本例即典型之两感症，若不急扶少阴之阳， 开太阳气机，则两感之邪难有出路，烦不易治。兹用脉黄附子细辛汤，实属有是症，立是法，用是方，故危重之症亦愈。寄语学者：凡治外感诸症，必须熟悉六经错综复杂变化之机制，则病情自无遁形，而施治始可中的。
李××，女，四十余岁。发热恶寒，自汗，腹痛欲呕，病已二十余日。住某医院治疗，延余会诊。症如上述，舌质淡润，苔白腻，脉弦。脉症合参，诊为太阳、少阳合病兼脾湿不化。处以柴胡桂枝汤加减。处方：
方用小柴胡汤去参，和解少阳枢机以除寒热。用桂枝汤调和营卫以解太阳。重用杭芍和营敛汗，加木香、白蔻仁温脾化湿以止腹痛欲呕等症。
二诊：上方服一剂，热退，腹痛止，舌白腻亦减，脉弦转绥。继以四逆散与桂枝汤二方合用，服药三剂诸症全愈。太阳阳明合病
戴××，女，二十七岁，壮热不恶寒，身痛项强、烦渴引饮，已十余日。脉洪大，舌质红，苔厚腻。前医曾用小柴胡汤未解。症属湿热羁留于太阳、阳明二经，应开太阳气机，清泻阳明，使邪从外解。方用《伤寒论》桂枝汤与白虎汤合方化裁。处方：
白虎汤能清金保肺，峻泻阳明独盛之热。桂枝去芍药汤解肌表之邪，使之从太阳而解。葛根为阳明经药，具解表、退热、解毒诸作用，配桂枝发汗解肌，引邪外出。
服一剂，热稍退，余症如前，又增胸闷，干呕，口苦，自汗，大便不通。此阳邪陷里，当用表里双解法。改用《伤寒论》大柴胡汤。处方：
此表里两解，攻内解外之方，仲景用治“伤寒发热，汗出不解，热结在里，表里俱病”之证候。
服一剂，便通烦定，胸闷、口苦解除。但热未全退，周身关节疼痛，舌苔仍腻。可知因湿邪太盛，阻滞太阳经络所致。当以除湿透络为主，方用《金匮要略》麻黄加术汤合麻杏苡甘汤。处方：
甘草6克
方中，麻黄发汗，桂枝解肌，杏仁利肺气，甘草和中。因其湿盛，故用白术燥湿，苡仁渗湿。
服一剂，身痛全消，热退身凉。继以甘露饮(生地、熟地、天冬、麦冬、茵陈、黄芩、枇杷叶、石斛、甘草)调理而愈。
[按]：足太阳循身之表，为一身之藩篱，乃机体最外一层，风、寒、暑、湿、燥、火六淫之邪，多由太阳侵入。故本症治疗，自始至终，均以解散表邪为主，使邪从外解，庶免深入之患。至于具体的立方用药，则视病情而定。如初时用白虎合桂枝汤，湿热用桂枝等品，此亦说明在辛凉清气解肌方中，适当佐以必要之辛温药物，似更能加强全方之作用。
赵××，女，四十岁。患者发热，汗出，口苦，耳聋，自利不止，口渴，小便短少。病已十余日，曾服辛凉解表之剂不效，延余往诊。诊脉浮弦，舌心滑润，气弱神倦。此三阳合病也。发热、汗出者，太阳中风证也。口苦、耳聋者，少阳证也。自利不止者，《伤寒论》云：“太阳与阳明合病者，必自下利”。口渴尿少者，太阳腑证也。太阳主表，故脉浮，弦又为少阳主脉。舌滑润为津液未伤，气弱神倦者，误用辛凉，正气被损也。本病治法，重在调和表里，三阳并治。《医学心悟》云：“不论三阳、三阴，凡两经合病，则用两经药同治之，三经合病，则用三经药同治之。”因合用小柴胡汤、硅枝加葛根汤和五苓散三方化裁。处方；
笺诊：服一剂，热退泻止，余症亦减。继以五味异功散善肟。处方：
嘱服二剂，诸症悉除。
寒入厥阴救逆
杨××，女，十五岁，病已～周。初病发热呕吐，泻利，头痛，恶寒，曾先后延医诊治无效。现呕逆不止，腹痛硬满，面赤，烦躁。仍感头痛，恶寒，手足僵冷。查其以前所服诸方，均以小柴胡汤为基础，甚至加三棱、莪术攻伐，服后月经适来，病更加剧。
察其脉细而欲绝，舌淡紫，与上述病情合参，乃寒入厥阴，其病在肝。肝与胆相表里，肝寒而气郁不升，则影响于胆，气逆不降，故呕逆不止。厥阴为风木之脏，木郁克土，故腹痛硬满。寒入于阴，则阳浮于上，故面赤。吐泻后，阳气与津液俱伤，心肾不交，水火离隔，故烦躁。厥阴外证未解，故头痛、恶寒。肝脾不和，阳气不能达于四肢，故手足僵冷。小柴胡汤乃和解少阳之方，其所以误者， 因惑于发热、呕吐，未注意尚有太阳表证之头痛、恶寒、阳明之下利也。若当时投以葛根汤，两解太阳、阳明之邪，则其病早愈。由于越经用药，引邪深入，柴、芩皆清泻肝胆之品，反复用之，攻伐无过，以致病情加剧。幸患者年青，生机旺盛．正气尚能支持，急投以《伤寒论》当归四逆加吴茱萸生姜汤加味。处方：
方中当归、桂枝、杭芍温经活血，细辛散少阴之寒，吴萸、生姜散寒止呕，炙草、大枣补中生血。通草通经络利关节，尤在泾谓本品有“通脉续绝之功”。加小茴、砂仁以理气通滞而止痛，少加黄连、配吴萸取“左金”之意以平肝而为反佐。
上方服后，次日来诊，呕逆全止，肢已转温，面赤，烦躁、腹痛均减。续处以吴萸四逆汤。处方：
此方本可先甩，其所以不先用者，在于本病既经误治克伐，不但厥阴外证未解，且使肝血为寒所凝而不能畅运，故先予当归四逆汤温血达表，以作响导，继用吴萸四逆汤，温中扶阳，驱除浊阴。如此施治，始可引邪向外一举而平。故服第二方后，诸症悉除，且满身出现红斑，此病邪由里达表，已收预期之效。乃因势利导，以四逆汤振奋阳气，驱邪外散，遂告全愈。
[按]：《伤寒论．·辨厥阴病脉证并治》云：“手足厥寒，脉细欲绝者，当归四逆汤主之。”又云：“若其人内有久寒者，宜当归四逆加吴茱萸生姜汤。”此二条指出厥阴病的治疗途径之一。本例由误治而导致寒入厥阴， 因证候与《伤寒》所逆相符，故用之有桴鼓之应。厥阴为肝木所主，肝主藏血，脉细如绝为厥阴病血虚之候。血虚者当以补血行血为主。正如尤在泾所说：“欲续其脉，必益其血，欲益其血，必温其经。”然因过用寒凉及攻伐之品，不仅血虚，真阳亦有亏损，故益血温经之后，又用吴萸四逆汤扶阳温中而散寒。因病证如此，故用药亦不得不如此。
高年中风
孙××，男，八十余岁。家属代诉：平素嗜酒，曾患风湿，关节疼痛、足不任地多年。因神志昏迷，住某医院，诊断为中风症，治疗无效，延余会诊。症见：昏迷，喉间痰鸣，面色枯焦而紫赤，不大便已十余日，病势严重。苔白腻，脉弦数。症由湿痰内蕴，郁久化热所致。治法本应清化痰热，但苔白腻为湿痰兼夹之象，且又在高年，心肺之阳易虚。治疗先以温扶心肺之阳，降逆化痰、行水散结之剂。用姜桂苓半汤以干姜易生姜，消息之。处方：
服药一剂后，舌苔白腻转黄，热象显露。此时症结所在，以通便为当务之急。患者年事虽高，但证现实热，本“有故无殒”之旨，予黄龙汤加减。处方：
