此型牙痛多半时剧时缓，夜间痛甚，牙龈无红肿之象，但心烦，潮热，或尿短赤，舌质多红，少苔，-脉多细。法当育阴清热祛风。兼虚火上越者，脉多细数。可予以下二方：
第一方，生地骨碎补汤：
天麻15克 粉丹皮10克 焦黄柏10克 桑叶10克 乳香6克
此方系自拟经验方，不仅用于阴虚有热之牙痛，并可用于阴虚所致三叉神经痛，其效亦佳。
方中骨碎补益肾行血，固精髓，镇牙痛，生地、丹皮凉血养阴。露蜂房祛风，细辛散寒止痛。乳香疏利散瘀，活血止痛，蝉蜕、桑叶、薄荷、秦艽以祛风热。黄柏滋水泻火，天麻熄风镇痛。寒温并用，以达育阴清热而止痛。
第二方，当归石决明散：
当归15克 石决明30克 龟板15克 磁石30克 女贞子15克
此方治肝肾阴亏导致虚火上越之牙痛，具有养肝肾、潜阳熄风之效。较六味地黄丸仅具养肝肾之阴之作用者，疗效较理想。若阴虚兼有风热者用第一方；阴虚兼有肝血不足和虚火上越者可用第二方。
此型多属老年肾精虚亏，相火浮越。牙痛特征：疼痛不剧，昼轻夜重，绵绵不休，无牙齿红肿之象，舌质多青，苔淡润多津，脉多沉或沉弦。治宜温阳固肾。余常选用桂附八味丸，改为汤剂。选上肉桂以引火归源。
如肾阳大虚，面青畏寒特甚，选用白通汤加北细辛。热药冷服，取其反佐。
(五)龋齿(虫牙)
此型疼痛较剧，可因冷热或刺激性食物而诱发。可选黄坤载柴胡桃仁汤效果较好。处方：
方中柴胡调气舒郁，配骨碎补镇痛，桃仁行血逐瘀而缓痛，生石膏清热泻火。此方用于缓解龋齿疼痛，有立竿见影之功效。
以上五型牙痛为临床所常见者。因治验病案甚多，不便一一列举。仅提出以上分型论治之理法方药，供临证选取。 医 案 暑温夹疠
叶××，男，三十岁。于1949年盛夏，发热不退，已月余，经西医治疗热仍未解，延余会诊。症见：卧床不起，面垢而黄，双目发黄，壮热烦渴，自汗出，身重。舌苔白腻，右脉洪大有力。因思病发于七月，节令正当大小暑之际，系暴感暑热之气所致。吴鞠通氏云：“暑兼湿热，偏于暑之热者为暑温，然病势既暴，必夹疠气为患”，乃断为暑温夹疠。症既见壮热、烦渴、汗出、面垢，右脉洪大有力，乃热邪内伏，与《伤寒论》白虎汤证相似。予白虎加苍术汤。处方：
方中石膏清肺热、泻胃火，知母清肺热、育肾阴，甘草、粳米和中护胃气，苍术燥湿辟秽。诸药合用共奏清热除烦、燥湿解暑之功。
二诊：药后烦渴、发热减轻，脉由洪大转弦细，舌苔微薄，尚有口渴、心烦、微热。证属暑热内闭，宜清热除烦，透热外出。改予芳香散。处方。
方中用僵蚕、蝉蜕皆清化之品，涤疠除秽；苦参清热燥湿，玄参清火退热而养阴；合以石膏、黄芩、黄连、栀子，增强退热之效。经云“火郁发之”，用荆芥以透热外出，花粉生津止渴，神曲消食化秽，茯神安神，甘草顾胃和中，调和诸药。
三诊：服一剂后，发热烦渴顿减，苔腻全退，舌质转紫，已现津虚本质，此郁遏之伏热外露，佳兆也。惟大便秘结多日，里急腹痛，由热郁日久，内结为患，应当急下，用《伤寒六书》黄龙汤加减。盖本证虽属温热，然因病程已久，热结于里，灼伤津液，肠液枯涸，若专以攻下泻热，则不免有“病去人亡”之虞，故拟攻补兼施之法为妥。处方：
酒炒生地15克 当归15克 大黄6克 潞党参15克 芒硝6克
此方乃大承气汤加味而成。方中生地养阴生津，酒炒后尤能活血；配以潞党参、当归补气生血；甘草和胃，更加白蜜滋养胃阴而润燥。如此组合，集扶正攻邪于一方，则攻邪而不伤正，扶正而不碍邪，方与证衡，自属相得。
服药一次，便稍通，然不甚畅。服二次，小腹急胀，随即下黑便甚多，间有血块，可见若迁延失下，姑息养奸，势必阳盛阴亡，有生命危险。今患者虽神形倦怠，然发热月余，烦渴虽解，自觉轻快。但汗出不已，形体消瘦，下午微热。处以补血养阴之剂调理。不料其家属请某医处以附片、鳖甲、杭芍、元肉之方插服，服后烦躁不安，此乃病退阻亏，不耐扶阳，虽上方亦有养阴之品，但在阴亏阳盛之际，投以附片等物，终不相宜也。复延余诊，纯从养阴立法。处方：
全方主旨在养肺胃之阴液。五味子、牡蛎敛汗育阴；阿胶补益肺津，滋益肝肾，龟板益阴滋水；玉竹、麦冬、石斛和玄参生津润燥；少佐黄连以降心经之浮热，加黄柏泻火而坚肾。服后，烦定汗收。继以大剂补阴煎，重用龟板、熟地及知柏八味，重用淮山药调理数剂而告痊愈。
[按]：暑温易夹疠气，本案病虽月余，热邪羁留气分，证似白虎，因予白虎加苍术汤，药后热势缓解，继用芳香散透热外出，诸症顿减。然因热邪郁结既久，阳明腑实，非攻下无以捣其巢穴。但久热伤阴，正气也虚，不养阴扶正，则难任攻下，两全之策，只有攻补兼施，黄龙汤是理想之剂。攻下之后，本来补血养阴即可痊愈，但病家易医更方，兼用扶阳，致有一时之变。说明暑温病至后期阴虚生内热，内热必伤阴，形成恶性循环。阴虚者必滋养之，此千古不易之法。病非阴阳两虚，故不必阴阳双补，否则，“画蛇添足”，反而偾事。
夹阴伤寒
陆××，男，五十余岁。于1943年夏，因发热不退，住某医院，经西医诊断为“肠伤寒”。用西药治疗无效．又用小柴胡汤加二陈、生地、牡蛎、丹皮之类，病势日趋沉重．已二十多日，乃请余诊治。症见：高热无汗，面色晦滞．声低懒言，项背强痛，时见惊惧，舌苔厚腻而滑，口不渴，脉沉迟而紧。据症分析，患者病程虽达二十多日，尤高热无汗，项背强痛，显系太阳未解。然面色晦滞，脉沉迟而紧，声低懒言者，又属表邪闭甚而里气不足所致。不足者，即“气怯”之意也。余询之，患者病作之初，又犯房劳，因而致有里气不足之象。舌苔厚腻，则系湿邪郁甚。此症初起即应以汗法解表，若汗之得当，邪随汗解，万不致迁延时日，愈演愈烈，至于此极。患者当前所现症状，原系太阳、少阴两感证，初起误治，专从和解少阳着眼，屡用小柴胡加减，何能胜任!且生地、丹皮之阴而敛，牡蛎之涩而收，柴胡之升而散，黄芩之清而降，不但不能尽其解表之功，反足以抑减体功之抗力。肌腠愈闭，致使体温愈激愈高，神明将频亍混乱，心机亦日趋衰弱，故时见惊惧。斯时据理而立法遣方，固宜解太阳之表，温少阴之经，而以麻黄附子细辛汤；但又考虑病势初起，前医屡甩柴胡一升再升，今时见惊惧，若循规再用麻辛之升散，恐致心神飞越之不良后果。两全之策，唯有温扶肾阳，开太阳气机，引病邪由里达外，遂决定用自拟附子桂枝独活寄生汤：
附片60克 桂枝9克 桑寄生9克 杭芍9克 法夏9克
茯苓15克 独活6克 防风9克 川芎6克 台乌9克
方解见本书“风寒湿痹”案。
