患者所现诸症，显系心肾阳虚，中阳不足，元气不能收纳所致。心阳虚，阳神不藏，以致心悸、气短。肾主五液，肾阳虚衰，元气不能收纳，上不能统摄阴液，而致涕泗交流，下不能约束膀胱，而致小便频数。且心肾之阳相通，互相影响。肾阳虚衰，可引起心阳不足，心阳不足，亦可伤及肾阳。故肾阳虚者，心阳易虚；心阳虚者，肾阳亦多感不足。然其相互交通之作用，全凭中气为之斡旋，所以郑钦安说。“中也者，调和上下之枢机也。”此症之治，宜补阳以运中，补中以助阳，先后天同时兼顾。但用药应刚柔相济，使之适于病情，遂处以郑钦安附子甘草汤：
方中附子辛热，补先天心肾之阳，其性刚烈，甘草味甘，专补后天脾土，其性和缓。黄坤载谓其：“备冲和之正味，秉淳厚之良资，……培植中间，养育四旁，交媾精神之妙药，调剂气血之灵丹。”甘草与附子相伍，可缓和其刚烈之性。同时，脾得先天真阳以运之，而中气愈旺，愈能交通先天心肾之阳。此先后天并补之剂也。
上方连服三剂，症情好转。宜加强补中作用，兼补心气。原方加高丽参，由6克至15克，服三剂，诸症大减，且觉安静、恬适。至此，心肾之阳恢复，欲图巩固，须阴阳兼顾，本《内经》“阴平阳秘，精神乃治”之旨而立法，易方用郑钦安补坎益离汤和潜阳汤加味。处方： 第一方，补坎益离汤： 黑附片60克 桂心9克 蛤粉15克 炙甘草6克 生姜15克 第二方，潜阳汤： 黑附片60克 龟板15克 砂仁6克 桂心9克 炙甘草9克 高丽参9克 补坎益离汤，用附、桂补心肾之阳，蛤粉补肾阴，启下焦水津上潮，姜、草调中，最能交通上下。虽附、桂同用，然有蛤粉补阴以济之，甘草之甘以缓之，不但刚烈之性大减，且水火互济，上下不乖，心悸自不作矣。
潜阳汤，龟板潜阳滋阴，附、桂补心肾之阳，加高丽参补益元气，又得砂仁、甘草理气调中，使上下气机交通，水火调平矣。
患者各服上方二剂后，诸症消失，精神亦较前增加。
风 水
刘××，女，十三岁。发热、咳嗽、呕吐，继之颜面眼验浮肿，血尿。西医诊断为急性肾炎，治疗一周，见效不显，转余诊治。症现发热持续一周不退，咳嗽较剧且呕吐，尿短频，肉眼血尿。脉浮而数，舌质红，苔白而干。此系外受风热之邪，内有水湿蕴结，以致肺失宣降而发热咳嗽。胃气上逆则呕吐，水湿蕴结，郁而化热，下注膀胱则为血尿。证属“风水”。治宜宣肺清热、理气利湿为当务之急。予自拟方桑叶连贝散加减。处方：
桑叶10克
方中桑叶、连翘、枯芩、贝母、杏仁宣肺清热，藿香、茯苓、陈皮理气利湿，焦楂化腑热、去淤滞，竹茹清热止呕。
二诊：上方服二剂，发热退，咳嗽减，脉浮数已转微紧。舌干转润，仍有薄自苔。面浮，仍有血尿，呕吐未止。此时风邪虽减而胃气不和，宜化饮降逆止呕为治。用《金匮》小半夏汤。处方：
三诊：服一剂后，呕吐止，面浮略减。仍有微咳，血尿仍存。此系表邪未尽，太阳气机郁遏不畅。用桂麻各半汤加减。处方：
桂麻各半汤开太阳气机，以解太阳未尽之表邪，发汗行水，加苏叶、陈皮、防风辛香理气，祛风胜湿。
四诊：服一剂后，面浮遂减，小便较前增多，舌转腻，脉转沉细。此水饮已有外泄之征象。此时血尿虽存，但心肺阳虚之征已现。用自拟姜桂苓半汤以扶心肺之阳。处方；
方解见本书“姜桂苓半汤的组成原理及临床运用”。
五诊：服二剂后，面浮消，舌腻已退，血尿减少。用《伤寒论》猪苓汤，利湿、育阴、泻未尽之余热。此方连服五剂后，血尿全止，面浮全消。
[按]：本例水气上泛之因，为风邪外袭，肺失宣降，胃气不和，膀胱气化不利，故不能通调水道，以致在上而为咳嗽、面浮，在中则为呕吐水饮，风邪不能及时宣散，与内蕴之水饮郁而化热，在下则为血尿。治疗关键在于分清表里，宣通肺气，清散风热之邪为急。俟风热之邪宣散，再予小半夏汤化饮降逆，和中止呕。进而以桂麻各半汤开太阳气机，再佐以姜挂苓半汤，复心肺之阳而助宣肺化饮之力。待阳复继以猪苓汤育阴、利湿，泻未尽之余热而治血尿。此证如表邪未尽，即用里证之猪苓汤，无异引邪深入，关门缉盗，病势缠绵，难期速效。本例虽有血尿，而用桂麻各半汤者，意在宣通膀胱气机，使病邪外散，用姜桂苓半汤者，意在助心肺之阳，为下步用猪苓汤创连育阴、利湿之条件。
肾虚全身浮肿
孙××，男，八岁。全身浮肿已三月余，尤以面目及四肢为甚，求医殆遍，多以五苓散、五皮饮一类通套方剂施治。又兼西药利尿剂屡用，不但无效，反而病势日增。某医院诊断为慢性肾炎，请余会诊。诊见患者面青暗滞，精神萎顿，四肢不温，口不渴，浮肿按之凹陷久而不起，舌白滑，脉沉细。脉症合参，已显露元阳衰惫之象。急宜扶阳抑阴。用《伤寒论》茯苓四逆汤去人参。处方：
二诊：服上方三剂后，小便通，肿势减。继用《伤寒论》理中汤加附予。处方：
此方重在温肾理中，扶助元阳。
三诊：服三剂，肿胀续减。惟小便量尚少，显系温阳之力犹嫌不足。予《伤寒论》自通汤，重用姜、附，交通刚阳，宣达气机。处方：
四诊：服二剂后，小便通畅，肿势火减。嘱原方再服五剂，症状消失。
[按]：慢性肾炎，多属脾肾两虚，元阳衰惫，故不可徒事利尿驱邪，舍本逐末。《内经》云：“善诊者察色按脉，先别阴阳。”临证时宜把握阴阳，权衡利弊。本症全身浮肿，面青暗滞，精神萎顿，四肢不温，已属正气大虚，元阳不振，机体气化功能衰惫，急当温补以增强气化功能。张景岳曾说：“温补即所以化气，气化而愈者，愈出自然。”故临床上，凡遇本病属阳虚者，直接温补阳气，宣通气化，不利尿而尿自通，不消肿而肿自退。
虚损浮肿
邓××教授，男，五十余岁。于1951年患全身水肿，历时半年，经住院治疗，抽水、利尿均未见效，病势危重，延余往诊。初诊之时，即见其面色不华，额部黧黑，头身倾视，毛发、爪甲、皮肤、唇齿均见憔悴枯槁之象。目无精光，神倦息短，动则喘促。两脚显著浮肿，腹部鼓胀，小便短涩。失眠，多梦，肿势延及阴囊。舌苔黄腻而润，脉空无根。“冰冻三尺，非一日之寒”，病势至此，亦非一朝一夕。综合言之，此症五脏虚损，精血大亏，神气将脱。何以知之?盖心主血，其华在面，其充在血脉，发为血之余。心脏亏损，故面色无华，脉空无根，并见毛发枯槁。心藏神，神不守舍，故见失眠、多梦。心阳源于肾阳，心阳亏，肾阳亦亏。肾属水，其色黑，肾水上泛，则额现黧黑。肾主骨，齿乃骨之余，肾亏则齿枯。肝肾同源，肾精上注于目，肝开窍于目，肝肾两亏，精血不足，则目精无光。肝主筋，其华在爪，肝血不足，故爪甲枯焦。肺合皮毛，肺气不足，则皮毛憔悴。今心肺肝肾均亏，脾为中土，亦未有不亏者，其肿势之泛滥，与脾之不能制水有关。更有甚者，头倾视深，目无光泽，为神将脱绝之候。所幸尚能进食，食能知味。精神虽困顿，神智尚清楚。生机未绝，应尽力救治。但五脏俱病，何以为主?经曰：“肾为先天之本”，应以肾为根本。故此症之治，必须峻补命门，俾元气得复，其症始可望愈。然久病之人，最易感受风寒湿邪，导致经络闭塞，应先温阳解表疏通经络，使经络疏通，气血畅行，然后再以峻补命门之剂，始可化气而行水。辨证清，立法定，遂决定先用自拟方附子桂枝独活寄生汤。处方：