元明粉9克 党参15克 白蜜15克
此方主治应下失下，肠燥津枯，痞满坚实俱备之证。故用大承气汤急攻其急，并加党参以固元气，当归、生地、白蜜滋阴养血。如此攻补兼施，下则无碍。
服一剂，大便仍不通，易方用大承气汤(枳实、厚朴、大黄、芒硝)以攻积，加白蜜18克以润肠，加瓜蒌仁9克以宽中润下。服一剂，病无增减，因病势积重难通，再易方用小承气汤(枳实、厚朴、大黄)加白蜜18克、蒌仁9克、当归15克、白芍12克，以养血润燥。连服五剂，大便渐通，神志渐清。继服养血润燥活络之剂调理后，下肢行动自如，康复如初。
类 中 风
苏××，女，五十余岁。婚后迄未孕育，常自苦闷，忧郁成疾，遂患臌胀。经西医治疗虽有好转，于1951年春．因饮食不慎．以致大吐，旋即昏迷不省人事，送医院急救，历三日仍处于昏迷状态。某中医以小续命汤，服之不应，并称患者循衣摸床，病已不治，家人为其料理后事。延至第五日，始延余往诊。据其体质素弱，又常忧郁。今病昏迷，唇色润．活，舌苔白燥，脉沉细和缓，触之无汗，并无口开、手撒、声鼾、眼合、遗尿、汗出如油等绝症败象，是皆元气内竭，病况危殆。
思之良久，乃谓家人曰：“此症系血虚肝郁，又经大吐伤中，湿聚痰生，以致肝风内动，风痰纠结，猝倒无知，昏迷不醒，不食、不便已五日。幸无其他败象，脉沉细和缓，来去分明，胃气未绝，尚有挽回余地。至于猝倒无知，舌强不语，系阴火(肝肾虚火)上冲，风痰上扰。若用药偏温，则反助火势；偏凉则中宫更伤。今惟有扶正祛邪、熄风化痰一注。”乃处以下方：
竹沥二匙 姜汁(少许为引)
此方即资寿解语汤加桑叶、菊花也。方中羚羊角、天麻、桑叶、菊花清肝熄风，尤以羚羊角镇痉治头目之风最效。竹沥、姜汁化痰，羌活、防风镇痛、镇痉而祛风。用肉桂引火归元，配附片，枣仁强心温肾，扶助机体，增强抗力，甘草和中。诸药台用，有熄风化痰，引火归元，扶正祛邪之效。
上方服后，神识较清，已能识人，惟身重不能转侧，头闷痛，恶心。舌苔由白燥转白腻，脉由沉细转弦滑。此内湿素盛，痰湿上逆，治应除湿、祛风、益气、扶脾、涤痰。方用李东垣半夏天麻自术汤。处方：
上方服二剂，神识更清，但仍不能起床。自以为病势好转，虑余诊务繁忙，乃另邀某医作调理治疗，处以大橘皮汤加减，药用茯苓、猪苓、泽泻、桂枝、白术、木香、陈皮、槟榔、六一散、扁豆等。服后即见烦躁、失眠、手足抽搐，复延余诊。症见：脉弦细，舌红燥。盖由利湿伤阴，阴虚动风，肝阳不潜，冶应柔肝熄风，安神定志。予自拟首乌黑芝麻散和桂枝龙骨牡蛎汤加减。处方：
甘草5克
方中首乌、黑芝麻滋养肝肾，补血祛风。石斛益阴补精，钩藤、桑叶、菊花清肝熄风，平降肝阳。桂、芍、龙、牡、草，安神定志，潜镇浮阳。
连服三剂，搐溺已止，渐能活动，烦躁失眠症亦减去七、八，宜继续养血柔肝、育阴潜阳治之，方用自制二甲散加减。处方；
服三剂后，病体逐渐恢复，已能起床，出院回家，继以饮食调养。
杨××，女，三十岁。初患上腹疼痛，发高热，大便秘结。病已四日。曾用灌肠法通便，反致腹痛、吐泻、手足厥冷，烦躁不安，面青，脉微。经服大剂附子理中汤(重用附子)，服后病情加剧，乃邀余往诊。症见：面青，神烦，肢冷，吐泻发热，口唇焦燥。舌呈紫色，脉象闭伏。细审之：手背虽冷，但手心灼热，加以烦渴引冷，口臭气粗，舌唇焦紫等症状，并非阳气不足，实为邪热有余之象。若属真寒，必现手心手背两面俱冷，岂有手心独热之理，这是辨证的关键所在。脉虽不显，由于热邪闭伏于里，阳盛格阴，阳气不能达于四末，故见肢冷脉闭。综上判断，确系真热假寒，阳极似阴，即《内经》所谓“热深厥深”，实属有余之热证，用附子理中汤而病情反剧者，缘犯“实实”之戒，以阳药治阳症，热势愈盛，重热则寒，物极必反，故外现阴寒之假象。法宜急泻其火以救阴。处方：
第一方：
地浆水适量 (掘地作坑，灌水搅之，待其澄清后，去泡沫取水)
绿豆30克(用地浆水煨服)
第二方，葛根黄芩黄连汤：
本病例是典型的“两感”证（指表里两经同时受邪的严重外感病），如果不紧急扶助少阴之阳，开通太阳之气机，那么两感之邪难以找到出路，烦躁等症状不易治疗。此处使用脉黄附子细辛汤，确实是遵循了“有是症，立是法，用是方”的原则，所以危重的病症也能治愈。寄语各位学者：凡是治疗各种外感病症，必须熟悉六经错综复杂变化的机制，这样病情自然无处隐藏，施治才能准确命中目标。
患者李××，女性，四十多岁。发热恶寒，自汗出，腹痛想呕吐，患病已二十多天。在某医院住院治疗，邀请我会诊。症状如上所述，舌质淡而湿润，苔白腻，脉弦。脉象与症状结合分析，诊断为太阳、少阳合病兼脾湿不化。处以柴胡桂枝汤加减。处方如下：
柴胡9克 炒黄芩9克 法半夏10克 桂枝10克 杭白芍12克
方中用小柴胡汤去掉人参，以和解少阳枢机来消除寒热往来。用桂枝汤调和营卫以解除太阳表邪。重用杭白芍和营敛汗，加入木香、白蔻仁温脾化湿，以止腹痛欲呕等症状。
二诊：服用上方一剂后，热退，腹痛停止，舌上白腻苔也减轻，脉弦转为缓和。继续将四逆散与桂枝汤两方合用，服药三剂后所有症状痊愈。
太阳与阳明合病
患者戴××，女性，二十七岁，高热不怕冷，身体疼痛项背强直、烦躁口渴引饮，患病已十多天。脉洪大，舌质红，苔厚腻。前医曾用小柴胡汤未见效。症状属于湿热羁留于太阳、阳明二经，应当开通太阳气机，清泻阳明，使邪气从体表解除。方用《伤寒论》中的桂枝汤与白虎汤合方化裁。处方如下：
白虎汤能清金保肺，峻泻阳明独盛之热。桂枝去芍药汤解肌表之邪，使之从太阳而解。葛根为阳明经药，具解表、退热、解毒诸作用，配桂枝发汗解肌，引邪外出。
服一剂，热稍退，余症如前，又增胸闷，干呕，口苦，自汗，大便不通。此阳邪陷里，当用表里双解法。改用《伤寒论》大柴胡汤。处方如下：
此方表里两解，攻内解外，张仲景用于治疗“伤寒发热，汗出不解，热结在里，表里俱病”的证候。
服一剂，大便通，烦躁定，胸闷、口苦解除。但热未全退，周身关节疼痛，舌苔仍腻。可知因湿邪太盛，阻滞太阳经络所致。当以除湿透络为主，方用《金匮要略》麻黄加术汤合麻杏苡甘汤。处方如下：
甘草6克
方中，麻黄发汗，桂枝解肌，杏仁利肺气，甘草和中。因其湿盛，故用白术燥湿，苡仁渗湿。
