甚为焦虑，惴惴不安。
分析其病情，脉空无根者，是肾阳大虚，体质亏损到了极点。舌苔白而厚腻，是寒湿内蕴，胃浊不化。四肢厥冷者，是生阳之气不能透达于四肢末端。太阳经脉行于背部，太阳与少阴相表里，现在少阴之阳衰，而阴寒之气窜入太阳之经，所以背部时时恶寒。午后为阴盛之时，阴盛则阳衰，所以发冷加剧，寒战不休，牙齿打颤，乃是沉寒痼冷之候。肾之精华皆上注于目，肾精耗损，双目无光彩，如蓝雾所蒙。肾主五液，现在肾气大衰，气不摄液，所以冷汗淋漓，鼻涕、眼泪、口涎俱出。以上症状，皆是肾阳过虚，阴寒过盛，元气欲脱使然。本病关键在于肾阳大虚，尤其午后寒热交作如疟状，远较寒热往来之少阳症，病势更为凶险，此为阴阳不相维系之故。本病虽以疟命名，但不可按疟疾治疗，急应引阳归舍，整顿纲维，大固中焦，能得阴阳调和，则寒热可止。然而病已拖延日久，实非易事，若再用小柴胡汤一类和解少阳，恐有阳气外脱的危险。宜急回阳救逆，用《伤寒论》四逆汤和白通汤。处方：
第一方：
第二方：
二诊：其母亲代诉，上方各服十二剂，病虽未增，亦无明显好转。家属疑惧。然而此病确为阴寒重症，除四逆汤、白通汤大扶元阳外，别无他法。为何不效？非药不对症，乃病重药轻，不足以驱除阴寒之邪。仍守原方，将炙附片改用盐附子，加大剂量以增强回阳驱寒之力，嘱各服三剂。
三诊：患者自诉，服药后，犹如坚冰消融，泻下黑水甚多，冷汗渐收，手足渐温，午后寒热消失。此乃里阳得回，阳气渐充，弥漫满腹之浊阴得以消除。改以附子理中汤。处方：
黑附片90克 潞党参15克 白术15克 干姜24克 甘草9克
四诊：服用十剂，诸症均减，精神大有好转，面部及指甲转现红润之色。但背部仍感恶寒，脉沉细，舌淡苔白。改予《伤寒论》附子汤与桂枝汤合方。处方：
黑附片90克 潞党参15克 白术12克 茯苓15克 桂枝15克
五诊：服用四剂，背部恶寒不除，再予温阳益气，脾肾两补之方。换方用四逆汤加潞党参，嘱服五剂，并加外治配合。处方：
外用：生姜汁一斤，牛皮胶120克，二味熬成稀膏。摊于布上，贴背部肺俞穴。此膏张锡纯名为姜胶膏。原注云：“用贴肢体受凉疼痛，或有凝寒阻碍血脉，麻木不仁”。其义如张氏所云：“鲜姜之辛辣开通，热而能散，故能温暖肌肉，深透筋骨，以除其凝寒痼冷，而焕然若冰释也；用水胶(即牛皮胶)者，借其粘滞之力，然后可熬之成膏也。”此膏既能除“凝寒痼冷”，今借用于背部恶寒难除亦当有效。
六诊：经上述内服外贴后，背部恶寒全部消除，仍用四逆汤、白通汤、附子理中汤等调理，以恢复机体功能。病乃痊愈。
本病治愈全过程历时三月之久，服药百余剂，所用附片甚多。
[按语]：疟疾这一疾病，《内经》记载颇详，经历代医家不断补充和发展，内容和治法十分丰富。然而在阳虚方面，论述较少。中医治病，主要重视辨证，也不忽略病名。如疟疾是病名，但不同的人，具体的病机不同，因而治法亦异。若只注意病名，而一再抗疟、截疟，不考虑患者体质，忽略人的机体功能，专以杀灭原虫为务，并非全面。本例虽患疟疾，但背部恶寒极甚，午后寒战不休，结合色脉，阳虚之象十分明显。《灵枢·口问篇》云：“寒气客于皮肤，阴气盛，阳气虚，故为振寒寒栗。补诸阳。”尤在泾亦云：“凡疟疾……多寒而久不解者，其人必本阳虚，法当甘温散邪，非干姜附子桂枝人参之属，不能已也。”（见《金匮翼·疟疾统论》）尤氏此语，实为经验之谈。
此外，还可看出，治慢性病，贵在“有方有守”，既确诊为阳气大虚之阴寒重症，则回阳救逆之法不可轻易改变，一经确诊，则宜持重守方，直至见功为止。
中气暴脱寒热似疟
许某某，男性，二十岁。1951年1月初发病，每日午后恶寒发热，继即大汗如洗。汗后热退，至次日午后又复发作。病程持续已达二十余日之久，曾用西药奎宁等类作抗疟治疗，见效不大，改请某中医用小柴胡汤仍然无效，而症象如故，体力渐难支持，由其父扶持来就诊。细审此症，面色青暗，两眼无神而呆视，语音低微，少气懒言，脉来沉细，重按无根，舌苔滑润质淡。其父亲代诉云：“发病时，恶寒则冷如冰雪，发热则如抱炉火。”据其脉症，每日午后寒热，状似疟疾，但热后汗出淋漓如洗，显系中阳不能内守，元气外越，此乃辨证之关键所在。再由患者面色、眼神、舌色等综合观察，已现一派体功不足之虚象，用药不可再事发散。急应扶其中阳，收纳元气，不使外越，或可取效。法当先用理中汤加味。处方：
理中汤，本为中焦虚寒而立。党参补气养液而益脾，白术健脾燥湿，干姜温中散寒，炙草甘温，配参、术则补中益气，配干姜则辛甘化阳，阳气化行，何患寒邪不散！四味组合，功能扶中阳、固元气、健脾胃、除虚寒。加砂仁纳气归肾，茯苓燥湿健脾，法夏温健脾胃、降逆止呕。如此加减，使脾胃阳气得复，诸证自可随之而解。
次日复诊：自诉服前方后，寒热大减，汗液渐收。脉搏、呼吸、眼神均见好转之象。法当继续扶正祛邪，沿原方加附子温肾扶阳，以固命门。处方：
附片60克 潞党参15克 白术15克 干姜30克 炙甘草6克