处方毕，特语其家属曰：“此症之转机，若能由阴转阳，阳回阴消，则属易治，似此发热不退至二十余日，将来恐不免白痦红斑接踵而发。此方主旨，即在导邪外出，庶免肠壁穿孔之患。”
次日复诊：服药后，神形较安，惟发热如故。仍守原方加重附片至90克。三、四诊均守原方另加淮牛膝9克、杜仲15克、金毛狗脊9克以温壮元阳而疗其腰脊之痛。
前数方服后，均未得汗，服大剂白通汤一剂后，始濈然汗出，足见表邪固闭之甚，非大剂温里通阳不能逮也。两周来均未大便，近五日所服之方，均以附片温壮元阳，强心益火增强体功抗力为主。
六诊：服白通汤一剂后，虽已得汗，里阳渐回，发热未退，然全身痛楚大减，神气转佳，惊惧已平，面色润泽。病已由阴转阳，脉现洪大有力。烦渴思饮，病者已由初之形气俱怯转为形气皆盛，实乃预后良好之征兆也，乃用《伤寒论》白虎加人参汤。处方：
七诊：服上方后，烦热缓解，且得安眠。果然胸间隐隐出现白痦，足征肺郁已宣，惟胸闷脘痞殊甚，不大便已十余日，脉仍有力，热传于胃，腑气已实，可下之征备矣。
西医治疗“肠伤寒”，便秘禁用下法，下之则因肠蠕动过剧而引起肠出血等危症。然只要具备可下之症，未尝不可用下，故毅然用大承气汤。处方：
八诊：药后，排出臭粪甚多，十余日来之积垢，大为荡除。惟自痦仍续出，并现呕吐。此非大承气汤下后之变．系患者胃气初复，寒热失调所致。给以调和胃气，方用《伤寒论》半夏泻心汤加减。处方：
此方原治伤寒下后，胸满不痛之痞证，身寒而呕吐之主方。方中法夏止呕逆，散结气；芩、连消痞，参、草、姜，补脾和中以通上下而交阴阳；加神曲、麦芽、鸡内金．消导积滞。
九诊：诸症均减，饮食渐增，但发热转为潮热，神倦，胸稍闷，又四日未大便，时有恶寒。此邪热有余而阳气不足也。《伤寒论》云：“心下痞、而复恶寒汗出者，附子泻心汤主之”，正符此候，乃予是方治之。处方：
心下痞，胸闷不舒，虚热内伏也。恶寒者，阳虚于内也，予泻心汤攻痞通便，加附子以助阳。
十诊：服后便通，周身旋出红斑，色甚鲜艳(若色黑，则系胃阴枯绝，难治也)。前于胸间所发白痦，今已全退。患者至此，神形倦怠，骨瘦如柴。宜保津液、养胃阴为治。处以下方：
十一诊：服上方后，神气转佳，饮食增进，旋又潮热鼻衄，此静胃余热未尽，血热妄行。宜清肺胃郁热，凉血止衄。方用扁鹊三豆饮加减。处方：
枇杷叶9克 连翘9克 麦冬9克 枳壳6克 藕节5个
竹茹6克 甘草3克
十二诊：上方服一剂，鼻衄即止，潮热亦退，续以养阴润燥滋养之剂调理。方用上方加减。处方：
次同煎)
上方连服五剂，诸证痊愈。
[按]：综观此症，病程较长，机转亦繁，概而论之，因患者表实里虚，抗力不足，故先用附子桂枝独活寄生汤、白通汤温扶。之后，患者体功由虚转实，即按祝昧菊先生所说：“治法以人体为主”，及“立法处方，不必细审为何细茵，但了然于其病灶之所在，就体功反常之处为调治南针”。毅然以白虎加人参汤清其肺胃之热，以大承气汤下其久滞不通之结热；白痦未尽，红斑旋出，邪势遂因之而渐衰。倘于此时因循坐误必失良机。病者自服白通汤后，汗出濈濈，从未中止，是病邪外达，有利于减轻肠胃之壅热，此为顺症之所当然，亦即预后良好之征兆。在整个治疗过程中，用寒用热，悉以体气之盛衰而为定，在体功与病邪方面，则根据“体功重于病邪”、“阳气重于阴气”的观点，先着重调理体功(机体功能)及扶持阳气，使正气旺盛，抗力增强，然后再处以治病之方，总以救人为先。此余平生用药心得之一也。
另据此案，可知西医之肠伤寒亦未必都是中医的湿温症，临床辨证勿为病名所惑：
头痛八例
例一：
李××，女，四十三岁，患头痛日久，来所就诊。自诉：每日工作即感头痛脑鸣，目眩，心烦。休息即止，口中干燥少津，舌色紫，脉细数。脉症合参，系用脑过度，肾水亏虚，不能涵养肝木，以致风火上扰清空。治当滋肾水，养肝木，熄风火。用六味地黄汤加味。处方：
这种类型的牙痛大多时轻时重，夜间疼痛加剧，牙龈没有红肿的现象，但伴有心烦、潮热，或者小便短少且颜色深黄，舌质多呈红色，苔少，脉象多细弱。治疗法则应当是滋养阴液、清除虚热并祛风。兼有虚火上炎者，脉象多细而数。可以使用以下两个方剂：
第一方，生地骨碎补汤：
天麻15克 牡丹皮10克 焦黄柏10克 桑叶10克 乳香6克
此方为作者自拟的经验方，不仅适用于阴虚有热引起的牙痛，也可用于阴虚导致的三叉神经痛，疗效同样良好。
方中骨碎补能补肾行血，坚固精髓，镇静牙痛；生地黄、牡丹皮能凉血养阴。露蜂房祛风，细辛散寒止痛。乳香疏通气血、消散瘀滞，活血止痛；蝉蜕、桑叶、薄荷、秦艽用以祛除风热。黄柏滋肾水以泻相火，天麻熄风镇痛。寒温药物并用，以达到滋养阴液、清除虚热从而止痛的目的。
第二方，当归石决明散：
当归15克 石决明30克 龟板15克 磁石30克 女贞子15克
此方治疗因肝肾阴亏导致虚火上炎引起的牙痛，具有滋养肝肾、潜阳熄风的功效。相较于仅具滋养肝肾之阴作用的六味地黄丸，其疗效更为理想。若阴虚兼有风热者用第一方；若阴虚兼有肝血不足和虚火上炎者可用第二方。
此型多属于老年人肾精亏虚，相火浮越。牙痛的特征是：疼痛不剧烈，白天轻晚上重，绵绵不断，无牙齿红肿现象，舌质多青紫，苔淡润多津液，脉象多沉或沉弦。治疗宜温补阳气、固护肾脏。我常选用桂附八味丸，改为汤剂服用。选取上肉桂以引火归源。
如果肾阳极度虚弱，面色青暗、特别怕冷，选用白通汤加北细辛。热药冷服，取其反佐之意。
(五)龋齿（虫牙）
此型疼痛较为剧烈，可因冷热或刺激性食物诱发。可选用黄坤载的柴胡桃仁汤，效果较好。处方如下：
方中柴胡调理气机、舒展郁结，配合骨碎补镇痛；桃仁行血逐瘀以缓解疼痛；生石膏清热泻火。此方用于缓解龋齿疼痛，有立竿见影的功效。
以上五种类型的牙痛是临床上常见的。因为治愈的病案很多，不便一一列举。仅提出以上分型论治的理论、法则、方剂和药物，供临床参考选用。 医案：暑温夹疠
叶××，男，三十岁。在1949年盛夏，发热不退，已有一个多月，经西医治疗后热仍未退，邀请余会诊。症状表现为：卧床不起，面部污垢且发黄，双目发黄，高热烦躁口渴，自汗出，身体沉重。舌苔白腻，右脉洪大有力。考虑到病发于七月，节气正值大小暑之际，这是暴感暑热之气所致。吴鞠通说：“暑兼湿热，偏于暑之热者为暑温，然而病势既猛烈，必然夹杂疠气为患”，于是断定为暑温夹疠。症状既然见到壮热、烦渴、汗出、面垢，右脉洪大有力，这是热邪内伏，与《伤寒论》中的白虎汤证相似。给予白虎加苍术汤。处方：