服一剂，身痛全消，热退身凉。继以甘露饮(生地、熟地、天冬、麦冬、茵陈、黄芩、枇杷叶、石斛、甘草)调理而愈。
[按语]：足太阳膀胱经循行于身体表面，是一身的藩篱，乃机体最外一层，风、寒、暑、湿、燥、火六淫之邪，多由太阳侵入。故本症治疗，自始至终，均以解散表邪为主，使邪从外解，庶免深入之患。至于具体的立方用药，则视病情而定。如初时用白虎合桂枝汤，湿热用桂枝等品，此亦说明在辛凉清气解肌方中，适当佐以必要之辛温药物，似更能加强全方之作用。
患者赵××，女性，四十岁。患者发热，汗出，口苦，耳聋，自利不止，口渴，小便短少。病已十余日，曾服辛凉解表之剂不效，延余往诊。诊脉浮弦，舌心滑润，气弱神倦。此为三阳合病也。发热、汗出者，太阳中风证也。口苦、耳聋者，少阳证也。自利不止者，《伤寒论》云：“太阳与阳明合病者，必自下利”。口渴尿少者，太阳腑证也。太阳主表，故脉浮，弦又为少阳主脉。舌滑润为津液未伤，气弱神倦者，误用辛凉，正气被损也。本病治法，重在调和表里，三阳并治。《医学心悟》云：“不论三阳、三阴，凡两经合病，则用两经药同治之，三经合病，则用三经药同治之。”因合用小柴胡汤、桂枝加葛根汤和五苓散三方化裁。处方如下：
笺注诊断：服一剂，热退泻止，余症亦减。继以五味异功散善后调理。处方如下：
嘱服二剂，诸症悉除。
寒入厥阴救逆
患者杨××，女性，十五岁，患病已一周。初病发热呕吐，泻利，头痛，恶寒，曾先后延医诊治无效。现呕逆不止，腹痛硬满，面赤，烦躁。仍感头痛，恶寒，手足僵冷。查其以前所服诸方，均以小柴胡汤为基础，甚至加三棱、莪术攻伐，服后月经适来，病更加剧。
察其脉细而欲绝，舌淡紫，与上述病情合参，乃寒入厥阴，其病在肝。肝与胆相表里，肝寒而气郁不升，则影响于胆，气逆不降，故呕逆不止。厥阴为风木之脏，木郁克土，故腹痛硬满。寒入于阴，则阳浮于上，故面赤。吐泻后，阳气与津液俱伤，心肾不交，水火离隔，故烦躁。厥阴外证未解，故头痛、恶寒。肝脾不和，阳气不能达于四肢，故手足僵冷。小柴胡汤乃和解少阳之方，其所以误者，因惑于发热、呕吐，未注意尚有太阳表证之头痛、恶寒、阳明之下利也。若当时投以葛根汤，两解太阳、阳明之邪，则其病早愈。由于越经用药，引邪深入，柴、芩皆清泻肝胆之品，反复用之，攻伐无过，以致病情加剧。幸患者年青，生机旺盛．正气尚能支持，急投以《伤寒论》当归四逆加吴茱萸生姜汤加味。处方如下：
当归12克 桂枝9克 炒杭白芍12克 炒吴茱萸6克 细辛2克
方中当归、桂枝、杭白芍温经活血，细辛散少阴之寒，吴茱萸、生姜散寒止呕，炙草、大枣补中生血。通草通经络利关节，尤在泾谓本品有“通脉续绝之功”。加小茴、砂仁以理气通滞而止痛，少加黄连、配吴茱萸取“左金”之意以平肝而为反佐。
上方服后，次日来诊，呕逆全止，肢已转温，面赤，烦躁、腹痛均减。续处以吴茱萸四逆汤。处方如下：
此方本可先用，其所以不先用者，在于本病既经误治克伐，不但厥阴外证未解，且使肝血为寒所凝而不能畅运，故先予当归四逆汤温血达表，以作向导，继用吴茱萸四逆汤，温中扶阳，驱除浊阴。如此施治，始可引邪向外一举而平。故服第二方后，诸症悉除，且满身出现红斑，此病邪由里达表，已收预期之效。乃因势利导，以四逆汤振奋阳气，驱邪外散，遂告全愈。
[按语]：《伤寒论·辨厥阴病脉证并治》云：“手足厥寒，脉细欲绝者，当归四逆汤主之。”又云：“若其人内有久寒者，宜当归四逆加吴茱萸生姜汤。”此二条指出厥阴病的治疗途径之一。本例由误治而导致寒入厥阴，因证候与《伤寒》所述相符，故用之有桴鼓之应。厥阴为肝木所主，肝主藏血，脉细如绝为厥阴病血虚之候。血虚者当以补血行血为主。正如尤在泾所说：“欲续其脉，必益其血，欲益其血，必温其经。”然因过用寒凉及攻伐之品，不仅血虚，真阳亦有亏损，故益血温经之后，又用吴茱萸四逆汤扶阳温中而散寒。因病证如此，故用药亦不得不如此。
高年中风
患者孙××，男性，八十余岁。家属代诉：平素嗜酒，曾患风湿，关节疼痛、足不任地多年。因神志昏迷，住某医院，诊断为中风症，治疗无效，延余会诊。症见：昏迷，喉间痰鸣，面色枯焦而紫赤，不大便已十余日，病势严重。苔白腻，脉弦数。症由湿痰内蕴，郁久化热所致。治法本应清化痰热，但苔白腻为湿痰兼夹之象，且又在高年，心肺之阳易虚。治疗先以温扶心肺之阳，降逆化痰、行水散结之剂。用姜桂苓半汤以干姜易生姜，消息之（斟酌调整）。处方如下：
服药一剂后，舌苔白腻转黄，热象显露。此时症结所在，以通便为当务之急。患者年事虽高，但证现实热，本“有故无殒”之旨，予黄龙汤加减。处方如下：
元明粉9克 党参15克 白蜜15克
此方主治应下失下，肠燥津枯，痞满坚实俱备之证。故用大承气汤急攻其急，并加党参以固元气，当归、生地、白蜜滋阴养血。如此攻补兼施，下则无碍。
服一剂，大便仍不通，易方用大承气汤(枳实、厚朴、大黄、芒硝)以攻积，加白蜜18克以润肠，加瓜蒌仁9克以宽中润下。服一剂，病无增减，因病势积重难通，再易方用小承气汤(枳实、厚朴、大黄)加白蜜18克、蒌仁9克、当归15克、白芍12克，以养血润燥。连服五剂，大便渐通，神志渐清。继服养血润燥活络之剂调理后，下肢行动自如，康复如初。
患者苏××，女性，五十余岁。婚后迄未孕育，常自苦闷，忧郁成疾，遂患臌胀。经西医治疗虽有好转，于1951年春．因饮食不慎．以致大吐，旋即昏迷不省人事，送医院急救，历三日仍处于昏迷状态。某中医以小续命汤，服之不应，并称患者循衣摸床，病已不治，家人为其料理后事。延至第五日，始延余往诊。据其体质素弱，又常忧郁。今病昏迷，唇色润．活，舌苔白燥，脉沉细和缓，触之无汗，并无口开、手撒、声鼾、眼合、遗尿、汗出如油等绝症败象，是皆元气内竭，病况危殆。
思之良久，乃谓家人曰：“此症系血虚肝郁，又经大吐伤中，湿聚痰生，以致肝风内动，风痰纠结，猝倒无知，昏迷不醒，不食、不便已五日。幸无其他败象，脉沉细和缓，来去分明，胃气未绝，尚有挽回余地。至于猝倒无知，舌强不语，系阴火(肝肾虚火)上冲，风痰上扰。若用药偏温，则反助火势；偏凉则中宫更伤。今惟有扶正祛邪、熄风化痰一法。”乃处以下方：
竹沥二匙 姜汁(少许为引)
