[方药]咳嗽遗尿方加减：
柴胡6克 半夏9克 陈皮9克 青皮9克 党参9克麦冬9克 五味子9克 当归9克 白芍9克 黄芩9克
[加减]咳嗽严重者，加紫菀9克。若无柴胡，可改用川芎9克。
[案例]
柳某，女，54岁。门诊号：49051。
1961年11月20日初诊：咳嗽30余年，气短10余年。最近入冬以来咳嗽气短严重，不能乎卧，不能走路，心烦心悸，胸胁时而窜痛，头晕头痛，食欲很差，手足心热，口干苦，下肢高度浮肿，舌苔白，口唇舌质均紫暗，脉弦滑。治宜益气养阴以培本，理气化痰祛瘀治其标。方用咳嗽遗尿方加减：
柴胡9克 当归9克 白芍9克 麦冬9克 党参9克五味子9克 半夏9克 陈皮9克 黄芩9克 紫菀9克茯苓9克
服药2剂后．咳喘气短、浮肿均明显改善，继服40剂而症状基本消失。 五、气阴两虚，痰浊中阻．上热下寒型 [证候表现]喘咳气短不能平卧，或因精神极度疲惫而不能坐起，或不能翻身，全身浮肿，或下肢浮肿，全身极度消瘦，口苦干，夜间尤甚，腹胀而怕冷，烦躁易怒，心悸心烦，脉弦滑而大或虚大，舌苔薄白或光剥如镜，舌质紫暗。
[治则]益气养阴，理气化痰，清热温肾。
[方药]黄芪鳖甲散加减：
黄芪]5克 人参6克 地骨皮9克 紫菀9克 茯苓9克 柴胡9克 半夏9克 知母9克 生地9克 白芍9克麦冬9克 肉桂9克 陈皮9克 甘草6克
[加减]心悸较重者，加五味子9克。
[案例]
郭某，女，73岁。门诊号：68243。
1963年1]月24日初诊：3年前曾因气胸而手术治疗，术后经常气短，疲乏无力。近7—8天来发现咳喘、浮肿、紫绀，西医诊断为肺心病。给予地高辛、氨茶碱及青霉素、链霉素、庆大霉素、红霉素等抗生素而病情不见好转，并出现呕吐、神志朦胧、时而谵语等现象。患者家属要求中药配合治疗。查其舌质如猪腰子之状，喉中痰声辘辘，神志朦胧，时而谵语，轻度浮肿，脉弦滑大。证属气阴欲脱、痰浊中阻、上热下寒之重症。治宜益气滋阴温肾以固其脱，辅以理气化痰清热平喘以治其标。方用黄芪鳖甲散加减：
黄芪15克 人参6克 五味子9克 紫菀9克 茯苓9克 柴胡9克 半夏9克 知母9克 生地9克 白芍9克麦冬9克 肉桂9克 陈皮9克 甘草6克
2天1夜，连服3剂后，第2天夜晚神志完全清楚，精神好转，咳喘、气短、浮肿亦减轻。继服3剂后，咳喘气短大部分消失，浮肿亦减六七成。嘱其停用西药，单独服用中药36剂而基本痊愈。
按：本案属气阴两虚、痰浊壅盛、寒热错杂之危急重症，故重用黄芪合用人参益气固脱，生脉散(人参、麦冬、五味子)合生地、白芍重剂滋阴生津，上述两组药益气滋阴以治其本。二陈汤(半夏、陈皮、茯苓、甘草)燥湿化痰，理气和中，可祛壅阻中焦之痰浊；紫菀辛苦温，化痰止咳平喘；柴胡、知母清热；肉桂辛甘大热，温补脾肾之阳而散寒。诸药配伍，标本兼顾，寒热并用，故能使气阴复而正气得固，痰浊除而咳喘自止。
心力衰竭
心衰多阳虚 补阳宜小剂
少火能生气 壮火则食气
心力衰竭，从总的方面看是一个心肾阳虚证，所以常用真武汤加人参、杏仁取效。又因本证是一个正虚邪实证。补阳则阴不支，补阴则阳易败，所以用药稍有不慎即会使病情加重。例如：患者和某，女，35岁，风湿性心脏病，二尖辦狭窄，反复咳血20年。2年前在某院手术后出现全心衰竭，至今不但不见改善，反日渐严重。全身浮肿，尿少，呼吸困难，心悸心烦，不得平卧。改请某医以中药治疗。医查其症见口渴身热，心悸心烦，气短而喘，不得平卧，脉数而结代(注：应称促代脉)，诊为心阴亏损。处方：人参10克，麦冬10克，生地10克，花粉15克，黄连10克，五味子10克，石斛1O克，白芍15克，甘草10克。并继续配合服用地高辛等西药。服药后，是夜诸症更加严重，呼吸困难，神色慌张，有欲死之状。邀李老诊视，李老云：患者高度水肿，心悸气短，乃心肾阳虚、水气上逆凌犯心肺之象，危证也，急宜真武汤加减治之。处方：附子l克，白芍1．5克，白术1.5克，人参1克，茯苓1．5克，杏仁1克。次日之晨，诊其浮肿减轻，尿量增多，呼吸困难明显改善。此时因李老公务繁忙，由笔者代其诊治，患者家属云： “此方量小力微，病情深重，可否改加分量?”前医亦适在其侧，云：“兵微将寡岂能制大敌，不可也。”余听后亦感颇有道理，乃在原方上加1O倍量予之。次日，家属来邀云：“诸症加剧，请速前往诊治。”李老询诸症之后，云：“此患阴阳大衰，又兼水肿实邪，正虚而邪实，补其阳则阴大伤，而烦躁倍加，补其阴则阳气难支，浮肿短气更甚。其脉一息七至，且有间歇，乃阴不恋阳，阳气欲败，非热盛之实证，亦非阴虚有热之虚证，故治之宜小剂耳。君不知《内经》有‘少火生气，壮火食气’乎!此病用药之量稍有不慎，则命在顷刻矣。”余遵其意，再以原方原量子之。1月之后，患者呼吸困难大见改善，浮肿消失，并能到户外活动。
眩
晕
眩晕四证 风火痰虚
风为病源 治从肝脾
眩是眼黑，晕是头旋，眩晕即古人所说的头旋眼黑，俗语所谓发“黑眼风”是也。此证轻者闭目定神则止，重者如坐车船，甚者不敢开目，自觉天旋地转，不能站立。对于该病的病因病机，历代医家虽众说纷纭，但明清以来，临床医家多宗汉代张仲景及金元四大家中刘河间、朱丹溪的“无痰不作眩”理论，主张痰为病源，从痰论治。如《金匮要略。痰饮咳嗽病脉证并治篇》说： “心下有支饮，其人苦冒眩。泽泻汤主之……卒呕吐，心下痞，膈间有水，眩悸者，小半夏加茯苓汤主之。”后世刘河间、朱丹溪在此基础上进一步提出“无痰不作眩”、“因痰致眩”的学说。如《丹溪心法·头眩》曰：“头眩，痰夹气虚并火，治痰为主，夹补气药及降火药。无痰则不作眩……”李老对此有不同看法，认为眩晕总分四类证候，即风、火、痰、虚，其中风为病源，即痰、火皆因风起，在脏腑病机上，与肝、脾、．肾最为相关，且实证多起于肝，虚证多源于脾肾。 一、风火痰郁，起于肝风 眩晕本是风的症状，但这里的风，多属内风，正如《医学从众录》言：“以为风者，非外来之风，指厥阴风木而言，与少阳相火同居，厥阴气逆，于是风升火动，风生必夹木势而克土，土病则聚液而成痰。”《内经》云“诸风掉眩，皆属于肝”。 “肝开窍于目”。肝上连目系而应于风，肝气易郁，肝阳易亢，肝阴易虚，这些均易引致肝风内动，风动则火随风升，火升则痰因火动，风夹痰、火上冲于头目，则发为眩晕之症。因此，李老认为眩晕的主要原因就是肝风内动，故治眩之中，应时时不忘肝风，可随证加入天麻、钩藤、菊花、石决明等平肝熄风之品。