方中石膏清肺热、泻胃火，知母清肺热、育肾阴，甘草、粳米调和脾胃、保护胃气，苍术燥湿辟秽。诸药合用共奏清热除烦、燥湿解暑之功。
二诊：服药后烦躁口渴、发热减轻，脉由洪大转为弦细，舌苔微薄，尚有口渴、心烦、微热。证属暑热内闭，宜清热除烦，透热外出。改予芳香散。处方：
方中用僵蚕、蝉蜕皆属清化之品，涤除疠气、去除秽浊；苦参清热燥湿，玄参清火退热而养阴；配合石膏、黄芩、黄连、栀子，增强退热之效。《内经》云“火郁发之”，用荆芥以透热外出，花粉生津止渴，神曲消食化秽，茯神安神，甘草顾护胃气、调和诸药。
三诊：服一剂后，发热烦渴顿减，苔腻全退，舌质转紫，已显现津液亏损的本质，这是郁遏的伏热外露的好兆头。只是大便秘结多日，里急腹痛，由于热郁日久，内结为患，应当急下，用《伤寒六书》黄龙汤加减。盖本证虽属温热，但因病程已久，热结于里，灼伤津液，肠液枯涸，若专以攻下泻热，则不免有“病去人亡”的担忧，故拟定攻补兼施的方法为妥。处方：
酒炒生地15克 当归15克 大黄6克 潞党参15克 芒硝6克
此方乃大承气汤加味而成。方中生地养阴生津，酒炒后尤能活血；配以潞党参、当归补气生血；甘草和胃，更加白蜜滋养胃阴而润燥。如此组合，集扶正攻邪于一方，则攻邪而不伤正，扶正而不碍邪，方与证衡，自属相得。
服药一次，大便稍通，然不甚通畅。服二次，小腹急胀，随即排出黑便甚多，间有血块，可见若迁延失下，姑息养奸，势必阳盛阴亡，有生命危险。今患者虽神形倦怠，然发热月余，烦渴虽解，自觉轻快。但汗出不已，形体消瘦，下午微热。处以补血养阴之剂调理。不料其家属请某医处以附片、鳖甲、杭芍、元肉之方插服，服后烦躁不安，此乃病退阻亏，不耐扶阳，虽上方亦有养阴之品，但在阴亏阳盛之际，投以附片等物，终不相宜也。复延余诊，纯从养阴立法。处方：
全方主旨在养肺胃之阴液。五味子、牡蛎敛汗育阴；阿胶补益肺津，滋益肝肾，龟板益阴滋水；玉竹、麦冬、石斛和玄参生津润燥；少佐黄连以降心经之浮热，加黄柏泻火而坚肾。服后，烦定汗收。继以大剂补阴煎，重用龟板、熟地及知柏八味，重用淮山药调理数剂而告痊愈。
[按]：暑温易夹疠气，本案病虽月余，热邪羁留气分，证似白虎，因予白虎加苍术汤，药后热势缓解，继用芳香散透热外出，诸症顿减。然因热邪郁结既久，阳明腑实，非攻下无以捣其巢穴。但久热伤阴，正气也虚，不养阴扶正，则难任攻下，两全之策，只有攻补兼施，黄龙汤是理想之剂。攻下之后，本来补血养阴即可痊愈，但病家易医更方，兼用扶阳，致有一时之变。说明暑温病至后期阴虚生内热，内热必伤阴，形成恶性循环。阴虚者必滋养之，此千古不易之法。病非阴阳两虚，故不必阴阳双补，否则，“画蛇添足”，反而偾事。
夹阴伤寒
陆××，男，五十余岁。于1943年夏，因发热不退，住某医院，经西医诊断为“肠伤寒”。用西药治疗无效．又用小柴胡汤加二陈、生地、牡蛎、丹皮之类，病势日趋沉重．已二十多日，乃请余诊治。症见：高热无汗，面色晦滞．声低懒言，项背强痛，时见惊惧，舌苔厚腻而滑，口不渴，脉沉迟而紧。据症分析，患者病程虽达二十多日，尤高热无汗，项背强痛，显系太阳未解。然面色晦滞，脉沉迟而紧，声低懒言者，又属表邪闭甚而里气不足所致。不足者，即“气怯”之意也。余询之，患者病作之初，又犯房劳，因而致有里气不足之象。舌苔厚腻，则系湿邪郁甚。此症初起即应以汗法解表，若汗之得当，邪随汗解，万不致迁延时日，愈演愈烈，至于此极。患者当前所现症状，原系太阳、少阴两感证，初起误治，专从和解少阳着眼，屡用小柴胡加减，何能胜任!且生地、丹皮之阴而敛，牡蛎之涩而收，柴胡之升而散，黄芩之清而降，不但不能尽其解表之功，反足以抑减体功之抗力。肌腠愈闭，致使体温愈激愈高，神明将频亍混乱，心机亦日趋衰弱，故时见惊惧。斯时据理而立法遣方，固宜解太阳之表，温少阴之经，而以麻黄附子细辛汤；但又考虑病势初起，前医屡甩柴胡一升再升，今时见惊惧，若循规再用麻辛之升散，恐致心神飞越之不良后果。两全之策，唯有温扶肾阳，开太阳气机，引病邪由里达外，遂决定用自拟附子桂枝独活寄生汤：
茯苓15克 独活6克 防风9克 川芎6克 台乌9克
方解见本书“风寒湿痹”案。
处方毕，特语其家属曰：“此症之转机，若能由阴转阳，阳回阴消，则属易治，似此发热不退至二十余日，将来恐不免白痦红斑接踵而发。此方主旨，即在导邪外出，庶免肠壁穿孔之患。”
次日复诊：服药后，神形较安，惟发热如故。仍守原方加重附片至90克。三、四诊均守原方另加淮牛膝9克、杜仲15克、金毛狗脊9克以温壮元阳而疗其腰脊之痛。
前数方服后，均未得汗，服大剂白通汤一剂后，始濈然汗出，足见表邪固闭之甚，非大剂温里通阳不能逮也。两周来均未大便，近五日所服之方，均以附片温壮元阳，强心益火增强体功抗力为主。
六诊：服白通汤一剂后，虽已得汗，里阳渐回，发热未退，然全身痛楚大减，神气转佳，惊惧已平，面色润泽。病已由阴转阳，脉现洪大有力。烦渴思饮，病者已由初之形气俱怯转为形气皆盛，实乃预后良好之征兆也，乃用《伤寒论》白虎加人参汤。处方：
七诊：服上方后，烦热缓解，且得安眠。果然胸间隐隐出现白痦，足征肺郁已宣，惟胸闷脘痞殊甚，不大便已十余日，脉仍有力，热传于胃，腑气已实，可下之征备矣。
西医治疗“肠伤寒”，便秘禁用下法，下之则因肠蠕动过剧而引起肠出血等危症。然只要具备可下之症，未尝不可用下，故毅然用大承气汤。处方：
八诊：药后，排出臭粪甚多，十余日来之积垢，大为荡除。惟自痦仍续出，并现呕吐。此非大承气汤下后之变．系患者胃气初复，寒热失调所致。给以调和胃气，方用《伤寒论》半夏泻心汤加减。处方：
此方原治伤寒下后，胸满不痛之痞证，身寒而呕吐之主方。方中法半夏止呕逆，散结气；芩、连消痞，参、草、姜，补脾和中以通上下而交阴阳；加神曲、麦芽、鸡内金．消导积滞。
九诊：诸症均减，饮食渐增，但发热转为潮热，神倦，胸稍闷，又四日未大便，时有恶寒。此邪热有余而阳气不足也。《伤寒论》云：“心下痞、而复恶寒汗出者，附子泻心汤主之”，正符此候，乃予是方治之。处方：
心下痞，胸闷不舒，虚热内伏也。恶寒者，阳虚于内也，予泻心汤攻痞通便，加附子以助阳。
十诊：服后便通，周身旋出红斑，色甚鲜艳(若色黑，则系胃阴枯绝，难治也)。前于胸间所发白痦，今已全退。患者至此，神形倦怠，骨瘦如柴。宜保津液、养胃阴为治。处以下方：
十一诊：服上方后，神气转佳，饮食增进，旋又潮热鼻衄，此静胃余热未尽，血热妄行。宜清肺胃郁热，凉血止衄。方用扁鹊三豆饮加减。处方：