此方即资寿解语汤加桑叶、菊花也。方中羚羊角、天麻、桑叶、菊花清肝熄风，尤以羚羊角镇痉治头目之风最效。竹沥、姜汁化痰，羌活、防风镇痛、镇痉而祛风。用肉桂引火归元，配附片，枣仁强心温肾，扶助机体，增强抗力，甘草和中。诸药合用，有熄风化痰，引火归元，扶正祛邪之效。
上方服后，神识较清，已能识人，惟身重不能转侧，头闷痛，恶心。舌苔由白燥转白腻，脉由沉细转弦滑。此内湿素盛，痰湿上逆，治应除湿、祛风、益气、扶脾、涤痰。方用李东垣半夏天麻白术汤。处方如下：
上方服二剂，神识更清，但仍不能起床。自以为病势好转，虑余诊务繁忙，乃另邀某医作调理治疗，处以大橘皮汤加减，药用茯苓、猪苓、泽泻、桂枝、白术、木香、陈皮、槟榔、六一散、扁豆等。服后即见烦躁、失眠、手足抽搐，复延余诊。症见：脉弦细，舌红燥。盖由利湿伤阴，阴虚动风，肝阳不潜，冶应柔肝熄风，安神定志。予自拟首乌黑芝麻散和桂枝龙骨牡蛎汤加减。处方如下：
甘草5克
方中首乌、黑芝麻滋养肝肾，补血祛风。石斛益阴补精，钩藤、桑叶、菊花清肝熄风，平降肝阳。桂、芍、龙、牡、草，安神定志，潜镇浮阳。
连服三剂，搐溺已止，渐能活动，烦躁失眠症亦减去七、八，宜继续养血柔肝、育阴潜阳治之，方用自制二甲散加减。处方如下：
服三剂后，病体逐渐恢复，已能起床，出院回家，继以饮食调养。
患者杨××，女性，三十岁。初患上腹疼痛，发高热，大便秘结。病已四日。曾用灌肠法通便，反致腹痛、吐泻、手足厥冷，烦躁不安，面青，脉微。经服大剂附子理中汤(重用附子)，服后病情加剧，乃邀余往诊。症见：面青，神烦，肢冷，吐泻发热，口唇焦燥。舌呈紫色，脉象闭伏。细审之：手背虽冷，但手心灼热，加以烦渴引冷，口臭气粗，舌唇焦紫等症状，并非阳气不足，实为邪热有余之象。若属真寒，必现手心手背两面俱冷，岂有手心独热之理，这是辨证的关键所在。脉虽不显，由于热邪闭伏于里，阳盛格阴，阳气不能达于四末，故见肢冷脉闭。综上判断，确系真热假寒，阳极似阴，即《内经》所谓“热深厥深”，实属有余之热证，用附子理中汤而病情反剧者，缘犯“实实”之戒，以阳药治阳症，热势愈盛，重热则寒，物极必反，故外现阴寒之假象。法宜急泻其火以救阴。处方如下：
第一方：
地浆水适量 (掘地作坑，灌水搅之，待其澄清后，去泡沫取水)
绿豆30克(用地浆水煨服)
第二方，葛根黄芩黄连汤：
This case is a typical example of *Lianggan* syndrome (a severe exogenous disease where both exterior and interior meridians are simultaneously affected by pathogens). If the Yang Qi of Shaoyin is not urgently supported, and the Qi mechanism of Taiyang is not opened, the pathogens of Lianggan will have no outlet, and irritability will be difficult to treat. Here, Maihuang Fuzi Xixin Tang is used, strictly following the principle of "establishing the method and using the prescription according to the symptoms." Thus, even critical conditions can be cured. A message to scholars: When treating various exogenous diseases, one must be familiar with the complex and intricate changes of the Six Meridians. Only then will the condition reveal itself without hiding, allowing for precise treatment.
Combined Disease of Taiyang and Shaoyang
Patient Li XX, female, over forty years old. Symptoms include fever with aversion to cold, spontaneous sweating, abdominal pain with urge to vomit. The illness has persisted for more than twenty days. She was hospitalized in a certain hospital, and I was invited for consultation. The symptoms are as described above. The tongue body is pale and moist, with a white greasy coating; the pulse is wiry. Combining pulse and symptoms, the diagnosis is Combined Disease of Taiyang and Shaoyang complicated by Spleen dampness failing to transform. The prescription is Chaihu Guizhi Tang modified. Formula:
Chai Hu (Bupleuri Radix) 9g, Chao Huang Qin (Scutellariae Radix, stir-fried) 9g, Fa Ban Xia (Pinelliae Rhizoma, processed) 10g, Gui Zhi (Cinnamomi Ramulus) 10g, Hang Shao Yao (Paeoniae Radix Alba) 12g.