附案：
案一 侯某，女，69岁。门诊号：51458。
]962年2月23日初诊：主诉：头晕目眩，心悸，头目胀痛。面潮红。素有高血压病病史，舌苔薄白，脉弦。证属肝肾亏虚，肝阳上亢型。治宜补肝肾，潜肝阳，熄肝风。处方：
生石决明9克 杭菊花9克 天麻6克 橘红6克 生龙牡各9克 茯神4．5克 半夏4．5克 薄荷3克 生杜仲9克 牛膝9克
服上方3剂，头晕目眩明显减轻，但仍有头胀头痛感。原方加钩藤9克，继服1剂，诸症大都消失。
按：此患者年逾古稀，肝肾亏虚，水不涵木，肝阳上亢，发为眩晕。故治宜补肝肾，潜肝阳，熄肝风。方中杜仲、牛膝补肝肾，强筋骨，益腰膝；天麻、钩藤、石决明、生龙牡等潜肝阳，熄肝风；橘红、半夏健脾化痰，和中降逆止呕；菊花疏散风热，清肝明目，薄荷散风热而清利头目；茯神安神定悸，以增强平肝潜阳之功。诸药配伍可补肝肾而潜肝阳，化痰浊而散风热，达到熄肝风而止眩晕的目的。
案二 王某，男，26岁。门诊号：79257。
1963年6月14日初诊：头晕，头痛，视物不清，直视，眼球不活动已半月余，经省城某医院眼科诊断为“内直肌麻痹”。舌苔薄白，脉滑。证属肝旺脾虚，风痰上扰型。治宜平肝熄风，燥湿化痰。方用二陈汤加味：
橘红7。5克 半夏6克 南星4．5克 茯苓6克 杭菊花6克 枳壳4。5克 僵蚕6克 全蝎3克 甘草3克
服上方2剂后，头晕、头痛消失。上方去菊花继服2剂后，眼球稍能活动，嘱其守方继服10剂后眼球活动复常，视物渐清。
按：此案系肝旺脾虚，风痰上扰，蒙蔽清窍所致，故以二陈汤加平肝熄风之品治之。方中二陈汤健脾理气，燥湿化痰。南星助半夏以化痰，并善除经络中之风痰，主要用于由风痰上扰所致的头目眩晕。全蝎辛而善走，为熄风、祛风之要药，专能熄风解痉，祛风止痛，并能引诸熄风之药直达病所，以增强诸药熄风止痉定搐之作用。僵蚕善于疏散肝经风热，菊花则平肝明目而止眩。诸药配伍，健脾燥湿化痰，平肝熄风而解痉，达到风痰除而眩晕停、眼转动而视物清的效果。 二、痰浊致眩．脾虚湿盛 脾主运化升清，但在病理情况下又是“生痰之源”。脾之功能正常，则水谷得以运化，其中之精微物质赖脾气之升清上输于肺而营运全身，浊阴下降，使糟粕得以排泄。若嗜酒肥甘，饥饱无常，或思虑劳倦，伤及于脾，则脾失健运，水谷不能化为精微，聚湿而生痰，痰浊中阻，清阳不升，浊阴不降，蒙蔽清窍，发为眩晕。若痰浊郁久，极易化火，痰火上犯清窍，亦可致眩晕加重。如《医灯续焰》说：“胸中痰浊，随气上升，头目高而空明，清阳所注，淆浊之气扰乱其间，欲其不晕不眩，不再得矣。或兼见吐痰呕饮、胸痞肠鸣等症，脉左滑。”《丹溪心法．头眩)也说：“头眩，痰夹气虚并火，治痰为主……无痰则不作眩，痰因火动，又有湿痰者，有火痰者。”同时，脾之运化升清有赖于肝气疏泄调畅气机，若肝木横肆，乘及脾土，则可致使脾虚，从而形成肝气犯脾、痰浊中阻的眩晕，甚至形成虚中夹实、寒热错杂的证候。因此，在治疗上，应以健脾燥湿化痰为主，方用六君、二陈之类，根据具体证候不同，或加理气、平肝、祛风、熄风之品等。
附案：
案一 李某，女，47岁。门诊号：20244。
1959年10月7日初诊：头晕近2周，近日渐加重，伴有恶心、汗出、纳呆、乏力，舌苔白腻，脉沉细无力。证属脾胃虚弱，痰浊中阻。治宜健脾益气、燥湿化痰为主，兼以镇肝熄风，收敛止汗。方用六君子汤加味：
党参9克 生白术9克 茯苓7．5克 半夏6克 陈皮4．5克 鸡内金4．5克 生龙骨9克 生牡蛎9克 远志4．5克 炙甘草3克
二诊：服上方2剂后，头晕恶心、纳呆、汗出、乏力均减轻，惟大便时有下坠感，同时白带较多。此中气虚也。上方加生黄芪15克，以补气升阳，治气虚下陷，大便下坠感。另加生山药9克，以健脾燥湿止带。2剂，水煎服。
三诊：服药后诸症均进一步减轻，但胁痛明显，系肝气横逆所致。二诊方加炒白芍9克，以养血敛阴，平肝止痛。2剂，水煎服。
四诊：服药后，诸症基本消失，但月经来潮时，又有反复，感到头晕，背冷，汗出多。此仍素体脾虚，阳气不达，卫气不固所致。继服上方2剂，以益气敛汗。并嘱其每遇月经来潮即服此药2剂。追访照此用药2月，以后停用，经期亦未再犯。
按：本案系脾虚湿盛，痰浊中阻，蒙蔽清窍而致眩晕，故以六君子汤健脾益气，祛除痰湿，加鸡内金以助消化，加生龙牡、远志以镇肝熄风。收敛止汗。二诊因脾虚湿盛，中气下陷而小腹下坠，白带增多，故加山药以健脾燥湿，加黄芪以补中益气，升阳固脱。三诊加炒白芍意在养血敛阴，柔肝而缓急止胁痛。
案二 王某，女，52岁。门诊号：83020。
1964年12月16日初诊：近1个月来自觉头晕目眩，身倦无力，胃脘痞满，口苦，恶心，不欲冷饮，大便溏泻，每日2～3次，尿黄，时有足肿，午后加重，苔薄白，脉虚而细。此乃脾阳不振，痰湿中阻，兼肝阳上亢之证。治宜健脾益气，燥湿化痰，平肝熄风。方用六君子汤加减：
党参6克 生白术9克 茯苓6克 陈皮7．5克 半夏7。5克 泽泻6克 苍术6克 杭菊花9克 天麻6克 白蔻仁3克
[方药]咳嗽遗尿方加减：
柴胡6克 半夏9克 陈皮9克 青皮9克 党参9克 麦冬9克 五味子9克 当归9克 白芍9克 黄芩9克
[加减]咳嗽严重者，加紫菀9克。若无柴胡，可改用川芎9克。
[案例]
柳某，女，54岁。门诊号：49051。