枇杷叶9克 连翘9克 麦冬9克 枳壳6克 藕节5个
竹茹6克 甘草3克
十二诊：上方服一剂，鼻衄即止，潮热亦退，续以养阴润燥滋养之剂调理。方用上方加减。处方：
次同煎)
上方连服五剂，诸证痊愈。
[按]：综观此症，病程较长，机转亦繁，概而论之，因患者表实里虚，抗力不足，故先用附子桂枝独活寄生汤、白通汤温扶。之后，患者体功由虚转实，即按祝昧菊先生所说：“治法以人体为主”，及“立法处方，不必细审为何细茵，但了然于其病灶之所在，就体功反常之处为调治南针”。毅然以白虎加人参汤清其肺胃之热，以大承气汤下其久滞不通之结热；白痦未尽，红斑旋出，邪势遂因之而渐衰。倘于此时因循坐误必失良机。病者自服白通汤后，汗出濈濈，从未中止，是病邪外达，有利于减轻肠胃之壅热，此为顺症之所当然，亦即预后良好之征兆。在整个治疗过程中，用寒用热，悉以体气之盛衰而为定，在体功与病邪方面，则根据“体功重于病邪”、“阳气重于阴气”的观点，先着重调理体功(机体功能)及扶持阳气，使正气旺盛，抗力增强，然后再处以治病之方，总以救人为先。此余平生用药心得之一也。
另据此案，可知西医之肠伤寒亦未必都是中医的湿温症，临床辨证勿为病名所惑：
头痛八例
例一：
李××，女，四十三岁，患头痛日久，来所就诊。自诉：每日工作即感头痛脑鸣，目眩，心烦。休息即止，口中干燥少津，舌色紫，脉细数。脉症合参，系用脑过度，肾水亏虚，不能涵养肝木，以致风火上扰清空。治当滋肾水，养肝木，熄风火。用六味地黄汤加味。处方：
This type of toothache is mostly intermittent, with severe pain at night, without redness or swelling of the gums, but accompanied by mental restlessness, tidal fever, or short and dark urine. The tongue body is mostly red with little coating, and the pulse is mostly fine. The treatment principle should be to nourish Yin, clear heat, and dispel wind. In cases complicated by defluxion of deficient fire, the pulse is mostly fine and rapid. The following two formulas may be used:
First Formula, Shengdi Gusuibu Decoction (Rehmanniae Radix et Drynariae Rhizoma Decoction):
Drynariae Rhizoma (Gusuibu, 骨碎补) 30g, Rehmanniae Radix (Shengdi, 生地) 30g, Menthae Haplocalycis Herba (Bohe, 薄荷) 6g, Asari Radix et Rhizoma (Xixin, 细辛) 6g, Bombyx Batryticatus (Chantui, 蝉蜕) 10g
Gastrodiae Rhizoma (Tianma, 天麻) 15g, Moutan Cortex (Mudanpi, 粉丹皮) 10g, Phellodendri Cortex (Huangbai, 焦黄柏) 10g, Mori Folium (Sangye, 桑叶) 10g, Frankincense (Ruxiang, 乳香) 6g
Kochiae Caulis (Qinjiao, 秦艽) 6g, Vespa Nidus (Lufengfang, 露蜂房) 10g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 6g
This formula is an empirical prescription self-developed by the author. It is not only applicable to toothache caused by Yin deficiency with heat, but also effective for trigeminal neuralgia caused by Yin deficiency.
In this formula, Drynariae Rhizoma tonifies the Kidney, promotes blood circulation, consolidates essence and marrow, and alleviates toothache; Rehmanniae Radix and Moutan Cortex cool the blood and nourish Yin. Vespa Nidus dispels wind, and Asari Radix et Rhizoma disperses cold and alleviates pain. Frankincense regulates Qi and blood, dissipates stasis, and alleviates pain; Bombyx Batryticatus, Mori Folium, Menthae Haplocalycis Herba, and Kochiae Caulis are used to dispel wind-heat. Phellodendri Cortex nourishes Kidney Water to drain fire, and Gastrodiae Rhizoma extinguishes wind and relieves pain. Cold and warm herbs are used together to achieve the effect of nourishing Yin, clearing heat, and relieving pain.