此方之用，本王冰所谓“益火之原，以消阴翳”的原理，加附子温扶先天之阳。先天阳旺，则中焦之阳得复而寒邪自除，脾肾阳旺则阴邪消散。清代医家郑钦安说：“阳旺始能镇纳群阴，阴气始得下降，阳气始得潜藏，乃不外亡。”
三日复诊：寒热全退，汗出全止，脉象已由沉细无根转为和缓，病势大有好转。乃着重培土建中，中气健运，可望巩固。处以黄芪建中汤加味调治：
嘱服三剂后，病渐痊愈。
Zeng, male, 41 years old. Constitutionally weak since youth, complicated by phlegm-fluid retention (pathological accumulation of fluids in the body). In February 1951, he came to the clinic for consultation. Pressing on the right hypochondrium caused unbearable pain, accompanied by incessant moaning. Symptoms included fever, cough, coarse breathing, insomnia at night, and a dark complexion around the eyes and face. The pulse was wiry and tight, and the tongue coating was white and greasy. Synthesizing the pulse and symptoms, this case is attributed to wind-cold constraining the exterior and phlegm-fluids lurking internally, which stagnated over time and transformed into heat. Given the patient's congenital weakness, the overall picture indicates excess pathogenic factors and deficient healthy qi. Medication must comprehensively protect the healthy qi without neglecting either aspect. Prescription:
Fuzi (Prepared Aconite Root Lateralis) 60g, Suanzaoren (Ziziphus Seed) 15g, Sheng Shigao (Raw Gypsum Fibrosum) 15g, Mahuang (Ephedra Stem) 6g, Faxia (Pinellia Rhizoma Preparata) 9g
Muli (Ostrea Concha) 15g, Xiebai (Allium Macrostemon Bulbus) 9g, Quan Gualou (Trichosanthes Fruit) 9g, Yujin (Curcuma Radix) 6g, Baijiezi (Sinapis Semen) 6g
Shichangpu (Acorus Tatarinowii Rhizome) 6g
In the formula, Fuzi is acrid and hot, while Shigao is sweet and cold. Together, they combine cold and hot properties: one supports Yang, the other clears heat. Fuzi combined with Faxia, Xiebai, and Baijiezi warms and disseminates chest Yang, dispels phlegm and fluids; combined with Suanzaoren, it strengthens the Heart and calms the Spirit. Shigao clears stagnant heat, and together with Mahuang opens the obstruction of Lung Qi. Muli softens hardness and nourishes the Liver, relieving urgency and pain. Yujin and Shichangpu promote Qi circulation, dissipate nodules, and relieve stagnation to alleviate right hypochondriac pain.