1961年11月20日初诊：咳嗽30余年，气短10余年。最近入冬以来咳嗽气短严重，不能平卧，不能走路，心烦心悸，胸胁时而窜痛，头晕头痛，食欲很差，手足心热，口干苦，下肢高度浮肿，舌苔白，口唇舌质均紫暗，脉弦滑。治宜益气养阴以培本，理气化痰祛瘀治其标。方用咳嗽遗尿方加减：
柴胡9克 当归9克 白芍9克 麦冬9克 党参9克 五味子9克 半夏9克 陈皮9克 黄芩9克 紫菀9克 茯苓9克
服药2剂后．咳喘气短、浮肿均明显改善，继服40剂而症状基本消失。 五、气阴两虚，痰浊中阻．上热下寒型 [证候表现]喘咳气短不能平卧，或因精神极度疲惫而不能坐起，或不能翻身，全身浮肿，或下肢浮肿，全身极度消瘦，口苦干，夜间尤甚，腹胀而怕冷，烦躁易怒，心悸心烦，脉弦滑而大或虚大，舌苔薄白或光剥如镜，舌质紫暗。
[治则]益气养阴，理气化痰，清热温肾。
[方药]黄芪鳖甲散加减：
黄芪15克 人参6克 地骨皮9克 紫菀9克 茯苓9克 柴胡9克 半夏9克 知母9克 生地9克 白芍9克 麦冬9克 肉桂9克 陈皮9克 甘草6克
[加减]心悸较重者，加五味子9克。
[案例]
郭某，女，73岁。门诊号：68243。
1963年1月24日初诊：3年前曾因气胸而手术治疗，术后经常气短，疲乏无力。近7—8天来发现咳喘、浮肿、紫绀，西医诊断为肺心病。给予地高辛、氨茶碱及青霉素、链霉素、庆大霉素、红霉素等抗生素而病情不见好转，并出现呕吐、神志朦胧、时而谵语等现象。患者家属要求中药配合治疗。查其舌质如猪腰子之状，喉中痰声辘辘，神志朦胧，时而谵语，轻度浮肿，脉弦滑大。证属气阴欲脱、痰浊中阻、上热下寒之重症。治宜益气滋阴温肾以固其脱，辅以理气化痰清热平喘以治其标。方用黄芪鳖甲散加减：
黄芪15克 人参6克 五味子9克 紫菀9克 茯苓9克 柴胡9克 半夏9克 知母9克 生地9克 白芍9克 麦冬9克 肉桂9克 陈皮9克 甘草6克
2天1夜，连服3剂后，第2天夜晚神志完全清楚，精神好转，咳喘、气短、浮肿亦减轻。继服3剂后，咳喘气短大部分消失，浮肿亦减六七成。嘱其停用西药，单独服用中药36剂而基本痊愈。
按：本案属气阴两虚、痰浊壅盛、寒热错杂之危急重症，故重用黄芪合用人参益气固脱，生脉散(人参、麦冬、五味子)合生地、白芍重剂滋阴生津，上述两组药益气滋阴以治其本。二陈汤(半夏、陈皮、茯苓、甘草)燥湿化痰，理气和中，可祛壅阻中焦之痰浊；紫菀辛苦温，化痰止咳平喘；柴胡、知母清热；肉桂辛甘大热，温补脾肾之阳而散寒。诸药配伍，标本兼顾，寒热并用，故能使气阴复而正气得固，痰浊除而咳喘自止。
心力衰竭
心衰多阳虚 补阳宜小剂
少火能生气 壮火则食气
心力衰竭，从总的方面看是一个心肾阳虚证，所以常用真武汤加人参、杏仁取效。又因本证是一个正虚邪实证。补阳则阴不支，补阴则阳易败，所以用药稍有不慎即会使病情加重。例如：患者和某，女，35岁，风湿性心脏病，二尖瓣狭窄，反复咳血20年。2年前在某院手术后出现全心衰竭，至今不但不见改善，反日渐严重。全身浮肿，尿少，呼吸困难，心悸心烦，不得平卧。改请某医以中药治疗。医查其症见口渴身热，心悸心烦，气短而喘，不得平卧，脉数而结代(注：应称促代脉)，诊为心阴亏损。处方：人参10克，麦冬10克，生地10克，花粉15克，黄连10克，五味子10克，石斛10克，白芍15克，甘草10克。并继续配合服用地高辛等西药。服药后，是夜诸症更加严重，呼吸困难，神色慌张，有欲死之状。邀李老诊视，李老云：患者高度水肿，心悸气短，乃心肾阳虚、水气上逆凌犯心肺之象，危证也，急宜真武汤加减治之。处方：附子1克，白芍1.5克，白术1.5克，人参1克，茯苓1.5克，杏仁1克。次日之晨，诊其浮肿减轻，尿量增多，呼吸困难明显改善。此时因李老公务繁忙，由笔者代其诊治，患者家属云： “此方量小力微，病情深重，可否改加分量?”前医亦适在其侧，云：“兵微将寡岂能制大敌，不可也。”余听后亦感颇有道理，乃在原方上加1O倍量予之。次日，家属来邀云：“诸症加剧，请速前往诊治。”李老询诸症之后，云：“此患阴阳大衰，又兼水肿实邪，正虚而邪实，补其阳则阴大伤，而烦躁倍加，补其阴则阳气难支，浮肿短气更甚。其脉一息七至，且有间歇，乃阴不恋阳，阳气欲败，非热盛之实证，亦非阴虚有热之虚证，故治之宜小剂耳。君不知《内经》有‘少火生气，壮火食气’乎!此病用药之量稍有不慎，则命在顷刻矣。”余遵其意，再以原方原量子之。1月之后，患者呼吸困难大见改善，浮肿消失，并能到户外活动。
眩晕
眩晕四证 风火痰虚
风为病源 治从肝脾
眩是眼黑，晕是头旋，眩晕即古人所说的头旋眼黑，俗语所谓发“黑眼风”是也。此证轻者闭目定神则止，重者如坐车船，甚者不敢开目，自觉天旋地转，不能站立。对于该病的病因病机，历代医家虽众说纷纭，但明清以来，临床医家多宗汉代张仲景及金元四大家中刘河间、朱丹溪的“无痰不作眩”理论，主张痰为病源，从痰论治。如《金匮要略。痰饮咳嗽病脉证并治篇》说： “心下有支饮，其人苦冒眩。泽泻汤主之……卒呕吐，心下痞，膈间有水，眩悸者，小半夏加茯苓汤主之。”后世刘河间、朱丹溪在此基础上进一步提出“无痰不作眩”、“因痰致眩”的学说。如《丹溪心法·头眩》曰：“头眩，痰夹气虚并火，治痰为主，夹补气药及降火药。无痰则不作眩……”李老对此有不同看法，认为眩晕总分四类证候，即风、火、痰、虚，其中风为病源，即痰、火皆因风起，在脏腑病机上，与肝、脾、肾最为相关，且实证多起于肝，虚证多源于脾肾。 一、风火痰郁，起于肝风 眩晕本是风的症状，但这里的风，多属内风，正如《医学从众录》言：“以为风者，非外来之风，指厥阴风木而言，与少阳相火同居，厥阴气逆，于是风升火动，风生必夹木势而克土，土病则聚液而成痰。”《内经》云“诸风掉眩，皆属于肝”。 “肝开窍于目”。肝上连目系而应于风，肝气易郁，肝阳易亢，肝阴易虚，这些均易引致肝风内动，风动则火随风升，火升则痰因火动，风夹痰、火上冲于头目，则发为眩晕之症。因此，李老认为眩晕的主要原因就是肝风内动，故治眩之中，应时时不忘肝风，可随证加入天麻、钩藤、菊花、石决明等平肝熄风之品。
