第一方地浆水，能治腹内热毒绞痛，并解药物、鱼、肉及果、菌诸毒，绿豆清热解毒，涤胃清心，行血脉。二药合用，解毒之力尤强，嘱先服此方以夺腹内炽热之势，继服第二方以清表里之热，并使内陷之邪外出。
二诊：上方各服一剂，自诉肢厥回，体热退，腹痛大减，呕泻均止。面已不青，六脉显现。口臭气粗益甚，烦渴饮冷如故，真热之象已逐渐外呈。宜清肺胃之热而保津。方用王孟英驾轻汤加减。处方：
三诊：上方服一剂，仍感烦躁口渴，口臭气粗，六脉洪数，气分热势仍张。殆因表气闭塞，热邪不能外透，里热过重，内外不通。改予发表攻里之剂。方用三黄石膏汤。处方：
四诊：服一剂，气分热势虽清，但因胃浊不降，大便多日不解，腹胀气粗，苔黄燥，脉现滑数有力。证转阳明腑实，下证已具，宜釜底抽薪。用《伤寒论》大承气汤。处方：
五诊：服一剂，大便得下，里热得除，病势大减宜继续清理肠胃湿热，养阴生津以善其后。方用《局方》甘露饮。处方：
嘱服二剂，诸症消失，其病遂愈。
[按]：真热假寒之证，本可观厥。仲景云：“厥深者热亦深，厥微者热亦微。”但医者稍有疏忽，极易误治。本案抓住手心灼热，结合口唇焦燥、舌紫、烦渴饮冷、口臭气粗等真热现象，不为面青、肢冷、吐泻、脉伏等“寒象”所惑，仍按真热治之。用地浆水煮绿豆，先夺腹内炽热之势，同时予葛根芩连汤解肌透热，引内伏之热邪出外。药后．果然内热外观，真象毕露，假寒尽除。继以清热生津，扶持正气，俟攻下条件成熟，以大承气汤一鼓作气扫荡热邪而诸症悉解。诚如唐容川论佚火之厥谓：“先宜治其伏火，使火得发，转厥为热，次乃更清其热，斯可愈尔。”
戴 阳 证
施××，女，十七岁。因发热持续不退，入某医院治疗未愈，邀余会诊。症见：高热，全身冷汗不止，声低息短，四肢逆冷，面赤如硃，身重难以转侧，二便如常。右脉沉细，左脉浮大无根，舌青滑，不思饮。询问服药情况，始知前医曾用葛根芩连汤、银翘散和白虎汤等方，而发热日增。细审此症之发热，实乃元阳外越。面赤如硃，系阴寒过盛，虚阳上越之假热证，所谓“戴阳证”也。因误用寒凉，故病势日益增剧。急宜交通阴阳，收纳元气，乃用《伤寒论》白通汤。处方：
复诊：上方服一剂，病如故。认为药已对证，但疗效不显，是由于阴寒格拒过盛，药不能直达病所。应从阴引阳。本着“甚者从之”，“热因寒用”的治则，于原方加猪胆汁数滴，童便一杯。服后热竟全退，冷汗亦止，面赤身热大为减轻，惟四肢尚冷。继以《伤寒论》干姜附子汤峻扶元阳，交通上下。处方：
姜、附二味为阳中之阳，不加甘草，较四逆汤扶阳之力更专，故服后诸症悉愈。
[按]：“戴阳证”最易与实热证混淆，若只见高热不细加审究，极易误治。但病既真假相混，必有其本质可寻。如冷汗不止、声低息短、肢冷、脉浮大无根，即其内寒本质所在，发热面赤非其本也。结合以前所服方药，为真寒假热之“戴阳证”，急用白通汤回阳收纳。然因阴寒格拒，初效不显，后于原方加苦寒反佐，服之果验。若审证不详，略有疏忽，见药不效，改弦易辙，则病终难愈也。 “阴阳交”二例
例一：
汪××，男，十五岁，患发热不退，已近一月。夜重昼轻，汗出不止，有时汗干而热不退。服西药解热剂，热虽暂退，旋又复热，且热度极高，目上视不瞑，烦躁不安，喘促气微，汗出如洗。病情危重，急来求余会诊。余详加诊视，症见：舌紫而腻，脉浮大而劲，壮热汗出，热不为汗衰，此病名“阴阳交”。《内经》论之甚详，若属温热病之坏证(逆证)，预后多不良。所幸者，尚能饮食，胃气未绝，尚有一线生机。盖汗出热当退，今热不为汗衰，发热和汗出，兼而有之，足证气机不收，阳越于上，故发热汗出也。肾属水而主五液，若肾水不能温升，心火不能凉降，坎离不济，阴阳不交，升降失司，则为此病所以至危之理也。王叔和云：“汗后脉静身凉则安，汗后脉躁热甚则难。”但若治之得法，尚可挽救。治法当在通阳交阴，使气得收，津液能藏，俾能热退汗敛，则病可愈也。乃用《张氏医通》益元汤加猪胆汁，勉力救治。处方：
黑附片60克 干姜12克 炙艾叶9克 大寸冬12克 甘草3克
此方以附片、干姜温肾培其本元为主，辅以艾叶温肝暖肾，佐寸冬、知母、黄连清上焦之心火，藉以育阴退热。洋参、麦冬、五味为生脉散，能益气、止汗、润肺、清心、滋水。葱白通阳交阴，童便引热下行，加胆汁之苦降导药力入于丹田。此方原治面赤身热，不烦而躁，思饮不入于口，阴盛格阳之戴阳证。今借用是方以治此症，甚为恰当。因方中附片、干姜、甘草四逆汤也，洋参、麦冬、五味生脉散也，合以艾叶、生姜、大枣保其精也，黄连、知母、猪胆汁、童便攻其邪也。一攻一守，保精攻邪，庶使正能胜邪，则热自退，汗自收也。
上方于是日上午服后，至下午五时许，其父来家告曰：“服药后，眼已能闭，热亦稍退，喘促较平，汗出减少。”遂将原方附片加至120克，嘱其再进一剂。服后深夜汗收、热退，喘促全平，诸证已减。但旋又下肢浮肿。遂予白通汤调理而愈。观是症之所以得愈，全赖能食，胃气未败也。
白通汤系交阴阳之方，亦即交水火之方。附片补先天之火以培元，干姜温后天之土以暖中，葱白能引心火下交于肾，附片启肾水上济于心。水火溉济，阴阳互根，而得其平秘矣。故对“阴阳交”证，亦可先投白通汤，若服药拒纳，以益元汤加童便反佐为治。
例二：李××，男，四十三岁。亦患上证，症状与上同，惟烦躁较甚，脉空大而散，舌润苔白腻，满口津液。病已半月，幸能食。投以白通汤，烦躁止而神安，热退而汗收。周身旋出斑疹。经用三豆汤加乌梅、桑叶、苡仁服三剂即愈。越三年复病，症同前。先延二医诊治，一用小柴胡汤，一用白通汤，均无效。复延余诊。询其不能饮食已六日．断为胃气已绝，不予书方，果次日而亡。