上方服三剂，患者感到全身舒适。说明经络疏通，急宜直补命门，兼利水治之。方用严用和济生肾气汤。处方：
淮牛膝9克 肉桂15克 粉丹皮6克 山萸肉12克 车前子9克
汪切庵解是方曰：“此太阴少阴药也。土为万物之母，脾虚则土不能制水而洋溢，水为万物之源(小注略，下同)，肾虚则水不安其位而妄行，以致泛滥皮肤肢体之间。因而攻之，虚虚之祸，不待言矣。桂附八昧丸滋真阴而能行水，补命火因以强脾，加车前子利小便则不走气，加牛膝益肝肾，藉以下行，故使水道通而肿胀已，又无损于真元也。”
喻嘉言用此方，主张以附子为君药，指出“肾之关门不开，必以附子回阳，蒸动肾气，其关始开，胃中积水始下，以阳主开故也。”此言实有至理。
余治此症，因恐病重药轻，不能胜任，故施用上方，仝作大剂。初服数剂，病未稍动，守方服至二十七剂，有时方珏赤石脂60克于方中，以加强补土之力。至是，小便渐利，肿亦渐消。然五脏俱虚，补肾已达相当阶段，则兼补肝血亦为当务之急。易方用景岳右归饮和桂附八味丸化裁。处方：
黑附片60克 熟地30克 淮山药2l克 山萸肉12克 泽泻9克
此方用意，附、桂温补肾阳，配熟地、萸肉、山药补阴，可使阳复而有所依附；而熟地、萸肉、山药补阴，得桂附之助阳，可以蒸腾肾气．使肾阳旺盛，仍用茯苓、泽泻渗利水湿，使补中有泻。用杜仲、果杞强腰肾，当归补肝血，赤石脂、小茴香健脾利气。服至二十余剂，小便较长，肿势大消。惟每天午后肿胀反复，此由于阳虽回但尚不足以制阴。改以白通汤、四逆汤各数剂后，午后肿胀得以控制。再以理中汤温脾阳祛中寒，由此肿势全消，息已不短。但患者至此骨瘦如柴，赢弱不堪，心悸失眠，脉如蛛丝，足不任地。此久病后真阴枯涸，有转痿症之虞，应本“损者益之”，“精不足者，补之以味”，用血肉有情之品服食之。处方：
枸杞30克 海参30克 猪蹄筋60克 老肥鸭1只 老母鸡1只
上方配齐，混合炖熟，仅饮其汁，一日数次。方中老鸭最能滋阴，为虚劳圣药。老母鸡治虚损，长于养血补气。猪蹄筋填精补髓，海参、枸杞滋肾益精。服至五剂，脚已能立，且能行走，皮肉渐充．毛发爪甲均转润泽，心悸失眠已除，饮食增进，病情遂逐渐好转而康复。
李××，男，三十岁。患者双下肢肿痛已三月余，面色萎黄，举步缓慢而感疼痛，久治未愈，曾经某医院诊为营养不良。舌质淡，苔薄白，右脉沉缓，左脉微弱。系脾虚运化失司，水湿积于下肢而为肿，肝虚疏泄不及，以致经络闭塞，气血凝滞而作痛。先予健脾扶中，散寒运湿。处方：
方中花生米甘、辛、体润气香，性平无毒，健脾开胃，有滋养之功效，大枣甘、平入脾，补益脾胃而扶中；大蒜辛、温入胃、大肠二经，功能散寒湿、辟阴邪、下气暖中、解毒行水。
二诊：上方连服五剂后肿消，惟下肢仍觉疼痛，左脉微弱不起，乃肝虚、气血瘀滞所致。治以补肝祛瘀、活络止痛之剂。用张锡纯《衷中参西录》曲直汤加口芪治之。处方：
是方张氏原注“治肝虚腿疼，左部脉微弱者”。余据病情改变剂量而投之，连服三剂而痛止病愈。
方中山萸肉补肝，丹参、当归、乳香、没药疏通气血，活络祛瘀而止痛。因久病体虚，故加口芪以补气，知母监制口芪之热。制方得体，加减适宜，用之必效。
至于肝虚腿疼之理，张氏论之颇详，余不复述。
马××，女，五十岁。患干咳无痰，面足浮肿，多年不愈。经西医诊断为支气管扩张并肺心病。屡用中西药治疗，见效不大。接诊时，除上述症状外，兼见小便短少，心悸失眠，气短乏力，食欲不振。舌暗淡苔薄白，脉三、五不整，重按无力。
据症分析：脾虚湿滞，土不生金，肺失滋润，以致干咳日久不止。脾虚化源不足，肺气虚损，清肃失司，不能通调水道，以致浮肿尿少。肺为肾之母，母病不能荫子，肾水不升，则心火不降，心肾不交，以致心悸失眠。肺主气，脾益气，肺脾两虚，则气短乏力。脾虚则运化力差，放食欲不振。
患者所表现出的各种症状，明显是由于心肾阳气虚弱、中焦阳气不足，导致元气无法收纳所致。心阳虚，则阳神不能潜藏，从而引起心悸、气短。肾主管五液，肾阳虚衰，元气无法收纳，向上不能统摄阴液，导致鼻涕眼泪交流；向下不能约束膀胱，导致小便频数。而且心与肾的阳气相互贯通，互相影响。肾阳虚衰，可引起心阳不足；心阳不足，也会损伤肾阳。所以肾阳虚的人，心阳容易虚；心阳虚的人，肾阳也多感不足。然而它们之间相互交通的作用，全凭中气来斡旋调节，所以郑钦安说：“中气，是调和上下枢机的关键。”此症的治疗，应当补阳以运化中气，补中以助阳，先后天同时兼顾。但用药应刚柔相济，使之适合病情，于是开具郑钦安的附子甘草汤：
方中的附子味辛性热，能补先天心肾之阳，其性质刚烈；甘草味甘，专补后天脾土，其性质和缓。黄坤载说它：“具备冲和的正味，秉承淳厚的优良资质，……培植中宫，养育四旁，是交媾精神的妙药，调剂气血的灵丹。”甘草与附子配合，可以缓和附子的刚烈之性。同时，脾得到先天的真阳来运化，中气就会更加旺盛，越能交通先天的心肾之阳。这是先后天并补的方剂。
上方连续服用三剂后，病情好转。应当加强补中的作用，兼补心气。在原方中加入高丽参，剂量由6克增至15克，再服三剂，所有症状大幅减轻，且感觉安静、舒适。至此，心肾之阳恢复，为了巩固疗效，必须阴阳兼顾，遵循《内经》“阴平阳秘，精神乃治”的宗旨而立法，更换方剂使用郑钦安的补坎益离汤和潜阳汤加味。处方：第一方，补坎益离汤：黑附片60克 桂心9克 蛤粉15克 炙甘草6克 生姜15克 第二方，潜阳汤：黑附片60克 龟板15克 砂仁6克 桂心9克 炙甘草9克 高丽参9克 补坎益离汤，用附子、桂心补心肾之阳，蛤粉补肾阴，启动下焦水津上潮，姜、草调和中焦，最能交通上下。虽然附子、桂心同用，但有蛤粉补阴来济助，甘草的甘味来缓和，不但刚烈之性大减，而且水火互济，上下协调，心悸自然不再发作。
潜阳汤，龟板潜阳滋阴，附子、桂心补心肾之阳，加入高丽参补益元气，又得砂仁、甘草理气调中，使上下气机交通，水火调平。
患者各服用上方二剂后，所有症状消失，精神也比以前增加。
风水病