附案：
案一 侯某，女，69岁。门诊号：51458。
1962年2月23日初诊：主诉：头晕目眩，心悸，头目胀痛。面潮红。素有高血压病病史，舌苔薄白，脉弦。证属肝肾亏虚，肝阳上亢型。治宜补肝肾，潜肝阳，熄肝风。处方：
生石决明9克 杭菊花9克 天麻6克 橘红6克 生龙牡各9克 茯神4.5克 半夏4.5克 薄荷3克 生杜仲9克 牛膝9克
服上方3剂，头晕目眩明显减轻，但仍有头胀头痛感。原方加钩藤9克，继服1剂，诸症大都消失。
按：此患者年逾古稀，肝肾亏虚，水不涵木，肝阳上亢，发为眩晕。故治宜补肝肾，潜肝阳，熄肝风。方中杜仲、牛膝补肝肾，强筋骨，益腰膝；天麻、钩藤、石决明、生龙牡等潜肝阳，熄肝风；橘红、半夏健脾化痰，和中降逆止呕；菊花疏散风热，清肝明目，薄荷散风热而清利头目；茯神安神定悸，以增强平肝潜阳之功。诸药配伍可补肝肾而潜肝阳，化痰浊而散风热，达到熄肝风而止眩晕的目的。
案二 王某，男，26岁。门诊号：79257。
1963年6月14日初诊：头晕，头痛，视物不清，直视，眼球不活动已半月余，经省城某医院眼科诊断为“内直肌麻痹”。舌苔薄白，脉滑。证属肝旺脾虚，风痰上扰型。治宜平肝熄风，燥湿化痰。方用二陈汤加味：
橘红7.5克 半夏6克 南星4.5克 茯苓6克 杭菊花6克 枳壳4.5克 僵蚕6克 全蝎3克 甘草3克
服上方2剂后，头晕、头痛消失。上方去菊花继服2剂后，眼球稍能活动，嘱其守方继服10剂后眼球活动复常，视物渐清。
按：此案系肝旺脾虚，风痰上扰，蒙蔽清窍所致，故以二陈汤加平肝熄风之品治之。方中二陈汤健脾理气，燥湿化痰。南星助半夏以化痰，并善除经络中之风痰，主要用于由风痰上扰所致的头目眩晕。全蝎辛而善走，为熄风、祛风之要药，专能熄风解痉，祛风止痛，并能引诸熄风之药直达病所，以增强诸药熄风止痉定搐之作用。僵蚕善于疏散肝经风热，菊花则平肝明目而止眩。诸药配伍，健脾燥湿化痰，平肝熄风而解痉，达到风痰除而眩晕停、眼转动而视物清的效果。 二、痰浊致眩．脾虚湿盛 脾主运化升清，但在病理情况下又是“生痰之源”。脾之功能正常，则水谷得以运化，其中之精微物质赖脾气之升清上输于肺而营运全身，浊阴下降，使糟粕得以排泄。若嗜酒肥甘，饥饱无常，或思虑劳倦，伤及于脾，则脾失健运，水谷不能化为精微，聚湿而生痰，痰浊中阻，清阳不升，浊阴不降，蒙蔽清窍，发为眩晕。若痰浊郁久，极易化火，痰火上犯清窍，亦可致眩晕加重。如《医灯续焰》说：“胸中痰浊，随气上升，头目高而空明，清阳所注，淆浊之气扰乱其间，欲其不晕不眩，不再得矣。或兼见吐痰呕饮、胸痞肠鸣等症，脉左滑。”《丹溪心法．头眩)也说：“头眩，痰夹气虚并火，治痰为主……无痰则不作眩，痰因火动，又有湿痰者，有火痰者。”同时，脾之运化升清有赖于肝气疏泄调畅气机，若肝木横肆，乘及脾土，则可致使脾虚，从而形成肝气犯脾、痰浊中阻的眩晕，甚至形成虚中夹实、寒热错杂的证候。因此，在治疗上，应以健脾燥湿化痰为主，方用六君、二陈之类，根据具体证候不同，或加理气、平肝、祛风、熄风之品等。
附案：
案一 李某，女，47岁。门诊号：20244。
1959年10月7日初诊：头晕近2周，近日渐加重，伴有恶心、汗出、纳呆、乏力，舌苔白腻，脉沉细无力。证属脾胃虚弱，痰浊中阻。治宜健脾益气、燥湿化痰为主，兼以镇肝熄风，收敛止汗。方用六君子汤加味：
党参9克 生白术9克 茯苓7.5克 半夏6克 陈皮4.5克 鸡内金4.5克 生龙骨9克 生牡蛎9克 远志4.5克 炙甘草3克
二诊：服上方2剂后，头晕恶心、纳呆、汗出、乏力均减轻，惟大便时有下坠感，同时白带较多。此中气虚也。上方加生黄芪15克，以补气升阳，治气虚下陷，大便下坠感。另加生山药9克，以健脾燥湿止带。2剂，水煎服。
三诊：服药后诸症均进一步减轻，但胁痛明显，系肝气横逆所致。二诊方加炒白芍9克，以养血敛阴，平肝止痛。2剂，水煎服。
四诊：服药后，诸症基本消失，但月经来潮时，又有反复，感到头晕，背冷，汗出多。此仍素体脾虚，阳气不达，卫气不固所致。继服上方2剂，以益气敛汗。并嘱其每遇月经来潮即服此药2剂。追访照此用药2月，以后停用，经期亦未再犯。
按：本案系脾虚湿盛，痰浊中阻，蒙蔽清窍而致眩晕，故以六君子汤健脾益气，祛除痰湿，加鸡内金以助消化，加生龙牡、远志以镇肝熄风。收敛止汗。二诊因脾虚湿盛，中气下陷而小腹下坠，白带增多，故加山药以健脾燥湿，加黄芪以补中益气，升阳固脱。三诊加炒白芍意在养血敛阴，柔肝而缓急止胁痛。
案二 王某，女，52岁。门诊号：83020。
1964年12月16日初诊：近1个月来自觉头晕目眩，身倦无力，胃脘痞满，口苦，恶心，不欲冷饮，大便溏泻，每日2～3次，尿黄，时有足肿，午后加重，苔薄白，脉虚而细。此乃脾阳不振，痰湿中阻，兼肝阳上亢之证。治宜健脾益气，燥湿化痰，平肝熄风。方用六君子汤加减：
党参6克 生白术9克 茯苓6克 陈皮7.5克 半夏7.5克 泽泻6克 苍术6克 杭菊花9克 天麻6克 白蔻仁3克
[Prescription] Modified Cough and Enuresis Formula:
Chai Hu (Bupleuri Radix) 6g, Ban Xia (Pinelliae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Qing Pi (Citri Reticulatae Pericarpium Viride) 9g, Dang Shen (Codonopsis Radix) 9g, Mai Dong (Ophiopogonis Radix) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Huang Qin (Scutellariae Radix) 9g.