Second Formula, Danggui Shijueming San (Angelica Sinensis and Haliotidis Concha Powder):
Angelicae Sinensis Radix (Danggui, 当归) 15g, Haliotidis Concha (Shijueming, 石决明) 30g, Testudinis Carapax et Plastrum (Guiban, 龟板) 15g, Magnetitum (Cishi, 磁石) 30g, Ligustri Lucidi Fructus (Nvzhenzi, 女贞子) 15g
Paeoniae Radix Alba (Baishao, 杭芍) 15g, Poria (Fuling, 茯苓) 15g, Moutan Cortex (Mudanpi, 粉丹皮) 15g, Asari Radix et Rhizoma (Xixin, 细辛) 5g
This formula treats toothache caused by defluxion of deficient fire due to Liver-Kidney Yin deficiency, having the effects of nourishing the Liver and Kidneys, subduing Yang, and extinguishing wind. Compared to Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), which only nourishes Liver-Kidney Yin, its therapeutic effect is more ideal. For Yin deficiency complicated by wind-heat, use the first formula; for Yin deficiency complicated by Liver Blood insufficiency and defluxion of deficient fire, use the second formula.
(IV) Kidney Yang Deficiency Type
This type mostly belongs to elderly patients with Kidney Essence deficiency and floating of Ministerial Fire. Characteristics of toothache: pain is not severe, lighter during the day and heavier at night, continuous and lingering, without redness or swelling of the teeth. The tongue body is mostly bluish-purple, with a pale, moist, and slippery coating; the pulse is mostly deep or deep-wiry. Treatment should focus on warming Yang and consolidating the Kidneys. I often select Guifu Bawei Wan (Cinnamon Twig and Aconite Eight-Ingredient Pill), modified into a decoction. I select Cinnamon Twig (Rougui, 肉桂) to guide fire back to its source.
If Kidney Yang is severely deficient, with a cyan complexion and extreme aversion to cold, Baitong Tang (White Pass Decoction) plus Northern Asari Radix et Rhizoma is selected. Hot medicine is taken cold, utilizing the principle of counter-assistance.
(V) Dental Caries (Tooth Decay)
The pain in this type is relatively severe and can be triggered by hot, cold, or stimulating foods. Huang Kunzai's Chaihu Tao Ren Tang (Bupleurum and Peach Kernel Decoction) can be selected for better results. Prescription:
Bupleuri Radix (Chaihu, 柴胡) 10g, Persicam Semen (Taoren, 桃仁) 10g, Gypsum Fibrosum (Sheng Shigao, 生石膏) 20g, Stir-fried Drynariae Rhizoma (Chao Gusuibu, 炒骨碎补) 20g
In this formula, Bupleuri Radix regulates Qi and relieves depression, combined with Drynariae Rhizoma for analgesia; Persicam Semen promotes blood circulation and removes stasis to relieve pain; Gypsum Fibrosum clears heat and drains fire. This formula has an immediate effect in relieving dental caries pain.
The above five types of toothache are commonly seen in clinical practice. Due to the large number of cured cases, it is inconvenient to list them one by one. Only the principles, methods, formulas, and drugs for differentiated treatment are proposed for clinical reference. Medical Case: Summer-Heat Warmth Complicated by Pestilential Qi
Ye XX, Male, 30 years old. In midsummer of 1949, he suffered from persistent fever for over a month. After Western medical treatment, the fever did not subside, so I was invited to consult. Symptoms included: inability to get out of bed, dirty and yellowish complexion, yellow eyes, high fever with mental restlessness and thirst, spontaneous sweating, and heavy body. Tongue coating was white and greasy; right pulse was surging and forceful. Considering the disease started in July, during the solar terms of Major Heat and Minor Heat, it was caused by sudden exposure to summer-heat Qi. Wu Jutong said: "Summer-heat combines with dampness; when biased towards heat, it is called Summer-Heat Warmth. However, since the disease onset is violent, it must be complicated by pestilential Qi." Thus, it was diagnosed as Summer-Heat Warmth complicated by pestilential qi. Since symptoms showed high fever, mental restlessness, thirst, sweating, dirty face, and a surging right pulse, this indicated heat pathogen lying hidden internally, similar to the Baihu Tang syndrome in Shanghan Lun. Baihu Jia Cang Zhu Tang (White Tiger Plus Atractylodes Macrocephala Decoction) was prescribed. Prescription:
Gypsum Fibrosum (Sheng Shigao, 生石膏) 30g, Stir-fried Anemarrhenae Rhizoma (Chao Zhimu, 炒知母) 9g, Stir-fried Atractylodis Macrocephalae Rhizoma (Chao Cangzhu, 炒苍术) 6g, Oryza Sativa Grain (Jingshi, 粳米) 15g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 6g
In this formula, Gypsum Fibrosum clears Lung heat and drains Stomach fire; Anemarrhenae Rhizoma clears Lung heat and nourishes Kidney Yin; Glycyrrhizae Radix et Rhizoma and Oryza Sativa Grain harmonize the Middle and protect Stomach Qi; Atractylodis Macrocephalae Rhizoma dries dampness and dispels filth. The combination of these herbs achieves the effect of clearing heat, relieving restlessness, drying dampness, and resolving summer-heat.
Second Visit: After taking the medicine, mental restlessness, thirst, and fever decreased. The pulse changed from surging to wiry and fine, and the tongue coating became thin. There was still thirst, mental restlessness, and slight fever. The syndrome belongs to internal closure of summer-heat, requiring clearing heat, relieving restlessness, and venting heat outward. Fangxiang San (Fragrant Dispelling Powder) was substituted. Prescription:
Bombyx Batryticatus (Jiangcan, 僵蚕) 6g, Bombyx Batryticatus (Chantui, 蝉蜕) 6g, Gypsum Fibrosum (Sheng Shigao, 生石膏) 15g, Scrophulariae Radix (Xuanshen, 玄参) 15g, Sophorae Flavescentis Radix (Kushen, 苦参) 4.5g
Stir-fried Medicated Leaven (Shao Shenqu, 烧神曲) 9g, Schizonepetae Spica (Jingjie, 荆芥) 6g, Poria with Hostwood (Fushen, 茯神) 15g, Stir-fried Gardeniae Fructus (Jiao Zhizi, 焦栀子) 9g, Stir-fried Scutellariae Radix (Chao Huangqin, 炒黄芩) 6g
Stir-fried Coptidis Rhizoma (Chao Chuanlian, 炒川连) 2g, Stir-fried Phellodendri Cortex (Jiao Huangbai, 焦黄柏) 6g, Tetrastigmae Caulis (Tianhuafen, 天花粉) 9g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 4.5g
In this formula, Bombyx Batryticatus and Chantui are both clearing and transforming agents, eliminating pestilential qi and filth; Sophorae Flavescentis Radix clears heat and dries dampness; Scrophulariae Radix clears fire, reduces fever, and nourishes Yin; combined with Gypsum Fibrosum, Scutellariae Radix, Coptidis Rhizoma, and Gardeniae Fructus to enhance the antipyretic effect. The Classic says, "For fire stagnation, emit it." Schizonepetae Spica is used to vent heat outward; Tetrastigmae Caulis generates fluids and stops thirst; Medicated Leaven digests food and transforms filth; Poria with Hostwood calms the spirit; Glycyrrhizae Radix et Rhizoma protects Stomach Qi and harmonizes all herbs.