刘××，女，十三岁。发热、咳嗽、呕吐，随后颜面眼睑浮肿，出现血尿。西医诊断为急性肾炎，治疗一周，见效不明显，转求余诊治。症状表现为发热持续一周不退，咳嗽剧烈且呕吐，尿短频，肉眼可见血尿。脉浮而数，舌质红，苔白而干。这是外受风热之邪，内有水湿蕴结，导致肺失宣降而发热咳嗽。胃气上逆则呕吐，水湿蕴结，郁而化热，下注膀胱则为血尿。证属“风水”。治疗宜宣肺清热、理气利湿为当务之急。给予自拟方桑叶连贝散加减。处方：
桑叶10克
方中桑叶、连翘、枯芩、贝母、杏仁宣肺清热，藿香、茯苓、陈皮理气利湿，焦山楂化腑热、去淤滞，竹茹清热止呕。
二诊：上方服用两剂后，发热退去，咳嗽减轻，脉浮数已转为微紧。舌干转为润泽，仍有薄白苔。面部浮肿仍在，仍有血尿，呕吐未止。此时风邪虽减但胃气不和，宜化饮降逆止呕为治法。使用《金匮要略》的小半夏汤。处方：
法半夏9克 生姜30克
三诊：服用一剂后，呕吐停止，面部浮肿略有减轻。仍有轻微咳嗽，血尿仍存在。这是表邪未尽，太阳经气机郁遏不畅。使用桂枝麻黄各半汤加减。处方：
桂枝麻黄各半汤开通太阳经气机，以解太阳未尽之表邪，发汗行水，加苏叶、陈皮、防风辛香理气，祛风胜湿。
四诊：服用一剂后，面部浮肿遂减，小便较前增多，舌苔转腻，脉转沉细。这是水饮已有外泄的迹象。此时血尿虽存，但心肺阳虚之征象已现。使用自拟姜桂苓半汤以扶助心肺之阳。处方：
方解见本书“姜桂苓半汤的组成原理及临床运用”。
五诊：服用两剂后，面部浮肿消退，舌苔腻已退，血尿减少。使用《伤寒论》猪苓汤，利湿、育阴、泻未尽之余热。此方连续服用五剂后，血尿全止，面部浮肿全消。
[按语]：本例水气上泛的原因，是风邪外袭，肺失宣降，胃气不和，膀胱气化不利，故不能通调水道，以致在上而为咳嗽、面浮，在中则为呕吐水饮，风邪不能及时宣散，与内蕴之水饮郁而化热，在下则为血尿。治疗关键在于分清表里，宣通肺气，清散风热之邪为急。待风热之邪宣散后，再予小半夏汤化饮降逆，和中止呕。进而以桂枝麻黄各半汤开通太阳经气机，再佐以姜桂苓半汤，恢复心肺之阳而助宣肺化饮之力。待阳气恢复后继以猪苓汤育阴、利湿，泻未尽之余热而治血尿。此证如果表邪未尽，即用里证之猪苓汤，无异于引邪深入，关门缉盗，病势缠绵，难期速效。本例虽有血尿，而用桂枝麻黄各半汤者，意在宣通膀胱气机，使病邪外散；用姜桂苓半汤者，意在助心肺之阳，为下一步用猪苓汤创造育阴、利湿的条件。
肾虚全身浮肿
孙××，男，八岁。全身浮肿已三月余，尤以面目及四肢为甚，求医遍访，多以五苓散、五皮饮一类通套方剂施治。又兼西药利尿剂屡用，不但无效，反而病势日增。某医院诊断为慢性肾炎，请余会诊。诊见患者面色青暗滞涩，精神萎顿，四肢不温，口不渴，浮肿按之凹陷久而不起，舌白滑，脉沉细。脉症合参，已显露元阳衰惫之象。急宜扶阳抑阴。使用《伤寒论》茯苓四逆汤去人参。处方：
二诊：服用上方三剂后，小便通畅，肿势减轻。继用《伤寒论》理中汤加附子。处方：
此方重在温肾理中，扶助元阳。
三诊：服用三剂，肿胀继续减轻。惟小便量尚少，明显是温阳之力犹嫌不足。给予《伤寒论》自通汤，重用姜、附，交通刚阳，宣达气机。处方：
四诊：服用两剂后，小便通畅，肿势大减。嘱原方再服五剂，症状消失。
[按语]：慢性肾炎，多属脾肾两虚，元阳衰惫，故不可徒事利尿驱邪，舍本逐末。《内经》云：“善于诊察的人观察面色按压脉搏，先辨别阴阳。”临证时宜把握阴阳，权衡利弊。本症全身浮肿，面色青暗滞涩，精神萎顿，四肢不温，已属正气大虚，元阳不振，机体气化功能衰惫，急当温补以增强气化功能。张景岳曾说：“温补即所以化气，气化而愈者，愈出自然。”故临床上，凡遇本病属阳虚者，直接温补阳气，宣通气化，不利尿而尿自通，不消肿而肿自退。
虚损浮肿
邓××教授，男，五十余岁。于1951年患全身水肿，历时半年，经住院治疗，抽水、利尿均未见效，病势危重，延余往诊。初诊之时，即见其面色不华，额部黧黑，头倾视深，毛发、爪甲、皮肤、唇齿均见憔悴枯槁之象。目无精光，神倦息短，动则喘促。两脚显著浮肿，腹部鼓胀，小便短涩。失眠，多梦，肿势延及阴囊。舌苔黄腻而润，脉空无根。“冰冻三尺，非一日之寒”，病势至此，亦非一朝一夕。综合言之，此症五脏虚损，精血大亏，神气将脱。何以知之?盖心主血，其华在面，其充在血脉，发为血之余。心脏亏损，故面色无华，脉空无根，并见毛发枯槁。心藏神，神不守舍，故见失眠、多梦。心阳源于肾阳，心阳亏，肾阳亦亏。肾属水，其色黑，肾水上泛，则额现黧黑。肾主骨，齿乃骨之余，肾亏则齿枯。肝肾同源，肾精上注于目，肝开窍于目，肝肾两亏，精血不足，则目精无光。肝主筋，其华在爪，肝血不足，故爪甲枯焦。肺合皮毛，肺气不足，则皮毛憔悴。今心肺肝肾均亏，脾为中土，亦未有不亏者，其肿势之泛滥，与脾之不能制水有关。更有甚者，头倾视深，目无光泽，为神将脱绝之候。所幸尚能进食，食能知味。精神虽困顿，神智尚清楚。生机未绝，应尽力救治。但五脏俱病，何以为主?经曰：“肾为先天之本”，应以肾为根本。故此症之治，必须峻补命门，俾元气得复，其症始可望愈。然久病之人，最易感受风寒湿邪，导致经络闭塞，应先温阳解表疏通经络，使经络疏通，气血畅行，然后再以峻补命门之剂，始可化气而行水。辨证清，立法定，遂决定先用自拟方附子桂枝独活寄生汤。处方：
上方服用三剂，患者感到全身舒适。说明经络疏通，急宜直补命门，兼利水治之。方用严用和济生肾气汤。处方：
淮牛膝9克 肉桂15克 粉丹皮6克 山萸肉12克 车前子9克
汪切庵解释此方说：“这是太阴少阴的药。土为万物之母，脾虚则土不能制水而洋溢，水为万物之源(小注略，下同)，肾虚则水不安其位而妄行，以致泛滥皮肤肢体之间。因而攻之，虚虚之祸，不待言矣。桂附八味丸滋真阴而能行水，补命火因以强脾，加车前子利小便则不走气，加牛膝益肝肾，藉以下行，故使水道通而肿胀已，又无损于真元也。”
喻嘉言用此方，主张以附子为君药，指出“肾之关门不开，必以附子回阳，蒸动肾气，其关始开，胃中积水始下，以阳主开故也。”此言实有至理。
我治疗此症，因恐病重药轻，不能胜任，故施用上方，全部作为大剂。初服数剂，病未稍动，守方服至二十七剂，有时方中加赤石脂60克，以加强补土之力。至此，小便渐利，肿亦渐消。然五脏俱虚，补肾已达相当阶段，则兼补肝血亦为当务之急。更换方剂用景岳右归饮和桂附八味丸化裁。处方：
黑附片60克 熟地30克 淮山药21克 山萸肉12克 泽泻9克