[Modifications] For severe cough, add Zi Wan (Asteris Radix) 9g. If Chai Hu is unavailable, substitute with Chuan Xiong (Ligustici Chuanxiong Rhizoma) 9g.
[Case]
Patient Liu, female, 54 years old. Outpatient No.: 49051.
First visit on November 20, 1961: Cough for over 30 years, shortness of breath for over 10 years. Since winter recently, the cough and shortness of breath have worsened significantly; unable to lie flat, unable to walk. Irritability, palpitations, intermittent distending pain in the chest and hypochondrium, dizziness, headache, poor appetite, heat sensation in the palms and soles, dry mouth with bitter taste, severe edema of the lower limbs, white tongue coating, purple-dark lips and tongue body, wiry and slippery pulse. Treatment principle: Tonify qi and nourish yin to support the root, regulate qi, resolve phlegm, and remove blood stasis to treat the branch. Prescription: Modified Cough and Enuresis Formula:
Chai Hu (Bupleuri Radix) 9g, Dang Gui (Angelicae Sinensis Radix) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Mai Dong (Ophiopogonis Radix) 9g, Dang Shen (Codonopsis Radix) 9g, Wu Wei Zi (Schisandrae Chinensis Fructus) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Huang Qin (Scutellariae Radix) 9g, Zi Wan (Asteris Radix) 9g, Fu Ling (Poria) 9g.
After taking 2 doses, coughing, wheezing, shortness of breath, and edema improved significantly. After continuing for 40 doses, symptoms basically disappeared.
V. Qi and Yin Deficiency with Phlegm-Turbidity Obstructing the Middle, Upper Heat and Lower Cold Pattern
[Symptoms] Wheezing, coughing, shortness of breath, inability to lie flat; or inability to sit up or turn over due to extreme mental fatigue; generalized edema or lower limb edema; extreme emaciation; dry and bitter mouth, worse at night; abdominal distension with aversion to cold; irritability and anger; palpitations and restlessness; wiry, slippery, large, or deficient-large pulse; thin white or peeled mirror-like tongue coating, purple-dark tongue body.
[Treatment Principle] Tonify qi and nourish yin, regulate qi and resolve phlegm, clear heat and warm the kidney.
[Prescription] Modified Huangqi Biejia San (Astragalus and Softshell Turtle Shell Decoction):
Huang Qi (Astragali Radix) 15g, Ren Shen (Ginseng Radix) 6g, Di Gu Pi (Lycii Cortex) 9g, Zi Wan (Asteris Radix) 9g, Fu Ling (Poria) 9g, Chai Hu (Bupleuri Radix) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Zhi Mu (Anemarrhenae Rhizoma) 9g, Sheng Di Huang (Rehmanniae Radix Preparata) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Mai Dong (Ophiopogonis Radix) 9g, Rou Gui (Cinnamomi Cortex) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
[Modifications] For severe palpitations, add Wu Wei Zi (Schisandrae Chinensis Fructus) 9g.
[Case]
Patient Guo, female, 73 years old. Outpatient No.: 68243.
First visit on January 24, 1963: Underwent surgery for pneumothorax 3 years ago, followed by frequent shortness of breath and fatigue since then. In the past 7-8 days, developed coughing, wheezing, edema, and cyanosis; Western medicine diagnosed as cor pulmonale. Treated with digoxin, aminophylline, and antibiotics such as penicillin, streptomycin, gentamicin, and erythromycin, but condition did not improve, accompanied by vomiting, clouded consciousness, and occasional delirium. Family requested Chinese medicine adjunctive therapy. Tongue body resembled a pig kidney, rattling phlegm sound in throat, clouded consciousness, occasional delirium, mild edema, wiry-slippery-large pulse. Syndrome belongs to critical severity of impending collapse of qi and yin, phlegm-turbidity obstructing the middle, upper heat and lower cold. Treatment principle: Tonify qi, nourish yin, and warm the kidney to secure against collapse, assisted by regulating qi, resolving phlegm, clearing heat, and calming wheezing to treat the branch. Prescription: Modified Huangqi Biejia San (Astragalus and Softshell Turtle Shell Decoction):
Huang Qi (Astragali Radix) 15g, Ren Shen (Ginseng Radix) 6g, Wu Wei Zi (Schisandrae Chinensis Fructus) 9g, Zi Wan (Asteris Radix) 9g, Fu Ling (Poria) 9g, Chai Hu (Bupleuri Radix) 9g, Ban Xia (Pinelliae Rhizoma) 9g, Zhi Mu (Anemarrhenae Rhizoma) 9g, Sheng Di Huang (Rehmanniae Radix Preparata) 9g, Bai Shao (Paeoniae Radix Alba) 9g, Mai Dong (Ophiopogonis Radix) 9g, Rou Gui (Cinnamomi Cortex) 9g, Chen Pi (Citri Reticulatae Pericarpium) 9g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g.
After taking 3 doses continuously over 2 days and 1 night, consciousness was completely clear on the second night, spirit improved, and coughing, wheezing, shortness of breath, and edema also alleviated. After continuing for 3 more doses, most coughing and shortness of breath disappeared, and edema reduced by 60-70%. Advised to stop Western medicines and take only Chinese medicine for 36 doses, resulting in basic recovery.