[按]：“阴阳交”一证，《内经》早有论述。据《素问·评热病论》记载：“有病温者，汗出辄复热而脉躁疾不为’汗衰，狂言不能食，病名阴阳交，交者死也。”“人所以汗出者，皆生于谷，谷生于精，今邪气交争于骨肉而得汗者，是邪却而精胜也。精胜则当能食而不复热；复热者，邪气也，汗者精气也。今汗出而辄复热者，是邪气胜也，不能食者，精无俾也。病而留者，其寿可立而倾也。且夫热论日，汗出而脉尚躁盛者死。今脉不与汗相应，此不胜其病也，其死明矣。狂言者是失志，失志者死，今见三死，不见一生，虽愈必死也。”这段论述是很精辟的，值得重视。所谓“阴阳交”系指阳邪交于阴分，交结不解，消耗阴气所致，为温热病中的危重证候。本段论述还指出，汗出而热不去，死有三候：一不能食，二脉躁疾，三狂言失治，故曰“三死”。实践证明，这一论断是颇有参考价值的。但临床上有阴气被耗所致“阴阳交”，亦有阳气外越，气机不收所致“阴阳交”。证候不同，治法殊异，临证时须细心审查，不可误治。本病预后之好环，全在是否能食，以判断胃气有无，“有胃气则．生，无胃气则死。”这些经验同样是宝贵的。
失血后阳虚寒战
吴××，男，七十四岁。因头顶部外伤流血过多，入某医院急救，经用冷水洗涤创口后，进入昏迷，且寒战不止，因而邀余会诊。症见：舌淡青滑，脉沉，患者踡卧，血虽止而目瞑不语。检视创口，正当巅顶部位。巅顶乃督脉与足厥阴肝经会合之处。督脉总督一身之阳经，为阳脉之海，寒气侵入，诸阳抑遏，故发寒战。厥阴乃多血少气之经，流血过多，气随血散，寒气侵入，阳气困顿，心窍不宣，故现昏迷。证属阴寒重证，急当峻扶元阳，驱散阴寒，温暖血脉为治。方用《伤寒论》干姜附子汤，加大剂量投之。处方：
上方专复元阳，消除阴邪，增强体功。服一剂后寒战止。再服一剂，神识转清。因患者年老，元阳本虚，非大剂连服，不能尽功。续以附子汤、四逆汤调理旬日，逐渐平复如初。
[按]：此症寒战，昏迷神倦，属气随血耗，阴寒凝闭，阳气不足所致。《内经》云：“气有余便是火，气不足便是寒。”故治疗关键在于峻扶元阳，振奋全身气机，故用大剂干姜附子汤。附片温下焦之元阳，干姜培中土之生气．干姜得附片则温中之力愈大，附片得干姜则温下之力愈宏。
胡××，男，五十一岁。因恶寒发热，不思饮食，经服发汗药后，热仍不退。某中医断为暑热，用栀子、滑石、芩、连之类，服后寒热似疟。改用西药治疟之针剂，针后又觉四肢酸软无力，手足厥冷，眼神发呆，彻夜不眠；又改服中药附片、干姜、参、芪等益气回阳之剂，服后变为神昏、诂语、发痉，又改投寸冬、黄连、口芪、厚朴、瓜蒌壳、枳壳、菖蒲等药，症现呕逆不止，头目眩晕、心神恍惚，手足厥冷至肘膝，已四日未大便，病已半月，症势垂危。， 来诊时，除上述症状外，且见患者面容惨白，双目无神，舌心黑而干燥，切其脉沉而细微。此乃寒湿不化．元气不收所致。然从其呕逆不止，神气困顿观之，惟恐元气虚脱而莫救。急用下方：
甘草6克
此方乃理中汤加味而成。因病已半月，药石乱投，导致中阳大虚，呕逆不止。此为胃气欲绝之候。先后天本属一气，胃气欲绝，肾气亦将败越。理中汤以中焦脾胃虚寒立法：姜、术温运中宫之阳，条参、甘草甘缓益脾。如此组合，有刚柔相济之妙，加丁香、桂子以温中降逆，柿蒂苦温下气；半夏辛温化痰。四药合用，更显降逆之功，茯苓健脾利湿，砂仁扶气调中。诸药与理中汤相配，既祛痰不耗气，又降逆而不滞气。
服药后至晚八时，呕逆轻减，突然腹痛便急．解下黑色粪便甚多，至夜半呕逆全止。
次日来诊，肢倦身软，脉转滑大，舌腻而干、胸闷。此胃浊不化，续前方加附片60克以助命火。此所谓“益火之源，以消阴翳”者也，合理中汤则先后天之阳均得兼扶，而胃浊自降矣。
服后，胸闷全消，神形转佳，但觉心烦不安，腮肿及牙龈隐痛。处以《伤寒论》枳实栀子豉汤加苏条参：
枳实栀子豉汤为仲景宽中下气、交心肾、除虚烦之方，加苏条参以顾护元气。服后心烦大减，但腮肿未全消，牙略痛，用自拟方姜桂苓半汤化裁：
方以干姜除寒散结，桂枝温经通脉，茯苓利水行痰，半夏胆汁炒更能化痰降逆，引浮越之阴火得以潜藏。
服方一剂，腮肿消，牙痛止，但天明时又现两腿疼痛且．浮肿，舌白腻。此因上方之散寒降逆，寒趋于下，故腿现浮肿，总由寒湿未尽，阳不宣达所致。续处下方：
甘草6克
此方为麻黄加术汤和麻杏苡甘汤之合方。有使蕴积之寒湿由尿、汗两解之妙，故服后腿痛即减，浮肿未全消，继以苓桂术甘汤加附片，及四逆汤加苓、术调理而愈。
[按]：此病初起，由于医者未细心审证，杂乱投药，导致症变多端，脾肾欲绝，出现呕逆不止，实系阳虚、寒湿不化之证。至于舌黑而干，结合脉症，乃阳虚而津液不能上承，井非热象。阳虚乃病之本，湿寒乃病之标。审证如此，故自始至终，紧紧抓住这一关键随症用药，无论其阴邪上越为牙疼腮肿，或下降为腿肿痹痛，症状虽异，而致病之本源则同。本着“治病必求其本”之原则，从扶阳气、祛寒湿出发，步步为营，竟收全功。
心肾阳虚不耐燥烈
吕××，男，七十七岁，素性勤苦，虽处高年，尚在操持家务。近二月来，渐觉心悸、气短，且日愈加重。小便频数，涕泗交流。屡治无效，来求余诊。察其脉代，舌白滑。余诊毕，患者告曰：“诸医皆谓吾病系阳虚，但扶阳方中若加肉桂，反觉心悸更甚，不知何故。”余曰：“扶阳不离姜、附、桂，但附子无姜不热，无桂不燥，是以扶阳方中加桂，则燥性大增，纯阳刚烈，过于兴奋，故有不受。然若调剂得宜，则又不忌。”
第一方为地浆水，能够治疗腹内热毒引起的绞痛，并解除药物、鱼、肉以及水果、菌类等各种毒素。绿豆具有清热解毒的功效，能洗涤胃腑、清心火、通行血脉。两药合用，解毒的力量尤为强大。嘱咐患者先服用此方以消除腹内炽热的病势，随后服用第二方以清除表里之热，并使内陷的邪气向外透发。
二诊：上方各服一剂后，患者自述四肢厥冷回温，身体发热消退，腹痛大幅减轻，呕吐和腹泻均停止。面色不再发青，六脉显现。口臭气粗更加严重，烦躁口渴想喝冷水的情况依旧，真热的征象已逐渐显露于外。适宜清泄肺胃之热以保护津液。方用王孟英的驾轻汤加减。处方如下：
三诊：上方服一剂后，仍感到烦躁口渴，口臭气粗，六脉洪大且数，气分的热势依然强盛。大概是因为表气闭塞，热邪不能向外透发，里热过重，导致内外不通。改予发表攻里的方剂。方用三黄石膏汤。处方如下：
四诊：服一剂后，气分的热势虽然清除，但因为胃中浊气不降，大便多日未解，腹胀气粗，舌苔黄燥，脉象滑数有力。证候转为阳明腑实证，下法的指征已经具备，宜采用釜底抽薪之法。使用《伤寒论》中的大承气汤。处方如下：