此方用意，附子、肉桂温补肾阳，配熟地、山萸肉、山药补阴，可使阳复而有所依附；而熟地、山萸肉、山药补阴，得桂附之助阳，可以蒸腾肾气，使肾阳旺盛，仍用茯苓、泽泻渗利水湿，使补中有泻。用杜仲、枸杞强腰肾，当归补肝血，赤石脂、小茴香健脾利气。服用二十余剂，小便较长（通畅），肿势大消。惟每天午后肿胀反复，这是由于阳虽回但尚不足以制阴。改以白通汤、四逆汤各数剂后，午后肿胀得以控制。再以理中汤温脾阳祛中寒，由此肿势全消，呼吸已不短促。但患者至此骨瘦如柴，羸弱不堪，心悸失眠，脉如蛛丝，足不任地。此为久病后真阴枯涸，有转痿症之虞，应本“损者益之”，“精不足者，补之以味”的原则，用血肉有情之品服食之。处方：
枸杞30克 海参30克 猪蹄筋60克 老肥鸭1只 老母鸡1只
上方配齐，混合炖熟，仅饮其汁，一日数次。方中老鸭最能滋阴，为虚劳圣药。老母鸡治虚损，长于养血补气。猪蹄筋填精补髓，海参、枸杞滋肾益精。服用五剂，脚已能站立，且能行走，皮肉渐充，毛发爪甲均转润泽，心悸失眠已除，饮食增进，病情遂逐渐好转而康复。
李××，男，三十岁。患者双下肢肿痛已三月余，面色萎黄，举步缓慢而感疼痛，久治未愈，曾经某医院诊为营养不良。舌质淡，苔薄白，右脉沉缓，左脉微弱。系脾虚运化失司，水湿积于下肢而为肿，肝虚疏泄不及，以致经络闭塞，气血凝滞而作痛。先予健脾扶中，散寒运湿。处方：
方中花生米甘、辛、体润气香，性平无毒，健脾开胃，有滋养之功效，大枣甘、平入脾，补益脾胃而扶中；大蒜辛、温入胃、大肠二经，功能散寒湿、辟阴邪、下气暖中、解毒行水。
二诊：上方连续服用五剂后肿消，惟下肢仍觉疼痛，左脉微弱不起，乃肝虚、气血瘀滞所致。治以补肝祛瘀、活络止痛之剂。使用张锡纯《衷中参西录》曲直汤加黄芪治之。处方：
是方张氏原注“治肝虚腿疼，左部脉微弱者”。我据病情改变剂量而投之，连续服用三剂而痛止病愈。
方中山萸肉补肝，丹参、当归、乳香、没药疏通气血，活络祛瘀而止痛。因久病体虚，故加黄芪以补气，知母监制黄芪之热。制方得体，加减适宜，用之必效。
至于肝虚腿疼之理，张氏论之颇详，我不再复述。
马××，女，五十岁。患干咳无痰，面足浮肿，多年不愈。经西医诊断为支气管扩张并肺心病。屡用中西药治疗，见效不大。接诊时，除上述症状外，兼见小便短少，心悸失眠，气短乏力，食欲不振。舌暗淡苔薄白，脉三、五不整，重按无力。
据症分析：脾虚湿滞，土不生金，肺失滋润，以致干咳日久不止。脾虚化源不足，肺气虚损，清肃失司，不能通调水道，以致浮肿尿少。肺为肾之母，母病不能荫子，肾水不升，则心火不降，心肾不交，以致心悸失眠。肺主气，脾益气，肺脾两虚，则气短乏力。脾虚则运化力差，故食欲不振。
The various symptoms manifested by the patient are obviously caused by deficiency of Heart and Kidney Yang, insufficiency of Middle Jiao (Middle Burner) Yang, and failure of Yuan Qi (Original Qi) to be retained. When Heart Yang is deficient, the Yang Spirit cannot be concealed, leading to palpitations and shortness of breath. The Kidneys govern the five fluids. With decline in Kidney Yang and inability of Yuan Qi to be retained, it fails to control Yin fluids upwards, resulting in flowing tears and nasal discharge; downwards, it fails to constrain the Bladder, causing frequent urination. Furthermore, the Yang of the Heart and Kidneys are interconnected and influence each other. Decline in Kidney Yang can lead to insufficiency of Heart Yang; insufficiency of Heart Yang can also damage Kidney Yang. Therefore, those with Kidney Yang deficiency often have deficient Heart Yang; those with Heart Yang deficiency often feel insufficient Kidney Yang. However, their mutual interaction relies entirely on the mediation of Zhong Qi (Middle Qi). Thus, Zheng Qin'an stated: "Zhong Qi is the pivot that harmonizes the upper and lower." The treatment for this condition should involve tonifying Yang to facilitate the movement of Zhong Qi, and tonifying the Middle to assist Yang, addressing both the Pre-heaven and Post-heaven simultaneously. However, the herbs used should combine rigid and gentle properties to suit the condition. Therefore, I prescribed Zheng Qin'an's Fuzi Gancao Tang (Aconite and Licorice Decoction):
Hei Fu Pian (Black Prepared Aconite Root) 60g, Zhi Gan Cao (Honey-fried Licorice Root) 9g.