Commentary: This case is a critical and urgent syndrome of dual deficiency of qi and yin, abundance of turbid phlegm, and mixed cold and heat. Therefore, heavy use of Huang Qi (Astragali Radix) combined with Ren Shen (Ginseng Radix) tonifies qi and secures against collapse. Sheng Mai San (Ren Shen, Mai Dong, Wu Wei Zi) combined with heavy doses of Sheng Di Huang (Rehmanniae Radix Preparata) and Bai Shao (Paeoniae Radix Alba) nourishes yin and generates fluids. These two groups tonify qi and yin to treat the root. Er Chen Tang (Ban Xia, Chen Pi, Fu Ling, Gan Cao) dries dampness and resolves phlegm, regulates qi and harmonizes the middle, removing phlegm-turbidity obstructing the middle jiao; Zi Wan (Asteris Radix) is pungent, bitter, and warm, resolving phlegm, stopping cough, and calming wheezing; Chai Hu (Bupleuri Radix) and Zhi Mu (Anemarrhenae Rhizoma) clear heat; Rou Gui (Cinnamomi Cortex) is pungent, sweet, and greatly hot, warming and tonifying spleen and kidney yang while dispersing cold. The combination of herbs addresses both root and branch, uses both cold and heat properties, thus restoring qi and yin, securing righteous qi, eliminating phlegm-turbidity, and naturally stopping coughing and wheezing.
Heart Failure
Heart failure is mostly yang deficiency; tonifying yang should use small doses.
Mild fire can generate qi; excessive fire consumes qi.
Heart failure, generally speaking, is a syndrome of heart and kidney yang deficiency, so Zhenwu Tang (True Warrior Decoction) added with Ren Shen (Ginseng Radix) and Xing Ren (Armeniacae Semen Amarum) is often effective. Furthermore, this syndrome involves both righteous deficiency and pathogenic excess. Tonifying yang may overwhelm yin, and tonifying yin may easily damage yang; thus, slight carelessness in medication will aggravate the condition. For example: Patient He, female, 35 years old, rheumatic heart disease, mitral stenosis, recurrent hemoptysis for 20 years. Developed total heart failure after surgery at another hospital 2 years ago; condition has not improved but worsened daily. Generalized edema, oliguria, dyspnea, palpitations, restlessness, inability to lie flat. Consulted another doctor for Chinese medicine treatment. The doctor observed thirst, body heat, palpitations, restlessness, shortness of breath with wheezing, inability to lie flat, rapid pulse with irregular intervals (note: should be called Cu Dai Mai, hurried and intermittent pulse), diagnosed as heart yin deficiency. Prescription: Ren Shen (Ginseng Radix) 10g, Mai Dong (Ophiopogonis Radix) 10g, Sheng Di Huang (Rehmanniae Radix Preparata) 10g, Hua Fen (Trichosanthis Radix) 15g, Huang Lian (Coptidis Rhizoma) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Shi Hu (Dendrobii Caulis) 10g, Bai Shao (Paeoniae Radix Alba) 15g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g. Continued to take Western medicines like digoxin. After taking the medicine, that night all symptoms worsened significantly: dyspnea, panicked expression, feeling of impending death. Invited Elder Li to examine. Elder Li said: "The patient has severe edema, palpitations, and shortness of breath, which are signs of heart and kidney yang deficiency with water qi counterflow invading the heart and lungs. This is a critical syndrome; urgently treat with modified Zhenwu Tang (True Warrior Decoction). Prescription: Fu Zi (Aconiti Lateralis Radix Preparata) 1g, Bai Shao (Paeoniae Radix Alba) 1.5g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1.5g, Ren Shen (Ginseng Radix) 1g, Fu Ling (Poria) 1.5g, Xing Ren (Armeniacae Semen Amarum) 1g. Next morning, edema had decreased, urine volume increased, dyspnea significantly improved. At this time, due to Elder Li's busy schedule, I treated the patient on his behalf. The family said: 'This prescription has small dosage and weak effect; the condition is deep and severe. Can we increase the dosage?' The previous doctor was also present and said: 'How can few soldiers and weak generals defeat a great enemy? It cannot be done.' Hearing this, I also felt it made sense, so I increased the original prescription by 10 times. The next day, the family invited me saying: 'All symptoms aggravated, please come quickly to treat.' After inquiring about the symptoms, Elder Li said: 'This patient suffers from severe decline of both yin and yang, accompanied by solid pathogenic factors of edema. Righteous qi is deficient while pathogenic factors are excess. Tonifying yang will severely damage yin, increasing irritability; tonifying yin will make it difficult for yang to support, worsening edema and shortness of breath. Her pulse beats seven times per breath with interruptions, indicating yin failing to anchor yang, and yang qi about to fail. This is neither an excess syndrome of intense heat nor a deficiency syndrome of yin deficiency with heat; therefore, treatment should use small doses. Do you not know the statement in Nei Jing: "Mild fire generates qi, excessive fire consumes qi"? With this disease, slight carelessness in dosage could lead to death in an instant.' I followed his advice and administered the original prescription with the original dosage again. One month later, the patient's dyspnea improved greatly, edema disappeared, and she was able to go outdoors for activities.
Vertigo and Dizziness
Four syndromes of vertigo and dizziness: wind, fire, phlegm, deficiency.
Wind is the source of disease; treatment focuses on liver and spleen.
Xuan refers to blackness in the eyes, Yun refers to spinning of the head. Vertigo and dizziness refer to what ancients called spinning head and black eyes, commonly known as "black eye wind." Mild cases stop when closing eyes and calming the spirit; severe cases feel like riding in a boat or carriage; extreme cases dare not open eyes, feeling heaven and earth spinning, unable to stand. Regarding the etiology and pathogenesis of this disease, although doctors of past dynasties had various opinions, since Ming and Qing dynasties, clinical doctors mostly followed Zhang Zhongjing of Han Dynasty and Liu Hejian and Zhu Danxi of the Four Great Masters of Jin and Yuan dynasties' theory of "no phlegm, no vertigo," advocating phlegm as the source of disease and treating from phlegm. For example, *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), Chapter on Phlegm-Fluids, Cough, and Asthma Pulse and Syndrome Treatment says: "There is branched fluid retention under the heart; the person suffers from dizziness and vertigo. Zexie Tang (Alisma Decoction) governs it... Sudden vomiting, epigastric fullness, water between diaphragm, vertigo and palpitations, Xiao Banxia Jia Fuling Tang (Minor Pinellia plus Poria Decoction) governs it." Later, Liu Hejian and Zhu Danxi further proposed theories of "no phlegm, no vertigo" and "vertigo caused by phlegm" on this basis. For example, *Danxi Xinfa* (Methods of Danxi), Head Vertigo states: "Head vertigo, phlegm combined with qi deficiency and fire, treat phlegm as primary, add qi-tonifying and fire-descending medicines. Without phlegm, there is no vertigo..." Elder Li has a different view, believing that vertigo and dizziness are divided into four categories of syndromes: wind, fire, phlegm, and deficiency. Among them, wind is the source of disease, meaning phlegm and fire both arise from wind. In terms of zang-fu pathogenesis, it is most related to liver, spleen, and kidney; excess syndromes mostly originate from liver, while deficiency syndromes mostly stem from spleen and kidney.