Guang Mu Xiang (Aucklandiae Radix) 3g, Bai Kou Ren (Amomi Fructus Rotundus) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
The formula uses Xiao Chai Hu Tang (Minor Bupleurum Decoction) minus Ren Shen (Ginseng Radix) to harmonize the Shaoyang pivot and eliminate alternating chills and fever. It uses Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei (Nutritive and Defensive levels) to resolve the Taiyang exterior. Heavy use of Hang Shao Yao harmonizes Ying and astringes sweat; Mu Xiang and Bai Kou Ren warm the Spleen and transform dampness to stop abdominal pain and the urge to vomit.
Second Visit: After one dose of the above prescription, the fever subsided, abdominal pain stopped, the white greasy tongue coating decreased, and the wiry pulse became relaxed. Subsequently, Si Ni San (Four Counterflow Powder) and Guizhi Tang were combined. After three doses, all symptoms resolved completely.
Combined Disease of Taiyang and Yangming
Patient Dai XX, female, twenty-seven years old. High fever without aversion to cold, body pain with neck stiffness, irritability, and excessive thirst requiring drinking. The illness has persisted for more than ten days. The pulse is surging and large; the tongue body is red with a thick greasy coating. Previous physicians used Xiao Chai Hu Tang without effect. The symptoms belong to Damp-Heat lingering in the Taiyang and Yangming meridians. The treatment should open the Taiyang Qi mechanism and clear/flush Yangming heat, allowing pathogens to exit from the exterior. The formula uses a modification of Guizhi Tang combined with Baihu Tang (White Tiger Decoction) from *Shanghan Lun*. Formula:
Gui Zhi (Cinnamomi Ramulus) 9g, Ge Gen (Puerariae Lobatae Radix) 12g, Sheng Shi Gao (Gypsum Fibrosum) 15g, Chao Zhi Mu (Anemarrhenae Rhizoma, stir-fried) 6g, Jing Mi (Oryzae Sativa Semen) 9g.
Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g, Shao Sheng Jiang (Zingiberis Rhizoma Recens, roasted) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
Baihu Tang clears Metal and protects the Lung, vigorously flushing the excess heat in Yangming. Guizhi Tang minus Shao Yao resolves muscle-level pathogens, allowing them to exit via Taiyang. Ge Gen is a herb for the Yangming meridian, possessing effects of releasing the exterior, reducing fever, and detoxifying. Paired with Gui Zhi to induce sweating and release the muscle layer, it guides pathogens outward.
After one dose, the fever slightly decreased, but other symptoms remained. New symptoms included chest tightness, dry retching, bitter taste in the mouth, spontaneous sweating, and constipation. This indicates Yang pathogens sinking into the interior. The treatment requires simultaneous resolution of exterior and interior. Switch to Da Chai Hu Tang (Major Bupleurum Decoction) from *Shanghan Lun*. Formula:
Chao Chai Hu (Bupleuri Radix, stir-fried) 9g, Fa Ban Xia (Pinelliae Rhizoma, processed) 9g, Chao Huang Qin (Scutellariae Radix, stir-fried) 6g, Chao Zhi Shi (Aurantii Fructus Immaturus, stir-fried) 6g.
Chao Hang Shao Yao (Paeoniae Radix Alba, stir-fried) 6g, Da Huang (Rhei Radix et Rhizoma) 6g, Shao Sheng Jiang (Zingiberis Rhizoma Recens, roasted) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
This formula resolves both exterior and interior, attacking internally while releasing externally. Zhang Zhongjing used it for syndromes of "cold damage with fever, sweating without relief, heat accumulation in the interior, and simultaneous involvement of exterior and interior."
After one dose, bowel movement occurred, irritability settled, and chest tightness and bitter taste resolved. However, the fever did not fully subside, joint pain throughout the body persisted, and the tongue coating remained greasy. This indicates that excessive Dampness obstructs the Taiyang collaterals. The primary treatment should be draining dampness and unblocking collaterals. Use Mahuang Jia Zhu Tang (Ephedra Decoction plus Atractylodes Macrocephala) combined with Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coix Seed, and Licorice Decoction) from *Jingui Yaolue*. Formula:
Ma Rong (Ephedrae Herba, tender tips) 6g, Xing Ren (Armeniacae Semen Amarum) 9g, Gui Zhi (Cinnamomi Ramulus) 9g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 15g, Yi Yi Ren (Coicis Semen) 15g.
Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
In this formula, Ma Huang induces sweating, Gui Zhi releases the muscle layer, Xing Ren benefits Lung Qi, and Gan Cao harmonizes the Middle. Due to excessive dampness, Bai Zhu dries dampness, and Yi Yi Ren seeps out dampness.
After one dose, body pain disappeared completely, and the fever subsided leaving the body cool. Subsequently, Ganlu Yin (Sweet Dew Drink) was used for regulation and cure. Formula ingredients: Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Rehmanniae Radix Preparata), Tian Dong (Asparagi Radix), Mai Dong (Ophiopogonis Radix), Yin Chen (Artemisiae Scopariae Herba), Huang Qin (Scutellariae Radix), Pi Pa Ye (Loquat Leaf), Shi Hu (Dendrobii Caulis), Gan Cao (Glycyrrhizae Radix et Rhizoma).
[Commentary]: The Foot-Taiyang Bladder Meridian circulates on the surface of the body, serving as the shield of the whole body, the outermost layer of the organism. Pathogenic factors of Wind, Cold, Summerheat, Dampness, Dryness, and Fire (Six Excesses) mostly invade via Taiyang. Therefore, the treatment of this case focused throughout on dispersing exterior pathogens to allow them to exit from the outside, preventing deep invasion. Specific prescription and medication depend on the condition. Initially, Baihu Tang combined with Guizhi Tang was used; for damp-heat, herbs like Gui Zhi were employed. This illustrates that adding necessary acrid-warm herbs to acrid-cool formulas that clear heat and release the muscle layer may further enhance the overall efficacy.