五诊：服一剂后，大便得以下行，里热得以清除，病势大幅减轻。适宜继续清理肠胃湿热，养阴生津以善后。方用《局方》甘露饮。处方如下：
嘱咐服用两剂，各种症状消失，疾病痊愈。
[按语]：真热假寒的证候，本可见到四肢厥冷。张仲景说：“厥逆深的，热邪也深；厥逆浅的，热邪也浅。”但医者稍有疏忽，极易误治。本案抓住手心灼热，结合口唇焦燥、舌质紫暗、烦躁口渴喜冷饮、口臭气粗等真热现象，不被面色青、肢冷、吐泻、脉伏等“寒象”所迷惑，仍然按照真热证治疗。用地浆水煮绿豆，先消除腹内炽热的病势，同时给予葛根芩连汤解肌透热，引导内伏的热邪外出。服药后，果然内热外现，真象毕露，假寒尽除。继以清热生津，扶持正气，等到攻下的条件成熟时，以大承气汤一鼓作气扫荡热邪而诸症悉解。正如唐容川论述伏火致厥时说：“先宜治疗其伏火，使火得以发散，将厥逆转为热证，然后再清其热，这样才可以痊愈。”
施某某，女，十七岁。因发热持续不退，在某医院治疗未愈，邀请余会诊。症状见：高热，全身冷汗不止，声音低微气息短促，四肢逆冷，面赤如朱砂，身体沉重难以转侧，大小便正常。右脉沉细，左脉浮大无根，舌质青滑，不想饮水。询问服药情况，才知道前医曾用过葛根芩连汤、银翘散和白虎汤等方，而发热日益加重。仔细审查此症的发热，实则是元阳外越。面赤如朱砂，是阴寒过盛，虚阳上越的假热证，即所谓的“戴阳证”。因为误用寒凉药，所以病势日益加剧。急宜交通阴阳，收纳元气，于是使用《伤寒论》中的白通汤。处方如下：
复诊：上方服一剂后，病情如故。认为药已对证，但疗效不显，是由于阴寒格拒过盛，药力不能直达病所。应从阴引阳。本着“甚者从之”、“热因寒用”的治疗原则，在原方中加入猪胆汁数滴，童便一杯。服后热竟全退，冷汗也止住，面赤身热大为减轻，只是四肢尚冷。继以《伤寒论》中的干姜附子汤峻补元阳，交通上下。处方如下：
姜、附二味属于阳中之阳，不加甘草，比四逆汤扶阳之力更专一，所以服后诸症悉愈。
[按语]：“戴阳证”最容易与实热证混淆，若只见高热而不仔细审究，极易误治。但病既真假相混，必有其本质可寻。如冷汗不止、声音低微气息短促、肢冷、脉浮大无根，即是其内寒的本质所在，发热面赤并非其本。结合以前所服的方药，确认为真寒假热的“戴阳证”，急用白通汤回阳收纳。然而因阴寒格拒，初效不显，后来在原方中加入苦寒药作为反佐，服药果然有效。如果审证不详，略有疏忽，见药不效就改弦易辙，则病终难愈。 “阴阳交”二例
例一：
汪某某，男，十五岁，患发热不退，已近一个月。夜间重白天轻，汗出不止，有时汗干了热也不退。服用西药解热剂，热虽暂时退去，随即又复发，且热度极高，眼睛向上视不能闭合，烦躁不安，喘促气微，汗出如洗。病情危重，急忙来求余会诊。余详细诊视，症状见：舌紫而腻，脉浮大而劲，壮热汗出，热不因汗出而衰减，此病名为“阴阳交”。《内经》对此论述甚详，若属温热病的坏证（逆证），预后多不良。所幸的是，患者尚能饮食，胃气未绝，尚有一线生机。盖因汗出后热应当退，现在热不因汗出而衰减，发热和汗出兼而有之，足以证明气机不收，阳气越于上，所以发热汗出。肾属水而主五液，若肾水不能温升，心火不能凉降，坎离不济，阴阳不交，升降失司，这就是此病至危的道理。王叔和说：“汗后脉静身凉则安，汗后脉躁热甚则难。”但若治之得法，尚可挽救。治法应当在通阳交阴，使气得收，津液能藏，俾能使热退汗敛，则病可愈。于是使用《张氏医通》中的益元汤加猪胆汁，勉力救治。处方如下：
黑附片60克 干姜12克 炙艾叶9克 大寸冬12克 甘草3克
此方以附片、干姜温肾培其本元为主，辅以艾叶温肝暖肾，佐以寸冬、知母、黄连清上焦之心火，藉以育阴退热。洋参、麦冬、五味子为生脉散，能益气、止汗、润肺、清心、滋水。葱白通阳交阴，童便引热下行，加胆汁之苦降导药力入于丹田。此方原治面赤身热，不烦而躁，思饮不入于口，阴盛格阳的戴阳证。今借用是方以治此症，甚为恰当。因方中附片、干姜、甘草组成四逆汤，洋参、麦冬、五味子组成生脉散，合以艾叶、生姜、大枣保其精，黄连、知母、猪胆汁、童便攻其邪。一攻一守，保精攻邪，庶使正能胜邪，则热自退，汗自收也。
上方于是日上午服后，至下午五时许，其父来家告知：“服药后，眼已能闭，热亦稍退，喘促较平，汗出减少。”遂将原方附片加至120克，嘱其再进一剂。服后深夜汗收、热退，喘促全平，诸证已减。但旋即出现下肢浮肿。遂予白通汤调理而愈。观此症之所以得愈，全赖能食，胃气未败也。
白通汤系交阴阳之方，亦即交水火之方。附片补先天之火以培元，干姜温后天之土以暖中，葱白能引心火下交于肾，附片启肾水上济于心。水火溉济，阴阳互根，而得其平秘矣。故对“阴阳交”证，亦可先投白通汤，若服药拒纳，以益元汤加童便反佐为治。
例二：李某某，男，四十三岁。亦患上证，症状与上同，惟烦躁较甚，脉空大而散，舌润苔白腻，满口津液。病已半月，幸能食。投以白通汤，烦躁止而神安，热退而汗收。周身旋出斑疹。经用三豆汤加乌梅、桑叶、苡仁服三剂即愈。越三年复病，症同前。先延二医诊治，一用小柴胡汤，一用白通汤，均无效。复延余诊。询其不能饮食已六日，断为胃气已绝，不予书方，果次日而亡。
[按语]：“阴阳交”一证，《内经》早有论述。据《素问·评热病论》记载：“有病温者，汗出辄复热而脉躁疾不为汗衰，狂言不能食，病名阴阳交，交者死也。”“人所以汗出者，皆生于谷，谷生于精，今邪气交争于骨肉而得汗者，是邪却而精胜也。精胜则当能食而不复热；复热者，邪气也，汗者精气也。今汗出而辄复热者，是邪气胜也，不能食者，精无俾也。病而留者，其寿可立而倾也。且夫热论曰，汗出而脉尚躁盛者死。今脉不与汗相应，此不胜其病也，其死明矣。狂言者是失志，失志者死，今见三死，不见一生，虽愈必死也。”这段论述是很精辟的，值得重视。所谓“阴阳交”系指阳邪交于阴分，交结不解，消耗阴气所致，为温热病中的危重证候。本段论述还指出，汗出而热不去，死有三候：一不能食，二脉躁疾，三狂言失治，故曰“三死”。实践证明，这一论断是颇有参考价值的。但临床上有阴气被耗所致“阴阳交”，亦有阳气外越，气机不收所致“阴阳交”。证候不同，治法殊异，临证时须细心审查，不可误治。本病预后之好坏，全在是否能食，以判断胃气有无，“有胃气则生，无胃气则死。”这些经验同样是宝贵的。