I. Wind, Fire, Phlegm, and Depression arising from Liver Wind
Vertigo and dizziness are originally symptoms of wind, but the wind here mostly belongs to internal wind, just as *Yixue Congzhong Lu* (Records of Medicine Following Public Opinion) says: "When people say wind, they do not mean external wind, but refer to Jueyin Wind-Wood, residing together with Shaoyang Ministerial Fire. When Jueyin qi rebels, wind rises and fire moves. When wind arises, it must carry wood energy to overcome earth. When earth is diseased, fluids gather to form phlegm." *Nei Jing* (Inner Canon) says, "All wind tremors and vertigo belong to the liver." "The liver opens into the eyes." The liver connects upward to the eye system and corresponds to wind. Liver qi easily stagnates, liver yang easily hyperactive, liver yin easily deficient; these all easily induce internal stirring of liver wind. When wind stirs, fire rises with it; when fire rises, phlegm moves due to fire. Wind carrying phlegm and fire rushing upward to the head and eyes causes vertigo and dizziness. Therefore, Elder Li believes the main cause of vertigo and dizziness is internal stirring of liver wind. Thus, in treating vertigo, one should always keep liver wind in mind and can add Pinggan Xifeng (calm liver and extinguish wind) herbs such as Tian Ma (Gastrodiae Rhizoma), Gou Teng (Uncariae Ramulus cum Uncis), Ju Hua (Chrysanthemi Flos), and Shi Jue Ming (Haliotidis Concha) according to the syndrome.
Attached Cases:
Case 1: Patient Hou, female, 69 years old. Outpatient No.: 51458.
First visit on February 23, 1962: Chief complaint: Dizziness and vertigo, palpitations, distending and painful headache. Facial flushing. History of hypertension. Thin white tongue coating, wiry pulse. Syndrome belongs to liver and kidney deficiency with hyperactive liver yang. Treatment principle: Tonify liver and kidney, submerge liver yang, extinguish liver wind. Prescription:
Sheng Shi Jue Ming (Concha Haliotidis Preparata) 9g, Hang Ju Hua (Flos Chrysanthemi Preparatus) 9g, Tian Ma (Gastrodiae Rhizoma) 6g, Ju Hong (Citri Reticulatae Pericarpium Rubrum) 6g, Sheng Long Gu (Os Draconis Preparatum) and Sheng Mu Li (Concha Ostreae Preparata) each 9g, Fu Shen (Poria cum Radix) 4.5g, Ban Xia (Pinelliae Rhizoma) 4.5g, Bo He (Menthae Haplocalycis Herba) 3g, Sheng Du Zhong (Eucommiae Cortex Preparata) 9g, Niu Xi (Achyranthis Bidentatae Radix) 9g.
After taking 3 doses of the above prescription, dizziness and vertigo significantly alleviated, but still had head distension and pain. Added Gou Teng (Uncariae Ramulus cum Uncis) 9g to the original prescription, continued for 1 dose, most symptoms disappeared.
Commentary: This patient is over seventy, with liver and kidney deficiency, water failing to nourish wood, leading to hyperactive liver yang causing vertigo. Thus, treatment should tonify liver and kidney, submerge liver yang, and extinguish liver wind. In the formula, Du Zhong (Eucommiae Cortex) and Niu Xi (Achyranthis Bidentatae Radix) tonify liver and kidney, strengthen sinews and bones, benefit waist and knees; Tian Ma (Gastrodiae Rhizoma), Gou Teng (Uncariae Ramulus cum Uncis), Shi Jue Ming (Haliotidis Concha), Sheng Long Gu (Os Draconis Preparatum), and Sheng Mu Li (Concha Ostreae Preparatum) submerge liver yang and extinguish liver wind; Ju Hong (Citri Reticulatae Pericarpium Rubrum) and Ban Xia (Pinelliae Rhizoma) strengthen spleen, resolve phlegm, harmonize middle, direct rebellious qi downward, and stop vomiting; Ju Hua (Chrysanthemi Flos) disperses wind-heat, clears liver and brightens eyes; Bo He (Menthae Haplocalycis Herba) disperses wind-heat and clears head and eyes; Fu Shen (Poria cum Radix) calms spirit and stabilizes palpitations, enhancing the effect of calming liver and submerging yang. The combination of herbs tonifies liver and kidney while submerging liver yang, resolves phlegm-turbidity while dispersing wind-heat, achieving the goal of extinguishing liver wind and stopping vertigo.
Case 2: Patient Wang, male, 26 years old. Outpatient No.: 79257.
First visit on June 14, 1963: Dizziness, headache, blurred vision, staring straight ahead, eyeballs immobile for over half a month. Diagnosed with "medial rectus muscle paralysis" by ophthalmology department of a provincial hospital. Thin white tongue coating, slippery pulse. Syndrome belongs to hyperactive liver and deficient spleen with wind-phlegm disturbing upward. Treatment principle: Calm liver and extinguish wind, dry dampness and resolve phlegm. Prescription: Modified Er Chen Tang (Two-Aged Phlegm Resolving Decoction):
Ju Hong (Citri Reticulatae Pericarpium Rubrum) 7.5g, Ban Xia (Pinelliae Rhizoma) 6g, Nan Xing (Arisaematis Cum Bile Rhizoma) 4.5g, Fu Ling (Poria) 6g, Hang Ju Hua (Flos Chrysanthemi Preparatus) 6g, Zhi Ke (Aurantii Fructus Immaturus) 4.5g, Jiang Can (Bombyx Batryticatus) 6g, Quan Xie (Scorpio) 3g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3g.
After taking 2 doses of the above prescription, dizziness and headache disappeared. Removed Ju Hua (Chrysanthemi Flos) from the above prescription and continued for 2 doses, then eyeballs could move slightly. Advised to stick to the prescription and continue for 10 doses, after which eyeball movement returned to normal and vision gradually cleared.
Commentary: This case is caused by hyperactive liver and deficient spleen, wind-phlegm disturbing upward, obscuring the clear orifices. Thus, treated with Er Chen Tang (Two-Aged Phlegm Resolving Decoction) added with herbs to calm liver and extinguish wind. In the formula, Er Chen Tang (Two-Aged Phlegm Resolving Decoction) strengthens spleen, regulates qi, dries dampness, and resolves phlegm. Nan Xing (Arisaematis Cum Bile Rhizoma) assists Ban Xia (Pinelliae Rhizoma) in resolving phlegm and is good at removing wind-phlegm in meridians, mainly used for head and eye vertigo caused by wind-phlegm disturbing upward. Quan Xie (Scorpio) is pungent and agile in movement, a key herb for extinguishing wind and dispelling wind, specifically capable of extinguishing wind, relieving spasms, dispelling wind, and stopping pain, and can guide other wind-extinguishing herbs directly to the disease site, enhancing their effects of extinguishing wind, relieving spasms, and stopping convulsions. Jiang Can (Bombyx Batryticatus) is good at dispersing liver meridian wind-heat, and Ju Hua (Chrysanthemi Flos) calms liver, brightens eyes, and stops vertigo. The combination of herbs strengthens spleen, dries dampness, resolves phlegm, calms liver, extinguishes wind, relieves spasms, achieving the effect of eliminating wind-phlegm, stopping vertigo, restoring eye movement, and clearing vision.