After two doses, all symptoms decreased, and mental spirit improved, though fever and cough persisted. Treatment continued with warming the Kidney, supporting Yang, dispelling wind and cold, descending rebellious Qi, and transforming phlegm. A self-formulated formula, Fuzi Guizhi Duhuo Jisheng Tang with modifications, was used. Prescription:
Fuzi (Prepared Aconite Root Lateralis) 60g, Guizhi (Cinnamon Twig) 9g, Hangshao (Paeonia Radix Alba) 9g, Faxia (Pinellia Rhizoma Preparata) 9g, Fuling (Poria) 15g
Chuanxiong (Ligusticum Chuanxiong Rhizome) 6g, Sangjisheng (Taxillus Chinensis Herba) 15g, Duhuo (Angelica Pubescens Radix) 6g, Fangfeng (Saposhnikovia Root) 9g, Chenpi (Citrus Reticulata Pericarpium) 6g
Taiwu (Cyathula Root) 9g, Gancao (Licorice Root) 6g, Shengjiang (Fresh Ginger) 3 slices, Dazao (Jujube Fruit) 3 pieces
After one dose, fever resolved. Except for cough with excessive phlegm, other symptoms improved. Subsequent treatment focused on diffusing and descending Lung Qi, stopping cough, and transforming phlegm. Erchen Tang combined with Sanzi Yangqin Tang with modifications was prescribed. Prescription:
Faxia (Pinellia Rhizoma Preparata) 9g, Fuling (Poria) 15g, Chenpi (Citrus Reticulata Pericarpium) 6g, Baijiezi (Sinapis Semen) 9g, Zisuzi (Perilla Fructus) 9g
Zhi Donghua (Farfarae Flos) 9g, Xingren (Prunus Armeniaca Seed) 9g, Chuanbeimu (Fritillaria Cirrhosa Bulbus) 9g, Zhike (Aurantii Fructus Immaturus) 9g, Quan Gualou (Trichosanthes Fruit) 9g
Yujin (Curcuma Radix) 6g, Gancao (Licorice Root) 4.5g
After one dose, cough decreased. The prescription was changed to Chenxia Liujun Tang for convalescence.
[Commentary]: In clinical practice, the use of cold or hot herbs, or their combination, depends entirely on the condition. One should follow Zhang Zhongjing’s principle: "Observe the pulse and symptoms, understand the deviation, and treat according to the syndrome." This case presents simultaneous exterior and interior involvement, mixed deficiency and excess, and mixed cold and heat. Therefore, there is no hesitation in using Fuzi to warm Yang and support healthy qi, and Shigao to clear stagnant heat (Shigao combined with Mahuang also helps diffuse Lung Qi obstruction). Although the herb properties differ, each has its specific function. This usage is well-founded. The Yuebi Tang in *Jingui Yaolue* mentions "add Fuzi if aversion to wind is present," and Yuebi Tang in *Qianjin Fang* often combines Fuzi and Shigao directly. Such combinations are not uncommon.
Furthermore, in this case, Fuzi, Banxia, and Gualou—herbs traditionally considered incompatible under the "Eighteen Incompatible Medicaments" (Shiba Fan)—were used together without adverse reactions, seemingly enhancing the effect of unblocking Yang and resolving phlegm. This suggests that the "Eighteen Incompatibilities" are not absolute and warrant further research.