失血后阳虚寒战
吴某某，男，七十四岁。因头顶部外伤流血过多，入某医院急救，经用冷水洗涤创口后，进入昏迷，且寒战不止，因而邀余会诊。症状见：舌淡青滑，脉沉，患者蜷卧，血虽止而目瞑不语。检视创口，正当巅顶部位。巅顶乃督脉与足厥阴肝经会合之处。督脉总督一身之阳经，为阳脉之海，寒气侵入，诸阳抑遏，故发寒战。厥阴乃多血少气之经，流血过多，气随血散，寒气侵入，阳气困顿，心窍不宣，故现昏迷。证属阴寒重证，急当峻扶元阳，驱散阴寒，温暖血脉为治。方用《伤寒论》干姜附子汤，加大剂量投之。处方如下：
上方专复元阳，消除阴邪，增强体功。服一剂后寒战止。再服一剂，神识转清。因患者年老，元阳本虚，非大剂连服，不能尽功。续以附子汤、四逆汤调理旬日，逐渐平复如初。
[按语]：此症寒战，昏迷神倦，属气随血耗，阴寒凝闭，阳气不足所致。《内经》云：“气有余便是火，气不足便是寒。”故治疗关键在于峻扶元阳，振奋全身气机，故用大剂干姜附子汤。附片温下焦之元阳，干姜培中土之生气，干姜得附片则温中之力愈大，附片得干姜则温下之力愈宏。
胡某某，男，五十一岁。因恶寒发热，不思饮食，经服发汗药后，热仍不退。某中医断为暑热，用栀子、滑石、芩、连之类，服后寒热似疟。改用西药治疟之针剂，针后又觉四肢酸软无力，手足厥冷，眼神发呆，彻夜不眠；又改服中药附片、干姜、参、芪等益气回阳之剂，服后变为神昏、谵语、发痉，又改投寸冬、黄连、口芪、厚朴、瓜蒌壳、枳壳、菖蒲等药，症现呕逆不止，头目眩晕、心神恍惚，手足厥冷至肘膝，已四日未大便，病已半月，症势垂危。来诊时，除上述症状外，且见患者面容惨白，双目无神，舌心黑而干燥，切其脉沉而细微。此乃寒湿不化，元气不收所致。然从其呕逆不止，神气困顿观之，惟恐元气虚脱而莫救。急用下方：
甘草6克
此方乃理中汤加味而成。因病已半月，药石乱投，导致中阳大虚，呕逆不止。此为胃气欲绝之候。先后天本属一气，胃气欲绝，肾气亦将败越。理中汤以中焦脾胃虚寒立法：姜、术温运中宫之阳，条参、甘草甘缓益脾。如此组合，有刚柔相济之妙，加丁香、桂子以温中降逆，柿蒂苦温下气；半夏辛温化痰。四药合用，更显降逆之功，茯苓健脾利湿，砂仁扶气调中。诸药与理中汤相配，既祛痰不耗气，又降逆而不滞气。
服药后至晚八时，呕逆轻减，突然腹痛便急，解下黑色粪便甚多，至夜半呕逆全止。
次日来诊，肢倦身软，脉转滑大，舌腻而干、胸闷。此胃浊不化，续前方加附片60克以助命火。此所谓“益火之源，以消阴翳”者也，合理中汤则先后天之阳均得兼扶，而胃浊自降矣。
服后，胸闷全消，神形转佳，但觉心烦不安，腮肿及牙龈隐痛。处以《伤寒论》枳实栀子豉汤加苏条参：
枳实栀子豉汤为仲景宽中下气、交心肾、除虚烦之方，加苏条参以顾护元气。服后心烦大减，但腮肿未全消，牙略痛，用自拟方姜桂苓半汤化裁：
方以干姜除寒散结，桂枝温经通脉，茯苓利水行痰，半夏胆汁炒更能化痰降逆，引浮越之阴火得以潜藏。
服方一剂，腮肿消，牙痛止，但天明时又现两腿疼痛且浮肿，舌白腻。此因上方之散寒降逆，寒趋于下，故腿现浮肿，总由寒湿未尽，阳不宣达所致。续处下方：
甘草6克
此方为麻黄加术汤和麻杏苡甘汤之合方。有使蕴积之寒湿由尿、汗两解之妙，故服后腿痛即减，浮肿未全消，继以苓桂术甘汤加附片，及四逆汤加苓、术调理而愈。
[按语]：此病初起，由于医者未细心审证，杂乱投药，导致症变多端，脾肾欲绝，出现呕逆不止，实系阳虚、寒湿不化之证。至于舌黑而干，结合脉症，乃阳虚而津液不能上承，并非热象。阳虚乃病之本，湿寒乃病之标。审证如此，故自始至终，紧紧抓住这一关键随症用药，无论其阴邪上越为牙疼腮肿，或下降为腿肿痹痛，症状虽异，而致病之本源则同。本着“治病必求其本”之原则，从扶阳气、祛寒湿出发，步步为营，竟收全功。
心肾阳虚不耐燥烈
吕某某，男，七十七岁，素性勤苦，虽处高年，尚在操持家务。近二月来，渐觉心悸、气短，且日愈加重。小便频数，涕泗交流。屡治无效，来求余诊。察其脉代，舌白滑。余诊毕，患者告曰：“诸医皆谓吾病系阳虚，但扶阳方中若加肉桂，反觉心悸更甚，不知何故。”余曰：“扶阳不离姜、附、桂，但附子无姜不热，无桂不燥，是以扶阳方中加桂，则燥性大增，纯阳刚烈，过于兴奋，故有不受。然若调剂得宜，则又不忌。”
First prescription: Dilujiangshui (Earth Slurry Water) can treat colicky pain caused by heat-toxin in the abdomen, and detoxify various poisons from medicines, fish, meat, fruits, and fungi. Lüdou (Mung Bean Seed) clears heat and detoxifies, purges the stomach and heart, and promotes blood circulation. The combination of these two herbs significantly enhances the detoxifying power. It is instructed to take this prescription first to subdue the intense heat in the abdomen, followed by the second prescription to clear heat from both the exterior and interior, and to expel pathogens that have sunk inward.