Combined Disease of the Three Yangs
Patient Zhao XX, female, forty years old. Symptoms include fever, sweating, bitter taste in the mouth, deafness, continuous spontaneous diarrhea, thirst, and scanty urine. The illness has persisted for more than ten days. Acrid-cool exterior-releasing agents were taken without effect. I was invited for consultation. The pulse is floating and wiry; the center of the tongue is slippery and moist; Qi is weak and spirit is fatigued. This is Combined Disease of the Three Yangs. Fever and sweating indicate Taiyang Wind Strike syndrome. Bitter taste and deafness indicate Shaoyang syndrome. Continuous spontaneous diarrhea corresponds to the *Shanghan Lun* statement: "When Taiyang and Yangming combine, there must be spontaneous diarrhea." Thirst and scanty urine indicate Taiyang Fu organ syndrome. Taiyang governs the exterior, hence the floating pulse; wiry is the master pulse of Shaoyang. Slippery-moist tongue indicates fluids are not yet damaged; weak Qi and fatigued spirit result from the erroneous use of acrid-cool herbs damaging righteous Qi. The treatment focuses on harmonizing interior and exterior, treating the Three Yangs simultaneously. *Yixue Xinwu* states: "Regardless of Three Yang or Three Yin, if two meridians combine, use herbs of both meridians to treat together; if three meridians combine, use herbs of all three meridians to treat together." Therefore, Xiao Chai Hu Tang (Minor Bupleurum Decoction), Guizhi Jia Ge Gen Tang (Cinnamon Twig Decoction plus Pueraria Decoction), and Wuling San (Five-Ling Powder) were combined and modified. Formula:
Chao Chai Hu (Bupleuri Radix, stir-fried) 6g, Chao Huang Qin (Scutellariae Radix, stir-fried) 6g, Fa Ban Xia (Pinelliae Rhizoma, processed) 9g, Gui Zhi (Cinnamomi Ramulus) 9g, Ge Gen (Puerariae Lobatae Radix) 15g.
Zhu Ling (Polyporus) 9g, Fu Ling (Poria) 15g, Chao Ze Xie (Alismatis Rhizoma, stir-fried) 6g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
Note on Diagnosis: After one dose, fever subsided, diarrhea stopped, and other symptoms decreased. Subsequently, Wuwei Yigong San (Five-Agent Extraordinary Efficacy Powder) was used for recovery. Formula:
Su Tiao Shen (Codonopsis Radix) 15g, Piao Bai Zhu (Atractylodis Rhizoma, bleached) 9g, Fu Ling (Poria) 15g, Chen Pi (Citri Reticulatae Pericarpium) 3g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) 6g.
Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
Instructed to take two doses; all symptoms disappeared.
Cold Invading Jueyin Reversing Rescue
Patient Yang XX, female, fifteen years old. Illness has lasted one week. Initially, fever, vomiting, diarrhea, headache, and aversion to cold occurred. Multiple doctors treated her without success. Currently, incessant regurgitation/vomiting, abdominal pain with hardness and fullness, flushed face, and irritability. Still experiencing headache and aversion to cold, with stiff and cold hands and feet. Reviewing previous prescriptions, they were based on Xiao Chai Hu Tang (Minor Bupleurum Decoction), even adding San Leng (Curcumae Rhizoma) and E Zhu (Curcumae Rhizoma) for attack. After taking these, menstruation started, and the condition worsened.
Observation: Pulse is fine and nearly absent; tongue is pale purple. Correlating with the above condition, Cold has invaded Jueyin, the disease lies in the Liver. Liver and Gallbladder are exterior-interior related. Liver cold causes Qi stagnation and failure to ascend, affecting the Gallbladder, causing Qi rebellion and failure to descend, hence incessant vomiting/regurgitation. Jueyin is the organ of Wind-Wood. Wood stagnation attacks Earth (Spleen/Stomach), causing abdominal pain, hardness, and fullness. Cold entering Yin causes Yang to float upward, hence flushed face. After vomiting and diarrhea, both Yang Qi and Fluids are damaged; Heart and Kidney do not interact, Water and Fire are separated, hence irritability. Jueyin exterior syndrome is unresolved, hence headache and aversion to cold. Liver and Spleen disharmony prevents Yang Qi from reaching the four limbs, hence stiff and cold hands and feet. Xiao Chai Hu Tang is a formula for harmonizing Shaoyang. The error lay in being confused by fever and vomiting, ignoring the Taiyang exterior signs of headache and aversion to cold, and Yangming diarrhea. If Gegen Tang (Kudzu Decoction) had been administered initially to resolve both Taiyang and Yangming pathogens, the disease would have healed early. Using herbs across meridians drew pathogens deeper. Chai Hu and Huang Qin clear and drain Liver/Gallbladder; repeated use caused excessive attack, worsening the condition. Fortunately, the patient is young with vigorous vitality and sufficient righteous Qi. Urgently administer Danggui Sini Jia Wuzhuyu Shengjiang Tang (Angelica Sinensis Decoction for Cold Hands and Feet plus Evodia and Ginger Decoction) modified from *Shanghan Lun*. Formula:
Dang Gui (Angelicae Sinensis Radix) 12g, Gui Zhi (Cinnamomi Ramulus) 9g, Chao Hang Shao Yao (Paeoniae Radix Alba, stir-fried) 12g, Chao Wu Zhu Yu (Evodiae Fructus, stir-fried) 6g, Xi Xin (Asari Radix et Rhizoma) 2g.
Tong Cao (Tetrapanacis Medulla) 6g, Chao Xiao Hui Xiang (Foeniculi Fructus, stir-fried) 6g, Sha Ren (Amomi Fructus) 6g, Chuan Lian Zi (Meliae Fructus) 3g.
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) 6g, Shao Sheng Jiang (Zingiberis Rhizoma Recens, roasted) 3 slices, Da Zao (Jujubae Fructus) 3 pieces.
In this formula, Dang Gui, Gui Zhi, and Hang Shao Yao warm meridians and invigorate blood; Xi Xin disperses Shaoyin cold; Wu Zhu Yu and Sheng Jiang disperse cold and stop vomiting; Zhi Gan Cao and Da Zao tonify Middle and generate blood. Tong Cao unblocks collaterals and benefits joints; You Zaijing stated it has the function of "unblocking vessels and continuing severed connections." Added Xiao Hui Xiang and Sha Ren to regulate Qi, unblock stagnation, and stop pain. A small amount of Chuan Lian Zi paired with Wu Zhu Yu takes the meaning of "Left Metal" to calm the Liver as a counter-agent.
After taking the above prescription, visited the next day: vomiting/regurgitation stopped completely, limbs turned warm, flushed face, irritability, and abdominal pain all decreased. Subsequently prescribed Wuzhuyu Sini Tang (Evodia Four Counterflow Decoction). Formula:
Hei Fu Pian (Aconiti Lateralis Radix Preparata, black slice) 60g, Chao Wu Zhu Yu (Evodiae Fructus, stir-fried) 9g, Gan Jiang (Zingiberis Rhizoma) 12g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried) 6g.
This formula could have been used first, but because the disease underwent erroneous treatment and attack, not only was the Jueyin exterior syndrome unresolved, but Liver Blood was congealed by Cold and failed to circulate freely. Therefore, Danggui Sini Tang was given first to warm blood and reach the exterior as a guide, followed by Wuzhuyu Sini Tang to warm the Middle, support Yang, and expel turbid Yin. Such treatment allows guiding pathogens outward in one move. After taking the second formula, all symptoms disappeared, and red spots appeared all over the body. This indicates pathogens moved from interior to exterior, achieving the expected effect. Then, leveraging the momentum, Sini Tang (Four Counterflow Decoction) was used to振奋 (stimulate/uplift) Yang Qi and drive pathogens outward, leading to complete recovery.