In this formula, Fuzi (Prepared Aconite Root) is acrid and hot, tonifying the Pre-heaven Heart and Kidney Yang; its nature is vigorous and fierce. Gan Cao (Licorice Root) is sweet, specifically tonifying the Post-heaven Spleen Earth; its nature is mild and slow. Huang Kunzai described it as: "Possessing the correct flavor of harmony and balance, inheriting the excellent qualities of purity and thickness... cultivating the center, nourishing the four peripheries, it is a miraculous drug for the conjunction of Spirit and Essence, and a spiritual elixir for regulating Qi and Blood." When combined with Gan Cao, the vigorous nature of Fuzi is moderated. Meanwhile, the Spleen receives the True Yang of the Pre-heaven to transform, making Zhong Qi even more robust, thereby better facilitating the connection between the Pre-heaven Heart and Kidney Yang. This is a formula that tonifies both Pre-heaven and Post-heaven.
After taking the above prescription continuously for three doses, the condition improved. It was appropriate to strengthen the action of tonifying the Middle and concurrently tonify Heart Qi. Ginseng Koreensis Radix (Gao Li Shen) was added to the original formula, increasing from 6g to 15g. After taking it for another three doses, all symptoms decreased significantly, and the patient felt calm and comfortable. At this point, the Yang of the Heart and Kidneys had recovered. To consolidate the effect, Yin and Yang must be addressed simultaneously. Following the principle of the *Neijing* ("When Yin is balanced and Yang is firm, Spirit and Essence will be regulated"), the prescription was changed to Zheng Qin'an's Bukan Yili Tang (Tonify Kan and Benefit Li Decoction) and Qianyang Tang (Subdue Yang Decoction) with modifications. Prescription: First Formula, Bukan Yili Tang: Hei Fu Pian (Black Prepared Aconite Root) 60g, Guixin (Cinnamon Bark) 9g, Gafen (Clam Shell Powder) 15g, Zhi Gan Cao (Honey-fried Licorice Root) 6g, Shengjiang (Fresh Ginger) 15g. Second Formula, Qianyang Tang: Hei Fu Pian (Black Prepared Aconite Root) 60g, Gui Ban (Tortoise Shell) 15g, Sharen (Amomum Fruit) 6g, Guixin (Cinnamon Bark) 9g, Zhi Gan Cao (Honey-fried Licorice Root) 9g, Renshen (Ginseng Root) 9g. Bukan Yili Tang uses Fuzi and Guixin to tonify Heart and Kidney Yang, Gafen to tonify Kidney Yin, initiating the rising of water fluids from the Lower Jiao. Ginger and Licorice regulate the Middle, best facilitating communication between upper and lower. Although Fuzi and Guixin are used together, Gafen tonifies Yin to assist, and the sweetness of Licorice moderates, greatly reducing the vigorous nature. Moreover, Water and Fire mutually assist, upper and lower remain harmonious, and palpitations naturally cease.
Qianyang Tang uses Gui Ban to subdue Yang and tonify Yin, Fuzi and Guixin to tonify Heart and Kidney Yang, plus Renshen to tonify Yuan Qi. Sharen and Licorice regulate Qi and harmonize the Middle, allowing Qi mechanisms of upper and lower to communicate and Water and Fire to be balanced.
After the patient took two doses of each formula, all symptoms disappeared, and mental energy increased compared to before.
Wind Edema
Liu XX, Female, 13 years old. Fever, cough, vomiting, followed by facial and eyelid edema and hematuria. Diagnosed by Western medicine as acute nephritis. After one week of treatment, efficacy was not obvious, so she sought my consultation. Symptoms included persistent fever for one week without abatement, severe cough with vomiting, short and frequent urination, and visible hematuria. Pulse was floating and rapid; tongue body was red, coating white and dry. This is due to external contraction of Wind-Heat pathogenic factors and internal accumulation of Dampness-Water, leading to loss of Lung dispersing and descending functions, causing fever and cough. Rebellious Stomach Qi causes vomiting; accumulated Dampness-Water stagnates and transforms into Heat, pouring downward into the Bladder causing hematuria. The pattern belongs to "Wind Edema" (Feng Shui). The urgent treatment should be to diffuse the Lungs, clear Heat, regulate Qi, and promote diuresis. I prescribed my self-formulated Sangye Lianbei San (Mulberry Leaf and Forsythia-Bearnut Powder) with modifications. Prescription:
Sang Ye (Mulberry Leaf) 10g
Lian Qiao (Forsythia Fruit) 10g, Bei Mu (Fritillaria Bulb) 10g, Chen Pi (Citrus Peel) 10g, Fu Ling (Poria) 15g
Jiao Zha (Charred Hawthorn Fruit) 20g, Xing Ren (Apricot Seed) 10g, Huo Xiang (Patchouli Herb) 6g, Ku Qin (Scutellaria Root) 6g, Zhu Ru (Bamboo Shavings) 3g.
In the formula, Sang Ye, Lian Qiao, Ku Qin, Bei Mu, and Xing Ren diffuse the Lungs and clear Heat; Huo Xiang, Fu Ling, and Chen Pi regulate Qi and promote diuresis; Jiao Zha resolves interior Heat and removes stasis; Zhu Ru clears Heat and stops vomiting.