Second visit: After taking one dose of each of the above prescriptions, the patient reported that cold extremities had warmed up, body fever subsided, abdominal pain decreased significantly, and vomiting and diarrhea stopped. The complexion was no longer cyanotic, and the six pulses became palpable. Bad breath and coarse breathing worsened, and irritability with a strong desire for cold drinks persisted. Signs of true heat were gradually manifesting externally. It is appropriate to clear heat from the Lung and Stomach to preserve fluids. The formula used is Wang Mengying's Jiaqing Tang (Light-riding Decoction) modified. Prescription:
Xian Zhuye (Fresh Bamboo Leaf) 9g, Sheng Biandou (Raw Lablab Bean) 9g, Yiren (Coix Seed) 9g, Dan Douchi (Fermented Soybean) 6g
Jiao Zhizi (Charred Gardenia Fruit) 6g, Huangqin (Scutellaria Root) 9g, Chen Mugua (Dried Quince) 6g, Pipaye (Loquat Leaf) 9g, Houpo (Magnolia Bark) 6g
Chenpi (Aged Tangerine Peel) 6g, Shihu (Dendrobium Stem) 9g
Third visit: After taking one dose of the above prescription, the patient still felt irritable and thirsty, with bad breath and coarse breathing. The six pulses were surging and rapid, indicating that the heat in the Qi level remained vigorous. This is likely due to the closure of the exterior Qi, preventing the heat pathogen from penetrating outward, and excessive internal heat causing blockage between the interior and exterior. A formula for releasing the exterior and purging the interior is prescribed. The formula used is Sanhuang Shigao Tang (Three-Yellow and Gypsum Decoction). Prescription:
Huanglian (Coptis Rhizome) 6g, Huangqin (Scutellaria Root) 9g, Huangbai (Phellodendron Bark) 9g, Mahuang (Ephedra Herb) 6g, Zhizi (Gardenia Fruit) 6g
Sheng Shigao (Raw Gypsum Fibrosum) 30g, Dan Douchi (Fermented Soybean) 6g, Shengjiang (Fresh Ginger) 3 slices, Lvcha (Green Tea Leaf) 9g, Dazao (Jujube Fruit) 3 pieces
Fourth visit: After taking one dose, although the heat in the Qi level was cleared, due to the failure of Stomach turbidity to descend, there had been no bowel movement for many days. The abdomen was distended with coarse breathing, the tongue coating was yellow and dry, and the pulse was slippery, rapid, and forceful. The syndrome transformed into Yangming Fu-organ excess syndrome, with indications for purgation present. It is appropriate to employ the method of "removing firewood from under the pot" (treating the root cause). Use Dachengqi Tang (Major Order the Qi Decoction) from *Shanghan Lun*. Prescription:
Dahuang (Rhubarb Root) 9g, Houpo (Magnolia Bark) 9g, Yuanmingfen (Mirabilite) 9g, Zhishi (Immature Bitter Orange) 9g
Fifth visit: After taking one dose, bowel movement occurred, internal heat was eliminated, and the disease trend decreased significantly. It is appropriate to continue clearing damp-heat from the intestines and stomach, nourishing Yin and generating fluids to conclude treatment. Use Ganlu Yin (Sweet Dew Drink) from *Ju Fang*. Prescription:
Shengdi (Rehmannia Root) 15g, Shudi (Prepared Rehmannia Root) 15g, Tiandong (Asparagus Tuber) 9g, Maidong (Ophiopogon Tuber) 9g, Shihu (Dendrobium Stem) 9g
Huangqin (Scutellaria Root) 6g, Yinchen (Artemisia Capillaris) 9g, Zhiqiao (Bitter Orange Fruit) 6g, Zhi Pipaye (Roasted Loquat Leaf) 9g, Gancao (Licorice Root) 5g
Instructed to take two doses. All symptoms disappeared, and the disease was cured.
[Commentary]: In cases of true heat with false cold, cold extremities may be observed. Zhang Zhongjing stated: "The deeper the cold extremities, the deeper the heat; the milder the cold extremities, the milder the heat." However, if the physician is slightly negligent, misdiagnosis is highly likely. This case focused on the burning sensation in the palms, combined with true heat signs such as dry and cracked lips, purple tongue, irritability with a desire for cold drinks, and bad breath with coarse breathing. The physician was not confused by false cold signs like cyanotic complexion, cold limbs, vomiting/diarrhea, and hidden pulse, and continued to treat it as true heat. Dilujiangshui (Earth Slurry Water) boiled with Lüdou (Mung Bean Seed) was used first to subdue the intense abdominal heat, while Gegen Qinlian Tang (Kudzu and Scutellaria Decoction) was given simultaneously to release the muscle layer and vent heat, guiding the latent heat pathogen outward. As expected, internal heat manifested externally, revealing the true nature and eliminating the false cold. Subsequently, clearing heat and generating fluids supported the healthy Qi. Once conditions for purgation were ripe, Dachengqi Tang (Major Order the Qi Decoction) was used to sweep away the heat pathogen in one stroke, resolving all symptoms. As Tang Rongchuan said regarding cold extremities caused by latent fire: "First, treat the latent fire to allow it to disperse, transforming cold extremities into heat; then clear the heat, and only then can recovery occur."