Two Cases of Yin Deficiency with Horizontal Flow of Liver Qi
Case 1: Severe Hypochondriac Pain
Wang, female, 50 years old. History of opium addiction, constitutionally frail. In January 1951, she suddenly suffered unbearable epigastric and lower abdominal pain, with no bowel movement for several days. A previous doctor prescribed Zhishi Daozhi Tang. Due to her weak constitution, she could not tolerate this harsh formula. Although bowel movement occurred after administration, pain intensified, leaving her critically ill. The doctor then prescribed Xiaoyao San with Xiangfu and Qingpi to regulate Qi and stop pain, but pain persisted, and she could not lie supine or turn over. A Western doctor diagnosed hepatitis and cholecystitis; Western medicine proved ineffective. Upon consultation, lips and tongue were purple, tongue root very dry, pulse fine and wiry, and food intake minimal. Synthesizing pulse and symptoms, the diagnosis was Yin deficiency, horizontal flow of Liver Qi, and failure of Middle Qi to circulate. Given her constitutional weakness and prior purgative treatment damaging Middle Qi, despite constipation, further purgation was contraindicated. Following Zhang Zhongjing’s principle, "When treating Liver disease, knowing it transmits to the Spleen, first strengthen the Spleen," and Zhu Weiju’s principle, "Healthy qi is more important than pathogenic factors," the priority was to establish and transport Middle Qi and support healthy qi. Da Jianzhong Tang from *Jingui Yaolue* was administered. Prescription:
Ludangshen (Codonopsis Radix) 15g, Sichuan Huajiao (Zanthoxylum Bungeanum Pericarpium) 40 grains, Ganjiang (Dried Ginger Rhizome) 9g, Shao Yitang (Roasted Maltose) 30g
Huajiao and Ganjiang disperse cold and dampness, warm the middle and open the diaphragm. Combined with Ludangshen and Yitang to harmonize the middle and benefit Qi, this achieves the effect of strongly building Middle Qi and warming/nourishing the Spleen and Stomach.
After one dose, abdominal flatus occurred, epigastric and lower abdominal pain decreased, and spirit slightly improved, but hypochondriac pain remained. Treatment shifted to the Liver, imitating Ye Tianshi’s methods for Liver diseases. Prescription:
Biejia (Testudinis Carapax et Plastrum) 15g, Guiban (Testudinis Plastrum) 15g, Danggui (Angelica Sinensis Radix) 15g, Chao Hangshao (Stir-fried Paeonia Radix Alba) 9g, Yanhusuo (Corydalis Rhizome) 9g
Chao Chuanlianzi (Stir-fried Toosendan Fruit) 9g, Wumei (Mume Fructus) 4 pieces, Sichuan Huajiao (Zanthoxylum Bungeanum Pericarpium) 30 grains, Sharen (Amomi Fructus) 6g, Duzhong (Eucommia Bark) 15g
Fushen (Poria with Hostwood) 15g, Gancao (Licorice Root) 6g
Danggui and Hangshao nourish and invigorate Blood. Combined with Huajiao and Wumei, they nourish the Liver, warm Ying-Blood, and warm the Stomach. Yanhusuo and Chuanlianzi soothe the Liver, remove blood stasis, and stop pain. Sharen moves stagnant Qi; Fushen and Gancao benefit the Heart and Spleen and tonify the Middle. Duzhong tonifies the Liver and Kidneys. Combined with Guiban and Biejia for nourishing Yin, benefiting Blood, and dissipating nodules, the formula fully possesses the power to resolve depression, soothe Qi, soften the Liver, and stop pain.
After two doses, hypochondriac pain decreased by 70-80%, and bowels moved smoothly. However, five-palm heat and scant sleep at night appeared, revealing the true nature of Yin deficiency. Yanhusuo and Huajiao were removed from the previous formula, and Longgu, Muli, Nvzhenzi, Suanzaoren, and Shanzhuyu were added to calm the Spirit, moisten dryness, and relieve irritability. After two consecutive doses, irritability ceased, sleep normalized, and two more doses of Da Jianzhong Tang eliminated all pain. Finally, Guishao Liujun Tang was used for convalescence, leading to recovery.