Second Visit: After taking two doses of the above prescription, fever subsided, cough decreased, and the floating-rapid pulse turned slightly tight. The dry tongue became moist, with a thin white coating remaining. Facial edema persisted, hematuria remained, and vomiting had not stopped. Although Wind pathogen had decreased, Stomach Qi was disharmonious. The treatment should focus on resolving fluid retention, directing rebellious Qi downward, and stopping vomiting. I used Xiao Banxia Tang (Minor Pinellia Decoction) from the *Jin Gui Yao Lue*. Prescription:
Fa Xia (Prepared Pinellia Tuber) 9g, Sheng Jiang (Fresh Ginger) 30g.
In the formula, heavy use of Sheng Jiang releases the exterior, promotes water movement, and dispels Cold; paired with Fa Xia to harmonize the Middle, direct rebellious Qi downward, and stop vomiting.
Third Visit: After one dose, vomiting stopped, and facial edema slightly decreased. Mild cough and hematuria persisted. This indicates incomplete resolution of exterior pathogen and stagnation of Taiyang Qi mechanism. I used Guizhi Mahuang Ge Ban Tang (Guizhi and Mahuang Half-and-Half Decoction) with modifications. Prescription:
Ma Rong (Processed Ephedra Stem) 6g, Xing Ren (Apricot Seed) 9g, Guizhi (Cinnamon Twig) 9g, Hang Shao (White Peony Root) 10g, Su Ye (Perilla Leaf) 6g
Fang Feng (Saposhnikovia Root) 6g, Chen Pi (Citrus Peel) 6g, Gan Cao (Licorice Root) 6g, Sheng Jiang (Fresh Ginger) 3 slices.
Guizhi Mahuang Ge Ban Tang opens the Taiyang Qi mechanism to resolve residual exterior pathogen of Taiyang, induces sweating and moves water. Added Su Ye, Chen Pi, and Fang Feng to use their acrid-aromatic properties to regulate Qi, dispel Wind, and overcome Dampness.
Fourth Visit: After one dose, facial edema decreased, urine volume increased, tongue coating became greasy, and pulse turned deep and fine. This indicates signs of fluid retention draining outward. Although hematuria persists, signs of Heart and Lung Yang deficiency have appeared. I used my self-formulated Jianggui Lingban Tang (Ginger-Cinnamon-Poria-Pinellia Decoction) to support Heart and Lung Yang. Prescription:
Sheng Jiang (Fresh Ginger) 9g, Guizhi (Cinnamon Twig) 9g, Fu Ling (Poria) 15g, Fa Xia (Prepared Pinellia Tuber) 9g.
For formula analysis, see "Composition Principle and Clinical Application of Jianggui Lingban Tang" in this book.
Fifth Visit: After two doses, facial edema resolved, greasy tongue coating receded, and hematuria decreased. I used Zhuling Tang (Polyporus Decoction) from the *Shanghan Lun* to promote diuresis, nourish Yin, and drain residual Heat. After taking this formula continuously for five doses, hematuria completely stopped, and facial edema completely resolved.
[Commentary]: The cause of water Qi flooding upward in this case is external invasion of Wind pathogen, loss of Lung dispersing and descending functions, disharmony of Stomach Qi, and dysfunction of Bladder Qi transformation. Thus, water passages cannot be regulated properly. Upward, this manifests as cough and facial edema; in the Middle, as vomiting of fluid retention; Wind pathogen failing to disperse timely combines with internally accumulated fluid retention, stagnating and transforming into Heat, manifesting downward as hematuria. The key to treatment lies in distinguishing exterior and interior, diffusing Lung Qi, and urgently clearing and dispersing Wind-Heat pathogen. Once Wind-Heat is dispersed, Xiao Banxia Tang is used to resolve fluid retention, direct rebellious Qi downward, harmonize the Middle, and stop vomiting. Then, Guizhi Mahuang Ge Ban Tang is used to open the Taiyang Qi mechanism, assisted by Jianggui Lingban Tang to restore Heart and Lung Yang and aid Lung diffusion and fluid resolution. After Yang recovery, Zhuling Tang is used to nourish Yin, promote diuresis, and drain residual Heat to treat hematuria. If this pattern has unresolved exterior pathogen and Zhuling Tang (an interior formula) is used immediately, it is equivalent to inviting the pathogen deeper, locking the door to catch the thief, leading to lingering disease and difficulty in achieving quick effects. Although this case has hematuria, Guizhi Mahuang Ge Ban Tang is used to diffuse Bladder Qi mechanism and scatter pathogen outward; Jianggui Lingban Tang is used to assist Heart and Lung Yang, creating conditions for the subsequent use of Zhuling Tang to nourish Yin and promote diuresis.
Kidney Deficiency Generalized Edema
Sun XX, Male, 8 years old. Generalized edema for over three months, especially severe in face and limbs. Sought medical help extensively, mostly treated with standard formulas like Wuling San (Five-Ingredient Powder with Poria) and Wupi Yin (Five-Peel Decoction). Combined with repeated use of Western diuretics, which were ineffective and worsened the condition daily. Diagnosed by a certain hospital as chronic nephritis, consulted me. Examination revealed dark cyan complexion, listless spirit, cold limbs, no thirst, pitting edema that remains depressed for a long time, white slippery tongue, and deep-fine pulse. Combining pulse and symptoms, signs of衰竭 of Yuan Yang (Primal Yang) are evident. Urgent treatment requires supporting Yang and suppressing Yin. I used Fuling Sini Tang (Poria and Sini Decoction) from the *Shanghan Lun*, removing Renshen. Prescription:
Fu Pian (Prepared Aconite Root) 60g, Fu Ling (Poria) 15g, Gan Jiang (Dried Ginger) 15g, Zhi Gan Cao (Honey-fried Licorice Root) 6g.
This formula aims to vigorously support Yuan Yang, warm the Kidneys, and move water.
Second Visit: After three doses, urination resumed, and edema decreased. Continued using Lizhong Tang (Regulate the Middle Decoction) from the *Shanghan Lun* plus Fuzi. Prescription:
Fu Pian (Prepared Aconite Root) 60g, Lu Dang Shen (Codonopsis Root) 15g, Bai Zhu (Atractylodes Rhizome) 9g, Gan Jiang (Dried Ginger) 9g, Zhi Gan Cao (Honey-fried Licorice Root) 6g.
This formula focuses on warming the Kidneys and regulating the Middle, supporting Yuan Yang.
Third Visit: After three doses, swelling continued to decrease. Urine volume was still low, indicating insufficient warming Yang power. I gave Zitong Tang (Self-Unblocking Decoction) from the *Shanghan Lun*, heavily using Ginger and Aconite to connect Gang Yang (Vigorous Yang) and disseminate Qi mechanism. Prescription:
Fu Pian (Prepared Aconite Root) 90g, Gan Jiang (Dried Ginger) 24g, Cong Bai (Green Onion White) 3 stalks.
Fourth Visit: After two doses, urination was smooth, edema greatly reduced. Advised to take the original formula for another five doses; symptoms disappeared.