Daiyang Syndrome (Floating Yang Syndrome)
Patient Shi XX, female, 17 years old. Due to persistent high fever unresponsive to hospital treatment, she was invited for consultation. Symptoms included: high fever, continuous profuse cold sweat, low voice and short breath, cold extremities, red face like cinnabar, heavy body difficult to turn, normal urination and defecation. Right pulse was deep and fine; left pulse was floating, large, and rootless. Tongue was blue-green and slippery; no desire to drink. Inquiry revealed previous doctors had used Gegen Qinlian Tang (Kudzu and Scutellaria Decoction), Yinqiao San (Honeysuckle and Forsythia Powder), and Baihu Tang (White Tiger Decoction), yet fever increased daily. Careful examination revealed the fever was actually due to Yuan Yang (Original Yang) floating outward. The red face like cinnabar is a false heat sign caused by excessive Yin-cold forcing deficient Yang upward, known as "Daiyang Syndrome" (Floating Yang Syndrome). Misuse of cold-natured medicines exacerbated the condition. Urgent treatment required communicating Yin and Yang and gathering Original Yang. Thus, Baotong Tang (White Connecting Decoction) from *Shanghan Lun* was used. Prescription:
Fupian (Prepared Aconite Root) 60g, Ganjiang (Dried Ginger) 12g, Congbai (Green Onion White) 3 stalks
Follow-up visit: After one dose, the condition remained unchanged. The medicine was correct, but efficacy was poor because severe Yin-cold rejection prevented the medicine from reaching the disease site. Treatment should draw Yang from Yin. Following the principles of "treat severe conditions according to their nature" and "use heat for cold," several drops of Zhu Danzhi (Pig Gallbladder Bile) and one cup of Tongbian (Child Urine) were added to the original prescription. After ingestion, fever completely subsided, cold sweat stopped, facial redness and body heat greatly reduced, though extremities remained cold. Subsequently, Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) from *Shanghan Lun* was used to vigorously support Original Yang and communicate upper and lower. Prescription:
Fupian (Prepared Aconite Root) 60g, Ganjiang (Dried Ginger) 15g
Ginger and Aconite are Yang within Yang. Without Licorice, their Yang-supporting power is more focused than in Sini Tang (Reverse the Collapse Decoction), leading to complete resolution of symptoms after ingestion.
[Commentary]: Daiyang Syndrome (Floating Yang Syndrome) is easily confused with Excess Heat syndrome. If only high fever is seen without careful investigation, misdiagnosis is likely. However, when true and false mix, the essence must be sought. Continuous cold sweat, low voice/short breath, cold limbs, and floating-large-rootless pulse indicate the underlying internal cold; fever and red face are not the essence. Combined with previous medications, this confirms True Cold False Heat "Daiyang Syndrome". Urgent use of Baotong Tang (White Connecting Decoction) restores Yang and gathers Qi. However, due to Yin-cold rejection, initial efficacy was poor. Adding bitter-cold medicine as an antagonist later proved effective. If diagnosis is unclear and treatment changes upon lack of immediate effect, the disease will remain incurable. Two Cases of "Yinyang Jiao" (Yin-Yang Intersection)
Case 1:
Patient Wang XX, male, 15 years old. Suffered from persistent fever for nearly a month. Worse at night, lighter during day. Profuse sweating, sometimes sweat stops but fever persists. Western antipyretics provided temporary relief, but fever returned quickly with extreme intensity. Eyes rolled up and could not close, irritability, panting with weak breath, sweating like washing. Condition critical. Detailed examination showed: purple and greasy tongue, floating-large-tense pulse, high fever with sweating, fever not alleviated by sweat. This disease is named "Yinyang Jiao" (Yin-Yang Intersection). *Neijing* discusses this extensively. If it is a deteriorated syndrome (adverse syndrome) of warm diseases, prognosis is generally poor. Fortunately, the patient could still eat, indicating Stomach Qi was not exhausted, leaving a glimmer of hope. Normally, sweat should reduce fever; now fever does not decrease with sweat. The combination of fever and sweating proves Qi mechanism fails to gather, and Yang floats upward. Kidney belongs to Water and governs the five fluids. If Kidney Water cannot warm and ascend, and Heart Fire cannot cool and descend, Kan-Li (Water-Fire) do not assist each other, Yin-Yang do not intersect, and ascending-descending functions fail, leading to this critical state. Wang Shuhe said: "After sweating, if pulse is quiet and body cool, peace ensues; if pulse is restless and heat severe, difficulty arises." But with proper treatment, rescue is possible. Treatment should focus on communicating Yang and connecting Yin, allowing Qi to gather and fluids to store, so heat recedes and sweat stops. Thus, Yiyuan Tang (Benefit Origin Decoction) from *Zhangshi Yitong* plus Pig Gallbladder Bile was used for rescue. Prescription:
Hei Fupian (Black Prepared Aconite Root) 60g, Ganjiang (Dried Ginger) 12g, Zhi Aiye (Moxa Leaf) 9g, Da Cundong (Large Ophiopogon Tuber) 12g, Gancao (Licorice Root) 3g
Chao Zhimu (Fried Anemarrhena Rhizome) 6g, Chao Huanglian (Fried Coptis Rhizome) 3g, Shengjiang (Fresh Ginger) 3 slices, Bai Yangshen (American Ginseng) 9g
Wuweizi (Schisandra Berry) 10g, Dazao (Jujube Fruit) 3 pieces, Congbai (Green Onion White) 3 stalks
One Pig Gallbladder Bile, divided into three parts mixed into the medicine. A few drops of Child Urine as guide.
This formula uses Fupian (Prepared Aconite Root) and Ganjiang (Dried Ginger) to warm Kidney and cultivate Original Essence as the main action, assisted by Aiye (Moxa Leaf) to warm Liver and Kidney, and aided by Cundong (Ophiopogon Tuber), Zhimu (Anemarrhena Rhizome), and Huanglian (Coptis Rhizome) to clear Upper Jiao Heart Fire, thereby nourishing Yin and reducing heat. Yangshen (American Ginseng), Maidong (Ophiopogon Tuber), and Wuweizi (Schisandra Berry) form Shengmai San (Generate Pulse Powder), which benefits Qi, stops sweating, moistens Lung, clears Heart, and nourishes Water. Congbai (Green Onion White) communicates Yang and connects Yin; Tongbian (Child Urine) guides heat downward; adding bile’s bitter descent directs medicinal power to Dantian. This formula originally treats Daiyang Syndrome (Floating Yang Syndrome) with red face/body heat, non-irritable but restless, desire to drink but unable to swallow, and Yin-cold rejecting Yang. Borrowing it here is appropriate. The formula contains Sini Tang (Reverse the Collapse Decoction) [Fupian, Ganjiang, Gancao], Shengmai San (Generate Pulse Powder) [Yangshen, Maidong, Wuweizi], combined with Aiye, Shengjiang, Dazao to protect Essence, and Huanglian, Zhimu, Zhu Danzhi, Tongbian to attack Pathogens. One attacks, one defends, protecting Essence and attacking Pathogens, allowing Healthy Qi to overcome Pathogens, thus heat retreats and sweat stops.
After taking the prescription on the morning of that day, by 5 PM, the father reported: "After medication, eyes can close, heat slightly reduced, panting calmer, sweating decreased." The dose of Fupian (Prepared Aconite Root) in the original prescription was increased to 120g, instructed to take another dose. Late at night, sweat stopped, heat receded, panting completely calmed, symptoms reduced. However, lower limb edema appeared subsequently. Baotong Tang (White Connecting Decoction) was used for regulation, leading to cure. The reason for recovery relied entirely on the ability to eat, indicating Stomach Qi was not destroyed.