[Commentary]: *Shanghan Lun · Differentiation of Jueyin Disease Pulse and Symptoms* states: "Cold hands and feet, pulse fine and nearly absent: Danggui Sini Tang governs." And: "If the person has chronic cold inside, Danggui Sini Tang plus Wuzhuyu and Ginger Decoction is appropriate." These two clauses point to one treatment pathway for Jueyin disease. This case led to Cold invading Jueyin due to erroneous treatment. Since the symptoms matched those described in *Shanghan Lun*, the response was immediate (like a drumstick hitting a drum). Jueyin is governed by Liver Wood; Liver stores Blood. Pulse fine as if absent is a sign of Blood deficiency in Jueyin disease. For Blood deficiency, tonifying and moving Blood is primary. As You Zaijing said: "To continue the pulse, one must benefit Blood; to benefit Blood, one must warm the meridians." However, due to overuse of cold-cooling and attacking herbs, not only is there Blood deficiency, but True Yang is also damaged. Therefore, after benefiting Blood and warming meridians, Wuzhuyu Sini Tang was used to support Yang, warm the Middle, and dispel Cold. Given the syndrome, the medication was necessarily so.
Stroke in Elderly Age
Patient Sun XX, male, over eighty years old. Family reported: Habitually drinks alcohol, suffered from Wind-Dampness for years with joint pain and inability to bear weight on feet. Admitted to a certain hospital due to coma, diagnosed as Stroke, treatment ineffective. Invited for consultation. Symptoms: Coma, phlegm rattle in throat, withered and scorched complexion with purplish-red hue, no bowel movement for more than ten days, serious condition. Tongue coating white greasy, pulse wiry and rapid. Syndrome caused by internal accumulation of Damp-Phlegm, stagnating for long time transforming into Heat. Treatment should originally clear Phlegm-Heat, but white greasy coating indicates Damp-Phlegm complication, and in advanced age, Heart and Lung Yang are prone to deficiency. Treatment first warms/supports Heart and Lung Yang, descends rebellion, transforms Phlegm, moves Water, and dissipates nodules. Used Jianggui Lingban Tang (Ginger-Cinnamon-Poria-Banxia Decoction) substituting Gan Jiang (Dried Ginger) for Sheng Jiang (Fresh Ginger), adjusting carefully. Formula:
Gui Zhi (Cinnamomi Ramulus) 9g, Fu Ling (Poria) 15g, Danzhi Ban Xia (Pinelliae Rhizoma fried with bile) 9g, Sheng Jiang (Zingiberis Rhizoma Recens) 9g.
After one dose, tongue coating changed from white greasy to yellow, Heat signs emerged. At this point, the crux is clearing bowels as the urgent priority. Although elderly, the syndrome manifests Real Heat. Following the principle of "having pathology, no injury," Huanglong Tang (Yellow Dragon Decoction) was modified. Formula:
Sheng Di Huang (Rehmanniae Radix) 15g, Dang Gui (Angelicae Sinensis Radix) 15g, Hou Po (Magnoliae Officinalis Cortex) 9g, Zhi Shi (Aurantii Fructus Immaturus) 6g, Jiu Jun (Radix Rhei Preparata with wine) 9g.
Yuan Ming Fen (Natrii Sulfas) 9g, Dang Shen (Codonopsis Radix) 15g, Bai Mi (Honey) 15g.
This formula treats cases where purgation was indicated but missed, resulting in intestinal dryness and fluid depletion, with fullness, oppression, hardness, and solidity all present. Thus, Dachengqi Tang (Major Order the Yellow Dragon Decoction) was used to urgently attack, plus Dang Shen to secure Yuan Qi, Dang Gui, Sheng Di Huang, and Bai Mi to nourish Yin and tonify Blood. Such combination of attacking and tonifying ensures purgation does not harm.
After one dose, bowel movement still did not occur. Changed to Dachengqi Tang (Zhi Shi, Hou Po, Da Huang, Mang Xiao) to attack accumulation, added Bai Mi 18g to moisten intestines, added Gua Lou Ren (Trichosanthis Semen) 9g to broaden middle and moisten downward. After one dose, no change. Because pathogen accumulation was heavy and difficult to pass, changed again to Xiaochengqi Tang (Minor Order the Yellow Dragon Decoction: Zhi Shi, Hou Po, Da Huang) plus Bai Mi 18g, Lou Ren 9g, Dang Gui 15g, Bai Shao 12g to nourish Blood and moisten dryness. Taken continuously for five doses, bowel movements gradually passed, consciousness gradually cleared. Subsequently regulated with Blood-nourishing, dryness-moistening, and collateral-activating agents. Lower limbs moved freely, recovered as before.
Quasi-Stroke
Patient Su XX, female, over fifty years old. Married but never conceived, often distressed, depression became illness, leading to Drum Distension (Abdominal Ascites). Western medicine treatment showed improvement. In Spring 1951, due to dietary indiscretion, severe vomiting occurred, followed immediately by coma and loss of consciousness. Sent to hospital for emergency rescue, remained comatose for three days. A Chinese physician used Xiao Xuming Tang (Minor Continue Life Decoction), which was ineffective, stating that the patient picking at clothes and touching bed indicates incurable disease. Family prepared funeral arrangements. On the fifth day, invited me for consultation. Constitution generally weak, often depressed. Now comatose, lips moist and lively, tongue coating white and dry, pulse deep, fine, and gentle. Touching reveals no sweat. No terminal signs such as open mouth, scattered hands, snoring, closed eyes, enuresis, or sweat like oil. All indicate internal exhaustion of Yuan Qi, critical condition.
After long thought, told family: "This syndrome is Blood deficiency with Liver stagnation, compounded by severe vomiting damaging the Middle, Dampness gathering and Phlegm generating, leading to internal stirring of Liver Wind. Wind and Phlegm knot together, sudden collapse without awareness, coma, not eating or having bowel movement for five days. Fortunately, no other terminal signs. Pulse deep, fine, gentle, distinct coming and going, Stomach Qi not exhausted, still room for reversal. As for sudden collapse, tongue stiffness, and inability to speak, this is Yin Fire (deficiency fire of Liver/Kidney) rushing upward, Wind-Phlegm disturbing upwards. If medication leans warm, it aids Fire; if lean cool, it damages the Middle Palace more. Currently, only supporting Righteousness, expelling Pathogens, extinguishing Wind, and transforming Phlegm is the method." Prescribed below:
Ling Yang Jiao (Saiga Antelope Horn) 3g, Zao Ren (Ziziphi Spinosae Semen) 12g, Shang Rou Gui (Cinnamomi Cortex) 6g, Fu Pian (Aconiti Lateralis Radix Preparata) 30g, Tian Ma (Gastrodiae Rhizoma) 9g.
Qiang Huo (Notopterygii Rhizoma et Radix) 6g, Fang Feng (Saposhnikoviae Radix) 9g, Sang Ye (Mori Folium) 6g, Ju Hua (Chrysanthemi Flos) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 5g.
Zhu Li (Bambusae Succus) 2 spoons, Jiang Zhi (Zingiberis Succus) (small amount as guide).