Third Visit: After one dose, fever and mental restlessness/thirst decreased sharply, and the greasy tongue coating completely disappeared. The tongue body turned purple, revealing the underlying essence of fluid deficiency. This is a good sign of latent heat breaking through stagnation. However, there was constipation for many days, tenesmus, and abdominal pain due to long-standing heat stagnation forming internal knots. Urgent purgation was needed, using Longhu Tang (Yellow Dragon Decoction) from Shanghan Liushu, modified. Although this case belongs to warm diseases, due to the long course, heat has knotted internally, burning fluids and causing intestinal dryness. If only purgation is used to drain heat, there is a risk of "disease gone but person perishing." Therefore, a method combining purgation and tonification is appropriate. Prescription:
Wine-stir-fried Rehmanniae Radix (Jiu Chao Shengdi, 酒炒生地) 15g, Angelicae Sinensis Radix (Danggui, 当归) 15g, Rheii Radix et Rhizoma (Dahuang, 大黄) 6g, Codonopsis Radix (Luodangshen, 潞党参) 15g, Natrii Sulfas (Mangxiao, 芒硝) 6g
Magnoliae Officinalis Cortex (Houpo, 厚朴) 6g, Stir-fried Immature Bitter Orange (Chao Zhishi, 炒枳实) 6g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 4.5g, White Honey (Baimi, 白蜜) 3 spoons as a guide
This formula is Da Chengqi Tang (Major Order the Qi Decoction) with additions. In this formula, Rehmanniae Radix nourishes Yin and generates fluids; wine-stir-frying enhances blood circulation; combined with Codonopsis Radix and Angelicae Sinensis Radix to tonify Qi and generate Blood; Glycyrrhizae Radix et Rhizoma harmonizes the Stomach; adding White Honey nourishes Stomach Yin and moistens dryness. Such a combination integrates supporting healthy Qi and attacking pathogens in one formula, attacking pathogens without damaging healthy Qi, and supporting healthy Qi without hindering pathogen expulsion. The formula matches the syndrome perfectly.
After one dose, stool passed slightly but not smoothly. After two doses, lower abdomen became urgent and distended, followed by passage of much black stool with occasional blood clots. This shows that if purgation is delayed, indulging the pathogen will inevitably lead to excessive Yang and depletion of Yin, posing a life-threatening danger. Now, although the patient is mentally and physically fatigued, after a month of fever, with relief of thirst/restlessness, he feels lighter. However, sweating continues, body is emaciated, with slight afternoon fever. A formula for nourishing Blood and Yin was prescribed for regulation. Unexpectedly, his family asked another doctor to prescribe a formula containing Prepared Aconite Root (Fupian, 附片), Trionycis Carapax (Biejia, 鳖甲), Paeoniae Radix Alba (Baishao, 杭芍), and Jujubae Fructus (Yuanrou, 元肉) to take concurrently. After taking it, he became restless and uneasy. This is because the disease receded but Yin was deficient, unable to tolerate Yang-tonifying herbs. Although the previous formula also contained Yin-nourishing herbs, administering Prepared Aconite Root etc. during a time of Yin deficiency and Yang excess was inappropriate. I was consulted again, and the treatment strictly focused on nourishing Yin. Prescription:
Wine-stir-fried Rehmanniae Radix (Jiu Chao Shengdi, 酒炒生地) 15g, Testudinis Carapax et Plastrum (Guiban, 龟板) 15g, Dendrobii Caulis (Shihu, 金石斛) 9g, Schisandrae Fructus (Wuweizi, 五味子) 2g
Ostreum Concha (Muli, 牡蛎) 15g, Stir-fried Phellodendri Cortex (Jiao Huangbai, 焦黄柏) 6g, Stir-fried Coptidis Rhizoma (Chao Chuanlian, 炒川连) 2g, Polygonati Odorati Rhizoma (Yuzhu, 玉竹) 9g, Ophiopogonis Radix (Maidong, 麦冬) 9g
Scrophulariae Radix (Xuanshen, 玄参) 15g, Ecorii Asini Colla (Ejiao, 阿胶) 9g, Anemarrhenae Rhizoma (Zhimu, 知母) 6g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 4.5g
The main aim of the entire formula is to nourish Lung and Stomach Yin fluids. Schisandrae Fructus and Ostreum Concha stop sweating and nourish Yin; Ecorii Asini Colla tonifies Lung Jin, nourishes Liver and Kidney; Testudinis Carapax et Plastrum benefits Yin and nourishes Water; Polygonati Odorati Rhizoma, Ophiopogonis Radix, Dendrobii Caulis, and Scrophulariae Radix generate fluids and moisten dryness; a small amount of Coptidis Rhizoma descends floating heat of the Heart meridian; Phellodendri Cortex drains fire and strengthens the Kidney. After taking, mental restlessness settled and sweating stopped. Subsequently, a large dose of Buyin Jian (Nourish Yin Decoction) was used, heavily featuring Testudinis Carapax et Plastrum, Rehmanniae Radix Preparata (Shudi, 熟地), and Zhibai Bawei Wan (Anemarrhena, Phellodendron and Eight-Ingredient Rehmannia Pill), along with Dioscoreae Hypoglaucae Rhizoma (Huai Shanyao, 淮山药) for several doses until recovery.
[Commentary]: Summer-Heat Warmth easily complicates with pestilential qi. Although this case lasted over a month, the heat pathogen remained in the Qi level, resembling Baihu Tang syndrome, so Baihu Jia Cang Zhu Tang was given. After medication, the fever subsided, then Fangxiang San was used to vent heat outward, reducing all symptoms suddenly. However, due to long-standing heat stagnation, Yangming Fu organ excess formed, and only purgation could destroy its nest. But long-term heat damages Yin, and healthy Qi is also deficient. Without nourishing Yin and supporting healthy Qi, purgation cannot be tolerated. The best strategy is combining purgation and tonification; Longhu Tang is an ideal formula. After purgation, recovering with Blood-nourishing and Yin-nourishing would suffice. However, the family changed doctors and added Yang-tonifying herbs, causing temporary changes. This illustrates that in late-stage Summer-Heat Warmth, Yin deficiency generates internal heat, which further damages Yin, forming a vicious cycle. Those with Yin deficiency must be nourished; this is an unchanging principle for eternity. Since the disease is not dual deficiency of Yin and Yang, dual tonification is unnecessary; otherwise, it is like "drawing legs on a snake," causing failure.