Baotong Tang (White Connecting Decoction) is a formula for communicating Yin and Yang, i.e., Water and Fire. Fupian (Prepared Aconite Root) supplements congenital Fire to cultivate Origin; Ganjiang (Dried Ginger) warms acquired Earth to warm Middle; Congbai (Green Onion White) guides Heart Fire down to Kidney; Fupian (Prepared Aconite Root) initiates Kidney Water up to Heart. Water and Fire irrigate each other, Yin and Yang root each other, achieving balance. Therefore, for "Yinyang Jiao" (Yin-Yang Intersection), Baotong Tang (White Connecting Decoction) can be administered first. If rejected, Yiyuan Tang (Benefit Origin Decoction) with Child Urine as antagonist is used.
Case 2: Patient Li XX, male, 43 years old. Also suffered from the above syndrome, symptoms identical, but irritability was more severe. Pulse was empty, large, and scattered; tongue moist with white greasy coating, mouth full of saliva. Disease lasted half a month, fortunately able to eat. Administered Baotong Tang (White Connecting Decoction); irritability stopped, spirit calm, heat receded, sweat stopped. Macules and rashes appeared on the body shortly after. Treated with Sandou Tang (Three-Bean Decoction) plus Wumei (Myrobalan), Sangye (Mulberry Leaf), Yiren (Coix Seed) for three doses, resulting in cure. Three years later, disease relapsed with same symptoms. Two doctors were consulted first; one used Xiaochaihu Tang (Minor Bupleurum Decoction), the other Baotong Tang (White Connecting Decoction), both ineffective. Consulted again. Inquiry revealed inability to eat for six days. Diagnosed as exhaustion of Stomach Qi, did not prescribe, and indeed the patient died the next day.
[Commentary]: "Yinyang Jiao" (Yin-Yang Intersection) is discussed early in *Neijing*. According to *Suwen: Ping Re Bing Lun*: "In warm disease, sweating is followed immediately by recurrence of fever, pulse is rapid and restless, not alleviated by sweat, delirium occurs, inability to eat. This is named Yinyang Jiao (Yin-Yang Intersection); intersection means death." "Humans sweat because of grain; grain generates Jing (Essence). Now, when pathogens contend in flesh and bones and sweat results, it means pathogens retreat and Essence prevails. If Essence prevails, one should be able to eat and not recur with fever; recurring fever indicates pathogens; sweat is Essence. Now, sweating followed immediately by fever means pathogens prevail; inability to eat means Essence has no support. Disease lingering implies life can collapse instantly. Furthermore, *Relun* states: 'Sweating with still rapid/full pulse indicates death.' Now pulse does not correspond to sweat, meaning it cannot overcome the disease; death is clear. Delirium indicates loss of Will/Zhi; loss of Will means death. Seeing three deaths and no life, even if seemingly recovered, death is certain." This discussion is profound and worthy of attention. "Yinyang Jiao" refers to Yang pathogens intersecting with Yin levels, knotting unresolved, consuming Yin Qi, representing a critical syndrome in warm diseases. The text points out three signs of death when fever persists despite sweating: 1. Inability to eat, 2. Rapid/restless pulse, 3. Delirium and loss of Will, hence "three deaths." Practice proves this judgment valuable. However, clinically, "Yinyang Jiao" can result from consumption of Yin Qi or from Yang floating outward with failure of Qi mechanism to gather. Syndromes differ, treatments vary; careful examination is required to avoid misdiagnosis. Prognosis depends entirely on ability to eat, judging presence of Stomach Qi: "With Stomach Qi, life; without Stomach Qi, death." These experiences are equally precious.
Post-Hemorrhagic Yang Deficiency with Chills
Patient Wu XX, male, 74 years old. Due to excessive bleeding from scalp trauma, admitted to hospital for emergency care. After wound cleaning with cold water, entered coma with incessant chills. Consultation requested. Symptoms: pale-blue-green slippery tongue, deep pulse, patient curled up. Bleeding stopped, but eyes closed and silent. Wound located at vertex. Vertex is where Du Mai (Governor Vessel) and Foot Jueyin Liver Meridian meet. Du Mai commands all Yang meridians, sea of Yang vessels. Invasion of cold Qi suppresses all Yang, causing chills. Jueyin is a meridian with much Blood and little Qi. Excessive bleeding disperses Qi with Blood; invasion of cold Qi traps Yang, obstructing Heart Orifices, causing coma. Syndrome is severe Yin-cold. Urgent treatment requires vigorously supporting Original Yang, dispelling Yin-cold, and warming blood vessels. Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) from *Shanghan Lun* was used with increased dosage. Prescription:
Fupian (Prepared Aconite Root) 120g, Ganjiang (Dried Ginger) 30g
This prescription specifically restores Original Yang, eliminates Yin pathogens, and enhances bodily function. After one dose, chills stopped. After another dose, consciousness cleared. Due to advanced age and inherent deficiency of Original Yang, large doses continuously were necessary for full effect. Subsequently, Fuzi Tang (Aconite Decoction) and Sini Tang (Reverse the Collapse Decoction) were used for regulation over ten days, gradually returning to normal.
[Commentary]: This case of chills and comatose fatigue is caused by Qi consumption following Blood loss, Yin-cold coagulation, and insufficient Yang. *Neijing* states: "Excess Qi becomes Fire; Deficient Qi becomes Cold." Thus, treatment key is vigorously supporting Original Yang and stimulating whole-body Qi mechanism. Large dose of Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction) was used. Fupian (Prepared Aconite Root) warms Lower Jiao Original Yang; Ganjiang (Dried Ginger) cultivates Middle Earth Sheng Qi. Ganjiang gains greater warming power with Fupian; Fupian gains greater warming power below with Ganjiang.