Case 2: Facial and Limb Edema
Chen, female, 51 years old. Suffered from facial and limb edema. Previous doctors used Linggui Zhugan Tang and Lizhong Tang with modifications to warm Yang, promote urination, strengthen the Spleen, and dry dampness, without success. Instead, irritability and Qi rushing upward increased. Upon consultation, pulse was fine and rapid, tongue purple with greasy and dry coating. Although limbs were swollen, pressing left no indentation. Synthesizing pulse and symptoms, the diagnosis was Yin deficiency and upward rebellion of Liver Qi. Prescription:
Biejia (Testudinis Carapax et Plastrum) 15g, Guiban (Testudinis Plastrum) 15g, Chao Hangshao (Stir-fried Paeonia Radix Alba) 9g, Wumei (Mume Fructus) 4 pieces, Gouqi (Lycium Fruit) 9g
Chuanlianzi (Toosendan Fruit) 9g, Tusizi (Cuscuta Seed) 9g, Nvzhenzi (Ligustrum Fruit) 9g, Shanzhuyu (Cornus Fruit) 9g
Baiwei (Cynanchum Atratum Root) 9g, Chao Guya (Stir-fried Millet Sprout) 9g, Gancao (Licorice Root) 6g
Guiban and Biejia nourish Yin and anchor Yang. Hangshao and Wumei invigorate Blood, astringe Yin, and nourish the Liver. Chuanlianzi soothes the Liver and regulates Qi. Gouqi, Tusizi, Nvzhenzi, and Shanzhuyu tonify the Liver and Kidneys, benefit Essence, and soften the Liver. Baiwei clears heat and relieves irritability. Guya aids digestion and strengthens the Stomach, preventing cloying effects of tonics. Together, these herbs nourish Yin and Blood, tonify the Liver and Kidneys, and gather scattered Liver Qi.
After two doses, most of the long-standing facial and limb edema subsided, and irritability/Qi rushing stabilized. Suddenly, generalized pruritus and dry skin appeared. This resulted from insufficient Yin-Blood, non-flowing Jin-Ye (body fluids), and malnourishment of the skin. Prescription:
Biejia (Testudinis Carapax et Plastrum) 15g, Guiban (Testudinis Plastrum) 15g, Zhi Shouwu (Prepared Polygonum Multiflorum Root) 15g, Danggui (Angelica Sinensis Radix) 15g, Danpi (Moutan Cortex) 6g
Chao Hangshao (Stir-fried Paeonia Radix Alba) 15g, Maidong (Ophiopogon Tuber) 9g, Sangye (Mori Folium) 9g, Gan Juhua (Chrysanthemum Flower) 6g, Wumei (Mume Fructus) 4 pieces
Nvzhenzi (Ligustrum Fruit) 9g, Shanzhuyu (Cornus Fruit) 9g, Gancao (Licorice Root) 6g
Biejia and Guiban nourish Yin and Blood. Zhi Shouwu tonifies the Liver and Kidneys, benefits Essence and Blood, and dispels wind. Danggui and Hangshao invigorate Blood and nourish the Liver. Danpi clears heat, cools Blood, and removes stasis. Maidong, Sangye, Juhua, Wumei, Shanzhuyu, and Nvzhenzi nourish Liver Yin, moisten Lung dryness, and gather Liver Qi.
After taking the above prescription, skin itching disappeared completely, and swelling resolved entirely.
[Commentary]: Among various methods for treating the Liver, Ye Tianshi excelled because the Liver is a rigid organ, with substance as Yin and function as Yang. Disease manifestation is either "excessive Liver function" or "insufficient Liver substance." However, clinically, Liver function can also be damaged. Therefore, medication must avoid extremism, as both excessive cold and heat fail to hit the target. Over-warming and dispersing injures Yin and depletes the Liver substance; over-cooling and moistening injures Yang, suppresses ascending mechanisms, and easily damages the Spleen and Stomach, leading to collapse of Middle Qi. The normal function of the Liver relies on Blood nourishment, Kidney water immersion, Lung Qi convergence, and Spleen Earth support. Thus, medication must consider blood-nourishing, Kidney-moistening, Lung-converging, and Spleen-supporting aspects to allow free and smooth flow. The above two cases considered these aspects.