[Commentary]: Chronic nephritis mostly belongs to Spleen and Kidney dual deficiency, with衰竭 of Yuan Yang. Therefore, one should not merely employ diuresis to drive out pathogens, abandoning the root for the branch. The *Neijing* states: "Those skilled in diagnosis observe complexion and press pulses, first distinguishing Yin and Yang." In clinical practice, one must grasp Yin and Yang and weigh pros and cons. This case of generalized edema, dark cyan complexion, listlessness, and cold limbs belongs to great deficiency of Righteous Qi, depression of Yuan Yang, and衰竭 of bodily Qi transformation function. Urgent warming and tonification are needed to enhance Qi transformation. Zhang Jingyue once said: "Warming and tonifying is how Qi is transformed; healing through Qi transformation occurs naturally." Thus, clinically, for cases belonging to Yang deficiency, directly warming and tonifying Yang, diffusing and unblocking Qi transformation allows urination to flow spontaneously without diuretics, and edema to recede without reducing swelling.
Deficiency Edema
Professor Deng XX, Male, over 50 years old. Suffered from generalized edema in 1951, lasting half a year. Hospital treatment, including paracentesis and diuresis, was ineffective. Condition was critical, so he invited me for consultation. At initial examination, his complexion was lusterless, forehead black, head tilted and eyes sunken, hair, nails, skin, lips, and teeth all withered and emaciated. Eyes lacked brilliance, spirit was fatigued, breathing short, panting upon movement. Significant edema in both feet, distended abdomen, short and scanty urination. Insomnia, frequent dreams, edema extended to scrotum. Tongue coating yellow, greasy, and moist; pulse empty and rootless. "Three feet of ice does not form in a single day"; the condition reaching this state did not happen overnight. Synthesizing these, this condition involves deficiency and damage of the Five Zang organs, great depletion of Essence and Blood, and impending departure of Spirit Qi. How do I know this? The Heart governs Blood, its splendor is in the face, its filling is in the blood vessels, and hair is the surplus of Blood. Heart deficiency causes lusterless complexion, empty-rootless pulse, and withered hair. The Heart stores Spirit; if Spirit does not reside in its house, insomnia and frequent dreams occur. Heart Yang originates from Kidney Yang; Heart Yang deficiency implies Kidney Yang deficiency. Kidney belongs to Water, its color is black; when Kidney Water floods upward, the forehead appears black. Kidneys govern bones, teeth are the surplus of bones; Kidney deficiency leads to withered teeth. Liver and Kidneys share the same source; Kidney Essence pours upward into the eyes, Liver opens into the eyes; Liver and Kidney dual deficiency with insufficient Essence and Blood results in lack of brilliance in the eyes. Liver governs sinews, its splendor is in the nails; Liver Blood deficiency leads to brittle nails. Lungs combine with skin and hair; Lung Qi insufficiency leads to withered skin and hair. Now Heart, Lungs, Liver, and Kidneys are all deficient; Spleen, the Central Earth, is inevitably deficient too. The flooding of edema is related to the Spleen's inability to control Water. Worse still, tilted head and sunken eyes with lusterless gaze are signs of impending Spirit departure. Fortunately, he could still eat and taste food. Although spirit was fatigued, consciousness was clear. Vitality was not extinguished, so every effort should be made to save him. But with all Five Zang diseased, which is primary? The Classics state: "Kidney is the foundation of Pre-heaven," so Kidney should be taken as the root. Therefore, treatment of this condition must vigorously tonify Mingmen (Gate of Life) so that Yuan Qi can recover, and the condition may hope to heal. However, patients with chronic illness easily contract Wind, Cold, and Damp pathogens, leading to meridian blockage. One should first warm Yang, release the exterior, and unblock meridians. Once meridians are unblocked and Qi and Blood flow freely, then vigorously tonifying Mingmen can transform Qi and move water. With clear differentiation and established law, I decided to first use my self-formulated Fuzi Guizhi Duhuo Jisheng Tang (Aconite, Cinnamon Twig, Notopterygium, and Taxillus Decoction). Prescription:
Fu Pian (Prepared Aconite Root) 60g, Guizhi (Cinnamon Twig) 9g, Hang Shao (White Peony Root) 9g, Fa Xia (Prepared Pinellia Tuber) 9g, Fu Ling (Poria) 15g
Chuan Xiong (Ligusticum Rhizome) 6g, Duhuo (Angelica Pubescens Root) 6g, Fang Feng (Saposhnikovia Root) 9g, Sang Jisheng (Taxillus Branch) 15g, Chen Pi (Citrus Peel) 6g
Tai Wu (Curcuma Rhizome) 9g, Gan Cao (Licorice Root) 6g, Sheng Jiang (Fresh Ginger) 3 slices, Da Zao (Jujube Fruit) 2 pieces.
After taking the above prescription for three doses, the patient felt comfortable throughout the body. This indicates meridians were unblocked. It was urgent to directly tonify Mingmen and treat with diuresis. I used Yan Yonghe's Jisheng Shenqi Tang (Life-Sustaining Kidney Qi Decoction). Prescription:
Fu Pian (Prepared Aconite Root) 90g, Shu Di (Prepared Rehmannia Root) 15g, Huai Shan Yao (Chinese Yam) 15g, Fu Ling (Poria) 24g, Ze Xie (Alisma Rhizome) 9g
Huai Niu Xi (Achyranthes Root) 9g, Rou Gui (Cinnamon Bark) 15g, Fen Dan Pi (Moutan Cortex) 6g, Shan Yu Rou (Cornus Fruit) 12g, Che Qian Zi (Plantago Seed) 9g.
Wang Qie'an explained this formula: "These are medicines for Taiyin and Shaoyin. Earth is the mother of all things; Spleen deficiency means Earth cannot control Water, leading to overflow. Water is the source of all things; Kidney deficiency means Water does not stay in its position and acts recklessly, flooding between skin and limbs. Attacking it would cause disaster of double deficiency, needless to say. Gui Fu Ba Wei Wan (Eight-Ingredient Pill with Cinnamon and Aconite) nourishes True Yin and moves Water; tonifying Mingming Fire strengthens Spleen. Adding Che Qian Zi promotes urination without depleting Qi; adding Niu Xi benefits Liver and Kidneys, guiding downward. Thus, water passages open and swelling resolves, without damaging True Yuan."
Yu Jiayan, using this formula, advocated using Fuzi as the Sovereign herb, stating: "If the gate of the Kidney does not open, Fuzi must be used to return Yang, vaporize Kidney Qi, so the gate opens, and water accumulation in the Stomach flows down, because Yang governs opening." This statement holds true reason.
In treating this case, fearing the disease was severe and medication light, unable to handle it, I used the above formulas in large doses. After several initial doses, the disease did not move slightly. Continuing the formula for twenty-seven doses, sometimes adding Chi Shi Zhi (Red Halloysite) 60g to the formula to strengthen tonifying Earth. At this point, urination gradually increased, and swelling gradually subsided. However, with all Five Zang deficient, tonifying Kidneys reached a considerable stage, so concurrently tonifying Liver Blood became urgent. I changed the formula to Jingyue's Yougui Yin (Right Restoration Decoction) and Gui Fu Ba Wei Wan (Eight-Ingredient Pill with Cinnamon and Aconite) with modifications. Prescription:
Hei Fu Pian (Black Prepared Aconite Root) 60g, Shu Di (Prepared Rehmannia Root) 30g, Huai Shan Yao (Chinese Yam) 21g, Shan Yu Rou (Cornus Fruit) 12g, Ze Xie (Alisma Rhizome) 9g
Shang Rou Gui (Top-grade Cinnamon Bark) 15g, Du Zhong (Eucommia Bark) 30g, Tu Chao Dang Gui (Earth-fried Angelica Root) 15g, Gou Qi (Goji Berry) 15g
Xiao Hui Xiang (Fennel Fruit) 6g, Fu Ling (Poria) 15g, Zhi Gan Cao (Honey-fried Licorice Root) 3g, Chi Shi Zhi (Red Halloysite) 60g.