II. Phlegm-Turbidity Causing Vertigo, Spleen Deficiency with Dampness Abundance
Spleen governs transportation and transformation and ascending of clear qi, but in pathological conditions, it is also the "source of generating phlegm." When spleen function is normal, food and drink are transported and transformed; their refined substances rely on spleen qi's ascending of clear qi to transport to lungs and circulate throughout the body, while turbid yin descends, allowing waste to be excreted. If indulging in alcohol and rich/greasy foods, irregular eating, or excessive thinking and labor injure the spleen, then spleen loses healthy transportation, food and drink cannot transform into refined substances, dampness gathers to generate phlegm. Phlegm-turbidity obstructs the middle, clear yang fails to ascend, turbid yin fails to descend, obscuring clear orifices, causing vertigo. If phlegm-turbidity stagnates for a long time, it easily transforms into fire. Phlegm-fire attacking clear orifices can also exacerbate vertigo. As *Yi Deng Xu Yan* (Continued Flame of Medical Lamp) says: "Phlegm-turbidity in the chest rises with qi. The head and eyes are high and empty/clear, where clear yang focuses. Turbid qi disturbs among them; wanting them not to be dizzy or vertiginous is impossible. Or accompanied by spitting phlegm, vomiting fluids, epigastric fullness, borborygmus, etc., left pulse slippery." *Danxi Xinfa* (Methods of Danxi), Head Vertigo also says: "Head vertigo, phlegm combined with qi deficiency and fire, treat phlegm as primary... Without phlegm, there is no vertigo. Phlegm moves due to fire. There are also damp-phlegm and fire-phlegm." Meanwhile, spleen's transportation and ascending of clear qi relies on liver qi's free flow to regulate qi mechanism. If liver wood acts recklessly, overcoming spleen earth, it can cause spleen deficiency, thereby forming vertigo of liver qi invading spleen and phlegm-turbidity obstructing the middle, even forming syndromes of deficiency mixed with excess, and cold mixed with heat. Therefore, in treatment, focus should be on strengthening spleen, drying dampness, and resolving phlegm, using formulas like Liu Jun Zi Tang (Six Gentlemen Decoction) or Er Chen Tang (Two-Aged Phlegm Resolving Decoction). Depending on specific syndromes, add herbs to regulate qi, calm liver, dispel wind, or extinguish wind.
Attached Cases:
Case 1: Patient Li, female, 47 years old. Outpatient No.: 20244.
First visit on October 7, 1959: Dizziness for nearly 2 weeks, gradually worsening recently, accompanied by nausea, sweating, poor appetite, fatigue. White greasy tongue coating, deep, fine, and weak pulse. Syndrome belongs to spleen and stomach weakness with phlegm-turbidity obstructing the middle. Treatment principle: Strengthen spleen, boost qi, dry dampness, and resolve phlegm as primary, supplemented by suppressing liver and extinguishing wind, astringing and stopping sweat. Prescription: Modified Liu Jun Zi Tang (Six Gentlemen Decoction):
Dang Shen (Codonopsis Radix) 9g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma Preparatum) 9g, Fu Ling (Poria) 7.5g, Ban Xia (Pinelliae Rhizoma) 6g, Chen Pi (Citri Reticulatae Pericarpium) 4.5g, Ji Nei Jin (Endothelium Corneum Gigeriae Galli) 4.5g, Sheng Long Gu (Os Draconis Preparatum) 9g, Sheng Mu Li (Concha Ostreae Preparata) 9g, Yuan Zhi (Polygalae Radix) 4.5g, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparatum cum Melle) 3g.
Second visit: After taking 2 doses of the above prescription, dizziness, nausea, poor appetite, sweating, and fatigue all alleviated, only occasional feeling of heaviness in defecation, and increased leukorrhea. This is deficiency of middle qi. Added Sheng Huang Qi (Astragali Radix) 15g to the above prescription to boost qi and raise yang, treating qi deficiency sinking and feeling of heaviness in defecation. Also added Sheng Shan Yao (Dioscoreae Rhizoma) 9g to strengthen spleen, dry dampness, and stop leukorrhea. 2 doses, decocted in water and taken orally.
Third visit: After taking medicine, all symptoms further alleviated, but obvious hypochondriac pain occurred, caused by liver qi rebelling horizontally. Added Chao Bai Shao (Paeoniae Radix Alba Preparata) 9g to the second visit prescription to nourish blood, astringe yin, calm liver, and stop pain. 2 doses, decocted in water and taken orally.
Fourth visit: After taking medicine, all symptoms basically disappeared, but recurred during menstruation, feeling dizzy, cold back, and profuse sweating. This is still due to constitutionally spleen deficiency, yang qi failing to reach, and defensive qi failing to secure. Continued taking the above prescription for 2 doses to boost qi and astringe sweat. Advised to take 2 doses of this medicine every time menstruation occurs. Follow-up showed that using this medicine for 2 months, then stopping, resulted in no recurrence during menstruation thereafter.
Commentary: This case is vertigo caused by spleen deficiency with dampness abundance, phlegm-turbidity obstructing the middle, obscuring clear orifices. Thus, Liu Jun Zi Tang (Six Gentlemen Decoction) is used to strengthen spleen and boost qi, remove dampness and phlegm. Ji Nei Jin (Endothelium Corneum Gigeriae Galli) is added to aid digestion. Sheng Long Gu (Os Draconis Preparatum) and Sheng Mu Li (Concha Ostreae Preparata) and Yuan Zhi (Polygalae Radix) are added to suppress liver and extinguish wind, astringe and stop sweat. Second visit: Due to spleen deficiency with dampness abundance, middle qi sinking causing lower abdominal heaviness and increased leukorrhea, Shan Yao (Dioscoreae Rhizoma) is added to strengthen spleen and dry dampness, Huang Qi (Astragali Radix) is added to tonify middle and boost qi, raise yang, and secure collapse. Third visit: Adding Chao Bai Shao (Paeoniae Radix Alba Preparata) aims to nourish blood, astringe yin, soften liver, and relieve urgency to stop hypochondriac pain.
Case 2: Patient Wang, female, 52 years old. Outpatient No.: 83020.
First visit on December 16, 1964: For nearly 1 month, self-feeling dizziness and vertigo, body fatigue and weakness, epigastric fullness, bitter taste in mouth, nausea, no desire for cold drinks, loose stools 2-3 times daily, yellow urine, occasional foot swelling, worsening in afternoon. Thin white coating, deficient and fine pulse. This is a syndrome of spleen yang not stirring, phlegm-dampness obstructing the middle, combined with hyperactive liver yang. Treatment principle: Strengthen spleen, boost qi, dry dampness, resolve phlegm, calm liver, and extinguish wind. Prescription: Modified Liu Jun Zi Tang (Six Gentlemen Decoction):
Dang Shen (Codonopsis Radix) 6g, Sheng Bai Zhu (Atractylodis Macrocephalae Rhizoma Preparatum) 9g, Fu Ling (Poria) 6g, Chen Pi (Citri Reticulatae Pericarpium) 7.5g, Ban Xia (Pinelliae Rhizoma) 7.5g, Ze Xie (Alismatis Rhizoma) 6g, Cang Zhu (Atractylodis Rhizoma) 6g, Hang Ju Hua (Flos Chrysanthemi Preparatus) 9g, Tian Ma (Gastrodiae Rhizoma) 6g, Bai Kou Ren (Amomi Fructus Rotundus) 3g.