Malaria with Massive Yang Deficiency
Hua, male, 28 years old, working on the China-Vietnam border in Yunnan. Before liberation, malaria was prevalent in the area. Hua had a weak constitution and worked excessively. He contracted malarial fever during the summer-autumn transition. Local Chinese and Western medical treatments failed. His condition worsened daily, leading him to Kunming for treatment. Western anti-malarial drugs and Chinese Xiao Chaihu Tang combined with Changshan and Binglang were ineffective. He then sought treatment at our clinic. Pulse was empty and rootless; tongue coating was white and thick/greasy; extremities were cold. Complexion was blue-black, nails black, eyes lusterless, sclera covered by a blue mist, profuse cold sweat, and hair standing on end. His mother reported constant back chilliness, afternoon chills with relentless shivering, teeth chattering, followed by fever with running nose, tears, and saliva. This had persisted for over two months. Family members were anxious.
Analysis: Empty, rootless pulse indicates massive Kidney Yang deficiency and extreme constitutional depletion. White, thick/greasy tongue coating indicates internal cold-dampness and stomach turbidity failing to transform. Cold extremities indicate vital Yang Qi failing to reach the four ends. The Taiyang meridian runs along the back; Taiyang and Shaoyin are exterior-interior pairs. Now, Shaoyin Yang is declining, allowing Yin-cold Qi to invade the Taiyang meridian, causing back chilliness. Afternoon is when Yin is abundant; abundance of Yin leads to decline of Yang, worsening chills and shivering. Teeth chattering indicates deep-seated cold. Kidney essence ascends to the eyes; Kidney Essence depletion causes lusterless eyes obscured by blue mist. The Kidney governs the five fluids; severe Kidney Qi failure fails to control fluids, causing cold sweat, runny nose, tears, and saliva. These symptoms result from excessive Kidney Yang deficiency, overwhelming Yin-cold, and impending Yuan Qi collapse. The key is massive Kidney Yang deficiency. The afternoon alternating chills and fever resembling malaria is far more dangerous than the alternating chills and fever of Shaoyang syndrome, due to the failure of Yin and Yang to sustain each other. Although named malaria, it should not be treated as such. Urgent action is needed to guide Yang back to its residence, restore regulation, and firmly secure the Middle Jiao. Harmonizing Yin and Yang will stop chills and fever. However, the disease has dragged on for a long time, making it difficult. Using Xiao Chaihu Tang to harmonize Shaoyang risks Yang collapse. Urgent return of Yang and rescue from collapse is required using Si Ni Tang and Bai Tong Tang from *Shanghan Lun*. Prescription:
Formula 1:
Hei Fupian (Black Prepared Aconite Root Lateralis) 60g, Ganjiang (Dried Ginger Rhizome) 30g, Zhi Gancao (Honey-fried Licorice Root) 6g
Formula 2:
Hei Fupian (Black Prepared Aconite Root Lateralis) 60g, Ganjiang (Dried Ginger Rhizome) 30g, Congbai (Scallion White) 3 stems
Second Visit: Mother reported taking twelve doses of each formula. Condition did not worsen but showed no obvious improvement. Family was fearful. This is indeed a severe Yin-cold illness. Besides Si Ni Tang and Bai Tong Tang strongly supporting primal Yang, there is no other method. Why ineffective? Not wrong indication, but heavy disease with light medication, insufficient to drive out Yin-cold pathogens. Stick to original formulas, change Zhi Fupian to Yan Fuzi (Salt-processed Aconite), increase dosage to enhance returning Yang and driving out cold. Take three doses of each.