The intention of this formula: Fuzi and Rou Gui warm and tonify Kidney Yang; paired with Shu Di, Shan Yu Rou, and Shan Yao to tonify Yin, allowing Yang recovery to have a basis; Shu Di, Shan Yu Rou, and Shan Yao tonify Yin, aided by Gui and Fuzi to vaporize Kidney Qi, making Kidney Yang vigorous. Still using Fu Ling and Ze Xie to渗利 (percolate and drain) Dampness-Water, ensuring tonification includes drainage. Du Zhong and Gou Qi strengthen waist and Kidneys; Dang Gui tonifies Liver Blood; Chi Shi Zhi and Xiao Hui Xiang benefit Spleen and promote Qi movement. After taking over twenty doses, urination became longer (smoother), and swelling greatly decreased. However, swelling recurred every afternoon, due to Yang returning but being insufficient to control Yin. Changed to Baitong Tang (White Unblocking Decoction) and Sini Tang (Reverse the Yin Decoction) for several doses each, controlling afternoon swelling. Then used Lizhong Tang to warm Spleen Yang and dispel Middle Cold, after which swelling completely resolved and breathing was no longer short. But at this point, the patient was skeletal, extremely weak, with palpitations and insomnia, pulse like a spider thread, unable to stand on feet. This is withered True Yin after chronic illness, with risk of turning into Wei Syndrome (Flaccidity Syndrome). Should follow "Deficient ones are benefited," "Insufficient Essence is supplemented with flavor," using products of flesh and blood to consume. Prescription:
Gou Qi (Goji Berry) 30g, Hai Shen (Sea Cucumber) 30g, Zhu Ti Jin (Pig Trotter Tendon) 60g, Lao Fei Ya (Old Fat Duck) 1, Lao Mu Ji (Old Hen) 1.
All above ingredients prepared, stewed mixed together, drinking only the juice several times a day. Old Duck in the formula best nourishes Yin, a holy medicine for consumptive disease. Old Hen treats deficiency, excelling in tonifying Blood and benefiting Qi. Pig Trotter Tendon fills Essence and supplements Marrow; Sea Cucumber and Goji nourish Kidney and benefit Essence. After five doses, feet could stand and walk, flesh and skin gradually filled, hair and nails became lustrous, palpitations and insomnia removed, diet increased, condition gradually improved and recovered.
Liver Deficiency Spleen Dampness Lower Limb Swelling and Pain
Li XX, Male, 30 years old. Patient suffered from swelling and pain in both lower limbs for over three months, sallow complexion, walking slowly with pain, untreated for a long time, diagnosed by a certain hospital as malnutrition. Tongue body pale, coating thin white, right pulse deep-slow, left pulse weak. This is due to Spleen deficiency failing to transport and transform, accumulating Dampness-Water in lower limbs causing swelling; Liver deficiency failing to distribute and drain, leading to meridian blockage, Qi and Blood stagnation causing pain. First, tonify Spleen and support Middle, dispel Cold and move Dampness. Prescription:
Sheng Da Suan (Raw Garlic, peeled) 30g, Hua Sheng Mi (Peanuts, with skin) 60g, Da Zao (Jujube Fruit) 10 pieces.
In the formula, Peanuts are sweet, acrid, moist, aromatic, neutral in nature, non-toxic; they benefit Spleen, open appetite, and have nourishing effects. Jujubes are sweet, neutral, enter Spleen; they benefit Spleen and Stomach and support Middle. Garlic is acrid, warm, enters Stomach and Large Intestine meridians; functions to dispel Cold-Dampness, ward off Yin pathogens, descend Qi, warm Middle, detoxify, and move water.
Second Visit: After taking the above prescription continuously for five doses, swelling subsided, but lower limbs still felt painful, left pulse weak and unrising. This is caused by Liver deficiency and Qi-Blood stasis. Treatment should use formulas to tonify Liver, remove stasis, unblock collaterals, and stop pain. I used Quzhi Tang (Quzhi Decoction) from Zhang Xichun's *Zhongzhong Canxi Lu* (Records of Integrating Chinese and Western Medicine) plus Huang Qi (Astragalus Root). Prescription:
Bei Huang Qi (Northern Astragalus Root) 15g, Chao Zhi Mu (Stir-fried Anemarrhena Rhizome) 9g, Shan Yu Rou (Cornus Fruit) 15g, Zi Dan Shen (Purple Salvia Root) 15g
Dang Gui (Angelica Root) 15g, Ru Xiang (Frankincense) 6g, Mo Yao (Myrrh) 6g.
Zhang's original note for this formula says: "Treats Liver deficiency leg pain, with weak left pulse." I adjusted the dosage according to the changing condition and administered it. After taking continuously for three doses, pain stopped and disease cured.
In the formula, Shan Yu Rou tonifies Liver; Dan Shen, Dang Gui, Ru Xiang, and Mo Yao unblock Qi and Blood, activate collaterals, remove stasis, and stop pain. Due to chronic illness and body deficiency, Huang Qi was added to tonify Qi, and Zhi Mu was used to restrain the heat of Huang Qi. The formula formulation was appropriate, additions and subtractions suitable, thus effective.
As for the theory of Liver deficiency leg pain, Zhang discussed it in detail, so I will not repeat it.
Spleen Deficiency Lung Dryness Dry Cough and Edema
Ma XX, Female, 50 years old. Suffered from dry cough without phlegm, facial and foot edema, untreatable for many years. Diagnosed by Western medicine as bronchiectasis complicated with cor pulmonale. Repeated treatments with Chinese and Western medicines showed little effect. Upon consultation, besides the above symptoms, there was also short and scanty urination, palpitations and insomnia, shortness of breath and fatigue, and poor appetite. Tongue dark pale with thin white coating, pulse irregular (three or five interruptions), powerless on deep pressure.
Analysis based on symptoms: Spleen deficiency with Dampness stagnation, Earth failing to generate Metal, Lung losing nourishment, leading to prolonged dry cough. Spleen deficiency leads to insufficient source of transformation, Lung Qi deficiency, loss of clear descending function, inability to regulate water passages, leading to edema and oliguria. Lung is the mother of Kidney; maternal disease cannot protect the child, Kidney Water does not rise, Heart Fire does not descend, Heart-Kidney non-interaction, leading to palpitations and insomnia. Lungs govern Qi, Spleen benefits Qi; Lung and Spleen dual deficiency leads to shortness of breath and fatigue. Spleen deficiency leads to poor transport and transformation power, hence poor appetite.