Yang Deficiency with Cold-Dampness
Patient Hu XX, male, 51 years old. Due to aversion to cold and fever, loss of appetite. After taking diaphoretic medicines, fever persisted. A TCM doctor diagnosed Summerheat-Heat, using Zhizi (Gardenia Fruit), Huashi (Talcum), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome). After ingestion, chills and fever resembled malaria. Switched to Western anti-malaria injections; afterward, limbs felt sore and weak, hands and feet cold, blank stare, insomnia all night. Changed to Chinese medicines Fupian (Prepared Aconite Root), Ganjiang (Dried Ginger), Renshen (Ginseng Root), Huangqi (Astragalus Root) to benefit Qi and restore Yang. After ingestion, became comatose, spoke nonsense, developed spasms. Changed to Cundong (Ophiopogon Tuber), Huanglian (Coptis Rhizome), Kouqi (likely Astragalus typo), Houpo (Magnolia Bark), Gualouqiao (Trichosanthes Peel), Zhiqiao (Bitter Orange Fruit), Changpu (Acorus Rhizome). Symptoms became incessant vomiting and regurgitation, dizziness, mental confusion, cold extremities up to elbows and knees. No bowel movement for four days. Disease duration half a month, critical condition. Upon consultation, besides above symptoms, patient had pale face, spiritless eyes, black and dry center of tongue, deep and fine pulse. This is due to failure to transform Cold-Dampness and failure to gather Original Qi. Given incessant vomiting and exhausted spirit, fear of Original Qi collapse and untreatability. Urgently used below prescription:
Gong Dingxiang (Clove) 4g, Rouguizi (Cinnamon Fruit) 6g, Shidi (Persimmon Calyx) 5g, Su Tiaoshen (Codonopsis Root) 15g
Baizhu (Atractylodes Macrocephala Rhizome) 9g, Ganjiang (Dried Ginger) 12g, Fa Xia (Processed Pinellia Tuber) 9g, Fuling (Poria) 15g, Sharen (Amomum Fruit) 6g
Gancao (Licorice Root) 6g
This formula is Lizhong Tang (Regulate the Middle Decoction) modified. Disease lasted half a month, chaotic medication led to severe deficiency of Middle Yang and incessant vomiting. This is a sign of impending Stomach Qi exhaustion. Pre-Heaven and Post-Heaven belong to one Qi. If Stomach Qi exhausts, Kidney Qi will also fail. Lizhong Tang (Regulate the Middle Decoction) is based on Middle Jiao Spleen-Stomach deficiency-cold: Ginger and Atractylodes warm and move Middle Palace Yang; Codonopsis and Licorice sweetly slow and benefit Spleen. This combination has the wonder of rigid and soft complementing each other. Added Dingxiang (Clove) and Guizi (Cinnamon Fruit) to warm Middle and direct rebellious Qi downward; Shidi (Persimmon Calyx) bitter-warm directs Qi down; Banxia (Pinellia Tuber) acrid-warm transforms phlegm. These four drugs enhance directing rebellious Qi downward. Fuling (Poria) strengthens Spleen and drains dampness; Sharen (Amomum Fruit) supports Qi and regulates Middle. Combined with Lizhong Tang (Regulate the Middle Decoction), it transforms phlegm without consuming Qi and directs rebellious Qi without stagnating Qi.
By 8 PM after taking medicine, vomiting/regurgitation lightened. Suddenly abdominal pain and urgent defecation occurred, passing large amount of black stool. By midnight, vomiting/regurgitation completely stopped.
Next day consultation: Limbs weary, body soft, pulse turned slippery-large, tongue greasy and dry, chest tightness. This is failure to transform Stomach turbidity. Continued previous prescription adding Fupian (Prepared Aconite Root) 60g to assist Mingmen Fire. This is "benefiting the source of Fire to eliminate Yin shadows." Combined with Lizhong Tang (Regulate the Middle Decoction), both Pre-Heaven and Post-Heaven Yang are supported, and Stomach turbidity naturally descends.
After taking, chest tightness completely disappeared, spirit and form improved, but felt irritable, cheek swelling, and dull gum pain. Prescribed Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) from *Shanghan Lun* plus Su Tiaoshen (Codonopsis Root):
Chao Zhishi (Fried Immature Bitter Orange) 6g, Jiao Zhiren (Charred Gardenia Kernel) 9g, Dan Douchi (Fermented Soybean) 9g, Su Tiaoshen (Codonopsis Root) 15g
Zhishi Zhizi Chi Tang (Immature Bitter Orange, Gardenia, and Fermented Soybean Decoction) is a formula by Zhongjing to broaden Middle and direct Qi downward, communicate Heart and Kidney, and remove deficiency irritability. Added Su Tiaoshen (Codonopsis Root) to protect Original Qi. After taking, irritability greatly reduced, but cheek swelling not fully resolved, slight tooth pain. Used self-formulated Jianggui Lingban Tang (Ginger, Cinnamon, Poria, and Pinellia Decoction) modified:
Ganjiang (Dried Ginger) 12g, Guizhi (Cinnamon Twig) 12g, Fuling (Poria) 15g, Dan Chao Banxia (Bile-fried Pinellia Tuber) 9g
Formula uses Ganjiang (Dried Ginger) to dispel cold and dissipate knots, Guizhi (Cinnamon Twig) to warm meridians and unblock vessels, Fuling (Poria) to promote urination and move phlegm, Banxia (Pinellia Tuber) fried with bile further transforms phlegm and directs rebellious Qi downward, allowing floating Yin Fire to subside.
After one dose, cheek swelling subsided, tooth pain stopped. But at dawn, leg pain and edema appeared again, tongue white and greasy. This is because the previous formula dispersed cold and directed Qi downward, causing cold to sink downward, hence leg edema. Overall due to incomplete elimination of Cold-Dampness and failure of Yang to disseminate. Continued with below prescription:
Mahuang (Ephedra Herb) 6g, Xingren (Apricot Seed) 9g, Guizhi (Cinnamon Twig) 9g, Baizhu (Atractylodes Macrocephala Rhizome) 15g, Yiren (Coix Seed) 15g
Gancao (Licorice Root) 6g
This formula is a combination of Mahuang Jia Zhu Tang (Ephedra Plus Atractylodes Decoction) and Maxing Yigan Tang (Ephedra, Apricot Seed, Licorice, and Coix Seed Decoction). It has the妙 (wonder) of resolving accumulated Cold-Dampness through urine and sweat. After taking, leg pain decreased, edema not fully resolved. Subsequently regulated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) plus Fupian (Prepared Aconite Root), and Sini Tang (Reverse the Collapse Decoction) plus Fuling (Poria) and Baizhu (Atractylodes Macrocephala Rhizome), leading to cure.
[Commentary]: Initially, due to physician's lack of careful syndrome differentiation and chaotic medication, symptoms changed manifold, Spleen and Kidney approached exhaustion, presenting incessant vomiting/regurgitation. This is actually a syndrome of Yang deficiency and failure to transform Cold-Dampness. Regarding black-dry tongue, combined with pulse/symptoms, it is due to Yang deficiency failing to transport fluids upward, not a heat sign. Yang deficiency is the root of disease; Cold-Dampness is the branch. With such syndrome differentiation, consistently grasping this key point for symptom-based medication throughout, whether Yin pathogens float upward causing toothache/cheek swelling or sink downward causing leg swelling/arthralgia, symptoms differ but origin is same. Following principle "treatment must seek the root," starting from supporting Yang Qi and dispelling Cold-Dampness, advancing step by step, ultimately achieving full success.
Heart-Kidney Yang Deficiency Intolerant to Acrid-Warm Dryness
Patient Lu XX, male, 77 years old. Naturally diligent, even in advanced age, still managing household chores. For past two months, gradually felt palpitations and shortness of breath, worsening daily. Frequent urination, running nose and tears. Multiple treatments ineffective, sought consultation. Pulse was intermittent (Dai), tongue white and slippery. After consultation, patient said: "All doctors say my disease is Yang deficiency. But if Guiji (Cinnamon Bark) is added to Yang-supporting formulas, palpitations worsen. I don't know why." I said: "Supporting Yang relies on Jiang (Ginger), Fu (Aconite), Gui (Cinnamon). But Aconite is not hot without Ginger, not drying without Cinnamon. Therefore, adding Cinnamon to Yang-supporting formulas greatly increases drying nature, pure Yang is harsh and fierce, overly exciting, hence some cannot tolerate it. However, if balanced properly, it is not taboo."