Third Visit: Patient reported feeling like solid ice melting, passing large amounts of black water, cold sweat gradually stopping, hands and feet warming, and afternoon chills/fever disappearing. Interior Yang returned, Yang Qi gradually filled, eliminating turbid Yin filling the abdomen. Changed to Fuzi Lizhong Tang. Prescription:
Hei Fupian (Black Prepared Aconite Root Lateralis) 90g, Ludangshen (Codonopsis Radix) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 15g, Ganjiang (Dried Ginger Rhizome) 24g, Gancao (Licorice Root) 9g
Fourth Visit: After ten doses, all symptoms decreased, spirit greatly improved, face and nails turned ruddy. Back still felt chilly, pulse deep and fine, tongue pale with white coating. Changed to a combined formula of Fuzi Tang and Guizhi Tang from *Shanghan Lun*. Prescription:
Hei Fupian (Black Prepared Aconite Root Lateralis) 90g, Ludangshen (Codonopsis Radix) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 12g, Fuling (Poria) 15g, Guizhi (Cinnamon Twig) 15g
Chao Hangshao (Stir-fried Paeonia Radix Alba) 15g, Zhi Gancao (Honey-fried Licorice Root) 9g, Shao Shengjiang (Roasted Fresh Ginger) 5 slices, Dazao (Jujube Fruit) 5 pieces
Fifth Visit: After four doses, back chilliness persisted. Prescribed another formula to warm Yang, benefit Qi, and tonify both Spleen and Kidney. Changed to Si Ni Tang plus Ludangshen, take five doses, combined with external therapy. Prescription:
Hei Fupian (Black Prepared Aconite Root Lateralis) 90g, Ganjiang (Dried Ginger Rhizome) 45g, Zhi Gancao (Honey-fried Licorice Root) 9g, Ludangshen (Codonopsis Radix) 15g
External Use: Shengjiang Juice (Fresh Ginger Juice) 500g, Niujiaojiao (Colla Corii Asini) 120g. Boil into a thin paste. Spread on cloth and apply to Feishu (BL13) acupoint on the back. This paste is called Jiangjiao Gao by Zhang Xichun. Original note: "Apply to limbs affected by cold pain, or where凝寒 (coagulated cold) obstructs blood vessels, causing numbness." Meaning as Zhang stated: "Fresh ginger's pungency opens and unblocks, heat disperses, thus warming muscles and penetrating bones to remove coagulated cold and deep-seated chill, melting away like ice; using animal glue (Niujiaojiao) leverages its sticky nature to form a paste." This paste removes "coagulated cold and deep-seated chill"; applying it to persistent back chilliness should be effective.
Sixth Visit: After internal medicine and external application, back chilliness completely resolved. Continued regulating with Si Ni Tang, Bai Tong Tang, and Fuzi Lizhong Tang to restore healthy qi. Disease cured.
The entire cure process lasted three months, taking over a hundred doses, with significant amounts of Fupian used.
[Commentary]: Malaria is well-documented in *Neijing*, with rich content and methods developed by generations of physicians. However, discussions on Yang deficiency are scarce. TCM emphasizes syndrome differentiation but does not ignore disease names. Malaria is a disease name, but different patients have different pathogenesis, requiring different treatments. Focusing only on the disease name and repeatedly using anti-malarial or malaria-stopping methods without considering constitution and healthy qi, solely targeting parasite elimination, is incomplete. Although this patient had malaria, severe back chilliness and relentless afternoon shivering, combined with color and pulse signs, clearly indicated Yang deficiency. *Lingshu·Kouwen* states: "Cold qi lodges in the skin, Yin is abundant, Yang is deficient, hence trembling chills. Tonify all Yangs." You Zaijing also said: "For malaria... those with much cold persisting long-term must fundamentally have Yang deficiency. Method should use sweet-warm to scatter pathogens; without Ganjiang, Fuzi, Guizhi, Renshen, it cannot cease." (*Jingui Yi·Malie Tonglun*). You’s words are experiential wisdom.
Furthermore, treating chronic diseases values "having a formula and maintaining it." Once diagnosed as severe Yin-cold illness with massive Yang deficiency, the method of returning Yang and rescuing from collapse should not be easily changed. After confirmation, hold the prescription steadily until efficacy appears.