Cold Damage Complicated by Intercourse
Lu XX, Male, over 50 years old. In summer 1943, due to persistent fever, he was hospitalized in a certain hospital. Western medicine diagnosed him with "Typhoid Fever." Western medicine treatment was ineffective. Then Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Erchen Tang (Two-Aged Thing Decoction), Rehmanniae Radix, Ostreum Concha, Moutan Cortex, etc., were used. The condition worsened day by day. After more than twenty days, I was invited to treat. Symptoms included: high fever without sweat, dull complexion, low voice and reluctance to speak, stiffness and pain in the neck and back, occasional fearfulness, thick, greasy, and slippery tongue coating, no thirst, and deep, slow, and tight pulse. Analysis of symptoms: although the course reached over twenty days, especially high fever without sweat and neck/back stiffness clearly indicates Taiyang has not resolved. However, dull complexion, deep-slow-tight pulse, and low voice indicate severe exterior closure with insufficient interior Qi. Insufficiency here means "Qi timidity." I asked, and learned that at the onset of the illness, the patient engaged in sexual intercourse, leading to signs of insufficient interior Qi. Thick greasy tongue coating indicates severe dampness stagnation. At the beginning, this syndrome should have been treated with diaphoresis to release the exterior. If done correctly, the pathogen would resolve with sweat, never dragging on and worsening to this extent. The current symptoms originally belonged to simultaneous Taiyang and Shaoyin cold damage. Initial misdiagnosis focused solely on harmonizing Shaoyang, repeatedly using modified Xiao Chaihu Tang, which was inadequate! Moreover, Rehmanniae Radix and Moutan Cortex are Yin and astringent; Ostreum Concha is sour and contracting; Bupleuri Radix is ascending and dispersing; Scutellariae Radix is clearing and descending. Not only did they fail to fully release the exterior, but they also suppressed the body's resistance. Muscle pores closed further, causing temperature to rise higher, spirit becoming chaotic, heart function weakening, hence occasional fearfulness. At this point, based on reasoning, the method should be releasing Taiyang exterior and warming Shaoyin meridian, using Mahuang Fuzi Xixin Tang (Ephedra, Aconite and Asari Decoction). But considering the initial stage, previous doctors repeatedly used Bupleuri Radix to ascend again and again. Now seeing fearfulness, if continuing with the ascending and dispersing nature of Ephedra and Asari, it might cause adverse consequences of spirit flying away. The best strategy is to warm and support Kidney Yang, open Taiyang Qi mechanism, and guide pathogens from interior to exterior. Thus, deciding to use self-developed Fuzi Guizhi Duhuo Jisheng Tang (Aconite, Cinnamon Twig, and Notopterygium Decoction):
Prepared Aconite Root (Fupian, 附片) 60g, Cinnamomi Ramulus (Guizhi, 桂枝) 9g, Taxilli Caulis (Sangjisheng, 桑寄生) 9g, Paeoniae Radix Alba (Baishao, 杭芍) 9g, Pinelliae Rhizoma Praeparatum (Banxia, 法夏) 9g
Poria (Fuling, 茯苓) 15g, Notopterygii Rhizoma et Radix (Duhuo, 独活) 6g, Saposhnikoviae Radix (Fangfeng, 防风) 9g, Chuanxiong Rhizoma (Chuanxiong, 川芎) 6g, Arecae Cathayensis Semen (Taiwu, 台乌) 9g
Citri Reticulatae Pericarpium (Chenpi, 陈皮) 6g, Burned Ginger (Shao Shengjiang, 烧生姜) 3 slices, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 6g, Jujubae Fructus (Dazao, 大枣) 3 pieces
Formula explanation is seen in the "Wind-Cold-Damp Bi" case in this book.
After prescribing, I specifically told his family: "The turning point of this syndrome, if it can turn from Yin to Yang, with Yang returning and Yin消退, is easy to treat. With fever persisting for over twenty days, white millet-like rash and red spots may follow. The main purpose of this formula is to guide pathogens outward, avoiding perforation of the intestinal wall."
Next Day Second Visit: After taking medicine, spirit and form were relatively calm, but fever remained the same. Still adhering to the original formula, increasing Prepared Aconite Root to 90g. Third and Fourth Visits: Adhered to the original formula, adding Achyranthis Bidentatae Radix (Huainiuxi, 淮牛膝) 9g, Eucommiae Cortex (Duzhong, 杜zhong) 15g, Cibotii Rhizoma (Jinmao Gouji, 金毛狗脊) 9g to warmly strengthen Primordial Yang and treat waist/spine pain.
Fifth Visit: Used a large dose of Baitong Tang to encourage Qi mechanism and connect Heart-Kidney Yang. Prescription:
Prepared Aconite Root (Fupian, 附片) 120g, Zingiberis Rhizoma Recens (Ganjiang, 干姜) 15g, Allii Fistulosi Bulbus (Congbai, 葱白) 3 pieces
After taking previous formulas, no sweat was produced. After one dose of large-dose Baitong Tang, profuse sweating occurred, sufficient to show that exterior pathogen was firmly closed, requiring large-dose warming interior and unblocking Yang to reach it. No bowel movement for two weeks. In the past five days, formulas mainly used Prepared Aconite Root to warm Primordial Yang, strengthen heart, benefit fire, and enhance body resistance.
Sixth Visit: After one dose of Baitong Tang, although sweat was obtained and interior Yang gradually returned, fever did not subside. However, whole-body pain greatly reduced, spirit improved, fearfulness ceased, and complexion became lustrous. The disease had turned from Yin to Yang, pulse became surging and forceful. Mental restlessness, thirst, and desire to drink. The patient had transformed from initial physical and Qi timidity to fullness of form and Qi, truly a good prognostic sign. Thus, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) from Shanghan Lun was used. Prescription:
American Ginseng (Baiyangshen, 白洋参) 9g, Gypsum Fibrosum (Sheng Shigao, 生石膏) 15g, Stir-fried Anemarrhenae Rhizoma (Chao Zhimu, 炒知母) 9g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 6g, Oryza Sativa Grain (Jingshi, 粳米) 15g
Seventh Visit: After taking the above formula, irritability and heat relieved, and sleep was achieved. Indeed, faint white millet-like rashes appeared on the chest, proving Lung stagnation had been vented. However, chest stuffiness and epigastric fullness were severe, no bowel movement for over ten days, pulse still forceful, heat transmitted to Stomach, Fu Qi was solid, indications for purgation were complete.
Western medicine treats "Typhoid Fever"; constipation prohibits purgation. Purging causes excessive intestinal peristalsis leading to intestinal hemorrhage and other critical conditions. However, as long as indications for purgation exist, purgation can be used. Thus, Da Chengqi Tang (Major Order the Qi Decoction) was resolutely used. Prescription:
Rhei Radix et Rhizoma (Dahuang, 大黄) 9g, Natrii Sulfas (Yuanmingfen, 元明粉) 9g, Magnoliae Officinalis Cortex (Houpo, 厚朴) 9g, Immature Bitter Orange (Zhishi, 枳实) 9g
Eighth Visit: After medicine, much foul stool was discharged, removing accumulation of over ten days. However, white millet-like rashes continued to appear, and vomiting occurred. This was not a change after Da Chengqi Tang purgation, but due to initial recovery of Stomach Qi and disharmony of cold and heat. To harmonize Stomach Qi, Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) from Shanghan Lun was used, modified. Prescription:
Pinelliae Rhizoma Praeparatum (Banxia, 法夏) 9g, Stir-fried Coptidis Rhizoma (Chao Huanglian, 炒黄连) 3g, Stir-fried Scutellariae Radix (Chao Huangqin, 炒黄芩) 6g, Codonopsis Radix (Luodangshen, 潞党参) 15g, Medicated Leaven (Shenqu, 神曲) 9g
Endopermium Sacrum (Jineijin, 鸡内金) 9g, Hordeum Vulgare Fructus (Maiya, 麦芽) 15g, Zingiberis Rhizoma Recens (Ganjiang, 干姜) 12g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 6g, Jujubae Fructus (Dazao, 大枣) 3 pieces
This formula originally treats post-purgation fullness without pain in the chest (Pi syndrome) and vomiting with cold body in cold damage. In this formula, Pinelliae Rhizoma Praeparatum stops vomiting and dissipates knotting Qi; Scutellariae Radix and Coptidis Rhizoma eliminate fullness; Codonopsis Radix, Glycyrrhizae Radix et Rhizoma, and Zingiberis Rhizoma Recens tonify Spleen and harmonize Middle to connect upper and lower and interact Yin and Yang; adding Medicated Leaven, Hordeum Vulgare Fructus, and Endopermium Sacrum to digest and guide stagnation.