This formula is Zishou Jieyu Tang (Longevity Speech-Unblocking Decoction) plus Sang Ye and Ju Hua. In the formula, Ling Yang Jiao, Tian Ma, Sang Ye, and Ju Hua clear Liver and extinguish Wind; Ling Yang Jiao is most effective for calming spasms and treating Wind of head and eyes. Zhu Li and Jiang Zhi transform Phlegm; Qiang Huo and Fang Feng relieve pain, calm spasms, and expel Wind. Rou Gui guides Fire back to its source; paired with Fu Pian and Zao Ren to strengthen Heart and warm Kidney, support organism, and enhance resistance. Gan Cao harmonizes Middle. All herbs combined have effects of extinguishing Wind, transforming Phlegm, guiding Fire back to source, supporting Righteousness, and expelling Pathogens.
After taking the above prescription, consciousness clearer, able to recognize people, but body heavy unable to turn, head stuffy/painful, nausea. Tongue coating changed from white-dry to white-greasy, pulse changed from deep-fine to wiry-slippery. Internal Dampness is abundant, Phlegm-Damp rebels upward. Treatment should drain Dampness, expel Wind, benefit Qi, support Spleen, and wash away Phlegm. Use Li Dongyuan's Banxia Tianma Baizhu Tang (Pinellia, Gastrodia, and Atractylodes Decoction). Formula:
Fa Ban Xia (Pinelliae Rhizoma, processed) 9g, Bai Zhu (Atractylodis Rhizoma) 9g, Ming Tian Ma (Gastrodiae Rhizoma) 9g, Shao Shen Qu (Medicated Leaven, roasted) 9g, Chao Mai Ya (Hordei Fructus Germinatus, stir-fried) 9g.
Fu Ling (Poria) 15g, Chao Cang Zhu (Atractylodis Rhizoma, stir-fried) 9g, Chen Pi (Citri Reticulatae Pericarpium) 6g, Ze Xie (Alismatis Rhizoma) 9g, Bei Huang Qi (Astragali Radix) 15g.
Lu Dang Shen (Codonopsis Radix) 15g, Gan Jiang (Zingiberis Rhizoma) 9g, Jiao Huang Bo (Phellodendri Cortex, charred) 6g.
After two doses of the above prescription, consciousness clearer, but still unable to get up. Believing condition improved, and considering my busy schedule, invited another doctor for regulation. Prescribed Daju Pi Tang (Large Tangerine Peel Decoction) modified, using Fu Ling, Zhu Ling, Ze Xie, Gui Zhi, Bai Zhu, Mu Xiang, Chen Pi, Bing Lang, Liu Yi San, Bian Dou, etc. After taking, irritability, insomnia, and hand-foot convulsions appeared. Invited me again. Symptoms: Pulse wiry-fine, tongue red and dry. Caused by diuretics damaging Yin, Yin deficiency stirring Wind, Liver Yang not submerged. Treatment should soften Liver, extinguish Wind, calm Spirit, and stabilize Will. Prescribed self-made Shouwu Hei Zhima San (Polygonum Multiflorum and Black Sesame Powder) and Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction) modified. Formula:
Zhi Shou Wu (Polygoni Multiflori Preparata Radix, honey-fried) 15g, Hei Zhi Ma (Sesami Nigris Semen) 15g, Jin Shi Hu (Dendrobii Caulis) 6g, Gou Teng (Uncariae Ramulus cum Uncis) 9g, Sang Ye (Mori Folium) 9g.
Ju Hua (Chrysanthemi Flos) 6g, Gui Zhi (Cinnamomi Ramulus) 9g, Hang Shao Yao (Paeoniae Radix Alba) 9g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g.
Gan Cao (Glycyrrhizae Radix et Rhizoma) 5g.
In the formula, Shou Wu and Hei Zhi Ma nourish Liver and Kidney, tonify Blood, and expel Wind. Shi Hu benefits Yin and tonifies Essence; Gou Teng, Sang Ye, and Ju Hua clear Liver, extinguish Wind, and level/submerge Liver Yang. Gui, Shao, Long, Mu, Cao calm Spirit, stabilize Will, and submerge floating Yang.
Taken continuously for three doses, convulsions stopped, gradual ability to move, irritability and insomnia reduced by seven or eight parts. Should continue nourishing Blood, softening Liver, nurturing Yin, and submerging Yang. Use self-made Erjia San (Two Shells Powder) modified. Formula:
Gui Ban (Testudinis Carapax et Plastrum) 15g, Bie Jia (Trionycis Carapax) 15g, Long Gu (Fossilia Ossis Mastodi) 15g, Mu Li (Ostreae Concha) 15g, Dang Gui (Angelicae Sinensis Radix) 9g.
Hang Shao Yao (Paeoniae Radix Alba) 9g, Zao Ren (Ziziphi Spinosae Semen) 15g, Nu Zhen Zi (Ligustri Lucidi Fructus) 9g, Zhi Shou Wu (Polygoni Multiflori Preparata Radix, honey-fried) 15g, Wu Mei (Mume Fructus) 3 pieces.
Chuan Lian Zi (Meliae Fructus) 6g, Yan Hu Suo (Corydalis Rhizoma) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
After three doses, body gradually recovered, able to get up, discharged home, continued with dietary regulation.
True Heat False Cold Syndrome
Patient Yang XX, female, thirty years old. Initially upper abdominal pain, high fever, constipation. Illness lasted four days. Enema used to promote bowel movement, instead causing abdominal pain, vomiting/diarrhea, cold hands and feet, irritability, blue-green face, and faint pulse. Took large dose of Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction, heavy use of Fu Zi). Condition worsened after taking, invited me for consultation. Symptoms: Blue-green face, mental irritability, cold limbs, vomiting/diarrhea with fever, scorched dry lips. Tongue purple, pulse concealed. Careful examination: Back of hands cold, but palms burning hot. Plus irritability/thirst preferring cold, foul breath, coarse breathing, scorched purple tongue/lips. Not Yang deficiency, but actually excess Pathogenic Heat. If true Cold, both palms and backs of hands would be cold; how could only palms be hot? This is the key to differentiation. Pulse not apparent, but due to Heat pathogens concealed in interior, Yang excess repelling Yin, Yang Qi cannot reach extremities, hence cold limbs and concealed pulse. Comprehensive judgment confirms True Heat False Cold, Extreme Yang resembling Yin, i.e., "Deep Heat leads to Deep Cold" (*Neijing*). Actually an excess Heat syndrome. Taking Fuzi Lizhong Tang worsened condition because it violated the prohibition of "treating Excess with Excess" (adding fire to fire). Using Yang herbs for Yang syndrome makes Heat fiercer. Extreme Heat manifests Cold (Repetition of Heat becomes Cold, things reverse at extremes), hence external false Yin-Cold appearance. Method should urgently purge Fire to save Yin. Prescription:
First Formula:
Di Jiang Shui (Earth Well Water) appropriate amount (dig pit, fill with water, stir, wait to clarify, remove foam, take water).
Lu Dou (Vigna Radiata Semen) 30g (cook with Di Jiang Shui).
Second Formula, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction):
Fen Ge (Puerariae Lobatae Radix) 15g, Chao Huang Qin (Scutellariae Radix, stir-fried) 9g, Yun Huang Lian (Coptidis Rhizoma) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.