Middle Qi Sudden Collapse with Chills and Fever Resembling Malaria
Xu, male, 20 years old. Illness began in early January 1951. Daily afternoon chills and fever, followed by profuse sweating like washing. Heat subsided after sweating, recurring the next afternoon. Duration exceeded twenty days. Western Quinine anti-malarial treatment had little effect. A Chinese doctor used Xiao Chaihu Tang, also ineffective. Symptoms remained, physical strength declined, supported by father for consultation. Careful examination: complexion dark blue, eyes listless and staring, voice low, shortness of breath, reluctance to speak, pulse deep and fine, rootless upon heavy pressure, tongue coating slippery/moist with pale texture. Father reported: "During onset, chills feel like ice/snow, fever feels like hugging a furnace." Based on pulse and symptoms, daily afternoon chills/fever resemble malaria, but profuse sweating after heat indicates Middle Yang failing to retain internally and Yuan Qi escaping outward. This is the key to differentiation. Comprehensive observation of complexion, eyes, and tongue shows a picture of healthy qi deficiency. Medication must not disperse further. Urgently support Middle Yang, gather Yuan Qi, prevent outward escape, possibly achieving efficacy. Method: First use Lizhong Tang with modifications. Prescription:
Ludangshen (Codonopsis Radix) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 15g, Ganjiang (Dried Ginger Rhizome) 15g, Zhi Gancao (Honey-fried Licorice Root) 6g
Sharen (Amomi Fructus) 6g, Faxia (Pinellia Rhizoma Preparata) 9g, Fuling (Poria) 15g
Lizhong Tang is established for Middle Jiao deficiency-cold. Dangshen benefits Qi, nourishes fluids, and strengthens Spleen. Baizhu strengthens Spleen and dries dampness. Ganjiang warms middle and disperses cold. Zhi Gancao is sweet and warm; combined with Dangshen and Baizhu, it tonifies Middle and benefits Qi; combined with Ganjiang, acrid-sweet transforms into Yang. With Yang Qi transforming and moving, how can cold pathogens not disperse? The four ingredients function to support Middle Yang, consolidate Yuan Qi, strengthen Spleen/Stomach, and remove deficiency-cold. Added Sharen gathers Qi to Kidney, Fuling dries dampness and strengthens Spleen, Faxia warms/strengthens Spleen/Stomach, descends rebellious Qi, and stops vomiting. Such modifications restore Spleen/Stomach Yang Qi, resolving all symptoms.
Next Day Second Visit: Reported significant reduction in chills/fever and gradual cessation of sweating. Pulse, respiration, and eyes showed improvement. Method: Continue supporting healthy qi and dispelling pathogens. Follow original formula, add Fuzi to warm Kidney and support Yang, securing Mingmen. Prescription:
Fupian (Prepared Aconite Root Lateralis) 60g, Ludangshen (Codonopsis Radix) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 15g, Ganjiang (Dried Ginger Rhizome) 30g, Zhi Gancao (Honey-fried Licorice Root) 6g
Sharen (Amomi Fructus) 6g, Faxia (Pinellia Rhizoma Preparata) 9g, Fuling (Poria) 15g
This formula uses Wang Bing’s principle: "Benefit the source of Fire to eliminate Yin shadows." Adding Fuzi warms and supports Primal Yang. When Primal Yang is vigorous, Middle Jiao Yang recovers, cold pathogens disappear naturally. Spleen/Kidney Yang vigor dissipates Yin pathogens. Qing Dynasty physician Zheng Qin’an said: "Only when Yang is vigorous can it suppress and gather Yin; only then can Yin descend, Yang hide, and not escape outward."
Three-Day Third Visit: Chills/fever completely retreated, sweating stopped entirely. Pulse changed from deep/fine/rootless to harmonious. Condition greatly improved. Focus on building Earth and strengthening Middle. With robust Middle Qi, consolidation is expected. Prescribed Huangqi Jianzhong Tang with modifications for regulation:
Beiqi (Astragalus Root) 15g, Chao Hangshao (Stir-fried Paeonia Radix Alba) 18g, Guizhi (Cinnamon Twig) 9g, Shao Yitang (Roasted Maltose) 30g
Faxia (Pinellia Rhizoma Preparata) 9g, Fuling (Poria) 15g, Zhi Gancao (Honey-fried Licorice Root) 6g, Shao Shengjiang (Roasted Fresh Ginger) 3 slices
Dazao (Jujube Fruit) 3 pieces, Huaishanyao (Dioscorea Rhizome) 15g, Bei Wuwei (Schisandra Fruit) 10g
Advised to take three doses. Condition gradually recovered.