Ninth Visit: All symptoms decreased, diet gradually increased, but fever turned into tidal fever, spirit fatigue, slight chest stuffiness, no bowel movement for four days, occasional aversion to cold. This is excess evil heat and insufficient Yang. Shanghan Lun says: "Epigastric fullness with aversion to cold and sweating, Fuzi Xiexin Tang governs." This fits the condition exactly, so this formula was given. Prescription:
Prepared Aconite Root (Fupian, 附片) 60g, Rhei Radix et Rhizoma (Dahuang, 大黄) 6g, Coptidis Rhizoma (Huanglian, 黄连) 3g, Scutellariae Radix (Huangqin, 黄芩) 6g
Epigastric fullness and chest discomfort indicate latent deficient heat. Aversion to cold indicates interior Yang deficiency. Giving Xiexin Tang to attack fullness and unblock bowels, adding Prepared Aconite Root to assist Yang.
Tenth Visit: After taking, bowels opened, red spots appeared all over the body, very bright in color (if black, it indicates Stomach Yin exhaustion, difficult to treat). The white millet-like rashes previously on the chest have now completely retreated. The patient is now mentally and physically fatigued, skeletal. Preservation of fluids and nourishing Stomach Yin should be the treatment. Prescription below:
Rehmanniae Radix (Shengdi, 生地) 15g, Rehmanniae Radix Preparata (Shudi, 熟地) 15g, Ophiopogonis Radix (Maidong, 麦冬) 9g, Asparagi Radix (Tian dong, 天冬) 9g, Citri Reticulatae Pericarpium (Chenpi, 陈皮) 6g
American Ginseng (Baiyangshen, 白洋参) 9g, Anemarrhenae Rhizoma (Zhimu, 知母) 6g, Oryza Sativa Grain (Jingshi, 粳米) 15g, Rhinocerotis Cornu (Xijiao, 犀角) 3g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 6g
Eleventh Visit: After taking the above formula, spirit improved, diet increased, then tidal fever and epistaxis occurred again. This is residual heat in Stomach not yet cleared, blood heat moving recklessly. Clearing Lung-Stomach stagnant heat and cooling blood to stop bleeding is suitable. Bianque Sandou Yin (Three Bean Drink of Bian Que) modified was used. Prescription:
Sojae Semen Nigrum (Heidou, 黑豆) 9g, Phaseoli Radiatus Semen (Lv dou, 绿豆) 9g, Stir-fried Gardeniae Fructus Pericarpium (Jiao Zhipi, 焦栀皮) 3g, Dolichoris Semen (Biandou, 扁豆) 9g, Mori Folium (Sangye, 桑叶) 6g
Loquat Leaf (Pipaye, 枇杷叶) 9g, Forsythiae Fructus (Lianqiao, 连翘) 9g, Ophiopogonis Radix (Maidong, 麦冬) 9g, Aurantii Fructus Immaturus (Zhiqiao, 枳壳) 6g, Nelumbinis Rhizomatis Nodus (Oujie, 藕节) 5 pieces
Bambusae Caulis in Taenia (Zhuru, 竹茹) 6g, Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) 3g
Twelfth Visit: After one dose of the above formula, epistaxis stopped immediately, and tidal fever also subsided. Continued with nourishing Yin, moistening dryness, and nourishing agents for regulation. Formula used modification of the above. Prescription:
Sojae Semen Nigrum (Heidou, 黑豆) 9g, Phaseoli Radiatus Semen (Lv dou, 绿豆) 9g, Dolichoris Semen (Biandou, 扁豆) 9g, Mume Fructus (Wumei, 乌梅) 9g, Saccharum (Bingtang, 冰糖) 15g (boiled together in three portions)
Taking the above formula continuously for five doses, all symptoms recovered.
[Commentary]: Observing this case, the course was long, and the transformation complex. Generally speaking, because the patient had exterior excess and interior deficiency with insufficient resistance, Fuzi Guizhi Duhuo Jisheng Tang and Baitong Tang were first used to warm and support. Afterwards, the patient's bodily function turned from deficiency to excess. Following Mr. Zhu Meiju's saying: "Treatment focuses on the human body," and "Legislating prescriptions does not require detailed examination of what bacteria, but understanding the location of the lesion and adjusting based on abnormalities in bodily function." Resolutely, Baihu Jia Renshen Tang was used to clear Lung-Stomach heat, and Da Chengqi Tang to purge long-standing stagnant heat. As white millet-like rashes were not fully cleared and red spots appeared, the pathogenic trend gradually declined. If one hesitates at this time, the opportunity will be lost. After the patient took Baitong Tang himself, sweating was profuse and uninterrupted, indicating pathogen reaching outward, beneficial for reducing gastrointestinal congestion. This is the natural progression of a favorable syndrome and a good prognostic sign. Throughout the entire treatment process, the use of cold or heat was determined by the flourishing or declining state of bodily Qi. Regarding bodily function and pathogen, based on the view that "bodily function is more important than pathogen" and "Yang is more important than Yin," priority was given to regulating bodily function (organism function) and supporting Yang, making healthy Qi vigorous and resistance enhanced, then prescribing disease-treating formulas, always prioritizing saving lives. This is one of my lifelong insights in medication.
Additionally, based on this case, it is known that Western medicine's Typhoid Fever is not necessarily Chinese Medicine's Damp-Warmth syndrome. Clinical differentiation should not be confused by disease names:
Eight Cases of Headache
Case 1:
Li XX, Female, 43 years old, suffering from chronic headache, came to the clinic for consultation. She reported: feeling headache and tinnitus, dizziness, and mental restlessness upon daily work. Resting stops it. Mouth is dry with little saliva, tongue color is purple, pulse is fine and rapid. Combining pulse and symptoms, it is due to overuse of the brain, Kidney Water deficiency, failing to nourish Liver Wood, leading to Wind-Fire harassing the clear orifices. Treatment should nourish Kidney Water, nourish Liver Wood, and extinguish Wind-Fire. Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) with modifications was used. Prescription:
Rehmanniae Radix (Shengdi, 生地) 15g, Moutan Cortex (Mudanpi, 粉丹皮) 10g, Alisma Rhizoma (Zexie, 泽泻) 9g, Poria (Fuling, 茯苓) 9g, Dioscoreae Hypoglaucae Rhizoma (Huai Shanyao, 淮山药) 15g
Bupleuri Radix (Chaihu, 柴胡) 6g, Viticis Fructus (Manjingzi, 蔓荆子) 9g, Uncariae Ramulus cum Uncis (Gouteng, 钩藤) 10g